Fatma Tritar

Prise en charge du pneumomédiastin spontané chez l’adulte : à propos de 14 cas avec revue de la littérature

The authors report a series of 14 patients hospitalized for spontaneous pneumomediastinium between 1992 and 2006. They included 10 men and four women with an average age of 27.84 years. Dyspnoea dominated the symptoms. The pneumomediastinum was idiopathic in five patients and secondary in the other nine patients, involving an attack of severe asthma in half of the patients, polymyositis in one patient and idiopathic pulmonary fibrosis in one patient, respectively. The patients presenting polymyositis and pulmonary fibrosis died due to respiratory distress. The other patients benefited from asthma treatment or thoracic drainage, and were kept at rest. Their outcome was good. No cases of relapse were observed after an average follow up of 2.11 years.

Kyste hydatique de la paroi thoracique mimant une métastase de cancer colique

Chest wall hydatidosis, rare even in the endemic countries, represents 0.09 to 0.3 % of all cases of thoracic echinococcosis. The authors report the case of a 76 year-old man presenting a chest wall mass 4 years after surgery for colic carcinoma. The mass presented both hypoechoic and hyperechoic structures in the ultrasound chest echography. Therefore, metastastic colon cancer was suspected. The pathological study of the mass revealed hydatid membranes. Thoracic tomodensitometry supported the diagnosis of costovertebral and soft tissue hydatid cysts. The patient underwent the surgical resection of two rib arches, a transverse apophysis and the neighbouring soft tissue associated with pre- and post-surgical albendazole. No clinical manifestations were noted in the follow-up after 1 year.

Evaluation of the Microvessel Density and the Expression of Metalloproteases 2 and 9 and Ttf1 in the Different Subtypes of Lung Adenocarcinoma in Tunisia: A Retrospective Study of 46 Cases

Despite the new available histologic classification of lung cancers, it remains difficult to assess the real prognostic relevance of the different subtypes of lung adenocarcinomas. Facing the prognostic relevance of microvessel density (MVD) and the expression of metalloproteases and thyroid tyrosine factor 1 (TTF1) in different cancers, we tried to compare these parameters in the different subtypes of lung adenocarcinomas. We conducted a retrospective study of 46 adenocarcinomas surgically resected. An immunohistochemical study using the cluster of differentiation 34 (CD34), TTF1, metalloproteases 2 (MMP2), and metalloproteases 9 (MMP9) antibodies was performed on all samples while MVD was evaluated using CD34 antibody. The analyzed cases included 19 acinar, 7 papillary, 1 lepidic, and 19 solid predominant American Thoracic Classification of lung adenocarcinomas (ASK). The higher MVD levels were observed in papillary and acinar subtypes types and a statically significant difference in the MVD was observed in the different subtypes (p< 0,001). This study didn’t show significant statistical results concerning MMP and TTF1 expression but it revealed a tendency to an equal expression of these antibodies in the different subtypes. The difference in the MVD between the different subtypes of adenocarcinoma puts emphasis on their prognostic relevance.

Risk factors of severe clinical forms of tuberculosis

Globally, efforts are done to control Tuberculosis (TB) as a worldwide health problem.However,severe clinical forms of this disease are still observed especially in burden countries.Our study aims to identify risk factors,clinical presentation,evolution and prognosis of severe TB among immunocompetent patients.It is about a cohort study carried out in our pneumology department . Four hundred (400) cases of TB (2005 -2014) are enrolled. All possible Data are collected.The prevalence of severe cases of TB was 9 % (36 patients): Acute respiratory failure (13 patients),disseminated TB with neurological and miliary forms (13 patients)and death issue (10 patients).These patients were older(46y vs 35;p

Antituberculosis fixed multi-dose combination and single drug therapy in active tuberculosis: What is about drug hypersensitivity reactions?

BACKGROUND: Use of fixed-dose combinations(FDCs) of tablets against tuberculosis(TB)is now being recommended by WHO .However,the composition and dosage recommendations for FDCs differ from those for separate formulations. OBJECTIVE: Compare drug hypersensitivity reactions of anti-TB FDCs as single tablets(ST)in patients with active TB. METHODS: Retrospective study including 560 patients,divided into: Group1(G1 n=250) treated daily with FDCs (rifampicin,isoniazid , ethambutol, pyrazinamid)during 2months and FDCs(rifampicin, isoniazid)during 4months and Control group(G2 n= 290) treated with standardized regimen(2HRZE/4HR). RESULTS: The mean age was 38,1years and active pulmonary TB was predominant in 2groups.Drug hypersensitivity reaction was noted in respectively 13,2%(G1) and 14,8 %(G2). Urticarial reactions was the most adverse effect noted in 28,2%(12,4%vs15,8%).According of the adverse effects there was no statistically difference except hematologic effects:Thrombopenia and leucopenia were stastically higher in patients treated with FDCs (p=0,018).Pyrazinamide was implicated in most cases(55.8%vs 47%, p CONCLUSION: Adverse drug reaction anti-TB drugs whatever form is not an uncommon. Hematologic effects significantly higher in patients treated with FDCs and Significant difference in doses of Isoniazid and Rifampicin can be the reason of these.

