Apport du test expert MTBRIF dans le diagnostic de la tuberculose toute forme à Saint-Louis / contribution of the Xpert MTB / Rif test in the diagnosis of tuberculosis of any form in Saint-Louis

Introduction: le test Xpert MTB/RIF présente un double avantage d'une part le diagnostic rapide des cas mêmes difficiles par la technique standard de l'examen direct à la microscopie et d'autre part par la détection de la résistance à la rifampicine. Notre objectif était de déterminer l'apport du test Xpert dans le diagnostic de la tuberculose toutes formes confondues. Matériels et méthode : étude transversale, descriptive à collecte rétrospective menée dans le service de Pneumophtisiologie de CHRU de Saint-Louis. Tous les cas suspects de tuberculose qui avaient bénéficié d'un test Xpert de 2018 à 2020avec un dossier médical accessible et exploitable ont été inclus. Les paramètres étudiés étaient les données sociodémographiques, cliniques et biologiques. Résultats : Nous avions colligés 524dossiers de malades avec un sex-ratio de 1,3. L'âge moyen des patients était de 37 ans+/-15 ans. Il y'avait 285 prélèvements positifs au GeneXpert dont 224 d'origine pulmonaire et 61d'origine extra pulmonaire. Le nombre d'échantillons résistants à la rifampicine était de cinq, tous d'origine respiratoire. Conclusion: le test Xpert est une nouvelle technique moléculaire recommandée par l'OMS dans le diagnostic de la tuberculose pulmonaire. Toutefois il doit être évaluer dans le diagnostic de la tuberculose extra pulmonaire

Introduction: The Xpert MTB / RIF assay has a dual advantage on the one hand, the rapid diagnosis of even difficult cases by the standard technique of direct microscopic examination and on the other hand by the detection of resistance to rifampicin. Our objective was to determine the contribution of the Xpert test in the diagnosis of tuberculosis of all forms. Materials and method: retrospective, descriptive and analytical study carried out in the Pneumophtisiology department of the CHRU of Saint-Louis. All suspected tuberculosis cases who had received an Xpert test from 2018 to 2020 were included. The parameters studied were socio-demographic, clinical and biological data. Results: 524 patient records included in the study with a sex ratio of 1.3. The mean age of the patients was 37 +/-15 years. There were 285 positive GeneXpert samples, of which 224 were of pulmonary origin and 61 of extra-pulmonary origin. The number of rifampicin resistant samples was five, all of respiratory origin. Conclusion: the Xpert test is a new molecular technique recommended by the WHO in the diagnosis of pulmonary tuberculosis

Advancing pediatric lung health in Africa: COVID-19 and beyond

Respiratory illnesses in children are an important cause of morbidity and mortality in Africa where poverty, food insecurity, malnutrition, and human immunodeficiency virus infection are aggravating factors in many countries. These factors, in addition to under resourced health-care infrastructure, remain important barriers to improving child lung health outcomes in Africa. However, despite these challenges, there have been significant recent advancements in understanding the epidemiology, causes, measurement tools, and treatment of childhood respiratory illnesses. In this review, we highlight some advances in childhood pneumonia, tuberculosis, asthma, and other important non-communicable lung diseases common in children. Furthermore, we discuss the role of environmental influences on children's lung health in Africa and highlight novel methods of measuring lung function in children. Although children contribute a small role in the global epidemiology of COVID-19 pandemic, socioeconomic and health-care delivery disruptions caused by government responses to contain the pandemic have resulted in significant indirect setbacks to child health. We further highlight how the COVID-19 pandemic has impacted areas of pediatric lung health and discuss ways to mitigate effects of COVID-19 in Africa

Occupational lung disease among Basotho ex-miners in a large outreach medical assessment programme

