[Attitudes and knowledge about smoking among Moroccan physicians looking after patients with tuberculosis]. / Attitudes et connaissances des pneumo-phtisiologues marocains vis-à-vis du tabagisme chez leurs patients tuberculeux.

Cigarette smoking is known to be a risk factor for the development of pulmonary tuberculosis; the management of the disease offers a good opportunity for smoking prevention. The aim of this study was to evaluate attitudes and knowledge of Moroccan respiratory physicians towards smoking in the management of patients with tuberculosis and the feasibility of integrating anti-smoking interventions into the national anti-TB program (PNLAT). A questionnaire was administered using a phone interview to Moroccan respiratory physicians practicing at the Tuberculosis and Respiratory Diagnostic Centre (CDTMR). 75 respiratory physicians answered the questionnaire representing 83.3% of all those approached. The rate of smoking in medical doctors was 10.7%. 66.7% of those interviewed considered that smoking increases the incidence of tuberculosis while 96% believed that smoking would worsen the pathology. More than 84% inquired about the smoking habits of their patients. Only 5.3% believed that they were well trained to help smokers to stop. 78.7% recognized the desirability of integrating a systematic smoking cessation program into the national anti-TB strategy. The rate of smoking among patients with TB is considered high by Moroccan doctors caring for the condition. However, they do not feel that they are sufficiently trained in smoking cessation techniques to help their patients. Therefore, education on smoking cessation needs to be integrated into the national anti-TB strategy.

[Subcutaneous emphysema, pneumomediastinum, pneumopericardium, pneumorachis, and pneumoretroperitoneum revealing an unknown foreign body aspiration]. / Emphysème sous-cutané massif, pneumomédiastin, pneumopéricarde, pneumorachis et pneumorétropéritoine révélant une inhalation méconnue d'un corps étranger.

Subcutaneous emphysema develops from the spread of air essentially from the mediastinum into the subcutaneous tissue causing progressive distension and infiltration. Diagnostic and therapeutic delay expose the patient to massive air effusion and risk of compression of cervical and mediastinal structures. The initial mechanism is a breach in the tracheobronchial tree with air diffusion into the interstitial space and along the perivascular spaces toward the mediastinum, and then spread and dissection in the subcutaneous tissue. A tracheobronchial foreign body is a very rare cause of emphysema and is often localized. An association with a combination of epidural emphysema, pneumopericardium, or pneumoretroperitoneum is exceptional. Here, we present a unique case associating massive subcutaneous emphysema, pneumomediastinum, pneumopericardium, pneumorrhachis, and pneumoretroperitoneum in a 3.5-year-old child complicating an unrecognized aspirated foreign body. The extraction of the foreign body resulted in gradual regression of the symptoms and the disappearance of these emphysematous locations.