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Table of Contents
May-August 2015
Volume 9 | Issue 2
Page Nos. 113-223
Online since Thursday, June 4, 2015
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EDITORIAL
Updates in acute respiratory distress syndrome
p. 113
Gamal M Agmy
DOI
:10.4103/1687-8426.158023
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AIRWAYS IN HEALTH AND DISEASE - ORIGINAL ARTICLES
Study of serum leptin level in obese and nonobese asthmatic patients
p. 118
Etemad A Mohammed, Magdy M Omar, Nabil A Abdelghaffar Hibah, Hesham A Essa
DOI
:10.4103/1687-8426.158038
Aim:
The aim of the study was to investigate serum leptin levels in obese and nonobese asthmatic patients and its change during acute attack and in remission, as well as its relation to the changes in pulmonary functions.
Methods:
The study was carried out on 55 participants (40 asthmatic patients and 15 controls) who were divided according to BMI into obese [(BMI >30 kg/m
2
), 20 asthmatic patients and eight controls] and nonobese [(BMI <25 kg/m
2
), 20 asthmatic patients and seven controls]. All participants were subjected to calculation of BMI, pulmonary function tests, and morning serum leptin level estimation (after at least 8 h of fasting).
Results:
Serum leptin levels (mean in ng/ml) in obese controls (64 ng/ml) and obese asthmatic patients (80.4 ng/ml during remission and 92.9 during exacerbation) were significantly higher than that in nonobese controls (6.3 ng/ml) and nonobese asthmatic patients (33.8 ng/ml during remission and 48.8 during exacerbation). There was a significant (
r
= −0.456 and
P
≤ 0.05) negative correlation between the change in serum leptin (ng/ml) and the change in forced vital capacity (FVC) (% Predicted) and forced expiratory volume in first second (FEV
1
) (% Predicted) in obese asthmatic patients, but not in nonobese asthmatic patients. There was a significant positive correlation between BMI (kg/m
2
) and serum leptin levels (ng/ml) in obese (
r
= 0.712 and
P
≤ 0.05) and nonobese (
r
= 0.747 and
P
≤ 0.05) controls and a higher significant positive correlation in obese (
r
= 0.94 during exacerbation and
r
= 0.833 during remission,
P
≤ 0.001) and nonobese (
r
= 0.687 during exacerbation,
P
≤ 0.001 and
r
= 0.488 during remission,
P
≤ 0.05) asthmatic patients.
Conclusion:
Serum leptin levels were higher in all asthmatic patients (more during exacerbation) compared with controls and the values were higher in obese than in nonobese asthmatic patients with a significant negative correlation between the change in serum leptin and the change in FEV
1
and FVC in obese asthmatic patients. These findings indicate that leptin is involved in asthma inflammation.
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The impact of pulmonary functions on outcome of intubated patients with chronic obstructive pulmonary disease
p. 125
Ahmed Metwally, Khaled Hussein, Ashraf Zein El-Abdeen, Ahmed Hamed, Azaa Ez-Eldeen
DOI
:10.4103/1687-8426.158041
Background:
Assessment of lung mechanics and respiratory muscle determinants is considered to be useful for adjustment of ventilator settings to minimize dynamic hyperinflation in patients with chronic obstructive pulmonary disease (COPD).
Objective:
The aim of this study is to assess the impact of pulmonary functions on the outcome of mechanically ventilated COPD patients.
Patients and methods:
This study was carried out in the respiratory ICU, chest department, Assiut University Hospital. A total of 47 mechanically ventilated COPD patients were recruited into the study. The patients were divided into two groups on the basis of outcomes: successful group (36 patients) and failed group (11 patients). Analyses of different lung mechanics and respiratory muscle determinants were carried out for both groups.
