Export selected to
Endnote
Reference Manager
Procite
Medlars Format
RefWorks Format
BibTex Format
   Table of Contents - Current issue
Coverpage
Special Issue 2019
Volume 13 | Issue 5 (Supplement)
Page Nos. 575-787

Online since Tuesday, January 21, 2020

Accessed 15,836 times.
View as eBookView issue as eBook
Access StatisticsIssue statistics
RSS FeedRSS
Hide all abstracts  Show selected abstracts  Export selected to  Add to my list
ORIGINAL ARTICLES - AIRWAY DISEASES  

Assessment of serum interleukin 6 level in patients with chronic obstructive pulmonary disease: is it related to disease severity? p. 575
Esmat A Abd Elnaby, Samah S Abd Elnaiem, Amira I Mostafa, Dina Sabry, Alshaimaa Rezk l R Alnaggar, Mohamed K Haswa
DOI:10.4103/ejb.ejb_50_19  
Background Chronic obstructive pulmonary disease (COPD) is a common disease that can be prevented and even treated. It leads to high morbidity and mortality rates. Pro-inflammatory cytokines and oxidative radicals were found to be implicated in COPD pathogenesis. Objectives To measure serum level of interleukin 6 (IL-6) in patients with stable COPD and also to detect the relationship of IL-6 levels with COPD severity. Patients and methods A total of 50 patients having stable COPD, in addition to 20 healthy control individuals, were included in the study. History taking and clinical examination, BMI calculation, spirometry (postbronchodilator spirometry in COPD group), and 6-min walk test were done for all patients. Measurement of serum level of IL-6 was done by using the enzyme-linked immunosorbent assay. Results Serum level of IL-6 showed significantly higher concentrations among patients with COPD compared with healthy individuals [359.87±106.99 and 188.92±77.97 pg/ml, respectively; P<0.001]. An inverse nonsignificant correlation was found between serum level of IL-6 and 6-min walk test distance, forced expiratory volume in the 1 s, forced vital capacity, and maximum expiratory flow 25–75% predicted values. Mean IL-6 level was higher in the patients with severe and very severe COPD (371.75±103.12 pg/ml) compared with those with mild and moderate COPD (336.82±113.72 pg/ml) (P=0.291). Conclusion Serum level of IL-6 showed significant higher concentrations in patients with COPD when compared with control ones, but IL-6 level did not show significant correlation with the disease severity.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Airway inflammatory biomarkers in different asthma phenotypes p. 580
Amal M Osman, Afaf M Elsaid
DOI:10.4103/ejb.ejb_38_19  
Background Asthma is a diverse disease with various phenotypes. Correlation of clinical asthma phenotypes with their underlying inflammatory biomarkers could help tailor asthma management and in turn improve the patient’s outcome. Aim of the study To validate the clinical classification of asthma phenotypes and to portray cough-predominant asthma phenotype and wheezy phenotype in accordance with their related inflammatory biomarkers. Patients and methods This is a case–control study comprising 50 patients with cough-predominant asthma phenotype and 50 patients with wheezy asthma phenotype, together with 50 healthy controls. Serum interleukin-10 (IL-10), transforming growth factor-beta 1 (TGF-β1), and total serum immunoglobulin E (IgE) levels were assessed using immunoassay techniques. Results The asthmatic children showed a significant increase of eosinophilic percentage, total serum IgE, and TGF-β1, when compared with the control group, whereas they showed a significant decrease of serum IL-10 when compared with the control group. As regards the clinical characteristics of both phenotypes, the prevalence of associated allergic rhinitis and atopic dermatitis in patients with cough-predominant asthma was significantly higher compared with the wheezy group. As regards laboratory biomarkers, total serum IgE was significantly elevated in cough-predominant asthma phenotype compared to wheezy phenotype. No significant differences were found between both phenotypes regarding serum TGF-β1 and IL-10. Conclusion Cough-predominant asthma phenotype is characterized by prominent atopic features (allergic manifestations and elevated total IgE). However, cough-predominant asthma and wheezy asthma phenotypes were similar regarding serum TGF-β1 and IL-10.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Does vitamin D deficiency worsen the clinical and functional parameters of stable chronic obstructive pulmonary disease patients? p. 584
Esmat A Abd Elnaby, Samah S Abd Elnaiem, Amira I Mostafa, Dina Sabry, Mohamed K Haswa
DOI:10.4103/ejb.ejb_44_19  
Introduction There is not much data about the effect of deficient vitamin D on stable chronic obstructive pulmonary disease (COPD) patients and its relation to the disease severity. Objective The aim was to measure the serum level of 25-hydroxy (OH) vitamin D in stable COPD patients, and to assess its relation to COPD severity and functional parameters. Patients and methods A prospective study that was carried out at Chest Department, Kasr El-Aini Hospital, Cairo University. It was carried out on 70 male individuals: 50 stable COPD patients and 20 healthy individuals. All persons were subjected to history taking, clinical examination, 6 min walk test (6MWT), spirometry, and measurement of 25(OH) vitamin D serum level. Results Our results showed a deficiency of vitamin D in 37 (74%) of the COPD patients. It showed a significant lower level of 25(OH) vitamin D in COPD cases who were severe and very severe, compared with those who were mild and moderate ones (P=0.017). There was also a positive significant correlation between vitamin D level and 6 min walk distance, basal oxygen saturation, post-6MWT oxygen saturation, and forced expiratory volume in the first second predicted, and an inverse correlation with basal heart rate and post-6MWT heart rate. Conclusion The study highlights the value of measurement of vitamin D level in COPD, as a potential therapeutic agent. Vitamin D serum level showed low values in COPD cases compared with healthy ones and was correlated significantly to forced expiratory volume in the first second predicted.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Cardiovascular comorbidities associated with patients with chronic obstructive pulmonary disease – a hospital-based study Highly accessed article p. 591
Amit S Gupta, Venkitakrishnan Rajesh, Ponneduthamkuzhy James
DOI:10.4103/ejb.ejb_64_19  
Background Most patients with chronic obstructive pulmonary disease (COPD) have cardiovascular comorbidities (CVD), which significantly contribute to the mortality and morbidity in these patients. Objective The primary objective was to assess the prevalence of CVD in hospitalized patients with COPD. The secondary objectives were to study the risk factors associated with CVD in patients with COPD and to assess if the severity of COPD was related to the prevalence of CVD. Patients and methods The present study was a prospective observational study. The study period spanned from January 2013 to December 2014. All consecutive patients admitted with a diagnosis of COPD were included in the study. Patients with coexisting chronic respiratory illnesses, like obstructive sleep apnea, interstitial lung disease, and bronchiectasis, were excluded. The presence of various CVD was assessed with a history, physical evaluation, and limited tests [ECG, troponin levels, serum brain natriuretic peptide (BNP), and echocardiography). χ2 test was used to test the statistical significance. Clearance from ethical committee and consent from patients were obtained before the study. Results A total of 100 patients with COPD were included in the study. Overall, 60% of the patients had CVD. Common CVD were ischemic heart disease (21%), congestive heart failure (20%), stroke (5%), and arrhythmias (3%). The prevalence of CVD among patients with stages 1 and 2 COPD was 44.4%, stage 3 COPD was 61.5% and stage 4 COPD was 66.7% (P=0.298). Using multiple linear regression analysis, significant risk factors for CVD were serum BNP levels [P=0.001; odds ratio (OR), 17.5], dyslipidemia (P=0.037; OR, 3.6), and systemic hypertension (P=0.002; OR, 4.6). Patients with COPD and CVD had a lower BMI as compared with those without CVD. Conclusion Ischemic heart disease, congestive cardiac failure, and stroke were the most commonly identified CVD in patients with COPD. Systemic hypertension, dyslipidemia, and serum BNP levels were identified as important predictors for CVD in our study.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Functional and radiological characteristics of asthma combined chronic obstructive pulmonary disease overlap p. 596
Hamada K Fayed, Yasen G Abd-Elkareem, Wassem A Samaha, Maher S Abdalshakour
DOI:10.4103/ejb.ejb_14_19  
