H. Aouina

Spirometric profile of narghile smokers

INTRODUCTION Studies of the spirometric profiles of narghile smokers are few, have some methodological limits (i.e. small sample size), and present contradictory conclusions. AIMS (i) To determine the percentage of narghile smokers with obstructive ventilatory defect (OVD) and/or restrictive ventilatory defect (RVD) or static hyperinflation (SHI); (ii) to compare the chronological and estimated lung ages. POPULATION AND METHODS INCLUSION CRITERIA men aged 20 to 60 years, narghile smokers (>1 narghile-year [NY]). EXCLUSION CRITERIA cigar or cigarette smokers and comorbidity. Narghile use quantification: NY and kg of cumulative tobacco use (1 NY=9.125 kg of cumulative tobacco use). DEFINITIONS Large airway obstructive ventilatory defect (OVD): forced expired volume in one second (FEV(1))/forced vital capacity (FVC) less than lower limit of normal (LLN). Small airway OVD: FVC more than LLN and decrease (less than LLN) of one or more peripheral flows. RVD: total lung capacity (TLC) less than LLN. SHI: residual volume (RV) more than upper limit of normal. SPIROMETRIC MEASURES: (Vmax 22 Series/6200 Autobox, SensorMedics, Yorba Linda, California, USA with measurement of functional residual capacity by nitrogen washout). Measurements were made according to international recommendations. RESULTS One hundred and ten narghile smokers were included (34±10 years; 1.76±0.07m; 84±14kg). Thirty-six percent of the subjects had SHI; 14% had small airway OVD; 14% had RVD, and 6% had large airway OVD. Estimated lung age was higher than chronological lung age (47±18 years vs. 34±10 years, P<0.05). CONCLUSION Narghile use accelerates lung ageing. This study provides the health authorities with valid arguments to fight this blight on society, which increasingly involves children and pregnant women.

Rhabdomyolyse aiguë au cours des pneumonies à pneumocoque: À propos de deux observations

Acute rhabdomyolysis is a clinical and biological syndrome generally with a toxic or traumatic cause. Only 5% of cases are infectious, and rarely in relation to a pneumococcal infection. We report two cases of acute rhabdomyolysis which developed in patients with severe Streptococcus pneumoniae pneumonia. No other cause could be identified in these two patients aged 32 and 37 years. Rhabdomyolysis was discovered in the first patient because of acute kidney failure and elevated serum transaminase levels. The second patient presented an inflammatory edema affecting the soft tissues. Blood cultures isolated a pneumococcus in both patients. The rhabdomyolysis regressed favorably in both patients despite the transient renal failure in the first patient. Prognosis is generally poor for rhabdomyolysis during the course of pneumococcal pneumonia, with increased morbidity and mortality for these infections. Early detection of bacteriemia enables rapid and adequate treatment and prevention of renal failure.Resume La rhabdomyolyse aigue est un syndrome clinique et biologique le plus souvent d’origine toxique ou traumatique, et, seulement dans 5% des cas, d’origine infectieuse. Il a ete rarement decrit au cours des pneumonies a pneumocoque. Nous rapportons deux observations de rhabdomyolyse aigue survenue au cours de pneumonies graves a Streptococcus pneumoniae chez deux patients âges de 32 et 37 ans, et non expliquee par une autre cause. La rhabdomyolyse a ete decouverte chez le premier patient lors du bilan d’une insuffisance renale aigue avec cytolyse hepatique, et chez le deuxieme devant un œdeme inflammatoire des parties molles. Les hemocultures ont isole un pneumocoque dans les deux cas. L’evolution de la rhabdomyolyse a ete favorable dans les deux cas, malgre l’insuffisance renale transitoire chez le premier patient. La rhabdomyolyse au cours des pneumonies a pneumocoque reste generalement de mauvais pronostic, car elle augmente la morbidite et la mortalite de ces infections. Sa detection precoce au cours de toute bacteriemie permet d’instaurer rapidement une therapeutique adequate et de prevenir l’insuffisance renale.

Traitement de la tuberculose

The aim of this article is to give practicing physicians a practical approach to the treatment of latent and active tuberculosis. Most patients follow TB standard treatment recommended by WHO that depend on category of patient. It is a combination of four essential tuberculosis drugs of the first group: isoniazid, rifampicin, pyrazinamid and ethambutol; in some cases streptomycin can replace ethambutol. This initial phase of intensive treatment is followed by a consolidation phase. Drugs should be administered in the morning on an empty stomach one hour before meals. Treatment of latent tuberculosis (TB) infection is an important component of TB control programs. Preventive treatment can reduce the risk of developing active TB.

