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2019| October-December | Volume 13 | Issue 4
Online since
October 25, 2019
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ORIGINAL ARTICLES - PULMONARY INFECTIONS
Role of lactate dehydrogenase and other biomarkers in predicting prognosis of community-acquired pneumonia
Rasha M Hendy, Mona A Elawady, Heba M Abd EL Kareem
October-December 2019, 13(4):539-544
DOI
:10.4103/ejb.ejb_22_19
Background
An increase in serum lactate dehydrogenase (LDH) activity is commonly taken to support the presumptive diagnosis of some lung diseases and a variety of extrapulmonary disorders, but the role of LDH as an early prognostic factor in detecting outcome in patients with community acquired pneumonia (CAP) was not well studied before.
Aim
To assess the prognostic value of LDH and other laboratory markers [C-reactive protein (CRP), serum albumin, and neutrophil percentage] in patients with CAP.
Patients and methods
We compared levels of LDH and other laboratory markers (CRP, serum albumin, and neutrophil percentage) with each other and with CURB65 score, length of hospital stay, and worse outcomes (ICU admission, mechanical ventilation, and mortality) in 62 (33 males and 29 females) patients with CAP who were admitted to Pulmonology Department, Benha University Hospital, between March 2016 and March 2017 after ethical committee approval.
Results
Most of the patients with worse outcomes showed significant high levels of LDH, CRP, albumin, and neutrophil percentage early on admission.
Conclusion
LDH was a highly sensitive biomarker for early prediction of worse outcomes in patients with CAP.
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Effect of adding inhalation of sodium bicarbonate 8.4% to the usual treatment on smear-positive pulmonary tuberculosis: a prospective controlled study
Mohammad K El-Badrawy, Eman O Arram, Dina A Abdalla, Dina Al-Sagheer, Alaa Zahran, Mohammad A AboElEla, Adel El-Badrawy, Wagdy Amin
October-December 2019, 13(4):531-538
DOI
:10.4103/ejb.ejb_18_19
Background
Pulmonary tuberculosis (TB) lesion is acidic, and changing this acidic pH may affect growth of TB bacilli and response to therapy. We aimed to assess the effect of adjuvant inhalation of sodium bicarbonate (SB) 8.4% on clinical, radiological, and microbiological responses in patients with sputum-positive drug-sensitive pulmonary TB.
Patients and methods
One hundred and three patients with pulmonary TB completed the study, and they were classified into two groups: group I included 55 patients who received standard anti-TB regimen plus SB inhalation, and group II included 48 patients who received anti-TB regimen only. The responses in both groups were evaluated clinically, microbiologically, and radiologically.
Results
There was no statistically significant difference between both groups in baseline bacillary load, clinical picture, and radiology. Both groups improved clinically 1 month after start of therapy. In group I only, there was a statistically significant improvement in chest radiograph after 1 month (
P
<0.001). The median duration of smear conversion for group I was 3 weeks (1–8) compared with 9.5 (2–17) in group II, with a statistically significant difference (
P
<0.001). Moreover, the median duration of culture conversion for group I was 1 month (1–3) compared with 3 months (1–4) in group II, with a statistically significant difference (
P
<0.001).
Conclusion
Adjuvant inhalation of SB in smear-positive pulmonary TB to standard anti-TB drugs accelerates smear conversion, culture conversion, and clinical and radiological improvement.
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ORIGINAL ARTICLES: PULMONARY FUNCTIONS
Effect of different classes of obesity on the pulmonary functions among adult Egyptians: a cross-sectional study
Ashraf M Hatem, Mohamed S Ismail, Yasmine H El-Hinnawy
October-December 2019, 13(4):510-515
DOI
:10.4103/ejb.ejb_21_19
Introduction
Obesity is a common chronic disease, representing a major health hazard. Obesity has several delirious effects on the respiratory functions.
Aim of the study
To study the effect of obesity on pulmonary functions among our local population of obese adults and to assess the correlation between the severity of lung function impairment and the degree of obesity.
Patients and methods
Healthy nonsmoker adult patients were recruited in our cross-sectional study. After full medical evaluation, measurement of height and weight, and calculation of BMI, patients underwent spirometry tests with measurement of forced expiratory volume in first second (FEV1), forced vital capacity (FVC), forced mid-expiratory flow, and peak expiratory flow rate. Then, they were classified according to their BMI into five groups.
