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Comparison between bronchoscopy under general anesthesia using laryngeal mask airway and local anesthesia with conscious sedation: a patient-centered and operator-centered outcome
Hesham Raafat, Mahmoud Abbas, Sameh Salem
July-December 2014, 8(2):128-137
Background and objectives With the evolution of complex bronchoscopic procedures, search for procedures that were less painful to patients and easier for the operators to perform commenced. Conscious sedation partially achieved this target. We aimed to compare conscious sedation with general anesthesia (GA) in achieving a safer and more painless procedure. Patients and methods Eighty patients were included: 36 (45%) were subjected to local anesthesia (LA) with midazolam and 44 (55%) to GA through laryngeal mask airway. Patients responded to a visual analogue scale (VAS) for cough, choking, dyspnea, nausea, vomiting, nasal symptoms, chest pain, and anxiety during bronchoscopy. Postbronchoscopy VAS included cough, fever, dyspnea, nausea, vomiting, nasal symptoms, and hemoptysis. Lastly, VAS for the tolerability of bronchoscopy and acceptance to repeat the procedure were answered. Operator VAS included cough, desaturations, easiness of the procedure, and success. Bronchoscopy, recovery times, the number of biopsies, and cost were recorded. Results GA was significantly less symptomatic during bronchoscopy than LA (P = 0.0001). Nasal symptoms were more in LA after bronchoscopy (P = 0.003). Anxiety was more in LA (P = 0.014). The GA group found bronchoscopy to be more tolerable (P = 0.0001), and accepted to repeat the procedure (P = 0.001). The operator found that GA was associated with significantly less cough and desaturations, and was easier to perform (P = 0.0001). The duration of the procedure, the recovery time, the number of biopsies, and the cost were significantly higher in GA (P = 0.0001). Safety was equal in both groups. Conclusion GA serves as a more peaceful procedure for the patient and the operator than LA, but at the expense of recovery time and cost. Egypt J Broncho 2014 8:128-137
  2,166 161 -
Early detection of malignant pleural mesothelioma
Hussein F Mahmoud
January-June 2014, 8(1):1-9
Malignant pleural mesothelioma (MPM) is a rare tumour. Exposure to asbestos is a well-established aetiological factor for MPM. Patients typically present with shortness of breath due to pleural effusion or chest pain in a more advanced stage. The diagnosis is usually suggested by imaging studies (unilateral pleural thickening; pleural effusion). An occupational history must be obtained. Cytological examination of the effusion can be diagnostic, but often shows equivocal results. Therefore, histology, including immunohistochemistry, is the gold standard. Thoracoscopy, a video-assisted surgical procedure or open pleural biopsy in a fused pleural space may be necessary to provide sufficient material for accurate histological diagnosis. There are three main histological types (epithelial, sarcomatous and mixed) with ∼60% being epithelial. Data suggest the possible contribution of serum mesothelin-related proteins and osteopontin along with others as useful markers to support the diagnosis of mesothelioma; however, the precise role of these markers is yet to be defined.
  1,901 230 -
Evaluation of diffusing capacity of the lung for carbon monoxide normalized per liter alveolar volume as a parameter for assessment of interstitial lung diseases
Nermine M Riad, Hala M Salem, Haytham S Diab
January-June 2014, 8(1):51-56
Introduction The single-breath (SB) diffusing capacity for carbon monoxide (DLCO) is the most clinically useful routine pulmonary function test after spirometry and lung volumes. The DLCO is the product of two measurements during breath holding at full inflation: (i) the rate constant for carbon monoxide uptake from alveolar gas and (ii) the accessible alveolar volume (VA). DLCO divided by VA (DLCO/VA), also called Krogh factor, reflects physiology more appropriately. It reflects the diffusing capacity in the available alveolar spaces. AimThe aim of the study was to assess the validity of DLCO/VA interpretation in patients with interstitial lung diseases. Patients and methods This study involved 53 patients diagnosed as interstitial lung disease who presented to our pulmonary function laboratory in the Chest Department at Ain Shams University Hospital. Spirometry and DLCO-SB technique were performed. Results Fifty-three patients with mean age of 47.11 ± 13.7 years were included, 20 women and 33 men. The study showed positive correlation between age and forced vital capacity (FVC) and negative correlation between age and residual volume (RV). Height was significantly statistically related to DLCO, DLCO/VA, and total lung capacity (TLC)-SB. FVC showed no correlation with both DLCO and DLCO/VA. However, it was positively correlated with TLC-SB, VA, RV, and functional residual capacity. The mean of DLCO was 45.62 ± 17.19 and of DLCO/VA was 76.5 ± 31.7. DLCO showed a significant relationship with the following parameters: DLCO/VA, TLC, and RV/TLC. DLCO/VA showed positive statistical correlation with DLCO and TLC and negative correlation with VA. VA was positively correlated with TLC, FVC, and RV. However, it was negatively correlated with DLCO/VA. Conclusion DLCO and DLCO/VA should be interpreted coherently with each other especially in restrictive lung diseases; in addition, VA and TLC-SB give a good guide for lung volume in interstitial lung disease.
