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Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) is a heterogeneous entity often overlooked in contemporary medicine. Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) is a heterogeneous entity often overlooked in contemporary medicine. To assess incidence and characteristics of MINOCA in a large cohort of patients admitted for myocardial infarction. A total of 1734 consecutive patients were retrospectively enrolled in the STEMI registry of the cardiology B department of Fattouma Bourguiba university. MINOCA was defined as a non-obstructive coronary artery disease and a lack of previous coronary revascularization. Clinical profile and prognosis of all patients were assessed. The proportion of MINOCA patients among all myocardial infarction was 2.7%. The MINOCA patients were younger (age 47 ± 14.9 vs. 60.7 ± 12.4 years), more often males (87.2% vs. 78.7%) with significantly lower rates of diabetes mellitus (19.1% vs. 36.4%, p = 0.015), hypertension (10.6% vs. 30.6%, p = 0.003), kidney disease (2.1% vs. 7.8%, p = 0.032), peripheral artery disease (2.8% vs. 8.3%, p = 0.015) and previous MI (2.1% vs. 11.1%, p = 0.028) comparing to patients with obstructive coronary artery disease (CAD). History of smoking was more common in the MINOCA group. Typical chest pain at presentation was higher in MINOCA patients (98.6% vs. 93,4%, p = 0.046). MINOCA patients presented more frequently anterior ST- segment elevation. All-cause in-hospital and 5 years follow-up mortality rate was lower in the MINOCA patients (1.5% vs. 9.6%, p < 0.001; 7.6 vs. 13.8%, p = 0.036 respectively). MINOCA represents a challenging group of heterogeneous patients whose clinical characteristics contrast with classical cardiovascular risk factors. A search for etiology and eventual treatment provides a rich avenue for improving prognosis in patients with MINOCA. [ABSTRACT FROM AUTHOR]

Background: Infective endocarditis (IE) is a rare condition in the paediatric setting. No data on the epidemiology and prognosis of IE in children are available from North African countries., Aim: To investigate the epidemiological profile and prognosis of IE in children in Tunisia., Methods: All patients aged≤18 years presenting with IE in three Tunisian tertiary care centres between January 1997 and September 2013 were included. Clinical features and 30-day and 6-month mortality rates were studied. Factors predictive of death at 6-month follow-up were determined., Results: A total of 73 patients were included in the present study. The mean age was 12±4.8 years; 35 (50.7%) patients were male. Rheumatic heart disease (RHD) was the underlying heart disease in 17 (23.3%) cases and IE occurred in a structurally normal heart in 36 (49.3%) cases. Staphylococcus species were isolated in 17 (23.3%) cases. Regarding IE localization, the mitral valve was involved in 28 (38.4%) cases and the aortic valve in 14 (19.2%) cases. Recourse to surgery was reported in 37 (50.7%) cases. Thirty-day and 6-month mortality rates were 13.6% and 19.2%, respectively. Heart failure on admission or during the hospital course, acute renal failure and neurological complications were significantly associated with death at 6-month follow-up in the univariate analysis and after adjustment for age and sex., Conclusions: In the Tunisian context, IE in children is still characterized by the high prevalence of RHD as an underlying heart disease. Short- and long-term mortality rates remain high. Heart failure, acute renal failure and neurological complications are significantly associated with death at 6-month follow-up., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)