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PULMONARY CRITICAL CASE MEDICINE - ORIGINAL ARTICLES
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
DOI:10.4103/1687-8426.158103  
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.
  13,484 531 -
REVIEW ARTICLE
Effects of obesity on respiratory mechanics at rest and during exercise
Amr Shoukri
September-December 2015, 9(3):224-226
DOI:10.4103/1687-8426.165884  
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.
  3,290 3,819 1
ORIGINAL ARTICLES
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
DOI:10.4103/1687-8426.145707  
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
  5,191 370 1
REVIEW ARTICLE
Rapid on-site evaluation: what a microscope will add to the bronchoscopy unit? a concise review
Maged Hassan
September 2016, 10(3):206-211
DOI:10.4103/1687-8426.193634  
Rapid on-site evaluation (ROSE) of samples obtained by transbronchial needle aspiration during flexible bronchoscopy or endobronchial ultrasound has been practised for more than two decades. Earlier studies evaluating its role have reported a magical impact on improving the diagnostic yield and the adequacy of samples produced by transbronchial needle aspiration. Subsequent studies with more rigorous methodologies failed to find a significant increase in sensitivity with ROSE but consistently demonstrated a trend toward performing shorter procedures with fewer complications when ROSE is utilized. There are new exciting fronts for ROSE, such as using it to direct molecular testing for lung cancer. In the future, we expect more centers to apply ROSE, now that pulmonologists have succeeded in doing so and telecytopathology has become reality.
  2,121 3,153 1
ORIGINAL ARTICLES
Diagnostic impact of integrating ultrasonography into routine practice in respiratory intensive care units
Haitham Salah
July-December 2014, 8(2):66-69
DOI:10.4103/1687-8426.145686  
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.
  1,941 3,319 -
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
DOI:10.4103/1687-8426.123985  
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.
  1,702 3,136 -
CRITICAL CARE
Effect of gastroesophageal reflux disease on spirometry, lung diffusion, and impulse oscillometry
Eman R Ali, Hossam M Abdelhamid, Hassan Shalaby
May-August 2016, 10(2):189-196
DOI:10.4103/1687-8426.184368  
Background: Gastroesophageal reflux disease (GERD) is known to be associated with many forms of respiratory diseases, including asthma, pulmonary fibrosis, cystic fibrosis, and obstructive sleep apnea syndrome. It is frequently coexistent, and may be causative or may exacerbate pre-existing lung disease. The main purpose of this study was to assess the effects of GERD on spirometry, lung diffusion, and impulse oscillometry. Patients and methods: This study included 48 consecutive newly endoscopically diagnosed GERD patients with no pulmonary symptoms or previous smoking history who attended the Gastrointestinal Clinic at Ain Shams Hospital and Misr University for Science and Technology with complaints of reflux symptoms. Spirometry, lung diffusion, and oscillometry were performed in all included patients. Results: There were statistically significant differences between cases with different grades of reflux as regards age. Most of the patients were included within grade B GERD with the highest mean age being 46.33±11.51. However, there was no significant difference as regards sex. There were statistically significant differences between cases with different grades of reflux as regards forced expiratory volume at the first second/forced vital capacity, maximum expiratory flow 25–75, and diffusing capacity of the lung for carbon monoxide (DLCO), but there was a highly statistically significant difference regarding residual volume/total lung capacity and residual volume. The grade of reflux was the only independent factor affecting DLCO, and grade B patients showed lower DLCO compared with grade A patients. There was a statistically significant positive correlation between grades of reflux and forced expiratory volume at the first second/forced vital capacity, maximum expiratory flow 25–75, and maximum mid-expiratory flow/peak expiratory flow, and a statistically significant negative correlation between grades of reflux and R20. There was a negative correlation between grades of reflux and DLCO, but it was not significant. Conclusion: GERD severity is associated with impairment of gas exchange (DLCO) and central airway affection (R20) on impulse oscillometry. This may be due to microaspiration of gastric acid or fluid into the airways.
  4,299 297 1
ORIGINAL ARTICLES
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
DOI:10.4103/1687-8426.137352  
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.
  4,034 281 -
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
DOI:10.4103/1687-8426.145698  
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.
