Hypertension control in the Tunisian elderly

Background: Hypertension is a major public health problem. Despite therapeutic progress, blood pressure control remains insufficient particularly in the elderly. Purpose: The aim of our study was to identify the factors associated with poor blood pressure control in the elderly in Tunisia. Material and methods: We conducted a descriptive study including 101 Tunisian treated hypertensive patients, aged 65 years and over, followed on an outpatient basis between November and December 2019. Results: Median age was 73 and sex ratio was 0.57. The major cardiovascular risk factor was diabetes in 60.4% of cases, followed by dyslipidaemia (48.5%) and smoking (40.6%). About 33% of the hypertensive patients realized regular physical activity and 31% had a high-sodium diet. Our patients were completely dependent in 4% of cases and among those aged 80 and over, 68.2% were frail. The prevalence of poor blood pressure control was 59%. Adherence to treatment was satisfactory in 75.2% of cases. In multivariate analysis, the factors associated with poor blood pressure control were: non-compliance with treatment [odds ratio (OR) = 0.19; p = 0.013], frailty (OR = 7.194; p = 0.004), the number of antihypertensive tablets (OR = 0.382; p = 0.008), non-use of thiazide diuretics (OR = 25.903; p = 0.001) and the patient's lack of knowledge of antihypertensive treatment (OR = 0.56; p = 0.008). Conclusion: Detection of the risk of non-compliance, the use of combined treatments screening for frailty and informing the patient about his/her treatment are necessary to improve blood pressure control in our Tunisian context

Harnessing the power of identity to encourage farmers to protect the environment

International audienceWe argue that farmers exhibit identity concerns that can be conducive or detrimental to environmental conservation. In addition to recognizing the existence and importance of these concerns, we posit how they modify traditional predictions in unexpected directions. We characterize the propensity to adopt environmental measures within a two-dimensional space defined by farmers’ expectations about how adoption will impact profit as well as identity-related concerns. In doing so, we emphasize that identity concerns can be (inadvertently) activated and/or manipulated in directions that can be (un)favorable to socially desirable goals. We also develop some original and practical ways to better understand and exploit the identity dynamics to reach environmental conservation objectives

Ulcer like projection: a case report and follow up

Here we report the case of a 57-year-old female with an aortic intramural hematoma that was treated with medical approach. Follow confirmed the favorable clinical evolution.The Pan African Medical Journal 2016;2

Isolation, characterization and identification of a new lysinibacillus fusiformis strain zc from metlaoui phosphate laundries wastewater: Bio-treatment assays

The aim of the present study is to isolate, characterize and identify a novel strain ZC from the Metlaoui phosphate laundries wastewater (MPLW). The chemical characterization of this phosphate rich effluent showed an alkaline pH and is saline, highly turbid and rich in suspended matter and total solids. The MPLW samples were loaded with potentially toxic metals, presented in decreasing order as follows: magnesium (5655 mg L), potassium (45 mg L), lead (1 mg L), iron (0.7 mg L), cadmium (0.5 mg L), copper (0.3 mg L) and zinc (0.1 mg L). Due to the high COD/BOD ratio, a poorly biodegradable organic load is underlining. The newly isolated strain was identified as Lysinibacillus fusiformis using 16S rDNA sequencing analysis. The viability of this new strain was tested in presence of the zinc, lead, cadmium, manganese and copper at 1, 10 and 100 mM. The L. fusiformis survival, under metallic stress, was inversely proportional to metal ion concentrations, while lead and zinc were the most toxic ones using MTT assay. Then, the newly isolated strain was characterized in terms of enzyme production, proteomic alteration and antibiotic resistance. The strain ZC revealed some modifications in the biochemical and enzymatic profiles by either the appearance or/and the disappearance of some activities. In addition, the increase in metal ions stress and concentrations was proportional to the adherence and to the hydrophobicity. The presence of the metal ions suggested the change of sensitivity to the resistance of this strain towards tobramycin, kanamycin, neomycin, netilmicin and cefoxitin, showing an increase in the MAR. The strain ZC, used as a biological tool for MPLW treatment, showed a reduction in the metal ion contents. This reduction was due to accumulation and/or adsorption, showing a bioprocessing performance of the newly isolated L. fusiformis

Urinary tract infections following renal transplantation: A single-center experience

Urinary tract infection (UTI) is the most frequent infectious complication among renal transplant recipients and a frequent cause of bacteremia, sepsis and acute graft failure. To evaluate the incidence, risk factors, type of pathogens and long-term effect of UTIs on graft and patient survivals in our center, we performed a retrospective cohort study reviewing the medical records of patients who received a renal transplant at our center from June 1986 to December 2009, excluding patients who lost their grafts in the first month due to arterial or veins thrombosis and acute antibody-mediated rejection. We studied 393 kidney-transplanted recipients; at least one UTI occurred in 221 (53.69%) patients during the follow-up period. The most frequent pathogens isolated in urine culture were Escherichia coli (n = 39, 18.4%) and Klebsiella pneumonia (n = 31, 14.6%). When patients with UTIs were compared with those without UTIs, female gender and use of mycophenolate mofetil or azathioprine seemed to be risk factors for UTIs on univariate analysis. However, female gender was the only independent risk factor on multivariate analysis RR = 1.964 (1.202-3.207), P = 0.007. This study confirmed that UTIs remain a major problem in renal transplant recipients, and female gender was the only independent risk factor

