[Aspects of mycardic parameters of Tunisian handball players: an echocardiographic study]

Given that handball is a mixed sports activity requiring 3 energy eystems, namely aerobic, anaerobic alactic and lactic, it supposes then a cavity dilatation for the efforts involving endurance and a parietal hypertrophy for the efforts involving anaerobic work. To obtain, using the echocardiographic method, myocardic measurements from 3 groups of Tunisian handball players of different ages, in order to define the myocardic predispositions of the young players and to define the myocardic predispositions of the young players and to define the myocardynamic adaptation of the heart of the adult players so that the impact of the specialty on the operation and the morphology of the heart can be better explained. Two-dimensional and time motion [TM] echocardiography [using a TOSHIBA SSH 104 A] was conducted to examine the following parameters: diastolic and systolic diameters of the left ventricle, the root of the aorta, the left atrium and the right ventricle, as well as the mean velocity of the shortening of circumferential fibers, the ejection time of left ventricle, and the dimensions of the inter-ventricular septum and the posterior wall as well as the E/A ratio. The echocardiograms were performed by medical technicians and reviewed by physicians. Thirty six handball players were involved in this study. Height and weight of all players were measured before the medical test. The Obtained results enable us to advance that the loads of drive and competition in handball requested the increase in the parameters of dilatation in the young players of 11-12 years to 15-16 years, whereas parameterize them of hypertrophy improved therafter. What justifies the idea, which says that in the young players work must be based primarity on the improvement of aerobic quality requesting the dilatation of the myocardium, thereafter one can consider anaerobic work. The practice of handball at an early age may induce both cavity dilatation and parietal hypertrophy. The long-term consequences and significance of this marked remodeling of the athlet's heart is not known

[In hospital prognosis of right ventricular myocardial infarction]

To identify prognostic risk factors for in-hospital outcome of right ventricular myocardial infarction [RVI]. A retrospective study of 20 patients admitted with acute myocardial infarction with a RVI defined by ST segment elevation 1mm in V3R and V4R leads. The mean age was 62 years. RVI was associated with an inferior myocardial infarction in 18 patients. Half of the patients had hemodynamic complication on admissioc [cardiogenic shock in 4 cases, right ventricular failure in 6 cases] and third degree atrio-ventricular block was present H 5 patients. Sixteen patients [80%] received thrombolysis and 3 went to an emergency angioplasty. The in-hospitv mortality was 25%caused by a cardiogenic shock in patients and a ventricular fibrillation in 1 patient. Statistic: analysis showed that cardiogenic shock on admission. e absence of thrombolytic therapy and the low ejection fraction of the left ventricle were associated with a high in-hospital mortality [p=0.004, p=0.03, p=0.03 respectively]. In-hospital outcome of RVI is characterized by hemodynamic complications leading to a high incidence-mortality. Thus RVJ must be diagnosed quickly and maxims therapeutic efforts must be done to procure the opening of the occluded coronary artery

Echocardiographic factors determining immediate result of percutaneous mitral balloon commissurotomy

Define echocardiographie predictors of the result after percutaneous mitral balloon commissurotomy [PMC]. PMC by the Inoue balloon was attempted in 247 patients -[77% female] with severe mitral valve stenosis. The mean age was 35 years. All the patients had undergone echocardiographie examination before PMC to assess mitral anatomy, commissural calcification, and to determine the Wilkins score. The mean value of Wilkins score was 7,98 +/- 1,61 [range 5-13] and the mean mitral valve area [MVA] before PMC was 1 +/- 0,19 cm2 [range 0,5- 1,4 cm2]. 29 patients [11,7%] had one-commissural calcification and 2 patients [0,8%] had bi-commissural calcifications. After PMC, the mean MVA increased to 1,79 +/- 0,34 cm2 [p <0,001] resulting in a success rate of 83%. Severe mitral regurgitation [>grade 3] occurred in five patients [2%]. Wilkins score was an independent predictor of the immediate result of PMC but, if > 8, this score had a weak predictive value. Commissural morphology was another independent predictor of the immediate result of PMC. Echocardiography is now the cornerstone for the assessment of mitral anatomy before PMC and should integrate Wilkins score and commissural morphology for the selection of patients to PMC

transition epidemiologique ses determinants et son impact sur les systemes de sante a travers l'analyse de la tendance des maladies cardiovasculaires en Tunisie

We aim at analyzing the increase of CVDs in the Tunisian hospitals in order to assess the burden of NCDs in the transitional context. Data are recorded through the Tunisian National Morbidity and Mortality Survey [TNMMS]. In order to assess the CVDs [CHDs vs RHDs] trend, two representative samples of Cardiology Departments patients were compared one is selected from the TNMMS and the second from the hospitalizations recorded in 1992. Causes, stay duration, status at the end of the hospitalization, transfer to an other hospital and patients socio-demographic characteristics are recorded and compared for the two periods. All the diagnosis are coded referring to the DMC 10. To analyze the determinant of the epidemiological transition, we have elaborated the CVD causal pattern and we have documented all their determinants. CHD rate has dramatically increased, while RHD has decreased especially on men. In 1992, 39.2% of men and 11.8% of women were admitted for CHD. In 2002, these rate are respectively 58,8% and 38, 2% while RHD rates were, in 1992, 11.8% on men and 25.3% on women vs 4.4% and 11.7% respectively. This study has confirmed that so far controlling transmitted diseases seems to be successful, Tunisian people are about to face a new problems as hypertension, obesity, diabetes and tobacco smoking. The new challenge with the burden of diseases requires the implementation of a national strategy relevant to the epidemiological. social and economical transition. Population needs and cost effectiveness of interventions assessment is crucial to set the national priorities

