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Introduction. - Paraneoplastic Cushing's syndrome is a rare cause of endogenous hypercorticism. It is caused by ectopic secretion of ACTH by a non-pituitary endocrine tumor. The aetiological biological and radiological data are often inconclusive, which creates a problem of differential diagnosis with Cushing's disease. In addition, these tumors are often small and their location is extremely variable. As a result, the difficulties of localization require the use of specific imaging techniques.Observation. - We report the observation of a 44-year-old man suffering from diabetes and high blood pressure, presenting a severe and rapidly progressive Cushing syndrome, in connection with a hypercorticism caused by an ectopic ACTH secretion. The thoracic computed tomography performed within the framework of a search for a neoplastic origin objectified a 15 mm nodule isolated at the level of the middle lobe, the scintigraphy with octreotide marked with indium-111 found a significant fixation at the level of the lung nodule. The patient had a middle lobe lobectomy. The outcome was favorable with regression of Cushing's syndrome. Pathological examination was in favor of a typical carcinoid tumor, and the immunohistochemical complement showed tumor cell positivity for ACTH, CD56, chromogranin, and synaptophysin.Conclusion. - This observation illustrates the dilemma between the need to locate an ectopic ACTH secretion and the control of aggressive and threatening Cushing's syndrome. Early use of the octreotide scintigraphy should be considered if a topographic diagnosis of the causative tumor cannot be done through conventional imaging techniques.

No previous study has evaluated the effects of RF on inflammatory and hematological indices of COPD patients. The main objective of the present pilot study was to assess the effects of RF on some inflammatory and hematological indices measured in male patients with stable COPD. Fifteen COPD patients (mean ± SD of age: 71 ± 6 years) who fasted during Ramadan 2017 volunteered for the study. Three sessions (Before-Ramadan, End-Ramadan and After-Ramadan) were selected. Spirometry tests and blood samples were consistently performed 2.5–4.5 hr before the interruption of the fasting. Assessment sessions comprised: spirometry, inflammatory [erythrocyte sedimentation rate (ESR); C-reactive protein (CRP)] and hematological [red and white blood cells (RBC, WBC); hemoglobin; hematocrit; mean corpuscular volume; mean corpuscular hemoglobin; platelets] indices. Findings were analyzed by applying Friedman ANOVA. The median (lower–upper quartiles) of ESR (Before-Ramadan: 3 (2–9), End-Ramadan: 7 (0–13), After-Ramadan: 9 (5–15) mm/h) and CRP (Before-Ramadan: 20 (11–38), End-Ramadan: 15 (9–34), After-Ramadan: 20 (12–46) mg/L) were not significantly affected by RF. Among all the hematological indices, RF influenced only hemoglobin (Before-Ramadan: 14.4 ± 2.2, End-Ramadan: 13.4 ± 1.3, After-Ramadan: 12.2 ± 0.9 g/dL), hematocrit (Before-Ramadan: 45 ± 7, End-Ramadan: 40 ± 4, After-Ramadan: 39 ± 4%), RBC (Before-Ramadan: 5.1 ± 1.0, End-Ramadan: 4.6 ± 0.7, After-Ramadan: 4.4 ± 0.5 106/mm3) and WBC (Before-Ramadan: 8,673 ± 1,911, End-Ramadan: 7,840 ± 1,526, After-Ramadan: 9,507 ± 2,190/mm3). Compared to the Before-Ramadan session, the End-Ramadan session values for hemoglobin, hematocrit, RBC and WBC were lower. Compared to the After-Ramadan session, the End-Ramadan session values for hemoglobin and WBC were higher and lower, respectively. In conclusion, RF caused significant reduction in hemoglobin, hematocrit, RBC and WBC. However, it did not induce any significant changes in the CRP and ESR indices.

