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   2018| January-March  | Volume 12 | Issue 1  
    Online since January 12, 2018

 
 
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REVIEW ARTICLE - PULMONARY INFECTIONS
What does pulmonary–renal syndrome stand for?
Taghreed S Farag, Abeer S Farag
January-March 2018, 12(1):1-13
DOI:10.4103/ejb.ejb_6_17  
Pulmonary–renal disorder (PRS) is an emergency situation described by a rapidly progressive course without an early intervention. It is appropriate time to review this disorder, this is may be attributable to frequent patients’ attendance to pulmonologist with both vague pulmonary and/or renal symptoms with disproportionate lack of information concerning consequent care. In addition, the outcome data for PRS still confined to little studies with limited follow-up. An updated working knowledge of PRS including the disease pathogenesis, complications as well as quickly advancing field focused on current new immunomodulatory therapies which offer life-saving options for refractory disease. An often-multi-disciplinary team is required for management. Early rapid identification relies upon a high index of clinical suspicious, carful medical evaluation, accessible laboratory investigations, imaging study, histopathology, with exclusion of differential diagnosis. An accurate diagnosis, exclusion of infection, close monitoring of the patient as well as timely initiation of aggressive therapy are crucial for the patient’s outcome. The mortality rate of PRS, reach up to 25–50 % [1].
  6,106 673 2
ORIGINAL ARTICLES - AIRWAY DISEASES
Study of voice disorders in patients with bronchial asthma and chronic obstructive pulmonary disease
Adel M Saeed, Nermine M Riad, Nehad M Osman, Ahmed Nabil Khattab, Shymaa E Mohammed
January-March 2018, 12(1):20-26
DOI:10.4103/ejb.ejb_34_17  
Background Chronic obstructive pulmonary disease (COPD) and bronchial asthma are known to cause adverse effects on voice, which might affect the quality of life of an individual. Aim The study was designed to study the voice disorders in patients with COPD and bronchial asthma and its relation to disease severity and medication. Patients and methods Totally, 60 patients were recruited: 30 stable bronchial asthma patients and 30 stable COPD patients. All participants underwent spirometry and study of voice parameters using auditory perceptual assessment, videolaryngostroboscopy system, voice recording, and acoustic analysis. Results Impaired voice quality and various grades of dysphonia were detected in the COPD group in 30% by means of auditory perceptual assessment; structural changes in the vocal folds (diffuse congestion, unhealthy mucosa, and edema) were detected in 36.6%. In the bronchial asthma group, impaired voice quality and various grades of dysphonia were detected in 16.7% and structural changes were detected in 20% of them, whereas acoustic analysis showed a highly significant increase in jitter and shimmer and decreased harmonic-to-noise ratio in 100% of patients of both groups. These changes were greater in metered dose inhaler users than in dry-powder inhaler users. In the bronchial asthma group, fluticasone propionate users had a significantly decreased harmonic-to-noise ratio compared with beclomethasone dipropionate and budesonide users, as well as the least pitch and highest shimmer and jitter. A significant statistical correlation was found between ipratropium inhalation usage and increased shimmer in the COPD group. There was a highly significant correlation between spirometric severity and both grade of dysphonia and character of voice in bronchial asthma patients. Conclusion All COPD and bronchial asthma patients had dysphonia, either due to organic causes or due to functional causes. Voice changes were directly correlated with degree of severity and fluticasone propionate inhalation use in bronchial asthma patients, and with ipratropium bromide inhalation in the COPD group.
