[Level of knowledge on occupational asthma and asthmagens: Assessment among healthcare workers by a validated questionnaire]. / Niveau de connaissance sur l'asthme professionnel et les agents asthmogènes : évaluation auprès du personnel de santé par un questionnaire validé.

INTRODUCTION: The health system is one of the professional sectors perhaps most at risk of occupational asthma. The aims of this study were to evaluate the level of knowledge of health care workers (HCWs) on occupational asthma and asthmogenic agents and to pave the way to effective educational action on the subject. METHODS: A multicenter transversal study including 180 HCWs was carried out between July and December 2020. A validated questionnaire addressed four dimensions: knowledge of asthmatic disease, knowledge of occupational asthma, knowledge of prognosis of occupational asthma and knowledge on the prevention of occupational asthma. RESULTS: The average total score was 13.71/18 (76.17%). There was no correlation between average total score and age, educational level, seniority or status of paramedical staff. Mean total scores were significantly higher for participants with no fixed work schedule and those practicing in non-university structures. The difficulty indexes for the four aforementioned dimensions were 82.22%, 77.56%, 53.52% and 66.67% respectively. CONCLUSIONS: Knowledge gaps affect all professional categories but to different degrees. A review of the level of knowledge of persons in each category would be the first step on the road to planned educational action.

Isolated Persistent Left Superior Vena Cava Revealed by an Associated Asthma.

BACKGROUND: Persistent left superior vena cava (PLSVC) is a rare anomaly of the thoracic venous system. Case Report. We present a case of a patient with isolated asymptomatic PLSVC, who was diagnosed because of dyspnea revealing an associated asthma. An 18-year-old male patient complained of paroxystic sibilant dyspnea. He did not have any anomaly in physical examination. The chest X-ray revealed cardiomegaly with a widening of lower mediastinum. The electrocardiogram does not show any anomaly. Echocardiography showed the PLSVC. The thoracic contrast computed tomography of the chest showed ecstasies of the right cardiac cavities and a double superior vena cava. The patient did not have similar family cases. Respiratory functional explorations led to the diagnosis of an associated asthma. Currently, he is followed up periodically. Asthma was improved with inhaled corticosteroid treatment. CONCLUSION: PLSVC is rare but can have important clinical implications. Associated severe cardiac malformations must be systematically sought.

A Delicate Surgical Resection to Treat a Proximal Pulmonary Adenoid Cystic Carcinoma.

Pulmonary adenoid cystic carcinoma (PACC) is an exceedingly rare tumor of low-grade malignancy. Diagnosis is often late, so the tumoral process may be huge at presentation. Surgical resection could be challenging, and the recurrence rate would be greater. We report, hereby, a case of proximal PACC with involvement of the carina in a young male adult, without respiratory distress. Surgical resection was performed through a left pneumonectomy followed by a complex trachea-bronchoplastic procedure. During the operative time, the assisted ventilatory mode was carefully chosen. No adjuvant treatment was needed. Our patient is still under clinicoradiological surveillance and remains disease-free.

[A questionnaire assessing knowledge level concerning occupational asthma]. / Questionnaire d'évaluation du niveau de connaissances sur l'asthme professionnel.

INTRODUCTION: Screening for occupational asthma is should still be promoted. In order to improve the efficiency of any educational intervention we need to evaluate the patient's knowledge of the disease. OBJECTIVES: The aims were to evaluate objectively the knowledge level of Tunisian asthmatic patients concerning occupational asthma using a self-questionnaire in Arabic Tunisian dialect, then to conduct a validation process of the questionnaire. METHODS: We followed De Vellis's rules during all stages of redaction of the self-questionnaire. It contained 18 items allocated in 4 dimensions: knowledge about asthma; knowledge about occupational asthma; prognosis of occupational asthma; prevention of occupational asthma. A pre-test was conducted on 18 asthmatic patients to assess the clarity and comprehensibility of all the questions. The questionnaire was then applied to 107 asthmatic patients. RESULTS: The statistical analysis proved the discrimination value in 14 of the 18 items. The internal consistency of the questionnaire was demonstrated by a KR20 index of 0.731. Factorial analysis of the principal components showed the reliability of the questionnaire and of its uni-dimensional structure. The statistical findings proved the positive correlation between the mean scores of all its dimensions. CONCLUSIONS: Using this questionnaire in daily practice should inform health care providers about the level of knowledge of occupational asthma in the targeted population and improve the effectiveness of any further educational intervention.

Comparison of Sleep Quality before and after Chemotherapy in Locally Advanced Nonsmall Cell Lung Cancer Patients: A Prospective Study.

