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Introduction: The aim of our study was to determine if the gender influences the clinical presentation and/or the outcome of the new coronavirus disease 2019 (COVID-19) in Tunisian population. Methods: Prospective cross-sectional study including 143 patients with confirmed COVID-19 infection, admitted in the Pneumology Department of the Military Hospital of Tunis between September 2020 and January 2021, during the first infection-wave. Results: There were 99 men (69.2%) and 44 women (30.8%) with a mean age of 61.66 years: 61.66 years for men and 61.68 years for women, and a sex-ratio of 2.25. The clinical presentation of the infection was significantly more severe in men: Tachycardia>100 bpm (15.2% Vs 2.3%, p=0.034), neurological symptoms (5.1% Vs 4.5%, p=0.008) and oxygen desaturation

Background: Dieulafoy’s disease of the bronchus can cause massive and even fatal hemoptysis. Even though it is rare, it should be considered by physicians all over the world, as several cases are reported by literature. Methods and results: We report the case of a 41-year-old man, so far in good health, presenting with massive hemoptysis. Bronchoscopy showed blood clots and a protruding lesion covered by mucosa with a white pointed cap at the entrance of the right upper lobe. Biopsies were not attempted. Embolization of bronchial artery was first realized and was not successful, with post procedure complications. Surgical intervention stopped the bleeding and pathological examination of the resected specimen confirmed Dieulafoy’s disease of the bronchus. Conclusion: To our knowledge, this is the first case of bronchial Dieulafoy’s disease to be reported in Tunisia and North Africa. When the diagnosis is suspected, bronchoscopy biopsy should be avoided as it might lead to fatal hemorrhage. Selective bronchial artery embolization can stop the bleeding, but surgery can be required.

Amyloidosis is a rare illness characterized by the deposition in organs of amyloid, which can be detected by histological staining. Amyloidosis restricted to the lower respiratory tract is unusual.We reported the case of a 68-year-old woman with no history of chronic diseasewho presented with dyspnoea on exertion, cough and fatigue. The physical examination was unremarkable. A CT scan showed a cystic mass with a thickened wall in the apical segment of the left lower lobe. A biopsy of the mass was performed, and histological and immunohistochemical study confirmed the diagnosis of AL amyloidosis. The patient's clinical and radiological symptoms spontaneously improved without treatment after 3 years.Amyloid-related cystic lung disease is a rare presentation of amyloidosis in the thorax. More case reports are required to determine if such masses can resolve without treatment and whether amyloid-associated cystic lung disease actually exists.Dyspnoea and cough are a rare atypical presentation that can reveal pulmonary amyloidosis.A cystic lung mass should raise suspicion for pulmonary amyloidosis.Clinical symptoms and radiological findings of a cystic mass spontaneously resolved without treatment after 3 years in this patient with pulmonary amyloidosis.

Since December 2019, a novel coronavirus (SARS-CoV-2) has triggered a global pandemic with a heavy medical and societal-economic toll. The health consequences were not similar during the successive waves that affected several countries. The aim of our study was to compare the sociodemographic, clinical and evolutionary features of COVID-19 patients hospitalized at the Military Hospital of Tunis (HMPIT) during the 2Observational prospective study involving 1,527 COVID-19 patients hospitalized at HMPIT over 11 months, divided into two periods: from July 2020 to December 2020 called the second wave (V2) and from January 2021 to May 2021 called the third wave (V3). We compared the epidemiological data, the clinical form and the evolution of the patients for each period.The number of hospitalized patients was 636 during V2 compared to 891 during V3. Average age was 63.5 ± 15.3 years during V2This study revealed a decrease in severe and critical clinical forms during the 3rd wave, as well as a decrease in the case fatality rate compared to the previous wave, due to improved management and vaccination. On the other hand, the percentage of ARDS was significantly higher during this wave probably related to the beginning of circulation in our country of the Delta variant causing more severe clinical cases.

