L’embolie pulmonaire aiguë au cours des infections COVID-19

Introduction

Le COVID-19 est associé à un état d’hypercoagulabilité responsable de complications thromboemboliques. L’embolie pulmonaire fait partie de ces complications qu’on doit s’y intéresser. Le but de notre travail est de décrire les particularités de l’embolie pulmonaire (EP) au cours de l’infection COVID-19.

Méthodes

Nous avons mené une étude rétrospective et descriptive colligeant les patients COVID-19 hospitalisés au service de pneumologie de Sfax entre janvier et mai 2021. Nous avons dégagé les caractéristiques cliniques, radiologiques et évolutives des patients qui ont développé une embolie pulmonaire confirmée par un angio-scanner thoracique.

Résultats

Nous avons inclus 874 patients dont 11 (5 femmes et 6 hommes) ont développé une embolie pulmonaire, ce qui fait une incidence de 1,25 %. La moyenne des âges est de 59,36 ans. Neuf patients avaient au moins une comorbidité (5 patients diabétiques, 2 hypertendus, 1 avec insuffisance coronarienne et 1 patient avec un cancer évolutif). Il n’y a avait aucun patient avec un antécédent d’un accident thromboembolique. Le délai entre le diagnostic du COVID et l’embolie pulmonaire était de 11,55 ± 9,36 jours. Quatre patients ont reçu une anticoagulation préventive avant la survenue de l’EP. La dyspnée aiguë était le signe clinique le plus fréquent (85,7 %), une insuffisance respiratoire aiguë était notée dans 57,14 % des cas. Les anomalies électriques étaient notées chez 5 patients à type de tachycardie sinusale pour 4 patients et un bloc de branche droit pour un patient. Le risque de mortalité évalué par le score de PESI simplifié était faible chez 4 patients et intermédiaire chez 7 patients. L’embolie pulmonaire était proximale dans 7 cas, unique chez 4 patients (57,14 %) et multiple chez 7 patients (42,85 %). Un traitement par l’anti-vitamine K était prescrit chez 10 patients. Un seul patient était traité par les anticoagulants oraux directs. L’évolution était favorable pour 9 patients. Deux patients ont nécessité le transfert en réanimation. On n’a noté aucun cas de décès.

Conclusion

L’embolie pulmonaire est une complication non rare des infections au COVID-19. Le clinicien doit veiller à suspecter cette complication et la traiter à temps.

Effet de la musicothérapie chez les patients hospitalisés pour une infection au COVID-19

Introduction

Les effets psychologiques du coronavirus doivent être pris en compte, en particulier chez les patients qui nécessitent des soins intensifs et qui pourraient constituer un groupe à haut risque pour le développement de troubles psychiatriques. Ces symptômes psychiatriques sont probablement sous-évalués et insuffisamment traités. Dans la littérature [1], 47 % des patients présentaient un niveau élevé d’anxiété. Les objectifs de notre étude étaient d’identifier les niveaux de base de l’anxiété et de démontrer les effets psychiques positifs de la musicothérapie chez les patients hospitalisés et atteints d’une infection au COVID-19.

Méthodes

Nous avons réalisé une étude prospective contrôlée sur 38 patients hospitalisés pour une infection modérée à sévère au COVID-19. Les patients ont été répartis entre un groupe recevant une musicothérapie (MT) (n = 19) et un groupe témoin (n = 19). Les patients du groupe MT ont bénéficié d’une séance de 20 minutes de musique jouée en direct par un médecin qui est également un violoniste formé au conservatoire, deux fois par semaine, durant la période d’hospitalisation. L’évaluation de l’anxiété par le score HAD a été faite au début et à la fin de l’étude pour chaque patient.

Résultats

L’âge moyen des patients du groupe MT était de 63 ans et celui du groupe témoin de 58 ans (Tableau 1). Nous n’avons pas trouvé de différence significative entre les deux groupes concernant l’étendue des lésions pulmonaires à la TDM thoracique, le débit d’oxygène nécessaire et la fréquence de l’anxiété (Tableau 1). Dans le groupe MT, le score HAD des patients au début de l’étude, était normal (<7) dans 8 cas et limite (7–10) dans 6 cas. L’anxiété était certaine (>11) dans 5 cas (26 % des patients). A la fin de l’étude, un seul patient était anxieux et 15 patients avaient un niveau normal. Dans le groupe témoin, une anxiété certaine était trouvée au début et à la fin de l’étude chez respectivement 7 et 5 patients. Une différence statistiquement significative entre les deux groupes était notée concernant la réduction du niveau de l’anxiété.

Conclusion

Nous suggérons fortement que la musicothérapie a un effet positif sur l’anxiété chez les patients hospitalisés pour une pneumopathie COVID.

