Autonomic dysregulation and phenobarbital in patients with masked primary hypertension.

INTRODUCTION: Primary hypertension can be masked and be responsible of a severe impact on the target bodies. The purpose of this study was to see if Phenobarbital at low dose is able to decrease the sympathetic hyperactivity assessed by cardiovascular autonomic reflexes in patients with masked hypertension. MATERIALS AND METHODS: This prospective study was conducted on a total of 91 patients with masked hypertension (average age 52.1 ± 10.3 years old). The cardiovascular autonomic tests performed in this group, before and after 3 months of daily oral administration of Phenobarbital, included deep breathing, hand-grip, mental stress and orthostatic tests. Statistical analysis was done using the Student's t-test, Univariate and Multivariate logistic regression analysis; p is significant if < 0.05. RESULTS: Cardiovascular autonomic reflexes responses before and after 3 months of Phenobarbital oral administration were as follows: Vagal response (XDB) obtained on deep breathing test was of 32.6 ± 5.4% VS 30.4 ± 6.1%, (p = 0.08), alpha peripheral sympathetic response (alpha SP) obtained on hand grip test was of 35.6 ± 8.7% VS 12.0 ± 2.5%, (p < 0.001), alpha central sympathetic response (alpha SC), beta central sympathetic response (beta SC) obtained during mental stress were of respectively 29.3 ± 9.2% VS 11.8 ± 2.4%, (p < 0.001) and 11.0 ± 5.3% VS 10.4 ± 6.1%, (p = 0.2), alpha peripheral adrenergic sympathetic (alpha PAS) obtained during orthostatic test was of 25.3 ± 6.0% VS 13.0 ± 3.4%, (p < 0.001). CONCLUSION: These results demonstrated that Phenobarbital at low dose may have an anti-sympathetic effect in patients with masked hypertension.

Factors associated with discrepancies between poor dyspnea perception and abnormal lung function in 65 asthmatic patients.

BACKGROUND: Dyspnea is a subjective symptom of asthma whose perception is characterized by an interindividual variability. Poor dyspnea perception is usually associated with increased risk of exacerbation and may lead to inappropriate asthma management and under-treatment. We sought to identify factors associated with discrepancies between poor dyspnea perception and abnormal lung function in patients with moderate persistent asthma. METHODOLOGY: 65 patients, who attended their scheduled follow-up pulmonology consultation at Ibn Sina Hospital (Rabat - Morocco), underwent interrogation including modified Medical Research Council (mMRC) scale for dyspnea, physical examination and spirometry. Two groups, those with mMRC < 2 (poor dyspnea perceivers) and those with mMRC scale ≥ 2 were compared. RESULTS: Poor dyspnea perception was found in 21 patients (32.3%). Associated factors were male sex (p : 0.03), low socio-economic income (p : 0.01), an onset of symptoms greater than 10 years (p : 0.01), BMI ≥ 25 Kg/m2 (p : 0.04) and depression (p : 0.04). CONCLUSION: The results revealed factors significantly associated with poor dyspnea perception despite an obstructive ventilatory disorder. These factors could usefully be considered to successfully manage asthma as well as the regular prescription of an objective test like spirometry.

The combination of a blood test and Fibroscan improves the non-invasive diagnosis of liver fibrosis.

BACKGROUND AND AIMS: Blood tests and liver stiffness evaluation (LSE) by ultrasonographic elastometry are accurate tools for diagnosing liver fibrosis. We evaluated whether their synchronous combination in new scores could improve the diagnostic accuracy and reduce liver biopsy requirement in algorithm. METHODS: Three hundred and ninety patients with chronic liver disease of miscellaneous causes were included. Five blood fibrosis tests were evaluated: APRI, FIB-4, Hepascore, Fibrotest and FibroMeter. The reference was fibrosis Metavir staging. RESULTS: Diagnosis of significant fibrosis (Metavir F>or=2). The most accurate synchronous combination was FibroMeter+LSE, which provided a significantly higher area under the receiver operating characteristic curve (0.892) than LSE alone (0.867, P=0.011) or Fibrometer (0.834, P<10(-3)). An algorithm using the FibroMeter+LSE combination and then a liver biopsy in indeterminate cases had 91.9% diagnostic accuracy and required significantly fewer biopsies (20.2%) than previously published Bordeaux algorithm (28.6%, P=0.02) or sequential algorithm for fibrosis evaluation (SAFE) (55.7%, P<10(-3)). The Angers algorithm performance was not significantly different between viral hepatitis and other causes. Diagnosis of cirrhosis. The most accurate synchronous combination was LSE+FibroMeter, which provided >or=90% predictive values for cirrhosis in 90.6% of patients vs 87.4% for LSE (P=0.02) and 57.9% for FibroMeter (P<10(-3)). An algorithm including the LSE+FibroMeter combination, and then a liver biopsy in indeterminate cases, had a significantly higher diagnostic accuracy than the SAFE algorithm (91.0 vs 79.8%, P<10(-3)), and required significantly fewer biopsies than the Bordeaux algorithm (9.3 vs 25.3%, P<10(-3)). CONCLUSION: The synchronous combination of a blood test plus LSE improves the accuracy of the non-invasive diagnosis of liver fibrosis and, consequently, markedly decreases the biopsy requirement in the diagnostic algorithm, notably to <10% in cirrhosis diagnosis.

