[Sudden death during sport activity in Tunisia: autopsy study in 32 cases]. / La mort subite au cours d'une activité sportive en Tunisie : à propos d'une série autopsique de 32 cas.

PURPOSE: To develop profile of the victims and to study circumstances, causes of death and autopsy findings. METHODS: Retrospective study of cases of sudden death in sport activity whose autopsy was performed in forensic department of Tunis, between January 2005 and December 2009. RESULTS: During study period, 32 cases of SD in sport activity were recorded. These are amateur athletes predominantly male (84% of cases). Victims are aged between 15 and 79 years with an average age of about 33.16 years. Young subjects whose age is less than 35 years representing 68.7% of cases. 9.3% of victims had a family history of SD and 18.7% of cases had a known cardiac history. The sports most involved are running (40.6% of cases), football (31.3% of cases) and dance (12.5% of cases). Sixty-nine percent of victims died during sports activities. Presence of witnesses was noted in all cases; however, none of these witnesses has begun resuscitation. Cause of death was cardiac in 84.4% of cases. In young athletes, hypertrophic cardiomyopathy is the leading cause (nine cases), followed by arrhythmogenic right ventricular dysplasia (three cases). Among other causes, there is the myocardial bridge, congenital anomalies of the coronary arteries, aortic dissection and dilated cardiomyopathy. Beyond 35 years, coronary artery diseases represent the cause of death (nine cases). Only case of death secondary to non-cardiac disease occurred after a severe asthma attack. In four cases (12.5%), no cause of death was identified after a complete autopsy accompanied by further investigations. The cause of the death was imputed to a rhythmic pathology. CONCLUSION: This is the first study dealing with autopsy in SD in sport have provided a specific profile of victims. Other studies on larger samples and using standardized autopsy protocols are needed.

Disease-specific medical records improve the recording of processes of care in the management of type 2 diabetes mellitus.

A retrospective review of the medical records of 961 patients with type 2 diabetes managed in primary care in Tunisia was undertaken. Recording of process of care measurements improved from 65 to 84% for blood pressure, from 60 to 71% for fasting glucose, and from 11 to 53% for weight measurement (P<0.001 for all). The introduction of disease-specific medical records significantly improves the recording of care of patients with type 2 diabetes mellitus.

Variations in care of diabetes in primary care centres in Tunis.

The aim of this study was to investigate the care of diabetes in primary care in the public sector in Greater Tunis and in particular, to assess variations in care across centres with the intention of seeking explanations for any differences identified. We undertook a retrospective medical review of patients with diabetes from four primary care health centres. Data were collected concerning patient characteristics, process of care criteria, outcome of care criteria, attendance rates, treatment and health centre characteristics. The total sample size was 235 patients. Outcome of care criteria were found to be similar across each of the centres. Process of care criteria were found to be significantly varied between the centres for all measurements used. Variations were also found in treatment and attendance rates across the health centres. In conclusion, there is a significant variation in the management of diabetes in primary care across centres within Greater Tunis, despite the use of standardised, national guidelines. A number of factors related to the centres may have given rise to these variations.