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

Heat transfer and pressure drop characteristics of a plate heat exchanger using water based Al2O3 nanofluid for 30° and 60° chevron angles

Nanofluid is a new class of engineering fluid that has good heat transfer characteristics which is essential to increase the heat transfer performance in various engineering applications such as heat exchangers and cooling of electronics. In this study, experiments were conducted to compare the heat transfer performance and pressure drop characteristics in a plate heat exchanger (PHE) for 30° and 60° chevron angles using water based Al2O3 nanofluid at the concentrations from 0 to 0.5 vol.% for different Reynolds numbers. The thermo-physical properties has been determined and presented in this paper. At 0.5 vol% concentration, the maximum heat transfer coefficient, the overall heat transfer coefficient and the heat transfer rate for 60° chevron angle have attained a higher percentage of 15.14%, 7.8% and 15.4%, respectively in comparison with the base fluid. Consequently, when the volume concentration or Reynolds number increases, the heat transfer coefficient and the overall heat transfer coefficient as well as the heat transfer rate of the PHE (Plate Heat Exchangers) increases respectively. Similarly, the pressure drop increases with the volume concentration. 60° chevron angle showed better performance in comparison with 30° chevron angle

Computing with and without arbitrary large numbers

In the study of random access machines (RAMs) it has been shown that the availability of an extra input integer, having no special properties other than being sufficiently large, is enough to reduce the computational complexity of some problems. However, this has only been shown so far for specific problems. We provide a characterization of the power of such extra inputs for general problems. To do so, we first correct a classical result by Simon and Szegedy (1992) as well as one by Simon (1981). In the former we show mistakes in the proof and correct these by an entirely new construction, with no great change to the results. In the latter, the original proof direction stands with only minor modifications, but the new results are far stronger than those of Simon (1981). In both cases, the new constructions provide the theoretical tools required to characterize the power of arbitrary large numbers.Comment: 12 pages (main text) + 30 pages (appendices), 1 figure. Extended abstract. The full paper was presented at TAMC 2013. (Reference given is for the paper version, as it appears in the proceedings.

Customer acceptance of humanoid service robots in hotels: moderating effects of service voluntariness and culture

Purpose: The current study proposes a research model integrating TAM3 constructs and human aspects of humanoid service robots (HSRs), measured by the Godspeed questionnaire series (GQS), and tested across two hotel properties in Japan and the US. Design/methodology/approach: Potential participants were approached randomly by e-mail invitation. A final sample size of 395, across two hotels, one in Japan and the other in the US, was obtained and the data were analyzed using structural equation modelling. Findings: The results confirm that perceived usefulness (PU), driven by subjective norms and output quality, and perceived ease of use (PEOU), driven by perceived enjoyment and absence of anxiety, are the immediate direct determinants of users' re-patronage intentions for HSRs. Results also showed that users prefer anthropomorphism, perceived intelligence, and the safety of an HSR for re-using it. Implications: The findings have practical implications for the hospitality industry suggesting multiple attributes of an HSRs that managers need to consider before deploying them in their properties. Originality: The current study proposes an integrated model determining factors that affect the re-patronage of HSRs in hotels

Premature mortality attributable to smoking among Tunisian men in 2009

INTRODUCTION: Tobacco smoking is a significant public health threat in the world, a risk factor for many diseases, and has been increasing in prevalence in many developing countries. In this study, we aimed to estimate the burden of premature deaths attributable to smoking among Tunisian men aged 35-69 years in 2009. METHODS: The number of deaths attributable to smoking was estimated using the population attributable risk fraction method. Smoking prevalence was obtained from a nationally representative survey. Causes of death were obtained from the registry of the National Public Health Institute. Relative risks were taken from the American Cancer Society Prevention Study (CPS-II). RESULTS: Total estimated premature deaths attributable to smoking among men in Tunisia were 2601 (95% CI: 2268-2877), accounting for 25% (95% CI: 23.3-26.6) of total male adult mortality. Cancer, cardiovascular and respiratory diseases were the major causes of premature deaths attributable to smoking with 1272 (95% CI: 1188-1329), 966 (95% CI: 779-1133) and 364 (300-415) deaths, respectively. CONCLUSIONS: Tobacco smoking is highly relevant and is related to substantial premature mortality in Tunisia, around double that estimated for the region as a whole. This also has not decreased over the past 20 years. Urgent actions are needed to reduce this pandemic

Pomological and Olive Oil Quality Characteristics Evaluation under Short Time Irrigation of Olive Trees cv. Chemlali with Untreated Industrial Poultry Wastewater

The aim of this work was the investigation of the effect of wastewater generated from the poultry meat industry on the irrigation of olive trees, during a short time period, in order to evaluate its impact on pomological criteria and olive oil quality. Olive trees were subjected to irrigation with different water qualities: (i) poultry wastewater (PWW), (ii) poultry wastewater diluted with tap water 50:50 (v/v) (PWTWW), (iii) rain-fed cultivation system (control). The results showed that PWTWW contains the optimal mineral proportions, leading to improved pomological criteria. However, the highest significant pulp oil content was obtained using poultry wastewater irrigation (69.51%), while this was 66.71% using diluted poultry wastewater, and 58.03 % for the control. Poultry wastewater irrigation yielded the best results in oil standard quality indices. In addition, an enrichment in oil total polyphenols content was achieved. The oil fatty acid profile was not affected following irrigation with poultry wastewater. Nevertheless, there was a significant increase in the contents of oleic acid and alcohols, accompanied by a decrease in total sterols. However, heavy metals accumulation was observed in both fruits and olive oil. In conclusion, our results suggest that among the three water qualities, poultry wastewater is the best alternative to improve olive oil quality

