Characteristics of Obese Patients with Acute Hypercapnia Respiratory Failure Admitted in the Department of Pneumology: An Observational Study of a North African Population.

BACKGROUND: Acute hypercapnic respiratory failure (AHRF) is a common life-threatening event in patients with obesity hypoventilation syndrome (OHS). OBJECTIVES: To study the clinical pattern, noninvasive ventilatory support, as well as the short- and long-term outcomes of patients with OHS admitted in a ward because of AHRF. METHODS: We conducted a retrospective cohort study including all adults with OHS aged ≥ 18 - year - old, admitted in a 90-bed-ward for AHRF. RESULTS: A total of 44 patients were included. Fifteen (34.1%) and 29 (65.9%) patients were diagnosed with malignant OHS (mOHS) and nonmalignant OHS (non-mOHS), respectively, while 36 (81.8%) had coexisting obstructive sleep apnea hypopnea syndrome (OSAHS). Patients with mOHS had a significantly higher rate of heart failure (100% vs. 31%; p < 0.001), chronic renal insufficiency (CRI) (73.3% vs. 41.4%; p = 0.04), and dyslipidemia (66.7% vs. 34.5%; p = 0.04) than those with non-mOHS. The mean forced vital capacity (FVC) in our patients was of 59.5% ± 18.5 of the predicted value, lower than what is usually reported in stable patients with OHS. At hospital admission, more than two-thirds (n = 34, 77.3%) were misdiagnosed as having asthma exacerbation (n = 4, 4.9.1%), chronic obstructive pulmonary disease (COPD) exacerbation (n = 12, 27.3%) and/or heart failure (n = 29, 65.9%). Acute pulmonary oedema (ACPE) (n = 16, 36.4%) and acute viral bronchitis (n = 12, 27.3%) were the main identified causal factors, while no cause could be determined in 5 (11.4%) patients. Noninvasive positive pressure ventilation (NIPPV) using bilevel positive airway pressure (BIPAP) was very highly effective to treat AHRF, with only 2.27% of patients failing the modality. Median overall duration of ventilation was 9 hours per day (1.3-20) and was significantly longer in patients with mOHS than in those with non-mOHS (10 [6-18] vs. 8 [1.3-20], respectively; p = 0.01). Forty two of the forty-three patients discharged alive were treated with BIPAP or continuous positive airway pressure (CPAP) in 26 and 16 patients, respectively. The probability of survival was 90% at 12 months, while the probability of readmission for a new episode of AHRF was 56% at 6 months and 22% at 12 months, respectively. CONCLUSION: AHRF in OHS patients is a life-threatening event which can be successfully and safely treated with BIPAP, with a low long-term mortality even in patients with mOHS.

Secondary pleural hydatidosis: Complication of intrapulmonary echinococcosis.

Hydatid disease has a wide geographic distribution around the world. In human, the liver is the most commonly affected organ, followed by the lungs. Intrathoracic extrapulmonary locations are generally the mediastinum, pleura, pericardium and chest wall. Pleural involvement usually follows the rupture of a pulmonary or hepatic cyst inside the pleural space causing secondary pleural hydatidosis. We report four cases of patients who were referred to our hospital for management of pleural hydatid disease as a complication of intrapulmonary echinococcosis.

[Thoracic involvement revealing lymphomas: report on 17 cases]. / Manifestations thoraciques revelatrices de lymphomes: a propos de 17 cas.

BACKGROUND: Thoracic manifestations of lymphomas are frequents and various. They are frequently described in secondary than as a primary manifestation. AIM: This work aims to analyze the clinical, radiological, and prognostic characteristics of initial thoracic features of lymphomas. The authors stress the diagnosis and therapeutic difficulties which they encountered. METHODS: We report a retrospective work of initial thoracic involvement of lymphomas and their radiologic features observed in 17 patients hospitalized in pneumology service of Sfax. RESULTS: There were 10 cases of non Hodgkin's lymphoma and 7 cases of Hodgkin disease. For the patients with non Hodgkin's lymphoma, the mediastinal involvement was present in 8 cases. The parenchymal involvement was noted among 2 patients such as nodules or masses, with concomitant mediastinal lymph nodes. The pleural effusion such as pleurisy or solid mass was seen in 3 cases. Pericardial and parietal involvements were noted in one case. For the patients with Hodgkin's disease, the mediastinal lymph nodes were seen among 6 patients. The parenchymal involvement was noted in one case. One case of primary thymic lymphoma involvement and one case of tracheal involvement were noted. No case of pleural effusion was deplored. CONCLUSION: Initial thoracic involvements, rarely described, cause a variety of features which are often nonspecific. The diagnosis, often difficult, has beneficiated, from imaging and endoscopy's progress. However, treatment should be optimized in order to improve the prognosis which is also reserved particularly in non Hodgkin lymphoma.

Colistin as a salvage therapy for nosocomial infections caused by multidrug-resistant bacteria in the ICU.

The objective of this study was to determine the efficacy of systemic colistin therapy in the treatment of nosocomial infections caused by multidrug-resistant Acinetobacter baumannii or Pseudomonas aeruginosa and to study related adverse events. We prospectively studied 78 infections caused by multidrug-resistant A. baumannii or P. aeruginosa that were treated with colistin. The sites of infection were pulmonary infection (78.2%), urinary tract infection (7.7%), primary bloodstream infection (11.5%) and meningitis (2.6%). The mean daily dose of colistin was 5.5+/-1.1 MU/day (range 2-9 MU/day) and the mean duration of colistin therapy was 9.3+/-3.8 days (range 5-21 days). A favourable clinical response to colistin occurred in 60 cases (76.9%). Renal failure occurred in only seven cases. We conclude that colistin can be a safe and effective salvage therapeutic option for nosocomial infections caused by multidrug-resistant A. baumannii or P. aeruginosa.