Beneficial role of healthy eating Index-2015 score & physical activity on COVID-19 outcomes.

BACKGROUND: Nutritional status and physical activity are essential to maintain a strong immune system. No definite pharmacological strategies for Coronavirus disease 2019 treatment are presently available, so natural enhancement of the immune system is in need. Our goal was to assess the correlation of healthy diet and physical activity on COVID-19 disease outcome. METHODS: This cohort study was conducted on 68 adult patients who contracted mild (38) or moderate [30] cases of COVID-19, recruited via a convenience sampling technique from the outpatient clinic, Kasr Al-Aini Faculty of Medicine, Cairo University Hospital. Patients' Healthy Eating Index (HEI) and degree of physical activity as measured by the Global Physical Activity Questionnaire were evaluated and linked with several inflammatory markers. RESULTS: Most of patients with mild COVID-19 patients (92.1%) were physically active, compared to only 50% of moderate COVID-19. The total Metabolic Equivalent Task-min/week was positively correlated with the lymphocyte percentage. The median total HEI score was significantly higher in the patients with mild COVID-19 than with moderate COVID. Significant positive correlations observed among the lymphocyte count and total HEI-2015. There was approximately a 64% reduction in the probability of acquiring moderate COVID-19 illness for each unit rise in The HEI. CONCLUSION: Healthier nutrition and Physical activity correlated with reduced COVID-19 disease severity. TRIAL REGISTRATION: The study was registered on clinical trial.gov maintained by the US National Library of Medicine (CinicalTrials.gov identifier = NCT04447144; https://clinicaltrials.gov/ ) (25/06/2020).

Esophageal motility disorders in symptomatic patients and its relation to age.

BACKGROUND: Although swallowing disorders can impact individuals of any age, some are unique to the elderly, and others are frequent. Some disorders, such as achalasia, are diagnosed by esophageal manometry studies, which assess lower esophageal sphincter (LES) pressure and relaxation, peristalsis in the esophageal body, and contraction wave characteristics. This research aimed to evaluate esophageal motility dysfunction in symptomatic patients and its relation to age. METHODS: Conventional esophageal manometry was performed on 385 symptomatic patients who were divided into two groups; Group A (age < 65 years old) and Group B (age ≥ 65 years). The geriatric assessment for Group B included cognitive, functional, and clinical frailty scales (CFS). Additionally, a nutritional assessment was done for all patients. RESULTS: About one-third of the patients (33%) had achalasia, in which manometric results were significantly higher in Group B (43.4%) than in Group A (28.7%) (P = 0.016). The resting lower esophageal sphincter (LES) pressure, as determined by manometry examination, was significantly lower in Group A than in Group B. In contrast, complete LES relaxation percentage and normal esophageal body peristalsis were significantly higher in Group A than in Group B. Patients who exhibited evidence of achalasia in the manometric study had a significantly increased risk of established malnutrition and functional impairment. CONCLUSIONS: Achalasia is a prevalent cause of dysphagia in elderly patients, placing them at risk of malnutrition and functional impairment. Thus, a multidisciplinary approach is vital when providing care for this population.

Human ACE-2, MCP1 and micro-RNA 146 as Novel Markers for COVID- 19 Affection and Severity.

BACKGROUND & AIMS: Coronavirus disease - 2019 (COVID-19) is a major pandemic that causes high morbidity and mortality rates. AIM OF THIS STUDY: to detect the relations between many risk factors, ACE-2, MCP-1, Micro RNA 146 gene expression, and COVID-19 infection and disease severity. METHODS: This study was carried out on 165 cases of COVID-19 and 138 controls. ACE2 and MCP1 levels were measured in COVID-19 cases and control by ELISA and micro-RNA-146 expression by PCR. RESULTS: We found an increased blood level of ACE2 and MCP1 in COVID- 19 patients than in healthy persons and a significant down-regulation of micro-RNA 146 gene expression in cases than in controls. There was a significant correlation between increased blood level of ACE2, regulation of micro-RNA 146 gene expression and severity of lung affection, a significant correlation was found between increased blood level of MCP1 and thrombosis in COVID-19 patients. Neurological complications were significantly correlated with more viral load, more ACE2 blood level, and down regulation of micro RNA146 expression. CONCLUSION: High viral load, increased blood level of ACE2, and down-regulation of micro-RNA 146 expression are associated with more severe lung injury and the presence of neurologic complications like convulsions and coma in COVID-19 Egyptian patients.