Plasmocytome Ganglionnaire A Propos D\'un Cas

Les plasmocytomes ganglionnaires sont très rares. Ils peuvent être en rapport avec des métastases à partir d\'un myélome multiple ou d\'un plasmocytome extramédullaire. Les localisations primaires ganglionnaires restent exceptionnelles. Nous rapportons un cas colligé et opéré au service d\'ORL et CMF de l\'hôpital la Rabta. Il s\'agit d\'une femme de 74 ans opérée d\'une tuméfaction submandibulaire gauche. Le diagnostic est fait à l\'examen histologique qui a révélé un plasmocytome ganglionnaire primaire. Le traitement est radiochirurgical. Nous présentons les aspects histopatologiques, cliniques, biologiques et thérapeuthiques de cette affection rare. Keywords: plasmocytomes ganglionnaires, adénopathie cervicale. Journal Tunisien d\'ORL et de chirurgie cervico-faciale Vol. 18 2007: pp. 53-5

A cost effectiveness analysis of salt reduction policies to reduce coronary heart disease in four Eastern Mediterranean countries.

BACKGROUND: Coronary Heart Disease (CHD) is rising in middle income countries. Population based strategies to reduce specific CHD risk factors have an important role to play in reducing overall CHD mortality. Reducing dietary salt consumption is a potentially cost-effective way to reduce CHD events. This paper presents an economic evaluation of population based salt reduction policies in Tunisia, Syria, Palestine and Turkey. METHODS AND FINDINGS: Three policies to reduce dietary salt intake were evaluated: a health promotion campaign, labelling of food packaging and mandatory reformulation of salt content in processed food. These were evaluated separately and in combination. Estimates of the effectiveness of salt reduction on blood pressure were based on a literature review. The reduction in mortality was estimated using the IMPACT CHD model specific to that country. Cumulative population health effects were quantified as life years gained (LYG) over a 10 year time frame. The costs of each policy were estimated using evidence from comparable policies and expert opinion including public sector costs and costs to the food industry. Health care costs associated with CHDs were estimated using standardized unit costs. The total cost of implementing each policy was compared against the current baseline (no policy). All costs were calculated using 2010 PPP exchange rates. In all four countries most policies were cost saving compared with the baseline. The combination of all three policies (reducing salt consumption by 30%) resulted in estimated cost savings of $235,000,000 and 6455 LYG in Tunisia;$39,000,000 and 31674 LYG in Syria; $6,000,000 and 2682 LYG in Palestine and$1,3000,000,000 and 378439 LYG in Turkey. CONCLUSION: Decreasing dietary salt intake will reduce coronary heart disease deaths in the four countries. A comprehensive strategy of health education and food industry actions to label and reduce salt content would save both money and lives

Robustness and Generalization

We derive generalization bounds for learning algorithms based on their robustness: the property that if a testing sample is "similar" to a training sample, then the testing error is close to the training error. This provides a novel approach, different from the complexity or stability arguments, to study generalization of learning algorithms. We further show that a weak notion of robustness is both sufficient and necessary for generalizability, which implies that robustness is a fundamental property for learning algorithms to work

Polar extracts from (Tunisian) Acacia salicina Lindl. Study of the antimicrobial and antigenotoxic activities

<p>Abstract</p> <p>Background</p> <p>Methanolic, aqueous and Total Oligomer Flavonoids (TOF)-enriched extracts obtained from the leaves of <it>Acacia salicina </it>'Lindl.' were investigated for antibacterial, antimutagenic and antioxidant activities.</p> <p>Methods</p> <p>The antimicrobial activity was tested on the Gram positive and Gram negative reference bacterial strains. The Mutagenic and antimutagenic activities against direct acting mutagens, methylmethane sulfonate (MMS) and 4-nitro-o-phenylenediamine (NOPD), and indirect acting mutagens, 2-aminoanthracene (2-AA) and benzo[a]pyrene (B(a)P) were performed with <it>S. typhimurium </it>TA102 and TA98 assay systems. In addition, the enzymatic and nonenzymatic methods were employed to evaluate the anti-oxidative effects of the tested extracts.</p> <p>Results</p> <p>A significant effect against the Gram positive and Gram negative reference bacterial strains was observed with all the extracts. The mutagenic and antimutagenic studies revealed that all the extracts decreased the mutagenicity induced by B(a)P (7.5 μg/plate), 2-AA (5 μg/plate), MMS (1.3 mg/plate) and NOPD (10 μg/plate). Likewise, all the extracts showed an important free radical scavenging activity towards the superoxide anion generated by the xanthine/xanthine oxidase assay system, as well as high Trolox Equivalent Antioxidant Capacity (TEAC), against the 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) diammonium salt (ABTS)⁺• radical. TOF-enriched extract exhibited the highest protective effect against free radicals, direct acting-mutagen and metabolically activated S9-dependent mutagens.</p> <p>Conclusions</p> <p>The present study indicates that the extracts from <it>A. salicina </it>leaves are a significant source of compounds with the antimutagenic and antioxidant activities, and this may be useful for developing potential chemopreventive substances.</p