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   Table of Contents - Current issue
October-December 2017
Volume 11 | Issue 4
Page Nos. 293-390

Online since Friday, November 3, 2017

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The impact of metabolic syndrome on ventilatory pulmonary functions p. 293
Medhat F Negm, Tarek S Essawy, Osama I Mohammad, Tahany M Gouda, Ayman M EL-Badawy, Asmaa G Shahoot
Background A relationship between metabolic syndrome (MS) and lung disease has been observed in several cross-sectional and longitudinal studies. This syndrome has been identified as an independent risk factor for worsening respiratory symptoms and higher lung function impairment. Aim The aim of this study was to analyze the effect of MS on ventilatory pulmonary functions. Patients and methods This study included 60 participants. They were divided to two groups − group A included 45 patients with MS, and group B included 15 apparently healthy participants as a control group. All of them were subjected to the following: complete history taking and physical examination (blood pressure, BMI, and waist circumference), laboratory investigations for fasting blood glucose, lipid profile (triglyceride and high-density lipoprotein), C-reactive protein, and HbA1C, and spirometry [forced vital capacity (FVC), forced expiratory volume in first second (FEV1), and FEV1/FVC]. Results Among MS participants (n=45), 28 (63%) had the restrictive ventilatory pattern, three (6%) had the obstructive pattern, nine (20%) were normal, and five (11%) had a mixed pattern. Pulmonary functions were impaired more among MS cases. FVC% predicted of group A was 61.49±17.56%, whereas in group B it was 85.73±5.24%. FEV1% predicted of group A was 66.22±18.7%, whereas in group B it was 87.73±7.98%. The differences were statistically highly significant. Pulmonary function impairment was more prominent among males than among females. After examining the association between metabolic components and both FVC% predicted and FEV1% predicted, the results revealed that there was a strong linear decrease in FVC% predicted and FEV1% predicted as the number of components of MS increased. The β coefficients of FVC% predicted for those with 1, 2, 3, 4, and 5 features of MS were 0.011, −0.018, −0.023, −0.035, and −0.048 in men and 0.020, −0.029, −0.035, −0.047, and −0.068 in women, respectively. The β coefficients of FEV1% predicted for those with 1, 2, 3, 4, and 5 features of MS were 0.009, −0.015, −0.026, −0.041, and −0.051 in men and 0.004, −0.009, −0.017, −0.029, and −0.038 in women, respectively. Conclusion Pulmonary function impairment (mainly restrictive pattern) is commonly associated with MS. FVC and FEV1 are inversely associated with the accumulation of elements of MS and also associated independently with each element of MS, especially waist circumference.
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Prescription of inhalers among pulmonologists and nonpulmonologists: is there a difference? p. 301
Mohammad Taha Abdel Fattah, Ali Omar Abdel Aziz, Mohammad Omar Abdel Aziz, Mohammad Ibrahim Atta, Samir Mohammad Mounir, Sayed Ali Amin
Objective The objectives of this study were to evaluate prescription of inhalers and to assess knowledge and practice of doctors who can deal with asthma and chronic obstructive pulmonary disease patients, regarding inhalation therapies and inhalation techniques. Patients and methods A prospective, cross-sectional survey was carried out on physicians from different specialties who can deal with asthma and chronic obstructive pulmonary disease patients. Results The questionnaire was completed by 443 respondents. Ninety percent of nonpulmonologists mentioned that they frequently see and manage patients with chronic pulmonary diseases. Totally, 25 physicians reported that they never prescribe inhaler medications. The most common cause for no or little prescription was that ‘patients refused to use inhalers’ (42.0%). The respondents were pediatricians (37.3%), internists (33.7%), primary-care physicians (16.0%), and pulmonologists (12.9%). About 52% stated that they themselves provided device training for their patients. Pressurized metered dose inhalers were preferred by 64.8% of physicians. Only 21.3% had good general inhaler therapy knowledge (score >2). Pulmonologists scored higher than other specialty groups regarding good knowledge of inhalation therapy (66.7%), whereas pediatricians scored the lowest (8.3%). Conclusion Prescription of inhalers, knowledge among physicians regarding inhalation therapy, and correct use of inhalers varied between pulmonologists and nonpulmonologists, and was generally inadequate. More effort is needed to change the attitude of physicians toward the concept of inhalation therapy.
