Objective: Compared with the extensive data on left sided infective endocarditis, right-sided infective endocarditis (RSIE) remains a rare condition. It accounts for 5–10% of all cases of infective endocarditis (IE) [1] [2] [3].Although it is predominantly encountered in the injecting drug user (IDU) population, where HIV and HCV infections often coexist, rheumatic heart disease remains the most important predisposing factor for IE in our context. The aim our study is to report clinical, investigation, management and outcome data in 5 patients diagnosed with RSIE in our department during the last 2 years. Methods: A retrospective analysis of data of 5 patients with right sided endocarditis in a tertiary care center from 2018 to 2020 was done. Results: All of our patients were young aged females none of them had cardiac devices or history of drug use. Persistent fever was the most common clinical presentation. Interestingly, 4 patients presented clinical heart failure. 3 patients had isolated tricuspid valve IE, one patient had isolated pulmonary valve IE, and one patient have both tricuspid and pulmonary valve IE. Blood cultures were negative in two cases, whilst two others were positive to Streptococcus (alpha) and one positive to Staphylococcus. 4 patients underwent surgical treatment after well conducted antibiotic therapy the indications were the presence of right heart failure secondary to severe tricuspid regurgitation and the size of the vegetations. Unfortunately, one patient died of massive pulmonary embolism despite well conducted antibiotherapy. Conclusion: RSIE is rare and occurs in a wide range of underlying conditions like implantable electronic devices, indwelling catheters, CHD and immune compromised state. Surprisingly, it can occur in young individuals without known risk factors. In our context, rheumatic heart disease remains the most incriminated etiology which lead us to question three essential points: 1. The interest of antibiotic prophylaxis in young patients with VSDs 2. The use of empiric antibiotics with action against streptococcus 3. Early surgical treatment in rheumatic heart disease.
Anticoagulation with acenocoumarol is influenced by dietary changes but the effect of fasting on acenocoumarol therapy is unknown. Objectives: To study changes in international normalized ratio (INR) and the percentage of time within therapeutic range (%TTR) before and during Ramadan. Methods/Patients: In this prospective study, weekly INR readings were taken from participating patients during two study periods: before and during Ramadan. Readings were blinded to patients and their primary physicians except for when pre-set study endpoints were reached. Results: Among 128 participating patients, mean INR increased by 0.25 (P = 0.006) during Ramadan from the pre-Ramadan month. There was no significant difference (P = 0,02) in mean INR between the non-Ramadan months. No bleeding or thrombotic events were recorded. Conclusion: Fasting significantly increases the mean INR of medically stable patients taking acenocoumarol and the likelihood of having an INR above therapeutic targets.
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