The AIRBAg study was designed to assess the prevalence of chronic obstructive pulmonary disease (COPD) in dairy farmers and to define its associated risk factors.
Between March 2012 and February 2017 ...randomly selected dairy farmers in the French region of Brittany were asked to complete a self-administered questionnaire and undergo an occupational health check-up with electronic mini-spirometry and standard spirometry. Those having one or more of the following features: chronic cough, chronic bronchitis, wheezing, dyspnea and/or a ratio FEV1/FEV6 < 80% were then referred to a pulmonologist for further check-up including spirometry with a reversibility test. Each COPD case was matched with three controls (dairy farmers and non-farm employees), for sex and age ( ± 5 years). Conditional multivariate logistic regression models were used to estimate the odds ratios between COPD occurrence and various risk factors.
The 1203 farmers examined included 525 (43.6%) who were "at risk of bronchial obstruction" and 432 (35.9%) of these saw the pulmonologist. This screening identified 16 (1.3%) cases of COPD, including eight non-smokers and five with an FEV1 < 80% of predicted values. Their average age was 54.6 ( ± 7.7) years and 10 of them were men. None complained of illness before the study. Multivariate analyses revealed no significant occupational risk factors for COPD.
This unexpected result may be because Breton dairy farms began to modernize early (1950s), giving rise to conditions with much lower exposure to airborne contaminants.
•Occupational exposure could be involved in the pathophysiology of COPD.•A total of 1203 dairy farmers (Brittany, France) were screened for COPD.•Risk factors were identified by comparing COPD cases with two control populations.•Multivariate analyses revealed no significant occupational risk factors for COPD.•Farm modernization from 1950 onwards could explain this unexpected result.
Contexte : L’examen écrit de pneumologie des étudiants de deuxième année du deuxième cycle des études médicales (DCEM2) à la faculté de médecine de Rennes est constitué d’un cas clinique (CC). But : ...L’introduction des tests de concordance de script (TCS), qui mesurent l’interprétation des données cliniques en contexte d’incertitude, pourrait améliorer l’évaluation du raisonnement clinique des étudiants. Matériel et méthodes : Les étudiants du deuxième semestre de DCEM2 (n = 85) ont été évalués par un CC (2/3 du score) associé à 20 items de TCS (1/3 du score). La fidélité des TCS a été évaluée par le coefficient α de Cronbach. Les scores des étudiants du CC et des TCS ont été corrélés (test de Spearman). Le degré d’organisation des réponses au CC a été évalué. Résultats : Le coefficient α de Cronbach était de 0,35 pour les étudiants. Les scores des étudiants aux TCS étaient significativement corrélés à ceux du CC (r = 0,304, p = 0,005). Les étudiants avec de bons scores aux TCS avaient des réponses au CC plus hiérarchisées et plus ordonnées que les étudiants avec de mauvais scores aux TCS qui avaient tendance à écrire des réponses plus longue avec une hiérarchisation absente ou plus floue (évaluation qualitative globale). Les étudiants aux réponses les plus hiérarchisées avaient des notes plus élevées comparés aux copies les moins hiérarchisées : 16,3 versus 11,8 (p < 0,0001) pour les CC et 12,5 versus 10,6 (p = 0,021) pour les TCS. Les TCS semblent toujours être bons chez les étudiants aux connaissances bien organisées. Les étudiants qui ont effectué leur stage pratique dans le service de pneumologie avaient un score moyen aux TCS supérieur à ceux qui n’étaient pas passés dans le service : 12,6 versus 11,3, p = 0,008. Cette différence n’était pas retrouvée pour le CC. Conclusions : Il semble que l’introduction des TCS améliore l’évaluation du raisonnement clinique des étudiants de DCEM2 lors de l'examen écrit de pneumologie en association avec le CC.
