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Purpose: The aim of this review was to compare the currently available root canal filling materials for primary teeth to zinc oxide eugenol (ZOE) to find a suitable alternative. The search question was: which root canal filling materials used in pulpectomy for primary teeth give better clinical and radiographic success rates than ZOE? Methods: A systematic search was conducted using five databases, namely Cochrane central register of controlled trials (CENTRAL), MEDLINE via PubMed, Science Direct, Scopus and EBSCOhost using a selection of "MeSH terms". The "Modified Jadad Scale" was used for the methodology assessment of the included studies. Results: Out of 480 articles identified in the initial search, 8 articles met all the inclusion criteria. The results showed that, compared to ZOE, ZOE with calcium hydroxide and iodoform had better clinical and radiographic success rates, a resorption rate similar to that of the roots, faster resorption of extruded particles and a maximum decrease in the size of pre-operative inter-radicular radiolucencies. Conclusion: Numerous materials, proposed and used by clinicians in root canal filling in primary teeth, can be recommended as alternatives to ZOE. However, none of them could be the ideal material in primary teeth. Thus, more high-quality well-designed randomised clinical trials are required to develop more high-performing materials. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to systematically review the literature to answer the question: Are parental stress associated with early childhood caries (ECC)? Methods: Electronic databases including MEDLINE (via Pubmed), Scopus and SciELO were searched. Cross-sectional and case–control studies that investigate the association between parental stress and ECC were included. The Newcastle–Ottawa scale was used to assess the risk of bias of the included articles. Results: Out of 498 articles identified in initial research, 7 articles met the inclusion criteria; five were cross-sectional and two were control–case in design. A statistically significant correlation between ECC and total parental stress as well as a higher level of carious activity associated with total parental stress was reported in four studies. In two studies, no significant relationship between stress and ECC was found (P > 0.05) and in one study, parental stress was inversely associated with children's ECC status with better dental outcomes significantly associated with a higher level of parenting stress. Conclusion: Despite the fact that the heterogenicity of the following data precluded conclusions to be drawn, it was obvious that parenting stress or some of its domains may influence the development of carious lesions in young children. [ABSTRACT FROM AUTHOR]

Aim: To assess the prevalence of black tooth stains and to investigate its correlation with caries experience in the primary dentition of 3–5-year-old children in the region of Monastir, Tunisia. Methods: It was a descriptive cross-sectional study involving children in preschool establishments in Monastir, Tunisia. It consisted of an oral examination of 393 children and data collection through a questionnaire completed by parents. ANOVA test and Pearson Chi-square test were used to assess the prevalence of black stains and its association with dental caries. Results: The overall mean decayed, missing, and filled teeth (dmft) index was 1.42 ± 0.1. Caries prevalence was 49.9%. Of all the children involved, 6.1% had black stains. A statistically significant relationship was found between black stain and the prevalence of early childhood caries (p = 0.047). However, the association with the dmft index was not statistically significant (p = 0.08). Conclusion: Preschool children with black tooth stain had lower dental caries experience. The results of the present study suggest that black stains are a protective factor for early childhood caries. More studies are needed to explore the risk factors of black stains. [ABSTRACT FROM AUTHOR]

Background: Necrosis of permanent immature teeth is a common reason for consultation in paediatric dentistry. Apexification is a therapeutic procedure aiming to create an apical calcified barrier in open apex teeth.Case report: Two cases are presented in which apexification were completed on immature permanent traumatised incisors using a mineral trioxide aggregate (MTA) plug.Follow-up: At 2 and 5 years showed apical closure and radicular elongation beyond the MTA plug.Conclusion: Unexpectedly, a regeneration of mineral tissues beyond the MTA plug occurred which is an uncommon outcome. [ABSTRACT FROM AUTHOR]

Smoking is a well established cardiac risk factor. However, outcomes of primary percutaneous coronary intervention (PCI) for acute ST elevation myocardial infarction (STEMI) in smokers are expected to be better than non-smokers patients. The purpose of this study was to determine clinical and angiographic profile of smokers with STEMI treated by primary PCI. We analyzed all consecutive patinets with STEMI hospitalized in Cardiology B deprtment of Fattouma Bourguiba university hospital between January 2000 and March 2017. A total of 352 patients were included in this study. Current smokers consist of 55.7% (196) of the total sample. Smokers were relatively younger as compared to non smokers with mean age of 57.2 ± 11.2 years vs. 63.6 ± 11 years (P < 0.001). A high majority of somkers were male (194 patients, 99%) and had lower prevalence of hypertension (39.4% vs. 62.5%, P < 0.001) and diabetes mellitus (44.3% vs. 61.2%, P = 0.03). Smokers had lower heart rate (68 ± 22.5bpm vs. 79.7 ± 21.7 bpm, P = 0.032) and systolic blood pressure (108 ± 22.9 mmHg vs. 119 ± 23 mmHg, P = 0.020) but they had similar left ventricular ejection fraction. On coronarography, smokers trended to have higher thrombus burden (P = 0.02) but less multivessel coronary artery disease (P = 0.037) and no-reflow phenomenon (P = 0.01). Smokers had better baseline and post procedural TIMI flow. Complications after angioplasty were less present in smokers (14.8% vs. 23.7%, P = 0.023). In-hospital mortality was not significatively higher in smokers (9.2% vs. 11.7%, P = 0.07). This study documents that the smoker's paradox may be explained by the younger age and fewer cardiovascular risk factors in smokers compared to non smokers. [ABSTRACT FROM AUTHOR]

Coronary artery disease is often thought to be associated with older age. Nowadays the number of young adults suffering from CAD is increasing. Such pattern needs to be studied carefully to identify high risk patients. To study the epidemiological profile of the very young (≤ 40 years) adults presenting with ST-segment elevation myocardial infraction. Over the 25 years period, 1609 STEMI patients were admitted to our university hospital. This post-hoc analysis included patients aged 40 years old or less. Then we compared their characteristics to a control group of patients > 40 years. There were 90 patients meeting the inclusion criteria representing 5,59% of the total population. The mean age was 35 years. 91,1% were males and 77% were active smokers. Diabetes was found in 20% of patients, hypertension was found in 8,9%, dyslipidaemia was found in 11,1% and obesity in 65%. There was a significant difference in cardiovascular risk factors profile: older patients had more diabetes and hypertension whereas the very young group had more smokers. There was no significant difference in dyslipidaemia. Very young adults presenting with acute myocardial infarction have different characteristics compared to older subjects. [ABSTRACT FROM AUTHOR]