  4,503 286 6
Medication adherence and treatment satisfaction in some Egyptian patients with chronic obstructive pulmonary disease and bronchial asthma
Iman H Galal, Yasser M Mohammad, Abeer A Nada, Yosra E Mohran
January-March 2018, 12(1):33-40
DOI:10.4103/ejb.ejb_56_17  
Background The degree of effectiveness in the management of asthma and chronic obstructive pulmonary disease (COPD) entails proper treatment adherence and satisfaction. In this study, medication adherence and treatment satisfaction were assessed among some Egyptian patients with asthma and COPD. Materials and methods Consecutive asthma and COPD patients were recruited from the outpatient clinic or inpatients admitted to the Chest Department at Ain Shams University Hospital, Abbassia, and Qena Chest Hospitals. Self-reported medication adherence and treatment satisfaction were tested using the Arabic versions of the eight-item Morisky Medication Adherence Scale and Treatment Satisfaction Questionnaire for Medication (TSQM 1.4), respectively. Results Totally, 474 asthmatic patients (mean: 34.41 years, 61.2% male and 38.8% female) and 509 COPD patients (mean: 60.39 years, 91.7% male and 8.3% female) were included. According to eight-item Morisky Medication Adherence Scale, mean adherence was 4.55±2.01 and 3.88±1.63 in asthma and COPD, respectively, with no significant difference. In asthma and COPD, low adherence was found in 71.7 and 79.4%, medium adherence in 19.8 and 13.6%, and high adherence in 8.4 and 7.1%, respectively. There was a significant difference in all domains of TSQM between asthma and COPD, with more effectiveness, convenience, and global satisfaction but less side effects among asthma patients compared with COPD. There was a significant correlation in asthmatic patients between adherence and all domains of TSQM, whereas in COPD only side effects and convenience correlated significantly with adherence. In COPD, adherence was better in male smokers, with low smoking index, living in urban areas, having severe small airway obstruction, and treated by pulmonologists. In asthma, adherence was mainly affected by treatment satisfaction. Conclusion Most of the asthma and COPD patients were nonadherent to their medications. Asthma patients were more satisfied with treatment compared with COPD patients.
  3,548 326 8
Transthoracic ultrasonographic evaluation of diaphragmatic excursion in patients with chronic obstructive pulmonary disease
Ayman Amin, Moustafa Zedan
January-March 2018, 12(1):27-32
DOI:10.4103/1687-8426.217411  
Background Chronic obstructive pulmonary disease (COPD) is a multisystem disorder that mainly besides the lungs also affects the muscle mass. The force generated by the respiratory muscles decreases, resulting in a negative effect on ventilation and exercise capacity. Recent studies have reported that M-mode ultrasonography is reliable and relatively easy to use for assessment of diaphragmatic motion. Objective To evaluate diaphragmatic excursion by M-mode ultrasonography in patients with COPD and to correlate it with different clinical and ventilatory variables. Patients and methods A total of 40 patients with COPD who attended Chest Diseases Department Al-Azhar University Hospitals from January 2017 to May 2017 were recruited in this study. Informed consent was obtained. Diagnosis and severity of COPD was made according to the Global Initiative for Chronic Obstructive Lung Disease guidelines. All patients in this study were subjected to full medical history, clinical examination, pulmonary function tests, calculation of BMI, arterial blood gases analysis, 6-min walk test, and ultrasound imaging of the diaphragm. Results Diaphragmatic excursion during quiet breathing did not differ significantly between the patients and the controls (P=0.085). However, during deep breathing, the degree of diaphragmatic excursion was lower in the patients (P=0.001). Diaphragmatic excursion during deep breathing correlated significantly with disease severity(r=0.86); the percentage of the predicted forced expiratory volume in the first second, forced vital capacity, and forced expiratory volume in the first second/forced vital capacity (r=0.84, 0.72, and 0.80, respectively); and the 6-min walk test (r=0.47). Conclusion M-mode ultrasonography is an easy, noninvasive and inexpensive method for evaluation of diaphragmatic excursion. Patients with COPD had significantly lower diaphragmatic excursion than normal ones.
