[Influenza A [H1N1]: about 189 cases]

Influenza A [H1N1] is a contagious acute respiratory infection caused by a subtype influenza virus A [H1N1]. The later had caused a pandemic in 2009. Despite its low mortality, the disease was more severe in some subgroups. Describe confirmed cases of influenza A [H1N1] addressed to the pulmonary department of the Rabta hospital and identify risk factors. During the pandemic influenza A [H1N1], pulmonary department of Rabta hospital was identified among the centers to receive and detect new cases in addition to hospitalization of severe ones. All subjects had nasal and pharyngeal swabs. The authors distinguished non-severe and severe cases; hospitalization was indicated for severe forms. From September 2009 to March 2010, influenza A [H1N1] has been confirmed in 189 patients. The average age was 27.3 years [2-72 years]. Sex ratio was 1.2. Contagion was found in all patients. Twenty-two patients were hospitalized for the severe form. Mean age was 56 years, sex ratio was 0.47. Among them, 20 patients had at least one co-morbidity. Most frequently found risk factors were diabetes [9 cases], chronic respiratory disease [9 cases] and pregnancy [6 cases]. All patients received ozeltamivir. The dose was doubled in severe cases. Nonspecific antibiotic therapy was prescribed in 11 cases. Seven patients were hospitalized in intensive care unit, among whom 4 died. Mortality in severe forms was 18% and overall mortality 2.1%. Through this Tunisian series, we emphasize the potential severity of influenza A [H1N1]. This justifies a systematic vaccination of subjects at risk even away from pandemic period

[Diagnosis approach of pulmonary embolism]

Pulmonary embolism [PE] is a fairly common condition that can be fatal. The variability of presentation sets clinician up for potentially missing the diagnosis. Routine laboratory findings are nonspecific and are not useful in diagnosis of PE. Diagnosis is based on clinical prediction rule in combination with laboratory tests such as the D-dimers test leading to the realization of a confirming examination. To precise the confirming examinations of PE and propose an algorithm based on clinical prediction rules in combination with D dimmers. A Pub Med search was conducted using the following key words: pulmonary embolism computed tomography pulmonary angiography, scintigraphy and D Dimer. The study was based on a review of 18 studies including meta analysis, reviews and original articles referring recent strategy diagnosis of pulmonary embolism. Ventilation/ perfusion scan is a type of examination that is used less often because it is not a widespread technology. However, it may be useful in patients who have an allergy to iodinated contrast. Ultrasonography of the legs, also known as leg doppler, in search of deep venous thrombosis [DVT] may help the diagnosis approach particularly when other exams are not available or contraindicated. This may be a valid approach in pregnancy. The gold standard for diagnosing PE is pulmonary angiography. It is used less often due to wider acceptance of multi detector CT scans, which are non-invasive. A normal ventilation/perfusion scan rules out the diagnosis of PE with negative predictive value of 97%. There is no consensus in pregnancy. Finally, the MRI has a low and insufficient sensibility to diagnose PE. D Dimers, multidetector CT, ventilation/ perfusion scintigraphy and ultrasonography of the legs are the most useful examinations to diagnose PE. Many algorithms were established depends on medical experience and examination availability

[Sarcoidosis in Tunisia: epidemiologic and clinical study]

The epidemiologic study of sarcoidosis is problematic and differing incidences across the world are reported. In Tunisia, the incidence of this affection is yet unknown. This is at least attributable to the lack of large series and the overshadowing presence of tuberculosis. To determine presenting signs, symptoms and investigations particularities. We report a retrospective series patients with sarcoidosis followed up in the Rabta university hospital between 1991 and 2005 and try to determine presenting signs, symptoms and investigations particularities. 131 patients [79 women and 52 men] with a median age of 47 +/- 14 years were reviewed. They were symptomatic in 95% of cases. Cutaneous symptoms were present at onset in 56.8%, respiratory symptoms in 48.6% and general symptoms in 41.6%. Thoracic presentation was observed in 81.3%. Chest X-ray changes and tomodensitometry showed that type II and III were predominant. Lung function was disturbed in 58.5% of the cases. Extrathoracic involvement, observed in 89.3% of the cases, was largely dominated by cutaneous lesions. Histopathological lesions provided diagnosis in 66.6%. The relative high frequency of dermatological lesions suggests genetic or even environmental predisposition to develop sarcoidosis such as sunlight exposition