Overlap syndrome: Association of chronic obstructive pulmonary disease and obstructive sleep apnea syndrome

Abstract: COPD and the OSAHS are both common diseases affecting respectively 10% and 5% of the adult population over 40 years of age. Their coexistence, which is denominated as "overlap syndrome", can occur in about 0.5% of this population

Aim and materials: To assess the existence of a prevalence of OSAHS in patients with COPD through a prospective analysis: 70 had a confirmed isolated OSAHS [group A] and 11 had an OS [group B], all were compiled from January 2007 to June 2012

Results: The prevalence of OS in our study was 13.6%, OS patients were older than the isolated OSAHS patients [p < 0.05] with a male predominance in the Overlap arm [p < 0.05], and BMI was similar between the 2 groups [p = 0.22]. Tobacco is retained as a risk factor and 81.8% of patients with Overlap were smoking [p < 0.05]. Clinical signs most reported are nocturnal snoring and daytime sleepiness. The Epworth Sleepiness Scale was higher than 10 in the 2 groups [p < 0.05]. The Berlin questionnaire realized in 30 subjects in group A, was positive [40% of cases] and was positive in 63.6% of 7 subjects in group B. Spirometry showed that vital capacity, FEV1 and FEV1/CV were significantly decreased in the Overlap group [p < 0.001]. The recording shows a sleep apnea-hypopnea index [AHI] similar in the two groups [p < 0.05]

Conclusion: There was no correlation between COPD and OSAHS. The latter is a risk factor for the first

Pulmonary tuberculosis in its pseudotumoral form; one new case

Pulmonary tuberculosis in its pseudo tumoral form is a rare entity. This pseudo tumor is suggested by a radiological parenchymal lesion or neoplastic-like presence in bronchoscopy of a bud or lung infiltration. The diagnosis is confirmed by bacteriological and/or different histological samples. We report a patient aged 26 with no history conditions, no notion of contagious tuberculosis and without toxic habits, who reports with three months isolated type left chest pain operating in a context of significant weight loss but not encrypted, evening fever and altered general condition. The clinical syndrome is a condensation of apical left and the rest of the examination is unremarkable. The chest radiograph shows an opaque round, dense and homogeneous apical left chest scan objective mass density tissue. Bronchoscopy was performed of a small bud at the apex of the segmental left upper lobe whose biopsy was inconclusive. Transparietal puncture with histological study confirmed the diagnosis of pulmonary tuberculosis. The patient was then put under treatment with antibacillaire. The diagnosis of tuberculosis should be considered in any tumor-like lung, as well as to step up bronchoscopic radiation, especially in an epidemiological context and is suggestive. This will allow early treatment of tuberculosis. The aim of our study is to report the rare and special appearance of pulmonary tuberculosis pseudo-tumoral form in imaging

[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

[ bagassose: extrinxic allergic alveolite]

The extrinsic allergic alveolites are interstitial and alveolar pneumopathies of complex immunological mechanisms, related to the inhalation organic chronicles of substances. We report the observation of a 61 years old, old patient nicotinic chronicle, without particular pathological antecedents, having a concept of professional exposure to the cane with sugar during 40 years. It presents 4 months before its hospitalization a dyspnea of effort of progressive aggravation currently stage IV of the EEC associated with a productive cough mucopurulente, the whole evolving/ moving in a context of apyrexie and slimming quantified to 15 kg. The clinical examination finds a patient polypneic with 26c/mn and rails crepitants bilateral with the sounding pleuropulmonaire. Thoracic radiography shows an interstitial syndrome diffuse reticulo-micronodulaire. The thoracic TDM highlights an aspect in honeycomb evoking a pulmonary fibrosis. Washing bronchioloalveolaire objectifies a rate of polynuclear neutrophiles with 6%. Respiratory functional exploration finds a moderate restrictive syndrome with a reduction in the DLCO. In front of these clinical, radiological and functional criteria, the diagnosis of the bagassose was retained. In the light of this observation, we underline the diagnostic difficulties of the alveolite allergic extrinsic and we propose a review of the literature

[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

[Allergy to the latex]

The immediate allergy to the natural latex did not stop increasing during this last decade in exposed persons particularly in health professionals. Its frequency is very variable. The aim of this work is to evaluate the frequency of allergy to the natural latex proteins in the paramedical staff of Ibn Sina academic hospital center of Rabat. It is a prospective survey lasts for a period of three months, aided by a questionnaire. 22 departments were participated in this survey, the number of distributed questionnaire depends on the work force of each department, it was 619. Among only 268 have been filled i-e 43,2%. And only 119 participants reported allergic manifestations i-e 44.4% Alter making an allergiology consultation only 45 persons had a real allergic manifestations related to manipulation with natural late proteins i-e 16-7%. Clinical pictures were: prauritus [51%] allergic rhinitis [48.8%], conjunctivitis [46.6%], contact eczyma [26.6%], contact rash [8.8%], asthma [8.8%] and only one case of Quink edema [2%]. Prick tests to the current pneumoallergenes and to some exotic fruits have been done to all the participants, 45 positivity was found in 5 persons i.e [11.1%] Sentization was isolated in two cases one was sensitized to avocet only, associate to a sensitization to avocet DP type, DF in one case and to avocet, banana and kiwi for the other case. The frequency of allergy to latex in this selected sample was of 11.1% which remains comparable to the data of literatures

[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

Hernies diaphragmatiques post-traumatiques

Diaphragmatic hernia is a surgical emergency, its diagnosis is often misknown. We remind this pathology through two cases. The diagnosis should be early, and surgical treatment immediately

adrenaline in the severe acute asthma

The severe acute asthma is a frequent complication of the asthma which threatens the life of patients. Therapeutic objective in the severe acute asthma is to play rapidly on the bronchial obstruction components. The adrenaline, by its alpha actions which are theoretically benefic, allowing the reduction of the bronchial oedema and by its B-2 agonists which has a strong bronchodilator action, is indicated in the treatment of the severe acute asthma after failure of the B-2 agonists. The objective of this article is the study of the actions of the adrenaline and its use in the treatment of the severe acute asthma