Screening for Coronary Artery Disease in Asymptomatic Pilots with Diabetes Mellitus.

INTRODUCTION: Coronary artery disease (CAD) is a cause of death in 75% of patients with diabetes. Its often asymptomatic nature delays diagnosis. In aeronautics, it can cause in-flight incapacitation, beyond which it represents a major fear for the medical expert. Screening for CAD is still a topical subject with the advent of new cardiovascular (CV) risk biomarkers and more effective screening tests. We report the experience of the Aeromedical Expertise Center of Rabat in this screening of diabetic pilots, with a recommendations review.METHODS: A prospective study over 1 yr included diabetic pilots who benefited from systematic screening for CAD after a CV risk stratification. Coronary angiography is performed if a screening test is positive. Subsequent follow-up is carried out in consultation with the attending physician with regular evaluation in our center.RESULTS: There were 38 pilots included in our study. The average age was 55 ± 4.19 yr and about 73% had a high CV risk. CAD was detected in 4 cases (10.52%) who had abnormal resting electrocardiograms and required revascularization with the placement of active stents. Approximately 75% of pilots with CAD returned to fly through a waiver with restrictions.DISCUSSION: Screening for coronary disease in diabetics is controversial, and current recommendations are not unanimous. In our study, the screening did not identify coronary diabetic pilots who could benefit from bypass surgery. Nevertheless, coronary disease was diagnosed, justifying grounding to preserve flight safety, which is an absolute priority in aviation medicine.Zerrik M, Moumen A, El Ghazi M, Smiress FB, Iloughmane Z, El M'hadi C, Chemsi M. Screening for coronary artery disease in asymptomatic pilot with diabetes mellitus. Aerosp Med Hum Perform. 2024; 95(4):200-205.

High blood pressure and aeronautical fitness: experience at the aeromedical expertise center of Rabat.

High blood pressure is a major cardiovascular risk factor closely linked to serious cardiovascular events. A real public health problem affecting more than one in three adults. Aircrew does not escape this pathology, despite very strict medical selection and rigorous and regular medical monitoring by the aircrew doctor during revision visits. We conducted a retrospective study at the medical expertise center for aircrew in Rabat which made it possible to collect 34 hypertensive civilian aircrew for 10 years, from January 2012 to December 2022. The median age at the time of the study was 56.5. The aeronautical specialties practiced by our aircrew population were dominated by class 1. The prevalence of hypertension in Moroccan civilian aircrew: out of 2000 monitored annually at the Aeromedical Expertise Center for 10 years, 34 cases were collected, i.e.: 1.7%. The average age of discovery was 49 years and in 23 cases the diagnosis was established by systematic screening during periodic fitness visits. More than 24 aircrews had no family history of hypertension. On the therapeutic level, lifestyle and dietary measures were systematically prescribed in all our aircrew, 18 patients were put on monotherapy, 11 on dual therapy, and 2 on triple therapy. Compared to fitness decisions, they were variable according to the grade of hypertension, the control of complications, and the aeronautical function. The discovery of hypertension in aircrew can jeopardize aviation safety with the risk of subtle or sudden incapacity in flight through neurological or cardiovascular complications, which could impact the fitness decision. However, advances in medicine and the management of hypertension made in recent years have prompted the medical and aeronautical authorities to revise the standards of aptitude.

Tumor-Stroma Ratio in ER+/HER2- Breast Cancer: Is it a Tool for Treatment Decision?

PURPOSE: The primary aim of this study is to determine the relationship between tumor-stroma ratio (TSR) and traditional prognostic factors in luminal early breast cancer in women treated at the medical oncology department of the military hospital of Rabat in Morocco. METHODS: A retrospective study was performed on primary invasive ER+/HER2- breast cancer in the period from January 1st, 2019 to December 31st, 2019. Prognostic factors included age, tumour size, lymph nodes status, Scarff-Bloom-Richardson grading, lymphovascular invasion (LVI), Ki67 and the stage of the disease. The type of Adjuvant systemic therapy was also reported .Two independent pathologists have assessed TSR by microscopic evaluation of haematoxylin and eosin tumor slides .Patients with less than 50% stroma were classified as low-stroma, the others are classified as high-stroma. RESULTS: Of 53 ER+/HER2- operable breast cancer, 41.5% patients had low-stroma and 58.5% patients had high stroma-tumour. High stroma was significantly associated with more stage III (p=0.041), more LVI (0.034), high Ki-67 (p=0.002) and more luminal B disease (p=0.001). Also, high stroma received more adjuvant chemotherapy (p=0.005). The results are maintained in univariate analysis. CONCLUSIONS: Data suggest that TSR can be used to guide decisions on adjuvant systemic therapy for ER+/HER2- breast cancer. The integration in routine of this simple and reproducible parameter requires a homogenization of the techniques as well as a prospective validation.