Background: Current initiatives in southern Africa to medically assess former migrant miners for silicosis and tuberculosis, including statutory and lawsuit derived compensation programmes, require burden of disease information. nObjective: To use clinical information collected on ex-miners examined at the Occupational Health Service Centre (OHSC) in Lesotho, operated under the Tuberculosis in Mining Sector in Southern Africa (TIMS) project, to measure the burden of lung disease and respiratory impairment. Methods: Demographic, occupational and medical history information, chest radiology, spirometry, GeneXpert testing for tuberculosis, and pulse oximetry outcomes were analysed, and descriptive summary measures calculated, in a group of ex-miners examined in 2017 and 2018. Results: The study sample comprised 2 758 Basotho former underground miners, with median age of 62 years and median length of service of 28 years. Among ex-gold miners (n = 2 678), disease prevalence was high: radiological tuberculosis (consistent with previous or current disease) 60.9%, silicosis 42.5%, HIV 30.7%, silicotuberculosis 25.7%, and current active tuberculosis 6.8%. Of those with tuberculosis diagnosed microbiologically, 6.7% had no radiological evidence of tuberculosis and 54.1% did not report cough. Conclusion: The findings have public health and compensation implications. There are large numbers of ex-miners with potentially compensable disease under both the statutory system and a settlement trust set up following litigation. This overlaps with a tuberculosis-HIV co-epidemic which requires screening and treatment for tuberculosis and HIV, and managing a considerable disability and care burden on families and the Lesotho health system. Coordinated planning and substantial resources are needed for these programmes to do justice to their mandates

Chronic lung disease and a history of tuberculosis (post-tuberculosis lung disease): Clinical features and in-hospital outcomes in a resource-limited setting with a high HIV burden

Background. Many patients with previous pulmonary tuberculosis (PTB) continue to experience respiratory symptoms long after completion of tuberculosis (TB) therapy, often resulting in numerous hospital visits and admissions.Objectives. To describe the profile of patients with chronic lung disease (CLD) with or without a history of PTB, and their in-hospital outcomes. Methods. We conducted a retrospective review of patients with CLD admitted with respiratory symptoms to Dora Nginza Hospital, Port Elizabeth, South Africa, from 1 April 2016 to 31 October 2016. These patients were divided into two groups: CLD with a history of PTB (CLD-TB) and CLD without a history of PTB. Patients with current culture-positive TB were excluded. Baseline characteristics and clinical outcomes (duration of hospitalisation and in-hospital mortality) were compared between the two groups.Results. During the study period, a total of 4 884 patients were admitted and 242 patients received a diagnosis of CLD. In the CLD patient group, 173 had CLD-TB and 69 had no history of PTB. Patients with CLD-TB presented with respiratory symptoms a median of 41 months (interquartile range (IQR) 101) after completion of TB therapy. CLD-TB patients were predominantly male (59.5%), and compared with patients with no history of PTB were more likely to be HIV-positive (49.7% v. 8.7%; p=0.001) and had had more frequent hospital admissions before the current admission (median 2.0 (IQR 2.0) v. 0; p=0.001) and longer hospital stays (median 5 days (IQR 7) v. 2 (4); p=0.002). However, there was no statistically significant difference in in-hospital mortality between the two groups (17.3% v. 10.1%; p=0.165).Conclusions. In patients with CLD, a history of PTB is associated with numerous hospital admissions and longer hospital stays but not with increased in-hospital mortality. TB therefore continues to be a public health burden long after cure of active disease

A Review of Chronic Lung Disease in Neonates at Charlotte Maxeke Johannesburg Academic Hospital from 1 January 2013 to 31 December 2014

