COPD prevalence in smokers with stable ischemic heart disease: A cross-sectional study in Tunisia.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) and ischemic heart disease (IHD) are common causes of mortality worldwide, with shared risk factors. COPD continues to be largely underdiagnosed and undertreated, especially in patients with IHD. OBJECTIVE: To investigate the prevalence of COPD in smokers with confirmed IHD and to compare IHD characteristics between COPD patients and those without COPD. METHODS: It was a cross-sectional study, conducted between August and December 2017, including patients over 40 years of age, current or former smokers, with stable and confirmed IHD. Spirometry was undertaken for all participants, and COPD was defined according to GOLD criteria. RESULTS: A total of 122 patients, with mean age of 59.3 years and mean pack-year of 52.3, were enrolled. Spirometry was normal in 63.2% of patients and airflow limitation was the most frequent ventilatory disorder (20.5%). COPD was diagnosed in 19.7% of patients. Of the 24 COPD patients, 17 (70.8%) were previously undiagnosed. Airflow limitation severity in COPD patients was classified mild, moderate, severe and very severe in 25%, 62.5%, 8.3% and 4.2% of patients. Comparison between COPD patients and non-COPD patients showed that comorbidities, respiratory symptoms, chest x-ray abnormalities, life-threatening lesions, three vessel disease, pulmonary hypertension and right ventricle dysfunction were significantly more frequent in COPD patients. CONCLUSIONS: There was a high prevalence of COPD among smoking patients with IHD, and most were undiagnosed despite being symptomatic. Smokers with IHD, especially if having respiratory symptoms, radiological or ultrasound abnormalities or life-threatening coronary lesions should be evaluated for airflow limitation.

Complete Atrio-ventricular Block due to Cardiac Metastasis of Lung Adenocarcinoma / Bloqueo auriculoventricular completo debido a metástasis cardíaca de un adenocarcinoma pulmonaries

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Researchers' And Medical Student' Experience in Reference Management Software in a Low-Income Country.

INTRODUCTION: Although the use of Reference Management Software (RMS) is increasing in developed countries, they seem to be unknown and less used in low-income countries. AIM: To discover the major trends in the use of RMS among researchers and Ph.D. students in Tunisia, as a low-income country. METHODS: A hardcopy survey was filled out by researchers and Ph.D. students during an educational seminar at the faculty of medicine of Sfax in 2016 with the aim to collect qualitative data to determine the participants' knowledge and use of RMS. RESULTS: The survey collected 121 participants, among them, 53.7% know RMS. Mendeley proved to be the best-known software (41.5%), followed by Zotero (35.3%) and Endnote (23%). Training sessions in RMS were taken by 5% of participants. Among the 121 participants, 26.5%of them use RMS., Mendeley was the most used (46.9%), followed by EndNote (28.1%) and Zotero (25%). The most commonly popular feature in RMS is inserting citations (66.9%). Therefore, the analysis, of the reasons behind the choice of RMS proves that the software was used because it is convenient (38.4%),  most known (38.4%),  easy (30.7%), or suggested by colleagues (30.7%). The free and open-source software was preferred by 81% of the participants. g. However, 50.4% ignore the fact that Zotero is free. Several types and sources of captured citations were unknown by 53.8% and 59% of the rest of the participants. CONCLUSION: The results clearly show that the lack of awareness about RMS in Tunisia is due to the absence of a formal training. As a result, the need for such training is highly important for researchers to be able to benefit from the different advantages of RMS while conducting their academic medical education.

The relationship between the fraction of exhaled nitric oxide and the level of asthma control.

