[Assessment of body composition during pulmonary tuberculosis]. / Évaluation de la composition corporelle au cours de la tuberculose pulmonaire.

BACKGROUND: Although the body mass index (BMI) is the most commonly used tool to assess the nutritional status of patients with active tuberculosis (TB), it does not assess changes in body composition. This study aims to assess the contribution of bioelectrical impedancemetry (BIA) for the assessment of body composition during the course of TB compared to BMI and to examine the associated factors. METHODS: Cross-sectional study carried out in patients with active TB at the pulmonology department of CHU la Rabta in Tunis, Tunisia. The nutritional assessment was based on the measurement of BMI and the analysis of body composition by BIA. Malnutrition was accepted when the lean mass index (LMI) was ≤16kg/m2 in men and 15kg/m2 in women. RESULTS: Ninety-five patients were included. According to their LMI, 38 patients were undernourished. The decline in LMI was associated with the severity of TB. Although BMI and LMI were correlated, the use of BMI alone failed to recognize lean mass loss in one in ten patients. CONCLUSION: Undernutrition is frequent in patients with active TB. It is correlated with the severity of the disease. In addition to anti-tuberculosis drugs, nutritional management of these patients is essential.

[Testosterone and chronic obstructive pulmonary disease]. / Testostéronémie et bronchopneumopathie chronique obstructive.

INTRODUCTION: Testosterone level has been shown to be associated with respiratory function and loss of lean body mass in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to assess the relationship between testosterone level and functional respiratory parameters during COPD. METHODS: We conducted a cross-sectional study that included 95 male patients with stable COPD. Functional tests (body plethysmography, six-minute walk test (6MWT), arterial blood gas) were performed in all patients and serum levels of testosterone, prolactin, FSH, LH and C-reactive protein were determined. Lean body mass was measured using bioelectric impedance. RESULTS: The average age was 63.78±8.90years. COPD was classified as stage 3 in 38% of cases and stage 4 in 11% of cases, group C in 10% of cases and group D in 18% of cases. The average testosterone was 20.87±8.60nmol/L. A significant positive correlation was found between FEV1 (P=0.005), FVC (P=0.005), FEV1/FVC ratio (P=0.001), lean mass index (P=0.021), and testosterone. However, testosterone was not correlated with 6MWT or blood gas parameters. Similarly, it was not correlated with FSH, LH, prolactin and C-reactive protein. CONCLUSION: This study found that serum testosterone level was associated with lung function and lean mass during COPD. Further investigations are required to better evaluate the relationship between COPD and serum testosterone levels and the effect of androgen substitution in lung function.

[Assessment of insomnia among Tunisian patients with lung cancer]. / Évaluation de l'insomnie chez les patients tunisiens atteints de cancers bronchopulmonaires primitifs.

INTRODUCTION: Sleep disorders are relatively common in oncology. However, they have not been well studied and are often treated insufficiently. AIM: To assess the prevalence and severity of insomnia in lung cancer patients and evaluate the relationship between insomnia and certain clinical parameters. METHODS: A cross-sectional study was undertaken of patients in Tunis with primary lung cancer. Socio-demographic and clinical data were obtained from the medical records Patients were then asked to answer questionnaires related to insomnia (ISI), depression-anxiety (HAD) and quality of life (QLQ-C30). RESULTS: Fifty patients with lung cancer were included (46 men, 4 women). The average age was 59±9 years. Insomnia was found in 24 patients (48%) and 60% of patients had depression. HAD was significantly higher in the insomniac patients (21.54±8.96 vs. 9.81±5.28, P<0.0001). Similarly, the QLQ-C30 was significantly lower in these patients (41.24±12.55 vs. 56±16.88, P<0.01). ISI was significantly correlated with HAD and QLQ-C30. CONCLUSION: Insomnia is common in patients with lung cancer. It is responsible for impaired quality of life and psychological distress. Diagnosis and management of insomnia in patients with lung cancer is therefore mandatory.

[Tuberculous pseudotumour, a challenging diagnosis]. / La tuberculose pseudotumorale, un diagnostic difficile.

