Mantoux test: what threshold? for what purpose?

The tuberculin skin test [TST] is a widely used diagnostic test, but its interpretation depends on the cut-off used for positivity. This study determined the threshold value of positivity of TST when screening for tuberculosis infection and when directly diagnosing tuberculosis disease. We conducted a prospective study over 2 years among 174 patients with confirmed tuberculosis and 205 healthy controls recruited at Moulay Youssef Hospital, Rabat, Morocco. Participants underwent the TST and the diameter of induration was measured after 72 hours. A second reading was made after 5 and 7 days in patients > 65 years when the test was negative. Using the ROC curve we determined 2 thresholds of positivity for TST: 9 mm had a 68% sensitivity and 78% specificity, and 13 mm a 54% sensitivity and 90% specificity. Thus 9 mm is sufficient to diagnose tuberculosis infection, but 13 mm is needed to diagnose tuberculosis disease

[Obstructive sleep apnea-hypopnea syndrome: risk factors and comorbidities]

A common condition in the middle-aged adults, the obstructive sleep apnea-hypopnea syndrome is a disease which has been considered both rare and benign illness. Now it is "taken seriously" and considered as a real public health problem because, it untreated, it leads to increased morbidity or even mortality concerning the cardiovascular system [hypertension particularly resistant to medical treatment, coronary artery disease.], the endocrine system [metabolic syndrome], the neurological system [stroke, thromboembolic disease.] and also psychologically [depression, impairment of cognitive performance.]. As concern the pathophysiology, the disease is characterized by a complete or partial obstruction of the upper airways on inspiration due to a collapse of the pharyngeal structures occurring repeatedly during sleep. This collapse is secondary to a number of risk factors crucial to recognize because they allow to suspect the disease [male gender, advanced age, obesity, drug taking, certain disorders as endocrinal diseases, malformation diseases, digestive diseases.]. Due to its pathophysiology, the diversity of its risk factors, comorbidities and complications, the pathology is considered as "transversal" that support should be multidisciplinary

[Inhalation of scarf pin: specificities of this foreign body]

The inhalation of scarf pin is a phenomenon increasingly common in countries where women wear the veil and whose consequences can be grave. The aim of this study is to emphasize the danger of holding this object in the mouth and to describe through a retrospective study the diagnostic, the clinical features and the management of 24 cases of inhalation of this foreign body. All cases were young veiled women aged between 13 and 23 years, all victims of accidental inhalation of a metal pin. The most frequently reported symptom was cough in 58% of cases. Chest radiography helped confirm diagnosis and guide the location of the foreign body which was in equal frequency at the right and left bronchial tree [46%] and 8% in the trachea. Flexible bronchoscopy, performed by first intention in all our patients, helped to locate the pin in 19 cases and its extraction in extraction. The spontaneous expulsion was noted in five cases. The inhalation of pin is a pulmonary emergency where endoscopy occupies a primordial place. Prevention remains the best treatment

[Exploration of sleep-disordered breathing]

Sleep-disordered breathing become more frequent mostly affecting adult male subjects and overweight. We distinguish in this context apneic and non apneic sleep-disordered breathing whose leaders are respectively sleep apnea syndrome and obesity-hypoventilation syndrome. The diagnosis of these disorders is obligatory based on explorations achievable only in sheep laboratory. In these explorations, it is important to distinguish two types of investigations. The ventilatory polygraphy: simple investigation, but limited to the registration of different ventilation parameters of severe sleep apnea syndrome with an apnea-hyponea index >30/ h. Polysomnography, besides the respiratory signals recorded previously, it collects other signals that can recognize the succession of different stages of sleep [hypnogram]. It remains the gold standard of sleep-related breathing disorders. Through this update we will discuss the technical side of these two investigations and also their relevance