Adult Langerhans' cell histiocytosis with multisystem bone and lung involvement: About a case.

INTRODUCTION: Langerhans cell histiocytosis (LCH) is a rare systemic disease characterized by the abnormal overproduction of histiocytes that tend to infiltrate single or multiple organ systems leading to significant tissue damage. Although LCH can involve various organs including bone, skin, and lymph nodes, multisystem involvement of LCH is rare in adults. CASE PRESENTATION: We report the case of a 31-year-old man with LCH involving his lungs and bone. The initial radio-clinical presentation was rather in favor of pulmonary tuberculosis. Through this observation we draw attention to this rare pathology and we discuss the diagnostic elements and the therapeutic management of this pathology. CONCLUSION: Although it is occasionally difficult to discriminate LCH from other disorders, systemic evaluation might be helpful for differential diagnosis. As LCH isn't infiltrating malignant cells, strong chemotherapy regimen is not recommended in order to avoid severe toxic and side effects.

Impact of cardiorespiratory rehabilitation program on submaximal exercise capacity of Tunisian male patients with post-COVID19: A pilot study.

Post-COVID19 patients suffer from persistent respiratory, cardiovascular, neurological, and musculoskeletal health complaints such as dyspnea, chest pain/discomfort, and fatigue. In Tunisia, the potential benefits of a cardiorespiratory rehabilitation program (CRRP) after COVID19 remain unclear. The main aim of this study was to evaluate the impact of a CRRP on submaximal exercise capacity, evaluated through the 6-min walk test (6MWT) data in post-COVID19 Tunisian patients. This was a cross-sectional study including 14 moderate to severe COVID19 patients aged from 50 to 70 years. CRRP was performed after the end of patients' hospitalization in COVID19 units for extensive or severe extents of COVID19. Dyspnea (modified medical research council), spirometry data, handgrip strength values, 6MWT data, and 6-min walk work (i.e., 6-min walk distance x weight) were evaluated 1-week pre-CRRP, and 1-week post-CRRP. CRRP included 12 sessions [3 sessions (70 min each)/week for 4 weeks]. Exercise-training included aerobic cycle endurance, strength training, and educational sessions. Comparing pre- and post- CRRP results showed significant improvements in the means±standard deviations of dyspnea by 1.79 ± 0.80 points (p < 0.001), forced expiratory volume in one second by 110 ± 180 ml (p = 0.04), 6-min walk distance by 35 ± 42 m (p = 0.01), 6-min walk work by 2,448 ± 3,925 mkg (p = 0.048), resting heart-rate by 7 ± 9 bpm (p = 0.02) and resting diastolic blood pressure by 6 ± 10 mmHg (p = 0.045). In Tunisia, CRRP seems to improve the submaximal exercise capacity of post-COVID19 patients, mainly the 6-min walk distance and work.

Prognostic value of Quality of life (QoL) assessment among Tunisian lung cancer patients.

OBJECTIF: Etudier la valeur pronostique de l'évaluation de la qualité de vie (QDV) pour la survie chez les patients Tunisiens atteints du CDP. Méthodes: Une étude prospective de cohorte a été réalisée entre Janvier 2018 et Juin 2019. Le Performance status (PS), QoL questionnairecore30 (QLQ-C30), QoL questionnaire-Lung Cancer 13 (QLQ-LC13) et European QoL-5 dimensions-3level version questionnaire (EQ-5D-3L) ont été utilisés pour l'évaluation de la QDV. Les patients ont été divisés en 2 groupes selon le score global QLQ-C30, un Déficit Cliniquement Significatif (DCS) a été considéré si le score était ≤50. Les modèles de régression de Cox et Stepwise ont été réalisée pour évaluer la signification pronostique de la QDV. La survie globale (SG) a été calculée à l'aide de la méthode de Kaplan-Meier. Le test du log-rank a été utilisé pour comparer les courbes de survie. Le seuil de valeur de p pour la signification statistique était de 0,05. Résultats: Cent patients ont été inclus. La médiane de SG des patients avec DCS en qualité de vie était significativement inférieure à celle des patients sans déficit : respectivement 365 jours versus 467 jours, (test du log-rank, p = 0,036). De même pour la médiane de survie sans progression : 122 jours versus 326 jours pour ceux qui n'ont pas signalé de différence significative en QDV (test du log-rank, p = 0,05). L'analyse de régression multivariée stepwise a montré que le score global de QDV (QLQ-C30) était un facteur prédictif significatif de SG (coefficient estimate (CE)= 0.336, p=0.005), ainsi que le stade IV (CE=-0.193, p=0.033) et la progression tumorale (CE =-0.238, p=0.047). CONCLUSION: La QDV était un facteur prédictif de survie dans notre cohorte de patients atteints de CDP. Cela devrait recommander une intervention active en soins palliatifs précoces pour les patients présentant un déficit significatif en QDV.