Background. Chronic lung disease (CLD) remains a significant morbidity in preterm babies despite advances in neonatal care. The use of postnatal corticosteroids (PNCSs) to treat CLD remains controversial.Objectives. To describe the clinical characteristics of babies with CLD at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) and to explore the use of PNCSs for the prevention and treatment of CLD.Methods. This was a 2-year retrospective review of neonates admitted to CMJAH. Neonates who were in hospital for =28 days were included. Comparisons were made between neonates with evolving CLD and those with no CLD.Results. A total of 485 neonates were analysed: 237 had evolving CLD and 245 did not have CLD. Overall incidence of evolving CLD was 5%. More neonates with CLD than those without CLD needed resuscitation at birth (48.5% v. 39.8%; p=0.02) and had low 5-minute Apgar scores (17.2% v. 10.6%; p=0.001). Neonates with CLD had increased prevalence of patent ductus arteriosus (30.4% v. 7.7%; p=0.001) and late-onset sepsis (56.5% v. 23.6%; p=0.001). The mortality rate was also higher in CLD babies (10.2 v. 2.4%; p=0.001). Necrotising enterocolitis (NEC) (29.2% v. 8%; p=0.005) and sepsis (83.3% v. 53.8%; p=0.008) were associated with increased mortality. The use of PNCSs was associated with less NEC (3.5% v. 17.2%; p=0.001) and improved survival (95.6% v. 81.7%; p=0.001).Conclusions. CLD remains a common morbidity in neonates despite advances in neonatal care. The use of PNCSs was shown to have short-term benefits. To get the most out of PNCS use for CLD; further studies need to be conducted to determine the safest type of steroid; safe doses and the duration of treatment

Eosinophilic Lung Disease: A Review

The terms 'eosinophilic pneumonia' and 'eosinophilic lung disease' loosely describe a heterogeneous group of pulmonary diseases of varying aetiologies and severity. The diseases are characterised by infiltration of lung parenchyma by eosinophils; peripheral eosinophilia is not required for diagnosis. In this article; major clinical entities are appraised with respect to clinical; pathological and radiological features. Diseases without pulmonary infiltration or radiographic abnormalities; such as allergic asthma; are not included in this review

Manifestations pleuro-pulmonaires au cours des connectivites chez les sujets ouest-africains dans un pays à ressources limitées

Objectif : Déterminer les caractéristiques épidémiologiques et cliniques des atteintes pleuro-pulmonaires au cours des connectivites dans l'unité de rhumatologie du CNHU-HKM.Patients et méthodes : Il s'agit d'une étude rétrospective à visée descriptive portant sur des dossiers des patients vus l'unité de rhumatologie dans la période de janvier 2000 à Mars 2013. Dans un premier temps, les dossiers des patients ayant souffert d'une connectivite ont été recensés. Le diagnostic de connectivite a été retenu selon les différents critères diagnostiques TANIMOTO 1995 pour la Dermatopolymyosite (DPM), ACR 1987 pour la Polyarthrite Rhumatoïde (PR), ACR 1997 pour le lupus érythémateux systémique (LES), ACR 1989 pour la sclérodermie, Communauté Européenne 1993 pour le Goujerot-Sjögren, SHARP pour les connectivites mixtes. Dans un deuxième temps, les dossiers des patients ayant souffert de manifestations pleuro-pulmonaires ont été dépouillés. Le diagnostic d'atteinte pulmonaire a été posé sur des arguments clinique, radiologique et/ou après un test thérapeutique. Les données recueillies ont été analysées grâce au logiciel épi info 6.0.Résultats : Sur 9785 patients vus dans l'unité de rhumatologie, 127 cas (1,3%) de connectivites ont été diagnostiqués. Il s'agissait de 99 béninois, 13 nigérians, 5 togolais, 4 ivoiriens, 3 maliennes, 2 burkinabés et une sénégalaise. La sex-ratio était de 0,17. L'âge moyen des patients était de 35,2± 5,2 [18-71] ans. Dix-sept (17) patients ont présenté des manifestations pleuro-pulmonaires. Elles étaient associées à d'autres atteintes séreuses (péricarde et péritoine) dans 6 cas. La toux était présente chez tous les patients. Elle était sèche dans n=14 cas et associée à une dyspnée dans n=5 cas. Les manifestations se présentaient comme suit : pleurésies rattachées au LES et à la PR (n=3 cas chacun), toxicité pulmonaire probablement liée au méthotrexate confirmée par l'arrêt du traitement de fond (n=5), broncho-pneumopathies infectieuses (n=4) et la fibrose pulmonaire en rapport avec la PR (n=2). L'évolution sous traitement (corticothérapie seule ou associée à un traitement de fond) a été favorable chez 14 patients, stationnaire chez 2 patients. Un cas de décès a été noté. Conclusion : Les atteintes pleuro-pulmonaires occupent une place non négligeable parmi les complications liées aux connectivites. La corticothérapie et le traitement de fond par les DMARDs ne sont pas non plus dénudés de complications pulmonaires. La mise en place d'une équipe pluridisciplinaire s'impose pour le dépistage précoce et la prise en charge de ces complications

