Prevalence of comorbid asthma in Tunisian patients with COVID-19: clinical features and outcomes

INTRODUCTION

The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has resulted in around 1 million COVID-19 infection cases and over 29,000 deaths in Tunisia thus far. There is great variability in the prevalence of asthma among patients with COVID-19, but the impact of asthma on patients with COVID-19 is not clear. We sought to describe the clinical features of Tunisian patients with COVID-19 and to compare asthmatic and non-asthmatic patients.

METHODOLOGY

This retrospective study included 675 Tunisian patients who were hospitalized with COVID-19. Clinical characteristics were collected from medical records. Bivariate analyses and multivariate regression models were used to assess the associations between asthma and the risk of severe symptoms, including death/recovery.

RESULTS

The prevalence of asthma in the sample was 14.5%. The results show that asthmatic patients with COVID-19 have significantly less severe symptoms and better outcomes than non-asthmatic patients.

CONCLUSIONS

Asthma was not found to be associated with higher severity or worse prognosis among patients with COVID-19 in Tunisia.

Sleep habits and quality among war and conflict-affected Palestinian adults in the Gaza strip

OBJECTIVES/BACKGROUND

Sleep may be affected by traumatic experiences leading to an increased risk of poor quality of life and daily functioning. However, studies related to sleep habits and problems in conflict-affected areas are still sparse. The present study attended to describe sleep habits, estimate the prevalence rate of sleep disturbances, and identify associated factors in the Gaza strip.

PATIENTS/METHODS

A population-based cross-sectional study including 1458 Palestinian adults aged ≥18 years living in the Gaza strip was carried out during the period between 18 February and March 31, 2022. An electronic survey through the free-of-charge Google Forms tool was used for data collection. A range of self-report measures related to sleep, mood, and subjective quality of life were used: the Pittsburgh Sleep Quality Index (PSQI), the World Health Organisation-Five Well-Being Index (WHO-5), the Epworth Sleepiness Scale (ESS), and the Patient Health Questionnaire (PHQ)-9.

RESULTS

Three out of five of participants (n = 882, 60.5%) were females and the mean age was 34.8 ± 12.77 years. More than one-third of participants (n = 556, 38.1%) had poor well-being as assessed by the WHO-5 and 108 (7.4%) had a PHQ-9 score ≥ 20 indicating severe depression. The prevalence of poor sleep quality was 52.8% when defined as PSQI ≥ 6 and 30.5% when defined as PSQI ≥ 8. The prevalence of excessive daytime sleepiness (EDS), short sleep duration, severe depression, and poor well-being were 43.6%, 26.4%, 7.1%, and 38.1% respectively. Women and the youngest participants reached the highest prevalence rates for sleep and mood disturbance as well as for daytime dysfunction. Using multivariate binary logistic regression analysis, severe depression, being divorced, a history of psychological disease, poor well-being and previous war injuries were identified as the strongest predictors of poor sleep quality.

CONCLUSION

Poor sleep quality, EDS, severe depression, and poor well-being in our sample were strikingly increased. Females and the youngest participants were the most affected. The conflict-affected situation in the Gaza strip combined with the high population density and worsening socio-economic conditions may play an important role in sleep disturbances, mainly because of a high prevalence of mood disturbances. Sleep and mood disturbances also adversely affect the quality of life.

Sulodexide Significantly Improves Endothelial Dysfunction and Alleviates Chest Pain and Palpitations in Patients With Long-COVID-19: Insights From TUN-EndCOV Study

Objective

Non-respiratory long-coronavirus disease 2019 (COVID-19) symptoms are mainly related to a long-lasting endothelial dysfunction and microcirculation impairment. We hypothesized that Sulodexide, a purified glycosaminoglycan mixture with a beneficial endothelial effect in arterial and venous peripheral diseases, may be effective in a subset of patients with long COVID-19.

