Prevalence of depression and anxiety in obstructive sleep apnea.

INTRODUCTION: Organic comorbidities of obstructive sleep apnea (OSA) have been widely studied. However, psychiatric disorders, especially depression and anxiety, have not attracted so much attention. AIM: The primary aim was to determine the prevalence and the predictive factors of depression and anxiety in OSA patients. The secondary aim was to investigate the association between OSA severity and these psychiatric disorders. METHODS: A cross-sectional study including untreated OSA patients without mental illness history was conducted. Patients were administered the Hospital Anxiety (HADS-A) and Depression Scale (HADS-D). Depression and anxiety were diagnosed for HAD-D and HAD-A scores ≥ 8. RESULTS: Eighty patients were included (mean age: 54.83 ± 13.12 yr; female: 52 (65%); mean Body mass index (BMI) :34.7±6.14 kg/m2). The prevalence of depression and anxiety was 35 % and 43.8% of patients respectively. Both depressive and anxious OSA patients had more libido disorder ( p=0.011, p=0.0007 ;respectively), anhedonia (p= 10-4, p= 10-4respectively ) and suicidal ideas(p= 0.002 ,p=0.019 respectively). Moreover, depressed OSA patients had lower socio-economic condition (p= 0.019), more coronary artery diseases (CAD) (p=0.019) and less cognitive disorder (p= 0.005). The HADS-D (r=0,095; p=0,404) and the HADS-A (r=0,212; p=0,059) were not correlated with the Apnea/Hyponea Index. The determinants of depressive and anxious mood were female-sex (p= 0.035, p=0.004 respectively) and libido disorder (p=0.040, p=0.02 respectively). Anhedonia (p=10-4) and CAD (p=0.010) were also identified as a predictive factors of depression. CONCLUSIONS: In our study, the high prevalence of depression and axiety in apneic patients demonstrates the importance of the psychiatric component in the management of this disease. A collaboration between pneumologists and psychiatrists is necessary in order to improve the quality of life of these patients.

Spontaneous hemothorax and neurofibromatosis type 1: How to explain it, how to explore it and how to treat it?

Neurofibromatosis type 1 (NF1), also known as Von Recklinghausen's disease is an autosomal dominant genetic disorder. It is the most common of phacomatoses. Pulmonary complications have been rarely described in the literature. It is generally a benign disease, but has the potential for rare and fatal complications, such as spontaneous hemothorax. We reported two cases of patients with a history of von Recklinghausen's disease. Both of them suffered sudden chest pain. Chest-X ray revealed a hemi-thoracic opacity. Enhanced chest computed tomography showed massive hemothorax, but no evidence of tumors or an obvious bleeding point in the thorax. After we had ensured a stable hemodynamic condition, we performed video-assisted thoracic surgery to remove the hematoma. No evidence of bleeding was noticed in the first patient whereas an active bleeding was observed in the second patient. We could not determine which vessel was responsible of the hemorrhage. Electrocoagulation and clot removal were performed.  Evolution was favorable for both patients. Spontaneous hemothorax is a rare and potentially life threatening NF1's complication. A tumor like neurofibroma or more rarely vascular involvement of large or small caliber arteries may be at hemothorax's origin.

Effect of Continuous Positive Airway Pressure on glycated hemoglobin in patients with type 2 diabetes and Obstructive Sleep Apnea.

INTRODUCTION: Obstructive sleep apnea (OSA) is a risk factor for type 2 diabetes that adversely impacts glycemic control. However, there is little evidence about the effect of continuous positive airway pressure (CPAP) on glycemic control in patients with diabetes. AIM: Assess the effect of CPAP on glycated hemoglobin (HbA1c) levels in patients with type 2 diabetes and OSA. METHODS: it was a prospective study including type 2 diabetic patients with OSA and a CPAP therapy indication. All participants had HbA1c measurement at baseline (T0) and 2 months after the onset of CPAP (T1) with a compliance ≥ 4 hours / night. Patients who changed anti-diabetic treatment during follow-up were excluded. The HbA1c level goal was ≤ 7%. RESULTS: Thirty patients were included (4 men and 26 women) with a mean age of 61.3 ± 8.8 years. The mean diabetes duration was 5.8 ± 3.7 years. Twenty-four patients had poorly controlled diabetes. Associated comorbidities were dominated by hypertension (n=22) and obesity (n=22). The mean apnea hypopnea index was 38.0 ± 12.7/ hour. Two months after the CPAP use, a significant decrease of 1.1 ± 0.8 % in the mean HbA1c level was observed (HbA1c: T0= 8.9 ± 1.5 % vs T1=7.8 ± 1.1 %; p<0.001). This rate was significantly correlated with the body weight (r = 0.51, p = 0.003), the body mass index (r = 0.42, p = 0.02) and the HbA1c level at baseline (r = 0, 76, p <0.001). The only factor associated with glycemic control improvement was an initial HbA1c level > 9% (Odds Ratio = 8.3, p = 0.04). CONCLUSION: CPAP therapy improved diabetes control in type 2 diabetic patients with OSA, in particular in those with an initial HbA1c> 9%.