Delayed sputum smear conversion due to cigarette smoking in active pulmonary tuberculosis

Although many studies have assessed factors affecting Sputum smear conversion during tuberculosis (TB) treatment, few have looked into the effect of tobacco smoking. Our study aims to identify effect of tobacco consumption on sputum smear(SS) conversion delay. We conducted a retrospective comparative study enrolling 355 patients treated for pulmonary TB. We defined 2 groups: G1: 218 smokers patients, G2: 137 non smokers patients.Mean age was about 39 years in both groups. There is no difference in gender and educational level. However, smokers are more likely to be jobless without health insurance (57% vs 32%, p=0.06), living in urban area (84% vs 72%, p=0.02), alcoholic (43% vs 3%, p=0.03) ; drug users (9% vs 1%, p=0.01)with a history of incarceration(20% vs2%,p=0.001). Comorbidities are more observed in G1. Among smokers, chest radiograph showed more cavitations (58% vs 40%,p=0.001) with extended lesions in 41% of cases vs 19%.During treatment, smokers are more likely to develop side effects with a higher rate of non observance to medication.Current smokers had a higher risk of non-conversion after two months of therapy when compared to never and ex-smokers (53% vs 31%,p=0.035)Cavities on chest X-ray and non observance to treatment were shown to confound this association. After adjustment for these factors current smokers compared to current non-smokers remained significantly associated with SS non-conversion at 60 days of treatment. Also, Tobacco intoxication average is higher among patients with delayed conversion (32PA vs18PA, p=0.018). In conclusion tobacco smoking was found to delay SS conversion during treatment for pulmonary TB in a dose-dependent manner.

Healing predictors when treating MDR-TB

Introduction: The WHO estimates that 450000 people around the world have MDR-TB, in 2012, of which 170000 have died. This form of TB has a lower cure rate than simple TB, and this is due to the high cost, toxicity and prolonged duration of treatment. Aim: Determine predictors of a favorable outcome with healing in an MDR-TB. Methods: Retrospective study (2009- 2013) including patients with MDR-TB confirmed with drug sensitive test and treated according to WHO recommendations in the 2 referral centers for care of MDR-TB in Tunisia. Healing was declared when the patient has completed treatment with negative culture of KB five consecutive times in the last 12 months. Quantitative and qualitative variables were analyzed by SPSS17.0 software. Results: Fifty-four cases of MDR-TB (mean age was 38±13 years, sex ratio= 3.15) were collected. More than medical treatment, one patient was operated at 9 months of TB treatment. Recovery was reported in 32 cases, 14 are being treated, 5 died and 3 had treatment failure. Unemployment (n=12) was statistically significantly correlated with healing (p<0.05) because the patients were motivated by the financial support which they received during their follow-up. Moreover, healing was inversely correlated to the isolated resistance to isoniazid and rifampicin (p<0.01), the partial chest X-ray cleaning (p<0.01) and the absence of radiological improvement (p<0.05). Neither the absence of a history of TB nor good drug tolerance were correlated with favorable outcome. Conclusion: Treatment and monitoring of MDR-TB are interspersed with several challenges and outcome remains uncertain with a significant failure and death rates. Good adherence remains the only guarantee of a favorable outcome.

Tuberculous empyema: Risk factors and prognosis

Background: Empyema is a well known complication of pulmonary tuberculosis (TB), particularly in patients with advanced TB. Aim of study: To identify risk factors and prognosis of tuberculous empyema. Methods: Retrospective comparative study of 210 patients followed up between 2010 and 2014 for pulmonary TB. We defined 2 groups: G1 (39 TB patients with empyema) and G2: (176 TB patients without empyema). Results: Of the 39 patients in G1, 30 (78%) were male. The mean age in G1 was 37 years (12-74 years). Empyema was not significantly associated with sex, age, vaccination or medical history of TB. It was significantly more common in patients from rural area, who have served time with smoking history, drug and alcohol use. Mean time of general symptoms was about 81 days in G1 and there were no differences compared to G2. Cachexia was noted in 32% of our patients and it was statistically more common. In terms of radiological manifestations, 56% of patients with empyema had cavitary lesions and pulmonary infiltration. These lesions were not significantly more frequent. All patients had pleural drainage, respiratory physiotherapy and antitubercular drugs. Five patients in G1 had surgical treatment. At the end of treatment, extended radiological images and pulmonary sequelae were statistically more common in G1. Conclusions: Tuberculous empyema has as risk factors: smoking history, drug and alcohol use and living in rural area. Its early management is necessary to reduce pulmonary sequelae.