Background Persons with asthma–chronic obstructive pulmonary disease (COPD) overlap (ACO) are a crucial but poorly characterized group. In spite of the numbers of patients with ACO have increased, there is minimal confirmed evidence regarding diagnostic features and choices of treatment. So, the aim of this study was to identify the physiological and radiological characteristics of patients with ACO. Patients and methods This study was performed on 200 patients classified into 38 patients diagnosed as having asthma, 132 patients diagnosed as having COPD, and 30 patients diagnosed as having ACO, who were chosen based on clinical features. All patients underwent pulmonary function tests, and multislice computed tomography imaging. Results The mean age of our study population was 61 years. The mean age in COPD group was higher compared with asthma and ACO groups (63.9±7.8 vs. 44.84±12.2 and 56.7±8, respectively), with a predominance of males in COPD and females in asthma, with a higher smoking index in patients with COPD than those with ACO and asthma (47.05±37.7, 13.53±2.2, and 2.47±1.46, respectively). Measurements of forced expiratory volume in 1 s (FEV1) by liters before bronchodilator therapy is greater in patients with asthma than ACO and COPD groups (1.89±0.42, 1.52±0.39, and 1.35±0.4, respectively), with highly significant difference (P<0.001). With airway reversibility, it is also greater in patients with asthma than ACO and COPD groups (2.85±0.49, 1.99±0.47, and 1.41±0.39, respectively), with a highly significant difference (P<0.001). Airway internal diameter of patients with COPD is greater than ACO and asthma groups (4.03±0.3, 3.92±0.17, and 2.82±0.31, respectively), with a highly significant difference (P<0.001). On the contrary, airway external diameter of patients with COPD is greater than asthma and ACO groups, with a highly significant difference (P<0.001). Airway wall thickness of patients with asthma is greater than ACO and COPD groups, with a highly statistical difference (P<0.001). There is no relation between thickness of airway wall and airway obstruction, expressed as FEV1 %predicted, in patients with asthma and COPD. This study results confirmed the correlation between the thickness of airway wall and airway obstruction, expressed as FEV1 %predicted, in patients with ACO. Conclusion Bronchial wall thickness measured by chest high resolution computed tomography (HRCT) is increased in patients with asthma than those with ACO and COPD, with a high statistical significance.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Blood eosinophils and C-reactive protein as prognostic factors in severe chronic obstructive pulmonary disease exacerbations p. 605
Hamed A Hafiz, Heba Moussa
DOI:10.4103/ejb.ejb_42_19  
Background Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Exacerbations of COPD are heterogeneous and have significant effect on the socioeconomic burden. The value of eosinophils (Eos) in predicting response to corticosteroids is documented in bronchial asthma exacerbation, but this value is not clear in COPD exacerbation. The aim of the study is to assess the prognostic value of blood Eos and C-reactive protein (CRP) in severe COPD exacerbations. Patients and methods A total of 120 patients with COPD with severe exacerbations were subjected to complete blood count picture analysis with differential count, including Eos and CRP. Cases were divided into eosinophilic and nonesinophilic groups using 2% as a threshold, and the outcomes were observed. Results The inpatient mortality rate was 10%, and it significantly correlated with noneosinophilic group (≤2%) (P=0.02). The length of stay in hospital and ICU was significantly lower in patients with eosinophilia more than or equal to 2%, with P value less than 0.001 for both. CRP and length of stay in hospital and ICU showed significant positive correlation. Conclusion Higher blood Eos and lower CRP levels can be used as predictors for better outcome in severe COPD exacerbations.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Assessment of high-dose inhalational corticosteroids vs systemic corticosteroids in acute exacerbations of COPD in diabetic patients p. 610
A.S. Magdy, Haytham S Diab
DOI:10.4103/ejb.ejb_71_19  
Background Systemic corticosteroids (SCS) are effective in the management of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, they are not without adverse effects, especially hyperglycemia. Inhaled corticosteroids (ICS) showed satisfactory outcomes with good safety. These benefits were not evaluated in patients with AECOPD with diabetes mellitus. The aim was to compare the efficacy and safety of high dose of ICS vs SCS in the treatment of AECOPD in diabetic patients. Patients and methods A total of 126 patients with AECOPD were screened, and thirty of them were found to be eligible and were enrolled into two groups: group 1 (n=15) received 1 mg budesonide by jet nebulizer four times daily, and group 2 (n=15) received 40 mg prednisolone or equivalent systemically. Postbronchodilator forced expiratory volume in 1 s (FEV1%) of predicted was measured at day 1 and day 7, and random blood sugar (RBG) was measured twice daily in all patients. Results There was a significant increase in the mean FEV1 at day 7 as compared with mean FEV1 at day 1 in groups 1 and 2, with the increase in mean FEV1 being 19.6 and 21% in groups 1 and 2, respectively. There was a significant difference, with higher mean RBG in group 2 when compared with group 1, at day 4 of treatment and continued onward. Interestingly, there was a significant elevation in mean RBG among patients in group 2 (SCS) starting by day 3 of treatment and continued onward, with no significant rise in the first two days, although there was no evident effect of ICS on the mean RBG among patients in group 1 (ICS) during the follow-up days. Conclusion Both ICS and SCS improve airflow in patients with AECOPD, taking into consideration the existence of diabetes mellitus. ICS may be an excellent substitute to SCS in the treatment of AECOPD in diabetic patients.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Pulmonary rehabilitation outcome in chronic obstructive pulmonary disease patients with a different body composition p. 616
Laila A Alsharaway
DOI:10.4103/ejb.ejb_33_19  
Context Change in body composition is commonly present in chronic obstructive pulmonary disease (COPD) patients. Aim The aim of this study was to investigate the effects of pulmonary rehabilitation program (PRP) on COPD patients who have a different body composition. Materials and methods In this study, we measure;Deg;BM;Deg;I and fat-free mass index (FFMI) using a single-frequency bioelectrical impedance analysis apparatus to classify patients into three categories: Group 1 nonmuscle depleted;Deg;BM;Deg;I greater than or equal to 21 kg/m2 and FFMI greater than or equal to 16. Group 2 muscle depleted;Deg;BM;Deg;I greater than or equal to 21 kg/m2 and FFMI less than 16 in men or FFMI less than 15 in women. Group 3 muscle depleted with cachexia;Deg;BM;Deg;I less than 21 kg/m2 and FFMI less than 16 in men or FFMI less than 15 in women. PRP outcomes were assessed by the improvement in pulmonary function severity, exercise capacity by 6-min walk test, dyspnea score by modified-British Medical Research Council, and health status by combined assessment test score and arterial blood gas improvements. Results Forty-four patients with FFMI were measured by bioelectrical impedance analysis. The patients were mainly elderly men (N=35; 79%), who have a mean age of 65 years with different global initiative obstructive lung disease stage I–IV. In the nonmuscle depleted group, there were statistically significant improvements in the mean values of FFMI (kg/m2) while in the muscle depleted group there were improvements as regards the mean values of dyspnea score by modified-British Medical Research Council; in the cachectic group there were statistically significant improvements in the mean values of BMI (kg/m2), forced expiratory volume in the first second (FEV1), forced expiratory volume in first second divided by forced vital capacity ratio, combined assessment test score after PRP. Conclusions A comprehensive PRP outcome change in COPD patients with different body compositions.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Assessment of bronchial asthma exacerbation: the utility of platelet indices p. 623
Manal R Hafez, Hoda A Eid, Sawsan B Elsawy, Nehad Emad Eldin, Asmaa A El Madbouly
DOI:10.4103/ejb.ejb_69_19  
Background Activated platelets and platelet indices have a vital role in bronchial hyper-responsiveness, bronchoconstriction, bronchial inflammation, airway remodeling, angiogenesis, allergic reactions, and repair and renewal of tissues; platelets contain mediators that lead to inflammatory response. Aim The aim was to assess the use of platelet indices [mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), and platelet large cell ratio (PLCR)] as cheap and readily available biomarkers for bronchial asthma exacerbation. Patients and methods A case–control study involved 45 bronchial asthma female patients during both stable and exacerbation phases, and 45 age-matched healthy female patients as a control group. Measurements of platelet counts, MPV, PDW, PCT, PLCR, C-reactive protein (CRP), spirometric indices, and arterial blood gases were performed for all participants. Results The MPV and PDW were significantly lower, whereas the PCT and PLCR were considerably higher in exacerbation phase compared with stable phase and in stable phase in comparison with controls (P<0.001). The MPV and PDW were negatively correlated with white blood cells, PaCO2, symptoms duration, and hs-CRP (high sensitive), with positive correlation with forced expiratory volume in the first second and PaO2 (P<0.001). PCT and PLCR were positively correlated with white blood cells, PaO2, and symptoms duration, and negatively correlated with forced expiratory volume in the first second, symptoms duration, and hs-CRP (P<0.001). Conclusion The platelet indices were altered in exacerbation phase compared with stable phase and control group. Therefore, clinicians should not ignore interpreting platelet indices during asthma exacerbation, especially as these tests are simple, readily available, and of lower cost. It appears that measurement of the platelet indices is a valuable indicator of asthma severity/activity and appears as a useful screening test for asthma exacerbation.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
ORIGINAL ARTICLES: BRONCHOSCOPY Top

