Export selected to
Endnote
Reference Manager
Procite
Medlars Format
RefWorks Format
BibTex Format
  Citation statistics : Table of Contents
   2014| July-December  | Volume 8 | Issue 2  
    Online since November 29, 2014

 
 
  Archives   Previous Issue   Next Issue   Most popular articles   Most cited articles
 
Hide all abstracts  Show selected abstracts  Export selected to
  Cited Viewed PDF
ORIGINAL ARTICLES
A study of IL-6, IL-8, and TNF-α as inflammatory markers in COPD patients
Wafaa S El-Shimy, Ayman S El-Dib, Hala M Nagy, Wael Sabry
July-December 2014, 8(2):91-99
DOI:10.4103/1687-8426.145698  
Aim To assess the diagnostic value of interleukin 6 (IL-6), IL-8 and tumor necrosis factor-α (TNF-α) as inflammatory markers in chronic obstructive pulmonary disease (COPD) patients. Methods and results IL-6, IL-8 and TNF-α levels were measured by ELISA in the serum and the bronchoalveolar lavage (BAL) in 10 control participants and 25 mild and moderate COPD patients, whereas 25 patients with severe COPD were studied for the serum level of these inflammatory biomarkers. The mean value and SD of BAL and serum IL-6, IL-8 and TNF-α levels were significantly higher in COPD patients when compared with control participants; the serum level of these biomarkers were also significantly higher in severe compared with mild and moderate COPD patients. Conclusion Increased srum and/or BAL IL-6, IL-8 and TNF-α can be used as biomarkers of the systemic inflammatory response in COPD patients, and their levels are correlated with the severity of COPD. Egypt J Broncho 2014 8:91-99 ͹ 2014 Egyptian Journal of Bronchology.
  17 5,244 10,099
Serum uric acid as a biomarker for prediction of outcomes of patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease
Sameh Embarak, Ashraf E Sileem, Maged Abdrabboh, Ahmed Mokhtar
July-December 2014, 8(2):115-120
DOI:10.4103/1687-8426.145703  
Background Serum uric acid, the final product of purine degradation, has been shown to be increased in the hypoxic state as well as in systemic inflammation including patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to assess the possible role of serum uric acid as a biomarker for the prediction of outcome of patients hospitalized for acute exacerbation of COPD (AECOPD). Patients and methods Serum uric acid levels were measured in 115 eligible AECOPD patients on admission. The primary end-point was all-cause mortality at 30 days. The secondary outcomes included the length of hospital stay, need for noninvasive ventilation, or ICU admission within 30 days. Results Serum uric acid presented an area under the receiver operating characteristic curve of 0.721 (95% confidence interval: 0.63-0.80) for the prediction of 30-day mortality in patients with AECOPD, with a sensitivity of 0.82 and a specificity of 0.61 for the cutoff point greater than 6.9 mg/dl (P = 0.021). Also, patients with higher serum uric acid levels required longer hospitalization and more often required the use of noninvasive ventilation and ICU admission at 30 days. In addition, serum uric acid levels were higher in patients with more severe airflow limitation, patients with cardiovascular comorbidity, and among frequent exacerbators. Conclusion High serum uric acid levels on admission were associated with increased 30-day mortality in patients with AECOPD. The results of this work suggest a possible role for serum uric acid in the identification of COPD patients at an increased risk of adverse outcomes who may need early intensive management. Egypt J Broncho 2014 8:115-120 ͹ 2014 Egyptian Journal of Bronchology.
