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Mahjoub L, Youssef R, Yaakoubi H, Salah HB, Jaballah R, Mejri M, Sekma A, Trabelsi I, Nouira S, Khrouf M, Soltane HB, Mezgar Z, Boukadida L, Zorgati A, Boukef R. Melatonin, vitamins and minerals supplements for the treatment of Covid-19 and Covid-like illness: A prospective, randomized, double-blind multicenter study. Explore (NY) 2024; 20:95-100. [PMID: 37419768 PMCID: PMC10281695 DOI: 10.1016/j.explore.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/09/2023] [Accepted: 06/19/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Melatonin, zinc, and multivitamins are among most recommended supplements in the fight against coronavirus disease 2019 (COVID-19). We aimed to examine the efficacy and safety of this association in the treatment of COVID-19 and COVID-like illnesses. METHODS We conducted a multicenter prospective, randomized, double-blind, controlled trial. Patients with no medical history consulting the emergency department for covid and covid-like illness and who were not hospitalized were included. Patients were assigned in a 1:1 ratio to the treatment or the placebo group. The primary outcome was studying the effectiveness of zinc multivitamin supplement and melatonin in the treatment of COVID and -like illnesses symptoms' according to the time from randomization to clinical improvement. The pre-specified secondary outcomes were date of disappearance of symptoms present on admission, appearance of an adverse effect due to the administration of the treatment, number of patients developing complications, requiring hospitalization, requiring respiratory support. RESULTS One hundred sixty four patients were eligible for the study and were randomized to either the treatment group or the placebo group. Overall, 128 of the 164 patients had a PCR for SARS-CoV-2, yielding a positive PCR result in 49.1% of them. Regarding the disappearance of all initial presenting symptoms: on the 5th day of the follow-up, there was a significant difference between the two groups with a p value 0.04;On the 10th day, there was a significant difference too with p value of 0.038. There were no significant differences between the two groups in recovery during the 15th day of follow-up p>0.5. Finally, 100% of patients fully recovered in the treatment group vs 98.8% in the placebo group. No severe adverse events were reported throughout the trial. CONCLUSIONS Our results showed that daily doses of Melatonin, zinc and vitamins did significantly reduce the duration of symptoms accelerating its disappearance among patients consulting with COVID-19 or COVID-19 like illness.
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Affiliation(s)
- Lobna Mahjoub
- Emergency Department, Sahloul University Hospital, 4011 Sousse, Tunisia
| | - Rym Youssef
- Emergency Department, Sahloul University Hospital, 4011 Sousse, Tunisia
| | - Hajer Yaakoubi
- Emergency Department, Sahloul University Hospital, 4011 Sousse, Tunisia
| | - Houda Ben Salah
- Emergency Department, Sahloul University Hospital, 4011 Sousse, Tunisia
| | - Rahma Jaballah
- Emergency Department, Sahloul University Hospital, 4011 Sousse, Tunisia.
| | - Moez Mejri
- Emergency Department, Sahloul University Hospital, 4011 Sousse, Tunisia
| | - Adel Sekma
- Research Laboratory LR12SP18, Monastir University, 5019 Tunisia
| | - Imen Trabelsi
- Research Laboratory LR12SP18, Monastir University, 5019 Tunisia
| | - Semir Nouira
- Research Laboratory LR12SP18, Monastir University, 5019 Tunisia
| | - Mariem Khrouf
- Emergency department, Farhat Hached University Hospital, 4031 Sousse, Tunisia
| | - Houda Ben Soltane
- Emergency department, Farhat Hached University Hospital, 4031 Sousse, Tunisia
| | - Zied Mezgar
- Emergency department, Farhat Hached University Hospital, 4031 Sousse, Tunisia
| | - Lotfi Boukadida
- Emergency Department, Sahloul University Hospital, 4011 Sousse, Tunisia
| | - Asma Zorgati
- Emergency Department, Sahloul University Hospital, 4011 Sousse, Tunisia
| | - Riadh Boukef
- Emergency Department, Sahloul University Hospital, 4011 Sousse, Tunisia
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Nizar D, Amine MSM, Aissi M, Machraoui R, Adel S, Khaoula BHA, Blel S, Younes S, Boukef R, Henteti F, Nouira S, Hamdi B, Frih M. External validations of the ABCD2 score in prediction of stroke risk after transient ischemic attack. A Tunisian hospital-based cohort study. Int J Neurosci 2023; 133:1218-1223. [PMID: 33059508 DOI: 10.1080/00207454.2020.1835897] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 09/18/2020] [Accepted: 09/24/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND PURPOSE Identification of patients with high risk of stroke after transient ischemic attack (TIA) could be helpful to optimize stroke prevention. We aimed to externally validate the ABCD2 score for the prediction of stroke after TIA in a Tunisian population. METHODS We conducted a retrospective observational study of consecutive patients admitted for TIA in four university hospitals in Tunisia. Patients were screened for onset of stroke. Sensitivity, specificity, positive and negative predictive values with areas under the receiver operating characteristic (ROC) curves were calculated for risk of stroke at 2, 7, 30 and 90 days after the index event. RESULTS Of 415 patients screened in this study, the total cumulative subsequent stroke rates after TIA at 2, 7, 30 and 90 days were respectively, 4.8%, 10.6%, 13.5% and 20.2%. Using a cut-off value of 4, the ABCD2 showed an overall good sensitivity (95%, 97.7%, 96.4% and 97.6% respectively at 2, 7, 30 and 90 days). Areas under ROC cure of the ABCD2 score in patients with TIA for stroke onset at 2, 7, 30 and 90 days were respectively 0.67 (95% CI, 0.55-0.79), 0.79 (95% CI, 0.71-0.85), 0.79 (95% CI, 0.72-0.85), and 0.76 (95% CI, 0.70-0.81). CONCLUSION Our findings suggest that the ABCD2 score could be used in our population to discriminate patient with TIA at low and high risk of developing recurrent stroke.
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Affiliation(s)
- Daoussi Nizar
- Department of Neurology, University Hospital of Monastir, Monastir, Tunisia
| | - MSolli M Amine
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
- Emergency Department, University Hospital of Monastir, Monastir, Tunisia
| | - Mouna Aissi
- Department of Neurology, University Hospital of Monastir, Monastir, Tunisia
| | - Rafik Machraoui
- Department of Endocrinology and Internal Medicine, Tahar Sfar Hospital of Mahdia, Mahdia, Tunisia
| | - Sekma Adel
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
- Emergency Department, University Hospital of Monastir, Monastir, Tunisia
| | - Bel Haj Ali Khaoula
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
- Emergency Department, University Hospital of Monastir, Monastir, Tunisia
| | - Semir Blel
- Neurology Department, Mongi Ben Hmida National Institute of Neurology, Tunis, Tunisia
| | - Samia Younes
- Department of Endocrinology and Internal Medicine, Tahar Sfar Hospital of Mahdia, Mahdia, Tunisia
| | - Riadh Boukef
- Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Fayçal Henteti
- Neurology Department, Mongi Ben Hmida National Institute of Neurology, Tunis, Tunisia
| | - Semir Nouira
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
- Emergency Department, University Hospital of Monastir, Monastir, Tunisia
| | - Boubaker Hamdi
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
- Emergency Department, University Hospital of Monastir, Monastir, Tunisia
| | - Mahbouba Frih
- Department of Neurology, University Hospital of Monastir, Monastir, Tunisia
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Kouraichi C, Sekma A, Bel Haj Ali K, Chamtouri I, Sassi S, Toumia M, Yaakoubi H, Youssef R, Msolli MA, Beltaief K, Mezgar Z, Khrouf M, Bouida W, Dridi Z, Boukef R, Boubaker H, Grissa MH, Nouira S. Value of inferior vena cava collapsibility index as marker of heart failure in chronic obstructive pulmonary disease exacerbation. BMC Cardiovasc Disord 2023; 23:579. [PMID: 37996792 PMCID: PMC10668419 DOI: 10.1186/s12872-023-03585-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 10/27/2023] [Indexed: 11/25/2023] Open
Abstract
INTRODUCTION Inferior vena cava (IVC) diameter variability with respiration measured by ultrasound was found to be useful for the diagnosis of heart failure (HF) in ED patients with acute dyspnea. Its value in identifying HF in acute exacerbation of chronic obstructive pulmonary disease exacerbation (AECOPD) was not specifically demonstrated. OBJECTIVE To determine the value of ΔIVC in the diagnosis of HF patients with AECOPD. METHODS This is a prospective study conducted in the ED of three Tunisian university hospitals including patients with AECOPD. During this period, 401 patients met the inclusion criteria. The final diagnosis of HF is based on the opinion of two emergency experts after consulting the data from clinical examination, cardiac echocardiography, and BNP level. The ΔIVC was calculated by two experienced emergency physicians who were blinded from the patient's clinical and laboratory data. A cut off of 15% was used to define the presence (< 15%) or absence of HF (≥ 15%). Left ventricular ejection fraction (LVEF) was also measured. The area under the ROC curve, sensitivity, specificity, and positive and negative predictive values were calculated to determine the diagnostic and predictive accuracy of the ΔIVC in predicting HF. RESULTS The study population included 401 patients with AECOPD, mean age 67.2 years with male (68.9%) predominance. HF was diagnosed in 165 (41.1%) patients (HF group) and in 236 patients (58.9%) HF was excluded (non HF group). The assessment of the performance of the ΔIVC in the diagnosis of HF showed a sensitivity of 37.4% and a specificity of 89.7% using the threshold of 15%. The positive predictive value was 70.9% and the negative predictive value was 66.7%. The area under the ROC curve was 0.71(95%, CI 0.65-0.76). ΔIVC values were not different between HF patients with reduced LVEF and those with preserved LVEF. CONCLUSION Our results showed that ΔIVC has a good value for ruling out HF in ED patients consulting for AECOPD.
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Affiliation(s)
- Cyrine Kouraichi
- Research Laboratory LR12SP18, Monastir University, 5000, Monastir, Tunisia
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia
| | - Adel Sekma
- Research Laboratory LR12SP18, Monastir University, 5000, Monastir, Tunisia
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia
| | - Khaoula Bel Haj Ali
- Research Laboratory LR12SP18, Monastir University, 5000, Monastir, Tunisia
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia
| | - Ikram Chamtouri
- Cardiology Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia
| | - Sarra Sassi
- Research Laboratory LR12SP18, Monastir University, 5000, Monastir, Tunisia
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia
| | - Marwa Toumia
- Research Laboratory LR12SP18, Monastir University, 5000, Monastir, Tunisia
- Emergency Department, Regional Hospital Ksar Helal, Monastir, Tunisia
| | - Hajer Yaakoubi
- Emergency Department, Sahloul University Hospital, 4011, Sousse, Tunisia
| | - Rym Youssef
- Emergency Department, Sahloul University Hospital, 4011, Sousse, Tunisia
| | - Mohamed Amine Msolli
- Research Laboratory LR12SP18, Monastir University, 5000, Monastir, Tunisia
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia
| | - Kaouthar Beltaief
- Research Laboratory LR12SP18, Monastir University, 5000, Monastir, Tunisia
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia
| | - Zied Mezgar
- Emergency Department, Farhat Hached University Hospital, 4031, Sousse, Tunisia
| | - Mariem Khrouf
- Emergency Department, Farhat Hached University Hospital, 4031, Sousse, Tunisia
| | - Wahid Bouida
- Research Laboratory LR12SP18, Monastir University, 5000, Monastir, Tunisia
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia
| | - Zohra Dridi
- Emergency Department, Farhat Hached University Hospital, 4031, Sousse, Tunisia
| | - Riadh Boukef
- Research Laboratory LR12SP18, Monastir University, 5000, Monastir, Tunisia
- Emergency Department, Sahloul University Hospital, 4011, Sousse, Tunisia
| | - Hamdi Boubaker
- Research Laboratory LR12SP18, Monastir University, 5000, Monastir, Tunisia
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia
| | - Mohamed Habib Grissa
- Research Laboratory LR12SP18, Monastir University, 5000, Monastir, Tunisia
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia
| | - Semir Nouira
- Research Laboratory LR12SP18, Monastir University, 5000, Monastir, Tunisia.
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.
- Emergency Department and Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.
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Grissa MH, Dhaoui R, Bel Haj Ali K, Sekma A, Toumia M, Sassi S, Sakly AK, Zorgati A, Bouraoui H, Ben Soltane H, Mezgar Z, Boukef R, Boubaker H, Bouida W, Beltaief K, Nouira S. Comparison of simulation and video-based training for acute asthma. BMC Med Educ 2023; 23:873. [PMID: 37974223 PMCID: PMC10655321 DOI: 10.1186/s12909-023-04836-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Emergency medicine is particularly well suited to simulation training. However, evidence for the efficacy of simulation-based medical training remains limited especially to manage high-risk cases such as acute asthma. OBJECTIVE The objective of our study was to compare the performance of high-fidelity simulation (HFS) and interactive video-case challenge-based training (IVC) for final-year medical students in the management of acute asthma. METHODS This was a prospective randomized controlled study conducted at the emergency department (ED) of Monastir University hospital ( Tunisia). 69 final-year medical students were randomized to HFS (n = 34) and IVC (n = 35) training on acute asthma topic. The study was conducted over a 1-week period. Efficacy of each teaching method was compared through the use of multiple-choice questionnaires (MCQ) before (pre-test), after (post-test) training and a simulation scenario test conducted 1 week later. The scenario was based on acute asthma management graded on predefined critical actions using two scores: the checklist clinical score (range 0 to 30), and the team skills score (range 0 to 16). Student satisfaction was also evaluated with the Likert 5 points scale. Two years after the post-test, both groups underwent a third MCQ testing to assess sustainability of knowledge. RESULTS There were no differences in age between groups. There was no statistically significant difference between the HFS and IVC groups pre-test scores (p = 0.07). Both groups demonstrated improvement in MCQ post-test from baseline after training session; the HFS MCQ post-test score increased significantly more than the IVC score (p < 0.001). The HFS group performed better than the IVC group on the acute asthma simulation scenario (p < 0.001). Mean checklist clinical score and mean team skills score were significantly higher in HFS group compared to IVC group (respectively 22.9 ± 4.8 and 11.5 ± 2.5 in HFS group vs 19.1 ± 3 and 8.4 ± 3.1 in IVC group) (p < 0.001). After 2 years, MCQ post-test scores decreased in both groups but the decrease was lower in HFS group compared to the IVC group. CONCLUSION High-fidelity simulation-based training was superior to interactive video-case challenge for teaching final year medical students,and led to more long-term knowledge retention in the management of simulated acute asthma patients. TRIAL REGISTRATION The study was registered at www. CLINICALTRIALS gov NCT02776358 on 18/05/2016.
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Affiliation(s)
- Mohamed Habib Grissa
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
| | - Randa Dhaoui
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
- Research Laboratory LR12SP18, University of Monastir, Monastir, 5000, Tunisia
| | - Khaoula Bel Haj Ali
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
- Research Laboratory LR12SP18, University of Monastir, Monastir, 5000, Tunisia
| | - Adel Sekma
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
- Research Laboratory LR12SP18, University of Monastir, Monastir, 5000, Tunisia
| | - Maroua Toumia
- Emergency Department, Haj Ali Soua Regional Hospital of Ksar Hellal, Ksar Hellal, 5070, Tunisia
| | - Sarra Sassi
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
- Research Laboratory LR12SP18, University of Monastir, Monastir, 5000, Tunisia
| | - Abdel Karim Sakly
- Orthopedic Department, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
| | - Asma Zorgati
- Emergency Department, Sahloul University Hospital, Sousse, 4000, Tunisia
| | - Hajer Bouraoui
- Pharmacology Department Faculty of Medicine, University of Monastir, Monastir, 5000, Tunisia
| | - Houda Ben Soltane
- Emergency Department, Farhat Hached University Hospital, Sousse, 4000, Tunisia
| | - Zied Mezgar
- Emergency Department, Farhat Hached University Hospital, Sousse, 4000, Tunisia
| | - Riadh Boukef
- Research Laboratory LR12SP18, University of Monastir, Monastir, 5000, Tunisia
- Emergency Department, Sahloul University Hospital, Sousse, 4000, Tunisia
| | - Hamdi Boubaker
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
- Research Laboratory LR12SP18, University of Monastir, Monastir, 5000, Tunisia
| | - Wahid Bouida
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
- Research Laboratory LR12SP18, University of Monastir, Monastir, 5000, Tunisia
| | - Kaouthar Beltaief
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia
- Research Laboratory LR12SP18, University of Monastir, Monastir, 5000, Tunisia
| | - Semir Nouira
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia.
