Association Between the Triglyceride-Glucose Index and Serum Uric Acid to High-Density Lipoprotein (HDL) Cholesterol Ratio in Type 2 Diabetes Mellitus in Gabes City, Tunisia.

Background Type 2 diabetes mellitus (T2DM) is a significant risk factor for cardiovascular diseases (CVD). The triglyceride-glucose index (TyGi) is a novel biomarker for insulin resistance, strongly linked to CVD. Elevated serum uric acid levels and the uric acid to high-density lipoprotein cholesterol ratio (UHR) are emerging as markers of metabolic syndrome and cardiovascular risk in T2DM. This study aimed to explore the association between the TyGi and UHR in T2DM patients. Objectives The aim of this study is to compare metabolic parameters in T2DM patients and assess the association between the TyGi and serum UHR. Methodology A cross-sectional case-control study was conducted at the University Hospital of Gabes, Gabes City, Tunisia with 50 T2DM patients and 50 gender-matched healthy controls. Inclusion criteria included adults aged 30-75 years with a confirmed diagnosis of T2DM on stable medication for at least three months. Exclusion criteria included other types of diabetes, significant liver or kidney disease, recent cardiovascular events, endocrine disorders, and substance abuse. Metabolic and biochemical parameters, including fasting blood sugar, postprandial blood sugar, glycosylated hemoglobin, lipid profile, and renal function, were measured. The TyGi and serum UHR were calculated and analyzed for correlations. Results T2DM patients exhibited significantly higher fasting blood sugar, postprandial blood sugar, glycosylated hemoglobin, TyGi, and serum UHR compared to controls, indicating impaired glycemic control and adverse lipid profiles. The UHR showed a positive correlation with a strong negative correlation with HDL and a positive correlation with uric acid levels. The linear regression analysis indicated a weak positive trend between the TyGi and serum UHR, although not statistically significant. Conclusion This study underscores the importance of the TyGi and serum UHR as biomarkers for evaluating metabolic and cardiovascular risk in T2DM. Further research is needed to explore their combined utility in clinical practice for early detection and management of cardiovascular complications in diabetic patients.

Impact of Outdoor Air Pollutants Exposure on the Severity and Outcomes of Community-Acquired Pneumonia in Gabes Region, Tunisia.

Background Acute community-acquired pneumonia (CAP) is considered the leading cause of infectious death worldwide. Air pollution and prolonged exposure to airborne contaminants have been implicated in various respiratory conditions, including asthma and chronic obstructive pulmonary disease (COPD). However, the specific impact of air pollution on pneumonia, particularly CAP, remains underexplored. Given the rising levels of urban air pollution and its potential health ramifications, our study aimed to examine the association between exposure to outdoor air pollution and severity as well as the outcomes of pneumonia cases requiring hospitalization. Methodology A cohort analytical study with retrospective data collection was carried out in the pulmonology department of the Gabès University Hospital between January and October 2022. We compared levels of particulate matter less than or equal to 10µm in aerodynamic diameter (PM10), sulfur dioxide (SO2), ozone (O3), moisture and ambient temperature with severity and outcomes of pneumonia requiring hospitalization. The choice of these specific pollutants and environmental factors was based on their established impact on respiratory health and their prevalence in the study region. Results Increased sulfur dioxide (SO2) levels were associated with increased use of non-invasive ventilation (NIV) (r = 0.400). Higher levels of particulate matter (PM10) were significantly associated with the development of lung abscesses. Similarly, increased humidity and ambient temperature were strongly correlated with the development of lung abscesses. Increased air SO2 levels were correlated with a higher CURB65 score (r = 0.299). High outdoor SO2 levels and increasing moisture content were associated with increased Pneumonia Severity Index (PSI) score (r = 0.303 and = 0.310, respectively). Higher levels of PM10 were associated with an increased risk of pleural effusion, a serious complication of pneumonia. Finally, higher ambient temperatures were correlated with more extensive opacities on chest X-rays (r = 0.706), suggesting the severity of pneumonia. Conclusion This study highlights the significant associations between environmental factors and various clinical parameters in pneumonia patients. The findings underscore the importance of considering environmental exposures, such as air quality and weather conditions, in understanding and managing the severity of pneumonia.

[Predictive factors of severity and mortality in acute community-acquired pneumonia : results of a monocentric study in Tunisia]. / Facteurs prédictifs de gravité et de mortalité des pneumonies aiguës communautaires :étude monocentrique en Tunisie.