  2,569 216 3
ORIGINAL ARTICLE - INTERSTITIAL LUNG DISEASES
Combined pulmonary fibrosis and emphysema syndrome: clinical, functional, and radiological assessment
Maha K Ghanem, Hoda A Makhlouf, Ali A Hassan, Heba A Hamed
January-March 2018, 12(1):76-82
DOI:10.4103/ejb.ejb_51_17  
Background The coexistence of pulmonary fibrosis and emphysema is increasingly recognized. Objective To assess the clinical, physiological and radiological characteristics of patients with combined pulmonary fibrosis and emphysema (CPFE) and compare it with patients with chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) alone. Patients and methods One hundred-twenty patients were enrolled and divided into three groups; 40 had COPD based on poorly reversible airflow obstruction in spirometry; 40 had ILD based on high-resolution computed tomography (HRCT); and 40 had CPFE based on the presence of emphysematous changes in the upper lung zones and pulmonary fibrosis in lower zones in HRCT. Modified Medical Research Council dyspnea scale, arterial blood gas analysis, spirometry, diffusion capacity for carbon monoxide (DLCO), polythesmography, HRCT chest, and echocardiography were done. Results More than 57% of patients with CPFE were men and the majority of them were smokers. There was no significant difference in dyspnea grade between CPFE group and other groups (P>0.05). The rate of exacerbation per year was significantly higher in the CPFE group (4.2±1.02) compared with either COPD group (3.33±1.56) or ILD group (3.15±1.05). CPFE patients had both emphysematous and fibrotic changes on radiological examination. Lung volumes were preserved but DLCO% was significantly lower and the mean pulmonary artery systolic pressure was significantly higher in the CPFE group compared with COPD and ILD. Conclusion CPFE is a distinct syndrome that has characteristic radiological findings and lung function profile with a significant reduction of DLCO and a significant increase in pulmonary artery systolic pressure.
  2,229 195 1
ORIGINAL ARTICLE - INTERVENTIONAL PULMONOLOGY
Use of videobronchoscopic narrow band imaging compared with white light in diagnosing some bronchopulmonary diseases
Ehab M Atta, Suzan M.F Helal, Rasha G.A Daabis, Alaa A Abdallah, Amr M.I Yehya
January-March 2018, 12(1):83-91
DOI:10.4103/ejb.ejb_12_17  
Objective Narrow band imaging (NBI) videobronchoscopy is an advanced technique aiming at obvious mucosal vasculature detection. This study investigated its role in diagnosing some bronchopulmonary diseases, compared with white light videobronchoscopy (WLB). Methods In this study, we evaluated 30 patients presenting with different bronchopulmonary diseases and 15 controls presenting with chronic cough for at least 3 months. Full airway examination was done by fiberoptic bronchoscopy first under WLB then under NBI. Multiple biopsies were taken from susceptible lesions; pathological interpretation was performed. Results In the present study, the most frequent presentations in CT scan in group A were lung masses in 16 patients. Endobronchial masses were detected in 8 patients by both WLB and NBI, all (100%) were pathologically positive by NBI compared to 7 patients (87.5%) by WLB. Eight patients were presented with peripheral masses, 4 patients (50%) were pathologically positive while none of them (0%) was positive by WLB samples. NBI showed better sensitivity and accuracy in comparison to WLB (100% and 90.0% in NBI and 52.94% and 63.33% in WLB respectively), with similar specificity (76.92%). Conclusions NBI is a safe and effective modality that can be used in combination with WLB to improve the in diagnosis of different bronchopulmonary disorders particularly lung cancer. It proved to be more sensitive and accurate than WLB alone. NBI could have a better diagnostic yield than WLB for lung cancer especially in peripheral lung masses. NBI is useful for characterization of vascular pattern of malignant lesions of the bronchial mucosa.