Results
The study included 293 patients divided into five groups according to their BMI. Significant statistical differences were noticed between nonobese patients and patients with classes II and III obesity regarding FVC, FEV1, and forced mid-expiratory flow, but no differences regarding peak expiratory flow rate and FEV1/FVC ratio. Overall, 28.9% of the total obese patients presented with restrictive pattern of spirometry, 2.8% with obstructive, and 2.4% with mixed patterns.
Conclusion
Obesity of especially marked degrees with BMI of more than 35 kg/m
2
negatively affects the spirometric parameters. Restrictive pattern was the commonest abnormality observed in the spirometry of obese patients.
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ORIGINAL ARTICLES - AIRWAY DISEASES
Impulse oscillometry usefulness in small-airway dysfunction in asthmatics and its utility in asthma control
Ragia S Sharshar
October-December 2019, 13(4):452-458
DOI
:10.4103/ejb.ejb_16_19
Background
Small-airway affection and its relation to clinical status in asthmatic patients became an increasing interest during the last decade. Spirometry is a basic diagnostic tool for measuring pulmonary function in asthmatics but not fully illustrative especially in assessing small airways. Impulse oscillometry (IOS) can be considered a complementary and sometimes alternative technique to spirometry because it is used during quiet breathing and so gives more data about small-airways affection in asthmatic patients.
Aim
To evaluate IOS usefulness in the detection of small-airways disease in asthma and its correlation to the level of disease control.
Patients and methods
The study was conducted on 44 asthmatic patients who were classified into two groups: controlled asthma and uncontrolled asthma by asthma control test questionnaire (ACT score). Spirometry and IOS were performed on all patients.
Results
Small-airway IOS values (R5–20, X5, and AX) were found to be statistically significant between two groups. Moreover, they strongly correlated significantly with clinical symptoms, assessed by ACT. There was high sensitivity and specificity of (R5–20) 80 and 82%, (X5) 80 and 86%, and (AX) 86 and 89%, while for spirometric data only forced expiratory flow (FEF
25–75%
) showed a statistically significant difference between the two groups, and not FEV
1
% and there was poor correlation between ACT and FEF
25–75%
.
Conclusion
IOS provides an easy and rapid tool to diagnose and assess small-airways disease in adult, asthmatic patients
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ORIGINAL ARTICLES: CRITICAL CARES
Diaphragm and weaning from mechanical ventilation: anticipation and outcome
Rasha M Abdelhafeez, Ahmed M Abumossalam, Eman O Arram, Mohsen M Elshafey, Mohammed E Abushehata
October-December 2019, 13(4):489-497
DOI
:10.4103/ejb.ejb_13_19
Background
Determining the optimal moment to extubate a critically ill patient remains a challenge. The parameters of diaphragm sonography offer precious data in the evaluation and follow-up of critically ill patients on mechanical ventilation.
Aim
To evaluate the diaphragm role in the weaning outcome through the following objectives: detect the association between ultrasonographic parameters of diaphragm [thickness, excursion, and velocity of contraction (slope)] and weaning outcome, success, or failure, in addition to evaluation of the weaning process by measuring the total duration of ventilation, weaning duration, ICU stay, and reventilation.
Patients and methods
A longitudinal, observational, prospective study. The primary endpoint was weaning outcome (failed or successful), while the secondary endpoints included length of ICU stay, weaning duration, ventilation duration, presence or absence of complications, and mortality. It was conducted on 240 (138 men and 102 women) invasively mechanically ventilated patients aged between 20 and 78 years were chosen from our Respiratory ICU of Chest Department, Mansoura University Hospital.
Results
There were statistically significant higher values of all sonographic measurements in the survived compared with the died group (
P
<0.001). There was statistically significantly higher sonographic diaphragmatic measurements in the successful group compared with the failed group (
P
<0.001).
Conclusion
The measurement of percent change of diaphragmatic thickness as well as excursion and slope could be applied in correlation more with weaning outcome with a sensitivity of 100% and specificity of 97.4%.
