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1.
J Allergy Clin Immunol ; 130(5): 1049-62, 2012 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-23040884

RESUMEN

Allergic rhinitis (AR) and asthma represent global health problems for all age groups. Asthma and rhinitis frequently coexist in the same subjects. Allergic Rhinitis and its Impact on Asthma (ARIA) was initiated during a World Health Organization workshop in 1999 (published in 2001). ARIA has reclassified AR as mild/moderate-severe and intermittent/persistent. This classification closely reflects patients' needs and underlines the close relationship between rhinitis and asthma. Patients, clinicians, and other health care professionals are confronted with various treatment choices for the management of AR. This contributes to considerable variation in clinical practice, and worldwide, patients, clinicians, and other health care professionals are faced with uncertainty about the relative merits and downsides of the various treatment options. In its 2010 Revision, ARIA developed clinical practice guidelines for the management of AR and asthma comorbidities based on the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) system. ARIA is disseminated and implemented in more than 50 countries of the world. Ten years after the publication of the ARIA World Health Organization workshop report, it is important to make a summary of its achievements and identify the still unmet clinical, research, and implementation needs to strengthen the 2011 European Union Priority on allergy and asthma in children.


Asunto(s)
Asma/epidemiología , Rinitis Alérgica Perenne/epidemiología , Rinitis Alérgica Estacional/epidemiología , Animales , Asma/clasificación , Asma/complicaciones , Niño , Ensayos Clínicos como Asunto , Europa (Continente) , Humanos , Guías de Práctica Clínica como Asunto , Rinitis Alérgica Perenne/clasificación , Rinitis Alérgica Perenne/complicaciones , Rinitis Alérgica Estacional/clasificación , Rinitis Alérgica Estacional/complicaciones , Organización Mundial de la Salud
2.
Int Arch Allergy Immunol ; 158(3): 216-31, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22382913

RESUMEN

Concepts of disease severity, activity, control and responsiveness to treatment are linked but different. Severity refers to the loss of function of the organs induced by the disease process or to the occurrence of severe acute exacerbations. Severity may vary over time and needs regular follow-up. Control is the degree to which therapy goals are currently met. These concepts have evolved over time for asthma in guidelines, task forces or consensus meetings. The aim of this paper is to generalize the approach of the uniform definition of severe asthma presented to WHO for chronic allergic and associated diseases (rhinitis, chronic rhinosinusitis, chronic urticaria and atopic dermatitis) in order to have a uniform definition of severity, control and risk, usable in most situations. It is based on the appropriate diagnosis, availability and accessibility of treatments, treatment responsiveness and associated factors such as comorbidities and risk factors. This uniform definition will allow a better definition of the phenotypes of severe allergic (and related) diseases for clinical practice, research (including epidemiology), public health purposes, education and the discovery of novel therapies.


Asunto(s)
Asma/fisiopatología , Hipersensibilidad/complicaciones , Guías de Práctica Clínica como Asunto/normas , Índice de Severidad de la Enfermedad , Asma/terapia , Enfermedad Crónica , Comorbilidad , Dermatitis Atópica/complicaciones , Humanos , Hipersensibilidad/epidemiología , Rinitis/complicaciones , Rinitis/epidemiología , Sinusitis/complicaciones , Sinusitis/epidemiología , Urticaria/complicaciones , Urticaria/epidemiología
4.
Ann Cardiol Angeiol (Paris) ; 70(1): 33-40, 2021 Feb.
Artículo en Francés | MEDLINE | ID: mdl-33256951

RESUMEN

BACKGROUND: The association between arterial stiffness (AS) and stable coronary artery disease (CAD) has been previously demonstrated. Whether increased arterial stiffness is associated with severe CAD in patients with acute coronary syndrome (ACS) is less explored. AIM: We aim to investigate the relationship between AS parameters and the extent and severity of CAD in patients with ACS. METHODS: The study population consisted of 275 patients with ACS. We measured various AS parameters including pulse wave velocity (PWV), augmentation index (AIx), and central pulse pressure (cPP). CAD extent and severity was evaluated by the number of vessels with greater than 70% stenosis. RESULTS: The study population was predominantly men (77, 5%) with an average age of 56, 4±10, 6 years. One hundred and fifteen patients were diabetic and 97 were hypertensive. One hundred fifty patients were admitted for ST elevation myocardial infarction (54, 5%) and 37, 5% for non ST elevation myocardial infarction. Thirty six percent of patients had single vessel disease and 47, 6% of the study population had multivessel disease. At the multivariate analysis, a positive correlation was observed between the number of coronary vessels disease and PWV. PWV (OR=1,272; IC95% [1,090; 1,483]; p=0,002) and cPP (OR=1,071; IC95% [1,024; 1,121]; p=0,003) were also independent predictors of multivessel disease. CONCLUSION: In patient with ACS, PWV is correlated with the extent of coronary artery disease, as measured by the number of vessels disease. PWV and cPP were also independent predictors of multivessel disease.


