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CRITICAL CARE
Role of ultrasound in assessment of diaphragmatic function in chronic obstructive pulmonary disease patients during weaning from mechanical ventilation
Adel M Saeed, Gehan I El Assal, Tamer M Ali, Mahmoud M Hendawy
May-August 2016, 10(2):167-172
DOI
:10.4103/1687-8426.184363
Objectives:
The aim of the study was to investigate the role of ultrasound in the evaluation of movement of the diaphragm and its value in predicting successful extubation in mechanically ventilated chronic obstructive pulmonary disease (COPD) patients in relation to other weaning parameters.
Introduction:
Chest ultrasound is a beneficial tool for evaluation of the diaphragm during weaning from mechanical ventilation in COPD patients. Chest ultrasound offers some advantages over fluoroscopy, including the lack of ionizing radiation and the possibility of use at the bedside of the patient, as well as facilitating direct quantification of the movement of the diaphragm.
Patients and methods:
The present study was conducted on 50 patients in the respiratory ICU and the Chest Department of Ain Shams University Hospitals. Patients were divided into two groups: group A and group B. Group A consisted of 30 mechanically ventilated COPD patients admitted to the respiratory ICU and group B consisted of 20 COPD patients not mechanically ventilated during attendance at the Chest Department.
Results:
Diaphragmatic movement was assessed in the two groups. The mean value of diaphragmatic displacement was higher in group B. In group A this value was higher among those with successful weaning using a cutoff value of 1.1 cm with sensitivity of 86.4%, specificity of 87.5%, and accuracy of 89.5%. There was a significant correlation between diaphragmatic displacement and other weaning parameters, which was better in the group with successful weaning.
Conclusion:
Diaphragmatic displacement measured by ultrasound is one of the most sensitive, specific, and accurate parameters for weaning of COPD patients from mechanical ventilation, especially in relationship with other weaning parameters.
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Diaphragmatic ultrasound as a predictor of successful extubation from mechanical ventilation: thickness, displacement, or both?
Ayman I Baess, Tamer H Abdallah, Doaa M Emara, Maged Hassan
May-August 2016, 10(2):162-166
DOI
:10.4103/1687-8426.184370
Background:
Best predictor of successful extubation after mechanical ventilation is a matter of debate.
Objective:
The aim of this study was to assess whether the degree of diaphragm thickening and/or diaphragm displacement (DD) as measured by means of ultrasound during a weaning trial can predict extubation outcomes.
Methods:
Thirty patients who were planned for weaning after being intubated and mechanically ventilated were prospectively enrolled in the study between January and June 2015. The rapid-shallow breathing index (RSBI) was subsequently calculated, and diaphragmatic ultrasound was then carried out to assess DD and diaphragm thickening during tidal inspiration. The primary outcome was extubation success or failure.
Results:
Of the 30 patients included in the study, 15 were male. The mean age of patients was 59.17+13.17 years. The median duration of intubation before weaning was 4 days. There was a significant difference between mean inspiratory and expiratory diaphragmatic thickness (TDI) (t=9.66, P<0.001). An receiver operating characteristic curve was constructed for the end inspiratory TDI, end expiratory TDI, delta TDI, DD, and RSBI. The RSBI performed better than all other parameters, with an area under the curve of 0.968. A cut-off value of 73.5 had 87% sensitivity and 100% specificity for predicting extubation success. All other parameters had an area under the curve less than 0.7. (0.559, 0.624, 0.655, and 0.512 for end inspiratory TDI, end expiratory TDI, delta TDI, and diaphragmatic displacement, respectively).
Conclusion:
Sonographically measured TDI performed better than displacement in predicting value for weaning outcome. In a respiratory ICU, however, the RSBI seems to be a more reliable and accurate tool for the purpose and should be considered in every weaning protocol. Whether TDI can be evaluated using low-frequency ultrasound probes needs to be validated by further studies.
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593
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.
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17
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ORIGINAL ARTICLES - AIRWAY DISEASES
Evaluation of health-related quality of life in patients with chronic obstructive pulmonary disease
Taghreed S Farag, Eman S.M Sobh, Sawsan B Elsawy, Bardees M Fahmy
July-September 2018, 12(3):288-294
DOI
:10.4103/ejb.ejb_11_18
Introduction
The quality of life plays an important role in chronic disease management, including chronic obstructive pulmonary disease (COPD).
Objective
To assess the quality of life in COPD patients and its relationship to disease severity.
Patients and methods
Two hundred Egyptian COPD patients were included in the study. We collected demographic data, comorbidities, dyspnea score, and other symptoms. Spirometry, 6-min walk tests were also conducted. Health-related quality of life (HRQoL) assessment was done with the Arabic version of St George’s Respiratory Questionnaire.