- Research Laboratory LR12SP18, University of Monastir, Monastir, 5000, Tunisia.
- Emergency Department and Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia.
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5
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Romdhane K, Sekma A, Sassi S, Yaakoubi H, Youssef R, Msolli MA, Beltaief K, Grissa MH, Boubaker H, Ben Soltane H, Mezgar Z, Boukef R, Bouida W, Belghith A, Bel Haj Ali K, Zorgati A, Nouira S. Mobile Phone-Based Telemonitoring for Improving Adherence to Analgesic Treatment in Trauma Patients After Emergency Department Discharge: A Randomized Controlled Trial. Clin J Pain 2023; 39:546-550. [PMID: 37440334 DOI: 10.1097/ajp.0000000000001145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/22/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVE To determine the impact of mobile-phone telemonitoring on patients' adherence and satisfaction with posttrauma pain treatment. MATERIALS AND METHODS We conducted a prospective randomized clinical trial including patients with minor trauma discharged from the emergency department (ED) with analgesic treatment. Patients were randomized to one of 3 groups, the control group, where patients received a phone call on day-7, the short message service (SMS) group, where patients received a daily text message to remind them to take their treatment during 7 days, and the mobile-phone based telemonitoring (TLM) group. Patients' adherence to analgesic treatments using the Morisky Medication Adherence Scale, current pain by using a visual analogue scale, and patients' satisfaction were assessed. For the TLM group, the assessment was performed at day-2, 4 and 7. RESULTS Good adherence was observed in 418 patients (92.9%) in the TLM group versus 398 patients (88.6%) in the SMS group and 380 patients (84.8%) in the control group ( P <0.001). The factor mostly associated with adherence was telemonitoring (OR 2.40 95% CI 1.55-3.71). The decrease in pain visual analogue scale was highest in the TLM group compared with SMS and control groups ( P <0.001). The percentage of patients' satisfaction at 7 days post-ED discharge was 93% in the TLM group versus 88% in the SMS group and 84% in the standard group ( P =0.02). DISCUSSION Our findings suggest that mobile-phone-based telemonitoring is beneficial in the treatment of pain in trauma patients after ED discharge. This approach improved patients' adherence and satisfaction.
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Affiliation(s)
| | - Adel Sekma
- Emergency Department and Laboratory Research (LR12SP18)
| | - Sarra Sassi
- Emergency Department and Laboratory Research (LR12SP18)
| | | | - Rym Youssef
- Emergency Department, Sahloul University Hospital
| | | | | | | | | | - Houda Ben Soltane
- Emergency Department, Farhat Hached University Hospital, 4031 Sousse, Tunisia
| | - Zied Mezgar
- Emergency Department, Farhat Hached University Hospital, 4031 Sousse, Tunisia
| | - Riadh Boukef
- Emergency Department, Sahloul University Hospital
| | - Wahid Bouida
- Emergency Department and Laboratory Research (LR12SP18)
| | - Asma Belghith
- Department of Preventive Medicine, Fattouma Bourguiba University Hospital, Monastir
| | | | - Asma Zorgati
- Emergency Department, Sahloul University Hospital
| | - Semir Nouira
- Emergency Department and Laboratory Research (LR12SP18)
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Daldoul O, Bel Haj Ali K, Sekma A, Sassi S, Kouraichi C, Boubaker H, Zorgati A, Boukef R, Nouira S. Reply to Gowthaman and Vasoo. Clin Infect Dis 2023; 77:667. [PMID: 37216379 DOI: 10.1093/cid/ciad302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 05/17/2023] [Indexed: 05/24/2023] Open
Affiliation(s)
- Oussema Daldoul
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Khaoula Bel Haj Ali
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Adel Sekma
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Sarra Sassi
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Cyrine Kouraichi
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Hamdi Boubaker
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Asma Zorgati
- Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Riadh Boukef
- Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Semir Nouira
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
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7
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Haj Ali KB, Sekma A, Trabelsi I, Belguith A, Razgallah R, Nouira S. Reply to Swindells et al. Clin Infect Dis 2023; 77:662-663. [PMID: 37073629 DOI: 10.1093/cid/ciad228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/30/2023] [Accepted: 04/12/2023] [Indexed: 04/20/2023] Open
Affiliation(s)
- Khaoula Bel Haj Ali
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Adel Sekma
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Imen Trabelsi
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Asma Belguith
- Laboratory of Microbiology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | | | - Semir Nouira
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
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8
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Bel Haj Ali K, Sekma A, Mhalla Y, Zorgati A, Nouira S. Reply to Mori et al. Clin Infect Dis 2023; 76:2211-2212. [PMID: 36929831 DOI: 10.1093/cid/ciad154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023] Open
Affiliation(s)
- Khaoula Bel Haj Ali
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Adel Sekma
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Yosra Mhalla
- Laboratory of Microbiology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Asma Zorgati
- Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Semir Nouira
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
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9
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Bel Haj Ali K, Sekma A, Mhalla Y, Nouira S. Reply to Hemilä and Chalker. Clin Infect Dis 2023; 76:1866. [PMID: 36785531 DOI: 10.1093/cid/ciad080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/08/2023] [Indexed: 02/15/2023] Open
Affiliation(s)
- Khaoula Bel Haj Ali
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Adel Sekma
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Yosra Mhalla
- Laboratory of Microbiology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Semir Nouira
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
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Bel Haj Ali K, Sekma A, Chamtouri I, Beltaief K, Msolli MA, Mezgar Z, Bouida W, Boukef R, Boubaker H, Grissa MH, Nouira S. Pulse amplitude ratio under noninvasive ventilation as a new method in the diagnosis of left heart failure in patients with acute exacerbation of chronic obstructive pulmonary disease. BMC Cardiovasc Disord 2023; 23:105. [PMID: 36829108 PMCID: PMC9951466 DOI: 10.1186/s12872-023-03089-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 01/24/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Left heart failure (LHF) is commonly associated with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) but its role is often underestimated. AIM OF STUDY To evaluate the performance of a new diagnostic technique based on the measurement of the pulse amplitude ratio (PAR) using non-invasive ventilation (NIV) for the early identification LHF in patients admitted to the emergency department (ED) for AECOPD. RESULTS 73 patients were included in this study: 32 in LHF group and 41 in non LHF- group. The two groups had comparable demographic and clinical characteristics at admission. The mean values of PARNIV was significantly higher among LHF patients (0.86 vs. 0.71; p < 0.01). The area under the receiver operating characteristic curve of PARNIV was 0.75. Using the best cut-off (0.6), the sensitivity of PARNIV was 93% with a specificity 21%, a positive predictive value of 48%, and a negative predictive value of 81%. Correlation between PARNIV and BNP was significant (r = 0.52; p = 0.002). CONCLUSION Measurement of PARNIV in patients presenting to the ED with AECOPD had a good diagnostic performance for the detection of LHF and could represent an interesting alternative for the currently available methods. Trial registration The study was registered in the Clinical Trial Registration System (clinicaltrials.gov) under the study number NCT05189119, https://register. CLINICALTRIALS gov/prs/app/action/SelectProtocol?sid=S000BOO4&selectaction=Edit&uid=U0000QAM&ts=2&cx=qrmluh .
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Affiliation(s)
- Khaoula Bel Haj Ali
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Adel Sekma
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Ikram Chamtouri
- Cardiology Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia
| | - Kaouthar Beltaief
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Mohamed Amine Msolli
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Zied Mezgar
- Emergency Department, Farhat Hached University Hospital, 4031, Sousse, Tunisia
| | - Wahid Bouida
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Riadh Boukef
- Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia.,Emergency Department, Sahloul University Hospital, 4011, Sousse, Tunisia
| | - Hamdi Boubaker
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Mohamed Habib Grissa
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Semir Nouira
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia. .,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia.
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Hasni Y, Nouira S, Elfekih H, Allegue S, Maaroufi A, Kacem M, Chaieb M, Ach K. Le passage à l’insuline humaine chez les diabétiques type 2 : serait-t-il le garant d’un meilleur équilibre des chiffres glycémiques ? Annales d'Endocrinologie 2023. [DOI: 10.1016/j.ando.2022.12.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Ben Belgacem W, Ben Fredj S, Ghammem R, Zammit N, Ach T, Hasni Y, Maatouk A, Nouira S, Ouertani M, Guesmi N, Ghannem H. Association entre l’obésité et l’activité physique chez les adolescents scolarisés à Sousse (Tunisie). Annales d'Endocrinologie 2023. [DOI: 10.1016/j.ando.2022.12.400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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13
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Khedher S, Zemni I, Nouira S, Asma B. Impact de l’éducation thérapeutique chez le patient diabétique au cours du mois de ramadan. Annales d'Endocrinologie 2023. [DOI: 10.1016/j.ando.2022.12.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Ben Belgacem W, Ben Fredj S, Ghammem R, Zammit N, Ach T, Hasni Y, Maatouk A, Nouira S, Ouertani M, Guesmi N, Ghannem H. L’effet de certains facteurs sociodémographiques sur l’obésité chez les adolescents. Annales d'Endocrinologie 2023. [DOI: 10.1016/j.ando.2022.12.407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Hasni Y, Nouira S, Elfekih H, Saad G, Maaroufi A, Kacem M, Chaieb M, Ach K. L’association HTA-diabète sucré : quel lien avec les complications dégénératives ? Annales d'Endocrinologie 2023. [DOI: 10.1016/j.ando.2022.12.358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Nouira S, Ben Fredj S, Ghammem R, Zammit N, Ach T, Maatouk A, Ouertani M, Benbelgacem W, Guesmi N, Hasni Y, Ghannem H. Obésité et santé mentale : y’a-t-il un lien ? Annales d'Endocrinologie 2023. [DOI: 10.1016/j.ando.2022.12.398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Nouira S, Ben Fredj S, Ghammem R, Zammit N, Ach T, Maatouk A, Ouertani M, Benbelgacem W, Guesmi N, Hasni Y, Ghannem H. Image du corps et estime de soi chez des adolescents obèses dans le gouvernorat de Sousse, Tunisie. Annales d'Endocrinologie 2023. [DOI: 10.1016/j.ando.2022.12.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Nouira S, Ben Fredj S, Ghammem R, Zammit N, Ach T, Maatouk A, Ouertani M, Benbelgacem W, Guesmi N, Hasni Y, Ghannem H. La prévalence de l’obésité des adolescents dans le gouvernorat de Sousse, Tunisie. Annales d'Endocrinologie 2023. [DOI: 10.1016/j.ando.2022.12.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Ben Belgacem W, Ben Fredj S, Ghammem R, Zammit N, Ach T, Hasni Y, Maatouk A, Nouira S, Ouertani M, Guesmi N, Ghannem H. Relations entre l’activité physique, la dépression et l’anxiété chez les adolescents scolarisés à Sousse (Tunisie). Annales d'Endocrinologie 2023. [DOI: 10.1016/j.ando.2022.12.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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Ben Abdallah S, Mhalla Y, Trabelsi I, Sekma A, Youssef R, Bel Haj Ali K, Ben Soltane H, Yacoubi H, Msolli MA, Stambouli N, Beltaief K, Grissa MH, Khrouf M, Mezgar Z, Loussaief C, Bouida W, Razgallah R, Hezbri K, Belguith A, Belkacem N, Dridi Z, Boubaker H, Boukef R, Nouira S. Twice-Daily Oral Zinc in the Treatment of Patients With Coronavirus Disease 2019: A Randomized Double-Blind Controlled Trial. Clin Infect Dis 2023; 76:185-191. [PMID: 36367144 DOI: 10.1093/cid/ciac807] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Zinc supplementation has been considered a potential therapy for coronavirus disease 2019 (COVID-19). We aimed to examine zinc efficacy in adult patients with COVID-19 infection. METHODS We conducted a prospective, randomized, double-blind, placebo-controlled multicenter trial. Patients who were tested positive for COVID-19 without end-organ failure were randomized to oral zinc (n = 231) or matching placebo (n = 239) for 15 days. The primary combined outcome was death due to COVID-19 or intensive care unit (ICU) admission ≤30 days after randomization. Secondary outcomes included length of hospital stay for inpatients and duration of COVID-19 symptoms with COVID-19-related hospitalization for outpatients. RESULTS 190 patients (40.4%) were ambulatory and 280 patients (59.6%) were hospitalized. Mortality at 30 days was 6.5% in the zinc group and 9.2% in the placebo group (OR: .68; 95% CI .34-1.35); ICU admission rates were, respectively, 5.2% and 11.3% (OR: .43; 95% CI .21-.87). Combined outcome was lower in the zinc group versus the placebo group (OR: .58; 95% CI .33-.99). Consistent results were observed in prespecified subgroups of patients aged <65 years, those with comorbidity, and those who needed oxygen therapy at baseline. Length of hospital stay was shorter in the zinc group versus the placebo group (difference: 3.5 days; 95% CI 2.76-4.23) in the inpatient group; duration of COVID-19 symptoms decreased with zinc treatment versus placebo in outpatients (difference: 1.9 days; 95% CI .62-2.6). No severe adverse events were observed during the study. CONCLUSIONS Our results showed that, in COVID-19 patients, oral zinc can decrease 30-day death, ICU admission rate and can shorten symptom duration. Clinical Trials Registration. ClinicalTrials.gov, NCT05212480.