  1,844 146 -
Effects of obesity on respiratory mechanics at rest and during exercise
Amr Shoukri
September-December 2015, 9(3):224-226
Obesity is a major health problem worldwide. The prevalence of obesity is increasing and its association with multiple comorbidities is now firmly established. It is considered as an independent risk factor for reduced survival. Obesity directly affects respiratory mechanics at rest and during exercise. Obese individuals usually show changes in certain lung volumes, respiratory compliance and ventilatory behaviour. Dyspnoea is the limiting symptom usually experienced by these individuals.
  674 1,292 -
A study of IL-6, IL-8, and TNF-α as inflammatory markers in COPD patients
Wafaa S El-Shimy, Ayman S El-Dib, Hala M Nagy, Wael Sabry
July-December 2014, 8(2):91-99
Aim To assess the diagnostic value of interleukin 6 (IL-6), IL-8 and tumor necrosis factor-α (TNF-α) as inflammatory markers in chronic obstructive pulmonary disease (COPD) patients. Methods and results IL-6, IL-8 and TNF-α levels were measured by ELISA in the serum and the bronchoalveolar lavage (BAL) in 10 control participants and 25 mild and moderate COPD patients, whereas 25 patients with severe COPD were studied for the serum level of these inflammatory biomarkers. The mean value and SD of BAL and serum IL-6, IL-8 and TNF-α levels were significantly higher in COPD patients when compared with control participants; the serum level of these biomarkers were also significantly higher in severe compared with mild and moderate COPD patients. Conclusion Increased srum and/or BAL IL-6, IL-8 and TNF-α can be used as biomarkers of the systemic inflammatory response in COPD patients, and their levels are correlated with the severity of COPD. Egypt J Broncho 2014 8:91-99 ͹ 2014 Egyptian Journal of Bronchology.
  1,592 289 1
Flow versus pressure triggering in mechanically ventilated acute respiratory failure patients
Magdy M Khalil, Nevine M Elfattah, Mohsen M El-Shafey, Nermine M Riad, Raed A Aid, Alaa M Anany
May-August 2015, 9(2):198-210
Background: The effects of flow triggering (FT) compared with pressure triggering (PT) on breathing effort have been the focus of several studies, and discrepant results have been reported; yet, it remains an area of conflict that warrants further studies. Objective: The aim of this work is to compare flow versus PT in ventilating patients with acute respiratory failure. Patients and methods: One hundred patients with acute respiratory failure of pulmonary origin were assigned randomly to two groups: 50 patients ventilated with PT and 50 patients ventilated with FT. The primary end points were weaning duration, evaluation of patient/machine synchronization, total duration of ventilation and ICU stay as well time under sedation and occurrence of complications. Mortality was considered the secondary end point. Patients were categorized into those with obstructive, restrictive, and combined pulmonary disease according to their medical history, and clinical and radiological assessment, and also more and less severe disease according to the APACHE II score level (cut-off point). Results: In all the patients studied, including those with restrictive pulmonary disorder and more severe disease (APACHE II score ≥32.5), there was a statistically significantly shorter duration of weaning, duration of ventilation, and duration of ICU stay in the FT group than the PT group. The pre-extubation oxygenation index was highly statistically significantly better in the FT group than the PT group (P < 0.001). In patients with obstructive pulmonary disorders, combined pulmonary disorders, and less severe disease (APACHE II <32.5), there was no significant difference between both PT and FT groups in these parameters. Conclusion: FT may be considered to be better than PT in ventilating acute respiratory failure patients with a restrictive pattern and those with higher severity scoring. In obstructive and mixed ventilatory impairment, use of either of them does not make a difference.
  1,726 152 -
Diagnostic impact of integrating ultrasonography into routine practice in respiratory intensive care units
Haitham Salah
July-December 2014, 8(2):66-69
Ultrasound (US) has received increasing interest from chest physicians in recent years especially in Respiratory ICU (RICU) settings. US examination is a valuable method in diagnosis of various thoracic conditions including pleural or pericardial effusion, empyema, pneumothorax, pulmonary embolism, and pneumonia. Its bedside application, easy to learn, short examination time, lower cost, guiding biopsy procedures, altering treatment plans and shortening ICU stay made US a valuable indispensable routine tool in daily management of critically ill RICU patients.