Non-alcoholic fatty liver disease related knowledge among a sample of Egyptians: an exploratory cross-sectional study.

Introduction: The global prevalence of Non-alcoholic fatty liver disease (NAFLD) is about 25% worldwide making it an actual health disaster. This study aimed to assess non-alcoholic fatty liver disease (NAFLD)-related knowledge in a sample of Egyptians. Materials and methods: This exploratory cross-sectional study was conducted on 3,124 individuals using 2000 online and 1,124 printed questionnaire forms. These questionnaires, covering sociodemographic characteristics and fatty liver-related knowledge, comprised 30 items. These items include ten questions on definition, symptoms, and complications: 14 about risk factors, and six about prevention and therapy. The data were analyzed using SPSS. Categorical variables were expressed in proportions and percentages. Chi-square and Fisher's exact tests were applied as appropriate. For quantitative variables, the t-test, Mann-Whitney U test, Kruskal-Wallis test, and ANOVA test were used for comparisons. Results: A total of 3,124 respondents were enrolled in the current study. More than half (57%) were females, and 25% ranged in age from 18 to 29. 10.8% of the participants believed that fatty liver patients were asymptomatic, and 34% knew that fatty liver disease was caused by fat accumulation. Regarding predisposing factors, hypercholesterolemia, increased fat in the diet, and obesity had the highest proportion of accurate responses (60, 54, and 46.6%, respectively). On the other hand, 89.3% believed it could be prevented, and 81.4% of the respondents knew that weight reduction could prevent the condition. All respondents (100%) stated wrongly that it was a familial disease related to aging, and most participants (97.3%) did not believe that fatty liver could be treated. Females demonstrated a significantly higher score in preventive measures, while the employed participants scored significantly higher in general knowledge of fatty liver, risk factors, and preventive measures. Conclusion: Despite the increasing NAFLD prevalence, the current study indicated that Egyptians had fair to moderate knowledge about fatty liver and its risk factors, preventive measures, and therapy. However, a false belief was documented by all respondents that it is a disease that runs in families and occurs only in old age. A fundamental shift in healthcare management with a prioritization of prevention, proactive measures, and early detection of NAFLD should be emphasized.

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.

Two-day versus seven-day course of levofloxacin in acute COPD exacerbation: a randomized controlled trial.

INTRODUCTION: Duration of antibiotic treatment in acute exacerbation of COPD (AECOPD) is most commonly based on expert opinion. Typical administration periods range from 5 to 7 days. A 2-day course with levofloxacin was not previously assessed. We performed a randomized clinical trial to evaluate the efficacy of 2-day versus 7-day treatment with levofloxacin in patients with AECOPD. METHODS AND ANALYSIS: Patients with AECOPD were randomized to receive levofloxacin for 2 days and 5 days placebo (n = 155) or levofloxacin for 7 days (n = 155). All patients received a common dose of intravenous prednisone daily for 5 days. The primary outcome measure was cure rate, and secondary outcomes included need for additional antibiotics, ICU admission rate, re-exacerbation rate, death rate, and exacerbation-free interval (EFI) within 1-year follow-up. The study protocol has been prepared in accordance with the revised Helsinki Declaration for Biomedical Research Involving Human Subjects and Guidelines for Good Clinical Practice. The study was approved by ethics committees of all participating centers prior to implementation (Monastir and Sousse Universities). RESULTS: 310 patients were randomized to receive 2-day course of levofloxacin (n = 155) or 7-day course (n = 155). Cure rate was 79.3% (n = 123) and 74.2% (n = 115), respectively, in 2-day and 7-day groups [OR 1.3; 95% CI 0.78-2.2 (p = 0.28)]. Need for additional antibiotics rate was 3.2% and 1.9% in the 2-day group and 7-day group, respectively; (p = 0.43). ICU admission rate was not significantly different between both groups. One-year re-exacerbation rate was 34.8% (n = 54) in 2-day group versus 29% (n = 45) in 7-day group (p = 0.19); the EFI was 121 days (interquartile range, 99-149) versus 110 days (interquartile range, 89-132) in 2-day and 7-day treatment groups, respectively; (p = 0.73). One-year death rate was not significantly different between the 2 groups, 5.2% versus 7.1% in the 2-day group and 7-day group, respectively; (p = 0.26). No difference in adverse effects was detected. CONCLUSION: Levofloxacin once daily for 2 days is not inferior to 7 days with respect to cure rate, need for additional antibiotics and hospital readmission in AECOPD. Our findings would improve patient compliance and reduce the incidence of bacterial resistance and adverse effects.

