Sudden death due to pulmonary embolism in north Tunisia: 37 cases study

To determine frequency of pulmonary embolism as the cause of sudden death and to study clinical, epidemiological characteristics and risk factors. Prospective study of cases of sudden death secondary to pulmonary embolism, whose autopsy was performed in the forensic department of Tunis, between October 2009 and of September, 2011. During study period, 37 cases of pulmonary embolism were recorded. They represented 6.8 % of all cases of sudden cardiovascular deaths. Victims were male in most cases [65 %]. Victims were aged between 21 and 87 years with an average age of about 52 years. Pathological histories were noted in 9 cases: three cases of recent surgery, four cases of pelvic trauma, a case of ovarian tumor and a case of which the PE arose in post-partum. Concerning other risk factors of pulmonary embolism, confinement to bed was noted in 24 cases [64.8 %], obesity in 12 cases [32.4 %], an arterial high blood pressure in 4 cases. Histories of psychiatric pathology were noted in 5 cases [13.5 %]. Symptomatology preceding death was dominated by sudden death [35 %] followed by dyspnoea [30 %] and thoracic pains [16%] . In 8 cases, victims consulted emergencies within 48 hours preceding death, for a varied symptomatology without diagnosis of pulmonary embolism is suspected. At autopsy, in 30 cases embolism was massive. In 29 % of the cases, a deep venous thrombosis was revealing in particular at the primitive iliac veins. Pulmonary embolism is an affection that still kills a lot. It can benefit from prevention and from an effective treatment. This testifies the major importance of clinical diagnosis of pulmonary embolism as well as the technical means for the diagnosis

[Relationship between ambient temperature, humidity and sudden cardiac death in Northern Tunisia]

Several studies have suggested a relationship between weather parameters and the occurrence of sudden cardiac death. The aim of this work was to study the impact of changes in temperature and humidity level on the occurrence of sudden cardiac death in the north of Tunisia. It's an autopsic study that included all victims of sudden cardiac death occurring in northern Tunisia between October 2010 and September 2012. The minimum, maximum and average of daily temperatures and humidity during the study period were recorded and compared with the monthly variation in the occurrence of sudden death. The study population included 392 men and 108 women with a mean age of 52.2 +/- 15.8 years. The highest rate of sudden death [37%] was observed at ambient temperatures below 15 degrees and only 4.2% of deaths occurred at temperatures above 30 degrees ambient temperatures [p <0.001]. Among the population aged over 60 years, the highest mortality rate [47.3%] were recorded at temperatures below 15 degrees, while 35.5% of young patients under 40 years died during periods with temperatures between 20 and 30 degrees and 56.8% of deaths occurred in the humidity levels between 60 and 78% . In the north of Tunisia where the climate is temperate, a temperature drop below 15 degrees was significantly associated with a sudden cardiac death. This excess winter cardiac mortality was more pronounced in the elderly

[Clinical and sociodemographic characteristics of sudden cardiac death victims in northen Tunisia]

The sudden cardiac death remains a major public health problem. This dramatic event has not been well investigated in Tunisia. The aim of this work is to study the epidemiological and socio demographic characteristics of Tunisian victims. We prospectively collected clinical, socio demographic and pathology data of victims of sudden cardiac death occurring in the northern Tunisia from October 2010 to September 2012. The study population included 392 men and 108 women with a mean age of 52,2 + / - 15,8 years. Three quarters of the victims were sedentary, 57,9% were smoker and a family history of sudden death was identified in 9,8% of cases. Half of victims had a primary school education, only 8,4% has a university education, 65,6% of subjects lived in urban areas and 64% of victims were married. The vast majority of deaths had occurred either in a public place [41,4%] or at home [36,6%]. The most frequent circumstance of death was at rest [67%]. Only 5,1% of victims were transported by emergency medical services and 12,1% by civil protection. Ischemic heart disease was the leading cause of death with 267 cases; however a negative autopsy was denoted in 13,9% of victims. Victims of sudden cardiac death in northern Tunisia were relatively young with a male predominance. Physical inactivity and smoking were the most common risk factors for cardiovascular disease. The majority of victims were married, had an urban origin and a low level of education. Ischemic heart disease was the first etiology of sudden death

[Weekly variation of sudden cardiac death in northen Tunisia]

The sudden cardiac death remains a major public health problem. Several studies have reported weekly variation of this dramatic event. The aim of this work is to determine the day-of-week variability in sudden cardiac death in northen Tunisia. Methods: We prospectively collected clinical, socio demographic and autopsic data of victims of sudden cardiac death occurring in the northern Tunisia between October 1 st ,2010 and September 30,2012. The study population included 392 men and 108 women with a mean age of 52.27 + / - 15.8 years. Three quarters of the victims was sedentary, 57.9% were smoker and a family history of sudden death was identified in 9.8% of cases. The vast majority of deaths had occurred either in a public place [41.4%] or at home [36.6%]. Ischemic heart disease was the leading cause of death with 267 cases [53.4%]; however a negative autopsy was found in 13.9% of victims. The highest sudden death occurrence was on Sundays [17.8%] and the lowest on Mondays [11.4% p: 0.01].The same weekly variation was noted among both men and women, and also in victims > 60 years, a minimum of events occurred on Mondays [11.6%] and a maximum on Sundays [21.9%]. In addition, we found the same peak of mortality on Sunday [18.8%] in young adults and the nadir on Monday [10.3%]. The present study demonstrates marked variation in the occurrence of sudden cardiac death in the northern Tunisia with peak on Sundays and nadir on Mondays. No age or gender- related differences were found in weekly variation of sudden death

[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

Hypertenisve emergencies

Hypertensive emergencies include clinical situations with different prognosis. The emergencies are defined by the gravity of acute visceral failures. They need a parenteral treatment. Hypertensive emergency is less severe when blood pressure increase remain isolated and then is controlled progressively by oral treatment. The use of the calcium inhibitors by sublingual way is non controversies. Injectable nicardipine and uradipil represent an important progress in pharmacologic management of hypertensive emergencies

[Infective endocarditis caused by enterococcus isolate resistant to glycopeptides]

Enterococci are an important cause of infective endocarditis. Their resistance to most of the antibiotics involve real therapeutic problems. We report the first clinical isolate of glycopeptide resistant enterococus from blood culture of patient with a prostetic valve endocarditis. The strain is an E.faecium with a high level of resistance to vancomycin and teicoplanin [MlC>256mg/I],a low level of resistance to gentomycin [MIC=6mg/l] and susceptibile to ampicillin [MIC=1.5mg/I]. Therapeutic failure was observed leading to a surgical treatment. Therapy of such infection caused by multiresistant Enterococcus must be based on the study of bactericidal activity of antibiotic associations. In order to control the spread of this emerging resistance, the implementation of control measures is necessary