  1,047 730 -
Effect of airway vibratory mucus disintegration on clinical morbidity and management of chronic obstructive pulmonary disease patients
Ahmed Y Gad, Sayed A El-Shafe
July-December 2013, 7(2):43-49
Background Chronic obstructive pulmonary disease (COPD) is the fifth cause of morbidity and mortality in the developed world and represents a substantial economic and social burden. Patients experience a progressive deterioration characterized by airflow limitation, limited and declining performance status with chronic respiratory failure, and severe systemic manifestations/complications. Aim of study The aim of the study was to evaluate the effect of airway vibratory mucus disintegration on clinical morbidity and management of COPD patients. Patients and methods This prospective study was conducted on 30 COPD patients admitted to the Chest Department, Main University Hospital in Alexandria during the period from January 2012 to November 2012. The patients were subdivided into two groups: group I included 15 patients with COPD subjected to conventional treatment and group II included 15 patients with COPD subjected to conventional treatment and mucus disintegration by mechanical vibration. Results A general improvement in cough and dyspnea was observed in the two groups after treatment. Six-minute walking distance was improved after treatment in both groups, but the improvement was statistically significant only in group II after treatment. Partial pressure of oxygen in the blood (PaO 2 ), partial pressure of CO 2 in the blood (PaCO 2 ), and bicarbonate (HCO 3 ) and oxygen saturation (SaO 2 ) showed significant differences before and after treatment among group II patients. The total duration of hospital stay was significantly lower in group II patients than in group I patients. Conclusion We can conclude that there were no adverse effects. Flutter is simple to use, inexpensive, and fully portable, and once the patient and family are instructed its use, it does not require the assistance of a caregiver.
  1,021 681 -
Role of multislice computed tomography in evaluation of thoracic lymphadenopathy
Adel Rezk, Sameh Hafez, Alaa Abd Al-Hamid, Ahmed Youssef Shaaban Gad, Mohamed Khamis
January-June 2014, 8(1):17-22
Background Mediastinal masses and lymphadenopathy are often incidentally detected on chest radiograph. Despite diagnostic limitations, the chest radiograph is also important for detecting and localizing mediastinal masses and lymphadenopathy when suspected clinically. Multislice computed tomography (CT) has transformed CT from a transaxial cross-sectional technique to a three-dimensional imaging modality. Aim The aim of this study was to assess the role of multislice CT in evaluation of thoracic lymphadenopathy (lymph node). Patients and methods The present study was conducted on 25 patients with thoracic lymphadenopathy on plain chest radiograph or clinically suspected with unremarkable chest radiograph recruited from the main university hospital of Alexandria. All patients were subjected to detailed history taking, full clinical examination, and conventional radiograph and multidetector CT of the chest with intravenous contrast, using four and six multidetector CT scanners, GE Lightspeed and Simens Emotion 6, respectively. The scan parameters used were 120 kVP and less than 240 mA per slice; tube rotation was 0.75 s and slice thickness was 1.25 mm. Fiberoptic bronchoscopy with transbronchial needle aspiration biopsy was performed according to radiological and bronchoscopic landmarks for cytological examination and histological examination. Results In this study, metastatic lymphadenopathy was encountered in nine patients, pulmonary tuberculosis in four, lymphoma in eight, and sarcoidosis in four. The diagnosis was confirmed by transbronchial needle aspiration biopsy and percutaneous needle aspiration from the peripheral lymph node. Conclusion Multislice CT of the chest is considered as a simple, safe, and minimally invasive procedure.
