Role of Serum Amyloid A as a Biomarker for Predicting the Severity and Prognosis of COVID-19.

Objective: To detect biomarkers that can be used to predict COVID-19 severity to identify patients with high probability of disease progression and poor prognosis. Methods: Of the 102 patients with confirmed COVID-19 who were admitted to King Fahd General Hospital, Jeddah City, Saudi Arabia, from July 1, 2021 to August 5, 2021, 50 were included in this cross-sectional study to investigate the influence of serum amyloid A (SAA) on disease severity and survival outcomes of COVID-19 patients. Dynamic shifts in SAA, C-reactive protein (CRP), white blood cell (WBC), lymphocytes, neutrophils, biochemical markers, and disease progression were examined. At admission, and at three, five, and seven days after treatment, at least four data samples were collected from all patients, and they underwent clinical status assessments. Results: Critically ill patients showed higher SAA and CRP levels and WBC and neutrophil counts and significantly lower lymphocyte and eosinophil counts compared to the moderately/severely ill patients, especially with regard to disease progression. Similarly, nonsurvivors had higher SAA levels than survivors. The moderately/severely ill patients and the survivors had significantly higher dynamic changes in SAA compared to the critically ill patients and nonsurvivors, respectively, with differences clearly noticed on the fifth and seventh day of treatment. ROC curve analysis revealed that the combination of SAA and CRP was valuable in evaluating the disease progression and prognosis of COVID-19 patients at different time points; however, a combination of SAA and lymphocyte counts was more sensitive for disease severity prediction on admission. The most sensitive parameters for predicting survival on admission were the combination of SAA/WBC and SAA/neutrophil count. Conclusions: The study findings indicate that SAA can be used as a sensitive indicator to assess the degree of disease severity and survival outcomes of COVID-19 patients.

[Early detection of COPD in smoking cessation outpatients]. / Détection précoce de la BPCO dans les consultations d'aide au sevrage tabagique.

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is among the leading causes of chronic morbidity and mortality throughout the world. Potentially, COPD can be prevented by the early detection of COPD, which generally entails spirometry. Physicians in smoking cessation outpatient are in an ideal position to detect early-stage of COPD by the simple examination of the patient. They can also perform spirometry to confirm the diagnosis of COPD. The main objective of this study was to assess the frequency of COPD among smokers in smoking cessation outpatient. Secondary objectives were to Compare two methods for COPD screening, the questionnaire (clinical score) and the mini-electronic spirometer (Neo-6) and to assess the degree of motivation to stop smoking by the announcement of lung age to smokers. METHODS: a prospective cross-sectional study was carried out in four consultations for smoking cessation. Inclusion criteria were male patients aged over 35 years and seen in smoking cessation outpatient. A clinical score was then calculated to detect COPD. This score is based on age, BMI, the quantity of tobacco smoking and the respiratory clinical signs. By establishing this score, we could classify our smokers on consultants with likely COPD if the clinical score>16. Secondly, a measure of the breath with a portable minispirometre "neo6" was performed with quantification of the first second forced expiratory volume (FEV1), forced expiratory volume in 6 seconds (FEV6) and their ratio (FEV1/FEV6). A ratio FEV1/FEV6 less than 0.8 was in favor of an obstructive ventilator defect (DVO). In this case a total body plethysmography was indicated. RESULTS: The sample of the study consisted of 115 male smokers with a mean age of 48±12 years old. A low socio-economic level and a low level of education were found respectively in 50.4% and 58% of smokers. Cigarette smoking is the most consumed form of tobacco. A significant clinical score predicting COPD, was found in 54 patients. The measurement of the breath through the Neo-6 found that 23 (20%) smokers had FEV1/FEV6 less than or equal to 0.7 predicting bronchial obstruction and 26 had a ratio between 0.7 and 0.8. plethysmography confirmed the diagnosis of COPD for 27 patients. So the prevalence of COPD in our sample was of 23.48%. The clinical score had a sensibility of 81.48% and a specificity of 63.64 with a negative predictive value of 91.8%. The sensitivity of the Neo 6 (70.37%) is smaller than the clinical score but the specificity is better than 95.94 % of the clinical score. Its negative predictive value was 91.3%. So when VEMS/VEM6 ratio is greater than 0.7, the probability of COPD remains very low. The announcement of the pulmonary patient age is an important parameter for the motivation to stop smoking. CONCLUSION: The combination of a standardized questionnaire to the measure of breath by Neo6 can further optimize COPD screening.

[The announcement of the lung age it is a motivation to quit smoking?]. / L'annonce de l'âge pulmonaire aux fumeurs est-elle une motivation au sevrage tabagique?

BACKGROUND: Smoking represents an ever-increasing problem of public health in the world, the impact of which is actually rising. The majority of smokers wish to stop smoking one day. This fact is one of the major acts leading to a better health and wellbeing. In the eighties, the lung age was already mentioned by Morris and Temple, a further tool motivating tobacco cessation. AIM: To determine the lung age of a population of workers and to evaluate the impact of its announcement on the smoking behavior. METHODS: It is a prospective study realized during a year (November 2010-November 2011) in a wire enterprise LEONI in Sousse (Tunisia), during an intervention program. 35 adult smokers were concerned by our study. A measurement of the breathing function by "Néo6" and a calculation of the lung age were practiced on all smokers. RESULTS: 35 smoking men (mean ± SD age of 36 ± 7 years, 27 and 28 smokers have, respectively, a high socio-economic level and a high schooling level) were included. The number of daily cigarettes consumed was from 5 to 40. The measurement of the smokers' respiratory function by the "Neo 6" did not show a pulmonary function defect. The lung age was of 45 ±13 years, significantly higher than the chronological age. The evaluation of the announcement of the lung age, realized one year after, showed that 8 among the 35 workers have stopped smoking and 7 smokers have reduced their tobacco consumption. CONCLUSION: Communicating the lung age results is an additional tool motivating tobacco cessation.