Results
There was male predominance (72%); in most of the cases (79%), there were more than 50 years old. COPD patients who had significantly reduced HRQoL. Age, frequency of exacerbations per year, comorbidity, particularly hypertension and ischemic heart disease, modified Medical Council Research Dyspnea scale dyspnea scale, BODE index, GOLD spirometric staging, and New GOLD stage showed significant positive correlation with St George’s Respiratory Questionnaire. Lower spirometric parameters, 6-min walk tests, and SpO
2
%, were correlated with impaired HRQoL.
Conclusion
Patients with COPD had reduced HRQoL. Frequent exacerbations, advanced airway obstruction, and dyspnea severity had negative impact on HRQoL.
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367
AIRWAY DISEASES - ORIGINAL ARTICLES
The relationship between metabolic syndrome and chronic obstructive pulmonary disease
Therese Ghatas
January-March 2017, 11(1):11-15
DOI
:10.4103/1687-8426.198983
Background
Metabolic syndrome is a condition frequently found among individuals. It predisposes affected individuals to systemic inflammation and physical inactivity. The aim of the present study was to investigate the frequency of metabolic syndrome and C-reactive protein (CRP) levels as markers of systemic inflammation in stable chronic obstructive pulmonary disease (COPD) patients with different severity levels and in an age-matched and sex-matched control group.
Patients and methods
One hundred COPD patients and 50 controls were included in this study. The severity level in patients with COPD was determined according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages I−IV, we measured the characteristics of the metabolic syndrome and systemic inflammation (high-sensitivity C-reactive protein).
Results
The frequency of metabolic syndrome was found to be higher in the patient group than in control individuals, especially in GOLD stages I and II. Abdominal obesity, hypertension, and hyperglycemia components of metabolic syndrome were significantly more prevalent in the patient group (
P
<0.05 for all). Increased CRP levels were higher in control and patient groups in all GOLD stages, with metabolic syndrome than without metabolic syndrome.
P
-values for control group and GOLD stages I–IV were 0.044, 0.483, less than 0.01, 0.048, and 0.076, respectively.
Conclusion
Metabolic syndrome is substantial among stable COPD patients, especially in the early stages (GOLD stages I−II). Abdominal obesity, hypertension, and hyperglycemia were significantly more in COPD patients with metabolic syndrome. An impaired profile of CRP levels was found in patients and control groups with metabolic syndrome than in individuals without metabolic syndrome.
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355
ORIGINAL ARTICLES
Acute exacerbations of chronic obstructive pulmonary disease: etiological bacterial pathogens and antibiotic resistance in Upper Egypt
Alaa T Hassan, Sherif A.A Mohamed, Mona S.E Mohamed, Mohamed A El-Mokhtar
September 2016, 10(3):283-290
DOI
:10.4103/1687-8426.193640
Context
Previous data on etiologic bacteria in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in Upper Egypt are limited.
Aim
The aim of this study was to identify the causative bacteria in AECOPD and to determine the antibiotic resistance patterns for AECOPD in Upper Egypt.
Settings and design
The study design was a prospective one and was conducted in a University Hospital.
Materials and methods
Patients who were admitted in Assiut University Hospital with AECOPD were prospectively enrolled. Sputum specimens were investigated using culture. Susceptibilities of the isolated bacterial strains to different antibiotics were determined using the disk diffusion method.
Results
During 18 months, 156 patients who experienced 218 AECOPD were enrolled. A significant bacterial growth was found in 77% of patients during 81% of exacerbations. The most commonly detected bacteria were
Haemophilus influenzae
(18%),
Streptococcus pneumoniae
(15%), and
Klebsiella pneumoniae
(
14%). The majority of the isolated strains showed high resistance rates to most groups of antibiotics; 63% of the isolated strains were multidrug resistant, 29% were extensively drug resistant, and 5% were pandrug resistant. High resistance rates were observed against penicillins and cephalosporins, moderate rates against fluoroquinolones, and lowest rates against the carbapenems. All gram-positive bacteria were sensitive to linezolid. Increased severity of chronic obstructive pulmonary disease was related to increased prevalence of antibiotic resistance.
Conclusion
The predominant bacterial pathogens for AECOPD in Upper Egypt are
H. influenzae, S. pneumoniae
, and
K. pneumoniae
. Bacterial resistance rates were the highest against penicillins and cephalosporins, moderate against fluoroquinolones, and least against carbapenems. Increased severity of chronic obstructive pulmonary disease is related to an increased prevalence of antibiotic resistance.