Introduction: Risk of venous thromboembolism (VTE) in lung cancer patients substantially increases with the addition of chemotherapy. Platinum-based regimens claim to be associated with a very high VTE rate. Objectives: Determine the prevalence and characteristics of VTE in adult patients receiving platinum-based chemotherapy and analyze the importance of the patients’ tumor and treatment characteristics in predicting the occurrence of VTE. Patients and Methods: Patients who had received platinum based chemotherapy for lung cancer between January 2016 and December 2018 were retrospectively identified. Patients were followed for development of VTE throughout the entire duration of therapy and one month thereafter. Results: Eighteen patients (88.8% males, median age: 62 years) treated with platinum-based regimens (49 cisplatin, 31 carboplatin) were included. VTE were reported in 15 patients (18.8%). Thrombosis included deep vein thrombosis (DVT) in 8 (10%), pulmonary embolism (PE) in 6 (7,5%) and DVT with PE in 1 (1,25%). Most patients (70%) had stage IV cancer and only 5% had stage I or II. In the multivariate analysis, the occurrence of TVE were not associated statistically with advanced-stage disease, gender, age, and different risk scores. Carboplatin-Etoposide was associated with a higher risk of VTE (p=0.049) in univariate analysis. In multivariate analysis, Carboplatin-Etoposide (p=0,045) and carboplatin-Navelbine (p=0.048) increased the risk of VTE. Conclusion: A high incidence of VTE in patients receiving platinum based chemotherapy was demonstrated in this study. Prospective studies are crucial to highlight the necessity of thromboprophylaxis in patients receiving platinum based chemotherapy.

Introduction: In Tunisia, tuberculosis typically represents the most frequent cause of exudative pleural effusion with clear fluid. Different tools are used in the diagnosis of tuberculous pleurisy. Aim: to determine the diagnostic approach of the pleural tuberculosis. Methods: A retrospective study was conducted in the IBN NAFISS pneumo-allergology department at the Abderrahmane Mami Hospital in Ariana, Tunisia, involving 95 cases of pleural tuberculosis collected over a nine-year period from October 2009 to January 2019. Results: The mean age of our patients was 38 years. The study population was predominantly male (55%). Two patients had a history of tuberculosis. A tuberculous contagion was revealed in 17 cases (18%). The onset of symptomatology was progressive in 74% of cases. The patients presented chest pain in 84 cases (88%), fever in 62 cases (65%) and weight loss in 58 cases (61%). An associated pulmonary tuberculosis was revealed in 18 patients (19%). The diagnosis of tuberculous pleurisy was established after microscopy for acid fast bacilli (AFB) in sputum in 14 cases (15%), microscopy for AFB in pleural fluid in 4 cases (4%), Abrams pleural needle biopsy in 63 cases (66%) and thoracoscopic pleural biopsy in 4 cases (4%). Eight patients were treated for pleural tuberculosis considering the symptoms and a positive tuberculin skin test. The tuberculin skin test was positive in 65% of cases. The Abrams pleural needle biopsy was performed in 76 patients (80%) with a profitability of 83%. Conclusion: The Abrams pleural needle biopsy, a simple method that does not require general anesthesia, represent a key-step in the etiological diagnosis of exudative pleurisy with clear fluid and especially tuberculous pleurisy with a good efficiency.

No prior study has evaluated the impacts of Ramadan intermittent fasting (RIF) on oxidant/antioxidant stress (OS/AOS) biomarkers in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to assess the impacts of RIF on some OS/AOS biomarkers measured in male patients with stable COPD. Fifteen COPD patients (mean age: 71 ± 6 years) fasting Ramadan in 2017 volunteered to take part in the study. Three sessions (before Ramadan [BR], end Ramadan [ER], after Ramadan [AR]) were selected. Blood samples of OS (homocysteine [μmol/L], thiobarbituric acid reactive substances [TBARS, μmol/L]) and AOS (catalase [U/ml], ceruloplasmin [g/L], superoxide dismutase [SOD, ng/ml], zinc [µmol/L], albumin [g/L]) biomarkers were consistently taken 4.5 to 2.5 hr before the iftar . Findings were analyzed by applying Friedman or Kruskal–Wallis ANOVA. Comparisons of the number of patients with high OS [high homocysteine and/or TBARS] and low AOS (low catalase and/or ceruloplasmin and/or SOD and/or zinc and/or albumin) blood values between the three sessions were performed using the Cochran test. The median ± interquartile of homocysteine (BR: 21.48 [18.98–24.49], ER: 23.15 [21.77–26.45], AR: 24.87 [21.91–37.12]), ceruloplasmin (BR: 0.27 [0.24–0.30], ER: 0.28 [0.26–0.33], AR: 0.28 [0.25–0.32]), SOD (BR: 288.00 [112.00–400.00], ER: 182.00 [152.00–386.00], AR: 234.00 [190.00–420.00]) and the mean ± SD of TBARS (BR: 5.66 ± 1.26, ER: 4.59 ± 0.78, AR: 5.29 ± 1.69), catalase (BR: 120.97 ± 54.62, ER: 106.73 ± 50.92, AR: 137.39 ± 40.88), zinc (BR: 11.85 ± 2.01, ER: 12.47 ± 2.34, AR: 12.21 ± 2.58) and albumin (BR: 39.78 ± 3.19, ER: 40.74 ± 2.26, AR: 40.56 ± 2.38) were not significantly affected by RIF. The number of patients with high OS (BR [ n = 13], ER [ n = 15], AR [ n = 14]) or low AOS (BR [ n = 12], ER [ n = 13], AR [ n = 13]) statuses were not significantly influenced by RIF. In conclusion, RIF did not induce any significant statistical or clinical changes in OS/AOS biomarkers or statuses in COPD patients.