  1,496 141 -
Updates in acute respiratory distress syndrome
Gamal M Agmy
May-August 2015, 9(2):113-117
  1,128 291 -
Cancer-related medical emergencies
Gamal M Agmy
January-June 2015, 9(1):1-9
  1,317 98 -
Prevalence and predictors of chronic obstructive pulmonary disease among high-risk Egyptians
Azza F Said, Ashraf A Ewis, Ahmad A Omran, Mohamed E Magdy, Micheal F Saleeb
January-June 2015, 9(1):27-33
Background Chronic obstructive pulmonary disease (COPD) is the fourth most common cause of death in the world. COPD prevalence, morbidity, and mortality vary across countries and across different groups within countries. In Egypt, COPD is a rising significant health problem; however, information on its prevalence, morbidity, and mortality is still lacking. Aim of the study The first aim was to detect the prevalence of COPD among high-risk Egyptians Global using Initiative for Chronic Obstructive Lung Disease (GOLD) and FEV 1 /FVC < lower limit of normal (LLN) definitions. The second goal was to identify the factors predictive for diagnosis of COPD. Patients and methods This study included 363 randomly selected individuals with a high risk for COPD; 176 were smokers (group I), 107 were construction and brick manufacturer workers (group II), and 80 were women exposed to biomass fuel (group III). All individuals filled out a respiratory questionnaire, were clinically examined, and subjected to spirometric evaluation. Results The prevalence of COPD among high-risk individuals was 9.6 and 17.4% on the basis of GOLD and LLN, respectively. The sensitivity and specificity of prebronchodilator values of FEV 1 /FVC < LLN were 94.3 and 90.8%, respectively, for the diagnosis of COPD. However, our findings support that the postbronchodilator LLN definition is superior in ruling out the presence of COPD, as it has a good negative test specificity of 99.7%. Chest wheezes were the only symptom that was an independent predictor of COPD (odds ratio 4.80, 95% confidence interval 1.57-14.74, P = 0.02). Increasing age, smoking, and mean pack-years were also factors predictive for COPD. Conclusion The prevalence of COPD among high-risk individuals in Egypt was estimated to be about 10% as per GOLD. Prebronchodilator LLN is a reliable method for the diagnosis of COPD and it yields comparable results to the GOLD criteria. The main predictors for COPD diagnosis are old age, smoking history, and presence of chest wheezes.
  1,239 171 -
Chronic obstructive pulmonary disease in treated pulmonary tuberculous patients
Mohamed W Zakaria, Heba A Moussa
January-June 2015, 9(1):10-13
Background/Aim To detect the prevalence of chronic obstructive pulmonary disease (COPD) as a sequel of treated pulmonary tuberculosis (PTB). Materials and methods A total of 50 adults, 28 men and 22 women, with a definite diagnosis of PTB and complete antituberculous therapy, with subsequent presentation of exertional dyspnea and/or cough, and expectorations for which no other alternative cause was found, were included in our study. All the patients underwent full history taking, full clinical examination, chest radiography, erythrocyte sedimentation rate, prebronchodilator and postbronchodilator forced vital capacity (FVC%), and forced expiratory volume (FEV 1 %) in the first second of FEV 1 /FVC%. Results Pulmonary function testing showed 22 patients (44%) with irreversible obstructive pattern denoting chronic obstructive pulmonary disease (COPD), seven patients had restrictive ventilatory defect, and three patients had mixed obstructive and restrictive pattern. Of those 22 patients with irreversible obstructive pattern (COPD), 11 patients (50%) had mild obstruction, nine patients (40.9%) had moderate obstruction, and two patients (9.1%) had severe obstruction. There is a positive correlation between dyspnea and post-tuberculous COPD patients, and a negative correlation between cough and post-tuberculous COPD patients. There is no correlation between the duration since the completion of antituberculous therapy and development of COPD. Conclusion COPD can be a sequel of PTB and should be overlooked, especially in those patients complaining of dyspnea even in the absence of any history of smoking. Post-tuberculous COPD as a cause of COPD in nonsmokers should be now more recognized in countries where the prevalence of PTB is still high.
  1,177 173 -
Evaluation of nasal optiflow device in the management of chronic obstructive pulmonary disease patients with acute excerbations
Adel M Saeed, Khaled M Wagih, Nasra A Hussein
January-June 2015, 9(1):34-42
Background A new form of therapy that provides humidified high-flow oxygen through a nasal cannula has been introduced recently as an alternative in the treatment of spontaneously ventilating patients with high oxygen requirements. Objective The aim of the study was to evaluate the efficacy of a nasal optiflow device in the management of chronic obstructive pulmonary disease (COPD) patients with acute exacerbations in comparison with a conventional venturi mask. Patients and methods Forty-five COPD patients with respiratory failure type II admitted to the RICU at Abbasia Chest Hospital were recruited and divided into two groups: group 1 included 20 randomly selected COPD patients with acute exacerbations connected to a venturi mask; group 2 included 25 randomly selected COPD patients with acute exacerbations connected to nasal high flow (NHF) oxygen with an optiflow system. All patients were subjected to full history taking, thorough clinical examination, and routine laboratory investigations with chest X ray (CXR) and repeated analyses of arterial blood gases (ABGs). Results No statistically significant difference was observed between the two groups with respect to baseline ABG variables (on admission). In both methods (NHF and venturi mask) there was statistically significant improvement in ABG variables in the form of raised pH, PO 2 , and O 2 saturation and reduced PCO 2 when compared with baseline ABG values. Although there was no significant difference in weaning results between the two groups, there was significant decline in PCO 2 in the NHF group. There was no significant difference in the outcome and end result between the two groups; successful weaning was achieved in 70% of patients in the venturi group and in 64% of the NHF group, whereas failure was reported in 30% of patients in the venturi group and in 36% in the NHF group. Conclusion The nasal optiflow device is highly expensive compared with the venturi mask, although both are approximately equally successful in the treatment of COPD patients with respiratory failure type II.