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203
LUNG FUNCTION TESTS - ORIGINAL ARTICLE
Assessment of functional lung impairment in patients with thyroid disorders
Eman R Ali
September 2016, 10(3):337-347
DOI
:10.4103/1687-8426.193641
Background and objective
Many thyroid diseases can lead to pulmonary problems. Hypothyroidism reduces respiratory drive and can cause obstructive sleep apnea, pleural effusion, skeletal muscle myopathy, and decreased carbon monoxide diffusing capacity, whereas hyperthyroidism increases respiratory drive and can cause dyspnea on exertion. Thus, the aim of this study was to evaluate and compare the frequency of clinical presentations, the extent of lung functional endurance (spirometric and diffusion lung capacity), and arterial blood gases affection between patients with hypothyroidism and hyperthyroidism when compared with normal euthyroid volunteers and find out who could compromise the respiratory system more.
Patients and methods
This study included 90 participants (30 patients with hyperthyroidism, 30 patients with hypothyroidism, and the remaining 30 were normal healthy volunteers as control) referred from the Endocrinology and Internal Medicine Departments in Ain Shams University Hospitals and Misr University for Science and Technology according to their serum free thyroid hormone 3, free thyroid hormone 4, and thyroid-stimulating hormone values. Spirometric function tests and diffusing capacity of the lung for carbon monoxide evaluation were performed for all participants.
Results
Respiratory symptoms were more frequent in hypothyroid than in hyperthyroid patients, especially cough, sputum production, and chest wheezes. All spirometric functional parameters and respiratory muscle function were decreased (whether or not significant) among patients with hypothyroidism and hyperthyroidism compared with normal euthyroid controls. More statistically significant respiratory functional impairment was noticed among patients with hypothyroidism than among those with hyperthyroidism. Diffusion was more affected in the hypothyroidism group than in the hyperthyroid group, but it was statistically nonsignificant. A statistically significant increase in partial carbon dioxide pressure was observed among patients with hypothyroidism than in patients in hyperthyroidism (However, there was a statistically significant decrease in partial oxygen pressure and pH in patients with hypothyroidism than in those with hyperthyroidism.). Although oxygen saturation was lower in hypothyroidism, it was statistically nonsignificant.
Conclusion
Hypothyroidism causes greater respiratory system endurance compared with hyperthyroidism. Early diagnosis and hormonal replacement may be of value.
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ORIGINAL ARTICLES - AIRWAY DISEASES
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.
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ORIGINAL ARTICLES - CRITICAL CARE
Real-time tracheal ultrasonography for confirming endotracheal tube placement
Ahmed E Kabil, Ahmed M Ewis, Ahmed M Al-Ashkar, Mohamed A.A Abdelatif, Mohamed O Nour
July-September 2018, 12(3):323-328
DOI
:10.4103/ejb.ejb_88_17
Objective
To evaluate the accuracy of tracheal ultrasonography for confirming the endotracheal tube placement during patients’ intubation.
Patients and methods
The current study was a prospective, randomized study performed at the ICU of Al-Hussein Hospital, Cairo. Intubated for respiratory failure, cardiac arrest or other medical causes were included in the current study. Real-time tracheal ultrasonography was conducted during intubation with the ultrasound probe placed transversely over the trachea above the suprasternal notch for confirming the tube position, either tracheal or esophageal. The standard method for confirming endotracheal tube placement include clinical evaluation and rapid bronchoscopic confirmation. The main outcomes were the degree of accuracy and timeliness of tracheal ultrasound in confirming endotracheal tube placement.
Results
Forty patients eligible for endotracheal intubation were randomized in the current study and only four (10%) patients had confirmed esophageal intubations. Our results concluded that tracheal ultrasound had a diagnostic accuracy of 97.5% in the detection of endotracheal tube site. The sensitivity was 97.2%, while the specificity was 100%. Tracheal ultrasound had a positive predictive value of 100%, while the negative predictive value was 80%. The total operating time of ultrasonography was significantly lower than that of bronchoscopy.
Conclusion
Real-time ultrasound of the trachea is an accurate, feasible, and fast method in confirming endotracheal tube placement.
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184
ORIGINAL ARTICLES: CRITICAL CARES
Bacteriological profile of critically ill patients with chronic obstructive pulmonary disease in respiratory intensive care unit in Assuit University Hospital
Maha K Ghanem, Hoda A Makhlouf, Ali A Hasan, Heba G Rashed, Hadeer S Khalifa
July-September 2019, 13(3):343-348
DOI
:10.4103/ejb.ejb_83_18
Background
Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is responsible for a high proportion of morbidity and antibiotic use. This study aimed to identify the causative bacteria, antimicrobial sensitivity, and resistance of hospitalized patients in respiratory ICU owing to AECOPD.
Patients and methods
This prospective study was performed at Assiut University Hospitals on 50 patients with AECOPD who needed ICU admission. Samples included sputum for staining and culture. Samples were cultured on two bacteriological media (blood and MacConkey’s agars) to detect gram-positive and gram-negative organisms and their sensitivity to different antibiotics.
