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BACKGROUND Since the Cleopatra trial, the therapeutic standard for HER-metastatic breast cancer (BC) is combination of Pertuzumab, Trastuzumab and Docetaxel. Given the lack of availability of Pertuzumab in Tunisia, treating these diseases according to international recommendations remains a challenge. We report the case of a patient in which this protocol could be administered with favorable outcomes. CASE REPORT This observation is reporting the case of a luminal B-HER2 overexpressed BC in a 36 year-old woman. At presentation, radiological investigations revealed bone, hepatic, pulmonary, cerebral and meningeal metastasis. She was first treated with combination of Trastuzumab-Paclitaxel (8 courses)-Zoledronic Acid followed by whole brain radiotherapy (RT). A subsequent CT scan showed cerebral and hepatic complete response with pulmonary partial response. Thus, the patient was put on Tamoxifen with Trastuzumab as a maintenance treatment. 8 months later, the CA 15-3 level was rising without radiological progression. She had achieved surgical castration and the anatomopathological examination revealed ovarian metastasis. We rechallenged Paclitaxel with Trastuzumab and only 6 courses of Pertuzumab. Normalization of the CA 15-3 rate has been achieved. A relay by Anastrozole with Trastuzumab (Total of 27 injections) was done. The last workup concluded with a complete hepatic, pulmonary and cerebral response and a condensation of bone lesions. She is alive in excellent general condition 3 years after diagnosis. CONCLUSION Efforts by our health authorities are underway to offer anti HER therapies to comply with international standards. Meanwhile, this case has shown that thanks to continuous anti HER pressure with trastuzumab combined with only 6 injections of Pertuzumab, we have achieved prolonged survival in this patient. [ABSTRACT FROM AUTHOR]

BACKGROUND Medulloblastoma is a primitive neuroectodermal tumor (PNET) characterized by both radiosensitivity and chemosensitivity. Usually it occurs in the pediatric age while it remains unusual in adults. We report 2 cases of adult medulloblastoma in order to discuss epidemiological, clinical and therapeutic features of this rare entity. PRESENTATION OF CASES : Mr T. A., 22 years old, had in July 2014 an excisional surgery of a cerebellar mass and histopathology showed a grade IV desmoplastic medulloblastoma. The resection was macroscopically complete. He started adjuvant radiotherapy 45 days after surgery. He received a dose of 54 Gy on the tumor bed and 34 Gy on the cerebrospinal axis. The MRI performed at the end of the radiotherapy revealed a residual mass of 1.5 cm. The patient was classified as a high risk group. He had 6 cycles of Etoposide Carboplatin with complete response. He is in complete remission since 4 years. Mrs T.M, 30 years old, presented with a 3 months history of headaches and vomiting. At the end of the explorations, the diagnosis of grade IV desmoplatic medulloblastoma was established. She underwent surgical resection of a cerebellar mass with no tumoral margins. The examination of the cerebrospinal fluid during the initial workup could not be done, so the patient was classified in the high-risk group. Conclusion : Because adult medulloblastoma is not common, the optimal treatment strategy has not been established. More prospective trials are required to better define it. [ABSTRACT FROM AUTHOR]

