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   Table of Contents - Current issue
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July-September 2017
Volume 11 | Issue 3
Page Nos. 173-292

Online since Monday, July 24, 2017

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REVIEW ARTICLE  

Noninvasive ventilation series Highly accessed article p. 173
Khaled Hussein
DOI:10.4103/ejb.ejb_16_17  
NIV is rapidly gaining acceptance around the world as the preferred choice of treatment over invasive ventilation. These series discussing several titles upon daily practice on NIV which be detailed in every section.
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ORIGINAL ARTICLE - INTERSTITIAL LUNG DISEASES Top

Transthoracic ultrasonographic features of diffuse parenchymal lung diseases p. 179
Taghreed S Farag, Zeinab R Adawy, Lobna K Sakr, Hanaa S Abdellateef
DOI:10.4103/ejb.ejb_3_17  
Objectives The value of transthoracic ultrasonography (TTUS) in diffuse parenchymal lung disease (DPLD) has not been established yet. This prospective study was conducted to assess pleural and parenchymal alterations in patients with DPLD by TTUS and to compare the results with chest high-resolution computed tomography (HRCT). The results of TTUS were compared with some arterial blood gas (ABG) parameters and 6-min walk test (6MWT). Patients and methods This study was conducted on 50 patients. All patients underwent HRCT, resting ABGs, and 6MWT, in addition to TTUS to evaluate (a) the presence and number of B-line and distance between them, (b) pleural effusion, (c) pleural thickening, (d) an irregular, fragmented pleural line, and (e) subpleural alterations. Results The studied group showed female predominance, wide range of age, and most of them were nonsmokers. All patients had diffuse bilateral B-lines. B-line numbers were inversely correlated with severity of pulmonary fibrosis detected by HRCT modified Warrick score; however, distance between B-lines was directly correlated with severity of pulmonary fibrosis. Some ABGs (resting PaO2, resting SpO2%, AaDO2) and 6MWT parameters were correlated with B-line number and distance between them. As detected by TTUS, the majority of patients (82%) had irregular thickened pleural line, whereas 44% of them had absent lung sliding. Conclusion TTUS can play a complementary role in the diagnosis and monitoring of DPLD patients. Multiple B-lines distributed over the entire lung surface in combination with a thickened, irregular, and fragmented pleural line are strongly suggestive of the presence of DPLD. TTUS gives an idea about diffuse or limited, early, or advanced DPLD.
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ORIGINAL ARTICLES - AIRWAY DISEASES Top