  3 3,352 481
Evaluation of the psychological status of patients during and after weaning from mechanical ventilation
Adel M Saeed, Iman H Galal, Aalaa K Shata
July-December 2014, 8(2):160-166
DOI:10.4103/1687-8426.145718  
Background Care for mechanically ventilated patients must incorporate psychological care. Aim The aim of the study was to evaluate the overall satisfaction of ICU survivors who needed mechanical ventilation (MV) with their ICU stay including the assessment of different psychological changes. Patients and methods One hundred mechanically ventilated patients (32 medical and 68 surgical) were interviewed after extubation. Results Medical patients were older than surgical patients (57.44 ± 13.27 vs. 48.69 ± 14.74 years, P = 0.005), had more days on MV (5.8 ± 4 vs. 2.6 ± 3.7 days, P = 0.0001), had a positive history of previous MV (18.8 vs. 0%, P = 0.001), and had more weaning trials (P = 0.0001). Items that were bothersome for patients included noise (97%), poor communication with nurses (98%), poor performance of nurses and doctors (22 and 20%, respectively), nursing shift changeover (26%), being connected and ventilated by a machine (100%), discomfort because of endotracheal tube (100%), tracheal suctioning by endotracheal tube (76%), Ryle feeding (75%), being hungry and thirsty (92 and 93%, respectively), insomnia (98%), not getting enough sleep (34%), not being able to talk (99%), lack of social communication (100%), immobilization (100%), pain (99%), loss of time orientation (83%), feelings of fearful (97%), loneliness (96%), bored (95%), hallucinations (17%), depressed (97%), neglected (66%), isolated (95%), insecurity (74%), lack of self-confidence (91%), not accepting the situation (98%), and postextubation complications including voice problems (34%), difficulty swallowing (9%), and movement problems (27%). Duration of MV correlated significantly with hallucinations (P = 0.0001) and feeling neglected (P = 0.019). Conclusion ICU experiences were mostly negative.
  3 3,940 651
Outcome of active pulmonary tuberculosis patients requiring respiratory intensive care admission
Mona Mansour, Ashraf Madkour, Mourad Fouda
July-December 2014, 8(2):79-86
DOI:10.4103/1687-8426.145692  
Introduction There are limited data regarding active pulmonary tuberculosis (APTB) patients requiring ICU admission. Aim This study aimed to determine the mortality rate and risk factors associated with mortality in patients with APTB requiring respiratory intensive care unit (RICU) admission. Patients and methods A combined retrospective-prospective study was conducted during the period between January 2009 and December 2010 (retrospective part) and between January and December 2011 (prospective part) on adult patients with APTB admitted to the RICU of Abbassia Chest Hospital for a period of more than 24 h. Demographic, clinical, and therapeutics characteristics as well as outcome (RICU morality) were obtained from the medical records. Results A total of 100 patients (median age 38 years) were included (60 retrospective and 40 prospective). The RICU morality rate was 74%. The overall median length of stay in RICU was 5 days. Respiratory failure was the most common cause of admission. Mechanical ventilation (MV) was needed in 65% of patients. Complications occurred in 45% of cases. Female sex, lower diastolic blood pressure, far advanced lesion, respiratory failure type II, higher Acute Physiology and Chronic Health Evaluation II score, lower Glasgow Coma Scale score, increased need for MV, and electrolytes disturbances were significantly more frequent in nonsurvivors than in survivors in the RICU. Risk factors identified for nonsurvival were pneumonia pattern and far advanced lesion by radiology, female sex, and renal impairment. MV was the only predictor of RICU mortality. Conclusion The present study found a very high mortality rate among APTB patients requiring RICU admission and identified associated risk factors and a predictor of RICU mortality.
  3 2,740 581
Diagnostic impact of integrating ultrasonography into routine practice in respiratory intensive care units
Haitham Salah
July-December 2014, 8(2):66-69
DOI:10.4103/1687-8426.145686  
Ultrasound (US) has received increasing interest from chest physicians in recent years especially in Respiratory ICU (RICU) settings. US examination is a valuable method in diagnosis of various thoracic conditions including pleural or pericardial effusion, empyema, pneumothorax, pulmonary embolism, and pneumonia. Its bedside application, easy to learn, short examination time, lower cost, guiding biopsy procedures, altering treatment plans and shortening ICU stay made US a valuable indispensable routine tool in daily management of critically ill RICU patients.