Asunto(s)
Síndrome Coronario Agudo/complicaciones , Enfermedad de la Arteria Coronaria/patología , Análisis de la Onda del Pulso , Índice de Severidad de la Enfermedad , Rigidez Vascular , Adulto , Anciano , Presión Sanguínea/fisiología , Enfermedad de la Arteria Coronaria/fisiopatología , Vasos Coronarios/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad
6.
Tunis Med ; 88(10): 690-5, 2010 Oct.
Artículo en Francés | MEDLINE | ID: mdl-20890812

RESUMEN

BACKGROUND: Allergic rhinitis is a daily problem to which are confronted principally general practitioner, paediatrician, ear, nose and throat specialist and allergologist. also, this subject is still always alive because allergy seems in a constant progression in our society. AIM: To clarify diagnostic and therapeutic criteria of this affection. METHODS: we have realized a literature review concerning physiopathology, clinical symptoms, the position of paraclinical investigations and finally therapeutic modality of allergic rhinitis. RESULTS: Appropriated treatment of allergic rhinitis should be général it requires a knowledge and better comprehension of the disease and optimum prevention, if it is possible, of allergic symptoms.


Asunto(s)
Rinitis Alérgica Perenne/terapia , Rinitis Alérgica Estacional/terapia , Humanos , Rinitis Alérgica Perenne/diagnóstico , Rinitis Alérgica Perenne/fisiopatología , Rinitis Alérgica Estacional/diagnóstico , Rinitis Alérgica Estacional/fisiopatología
8.
Rev Mal Respir ; 35(3): 295-304, 2018 Mar.
Artículo en Francés | MEDLINE | ID: mdl-29627293

RESUMEN

INTRODUCTION: The pseudotumorous form of tuberculosis is a rare entity. Whatever its location, it can simulate neoplasia by its radiological and/or endoscopic appearances. We highlight the diagnostic difficulties associated with this type of presentation. METHODS: We performed a retrospective study of inpatient records from 2003 to 2016 in the pneumology department of La Rabta Hospital to identify cases of thoracic tuberculous pseudo-tumor. RESULTS: Seventeen patients were identified. The median age was 41 years and their symptomatology was dominated by cough and general debility. All had abnormal radiology with 10 cases of suspect lesions. Fibre-optic bronchoscopy revealed endobronchial abnormalities in 11 cases. The median overall diagnostic delay was 97 days. The diagnosis was confirmed bacteriologically in five cases, histologically in 14 cases and based on clinical presumption in one case. The progression was favourable: 13 patients have been declared cured and four patients are still undergoing treatment. CONCLUSION: Making a positive diagnosis of thoracic tuberculous pseudotumour can be difficult, as bacteriological samples are often negative. This can lead to a significant delay in diagnosis and treatment.


Asunto(s)
Granuloma de Células Plasmáticas/diagnóstico , Tuberculosis Pulmonar/diagnóstico , Adulto , Broncoscopía , Diagnóstico Diferencial , Femenino , Granuloma de Células Plasmáticas/microbiología , Hemoptisis/diagnóstico , Hemoptisis/microbiología , Humanos , Masculino , Persona de Mediana Edad , Radiografía Torácica , Estudios Retrospectivos , Tuberculosis Pulmonar/complicaciones , Túnez , Adulto Joven
9.
Rev Pneumol Clin ; 74(4): 235-241, 2018 Sep.
Artículo en Francés | MEDLINE | ID: mdl-29650284

RESUMEN

INTRODUCTION: The benefits of long-term non-invasive ventilation (NIV) in the management of chronic obstructive pulmonary disease (COPD) patients remain controversial. AIM: To analyze the characteristics of COPD patients under home NIV and to evaluate its impact among this population. METHODS: We carried out a retrospective study between January 2002 and April 2016 of COPD patients under long-term NIV at "la Rabta" and the Military Hospital. RESULTS: There were 27 patients with an average age of 64 and a sex ratio (M/F) of 0.92. Active smoking was reported in 96.3%. A persistent hypercapnia following an acute exacerbation of COPD with failure to wean the NIV was the main indication of long-term NIV. We noted a reduction in hospital admissions in the first year of 60% and in intensive care of 83.3% (P<10-3). There was no non-significant decrease of PaCO2 (4.5mmHg). There was no modification in FEV 1 and in FVC (P>0.05). The survival rate was 96.3% at 1 year, 83.3% at 2 years and a median survival of 24 months. CONCLUSIONS: Our study suggests that home NIV contributes to the stabilization of some COPD patients by reducing the hospitalizations rates for exacerbation. More prospective studies are needed to better assess the impact of NIV on survival and quality of life and to better define the COPD patients who require NIV.