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Affiliation(s)
- Saoussen Ben Abdallah
- Medical Intensive Care Unit, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Yosra Mhalla
- Laboratory of Microbiology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Imen Trabelsi
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Adel Sekma
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Rim Youssef
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
- Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Khaoula Bel Haj Ali
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Houda Ben Soltane
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
- Emergency Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Hajer Yacoubi
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
- Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Mohamed Amine Msolli
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Nejla Stambouli
- UR17DN03-Research Unit, Military Defense, Military Hospital of Tunis, Tunis, Tunisia
| | - Kaouthar Beltaief
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Mohamed Habib Grissa
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Meriem Khrouf
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
- Emergency Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Zied Mezgar
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
- Emergency Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Chawki Loussaief
- Department of Infectious Disease, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Wahid Bouida
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | | | | | - Asma Belguith
- Department of Preventive Medicine, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Naouel Belkacem
- Emergency Department, District Hospital Teboulba, Teboulba, Tunisia
| | - Zohra Dridi
- Department of Cardiology, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Hamdi Boubaker
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Riadh Boukef
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
- Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Semir Nouira
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
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Bel Haj Ali K, Sekma A, Messous S, Trabelsi I, Ben Youssef J, Maghraoui H, Razgallah R, walha A, Grissa MH, Beltaief K, Mezgar Z, Coubantini A, Bouida W, Msolli MA, Boukef R, Boubaker H, Nouira S. Appropriateness of antibiotic treatment of acute respiratory tract infections in Tunisian primary care and emergency departments: a multicenter cross-sectional study. BMC Prim Care 2022; 23:295. [PMID: 36418965 PMCID: PMC9682766 DOI: 10.1186/s12875-022-01904-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 07/13/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Little is known about the pattern and appropriateness of antibiotic prescriptions in patients with acute respiratory tract infections (ARTIs). OBJECTIVE Describe the antibiotics used to treat ARTIs in Tunisian primary care offices and emergency departments (EDs), and assess the appropriateness of their use. METHODS It was a prospective multicenter cross-sectional observational clinical study conducted at 63 primary care offices and 6 EDS during a period of 8 months. Appropriateness of antibiotic prescription was evaluated by trained physicians using the medication appropriateness index (MAI). The MAI ratings generated a weighted score of 0 to 18 with higher scores indicating low appropriateness. The study was conducted in accordance with the Declaration of Helsinki and national and institutional standards. The study was approved by the Ethics committee of Monastir Medical Faculty. RESULTS From the 12,880 patients screened we included 9886 patients. The mean age was 47.4, and 55.4% were men. The most frequent diagnosis of ARTI was were acute bronchitis (45.3%), COPD exacerbation (16.3%), tonsillitis (14.6%), rhinopharyngitis (12.2%) and sinusitis (11.5%). The most prescribed classes of antibiotics were penicillins (58.3%), fluoroquinolones (17.6%), and macrolides (16.9%). Antibiotic therapy was inappropriate in 75.5% of patients of whom 65.2% had bronchitis. 65% of patients had one or more antibiotic prescribing inappropriateness criteria as assessed by the MAI. The most frequently rated criteria were with expensiveness (75.8%) and indication (40%). Amoxicillin-clavulanic acid and levofloxacin were the most inappropriately prescribed antibiotics. History of cardiac ischemia ([OR] 3.66; 95% [CI] 2.17-10.26; p < 0.001), asthma ([OR] 3.29, 95% [CI] 1.77-6.13; p < 0.001), diabetes ([OR] 2.09, 95% [CI] 1.54-2.97; p = 0.003), history of COPD ([OR] 1.75, 95% [CI] 1.43-2.15; p < 0.001) and age > 65 years (Odds Ratio [OR] 1.35, 95% confidence interval [CI] 1.16-1.58; p < 0.001) were associated with a higher likelihood of inappropriate prescribing. CONCLUSION Our findings indicate a high inappropriate use of antibiotics in ARTIs treated in in primary care and EDs. This was mostly related to antibiotic prescription in acute bronchitis and overuse of expensive broad spectrum antibiotics. Future interventions to improve antibiotic prescribing in primary care and EDs is needed. TRIAL REGISTRATION the trial is registered at Clinicaltrials.gov registry (NCT04482231).
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Affiliation(s)
- Khaoula Bel Haj Ali
- grid.420157.5Emergency Department, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia ,grid.411838.70000 0004 0593 5040Research Laboratory LR12SP18, Monastir University, 5019 Monastir, Tunisia
| | - Adel Sekma
- grid.420157.5Emergency Department, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia ,grid.411838.70000 0004 0593 5040Research Laboratory LR12SP18, Monastir University, 5019 Monastir, Tunisia
| | - Selma Messous
- grid.411838.70000 0004 0593 5040Research Laboratory LR12SP18, Monastir University, 5019 Monastir, Tunisia
| | - Imen Trabelsi
- grid.411838.70000 0004 0593 5040Research Laboratory LR12SP18, Monastir University, 5019 Monastir, Tunisia
| | - Jalel Ben Youssef
- Vice-president of the Tunisian Society of Family Medicine, Tunis, Tunisia
| | - Hamida Maghraoui
- Emergency Department, Rabta University Hospital, 1007 Tunis, Tunisia
| | | | - Adel walha
- grid.420157.5Emergency Department, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia ,grid.411838.70000 0004 0593 5040Research Laboratory LR12SP18, Monastir University, 5019 Monastir, Tunisia
| | - Mohamed Habib Grissa
- grid.420157.5Emergency Department, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia ,grid.411838.70000 0004 0593 5040Research Laboratory LR12SP18, Monastir University, 5019 Monastir, Tunisia
| | - Kaouthar Beltaief
- grid.420157.5Emergency Department, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia ,grid.411838.70000 0004 0593 5040Research Laboratory LR12SP18, Monastir University, 5019 Monastir, Tunisia
| | - Zied Mezgar
- grid.412791.80000 0004 0508 0097Emergency Department, Farhat Hached University Hospital, 4031 Sousse, Tunisia
| | - Ahmed Coubantini
- Department of Infectious Disease, Rabta University Hospital, 1007 Tunis, Tunisia
| | - Wahid Bouida
- grid.420157.5Emergency Department, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia ,grid.411838.70000 0004 0593 5040Research Laboratory LR12SP18, Monastir University, 5019 Monastir, Tunisia
| | - Mohamed Amine Msolli
- grid.420157.5Emergency Department, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia ,grid.411838.70000 0004 0593 5040Research Laboratory LR12SP18, Monastir University, 5019 Monastir, Tunisia
| | - Riadh Boukef
- grid.411838.70000 0004 0593 5040Research Laboratory LR12SP18, Monastir University, 5019 Monastir, Tunisia ,grid.412356.70000 0004 9226 7916Emergency Department, Sahloul University Hospital, 4011 Sousse, Tunisia
| | - Hamdi Boubaker
- grid.420157.5Emergency Department, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia ,grid.411838.70000 0004 0593 5040Research Laboratory LR12SP18, Monastir University, 5019 Monastir, Tunisia
| | - Semir Nouira
- grid.420157.5Emergency Department, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia ,grid.411838.70000 0004 0593 5040Research Laboratory LR12SP18, Monastir University, 5019 Monastir, Tunisia
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Bel haj ali K, Sekma A, Ben Abdallah S, Yaakoubi H, Trabelsi I, Frikha N, Ben Soltane H, Grissa MH, Boubaker H, Msolli MA, Mezgar Z, Beltaief K, Boukef R, Nouira S. Analgesic effect of topical piroxicam versus phytotherapy gel in the treatment of acute soft tissues injuries: a randomized controlled non-inferiority study. Pain Medicine 2022:6820952. [DOI: 10.1093/pm/pnac176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 10/01/2022] [Accepted: 11/03/2022] [Indexed: 11/12/2022]
Abstract
Abstract
Objective
The study compared the efficacy and tolerability of piroxicam gel and a new topical combination of medicinal plant products (Soulagel®) to treat pain caused by soft tissue injuries.
Methods
1525 patients were assigned to receive piroxicam gel or Soulagel®. Efficacy assessments included pain-on-movement (POM) VNS (visual numeric scale) change from emergency department (ED) discharge (baseline) by at least 50% at day-7 final assessment, the time required to reach pain resolution criteria, need for rescue analgesia, patients’ satisfaction, and rate of adverse effects.
Results
At day-7, 1216 patients (79.7%) achieved at least 50% reduction of VNS from baseline; 623 patients (82.4%) in Soulagel® group vs. 593 patients (77.1%) in piroxicam group (p = 0.01). Time to decrease POM by 50% was significantly higher with piroxicam gel compared to Soulagel® (34±1 vs 33±1 days respectively; p = 0.54). At day 7, 96.4% of patients in Soulagel® group declared being “very satisfied” to “satisfied” vs. 68% in piroxicam group (p < 0.001). There was no major adverse events in both groups.
Conclusion
Soulagel® is not inferior to piroxicam gel for managing pain related to a soft tissues injuries. Further studies will help ascertain whether this new gel offers an alternative treatment option in this common ED condition.
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Affiliation(s)
- Khaoula Bel haj ali
- Fattouma Bourguiba University Hospital Emergency Department, , 5000 Monastir, Tunisia
- Research Laboratory LR12SP18, University of Monastir , 5019 Tunisia
| | - Adel Sekma
- Fattouma Bourguiba University Hospital Emergency Department, , 5000 Monastir, Tunisia
- Research Laboratory LR12SP18, University of Monastir , 5019 Tunisia
| | - Saoussen Ben Abdallah
- Fattouma Bourguiba University Hospital Critical Care Deparment, , 5000 Monastir, Tunisia
| | - Hajer Yaakoubi
- Sahloul University Hospital Emergency Department, , 4011 Sousse, Tunisia
| | - Imen Trabelsi
- Research Laboratory LR12SP18, University of Monastir , 5019 Tunisia
| | | | - Houda Ben Soltane
- Farhat Hached University Hospital Emergency Department, , 4031 Sousse, Tunisia
| | - Mohamed Habib Grissa
- Fattouma Bourguiba University Hospital Emergency Department, , 5000 Monastir, Tunisia
- Research Laboratory LR12SP18, University of Monastir , 5019 Tunisia
| | - Hamdi Boubaker
- Fattouma Bourguiba University Hospital Emergency Department, , 5000 Monastir, Tunisia
- Research Laboratory LR12SP18, University of Monastir , 5019 Tunisia
| | - Mohamed Amine Msolli
- Fattouma Bourguiba University Hospital Emergency Department, , 5000 Monastir, Tunisia
- Research Laboratory LR12SP18, University of Monastir , 5019 Tunisia
| | - Zied Mezgar
- Farhat Hached University Hospital Emergency Department, , 4031 Sousse, Tunisia
| | - Kaouthar Beltaief
- Fattouma Bourguiba University Hospital Emergency Department, , 5000 Monastir, Tunisia
- Research Laboratory LR12SP18, University of Monastir , 5019 Tunisia
| | - Riadh Boukef
- Sahloul University Hospital Emergency Department, , 4011 Sousse, Tunisia
| | - Semir Nouira
- Fattouma Bourguiba University Hospital Emergency Department, , 5000 Monastir, Tunisia
- Research Laboratory LR12SP18, University of Monastir , 5019 Tunisia
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Sakly R, Wolffenbuttel BHR, Khochtali I, Bouida W, Boubaker H, Nouira S, Abid S, Kerkeni M. Increased skin autofluorescence of advanced glycation end products (AGEs) in subjects with cardiovascular risk factors. Int J Diabetes Dev Ctries 2022. [DOI: 10.1007/s13410-022-01121-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Ben Abdelaziz A, Chebil D, Nouira S, Triki M, Othmane Y, Dammak N, Fredj AB, Abdelfattah S, Melki S. 201 - Délais de management de la fracture de la hanche dans quatre services orthopédiques, Tunisie, 2018. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.06.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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25
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Haddad N, Chebil D, Nouira S, Melki S, Hassine DB, Abdelaziz AB. 211 - Devenir éditorial des thèses tunisiennes de médecine préventive et communautaire. Rev Epidemiol Sante Publique 2022. [DOI: 10.1016/j.respe.2022.06.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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26
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Ben Hafaiedh S, Ben Daya Y, Radoui AH, Bouchoucha M, Razgallah R, Nouira S. Home Telemonitoring of Arterial Hypertension With Antihypertensive Treatment Titration: Protocol for a Randomized Controlled Prospective Trial (HOROSCOPE Study). JMIR Res Protoc 2022; 11:e26184. [PMID: 35230254 PMCID: PMC8924775 DOI: 10.2196/26184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/31/2021] [Accepted: 04/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background Despite the availability of effective treatment, the control of hypertension remains insufficient. Telemonitoring in the management of hypertension would be an effective way to improve blood pressure control. Objective The aim of our study will be to evaluate the effects of telemonitoring with antihypertensive treatment titration on blood pressure control in Tunisian patients with hypertension. Methods Our trial will be a prospective, rater-blinded randomized controlled trial carried out with primary care physicians in the Sahel region of Tunisia. Patients will be eligible for enrollment if they are aged over 35 years, are newly diagnosed with hypertension, or are known to be poorly controlled on antihypertensive therapy. Participants will be randomly assigned in a 1:1 ratio to the telemonitoring arm or usual care arm. The telemonitoring arm will involve a weekly telephone call for the collection of the home blood pressure measurements, therapeutic education, and treatment compliance assessment as well as a monthly call for treatment titration and a side effect check. Randomization will be done via the use of an interactive web responsive system, and patients will be stratified by investigation center. Neither participants nor investigators will be masked to the group assignments. The primary outcome will be the change in mean 24-hour systolic blood pressure from baseline to the 6-month follow-up in the 2 groups. All randomized patients who attend the follow-up visit at 6 months and have no missing data for the primary outcome will be included in the analysis. Results Recruitment to the trial started in July 2020. The study was initiated with 17 primary care physicians. We expect the inclusion period to last for approximately 6 months. We expect to complete data collection by the end of 2021 and plan to disseminate the results subsequently. Conclusions The HOROSCOPE (Home Telemonitoring of Arterial Hypertension With Antihypertensive Treatment Titration: Randomized Controlled Prospective Trial) study will provide important new evidence that could shed some light on the feasibility and impact of telemonitoring and self-monitoring in a Tunisian population of patients with hypertension who consult primary care physicians. Trial Registration ClinicalTrials.gov NCT04607239; https://clinicaltrials.gov/ct2/show/NCT04607239 International Registered Report Identifier (IRRID) DERR1-10.2196/26184
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Affiliation(s)
| | | | | | | | | | - Semir Nouira
- Emergency Department and Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital, Monastir, Tunisia
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Messous S, Trabelsi I, Bel Haj Ali K, Abdelghani A, Ben Daya Y, Razgallah R, Grissa MH, Beltaief K, Mezgar Z, Belguith A, Bouida W, Boukef R, Boubaker H, Msolli MA, Sekma A, Nouira S. Two-day versus seven-day course of levofloxacin in acute COPD exacerbation: a randomized controlled trial. Ther Adv Respir Dis 2022; 16:17534666221099729. [PMID: 35657073 PMCID: PMC9168850 DOI: 10.1177/17534666221099729] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/25/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Duration of antibiotic treatment in acute exacerbation of COPD (AECOPD) is most commonly based on expert opinion. Typical administration periods range from 5 to 7 days. A 2-day course with levofloxacin was not previously assessed. We performed a randomized clinical trial to evaluate the efficacy of 2-day versus 7-day treatment with levofloxacin in patients with AECOPD. METHODS AND ANALYSIS Patients with AECOPD were randomized to receive levofloxacin for 2 days and 5 days placebo (n = 155) or levofloxacin for 7 days (n = 155). All patients received a common dose of intravenous prednisone daily for 5 days. The primary outcome measure was cure rate, and secondary outcomes included need for additional antibiotics, ICU admission rate, re-exacerbation rate, death rate, and exacerbation-free interval (EFI) within 1-year follow-up. The study protocol has been prepared in accordance with the revised Helsinki Declaration for Biomedical Research Involving Human Subjects and Guidelines for Good Clinical Practice. The study was approved by ethics committees of all participating centers prior to implementation (Monastir and Sousse Universities). RESULTS 310 patients were randomized to receive 2-day course of levofloxacin (n = 155) or 7-day course (n = 155). Cure rate was 79.3% (n = 123) and 74.2% (n = 115), respectively, in 2-day and 7-day groups [OR 1.3; 95% CI 0.78-2.2 (p = 0.28)]. Need for additional antibiotics rate was 3.2% and 1.9% in the 2-day group and 7-day group, respectively; (p = 0.43). ICU admission rate was not significantly different between both groups. One-year re-exacerbation rate was 34.8% (n = 54) in 2-day group versus 29% (n = 45) in 7-day group (p = 0.19); the EFI was 121 days (interquartile range, 99-149) versus 110 days (interquartile range, 89-132) in 2-day and 7-day treatment groups, respectively; (p = 0.73). One-year death rate was not significantly different between the 2 groups, 5.2% versus 7.1% in the 2-day group and 7-day group, respectively; (p = 0.26). No difference in adverse effects was detected. CONCLUSION Levofloxacin once daily for 2 days is not inferior to 7 days with respect to cure rate, need for additional antibiotics and hospital readmission in AECOPD. Our findings would improve patient compliance and reduce the incidence of bacterial resistance and adverse effects.
