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Candida albicans colonizes the respiratory tract of patients with Cystic Fibrosis (CF). It competes with CF-associated pathogens, such as Pseudomonas aeruginosa and Staphylococcus aureus, and contributes to disease severity. We serially... more
Candida albicans colonizes the respiratory tract of patients with Cystic Fibrosis (CF). It competes with CF-associated pathogens, such as Pseudomonas aeruginosa and Staphylococcus aureus, and contributes to disease severity. We serially recovered 160 C. albicans clinical isolates over a period of 30 months from the sputum of 23 pediatric and 2 adult antifungal-naive CF patients at Children’s Hospital Tunis and characterized the genotype and phenotype of a subset of strains using multilocus sequence typing (MLST) and growth assays on multiple stress-, filamentous growth- and biofilm-inducing media. Out of 16 patients regularly sampled for at least 9 months, 8 and 4 were chronically and transiently colonized with C. albicans, respectively. MLST analyses of 56 strains originating from 15 patients indicated that each patient was colonized with a single strain, while 8 patients (53%) carried isolates from clade 4 known to be enriched with strains from Middle East-Africa. A subset of thes...
Pre-requis: Les convulsions febriles constituent un motif frequent d'hospitalisation. Leur prise en charge demeure problematique. En effet, la pratique de la ponction lombaire est controversee. Selon l'Americain Academy of... more
Pre-requis: Les convulsions febriles constituent un motif frequent d'hospitalisation. Leur prise en charge demeure problematique. En effet, la pratique de la ponction lombaire est controversee. Selon l'Americain Academy of Pediatrics, la ponction lombaire est fortement recommandee en cas de convulsion febrile chez le nourrisson de moins de 1 an ; Cependant ce geste n'est pas denue de risque. But: Preciser la place de la ponction lombaire dans la prise en charge des convulsions febriles chez le nourrisson de moins de 12 mois en identifiant les facteurs predictifs de meningite et en repondant a la question suivante « chez quels nourrissons presentant une convulsion febrile avec un examen neurologique normal faut-il pratiquer la ponction lombaire ? ». Methodes: Eude retrospective realisee au service de medecine infantile B de l'Hopital d'Enfants de Tunis, portant sur les observations de convulsion febrile entre 3 mois et 12 mois durant une periode de huit ans ( 2000...
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BACKGROUND Acute bronchiolitis management involves all pediatricians and primary care physicians. The national guidelines for bronchiolitis diagnosis and treatment were published in Tunisia to reduce excessive use of diagnostic tests and... more
BACKGROUND Acute bronchiolitis management involves all pediatricians and primary care physicians. The national guidelines for bronchiolitis diagnosis and treatment were published in Tunisia to reduce excessive use of diagnostic tests and unify bronchiolitis management. OBJECTIVES We aimed to assess the real impact of the national guidelines on acute bronchiolitis management in Tunisia. METHODS We conducted an evaluative cross-sectional study. We randomly distributed anonymous questionnaires to physicians managing acute bronchiolitis during the period from 1st March 2014 to 30 November 2015. RESULTS We analyzed 140 questionnaires. Ninety-three interviewed physicians (66.4%) were advised of the latest national guidelines, half of them (33.6%) declared they didn't follow these guidelines. Real and complete guidelines adherence was observed in only 1.4% of interviewed physicians. According to bronchiolitis diagnosis, appropriate Chest X-rays and blood tests were requested respective...
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Les tumeurs intra-rachidiennes de l'enfant sont relativement peu frequentes. La symptomatologie clinique est polymorphe et souvent trompeuse. Les auteurs rapportent l'observation d'une fillette de 6 ans, hospitalisee pour... more
Les tumeurs intra-rachidiennes de l'enfant sont relativement peu frequentes. La symptomatologie clinique est polymorphe et souvent trompeuse. Les auteurs rapportent l'observation d'une fillette de 6 ans, hospitalisee pour boiterie, raideur rachidienne et amaigrissement., L'examen clinique trouve un effacement de la lordose lombaire, une raideur du rachis dorso-lombaire, un syndrome pyramidal faisant evoquer une atteinte medullaire. L'angio-IRM medullaire confirme le diagnostic d'une tumeur intra-durale extra-medullaire. L'examen anatomopathologique de la piece operatoire conclut a un meningiome. Les suites post operatoires sont simples.
