Maladies cardiovasculaires et diagnostic

Meningoencephalitis and community endocarditis caused by Klebsiella pneumonia (K. pneumonia) is uncommon, with a poor prognosis. This severity is related to the virulence of the organism. Associated fragile terrain is frequent and participates in infection prognosis. We report the first Moroccan case involving meningoencephalitis and community endocarditis K. pneumonia in adults with craniofacial trauma and chronic alcoholism history. The history and clinical data associated with imagery are in favor of a complicated meningitis endocarditis K. pneumoniae. The early management of our patient resulted in a cure without sequelae. This case illustrates the severity of community acquired K. pneumoniae infection. It also helps to emphasize the search of heart and neuromeningeal location in front of any sepsis related to this germ.

Objective: To determine the HbA1c levels correlation with cardiovascular events among non-diabetic patients.

Material and methods: The prospective study was conducted at cardiology department of Liaquat University of medical and health science. Total 130 cases were selected in this study. All the cases were selected with different cardiovascular diseases and having age more than 40 years. All the cases having multiple risk factors of cardio vascular disease were excluded from the study. HbA1c blood test was send to the diagnostic research lab of Liaquat University of Medical and health science. HbA1c was recorded in the proforma according to risk factors. All the data regarding HbA1c level and its related cardiovascular risk were entered in the proforma.

Results: Mean age of the patients was found as Mean+SD=42.4+5.43 years. While majority of the cases 45 (42.6%) were found with age group of 51–60 years. Male were found in the majority 64% and female were found 36% in the cases. According to the cardiovascular risk factors smoking was found most common in 30.76% of the cases, 2nd most common risk factors were found hypertension and dyslipidemia, with percentage of 25.38% and 23.07% respectively. In this series HbA1c associated with hypertension, obesity and dyslipidemia.

Conclusion: We have found that HbA1c level is highly correlated with risk factors of CVD, especially in obesity, hypertension and dyslipidemia amongst individuals without DM.

Introduction: Anesthesia for cesarean section in a patient with preeclampsia is far more complicated than an otherwise normal pregnancy for several reasons. Apart from the risks of high incidence of intrauterine growth restriction, fetal distress and prematurity, there are risk of increased perioperative morbidity due to altered hemodynamics

Material and methods: This study was conducted on 100 booked pregnant woman of ASA physical status I and II (Normotensive) or III (Preeclamptic), between 19 to 30 years of age, carrying a live, mature, healthy, single fetus posted for elective cesarean section. Patients were counseled during preoperative examination and 50 normotensive and 50 preeclamptic patients were recruited for this study after obtaining informed consent from each of the patient in their own language.

Result and Analyses: In this study, the authors found significant differences in SBP, DBP and MAP at different point of times in both the groups. One probable explanation of this may be the use of invasive arterial blood pressure monitoring in place of non-invasive monitoring unlike other studies. Also the preoperative blood pressure values were significantly different in both the groups. More phenylephrine consumption was noted in the normotensive group.

Conclusion: subarachnoid block in preeclampsia patients associated with better perioperative hemodynamic stability, less hypotension, less vasopressor consumption and more gradual blood pressure changes.

Objectives: Transcatheter Aortic Valve Implantation is now a well-established procedure and continuous development has improved the technique. The object of this paper is to describe the successive steps taken at our department to improve our protocol, resulting in a more effective and patient-safe procedure.

Design: An echo-guided method for aortic cusp alignment was used in 229 patients. In 139 patients pre-dilatation was excluded from the protocol. In the last 47 of the patients we exchanged the stiff guide-wire in the left ventricle with a soft wire for valve placement.

Results: There was a significant decrease in the use of contrast medium during the period with 90% of patients receiving less than 50 ml contrast and 35% no contrast at all. In more than half the patients we only used rapid pacing in association with deployment of the stent valve. We had six cases ofpericardial bleeding due to penetration of the stiff guide wire through the left ventricular (LV) wall. This complication was avoided in all subsequent patients where we exchanged the stiff catheter to a soft guidewire in the ascending aorta before introduction of the wire and stent valve into the LV.

Conclusions: We have successively modified our standard protocol for implantation of a balloon-expandable transcatheter aortic valve. This has simplified the procedure and reduced the risk for certain procedure-related complications.

Objective: To determine whether fondaparinux is effective in the treatment of thrombosis due to heparin-induced thrombocytopenia (HIT) in cardiac surgery we reported three cases successfully treated with fondaparinux and withdrawal of all heparins.

Patients: All three patients were female and underwent heart valve replacement using cardiopulmonary bypass. Combined clinical criteria, "4T score" (Thrombocytopenia, Timing, Thrombosis, and absence of oTher explanations) and laboratory testing have been used for diagnosis. In all patients the point of heparin immunization occurred in the preoperative period, during the angiography when a standard dose of UFH (5,000 IU) was administered. Then, during cardiac surgery, patients received a high dose of UFH, and later LMWH was used. Thrombocytopenia occurring between postoperative days 5 and 10 was associated with severe venous end/or arterial thrombosis. Other causes of thrombocytopenia were excluded. Thus, there was a high clinical suspicion (4T's=7 points) of HIT, and while awaiting the results of laboratory tests all sources of heparin were removed and fondaparinux was administered at therapeutical doses. Clinical and cardio-pulmonary thrombosis imaging resolution and platelet recovery were achieved in all cases with no new thrombotic or haemorrhagic event.

Conclusions: Despite significant limitations exist regarding this retrospective evaluation, our data further support the observational evidence that fondaparinux is a safe and effective option in HITâ€Ârelated thromboembolic complications with a good anticoagulant action and low risk of bleeding events.