[Lung abscess: Diagnosis and management]

Lung abscesses are necrotic cavitary lesions of the lung parenchyma. They are usually caused by anaerobic bacteria or mixed flora and typically occur after aspiration. Primary lung abscesses occur in previously healthy patients with no underlying medical disorders and are usually solitary. Secondary lung abscesses occur in patients with underlying or predisposing conditions and may be multiple. The initial diagnosis is usually made by chest radiography showing a lung cavity with an air-fluid level. Typically, the cavity wall is thick and irregular, and a surrounding pulmonary infiltrate is often present. The differential diagnosis of pulmonary cavitation is wide, including different types of possible infections, neoplasia and malformations of the bronchial tree. Management is usually based on prolonged antibiotic treatment. Failure of conservative management, manifested by the persistence of sepsis and/or other abscess complications, may necessitate drainage with invasive techniques (percutaneous, endoscopic or surgical) or open surgical removal of the lung lesion in patients with good performance status and sufficient respiratory reserve.

Burnout in Medical Residents: Prevalence and Risk Factors

Background

Burnout is a state of mental and physical exhaustion related to work. It is manifested in a variety of professions and is prevalent in contexts in which health professionals are required to interact directly with the public.

Objectives

To estimate the burnout syndrome (BOS) prevalence and to identify its associated factors among medical residents.

Methods

A descriptive and analytic study conducted during a period from 2012 until 2014, including 184 residents exerting at the two university hospitals of Sfax, Tunisia. Data collection was conducted using an anonymous self-questionnaire, including demographic items and working conditions items. Maslach Burn-out Inventory (MBI) was used to assess BOS.

Results

The average age was 25.14 ± 1.47 years. The sex-ratio was 0.65. The majority (154 residents) was single. Over than half (58.2%) of medical residents endure a high emotional exhaustion, 62.5% a high depersonalisation and 12.5% a low personal accomplishment. About eighty percent (79.3%) of them were in burn out with 37% at intermediate and 11.3% at a severe degree. No statistical association was found between the personal characteristics and BOS. Whereas, several factors related to employment status were correlated with the presence of BOS such us: number of working hours > 30 h/week, a number of free weekends < 2/month and a number of days off ≤ 30 days/year. In addition, we found that psychotropic and alcohol consumption were significantly associated to BOS with respectively P = 0.050 and P = 0.002.

Conclusion

Burnout is a worrying reality among young doctors. Individual as well as organizational interventions should be targeted to prevention.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Essential Oils' Chemical Characterization and Investigation of Some Biological Activities: A Critical Review

This review covers literature data summarizing, on one hand, the chemistry of essential oils and, on the other hand, their most important activities. Essential oils, which are complex mixtures of volatile compounds particularly abundant in aromatic plants, are mainly composed of terpenes biogenerated by the mevalonate pathway. These volatile molecules include monoterpenes (hydrocarbon and oxygenated monoterpens), and also sesquiterpenes (hydrocarbon and oxygenated sesquiterpens). Furthermore, they contain phenolic compounds, which are derived via the shikimate pathway. Thanks to their chemical composition, essential oils possess numerous biological activities (antioxidant, anti-inflammatory, antimicrobial, etc…) of great interest in food and cosmetic industries, as well as in the human health field.

Aqueous Extracts from Tunisian Diplotaxis: Phenol Content, Antioxidant and Anti-Acetylcholinesterase Activities, and Impact of Exposure to Simulated Gastrointestinal Fluids

Antioxidants have been considered essential for preventing cell damage by scavenging deleterious free radicals. The consumption of antioxidant-rich plants is associated with a reduced risk of some chronic diseases. This study evaluates the antioxidant and acetylcholinesterase inhibition activities of aqueous extracts obtained from different parts of Diplotaxis simplex and Diplotaxis harra from Tunisia. The study also aimed to investigate the action of simulated gastrointestinal juice on antioxidant activities of both extracts. The total phenolic, flavone and flavonol, and flavanone and dihydroflavonol contents were determined by Folin-Ciocalteau, aluminum chloride and 2,4-dinitrophenylhydrazine colorimetric methods, respectively. The metal ion chelating activity, acetylcholinesterase inhibition capacity, and free radical scavenging potential of the extracts towards ABTS (2,2'-azinobis-(3-ethylbenzothiazoline-6-sulfonic acid), DPPH (2,2-diphenyl-1-picrylhydrazyl), hydroxyl, superoxide and nitric oxide were also evaluated. The action of simulated gastro-intestinal fluids on the flavone and flavonol content and total antioxidant activity of the flower extracts was surveyed. Extracts from the seeds and flowers of D. simplex and D. harra displayed the highest amounts of phenols (2691.7 and 2694.5 mg Caffeic Acid Equivalent (CAE)/100 mg; 3433.4 and 2647.2 mg CAE/100 mg, respectively) and flavonols/flavones (2144.4 and 2061.1 mg Rutin Equivalent (RE)/100 g; 1922.6 and 1461.1 mg RE/100 g, respectively). The flower and seed extracts exhibited the highest rates of antioxidant and acetylcholinesterase inhibition activities. A decrease in the flavonoid content and antioxidant activity was observed after extract exposure to simulated saliva. Antioxidant and acetylcholinesterase inhibition activities were noted to depend on plant species and plant parts. In vitro gastrointestinal digestion is useful in assessing the bio-accessibility of compounds with biological activities from food. The simulated gastrointestinal fluids influenced the flavonoid concentration and antioxidant activity.

