COPD prevalence in smokers with stable ischemic heart disease: A cross-sectional study in Tunisia.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) and ischemic heart disease (IHD) are common causes of mortality worldwide, with shared risk factors. COPD continues to be largely underdiagnosed and undertreated, especially in patients with IHD. OBJECTIVE: To investigate the prevalence of COPD in smokers with confirmed IHD and to compare IHD characteristics between COPD patients and those without COPD. METHODS: It was a cross-sectional study, conducted between August and December 2017, including patients over 40 years of age, current or former smokers, with stable and confirmed IHD. Spirometry was undertaken for all participants, and COPD was defined according to GOLD criteria. RESULTS: A total of 122 patients, with mean age of 59.3 years and mean pack-year of 52.3, were enrolled. Spirometry was normal in 63.2% of patients and airflow limitation was the most frequent ventilatory disorder (20.5%). COPD was diagnosed in 19.7% of patients. Of the 24 COPD patients, 17 (70.8%) were previously undiagnosed. Airflow limitation severity in COPD patients was classified mild, moderate, severe and very severe in 25%, 62.5%, 8.3% and 4.2% of patients. Comparison between COPD patients and non-COPD patients showed that comorbidities, respiratory symptoms, chest x-ray abnormalities, life-threatening lesions, three vessel disease, pulmonary hypertension and right ventricle dysfunction were significantly more frequent in COPD patients. CONCLUSIONS: There was a high prevalence of COPD among smoking patients with IHD, and most were undiagnosed despite being symptomatic. Smokers with IHD, especially if having respiratory symptoms, radiological or ultrasound abnormalities or life-threatening coronary lesions should be evaluated for airflow limitation.

Researchers' And Medical Student' Experience in Reference Management Software in a Low-Income Country.

INTRODUCTION: Although the use of Reference Management Software (RMS) is increasing in developed countries, they seem to be unknown and less used in low-income countries. AIM: To discover the major trends in the use of RMS among researchers and Ph.D. students in Tunisia, as a low-income country. METHODS: A hardcopy survey was filled out by researchers and Ph.D. students during an educational seminar at the faculty of medicine of Sfax in 2016 with the aim to collect qualitative data to determine the participants' knowledge and use of RMS. RESULTS: The survey collected 121 participants, among them, 53.7% know RMS. Mendeley proved to be the best-known software (41.5%), followed by Zotero (35.3%) and Endnote (23%). Training sessions in RMS were taken by 5% of participants. Among the 121 participants, 26.5%of them use RMS., Mendeley was the most used (46.9%), followed by EndNote (28.1%) and Zotero (25%). The most commonly popular feature in RMS is inserting citations (66.9%). Therefore, the analysis, of the reasons behind the choice of RMS proves that the software was used because it is convenient (38.4%),  most known (38.4%),  easy (30.7%), or suggested by colleagues (30.7%). The free and open-source software was preferred by 81% of the participants. g. However, 50.4% ignore the fact that Zotero is free. Several types and sources of captured citations were unknown by 53.8% and 59% of the rest of the participants. CONCLUSION: The results clearly show that the lack of awareness about RMS in Tunisia is due to the absence of a formal training. As a result, the need for such training is highly important for researchers to be able to benefit from the different advantages of RMS while conducting their academic medical education.

The relationship between the fraction of exhaled nitric oxide and the level of asthma control.

BACKGROUND: The evaluation of asthma control, based on symptoms and risk factors for exacerbation does not provide information about airway inflammation, reflected by fractional exhaled nitric oxide (FeNO). The impact of FeNO in the evaluation of asthma control has not been well recognized. The purpose of this study was to evaluate the contribution of FeNO measurement in the assessment of asthma control. METHODS: A prospective cross-sectional study was carried out for four months and included 148 adult asthmatics. For each patient, the demographic data, asthma control test (ACT) score, medication adherence, skin prick test positivity, FeNO level, and spirometry results were recorded independently. The correlation between ACT score and FeNO level was analyzed. RESULTS: The mean ACT score was 20.9±3.7 and the mean exhaled FeNO level was 30.4±25.8 ppb. Asthma was controlled in 71.6% of patients. Mean FeNO values were significantly higher in patients with uncontrolled asthma (42.1±30.8 versus 27±19 ppb, p=0.01). A significant negative correlation was observed between FeNO level and ACT score (r=-0.33, 95% confidence interval [CI], -0.51-0.10; p=0.001). FeNO had a high negative predictive value (79.9%) and specificity (63.2%), but a low sensitivity (59.5%) and positive predictive value (39%). The area under the receiver operating characteristic (ROC) curve was of 0.7 (95% confidence interval [CI], 0.53-0.74; p=0.01). CONCLUSIONS: Using just FeNO to evaluate asthma control represents a limited approach because of the low predictive accuracy of FeNO for diagnosing uncontrolled asthma.