  1,166 124 -
Chest ultrasound versus chest computed tomography for imaging assessment before medical thoracoscopy
Magdy Khalil, Haytham Samy Diab, Hanan Hosny, Emad Edward, Ehab Thabet, Wael Emara, Ahmed Soliman, Hanaa Fayez
July-December 2014, 8(2):149-152
Background and objective The aim of this work was to assess the concordance between chest ultrasound (US) and chest computed tomography (CT) findings before medical thoracoscopy (MT) and the impact of the findings on the conduct and outcome of MT. Materials and methods The study was conducted prospectively on 52 patients referred for MT. All patients received chest X-ray (CXR), chest US, and chest CT before the procedure. Images were evaluated and findings were correlated with thoracoscopic findings. Results US findings were discordant with CT findings regarding consistency, septation, and loculation of effusion in 24/52 patients, with US detecting the findings in 24/24 patients. None of these findings was detectable on CT. US was superior to CT in detection of diaphragmatic nodules (16/52, 3/52, respectively). US findings affected MT conduct in 20/52 cases and outcome in 5/40 cases, and they were consistent with MT findings in 39/40 cases; US and CT missed septation in one case. US findings were concordant with CT findings regarding site and size of effusion and pleural masses, sizable nodules, and thickening. US missed discrete small parietal nodules in 10/52, consolidation in 2/52, mediastinal lymphadenopathy in 6/52, and mediastinal shift in 42/52 cases. CXR could identify mediastinal shift but none of other CT findings were missed by US. None of US-missed abnormalities directly altered MT management. Conclusion US identifies more explicitly the imaging information relevant to MT compared with chest CT. Pre-MT imaging workup can be limited to CXR and US, reserving chest CT for cases in which US is technically unrevealing.
  1,182 108 -
Serum uric acid as a biomarker for prediction of outcomes of patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease
Sameh Embarak, Ashraf E Sileem, Maged Abdrabboh, Ahmed Mokhtar
July-December 2014, 8(2):115-120
Background Serum uric acid, the final product of purine degradation, has been shown to be increased in the hypoxic state as well as in systemic inflammation including patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to assess the possible role of serum uric acid as a biomarker for the prediction of outcome of patients hospitalized for acute exacerbation of COPD (AECOPD). Patients and methods Serum uric acid levels were measured in 115 eligible AECOPD patients on admission. The primary end-point was all-cause mortality at 30 days. The secondary outcomes included the length of hospital stay, need for noninvasive ventilation, or ICU admission within 30 days. Results Serum uric acid presented an area under the receiver operating characteristic curve of 0.721 (95% confidence interval: 0.63-0.80) for the prediction of 30-day mortality in patients with AECOPD, with a sensitivity of 0.82 and a specificity of 0.61 for the cutoff point greater than 6.9 mg/dl (P = 0.021). Also, patients with higher serum uric acid levels required longer hospitalization and more often required the use of noninvasive ventilation and ICU admission at 30 days. In addition, serum uric acid levels were higher in patients with more severe airflow limitation, patients with cardiovascular comorbidity, and among frequent exacerbators. Conclusion High serum uric acid levels on admission were associated with increased 30-day mortality in patients with AECOPD. The results of this work suggest a possible role for serum uric acid in the identification of COPD patients at an increased risk of adverse outcomes who may need early intensive management. Egypt J Broncho 2014 8:115-120 ͹ 2014 Egyptian Journal of Bronchology.