Introduction: Cancer management in Africa faces diverse challenges due to limited resources, health system challenges, and other matters. Identifying hereditary cancer syndromic cases is crucial to improve clinical management and preventive care in these settings. This study aims to explore the clinicopathological features and genetic factors associated with hereditary cancer in Tunisia, a North African country with a rising cancer burden MATERIALS AND METHODS: Clinicopathological features and personal/family history of cancer were explored in 521 patients. Genetic analysis using Sanger and next-generation sequencing was performed for a set of patients RESULTS: Hereditary breast and ovarian cancer syndrome was the most frequent cluster in which 36 BRCA mutations were identified. We described a subgroup of patients with likely ''breast cancer-only syndrome'' among this cluster. Two cases of Li-Fraumeni syndrome with distinct TP53 mutations namely c.638G>A and c.733G>A have been identified. Genetic investigation also allowed the identification of a new BLM homozygous mutation (c.3254dupT) in one patient with multiple primary cancers. Phenotype-genotype correlation suggests the diagnosis of Bloom syndrome. A recurrent MUTYH mutation (c.1143_1144dup) was identified in three patients with different phenotypes CONCLUSION: Our study calls for comprehensive genetic education and the implementation of genetic screening in Tunisia and other African countries health systems, to reduce the burden of hereditary diseases and improve cancer outcomes in resource-stratified settings., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Silica surface functionalization is often done through the condensation of functional silanes on silanols, silica surfaces' terminal groups. APTES, aminopropyltriethoxysilane, is widely used due to its assumed high reactivity with silanols, kinetically promoted by the catalytic action of the terminal amine function. Here, we revisit, based on a quantitative analysis by solid-state 29 Si NMR, the assembly of this silane on silica surfaces to investigate whether its presence results from grafting, i.e., hetero-condensation with silanol groups or from homo-condensation of silane molecules in solution leading to polycondensates physisorbed on silica. We investigate the interaction of APTES with a crystalline layered silicate, ilerite, and with amorphous nonporous silica. We also studied a second silane, cyanopropyltrichlorosilane (CPTCS), terminated with a nitrile group. Our results undoubtedly prove that while CPTCS is grafted on the silica surface, the presence of APTES on silica and silicate materials is only marginally associated with silanol consumption. The analysis of the signal related to silicon atoms from silanes (T n species) and those from silica (Q n species) allowed for the accurate estimation of the extent of homo-condensation vs grafting based on the ratio of T-O-T/Q-O-T siloxane bridges. These findings deeply question the well-established certainties on APTES assembly on silica that should no longer be seen as grafting of alkoxysilane by hetero-condensation with silanol groups but more accurately as a homo-condensed network of silanes, predominantly physisorbed on the surface but including some sparse anchoring points to the surface involving less than 6% of the overall silanol groups.

The aim of this study is to determine the general state of the Korba aquifer (northwestern Tunisia) with respect to seawater intrusion and to assess the suitability of groundwater for drinking and irrigation purposes. A total of 60 groundwater samples were collected and analysed for physicochemical parameters (pH, EC, TDS, Na + , K + , Ca 2+ , Mg 2+ , HCO3 - , Cl - , NO 3 - , SO 4 2- and Br - ). Major ionic ratios highlighted the dominance of the reverse ion exchange process triggered by the marine intrusion. Br - /Cl - ratio suggested that the irrigation with saline water and wastewater were potential additional sources of salinization. Hydrochemical Facies Evolution Diagram coupled with a GIS-based framework revealed that most of samples are located beneath the mixing line, showing dominant marine intrusion process. Based on the water quality index, most of groundwater samples were unsuitable for drinking. In addition, according to high sodium adsorption ratio, the groundwater quality was limited for irrigation purposes., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

High-quality and accurate environmental investigations are essential for the evaluation of contamination and subsequent decision-making processes. A combination of environmental geochemical indices, multivariate analyses and geographic information system approach was successfully used to assess contamination status and source apportionment of trace elements (Ag, As, Cd, Cr, Cu, Hg, Ni, Pb, Sb, V and Zn) in surface stream sediments from the Oued Rarai basin in north-western Tunisia, containing various metal and metalloid ores. The contamination level reported in this study indicates a non-negligible potential ecological risk, mainly related to sediment transport along the river. Antimony (concentrations ranged from 0.02 to 297 mg kg -1 and Igeo > 5), arsenic (from 0.5 to 1490 mg kg -1 and Igeo > 5), lead (from 2.9 to 5150 mg kg -1 and Igeo > 5) mercury (from 0.05 to 54.4 mg kg -1 and Igeo > 5) and silver (from 0.05 to 9.4 mg kg -1 and Igeo > 5) showed the most crucial contamination. Besides, potential ecological risk index values were maximum for arsenic with a median of 302, indicating a very high to serious ecological risk (> 160). Results from correlation analysis and principal component analysis revealed three main geochemical associations related to lithologic, tectonic and anthropogenic sources. V, Cr and Cu mainly originated from natural bedrock and soil. Ag and Cd were more controlled by both natural and mining enrichments. Mercury and Pb were mostly influenced by the ancient ore-related activities at the Oued Rarai site and north-east-south-west trending faults. Finally, Sb, As, Ni and Zn were largely controlled by the siliciclastic continental Neogene sequences. Finally, the physical and chemical dynamics of the watershed system, lithological properties, mineralisation, tectonic settings and mobilisation of subsurface sediments largely controlled both concentrations and spatial patterns of trace elements in the study basin. These results need to be considered in the strategies of suitable environmental management at former and current mining sites in north-western Tunisia., (© 2021. The Author(s).)