Tracheobronchopathia osteochondroplastica : a rare cause of hemoptysis.

Tracheobronchopathia osteochondroplastica (TO) is a rare and benign pathological condition of the upper pulmonary tract of unknown cause. Often diagnosed after 50 years of age, it is more common in men. Clinical manifestations are variable and unspecific. Endoscopic findings are the main argument for the diagnosis. We report the case of a 41 year-old woman with TO, presenting a chronic cough and recurrent hemoptysis.

Granzyme B induced by Rv0140 antigen discriminates latently infected from active tuberculosis individuals.

Nearly two billion people are latently infected with Mtb (LTBI). Detection of LTBI with high risk to develop active tuberculosis (aTB) is considered the cornerstone to control the disease. The current challenge is to identify markers that better classify LTBI versus aTB. It has been previously shown that Rv0140, a reactivation-associated antigen of Mtb, induces significantly higher IFN-γ production in LTBI individuals as compared to aTB patients. Herein, we show that Rv0140 induces high granzyme B level by PBMCs derived from LTBI (n = 34) as compared to aTB (n = 18). Receiving operator characteristic (ROC) curves were used to evaluate the capacity of Rv0140 to discriminate between LTBI and aTB by measuring IFN-γ and granzyme B secretion. Our results show that, in response to Rv0140, granzyme B seems to allow better discrimination of LTBI from aTB with areas under the curve (AUC) of 0.88 (95% CI 0.79-0.98) as compared to IFN-γ with AUC of 0.85 (95% CI 0.74-0.96) even though CI overlap. Intracellular staining (ICS) experiments and the use of anti-MHC I antibody showed that granzyme B is mainly produced by CD8+ T cells in response to Rv0140. Thus, we propose granzyme B as a host marker to help identify LTBI individuals.

Cold abscess in the immunocompetent subject.

INTRODUCTION: Tuberculous cold abscesses are a rare and unusual form, accounting for 1% of extrapulmonary tuberculosis (TB). AIM: To describe clinical, diagnostic, therapeutic and prognostic aspects of cold tuberculous abscesses. METHODS: Retrospective multicentre study of 26 patients followed for cold abscesses tuberculous in respiratory departments of AbderrahmenMami hospital between 2009 and 2017. RESULTS: We included 24 patients. Mean age was 36.9 years. Six patients had a personal history of pulmonary TB. Circumstances of the discovery were chronic pain (n = 15), parietal swelling (n = 7) and parietal fistulization (n = 2). The mean duration of the symptoms was 2.8 months. Fever was absent in 15 patients. The cold abscess was multifocal in 3 patients, associated with pleuropulmonary TB in 16 patients and extrapulmonary TB in 9 patients. Thoracic wall was the most frequent localization (n=13), followed by subcutaneous and intramuscular localization (n = 6). The surgical flattening of the abscess with biopsy of the edges was performed in 15 patients. The positive diagnosis was pathological in 15 patients and bacteriological in 12 patients. GeneXpert was positive in 2 patients. All patients received anti-tuberculosis treatment. The mean duration of TB was 10.7 months. Evolution was marked by the cure of 20 patients and tuberculous relapse in 1 patient after 6 months. CONCLUSION: Tuberculous cold abscess should be evoked in front of any chronique collection occurring especially in a context of risk factors of TB. Early diagnosis is the best guarantee of a cure without complications.

The utility of bronchoalveolar lavage in the evaluation of interstitial lung diseases: A clinicopathological perspective.

Bronchoalveolar lavage (BAL) is a noninvasive and well-tolerated procedure that is performed with a fiberoptic bronchoscope in the wedged position within a selected bronchopulmonary segment. After it was introduced to clinical practice, BAL rapidly gained acceptance in a large number of centers as a procedure that could be applied to the clinical evaluation of patients with various pulmonary disorders, especially the group of interstitial lung diseases (ILD). Cytological and flow cytometric analysis of BAL fluid in ILD is done with knowledge of the clinical presentation and radiological findings. BAL typically reveals variations in the types and numbers of nucleated immune cells and acellular components in patients with ILD, which differ from those seen in normal control subjects. Many clinicians currently use this technique as a guide in the differential diagnoses of ILD; it can also be used to monitor the course of disease and possible response to therapeutic interventions. This article summarizes current clinicopathological information concerning the use of BAL by pulmonologists and pathologists.