  2 2,749 4,103
Comparison between bronchoscopy under general anesthesia using laryngeal mask airway and local anesthesia with conscious sedation: a patient-centered and operator-centered outcome
Hesham Raafat, Mahmoud Abbas, Sameh Salem
July-December 2014, 8(2):128-137
DOI:10.4103/1687-8426.145707  
Background and objectives With the evolution of complex bronchoscopic procedures, search for procedures that were less painful to patients and easier for the operators to perform commenced. Conscious sedation partially achieved this target. We aimed to compare conscious sedation with general anesthesia (GA) in achieving a safer and more painless procedure. Patients and methods Eighty patients were included: 36 (45%) were subjected to local anesthesia (LA) with midazolam and 44 (55%) to GA through laryngeal mask airway. Patients responded to a visual analogue scale (VAS) for cough, choking, dyspnea, nausea, vomiting, nasal symptoms, chest pain, and anxiety during bronchoscopy. Postbronchoscopy VAS included cough, fever, dyspnea, nausea, vomiting, nasal symptoms, and hemoptysis. Lastly, VAS for the tolerability of bronchoscopy and acceptance to repeat the procedure were answered. Operator VAS included cough, desaturations, easiness of the procedure, and success. Bronchoscopy, recovery times, the number of biopsies, and cost were recorded. Results GA was significantly less symptomatic during bronchoscopy than LA (P = 0.0001). Nasal symptoms were more in LA after bronchoscopy (P = 0.003). Anxiety was more in LA (P = 0.014). The GA group found bronchoscopy to be more tolerable (P = 0.0001), and accepted to repeat the procedure (P = 0.001). The operator found that GA was associated with significantly less cough and desaturations, and was easier to perform (P = 0.0001). The duration of the procedure, the recovery time, the number of biopsies, and the cost were significantly higher in GA (P = 0.0001). Safety was equal in both groups. Conclusion GA serves as a more peaceful procedure for the patient and the operator than LA, but at the expense of recovery time and cost. Egypt J Broncho 2014 8:128-137
  2 7,604 488
Assessment of the outcome of mechanically ventilated chronic obstructive pulmonary disease patients admitted in the respiratory ICU in Ain Shams University Hospital
Magdy M Khalil, Nevine Abd Elfattah, Amr S El-Qusy
July-December 2014, 8(2):138-142
DOI:10.4103/1687-8426.145708  
Background Mechanical ventilation (MV) alters the outcome of patients with chronic obstructive pulmonary disease (COPD). Aim This study aimed to assess the outcome of mechanically ventilated COPD patients admitted in the respiratory ICU and the factors influencing the outcome. Patients and methods This prospective study included 50 mechanically ventilated COPD patients. For all patients, arterial blood gas analysis and vital data (before intubation, before extubation, and 30 min after extubation), complications of MV, the length of ICU stay, duration of MV, different trials of weaning from MV, and outcome were documented. Results Nonsurvivors were significantly older (68.1 ± 10.3 vs. 60.7 ± 11.1, P = 0.034), had longer duration of MV (11.8 ± 10.4 vs. 5.4 ± 5.2, P = 0.02), prolonged ICU stay (17.7 ± 10.2 vs. 9.3 ± 5.6, P = 0.01), more frequent tracheostomy (4 vs. 1, P = 0.018), less liable to be weaned from the first trial (5 vs. 28, P = 0.008), and more complications of MV (P = 0.04). Only PaCO 2 before intubation differed significantly between survivors and nonsurvivors (92.6 ± 14.9 vs. 81.0 ± 18.2, P = 0.025). The length of ICU stay correlated significantly with both systolic and diastolic blood pressure (P = 0.009 and 0.022, respectively), complications of MV (P = 0.001), and the duration of MV (P = 0.0001). Conclusion Several predictors can affect the outcome of COPD patients on MV, ultimately increasing the length of stay and mortality rate, including age, failure of several trials of weaning, presence of ventilator-associated pneumonia, adult respiratory distress syndrome, presence of tracheostomy, and prolonged MV duration.