Qualitative role of endobronchial elastography with endobronchial ultrasound in differentiating malignant and benign lesions: a retrospective single-center study from India p. 630
Rajesh Gupta, Sharad Joshi, Ankit Bhatia, Nitesh Tayal, Praveen Pandey
DOI:10.4103/ejb.ejb_49_19  
Background Endobronchial ultrasound (EBUS) is useful in guiding needle biopsy of mediastinal lesions. Sonoelastography in latest generation machines have enabled mapping the elasticity of the lymph nodes (LNs) leading to potentially better guidance in taking samples. Aim We aim to assess the practical usefulness of elastography in assessing mediastinal lymphadenopathy by comparing the patterns seen on EBUS elastography with the final pathological diagnosis from EBUS-guided transbronchial needle aspiration. Patients and methods The EBUS scope (convex) was intubated via the oral route, and images were generated to evaluate the patterns produced during elastography according to color distribution: type 1 was taken as predominantly nonblue (yellow, red, and green); type 2 was less than 50% blue color, part nonblue (yellow, red, and green); type 3 predominant blue. Elastography patterns were subsequently compared with the eventual pathological results. Results In the study period, 105 LNs in 80 patients were studied, 79 were found to be of benign nature while 26 patients were diagnosed as malignancy. Type 1 LNs were of benign pathology in 42/46 (91.30%) cases and malignant in 4/46 (8.70%) cases; for type 2 LNs, 24/30 (80%) cases were benign and 6/30 (20%) cases were malignant. Type 3 nodes were found to be of benign nature in 13/29 (44.82%) cases and malignant in 16 (55.14%) cases. On classifying type 1 group and type 2 group as ‘benign’ and type 3 group as malignant in nature, the sensitivity, specificity, negative predictive value, positive predictive value, and diagnostic accuracy rates were found to be 83.54, 61.54, 86.84, 55.17, and 78.10%. Conclusions The addition of elastography while performing EBUS of mediastinal lymphadenopathy is a technique that may be helpful in selecting sites for EBUS-guided transbronchial needle aspiration; however, more studies are needed to access its practical usefulness.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Comparison between cryobiopsy and forceps biopsy in detection of epidermal growth factor receptor amplification in non-small-cell lung cancer p. 636
Ahmed S.H Mohamed, Mohamed Hantera, Ragia S Sharshar, Amira Y Abdelnaby, Ayman El Saka
DOI:10.4103/ejb.ejb_40_19  
Background Non-small-cell lung cancer (NSCLC) represents 85% of lung cancer cases. Genotyping is now considered as a cornerstone in proper management and better results of such cancers, especially with targeted therapy. Cryobiopsy is a promising tool in NSCLC to obtain larger samples, with well-preserved tissue sufficient for accurate histopathological and gene detection. Aim To compare cryobiopsy and ordinary forceps results in detection of epidermal growth factor receptor (EGFR) amplification in NSCLC. Materials and methods Samples from 34 patients with proven NSCLC by cryobiopsy versus forceps biopsy were compared for size, quality, and diagnostic yield of EGFR gene amplification. Results The samples obtained by cryoprobe had larger size and better artifact-free areas with more diagnostic yield of EGFR gene amplification (29.4%) versus with forceps biopsy (8.8%), with gene amplification showing higher statistical significance in younger patients, never smokers, and women (P<0.001). Conclusion Cryobiopsy is an excellent tool for larger, better-quality sampling and for higher diagnostic yield of EGFR amplification in NSCLC.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