Sleep disorders and poor sleep quality are important issues for MS. Aim: to determine sleep patterns and risk factors of poor sleep quality among Tunisian MS. Methods: a cross sectional study using an anonymous self-administered questionnaire was conducted among students at Medical university of Sousse during October-November 2017. The questionnaire was administered during the obligatory supervised teaching sessions. The sleep quality was based on the Pittsburgh Sleep Quality Index (PSQI). Results: A total of 310 students were enrolled (response rate 79%). Among them, 232 (74.8%) were female. Mean age was 21.56±1.68 years. About two thirds of MS were in clinical phase. Sleep onset latency and sleep duration mean were respectively 23.8±24.8 minutes and 6.9±1.3 hours. One hundred and twenty (38.7%) MS slept less than 7 hours and 58 (18.7%) slept after midnight. Moreover, 94 (30.3%) respondents reported fairly bad to very bad sleep quality. Mean PSQI score was 5.8±2.9. Poor sleep quality (PSQI ≥8) was reported by 76 (24.6%) students. Going to sleep late and shorter sleep duration were identified in univariate analysis as predictors of poor sleep quality (p= 0.001 and p Conclusion: Sleep disturbances and poor sleep quality are very common among medical students. Sleep duration was identified as the sole independent factor of poor sleep quality.

Background: Asthma is generally characterized by reversible airway obstruction. However, some asthma patients demonstrate fixed airway obstruction (FAO) despite optimal treatment. The aim of this study is to assess the relationship between FAO and clinical features of asthma and the effect of FAO on treatment response. Methods: A cross-sectional study including asthma patients was conducted between January and December 2016. Spirometry was performed on all patients. Patients with post bronchodilator FEV1/FVC ratio ≤ 70% at two annual consecutive visits were considered with FAO. Patients with concomitant chronic obstructive pulmonary disease were excluded. We compared two groups: group 1 (G1) with FAO and group 2 (G2) without FAO. Results: Of the total of 204 patients, 17% had FAO. Mean age was higher in G1 (49.6 vs 44 years, p=0.04). Male predominance was seen in G1 (58% vs 47%, p=0.2). There were no difference on BMI between the two groups. Smoking history was frequent, but higher in G1 (60% vs 51%, p=0.3). Gastro oesophageal reflux was more frequent in G1 (37% vs 34%, p=0.8). Allergic asthma was predominant in the two groups. FEV1 was lower in G1 (68% vs 88%, p=0.01). Well control asthma control was more frequent in G2 (45% vs 65%, p=0.03). Exacerbations of asthma in the previous year were more frequent in G1 (77% vs 53%, p=0.01). Association of high dose of inhaled corticosteroid with inhaled long acting beta agonist was more frequent in G1 (20% vs. 6%, p=0.01). Conclusion: Tunisian asthmatics with FAO tended to be male, elderly and smokers. These patients had severe asthma requiring a high dose of inhaled treatment.

