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Monsuez J.-J.,Hopitaux Universitaires Of Paris Seine Saint Denis | Gesquiere-Dando A.,Service de Neurologie | Rivera S.,Service dOncologie Radiotherapie
Cardiology Research and Practice | Year: 2011

Midlife cardiovascular risk factors, including diabetes, hypertension, dyslipemia, and an unhealthy lifestyle, have been linked to subsequent incidence, delay of onset, and progression rate of Alzheimer disease and vascular dementia. Conversely, optimal treatment of cardiovascular risk factors prevents and slows down age-related cognitive disorders. The impact of antihypertensive therapy on cognitive outcome in patients with hypertension was assessed in large trials which demonstrated a reduction in progression of MRI white matter hyperintensities, in cognitive decline and in incidence of dementia. Large-scale database correlated statin use and reduction in the incidence of dementia, mainly in patients with documented atherosclerosis, but clinical trials failed to reach similar conclusions. Whether a multitargeted intervention would substantially improve protection, quality of life, and reduce medical cost expenditures in patients with lower risk profile has not been ascertained. This would require appropriately designed trials targeting large populations and focusing on cognitive decline as a primary outcome endpoint. Copyright © 2011 Jean-Jacques Monsuez et al. Source

Kingue S.,Cardiac Center Shisong | Ba S.A.,Hopital Aristide Le Dantec | Balde D.,CHU Ignace Deen | Diarra M.B.,CHU de Bamako | And 14 more authors.
Archives of Cardiovascular Diseases | Year: 2016

Background. - There are few African data available on rheumatic heart disease (RHD). Aim. - To provide data on the clinical characteristics and treatment of patients with RHD hospitalized in sub-Saharan Africa. Methods. - The VALVAFRIC study is a multicentre hospital-based retrospective registry of patients with RHD hospitalized in African cardiology departments from 2004 to 2008. Results. - Among 3441 patients with at least one mild RHD lesion seen on echocardiography in 5 years in 12 cardiology departments from seven countries, 1385 had severe lesions (502 men; 803 women; mean age 29.3 ± 15.6 years). The ratio of severe to any RHD valvular lesion was higher in countries with the lowest gross domestic product (GDP). Mitral valve regurgitation was seen in 52.8% of cases, aortic regurgitation in 32.1%, mitral stenosis in 13.4% and aortic stenosis in 1.8%. Combined valvular lesions were observed in 13% of cases. Heart failure was present in 40% of patients. Major left ventricular dilatation was observed in 13.6% of patients, ectasic left atrial dilatation in 13.8%, dilatation of the right cardiac chambers in 19.8% and pulmonary hypertension in 28.7%. Patients with no formal schooling (41.5%) were older and had a higher New York Heart Association (NYHA) class and a lower ejection fraction (EF). Among patients aged < 20 years (mean age 14.5 ± 3.8 years), those who were schooled had a lower NYHA class (2.86 ± 0.92 vs 3.42 ± 0.93; P < 0.01) and a higher EF (60.3 ± 11.7 vs. 54.8 ± 12.8; P < 0.05) than those who were not. RHD-related delays or school failures were affected by NYHA class, EF and the number of children in the household. Although 1200 of 1334 patients required valve repair or replacement, only 27 had surgery. In-hospital outcomes included death (16%), heart failure (62%), arrhythmias (22%), endocarditis (4%) and thromboembolic events (4%). Subsequently, 176 patients were readmitted (13.6%). Conclusions. - Patients with RHD hospitalized in sub-Saharan Africa are young, socially disad-vantaged, with a high mortality rate and extremely low access to surgery. Poverty, as quantified by GDP and educational level, affects RHD-related severity, NYHA class and left ventricular dysfunction. © 2016 Elsevier Masson SAS. All rights reserved. Source

Kakou-Guikahue M.,Institute Of Cardiologie Dabidjan | N'Guetta R.,Institute Of Cardiologie Dabidjan | Anzouan-Kacou J.-B.,Institute Of Cardiologie Dabidjan | Kramoh E.,Institute Of Cardiologie Dabidjan | And 23 more authors.
Archives of Cardiovascular Diseases | Year: 2016