The role of convex probe endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of hilar and mediastinal lesions p. 644
Laila A Helalah, Ashraf M Madkour, Nevine M.A Elfattah, Rehab M Mohammed, Ayman A.H Farghaly, Ragaa A Fawzy, Asmaa M.A Elasser
DOI:10.4103/ejb.ejb_57_19  
Background Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has been recently introduced as a new technique for sampling the hilar/mediastinal lesions [lymph node (LN) enlargement or masses] with a potential to improve the diagnostic yield as it allows direct visualization of lesion beyond the tracheobronchial wall allowing real-time sampling. EBUS-TBNA diagnostic yield has been satisfactory for both benign and malignant lesions. Aim To evaluate the utility of convex probe EBUS-TBNA in the diagnosis of hilar and mediastinal lesions (LN enlargement or masses). Patients and methods This is a prospective study in which EBUS-guided TBNA via a real-time ultrasound bronchoscope was used to diagnose 25 patients with mediastinal or hilar LN enlargement or masses. Results EBUS-guided TBNA was performed on 15 patients with enlarged mediastinal/hilar LNs and 11 patients with mediastinal masses, achieving specific diagnosis in 73.3% (11/15) and 81.8% (9/11), respectively. The overall diagnostic yield of EBUS-TBNA was 76% (19/25). Overall sensitivity was 82.6%, specificity 100%, positive predictive value 100%, and negative predictive value 33.33%. EBUS-TBNA procedure had no complications in 76% of cases. Conclusion EBUS-TBNA is a minimally invasive, safe, yet still underutilized diagnostic technique with adequate diagnostic yield. Its nationwide application in the field of diagnostic bronchoscopy should be encouraged.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
ORIGINAL ARTICLES - CRITICAL CARE Top

Effectiveness of APACHE II and SAPS II scoring models in foreseeing the outcome of critically ill COPD patients p. 654
Yousef Ahmed, Mohamed Adam, Lamees M Bakkar
DOI:10.4103/ejb.ejb_72_19  
Background Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II) scoring systems are the two models that are greatly used by the majority of ICUs to predict clinical consequence. Objective The aim of the study was to assess the performance of APACHE II and SAPS II scoring methods in foreseeing death among critically ill chronic obstructive pulmonary disease (COPD) patients. Materials and methods This prospective research included 104 COPD patients who were admitted to the respiratory intensive care unit (RICU) at Assiut University Hospital. The patients were classified as survivors and nonsurvivors. Each scoring system was assessed for its discrimination, calibration, and overall performance. Results On the basis of the outcome of the study population, 36 (34.6%) patients were non-survivors while 68 (65.4%) patients were survivors. Both APACHE II and SAPS II scores were significantly higher in nonsurvivors. The discriminative power of both models was good as determined by the receiver operating characteristic curve. At a cutoff point greater than 20 for APACHE II and greater than 48 for SAPS II, survival or death can be predicted. The Lemeshow–Hosmer goodness-of-fit C statistics showed good performance and good calibration for both models. APACHE II score had the least Brier score and reliability but had the highest resolution. Conclusion The conclusions made were first, APACHE II and SAPS II have nearly similar performance in predicting mortality among COPD patients but with some preference for APACHE. Second, Both models have good discrimination and good calibration.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
ORIGINAL ARTICLE: DIFFUSE PARENCHYMAL LUNG DISEASES Top

Histopathological findings in patients with refractory nonfibrotic hypersensitivity pneumonitis p. 660
Yosri M.K Akl, Raef H Emam, Ahmed H El-Habashi, Mohamed S Ismail, Hossam Abdallah
DOI:10.4103/ejb.ejb_28_19  
Background The course of hypersensitivity pneumonitis (HP) is characterized by variable patterns of disease progression. Refractory HP is defined as poor or lack of response to different modalities of treatment with worsening of the functional status. Aim To assess the causes of refractory HP and to evaluate the correlation between disease progression and different histopathologic findings in patients with HP. Patients and methods We included 20 patients who were diagnosed primarily as HP and proved to be refractory to treatment. All patients were subjected to the following: complete history taking and clinical examination, spirometry, 6-min walk test, high-resolution CT chest, echocardiography, and transbronchial lung biopsy. Results Female sex was predominant among the studied patients. The mean age of our patients was 39.9±13.49 years. Overall, 65% of these patients were raising birds, but the offending agent was not identified in 30% of patients. Almost all patients presented with restrictive lung functions (mean forced vital capacity=59±10%), and radiologically, they mainly presented with centrilobular ground-glass and nodular opacities. Histopathological results showed that there was isolated HP pathology in 40% of patients and HP with associated pathologies in 60% of cases without significant fibrotic changes. Conclusion HP is more common in women and middle ages. Histopathological findings revealed no significant fibrotic changes in most of the cases, so other mechanisms may be involved in disease progression and may affect treatment response.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
ORIGINAL ARTICLES - INTERVENTIONAL PULMONOLOGY Top

