Value of Lung Ultrasound Sonography B-Lines Quantification as a Marker of Heart Failure in COPD Exacerbation

Fadwa Lajili,1,2 Marwa Toumia,1,2 Adel Sekma,1,2 Khaoula Bel Haj Ali,1,2 Sarra Sassi,1,2 Asma Zorgati,3 Hajer Yaakoubi,3 Rym Youssef,3 Mohamed Habib Grissa,1,2 Kaouther Beltaief,1,2 Zied Mezgar,4 Mariem Khrouf,4 Ikram Chamtouri,5 Wahid Bouida,1,2 Hamdi Boubaker,1,2 Mohamed Amine Msolli,1,2 Zohra Dridi,6 Riadh Boukef,1,3 Semir Nouira1,2 1Research Laboratory LR12SP18, Monastir University, Monastir, 5019, Tunisia; 2Emergency Department, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia; 3Emergency Department, Sahloul University Hospital, Sousse, 4011, Tunisia; 4Emergency Department, Farhat Hached University Hospital, Sousse, 4031, Tunisia; 5Department of Cardiology B, Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia; 6Department of Cardiology A, Fattouma Bourguiba University Hospital, Monastir, 5000, TunisiaCorrespondence: Semir Nouira, Emergency Department and Laboratory Research(LR12SP18), Fattouma Bourguiba University Hospital, Monastir, 5000, Tunisia, Tel +21673106046, Email [email protected]: Identifying heart failure (HF) in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) can be challenging. Lung ultrasound sonography (LUS) B-lines quantification has recently gained a large place in the diagnosis of HF, but its diagnostic performance in AECOPD remains poorly studied.Purpose: This study aimed to assess the contribution of LUS B-lines score (LUS score) in the diagnosis of HF in AECOPD patients.Patients and methods: This is a prospective cross-sectional multicenter cohort study including patients admitted to the emergency department for AECOPD. All included patients underwent LUS. A lung ultrasound score (LUS score) based on B-lines calculation was assessed. A cardiac origin of dyspnea was retained for a LUS score greater than 15. HF diagnosis was based on clinical examination, pro-brain natriuretic peptide levels, and echocardiographic findings. The LUS score diagnostic performance was assessed by receiver operating characteristic (ROC) curve, sensitivity, specificity, and likelihood ratio at the best cutoffs.Results: We included 380 patients, mean age was 68± 11.6 years, sex ratio (M/F) 1.96. Patients were divided into two groups: the HF group [n=157 (41.4%)] and the non-HF group [n=223 (58.6%)]. Mean LUS score was higher in the HF group (26.8± 8.4 vs 15.3± 7.1; p< 0.001). The mean LUS score in the HF patients with reduced LVEF was 29.2± 8.7, and was 24.5± 7.6 in the HF patients with preserved LVEF. LUS score area under ROC curve for the diagnosis of HF was 0.71 [0.65– 0.76]. The best sensitivity (89% [85.9– 92,1]) was observed at the threshold of 5; the best specificity (85% [81.4– 88.6]) was observed at the threshold of 30. Correlation between LUS score and E/E’ ratio was good (R=0.46, p=0.0001).Conclusion: Our results suggest that LUS score could be helpful and should be considered in the diagnostic approach of HF in AECOPD patients, at least as a ruling in test.Keywords: chronic obstructive pulmonary disease, COPD, heart failure, dyspnea, lung ultrasound sonograph

Avulsion of the Lesser Trochanter Following a Shot Put Sport Session

Avulsion of the lesser trochanter is an uncommon injury. In children and adolescents it usually occurs as a sports injury via traumatic avulsion of the psoas major tendon. In adults, isolated fractures of the lesser trochanter are most commonly pathological due to metastatic tumor invasion of the proximal femur. This case report documents how a 14-year-old boy, who presented with an avulsion of the lesser trochanter of the proximal femur following a seemingly atraumatic shot put session at a track and field event, was diagnosed and successfully treated with a conservative approach

Avulsion of the Lesser Trochanter Following a Shot Put Sport Session

Avulsion of the lesser trochanter is an uncommon injury. In children and adolescents it usually occurs as a sports injury via traumatic avulsion of the psoas major tendon. In adults, isolated fractures of the lesser trochanter are most commonly pathological due to metastatic tumor invasion of the proximal femur. This case report documents how a 14-year-old boy, who presented with an avulsion of the lesser trochanter of the proximal femur following a seemingly atraumatic shot put session at a track and field event, was diagnosed and successfully treated with a conservative approach

Acupuncture versus titrated morphine in acute renal colic: a randomized controlled trial

Kaouthar Beltaief,1,2 Mohamed Habib Grissa,1,2 Mohamed Amine Msolli,1,2 Nasri Bzeouich,1,2 Nizar Fredj,1,2 Adel Sakma,1,2 Hamdi Boubaker,1,2 Wahid Bouida,1,2 Riadh Boukef,1,3 Semir Nouira1,2 1Emergency Department, Fattouma Bourguiba University Hospital, 2Research Laboratory LR12SP18, University of Monastir, Monastir, 3Emergency Department, Sahloul University Hospital, Sousse, Tunisia 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. Keywords: acupuncture, morphine, renal coli