Besma Hamdi

Vitamin D reduces the differentiation and expansion of Th17 cells in young asthmatic children.

Vitamin D [25(OH)D3] deficiency has been associated with asthma as in many inflammatory and autoimmune pathologies; however, there is still a lack of data about the effects of administration of vitamin D in immune regulation in young asthmatic patients. In this study, we investigated its inhibitory effect on the immune response in young asthmatic patients and the possible mechanisms involved. Peripheral blood CD4(+) T cells from 10 asthmatic patients and 10 healthy controls were cultured under Th17 polarizing conditions in the presence or absence of [25(OH)D3], IL-17 cytokine production was determined by ELISA and flow cytometry. Messenger RNA (mRNA) expression of several factors related to Th17 cell function was determined by real-time PCR. The effect of [25(OH)D3]-treated dendritic cells (DCs) on CD4(+) T cell response was determined by ELISA and flow cytometry. Stimulation of naive CD4(+) T cells under Th17 polarizing conditions showed a higher Th17 cell differentiation in asthmatic patients than healthy controls. The addition of [25(OH)D3] significantly inhibited Th17 cell differentiation both in patients [P<0.001] and in normal controls [P=0.001] in a dose-dependent way. [25(OH)D3] was able to inhibit the gene expression of RORC, IL-17, IL-23R, and CCR6. [25(OH)D3]-treated DCs significantly inhibited IL-17 production [P=0.002] and decreased the percentage of CD4(+)IL-17(+) [P=0.007] in young asthmatics. The findings suggest that the inhibitory effect of [25(OH)D3] on the Th17 response was mediated via both T cells and DCs. DCs pathway is involved in the direct inhibition of 25(OH)D3 on Th17 cell differentiation in young asthmatics.

Giant pulmonary hydatid cyst in children

Background: Lungs are the second most common site for hydatid disease after the liver. Giant hydatid cysts (GHC) of the lung are a special clinical entity in children and are related to higher lung tissue elasticity. Aim: To compare the characteristics on presentation, location of the cyst, type of the intervention, postoperative complications and long-term results in GHC and non-giant pulmonary hydatid cysts (NGHC) in children. Methods: A retrospective study was undertaken. The data analyzed were taken from medical records of pulmonary hydatid cyst (PHC) children hospitalized in a Pulmonary Department between 2004 and 2016. Cysts were divided according to their size into GHC (>10cm) and NGHC (≤10cm). Results: In the period of study, 94 PHC were recorded in 74 children. GHC accounted for 13 (13.8%) and NGHC for 81 (86.2%). Mean age of children was 11.21 years (9.5 in GHC vs 11.5 years in NGHC). Hemoptysis was founded in 25% of children with GHC vs 45.2% in those with NGHC (p=0.19). Cysts were unique in 61.7% of cases and predominated at right in 59.1% and in inferior lobes in 70% of cases. GHC were significantly less frequently complicated (46.2% vs 76.6% in NGHC, p≤0.05). Parenchymal resection was realized in 61.5% of GHC vs 14.8% of NGHC. No significant difference in post-operative complications was found between the two groups. Sequels were found in 58.3% of GHC vs 45.2% of NGHC (p>0.05). Any child had recurrent cyst. Conclusions: GHC is a frequent clinical entity in children because of lower frequency of complications (hemoptysis and rupture) and thus delayed diagnosis. They are associated with more frequent sequels, require major surgery with parenchymal resection and therefore require early diagnostic and therapeutic management.

Estimation of the hospitalization cost for asthma exacerbation in a pulmonology department

Background: Asthma has an economic burden on public health, particularly linked to hospitalization during exacerbations. In fact, according to literature 70% of the overall disease cost is due to exacerbations. The purpose of this study was to calculate the direct cost of an hospitalization due to asthma flare up in pour department and to propose measures reducing this cost. Methods: This retrospective study included 100 patients who were admitted with an acute asthma exacerbation between 1st January 2012 and 30th September 2015 in Abdurrahman Mami hospital. Direct costs included hospital charges, human resources utilization, diagnostic tests and medications. Results: The mean age of the patients was 53.18 ± 16.7 years. Sixty-three had one or more co-morbidities. Asthma was severe in 67% and moderate in 23% of patients. The average direct cost of asthma exacerbation was 393,13€ ± 164,93€/ hospitalization. Hospital charges accounted for 34% of the direct cost (134,78€ ± 61,69€), followed by the cost of human resources utilization, which represented 29% (114,22 ± 52,28€), then the cost of diagnostic tests 26% (100,51 ± 45,48€) and the treatment 11% ( 44,06 ± 33,02€). A statistically significant relationship was found between the mean direct hospitalization cost and age (p = 0.001), presence of co-morbidities (p = 0.001) and asthma severity (p = 0.011). Conclusion: In our study, the cost of hospitalization for asthma and its economic burden on public health could be reduced by limiting unnecessary complementary tests, antibiotics prescription and reducing the length of hospital stay.