  2,214 129 1
ORIGINAL ARTICLE - SEEP MEDICINE
Pulse transit time in patients with sleep-disordered breathing
Marwa El-Sayed El-Naggar
January-March 2018, 12(1):114-118
DOI:10.4103/ejb.ejb_49_17  
Background Pulse transit time (PTT) represents a noninvasive marker of sleep fragmentation in patients with obstructive sleep apnea–hypopnea syndrome (OSAHS). Little is known regarding changes in PTT in patients with excessive daytime sleepiness associated with nocturnal inspiratory flow limitation (IFL) without apneas or desaturation. Patients and methods A total of 20 patients with nocturnal IFL were age and sex matched with a group of patients with OSAHS and another without significant breathing disorders during sleep [nonflow limited (NFL)]. PTT arousal index (PTT Ar) is the number of PTT arousals per hour. Results Overall, 20 patients with IFL were age and sex matched with two groups: one with OSAHS and another without significant sleep-disordered breathing (SDB) (NFL). There was a significant increase in the median BMI of the IFL group compared with the NFL group (40 vs. 30; P<0.05) but not with the OSAHS group (40 vs. 44; P>0.05). The PTT Ar in the IFL group (36.5/h) was significantly higher than that in the NFL group (16.3/h) and lower than that observed in the OSAHS group (60/h; P<0.001). PTT Ar correlated positively with BMI, apnea–hypopnea index, oxygen desaturation index, respiratory disturbance index, snoring index, and Epworth sleepiness scale. Conclusion The PTT Ar increased with SDB with significantly higher values in patients with excessive daytime sleepiness associated with nocturnal IFL compared with controls. Patients with IFL were mainly females with an elevated BMI. Thus, PTT could be used as a marker of sleep fragmentation apart from electroencephalogram in the diagnosis of SDB.
  2,138 130 1
(MISCELLANEOUS)
Frequency of hepatopulmonary syndrome and portopulmonary hypertension in cirrhotic liver patients
Abbas S El-Maraghy, Ahmed A Abu Naglah, Ayman Amin, Kamal A Merghany, Mohamed M Khalil
January-March 2018, 12(1):119-128
DOI:10.4103/ejb.ejb_26_17  
Background Chronic liver diseases may cause abnormal changes in the pulmonary vascular bed. There are two important and pathophysiologically different pulmonary vascular abnormalities − hepatopulmonary syndrome (HPS) and portopulmonary hypertension (PPHTN). Pathophysiologically, HPS results from vasodilatation, whereas PPHTN results from vasoconstriction. Objective The objective of this study was to determine the frequency of HPS and PPHTN in dyspneic cirrhotic hepatic patients. Patients and methods This study included 87 patients with cirrhotic liver disease admitted to Al-Azhar University Hospitals from September 2013 to September 2015. The diagnosis of cirrhosis was based on clinical, biochemical, serological, and metabolic workup, abdominal ultrasound, or liver biopsy. All patients in this study were subjected to complete medical history taking and clinical examination, liver function tests, plain chest radiography, and thoracic high-resolution computed tomography, abdominal ultrasonography, arterial blood gas analysis in the supine and standing positions, calculation of alveolar–arterial oxygen gradient, saline two-dimensional contrast-enhanced echocardiography, and right-heart catheterization only for all cases with PPHTN. Results The present study showed that the prevalence of HPS was 25.28% (22 out of 87 cases) and was higher than the prevalence of PPHTN, which was 5.7% (5 out of 87 cases). Conclusion HPS and PPHTN are not uncommon in patients with hypoxemia and chronic hepatic disease. Diagnoses of such disorders are essential, especially in patients who are listed for liver transplantation.