Cannon Ball Diagnosis and Management in a Flight Attendant Candidate.

BACKGROUND: ''Cannon ball'' opacities on chest X-rays are a common manifestation of hematogenous dissemination of a malignant tumor in the lungs. They indicate an advanced stage of disease with a very grim prognosis in terms of cure and survival. In aerospace medicine, this aspect means the patient is unfit for flight duties. Nonmetastatic etiologies of pulmonary nodules are rare. We report a case of cannon ball opacities discovered fortuitously during an admission visit. CASE REPORT: A 23-yr-old flight attendant candidate came to the Aeromedical Expertise Center of the Military Hospital in Rabat for medical evaluation. He had no previous medical comorbidities and was asymptomatic. The physical examination was unremarkable. Chest X-ray revealed multiple poorly defined pulmonary nodular opacities, without mediastinal widening. After excluding other possibilities, such as infection or malignancy, the diagnosis of a pseudotumoral form of thoracic sarcoidosis was established by clinical and radiological findings, supported by histopathologic analysis. DISCUSSION: The pseudotumoral form of sarcoidosis is rare. It is usually seen in young people who are asymptomatic. Chest X-ray shows bilateral nodular opacities of different sizes. CT scan shows snowballs, which may or may not manifest with air bronchogram or mediastinal lymph nodes. Laboratory investigations are nonspecific. Pulmonary functions are normal or may show a restrictive pattern. Evolution is spontaneously favorable and does not require any treatment in asymptomatic patients. Aeromedical fitness in sarcoidosis disease depends on several conditions. This observation affirms the benefit of routine chest X-ray during medical evaulations to detect possible entities that may endanger flight safety.Zerrik M, Echchachoui H, Iloughmane Z, El'mhadi C, Elkhader S, Benaissa L, Chemsi M. Cannon ball diagnosis and management in a flight attendant candidate. Aerosp Med Hum Perform. 2017; 88(10):958-961.

A Long Survival Woman with Primary Small-Cell Carcinoma of the Gallbladder: Role of Chemotherapy Maintenance.

Gallbladder small-cell carcinoma (SCC) is an extremely rare cancer characterized by early metastases and associated with poor survival outcomes. The therapeutic options are limited in this indication and dedicated prospective trials are difficult to achieve. Maintenance chemotherapy is an evolving concept in medical oncology whose goal is to prolong chemotherapy-induced response. The role of maintenance therapy has been demonstrated especially in many cancers but the results remain controversial in small cell cancer. We report a case of a 49-year-old woman admitted in our institution with biliary colic, postprandial bilious vomiting, right hypochondrial mass, and deteriorated general condition. Abdominal computed tomography (CT) revealed a mass of the gallbladder with lymphadenopathy in the hepatic hilum and multiple liver metastases. CT-guided biopsy was performed that showed small, round cells with high nuclear-to-cytoplasmic ratio, and frequent atypical mitosis, which is consistent with high-grade small cell neuroendocrine carcinoma. Tumor cells were positive for chromogranin A, synaptophysin, and CD56. Ki-67 shows a high proliferation rate with 90% tumor cell staining and the diagnosis of gallbladder SCC was confirmed. The treatment used a combination of carboplatin and etoposide, interrupted by the generalized discomfort and shortness of breath during the second course of the etoposide. Repeated CT scan showed a partial radiological response in the order of 35% and carboplatin monotherapy was maintained with good tolerance and stability of the disease until the 11th cure. Thrombocytopenia at 70,000 per mm3 appeared, and its persistence forced the cessation of this treatment. Five months later, the disease progressed and second-line chemotherapy by irinotecan was given weekly. The death occurred 18 months after initiation of medical treatment due to hepatocellular insufficiency. Maintenance therapy in SCC should be considered as a promising therapeutic option when it is well tolerated.