[Assessment of nutritional status in patients with primary lung cancer]

Lung cancer is the leading cause of cancer-related mortality worldwide. Malnutrition is a common problem among patients with cancer, affecting up to 85% of patients with certain cancers and represents a risk factor for poor prognosis. Evaluate nutritional status in patients with lung cancer before and during treatment using nutritional risk index. It's a prospective study conducted in pneumology IV department in Abderahman Mami hospital, from January to May 2011. 30 male patients with a lung cancer were included. Nutritional status was assessed before and during treatment based on anthropometric measures, biological markers and nutritional risk index [NRI]. Mean age of patients was 58 +/- 12 years, ranging from 19 to 82 years. 29 patients had non small cell lung cancer and one patient had small cell cancer. Malnutrition was noted in 14 patients [47%] before treatment according to the NRI. It was noted in 23 patients [77%] after three cycles of chemotherapy with severe malnutrition in 8 patients. Relationship between body mass index [BMI] and the NRI was linear, but NRI tends to evaluate more objectively risk of malnutrition in patients with lung cancer. Nutritional assessment in patient with lung cancer should be performed systematically, early and repeatedly. Several markers can be used such as BMI and NRI. Nutritional support will reduce morbidity and improve quality of life in patients with lung cancer

Association of obesity with asthma severity, control and quality of life

The association between asthma and obesity is becoming increasingly established but the mechanism that might explain the observed differences in asthma severity, control and quality of life between obese and non-obese adult asthmatics is not clear. The purpose of this study was: 1] to determine asthma severity, control and quality of life in obese asthmatics and 2] to explore, according to the body mass index [BMI], the systemic inflammatory state of asthmatic people. A cross-sectional study was conducted between 2009 and 2010. Two hundred adult asthmatic patients were included. Data analysis consisted of univariate analysis with chi-square comparison test followed by a multivariate logistic regression. Obesity worsens the severity of asthma. This finding was more strongly observed among women than men. Obesity and overweight are associated with a poorer control of asthma. According to BMI, obese asthmatics had 6 times more frequent emergency visits, 5 times more frequent hospitalizations for asthma related complaints, increased missed work days and greater dose of inhaled corticosteroids [1025 micro g/day vs. 759 micro g/day of beclometasone equivalent]. Mean serum level of C-reactive protein [CRP] and leptin was significantly correlated with asthma severity based on GINA classification [5.75 vs. 2.81 mg/l; 20.5 vs. 5.38 ng/ml; respectively]. In summary, it appears that obesity is significantly associated with a greater asthma severity and a poorer asthma control and quality of life. Chronic systemic inflammation state may explain the relationship between obesity and asthma

[Predictive factors of obstructive sleep apnea syndrome in obesity]

Obstructive sleep apnea [OSA] syndrome is frequent, and misdiagnosed. Of this study is to assess the prevalence of OSA syndrome in a Tunisian population of obese [body mass index>or=30 Kg/m[2]] and to determine its predictive factors. It's a transversal study. One hundred patients [63 females, 37 males] were inculded. All patients underwent nocturnal polysomnography or respiratory polygraphy. Sixty-five patients had an OSA syndrome: mild [24.6%], moderate [30.7%] and severe [44.6%]. We compared, by a statistical analysis, the group with OSA syndrome and the group without OSA syndrome. There was a predominance of men [81%of men vs 55.5 of women had OSA]. Age was higher in the group with OSA syndrome [56.8 years +/- 10vs 48.1 +1-12, P=0.04]. Clinical symptoms such as snoring, daytime sleepiness, nocturnal awakening and respiratory pauses were more frequent in the group with OSA syndrome. Morphological abnormalities such as retrognathy and/or short neck were significantly more frequent in the group with OSA syndrome [p=0.05 and 0.02 respectively]. Cardiopathies and diabetes were more frequent in obese with OSA syndrome. In obese persons, male gender, comorbidities and diabetes clinical symptoms such as snoring, daytime sleepiness, nocturnal awakening and respiratory pauses, retrognathy and/or short neck are predictive of OSA syndrome. So, we propose a nocturnal recording in obese presenting at least one of these predictive factors

Last discovery of a congenital broncho-oesophageal fistula

Broncho-oesophageal fistula is rare and occurs mostly in acquired condition. Report of a new case. We report a case of a 58-years-old woman which has, since 38 years ago, a chronic cough, recurrent bronchopulmonary suppurations and hemoptysis. Clinical examination let to the diagnosis of a broncho-oesophageal fistula. Surgical treatment resulted in complete recovery. There was no evidence of any aetiology. Congenital origin of the fistula was deduced