Results:
There was no significant difference in age between both the groups. Arterial blood gases analysis showed a significantly decreased pH, PaO
2
, and SaO
2
in the failed group and a significantly increased PaCO
2
in the failed group after 1, 24, and 48 h of mechanical ventilation. Values of lung mechanics in the failed group, compared with the successful group, showed a significantly lower respiratory compliance (29.18 ± 1.47 vs. 45.92 ± 4.08 ml/cm H
2
O), a significantly higher respiratory resistance (24.73 ± 1.19 vs. 22.39 ± 1.10 cm H
2
O/L/S), and a significantly higher intrinsic positive end expiratory pressure (8.36 ± 0.67 vs. 7.58 ± 0.94 cm H
2
O). Values of respiratory muscle determinants in the failed group showed a significantly lower negative inspiratory force (−17.18 ± 2.82 vs. −26.44 ± 3.32 cm H
2
O), a significantly lower vital capacity (382.27 ± 102.75 vs. 810.00 ± 133.03 ml), and a significantly higher occlusion pressure P0.1 (6.09 ± 1.04 vs. 1.72 ± 0.66 cm H
2
O).
Conclusion:
Pulmonary functions in mechanically ventilated COPD patients including lung mechanics and respiratory muscle determinants had an important impact on outcome. A significant decrease in respiratory compliance, negative inspiratory force, and vital capacity with a significant increase in respiratory resistance, intrinsic positive end expiratory pressure, and occlusion pressure P0.1 was observed in the COPD group with failed extubation.
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Effect of truncal obesity on airway resistance
p. 133
Hesham A AbdelHalim, Heba H AboElNaga, Ahmed M ElMansoury
DOI
:10.4103/1687-8426.158043
Background and objective:
Truncal obesity can influence respiratory mechanisms regardless of BMI. This study evaluated the impact of truncal obesity on both spirometry and impulse oscillometry (IOS).
Patients and methods:
The study included 102 patients recruited from the Outpatient Department of Ain Shams University Hospital. All patients were subjected to clinical examination, anthropometric measurements, IOS, and spirometry. According to BMI, the patients were categorized into the obese group (71 patients) and the nonobese group (31 patients). The obese group was subclassified into overweight, obese, and morbidly obese groups. The obese subgroup was reclassified according to waist to hip ratio (WHR) into the truncal obese group (41 patients) and the nontruncal obese group (30 patients). The data collected were comparatively analyzed using either the independent-samples
t
-test or one-way analysis of variance. Pearson's correlation coefficient was used to study the correlations between data. Multiple linear regression analysis was carried out to examine the simultaneous influences of anthropometric measures on the IOS data.
Results:
There were significant differences in IOS and spirometry data between the obese and nonobese groups as well as among the four groups. Regarding WHR, there were significant correlations with IOS data and negative correlations with spirometry data except maximal mid expiratory flow. Using multiple linear regression analysis, it was revealed that WHR was the most powerful predictor for R5. BMI followed by WHR was the most powerful predictor for R5-R20.
Conclusion:
Truncal obesity significantly affects airway resistance, as evaluated by spirometry and IOS.
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Subclinical cardiovascular changes in chronic obstructive pulmonary disease patients: Doppler ultrasound evaluation
p. 140
Samiaa H Sadek, Ali A Hassan, Ghada AbdElrahman, Soheir M Kasem, Lobna AbdElwahed, Hanan S Eldein, Mohamed Zedan
DOI
:10.4103/1687-8426.158046
Introduction:
Chronic obstructive pulmonary disease (COPD) is a disease characterized by progressive poorly reversible airway obstruction. COPD is associated with chronic systemic inflammation, hypercoagulable status, platelet activation, and oxidative stress. These factors may result in subclinical cardiovascular diseases (CVD): for example, carotid atherosclerosis, peripheral arterial diseases, and coronary artery diseases.
Aims:
The aim of this case-control study was the detection of subclinical CVD in COPD patients.
Settings and design:
This was a case-control study.
Materials and methods:
A total of 62 COPD patients and 62 healthy volunteers were enrolled in the present study. All patients were subjected to full medical history and clinical examination, chest radiography, arterial blood gas analysis, laboratory assessment of C-reactive protein, complete blood count, lipid profile, spirometry, transthoracic echocardiography, carotid Doppler ultrasound, and measurement of ankle-brachial index. A comparison between COPD and control groups regarding different parameters was performed, and a comparison between different stages of COPD regarding different parameters was also performed.