Adherence of North-African Pulmonologists to the 2017-Global Initiative for Chronic Obstructive Lung Disease (GOLD) Pharmacological Treatment Guidelines (PTGs) of Stable Chronic Obstructive Pulmonary Disease (COPD).

BACKGROUND: No previous study has investigated the adherence rate of North-African pulmonologists to the 2017-GOLD PTGs. AIMS: To investigate the adherence rate of Tunisian pulmonologists to the 2017-GOLD PTGs and to identify the barriers to their adherence. METHODS: This was a cohort study involving clinically stable COPD patients who presented to a pulmonology outpatient consultation. The patients were classified as having been appropriately and inappropriately (over- or undertreatment) treated for the GOLD group. Logistic regression was performed to determine the adherence barriers to the 2017-GOLD PTGs. RESULTS: A total of 296 patients were included (88.1% males, mean age: 68 ± 10 years; GOLD A (7.1%), B (36.1%), C (4.1%), and D (52.7%)). The pulmonologists' adherence rate to the 2017-GOLD PTGs was 29.7%. There was a significant statistical difference between the adherence rates among the four GOLD groups (A: 19.0%, B: 20.6%, C: 8.3%, and D: 39.1%; p = 0.001). Differences were statistically significant between the GOLD group D and groups B (p = 0.001). Differences were statistically significant between the GOLD group D and groups B (p = 0.001). Differences were statistically significant between the GOLD group D and groups B (. CONCLUSION: The adherence rate of Tunisian pulmonologists to the 2017-GOLD PTGs is low. It seems that the patients' age, socioeconomic level, national health insurance coverage, and GOLD groups influenced their adherence.

Seasonality of Pulmonary Tuberculosis in Sousse (Tunisia).

INTRODUCTION: Seasonal variation of Pulmonary tuberculosis (TB) has attracted the attention in several regions of the world. AIM: To explore the relationship between variations of mean meteorological parameters (temperature, atmospheric pressure, relative humidity and duration of sunshine) and the occurrence of cases of pulmonary TB. METHODS: This is a retrospective descriptive study of two-time series (meteorological data, case of pulmonary TB) from 1th January 2010 to 31th December 2014.Meteorological data were collected throughout the 5-year period. RESULTS: We collected 180 cases confirmed by direct examination. The relationship between seasonality and the occurrence of TB cases was addressed in two ways considering either the date of the bacteriological diagnosis or the date date of onset of symptoms of TB as the date of the census of cases. Taking into account the date of bacteriological diagnosis, it appeared that spring (33.7%) and summer (25.9%) had the most days with positive diagnosis (p = 0.012). However, considering the date of onset of symptoms of TB , it appeared that winter (34.2%) and spring (28%) had the most days with positive diagnosis with a significant difference. The comparison of the mean of meteorological parameters between days with and without bacteriological diagnosis showed that only the mean duration of sunshine was significatively associated with more cases(p=0.002). This same comparison between the days with and without TB according to the date of onset of symptoms of TB showed significant difference only for mean temperatures which were lower  during the days when patients présented symptoms of TB (p=0.013). CONCLUSION: Our results have highlighted the possible implication of meteorological parameters in the occurrence of pulmonary TB cases.

A rare cause of cough: Agenesis of the right pulmonary artery.

Unilateral pulmonary artery agenesis is a rare malformation. It can lead to several complications.The diagnosis is usually set at adolescence, however it can remain asymptomatic and late diagnosis is possible. Diagnosis is based on thoracic angioscanner. Treatment is essentially symptomatic. A 20-year-old male patient presented to our clinic with a history of cough and dyspnea with an abnormal chest X-ray. Physical examination was normal. Chest X-ray, CT-Scan and Pulmonary ventilation-perfusion scintigraphy led to the diagnosis of right pulmonary artery agenesis. Unilateral agenesis of the pulmonary artery with pulmonary hypoplasia is a rare malformation whose prognosis can be fatal. Once the diagnosis has been established medical follow up is mandatory.

Influence of Weather Conditions on the Onset of Spontaneous Pneumothorax in the Region of Sousse (Tunisia): Analysis of Time Series.