Introduction: Covid-19 pneumonia has been shown to be associated with an increased prevalence of pulmonary embolism (PE) and along with it, an expected higher risk of morbidity and mortality. Aim: Identifying risk factors for PE and eventual prognosis relating to these factors. Methods: 139 patients were admitted to the military hospital of Tunis, positive on covid-19 RT-PCR testing, from September 2020 to February 2021. Results: Out of those patients,12 (11.8%) had a pulmonary embolism confirmed by CT-angiography.There was no significant correlation between PE and gender, history of pulmonary disease (asthma and COPD), or cardiovascular risk factors (type-2 diabetes, hypertension, dyslipidemia).There was a statistically significant difference between Hemoglobin serum levels in the PE positive group vs the PE negative group(11,66 g/dL vs 13,01 g/dL, p-value 0,22).This was also the case for prothrombin ratio which was lower in the PE positive group than in the negative group(79,5% vs 90,32%, p-value 0,39).Mean D-dimer, measured on admission, was not significantly higher in the PE positive group (5052 ng/mL) than the PE negative group(2404 ng/mL), similarly to C-reactive protein levels(129,12 mg/L vs 152,7mg/L).No significant correlation was found between PE, fibrinogen and ferritinemia serum levels.On CT-scans, out of 12 patients, 5 had a 25-50% lesion extent,3 had 50-75% and only 1 had >75% while the rest were not siginificant.PE was not associated with a worst outcome:no patients needed optiflow or intubation during admission and there was no significant difference in death between the two groups. Conclusion: These findings give another perspective on PE in the context of covid-19 and emphasize the heterogeneity of its induced coagulopathy.

Introduction: Health care workers (HCW) are at a high risk of COVID 19 infection and may endure mental health disorders facing this stressful situation. Aims: Evaluate the degree of anxiety, insomnia and depression in Tunisian healthcare workers during COVID19 pandemic. Methods: A cross-sectional study based on a self-administrated questionnaire in February 2021 has included HCW of the military hospital of Tunis. Depression, anxiety and insomnia were assessed by the French versions of the Hospital Anxiety and Depression Scale and the Insomnia Severity Index. Results: A total of 110 HCW responded to the questionnaire. Sex ratio was 0.89. Fifty-seven (51.8%) were single. The mean age was 33.7 years (SD 9.3). Our participants were doctors in 45.5%, nurses in 26.4% and technicians in 12.7%. The mean professional seniority was 9.5 years (SD 9.9). HCW worked in medical services in 77.3% and in COVID units in 81.8%. Sixty five per cent of respondents perceived that their put them in a great risk of contamination. Almost 37 % of them declared that their work is no longer important compared to their health (93.6%) and their social relationships (84.6%). The mean scores of anxiety and depression were 8.31(SD 4.27) and 8.43(SD 3.63) respectively. Anxiety and depression was found in 30% and 25.5% of HCW. The mean score of ISI was 8.71(SD 7.64). Insomnia was found in 41.8%. This disorder was moderate and severe in 6.4% and 10% respectively. Conclusions: Health care workers have high levels of insomnia, anxiety and depression. These mental disorders may have a negative impact on social and professional quality of life.

In thoracocentesis, the clinician usually relies on his clinical examination and chest x-ray to choose the appropriate site. This can be easy and safe for abundant pleural effusion . For pleural effusions of low to medium abundance ultrasound tracking is necessary. Aims: To Compare the accuracy of the diagnostic pleural puncture site between the clinical location and the ultrasound location in the patient9s bed. Methods: We carried out a prospective comparative study including 29 patients hospitalised for exploration of a pleural effusion based on the chest radiography. First, each patient had a double-blind clinical detection (based on the clinical examination and the chest X-ray) by an experienced doctor and a an intern. In a second step, and without changing the patient9s position, this site was checked by a doctor trained in thoracic ultrasound. our study included 29 patients (58 ± 18 y). A pleuritic syndrome was found in 95% of the cases. The abundance of effusion based on the radiography was estimated to be low to medium in 68% cases.Ultrasound did not confirm the presence of effusion in 4 patients (13%) rather revealing atelectasis (n=2) and pachypleuritis (n=2). The clinical identification proposed by the expert verified on ultrasound was precise and adequate in 69% of cases, versus 31% of an inadequate and dangerous site (liver, diaphragm or lung), especially in low abundance pleurisy.For interns, a pleural puncture site error was detected in 51% of the cases (liver, spleen, diaphragm or lung). Ultrasound tracking corrected the site chosen by clinical tracking in more than 50% of cases in both groups.