Evaluation of an interactive teaching method in the teaching of Pulmonology.

INTRODUCTION: For several years, interactive teaching has proved its effectiveness in learning. At the Faculty of Medicine of Tunis (FMT), the interactive sessions are sessions of clarification, illustration, application, and participation (CIAP). AIM: To evaluate pneumology CIAP session in the acquisition of learning by first-year students of the second cycle of medical studies (SCMS1). METHODS: It was a cross-sectional study carried out at the FMT during the academic year 2016-2017 and included students from SCMS1. CIAP session subject was "The chronic respiratory failure". A pre-test and a post-test, with the same subject, were distributed during the session. Knowledge acquisition was evaluated by comparing the scores assigned to the tests. An evaluation of the students' satisfaction with the session progress was made. RESULTS: Ten students attended the CIAP session. The mean score of the pre-test was 2.1 ± 0.7 over 10 points. A statistically significant (p = 0.003) increase in the score was observed for the post-test, which increased to 4.8 ± 0.2. For the evaluation of the session by the students, the best scores were assigned for the items evaluating the achievement of objectives and the facilitation of the session by the teacher (1.9 points).The lowest score was given for the item evaluating the time required for the session (1 point). CONCLUSION: The interactive teaching method "CIAP" was beneficial in terms of learning, as demonstrated by the statistically significant improvement of the post-test score compared to the pre-test and the satisfaction of the students at the end of the session. Moreover, the involvement of all the stakeholders (students, teachers, and institutions) is necessary for the success of this teaching.

Tuberculosis cost in tunisia.

BACKGROUND: Tuberculosis (TB) infects one third of the world population. Its economic impact is important, affecting the global economy in the World. OBJECTIVE: To determine the economic costs related to tuberculosis in Tunisia. METHODS: Calculations were made for the reference year 2013; we covered all cost components of the disease, which are related to program management, BCG vaccination, health workers training, social mobilization, screening, chemoprophylaxis, and tuberculosis care. With the exception of costs related to care, which were the subject of a specific survey, the costs of other categories were obtained from the National TB Control Program. RESULTS: The cost of the different components related to the management, prevention, screening and tuberculosis care in 2013 amounted 504688,000DT. The cost of care represented 80.0% of total costs (6807 808,000DT) ; cost related to program  management represented 13.2% (1 121 580,00 DT) and the BCG vaccination  6.0% e (512 300,00DT) The average cost per patient was 1447,360 DTin 2013. CONCLUSION: Reducing the cost of tuberculosis, would involve reducing diagnostic delay. It is also recommended to reduce hospitalization recourse, and prevent multidrug resistance which lead to additional expenditures.

Impact of obstructive sleep apnea on the right ventricle.

BACKGROUND: Right ventricular (RV) involvement in obstructive sleep apnea syndrome (OAS) is controversial. The aim of this study was to determine a correlation between echocardiographic parameters of RV function and severity of OSA assessed by the apnea- hypopnea index (AHI). METHODS: Sixty patients with suspected OSA were enrolled. All patients had overnight polygraphy and an echocardiographic assessment of RV structure and function. Patients were divided into three groups: a control group (n=20) with an AHI<5/h, a group of mild to moderate OSA (n=18) with an AHI=5-30/h and a group of severe OSA (n=22) with AHI≥30/h. RESULTS: There were no differences of age, body mass index and sex among the three groups. There was no difference in systolic pulmonary pressure. RV free wall thickness, end-diastolic surface and right atrium surface were statistically higher in OSA patients compared with controls. The peak systolic myocardial velocity at tricuspid lateral annulus S' were significantly lower in patients compared with controls (14.5±3 vs 12.2±2 cm / s, p<0.001; respectively). This decrease was greater in patients with severe OSA compared with mild to moderate OSA (11.4±3 vs 13.0±1 cm/s, p=0.05, respectively). Right ventricular myocardial performance index (MPI) was significantly higher in OSA compared with controls (0.55±0.12 vs 0.46±0.14, p=0.024, respectively) but it was not correlated with the severity of IAH. CONCLUSIONS: In OSA patients, there was a significant RV dysfunction independently of pulmonary pressure, although the correlation with the severity of IAH was moderate.

