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Introduction: Despite different ultrasound parameters, left ventricular filling pressures (LVFP) assessment remains inconclusive in some cases. We aimed to determine the contribution of left atrial strain (LAS) in estimating LVFP in patients suspected of having heart failure with preserved ejection fraction (HFpEF). Methods: This was a monocentric study, carried out in the cardiology department of the Interior Security Forces Hospital of Marsa, between October 2021 and March 2022. Patients had a physical examination, a biological assessment and an ultrasound examination at rest and, if necessary, during exercise. We investigated the performance of LAS components (Peak atrial longitudinal strain (PALS), peak atrial contraction strain (PACS) and conduit function (FnC) in predicting LVFP rising. Results: We enrolled 73 patients. The mean age was 61 ± 12 years old with a female predominance (57.5%). The median PALS was 29.3% [21.4-32.4]. The mean PACS and FnC values were 13.4% ±4.9 and 13.7% ±4.7, respectively. patients were categorized into two finals groups according to LVFP: Group A= high LVFP at rest or during exercise (25=34%) and Group B= not-high LVFP at rest and during exercise (48=66%). Patients with high LVFP, had lower LAS parameters and higher NT-Pro BNP levels. LAS had negative correlations with the E/e' ratio and NT-Pro BNP. PALS was an independent predictor of LVFP raising (HR= 0.711; 95% CI: 0.513-0.986; p= 0.041). Conclusion: LAS is a simple, reproducible and sensitive ultrasound parameter for the diagnosis of HFpEF.

The 2022 report of the Intergovernmental Panel on Climate Change (IPCC) paints a dark picture of the future of life on earth, characterised by ecosystem collapse, species extinction, and climate hazards such as heatwaves and floods (1). These are all linked to physical and mental health problems, with direct and indirect consequences of increased morbidity and mortality.COP27 is the fifth Conference of the Parties (COP) to be organised in Africa since its inception in 1995. Ahead of this meeting, we—as health journal editors from across the continent—call for urgent action to ensure it is the COP that finally delivers climate justice for Africa and vulnerable countries. This is essential not just for the health of those countries, but for the health of the whole world.

As part of the strategy to safeguard the indexing of the review «La Tunisie Médicale», and the consolidation of its scientific reputation, in Tunisia, the Maghreb and Africa, the new editorial team reported the lessons of a recent bibliometric audit for the management of manuscripts submitted to the journal «La Tunisie Médicale» during the period 2015-2019. During this five-year study, 2376 papers were received by the journal "La Tunisie Médicale", 87% of which came from Tunisia, particularly Cardiology, Pathological Anatomy and Cytology, and Pneumology. If 17% of the manuscripts persisted as «case reports», only 7% were summaries of the literature. During this five-year period, 923 reviewers were mobilized, and the acceptance rate was 32%. Based on this editorial audit and taking into consideration the difficulties of scientific publishing, the plan to safeguard the indexing of our national journal and its resilience should consist of the following measures: 1. Submission development scientific manuscripts, at a rate of 1000 papers per year, by the year 2025; 2. Ensure representation of all health science disciplines on the editorial team; 3. Prioritize the publication of research articles, having a better chance of citation; 4. Enrich the base of readers by more approved reviewers; 5. Establish a didactic reviewing model, centered on the development of authors' skills and their support.

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During the month of Ramadan, over one billion Muslims observe a water and food fast from sunrise to sunset. The practice of this religious duty causes marked changes in eating and sleeping habits. With the increasing incidence of cardiovascular (CV) risk factors, the number of patients with CV pathologies who wish to fast is increasing worldwide, and in Tunisia, which is ranked as a high CV risk country. If fasting has been shown to be beneficial for the improvement of some metabolic parameters, its practice in patients with CV pathology remains debated. The Tunisian Society of Cardiology and Cardiovascular Surgery (STCCCV) in consultation with the National Instance of Evaluation and Accreditation in Health (INEAS) has established this document in the form of a consensus after having analysed the literature with the aim of addressing these questions: -What is the impact of fasting in patients with CV pathologies? -How to stratify the risk of fasting according to CV pathology and comorbidities? -How to plan fasting in patients with CV diseases? -What are the hygienic and dietary measures to be recommended during fasting in patients with CV pathologies? -How to manage medication during the month of Ramadan in patients with CV diseases?