Outcomes and safety of bronchial artery embolization in control of massive hemoptysis p. 666
Gehan H AboEl-Magd, Ahmad H Abouissa, Mohamed M Harraz
DOI:10.4103/ejb.ejb_51_19  
Background The most frequent causes of massive hemoptysis are bronchiectasis, myecetoma, tuberculosis, bronchial carcinoma, and cryptogenic hemoptysis. Objective This study aimed to investigate the outcomes, safety, and complications of bronchial artery embolization (BAE) in the management of massive hemoptysis. Patients and methods This study included 32 patients who presented with massive hemoptysis who were indicated for BAE. The following data were obtained from each patient: detailed history, clinical examination, chest radiograph, computed tomography pulmonary angiography, fiberoptic bronchoscopy, and BAE. Results Fifteen patients underwent BAE as an urgent procedure for control of massive hemoptysis and 17 patients underwent BAE as an elective procedure. The complications of BAE were fever in four patients (12.5%), back pain in three (9.38%), failure of BAE in two (6.25%), recurrence of hemoptysis in one (3.13%), and no mortality. BAE was successful in 30 out of 32 (93.75%) cases. Failure of catheterization was encountered in one (3.13%) case because of dissection during negotiations; therefore, no catheterization was performed. The second (3.13%) case showed extensive bronchial–pulmonary shunt with severe lung destruction, so that the procedure was deemed futile. After the procedure, immediate control of hemoptysis was achieved in 29 (90.62%) patients. Conclusion BAE can be used safely and effectively for control of massive hemoptysis; it can be used as an alternative nonsurgical option along with medical treatment or as a bridge to stabilize the patient until definitive surgical management can be performed. BAE can be considered an alternative to surgery if the patient is not fit for surgical intervention.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Role of ultrasound in airway assessment in the respiratory ICUs p. 672
Mona M Ahmed, Iman H.E Galal, Hossam M Sakr, Ashraf A Gomaa, Ahmed M Osman, Marwa H El-Assal
DOI:10.4103/ejb.ejb_59_19  
Background Airway evaluation and its management remain an emerging clinical science. Ultrasound (US) provides point-of-care dynamic views of the airway in perioperative, emergency, and critical care settings. Identification of a difficult airway before intubation allows for optimal preparation, equipment selection, and participation of experienced personnel. Objective The aim of this study was to evaluate the role of US in the assessment of airways and to determine whether US has the potential to serve as an effective, noninvasive method for the diagnosis of tracheomalacia. Patients and methods A prospective cross-sectional study was carried out on patients admitted at the respiratory ICU. US examination of the airways and diaphragm was performed together with either fiberoptic bronchoscopy (FOB) or dynamic expiratory computed tomography chest. Dynamic expiratory computed tomography chest and FOB were done within 24 h of US examination. Results A total of 53 patients were included. US could successfully confirm endotracheal tube (ETT) placement in all patients. ETT was endotracheal in 30 (94%) patients, whereas it was esophageal in two (6%) patients. Hyomental distance at a cut-off of up to 4.51 cm was a good predictor of difficult intubation with 100% sensitivity and 87.5% specificity. Subglottic airway transverse diameter was used as a predictor of ETT size. Patients with tracheomalacia by FOB had a significantly longer duration of mechanical ventilation. Lateral pharyngeal wall thickness was used as a predictor of obstructive sleep apnea, a new cut-off point was used at more than 4.1 cm in the intubated group of patients with 87.5% sensitivity and 95.8% specificity, whereas a cut-off point more than 4.2 cm in the nonintubated patients had 100% sensitivity and 100% specificity. In the intubated group, out of the seven cases diagnosed with tracheomalacia by FOB, five patients were missed by US with 40% sensitivity, whereas in the nonintubated group, the results were significantly better, where only one case was missed by US with 80% sensitivity. Conclusion US has many advantages for imaging the airway; it is safe, quick, repeatable, portable, widely available, and provides real-time dynamic images relevant for several aspects of management of the airway. Thus, it seems reasonable to consider the routine use of airway US in the ICU.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Reliability of ultrasound in confirming endotracheal tube placement as a new and fast tool p. 684
Mohammad W.S Moghawri, Niveen E Zayed, Dalia A Ibrahim
DOI:10.4103/ejb.ejb_79_19  
Background Chest ultrasound has been an important tool for the diagnosis of many chest diseases, and, recently, it became an important tool for confirmation of the site of endotracheal tube placement. In our study, we used the ultrasound for this confirmation and compared this with capnography and clinical examination as gold standards and also with chest radiograph. Patients and methods This is a cross-sectional study conducted in our chest ICU from January 2019 to August 2019. We included 30 chronic obstructive pulmonary disease patients with acute respiratory failure who needed endotracheal intubation according to the protocols. Ultrasound was used to identify and confirm endotracheal tube placement simultaneously with a quantitative waveform capnography (end-tidal carbon dioxide), clinical methods, and chest radiograph. Confirmation of tube placement and time taken for the confirmation were noted by our staff. Results Of the 30 intubation attempts, six (20%) had esophageal intubations. The sensitivity and specificity of diagnosis using ultrasonography were 95.8 and 93.3%, respectively. This was statistically comparable with the other three modalities. The time taken to confirm tube placement with ultrasonography was 7.7±1.6 s compared with waveform capnography, clinical examination, and chest radiograph, which were18.8±2.6, 26.1±3.4, and 73.6±7.7 s, respectively. The time taken by ultrasonography was significantly less. Conclusion Sonar-confirmed endotracheal intubation saves time and life, particularly in patients with low pulmonary blood flow in comparison with other traditional methods of confirmation.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Ultrasonographic evaluation of the diaphragm p. 690
Youssriah Y Sabri, Sabah A.M Hussein, Ahmed A.M Baz, Amal A.M Aglan
DOI:10.4103/ejb.ejb_73_19  
Background Ultrasonography is a promising technique for structural and functional evaluation of the diaphragm. It is accurate, reproducible, and portable with no ionizing radiation. Multiple studies have reported ultrasonography as the modality of choice for evaluation of the diaphragm. Objective The aim was to assess the role of ultrasound (US) in the evaluation of the diaphragm, either normal or abnormal, through evaluating its morphology, integrity, and measuring different parameters such as diaphragmatic thickness, thickening fraction, and excursion with proper assessment of supra/infradiaphragmatic lesions that affect the diaphragm. Patients and methods In all, 118 patients were recruited from the Chest and Radiology Departments, Cairo University, in the period from January to July 2019. All patients were subjected to history taking, clinical examination, and ultrasonographic assessment of the diaphragm. High-frequency linear transducer of 7.5–12 MHz was used for imaging the diaphragm and measuring its thickness. A low-frequency curvilinear transducer with a frequency of 3.5–5 MHz was used for assessing diaphragmatic excursion. Results Cases were grouped into two groups, those with normal US findings of the diaphragm represented group A, while patients with any diaphragmatic abnormality represented group B. Group B included 41 patients with intrinsic (56.09%) and extrinsic diaphragmatic abnormalities (46.34%). Five (12.2%) cases have thickened diaphragm; two (4.9%) cases have thinned-out diaphragm; two (4.9%) cases showed congenital diaphragmatic defects; three (7.3%) cases showed acquired diaphragmatic defects; 10 (24.4%) cases showed diaphragmatic weakness; and nine (21.95%) cases showed diaphragmatic paralysis (7.6%). Conclusion US is the technique of choice for assessing diaphragmatic movement on suspicion of malfunctioning. Ultrasonography is a promising technique for structural and functional evaluation of the diaphragm.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
ORIGINAL ARTICLES: MISCELLANEOUS Top

The use of tranexamic acid in elective lung surgery: a single-center experience p. 699
Ayman A Sallam, Mohamed M Abo El Nasr, Ahmed S Elgebaly, Wael M El Feky
DOI:10.4103/ejb.ejb_29_19  
Context Acute pulmonary embolism (PE) is a lethal sequela of venous thromboembolism (VTE). Surgical trauma injures the tissue directly, releasing a large number of tissue agent. The frequency of re-exploration owing to bleeding after lung surgery is between 1 and 3.7%, whereas the need of allogenic blood transfusion spans from 20 to 52%. Aims To assess the role of tranexamic acid (TXA) in reducing the need of allogenic blood transfusion in patients undergoing elective lung surgery. Patients and methods This retrospective study was conducted on 140 patients who underwent elective lung surgery. Patients were allocated into two groups. Group I patients received TXA at the end of procedure, and group II patients received blood and/or blood product transfusion. Statistical analysis Qualitative variables are expressed as mean±SD. Quantitative variables are compared by using the Student’s t test. Results The patients comprised 80 males and 60 females in our series. All cases in group II needed transfusion of one or more of the following: concentrated red blood cells, whole blood, fresh frozen plasma, and platelets. There was an obvious decrease in the postoperative hemoglobin level between groups, in favor of blood transfusion group (group II), and this was statistically significant. Conclusions Elective thoracic surgery patients have a low incidence of VTE and PE (2.85 and 2.14%, respectively). Hence, TXA helps in minimizing not only transfusion-related hazards but also operative cost.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Pattern of chest diseases among addicts in Poison Control Center of Ain Shams University Hospitals p. 704
Aya M AbdelDayem, Mahmoud L Sakr, Nehad M Osman, Maryam A Abd El Kader, Sherehan EL Sayed Abd El-Aaty
DOI:10.4103/ejb.ejb_60_19  
Background Drug addiction results in serious pulmonary complications. Thoracic complications of drug addiction vary depending on the type and the route of administration of the drug that has been abused. Aim To study the pattern of chest diseases among addicts in Poison Control Center of Ain Shams University Hospitals. Patients and methods A total of 200 addict patients were selected from Poison Control Center of Ain Shams University Hospitals in the duration between June 2016 and June 2018. All patients with pulmonary complications referred to Abbasia Chest Hospital were included. Results A total of 200 addict patients were enrolled in this study. Of them, 100 addicts with drug overdose with no pulmonary complications were excluded, and the other 100 patients were included, comprising 99 males and only one female, with mean age of 39.91±10.75 years. Overall, 63% of drug addicts were cannabis addicts, 27.0% were opiate addicts, 8.0% were polysubstance abusers, and 2.0% were alcohol addicts. Pulmonary tuberculosis was the most common pulmonary complication of all drug addicts. There was a statistically significant correlation between the type of drug addiction and the pulmonary complications. Pulmonary tuberculosis was the most common among cannabis addicts as well as polysubstance abusers. Parenchymal lung diseases (pneumonia and lung abscess) were the most common among opiate and intravenous drug addicts. There was no significant difference between different types of drugs and outcomes of the patients. Mortality represented 3.0% of all drug addicts. Conclusion Many pulmonary complications are associated with drug addiction. Achievement of early diagnosis and treatment can be obtained by proper counseling and therapeutic programs.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
ORIGINAL ARTICLE - PLEURAL DISEASES Top