Tuberculosis cost in tunisia.

BACKGROUND: Tuberculosis (TB) infects one third of the world population. Its economic impact is important, affecting the global economy in the World. OBJECTIVE: To determine the economic costs related to tuberculosis in Tunisia. METHODS: Calculations were made for the reference year 2013; we covered all cost components of the disease, which are related to program management, BCG vaccination, health workers training, social mobilization, screening, chemoprophylaxis, and tuberculosis care. With the exception of costs related to care, which were the subject of a specific survey, the costs of other categories were obtained from the National TB Control Program. RESULTS: The cost of the different components related to the management, prevention, screening and tuberculosis care in 2013 amounted 504688,000DT. The cost of care represented 80.0% of total costs (6807 808,000DT) ; cost related to program  management represented 13.2% (1 121 580,00 DT) and the BCG vaccination  6.0% e (512 300,00DT) The average cost per patient was 1447,360 DTin 2013. CONCLUSION: Reducing the cost of tuberculosis, would involve reducing diagnostic delay. It is also recommended to reduce hospitalization recourse, and prevent multidrug resistance which lead to additional expenditures.

Impact of obstructive sleep apnea on the right ventricle.

BACKGROUND: Right ventricular (RV) involvement in obstructive sleep apnea syndrome (OAS) is controversial. The aim of this study was to determine a correlation between echocardiographic parameters of RV function and severity of OSA assessed by the apnea- hypopnea index (AHI). METHODS: Sixty patients with suspected OSA were enrolled. All patients had overnight polygraphy and an echocardiographic assessment of RV structure and function. Patients were divided into three groups: a control group (n=20) with an AHI<5/h, a group of mild to moderate OSA (n=18) with an AHI=5-30/h and a group of severe OSA (n=22) with AHI≥30/h. RESULTS: There were no differences of age, body mass index and sex among the three groups. There was no difference in systolic pulmonary pressure. RV free wall thickness, end-diastolic surface and right atrium surface were statistically higher in OSA patients compared with controls. The peak systolic myocardial velocity at tricuspid lateral annulus S' were significantly lower in patients compared with controls (14.5±3 vs 12.2±2 cm / s, p<0.001; respectively). This decrease was greater in patients with severe OSA compared with mild to moderate OSA (11.4±3 vs 13.0±1 cm/s, p=0.05, respectively). Right ventricular myocardial performance index (MPI) was significantly higher in OSA compared with controls (0.55±0.12 vs 0.46±0.14, p=0.024, respectively) but it was not correlated with the severity of IAH. CONCLUSIONS: In OSA patients, there was a significant RV dysfunction independently of pulmonary pressure, although the correlation with the severity of IAH was moderate.

Sleep-Related Painful Erections in a Patient With Obstructive Sleep Apnea Syndrome.

Sleep-related painful erection (SRPE) is a rare sleep disorder characterized by recurrent, painful penile erections occurring when awakening from rapid eye movement sleep, while erections are painless during wakefulness. Almost 35 cases have been reported worldwide, and only two of them had an associated obstructive sleep apnea syndrome (OSAS). We report a new case of a 61-year-old man suffering from SRPE associated with OSAS. The adequate treatment of respiratory events with continuous positive airway pressure did not alleviate the SRPE symptoms and excessive daytime sleepiness. The SRPE diagnosis was made by polysomnography coupled with video surveillance when the patient was referred to the sleep laboratory for residual excessive daytime sleepiness. The patient had 2-4 episodes of SRPE/night. Beta-blocker did not alleviate the SRPE, but a transient improvement was noted when the patient was treated with paroxetine. In contrast with the two previously published cases of SRPE plus OSAS, continuous positive airway treatment did not improve SRPE symptoms in our patient.

[Effect of inhaled corticosteroids on bone mineral density in asthmatic adults: a 20 cases study]. / Effet de la corticothérapie inhalée sur la densité minérale osseuse chez l'adulte jeune asthmatique : a propos de 20 patients.

