Mohamed Boussarsar

The Effects of Ramadan Intermittent Fasting (RIF) on Spirometric Data of Stable COPD Patients: A Pilot Study:

No previous study has raised the effects of RIF on lung function data of chronic obstructive pulmonary disease (COPD) patients. The objective of the present study was to assess the effects of RIF on spirometric data measured in male patients with a stable COPD. Sixteen patients with stable COPD (mean ± SD of age: 64 ± 7 years) who fasted during Ramadan volunteered to the study. Three sessions (Before-R, End-R, and After-R) were selected for spirometry tests that were consistently performed 2.5–4.5 hr before fasting break. Assessment sessions comprised: forced vital capacity (FVC), 1st s forced expiratory volume (FEV1), FEV1/FVC, peak expiratory flow (PEF), maximal mid-expiratory flow (MMEF), and forced expiratory flow rate at the x% of FVC to be exhaled (FEFx%). A reversibility test was performed only during the Before-Ramadan session. Spirometric data were expressed in percentages of local reference values. Findings were analyzed by applying repeated measures analysis of variance. The mean ± SD of the postbronchodilator FEV1/FVC ratio and the FEV1 were, respectively, 0.52 ± 0.14 and 48 ± 19%. The mean ± SD of FEV1 (Before-R: 47 ± 19, End-R: 45 ± 18, After-R: 44 ± 19%), FVC (Before-R: 73 ± 18, End-R: 71 ± 16, After-R: 69 ± 17%), FEV1/FVC (Before-R: 67 ± 16, End-R: 66 ± 16, After-R: 65 ± 16%), PEF (Before-R: 46 ± 19, End-R: 47 ± 22, After-R: 45 ± 21%), MMEF (Before-R: 19 ± 10, End-R: 18 ± 8, After-R: 18 ± 9%), FEF25% (Before-R: 16 ± 6, End-R: 16 ± 5, After-R: 15 ± 5%), FEF50% (Before-R: 21 ± 14, End-R: 20 ± 12, After-R: 20 ± 12%) and FEF75% (Before-R: 27 ± 19, End-R: 27 ± 19, After-R: 27 ± 19%) were not significantly influenced by RIF. RIF did not bring about any significant changes in the spirometric data of stable COPD male patients fasting the 2016 holy month of Ramadan.

Characteristics and outcome of ill critical patients with influenza A infection

Introduction To describe all patients admitted to Tunisian intensive care unit with a diagnosis of influenza A/H1N1 virus infection after the 2009 influenza pandemic and to analyse their characteristics, predictors of complications and outcome. Methods All patients with influenza > 18-years-old hospitalized to the ICU department of Tunisian University hospital of Sousse, between December 1, 2009 and March 31, 2016, with a positive influenza A/H1N1/09 reverse transcriptase polymerase chain reaction (RT-PCR) from a nasopharyngeal specimen were included, were included. Results 40 cases were admitted to intensive care units. During the reporting period, 22 deaths in intensive care units (55%) were reported, the median age was 53 years (IQR 37-61), 24 (61%) were male, The median scores SAPS II and SOFA were respectively 29 (IQR 23-36) and 6 (IQR 3-10), 27% had chronic obstructive pulmonary disease (COPD), 33.3% diabetic and no patients were vaccinated against influenza A. The cause of admission was in 72.5% of the cases was hypoxemic pneumonae. By using a logistic regression, we found after adjustment to age, that acute respiratory distress syndrome (ARDS) (OR = 27; 95%CI: 3.62-203.78) was the only factor significantly associated with severe outcomes of the cases. Conclusion Patients in the first post pandemic season were significantly older and more frequently had underlying medical conditions. Multivariate analysis showed that older male patients with chronic lung disease were at increased risk for a severe clinical outcome.

