[Effect of polymorphisms on key enzymes in homocysteine metabolism, on plasma homocysteine level and on coronary artery-disease risk in a Tunisian population]. / Effet des polymorphismes des enzymes clés du métabolisme de l'homocystéine sur l'homocystéinémie et le risque coronarien chez une population tunisienne.

BACKGROUND: Hyperhomocysteinemia is known as an independent-risk factor for coronary-artery disease (CAD). However, the effect of homocystein metabolic enzymes polymorphisms on CAD is still controversed. We investigated the relation between homocystein metabolic key enzymes polymorphisms, homocystenemia and coronary stenosis in a Tunisian population. METHODS: Samples were collected from 251 CAD patients documented by angiography. Genotyping were performed for C677T methylene-tetrahydrofolate reductase (MTHFR), A2756G methionine-synthase (MS) and 844ins 68 cystathionine-beta-synthase (CBS). We measured fasting plasma tHcy, folate and vitamin B12. RESULTS: There was significant increase in homocysteinemia for homozygous genotypes of C677T MTHFR (p<0.001) and A2756G MS (p=0.01), but not for 844ins68 CBS (p=0.105). Potential confounders adjusted odds-ratios for significant coronary stenosis, associated with MTHFR TT, MS GG and CBS insertion, were respectively 1.78 (p=0.041); 2.33 (p=0.036) and 0.87 (p=0.823). The effect of mutated MTHFR genotype was more pronounced on homocysteinemia (21.4+/-9.1 micromol/L; p<0.001) and coronary stenosis (OR=2.73; p=0.033) at low folatemia (< or =6.1 ng/mL). CONCLUSION: MTHFR TT and MS GG genotypes increase tHcy concentration and coronary stenosis risk, especially with low folatemia.

[Distribution of cardiovascular risk factors in coronary patients in Sahel, Tunisia]. / Distribution des facteurs de risque cardio-vasculaire chez des patients coronariens dans le Sahel tunisien.

We evaluated cardiovascular risk factors and their association in patients in Sahel, hospitalized for coronary disease over the period 1994-1998. The clinical features of 3455 patients (72.4% men, 1741 with myocardial infarction, 1714 with unstable angina) were analysed on hospital admission. The prevalence of smoking, dyslipidaemia, hypertension, diabetes and obesity was 77.4%, 39.4%, 28.5%, 42.5% and 25.1% respectively in men and 2.9%, 43.7%, 59.2%, 56.6% and 31.9% respectively in women. With this risk factor profile a national strategy of primary prevention and heart health promotion is needed in Tunisia.

[Distribution of cardiovascular risk factors in coronary patients in Sahel Tunisia]

We evaluated cardiovascular risk factors and their association in patients in Sahel, hospitalized for coronary disease over the period 1994-1998. The clinical features of 3455 patients [72.4% men, 1741 with myocardial infarction, 1714 with unstable angina] were analysed on hospital admission. The prevalence of smoking, dyslipidaemia, hypertension, diabetes and obesity was 77.4%, 39.4%, 28.5%, 42.5% and 25.1% respectively in men and 2.9%, 43.7%, 59.2%, 56.6% and 31.9% respectively in women. With this risk factor profile a national strategy of primary prevention and heart health promotion is needed in Tunisia

[Percutaneous mitral commisurotomy in patients aged 60 years and more]. / La commissurotomie mitrale percutanée chez les sujets agés de 60 ans et plus.

Of 745 patients treated by balloon mitral commissurotomy (BMC) between February 1988 and December 2002, 45 were > or = 60-years old. Immediate and late outcomes in this group (group 1) were compared with those in the patients aged < 60-years (group 2). Baseline hemodynamic parameters were comparable in the two groups. Mitral surface area and hemodynamic parameters improved significantly after BMC in group 1: mean left atrial pressure fell from 18.76 +/- 6.18 to 10.65 +/- 4.38 mmHg (P < 0.001), mean transmitral gradient from 11.03 +/- 4.70 to 4.63 +/- 2.05 mmHg (p < 0.001) and mitral valve area from 0.99 +/- 0.22 to 1.88 +/- 0.41 cm2 (p < 0.001). Similar significant improvements were seen in group 2. The hemodynamic result was good in 69% of group 1 patients. Tamponade occurred in one patient. Mitral regurgitation grade I or II developed in 8 patients and remained stable in 13 patients. These complication rates were comparable to those seen in group 2. In the group 1, a good result was maintained in 60% of patients after 43 +/- 23 months of follow-up. Although restenosis was observed in 40% of patients, functional amelioration was obtained in most of cases. In the group 2, restenosis was observed in 25% of patients. The data from this study suggest that BMC is effective first therapy in patients aged > or = 60-years with symptomatic mitral stenosis.

[Arachidonate to saturated fatty acid ratio of circulating sterides and phospholipids: can it be risk marker of coronary stenosis? A Tunisian study]. / Le rapport arachidonate sur acides gras saturés des stérides et des phospholipides circulants: peut-il être un témon du risque de sténose coronarienne? Etude dans une population tunisienne.

The prevention and early diagnosis of cardiovascular diseases is a public health priority in Tunisia and actions are undertaken to evaluate biologic marquers in at risk populations. Concentrations of fatty acids in serum phospholipids and sterides have been measured using thin layer chromatography and gaz chromatography of transmethyled derivatives. The study concerned 98 coronarographed patients, presenting (n = 72) or not coronary artery disease (n = 26). The results have been compared to those of a reference population (n = 43) without any cardiac pathology. The mean concentrations of most of sterides fatty acids in coronarographed patients were higher than in controls, except for arachidonic acid which was slightly lower (68 +/- 34 mg/L versus 77 +/- 19,6 mg/L in controls). Considering concentrations of sterides fatty acids in the two subgroups of patients, coronary artery disease was associated with an increase of all these fatty acids, which was statistically significant for palmitate, linoleate and linolenate. Measurements of fatty acids in phospholipids showed a reduction of arachidonic acid in coronarographed patients (76 +/- 36,7 mg/L versus 135 +/- 49,3 mg/L in controls), but without correlation with the severity of the stenosis.

[Complicated hydatid cyst of the right atrium simulating myxoma of the tricuspid valve]. / Kyste hydatique de l'oreillette droite compliqué simulant un myxome de la tricuspide.

The authors report the case of a 6-year-old girl with multi-organ hydatid disease, revealed by a complication: hydatid cyst of the right atrium. They emphasize the latency and clinical polymorphism of right cardiac sites of hydatid cyst and the severity of its prognosis. The particular site of this right atrial tumour and its relations with the septal leaflet of the tricuspid valve could be confused, on echocardiography, with myxoma of the tricuspid valve. The aetiology in this case was confirmed at surgery.