Approach and Results

We conducted a multicenter prospective quasi-experimental study. A total of 290 patients from the TUN-EndCOV study with long-COVID-19 symptoms and endothelial dysfunction were included. The endothelial function was clinically assessed using a post-occlusive reactive hyperemia protocol with finger thermal monitoring device. Endothelial quality index (EQI) was assessed at inclusion and at 21 days later. The study population was assigned to a sulodexide group (144 patients) or a no-medical treatment group (146 patients). Clinical characteristics were similar at inclusion in the two groups. Fatigue, shortness of breath, and chest pain were the most common symptoms, respectively, 54.5, 53.8, and 28.3%. At 21 days, the sulodexide group improved significantly better than the no-medical treatment group in chest pain (83.7 vs. 43.6%, p < 10⁻³), palpitations (85.2 vs. 52.9%, p = 0.009), and endothelial function [median delta-EQI 0.66 (0.6) vs. 0.18 (0.3); p < 10⁻³]. Endothelial function improvement was significantly correlated with chest pain and palpitations recovery (AUC, i.e., area under the curve = 0.66, CI [0.57– 0.75], p = 0.001 and AUC = 0.60, CI [0.51– 0.69], p = 0.03, respectively).

Conclusion

Sulodexide significantly improves long-lasting post-COVID-19 endothelial dysfunction and alleviates chest pain and palpitations.

Primary thoracic synovial sarcomas: A case report

Primary pulmonary synovial sarcoma (SS) is a rare neoplasm. Its clinicoradiologic attributes are not yet well defined. We report the observation of a patient followed for primary pulmonary synovial sarcoma. We report the radio‐clinical features of this rare tumor.

Sulodexide in the treatment of patients with long COVID 19 symptoms and endothelial dysfunction: The results of TUN-EndCOV study

Background

Endothelial dysfunction is probably one of the mechanisms of long COVID-19 symptoms. Sulodexide has pleiotropic properties within the vascular endothelium that can prove beneficial in the long COVID-19 symptoms.

Purpose

We aimed to evaluate the effect of sulodexide when used in patients with endothelial dysfunction and long COVID-19 symptoms.

Methods

We conducted a prospective multicenter longitudinal case-control study. Endothelial function was evaluated with DTM “E4-Diagnose” Polymath based on the Endothelium Quality Index (EQI). A group of patients with endothelial dysfunction (EQI < 2.0) received sulodexide. All the patients were followed-up 21 days after inclusion. Primary outcomes were defined as endothelial function amelioration (delta EQI) and long COVID-19 symptoms evolution during the follow-up.

Results

A total of 410 patients were included in this study. Patients were included at an average time of 1.89 ± 1.2 month after COVID-19 infection. At inclusion, 210 (51.2%) patients had an EQI < 2. The median age was 49 ± 13.8 (18–80) years. Among the patients with endothelial dysfunction, only 79 patients received sulodexide. Patients in sulodexide group had lower EQI than the non-medical intervention group (0.94 ± 0.6 vs. 1.52 ± 0.4; P < 10⁻³). They were more diabetic, hypertensive, had more coronary artery disease and received more long-term medications (aspirin, Bblockers and statins) than the others (P = 0.01, 0.002, 0.01, 0.009, 0.001 and 0.01, respectively). At the 21-days follow-up, patients in sulodexide group presented lower long COVID symptoms especially chest pain, palpitations, fatigue and neuro-cognitive difficulties associated to a significant amelioration of endothelial function (delta EQI 1.26 ± 1.07 vs. 0.22 ± 0.7; P < 10⁻³).

Conclusion

Sulodexide in patients with long COVID-19 may be a good intervention to ameliorate chest pain, palpitations, fatigue and neuro-cognitive difficulties associated to endothelial dysfunction.

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.

Endothelial dysfunction is the key of long COVID-19 symptoms: The results of TUN-EndCOV study

Background

The COVID-19 disease is a multisystem disease due to in part to the vascular endothelium injury. Lasting effects and long-term sequalae could persist after the infection and may be due to persistent endothelial dysfunction.

Purpose

Our study focused on the study of endothelial function measurement by digital thermal monitoring (DTM) of endothelial quality index with E4 diagnosis Polymath in a large cohort of long COVID-19 patients to determine whether long COVID-19 symptoms are due to endothelial dysfunction.

Methods

This is a prospective multicenter longitudinal observational cohort study. Endothelial function was evaluated with “E4-Diagnose” Polymath Tunisia based on the Endothelium Quality Index (EQI). A complete echocardiographic evaluation analysis was performed. Primary outcomes were defined as the occurrence of long COVID-19 symptoms in patients with endothelial dysfunction measured by EQI.