Pro-Neurotensin as a Potential Novel Diagnostic Biomarker for Detection of Nonalcoholic Fatty Liver Disease.

Background and Aims: Currently, liver biopsy is the gold standard method for diagnosis of non-alcoholic fatty liver severity. It is critical to develop non-invasive diagnostic method to diagnose nonalcoholic fatty liver rather than invasive techniques. Our case-control study was to address the value of circulating miRNA-122 and serum pro-neurotensin as a potential non-invasive biomarker for the diagnosis of non-alcoholic fatty acid diseases. Methods: Clinical assessment, laboratory investigations, and anthropometric measurements were reported for 157 patients with proven NAFLD. Apparently, healthy participants (n=100) were enrolled as a control group. Serum samples were tested for micro-RNAs-122 and pro-neurotensin. Results: Compared with the control subjects, both mi-RNA-122 and serum proneurotensin levels were increased in NAFLD (p<0.001) and at a cut-off ≥6.83, mi-RNA-122 had 51.0% sensitivity, 70.0% specificity to differentiate NAFLD from healthy controls, while serum proneurotensin had 80.0% sensitivity and 80.0% specificity at a cutoff ≥108. Conclusion: The circulating pro-neurotensin might be used as a novel biomarker for diagnosis of patients with NAFLD, wherefore the integration of a circulating mi-RNA-122 and serum pro-neurotensin could be beneficial to diagnose NAFLD cases. Large-scale studies are needed to investigate the possible role of mi-RNA-122 and pro-neurotensin in the development, progression, and prognosis of NAFLD and NASH.

Beyond probiotic legend: ESSAP gut microbiota health score to delineate SARS-COV-2 infection severity.

COVID-19 pandemic continues to be a global health crisis. The gut microbiome critically affects the immune system, and some respiratory infections are associated with changes in the gut microbiome; here, we evaluated the role of nutritional and lifestyle habits that modulate gut microbiota on COVID-19 outcomes in a longitudinal cohort study that included 200 patients infected with COVID-19. Of these, 122 cases were mild and seventy-eight were moderate, according to WHO classification. After detailed explanation by a consultant in clinical nutrition, participants responded to a written questionnaire on daily sugar, prebiotic intake in food, sleeping hours, exercise duration and antibiotic prescription, during the past 1 year before infection. Daily consumption of prebiotic-containing foods, less sugar, regular exercise, adequate sleep and fewer antibiotic prescriptions led to a milder disease and rapid virus clearance. Additionally, data on these factors were compiled into a single score, the ESSAP score (Exercise, Sugar consumption, Sleeping hours, Antibiotics taken, and Prebiotics consumption; 0-11 points), median ESSAP score was 5 for both mild and moderate cases; however, the range was 4-8 in mild cases, but 1-6 in moderate (P = 0·001, OR: 4·2, 95 % CI 1·9, 9·1); our results showed a negative correlation between regular consumption of yogurt containing probiotics and disease severity (P = 0·007, OR: 1·6, 95 % CI 1·1, 2·1). Mild COVID-19 disease was associated with 10-20 min of daily exercise (P = 0·016), sleeping at least 8 h daily, prescribed antibiotics less than 5 times per year (P = 0·077) and ate plenty of prebiotic-containing food.

Glutathione-S-transferase genetic polymorphism and risk of hepatotoxicity to antitubercular drugs in a North-African population: A case-control study.

INTRODUCTION: GST non-functional genotypes can lead to the accumulation of toxic intermediates, resulting in liver damage and increasing susceptibility to ATDH. AIM: To investigate the impact of GST Mu (GSTM1), GST Theta (GSTT1) null genotypes, and GST Pi (GSTP1; adenosine (A) > guanine (G), rs1695) variant allele on the development of ATDH in Tunisian patients treated with anti-tuberculosis therapy. METHODS: This was a case-control study including patients receiving anti-tuberculosis regimen. Cases (n = 23) were tuberculosis patients presenting ATDH during two months of anti-tuberculosis drug therapy. Controls (n = 30) were patients treated for tuberculosis, but presenting no ATDH. Genotyping was performed using a polymerase chain reaction-restriction fragment length polymorphism. RESULTS: No statistically significant association was observed between GSTM1 and GSTT1 homozygous null genotypes, and the risk of ATDH. A statistically significant association between GSTM1 and GSTT1 double null genotypes, and the risk of ATDH was found (p = 0.033) between cases and controls. For GSTP1, the distribution of GG homozygous mutant genotype was significantly associated with ATDH compared with the wild and the transition A to G (AA + AG) genotypes. CONCLUSION: Double deletion of GSTM1 and GSTT1 may predispose to ATDH in a Tunisian population. Moreover, GSTP1 rs1695 (A > G) genotyping can predict susceptibility to developing ATDH.