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ORIGINAL ARTICLE: BRONCHOSOCOPY & INTERVENTIONAL PULMONOLOGY
Diagnostic yield of ultrasound-guided transthoracic biopsy in peripheral lung lesions
Fayed H Kawshty, Ahmed A Abd Elradi, Ahmed M Ahmed
October-December 2019, 13(4):469-476
DOI
:10.4103/ejb.ejb_25_19
Background
Ultrasonography (US) guidance of transthoracic needle biopsy of peripheral lung lesions is a useful diagnostic technique. It is a relatively easy and safe procedure under real-time US guidance and may give enough tissue sampling of lesions for histopathological examination. The aim of this study was to determine the diagnostic accuracy and safety of this technique in the diagnosis of peripheral lung lesions.
Patients and methods
A total of 60 patients underwent US-guided percutaneous needle biopsy of peripheral lung lesions from November 2017 to October 2018 in the Chest Department. The age of patients ranged from 27 to 79 years, with mean age of 58.4 years. Overall, 48 (80%) patients of the studied group were males, whereas 12 (20%) patients were females.
Results
According to the final diagnoses, 48 (80%) cases were malignant and 12 (20%) cases were benign. Diagnostic accuracy was 90%, sensitivity was 96%, both specificity and positive predictive value were 100%, and the negative predictive value was 60%. Pneumothorax and hemoptysis occurred in two (3.33%) patients each.
Conclusion
Chest US-guided biopsy in the diagnosis of peripheral lung lesions is a safe and fast procedure with high diagnostic yield and fewer complications.
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ORIGINAL ARTICLES - PULMONARY INFECTIONS
Study of the prevalence and pattern of fungal pneumonias in respiratory intensive care units
Mona M Ahmed, Ayman A Farghaly, Riham H Raafat, Waleed M Abd Elsattar
October-December 2019, 13(4):545-550
DOI
:10.4103/ejb.ejb_37_19
Background
Fungal pneumonia is an infectious process in the lung caused by one or more endemic or opportunistic fungi. Fungal infection occurs following the inhalation of spores, after the inhalation of conidia, or by the reactivation of a latent infection. Hematogenous dissemination frequently occurs, especially in an immunocompromised host.
Aim of the work
To assess the prevalence of fungal pneumonias in a group of respiratory ICUs and identify their pattern.
Patients and methods
This study was carried out on 60 patients who were admitted in respiratory ICUs of different hospitals: Ain Shams University and Military Hospitals from March 2018 till February 2019 to assess the prevalence of fungal chest infection in that group of patients and furthermore to identify their pattern. All patients were subjected to the following: history, clinical examination, radiology (plain chest radiograph and computed tomography of the chest), routine laboratory investigations and finally mycological analysis including direct microscopic examination and culture examination of the collected respiratory samples.
Results
The mean age of all patients was 55.43 years. Regarding sex of the patients, the majority (76.67%) of patients were men, while 23.33% were women. Forty (66.67%) patients out of 60 patients with respiratory diseases had been culture positive for fungus and 20 (33.33%) patients had been culture-negative. The major fungal species encountered in this study were Candida species in 23 (57.5%) cases followed by Aspergillus species in 17 (42.5%) cases.
Candida albicans
was isolated in 23.33% of patients followed by Aspergillus nonfumigatus (18.33%) then Candida nonalbicans (15%), and finally
Aspergillus fumigatus
(10%).
Conclusion
From the current study, we can conclude that pulmonary fungal infection appears to be an important problem in patients with respiratory diseases especially patients who are admitted in respiratory ICUs regardless of their age or sex.
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ORIGINAL ARTICLES: CRITICAL CARES
Sonographic measurement of lung aeration versus rapid shallow breathing index as a predictor of successful weaning from mechanical ventilation
Nabila I Laz, Mohammad F Mohammad, Sahar M Abdelsalam, Radwa M Abdelwahab
October-December 2019, 13(4):477-483
DOI
:10.4103/ejb.ejb_7_19
Background
Lung ultrasonography is a beneficial tool for evaluation of the extent of lung aeration through measurement of the amount of extravascular lung water. Lung ultrasonography offers some advantages over other methods of assessment of lung aeration including the lack of ionizing radiation and the possibility of use at patient’s bedside. It facilitates dynamic assessment of the lung during mechanical ventilation and during weaning.
Aim
To assess lung aeration by lung ultrasonography in patients ready for weaning and to validate the significance of its use as a predictor of weaning outcome in comparison with rapid shallow breathing index.
