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Objectives: The survival benefits achieved by prescription of antiplatelet agents, B-adrenoreceptor antagonists (beta-blockers), angiotensin II receptor blockers (ARB), and lipid lowering agents in patients surviving the myocardial infarction (MI) have been well documented in large clinical trial. Despite well-established benefits, these pharmacological agents continue to be underutilized. The main objective of this study was to evaluate the progress of cardiovascular secondary prevention practices in Tunisia. Methods: The PREMISE (Prevention of Recurrence of Myocardial Infarction and Stroke) is a descriptive, cross-sectional study conducted in Tunisia in two phases (2002 and 2009). Seven hundred eighty two patients were recruited. The recruitment criteria were: previous MI, stable angina, unstable angina, percutaneous transluminal coronary angioplasty (PTCA), coronary artery bypass graft (CABG), stroke, transient ischemic attack (TIA) or carotid endarterectomy. This analysis is limited to coronary heart disease (CHD) patients. Five hundred hospital patients were interviewed and their medical records were reviewed: 250 in 2002 and 250 in 2009. Patients were included if they had confirmed diagnosis of MI, angina, CABG or PTCA, and if their first cardiovascular event had occurred more than one month but not later than 3 years ago. We compared the total of both patient groups, using the prevalence of Cardio-Vascular Risk Factors (CVRF) and the treatment prescribed at hospital discharge. Results: The proportion of patients with reported hypertension, diabetes, hypercholesterolemia and current smoker patients had decreased. Concerning pharmacological prescriptions, a significant increase was observed in prescribing statins (38.9% vs. 70.3%) and ACE inhibitors (49.3% vs. 69.9%), non pharmacological prescriptions as healthy diet or tobacco cessation had opposite trends. Adherence to treatment did not change substantially. Conclusion: Although the use of cardioprotective drugs had increased in CHD patients, there are still gaps in secondary prevention in Tunisia. The recommended strategies of secondary prevention need to be applied more intensively in clinical practice. [Copyright &y& Elsevier]

Abstract: Objectives: The aim of this study was to evaluate the effect of the G3057A (rs62589000) LEPR polymorphism on obesity risk and plasma leptin, insulin, and lipid levels in a sample of the Tunisian population. Design and methods: Three hundred and ninety-three obese patients and 317 controls participated in this study. The G3057A genotype was determined by polymerase chain reaction–restriction fragment length polymorphism (PCR–RFLP) analysis. Results: In the entire study sample, no significant differences in genotype frequencies were observed between obese patients and controls. However, stratified analysis by gender revealed a quantitative increase in the variant allele (33.3% vs. 25.8%; χ 2 =4.90, p =0.026) in obese women (but not men) compared to controls. When a dominant model of inheritance was assumed, the GA+AA genotypes were more prevalent in these obese female patients than in controls (58.3% vs. 47.8%; χ 2 =4.08, p =0.044). Unconditional logistic regression showed that in women only, obesity risk was significantly higher for homozygotes for the variant allele (OR=2.73, 95% CI 1.03–7.21) and for carriers of GA+AA genotypes (OR=1.53, 95% CI 1.01–2.31) compared with homozygotes for the normal allele. The association between the G3057A LEPR variant and obesity remained statistically significant even after adjustment for age. No relationship was found between the G3057A LEPR polymorphism and leptin and insulin levels. Additionally, this LEPR gene variant had no effect on plasma lipid concentrations. Conclusion: There is evidence in this study that the G3057A LEPR polymorphism is associated with obesity in Tunisian women. [Copyright &y& Elsevier]

Introduction La dose de dialyse est mesurée au moins une fois par mois chez l’hémodialysé chronique soit par prélèvements sanguins pour calculer le Kt/Vsp et PRU, soit par mesure de la dialysance ionique en temps réel (Kt/Vocm). L’objectif de ce travail est de déterminer l’intérêt de la mesure de dialysance ionique dans l’évaluation de la dose de dialyse. Patients et méthodes Étude prospective sur 2 mois, menée chez des patients en hémodialyse périodique depuis au moins 6 mois. Trente séances d’hémodialyse ont été évaluées. Durant chaque séance, nous avons pratiqué une mesure du Kt/Vocm par dialysance ionique en temps réel grâce au module online clearing monitoring (OCM) intégré au générateur Fresenius 4008S et un calcul du Kt/Vsp ( single pool ) calculé par la formule de Daugirdas 2 e génération, ainsi que du PRU. Résultats Nous avons inclus dans notre travail 30 HDC (15 femmes, 15 hommes), d’âge moyen 60,3 ± 15,12 ans. Pour un volume de distribution d’urée (VDU) moyen de 33,75 ± 5,44 L et volume de sang épuré moyen de 59,1 ± 5,3 L, la moyenne du Kt/Vocm, Kt/Vsp et PRU était respectivement de 1,19 ± 0,2, 1,31 ± 0,26 et 66,4 ± 7,2. Nous avons constaté une corrélation positive statistiquement significative entre Kt/Vocm et Kt/Vsp ( r = 0,89 ; p < 0,001), d’une part, et entre Kt/Vocm et PRU ( r = 0,84 ; p < 0,001), d’autre part. Cependant, 66,7 % de notre population avaient un Kt/V ≥ 1,2 lorsqu’il est calculé à partir des prélèvements sanguins (Kt/Vsp) contre 46,7 % pour celui déterminé par dialysance ionique (Kt/Vocm). En effet, la dialysance ionique sous-estime de 20 % le Kt/Vsp. Discussion Les recommandations de dialyse adéquate chez l’HDC postulent que la dose de dialyse administrée doit être mesurée mensuellement et le Kt/V idéal doit être ≥ 1,2. Nos résultats montre que l’évaluation de la dose de dialyse par la méthode de dialysance ionique en temps réel (Kt/Vocm) est aussi valide qu’avec les autres méthodes (Kt/Vsp, PRU). La constatation d’une sous-estimation du Kt/Vocm comparativement au Kt/Vsp peut être rendu aux méthodes d’estimation du VDU réel ou calculé par la formule de Watson. Conclusion Les générateurs munis d’un module OCM sont d’utilisation facile et rapide, permettant une mesure en temps réel de la dose de dialyse (Kt/Vocm) sans avoir recours aux prélèvements sanguins. Ceci est de plus valide avec une bonne estimation du VDU. [ABSTRACT FROM AUTHOR]