Assessment of therapeutic compliance and its associated factors in tunisian adult asthmatic patients.

INTRODUCTION: Despite therapeutic advances, morbidity attributed to asthma continues to increase. This seems partly to be due to poor adherence. AIM: To assess therapeutic adherence and the association between poor compliance and asthma control. METHODS: We carried out a descriptive cross-sectional study on a sample of 150 asthmatics, followed in the pneumology department of Charles Nicolle hospital for more than 6 months. The survey took place over 1 month. The 4-item Morisky questionnaire (MMAS-4) was used to assess adherence to therapy. RESULTS: Our patients had a median age of 44.2 years and a sex ratio of 0.47. Asthma was severe in 48% of cases and poorly controlled in 34% of cases. Adherence was poor in 66% of patients. Factors significantly associated with adherence were educationlevel (p=0.02), socio- economic status (p = 0.01), treatment cost (p= 0.02), its availability (p=0.04) and its free cost (p = 0.001), consultation waiting time (p=0.03) and knowledge on asthma (p=0,04). We retained in multivariate analyze two factors determining therapeutic adherence, which are socio-economic status (OR = 2.02 ; [1.2-6.26]) and participation in the therapeutic choice (OR = 1.2 ; 95% CI [2.02-4.25]). CONCLUSIONS: It appears that medication adherence is widely influenced by socio-economic status. So, improving these conditions would guarantee better treatment compliance.

Misdiagnosis asthma in adult, three rare causes.

INTRODUCTION: All that wheezes is not asthma. Although, asthma is the most common cause of wheeze and cough in children and adults, it is often attributed inappropriately to these symptoms from other causes. AIM: We illustrate through this manuscript three rare causes of wheeze in adults, misdiagnosis as asthma. OBSERVATIONS: The three reported cases were misdiagnosed as difficult-to-treat asthma. They were found as mimicking asthma. Final diagnoses were localized tracheobronchial amyloidosis, aortic arch anomalies, and idiopathic chronic eosinophilic pneumonia. CONCLUSION: Although asthma is a common cause of various respiratory symptoms, all that coughs and wheezes is not asthma. So before retaining the severe asthma diagnosis, we have to exclude various differential diagnoses, even the rarest ones. Several diagnostic tests have to be done to have the appropriate diagnosis.

Structured observation summaries : educational interest in the teaching of pulmonology.

BACKGROUND: The structured observation summary (SOS) is a method of active case-based learning, whose diagnosis is known to learners. AIM: To assess the value of SOS in the learning of clinical reasoning in pulmonology among first year students of the second cycle of medical studies. METHODS: This was a descriptive cross-sectional study. Teaching was provided to 3 groups of students in three sessions per group in the staff room of the pneumology department of Charles Nicolle Hospital in Tunis, during the second semester of the 2019/2020 academic year. We compared the scores assigned to a given test before and at the end of the session to assess knowledge acquisition. The students filled out a satisfaction questionnaire at the end of the session. RESULTS: We held 9 tutorial sessions in which 30 learners participated and 78 SOSs were completed. The subjects chosen were respectively tuberculosis, pneumothorax, and fluid pleurisy. After correcting the SOS cards, we saw an improvement in averages and scores during the sessions. Learners found no difficulty in completing the items relating to historical data and physical examination. The section relating to «particularities to report¼ was not completed throughout the sessions. By comparing the scores assigned to the test before and at the end of the session, a statistically significant improvement was noted for the 3 themes with p=0.003, p=0.001, p=0.002, respectively. The response to the satisfaction questionnaire revealed that most students were satisfied with the general learning process (95%). They judged the content of the sessions to be relevant (95%) and felt that this teaching facilitated the process of their clinical reasoning (97%). CONCLUSIONS: The satisfaction recorded by the students regarding this project invites us to extend its scope. However, some changes need to be made to the SOS form.

Comparative study of six SARS-CoV-2 serology assays: Diagnostic performance and antibody dynamics in a cohort of hospitalized patients for moderate to critical COVID-19.

BACKGROUND: To overcome the COVID-19 pandemic, serology assays are needed to identify past and ongoing infections. In this context, we evaluated the diagnostic performance of 6 immunoassays on samples from hospitalized patients for moderate to critical COVID-19. METHODS: 701 serum samples obtained from 443 COVID-19 patients (G1: 356 positive RT-PCR patients and G2: 87 negative RT-PCR cases) and 108 pre-pandemic sera from blood donors were tested with 6 commercial immunoassays: (1) Elecsys Anti-SARS-CoV-2, Roche (Nucleocapsid, N), (2) Elecsys Anti-SARS-CoV-2 S, Roche (Spike, S), (3) Vidas SARS-COV-2 IgM/IgG, BioMérieux (S), (4) SARS-CoV-2 IgG, Abbott (N), (5) Access SARS-CoV-2 IgG, Beckman Coulter (Receptor Binding Domain), and (6) Standard F COVID-19 IgM/IgG Combo FIA, SD Biosensor (N). RESULTS: Global sensitivities of the evaluated assays were as follows: (1) Roche anti-N = 74.5% [69.6-79.3], (2) Roche anti-S = 92.7% [84.7-100], (3) Vidas IgM = 74.9% [68.6-81.2], (4) Vidas IgG = 73.9% [67.6-80.1], (5) Abbott = 78.6% [63.4-93.8], (6) Beckman Coulter = 74.5% [62-86.9], (7) SD Biosensor IgM = 73.1% [61-85.1], and (8) SD Biosensor IgG = 76.9% [65.4-88.4]. Sensitivities increased gradually from week 1 to week 3 as follow: (1) Roche anti-N: 63.3%, 81% and 82.1%; (2) Vidas IgM: 68.2%, 83.2% and 85.9%; and (3) Vidas IgG: 66.7%, 79.1% and 86.6%. All immunoassays showed a specificity of 100%. Seropositivity was significantly associated with a higher frequency of critical COVID-19 (50.8% vs. 38.2%), p = 0.018, OR [95% CI] = 1.668 [1.09-2.553]. Inversely, death occurred more frequently in seronegative patients (28.7% vs. 13.6%), p=3.02 E-4, OR [95% CI] = 0.392 [0.233-0.658]. CONCLUSION: Evaluated serology assays exhibited good sensitivities and excellent specificities. Sensitivities increased gradually after symptoms onset. Even if seropositivity is more frequent in patients with critical COVID-19, it may predict a recovery outcome.

Unusual bone localization of sarcoidosis mimicking metastatic lesions: case report and review of literature.

Sarcoidosis is a multisystem disease of unknown origin. Diagnosis remains challenging, based on organ site involvement, histological confirmation of non-caseating granuloma and an appropriate clinical syndrome. Granulomatous bone involvement is rare and may be ignored because it is usually asymptomatic. Vertebrae, ribs and skull localizations are rarely reported. We described an interesting case of a woman with chronic and multiorgan sarcoidosis with unusual bone localizations.