BACKGROUND: The evaluation of asthma control, based on symptoms and risk factors for exacerbation does not provide information about airway inflammation, reflected by fractional exhaled nitric oxide (FeNO). The impact of FeNO in the evaluation of asthma control has not been well recognized. The purpose of this study was to evaluate the contribution of FeNO measurement in the assessment of asthma control. METHODS: A prospective cross-sectional study was carried out for four months and included 148 adult asthmatics. For each patient, the demographic data, asthma control test (ACT) score, medication adherence, skin prick test positivity, FeNO level, and spirometry results were recorded independently. The correlation between ACT score and FeNO level was analyzed. RESULTS: The mean ACT score was 20.9±3.7 and the mean exhaled FeNO level was 30.4±25.8 ppb. Asthma was controlled in 71.6% of patients. Mean FeNO values were significantly higher in patients with uncontrolled asthma (42.1±30.8 versus 27±19 ppb, p=0.01). A significant negative correlation was observed between FeNO level and ACT score (r=-0.33, 95% confidence interval [CI], -0.51-0.10; p=0.001). FeNO had a high negative predictive value (79.9%) and specificity (63.2%), but a low sensitivity (59.5%) and positive predictive value (39%). The area under the receiver operating characteristic (ROC) curve was of 0.7 (95% confidence interval [CI], 0.53-0.74; p=0.01). CONCLUSIONS: Using just FeNO to evaluate asthma control represents a limited approach because of the low predictive accuracy of FeNO for diagnosing uncontrolled asthma.

Evaluation of an interactive teaching method in the teaching of Pulmonology.

INTRODUCTION: For several years, interactive teaching has proved its effectiveness in learning. At the Faculty of Medicine of Tunis (FMT), the interactive sessions are sessions of clarification, illustration, application, and participation (CIAP). AIM: To evaluate pneumology CIAP session in the acquisition of learning by first-year students of the second cycle of medical studies (SCMS1). METHODS: It was a cross-sectional study carried out at the FMT during the academic year 2016-2017 and included students from SCMS1. CIAP session subject was "The chronic respiratory failure". A pre-test and a post-test, with the same subject, were distributed during the session. Knowledge acquisition was evaluated by comparing the scores assigned to the tests. An evaluation of the students' satisfaction with the session progress was made. RESULTS: Ten students attended the CIAP session. The mean score of the pre-test was 2.1 ± 0.7 over 10 points. A statistically significant (p = 0.003) increase in the score was observed for the post-test, which increased to 4.8 ± 0.2. For the evaluation of the session by the students, the best scores were assigned for the items evaluating the achievement of objectives and the facilitation of the session by the teacher (1.9 points).The lowest score was given for the item evaluating the time required for the session (1 point). CONCLUSION: The interactive teaching method "CIAP" was beneficial in terms of learning, as demonstrated by the statistically significant improvement of the post-test score compared to the pre-test and the satisfaction of the students at the end of the session. Moreover, the involvement of all the stakeholders (students, teachers, and institutions) is necessary for the success of this teaching.

A spiritual sleepiness scale: the Friday prayer.

BACKGROUND: Excessive daytime sleepiness (EDS) affects 5% to 20% of the population and is involved in a large number of traffic accidents. EDS is a major symptom in sleep disorders, especially obstructive sleep apnea syndrome (OSA). The daytime sleepiness is evaluated subjectively using scales and questionnaires based on perception. This study is aimed to build a new questionnaire more suited to our lifestyle and then to compare it to the Epworth sleepiness scales (ESS). METHODS: We administered to 91 adult's patients (76 men and 15 women) consulting for sleep disturbance the ESS and a single subjective question tendency to drowsiness during the Friday prayer. Patients were listed in four groups according to their response to the question «During the past month, have you ever doze or fall asleep during the sermon of the Friday prayer? ¼ By G1 never dozes, G2 low chance of falling asleep, G3 average chance of dozing, G4 high chance of falling asleep. RESULTS: Only 63 patients (58 men and 5 women) responded to both questionnaires. Group 1 included 14 patients with a ESS of 5.5 +/- 1.8, Group 2 included 18 patients with a ESS of 7.3 +/- 1.9, Group 3 included 18 patients with a ESS of 11.05 +/- 2 and Group 4 included 13 patients with a ESS of 14.69 +/- 2.3. The Rho correlation coefficient was high (0.86) and shows a strong correlation between the Results of the two questionnaires. CONCLUSION: the answer to the question " During the past month, have you ever doze or fall asleep during the sermon of the Friday prayer? ¼ seems to be an appropriate Sleepiness Scale among Muslim patients.