The SCImago platform had just announced, at the beginning of 2022, the new position of the journal «La Tunisie Médicale» (ISSN: 0041-4131; IeSSN: 2724-7031) in the third quartile (Q3) of journals in the field. Medicine/General Medicine, with an SJR index (2021) of 0.29 and an Impact Score (2 years) of 0.53. As for the Scopus® platform, it reported for the journal «La Tunisie Médicale», a CiteScore 2021 of 0.8 (between 2018-2021: 514 citations and 630 documents) and a position at the 34th percentile. To improve its notoriety indices, the new editorial team of the journal "La Tunisie Médicale" will immediately: 1. Select research manuscripts with a high level of evidence; 2. Invite leaders in scientific biomedical writing to actively participate in its special thematic issues; 3. Mobilize an international team of competent, available and committed reviewers.

As part of the strategy for developing its editorial performance Tunis'Med'2030, based on productivity, quality and visibility, the journal «La Tunisie Medicale» (ISSN: 0041-4131, IeSSN: 2724-7031), focused on the identification of Tunisian champions of scientific medical writing, to invite them to submit editorials, describing the prospects for the development of their specialties, and motivating young researchers from low-income countries to excellence academic. The identification of these leaders in scientific medical research was based on the new edition of the Research.com platform (https://research.com/scientists-rankings/medicine) of December 2021. After contacting these national champions of scientific writing, the journal «La Tunisie Medicale» hopes on the one hand to improve its scientific citation and its international notoriety and on the other hand to provide a framework for partnership between national immigrant skills and young researchers residing in the country, under the teaches the social responsibility of scientific research.

Dyslipidemias are a major cardiovascular risk factor. The control of LDLc level is one of the major targets in patients admitted for an acute coronary syndrome (ACS).To study the lipid profile after ACS and to assess the degree of applicability of the European guidelines in Tunisia.This was a prospective, multicentric, non-randomized study involving consecutive patients admitted for ACS between October 2019 and March 2020; for whom a lipid assessment was carried out on admission and checked after four to six weeks under high dose of statin.One hundred patients were included. The mean age of our population was 58.7 years and the sex ratio was 5.7. Obesity was present in 15%, Diabetes in 35%, hypertension in 34% and smoking in 61% of cases. Our patients presented with ST segment elevation myocardial infraction in 51%. The mean total plasma LDLc level was 1.04±0.26g/L. A reduction in LDLc levels of more than 50% was noted in 33% of patients. A value less than 0.55g/L of LDLc was noted in 46% of patients. The therapeutic target (LDLc.

Background Contemporary registries on atrial fibrillation (AF) are scare in North African countries. Hypothesis In the context of the epidemiological transition, prevalence of valvular AF in Tunisia has decreased and the quality of management is still suboptimal. Methods NATURE‐AF is a prospective Tunisian registry, involving consecutive patients with AF from March 1, 2017 to May 31, 2017, with a one‐year follow‐up period. All the patients with an Electrocardiogram‐documented AF, confirmed in the year prior to enrolment were eligible. The epidemiological characteristics and outcomes were described. Results A total of 915 patients were included in this study, with a mean age of 64.3 ± 22 years and a male/female sex ratio of 0.93. Valvular AF was identified in 22.4% of the patients. The mean CHA2DS2VASC score in nonvalvular AF was 2.4 ± 1.6. Monotherapy with antiplatelet agents was prescribed for 13.8% of the patients. However, 21.7% of the subjects did not receive any antithrombotic agent. Oral anticoagulants were prescribed for half of the patients with a low embolic risk score. In 341 patients, the mean time in therapeutic range was 48.87 ± 28.69%. Amiodarone was the most common antiarrhythmic agent used (52.6%). During a 12‐month follow‐up period, 15 patients (1.64%) had thromboembolism, 53 patients (5.8%) had major hemorrhage, and 52 patients (5.7%) died. Conclusions NATURE‐AF has provided systematic collection of contemporary data regarding the epidemiological and clinical characteristics as well as the management of AF by cardiologists in Tunisia. Valvular AF is still prevalent and the quality of anticoagulation was suboptimal.

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.

In patients with cardiac implantable electronic devices CIEDs, including cardiac pacemakers (PM) and implantable cardioverter-defibrillators (ICD), radiotherapy (RT) could compromise CIED function. Managing radiotherapy patients with CIED, has been a great practical and procedural challenge in radiotherapy and requires a structured multidisciplinary approach. A consensus document is presented as a result of a multidisciplinary working group involving cardiac electrophysiologists, Radiation Oncologists and Medical physicists. It aims to propose recommendations on risk stratification, management approach before, during and after radiation treatment/course of patients with CIED.

