MACVIA-ARIA Sentinel NetworK for allergic rhinitis (MASK-rhinitis): the new generation guideline implementation.

Several unmet needs have been identified in allergic rhinitis: identification of the time of onset of the pollen season, optimal control of rhinitis and comorbidities, patient stratification, multidisciplinary team for integrated care pathways, innovation in clinical trials and, above all, patient empowerment. MASK-rhinitis (MACVIA-ARIA Sentinel NetworK for allergic rhinitis) is a simple system centred around the patient which was devised to fill many of these gaps using Information and Communications Technology (ICT) tools and a clinical decision support system (CDSS) based on the most widely used guideline in allergic rhinitis and its asthma comorbidity (ARIA 2015 revision). It is one of the implementation systems of Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing (EIP on AHA). Three tools are used for the electronic monitoring of allergic diseases: a cell phone-based daily visual analogue scale (VAS) assessment of disease control, CARAT (Control of Allergic Rhinitis and Asthma Test) and e-Allergy screening (premedical system of early diagnosis of allergy and asthma based on online tools). These tools are combined with a clinical decision support system (CDSS) and are available in many languages. An e-CRF and an e-learning tool complete MASK. MASK is flexible and other tools can be added. It appears to be an advanced, global and integrated ICT answer for many unmet needs in allergic diseases which will improve policies and standards.

[Treatment and prognosis of advanced stage non-small-cell lung cancer]. / Traitement et pronostic du cancer bronchique non à petites cellules au stade avancé.

INTRODUCTION: Lung cancer is the main cause of death from cancer in both men and women worldwide. In 70 to 80% of cases, the diagnosis is made at an advanced stage. Although the management of non-small-cell lung cancer (NSCLC) has continued to improve over the last 5 years, the prognosis remains poor with a 5-year survival rate of about 16%. The aim of this study was to evaluate the management of locally advanced or metastatic NSCLC in our patients and to analyze overall survival (OS) and prognostic factors at these stages. MATERIALS AND METHODS: A retrospective study, including cases of locally advanced and metastatic NSCLC diagnosed in our department between 2008 and 2011. RESULTS: We included 150 patients with a mean age of 60.2 years. The cancer was at stage IIIA in 21% of cases, IIIB in 14% of cases and IV in 65% of cases. Thoracic surgery was performed in 5 patients; 61.4% of patients received chemotherapy and chemo-radiotherapy was given in 21% of patients. Overall survival was 6 months. Better survival was observed in patients aged less than 60 years, having better performance status (PS), having no metastatic mediastinal lymph nodes and patients who received specific anti-tumor treatment. CONCLUSIONS: The prognostic factors in locally advanced and metastatic NSCLC in our patients were: age, PS, status of mediastinal lymph nodes at diagnosis and treatment. These factors should be considered by physicians when treating patients with advanced stage NSCLC.

[Sternal tuberculosis causing spontaneous fracture of the sternum]. / Tuberculose sternale avec fracture spontanée du sternum.

Sternal tuberculosis is an uncommon condition. Few cases have been reported. We report the case of a 74-year-old man, presented with a swelling and pain of the anterior chest wall associated to worsening of general state. All routine investigations were normal. Chest radiograph in lateral view showed sternal and chest wall hypertrophy with spontaneous fracture of the sternum. Computed tomography (CT) scan demonstrated ring-enhancing hypodense soft tissue mass surrounding the sternum with sternal fracture. Tuberculosis diagnosis was confirmed by histological study of the mass biopsy. We noted clinical and radiological recovery with medical tuberculosis treatment.

Severe chronic allergic (and related) diseases: a uniform approach--a MeDALL--GA2LEN--ARIA position paper.

Concepts of disease severity, activity, control and responsiveness to treatment are linked but different. Severity refers to the loss of function of the organs induced by the disease process or to the occurrence of severe acute exacerbations. Severity may vary over time and needs regular follow-up. Control is the degree to which therapy goals are currently met. These concepts have evolved over time for asthma in guidelines, task forces or consensus meetings. The aim of this paper is to generalize the approach of the uniform definition of severe asthma presented to WHO for chronic allergic and associated diseases (rhinitis, chronic rhinosinusitis, chronic urticaria and atopic dermatitis) in order to have a uniform definition of severity, control and risk, usable in most situations. It is based on the appropriate diagnosis, availability and accessibility of treatments, treatment responsiveness and associated factors such as comorbidities and risk factors. This uniform definition will allow a better definition of the phenotypes of severe allergic (and related) diseases for clinical practice, research (including epidemiology), public health purposes, education and the discovery of novel therapies.

