Houda Ben Ayed

Pediatric respiratory tract diseases: Chronological trends and perspectives

The aim of this study was to describe the epidemiological profile of childhood respiratory tract diseases (RTD) in the region of Sfax, Tunisia, and to evaluate their trends over a 13 year period.

Safety and Disease Evolution of Fixed-Dose Combination of Antitubercular Treatment Compared to Separate-Drugs Preparation in Extra-Pulmonary Tuberculosis

Purpose of ReviewExtra-pulmonary tuberculosis (EPTB) treatment was previously based on separate-drugs preparation (SDP). In the hope of reducing the rates of treatment default and resistance, the WHO have recommended the use of fixed-dose combination (FDC) for first-line in EPTB. We aimed to compare the tolerance and the disease evolution between FDC and SDP regimens in EPTB patients.Recent FindingsWe conducted a retrospective study including 388 cases of EPTB hospitalized between 1996 and 2016. We compared anti-tuberculosis treatment outcomes and the disease evolution between patients receiving FDC and those receiving SDP. The main EPTB site was lymph node (39.2%). There were no statistical differences between the two groups in terms of musculoskeletal, hematological disorders, cutaneous events, and hepatotoxicity. We noted that neurological disorder (OR = 12; p < 0.001), notably paresthesia (OR = 16; p < 0.001), and retrobulbar neuritis (OR = 10; p = 0.006), as well as gastro-intestinal intolerance (OR = 4; p = 0.015) including nausea (OR = 8.9; p = 0.011) and vomiting (OR = 1.1; p = 0.005) were significantly more frequent in the SDP group. The disease evolution comparison showed that complicated forms were statistically more frequent in the SDP group than those in the FDC group (OR = 2.4; p = 0.003), while there was no significant difference in relapse, sequelae, and death frequencies between the two groups.SummarySDP tolerance was characterized by higher frequency of paresthesia, retrobulbar neuritis, nausea, and vomiting than FDC. Evolutionary profiles were similar, except a higher risk of complicated forms in SDP.

Elevated Neutrophil-to-Lymphocyte Ratio is an Effective Prognosis Indicator In Extra-Pulmonary Tuberculosis

Abstract Background Extra-pulmonary tuberculosis (EPT) may lead to serious outcomes in the absence of an adequate treatment. Factors related to poor prognosis (PP) are still insufficiently understood. The peripheral blood neutrophil to lymphocyte ratio (NLR) has been reported to correlate with the prognosis of many acute or chronic infectious diseases. In this perspective, we aimed to investigate the prognostic relevance of NLR in EPT patients. Methods Data were collected from EPT patients, diagnosed between 1990 and 2014. We defined a PP by the occurrence of clinical complications during the hospital-stay or the follow-up. We evaluated the performance of NLR in identifying PP. The Kaplan-Meier method was used to generate complication-free survival curves which were compared by Log rank test according to NLR categories. Cox proportional hazard regression analysis was used to reveal the independent prognostic factors. Results We included 265 patients with EPT among them 68 cases (25.7%) had a PP. The mean age was 42 ± 19.2 years. Sex ratio was 0.8. EPT incriminated lymph node in 95 cases (35.8%), neuromeningeal sites in 50 cases (19%) and bones in 42 cases (15.8%). Mean value of NLR was significantly higher in the PP group (4.5 ± 3 vs. 3.2 ± 2.5; P = 0.01). NLR had an Area Under the Receiving Operating Curve (AUROC) of 0.63 in predicting PP (P = 0.004). At an optimal cutoff of 2.7, sensitivity and specificity were of 60%. There were 128 cases (48.3%) with a high NLR (≥ 2.7). Positive predictive value of NLR was 67.2% while negative predictive value achieved 80%. Overall, the median complication-free survival was 33 days (CI95% 19.2–46.7). When stratified by NLR cutoff, survival curve analysis showed that the one-month complication-free survival rate was lower in patients with high NLR (45% vs. 55%; P = 0.042). In multivariate Cox regression analysis, high NLR was an independent risk factor of predicting PP in EPT patients (HR=1.7; CI95% 1.1–2.9; P = 0.048). Conclusion In this study, NLR was a useful prognostic factor to predict complications in patients with EPT and may be applied in clinical management of EPT in association with other prognostic indicators in order to identify high-risk patients. Disclosures All authors: No reported disclosures.

APRI Score as a Predictor of Significant Liver Fibrosis in Chronic Hepatitis B

Abstract Background Chronic hepatitis B (CHB) is a global public health problem. Histologic staging of liver fibrosis is crucial to identify patients who need antiviral treatment. As an alternative to percutaneous liver biopsy (PLB), Aminotransferase Platelet Ratio index (APRI) score was recently validated by the WHO. We aimed to evaluate the performance of APRI score in predicting significant fibrosis (SF) in patients with CHB. Methods We conducted a retrospective study including 179 patients aged ≥ 15 years with documented CHB and who underwent a PLB during the period 2008-2016. A SF was defined according to Metavir score (≥ F2). ROC curves assessed the performance of APRI score in predicting SF. We estimated PLB cost of 60 Dollars in our institution. Results Mean age of patients was 37.6 ± 10 years and sex ratio was 1.48. There were 93 patients with SF (52%) who had a high level of aspartate aminotransferase (ASAT) (71.4 ± 38 vs. 34 ± 16 IU/L; P < 0.001) but a low level of platelet count (195 ± 53 vs. 208 ± 52 G/L; P = 0.04). APRI score was significantly higher in patients with SF (1.1 ± 0.7 vs. 0.48 ± 0.26; P < 0.001). Multivariate analysis using logistic regression showed that only APRI score was independently predictive of a SF (HR = 3.78, CI95% 1.23-11.6; P = 0.02). APRI predicted accurately SF with an Area Under the Receiving Operating Curve (AUROC) of 0.7 (CI 95% 0.62–0.77; P < 0.001). At a threshold of 0.5, APRI had a sensitivity of 62%, a specificity of 68%, a positive predictive value of 64.4% and a negative predictive value of 60.7%. The number of avoided PLB with APRI score was 112 PLB with a diagnostic accuracy of 62.5%. Subsequently, the saved cost was estimated to be around 6720 Dollars. Conclusion APRI score was well performing in predicting SF in patients with CHB. This could be of paramount importance particularly in developing countries given that this non-invasive score may help to assess liver fibrosis in CHB. Larger scale and analytic prospective studies are required in order to strengthen the accuracy of this score. Disclosures All authors: No reported disclosures.

How Easy is the Differential Diagnosis Between Brucellar and Tuberculous Spondylodiscitis

• Spondylodiscitis is a common disease that may lead to serious vertebral sequelae. This entity has aroused a major interest in the endemic countries where M. Tuberculosis and Brucella spp are frequently involved. • The aim of our study was to compare the clinical, biological, radiological and therapeutic characteristics of brucellar (BS) and tuberculous spondylodiscitis (TS). How Easy is the Differential Diagnosis Between Brucellar and Tuberculous Spondylodiscitis ?