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  Citation statistics : Table of Contents
   2015| September-December  | Volume 9 | Issue 3  
    Online since September 22, 2015

 
 
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BRONCHOLOGY
Sequential use of cryoextraction postelectrocautery for airway recanalization using fiberoptic bronchoscopy
Mohammad Kh. El Badrawy, Nesrein M Shalabi, Asem A Hewidy, Ahmed M Fouda
September-December 2015, 9(3):269-275
DOI:10.4103/1687-8426.165920  
Background: Airway obstruction presents with dyspnea, cough, hemoptysis, and atelectasis. Removing or decreasing the size of the obstructing lesions improves patient's symptoms and life quality. Aim: Assessing the efficacy and safety of sequential use of cryoextraction and electrocautery in achievement of airway patency using fiberoptic bronchoscopy (FOB). Patients and methods: This study was conducted at the Chest Medicine Department, Mansoura University, Egypt and included 22 patients with central airway obstruction (15 males and seven females) with a mean age of 50.5 ± 18.3 years. After etiologic diagnosis of airway obstruction, they were divided into two groups: group A (nonmalignant); eight patients and group B (malignant); 14 patients. All patients were subjected to sequential use of cryoextraction after electrocautery. Operable, unfit patients or patients with extraluminal obstruction were excluded. Clinical, radiological, functional, and bronchoscopic data were evaluated before and after FOB. Results: The improvement in performance scale was highly significant in group B (P < 0.001) and significant in group A (P = 0.001). Spirometric parameters improved in both groups but were highly significant in group B (P < 0.001). Radiological improvement occurred in four out of eight of group A and in three out of 14 of group B. FOB score improved in group B (P = 0.003) and was more significant in group A. The procedure was complicated with atrial fibrillation and hemoptysis in one case and postbronchoscopy hypoxemia in two cases with no deaths. Conclusion: Cryoextraction after electrocautery using FOB are effective, safe, easy, and cheap in achieving airway patency.
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CASE REPORTS
Postpartum pulmonary edema in twin parturient: beyond the fluids
Sukhen Samanta, Sujay Samanta, Abhishek Jha, Kajal Jain
September-December 2015, 9(3):296-298
DOI:10.4103/1687-8426.165939  
Pulmonary edema (PE) after postpartum hemorrhage (PPH) resuscitation is mainly due to fluid overload or transfusion-related acute lung injury. Here we present the case of a 30-year-old primigravida having uncomplicated twin pregnancy. She developed PPH and PE simultaneously during the early postpartum period. Chest radiography was inconclusive to exclude fluid overload. Echocardiography and lung ultrasound ruled out volume overload. PE could be due to adverse effects of drugs, or negative pressure from laryngospasm originating from incisional pain during uterine manipulation. Caution should be exercised while administering methylergometrine or carboprost for atonic PPH, with continued vigilance for detection of signs of PE, especially in high-risk pregnancy. Moreover, the risk versus benefit ratio should be considered for performing abdominal uterine massage as it may be more harmful than beneficial in such subset of patients.
  1 1,166 126
PLEURAL DISEASES
A study of CA-125 in patients with pleural effusion
Alaa El Din O Shalaby, Heba Allah A Moussa, Aml S Nasr, Mostafa N Abdel Samad
September-December 2015, 9(3):283-286
DOI:10.4103/1687-8426.165936  
Background: A significant concern of physicians treating patients with pleural effusion is to rule out a malignant etiology, which, in the majority of series, is the first cause of pleural exudates. Determination of tumor markers in serum and pleural fluid has been proposed as a nonaggressive means of establishing a diagnosis of pleural malignancy. Cancer antigen 125 (CA-125) is not a specific tumor marker and it is synthesized by normal and malignant cells of different origins. Recently, it has been shown that various diseases are associated with increased CA-125 levels, especially in the presence of serosal fluid. Aim: The aim of this study was to determine the level of serum and pleural fluid CA-125 to evaluate its value as a marker for differentiation between different types of pleural effusion. Patients and methods: The study was carried out on 30 patients with pleural effusion of different etiologies. They were further subdivided into two groups: exudates and transudates; the levels of both serum and pleural fluid CA-125 were evaluated. Results: In terms of pleural CA-125, there was a statistically significant increase in the exudative subgroup compared with transudative subgroup. Furthermore, it was found that malignant effusion was observed more frequently compared with benign effusion and tuberculosis was observed more frequently in comparison with other infections. Conclusion: The highest level of pleural fluid CA-125 was found in malignancy, followed by tuberculosis, and so pleural fluid CA-125 can be used as a marker for the diagnosis of pleural effusion.
  1 1,844 174
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.
