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title: Quantification of rheumatic mitral stenosis severity with three dimensional vena contracta area
abstract: Rheumatic mitral stenosis is a real public health problem in developing countries. Assessment of the mitral valve area (MVA) is essential for the choice of the intervention time. Most of the evaluation parameters of rheumatic MS are derived of two dimensional echocardiography (2D) Three dimensional transthoracic echocardiography (3D) is commonly used in our daily practice today. The purpose of this study was to evaluate the value of the vena contracta area (VCA) to predict the severity of rheumatic MS by comparing 3D planimetry.  Patients who were diagnosed with severe rheumatic MS with conventional methods (half pressure, planimetry) by 2D transthoracic echocardiography (TTE) underwent 3D TTE assessment. The VCA of the mitral valve was measured at maximum opening, with measurement planimetry MVA by metre/cropping TTE 3D. Results We studied 92 patients (mean age: 42 years) with Rheumatic MS. 15% (14 cases) had a 3D mitral area smaller than the mitral area per vena contracta, 80% (73 cases) the mitral area per vena contracta was smaller than 3D and 5% (5 cas) SP was equal in the two methods.  The results of our study provide evidence that the VCA of the 3D TTE mitral valve can be used routinely to detect the severity of mitral stenosis.

title: Mitral Regurgitation of Native Valve with Ostium Secundum Atrial Septal Defect Realizing Tiger Stripes Sign that Disappears after Mechanical Valve Replacement: A Case Report with Literature Review
abstract: Tiger stripes sign is the high amplitude band like signal noted on Doppler spectral recordings of valvular regurgitation. This is noted most often in patients with porcine mitral prosthetic valves and may be indicative of flail prosthetic leaflet. We herein describe a patient with tiger stripes sign in a severe mitral regurgitation on native valve associated with Ostium secundum atrial septal defect (ASD)  Tiger stripes sign is the high amplitude band like signal noted on Doppler spectral recordings (pulsed and continuous both) of valvular regurgitation. Other conditions associated with tiger stripes sign are any intracardiac oscillating mass and paraprosthetic leak. The mechanism of its formation is still not clear. In our case, tiger stripes sign was present in a patient with severe mitral regurgitation on native valve associated with ostium secundum atrial septal defect. The purpose of this report is to help us better understand the pathophysiological mechanism of this sign.  A 41 year old woman hospitalized for progressively worsening exertional dyspnea NYHA (New York Heart Association) class III associated with chest pain evolving for the past 3 years. The patient's medical history includes Grave's disease. Clinical examination revealed a grade 5/6 blowing holosystolic murmur at the apex and a grade 4/6 blowing murmur at the tricuspid area. ECG showed Atrial Fibrillation. Echocardiography showed the presence of severe mitral regurgitation, severe tricuspid regurgitation and secundum atrial septal defect with 10 mm diameter. Doppler showed the appearance of tiger stripes sign in continuous wave doppler (CW) and in pulsed wave doppler (PW) on the mitral valve.  The presence of regurgitation with divergent jet associated with ASD can favor the appearance of the tiger stripes sign.

title: Heart Myxoma of the Left Atrium Complicated by Takotsubo
abstract: Myxomas are the most common primary cardiac tumor. It is estimated that more than 75% of myxomas originate in the left atrium either at the mitral annulus or the fossa ovalis border of the interatrial septum; 20% arise from the right atrium, while 5% stem from both atria and the ventricle.  56 year old woman hospitalized in our cardio department for progressively worsening exertional dyspnea NYHA class III with no significant cardiovascular risk factor; Clinical examination blood pressure 130/70 mmHg with pulse rate of 71bpm, a grade 3/6 blowing holosystolic murmur at the apex along.  Atrial Fibrillation with heart rate of 70 bpm.  The patient had good ventricular function, LVEF 60% moderate mitral eccentric regurgitation secondary to restriction of the small valve; pulmonary arterial systolic pressure was 30+ 5 mmHg. We noted the presence of a tissue mass occupying almost the whole of the left auricle. The patient was operated on with a complete resection of the myxoma on the second day after surgery. Ultrasound monitoring showed left ventricular dysfunction with basal hyperkinesia associated with apical aknesia; with LVEF estimated at 25% with hemodynamic instability with placement of ECMO for 6 days. Coronary angiography was performed, which became normal. Therefore, takotsubo was retained as diagnosis. Unfortunately, the cardiac MRI was not available. Evolution was marked by the recovery of the LVEF after 10 days postoperative. Anatomy pathology confirms typical appearance related to myxoma.  Takotsubo heart disease is a rare postoperative complication in patients operated on for myxoma of the left atrium.

