Cryoballoon Catheter Ablation in Atrial Fibrillation

Pulmonary vein isolation with catheter ablation is an effective treatment in patients with symptomatic atrial fibrillation refractory or intolerant to antiarrhythmic medications. The cryoballoon catheter was recently approved for this procedure. In this paper, the basics of cryothermal energy ablation are reviewed including its ability of creating homogenous lesion formation, minimal destruction to surrounding vasculature, preserved tissue integrity, and lower risk of thrombus formation. Also summarized here are the publications describing the clinical experience with the cryoballoon catheter ablation in both paroxysmal and persistent atrial fibrillation, its safety and efficacy, and discussions on the technical aspect of the cryoballoon ablation procedure

Detection and diagnosis of breast lesions: Performance evaluation of digital breast tomosynthesis and magnetic resonance mammography

AbstractObjectiveTo assess the impact of digital breast tomosynthesis (DBT) and magnetic resonance mammography (MRM) in enhancing the performance of digital mammography (DM) in the detection and evaluation of different breast lesions.Patients and methodsIn this retrospective study, 98 patients with 103 breast lesions were assessed by DM, DBT and MRM. Mammography images were acquired using the “combo mode", where both DM and DBT scanned in the same compression. MRM was performed by 1T open system. Each lesion was assigned a blinded category in an individual performance for each modality. The resultant BI-RADS categories were correlated with reports of the pathology specimens or outcome of 18-month follow-up.ResultsBoth DBT and MRM showed equivalent sensitivity of 92%. The specificity for DBT and MRM was 80.7% and 89.7% respectively. The efficacy of DM was raised from 61% to 83.5% with DBT and 90.2% with MRM. The results of the three modalities and the final diagnosis revealed a significant correlation (p=0.035).The association between the results of DBT and those of MRM showed statistically significant difference between DBT and MRM for diagnosing breast lesions (p=0.001).ConclusionBoth MRM and DBT provide better performance than classic DM. Adding either of these modalities to the classic examination enhances diagnosis and precise disease distribution

The Toposequential Analysis and Cultivation of the Land Skills Misserghin Region (the Northern Margin of the Oran Great Sebkha-Algeria)

Abstract Topo-sequential analysis based on data of: clay analysis, climate, vegetation, geology and geomorphology of soil. This allows identifying different types of soil in Misserghin area. Our results show the presence of three types of soil as following: (i) The Iron siallitic soils founded at the bottom of Murdjadjo Mountain. It corresponds to an agrological poor quality land. It is situated in a medium depth. These soils have one or more adverse characters that can be developed in a modest way; (ii) The Alluvial soils, which occupying the plain of Misserghin on a medium slopes, these corresponds to an agrological good quality land, (iii) The Saline sodic soils (or salino-sols) which are founded in the downstream part of the catchment area (in the proximity of the Sebkha) and they showed very poor agrological quality. The key recommendation in relation to the development of agriculture in the north of the Oran Great Sebkha, is the concentration of farming activities in the alluvial soils that have good agrological quality land where the slope is delivering an average vast plain like the Misserghin plain. This area served as a model of cultural aptitudes of studies based on a thin topo-sequential analysis

Pseudo tumor tuberculosis of the uterine cervix: about a case at the colposcopy and cervico vaginal pathologies unit of the University hospital Le Dantec, Dakar, Senegal

Tuberculosis is still common in developing countries and particularly in sub-Saharan Africa since the advent of the HIV/AIDS. Genital tuberculosis usually affects young women in genital activity period. The most frequent locations are tubal, endometrial and ovarian. The cervical location is rare. We report on the case of a 36 years old patient with eight pregnancies and eight deliveries who lives in a rural area and has got in her history 8 vaginal deliveries with four living children and 4 dead children and who was referred by a colleague for a "tumor of the uterine cervix". In her medical history, there was a BCG vaccination during childhood and she had never received Pap smear. The colposcopy revealed an ulcerating budding tumor of the cervix with necrotic areas. The colposcopy biopsy revealed fibrocaseous tuberculosis of the uterine cervix. Tuberculosis is still a common disease in developing countries. The cervical localization is rare but should be considered in case of an ulcerating tumor budding of the cervix

Infections Du Site Opératoire À l’Hôpital National De Zinder, Niger: Aspects Épidémiologiques Et Bactériologiques