Validation of a simple computed tomography scoring system to predict the malignant nature of pleural effusion p. 710
Rania A Sweed, Ayman I Baess
DOI:10.4103/ejb.ejb_46_19  
Objective We aimed to validate a computed tomography (CT) scoring system and assess its sensitivity and specificity to predict the malignant nature of pleural effusion that is exudative and of undetermined origin. Patients and methods This is a retrospective study that enrolled 123 patients who were referred for medical thoracoscopy in the Chest Department, Alexandria Main University Hospital, between 2013 and 2017 for diagnosing exudative pleural effusion of undetermined origin. CT scans were reviewed by a radiologist who was blinded to the final diagnosis. We applied a scoring system that was generated by Porcel et al. Scoring results were then evaluated using the final diagnosis of thoracoscopic pleural biopsies as the reference. Results The CT score showed a sensitivity and a specificity of 70 and 66.7%, respectively, with an negative predictive value 83% and a positive predictive value 48%, and the area under the receiver operating characteristic curve was 0.745.using a cut-off value of at least 7. Conclusion The CT scoring system could not predict the malignant nature of exudative effusion with great accuracy.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
ORIGINAL ARTICLE - PULMONARY FUNCTION TESTS Top

Effect of incentive spirometer exercise on pulmonary functions in children with spastic cerebral palsy p. 716
Magda Y Elseify, Dina A Ramadan, Sally R Ishak
DOI:10.4103/ejb.ejb_53_19  
Background Spastic cerebral palsy (CP) patients have lower pulmonary functions than normal healthy individuals as they usually have decreased chest wall mobility, deviation of optimal chest wall structure, and weak respiratory muscles. Purpose The aim was to study the effect of incentive spirometer exercise (ISE) on spirometry pulmonary function in children with spastic CP. Materials and methods Fifty spastic CP patients were randomly divided into two groups: the study group consisted of 30 patients and the control group consisted of 20 patients. Both groups were following and doing physiotherapy in the National Institute of Neuromotor System, the study group added incentive spirometer exercise to their physiotherapy program. We assessed forced expiratory volume at first second (FEV1%), the forced vital capacity (FVC %), FEV1/FVC ratio, and maximal mid-expiratory flow before and after 4 weeks of exercise and lastly after another 4 weeks of exercise. Results The authors found significant improvements in FEV1%, FVC %, and maximal mid-expiratory flow in the study group, but not in the control group. Conclusion The authors support the use of ISE for improving pulmonary functions in children with spastic CP.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
ORIGINAL ARTICLES - PULMONARY INFECTIONS Top

Tuberculosis in Upper and Lower Egypt before and after directly observed treatment short-course strategy: a multi-governorate study p. 722
Medhat F Negm, Amira H Allam, Tahany M Goda, Mona Elawady
DOI:10.4103/ejb.ejb_47_19  
Background Tuberculosis (TB) is a major problem in developing countries. TB in Egypt is considered an important public health problem. Egypt is ranked among the mid-level incidence countries. Objective To evaluate TB status in 19 governorates and to compare the TB situation in Upper and Lower Egypt over 20 years from 1992 to 2012 before and after the application of directly observed treatment short-course strategy (DOTS). Patients and methods This is a retrospective study involving record review. The registered data were collected from TB registration units in the 19 governorates. Results The highest percentage of TB cases was in the age group 15–30 years. Infection was higher in males than females and in rural areas more than urban areas. Pulmonary TB and smear positivity at diagnosis, second, third, and fifth month were higher in Lower Egypt. Treatment after failure or relapse was significantly higher in Upper Egypt, whereas default rate, failure rate, and death rate were significantly higher in Lower Egypt. Regarding treatment outcome, cure, complete treatment, and transfer out were significantly increased after DOTS than before. Failure, default, and death were significantly reduced after DOTS than before DOTS. Upper Egypt included higher incidence rates of TB, new adult smear-positive cases, new extrapulmonary TB cases, and sputum conversion rate at the end of the initial phase of treatment. Cure rate and treatment success rate were significantly higher among patients of Upper Egypt, whereas transfer out rate and retreatment failure rate were significantly higher among Lower Egypt patients. Conclusion TB is still a health problem in Egypt, with pulmonary TB more in Lower Egypt, whereas extrapulmonary more in Upper Egypt, but after the introduction of DOTS, there is a significant increase in cure and success rate, with markers of success being more in Upper Egypt.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Serum zinc levels in hospitalized children with pneumonia: a hospital-based case–control study p. 730
Amira M.M Hamed, Yasser T Kassem, Hamada K Fayed, Ahmed M Solaiman
DOI:10.4103/ejb.ejb_30_19  
Background Zinc is an important micronutrient in humans. Globally, pneumonia represents 18% of mortality in children under 5 years of age and the main infectious purpose of early life mortality. There is a higher pneumonia risk in a population with zinc deficiency. The aim of our study is to compare the level of serum zinc in children with pneumonia with age, sex, and nutritional matched healthy controls. Patients and methods Serum zinc level in 90 children admitted with pneumonia was compared with the matched controls. Results The mean level of serum zinc in children with pneumonia (67.5±21.8) is significantly lower than that of controls (91.8±19.94) with (P<0.001). Conclusion Children with pneumonia has a significantly lower serum zinc levels than matched healthy controls.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