Community-acquired pneumonia (CAP), a frequent reason for hospitalization in pulmonology, is a major cause of morbidity and mortality in adults. METHODS: It is a retrospective, descriptive and analytical study including patients hospitalized for CAP. We studied the predictors of NIV, ICU transfer and hospital mortality. RESULTS: we included 50 patients (mean age: 56.3 ± 12.8 years). Predictive factors of NIV were PaCO2 ≥ 45 mmHg [Odds Ratio (OR): 15.45, 95 % Confidence Interval (IC): 1.29-184.7], pH ≤ 7.35 (OR: 6.42;1.72-23.9), Fine ≥ 57.5 (OR: 17.36;4.32-693.9) and CURB-65 ≥ 2 (OR: 13.54;1.73-105.7). Taking antibiotics before hospitalization (OR: 1.92;1.08-3.49), PaO2 ≤ 60 mmHg (OR: 4.15;1.27-13.60), Fine score ≥ 100 (OR: 13.54;1.73-105.7) and CURB-65 ≥ 2 (OR: 7.50;1.44-36.9) were associated with the admission in the ICU. PH ≤ 7.35 (OR: 6.39;1.77-23.2) and Fine score ≥ 100 (OR: 8.86;3.33-25.2) were correlated with mortality. CONCLUSION: Arterial pH ≤ 7.35, hypoxemia, hypercapnia, CURB-65 ≥ 2, Fine ≥ 100 and taking antibiotics before hospitalization are predictive factors of a poor prognosis of CAP.

Les pneumonies aiguës (PAC), motifs fréquents d'hospitalisation en pneumologie, constituent une cause majeure de morbidité et de mortalité chez l'adulte. Méthodes : Etude rétrospective, descriptive et analytique incluant les patients hospitalisés pour PAC. Nous avons étudié les facteurs prédictifs de recours à la ventilation non invasive (VNI), de transfert en réanimation et de mortalité hospitalière. Résultats : Au total, 50 cas de PAC ont été colligés (âge moyen : 56,3 ± 12,8 ans). Les facteurs prédictifs de recours à la VNI étaient la PaCO2 ≥ 45 mmHg [Odds Ratio (OR) : 15,45, Intervalle de confiance (IC) 95 % : 1,29-184,7], le pH artériel ≤ 7,35 (OR : 6,42; 1,72-23,9), un score de Fine ≥ 57,5 (OR : 17,36;. 4,32-69,9), et un score CURB-65 ≥ 2 (OR : 13,54; 1,73-105,7). La prise d'antibiotiques avant l'hospitalisation (OR : 1,92 ;1,08-3,49), la PaO2 ≤ 60 mmHg (OR : 4,15; 1,27-13,6), un score de Fine ≥ 100 (OR : 13,54; 1,73-105,7) et un score CURB-65 ≥ 2 (OR : 7,50;1,44-36,9) étaient associés au transfert en réanimation. Le pH ≤ 7,35 (OR : 6,39; 1,77-23,2) et un score de Fine ≥ 100 (OR : 8,86; 3,33-25,2) étaient corrélés à la mortalité. Conclusion : Un pH ≤ 7,35, l'hypoxémie, l'hypercapnie, un score CURB-65 ≥ 2, un score Fine ≥ 100 et la prise d'antibiotiques avant l'hospitalisation sont des facteurs prédictifs d'un mauvais pronostic des PAC.

Pneumocystis jirovecii pneumonia in a healthy immunocompetent patient: A case report and literature review.

Pneumocystis jirovecii pneumonia, typically an opportunistic infection, is commonly associated with risk factors such as low CD4+ lymphocyte count, underlying malignancies, organ transplantation, or immunosuppressive medications. However, occurrences in healthy individuals without known risk factors are exceptionally rare and sparsely documented. In our retrospective analysis of a 42-year-old male without past medical history at Abderrahmane Mami Hospital, Tunisia, Pneumocystis jirovecii pneumonia was diagnosed. The patient presented with fever, productive cough, hemoptysis, and a decline in general health. Clinical examination revealed fever and hypoxemia, and imaging studies demonstrated bilateral necrotic alveolar opacities. Despite empirical antibiotics, nonresponse necessitated bronchoscopy, confirming Pneumocystis jirovecii. Treatment with oral Sulfamethoxazole-Trimethoprim yielded excellent outcomes. This case highlights the potential occurrence of Pneumocystis jirovecii pneumonia in immunocompetent individuals, underscoring the importance of direct microbiological methods in assessing suggestive clinical and radiological features.

Hypoxemia and if it is the liver? Hepatopulmonary syndrome : about a case.