  1,846 130 -
ORIGINAL ARTICLES - AIRWAY DISEASES
Magnetic resonance spectroscopy in evaluating cerebral metabolite imbalance in chronic obstructive pulmonary disease
Olfat M El-Shinnawy, Eman M Khedr, Mohamed M Metwally, Alaa EL-din Thabiet Hassan, Ahmad M Shaddad, Radwa Kamel Soliman
January-March 2018, 12(1):14-19
DOI:10.4103/ejb.ejb_28_17  
Rationale Magnetic resonance spectroscopy (MRS) is a powerful research tool and has been proved to provide additional clinically relevant information for several diseases such as brain tumors, metabolic disorders, and systemic diseases. Aim The aims of this study were to evaluate cerebral metabolic imbalance in chronic obstructive pulmonary disease (COPD) and to correlate the abnormalities with spirometric and gasometric parameters. Patients and methods In a case–control study, eight COPD patients and eight age-matched and sex-matched healthy control individuals were compared. 1H-MRS was performed using 1.5-T MRI/MRS scanner. Using 1H-MRS single-voxel technique, N-acetyl aspartate/choline (NAA/Cho), choline/creatine (Cho/Cr), and N-acetyl aspartate/creatine (NAA/Cr) ratios were estimated and compared in both groups. Results There were significant differences regarding the distribution of neurotransmitters in the temporal lobe only between COPD and control groups; there were significant positive correlations between the NAA/Cho ratio at the thalamus with both partial pressure of arterial carbon dioxide and base excess or base deficit. However, there was a significant positive correlation between the Cho/Cr ratio at the thalamus and forced vital capacity (l), and a significant positive correlation between the NAA/Cr ratio at the thalamus and BMI, and a negative correlation between the NAA/Cr ratio at the thalamus and partial pressure of arterial oxygen. There was a significant negative correlation between the NAA/Cr ratio at the temporal lobe and partial pressure of arterial carbon dioxide. Conclusion MRS provided an insight to study the neurochemical changes that occur in COPD patients. Chronic hypoxemia and hypercapnia seem to play a key role in the pathophysiology of neurochemical changes in COPD.
  1,806 144 -
ORIGINAL ARTICLES - CRITICAL CARE
Predictors of failure of early shift from invasive to noninvasive ventilation in weaning chronic obstructive pulmonary disease patients who have failed the initial spontaneous breathing trial: a prospective cohort study
Sameh A Moneim, Tamer S Fahmy, Nashwa Abed
January-March 2018, 12(1):49-56
DOI:10.4103/1687-8426.223062  
Context Noninvasive ventilation (NIV) is a well-established modality for difficult and prolonged weaning of chronic obstructive pulmonary disease (COPD) patients. Although several studies have addressed the early shifting to NIV, predictors of its success remain to be determined. Aims The aim of the study was to find predictors of success of early shift of COPD patients who have failed the spontaneous breathing trail (SBT) to NIV. Design and settings This investigation was designed as a double-centered prospective cohort study involving the ICUs of Critical Care Medicine of Cairo University and Shebin El-Kom Teaching Hospital. Patients and methods Consecutive COPD patients who failed the initial SBT were extubated and shifted to NIV. We compared arterial blood gases, lung mechanics, and spontaneous breathing parameters in successful patients with these parameters in those who failed the early shift to NIV. Results Out of the 30 patients, 21 (70%) were successfully weaned by early shift to NIV. The failed group had a significantly higher autopositive end-expiratory pressure (P<0.001), rapid shallow breathing index (RSBI) (P<0.05), and significantly lower static compliance and negative inspiratory pressure (NIP) (P<0.001) on admission. Admission RSBI and NIP were the only predictors of failure of early shift to NIV. Just before SBT, the failed group had a significantly higher autopositive end-expiratory pressure (P<0.001), RSBI (P<0.001), and airway resistance (Raw) (P<0.001) and significantly lower static compliance, NIP, and PO2/FIO2 (P/F) ratio. Raw and NIP before SBT were the only predictors of success of early shift to NIV. Conclusion RSBI, NIP, and Raw, rather than arterial blood gases, are the most important predictors for success of early shift to NIV in COPD patients who have failed the initial SBT.