There is a rich literature on ST elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS). However, little is known about patients who are initially hemodynamically stable and develop CS after percutaneous coronary intervention (PCI). To determine incidence and evaluate clinical characteristics as well as in-hospital outcomes of patients with STEMI who develop cardiogenic shock after PCI. A total of 352 consecutive patients were retrospectively enrolled in the PAMI registry of the cardiology B department of Fattouma Bourguiba university hospital between January 2000 and March 2017. Patients with hemodynamic instability at presentation prior to PCI were excluded. Out of 352 patients with STEMI, 35 patients (9.9%) develop cardiogenic shock after PCI. These patients were older (age > 65 years; P = 0.021), more often diabetic (68.3% vs. 37.2%; P = 0.002), and had prior stroke/transient ischemic attack (22.2% vs. 10.5%; P = 0.027). Cardiogenic shock after PCI occured more frequently in patients with anterior STEMI (P = 0.012), door to balloon time > 120 minutes (P = 0.02), and systolic blood pressure at admission < 120 mmHg (P < 0.001). On the electrocardiogram, wide QRS at presentation (P = 0.033), presence of bundle branch block (P = 0.021) and persistence of ST segment elevation after PCI (P < 0.001) were associated with higher incidence of CS after PCI. The overall in-hospital mortality of patients with post procedural CS was 64.3% vs. 3.5%, P < 0.001. At multivariate analysis, significant predictors of an increased risk of CS after PCI were: age > 65 years (odd ratio = 1.05;95% CI:0.49-2.33; P = 0.02), systolic blood pressure < 120 mmHg (odd ratio = 3.9,95% CI: 1.95–7.78, P < 0.001) and door to balloon time > 120 minutes (odd ratio =1.07, 95% CI 0.49–2.33; P = 0.02). Cardiogenic shock after PCI in STEMI carries an extremely high mortality. These patients had unfavourable premorbid conditions and poor outcomes. [ABSTRACT FROM AUTHOR]

Copyright of Eastern Mediterranean Health Journal is the property of World Health Organization and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In 1981, the World Health Organization (WHO) together with the Fédération Dentaire Internationale (FDI) set global dental health goals for the year 2000 within the global strategy of health for all. In 1999, a team of experts drew up new goals to be achieved by 2020, which aimed to facilitate specific oral health policy development for each country. These goals are more general and have to be adapted to local circumstances. This paper aimed to adapt the WHO/FDI/IADR's Global goals for oral health 2020 to Tunisia and draw up new national goals and targets for Tunisia based on previous national oral health surveys. [ABSTRACT FROM AUTHOR]

Copyright of Eastern Mediterranean Health Journal is the property of World Health Organization and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of IBS, Immuno-analyse & Biologie Specialisee is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Right-sided infective endocarditis (RSIE) represents 5–10% of all cases of infective endocarditis (IE). Its optimal diagnosis, management and prognosis remain a challenge for cardiologist. Our study aimed to determine clinical features and prognosis of RSIE. From January 1998 to March 2015, we retrospectively reported all patients admitted for infective endocarditis in Cardiology B department. The modified Duke criteria were used for diagnosis. Clinical findings and prognosis of RSIE were compared to those of left-sided IE (LSIE). Among the 235 patients, 20 (8.5%) patients had RSIE including seven (35%) cases of IE on cardiac device. Mean age was 30 ± 19.5 years. Sixty-five percent was female. They had higher incidence of congenital heart disease (35% vs. 7.9%, P < 0.0001). Cutaneous root was implicated in 30% of cases. Blood culture was more frequently positive (70% vs. 44.9%, P = 0.015). Staphylococcus species was the most common causative pathogen compared to LSIE (78.6% vs. 43.6%, P = 0.012). Detection of vegetation on ultrasound was similar in both groups but vegetation size was higher in RSIE (15.7 ± 8.6 mm vs. 11.6 ± 5.4 mm, P = 0.026). Pulmonary embolism was higher in RSIE. The occurrence of atrioventriculair block (degree 2 and 3) was higher (5% vs. 0.5% P = 0.043) in RSIE and only 8.6% of them required implantable pacemaker. Heart failure, cerebrovascular events, need of cardiac surgery and in-hospital mortality were not different between the two groups. This study showed that RSIE is relatively rare and differs with regards to epidemiology, clinical characteristics and complications compared with LSIE. [ABSTRACT FROM AUTHOR]

Many studies conclude that women presenting with acute coronary syndrome are treated less intensively in the acute phase. Consequently, poor in-hospital and long term prognosis are found in female category. To study differences between women and men in the management and outcomes of Non-ST-Elevation Acute Coronary Syndrome (NSTE-ACS). Cohort study of 340 consecutive patients admitted for NSTE-ACS in cardiology B department. Follow-up at 3 years was reported. We studied sex difference in invasive strategy and long-term mortality. One hundred thirty six patients (40%) were women. Compared to men, they were older (66.2 ± 3.6 versus 62.1 ± 4.5years, P = 0.03). In women group, artery hypertension and diabetes were more frequent while myocardial infarction and coronary revascularization were less found. Conservative strategy was adopted in 25% of women compared to 14.7% of men, P = 0.017. Coronary revascularisation was performed more often in men (63.5%, 48.5%; P = 0.01). Three -year- mortality was higher in women16.8% versus 14.5%, P = 0.04. In multi variate analysis, female gender was not independently associated to a higher 3-yearmortality (OR = 1.8, IC 0.8–5.4, P = 0.4). Although women are less treated by invasive procedures there is no gender difference in long term mortality after NSTE-ACS. [ABSTRACT FROM AUTHOR]