[The syndrome of increased upper airways resistance: What are the clinical features and diagnostic procedures?]

The upper airway resistance syndrome "UARS" is a poorly defined entity, often described as a moderate variant of the obstructive sleep apnea syndrome. It is associated with respiratory effort-related arousal, absence of obstructive sleep apnea, and absence of significant desaturation. It is a relatively common condition that predominantly affects non-obese young adults, with no predominance in either sex. The degree of upper airway collapsibility during sleep of patients with UARS is intermediate between that of normal subjects and that of patients with mild-to-moderate sleep apnea syndrome. Craniofacial and palatal abnormalities are often noted. Patients frequently complain of a functional somatic syndrome, especially daytime sleepiness and chronic fatigue. Polysomnography with esophageal pressure measurements remains the gold standard diagnostic test. The absence of any neurological abnormality gives UARS a good prognosis and it is potentially reversible if treated early. However, some studies suggest that untreated UARS has an increased risk of arterial hypertension. It can also evolve into obstructive sleep apnea.

[Determinants of quality of life in chronic obstructive pulmonary disease]

INTRODUCTION

Chronic obstructive pulmonary disease (COPD) is considered as a systemic disease with pulmonary starting point. The use of spirometry alone is certainly not the best way to reflect the impact of disease on quality of life for patients.

PATIENTS AND METHODS

Prospective study concerning 70 patients treated for COPD. Quality of life was assessed using the French version of the Saint-George questionnaire.

RESULTS

Our population was predominantly male (97%) with a mean age of 63 years. All patients were smokers with an average of 46 pack-years. The total score of the Saint-Georges respiratory questionnaire was 50.7%. The mean scores of different fields were 68% for the field activities, 49% for impact and 26% for the item of symptoms. The multidimensional BODE index was correlated with the quality of life and its various fields were more powerfully than the forced expiratory volume per second, the number of exacerbations, the six-minute walking test and dyspnea score.

CONCLUSION

It is important to integrate the multidimensional classification indices in assessing the severity of the disease because only these indices can reflect the systemic aspect of the disease.

[Flexible bronchoscopy as it is lived by the patient]

INTRODUCTION

Flexible bronchoscopy is an indispensable complementary exam in respiratory medicine for both diagnosis of many pulmonary diseases and their treatment. Only a few studies in literature have been conducted to evaluate the safety and acceptability of this act.

PATIENTS AND METHODS

Prospective, mono-center, non-comparative study involving 120 patients who underwent a flexible bronchoscopy for diagnostic.

RESULTS

During the study, flexible bronchoscopy has caused neither deaths nor major complications. However, minor incidents have been deplored: hemoptysis (13.3%), epistaxis (3.3%), desaturation less than 90% (4.2%), laryngospasm (3.3%) and vagal discomfort (1.7%). 56.7% of patients were anxious before the exam and 24% of patients preferred to have general anesthesia. The patients reported cough in 78.3% of cases, difficulty in breathing in 55% of cases and pain in 13.3% of cases. The occurrence of nausea, noted in 15.8% of cases, was correlated with the pathway of the bronchoscope (P=0.002). At the end of the endoscopy, 67.5% of patients agreed to repeat the examination, if necessary, under the same conditions.

CONCLUSION

The results of our study confirm that many complications during a flexible bronchoscopy are rare and generally mild failing in life-threatening. However, the occurrence of discomfort (cough, pain, vomiting, dyspnea) or incidents (asphyxia, vagal discomfort, laryngeal spasm) are likely to alter patient comfort during the exam.

[Intra-alveolar hemorrhage: rare presentation of fat pulmonary embolism]

INTRODUCTION

Fat embolism syndrome is a severe complication of long bone fractures, corresponding to the obstruction of small vessels by microdroplets of fat, originating from medulla ossium. Pulmonary involvement, present in 90% cases, makes the severity of the disease.

CASE REPORT

We report the case of a 22-year-old man who presented, two days after industrial accident causing an opened tibial fracture, acute dyspnea with hemoptysis. Angio-CT-scan didn't show any proximal vascular obstruction, but parenchymal sections showed diffuse, bilateral and multifocal hyperdensities predominating at the periphery. Broncho-alveolar lavage brought a hemorrhagic liquid, with a high macrophage content and lipid inclusions in macrophages. Exams for the etiologic diagnosis of intra-alveolar hemorrhage were negative: renal function, 24-hour proteinuria, antinuclear antibodies, antineutrophil cytoplasmic antibodies. The diagnosis of intra-alveolar hemorrhage secondary to fat embolism was established. The outcome was spontaneously favorable.

CONCLUSION

The occurrence of intra-alveolar hemorrhage in the course fat embolism is rarely reported. Its pathogenic mechanisms are not understood. It is mandatory to eliminate the other causes of alveolar hemorrhage before holding the diagnosis of fat embolism. Treatment is only symptomatic, based on respiratory reanimation.