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. 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.

North African reference equation for peak nasal inspiratory flow.

AIM: To assess, in healthy North African subjects, the applicability and reliability of a previously published reference equation and normal values for peak nasal inspiratory flow, and to calculate a peak nasal inspiratory flow reference equation in this population. SUBJECTS AND METHODS: Anthropometric data were recorded in 212 volunteers (100 females and 112 males) aged 13-27 years. Peak nasal inspiratory flow was measured several times. Univariate and multiple linear regression analyses were used to determine the reference equation. RESULTS: The previously published reference equation and normal values did not reliably predict peak nasal inspiratory flow in the study population. In our subjects, the reference equation (r2 = 30 per cent) for peak nasal inspiratory flow (l/min) was 1.4256 × height (m) + 33.0215 × gender (where 0 = female, 1 = male) + 1.4117 × age (years) - 136.6778. The lower limit of normal was calculated by subtracting from the peak nasal inspiratory flow reference value (84 l/min). CONCLUSION: This is the first published study to calculate a reference equation for peak nasal inspiratory flow in North African subjects. This equation enables objective evaluation of nasal airway patency in patients of North African origin.

Adiponectin responses to acute moderate and heavy exercises in overweight middle aged subjects.

AIM: The purpose of this study was to investigate the effect of acute moderate and heavy exercises on adiponectin, leptin and insulin concentrations in untrained subjects. METHODS: Seven overweight middle-aged males participated in this study (age: 36.00 ± 5.16 years; body weight: 93.94 ± 6.48 kg; percent body fat: 26.64 ± 2.75%; Body Mass Index: 28.32 ± 1.74 kg.m2). They took part in two sub-maximal cycling exercises; moderate; 20 min cycling at 60% of peak aerobic power (PAP) and heavy: 20 min cycling at 80% of PAP. Venous blood samples were obtained before, after 30, 60 and 90 min recovery. RESULTS: Adiponectin concentrations were unchanged (P>0.05) after exercises. However, leptin was significantly decreased under resting values after 30 min (-12.74%, P=0.0023), 60 min (-11.66%, P=0.0084) and 90 min (-8.42%, P=0.0023) after the heavy exercise. Similarly, insulin was lowered after 90 min after the heavy exercise (-55.96%, P=0.014). Basal adiponectin during moderate exercise was significantly and negatively related to BMI (r=-0.778, P=0.033) and percent body fat (r=-0.897, P=0.0061). CONCLUSION: In conclusion our results suggested that 20 min moderate or heavy sub-maximal exercises not stimulate the production and the release of adiponectin during 1.5 hour recovery post-acute exercises. Furthermore, it appears that after acute heavy exercise adiponectin is not associated with leptin or/and insulin modifications.

[Submaximal exercise capacity and quality of life in exclusive water-pipe smokers]. / Aptitude aérobie sous-maximale et qualité de vie des fumeurs exclusifs de narguilé

BACKGROUND: It is well known that oxidative stress is increased significantly by regular water-pipe smoking (WPS). This could lead to muscle dysfunction and thus to impairments of exercise and quality of life (QOL). Considering the impressive number of WP smokers, we intend to investigate the potential effect of WPS on submaximal exercise capacity and QOL. AIMS: (1). To evaluate the submaximal exercise capacity by the 6-minutes walking test (6-MWT). (2). To compare the deficiency, incapacity and QOL data of exclusive WPS with those of two control groups (never smokers and exclusive cigarette smokers). (3). To determine the factors influencing the 6-minutes walk distance (6-MWD) of WPS subjects. METHODS: A multicentre study including 180 exclusive WPS [> or =5 WP-year] men aged > or =40 years. Cigar or cigarette smoking, contraindications to the 6-MWT or cortico-steroid therapy will be exclusion criteria. QOL evaluation, spirometry, electrocardiogram and two 6-MWT will be performed. Signs of exercise impairment will be: 6-MWD< or =lower limit of normal, end of walk dyspnoea > or =5/10, haemoglobin saturation fall > or =5 points. Data from WPS subjects will be compared with those from 90 never smoking subjects and 90 exclusives cigarettes smokers. EXPECTED RESULTS: (1). WPS will affect significantly the submaximal exercise capacity. (2). Resting spirometric, 6-MWT and QOL data of exclusive WPS subjects will be significantly reduced compared to never smoking subjects. (3). The 6-MWD's of exclusive WPS subjects will be significantly influenced by cumulative WP consumption, by resting spirometric data, by obesity and by physical activity score.