  3,448 560 4
LUNG FUNCTION TESTS - ORIGINAL ARTICLE
Assessment of functional lung impairment in patients with thyroid disorders
Eman R Ali
September 2016, 10(3):337-347
DOI:10.4103/1687-8426.193641  
Background and objective Many thyroid diseases can lead to pulmonary problems. Hypothyroidism reduces respiratory drive and can cause obstructive sleep apnea, pleural effusion, skeletal muscle myopathy, and decreased carbon monoxide diffusing capacity, whereas hyperthyroidism increases respiratory drive and can cause dyspnea on exertion. Thus, the aim of this study was to evaluate and compare the frequency of clinical presentations, the extent of lung functional endurance (spirometric and diffusion lung capacity), and arterial blood gases affection between patients with hypothyroidism and hyperthyroidism when compared with normal euthyroid volunteers and find out who could compromise the respiratory system more. Patients and methods This study included 90 participants (30 patients with hyperthyroidism, 30 patients with hypothyroidism, and the remaining 30 were normal healthy volunteers as control) referred from the Endocrinology and Internal Medicine Departments in Ain Shams University Hospitals and Misr University for Science and Technology according to their serum free thyroid hormone 3, free thyroid hormone 4, and thyroid-stimulating hormone values. Spirometric function tests and diffusing capacity of the lung for carbon monoxide evaluation were performed for all participants. Results Respiratory symptoms were more frequent in hypothyroid than in hyperthyroid patients, especially cough, sputum production, and chest wheezes. All spirometric functional parameters and respiratory muscle function were decreased (whether or not significant) among patients with hypothyroidism and hyperthyroidism compared with normal euthyroid controls. More statistically significant respiratory functional impairment was noticed among patients with hypothyroidism than among those with hyperthyroidism. Diffusion was more affected in the hypothyroidism group than in the hyperthyroid group, but it was statistically nonsignificant. A statistically significant increase in partial carbon dioxide pressure was observed among patients with hypothyroidism than in patients in hyperthyroidism (However, there was a statistically significant decrease in partial oxygen pressure and pH in patients with hypothyroidism than in those with hyperthyroidism.). Although oxygen saturation was lower in hypothyroidism, it was statistically nonsignificant. Conclusion Hypothyroidism causes greater respiratory system endurance compared with hyperthyroidism. Early diagnosis and hormonal replacement may be of value.
  3,216 217 -
ORIGINAL ARTICLES
Early detection of malignant pleural mesothelioma
Hussein F Mahmoud
January-June 2014, 8(1):1-9
DOI:10.4103/1687-8426.137342  
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.
  2,982 331 -
AIRWAYS IN HEALTH AND DISEASE
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
DOI:10.4103/1687-8426.153586  
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.
  2,888 343 -
Chronic obstructive pulmonary disease in treated pulmonary tuberculous patients
Mohamed W Zakaria, Heba A Moussa
January-June 2015, 9(1):10-13
DOI:10.4103/1687-8426.153519  
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.
  2,800 395 -
REVIEW ARTICLE - PULMONARY INFECTIONS
What does pulmonary–renal syndrome stand for?
Taghreed S Farag, Abeer S Farag
January-March 2018, 12(1):1-13
DOI:10.4103/ejb.ejb_6_17  
Pulmonary–renal disorder (PRS) is an emergency situation described by a rapidly progressive course without an early intervention. It is appropriate time to review this disorder, this is may be attributable to frequent patients’ attendance to pulmonologist with both vague pulmonary and/or renal symptoms with disproportionate lack of information concerning consequent care. In addition, the outcome data for PRS still confined to little studies with limited follow-up. An updated working knowledge of PRS including the disease pathogenesis, complications as well as quickly advancing field focused on current new immunomodulatory therapies which offer life-saving options for refractory disease. An often-multi-disciplinary team is required for management. Early rapid identification relies upon a high index of clinical suspicious, carful medical evaluation, accessible laboratory investigations, imaging study, histopathology, with exclusion of differential diagnosis. An accurate diagnosis, exclusion of infection, close monitoring of the patient as well as timely initiation of aggressive therapy are crucial for the patient’s outcome. The mortality rate of PRS, reach up to 25–50 % [1].