BackgroundHypertension is the leading cause of morbi-moratlity in low, middle as well as high incomes countries. Tunisia is a developing country with a high cardiovascular profile and the prevalence of hypertension has widely increased during the last decades. Thus, we conducted this national survey on hypertension to analyze the profile of the Tunisian hypertensive patient and to assess the level of blood pressure control. MethodsNature HTN is an observational multicentric survey, including hypertensive individuals and consulting their doctors during the period of the study. The primary endpoint of our study was uncontrolled hypertension defined by a systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90mmHg. Our objective is to assess the predictors of uncontrolled hypertension in our population. Results Three hundred twenty one investigators from all the Tunisian governorates participated in the study. We enrolled 25890 patients with a female predominance (Sex ratio 1.21) and an average age 64.4±12.2 year-old. Most of individuals were treated in the public sector (74%), 39.4% of patients were diabetic, 25.8% were obese, 44.6% were overweight and 14% were smokers. Hypertension was controlled in 51.7% of cases if we consider 140/90 as BP target and only in 18.6% if we consider 130/80 as a target. The independents predictors of uncontrolled blood pressure were male sex (OR=1.09, 95%CI [1.02-1.16]), age> 65 year-old (OR=1.07, 95% CI[1.01-1.13], diabetes (OR=1.18, 95% CI [1.11-1.25], Smoking (OR=1.15, 95% CI [1.05-1.25]), Obesity (OR=1.14, 95% CI[1.07-1.21]), management in public sector (OR=1.25, 95% CI [1.16-1.34]) and Heart rate >80bpm (OR=1.59, 95% CI [1.48-1.71]). Contrarily, high educational level (OR=0.9, 95% CI [0.84-0.97], absence of history of coronary disease (OR=0.86, 95% CI [0.8-0.93]), salt restriction (OR=0.48, 95% CI [0.45-0.51]), drug compliance (OR=0.57, 95% CI[0.52-0.61]) and regular physical activity (OR=0.77, 95% CI[0.71-0.84]) are strong predictors of blood pressure control. Conclusion Nature HTN showed a remarkable improvement of blood pressure control amongst Tunisian people. The control remains low in patients with high cardiovascular profile and those treated in the public sector. A national health program based on therapeutic education, regular control and continuous giving much support to the public institutions is needed to decrease the hypertension burden affection rate in our population.

Background Hypertension is the leading cause of morbi-mortality in our country. Thus, we conducted this national survey on hypertension to analyze the profile of the Tunisian hypertensive patient and to assess the level of blood pressure control. Methods Nature HTN is an observational multicentric survey, including hypertensive individuals and consulting their doctors during the period of the study. Blood pressure measurements were conducted during consultation, using a standardized auscultatory or oscillometric sphygmomanometer after at least 15 min of rest. The diagnosis of new hypertension is based on the 2018 ESC/ESH criteria. The primary endpoint of our study was uncontrolled hypertension defined by a systolic blood pressure ≥ 140 mmHg and/or diastolic blood pressure ≥ 90 mmHg. Results Three hundred twenty-one investigators participated in the study. We enrolled 25,890 patients with a female predominance (Sex ratio, 1.21) and an average age of 64.4 ± 12.2 years. Most individuals were treated in the public sector (74%), 39.4% of patients were diabetic, 25.8% were obese, 44.6% were overweight and 14% were smokers. Hypertension was controlled in 51.7% of cases if we consider 140/90 as a BP target, and only in 18.6% if we consider 130/80 as a target. The independent predictors of uncontrolled blood pressure were male sex (OR = 1.09, 95%CI [1.02–1.16]), age > 65 year-old (OR = 1.07, 95% CI[1.01–1.13], diabetes (OR = 1.18, 95% CI [1.11–1.25], Smoking (OR = 1.15, 95% CI [1.05–1.25]), Obesity (OR = 1.14, 95% CI[1.07–1.21]), management in public sector (OR = 1.25, 95% CI [1.16–1.34]), and Heart rate > 80 bpm (OR = 1.59, 95% CI [1.48–1.71]). Contrarily, high educational level (OR = 0.9, 95% CI [0.84–0.97], absence of history of coronary disease (OR = 0.86, 95% CI [0.8–0.93]), salt restriction (OR = 0.48, 95% CI [0.45–0.51]), drug compliance (OR = 0.57, 95% CI[0.52–0.61]), and regular physical activity (OR = 0.77, 95% CI[0.71–0.84]) are strong predictors of blood pressure control. Conclusion NaTuRe HTN showed that blood pressure control was reached in more than half of the Tunisian people. The control remains low in patients with high cardiovascular profiles and in those treated in the public sector. A national health program based on therapeutic education, regular control and continuous support to the public institutions is needed to decrease the burden of hypertension incidence rate.