Results
Klebsiella pneumoniae
was the most frequently detected organism in 29 (58%) patients followed by
Pseudomonas aeruginosa
in 14 (28%) patients, methicillin resistant
Staphylococcus aureus
(MRSA) in eight (16%) patients,
Acinetobacter
baumannii
in seven (14%) patients,
Proteus
spp. and
Staphylococcus aureus
in five (10%) patients each, and
Escherichia coli
in three (6%) patients. No growth was reported in three (6%) patients. Among gram-positive organisms, linezolid had the upper hand of efficacy followed by vancomycin and teicoplanin. Gram-negative organisms had high rate or resistance to most tested antibiotics. Frequency of death was more (62.5%) in patients with MRSA.
Conclusion
K.
pneumoniae
was the most frequent organism followed by
P.
aeruginosa
, MRSA, and
A. baumannii
. The isolated bacterial strains were characterized by high resistance rates to the most used antimicrobials. Mortality rate was more among patients with MRSA.
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117
AIRWAYS IN HEALTH AND DISEASE
Prevalence and predictors of chronic obstructive pulmonary disease among high-risk Egyptians
Azza F Said, Ashraf A Ewis, Ahmad A Omran, Mohamed E Magdy, Micheal F Saleeb
January-June 2015, 9(1):27-33
DOI
:10.4103/1687-8426.153586
Background
Chronic obstructive pulmonary disease (COPD) is the fourth most common cause of death in the world. COPD prevalence, morbidity, and mortality vary across countries and across different groups within countries. In Egypt, COPD is a rising significant health problem; however, information on its prevalence, morbidity, and mortality is still lacking.
Aim of the study
The first aim was to detect the prevalence of COPD among high-risk Egyptians Global using Initiative for Chronic Obstructive Lung Disease (GOLD) and FEV
1
/FVC < lower limit of normal (LLN) definitions. The second goal was to identify the factors predictive for diagnosis of COPD.
Patients and methods
This study included 363 randomly selected individuals with a high risk for COPD; 176 were smokers (group I), 107 were construction and brick manufacturer workers (group II), and 80 were women exposed to biomass fuel (group III). All individuals filled out a respiratory questionnaire, were clinically examined, and subjected to spirometric evaluation.
Results
The prevalence of COPD among high-risk individuals was 9.6 and 17.4% on the basis of GOLD and LLN, respectively. The sensitivity and specificity of prebronchodilator values of FEV
1
/FVC < LLN were 94.3 and 90.8%, respectively, for the diagnosis of COPD. However, our findings support that the postbronchodilator LLN definition is superior in ruling out the presence of COPD, as it has a good negative test specificity of 99.7%. Chest wheezes were the only symptom that was an independent predictor of COPD (odds ratio 4.80, 95% confidence interval 1.57-14.74,
P
= 0.02). Increasing age, smoking, and mean pack-years were also factors predictive for COPD.
Conclusion
The prevalence of COPD among high-risk individuals in Egypt was estimated to be about 10% as per GOLD. Prebronchodilator LLN is a reliable method for the diagnosis of COPD and it yields comparable results to the GOLD criteria. The main predictors for COPD diagnosis are old age, smoking history, and presence of chest wheezes.
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462
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.
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6
4,507
286
ORIGINAL ARTICLES - PULMONARY INFECTIONS
Incidence of ventilator-associated pneumonia: Egyptian study
Reham M Elkolaly, Hoda M Bahr, Basem I El-Shafey, Ahmed S Basuoni, Eman H Elber
April-June 2019, 13(2):258-266
DOI
:10.4103/ejb.ejb_43_18
Background
Despite different ICU admission causes, ventilator-associated pneumonia (VAP) is still a common cause of mortality and morbidity in intubated patients and impedes obvious progression in diagnostic modalities and management of these infections.
Aim of study
The aim of this study was to estimate VAP incidence in Tanta University Hospitals ICUs.
Settings and design
This was a crossover observational study.
Patients and methods
This was a one-year study (April 2015 to March 2016), including patients on invasive ventilation who developed VAP, with evaluation of admission and ventilation causes, isolation of causative organisms, and study of used antibiotics and ventilation modes.
Statistical analysis
Data were statistically analyzed using the SPSS software for Windows (IBM SPSS Statistics 21.0).
Results
It is a statistics based study aimed to trace infection incidence in national hospital ICUs. Among 222 admitted patients, only 38.4% fulfilled the criteria of VAP. Admission was because of cardiovascular impairment, cardiac arrest, respiratory failure, or head trauma. The ventilation mode at VAP time was assisted control (75%) and synchronized intermittent mandatory ventilation (25%). The minimum intubation period was 7 days, whereas the maximum period was 37 days. Isolated organisms were Pseudomonas (37.5%), Klebsiella (25%), Staphylococcus (20.8%), and methicillin-resistant
Staphylococcus aureus
(4.2%). The antibiotics used were amikacin, imipenem, vancomycin, levofloxacin, ceftazidime, and teicoplanin (29, 25, 21, 12.5, 8.3, and 4.2%, respectively). The minimum period of antibiotic used was 5 days, whereas the maximum period was 35 days. The highest incidence of VAP occurred in February, whereas the lowest incidence occurred in July.