INTRODUCTION: Weather conditions were implicated in the onset of spontaneous pneumothorax (SP). AIM: Investigate the influence of weather conditions on the onset of SP. METHODS: A total of 200 patients with SP in Sousse (Tunisia) were enrolled in the study between January 2010 and December 2014. An analysis of two time series (meteorological data and pneumothorax cases) was performed. Data on weather conditions were collected daily throughout the 5-year period. RESULTS: A comparison of the mean temperature between days with and without SP showed significantly higher temperatures during the days with SP. A decrease of 1% in the relative humidity one day lag (D-1) was associated with an increase in the risk of SP by 1.6% (p=0,02). The occurrence of clusters was associated significantly with higher temperature averages on the same days. This same observation was made regarding the mean duration of sunshine two days before the cluster onset (p = 0.05). The occurrence of storms two days before clusters was also significantly associated with a risk multiplied by 1.96. CONCLUSION: There was a correlation between clusters of spontaneous pneumothorax and weather conditions in the region of Sousse-Tunisia.

The Effects of Ramadan-Fasting (RF) on Inflammatory and Hematological Indices of Stable Chronic Obstructive Pulmonary Disease (COPD) Male Patients: A Pilot Study.

No previous study has evaluated the effects of RF on inflammatory and hematological indices of COPD patients. The main objective of the present pilot study was to assess the effects of RF on some inflammatory and hematological indices measured in male patients with stable COPD. Fifteen COPD patients (mean ± SD of age: 71 ± 6 years) who fasted during Ramadan 2017 volunteered for the study. Three sessions (Before-Ramadan, End-Ramadan and After-Ramadan) were selected. Spirometry tests and blood samples were consistently performed 2.5-4.5 hr before the interruption of the fasting. Assessment sessions comprised: spirometry, inflammatory [erythrocyte sedimentation rate (ESR); C-reactive protein (CRP)] and hematological [red and white blood cells (RBC, WBC); hemoglobin; hematocrit; mean corpuscular volume; mean corpuscular hemoglobin; platelets] indices. Findings were analyzed by applying Friedman ANOVA. The median (lower-upper quartiles) of ESR (Before-Ramadan: 3 (2-9), End-Ramadan: 7 (0-13), After-Ramadan: 9 (5-15) mm/h) and CRP (Before-Ramadan: 20 (11-38), End-Ramadan: 15 (9-34), After-Ramadan: 20 (12-46) mg/L) were not significantly affected by RF. Among all the hematological indices, RF influenced only hemoglobin (Before-Ramadan: 14.4 ± 2.2, End-Ramadan: 13.4 ± 1.3, After-Ramadan: 12.2 ± 0.9 g/dL), hematocrit (Before-Ramadan: 45 ± 7, End-Ramadan: 40 ± 4, After-Ramadan: 39 ± 4%), RBC (Before-Ramadan: 5.1 ± 1.0, End-Ramadan: 4.6 ± 0.7, After-Ramadan: 4.4 ± 0.5 106/mm3) and WBC (Before-Ramadan: 8,673 ± 1,911, End-Ramadan: 7,840 ± 1,526, After-Ramadan: 9,507 ± 2,190/mm3). Compared to the Before-Ramadan session, the End-Ramadan session values for hemoglobin, hematocrit, RBC and WBC were lower. Compared to the After-Ramadan session, the End-Ramadan session values for hemoglobin and WBC were higher and lower, respectively. In conclusion, RF caused significant reduction in hemoglobin, hematocrit, RBC and WBC. However, it did not induce any significant changes in the CRP and ESR indices.

Lung Adenocarcinoma with Gingival Metastasis.

Gingival metastasis of lung cancer is uncommon. We report the case of an 82-year-old male smoker admitted to the pulmonology department with right pleural effusion. A chest computed tomography (CT) scan showed an invasive right hilar tumour, adherent to the superior vena cava, pulmonary artery, main right bronchus, mediastinal pleura and pericardium with lymphangitic carcinomatosis of the right lung. Pleural biopsy revealed pleural metastasis of pulmonary adenocarcinoma, its primary lung origin being confirmed by immunohistochemistry. One month later, the patient developed an ulcerated polypoid gingival mass. Biopsy of this lesion showed a poorly differentiated carcinoma compatible with metastasis from the lung adenocarcinoma. The patient underwent irradiation of the gingival mass at a dose of 30 Gray, but his condition worsened rapidly and he was not fit for chemotherapy. He received palliative treatment and died 2 months after diagnosis of his metastatic lung cancer. LEARNING POINTS: Lung cancers mostly metastasize to the bones, liver, lymph nodes, brain, lung and adrenal glands, with adenocarcinoma being the most common histological type.Distant metastasis to the oral region is very uncommon but can be the first manifestation of a primary tumour.Oral metastasis can be mistaken for a benign lesion, so a biopsy should be taken for further analysis.

