[Factors predicting the need for invasive mechanical ventilation in patients with chronic obstructive pulmonary disease (COPD)]. / Facteurs prédictifs de la ventilation mécanique invasive chez les patients atteints de broncho-pneumopathie chronique obstructive (BPCO).

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.

Disseminated intravascular coagulation type of amniotic fluid embolism: a challenging case report with favorable outcome.

Amniotic fluid embolism (AFE) is an unforeseeable, life-threatening complication of pregnancy and child birth. Although rare in an absolute sense, most contemporary series of maternal deaths from developed countries report AFE as a leading cause of mortality in the pregnant population. It has a heterogeneous presentation. This clinical heterogeneity makes the diagnosis of AFE difficult based on a beam of clinical and para-clinical arguments. Rapid diagnosis and immediate interdisciplinary treatment are essential for a good outcome. The present is a case of AFE with a disseminated intravascular coagulation (DIC) and a cardiorespiratory collapse following a vaginal delivery.

[Effect of intensity of smoking intoxication on severity parameters of acute exacerbations of chronic obstructive pulmonary disease treated in a hospital milieu]. / Influence de l'intensité de l'intoxication tabagique sur les paramètres de sévérité des exacerbations aiguës de la broncho-pneumopathie chronique obstructive traitées en milieu hospitalier.

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.

Simultaneous bilateral spontaneous pneumothorax as the first manifestation of primary pulmonary MALT lymphoma.

Primary pulmonary lymphoma is a rare entity. Furthermore, simultaneous bilateral spontaneous pneumothorax (SBSP) is a very rare condition which is often related to therapeutic complications. We present, to the best of our knowledge, the first case of primary pulmonary mucosa associated lymphoid tissue (MALT) lymphoma revealed by SBSP. A 50-year-old female was diagnosed with organizing pneumonia. One month later, she presented with sudden chest pain and shortness of breath due to SBSP. Bilateral chest tubes were inserted. A scan- guided right lung biopsy led to the diagnosis of primary pulmonary MALT lymphoma. The patient was treated with R-CHOP chemotherapy. The association between lymphoma and pneumothorax is extremely rare, often related to therapeutic toxicity. We report the case of SBSP as the first manifestation of primary pulmonary MALT lymphoma.

[Recurrence score to predict the risk of recurrence after first episode of primary spontaneous pneumothorax]. / Score de prédiction de récidive après un premier épisode de pneumothorax spontané primitive.

INTRODUCTION: the relationship between computed tomography (CT) scan findings and the risk of recurrence of primary spontaneous pneumothorax (PSP) is controversial. The purpose of this study is to determine the relationship between the Dystrophy Severity Score (DSS) and PSP recurrence after an initial episode. METHODS: we conducted a retrospective study including patients admitted to the hospital with PSP (first episode) between 2005-2017. The study population was divided into 2 groups, G1: PSP recurrence, G2: No recurrence. We undertook univariate analysis including various variables such as the DSS score followed by multivariate analysis. RESULTS: eighty-six patients were included in this study. Forty-eight percent of cases had PSP recurrence. Although the DSS score was significantly associated with PSP recurrence (p=0.008), multivariate analysis showed that the presence of bubbles on chest CT scan was the independent risk factor associated with PSP recurrence after a first episode (risk report: 3.26, p < 0.008). CONCLUSION: the risk of PSP recurrence is significantly associated with the presence of bubbles on chest CT scan. Further studies are needed for better assessment of the DSS score.

[Asthma and obesity: relationship and therapeutic implications in patients with asthma at the Department of Pneumology in Monastir, Tunisia]. / Asthme et obésité: relation et implications thérapeutiques auprès des patients asthmatiques du Service de Pneumologie de Monastir, Tunisie.