title: Peculiarity of Meadows Heart Disease
abstract: Peripartum cardiomyopathy is a rare, unrecognized and a life threatening pregnancy associated disease. It is established as left ventricular dysfunction occurring in the last month of pregnancy or the first 5 months postpartum in the absence of known aetiology or pre existing heart disease.  We have conducted a prospective case study between January 2020 and October 2020 including all the patients admitted for peripartum cardiomyopathy in tertiary care center clinical of Casablanca. Clinical and baseline characteristics and prognosis of patients were analysed.  Six patients were included in our study with a mean (SD) age 34.8 years and range between 24 and 55 years. Baseline clinical characteristics showed only 14% of our patients had risk factor of cardiovascular disease and 86% had no pre existing comorbidities. Dyspnea was the main symptoms that revealed the cardiomyopathy with 100% of our patients had dyspnea at admission. Preeclampsia was associated with peripartum cardiomyopathy in only one patient. Only one patient died during our study with a mortality rate 14% and the main cause was arrythmia. On the other hand, spectacular left ventricular function amelioration was found in 86% Mortality was significantly associated with episode of arrythmia on the Holter ECG (p 0.017) and with severe left ventricular dysfunction at admission (p=0.03) Our study didn't show any association between preeclampsia, age or number of pregnancies and mortality. The incidence of CMPP varies from 1/1300 to 1/15000 depending on the geographic region considered.  The risk factors mentioned in the literature are: African ethnicity, age over 30, multiparity, multiple pregnancies and toxemia of pregnancy. The etiology of CMPP is still uncertain, myocarditis of viral, autoimmune or idiopathic origin is strongly suspected.

title: Patent Foramen Ovale and Inherited Thrombophilia in the Pathogenesis of Arterial Thrombosis in a Young Patient: A Case Report and Literature Review
abstract: A Patent Foramen Ovale (PFO) is frequently associated with cryptogenic stroke in young patients with paradoxical embolism as the presumed mechanism. Moreover, hypercoagulable states that are known in the pathogenesis of venous thrombosis, can sometimes be found in patients with stroke, which can be explained by the PFO, that provides the missing link. The association between PFO and prothrombotic state may hence increase the risk for paradoxical embolism. Yet, the cause and effect relationship between these pathologies is not clearly established and the best therapeutic and preventive strategy are unelucidated.  We report a case associating ischemic stroke, left internal carotid occlusion, and pulmonary embolism with the discovery of a PFO and inherited thrombophilic disorders, in a young woman under combined contraceptives.  We believe that this case is important since it shows the importance of searching for a PFO in young patients with arterial events and thrombophilia and also the interest of systematic screening for procoagulant disorders in those with stroke and PFO, and highlights the challenge in the multidisciplinary management of such patients.

