M.R. Charfi

Sleep-Related Painful Erections in a Patient With Obstructive Sleep Apnea Syndrome

Sleep-related painful erection (SRPE) is a rare sleep disorder characterized by recurrent, painful penile erections occurring when awakening from rapid eye movement sleep, while erections are painless during wakefulness. Almost 35 cases have been reported worldwide, and only two of them had an associated obstructive sleep apnea syndrome (OSAS). We report a new case of a 61-year-old man suffering from SRPE associated with OSAS. The adequate treatment of respiratory events with continuous positive airway pressure did not alleviate the SRPE symptoms and excessive daytime sleepiness. The SRPE diagnosis was made by polysomnography coupled with video surveillance when the patient was referred to the sleep laboratory for residual excessive daytime sleepiness. The patient had 2–4 episodes of SRPE/night. Beta-blocker did not alleviate the SRPE, but a transient improvement was noted when the patient was treated with paroxetine. In contrast with the two previously published cases of SRPE plus OSAS, continuous positive airway treatment did not improve SRPE symptoms in our patient.

Tracheobronchopathia osteochondroplastica: an unusual cause of chronic cough

Learning point for clinicians Chronic cough is a common reason for consultation and management presents a challenge for the clinician. Various rare causes of chronic cough should be considered when the classical etiologies have been eliminated. These rare causes of chronic cough include benign lesions of the trachea such as Tracheobronchopathia osteochondroplastica (TO).1 TO is a rare disease of unknown origin characterized by multiple submucosal nodules osteocartilaginous of the trachea and major airways. We report a case of TO incidentally discovered at imaging in old woman suffering of chronic cough. …

Correlation between Arabic version of the asthma control test, forced expiratory volume at 1 s and exhaled nitric oxide in Tunisian asthmatic patients

Background Numerous markers of asthma severity and activity are available. Among them, functional parameters, clinical assessment and biomarkers of inflammation are the most widely used. It is difficult to establish a clear correlation among theses parameters, as each of them measure a particular aspect of the disease. Objective The aim of the study was to clarify the correlation between Asthma Control Test (ACT) scores, exhaled nitric oxide (eNO) levels and forced expiratory volume at 1s (FEV1). Methods It was a cross sectional study including patients treated for asthma for at least 3 months. All patients completed the ACT questionnaire and underwent testing for eNO and spirometry. Results A total of 148 asthmatic patients were included. The mean age was 44.2 ±14.7 years and 55.4% of patients were female. The ACT scores varied from 5 to 25 (median 22), and asthma control was obtained in 71.7% of patients. The percentage of predicted FEV1 ranged from 42% to 121% (mean 86%) and eNO varied between 10 and 175 ppb (mean 30.4 ppb). ENO values in the controlled group were significantly better than in uncontrolled group (27 ppb vs 42.1, p=0.01). The ACT score was negatively correlated with eNO values (r= - 0.33, p=0,001) and positively correlated with percentage of predicted FEV1 (r=0.1, p= 0.08). However, the association was weak in view of each correlation coefficient value. There was no correlation between FEV1 and eNO ( r=0.06, p=0.4). Conclusion ACT, FEV1 and eNO quantify variables that evaluate asthma in different ways and they are complementary. Thus, ACT should be used in combination with pulmonary function tests and/or eNO measurements.

The levels of exhaled nitric oxide in controlled asthmatic patients with and without rhinitis

