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Table of Contents
July-December 2013
Volume 7 | Issue 2
Page Nos. 43-77
Online since Tuesday, December 31, 2013
Accessed 24,514 times.
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ORIGINAL ARTICLES
Effect of airway vibratory mucus disintegration on clinical morbidity and management of chronic obstructive pulmonary disease patients
p. 43
Ahmed Y Gad, Sayed A El-Shafe
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.
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Medical thoracoscopy: past, present, and future
p. 50
Amr Shoukri
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.
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A patient with ankylosing spondylitis and hemoptysis: is there a hidden disease?
p. 53
Tamer Ibraheem
DOI
:10.4103/1687-8426.123994
Background
An overlap syndrome of Behçet's disease and ankylosing spondylitis is a rare autoimmune disease of connective tissue in which a patient presents with symptoms of two diseases.
Case presentation
We report a case of non-smoking 25 years old known to have ankylosing spondylitis presented by haemoptysis due to a cause not usually associated with his primary disease leading to the search for another cause.
Conclusion
The coexistence of Behçet's disease and ankylosing spondylitis may be encountered in clinical practice, although it is rare. If there is a resistance to the conservative treatments, TN-alpha blocking agents may be an alternative therapeutic option in these diseases.
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Study of the role of different severity scores in respiratory ICU
p. 55
Mona Mansour, Iman Galal, Enas Kassem
DOI
:10.4103/1687-8426.123995
Background
Scoring systems are increasingly used in the ICUs in an attempt to accurately predict the mortality outcome in critically ill patients.
Objective
The performance of the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, the Sequential Organ Failure Assessment (SOFA) score, and the Simplified Acute Physiology Score (SAPS) II was compared in terms of calibration and discrimination in critically ill patients admitted to the respiratory ICU.
Materials and methods
Mean admission APACHE II, SAPS II, and SOFA scores were compared in 105 patients. The outcome measure was ICU mortality. The discriminatory ability of the scores was evaluated using the area under the receiver operating characteristic curve. Calibration was tested using the Hosmer-Lemeshow goodness-of-fit test.
Results
The mean admission APACHE II, SAPS II, and SOFA scores were higher in nonsurvivors compared with survivors; yet, only admission SOFA score differed significantly. There was highly significant positive correlation between the three scores. The cutoffs obtained by the receiver operating characteristic curve were 11 for APACHE II, 7.5 for SOFA, and 40 for SAPS II score. Discrimination power of the three scores was poor; yet, in the order of best discrimination, SOFA [area under the curve (AUC) = 0.63] was followed by APACHE II (AUC = 0.60) and then SAPS II (AUC = 0.59). In terms of calibration, SAPS II (χ
2
= 4.82;
P
= 0.78) had the best calibration and APACHE II (χ
2
= 7.34;
P
= 0.39) had the worst. Logistic regression analysis showed that, of the three scores, only the SOFA score was an independent predictor of mortality among the respiratory ICU patients; with a unit increase in the SOFA score, there was a 1.2 times higher risk for mortality.
Conclusion
The SOFA score performed well in terms of calibration, whereas the SAPS II score performed well in terms of discrimination. The APACHE II score did not perform well in terms of calibration and had poor discrimination power.
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Studying the signs of pulmonary hypertension shown by CT scans and correlating data obtained with echocardiography in suspected patients of pulmonary hypertension
p. 60
Youssriah Y Sabri, Iman M Hamdy, Irene M Sabry, Assad A Saif Al-Hadi
Introduction
Pulmonary arterial hypertension is a devastating disease with significant disability and mortality, and it has much higher prevalence than previously thought.
Purpose
The aim was to study the signs of pulmonary hypertension shown by computed tomography (CT) scans and correlate the data obtained with echocardiography in suspected patients with pulmonary hypertension in a trial to survey patients eligible for right heart catheterization.
Patients and methods
In this study, 50 patients underwent high-resolution CT (18 cases) or CT pulmonary angiography (32 cases) using a 4-MDCT scanner for evaluation of their pulmonary parenchyma, pulmonary vasculature, and mediastinal structures to detect different diagnostic criteria, types, causes, associations, and complications of pulmonary arterial hypertension. All the 50 patients underwent echocardiography.