Introduction Les tumeurs fibreuses solitaires (TFS) sont des tumeurs mesenchymateuses rares. La localisation pleurale est la plus frequente. Le traitement de reference reste la chirurgie, qui permet de confirmer le diagnostic apres etude histologique. L’objectif de ce travail etait de decrire les aspects cliniques, radiologiques, therapeutiques et evolutifs des TFS intrathoraciques operees. Methodes Etude retrospective (2004–2019) sur dossiers de patients presentant une TFS a l’examen histologique definitif, operes dans le service de chirurgie thoracique et cardiovasculaire de l’Ariana. Resultats Quatorze patients (7 hommes–7 femmes) ont ete colliges. L’âge moyen etait a 50 ans. La majorite des patients (11) etait sans antecedents notables. La symptomatologie clinique etait dominee par les douleurs thoraciques (10 cas), la toux (8 cas), et la dyspnee d’effort (5 cas). La duree moyenne d’evolution des symptomes etait de 5,6 mois. Un patient a consulte devant l’apparition d’une tumefaction parietale. La decouverte etait fortuite chez un patient. L’imagerie a montre une masse tissulaire pleurale dans 8 cas, un nodule pulmonaire solitaire dans 3 cas et une masse mediastinale dans 1 cas. La localisation droite etait la plus frequente (10 cas). La taille moyenne etait a 6 cm. La biopsie transparietale etait pratiquee chez 3 patients. La resection etait complete dans tous les cas. L’histologie a conclu a une origine pleurale chez 12 patients et a une origine pulmonaire chez 2 patients, et a la malignite dans 2 cas. L’evolution etait marquee par l’absence de recidive chez la majorite des patients, y compris ceux avec une tumeur maligne. La recidive a ete notee chez un patient apres un delai de 8 ans. Conclusion Les TFS thoraciques sont des tumeurs rares. La presentation clinique n’est pas specifique. Le diagnostic peut etre evoque par l’imagerie et est confirme par histologie apres l’exerese chirurgicale. Le pronostic depend de la nature et de la localisation. La surveillance au long court est necessaire pour depister les recidives ou la transformation maligne.

Introduction Le cancer du poumon est la principale cause de deces par cancer. Le cancer bronchopulmonaire (CBP) reste le cancer le plus frequent chez l’homme. C’est donc un reel probleme de sante publique. L’objectif de notre travail etait de determiner l’evolution du profil epidemiologique du CBP. Methodes Nous avons mene une etude retrospective et descriptive portant sur 291 cas de cancer du poumon hospitalises au service de pneumologie Ibn-Nafiss de l’hopital Abderrahmen-Mami pour le cancer du poumon au cours des annees 1991, 2001, 2010 et 2018. Resultats L’âge moyen de nos patients etait de 60 ans pour les trois premiers groupes et de 57 ans pour le groupe etudie en 2018. En 1991, 43 patients inclus etaient tous des hommes, contre 57 en 2001 (53 hommes et 4 femmes), 90 en 2010 (83 hommes et 7 femmes) et 99 en 2018 (84 hommes et 15 femmes). Il y avait une augmentation du nombre de patients non fumeurs au cours des annees 2 %, 3,5 %, 7,7 % et 15 %, respectivement. Le carcinome pulmonaire non a petites cellules (CPNPC) etait le type histologique predominant (73 %). L’adenocarcinome occupe la premiere place au cours des huit dernieres annees, avec 58 % de cas en 2010 et 50 % en 2018, contre 4 % en 1991 et 10 % en 2001. En revanche, le carcinome epidermoide etait predominant en 1991 avec 14 patients (32 %) 6 patients (10 %) en 2001 contre 13 patients (14 %) en 2010 contre 29 patients (29 %) en 2018. Le carcinome a petites cellules (CPC) a ete diagnostique dans 7 cas (16,2 %) en 1991 contre 6 cas (10,5 %) en 2001 contre 14 cas (15 %) en 2010 et 20 cas (20 %) en 2018. Les patients etaient diagnostiques dans 53 % des cas au stade metastatique : 53 % en 1991, 45 % en 2001, 55 % en 2010 et 61 % en 2018. Nous n’avons releve aucune amelioration de la survie des patients au cours de ces 28 annees. Les delais de traitement ont ete legerement raccourcis (59 contre 67, contre 49 contre 42 jours). Cependant, le delai entre consultation et diagnostic n’a pas change : 30 jours en 1991, 28 jours en 2001, 35 jours en 2010 et 29 jours en 2018. Conclusion A travers cette etude, nous remarquons l’augmentation de la frequence du cancer du poumon chez les femmes, ainsi que celle du carcinome a petites cellules et du carcinome epidermoide, mais l’adenocarcinome pulmonaire reste en tete de liste et l’augmentation des patients ayant un CBP non-fumeurs.

