Synthesis of New Iminocoumarins Bearing Parabanic Moieties

The synthesis of novel substituted 3-p-nitro-phenyliminocoumarins and corresponding N-ureaiminocoumarins is described. The condensation of these materials with oxalyl chloride leads to the corresponding N-parabanic iminocoumarins, which have not previously been described, in moderate or good yields and high selectivity. The structures were characterized by Fourier transform infrared, 1H and 13C NMR, and elemental analysis

Urbanization of Information Systems as a Trigger for enhancing Agility: A State in The Tunisian Firms

Nowadays, the information Systems (IS) became one of the main assets of modern corporations, but it faces many problems. Among the most important are low productivity and a large number of failures like obsolescence, heavier, slower and complexity of applications integration. The problem of low productivity of IS was the product of the software crisis, as indicated by the delayed development and implementation of ISs and accumulation which leads to maintenance problems. Requests for new or improved version of the IS have grown faster than the ability of the Chief Information Officer (CIO) to develop the existing IS. Some reasons are: the increase in the cost of software development and the IT choices of the CIO. All the above problems are further exacerbated by the growing complexity and size of software products. The IS is obliged to overcome these difficulties and ensure its evolution. To do this, urbanization is a framework that aims to simplify the IS, to improve communication between its components and to ensure its evolution. In an exploratory approach, this study examines the concept of urbanization studying its impact on the IS to ascertain agility. This was done in order to ascertain the evolution of IS and guarantee the agility facing the environment turbulence. The general assertion is that the Urbanized Information Systems (UIS) changes a firm vision because its procure flexibility, reactivity and interoperability of UIS. The originality of this paper is to explore IS urbanization considered as a French framework of Enterprise Architecture (EA), this study is an empirical validation of the agility of UIS. Keywords Information Systems, Urbanization, Enterprise Architecture (EA), flexibility, Agilit

Acute myocardial infarction in young adults with Antiphospholipid syndrome: report of two cases and literature review

Acute myocardial infarction (AMI) is rarely associated with antiphospholipid syndrome. The treatment of these patients is a clinical challenge. We report the observations of 2 young adults (1 woman and 1 man), admitted in our acute care unit for acute myocardial infarction (AMI). A coagulopathy work-up concludes the existence of antiphospholipid syndrome (APS) in the 2 cases. APS syndrome was considered primary in 2 cases. All patients presented an intense inflammatory syndrome (high level of CRP). Anticardiolipine was present in the 2 cases. However, anti B2 glycoprotein I antibodies were detected in only one case. Emergency percutaneous transluminal coronary angioplasty (PTCA) with direct stenting had been performed successfully only in the first case, and the follow-up was uncomplicated. Thereafter, long-term oral anticoagulant appeared to be effective. The last patient was admitted because of peripheral acute ischemia of legs. Standard electrocardiogram showed signs of previous silent anteroseptal wall myocardial infarction confirmed by echocardiography. The latter revealed an apical thrombus and a very low left ventricular ejection fraction. Amputation of the right leg was necessary because of consultation occurred too late. However, he died four weeks later. Primary antiphospholipid syndrome should be considered as a cause of acute myocardial infarction in young adults, and PTCA with anticoagulant treatment is effective for initial treatment of this complicatio

0528: The role of brain natriuretic peptide and cystatin C in the evaluation of left ventricular diastolic dysfunction: correlation with echocardio-graphic indexes after myocardial infarction

BackgroundThe utility of Brain Natriuretic Peptide (BNP) and cystatin C for detecting left ventricular (LV) diastolic dysfunction after myocardial infarction (MI) in patients without heart failure symptoms still unclear. In this study, we investigated the relation between BNP, serum cystatin C levels and LV diastolic dysfunction after MI in patients without systolic dysfunction.MethodsWe studied 127 patients without renal dysfunction after first acute coronary syndrome (ACS). LV diastolic function was assessed with conventional Doppler, by means of mitral inflow and with tissue Doppler echo-cardiography by means of mitral annulus. The ratio of early diastolic transmitral E wave velocities to tissue Doppler mitral annulus early diastolic E’ wave velocities (E/E’), was used to detect LV filling pressures. Patients were divided in three groups according to E/E’ ratios<10 (group I), E/E’ ratios “between” 10 and 15 (group II) and E/E’ ratios>15 (group III). Plasma concentrations of BNP and serum cystatin C were measured at admission.ResultsThe BNP and serum cystatin C levels were positively correlated significantly with E/E’ ratio (r=0.786, P<0.001 and r=0.458, p=0.02). Patients with elevated LV end diastolic pressure (LVEDP), defined as E/E’>15 had highest BNP (321±75pg/mL) and cystatin C (1.1±0.2mg/L) levels. E/E’ 10 to 15 group had a mean BNP level of 151±28pg/mL and a mean cystatin C value of 0.78±0.1mg/L, and those with E/E’<10 had a mean BNP value of 69±20pg/ mL. A BNP value of 89pg/mL had a sensitivity of 84% and a specificity of 69% for predicting E/E’>15.ConclusionThe assessment of the blood concentration of BNP and cystatin C is of potential value for identification of those patients after myocardial infarction to detect early cardiovascular changes, especially LV diastolic dys-function