Article originalMaladie veineuse thromboembolique au cours de la tuberculoseVenous thromboembolism in patients with acute tuberculosis

BACKGROUND Studies have demonstrated a link between tuberculosis and hypercoagulable state, with reported rates of 0,6%-10% venous thromboembolism (VTE) in all adults with tuberculosis. The present study aimed to evaluate the current incidence and characteristics of VTE in a large sample of patients with acute tuberculosis. METHODS We report a retrospective study about 26 patients who have confirmed tuberculosis complicated with VTE disease. RESULTS Sixteen men and ten women were brought together. The mean age was 42.58 years. The thromboembolic complication revealed tuberculosis among 5 patients, appearing during hospitalization of 21 patients among which 16 of them receiving antituberculosis drug. We have listed 10 cases of immediate pulmonary thromboembolism and 16 cases of deep vein thrombosis complicated with pulmonary embolism in 6 cases. Oral anticoagulation drug were associated with heparin after a mean of 4.57 days. Duration average of achievement of an effective dose was of 21.05 days and we prescribe low molecular weight heparin for 6 months on 2 cases. There was favorable evolution among 14 patients, 4 of them have lost sight and the evolution was fatal by cataclysmic haemoptysis in one case, a patient died hepatocellular insufficiency and 6 died by pulmonary embolism. CONCLUSION Immunological and hematological abnormalities are incriminated in the genesis of VTE disease during tuberculosis by creating hypercoagulate state. The accumulation of morbidity of these two affections as well as the difficulty of therapeutic care made by medical interaction ifampicin-anticoagulants aggravate the prognostic.

Maladie veineuse thromboembolique au cours de la tuberculose

BACKGROUND Studies have demonstrated a link between tuberculosis and hypercoagulable state, with reported rates of 0,6%-10% venous thromboembolism (VTE) in all adults with tuberculosis. The present study aimed to evaluate the current incidence and characteristics of VTE in a large sample of patients with acute tuberculosis. METHODS We report a retrospective study about 26 patients who have confirmed tuberculosis complicated with VTE disease. RESULTS Sixteen men and ten women were brought together. The mean age was 42.58 years. The thromboembolic complication revealed tuberculosis among 5 patients, appearing during hospitalization of 21 patients among which 16 of them receiving antituberculosis drug. We have listed 10 cases of immediate pulmonary thromboembolism and 16 cases of deep vein thrombosis complicated with pulmonary embolism in 6 cases. Oral anticoagulation drug were associated with heparin after a mean of 4.57 days. Duration average of achievement of an effective dose was of 21.05 days and we prescribe low molecular weight heparin for 6 months on 2 cases. There was favorable evolution among 14 patients, 4 of them have lost sight and the evolution was fatal by cataclysmic haemoptysis in one case, a patient died hepatocellular insufficiency and 6 died by pulmonary embolism. CONCLUSION Immunological and hematological abnormalities are incriminated in the genesis of VTE disease during tuberculosis by creating hypercoagulate state. The accumulation of morbidity of these two affections as well as the difficulty of therapeutic care made by medical interaction ifampicin-anticoagulants aggravate the prognostic.

Infections pulmonaires mycosiques chez des patients non neutropéniques

UNLABELLED Lung mycosis is rare. Diagnosis and treatment must be done the earliest possible. METHODS It is about a retrospective study on clinical records including patients hospitalized for lung infection. RESULTS From 2008 to 2011, 16 patients (13 men and three women, average age 42 years) developed a pulmonary infection. Twelve of our patients had respiratory or extrarespiratory histories. None of our patients had a neutropenia. The diagnoses were lung aspergilloma in four cases, invasive lung aspergillosis in three cases, allergic bronchopulmonary aspergillosis in three cases, mucormycosis in three cases, trichosporonosis in a case, actinomycosis in one case and penicilliosis in one case. An antifungal treatment consisting in amphotericin B or itraconazole was given to four patients and six patients, respectively. Surgery was chosen for six patients. The evolution was good for 12 patients, one presented renal failure, and three patients died.