COVID-19 Disease Outcomes: Does Gastrointestinal Burden Play a Role?

BACKGROUND: The novel coronavirus disease 2019 presents an urgent threat to global health. As the epidemic grows, prognosis prediction is essential for monitoring risky patient. It is thus important to consider gastrointestinal manifestations and the duration of symptoms as predictors of prognosis. Our aim was to determine the correlation of gastrointestinal symptoms and laboratory markers with disease outcomes and whether symptom duration varies substantially between patients. We also undertook this study to determine the optimal time to predict COVID-19 outcome. PATIENTS AND METHODS: A total of 190 patients with polymerase chain reaction-confirmed COVID-19 were followed up until recovery. We proposed a correlation between gastrointestinal symptoms and disease severity (based on clinical data, and diagnostic investigations) to estimate the duration of symptoms as a predictor of COVID-19 prognosis. RESULTS: The prevalence of gastrointestinal symptoms was 49.5%, consisting mainly of diarrhea in 27.9% of patients. In addition, a longer disease duration and higher temperature were observed in patients with diarrhea. Symptom duration was variable, with a median of 12 days and a range of 1-55 days. Statistical analysis indicated that patients with a duration of symptoms ≥12 day had more severe symptoms and a worse prognosis. Patients who complained of diarrhea had 2.7 times the odds of a longer duration of symptoms, and those with a history of chronic lung disease have 7.2 times the odds of a longer duration of symptoms. CONCLUSION: GIT manifestations (mainly diarrhea) and the duration of symptoms of COVID-19 provide prognostic evidence of COVID-19 outcomes, irrespective of earlier categorization by the World Health Organization. Thus, patients with mild symptoms who present with diarrhea and a duration of symptoms longer than 12 days are expected to have a worse prognosis.

Longitudinal Study of the Bulk Tank Milk Microbiota Reveals Major Temporal Shifts in Composition.

Introduction of microbial contaminations in the dairy value chain starts at the farm level and the initial microbial composition may severely affect the production of high-quality dairy products. Therefore, understanding the farm-to-farm variation and longitudinal shifts in the composition of the bulk tank milk microbiota is fundamental to increase the quality and reduce the spoilage and waste of milk and dairy products. In this study, we performed a double experiment to study long- and short-term longitudinal shifts in microbial composition using 16S rRNA gene amplicon sequencing. We analyzed milk from 37 farms, that had also been investigated two years earlier, to understand the stability and overall microbial changes over a longer time span. In addition, we sampled bulk tank milk from five farms every 1-2 weeks for up to 7 months to observe short-term changes in microbial composition. We demonstrated that a persistent and farm-specific microbiota is found in bulk tank milk and that changes in composition within the same farm are mostly driven by bacterial genera associated with mastitis (e.g., Staphylococcus and Streptococcus). On a long-term, we detected that major shift in milk microbiota were not correlated with farm settings, such as milking system, number of cows and quality of the milk but other factors, such as weather and feeding, may have had a greater impact on the main shifts in composition of the bulk tank milk microbiota. Our results provide new information regarding the ecology of raw milk microbiota at the farm level.

Adherence of North-African Pulmonologists to the 2017-Global Initiative for Chronic Obstructive Lung Disease (GOLD) Pharmacological Treatment Guidelines (PTGs) of Stable Chronic Obstructive Pulmonary Disease (COPD).