BACKGROUND: Preservation of sleep quality is a modifiable and treatable factor, which may enhance the patient's adherence to other supportive and palliative care procedures. The outcome of sleep disturbances in lung cancer patients before and after treatment aren't reported. The aim of this study was to investigate changes in sleep quality before and after chemotherapy in locally advanced or metastatic NSCLC patients. METHODS: It was a prospective study including 64 patients with stage III or IV nonsmall-cell lung cancer. Patients answered the Tunisian dialectal version of the following questionnaires: PSQI and QLQ-C30 in order to evaluate, respectively, the sleep quality and the quality of life. The assessments took place before chemotherapy and then repeated after the chemotherapy course was over. RESULTS: The mean age was 62.9 years. All patients were active smokers. Before chemotherapy, there were 10 patients (15%) with poor sleep quality. The most frequent complaints were daytime sleepiness (70%) and nocturnal arousals (100%). After chemotherapy, the mean PSQI score increased from 2.9 to 5.4, and 45% of all patients had poor sleep quality. Most frequent complaints were the extension of sleep latency (69%), daytime sleepiness (98%), and nocturnal arousals (100%). Predicting factors of sleep disturbance according to statistical univariate analysis were delayed diagnosis confirmation (p = 0.05), delayed treatment onset (p < 10-3), depressive mood (p = 0.001), and anxious mood (p = 0.001). Multivariate analysis had shown a significant and independent correlation between sleep quality and shortened diagnosis and treatment delays. Sociodemographic parameters, clinical parameters, and factors related to treatment procedure had no correlation with sleep quality. CONCLUSIONS: Our study demonstrates the persistence and potential intensity worsening of sleep disturbances in advanced stage nonsmall-cell lung cancer patients. We, hereby, reported a statistical correlation between sleep quality and quality of life in our patients.

[Treatment and prognosis of advanced stage non-small-cell lung cancer]. / Traitement et pronostic du cancer bronchique non à petites cellules au stade avancé.

INTRODUCTION: Lung cancer is the main cause of death from cancer in both men and women worldwide. In 70 to 80% of cases, the diagnosis is made at an advanced stage. Although the management of non-small-cell lung cancer (NSCLC) has continued to improve over the last 5 years, the prognosis remains poor with a 5-year survival rate of about 16%. The aim of this study was to evaluate the management of locally advanced or metastatic NSCLC in our patients and to analyze overall survival (OS) and prognostic factors at these stages. MATERIALS AND METHODS: A retrospective study, including cases of locally advanced and metastatic NSCLC diagnosed in our department between 2008 and 2011. RESULTS: We included 150 patients with a mean age of 60.2 years. The cancer was at stage IIIA in 21% of cases, IIIB in 14% of cases and IV in 65% of cases. Thoracic surgery was performed in 5 patients; 61.4% of patients received chemotherapy and chemo-radiotherapy was given in 21% of patients. Overall survival was 6 months. Better survival was observed in patients aged less than 60 years, having better performance status (PS), having no metastatic mediastinal lymph nodes and patients who received specific anti-tumor treatment. CONCLUSIONS: The prognostic factors in locally advanced and metastatic NSCLC in our patients were: age, PS, status of mediastinal lymph nodes at diagnosis and treatment. These factors should be considered by physicians when treating patients with advanced stage NSCLC.

[Sternal tuberculosis causing spontaneous fracture of the sternum]. / Tuberculose sternale avec fracture spontanée du sternum.

Sternal tuberculosis is an uncommon condition. Few cases have been reported. We report the case of a 74-year-old man, presented with a swelling and pain of the anterior chest wall associated to worsening of general state. All routine investigations were normal. Chest radiograph in lateral view showed sternal and chest wall hypertrophy with spontaneous fracture of the sternum. Computed tomography (CT) scan demonstrated ring-enhancing hypodense soft tissue mass surrounding the sternum with sternal fracture. Tuberculosis diagnosis was confirmed by histological study of the mass biopsy. We noted clinical and radiological recovery with medical tuberculosis treatment.

[Solitary malignant fibrous tumors of the pleura]. / Les tumeurs fibreuses solitaires malignes de la plèvre.

Solitary fibrous tumours of the pleura are usually benign. However, malignancy is observed in 13% of the cases. The authors report two cases of 27 and 69 year-old patients, presenting chest pain and dyspnoea. The roentgenograms and computed tomography scanning revealed a pleural tumour in both cases. The patients underwent complete resections of these tumours. The immunohistochemical study confirmed the diagnosis of malignant solitary pleural fibroma. The patients succumbed to their disease secondary to local recurrences. Histopathology is very helpful in the diagnosis of malignant pleural fibroma. Surgery and long-term follow-up are mandatory.

[Unusual presentation of pulmonary alveolar proteinosis]. / Lipoprotéinose alvéolaire pulmonaire de présentation inhabituelle.

Pulmonary alveolar proteinosis is a rare disease characterized by the accumulation of granular lipoproteinaceous material within the alveoli; the interstitium is preserved. We report the case of a 27-year-old patient hospitalized for exploration of asymptomatic bilateral interstitial syndrome. Neither the radiographic signs nor the aspect of bronchoalveolar lavage was typical. The diagnosis was confirmed by pathology examination of surgical lung biopsy specimen which revealed lesions of interstitial fibrosis and cholesterol granulomas in association with pulmonary alveolar proteinosis. Since there was no functional deterioration, therapeutic abstention was decided.