Prediction equations for spirometry in healthy children from Djibouti.

OBJECTIVE: To determine normal spirometric values in Djiboutian children and to compare these data with values reported by African studies and by the 2012 Global Lung Function Initiative. METHODS: Spirometric data from healthy Djiboutian children were collected and reference equations derived using the least mean squared method, which includes modelling skewness (λ, L), mean (µ, M) and coefficient of variation (σ, S) according to sex, age and height. In addition, the age-dependent lower limits of normal were calculated. RESULTS: Spirometric values in Djiboutian children were lower than those obtained for other Black children; these differences were relatively small and clinically irrelevant, representing differences of approximately 3% predicted. However, significant differences were observed between our equations and those for Tunisian children. CONCLUSION: The results of the present study could help to improve the clinical diagnosis of respiratory diseases in Djiboutian children.

[Assessment of insomnia among Tunisian patients with lung cancer]. / Évaluation de l'insomnie chez les patients tunisiens atteints de cancers bronchopulmonaires primitifs.

INTRODUCTION: Sleep disorders are relatively common in oncology. However, they have not been well studied and are often treated insufficiently. AIM: To assess the prevalence and severity of insomnia in lung cancer patients and evaluate the relationship between insomnia and certain clinical parameters. METHODS: A cross-sectional study was undertaken of patients in Tunis with primary lung cancer. Socio-demographic and clinical data were obtained from the medical records Patients were then asked to answer questionnaires related to insomnia (ISI), depression-anxiety (HAD) and quality of life (QLQ-C30). RESULTS: Fifty patients with lung cancer were included (46 men, 4 women). The average age was 59±9 years. Insomnia was found in 24 patients (48%) and 60% of patients had depression. HAD was significantly higher in the insomniac patients (21.54±8.96 vs. 9.81±5.28, P<0.0001). Similarly, the QLQ-C30 was significantly lower in these patients (41.24±12.55 vs. 56±16.88, P<0.01). ISI was significantly correlated with HAD and QLQ-C30. CONCLUSION: Insomnia is common in patients with lung cancer. It is responsible for impaired quality of life and psychological distress. Diagnosis and management of insomnia in patients with lung cancer is therefore mandatory.

[Clinical and microbiological profile of patients experiencing relapses of tuberculosis in Tunisia]. / Profil clinique et microbiologique des patients en situation de rechute tuberculeuse en Tunisie.

INTRODUCTION: Relapse of tuberculosis (TB) is known to be as one of the major risk factors for resistant TB. The aim of this study is to focus on clinical, radiological and bacteriological features of patients with pulmonary TB relapse. METHODS: We performed a retrospective survey in the respiratory department of the teaching hospital La Rabta in Tunis between January 2000 and December 2014. Data of patients with a pulmonary TB relapse were analyzed. RESULTS: During the study period, among 1250 patients hospitalized for pulmonary TB, 44 had a TB relapse. The TB relapse rate was estimated to be at 3.5%. The average age was 43.95±16.7 years. Sex ratio was 5,2. Eighty one percent of patients were current smokers. Alcoholism was found in 40.9% of cases. The mean time to relapse was 6.37±3.7 years. The radiological lesions were moderately extended at least in 54.6% of cases. A resistant TB was found in 33% of cases (mono-resistance: 33.3%, multi-drug resistance (TB-MR): 11,1%, poly-resistance: 55.5%). The most incriminated drugs were isoniazid, rifampicin and pyrazinamide. One patient received TB-MR treatment regimen for 18 months. In the other cases, the duration of treatment was prolonged. Recovery was obtained in 72.7% of cases, two patients died and 22.7% of patients were lost to follow up. CONCLUSION: In Tunisia, TB relapse usually affects young male patients who are often alcoholic and smokers. Resistant TB is frequent among these patients. These findings lead us to emphasize the need of rapid diagnosis tools and adapted treatment regimen in these patients.