BACKGROUND: No previous study has investigated the adherence rate of North-African pulmonologists to the 2017-GOLD PTGs. AIMS: To investigate the adherence rate of Tunisian pulmonologists to the 2017-GOLD PTGs and to identify the barriers to their adherence. METHODS: This was a cohort study involving clinically stable COPD patients who presented to a pulmonology outpatient consultation. The patients were classified as having been appropriately and inappropriately (over- or undertreatment) treated for the GOLD group. Logistic regression was performed to determine the adherence barriers to the 2017-GOLD PTGs. RESULTS: A total of 296 patients were included (88.1% males, mean age: 68 ± 10 years; GOLD A (7.1%), B (36.1%), C (4.1%), and D (52.7%)). The pulmonologists' adherence rate to the 2017-GOLD PTGs was 29.7%. There was a significant statistical difference between the adherence rates among the four GOLD groups (A: 19.0%, B: 20.6%, C: 8.3%, and D: 39.1%; p = 0.001). Differences were statistically significant between the GOLD group D and groups B (p = 0.001). Differences were statistically significant between the GOLD group D and groups B (p = 0.001). Differences were statistically significant between the GOLD group D and groups B (. CONCLUSION: The adherence rate of Tunisian pulmonologists to the 2017-GOLD PTGs is low. It seems that the patients' age, socioeconomic level, national health insurance coverage, and GOLD groups influenced their adherence.

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.

Influence of Weather Conditions on the Onset of Spontaneous Pneumothorax in the Region of Sousse (Tunisia): Analysis of Time Series.

INTRODUCTION: Weather conditions were implicated in the onset of spontaneous pneumothorax (SP). AIM: Investigate the influence of weather conditions on the onset of SP. METHODS: A total of 200 patients with SP in Sousse (Tunisia) were enrolled in the study between January 2010 and December 2014. An analysis of two time series (meteorological data and pneumothorax cases) was performed. Data on weather conditions were collected daily throughout the 5-year period. RESULTS: A comparison of the mean temperature between days with and without SP showed significantly higher temperatures during the days with SP. A decrease of 1% in the relative humidity one day lag (D-1) was associated with an increase in the risk of SP by 1.6% (p=0,02). The occurrence of clusters was associated significantly with higher temperature averages on the same days. This same observation was made regarding the mean duration of sunshine two days before the cluster onset (p = 0.05). The occurrence of storms two days before clusters was also significantly associated with a risk multiplied by 1.96. CONCLUSION: There was a correlation between clusters of spontaneous pneumothorax and weather conditions in the region of Sousse-Tunisia.

The Effects of Ramadan Intermittent Fasting (RIF) on Spirometric Data of Stable COPD Patients: A Pilot Study.

No previous study has raised the effects of RIF on lung function data of chronic obstructive pulmonary disease (COPD) patients. The objective of the present study was to assess the effects of RIF on spirometric data measured in male patients with a stable COPD. Sixteen patients with stable COPD (mean ± SD of age: 64 ± 7 years) who fasted during Ramadan volunteered to the study. Three sessions (Before-R, End-R, and After-R) were selected for spirometry tests that were consistently performed 2.5-4.5 hr before fasting break. Assessment sessions comprised: forced vital capacity (FVC), 1st s forced expiratory volume (FEV1), FEV1/FVC, peak expiratory flow (PEF), maximal mid-expiratory flow (MMEF), and forced expiratory flow rate at the x% of FVC to be exhaled (FEFx%). A reversibility test was performed only during the Before-Ramadan session. Spirometric data were expressed in percentages of local reference values. Findings were analyzed by applying repeated measures analysis of variance. The mean ± SD of the postbronchodilator FEV1/FVC ratio and the FEV1 were, respectively, 0.52 ± 0.14 and 48 ± 19%. The mean ± SD of FEV1 (Before-R: 47 ± 19, End-R: 45 ± 18, After-R: 44 ± 19%), FVC (Before-R: 73 ± 18, End-R: 71 ± 16, After-R: 69 ± 17%), FEV1/FVC (Before-R: 67 ± 16, End-R: 66 ± 16, After-R: 65 ± 16%), PEF (Before-R: 46 ± 19, End-R: 47 ± 22, After-R: 45 ± 21%), MMEF (Before-R: 19 ± 10, End-R: 18 ± 8, After-R: 18 ± 9%), FEF25% (Before-R: 16 ± 6, End-R: 16 ± 5, After-R: 15 ± 5%), FEF50% (Before-R: 21 ± 14, End-R: 20 ± 12, After-R: 20 ± 12%) and FEF75% (Before-R: 27 ± 19, End-R: 27 ± 19, After-R: 27 ± 19%) were not significantly influenced by RIF. RIF did not bring about any significant changes in the spirometric data of stable COPD male patients fasting the 2016 holy month of Ramadan.

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.