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Left atrial ball thrombus is a rare complication of rheumatic mitral stenosis. We report on a patient with a left atrial ball thrombus combined with rheumatic mitral stenosis, which was detected during echocardiographic in the context of an etiological assessment of an ischemic stroke

Turner syndrome is characterized by short stature and dysmorphism in young girls and women. Hypertension increases the risk of aortic dissection. We report a case of chronic Stanford type-A aortic dissection in a woman with a strong suspicion of Turner syndrome. Our aim to recall the clinic and its complications.

Chest pain is one of the different elements of orientation for the diagnosis of acute coronary syndrome. Sometimes its clinical presentation is misleading. The objective of this study was to describe the characteristics of chest pain during an acute coronary syndrome in the cardiology department of the Joseph Raseta Befelatanana University Hospital Center, Antananarivo, Madagascar.We carried out a cross-sectional, descriptive study of 10 months from January 2019 to October 2019. All patients diagnosed with acute coronary syndrome during this period were included.Sixty-five cases were included. A "typical chest pain" was only encountered in 7.7% of cases. Advanced age (p = 0.04) and sedentary lifestyle (p = 0.03) were associated with the occurrence of silent myocardial ischemia, and. hypertension with a prolonged duration (≥15 minutes) of chest pain (p = 0.03). Dyslipidemia was associated with atypical irradiation of chest pain (p = 0.003). Alcoholism had an impact on pain triggered by effort (p = 0.01) and relieved by rest (p = 0.04).The current symptomatology of acute coronary syndrome is increasingly atypical. Knowledge of the factors that can influence the different characteristics of chest pain could serve as a benchmark in clinical practice in our population.

L'endocardite de Libman-Sacks constitue une manifestation cardiaque peu fréquente de la maladie lupique au cours de laquelle il existe une végétation non infectieuse au niveau des valves cardiaques. Il y a un risque important d'endocardite infectieuse. Notre patiente était une femme de 38 ans, présentant une fièvre persistante et une polyarthralgie inflammatoire au niveau des poignets et des chevilles. Elle présentait un souffle systolique mitral 2 sur 6 et une tuméfaction douloureuse des poignets et des chevilles. Nous avions objectivé un syndrome inflammatoire biologique. Le dosage des anticorps anti-nucléaire était positif avec un aspect moucheté, ainsi que les anticorps anti-DNA natifs. La recherche de syndrome des anti-phospholipides (SAPL) était négative. L'échographie doppler cardiaque avait objectivé des végétations au niveau des valves mitrales et aortiques. Les améliorations clinique, biologique et morphologique n'avaient été obtenues qu'après association antibiothérapie et corticothérapie. Nous pouvons conclure que l'endocardite de Libman-Sacks est d'évolution favorable en l'absence d'un syndrome des anti-phospholipides associé. Il faut toujours craindre dans tous les cas une greffe bactérienne. Le traitement est basé sur l'association antibiothérapie-corticothérapie-antipaludéen de synthèse.

Summary Aim: Cardiovascular diseases (CVDs) are a global challenge but the burden in sub-Saharan African (SSA) countries is less well documented than elsewhere. We aimed to describe the key cardiometabolic risk factors in four SSA countries. Methods: A cross-sectional, multi-national, hospital-based study was carried out among adults (> 35 years) across four SSA countries from 12 December 2011 to 7 February 2013. Risk factors were defined using the World Health Organisation and International Diabetes Federation guidelines. Results: Of the 844 adults (57.4% female, mean age 52.6 years), 76.6% were urban residents. The predominant CVD risk factors were hypertension (74.1%), obesity (36.2%) and excessive alcohol consumption (25.6%). Diabetes (17.7 vs 10.0%), obesity (42.8 vs 16.8%) and hypercholesterolaemia (25.8 vs 18.0%) were more prevalent among the hypertensive subjects (all p < 0.007) than the normotensives. The metabolic syndrome (39.4%) was more common in women and hypertensive subjects. Conclusions: Hospital patients in SSA countries present with excessive rates of cardiometabolic risk factors. Focus on their prevention and control is warranted.

Introduction The multivessel nature of a coronary lesion is a marker of high risk of death in myocardial infarction. The objective of that study was to determine the factors associated with this type of lesion during coronary artery disease. Methods We performed a retrospective case-control study for 39 months; from March 2014 to May 2017. Patients with at least one significant coronary lesion were included. Results Sixty-four patients were included. Signs suggestive of multivessel lesion were history of exercise angina (P = 0.037), dyspnea (P = 0.045), and right coronary involvement (P = 6.10–7). Four risk factors were incriminated: arterial hypertension (OR = 2.565[0,904–7,275]), diabetes (OR = 5.25[1,833–15,03]), dyslipidemia (OR = 5.25[1,7311–15,9224]) and resting heart rate > 80 per minute (OR = 2,9615[1,1043–7,9424]). Adjusted OR concluded that the first risk factor was diabetes. Conclusion The knowledge of the risk factors and the signs suggestive of a multivessel coronary lesion makes it possible to anticipate the severity of this type of lesion both preventive and curative.