  2 1,842 182
Chest ultrasound versus chest computed tomography for imaging assessment before medical thoracoscopy
Magdy Khalil, Haytham Samy Diab, Hanan Hosny, Emad Edward, Ehab Thabet, Wael Emara, Ahmed Soliman, Hanaa Fayez
July-December 2014, 8(2):149-152
DOI:10.4103/1687-8426.145714  
Background and objective The aim of this work was to assess the concordance between chest ultrasound (US) and chest computed tomography (CT) findings before medical thoracoscopy (MT) and the impact of the findings on the conduct and outcome of MT. Materials and methods The study was conducted prospectively on 52 patients referred for MT. All patients received chest X-ray (CXR), chest US, and chest CT before the procedure. Images were evaluated and findings were correlated with thoracoscopic findings. Results US findings were discordant with CT findings regarding consistency, septation, and loculation of effusion in 24/52 patients, with US detecting the findings in 24/24 patients. None of these findings was detectable on CT. US was superior to CT in detection of diaphragmatic nodules (16/52, 3/52, respectively). US findings affected MT conduct in 20/52 cases and outcome in 5/40 cases, and they were consistent with MT findings in 39/40 cases; US and CT missed septation in one case. US findings were concordant with CT findings regarding site and size of effusion and pleural masses, sizable nodules, and thickening. US missed discrete small parietal nodules in 10/52, consolidation in 2/52, mediastinal lymphadenopathy in 6/52, and mediastinal shift in 42/52 cases. CXR could identify mediastinal shift but none of other CT findings were missed by US. None of US-missed abnormalities directly altered MT management. Conclusion US identifies more explicitly the imaging information relevant to MT compared with chest CT. Pre-MT imaging workup can be limited to CXR and US, reserving chest CT for cases in which US is technically unrevealing.
  2 3,401 300
Evaluation of carbon monoxide diffusing capacity as an early detection of pulmonary involvement in rheumatoid arthritis patients without respiratory symptoms
Mohammed A Farrag, Adel M El-Sayed, Rehab M Mohammed, Mohammed F El Bagalatya
July-December 2014, 8(2):167-172
DOI:10.4103/1687-8426.145721  
Background The risk of death for rheumatoid arthritis (RA) patients with interstitial lung disease (ILD) is three times higher than that in RA patients free from ILD. Therefore, this study was carried out to assess the value of carbon monoxide diffusing capacity (DL CO ) in the early detection of pulmonary involvement in RA. Patients and methods This prospective study was carried out in 30 nonsmoker patients with RA (29 women and one men) ranging in age from 21 to 66 years, mean age 42.6 ± 1.9 years. All RA patients were clinically free from respiratory symptoms with normal chest radiograph. For all patients, spirometry and DL CO were performed. Results Twenty (66.67%) cases had a diffusion defect in DL CO ; the defect was mild in 17 cases and moderate in three cases. The severity of DL CO differed significantly with the duration of RA and decrease in forced vital capacity (P < 0.05), but did not differ significantly with either the rheumatoid factor titer or the duration of methotrexate therapy (P > 0.05), although the use of methotrexate was higher among patients with abnormal DL CO . The severity of DL CO correlated significantly and inversely with the duration of RA (P < 0.05). A normal pattern of spirometry was the predominant pattern, followed by a restrictive pattern and small airway obstruction, whereas the obstructive pattern was the least observed. Conclusion There is a high incidence of pulmonary involvement in RA patients, especially in those receiving methotrexate therapy. Pulmonary function testing, and more specifically DL CO , can serve as useful screening tools for the early detection of RA-ILD even in clinically asymptomatic patients with normal chest radiograph.