Objectif : Rapporter les caractéristiques épidémiologiques et bactériologiques des infections du site opératoire (ISO) dans les services de chirurgie de l'hôpital national de Zinder, Niger. Patients et méthodes : Il s’agissait d’une étude transversale qui s’est déroulée sur une période de 5 mois (Mai à Aout 2016) aux services de chirurgie et de laboratoire de l’Hôpital National de Zinder (HNZ) au Niger incluant tous les patients opérés et ayant développé une ISO. Résultats : Durant l’étude, 485 patients avaient été opérés et 38 cas d’ISO étaient enregistrés soit une incidence de 7,83 %. L’âge médian était de 31,5 ans (8-78 ans). Le sexe masculin était majoritaire avec un sexratio de 6,6 (33/5). Les urgences chirurgicales représentaient 57,9% des cas (n=22). Selon la classification d’Alte Meier, 13 cas (34,2%) étaient considérés comme une chirurgie contaminée et 21 cas (55,3%) une chirurgie sale. Les ISO étaient superficielles dans 36,8% (n=14), profondes dans 42,1% (n=16). Sur les 38 prélèvements analysés, 33 cultures étaient positives soit 86,8%. Les entérobactéries représentaient 69,7% (n=23), les Cocci à Gram positif 24,2% (n=8). Escherichia coli était l’espèce prédominante avec 45,5% (n=15), suivie de Staphylococcus aureus avec 18,2% (n=6). La majeure partie des cultures positives provenait du service de chirurgie viscérale 15 cas (45,5%) puis de l’urologie et de traumatologie-orthopédie avec respectivement 10 cas (30,3%) et 8 cas (24,2%). La quasi-totalité des entérobactéries était résistante aux antibiotiques usuels (amoxicilline, amoxicilline-acide clavulanique) et plus de 84% étaient résistantes à la ceftriaxone. En général les bacilles Gram négatifs étaient sensibles à l’imipenème (100%), la colistine (93,8%), l’aztréonam (68,7%) et le chloramphénicol (47,8%). Les cocci-Gram positifs étaient sensibles à la vancomycine, au chloramphénicol et à l’érythromycine dans respectivement 100% ; 62,5% et 57,1%. Conclusion : Les infections du site opératoires représentent un problème majeur. La fréquence des ISO rend indispensable la mise en place d'une équipe multidisciplinaire pour la surveillance de celles-ci. Le fort taux de résistance aux antibiotiques usuels doit susciter des actions préventives et systématiser l’examen bactériologique en cas de suppurations postopératoires. Objective: To report the epidemiological and bacteriological characteristics of surgical site infections (SSI) in the surgical departments of Zinder National Hospital. Patients and methods: This was a cross-sectional study that took place over a period of 5 months (May to August 2016) at the Zinder National Hospital (HNZ) Surgical and Laboratory Services in Niger including all patients operated on and having developed an SSI. Results: During the study, 485 patients had been operated on and 38 cases of ISO were recorded with an incidence of 7.83%. The median age was 31.5 years (8-78 years). The male sex was in the majoritywith a sex ratio of 6.6 (33/5). Surgical emergencies accounted for 57.9% of cases (n = 22). According to Altemeier's classification, 13 cases (34.2%) were considered as contaminated surgery and 21 cases (55.3%) were dirty surgery. Surgical site infections were superficial in 36.8% (n = 14), deep in 42.1% (n = 16). Of the 38 samplings analyzed, 33 cultures were positive, i.e. 86.8%. The enterobacteria accounted for 69.7% (n = 23), Gram-positive Cocci 24.2% (n = 8). Escherichia coli was the predominant species with 45.5% (n = 15), followed by Staphylococcus aureus with 18.2% (n = 6). The majority of positive cultures came from the visceral surgery department 15 cases (45.5%) followed by urology and orthopedic trauma with respectively 10 cases (30.3%) and 8 cases (24.2%). Virtually all enterobacteria were resistant to the usual antibiotics (amoxicillin, amoxicillinclavulanic acid) and more than 84% were resistant to ceftriaxone. In general Gram-negative bacilli were sensitive to imipenem (100%), colistin (93.8%), aztreonam (68.7%) and chloramphenicol (47.8%). Gram-positive cocci were sensitive to vancomycin, chloramphenicol and erythromycin in 100%, respectively; 62.5% and 57.1%. Conclusion: Surgical site infections represent a major problem. The frequency of SSI makes it essential to set up a multidisciplinary team to monitor them. The high rate of resistance to the usual antibiotics must provoke preventive actions and systematize the bacteriological examination in case of postoperative suppuration

