Introduction-Aim: Bronchiectasis, which was once considered an orphan disease in developed countries, is common in Tunisia as in all emerging countries. The purpose of the present study is to determine radio-clinical features, etiologies and evolution of bronchiectasis.

Monocentric, retrospective and descriptive study including all patients followed in the pulmonology department, Gabes University Hospital, for bronchiectasis confirmed by a chest CT scan between January 2016 and December 2023.

A total of 70 patients were included in the study. The mean age was 60.39±18.68 years. Symptomatology was dominated by cough and morning bronchorrhea. The diagnosis of bronchiectasis was confirmed in all patients. Chest CT scan showed diffused bronchiectasis in 85.7% cases, localized in 14.2% cases and bilateral in 87% cases. Bronchiectasis was secondary to pulmonary tuberculosis in 62.8% of cases and idiopathic in 12.8% of cases. Complications were dominated by bronchopulmonary infections (21.4% of cases) and hemoptysis (28.5% of cases). Ten patients (14.2%) with diffuse and bilateral bronchiectasis progressed to chronic respiratory failure.

Our study shows that the etiologies of bronchiectasis are dominated in our context by tuberculosis despite the national tuberculosis control program. Diffuse and bilateral bronchiectasis are frequent and associated with a poor prognosis.

In Tunisia, during the Coronavirus Disease 19 pandemic, the transition to e-learning was brutal. The aim of this study was to assess undergraduate medical students (UMSs)' perception of the e-learning experience at the Faculty of Medicine of Sousse, and to derive some determinants of its implementation.

Eligible participants were all UMSs (n=1397). The data was collected from an email questionnaire distributed in January/March 2021. The questionnaire consisted of 89 items exploring three main parameters: institution role, students' personal experience, and environment impact.

A total of 419 UMSs responded (30% response rate). Half of the UMSs described this transition as difficult, and three-quarters felt concerned about the credibility of their degrees. Logistical issues negatively affected the transition to e-learning, particularly those related to Internet speed. Understanding difficulty via the screen interface was reported by 40% of UMSs. ''Face-to-face" sessions were described as more conducive to assimilation by 64% of UMSs. As far as "information retrieval" is concerned, 83% of UMSs turned to social networks and adopted Wikipedia as a reference.

In Tunisia, as an example of North African country, the transition to exclusive e-learning has been largely impacted by the drawbacks of limited logistics. This study highlights the multiple facets to be considered in the future for the successful implementation of e-learning in medical education.

To investigate factors associated with Pediatric Intensive Care Unit (PICU) admission in children with severe MIS-C.

We conducted an observational cohort study between July 1, 2020, and May 31, 2021, in the only pediatric hospital in Tunisia.

A total of 45 children (33 males) with no recent history of COVID-19 infection were included. Mean age was 7±3.2 years. Sixteen patients (35%) required PICU admission. There was no significant difference in mean age of patients with and without PICU admission (7.5±2.7 vs. 6.76±3.46 years; p=0.4). The frequency of respiratory distress (p=0.001), shock (p=0.001), cardiac dysfunction (p=0.003), mean CRP (p=0.001), and median troponin (p=0.003) were significantly higher in patients with PICU admission than in those without. The independent predictive factor for PICU admission was cardiac dysfunction; adjusted Odds Ratio (aOR) = 12.8, 95% CI = (2.1-76.4), p=0.002.

The only independent risk factor for PICU admission in patients with MIS-C was cardiac dysfunction.

Several nations have seen an increase in COVID-19 cases in 2020, exhibiting a wave pattern. Different COVID-19 variants caused these waves. In this perspective, the aim of the study was  to compare epidemiological, clinical and evolutive profile of COVID-19 infection during two waves of COVID-19.

Data collection was carried out using a questionnaire self-administered in French and Arabic developed with Google Forms and shared online via social media with weekly reminders. Duration of one month was enough to get the necessary number of participants calculated. The study included all Tunisians who were infected with COVID-19 at least once and agreed to participate in the study.  Results: In total, 1328 COVID-19 patients were included. Eight hundred eighty-three patients were infected during the Alpha wave (66.5%) and 445 were infected during the Delta wave (33.5%). The median age was 37 years (interquartile range (IQR): 30-41 years). Clinically, during delta wave, these symptoms were more frequent; fever (57.8% versus 51.9%, p= 0.042), loss of smell (75.1% versus 65.1%, p On the other hand, aches were more frequent during Alpha wave (65.2% versus 56.2%, p = 0.001) and the impact of health professionals was greater (27.6% versus 15.7%, p≤10-3).

The Alpha variant had more pronounced clinical symptoms than the Delta variant. This can be explained by the high vaccination coverage during the pandemic by the Delta variant.

Chronic obstructive pulmonary disease (COPD) acute exacerbation (AE) increases morbidity and has an impact on health status. Inflammation plays a key role in these events. Current evidence supports use of biomarkers to guide corticosteroid therapy, which is included in the treatments of COPD AE.

The aim of our study was to determine the prognostic value of hypereosinophilia (HEo +) in patients admitted to emergency department (ED) with COPD AE in terms of recurrence (Recurrence+).