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Vitamin D deficiency during chronic obstructive pulmonary disease exacerbations p. 311
Hassan A Shabana, Naser K Abdelnaby, Moustafa S Moustafa, Waleed R Arafat
Background Vitamin D deficiency is widespread and associated with increased risk of chronic diseases. The relation between chronic obstructive pulmonary disease (COPD) and vitamin D is complex owing to comorbidities, which are affected by vitamin D. Patients with low vitamin D showed higher risk for exacerbations. Aim The aim was to study the status of vitamin D in patients during exacerbation of chronic obstructive pulmonary disease (AECOPD). Patients and methods The study included 205 patients presented with AECOPD and 150 controls. Patients and controls were subjected to full clinical history and examination, pulmonary function testing, and vitamin D [hydroxyvitamin D, 25(OH)D] examination by Liaison 25 OH Vitamin D assay (direct competitive chemiluminescence immunoassay, DiaSorin Inc, Stillwater, Minnesota, USA) in serum. Symptom scoring was done using modified Medical Research Council (mMRC) and combined assessment of Global Initiative for Chronic Obstructive Lung Disease COPD classification, with division into groups A, B, C, and D. Data related to severity of exacerbation, site of care, and hospital days were gathered. Statistics Pearson’s χ2-test was used to compare the prevalence of categorical variables between patients with COPD and control groups. t-Test was used to compare differences in the levels of continuous variables between the two groups. R2-test was used to measure how close the data are to be fitted in the regression line. Results 25(OH)D was significantly lower in patients with AECOPD than control group (mean: 39.5±32.5 vs. 56.3±43.7 nmol/l, P˂0.05). Vitamin D insufficiency (25–75 nmol/l) was significantly higher in patients than controls [115 (56.09%) patients vs. 51 (34%) controls, P<0.05]. Dyspnea score (mMRC) was higher in deficiency group (70.1% having two or more mMRC score) compared in insufficiency and sufficiency groups (51.3 and 51.5%, respectively). Patients with mild and moderate COPD (forced expiratory volume in first second >50%) showed higher 25(OH)D (69.4±23.1) than patients with severe and very severe COPD (forced expiratory volume in first second <50%) (47.4±28.3), with P value less than 0.05. Patients required hospitalization showed lower levels of 25(OH)D compared with patients treated at home (23±14.9 and 52±22.1, respectively), with P value less than 0.05. Hospital days were higher in deficiency group (3.78±3.51 days) compared with insufficiency group (1.68±2.33 days) or sufficiency group (1.3±1.7 days), with P value less than 0.05. Conclusion Vitamin D is low in patients with COPD during AECOPD. The relationship is linear with lung function, disease severity groups and with previous exacerbation rate. Severe exacerbations requiring hospital admission and lengthy hospital stay were demonstrated in patients with low vitamin D.