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Affiliation(s)
- Salma Messous
- Research Laboratory LR12SP18, Monastir
University, Monastir, Tunisia
| | - Imen Trabelsi
- Research Laboratory LR12SP18, Monastir
University, Monastir, Tunisia
| | - Khaoula Bel Haj Ali
- Emergency Department and Laboratory Research
(LR12SP18), Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Ahmed Abdelghani
- Pneumology Department, Farhat Hached University
Hospital, Sousse, Tunisia
| | | | | | - Mohamed Habib Grissa
- Emergency Department and Laboratory Research
(LR12SP18), Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Kaouthar Beltaief
- Emergency Department and Laboratory Research
(LR12SP18), Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Zied Mezgar
- Emergency Department, Farhat Hached University
Hospital, Sousse, Tunisia
| | - Asma Belguith
- Department of Preventive Medicine, Fattouma
Bourguiba University Hospital, Monastir, Tunisia
| | - Wahid Bouida
- Emergency Department and Laboratory Research
(LR12SP18), Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Riadh Boukef
- Emergency Department, Sahloul University
Hospital, Sousse, Tunisia
- Emergency Department and Laboratory Research
(LR12SP18), Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Hamdi Boubaker
- Emergency Department and Laboratory Research
(LR12SP18), Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Mohamed Amine Msolli
- Emergency Department and Laboratory Research
(LR12SP18), Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Adel Sekma
- Emergency Department and Laboratory Research
(LR12SP18), Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Semir Nouira
- Research Laboratory LR12SP18, Monastir
University, Tunisia
- Emergency Department and Laboratory Research
(LR12SP18), Fattouma Bourguiba University Hospital, 5000 Monastir,
Tunisia
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28
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Khalil MH, Sekma A, Yaakoubi H, Bel Haj Ali K, Msolli MA, Beltaief K, Grissa MH, Boubaker H, Sassi M, Chouchene H, Hassen Y, Ben Soltane H, Mezgar Z, Boukef R, Bouida W, Nouira S. 30 day predicted outcome in undifferentiated chest pain: multicenter validation of the HEART score in Tunisian population. BMC Cardiovasc Disord 2021; 21:555. [PMID: 34798811 PMCID: PMC8603499 DOI: 10.1186/s12872-021-02381-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 11/02/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Chest pain remains one of the most challenging serious complaints in the emergency department (ED). A prompt and accurate risk stratification tool for chest pain patients is paramount to help physcian effectively progrnosticate outcomes. HEART score is considered one of the best scores for chest pain risk stratification. However, most validation studies of HEART score were not performed in populations different from those included in the original one. OBJECTIVE To validate HEART score as a prognostication tool, among Tunisian ED patients with undifferentiated chest pain. METHODS Our prospective, multicenter study enrolled adult patients presenting with chest pain at chest pain units. Patients over 30 years of age with a primary complaint of chest pain were enrolled. HEART score was calculated for every patient. The primary outcome was major cardiovascular events (MACE) occurrence, including all-cause mortality, non-fatal myocardial infarction (MI), and coronary revascularisation over 30 days following the ED visit. The discriminative power of HEART score was evaluated by the area under the ROC curve. A calibration analysis of the HEART score in this population was performed using Hosmer-Lemeshow goodness of test. RESULTS We enrolled 3880 patients (age 56.3; 59.5% males). The application of HEART score showed that most patients were in intermediate risk category (55.3%). Within 30 days of ED visit, MACE were reported in 628 (16.2%) patients, with an incidence of 1.2% in the low risk group, 10.8% in the intermediate risk group and 62.4% in the high risk group. The area under receiver operating characteristic curve was 0.87 (95% CI 0.85-0.88). HEART score was not well calibrated (χ2 statistic = 12.34; p = 0.03). CONCLUSION HEART score showed a good discrimination performance in predicting MACE occurrence at 30 days for Tunisian patients with undifferentiated acute chest pain. Heart score was not well calibrated in our population.
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Affiliation(s)
- Mohamed Hassene Khalil
- Emergency Department and Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia. .,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia.
| | - Adel Sekma
- Emergency Department and Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Hajer Yaakoubi
- Emergency Department, Sahloul University Hospital, 4011, Sousse, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Khaoula Bel Haj Ali
- Emergency Department and Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Mohamed Amine Msolli
- Emergency Department and Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Kaouthar Beltaief
- Emergency Department and Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Mohamed Habib Grissa
- Emergency Department and Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Hamdi Boubaker
- Emergency Department and Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Mohamed Sassi
- Emergency Department and Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Hamadi Chouchene
- Emergency Department and Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Youssef Hassen
- Emergency Department and Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Houda Ben Soltane
- Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia.,Emergency Department, Farhat Hached University Hospital, 4031, Sousse, Tunisia
| | - Zied Mezgar
- Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia.,Emergency Department, Farhat Hached University Hospital, 4031, Sousse, Tunisia
| | - Riadh Boukef
- Emergency Department, Sahloul University Hospital, 4011, Sousse, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Wahid Bouida
- Emergency Department and Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Semir Nouira
- Emergency Department and Laboratory Research (LR12SP18), Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
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Mlouki I, Nouira S, Omrane A, Ourchefeni M, Omri N, Youssef FB, Sfar H, El Absi M, El Mhamdi S. Adverse childhood experiences and risky behaviours in two Tunisian University Hospitals. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
According to the Health Word Organization (WHO), adverse childhood experiences (ACEs) have several harmful outcomes on mental health in adolescence and later life. We aimed at investigating the relationship between ACEs and risky behaviors among Tunisian health professionals.
Methods
A cross sectional study was conducted between November 2018 and March 2019 among health care workers in two University Hospitals in Tunisia. We assessed exposure to violence in the hospital, behavioral (cyberaddiction) and chemical addiction (tobacco and alcohol use). ACEs were screened using the Arabic validated version of the Adverse childhood experiences-International Questionnaire (ACE-IQ) developed by the WHO.
Results
A total of 546 health professionals were enrolled with a mean age of 34.5 ± 9.6 years and a majority being female (70%). Almost 34.8% were doctors. The majority of them (67.3%) reported exposure to physical violence at work by patient or their families. The most common hazardous practice was internet addiction (18.5%) followed by tobacco use (13.2%). All health risk behaviors were significantly more prevalent among males and youth (<35 years) (p < 0.01). After adjustment for violence at work and socidemographic characteristics, logistic regression revealed that ACEs especially physical violence (OR = 1.8; IC [1.1-2.9]), emotional abuse (OR = 4.5 [1.2-16.6]) and bullying (OR = 2.6 [1.6-4.2]) increase the risk of the adoption of addictive behaviors among health caregivers.
Conclusions
Policy makers might implement collaborative interventions with psychiatrics targeting the prevention of early life adversities, this could be helpful to delay the onset of risky behaviors.
Key messages
Exposure to early life adversities increase the risk of addictive behaviors among health caregivers. Collaborative interventions with psychiatrics targeting screening childhood adversities could be helpful to delay the onset of risky behaviours.
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Affiliation(s)
- I Mlouki
- Department of Preventive and Community Medicine, University Hospital Taher Sfar, Mahdia, Tunisia
- Department of Community Medicine, Faculty of Medicine of Monastir, Monastir, Tunisia
- Research Laboratory, Epidemiology Applied to Maternal and Child Health 12SP17, Monastir, Tunisia
| | - S Nouira
- Department of Preventive and Community Medicine, University Hospital Taher Sfar, Mahdia, Tunisia
| | - A Omrane
- Department of Occupational Medicine, University Hospital Taher Sfar, Mahdia, Tunisia
| | - M Ourchefeni
- Department of Occupational Medicine, University Hospital Taher Sfar, Mahdia, Tunisia
| | - N Omri
- Department of Preventive and Community Medicine, University Hospital Taher Sfar, Mahdia, Tunisia
- Department of Community Medicine, Faculty of Medicine of Monastir, Monastir, Tunisia
- Research Laboratory, Epidemiology Applied to Maternal and Child Health 12SP17, Monastir, Tunisia
| | - F Ben Youssef
- Department of Preventive and Community Medicine, University Hospital Taher Sfar, Mahdia, Tunisia
- Department of Community Medicine, Faculty of Medicine of Monastir, Monastir, Tunisia
- Research Laboratory, Epidemiology Applied to Maternal and Child Health 12SP17, Monastir, Tunisia
| | - H Sfar
- Department of Preventive and Community Medicine, University Hospital Taher Sfar, Mahdia, Tunisia
| | - M El Absi
- Research Laboratory, Epidemiology Applied to Maternal and Child Health 12SP17, Monastir, Tunisia
| | - S El Mhamdi
- Department of Preventive and Community Medicine, University Hospital Taher Sfar, Mahdia, Tunisia
- Department of Community Medicine, Faculty of Medicine of Monastir, Monastir, Tunisia
- Research Laboratory, Epidemiology Applied to Maternal and Child Health 12SP17, Monastir, Tunisia
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30
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Bel Haj Ali K, Sekma A, Nouira S. Response to "practical implication of nitroglycerin test for diagnosing heart failure in emergency department". Clin Cardiol 2021; 44:1332. [PMID: 34515359 PMCID: PMC8495073 DOI: 10.1002/clc.23721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 11/08/2022] Open
Affiliation(s)
- Khaoula Bel Haj Ali
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Adel Sekma
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Semir Nouira
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
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31
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Bouida W, Bel Haj Ali K, Ben Soltane H, Msolli MA, Boubaker H, Sekma A, Beltaief K, Grissa MH, Methamem M, Boukef R, Belguith A, Nouira S. Effect on Opioids Requirement of Early Administration of Intranasal Ketamine for Acute Traumatic Pain. Clin J Pain 2021; 36:458-462. [PMID: 32080000 DOI: 10.1097/ajp.0000000000000821] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the efficacy and safety of early administration of low-dose intranasal ketamine on reducing the need for opioid and nonopioid analgesic agents in emergency department (ED) patients with acute moderate to severe acute limbs' trauma pain. PATIENTS AND METHODS This is a double-blind, randomized, prospective, controlled study conducted in the ED. The included patients were randomly assigned to intranasal pulverization of ketamine or placebo. Protocol treatment was given at the triage. The primary outcome is the need for opioids during ED stay. Secondary outcome included the requirement of nonopioid analgesic agents and the percentage of patients discharged from the ED with a visual analog scale (VAS) <30. A combined outcome score including the 3 outcome items was constructed. RESULTS The authors included 1102 patients, 550 patients in the placebo group, and 552 in the intranasal ketamine group. The groups were similar regarding demographics, clinical characteristics, and baseline VAS. The need for opioids was decreased in the intranasal ketamine group compared with the placebo group (17.2% vs. 26.5%; P<0.001). The need for nonopioid analgesics was significantly lower in the intranasal ketamine group compared with the placebo group (31.1% vs. 39.6%; P=0.003). The percentage of patients discharged with a VAS score <30 was significantly higher in the intranasal ketamine group (P<0.001). The mean combined outcome score was 0.97 in the placebo group and 0.67 in the intranasal ketamine group (P<0.001). CONCLUSION Intranasal ketamine administered early in the triage was associated with a decrease in opioids and nonopioid analgesics need in patients with acute limb trauma-related pain.
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Affiliation(s)
- Wahid Bouida
- Emergency Department, Fattouma Bourguiba University Hospital.,Research Laboratory LR12SP18, University of Monastir
| | - Khaoula Bel Haj Ali
- Emergency Department, Fattouma Bourguiba University Hospital.,Research Laboratory LR12SP18, University of Monastir
| | - Houda Ben Soltane
- Research Laboratory LR12SP18, University of Monastir.,Emergency Department, Farhat Hached University Hospital
| | - Mohamed Amine Msolli
- Emergency Department, Fattouma Bourguiba University Hospital.,Research Laboratory LR12SP18, University of Monastir
| | - Hamdi Boubaker
- Emergency Department, Fattouma Bourguiba University Hospital.,Research Laboratory LR12SP18, University of Monastir
| | - Adel Sekma
- Emergency Department, Fattouma Bourguiba University Hospital.,Research Laboratory LR12SP18, University of Monastir
| | - Kaouthar Beltaief
- Emergency Department, Fattouma Bourguiba University Hospital.,Research Laboratory LR12SP18, University of Monastir
| | - Mohamed Habib Grissa
- Emergency Department, Fattouma Bourguiba University Hospital.,Research Laboratory LR12SP18, University of Monastir
| | | | - Riadh Boukef
- Research Laboratory LR12SP18, University of Monastir.,Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Asma Belguith
- Epidemiology and Preventive Medicine Department, University Hospital of Monastir, Monastir
| | - Semir Nouira
- Emergency Department, Fattouma Bourguiba University Hospital.,Research Laboratory LR12SP18, University of Monastir
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Khalil MH, Sekma A, Zhani W, Zorgati A, Ben Soltane H, Nouira S. Variation in central venous oxygen saturation to assess volume responsiveness in hemodynamically unstable patients under mechanical ventilation: a prospective cohort study. Crit Care 2021; 25:245. [PMID: 34256822 PMCID: PMC8278591 DOI: 10.1186/s13054-021-03683-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/06/2021] [Indexed: 11/10/2022]
Affiliation(s)
- Mohamed Hassene Khalil
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Adel Sekma
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Wafa Zhani
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Asma Zorgati
- Emergency Department, Sahloul University Hospital, 4011, Sousse, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Houda Ben Soltane
- Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia.,Emergency Department, Farhat Hached University Hospital, 4031, Sousse, Tunisia
| | - Semir Nouira
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia. .,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia.