Conclusion
The incidence of VAP is still high and varies according to the intubation cause and period, and the underlying morbidity. More efforts must be made to prevent, diagnose, and manage infection early and properly to reduce patient suffering and to reduce the burden on the serving hospitals.
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6
2,719
258
ORIGINAL ARTICLES
Study of the role of different severity scores in respiratory ICU
Mona Mansour, Iman Galal, Enas Kassem
July-December 2013, 7(2):55-59
DOI
:10.4103/1687-8426.123995
Background
Scoring systems are increasingly used in the ICUs in an attempt to accurately predict the mortality outcome in critically ill patients.
Objective
The performance of the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, the Sequential Organ Failure Assessment (SOFA) score, and the Simplified Acute Physiology Score (SAPS) II was compared in terms of calibration and discrimination in critically ill patients admitted to the respiratory ICU.
Materials and methods
Mean admission APACHE II, SAPS II, and SOFA scores were compared in 105 patients. The outcome measure was ICU mortality. The discriminatory ability of the scores was evaluated using the area under the receiver operating characteristic curve. Calibration was tested using the Hosmer-Lemeshow goodness-of-fit test.
Results
The mean admission APACHE II, SAPS II, and SOFA scores were higher in nonsurvivors compared with survivors; yet, only admission SOFA score differed significantly. There was highly significant positive correlation between the three scores. The cutoffs obtained by the receiver operating characteristic curve were 11 for APACHE II, 7.5 for SOFA, and 40 for SAPS II score. Discrimination power of the three scores was poor; yet, in the order of best discrimination, SOFA [area under the curve (AUC) = 0.63] was followed by APACHE II (AUC = 0.60) and then SAPS II (AUC = 0.59). In terms of calibration, SAPS II (χ
2
= 4.82;
P
= 0.78) had the best calibration and APACHE II (χ
2
= 7.34;
P
= 0.39) had the worst. Logistic regression analysis showed that, of the three scores, only the SOFA score was an independent predictor of mortality among the respiratory ICU patients; with a unit increase in the SOFA score, there was a 1.2 times higher risk for mortality.
Conclusion
The SOFA score performed well in terms of calibration, whereas the SAPS II score performed well in terms of discrimination. The APACHE II score did not perform well in terms of calibration and had poor discrimination power.
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5
2,136
565
PULMONARY INFECTIONS
Assessment of tuberculosis situation in Cairo governorate from 2006 to 2012 after application of directly observed therapy short-course strategy
Sherif A Eissa, Ali A Okab, Tarek S Essawy, Eman A El Ghany
January-April 2016, 10(1):52-57
DOI
:10.4103/1687-8426.176787
Background
Directly observed therapy short course (DOTS) is a strategy in which a trained healthcare worker or a designated individual provides the prescribed antituberculous drugs and watches the patient to ensure the patient is taking each dose.
Aim
The objective of this work was to study tuberculosis situation in Cairo governorate from 2006 to 2012 after application of DOTS.
Methodology
This was a retrospective clinical cohort study carried out at the Cairo governorate.
Results
Percentages of cure and complete treatment were 61.6 and 20.4%, respectively. The incidence of failure, death, default, and transfer out decreased after DOTS (2.2, 4.5, 8.6, and 2.7, respectively).
Conclusion
The introduction of DOTS in the Cairo governorate has led to a treatment success rate of 82% (nearly similar to the WHO target of '85%').
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5
2,100
211
AIRWAYS IN HEALTH AND DISEASE
Chronic obstructive pulmonary disease in treated pulmonary tuberculous patients
Mohamed W Zakaria, Heba A Moussa
January-June 2015, 9(1):10-13
DOI
:10.4103/1687-8426.153519
Background/Aim
To detect the prevalence of chronic obstructive pulmonary disease (COPD) as a sequel of treated pulmonary tuberculosis (PTB).
Materials and methods
A total of 50 adults, 28 men and 22 women, with a definite diagnosis of PTB and complete antituberculous therapy, with subsequent presentation of exertional dyspnea and/or cough, and expectorations for which no other alternative cause was found, were included in our study. All the patients underwent full history taking, full clinical examination, chest radiography, erythrocyte sedimentation rate, prebronchodilator and postbronchodilator forced vital capacity (FVC%), and forced expiratory volume (FEV
1
%) in the first second of FEV
1
/FVC%.