  1 3,567 3,929
AIRWAY DISEASES
Chronic obstructive pulmonary disease among women using biomass fuels in some rural areas of Fayoum governorate
Assem F El-Essawy, Mohammed A Ali, Naglaa A Al-Sherbiny, Radwa A Elhefny, Enas S Farhat
September-December 2015, 9(3):227-230
DOI:10.4103/1687-8426.165891  
Context: Chronic obstructive pulmonary disease (COPD) is an important health problem; it represents an important health challenge in terms of both prevention and treatment. Although smoking is recognized as the most important risk factor for COPD, rural women in developing countries have a greater risk not as a result of smoking, as smoking is uncommon there, but due to smoke from domestic biomass fuel combustion, which is another potential risk factor. Aims: The aim of this study was to investigate exposure to biomass fuel as a potential risk factor for COPD among women in the rural areas of Fayoum governorate in whom cigarette smoking was not the risk factor. Materials and methods: This study included 100 nonsmoker women who used biomass fuels and 100 women who had not used biomass throughout their life who served as controls. All groups in the study were subjected to questionnaire on respiratory symptoms, clinical examination, and were investigated using spirometer. Statistical analysis: Data were analyzed using SPSS, version 11. Quantitative data were analyzed using the χ2 -test, whereas the t-test was used for comparison between groups as regards quantitative data. Results: Biomass fuel is an important risk factor for development of COPD among rural nonsmoker women who use biomass. The decline in forced expiratory volume in first second and forced expiratory flow 25-75% is significantly related to the duration of exposure to biomass fuels. Conclusion: It was detected that biomass fuel is an important risk factor for development of COPD. Biomass fuels affect pulmonary functions and this is strongly related to the duration of biomass use.
  - 958 1,220
CASE REPORTS
Pulmonary plasmacytoma in multiple myeloma: a rare case of extramedullary spread
Santosh Rai, Hanaganahalli B Sridevi, Vishak Acharya, Flora Lobo, Jyoti Kini
September-December 2015, 9(3):293-295
DOI:10.4103/1687-8426.165938  
  - 1,265 123
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 CARE
Risk factors for hospital mortality among mechanically ventilated patients in respiratory ICU
Hammad El-Shahat, Suzan Salama, Safaa Wafy, Hassan Bayoumi
September-December 2015, 9(3):231-237
DOI:10.4103/1687-8426.165895  
Background: The possible factors affecting hospital mortality among mechanically ventilated patients in respiratory ICU is still not fully studied. Objective: The aim of this study was to identify the predictors of hospital mortality among mechanically ventilated patients in respiratory ICU. Patients and methods: In a prospective descriptive study, all eligible patients of Assiut Chest Department who were mechanically ventilated for more than 1 day (247 patients) during the period from April 2010 to March 2012 were included in this study. Different clinical and laboratory variables were recorded at the time of admission and followed until hospital discharge and were compared between survivors (146 patients) and nonsurvivors (101 patients). Results: A total of 247 patients were included in the study. The mean age was 57.6 ± 13.3 years. Male patients represented 65.6% of the study cohort. The hospital mortality was 40.9%. On multivariate analysis, risk factors for hospital mortality were as follows: patients diagnosed with adult respiratory distress syndrome, interstitial lung diseases, and pulmonary embolism [odds ratio (OR) = 14.2 95% confidence interval (CI), P = 0.031]; hospital complications (OR = 9.17 95% CI, P = 0.000); reintubation (OR = 8.56 95% CI, P = 0.000); use of sedatives for 24 h or more (OR = 3.72 95% CI, P = 0.04); and comorbidity burden (OR = 2.36 95% CI, P = 0.006). Conclusion: The major independent risk factor for hospital mortality was patients diagnosed with adult respiratory distress syndrome, interstitial lung diseases, and pulmonary embolism. In addition, patients suffering from more comorbidities or hospital complications and patients requiring longer use of sedation (≥24 h) should be monitored closely in ICU because of their high risk for hospital nonsurvival.
  - 1,573 563
Impact of C-reactive protein and BMI on patient outcome in respiratory ICU in Abbassia Chest Hospital
Taher A EL Naggar, Khaled M Wagih, Hossam S Mohamed
September-December 2015, 9(3):238-244
DOI:10.4103/1687-8426.165901  
Introduction: C-reactive protein (CRP) is the most widely used biomarker of infection in critically ill patients and some data are available on the morbidity and mortality in obese patients in the medical intensive care setting, but it is widely held that their outcomes are poor. Aim of the work: This study aimed to evaluate the impact of CRP and BMI on the outcome of patients admitted in the respiratory ICU (RICU) in Abbassia Chest Hospital. Materials and methods: This prospective study was carried out on 71 patients admitted to the RICU at Abbassia Chest Hospital from January 2011 to July 2011. A full assessment of history, a thorough clinical examination, length of stay (LOS), and need for mechanical ventilation were assessed, and BMI and CRP were measured. Results: There was a highly significant correlation between BMI categories and outcome in which the mortality rate was high among underweight patients; there was also a significant correlation with complications, wherein septicemia was more common in underweight patients. Complications of mechanical ventilation were more common in morbidly obese patients and nosocomial infection was more common in obese patients. The results showed an insignificant correlation between smoking, need for mechanical ventilation, duration of MV, LOS in ICU, and outcome in terms of the CRP level. Conclusion: The study concluded that CRP exerted an independent effect on the duration of mechanical ventilation (MV) and LOS in RICU. The mortality rate was high in underweight patients, but not in overweight, obese, or severely obese patients.