A significant proportion of patients hospitalized for ST elevation myocardial infarction (STEMI) may develop cardiogenic shock (CS) after primary percutaneous coronary intervention (PCI). The identification of these patients would be very important in order to improve their outcomes. To identify the angiographic predictors for developing cardiogenic shock after PCI in patients with STEMI. A total of 352 consecutive patients were retrospectively enrolled in the PAMI registry of the cardiology B department of Fattouma Bourguiba university hospital between January 2000 and March 2017. Patients with hemodynamic instability at presentation prior to PCI were excluded. Among the 352 patients, a total of 35 patients (9.9%) developed cardiogenic shock after PCI. Mean age was 63.5 ± 9.4 years. There was no difference between male and female. Percutaneous coronary interventions were proposed for all patients and performed in a primary setting in 95.2%. Patients who developed CS after PCI had more frequently multivesel coronary artery disease, baseline thrombolysis in myocardial infarction (TIMI) flow grade < 3 and thrombus burden grade ≥ 3 (P < 0.001 for all). The culprit lesion was the left main in 26.3% and left anterior descending artery in 42.7% (P = 0.001 for both). Most patients had post PCI TIMI flow grade ≤ 2 (P < 0.001). No-reflow phenomenon was significatively higher in patients who developed CS after PCI (35.6% vs. 7.2%; P < 0.001). On multivariate analysis, no-reflow phenomenon and multivessel disease were independent predictors of post-procedural CS. The total in-hospital mortality was 11.9% and mortality was significatively higher in patients who developed CS after PCI (64.3%; P < 0.001). Despite invasive management strategy, mortality of cardiogenic shock complicating STEMI after PCI remains high. The identification of these patients may help in preventing this complication. [ABSTRACT FROM AUTHOR]

The presence of right bundle branch block (RBBB) in patients with ST elevation myocardial infarction (STEMI) has been associated with poor outcomes. However, the clinical and angiographic impact of RBBB in patients undergoing primary angioplasty are poorly established. This study aimed to evaulate the incidence, clinical and angiographic impact of RBBB in patients with STEMI treated with primary percutaneous coronary intervention (PCI). We included 352 patients admitted for STEMI and managed with primary PCI. They were enrolled between January 2000 and March 2017 in Cardiology B department of Fattouma Bourguiba university hospital. The presence of RBBB was made by a systematic electrocardiogram at admission. Right bundle branch block was documented in 12 patients (3.4%). Patients with RBBB were older (Mean age = 68.3 ± 13.35 years versus 59.7 ± 11.4 years, P = 0.012). There was not difference between male and female. Diabetes and history of angina were significantly higher in patients with RBBB (P < 0.001 for both). These patients presented more frequently anterior STEMI, congestive heart failure, cardiogenic shock at admission (P < 0.001 for all) and ventricular arrythmias (P = 0.029). On coronarography, RBBB patients had higher incidence of multivessel disease (P = 0.032), initial TIMI flow ≤ 1 (P = 0.024) and no-reflow after PCI (P = 0.014). All cause in-hospital mortality was greater in patients with RBBB (25% vs. 11.7%, P < 0.001). On multivariate analysis, persistant RBBB emerged as an independent predictor of in-hospital death (Odd ratio= 1.6; CI = 95%: 1.12–3.43; P < 0.001). Although RBBB presents in only about 3.5% of patients with STEMI, it was associated with poor in-hospital prognosis and increased in-hospital mortality. [ABSTRACT FROM AUTHOR]

Despite all improvements in diagnostic imaging and therapeutic modalities, Infective endocarditis (IE) remains a highly letal disease especially in children. Stroke is an uncommon complication of endocarditis in children but it is an major cause of acquired brain injury and is assiociated with a higher mortality rate. To determine the prevalence of neurological events in infective endocarditis among children in the Tunisian context. This was a prospective study that enrolled all children admitted for IE in the cardiology department of Monastir hospital between 1983 and 2017. Included Patients had definite IE based on the modified Ducke criteria. Fourty children with IE were identified, including 19 boys and 21 girls aged one to eighteen years. Sixteen (40%) had congenital heart disease. Left-sided IE occurred in 33 patients (82.5%), and vegetations were identified in 33 individuals (82.5%). The most often encountered microorganisms in our population were Streptococcus viridans and Staphylococcus aureus, which were identified in five and four patients, respectively. Stroke occurred in 9 patients, including five with cerebral infarction and three with intracerebral hemorrhage. The incidence of stroke in children with left-sided IE was significantly higher than in those with right-sided IE (17.5% vs. 2.5%, P < 0.001). The most common manifestation of stroke was hemiparesis (63%). The mortality in children with IE was 50%. The mortality rate in patients who had stroke was significantly higher than those who hadn't (75% versus 35%, P = 0.05). Our study indicates that stroke is common among children with IE, especially in those with left-sided IE, and stroke may increase their risk of death. [ABSTRACT FROM AUTHOR]

Myocardial infarction (MI) is the leading cause of death in Tunisia. We wanted to determine the predictors of mortality in the wake of an IDM to ensure better care. This is a study that included 1562 patients (1221 men and 341 women) hospitalized for Acute Coronary Syndrome with ST segment elevation in the Fattouma Bourguiba Monastir Heart Hospital B ward from January 1998 to September 2015. The predictive factors for 1-month mortality of MI were studied. The mortality rate was estimated at 8.3%. Sex was not a predictor of mortality (7.3% vs. 12%, P = 0.055). The history of coronary artery disease or heart failure was not a predictor of death with p equal to 0.553 and 0.575, respectively. Age over 75, diabetes, hypertension, use of an inotropic agent at admission, the occurrence of a complete atrioventricular block, complicated MI of a severe rhythm disorder (ventricular tachycardia or ventricular fibrillation) and the occurrence of severe acute mitral insufficiency would be predictive of mortality with p respectively equal to 0.03; < 0.001; 0.002; < 0.001; < 0, 001; < 0.001; 0.001. The infarct territory was also a predictor of mortality: the death rate was 10.6% in the anterior MIs, 7.6% in the inferior MIs and 2.5% in the lateral MIs (P < 0.001). The advanced age, the diabetes, the HTA, the use of an inotropic agent at the admission, the occurrence of a serious rhythmic complication or of important acute mitral insufficiency and the anterior seat of the infarct are the predictors of mortality for 1-month of MI. [ABSTRACT FROM AUTHOR]