Results:
The carotid intima-media thickness and carotid plaques were significantly higher, whereas the ankle-brachial index was significantly lower in COPD patients compared with the control group, with no differences observed in different stages of COPD. Pulmonary hypertension and right ventricular dilatation were significantly common in COPD patients compared with the control group, and they were significantly increased with progressive stages of COPD. Pulmonary artery systolic pressure and carotid intima-media thickness showed a significant negative correlation with PaO
2
, but showed a significant positive correlation with PaCO
2
.
Conclusion:
COPD is a risk factor for subclinical CVD, mainly carotid artery atherosclerosis and peripheral arterial diseases.
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Interventional bronchoscopy in the initial management of benign and malignant tracheal stenoses
p. 146
Ashraf Madkour, Ahmed Elmansoury, Samar Elsharkawy
DOI
:10.4103/1687-8426.158049
Introduction:
Management of tracheal stenoses is inconsistent. Interventional bronchoscopy (IB) is one of the therapeutic options used.
Aim:
The aim of the study was to investigate the role of IB in the initial management of tracheal stenosis, evaluating the treatment strategies used and complications encountered.
Patients and methods:
We prospectively recruited 30 patients presenting with bronchoscopically confirmed tracheal stenoses over 1 year. Twenty benign (six simple and 14 complex) and 10 inoperable malignant tracheal stenoses were studied. All except two patients underwent rigid IB with different modalities. Each patient was followed up for 6 months.
Results:
All simple, 12 complex (not eligible for surgery), and all malignant stenoses were treated with 17 (mean of 2.83 per patient), 52 (mean of 4.33 per patient), and 39 (mean of 2.83 per patient) IB procedures, respectively, including 1, 10, and 8 stent placements, respectively, with overall good therapeutic response after IB. Two patients with complex stenoses were sent for surgery. During the first 6 months after stent insertion, stent migration occurred in 27 and 12% and obstruction by mucus secretions occurred in 64 and 37% of benign and malignant stenoses, respectively. Granuloma formation occurred in 45% of benign stenoses. Tumor in-growth occurred in 37% of malignant stenoses. All complications were non-life-threatening stent-related complications that were easily managed. During follow-up, two malignant patients died of disease progression.
Conclusion:
IB is a useful option in the management of simple benign and inoperable complex benign and malignant tracheal stenoses associated with a relatively high rate of non-life-threatening stent-related complications that were easily managed.
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INTERSTITIAL LUNG DISEASES - ORIGINAL ARTICLES
Scope on idiopathic pulmonary fibrosis in Upper Egypt
p. 154
Nizar Rifaat, Ali A Hasan
DOI
:10.4103/1687-8426.158053
Background:
Clinical features of idiopathic pulmonary fibrosis (IPF) are not the same in all patients and are characterized by being nonspecific. Symptoms range from nothing at all to severe disabling dyspnea.
Aim:
To explore the demographic, clinical and physiological characteristics of IPF patients attending the outpatient clinic at El-Minia and Assiut University Hospitals to see whether they match with or differ from the common features of the disease known worldwide.
Patients and methods:
One hundred-twenty six patients diagnosed as IPF underwent detailed history taking, clinical examination, spirometery, oxygen saturation and trans-thoracic echocardiography.
Results:
About 43% of patients developed IPF before age of 50 and the mean age at time of diagnosis was 48.6 ± 12.9 years. Eighty four (66.7%) patients were males. Ninety (71.4%) patients had significant tobacco smoke exposure. Dyspnea was present in 120 (95.2%) patients and the majority had grade 3 and 4 dyspnea. Ninety-five percentage of patients had cough. Clubbing of fingers was present in 72 (57.1%). All patients had bilateral basal crepitation. The mean of FVC was 52.5 ± 15.2% while the mean O
2
saturation was 91.9 ± 4.8%. One third of patients (33.3%) had corpulmonal and those have significantly longer duration of illness and significantly lower FVC and O
2
saturation (
P
< 0.001 for each).
Conclusion:
In our locality IPF patients had younger age of presentation while other demographic, clinical and physiological features were more or less similar to those recorded worldwide.
