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Management of Acenocoumarol in Tunisian elderly population : Risk factors of overdose and bleeding 突尼斯老年人口中的醋硝香豆素管理 :用药过量和出血的风险因素
IF 0.3 Q4 Medicine Pub Date : 2025-04-11 DOI: 10.1016/j.ancard.2025.101894
Ines Kechaou , Mohamed Salah Hamdi , Asma Tekaya , Amira Taouay , Eya Cherif , Lamia Ben Hassine

Introduction

Anticoagulant therapy, often required in the elderly, is not without risk. This study aims to investigate the particularities of the use of anticoagulants in the elderly during hospital stay, along with the factors associated with bleeding and overdose.

Results

There were 55 women and 45 men (sex ratio: 0.81), with a mean age of 75.7 ± 6.9 years. The indications for anticoagulant treatment were venous thromboembolism (VTE) (92%) and atrial fibrillation (AF) (8%).
The average duration of treatment with acenocoumarol was 17.22 days ± 7.9. The dose of acenocoumarol initiation was 1 mg in 85% of patients and 2 mg in 15%.
INR < 2 was observed in 15% of patients. INR in the target area was obtained in 47% of patients with a mean dose of 2.33 mg of acenocoumarol. An overdose of acenocoumarol was noted in 38% of patients: average INR at 4.7. Seven patients had bleeding events. An overdose was reported in 4 of them.
Fever, infection, inflammatory syndrome, hypoalbuminemia, hypoprotidemia, and malnutrition were associated with a greater risk of overdose in our patients. Gastroduodenal ulcer disease, past medical history of gastrointestinal bleeding and renal failure were risk factors for bleeding in our patients.

Conclusion

The use of anticoagulants in the elderly requires a comprehensive assessment, including comorbidities, geriatric settings, and social environment.
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引用次数: 0
Hémoptysie révélatrice d'une agénésie de l'artère pulmonaire gauche : à propos d'un cas
IF 0.3 Q4 Medicine Pub Date : 2025-04-11 DOI: 10.1016/j.ancard.2025.101895
Labied Mohamed, Bouzid Ismail, El Oualladi Feryal, Mountassir Chorouk, Lembarki Ghizlane, Sabiri Mouna, Lezar Samira
Unilateral agenesis of the pulmonary artery is a rare congenital malformation. Diagnosis is based on imaging due to the nonspecificity of clinical symptoms. Hemoptysis is among the rare manifestations of this malformation. Standard radiography provides relevant orientation elements; however, CT pulmonary angiography remains the reference examination for positive diagnosis. We report the case of a 47-year-old patient presenting with recurrent episodes of minimal hemoptysis occurring quietly. A CT pulmonary angiography was performed, revealing agenesis of the left pulmonary artery.
单侧肺动脉缺失是一种罕见的先天性畸形。由于临床症状无特异性,诊断主要依靠影像学检查。咯血是这种畸形的罕见表现之一。标准影像学检查可提供相关的定位要素;然而,CT 肺血管造影仍是阳性诊断的参考检查。我们报告了一例 47 岁患者的病例,该患者反复发作轻微咯血,且悄无声息。CT 肺血管造影显示左肺动脉发育不全。
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引用次数: 0
La santé mentale des auxiliaires médicaux en rythmologie interventionnelle
IF 0.3 Q4 Medicine Pub Date : 2025-04-11 DOI: 10.1016/j.ancard.2025.101891
Carole Mette , Karine Petit , Laurent Fauchier
The mental health of allied professionals in interventional electrophysiology is an increasingly concerning topic given the emotional and physical demands inherent in their role, which deserves particular attention. This article examines the impact of stress, anxiety, and burnout on these healthcare professionals. To this end, an anonymous survey of allied professionals in interventional electrophysiology was conducted using a questionnaire via a dedicated survey platform over a period from October 17 to December 10, 2024. The data extracted and analyzed with the help of the platform revealed the following difficulties: lack of recognition, unsatisfactory working conditions, high workload, relational difficulties, and a lack of organization. This has resulted in an impact on the feelings of the allied professionals and especially on their work. In conclusion, this study reveals a generalized feeling of malaise among all allied professionals in interventional electrophysiology on a psychological, emotional, and physical level, as well as the importance of investing in the mental health of allied professionals for the improvement of the entire healthcare system.
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引用次数: 0
Knowledge, attitudes, and practices of a group of Cameroonian physicians regarding cardiopulmonary resuscitation : a cross-sectional study
IF 0.3 Q4 Medicine Pub Date : 2025-04-11 DOI: 10.1016/j.ancard.2025.101893
Loïc Alban Mbosso Tasong , Junette Arlette Metogo Mbengono-Njoki , Chris Nadège Nganou-Gnindjio

Background

Identification of cardiopulmonary arrest and its immediate and effective management are decisive factors in survival.