Meningococcemia complicated by myocarditis in a 16-year-old young man: a case report

Fulminant meningococcemia is a relatively rare life-threatening disease caused by Neisseria meningitidis. The clinical presentation is varied, but, when associated with myocarditis, it carries a particularly poor prognosis. We report a case of a patient with fulminant meningococcemia who subsequently developed severe myocardial dysfunction and successfully recovered within a period of 7 days of hospitalization. A 15-year-old girl presented with headache, fever, body ache for 1 day and few ecchymotic rash over her body for 3 hours. Blood cultures confirmed infection with N. meningitidis. After 2 days in the hospital, the patient developed dyspnea, elevated jugular venous pressure and shock. The patient was managed with intravenous ceftriaxone, furosemide and norepinephrine. Over the next 4 days the patient rapidly improved. Meningococcemia complicated by myocarditis has an extremely poor prognosis with high mortality. Our case suggests that recovery from a severe myocardial dysfunction can occur rapidly within a few days. Prompt recognition and management in this case might have contributed to the patients rapid recovery from myocarditis.

Pulmonary Barotrauma Including Huge Pulmonary Interstitial Emphysema in an Adult with Status Asthmaticus: Diagnostic and Therapeutic Challenges

Introduction Pulmonary interstitial emphysema is a rare finding defined as abnormal air collection inside the lung interstitial tissues. Described more frequently in ventilated new-borns, pulmonary interstitial emphysema is an uncommon barotrauma-related complication in adults. Management and clinical sequelae are poorly described. Patient We describe the case of a 64-year-old man who presented with huge pulmonary interstitial emphysema together with simultaneous pulmonary barotrauma in status asthmaticus requiring invasive ventilation. Discussion There are no guidelines for the management of such complications and their possible sequelae but conservative treatment seems to be effective. The treatment of our patient is described. LEARNING POINTS We describe ventilation-induced tension pulmonary interstitial emphysema combined with contralateral pneumothorax, pneumomediastinum, pneumoperitoneum and subcutaneous emphysema which developed immediately after difficult airway management of acutely decompensated asthma in an adult. The present case highlights the importance of crash induction, cautious airway management and protective re-ventilation in the management of acute respiratory failure with dynamic hyperinflation, such as status asthmaticus. Minimally invasive management by percutaneous trans-thoracic intrabullous chest-tube drainage is feasible, safe and relatively effective.

Cerebral Vasculitis Complicating Pneumococcal Meningitis

Introduction Cerebral vasculitis is an uncommon life-threatening complication of community-acquired bacterial meningitis. Patient and methods We report the case of a 64-year-old woman with pneumococcal meningitis who developed parainfectious vasculitis causing ischaemic brain damage. Cerebral magnetic resonance imaging (MRI) confirmed the diagnosis. Clinical and radiological recovery after delayed addition of corticosteroid was achieved. Discussion This report shows that the onset of neurological deficits following pneumococcal meningitis can be caused by cerebral vasculitis. Underdosing with antibiotics and delayed adjunctive dexamethasone seem to favour this complication. There are no guidelines for treatment but high doses of steroids led to resolution in this case. LEARNING POINTS Pneumococcal meningitis complicated by cerebral vasculitis can be treated with high-dose steroids. A repeat lumbar puncture is recommended to rule out relapsing or persistent infection in patients who deteriorate after 48 h of adequate antibiotic therapy. The cerebral vasculitis in our patient may have been caused by antibiotic underdosing and by delayed dexamethasone administration.

Critical appraisal of the clinical utility of sublingual immunotherapy in allergy

Since it was introduced by Noon in 1911, allergen-specific immunotherapy or desensitization has been widely prescribed in the management of allergic diseases. Aimed at the etiology, it represents the only effective treatment for allergy. The basic mechanisms of immunotherapy are becoming better understood and allow us to improve this technique in the future. The sublingual immunotherapy as an alternative to subcutaneous route has been widely studied. Several clinical trials confirmed that sublingual immunotherapy is efficient in reducing allergic respiratory symptoms. The sublingual immunotherapy reduces the risk of developing serious side effects due to desensitization. We performed a literature review in order to remind the mechanisms of action and to demonstrate efficacy and tolerability of the sublingual immunotherapy in the treatment of allergic rhinoconjunctivitis and asthma and its impact on the quality of life.