  2,748 396 -
PULMONARY INFECTIONS
Diagnostic utility of serum adenosine deaminase level in the diagnosis of pulmonary tuberculosis
Abdelsadek H Alaarag, Osama I Mohammad, Naglaa M Farag
May-August 2016, 10(2):133-139
DOI:10.4103/1687-8426.184369  
Aim of the work: This study was conducted to evaluate the role of serum adenosine deaminase (ADA) level in the diagnosis of pulmonary tuberculosis (TB) and its relationship with clinical, radiological, and laboratory parameters. Patients and methods: This study was performed on 70 individuals: 60 patients with tuberculous and nontuberculous pulmonary diseases and 10 apparently healthy individuals as a control group. The participants were divided into four groups: group I included 30 patients with active pulmonary TB who were subdivided into group IA, which included 20 patients with sputum smear-positive pulmonary TB, and group IB, which included 10 patients with sputum smear-negative pulmonary TB (culture positive); group II included 10 patients with tuberculous pleural effusion; group III included 20 patients with nontuberculous lung diseases (five cases with pneumonia, five cases with pyogenic lung abscess, five cases with bronchiectasis, three cases with lung cancer, and two cases with mesothelioma); and group IV included 10 apparently healthy individuals as a control group. Patients were subjected to history taking, clinical examination, plain chest radiography posterior–anterior view, three consecutive sputum smears for acid-fast bacilli (AFB), sputum culture for AFB using BACTEC TB-460 system in group IB, laboratory investigations, tuberculin skin test, serum ADA level evaluation in all participants, and pleural ADA level evaluation in cases of tuberculous pleural effusion. Results: Serum ADA showed high percentage positivity (90%) in the diagnosis of pulmonary TB, followed by tuberculin skin test (83.3%), chest radiography (73.3%), erythrocyte sedimentation rate (70%), sputum for AFB (66.6%), toxic symptoms (53.3%), and hemoptysis (36.3%). Serum ADA sensitivity and specificity at cut-off point 30.15 µ/l were 95 and 86.7%, respectively, with a positive predictive value of 90.5%, negative predictive value of 92.2%, and accuracy of 91.4%. Conclusion: Serum ADA level shows higher percentage positivity compared with clinical, radiological, and laboratory parameters in the diagnosis of pulmonary TB.
  2,890 252 -
ORIGINAL ARTICLES
Medical thoracoscopy: past, present, and future
Amr Shoukri
July-December 2013, 7(2):50-52
DOI:10.4103/1687-8426.123988  
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.
  1,786 1,353 -
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
DOI:10.4103/1687-8426.137347  
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.
  2,803 242 -
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
DOI:10.4103/1687-8426.145718  
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.
  2,435 564 2
SMOKING CESSATION
Evaluation of cupping therapy as an adjuvant therapy in a smoking cessation program
Adel M Saeed, Rehab M Mohammed, Marwa E.A. Aty Ibrahim
September-December 2015, 9(3):276-282
DOI:10.4103/1687-8426.165935  
Background: Despite the methods available to aid smoking cessation, it still remains a major problem; thus, there is a need for a new alternative approach to control smoking. This study was carried out to evaluate the effectiveness of cupping therapy as an adjuvant therapy in a smoking cessation program. Participants and methods: This pilot randomized study included 46 male smokers attending the outpatient smoking cessation clinic. Patients were divided into two matched groups: the first group included 20 male smokers subjected to a smoking cessation program, whereas the second group included 26 male smokers subjected to the same smoking cessation program as group I in addition to a monthly bloodletting cupping session for 3 consecutive months as an adjuvant. All the smokers included attended three follow-up monthly visits for assessment of outcomes and frequency of withdrawal symptoms. Results: The success rate was the highest in the first follow-up compared with the second and the third follow-up in group II. There was no significant difference between both groups in the frequency of withdrawal symptoms during the first follow-up. During the second follow-up, there was a significant decrease in the frequency of occurrence of headaches and in the frequency of anxiety in the patients in group II compared with the patients in group I. During the third follow-up, there was a significant decrease in the frequency of occurrence of headache, weight gain, and tiredness in group II compared with group I. There was no significant difference between the outcomes of groups I and II; however, the success rate in group I was higher than that in group II. No significant differences were detected between the outcome in both groups in terms of age and smoking index. There was a significant difference in the effect of the number of cupping therapy sessions in the ability to quit smoking in group II. Conclusion: Bloodletting cupping therapy, which is not harmful if performed appropriately, is a simple procedure, economic, practical, and may be effective as an adjuvant in a smoking cessation program.
  2,698 174 -
LUNG IN SYSTEMIC DISEASES
Role of pulmonary function tests in screening pulmonary arterial hypertension in scleroderma
Nermine M Riad, Nashwa A Morshedy, Amr M Shoukri
September-December 2015, 9(3):287-292
DOI:10.4103/1687-8426.165937  
Introduction: Pulmonary arterial hypertension (PAH) is a life-threatening complication of scleroderma. Its prevalence is estimated to be between 12 and 29%. The symptoms are usually nonspecific and overlooked in those patients already limited by other complications of their condition. It is recommended to perform noninvasive screening for scleroderma patients for early detection of PAH, which has a significant impact on treatment strategy and clinical outcomes. Aim of the study: The aim of this study was to assess the role of certain pulmonary function parameters [forced vital capacity (FVC), diffusion capacity of the lung for carbon monoxide (DLCO), FVC/DLCO] in the early prediction of PAH in scleroderma patients. Patients and methods: This prospective study was conducted on 30 scleroderma-diagnosed patients; all patients were subjected to routine laboratory investigations, plain chest radiographic posteroanterior view, computed tomography of the chest, transthoracic echocardiography, spirometry, and DLCO. Results: The echocardiographic results showed pulmonary artery systolic pressure greater than 35 mmHg in eight patients, which led to suspect a possibility of pulmonary hypertension (PH) in those patients. On comparing patients with suspected PH and others, we found significant differences in the values of FVC% and DLCO%, which was significantly lower in patients with suspected PH (P < 0.05), and FVC%/DLCO% was significantly higher in those patients (P < 0.05). The best cutoff value of FVC/DLCO for predicting suspected PH among the studied cases was a value greater than 1.91, with a sensitivity of 87.5% and a specificity of 100%. Conclusion: Assessment of pulmonary functions is an easy and helpful tool in screening pulmonary vasculopathy in scleroderma patients. It helps to suspect patients with early PH, which can be subsequently confirmed with further appropriate tests.
