057 A simple prediction score for significant renal artery stenosis in patients with coronary artery disease

BackgroundRenal artery stenosis (RAS) is a strong independent predictor of mortality in patients (pts) with coronary artery disease (CAD).Aim of studyTo develop and validate a score predicting RAS in patients with CAD.MethodsThree hundred consecutive pts (50 females) with significant CAD underwent abdominal aortography following coronary angiography to screen for significant RAS defined as luminal narrowing of > 50%. Univariate and multivariate analyses were performed comparing pts with and without RAS. Significant factors associated with RAS were included in constructing a score that predicts RAS.The score was internally validated in pts randomly selected from the entire study group (validation group; n=103), using ROC curves and the Hosmer-Lemeshow goodness-of-fit test.ResultsTwenty-seven pts (9%) had a significant RAS. Univariate predictors of significant RAS were: age > 65 years (OR=4.5, p < 0.0001), hypertension (OR=3.6, p=0.001), and female gender (OR=3.6, p=0.015). We found a tendency of more prevalent renal insufficiency (37.1% vs. 21.5%; p=0.05) and the presence of 2 or more significant CAD lesions (70.4% vs. 50.9%; p=0.05) in pts with RAS.Multivariate analysis showed that age > 65 years (OR=4.1%, 95% CI=1.6-10.3, p=0.003) and hypertension (OR=3.1, 95% CI=1.2-7.7, p=0.015) were independent predictors of RAS. The ranged from 0 to 7: 2 points for age > 65 years and hypertension 1 point for female gender, renal insufficiency, and > 3-vessel disease). Internal validation showed a good performance (ROC curve = 0.79 and Chi2 Lemeshow = 3.45). For a score < 2, the negative predictive value is 98%. Applying this criteria, 48.3% of our population would not require systematic abdominal angiography.ConclusionThe performance of our predictive score was good, and significant reduction in the need to perform systematic abdominal aortography could be expected with the use of this score

0425: Predictive factors of side effects of amiodarone in the amiotox registry

BackroundAmiodarone is a widely used antiarrhythmic drug in Tunisia and worldwide. However, its side effects are quite frequent hampering its use despite its efficacy.ObjectiveThe purpose of our study was to determin the prevalence of amiodarone side effects and to analyse its predictors in our population.ResultsFrom May 1st 2010 to April 30th 2012, 200 consecutive patients (mean age: 61.9±12.9 years) were included. Mean duration of amiodarone therapy was 51.9±48.4 months with a mean dose of 288.1±274.2g. Atrial fibrillation (81.5%) was the most common indication. Amiodarone side effects occurred in 144 patients (72%). Refering to multivariate analysis, independent predictors were:–Advanced age (p=0.02), treatment duration (p<0.001) and cumulative dose (p<0.001) for occurrence of all side effects.–Treatment duration > 6 months (p=0.008) for corneal deposits.–Age >70 years (p=0.001) and cumulative dose (p<0.00.1 with a logarithmic correlation) for thyroid toxicity.–Cumulative dose (p<0.001) and thyroid disease history (p=0.047) for hypothyroidism.–Age >70 years (p=0.002) and treatment duration (p<0.001 with a linear correlation) for cutaneous toxicity.–Cumulative dose >300g (p=0.012) and heart failure (p= 0.05) for bradycardia.–Cumulative dose >100g (p= 0.012) for QT prolongation–Treatment duration (p<0.001 with a linear correlation) and betablokers concomittent use (p=0.046) for PR elongation.–Treatment duration (p<0.001 with an exponential correlation) and concomittent VKA use (p=0.018) for hepatic toxicity.–Treatment duration > 18 months (p=0.009) and concomittent CCB use (p<0.001) for neurological toxicity.ConlusionThe results of our study confirmed that amiodarone side effects are quite frequent in our population, and that in addition to treatment dose and duration, other predictors for these effects were identified such as age and some drug associations

Analysis of the Effects of Drought on Vegetation Cover in a Mediterranean Region through the Use of SPOT-VGT and TERRA-MODIS Long Time Series