Asunto(s)
Servicios de Atención de Salud a Domicilio , Ventilación no Invasiva , Enfermedad Pulmonar Obstructiva Crónica/terapia , Anciano , Anciano de 80 o más Años , Femenino , Hospitales Militares , Humanos , Masculino , Persona de Mediana Edad , Personal Militar/estadística & datos numéricos , Ventilación no Invasiva/instrumentación , Ventilación no Invasiva/métodos , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Insuficiencia Respiratoria/epidemiología , Insuficiencia Respiratoria/terapia , Estudios Retrospectivos
11.
Rev Mal Respir ; 33(9): 775-780, 2016 Nov.
Artículo en Francés | MEDLINE | ID: mdl-27179365

RESUMEN

The apnoea-hypopnoea index (AHI) is the primary measurement used to characterize the obstructive sleep apnoea-hypopnoea syndrome (OSAHS). Despite its popularity, there are limiting factors to its application such as night-to-night variability. AIM: To evaluate the variability of AHI in the OSAHS. PATIENTS AND METHODS: A prospective study was designed in our university hospital's sleep unit. Adults with clinical suspicion of OSAHS underwent 2 consecutive nights of polysomnographic recording. The population was divided in two groups according to an AHI>or<10. Patients with psychiatric disorders or professions that might result in sleep deprivation or an altered sleep/wake cycle were excluded. RESULTS: Twenty patients were enrolled. The mean age was 50.6±9.3 years. OSAHS was mild in 4 cases, moderate in 6 cases and severe in 8 cases. AHI was less than 5 in two cases. AHI values were not significantly altered throughout both recording nights (33.2 vs. 31.8 events/h). A significant positive correlation was found between AHI measured on the first and the second night. However, a significant individual variability was noted. Comparison between both patient's groups showed a correlation between AHI and the body mass index. CONCLUSION: This study demonstrates that the AHI in OSAHS patients is well correlated between two consecutive nights. However, a significant individual variability should be taken into consideration, especially when AHI is used in the classification of OSAHS or as a criterion of therapeutic success.


Asunto(s)
Ritmo Circadiano/fisiología , Apnea Obstructiva del Sueño/patología , Apnea Obstructiva del Sueño/fisiopatología , Sueño/fisiología , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Polisomnografía/estadística & datos numéricos , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Apnea Obstructiva del Sueño/epidemiología
12.
Rev Pneumol Clin ; 72(4): 228-33, 2016 Aug.
Artículo en Francés | MEDLINE | ID: mdl-27349827

RESUMEN

INTRODUCTION: Asthma takes up a great importance in occupational diseases but remains underestimated as it is insufficiently diagnosed. OBJECTIVE: We aimed to access the clinical and professional profile of the Tunisian asthmatic worker. MATERIALS AND METHODS: It was a retrospective descriptive study in a professional pathology unit in a university hospital. All patients referred by their doctor for symptoms suggestive of occupational asthma, during a period from 2000 to 2008, were included. RESULTS: Forty-eight patients were selected from 172. The mean age was 40 years, with a male predominance (56 %). In 2/3 of the cases, it was the textile workers, food and chemical industry. The etiological agents incriminated were textile dust in 18.8 % of cases followed by isocyanates and flour. Typical episodes of wheezing dyspnea were present in 52 % and atopy in 54.2 % of workers. In 2 % of cases, symptoms disappeared and worsened in 18.8 %. CONCLUSIONS: The prognosis of OA depends on early end accurate diagnosis. The physician's role is to initiate the appropriate diagnostic approach, which must comply with the Tunisian conditions.


Asunto(s)
Asma Ocupacional/epidemiología , Ocupaciones/estadística & datos numéricos , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Túnez/epidemiología , Adulto Joven
14.
Rev Pneumol Clin ; 71(2-3): 73-82, 2015.
Artículo en Francés | MEDLINE | ID: mdl-25749628

RESUMEN

Tuberculosis is a major public health problem worldwide. Indeed, a third of the world population is infected with Mycobacterium tuberculosis and more than 8 million new cases of tuberculosis each year. Pulmonary tuberculosis is the most common location. Its diagnosis is difficult and often established with a delay causing a spread of infection. The diagnosis of tuberculosis infection is mainly based on immunological tests represented by the tuberculin skin test and detection of gamma interferon, while the diagnosis of pulmonary tuberculosis is suspected on epidemiological context, lasting general and respiratory symptoms, contrasting usually with normal lung examination, and a chest radiography showing suggestive lesions. The radioclinical feature may be atypical in patients with extreme ages and in case of immunodeficiency. Confirmation of tuberculosis is bacteriological. Conventional bacteriological methods remain the reference. Innovative tests using the technique of molecular biology have improved the diagnosis of tuberculosis in terms of sensitivity and especially speed. However, those techniques are of limited use.