Patients and methods
A prospective observational study was conducted on 30 critically ill mechanically ventilated patients for 48 h or more, and ready to undergo spontaneous breathing trial (SBT), according to the readiness criteria. It was conducted in Beni-Suef University Hospital from October 2017 to May 2018. Rapid shallow breathing index was measured before initiation of SBT, and lung ultrasound was done, before, during, and after SBT [lung ultrasound score (LUS) 1, 2, and 3] and were used as predictors for SBT outcome. Patients were divided, according to outcome, into successful weaning group (group A) and failed weaning group (group B).
Results
In the failed weaning group, LUS1, LUS2, and LUS3 were significantly higher than those of the successful weaning group. At cutoff value of 8.5, LUS3 could be used for prediction of weaning failure with sensitivity 85% and specificity 100%. Moreover, there was a statistically significant relation between LUS and the other variables including hospital stay, mechanical ventilation duration, and mortality.
Conclusion
Lung ultrasound is useful as a bedside tool that can help physicians in their weaning decisions.
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ORIGINAL ARTICLES - AIRWAY DISEASES
Correlation between ventricular function as assessed by echocardiography and six-minute walk test as a surrogate of functional capacity in patients with chronic obstructive pulmonary disease
Magdy M Khalil, Hala M Salem, Hossam-Eldin M Abdil-Hamid, Muhammad Y Zakaria
October-December 2019, 13(4):459-468
DOI
:10.4103/ejb.ejb_48_19
Background
Exercise intolerance is common in patients with chronic obstructive pulmonary disease (COPD), which has multiple mechanisms underlying its progression. Ventricular dysfunction may play a role in the development of exercise incapacity in patients with COPD.
Aim
To investigate the possible contribution of left ventricular (LV) and right ventricular (RV) dysfunction (either systolic or diastolic) in development of exercise intolerance in patients with COPD.
Patients and methods
A total of 60 patients with diagnosis of COPD were categorized according to GOLD spirometric stage into two groups (group 1: mild to moderate COPD, and group 2: severe to very severe COPD). Both groups were evaluated by spirometry, ECG, chest radiography, routine laboratory investigation, 6-min walk test, and echocardiography including tissue Doppler imaging.
Results
The average age in the whole study group was 56.63±10.33 years. Male patients in the study were 46 (76.7%) and female patients were 14 (23.3%). Mean maximum walk distance among the whole group was 342.75±54.85 m. There was a significant correlation between 6-min walk distance and transtricuspid E velocity, tricuspid E/A, and transtricuspid deceleration time (
P
=0.011, 0.015, and 0.021, respectively). There was no significant correlation between 6-min walk distance and parameters of LV diastolic dysfunction. Prevalence of ventricular dysfunction was as follow: LV systolic dysfunction 3.3%, LV diastolic dysfunction 30%, RV systolic dysfunction 21%, and RV diastolic dysfunction 46%.
Conclusion
RV diastolic dysfunction may be a contributing factor in the progression of exercise intolerance in COPD. Although LV diastolic dysfunction may not be associated with exercise intolerance, it is still prevalent in COPD and must be assessed and managed through the course of the disease and especially during exacerbation.
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A study of plasma copeptin level as a predictor of severity during acute exacerbation of bronchial asthma
Ahmed G El Gazzar, Khaled M Belal, Tarek S Essawy, Neveen M Abd-Elfattah
October-December 2019, 13(4):443-451
DOI
:10.4103/ejb.ejb_61_18
Background
An exacerbation of asthma is an episode, characterized by a progressive increase in one or more typical asthma symptoms (shortness of breath, wheezing, cough, and chest tightness). Copeptin is a 39-amino acid glycopeptide that is derived from the c-terminal part of the pre–pro-hormone of arginine vasopressin.
Aim
The aim of our study was to evaluate the role of copeptin in asthmatic patients and its relationship to disease severity.
Patients and methods
This was a prospective observational study carried out on 45 patients during acute exacerbation of bronchial asthma (15 mild, 15 moderate, and 15 severe cases) and 15 healthy participants.