  1,071 217 -
The efficacy of fiberoptic bronchoscopy through laryngeal mask airway in pediatric foreign body extraction
Ashraf Madkour, Ahmed Elmansoury, Samar Sharkawy
January-June 2014, 8(1):57-63
Background The use of fiberoptic bronchoscopy (FOB) through laryngeal mask airway (LMA) in children allows the use of an adult-size bronchoscope with its grasping tools; thus, it may aid in foreign body (FB) extraction. Aim We aimed to evaluate the efficacy of FOB through LMA in pediatric FB extraction. Patients and methods We prospectively recruited all children (≤16 years) who presented to or were referred to the Department of Pulmonary Medicine, Ain Shams University Hospital, with a clinical suspicion of FB inhalation between June 2012 and June 2013. All the patients were subjected to FOB through LMA under general anesthesia. Rigid bronchoscopy (RB) was available to extract any FB that could not be removed. Results Of the 49 children suspected to have FBs, 41 FBs were identified in 28 boys and 13 girls, mean age 5.9 years (9 months to 16 years). FBs were more often lodged in the right side than in the left one (48 vs. 38%) and with predominance of organic FBs (75.6%), mainly seeds (60.9%). Successful extraction by the current technique was achieved in 34 of 41 (82.9%) FBs identified. Extraction of six of seven FBs that could not be removed was successful with the use of RB and open thoracotomy was required in one case. Noncritical complications related to FOB through LMA included laryngeal edema, transient hypoxia, gastric distension, mild hemoptysis, and fever, which occurred in five, five, four, three, and two patients, respectively. One critical complication (stridor) occurred that was related to RB. Conclusion In conclusion, FOB through LMA is safe and effective in pediatric FB retrieval under general anesthesia with RB backup.
  1,118 100 -
Medical thoracoscopy: past, present, and future
Amr Shoukri
July-December 2013, 7(2):50-52
Background Medical thoracoscopy is an old interventional technique that has evoluted over more than hundred years. The role of medical thoracoscopy in modern pulmonary medicine is well established, its application is accepted, and in particular for diagnosis of pleural effusion, and it also has other several diagnostic and therapeutic implications. The procedure is safe and simple, and can be done under local or general anesthesia. There are different forms of equipments that are available, but still the rigid thoracoscope is the most efficient. Medical thoracoscopy has to be strongly considered as a research tool, it provides large biopsies permitting molecular research. Conclusion The procedure is expected to progress more in the future with the advances in technologies that can be applied it.
  1,002 165 -
Assessment of patients' satisfaction with flexible bronchoscopy: Initial Egyptian experience
Ashraf Madkour, Nehad Osman, Samar Sharkawy, Ashraf Gomaa
July-December 2013, 7(2):71-77
Introduction Data regarding the patients' satisfaction with flexible bronchoscopy (FB) in our country, which is the major driving force in defining our practice, are lacking and have not been studied. We aimed to assess our patients' satisfaction with FB. Materials and methods Prospective administration of a questionnaire assessing patients' evaluations of various aspects of their bronchoscopy experience, overall satisfaction, tolerance and willingness to return for another FB was carried out with inclusion of 115 patients in the analysis. Results The pre-FB and final post-FB information were positively rated in 93.9 and 89.6% of patients, respectively. The nursing attitudes towards patients before, during and after FB were positive in 98, 98 and 95% of patients, respectively, whereas the doctors' attitude before, during and after FB was positive in 99, 100 and 98% of patients, respectively. Patients' tolerance to examination on a 10-cm visual analogue scale was 7.22. The overall positive patient satisfaction with FB was 89.6%, but only 25.2% of patients would (definitely or probably) return for repeat FB. Stepwise logistic multiregression analysis showed that both (very good) final information and (very good) doctor's attitude after the procedure are the most sensitive discriminators for prediction of a patient with maximum satisfaction (P<0.0001). Scope insertion through tracheostomy and tolerance to the examination by visual analogue scale were significant predictors associated with a likelihood of definitely returning for a repeat FB if needed. Conclusion Our results show that, although the majority of studied patients were satisfied with different aspects of their FB examination, only a minority would repeat this experience if needed.
  1,058 106 -
Evaluation of the psychological status of patients during and after weaning from mechanical ventilation
Adel M Saeed, Iman H Galal, Aalaa K Shata
July-December 2014, 8(2):160-166
Background Care for mechanically ventilated patients must incorporate psychological care. Aim The aim of the study was to evaluate the overall satisfaction of ICU survivors who needed mechanical ventilation (MV) with their ICU stay including the assessment of different psychological changes. Patients and methods One hundred mechanically ventilated patients (32 medical and 68 surgical) were interviewed after extubation. Results Medical patients were older than surgical patients (57.44 ± 13.27 vs. 48.69 ± 14.74 years, P = 0.005), had more days on MV (5.8 ± 4 vs. 2.6 ± 3.7 days, P = 0.0001), had a positive history of previous MV (18.8 vs. 0%, P = 0.001), and had more weaning trials (P = 0.0001). Items that were bothersome for patients included noise (97%), poor communication with nurses (98%), poor performance of nurses and doctors (22 and 20%, respectively), nursing shift changeover (26%), being connected and ventilated by a machine (100%), discomfort because of endotracheal tube (100%), tracheal suctioning by endotracheal tube (76%), Ryle feeding (75%), being hungry and thirsty (92 and 93%, respectively), insomnia (98%), not getting enough sleep (34%), not being able to talk (99%), lack of social communication (100%), immobilization (100%), pain (99%), loss of time orientation (83%), feelings of fearful (97%), loneliness (96%), bored (95%), hallucinations (17%), depressed (97%), neglected (66%), isolated (95%), insecurity (74%), lack of self-confidence (91%), not accepting the situation (98%), and postextubation complications including voice problems (34%), difficulty swallowing (9%), and movement problems (27%). Duration of MV correlated significantly with hallucinations (P = 0.0001) and feeling neglected (P = 0.019). Conclusion ICU experiences were mostly negative.