  1 2,116 141
CASE REPORT
A rare presentation of a rare disease
Tamer Ibraheem
July-December 2014, 8(2):173-174
DOI:10.4103/1687-8426.145724  
Background Castleman's disease, a rare condition of uncertain etiology, is associated with lymphoproliferation. It is histologically and prognostically distinct from malignant lymph node hyperplasia. Case presentation We report a case of a female patient who presented with interstitial lung disease and mediastinal lymphadenopathy, not responding to usual treatment. Conclusion Definitive histological diagnosis in patients with lymphadenopathic presentation associated with systemic symptoms is important to differentiate Castleman's disease from malignant lymphoma.
  - 1,479 132
ORIGINAL ARTICLE
Hepatopulmonary syndrome in noncirrhotic patients with chronic viral hepatitis
Mahmoud M El-Habashy, Ahmed A Khamis, Mahmoud Kamel, Abdallah Essa, Walid Shehab-Eldin, Mohamed Shaban
July-December 2014, 8(2):175-180
DOI:10.4103/1687-8426.145728  
Background Hepatopulmonary syndrome (HPS) is hypoxemia and functional intrapulmonary right-to-left shunts in patients with liver disease. It is a well-known complication of liver cirrhosis, portal hypertension, and acute liver failure. Aim The aim of this study was to determine the extent to which pulmonary functions were affected and the possible existence of HPS in noncirrhotic patients with chronic viral hepatitis. Patients and methods Lung function tests were carried out on 60 patients with chronic viral hepatitis (43 with hepatitis C and 17 with hepatitis B). All hypoxemic patients or patients with reduced diffusion capacity were subjected to contrast echocardiography to demonstrate intrapulmonary shunting. Results Twelve patients showed pulmonary dysfunction. Only seven of 60 patients (11.67%) showed hypoxemia. Intrapulmonary shunting was observed in three of those 12 patients. Two of these patients fulfilled the diagnostic criteria of HPS. Conclusion HPS exists in some patients with chronic viral hepatitis and is thus not restricted to patients with end-stage liver disease.
  - 1,807 153
ORIGINAL ARTICLES
A study of the outcome of confirmed avian flu and swine flu cases admitted to Abbassia Chest Hospital between 2006 and 2010
Adel Mahmoud Khattab, Khaled Mohamed Wagih, Amr Mohamed Awad Tag Eldin
July-December 2014, 8(2):70-78
DOI:10.4103/1687-8426.145689  
Aim The aim of this study was to evaluate the clinical and epidemiological features and the treatment outcome of confirmed cases of avian flu and swine flu admitted in Abbassia Chest Hospital between 2006 and 2010. Patients and methods This was a retrospective study that included 213 patients PCR-positive for influenza A H1N1 and 23 patients PCR-positive for influenza A H5N1, who were admitted to Abbassia Chest Hospital during the period from March 2006 to December 2010. The following data were collected by retrospective reviews of hospital records for each patient: epidemiological data through interview with the patient or their relatives, full history data, complete clinical examination data, full laboratory investigations, chest radiograph film at the time of admission and during the hospitalization period, a nasopharyngeal swab, ECG, and arterial blood gases. Statistical analysis of the data was then carried out. Results Regarding swine flu cases, there was no statistical difference with regard to the age distribution, the sex distribution, the presence of comorbidities, and the time of presentation among the studied patients. The results showed that 170 patients recovered, whereas 43 died, with a mortality rate of 20.2%. Among the avian flu cases, seven patients recovered, whereas 16 died, with a mortality rate of 69.5%. The mortality rate was high in renal patients, patients having bilateral complicating pneumonia, and in the patients who needed mechanical ventilation. Conclusion Some comorbidities, such as diabetes mellitus, cardiac illness, and chronic chest illness, have no implication on mortality. In contrast, renal conditions and the need of mechanical ventilation were associated with a high mortality rate.