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PULMONARY CRITICAL CASE MEDICINE - ORIGINAL ARTICLES
Assessment of patients' satisfaction in Ain Shams University Hospitals
Haytham S Diab
May-August 2015, 9(2):211-220
DOI:10.4103/1687-8426.158107  
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.
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ORIGINAL ARTICLES
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
DOI:10.4103/1687-8426.145714  
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.
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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
DOI:10.4103/1687-8426.145703  
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.
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A study of the outcome of confirmed avian flu and swine flu cases admitted to Abbassia Chest Hospital between 2006 and 2010
Adel Mahmoud Khattab, Khaled Mohamed Wagih, Amr Mohamed Awad Tag Eldin
July-December 2014, 8(2):70-78
DOI:10.4103/1687-8426.145689  
Aim The aim of this study was to evaluate the clinical and epidemiological features and the treatment outcome of confirmed cases of avian flu and swine flu admitted in Abbassia Chest Hospital between 2006 and 2010. Patients and methods This was a retrospective study that included 213 patients PCR-positive for influenza A H1N1 and 23 patients PCR-positive for influenza A H5N1, who were admitted to Abbassia Chest Hospital during the period from March 2006 to December 2010. The following data were collected by retrospective reviews of hospital records for each patient: epidemiological data through interview with the patient or their relatives, full history data, complete clinical examination data, full laboratory investigations, chest radiograph film at the time of admission and during the hospitalization period, a nasopharyngeal swab, ECG, and arterial blood gases. Statistical analysis of the data was then carried out. Results Regarding swine flu cases, there was no statistical difference with regard to the age distribution, the sex distribution, the presence of comorbidities, and the time of presentation among the studied patients. The results showed that 170 patients recovered, whereas 43 died, with a mortality rate of 20.2%. Among the avian flu cases, seven patients recovered, whereas 16 died, with a mortality rate of 69.5%. The mortality rate was high in renal patients, patients having bilateral complicating pneumonia, and in the patients who needed mechanical ventilation. Conclusion Some comorbidities, such as diabetes mellitus, cardiac illness, and chronic chest illness, have no implication on mortality. In contrast, renal conditions and the need of mechanical ventilation were associated with a high mortality rate.
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PULMONARY CRITICAL CARE
Automatic tube compensation versus pressure support ventilation as a weaning mode: does it make a difference?
Hammad El-Shahat, Suzan Salama, Safaa Wafy, Hassan Bayoumi
September-December 2015, 9(3):253-260
DOI:10.4103/1687-8426.165905  
Background: Automatic tube compensation (ATC) is one of the newer weaning modes that seem promising to improve the weaning process. Objective: To evaluate the benefit of ATC in hastening and improving the weaning process. Patients and methods: In a prospective randomized-controlled trial, all eligible patients of Assiut Chest Department who were mechanically ventilated were included during the period from April 2010 to March 2012. They were divided into two groups, 88 patients weaned by pressure support ventilation (PSV) and 78 patients weaned by ATC. The primary outcomes measure was the ability to maintain spontaneous breathing for more than 48 h after extubation and weaning duration. Results: A total of 166 patients were included; the mean age was 58.6 ± 12.3 years; males represented 70%. The weaning duration was shorter in ATC than in PSV (19.7 vs. 29.9 h, respectively). Also, ATC had a higher trend toward successful extubation than PSV (88.5 vs. 78.4%). Patients who underwent weaning by ATC had a nonsignificant trend toward simple weaning. Moreover, hospital mortality was less in ATC (ATC 15.4% vs. PSV 22.7%). However, the difference did not reach significance in all primary and secondary outcomes. Conclusion: In respiratory ICU patients, the weaning process can be usefully performed by ATC (at least as effective as PSV) but without significant hastening of the weaning process. All primary and secondary outcomes were potentially improved (weaning duration, extubation outcome, predictive value of ATC-assisted ratio of respiratory rate and tidal volume, number of spontaneous breathing trials, weaning category, reintubation rate, complications, and hospital mortality).
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