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Total antioxidant capacity as a marker in predicting severity of chronic obstructive pulmonary diseases p. 322
Ragaa H.M. Salama, Maha M Elkholy, Samiaa Hamdy Sadek, Israa G Mahdy
Background The pathogenesis of chronic obstructive pulmonary disease (COPD) is multifactorial; oxidative stress is suggested to be one of the pathogenetic factors. Objective The aim of this study was to assess the role of antioxidant status in pathogenesis of COPD and in predicting the severity of airway obstruction. Patients and methods This case-controlled study was carried on 60 patients with COPD, and on 15 apparently healthy age-matched smokers and 15 apparently healthy age-matched nonsmokers, which served as control groups. Bronchoscopy with bronchoalveolar lavage was carried out for 10 COPD patients. Chest radiography, pulmonary function testing, and arterial blood gases were carried out for all groups. Serum level of total antioxidant (TAO) was also measured in all groups by using the enzyme-linked immunosorbent assay kit. Results Serum TAO level was significantly reduced in COPD patients and healthy smokers compared with healthy nonsmokers (P<0.001, respectively); moreover, serum TAO level was significantly reduced in COPD compared with healthy smokers (P<0.001), and serum TAO was significantly reduced in severe and very severe COPD compared with mild and moderate COPD (P=0.01 and 0.006, respectively). TAO level significantly negatively correlated with each of PaCO2 and HCO3 in COPD patients, and it was significantly positively correlated with each of forced expiratory volume in 1 s/forced vital capacity and forced expiratory volume in 1 s %. TAO had a sensitivity and specificity of 86.67 and 93.33, respectively, as a biomarker for identification and predicting the severity of COPD with an area under the curve of 0.921. Conclusion Serum TAO is a valuable biomarker in identifying and predicting the severity of COPD.
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Association of acute kidney injury defined with the AKIN criteria and poor outcome in acute respiratory distress syndrome patients Highly accessed article p. 327
Mohamed H Saleh, Mohamed O Elghonemi
Background Few studies have reported the deleterious association between acute respiratory distress syndrome (ARDS) and acute kidney injury (AKI). We aimed to evaluate the association of AKI and poor outcome in ARDS patients and whether this association is related to fluid overload or not. Patients and methods Sixty-four patients diagnosed with ARDS and had been mechanically ventilated were enrolled. AKI was diagnosed using the Acute Kidney Injury Network criteria. Patients were stratified into two groups according to the degree of renal impairment. All data were statistically analyzed. Results The mean age of the studied patients was 47.23±10.12 years; 33 (51.6%) were men. In group 2, the follow-up Lung Injury Severity Score and length of hospital stay were significantly higher compared with group 1: 3.33±0.74 points and 19.11±6.37 days versus 2.84±0.57 points and 12.38±4.21 days (P=0.004 and <0.001, respectively). Also, they had higher need to use vasoactive (VA) agents, 21 (55.3%) versus 6 (23.1%) patients, and spent more days on mechanical ventilation, 14.18±4.59 versus 8.51±3.77 (P=0.019 and <0.001, respectively). In-patient mortality was higher in group 2 compared with group 1: 18 (66.7%) versus 6 (23.1%) (P=0.019). In-patient mortality was significantly correlated with the need to use VA agents and higher cumulative fluid balance (R=0.394 and 0.24, P=0.001 and 0.05, respectively). The need to use VA agents was the only independent predictor of mortality (odds ratio=4.18, P=0.022). Conclusion AKI as defined on the basis of the Acute Kidney Injury Network criteria is associated with poor outcome in ARDS patients.
