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Coronary artery disease remains the most common cause of morbidity and mortality in the general population. Several studies in developed countries have reported a gender-related difference in ST-segment elevation myocardial infarction (STEMI) in terms of risk factors, clinical presentation, delays in management, therapeutic modalities, and in-hospital as well as one-year outcomes. Data from non-developed countries about women with STEMI remain rare. We therefore aimed through this study to investigate the baseline characteristics of STEMI in Tunisian women compared to men and to determine the impact of gender difference on STEMI complications, in-hospital mortality, and one-year follow-up outcomes.All patients presenting to our center for STEMI between January 2001 and January 2021 were retrospectively enrolled in this analysis. Clinical features, therapeutic management, and in-hospital as well as one-year outcomes were compared between women and men. Predictive factors of in-hospital mortality in women were determined.Out of 1670 STEMI hospitalizations, 359 (21.4%) were female. Compared to male, female had higher rates of hypertension (51.5% vs. 24.4%, p0.001), diabetes (50.1% vs. 32.2%, p0.001), and obesity (63.8% vs. 55%, p = 0.003). The clinical presentation was characterized by less prevalent inaugural chest pain (58.8% vs. 68.6%, p0.001). Atypical symptoms were significantly higher in women compared to men (55.2% vs. 5%, p0.001). On admission, women had higher prevalence of anemia, renal failure, and hyperglycemia compared to men. Primary percutaneous coronary intervention (pPCI) was the reperfusion strategy of choice in 37.9% of women vs. 33.1% of men (p=0.02). Women were significantly less likely to receive thrombolysis (p = 0.004), with a significantly less prevalent successful thrombolysis (55.6% vs. 67.2%, p=0.013). In-hospital mortality was markedly higher in women compared to men (12.8% vs. 7.3%, p=0.001). Compared to surviving women (n = 313), those who died (n = 46) frequently had more diabetes and hypertension (65.2% vs. 47.9%, p= 0.02 and 67.4% vs. 49.2%, p = 0.02, respectively). New-onset atrial fibrillation, acute left heart failure, cardiogenic shock, ventricular tachycardia, and atrioventricular block markedly occurred in women who died (52.2% vs. 23.3%, p=0.001; 17.4% vs. 1.9%, p0.001; 19.6% vs. 8.3%, p = 0.016; 15.2% vs. 1.6%, p0.001 and 34.8% vs. 10.2%, p0.001, respectively).Compared to men, Tunisian women presenting for STEMI had higher prevalence of risk factors and atypical symptoms. Women had more in-hospital complications and mortality.

Summary Background: Stroke is a major complication of nonvalvular atrial fibrillation (AF). Despite its proven efficacy in stroke prevention, oral anticoagulation (OAC) is associated to a significant increase in bleeding complications. New techniques such as percutaneous left atrial appendage (LAA) closure were developed. Aim: To evaluate immediate, mid- and long-term outcomes after percutaneous LAA closure in Tunisian patients presenting with nonvalvular AF. Methods and Results: Nineteen patients with nonvalvular AF were prospectively enrolled for percutaneous LAA closure between February 2013 and June 2014. The Watchman device was used in all LAA closure procedures. Clinical and echocardiographic follow-up were carried-out at 1, 6, 12 months and six years in all patients. Mean age was 68.4 ± 7.5 years. Thirteen patients were female, 16 had hypertension, 12 had diabetes mellitus and seven had a history of stroke or transient ischemic attack (TIA). Average CHA2DS2VASc (Congestive Heart Failure/Left Ventricular Dysfunction, Hypertension, Age≥75, Diabetes mellitus, Stroke/Transient Ischemic Attack/Thromboembolic event, Vascular disease,Age≥65, Sex category) score was 4.2 ± 1.5 and HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding tendency, Labile INR, Age≥65, Drugs) score was 3.5 ± 1. Ten patients had a history of severe bleeding. Procedural success was achieved in all patients. Pericardial effusion with tamponade was reported in one case. No post-procedural death was reported. Regular follow-up at 1, 6 and12 months then every year up to 6 years reported no stroke, no thromboembolic event, no Watchman device thrombosis and three cases of death caused by a respiratory problem and cancers. Conclusion According to this study, LAA closure with Watchman device was safe and effective in preventing stroke in patients with nonvalvular AF and contra indication to OAC.

Coronary artery disease is the leading cause of death in emerging countries. Contemporary data about clinical profile and prognosis in Tunisian patients presenting for non ST-elevation acute coronary syndrome (NSTE-ACS) are lacking.We sought to study the risk profile and 3-year mortality predictors in Tunisian patients presenting for NSTE-ACS in the contemporary setting.In this single center study, data about all consecutive patients presenting to our center for NSTE-ACS from April 2014 to July 2016 were extracted and outcomes exhaustively updated. 3-year mortality predictors were determined by multivariable survival analysis.A total of 340 patients were included, of which 204 (61.8%) were male. Mean age was 63.6 ± 10.3 years. Prevalence of diabetes mellitus, hypertension and smoking was 57.3%, 62.4%, and 45.3%, respectively. In-hospital, 6, 12 and 36-month mortality rate was 2.3%, 3.2%, 7.1% and 15.2%, respectively. In multivariable survival analysis, independent predictors of death were age75 (HR=5.45, 95% CI: 2.9-10.03, p0.001), ST-segment deviation (HR=1.86, 95% CI: 1.04-3.33, p=0.036), anemia (HR=2.56, 95% CI: 1.41-4.67, p=0.002), left ventricular ejection fraction (LVEF)40% (HR=3.5, 95% CI: 1.84-6.67, p0.001) and a Global Registry of Acute Coronary Events (GRACE) score ≥140 (HR=2.38, 95% CI: 1.02-5.57, p=0.044).In Tunisian patients presenting for NSTE-ACS, long-term mortality was high. Advanced age, ST-segment deviation, anemia, LVEF40% and a GRACE score ≥140 were independent long-term predictors of death.

