Feasibility of a home-designed respiratory rehabilitation program for chronic obstructive pulmonary disease.

BACKGROUND: According to international guidelines, respiratory rehabilitation (RR) for patients with chronic obstructive pulmonary disease (COPD) is a cornerstone of standard non-pharmacological treatment. AIMS: To evaluate feasibility of a home-designed RR program and analyze its medium-term impact on respiratory parameters and quality of life. METHODS: This was a prospective study involving 74 COPD patients enrolled in January 2019 and put on inhaled bronchodilator treatment associated with RR at home following a written protocol, for 16 weeks. The comparative statistical analysis highlights the difference before and after RR in terms of clinical and functional respiratory parameters as well as in terms of quality of life (assessed on the short form 36 (SF-36) questionnaire). The comparison involves RR-adherent patients versus non-adherent patients. RESULTS: Mean age was 66.7 ± 8.3 years with a median of 67 years. All patients were smokers, out of which 42 patients (57%) did not quit yet. Forty-one percent of patients were frequent exacerbators. The average COPD assessment test (CAT) score in our patients was 23. The average 6-minutes walk distance (MWD) was 304 m. The BODE index in our patients was 4.11 on average. The RR program was followed by 36 patients (48%). Thirty patients (40%) applied it at least twice a week. RR-adherent patients had an average CAT score decreasing from 23 to 14.5 (P = 0.011). Their average 6-MWD was 444.6 m by the end of the study, which would be 64.2% of the calculated theoretical value. The average FEV1 increase after RR was 283 mL. The majority (69%) of RR-adherent patients were ranked as quartile 1; BODE index ≤2. The average scores of physical, psycho-social, and general dimensions assessed on the SF-36 questionnaire improved in RR-adherent patients. CONCLUSIONS: RR is a key non-pharmacological treatment for COPD. Its interest originates from its multidisciplinary nature, hence its effectiveness in several respiratory parameters. Our study reflects the feasibility of home-designed protocols in the absence of contraindications. We highlight also the positive impact on quality of life after RR at home.

Switching to a Coronavirus Disease 2019 (COVID-19) Center: Lessons From Ariana Hospital Experience.

After the translating of the worldwide pandemic coronavirus disease 2019 (COVID-19) disease from South East Asia to Europe, North African countries accelerate their steps to follow WHO guidelines to prepare the outbreak response. In March 2020, the Tunisian Ministry of Health switched Abderrahmen Mami Hospital to a COVID-19 center. The main objectives were management of patients but also setting-up new rules to permit enough safety for the staff members and harmony between medical, nonmedical, and administrative departments within the facility. Organization and communication during the fast-paced preparation process were crucial to get enough qualified human resources, material resources, and clear procedural texts in place before cases arrived in huge numbers. A group of medical and administrative experts within a central crisis unit brought this challenge into reality.

An unusual clinical manifestation of a relapsed typical pulmonary carcinoϊd tumor.

Typical carcinoid tumors of the lungs carry an excellent prognosis after complete surgical excision. However, recurrence of these cancers remains poorly described in the literature and may occur many years after surgery. We report a case of carcinoid tumor of the lung. Clinical presentation and follow-up were uneventful. The 55 years old patient had got a surgical removal of a huge typical carcinoid tumor of the left lung. A left pneumonectomy with a mediastinal lymph node resection were performed. Thirteen years later, paraneoplastic acromegaly revealed a pulmonary and extrapulmonary recurrence of the tumor. We prescribed a chemotherapy regimen including Cisplatin and Etoposide. Endocrine paraneoplastic syndromes are related to mutations in specifically known genes. Several mutations may become a promising therapeutic target in the future. In the case of neuro-endocrine pulmonary tumors, authors described BCOR gene mutation as an oncogenic development inducer and an eventual generator of ectopic tumoral secretions. The more we get familiar with carcinoid tumor mutations, the closer we get to targeted therapy for non-resectable tumors.

[Bronchiectasis associated with chronic obstructive pulmonary disease: clinical and evolutionary profile]. / Dilatations des bronches associées à la broncho pneumopathie chronique obstructive: profil clinique et évolutif.

INTRODUCTION: in recent years, the combination of bronchiectases (BRs) and chronic obstructive pulmonary disease (COPD) has been described as a potential new phenotype of COPD due to its clinical features and different prognosis. The purpose of this study was to analyse the clinical profile and paraclinical features of COPD in patients with BRs and to determine the impact of BRs on disease progression. METHODS: we conducted a retrospective study of 100 patients diagnosed with COPD and treated in the Department of Pneumology 4 at the Abderrahmane Mami Hospital between 2014 and 2018. Patients were divided into two groups: group 1: patients with COPD associated with BRs (n=50) and group 2: patients with COPD without BRs (n=50). Both groups were matched based on their epidemiological characteristics. RESULTS: all patients were male, with an average age of 65,9 years. Patients with COPD associated with BRs had a higher rate of ischemic heart disease (p=0.037), more severe breathlessness assessed using the modified Medical Resaerch Council (mMRC≥2) (p=0.02), more severe bronchial obstruction (p=0.005) and a higher prevalence of acute exacerbations (p<0.001) and hospitalizations (p=0.004). In a multivariate study, independent factors associated with BRs were severe bronchial obstruction (OR=9.16), frequent exacerbator phenotype (≥2 exacerbations per year) (OR=1.91) and isolation of germs by cytobacteriological examination of sputum (OR=4.99). CONCLUSION: COPD associated with BRs could thus be a phenotype distinct from COPD and correlated with a more reserved prognosis.

[Pulmonary blastomycosis]. / Blastomycose pulmonaire.

Blastomycosis is a rare fungal disease in Africa which is often due to inhalation of "Blastomyces dermatitidis". Pulmonary blastomycosis is the most common clinical manifestation which presents with a variety of clinical features, ranging from asymptomatic to rapidly fatal. We report the case of a Tunisian patient aged 35 years with no previous medical history, hospitalized with chronic cough, bilateral basithoracic pain, fever and weight loss. Clincal examination showed fever and left paravertebral subcutaneous swelling next to the tenth thoracic vertebra (T10). Chest imaging objectified bilateral alveolar and nodular opacities with excavations in some places. Sputum stain for Koch bacillus (BK) was negative (direct examination and culture). Bronchial fibroscopy was normal. Anatomopathological examination of dorsal mass biopsy revealed blastomycosis. The diagnosis was confirmed by cultures of the biopsic fragments of the mass. Antifungal therapy with itraconazole was started with clinical and radiological improvement. This case study highlights challenges in the diagnosis of blastomycosis in our country, in particular when lesions mimick tuberculosis; hence delayed therapy.

Paraneoplastic limbic encephalitis revealing a small cell carcinoma of the lung.

INTRODUCTION: Paraneoplastic limbic encephalitis is a rare disease, usually associated with small cell lung cancer. CASE REPORT: We report in this publication the cases with different age brackets, who presented with various neurological symptoms such as repetitive seizures or anterograde amnesia. Cerebral CT-scan, cerebral MRI and anti onco-neural paraneoplastic antibodies were suggesting the diagnosis of paraneoplastic limbic encephalitis. Etiological exploration lead to the diagnosis of locally advanced small cell carcinoma of the lung. We started rapidly a curative protocol associating chemotherapy and sequential thoracic radiotherapy. CONCLUSIONS: we insist on the diversity of the imaging findings, immunological analyses and outcome on treatment of this entity. Prognostic impact remains also unclear.