[Cost estimation of medical care management of lung cancer in Tunisia]

Background: Lung cancer management is very expensive for the Tunisian healthcare system.

Aim: The aim of this study was to evaluate the direct costs of treating lung cancer in Tunisia, and to identify the main treatment of high expenditure.

Methods: A retrospective study was conducted in 2012 including all patients admitted between 2008 and 2010 for lung cancer management. The hospital payment system was used to estimate the direct costs of the medical care management of lung cancer.

Results: We collected 549 patients and the majority of patients were diagnosed with advanced stages of the disease: 60% in stage T4 and 59% in stage M1. 26% of patients underwent surgery and 44.1% chemotherapy. The total direct costs of lung cancer management were estimated to be TND 3900 [US$ 1980] per patient.

Conclusions: Chemotherapy accounted for the largest percentage of direct costs [46%] followed by the cost of the hospital stay. Primary prevention, based on the application of policies to control tobacco, is the best strategy to reduce this morbidity

[Diagnostic value of the bronchoalveolar lavage in interstitial lung disease]

Background: The bronchoalveolar lavage [BAL] cellular analysis is an invasive method of exploration of the lung. Its diagnostic value in interstitial lung disease [ILD] is integrated to a multi-disciplianry approach implicating clinicians, radiologists and pathologists

Aim: We targeted to evaluate the diagnostic value of the BAL

Methods: We reported a retrospective study about patients hospitalized for an ILD since the 1st January 2011 to the 31th December 2013. Thirty three patients were admitted in the Department of Pulmonology and the BAL analyses were studied in the Department of Pathology of the same hospital. The different cell patterns were compared to the final diagnostics

Results: our study contained 4 non specific interstitial pneumonia [NSIP], 10 usual interstitial pneumoniae [UIP], 4 organizing pneumoniae [COP], 8 sarcoidosis, 2 hypersensitivity pneumonitis, 3 infectious pneumonitis, 1 lymphoma and a pulmonary adenocarcinoma. We considered positive results those that were compatible with the final diagnosis. The profile lavage was typical in 1 NSIP, 3 UIP, 3 COP, 1 hypersensitivity pneumonitis, 6 sarcoidosis, 3 infectious pneumonitis and 1 adenocarcinoma. Among the 17 cases with an atypical profile lavage, radiological features were diagnostic in 10 cases. This finding highlights the fact that 7 cases/ 33 presented simultaneously an atypical profile lavage and non specific radiological findings

Conclusion: Our results put emphasis on the diagnostic value of BAL especially when it is integrated to a multi-disciplinary approach. Its value in the follow up, the evaluation of the activity of the disease and the prognosis is being more and more reported

Association of Single Nucleotide Polymorphisms in Toll-like Receptor Genes With Asthma Risk: a Systematic Review and Meta-analysis

PURPOSE: Asthma is a complex disease, with contributions from multiple genes, various genetic backgrounds, and environmental factors. Many human epidemiological studies have demonstrated that single nucleotide polymorphisms (SNPs) in Toll-like receptor (TLR) genes are inconsistently associated with asthma risk. Some have demonstrated differences concerning the study design and effect size, and conflicting results have been reported. A meta-analysis is necessary to determine the magnitude of this association. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a systematic search and meta-analysis of the literature was conducted to estimate the association of SNPs in TLR genes with asthma risk. We screened the medical literature based on the following keyword searches in MEDLINE and EMBASE databases: 'TLR', 'polymorphism', 'asthma', and their combinations. RESULTS: Meta-analysis of eight studies on TLR4 Asp299Gly showed a marginal association of TLR4 with asthma risk (odds ratio [OR]=0.814 [95% confidence interval [CI], 0.652-1.016; P=0.069]) in the recessive model. TLR4 Thr399Ile was not associated with asthma risk under any genetic model. Meta-analysis of four studies on TLR2 Arg753Gln indicated that TLR2 might be significantly associated with asthma in the dominant and codominant models (P=0.029, P=0.030, and P=0.009, respectively). TLR9 -1237 was marginally associated with asthma risk (OR=0.408 [95% CI, 0.163-1.021; P=0.065]) in the codominant model. Analysis using the allele contrast model showed that the major TLR9 -1237 T allele tended to be a significant protective factor with OR=0.689 (95% CI, 0.471-1.007; P=0.055). CONCLUSIONS: The results showed that TLR4 Asp299Gly, TLR2 Arg753Gln, and TLR9-1237 might contribute significantly to asthma susceptibility. Future genetic association studies would consolidate these findings.