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BACKGROUND Influenza A (H1N1) is a contagious acute respiratory infection caused a pandemic in 2009. The outcome was variable among populations. AIM To describe a clinical spectrum and the outcome of Tunisian children with pandemic... more
BACKGROUND Influenza A (H1N1) is a contagious acute respiratory infection caused a pandemic in 2009. The outcome was variable among populations. AIM To describe a clinical spectrum and the outcome of Tunisian children with pandemic H1N1/09 influenza virus. METHODS This is a retrospective, descriptive study of children with pandemic H1N1/09 influenza virus hospitalized in the children's hospital of tunis, between November 2009 and February 2010. The diagnosis was made on positive rapid test or PCR. RESULTS thirty two children were included. The median age was 12 months. The most frequently symptoms were: fever (87,5%), digestive disorders ( 59,4%) and dyspnea (15,6%). The mean length of stay was 3,8 days. The outcome was complicated by a bacterial infection (56,3%), and one death. CONCLUSION Mild form of H1N1/influenza virus is the most common presentation; however severe forms can be observed especially in infants.
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West Nile virus is currently one of the most widely distributed zoonotic arbovirus in the world, progressing into epidemics in many countries. While most infected patients experience mild to no symptoms, thousands of West Nile... more
West Nile virus is currently one of the most widely distributed zoonotic arbovirus in the world, progressing into epidemics in many countries. While most infected patients experience mild to no symptoms, thousands of West Nile virus-associated neuroinvasive cases, presenting as meningitis, encephalitis, or acute flaccid paralysis, have been reported, even in children. However, few neonatal cases have been described in literature. West Nile Virus neuroinvasive disease can lead to severe neurological disability or death, especially in infant. We report the first tunisian case of West Nile Virus meningoencephalitis in a newborn and its outcome.
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La malformation adenomatoide congenitale du poumon est une malformation rare. L'âge et les circonstances du diagnostic sont variables. Nous rapportons l'observation d'une fillette de 6 ans qui est hospitalisee pour une... more
La malformation adenomatoide congenitale du poumon est une malformation rare. L'âge et les circonstances du diagnostic sont variables. Nous rapportons l'observation d'une fillette de 6 ans qui est hospitalisee pour une pneumopathie recidivante. La radiographie du thorax montre une opacite du lobe inferieur gauche. L'IRM thoracique montre une volumineuse formation kystique avec un niveau liquide. L'enfant a ete opere avec des suites simples. L'analyse histologique de la piece operatoire conclut a une malformation adenomatoide kystique.
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Prerequis: Les pneumopathies communautaires sont responsables d'une lourde morbidite infantile. Le diagnostic etiologique n'est pas toujours aise et le traitement reste probabiliste. But: Etudier les aspects cliniques et evolutifs... more
Prerequis: Les pneumopathies communautaires sont responsables d'une lourde morbidite infantile. Le diagnostic etiologique n'est pas toujours aise et le traitement reste probabiliste. But: Etudier les aspects cliniques et evolutifs des pneumopathies communautaires, rechercher les arguments cliniques, biologiques en faveur d'une orientation etiologique et de preciser la place des examens microbiologiques dans l'identification du germe. Methodes: Etude prospective sur une periode de 7 mois (1er decembre 2004 - 30 juin 2005) realisee au service de Medecine Infantile B de l'Hopital d'Enfants de Tunis. Ont ete inclus dans cette etude les enfants âges de 6 mois a 15 ans presentant une pneumopathie communautaire. Resultats: Trente neuf enfants ont ete inclus (20 garcons et 19 filles). L'âge moyen etait de 3 ans 3 mois. Le germe a ete identifie dans 41% des cas: un mycoplasme pneumoniae dans 7 cas, un pneumocoque et un hemophilus dans 4 cas chacun, et d'une co...
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La pleuresie a meningocoque est rare chez l'enfant. Cette observation rapporte le cas d'une pleuresie purulente a meningocoque C chez un enfant de 3 ans. Le diagnostic a ete porte sur l'analyse bacteriologique du liquide de... more
La pleuresie a meningocoque est rare chez l'enfant. Cette observation rapporte le cas d'une pleuresie purulente a meningocoque C chez un enfant de 3 ans. Le diagnostic a ete porte sur l'analyse bacteriologique du liquide de ponction pleurale. L'evolution etait favorable sous antibiotiques. La pleuresie a meningocoque doit etre suspectee meme en l'absence de signe de sepsis severe et de purpura.
