[Acute coronary syndrome during antiretroviral treatment]

The aim of this study is to determine epidemiological, clinical, therapeutic and outcome characteristics of acute coronary syndrome in AIDS patients under HAART. The charts of 5 patients were reviewed. The mean age, at the time of the discovery of HIV infection, was 35 years. Three patients were smokers and one had a family history of diabetes and acute coronary syndrome [ACS]. Three patients received 2 nucleoside reverse transcriptase inhibitors [NRTIs] with indinavir. The 2 others received 2 NRTIs with efavirenz with good immunovirologic response. Four patients developed mixed dyslipidemia after an average period of 26 months. Tow patients developed diabetes and one a hypertension. A specific treatment was initiated in all cases. These five patients developed an ACS after respectively 51, 95, 96,103 and 145 months of ART [median=98 months]. ACS occurred in 3 patients receiving 2 NRTIs and PI and two others 2 NRTIs with efavirenz. The mean age at the onset of ACS was 46 years. One patient underwent a triple bypass surgery, tow a stenting of the stenotic coronary and the last 2 patients received medical treatment with a good clinical outcome. The PI was replaced by efavirenz in two patients. Four patients had a recurrence of ACS respectively after 2months, 3 months, 12 months, and 62 months after the first episode. The five patients are still followed with good clinical and biological outcome

[Ambulatory pediatric morbidity. Evaluation of one year activity of consultation in department of Pediatrics, emergency and consultations of children's hospital of Tunis]

Pediatric morbidity has been the subject of many studies, nevertheless those concerning with ambulatory morbidity are rare. The subject of this study is to establish the epidemiologic profile of patients. Identify the encountered pathologies and their frequency, precise morbidity characteristics and raise difficulties in the diagnostic and therapeutic management. In this retrospective study we reviewed the data of 4387 children that have consult for the first time external consultation of the department of Pediatric External Consultations and Emergency [PUC] of the Children's Hospital of Tunis during the year 2003. The 4387 patients benefit from 7323 consultations which represent 44.3 per cent of the total of consultations of the year 2003 [16 507]. 59.4 percent of the studied population was male [sex ratio = 1.2] and two thirds were aged under 6 years old. The main motif of consultations was recurrent bronchopneumonia [15.2 percent], cutaneous disease [6.2 percent], vomiting [6.1 percent] and abdominal pain [5.6 percent]. 3.2 percent of the children were admitted. Ambulatory morbidity was dominated by four pathologies: digestive 16 percent, pulmonary 14.9 percent, neurologic 6.7 percent and hematologic pathothologies [6 percent]. Gastro-oesophageal reflux was the major digestive disease followed by acute diarrhea [10.6 percent]. The principal pulmonary disease were bronchopneumonia [60.5 percent], acute bronchitis [21.6 percent] and asthma [14.4 percent]. 59.9 percent of the neurologic pathology were represented by seizures. 28.4 percent of the seizures were feverous. Anemia is the most frequent hematologic pathology [55.1 percent]. It was caused by iron deficiency in 87 percent of cases. The endocrinologic pathology is essentially represented by the short stature. We suggest to informatize medical data so it would be more exploited for studies, to make more complementary explorations available in the Children's Hospital of Tunis and to decentralize the management of the simples diseases