Background Exhaled nitric oxide (eNO) is a non invasive biomarker of eosinophilic airway inflammation and a high level of eNO was shown in patient with asthma. ENO was higher in patients with asthma and rhinitis compared to patients with rhinitis alone or patients with rhinitis and bronchial hyperreactivity. Otherwise, we don9t know the influence of rhinitis on the eNO levels in asthmatic patients. Objectives The aim of this study is to evaluate airway inflammation by eNO in asthmatic patients and its relationship with rhinitis. Methods It was a cross sectional study including controlled asthmatic patients treated with nasal and/or inhalant corticoids. All patients underwent eNO measurements and skin prick tests. The patients were devised in two groups G1: with rhinitisand G2 without rhinitis. Results A total of 106 controlled asthmatics, 85 patients in G1 and 21 patients in G2 were included. The patients of G1 were younger than the patients of the G2 (43.9 vs 48 years old, p=0.2). Family history of atopy was more frequent in the G1 (75.2 % vs 61.9%,p=0.2). The association of conjunctivitis to asthma was more significantly frequent in the G1 (60% vs 4.8%, p=10 -6 ). Mean percentage of predicted FEV1 value was significantly better in G2 (93% vs 87%, p=0.1). The sensitizations to house dust mites and pollens were the more frequent in two groups. The sensitizations animal dander and to cockroaches were higher in the G1. However, sensitizations to molds was more frequent in G2. there was no difference in mean eNO values in two groups (25.3 vs 25.1 ppb, p=0.2). Conclusion Our data suggest that allergic rhinitis is not associated with high levels of eNO in controlled asthmatics.

Neuropathie axonale révélant un lymphome pleural primitif sur séquelles de collapsothérapie

Peripheral neuropathy is a rare presenting feature of malignant lymphoma, and commonly associated with diagnostic delay. We report a patient with axonal neuropathy revealing primary pleural lymphoma as a late outcome of pulmonary tuberculosis. A 72-year-old-man with a past medical history of pulmonary tuberculosis presented with a 5-month history of axonal neuropathy. The patient complained of chest pain, altered general status. Chest computed tomography (CT) showed pleural tumour invading the chest wall and CT-guided pleural biopsy revealed a B-cell lymphoma. Chemotherapy was not started in consideration of the poor performance status of the patient. Despite corticosteroids, the peripheral neuropathy worsened and the patient died 2 months after the diagnosis of lymphoma. To our knowledge, no previous case of peripheral neuropathy revealing pleural lymphoma has been reported. The diagnosis of lymphoma must be entertained in the presence of peripheral neuropathy of unknown aetiology. Neuropathy associated to lymphoma results from various mechanisms and is characterised by clinical polymorphism. Their prognosis depends on the mechanism of the neuropathy and the severity of the lymphoma.

L’embolie pulmonaire hydatique : à propos de deux observations

Le profil de l’asthme chez les sujets âgés est très hétérogène. Nous avons mené une étude rétrospective en comparant le profil de 51 patients asthmatiques répartis en 2 groupes, le groupe 1 comprend 16 sujets âgés de plus de 65 ans et le groupe 2 comprend 35 patients âgés de moins de 65 ans. La moyenne d’âge est de 66 ans dans le groupe 1 et de 37 ans dans le groupe 2, il existe une prédominance féminine dans les 2 groupes. L’atopie familiale est présente dans 62,5 % dans le groupe 1 et 48,6 % dans le groupe 2 (p = 0,35). L’asthme est classé stade I dans 25 % et 31,5 % (p = 0,64), stade II dans 25 % et 11,5 % (p = 0,22), stade III dans 12,5 % et 40 % (p = 0,05) et stade IV dans 37.5 % et 17 % (p = 0,11) respectivement dans le groupe 1 et 2. La rhinite est présente dans 62 % et 74 % (p = 0,39) et la conjonctivite dans 43 % et 31 % (p = 0,39) respectivement dans le groupe 1 et 2. Les prick-tests sont positifs dans 81 % et 86 % dans le groupe 1 et 2. La spirométrie est réalisée chez 37 % du groupe 1 et tous les patients du groupe 2. Elle est normale dans 43 % dans le groupe 2 et dans aucun cas du groupe 1 (p = 0,002), le trouble ventilatoire léger est plus fréquent chez le sujet jeune. Le traitement de fond repose sur les bêtamimétiques inhalés à la demande chez tous les patients et et la corticothérapie inhalée en fonction des stades de la maladie. Selon certaines études, l’asthme du sujet âgé semble plus sévère, l’observance du traitement plus délicate et le retentissement sur la qualité de vie plus important. 50 L’embolie pulmonaire hydatique : à propos de deux observations N. Fajraoui, L. Zakhama, E. Bousabbah, H. Khouani, M.R. Charfi