Results
Pulmonary function testing showed 22 patients (44%) with irreversible obstructive pattern denoting chronic obstructive pulmonary disease (COPD), seven patients had restrictive ventilatory defect, and three patients had mixed obstructive and restrictive pattern. Of those 22 patients with irreversible obstructive pattern (COPD), 11 patients (50%) had mild obstruction, nine patients (40.9%) had moderate obstruction, and two patients (9.1%) had severe obstruction. There is a positive correlation between dyspnea and post-tuberculous COPD patients, and a negative correlation between cough and post-tuberculous COPD patients. There is no correlation between the duration since the completion of antituberculous therapy and development of COPD.
Conclusion
COPD can be a sequel of PTB and should be overlooked, especially in those patients complaining of dyspnea even in the absence of any history of smoking. Post-tuberculous COPD as a cause of COPD in nonsmokers should be now more recognized in countries where the prevalence of PTB is still high.
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3,966
474
Telomere length in chronic obstructive pulmonary disease
Galal-Eldin M Magd, Ahmad S Entesar, Hafez R Manal, Sobh M Eman, Alrayes H Mona
January-June 2015, 9(1):20-26
DOI
:10.4103/1687-8426.153569
Background
Telomere length (TL) is considered a biomarker of cellular aging. Chronic obstructive pulmonary disease (COPD) is found to be associated with premature aging and the senescence hypothesis is now accepted as a molecular pathway for COPD development.
Purpose
The aim of this study was to measure TL in COPD patients and to study its relation to demographic data, spirometric indices, and arterial blood gases parameters.
Participants and methods
We measured TL using quantitative PCR in 20 patients with severe to very severe COPD and 11 age-matched and sex-matched nonsmokers.
Results
TL was significantly shorter in COPD patients (
P
< 0.001). Among COPD patients, TL was significantly shorter in current smokers than ex-smokers. In COPD patients, TL was correlated positively with SpO
2
%, pH (
P
< 0.05), PaO
2
(
P
< 0.01), FVC% (
P
< 0.05) and FEV
1
%, and FEF
25-75
% (
P
< 0.001) and not correlated with pack-year. The BODE (Body mass index, airflow Obstruction, Dyspnea, and Exercise capacity) index was correlated negatively with TL (
P
< 0.01); among BODE index parameters, the dyspnea score correlated negatively (
P
< 0.05) with TL. TL was shorter in very severe COPD than severe COPD (
P
< 0.001).
Conclusion
Our data support accelerated cellular senescence in COPD represented by shortening of TL; TL was correlated positively with airflow limitation and it may be related to impaired physical activities in COPD, which is a manifestation of the aging process.
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2,021
161
CASE REPORT
Recurrent heart failure in pulmonary tuberculosis patients on antitubercular therapy: A case of protector turning predator!
Animesh Ray, Vivek Nangia, RS Chatterji, Navin Dalal, Ruchismita Satpathy Ray
July-September 2017, 11(3):288-291
DOI
:10.4103/1687-8426.211400
Anti-tubercular drugs are associated some common and uncommon adverse effects. We report the association between cardiomyopathy and the use of anti-tubercular drugs. In the two cases described in the case report the different causes of cardiomyopathy are ruled out leading to the diagnosis of drug induced cardiomyopathy. The report also throws light on the various aspects of this association and the clinical implications.
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5,045
264
INTERVENTIONAL BRONCHOLOGY AND PULMONOLOGY
Outcomes and complications of medical thoracoscopy in undiagnosed exudative pleural effusion
Mona M Ahmed, Hesham Atef Abdel Halim, Ehab Thabet Aziz, Rania Mohammed El-Shorbagy
May-August 2016, 10(2):93-99
DOI
:10.4103/1687-8426.184367
Background:
Thoracoscopy has long been established as the procedure of choice for various chest diseases, among which is undiagnosed pleural effusions. Thoracoscopy does not only visualizes the extent of the disease but allows adequate tissue biopsy sampling.
Objective:
The aim of the present study was to detect outcomes and complications of medical thoracoscopy in undiagnosed pleural effusion.
Patients and methods:
This study was conducted on 50 patients with unexplained exudative pleural effusion referred for medical thoracoscopy at Abbassia Chest Hospital.
Results:
Medical thoracoscopy is a safe and valuable tool for the diagnosis of pleural effusion, particularly for patients with suspected malignancy. Overall cost-effectiveness of thoracoscopy is better due to its better yield and lesser duration of hospital stay. Medical thoracoscopy gave a definitive diagnosis with a diagnostic yield of 96%. Histopathological results of thoracoscopic pleural biopsy revealed that the most common diagnosis was malignancy (92%), followed by tuberculous pleurisy (2%), and fibrotic pleurisy (2%); only 4% of the patients remained undiagnosed. The most common malignant pathological type was malignant pleural mesothelioma (60%), followed by metastatic adenocarcinoma (12%). According to the residence of studied patients, we found that environmental exposure to asbestos has a relationship with mesothelioma in patients living in Shoubra El-Kheima and Helwan. Medical thoracoscopy is a safe tool for diagnosing pleural effusion; although no major complications were found in the present study, minor complications occurred only in 10% of the patients.