Risk factors of chronic obstructive pulmonary disease among rural women, Chittagong, Bangladesh Highly accessed article p. 188
Rajat S.R. Biswas, Fazlee K Chowdhury
DOI:10.4103/1687-8426.211395  
Background There are different risk factors for chronic obstructive pulmonary disease (COPD). Village women of developing countries such as Bangladesh are at a risk of COPD. Aim The present study was aimed to find risk factors of COPD among rural women of Bangladesh. Patients and methods This observational study was conducted in different villages of Chittagong, Bangladesh, among 250 women who were exposed to different risk factors of COPD Women aged over 40 years were given a questionnaire adopted from a previous prevalence study of COPD in Bangladesh. Spirometry was performed in all subjects. A postbronchodilator ratio of the forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) was calculated among all women who had FEV1/FVC ratio less than 0.70. Women having postbronchodilator FEV1/FVC ratio less than 0.70 were diagnosed to have COPD (GOLD criteria). After collection, all data were analyzed by SPSS-20. Results Overall prevalence of COPD in rural women aged over 40 years was 20.4%. Most (76.9%) of them who did not have COPD were in the age group of 40–49 years and those who had COPD were in the age group of 60–69 years (51.0%). A majority (60%) of the women were poorly educated or not educated. Most women were housewives (86.4%). FEV1/FVC ratio significantly reduced in relation with different risk factors of COPD. Multinomial logistic regression analysis showed that respiratory distress in family members [odds ratio (OR)=0.633], nature of kitchen (1.206), seasonal variation in cooking (OR=1.245), cough in childhood (OR=0.336), tobacco chewing habit (OR=12.491), type of stove (OR=0.191), history of cough (OR=0.130), and life-time smoking history (OR=0.376) influenced the development of COPD. Lung function also was significantly reduced (P<0.05) among women who were using biomass compared with those using cleaner fuels such as natural gas/liquid petroleum gas. Conclusion In the living conditions existing in the rural areas of Chittagong, Bangladesh, biomass smoke pollution, smoking, and cooking habits are some important risk factors of COPD in rural Bangladesh.
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Assessment of prescription practices according to international chronic obstructive pulmonary disease guidelines on Egyptian doctors p. 193
Nasr H Kahlil, Hossam M Abdel-Hamid, Yasser M Mohammed
DOI:10.4103/ejb.ejb_75_16  
Background and objectives Chronic obstructive pulmonary disease (COPD) is defined as ‘a preventable and treatable disease with some significant extrapulmonary effects that may contribute to the severity in individual patients’. Its pulmonary component is characterized by airflow limitation that is not fully reversible. There is a wide variation in physicians’ management of the condition, and this may be ascribed to nonadherence to the guidelines. Adherence to COPD guidelines in clinical practice in most countries is not satisfactory. Aim The aim of this work is to assess the prescription pattern and clinical practice attitudes toward Egyptian COPD patients managed by chest physicians and internal medicine physicians in Abbassia Chest Hospital and Ain Shams University Hospitals during the period from February 2013 to January 2014. Patients and methods In this study, one questionnaire was specifically directed to physicians. Sixty doctors were at Abbassia Chest Hospital, 63 at Ain Shams University Hospitals, and six doctors at Ministry Hospitals. Doctors were chest residents (29.5%), chest physicians with masters degree (33.3%), chest physicians with MD (13.2%), or internal medicine doctors (34%). Results Only 53 physicians performed spirometry. Most of the physicians prescribed antibiotics and systemic steroids to their patients in exacerbations. Macrolides, cephalosporins, and quinolones were the most commonly prescribed antibiotics by physicians in COPD exacerbations. Only 46 physicians used noninvasive ventilation in hypercapnic respiratory failure. Only 33 physicians were following GOLD 2013 guidelines. Conclusion Doctors’ awareness of guidelines is suboptimal; major deviations from the GOLD guidelines were in the form of underuse of spirometry, smoke cessation programs, and of noninvasive ventilation in exacerbations and lack of use of pulmonary rehabilitation treatment.
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Pattern of antiendothelial cell antibodies in patients with chronic obstructive pulmonary disease p. 203
Randa Salah Eldin Mohamed, Mahmoud Mohamed Elbatanony, Abeer Salah Eldin Mohamed, Sherif Elhadary
DOI:10.4103/1687-8426.203801  
Background Autoimmune mechanisms have been recently recognized as being partly involved in the pathogenesis of chronic obstructive pulmonary disease (COPD). Circulating autoantibodies have been detected in patients with COPD. Objectives The aim of this study was to estimate the level of antiendothelial cell antibodies (AECA) in COPD patients in the various GOLD stages. Patients and methods A comparative study assessed the level of AECA in three groups. COPD patients without cor pulmonale (18), with cor pulmonale (12), and the control group (10), from Beni-Suef University Hospital. Each group underwent background questionnaires and BMI measures. Enzyme-linked immunosorbent assay was used to measure the level of AECA in serum (ng/ml). Right ventricular systolic pressure (mm Hg) was measured in COPD patients with cor pulmonale. Results The studied groups consisted of male patients (age: 50–80 years). BMI was significantly lower (20.36) in the COPD group with cor pulmonale. Spirometry forced expiratory volume and forced expiratory volume/forced vital capacity ratios showed significantly lower levels among the COPD patients without cor pulmonale. AECA showed a lower level in the control group (26.25) compared with the COPD without cor pulmonale (57.87) and much lowered when compared to cor pulmonale group (71.47). The level of AECD was higher in the patients in third (74.78) and fourth stages (79.10) compared with those in the second stage (58.75). Conclusion There is a much higher level of AECA in COPD patients with cor pulmonale and in advanced stages in comparison with patients without cor pulmonale and at early stages, and a significant positive correlation was found between AECA levels and right ventricular systolic pressure.
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ORIGINAL ARTICLE - INTERVENTIONAL PULMONOLOGY Top