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Pulmonary fibrosis as a risk factor for thromboembolic disease
p. 160
Shereen Farghaly, Ashraf Z El-Abdin
DOI
:10.4103/1687-8426.158056
Background:
Chronic obstructive pulmonary disease (COPD) and lung cancer are well known to be associated with increased risk for venous thromboembolism (VTE). However, there are few data about the association between idiopathic pulmonary fibrosis (IPF) and VTE.
Aim of this study:
The aim of the study was to investigate the prevalence of venous thromboembolic events in hospitalized IPF patients and compare it with the incidence in COPD patients.
Patients and methods:
We retrospectively analyzed the database of interstitial lung disease from 2007 to 2013. We included 629 IPF patients after exclusion of patients with secondary pulmonary fibrosis and those with a concurrent diagnosis of COPD or lung cancer. VTE disease was defined as either deep venous thrombosis, pulmonary embolism, or both deep venous thrombosis and pulmonary embolism. For comparison, we also analyzed the database of COPD patients.
Results:
Out of the 629 included IPF patients, 13 had thromboembolic events, showing a prevalence for VTE in IPF that is significantly higher than that in COPD (2.1 vs. 1.1%; odds ratio: 1.9; confidence interval: 1.039-3.530;
P
= 0.035). The prevalence is also significantly higher in female and nonsmoker IPF patients compared with COPD patients (
P
= 0.008 and 0.011 respectively). Among IPF patients, men had significantly lower risk for VTE compared with women (
P
= 0.045).
Conclusion:
IPF, especially in women, is associated with increased risk for VTE, being greater than the risk in COPD.
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PLEURAL DISEASES - ORIGINAL ARTICLE
Can chest ultrasonography differentiate between benign and malignant effusions?
p. 165
Wafaa A Hassan, Atef F Alkarn, Mahmoud Kamel
DOI
:10.4103/1687-8426.158061
Background:
The differential diagnosis of exudative pleural effusion is a major challenge for chest physicians particularly in a country with limited financial resources.
Objective:
The aim of this study was to evaluate the role of the sonographic features in the prediction of exudative malignant pleural effusion.
Design:
This was a prospective cross-sectional study.
Setting:
This study was carried out between May 2013 and June 2014 in the Chest Department of Assiut University Hospital.
Patients:
The patients enrolled included 25 patients with malignant pleural effusion and 25 patients with other different benign causes.
Main outcome measures:
The sonographic appearances of pleural effusions were defined in terms of five patterns: anechoic, complex septated, complex nonseptated, pleural thickening, and pleural nodules.
Results:
Among the 25 malignant exudative pleural effusions, a complex nonseptated pattern is a useful diagnostic predictor, with sensitivity, specificity, positive predictive value, and negative predictive value of 60, 68, 65, and 63%, respectively. Pleural nodules were only found in malignant effusion (100% specificity). If we define the complex septated sonographic pattern as a predictor for benign effusion, we can achieve sensitivity, specificity, positive predictive value, and negative predictive value of 52, 88, 81, and 65%, respectively.
Conclusion:
Pleural nodules and a complex nonseptated pattern in the sonographic appearance are useful predictors of malignant pleural effusions, whereas a complex septated pattern is a useful predictor in nonmalignant effusion.
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RESPIRATORY INFECTIONS - ORIGINAL ARTICLES
Pattern of sputum bacteriology in acute exacerbations of chronic obstructive pulmonary disease
p. 170
Khaled Eid Sobhy, Ahmed M Abd El-Hafeez, Faten A Shoukry, Eman S Refaai
DOI
:10.4103/1687-8426.158065
Background:
Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality worldwide. Acute exacerbation of COPD is redefined as a sustained worsening of a patient's condition from a stable state (beyond normal day-to-day variations) that is acute in onset and that may warrant additional treatment in a patient with underlying COPD.
Aim:
This study aimed at searching for a pattern of sputum bacteriology and antibiotic sensitivity for acute exacerbation of COPD in patients admitted to Abbassia Chest Diseases Hospital.
Patients and methods:
This study included 110 patients who presented with acute exacerbation of COPD. The patients were classified into several groups according to different variables, such as severity, respiratory acidosis, and smoking habits. Bacteriological investigations were performed for all patients including Gram stain examination together with culture and sensitivity testing after proper processing of sputum or endotracheal samples.
