[Prognostic factors in idiopathic pulmonary fibrosis in a tunisian cohort]. / Facteurs pronostiques au cours de la fibrose pulmonaire idiopathique : étude d'une cohorte tunisienne.

We present data on prognostic factors in a Tunisian cohort of people with Idiopathic pulmonary fibrosis. INTRODUCTION: Idiopathic pulmonary fibrosis (IPF) has a poor prognosis, with a median survival in patients with the condition of only 3 to 5 years. Previous studies have identified a number of prognostic factors in this chronic pulmonary disease. METHODS: We conducted a retrospective study, including patients with idiopathic pulmonary fibrosis (IPF) who were diagnosed at the Pneumology Department of the University Hospital Fattouma-Bourguiba, Monastir, between 1991 and 2014. The aim of this study was to compare clinical, radiological, pulmonary functional predictors of survival in IPF in a Tunisian cohort with those of previous studies. RESULTS: This study included 126 patients. Their mean age was 66 years, with a male predominance (68.3%). Respiratory function tests revealed a restrictive ventilatory deficit in 72.6% of cases. The median survival of our study population was 22.5 months [6.7-49.5]. In univariate analysis, factors associated with a poor prognosis were: lower baseline values of TLC, FCV and DLco, level of dyspnea assessed by mMRC scale, hypoxemia at diagnosis, the degree of desaturation during exercise, a higher annual decline of FVC and DLco, acute respiratory distress and also the GAP score. In multivariate analysis, independent prognostic factors were: baseline DLco, level of dyspnea, desaturation at exertion and the annual decline of the DLco. CONCLUSION: Lower baseline DLco, the level of dyspnea, desaturation on exercise, and annual decline in DLco are all associated with a poor prognosis in IPF.

[Fight against tuberculosis in the world]. / La lutte antituberculeuse dans le monde.

Tuberculosis (TB) in a major health problem in the world. WHO and its partners especially, the stop TB partnership launched numerous strategies against TB especially in the 1990. Strategy DOTS (directly observed therapy short course) was launched in 1995. One main key was the direct supervision of drug intake by patients. Progress was achieved but it was insufficient. A new strategy called "Stop TB Strategy 2006-2015" was launched in 2006 in the context of Millennium Development Goals (MDG) elaborated by United Nations. The common goals were to halt and start to reverse the incidence of TB, reduce the prevalence and death rate by 50% compared to their level in 1990 by 2015 to eliminate TB as a public health problem by 2050. The end of 2010 marks the mid-point of the Global Plan and is an obvious time to update it and take into account actual progress with a focus on the 2015 to reach goals. So an updated Global Plan to stop TB 2011-2015, was launched. Expected progress and targets were defined for 2015, in diagnosis and treatment, in co-infection TB/HIV, in drug-resistant TB and achievements expected in new tests for diagnosis, new medications, new vaccines and new regimens with shorter duration of treatment. WHO and partners have started discussions to define the new post 2015 strategy to TB control and elimination. Risk factors (diabetes, malnutrition, tobacco smoke…) and socioeconomic factors, which are associated with TB, should be included in the new strategy to eliminate TB in 2050.

[The importance of lung volumes in the investigation of heavy smokers]. / Place de la distension pulmonaire dans l'exploration des gros fumeurs de cigarettes.

INTRODUCTION: Lung hyperinflation (LH) has become a major concern in the management of chronic obstructive pulmonary disease (COPD). MAIN AIM: To evaluate the role of lung volumes in the positive diagnosis of COPD and in the assessment of airway obstruction reversibility. POPULATION AND METHODS: Three hundred and sixty-six male smokers over the age of 35 with more than 40 pack-years exposure were included in the study. Plethysmographic data were determined before/after taking a bronchodilator (BBD, ABD). Applied definitions: airflow obstruction: BBD FEV1/FVC<0.70. LH: BBD residual volume (RV)>upper limit of normal. Expressions of reversibility: Δvariable=(ABD-BBD) values; Δinit%=Δvariable/BBD value and Δref%=Δvariable/reference value. A 12%init and a 0.2L increase in either FEV1 or FVC or a 10%ref or - 300 mL decrease in RV were considered as clinically significant. RESULTS: Over the 85 smokers without airflow obstruction, 68% had LH. In the hyperinflated group (n=314), and compared to changes in FEV1 and FVC, these RV changes detected more respondents (54% for FEV1 and FVC vs. 65% for RV, P=0.002). This was not the case for the group free from LH (n=52) (23% for FEV1 and FVC vs. 35% for RV, P=0.09). In the 58 hyperinflated groups free from airflow obstruction, and compared to changes in FEV1 and FVC, changes in RV detected more respondents (24% for FEV1 and FVC vs. 71% for RV, P=0.0001). CONCLUSION: In heavy smokers, it seems essential to include LH as a criterion for a positive diagnosis of COPD and of reversibility evaluation.

[Choroid metastases revealing pulmonary adenocarcioma resolved with chemotherapy]. / Métastases choroïdiennes révélatrices d'un adénocarcinome bronchique et involuant sous chimiothérapie.

Lung cancer is the leading cause of choroidal metastasis in men, but choroidal metastasis is rarely inaugural. With the advent of new generations of chemotherapy molecules non-small-cell lung cancer (NSCLC) has become more chemosensitive. Choroidal metastasis may respond to chemotherapy. We report a case of a 52-year-old men who developed choroidal metastasis revealing pulmonary adenocarcinoma confirmed by the bronchial biopsy. Systemic chemotherapy using gemcitabine-cisplatin led to total involution of the choroidal metastasis with improvement of the visual acuity in one eye and stabilization in the other. Systematic search for lung cancer is required in patients presenting choroidal metastasis. If compatible with the patient's general status, histologically-adapted chemotherapy must be instituted. This approach can avoid the use of radiotherapy and therefore deterioration of visual acuity after radiation.

Possible Behçet's disease revealed by pulmonary aneurysms.

Behçet's disease (BD) is a multisystem disease which may affect many organ systems in addition to the originally described triple symptom complex. Pulmonary aneurysm is one of the rare complications of the disease. We report a case of bilateral pulmonary aneurysm in which usual criteria for the clinical diagnosis of BD were absent and we believe that pulmonary aneurysm could be the first appearance of the disease.

[Endothoracic vascular involvement in Behçet's disease]. / Les atteintes vasculaires endothoraciques au cours de la maladie de Behçet.

The observation of 3 cases has prompted the authors to review the characteristics of vascular abnormalities that may be found in Behçet's disease. These lesions, the frequency of which has diversely been estimated, involve the veins more often than the arteries. Arterial lesions occur, after a varying length of time, as occlusions or aneurysms, both treated by surgery. Phlebitis and venous thrombosis may be complicated by severe pulmonary embolism and therefore require anticoagulant therapy.