Background: Breast cancer is the world's most common cancer among women. It is becoming an increasingly urgent problem in low- and middle-income countries (LMICs) where a large fraction of women is diagnosed with advanced-stage disease and have no access to treatment or basic palliative care. About 5-10% of all breast cancers can be attributed to hereditary genetic components and up to 25% of familial cases are due to mutations in BRCA1 /2 genes. Since their discovery in 1994 and 1995, as few as 18 mutations have been identified in BRCA genes in the Tunisian population. The aim of this study is to identify additional BRCA mutations, to estimate their contribution to the hereditary breast and ovarian cancers in Tunisia and to investigate the clinicopathological signatures associated with BRCA mutations., Methods: A total of 354 patients diagnosed with breast and ovarian cancers, including 5 male breast cancer cases, have been investigated for BRCA1/2 mutations using traditional and/or next generation sequencing technologies. Clinicopathological signatures associated with BRCA mutations have also been investigated., Results: In the current study, 16 distinct mutations were detected: 10 in BRCA1 and 6 in BRCA2 , of which 11 are described for the first time in Tunisia including 3 variations that have not been reported previously in public databases namely BRCA1 _c.915T>A; BRCA2 _c.-227-?_7805+? and BRCA2 _c.249delG. Early age at onset, family history of ovarian cancer and high tumor grade were significantly associated with BRCA status. BRCA1 carriers were more likely to be triple negative breast cancer compared to BRCA2 carriers. A relatively high frequency of contralateral breast cancer and ovarian cancer occurrence was observed among BRCA carriers and was more frequent in patients carrying BRCA1 mutations., Conclusion: Our study provides new insights into breast and ovarian cancer genetic landscape in the under-represented North African populations. The prevalence assessment of novel and recurrent BRCA1/2 pathogenic mutations will enhance the use of personalized treatment and precise screening strategies by both affected and unaffected North African cancer cases., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Hamdi, Mighri, Boujemaa, Mejri, Ben Nasr, Ben Rekaya, Messaoud, Bouaziz, Berrazega, Rachdi, Jaidane, Daoud, Zribi, Ayari, El Benna, Labidi, Ben Hassouna, Haddaoui, Rahal, Benna, Mrad, Ben Ahmed, Boussen, Boubaker and Abdelhak.)

