Amel Khattab

Facteurs pronostiques du cancer bronchique non à petites cellules au stade avancé

INTRODUCTION Primary lung cancer is the leading cause of cancer death in men in the world. Although the introduction of new drugs, new therapeutic strategies and despite therapeutic advances, the prognosis is relatively improved during the last years. AIM To evaluate the prognosis of patients with locally advanced or metastatic non-small-cell lung cancer (NSCLC) and to identify prognostic factors at these stages. METHODS A retrospective study, including 140 cases of locally advanced or metastatic NSCLC diagnosed in our department between 2003 and 2013. RESULTS The average age was 61±10 years (35 to 90 years). Sex ratio was 18. The delays management were 80±25 days for presentation, 45±20 days for the diagnostic, while the treatment delay was 8±2.33 days. The cancer was at stage IIIA in 14%, IIIB in 27% and IV in 59%. Six months and one-year survival was between 50 and 74% and between 9 and 25%, respectively. Better survival was observed in patients with NSCLC on stage III, having better performance status, having comorbid conditions, with prolonged delays management, a short therapeutic delay and patients who received specific antitumor treatment. CONCLUSION The prognostic factors in locally advanced and metastatic NSCLC in our patients were: stage of cancer, performance status, comorbid conditions, delay of management and specific antitumoral treatment. These factors should be considered in the management of patients with advanced NSCLC.

Risk factors for another hospitalization in COPD patients hospitalized for exacerbation

Introduction: COPD exacerbation is a potentially life threatening event in the course of COPD. Each episode should be as strongly avoided as possible. Aim: To determine the severity criteria of a COPD exacerbation that are predictive of another readmission. Materials and methods: Retrospective study of 151 patients admitted in our department for COPD exacerbation. Two groups were identified: G1: patients rehospitalized for COPD exacerbation, G2: patients not rehospitalized for COPD exacerbation. Results: G1: 73 patients (48%) and G2: 78 patients (52%). Male patients represented 145 (96%) of all patients. G1 patients were younger than G2 (63 years vs 67 years; p=0.017). Associated cardio-vascular diseases, diabetes mellitus and tobacco smoking didn9t differ from G1 to G2 (27.4% vs 19.2% ; p=0.2, 22% vs 17% ; p=0.4 and 62 pack- year vs 58 pack- year respectively ; p=0.53). G1 patients had less frequently polypnea compared to G2 (83.5% vs 91% ; p=0.001). Consciousness alteration was more frequently noticed in G1 as compared to G2 (23.2% vs 11.5% ; p=0.05). Nevertheless: neither orthopnea nor tachycardia nor lower limb oedema nor hypoxemia nor hypercapnia nor acidosis were associated in an increased risk of another hospitalisation for COPD exacerbation between G1 and G2 (11% vs 9.5% ; p=0,6) , (26% vs 33% ; p=0.13) , (6.8% vs 7.6% ; p=0.9), (48% vs 46% ; p=0.5) , (52% vs 51% ; p=0.7), ( 28.7% vs 37% ; p=0.3) respectively. Moreover the fact that a patient was readmitted in intensive care unit for the first COPD exacerbation wasn9t a risk factor for his admission in hospital another time for COPD exacerbation (22% vs 11.7% ; p=0.09).