Background. - Whereas the coronary artery disease death rate has declined in high-incomecountries, the incidence of acute coronary syndromes (ACS) is increasing in sub-Saharan Africa,where their management remains a challenge.Aim. - To propose a consensus statement to optimize management of ACS in sub-Saharan Africaon the basis of realistic considerations.Methods. - The AFRICARDIO-2 conference (Yamoussoukro, May 2015) reviewed the ongoing fea-tures of ACS in 10 sub-Saharan countries (Benin, Burkina-Faso, Congo-Brazzaville, Guinea, IvoryCoast, Mali, Mauritania, Niger, Senegal, Togo), and analysed whether improvements in strategiesand policies may be expected using readily available healthcare facilities.Results. - The outcome of patients with ACS is affected by clearly identified factors, including:delay to reaching first medical contact, achieving effective hospital transportation, increasedtime from symptom onset to reperfusion therapy, limited primary emergency facilities (espe-cially in rural areas) and emergency medical service (EMS) prehospital management, and hencelimited numbers of patients eligible for myocardial reperfusion (thrombolytic therapy and/orpercutaneous coronary intervention [PCI]). With only five catheterization laboratories in the10 participating countries, PCI rates are very low. However, in recent years, catheterizationlaboratories have been built in referral cardiology departments in large African towns (Abidjanand Dakar). Improvements in patient care and outcomes should target limited but selectedobjectives: increasing awareness and recognition of ACS symptoms; education of rural-basedhealthcare professionals; and developing and managing a network between first-line healthcarefacilities in rural areas or small cities, emergency rooms in larger towns, the EMS, hospital-basedcardiology departments and catheterization laboratories.Conclusion. - Faced with the increasing prevalence of ACS in sub-Saharan Africa, healthcarepolicies should be developed to overcome the multiple shortcomings blunting optimal manage-ment. European and/or North American management guidelines should be adapted to Africanspecificities. Our consensus statement aims to optimize patient management on the basis ofrealistic considerations, given the healthcare facilities, organizations and few cardiology teamsthat are available. © 2016 Elsevier Masson SAS. All rights reserved. Source

Tardieu M.,Hopitaux Universitaires Of Paris Seine Saint Denis | Schlatter J.,Hopitaux Universitaires Of Paris Seine Saint Denis
Journal de Pharmacie Clinique | Year: 2012

We report the case of a negative pressure pulmonary edema (NPPE) after fatal residual neuromuscular blockade due to an insufficient dosage of neostigmine. A 28-years old woman with a BMI of 54 kg/m2 was scheduled for removal of her gastric band. The patient received an administration of 50mg atracurium. The reversal was initiated by the injection of 3mg neostigmine and 1.5mg atropine. Extubation was performed about 10 min after the reversal of residual neuromuscular block. After 3-4 min, the patient developed an abnormal ventilatory pattern. Stimulation of the ulnar nerve revealed a partial response of the thumb adductor. The patient dies four hours later. A volume of 3.5 L plasma is drawn from the tracheal tube. The use of low doses of neostigmine in a patient with morbid obesity should be restricted when the TOF ratio is between 0.7 and 0.9. Source

Brichler S.,Hopitaux Universitaires Of Paris Seine Saint Denis | Brichler S.,University of Paris Pantheon Sorbonne | Le Gal F.,Hopitaux Universitaires Of Paris Seine Saint Denis | Le Gal F.,University of Paris Pantheon Sorbonne | And 7 more authors.
Clinical Gastroenterology and Hepatology | Year: 2013

BACKGROUND & AIMS: Hepatitis delta virus (HDV) infection causes fulminant hepatitis and increases the severity of chronic hepatitis B virus infection, leading to cirrhosis, liver failure, or hepatocellular carcinoma. There are 8 HDV genotypes (genotypes 1-8). We previously developed a TaqMan real-time reverse transcriptase (RT)-PCR method that is able to quantify viral load of all HDV genotypes (linear from 2 to 8 log10 copies/mL). We compared its results with those from 3 commercial real-time RT-PCR assays: the Lightmix HDV kit (designed to quantify HDV genotype 1 [HDV-1]), and the RoboGene and the DiaPro HDV RNA quantification kits (designed to quantify all genotypes). METHODS: We selected RNA from 128 clinical samples of all HDV genotypes except HDV-4, with various HDV viral load values. We also analyzed 5 samples, collected over time, from each of 6 patients infected with strains of different genotypes. RESULTS: Quantification results from the commercial kits for HDV-1 from European or Asian samples were consistent with those from our method, however, they underestimated (0.5-1 log10 with Lightmix and DiaPro) and did not detect (1 and 4 samples with Lightmix and DiaPro, respectively) HDV-1 African samples. Moreover, the commercial kits greatly underestimated HDV viral load of almost all non-genotype-1 strains (about 2-3 log10), and even did not detect HDV-7 or HDV-8 RNA in several samples with high concentrations of virus. CONCLUSIONS: Commercial kits accurately quantify HDV-1 in samples from European and Asian patients. However, they can dramatically underestimate or fail to quantify HDV viral load from samples from African patients infected with strains of genotypes 1 and 5 to 8.© 2013 AGA Institute. Source

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