Introduction L’association entre la maladie cancereuse et les troubles anxieux et depressifs est de plus en plus evoquee dans la litterature. Cette association a un impact sur le pronostic du cancer en compromettant l’adhesion au traitement. Notre etude a pour but d’etudier la prevalence de la depression et de l’anxiete chez des patients atteints d’un KBP. Methodes Il s’agit d’une etude prospective transversale menee aupres de sujets sans antecedents psychiatriques, atteints d’un KBP et qui ont ete hospitalises dans notre service entre janvier et juin 2017. Une version en dialecte tunisien du « Hospital Anxiety and Depression Scale » a ete elaboree. Resultats Cinquante patients dont 48 tabagiques (48 hommes, 2 femmes), etaient colliges. L’âge moyen etait de 59,54 ans avec des extremes allant de 32 ans a 80 ans. Quarante-six patients etaient maries et 4 patients etaient celibataires dont 2 sans aucun soutien familial. Quatre-vingt-sept pour cent des patients avaient une situation professionnelle stable (48 % retraites, 39 % actifs). Soixante-dix pour cent des patients etaient sans antecedents. Tous les patients n’etaient pas au courant du diagnostic. Six patients seulement avaient des doutes sur le diagnostic. Vingt-quatre patients etaient a un stade metastatique au moment du diagnostic. Les prevalences de l’anxiete et de la depression etaient respectivement de 47 % et de 20 %. La religion etait la strategie de coping la plus frequemment evoquee par les malades. Conclusion Notre etude demontre que la prevalence de la depression et l’anxiete est augmentee au cours du KBP. Ces pathologies sont largement sous-diagnostiquees et donc sous-traitees, ce qui peut etre a l’origine de l’aggravation de la maladie cancereuse. L’intervention psychologique dans ce cas s’avere essentielle, non seulement au moment de l’annonce, mais aussi tout au long du traitement.

Objectif Evaluer la tolerance de la pression positive continue (PPC) et son influence sur l’observance. Methodes Etude prospective incluant 83 patients ayant un syndrome d’apnees du sommeil severe diagnostiques en 2010 et ayant accepte le traitement par PPC. La duree de suivi etait de 4 ans. Resultats L’âge moyen etait de 52 ans. Les effets secondaires (EI) etaient notes chez 75,9 % des patients. Les EI nasaux etaient les plus frequents. Ils etaient representes par la secheresse nasale (43,3 %) et l’obstruction nasale (25,3 %). Le traitement a consiste en l’ajout d’un humidificateur (15,6 %), la prescription de corticoides nasaux (9,6 %), de vasoconstricteurs (1,2 %) et le traitement chirurgical (1,2 %). Chez nos patients, des complications liees au masque etaient representees par l’usure du masque (26,5 %), les fuites autour du masque (20,5 %), les lesions cutanees (3,6 %), les lesions oculaires (3,6 %) et la claustrophobie (1,2 %). Le traitement etait un changement du masque dans 42 % des cas, une adaptation de la methode du port du masque dans 12 % et une reparation de l’appareil de PPC dans 3,6 %. L’observance therapeutique etait associee a des EI moindres notamment la sensation de suffocation ( p p = 0,029) et les fuites par le masque ( p = 0,007). Conclusion Malgre les nombreux progres technologiques realises en termes d’etancheite, de confort et d’ergonomie des masques, la majorite des patients traites par PPC developpent des effets indesirables lies a l’interface. Un traitement adequat permet d’ameliorer l’observance et la tolerance de la PPC.