Obesity induced bronchopulmonary hyperresponsiveness in Tunisian women.

OBJECTIVE: The specific objective of this investigation was to determine whether bronchopulmonary responsiveness (BPR) to methacholine (MCH) was associated with the body mass index (BMI) of Tunisian women. SUBJECTS: In all, 160 healthy nonsmoker women (52 lean, 45 overweight and 63 obese) were recruited and examined in the Clinical Laboratory of Physiology located in the Medical School of Sousse. The average ages (+/-s.e.) of the three categories of lean, overweight and obese subjects were 27.7+/-1.1, 33.2+/-1.7 and 37.5+/-1.3 years, respectively. Their corresponding mean BMIs (+/-s.e.) were 21.9+/-0.3, 27.7+/-0.2 and 36.5+/-0.8 kg m(-2), respectively. MEASUREMENTS: Before their inclusion into the study, subjects were screened for their lung status by measuring their pulmonary function testing parameters using a whole body plethysmograph. BPR was assessed, using a cumulative concentration response curve technique, by measuring with a spirometer the decrease in forced expiratory volume in 1 s (FEV(1)) in response to a cumulative dose of MCH. RESULTS: After adjusting for age, significant differences in both FEV(1) and forced vital capacity (VC) were found between the obese and lean groups (P<0.01), as well as between the obese and overweight groups (P<0.01). In addition, forced expiratory flow between 25 and 75% of VC was significantly different between the obese and lean groups (P<0.001), as well as between the lean and overweight groups (P=0.015). The mean maximum fall of FEV(1) in response to MCH challenge was significantly higher for the obese group (12.0%) than for the overweight (9.8%) or the lean (6.6%) group (P<0.01). Furthermore, the efficacy of the MCH agonist promoting the maximal response (E(max)) and its potency or effective dose producing 50% of the maximal response (ED(50)) were both associated with BMI (the higher the BMI, the higher the E(max) and the lower the ED(50)). CONCLUSION: Our data clearly show that obesity affects pulmonary function performance in Tunisian women by potentially promoting their bronchial hyperreactivity as suggested by the significant correlation between their BMI and the efficacy of the MCH, as well as its potency.

Review on leptin and adiponectin responses and adaptations to acute and chronic exercise.

Leptin and adiponectin represent two newly discovered adipose tissue derived hormones; that are both associated with health status and glucose and free fatty acid (FFA) metabolism. Moreover, acute and chronic exercises affect body composition, carbohydrate and lipid metabolism. It is thus interesting to evaluate the effects of physical exercise and training on leptin and adiponectin levels. It seems that leptin concentration is not modified after short-term exercise (<60 min) or exercise that generates an energy expenditure lower than 800 kcal. Leptin levels decrease after long-term exercise (> or =60 min) stimulating FFA release, or after exercise that generates energy expenditure higher than 800 kcal. Adiponectin concentration presents a delayed increase (30 min) after short-term intense exercise (<60 min) performed by trained athletes. For adiponectin, limited data suggest that adiponectin concentration presents a delayed increase (30 min) after short-term intense exercise (<60 min) performed by trained athletes. It seems that adiponectin concentrations do not change in response to long-term exercise (> or =60 min). Short-term training (<12 weeks) and long-term training (> or =12 weeks) show contrasting results regarding leptin and adiponectin. Most training studies which improve fitness levels and affect body composition could decrease leptin and increase adiponectin concentrations.

[Determining factors of pulmonary function in healthy Tunisian children]. / Déterminants de la fonction pulmonaire chez l'enfant sain en Tunisie.