Spontaneous Right Hemothorax in the Elderly.

Rupture of thoracic aortic aneurysm is a life threatening condition. Rupture in the right pleural cavity is extremely rare. We report the case of an 80-year-old man with a spontaneous right hemothorax. Diagnosis was made by computed tomography (CT) scan. He was managed with chest tube and stabilization. The patient died before any surgical intervention. We report this case to emphasize that rupture of aortic aneurysm should be considered in the evaluation of spontaneous hemothorax even if it is right-sided particularly in the elderly. Emergent therapy is necessary to prevent mortality.

Metabolic and cardiorespiratory response in swimmers during head-out immersion: a prospective study.

BACKGROUND: Sport represents a stress for the body. Many metabolic and cardiorespiratory changes are known during physical activity.However, litte is known in swimmers particularly during head-out immersion. AIM: To determine the metabolic and cardiorespiratory response in swimmers during head-out immersion. METHODS: The energetic, cardiovascular function and ventilatory requirements of a 10 min steady state arm exercise performed by 13 healthy subjects in air and during immersion up to the hip in 26°C water were compared. RESULTS: The same ergometric work load was achieved with an average maximum oxygen uptake of 3.9 ± 2.63 l/min in air versus 3.55 ± 2.48 l/min in water (p=0.953). During exercise, the average values of minute ventilation, ventilation equivalent for oxygen, ventilation equivalent for CO2, peak expiratory flow, respiratory exchange ratio and heart rate were not different in water and in air. However, first ventilatory threshold was significantly higher in water than in air. The mean value of the first ventilatory threshold was 0.89 ± 0.23 l/min in air, and 1.08 ± 0.23 l/min in water immersion; (p=0.016). CONCLUSION: These results suggest that training swimmers favoring immersion (weight belts) may improve their aerobic capacity.

The syndrome of combined pulmonary fibrosis and emphysema.

A syndrome associating an upper-lobe emphysema and pulmonary fibrosis of the lower lung was recently characterized. Few cases were identified in the literature. We report a case of a 68 year- old smoker man presented for exacerbation of a severe dyspnea. Physical examination revealed basal crackles and finger clubbing. Blood gas analysis showed hypoxemia. Chest radiography showed features compatible with emphysema of the upper lobes and fibrosis of the basis. Chest computed tomography confirmed chest radiography's findings and revealed fibrosis. The diagnosis of idiopathic pulmonary fibrosis was made. Pulmonary function tests showed obstructive pattern. Systolic pulmonary arterial pressure was elevated up to 87 mm Hg on heart ultrasonography. The authors emphasize the importance of the diagnosis of this entity made through chest computed tomography and the fact that it is characterized by severe impairment of gas exchange, the high prevalence of pulmonary hypertension and poor survival.

[Asthma control status in Tunisia]. / Etat de contrôle de l'asthme en Tunisie.

AIM: Transversal study during hospital allergology visit which aim is to evaluate asthma control levels in Tunisia. METHODS: Questionnaire issue of global initiative for asthma (GINA) guidelines. RESULTS: 400 asthmatics were included (70% of women and 30% men), aged 32 +/- 11 years old. Asthma was intermittent in 43% of patients, mild persistant (27%), moderate (14%) and severe in 16% of patients. Daytime symptoms were observed in 56% of cases, nocturnal symptoms in 40%, exacerbations in 39% of cases, activities limitation in 44% of cases and need of rescue treatment in 56%. Controller medications were used in 63% of patients. Inhaled Glucocorticosteroids were used in 90% of patients with persistent asthma. Subjective self evaluation of asthma showed that 83% of patients felled better with treatment, whereas, asthma objective control was obtained only in 10% of them. For the rest, asthma was partly controlled in 35% of patients and uncontrolled in 55%. College and professional absenteeism was observed in 60% of cases, with a mean of 1 to 5 days per month. Control factors seem to be young age, non smoker status and mild persistent asthma. CONCLUSION: Although GINA 2006 guidelines and treatment progress, an important rate of asthmatics (90%) continue to present symptoms, underuse their treatment and overestimate control level of their disease.