Use of a small bore pleural catheter in the management of patients with malignant pleural effusion p. 209
Mohamed A Farrag, Samar H Sharkawy, Haytham S Diab, Dina R Abd El Sadek
DOI:10.4103/ejb.ejb_21_17  
Background Malignant pleural effusions (MPEs) can produce significant respiratory symptoms and decreased quality of life in patients with terminal malignancies; palliation of respiratory symptoms can be performed by several different approaches, but a minimally invasive procedure to provide relief of respiratory symptoms would be optimal. Objective This study aimed to evaluate the usage of a small bore catheter in outpatients as an alternative, effective, and safe method to the traditionally large bore chest tube in the management of MPE. Patients and methods Fifty patients with MPE were grouped randomly into two groups according to the method of drainage. Results The results showed that there were significant statistical differences in the results of both groups as the duration of catheter was 4 (3–5) days to 11 (10–10.25) days in the chest tube group; the cost of hospital and medication was 780±1400 LE in the pleural catheter group, whereas in the chest tube group, it was 11 520±1895.61 LE and the total cost was 5520±17 600 in the pleural catheter group and 14 020.00±1895.61 LE in the chest tube group. The modified Borg scale for dyspnea after insertion showed a 43% improvement in dyspnea in the small bore pleural catheter group compared with 41% in the chest tube group. Conclusion On the basis of the results of this study and other studies, we conclude that a small bore catheter is as effective and safe as a large bore chest tube in the treatment of MPEs and use in the outpatient clinic led to few complications.
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ORIGINAL ARTICLES - CRITICAL CARE Top

Effectiveness and safety of noninvasive positive-pressure ventilation in hypercapnia respiratory failure secondary to acute exacerbation of chronic obstructive pulmonary disease p. 215
Ali O Abdel Aziz, Islam M Abdel El Bary, Mohammad T Abdel Fattah, Mohamd A Magdy, Ashraf M Osman
DOI:10.4103/1687-8426.211398  
Background Patients with acute respiratory acidosis caused by an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) constitute the group that benefits most from noninvasive positive-pressure ventilation (NIPPV). However, there are some patients who do not respond to NIPPV. Studies from the west report variable failure rates. Delays in recognizing nonresponders can increase hospital morbidity and mortality. Objective The aim of this study was to assess the effectiveness and safety of NIPPV in patients with acute hypercapnia respiratory failure (AHRF) secondary to AECOPD. Patients and methods This was a prospective observational study of 119 consecutive chronic obstructive pulmonary disease patients who were admitted with a diagnosis of AHRF and in whom NIPPV was applied. Results The overall success rate of NIPPV in the studied group was 94%. Mortality and duration of hospitalization were significantly higher in the failure group (P=0.0001 and 0.002, respectively). The most encountered complications were air leak (29%) and mask discomfort (24%). Comparison between the success and the failure group at the time of hospital admission revealed that the failure group was associated with old age (P=0.043), low hemoglobin (Hb) (P=0.037), low albumin (0.017), lower Glasgow Coma Scale (GCS) score (P=0.0001), higher Acute Physiology and Chronic Health Evaluation II (APACHE II) score (P=0.001), higher heart rate (P=0.002), lower systolic blood pressure (SBP) (P=0.013), lower diastolic blood pressure (DBP) (P=0.034), and higher white blood cells (WBCs) (P=0.0001). Multiple regression analysis identified age more than 65 years, respiratory rate 35 or more, pH less than 7.26, and WBCs more than or equal to 20 000 or less than 4000 as significant independent predictors of NIPPV failure in our patients. Conclusion NIPPV is an effective and safe modality for treating patients with AHRF secondary to AECOPD. Widespread availability and training of medical staff in the use of NIPPV is recommended.
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Comparison between the effect of heated and humidified high-flow nasal oxygen and conventional oxygen during acute hypoxemic respiratory failure p. 224
Ghada A Attia, Adel S Bediwy, Radwa M Ashour
DOI:10.4103/1687-8426.211399  
Background Hypoxemia is the most serious threat to organ function. Therefore, the goal is to reverse tissue hypoxia. The aim of this study was to compare heated and humidified high-flow nasal cannula (HFNC) with conventional low-flow nasal cannula (LFNC) oxygen therapy in acute hypoxemic respiratory failure (RF). Patients and methods This prospective study was conducted on 60 patients with acute hypoxemic RF. Patients were randomly classified into two groups. Group I received LFNC oxygen therapy. Group II received heated humidified HFNC oxygen therapy. Comparison between the two groups was made using dyspnea scales, heart rate, respiratory rate, and oxygenation status. Results There were no statistically significant differences as regards age, sex, smoking status, causes of RF, and presence of comorbidities between the two groups. There was no statistically significant difference in the modified Borg scale and visual analog scale (VAS) score between the two groups at baseline (P>0.05). After 24 h, the HFNC group had a significant decrease in these scores (P<0.05). Respiratory rate and heart rate significantly decreased, whereas arterial oxygen saturation and tension increased significantly in the HFNC group compared with the conventional LFNC group (P<0.05). Only one patient in the HFNC group versus three patients in the LFNC group required mechanical ventilation. Two patients experienced nasal discomfort in the HFNC group versus five patients in the LFNC group. Conclusion Treatment of acute hypoxemic RF with HFNC was associated with better and rapid improvement in oxygenation when compared with LFNC, with fewer side effects, better convenience, and lesser need for mechanical ventilation.
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Average volume-assured pressure support ventilation mode in the management of acute hypercapnic respiratory failure Highly accessed article p. 231
Ashraf Zin El-Abdin, Lamiaa H Shaaban, Shereen Farghaly, Sarah Hashim
DOI:10.4103/1687-8426.203802  
Background Although average volume-assured pressure support (AVAPS) mode has been studied in chronic respiratory failure, studies evaluating its efficacy in acute hypercapnic respiratory failure (AHRF) are limited. Objective The aim of this study was to investigate the benefits of spontaneous timed AVAPS (ST/AVAPS) mode in delivering noninvasive ventilation (NIV) for patients with AHRF compared with the conventional ST/BiPAP (ResMED, San Diego, California, USA) mode.
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ORIGINAL ARTICLES - INTERVENTIONAL PULMONOLOGY Top