Migration of intrauterine device into the pelvic cavity: exploration strategy and management in African environment

IUD migration is a rare complication. We report our experience in the treatment of five cases of uterine perforation and migration of IUDs. The average age of patients was 34.6 years, an average parity was 4. All patients felt an unusual pain during insertion of the IUD Tcu 380A. The location of the IUD was done through ultrasound and hysterography. Removal by laparoscopy was performed in all cases. The immediate impacts of the surgery were simple. Hysterography has its place in the location of the migrated IUD. Prevention is a good IUD insertion technique

Dermatomyosite avec atteinte cardiaque : A propos d’un cas observe au Senegal

Introduction : La dermatomyosite est une myopathie inflammatoire chronique caractérisée essentiellement par une faiblesse musculaire associée à des lésions cutanées caractéristiques.Cas clinique : Nous rapportons l‘observation d‘une patiente de 20 ans qui a présenté 6 mois auparavant une faiblesse musculaire d‘installation progressive associée à des troubles de la déglutition. L‘examen clinique retrouvait un déficit moteur des 4 membres à 1/5 en proximal et 3/5 en distal avec des lésions dermatologiques érythématosquameuses, et une tachyarythmie à l‘auscultation cardiaque. L‘électroneuromyogramme a montré des potentiels d‘unités motrices polyphasiques, d‘amplitude et de durée limitée, avec des vitesses de  conduction nerveuse motrice et sensitive normales. L‘écho-Doppler cardiaque a montré une fraction d‘éjection systolique à 40%. Le dosage des enzymes musculaires révélait une élévation des CPK à 1200 UI/L, LDH à 1284 UI/L et des aldolases à 35 UI/L. Le diagnostic de dermatomyosite associée à une atteinte cardiaque a été  retenu. La patiente a été traitée par corticothérapie avec une bonne évolution clinique.Conclusion : Notre observation souligne l‘intérêt de rechercher systématiquement une atteinte cardiaque chez les patients présentant un tableau de dermatomyosite. English title: Introduction : Dermatomyositis associated with cardiac involvement: A case observed in Senegal Background: Dermatomyositis is a chronic inflammatory myopathy characterized by muscle weakness associated with characteristic skin lesions.Case report: We report the case of a 20-year-old woman who presented 6 months before muscle weakness and swallowing disorders. Clinical examination showed a motor deficit of four limbs (1/5 proximal and 3/5 distal)  with dermatological lesions and tachyarrhythmia in cardiac auscultation. Electromyography showed multiphase motor unit potentials, with decreased amplitude and duration, and normal motor and sensory nerve   conduction velocities. Echocardiography showed a reduced left ventricular ejection of 40%. The dosage of the muscle enzymes revealed a high rate of Creatine Phosphokinase at 1200 IU/L, LDH at 1284 UI/L and aldolase at 35 UI/L. Diagnosis of dermatomyositis associated with cardiac involvement was retained. The patient was   treated with steroids with a good clinical response.Conclusion: Our observation underlines the value of systematically looking at cardiac involvement in patients with dermatomyositis

Assessment of the quality of the management of childbirth by vaginal delivery in 5 reference maternity clinics in Dakar, Senegal