Purpose: Luminal, human epidermal growth factor receptor 2-negative breast cancer represents the most common subtype of breast malignancies. Neoadjuvant strategies of operable breast cancer are mostly based on chemotherapy, whereas it is not completely understood which patients might benefit from neoadjuvant hormone therapy (NAHT)., Materials and Methods: The SAFIA trial is a prospective multicenter, international, double-blind, neoadjuvant phase III trial, using upfront 21-gene Oncotype DX Breast Recurrence Score assay (recurrence score [RS] < 31) to select operable luminal human epidermal growth factor receptor 2-negative patients, for induction hormonal therapy HT (fulvestrant 500 mg with or without goserelin) before randomly assigning responding patients to fulvestrant 500 mg (with or without goserelin) plus either palbociclib (cyclin-dependent kinase 4/6 inhibitor) or placebo. The objectives of this interim analysis were to assess the feasibility of upfront RS determination on core biopsies in the Middle-East and North Africa region and evaluate the efficacy of induction NAHT in patients with an RS < 31., Results: At the time of this interim analysis, 258 patients with relative risk were accrued, including 202 patients (RS < 31% to 78.3%) treated with induction NAHT and 182 patients evaluable so far for response. The feasibility of performing the Oncotype DX assays on core biopsy specimens was optimal in 96.4% of cases. Overall, 93.4% of patients showed hormone sensitivity and no difference in NAHT efficacy was noticed between RS 0-10, 11-25, and 26-30. Interestingly, patients with high RS (26-30) showed a trend toward a higher major response rate ( P = .05)., Conclusion: The upfront 21-gene assay performed on biopsies is feasible in our population and has allowed us to select patients with high hormone sensitivity (RS < 31). This approach could be an alternative to upfront surgery without significant risk of progression, particularly during pandemic times., Competing Interests: Khalid AlSalehHonoraria: Amgen, AstraZeneca, Novartis, Pfizer, RocheResearch Funding: Pfizer, AstraZeneca Mohammed OukkalConsulting or Advisory Role: Amgen, Roche, Novartis, PfizerSpeakers' Bureau: Bayer, Ipsen Ahmed SaadeddinConsulting or Advisory Role: NovartisTravel, Accommodations, Expenses: Novartis, Roche, MSD, Sanofi Kamel BouzidConsulting or Advisory Role: Roche, Pfizer, MSD Oncology, Merck, SANFI, Mylan Omalkhair AbulkhairTravel, Accommodations, Expenses: MSD, Roche Meteb Al-FoheidiHonoraria: Pfizer, Lilly, Roche, NovartisConsulting or Advisory Role: NovartisSpeakers' Bureau: Pfizer, Roche, AstraZeneca, Novartis, LillyTravel, Accommodations, Expenses: Pfizer, Roche, Novartis, AstraZeneca Hassan ErrihaniConsulting or Advisory Role: Pfizer, Roche, MSD, Merck, Janssen Oncology, AstraZenecaSpeakers' Bureau: Novartis, Amgen, Astellas Pharma, ServierResearch Funding: RocheTravel, Accommodations, Expenses: Pierre Fabre, Merck Marwan GhosnConsulting or Advisory Role: Bayer, MSD Oncology, Bristol Myers Squibb, Pfizer, Novartis, Sanofi, Lilly, Astellas PharmaResearch Funding: Pfizer, Novartis, SanofiTravel, Accommodations, Expenses: Astellas Pharma, Bristol Myers Squibb, Celgene Haleem RasoolTravel, Accommodations, Expenses: Bayer Mohun BahadoorTravel, Accommodations, Expenses: Pfizer Sharif KullabTravel, Accommodations, Expenses: Pfizer Jean-Marc NabholtzConsulting or Advisory Roles: Pfizer, AstraZeneca, Genomic Health, MSD, RocheHonoraria: Pfizer, AstraZeneca, AMGEN, Novartis, RocheResearch Funding: Pfizer, AstraZeneca, Genomic HealthTravel, Accommodations, Expenses: Pfizer, AstraZeneca, Roche, NovartisNo other potential conflicts of interest were reported.

Introduction: Taxanes are widely used in medical oncology. The aim of our study was to report and analyze the toxicity features of these drugs in Tunisian patients and to determine their impact on treatment response., Methods: Our retrospective study concerned 90 patients treated by taxanes in a medical oncology unit, from January 2014 to January 2017. We collected their epidemiologic and anatomo-clinical data and we detailed toxicity features including types grades and impact on tumor response., Results: Median age was 46 years. 80% of patients had breast cancer. Tumors were metastatic in 23.3% of cases. Nail toxicity was observed in 100% of patients. Grade I-II digestive toxicity was observed in 54.4% of cases. Hematological toxicity was noted in 42.2% of patients and it reached grade III-IV in five patients. Neurological toxicity occurred in 31% of patients and was grade III-IV in 6 cases. Alopecia was observed in 60% of patients. Fatigue was noted in 57.8% of patients. Myalgia was observed in 42.2% of patients. Toxicity did not affect the response to treatment., Conclusion: The taxanes' toxicity profile in Tunisian patients is characterized by more frequent digestive and nail toxicities and less frequent hematological toxicities, dose reduction and treatment delays than other populations., (Copyright © 2020 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