  - 2,401 1,593
Can transthoracic ultrasound differentiate between simple and obstructed pneumonia?
Gamal R Agmy, Safaa M Wafy, Aliae A.R. Mohamed Hussein, Randa E Abd Elkader
July-December 2014, 8(2):87-90
DOI:10.4103/1687-8426.145695  
Background The advantages of low cost, bedside availability, and no radiation exposure have made ultrasound an indispensable diagnostic tool in modern pulmonary medicine. Color Doppler ultrasound demonstrates normal or increased flow in the normal vessels of the consolidated lung and may be helpful in distinguishing simple pneumonia from postobstructive pneumonia. Aim of the work The aim of this work was to describe sonographic features of simple and obstructed pneumonia and discuss the value of transthoracic ultrasound to differentiate between both diseases. Results The study included 18 patients with simple pneumonia and seven patients with obstructed pneumonia. The sonographic findings were as follows: positive air bronchogram recorded in 100% of the cases of simple pneumonia, but not found in any case of obstructed pneumonia; fluid bronchogram not found in any case of simple pneumonia and present in 100% of obstructed pneumonia (P = 0.005). Oval and rounded shape, irregular shape, sharp well-demarcated, blurred-border, homogenous, heterogeneous, and hypoechoic echo patterns were found in 38.9, 61.1, 33.3, 66.7, 11.1, 88.9, and 100% of the cases of simple pneumonia and in 42.9, 57.1, 28.6, 71.4, 0, 100, and 85.7% of the cases of obstructed pneumonia, respectively. Pleural effusion was present in 44.4 and 42.9% of cases of simple and obstructed pneumonia, respectively. Fluid bronchogram was seen in the bronchial obstruction, as a result of either impacted secretions or a proximal tumor. Conclusion The presence of signs of fluid bronchogram in the appropriate clinical context should raise the suspicion of postobstructive pneumonitis. Transthoracic ultrasound helps in distinguishing the central obstructing tumor as a hypoechoic mass from distal more echogenic consolidations.
  - 2,215 168
Ventilator-associated tracheobronchitis in a surgical ICU population
Sohair Sadek, Amr El-Said, Ashraf Madkour, Amal Rabie, Yahia Maky
July-December 2014, 8(2):153-159
DOI:10.4103/1687-8426.145717  
Introduction Ventilator-associated tracheobronchitis (VAT) rates in the ICU are variable and may depend on the population examined. The overlap between VAT and ventilator-associated pneumonia (VAP) remains poorly defined. Aim This study aims to determine the incidence of VAT and its relation to VAP in the surgical ICU. Patients and methods Patients who were intubated postoperatively for more than 48 h in surgical ICUs of the Ain Shams University Hospital were monitored daily for the development of VAT and VAP during a 2-year period. Patients were followed until ICU discharge or death. Patient demographics, causative pathogens and clinical outcomes were recorded. Results Among the 50 patients studied, there were five (10%) patients with VAT and 12 (24%) patients with VAP. VAT progressed to VAP in two patients (40%) despite antibiotic therapy. The incidence of VAP was significantly greater than the incidence of VAT. The mean onset times of VAT and VAP were 4 ± 1 and 5.1 ± 0.8 days, respectively. VAT and VAP were caused by multidrug-resistant pathogens in two patients (40%) and six patients (50%), respectively. VAT occurrence was the most common among patients undergoing cardiothoracic surgery and neurosurgery. There was no significant difference in the duration of mechanical ventilation and ICU stay and days of antibiotic use between the VAT and the VAP groups. There was no significant difference in the ICU mortality between patients with VAP and VAT (33.3 vs. 40%; P = 0.70). Conclusion VAT occurs less commonly than VAP. VAT does not appear to be a necessary precursor for all VAP cases. VAT patients had outcomes similar to those with VAP.