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33
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Msolli MA, Bel Haj Ali K, Sekma A, Bzeouich N, Trabelsi I, Gannoun I, Grissa MH, Boubaker H, Beltaief K, Dridi Z, Boukef R, Nouira S. Corrigendum to "Value of Dynamic Variation of Impedance Cardiac output in the diagnosis of Heart Failure in emergency department patients with undifferentiated dyspnea", [American Journal of Emergency Medicine, 49C, 29-34]. Am J Emerg Med 2021; 47:352. [PMID: 34226088 DOI: 10.1016/j.ajem.2021.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Mohamed Amine Msolli
- Emergency Department, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia; Research Laboratory LR12SP18, University of Monastir, 5019, Tunisia
| | - Khaoula Bel Haj Ali
- Emergency Department, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia; Research Laboratory LR12SP18, University of Monastir, 5019, Tunisia.
| | - Adel Sekma
- Emergency Department, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia; Research Laboratory LR12SP18, University of Monastir, 5019, Tunisia
| | - Nasri Bzeouich
- Emergency Department, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia; Research Laboratory LR12SP18, University of Monastir, 5019, Tunisia
| | - Imen Trabelsi
- Research Laboratory LR12SP18, University of Monastir, 5019, Tunisia
| | - Imen Gannoun
- Research Laboratory LR12SP18, University of Monastir, 5019, Tunisia
| | - Mohamed Habib Grissa
- Emergency Department, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia; Research Laboratory LR12SP18, University of Monastir, 5019, Tunisia
| | - Hamdi Boubaker
- Emergency Department, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia; Research Laboratory LR12SP18, University of Monastir, 5019, Tunisia
| | - Kaouthar Beltaief
- Emergency Department, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia; Research Laboratory LR12SP18, University of Monastir, 5019, Tunisia
| | - Zohra Dridi
- Cardiology Department, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia
| | - Riadh Boukef
- Emergency Department, Sahloul University Hospital, 4011 Sousse, Tunisia; Research Laboratory LR12SP18, University of Monastir, 5019, Tunisia
| | - Semir Nouira
- Emergency Department, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia; Research Laboratory LR12SP18, University of Monastir, 5019, Tunisia
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Sekma A, Bel Haj Ali K, Jeddi C, Ben Brahim N, Bzeouich N, Gannoun I, Trabelssi I, Laouiti K, Grissa MH, Beltaief K, Zohra D, Asma Z, Lotfi B, Rym Y, Ben Soltane H, Zied M, Mariem K, Msolli MA, Riadh B, Bouida W, Boubaker H, Nouira S. Value of nitroglycerin test in the diagnosis of heart failure in emergency department patients with undifferentiated dyspnea. Clin Cardiol 2021; 44:932-937. [PMID: 34076282 PMCID: PMC8259157 DOI: 10.1002/clc.23615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/07/2021] [Accepted: 04/19/2021] [Indexed: 01/06/2023] Open
Abstract
Background Rapid diagnosis of heart failure (HF) in acutely dyspneic patients can be challenging for emergency department (ED) physicians. Hypothesis Cardiac output (CO) change with sublingual nitroglycerin (NTG) could be helpful in the diagnosis of HF in patients with acute undifferentiated dyspnea. Materials and Methods A prospective study of patients >18 years admitted to the ED for acute dyspnea. Using thoracic bioimpedance, we measured CO change at baseline and after sublingual administration of 0.6 mg of NTG. HF was defined on the basis of clinical examination, pro‐brain natriuretic peptide levels, and echocardiographic findings. Diagnostic performance of delta CO was calculated by sensitivity, specificity, likelihood ratio and receiver operating characteristic (ROC) curve. Results This study included 184 patients with mean age of 64 years. Baseline CO was comparable between the HF group and the non‐HF group. At its best cutoff (29%), delta CO showed good accuracy in the diagnosis of HF with a sensitivity, specificity, positive and negative likelihood ratios of 80%, 44%, 57%, and 66% respectively. Area under ROC curve was 0.701 [95% CI 0.636–0.760]. The decrease of CO with sublingual NTG was significantly higher in patients with HFpEF compared with those with HFrEF. Multivariate analysis, showed that delta CO was an independent factor associated with HF diagnosis [OR 0.19 (95% CI 0.11–0.29); p < .001]. Conclusions Our study showed that CO change with sublingual nitroglycerin is a simple tool that may be helpful for the diagnosis of HF in ED patients with undifferentiated dyspnea.
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Affiliation(s)
- Adel Sekma
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Khaoula Bel Haj Ali
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Camilia Jeddi
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Nadia Ben Brahim
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Nasri Bzeouich
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Imen Gannoun
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Imen Trabelssi
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Kamel Laouiti
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Mohamed Habib Grissa
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Kaouthar Beltaief
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Dridi Zohra
- Cardiology Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Zorgati Asma
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia.,Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Boukadida Lotfi
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia.,Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Youssef Rym
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia.,Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Houda Ben Soltane
- Emergency Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Mezgar Zied
- Emergency Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Khrouf Mariem
- Emergency Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Mohamed Amine Msolli
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Boukef Riadh
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia.,Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Wahid Bouida
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Hamdi Boubaker
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Semir Nouira
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
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Bel Haj Ali K, Sekma A, Msolli MA, Bezouich N, Gannoun I, Grissa MH, Boubaker H, Beltaief K, Dridi Z, Nouira S. Value of DYnamicVariation of impedance cardiac output in the diagnosis of heart failure in emergency department patients with undifferentiated dyspnea. Am J Emerg Med 2021; 49:29-34. [PMID: 34051399 DOI: 10.1016/j.ajem.2021.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 05/08/2021] [Accepted: 05/14/2021] [Indexed: 10/21/2022] Open
Abstract
AIM OF STUDY Cardiac output (CO) responses to acute changes in body position and Valsalva maneuver (VM) were proposed to assess cardiac contractile reserve. We investigated the value of sitting position (SP), leg raising (LR), and VM for identifying heart failure (HF) in patients with undifferentiated dyspnea. MATERIALS AND METHODS It is a prospective study including patients over 18 years old admitted to the emergency department (ED) for dyspnea. Bioimpedance CO was measured at baseline, under SP, LR, and VM. HF diagnosis was based on clinical assessment, serum levels of brain natriuretic peptide (BNP) and echocardiography findings. Study population was divided into patients with heart failure (HF group) and patients without HF (non-HF group). Diagnostic performance of CO change under the three maneuvers was calculated by sensitivity, specificity, likelihood ratio and receiver operating characteristic (ROC) curve. RESULTS 290 patients were enrolled in the study. The final diagnosis was dyspnea due to congestive heart failure in 147 patients (50.7%). CO change with VM was the most accurate exam in identifying congestive heart failure as the cause of dyspnea with a sensitivity, specificity, positive and negative likelihood ratios of 79%, 60%, 1.97, and 0.36 respectively. Area under ROC curve was 0.62(95% CI, 0.55-0.69), 0.63(95% CI, 0.56-0.69), and 0.70(95% CI, 0.64-0.76) respectively for SP, LR, and VM. In a multivariate analysis, CO change with VM, but not with SP or LR, carried independent diagnostic value (p < 0.001). CONCLUSION the diagnosis of HF can be aided with use of analyzing the effect of VM on non-invasively measured CO among patients admitted to the ED with undifferentiated dyspnea. Diagnostic yield of SP and LR was poor.
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Affiliation(s)
- Khaoula Bel Haj Ali
- Emergency Department, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia; Research Laboratory LR12SP18, University of Monastir, 5019, Tunisia.
| | - Adel Sekma
- Emergency Department, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia; Research Laboratory LR12SP18, University of Monastir, 5019, Tunisia
| | - Mohamed Amine Msolli
- Emergency Department, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia; Research Laboratory LR12SP18, University of Monastir, 5019, Tunisia
| | - Nasri Bezouich
- Emergency Department, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia; Research Laboratory LR12SP18, University of Monastir, 5019, Tunisia
| | - Imen Gannoun
- Research Laboratory LR12SP18, University of Monastir, 5019, Tunisia
| | - Mohamed Habib Grissa
- Emergency Department, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia; Research Laboratory LR12SP18, University of Monastir, 5019, Tunisia
| | - Hamdi Boubaker
- Emergency Department, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia; Research Laboratory LR12SP18, University of Monastir, 5019, Tunisia
| | - Kaouthar Beltaief
- Emergency Department, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia; Research Laboratory LR12SP18, University of Monastir, 5019, Tunisia
| | - Zohra Dridi
- Cardiology Department, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia
| | - Semir Nouira
- Emergency Department, Fattouma Bourguiba University Hospital, 5000 Monastir, Tunisia; Research Laboratory LR12SP18, University of Monastir, 5019, Tunisia
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Ben Abdelaziz A, El Haddad N, Hannachi H, Nouira S, Melki S, Chebil D, Chelly S, Quessar A, Boussouf N. [Quality of "crisis communication" media during the COVID-19 pandemic in the Great Maghreb countries]. Rev Epidemiol Sante Publique 2021; 69:116-126. [PMID: 33966926 PMCID: PMC7985927 DOI: 10.1016/j.respe.2021.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 12/25/2020] [Accepted: 03/02/2021] [Indexed: 11/29/2022] Open
Abstract
Objectif Évaluer la qualité des supports de communication de crise, au cours de la pandémie de la COVID-19, dans trois pays du Grand Maghreb (Tunisie, Algérie, Maroc). Méthodes Il s’agit d’un audit de la conformité des communiqués de presse et des bulletins épidémiologiques, analysés via un référentiel de qualité, spécialement conçu par les auteurs. Ce référentiel, composé de cinq dimensions et de 50 items, cotés (0/1), a été appliqué par deux chercheurs en médecine préventive. La multiplication des notes par un coefficient de deux, a permis d’avoir un score partiel de 20 points pour chaque dimension et un score total de 100 points pour l’ensemble de la check list. La qualité des supports de communication a été jugée bonne au-delà des seuils de 15/20 pour les dimensions du référentiel et de 75/100 pour la totalité de la grille. Résultats Un total de 141 supports de communication a été inclus dans cet audit (Tunisie : 60, Algérie : 60, Maroc : 21). Le score global médian de la qualité de ces supports a été seulement de 56/100 (IIQ : [46–58]), sans variabilité notable entre les pays. La dimension la plus appréciée a été le « maintien de la confiance de la population » avec un score médian global de 14/20 (12/20 pour les bulletins épidémiologiques et 16/20 pour les communiqués de presse). La dimension la moins bien notée a été le « renforcement de la participation communautaire », avec un score médian de seulement 4/20 (6/20 pour les bulletins épidémiologiques et 4/20 pour les communiqués de presse). Conclusion La qualité des supports maghrébins de communication de crise, au cours de la COVID-19, a été insuffisante dans la majorité de ses dimensions et de ses items (dont surtout psychosociaux). Le renforcement des capacités des chargés de communication, dans l’élaboration des supports d’information, au cours des crises sanitaires, est indispensable et urgent.
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Affiliation(s)
- A Ben Abdelaziz
- Maghreb PRP2S Network (Pedagogy-Research-Health sciences publication), Sousse, Tunisie; Research laboratory LR19SP01, "Measurement and support for health establishment performance", Sousse, Tunisie; Research group COV-MAG (COVID-MAGHREB), Sousse, Tunisie; Information systems directorate, CHU Sahloul of Sousse, Sousse, Tunisie; Ibn El Jazzar medicine faculty of Sousse. University of Sousse, Sousse, Tunisie.
| | - N El Haddad
- Research laboratory LR19SP01, "Measurement and support for health establishment performance", Sousse, Tunisie; Research group COV-MAG (COVID-MAGHREB), Sousse, Tunisie; Ibn El Jazzar medicine faculty of Sousse. University of Sousse, Sousse, Tunisie
| | - H Hannachi
- Research group COV-MAG (COVID-MAGHREB), Sousse, Tunisie; Ibn El Jazzar medicine faculty of Sousse. University of Sousse, Sousse, Tunisie
| | - S Nouira
- Maghreb PRP2S Network (Pedagogy-Research-Health sciences publication), Sousse, Tunisie; Information systems directorate, CHU Sahloul of Sousse, Sousse, Tunisie
| | - S Melki
- Maghreb PRP2S Network (Pedagogy-Research-Health sciences publication), Sousse, Tunisie; Ibn El Jazzar medicine faculty of Sousse. University of Sousse, Sousse, Tunisie
| | - D Chebil
- Maghreb PRP2S Network (Pedagogy-Research-Health sciences publication), Sousse, Tunisie; Research group COV-MAG (COVID-MAGHREB), Sousse, Tunisie; Ibn El Jazzar medicine faculty of Sousse. University of Sousse, Sousse, Tunisie
| | - S Chelly
- Research group COV-MAG (COVID-MAGHREB), Sousse, Tunisie; Ibn El Jazzar medicine faculty of Sousse. University of Sousse, Sousse, Tunisie
| | - A Quessar
- Maghreb PRP2S Network (Pedagogy-Research-Health sciences publication), Sousse, Tunisie; Research group COV-MAG (COVID-MAGHREB), Sousse, Tunisie; Medicine and pharmacy faculty of Casablanca, Casablanca, Maroc
| | - N Boussouf
- Maghreb PRP2S Network (Pedagogy-Research-Health sciences publication), Sousse, Tunisie; Research group COV-MAG (COVID-MAGHREB), Sousse, Tunisie; Medicine faculty of Constantine, Constantine, Algérie
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Msolli MA, Sekma A, Marzouk MB, Chaabane W, Bel Haj Ali K, Boukadida L, Bzeouich N, Gannoun I, Trabelssi I, Laaouiti K, Grissa MH, Beltaief K, Dridi Z, Belguith A, Methamem M, Bouida W, Boukef R, Boubaker H, Nouira S. Bedside lung ultrasonography by emergency department residents as an aid for identifying heart failure in patients with acute dyspnea after a 2-h training course. Ultrasound J 2021; 13:5. [PMID: 33559777 PMCID: PMC7873143 DOI: 10.1186/s13089-021-00207-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 02/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ultrasonographic B-lines have recently emerged as a bedside imaging tool for the differential diagnosis of acute dyspnea in the Emergency Department (ED). However, despite its simplicity, LUS has not fully penetrated emergency department. This study aimed to assess the accuracy and reproducibility of ultrasonographic B-lines performed by emergency medicine (EM) residents for the diagnosis of congestive heart failure (CHF) in patients admitted to ED for acute dyspnea. PATIENTS AND METHODS This is a cross-sectional prospective study conducted between January 2016 and October 2017 including patients aged over 18 years admitted to ED for acute dyspnea. At admission, two consecutive bedside LUS study were performed by a pair of EM residents who received a 2-h course for recognition of sonographic B-lines to determine independently B-lines score and B-profile pattern. All participating sonographers were blinded to patients' clinical data. B-lines score ≥ 15 or a B-profile pattern was considered as suggestive of CHF. The final leading diagnosis was assessed by two expert sonographers, who were blinded to the residents' interpretations, based on clinical findings, chest X-ray, brain natriuretic peptide, cardiac and lung ultrasound testing. Accuracy and agreement of B-lines score and B-profile pattern were calculated. RESULTS We included 700 patients with a mean age of 68 ± 12.6 years and a sex ratio (M/F) of 1.43. The diagnosis of CHF was recorded in 371 patients (53%). The diagnostic performance of B-lines score at a cut-off 15 and B-profile pattern was, respectively, 88% and 82.5% for sensitivity, 75% and 84% for specificity, 80% and 85% for positive predictive value, 84% and 81% for negative predictive value. The area under receiver operating characteristic curve was 0.86 [0.83-0.89] and 0.83 [0.80-0.86], respectively, for B-lines score and B-profile pattern. There was an excellent agreement between residents for the diagnosis of CHF using both scores (kappa = 0.81 and 0.85, respectively, for ordinal scale B-lines score and B-profile pattern). CONCLUSION Lung ultrasound B-lines assessment has a good accuracy and an excellent reproducibility in the diagnosis of CHF in the hand of EM residents following a short training program. Trial registration Name of the registry: clinicaltrials.gov; Trial registration number: NCT03717779; Date of registration: October 24, 2018 'Retrospectively registered'; URL of trial registry record: clinicaltrials.gov.