[Tuberculous pneumothorax: Diagnosis and treatment]. / Pneumothorax tuberculeux : prise en charge diagnostique et thérapeutique.

BACKGROUND: Pneumothorax is a serious complication of cavitary pulmonary tuberculosis. The aim of this study was to describe clinical futures, to highlight challenges of its management. METHODS: A retrospective multicentric and descriptive study including 65 patients treated for PT (1999-2015) was conducted to figure out clinical futures and its work-up. RESULTS: The mean age was 37.8 years. The sex ratio was 3.6. Smoking history and incarceration were noted respectively in 67.6 and 15.3% of cases. Acute respiratory failure and cachexia were reported in 26.1 and 10.7% of cases. The PT was inaugural in 41.5% of cases. Pyo-pneumothorax was noted in 69.2% of cases. The duration of antituberculous treatment ranged from 6 to 15 months for susceptible TB and was at least 12 months for resistant TB (4 cases). Thoracic drainage was performed in 90.7% patients. Its average length was 47 days. The drain drop was noted in 20% of cases. Bronchopleural fistula was diagnosed in 6 cases and pleural infection in 5 of cases. Surgery treatment was necessary in 6 cases. Mean time to surgery was 171 days. Six patients had pleural decortication associated with pulmonary resection in 4 cases. Persistent chronic PT was noted in 12.6% and chronic respiratory failure in 3% of cases and death in 15.3% of cases. CONCLUSION: The diagnosis of the PT is often easy. Its treatment encounters multiples difficulties. Duration of thoracic drainage and anti-TB treatment are usually long. Surgery is proposed lately.

[Tuberculous pseudotumour, a challenging diagnosis]. / La tuberculose pseudotumorale, un diagnostic difficile.

INTRODUCTION: The pseudotumorous form of tuberculosis is a rare entity. Whatever its location, it can simulate neoplasia by its radiological and/or endoscopic appearances. We highlight the diagnostic difficulties associated with this type of presentation. METHODS: We performed a retrospective study of inpatient records from 2003 to 2016 in the pneumology department of La Rabta Hospital to identify cases of thoracic tuberculous pseudo-tumor. RESULTS: Seventeen patients were identified. The median age was 41 years and their symptomatology was dominated by cough and general debility. All had abnormal radiology with 10 cases of suspect lesions. Fibre-optic bronchoscopy revealed endobronchial abnormalities in 11 cases. The median overall diagnostic delay was 97 days. The diagnosis was confirmed bacteriologically in five cases, histologically in 14 cases and based on clinical presumption in one case. The progression was favourable: 13 patients have been declared cured and four patients are still undergoing treatment. CONCLUSION: Making a positive diagnosis of thoracic tuberculous pseudotumour can be difficult, as bacteriological samples are often negative. This can lead to a significant delay in diagnosis and treatment.

[Home non-invasive ventilation for chronic obstructive pulmonary disease]. / Ventilation non invasive à domicile au cours de la broncho-pneumopathie chronique obstructive.

INTRODUCTION: The benefits of long-term non-invasive ventilation (NIV) in the management of chronic obstructive pulmonary disease (COPD) patients remain controversial. AIM: To analyze the characteristics of COPD patients under home NIV and to evaluate its impact among this population. METHODS: We carried out a retrospective study between January 2002 and April 2016 of COPD patients under long-term NIV at "la Rabta" and the Military Hospital. RESULTS: There were 27 patients with an average age of 64 and a sex ratio (M/F) of 0.92. Active smoking was reported in 96.3%. A persistent hypercapnia following an acute exacerbation of COPD with failure to wean the NIV was the main indication of long-term NIV. We noted a reduction in hospital admissions in the first year of 60% and in intensive care of 83.3% (P<10-3). There was no non-significant decrease of PaCO2 (4.5mmHg). There was no modification in FEV 1 and in FVC (P>0.05). The survival rate was 96.3% at 1 year, 83.3% at 2 years and a median survival of 24 months. CONCLUSIONS: Our study suggests that home NIV contributes to the stabilization of some COPD patients by reducing the hospitalizations rates for exacerbation. More prospective studies are needed to better assess the impact of NIV on survival and quality of life and to better define the COPD patients who require NIV.