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Does nebulized heparin have value in acute respiratory distress syndrome patients in the setting of polytrauma? p. 332
Mohamed H Saleh, Emad Omar
Background Several studies have been conducted with anticoagulants in the setting of experimental lung injury in animals and acute respiratory distress syndrome (ARDS) in humans. However, the clinical evidence for pulmonary anticoagulant therapy is still limited. Aim We aimed to assess the value of the use of nebulized heparin in ARDS patients in the setting of polytrauma. Patients and methods Eighty patients admitted with polytrauma and diagnosed to have ARDS and mechanically ventilated were enrolled. Patients were divided randomly into two groups, and each group included 40 patients: group 1 received nebulized heparin at a dose 5000 IU every 4 h, and group 2 served as control. All clinical and laboratory data were recorded. Patients were followed up during their whole ICU stay. All data were statistically analyzed. Results The mean age of the studied patients was 34.35±14.6 and 34.87±14.86 years in group 1 and group 2, respectively. After 1 week, patients in group 1 had significant improvement in their PO2/FiO2 and lung injury severity score compared with patients in group 2 (231.1±42.7 and 1.82±0.66 vs. 203.6±45.9 and 2.35±0.35, P<0.001, respectively). Group 1 spent less days on mechanical ventilation and their length of ICU stay was lower compared with group 2 (9.6±13.5 and 12.7±4.3 days vs. 13.5±3.1 and 17.7±3.7 days, respectively, P<0.001). Other outcome parameters such as development of multiple organ dysfunction syndrome, the need to use vasoactive agents, and mortality did not differ between both groups (12, 62.5, and 20% vs. 15, 57.5, and 22.5%, P=0.5, 0.41, and 0.61, respectively). Conclusion Nebulized heparin may be beneficial and safe but has no survival benefit in ARDS patients in the setting of polytrauma.
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The value of rapid on-site evaluation during endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of mediastinal lesions p. 336
Adel S Bediwy, Khaled Zamzam, Mohamed Hantira, Dalia El-Sharawy, Ayman ElSaqa, Yomna Zamzam
Introduction Rapid on-site evaluation (ROSE) is a technique used for immediate interpretation of transbronchial aspirates; there is debate as regards the contribution of ROSE to the diagnostic or staging process in patients with lung cancer undergoing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Aim of the study The aim of this study was to evaluate the role of ROSE during EBUS-guided TBNA in the diagnosis of the nature of mediastinal/hilar lesions detected using thoracic computed tomography regardless of whether or not there is a known lung malignancy. Patients and methods All patients with hilar/mediastinal lymph nodes having short axis of at least 1 cm on new thoracic computed tomography scan were included. The target lymph node was examined using real-time EBUS B-mode, and then TBNA was performed by inserting a dedicated 22-G needle through the working channel of the bronchoscopy. The samples were examined using the ROSE technique and then compared with the results of the final pathologic diagnosis. Results The current study was conducted on 47 patients (29 male and 18 female) with a age (mean±SD) of 56±15.4 years. EBUS-TBNA was performed for 129 mediastinal lesions in different stations. Among them, 77 of them were diagnosed as malignant initially on performing ROSE. After final histopathological and immunological examination, 74 lesions were proved to be malignant, whereas three lesions turned out to be benign. 52 lesions were diagnosed as benign on ROSE, whereas four of them were proved to be malignant on the final diagnosis, giving ROSE a specificity of 94.12%, sensitivity of 94.87%, and diagnostic accuracy of 94.57%. Conclusion ROSE has add-on advantages to EBUS-TBNA in many aspects, increasing diagnostic accuracy of EBUS-TBNA, increasing safety, and providing sufficient samples for subsequent immunocytochemical and molecular analysis.
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Real-time polymerase chain reaction as an alternative method for diagnosis of multidrug-resistant tuberculosis: can it stand alone in this concern? p. 342
Gamal Rabie Agamy, Safaa Moktar Wafy, Asmaa Omar Ahmed, Lamees Mohamed Bakar
Background Delays in diagnosing multidrug-resistant tuberculosis (MDR-TB) are responsible for higher tuberculosis morbidity and mortality and its subsequent transmission. Molecular assays such as real-time PCR (RT-PCR) used to identify drug resistance in Mycobacterium tuberculosis are more rapid than standard drug susceptibility testing. Objectives The aim of this study was to evaluate the diagnostic performance of the Anyplex MTB/MDR RT-PCR assay in detecting MDR-TB strains. Patients and methods Sputum samples were collected from 29 patients with symptoms and radiological findings suggestive of active pulmonary tuberculosis, with at least one of three sputum smear samples showing acid-fast bacilli and/or sputum culture isolates positive for M. tuberculosis. The results obtained by RT-PCR were compared with those obtained by the Mycobacterium growth indicator tube SIRE method. Results M. tuberculosis was confirmed in 29 specimens. Only six cases determined as MDR-TB were obtained by Mycobacterium growth indicator tube SIRE. For detection of rifampicin-resistant and isoniazid-resistant strains, the RT-PCR assay yielded a sensitivity of 62.5 and 66.66% and specificity of 80 and 95%, respectively. The overall sensitivity of that assay was 64.2% and specificity was 88.88%. Conclusion RT-PCR is an easy and reliable assay for rapid detection of MDR-TB in clinical specimens. However, RT-PCR should be followed by a culture method to increase the overall sensitivity of that assay.