The myocardial infarction (MI) of the young subject is a singular entity. The objective of our study was to analyze the epidemiological, clinical and progressive features of acute myocardial infarction in the young adult in the Monestir _ Tunisia Cardiology B department. This is a study that included 1525 patients (1433 men and 92 women) hospitalized for Acute Coronary Syndrome with ST segment elevation in the Fattouma Bourguiba Monastir Heart Hospital B ward from January 1998 to September 2015. In our series, 1475 (94.4%) patients were older than 40 years old so 77.4% were men. Eighty-seven patients (5.6%) were under the age of 40, so 90.8% were men (P = 0.003). Diabetes, arterial hypertension and antecedent coronary pathology are the predominant risk factors in the elderly group with p respectively equal to 0.003; < 0.001 and 0.022. Active smoking was present in 85.1% of young people with IDM and 65.7% in older adults (P < 0.001). The inaugural presentation is more frequent in the youth group (75.9% vs. 56.9%, P < 0.05). MI was complicated of atrioventricular block in 9.9% of the elderly vs. 2.3% of the youth (P = 0.019); of ventricular tachycardia (VT) in 3.7% of the elderly, while no youth presented a TV (P = 0.05) and OAP in 37.3% in the elderly vs. 14% in the young (P = 0.01). Mortality was 8.6% in the elderly group and 3.4% in the youth group. Males and tobacco are the two leading risk factors in the group of young people presenting a MI. The clinical presentation is often inaugural. The complications are rare but serious with a risk of mortality that remains high. [ABSTRACT FROM AUTHOR]

Epidemiological features of infective endocarditis have changed during the last decades because of an increase in degenerative valvular disease in the elderly, placement of prosthetic valves, and exposure to invasive procedures. Although lower mortality rates have been observed over the last decades, overall mortality remains high. This was a prospective study which included all patients diagnosed with infective endocarditis (IE) and hospitalized in the cardiology department of Monastir hospital between 1983 and 2017. We included patients who were diagnosed with definite infective endocarditis based on the modified Ducke criteria. And the aim was to analyse epidemiology, and predictors of 6-month mortality in infective endocarditis. A prospective observational cohort study included 240 patients with definite IE. Thirty-two percent of episodes involved prosthetic valves. Thirty percent of episodes were nosocomial. Thirty-three percent included staphylococci, 22% streptococci, and 10% enterococci. At least one complication occurred in 59% of the episodes and 43% had surgical intervention. Six-month mortality was 20%: 29% for staphylococci, 19% for enterococci, and 9% for streptococci. Seventy-one percent of patients with a contraindication to surgery died when compared with 7% with medical treatment without a contraindication and 13% with surgical treatment. In multivariable logistic regression, predictors of 6-month mortality were age (P = 0.04), the causative microorganism (P = 0.03), and treatment group (P = 0.03). Compared with older series, we observed more prosthetic valve IE, nosocomial IE, and surgery. Staphylococcus aureus was the predominant microorganism. Age, staphylococci, and the contraindication to surgery were the main predictors of 6-month mortality. [ABSTRACT FROM AUTHOR]

Infective endocarditis (IE) is a life threatening complication in patients with congenital heart disease (CHD). We aimed to determine the incidence, clinical features and outcomes of IE in patients with CHD. A retrospective single centre review of patients who presented IE (defined by modified Duke criteria) admitted on the cardiology B department of Fattouma Bourguiba University Hospital between January 1998 and march 2015. Among the 235 patients included, 10.2% (24 patients) had CHD. The most frequent CHD was ventricular septal defect (30%). Patients with CHD had lower mean age (24 ± 10 years vs. 38 ± 17 years, P < 0.0001). There was no significant difference for sex. Comorbidity in patients with CHD was low. The most common valves involved were tricuspid and aortic valve (19% vs. 5.44%–14.3% vs. 12.4%, P < 0.0001 respectively). Half of blood-culture was negative. Among culture-positive patients, staphyloccocus species was the most frequently implicated as causative pathogen. Detection of vegetation on trans-thoracic and trans-oesophageal echocardiography was not significantly different (91.3% vs. 81.3%, P = 0.186 and 100% vs. 91.8%, P = 0.3 respectively). Heart failure, embolic events, cerebro-vascular complications and in-hospital mortality were similar compared to patients without CHD. Population with CHD had higher recurrence rate of IE (33.3% vs. 9.1%, P = 0.023). IE in patients with CHD occurs at young age. It implicates most commonly right heart and aortic valve. Its prognosis is not different from IE in the general population but has higher recurrence rate. [ABSTRACT FROM AUTHOR]

Infective endocarditis (IE) is a severe infection with high in-hospital mortality rate. Identification of patients at high risk of death may improve their outcomes. We aim to determine clinical features and predictive factors of intra hospital mortality in patients with IE. Retrospective single-center study including patients with IE admitted during 17 years (1998–2015) in Cardiology B department of Fattouma Bourguiba University Hospital. Diagnosis of IE was made according to the modified Duke classification. A Total of 235 patients were included, 56.3% were male. Mea age was 36 ± 17 years. Forty-three percent of them had previous valvular heart disease. Prosthetic IE occurred in 25.1%. Mitral valve was the most affected by infection. In-hospital mortality rate was 18.3% (43 patients). Dead patients presented significatively more heart failure at admission (53.5% vs. 25.7%, P < 0.001), peripheral embolization (32.6% vs. 5.7%, P = 0.012), major cerebro-vascular events such as hemorrhagic stroke (16.3% vs. 3.7%, P = 0.002), mycotic cerebral aneurysm (14% vs. 4.2%, P = 0.02) and cerebral abcess (7% vs. 0.5%, P = 0.017). In multivaraite analysis, predictive factors of in-hospital death were heart failure at admission (OR = 3.8, 95% CI: 1.8–7.9, P < 0.001), embolic events (OR = 2.28, 95% CI: 1.01–5.2, P = 0.02) and hemorrhagic stroke (OR = 6.06, 95% CI: 1.8–19.5, P = 0.017). IE remains awful disease with high mortality rate. The risk factors of in-hospital death were heart failure, embolic events and hemorrhagic stroke. [ABSTRACT FROM AUTHOR]