[Etiology and evolution of bronchiectasis in women]. / Profil étiologique et évolutif des bronchectasies chez la femme.

INTRODUCTION: Although considered as an orphan disease in the developed countries, bronchiectasis are frequent in our country as in all emerging ones. They are most common in women and they represent a frequent cause for consultation and hospitalization in pulmonology departments. PATIENTS AND METHODS: To determine the etiology and prognosis of the bronchectasies in women, a retrospective study was performed including 200 patients. RESULTS: The mean age was 55.60 years. The diagnosis of bronchiectasis was confirmed in all patients. Bronchiectasis were post-tuberculosis in 56.5% of cases and primitive in 29.5% of cases. The systemic diseases, in particular the rheumatoid polyarthritis represented 3% of cases. The infectious complications and the chronic respiratory failure were more frequent in patients with primitive bronchiectasis than those with secondary bronchiectasis. However this difference was statistically significant only for the chronic respiratory failure. CONCLUSION: The bronchiectasis remains frequent in women in our country, as a sequel of pulmonary tuberculosis more than primitive forms. Bronchiectasis secondary to systemic diseases, although rare, must be known.

[Idiopathic mediastinal fibrosis]. / Fibrose médiastinale idiopathique.

Mediastinal fibrosis or fibrosing mediastinitis is a rare condition characterized by chronic fibrosis occurring in mediastinal structures, in proliferating fibrous scar tissue. The disease may be secondary or idiopathic. The authors report the case of a 46-year-old woman, without a particular past history, who, in December 2006, presented dyspnoea on exertion and a superior vena cava syndrome. Her chest X-ray showed a right laterotracheal opacity. Fiberoptic bronchoscopy revealed concentric tracheobronchial narrowing, severe hyperemia and mucosal edema. The chest computed tomography documented the obstruction of the superior vena cava, the right main bronchus and the right upper lobe bronchus secondary to a mediastinal mass. Mediastinoscopy revealed a hard and dense mass, surrounding the different structures of the mediastinum. Pathologic examination corroborated mediastinal fibrosis. No cause was determined. Prednisone and anticoagulant were prescribed during 2 years with a regression of dyspnoea and the superior vena cava syndrome and an important regression of radiological lesions. In conclusion, prolonged corticosteroids may be efficient in the treatment of idiopathic mediastinal fibrosis.

Information-processing under incremental levels of physical loads: comparing racquet to combat sports.

AIM: Skillful performance in combat and racquet sports consists of proficient technique accompanied with efficient information-processing while engaged in moderate to high physical effort. This study examined information processing and decision-making using simple reaction time (SRT) and choice reaction time (CRT) paradigms in athletes of combat sports and racquet ball games while undergoing incrementally increasing physical effort ranging from low to high intensities. METHODS: Forty national level experienced athletics in the sports of tennis, table tennis, fencing, and boxing were selected for this study. Each subject performed both simple (SRT) and four-choice reaction time (4-CRT) tasks at rest, and while pedaling on a cycle ergometer at 20%, 40%, 60%, and 80% of their own maximal aerobic power (Pmax). RESULTS: RM MANCOVA revealed significant sport-type by physical load interaction effect mainly on CRT. Least significant difference (LSD) posthoc contrasts indicated that fencers and tennis players process information faster with incrementally increasing workload, while different patterns were obtained for boxers and table-tennis players. The error rate remained stable for each sport type over all conditions. Between-sport differences in SRT and CRT among the athletes were also noted. CONCLUSIONS: Findings provide evidence that the 4-CRT is a task that more closely corresponds to the original task athletes are familiar with and utilize in their practices and competitions. However, additional tests that mimic the real world experiences of each sport must be developed and used to capture the nature of information processing and response-selection in specific sports.