The overall prognosis in patients with advanced and metastatic lung cancer is poor, however a subset of these patients has durable survival and they are called long-term survivors (LS). The definition of LS varies in published series from 18 months to 5 years. Few studies have focused on them. We report six cases of LS patients: three cases of non-small- cell lung cancer (stage IIIB and stage IV), two case of small cell lung cancer, and a case of composite carcinoma (small cell carcinoma and squamous carcinoma), all having a survival of five years or more. Our patients show clinical and evolutionary similarities with LS in the literature regarding the prognostic factors associated with prolonged survival namely performance status and good response to first-line chemotherapy.

Resume Introduction La prevalence croissante de l’allergie et son impact sur la qualite de vie individuelle soulignent la necessite d’une amelioration des options de traitement afin de modifier le cours naturel des maladies allergiques. La desensibilisation reste le seul traitement etiologique des maladies allergiques. Le developpement de la voie sublinguale represente une approche actuellement disponible pour reorienter la reponse immunitaire inappropriee chez les patients atopiques et a un meilleur profil de tolerance que la voie sous-cutanee. But Etudier l’interet de l’immunotherapie allergenique par voie sublinguale dans le traitement des allergies respiratoires et d’evaluer l’observance, l’efficacite et la tolerance de cette voie en suivant le protocole ultra Rush. Methodes Etude prospective longitudinale incluant 200 patients atteints d’une maladie allergique chez qui un traitement sublingual a ete demarre selon le protocole ultra Rush et a ete poursuit pendant 3 a 5 ans. Resultats L’âge moyen de nos patients etait de 18 ans avec des extremes allant de 3 a 44 ans. L’indication de la desensibilisation a ete retenue devant une rhinite allergique persistante severe isolee (25 %) ou associe a un asthme persistant leger a modere associe (75 % des cas). La sensibilite aux acariens a ete objectivee chez tous nos patients confirmee par TCA (100 % des cas). Les effets secondaires locaux notes etaient a type de prurit buccal (12 % des cas). Aucun effet systemique grave n’a ete note notamment aucun cas de choc anaphylactique, œdeme de Quincke, ou crise d’asthme moderee ou severe. L’efficacite a ete evaluee sur l’amelioration de scores de symptomes et sur la quantification de la consommation medicamenteuse qui a diminue de 55 %. Aucun passage de la rhinite a l’asthme n’a ete note. Aucune nouvelle allergie n’est apparue. Conclusion L’immunotherapie allergenique sublinguale est efficace dans la rhinite allergique et l’asthme stable. Elle constitue le seul traitement etiologique disponible. L’efficacite et la tolerance de cette voie depend cependant du strict respect des regles de prescription, des indications et contre-indications.

Objectif Des liens entre le tabagisme et le syndrome d’apnees-hypopnees obstructives du sommeil (SAOS) sont de plus en plus evoques. Cependant, l’impact du tabac sur la severite du SAOS reste peu etudie. L’objectif de notre travail etait d’etudier l’impact du tabac sur la severite du SAOS. Methodes Etude retrospective descriptive ayant collige tous les patients adresses a notre consultation pour suspicion de SAOS entre 2017 et 2019, confirmee par une polygraphie ventilatoire. Selon l’index apnees-hypopnees (IAH), ils etaient classes en SAOS leger (5–15), modere (16–30) et severe (> 30). Deux groupes etaient definis : G1 (tabagiques actifs ou sevres) et G0 (non tabagiques). Resultats Cent-cinquante patients etaient inclus. L’âge moyen en annees etait de 46 ± 10,75 dans G1 (66 pts) vs 55,3 ± 13 dans G0 (84 pts) ; p Conclusion Selon nos resultats, le tabagisme s’associe a un SAOS severe. Le sevrage tabagique est donc necessaire dans la prise en charge therapeutique.

