Publications by authors named "S Toujani"

50 Publications

[Nutritional status and dietary intake in patients with chonic obstructive pulmonary disease].

Rev Mal Respir 2021 Jun 3. Epub 2021 Jun 3.

Service de pneumologie, faculté de médecine de Tunis, université Tunis El Manar, CHU la Rabta, rue Jbel Lakhdar La Rabta, LR18SP02, 1007 Tunis, Tunisie.

Introduction: Undernutrition is a predictor of mortality in chronic obstructive pulmonary disease (COPD). The objectives of our study were to assess nutritional intake in COPD and to study its relationship with disease severity.

Methods: A cross-sectional study that included 66 patients followed for COPD. Patients included had a body composition study and a respiratory and nutritional assessment.

Results: The mean age of the population was 66±9 years. The lean body mass index (LMI) was reduced in 26.1% of patients. It was significantly associated with the GOLD group (P=0.04) and significantly correlated with the forced expiratory volume in the first second (FEV1) (P=0.02) and the distance covered during the six-minute walk test (TM6) (P=0.01). A significant difference was found between the caloric intakes and the different GOLD groups (P=0.04). Mean intakes of calories (P=0.002; r=0.07), protein (P=0.01; r=0.16), carbohydrates (P=0.02; r=0.2) and iron (P=0.01; r=0.13) were significantly correlated with the TM6 results. Caloric intake was significantly correlated with LMI (P=0.01; r=0.16), body mass index (P=0.04; r=0.12), FEV1 (P=0.04; r=-0.12) and GOLD stage (0.002). Similarly, protein intake was significantly correlated with LMI (P=0.001; r=0.11), body mass index (P=0.02; r=0.16), FEV1(%) (P=0.001; r=-0.16) and GOLD stage (P=0.002).

Conclusion: Undernutrition in COPD is caused by decreased food intake and increased resting energy expenditure. Adequate intakes of glucose, protein, fibers, vitamins and zinc are associated with improved ventilatory function.
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http://dx.doi.org/10.1016/j.rmr.2021.04.017DOI Listing
June 2021

Maximal Voluntary Breath-Holding Tele-Inspiratory Test in Patients with Chronic Obstructive Pulmonary Disease.

Am J Mens Health 2021 May-Jun;15(3):15579883211015857

Pneumology Department, Research Laboratory RL18SP02, University of Tunis El Manar, La Rabta Hospital, Tunis, Tunisia.

Maximal voluntary inspiratory breath-holding time (MVIBHT) has proved to be of clinical utility in some obstructive ventilatory defects. This study aims to correlate the breath-holding time with pulmonary function tests in patients with chronic obstructive pulmonary disease (COPD) and to determine the feasibility of using a breath-holding test in assessing the severity of COPD.A cross-sectional study including male patients with stable COPD were conducted. Patients with respiratory comorbidities and severe or unstable cardiac diseases were excluded. Patients were interviewed and examined. Six-minute walk test (6MWT) and plethysmography were performed.For MVIBHT collection, the subject was asked to inspire deeply and to hold the breath as long as possible at the maximum inspiratory level. This maneuver was repeated three times. The best value was used for further analysis.A total of 79 patients (mean age: 64.2 ± 8) were included in this study. The mean value of MVIBHT was 24.2 ± 8.5 s. We identified a positive and significant correlations between MVIBHT and forced vital capacity ( = .630; < .001) as well as MVIBHT and forced expiratory volume in 1 s (FEV1%) ( = .671; < .001). A significant inverse correlation with total lung capacity ( = -.328; = .019) and residual volume to total lung capacity ratio ( = -.607; < .001) was noted. MVIBHT was significantly correlated to the distance in the 6MWT ( = .494; < .001). The mean MVIBHT was significantly different within spirometric grades ( < .001) and GOLD groups ( = .002). At 20.5 s, MVIBHT had a sensitivity of 72% and specificity of 96% in determining COPD patients with FEV1 <50%.Our results provide additional evidence of the usefulness of MVIBHT in COPD patients as a pulmonary function parameter.
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http://dx.doi.org/10.1177/15579883211015857DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8127757PMC
May 2021

Pheochromocytoma presenting as an authentic small vessel vasculitis and complicated with pulmonary embolism: An original presentation.

Ann Cardiol Angeiol (Paris) 2021 Jun 4;70(3):168-170. Epub 2021 May 4.

Service de médecine interne, Hôpital Mongi Slim La Marsa, Tunis, Tunisia.