Results and conclusion:
Klebsiella pneumoniae
and
Acinetobacter
spp. were the most common isolates in patients with mild to moderate COPD admitted to the respiratory ICU and to the ward. Each had an incidence of five (15.15%) isolates in the ICU, whereas in the ward there were 13 (14.9%) isolates of
Klebsiella
spp. and seven (8.04%) isolates of
Acinetobacter
spp.
Acinetobacter
spp., however, was the most common isolate in patients with severe to very severe COPD, with an incidence of five (17.9%) isolates. Imipenem was the most sensitive antibiotic in all patient groups in the ICU and ward.
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The diagnostic value of serum levels of C-reactive protein and procalcitonin in differentiation between active pulmonary TB and CAP
p. 178
Basem I El-Shafey, Hoda M Bahr, Salwa A Ganna, Mohmad S Attia, Mamdouh Rakhawy
DOI
:10.4103/1687-8426.158071
Introduction:
C-reactive protein (CRP) and procalcitonin (PCT) levels are elevated in patients with community-acquired pneumonia (CAP), but PCT does not increase in patients with pulmonary tuberculosis (TB).
Aim:
To evaluate the diagnostic value of serum levels of CRP and PCT in differentiating between active pulmonary TB and CAP.
Participants and methods:
The present study was carried out on 90 individuals divided into the following groups: group I included 10 control participants, group II included 40 patients with active pulmonary TB, and group III included 40 patients with CAP. Serum levels of CRP and PCT were measured.
Results:
CRP was significantly increased in group III compared with groups I and II. PCT was significantly increased in group III compared with groups I and II; also, there was a significant increase in group II compared with group I. The cut-off value of CRP between group II and group III was more than 24 (mg/dl), with a sensitivity of 100%, a specificity of 70%, and that of PCT was more than 530 (pg/ml), with a sensitivity of 67% and a specificity of 97.5%.
Conclusion:
Measurements of CRP and PCT were complementary to each other to differentiate between pulmonary TB and CAP.
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Prevalence of latent tuberculosis infection among multinational healthcare workers in Muhayil Saudi Arabia
p. 183
Nabil A Abdelghaffar Hibah, Hosam-Eldin Abdelhady Hasan
DOI
:10.4103/1687-8426.158078
Objectives:
The aim of this work was to assess the prevalence of latent tuberculosis infection (LTBI) in multinational healthcare workers (HCWs) in Muhayil, Saudi Arabia.
Materials and methods:
This work was carried out in 2013 and included all hired HCWs in Muhayil National Hospital (MNH), Muhayil, south of Saudi Arabia. Data were collected from HCWs including age, sex, job category, and country of citizenship. They were examined for LTBI using the tuberculin skin test (TST) after obtaining their consent to perform the test. CXR was also carried out in all participants to (and if needed sputum stain for
Mycobacterium tuberculosis
smear) for the detection of active disease. Statistical analysis was carried out, and
P
values less than 0.05 were considered significant.
Results:
Out of the 208 HCWs tested with TST, 47 (22.5%) were positive. The prevalence of LTBI was the highest in the age group of 50 years or more [26.3% (
n
= 5)] and the lowest in the age group 20-29 years [19% (
n
= 14)]. The prevalence of LTBI was the highest in nurses [28.7% (
n
= 21)] and the lowest in physicians [16.5% (
n
= 7)]. The prevalence of LTBI was the highest in HCWs from the Philippines [27.5% (
n
= 23)] and the lowest in HCWs from the Middle East, Saudi Arabia, and Yemen [16.5% (
n
= 3)]. Signs suggestive of inactive TB were found in 10% of the participants (
N
= 21), and all of them were TST positive (44.5% of all TST-positive participants).
Conclusion:
LTBI is prevalent in HCWs in MNH, especially in nurses and in HCWs from countries with high rates of tuberculosis (Philippine and South Asia).