  - 819 188
The prognostic value of the dead-space fraction and other physiological parameters in the weaning process of mechanical ventilation in patients with obstructive air flow
Gamal Rabie Agmy, Hala A Mohammad, Abeer AM Hassanin
September-December 2015, 9(3):245-252
DOI:10.4103/1687-8426.165902  
Background: Patients with obstructive air flow including chronic obstructive lung diseases and bronchial asthma use a substantial proportion of mechanical ventilation (MV) in the ICU, and their overall mortality with ventilator support can be significant. From the pathophysiological standpoint, they have increased airway resistance, pulmonary hyperinflation, and high pulmonary dead space, leading to an increased work of breathing. MV is an integral part of the treatment for acute respiratory failure. Aim of the work: The present study aimed to demonstrate the prognostic value of ventilatory parameters including that of the dead-space fraction (DSF), end-tidal carbon dioxide (ETCO 2 ), lung mechanics, and gas exchange during the application of MV. Patients and methods: Forty consecutive patients admitted to the ICU with acute respiratory failure due to chronic obstructive lung diseases and acute severe asthma were enrolled in the study. Lung mechanics (compliance and airway resistance), DSF, ETCO 2 , and arterial blood gases were measured at the following times: on admission to the ICU, initially, and finally before extubation. Results: Successfully weaned and survivors represent 60% (n = 24) of all patients included in this study. They had a lower MV duration at a mean of 3.75 days ±1.8 SD. Logistic regression analysis revealed a significant association between the MV duration, pH more than 7.32, and dynamic compliance on the one hand and extubation failure on the other, but no significant association was found between the DSF and extubation failure, with odds ratio equal to 2.08 (95% confidence interval: 0.05-85.78, P = 0.7). Conclusion: We concluded that DSF is not an influential predictor of extubation failure in patients with obstructive air flow, whereas dynamic compliance plays a strong prognostic role in the weaning process.
  - 1,043 125
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).
  - 2,452 226
Evaluation of serum-soluble triggering receptor expressed on myeloid cells-1 as a novel marker in the diagnosis of ventilator-associated pneumonia in adults
Wassila Morsy Mohamed, Mona Osama Ramadan, Ghada Atef Attia, Noha Sheref
September-December 2015, 9(3):261-268
DOI:10.4103/1687-8426.165907  
Ventilator-associated pneumonia (VAP) remains the most common nosocomial infection in ICUs. VAP occurs in 10-20% of patients who are mechanically ventilated for more than 48 h. The interval between diagnosis and the availability of microbiological results is the period when clinicians would most benefit from a reliable biomarker that could provide an early indication of poor response. Serum-soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) belongs to the immunoglobin superfamily, and it has the advantage of being increased during infectious processes but not in noninfectious inflammatory conditions. The aim of this study was to assess the value of serum level of sTREM-1 as a diagnostic biomarker for VAP in comparison with commonly used indicators, including procalcitonin (PCT) and C-reactive protein (CRP). This study was carried out on 60 participants. They were divided into two groups: group I included 30 adult patients with clinically suspected VAP, and group II included 30 ICU ventilated patients of the same age group without VAP and free of other infectious diseases who served as the control group. They were selected from the ICUs of Chest and other Departments, Tanta University Hospitals, during the period from January 2014 until September 2014. The present study revealed that serum level of sTREM-1 was significantly higher in patients with VAP in comparison with the control group. It was also concluded that serum level of sTREM-1 was significantly higher in VAP patients with bacterial growth culture results than in VAP patients with no growth culture results. A diagnostic cutoff value greater than 110 pg/ml with a sensitivity of 87.5%, specificity of 83.3%, positive predictive value of 95.5%, and negative predictive value of 62.5% of serum sTREM-1 level could discriminate positive culture results from negative culture results in VAP patients, which were higher than that of serum levels of PCT and CRP. It was concluded that serum level of sTREM-1 was significantly higher in VAP patients in comparison with non-VAP patients and it showed the highest sensitivity and specificity (87.5 and 83.3%, respectively) in differentiating between VAP patients with bacterial growth culture results and VAP patients with no growth culture results compared with PCT and CRP levels, thus rendering serum level of sTREM-1 a novel diagnostic marker for VAP.
  - 810 88
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.
  - 2,887 181
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