Simple and choice reaction times under varying levels of physical load in high skilled fencers.

AIM: Fencing requires rapid and accurate decision-making while competing and experiencing gradual perceived effort. This study examined the linkage between physical effort, simple reaction time and choice reaction time in fencers and non-fencer subjects. METHODS: Two age-matched groups participated in this experiment: 12 professional fencers and 12 sedentary subjects. Each subject performed both simple (SRT) and choice reaction time (CRT) tasks at rest, and while pedaling on a cycle ergometer at 20%, 40%, 60%, and 80% of their own maximal aerobic power (Pmax). RESULTS: At rest, no significant differences were found between experts and sedentary subjects neither in SRT nor CRT. The fencers showed shorter CRTs at 40%, 60% and 80% of Pmax compared to those measured at rest. In contrast, SRTs did not vary as a function of effort level. In sedentary subjects, workload did not affect SRTs and CRT. Moreover, the error rate remained stable for each group over all conditions. CONCLUSIONS: Current results showed that physical load results in enhancing information processing as measured by CRT without affecting SRT. The data provides evidence that aerobic exercise enhances attentional capability in fencers who are used to process information under similar physical conditions, but not in sedentary subjects unfamiliar to this environment. Exercise induces arousal that supports alertness to external environmental stimuli in highly trained athletes.

[Idiopathic pulmonary hemosiderosis in adults]. / Hémosidérose pulmonaire idiopathique de l'adulte.

Idiopathic pulmonary hemosiderosis (IPH) is a rare cause of diffuse alveolar hemorrhage characterized by abnormal deposition of hemosiderin iron in the macrophages of alveoli. Most cases occur in children. In adults, IPH is rare: almost 10 cases reported during the late 10 years. We report the case of a 20-year-old-girl with IPH. There was no evidence of pulmonary vasculitis or capillaritis. Long-term treatment with systemic corticosteroids was followed by clinical remission lasting 4 years.

Questionnaire on health systems and national resources for control of respiratory health in low-income countries.

BACKGROUND: Due to increased exposure to risk factors such as ageing and tobacco smoking, chronic respiratory diseases (CRDs) have become a major cause of morbidity and mortality worldwide. Data on CRDs and their management in developing countries (DC) are nevertheless sparse and not comparable. OBJECTIVE: To implement and validate a standardised self-administered questionnaire to be proposed to health authorities to assess the resources of their health system for dealing with respiratory diseases. METHODS: The questionnaire concerned social security, description of the health system, human resources available within the system, initial training and continuing education of health personnel, existence of a list of essential drugs, vaccine coverage and specific resources involved in CRD and tobacco control. RESULTS: The validity of the criteria of the questionnaire was tested in Reunion Island, where health data are accessible and reliable, and was found to be satisfactory. Its acceptability and relevance were deemed appropriate in Tunisia and in Mozambique. CONCLUSION: The self-administered questionnaire is a simple, reliable and cheap tool. Although designed for the study of respiratory diseases, it can easily be transposed and adapted to other pathologies.

[Endobronchial pulmonary rhabdomyosarcoma. A case report]. / Rhabdomyosarcome pulmonaire à présentation endobronchique. A propos d'une observation.

We report a case of pleiomorphous pulmonary rhabdomyosarcoma observed in a 64-year-old patient with no history of soft tissue tumor. The tumor was found extending into the right lower and middle lobes. The intra-parenchymatous extension protruded into the middle lobular bronchus and was prolonged by a 4 cm polyp. The polyp extended up to the carina and reached the contralateral common bronchus. Outcome was fatal after surgery performed in an emergency setting due to asphyxia. Explorations could not be continued to determine the primary or secondary nature of the tumor. An intraparenchymatous endobronchial localization is uncommon. Primary rhabdomyosarcoma is generally a purely intra-parenchymatous tumor. The endobronchial localization has been described before but is very exceptional. This localization would also be exceptional for secondary rhabdomyosarcoma mimicking a primary malignant tumor. The histology study revealed an undifferentiated pleiomorphous tumor. Immunohistochemistry provided the final diagnosis.