[Night-to-night variability of the obstructive sleep apnoea-hypopnoea syndrome]. / Variabilité inter-nuits du syndrome d'apnée-hypopnée obstructive du sommeil.

The apnoea-hypopnoea index (AHI) is the primary measurement used to characterize the obstructive sleep apnoea-hypopnoea syndrome (OSAHS). Despite its popularity, there are limiting factors to its application such as night-to-night variability. AIM: To evaluate the variability of AHI in the OSAHS. PATIENTS AND METHODS: A prospective study was designed in our university hospital's sleep unit. Adults with clinical suspicion of OSAHS underwent 2 consecutive nights of polysomnographic recording. The population was divided in two groups according to an AHI>or<10. Patients with psychiatric disorders or professions that might result in sleep deprivation or an altered sleep/wake cycle were excluded. RESULTS: Twenty patients were enrolled. The mean age was 50.6±9.3 years. OSAHS was mild in 4 cases, moderate in 6 cases and severe in 8 cases. AHI was less than 5 in two cases. AHI values were not significantly altered throughout both recording nights (33.2 vs. 31.8 events/h). A significant positive correlation was found between AHI measured on the first and the second night. However, a significant individual variability was noted. Comparison between both patient's groups showed a correlation between AHI and the body mass index. CONCLUSION: This study demonstrates that the AHI in OSAHS patients is well correlated between two consecutive nights. However, a significant individual variability should be taken into consideration, especially when AHI is used in the classification of OSAHS or as a criterion of therapeutic success.

[Occupational asthma: Clinical and professional profile of the Tunisian asthmatic worker]. / Asthme professionnel : profil clinique et professionnel du travailleur asthmatique tunisien.

INTRODUCTION: Asthma takes up a great importance in occupational diseases but remains underestimated as it is insufficiently diagnosed. OBJECTIVE: We aimed to access the clinical and professional profile of the Tunisian asthmatic worker. MATERIALS AND METHODS: It was a retrospective descriptive study in a professional pathology unit in a university hospital. All patients referred by their doctor for symptoms suggestive of occupational asthma, during a period from 2000 to 2008, were included. RESULTS: Forty-eight patients were selected from 172. The mean age was 40 years, with a male predominance (56 %). In 2/3 of the cases, it was the textile workers, food and chemical industry. The etiological agents incriminated were textile dust in 18.8 % of cases followed by isocyanates and flour. Typical episodes of wheezing dyspnea were present in 52 % and atopy in 54.2 % of workers. In 2 % of cases, symptoms disappeared and worsened in 18.8 %. CONCLUSIONS: The prognosis of OA depends on early end accurate diagnosis. The physician's role is to initiate the appropriate diagnostic approach, which must comply with the Tunisian conditions.

[Excavated right pleuro-pneumopathy with fever]. / Une pleuro-pneumopathie droite fébrile excavée.

Respiratory manifestations are rarely observed in pyonephrosis. We report a new case revealed by lower respiratory infection with Escherichia coli empyema. Ultrasound and computed tomography rectified the diagnosis.

[Epidemiology of tuberculosis]. / Épidémiologie de la tuberculose.

Tuberculosis is a contagious disease caused by Mycobacterium tuberculosis. It represents, according to World Health Organization (WHO), one of the most leading causes of death worldwide. With nearly 8 million new cases each year and more than 1 million deaths per year, tuberculosis is still a public health problem. Despite of the decrease in incidence, morbidity and mortality remain important partially due to co-infection with human immunodeficiency virus and emergence of resistant bacilli. All WHO regions are not uniformly affected by TB. Africa's region has the highest rates of morbidity and mortality. The epidemiological situation is also worrying in Eastern European countries where the proportion of drug-resistant tuberculosis is increasing. These regional disparities emphasize to develop screening, diagnosis and monitoring to the most vulnerable populations. In this context, the Stop TB program, developed by the WHO and its partner's, aims to reduce the burden of disease in accordance with the global targets set for 2015.