Results

A total of 798 patients were included in this study. Patients were included at an average time of 68.93 ± 43.1 days. The mean EQI was 2.02 ± 0.99 [0–5]. A total of 397 (49.7%) patients had poor or very poor EQI and 211 (26.4%) patients had very poor EQI. The median age was 49.94 ± 14.2 (18–80) years. A total of 618 patients (77.4%) had long COVID-19 symptoms. Patients with long COVID-19 symptoms had a reduced EQI (1.99 ± 0.97 vs. 2.09 ± 1.05, P = 0.24). Among long COVID-19 symptoms, fatigue was the most common symptom reported in 42.2%. Fatigue and chest pain were significantly associated to the endothelial dysfunction (P = 0.04 and 0.001 respectively). Patients with chest pain had significantly lower EQI (1.74 ± 1.0 vs. 2.09 ± 0.9, P ≤ 10⁻³) and LVGLS (−16.35 ± 3.0 vs. −17.16 ± 2.5, P = 0.04).

Conclusion

Long COVID-19 symptoms specifically chest pain and fatigue are due to persistent poor endothelial quality index. These findings allow a better care of patients with long COVID-19 symptoms.

Intérêt pronostique à cours et à long terme du scanner thoracique chez les patients atteints de COVID-19

Introduction

Le scanner thoracique a une place importante dans le diagnostic positif et l’évaluation de l’étendue des lésions pulmonaires chez les patients ayant une infection respiratoire au SARS-COV2. L’objectif est d’évaluer les facteurs pronostiques et évolutives à l’imagerie thoracique à l’admission et après 3 mois chez les patients COVID-19.

Méthodes

Il s’agit d’une étude rétrospective réalisée entre octobre 2020 et juillet 2021 au service de pneumologie – Covid19 à l’hôpital Hedi-Chaker de Sfax incluant des patients atteints de COVID-19 confirmé par PCR et ayant bénéficié d’un scanner thoracique à l’admission. La quantification des lésions pulmonaires, a été réalisée de manière visuelle par un radiologue pour permettre de classer les patients selon le degré de l’atteinte : scanner normal, atteinte minime ou modérée (1–25 %), importante (26–50 %), sévère (51–75 %) ou critique (> 75 %).

Résultats

Quatre-cent vingt-trois patients ont été inclus dans l’étude. L’âge moyen était de 64 ± 16 ans. Quarante-cinq pour cent des patients étaient de sexe masculin. L’atteinte scannographique a été minime ou modérée (18,6 %), importante (35,2 %), sévère (31,2 %) et critique (13,7 %). La majorité des patients avait des lésions en verre dépoli (92,1%) et des lésions de condensations (14,8 %). Au total, 28 % des patients ont présenté une forme sévère de COVID-19. L’extension des lésions au scanner était corrélée au risque de mortalité (p < 0,01). Il n’y avait pas de différence en termes d’âge ou de comorbidités selon le degré d’atteinte au scanner. Les patients ayant une atteinte > 50 % avaient un ratio PNN/lymphocytes significativement plus élevée que ceux avec des lésions ≤ 25 % (p -0,05). Soixante-quinze patients ont consulté après 3 mois d’infection SARS-COV2. Un scanner thoracique a été réalisé chez 50 % d’entre eux. Des séquelles à l’imagerie thoracique ont été notées dans 40 % des cas à type de des lésions de verre dépoli (25 %), de condensations (9 %) et de distorsions bronchiques (66 %). L’extension des lésions au scanner initial était corrélée à la présence des séquelles à l’imagerie thoracique de contrôle (p -0,02). Aucune corrélation n’a été notée entre l’âge, les comorbidités et la présence de séquelles.

Conclusion

Le scanner thoracique est un bon outil pronostique à court terme par l’évaluation de l’atteinte pulmonaire qui semble corrélée à une forme sévère, et à long terme par la recherche de séquelles en post Covid-19.

Long COVID 19 Syndrome: Is It Related to Microcirculation and Endothelial Dysfunction? Insights From TUN-EndCOV Study