Results
Our study showed no significant difference in age, sex, and BMI between case and control groups. There was a statistical highly significant differences in pulmonary function tests, partial pressure of oxygen in arterial blood, partial pressure of carbon dioxide in arterial blood, and oxygen saturation among mild, moderate, and severe cases, and significant increase in total leukocytic count and hospital stay in severe cases than mild and moderate cases. There was a highly significant increase of plasma copeptin in moderate and severe cases than mild cases and control groups. There were nonsignificant correlations between copeptin and pulmonary function tests in mild cases; a significant negative correlation between copeptin and forced expiratory volume in 1 s (FEV1) actual in moderate cases; significant negative correlations between copeptin, FEV1 actual, FEV1% predicted, forced vital capacity% predicted, and peak expiratory flow% predicted in severe cases; and highly significant negative correlations between copeptin and partial pressure of oxygen in arterial blood and oxygen saturation in all cases (
P
<0.001). Partial pressure of carbon dioxide in arterial blood exhibited a nonsignificant positive correlation with copeptin (
P
<0.05).
Conclusion
Copeptin is proven to be a novel biomarker and is increased in patients with asthma as compared with healthy controls.
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ORIGINAL ARTICLES: CRITICAL CARES
Usefulness of different prognostic scores for AECOPD: APACHE II, BAP65, 2008, and CAPS scores
Rania A Sweed, Mostafa Abd El Mageed Shaheen, Esraa A El Gendy
October-December 2019, 13(4):498-504
DOI
:10.4103/ejb.ejb_20_19
Purpose
The purpose of this study was to compare four different scores [Acute Physiology and Chronic Health Evaluation (APACHE II); elevated blood urea nitrogen, altered mental status, pulse >109/min, age >65 years (BAP65); chronic obstructive pulmonary disease (COPD) and Asthma Physiology Score (CAPS); and 2008 score) to test their predictive properties for the need of mechanical ventilation (MV) and short-term mortality in patients with acute exacerbation COPD (AECOPD).
Patients and methods
This study enrolled 100 consecutive patients with acute exacerbation COPD, over a 6-month duration, admitted to the Emergency Department in Alexandria Main University Hospitals. The four scores were calculated for each patient, and clinical data and outcome (need for MV and mortality during hospitalization or within a week after discharge) were recorded.
Results
Their mean age was 61.1±10.7 years, and 88% were males. Duration of hospital stay was less than or equal to 20 days in 67%. Mortality rate was 4%. Overall, 40% required MV. Blood urea nitrogen, pulse, CO
2
, pH, altered consciousness, and white blood cell were significant predictors of mortality in univariate but not multivariate analysis. Previous MV, cyanosis, and paradoxical abdominal movement were significant predictors of need for MV. The highest area under the receiver operating characteristic curve was that of APACHE II score regarding either mortality prediction [area under the curve (AUC), 0.982;
P
=0.001] or need for MV (AUC, 0.959;
P
<0.001), followed by BAP65 score for mortality prediction (AUC, 0.967;
P
=0.002) and 2008 score for predicting the need for MV (AUC, 0.851;
P
<0.001).
Conclusion
All studied scores correlated significantly with mortality, but only APACHE II and 2008 score correlated significantly with the need for MV. The highest area under the receiver operating characteristic curve was that of APACHE II score regarding either mortality or need for MV prediction. Previous need for MV was the most important predictor for the need for MV. The routine use of these practical scores in triage of patients may direct early interventions to reduce mortality rate.
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ORIGINAL ARTICLES - PULMONARY INFECTIONS
The impact of admission blood glucose level on patients with community-acquired pneumonia
Tamer M Ali, Hala M Salem, Dina R Sultan
October-December 2019, 13(4):551-555
DOI
:10.4103/ejb.ejb_58_19
Background
Pneumonia is one of the most common diseases with a high hospitalization rate. Many studies have suggested that there is a correlation between pre-existing diabetes and the alterations in serum glucose levels in patients with community-acquired pneumonia (CAP) and high death rate.
Aim
To study the impact of admission blood glucose level on patients’ outcomes with CAP.
Patients and methods
Sixty (30 nondiabetic and 30 diabetic patients) consecutive hospitalized adult patients with CAP were recruited over a 1-year period. Data on patients’ outcomes including duration of hospital stay, duration of antibiotic treatment, increase in oxygen requirements, increase in antibiotics coverage, ICU admission, mechanical ventilation, and in-hospital mortality were collected.