Chronic Obstructive Pulmonary Disease (COPD): A Review of the Clinical Management

Chronic Obstructive Pulmonary disease (COPD) is one of the most common chronic respiratory diseases which contribute significantly to the burden of non-communicable diseases(NCDs). With the increasing prevalence of COPD in developing countries a good knowledge of the diagnosis and adequate management are important tools for both primary care and specialist physicians to ensure appropriate treatment.Methods: Review of the available literature on the subject was done through Medline and Google search utilizing the following keywords COPD; epidemiology; pathogenesis and management.Result: Spirometry is an important tool in the diagnosis and staging of COPD. Various treatment targets aimed at improving breathing and the quality of life in patients are available.Conclusion: New therapies that have the potential to improve disease outcome are urgently needed

Les pneumopathies aigues du nourrisson en Cote d'Ivoire: apport de la radiographie thoracique dans la recherche etiologique et la prise en charge precoce

Introduction: Identifier les tableaux radio-cliniques actuels des pneumopathies aigues du nourrisson rencontres en Cote d'Ivoire et demontrer le role de la radiographie thoracique dans leur prise en charge. Methodes: Etude retrospective de 24 mois ayant concerne l'analyse de 165 radiographies thoraciques (RT) de face realisees chez des nourrissons ages de 1 a 24 mois; hospitalises dans le service de pediatrie du CHU de Yopougon (Abidjan-Cote d'Ivoire) pour pneumopathies aigues. Les elements epidemio-cliniques; therapeutiques et evolutifs ont ete obtenus a partir du dossier medical des nourrissons.. Resultats: L'age moyen des nourrissons etait de 9 mois avec des extremes entre 3 et 22 mois. Le sex-ratio etait egal a 1;2. Les syndromes radiographiques etaient domines par le syndrome alveolaire (70;3) suivi par l'association syndrome alveolaire-syndrome bronchique (29;7). Les signes radiographiques de gravite etaient presents dans 61;8.Les entites radio-cliniques etaient representees par les pneumopathies massives (32;7); la pneumonie franche lobaire aigue (4;2); les abces du poumon (7;3); les staphylococcies pleuro-pulmonaires (4;2); les pleuro-pneumopathies (13;3); le pyo-pneumothorax (4;9); les broncho-) et la primo-infection tuberculeuse (3;7pneumopathies (29;7). Conclusion: A travers la mise en parallele des entites radio-cliniques avec les elements epidemiologiques et cliniques; la RT a permis de prejuger de l'etiologie des pneumopathies et de mettre en route immediatement le traitement specifique. A l'ere de la pandemie du VIH-SIDA; cette etude montre que la tuberculose pulmonaire est paradoxalement l'entite radio-clinique la plus rare

"Profil des enfants avec infections respiratoires aigues recues au Centre Pediatrique 'Watoto"" de Lubumbashi; Congo"