Introduction Le guidage echographique des procedures pleurales est une recommandation de la BTS depuis 2010. Pour la ponction pleurale diagnostique, habituellement le clinicien se base sur son examen clinique et sur la radiographie thoracique afin de choisir le site approprie. Ceci peut etre facile et sans risque pour les pleuresies de grande abondance contrairement aux epanchements pleuraux de faible a moyenne abondance ou cloisonnes. Objectif Comparer la precision du site de ponction pleurale diagnostique entre le reperage clinique et le reperage echographique au lit du patient. Methodes Nous avons realise une etude comparative prospective faisant inclure 36 patients pris en charge dans le service de pneumologie de l’hopital militaire de Tunis pour exploration d’une opacite d’allure pleurale sur la radiographie du thorax. Dans un premier temps, chaque patient a eu en double aveugle un reperage clinique par un medecin experimente et un autre reperage par un pneumologue en cours de formation. Dans un 2e temps, et sans changer la position du patient, ce site a ete verifie par un medecin forme en echographie thoracique. Resultats Notre etude avait inclus 36 patients de sexe masculin dans 54 % des cas avec un âge moyen de 56 ± 12 ans. Un syndrome pleuretique a ete retrouve dans 95 % des cas. La radiographie du thorax trouvait % une opacite pleurale a droite (55 %), a gauche (36 %) et bilaterale (13 %). L’abondance de l’epanchement basee sur la radiographie etait estimee de faible a moyenne abondance dans 67 % des cas. L’echographie ne confirmait pas la presence de pleuresie chez 4 patients (15 %) revelant plutot une atelectasie (n = 2) et une pachypleurite (n = 2). L’echographie objectivait un epanchement libre dans 65 % des cas et cloisonnee dans 25 % des cas. L’epanchement etait anechogene dans 65 % des cas. Le reperage clinique propose par l’intervenant expert verifie a l’echographie etait juge precis et adequat dans 65 % des cas, versus 35 % de site inadequat et dangereux (foie, diaphragme ou poumon) notamment dans les pleuresies de faible abondance. Pour l’intervenant en cours de formation une erreur de site de ponction pleurale a ete detectee dans 53 % des cas (foie, rate, diaphragme ou poumon). Conclusion Conformement a la litterature, notre etude montre que le reperage clinique pour le choix de site de ponction pleurale necessite de l’experience. Cependant, le reperage echographique est indispensable pour ameliorer la rentabilite diagnostique et eviter les complications.

Smoking and tuberculosis (TB) represent two major health issues particularly in developing countries. Tobacco consumption increases risk of Mycobaterium tuberculosis infection among immunocompetent. Methods: A retrospective case control study carried out in the pulmonary department of military hospital of Tunis : 173 patients treated for TB were enrolled, subdivided in tow groups (G) : G1 : 106 smokers (61.3%), G2 : 67 non smokers (38.7%) . All possible data was collected. Aims: To compare the clinical course and radiological aspects of pulmonary TB between smokers and non smokers. Results: The mean age was 43 years [18 -93 years] with a higher male rate (95.3% versus 46.3%, p No significant difference in bacillary load was observed between ever and never smokers. Therefore, sputum smear conversion delay was longer in G1 (25 versus 31 days,p=0.58). Treatment adherence was better in smokers (94% versus 80,p=0.051) with a lower rate of side effects(27.4% versus 34.2%, p=0.12) and higher percentage of persistent sequels . It is clear that tobacco consumption is a avoidable risk factor for TB. The integration of smoking cessation should be a part of the strategy to control the higher burden of TB in developing countries.

