L’endocardite infectieuse au Maroc à travers l’expérience d’un service hospitalier

Infective endocarditis is a grave disease because of a high level of morbidity and mortality. We conducted a retrospective analysis of 100 patients hospitalized for infective endocarditis from January 2009 until December 2015. The mean age was 41 years with a male predominance. Infective endocarditis occurs on a native valve (77 patients), prosthetic valves (12 patients), Pacemaker (7 patients) and congenital heart disease (4 patients). The diagnostic delay was 77 days on average. The fever was present in 85 patients. Blood cultures were negative in 54 patients. Echocardiography allowed visualizing the vegetations in 95 patients. In patients with prosthetics valves, a paraprosthetic regurgitation was diagnosed in 54 % of these patients and vegetation in 18 %. The main complications are heart failure (42), neurological (19), spleen (10) and renal (23) complications. The evolution under medical treatment was marked by the clinical-laboratory improvement in 57 patients, the lack of improvement with persistent fever in 21 patients. The mortality rate of our series is 23 %. Only seven patients underwent urgent surgery for hemodynamic and infectious indications. At the end of this work, it is emphasized that the epidemiological profile of infective endocarditis does not follow the changes of Wold. Its management is difficult in our context (significant diagnostic delay, often negative blood cultures, high level of morbidity, lack of recourse to early surgery). The improvement of this disease consistes of the prevention of acute articular rhumatism and the establishment of an heart team endocarditis to adapt international recommendations to our context.     

Does hemithyroidectomy still provide any benefit?

Objectives

Multinodular goiter is a common disorder, found in 5% of the general population. If only one thyroid lobe is affected, hemithyroidectomy may be preferred to total thyroidectomy, to limit the risk of complications and avoid hormone replacement therapy, but incurs a risk of subsequent completion thyroidectomy. The aim of the present study is to determine whether the arguments in favor of hemithyroidectomy are justified and whether it still provides real benefit.

Prise en charge des événements indésirables chez les patients sous traitement par immunoglobulines : recommandations pour la pratique clinique

Both intravenous and subcutaneous immunoglobulins are therapeutic modalities approved in various conditions, including primary and secondary immune deficiencies and autoimmune disorders. To date, immunoglobulins have more often been considered as a safe medication, with minor adverse effects such as hypertension, fever and chills, nausea, myalgia or headache. However, with the wider use of immunoglobulins in the treatment of autoimmune diseases, severe side effects have also been reported to occur in immunoglobulin-treated patients, especially anaphylaxis, aseptic meningitis, acute renal impairment, thrombotic events as well as haematological manifestations. This paper reviews all the potential adverse events related to immunoglobulin therapy and establishes a comprehensive guideline for the management of these events.     

Le bilan optimal avant TAVI

The number of TAVI procedures is rapidly increasing owing to the extension of indications. Procedural and long-term success warrant appropriate patient selection and rigorous preparation of the procedure during the pre-TAVI work-up. The aims of this work-up are several: validation of the indication, feasibility and safety of the procedure, selection of the prosthesis and of the route, anticipation of technical challenges. The CT-scan is the cornerstone of this assessment allowing for valve and vascular access appraisal. The geriatric evaluation remains important in the elderly, frail, high-risk patients. The assessment of cardiac and extracardiac comorbidities is systematic and may be incorporated into dedicated risk scores to improve the prediction of post-TAVI outcomes; this should be the basis of the decision-making process by the Heart Team.     

Serious complications of sulfasalazine

Whereas minor side effects of sulfasalazine are common, serious adverse reactions to this drug generally are considered rare. However, this report discusses three major complications of sulfasalazine that occurred within the past three years, one resulting in the death of a patient. As more patients with inflammatory bowel disease are being managed by physicians of various disciplines, it is important to become familiar with the potentially dangerous side effects of all medications prescribed. For this reason, a brief review of the pharmacology, clinical use, and toxicity of sulfasalazine is presented.     

永久起搏器植入常见并发症及防治措施

目的 回顾性分析710例永久起搏器植入术并发症的发生率及原因,以提高起搏器植入技术的安全性和有效性.方法 连续选择2005年1月至2010年6月在我院行永久起搏器植入术的患者710例,随访0.5 ～6年,观察并发症的发生率及原因.结果 起搏器植入常见的并发症分别是囊袋内积血及血肿（n=10,1.41％）、电极导线移位（n=8,1.25％）、起搏阈值升高（n=6,0.93％）及囊袋侵蚀（n=2,0.28％）.出血的发生与年龄偏大有关;电极导线的脱位主要是电极导线固定不良所致;囊袋侵蚀与患者体型偏瘦、囊袋制作偏小,或与原起搏器形状不相称引起皮肤受压缺血有关.结论 随着技术熟练及采取相应措施,可以减少并发症发生.