The hepatopulmonary syndrome is defined as the triad of liver disease, pulmonary gas exchange abnormalities leading to arterial deoxygenation and widespread pulmonary vascular dilatation. It is one of the not infrequently cases of dyspnea within patients with liver disease. We report the case of a 32-year-old woman with cirrohsis and portal hypertention who presented with dyspnea worsning progressively. The blood gas revealed a deep hypoxemia with a PaO2 rate 42mmHg but clinically well tolerated. Pulmonary embolism and pneumonia were rapidly excluded by a CT pulmonary angiography. An echocadiography done in order to find any heart disease suspected a patent foramen ovale. A transthoracic contrast echocardiography showed an important pulmonary vascular dilatation.The association of cirrohsis, pulmonary vascular dilatation and hypoxemia made the diagnos of hepatopulmonary syndrome.

Cold abscess in the immunocompetent subject.

INTRODUCTION: Tuberculous cold abscesses are a rare and unusual form, accounting for 1% of extrapulmonary tuberculosis (TB). AIM: To describe clinical, diagnostic, therapeutic and prognostic aspects of cold tuberculous abscesses. METHODS: Retrospective multicentre study of 26 patients followed for cold abscesses tuberculous in respiratory departments of AbderrahmenMami hospital between 2009 and 2017. RESULTS: We included 24 patients. Mean age was 36.9 years. Six patients had a personal history of pulmonary TB. Circumstances of the discovery were chronic pain (n = 15), parietal swelling (n = 7) and parietal fistulization (n = 2). The mean duration of the symptoms was 2.8 months. Fever was absent in 15 patients. The cold abscess was multifocal in 3 patients, associated with pleuropulmonary TB in 16 patients and extrapulmonary TB in 9 patients. Thoracic wall was the most frequent localization (n=13), followed by subcutaneous and intramuscular localization (n = 6). The surgical flattening of the abscess with biopsy of the edges was performed in 15 patients. The positive diagnosis was pathological in 15 patients and bacteriological in 12 patients. GeneXpert was positive in 2 patients. All patients received anti-tuberculosis treatment. The mean duration of TB was 10.7 months. Evolution was marked by the cure of 20 patients and tuberculous relapse in 1 patient after 6 months. CONCLUSION: Tuberculous cold abscess should be evoked in front of any chronique collection occurring especially in a context of risk factors of TB. Early diagnosis is the best guarantee of a cure without complications.

Particularities of community- acquired pneumonia in the elderly.

BACKGROUND: Acute community-acquiredpneumonia in olderadults has averysevereprognosiswith a mortality rate whichcanreach 10%. Knowing the clinical, etiological, therapeutic and progressive features of thisdiseasecan help to establish management rulesthatcanimprove the prognosis. The aim of ourstudywas to compare the community-acquiredpneumonia profile in olderadults and youngerthem. METHODS: Retrospective comparative studyincluding patients hospitalized for community-acquiredpneumonia. Two groups of patients weredefined: group 1 subjectsagedbetween 18 and 64 years and group 2 subjectsaged 65 years and older. RESULTS: The meanage of elderlywas 76±6,18. COPD was five times more common in group 2 (p = 0.0001). Symptomsweredifferent in the two groups withpredominance of dyspnea in the group of elderly. Prognosisfactors scores (PSI and CURB_65) in elderlywerehighercompared to youngersubjects. Sputum culture wascontributory in third cases in both groups. Pseudomonas aeruginosawas the mostcommonpathogenidentified in the elderly. Empiricaltreatmentwas the mostprescribed in both groups. Evolution was more favorable in group 1 (p = 0.006). Complications, hospitalization in ICU and delay of recoveryweremostcommon in the group 2. CONCLUSION: Our studyconfirmedsomecharacteristics of community-acquiredpneumonia in elderly; it has mostlyrevealed the importance of microbiological tests in this population.

Spontaneous pneumothorax secondary to tuberculosis.