Results
Admission blood glucose level was elevated in diabetic patients (the mean plasma glucose level was 258.86±116.15 mg/dl in diabetics and 151.13±51.23 mg/dl in nondiabetics). There were statistically significant increases in the duration of hospital stay (7.633±3.567 nondiabetic vs. 11.267±4.291 diabetic patients in days), duration of antibiotic treatment (7.633±3.567 nondiabetic vs. 11.267±4.291 diabetic patients in days), increase in O
2
requirements (33.33 vs.70%), increase in antibiotics coverage (16.67 vs. 63.33%), and ICU admission (30 vs. 63.33%) in the diabetic group on comparing nondiabetic versus diabetic patients with CAP. Also, the previously mentioned outcomes increased significantly with increasing blood glucose levels among the entire study population.
Conclusion
On admission, CAP patients with increased blood glucose level, either diabetic or nondiabetic, are expected to have poor outcomes.
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ORIGINAL ARTICLES: CRITICAL CARES
Post ICU syndrome among survivors from respiratory critical illness. A prospective study
Ahmad Abbas, Niveen E Zayed, Samah M Lutfy
October-December 2019, 13(4):505-509
DOI
:10.4103/ejb.ejb_35_19
Context
Post-ICU syndrome (PICS) is a common impairment that develops after critical illness and persists after discharge. It is considered when a new or worsening impairment in physical, cognitive, or mental status develops among survivors from critical illness.
Aim
To assess the prevalence of PICS and to define the profile of patients at risk of each domain.
Patients and methods
A total of 420 critically ill patients were assessed at the time of ICU discharge for presence of one or more domains of PICS: cognitive dysfunction, psychiatric impairment, and physical disability.
Results
A total of 220 (52.4%) patients without preexisting impairment developed one or more PICS forms. Half of the participants developed cognitive impairment, 14.29% developed depression, 26.19 developed anxiety, and 35.71% experienced both muscle weakness and impaired balance. PICS presented in three different patterns: pattern A, with one domain, in which 2.38% presented with either cognitive or psychiatric affection; pattern B, with two (19.05%) domains, where 80 patients had cognitive dysfunction, combined with physical affection in 30 patients and psychiatric impairment in 50 patients; and pattern C, with all PICS domains (28.57%). Multivariate analysis was used to detect independent predictors associated with each domain of PICS.
Conclusion
Survivors from critical illness should be screened for different domains of PICS. Cognitive impairment was evident in those with prolonged duration of mechanical ventilation (MV), delirium, stroke, and hypotension. Psychiatric impairment was evident in females with prolonged sedation and duration of MV, delirium, and hypoglycemia. Physical impairments were evident in those with sepsis, undernutrition, and prolonged duration of MV.
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Clinical outcome of weaning in mechanically ventilated patients with chronic obstructive pulmonary disease
Suzan Salama Sayed, Khalid Hussein Ahmed, Sayed Abdelsabour Kinawy, Islam Galal Sayed
October-December 2019, 13(4):484-488
DOI
:10.4103/ejb.ejb_9_19
Background
Chronic obstructive pulmonary disease (COPD) represents a significant reason for mortality and morbidity worldwide that induces a high socioeconomic burden, with exacerbations necessitating mechanical ventilation representing a major aspect of illness management. Many patients with COPD frequently presented with troubles in the liberation from mechanical ventilation. The aim of the current study was to verify the validity of the weaning categorization that is classified according to the difficulty and length of the weaning procedure in mechanically ventilated patients with COPD and its effect on the different clinical and mortality outcome variables.
Patients and methods
A total of 102 patients with COPD who achieved the weaning criteria were classified according to the length and difficulty of weaning procedure into simple weaning group (
n
=60, 58.8%) and nonsimple weaning group (which include difficult and prolonged weaning categories) (
n
=42, 42.2%). The outcome measures are the length of mechanical ventilation, the duration of ICU stay, and lastly the mortality rate.
Results
Regarding baseline data recorded at admission, no significant difference between both weaning groups was found apart from Acute Physiology and Chronic Health Evaluation score II. The nonsimple weaning group had considerably higher duration of invasive mechanical ventilation, length of ICU stays, and lastly the mortality rate, in comparison with the simple weaning group.
Conclusion
Weaning categorization according to the length and the difficulty of the weaning procedure may be used as a suitable predictor of outcome in severe COPD exacerbation with the requirement for invasive mechanical ventilation.
