Jihen Ben Amar

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.

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.

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 on 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 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.