FAQ

Many people have high blood pressure, some of whom are aware of it and are all too often poorly monitored and treated, while others are unaware of it and are therefore not treated at all. It's important to know your blood pressure, so it's taken at almost every medical consultation, especially when patients are in good health and doctor's visits are limited.

Signs of the disease Hypertension usually has no symptoms to alert the patient. It is frequently discovered during routine medical examinations. Occasionally, however, certain signs may raise suspicions of arterial hypertension:

• Headaches in the morning on the top or back of the head.
• Dizziness.
• Visual disturbances: flying flies, fog in front of the eyes…
• Tiredness.
• Nosebleeds.
• Conjunctival hemorrhages.
• Muscle cramps.
• Pollakiuria (frequent urge to urinate).
• Dyspnea (difficulty breathing, indicating left ventricular failure).

Once the doctor has discovered high blood pressure, he checks it several times under different conditions: rest, effort, standing, lying down, right arm then left arm... In this way, he ensures that it is permanent.

Kidney transplantation is a surgical procedure in which a defective kidney is replaced by a healthy kidney from a donor. It is the only therapeutic alternative to dialysis in the management of advanced chronic renal failure.

In Tunisia, the general organization of organ harvesting and transplantation is the responsibility of a public establishment, the Centre National pour la Promotion de la Transplantation d'Organes (National Center for the Promotion of Organ Transplantation). Its missions include management of the waiting list, graft allocation, health vigilance and evaluation of transplant results.

After surgery, immunosuppressive treatment, which is essential throughout the life of the transplant, involves a combination of several drugs. Immunosuppression protocols vary according to the recipient's immunological status, the post-transplant period, and the possibility of acute rejection episodes. Each recipient must be clearly informed of the particularities of the treatment chosen and the side effects associated with the drugs used.

The first kidney transplant was performed by Professor Saadeddine ZMERLI's team at the Charles Nicolle Hospital in Tunis in 1986. Since then, five kidney transplant centers have performed more than 1,000 kidney transplants, with 90% of grafts coming from living donors.

What we know about Multiple Sclerosis (MS) :

Multiple sclerosis is an inflammatory, chronic and often disabling neurological disease that affects only the Central Nervous System (brain and spinal cord).

The disease is thought to be the result of various mechanisms, the most likely of which is immunological, with antibodies and lymphocytes directed against myelin, leading to its permanent destruction.

The clinical symptoms of this disease, which affects twice as many women as men, usually appear between the ages of 15 and 45, and include spasticity, sphincter disorders, pain, tremors, often with an associated depressive syndrome…

Diagnosis is based primarily on neurological examination and Magnetic Resonance Imaging (MRI).

The progression that usually leads to permanent disability varies greatly from one person to the next.

In 2013, 2.3 million people around the world were affected, with highly variable prevalence rates.

It is most widespread in North America and Europe, with rates of 140 and 108 cases per 100,000 inhabitants respectively.

In Tunisia, the number of patients is around 5,000 and the incidence is 1.3 per 100,000.

Current treatments, expensive as they are, are essentially aimed at reducing the frequency of relapses, delaying disability and providing the necessary psychological support, but we don't yet have a cure.

What we don't yet know about Multiple Sclerosis (MS) :

• Why does the disease occur in a given person?
• How to repair lesions?
• How to cure the disease?

Economy class syndrome

Deep Vein Thrombosis (DVT) is a well-known and severe condition, and the leading cause of death from pulmonary embolism.

The annual incidence of Thrombo Embolic Disease in the Caucasian population is 1 to 2 per 1000.

Cases of DVT have been described during air travel without attracting the attention of the medical profession or airlines, until the death of a 27-year-old woman at Heathrow airport after a flight from Australia.

Risk factors associated with air travel include immobilization, reduced local pressure and dehydration [1].

According to the conclusions of the Geneva meeting, long-haul air travel is unquestionably a risk factor for venous thrombosis in predisposed individuals.

Prevention

No systematic prevention should be proposed for flights of less than 4 hours, apart from the possible wearing of elastic medical compression socks, which is always recommended to avoid oedema.

