Hichem Aouina

Spontaneous chylothorax revealing a mediastinal and abdominal lymph node tuberculosis

Chylothorax is a rare manifestation of tuberculosis. We report a case of spontaneous chylothorax due to tuberculosis. A 62-year-old woman was admitted with fever, chest pain and dyspnea. Chest and abdominal computed tomography revealed a fluid collection with necrotic mediastinal and abdominal lymph nodes. Biopsy of lymph nodes by mediastinoscopy. The patient was treated with anti-tuberculosis medication. He is clinically improved and his pleural effusion also completely resolved.

ALK protein expression in Pulmonary Adenocarcinoma of Tunisian patients

ABSTRACT Background. It is now necessary to determine ALK status in order to use targeted therapy. Aim: herein, we assess immunohistochemical profile of ALK protein in a series of Tunisian patients with pulmonary adenocarcinoma. Materials and Methods. ALK protein expression was studied applying the D5F3 antibody with a fully automated Ventana CDx technique on a series of 19 patients. Results. Positive ALK expression was found in one case (5.2%) corresponding to a papillary adenocarcinoma which showed a strong granular and homogenous cytoplasmic staining. The patient was a 30-years-old woman. Conclusion. The frequency of positive ALK expression based on immunohistochemistry in our series was similar to that reported in the world literature.

Locally advanced and metastatic lung cancer management delay: Tunisian department experience

Introduction: Lung cancer is the leading cause of cancer-related mortalityworldwide , 5-years survival is just 15%; despite medical progress, mortality rate decreases very slowly.This poor prognosis is due to diagnosis delay. Aims: To evaluate the delay between onset of symptoms, consultation delay and the lung cancer diagnosis. Methods: Retrospective study assessing 180 clinical diagnosis of non-small lung cancer in our Charles Nicolle pneumology department between January 2007 and December 2014. Results: The average age of our patients (pts) was 61.5 year old with a male predominance (93.3%)Consultation delay was 93.6 days (0 to 720 days).Over than 65 years-old pts consult before the youngest (p= 0.011).Pts with poor general condition consult later (0.041).For the other studied factors, it was not found a statistically significant difference.Diagnosis delay was 39.8 days(3 to 240 days)Analyzed factors for this delay were: tumor site and histopathologicalconfirmation way.Pulmonary transparietal biopsy lengthen diagnosis delays (p= 0.04).There was also a relation between tumor site and diagnosis delay (p= 0.000).Treatment delay was 48 days (7 to 270 days).Chemotherapy increase this delay(p =0.001).Global median survival was 6months.1-year and 2-years survival were 30% and 18% respectively.Poor prognosis factors were: PS, early management delay ( 45 days. Conclusion: Prompt management is an important dimension for pts suffering from lung cancer.Our study has found very long prehospital and hospital delays.More efforts are needed to improve lung cancer management and prognosis.

Syndrome d’apnée de sommeil sévère et sevrage tabagique

Objectif Les principaux symptomes du syndrome d’apnee de sommeil (SAS) sont la somnolence et l’obesite. Il a ete demontre que la nicotine permet de diminuer ces deux symptomes ainsi que reduire la frequence et la duree des apnees. L’objectif de ce travail est d’evaluer l’efficacite du sevrage tabagique chez les patients ayant un SAS severe. Methodes Le programme du sevrage tabagique a ete effectue sur 10xa0semaines associe aux therapies de remplacement de la nicotine. Vingt-trois patients ayant un SAS severe sont inclus dans l’etude. L’evaluation a eu lieu au debut, a la fin du traitement, 3xa0mois apres le traitement et des seances hebdomadaires. Resultats L’âge moyen des patients etait 43,2xa0±xa07,6xa0ans. Ils etaient tous de sexe masculin et fumeurs des cigarettes (30,4xa0±xa05,7xa0paquets annee). Une forte dependance a la nicotine (test de Fagerstromxa0≥xa06) a ete retrouvee dans 74xa0% des cas (17xa0patients). Une faible dependance (test de Fagerstromxa0≤xa05) a ete detectee chez 6xa0patients (26xa0%). La motivation au sevrage tabagique etait forte chez 8xa0patients (35xa0%) et faible dans 52xa0% des cas (12xa0patients). Treize pour cent des cas n’avaient pas de motivation a arreter de fumer. La principale motivation pour continuer fumer etait l’effet stimulant du tabac. Il y avait une difference significative, apres 3xa0mois du sevrage tabagique, entre les patients ayant une bonne observance a la ventilation en pression positive continue (CPAP) (24xa0%) et ceux ayant une mauvaise observance (13xa0%). Conclusion Le programme d’aide au sevrage tabagique chez les patients ayant un SAS severe doit tenir compte de l’observance a la ventilation en pression positive continue.

Obstructive sleep apnea (OSA) in young and elderly patients – Does age matter?