Are there any differences between Tunisian and European COPD phenotypes

Background: Spirometric classification of COPD fails to account for the heterogeneity of this disease. Actually, clinical phenotyping would be an interesting approach to evaluate prognosis of this chronic disease. Aim: To compare COPD phenotypes characteristics in Tunisian patients (TP) with European Patients (EP). Methods: Retrospective cohort study including 228 COPD patients. Patients were classified into 4 phenotypes (P1, P2, P3 and P4) according to Burgel9s classification. Results: Every parameter in each phenotype group was compared between Tunisian and European population (Burger and al *). For the P1, n = 102 (44.7% vs 13%), TP were older than EP (the average age was 62 vs 58 years-old), have higher tobacco consumption (56 vs 39.5 pack-years), have lower number of exacerbations per year (2.5 vs 4 ) and more impaired quality of life (SGRQ 80 vs 69.5). For the P2, n= 49 (21.4% vs 27%), TP are older (75vs 68 years-old), have higher tobacco consumption (58 vs 40 pack-years), lower BMI (25.8 vs 28.1) and lower FEV1 Post BD (47% vs 68% of predicted value). For the P3, n = 37 (16.5% vs 28%), TP have better FEV1 Post BD (62% vs 46% of predicted value) but more exacerbations episodes per year (2.29 vs 1). For the P4, n = 40 (17.5% vs 29%), TP have higher tobacco consumption (51 vs 45 pack-years), lower FEV1 Post BD (39% vs 43% of predicted value) and more impaired quality of life (SGRQ 78 vs 58). Conclusion: Our study shows the predominance of phenotype 1 in COPD Tunisian patients in comparison with European COPD patients. This phenotype is associated to worse quality of live and poor prognosis. *: P-R. Burgel, J-L. Paillasseur, D. Caillaud, et al. Eur Respir J 2010; 36: 531–539.

Complicated hydatid cyst of lung

Introduction: The complicated hydatid cyst of the lung is defined as any cyst ruptured in the bronchi or in the pleural cavity, infected, and / or with several sites. Aim: To study the clinical, radiological and evolutive features of complicated pulmonary hydatidosis. Patients and methods: Retrospective study including 15 patients hospitalized in our department during the period between 2003 and 2012 for complicated pulmonary hydatidosis. Results: The mean age was 30 years.All patients are from rural area where shepherding is very common. Symptomatology was dominated by hemoptysis and hydatid vomica.Hydatid serology was positive in all patients.Chest radiography showed pleural effusion in 3 cases and multiple disseminated hydatid cysts throughout the lung fields in 4 cases. Thoracic ultrasonography was performed in 4 patients. Chest CT scan was performed in all patients. It has allowed confirmation of diagnosis of complicated pulmonary hydatidosis and the search for other hydatid locations.The complications found were:rupture of hydatid cyst in the bronchi (8 cases),in the pleura (3 cases),superinfection (2 cases) and multiple pulmonary hydatidosis in 2 cases associated with a hydatid pulmonary embolism in a patient.Multiple hydatidosiswere found in 4 patients.The treatment was surgical in 12 cases.The outcome was good in 13 cases. Conclusion: Complicated hydatid cyst remains a common disease. An early management is necessary in order to improve the functional and vital prognosis of patients.

C-reactive protein and pulmonary tuberculosis: What correlation with disease severity

Introduction: The C - reactive protein (CRP) is a sensitive and specific marker of acute phase of inflammation.Its rate increases particularly in bacterial infections. Aim: To evaluate the correlation of CRP with activity and severity of pulmonary tuberculosis. Patients and methods: Comparative study between two groups of 44 patients treated for pulmonary tuberculosis (31 patients with elevated CRP> 50 mg / l against 13 patients having a CRP Results: There were 44 men. The mean age was 41 yearsin the two groups. Tobacco smoking was more common in the group of patients with elevated CRP. In both groups, clinical features were dominated by decreased general status and cough.Cavitary lung lesions were more frequent in patients with elevated CRP (16 cases vs 3 cases) often with an extensive and bilateral pulmonary involvement (15 cases vs 3 cases).Similarly, positive acid-fast bacilli found in sputum were more frequent in the group of patients with elevated CRP (22 cases vs 6 cases).After excluding patients lost during the treatment, well clinical, bacteriological and radiological evolutions were noted in the term of six months inthe majority of patients with CRP 1month) to bacilli negativation. Conclusion: CRP can be used as a marker of the activity and severity of tuberculosis and can predict the course of the disease.