  - 1,968 148
Assessment of thrombocytopenia in critically ill patients
Mohammad A Faramawy, Iman H Galal, Asmaa M Elasser
July-December 2014, 8(2):143-148
DOI:10.4103/1687-8426.145712  
Background Thrombocytopenia is commonly observed among critically ill patients. Aim The aim of this study was to evaluate the incidence, risk factors, and the outcome of thrombocytopenia in patients admitted to the respiratory intensive care unit (RICU). Materials and methods Data were collected from 50 adult patients admitted to the RICU in a 6-month period. The baseline platelet count was measured and was repeated every other day during the RICU stay period. Thrombocytopenia was defined as platelet count of less than 150΄10 9 /l. Results The incidence of thrombocytopenia was 20% (10 patients). The overall mortality was 16%, of which 50% of the patients were having thrombocytopenia. The thrombocytopenic group had a higher mortality (40 vs. 10%, P < 0.05), a lower admission platelet count (215.3 ± 85.6 vs. 252.8 ± 73.2, P < 0.05), a lower nadir platelet count (111.1 ± 22.6 vs. 213.9 ± 53.2, P < 0.001), an increased transfusion requirement (30 vs. 2.5%, P < 0.05), and increased septic shock (40 vs. 2.5%, P < 0.05) compared with the nonthrombocytopenic group. Comorbidities, indications for RICU admission, the length of RICU stay, mechanical ventilation, days on mechanical ventilation, admission severity scores, bleeding, ICU-related complications, and medications administrated during the RICU stay did not differ significantly. A prolonged RICU stay of more than 15 days carried a 4.7 times higher incidence of development of thrombocytopenia. Thrombocytopenia differed significantly between survivors and nonsurvivors (P < 0.05), with a significant effect on mortality (P = 0.034). Conclusion Thrombocytopenia is common among critically ill patients and affects the mortality significantly. Prolonged ICU stay and septic shock are among the risk factors for thrombocytopenia.
  - 1,944 192
Cyclosporine as a treatment in acutely exacerbated interstitial pneumonia: does it add value?
Hammad El-Shahat, Gamal Mohamed Agmy, Safaa Mokhttar Wafy, Saburo Sone, Reham El-morshedy
July-December 2014, 8(2):121-127
DOI:10.4103/1687-8426.145704  
Objective The aim of this study was to evaluate the efficacy of combined therapy of cyclosporine A (CsA) with prednisolone for acutely exacerbated interstitial pneumonia. Patients and method Forty-eight patients who were diagnosed as having interstitial pneumonia were recruited in the study. These patients experienced clinical worsening as demonstrated by any one of the following within the past year: greater than 10% decrease in the percent predicted forced vital capacity, worsening high-resolution CT scan or clinical worsening of dyspnea at rest or on exertion. CsA was given at a dose range of 2 mg/kg/day in addition to corticosteroids. Patients were assessed at baseline and then at 1, 3, 6, and 9 months for response to therapy and for any adverse effect of the treatment. Results Patients were divided according to the underlying systemic disease into either patients with idiopathic pulmonary fibrosis (25 patients) or those with underlying collagen vascular diseases (CVDs; 23 patients). Those with underlying CVDs were divided into either UIP/CVDs (five patients) or nonspecific interstitial pneumonia (NSIP/CVDs) (18 patients). Our results showed an overall better response in the NSIP/CVD group of patients. Follow-up parameters in 14 patients with an improved response showed an improved grade of dyspnea, improved partial pressure of oxygen (PaO 2 ), %forced vital capacity, and diffusing capacity of carbon monoxide (%DL CO ); Krebs von den Lungen 6 (KL6) showed a significant decrease after initiation of CsA treatment when compared with baseline. Furthermore, a benefit of adding CsA to the treatment was the ability to reduce the dose of steroids during the course of treatment.
