Impact of cardiorespiratory rehabilitation program on submaximal exercise capacity of Tunisian male patients with post-COVID19: A pilot study

Post-COVID19 patients suffer from persistent respiratory, cardiovascular, neurological, and musculoskeletal health complaints such as dyspnea, chest pain/discomfort, and fatigue. In Tunisia, the potential benefits of a cardiorespiratory rehabilitation program (CRRP) after COVID19 remain unclear. The main aim of this study was to evaluate the impact of a CRRP on submaximal exercise capacity, evaluated through the 6-min walk test (6MWT) data in post-COVID19 Tunisian patients. This was a cross-sectional study including 14 moderate to severe COVID19 patients aged from 50 to 70 years. CRRP was performed after the end of patients’ hospitalization in COVID19 units for extensive or severe extents of COVID19. Dyspnea (modified medical research council), spirometry data, handgrip strength values, 6MWT data, and 6-min walk work (i.e., 6-min walk distance x weight) were evaluated 1-week pre-CRRP, and 1-week post-CRRP. CRRP included 12 sessions [3 sessions (70 min each)/week for 4 weeks]. Exercise-training included aerobic cycle endurance, strength training, and educational sessions. Comparing pre- and post- CRRP results showed significant improvements in the means±standard deviations of dyspnea by 1.79 ± 0.80 points (p < 0.001), forced expiratory volume in one second by 110 ± 180 ml (p = 0.04), 6-min walk distance by 35 ± 42 m (p = 0.01), 6-min walk work by 2,448 ± 3,925 mkg (p = 0.048), resting heart-rate by 7 ± 9 bpm (p = 0.02) and resting diastolic blood pressure by 6 ± 10 mmHg (p = 0.045). In Tunisia, CRRP seems to improve the submaximal exercise capacity of post-COVID19 patients, mainly the 6-min walk distance and work.

Adult Langerhans' cell histiocytosis with multisystem bone and lung involvement: About a case

INTRODUCTION

Langerhans cell histiocytosis (LCH) is a rare systemic disease characterized by the abnormal overproduction of histiocytes that tend to infiltrate single or multiple organ systems leading to significant tissue damage. Although LCH can involve various organs including bone, skin, and lymph nodes, multisystem involvement of LCH is rare in adults.

CASE PRESENTATION

We report the case of a 31-year-old man with LCH involving his lungs and bone. The initial radio-clinical presentation was rather in favor of pulmonary tuberculosis. Through this observation we draw attention to this rare pathology and we discuss the diagnostic elements and the therapeutic management of this pathology.

CONCLUSION

Although it is occasionally difficult to discriminate LCH from other disorders, systemic evaluation might be helpful for differential diagnosis. As LCH isn't infiltrating malignant cells, strong chemotherapy regimen is not recommended in order to avoid severe toxic and side effects.

Prognostic value of Quality of life (QoL) assessment among Tunisian lung cancer patients

OBJECTIF

Etudier la valeur pronostique de l'évaluation de la qualité de vie (QDV) pour la survie chez les patients Tunisiens atteints du CDP. Méthodes: Une étude prospective de cohorte a été réalisée entre Janvier 2018 et Juin 2019. Le Performance status (PS), QoL questionnairecore30 (QLQ-C30), QoL questionnaire-Lung Cancer 13 (QLQ-LC13) et European QoL-5 dimensions-3level version questionnaire (EQ-5D-3L) ont été utilisés pour l'évaluation de la QDV. Les patients ont été divisés en 2 groupes selon le score global QLQ-C30, un Déficit Cliniquement Significatif (DCS) a été considéré si le score était ≤50. Les modèles de régression de Cox et Stepwise ont été réalisée pour évaluer la signification pronostique de la QDV. La survie globale (SG) a été calculée à l'aide de la méthode de Kaplan-Meier. Le test du log-rank a été utilisé pour comparer les courbes de survie. Le seuil de valeur de p pour la signification statistique était de 0,05. Résultats: Cent patients ont été inclus. La médiane de SG des patients avec DCS en qualité de vie était significativement inférieure à celle des patients sans déficit : respectivement 365 jours versus 467 jours, (test du log-rank, p = 0,036). De même pour la médiane de survie sans progression : 122 jours versus 326 jours pour ceux qui n'ont pas signalé de différence significative en QDV (test du log-rank, p = 0,05). L'analyse de régression multivariée stepwise a montré que le score global de QDV (QLQ-C30) était un facteur prédictif significatif de SG (coefficient estimate (CE)= 0.336, p=0.005), ainsi que le stade IV (CE=-0.193, p=0.033) et la progression tumorale (CE =-0.238, p=0.047).