Results
In all cases, the main pulmonary artery (MPA) was larger than 29 mm, and was further divided according to the size into three groups (<35 mm = 52%, >35<40 mm = 22%, and ≥40 mm = 26%). A more than 1 : 1 relationship between the segmental pulmonary artery and the bronchus in different pulmonary lobes was seen in 78% of the cases. A more than 1 : 1 relationship between the MPA and the aorta was seen in 76% of the cases. Correlation between MPA and the mean pulmonary artery pressure measured in 50 cases showed significant correlation, with a
P
value of up to 0.001. According to other CT findings, the causes were divided into four groups.
Conclusion
Although right heart catheterization is the gold standard for the measurement of pulmonary artery pressure, this procedure is not without risk and expense. There is a need for accurate noninvasive markers that can be used appropriately to stratify patients for referral for right-sided heart catheterization.
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Assessment of cardinal respiratory symptoms at the internal medicine outpatient clinic of Suhaj Teaching Hospital
p. 67
Mohammad Abd-El Sabour, Iman Galal, Mahmoud Hassan
DOI
:10.4103/1687-8426.123999
Background
Assessment of respiratory symptoms is the cornerstone in the accurate diagnosis of various respiratory diseases.
Objective
This study aimed at evaluating the prevalence of cardinal respiratory symptoms among patients presenting to the internal medicine outpatient clinic of Suhaj Teaching Hospital.
Materials and methods
A total of 500 consecutive adult patients presenting to the internal medicine outpatient clinic of Suhaj Teaching Hospital and complaining of either respiratory or nonrespiratory symptoms were enrolled in the study. In all patients, the initial symptoms at the time of presentation, the symptoms after history taking, and the management plan were documented.
Results
The symptomatology of patients at the initial presentation to the outpatient clinic and after history taking were compared; 136 (27.2%) and 148 (29.6%) patients, respectively (
P
< 0.001), had pure respiratory symptoms, 332 (66.4%) and 147 (29.4%) patients, respectively (
P
< 0.001), had nonrespiratory symptoms, and the remaining 32 (6.4%) and 205 (41%) patients, respectively (
P
< 0.01), had mixed respiratory and nonrespiratory symptoms. All individual cardinal respiratory symptoms differed significantly (
P
< 0.001) between the initial presentation and after history taking. Of the 136 patients presenting with pure respiratory symptoms, only 27 had pure respiratory diseases after history taking, whereas of the 364 patients without pure respiratory symptoms, 325 had pure respiratory diseases. Residents were the medical personnel who took medical decision in 452 patients, specialists took the decision in 37 patients, and consultants in 11 patients. Thirty-five patients (7%) were admitted; 30 of them had pure respiratory diseases, constituting 6% of the total patients and 87.7% of the admitted patients.
Conclusion
Both respiratory symptoms and diseases are highly prevalent at the internal medicine outpatient clinics and are responsible for a large percentage of hospital admissions.
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Assessment of patients' satisfaction with flexible bronchoscopy: Initial Egyptian experience
p. 71
Ashraf Madkour, Nehad Osman, Samar Sharkawy, Ashraf Gomaa
DOI
:10.4103/1687-8426.124002
Introduction
Data regarding the patients' satisfaction with flexible bronchoscopy (FB) in our country, which is the major driving force in defining our practice, are lacking and have not been studied. We aimed to assess our patients' satisfaction with FB.
Materials and methods
Prospective administration of a questionnaire assessing patients' evaluations of various aspects of their bronchoscopy experience, overall satisfaction, tolerance and willingness to return for another FB was carried out with inclusion of 115 patients in the analysis.
Results
The pre-FB and final post-FB information were positively rated in 93.9 and 89.6% of patients, respectively. The nursing attitudes towards patients before, during and after FB were positive in 98, 98 and 95% of patients, respectively, whereas the doctors' attitude before, during and after FB was positive in 99, 100 and 98% of patients, respectively. Patients' tolerance to examination on a 10-cm visual analogue scale was 7.22. The overall positive patient satisfaction with FB was 89.6%, but only 25.2% of patients would (definitely or probably) return for repeat FB. Stepwise logistic multiregression analysis showed that both (very good) final information and (very good) doctor's attitude after the procedure are the most sensitive discriminators for prediction of a patient with maximum satisfaction (
P
<0.0001). Scope insertion through tracheostomy and tolerance to the examination by visual analogue scale were significant predictors associated with a likelihood of definitely returning for a repeat FB if needed.
Conclusion
Our results show that, although the majority of studied patients were satisfied with different aspects of their FB examination, only a minority would repeat this experience if needed.
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© Egyptian Journal of Bronchology | Published by Wolters Kluwer -
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Online since 31st Dec, 2013