[Evaluation of the risk of obstructive sleep apnea in patients awaiting general anesthesia in Burkina Faso]. / Évaluation du risque du syndrome d'apnées hypopnées obstructives du sommeil chez des patients en attente d'une anesthésie générale au Burkina Faso.

INTRODUCTION: General anaesthesia and surgery increase morbidity and mortality in patients with obstructive sleep apnea hypopnea syndrome (OSAHS) who are not known to have OSAHS and therefore not treated before surgery. The objective of this study is to evaluate the risk of OSAHS using the STOP-BANG questionnaire (SBQ) in patients undergoing general anaesthesia in Burkina Faso. MATERIAL AND METHOD: This is a cross-sectional study concerning patients having received pre-anaesthetic consultation from 1st July 2020 to 30th June 2021. Risk of OSAHS is considered "medium to high" when the risk of obstructive sleep apnea is medium or high on SBQ. RESULTS: Our population consisted in 599 persons. A medium to high risk of OSAHS was found in 11.18%. The ASA score and the Mallampati scale were independently associated with moderate to high risk of OSAHS (P<0.001; P<0.001). ASA score of I and Mallampati class of I decreased the risk of OSAHS by 17 and 45% respectively (P=0.012; P=0.031). CONCLUSION: The risk of OSAHS in this population is comparable to that of the general population. Confirmation of OSAHS by ventilatory polygraphy or polysomnography would help to achieve further precision.

[Study about the prevalence of the obstructive sleep apnoea syndrome in Vietnam]. / Étude de la prévalence du syndrome d'apnées obstructives du sommeil au Vietnam.

INTRODUCTION: Epidemiological studies on obstructive sleep apnoea syndrome (OSAS) in Asia, South East Asia in particular, are few. The EPSASIE study aimed to determine the prevalence of OSAS in an adult Vietnamese population and to describe its characteristics. METHODS: This is a prospective, observational, multicenter study. Nocturnal ventilatory polygraphy (PV) or polysomnography (PSG) were performed in patients having symptoms evocative of the SAS syndrome and an index of respiratory events (IER)>10/h or>25 in one hour, measured by RU Sleeping. RESULTS: A total of 667/750 validated questionnaires were received. The mean age of the study population was 44±12 years with a mean body mass index of 21.6±5.2kg/m2. PV or PSG were performed on 93 subjects after positive screening by RU Sleeping. OSAS with an apnoea-hypopnoea index (AHI)>5 was found in 57 subjects (8.5%) and in 35 subjects with AHI>15 (5.2% of cases). CONCLUSION: The prevalence of OSAS is quite high in the Vietnamese population and comparable with current literature data.

[The effects of inhaled steroids withdrawal in COPD]. / Impact du sevrage des corticostéroïdes inhalés dans la BPCO.

The key pathophysiological feature of chronic obstructive pulmonary disease (COPD) is an abnormal inflammatory bronchial reaction after inhalation of toxic substances. The priority is the avoidance of such toxic inhalations, but the use of anti-inflammatory drugs also seems appropriate, especially corticosteroids that are the sole anti-inflammatory drug available for this purpose in France. The risks associated with the prolonged use of these parenteral drugs are well known. Inhalation is therefore the optimal route, but inhaled drugs may also lead to adverse consequences. In COPD, there is an inhaled corticosteroids overuse, and a non-satisfactory respect of the guidelines. Consequently, their withdrawal should be considered. We reviewed seven clinical studies dealing with inhaled corticosteroids withdrawal in patients with COPD and found that included populations were heterogenous with different concomitant treatments. In non-frequent exacerbators receiving inhaled corticosteroids outside the recommendations, withdrawal appears to be safe under a well-managed bronchodilator treatment. In patients with severe COPD and frequent exacerbations, the risk of acute respiratory event is low when they receive concomitant optimal inhaled bronchodilators. However, other risks may be observed (declining lung function, quality of life) and a discussion of each case should be performed, especially in case of COPD and asthma overlap.

[The place of inhaled corticosteroids in COPD]. / Place des corticostéroïdes inhalés dans la BPCO.

INTRODUCTION: Clinical trials have provided some evidence of a favorable effect of inhaled corticosteroids on the frequency of exacerbations and on the quality of life of patients with chronic obstructive pulmonary disease (COPD). In contrast, ICS have little or no impact on lung function decline and on mortality. STATE OF THE ART: Inhaled corticosteroids are recommended only in a minority of COPD patients, those with severe disease and repeated exacerbations and probably those with the COPD and asthma overlap syndrome. However, surveys indicate that these drugs are inappropriately prescribed in a large population of patients with COPD. Overtreatment with inhaled corticosteroids exposes these patients to an increased risk of potentially severe side-effects such as pneumonia, osteoporosis, and oropharyngeal candidiasis. Moreover, it represents a major waste of health-care spending. CONCLUSION: Primary care physicians as well as pulmonologists should be better aware of the benefits as well as the side-effects and costs of inhaled corticosteroids.