International audience; The NATURE-HF registry was aimed to describe clinical epidemiology and 1-year outcomes of outpatients and inpatients with heart failure (HF). This is a prospective, multicenter, observational survey conducted in Tunisian Cardiology centers. A total of 2040 patients were included in the study. Of these, 1632 (80%) were outpatients with chronic HF (CHF). The mean hospital stay was 8.7 ± 8.2 days. The mortality rate during the initial hospitalization event for AHF was 7.4%. The all-cause 1-year mortality rate was 22.8% among AHF patients and 10.6% among CHF patients. Among CHF patients, the older age, diabetes, anemia, reduced EF, ischemic etiology, residual congestion and the absence of ACEI/ ARBs treatment were independent predictors of 1-year cumulative rates of rehospitalization and mortality. The female sex and the functional status were independent predictors of 1-year all-cause mortality and rehospitalization in AHF patients. This study confirmed that acute HF is still associated with a poor prognosis, while the mid-term outcomes in patients with chronic HF seems to be improved. Some differences across countries may be due to different clinical characteristics and differences in healthcare systems.

The quality of the training of medical students is one of the guarantors of the proper functioning of our health system. Gamification is an innovative educational pedagogical method that stimulates the pleasure of learning and encourages learner motivation.To evaluate the subjective and external motivations and academic self-efficacy of DCEM1 students by playing with TD sessions designed to learn the systematic interpretation of rhythm disorders on surface ECGs using playing cards.It was a descriptive, cross-sectional study. Three successive groups of 25 students each took part in this study which took place at the Faculty of Medicine of Tunis. Each group was subdivided into 5 subgroups. During the TD session, the same 18 playing cards are distributed to each subgroup, and various wide and thin QRS tachycardia ECG plots are projected successively. Each subgroup should collect playing cards related to the methodical interpretation of each ECG trace and establish the final diagnosis of rhythm disorder. At the end of the pedagogical training, an anonymous self-assessment questionnaire to measure the types of motivation and academic self-efficacy was submitted to the students.Seventy-five students participated in our study. They were mostly female (sex ratio = 4). Gamification learning using playing cards has generated learners' intrinsic motivation (5.89 ± 0.97), allowing them to feel more confident in themselves, capable of acquiring new skills. Regarding extrinsic motivation, having good results on the exam was not their main concern (4.34 ± 1.23). This learning method has created a feeling of self-efficacy among our learners (5,004 ± 0,98). Indeed, they proved to be able to assimilate the fundamental notions of the course (5.86 ± 1.26), to understand the most complex material of the course (5 ± 1.55) and to acquire the competences targeted by this course (5.41 ± 0.5 ). Finally, all learners were satisfied with the method of gamification learning using playing cards. They recommended that this method be generalized throughout all ECG sessions.Gamification learning seems to be an effective and appropriate approach to teaching in the medical field since it allows to associate the notion of pleasure and the act of learning and stimulating motivation and self-efficacy learners.

BACKGROUND Coronary diseases remain the first cause of death in the world; the management of this condition has improved, thanks to new technical tools and multicentric registries. Recently in Tunisia, the number of intervention procedures has markedly increased, giving the explosion of cardiovascular risk factors among Tunisian people. OBJECTIVE The aim of the study was to investigate the in-hospital and one-year clinical outcome of patients treated with percutaneous coronary intervention (PCI) in Tunisia. METHODS We will conduct a prospective, multicentric, observational study including patients > 18 year-old who underwent a PCI between 31January and 30 June 2020. The primary end point are the occurrence of a major adverse cardiovascular event , defined as cardiovascular death, myocardial infarction, cerebrovascular accident, and target vessel revascularization with either repeat PCI or coronary artery bypass surgery (CABG). Secondary end-points consist in procedural success rate, stent thrombosis, and the rate of redo-PCI/CABG for in-stent restenosis. RESULTS Results will be available at the end of the study as well as the demographic profile and general risk profile of Tunisian patients undergoing PCI. The complexity level of procedures, as left main, bifurcation, chronic occlusion PCI will be analyzed and immediate as well as long term results will be determined. NATURE-PCI will be the first national multicentric registry of angioplasty in Africa. CONCLUSIONS This study would add data and provide a valuable opportunity for real-world clinical epidemiology and practice in the field of interventional cardiology in Tunisia with insights into the uptake of contemporary coronary artery disease in this developing region. CLINICALTRIAL clinicaltrials.gov