Context: The written examination for respiratory medicine students (DCEM2) in the 4th year at Rennes university medical school is made up of a clinical case (CC). Goal: The introduction of script concordance tests (SCT) could enhance the assessment of students’ clinical reasoning. Material and methods: During the 2nd term, DCEM2 students (n = 85) were assessed using a CC (2/3 of score) and 20 SCT items (1/3 of the score). Reliability was determined by a Cronbach coefficient computation. The students’ results on CC and SCT were established using a Spearman rank correlation test. The organization of CC answers was assessed. Results: Cronbach α coefficient was 0.35 for the students. Student scores in SCT were significantly correlated to the results in CC (r = 0.304, p = 0.005). The students with good scores in SCT had shorter and more organized answers to the CC than students with poor scores in SCT who tended to have longer and less organized answers to the CC (qualitative global assessment). Students with highly organized CC answers had better scores compared to those with poorly organized scripts: 16.3 versus 11.8 (p < 0.0001) for CC and 12.5 versus 10.6 (p = 0.021) for SCT. Students with highly organized knowledge seem to always have good results with SCT. Mean SCT score for students who worked in the respiratory department was significantly higher than that of students who had not worked in the ward: 12.6 versus 11.3, p = 0.008. This difference was not demonstrated with the CC. Conclusions: In our opinion, SCT associated to CC seems to enhance the clinical learning assessment of DCEM2 students in their written examination for respiratory medicine.
La protéinose alvéolaire pulmonaire Jouneau, S.; Kerjouan, M.; Briens, E. ...
Revue des maladies respiratoires,
December 2014, Volume:
31, Issue:
10
Journal Article
Peer reviewed
Open access
La protéinose alvéolaire pulmonaire (PAP) est une maladie rare caractérisée par l’accumulation alvéolaire de composants du surfactant qui gêne les échanges gazeux. Les PAP sont séparées en trois ...groupes : les PAP auto-immunes caractérisées par la présence d’anticorps sériques anti-GM-CSF qui sont les plus fréquentes ; les PAP secondaires à une maladie sous-jacente, le plus souvent hématologique, mais aussi à l’inhalation de toxiques et à des infections ; enfin, les PAP d’origine génétique. Le diagnostic de PAP est évoqué sur le scanner thoracique avec une pneumopathie infiltrante diffuse ayant un aspect classique de crazy paving, puis confirmé par l’aspect laiteux du lavage bronchoalvéolaire, et la présence de matériel lipoprotéinacé PAS positif. La confirmation du diagnostic de PAP par biopsie pulmonaire chirurgicale est désormais rarement nécessaire. La positivité des anticorps sériques anti-GM-CSF signe le caractère auto-immun de la maladie. Le traitement de référence des PAP auto-immunes est le « grand lavage pulmonaire thérapeutique ». En cas de maladie réfractaire, d’autres traitements sont disponibles, tels que le GM-CSF en injection sous-cutanée ou en aérosol et le rituximab. L’évolution de la maladie est imprévisible. Une évolution spontanément favorable ou même une guérison spontanée peuvent survenir et la survie actuarielle à 5ans est de 95 %. Les principales complications sont infectieuses.
Alveolar proteinosis (AP) is a rare disease characterized by alveolar accumulation of surfactant components, which impairs gas exchange. AP is classified into three groups: auto-immune AP defined by the presence of plasma autoantibodies anti-GM-CSF, the most frequent form (90 % of all AP); secondary AP, mainly occurring as a consequence of haematological diseases, or following on from toxic inhalation or infections, and genetic AP, which affects almost exclusively children. AP diagnosis is suspected where chest CT-scan demonstrates interstitial lung disease with a crazy paving aspect; and confirmed by bronchoalveolar lavage, which has a milky appearance and contains periodic acid Schiff positive proteinaceous alveolar deposits. The use of surgical lung biopsy to confirm AP is less frequent nowadays. In this context, positive antibodies against GM-CSF indicates an auto-immune etiology of the AP. Concerning management, whole lung lavage is the gold standard therapy. In refractory AP, new treatments are available such as subcutaneous or inhaled GM-CSF supplementation, or rituximab infusions. The clinical course is unpredictable. Spontaneous improvement or even cure can occur, and the 5-year actuarial survival is 95 %. The most frequent complications are infectious etiology.
We report a case of idiopathic aneurysm of the azygos vein associated with lung cancer. This abnormality is exceptional because we could find only 8 previous published cases. Computed tomographic ...scan and especially transesophageal echography were of major importance in identifying the vascular nature of the radiographic abnormality and thus excluding extension of lung cancer.
Highlights • EGFR-mutated lung adenocarcinoma belongs to the spectrum of predisposed neoplasms in LFS. • We provide the first description of resistance mutation to EGFR-TKI in a patient with LFS and ...lung adenocarcinoma. • Response to targeted therapy may benefit to the same extent to LFS patient as in the general population.
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