3236 enfants souffrants des infections respiratoires aigues (IRA) ont ete recus au centre pediatrique WATOTO de Lubumbashi. Ces enfants avaient fait partie des 6499 enfants malades conduits a ce service pendant la periode donnee. Ils ont represente 52;5 des cas.Notre investigation a montre que L'atteinte respiratoire a predomine pendant la saison seche avec 57;6 des cas. Les enfants ages de 6 a 12 mois ont ete les plus affectes soit 23;0 ; les garcons ont ete plus affectes par rapport aux filles avec 53;4. Les IRA identifiees ont ete par ordre de frequence decroissant : la bronchite aigue; l'otite moyenne aigue; la bronchopneumonie; la rhinite; la rhinopharyngite; la pneumonie lobaire; l'amygdalite et l'adenoidite. Les decisions medicales prises ont ete les suivantes : 666 enfants avaient ete renvoyes a domicile; 72 de cas (soient 142 enfants) avaient ete mis en observation: 15;5 des cas (90 enfants) avaient ete hospitalises; 9;9 des cas 16 enfants etaient decedes : 1;7 des cas.La pneumonie lobaire avait totalise 55;7 des cas hospitalises et 68;7 des decedes. Les filles avaient eu plus de deces (56;2 ) que les garcons.Le taux de letalite a ete de 17;8.les maladies respiratoires aigues demeurent frequentes a Lubumbashi avec un taux de deces eleve

An Overview of Chronic Obstructive Pulmonary Disease (COPD): Epidemiology and Pathogenesis

Chronic Obstructive Pulmonary Disease (COPD) is one of the most common chronic respiratory diseases which contribute significantly to the burden of non-communicable diseases. With the increasing prevalence of COPD in developing countries a good knowledge of disease burden and process is essential.Methods: Review of the available literature on the subject was done through Medline and Google search utilising the following keywords COPD; epidemiology; pathogenesis and management.Result: COPD which is increasing in prevalence has varied pathogenetic mechanisms which are influenced by both intrinsic and extrinsic environmental promoters.Conclusion: The prevalence of COPD is increasing especially in developing countries. The pathogenesis is multifactorial and current understanding provides insights that are expected to improve on treatment and outcome

Sickle Cell Chronic Lung Disease among Young Adult Nigerians

BACKGROUND: Sickle cell chronic lung disease (SCLD) is often underappreciated by health care providers because its exact prevalence and methods of diagnosis have not been well studied. OBJECTIVE: To describe the pattern of SCLD among young adult Nigerians with sickle cell anaemia (SCA). METHODS: Ninety (43 males and 47 females) patients with SCA who were selected by balloting and 90 (54 males and 36 females) healthy subjects with normal adult haemoglobin were studied. Their ventilatory function test (spirometry and peak expiratory flow rates); radiological and electocardiographic parameters were obtained and analyzed for SCLD. RESULTS: Seventeen (18.9) of the patients had SCLD. Majority (94.1) of them were in stage1 disease; 5.9in stage two; and none in the more advanced stages3 and 4. The number of patients with SCLD increased with increasing age. SCLD was associated with more than five previous hospital admissions (82.4; OR=10.02; CI=4.51-22.22) and presence of symptoms suggesting previous acute chest syndrome (dyspnoea in 58.8; OR=33.33; CI=7.39-150.30; chest pain in 94.1; OR=81.33; CI= 9.83-672.85; cough in 47.1; OR=64.00; CI=7.15-572.60). CONCLUSION: SCLD may not be a rare event in Nigeria. Therefore efforts should be made to diagnose it in the early asymptomatic stage so as to offer effective intervention therapy to halt progression to the more disabling advanced stages

Rate of Pulmonary Function Decline in South African Children with Cystic Fibrosis