Adherence to treatment with continuous positive airway pressure in the obstructive sleep apnea syndrome.

INTRODUCTION: Continuous positive airway pressure (CPAP) is the most effective treatment for obstructive sleep apnea (OSA). Adequate compliance with the use of CPAP is cardinal to achieve cardiovascular, metabolic and neuropsychological benefits of treatment. AIM: Assess the factors affecting compliance to the CPAP treatment and analyze the long term acceptance. METHODS: Retrospective study on 130 patients treated by CPAP for OSA in the department of pulmonology between 2005 and 2014.  Long term acceptance was analysis using the method of survival analysis. RESULTS: These patients are characterized by a mean age of 55.4± 10.2 years; main comorbidities were found hypertension (47%), diabetes (25.5%) and COPD (11%). Median baseline apnea-hypopnea index was (AHI), 56 ± 19,5/h. One hundred thirty patients were enrolled with a mean follow up of 75 ± 34 months, 42 patients stopped their treatment, 21% of them in the first 6 months.  In compliant patients, the median value of daily CPAP use was 5, 5 ± 2 hours. Kaplan Meier analysis showed that 96% of patients were still using CPAP at 12 months, 69,4% at 5 years and 64,1% at 10 years. Chronic Obstructive Pulmonary Disease was identified as a predictor factor of long term CPAP use. Non observing patients had a higher probability to stop the use of CPAP compared to adherent patients Conclusion: the treatment of OSA with CPAP is generally well accepted in the long term. Treatment dropouts are more common among non-adherent patients justify regular monitoring in the first months of treatment.

[Common variable immunodeficiency: a 7 cases reported]. / Déficit immunitaire commun variable: a propos de 7 cas.

BACKGROUND: Common variable immunodeficiency (CVID) is an immune defect characterized by primary hypogammaglobulinemia. The most clinical manifestations are recurrent infection of respiratory tract. AIM: We reported seven cases of DICV which showed METHODS: We reported seven cases of CVID between 1994 and 2004, included six women and one man. RESULTS: The mean age at the first clinical symptoms is 23 years and the mean age at diagnosis is 38. Six patients presented recurrent bacterial infection particularly of the upper and the lower respiratory tract, these infections can lead to chronic diseases such as bronchiectasis. Two patients had chronic diarrhea caused by nodular lymphoid hyperplasia, we showed two cases of granulomatous: spleen tuberculosis and pulmonary sarcoidosis. The diagnostic was confirmed by protein electrophoresis and serum levels of immunoglobulin. All patients received treatment with intravenous immunoglobulin, with a decrease in frequency and severity of infection episodes. CONCLUSIONS: Protein electrophoresis must be done in a young adult with recurrent low respiratory tract infections and/or diffuse bronchectasis.

[Right atrium angiosarcoma disclosed by alveolar hemorrhage]. / Angiosarcome de l'oreillette droite révélé par une hemorragie alvéolaire.

UNLABELLED: Cardiac angiosarcoma represents a primary cardiac malignancy tumor whose early diagnosis is difficult because of its non specific clinical presentation. We present the case of a 57 years old patient with medium abundance hemoptysis. The chest X ray film and CT scan showed bilateral pulmonary infiltrate without cardiac anomaly. Abdominal echography showed disseminated hepatic tumoral lesions. A transthoracic echocardiography made after apparition of heart failure symptoms found a right atrium cardiac tumor. The hepatic lesion biopsy showed angiosarcoma. CONCLUSION: In presence of uncommon systemic symptoms like diffuse pulmonary lesions associated with cardiac anomaly, the diagnosis of angiosarcoma should be included.

[The quality of life in a Tunisian population of asthmatic patients]. / Etude de la qualite de vie chez une population Tunisienne d'asthmatiques.

Asthma is a chronic disease which disturb patient's quality of life (QL). The aim of our study is to evaluate the QL of 110 asthmatics patients aged from 18 to 70 years and the relationship between the QL and the severity of their asthma. We have used the "Chronic Respiratory Disease Questionnaire" translated in our arabic language and adapted to our tunisian environment. The asthmatic women was more affected then the asthmatic men at the environment dimension particularly when there were exposed to pollens, strong smells and perfumes (t < 0.003). QL was not influenced by age, disease's length and the education's level of the patients. Nevertheless, QL is more altered when asthma is more severe (p < 0.0005) and corticosteroids improve the QL for all the dimensions except the environment.