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ORIGINAL ARTICLES: PULMONARY FUNCTIONS
A study of the relationship between pulmonary function tests and both fasting plasma glucose and glycated hemoglobin levels among asymptomatic cigarette smokers
Magdy M Khalil, Rehab M Mohammed, Omnia H.S Hassan
October-December 2019, 13(4):516-522
DOI
:10.4103/ejb.ejb_36_19
Background
Tobacco smoke has been recognized as an independent risk factor for chronic obstructive pulmonary disease and diabetes mellitus type 2.
Aim
To investigate the association between the presence of airflow obstruction in pulmonary functions and both fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) levels among asymptomatic cigarette smokers.
Patients and methods
Pulmonary function indices via spirometry and both FPG and HbA1c levels were altogether assessed in 300 apparently healthy participants attending health checkup clinic. Participants were stratified according to their smoking status into group I, which included 150 current and former cigarette smokers (ever smokers), and group II, which included 150 participants with no history of smoking (never smokers).
Results
FPG and HbA1c% were significantly higher among group I compared with group II (
P
=0.001 and 0.002, respectively). However, percent of forced expiratory volume in 1 s/forced vital capacity ratio less than 70% was statistically more prevalent among group I compared with group II (17.3, 6.7%, respectively,
P
=0.042), and the odds ratio (OR) of its occurrence increased with FPG more than or equal to 100 mg/dl [OR=2.91; 95% confidence interval (CI)=1.62–4.01], HbA1c more than or equal to 5.6% (OR=2.07; 95% CI=0.12–0.77), age more than or equal to 50 years (OR=2.85; 95% CI=1.69–3.99), smoking index more than or equal to 25 pack-years (OR=3.11; 95% CI=1.85–3.66), and BMI more than or equal to 25 kg/m
2
(OR=2.33; 95% CI=0.06–0.84).
Conclusion
Risk of chronic obstructive pulmonary disease is increased among asymptomatic current or former cigarette smokers, especially elderly with impaired glucose homeostasis.
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ORIGINAL ARTICLES - PULMONARY INFECTIONS
Delay in the diagnosis and management of tuberculosis among patients in the Suez Canal Area
Noha M. Abu Bakr Elsaid, Amany H Refaat, Lamiaa A Fiala, Eman R Hamed
October-December 2019, 13(4):523-530
DOI
:10.4103/ejb.ejb_8_19
Background
Delayed diagnosis of tuberculosis (TB) can enhance the transmission of infection and worsen prognosis.
Aim
To identify the risk factors of delay in the management of TB cases for early management.
Patients and methods
A cross-sectional analytic study was performed to assess the proportion, duration of delay, and its determinants in the diagnosis and management of TB. To assess the risk factors of delay, the sample was dichotomized into ‘delay’ and ‘nondelay’ groups taking the median total delay in the diagnosis and management of TB as a cutoff point. The study included 183 TB patients, who were registered in TB records during the study period (first of January to end of June, 2017). Data were collected by an interview questionnaire.
Results
Nearly half of patients (49.20%) had unacceptable total delay in the diagnosis and management of TB. The median of total delay, patient delay, and health-care system delay were 65, 14, and 20 days, respectively. Significant risk factors of total delay in the diagnosis and management of TB were not consulting the health-care provider after onset of symptoms (
P
=0.002), visiting initially the health facility other than the chest hospital/TB clinics (
P
=0.019), not consulting a chest physician initially (
P
=0.043), negative sputum smear (
P
=0.001), more than two health visits before initial diagnosis (
P
<0.001), while low-degree TB stigma was protective (
P
=0.006).
Conclusion
Nearly half of patients had unacceptable total delay in the diagnosis and management of TB. The main determinants were seeking pharmacies instead of visiting health-care providers, not visiting initially chest hospital/TB clinics, not consulting a chest physician initially, negative sputum smear, and more than two health visits before initial diagnosis.
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ORIGINAL ARTICLES: SLEEP MEDICINE
Prepolysomnography evaluation can predict obstructive sleep apnea and is correlated to its severity
Hend M Esmaeel, Hamdy A Mohammadien, Abd-Elbaset M Saleh, Fatma H Mohamed
October-December 2019, 13(4):556-562
DOI
:10.4103/ejb.ejb_19_19
Background
Obstructive sleep apnea (OSA) is increasingly identified as a disease with major health consequences. The limited availability of the gold standard diagnostic test, polysomnography (PSG), mandates careful clinical evaluation of suspected patients. This can allow better patient selection for referral for confirmatory diagnostic test.