INTRODUCTION: Obesity and asthma are two chronic diseases affecting millions of people around the world. A causal relationship has been suggested. The purpose of our study is to examine the profile in obese people with asthma and to determine the relationship between the different severity parameters in asthma and the degree of obesity. METHODS: We conducted a retrospective, monocentric, analytical study involving 450 asthmatics with a body mass index (BMI) ≥ 30 kg/m2 having follow up visit at less than 6 months. The study was conducted in the Department of Pneumology and Allergology at the Fattouma Bourguiba Hospital in Monastir. RESULTS: The average age at diagnosis was 45±12.8 years. Mean BMI was 34.8±4.2 kg/m2. Asthma was well-controlled in 55.3% of patients. Severity criteria were reported in 37.4% of cases. According to GINA 2016, 24.2% of patients received treatment at step 4. Two asthma phenotypes associated with obesity were reported. The first phenotype (52.4%) was characterized by early-onset asthma associated with a higher incidence of allergic disease and manifestations of atopy. The second phenotype (47.6%) was characterized by late onset asthma, commonly occurring in female sex as well as a higher rate of comorbidities and hospitalizations. Patients with class II and III obesity had significant ventilatory deficiency (CVF: p = 0.002 and FEV1: p = 0.007). CONCLUSION: Obesity is one of the key factors involved in poor asthma control. Its management, which has not yet been codified, should be multidisciplinary.

[Influence of co-morbidities on the progression and prognosis of patients with chronic obstructive pulmonary disease in a Tunisian Hospital]. / Influence des comorbidités sur l'évolution et le pronostic des patients porteurs de broncho-pneumopathie chronique obstructive dans un centre tunisien.

INTRODUCTION: chronic obstructive pulmonary disease (COPD) has been frequently associated with co-morbidities. The purpose of our study is to analyze the impact of co-morbidities on the progression and prognosis of COPD. METHODS: we conducted a retrospective study of patients with COPD hospitalized and/or followed up in the Department of Pneumology at the Fattouma Bourguiba University Hospital in Monastir over the period January 2000-December 2017. The patients were initially divided into two groups, the G0 group (isolated COPD) and the G1 group (with at least one comorbidity). Patients in the G1 group were divided in two subgroups: A group (patients with 1-2 co-morbidities) and B group (≥ 3 comorbidities associated). Different parameters of COPD severity were compared between the different groups. RESULTS: a total of 1152 patients with COPD were enrolled. Seventy-nine percent of patients had at least a chronic disease associated with COPD. The presence of at least one co-morbidity was associated with an increase in the number of severe exacerbations (p = 0.004), in the use of Long-term oxygen therapy (p = 0.006) and with reduced survival (p = 0.001). Similarly, a greater number of co-morbidities (≥ 3 co-morbidities) were associated with more severe systemic inflammation, more frequent use of mechanical ventilation or non-invasive ventilation (p=0.04) and reduced survival (p = 0.05). CONCLUSION: the presence of co-morbidities in patients with COPD is associated with higher severity and poorer prognosis.

[Bronchial dilatations in patients with chronic obstructive pulmonary disease in a Tunisian center: effect on disease progression and prognosis]. / Dilatations des bronches chez les patients porteurs de bronchopneumopathie chronique obstructive au centre Tunisien: impact sur l'évolution et le pronostic.