Predicting left ventricular dysfunction after valve repair for mitral regurgitation due to leaflet prolapse: additive value of left ventricular end-systolic dimension to ejection fraction.

AIMS: Left ventricular (LV) dysfunction is the first cause of late mortality after mitral valve surgery. In this retrospective analysis, we studied the association between preoperative echocardiographic LV measures and occurrence of LV dysfunction after mitral valve repair (MVR). METHODS AND RESULTS: Between 1991 and 2009, 335 consecutive patients underwent MVR for severe mitral regurgitation due to leaflet prolapse in our institution. Echocardiography was performed preoperatively and at 10.8 (9.1-12.0) months after surgery in 303 patients who represented the study population. Cardiac events were recorded during follow-up. LV ejection fraction (EF) decreased from 68 ± 9% before surgery to 59 ± 9% post-operatively (P < 0.001). Preoperative EF <64% and LV end-systolic diameter (ESD) ≥ 37 mm were the best cut-off values for the prediction of post-operative LV dysfunction (EF < 50%). On the basis of a combined analysis, the occurrence of post-operative LV dysfunction was 9% when EF was ≥ 64% and LVESD < 37 mm, 21% with EF < 64% or LVESD ≥ 37 mm, and 33% with EF < 64% and LVESD ≥ 37 mm (P for trend < 0.001). The combined variable EF < 64% and LVESD ≥ 37 mm added incremental prognostic value to the multivariable regression model (P = 0.001). CONCLUSION: Simple preoperative echocardiography measures allow the prediction of LV dysfunction after MVR in patients with leaflet prolapse. Patients with preoperative EF ≥ 64% and LVESD < 37 mm incur relatively low risk of post-operative LV dysfunction.

Left atrial size is a potent predictor of mortality in mitral regurgitation due to flail leaflets: results from a large international multicenter study.

BACKGROUND: Left atrium (LA) enlargement is common in organic mitral regurgitation (MR) and is an emerging prognostic indicator. However, outcome implications of LA enlargement have not been analyzed in the context of routine clinical practice and in a multicenter study. METHODS AND RESULTS: The Mitral Regurgitation International DAtabase (MIDA) registry enrolls patients with organic MR due to flail leaflets, diagnosed in routine clinical practice, in 5 US and European centers. We investigated the relation between LA diameter and mortality under medical treatment and after mitral surgery in 788 patients in sinus rhythm (64±12 years; median LA, 48 [43 to 52] mm). LA diameter was independently associated with survival after diagnosis (hazard ratio, 1.08 [1.04 to 1.12] per 1 mm increment). Compared with patients with LA <55 mm, those with LA ≥55 mm had lower 8-year overall survival (P<0.001). LA ≥55 mm independently predicted overall mortality (hazard ratio, 3.67 [1.95 to 6.88]) and cardiac mortality (hazard ratio, 3.74 [1.72 to 8.13]) under medical treatment. The association of LA ≥55 mm and mortality was consistent in subgroups. Similar excess mortality associated with LA ≥55 mm was observed in asymptomatic and symptomatic patients (P for interaction, 0.77). In patients who underwent mitral surgery, LA ≥55 mm had no impact on postoperative outcome (P>0.20). Mitral surgery was associated with greater survival benefit in patients with LA ≥55 mm compared with LA <55 mm (P for interaction, 0.008). CONCLUSIONS: In MR caused by flail leaflets, LA diameter ≥55 mm is associated with increased mortality under medical treatment, independent of the presence of symptoms or left ventricular dysfunction.

[Common variable immunodeficiency: a 7 cases reported]. / Déficit immunitaire commun variable: a propos de 7 cas.

BACKGROUND: Common variable immunodeficiency (CVID) is an immune defect characterized by primary hypogammaglobulinemia. The most clinical manifestations are recurrent infection of respiratory tract. AIM: We reported seven cases of DICV which showed METHODS: We reported seven cases of CVID between 1994 and 2004, included six women and one man. RESULTS: The mean age at the first clinical symptoms is 23 years and the mean age at diagnosis is 38. Six patients presented recurrent bacterial infection particularly of the upper and the lower respiratory tract, these infections can lead to chronic diseases such as bronchiectasis. Two patients had chronic diarrhea caused by nodular lymphoid hyperplasia, we showed two cases of granulomatous: spleen tuberculosis and pulmonary sarcoidosis. The diagnostic was confirmed by protein electrophoresis and serum levels of immunoglobulin. All patients received treatment with intravenous immunoglobulin, with a decrease in frequency and severity of infection episodes. CONCLUSIONS: Protein electrophoresis must be done in a young adult with recurrent low respiratory tract infections and/or diffuse bronchectasis.