Objective
The study aimed at identifying the importance of pre-PSG evaluation in prediction of obstructive sleep apnea and its relation to disease severity.
Patients and methods
A total of 170 patients were included. Detailed demographic characteristics, anthropometric measures, and comorbid conditions were recorded. Correlation to PSG results was done, and multivariate analysis was used to identify predictors of disease.
Results
OSA was diagnosed in 58.8% of our studied patients. The patients with OSA and notably the severe subgroup were of older age, predominantly male, and current or ex-smoker. Mean BMI was highest in the patients with severe OSA (41.99±8.92) and same for mean neck and waist circumference, both were significantly higher in patients with severe OSA. In multivariate logistic regression analysis, significant predictive factors for OSA were older age, male sex, being nonemployed, having hypertension, and larger tonsillar size.
Conclusion
Patient demographics, anthropometric characteristics, and presence of comorbid conditions such as hypertension are strong predictors of having OSA and justify referral for diagnostic sleep study.
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2
Study of serum cystatin C levels in patients with obstructive sleep apnea
Eman Elfeky, Ayman Abd El-Zaher, Amal Elbendary, Salwa Ganna
October-December 2019, 13(4):563-569
DOI
:10.4103/ejb.ejb_31_19
Background
Serum cystatin C is a sensitive indicator for early renal impairment in patients with obstructive sleep apnea (OSA). In patients with OSA without known chronic kidney disease (CKD), serum cystatin C was found to be elevated, indicating latent renal disease, which may be caused by recurrent episodes of hypoxemia and reoxygenation that trigger inflammatory process.
Objective
To evaluate serum levels of cystatin C in otherwise healthy patients with OSA to predict the future risk of latent renal impairment in these patients.
Patients and methods
A total of 30 patients were classified into two groups: group I included 10 healthy controls, and group II included 20 patients with OSA. The following were done: full history taking, clinical examination, pulmonary function tests, subjective evaluation of daytime sleepiness using the Epworth Sleepiness Scale, and overnight polysomnography. Finally, serum cystatin C levels at the end of polysomnography and glomerular filtration rate was calculated using modification of diet in renal disease formula and CKD-Epidemiology Collaboration cystatin equation.
Results
In patients with OSA, the mean level of serum cystatin C was statistically significantly higher than that in controls. These higher levels were sex, age, and BMI independently. Moreover, serum levels of cystatin C in patients with OSA were significantly correlated with OSA severity (apnea-hypopnea index) and degree of nocturnal hypoxia through positive correlation with total sleep time less than 90%, total sleep time less than 80%, and respiratory disturbance index and negative correlation with average SPO
2
%, lowest SPO
2
%, and estimated glomerular filtration rate by CKD-Epidemiology Collaboration cystatin equation.
Conclusions
Higher serum levels of cystatin C were detected in patients with OSA without known comorbidities, which indicates that these patients are at a higher risk of developing CKD. Intermittent hypoxia seems to have the main role in the progression of this process.
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CASE REPORT
Mediastinal abscess complicating esophageal dilatation: a case report
Doaa M Magdy, Shereen Farghaly, Ahmed Metwally
October-December 2019, 13(4):570-573
DOI
:10.4103/ejb.ejb_10_19
Mediastinal abscess is a rare yet emergent infectious complication of the thoracic cavity following balloon dilatation of the esophagus. Early diagnosis and management could avoid its poor outcome. A 20-year-old man with esophageal stricture underwent balloon dilatation. A mediastinal abscess developed 2 weeks after procedure. Computed tomographic chest helped in diagnosis and guiding approach of management. Surgical drainage and debridement of the abscess were performed. Surgical treatment combined with systemic antibiotics was effective, leading to remission of the abscess. Mediastinal abscess should be considered as a possible infectious complication after upper endoscopy. Computed tomographic scan is a mandatory imaging modality to enable early diagnosis. Aggressive treatment including surgical drainage combined with medical management is the treatment of choice that may prevent catastrophic outcome.
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© Egyptian Journal of Bronchology | Published by Wolters Kluwer -
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Online since 31st Dec, 2013