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Very long coronary lesions account for 20% of coronary stenoses in the real world. There are few data on the effectiveness of angioplasty of these lesions with very long active stents (DES) in the literature. We conducted this study to assess the long-term outcomes of angioplasty with DES length ≥ 40 mm in a population with multiple cardiovascular risk factors.This is a retrospective, multicenter, descriptive, and prognostic study, conducted between January 2015 and January 2020, in four Tunisian centers, including all patients who underwent angioplasty with a DES of length ≥ 40 mm with a follow-up of at least one year. The primary outcome was a combined criteria (major cardiovascular and Cerebral events: MACCE) (stroke, acute coronary syndrome, revascularization of the target lesion: TLR, cardiovascular death: CVD).We included 480 procedures. More than half of the patients had at least three risk factors. The prevalence of high blood pressure, diabetes and smoking were 61.1%, 56.6% and 60.4%, respectively. The treated lesions were complex: 23.54% calcified lesions, 8.75% chronic occlusions, 25% bifurcation lesions and 12.08% ostial lesions. The average length of the stents was 47.72 mm. We noted 17 cases of per-procedural complications (3.55%). The median follow-up was 35 months (extremes 1-60 months). The rate of stent thrombosis was 0.83%. The incidence of MACCE, TLR and CVD were respectively 16.25%, 8.12% and 5.2%. In multivariate analysis, diabetes (HR = 1.7, 95% CI [1.01-2.9]), dyslipidemia (HR = 2.08, 95% CI [1.3-3.3]), familial coronary artery disease (HR = 1.9, 95% CI [1.01-3.6]), left ventricle dysfunction (HR = 2.07, 95% CI [1.1-3.6]) and bifurcation lesions (HR = 1.9, 95% CI [1.2-3.14]) were the independent predictors of MACCE, while statin intake (HR = 0.38, 95% CI [0.19-0.78]) was a protective factor.Angioplasty with very long DES is associated with low levels of MACCE, TLR, stent thrombosis and CVD in our population. Therefore, it could be an interesting alternative to cardiac surgery. Randomized comparative studies of the two treatment options are needed.

Introduction There are no clear data about the incidence and the prophylactic strategies of arterial and venous thromboembolic events (TE) in COVID-19 ambulatory patients. Thus, we conducted this study to analyze thromboembolic complications in this setting and to assess thromboprophylaxis management and outcomes in the real life. Patients and methods This is an observational study including Covid-19 ambulatory patients. We assessed incidence of venous and arterial TE events as well as thromboprophylaxis outcomes and hemorrhagic complications. We defined high risk thrombo-embolic factor according to the Belgian guidelines which are the only guidelines that described thromboprophylaxis in COVID-19 ambulatory patients. Results We included 2089 patients with a mean age of 43±16 years. The incidence of 30 days venous and arterial TE complications in our cohort was 1%. Venous thromboembolic complications occurred in 0.8% and arterial thromboembolic complications occurred in 0.3%.We noted at least one high-risk TE factor in 18.5% of patients but thromboprophylaxis was prescribed in 22.5% of the cases, LMWH in 18.1%, and Rivaroxaban in 3.7%. Hemorrhagic events occurred in eight patients (0.3%): five patients showed minor hemorrhagic events and three patients showed major ones (0.14%). Conclusions Our study showed that the incidence of thromboembolic complications is very low in COVID-19 ambulatory patients. Paradoxically, there is an over prescription of thrombo-prophylaxis in this population.

first-line physicians should play a key role in tobacco control. The purpose of this study is to assess the knowledge and attitudes of front-line physicians as well as their practices for smoking cessation, assess their smoking status and determine the barriers to smoking cessation support.we conducted a cross-sectional study among a representative sample of front-line physicians practising in the governorate of Sfax in November 2020.a total of 115 first-line physicians were included in the study, with a sex ratio (M/F) of 0.91 and an average age of 43 years (interquartile interval= [34-55 years]). Among the respondents, 26 (22.6%) stated that they were smokers; 98 of the physicians surveyed (85.2%) had not had any postgraduate training in smoking cessation. However, 71 (61.7%) had an idea on nicotine replacement therapy. Regarding attitudes,73 respondents (63.5%) were convinced that physicians were responsible for helping their patients quit smoking. Forty five physicians (39.1%) systematically asked all patients about their smoking habits. The least performed activities of the 5A strategy were the components "help" (14%) and "organize follow-up" (17.4%). Patients' disinterest was considered (53%) to be a significant barrier to smoking cessation assistance by the 61 physicians surveyed.there is a need to evaluate and improve the implementation of the national tobacco control strategy, in particular with regard to the training of front-line physicians.