title: Effet De La Combinaison Regeneration Naturelle Assistee (RNA) Et Microdose D'engrais Sur La Production Du Mil (Pennisetum Glaucum (L. R.Br) Dans Les Zones Agro Ecologiques Du Centre Sud Du Niger
abstract: Cette etude vise a identifier la microdose optimale d'engrais dans les champs de production du mil, ou des pratiques de la regeneration naturelle assistee (RNA) sont deja realisees. L'experimentation a ete conduite dans 26 villages pratiquant la RNA, dont 10 villages dans la zone sahelienne stricte, 10 villages dans la zone sahelo soudanienne et 6 villages dans la zone nord soudanienne du centre sud du Niger. Un dispositif en bloc randomise est installe dans chaque village comportant 5 traitements (RNA; RNA Fumure organique (F) RNA+F+NPK; RNA Phosphate naturel de Tahoua (PNT) F; RNA+PNT) et un temoin suivant les quatre points cardinaux. Les parametres mesures sont la croissance en hauteur, le nombre de talles, les rendements en grains et en paille de mil. Les resultats ont montre que la hauteur moyenne la plus elevee des plants est obtenue pour le traitement RNA+PNT dans la zone sahelienne stricte (283,9+ 86,2 cm) et le nombre eleve de talles moyens pour le temoin de la zone nord soudanienne (10,04+ 3,1) Dans toutes les zones, le traitement RNA+F+NPK a permis d'obtenir les plus grands rendements moyens en grains et en paille de mil. La zone sahelo soudanienne obtient les rendements moyens en grains (464,1+ 213,9 kg/ha) et en paille (2126+ 1193 kg/ha) de mil les plus eleves pour le traitement RNA+F+NPK. Par contre, les rendements les plus faibles des temoins sont obtenus dans la zone sahelienne stricte, avec 133,3+ 122,7 kg/ha pour les grains et 238,5+ 238,2 ka/ha pour la paille. Ces resultats peuvent etre utilises dans le cadre de l'optimisation de la production du mil dans les agrosystemes au Niger. This study aims to identify the optimal microdose of fertilizer in millet production fields, where Farmer Managed Natural Regeneration (FMNR) practices are already carried out. The experiment was carried out in 26 villages practicing RNA, including 10 villages in the strict Sahelian zone, 10 villages in the Sahelo Sudanian zone and 6 villages in the north Sudanian zone of south central Niger. A randomized block device is installed in each village comprising 5 treatments (RNA; RNA Organic manure (F) RNA F NPK; RNA Natural Phosphate of Tahoua (PNT) F; RNA PNT) and a next control the four cardinal points. The parameters measured are: height growth, number of tillers, grain and millet straw yields. The results showed that the highest average height of the plants is obtained for the RNA PNT treatment in the strict Sahelian zone (283.9 86.2 cm) and the high number of average tillers for the control in the northern zone. Sudanian (10.04 3.1) In all areas, RNA F NPK treatment resulted in the highest average grain and millet straw yields. The Sahelo Sudanian zone obtains the highest average grain (464.1 213.9 kg ha) and straw (2126 1193 kg ha) millet yields for the RNA F NPK treatment. On the other hand, the lowest yields of the controls are obtained in the strict Sahelian zone, with 133.3 122.7 kg ha for the grains and 238.5 238.2 ka ha for the straw. These results can be used in the optimization of millet production in agrosystems in Niger.

title: Mitral Regurgitation on Native Valve with Ostium Secundum Atrial Septal Defect (ASD) Realizingtiger Stripes Sign that Disappear after Mechanical Valve Replacement Case Report with Literature Review
abstract: Tiger stripes sign is the high amplitude band like signal noted on Doppler spectral recordings of valvular regurgitation. This is noted most often in patients with porcine mitral prosthetic valves and may be indicative of flail prosthetic leaflet. We herein describe a patient with tiger stripes signin a severe mitral regurgitation on native valve associated with Ostium secundum atrial septal Defect (ASD)  A 41 year old woman hospitalized for progressively worsening exertional dyspnea NYHA (New York Heart Association) class III associated with chest pain evolving for the past 3 years. The patient's medical history includes Grave's disease. Clinical examination revealeda grade 5/6 blowing holosystolic murmur at the apex and a grade 4/6 blowing murmur at the tricuspid area.ECG showed trial Fibrillation. Echocardiography showed the presence of severe mitral regurgitation  (A) severe tricuspid regurgitation and secundum atrial septal defect with 10 mm diameter. Doppler showed the appearance of tiger stripes sign in continuous wave doppler (CW) and in pulsed wave doppler (PW) on the mitral valve.  (B,C)

title: O USO DA MAQUETE COMO ALTERNATIVA METODOLOGICA NO ENSINO DA GEOGRAFIA

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title: Very rare electrocardiograph abnormalities in meningitis: a case report
abstract: Osborn waves are produced when the J point deviates from baseline. While there are many known causes of Osborn waves, hypothermia remains the most common. We report electrocardiographic changes with Osborn wave in a 32 year old woman with fatal meningoencephalitis, potentially reversible, probably non ischaemic myocardial dysfunction may occur in association with acute non cardiac illnesses, such as brain injuries or severe infections. The mechanisms of the electrocardiography (ECG) abnormalities in this disease are unclear.