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Diagnostic utility of QuantiFERON-TB Gold and Xpert MTB/RIF combined with adenosine deaminase in tuberculous pleural effusion: a prospective study p. 346
Hassan Aref
Objective Tuberculous pleural effusion remains difficult to diagnose despite numerous diagnostic tools. The aim of this study was to evaluate and compare the diagnostic efficiency of adenosine deaminase (ADA) analysis in the diagnosis of tuberculous pleural effusion when used alone or in combination with QuantiFERON-TB Gold (QFT-G) or Xpert MTB/RIF. Patients and methods Seventy-one patients with unknown bilateral or unilateral pleural effusion were subjected to pleural tapping, and pleural fluid samples were subjected to total ADA, QFT-G, and Xpert MTB/RIF. Pleural biopsies (thoracoscopic or closed) were performed for 41 patients, sent for histopathology of tuberculosis culture and Xpert MTB/RIF, and they were differentiated into tuberculous (TB) and non-TB effusions by culture for Myobacterium tuberculosis and/or histopathology of pleural biopsy. ADA results were further analyzed using receiver operating characteristic curve to determine the cutoff values to achieve the optimum sensitivity and specificity. Results Forty-six patients had definite TB pleural effusion and 25 patients had non-TB pleural effusion. For ADA at a cutoff point of >40 IU/l, the sensitivity was 97.83% (n=45) [95% confidence interval (CI): 88.47–99.94%) and specificity was 76.00% (95% CI: 54.87–90.64%), but at a cutoff point of 70 U/l, the specificity was 96.00% (95% CI: 79.65–99.90%) and sensitivity was 84.78% (n=39) (95% CI: 71.13–93.66%). The sensitivity of QFT-G was 23.91% (95% CI: 12.59–38.77%) and specificity was 96.00% (95% CI: 79.65–99.90%). The sensitivity of Xpert MTB/RIF was 47.83% (95% CI: of 32.89–63.05%) and specificity was 100.00% (95% CI: 86.28–100.00%). Combined analysis of ADA at a cutoff value greater than 70 U/l with Xpert MTB/RIF showed a sensitivity of 85.64% (95% CI: 71.13–96.23%) and specificity of 98.50% (95% CI: 78.64–99.93%). ADA at a lower cutoff value greater than 40 U/l showed a sensitivity of 96.78% (95% CI: 77.13–99.66%) and specificity of 97.00% (95% CI: 79.65–99.90%). Conclusion ADA is a useful marker in the diagnosis of TB pleural effusion. ADA specificity with low cutoff value can be improved by combining with Xpert MTB/RIF, resulting in an accurate test to identify patients with suspected TB pleural effusion.