The distal radial approach (DRA) is suggested to have benefits over the conventional radial approach (CRA) in terms of local complications and comfort of both patient and operator. Therefore, we aimed to compare the feasibility and safety of DRA and CRA in a real life population. We conducted a prospective, observational multicentric trial, including all patients undergoing coronary procedures in September 2019. Patients with impalpable proximal or distal radial pulse were excluded. Thus, the choice of the approach is left to the operator discretion. The primary endpoints were cannulation failure and procedure failure. The secondary endpoints were time of puncture, local complications and radial occlusion assessed by Doppler performed one day after the procedure. We enrolled 177 patients divided into two groups: CRA (n = 95) and DRA (n = 82). Percutaneous intervention was achieved in 37% in CRA group and 34% in DRA group (p = 0.7). Cannulation time was not significantly different between the two sets (p = 0.16). Cannulation failure was significantly higher in DRA group (4.8% vs 2%, p

Introduction: The GRACE and TIMI scores have been well validated for assessment of prognosis in non-ST-elevation acute coronary syndrome (NSTE-ACS). However, their value in predicting coronary artery disease (CAD) has been little studied. We aimed to assess the relationship between these scores and the extent of coronary disease. Methods: We analyzed 238 consecutive patients admitted for NSTE-ACS and undergoing a coronary angiogram during hospitalization. The severity of CAD was assessed using the SYNTAX score. Obstructive CAD was defined as ≥50% stenosis in the left main or ≥70% stenosis in other vessels. Severe CAD was defined as a SYNTAX score >32. The Pearson test was used to assess the correlation between scores. Results: The SYNTAX score was higher in patients at high risk (GRACE score: p32. O teste Pearson foi usado para avaliar a correlação entre os scores. Resultados: O valor do score Syntax foi superior nos doentes de alto risco (escore GRACE: p

Objectif L’obesite chez les adultes est une question preoccupante au niveau de la sante psychologique. L’objectif de ce travail etait d’etudier l’image corporelle chez les adultes obeses de la region de Sfax, Tunisie. Patients et methodes Etude observationnelle descriptive colligeant 150 adules obeses âges entre 19 et 64 ans avec un indice de masse corporelle (IMC)≥ 30 kg/m2. Nous avions recours a la version courte du questionnaire BSQ-8c(Body Shape Questionnaire) afin d’evaluer l’image corporelle. Resultats Il s’agissait de 115(76,7 %) femmes et 35 (23,3 %) hommes. L’IMC moyen etait de 36 kg/m2. Douze (24,7 %) patients avaient une obesite morbide. Le score BSQ-8c moyen etait de 28,72 avec des extremes allant de 12 a 50. L’analyse de l’echelle d’image corporelle (BSQ-8c) montrait que la majorite de notre population (33 %) presentaient une preoccupation moderee par rapport au corps (26≤ BSQ-8c score ≤ 33). La preoccupation etait extreme (BSQ-8c score > 33) et legere (19 ≤ BSQ-8c score Discussion Ce travail souligne l’impact de l’obesite sur l’image corporelle. La mise en place un programme national de prise en charge au parcours des patients obeses incluant des psychologues est obligatoire.

Objectif Evaluer les connaissances, attitudes et pratiques concernant l’activite physique chez les diabetiques de type 2. Materiel et methodes Etude transversale menee de novembre 2019 a fevrier 2020 chez des adultes diabetiques de type 2 suivis au service d’endocrinologie de l’hopital Hedi Chaker de Sfax et a la Caisse nationale de securite sociale de Sfax. Resultats Au total, 233 patients diabetiques de type 2 ont ete interroges, dont 142 femmes (60,1 %). L’âge moyen etait de 58,8 ans (ET = 10,8). La duree moyenne du diabete etait de 11,8 ans (ET = 9,1) ans. L’IMC moyen etait de 30,6 kg/m2 (ET = 6,6). L’hemoglobine glyquee moyenne etait de 8,78 % (ET = 1,98). Parmi nos patients, 91,4 % connaissaient que l’activite physique aide a equilibrer le diabete. Les connaissances de la frequence et la duree de l’exercice physique recommandees etaient limitees (4,7 % et 32,6 % respectivement). L’activite physique etait consideree comme une partie du traitement par 77,3 % des patients. Parmi les patients, 33,5 % faisaient une activite physique reguliere avec motivation : « pour ma sante » (69,2 %) et conseil du medecin (44,9 %). La marche etait le seul type cite. La duree moyenne de l’activite physique etait de 36,5 minutes (ET = 19,6). La frequence etait de 7 jours sur 7 chez 36,4 %. Parmi les patients, 66,5 % ne faisaient pas une activite physique pour raison de : manque de temps (37,6 %), manque de volonte (30,5 %) et probleme osteoarticulaire (42,9 %). Conclusion Notre etude a montre un manque de pratique de l’activite physique, ce qui appelle a insister sur son importance durant l’education therapeutique.

