Post-COVID central hypersomnia, a treatable trait in long COVID: 4 case reports

IntroductionFatigue is the most commonly reported post-COVID symptom. A minority of patients also report excessive daytime sleepiness, which could be a target for treatment.MethodsAmong 530 patients with a post-COVID condition, those with excessive daytime sleepiness were systematically assessed for objective central hypersomnia, with exclusion of all cases not clearly attributable to SARS-CoV-2 infection.ResultsFour cases of post-COVID central hypersomnia were identified, three fulfilling the criteria of the 3rd International Classification of Sleep Disorders for idiopathic hypersomnia, and one for type II narcolepsy. We report here their clinical history, sleep examination data and treatment, with a favorable response to methylphenidate in three cases and spontaneous resolution in one case.ConclusionWe highlight the importance of identifying cases of post-COVID central hypersomnia, as it may be a treatable trait of a post-COVID condition

Les antileucotriènes dans le traitement de l'asthme

This review aims to evaluate the efficacy of the leukotriene modifiers in the different stages and subgroups of asthma. In mild asthma, they bring some improvement as monotherapy, but less than inhaled steroids. In moderate asthma, leukotriene modifiers associated with inhaled steroids seem to offer a slight advantage over placebo. No evidence of additional effect has been published in severe asthma. Exercice- and aspirin-induced asthma are particulary responsive to leukotriene modifiers. This treatment may also play a role in acute asthma. In practice, it is possible to select patients who benefit from those molecules. If only these "responders" are treated, leukotriene modifiers are an adequate treatment, easy to use and well tolerated.L'objectif de cette revue est d'évaluer l'efficacité des antileucotriènes dans les différents stades et sous-groupes de l'asthme. Dans l'asthme léger, en monothérapie, ces molécules ont une efficacité indéniable, mais moindre que celle des stéroïdes inhalés. Dans l'asthme modéré, en combinaison avec des stéroïdes inhalés, ils semblent offrir un léger avantage. Aucune évidence de bénéfice n'a encore été publiée dans l'asthme sévère. L'asthme à l'effort et l'asthme à l'aspirine répondent particulièrement bien aux antileucotriènes. Ceux-ci pourraient également avoir une place dans l'asthme aigu. Dans la pratique, il est possible de sélectionner les patients qui tirent bénéfice de ces molécules. En ne traitant que ces «répondeurs», les antileucotriènes représentent un traitement adéquat, doté d'une excellente tolérance et d'une grande simplicité d'usage. Les antileucotriènes (anti-LT) sont apparus sur le marché suisse à la fin des années 90. Leur indication principale est l'asthme bronchique, même s'ils peuvent également être utiles dans la rhinite allergique,1 voire l'urticaire. Il faut rappeler que la BPCO n'est pas une indication aux anti-LT, qui sont pourtant souvent prescrits à tort dans cette pathologie. Le rôle exact de ces molécules dans l'asthme reste encore mal connu. Ce travail propose une mise à jour des connaissances sur leur efficacité dans les différents stades et sous-groupes de l'asthme bronchique

Severe Neuroexcitatory Reaction: A Rare and Underrecognized Life-Threatening Complication of Propofol-Induced Anesthesia

We describe a case of severe neuroexcitatory reaction with hyperthermia after administration of propofol in a 43-year-old patient suspected of a relapse of sarcoidosis who underwent bronchoscopy. This resulted in a lengthy stay in intensive care and long-term neuropsychological impairment. A review of the literature shows that severe neuroexcitatory symptoms (seizure-like phenomena, abnormal hypertonic, and/or jerky movements) occur rarely after propofol administration and may be life-threatening. Due to the paucity of data, the treatment is mostly empirical. The diagnosis can also be delayed owing to underrecognition. We conclude that health practitioners who frequently use propofol should be aware of this specific manifestation of drug toxicity, which albeit rare can be devastating for the patient

Rencontre du "GPS" et du poumon: navigation électromagnétique pour le diagnostic des lésions pulmonaires

Among recent technological progress, electromagnetic navigational bronchoscopy (ENB), based on the principle of "GPS", allows the bronchoscopist to reach parenchymal lesions situated beyond the field of regular bronchoscopy. Compared to CT-scan guided transthoracic needle aspiration, the yield is lower (65%). However, the rate of complication (pneumothorax, hemorrhage) is significantly lower and the patient is not irradiated. Moreover, the yield remains stable also for cases associated to a lower yield of the transthoracic approach (small and/or deep and/or benign lesion). Beyond the diagnosis of peripheral lung nodules, ENB (alone or in combination with endobronchial ultrasound) is also an efficient and safe tool for disease staging by simultaneous (during the same procedure) sampling of associated hypermetabolic lymph nodes

Somnolence résiduelle lors d’apnées du sommeil traitées par pression positive continue

Obstructive sleep apnea (OSA) is a common condition most often characterized by daytime sleepiness. cPAP therapy is very effective in reversing symptoms. However, some patients still complain of excessive daytime sleepiness despite treatment, It is essential to document sufficient use of CPAP and to rule out the presence of residual respiratory events. Search for other underlying causes of sleepiness are then to be investigated by a detailed history together with a sleep night recording. The purpose of this article is to guide the clinician in providing comprehensive medical care for those patients

Cas importés d'histoptasmose

Histoplasmosis is a fungal infection that may be opportunistic in the context of HIV. Rare in Europe, it is always imported. The two variants of histoplasmosis are encountered in defined geographic areas: var. capsulatum in Americas, Africa and Asia; and var duboisii in Africa only. In immuno-competent patients, acute infection is often asymptomatic, or it may cause a pulmonary syndrome of variable severity. Among immuno-compromised patients, histoplasmosis is disseminated and life-threatening. Diagnosis is typically made by cultures. The treatment of the disseminated form must be started immediately with anti-fungal therapy and highly active anti-retroviral treatment. In a globalized world, one has to remember the importation of unusual exotic diseases

Diagnostic yield and safety of electromagnetic navigation bronchoscopy for lung nodules: a systematic review and meta-analysis

Background: Electromagnetic navigation bronchoscopy (ENB) is an emerging endoscopic technique for the diagnosis of peripheral lung lesions. A thorough analysis of ENB's yield and safety is required for comparison to other sampling modalities

Bronchopneumopathie chronique obstructive: risques et bénéfices d’un traitement de testostérone

Muscular wasting is frequently encountered in COPD patients and is related to a decrease in exercise tolerance, a higher morbidity and mortality. One of the potential causes isa low serum testosterone, which is frequent in COPD. Various studies have explored the effect of testosterone administration alone or as part of combined pulmonary rehabilitation and nutrition protocols. Testosterone had a positive impact on muscle mass and force, and to a lesser extent on physical endurance and respiratory parameters. Future studies should better define appropriate dosage and treatment duration. In the meantime, testosterone should be administered to COPD patients with overt hypogonadism, or in multidisciplinary specialized programmes