Delai de prise en charge et acces aux soins de l'infarctus du myocarde dans les structures hospitalieres

We aimed to assess the acute myocardial infarction management in Tunis public hospitals during one year [from March 2000 to February 2001]. Method: A standard questionnaire was designed to record prospective data on 740 patients with a follow up during 28 days. Multivariate analysis was performed using the logistic regression model with all-factors as well as age, gender, CHD risk factors as predictors of the delay and fatality. 54% of patients were admitted during the first 6 hours after the onset of symptoms. In multivariate analysis, the delay of consultation is significantly correlated with gender [OR=2.3, p<0.001], age [OR=l.02, p<0.01] and health insurance [OR=1.5, p<0.01]. 90% of patients consulted in emergency wards. The emergency ambulance transported 19.6% of patients. 48% of patients underwent early revascularization of thrombolysis, 51% on men vs 31% on women [p <0.01]. The fatality rate was higher on women 14% vs 6.4% on men [p<0.01] at 5 days and 27.2% vs 13.6% at 28 days. In multivariate analysis, the principal fatality predictive factor was age [RR=l.08, p < 0,001] and delay [2.56 p <0.001] and tobacco smoking [RR=2,83, p <0.0001]. this study highlighted the problem of acute myocardial infarction management in public hospitals in Tunisia and it constitutes a baseline to assess different interventions focusing on cardiovascular diseases control and surveillance

Cout direct medical de la prise en charge de l'infarctus du myocarde en phase algue

to assess the medical direct cost of acute myocardial infarction. Method: data are recorded through a prospective study in 7 wards of cardiology of the District of Tunis during one year: from November 2001 to October 2002. cost of hospital stay, biologic analyses, drugs, functional investigations and possible non surgical cardiologic intervention [IC] was calculated. 632 AMI cases are recorded, the death rate is 7.8%. The average of hospital stay was 13.3 days. 49.1% of patients benefited from thrombolytic therapy, 55.5% benefited from a coronary angiography and 16.1% of an act of IC. The mean of direct cost [CGM] was 2171 Tunisian Dinars and the median was 1731 DT, of whom room costs 31.7%, 22.5% acts of IC, 7.2% drugs, 26.2% functional investigations and 12.4% biological analyses. The mean cost of IC was 3030 +/- 401 DT. The methodology of our study remains original in our country and can be used to assess the other aspects of AMI as other diseases cost management

Prevention secondaire des maladies cardiovasculaires: Connaissances et pratiques des malades

The aim of our study is to assess the degree of awareness and practices of patients with cardiovascular disease. Method: During October 2002- February 2003, we conducted a CAP study [Knowledge, attitudes, behaviors] at some outpatient clinic visit of Tunis District. Using a standardized questionnaire, investigators have collected demographic and personal data, informations about risk factor levels, knowledge and attitudinal characteristics related to risk factors for patients who satisfied the inclusion criteria. 443 patients have been interviewed [68.4% are men]; 40% have more than 65 years old. Half of patients have never been schooled. Most of them have low socioeconomic level [38.8%] or middle one [56.0%]. 66.9% of men have quitted tobacco smoking and 19.5% still smoking 41.3% of patients have some difficulties to change their lifestyle, The difference is statically significant by educational and occupational levels. Almost 60% of them used to practice daily a moderate physical activity, which was more frequent among men then women [p<0.01]. During the last year, majority of patients has had checked their blood pressure [98%], glycaemia [94%] and cholesterolemia [94%]. However, about 57% to 67% of patients knew if they have hypertension, diabetes or hypercholesterolemia. Most of patients are aware that healthy lifestyle can be important in preventing heart attacks and stroke and that control of blood pressure, cholesterolemia and glycaemia reduce recurrence of these attacks once they happened. CVDs prevention and control is facing the crucial question on lifestyle change and enhancing patients responsibility in their own health promotion

[Lipoprotein [A] as a risk factor for coronary artery disease]

Lp[a] may represent a link between the fields of atherosclerosis and thrombosis. Elevated Lp[a] levels > 300 mg/l have been associated with the presence of atherosclerotic disease. This prospective study initiated in 1995 and, until June 1999 enrolled 218 subjects divided in two groups: Gl: subjects with / without angiographically proven coronary artery disease[CAD], n = 124 and Gll: controls, n-94 The objective of this study was to assess the influence of high Lp[a] serum levels on the CAD. Secondary end point was to demonstrate a correlation between the level sevum Lp[a] and the severity of angiographic coronary findings, we found that the cases had significantly [p = 0.004] higher Lp[a] levels than the controls and that correlation existel between the value of Lp[a] serum levels and severity of angiographic findings. However, we do recommend Lp[a] screening for patients with curly CA 1:] or a family history of CAD