Les troubles de la conduction cardiaque dans le syndrome coronarien aigu avec sus-decalage de segment st : Etude de 53 cas

Objectifs : Préciser la prévalence, les facteurs de risque, les aspects électrocardiographiques, thérapeutiques et évolutifs des troubles de la conduction cardiaque chez les patients atteints d’un syndrome coronarien aigu avec sus-décalage du segment ST.Patients et méthode : Il s’agissait d’une étude rétrospective descriptive portant sur une période de 8 ans (Octobre 2010 à Octobre 2018) et  concernant 53 cas de troubles de la conduction cardiaque observés parmi 320 cas de syndrome coronariens avec susdécalage du segment ST.Résultats : La prévalence des troubles de la conduction cardiaque était de 16,5%. La moyenne d’âge de nos patients concernés était de 58 ans (extrêmes : 26 et 81 ans). L’hypertension artérielle était le facteur de risque prédominant (60,4 %). La localisation inférieure était la plus fréquente (53%) et les troubles de cardiaques étaient dominés par le bloc de branche droit (35,8%). La coronarographie a été réalisée chez tous nos patients ; les lésions retrouvées concernaient davantage l’artère circonflexe (32,1%) et l’artère inter ventriculaire antérieure (28,3%). L’angioplastie a été réalisée dans 66% des cas et la thrombolyse dans 9,4%. L’implantation d’un pace maker provisoire a été faite dans 32% des cas L’évolution était favorable chez tous nos patients.Conclusion : Les troubles de la conduction cardiaque au cours du syndrome coronarien avec sus-décalage du segment ST doivent être  diagnostiqués précocement et prises en charge immédiatement en raison du risque de mort subite. Mots clés : Hypertension artérielle, Bloc de branche droit, Syndrome coronarien aigu avec sus-décalage de ST.   English Title: Cardiac conduction disorders in acute coronary syndrome with st elevation: Study of 53 cases Introduction: Cardiac conduction disorders are quite common in the clinical evolution of acute coronary syndrome with ST segment elevation and have a significant influence on the patients prognosis.Objective: The determine the epidemiological clinical and therapeutic aspects of rhythm disorders with elevation in the ST segment.Methods: We have performed a descriptive retrospective study of 53 cases of rhythm disorder among 320 cases of coronaries syndromes with ST segment elevation.Results: The prevalence of cardiac conduction disorders was 16,5% over a period of 8 years. The average age of our patients was 58 years old (extremes: 26 to 81 years old). Hypertension was the most prevalent risk factor (60.4%). Low location was the most found (53%) and conduction disorders were dominated by right bundle branch block (35, 8%).Coronary angiography was performed in all our patients. The found lesions incoronary angiography concerned more the circumflex (32,1%) and anterior inter ventricular artery (28,3%). Coronary angioplasty has been  performed in 66 % of cases, and thrombolysis in 9, 4%. The implantation of temporary pace maker was done in 32% of cases. The evolution was favorable for all our patients.Conclusion: Arrhythmias in ST-segment elevation coronary syndrome should be diagnosed early and immediately be taken care of because of the risk of sudden death. Keywords: Arterial hypertension; Right bundle branch block, Acute coronary syndrome with ST elevation

Evaluation du risque de deces dans les syndromes coronariens aigus par le score de GRACE en Côte d’Ivoire