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Comparative study between tuberculin skin test and serum albumin level in patients with active pulmonary tuberculosis
p. 188
Ahmad A Mohammad, Osama E Mohammad, Abeer A Shoman
DOI
:10.4103/1687-8426.158086
Background:
Tuberculosis is difficult to diagnose and is an important cause of death among adults in developing countries. There is an urgent need for low-cost diagnostic markers in resource-limited settings.
Aim:
The aim of the study was to investigate the relationship between the intensity of the tuberculin test and serum albumin level in patients with active pulmonary tuberculosis.
Patients and methods:
Forty patients with active pulmonary tuberculosis before treatment were classified into two groups: group A and group B. Group A included 20 patients (17 men and three women; age 23-70 years) with serum albumin level below 3.5 g/dl. Group B included 20 patients (16 male and four female patients; age 15-68 years) with serum albumin level of 3.5 g/dl or more. Patients were subjected to full clinical evaluation. Comorbidities that may affect tuberculin reaction, such as HIV infection, alcoholism, chronic renal failure, and neoplasms, were excluded. Laboratory tests included complete blood count, evaluation of erythrocyte sedimentation rate, liver and kidney function tests, plain chest radiography, tuberculin skin test using the Mantoux technique, sputum test for acid fast bacilli by means of Ziehl-Neelsen staining for three consecutive days, and serum albumin level at the same time as the tuberculin test.
Results:
There was a statistically significant difference between the two groups as regards serum albumin level. The mean tuberculin skin test diameter in group A was 7.5 3.94 mm and in group B was 20.9 5.51 mm, which revealed statistically significant difference between the two groups. There was a statistically significant positive correlation between the intensity of tuberculin skin reaction at 72 h and serum albumin levels in both groups.
Conclusion:
Patients with active pulmonary tuberculosis and lower serum albumin levels have weaker skin responses to tuberculin test.
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THORACIC TUMORS - ORIGINAL ARTICLE
Effect of continuous positive airway pressure on oxidative stress accompanied by obstructive sleep apnea
p. 192
Mohmad G El-Kholy, Basem I El-Shafey, Mohmad S Hantera, Salwa A Ganna, Hesham A El-Sorogy, Abd El-Rhman F Faisl
DOI
:10.4103/1687-8426.158092
Introduction:
In obstructive sleep apnea (OSA), there is increased oxidative stress.
Aim of this work:
This study aimed to examine the effect of continuous positive airway pressure (CPAP) on oxidative stress occurring in OSA.
Participants and methods:
The present study was carried out on 40 individuals classified into four groups: group I included 10 control participants, group II included 10 obese individuals without OSA, group III included 10 patients with mild to moderate OSA, and group IV included 10 patients with severe OSA. Sleep study was carried out, and Thiobarbituric acid-reactive substance and superoxide dismutase enzyme were measured.
Results:
Thiobarbituric acid-reactive substance was significantly increased, but superoxide dismutase was significantly decreased in group IV, and CPAP led to an improvement in this condition.
Conclusion:
OSA leads to increased oxidative stress that improved with the use of CPAP.
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PULMONARY CRITICAL CASE MEDICINE - ORIGINAL ARTICLES
Flow versus pressure triggering in mechanically ventilated acute respiratory failure patients
p. 198
Magdy M Khalil, Nevine M Elfattah, Mohsen M El-Shafey, Nermine M Riad, Raed A Aid, Alaa M Anany
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.
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Assessment of patients' satisfaction in Ain Shams University Hospitals
p. 211
Haytham S Diab
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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CASE REPORT
Bronchogenic cyst presenting as neck swelling in an adult: A case report
p. 221
Shreya Bhattacharya, Smitha N Vijayan, Subramania Iyer
DOI
:10.4103/1687-8426.158112
Bronchogenic cysts are rare congenital malformations originating from budding of the tracheobronchial component during foregut development. Most cy sts are located in the mediastinum and the intrapulmonary region. Localization in the cervical area is unusual. The majority of cases have been reported in the pediatric population and few cases in adults. We report an unusual case of bronchogenic cyst presenting as a deep lateral neck mass with dysphagia in an adult female. This case presented with three unusual elements: adult female, lateral cervical location, and presence of symptoms.
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© Egyptian Journal of Bronchology | Published by Wolters Kluwer -
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Online since 31st Dec, 2013