For flights longer than 4 hours (8 hours according to the recommendations of the American College of Chest Physicians) [2] :

In patients with no personal history of DVT or known familial thrombophilia, it is recommended to (grade 1C) :

• Avoid wearing tight-fitting clothes.
• Do not consume alcoholic beverages.
• Avoid hypnotics (and the combination of alcohol and hypnotics).
• Wear elastic medical compression socks of 15 to 20 mm Hg.
• Regularly rotate and dorsi-flex both feet, avoiding crossing the legs.
• Make forced inspiratory and expiratory movements.
• Drink a glass of water every hour.
• Getting up every 2 or 3 hours to take a few steps in the corridor.

In patients with a history of recent or recurrent DVT, known and documented familial thrombophilia, advanced post-thrombotic disease, reduced mobility (gonarthrosis, coxarthrosis, disabling neurological disease) or progressive cancer, we recommend the same healthy lifestyle rules as described above, in combination with :

• Medical elastic compression with socks of 20 to 30 mmHg.
• A prescription for a preventive dose of Low Molecular Weight Heparin (LMWH). The subcutaneous injection should be given 1 to 2 hours before departure and repeated 1 to 2 hours before return (grade 2C).
• According to coagulation experts, aspirin has no preventive action on the venous system (grade 1B).

In the LONFILT study [2], of 467 subjects at risk of DVT, no thrombosis was observed during prophylaxis with LMWH (1,000 IU per 10 kg), whereas a thrombotic episode occurred in 3.6% of cases with aspirin and 4.8% in the absence of prophylaxis.

In patients with recent DVT, air travel will only be authorized after 10 days of anticoagulation with effective doses of LMWH or VKA, with 2 consecutive INR values between 2 and 3.

In patients who have had a semi-recent thromboembolic episode and are still taking VKAs, it is recommended to check the INR the week before the flight, and to prescribe elastic medical compression socks of 20 to 30 mmHg.

Bibliography

• F.Clheir, thromboembolic disease of air travel. ELSEVIER MASSON 20122.
• KEARON C, KAHN S, AGNELLI G et al. Antithrombotic therapy forvenous thromboembolic disease. American College of ChestPhysician (8e édition). Chest, 2008 ; 133 : 454S-545S.
• CEASARONE M. R, BELCARO G, NICOLAIDES A et al. Venous thrombis from Air Travel : The Lonflit study. Angiology, 2002 ; 53 : 1-6.

Dyslipidemia is an abnormally high or low concentration of lipids (cholesterol, triglycerides, phospholipids or free fatty acids) in the blood. There are several types, but cholesterol-related abnormalities are among the most common.

Cholesterol is a waxy substance (fat) naturally present in the body. It is used in the structure of cells, in the manufacture of certain hormones and vitamin D, and in the production of bile acids that help digest fats. Cholesterol comes from two sources: firstly, we make (mainly in the liver) the amount we need, but it is also present in some of the foods we eat. All foods containing animal fats contain some degree of cholesterol. The main sources of dietary cholesterol are cheese, egg yolks, beef, poultry and shrimps.

Cholesterol is therefore an essential substance for our bodies, but it is widely recognized that high cholesterol levels are one of the main risk factors for cardiovascular disease.

Cholesterol circulates in the blood in 2 forms, depending on its carrier: LDL (bad cholesterol) and HDL (good cholesterol).

« Bad » cholesterol can form deposits on artery walls (plaques). These deposits can narrow the arteries, reduce blood flow and can cause a heart attack or stroke. Conversely, high HDL levels reduce the risk of heart disease, hence the name « good »cholesterol. HDL («good» cholesterol) collects cholesterol and transports it to the liver, where it is eliminated.

Excessive LDL cholesterol and/or low HDL levels can be dangerous over the long term. Excess cholesterol deposits on the walls of arteries (such as the coronaries, the arteries of the heart), forming plaques that can grow over the years (atherosclerosis).

Plaques can slow down or even interrupt blood flow, causing angina pectoris or angina. If the flow is severely reduced, this may lead to myocardial infarction (destruction of heart tissue).

There are many triggers for headaches, and they vary from person to person. The most common are :

• Environmental factors: heat, bright light, noise, strong odors, etc.
• Dietary factors: alcoholic beverages, coffee, fatty dishes, chocolate…
• Hormonal factors: menstruation, taking the pill, puberty…
• Psychological factors: stress, anxiety, lack or excess of sleep.

Avoiding these factors can reduce the frequency of attacks. Every time you have a headache, remember to take note of the factors that triggered it, so that you can avoid them in the future.