  812 350 -
Role of ultrasound in the management of pleural diseases in respiratory intensive care patients
Leila A Helala, Ashraf Madkour, Nehad M Osman, Waleed M Hetta, Inas Hakim
January-June 2015, 9(1):79-91
Introduction Ultrasonography (US) has become an invaluable tool in the management of critically ill patients. Objectives This study aimed to evaluate the role of US in the diagnosis and treatment of pleural diseases in patients in the respiratory intensive care unit. Patients and methods This study recruited 55 patients who presented with suspected clinical and/or radiological evidence of pleural disease in whom US and chest radiography were performed. In addition, US-guided interventions were carried out whenever needed and computed tomography scans of the chest where obtained whenever possible. Results Pleural effusion was the most common pleural disease encountered (54.5%). US correctly predicted the nature of most pleural effusions, whether transudative or exudative (84%). US was significantly more sensitive than chest radiography in the diagnosis of pleural effusion and pleural thickening (P = 0.00 and 0.004, respectively) and had significantly better sensitivity for unilateral effusions and for septations compared with computed tomography (P = 0.004). There was almost perfect agreement between US results and the final diagnosis in all pleural diseases, with κ values ranging from 0.9 to 0.98. A total of 67 US-guided interventions were carried out, with a success rate of 94%, and only one (1.5%) complication was encountered in the form of partial pneumothorax. US affected the diagnosis and altered the treatment policy, with recorded favorable outcomes. Short-term training programs enable pulmonologists to acquire US examination skills after 30 examinations. Conclusion US is an efficient and suitable method for evaluating pleural disease in the respiratory intensive care unit, especially pleural effusion. US-guided pleural interventions have been successful and have shown favorable outcomes and minimal complications. Short-term training could enable mastering of US use.
  1,007 146 -
Correlation between computed tomography of the chest and medical thoracoscopic findings in primary pleural tumors
Tarek Safwat, Samar Sharkawy, Amr Shoukri, Suzan Mohamed
January-June 2014, 8(1):32-37
Background Malignant pleural mesothelioma (MPM) is an aggressive tumor arising from the mesothelial cells lining the pleura. It commonly presents with unilateral pleural effusion with variable degree of pleural thickening and nodularity. MPM usually develops on the parietal pleura, and involvement of the visceral pleura indicates more advanced stage. Treatment of MPM should not be started before correct diagnosis and staging with computed tomography (CT) and thoracoscopy. Aim of the study The aim of this study was to assess the correlation between findings on chest CT and those on thoracoscopy and to evaluate the sensitivity of chest CT to identify malignant pleural lesions. Patients and methods Patients with suspected MPM and indicated for medical thoracoscopy for diagnostic confirmation were enrolled in the present study. Twenty patients with confirmed diagnosis after tissue biopsies with medical thoracoscopy were selected. Comparison and correlation between CT findings and medical thoracoscopic findings were made. Results Thoracoscopy showed parietal pleural invasion in all patients, whereas noncontrast chest CT showed parietal pleural lesions in 14 patients (70%). Visceral pleural involvement was evident in 13 patients (65%) on thoracoscopy, but chest CT detected only one case (5%) with visceral pleural involvement. Three patients (15%) were found to have fibrous septations on thoracoscopy, compared with only one patient (5%) on chest CT. The sensitivity of noncontrast chest CT in the detection of MPM was 70%. Conclusion Although the sensitivity of noncontrast chest CT in the detection of MPM is high, thoracoscopy is needed not only to confirm the diagnosis but also to assess the different parts of the pleura and to allow proper staging of the disease.