Conclusion:
Medical thoracoscopy is a valuable tool in the diagnosis of undiagnosed pleural effusion. It is a simple and safe method with a high diagnostic yield and low complication rates.
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2,240
221
ORIGINAL ARTICLES
Assessment of patients' satisfaction with flexible bronchoscopy: Initial Egyptian experience
Ashraf Madkour, Nehad Osman, Samar Sharkawy, Ashraf Gomaa
July-December 2013, 7(2):71-77
DOI
:10.4103/1687-8426.124002
Introduction
Data regarding the patients' satisfaction with flexible bronchoscopy (FB) in our country, which is the major driving force in defining our practice, are lacking and have not been studied. We aimed to assess our patients' satisfaction with FB.
Materials and methods
Prospective administration of a questionnaire assessing patients' evaluations of various aspects of their bronchoscopy experience, overall satisfaction, tolerance and willingness to return for another FB was carried out with inclusion of 115 patients in the analysis.
Results
The pre-FB and final post-FB information were positively rated in 93.9 and 89.6% of patients, respectively. The nursing attitudes towards patients before, during and after FB were positive in 98, 98 and 95% of patients, respectively, whereas the doctors' attitude before, during and after FB was positive in 99, 100 and 98% of patients, respectively. Patients' tolerance to examination on a 10-cm visual analogue scale was 7.22. The overall positive patient satisfaction with FB was 89.6%, but only 25.2% of patients would (definitely or probably) return for repeat FB. Stepwise logistic multiregression analysis showed that both (very good) final information and (very good) doctor's attitude after the procedure are the most sensitive discriminators for prediction of a patient with maximum satisfaction (
P
<0.0001). Scope insertion through tracheostomy and tolerance to the examination by visual analogue scale were significant predictors associated with a likelihood of definitely returning for a repeat FB if needed.
Conclusion
Our results show that, although the majority of studied patients were satisfied with different aspects of their FB examination, only a minority would repeat this experience if needed.
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4
2,396
204
ORIGINAL ARTICLES - CRITICAL CARE
Does nebulized heparin have value in acute respiratory distress syndrome patients in the setting of polytrauma?
Mohamed H Saleh, Emad Omar
October-December 2017, 11(4):332-335
DOI
:10.4103/ejb.ejb_24_17
Background
Several studies have been conducted with anticoagulants in the setting of experimental lung injury in animals and acute respiratory distress syndrome (ARDS) in humans. However, the clinical evidence for pulmonary anticoagulant therapy is still limited.
Aim
We aimed to assess the value of the use of nebulized heparin in ARDS patients in the setting of polytrauma.
Patients and methods
Eighty patients admitted with polytrauma and diagnosed to have ARDS and mechanically ventilated were enrolled. Patients were divided randomly into two groups, and each group included 40 patients: group 1 received nebulized heparin at a dose 5000 IU every 4 h, and group 2 served as control. All clinical and laboratory data were recorded. Patients were followed up during their whole ICU stay. All data were statistically analyzed.
Results
The mean age of the studied patients was 34.35±14.6 and 34.87±14.86 years in group 1 and group 2, respectively. After 1 week, patients in group 1 had significant improvement in their PO
2
/FiO
2
and lung injury severity score compared with patients in group 2 (231.1±42.7 and 1.82±0.66 vs. 203.6±45.9 and 2.35±0.35,
P
<0.001, respectively). Group 1 spent less days on mechanical ventilation and their length of ICU stay was lower compared with group 2 (9.6±13.5 and 12.7±4.3 days vs. 13.5±3.1 and 17.7±3.7 days, respectively,
P
<0.001). Other outcome parameters such as development of multiple organ dysfunction syndrome, the need to use vasoactive agents, and mortality did not differ between both groups (12, 62.5, and 20% vs. 15, 57.5, and 22.5%,
P
=0.5, 0.41, and 0.61, respectively).
Conclusion
Nebulized heparin may be beneficial and safe but has no survival benefit in ARDS patients in the setting of polytrauma.
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3,053
156
ORIGINAL ARTICLES - INTERVENTIONAL PULMONOLOGY
Bronchoscopic instillation of tranexamic acid to control bronchopulmonary bleeding
Emad El-Din A Korraa, Ashraf M Madkour, Iman H Galal, Ibrahim M Ibrahim El-Saidy
July-September 2017, 11(3):244-249
DOI
:10.4103/ejb.ejb_27_17
Background
Tranexamic acid (TA), a potent antifibrinolytic agent, has the potency to stop bleeding in a variety of medical and surgical conditions. However, its role in controlling airway bleeding is not yet proven. This study aimed to evaluate the efficacy of endobronchial administration of TA in controlling bronchopulmonary bleeding.