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Le pseudohypoaldosteronisme de type 1 (PHAI), denomme egalement resistance aux mineralocorticoides, est une maladie rare caracterisee par son debut precoce et des manifestations severes associant un syndrome de perte de sel, une... more
Le pseudohypoaldosteronisme de type 1 (PHAI), denomme egalement resistance aux mineralocorticoides, est une maladie rare caracterisee par son debut precoce et des manifestations severes associant un syndrome de perte de sel, une deshydratation et des troubles ioniques. Deux formes distinctes de la maladie ont ete individualisees: une forme systemique severe de transmission autosomique recessive et une forme localisee renale, moderee de transmission autosomique dominante ou sporadique. Nous rapportons l'observation d'un nourrisson âge de un mois et trois semaines atteint d'un pseudohypoaldosteronisme type 1 dans sa forme systemique.
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BACKGROUND Due to the marked decline of maternal-fetal rhesus incompatibility, ABO alloimmunization has become the leading cause of the newborn hemolytic disease. It is estimated that 15-25 % of all pregnancies are concerned by ABO... more
BACKGROUND Due to the marked decline of maternal-fetal rhesus incompatibility, ABO alloimmunization has become the leading cause of the newborn hemolytic disease. It is estimated that 15-25 % of all pregnancies are concerned by ABO incompatibility. AIM Neonatal blood group B seems to be more predisposing to acute hemolysis and severe hyperbilirubinemia. We propose to find if the newborn's blood group B represents a risk factor for severe hemolysis and/or severe hyperbilirubinemia. METHODS We conducted a comparative study in the pediatrics department "B" of the Children Hospital of Tunis. We collected retrospectively the medical files of the newborn hospitalized for ABO alloimmunization (January 2011 - March 2014), then we compared two groups, OA group with OA alloimmunization and OB group with OB alloimmunization. A significant threshold was fixed to 0.05. RESULTS We collected 98 cases of newborn ABO hemolytic disease. Both groups, OA and OB, were similar for the onset...
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Objective Respiratory viruses are the most important cause of lower respiratory tract infections (LRTI) in children. Meteorological factors can influence viral outbreaks. The objective of this study was to determine the association... more
Objective Respiratory viruses are the most important cause of lower respiratory tract infections (LRTI) in children. Meteorological factors can influence viral outbreaks. The objective of this study was to determine the association between climate variables and respiratory virus detection. Methods Multicenter prospective 1-year surveillance was conducted among children hospitalized for LRTI in Tunisia. Nasopharyngeal aspirates were tested by direct immunofluorescence assay (DIFA) for the detection of respiratory syncytial virus (RSV); adenovirus (AdV); influenza virus (IFV) A and B; and parainfluenza virus 1, 2, and 3 (PIV1/2/3). Samples were further analyzed by reverse-transcription polymerase chain reaction for the detection of human metapneumovirus (hMPV). Monthly meteorological data were determined by consulting the National Institute of Meteorology and the World Weather Online Meteorological Company websites. Pearson's correlation tests were used to determine the statistica...
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Inhalation of laryngotracheobronchial foreign body in children is a serious accident that may compromise the prognosis of the child and the respiratory function in the long term. identify the predictive factors of respiratory sequelae of... more
Inhalation of laryngotracheobronchial foreign body in children is a serious accident that may compromise the prognosis of the child and the respiratory function in the long term. identify the predictive factors of respiratory sequelae of laryngotracheobronchial foreign body inhalation. This retrospective study was conducted in the children hospital of Tunis during a period of nine years (2000 - 2008). In all statistical tests, the significance level was set at 0.05. 60 children were included in the study. The average age was 24.9 +/- 3.4 months. 2 / 3 of the children were boys. The foreign body was plant in 80% of cases. The penetration syndrome was reported in 83.7% of cases. The average time of stay of foreign body was 14 days. The chest radiograph was abnormal in 77.4% of cases. Endoscopic extraction was performed in 59 cases and a pneumectomy was conducted in one child. 30 children were followed for an average of 23 months. 18 children had not respiratory sequelae (clinical, rad...