Objective

To evaluate the knowledge, attitudes, and practices of Cameroonian physicians concerning cardiopulmonary resuscitation

Methods

We conducted a cross-sectional study among doctors in Douala, Bafoussam, Garoua, and Yaoundé in Cameroon over three months from March 2024 to May 2024. We included specialists, residents/interns, and general practitioners practising in these cities who agreed to participate in the study. Were not included physicians who had been in practice for less than six months in Cameroon. Answers were validated by referring to the European Resuscitation Council 2015 recommendations and the American Heart Association 2020. Means were compared using the ANOVA and Kruskal-Wallis test. The association between different variables was assessed using a χ2 test or an exact Fisher test. A p-value < 0.05 was considered significant.

Results

Of the 95 participants recruited, the median age was 31 (IQR 28- 33), with extremes between 25 and 56. Residents/interns represented the largest group in our population, with 66 (69.5%) participants. We had 56 (58.9%) participants who had already attended a cardiopulmonary resuscitation training course. Participants who had never attended a previous cardiopulmonary resuscitation training course had a significantly lower mean than those who had (9.90 ± 1.93 vs. 11.61 ± 2.80, P = 0.002). Participants whose last training was more than a year ago had a significantly lower mean score than participants whose previous training was less than a year ago (11.05 ± 2.97 vs. 12.78 ± 2.02, P = 0.016). There was a significant difference between participants' means according to the city of exercise (P=0.037). The doctors practising in Yaoundé had more inadequate practices than those practising outside of Yaoundé (OR: 7.607; 95% CI 1.897–30.509; p = 0.005).

Conclusion

Most of our participants' knowledge and practices regarding cardiopulmonary resuscitation were incomplete and inadequate. However, our study noted a positive attitude toward physicians. Therefore, it is essential to emphasise the training of health care providers on cardiopulmonary resuscitation.
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引用次数: 0
Phéochromocytome révélé par une dissection coronaire spontanée : à propos d'un cas inhabituel
IF 0.3 Q4 Medicine Pub Date : 2025-04-11 DOI: 10.1016/j.ancard.2025.101896
Minh Tam Bailly, Marie Arnal, O Labidi, X Cerchez, E Berthelot

Background

Spontaneous coronary artery dissection (SCAD) is a rare and under-diagnosed disease that accounts for 1 to 4% of acute coronary syndromes and nearly one-third of heart attacks in women under the age of 50. We present a unique case of a pheochromocytoma that contributed to SCAD.

Case summary

A 49-year-old patient presented to the emergency department with chest pain that had been evolving for several days. The diagnosis was a late ST ST-segment elevation Myocardial Infarction (STEMI) in the anterior leads. Echocardiography has shown a severe left ventricular dysfunction related to a large akinesis of anterior and lateral segments. Coronary angiography revealed a recent occlusion due to spontaneous dissection of the mid left anterior descending artery and of the first and second obtuse marginal arteries. During the same hospitalization, incidental findings from a CT pulmonary angiography led to the discovery of a left adrenal mass. Subsequent abdominal scanning and blood/urine assays confirmed a diagnosis of pheochromocytoma. The patient underwent follow-up coronary angiography and cardiac MRI to evaluate cardiac involvement before undergoing surgical removal of the pheochromocytoma.
The patient has undergone successful surgical ablation two months after STEMI in a referral center for endocrinology surgery with an optimal cardiological technical platform.

Discussion

Spontaneous coronary artery dissection is a rare and potentially fatal disease and has never been described in the literature in association with a pheochromocytoma. Similar cases require a multidisciplinary approach, as well as surgery carried out in a facility equipped with advanced cardiac techniques. Given the curative potential of pheochromocytoma, early detection of SCAD is essential to reduce the risk of recurrence.
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引用次数: 0
Editorial board / Ours rédaction
IF 0.3 Q4 Medicine Pub Date : 2025-03-26 DOI: 10.1016/S0003-3928(25)00020-4
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引用次数: 0
Sommaire
IF 0.3 Q4 Medicine Pub Date : 2025-03-26 DOI: 10.1016/S0003-3928(25)00022-8
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引用次数: 0
Profil tensionnel et équilibre glycémique du sujet diabétique type 2 et hypertendu au Centre Hospitalier Universitaire Yalgado Ouédraogo : à propos de 116 Cas
IF 0.3 Q4 Medicine Pub Date : 2025-03-15 DOI: 10.1016/j.ancard.2025.101878
Koudougou Jonas Kologo , A. Tall-Thiam , G.R.C. Millogo , K.J. Nabi , S. Traore , Y. Kambire , Z.M. Some , M.R. Kationo , N.V. Yameogo , A.K. Samadoulogou , P. Zabsonre

Objective

To study the correlation between glycaemic control and blood pressure control, in order to determine the factors associated with blood pressure control in diabetic patients.

Methodology

This was a descriptive cross-sectional study with an analytical aim over a period of 7 months. Patients were recruited on an outpatient basis, and all underwent ABPM, measurement of glycated haemoglobin and creatinine levels, and assessment of compliance with treatment.

