S. Aissa

A case of Caplan syndrome in a recently diagnosed patient with silicosis: A case report

Rheumatoid pneumoconiosis, also known as Caplans syndrome is defined as the association between silicosis and rheumatoid arthritis (RA). It is a rare and usually diagnosed in an advanced stage of RA course. It affects generally patients with long exposure to silica. In this article, we report a case of Caplans syndrome.

Lung Adenocarcinoma with Gingival Metastasis

Gingival metastasis of lung cancer is uncommon. We report the case of an 82-year-old male smoker admitted to the pulmonology department with right pleural effusion. A chest computed tomography (CT) scan showed an invasive right hilar tumour, adherent to the superior vena cava, pulmonary artery, main right bronchus, mediastinal pleura and pericardium with lymphangitic carcinomatosis of the right lung. Pleural biopsy revealed pleural metastasis of pulmonary adenocarcinoma, its primary lung origin being confirmed by immunohistochemistry. One month later, the patient developed an ulcerated polypoid gingival mass. Biopsy of this lesion showed a poorly differentiated carcinoma compatible with metastasis from the lung adenocarcinoma. The patient underwent irradiation of the gingival mass at a dose of 30 Gray, but his condition worsened rapidly and he was not fit for chemotherapy. He received palliative treatment and died 2 months after diagnosis of his metastatic lung cancer. LEARNING POINTS Lung cancers mostly metastasize to the bones, liver, lymph nodes, brain, lung and adrenal glands, with adenocarcinoma being the most common histological type. Distant metastasis to the oral region is very uncommon but can be the first manifestation of a primary tumour. Oral metastasis can be mistaken for a benign lesion, so a biopsy should be taken for further analysis.

Catamenial pneumothorax revealing diaphragmatic endometriosis: a case report and revue of literature.

Catamenial pneumothorax (CP) is a rare entity of spontaneous, recurring pneumothorax in women. We aim to discuss the etiology, clinical course, and surgical treatment of a 42-year-old woman with CP. This patient had a right-sided spontaneous pneumothoraces occurred one week after menses. She had under-gone video-assisted thoracoscopic surgery (VATS) because of a persistent air leak under chest tube. VATS revealed multiple diaphragmatic fenestrations with an upper right nodule. Defects were removed and a large part of the diaphragm was resected. Pleural abrasion was then performed over the diaphragm. Diaphragmatic endometriosis was confirmed by microscopic examination. Medical treatment with GnRH agonists was prescribed, and after recovery, the patient has been symptoms free for 20 months.

Effects of smoking on the oral cavity

Introduction: Being the first relay, the oral cavity represents the first barrier to be reached by the effects of toxic and irritant substances contained in tobacco. Among the negative effects of smoking on the oral cavity: increased prevalence of periodontal disease (loss of periodontal attachment, increased depth of periodontal pockets and loss of bone Alveolar) and tobacco keratoses. Aim: Describe the characteristics of tobacco-related periodontal diseases and propose a strategy for primary and secondary prevention of these oral conditions. Materials and Methods: We conducted a descriptive retrospective study based on the files of patients who consulted in a dental office that were followed from 2013 to 2016. Results: Over a 4-year period, we collected 6720 patients, of whom 576 were active smokers (8.5%). Among smokers, smoking was found in 20% of tobacco keratoses (homogeneous and non-homogeneous) especially among heavy smokers who smoked more than 20 Year packages. Periodontal disease was observed in 80% of cases, more tartar formation in 70% of cases, periodontal pockets in 62% of cases, recessions or loss of attachment in 70% of cases, alveolysis in 61% of cases. Smokers group had more sites with deep pockets. Conclusion: Smoking is considered to be a major risk factor for periodontal disease, increasing its prevalence and is severity. It decreases the success of surgical and non-surgical treatments for periodontal disease. It also decreases the success of dental implants.

Trends in work sectors and exposures among patients with work-related asthma in the Tunisian central region

Background: Work-related asthma (WRA) is the most common occupational lung disease in Tunisia and all over the world. Several factors including socio-demographic status, industry, occupation and exposures increase its developing risk. Aims: To identify changes in characteristic, work sectors and exposures among WRA patients. Methods: A descriptive retrospective study, enrolling all cases of WRA declared in the private sector of the Tunisian center over a 12 years period. Data were collected from the regional center of the National Health Insurance Fund in Sousse. Patients were divided into two groups according to the periods of WRA diagosis (2003-2008 and 2009-2014). Comparisons between the two groups included socio-demographic characteristics, work sectors, and exposures. Results: WRA was diagnosed in 593 patients. It was more frequent in the second period (63,6% versus 37,4%). Patients mean age increased significantly from 39,2 years in the first period to 41.4 years in the second one (p=0.006). In the both period, WRA was more frequently diagnosed in females. Although WRA was most frequent in textile industry in both periods, a significant increase in its prevalence was noted in timber industry, automotive and mechanical industry and electronic industry. Vegetable textile dusts represented the most implicated etiologic agent in both period. Organic isocyanates have increased but not significatively. Conclusion: Our results suggest that the frequency of WRA is evolving because of industry and exposures developement. This information may assist in plans to develop WRA preventive programs and in facilitating early recognition and diagnosis by health care practitioners.

Critical appraisal of the clinical utility of sublingual immunotherapy in allergy

Since it was introduced by Noon in 1911, allergen-specific immunotherapy or desensitization has been widely prescribed in the management of allergic diseases. Aimed at the etiology, it represents the only effective treatment for allergy. The basic mechanisms of immunotherapy are becoming better understood and allow us to improve this technique in the future. The sublingual immunotherapy as an alternative to subcutaneous route has been widely studied. Several clinical trials confirmed that sublingual immunotherapy is efficient in reducing allergic respiratory symptoms. The sublingual immunotherapy reduces the risk of developing serious side effects due to desensitization. We performed a literature review in order to remind the mechanisms of action and to demonstrate efficacy and tolerability of the sublingual immunotherapy in the treatment of allergic rhinoconjunctivitis and asthma and its impact on the quality of life.

Prévalence du syndrome métabolique dans une population de patients apnéiques : étude prospective avec calcul du risque cardiovasculaire

BACKGROUND Obstructive sleep apnea syndrome (OSAS) is a highly prevalent clinical condition and frequently associated with obesity. Recent literature has suggested the independent contribution of OSAS in the pathogenesis of metabolic disturbances. Metabolic syndrome (MS), a cardiovascular risk factor, was frequently associated with OSAS. METHODS This is a prospective study without intervention. Will be included, all consecutive patients referred to the Department of Pulmonology for suspected OSAS confirmed by respiratory polygraphy. Anthropometric, clinical and biological parameters needed to define the MS will be collected. MS was defined according to the IDF 2005. Assessment of cardiovascular risk related to MS will be performed by appropriate scores. EXPECTED RESULTS To determine the prevalence of MS in a sample of OSAS patients recruited in the Department of Pulmonology of Farhat Hached Hospital (Sousse, Tunisia). To identify risk factors independently associated with the presence of MS in patients with OSAS among the following parameters (age, gender, degree of obesity and the various parameters of OSAS severity). To assess compared cardiovascular risks according to the presence of MS by validated scales to demonstrate the impact of MS in patients with OSAS.