Coronary disease represents a major cause of morbidity and mortality worldwide. To determine biological factors predicting in hospital death following primary percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI). We reviewed data from retrospective registry including 352 patients admitted in cardiology B department from January 2000 to March 2017 for STEMI. All patients were managed by primary PCI. In hospital mortality rate was 11.9% in population study. It was higher in women (23.2% vs. 9.8%; P = 0.005). Its biological predicting factors in univariate analysis were severe anemia with hemoglobin level below 8 g/dl (P < 0.001), renal failure (P < 0.001), hyperglycemia (blood glucose level greater than 11 mmol/l) (P < 0.001), leukocytosis (white blood cells count over 14.000/mm3) (P = 0.005) and platelet count over 250.000/mm3 (P = 0.037). In multivariate analysis, only renal failure and anemia were independent predicting factors of in hospital mortality (P < 0.001). Recognizing and understanding the biological risk factors of mortality after STEMI provide clinician important information to determine prognosis. [ABSTRACT FROM AUTHOR]

Coronary heart disease has been mainly considered as men disease. However, it is the leading cause of morbidity and mortality in women worldwide. We aimed to determine the clinical profile and angiographic outcomes in women following primary percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI). We included 352 patients admitted for STEMI and managed with PCI. They were enrolled between January 2000 and march 2017 in Cardiology B department of Fattouma Bourguiba university hospital. Among 352 patients, 56 were women (15.9%). They were older than men. Mean age was 66.5 ± 10 years versus 58 ± 11 years. Females had higher incidence of hypertension (55.4% vs. 24.7%; P < 0.001), diabetes (44.6% vs. 30.4%; P = 0.037), and dyslipidemia (12.5% vs. 10.8%; P = 0.012). Smoking and history of coronary disease were more prevalent in men (P < 0.001 and P = 0.024 respectively). Women had longer door to balloon time (P = 0.004). Anterior wall myocardial infarction was more represented in women population (62.5% vs. 47.3%; P = 0.020), but no significant difference was observed in the incidence of initial or post procedural cardiogenic shock. Women were more likely to have multivessel disease (17.9% vs. 10.8%; P = 0.01), initial reduced TIMI flow (78.6% vs. 70.3%; P = 0.04), no reflow (21.4% vs. 11%; P = 0.033) and per procedural coronary dissection (12.5% vs. 6.8%; P = 0.013). In hospital mortality rate was higher in female population (23.2% vs. 9.8%; P = 0.005). In multivariate analysis, female sex was not an independent factor of in hospital death. STEMI in women remains a serious pathology. Its particularities must be better known and studied in order to optimize management and prognosis. [ABSTRACT FROM AUTHOR]

Among patients with advanced chronic kidney disease (CKD), cardiovascular disease (CVD) is the leading cause of death, 15 to 30 times higher than the age-adjusted cardiovascular mortality rate il the general population. We sought to determine demographic features, cardiovascular risk factors, clinical presentation, in-hospital course and prognosis of patients on chronic hemodialysis undergoing percutaneous coronary intervention (PCI). The study was carried out on a retrospective registry including 6544 patients undergoing PCI in the Cardiology Department of Fattouma bourguiba University Hospital (Monastir, Tunisia) between January 2014 and March 2018. Out of the overall population, 214 patients were part of the CKD group and 71 were on chronic dialysis (1.1%) via arteriovenous fistula in 94.4% of cases. Forty-nine (69%) of them were male. Mean age was 58.9 ± 10.9 years (33–80 years). Dialysis patients had higher prevalence of high blood pressure (81.7%) and diabetes mellitus (49.3%). Only the third of patients was hospitalized in intensive care unit and median period of hospitalization was 10 days. At admission, CKD patients presented most commonly with non ST-elevation myocardial infarction, stable angina and ST-elevation myocardial infarction respectively in 49%, 29.5% and 14%. In-hospital complications were a blend of cardiogenic shock (2 cases), new onset atrial fibrillation (5 cases), atrioventricular block (2 cases), ventricular fibrillation (1 case), heart failure (12 cases) and ischemic mitral insufficiency (5 cases). Left ventricular function was preserved among 45% of patients and left ventricular hypertrophy was noted in 55%. Patients with CKD on chronic dialysis carry a considerable burden of CVD relative to patients with normal renal function. Initial clinical presentation was very impactful on in-hospital outcomes. [ABSTRACT FROM AUTHOR]

The Global Registry of Acute Coronary Events (GRACE) risk score is recommended in international guidelines for the risk stratification of non-ST-elevation acute coronary syndome (NSTE-ACS) for in-hospital and 6-month mortality. There is currently no validated risk model to predict mortality beyond 6 months in Tunisian context. We aimed to evaluate the performance of the GRACE risk score in predicting in-hospital, 6-month, 1-year and 3-year mortality. In this retrospective single center cohort study, all consecutive patients admitted to our department for NSTE-ACS from April 2014 to July 2016 were enrolled. Follow-up at 6 months, 1 year and 3 years was reported. The GRACE risk score was calculated for all patients and its discriminative performance for mortality prediction evaluated by means of area under the receiver operating curve (AUC). A total of 340 patients were included. Mean age was 65.2 ± 12.7 years, 61.8% were male, prevalence of diabetes mellitus and hypertension was 57.3% and 65.9%, respectively. Upon admission, 57% of patients had positive troponin assay and 13.5% had a GRACE score > 140. An invasive strategy was adopted in 86.2% of our patients and revascularization was proposed for 71.2% of them. In-hospital, 1-year and 3-year mortality were 2.35%, 3.2%, 7.6% and 15.2%, respectively. The performance of the GRACE risk score was not good for in-hospital mortality (AUC = 0.681 95% CI: 0.55–0.82, P = 0.2) probably due to the low mortality rate. The model performed well in 6-month mortality (AUC = 0.879, 95% CI: 0.82–0.93, P < 0.001), in 12-month mortality (AUC = 0.853, 95% CI: 0.77–0.92, P < 0.001) and in 3-year mortality (AUC = 0.879, 95% CI: 0.83–0.92, P < 0.001). In our context, the GRACE postdischarge risk score accurately discriminate mortality over the longer term (up to 3 years) in all subsets of NSTE-ACS patients, and thus may be used in our practice. [ABSTRACT FROM AUTHOR]