The analysis of vegetation dynamics and agricultural production is essential in semi-arid regions, in particular as a consequence of the frequent occurrence of periods of drought. In this paper, a multi-temporal series of the Normalized Difference of Vegetation Index (NDVI), derived from SPOT-VEGETATION (between September 1998 and August 2013) and TERRA-MODIS satellite data (between September 2000 and August 2013), was used to analyze the vegetation dynamics over the central region of Tunisia in North Africa, which is characterized by a semi-arid climate. Products derived from these two satellite sensors are generally found to be coherent. Our analysis of land use and NDVI anomalies, based on the Vegetation Anomaly Index (VAI), reveals a strong level of agreement between estimations made with the two satellites, but also some discrepancies related to the spatial resolution of these two products. The vegetation’s behavior is also analyzed during years affected by drought through the use of the Windowed Fourier Transform (WFT). Discussions of the dynamics of annual agricultural areas show that there is a combined effect between climate and farmers’ behavior, leading to an increase in the prevalence of bare soils during dry years

Hepatoprotective effect of Opuntia microdasys (Lehm.) Pfeiff flowers against diabetes type II induced in rats

Opuntia sp. has long been used as a folk medicine to treat hepatitis and diabetes in Sicile (Italy). To extract the polyphenols from the flower of Opuntia microdasys Lehm. at post flowring stage and evaluate the antidiabetic activity in vitro and in vivo. The hepatoprotective activity of Opuntia microdasys aqueous flowers extract at post flowering stage (OFP) has been tested for their antidiabetic activity. On fructose-alloxan induced diabete in rat model, evaluating the inhibitory effects of OFP on some carbohydrate metabolizing enzymes, pancreatic α-amylase and intestinal α-glucosidase activities in vitro. The OFP extract showed inhibitory activity against α-glucosidase (IC50 = 0.17 ± 0.012 mg/ml) and α-amylase (IC50 = 2.55 ± 0.41 mg/ml). The inhibitory potential of OFP extract on these enzymes suggests a positive and probable role of this extract in the management and treatment of diabetes mellitus, particularly, for type 2. Oral administration of the OFP at 200 mg/kg to diabetic male rats for 28 days demonstrated a significant protective effect by lowering the levels of glucose (123.21 ± 1.38 mg/dL) and hepatic marker enzymes (AST, ALT, LDH, γ-GT, BT, PAL, TC, LDL-C, HDL-C and TG). OFP attenuated oxidative stress by decreasing the SOD, CAT, GPX activity and the levels of PC and MDA in the liver and restored the histological architecture of the rat liver. OFP has protective effects on the protection of liver, thereby reducing some of the causes of diabetes in experimental animals

Value of inferior vena cava collapsibility index as marker of heart failure in chronic obstructive pulmonary disease exacerbation

Abstract Introduction Inferior vena cava (IVC) diameter variability with respiration measured by ultrasound was found to be useful for the diagnosis of heart failure (HF) in ED patients with acute dyspnea. Its value in identifying HF in acute exacerbation of chronic obstructive pulmonary disease exacerbation (AECOPD) was not specifically demonstrated. Objective To determine the value of ΔIVC in the diagnosis of HF patients with AECOPD. Methods This is a prospective study conducted in the ED of three Tunisian university hospitals including patients with AECOPD. During this period, 401 patients met the inclusion criteria. The final diagnosis of HF is based on the opinion of two emergency experts after consulting the data from clinical examination, cardiac echocardiography, and BNP level. The ΔIVC was calculated by two experienced emergency physicians who were blinded from the patient’s clinical and laboratory data. A cut off of 15% was used to define the presence (< 15%) or absence of HF (≥ 15%). Left ventricular ejection fraction (LVEF) was also measured. The area under the ROC curve, sensitivity, specificity, and positive and negative predictive values were calculated to determine the diagnostic and predictive accuracy of the ΔIVC in predicting HF. Results The study population included 401 patients with AECOPD, mean age 67.2 years with male (68.9%) predominance. HF was diagnosed in 165 (41.1%) patients (HF group) and in 236 patients (58.9%) HF was excluded (non HF group). The assessment of the performance of the ΔIVC in the diagnosis of HF showed a sensitivity of 37.4% and a specificity of 89.7% using the threshold of 15%. The positive predictive value was 70.9% and the negative predictive value was 66.7%. The area under the ROC curve was 0.71(95%, CI 0.65–0.76). ΔIVC values were not different between HF patients with reduced LVEF and those with preserved LVEF. Conclusion Our results showed that ΔIVC has a good value for ruling out HF in ED patients consulting for AECOPD