N. Bahloul

Do inhaled corticosteroids increase the risk of Pneumocystis pneumonia in people with lung cancer

Pneumocystis pneumonia (PCP) is a life-threatening infection in immunocompromised patients. It is relatively uncommon in patients with lung cancer. We report a case of PCP in a 59-year-old man with a past medical history of chronic obstructive pulmonary disease treated with formoterol and a moderate daily dose of inhaled budesonide. He had also advanced stage non-small lung cancer treated with concurrent chemo-radiation with a cisplatin-etoposide containing regimen. The diagnosis of PCP was suspected based on the context of rapidly increasing dyspnea, lymphopenia and the imaging findings. Polymerase chain reaction testing on an induced sputum specimen was positive for Pneumocystis jirovecii. The patient was treated with oral trimethoprim-sulfamethoxazole and systemic corticotherapy and had showed clinical and radiological improvement. Six months after the PCP diagnosis, he developed a malignant pleural effusion and expired on hospice care. Through this case, we remind the importance of screening for PCP in lung cancer patients under chemotherapeutic regimens and with increasing dyspnea. In addition, we alert to the fact that long-term inhaled corticosteroids may be a risk factor for PCP in patients with lung cancer. Despite intensive treatment, the mortality of PCP remains high, hence the importance of chemoprophylaxis should be considered.

Secondary pleural hydatidosis: Complication of intrapulmonary echinococcosis

Hydatid disease has a wide geographic distribution around the world. In human, the liver is the most commonly affected organ, followed by the lungs. Intrathoracic extrapulmonary locations are generally the mediastinum, pleura, pericardium and chest wall. Pleural involvement usually follows the rupture of a pulmonary or hepatic cyst inside the pleural space causing secondary pleural hydatidosis. We report four cases of patients who were referred to our hospital for management of pleural hydatid disease as a complication of intrapulmonary echinococcosis.

The Impact of Obstructive Sleep Apnea and Daytime Sleepiness on Work Performance: An Observational Cross-Sectional Study in a North African Population

Background: Obstructive sleep apnea hypopnea syndrome (OSAHS) has been shown to be associated with many serious health conditions. The impact on occupational health is still unclear as it was scarcely studied. Purpose: The aim of this study was to assess the association of work performance with OSAHS and daytime sleepiness. Methods: A cross-transversal study was conducted including Tunisian active adult subjects referred for suspected sleep disordered breathing. All subjects completed the Epworth Sleepiness Scale (ESS), the Work Productivity and Activity Impairment Questionnaire (WPAI), and the Patient Health Questionnaire 9 (PHQ9). They all underwent polygraph testing level 3. Result: One hundred thirty-nine subjects completed the survey, including 107 (77%) blue-collar workers, and 32 (23%) white-collar workers. Participants were classified as following: 50 patients with apnea hypopnea index (AHI) ≥ 30 and 89 with AHI <30. Among the four outcomes of the WPAI scale, only presenteeism was associated with AHI (p=0.012). A significant association has been found between daytime sleepiness and three outcomes of WPAI. Sleepy patients with ESS ≥ 11 had lower work performance in terms of presenteeism (42.46 ± 28.40 vs. 24.71 ± 24.77 p=0.0001), absenteeism (12.26 ± 25.51 vs. 6.05 ± 18.32, p=0.101), overall work productivity loss (47.43 ± 31.65 vs. 26.58 ± 28.47, p= 0.0001), and decline in activity (46.67 ± 30.75 vs. 32.14 ± 27.02, p=0.004) in comparison with non-sleepy participants. A strong correlation of presenteeism and overall work productivity loss scores with ESS was demonstrated among white-collar workers (r=0.624, p=0.0001; r=0.602, p=0.0001 respectively). PHQ9 score was significantly higher in sleepy subjects (p=0.0001). Near miss accidents in the workplace and work related accidents were significantly more frequent in those with ESS ≥ 11 (p=0.012, p=0.026; respectively). Conclusion: The most relevant finding of this study was the involvement of daytime sleepiness in performance impairment, while the impact of AHI was less clear.

Barriers to adherence to asthma medication

Methods: We prospectively identified (134) adults who had asthma and came to Hedi Chaker hospital center. Aim: To assess the adherence of patients diagnosed with asthma and identify their beliefs and behaviors related to treatment adherence. Results: In this study,the highest rates of asthma occures in women ( 65,5%). Comorbidities were noticed in 30% of cases. Almost all people know their disease (n=128) were informed that it9s a chronic one. Only (77%) accepted this truth. Prodromes and symptoms were defined by patients in (n=108) patients. The allergy was incriminated in (62) of cases. Only (n=37) patients think having normal life, anger about one9s condition or its treatment was (23%). Dissatisfaction with health care professionals was (34%). Social support, and drug availability were lacking in (64%). The complexity of the therapy was mentioned by (n=58) patients, fear of side effects of drugs reached (n=94) persons with a positive correlation with the dosage regimen (average dose=1000 microgram) and the duration of treatment (averade duration= 13 years) . The most used method of taking the drug was aerolizer (55,2%).It is associated with others drugs in (44,8%) of cases. Errors in inhalation technique have been reported (50%). The follow up was poor in most cases with lack of instruction (34%). Only (n=25) patients were able to make the difference between the action of each drug. Some patients (n=30) use both beta-2-mimetic and corticosteroid inhaler when having an asthma attack, while (n=5) go to the emergency without any medication use. Conclusion: Research on patient adherence has been limited by imprecise measurement tools to estimate inhaler use. Regular examination must be a priority even the patient is asymptomatic.