[Validation of an evaluation questionnaire for COPD acute exacerbations (Exascore)]. / Validation d'un questionnaire d'évaluation de l'exacerbation dans la BPCO : l'Exascore.

BACKGROUND: Early identification of acute exacerbations of COPD facilitates better care. This study was designed to validate a short questionnaire (Exascore) developed to help patients, relatives and carers to diagnose acute exacerbations. METHOD: We first addressed content validity that allowed the elaboration of two questionnaires, one assessing the current status and the other stable status (transition). The second step tested their construction validity, reproducibility and concomitant validity among 126 COPD patients aged 64.4±9.9 years. They included 56 presenting with an exacerbation and 70 in stable state, of whom 57 completed the questionnaire a second time after 7 days. The diagnosis of exacerbation and assessment of severity (gold standard) were established by the treating respiratory physician and confirmed by two independent experts. RESULTS: Factorial analyses established a "current status" questionnaire comprising 8 items and 2 dimensions. Cronbach's alpha coefficients were satisfactory, 0.867 for "respiratory impact", 0.886 for "psychosocial impact" and 0.886 for the total score. Concomitant validity and reproducibility were also adequate. The transition questionnaire did not obtain convincing psychometric results. CONCLUSIONS: The "current status" Exascore questionnaire satisfies psychometric quality criteria while being usable in clinical practice. It helps in diagnosing acute exacerbations and assessing their intensity. Further studies will need to test the adequacy of proposed thresholds, the factorial structure of the score in healthcare professionals and patients' relatives, and its predictive power.

[Pulmonary actinomycosis. Apropos of a case]. / Actinomycose pulmonaire. A propos d'un cas.

The authors report a case of pseudo-tumoral thoracic actinomycosis with lysis of a rib in a young man who was a heavy smoker and drinker. This observation is an opportunity to review the usual difficulties of diagnosis in patients with this rare disease occurring most often in a patient who is debilitated with important disease in the teeth and gingival margins. The standard treatment is penicillin G, which leads to a cure within one month.

[Chemotherapy of cerebral metastasis of lung cancer]. / Chimiothérapie des métastases cérébrales des cancers bronchiques.

Between November 1983 and November 1988, 60 patients with cerebral metastases arising from primary lung cancer were treated with chemotherapy. Thirty patients received a 5-day course of cisplatin (total dose: 200 mg/sq.m). The remaining 30 patients received VP 16 in doses of 250 mg/sq.m. administered 12-hourly by intravenous infusion over one hour (total dose: 1,500 mg/sq.m.). Twenty-seven percent of the patients who received cisplatin showed objective responses as assessed by computerized tomography; 10% had serious toxic reactions. Thirty percent of the patients who received VP 16 showed objective responses, but 43% had severe bone marrow aplasia resulting in a 33% death rate due to infection. The median survival of responders was 8 months in both treatment groups. The objective response rates as assessed by histology were 33% in patients with oat-cell carcinoma and 27% in patients with other histological types. VP 16 must be abandoned, being too toxic in high doses. High-dose cisplatin can be used in the treatment of cerebral metastases of lung cancer, side by side with radiotherapy.

[The VQ11, a short health-related quality of life questionnaire for routine practice in COPD patients]. / Le VQ11, un questionnaire de qualité de vie spécifique à la BPCO utilisable en clinique.

OBJECTIVE: The management of COPD aims to improve integrated indices such as health-related quality of life (HRQoL). Experts recommend repeated and methodical assessment of HRQoL, particularly by the use of questionnaires. Though these tools give pertinent information for groups of patients, they have limitations in describing the progress in one patient or indicating the prognosis. The purpose of this study is to validate a brief, self-administered HRQoL questionnaire, designed for the individual follow-up of COPD patients over a period of 3-6 months. METHOD: Following an initial validation of the contents and a review of the literature, 166 COPD patients completed an experimental version of a questionnaire including 24 items, three theoretical components (functional, psychological and relational) and 11 sub-dimensions. RESULTS: Confirmative factor analyses show a hierarchical model in respect of the current criteria (chi(2)=62.042; dl=41; ratio chi(2)/ddl=1.51; p<0.02; CFI=0.955; TLI=0.939; RMSEA=0.056; SRMR=0.054) composed of 11 items (one by a theoretical sub-dimension) distributed in three components (functional=3; psychological=4; relational=4). CONCLUSION: The questionnaire obtained, named VQ11, possesses an internal validation which satisfies international psychometric standards. It remains necessary to demonstrate whether the questionnaire satisfies the criteria of external validation and that it reveals thresholds of clinical change.