  - 2,123 141
Assessment of respiratory muscles' performance in patients with chronic renal failure immediately before and after hemodialysis
L Ashour, K Wagih, H Atef, W Bichari, D Fathya
July-December 2014, 8(2):100-107
DOI:10.4103/1687-8426.145699  
Background Physiological abnormalities are frequent in the skeletal muscle structure of patients with chronic renal failure (CRF), and their main signs are fatigue, muscular weakness, and low exercise tolerance. Respiratory muscular weakness may lead to hemodialysis; maximum respiratory pressure measurements may help in early diagnosis and to decide on therapeutic interventions for these patients. Objective To assess the respiratory muscle performance by measuring the maximum inspiratory pressure (PI max ) and the maximum expiratory pressure (PE max ) in patients with CRF immediately before and after hemodialysis (HD). Patients and Methods Sixty patients with CRF were recruited and divided into two groups: group 1 included patients undergoing HD and group 2 included those receiving conservative treatment. All the patients were subjected to arterial blood gases, pulmonary function test, PI max , and PE max . Results There was a significant difference between hemogasometric parameters (pH, PaCO 2 ), PI max %, and spirometric parameters (FEV 1 /FVC%, FEV 1 %, and MMEFR) before and after dialysis. There was, moreover, a significant difference in hemogasometric parameters (PaCO 2 , PaO 2 ), PI max %, and spirometric parameters (FVC%, FEV 1 %, and MMEFR) between CRF patients receiving conservative treatment and those under dialysis before the dialysis session. Furthermore, there was a significant difference in hemogasometric parameters (pH, PCO 2 , PO 2 ), PI max %, and spirometric parameters (FVC, FEV 1 %, FVC, and MMEFR) between both groups. There was a significant inverse relationship between pH and PE max % in group 2 and between PI max % and MMEFR FEV 1 in group 1 before dialysis. In contrast, a significant direct relationship was found between PaO 2 and MMEFR in group 2, between PI max % and FEV 1 in group 1 before dialysis as well as between PE max % and FVC/FEV 1 in group 1 before dialysis. Conclusion There was an obvious decrease in the respiratory muscle performance, arterial blood gases, and spirometric measurements in patients with CRF, both those who were receiving conservative treatment and those under HD, but this decrease was more apparent in those under HD.
  - 1,762 170
Role of serum proadrenomedullin in assessment of the severity and outcome of hospitalized healthcare-associated pneumonia patients
Amany Shaker, Doaa Mostafa Gad, Sameh Embarak, Hany A Labib
July-December 2014, 8(2):108-114
DOI:10.4103/1687-8426.145702  
Background Clinical judgment of healthcare-associated pneumonia (HCAP) represents a major concern as these fragile patients have an unusual presentation that frequently misleads severity assessment and results in poor clinical outcome. The aim of this study was to evaluate the role of proadrenomedullin (proADM) in predicting disease severity and outcome in HCAP patients in comparison with community-acquired pneumonia (CAP) patients. Patients and methods Thirty-one HCAP patients and twenty-five CAP patients were enrolled in this study. Measurement of serum proADM level was performed in the first 24-h of admission. Assessment of severity was carried out using the CURB-65 scoring system. Finally, the outcome of the patients was assessed. Results Serum proADM level was higher in HCAP patients than that in CAP patients, this difference was statistically significant. Also, serum proADM level increased significantly with increasing severity of HCAP patients guided by CURB-65, with a cut-off value of more than 1.8 nmol/l, with a sensitivity of 91.7%, a specificity of 95%, a positive predictive value of 91.7%, and a negative predictive value of 95%. However, a higher value (>2.9 nmol/l) was detected in HCAP patients who died, with high sensitivity and negative predictive value (100%) and low specificity (42.3%) and positive predictive value (25%). Conclusion The use of proADM as a novel biomarker enhances the performance of the CURB-65 scoring system for risk stratification of HCAP patients.
  - 1,717 139
Feedback