Maladie de Takayasu et polyarthrite rhumatoïde: une association rare - à propos d’une observation

L&#8217;art&#233;rite de Takayasu ou maladie de Takayasu (MT) et la polyarthrite rhumato&#239;de (PR) et sont deux maladies inflammatoires chroniques et leur association a &#233;t&#233; rapport&#233;e dans la litt&#233;rature &#224; travers quelques observations de cas sporadiques. Nous rapportons une nouvelle observation d&#8217;une telle association. Une patiente &#226;g&#233;e de 44 ans, diagnostiqu&#233;e avec une polyarthrite rhumato&#239;de &#224; facteur rhumato&#239;de positif, qui a d&#233;velopp&#233; des c&#233;phal&#233;es avec des vertiges de caract&#232;re permanent. L&#8217;examen r&#233;v&#233;lait un pouls radial et hum&#233;ral abolis &#224; droite, un souffle carotidien bilat&#233;ral et une tension art&#233;rielle imprenable &#224; droite. L&#8217;art&#233;riographie a confirm&#233; la pr&#233;sence d&#8217;une atteinte de l&#8217;arc aortique type MT. Le diagnostic d&#8217;une maladie de Takayasu associ&#233;e &#224; une polyarthrite rhumato&#239;de &#233;tait retenu. La patiente &#233;tait trait&#233;e par une corticoth&#233;rapie (prednisone &#224; la dose de 0,5 mg/kg par jour) et un traitement de fond par M&#233;thotrexate avec une bonne r&#233;ponse initiale. A travers notre observation et une revue de la litt&#233;rature, les caract&#233;ristiques &#233;pid&#233;miologiques, &#233;tiopathog&#233;niques, cliniques, th&#233;rapeutiques et &#233;volutives de cette association seront discut&#233;es. Pan African Medical Journal 2012; 12:6

A continuous murmur following a nonpenetrating chest trauma

AbstractWe reported a rare case of non-penetrating chest trauma-induced fistula from the right sinus of Valsalva to the right heart chambers. The ruptured sinus of Valsalva aneurysm was diagnosed preoperatively and operated on successfully. The rarity of this case highlights the need for a precise preoperative diagnosis, the role of transthoracic echocardiography, and the importance of a prompt surgical management

0363: Acute coronary syndrome complicated with left ventricular diastolic dysfunction: what is the contribution of brain natriuretic peptid?

