Trends in secondary prevention of coronary heart disease in Tunisia: prevention of recurrences of MI and stroke.

OBJECTIVES: The survival benefits achieved by prescription of antiplatelet agents, B-adrenoreceptor antagonists (beta-blockers), angiotensin II receptor blockers (ARB), and lipid lowering agents in patients surviving the myocardial infarction (MI) have been well documented in large clinical trial. Despite well-established benefits, these pharmacological agents continue to be underutilized. The main objective of this study was to evaluate the progress of cardiovascular secondary prevention practices in Tunisia. METHODS: The PREMISE (Prevention of Recurrence of Myocardial Infarction and Stroke) is a descriptive, cross-sectional study conducted in Tunisia in two phases (2002 and 2009). Seven hundred eighty two patients were recruited. The recruitment criteria were: previous MI, stable angina, unstable angina, percutaneous transluminal coronary angioplasty (PTCA), coronary artery bypass graft (CABG), stroke, transient ischemic attack (TIA) or carotid endarterectomy. This analysis is limited to coronary heart disease (CHD) patients. Five hundred hospital patients were interviewed and their medical records were reviewed: 250 in 2002 and 250 in 2009. Patients were included if they had confirmed diagnosis of MI, angina, CABG or PTCA, and if their first cardiovascular event had occurred more than one month but not later than 3 years ago. We compared the total of both patient groups, using the prevalence of Cardio-Vascular Risk Factors (CVRF) and the treatment prescribed at hospital discharge. RESULTS: The proportion of patients with reported hypertension, diabetes, hypercholesterolemia and current smoker patients had decreased. Concerning pharmacological prescriptions, a significant increase was observed in prescribing statins (38.9% vs. 70.3%) and ACE inhibitors (49.3% vs. 69.9%), non pharmacological prescriptions as healthy diet or tobacco cessation had opposite trends. Adherence to treatment did not change substantially. CONCLUSION: Although the use of cardioprotective drugs had increased in CHD patients, there are still gaps in secondary prevention in Tunisia. The recommended strategies of secondary prevention need to be applied more intensively in clinical practice.

The G3057A LEPR polymorphism is associated with obesity in Tunisian women.

OBJECTIVES: The aim of this study was to evaluate the effect of the G3057A (rs62589000) LEPR polymorphism on obesity risk and plasma leptin, insulin, and lipid levels in a sample of the Tunisian population. DESIGN AND METHODS: Three hundred and ninety-three obese patients and 317 controls participated in this study. The G3057A genotype was determined by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. RESULTS: In the entire study sample, no significant differences in genotype frequencies were observed between obese patients and controls. However, stratified analysis by gender revealed a quantitative increase in the variant allele (33.3% vs. 25.8%; χ(2)=4.90, p=0.026) in obese women (but not men) compared to controls. When a dominant model of inheritance was assumed, the GA+AA genotypes were more prevalent in these obese female patients than in controls (58.3% vs. 47.8%; χ(2)=4.08, p=0.044). Unconditional logistic regression showed that in women only, obesity risk was significantly higher for homozygotes for the variant allele (OR=2.73, 95% CI 1.03-7.21) and for carriers of GA+AA genotypes (OR=1.53, 95% CI 1.01-2.31) compared with homozygotes for the normal allele. The association between the G3057A LEPR variant and obesity remained statistically significant even after adjustment for age. No relationship was found between the G3057A LEPR polymorphism and leptin and insulin levels. Additionally, this LEPR gene variant had no effect on plasma lipid concentrations. CONCLUSION: There is evidence in this study that the G3057A LEPR polymorphism is associated with obesity in Tunisian women.

The -2548G/A LEP polymorphism is associated with blood pressure in Tunisian obese patients.