Research Interests: Medicine, Humans, Child, Female, Male, and 7 moreLung Diseases, Infant, Lung, Bronchoscopy, Retrospective Studies, Foreign Bodies, and Child preschool
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Le syndrome de Guillain-Barre represente la cause la plus frequente des paralysies flasques aigues de l'enfant. Notre etude retrospective portant sur 83 enfants a pour but d'etudier les caracteristiques epidemiologiques, cliniques... more
Le syndrome de Guillain-Barre represente la cause la plus frequente des paralysies flasques aigues de l'enfant. Notre etude retrospective portant sur 83 enfants a pour but d'etudier les caracteristiques epidemiologiques, cliniques et electro-physiologiques de la maladie. La moitie des enfants sont âges de moins de 5 ans. Le sex-ratio est de 1,5. Les signes sensitifs ont precede l'installation du deficit moteur dans 30 pour cent des cas. L'atteinte des nerfs crâniens etait observee dans 42 pour cent des cas. L'atteinte des muscles respiratoires observee chez 40 pour cent des enfants. Les troubles neurovegetatifs ont ete notes chez 21,7 pour cent des enfants. L'evolution est marquee par une guerison dans 74 pour cent des cas. La mortalite est de 7,2 pour cent. L'enregistrement electromyographique a montre une atteinte demyelinisante dans 71 pour cent des cas, une atteinte axonale dans 25 pour cent des cas. Les immunoglobulines intraveineuses representent le traitement specifique de choix dans les formes severes.
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Les auteurs rapportent l'observation d'un nourrisson âge de 5 mois qui presente une hernie diaphragmatique gauche a manifestations cliniques tardives. La symptomatologie initiale est celle d'une bronchiolite virale. Une... more
Les auteurs rapportent l'observation d'un nourrisson âge de 5 mois qui presente une hernie diaphragmatique gauche a manifestations cliniques tardives. La symptomatologie initiale est celle d'une bronchiolite virale. Une premiere radiographie thoracique est normale, sur la seconde on remarque une deviation a droite du mediastin. L'echographie abdominale et le TOGD confirment le diagnostic d'une hernie diaphragmatique. La revelation tardive des hernies diaphragmatiques congenitales est rare. Le pronostic est favorable surtout en l'absence de complications.
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1. Tunis Med. 1993 May;71(5):249-53. [Cardiac insufficiency in the young child: 82 cases]. [Article in French]. Trabelsi M, Ben Hariz M, Boussetta K, Hammami A, Taktak M, Ben Naceur B. Hôpital d'Enfant de Tunis. PMID: 8212342 [PubMed... more
1. Tunis Med. 1993 May;71(5):249-53. [Cardiac insufficiency in the young child: 82 cases]. [Article in French]. Trabelsi M, Ben Hariz M, Boussetta K, Hammami A, Taktak M, Ben Naceur B. Hôpital d'Enfant de Tunis. PMID: 8212342 [PubMed - indexed for MEDLINE]. ...
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The lack of specific symptoms and signs in patients with tuberculous meningitis makes early diagnosis difficult. In this report, we reviewed the clinical features and laboratory findings of 6 infants with central system nervous... more
The lack of specific symptoms and signs in patients with tuberculous meningitis makes early diagnosis difficult. In this report, we reviewed the clinical features and laboratory findings of 6 infants with central system nervous tuberculosis during a 10-year period. One of the patients had multifocal tuberculosis. The mean time to the diagnosis was 32 +/- 13.4 days. A contact source was identified in only 2 patients. All 6 patients had abnormal cerebrospinal fluid findings, less than 500 cells/microL with lymphocytic predominance. Computerized tomography (CT) and/or magnetic resonance imaging (MRI) revealed hydrocephalus with basal enhancement in 2 patients. One patient developed pontocerebellar and pituitary tuberculomas, which were responsible for compression and diabetes insipidus, 1 year after antituberculous treatment. These localizations are very rare. On the follow-up, 3 patients had hypoacousia and only 1 had severe sequelae, despite a diagnostic delay.
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ABSTRACT Langerhans cell histiocytosis, previously known as histiocytosis X, is a disease whose clinical presentation varies. Although it is uncommon, Langerhans cell histiocytosis may involve the perianal region. We report the case of a... more
ABSTRACT Langerhans cell histiocytosis, previously known as histiocytosis X, is a disease whose clinical presentation varies. Although it is uncommon, Langerhans cell histiocytosis may involve the perianal region. We report the case of a 2-year-old boy who presented with perianal ulcerated vegetative lesions and seborrheic dermatitis of the scalp. Biopsy of the lesions showed Langerhans cell histiocytosis. This patient did not have any other organ involvement, which is rare. The outcome was favourable with vinblastine and corticoids.