The syntheses of the novel silicon-bridged tris(tetraorganotin) compounds MeSi(CH 2 SnPh 2 R) 3 (2, R=Ph; 5, R=Me 3 SiCH 2 ) and their halogen-substituted derivatives MeSi(CH 2 SnPh (3-n) I n ) 3 (3, n=1; 4, n=2) and MeSi(CH 2 SnI 2 R) 3 (6, R=Me 3 SiCH 2 ) are reported. The reaction of compound 4 with di-t-butyltin oxide (t-Bu 2 SnO) 3 gives the oktokaideka-nuclear (18-nuclear) molecular diorganotin oxide [MeSi(CH 2 SnPhO) 3 ] 6 (7) while the reaction of 6 with sodium hydroxide, NaOH, provides the trikonta-nuclear (30-nuclear) molecular diorganotin oxide [MeSi(CH 2 SnRO) 3 ] 10 (8, R=Me 3 SiCH 2 ). Both 7 and 8 show belt-like ladder-type macrocyclic structures and are by far the biggest molecular diorganotin oxides reported to date. The compounds have been characterized by elemental analyses, electrospray mass spectrometry (ESI-MS), NMR spectroscopy, 1 H DOSY NMR spectroscopy (7), IR spectroscopy (7, 8), and single-crystal X-ray diffraction analysis (2, 7, 8)., (© 2020 The Authors. Published by Wiley-VCH GmbH.)

Background: Deleterious mutations on BRCA1/2 genes are known to confer high risk of developing breast and ovarian cancers. The identification of these mutations not only helped in selecting high risk individuals that need appropriate prevention approaches but also led to the development of the PARP-inhibitors targeted therapy. This study aims to assess the prevalence of the most frequent BRCA1 mutation in Tunisia, c.211dupA, and provide evidence of its common origin as well as its clinicopathological characteristics. We also aimed to identify additional actionable variants using classical and next generation sequencing technologies (NGS) which would allow to implement cost-effective genetic testing in limited resource countries., Patients and Methods: Using sanger sequencing, 112 breast cancer families were screened for c.211dupA. A set of patients that do not carry this mutation were investigated using NGS. Haplotype analysis was performed to assess the founder effect and to estimate the age of this mutation. Correlations between genetic and clinical data were also performed., Results: The c.211dupA mutation was identified in 8 carriers and a novel private BRCA1 mutation, c.2418dupA, was identified in one carrier. Both mutations are likely specific to North-Eastern Tunisia. Haplotype analysis supported the founder effect of c.211dupA and showed its recent origin. Phenotype-genotype correlation showed that both BRCA1 mutations seem to be associated with a severe phenotype. Whole Exome Sequencing (WES) analysis of a BRCA negative family revealed a Variant of Unknown Significance, c.3647C > G on RAD50 . Molecular modeling showed that this variant could be classified as deleterious as it is responsible for destabilizing the RAD50 protein structure. Variant prioritization and pathway analysis of the WES data showed additional interesting candidate genes including MITF and ANKS6., Conclusion: We recommend the prioritization of BRCA1 -c.211dupA screening in high risk breast cancer families originating from the North-East of Tunisia. We also highlighted the importance of NGS in detecting novel mutations, such as RAD50- c.3647C > G. In addition, we strongly recommend using data from different ethnic groups to review the pathogenicity of this variant and reconsider its classification in ClinVar., (Copyright © 2020 Mighri, Hamdi, Boujemaa, Othman, Ben Nasr, El Benna, Mejri, Labidi, Ayari, Jaidene, Bouaziz, Ben Rekaya, M’rad, Haddaoui, Rahal, Boussen, Boubaker and Abdelhak.)

The most important limits of oxaliplatin treatment is its peripheral neurotoxicity. The aim of our study was to evaluate the oxaliplatin-induced peripheral neuropathy, its impact on treatment and its management. One hundred chemo-naive patients treated with oxaliplatin-based regimen in the medical oncology department of the military hospital of Tunis between 2012 and 2017 were recruited retrospectively. Evaluation of neuropathy was done according to the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE V4). Fifty-six patients were aged more than 60 years. The sex-ratio was 1.56. Twenty-seven patients were overweight, 17 were obese and 56 had a BMI inferior to 25 kg/m 2 . Two patients were consuming alcohol. Twenty-three patients had diabetes. Sixty-four patients developed chronic peripheral neuropathy because of oxaliplatin (grade 1-2 in 58 cases and grade 3 in 6 cases). Sex, BMI, diabetes and alcohol consumption were not associated with the development of peripheral neuropathy. No association was found between grades of neuropathy and sex, alcohol consumption and diabetes. The median cumulative dose of oxaliplatin that induced neuropathy was 432.4 mg/m 2 . The most prescribed treatment was gabapentin (81%) and carbamazepine (16.8%). The treatment was not sufficient to stop neuropathy in 82.6% of cases. Dose reduction was done in 64.2% of cases, treatment delay in 10.7% of cases and treatment interruption in 10.7% of cases. We didn't find any association between known risk factors and peripheral neuropathy. The cumulative dose is interesting to define or to predict the timing of neurotoxicity., Competing Interests: The authors declare no competing interests., (© Aref Zribi et al.)

