Impact of smoking on the severity of Obstructive Sleep Apnea Hypopnea Syndrome.

BACKGROUND: Smoking is an established risk factor of several respiratory and extra respiratory diseases. However, the effect of smoking on obstructive sleep apnea syndrome (OSAS) is not well characterized. The purpose of this work is to study the influence of smoking on the severity of OSAS. METHODS: We performed a retrospective study, which included patients with an obstructive sleep apnea syndrome diagnosed in the pulmonology department of Charles Nicolle Hospital in Tunis, during the period from January 2008 to December 2014. RESULTS: We collected 104 patients with obstructive sleep apnea syndrome. The average age of patients was 49,4 years (14-81 years). The majority of patients were women (53,8%). Thirty two patients were smokers with an average consumption of 27 PA. The reasons for consultation were nocturnal snoring (90%), daytime sleepiness (77%), respiratory pauses (53%), nocturia (35%), daytime fatigue (34%) and headache (29% ). The average weight was 92 kg. The average BMI was 33 kg / m2. The average waist circumference was 98 cm. On average, the Epworth score was 12. The apnea hypopnea index was on average 32 / h. A slight OSAS was noted in 28,8% of cases, moderate OSAS in 14,4% of cases and severe OSAS in 53,8% of cases. The number of desaturations averaged 155. The CPAP treatment was fixed in 61 patients (58%) and self-controlled in 5 patients (4,8%). Adherence was checked in 48 patients (46%) and it was good in 85% of cases. The comparison between the smoking and non-smoking subjects was about; the Epworth scale, FEV, AHI, mean SpO2 and observance of treatment but no significant difference was found. CONCLUSION: Although our study did not find any difference between smokers and non smokers, smoking cessation takes an important place for management of a patient with OSAS.

Prognostic factors of advanced stage non-small-cell lung cancer.

Background Lung cancer is the main cause of death from cancer in the world. The 5-year survival is about 15%. Despite the progress of medicine the mortality rate decreased only marginally. This poor prognosis is due to late diagnosis. Aim To evaluate overall survival and prognostic factors in patients locally advanced or metastatic non small cell lung cancer (NSCLC). Methods Retrospective study including 180 patients with non-small cell lung cancer hospitalized in the department of Charles Nicolle Hospital of Tunis between January 2007 and December 2014. Results The mean age was 61.5 years with a male predominance (93.3%). The median overall survival was 6 months. The poor prognostic factors were the performans status (PS) and early delays of management (<30 days). The factors that improve survival were surgical treatment and delays of management more than 45 days.  Conclusion The prognostic factors in locally advanced and metastatic NSLC in our patient were: PS, management delay and treatment. These factors should be considered in management of patient with advanced stage NSCLC.

Contribution of fixed-dose combinations in the treatment of tuberculosis.

Background - The introduction of fixed-dose combinations (FDCs) of TB treatment in Tunisia is recent (July 2009). WHO and the National Tuberculosis Programme recommend the use of fixed-dose combination (FDC) tablets for the treatment of tuberculosis (TB). The effectiveness of ADF has been demonstrated, however the risk of relapse and tolerance were controversial. Objective - Through a retrospective study, we evaluate, the contribution of FDCs compared with dissociated treatment (TD) (efficacy, tolerance and the occurrence of relapses). Patients and methods - This is a retrospective study conducted in the Department of Pneumology la Rabta. Are included patients with pulmonary tuberculosis (TB) first attack. Two groups were studied: Group I (TC) treated between July 2009 and June 2011 who received ADF. Group II (TD) treated between July 2008 and June 2009 who received TB dissociated treatment. Results - One hundred and seventy one patients were included: 122 in the TC group with an average age of 39.2 years and 49 patients in the TD group with an average age of 38.2 years. Male predominance was observed in the two groups (82/75.5%). The period of apyrexia was below 7 days at more than 80% of patients in the two groups. Sputum smears conversion were obtained between one and two months (median 52,8 vs 55,8 days) in both groups with no significant difference (p = 0.06). The rate of smears conversion at 2 months was 74% in TC group versus 65.3 % (p = 0.12). Eighty patients (65%) of the TC group and 29 patients (59%) of the TD group had one or more adverse effects to treatment without significant difference (p = 0.270). The most common adverse effects were those related to digestive system (17.2% vs 6.1%), liver toxicity (7.4% vs 4.1 %) and urticaria (9.8% vs 8.1%). The treatment successful rate was: 73.7 % in TC group and 77.5 % in TD group. There was no significant difference in treatment compliance, neither in relapse rate nor in the death rate. Conclusion - This study demonstrated non-inferiority of the effectiveness of ADF with a comparable safety. Its effects in the prevention of relapse and resistance BK remain unproven.