Prognostic factors of advanced stage non-small-cell lung cancer.

Background Lung cancer is the main cause of death from cancer in the world. The 5-year survival is about 15%. Despite the progress of medicine the mortality rate decreased only marginally. This poor prognosis is due to late diagnosis. Aim To evaluate overall survival and prognostic factors in patients locally advanced or metastatic non small cell lung cancer (NSCLC). Methods Retrospective study including 180 patients with non-small cell lung cancer hospitalized in the department of Charles Nicolle Hospital of Tunis between January 2007 and December 2014. Results The mean age was 61.5 years with a male predominance (93.3%). The median overall survival was 6 months. The poor prognostic factors were the performans status (PS) and early delays of management (<30 days). The factors that improve survival were surgical treatment and delays of management more than 45 days.  Conclusion The prognostic factors in locally advanced and metastatic NSLC in our patient were: PS, management delay and treatment. These factors should be considered in management of patient with advanced stage NSCLC.

[Predictive factors of the outcome of smoking cessation among Tunisian women]. / Facteurs prédictifs des résultats du sevrage tabagique chez la femme tunisienne.

BACKGROUND: The spread of smoking among women in Tunisia has reached alarming proportions because of increasing smoker rate, the younger age of smoking initiation and therefore its duration. AIM: Identify predictors of success or failure of smoking cessation, Methods: we conducted a retrospective study (January 2008-June 2011), including 101 female smokers (19.8%) among 510 smokers of both sexes undergoing smoking cessation interventions. Univariate and multivariate analysis between groups of smokers who succeeded and who failed smoking cessation was performed. RESULTS: Average age of our patients was 44 years. The overall success rate at 6 months and 1 year were respectively 24.7 and 18.8%. In univariate analysis, a statistically significant difference in terms of successful weaning was observed in smokers who had a late age of smoking onset (after 20 years) (p=0.03), respiratory or cardiovascular comorbidities associated (p=0.03) and good adhesion to the consultation (p=0.02). In multivariate analysis only the presence of a tobacco-related disease (OR: 4.43, 95% CI [1.29- 15.17], p=0.01) and adherence to the consultation (OR 5.02 95% CI [1.29 -19.39], p=0.01) were significantly associated with a good prognosis for successful weaning at 6 months and one year. A possible but not significantly associated with age of smoking initiation was observed (OR=0.3 95% CI [0.08-1.07], p=0.06). CONCLUSION: Beyond validated smoking cessation and prolonged follow-up, a differential approach, taking into account women specificities, would increase the chances of quitting smoking.

[Obesity hypoventilation syndrome and obstructive sleep apnea syndrome: is there an association?]. / Syndrome d'obésité hypoventilation et syndrome d'apnées de sommeil : quel type d'association?

BACKGROUND: Severe obesity sometimes leads to a chronic alveolar hypoventilation: obesity hypoventilation syndrome (OHS), (Pao2<70mmHG, Paco2>45mmHG and body mass index (BMI)>30Kg/m2). The association with an OSAS is frequent. AIM: To assess predicting factors that lead to hypoventilation in a population of obese patients with SAS and to deduct the type of association between OHS and SAS. METHODS: We have study during 4 years, at pneumology service of Charles Nicolle hospital, 62 obese patients (BMI>30Kg /m2), 41men and 21 women and presenting an OSAS. We excluded those carriers of a bronchial obstruction (VEMS/CV <60%) and we have compared anthropométriques, functional, gazométriques and polysomographiques details of the groupe1 (G1): OHS=9 and of the groupe2 (G2): obesity without hypoventilation (n=53). RESULTS: We didn't identified any significant difference between the two groups concerning (age, sex, the frequency of smokers, the frequency of the nasopharynx region abnormalities, apnea-hypopnea index (AHI), the SAS severity and the respiratory functional exploration). The obesity is significant more important in the G1, it is sever (BMI>40) in 77.8% of patients of the G1 with significant difference with the G2 (P=0.004). We noted that there is a positive interrelationship between BMI and Paco2. We identified severe gazométrique perturbation in G1 (Pao2 medium = 61± 9 mmHg,Paco2 medium=50 ± 7 mmHg), in the G2 we noted a moderate hypoxemia. Patients of the group1 make of the minimal desaturation of 63 ± 17% and a Sao2 average of 81 ± 20% what is meaningfully more important than in the G2. CONCLUSION: The alveolar hypoventilation in SAS seems to be in correlation with the degree of obesity. The hypercapnie in the OHS is in relation neither with the SAOS nor with its severity. The OHSSAS association is usual but not synonym; the OHS is an autonomous disease.

[Risk factors of side effects of antituberculosis drugs]. / Facteurs de risque des effets indesirables des antituberculeux.

The aim of this study was to determine the side effects of standard antituberculosis therapy with isoniazid, rifampicin, pyrazinamide and streptomycine in patients treated for tuberculosis. One hundred eighty nine patients with proven tuberculosis, who initially received standard antituberculosis therapy, were retrospectively studied. Begaud and coll's method of side effects drugs imputability elaborated in 1999 was used in our study. Side effects related to therapy were present in 31.7% of the studied population. Gastrointestinal side effect was the most common (13.2%), isoniazid, rifampicin and pyrazinamide were often incriminated. The significant risk factors of hepatotoxicity were female gender (OR : 10.59) and concomitant hepatotoxic drugs (OR 6). Chocleovestibular toxicity was associated significantly with female gender (OR : 8.03) and diabetes mellitus (OR : 6.13). Patients aged above 50, proved to be at risk for pyrazinomide intolerance and females for streptomycine. The study did not reveal any susceptibility to isoniazid and rifadine intolerance.

[Smoking cessation]. / Le sevrage tabagique.

We estimate that more than 80% of tobacco-smokers hope that they will stop smoking one day. The major obstacle is the psychologic and pharmacologic dependence generated by the cigarette. Different weaning methods have been tried, but their rate of success remains low. The nicotinic sustitution by transdermic track (patch) will give good results providing it is prescribed within the framework of a medical help to wean away from smoking tobacco.

[Bronchopulmonary aspergillosis: study of 17 cases]. / L'aspergillose broncho-pulmonaire: etude de 17 cas.

Aspergillosis is a fungic infection depending on the local or general physiologic and immunologic state of the host. We report the result of retrospective five year study (1995-1999) about 17 cases in the laboratory of Parasitology-Mycology of Rabta hospital in Tunis. Six aspergillomas were observed, they occurred after a pulmonary tuberculosis, two cases of allergic broncho-pulmonary aspergillosis described in two asthmatic patients, nine cases of invasive pulmonary aspergillosis complicating two cancers, one leukaemia, six chronic granulomatous disease. Aspergillus fumigatus is the most frequent species (67%). The clinical and biological characteristic of those will be studied, and compared with those of the literature.