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Aim: To establish a preliminary national report on clinical and genetic features of cystic fibrosis (CF) in Tunisian children as a first measure for a better health care organization. Methods: All children with CF diagnosed by positive... more
Aim: To establish a preliminary national report on clinical and genetic features of cystic fibrosis (CF) in Tunisian children as a first measure for a better health care organization. Methods: All children with CF diagnosed by positive sweat tests between 1996 and 2015 in children’s departments of Tunisian university hospitals were included. Data was recorded at diagnosis and during the follow-up from patients’ medical records. Results: In 12 departments, 123 CF children were collected. The median age at diagnosis was 5 months with a median diag- nosis delay of 3 months. CF was revealed mostly by recurrent respiratory tract infections (69.9%), denutrition (55.2%), and/ or chronic diarrhea (41.4%). The mean sweat chloride concentration was 110.9mmol/L. At least one mutation was found in 95 cases (77.2%). The most frequent mutations were Phe508del (n=58) and E1104X (n=15). Fifty-five patients had a Pseudomonas Aeruginosa chronic colonization at a median age of 30 months. Cirrhosis and...
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Background Community-acquired pleuropneumonia (CPP) is a common complication of pneumonia in children. It is serious given its high morbidity and significant mortality. Aim To study clinical and paraclinical features of CPP in children... more
Background Community-acquired pleuropneumonia (CPP) is a common complication of pneumonia in children. It is serious given its high morbidity and significant mortality. Aim To study clinical and paraclinical features of CPP in children and to establish a common therapeutic strategy. Methods Our retrospective study included patients who were hospitalized for CPP between 2004 and 2012. All data were collected from patients' medical files. Statistical analysis was made by Epi-Info 6. Results One hundred and sixty four patients were registered. The mean age was 32 months (15 days - 14.5 years). The hospital incidence of CPP doubled between 2004 and 2012. The symptomatology was dominated by fever (93.9%), cough (56.7%) and dyspnea (48.1%). The pleural effusion was frequently moderately abundant and loculated. Pleural sample, performed in 53.6% of cases, was the most beneficial bacteriological examination (p=10-6 ). The bacteriological confirmation was attained in 44.5% of cases with ...
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Background: The prevalence of the allergic diseases increased considerably during the last decades. The clinical expression of allergy depends on the interaction of genetic and environmental factors. Aim: The aim of our study was to... more
Background: The prevalence of the allergic diseases increased considerably during the last decades. The clinical expression of allergy depends on the interaction of genetic and environmental factors. Aim: The aim of our study was to evaluate the prevalence of sensitizing to aeroallergens in the child and to determine the risk factors of sensitizing. Methods: We carried out a cross-sectional study relating to 200 pediatric patients of the Mahmoud El Matri hospital, aged from 3 to14 years. We performed skin prick test to 12 current aeroallergens. Results: The prevalence of sensitizing to aeroallergens was 14%. Acarina (DP and/or DF) represented the allergens accused in the majority of the cases (96,4% of the cases). The statistical analysis of the various risk factors of sensitizing showed that these factors were: the presence of a family atopy (p= 0,0034) particularly a maternal asthma (p< 0,001), the personal atopy specially an asthma, an allergic rhinitis or eczema atopic (p< 10-5), the short breast-feeding (p= 0,033) and the home humidity (p=0,0072). Several risk factors reported in the literature did not seem to intervene in our study (the passive smoking, the urban dweling, the age of food diversification, infections at the low age). Conclusion: The prevalence of sensitizing to aeroallergens is relatively high in our series. Many factors could explain the increase of the allergic diseases. Our study stresses the importance of the genetic, nutritional and environmental factors in the appearance of aeroallergens sensitization.