The COVID-19 disease is a multisystem disease due in part to the vascular endothelium injury. Lasting effects and long-term sequelae could persist after the infection and may be due to persistent endothelial dysfunction. Our study focused on the evaluation of endothelial quality index (EQI) by finger thermal monitoring with E4 diagnosis Polymath in a large cohort of long COVID-19 patients to determine whether long-covid 19 symptoms are associated with endothelial dysfunction. This is a cross-sectional multicenter observational study with prospective recruitment of patients. A total of 798 patients were included in this study. A total of 618 patients (77.4%) had long COVID-19 symptoms. The mean EQI was 2.02 ± 0.99 IC_95% [1.95-2.08]. A total of 397 (49.7%) patients had impaired EQI. Fatigue, chest pain, and neuro-cognitive difficulties were significantly associated with endothelium dysfunction with an EQI <2 after adjustment for age, sex, diabetes, hypertension, dyslipidemia, coronary heart disease, and the severity of acute COVID-19 infection. In multivariate analysis, endothelial dysfunction (EQI <2), female gender, and severe clinical status at acute COVID-19 infection with a need for oxygen supplementation were independent risk factors of long COVID-19 syndrome. Long COVID-19 symptoms, specifically non-respiratory symptoms, are due to persistent endothelial dysfunction. These findings allow for better care of patients with long COVID-19 symptoms.

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.

[Management of malignant vulvar tumors]

BACKGROUND

Vulva anatomy--FIGO classification--Vulva tumors anatomopathology--Tretments of vulva cancers.

METHODS

Our stady is a retrospective, longitudinal and continuous one. It concerns 11 malignant vulva tumors whith were treated in the département "C" of the centre of maternity of Tunis. The period of stady is fifty four months (2002-2006).

AIM

The aim of our study is to analyse the charactéristics of the vulva cancer and to compare our results to littérature.

RESULTS

Mean age of our patients is 67 years old. They are all menaused. The principal signs are vulva tuméfaction in 72.7% of the cases, vulva prurit in 27.3% of the cases and genital bleeding in 27.3% of the cases. The mean period of consultation is of 14 months. We have ten cases of vulvar epidermoid carcinoma and one melanoma. The treatment was surgical in the eleven cases (10 total vulvectomy and one hemivulvectomy) They all benefited of an inguinal bilateral curage. The adjuvant radiotérapie was indicated in 3 cases. A patient was classed stage Ib of FIGO, 7 stage II, one stage III and one stage IVa. Nine patients are in remission, 3 are dead: 2 because of their cancer and one due to a pulmonar embolism. The survival of 6 month is 72.2%.

CONCLUSION

The prevention of this cancer passes by the close follow of dystrophic states and viral pathologies of the vulva.

Répercussions maternelles et néonatales de l'anesthésie générale par rémifentanil pour césarienne programmée

OBJECTIVE

Opioids are routinely omitted at the induction of general anesthesia for Caesarean delivery because of the risks of respiratory neonatal depression. The short-acting opioid remifentanil may afford advantages at the induction and surgical stimulation, without subsequent neonatal depression.

PATIENTS AND METHODS

In this double-blinded study, 40 at term women undergoing elective Caesarean section and requiring general anaesthesia were allocated randomly to receive either remifentanil (0,5 microg/kg) at the induction of anaesthesia (G1, n=20) or placebo (G2, n=20). Induction of anaesthesia was performed with propofol 2 mg/kg and succinylcholine 1 mg/kg. Anaesthesia was maintained with nitrous oxide in oxygen (50/50%, v/v), propofol (100 microg/kg/min), remifentanil (0.2 microg/kg/min) and atracurium. Neonates were assessed by using Apgar scores, possible respiratory depression, with or without ventilation in the mask or intubation and umbilical cord blood gas (artery: UA and vein: UV). Values are expressed as mean values +/-SD. Pearson's Chi squared and t-test were used for statistical analysis P<0.05 was considered significant.

RESULTS

Maternal systolic pressure, mean pressure and heart rate were significantly higher in G1 at induction. Apgar scores, heart and respiratory rate were similar between groups. Seven episodes of respiratory depressions were noted (3 in G1, 4 in G2). Five neonates required only brief assisted ventilation by face-mask (2 in G1, 3 in G2).

CONCLUSION

Remifentanil (0.5 microg/kg) at the induction of anaesthesia in elective Caesarean section under general anaesthesia can be used without subsequent neonatal depression. However, we believe that further research is necessary to extrapolate these results to a pregnancy carrying an acutely distressed foetus.

[Post-traumatic tension pneumothorax and pneumopericardium in spontaneous ventilation]

The occurrence of tension pneumopericardium in patient in spontaneous ventilation after blunt trauma is rare. The diagnosis is difficult and it may remain unrecognized. The authors reported the case of a 50 year-old trauma patient with a tension pneumothorax associated with a pneumopericardium. The patient was not mechanically ventilated at any time. Pericardial relief was obtained by insertion of a chest tube.