Introduction Pulmonary function parameters are known to vary with age, sex, height and ethnic extraction. No normal values have been reported for pulmonary function in Tunisian children. Moreover, little attention has been paid to the factors affecting the development of lung function in Tunisian healthy children. State of art Birth weight and height, physical activity level, anthropometric, socioeconomic and environmental factors could influence the development of lung function in healthy children. Perspectives The studies conducted by our group have allowed us 1) to set reference values for spirometry in healthy Tunisian children; 2) to indicate that, in Tunisian adolescents, the use of only one morphological parameter such as height, is not sufficient, but the pubertal status could be taken into account to standardize the lung function and 3) to show the main predictive factors for pulmonary development to be the anthropometric factors such as height, weight, maximal inspiratory and expiratory thoracic perimeter, sex and age, and the environmental conditions (type of heating) in our population of healthy Tunisian children. Conclusion These findings should improve medical surveillance of respiratory diseases, stipulation of preventive and therapeutic measures in Tunisian children.

Establishment of reference serum insulin-like growth factor-I and insulin-like growth factor binding protein-3 levels of Tunisian children during childhood and adolescence.

BACKGROUND: The aim of the present study is to establish age- and sex-related reference ranges of serum IGF-I and IGF binding protein-3 (IGFBP-3) levels in a pattern of Tunisian children. SUBJECTS AND METHODS: Two hundred healthy Tunisian children (103 boys and 97 girls), aged between 6 and 16 yr, were considered in the study. RESULTS: Mean serum levels of IGF-I and IGFBP-3 are observed to be higher in girls compared to boys of the same age interval. However, these differences were statistically significant only in pubertal ages (11-14 yr) for IGF-I and in pre-pubertal ages (6-10 yr) for IGFBP- 3 (p<0.05). Steeper variations in IGF-I concentrations were obtained earlier in girls than in boys (11-12 vs 12-13 yr, Tanner stage 3-4). Peak of IGF-I levels are observed at almost the same age interval (12-14 yr). IGFBP-3 levels significantly increased at steeper variations of IGF-I for both sexes followed by steady values. CONCLUSIONS: Variations of IGF-I and IGFBP- 3 with the considered parameters (sex, age, and puberty stage), which concord with previous studies on various populations, emphasize the importance of locally established reference levels to construct a SD score prediction model. Establishment of reference serum IGF-I and IGFBP-3 ranges during childhood and adolescence in Tunisian subjects can help to enhance the diagnostic efficiency of IGF-I and IGFBP-3 in evaluating growth disorders in our population.

[Spirometric profile of narghile smokers]. / Profil spirométrique des fumeurs de narguilé

INTRODUCTION: Studies of the spirometric profile of narghile smokers are few, have some methodologic limits (ie. small sample size) and present contradictory conclusions. OBJECTIVE: (i) To determine the percentage of smokers having an obstructive ventilatory defect (OVD) and/or a restrictive ventilatory defect (RVD) or static hyperinflation (SHI). (ii) To compare the chronological and the estimated lung ages. INCLUSION CRITERIA: men aged 20-60 years smoking narghile (>1 narghile-year (NA). Non-inclusion criteria: cigar or cigarettes smoker and co-morbidity. Narghile consummation quantification: NA and kg of cumulated tobacco (1 NA=9.125 kg of cumulated tobacco). DEFINITIONS: large airway OVD: FEV1/FVCLLN and forced mid expiratory flowupper limit of normal. Spirometric measures (Vmax 22 Series/6200 Autobox, Yorba Linda, California, USA with measurement of functional residual capacity by nitrogen washout). Measurements were made according to international recommendations. RESULTS: 110 narghile smokers were included (34+/-10Yr; 1.76+/-0.07m; 84+/-14kg). 36% of subjects had SHI; 14% had small airway OVD; 14% had RVD and 6% had large airway OVD. (ii) Estimated lung age was higher than the chronological lung age (47+/-18Yr vs 34+/-10Yr, p<0.05). CONCLUSION: Narghile consumption accelerates ageing of the lung. This study provides the health authorities with valid arguments to fight this blight on society which increasingly involves children and pregnant women.

Effects of two-month physical-endurance and diet-restriction programmes on lipid profiles and insulin resistance in obese adolescent boys.