INTRODUCTION: The pseudotumorous form of tuberculosis is a rare entity. Whatever its location, it can simulate neoplasia by its radiological and/or endoscopic appearances. We highlight the diagnostic difficulties associated with this type of presentation. METHODS: We performed a retrospective study of inpatient records from 2003 to 2016 in the pneumology department of La Rabta Hospital to identify cases of thoracic tuberculous pseudo-tumor. RESULTS: Seventeen patients were identified. The median age was 41 years and their symptomatology was dominated by cough and general debility. All had abnormal radiology with 10 cases of suspect lesions. Fibre-optic bronchoscopy revealed endobronchial abnormalities in 11 cases. The median overall diagnostic delay was 97 days. The diagnosis was confirmed bacteriologically in five cases, histologically in 14 cases and based on clinical presumption in one case. The progression was favourable: 13 patients have been declared cured and four patients are still undergoing treatment. CONCLUSION: Making a positive diagnosis of thoracic tuberculous pseudotumour can be difficult, as bacteriological samples are often negative. This can lead to a significant delay in diagnosis and treatment.

[Home non-invasive ventilation for chronic obstructive pulmonary disease]. / Ventilation non invasive à domicile au cours de la broncho-pneumopathie chronique obstructive.

INTRODUCTION: The benefits of long-term non-invasive ventilation (NIV) in the management of chronic obstructive pulmonary disease (COPD) patients remain controversial. AIM: To analyze the characteristics of COPD patients under home NIV and to evaluate its impact among this population. METHODS: We carried out a retrospective study between January 2002 and April 2016 of COPD patients under long-term NIV at "la Rabta" and the Military Hospital. RESULTS: There were 27 patients with an average age of 64 and a sex ratio (M/F) of 0.92. Active smoking was reported in 96.3%. A persistent hypercapnia following an acute exacerbation of COPD with failure to wean the NIV was the main indication of long-term NIV. We noted a reduction in hospital admissions in the first year of 60% and in intensive care of 83.3% (P<10-3). There was no non-significant decrease of PaCO2 (4.5mmHg). There was no modification in FEV 1 and in FVC (P>0.05). The survival rate was 96.3% at 1 year, 83.3% at 2 years and a median survival of 24 months. CONCLUSIONS: Our study suggests that home NIV contributes to the stabilization of some COPD patients by reducing the hospitalizations rates for exacerbation. More prospective studies are needed to better assess the impact of NIV on survival and quality of life and to better define the COPD patients who require NIV.

[Clinical and microbiological profile of patients experiencing relapses of tuberculosis in Tunisia]. / Profil clinique et microbiologique des patients en situation de rechute tuberculeuse en Tunisie.

INTRODUCTION: Relapse of tuberculosis (TB) is known to be as one of the major risk factors for resistant TB. The aim of this study is to focus on clinical, radiological and bacteriological features of patients with pulmonary TB relapse. METHODS: We performed a retrospective survey in the respiratory department of the teaching hospital La Rabta in Tunis between January 2000 and December 2014. Data of patients with a pulmonary TB relapse were analyzed. RESULTS: During the study period, among 1250 patients hospitalized for pulmonary TB, 44 had a TB relapse. The TB relapse rate was estimated to be at 3.5%. The average age was 43.95±16.7 years. Sex ratio was 5,2. Eighty one percent of patients were current smokers. Alcoholism was found in 40.9% of cases. The mean time to relapse was 6.37±3.7 years. The radiological lesions were moderately extended at least in 54.6% of cases. A resistant TB was found in 33% of cases (mono-resistance: 33.3%, multi-drug resistance (TB-MR): 11,1%, poly-resistance: 55.5%). The most incriminated drugs were isoniazid, rifampicin and pyrazinamide. One patient received TB-MR treatment regimen for 18 months. In the other cases, the duration of treatment was prolonged. Recovery was obtained in 72.7% of cases, two patients died and 22.7% of patients were lost to follow up. CONCLUSION: In Tunisia, TB relapse usually affects young male patients who are often alcoholic and smokers. Resistant TB is frequent among these patients. These findings lead us to emphasize the need of rapid diagnosis tools and adapted treatment regimen in these patients.

[Night-to-night variability of the obstructive sleep apnoea-hypopnoea syndrome]. / Variabilité inter-nuits du syndrome d'apnée-hypopnée obstructive du sommeil.