Background. Pulmonary function tests (PFTs) objectively measure the extent and progression of cystic fibrosis (CF) lung disease. The rate of lung function decline in developing countries has not previously been studied. Aim. To investigate the average annual rates of pulmonary function decline in South African children with CF from 1999 to 2006. Methodology: The medical records and best PFT over 3-monthly intervals of children attending the CF clinic at Red Cross War Memorial Children's Hospital; Cape Town; were retrospectively reviewed and analysed using the mixed model regression method. Results. A total of 1 139 PFT were recorded on 79 patients; with a median (interquartile range) of 14 (6 - 21) PFTs per patient. The mean (standard error) forced expiratory volume in 1 second (FEV1) at age 6 years was estimated at 73.83 (3.34) per cent predicted with an FEV1 decline of 0.23 (0.43)per annum. FEV1 at age 6 was affected by age at CF diagnosis; genotype; and year of birth. Rate of FEV1 decline was significantly affected by Pseudomonas aeruginosa colonisation and genotype. Conclusions. Although FEV1 at age 6 years was low compared with developed countries; the annual rate of FEV1 decline in South African children with CF was minimal; setting the scene for improved survival in this population

The Appropriateness of the South African Thoracic Society's Guidelines for Antibiotic Treatment of Patients with Chronic Obstructive Pulmonary Disease Exacerbation in the Universitas Academic Hospital; Bloemfontein

Chronic obstructive pulmonary disease (COPD) is a progressive disease predominantly associated with smoking. Exacerbation of COPD frequently results from respiratory infections. The South African Thoracic Society (SATS) recommends treatment with amoxicillin/ clavulanate; cefuroxime or a fluoroquinolone. The study aimed to determine the appropriateness of these guidelines regarding organisms isolated from sputum of patients with COPD exacerbation at Universitas Academic Hospital; Bloemfontein. A descriptive study was performed. Seventeen hospitalised patients diagnosed with COPD exacerbation from July - October 2007; not treated with antibiotics or corticosteroids or having a respiratory infection four weeks prior to admission; were included. Demographic information (age; gender; area of residence; smoking history) was obtained from patients' files; as well as FEV1 values; FEV1/FVC ratio; infection markers; microorganisms isolated from sputum and their antibiotic susceptibility profiles. Nine patients were male and eight female; with a median age of 72 years (range 53 - 82 years). Twelve (70.6) patients resided in the Bloemfontein urban area. Three patients (18.8) never smoked; 25smoked previously and 56.3were active smokers (median pack years 45 years; range 17 - 70 years). Eight patients had culture-positive sputum specimens. Haemophilus influenzae; H. parainfluenzae; Streptococcus pneumoniae; Staphylococcus aureus; Pseudomonas aeruginosa; Serratia marcescens and Escherichia coli were isolated from sputa. With the exception of S. aureus; all isolates were susceptible to at least one antibiotic recommended by SATS. The guidelines proposed by SATS for treatment of COPD exacerbation were appropriate and would be effective in the management of these patients in the Free State region

The Appropriateness of the South African Thoracic Society's (SATS) Guidelines for Antibiotic Treatment of Patients with COPD Exacerbation in the Universitas Academic Hospital; Bloemfontein

Chronic obstructive pulmonary disease (COPD) is a progressive disease predominantly associated with smoking. Exacerbation of COPD frequently results from respiratory infections. The South African Thoracic Society (SATS) recommends treatment with amoxicillin/ clavulanate; cefuroxime or a fluoroquinolone. The study aimed to determine the appropriateness of these guidelines regarding organisms isolated from sputum of patients with COPD exacerbation at Universitas Academic Hospital; Bloemfontein. A descriptive study was performed. Seventeen hospitalised patients diagnosed with COPD exacerbation from July - October 2007; not treated with antibiotics or corticosteroids or having a respiratory infection four weeks prior to admission; were included. Demographic information (age; gender; area of residence; smoking history) was obtained from patients' files; as well as FEV1 values; FEV1/FVC ratio; infection markers; microorganisms isolated from sputum and their antibiotic susceptibility profiles. Nine patients were male and eight female; with a median age of 72 years (range 53 - 82 years). Twelve (70.6) patients resided in the Bloemfontein urban area. Three patients (18.8) never smoked; 25 smoked previously and 56.3 were active smokers (median pack years 45 years; range 17 - 70 years). Eight patients had culture-positive sputum specimens. Haemophilus influenzae; H. parainfluenzae; Streptococcus pneumoniae; Staphylococcus aureus; Pseudomonas aeruginosa; Serratia marcescens and Escherichia coli were isolated from sputa. With the exception of S. aureus; all isolates were susceptible to at least one antibiotic recommended by SATS. The guidelines proposed by SATS for treatment of COPD exacerbation were appropriate and would be effective in the management of these patients in the Free State region