The role of endobronchial ultrasound elastography in the diagnosis of mediastinal lymph nodes p. 238
Adel S Bediwy, Mohamed S Hantira, Dalia El Sharawy, Ayman El Saqa
DOI:10.4103/ejb.ejb_4_17  
Background Endobronchial ultrasound (EBUS) has become a powerful tool for the diagnosis of mediastinal and hilar lymph nodes (LNs). Elastography has been introduced recently to provide more accurate data about the lesions seen during EBUS. Aim The aim of this study was to evaluate the role of elastography during EBUS for the diagnosis of hilar and mediastinal LN. Patients and methods We carried out a prospective, cross-sectional study. Patients with hilar/mediastinal LN enlargement on computed tomography examination were included. Convex probe EBUS was performed using conventional B-mode and elastography with transbronchial needle aspiration from the examined LN. All data are presented as mean±SD. Receiver operating characteristic analysis was carried out to find the relative sensitivity and specificity of EBUS elastography and to compare the results with other B-mode findings such as mediastinal LNs. Results A total of 147 LNs from 56 patients were examined. Malignancy was found in 111 of them. The strain ratio was found to be more accurate when compared with other findings of B-mode when comparing malignant and benign LNs with a cut-off value of 7.5, giving a sensitivity of 95.5% and a specificity of 91.67%. About 63% of malignant LNs were diagnosed from the first pass with the help of elastography. Conclusion Elastography is a very helpful tool for diagnosing mediastinal LNs with a strain ratio above 7.5, having a strong suggestion of malignancy. Elastography can help in directing the needle during EBUS-transbronchial needle aspiration to reach the final diagnosis with the least possible number of passes and avoiding unnecessary punctures (ClinicalTrials.gov Identifier: NCT02724059).
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Bronchoscopic instillation of tranexamic acid to control bronchopulmonary bleeding p. 244
Emad El-Din A Korraa, Ashraf M Madkour, Iman H Galal, Ibrahim M Ibrahim El-Saidy
DOI:10.4103/ejb.ejb_27_17  
Background Tranexamic acid (TA), a potent antifibrinolytic agent, has the potency to stop bleeding in a variety of medical and surgical conditions. However, its role in controlling airway bleeding is not yet proven. This study aimed to evaluate the efficacy of endobronchial administration of TA in controlling bronchopulmonary bleeding. Materials and methods A prospective, comparative, observational study was carried out including 40 patients scheduled to undergo bronchoscopy. For management of hemoptysis or bronchoscopy-induced bleeding, patients were randomly subdivided into two groups of 20 patients each: the first group received endobronchial TA, whereas the second group received endobronchial cold saline±adrenaline. Results In the TA group, 19 patients were responders and only one patient was a nonresponder and was further managed with endobronchial adrenaline. All 20 patients of the cold saline±adrenaline group were responders. No significant statistical difference was found between both groups with regard to systolic and diastolic blood pressures, heart rate, and oxygen saturation either before or after bronchoscopy. However, heart rate significantly increased after bronchoscopy both in the first (P<0.001) and the second group (P=0.007). Systolic blood pressure increased significantly (P=0.001) after bronchoscopy in the second group only. The amount of bronchoscopy-induced bleeding as well as the time required for bronchoscopic hemostasis significantly and directly correlated with the dose of TA (r=0.535, P=0.015, and r=1.000, P<0.001, respectively) and cold saline±adrenaline (r=0.687, P=0.33, r=0.858, P<0.001, respectively). TA did not result in any intrabronchoscopic and postbronchoscopic drug-related complications in any of the patients. Conclusion Endobronchial installation of TA is an effective and safe modality of treatment for controlling nonlife-threatening bronchopulmonary bleeding.
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ORIGINAL ARTICLE - PLEURAL DISEASES Top