The apnoea-hypopnoea index (AHI) is the primary measurement used to characterize the obstructive sleep apnoea-hypopnoea syndrome (OSAHS). Despite its popularity, there are limiting factors to its application such as night-to-night variability. AIM: To evaluate the variability of AHI in the OSAHS. PATIENTS AND METHODS: A prospective study was designed in our university hospital's sleep unit. Adults with clinical suspicion of OSAHS underwent 2 consecutive nights of polysomnographic recording. The population was divided in two groups according to an AHI>or<10. Patients with psychiatric disorders or professions that might result in sleep deprivation or an altered sleep/wake cycle were excluded. RESULTS: Twenty patients were enrolled. The mean age was 50.6±9.3 years. OSAHS was mild in 4 cases, moderate in 6 cases and severe in 8 cases. AHI was less than 5 in two cases. AHI values were not significantly altered throughout both recording nights (33.2 vs. 31.8 events/h). A significant positive correlation was found between AHI measured on the first and the second night. However, a significant individual variability was noted. Comparison between both patient's groups showed a correlation between AHI and the body mass index. CONCLUSION: This study demonstrates that the AHI in OSAHS patients is well correlated between two consecutive nights. However, a significant individual variability should be taken into consideration, especially when AHI is used in the classification of OSAHS or as a criterion of therapeutic success.

[Epidemiology of tuberculosis]. / Épidémiologie de la tuberculose.

Tuberculosis is a contagious disease caused by Mycobacterium tuberculosis. It represents, according to World Health Organization (WHO), one of the most leading causes of death worldwide. With nearly 8 million new cases each year and more than 1 million deaths per year, tuberculosis is still a public health problem. Despite of the decrease in incidence, morbidity and mortality remain important partially due to co-infection with human immunodeficiency virus and emergence of resistant bacilli. All WHO regions are not uniformly affected by TB. Africa's region has the highest rates of morbidity and mortality. The epidemiological situation is also worrying in Eastern European countries where the proportion of drug-resistant tuberculosis is increasing. These regional disparities emphasize to develop screening, diagnosis and monitoring to the most vulnerable populations. In this context, the Stop TB program, developed by the WHO and its partner's, aims to reduce the burden of disease in accordance with the global targets set for 2015.

Effect of lingual paralysis on swallowing and breathing coordination in rats.

BACKGROUND: The tongue plays an important role in both swallowing and breathing. Lingual motor deficits with consequences for swallowing are often observed in many neurological disorders. However, the impact of such deficits on swallowing and breathing coordination is unknown. OBJECTIVE: Our objective was to study the swallowing and ventilatory patterns in rats with unilateral lingual paralysis. METHODS: Our study was carried out on 10 Wistar rats. Respiratory variables in unrestrained and healthy animals were measured at rest and during water swallowing using whole-body plethysmography and a video camera. The procedure was repeated after unilateral sectioning of the hypoglossal nerve (XII). Swallowing frequency and occurrence during inspiration and expiration, tidal volume, total time of the ventilatory cycle and respiratory drive were assessed. RESULTS: Unilateral sectioning of the hypoglossal nerve led to a swallowing deficit and drooling. Respiratory rhythm and ventilatory drive (16.39±2.13 ml/s vs. 13.67±1.28 ml/s) during swallowing decreased after hypoglossal nerve sectioning but were unaffected during rest without swallowing, while swallowing rate (17±5/15s) and occurrence during respiratory cycle phases did not change. CONCLUSIONS: A swallowing deficit induced by lingual paralysis decreased the ventilatory drive during swallowing. This may be a mechanism to reduce or prevent pulmonary aspiration.

Submental sensitive transcutaneous electrical stimulation (SSTES) at home in neurogenic oropharyngeal dysphagia: a pilot study.

