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Patients with ferromagnetic cardiac devices, particularly cardiac implantable electronic devices (CIED) such as pacemakers or implantable cardioverter defibrillators, are often inappropriately deprived of magnetic resonance imaging (MRI) for safety reasons. This consensus document is written by a multidisciplinary working group involving rhythmologists, interventional cardiologists, echocardiographists and radiologists. Its objective is to establish good practice recommendations to optimize the management of patients with cardiac devices requiring MRI examination, while ensuring their safety and facilitating their access to MRI.

The article starts with a report on the history of medical simulation with some examples, and then it explores the evolution of mannequins and the methods using simulation in medicine, from the beginning to their present use.

Galectin-3 is a new biomarker assumed to reflect fibrogenesis and inflammation. We aimed to investigate the relation of Gal-3 with the severity of coronary artery disease in patients with ST elevation myocardial infarction.The prospective study enrolled 62 patients with ST elevation myocardial infarction who underwent coronary angiography. The burden of atherosclerosis was assessed by the number of involved vessels, the number of coronary lesions with a stenosis diameter more than 50% and the Gensini score. Gal-3 levels were measured on admission on miniVIDAS (BioMérieux).The mean age of the patients was 56±11 years old; 93.5% were males. Diabetes, hypertension and hyperlipidemia were respectively 29%, 35.5% and 24.2%. Among patients, 80.6% were active smokers. Mean level of Gal-3was 17±11 ng/ml and didn't differ significantly from the number of involved coronary vessels (p=0.82) and the Gensini score (p=0.4). There was a positive correlation between the number of coronary lesions with a stenosis diameter greater than 50% and Gal-3 (p=0.04).In patient with ST elevation myocardial infarction we found a positive correlation between the number of coronary stenosis and Gal-3 level.

Background The rheumatoid arthritis is responsible of an increased risk of cardiovascular (CV) morbidity and mortality. Objectives The aim of the study is to determine, in established RA patients, the presence of silent myocardial ischemia using a stress test and its association with the disease activity and the CV risk factors and scores. Methods It is a transversal and prospective study in a rheumatologic center in Charles Nicolle hospital in Tunisia. 103 RA patients, asymptomatic for CV disease were submitted to a stress test. Demographic data, cardiovascular risk factors and the disease characteristics were assessed for all patients and risk factors of silent myocardial ischemia in RA patients were identified. The comparison of qualitative variables was performed with the Chi square test and the comparison of qualitative variable and quantitative ones was performed with the Student’s test. The significance level was set at 0.05. Results There were 103 patients (sex-ratio=0.3) with a mean age of 53±10 years. The evaluation of the disease activity showed that the mean DAS28 CRP, CDAI and SDAI were 3.9±1.38, 17.17±11.4 and 33.39±26, respectively. A screening for CV risk factors revealed: 13% of patients had a cardiovascular inheritance, 25% of patients were either smokers or hypertensives, 18% had diabetes, 70% were obese or overweighted and 14 patients had dyslipidemia. The ischemic ratio (CT/HDL) revealed that 42% of patients had a moderate to high myocardial ischemic risk. HeartSCORE was high in 35% of cases. A silent myocardial ischemia in the stress test was found in 11 patients (10.6%) and was associated with male sex (p=0.03), advanced age (p=0.04), erosive character (p=0.05), the advanced age of the rheumatoid arthritis diagnosis (p=0.01) and the ischemic ratio (p=0.06). No relationship was found with the majority of traditional CV factors nor with disease activity variables. Conclusion Our results corroborated the hypothesis that the stress test could reveal subclinical CV dysfunction, supported the utility of the Heartscore as a screening tool, and put in perspective the potential usefulness of complementary approaches in CV risk assessment in RA patients. Disclosure of Interests None declared

Implantable medical devices (IMDs) are surgically implanted into a human body to collect physiological data and perform medical therapeutic functions. They are increasingly being used to improve the quality of life of patients by treating chronic ailments such as cardiac arrhythmia, diabetes, and Parkinson's disease. However, recent research has demonstrated the deficiency of wireless IMDs in enforcing security and privacy, and discussed the impact of these attacks on the patient's safety and efficacy of medical treatments. This paper provides an overview of the main vulnerabilities of IMDs. It also reviews the recent research on IMD security and privacy, and discusses their advantages and limitations. In this paper, we also describe the main requirements for improving security of IMDs and identify and discuss a set of research challenges for designing the next generation of secure wireless IMDs. Copyright © 2013 John Wiley & Sons, Ltd.

Background : In Tunisia, diabetes mellitus and hemoglobinopathies are major public health problems. Glycated hemoglobin (HbA1c) is recommended for long-term monitoring of diabetes mellitus, but the presence of hemoglobin variants may interfere with HbA1c measurement. The aim was to determine the prevalence of hemoglobin variants in Tunisian diabetics and optimize the monitoring of diabetics using HbA1c. Methods : The study enrolled 9,792 Tunisian diabetic patients. HbA1c was measured by cation-exchange high-pressure liquid chromatography (HPLC). All the chromatograms were analyzed for the presence of Hb variants. Results : We identified 228 cases (2.33%) of Hb variants with D-10 HPLC (Bio-Rad): 191 with HbA/S trait, 27 with HbA/C trait, and 10 hemoglobin variants with the mention ‘Variant-Window’ on the chromatograms and subsequently identified as HbA/S on Variant I HPLC (Bio-Rad). Thus, the prevalence of HbS was 2.05%. We did not find any homozygous variant. All HbA1c results were reported to the treating physician. Conclusions : To evaluate glycated hemoglobin in populations with a high prevalence of hemoglobinopathies, we should use the HPLC method, which is easy, economical, and reliable. Based on an algorithm, hemoglobin variants visualized on HPLC should be reported to the physician to improve the management of patients. Keywords: hemoglobinopathies; HbA1c; HPLC; diabetes mellitus; prevalence; Tunisia (Published: 27 October 2014) Citation: Libyan J Med 2014, 9 : 25768 - http://dx.doi.org/10.3402/ljm.v9.25768