Swirling pattern in patients with exudative pleural effusion p. 250
Khaled Kamel, Raef H Emam, Amira I Almeldin, Yasmine H El Hinnawy
DOI:10.4103/ejb.ejb_65_16  
Objective Thoracic ultrasound is the gold-standard method for studying pleural effusions. It is more sensitive than chest radiography or computed tomography. Aim The aim of the paper was to determine whether the echogenic swirling pattern identifiable on real-time chest ultrasonographic images is a predictor of malignant pleural effusions. Design Medical records of patients undergoing chest ultrasonography in the Chest Department in Kasr Alaini Cairo University Hospital in the period from July 2013 to December 2014 were reviewed retrospectively. Patients with an echogenic swirling pattern in the pleural effusion, or with malignant diseases associated with pleural effusions, whose pleural fluids had been examined cytologically or whose pleural tissues had been examined pathologically, were enrolled in this study. A total of 45 patients were included. Malignant pleural effusions were diagnosed by the presence of malignant cells in the pleural fluid identified by pleural biopsy. The echogenic swirling pattern was defined as numerous echogenic floating particles within the pleural effusion, which swirled in response to respiratory movement or heartbeat. Results There was a statistically significant relation between the swirling sign and the diameter, type, and amount of pleural fluid, with P value of 0.001. There was no statistical significance between the swirling sign and each of the diagnosis, whether malignant or nonmalignant, malignant cases either primary or secondary malignancy, and side of effusion. Conclusion The presence of the swirling sign is related to the nature and amount of fluid and has no predilection to the diagnosis of the cause of pleural effusion.
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ORIGINAL ARTICLES - PULMONARY INFECTIONS Top