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Evaluation of the efficiency of anthropometric parameters and submental ultrasonographic indices as predictors for screening of obstructive sleep apnea and its severity p. 355
Eman Ramzy Ali, Ahmad Mostafa Mohamad
Background Obstructive sleep apnea (OSA) syndrome is a chronic disease characterized by episodes of upper airway collapse, and has been associated with increased cardiovascular morbidity. Clinical and epidemiological studies have shown that OSA and obesity are strongly associated. Aim The aim of this study was to demonstrate probable positive predictive anthropometric indices and ultrasonic parameters (anatomical and dynamic) and their possible cutoff values for the diagnosis of OSA and its severity. Patients and methods A total of 80 adult patients with at least one of the major OSA symptoms were included in this study, and polysomnography was performed to confirm diagnosis and classify patients according to apnea–hypopnea index into mild, moderate, and severe groups. Anthropometric indices such as abdominal circumference, hip circumference, and neck circumference (NC) were measured for all included patients. Submental ultrasound was performed to measure retropalatal diameter, distance between lingual arteries, retroglossal airspaces, and tongue base thickness. Results The cutoff values of 39.5 cm for NC (sensitivity of 80% and specificity of 77%) and of 25 mm for retropalatal diameter during Muller maneuver (sensitivity of 80% and specificity of 82%) showed the most predictive value for both the presence and the severity of OSA, especially when used concomitantly (with 100% sensitivity and 90% specificity). Conclusion Concomitant submental ultrasonography and NC may be a promising tool for screening of OSA and its severity for possible early intervention.
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Value of STOP-BANG and Berlin questionnaires in the diagnosis and severity prediction of obstructive sleep apnea hypopnea syndrome p. 367
Lucy A Suliman, Nesrien M Shalabi, Ahmed S Elmorsy, Mona K Moawed
Background Obstructive sleep apnea (OSA) screening questionnaires are used for predicting OSA in sleep clinics or in general population because of the unavailability and time-consuming nature and cost of polysomnography (PSG). Aim of the study This study was conducted to assess the value of STOP-BANG questionnaires as well as Berlin questionnaire in the diagnosis and severity prediction of OSA. Patients and methods This study was conducted on 50 patients suspected to have obstructive sleep apnea hypopnea syndrome (OSAHS) recruited from sleep clinic. STOP-BANG and Berlin questionnaires were administered to all patients with documentation of results and assessment of the validity of these results when compared with full-night PSG. Results The overall mean age of the studied patients was 45.80±10.97 years. Eighty percent constituted OSAHS patients and 20% constituted non-OSAHS patients. The cutoff point of STOP-BANG questionnaire for the diagnosis of OSAHS patients in this study was 2.5 with 82.5% sensitivity and 90% specificity (P<0.001). The cutoff point of Berlin questionnaire N for the diagnosis of OSAHS patients was 1.5 with 90% sensitivity and 80% specificity (P<0.001). For prediction of severity, the cutoff point of STOP-BANG questionnaire for severity scoring of OSAHS patients was 5.5 with 90% sensitivity and 100% specificity (P<0.001). The cutoff point of Berlin questionnaire for the prediction of severe OSAHS patients was 2.5 with 75% sensitivity and 55% specificity (P=0.058). Conclusion STOP-BANG and Berlin questionnaires are considered valid tools for the diagnosis and severity prediction of OSA with high sensitivity and specificity in comparison with PSG, and hence the number of patients referred for PSG could be decreased.
