Trends in Secondary Prevention of Coronary Heart Disease in Tunisia: Prevention of Recurrences of MI and Stroke

ObjectivesThe 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.MethodsThe 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.ResultsThe 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.ConclusionAlthough 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

On d-symmetric classical d-orthogonal polynomials

AbstractThe d-symmetric classical d-orthogonal polynomials are an extension of the standard symmetric classical polynomials according to the Hahn property. In this work, we give some characteristic properties for these polynomials related to generating functions and recurrence-differential equations. As applications, we characterize the d-symmetric classical d-orthogonal polynomials of Boas-Buck type, we construct a (d+1)-order linear differential equation with polynomial coefficients satisfied by each polynomial of a d-symmetric classical d-orthogonal set and we show that the d-symmetric classical d-orthogonal property is preserved by the derivative operator. Some of the obtained properties appear to be new, even for the case d=1

The Environmental Impacts of Radio Frequency and Power Line Communication for Advanced Metering Infrastructures in Smart Grids

In the neighborhood area network (NAN), the advanced metering infrastructure (AMI) enables a bidirectional connection between the smart meter (SM) and the data concentrator (DC). Sensors, such as smart meter nodes or environmental sensor nodes, play a crucial role in measuring and transmitting data to central units for advanced monitoring, management, and analysis of energy consumption. Wired and wireless communication technologies are used to implement the AMI-NAN. This paper delves into a novel approach for optimizing the choice of communication medium, air for radio frequency (RF) or power lines for power line communication (PLC), between the SM and DC in the context of the AMI-NAN. The authors methodically select the specific technologies, RF and NB-PLC (narrowband power line communication), and meticulously characterize their attributes. Then, a comparative analysis spanning rural, urban, and industrial settings is conducted to evaluate the proposed method. The overall reliability performance of the AMI-NAN system requires a packet error rate (PER) lower than 10%. To this end, an efficient approach is introduced to assess and enhance the reliability of NB-PLC and RF for AMI-NAN applications. Simulation results demonstrate that wireless communication is the optimal choice for the rural scenario, especially for a signal-to-noise ratio (SNR) lower than 25 dB. However, in urban environments characterized by higher SNR values and moderately dense networks, NB-PLC gains prominence. In denser networks, it outperforms wireless communication, exhibiting a remarkable 10 dB gain for a bit error rate (BER) of 10−3. Moreover, in industrial zones characterized by intricate network topologies and non-linear loads, the power line channel emerges as the optimal choice for data transmission

Les osteomes des sinus de la face

Introduction : Le but de notre travail est préciser le profil épidémio-clinique de cette pathologie, l’apport de l’imagerie dans le diagnostic, et discuter les modalités de l’exérèse chirurgicale et l’apport de la voie endoscopique.Patients et méthode : il s’agit d’une étude rétrospective de 18 patients porteurs d’ostéomes des sinus paranasaux opérés entre 1993 à 2010. Ont été exclus les patients non opérés et les malades perdus de vue.Résultats : il s’agit de 18 patients porteurs d’un ostéome symptomatique des sinus de la face, d’âge moyen 40 ans, sex ratio 0,38. La localisation la plus fréquente était le sinus frontal dans 55.5% des cas. Le traitement chirurgical était de mise pour les patients symptomatiques. La voie endonasale était indiquée dans 6 cas.la récidive a intéressé deux patients (11%) ayant un ostéome frontal et fronto-ethmoïdal. Pour le reste des malades l’évolution était favorable avec un recul moyen de 36 mois.Conclusion : L’ostéome des sinus paranasaux reste longtemps asymptomatique mais peut se compliquer par extension orbitaire ou cérébrale. L’abord endonasal a permis d’améliorer la prise en charge.Mots clés : Ostéome, sinus de la face, tomodensitométrie, chirurgie, voie endonasaleObjective : Lymph node infection is the most frequent localization of extrapulmonary tuberculosis. The treatment does not make general agreement. The aim of this study is to specify, from a review of the literature, the different ways of antimicrobial treatment and the indications of surgery.Patients and methods : il is about a retrospective study including 18 patients with paranasal sinus osteomas operated between 1993 and 2010. Were excluded unoperated and lost patients.Results : in this group of 18 patients with symptomatic sinus osteoma of the face, the mean age was 40 years, sex ratio was 0.38. the frontal sinus was the most affected, 55.5% of cases. Surgical treatment was set for symptomatic patients. The endonasal route was indicated in 6 cases. Recurrence was observed in two patients (11%) having a frontal osteoma and fronto-ethmoid. Outcomes were favorable in the remaining patients, mean follow-up was 36 months.Conclusion: Paranasal sinuses osteoma is a long asymptomatic tumor, but it may be complicated with orbital extending or stroke. Endonasal approach contributed to improve the treatment.Keyswords : Osteoma, paranasal sinus, computed tomography, surgery, endonasal approac