AIM: The aim of this study was to assess the impact of a two-month programme of physical endurance and dietary restriction, alone and combined, on plasma lipids and insulin resistance in obese adolescents. METHODS: A total of 24 obese adolescent boys participated in programmes of either dietary restriction (R), physical endurance at the point of maximum lipid oxidation (LIPOX(max)) (E) or diet combined with training (R+E). Anthropometric characteristics, metabolic measures and biochemical analyses were performed in all subjects before and after the interventions. An estimated insulin resistance was calculated using the homoeostasis model assessment (HOMA-IR) index. RESULTS: At the end of the two-month programmes, adolescents in the R+E group showed greater reductions in body mass index (-3.9+/-0.7 kg/m(2)) and waist circumference (-12.3+/-4.8 cm) (P<0.001) than either the R or E group. A significant decrease (P<0.01) in HOMA-IR index (-2.13+/-0.11), plasma triglycerides, LDL and total cholesterol was also seen in the R+E group. Moreover, at the end of the programme, the ratio of HDL cholesterol to triglycerides was significantly increased from baseline in the R+E group (0.93+/-0.09 vs. 0.68+/-0.11; P<0.01). CONCLUSION: Compared with either moderate physical endurance or dietary restriction, a combination of both resulted in a significant decrease in cardiovascular risk factors and HOMA-IR index in obese adolescent boys.

Factors affecting the development of lung function in Tunisian children.

We undertook to evaluate the impacts of morphology at birth, physical activity, anthropometric, socioeconomic and environmental factors on lung function in healthy Tunisian children. Pulmonary function parameters were measured with a Minato portable spirometer in a randomized population of 756 healthy children (388 males and 368 females) aged between 6 and 16. The morphology at birth, the gestational age, the physical activity, the socioeconomic status, the type of habitation, and the environmental factors were all assessed by a standard questionnaire. Using univariate analysis, we found that: (1) morphometric parameters (height, weight, maximal inspiratory, and expiratory perimeter), as well as sex were highly associated with pulmonary function parameters; (2) Height at birth showed strong significant relations with FVC, FEV(1), and FEV(1)/FVC; (3) lung function parameters were influenced by physical training of our children, socioeconomic status, indoor pollution, and passive smoking; and (4) we did not observe any association between the gestational age and the weight at their birth and lung function parameters. Using a general linear model analysis, morphometric parameters, age, sex, type of heating, and maximal inspiratory and expiratory perimeters had significant relation with respiratory parameters. In our population of healthy Tunisian children, the main predictive factors of the pulmonary development were the morphological factors such as height, weight, maximal inspiratory, and expiratory thoracic perimeter, sex and age, and the environmental conditions such as type of heating but not morphology at birth, physical activity, or socioeconomic status.

[Which definition to use when defining airflow obstruction?]. / Quelle définition faut-il choisir pour le déficit ventilatoire obstructif?

INTRODUCTION: There is no clear consensus as to what constitutes an obstructive ventilatory defect (OVD). According to the American Thoracic Society and European Respiratory Society, it is defined as being when the ratio of the forced expiratory volume (FEV1) and the slow expiratory vital capacity (VC) is below the lower limit of normal (LLN). According to the Global initiative for chronic Obstructive Lung Disease and the British Thoracic Society, it is an FEV1/forced expiratory vital capacity (FVC)<0.70 and an FEV1<80%. In addition, in daily practice, the OVD is diagnosed by a "Fixed ratio" FEV1/FVC<0.70 or

[Which definition to use when defining reversibility of airway obstruction?]. / Quelle définition faut-il choisir pour la réversibilité de l'obstruction bronchique?

INTRODUCTION: There is no clear consensus about what constitutes reversibility of airway obstruction. European Respiratory Society (ERS): Increase in FEV1 and/or FVC>12% of their theoretical value and>0.2l. British Thoracic Society: FEV1>15% of initial value and FEV1>0.2l. Global Initiative for Chronic Obstructive Lung Disease: Increase in FEV1>12% and>0.2l. Australia and New Zealand Thoracic Society: Increase in FEV1 >15%. American Thoracic Society/ERS: Increase in FEV1>12% and>0.2l or increase in FVC>12% and 0.2l. Our principal objective was to determine the percentage of patients with COPD (n=62) who were significant responders to the reversibility test according to the 5 recommendations. METHODS: Plethysmography was performed before and 15 minutes after inhalation of 400 micrograms of a short acting bronchodilator (BD). COPD is defined as a FEV1/FVC post BD<0.7. RESULTS: The percentage of responders varied from 24% to 50% depending on the recommendations used. CONCLUSION: Reversibility of airway obstruction is recommendation dependent.