CONCLUSION

La QDV était un facteur prédictif de survie dans notre cohorte de patients atteints de CDP. Cela devrait recommander une intervention active en soins palliatifs précoces pour les patients présentant un déficit significatif en QDV.

Cancer broncho-pulmonaire : est-il un facteur d’infection et d’aggravation au cours du COVID-19

Introduction

Le virus SARS-COV2 a un impact sur la prise en charge de plusieurs patients notamment sur les patients atteints de cancer broncho-pulmonaire (CBP). Nous abordons les caractéristiques de l’infection COVID-19 chez les patients atteints de CBP durant la pandémie COVID-19.

Méthodes

Étude descriptive portant sur 10 cas de COVID-19 chez des patients avec cancers Broncho-pulmonaire (CBP) colligés au service de pneumologie à l’hôpital de Sousse, de mars 2020 à juin 2021. Le diagnostic de COVID-19 a été confirmé par un test RT-PCR.

Résultats

Parmi les 100 cas de CBP confirmés histologiquement et suivis pendant la période de l’épidémie COVID-19, 10 patients avaient une infection confirmée par le SARS Cov2. Il s’agissait de 9 hommes et une femme, dont la moyenne d́âge était de 60,5 ans. Huit patients avaient un adénocarcinome pulmonaire, un patient avait un carcinome épidermoïde et un patient avait un carcinome à petites cellules. Parmi ces patients, 9 étaient au stade localement avancé non opérable et un patient était sous chimiothérapie palliative. Le délai moyen entre le début des symptômes et la confirmation virologique était 11 jours. Une TDM thoracique initiale avait montré une atteinte minime pour 80 % des cas. Un seul cas hospitalisé en réanimation avait une atteinte scannographique étendue. L’évolution clinique et radiologique était favorable dans la plupart des cas. Un seul patient était décédé, il avait une comorbidité cardio-vasculaire.

Conclusion

Il ne semble pas que le cancer du poumon soit un facteur de risque d’infection par le SARS-COV2 ou d’aggravation en cas d’infection, en tout cas, pas plus que les autres comorbidités tels que les maladies cardio-vasculaires, le diabète et l’âge avancé.

Long COVID-19 chez des patients Nord-Africains : l’incapacité évaluée par les données du test de marche de six minutes

Introduction

Le long COVID-19 est défini par la persistance des symptômes au-delà de 12 semaines sans diagnostic alternatif après l’acquisition de l’infection, quel que soit le statut viral. Dans le long COVID-19, les séquelles cardiorespiratoires, notamment l’incapacité ne sont pas encore bien élucidées. Le but de ce travail était d’évaluer l’aptitude aérobie sous-maximale (via les données du test de marche de six minutes (TM6)) des patients ayant présenté une pneumopathie hypoxémiante à COVID-19.

Méthodes

Cinquante-cinq patients atteints d’une pneumopathie hypoxémiante à COVID-19 étaient inclus. Les données anthropométriques (âge, indice de masse corporelle (IMC)) étaient collectées. Une spirométrie simple et unTM6 étaient pratiqués. Les données suivantes étaient notées: volume expiratoire maximal en une seconde sur la capacité vitale forcée (VEMS/CVF), distance de marche (Dm6, m, %), fréquence cardiaque (FC, bpm, %), saturation pulsée en oxygène (SpO₂, %), dyspnée (échelle visuelle analogique (EVAd)). Les définitions suivantes étaient appliquées: Dm6 anormale (Dm6 < à la limite inférieure de la normale), désaturation (chute de la SpO₂ > 5 points), dyspnée anormale (dyspnée à la fin du TM6 > 5), insuffisance chronotrope (FC à la fin du TM6 < 60 %), réponse cardiaque excessive (FC à la fin du TM6 > 80 %).