A prospective and observational study was conducted over nine months including patients admitted to ED with COPD AE. Patient history, clinical, paraclinical and therapeutic data was collected. HEo+, was defined as blood eosinophil count (BEC)≥200 cells/mm3. One month follow-up was performed. We compared two groups: Recurrence+ vs Recurrence- patients and HEo+ vs HEo- patients. Both univariate and multivariate analysis were performed to identify factors associated with COPD AE recurrence at one month.

We included 252 patients. Prevalence of HEo+ was 50%. Patients with HEo+ had less severe clinical signs on admission (p=0.03), less COPD AE recurrence (p <0.001) and required less hospitalization at one month (p=0.003). Mortality was higher in HEo- patients (p=0.05). Recurrence- patients had HEo+ more frequently (61% vs 19% ; p<0.001). In multivariate analysis, we identified two predictors of recurrence of COPD: COPD group D (adjusted OR 2,3; [95% IC 1,5-3,7]; p<0,001) and non-invasive ventilation on admission (adjusted OR 3,9; [95% IC 1,1-13]; p=0,03). HEo+ was a protective factor of COPD group D (adjusted OR 2,3; [95% IC 1,5-3,7]; p-0,001) and non-invasive ventilation on admission (adjusted OR 3,9; [95% IC 1,1-13]; p=0,03). HEo+ was a protective factor of COPD AE recurrence (adjusted OR 0,3; [95% CI] [0,17-0,4]; p-0,001).

Recurrence of COPD AE one month after ED visit was less frequent in patients with HEo+. BEC may predict systemic corticosteroid treatment failure or success. Identification of responders to corticotherapy can lead to less prescription of prednisone or equivalent and could be integrated into a therapeutic management algorithm.

Chronic obstructive pulmonary disease (COPD) is a widespread global health problem marked by chronic inflammation, emphysematous lung damage, and persistent airflow limitation. In COPD, hyperinflation exacerbates respiratory muscle weakness by causing diaphragmatic dysfunction. Diaphragmatic ultrasonography (US) is a non-invasive tool for evaluating diaphragmatic function, which may provide insight into the severity of hyperinflation in COPD. The purpose of this study is to evaluate the effectiveness of diaphragmatic ultrasonography in assessing lung hyperinflation in patients with COPD .

A diagnostic cross-sectional investigation will be carried out in two Tunisian pulmonology centers. COPD patients aged ≥40 years with confirmed diagnosis via spirometry and stable clinical status will be included. Exclusion criteria are other chronic respiratory diseases, neuromuscular diseases, or obesity. Diaphragmatic ultrasonography and whole-body plethysmography will be performed on the patients. During deep inspiration and forceful expiration, the diaphragmatic thickness and thickening fraction will be measured. RV > upper limit of normal (ULN) indicates lung hyperinflation. Pearson's or Spearman's correlation will be used to assess relationships between plethysmographic parameters and diaphragmatic ultrasound results. Diaphragmatic ultrasonography's diagnostic thershold for hyperinflation will be determined using ROC (receiver operating characteristic) curves.

If proven effective, diaphragmatic ultrasound could be a practical and cost-effective alternative to plethysmography for diagnosing hyperinflation in COPD.

Respiratory viruses are common causes of upper and lower respiratory tract illness and can also result in hospitalization and death. CDC conducts national surveillance using multiple systems to monitor ongoing and seasonal changes in the activity of selected respiratory viruses. This report summarizes U.S. trends in endemic respiratory virus activity during July 2024-June 2025. For SARS-CoV-2 and respiratory syncytial virus (RSV), national and regional trends; population-based hospitalization rates; vital records death counts; and preliminary estimates of associated illnesses, outpatient visits, hospitalizations, and deaths are described, as well as genetic characterization of circulating SARS-CoV-2 viruses. Some viruses, including SARS-CoV-2, showed bimodal peaks in positive laboratory test results, whereas others, including RSV and influenza viruses, were characterized by a single peak. The highest COVID-19-associated hospitalization rates were reported among adults aged ≥75 years (932.6 per 100,000 persons), infants aged <6 months (285.6), and adults aged 65-74 years (274.4). RSV-associated hospitalization rates were highest among infants aged <12 months (1,116.7 per 100,000; 95% CI = 1,078.4-1,157.9), children aged 12-23 months (770.6; 95% CI = 743.1-800.3), and adults aged ≥75 years (426.9; 95% CI = 366.6-510.8). COVID-19 was associated with an estimated 290,000-450,000 hospitalizations and 34,000-53,000 deaths; RSV was associated with 190,000-350,000 hospitalizations and 10,000-23,000 deaths. All circulating SARS-CoV-2 lineages were Omicron JN.1 descendants. Staying up to date with recommended COVID-19, RSV, and influenza vaccinations remains important to reducing the risk for severe disease caused by these viruses.

In randomized trials, early prophylactic hydrocortisone improved survival without bronchopulmonary dysplasia (BPD) with few adverse effects in extremely preterm infants. Large scale implementation data are needed to evaluate clinical effects and safety.