BACKGROUND: Inhaled corticosteroids are widely used in the treatment of asthma but their safety on bone density is controversial. AIM: To study in a population of adults with asthma receiving inhaled corticosteroids for long term, the effect of this therapy on bone mineral density. METHODS: Prospective study including 20 asthmatics, aged from 20 to 45 years, treated with inhaled corticosteroids for 12 months or more, with no risk factors for osteoporosis. We compared osteodensitometric parameters in our patients, bone mass and T-score at vertebral and femoral witness to a population matched by age and sex. RESULTS: The average age of our patients was 35.45 ± 5.43 years and the average BMI was 30.03 ± 5.77 kg/m2. The average daily dose of corticosteroid was 925 ± 133.27g of equivalent of beclometasone with an average take of 33.5 ± 21.3 months. The vertebral site bone mass average was 1216 ± 0106 g/cm2 in the studied group and 1201 ± 0099 g/cm2 in the control group without significant difference (p = 0380). At femur, the bone mass average was 1037 ± 0143 g/cm2 in the patient group and 1056 ± 0107 g/cm2 in the control group (p = 0380). We did not find a significant link between bone mineral density and cumulative dose or the duration of taking inhaled corticosteroids, BMI and tobacco. CONCLUSION: Our work confirms like other previous studies the safety of inhaled corticosteroids on bone mineral density.

[Contribution of serum total immunoglobulin E measurement in the diagnosis of respiratory allergic diseases]. / Apport du dosage des ige totales seriques dans le diagnostic de l'allergie respiratoire.

BACKGROUND: Serum total IgE measurement is one of the first allergic inflammation marker test. It has been currently used for the diagnosis of allergy. However, when it has been widely used in clinical practice, we discover its limit in the diagnosis of allergic disease. AIM: We carried a retrospective study about 1111 consecutive patients, seen in the Allergology Unit of the Home Ministry Hospital with suspicion of atopic disease. The aim of our study is to evaluate the contribution of serum total IgE measurement in the diagnosis of respiratory allergic diseases. METHODS: Our population was divided into three groups. Group A: 771 allergic symptomatic subjects (371 children with mean age of 7.8 +/- 3.4 years and 467 adults with mean age of 30.1 +/- 6.6 years). Group B: 117 controls (70 children with mean age of 6.6 +/- 3 years, and 47 adults with mean age of 30.7 +/- 6 years). 221 patients with doubtful diagnosis of allergy were excluded (group C). RESULTS: If we consider the cut-off I of 150 UI (for adults), 75% of allergic subjects have elevated serum total IgE, 62% of adults and 77.6% of children. When doubling the cut-off (cut-off II), 49% of allergic subjects have serum total IgE over 300 UI/ml, 36% of adults and 57% of children. In the control group: 35.8% of patients have total IgE over the cut-off value I and 17% over the cut-off value II. The variation of serum total IgE was related in allergic subjects to the type and the number of symptoms. The levels of total IgE were higher in asthma than in rhinitis and more elevated if the patient has several symptoms. With cut-off I we found a quite good sensibility of the test of 75% (62% in adults and 77.6% in children) and a poor specificity of 64% (68% in adults and 61% in children), with a negative predictive value of 28% and a positive predictive value of 93%. When doubling the cut-off, the sensibility falls to 49% and the specificity was improved at 82%. The serum total IgE measurement was in agreement with prick-tests in 80% of cases and with Phadiatop in 56% of cases if we consider cut-off I. CONCLUSION: Our results showed a large overlapping of serum total IgE in both allergic and control populations. The measurement of serum total IgE is not helpful for the diagnosis of allergic respiratory diseases because it has a quite good sensibility, a poor specificity and a poor negative predictive value. The test was more sensible and less specific in children.

[Family transmission of atopic organ manifestations and allergen sensitizing in 659 Tunisian families]. / Transmission familiale de l'atopie selon l'organe cible et de la sensibilisation allergénique: a propos de 659 familles Tunisiennes.

BACKGROUND: The atopic family transmission is the topic of many studies. In addition to the allergy total transmission, which is well established, it seems that atopic organ manifestations and their gravity are family transmitted. To our knowledge, very few authors studied the specific transmission of allergen sensitizing. AIM: The aim of this paper is to study the specific family transmission of atopic organ manifestations and allergen sensitizing, in Tunisian families. METHODS: 659 supposed allergic Tunisian families are studied, which include 1494 patients, 444 parents and 1050 children, consulting for rhinitis and/or asthma. All patients were submitted to a family investigation and had an allergologic check including skin prick test. RESULTS: We highlighted a transmission of the allergy according to the body between parents and their children. Asthma is more transmitted by the mother (p = 0.002) than by the father (p = 0.05). However, rhinitis is transmitted only by the father (p = 0.03). There is no significant concordance neither for asthma nor for rhinitis between children. Concerning the transmission of the allergenic sensitivity, our study doesn't show a statistically significant concordance between parents and children and between children. CONCLUSION: These results confirm the atopic family transmission of the symptoms especially between parents and children. It doesn't seem to exist of hereditary factor concerning the sensitizing allergen.