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Nocturnal heart rate variability in obstructive sleep apnea syndrome: effect of automatic positive airway pressure p. 372
Iman H Galal
Background The cyclic hypoxemia and arousal characteristic of obstructive sleep apnea (OSA) causes dysregulation in the autonomic nervous system (ANS) resulting in cardiac rhythm disturbances. Positive airway pressure therapy in OSA results in ANS regulation. This study aimed at investigating the effects of automatic positive airway pressure (APAP) over nocturnal heart rate variability (HRV) in OSA and to further identify this effect in hypertensive versus normotensive OSA patients. Patients and methods A total of 25 patients (four with moderate and 21 with severe OSA) were included (male/female: 22/3; mean age 49.52±15.69 years). Patients were subdivided into two groups: 13 (52%) normotensive and 12 (48%) hypertensive patients. Two overnight sleep studies with polysomnographic-based nocturnal HRV were carried out: the first study was diagnostic, whereas the second one was an APAP titration study. Results APAP results in significant reduction in most of time and frequency-domain indexes [except for standard deviation of average NN interval (SDANN, P=0.106), HRV triangular index (HRV TI, P=0.057), and high-frequency power (HF, P=0.109)]; RR interval (P=0.024), standard deviation of all RR intervals (SDNN, P=0.012), mean of the standard deviation of all RR intervals for all 5-min segments (SDNN Index, P=0.009), square root of the mean of the sum of the squares of differences between adjacent RR intervals (RMSSD, P=0.002), number of pairs of adjacent RR intervals differing by more than 50 ms in the entire analysis interval (NN50 count, P=0.004), NN50 count divided by the total number of all RR intervals (%NN50, P=0.001), total power (P=0.010), very low-frequency power (VLF, P=0.018), low-frequency power (LF, P=0.008), and low frequency/high frequency (LF/HF, P=0.012). HRV did not differ significantly between the two groups either before or after APAP; however, most of the time-domain and frequency-domain HRV indexes decreased significantly with APAP in the hypertensive group. Conclusion Nocturnal HRV improved with APAP in OSA. APAP was more beneficial in terms of ANS regulation in OSA patients with coexisting hypertension than normotensive OSA patients.
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Irritable bowel syndrome in obstructive sleep apnea: a preliminary Egyptian study p. 379
Adel M Saeed, Iman H Galal
Background Sleep disturbances represent a common extra-intestinal manifestation of functional gastrointestinal disorders. This study aimed to determine the prevalence of irritable bowel syndrome (IBS) among some Egyptian patients with obstructive sleep apnea (OSA) and to further assess the correlation between the prevalence of IBS and the severity of OSA. Patients and methods Patients referred to the Sleep Disorders Clinic with polysomnographically (PSG) confirmed OSA were included. A second group that included 15 patients with OSA-free IBS was enrolled as controls. For all patients, the Epworth Sleepiness Scale and the Berlin Questionnaire were used to assess subjective sleep quality and overnight PSG was performed to assess objective sleep quality. Results A total of 256 patients with OSA were included; 225 (87.9%) were men and 31 (12.1%) were women. The mean (SD) age of the patients was 49.84 (11.41) years, with a range of 24–81 years. In terms of the severity of OSA, 40 (15.6%) patients had mild OSA, 33 (12.9%) patients had moderate OSA, and the remaining 183 (71.5%) patients had severe OSA. Among the study participants with OSA, IBS was found in 93 patients (80 men and 13 women); the prevalence of IBS was 36.3%. The severity of OSA among OSA patients with IBS was as follows: 23 had mild OSA, 11 had moderate OSA, and 59 had severe OSA. There were nonsignificant differences between OSA patient subgroups for both Epworth Sleepiness Scale and the Berlin questionnaire (P>0.05); yet, two objective PSG parameters differenced significantly: apnea–hypopnea index (P=0.005) and sleep latency (P=0.01). Neither subjective nor objective sleep disturbances were found among the IBS controls. In the OSA group, IBS correlated significantly and inversely with apnea–hypopnea index (r=−0.171, P=0.006), and OSA grading of severity (r=−0.173, P=0.005). Conclusion IBS is prevalent in OSA patients and is correlated inversely with the severity grading of OSA.
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Severe thrombocytopenia and intracranial hemorrhage: Unusual presentation of tuberculosis p. 386
Saad R Samra
Background Although various hematologic abnormalities are seen in tuberculosis (TB), severe thrombocytopenia is a rare event. Case presentation We report a case of a 26-year-old female patient who presented with severe thrombocytopenia-induced hemoptysis, macroscopic hematuria, and intracranial hemorrhage. The patient was found to have clinical, microbiological, and histopathological evidence of TB. The thrombocytopenia was successfully treated with anti-TB drugs. Conclusion Severe thrombocytopenia can be one of the hematological manifestations of TB that is successfully treated with anti-TB drugs.
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