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Introduction: the use of invasive mechanical ventilation (IMV) in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) constitutes a negative turning point in the progression of the disease. The purpose of this study is to determine factors predicting the need for IMV in AECOPD., Methods: we conducted a retrospective study by reviewing the medical records of patients with AECOPD hospitalized in our Department over a 18-year period (2000-2017). We compared 2 groups: G1: patients with AECOPD undergoing at least one IMV and G2: patients who had never undergone IMV following AECOPD., Results: the study included 1152 patients with COPD: 133 in the G1 group (11.5%), and 1019 in the G2 group (88.5%). G1 patients were more symptomatic (p < 0.001), with more severe bronchial obstruction (p < 0.001). G1 patients had more exacerbations (p < 0.001), more hospitalizations and a higher need for non-invasive ventilation (NIV) (p < 0.001). Similarly, G1 patients more often developed chronic respiratory failure (p < 0.001) and had significantly lower survival rates. Independent risk factors associated with IMV were hypercapnia and decreased pH (in patients with severe AECOPD), a history of NIV, and chronic respiratory failure (CRF)., Conclusion: respiratory function impairment, the severity of exacerbation and the need for NIV in a previous episode are factors predicting the need for IMV and poor outcomes., Competing Interests: Les auteurs ne déclarent aucun conflit d´intérêts., (Copyright: Lobna Loued et al.)

Introduction: smoking is the leading risk factor for chronic obstructive pulmonary disease (COPD). Disease evolution is characterized by the occurrence of acute exacerbations (AE). The purpose of our study is to assess the effect of intensity of smoking intoxication (in packs-years (PAs)) on the different severity parameters of AE in smoking patients with COPD treated in hospital., Methods: we conducted a retrospective, monocentric study of 685 smoking patients with COPD who had been hospitalized at least once for an AE between 1990 and 2017. Patients were divided into 2 groups (G1: < 30PA, and G2: ≥ 30PA). The different severity parameters of COPD AE were compared between the two groups., Results: the average age of our patients was 66 years. There were no significant differences between the two groups with respect to the severity of biologic inflammatory syndrome, length of stay in hospital and antibiotic treatment duration. G2 was characterized by lower PaO2 levels during AE (G1: 63.5, G2: 59.3, p: 0.007), longer length of stay in the emergency department (p < 0,001), increased use of non-invasive ventilation (p: < 0.001) and invasive ventilation (p: 0,008). G2 had more EA/year (G1: 2.06. G2: 2.72/patient/year, p: 0.001) with a shorter mean time for severe AE (p: 0.038). Conclusion: the intensity of smoking intoxication has a negative impact on several severity parameters of severe COPD EAs. Hence the role of smoking cessation in preventing this disease and its complications., Competing Interests: Les auteurs ne déclarent aucun conflit d´intérêts., (Copyright: Ahmed Ben Saad et al.)

Background: We aimed to describe the episodes and trends of admissions for community-acquired Respiratory Infections (RI) over a 12-year period and to assess the impact of Haemophilus influenza type b (Hib) vaccine on RI admissions in children aged up to 3 years., Methods: We conducted a twelve-year retrospective observational study on all community-acquired RI admitted to Fattouma Bourguiba Hospital in Monastir Governorate (Tunisia) from 1 January 2002 to 31 December 2013. RI cases were selected from the Regional Registry of Hospital Morbidity. Data were coded according to ICD-10. To assess the impact of the Hib vaccine, three cohorts were defined based on vaccine status (unvaccinated cohort, first vaccinated cohort (VC) by monovalent form and second VC by pentavalent combination)., Results: Admissions for RI represented 17.6% (CI95%: 17.3-18.1) of all communicable diseases hospitalizations (n = 6 061/34 289). The crude incidence rates (CIR) per 100,000 inh were 24.2 for upper RI (URI) and 77.5 and for Lower RI (LRI) (p < 0.0001). Pneumonias represented 53.9% of LRI. Sex-ratio (male/female) was 1.12 for URI and 1.64 for LRI (p < 0.0001). At admission, the median age was 22 years (IQR: 3-52). Admission for Pneumonia increased significantly during study period (slope 'b' = 5.16; p < 0.0001) especially in children up to 5 years old (slope 'b' = 5.53) and in elderly (slope 'b' = 2.13). Among children up to 3 years old, the CIRs per 100,000 for Hib pneumonia admission were 11.6 in Non-Vaccinated Cohort (NVC), 10.6 in Vaccinated Cohort (VC) by protocol 1 (Hib Vaccine monovalent) and 0.80 in VC by protocol 2 (pentavalent vaccine combination).The relative risk reduction was 99% for protocol 2 (p < 0.001)., Conclusion: Admissions for RI in a  tertiary level hospital were common with an increasing trend. The Hib immunization program, in particular the pentavalent combination, has had a positive impact on the reduction of related acute diseases.