Late onset systemic lupus erythematosus

Late onset systemic lupus erythematosus [SLE] after 50-year-old is rare. We report a case of 84-year-old woman presenting with systemic lupus revealed by pleural effusion associated with renal involvement. The pleural effusion, renal abnormalities and the immunological abnormality improved within 4 weeks after prednisone therapy [1 mg/kg/day]. The late onset lupus differs from those with early onset, in terms of mild clinical presentation and favourable prognosis. Our observation is exceptional due to the very late onset of the lupus and involvement of a major organ, the kidney, which is usually exceptional in this age

[Asthma in the elderly]

Asthma in elderly is actually well individualized. Two entities are considered: - "Ageing asthmatics" who have had asthma since childhood, adolescence or adulthood and persisting after 65 years old. This situation is the most frequent.- Late-onset asthmatics in persons 65 years old and more. Clinically, asthma in elderly is frequently represented by a dyspnoea at rest during the day. Diagnosis remains difficult because of the non-specifity of clinical symptoms and the frequency of comorbidity. Many differential diagnosis must be considered, dominated by congestive heart failure and COPD. Concerning treatment of asthma in the elderly, a few particularities should be known: prudence in the prescription of beta-2-adrenergic drugs. Anticholinergic drugs have a place in the treatment. contrary to younger asthmatics. A great importance to inhalation devices should be allowed because of their use difficulties in the elderly. The main goal of asthma management in the elderly is to improve the quality of life

[Lung cancer and chondromatous hamarotma; a case report]

The association lung cancer with chondromatous hamartoma is frequent. We present a case of synchronous primary lung adenocarcinoma and chondromatous hamartoma. Although hamartoma is generally considered to be a benign tumor, there have been several reports of increased risk of lung cancer in patients with a chondromatous hamartoma. Therefore we recommend that patients with hamartoma should be submitted to a complete evaluation and to regular follow up, considering the risk of associated synchronous malignancy

[Treatment compliance in asthma: a Tunisian transversal study]

As a chronic disease, asthma requires a continued treatment and poses the problem of compliance with medication. To study in a Tunisian population of asthmatics, the level of compliance and the factors affecting it, we included 190 adults with persistent asthma in a transversal study using a self-questionnaire. The mean age was 38.56 years. 2/3 of patients had medium or poor socioeconomic status. 1/3 had severe persistent asthma, progressing for 5 years in 68% of case. All patients received inhaled corticosteroids only 44 had high dosed corticosteroids. 29.5% of patients were compliant with medication in our study. Omission and intentional negligence were the two main reasons for non-compliance. Level of compliance was positively related to socioeconomic status, urban way of life, history of hospitalization, high dosed corticosteroids and knowledge of their indication. We conclude that treatment compliance in asthma is very low. Further efforts should be made to improve compliance: by increasing the accessibility of medication and by the educational programs which should be a priority in the management of asthma

Corps etrangers tracheo-bronchiques de l'enfant. Aspects diagnostiques et therapeutiques.

In this retrospective study, the authors reviewed 31 cases of tracheobronchial foreign body in children ranging in age from one to 15 years, recruited in Ariana hospital since 1987. 74% of the patients were male, and only 26% were less than 3 years old. The foreign body is mostly revealed by a radio-clinical presentation of a feverish bronchopneumonia [32%]; children were referred to the hospital within 15,4 months. Although penetration syndrome was reported in 61% of patients, it represented the reason of consultation in only 19% of cases, and children were referred within 4,5 days. The main radiographic findings were atelectasis [32%] and non specific foci of pneumonia [19%]. Air trapping was noted in just 10% of cases. 55% of foreign bodies were vegetable in nature, with sunflower seeds at the head of the list [16%]. They have been lodged preferentially in the right bronchial tree [58%] and 51% of them were found in the mainstem bronchus. 71% were removed by endoscopic procedures; a surgical operation was performed in 6 cases [1 9%]: one case of pneumotomy to extract a metallic foreign body from distal respiratory tract, and five cases of parenchymal excision, including four for bronchiectasis. 77% of patients had symptoms that lasted at least 2 weeks before diagnosis; the long delay in diagnosis [average of 7,6 months] explains the high-level of bronchiectasis in our study [22%]. The authors emphasize the necessity to promote preventive measures by information parents and physicians on risks of foreign body aspiration, which early diagnosis can save much trouble in children