Dorra Bejar

Pleural effusions after cardiac surgery: Etiology and outcomes

Background: Pleural effusions (PE) occur commonly after cardiac surgery (CS). However little is known about risk factors for their developing. Objective: the aim of our study was to investigate the prevalence, the clinical course and risk factors of PE after CS. Methods: It was a retrospective study from January 2011 to December 2016. We enumerate patients who developed pleural effusion after a CS and studied epidemiological clinical, biological and radiological data. Results: Among 75 patients included in the study, 31 patients(41%) developed a PE. The mean age was 57 years (28 males and 3 females). Seventeen patients were smokers. The Most common comorbidities were hypertension (55%), diabetes (55%).The most of these effusions occurred 15 days post surgery (early onset). The mean time of occurrence was by the seventh post operative day. PE were on the left side (51%), and bilateral (22%). The etiology of most of PE remains unclear. Eight of the effusions were a pneumonitis reaction, 3 were attributed to congestive heart failure and 1 was an empyema. Pleural fluid was hemorrhagic and fluid analysis showed an exudate in most cases. The volume of effusion was under 120 ml in 80% of patients. Coronary artery bypass grafting (CAPG) (71%) and valvular replacement (VR) (22%) were the most common indications for CS. The PE occurred in 40% of cases after a CAPG and in 14% of cases after a VR. The mean duration of CBP in patients who developed PE was 99,11min.The treatment was based on the etiology and pleural physiotherapy. The evolution was favorable in most cases. Conclusion: PE is common complication of CS. The cause of many of PE remains unclear. CAPG is associated with greater proportion of them.

Survival in lung cancer: Associated factors in Tunisian patients

Introduction: Lung cancer remains a relevant health care problem in the world and Tunisia. Despite the advanced therapeutic, his prognosis still poor. Knowledge of prognostic factors is important for making the therapeutic decision. Objective: The aim of the study is to analyze survival in lung cancer and to investigate the association between clinical characteristics, treatment and prognosis. Methods: A retrospective study was conducted including 183 patients admitted between January 2010 and December 2011 with diagnosis of lung cancer. Results: Mean age was 61 ± 10 years. The sex ratio was 6.32 M/F. A smoking history was noted in 85% of cases. Non small cell lung cancer (NSCLC) was the most common histological type (89%). Small cell carcinoma (SCC) was identified in 11 % of cases. At diagnosis, 67% of patients were metastatic, 23% were at a locally advanced stage. Only 5% of patients had a localized tumor. Therapeutic decision was taken in a multidisciplinary team meeting in 52% of cases. Surgical treatment was possible in only 8% of cases. Palliative chemotherapy was prescribed in 66% of patients, radiotherapy in 25% of cases. Patients with SCC were treated by chemotherapy in 75% associated with radiotherapy in 56 % of cases. Supportive care was indicated in 19% of cases. The median of survival was 12 ± 1 month. Factors associated with long survival were age less than 65 years, performance status (0 or 1), absence of lung fibrosis history, absence of metastatic lymph nodes, adenocarcinoma type and multidisciplinar approach. Conclusion: survival in Tunisian patients with lung cancer is low.Screening,early diagnosis andmultidisciplinary approach may improve the prognosis of the disease.

Impact of alexithymia on asthma managment

Introduction: Alexithymia is the inability to understand and identify emotions and to describe emotions with words and express them. It has been associated with poorly controlled asthma and near-fatal asthma. Objective: The aim of the study was to assess the prevalence of alexithymia in asthmatics and investigate the relationship between alexithymia and asthma control, management, and health-related quality of life (HRQL). Material and Methods: Patients filled in the Twenty-Item Toronto Alexithymia Scale (TAS). They also underwent the Asthma Control Questionnaire (ACQ) and Asthma Quality of Life Questionnaire (AQLQ). Results: A total of 100 patients took part in the study (45.85 ± 16.4 years; 69% female). The prevalence of alexithymia was 42% with a mean total score on the TAS-20 of 54.6±20. According to a dimensional approach, asthmatics had a higher score (20.3 ± 7.4) concerning the cognitive component of alexithymia (Externally Oriented Thinking factor) but it was not statistically significant. Alexithymia mean scores were not statistically different across socio-demographic variables. It was related to a higher prevalence of some psychiatric disorders including anxiety (p=0.029), dysthymia (p=0.04) and panic troubles (p=0.03). A higher alexithymia score was associated with decreased pulmonary function (p=0.02), worse asthma control score (p=0.04), more emergency room visit (p=0.004), irregular follow-up (p=0,005) and poor adherence to asthma treatment. The three factors (F1, F2, and F3) of alexithymia were significantly associated to a worse quality of life score. Conclusion: This study demonstrates that the level of alexithymia among Tunisian patients with asthma is high and it affects control of the disease and quality of life.