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Primary immunodeficiencies (PIDs) are a large group of diseases characterized by susceptibility to not only recurrent infections but also autoimmune diseases and malignancies. The aim of this study was to describe and analyze the... more
Primary immunodeficiencies (PIDs) are a large group of diseases characterized by susceptibility to not only recurrent infections but also autoimmune diseases and malignancies. The aim of this study was to describe and analyze the distribution, clinical features and eventual outcome of PID among Tunisian patients. We reviewed the record of 710 patients diagnosed with Primary Immunodeficiency Diseases (PIDs) from the registry of the Tunisian Referral Centre for PIDs over a 25-year period. The male-to-female ratio was 1.4. The median age at the onset of symptoms was 6 months and at the time of diagnosis 2 years. The estimated prevalence was 4.3 per 100,000 populations. The consanguinity rate was found in 58.2 % of families. According to the International Union of Immunological Societies classification, spectrums of PIDs were as follows: combined T-cell and B-cell immunodeficiency disorders account for the most common category (28.6 %), followed by congenital defects of phagocyte (25.4 %), other well-defined immunodeficiency syndromes (22.7 %), predominant antibody deficiency diseases (17.7 %), diseases of immune dysregulation (4.8 %), defect of innate immunity (0.4 %) and complement deficiencies (0.4 %). Recurrent infections, particularly lower airway infections (62.3 %), presented the most common manifestation of PID patients. The overall mortality rate was 34.5 %, mainly observed with combined immunodeficiencies. The distribution of PIDs was different from that reported in Western countries, with a particularly high proportion of Combined Immunodeficiencies and phagocyte defects in number and/or function. More is needed to improve PID diagnosis and treatment in our country.
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Bronchiolitis is a public health problem in the word and in Tunisia. Nebulized hypertonic saline seems to have some benefits in bronchiolitis. The aim of this study is to evaluate the efficacy of nebulized 5% hypertonic saline alone or... more
Bronchiolitis is a public health problem in the word and in Tunisia. Nebulized hypertonic saline seems to have some benefits in bronchiolitis. The aim of this study is to evaluate the efficacy of nebulized 5% hypertonic saline alone or mixed with epinephrine in bronchiolitis as measured by improvement in clinical score, oxygen saturation or reduction in duration of hospitalization. This prospective, double blind, placebo controlled, randomized clinical trial was performed at Children's Hospital of Tunis from February 2012 to Mars 2012. A total of 94 patients less than 12 months of age with diagnosis of moderately severe bronchiolitis were enrolled and assigned to receive 5% nebulized hypertonic saline, mixed 5% hypertonic saline with standard epinephrine 0,1% or normal saline (placebo) at admission and every 4 hours during hospitalization. There were no significant difference between nebulized 5% hypertonic saline, mixed 5% hypertonic saline with epinephrine or normal saline at ...
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Thiamine-responsive megaloblastic anemia syndrome is a rare autosomal recessive disorder defined by the occurrence of megaloblastic anemia, diabetes mellitus, and neurosensoriel deafness, responding in varying degrees to thiamine... more
Thiamine-responsive megaloblastic anemia syndrome is a rare autosomal recessive disorder defined by the occurrence of megaloblastic anemia, diabetes mellitus, and neurosensoriel deafness, responding in varying degrees to thiamine treatment. Report an unusual case of this rare disorder We report the case of a four-year-old boy who presented unusual features of thiamine-responsive megaloblastic anemia. In addition to the typical triad of the syndrome, he presented leuconeutropenia, hepatosplenomegalia, cardiac abnormalities including absent P waves, mitral and tricuspid insufficiency, retinitis pigmentosa, nystagmus, developmental delay and a brain Magnetic resonance imaging ischemic lesion. Lactate levels in serum and the lactate/pyruvate ratio were increased. The mitochondrial mutation m.3243A > G located in MTTL1 gene encoding for transfer RNA leucine (tRNALeu(UUR)) was not found. Treatment with thiamine resulted in normalisation of the haemoglobin level, white cell count, and g...
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Despite the common clinical practice, the available evidence on the efficacy of bronchodilators therapy for bronchiolitis is conflicting. The aim of this study is to evaluate the efficacy of nebulized terbutaline in bronchiolitis as... more
Despite the common clinical practice, the available evidence on the efficacy of bronchodilators therapy for bronchiolitis is conflicting. The aim of this study is to evaluate the efficacy of nebulized terbutaline in bronchiolitis as measured by improvement in clinical score, oxygen saturation or reduction in duration of hospitalization. This prospective, double blind, placebo controlled, randomized clinical trial was performed at Children's Hospital of Tunis from December 2004 to April 2006. A total of 35 patients less than 12 months of age with diagnosis of moderately severe bronchiolitis were enrolled and assigned to receive nebulized terbutaline or normal saline placebo at admission (T0), at 30 minutes after admission (T30) and every four hours during a study period. Outcome measurements included: Respiratory Distress Assessment Instrument (RDAI) score, respiratory rate, oxygen saturation, heart rate and the duration of hospitalization. There were no significant difference be...