[Factors influencing pulmonary function in Tunisian women aged 45 years and more]. / Facteurs influençant les variables ventilatoires des Tunisiennes âgées de 45 ans et plus.

INTRODUCTION: The aim of this study was to analyse the factors influencing pulmonary function and inspiratory muscle strength in healthy Tunisian women aged >or=45 years and in particular to determine the effect of parity. METHODS: A medical questionnaire together with an evaluation of sporting activity score and 2 levels for schooling and socio-economic status was administered. Parity was introduced as numeric, as dichotomous (G1:or=4) and in 3 classes (C1:<2; C2:=3-4; C3: > 4). Plethysmography with measurement of airway conductance and maximal inspiratory pressure was performed. RESULTS: 108 women were included. According to the ascending multiple linear regression, and in decreasing order, the following influencing factors are noted: Age and height, parity, weight and daily activity, schooling level, and finally leisure activity, body mass index, and physical activity. With high parity, and especially in women aged >or=60 years, there was a decrease in inspiratory muscle strength and an obstructive tendency, without associated restrictive component. Parity effects are age independent. CONCLUSIONS: Factors influencing the pulmonary function of healthy Tunisian women aged >or=45 years are multiple. Lung function declines with increasing parity.

Effect of Ramadan fasting on fuel oxidation during exercise in trained male rugby players.

PURPOSE: The aim of this study was to assess the effect of Ramadan fasting on substrate oxidation in trained athletes during moderate-intensity exercise. METHODS: Nine trained men (age: 19+/-2 yr, Height: 1.78+/-0.74 m) were tested on three occasions: during a control period immediately before Ramadan (C), at the end of the first week (Beg-R), and during the fourth week of Ramadan (End-R). On each occasion, they performed submaximal cycle ergometer exercise, with work-rates that were increased progressively (loadings corresponding to 20, 30, 40, 50, 60% of Wmax). Steady-state substrate oxidation was evaluated by indirect calorimetry. RESULTS: Participants showed significant decreases in body mass and body fat at the end of Ramadan, relative to initial control values (P<0.001). The daily food intake was also reduced during Ramadan (P<0.01). Haemoglobin concentrations and hematocrit were significantly higher at the end-Ramadan, both at rest (P<0.001 and P<0.0001 respectively) and after exercise, (P<0.05 and P<0.01 respectively) compared to control measurements made before Ramadan. At the end of Ramadan, our subjects had increased their fat utilization during exercise. The cross-over was observed at a higher intensity at the End-R (35% vs. 30% of Wmax, P<0.001). For the same power output, the Lipox max was also higher at the End-R, compared to control value (265+/-38 vs. 199.1+/-20 mg/min, P<0.001). CONCLUSION: Ramadan fasting increases the lipid oxidation of trained athletes during submaximal exercise. The increased fat utilisation may be related to decreases in body mass and body fat content.

[Value of maximum expiratory volume per second and peak expiratory flow monitoring in asthma. 77 patients]. / Intérêt du monitoring du volume expiratoire maximum par seconde et du débit expiratoire de pointe dans l'asthme. A propos de 77 patients.

A retrospective study was conducted on a sample of 77 subjects to assess the interest of computerized flowmeter "one-flow" in the diagnosis and follow up of asthma. 77 patients and a control group matched for age and sex, measured four times by day, the forced expiratory volume in one second as well as the peak expiratory flow during 15 to 30 days. The monitoring of these two variables allowed to participate to the exclusion from the study of fifteen patients whose asthma diagnosis was informed. It also allowed the confirmation of four occupational asthma. Concerning the adherence of the treatment by patients, the conclusion of the study showed that 47% of patients modified their treatment at home without consulting their doctors, 38% resorted to their doctor and only 3% resorted to the emergencies.

[Bilateral brown tumor of the jaw. Apropos of a case]. / Tumeur brune bilatérale des maxillaires. A propos d'un cas.

A 42 years old woman was seen October 1987 because of tumor on the left maxilla. Removal of the lesion and histologic examination conclude at myeloplaxe tumor. A second giant cell lesion appears in the right maxilla 2 years later. The diagnosis of brown tumor was confirmed by the discovery of a parathyroid adenoma. We discuss about this case diagnosis difficulty of brown tumor from the others giant cell lesions of the jaws.