Perception of Sleep Disturbances due to Bedtime Use of Blue Light-Emitting Devices and Its Impact on Habits and Sleep Quality among Young Medical Students.

INTRODUCTION: The use of blue light-emitting devices (smartphones, tablets, and laptops) at bedtime has negative effects on sleep due to light stimulation and/or problematic excessive use. We aimed to evaluate, among young medical students, if the perception of sleep disturbances due to bedtime use of these devices is consistent with healthier habits and a better sleep quality. MATERIALS AND METHODS: 294 medical students in medicine and pharmacy from the Faculty of Medicine and Pharmacy of Rabat, Morocco, took part in this anonymous and voluntary cross-sectional study and answered an electronic questionnaire. Student and Mann-Whitney U tests were used to compare variables between 2 groups based on their perception of sleep disturbances. The level of significance was p ≤ 0.05. RESULTS: 286 students (97.3%) used a blue light-emitting smart device at bedtime before sleep, and sleep quality was poor (Pittsburgh Sleep Quality Index, PSQI > 5) in 101 students (35.3%). The perception of sleep disturbances due to this night usage was reported by 188 of them (65.7%). In this group, 154 (81.9%) used their device with all the lights turned off in the room (p=0.02), 34 (18.1%) put devices under pillows (p=0.04), 114 (60.6%) interrupted sleep to check messages (p < 0.001), and the mean duration use of these technologies at bedtime was 2 h ± 23 min per night (p=0.02). Also, the mean sleep duration was 6.3 hours ± 1.25 (p=0.04), 119 (63.3%) presented fatigue on waking more than one time per week (p=0.04), and 76 (40.4%) presented poor sleep quality (75.2% of the students with PSQI > 5) (p=0.005). CONCLUSIONS: Despite the perception of sleep disturbances due to bedtime use of blue light-emitting devices, unhealthy sleep habits tend to be frequent in young medical students and worrying because it is associated to significant poor sleep quality.

Corrigendum: Kounis syndrome induced by oral intake of aspirin: case report and literature review.

[This corrects the article DOI: 10.11604/pamj.2018.30.301.14948.].

Relationship between poor quality sleep, excessive daytime sleepiness and low academic performance in medical students.

Purpose: Poor quality of sleep and excessive daytime sleepiness affect cognitive ability and have a negative impact on the academic performance of medical students. This study aims to determine the prevalence of excessive daytime sleepiness, sleep quality and psychological distress as well as assess their association with low academic performance in this population. Participants and methods: A cross-sectional study was conducted among 457 medical students from the Faculty of Medicine and Pharmacy of Rabat, Morocco, who completed the Pittsburgh Sleep Quality Index (PSQI) questionnaire and the Epworth Sleepiness Scale to determine the quality of sleep and excessive daytime sleepiness, respectively. Sociodemographic variables and psychological distress (Kessler Psychological Distress Scale) were also measured. Multivariate linear regression was performed in order to evaluate the link between low academic performance and sleep quality after adjusting for other covariates. Results: Among the included students, the median age was 20 (19; 21) years; 70.7% of the participants were females. Almost one-third of the students (36.6%) had excessive daytime sleepiness and this was more frequently observed in female students (43% vs 20.1%, <0.001). Furthermore, 58.2% of the students were poor sleepers (PSQI ≥5), while 86.4% of them had psychological distress. The bivariate analysis showed that psychological distress was associated with decreased risk of low performance (ß=0.04; 95% CI=0.005-0.07; P=0.024). Being a poor sleeper was statistically associated with poor academic performance (ß= -0.07; 95% CI=-0.14 to -0.002; P=0.04) in the multivariate analysis. In our study, daytime sleepiness was not statistically associated with academic performance. Conclusion: A poor sleep quality determined by PSQI ≥5 was related to poor academic achievement at the end of the study year in medical students.

Kounis syndrome induced by oral intake of aspirin: case report and literature review.

The Kounis-Zavras syndrome is defined as the coincidental occurrence of acute coronary events and hypersensitivity reactions following an allergic reaction including a mast-cell degranulation of vasospastic mediators. This report describes a case of Kounis-Zavras syndrome in the setting of aspirin-induced asthma also known as Samter-Beer triad combining nasal polyps, asthma, and aspirin allergy leading to vasospasm and myocardial infarction. All physicians should be aware of The Kounis syndrome and always keep that unique clinical entity in mind to recognize it promptly and direct the therapy at suppressing the allergic reaction.

Knowledge, attitudes, and practice of organ donation in Morocco: A cross-sectional survey.