  1,795 128 -
ORIGINAL ARTICLE - PLEURAL DISEASES
Efficacy and safety of intrapleural cisplatin versus silver nitrate in treatment of malignant pleural effusion
Mohammad K El Badrawy, Raed El-Metwally Ali, Asem A Hewidy, Mohamed A El-Layeh, Fatma M.F Akl, Abdelhadi Shebl
January-March 2018, 12(1):98-104
DOI:10.4103/ejb.ejb_39_17  
Introduction Malignant pleural effusion is a frequent problem. Pleurodesis is performed to prevent its recurrence. New, effective, and safe sclerosing agents are needed. Aim The aim of this was to compare efficacy and safety of silver nitrate solution 0.5% versus cisplatin in achievement of pleurodesis in malignant pleural effusion. Patients and methods Prospective randomized single-blinded clinical trial performed at Chest, Clinical Oncology and Nuclear Medicine and Pathology Departments, Mansoura University, from February 2016 to March 2017. A total of 60 patients (26 male and 34 female) with malignant pleural effusion were divided into two groups: first group included 30 patients who were managed with silver nitrate pleurodesis, and second group included 30 patients who were managed by intrapleural cisplatin injection. The success rate of pleurodesis was considered if there was no clinical or radiological recurrence of effusion for 1 month after intervention. Results There were significant improvements in cough, chest pain, and dyspnea in the two groups after 1 month versus that before pleurodesis. The success rate of pleurodesis in silver nitrate group was 90 versus 76.7% in cisplatin group, without significant difference (P=0.166). Chest pain was reported in 26.7% in silver nitrate group and 13.3% in cisplatin group, and fever was reported in 33.3% in silver nitrate group and 20.0% in cisplatin group. Recurrence was reported in 10% in silver nitrate group and in 23.3% in cisplatin group. Conclusion Silver nitrate and cisplatin were nearly equally effective, safe, and less expensive agents in achievement of pleurodesis in patients with malignant effusion with high success rate and low complications.
  1,805 117 1
ORIGINAL ARTICLE - PULMONARY INFECTION
Study of addiction in newly diagnosed patients with pulmonary tuberculosis in Abbasia Chest Hospital
Adel M Saeed, Riham H Raafat, Eman M Elbaz
January-March 2018, 12(1):105-113
DOI:10.4103/ejb.ejb_115_17  
Background Drug abuse is an important factor in the epidemiology of tuberculosis (TB) in developing and developed countries, and there is a triple relationship between pulmonary TB, HIV, and drug users. Aim The aim of this work was to study the relation between addiction and newly diagnosed patients with pulmonary TB from Abbasia Chest Hospital’s outpatient clinic or admitted to the departments or ICU during the 8 months from August 2015 to April 2016. Patients and methods This prospective study was conducted on 100 addict male patients who were diagnosed as having new cases of pulmonary TB (positive sputum for ZN stain) at Chest Departments and respiratory ICU in Abbasia Chest Hospital during the 8 months from August 2015 to April 2016 to detect the relation between addiction and TB by full history, laboratory investigations, and chest radiography. Results Most of the cases were taking a combination of drugs and more of cannabis, except for dead cases, where intravenous heroin was the top drug abused with longer duration of addiction. Cavitary and infiltrative patterns were present in more than half of the cases, with being more infiltrative among dead cases, with grade III severity in the chest radiography taking the upper hand. A minority of the cases had pleural effusion, pneumothorax and lung abscess. Conclusion Drug abusers are at high risk of TB infection and disease, and intravenous drug abuse is considered an important factor in HIV-associated TB. Recommendations Drug addiction is a major public health problem that needs to be studied from different aspects.