Résultats

Les moyennes d’âge, d’IMC, et du rapport VEMS/CVF étaient, respectivement, de 59 ± 8 ans, de 30 ± 5 kg/m², et de 0,79 ± 0,08. La moyenne de la Dm6 (m, %) était de 574 ± 73 m (97 ± 14 %). Les moyennes de la FC (bpm, %) et de la dyspnée de repos étaient, respectivement, de 78 ± 11 bpm (55 ± 7 %), et 1 ± 1. À la fin du TM6, elles avaient augmenté d’une manière statistiquement significative avec des moyennes de 115 ± 23 bpm (67 ± 13 %) et 3 ± 2. La moyenne de la SpO₂ de repos était de 96 ± 2 % et a diminué d’une manière statistiquement significative à la fin du TM6 avec une moyenne de 94 ± 4 %. À la fin du TM6, 16 (29 %), 12 (22 %), 7 (13 %), 4 (7 %), et 4 (7 %) patients avaient, respectivement, une insuffisance chronotrope, une Dm6 anormale, une réponse cardiaque excessive, une désaturation, et une dyspnée anormale.

Conclusion

Les patients atteints du long COVID-19 semblent avoir une altération de l’aptitude aérobie sous-maximale. Un programme de réhabilitation respiratoire pourrait restituer cette altération.

Erythema Nodosum Revealing Metastatic Lung Cancer

Erythema nodosum (EN) is an inflammatory condition of the subcutaneous fat and has been reported in patients with haematological malignancies (lymphomas) or solid tumours. Lung cancer is the most common cause of paraneoplastic syndrome. We report a case of EN occurring as a paraneoplastic disease. A 48-year-old Tunisian woman, a non-smoker with no relevant medical history, presented with painful, erythematous, firm nodules on her legs with ankle swelling. The patient did not report any other symptoms. There were no abnormalities on examination except for moderate fever. An extensive infectious and immunological investigation was negative. Antistreptolysin antibodies were undetectable. Chest radiography showed a focal opacity in the right lung and a CT scan revealed a mass in the lower right pulmonary lobe with hilar and mediastinal lymphadenopathies, a nodule in the right adrenal gland, condensation in the iliac bone and multiple bilateral nodular cerebral expansive processes. Bronchial biopsies revealed a primitive and moderately differentiated adenocarcinoma. No argument for tuberculosis or sarcoidosis was found.

LEARNING POINTS

Erythema nodosum (EN) can be idiopathic.EN has rarely been associated with lung cancer and so the association may be coincidental in our patient.The lung cancer was easily identified by chest x-ray in this case and in cases described in the literature.

Seasonality of Pulmonary Tuberculosis in Sousse (Tunisia)

INTRODUCTION

Seasonal variation of Pulmonary tuberculosis (TB) has attracted the attention in several regions of the world.

AIM

To explore the relationship between variations of mean meteorological parameters (temperature, atmospheric pressure, relative humidity and duration of sunshine) and the occurrence of cases of pulmonary TB.

METHODS

This is a retrospective descriptive study of two-time series (meteorological data, case of pulmonary TB) from 1th January 2010 to 31th December 2014.Meteorological data were collected throughout the 5-year period.

RESULTS

We collected 180 cases confirmed by direct examination. The relationship between seasonality and the occurrence of TB cases was addressed in two ways considering either the date of the bacteriological diagnosis or the date date of onset of symptoms of TB as the date of the census of cases. Taking into account the date of bacteriological diagnosis, it appeared that spring (33.7%) and summer (25.9%) had the most days with positive diagnosis (p = 0.012). However, considering the date of onset of symptoms of TB , it appeared that winter (34.2%) and spring (28%) had the most days with positive diagnosis with a significant difference. The comparison of the mean of meteorological parameters between days with and without bacteriological diagnosis showed that only the mean duration of sunshine was significatively associated with more cases(p=0.002). This same comparison between the days with and without TB according to the date of onset of symptoms of TB showed significant difference only for mean temperatures which were lower  during the days when patients présented symptoms of TB (p=0.013).

CONCLUSION

Our results have highlighted the possible implication of meteorological parameters in the occurrence of pulmonary TB cases.