Otospongiose : a propos de 149 cas

Introduction : L’otospongiose est une ostéodystrophie de la capsule otique se traduisant par une surdité de transmission ou plus rarement une surdité mixte d’apparition progressive. Le but de notre travail est d’analyser les caractéristiques épidémiologiques, cliniques, paracliniques et comparer les résultats en fonction de l’âge, du stade de l’ostéodystrophie, de la technique chirurgicale et de la prothèse.Patients et méthodes : notre étude est rétrospective portant sur 124 patients (149 oreilles) colligés sur une période de 9 ans (2000-2008).Résultats : notre population a comporté 86 femmes et 38 hommes. La moyenne d’âge à l’intervention était de 39,82 ans. La surdité était bilatérale dans 61,3% des cas et unilatérale dans 38,3%. Les seuils moyens préopératoires de la conduction osseuse et aérienne étaient respectivement de 17,33 dB et 52,52 dB, le rinne moyen était de 35,19 dB. La tomodensitométrie a été réalisée chez 63 patients. On a réalisé 21 platinectomie totale, 24 platinectomie partielle et 101 platinotomie calibrée. Selon la classification de Portmann, on a trouvé une répartition sensiblement égale entre les stades II, III et IV. On a utilisé un piston téflon 6/10 mm dans 119 cas et 4/10 mm dans 27 cas. Le rinne moyen postopératoire était de 15,95 dB. a 1 an, le rinne était de 14,81 dB avec un résultat satisfaisant de 94,2%.Conclusion : Il ressort de notre travail que certains facteurs semblent prédictifs de bons résultats et qui sont : le sexe féminin, l’âge <50 ans, le stade chirurgical< stade IV, la platinotomie, et le piston 0,4 mm.Mots clés : otospongiose, conduction osseuse, conduction aérienne, platinotomie, platinectomie.Objective : Otosclerosis is a common disorder of the otic capsule characterized by the presence of a progressive conductive or rarely mixed hearing loss. The aims of this study were to analyses the epidemiologic, clinical, paraclinical characteristic and compare our results according to age, stage, surgical technique and prosthesis. Patients et méthodes : Our study is retrospective about 124 patients (149 ears) in the period of 9 years (2000-2008).Results: Our population included 86 female and 38 male patients. mean age at intervention time was 39,82 years. The hearing loss was bilateral in 61,3% of cases and unilateral in 38,3%. The bone and air conduction threshold was 17.33 dB and 52,52 dB, the air-bone gap was 35,19 dB. The CT scan was realized in 63 patients. We have realized 21stapedectomy, 24 partial stapedectomy and 101 stapedotomy. In accordance with Portmann classification, the distribution between II, III and IV stages was almost equal. We used 6/10 mm Teflon piston prosthesis in 119 cases and 4/10 mm in 27 cases. The postoperative air-bone gap was 15,95 dB. after 1 year, the air-bone gap was 14,81 dB with a satisfying results in 94,2%.Conclusion: it seems that some factors are predictive for good results like a female sex, age<50 years, stage< stage IV, platinotomy and piston 4/10 mm.Keyswords : otosclerosis, bone conduction, air conduction, stapedectomy, stapedotom

Menopause and metabolic syndrome in Tunisian women

Objectives. This study aimed to evaluate the effect of menopausal status on the risk of metabolic syndrome (MetS) in Tunisian women. Methods. We analyzed a total of 2680 women aged between 35 and 70 years. Blood pressure, anthropometric indices, fasting glucose, and lipid profile were measured. The MetS was assessed by the modified NCEP-ATPIII definition. Results. The mean values of waist circumference, blood pressure, plasma lipids, and fasting glucose were significantly higher in postmenopausal than in premenopausal women, a difference that was no longer present when adjusting for age. Except for hypertriglyceridaemia, the frequency of central obesity, hyperglycemia, high blood pressure, and high total cholesterol was significantly higher in postmenopausal than in premenopausal women. After adjusting for age, the significance persisted only for hyperglycemia. The overall prevalence of MetS was 35.9%, higher in postmenopausal (45.7% versus 25.6%) than in premenopausal women. A binary logistic regression analysis showed that menopause was independently associated with MetS (OR = 1.41, 95% CI 1.10-1.82) after adjusting for age, residence area, marital status, family history of cardiovascular disease, education level, and occupation. Conclusions. The present study provides evidence that the MetS is highly prevalent in this group of women. Menopause can be a predictor of MetS independent of age in Tunisian women