The relationship between level of the red cell distribution width and the outcomes of patients who acquired pneumonia from community p. 738
Yousef A Yousef, Mahmoud A Manal
DOI:10.4103/ejb.ejb_62_19  
Background Inflammatory and oxidative stress caused by infection has recently been proposed as a mechanism of association between the red cell distribution width (RDW) and infectious diseases, such as community-acquired pneumonia (CAP). Objective The present goal was to assess the prognostic importance of the RDW test in patients with CAP. Patients and methods The present research was a descriptive and prospective study of patients diagnosed with CAP. All were admitted to Chest Department of Assiut University Hospital between April 2017 and July 2018. Assessment of CAP severity at time of hospital admission using Pneumonia Severity Index was done for all enrolled patients. Complete blood count was measured by automated hematology analyzer, and RDW was reported as a part of the complete blood count result. Normal reference range of RDW was 11.5–14.5%. All of the patients were followed up until being discharged. The outcome variable was in-hospital mortality. Results The current study involved 94 patients with CAP: 77 (82%) survived and 17 (18%) died. RDW level was significantly higher in nonsurvivors compared with survivors (18.52±3.07 vs. 12.76±2.08; P=0.022). A significant positive relationship was found between RDW level and Pneumonia Severity Index points (r=0.664; P=0.000). Regarding the diagnostic performance of the RDW test, it was observed that RDW level at cutoff point more than 16.1% had 94.12% sensitivity and 98.70% specificity for the prediction of in-hospital mortality in patients with CAP. Conclusion The present data indicated that the measurement of RDW on admission may provide the physician with a tool to predict the outcomes of patients with CAP and thus assist in decision making and management in such cases either alone or alongside the other well-established means, taking into account that RDW testing is simple, cheaper, and readily available.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
ORIGINAL ARTICLES: PULMONARY VASCULAR DISEASES Top

Assessment of the role of computed tomography versus echocardiography in pulmonary hypertension p. 743
Ahmed Z.E Abdelhafiz, Khaled A. Al Khashab, Assem F Elessawy, Radwa A Elhefny, Fatmaalzahraa S Abdalrazik
DOI:10.4103/ejb.ejb_56_19  
Background The era of diagnosing pulmonary arterial hypertension is rapidly evolving. There are changes in the definition, screening, diagnostic modalities, and disease staging. Aim This study aims to assess pulmonary hypertension using computed tomography (CT) and echocardiography. Design This is a cross-sectional study. Participants and methods This study included 30 cases diagnosed with pulmonary artery hypertension according to the inclusion and exclusion criteria. All patients were subjected to a careful assessment of history, a skillful clinical examination, and investigations: (a) complete blood picture, liver kidney functions, bleeding profile, and arterial blood gases. (b) Spirometry. (c) Echocardiogram. (d) CT chest. Results The correlation between the ratio of main pulmonary artery and aorta to other study parameters was statistically significant. There was a negative statistically significant correlation between the mP/Ao ratio and oxygen saturation (P=0.001); however, we found a positive significant correlation between the mP/Ao ratio and ejection fraction (P=0.006), systolic pulmonary artery pressure (P<0.0001), and mean pulmonary artery pressure (P<0.0001). In contrast, the correlation was nonsignificant when the mP/Ao ratio was compared with other parameters (P>0.05), and a nonsignificant correlation was also found between systolic pulmonary artery pressure and duration of dyspnea (P>0.05). Conclusion This study has shown that combining CT and echocardiography in the diagnosis of pulmonary hypertension can be a reliable technique to measure mean pulmonary artery pressure than if any of both tests done separately.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Original, simplified, and modified pulmonary embolism severity indices in risk stratification of pulmonary embolism p. 747
Maha Yousif, Sabah A Hussein
DOI:10.4103/ejb.ejb_68_19  
Background Acute pulmonary embolism (PE) is a potentially fatal disease. Prognostic assessment is needed for proper management. Several prognostic models have been proposed. Aim The aim was to validate the original pulmonary embolism severity index (o-PESI) with its simplified version (s-PESI) and modified version (m-PESI) as predictors of in-hospital mortality and homeostatic morbidities (nonlethal repeated venous thromboembolism, and/or nonlethal serious hemorrhage) in patients with PE. Patients and methods Patients proved to have acute PE admitted to Menoufia and Cairo University Hospitals between March 2017 and March 2019 were included in the study. The o-PESI, s-PESI, and m-PESI were calculated for each patient. In-hospital mortality, homeostatic morbidities, and major adverse events (mortality and homeostatic morbidities) were registered. Results One hundred and two patients were recruited. In-hospital mortality rate was 13.7%, morbidity rate was 21.6%, whereas major adverse events rate was 31%. The s-PESI classified 31.4% of patients as low risk, and none of them had in-hospital mortality. The frequencies of major adverse events in the low-risk groups were 31.2, 9.1, and 75% for o-PESI, s-PESI, and m-PESI, respectively. Difference between adverse events and non-adverse events groups was significant when s-PESI was applied (P=0.008). The s-PESI had the highest sensitivity and negative predictive value in detecting mortality, morbidity, and major adverse events compared with o-PESI and m-PESI. The area under the curve for s-PESI was significantly above the other two indices (area under the curve=0.78, P=0.04). Conclusion In addition to its easy application, the s-PESI has a preferably superior prognostic accuracy than o-PESI and m-PESI in prognostication of low-risk patients with acute PE.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
ORIGINAL ARTICLES: SLEEP MEDICINE Top