[Smoking prevalence in A Mami hospital of Ariana: Prospective study about 700 health professionals]

Smoking is one of the most serious threats to public health worldwide. Health srtuctures are the cornerstone of each program against smoking, or some studies have shown a prevalence of smoking as high in hospitals than in the general population. To assess the prevalence of smoking, smoking behavior and attitudes of health professionals towards smoking within the A Mami Ariana Hospital This is a cross-sectional survey conducted among 700 health professionals [doctors, nurses, workers, technicians and administrative staff] in the first quarter of 2010, based on a detailed questionnaire containing 15 closed-end items. The average age was 37 years and the sex ratio 0,5. Response rate to questionnaire was 81,4% and overall smoking prevalence 24,8%, five times higher in men [52,5% vs 9,8% p< 0,001]. Smoking was greater among workers, night health professionals employees and employees of technical services, administration and intensive care services and only 13% among doctors. 50% of the surveyed have already tried at least once to quit, twice as many women than men. Former smokers accounted for 5,5% of all health professionals. Although our hospital has been declared non-smoking area since 2009, 75% of professionals continue to smoke at the scene of their work. Strengthening of existing measures against smoking as smoking bans in the hospital, and improving training of health professionals on the dangers of smoking and ways of weaning are needed now

[Impact of tobacco on bronchopulmonary affections: magnitude of the problem]

Tobacco smoking is frequent in the world affecting 20 a 50% of the population but with a decrease in occidental countries due to a huge effort based on sensiblisation and anti-tobacco decisions. To review the impact of tobacco on bronchopulmonary affections. A narrative review of literature. In the next future, yearly tobacco-related deaths could increase from 4.2 millions in 2000 to 10 millions in 2025-2030 making smoking as the main evitable cause of deaths by respiratory diseases. Lung cancer is the leading killer cancer. Tobacco is the most frequent cause of respiratory diseases. It is responsible of 80 to 90% of deaths by chronic obstructive pneumobronchopathiy [COPD] and 80 to 85% deaths by bronchopulmonary cancer. Tobacco is a " chronic disease " necessitating management with advices and medical treatment

[Current etiologies of hemoptysis in eldery: comparative study about 360 cases]

Hemoptysis is an alarming symptom. The etiology of hemoptysis varies among different series according to time of publications, geographic location and diagnosis tests employed but also according to the age of patients. To describe the etiologies of hemoptysis in eldery. We retrospectively reviewed of hemoptysis in eldery. We retrospectively reviewed the records of all patients admitted to three respiratory departments [B, I and C] in Abderrahmen Mami hospital between January 2003 and December 2007. Of the 360 patients hospitalized for hemoptysis, 248 were aged 18-64 years and 112 were aged more than 65 years. At the term of our study, bronchiectasis [21% versus 11,6%, p<0,03] and hydatid cyst [6% versus 0%, p>0,007] were the most common causes of hemoptysis in people less than 65, while tuberculosis sequel [20,5% versus 5,4%, p>0,01] and pulmonary oedema [16,9% versus 0,4%, p<0,001] were significantly more frequent in the eldery. There was no difference between the two groups concerning lung cancer [25% in patients less than 65 years versus 16,9% in eldery, p=NS], infections [10,5% in patients less than 65 years versus 12,5% in eldery, p=NS] and pulmonary tuberculosis [14,1% in patients less than 65 years versus 4,5% in eldery, p=NS]. Elderly patients are more likely than younger patients to have tuberculosis sequel and pulmonary oedema as an etiology of their hemoptysis, while bronchiectasis and hydatid cyst were more common in patients less than 65 years. The results of our study will allow us to better prioritize the investigations necessary to etiological diagnosis