Introduction : This study aimed to identify patients at risk for venous thromboembolism (VTE) among all patients hospitalised, and to determine the proportion of at-risk hospital patients who received effective types of VTE prophylaxis in sub-Saharan Africa (SSA). Methods : A multinational, observational, cross-sectional survey was carried out on 1 583 at-risk patients throughout five SSA countries. Results : The prevalence of VTE risk was 50.4% overall, 62.3% in medical and 43.8% in surgical patients. The proportion of at-risk patients receiving prophylaxis was 51.5% overall, 36.2% in medical and 64% in surgical patients. Low-molecular weight heparin was the most frequently used prophylactic method in 40.2% overall, 23.1% in medical and 49.9% in surgical patients. Discussion : This study showed a high prevalence of VTE risk among hospitalised patients and that less than half of all at-risk patients received an American College of Clinical Pharmacy-recommended method of prophylaxis. Conclusion : Recommended VTE prophylaxis is underused in SSA.

Introduction Le caractere multitronculaire des lesions coronaires constitue un marqueur de haut risque de deces devant un infarctus du myocarde. L’objectif de cette etude etait de determiner les facteurs associes a ce type d’atteinte au cours d’une coronaropathie. Methode Nous avons effectue une etude cas-temoin retrospective portant sur une periode de 39 mois allant du mois de mars 2014 au mois de mai 2017. Ont ete inclus, les patients presentant au moins une lesion coronaire significative. Resultats Soixante-quatre patients ont ete inclus. Les signes evocateurs d’une atteinte multitronculaire etaient l’antecedent d’angor d’effort (p = 0,037), la presence de dyspnee (p = 0,045) et l’atteinte de la coronaire droite (p = 6,10−7). Quatre facteurs de risque etaient incrimines : l’HTA (OR = 2,565), le diabete (OR = 5,25), la dyslipidemie (OR = 5,25) et la frequence cardiaque de repos superieure a 80 battements par minute (OR = 2,9615). L’OR ajuste avait permis de conclure que le premier facteur de risque etait le diabete. Conclusion La connaissance des facteurs de risque et des signes evocateurs d’une atteinte coronaire multitronculaire permet d’anticiper la gravite de ce type de lesion tant sur le plan preventif que curatif.

Introduction: Nicotinism is of world-wide growing concern among adolescents. The goal is to describe the epidemiological aspects of nicotinism among Antananarivo suburban high school students. Methods: This is a descriptive and analytical cross-sectional study conducted in 2015 through a cluster sampling. A standardised, anonymous self-completion questionnaire was given to 903 high school students. Results: We enrolled 901 students. The prevalence of students who experimented with tobacco use was 46.3% next to 11.7% of active smokers . Among active smokers, 47.6% were non-dependent, 14.3% slightly dependent, 29.5% moderately dependent and 6.7% strongly dependent on tobacco. The motive of 70.3% of smokers was to test tobacco. Among former smokers 72.7% stoped smoking for fear of the drawbacks of tobacco-related diseases. Fear of heart disease (p = 0.004) and cancer (p = 0.008) was significantly associated with non-smoking status. Female gender (p = 0.000, OR 0.261 [0.164-0.415], 95% IC) and having been informed on tobacco consequences (p = 0.003, OR 0.401 [0.213-0.753, 95% IC] were protecting factors against tobacco use. The existence of a smoking circle was a risk factor of being a smoker: close friend (p = 0.000, OR 2,677 [2,027-3,534], 95% IC), cousin (p = 0.002, OR 1,529 [1,174-1,993], 95% IC), brother/sister (p = 0.023, OR 1,478 [1,054-2,072], 95% IC). Conclusion: The prevalence of nicotinism is significant despite the current prevention measures. The influence of the smoking circle and education are paramount. An active participation of nonsmokers adolescents in passing the message or raising awareness could improve the outcomes because they have influence on their peers.

Summary Introduction This study aimed to identify patients at risk for venous thromboembolism (VTE) among all patients hospitalised, and to determine the proportion of at-risk hospital patients who received effective types of VTE prophylaxis in sub-Saharan Africa (SSA). Methods A multinational, observational, cross-sectional survey was carried out on 1 583 at-risk patients throughout five SSA countries. Results The prevalence of VTE risk was 50.4% overall, 62.3% in medical and 43.8% in surgical patients. The proportion of at-risk patients receiving prophylaxis was 51.5% overall, 36.2% in medical and 64% in surgical patients. Low-molecular weight heparin was the most frequently used prophylactic method in 40.2% overall, 23.1% in medical and 49.9% in surgical patients. Discussion This study showed a high prevalence of VTE risk among hospitalised patients and that less than half of all at-risk patients received an American College of Clinical Pharmacy-recommended method of prophylaxis. Conclusion Recommended VTE prophylaxis is underused in SSA.