OBJECTIVE: Oropharyngeal dysphagia is frequent in chronic neurological disorders and increases mortality, mainly due to pulmonary complications. Our aim was to show that submental sensitive transcutaneous electrical stimulation (SSTES) applied during swallowing at home can improve swallowing function in patients with chronic neurological disorders. METHODS: Thirteen patients were recruited for the study (4 f, 68 ± 12 years). They all suffered from neurogenic oropharyngeal dysphagia. We first compared the swallowing of paste and liquid with and without SSTES. Thereafter, the patients were asked to perform SSTES at home with each meal. Swallowing was evaluated before and after six weeks of SSTES using the SWAL-QoL questionnaire. RESULTS: With the stimulator switch turned on, swallowing coordination improved, with a decrease in swallow reaction time for the liquid (P<0.05) and paste boluses (P<0.01). Aspiration scores also decreased significantly with the electrical stimulations (P<0.05), with no change in stasis. At-home compliance was excellent and most patients tolerated the electrical stimulations with no discomfort. A comparison of the SWAL-QoL questionnaires after 6 weeks revealed an improvement in the burden (P=0.001), fatigue (P<0.05), and pharyngeal symptom (P<0.001) scales. CONCLUSION: The present study demonstrated that SSTES is easy to use at home and improves oropharyngeal dysphagia quality of life.

Involvement of the aero-digestive tract in swallowing-ventilation coordination: an animal study.

BACKGROUND: The precise coordination of swallowing and ventilation is considered an important mechanism for minimizing the risk of pulmonary aspiration. The aim of this study was to test the hypothesis that the aero-digestive tract is involved in swallowing-ventilation coordination in rats. METHODS: The goal of the first part of the study was to characterize swallowing events associated with ventilation signals obtained using a barometric plethysmograph. This was done in seven rats with the help of esophageal electromyograms. Thereafter, swallowing-ventilation coordination was assessed in 15 rats with right unilateral vocal cord paralysis and 10 rats following oropharyngeal anesthesia. KEY RESULTS: In healthy animals, 92 ± 11% of swallows occurred during expiration and 8 ± 11% during inspiration. Swallow frequency and swallowing characteristics based on ventilation did not change following unilateral laryngeal paralysis. Swallows during expiration decreased (71 ± 9%, P < 0.01) while swallows during inspiration increased (29 ± 11%, P < 0.01) following oropharyngeal anesthesia with lidocaine. CONCLUSIONS & INFERENCES: Our findings using a rat model need to be confirmed, however, they indicated that a rat model can be used to study oropharyngeal dysphagia and that laryngo-pharyngeal anesthesia alters swallowing-ventilation coordination.

[Physiological factors influencing pulmonary capillary volume and membrane diffusion]. / Facteurs physiologiques influençant le volume capillaire pulmonaire et la diffusion membranaire.

BACKGROUND: The lung is subject to many physiological changes during life. The aim of this study was to identify factors that influence gas transfer, which depends on membrane diffusion (Dm) and pulmonary capillary blood volume (Vc). METHODS: Dm and Vc measurements were performed at rest in 135 healthy patients divided into three groups according to age and after an exercise in 22 non-trained children. Measurements were made using a simultaneous transfer of 2 gases; nitric oxide (NO) and carbon monoxide (CO). RESULTS: Dm was correlated with height in the adult group and with weight in the elderly group. Vc was not correlated with weight in the three studied groups, but correlated with height in the adult group. Dm and Vc declined with age (p<0.05), For Dm this started at the age of forty whereas a fall in Vc was apparent at sixty. Pulmonary and vascular ageing could explain these results. Sex had no effect on Dm and Vc. Exercise led to a significant rise in Dm and Vc (p<0.05) which was attributed to pulmonary capillary distension and recruitment. CONCLUSION: Knowledge of these physiological changes permits a better understanding of pathological changes.

[Aging of the lung parenchyma]. / Vieillissement du poumon profond.

INTRODUCTION: The study of lung parenchymal function is focused on the measurement of carbon monoxide diffusing transfer (TLCO) which is a function of both membrane characteristics (Dm) and capillary lung volume (Vc) The objective of this study was to estimate the effect of age on both variables. METHODS: At rest, 134 healthy non-smokers (18-85 year old) were investigated by a double transfer NO-CO method. Capillary pulmonary compliance was estimated by applying a continuous negative pressure (CNP: -10 mmHg) at the mouth to 24 subjects. RESULTS: Significant decreases in VA, TLCO, TLNO, Dm and Vc in relation to age were observed (p < 0.05). CNP induced a significant increase in all variables, the increase in Vc in elderly was greater than that in younger subjects. CONCLUSION: Alveolo capillary membrane aging induces a decrease in Dm and Vc, however the increase in the estimated capillary compliance with CNP could provide an adaptation to the decrease in Vc.