Despite the progress in diagnostic modalities and therapeutic strategies, Infective endocarditis remains a lethal disease especially in children. We aimed to update current characteristics of infective endocarditis in children and to identify complications. We carried out in our department a retrospective study including 40 children diagnosed with infective endocarditis (IE) between 1983 and 2017. Forty children with IE were diagnosed by using modified Ducke criteria. There were 19 boys and 21 girls aged between 1 to 18 years. Sixteen children (40%) had congenital heart disease including inter ventricular septal defect, tetralogy of Fallot, patent ductus arteriosis. Left-side IE occurred in 33 patients (82.5%). There was no case of IE of prosthetic valve. Streptococcus viridans were identified in 4 patients and Staphylococcus aureus in 5 patients. Blood culture-negative IE was concluded in the other cases. Neurological complications occurred in 9 patients, including 5 with cerebral infarction and 3 with intra cerebral bleeding. Clinical signs of cerebral stroke were hemiparesis (63%), facial paralysis (18%) and speech disorder (27%). One case of pulmonary embolism was identified and 3 cases of splenic infraction. The mortality in children with IE was important (50%). The mortality rate in patients who had cerebral stroke was significantly higher than those who had not (75% versus 35%, P < 0.05). In our study, IE in child has various characteristics compared to IE in adult. IE complication increases the risk of death. [ABSTRACT FROM AUTHOR]

Right-sided infective endocarditis RSIE is considered as a differential diagnosis of patients with febrile syndrome, respiratory signs and predisposing factors. It concerns mainly patients with a history of intravenous drug use (IVDU) or who have a pacemaker or other intracardiac device. The clinical presentation and treatment are different from those of left-sided endocarditis and the prognosis is more favorable, as many patients can be cured with medical treatment alone. To determine epidemiological, clinical and microbiological characteristics of RSIE in a Tunisian cohort. This was a prospective study which included patients diagnosed with infective endocarditis (IE) and hospitalized in the cardiology department of Monastir hospital between 1983 and 2017. We included patients who were diagnosed with definite infective endocarditis based on the modified Ducke criteria. Two hundred forty patients were diagnosed with IE and showed vegetations on cross-sectional echocardiography. In 31 (12.9%) patients, only the right side of the heart was involved: specifically the tricuspid valve alone or associated with pulmonary valves or the right ventricular outflow tract or free wall in 29, and pulmonary valve alone in 2. Fourteen patients (51.6%) had underlying congenital heart disease, 7 had intravascular device whereas the remaining 10 patients (48.4%) did not have any underlying heart disease. The latter group, had isolated right-sided infective endocarditis. The diagnosis can be dramatically delayed, since right-sided murmurs often go undetected, Staphylococcus aureus SA was the most common organism with a high rate mortality. Most of IE are resolved conservatively by antibiotics and surgery is only indicated in particular cases. We conclude that, like western reports, the pattern of right-sided infective endocarditis in Tunisia is almost the same; IVDU was the commonest cause and the SA was the most frequent pathogen. [ABSTRACT FROM AUTHOR]

Infective endocarditis (IE) remains a life-threatening disease. Clinical features, epidemiological parameters, and bacteriological profile are changing over the years and necessitate periodical evaluation. To determine clinical, and prognostic features of Staphylococcus aureus infective endocarditis (IE) compared with endocarditis caused by other pathogens. We conducted a prospective study which included 240 patients diagnosed with infective endocarditis (IE) according to the Duke criteria and hospitalized in the cardiology department of Monastir hospital between 1983 and 2017. Patients without identified microorganisms were excluded. The S. aureus IE group (n = 72) was compared with the group with IE caused by other pathogens (n = 121). S. aureus IE was characterised by severe co-morbidity, a shorter duration of symptoms before diagnosis, and a higher prevalence of right-sided IE Compared with IE caused by other pathogens. Cutaneous portal of entry, and history of renal failure were more common in S. aureus IE. Severe sepsis, major neurological events, and multiple organ failure were more frequent during the acute phase in S. aureus IE. In-hospital mortality (29% vs. 9%, P < 0.001) was higher in patients with S. aureus IE and the 12 months survival rate was lower in S. aureus IE than in IE caused by other pathogens (51% vs. 69%, P = 0.002). Multivariate analyses identified S. aureus infection as a predictive factor for in-hospital mortality and for overall mortality. S. aureus IE compared with IE caused by other pathogens is characterised by a higher prevalence of severe sepsis, major neurological events and organ failure leading to higher mortality. [ABSTRACT FROM AUTHOR]

Epidemiological features of infective endocarditis (IE) have changed during the last decades because of an increase in degenerative valvular disease in the elderly, placement of prosthetic valves, and exposure to invasive procedures. Although lower mortality rates have been observed, overall mortality remains high. The aim of this study was to analyse epidemiology, and predictors of 6-month mortality in IE. This was a prospective study that enrolled 240 patients admitted for IE in the cardiology department of Monastir hospital between 1983 and 2017. Included Patients had definite IE according to the modified Ducke criteria. Thirty-two percent of episodes involved prosthetic valves. Thirty percent of episodes were nosocomial. Thirty-three percent included staphylococci, 22% streptococci, and 10% enterococci. At least one complication occurred in 59% of the episodes and 43% had surgical intervention. Six-month mortality was 20%: 29% for staphylococci, 19% for enterococci, and 9% for streptococci. Seventy-one percent of patients with a contraindication to surgery died when compared with 7% with medical treatment without a contraindication and 13% with surgical treatment. In multivariable logistic regression, predictors of 6-month mortality were age (P = 0.04), the causative microorganism (P = 0.03), and treatment group (P = 0.03). Compared with older series, we observed more prosthetic valve IE, nosocomial IE, and surgery. Staphylococcus aureus was the predominant microorganism. Age, staphylococci, and the contraindication to surgery were the main predictors of 6-month mortality. [ABSTRACT FROM AUTHOR]