  1,781 100 2
ORIGINAL ARTICLE - INTERVENTIONAL PULMONOLOGY
Assessment of severe dyspnea in critically ill patients by transthoracic sonography: Fayoum experience of the Bedside Lung Ultrasonography in Emergency protocol
Gamal R Agmy, Sherif Hamed, Mohamed A Saad, Randa Ibrahim, Aliaa A Mohamed
January-March 2018, 12(1):92-97
DOI:10.4103/ejb.ejb_30_17  
Background Management of critically ill patients requires imaging tools, which are important for optimizing diagnostic and therapeutic actions. Both bedside chest radiography and thoracic computed tomography have limitations that constrain their utility. The aim of our work is to explore the value of transthoracic ultrasound (TUS) using the Bedside Lung Ultrasonography in Emergency (BLUE) protocol in critical ill patients with severe dyspnea. Patients and methods This study included 109 ICU patients with acute dyspnea at Fayoum University Hospital. The judgments of chest ultrasound using the BLUE protocol were compared with the final diagnoses; rare diagnoses and uncertain diagnoses were excluded. Results By application of the BLUE protocol, TUS was absolutely sensitive, specific, and accurate for the diagnosis of pneumothorax. For pneumonia, the sensitivity, specificity, and diagnostic accuracy were 93.8, 95.7, and 95.8%, respectively, whereas these parameters for pulmonary edema were 100, 96.8, and 99%, respectively. TUS was absolutely sensitive in the diagnosis of chronic obstructive pulmonary disease, asthma, or diffuse parenchymal lung disease, whereas the specificity and diagnostic accuracy were 88.9 and 88.9%, respectively, for chronic obstructive pulmonary disease and asthma and 96.8 and 100%, respectively, for diffuse parenchymal lung disease.
  1,666 150 1
ORIGINAL ARTICLES - CRITICAL CARE
The effect of triggering type on post-triggering pressure variations during pressure support ventilation: a simplified surrogate for dyssynchrony
Maher M. H Al-Najjar, Tamer S Fahmy, Mohamed A Al-Shafee, Hatem Al-Atroush
January-March 2018, 12(1):41-48
DOI:10.4103/1687-8426.223061  
Context Several studies comparing flow and pressure triggering using invasive and noninvasive techniques have mostly focused on the trigger phase and favored flow triggering. Recently, there have been advancements in the technology of pressure triggering to improve its performance. Aims We sought to evaluate the effect of triggering type in old and new ventilators on patient’s synchrony in the post-trigger phase using variations in airway pressures with the set inspiratory pressure as a surrogate for dyssynchrony. Patients and methods Using three different ventilator types, 32 patients on pressure support ventilation were set on the two triggering types (at the same equivalent levels), each for 1 h, with all other ventilatory setting kept constant. At the end of the hour on each trigger mode, the measured peak pressure and its difference with the set inspiratory pressure [delta pressure (ΔP)], the mean airway pressure, and different ventilatory parameters and arterial blood gases were assessed. Results Pressure triggering resulted in a significantly higher peak pressure, ΔP, and lower dynamic compliance at any equivalent sensitivity and pressure support regardless of the level (<0.05). Moreover, at higher sensitivity levels (3 cmH2O and l/min), flow triggering produced higher mean airway pressures and oxygenation (<0.05). However, there was no significant difference as regards tidal volume, minute volume, frequency, rapid shallow breathing index, or PCO2. Conclusion Despite advances in pressure-triggering technology, flow triggering results in less pressure variation and better patient’s synchrony during pressure support ventilation; in this respect, ΔP and dynamic compliance are simple noninvasive measures for dyssynchrony.
  1,697 110 -
Predictors and outcome of prolonged stay in the respiratory ICU
Adel M Khattab, Ahmed Abd Elgawad El-Masry, Ashraf A El Maraghy, Noha O Ahmed
January-March 2018, 12(1):57-68
DOI:10.4103/ejb.ejb_44_17  
Introduction Prolonged ICU stay is associated with high mortality, morbidity, and costs. Understanding the predictors of prolonged stay ICU patients is helpful in improving the patients’ outcomes, especially if some factors could be modified or useful in clinical decisions. Aim The aim of this study was to evaluate the characteristics, outcomes, and cost of ICU patients with a prolonged stay (≥15 days) and very long stay (≥30 days) in Ain Shams University Hospital Respiratory ICUs. Patients and methods This multidisciplinary prospective study was conducted on 213 patients admitted at the two respiratory ICUs at Ain Shams University Hospitals from May 2013 to May 2014. In addition, the relationships between residents, consultants, nurses, and patients’ families are evaluated through multiple surveys. Results A total of 213 patients met the inclusion criteria in both ICUs, with a mean age of 54.7 years (minimum: 20 years; maximum: 80 years) and mean ICU stay of 23.4 days (minimum: 15 days; maximum: 60 days). Mechanical ventilation, vasopressor support, type of nutrition, BMI, tracheostomy, and Acute Physiology And Chronic Health Evaluation II Score on admission had a significant association with prolonged ICU stay and mortality. The surveys’ results showed that the nurse–physician relationship is of friendly stranger type. The residents’ pitfalls were mostly the grandiosity and lack of decision taking. Most of physicians of different medical degrees had highlightened the quality of leadership as the most important cause straining the relationship with colleagues. The family members’ satisfaction is correlated with the progression and length of stay of patients. Conclusion Patients with prolonged ICU stay consume the ICU resources. Studies identifying predictors of prolonged stay are essential to improve both resource utilization and the efficiency of ICU care. Personal relationship and communication skills have their impact on working environment.