Introduction Arterial hypertension (AH) is a potent factor of cardiovascular death in chronic dialysis patients (CDP). Development of ambulatory blood pressure monitoring (ABPM) allowed a better analysis of inter dialysis blood pressure (BP) profile. We studied the relationship between ABPM findings and clinical and biological data in CDP, to determinate its clinical application. Methods Retrospective study of 24 hours ABPM (after dialysis) in 28 CDP divided into 3 groups according to pre dialyses BP profile: G1: CDP with controlled AH (n=8) G2: CDP with un-controlled AH (n=12) G3: CDP without AH (n=8) Results ABPM findings are correlated to clinical BP measurements before and after dialysis. Mean systolic ABP is lower than pre dialysis clinical BP. 82% of CDP loose the BP circadian cycle. 64,3% of CDP and 83,3% of patients with AH had echocardiographic left ventricular (LV) hypertrophy. LV mass is correlated to BP load, the anemia's severity, the loss of the BP circadian cycle and the use of acetate in dialysis bath. Conclusion ABPM in CDP has various clinical applications: • diagnosis of AH • Evaluation of AH treatment • Evaluation of cardiovascular death risk

Echinococcosis is a human infection caused by the larvalstage of Echinococcocus granulosus. The most commonsites of infection are the liver and the lungs. Cardiac in-volvement is very rare (0.5-3%) even in regions in whichhydatic disease is endemic (the south Mediterranean coun-tries and Africa). We report a case of a 28-year-old man,who died suddenly. According to his family he was an ap-parently healthy man without medical history; he was founddead in the bathroom. The post-mortem examination re-vealed a large cyst (6×8 cm) in the left ventricle of the heartwith an intact wall (Picture 1) and a small daughter cystprotruding in the pericardial cavity (Picture 2, panel A). Thecytologic examination of the cyst fluid demonstrated thepresence of the characteristic scolices and hooklets and con-firmed the diagnosis of cardiac hydatid cyst. Causes of car-diac sudden death involve different mechanisms (1) includ-ing ventricular arrhythmia, cardiac outflow obstruction orconduction tract disturbance, pulmonary and cerebral embo-lism, cardiac tamponade, and myocardial ischemia.

Purpose Despite significant enhancements in resuscitation methodology, survival after sudden cardiac arrest remains low. Improved knowledge of warning signs and symptoms may help to detect victims for sudden death. Aim to study the warning symptoms prior to sudden cardiac death. Methods We prospectively collected epidemiological and autopsy data from victims of sudden cardiac death in northern Tunisia (3.6 million people) between October 2012 and September 2013. We included victims ?20 years old requiring a forensic autopsy. Data (risk factors, symptoms) were collected by assessment of the accounts of family members/relatives, witnesses, as well as medical records during this time period. The heart was weighed and then investigated by macroscopic examination looking for scars of myocardial infarction. The three main coronary arteries were macroscopically examined by transverse slices at 2-3-mm intervals along their lengths. Results Of the 542 sudden deaths within the study period, 372 males and 91 females were medico-legally autopsied. Mean age of victims was 50.9±15 years. Physical inactivity and smoking were the most common risk factors, accounting for 74.7% and 61.5%, respectively. A family history of sudden death was identified in 10.8% of victims. Most deaths occurred in a public place (39.3%) or at home (36.9%). Of the total deaths, 298 (64.4%) occurred while the individuals were relaxing, 52 (11.2%) while sleeping, 92 (19.9%) while dealing with an activity, and 21 (4.5%) under emotional stress. Syncope was the most frequent symptom occurring in 36.1%, chest pain in 18.6%, dyspnea in 8.6% and 10.1% had dizziness or fainting. The autopsic study showed that 231 deaths (49.9%) were due to coronary artery diseases. Eight percent of victims have consulted a doctor within the last 48 hours and 21% up to 1 month. Conclusions Warning symptoms prior to sudden cardiac death may occur longer before the death. Recognizing these precocious signs could have implications for prevention of this public health problem.

Introduction Heart failure is a common problem in elderly people. In the elderly population, heart failure with preserved ejection fraction (HFPEF) has been increasingly recognized. The aim of this study was to compare clinical features and clinical outcomes between HFPEF and HFREF in patients older than 65 years. Methods We enrolled 30 patients over 65 years old, who were admitted for heart failure between April 2009 and February 2010. We retrospectively analysed the clinical features including laboratory data and echocardiography parameters. Results In 19 patients (63%) left ventricular ejection fraction was preserved. Acute pulmonary edema (74% vs 27%) is the most frequent presentation in patients with HFPEF. Those patients have thicker left ventricular wall (68% vs 27%). The ischemic heart diseases as background disease is more frequent in HFREF (46% vs 5, 2%). There was no difference in short-term outcomes between HFPEF and HFREF. Conclusion Our study has shown that more than the half of the CHF patients over 65 years of age had HFPEF. Left ventricular hypertrophy was one of the risk factors for HFPEF, and the short-term outcomes of HFPEF in this population were not different from that of HFREF.