Spontaneous reperfusion (SR) in ST-elevation myocardial infarction has traditionally been assessed by coronary angiography. Recently, spontaneous reperfusion would be defined by reduction of ST-segment elevation and resolution of pain. In our study, we undertook a systematic assessment of SR using both clinical and angiographic techniques. To determine predictors of better prognosis in spontaneous reperfused STEMI. This was a retrospective study which included all patients diagnosed with STEMI and hospitalized in the cardiology department of Monastir hospital, Tunisia and treated by primary PCI, between 2008 and 2017. We compared clinical characteristics and outcomes in the two groups. Three hundred fifty-five patients are treated by primary percutaneous coronary intervention (PCI) and were studied: Electrocardiographic SR (>/ = 70% ST-segment resolution) occurred in 18% of patients and angiographic SR (pre-PCI Thrombolysis in Myocardial Infarction (TIMI) 3 flow) in 17.7% of patients. Thirty-day clinical outcomes of patients with ECG SR versus no ECG SR tended to have lower mortality (0% vs. 2.4%, P =.061), a lower composite of death/shock/congestive heart failure (6.9% vs. 12.2%, P =.148), and significant reductions in death/reinfarction (0% vs. 5.6%, P =.014). By contrast, no such significative differences were evident in patients with angiographic SR versus no SR for death (2.8% vs. 3.0%, P = 1.00), death/shock/congestive heart failure (10.3% vs. 11.8%, P =.498), or death/reinfarction (2.3% vs. 5.2%, P =.409). The frequency of SR was comparable using either ECG or angiographic criteria. Clinical outcomes were better assessed with ECG SR. These results support the role of ECG in detecting reperfusion versus infract-related artery epicardial patency alone. [ABSTRACT FROM AUTHOR]

The choice between thrombolysis and primary angioplasty in an acute myocardial infarction (MI) is still a topic of discussion. The objective of our study is to determine the predictive factors of success of thrombolysis in order to facilitate the choice of the therapeutic strategy in front of a MI. This is a study that included 525 patients (433 men and 92 women) thrombolyzed in the acute phase of Acute Coronary Syndromes with ST segment elevation and hospitalized in Fattouma Hospital's B Cardiology Monastir from January 1998 to September 2015. Factors influencing the response to thrombolytic therapy were investigated and a regression of the ST segment ≥ 50% at one hour after thrombolysis was selected as a re-perfusion criterion. Sex, age > 75 years, renal insufficiency and Killip IV heart failure would not be predictive of thrombolysis failure with P equals 0.609; 0.33; 0.081; 0.459,respectively. Anemia, diabetes, high blood pressure and the use of an inotropic agent at admission would be predictive of thrombolysis failure with p equal respectively to 0.03; 0.007; 0.002; < 0.001. Tobacco was also identified as a predictor of the success of fibrinolysis in patients presenting MI (74% vs. 59.8%, P = 0.001). Thrombolysis in less than 4 hours is also a predictor of success (46.8% vs. 27%, P < 0.001). In multivariate analysis, Hypertension (HR = 0.595, 95% CI 0.171–0.970, P = 0.037) and the use of inotropic drugs (HR = 0.293, 95% CI 0.171–0.504, P < 0.001) would be two independent factors of thrombolysis failure. A thrombolysis time of less than 4 hours is a predictive factor of success (HR = 0.516, 95% CI 0.329-0.809, P = 0.004). Hypertensive patients and those who required inotropes in the acute phase are less responsive to thrombolytic therapy. During the reperfusion strategy decision, the time factor with a delay of less than 4 hours is decisive in predicting the good results of fibrinolysis. [ABSTRACT FROM AUTHOR]

Embolic events (EEs) in infective endocarditis worsen prognosis. Searching early signs predicting EEs may change clinical decisions such as surgical timing and reduce mortality. Our study aimed to identify risk factors of embolic events in our population. This was a prospective study which included all patients diagnosed with infective endocarditis (IE) and hospitalized in the cardiology department of Monastir hospital, Tunisia, between 1983 and 2017. We included patients who were diagnosed with definite infective endocarditis based on the modified Ducke criteria. Three hundred forty patients were included in this study. The mean age of the patients was 37 ± 17.92 years; 56.4% men were and 33% had rheumatic heart disease. Major predictors of EEs were gram-negative bacillus infection (RR 1.4, 95% CI), mitral valve vegetation (RR 1.3, 95% CI), and vegetation size > 10 mm (RR 1.6, 95% CI). EEs risk was also higher elevated C reactive protein, renal failure, prosthetic mechanical valve vegetation, and lower with Streptococcus spp. and staphylococcus spp. infection. Given the serious consequences of embolism, early surgical intervention may be considered in patients with these risk factors. [ABSTRACT FROM AUTHOR]