[Primary infection and pulmonary tuberculosis]. / La primo-infection et la tuberculose pulmonaire.

Tuberculosis is a major public health problem worldwide. Indeed, a third of the world population is infected with Mycobacterium tuberculosis and more than 8 million new cases of tuberculosis each year. Pulmonary tuberculosis is the most common location. Its diagnosis is difficult and often established with a delay causing a spread of infection. The diagnosis of tuberculosis infection is mainly based on immunological tests represented by the tuberculin skin test and detection of gamma interferon, while the diagnosis of pulmonary tuberculosis is suspected on epidemiological context, lasting general and respiratory symptoms, contrasting usually with normal lung examination, and a chest radiography showing suggestive lesions. The radioclinical feature may be atypical in patients with extreme ages and in case of immunodeficiency. Confirmation of tuberculosis is bacteriological. Conventional bacteriological methods remain the reference. Innovative tests using the technique of molecular biology have improved the diagnosis of tuberculosis in terms of sensitivity and especially speed. However, those techniques are of limited use.

[Cervico-thoracic localization of a hydatid cyst]. / Localisation cervico-thoracique d'un kyste hydatique.

The authors report a case of cervico-thoracic region hydatid cyst suspected by the presence of a palpable right lower neck mass. This location is very rare. Neck ultrasound and computed tomography showed the cyst. Magnetic resonance imaging can be useful for diagnosis and provided the best anatomo-topographic evaluation before surgery.

[Pseudo-tumoral aspergilloma]. / Aspergillome pseudo-tumoral.

Aspergilloma is the most common form of pulmonary aspergillosis, generally developing pre-existing lung cavities. Fiberoptic bronchoscopy is required in case of hemoptysis. We report the case of a 74-year-old man with pulmonary aspergilloma where fiberoptic bronchoscopy visualized mycetoma and cavitation. Visualization and biopsy of the fungus ball during fiberoptic bronchoscopy is rare.

[Diagnosis delay of pleural and pulmonary tuberculosis]. / Délai diagnostique de la tuberculose pulmonaire et pleurale.

Tuberculosis (TB) is still being endemic in our country. Time until management determines both evolution and prognosis of this condition. The aim of this work is to evaluate the delay in diagnosis of TB in a respiratory unit from a university hospital series. The authors conducted a cross-sectional study including patients with pulmonary TBC and/or pleural. An evaluation of time management was conducted from the beginning of symptoms and various consultations with reference to the date of hospitalization and treatment set up. One hundred patients were included (pulmonary TB: 68 cases, pleural TB 23 cases, miliary pulmonary TB: 4 cases, pulmonary TB associated with other extrathoracic locations: 5 cases). The mean time of patient delay and total delay institution were respectively 43.6, 25.7 and 69.3 days. Variables responsible for long delays were: number of consultations more than 3 before hospitalization, empirical antibiotic therapy, of a regional hospital first consultation and the presence of extra-respiratory impairment. The patient delay was considered long. A reorganization of the TB control program, in particular by partial decentralization of care and health education is imperative in order to improve the quality of tuberculosis management in our country.

[Pulmonary arteriovenous malformation in a bronchoscopy simulating a carcinoid tumour]. / Formation tumorale framboisée à l'endoscopie bronchique simulant une tumeur carcinoïde.

The authors report a case of pulmonary arteriovenous malformation in a 48-year-old man. The bronchoscopy revealed a fragile lingular tumoral formation. The diagnosis was based on the thoracotomy and the histopathological findings. The endoscopic features and the different diagnostic options of pulmonary arteriovenous malformation are discussed.