When should we perform flexible bronchoscopy in children with recurrent lower respiratory tract infections (RLTI)

Many children experience RLTI. Physicians have to distinguish healthy subjects from those with an underlying chronic disease that requires further investigations.The aim of the study is to evaluate the need of flexible bronchoscopy (FB) in children with RLTI It is a retrospective study among 76 children who consulted our daycare hospital from 2013 to 2015 for RLTI.Every patient had a physical examination,blood count,prick-tests,chest radiography,an EGD-transit or an oesophageal ultrasound and a spirometry. Asthma,gastro esophageal reflux(GER) or upper respiratory tract infections were diagnosed in 57 children who didn9t need further examinations. twenty subjects (26.31%) underwent a FB.It was made immediately in 4 children with bronchiectasis because of abnormal chest x ray. Sixteen FB were made in children with uncontrolled asthma(3 cases),unexplained RLTI (11 cases) or persistent cough after GER treatment(2 cases).FB was normal in 8 children(6 with RLTI).The FB showed tracheal dyskinesia in 2 children with unexplained RLTI. Bacteriological examination of sputum aspirate was performed in 13 subjects and it was positif in 7 of them. Haemophilus Influenzae was isolated in 5 cases (1asthma,1GER,2bronchiectasis,2 unexplained RLTI) and streptococcus pneumonia in 1 case with RLTI. After antibiotic treatment there was an improvement in children with RLTI suggesting the diagnosis of protracted bacterial bronchitis. FB must be performed in case of unexplained RLTI,uncontrolled asthma or in presence of persistent chest x ray abnormalities. It also allows bacteriological analysis and thus to diagnose protracted bacterial bronchitis that is usually under-recognized.

Evaluation of adherence to tuberculosis screening in children

Introduction: In countries with a high incidence of tuberculosis (TB), screening have been shown to be effective in further reducing TB incidence. TB screening in children at high risk of TB infection can reduce rates of latent TB infection (LTBI) and TB infection (TBI). Objective: Evaluate adherence to TB screening program in children. Methods: We retrospectively studied data of children referred to our TB screening consultation, in pediatric pulmonology department, from januray 2014 to august 2015. Children in household contact with a TB index case, were screened for TBI or LTBI. Each child had a medical evaluation, tuberculin skin test (TST), chest X-ray and were followed up at one month, 3 months and 6 months. We measured rate of adherence and estimated factors associated to good adherence. Results: Children were aged from 2 months to 16 years. Of 87 children screened, 29.8% had LTBI and 6.9% had TBI. Sixty one children (70.1%) underwent prophylactic therapy. At one month, 70.1% children attended meeting with doctor, 37.9% at 3 months, and 5.7% at 6 months. Near relationship (59.3% vs 40.7%, p=0.04) and close contact with TB index case (55.9% vs 44.1%, p=0.03), seem to be factors associated with good adherence. Age less than 5 (46.7% vs 53.3%, p=0.107) and symptoms such as cough, fever and weight loss were not significant factors. Children with chest X-ray anomalies (61.9% vs 38.1%, p=0.284) and positive TST (54.8% vs 45.2%, p=0.584) had not significant better adherence. Only 56.3% children were compliant to therapy. Conclusion: TB investigation for children in household contact with an index case is important to detect LTBI cases and treat them early. But we should insist on adherence and compliance to therapy.

Link between vitamin D and IL33 and sST2 in children with asthma

It9s now admitted that vitamin D deficiency is associated with allergic diseases and asthma. Recently, IL33, an IL1 family cytokine was described as an “alarmin” that promotes TH2-type cytokines and airway inflammation in asthma. Recent data showed a possible interaction between IL33 and vitamin D levels when vitamin D supplementation increased sST2 levels a soluble IL33 receptor and inhibitor in situ of IL33. The aim of our study was to investigate the link between serum levels of IL33 and vitamin D (by ELISA) according to disease severity and control in winter and summer in 38 asthmatic children (17 mild asthmatics and 21 moderate asthmatics) compared to 30 healthy controls (HC). Our results showed that vitamin D levels were lower in asthmatics compared to HC in summer (p=0.004). These levels were lower in winter and in more severe asthma (p These results suggest that vitamin D deficiency may increase IL33 levels and thus induce TH2 inflammation. Vitamin D supplementation may reduce inflammation through sST2 production.

Hypersensitivity pneumonitis: Clinical spectrum and outcome

Background: Hypersensitity pneumonitis (HP) is a heterogeneous condition, both clinically and radiologically, resulting from the exposure and inhalation of a variety of organic and inorganic compounds. The pathological picture of chronic HP is, however, complicated This study aims to determine the clinical, radiological, and pathological features of HP. It is a retrospective study during from January 2007 to December 2014 including 8 patients hospitalized for Hypersensitity pneumonitis (HP). Results: Mean age was47 years (6 women, two Childs). None of them was a smoker. In half of cases there was chronic evolution of symptoms.Clinical manifestations were dominated by dyspnea in 4 cases, pulmonary crackles in 6 cases. The etiology was identified in all cases: Professional in 3 cases (dental prosthesis (n=1), farmers (n=2)), Drug induced HP in 2 cases (avlocardyl, amiodarone), Bird fancier9s lung (BFL) in one case and cow9s milk protein allergy in one case. Bronchoalveolar lavage fluid showed lymphocytic alveolitis in all cases the fraction of lymphocyts was estimated to 40% with an inversion of the CD4+/CD8+ ratio in 50% of cases. CT showed radiological signs of fibrosis in 50% of cases. All patients had restrictive pulmonary function. The treatment was eviction in all cases and oral corticosteroids in 7 cases. Improvement was notified in 6 cases, one patient developed an adrenal insufficiency, and one patient developed chronic respiratory failure. Conclusion: HP is recognised as an underdiagnosed condition and early recognition of the disease may help prevent continued antigen exposure to the patient which in turn may halt progression to irreversible fibrosis.