Objectif De nos jours, la physiopathologie du syndrome apnees-hypopnees obstructives du sommeil (SAOS) suggere son association a un risque cardiovasculaire (CV). Cependant, la frequence des comorbidites CV selon le degre de severite du SAOS reste peu etudiee. L’objectif de notre travail etait d’etudier la relation entre la severite du SAOS et la frequence des comorbidites CV. Methodes Etude retrospective menee sur les patients ayant beneficie d’une polygraphie ventilatoire dans notre service pour suspicion de SAOS entre 2017 et 2019. Selon l’index apnees-hypopnees (IAH), les patients etaient classes en SAOS leger a modere (IAH :5–30) : G0 ; et severe (IAH> 30) : G1. Resultats Cent-cinquante patients etaient inclus. L’âge moyen en annees etait de 50,2 ± 13 dans G1 (105 patients) vs 53 ± 12 dans G0 (45 patients) ; p = NS. Le sex-ratio H/F etait de 1,2 et 0,07 respectivement dans G1 et G0 ; p Conclusion Plus le SAOS est severe, plus les comorbidites cardio-vasculaires sont frequentes notamment l’hypertension arterielle et l’obesite. D’ou la majoration du risque de ces comorbidites chez les apneiques severes.

Objectif Le syndrome d’apnees-hypopnees du sommeil (SAHOS) est responsable d’une hypersomnolence diurne ayant des repercussions sur le devenir professionnel des militaires. L’objectif de notre etude etait d’evaluer l’impact socioprofessionnel d’un SAHOS severe appareille. Methodes Etude prospective, ayant inclus 51 militaires actifs presentant un SAHOS severe appareille par CPAP. On s’est base pour l’evaluation de l’impact professionnel sur le questionnaire WPAI (Work Productivity and Activity Impairment). Resultats Notre population etait exclusivement masculine avec un âge moyen de 42±9 ans. Un poste de securite etait occupe dans 41 % des cas avec un travail de nuit fixe chez 7,8 %. Les signes les plus revelateurs etaient le ronflement nocturne (90 %) et la somnolence diurne(68 %). La decision d’aptitude etait de declarer 43 % des cas aptes, avec restriction du travail de nuit et/ou des postes de securite et 4 % des cas inaptes avec reclassement professionnel. La duree moyenne quotidienne d’utilisation de la PPC etait de 6,3 h avec une bonne observance therapeutique dans 33 % des cas. La mise en place de la PPC avait ameliore la qualite de vie avec diminution du taux d’absenteisme du au SAHOS (de 19 a 14 %), de la perte de productivite (de 65 a 39 %) et de la gene pour les activites quotidiennes (de 60 a 20 %). Conclusion Il ressort de cette etude qu’un SAHOS appareille avec une bonne observance therapeutique avait un retentissement socioprofessionnelle p. D’ou l’interet d’un suivi regulier de ces patients et d’une prise en charge adaptee.

Background: Evaluation of fitness for military duty is sometimes complex. Respiratory diseases such as asthma may affect individuals9 fitness for military service. In order to assess fitness for military service in subjects with asthma symptoms, objective and reliable tests are needed. Aim: Determine the diagnostic value of the methacholine bronchial provocation test (BPT) in military patients referred for a qualifying visit due to a history of asthma, or atypic asthma symptoms at rest or exercise. Methods: Questionnaire, spirometry, BPT with methacholine and skin prick testing were conducted in 147 patients. A positive test is defined as the fall in FEV1 of 20% for a methacholine dose ≤ 1100 μg / Ml Asthma was diagnosed by a military physician according to the medical record, results of BPT, current respiratory symptoms and use of asthma medication. Results: The mean age of patients was 27.68 years with extremes ranging from 11 to 62 years. The sex ratio is 5,3 (124 men, 23 women). Seventy patients (47.6%) were smokers, and 21 (14.3%) reported the concept of familial atopy. The clinical signs were mainly the wheezing of the chest (32%), the dry cough (22,4%) and the difficulty with the effort (15%). Of the 147 subjects, 135 (91,8%) had normal baseline EFRs. 74 patients were BPT+ (50,3%), all reviewed: 35/77 (45,5%) were diagnosed with asthma. Thirty patients (20,4%) have been declared unfit. The sensitivity/specificity of metacholine to identify physician-diagnosed asthma was 41%/93%. Conclusion: When a methacholine test is practiced, its result should be considered as an additional element, but not necessarily discriminatory, in the decision of military aptitude.