Article original/Original articleInfections pulmonaires mycosiques chez des patients non neutropéniquesLung mycosis in non neuropenic patients

UNLABELLED Lung mycosis is rare. Diagnosis and treatment must be done the earliest possible. METHODS It is about a retrospective study on clinical records including patients hospitalized for lung infection. RESULTS From 2008 to 2011, 16 patients (13 men and three women, average age 42 years) developed a pulmonary infection. Twelve of our patients had respiratory or extrarespiratory histories. None of our patients had a neutropenia. The diagnoses were lung aspergilloma in four cases, invasive lung aspergillosis in three cases, allergic bronchopulmonary aspergillosis in three cases, mucormycosis in three cases, trichosporonosis in a case, actinomycosis in one case and penicilliosis in one case. An antifungal treatment consisting in amphotericin B or itraconazole was given to four patients and six patients, respectively. Surgery was chosen for six patients. The evolution was good for 12 patients, one presented renal failure, and three patients died.

Insuffisance respiratoire aiguë au cours de la maladie de Von Reckling Hausen

Au cours de la neurofibromatose type I ou maladie de Von ecklinghausen, l’appareil respiratoire peut être touché à ifférents niveaux avec une fréquence de 5 à 20 % en foncion des séries [1]. La manifestation la plus fréquente reste e développement de neurofibromes aux dépens des nerfs ntercostaux ou des nerfs intra pulmonaires. La cage thoraique peut être le siège d’anomalies dont les plus fréquentes ont des atteintes costales et rachidiennes, représentées par es cyphoscolioses, le scalloping vertébral, le spondylolishésis, et les défauts d’ossification. La cyphoscoliose et le calloping vertébral sont les plus fréquents (40 % des cas) [2] t prédominent au niveau cervical et thoracique [3]. Elles ntrainent des conséquences ventillatoires à type de trouble estrictif avec retentissement gazométrique pouvant préciiter l’évolution vers l’insuffisance respiratoire aiguë et le écès à l’occasion d’atteinte infectieuse pulmonaire. D’autres atteintes peuvent se voir notamment de la paroi rachéobronchique qui peut être rarement le siège de neuofibromes (moins de 30 cas rapportés dans la littérature) ont le développement se fait de façon pédiculé ou intraural. Cette atteinte peut être totalement asymptomatique omme elle peut mimer un asthme et se traduire par une yspnée [4] et c’est l’endoscopie qui va redresser le diagostic. Au niveau médiastinal, l’atteinte est représentée par des umeurs prédominant dans le médiastin postérieur qui sont réquemment des neurofibromes plexiformes, développés m h t c

Recurrent iliac hydatidosis: A case report

INTRODUCTION Hydatid cysts may occur in any area of the body, but they usually localize to the liver and the lungs. Primary localization in bone is not common. PRESENTATION OF CASE The authors report the case of multifocal hydatid disease appeared 3 years after the surgical treatment of a cyst of the hip. The patient presented with cough and chest pain of 2 months duration. Only the lung localization was symptomatic. The thoracic echography, the abdominal and chest scan allowed the diagnosis. DISCUSSION Hydatid recurrence remain frequent, whatever is the nature of the treatment, surgical or chemical. CONCLUSION The premature detection of recurrence is of great importance.

Intérêt en pneumologie des prélèvements bactériologiques chez les patients hospitalisés pour pneumopathies communautaires

Les pneumopathies communautaires constituent une cause importante de morbidite. Leur prise en charge est de mieux en mieux codifiee par les consensus internationaux, mais certains problemes persistent dans l’application pratique de ces recommandations. C’est le cas pour le recours aux prelevements bacteriologiques dans l’enquete etiologique. Afin d’evaluer le rendement des prelevements bacteriologiques et leur impact sur l’evolution et le pronostic des malades hospitalises pour pneumopathie communautaire, nous avons etudie retrospectivement les dossiers de 181 malades, repartis en deux groupes : un groupe de 85 patients ayant beneficie d’au moins un prelevement, et un groupe de 96 patients n’en ayant pas beneficie. Le rendement des prelevements etait de 10,4 % pour l’examen cyto-bacteriologique des crachats, de 18,75 % pour les hemocultures, de 46,6 % pour le prelevement distal protege et de 20 % pour le lavage bronchoalveolaire. La comparaison entre les 2 groupes, de l’evolution radio-clinique (favorable dans les 2/3 des cas), de la frequence des complications pulmonaires (8,28 % des cas) et de la mortalite (4,97 % des cas), n’a permis de retenir aucune difference significative. L’indication de l’hospitalisation de nos malades a ete souvent large, et le recours aux prelevements n’a pas toujours ete synonyme de gravite. L’apport de ces prelevements s’avere tres limite et leur indication loin d’etre systematique devrait se limiter a la severite ou a l’echec d’une premiere antibiotherapie.