[Which elderly with stable angina should be referred for cardiac surgery?] / Quel patient âgé, ayant un angor stable, doit être adressé en chirurgie cardiaque ?

The choice of revascularization of coronary patients, if it is well codified in the general population, remains in the elderly subject a daily dilemma for the clinician. We report 4 clinical cases (80 years and over) elective for coronary artery bypass or percutaneous coronary transluminal angioplasty (PTCA). No randomized studies dedicated to this population are available. Nevertheless, according to the registries, surgery versus PTCA has a superior benefit in the medium and long term, despite higher mortality and stroke. The coronary lesions in this population are actually more complex, usually leading to surgery compared to a younger population. However, the choice of the revascularization method is difficult depending on the co-morbidities and the higher surgical risk. What must be taken into account here are the cognitive abilities, the risk of cognitive decline, the frailty of the patient (correlated with mortality), frailty being a subjective data given without a consensually recognized scoring system. The indication of the revascularization method should include mortality risks as well as morbidity, in particular the potential risk of deterioration of the general condition and autonomy of patients, particularly the elderly. Randomized studies dedicated to this population, taking into account mortality and morbidity, and in particular the "concept of frailty", would make it possible to describe the specificities of aging subjects in recommendations and good practices.

Evaluating a malaria intervention strategy using knowledge, practices and coverage surveys in rural Bolifamba, southwest Cameroon.

We evaluated the impact of a malaria intervention in Bolifamba in rural Cameroon. The intervention consisted of educating the community on management of malaria and provision of a dispensary for early diagnosis and treatment. In July 2001, prior to the intervention, a questionnaire was used to obtain information on knowledge of and practices toward childhood malaria of 185 mothers of children aged 0-5 years. The same questionnaire was administered to 120 of the 185 mothers, one-year post-intervention. Clinical and laboratory investigations were carried out on children whose mothers were interviewed. A comparison of pre- and post-intervention data indicated significant changes in (i) the use of appropriate malaria treatment (from 50% to 81.7%); (ii) recognition of splenomegaly as a feature of malaria (from 18.4% to 80.8%); (iii) prevalence of splenomegaly (from 26.5% to 13.3%); (iv) prevalence of fever (from 27.8% to 13.3%); (v) parasite prevalence (from 60.5% to 44.2%) and (vi) severe malaria anaemia (from 2.6% to 0.0%). These findings revealed that proper education of villagers, particularly mothers, on malaria and the presence of health facilities, where treatment is readily available at affordable cost, close to villages, are important strategies that would reduce malaria morbidity and mortality significantly.

[Recurrent false infundibulo-pulmonary aneurysm after complete correction of Fallot tetralogy]. / Faux anévrysme infundibulo-pulmonaire récidivant après correction complète d'une tétralogie de Fallot.

Infundibulo-pulmonary aneurysm is a rare complication of complete correction of Tetralogy of Fallot and its recurrence has not been previously reported. A girl with Tetralogy of Fallot with two small pulmonary branches underwent complete correction at 3 years of age with widening of the infundibulum, the pulmonary annulus and artery with a pediculated pericordial path. Five years later, the left parasternal systolic murmur increased in intensity due to an infundibulo-pulmonary aneurysm and severe stenosis of the bifurcation of the pulmonary artery confirmed by echocardiography and catheterisation. The child was reoperated with resection of the aneurysm and widening of the pulmonary tract and its two branches with a Dacron patch. Three years later, the aneurysm and pulmonary stenoses recurred and required percutaneous angioplasty and stenting. The inadequacy of the result led to a further surgical procedure.

The epidemiology of malaria in Bolifamba, a rural community on the eastern slopes of Mount Cameroon: seasonal variation in the parasitological indices of transmission.

The prevalences of malarial parasitaemia, fever, splenomegaly and anaemia and the levels of parasitaemia were investigated, through part of one wet season (in 2001) and the following dry season (in 2002), in 2157 subjects in the village of Bolifamba, in south-western Cameroon. Overall, 55.9% of the villagers checked in the wet season but only 49.5% of those examined in the dry season were found smear-positive for malaria (P<0.0001). Rainfall was found to be significantly associated with the mean level of parasitaemia (P=0.001). The prevalences of fever (40.3% v. 19.6%), splenomegaly (37.4% v. 4.0%) and marked splenomegaly (i.e. a Hackett's score of 2 or higher; 25.8% v. 2.4%) were all significantly higher in the wet season than in the dry (P<0.0001 for each). No seasonal difference was observed, however, in the prevalence of anaemia. Parasitaemia, fever, splenomegaly and anaemia were all significantly more common in the young children investigated (i.e. those aged < 5 years) than in the older subjects. When the data were subjected to a multiple logistic regression, age-group, anaemia, fever, and month of examination were all found to be significantly associated with the presence of malarial parasitaemia. The results of this large-scale study, the first of its kind in the Buea district of Cameroon, indicate the intense transmission of malarial parasites in rural Bolifamba, with young children at greatest risk. The data collected provide a useful 'base line' for an ongoing study to assess the immune status of the residents of Bolifamba.

The effect of maternal, umbilical cord and placental malaria parasitaemia on the birthweight of newborns from South-western Cameroon.

AIM: The impact of maternal, umbilical cord and placental malaria parasitaemia on the incidence of low birthweight was investigated in pregnant women reporting for delivery at the Mutengene Maternity Centre, Fako Division, South West Province, Cameroon. METHODS: The malaria parasitaemia status of 770 umbilical cords, parturient women and placental impression smears were determined by light microscopy using blood samples collected between June 1999 and September 2001. The birthweights (BW) of the newborns were recorded soon after delivery. RESULTS: The results show that malaria parasites were present in the blood samples of 57 out of 730 (7.8%), 233/711 (32.8%) and 248/735 (33.7%) cord, maternal and placental biopsies respectively. Low birthweight (LBW) was recorded in 72 (9.6%) newborns, and the incidence was higher in primiparae. Newborns of mothers who had malaria parasites in their peripheral blood (12.4%) had a higher incidence (p=0.014) of LBW when compared with malaria parasite-free mothers (6.8%). Similarly, neonates born from malaria-positive placentas (13.5%) had a significantly higher incidence of LBW (p=0.006) than those from parasite-negative placentas (6.8%). Furthermore, newborns of malaria parasite-positive mothers, umbilical cords, placentas and primiparae had lower mean birthweight than malaria-negative mothers, placentas, umbilical cords and multiparae. CONCLUSION: We suggest that parity and maternal and placental malaria parasitaemia at delivery have an important negative impact on birthweight, especially in first pregnancies. This observation emphasizes the need for appropriate aggressive intervention strategies such as the use of insecticide-treated bed nets or intermittent preventive treatment to control malaria in pregnancy in the study area.