Detection of latent tuberculosis infection in hemodialysis patients: Comparison between the quantiferon-tuberculosis gold test and the tuberculin skin test p. 255
Mona T Hussein, Laila M Yousef, Ali T Ali
DOI:10.4103/ejb.ejb_19_17  
Background Tuberculosis (TB) remains an important cause of morbidity and mortality in hemodialysis (HD) patients. A gold standard for the diagnosis of latent tuberculosis infection (LTBI) is lacking. Objective The aim of this study was to compare the diagnostic utility of the QuantiFERON-Tuberculosis Gold (QFT-G) test with the tuberculin skin test (TST) in identifying LTBI in patients with end-stage renal disease (ESRD) on HD. Study design The present study had a prospective design. Patients and methods A total of 74 patients with ESRD on HD without active TB and other immunosuppressive conditions were tested for LTBI by the QFT-G test and the TST. Results LTBI, as estimated by the QFT-G test and TST, was detected in 35.1 and 13.5% of the HD patients, respectively; 37.8% of patients were positive for the QFT-G test and/or the TST. There was a poor agreement between QFT-G test and TST results in patients with ESRD on HD (QFT-G test vs. TST: κ=0.25, 95% confidence interval=0.12–0.37). TST was positive in 2.7% of patients when the QFT-G test was negative, and it was negative in 24.3% of patients when the QFT-G test was positive. There was no significant difference in duration of HD or creatinine levels between QFT-G-positive and QFT-G-negative patients (P=0.08 and 0.2, respectively). TST-positive patients had a significantly shorter duration of HD and lower creatinine levels than TST-negative patients (P=0.001 and 0.01, respectively). Conclusion In patients with ESRD and on HD, LTBI cannot be simply ruled out with a negative TST result, but rather a QFT-G test is recommended. Screening and treatment of LTBI should be carried in dialysis patients, aiming to prevent progression to active TB and secondary infection of others.
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Bedside inflammatory mediators in pulmonary tuberculosis p. 260
Samiaa H Sadek, Shereen Farghaly, Madleen A.A. Abdou, Mona H.M. Abdel-Rahim
DOI:10.4103/1687-8426.211402  
Background Monitoring of pulmonary tuberculosis (PTB) especially in poor countries is a major challenge aiming to find cheap valuable indices. Objective The objective of this study was to evaluate the use of simple laboratory parameters as complete blood count (CBC), especially platelet (PLT) indices, for assessment and monitoring of PTB activity. Patients and methods Totally, 140 PTB patients in addition to 30 healthy individuals as a control group were included in this case–control study. Patients were divided into three groups: 66 newly diagnosed active patients (group I), 39 patients after sputum and culture conversion (group II), and 35 patients defined as cured cases (group III). On the basis of chest radiography, only active PTB patients were classified into minimal, moderate, and far advanced cases. Laboratory parameters including CBC with PLT indices, erythrocyte sedimentation rate, and C-reactive protein (CRP) were performed for all enrolled participants. Results Compared with the control group, hemoglobin, mean PLT volume, and platelet distribution width (PDW) were significantly lower in group I and increased after treatment in groups II and III. On the other hand, PLT count, platelet crit %, CRP, and erythrocyte sedimentation rate were significantly higher in group I compared with the control group and decreased after treatment. In addition, there were significant correlations between CRP and all PLT indices. Regarding radiological extension, hemoglobin and mean PLT volume were significantly lower in far advanced PTB compared with both moderate and mild PTB, whereas PLT crit was significantly higher in moderate PTB compared with minimal PTB. Conclusion CBC, especially PLT indices, could be considered valuable cheap markers in assessment and monitoring of PTB activity.
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ORIGINAL ARTICLE - SLEEP DISORDERS Top

The prevalence of Helicobacter Pylori infection in patients with obstructive sleep apnea having metabolic syndrome and its relation to both disorders p. 268
Laila A.H. Banawan, Rasha G.A. Daabis, Wafaa H Elsheikh, Mona M Tolba, Amira M Youssef
DOI:10.4103/ejb.ejb_54_16  
Introduction Obstructive sleep apnea hypopnea syndrome (OSAHS) is a highly prevalent respiratory disorder and is associated with metabolic syndrome (MS). Helicobacter pylori (H. pylori) infection (Hp-I) may be involved in the pathogenesis of both obstructive sleep apnea (OSA) and gastroesophageal reflux disease (GERD); the latter is also associated with OSAHS. An association between Hp-I and OSA has been reported as well as a potential association between Hp-I and insulin resistance, which represents the pathogenetic basis of MS. Objective To study the prevalence of Hp-I in patients with OSAHS having MS and its relation to both OSAHS and MS and to asses GERD symptoms in the studied groups and its relation to the severity of OSA and to Hp-I. Patients and methods This study included 28 patients with confirmed OSAHS by overnight polysomnography, with half of them having MS. Demographic, comorbidities, anthropometric, and clinical data were collected. Stool analysis for H. pylori antigen was done. Results Patients with OSAHS with MS had significantly more severe OSA (P≤0.001*). The prevalence of both Hp-I and GERD was significantly higher in the MS group (P=0.023 and 0.018, respectively). GERD was significantly associated with H. pylori infection in the studied groups (P<0.001). The prevalence of Hp-I and GERD increased with the severity of OSAHS, but it did not reach statistical significance, as in patients with mild, moderate, and severe OSAHS, the prevalence of Hp-I and GERD was 16.7, 50, and 64.3%, respectively, and 12.5, 25, and 62.5%, respectively. Conclusion H. pylori infection can be considered as a potential confounder involved in OSAHS and GERD pathophysiology associated with MS.
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ORIGINAL ARTICLE - INTERVENTIONAL PULMONOLOGY Top