INTRODUCTION: bronchial dilations (BDs) seem to have a major role in the natural history of chronic obstructive pulmonary disease (COPD). The purpose of our study was to evaluate the impact of BDs on the severity and progression of COPD as well as on patients' prognosis. METHODS: we conducted a retrospective, single-center, analytical study over the period 1995- 2017. The study was based on data from the medical records of patients with COPD who had undergone chest CT scan during the follow-up period. We compared two groups (G) of patients: G1: COPD with BDs; G2: COPD without BDs. RESULTS: our study included 466 patients with COPD. Among them 101 (21.6%) had BDs associated with COPD. G1 patients had lower maximum expiratory volume in the first second (FEV1) (G1: 1.21 L, G2: 1.37 L, p = 0.015), lower forced vital capacity (FVC) (p = 0.014), a lower PaO2 at steady state (p = 0.049), a higher rate of acute exacerbations (AE) per year (G1: 3.31, G2: 2.44, p = 0.001) and a higher rate of hospitalizations in the Intensive Care Unit per year (p = 0.02). G1 patients with AE receiving treatment in hospital had lower PaO2 3) on admission (G1: 60 mmHg, G2: 63.7 mmHg, p = 0.02 G2: 63.7 mmHg, p = 0.023), more elevated carbon dioxide (CO2) levels (p = 0.001) and were characterized by a higher use of non-invasive ventilation (NIV) (p = 0.044) and invasive mechanical ventilation (p = 0.011). G2 patients had better overall survival (p = 0.002). CONCLUSION: bronchial dilatations are an indicator of poor prognosis in patients with chronic obstructive pulmonary disease, expecially because of the higher rate and severity of exacerbations, airway obstructions and mortality.

Primary adenoid cystic carcinoma of the tracheobronchial tree: report of two cases.

Adenoid cystic carcinoma (ACC) is a rare malignant epithelial tumor that predominantly originates in the salivary glands. Primary ACC of the tracheobronchial tree is extremely rare. We report two new cases of central airways primary ACC: a 58 year-old male with an ACC of the left main bronchus who underwent a pneumonectomy with node dissection, and a 52 year-old female with proximal tracheal ACC presenting as asthma treated by surgical resection and a postoperative radiotherapy. Primary ACC of the tracheobronchial tree is often misdiagnosed given the non-specific clinical presentation. An early diagnosis is essential to ensure good outcomes. An interdisciplinary treatment is required based especially on surgery and radiotherapy.

[Study of the role of blood eosinophil count in patients with severe acute exacerbation of chronic obstructive pulmonary disease hospitalized in a Tunisian Center]. / Etude de l'intérêt de l'éosinophilie sanguine au cours des exacerbations aiguës sévères de bronchopneumopathie chronique obstructive (BPCO) dans un centre tunisien.

INTRODUCTION: There is a controversy over the relationship between blood eosinophil count (BEC) and the severity of chronic obstructive pulmonary disease (COPD) exacerbations. The purpose of our study was to determine the relationship between blood eosinophil count and multiple parameters in assessing the severity of serious acute exacerbation (AE) of obstructive pulmonary disease. METHODS: We conducted a retrospective monocentric study of hospitalized patients with obstructive pulmonary disease treated between 2005 and 2015. We compared 2 groups of patients: G1(BEC+): BEC ≥ 200 cell/µl (103 cases, 20.4%), G2(BEC-): BEC < 200 cell/µl (403 patients: 79.6%). RESULTS: A total of 506 subjects with obstructive pulmonary disease were included in the study. No significant difference between the two groups in age, gender, forced expiratory volume in one second (FEV1), and the number of AE/year (BEC+: 2.6, BEC-:2.5 AE/year; p = 0.48) was found. The analysis of the parameters of severity of serious AE showed no difference between the two groups in partial pressure of oxygen PaO2 measured on admission (60.5, 59.2 mmHg; p = 0.26), capnia (p=0.57), pH (p=0.74), C-reactive protein rate (mg/L) (82.7, 81; p = 0.89), leukocytosis (p = 0.36), non-invasive mechanical ventilation (5.8%, 6.5%; p = 0.81), invasive mechanical ventilation (p = 0.5),length of stay in hospital (9.7, 9 days; p = 0.21), mean time to next AECOPD (p = 0.32). Survival at 1 year was comparable between the two groups (94% vs 96%; Log Rank: 0.708). CONCLUSION: Increased BEC in patients with COPD does not appear to have a negative effect on patients with severe AE. Despite the recent guidelines recommend to consider blood eosinophil count while making treatment decisions, the role and the prognostic interest of blood eosinophil count in patients with COPD could be population-dependent.