Despite all improvements in diagnostic imaging modalities and therapeutic regimens, Infective endocarditis remains a lethal disease especially in children. Stroke is an uncommon complication of endocarditis in children but it is an important cause of acquired brain injury which is associated with a higher mortality rate. This was a prospective study that included all children diagnosed with infective endocarditis (IE) and hospitalized in the cardiology department of Monastir hospital between 1983 and 2017. We included patients who were diagnosed with definite infective endocarditis based on the modified Ducke criteria. Forty children with infective endocarditis were identified, including 19 boys and 21 girls aged Twelve months to eighteen years sixteen (40%) of these individuals had congenital heart disease. Left-sided endocarditis occurred in 33 patients (82.5%), and vegetations were found in 33 individuals (82.5%). The most often encountered micro-organisms in our population were Streptococcus viridans and Staphylococcus aureus, which were identified in five and four patients, respectively. Postendocarditis stroke occurred in 9 patients, including five with cerebral infarction, three with intracerebral hemorrhage and one with pulmonary infraction. The incidence of stroke in children with left-sided endocarditis was significantly higher than those with right-sided endocarditis (17.5% versus 2.5%, P < 0.01). The most common manifestation of stroke was hemiparesis (63%). The mortality in children with endocarditis was important (50%). The mortality rate in patients who had stroke was significantly higher than those who had not (75% versus 35%, P < 0.05). Our study indicates that stroke is common among children with infective endocarditis, especially in those with left-sided endocarditis, and major stroke may increase their risk of death. [ABSTRACT FROM AUTHOR]

Despite all improvements in diagnostic imaging modalities and therapeutic regimens, Infective endocarditis remains a lethal disease which is associated with a high mortality rate. The early identification of patients at risk of infective endocarditis complications is essential to improve prognosis. We aimed at identifying the predictive factors at admission for poor outcomes in infective endocarditis patients. This was a prospective study which included all patients diagnosed with infective endocarditis (IE) and hospitalized in the cardiology department of Monastir hospital between 1983 and 2017. We included patients who were diagnosed with definite infective endocarditis based on the modified Ducke criteria. Three hundred forty patients were included in this study. The mean age of our patients was 37 ± 17.92 years. There were 56.4% men and 43.6% women. The third of the population had rheumatic heart disease. Cardiac surgery was performed in 76 patients (22.3%), and the overall in-hospital mortality rate was 25%. In the multivariable analysis, the independent predictors of death were: age > 60 years (odds ratio (OR) 1.13, 95% confidence interval (CI) 1.02–1.13), C-reactive protein (CRP) at hospital admission (OR 1.12, 95% CI 1.04–1.21), and the vegetation length on diagnosis (OR 1.15, 95% CI 1.03–1.28). Also, heart failure, cardiogenic shock and embolic events during hospitalization were associated with a poor prognosis. Age, C-reactive protein, and the vegetation size were independent factors associated with and in-hospital mortality. Identifying the predictive factors of mortality in infective endocarditis may improve outcomes. [ABSTRACT FROM AUTHOR]

Pericardial effusion (PE) is a frequent finding in the setting of infective endocarditis and is widely believed to signify more advanced infective endocarditis (IE) and generally worst outcomes. Our study aimed to identify clinical characteristics and outcomes of patients who had pericardial effusion. This was a prospective study which included all patients diagnosed with infective endocarditis (IE) and hospitalized in the cardiology department of Monastir hospital, Tunisia, between 1983 and 2017. We included patients who were diagnosed with definite infective endocarditis based on the modified Ducke criteria. Three hundred forty patients were included in this study. The mean age of the patients was 37 ± 17.92 years; 56.4% men and 33% had rheumatic heart disease. Pericardial effusion was observed in 6.35% of patients, most of them being mild or moderate (93.6%). Pericardial effusion was frequent in young patient. The presence of pericardial effusion was associated with a higher risk of heart failure during admission (60% vs. 32%, P = 0.05). Patients with pericardial effusion had a higher rate of early surgery (23.3% vs. 3.6%; P = 0.02) also. Despite these findings, the presence of pericardial effusion was not associated with a higher in-hospital or one-year mortality (16% vs. 21%; P = 0.2 and 25% vs. 37.3%; P = 0.70 respectively). Pericardial Effusion was not an independent predictor of mortality. Its presence is associated with the development of heart failure during hospitalization, frequent surgery, probably reflecting indirectly mechanical complication. [ABSTRACT FROM AUTHOR]

Persistent left superior vena cava (PLSVC) can be incidentally detected during pacemaker implantation from the left pectoral side. Optimal site pacing is technically difficult, and lead stability of the right ventricle (RV) can lead to such a situation. We describe a case of successful single-chamber pacemaker implantation in a 76-year-old woman with a PLSVC and concomitant agenesis of the right-sided superior vena cava, after failed attempts with the conventional procedure. The pacemaker had been working well after 12 months of follow-up. [ABSTRACT FROM AUTHOR]

Introduction The persistent ductus arteriosus remains a common congenital pathology. If percutaneous closure of wide channels by Amplatzer duct occluder is an attractive alternative to the surgical treatment, this prosthesis is however not recommended for infants less than 6 kg. Purpose Our objective was to evaluate the efficacy and the safety of use of this prosthesis in low-weight children. Patients and methods The records of children less than 6 kg who underwent closure by the Amplatzer Duct Occluder prosthesis between January 2010 and December 2015 were retrospectively analyzed. Results Fourteen patients [mean weight 5.7 kg (4.8 to 6); mean age 6.5 months (3–12)] have been included. The average diameter angiographic persistent ductus arteriosus was 3.5 mm (3–6 mm) with a good correlation with that found on ultrasound ( r = 0.68). The prosthesis was implanted successfully in 92.8% of cases. The immediate angiographic occlusion rate was 71.4%. The average duration of the procedure was 46 ± 12 min. Three children had a type of channel C of the classification Krichenko. Two complications occurred in two of our patients. Persistent ductus arteriosus C-type (tubular) and a diameter ratio of the persistent ductus arteriosus/weight of higher child 0.95 were significantly associated with a failure of intervention and/or major complications throughout the percutaneous closure of register having included 67 patients, while a weight of less than 6 kg was not retained as a predictor of failure of the procedure. No late embolisation occurred after 11 months of median follow up. During this monitoring, we noted a marked clinical improvement with normalization of pulmonary pressure. Conclusion Our study includes the few records reported in the literature assessing the feasibility of percutaneous closure in persistent ductus arteriosus in infants less or equal to 6 kg. It confirms the effectiveness of the procedure with a relatively low prevalence of complications. [ABSTRACT FROM AUTHOR]