Utility of medical thoracoscopy in patients with undiagnosed pleural effusion in chest department in beni-suef university p. 276
Abeer S.E. Mohamed, Neveen M Amin, Mahmoud El-Batanouny
DOI:10.4103/ejb.ejb_87_16  
Introduction Pleural diseases involve the parietal and visceral pleura and may be of either inflammatory or malignant origin, with pleural effusions. Medical thoracoscopy (MT) is a procedure involving internal examination and biopsy of masses within the pleural and thoracic cavity. It is a valuable tool that enables a wide variety of diagnostic and therapeutic procedures. Aim The aim of this work was to assess the role of MT in patients with exudative undiagnosed pleural effusion. Patients and methods A total of 42 patients with undiagnosed exudative pleural effusion were admitted to Chest Department, Faculty of Medicine, Beni-Suef University. They were subjected to written informed consent,full history, clinical examination, sputum analysis, chest radiography, chest computed tomography, ECG, routine liver and kidney functions tests, complete blood count, coagulation profile, viral markers, and Tuberculin test. Diagnostic thoracentesis was done. The pleural fluid was subjected to testing for sugar, protein, lactate dehydrogenase, adenosine deaminase, cytopathology, Gram’s stain, and acid-fast bacilli smear and culture. Patients in whom the pleural effusion remained undiagnosed were subjected to MT. Results This study was applied on 42 patients with inconclusive cytological results: 20 were malignant (nine malignant pleural mesothelioma and 11 metastases), five had tuberculous pleurisy, eight had empyema, and nine had nonspecific pleurisy. Regarding pleural fluid cytological analysis, five cases were positive for atypical mesothelial cells. Conclusion MT is a valuable tool in the diagnosis of undiagnosed exudative pleural effusion. It is simple and safe, with high diagnostic yield and lower complication rates.
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ORIGINAL ARTICLE - PULMONARY FUNCTION TESTS Top

Pulmonary function tests in patients with chronic rhinosinusitis and the effect of surgery p. 283
Ahmad M Yousof, Osama G Awada, Mohammad T Abdel Fattah, Shehab F Ahmada
DOI:10.4103/ejb.ejb_91_16  
Objectives The aims of this study were to assess the pulmonary functions in patients with chronic rhinosinusitis (CRS) in comparison with normal individuals and also to assess whether surgical correction of these patients’ condition through endoscopic sinus surgery (ESS) will result in any change in their pulmonary function tests (PFTs). Patients and methods A prospective study of 50 patients (group I included 25 normal individuals and group II included 25 patients who fulfilled the clinical criteria for the CRS reference) was carried out. Demographic and clinical data were obtained; spirometry was performed for all the participants studied. Postoperative spirometry was carried out for patients with CRS after 1 month of the ESS operation. Results The majority of patients had a computed tomography score of 14 (11 cases). The most affected group of sinuses was the maxillary sinuses and the least affected group of sinuses was the sphenoid. There were significantly lower values of mean forced vital capacity (FVC), FVC%, forced expiratory volume in the first second (FEV1), and FEV1% in the group of patients with chronic sinusitis compared with the control healthy group. In the group of patients undergoing ESS for CRS, the mean values of FVC, FVC%, FEV1, and FEV1% were significantly higher during the postoperative follow-up period than preoperative PFTs. Conclusion PFT in patient with refractory chronic sinusitis is significantly lower than that in normal individuals and the improvement in their sinus condition can lead to an improvement in their PFT.
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CASE REPORT Top

Recurrent heart failure in pulmonary tuberculosis patients on antitubercular therapy: A case of protector turning predator! p. 288
Animesh Ray, Vivek Nangia, RS Chatterji, Navin Dalal, Ruchismita Satpathy Ray
DOI:10.4103/1687-8426.211400  
Anti-tubercular drugs are associated some common and uncommon adverse effects. We report the association between cardiomyopathy and the use of anti-tubercular drugs. In the two cases described in the case report the different causes of cardiomyopathy are ruled out leading to the diagnosis of drug induced cardiomyopathy. The report also throws light on the various aspects of this association and the clinical implications.
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Erratum: Complications and follow-up of foreign body inhalation p. 292

DOI:10.4103/1687-8426.211451  
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