A rare cause of cough: Agenesis of the right pulmonary artery

Unilateral pulmonary artery agenesis is a rare malformation. It can lead to several complications.The diagnosis is usually set at adolescence, however it can remain asymptomatic and late diagnosis is possible. Diagnosis is based on thoracic angioscanner. Treatment is essentially symptomatic. A 20-year-old male patient presented to our clinic with a history of cough and dyspnea with an abnormal chest X-ray. Physical examination was normal. Chest X-ray, CT-Scan and Pulmonary ventilation-perfusion scintigraphy led to the diagnosis of right pulmonary artery agenesis. Unilateral agenesis of the pulmonary artery with pulmonary hypoplasia is a rare malformation whose prognosis can be fatal. Once the diagnosis has been established medical follow up is mandatory.

[Contribution of pulmonary CT angiography in assessing the severity of acute pulmonary embolism]

Chest CT angiography has taken a major role in the management of patients with suspected pulmonary embolism. Meanwhile, it became necessary to determine the severity criteria at the time of diagnosis in order to properly assess the risk/benefit of treatment to consider. In recent years, pulmonary CT angiography has emerged as a useful tool for assessing the severity of acute lung embolism, based on morphological criteria. The two main approaches that were studied were the quantification of obstruction of pulmonary arterial bed and recognition of signs of right heart failure. The aim of our work is to define the morphological parameters in cardiovascular pulmonary CT angiography and to determine their value in the current clinical prognostic stratification of acute pulmonary embolism of, especially their correlation with the risk of developing signs of clinical severity at diagnosis and at 3 months of the occurrence of pulmonary embolism.

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.

Quality of Life and Work Productivity Impairment of Patients with Allergic Occupational Rhinitis

BACKGROUND

Several studies demonstrated the negative impact of allergic rhinitis on Quality of Life (QOL) and occupational activities. Similar studies on allergic Occupational Rhinitis (OR) are rare. The aim of this study was to evaluate the QOL and work productivity of patients diagnosed with allergic occupational rhinitis.

MATERIALS AND METHODS

We conducted a cross-sectional study from January 2005 to December 2015 at the Department of Occupational Medicine in Farhat Hached Teaching Hospital-Tunisia including patients diagnosed with allergic OR. QOL was assessed by the Mini-RQLQ (Rhinitis quality of life questionnaire) and Work impairment was measured by WPAI (Work Productivity and Activity Impairment) questionnaire.

RESULTS

a total of 414 patients was enrolled in the study with a mean age of 37.82±8.08 years and a sex ratio = 0.33. Textile and clothing industry was the most represented sector (65.7%). The mean percent work time missed (absenteeism) due to allergic OR was 9.98±20.86% with a median of 0% and the mean presenteeism score was 46.7±32.67%. Overall QOL was 2.71±1.31. The most affected domains were practical problems and activity limitations. Absenteeism was positively correlated with age and eye symptoms scores. Both presenteeism and percent overall activity impairment were positively correlated with severe nasal obstruction and activity limitations score.

CONCLUSION

Allergic OR impairs QOL and work productivity. Although it doesn't seem to be associated with an important absenteeism, work productivity is reduced by an important rate of presenteeism. QOL and work productivity seem to interact significantly.

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

Rheumatoid pneumoconiosis, also known as Caplan's 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 Caplan's syndrome.

Disseminated histoplasmosis diagnosed in the bone marrow of an HIV-infected patient: First case imported in Tunisia

Histoplasmosis is a fungal infection caused by a dimorphic fungus, Histoplasma capsulatum. We report a first case of disseminated histoplasmosis in a 34-year-old woman, infected with human immunodeficiency virus (HIV), originating from Ivory Coast and living in Tunisia for 4 years. She was complaining from fever, chronic diarrhoea and pancytopenia. The Histoplasma capsulatum var. capsulatum was identified by direct microscopic examination of the bone marrow. She was treated by Amphotericin B, relayed by itraconazole. Even though a regression of symptoms and normalization of blood cell count (BCC), the patient died in a respiratory distress related to CMV hypoxemic pneumonia.

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.

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.

[Prevalence of metabolic syndrome in a population of apneic patients: a prospective study with cardiovascular risk estimation]

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.