Background.Cardiomyopathy mediated by iron disposition in cardiomyocytes is a dreadful cause of morbidity and mortality in patients with beta thalassemia major (BTM). Conventional transthoracic echocardiography (TTE) parameters are preserved at late stages of cardiomyopathy induced by iron overload. Therefore, cardiac imaging modalities based on myocardial deformation such as strain imaging are used for early detection of cardiac iron overload.Aim.To demonstrate the contribution of longitudinal strain (LS) in early detection of cardiac iron overload in children with BTM.Methods.Sixty children (30 children with BTM and 30 healthy controls) were enrolled in this study. Conventional TTE study was performed in both patient and control groups. LV regional longitudinal strain (RLS) were determined and compared between the two study groups.Results.Mean age was 10.4 ± 5years in BTM group compared to 10.2 ± 5 years in control group (p=0.876). Compared to control group, there was no significant difference in conventional TTE parameters except for indexed left atrium (LA) area and volume. LA was significantly larger in BTM children (27.59 ±13.1ml/m² vs. 18.23 ± 4.33 ml/m², p=0.001). RLS was lower in anterior, septal and inferior walls in basal and middle segments of LV in BTM group while there was no significant difference in RLS in apical segment between the two groups (-27.30 ± 5.1 vs. -28.83 ± 4.33, p=0.22).Conclusion.In asymptomatic BMT children with normal conventional TTE parameters, LS could be used for the detection of subclinical myocardial dysfunction.

IoT data collection networks, formerly known as wireless sensor networks, have become one of the most active areas of research in the field of information technology. The deployment of connected objects represents a fundamental phase on the establishment of IoT collection networks. The IoT deployment problem consists in positioning all the sensors constituting the network. This paper proposes an approach maximizing the coverage of a region of interest by the hybridization between the Voronoi diagram and the genetic algorithm. The first algorithm divides the field into cells and generates initial solutions (positions of deployed IoT objects). The latter algorithm is used to improve these positions in order to maximize the overall coverage of the region of interest. Obtained results reveal that the performance of the hybrid algorithm exceeds that of the original algorithms in terms of coverage degree, RSSI, lifetime and number of neighbor of objects.

Low-power wide area networks (LPWANs) has recently emerged as a popular long-range and low-speed radio communication technology as a result of the important growth of the Internet of Things (IoT) market. In fact, LoRa, Sigfox and NB-IoT are the three major LPWAN technologies which compete for IoT deployment. In this manuscript, we analyze and compare these technologies. The latter are efficiently applied to intelligent, autonomous and heterogeneous devices. Within this framework, 5G networks have to be used to guarantee full connectivity in the IoT networks.

International audience; IoT data collection networks, formerly known as wireless sensor networks, have become one of the most active areas of research in the field of information technology. The deployment of connected objects represents a fundamental phase on the establishment of IoT collection networks. The IoT deployment problem consists in positioning all the sensors constituting the network. This paper proposes an approach maximizing the coverage of a region of interest by the hybridization between the Voronoi diagram and the genetic algorithm. The first algorithm divides the field into cells and generates initial solutions (positions of deployed IoT objects). The latter algorithm is used to improve these positions in order to maximize the overall coverage of the region of interest. Obtained results reveal that the performance of the hybrid algorithm exceeds that of the original algorithms in terms of coverage degree, RSSI, lifetime and number of neighbor of objects.

International audience; Avec la croissance rapide du marché de l'Internet des objets (IoT), les réseaux étendus de faible puissance (LPWAN) sont devenus une des technologies populaires pour les communications radio à longue portée et à faible débit. Plusieurs réseaux LPWAN actuels utilisent des technologies concurrentes pour le déploiement de l'IoT. Cet article propose une analyse et une étude comparative de ces technologies, qui constituent des solutions efficaces pour connecter des objets intelligents, autonomes et hétérogènes.

International audience; Low-power wide area networks (LPWANs) has recently emerged as a popular long-range and low-speed radio communication technology as a result of the important growth of the Internet of Things (IoT) market. In fact, LoRa, Sigfox and NB-IoT are the three major LPWAN technologies which compete for IoT deployment. In this manuscript, we analyze and compare these technologies. The latter are efficiently applied to intelligent, autonomous and heterogeneous devices. Within this framework, 5G networks have to be used to guarantee full connectivity in the IoTnetworks. To evaluate the IoT collection networks behavior, a set of experiments were conducted on real testbeds using wifi and zigbee technologies in an indoor environment.