Background: The current strategy to fight maternal and perinatal mortalities is mainly based on three pillars: family planning, skilled delivery and emergency obstetric and neonatal cares. The objective of the study was to assess the quality of the management of low-risk deliveries in 5 reference maternity clinics in the region of Dakar.             Methods: This is an observation-based multicentric, prospective and descriptive study, carried out over a four-month period, from September 1st to December 31st, 2012, in 5 reference maternity hospitals in the region of Dakar. For each delivery, the focus was put on parturient socio-demographic features, the surveillance techniques of the labour, the handling of the exit and delivery phases, materno-fetal complications but also on the new-born care. To assess the quality of childbirth management, a comparison between the practices was made and observed on the field and the World Health Organization's recommendations which fall into 4 categories (A, B, C and D) depending on the appropriateness or not of their use. For data input and analysis, we used the 13.0 version of the SPSS software. Results: During the study period, 200 childbirths were observed. The epidemiologic profile used for this study was that of a literate woman with a low record of childbirth who was 27 on average with a mean parity of 3. Forty seven percent of childbirth deliveries were observed in Roi Baudouin hospital centre. The A-category recommendations of the World Health Organization, such as the consumption of drinks, mobility during labour, the use of a partograph, the active management of the third stage of labour (AMTSL) and the examination of the placenta were applied in 22.5%, 86.2%, 23.4%, 100% and 23.4% of cases respectively. As for the B-category recommendations, which recommend the removal of those practices deemed harmful such as the back position during labour, the placement of an intravenous line and the oxytocin infusion, they were carried out in 91.84%, 98.08% and 7.28% of cases respectively. C and D categories which deal with non-recommended practices such as the use of abdominal expressions during labour and episiotomy were used in 47.6% and 39.7% of cases respectively.Conclusions: In our study, the most followed A-category recommendations from the WHO are: encouraged mobility, the use of single-use equipment, AMTSL and skin-on-skin contact. However, some B, C and D-category practices are still widely used in our maternity hospitals. The health authorities should make sure that the WHO recommendations are followed

Active management of third stage of labour with low doses of oral misoprostol and oxytocin on low: risk parturient in a Sub-Saharan hospital, Dakar, Sénégal

Background: Assess the effectiveness of oral misoprostol as an alternative to oxytocin in the active management of the third stage of labour in Dakar/Senegal.Methods: Randomized controlled clinical trial conducted in the maternity ward of a university hospital on 304 women who had vaginal delivery. These women were randomly assigned into 2 groups based on active delivery conditions: the first group received an oral administration of misoprostol (400 mcg) and the second group 5 IU oxytocin through intravenous route.Results: The average volume of blood loss was 196.55 ml in the misoprostol group and 208.39 ml in the oxytocin group (p=0.63). The incidence of postpartum haemorrhage (>500 cc) was 6.49% in the misoprostol group and 9.33% in the oxytocin group (p=0.358). The average rate of haemo globin decline was 0.38 g/dl in the misoprostol group and 0.29 g/dl in the oxytocin group (p=0.99). The proportion of hyperthermia, shivering, and nausea in the misoprostol and oxytocin groups were respectively: 2.59% against 0.6% (p=0.123), 7.14% against 2% (p=0.001) and 2.59% against 0.6% (p=0.498).Conclusions: In Senegal, Misoprostol despite its side effects, is an effective alternative to oxytocin in the active management of the third stage of labour for low-risk parturient women to reduce the risk of maternal deaths due to post-partum hemorrhage

Outcomes of the roll-in cohort of the Amulet IDE trial of left atrial appendage occlusion.

Background Left atrial appendage (LAA) occlusion is an alternative therapy to oral anticoagulants to reduce stroke risk in patients with nonvalvular atrial fibrillation (NVAF). The Amulet IDE trial compared the Amplatzer™ Amulet™ occluder (Abbott) with the Watchman™ 2.5 device (Boston Scientific) for LAA occlusion in patients with NVAF. Objective The purpose of this study was to describe outcomes of the Amulet IDE trial roll-in cohort. Methods At US sites up to 3 patients per implanter could be implanted with the Amulet occluder in the roll-in phase. The primary Endpoints in the Amulet IDE trial included safety (composite of procedure-related complications, all-cause death, or major bleeding at 12 months), effectiveness (composite of ischemic stroke or systemic embolism at 18 months), and rate of LAA occlusion at 45 days. Results A total of 201 roll-in patients were enrolled. Device success occurred in 99% of patients, and device closure (residual jet ≤5 mm) was observed in 98.9% of patients at 45 days. The safety endpoint rate was numerically higher (worse) in the roll-in cohort compared to the randomized Amulet occluder cohort (18.4% vs 14.5%). Six patients (3.1%) experienced an ischemic stroke and 0 patients with a systemic embolism within 18 months, which was similar to the primary effectiveness endpoint rate in the randomized Amulet occluder cohort (2.8%). Conclusions Despite lack of experience of the operators with the Amulet occluder in the roll-in phase, device implant success was high, a high rate of device closure was achieved, and low stroke rates were observed in patients with NVAF