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ORIGINAL ARTICLE - INTERSTITIAL LUNG DISEASES
Serum interleukin 23 and its associations with interstitial lung disease and clinical manifestations of scleroderma
Gamal A Hammad, Refaat M Eltanawy, Rasha M Fawzy, Tahany M.A Gouda, Mona A Eltohamy
January-March 2018, 12(1):69-75
DOI:10.4103/ejb.ejb_22_17  
Introduction Systemic sclerosis (SSc) is a complex disease linked to immune system activation, vascular damage, associated with increased synthesis, and deposition of extracellular matrix, which contain excessive amounts of structurally normal collagen. Interleukin 23 (IL-23) might play a role in disease development and severity. This study aimed to assess the relationship between serum level of IL-23 and interstitial lung disease in SSc. Patients and methods Thirty patients with SSc together with 30 age-matched and sex-matched healthy volunteers were recruited in this study. Serum IL-23 levels were measured by enzyme-linked immunosorbent assay. Functionally, lung involvement was assessed by pulmonary function tests and radiologically by chest radiography and high-resolution computed tomography of the lungs. Results Mean serum IL-23 level was significantly highly elevated in SSc patients compared with healthy controls (P<0.005). Patients with elevated IL-23 levels exhibited shorter disease duration (P<0.05). Moreover, mean serum IL-23 level was elevated in diffuse SSc cases compared with limited SSc cases and in cases with pulmonary fibrosis (P<0.05), although they were not associated with other clinical features. Elevated mean serum IL-23 level was significantly higher in mild restrictive cases compared with moderate and severe restrictive cases. As regards high-resolution computed tomography, mean serum IL-23 level was statistically highly significantly elevated in cases with ground-glass appearance (P<0.001) compared with others. Conclusion Alterations in serum concentrations of IL-23 support the hypothesis that IL-23 is associated with induction of SSc generally and SSc associated with interstitial lung disease specifically. Presumably, blockage of IL-23 could be used as a potential therapeutic target in early SSc.
  1,464 96 1
CASE REPORT
Broncial stump aspergillosis, an unusual cause of hemoptysis, and review of the literature
Dipesh Maskey, Ritesh Agrawal
January-March 2018, 12(1):129-135
DOI:10.4103/ejb.ejb_9_17  
Aspergillus species are ubiquitous dimorphic molds found in an environment. of the 250 species, few of them are pathogenic to human and can cause various lung involvements, tracheobronchial being one of the variant. Bronchial stumps and anastomosis are prone for fungal infection and can present with cough, hemoptysis, central airway obstruction and bronchopleural fistula with its highest incidence in patients with lung transplantation. Its occurrence in other types of lung surgery is very rare and 20 cases have been described in English medical literature till date since first published in 1969. We present a case of recurrent hemoptysis caused by bronchial stump aspergillosis, first reporting from India, and systematically analyze the literature for all the reported cases of bronchial stump and anastomosis aspergillosis in patients with lung surgery other than transplantation.
  1,425 77 -
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