BackgroundThe utility of Brain Natriuretic Peptide (BNP) for detecting leftventricular (LV) diastolic dysfunction in patients presenting an acute coronary syndrome without heart failure symptoms is unclear. In this study, we investigated the relation between BNP plasma levels and LV diastolic dysfunction in patients with postmyocardial infarction without systolic dysfunction.MethodsWe studied 81 patients (12 women, mean age 55±11.79) admitted in our center for myocardial infarction with or without ST segment elevation. Patients with heart failure symptoms or abnormal systolic function were excluded. LV diastolic function was assessed with conventional Doppler, by means of mitral inflow and with tissue Doppler echocardiography by means of mitral annulus. The ratio of early diastolic transmitral E wave velocities to tissue Doppler mitral annulus early diastolic E’ wave velocities (E/E’), was used to detect LV filling pressures. Patients were divided in three groups according to E/E’ ratios < 10 (group I), E/E’ ratios between 10 and 15 (group II) and E/E’ ratios >15 (group III).Abstract 0109 – Table: Patients’ baseline characteristicsPatients’baseline characteristicsBMS (n=30)DES (n=300)pSex, M/F30/030/01Age, y52,03±6,3550,2±8,450,34Body mass index*, kg/m225,79±2,5625,00±2,970,28Hypertension, %16,661,661Dyslipidemia, %33,3333,331Diabetes mellitus, %001Family history, %26,666,660,07Cigarette smoking, %73,33600,41Previous CAD, Stroke, PAOD, %001Indication of coronary angiographyAMI (STEMI/NSTEMI, %86,6676,660,5UA, %13,3316,661SCAD, %06,660,49Time interval between PCI and blood sampling, d39,16±7,6838,73±6,760,81Stent length, mm16,3±4,2417,56±5,710,33LVEF, %58,66±7,3061,13±6,180,16Drug therapies*Statin, %1001001ASA, %1001001Second anti-platelet drugClopidogrel, %46,6643,331Prasugrel, %53,33501Ticagrelor, %06,660,49β-blocker, %85,71 (n=28)60 (n=25)0,059ACE inhibitor, %0 (n=28)0 (n=26)1OAC, %001Blood tests*LDL cholesterol, g/L0,75±0,180,68±0,190,19HDL cholesterol, g/L0,39±0,100,43±0,110,19Triglyceride, g/L0,96±0,320,93±0,290,72Hemoblogin, g/dl14,34±0,9714,4±0,830,82Platelets, G/L242,93±55,90239,56±49,610,8Serum creatinine, μmol/L2,07±2,021,39±1,300,12Fasted glycaemia, g/L0,97±0,111,01±0,090,14HbA1c, %5,74±0,395,73±0,400,92Continuous variables are presented as sample mean and standard deviation. P-values reflect comparisons between patients with a BMS and patients with DES and are derived from Student’s t-tests for continuous variables whereas qualitative data were compared with Fisher’s exact test.The characteristics marked with an asterisk were collected on the same day that blood was sampled (one month after PCI)ResultsThe BNP blood levels were positively correlated significantly with E/E’ ratio (p < 0.02). Patients with elevated LV end diastolic pressure (LVEDP), defined as E/E’ >15 (n = 27) had highest BNP (302±68pg/ml) levels. E/E’ 10 to 15 group (n = 24) had a mean BNP level of 136.4±27pg/ml, and those with E/E’ < 10 (n = 29) had 82±20pg/ml. A BNP value of 107.8pg/ml had a sensitivity of 89%, a specificity of 61% for predicting E/E’ >15. The area under the ROC curve for BNP to detect any diastolic dysfunction was 0.757. A BNP value of 72.7pg/ml had a sensitivity of 82.2% and a specificity of 66.7% for detecting a diastolic dysfunction.ConclusionsA rapid assay for BNP can detect the presence of diastolic abnormalities on echocardiography. In patients with preserved systolic function post myocardial infarction, elevated BNP levels might help to reinforce the diagnosis of LV diastolic dysfunction

158 Prothetic abcess complicating Infective endocarditis

The cardiac abscess formation is appraised to 20–30% during the infectious endocarditis (IE). It is more frequent during prosthesis endocarditis and it can reach 60%. The prognosis is generally reserved. Objective To determine echocardiographic, bacteriological and evolutive features of prothetic IE complicated of abscess.Retrospective study including 51 patients having certain or probable IE according to Duke criterias between 2002 and 2005. At 9 patients (17,64%) the endocarditis was complicated of prothetic abscess. It was about 6 men and 3 women with a middle age of 39 ± years. IE was la ate IE in 5 cases. Clinical and biological infectious syndrome was constant. Isolated germs were staphylococcus aureus in 2 cases, GRAM négatif Bacillus in 2 cases. Culture negative endocarditis were noted in 5 cases. Brucellosis serology was positive at one patient. Prothetic abcess was diagnosed by transthoracic echocardiography (TTE) at 2 patients and by transesophagal echocardiography (TEE) at all patients.The abcess was localized on the aortic prosthesis at 5 patients, mitral prothesis at 3 patients and mitroaortic prothesis at one patient. TEE identified annular abcess at 2 patients and a myocardial abcess at 1 patient. Secondary septic localizations were noted at 6 patients: 4 cerebral abscesses, 2 splenic localization, a renal localization and an articular localization. High degree atrioventricular blocks were observed at 3 patients. The recourse to the surgery was frequent (7 patient/9 patient). It was an emergent sugery at 2 patients because of a heart failure. For the others, the indication for surgery was medical failure treatment at a mean delay of 19 days. The evolution was fatal at 5 patients. and the evolution was favorable at the others.Prothetic endocarditis complicated of abscess are serious requiring frequently a prothetic replacement, a very high risked surgery. TEE must be systematic at all patients carrier of prosthesis if they have infectious syndrome in order to carry the early diagnosis of IE and to avoid abcess formation

An association of vertebral breast cancer metastasis and multiple myeloma, revealed by a spinal cord compression

Authors describe the case of a patient with breast cancer and multiple myeloma as the second metachronous disease responsible for spinal cord compression. Synchronous occurrence of bone marrow breast cancer  disease and multiple myeloma has not been described in the literature, as in this case. By presenting this case, we point to possible association between both diseases and the possible factors involved in the   development of second malignant disease.Key words: Myeloma, breast cancer, spinal cord compressio