Background: Strain has shown a promising diagnostic and prognostic value in acute coronary syndromes. With, however, less data in non-ST elevation myocardial infarction (NSEMI)., Aim: to evaluate in NSTEMI patients, the ability of strain to predict the severity of the disease, by assessing correlations to established prognostic parameters, and to predict culprit and occluded coronary arteries (CA). Secondary, to determine factors associated to strain changes during follow-up., Methods: The study was prospective, NSTEMI patients with significant coronary lesion and without significant non-ischaemic disease were included. Angiographic and echocardiographic investigation including global (GLS) and territorial (TLS) longitudinal strain were performed within 24h from admission. Syntax I score was calculated. Severe coronary artery disease (CAD) was defined by left main of three-vessel disease., Results: Seventy NSTEMI patients aged 60.2±10.1 years were enrolled; 61% were smokers, 54% diabetics and 46% hypertensive. 34% had a severe CAD, 7% had an acute coronary occlusion (ACO) and 14% a chronic coronary total occlusion (CTO). GLS >-15.3% predicted a left ventricular ejection fraction (LVEF) <50% with 80% Sensitivity (Se) and 78% Specificity (Sp). GLS was associated to CAD complexity and severity. GLS > -14.1% detected severe CAD with 83% Se and 80%Sp. TLS determined the culprit artery in 74% of cases and TLS > -9.2% predicted ACO with 85% Se and 85% Sp. TLS was also associated to CTO. At a 10 months median follow-up [3-12months], GLS significantly improved, baseline LVEF, GLS, wall motion score index and revascularization were the predictors of this improvement., Conclusion: In NSTEMI patients, GLS detected severe CAD and poor myocardial function. TLS predicted the culprit vessel and its occlusion. GLS improvement at midterm was predicted by baseline systolic LV function parameters and myocardial revascularization.

Background and Objectives: The effect of Ramadan fasting on anticoagulation by vitamin K antagonists has been previously investigated in small scale studies with controversial results. From this perspective, this study aimed to compare the fluctuations of anticoagulation in fasting and nonfasting patients taking Acenocoumarol and to identify the factors associated with such fluctuations., Methods: The study, conducted between May and August 2018, was a comparative one. Three study periods were defined: before Ramadan (BR), Ramadan and after Ramadan (AR). Enrolment involved ambulatory patients aged over eighteen, without medical contraindications to fasting (for the fasting group) and whom international normalized ratio (INR) was within the therapeutic target range during the last three months BR. Anticoagulation monitoring consisted in five consecutive INR assays; INR0 (during the 14 days BR), INR1 (between the 1st and the 14th day of Ramadan), INR2 (between the 15th and the 28th day of Ramadan), INR3 (28 days after INR2) and INR4 (28 days after INR3). INR stability was assessed by calculating four percentages of time in therapeutic range (TTR); TTR0 (between INR0 and INR1), TTR1 (between INR0 and INR2), TTR2 (between INR2 and INR3) and TTR3 (between INR3 and INR4). The null hypothesis was the occurrence of an anticoagulation imbalance (evaluated by TTR) in fasting patients in comparison with non-fasting ones., Results: One hundred and twenty-two patients (84 fasting patients), aged 60 ± 19 years, were included. In fasting patients, the average differences of INR1, 2, 3 and 4 compared with INR0 were statistically non-significant and accounted for +0.46, +0.34, +0.28 and +0.30 respectively. Among the three TTRs, only TTR2 significantly decreased in comparison with TTR0 in fasting group (50.3 ± 37.4 vs. 63.6 ± 39.3%, p=0.004). TTR1, 2 and 3 were comparable between fasting and non-fasting patients., Conclusions: The fluctuations of anticoagulation balance, assessed by TTR, were comparable between fasting and non-fasting patients taking Acenocoumarol.