Hypertension is the first cause of atrial fibrillation. Its onset is explained by intricate mechanisms such as atrial conduction impairment.To evaluate atrial conduction by tissue Doppler imaging in hypertensive patients compared to a control group.This is a comparative prospective study performed in the cardiology department of the FSI hospital enrolling 55 patients with hypertension and 55 controls. All of them underwent a complete echocardiocardiography exam with Doppler tissue imaging. We measured intraatrial and interatrial electromechanical delay by Pulsed Tissue Doppler. Statical analysis was conducted using SPSS version 22.0. Comparison of means was made with t student test.Left ventricular mass and septal thikness were more important in the hypertensive group. Mitral A wave was greater in hypertensive group compared to controls (7,1cm/s vs 5,6cm/s; p0,0001; respectively). Left atrial volume was of 32,7±6,8mL/m² in hypertensives vs 29,5±4,3 mL/m² in controls (p=0,006). Doppler Tissue study showed homogeneous statistically significant elongation of atrial conduction times in hypertensive patients compared to controls: interatrial time (16.8±7.8ms vs 12.4±4,2ms, p0.0003) and left intraatrial (27.6±8.6ms vs 19.0±4.3ms, p0.0001) and right intraatrial time (10.8±6.0ms vs 6.6±2.9ms, p0.0001; respectively for hypertensive and control subjects. There was a significant correlation between measured intraatrial and interatrial electromechanical delays and duration of hypertension, indexed left atrial volume ans indexed left ventricular mass (r 0.27-0.41, p0.001).Atrial conduction time is significantly longer in hypertensive patients. Impairment of atrial conduction may be predictive of atrial fibrillation and should prompt closer surveillance to detect this arrhythmia in these patients.

Many patients with COVID-19 have pre-existing cardiovascular (CV) co-morbidities or develop acute heart damage during the course of the disease.To study the risk of COVID-19 infection in the presence of preexisting CV diseases and to describe new CV manifestations during COVID-19.A "scoping review" was carried out via PubMed, to synthesize the results of research currently published on this subject.Patients with cardiovascular disease were at greater risk of developing COVID-19, especially in its severe form. These patients were five to ten times more at risk of death. Cardiac manifestations, de novo, were dominated by acute myocardial damage, defined by a significant elevation of cardiac troponins. These occurred in 7 to 17% of hospitalized patients. The presence of a new heart lesion in patients with COVID-19 was consistently associated with a poor prognosis.Given the enormous cardiovascular challenge posed by the COVID-19 pandemic and the prognostic impact of heart damage, additional research at a high level of evidence will be necessary.

Over the past few years, efforts have been made to ensure that the teachers of the Faculty of Medicine of Tunis (FMT) cite their affiliation to the FMT and the University of Tunis El Manar in addition to their hospital institutions and their research structure in their publications.In this study, we proposed to evaluate the FMT's membership in the publications of its teachers, to identify the different types of publications and to estimate the real number.In this bibliometric cross-sectional study, we retrieved the FMT publications indexed in medline/pubmed database (1964-June2019). We have chosen the keywords corresponding to the publications of group1 (referenced FMT) and group2 (referenced FMT or annexed hospital-university institutions). Next, we calculated the rate of group1 on group2 and sorted the different types of items in group2. Finally, We estimated, after randomization, the actual number of FMT publications for a 99% confidence interval (99% CI).For groups 1 and 2, 1477 and 5194 publications were retrieved, respectively. The FMT membership rate averaged 28% ranging from 4% (1990-2010) to 44% (2011-2019). Of the FMT publications, 30% were free of charge and 55% were original articles. After a draw for 300 group2 publications, the estimated number of total FMT publications was between 4519 and 4934 for a 99% CI.It is essential to mention its affiliation to «the Faculty of Medicine of Tunis» and to «the University of Tunis El Manar» in order to improve the visibility and ranking of our two academic institutions.