Asunto(s)
Ensayos de Liberación de Interferón gamma , Mycobacterium tuberculosis , Prueba de Tuberculina , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/epidemiología , Antituberculosos/uso terapéutico , Diagnóstico Tardío , Salud Global , Humanos , Incidencia , Ensayos de Liberación de Interferón gamma/métodos , Mycobacterium tuberculosis/aislamiento & purificación , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , Resultado del Tratamiento , Prueba de Tuberculina/métodos , Tuberculosis/diagnóstico , Tuberculosis/epidemiología , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/microbiología
15.
Rev Pneumol Clin ; 71(2-3): 67-72, 2015.
Artículo en Francés | MEDLINE | ID: mdl-25131367

RESUMEN

Tuberculosis is a contagious disease caused by Mycobacterium tuberculosis. It represents, according to World Health Organization (WHO), one of the most leading causes of death worldwide. With nearly 8 million new cases each year and more than 1 million deaths per year, tuberculosis is still a public health problem. Despite of the decrease in incidence, morbidity and mortality remain important partially due to co-infection with human immunodeficiency virus and emergence of resistant bacilli. All WHO regions are not uniformly affected by TB. Africa's region has the highest rates of morbidity and mortality. The epidemiological situation is also worrying in Eastern European countries where the proportion of drug-resistant tuberculosis is increasing. These regional disparities emphasize to develop screening, diagnosis and monitoring to the most vulnerable populations. In this context, the Stop TB program, developed by the WHO and its partner's, aims to reduce the burden of disease in accordance with the global targets set for 2015.


Asunto(s)
Mycobacterium tuberculosis , Tuberculosis/diagnóstico , Tuberculosis/epidemiología , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , África/epidemiología , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Humanos , Huésped Inmunocomprometido , Incidencia , Cooperación Internacional , Mycobacterium tuberculosis/aislamiento & purificación , Vigilancia de la Población , Prevalencia , Factores de Riesgo , Tuberculosis/complicaciones , Tuberculosis/microbiología , Tuberculosis/mortalidad , Tuberculosis Resistente a Múltiples Medicamentos/diagnóstico , Tuberculosis Resistente a Múltiples Medicamentos/epidemiología , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/epidemiología , Túnez/epidemiología , Organización Mundial de la Salud
16.
J Radiol ; 85(2 Pt 1): 135-7, 2004 Feb.
Artículo en Francés | MEDLINE | ID: mdl-15094629

RESUMEN

The authors report a case of cervico-thoracic region hydatid cyst suspected by the presence of a palpable right lower neck mass. This location is very rare. Neck ultrasound and computed tomography showed the cyst. Magnetic resonance imaging can be useful for diagnosis and provided the best anatomo-topographic evaluation before surgery.


Asunto(s)
Equinococosis/diagnóstico , Imagen por Resonancia Magnética , Enfermedades del Mediastino/diagnóstico , Cuello , Tomografía Computarizada por Rayos X , Adulto , Medios de Contraste/administración & dosificación , Diagnóstico Diferencial , Equinococosis/cirugía , Gadolinio , Humanos , Masculino , Enfermedades del Mediastino/cirugía , Cuello/cirugía
17.
Rev Mal Respir ; 10(1): 46-8, 1993.
Artículo en Francés | MEDLINE | ID: mdl-8451496

RESUMEN

The authors report a case of a child, aged fourteen, who had a primary malignant pulmonary haemangiopericytoma. The diagnosis could only be made following the histological study of the excised pneumonectomy specimen and after silver staining. There was a fatal outcome some six months after the operation, despite satisfactory surgery and complementary chemotherapy. The rarity of this type of tumour, notably in children, justifies the presentation of this case report.