Epidemiology of heart failure and long-term follow-up outcomes in a north-African population: Results from the NAtional TUnisian REgistry of Heart Failure (NATURE-HF)

International audienceThe NATURE-HF registry was aimed to describe clinical epidemiology and 1-year outcomes of outpatients and inpatients with heart failure (HF). This is a prospective, multicenter, observational survey conducted in Tunisian Cardiology centers. A total of 2040 patients were included in the study. Of these, 1632 (80%) were outpatients with chronic HF (CHF). The mean hospital stay was 8.7 ± 8.2 days. The mortality rate during the initial hospitalization event for AHF was 7.4%. The all-cause 1-year mortality rate was 22.8% among AHF patients and 10.6% among CHF patients. Among CHF patients, the older age, diabetes, anemia, reduced EF, ischemic etiology, residual congestion and the absence of ACEI/ ARBs treatment were independent predictors of 1-year cumulative rates of rehospitalization and mortality. The female sex and the functional status were independent predictors of 1-year all-cause mortality and rehospitalization in AHF patients. This study confirmed that acute HF is still associated with a poor prognosis, while the mid-term outcomes in patients with chronic HF seems to be improved. Some differences across countries may be due to different clinical characteristics and differences in healthcare systems

Design and Rationale of the National Tunisian Registry of Heart Failure (NATURE-HF): Protocol for a Multicenter Registry Study

BackgroundThe frequency of heart failure (HF) in Tunisia is on the rise and has now become a public health concern. This is mainly due to an aging Tunisian population (Tunisia has one of the oldest populations in Africa as well as the highest life expectancy in the continent) and an increase in coronary artery disease and hypertension. However, no extensive data are available on demographic characteristics, prognosis, and quality of care of patients with HF in Tunisia (nor in North Africa). ObjectiveThe aim of this study was to analyze, follow, and evaluate patients with HF in a large nation-wide multicenter trial. MethodsA total of 1700 patients with HF diagnosed by the investigator will be included in the National Tunisian Registry of Heart Failure study (NATURE-HF). Patients must visit the cardiology clinic 1, 3, and 12 months after study inclusion. This follow-up is provided by the investigator. All data are collected via the DACIMA Clinical Suite web interface. ResultsAt the end of the study, we will note the occurrence of cardiovascular death (sudden death, coronary artery disease, refractory HF, stroke), death from any cause (cardiovascular and noncardiovascular), and the occurrence of a rehospitalization episode for an HF relapse during the follow-up period. Based on these data, we will evaluate the demographic characteristics of the study patients, the characteristics of pathological antecedents, and symptomatic and clinical features of HF. In addition, we will report the paraclinical examination findings such as the laboratory standard parameters and brain natriuretic peptides, electrocardiogram or 24-hour Holter monitoring, echocardiography, and coronarography. We will also provide a description of the therapeutic environment and therapeutic changes that occur during the 1-year follow-up of patients, adverse events following medical treatment and intervention during the 3- and 12-month follow-up, the evaluation of left ventricular ejection fraction during the 3- and 12-month follow-up, the overall rate of rehospitalization over the 1-year follow-up for an HF relapse, and the rate of rehospitalization during the first 3 months after inclusion into the study. ConclusionsThe NATURE-HF study will fill a significant gap in the dynamic landscape of HF care and research. It will provide unique and necessary data on the management and outcomes of patients with HF. This study will yield the largest contemporary longitudinal cohort of patients with HF in Tunisia. Trial RegistrationClinicalTrials.gov NCT03262675; https://clinicaltrials.gov/ct2/show/NCT03262675 International Registered Report Identifier (IRRID)DERR1-10.2196/1226

Low incidence of SARS-CoV-2, risk factors of mortality and the course of illness in the French national cohort of dialysis patients

International audienceThe aim of this study was to estimate the incidence of COVID-19 disease in the French national population of dialysis patients, their course of illness and to identify the risk factors associated with mortality. Our study included all patients on dialysis recorded in the French REIN Registry in April 2020. Clinical characteristics at last follow-up and the evolution of COVID-19 illness severity over time were recorded for diagnosed cases (either suspicious clinical symptoms, characteristic signs on the chest scan or a positive reverse transcription polymerase chain reaction) for SARS-CoV-2. A total of 1,621 infected patients were reported on the REIN registry from March 16th, 2020 to May 4th, 2020. Of these, 344 died. The prevalence of COVID-19 patients varied from less than 1% to 10% between regions. The probability of being a case was higher in males, patients with diabetes, those in need of assistance for transfer or treated at a self-care unit. Dialysis at home was associated with a lower probability of being infected as was being a smoker, a former smoker, having an active malignancy, or peripheral vascular disease. Mortality in diagnosed cases (21%) was associated with the same causes as in the general population. Higher age, hypoalbuminemia and the presence of an ischemic heart disease were statistically independently associated with a higher risk of death. Being treated at a selfcare unit was associated with a lower risk. Thus, our study showed a relatively low frequency of COVID-19 among dialysis patients contrary to what might have been assumed