OBJECTIVE: To examine the association of a common -2548G/A (rs7799039) promoter variant of the human leptin gene (LEP) with obesity or body mass index (BMI) and its associated phenotypes such as blood pressure variability and the prevalence of hypertension in a sample of the Tunisian population. DESIGN AND METHODS: Two hundred and twenty-nine obese patients were screened and compared with 251 normal weight subjects. The -2548G/A LEP polymorphism was analysed by PCR-RFLP procedure. RESULTS: No significant association was found between the -2548G/A polymorphism and obesity or BMI. However, in obese patients subjects with AA genotype had significantly higher systolic (p = 0.003) and diastolic (p = 0.002) blood pressure compared with those with GA or GG genotypes. Stratified analysis by gender revealed that male patients but not female homozygous for -2548A allele exhibited significantly increased systolic (p = 0.01) and diastolic (p<0.001) blood pressure than did carriers of -2548G allele. Multiple linear regression analysis revealed that AA genotype significantly affect systolic and diastolic blood pressure in obese men. Additionally, significant association between AA genotype and higher prevalence of hypertension was found in male patients (p = 0.03). CONCLUSION: The present study showed that the -2548G/A LEP polymorphism is associated with blood pressure in obese male patients.

[Epidermoid cyst in the occipital skull vault. A case report]. / Kyste épidermoïde de la voûte du crâne. A propos d'une observation.

We report a case of an epidermoid cyst of the occipital skull vault in a 28 year-old woman. The symptomatology was an occipital swelling and pain. The diagnosis was evoked on the skull X-ray and computed tomography scan. Total removal of the tumor provided complete recovery.

[Multiple cerebral hydatic cysts of cardiac origin. A case report]. / Hydatidose cérébrale multiple d'origine cardiaque.

The hydatic cyst is a pathology observed in developing countries. Multiple cerebral localizations with a cardiac origin are exceptional and are sometimes diagnosed only after onset of complications. We present the case of a 22-year-old male student: the diagnosis of multiple cerebral hydatic cysts caused by rupture of a cardiac hydatic cyst was established after an episode of ischemia of the limbs with cerebral hemorrhage induced by heparin. One year later, the clinical situation consisted in intracranial hypertension, hemiplegia and convulsive seizures. We observed no cardiac symptoms. The brain CT showed 9 hydatic cysts and echocardiography showed a myxomatous cystic tumor. Abdominal CT detected renal and splenic hydatic cysts. The patient underwent total ablation of the cerebral and abdominal cysts and made a full recovery. After surgical removal of the cardiac cyst, the patient has been lost to follow-up. Cerebral hydatidosis of cardiac origin is highly exceptional and, due to nonspecific symptomatology, may go undiagnosed. In general, prognosis is good in case of a cerebral localization but the cardiac localization is associated with high mortality.

[Anterior approach of cervical spine in Pott's disease. Apropos of 7 cases]. / Abord antérieur du rachis cervical dans le mal de Pott. A propos de 7 cas.

This study reports 7 cases of cervical Pott's disease, gathered during 6 years in the department of neuro-surgery of Ibn Rochd U.H.C. 4 females and 3 males, aged between 9 and 52 years were included. All the patients complained of cervicobrachial pain and weakness of the limbs. Clinical features were: deterioration of general status, rachidian syndrome and neurological impairement with motor and sensitive deficit. Radiological analysis found a destructive and extensive lesion, cervical kyphosis from 10 degrees to 60 degrees, retropharyngeal abscess and intraspinal canal extension of infection. Diagnosis was confirmed by histological study in all cases. In addition to antituberculous therapy and preoperative cervical traction in 4 cases, all the patients had spinal fusion using an anterior approach. Post operative immobilization in a cervical collar varied from 9 to 12 months. All 7 patients had full neurological recovery, 6 patients had an excellent bony fusion and cervical kyphosis was corrected. For the remaining patient, the bone graft was mobilized without neurological disorders. This study confirms anterior arthrodesis efficiency. This procedure in conjunction with preoperative traction, allowed stabilization of the spine and healing of vertebral lesions with excellent kyphosis correction.

[Anal migration of ventriculo-peritoneal shunt catheter. Apropos of 3 cases]. / Migration anale du cathéter de dérivation ventriculo-péritonéale. A propos de 3 cas.

Three cases of abdominal catheter migration through the anus following ventriculo-peritoneal shunt are described. Two cases involved hydrocephalus secondary to tuberculous meningitis and the third myelomeningocele. Among the reasons for migration, the length of the abdominal catheter, trauma during the operation and infection must be taken into consideration. One patient was suffering from meningitis at the time of admission, while the two others were asymptomatic. Treatment involved removing the peritoneal catheter in 2 cases and the entire shunt system in the patient with meningitis. The shunt was replaced one to two weeks later. The outcome was favourable in all three cases.