[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

[ case of pyomyositis tuberculosis]

Pyomyositis is a muscular infection that is frequently due to commonplace bacteria particularly in immunocompetent patients. However, infections with specific germs can arise even without preliminary risk factors. We report the case of a young non-immunosuppressed patient, who has a sub acute painful tumefaction of a thigh without infectious signs. The clinical examination was in favour of thigh collection. The MRI confirmed this hypothesis and showed an associated osteo-arthritis of the knee. The pus microbiological examination was postitive for Mycobacterium tuberculosis. She favourably evolved under antituberculous treatment and surgical drainage of the collection. As tuberculosis is endemic in our country, we should always consider this diagnosis even in young patients without predisposing factors

[ quality of ambulatory care provided to non-insulin treated diabetic patients]

We assessed the quality of care provided to non-insulin treated diabetic patients by examining the medical records of 248 such patients attending our outpatient department in 2002. The mean age was 59.5 [SD 10.1] years, 62.1% were women and known duration of diabetes was 8.6 [SD 5.9] years. The majority of patients were treated with a combination of sulfonylurea and metformin. Glycaemic control was assessed using fasting blood glucose in 96.8% of patients, post-prandial blood glucose in 31.9% and glycated haemoglobin in 52.4%. Weight was measured at least once for 88.7% of patients, blood pressure for 91.1% of patients and lipid levels for 64.9%. Body mass index was less than 25 kg/m2 in 12.3% of patients and blood pressure less than 140/90 mmHg in 40.3%. Foot examination was noted in only 2% of records, electrocardiography was performed for 25% of patients and fundoscopy for 21%. Proteinuria was documented in 19.8% of patients and plasma urea and/or creatinine in 57.3%

[Microangiopathte among the patients type 2 diabetes at diagnosis]

Chronic complications may he preset at the moment of diagnosis in type 2 diabetes. To study the retinopathy and the nephropathy among recently diagnosed patients, we analyzed data of 194 patients admitted in our department and who underwent screening for these two complications. The mean age was 56.0 +/- 12.9 years and 52.6% of patients were female. Retinopathy was diagnosed in 7.2% of patients and was associated with lower BMI compared to patients without retinopathy. Nephropathy was identified in 7.7% of patients, who had higher systolic and diastolic blood pressure and higher serum cholesterol levels than patients without nephropathy. These results confirm the high, frequency of retinopathy and nephropathy at the time of diagnosis in type 2 diabetes in adulthood and the lack of link between these complications. They underline the importance of their independent detection at the initial investigation

[Isosporosis in AIDS, about five Tunisian cases]

Isosporosis is a digestive parasitosis that occurs on a sporadic basis in our country. It is caused by a protozoan of coccidia class: Isospora belli. Between the years 2000 and 2004, five cases of isosporosis were diagnosed in our laboratory in five AIDS patients. Its prevalence among tunisian patients suffering from Human Iminunodeficiency Virus [HIV] infection in our series is about 1.41%. Main clinical manifestations consisted of acute diarrhea, with malabsorption syndrome in one case. Medical management based on specific antibiotics [sulfamethoxazole-trimethoprime], is efficient in avoiding recurrent episodes. However, recurrency remain frequent as long as immunity remains compromised