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Affiliation(s)
- Mohamed Amine Msolli
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Adel Sekma
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Maryem Ben Marzouk
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Wael Chaabane
- Emergency Department, Sahloul University Hospital, 4011, Sousse, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Khaoula Bel Haj Ali
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia. .,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia.
| | - Lotfi Boukadida
- Emergency Department, Sahloul University Hospital, 4011, Sousse, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Nasri Bzeouich
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Imen Gannoun
- Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Imen Trabelssi
- Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Kamel Laaouiti
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Mohamed Habib Grissa
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Kaouthar Beltaief
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Zohra Dridi
- Cardiology Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia
| | - Asma Belguith
- Department of Preventive Medicine, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia
| | - Mehdi Methamem
- Emergency Department, Farhat Hached University Hospital, 4031, Sousse, Tunisia
| | - Wahid Bouida
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Riadh Boukef
- Emergency Department, Sahloul University Hospital, 4011, Sousse, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Hamdi Boubaker
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
| | - Semir Nouira
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, 5019, Monastir, Tunisia
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Msolli MA, Sekma A, Toumia M, Bel Haj Ali K, Khalil MH, Grissa MH, Bouida W, Beltaief K, Zorgati A, Methamem M, Belguith A, Boukef R, Boubaker H, Nouira S. Acetaminophen, Nonsteroidal Anti-inflammatory Drugs, or Combination of Both Analgesics in Acute Posttrauma Pain: A Randomized Controlled Trial. Acad Emerg Med 2021; 28:155-163. [PMID: 33145862 DOI: 10.1111/acem.14169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/27/2020] [Accepted: 10/27/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen (also called paracetamol) are the most frequent analgesics used to relieve posttrauma pain in the emergency department (ED). However, the utility of combining both treatments is still controversial. We sought to explore the benefits of combining an NSAID with acetaminophen compared to acetaminophen alone, or NSAID alone, in the treatment of posttraumatic pain of the extremity after discharge from the ED. METHODS This is a prospective, randomized controlled trial, carried out in a single ED from March 2017 to November 2018. The included patients were randomly assigned to receive paracetamol alone, high-dose NSAID (piroxicam) alone, or a combination of paracetamol and high-dose NSAID for 7 days after ED discharge. The primary outcome was need for additional oral analgesics. Secondary outcomes included the change of the visual numeric scale (VNS) between ED discharge (VNS D0) and 7 days later (VNS D7), ED revisits for residual pain, side effects, and patient satisfaction as assessed by a Likert satisfaction scale. RESULTS The need for additional oral analgesics was comparable between the paracetamol-NSAID combination group (9.8%) and the paracetamol group (11.4%; p = 0.43). ED readmission rate was also comparable between the two groups at 5.6 and 5.8%, respectively (p = 0.86). In contrast, need for new analgesics and ED revisit rates were both more frequent in the high-dose NSAID group. Mean VNS decreases on day 7 compared to day 0 were 66, 63, and 67%, respectively, in the paracetamol, NSAID, and paracetamol-NSAID combination groups (p = 0.32). Frequency of dissatisfaction was higher in the NSAID group. Side effects were more frequent in the NSAID and paracetamol-NSAID combination groups. CONCLUSION This study found that the combination of a high-dose NSAID with paracetamol does not increase the analgesic effect compared to paracetamol alone. We also found that paracetamol alone is superior to high-dose NSAID alone for posttraumatic extremity pain.
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Affiliation(s)
- Mohamed Amine Msolli
- From the Emergency Department Fattouma Bourguiba University HospitalMonastir Tunisia
- the Research Laboratory LR12SP18 University of Monastir MonastirTunisia
| | - Adel Sekma
- From the Emergency Department Fattouma Bourguiba University HospitalMonastir Tunisia
- the Research Laboratory LR12SP18 University of Monastir MonastirTunisia
| | - Marwa Toumia
- From the Emergency Department Fattouma Bourguiba University HospitalMonastir Tunisia
- the Research Laboratory LR12SP18 University of Monastir MonastirTunisia
| | - Khaoula Bel Haj Ali
- From the Emergency Department Fattouma Bourguiba University HospitalMonastir Tunisia
- the Research Laboratory LR12SP18 University of Monastir MonastirTunisia
| | - Mohamed Hassen Khalil
- From the Emergency Department Fattouma Bourguiba University HospitalMonastir Tunisia
- the Research Laboratory LR12SP18 University of Monastir MonastirTunisia
| | - Mohamed Habib Grissa
- From the Emergency Department Fattouma Bourguiba University HospitalMonastir Tunisia
- the Research Laboratory LR12SP18 University of Monastir MonastirTunisia
| | - Wahid Bouida
- From the Emergency Department Fattouma Bourguiba University HospitalMonastir Tunisia
- the Research Laboratory LR12SP18 University of Monastir MonastirTunisia
| | - Kaouthar Beltaief
- From the Emergency Department Fattouma Bourguiba University HospitalMonastir Tunisia
- the Research Laboratory LR12SP18 University of Monastir MonastirTunisia
| | - Asma Zorgati
- the Emergency Department Sahloul University HospitalSousse Tunisia
| | - Mehdi Methamem
- the Emergency Department Farhat Hached University Hospital Sousse Tunisia
| | - Asma Belguith
- and the Department of Preventive Medicine Fattouma Bourguiba University Hospital Monastir Tunisia
| | - Riadh Boukef
- the Research Laboratory LR12SP18 University of Monastir MonastirTunisia
- the Emergency Department Sahloul University HospitalSousse Tunisia
| | - Hamdi Boubaker
- From the Emergency Department Fattouma Bourguiba University HospitalMonastir Tunisia
- the Research Laboratory LR12SP18 University of Monastir MonastirTunisia
| | - Semir Nouira
- From the Emergency Department Fattouma Bourguiba University HospitalMonastir Tunisia
- the Research Laboratory LR12SP18 University of Monastir MonastirTunisia
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39
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Messous S, Elargoubi A, Pillet S, Rajoharison A, Hoffmann J, Trabelsi I, Grissa MH, Boukef R, Beltaief K, Mastouri M, Paranhos-Baccalà G, Nouira S, Pozzetto B. Bacterial and Viral Infection in Patients Hospitalized for Acute Exacerbation of Chronic Obstructive Pulmonary Disease: Implication for Antimicrobial Management and Clinical Outcome. COPD 2020; 18:53-61. [PMID: 33353408 DOI: 10.1080/15412555.2020.1854210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Patients with chronic obstructive pulmonary disease (COPD) exhibit frequent acute exacerbations (AE). The objectives of this study were first to evaluate the prevalence of pathogens associated to these episodes by combining conventional bacteriology and multiplex viral and bacterial PCR assays in sputum specimens, and second to determine whether C-reactive protein (CRP) value and clinical outcome could be influenced by the type of microbial agent(s) recovered from these samples. A cohort of 84 Tunisian patients hospitalized at the emergency room for AECOPD was investigated prospectively for the semi-quantitative detection of bacteria by conventional culture (the threshold of positivity was of 107 CFU/ml) and for the detection of viral genome and DNA of atypical bacteria by quantitative PCR using two commercial multiplex respiratory kits (Seegene and Fast-track). The two kits exhibited very similar performances although the Seegene assay was a bit more sensitive. A large number and variety of pathogens were recovered from the sputum samples of these 84 patients, including 15 conventional bacteria, one Chlamydia pneumoniae and 63 respiratory viruses, the most prevalent being rhinoviruses (n = 33) and influenza viruses (n = 13). From complete results available for 74 patients, the presence of bacteria was significantly associated with risk of recurrence at 6 and 12 months post-infection. The combination of these different markers appears useful for delineating correctly the antimicrobial treatment and for initiating a long-term surveillance in those patients with high risk of recurrent exacerbation episodes. A prospective study is required for confirming the benefits of this strategy aimed at improving the stewardship of antibiotics.
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Affiliation(s)
- Salma Messous
- Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia.,Microbiology Laboratory, Fattouma Bourguiba University Hospital of Monastir, Monastir, Tunisia
| | - Aida Elargoubi
- Microbiology Laboratory, Fattouma Bourguiba University Hospital of Monastir, Monastir, Tunisia
| | - Sylvie Pillet
- Laboratory of Infectious Agents and Hygiene, University Hospital of Saint-Etienne, and GIMAP group (EA 3064), Faculty of Medicine de Saint-Etienne, University of Lyon, Lyon, France
| | - Alain Rajoharison
- Laboratory of Emerging Pathogens, Mérieux Foundation, CIRI, Inserm U1111, Lyon, France
| | - Jonathan Hoffmann
- Laboratory of Emerging Pathogens, Mérieux Foundation, CIRI, Inserm U1111, Lyon, France
| | - Imen Trabelsi
- Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia
| | - Mohamed Habib Grissa
- Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia.,Department of Emergency, Fattouma Bourguiba University Hospital of Monastir, Monastir, Tunisia
| | - Riadh Boukef
- Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia.,Department of Emergency, Sahloul University Hospital, Sousse, Tunisia
| | - Kaouther Beltaief
- Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia.,Department of Emergency, Fattouma Bourguiba University Hospital of Monastir, Monastir, Tunisia
| | - Maha Mastouri
- Microbiology Laboratory, Fattouma Bourguiba University Hospital of Monastir, Monastir, Tunisia
| | | | - Semir Nouira
- Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia.,Department of Emergency, Fattouma Bourguiba University Hospital of Monastir, Monastir, Tunisia
| | - Bruno Pozzetto
- Laboratory of Infectious Agents and Hygiene, University Hospital of Saint-Etienne, and GIMAP group (EA 3064), Faculty of Medicine de Saint-Etienne, University of Lyon, Lyon, France
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Trabelsi I, Msolli MA, Sekma A, Fredj N, Dridi Z, Bzeouich N, Najjar MF, Gannoun I, Mzali M, Laouiti K, Beltaief K, Grissa MH, Belguith A, Boukef R, Bouida W, Boubaker H, Nouira S. Value of systolic time intervals in the diagnosis of heart failure in emergency department patients with undifferentiated dyspnea. Int J Clin Pract 2020; 74:e13572. [PMID: 32502312 DOI: 10.1111/ijcp.13572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 11/28/2022] Open
Abstract
AIM OF THE STUDY The diagnosis of heart failure in the emergency department (ED) is challenging. The aim of this study was to evaluate systolic time intervals (STIs) using phonoelectrocardiography for the diagnosis of heart failure (HF) in ED patients with undifferentiated dyspnea. METHODS A total of 855 patients with dyspnea and suspected HF were prospectively enrolled. They underwent echocardiographic measurements of left ventricular ejection fraction (LVEF), B-type natriuretic peptide (BNP) testing and computerised phonoelectrocardiography to assess STIs including electromechanical activation time (EMAT), left ventricular ejection time (LVET) and EMAT/LVET ratio. Diagnosis accuracy of STIs was calculated including sensitivity, specificity, likelihood ratio and receiver operating characteristic (ROC) curve. RESULTS Patients with HF (n = 530) had significantly higher EMAT and lower LVET compared with non-HF patients. ROC curve c-statistic was 0.74, 0.72 and 0.78 for EMAT, LVET and EMAT/LVET respectively. Sensitivity and specificity of EMAT/LVET at a cut-off = 40% were 72% and 88% respectively. EMAT/LVET had the highest correlation with LVEF (r = 0.48). In patients with intermediate BNP (n = 107), positive likelihood ratio increased from 1.8 with BNP alone to 3.6 with BNP combined to EMAT/LVET. Patients without HF had STIs values not significantly different from those with preserved LVEF (≥45%). CONCLUSIONS Given their immediate availability, phonoelectrocardiography STIs' parameters and particularly EMAT/LVET ratio could have an important role in the diagnosis approach of HF in patients with undifferentiated dyspnea in the ED.
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Affiliation(s)
- Imen Trabelsi
- Research Laboratory LR12SP18, University of Monastir, Tunisia
| | - Mohamed A Msolli
- Research Laboratory LR12SP18, University of Monastir, Tunisia
- Emergency Department, FattoumaBourguiba University Hospital, Monastir, Tunisia
| | - Adel Sekma
- Research Laboratory LR12SP18, University of Monastir, Tunisia
- Emergency Department, FattoumaBourguiba University Hospital, Monastir, Tunisia
| | - Nizar Fredj
- Research Laboratory LR12SP18, University of Monastir, Tunisia
- Emergency Department, FattoumaBourguiba University Hospital, Monastir, Tunisia
| | - Zohra Dridi
- Cardiology Department, FattoumaBourguiba University Hospital, Monastir, Tunisia
| | - Nasri Bzeouich
- Research Laboratory LR12SP18, University of Monastir, Tunisia
- Emergency Department, FattoumaBourguiba University Hospital, Monastir, Tunisia
| | - Mohamed F Najjar
- Biochemistry Department, FattoumaBourguiba University Hospital, Tunisia
| | - Imen Gannoun
- Research Laboratory LR12SP18, University of Monastir, Tunisia
| | - Malek Mzali
- Research Laboratory LR12SP18, University of Monastir, Tunisia
| | - Kamel Laouiti
- Research Laboratory LR12SP18, University of Monastir, Tunisia
- Emergency Department, FattoumaBourguiba University Hospital, Monastir, Tunisia
| | - Kaouthar Beltaief
- Research Laboratory LR12SP18, University of Monastir, Tunisia
- Emergency Department, FattoumaBourguiba University Hospital, Monastir, Tunisia
| | - Mohamed H Grissa
- Research Laboratory LR12SP18, University of Monastir, Tunisia
- Emergency Department, FattoumaBourguiba University Hospital, Monastir, Tunisia
| | - Asma Belguith
- Department of Preventive Medicine, FattoumaBourguiba University Hospital, Monastir, Tunisia
| | - Riadh Boukef
- Research Laboratory LR12SP18, University of Monastir, Tunisia
- Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Wahid Bouida
- Research Laboratory LR12SP18, University of Monastir, Tunisia
- Emergency Department, FattoumaBourguiba University Hospital, Monastir, Tunisia
| | - Hamdi Boubaker
- Research Laboratory LR12SP18, University of Monastir, Tunisia
- Emergency Department, FattoumaBourguiba University Hospital, Monastir, Tunisia
| | - Semir Nouira
- Research Laboratory LR12SP18, University of Monastir, Tunisia
- Emergency Department, FattoumaBourguiba University Hospital, Monastir, Tunisia
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41
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Beltaief K, Bouida W, Trabelsi I, Baccouche H, Sassi M, Dridi Z, Chakroun T, Hellara I, Boukef R, Hassine M, Addad F, Razgallah R, Khochtali I, Nouira S. Metabolic effects of Ramadan fasting in patients at high risk of cardiovascular diseases. Int J Gen Med 2019; 12:247-254. [PMID: 31410047 PMCID: PMC6643153 DOI: 10.2147/ijgm.s172341] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 02/14/2019] [Indexed: 01/08/2023] Open
Abstract
Background and aim The effects of Ramadan fasting on health are a little controversial. The present study is aimed at evaluating the metabolic effects on a group of 517 patients with ≥2 cardiovascular risk factors over a period running from 2012 to 2014. Methods Each patient was assessed at three visits: before, during, and after Ramadan. Demographical, clinical and biological tests were performed at each visit. Results Metabolically, we noted a significant and discrete rise in blood glucose level (+1.2 mmol/L), triglycerides (+0.3 mmol/L), cholesterol (+0.12 mmol/L) and creatinine (+3 µmol/L) during Ramadan. These disturbances decreased significantly after Ramadan. The same variations were observed among diabetics (n=323). However, there was a significant decrease in HbA1c after Ramadan (9.0% vs 7.6%, p<0.001). Our findings also revealed there was no significant correlation between variations of metabolic parameters and dietary intake. No acute metabolic incidents were reported during the study period. Conclusion The current study showed that Ramadan is responsible for a transient but well tolerated disturbance of metabolic parameters followed by a significant post-Ramadan improvement. These changes did not seem to be directly related to dietary intake.