Results

Our criteria enabled us to select 116 patients. Women predominated (69%). The mean age of the patients was 62 ± 7 years, with a peak between 60 and 70 years. The mean duration of hypertension was 12 years and that of diabetes 6 years. The most frequently associated cardiovascular risk factor was physical inactivity (71.5%), followed by age. 57.8% of patients had uncontrolled blood pressure at the practice, with systolic hypertension predominating (58.2%). MAPA found that 61.6% of patients were controlled, giving a white-coat hypertension rate of 47.8%. Glycaemic control was observed in 42.2% of cases, and 87% of patients had good renal function. Compliance with treatment was good in 53.4% of cases, and dual therapy was the most commonly used treatment modality (44.8%), followed by triple therapy. The factors associated with poor blood pressure control were glycaemic imbalance, lack of compliance and monotherapy. Combination therapy was associated with good blood pressure control.

Conclusion

The association of hypertension and type 2 diabetes is frequent. The risk of occurrence increases with age. ABPM is the best method of assessing blood pressure control. Optimising blood pressure control in hypertensive diabetics requires optimising glycaemic control.
目的 研究血糖控制与血压控制之间的相关性,以确定与糖尿病患者血压控制相关的因素。 方法 这是一项描述性横断面研究,旨在对 7 个月内的情况进行分析。患者在门诊招募,所有患者都接受了 ABPM、糖化血红蛋白和肌酐水平测量,并对治疗依从性进行了评估。女性患者占多数(69%)。患者的平均年龄为 62 ± 7 岁,最高年龄为 60 至 70 岁。高血压的平均病程为 12 年,糖尿病的平均病程为 6 年。最常见的心血管风险因素是缺乏运动(71.5%),其次是年龄。57.8%的患者在就诊时血压未得到控制,其中以收缩期高血压为主(58.2%)。MAPA 发现,61.6% 的患者血压得到控制,白大衣高血压率为 47.8%。42.2%的患者血糖得到控制,87%的患者肾功能良好。53.4%的患者对治疗的依从性良好,双重疗法是最常用的治疗方式(44.8%),其次是三重疗法。血压控制不佳的相关因素包括血糖失衡、缺乏依从性和单一疗法。结论:高血压与 2 型糖尿病的关系很常见。高血压与 2 型糖尿病的关联很常见,发生风险随年龄增长而增加。ABPM 是评估血压控制情况的最佳方法。优化高血压糖尿病患者的血压控制需要优化血糖控制。
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引用次数: 0
Défect de Gerbode acquis sur une endocardite streptococcique sur la valve aortique native
IF 0.3 Q4 Medicine Pub Date : 2025-03-10 DOI: 10.1016/j.ancard.2025.101862
Haletine Ag Elmehdi , Nicolas Piliero , Damien Bedague , Alexandre Sebestyen
L'endocardite infectieuse est une pathologie rare mais potentiellement mortelle. Ses manifestations cliniques peuvent rendre le diagnostic difficile. L'identification du microorganisme responsable est cruciale pour ajuster l'antibiothérapie. En outre, une intervention chirurgicale est recommandée dans les cas à haut risque d'embolie, d'insuffisance cardiaque ou d'infection non contrôlée. L'abcès annulaire constitue une évolution possible nécessitant une réparation chirurgicale adaptée à l’étendue des lésions. Nous rapportons ici un cas traité avec succès d'un défect de Gerbode acquis de type I, une forme clinique rare, pour laquelle nous décrivons notre stratégie diagnostique et thérapeutique.
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引用次数: 0
Cardiomyopathie dilatée compliquant un phéochromocytome d’évolution favorable après chirurgie : à propos d'un cas à Dakar « cas clinique avec revue de littérature »
IF 0.3 Q4 Medicine Pub Date : 2025-03-10 DOI: 10.1016/j.ancard.2025.101866
Wn Mboup , Sct Ndao , M Sarr , M Faye , Pm Guisse , Mm Ka , Mn Sarr , K Dia

Introduction

Dilated cardiomyopathy is a rare and often little-known complication of pheochromocytoma, it is likewise exceptionally its discovery circumstance. This is usually an acute, reversible cardiomyopathy.We report the case of a 20-year-old young adult hospitalized for hypokinetic dilated cardiomyopathy with severe impairment of left ventricular ejection fraction (LVEF) to 17%. High blood pressure persisted despite antihypertensive treatment, and the heart failure syndrome was refractory to medical treatment.
Abdominal CT scan revealed a heterogeneous adrenal mass strongly suggestive of pheochromocytoma. Determination of plasma metanephrines and normetanephrines led to the diagnosis of pheochromocytoma. After surgery, the course was marked by stabilization of blood pressure, normalization of Doppler echocardiography and complete clinical remission.
He remained asymptomatic at one year.
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引用次数: 0
期刊
Annales de cardiologie et d'angeiologie
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