INTRODUCTION: Spontaneous pneumothorax (SP) is a frequent complication of pulmonary tuberculosis (TB) and a severe form of the disease. In spite of the fact that TB is a common cause of pneumothorax, a very few series, have been reported. METHODS: We retrospectively analysed the experience of SP secondary to TB in patients who were hospitalized in our department between 2005 and 2015. RESULTS: The mean age of patients was 38,5±19 years. Two patients had a history of pulmonary tuberculosis. The chest x-ray showed a pneumothorax in 5 cases, a hydropneumothorax in 5 cases and cavitary lesions accompanying SP in 5 cases. Acido-alcoolo-resistant bacilli were isolated in the expectorations in all patients. Treatment associated antitubercular chemotherapy in compliance with the national plan of struggle against tuberculosis, chest drainage and respiratory physiotherapy. The average duration of chest tube drainage was 23 days. Two patients underwent surgery. The course was favourable in 5 cases. A delay (>1month) to bacilli negativation was noticed in 2 patients and pachypleuritis requiring surgical pleural decortications in 2 patients. CONCLUSION: In our study, tubercular pneumothorax was always associated with active cavitated tuberculosis. The course was most of the time favourable with antitubercular chemotherapy and chest drainage. However, pleural sequelae such as pachypleuritis persisted sometimes.

Use of the concept mapping in teaching during a medical rotation of interns: an exploratory study.

INTRODUCTION: Concept mapping is an excellent learning toolallowing to stimulate active learning.For this reason, the concept mapping is currently used increasingly in the medical and paramedical field. The aim of our study is to determine the contribution of teaching of medical interns by the concept mapping. METHODS: Fourteen students enrolled at the same time in a medical rotation in Pulmonology were recruited for this exploratory study. Interns are divided into two groups (A and B).Both groups are taught by the clinical case method, illustrated by a concept mapping for group A interns. RESULTS: The evolution of the knowledge accuracy at post-testing has been greater in the group taught by the method of concept mapping: the number of correct responses increased in all participants of group A versus only 4 of group B. All students taught by concept mapping had at the post-test a note higher than or equal to 10/20 versus only three of the group taught by the method without concept map. The average score was 13 (11-15) in group A versus 10.28 (6-14) in group B. CONCLUSION: We emphasize the use of concept mapping in teaching especially in the faculty of medicine and we encourage clinicians to use this method in teaching interns in the hospital.

Particularities of COPD exacerbations in different phenotypes of the disease in Tunisia.

BACKGROUND: Chronic Obstructive Pulmonary Disease is defined by a limitation of airflow. This disease is characterized by exacerbations that threaten the patient's life and worsens his prognosis. Moreover, COPD patients are different according to many parameters that define different phenotypes. Characteristics of exacerbations may depend on these phenotypes according to few recent studies. AIM: To determine the characteristics and the prognosis of the exacerbations in each phenotype of COPD patients phenotype in Tunisia. METHODS: Retrospective study including 153 male patients hospitalized for COPD exacerbation from January 2009 to June 2012. Patients were classified into 4 phenotypes according to Burgel's classification. RESULTS: Patients were divided into four phenotypes: phenotype (PH)1: (n=68), PH2: (n=33), PH3: (n=25) and PH4: (n=27). Mean age for PH1, 2, 3 and 4 was: 61, 74, 56 and 72 years. The number of exacerbations per year was higher in PH1. Dyspnea was more important in PH1 and 4. Hypercapnia on admission was higher in PH4. Non invasive ventilation and transfer to resuscitation unit were more frequently mandatory in PH3 and 4.   Death occurred 2% of PH1 and 5% of PH4. Hospitalization duration was more important in PH4. CONCLUSION: COPD patients are heterogenous and belong to different phenotypes. The characteristics of the exacerbations and their prognosis widely differ according to these different groups. In Tunisia, it seems that patients who had moderate respiratory functional tests impairment are the lowest responders to treatment with a higher frequency of resuscitation unit transfer.

Patient taking chemotherapy for a small cell lung cancer: not every cerebral nodule is a metastasis: the tree that hides the forest.

We report the case of a 53- year-old man in whom the diagnosis of small cell lung cancer (SCLC) was made by the biopsy of a mass of the right trapezius muscle. A tumor was revealed on flexible bronchoscopy which pathological study showed tuberculosis (TB). Chest computed tomography (CT) scan revealed findings related to the SCLC associated to micronodules and nodules compatible with pulmonary TB. Cerebral CT scan revealed a nodule of 4.5 mm in diameter presenting enhancement after contrast material injection thought to be a metastasis. The patient was administered antitubercular treatment. Fiveteen days later, the patient started chemoptherapy with etoposid and carboplatin. A control cerebral CT scan realized after the end of the chemotherapy (2 months and a half of antitubercular treatment) revealed numerous cortical and subcortical infracentimetric nodules with contrast enhancement with a tentorial and subtentorial location considered to be in relation with cerebral miliary TB. The nodule discovered on the first cerebral scan was therefore a posteriori considered to have been of tubercular origin. The PS of the patient rapidly worsened. He presented mental confusion and died in some days.