Summary Background Valvular heart diseases occur frequently in Tunisia, but no precise statistics are available. Aim To analyse the characteristics of patients with abnormal valvular structure and function, and to identify the aetiological spectrum, treatment and outcomes of valvular heart disease in a single cardiovascular centre in Tunisia. Methods This retrospective study included patients with abnormal valvular structure and function, who were screened by transthoracic echocardiography at a single cardiology department between January 2010 and December 2013. Data on baseline characteristics, potential aetiology, treatment strategies and discharge outcomes were collected from medical records. Results There were 959 patients with a significant valvular heart disease (mean age 53 ± 17 years; female/male ratio 0.57). Valvular heart disease was native in 77% of patients. Mitral stenosis was the most frequent lesion (44.1%), followed by multiple valve disease (22.3%). Rheumatic origin (66.6%) was the most frequent aetiology, followed by degenerative (17.2%) or ischaemic (8.1%) causes, endocarditis (1.4%) and congenital (0.9%) causes. Native valve disease was severe in 589 patients (61.4%). Percutaneous mitral balloon valvuloplasty was performed in 36.9% of patients with mitral stenosis. Among patients with severe valvular heart disease, surgical treatment was indicated for 446 (75.7%) patients. Only 161 (36.1%) patients were finally operated. Postoperative mortality was 13.6% for all valvular heart diseases. Conclusion This retrospective study has shown that the main cause of valvular heart disease in Tunisia is rheumatic fever. Mitral stenosis and multiple valve disease are the most frequent valvular heart diseases in Tunisia. Percutaneous mitral balloon valvuloplasty and prosthetic valve replacement are the preferred treatment methods for valvular heart disease.

In a context of economic difficulties, the Tunisian government is required to find solutions to meet the expectations of the population. Health sector is one of the critical areas requiring radical reform. The objective of this paper is to find the place of public private partnership project in the harmonious development of both public and private sectors in Tunisia. Indeed, the Tunisian health system consists of two main sectors: the public sector, and the private sector, booming since the 90s. Tunisian infrastructure and staff resources distribution is characterised by a very significant regional disparity, to the detriment of the interior regions, which is more pronounced in the private sector. This area, considered innovative and responsive, captures the local wealthy clientele, and the foreign highly specialized care seekers. It wins over the best healthcare providers, inspite of some reported claims against pricing abuses leading to user's lack of confidence. As for the public sector under funded, handicapped by red tape and some forms of lack of transparency and lobbying, it can not cope with the influx of customers of poor and middle classes. The relationship between the two sectors misses often. The current challenge in the Tunisian health sector is how can public and private sectors combine and harmonize their efforts to achieve common interest objectives. The public-private partnership, is a process helping the state to involve private investors in the realization of public interest projects and develop long term contracts. So, the two sectors will share resources and technical expertise and will access to further advantages. However, it is essential to establish clear and effective legal and institutional frameworks governing private participation in the public sector.

Cirrhotic cardiomyopathy is associated with poor prognosis and risk of acute heart failure after liver transplantation or interventional procedures. We aimed to assess the relationship between the severity of cardiac impairment and hepatic disease. Eighty patients and eighty controls underwent echocardiography, tissue Doppler imaging and speckle tracking measures. We assess the correlation between echocardiographic parameters and Child and MELD scores. Systolic parameters function (s wave, p < 0.001) and global longitudinal strain (p < 0.001) as well as diastolic parameters were significantly more impaired in cirrhotic patients compared to controls. There were no differences among the different groups in ‘Child score’ regarding systolic function as well as diastolic function. Paradoxically, the left atrium size correlated positively to both Child (p = 0.01, r = 0.26) and MELD scores (p = 0.02, r = 0.24). Left ventricular ejection fraction was significantly lower in decompensated patients as compared to compensated patients(p = 0.02).. We did not identify any association between severity of liver disease and cardiac dysfunction. Therefore, a transthoracic echocardiography should be performed in all cirrhotic patients before interventional and surgical procedures regardless of the severity of liver disease.

The risk of cardiovascular disease in elderly is significantly higher than in young subjects; paradoxically some treatments that have proven their efficacy in reducing cardiovascular risk are often under prescribed in this age group. The benefits of statins in secondary cardiovascular prevention are well established in patients

The risk of cardiovascular disease in elderly is significantly higher than in young subjects; paradoxically some treatments that have proven their efficacy in reducing cardiovascular risk are often under prescribed in this age group. The benefits of statins in secondary cardiovascular prevention are well established in patients80 years. In primary prevention, these drugs reduce the risk of myocardial infarction and stroke, but their effects on cardiovascular mortality remain uncertain. In very elderly patients, there are no randomized trials relative to the impact of statins on morbi-mortality in primary prevention as well in secondary prevention. Adverse effects in the elderly seem to be statistically similar to those occurring in young people , but the prescription in very old people should be individualized, taking into account the life expectancy, the life quality, the comorbidities, and especially the risk of drug interactions.