In any health system, public awareness of organ donation fundamentally affects the organ transplantation programs. The aim of this study was to evaluate the knowledge and perception of the people in Morocco toward organ donation as well as to identify the reasons and determinants for refusal of organ donation. This opinion survey included a representative sample of 2000 participants in Morocco, and data related to sociodemographic characteristics, knowledge and self-opinion about organ donation, and reasons behind refusal were collected. Statistical analysis showed that 55.2% of the participants were women, the median age was 21 years, and 60.8% of included participants had secondary education. Almost two-thirds of surveyed participants (62.3%) showed a low to mid-level of knowledge about organ donation and transplantation in Morocco. About half of the interviewed participants (48.8%) refused to donate their organs. Concern about risk of medical error and the belief in trafficking of procured organs were the main reasons for refusal, seen in 66% and 62% of the interviewees, respectively. Univariate and multivariate logistic regression models showed that the older, the less educated and the less informed a person is, the less he accepted organ donation. Therefore, promotion of organ donation in Morocco should involve a regular information and awareness among the general population.

Reversible Myocardial Injury and Intraventricular Thrombus Associated with Aluminium Phosphide Poisoning.

Aluminium phosphide (ALP) is widely used as a fumigant pesticide. In case of ALP poisoning, it is responsible for myocardial dysfunction, related to toxic myocarditis, and hemodynamic disorders. We report a case of a 28-year-old female who had intentionally ingested ALP and was admitted with cardiogenic shock. The transthoracic echocardiography (TTE) at the time of admission showed severe global myocardial hypokinesia with the presence of a giant left ventricular thrombus. Cardiovascular magnetic resonance (CMR) revealed extensive toxic myocarditis with a left ventricular systolic dysfunction. All cardiac lesions were reversible after symptomatic treatment, within 6 months. We aim, by reporting this case, to evidence the complete reversibility of cardiac injury due to aluminium phosphide poisoning documented by transthoracic echocardiography and cardiovascular magnetic resonance.

Independent predictor factors of supine tachycardia in patients with type 2 diabetes mellitus.

INTRODUCTION: Supine tachycardia, frequently encountered in diabetic patients, is usually considered as an isolated diabetic complication in cardiac autonomic neuropathy. The objective of this study was to determine independent predictor factors of supine tachycardia among the clinical characteristics of type 2 diabetes mellitus. METHODS: This prospective study included type 2 diabetic patients. Supine tachycardia was considered as 10 minutes resting heart rate equal or higher than 80 beats/minutes. According to presence or not of supine tachycardia, two groups were identified: tachycardia diabetic patients and none tachycardia diabetic patients. Cardiovascular autonomic tests: deep breathing, hand-grip, and mental stress tests and blood tests were performed in all patients. Statistical analysis was done using the Student's t-test, and univariate and multivariate logistic regression analysis. RESULTS: We included 91 patients. The vagal response measured by the deep breathing test was 24.5 ± 5.7% in tachycardia diabetic patients vs 35.6 ± 6.8% in none tachycardia diabetic patients (P=0.007). The odds of supine tachycardia increased with serum creatinine (OR=1.350, 95% CI: 1.065-1.712, P=0.013) and serum uric acid levels (OR=1.034, 95% CI: 1.005-1.064, P=0.02) respectively, in diabetic patients. The prevalence of moderate renal failure was 45.5% in tachycardia diabetic patients vs. 21.6% in none tachycardia diabetic patients (P=0.034). CONCLUSION: A high frequency of supine tachycardia in type 2 diabetic patients was significantly related with an impairment of the parasympathetic nervous system but other independent predictor factors were associated to the occurrence of this supine tachycardia, such as higher levels of serum creatinine and uric acid and moderate renal failure.

Cardiovascular autonomic response to amlodipine in primary hypertension.

Sympathetic hyperactivity may be involved in primary hypertension. The purpose of this study was to evaluate both sympathetic and vagal activity responses in patients receiving amlodipine as antihypertensive agent. Patients and Methods. This prospective study included a group of primary hypertensive patients (N = 32, mean age 54.6 ± 7.6 years). The cardiovascular autonomic tests performed in this group, before and after 3 months of daily oral administration of amlodipine, included deep breathing, hand-grip, and mental stress tests. Statistical analysis was done using the Student's t-test. Results. Cardiovascular autonomic reflexes responses before and after 3 months of amlodipine oral administration were as follows: the mental stress test stimulation method produced a central alpha adrenergic response of 23.9 ± 8.7% versus 11.2 ± 2.0% (P < 0.05), a central beta sympathetic response of 16.7 ± 9.2% versus 10.4 ± 1.3% (P < 0.05), a blood pressure increase in response to hand grip test of 20.5 ± 7.3% versus 10.7 ± 2.4% (P < 0.05), vagal response to deep breathing test was 21.2 ± 6.5% versus 30.8 ± 2.9%, (P < 0.05). Conclusion. The results attest that amlodipine may have an anti-sympathetic effect.