Day 1 :
The Diagnosis Center of the Mohammed V Hospital of Rabat welcomes patients from different regions of Morocco. The long-distance travel, difficulty of access to care in rural Morocco, transportation problems, and delayed appointments all make follow-up of patients a very difficult task.
MATERIALS AND METHODS :
This is a prospective, comparative analytic study of 200 patients under oral anticoagulant therapy based on vitamin K antagonists (VKA), followed in cardiology consultation, all of whom come from rural areas where access to care is difficult.
These 200 patients were followed during 1 year in consultation, 100 of them (group 1) in standard consultation according to the appointments elaborated by the computerized system of the Diagnosis Center. The other 100 (group 2) were followed, moreover, by their doctor via telephone. One year later, the evaluation of the management quality was based on one-year INR assessments, presented complications, and patients' personal expenses.
Patients of the 2nd group (group followed by telephone) were well anticoagulated most of the times with more frequent INR tests; 1305 INR performed by the 2nd group (1.09 per patient per month) compared with 500 INR by the 1st group (0.41 per patient per month). The number of complications was lower in the 2nd group as 5 patients presented a symptomatic overdose to anticoagulants and have evolved well, versus 12 for the 1st group, 4 of whom required hospitalization in the Intensive Care Unit for serious bleeding events, and one of them has deceased. Four patients in the first group had embolic events: 1 ischemic stroke with sequelae, 1 transient ischemic attack (TIA), and 2 prosthetic thromboses. Transportation expenses of the 2nd group were much smaller.
Telemedicine even by simple means has shown its potential contribution in terms of mortality and morbidity, in number of avoided hospitalizations with a great economic impact.
Saint Louis University
Aila Velasco is a graduate of Doctor of Medicine at Saint Louis University last June 2017, passing the Physician Licensure Examination in the Philippines last September 2018. She is currently under the training program for Internal Medicine. Her experience for research was based on her pre-medicine course in the University of the Philippines and during her post graduate years; where her skills for writing were honed by being a part of the University publication. Writing a medical paper in is a continuous process, a rapidly expanding experience, a challenge but also an opportunity for scientific knowledge.
Cor triatriatum is a rare cardiac condition involving the left atrium, representing only 0.1-0.4% of all congenital heart diseases. It presents as one of the atrium being divided into two chambers by a fibromuscular membrane and classically appear on the left atrium.
We report the case of a 23-year old Filipino female with orofacial cleft, presenting with symptoms of decompensated heart failure. Clinical examination revealed the presence of diastolic murmur, 5/6, with accentuated pulmonary component of the second heart sound. Cardiomegaly was seen on chest x-ray and right ventricular hypertrophy on electrocardiogram. Transthoracic echocardiogram (TTE) shows Cor triatrium sinistrum; dilated left atrium divided by a membrane into a proximal and distal chamber; dilated right atrium; dilated right ventricle with right ventricular hypertrophy; dilated main pulmonary artery; and severe pulmonic regurgitation with severe pulmonary hypertension.
TTE should provide accurate and sufficient characterization of cardiac anatomy for optimal diagnosis but because of its rarity, can be missed. A transesophageal echocardiography (TEE) provides excellent resolution and offers invaluable assistance to surgical intervention. TEE was done upon follow up to rule out associated congenital abnormalities which only showed patent ductus arteriosus.
Surgery provides a satisfactory early and long term survival. Therefore, accurate evaluation of cor triatriatum is the key. Our report highlights early diagnosis and the utility of transesophageal echocardiography in the diagnosis of such congenital cardiac abnormalities and associated lesions.