Background: The frequency of OSAS rises with age, however it also diagnosed in patients below the age of 40 years. Aim: The goal of this study was to investigate the clinical characteristics of OSAS in elderly patients and to compare the severity and clinical features of OSAS in young and elderly subjects. Material and Methods: One hundred fifty patients were investigated for suspected OSAHS in our department. We compare two groups of patients: group A: patients with age ≥ 60 years and group B with patients of age Results: 150 patients with OSAHS were included: 34 patients in the group A (24 women and 10 men, mean age 66 ± 5 years [60; 81]) and 34 patients in the group B (12 men and 22 women). 85.8 % of elderly patients had co-morbidity and OSAS. OSAS was diagnosed in 24 (70.6%) patients from group A and 22 (64.7%) patients from group B. BMI was significantly higher in group B as a whole than in group A (35.6±6.6 vs 33.3±5.5 kg/m2, p=0.04), so was the BMI of the patients with OSA from group B when compared to the patients with OSA from group A (38.6±4.8 vs 34,6.±5.6 kg/m2, p=0,04). The incidence of OSAS was significantly higher in elderly females when compared to the young ones (55.8 vs 20.5%). Patients with OSA from group A had a significantly higher AHI (37.8±25.3 vs 32.09 ±28.5h-1, p = 0.038) and a high number of desaturation (214,6 vs 157,3). CPAP therapy was initiated in 13 patients (54.1%). In group B, CPAP therapy was started in 16 patients (72.7%). Conclusions: We can conclude that OSA is more frequent in elderly patients and more severe in young patients.

Pulmonary embolism in young adults, what particularities?

Background: Pulmonary embolism (PE) is a frequently seen complication in pulmonology department. Little information is available on the presentation of this event in patients under the age of 50 years, yet early detection and treatment continue to be the main predictors of clinical course. Aim: We aimed to describe the clinical presentation of PE in patients less than 45 years old, with emphasis on identifying risk factors. Methods: Cases of PE diagnosed in our hospital9s pulmonology department over a period of 10 years were reviewed retrospectively. Patients were divided into 2 groups: group 1, composed of patients aged less than 50 years and group 2 of patients aged more than 50 years Results: Among 156 patients diagnosed during the period study, 147 were included (group 1: n = 53, group 2: n = 94). The epidemiological data, the risk factors (RF) identified, symptoms, and exploratory test findings in tow groups are summarized onn Conclusion: We would highlight that the risk of PE, especially in older patients, increased with the number of low-weight risk factors, and some are exclusively found in this age group.

Prevalence of nocturia in obstructive sleep apnea syndrom

Background: Nocturia (two or more urinations per night) is a common symptom in obstructive sleep apnea syndrom (OSAS). Increased intra-abdominal pressure, higher secretion of atrial natriuretic peptide and arousals are responsible for nocturnal urination. Aims and methods: The aim of this study was to evaluate prevalence of nocturia in confirmed OSA. Results: We studied 100 (47 males and 53 females) consecutive confirmed OSA patients (mean: age – 50.5±13.7 years, AHI – 33.4±25.5, BMI – 34.5±6.5). Cardiovascular complications were frequent in studied group - arterial hypertension (37%), coronary artery disease (25%), heart failure (9%) and diabetes (31%). To assess relations between nocturia and age, sex, AHI, overnight saturation, BMI, daytime sleepiness we divided subjects in two groups: 1st with nocturia (61 pts; 61% - group N) and 2nd (without nocturia – 39 pts; 39% - group WN). Characteristics of both groups in table below:n A univariate analysis revealed a significant non parametric correlation between nocturia and AHI ( p=0.02). Prevalence of nocturia in severe OSAS is higher than in mild OSAS (82 % vs 2%, p=0.001). Conclusion: Nocturia is frequent in males and females with OSAS. Nocturnal urination is related to severity of OSAS.

Prevalence of overlap syndrome and its correlation with severity of obstructive sleep apnea syndrome

Background: 9Overlap Syndrome9 is togetherness of Obstructive Sleep Apnea Syndrome (OSAS) with Chronic Obstructive Pulmonary Disease (COPD) and asthma. Aim: We aimed to determine frequency of COPD and Asthma in OSAS patients and effect of these diseases on severity of OSAS. A Tunisian group consisting of 150 patients, investigated for suspected OSAS, was recruited during 6 years. We divided the patients into four groups: Group 1= OSAS with COPD, group 2 = OSAS with asthma, group 3 = OSAS without COPD nor Asthma, group 4 = Non OSAS All cases were examined for COPD, Asthma and severe daytime sleepiness according to Epworth Sleepiness Scale (ESS). Results: Out of 150 cases, 106 (71.6 %) were diagnosed as OSAS, 30.6 % COPD, 8.66 % asthma. The mean age in group 1 (60,5 years ±7,8) was significantly higher than in group 3 (47,9 years ± 14,2) p = 0.041, as well as the Epworth scale was significantly higher in group 1 than in group 3, no significant difference in term of BMI was found. In group 2 comparing to group 3 there was no significant differences in frequency of female sex, the ESS was determined to be significantly higher in group 2 (13.8 versus 4.86 ; p = 0.003) also as the BMI (32.63 versus 29.57 ; p = 0.044). A relation between severity of OSAS and presence of COPD or asthma was found: Patients with COPD or asthma have a severe OSAS, the mean of apnea hypopnea index was 23.4 in patients with overlap syndrome versus 9.09 in patients without overlap (p=0.001) Conclusion: We must insist on the screening of overlap syndrome in patients with OSAS considering this association a predictive factor of severity of OSAS.