Interleukin6 prediction of mortality in critically ill COVID19 patients: A prospective observational cohort study.

OBJECTIVE: The aim of this study is to explore the role of IL6 in predicting outcome in critically ill COVID-19 patients. Design Prospective observational cohort study. Setting 20-bed respiratory medical intensive care unit of Abderrahmen Mami Teaching Hospital between September and December 2020. METHODS: We included all critically ill patients diagnosed with COVID-19 managed in ICU. IL6 was measured during the first 24 hours of hospitalization. RESULTS: 71 patients were included with mean age of 64 ± 12 years, gender ratio of 22. Most patients had comorbidities, including hypertension (n = 32, 45%), obesity (n = 32, 45%) and diabetes (n = 29, 41%). Dexamethasone 6 mg twice a day was initiated as treatment for all patients. Thirty patients (42%) needed high flow oxygenation; 59 (83%) underwent non-invasive ventilation for a median duration 2 [1-5] days. Invasive mechanical ventilation was required in 44 (62%) patients with a median initiation delay of 1 [0-4] days. Median ICU length of stay was 11 [7-17] days and overall mortality was 61%. During the first 24 hours, median IL6 was 34.4 [12.5-106] pg/ml. Multivariate analysis shows that IL-6 ≥ 20 pg/ml, CPK < 107 UI/L, AST < 30 UI/L and invasive ventilation requirement are independent risk factors for mortality. CONCLUSIONS: IL-6 is a strong mortality predictor among critically ill COVID19 patients. Since IL-6 antagonist agents are costly, this finding may help physicians to consider patients who should benefit from that treatment.

The Pollen-Food Olive-Olive Syndrome.

BACKGROUND: The pollen-foods syndrome is rare and of difficult diagnosis. The aim is to report a rare case, it's the four case reported in the literature. CASE REPORT: A 48-year-old woman presenting with palatal itching and generalized urticaria following ingestion of olive fruit, 5 years after being diagnosed with olive pollinosis. She did not have a history of other food allergy or urticaria. The prick-test was positive in olive pollen.The olive pollen specific IgE was positive. The oral provocation test was positive for olives and negative for olive oil. The diagnosis of "pollen-food olive-olive syndrome" was accepted. Interestingly, in this rare case the patient developed olive fruit allergy in the presence of olive pollinosis, but did not experience allergic symptoms to fruits other than olive. CONCLUSION: In spite its rarity this syndrome should be evoke particularly in our country.

Association of obesity with asthma severity, control and quality of life.

BACKGROUND: The association between asthma and obesity is becoming increasingly established but the mechanism that might explain the observed differences in asthma severity, control and quality of life between obese and non-obese adult asthmatics is not clear. THE PURPOSE OF THIS STUDY WAS: 1) to determine asthma severity, control and quality of life in obese asthmatics and 2) to explore, according to the body mass index (BMI), the systemic inflammatory state of asthmatic people. MATERIALS AND METHODS: A cross-sectional study was conducted between 2009 and 2010. Two hundred adult asthmatic patients were included. Data analysis consisted of univariate analysis with chi-square comparison test followed by a multivariate logistic regression. RESULTS: Obesity worsens the severity of asthma. This finding was more strongly observed among women than men. Obesity and overweight are associated with a poorer control of asthma. According to BMI, obese asthmatics had 6 times more frequent emergency visits, 5 times more frequent hospitalizations for asthma related complaints, increased missed work days and greater dose of inhaled corticosteroids (1025µg/day vs. 759µg/day of beclometasone equivalent). Mean serum level of C-reactive protein (CRP) and leptin was significantly correlated with asthma severity based on GINA classification (5.75 vs. 2.81 mg/l; 20.5 vs. 5.38 ng/ml; respectively). CONCLUSION: In summary, it appears that obesity is significantly associated with a greater asthma severity and a poorer asthma control and quality of life. Chronic systemic inflammation state may explain the relationship between obesity and asthma.

[Acquired isolated factor VII deficiency and bronchogenic carcinoma. A case report]. / Deficit acquis, isole en facteur VII et cancer bronchique. A propos d'un cas.

An acquired factor VII deficiency was identified in a 63-year-old man with bronchogenic carcinoma. Initial studies indicated a normal activated partial thromboplastin time and a prolonged prothrombin time. The factor VII level was 6%. No evidence of a factor VII inhibitor or inactivator was demonstrable. However, on account of the initial normal laboratory test of emostases, the partial correction of the prothrombin time with 50% normal plasma in vitro and the family history, the congenital deficiency in factor VII was ruled out. Whatever the mechanism involved, this factor VII deficiency was related to malignancy.