Effect of Continuous Positive Airway Pressure on glycated hemoglobin in patients with type 2 diabetes and Obstructive Sleep Apnea.

INTRODUCTION: Obstructive sleep apnea (OSA) is a risk factor for type 2 diabetes that adversely impacts glycemic control. However, there is little evidence about the effect of continuous positive airway pressure (CPAP) on glycemic control in patients with diabetes. AIM: Assess the effect of CPAP on glycated hemoglobin (HbA1c) levels in patients with type 2 diabetes and OSA. METHODS: it was a prospective study including type 2 diabetic patients with OSA and a CPAP therapy indication. All participants had HbA1c measurement at baseline (T0) and 2 months after the onset of CPAP (T1) with a compliance ≥ 4 hours / night. Patients who changed anti-diabetic treatment during follow-up were excluded. The HbA1c level goal was ≤ 7%. RESULTS: Thirty patients were included (4 men and 26 women) with a mean age of 61.3 ± 8.8 years. The mean diabetes duration was 5.8 ± 3.7 years. Twenty-four patients had poorly controlled diabetes. Associated comorbidities were dominated by hypertension (n=22) and obesity (n=22). The mean apnea hypopnea index was 38.0 ± 12.7/ hour. Two months after the CPAP use, a significant decrease of 1.1 ± 0.8 % in the mean HbA1c level was observed (HbA1c: T0= 8.9 ± 1.5 % vs T1=7.8 ± 1.1 %; p<0.001). This rate was significantly correlated with the body weight (r = 0.51, p = 0.003), the body mass index (r = 0.42, p = 0.02) and the HbA1c level at baseline (r = 0, 76, p <0.001). The only factor associated with glycemic control improvement was an initial HbA1c level > 9% (Odds Ratio = 8.3, p = 0.04). CONCLUSION: CPAP therapy improved diabetes control in type 2 diabetic patients with OSA, in particular in those with an initial HbA1c> 9%.

Antinuclear antibodies in interstitial lung disease: Prevalence and clinical significance.

INTRODUCTION: The diagnosis of interstitial lung disease (ILD) requires elimination of underlying connective tissue disease. Consequently, antinuclear antibodies (ANA) are routinely screened in patients with idiopathic interstitial pneumonia. However the clinical usefulness of this practice is not well clear. AIM: In this study, we evaluated the frequency of ANA in ILD's patients and investigated the clinical significance of the ANA's presence in these patients. METHODS: We conducted a retrospective study of hospitalized patients diagnosed ILD at pulmonary department and for which ANA was performed in the immunology laboratory of our institution. Demographic features, clinical symptoms, biological and radiologic findings and CTD-ILD diagnoses were compared between patients with positive ANA versus negative ANA. RESULTS: We enrolled 73 patients. The ANA's prevalence was 32%. There were no significant differences in demographics, pulmonary function test values and radiologic findings between patients with and without ANA. Patients with positive ANA had more cutaneous manifestations (p꞊0.011) and Raynaud's phenomenon (p꞊0.029). The diagnosis of connective tissue disease was made in 42% of patients with positive ANA versus 8% with negative ANA (p꞊ 0.001). ANA's titer higher than 1/320 was predictive of CTD diagnosis (OR꞊14.4) (p<0.001). CONCLUSIONS: The research of ANA in PID's patients is an important tool of CTD diagnosis specially in those with suggestive symptoms of autoimmune disease.

[Acquired hypogammaglobulinemia associated with thymoma: Good syndrome]. / Hypogammaglobulinémie acquise associée au thymome: le syndrome de Good.

Good syndrome (GS) is defined as the association between thymoma and immune deficiency. It is often complicated by broncho-pulmonary bacterial infections and rhinosinusitis. This disease accounts for only 5% of all parathymic syndromes. These recurrent respiratory infections can cause bronchiectasis associated with Good syndrome. We report the case of a 52-year old woman hospitalized for non resolutive infectious pneumonitis. Chest CT scan showed bronchiectasis associated with thymoma confirmed by biopsy. The discovery of hypogammaglobulinemia allowed the diagnosis of Good syndrome.

Structural, morphological, and optical properties of TiO2 thin films synthesized by the electro phoretic deposition technique.

In this work, we report the structural, morphological, and optical properties of TiO2 thin films synthesized by the electro phoretic deposition technique. The TiO2 film was formed on a doped fluorine tin oxide (SnO2:F, i.e., FTO) layer and used as a photo electrode in a dye solar cell (DSC). Using spectroscopic ellipsometry measurements in the 200 to 800 nm wavelengths domain, we obtain a thickness of the TiO2 film in the range of 70 to 80 nm. Characterizations by X-ray diffraction and atomic force microscopy (AFM) show a polycrystalline film. In addition, AFM investigation shows no cracks in the formed layer. Using an ultraviolet-visible near-infrared spectrophotometer, we found that the transmittance of the TiO2 film in the visible domain reaches 75%. From the measured current-voltage or I-V characteristic under AM1.5 illumination of the formed DSC, we obtain an open circuit voltage Voc = 628 mV and a short circuit current Isc = 22.6 µA, where the surface of the formed cell is 3.14 cm2.

Multispecific anti neutrophil cytoplasm antibodies: a case report.

AIM: To report the presence af ANCA with an unusual polyreactivity. CASE REPORT: 50 year-old woman with pulmonary fibrosis whose immunological investigations showed the presence of ANCA with an unusual polyreactivity against several neutrophil proteins (PR3,MPO, BPI, lysozyme, elastase and cathepsine G) which could be related to a polyclonal hypergammaglobulinemia occurring in this patient. CONCLUSION: The international consensus on the testing of ANCA recommends seeking major specificities like MPO and PR3 which are good markers of ANCA-associated vasculitides. The use of multiantigenic ELISA can be helpful to detect various target antigens at the same time and may thus explain some atypical fluorescent patterns observed when searching for ANCA by Indirect immunofluorescence, these results, however, must be interpreted with caution.

Molecular characterization of a discrete hemoglobinopathy upon investigation for a lung hydatic cyst in an old Tunisian patient.

We report the case of an old Tunisian patient hospitalized for a complicated hydatic cyst of the right lung. Primary laboratory investigation showed a microcytic hypochromic anemia with an abnormal hemoglobin pattern. Hemoglobin analysis and DNA sequencing of the ß-globin gene revealed a compound heterozygote, HbO-Arab/cd 39 ß°-thalassemia. This hemoglobinopathy was never diagnosed earlier. It spent undiagnosed until the patient presented with hydatic cyst. Coexistence of the two pathologies complicated the general state of the patient and led to a severe anemia. The patient has undergone a surgical therapy for the hydatic cyst and was advised to start a follow up for her hemoglobinopathy.