Diagnosis of pheochromocytoma can be simple when classic manifestations are present. It can also be challenging and complicated in some cases because of its wide array of faces and presentations. We present a case of a 30-year-old female patient who came with acute respiratory distress, chest pain, hemoptysis, asthenia, anorexia, weight loss of 20kg, and paresthesia in her lower limbs. Clinical examination found high blood pressure, accelerated heart and respiratory rates, signs of acute right heart failure with jugular venous distention and ankle edema, reticularis livedo in the four limbs, ulcers in both knees and in the 3rd metacarpo-phalangeal articulations and necrotic lesions in both calcaneal tendons and in the right toes. Further investigations concluded on myocarditis associated with alveolar hemorrhage, pericardic and pleuritic effusions and a segmental pulmonary embolism of the right inferior lobe. Neuro-muscular biopsy was suggestive of myositis. Cutaneous biopsy found nonspecific chronic dermatitis. ANCA antibodies were tested twice and were negative. Cryoglobulinemia was also negative. Thoraco-abdomino-pelvic scan was performed showing a large right adrenal mass suggestive of pheochromocytoma. Diagnosis of right adrenal pheochromocytoma was confirmed by MIBG-I123 hyperfixation findings and urinary normetanephrin levels. The patient was treated surgically. Postoperative outcomes were remarkably favorable with a complete regression of the cutaneous lesions and normalization of the blood pressure. Paresthesia significantly decreased. Control echocardiography at 3 months showed an improved heart function with a persistent apical and septal akinesis.
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http://dx.doi.org/10.1016/j.ancard.2021.04.006DOI Listing
June 2021

COPD patients' body composition and its impact on lung function.

Tunis Med 2021 Feb;99(2):285-290

Introduction: Despite fat-free mass index (FFMI) is one of the strongest predictive factors of survival during chronic obstructive pulmonary disease (COPD), there is a considerable lack of information regarding body composition in Tunisian patients with COPD.   Aim: Describe the body composition of Tunisian patients followed for COPD and examine the relationship between body composition and the severity of the disease.

Methods: Cross-sectional study of patients with stable COPD. Body composition was assessed by bioelectrical impedance analysis. Pulmonary function tests (PFT) included spirometry with plethysmography and the six-minute walking test. The severity of dyspnea was assessed by the mMRC scale.

Results: During the study period, 104 patients with stable COPD were included (average age= 65.9 years and average FEV1= 49.3%). Fifty-four percent of patients were GOLD D stage. According to the IMM, malnutrition was identified in 20.2% of cases. Patients with low FFMI were the most symptomatic, had a more severe air flow limitation and a more severe disease. The walking distance was lower in malnourished patients. However, FFMI was not significantly associated with exercise capacity.

Conclusions: Malnutrition is highly prevalent in COPD patients and is correlated to the severity of the disease. Thus, body composition analysis should be considered in COPD patient management.
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February 2021

[Characteristics of cardiac involvement in eosinophilic granulomatosis with polyangiitis].

Ann Cardiol Angeiol (Paris) 2021 Feb 23. Epub 2021 Feb 23.

Service de médecine interne, centre hospitalier universitaire Mongi-Slim, 2070 La Marsa, Tunisie.

Aim Of The Study: Our study aimed to identify the characteristics of cardiac involvement in eosinophilic granulomatosis with polyangiitis (EGPA).

Methods: We conducted a retrospective analytic study including EGPA cases diagnosed between 2000 and 2019 in an internal medicine department. Diagnosis was made according to the 1990 American College of Rheumatology criteria and the 2012 Chapel Hill Concensus.

Results: Eleven EGPA cases were included, 64% of patients were female. Median age at diagnosis was 52 years [42-58]. Heart damage revealed EGPA in 55% of cases with a significant predominance of women (p=0.015). The main cardiac manifestations were myocarditis, ischemic cardiomyopathy due to small vessel vasculitis, cardiac tamponade and intracardiac thrombus. Cardiac magnetic resonance imaging (MRI) mainly showed subendocardial hyposignal in early infusion and late enhancement in the same areas, nodular by locations, associated with impaired left ventricle function and micro-infarctions by distal vasculitis. Cardiac damage was associated to ANCA negativity in 83.3% of cases. The median Birmingham Vasculitis Activity Score version3 (BVAS v3) was 16 [10-17]. Under conventional treatment, no relapses had occurred. The median vasculitis damage index (VDI) was 2 [1-2.3] and the mortality rate was zero after a mean follow-up of 43 months.

Conclusion: Cardiomyopathy is a frequent revealing mode of EGPA. A late onset asthma and hypereosinophilia should guide the diagnosis. As ANCA research often turns out to be negative, histological evidence is recommended in this context. The contribution of cardiac MRI in the diagnosis of EGPA remains to be defined.
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http://dx.doi.org/10.1016/j.ancard.2020.12.002DOI Listing
February 2021