  1,000 107 -
Assessment of patients' satisfaction in Ain Shams University Hospitals
Haytham S Diab
May-August 2015, 9(2):211-220
Background: There is increasing international interest in using subjective evaluations of health states by individuals. The main method using which user views of healthcare performance have traditionally been elicited is through the measurement of patients' satisfaction, which is a valuable and widely used indicator of the quality of care and predictor of treatment compliance. The aim of this study was to assess the level of patients' satisfaction as regards the provided healthcare services in Ain Shams University Hospitals based on the patients' point of view. Patients and methods: In this cross-sectional study, 321 inpatients and 353 outpatients participated in the assessment of patients' satisfaction for the provided healthcare services at Al Demerdash University Hospital (DUH) and Ain Shams University Specialized Hospital (ASUH). Results: In DUH, it was found that inpatients' satisfaction for physicians' care of patients, nursing care, administrative facilities and physical environment was 61, 42, 52 and 46%, respectively, and outpatients' satisfaction for the same domains was 70, 63, 38 and 38%, respectively. In ASUH, it was found that, inpatients' satisfaction for the same domains was 81, 74, 71 and 72%, respectively, and outpatients' satisfaction for the same domains was 71, 67, 60 and 38%, respectively. Conclusion: The inpatients' and outpatients' questionnaires in both DUH and ASUH are simple, short and realistic and can be applied globally in governmental and private hospitals as a predictor for healthcare services.
  902 159 -
Outcome of active pulmonary tuberculosis patients requiring respiratory intensive care admission
Mona Mansour, Ashraf Madkour, Mourad Fouda
July-December 2014, 8(2):79-86
Introduction There are limited data regarding active pulmonary tuberculosis (APTB) patients requiring ICU admission. Aim This study aimed to determine the mortality rate and risk factors associated with mortality in patients with APTB requiring respiratory intensive care unit (RICU) admission. Patients and methods A combined retrospective-prospective study was conducted during the period between January 2009 and December 2010 (retrospective part) and between January and December 2011 (prospective part) on adult patients with APTB admitted to the RICU of Abbassia Chest Hospital for a period of more than 24 h. Demographic, clinical, and therapeutics characteristics as well as outcome (RICU morality) were obtained from the medical records. Results A total of 100 patients (median age 38 years) were included (60 retrospective and 40 prospective). The RICU morality rate was 74%. The overall median length of stay in RICU was 5 days. Respiratory failure was the most common cause of admission. Mechanical ventilation (MV) was needed in 65% of patients. Complications occurred in 45% of cases. Female sex, lower diastolic blood pressure, far advanced lesion, respiratory failure type II, higher Acute Physiology and Chronic Health Evaluation II score, lower Glasgow Coma Scale score, increased need for MV, and electrolytes disturbances were significantly more frequent in nonsurvivors than in survivors in the RICU. Risk factors identified for nonsurvival were pneumonia pattern and far advanced lesion by radiology, female sex, and renal impairment. MV was the only predictor of RICU mortality. Conclusion The present study found a very high mortality rate among APTB patients requiring RICU admission and identified associated risk factors and a predictor of RICU mortality.
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Evaluation of bronchoscopic placement of tracheobronchial silicone stents: an Ain Shams University Hospital experience
Emad Korraa, Ashraf Madkour, Amany Todary, Khaled Wagieh
January-June 2014, 8(1):38-43
Introduction Therapeutic rigid bronchoscopy with tracheobronchial stenting using silicone stents is a well-established procedure in the management of malignant and benign tracheobronchial stenosis. However, there is limited experience with this technique in Egypt. Aim This study aimed to retrospectively evaluate the results of our experience with bronchoscopic placement of tracheobronchial silicone stents. Materials and methods Between January 2007 and December 2011, 44 Dumon stents were inserted in the central airways of 40 patients using rigid bronchoscopy under general anesthesia. Data related to stent application were collected from patient's records. Results Of the 40 patients with either benign (20) or malignant (20) tracheal stenosis, stents were indicated in stabilizing airway patency after tumor debulking, counteracting extrinsic compression, sealing malignant fistulas, and treating complex-type benign strictures in 22.5, 27.5, 7.5, and 42.5% of patients, respectively. One stent was placed in 36 (90%) patients and two stents in four (10%) patients. Four (10%) patients required two stent procedures for adequate airway stabilization. Procedural complication in the form of trivial perforation of the bronchial wall occurred in one (2.5%) patient. Stent migration occurred in 10% of the patients, granuloma formation in 17.5%, tumor ingrowth in 7.5%, and stent obstruction by mucus secretions in 7.5% during the first 3 months after stent insertion, with an overall complication rate of 45%. All complications were non-life-threatening and all were reversibly managed. There was no mortality resulting from stent placement recorded during the first 3 months after stent insertion. Conclusion This study showed that bronchoscopic placement of Dumon silicone tracheobronchial stent is easily applied and effective in the maintenance of airway patency in malignant and benign tracheobronchial stenosis. Non-life-threatening stent-related complications occur but are easily managed.
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