[Pleural Textiloma discovered after treatment of a persistant arterial channel]

Post-operative foreign bodies are rare and inlocalized in the abdomen for the majority of cases. 80% of these foreign bodies were textiloma. Report a new case of post operative body localized in the pleukral cavity. A 6 years old boy, prevresly treated on age 11 months for persisitant arterial channel, was admitted with diagnosis of non systematized operety in middle fueld of cefts lung. Tumor with a posserior shadow one evaluated to scan alloy its longitudinal axis secondary by condensation of lung tissue, this among evolued in textiloma. CT scan showed a condensation of lung tissue hyperdense tumor in its center. Pleuval membrane because thick the foreign body was removed significally and a pleural decortication was performed post operative course was uneventful. Pleural textiloma, is rare but it still severe complications with its life listening wish an medico legal consequences

Pulmonary Sequestrations

Pulmonary sequestrations are defined by the presence of a non functional pulmonary parenchyma with an abnormal vascularisation. Their incidence ranges from 1.1% to 1.8% of all the malformations in the general population. Two types of sequestrations are described: - Intralobar sequestrations: the most common, localised within a normal parenchyma. - Extralobar sequestrations: totally separate from the lung with their own pleural covering. We report two cases of sequestrations. In the first case, the radioclinical presentation was strongly suggestive of this diagnosis in a 32 - year old woman with recurrent hemoptysis, airspace opacity in the left retrocardiac region and a systemic vascularisation of this mass on tomodensitometry. Pathological studies after surgery confirmed the diagnosis of intralobar sequestration type I in the classification of PRYCE. In the second case a thoracoscopy performed on a 14 - year-old boy who had a serohematic pleural effusion, revealed a left costodiaphragmatic mass. Surgical removal of this mass confirmed its extralobar pulmonary nature

Embolie pulmonaire hydatique compliquant un kyste hydatique du coeur. A propos d'un cas

Hydatic pulmonary embolism complication of a cardiac hydatic cyst:a case report Hydatic cardiac cyst is a rare condition and represents only 0.5 to 2% oF all visceral localisations of the hydatid disease. We reported a 28 year old patient with a multiple hydatic pulmonary embolism caused by the rupture of a hydatic cyst of the interventricular septum. The diagnosis was established by transthoracic echocardio-graphy and CT Scan. Surgery was performed without delay and the outcome was good after a five month follow-up This case illustrates the diagnostic value of the non invasive imaging means in hydatic cyst of the heart and underlines the importance of surgery realized before complications occur

Soluble adhesion molecules and sCd27 levels in patients with asthma

We examined in serum, soluble adhesion molecules VCAM1, ICAM-1 and E-selectin [SVCAM-1,SICAM-1, [s]E-selectin], soluble interleukin-2 receptor [SCD25] and soluble CD27 [SCD27] in sera of 20 patients with asthma. Measurement of soluble adhesion molecules were analysed by standard ELISA. Soluble CD27 was measured with an ELISA method using CLB-CD27/I and CLB-CD27/II monoclonal antibodies [mAbs]. Levels of serum SCD25 were determined using a commercial standars ELISA [Immunotech] distinct differences between asthma group and normal controls were depicted in the levels of SICAM-1, SE-selectin, SCD27 and SCD25. significantly higher levels of SICAM-1 AND SE- selectin were found in patients with asthma. A correlation between SICAM-1 and SE-selectin was observed in patients with asthma. The increased expression of adhesion molecules in patients with asthma, confirmed an important migration of inflammatory cells to the lung, and that CD27 antigen constitutes a marker of defect in the immunoregulation of asthma