Asunto(s)
Hemangiopericitoma/diagnóstico , Enfermedades Pulmonares/diagnóstico , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biopsia , Quimioterapia Adyuvante , Femenino , Hemangiopericitoma/epidemiología , Hemangiopericitoma/terapia , Humanos , Enfermedades Pulmonares/epidemiología , Enfermedades Pulmonares/terapia , Neumonectomía , Tomografía Computarizada por Rayos X
18.
Rev Mal Respir ; 10(4): 299-305, 1993.
Artículo en Francés | MEDLINE | ID: mdl-8235021

RESUMEN

Pulmonary emphysema can be defined in precise anatomical terms. Only histological examination of an entire lung will enable the extension and the severity of the emphysema to be fully assessed. The authors propose a visual score, using computed tomography to quantify emphysema in 61 subjects. 51 had chronic airflow obstruction (BPCO) and were divided into 31 chronic bronchitics (BC) and 20 emphysematous subjects (EP). 10 volunteers who were free of any respiratory pathology were chosen as controls. A visual score for the computed tomography was established for the subjects as a whole. Double reading of the data enabled the reproducibility of the method to be checked in 10 subjects (r = 0.98, p < 0.001). No emphysema was found in the 10 controls, the computed tomography score was appreciably more elevated in the EP subjects than in the BC group at 1.3 and 0.44 respectively (p < 0.001). In the BC, the computed tomographic score was not correlated with the PaO2 (r = 0.54, p < 0.001) and the FEV1 (VEMS) (r = < 0.44, p < 0.05). On the other hand, in the PE group, the score was correlated with the FEV1 (r = 0.52, p < 0.05) and the residual volume (r = 0.06, p < 0.05) and the total lung capacity (r = 0.63, p < 0.05) and the TLCO (r = 0.56, p < 0.05) and the TLCO/VA (r = 0.59, p < 0.05). The adoption of a visual computed tomographic score enabled the authors to find the correlations between pulmonary emphysema and the most specific tests of respiratory function.


Asunto(s)
Bronquitis/diagnóstico , Enfisema Pulmonar/diagnóstico , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X , Adulto , Anciano , Anciano de 80 o más Años , Análisis de los Gases de la Sangre , Bronquitis/sangre , Estudios de Casos y Controles , Enfermedad Crónica , Diagnóstico Diferencial , Femenino , Humanos , Modelos Lineales , Mediciones del Volumen Pulmonar , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Enfisema Pulmonar/sangre , Reproducibilidad de los Resultados
19.
Rev Mal Respir ; 14(2): 129-31, 1997 Apr.
Artículo en Francés | MEDLINE | ID: mdl-9198835

RESUMEN

We report a case in a patient aged 28 admitted with haemoptysis and dyspnoea. The chest x-ray showed multiple disseminated hydatid cysts throughout the lung fields. Computerized tomography and an abdominal echo found a hydatid cyst of the liver in contact with inferior vena cava which was probably responsible for the secondary pulmonary dissemination. Subsequently there was a multiplication of the lesions with rupture and infection of several cysts. After two years the disease progressed into chronic respiratory failure with the appearance of chronic cor pulmonale. The respiratory state rapidly worsened with several episodes of cardiorespiratory failure. Death occurred six months after the appearance of CPC.


Asunto(s)
Equinococosis Hepática/complicaciones , Equinococosis Pulmonar/complicaciones , Enfermedad Cardiopulmonar/parasitología , Adulto , Enfermedad Crónica , Equinococosis Hepática/diagnóstico por imagen , Equinococosis Pulmonar/diagnóstico por imagen , Resultado Fatal , Humanos , Masculino , Tomografía Computarizada por Rayos X
20.
Rev Mal Respir ; 16(2): 207-9, 1999 Apr.
Artículo en Francés | MEDLINE | ID: mdl-10339765

RESUMEN

A 72-year-old patient was admitted for exploration of an opacity of the left base discovered fortuitously on a routine chest x-ray. Initial blood tests were normal. Fiberoptic bronchoscopy was normal. Computed tomography (CT) led to the diagnosis of a left kidney which had risen into a retro-cardiac position. Magnetic resonance imaging established the sub-diaphragmatic position of the kidney. Renal excretion was normal on intravenous urography. An ectopic kidney in an intrathoracic position is very uncommon and may raise a major challenge when visualized as a mediastinal or pulmonary opacity. Computed tomography or intravenous urography can provide the diagnosis and magnetic resonance imaging demonstrates its precise sub-diaphragmatic or supra-diaphragmatic position.


Asunto(s)
Coristoma/diagnóstico por imagen , Riñón , Enfermedades Pulmonares/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Anciano , Coristoma/diagnóstico , Diagnóstico Diferencial , Femenino , Humanos , Enfermedades Pulmonares/diagnóstico , Imagen por Resonancia Magnética , Radiografía Torácica , Tomografía Computarizada por Rayos X
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