Prévalence du syndrome métabolique dans une population de patients apnéiques : étude prospective avec calcul du risque cardiovasculaire

BACKGROUND Obstructive sleep apnea syndrome (OSAS) is a highly prevalent clinical condition and frequently associated with obesity. Recent literature has suggested the independent contribution of OSAS in the pathogenesis of metabolic disturbances. Metabolic syndrome (MS), a cardiovascular risk factor, was frequently associated with OSAS. METHODS This is a prospective study without intervention. Will be included, all consecutive patients referred to the Department of Pulmonology for suspected OSAS confirmed by respiratory polygraphy. Anthropometric, clinical and biological parameters needed to define the MS will be collected. MS was defined according to the IDF 2005. Assessment of cardiovascular risk related to MS will be performed by appropriate scores. EXPECTED RESULTS To determine the prevalence of MS in a sample of OSAS patients recruited in the Department of Pulmonology of Farhat Hached Hospital (Sousse, Tunisia). To identify risk factors independently associated with the presence of MS in patients with OSAS among the following parameters (age, gender, degree of obesity and the various parameters of OSAS severity). To assess compared cardiovascular risks according to the presence of MS by validated scales to demonstrate the impact of MS in patients with OSAS.

Outcome and prognostic features in respiratory critically-ill patients with hematological malignancies

Introduction: Patients with hematological malignancies who develop severe pulmonary complications and require admission to ICU have a poor hospital outcome.We studied etiology, outcome and prognostic factors in respiratory critically-ill patients with hematological malignancies admitted to ICU. Methods: A retrospective cohort study in an 8-bed medical ICU of a university hospital. 105 critically-ill patients with hematological malignancies and pulmonary complications treated within a 10 year period were included. Were analyzed, patients clinical characteristics and outcome. Multivariate analysis was performed to identify prognostic factors. Results: The underlying malignancies were predominantly acute leukaemia, 67% ; non-Hodgkin lymphoma, 19% ; Hodgkin lymphoma, 5.8% ; myelodysplasia syndrome, 6.7% and multiple myeloma, 1.9%.Length of stay in the ICU was 4.77±6.14 days. All were ventilated (84%, invasive ventilation and 16%,NIV). Overall ICU mortality was 73.3%, with significantly higher mortality in invasive-ventilated patients (74%)vsNIV patients(12%), p Conclusion: The outcome of respiratory critically-ill patients with hematological malignancies was overall poor. SAPSII, catecholamine use and mechanical ventilation revealed independent prognostic factors.

Non-invasive ventilation (NIV) in acute respiratory failure in patients with idiopathic pulmonary fibrosis (IPF)

Introduction: A limited number of observational studies have reported that NIV can be an effective treatment in IPF. We aimed to investigate outcomes in IPF patients receiving NIV for ARF and to identify risk factors for its failure. Methods: A retrospective analysis of outcome in IPF patients being administered NIV for ARF in an 8-bed medical ICU. 28 IPF patients who were administered NIV between January 1st, 2007and December 31st, 2014, were included. The outcome measures were, need for endotracheal intubation, length of stay and ICU mortality. Multivariate analysis was performed to identify factors associated to NIV failure. Results: Patients were 64±15,62 years mean-aged. Disease duration was 3,55±3 years. 53% have poor baseline functional status(NYHA ≥III). Diagnoses at admission were, fibrosis exacerbation, 16; infectious decompensation, 2 and cardiac decompensation, 8. SAPSII score was 34.85±11. NIV was successful in 12 patients and failed in 16. All the patients in the NIV failure group died within 5.53±6.05 days. The patients in the NIV success group spent 7.75±6.01 days in the ICU and all survived. At admission, the patients in the failure group had significantly higher plasma NT-proBNPlevels (2847±2004vs 600±660 pg/mL;p=0.032) and significantly lower PaO2/FiO2ratio (135.62±67.75 vs 300.5±82.82; p=0.031). NIV failure was associated to the plasma NT-proBNP levels (OR, 5.81;95%CI, [4.20 , 10.08] ; p=0.032). Conclusion: The outcome of IPF patients who were administered NIV was quite poor. The use of NIV was, nevertheless, found to be associated with clinical benefits. Elevated plasma NT-proBNP levels may be a simple marker for poor NIV outcome.