The standard treatment for superficial vesical tumors is transurethral resection (TUR) followed by intravesical instillation of Bacillus Calmette and Guérin (BCG). Pulmonary complications of BCG-therapy are rare but could be life threatening. We report the case of a 54-year-old patient who received BCG-therapy after TUR. After the sixth session of BCG instillations, the patient was diagnosed with a miliary tuberculosis secondary to BCG-therapy. We observed a progressive clinical and radiological improvement under specific tuberculosis treatment. Early diagnosis of pulmonary side effects of BCG-therapy and prompt treatment are the keys to complete recovery and survival.

Background: Myocardial involvement mediated by chronic obstructive pulmonary disease (COPD) is a common cause of morbidity and mortality. Conventional transthoracic echocardiography (TTE) parameters are poor in the detection of subclinical myocardial dysfunction.Aim: To investigate the contribution of strain in the early detection of cardiac damage in clinically stable COPD patients.Methods: This was a comparative study between COPD patients (classified A or B) with normal and reduced right ventricle (RV) strain. The COPD assessment test (e.g., CAT score), spirometry [e.g., forced expiratory volume in 1 s (FEV₁, L)], 6 min walk test [e.g., 6 min walk distance (6MWD, m)], and both conventional TTE [i.e., left ventricular ejection fraction (LVEF), right atrium (RA), RV, left ventricle global longitudinal strain (LV GLS)], and strain (e.g., impaired RV strain is > −19), were performed.Results: Eighty COPD patients [mean ± standard deviation (SD): age = 66 ± 9 years, LVEF = 60.1 ± 5%, RA = 25 ± 7%, RV = −19.9 ± 3.7%, LV GLS v −21.1 ± 2, and 48% had impaired RV strain] were included. Compared to COPD patient with normal RV strain, those with reduced RV strain had (i) Lower 6MWD (310 ± 113 vs 470 ± 104 m; p = 0.001), (ii) Lower FEV₁ (1.63 ± 0.73 vs 2.18 ± 0.41 L; p = 0.012), and (iii) Higher CAT score (21 ± 10 vs 13 ± 6; p = 0.012). An impaired RV strain was associated with a higher risk of hospitalizations for acute exacerbation in the post inclusion year, (respectively for 55% and 25%; p = 0.024). No death was recorded during the study period.Conclusion: Group A and B COPD patients having normal conventional TTE parameters, speckle tracking is a key parameter in the detection of subclinical myocardial dysfunction.

COPD is a major public health problem due to its high morbidity and mortality. The evolution of COPD is marked by the occurrence of acute exacerbations (AECOPD). One of the major causes of AECOPD is non-adherence treatment. Telemedicine is an accessible educational tool that can help physicians to provide continuous, accessible educational support and monitoring for patients with COPD. Objectives: This study aimed to determine the impact of therapeutic education via phone-based telemedicine on ED visits and/or hospitalizations for AECOPD. Methods: This is a randomized controlled trial carried out in the emergency department (ED) of Fattouma Bourguiba Monastir over a period of 7 consecutive months, including patients admitted with a final diagnosis of AECOPD. Patients were randomly assigned to receive standard care (STD) or weekly phone-based telemonitoring (TLM). Outcomes (exacerbation and the need for hospitalization for AECOPD) were assessed at a 1-, 3-, and 6-month follow-up after being discharged from the hospital. Results: We included 163 patients (57 patients in the TLM group and 106 patients in the STD group). The mean age of the study population was 66.5 ± 12.5 years. The TLM group exhibited a significantly lower risk of ED visits for AECOPD compared to the STD group, with an odds ratio of 0.13 (95% CI: 0.04–0.40) and a p-value ≤ 0.001. Additionally, the TLM group had a notably lower hospitalization rate for AECOPD compared to the control group (15.8% vs. 44.3%, respectively), with an odds ratio of 0.23 (95% CI: 0.10–0.52) and a p-value < 0.001. The all-cause death rate was also lower in the TLM group at the 6-month follow-up. Conclusions: Telemedicine represents an innovative approach that could improve the management of patients with COPD.

Elghali M, et al. Clin Exp Vaccine Res. 2025 Jul;14:e34. https://doi.org/10.7774/cevr.2025.14.e34

Cardiac metastases are rare. Herein, we report a case of a 37-year-old female patient with a history of borderline breast phyllodes tumor (PT) treated by surgery, admitted to our department for concomitant cardiac and pulmonary metastases of malignant PT. Cardiac metastasis occurred through direct extension from pulmonary metastasis to the left atrium via the right inferior pulmonary vein, causing severe mitral valve obstruction. Although the total surgical removal of metastases, the patient had a huge relapse of the mediastinal metastasis resulting in her death.