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Affiliation(s)
- K Beltaief
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia
| | - W Bouida
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia
| | - I Trabelsi
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia
| | - H Baccouche
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia
| | - M Sassi
- Biological Laboratory, Maternity and Neonatal Medicine Center, Monastir, Tunisia
| | - Z Dridi
- Cardiology Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - T Chakroun
- Regional Blood Transfusion Center, Farhat Hached University Hospital, Sousse, Tunisia
| | - I Hellara
- Hematology Department, Fattouma Bourguiba University Hospital, Monasitr, Tunisia
| | - R Boukef
- Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - M Hassine
- Hematology Department, Fattouma Bourguiba University Hospital, Monasitr, Tunisia
| | - F Addad
- Cardiology Department, Abderrahman Mami University Hospital, Ariana 1080, Tunisia
| | | | - I Khochtali
- Endocrinology and Internal Medicine Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - S Nouira
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia
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Nouira S, Mebazaa A. Sahara dust in the heart of Europe. Emergencias 2019; 31:149-150. [PMID: 31210444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Semir Nouira
- Emergency Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Túnez; Research Laboratory LR12SP18, University of Monastir, 5019, Túnez
| | - Alexandre Mebazaa
- Department of Anaesthesia, Burn Critical Care. University hospitals Saint-Louis and Larboisière
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43
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Beltaief K, Msolli MA, Zorgati A, Sekma A, Fakhfakh M, Marzouk MB, Boubaker H, Grissa MH, Methamem M, Boukef R, Belguith A, Bouida W, Nouira S. Nebulized Terbutaline and Ipratropium Bromide Versus Terbutaline Alone in Acute Exacerbation of Chronic Obstructive Pulmonary Disease Requiring Noninvasive Ventilation: A Randomized Double-blind Controlled Trial. Acad Emerg Med 2019; 26:434-442. [PMID: 30156361 DOI: 10.1111/acem.13560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/10/2018] [Accepted: 07/14/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Short-acting β2 -agonists are the mainstay of treatment of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in the emergency department (ED). It is still unclear whether the addition of short-acting anticholinergics is clinically more effective care compared to treatment with β2 -agonists alone in patients with hypercapnic AECOPD. OBJECTIVE The objective was to evaluate whether combining ipratropium bromide (IB) to terbutaline reduces hospital and intensive care unit (ICU) admission rates compared to terbutaline alone in AECOPD hypercapnic patients. METHODS In this double-blind controlled trial, patients who were admitted to the ED for AECOPD requiring noninvasive ventilation (NIV) were randomized to receive either 5 mg of nebulized terbutaline combined to 0.5 mg of IB (terbutaline/IB group, n = 115) or 5 mg of terbutaline sulfate (terbutaline group, n = 117). Nebulization was repeated every 20 minutes for the first hour and every 4 hours within the first day. Primary outcomes were the rate of hospital admission and need for endotracheal intubation within the first 24 hours of the start of the experimental treatment. Secondary outcomes included changes from baseline of dyspnea, physiologic variables, length of hospital stay, ICU admission rate, and 7-day mortality. RESULTS The two groups were similar regarding baseline demographic and clinical characteristics. Hospital admission was observed in 70 patients (59.8%) in the terbutaline/IB group and in 75 patients (65.2%) in the terbutaline group (respiratory rate [RR] = 1.09, 95% confidence interval [CI] = 0.93 to 1.27, p = 0.39). ICU admission was required in 37 (32.2%) patients in the terbutaline/IB group and 30 patients (25.6%) in terbutaline group (RR = 1.25, 95% CI = 1.02 to 1.54, p = 0.27). There were no significant differences in dyspnea score, blood gas parameters changes, vital signs improvement, and 7-day death rate between both groups. CONCLUSION In patients admitted to the ED for AECOPD requiring NIV, combination of nebulized IB and terbutaline did not reduce hospital admission and need to ICU care.
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Affiliation(s)
- Kaouthar Beltaief
- Emergency Department Fattouma Bourguiba University Hospital Monastir Tunisia
- Research Laboratory LR12SP18 University of Monastir Monastir Tunisia
| | - Mohamed Amine Msolli
- Emergency Department Fattouma Bourguiba University Hospital Monastir Tunisia
- Research Laboratory LR12SP18 University of Monastir Monastir Tunisia
| | - Asma Zorgati
- Emergency Department Sahloul University Hospital Sousse Tunisia
| | - Adel Sekma
- Emergency Department Fattouma Bourguiba University Hospital Monastir Tunisia
- Research Laboratory LR12SP18 University of Monastir Monastir Tunisia
| | - Marwen Fakhfakh
- Emergency Department Fattouma Bourguiba University Hospital Monastir Tunisia
- Research Laboratory LR12SP18 University of Monastir Monastir Tunisia
| | - Maryem Ben Marzouk
- Emergency Department Fattouma Bourguiba University Hospital Monastir Tunisia
- Research Laboratory LR12SP18 University of Monastir Monastir Tunisia
| | - Hamdi Boubaker
- Emergency Department Fattouma Bourguiba University Hospital Monastir Tunisia
- Research Laboratory LR12SP18 University of Monastir Monastir Tunisia
| | - Mohamed Habib Grissa
- Emergency Department Fattouma Bourguiba University Hospital Monastir Tunisia
- Research Laboratory LR12SP18 University of Monastir Monastir Tunisia
| | - Mehdi Methamem
- Emergency Department Farhat Hached University Hospital Sousse Tunisia
| | - Riadh Boukef
- Emergency Department Sahloul University Hospital Sousse Tunisia
- Research Laboratory LR12SP18 University of Monastir Monastir Tunisia
| | - Asma Belguith
- Department of Preventive Medicine Fattouma Bourguiba University Hospital Monastir Tunisia
| | - Wahid Bouida
- Emergency Department Fattouma Bourguiba University Hospital Monastir Tunisia
- Research Laboratory LR12SP18 University of Monastir Monastir Tunisia
| | - Semir Nouira
- Emergency Department Fattouma Bourguiba University Hospital Monastir Tunisia
- Research Laboratory LR12SP18 University of Monastir Monastir Tunisia
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Bouida W, Beltaief K, Msolli MA, Ben Marzouk M, Boubaker H, Grissa MH, Zorgati A, Methamem M, Boukef R, Belguith A, Nouira S. Effect on Morphine Requirement of Early Administration of Oral Acetaminophen vs. Acetaminophen/Tramadol Combination in Acute Pain. Pain Pract 2019; 19:275-282. [PMID: 30303612 DOI: 10.1111/papr.12736] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 08/29/2018] [Accepted: 09/18/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the effect on opioid requirement of pain treatment starting at triage, and to evaluate satisfaction in emergency department (ED) patients with acute pain. METHODS This is a single-blind, randomized, prospective study conducted in the ED. The included patients were randomly assigned to single oral doses of placebo, acetaminophen, or a tramadol/acetaminophen combination. Protocol treatment was given at triage. The primary outcome was the need for rescue morphine during ED stay. The secondary outcome included patient satisfaction, ED length of stay, and percentage of patients discharged from the ED with a VAS score of <30. RESULTS We included 1,485 patients: 496 patients in the placebo group, 497 in the acetaminophen group, and 492 in the tramadol/acetaminophen combination group. The groups were similar regarding demographic and clinical characteristics and baseline VAS pain scores. Rescue morphine was significantly decreased in the tramadol/acetaminophen combination group compared to that in the placebo and acetaminophen groups (11.5%, 23.2%, and 18.9%, respectively; P = 0.03). Patient satisfaction was higher in the tramadol/acetaminophen combination group (77% vs. 69% in the acetaminophen group and 68% in the placebo group). A VAS score of <30 was observed in 84% of patients in the placebo group, 83% in the acetaminophen group, and 87% in the tramadol/acetaminophen combination group (P = 0.01 between the acetaminophen group and tramadol/acetaminophen combination group). The ED length of stay was 60 minutes for the acetaminophen group and tramadol/acetaminophen combination group and 71 minutes for the placebo group (P = 0.04). CONCLUSION Oral tramadol/acetaminophen combination administered early in triage was associated with a decrease in intravenous morphine requirement and increase in satisfaction among ED patients with acute pain when compared with patients taking acetaminophen. No significant increase in side effects was found. This intervention may be considered in EDs with an aim of similar benefits.
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Affiliation(s)
- Wahid Bouida
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Kaouthar Beltaief
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Mohamed Amine Msolli
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Maryem Ben Marzouk
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Hamdi Boubaker
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Mohamed Habib Grissa
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
| | - Asma Zorgati
- Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Mehdi Methamem
- Emergency Department, Farhat Hached University Hospital, Sousse, Tunisia
| | - Riadh Boukef
- Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia.,Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Asma Belguith
- Department of Preventive Medicine, Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | - Semir Nouira
- Emergency Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.,Research Laboratory LR12SP18, University of Monastir, Monastir, Tunisia
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Bouida W, Beltaief K, Msolli MA, Azaiez N, Ben Soltane H, Sekma A, Trabelsi I, Boubaker H, Grissa MH, Methemem M, Boukef R, Dridi Z, Belguith A, Nouira S. Low-dose Magnesium Sulfate Versus High Dose in the Early Management of Rapid Atrial Fibrillation: Randomized Controlled Double-blind Study (LOMAGHI Study). Acad Emerg Med 2019; 26:183-191. [PMID: 30025177 DOI: 10.1111/acem.13522] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/12/2018] [Accepted: 07/14/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We aim to determine the benefit of two different doses magnesium sulfate (MgSO4 ) compared to placebo in rate control of rapid atrial fibrillation (AF) managed in the emergency department (ED). METHODS We undertook a randomized, controlled, double-blind clinical trial in three university hospital EDs between August 2009 and December 2014. Patients > 18 years with rapid AF (>120 beats/min) were enrolled and randomized to 9 g of intravenous MgSO4 (high-dose group, n = 153), 4.5 g of intravenous MgSO4 (low-dose group, n = 148), or serum saline infusion (placebo group, n = 149), given in addition to atrioventricular (AV) nodal blocking agents. The primary outcome was the reduction of baseline ventricular rate (VR) to 90 beats/min or less or reduction of VR by 20% or greater from baseline (therapeutic response). Secondary outcome included resolution time (defined as the elapsed time from start of treatment to therapeutic response), sinus rhythm conversion rate, and adverse events within the first 24 hours. RESULTS At 4 hours, therapeutic response rate was higher in low- and high-MgSO4 groups compared to placebo group; the absolute differences were, respectively, 20.5% (risk ratio [RR] = 2.31, 95% confidence interval [CI] = 1.45-3.69) and +15.8% (RR = 1.89, 95% CI = 1.20-2.99). At 24 hours, compared to placebo group, therapeutic response difference was +14.1% (RR = 9.74, 95% CI = 2.87-17.05) with low-dose MgSO4 and +10.3% (RR = 3.22, 95% CI = 1.45-7.17) with high-dose MgSO4 . The lowest resolution time was observed in the low-dose MgSO4 group (5.2 ± 2 hours) compared to 6.1 ± 1.9 hours in the high-dose MgSO4 group and 8.4 ± 2.5 hours in the placebo group. Rhythm control rate at 24 hours was significantly higher in the low-dose MgSO4 group (22.9%) compared to the high-dose MgSO4 group (13.0%, p = 0.03) and the placebo group (10.7%). Adverse effects were minor and significantly more frequent with high-dose MgSO4 . CONCLUSIONS Intravenous MgSO4 appears to have a synergistic effect when combined with other AV nodal blockers resulting in improved rate control. Similar efficacy was observed with 4.5 and 9 g of MgSO4 but a dose of 9 g was associated with more side effects.
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Affiliation(s)
- Wahid Bouida
- Emergency Department Fattouma Bourguiba University Hospital Monastir
- Research Laboratory LR12SP18 University of Monastir Monastir
| | - Kaouthar Beltaief
- Emergency Department Fattouma Bourguiba University Hospital Monastir
- Research Laboratory LR12SP18 University of Monastir Monastir
| | - Mohamed Amine Msolli
- Emergency Department Fattouma Bourguiba University Hospital Monastir
- Research Laboratory LR12SP18 University of Monastir Monastir
| | | | - Houda Ben Soltane
- Research Laboratory LR12SP18 University of Monastir Monastir
- Emergency Department Farhat Hached University Hospital Sousse Tunisia
| | - Adel Sekma
- Emergency Department Fattouma Bourguiba University Hospital Monastir
- Research Laboratory LR12SP18 University of Monastir Monastir
| | - Imen Trabelsi
- Research Laboratory LR12SP18 University of Monastir Monastir
| | - Hamdi Boubaker
- Emergency Department Fattouma Bourguiba University Hospital Monastir
- Research Laboratory LR12SP18 University of Monastir Monastir
| | - Mohamed Habib Grissa
- Emergency Department Fattouma Bourguiba University Hospital Monastir
- Research Laboratory LR12SP18 University of Monastir Monastir
| | - Mehdi Methemem
- Emergency Department Farhat Hached University Hospital Sousse Tunisia
| | - Riadh Boukef
- Emergency Department Sahloul University Hospital Sousse
- Research Laboratory LR12SP18 University of Monastir Monastir
| | - Zohra Dridi
- Cardiology Department Fattouma Bourguiba University Hospital Monastir
| | - Asma Belguith
- Department of Preventive Medicine Fattouma Bourguiba University Hospital Monastir
| | - Semir Nouira
- Emergency Department Fattouma Bourguiba University Hospital Monastir
- Research Laboratory LR12SP18 University of Monastir Monastir
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Chouchene S, Dabboubi R, Raddaoui H, Abroug H, Ben Hamda K, Hadj Fredj S, Abderrazak F, Gaaloul M, Rezek M, Neffeti F, Hellara I, Sassi M, Khefacha L, Sriha A, Nouira S, Najjar MF, Maatouk F, Messaoud T, Hassine M. Clopidogrel utilization in patients with coronary artery disease and diabetes mellitus: should we determine CYP2C19*2 genotype? Eur J Clin Pharmacol 2018; 74:1567-1574. [PMID: 30073432 DOI: 10.1007/s00228-018-2530-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 07/26/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Clopidogrel non-responsiveness is multifactorial; several genetic and non-genetic factors may contribute to impaired platelet inhibition. The goal of this study is to determine the effect of the cytochrome P450 CYP2C19*2 polymorphism on the platelet response to clopidogrel in patients with and without diabetes mellitus (DM). METHODS We conducted an observational study in patients with coronary artery disease and consequent exposure to clopidogrel therapy (75 mg/day for at least 7 consecutive days). We have analyzed two groups of patients: group I (DM patients) and group II (non-diabetes mellitus patients). Platelet reactivity was assessed by the VerifyNow P2Y12 assay and high on clopidogrel platelet reactivity (HPR) was defined as P2Y12 reaction units (PRU) ≥ 208. Genotyping for CYP2C19*2 polymorphism was performed by PCR-RFLP. RESULTS We have included 150 subjects (76 DM and 74 non-diabetes mellitus patients). The carriage of CYP2C19*2 allele, in DM patients, was significantly associated to HPR (odds ratio (OR) 4.437, 95% confidence interval (CI) 1.134 to 17.359; p = 0.032). Furthermore, 8.4% of the variability in percent inhibition by clopidogrel could be attributed to CYP2C19*2 carrier status. However, in non-diabetes mellitus patients, there was no significant difference in platelet response to clopidogrel according to the presence or absence of CYP2C19*2 allele carriage (OR 1.260, 95% CI 0.288 to 5.522; p = 0.759). CONCLUSIONS Our study suggests that the carriage of CYP2C19*2 polymorphism, in DM patients, might be a potential predictor of persisting HPR in these high-risk individuals. TRIAL REGISTRATION Clinical Trials.gov NCT03373552 (Registered 13 December 2017).