Use of evidence to support healthy public policy: a policy effectiveness-feasibility loop

Public policy plays a key role in improving population health and in the control of diseases, including non-communicable diseases. However, an evidence-based approach to formulating healthy public policy has been difficult to implement, partly on account of barriers that hinder integrated work between researchers and policy-makers. This paper describes a “policy effectiveness–feasibility loop” (PEFL) that brings together epidemiological modelling, local situation analysis and option appraisal to foster collaboration between researchers and policy-makers. Epidemiological modelling explores the determinants of trends in disease and the potential health benefits of modifying them. Situation analysis investigates the current conceptualization of policy, the level of policy awareness and commitment among key stakeholders, and what actually happens in practice, thereby helping to identify policy gaps. Option appraisal integrates epidemiological modelling and situation analysis to investigate the feasibility, costs and likely health benefits of various policy options. The authors illustrate how PEFL was used in a project to inform public policy for the prevention of cardiovascular diseases and diabetes in four parts of the eastern Mediterranean. They conclude that PEFL may offer a useful framework for researchers and policy-makers to successfully work together to generate evidence-based policy, and they encourage further evaluation of this approach

Valeur de l’examen extemporane en pathologie thyroïdienne

OBJECTIF : Etudier la valeur de l’examen extemporané dans la pathologie thyroidienne et identifier ses limitesMATERIELS ET METHODES : Notre étude est rétrospective incluant 800 examens extemporanés réalisés sur des pièces de résectionthyroïdienne colligés dans notre service sur une période de 12 ans (2000-2011).Les résultats ont été comparés à ceux del’examen anatomopathologique définitif.RESULTATS : Les résultats étaient concordants dans 96,5%, discordants dans 3,5 %. La sensibilité de l’examen extemporané toustypes confondus était de 78 % et la spécificité de 100 %CONCLUSION : Notre étude a montré une spécificité parfaite de l’examen extemporané cependant l’interprétation difficile des lésionsthyroïdiennes d’architecture vésiculaire expliquent une sensibilité de 78 %.Mots Clés : Thyroïdectomie, examen extemporanOBJECTIVE: To assess the value of frozen-section examination in thyroid surgery and evaluate its limitationsPATIENTS AND METHODES: This retrospective study examined the results of 800 frozen-sections of thyroid specimens analysedover the 12 –year period (2000-2011). Their results were compared with definitive anatomo-pathological examinationRESULTS :Frozen-section diagnosis was concordant with subsequent histopathological examination in 96,5% ,discordant in 3,5%.The global specificity of frozen section analysis for all histological subtypes was 100 % and its sensitivity was 78 %.CONCLUSION: This study shows the good specificity of frozen section .Discordances between frozen-section and definitive diagnosiswas associated with microfllicular lesions wich explain the sensibility of 78%Key Words: Thyroid surgery, frozen section examinatio

CZT-Based Harmonic Analysis in Smart Grid Using Low-Cost Electronic Measurement Boards

This paper validates the use of a harmonic analysis algorithm on a microcontroller to perform measurements of non-stationary signals in the context of smart grids. The increasing presence of electronic devices such as inverters of distributed generators (DG), power converters of charging stations for electric vehicles, etc. can drain non-stationary currents during their operation. A classical fast Fourier transform (FFT) algorithm may not have sufficient spectral resolution for the evaluation of harmonics and inter-harmonics. Thus, in this paper, the implementation of a chirp-Z transform (CZT) algorithm is suggested, which has a spectral resolution independent from the observation window. The CZT is implemented on a low-cost commercial microcontroller, and the absolute error is evaluated with respect to the same algorithm implemented in the LabVIEW environment. The results of the tests show that the CZT implementation on a low-cost microcontroller allows for accurate measurement results, demonstrating the feasibility of reliable harmonic analysis measurements even in non-stationary conditions on smart grids