Study of upper airway inflammation in patients with obstructive sleep apnea–hypopnea syndrome p. 754
Enas E Mohamed, Ayman I Baess, Yasser M Eldowik
DOI:10.4103/ejb.ejb_27_19  
Background Pharyngeal lavage was reported as a novel technique for noninvasive assessment of inflammation of the pharynx. Aim To study upper airway inflammation in patients with obstructive sleep apnea–hypopnea syndrome (OSAHS) and its correlation with systemic inflammation. Patients and methods A total of 36 patients with known OSAHS, admitted to the Chest Department, Alexandria Main University Hospital (group I), and 15 healthy volunteers (group II) were enrolled into the study. Informed consent was taken from all participants. The two groups underwent complete history taking, assessment of BMI, measurement of serum C-reactive protein (CRP), overnight polysomnography, and oropharyngeal lavage (OPL) analysis. Results In group I, the most prevalent cell type of OPL was lymphocytes followed by neutrophils. Compared with control group (group II), the most prevalent cell type in OPL was macrophages followed by epithelial cells. Regarding the OPL differential cell count which denotes local pharyngeal inflammation, there was a statistically significant difference between both groups (P<0.001). Similarly, CRP, a marker of systemic inflammation, showed a significant statistical difference between both groups (P<0.001). Strikingly, there was no statistically significant correlation between CRP and apnea–hypopnea index (P=0.604). Snoring, apnea–hypopnea index, and other sleep parameters correlated significantly with lymphocytic predominance in OPL (P<0.001), whereas CRP correlates significantly with neutrophils and eosinophil’s in OPL (P<0.001 and P=0.015, respectively). Conclusion Our study had provided a novel vision into the pathophysiology of OSAHS in emphasizing the existence of upper airway lymphocytic inflammation. OPL is a simple, applicable, and easy noninvasive procedure for assessment of upper airway inflammation.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Validation of the NoSAS score for the screening of sleep-disordered breathing: a retrospective study in Egypt p. 760
Rania A Sweed, Mahmoud I Mahmoud
DOI:10.4103/ejb.ejb_45_19  
Background This study was carried out to validate the NoSAS score and assess its performance in predicting clinically significant sleep-disordered breathing (SDB) in patients referred for a sleep study and to compare its performance with the recent (No-Apnea score) and the STOP-BANG questionnaire. Patients and methods This is a retrospective study of an existing database of consecutive outpatients who were referred for suspected SDB at the sleep lab of Chest Department in Alexandria Main University Hospital from October 2012 to December 2018. We enrolled patients of at least 18 years who completed a full-night polysomnography. We defined clinically significant SDB as an apnea–hypopnea index (AHI) of at least 20 events/h. We assessed the validity of the NoSAS score and compared its performance with the No-Apnea score and the STOP-BANG questionnaire. Results After the exclusion of patients who did not fulfill our inclusion criteria, 362 out of 720 patients were enrolled. Only 5% were not diagnosed with SDB (AHI<5). Moderate-severe SDB was present in 82.4% of patients. Using a threshold of at least 8 at different AHI cut-offs (5, 10, 15, 20, 25, 30), the NoSAS score showed area under the curve (AUC) similar to the STOP-BANG Questionnaire only at AHI of at least 20 (AUC 0.77), whereas at the other AHI cut-offs (5, 10, 25, 30), the STOP-BANG Questionnaire showed higher AUC. At all AHI cut-offs, the NoSAS score was superior to the No-Apnea score. Conclusion Despite its simplicity, the NoSAS score is a valuable screening tool, especially when resources are limited.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Patterns of sleep disorders in women p. 767
Amany O Mohamed, Hoda A Makhouf, Shazly B Ali, Omar T Mahfouz
DOI:10.4103/ejb.ejb_41_19  
Background Across the lifespan, several biological and hormonal differences affect symptoms and consequences of sleep and circadian rhythm sleep-wake disorders in women. Published data on women with restless leg syndrome are few. Objective To find out the pattern of sleep disorders in premenopausal or postmenopausal women. Patients and methods This cross-sectional study included 60 women with a history of sleep disturbance fulfilled by the Epworth sleepiness scale. Medical history, anthropometric measures, and full night-attended polysomnography were done. Results Regarding STOP-Bang questionnaire, there was a statistically significantly higher proportion of women with hypertension, BMI more than 35 kg/m2, and neck size more than 17.5 cm in the postmenopausal group compared with the premenopausal group (P<0.05). The presence of restless leg syndrome was reported in 87.9% of the postmenopausal compared with 81% in the premenopausal group. Regarding the presence and type of insomnia, there was no significant difference. More than 30% of women had initiation insomnia and the vast majority of them had difficulty in maintaining sleeping. The proportion of women with insufficient length of sleep was significantly higher among postmenopausal women. The premenopausal group had a statistically significant lower proportion of N1 (9.2%) and N2 (3%) compared with N1 (18.2%) and N2 (6.1%) in the postmenopausal group (P<0.001). The average sleep efficiency, daytime sleep latency, and apnea–hypopnea index were comparable between both groups. Conclusion Postmenopausal women had statistically significant higher STOB-Bang score and insufficient length of sleep, which may reflect a significant change in sleep architecture and patterns after menopause, which could be explained by the hormonal changes that occur after menopause.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
CASE REPORTS Top

A piece of broken intubation tube stylet as endobronchial foreign body p. 774
Tajik Mohammed Shafi, Nithya Haridas, Preeti Belagundi, Asmita A Mehta
DOI:10.4103/ejb.ejb_52_19  
Endotracheal tube stylets are still being used in many medical centres for difficult intubations. In rare cases, it may break inside the trachea during endotracheal intubation and may sometimes move unnoticed deep into the tracheobronchial tree. In this case report, the authors describe a rare complication after endotracheal tube (ETT) stylet intubation in a patient in whom a broken piece of metal guide remained in her tracheobronchial tree. A 69-year-old lady was admitted to our hospital for management of shortness of breath and cough with expectoration. The patient was a known case of chronic obstructive pulmonary disease, cor pulmonale and coronary artery disease. The authors report a case of an unrecognized broken piece of stylet in her tracheobronchial tree and left main bronchus, which was later detected by computed tomography scan and extracted. Despite precise evaluation before use, signs of breakage in the stylet may be missed, and, consequently, it may break inside the trachea and result in serious complications. It is strongly recommended that the intensivists pay attention to the sounds and movements of the instruments.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Spontaneous resolution of persistent lymphadenitis: a case of Kikuchi–Fujimoto disease p. 778
Divya Ramachandran, Rajesh Venkitakrishnan, Jolsana Augustine, Melcy Cleetus
DOI:10.4103/ejb.ejb_26_19  
Cervical lymphadenopathy is common in all age groups. Persistently enlarged cervical lymph nodes often pose a diagnostic challenge and necessitate focused clinical evaluation with targeted investigations. Pathological examination of excised node yields conclusive answer in the vast majority of cases with unsettled diagnosis. We present a case of a young man with persistent posterior cervical lymphadenopathy which on excision biopsy turned out to be Kikuchi–Fujimoto disease. With watchful follow-up, he had a self-limiting clinical course in the next few months.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Submandibular salivary gland involvement in granulomatosis with polyangiitis p. 781
Mohamed F Abdelghany, Mohammad G.A Khalaf
DOI:10.4103/ejb.ejb_15_19  
Introduction Granulomatosis with polyangiitis (GPA) is one of the forms of small vessel vasculitis. It is a rare condition that needs a high degree of suspicion to reach the diagnosis. It is one of the causes of diffuse parenchymal lung disease, with a very wide differential diagnosis. It is commonly misdiagnosed with malignant, granulomatous, and infectious lung diseases. Case presentation We report a case of a 31-year-old male who presented with productive cough, shortness of breath, hemoptysis, nasal obstruction, and epistaxis together with submandibular salivary gland swelling. Diagnosis of GPA was based on characteristic cavitary lung lesions, nasal and salivary gland involvement, pathological samples that revealed necrotizing granulomatous inflammation, characteristic positive Cytoplasmic- ANCA (C-ANCA), together with exclusion of malignancy and tuberculosis. Conclusion GPA is a rare condition. Salivary gland involvement should raise suspicion about GPA, in addition to other systemic manifestations.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Tracheal bullet excreted with the stool: a rare course of events in airway gunshot injury p. 786
Nasir U Din Wani, Tasneem Muzaffar, Syed A Hussain, Yasir Wani, Danish Zahoor, Aaliya Wani, Farhana Bashir
DOI:10.4103/ejb.ejb_17_19  
Over the past 10 decades, only five cases have been published of firearm injuries of the chest with conservative management, who in the follow-up expectorated the bullet. We report the first case in the history of gunshot injury chest, where a bullet was found near the posterior-lateral wall of the trachea of the patient who eventually expectorated the bullet with subsequent ingestion and excretion with stools. We try to emphasize the role of repeat morning radiograph in these patients.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
Feedback

Subscribe this journal
Submit articles
Most popular articles
Joiu us as a reviewer
Email alerts
Recommend this journal