To examine the association between early prophylactic hydrocortisone and survival without BPD at 36 weeks' postmenstrual age (PMA) in extremely preterm infants in Sweden after guideline implementation and to assess treatment safety.

A national historical cohort study with prospectively collected data from the Swedish Neonatal Quality register from 4 Swedish centers where hydrocortisone prophylaxis was implemented. The study included infants born between 22 and 27 weeks' gestation between 2018 and 2023. Infants were divided into exposed and nonexposed groups according to the intention-to-treat principle.

Hydrocortisone, 1 mg/kg/d, for the first 7 days of life, followed by 0.5 mg/kg/d from days 8 through 10.

The primary outcome was survival without BPD at 36 weeks' PMA. A predefined statistical analysis plan with logistic regression was used to calculate unadjusted and adjusted odds ratios.

Among 1106 infants (median [IQR] gestational age, 25 weeks, 6 days [24 weeks, 3 days to 27 weeks]; median [IQR] birth weight, 780 [610-964] g), 474 received hydrocortisone prophylaxis and 632 did not. Survival without BPD occurred in 154 of 474 exposed (32.5%) and 185 of 632 nonexposed (29.3%) infants (adjusted odds ratio, 1.62; 95% CI, 1.16-2.27). BPD occurred in 233 exposed (49.2%) and 345 nonexposed (54.6%) infants (adjusted odds ratio, 0.65; 95% CI, 0.49-0.86). Death before 36 weeks' PMA occurred in 87 exposed (18.4%) and 102 nonexposed (16.1%) infants. Late-onset bacterial infection was more common in exposed infants, but not significant after adjustment. No other severe neonatal morbidities differed significantly between the 2 groups.

In this cohort study of extremely preterm infants, the introduction of prophylactic hydrocortisone was associated with increased survival without BPD, after adjusting for covariates. There was no significant increase in severe neonatal morbidities, except that late-onset bacterial infection was more common in the exposed group before adjustments.

Granulomatosis with polyangiitis (GPA), a subtype of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), is a systemic inflammatory disease that typically affects the respiratory tract and kidneys. However, atypical pancreatic manifestations have been reported, which may present clinically as acute pancreatitis or exocrine insufficiency, and radiologically as pancreatic enlargement or pseudotumour.A female in her 40s presented with nasal crusting and epistaxis. She subsequently developed fever, weight loss, haemoptysis, bilateral pulmonary nodules and a pancreatic tail mass. Pancreatic biopsy revealed caseating granulomatous inflammation, and antitubercular therapy was commenced.On developing haematuria and proteinuria, proteinase 3-ANCA testing and renal biopsy confirmed AAV. Treatment with rituximab and high-dose corticosteroids led to clinical improvement and radiological regression of both pulmonary and pancreatic lesions, consistent with systemic GPA involvement.This case highlights the importance of considering systemic inflammatory disease, alongside infective and malignant aetiologies, when evaluating pancreatic masses or focal pancreatitis with constitutional symptoms and multiorgan involvement.

Chimeric antigen receptor (CAR) T-cell therapy has transformed treatment of hematologic malignancies but causes profound immune dysfunction and a high infections risk. Real-world data on infection incidence and economic burden remain limited.

To characterize the incidence, recurrence, timing, and types of infections after CAR T-cell therapy and estimate infection-related clinic visits, hospitalizations, and patient out-of-pocket (OOP) costs.

This retrospective cohort study used Merative MarketScan Commercial Claims Database (2017-2022). Adults (≥18 years) receiving CAR T-cell therapy for hematologic malignancies were included. Infections were identified via International Classification of Diseases, Tenth Revision (ICD-10) codes and classified by pathogen (bacterial, viral, fungal, unspecified) and organ system. Infections were examined across post-infusion intervals (<30, 30-90, and >90 days) and incidence rates were reported per 100 patient-years. Bivariate analyses compared baseline characteristics by infection status. Infection-related outpatient visits, hospitalizations, length of stay (LOS), and OOP costs were evaluated.

Of 378 eligible patients, 213 (56%) developed ≥1 infection (289 events). Respiratory predominated the most common (34%). Overall incidence was 122 per 100 patient-years, peaking at 609 per 100 patient-years in days 30-90. Incidence differed significantly by hematologic malignancy subtype. Recurrent infections occurred in 157 patients (42%), totaling 1,373 distinct events (median 4 per patient; IQR, 2-11) with respiratory tract infections also being the most common (30%). The median time from the first to recurrent infection was 24 days (IQR, 4-69). Recurrence varied significantly by malignancy subtype and patient age. A total of 127 patients (34%) had 447 infection-related outpatient visits, and 67 patients (18%) had 95 infection-related hospitalizations. Median LOS was 7 days (IQR, 3-14). Total OOP costs were approximately $7,800 for outpatient visits and $35,000 for hospitalizations.

Infections are common, recurrent, and burdensome after CAR T-cell therapy, driving substantial healthcare utilization and OOP costs. Risk-stratified prophylaxis and management strategies are needed throughout the treatment continuum.