Rationnel : Le score de GRACE est un score recommandé pour l’évaluation pertinente du risque de décès pour une prise en charge efficiente des syndromes coronariens aigus (SCA). Objectif : Déterminer le risque de décès des SCA à Abidjan afin d’améliorer la prise en charge Matériel et Méthode : Nous avons mené une étude observationnelle transversale sur une période de quatre ans du 01 Janvier 2010 au 31 Décembre 2013. Tous les patients consécutifs âgés d’au moins 18 ans, admis en unité de soins intensifs de l’Institut de cardiologie d’Abidjan pour SCA ont été inclus. Les données épidémiologiques, cliniques et thérapeutiques ont été analysées. Le risque de décès a été évalué à partir du score de GRACE. Résultats : 370 patients ont été inclus. L'âge moyen des patients était de 55,4 ans. On notait une prédominance masculine avec un sex-ratio de 3,87. Le délai médian d’admission était de 20 heures. Dans 20,8% des cas, les patients ont bénéficié d’une angioplastie coronaire. La thrombolyse a été réalisée chez 8,3% des patients admis pour SCA ST+. Le score de GRACE moyen était de 96.36 ± 32.18. Il était significativement plus élevé en cas de SCA ST+ (p<0.01). Le taux de décès était de 10%. En analyse uni variable, le sexe féminin (p=0,005), l’insuffisance cardiaque à l’admission (p=0,01), la dysfonction ventriculaire gauche (p=0,04) et score de le score de GRACE (p<0,001) étaient associés à la survenue de décès dans les SCA avec sus décalage persistant du segment ST. Dans les SCA sans sus décalage du segment ST, le diabète (p=0,01) et la dysfonction ventriculaire gauche (p=0,02) étaient les facteurs de risque de décès. Conclusion : L’évaluation du risque de décès par le score de GRACE pourrait s’intégrer dans une évaluation plus large des patients admis pour SCA, et contribuer à améliorer leur prise en charge. English title: Mortality-risk assessment by grace score in acute coronary syndromes in Côte d’Ivoire Abstract Introduction: The GRACE score is a useful tool for mortality-risk assessment and management of patients hospitalized for an acute coronary syndrome (ACS). Objective: To assess the risk of death of ACS patients in order to improve their management Patients and methods: We carried out a cross-sectional observational study over a four-year period from January 01, 2010 to December 31, 2013. All consecutive patients aged 18 years or older, who presented to intensive care unit of Abidjan Heart Institute for ACS were included. Epidemiological, clinical and therapeutic data were analyzed. The risk of death was assessed by the GRACE score. Results: 370 patients were included. The mean age was 55.4 years. There was a male predominance with a sex ratio of 3.87. The median delay between onset of symptoms and admission was 20.0 hours. In 11.1% of cases, patients underwent coronary angioplasty. Thrombolysis was performed in 8.3% of patients admitted for STEMI. The average GRACE score was 96.36 ± 32.18. It was significantly higher in STEMI (p <0.01). In NSTEMI, the risk of death was significantly higher in diabetics (p = 0.005) as well as in those with left ventricular failure (p = 0.002). In-hospital death rate was 10%. In univariate analysis, female sex (p=0.005), heart failure at admission (p=0.01), reduced ejectional fraction (p=0.04) and GRACE score (p<0.001) were associated factors for death in ST-elevation myocardial infarction patients. In non ST-elevation ACS, diabetes (p=0.01) and reduced ejectional fraction (p=0.02) were predictive factors for death. Conclusion: As used in an integrated approach, GRACE score should be a useful tool in the management of ACS patients. Key words: Acute Coronary Syndrome - GRACE score – Côte d’Ivoir

An mHealth App (eSkinHealth) for Detecting and Managing Skin Diseases in Resource-Limited Settings: Mixed Methods Pilot Study

BackgroundIn sub-Saharan Africa, the disease burden from skin diseases, including skin-related neglected tropical diseases (skin NTDs), is extremely high. These diseases often are overlooked due to limited access to health care stemming from, for example, remote geographical locations and a lack of experts. To address these gaps, we developed a mobile health app, eSkinHealth, which is a field-adapted platform to serve as a portable electronic patient chart and for teledermatology. ObjectiveThe purpose of the study is to evaluate the usability and effectiveness of the app in rural Côte d’Ivoire for diagnosing and managing skin NTDs and other skin diseases. MethodsA 2-arm trial with local health care providers and patients with skin diseases was implemented over a 3-month period. The providers were assigned to an intervention receiving the eSkinHealth app or control with usual care. Four nurses and 8 community health care workers participated in each arm. The training was provided on the use of the app to the intervention arm only, while both arms were trained on skin diseases. For the usability study, we evaluated our approach with the System Usability Scale (SUS) and in-depth interviews. For the effectiveness study, our primary outcome was to evaluate the detection and management of 5 skin NTDs as our targeted diseases, namely, Buruli ulcer, leprosy, lymphatic filariasis, scabies, and yaws, using the eSkinHealth app. Procedures of our methods were reviewed and approved by the institutional review board of the Ministry of Health and by Tulane University. ResultsThe mean age of our participants (providers) was 40.5 and 42.5 years for the intervention and control arms, respectively, and all were male (n=24). The average SUS scores taken from the intervention arm at baseline, the midpoint (6 weeks), and the end of study (12 weeks) were 72.3 (SD 11.5), 72.3 (SD 12.4), and 86.3 (SD 10.8), respectively. All participants interviewed, including 4 dermatologists and program managers, were satisfied with the app. Especially community health care workers felt empowered by being equipped with the tool. A total of 79 cases of skin NTDs were reported in the intervention arm as compared to 17 cases in the control arm (P=.002). Besides the skin NTDs, more skin diseases and conditions were reported from the control than from the intervention arm (P<.001). However, 100 cases (66%) were not given any particular diagnosis in the control arm and were documented only as a “dermatosis.” In the intervention arm, 151 cases (72.9%) were diagnosed within the eSkinHealth platform, and the remaining were diagnosed on-site by dermatologists. ConclusionsThe study provided evidence for the usability and effectiveness of the eSkinHealth app embedded into our surveillance approach to improve the detection and management of skin NTDs and other skin diseases in Côte d’Ivoire and, furthermore, is expected to contribute to knowledge on mobile health approaches in the control of skin diseases in resource-limited settings. Trial RegistrationClinicalTrials.gov NCT05300399; https://clinicaltrials.gov/ct2/show/NCT0530039