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Affiliation(s)
- Saoussen Chouchene
- Hematology Department, Fattouma Bourguiba University Hospital, TN 5000, Monastir, Tunisia.
| | - Rym Dabboubi
- Biochemistry and Molecular Biology Laboratory (LR00SP03), Children's Hospital Bechir Hamza, 1006, Tunis, Tunisia
| | - Haythem Raddaoui
- Cardiology Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia
| | - Hela Abroug
- Epidemiology and Preventive Medicine Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia
| | - Khaldoun Ben Hamda
- Cardiology Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia
| | - Sondess Hadj Fredj
- Biochemistry and Molecular Biology Laboratory (LR00SP03), Children's Hospital Bechir Hamza, 1006, Tunis, Tunisia
| | - Fatma Abderrazak
- Hematology Department, Fattouma Bourguiba University Hospital, TN 5000, Monastir, Tunisia
| | - Mayssa Gaaloul
- Hematology Department, Fattouma Bourguiba University Hospital, TN 5000, Monastir, Tunisia
| | - Marwa Rezek
- Hematology Department, Fattouma Bourguiba University Hospital, TN 5000, Monastir, Tunisia
| | - Fadoua Neffeti
- Biochemistry Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia
| | - Ilhem Hellara
- Biochemistry Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia
| | - Mouna Sassi
- Biology Department, Maternity and Neonatal Medicine Center, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia
| | - Linda Khefacha
- Biology Department, Maternity and Neonatal Medicine Center, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia
| | - Asma Sriha
- Epidemiology and Preventive Medicine Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia
| | - Semir Nouira
- Research Laboratory (LR12SP18), University of Monastir, 5000, Monastir, Tunisia
| | - Mohamed Fadhel Najjar
- Biochemistry Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia
| | - Faouzi Maatouk
- Cardiology Department, Fattouma Bourguiba University Hospital, 5000, Monastir, Tunisia
| | - Taieb Messaoud
- Biochemistry and Molecular Biology Laboratory (LR00SP03), Children's Hospital Bechir Hamza, 1006, Tunis, Tunisia
| | - Mohsen Hassine
- Hematology Department, Fattouma Bourguiba University Hospital, TN 5000, Monastir, Tunisia
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Msolli MA, Beltaief K, Bouida W, Jerbi N, Grissa MH, Boubaker H, Boukef R, Nouira S. Value of early change of serum C reactive protein combined to modified Alvarado score in the diagnosis of acute appendicitis. BMC Emerg Med 2018; 18:15. [PMID: 29793425 PMCID: PMC5968536 DOI: 10.1186/s12873-018-0166-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 05/15/2018] [Indexed: 11/12/2022] Open
Abstract
Background The aim of this study is to test the diagnostic value of baseline and early change of C-reactive protein (CRP) concentrations, evaluated separately or in combination with the modified Alvarado score (MAS), in patients with clinically suspected acute appendicitis. Methods This is a prospective observational study including all patients presenting to the emergency department with an equivocal diagnosis of acute appendicitis. After inclusion, clinical and demographic data are recorded and blood samples were taken at baseline and 3 h after for serum CRP measurements (3 h CRP). The MAS is also calculated for all patients. The ultimate diagnosis of appendicitis was based on the histologic findings of the excised appendix in operated patients and clinical follow-up in emergency department discharged patients. Diagnostic accuracy of admission CRP, early change of CRP 3 h CRP minus admission CRP, MAS and the combination of these parameters was expressed by sensitivity, specificity, positive predictive value, negative predictive value and area under receiver operating characteristics curve. Results Five hundred patients were included from January 2010 to December 2013. Overall, 387 patients were operated the negative appendectomy rate was 8,3%. CRP concentrations were higher in patients with acute appendicitis. However, the diagnostic value of admission CRP, delta CRP and MAS was moderate with area under ROC curve respectively equal to 0.63, 0.53 and 0.6. Combining admission CRP and delta CRP values to MAS did not result in a better performance. The area under ROC curve did not exceed 0.7 with the different combinations. Conclusion Early change of CRP has a moderate diagnostic value in patients with clinically suspected acute appendicitis. Combining CRP values to MAS did not improve diagnostic accuracy.
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Affiliation(s)
- Mohamed Amine Msolli
- Emergency Department, FattoumaBourguiba University Hospital Monastir, 5000, Monastir, Tunisia. .,Research Laboratory (LR12SP18), University of Monastir, 5000, Monastir, Tunisia.
| | - Kaouther Beltaief
- Emergency Department, FattoumaBourguiba University Hospital Monastir, 5000, Monastir, Tunisia.,Research Laboratory (LR12SP18), University of Monastir, 5000, Monastir, Tunisia
| | - Wahid Bouida
- Emergency Department, FattoumaBourguiba University Hospital Monastir, 5000, Monastir, Tunisia.,Research Laboratory (LR12SP18), University of Monastir, 5000, Monastir, Tunisia
| | - Nahla Jerbi
- Emergency Department, Mahdia University Hospital, 5100, Mahdia, Tunisia.,Research Laboratory (LR12SP18), University of Monastir, 5000, Monastir, Tunisia
| | - Mohamed Habib Grissa
- Emergency Department, FattoumaBourguiba University Hospital Monastir, 5000, Monastir, Tunisia.,Research Laboratory (LR12SP18), University of Monastir, 5000, Monastir, Tunisia
| | - Hamdi Boubaker
- Emergency Department, FattoumaBourguiba University Hospital Monastir, 5000, Monastir, Tunisia.,Research Laboratory (LR12SP18), University of Monastir, 5000, Monastir, Tunisia
| | - Riadh Boukef
- Emergency Department, Sahloul University Hospital, 4011, Sousse, Tunisia.,Research Laboratory (LR12SP18), University of Monastir, 5000, Monastir, Tunisia
| | - Semir Nouira
- Emergency Department, FattoumaBourguiba University Hospital Monastir, 5000, Monastir, Tunisia.,Research Laboratory (LR12SP18), University of Monastir, 5000, Monastir, Tunisia
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Bouida W, Beltaief K, Baccouche H, Sassi M, Dridi Z, Trabelsi I, Laaouiti K, Chakroun T, Hellara I, Boukef R, Sakly N, Hassine M, Added F, Razgallah R, Najjar F, Nouira S. Effects of Ramadan fasting on aspirin resistance in type 2 diabetic patients. PLoS One 2018. [PMID: 29529091 PMCID: PMC5846719 DOI: 10.1371/journal.pone.0192590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Aims Ramadan fasting (RF) may affect aspirin resistance. We conducted this study in patients with cardiovascular risk (CVR) factors to assess the effect of RF on aspirin resistance and explore whether type 2 diabetes mellitus (DM) would influence this effect. Methods A total of 177 stable patients with ≥2 CVR factors were recruited. All patients observed RF and were taking aspirin. Physical exam and standard biological tests including glycaemia and serum lipids data were performed before Ramadan (Pre-R), at the last week of Ramadan (R) and four weeks after the end of Ramadan (Post-R). In the same visits caloric intake was calculated and platelet reactivity to aspirin was assessed using Verify Now point-of-care assay. Results In the overall population, there was no significant change in absolute aspirin reaction unit (ARU) values and in metabolic parameters. In DM patients (n = 127), ARU change from Pre-R values was+19.7 (p = 0.01) and +14.4 (p = 0.02) respectively at R and Post-R. During Ramadan, glycaemia, triglycerides, and cholesterol levels increased significantly and returned to Pre-R values thereafter. These changes were not observed in non-DM patients. Conclusions During RF aspirin resistance increased only in DM patients. This effect persisted one month after Ramadan. Simultaneous alteration of glycemic control and increase of serum lipids levels could potentially be a favorable factor. Study registration The protocol was registered at clinicaltrials.gov under: NCT02720133.
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Affiliation(s)
- Wahid Bouida
- Emergency Department, FattoumaBourguiba University Hospital, Monastir, Tunisia
- Research Laboratory (LR12SP18) University of Monastir, Monastir, Tunisia
| | - Kaouthar Beltaief
- Emergency Department, FattoumaBourguiba University Hospital, Monastir, Tunisia
- Research Laboratory (LR12SP18) University of Monastir, Monastir, Tunisia
| | - Houda Baccouche
- Emergency Department, FattoumaBourguiba University Hospital, Monastir, Tunisia
- Research Laboratory (LR12SP18) University of Monastir, Monastir, Tunisia
| | - Mouna Sassi
- Research Laboratory (LR12SP18) University of Monastir, Monastir, Tunisia
- Biological Laboratory, Maternity and Neonatal Medicine Center, Monastir, Tunisia
| | - Zohra Dridi
- Cardiology Department, FattoumaBourguiba University Hospital, Monastir, Tunisia
| | - Imen Trabelsi
- Emergency Department, FattoumaBourguiba University Hospital, Monastir, Tunisia
- Research Laboratory (LR12SP18) University of Monastir, Monastir, Tunisia
| | - Kamel Laaouiti
- Emergency Department, FattoumaBourguiba University Hospital, Monastir, Tunisia
- Research Laboratory (LR12SP18) University of Monastir, Monastir, Tunisia
| | - Taher Chakroun
- Regional blood transfusion center, FarhatHached University Hospital, Sousse, Tunisia
| | - Ilhem Hellara
- Research Laboratory (LR12SP18) University of Monastir, Monastir, Tunisia
- Hematology Department, FattoumaBourguiba University Hospital, Monastir, Tunisia
| | - Riadh Boukef
- Research Laboratory (LR12SP18) University of Monastir, Monastir, Tunisia
- Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Nabil Sakly
- Laboratory of Immunology, FattoumaBourguiba University Hospital, Monastir Tunisia
| | - Mohsen Hassine
- Research Laboratory (LR12SP18) University of Monastir, Monastir, Tunisia
- Hematology Department, FattoumaBourguiba University Hospital, Monastir, Tunisia
| | - Faouzi Added
- Research Laboratory (LR12SP18) University of Monastir, Monastir, Tunisia
- Cardiology Department, AbderrahmanMami University Hospital, Ariana Tunisia
| | | | - Fadhel Najjar
- Biochemistry Department, FattoumaBourguiba University Hospital, Monastir Tunisia
| | - Semir Nouira
- Emergency Department, FattoumaBourguiba University Hospital, Monastir, Tunisia
- Research Laboratory (LR12SP18) University of Monastir, Monastir, Tunisia
- * E-mail:
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Beltaief K, Grissa MH, Msolli MA, Bzeouich N, Fredj N, Sakma A, Boubaker H, Bouida W, Boukef R, Nouira S. Acupuncture versus titrated morphine in acute renal colic: a randomized controlled trial. J Pain Res 2018; 11:335-341. [PMID: 29483783 PMCID: PMC5815470 DOI: 10.2147/jpr.s136299] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objective The objective of this study was to compare the analgesic effect and tolerance profile of acupuncture versus intravenous (IV) titrated morphine in patients presenting to the emergency department (ED) with renal colic. Materials and methods A total of 115 patients were randomized into two groups. Patients in the IV titrated-morphine group (n=61) received 0.1 mg/kg morphine every 5 minutes until pain score dropped by at least 50% of its baseline value. Patients in the acupuncture group (n=54) received an acupuncture session of 30 minutes following a prespecified protocol. The visual analog scale (VAS) was used to assess pain intensity at baseline and at 10, 20, 30, 45, and 60 minutes following the start of the treatment protocol. Possible treatment side effects were also recorded. Results No significant differences were found between the two groups concerning age, sex, or baseline VAS score. From the 10th minute until the end of the intervention, acupuncture was associated with a deeper analgesic effect than titrated morphine (P<0.05 from the 10th minute and over). Analgesia was also faster in the acupuncture group, with time to obtain 50% reduction of baseline VAS of 14 minutes in the acupuncture group versus 28 minutes in the IV titrated-morphine group (P<0.001). Only three patients in the acupuncture group experienced minor side effects versus 42 in the morphine group (P<0.001). No major side effects were observed in this study. Conclusion In ED patients with renal colic, acupuncture was associated with a much faster and deeper analgesic effect and a better tolerance profile in comparison with titrated IV morphine.
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Affiliation(s)
- Kaouthar Beltaief
- Emergency Department, Fattouma Bourguiba University Hospital.,Research Laboratory LR12SP18, University of Monastir, Monastir
| | - Mohamed Habib Grissa
- Emergency Department, Fattouma Bourguiba University Hospital.,Research Laboratory LR12SP18, University of Monastir, Monastir
| | - Mohamed Amine Msolli
- Emergency Department, Fattouma Bourguiba University Hospital.,Research Laboratory LR12SP18, University of Monastir, Monastir
| | - Nasri Bzeouich
- Emergency Department, Fattouma Bourguiba University Hospital.,Research Laboratory LR12SP18, University of Monastir, Monastir
| | - Nizar Fredj
- Emergency Department, Fattouma Bourguiba University Hospital.,Research Laboratory LR12SP18, University of Monastir, Monastir
| | - Adel Sakma
- Emergency Department, Fattouma Bourguiba University Hospital.,Research Laboratory LR12SP18, University of Monastir, Monastir
| | - Hamdi Boubaker
- Emergency Department, Fattouma Bourguiba University Hospital.,Research Laboratory LR12SP18, University of Monastir, Monastir
| | - Wahid Bouida
- Emergency Department, Fattouma Bourguiba University Hospital.,Research Laboratory LR12SP18, University of Monastir, Monastir
| | - Riadh Boukef
- Emergency Department, Fattouma Bourguiba University Hospital.,Emergency Department, Sahloul University Hospital, Sousse, Tunisia
| | - Semir Nouira
- Emergency Department, Fattouma Bourguiba University Hospital.,Research Laboratory LR12SP18, University of Monastir, Monastir
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50
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Messous S, Grissa MH, Beltaief K, Boukef R, Nouira S, Mastouri M. [Bacteriology of acute exacerbations of chronic obstructive pulmonary disease in Tunisia]. Rev Mal Respir 2018; 35:36-47. [PMID: 29395563 DOI: 10.1016/j.rmr.2017.03.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 03/17/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The role of bacteria, including atypical organisms, in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) has been assessed in various ways in Tunisia. METHODS This was a descriptive and analytical study of patients with a mean age of 68.3±10.5 years hospitalized for AECOPD. Bacteriological examination included a cytological sputum exam and serology for atypical organisms including Mycoplasma pneumoniae, Coxiella burnetii, Chlamydophila pneumoniae and Legionella pneumophila using standard techniques. RESULTS Of the 240 patients enrolled, 175 sputum cultures (73%) were considered significant. Twenty-nine cultures were positive (16.5%) and 31 microorganisms were isolated of which the most frequent were P. aeruginosa (25.8%), K. pneumoniae (16.2%), H. influenzae (13%) and S. pneumoniae (9.7%). The prevalence of C. pneumoniae, M. pneumoniae and C. burnetii was 8.4%, 9% and 6.6%, respectively. No L. pneumophila infection was found. The Anthonisen criteria were associated with a positive culture (P=0.04). Almost half (40.9%) of the isolates were resistant to conventional first line antibiotics (43.7% to amoxicillin-clavulanic acid). CONCLUSIONS Awareness of the low positivity of quantitative sputum bacteriology and the large percentage of resistant strains with a predominance of exclusively multi-resistant Pseudomonas should help in the management of patients with AECOPD.
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Affiliation(s)
- S Messous
- Laboratoire de recherche (LR12SP18), université de Monastir, Monastir, Tunisie; Laboratoire de microbiologie, hôpital universitaire Fattouma Bourguiba de Monastir, Monastir, Tunisie.
| | - M H Grissa
- Laboratoire de recherche (LR12SP18), université de Monastir, Monastir, Tunisie; Services des urgences, hôpital universitaire Fattouma Bourguiba de Monastir, Monastir, Tunisie
| | - K Beltaief
- Laboratoire de recherche (LR12SP18), université de Monastir, Monastir, Tunisie; Services des urgences, hôpital universitaire Fattouma Bourguiba de Monastir, Monastir, Tunisie
| | - R Boukef
- Laboratoire de recherche (LR12SP18), université de Monastir, Monastir, Tunisie; Services des urgences, hôpital universitaire Sahloul de Sousse, Sousse, Tunisie
| | - S Nouira
- Laboratoire de recherche (LR12SP18), université de Monastir, Monastir, Tunisie; Services des urgences, hôpital universitaire Fattouma Bourguiba de Monastir, Monastir, Tunisie
| | - M Mastouri
- Laboratoire de recherche (LR12SP18), université de Monastir, Monastir, Tunisie; Laboratoire de microbiologie, hôpital universitaire Fattouma Bourguiba de Monastir, Monastir, Tunisie
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