Sickle cell chronic pulmonary disease among Africans: the need for increased recognition and treatment

The pulmonary complications of sickle cell disease (SCD) among adults are expected to increase since more of them are expected to survive into adulthood with improved healthcare delivery systems. Such complications; especially the chronic ones; which are usually collectively referred to as SCCLD (sickle cell chronic lung disease); are often under-appreciated by healthcare providers in sub-Saharan Africa. However; results of recent work in Nigeria show that SCCLD might not be as uncommon as previously thought. It is very important to detect SCCLD at an early stage; which is usually asymptomatic; the late stages are not usually responsive to conventional treatment. In Africa; outline spirometry can be used as a screening test for asymptomatic SCCLD in the follow-up of SCD. Patients with asymptomatic SCCLD should be offered measures that can prevent further deterioration of their condition; while those with more advanced symptomatic disease are treated symptomatically

Actualites sur les alveolites allergiques extresinques ou pneunomophathies d`hypersensibilite

Des avancees significatives ont ete notees dans la pathogenie et le diagnostic des alveolites allergiques extrinseques au cours de ces dernieres annees. En effet; les mecanismes immunologiques et facteurs favorisants ont ete mieux precises; les stades cliniques et criteres diagnostiques clairement definis; de nouveaux antigenes incrimines et certains agents etiologiques reclasses. L'explication pathogenique actuelle insiste sur l'immunite a mediation cellulaire (type IV) avec sensibilisation des lymphocytes T; activation des macrophages; formation d'anticorps de type IgG et d'immuns complexes; activation du complement et secretion de cytokines. L'implication de certaines classes HLA (HLA2; DR3; DRB1; DQB1); l'interaction des facteurs genetiques et environnementaux; le role de certains agents infectieux et du tabagisme ont ete demontres par plusieurs etudes. L'avenement de nouveaux criteres diagnostiques cliniques et biologiques a permis la decouverte de nouvelles AAE en milieu professionnel; une meilleure connaissance des elements pronostiques et une adaptation appropriee des mesures preventives

No benefit from pulmonary artery catheters for critically ill patients

InfoPOEMsr keep you current and answers your clinical medicine questions at the point of care with the right information. The practicing professionals of InfoPOEMsr; recognized experts in Information MasteryT; start with only the best research findings from a continuous survey of the top worldwide medical journals. They identify and summarize the most valid and clinically-applicable new evidence

Right azygos lobe occurring with fissural and lobation anomalies

Background: The azygos lobe is a rare anomaly of the lung that is separated from the rest of the upper lobe by an azygos fissure. The lobe is encountered mostly in the right lung but a few cases have also been described in the left lung. It occurs at a frequency of 0.25-1and has surgical and radiological importance. For example it can give rise to opacity on the X-ray that can mimic lung pathology.Observations: The azygos lobe was observed in the upper lobe of the right lung from a 45 years old male cadaver during dissection. The apex of the lung contained a vertical fissure that isolated medially the azygos lobe. The lobe appeared columnar in shape and it measured 4.7cm long and 3.7cm wide; its posterior border contained a notch. In addition to the azygos lobe the right lung also contained an incomplete horizontal fissure and therefore was divided by an oblique fissure into two lobes.Conclusion: The current observation has documented the co-existence of an azygos lobe with incomplete horizontal fissure and two lobes on the right lung. The findings have added knowledge on the morphology of the azygos lobe and have also raised awareness that it can occur with other fissural anomalies