Materials and methods
A prospective, comparative, observational study was carried out including 40 patients scheduled to undergo bronchoscopy. For management of hemoptysis or bronchoscopy-induced bleeding, patients were randomly subdivided into two groups of 20 patients each: the first group received endobronchial TA, whereas the second group received endobronchial cold saline±adrenaline.
Results
In the TA group, 19 patients were responders and only one patient was a nonresponder and was further managed with endobronchial adrenaline. All 20 patients of the cold saline±adrenaline group were responders. No significant statistical difference was found between both groups with regard to systolic and diastolic blood pressures, heart rate, and oxygen saturation either before or after bronchoscopy. However, heart rate significantly increased after bronchoscopy both in the first (
P
<0.001) and the second group (
P
=0.007). Systolic blood pressure increased significantly (
P
=0.001) after bronchoscopy in the second group only. The amount of bronchoscopy-induced bleeding as well as the time required for bronchoscopic hemostasis significantly and directly correlated with the dose of TA (
r
=0.535,
P
=0.015, and
r
=1.000,
P
<0.001, respectively) and cold saline±adrenaline (
r
=0.687,
P
=0.33,
r
=0.858,
P
<0.001, respectively). TA did not result in any intrabronchoscopic and postbronchoscopic drug-related complications in any of the patients.
Conclusion
Endobronchial installation of TA is an effective and safe modality of treatment for controlling nonlife-threatening bronchopulmonary bleeding.
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2,979
247
PULMONARY INFECTIONS
Situation of multidrug-resistant pulmonary tuberculosis in Alexandria governorate from July 2008 to December 2012
Osama I Mohammad, Ali A Okab, Mostafa E Zaki
January-April 2016, 10(1):64-68
DOI
:10.4103/1687-8426.176792
Aim
The aim of this study was to estimate the prevalence, possible risk factors, patterns of resistance, and fate of multidrug-resistant pulmonary tuberculosis (MDR-TB) in Alexandria governorate as a representative part of Egypt during the period between July 2008 and December 2012.
Patients and methods
This retrospective study included all patients with pulmonary TB that was recorded in Alexandria governorate during the period between July 2008 (the time that MDR ward was held in Alexandria) and December 2012. They were divided into two groups: group I included patients with pulmonary TB that was recorded in Alexandria governorate (1893 cases), and group II included patients with pulmonary TB who were admitted in El-Maamoura Chest Hospital (509 cases). They were subdivided into two subgroups: group IIa included patients with MDR pulmonary TB (82 cases), and group IIb included patients with pulmonary TB not categorized as MDR-TB (427 cases).
Results
All patients with MDR-TB had acquired resistance. MDR-TB was more common in the male population, diabetic patients, and those with chronic chest disease. The effect of treatment of MDR-TB cases was as follows: cured patients, 49 (59.8%); patients under treatment, 10 (12.2%); treatment failure, four cases (4.9%); deceased patients, 10 (12.2%); and defaulters, nine (10.9%). The overall total prevalence rate of MDR-TB in Alexandria governorate from 2008 to 2012 was 4.3%.
Conclusion
There was a decreasing trend of MDR-TB cases. History of anti-TB treatment is the strongest independent predictor of MDR-TB. The highest figures of resistance in the MDR group besides isoniazide and rifampicin were for streptomycin, whereas the lowest resistance was for ethambutol.
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1,777
222
Mortality predictors in patients with severe community-acquired pneumonia requiring ICU admission
Ali O Abdel Aziz, Mohammad T Abdel Fattah, Ahmed H Mohamed, Mohammad O Abdel Aziz, Mohammed S Mohammed
May-August 2016, 10(2):155-161
DOI
:10.4103/1687-8426.184373
Background:
Community-acquired pneumonia (CAP) is a major cause of mortality. This prospective study was conducted to describe patient’s characteristics, mortality rate, and etiological pathogens in patients with severe CAP who required ICU admission and to determine the predictors of mortality.
Patients and methods:
This was a multicenter prospective observational study of 57 consecutive patients who were admitted to the ICU with diagnosis of severe CAP from October 2012 to August 2015.
Results:
Overall 57 patients were included in the study and the overall ICU mortality rate was 49.1%. Heart disease and chronic obstructive pulmonary disease were the most common comorbidities associated with severe CAP. Comparison between survivors and nonsurvivors revealed that mortality was associated with old age (
P
=0.01), low diastolic blood pressure (
P
=0.04), low PaO
2
/FiO
2
(
P
=0.04), high acute physiology and chronic health evaluation II (APACHE II) score (
P
=0.001), (CURB-65) score (
P
=0.005), low hemoglobin (
P
=0.008), and high urea (
P
=0.04). The univariate analysis demonstrated that the following were the predictors of mortality: age older than 65 years (
P
=0.03); APACHE II score greater than 20 (
P
=0.007); CURB-65 of 3 or greater (0.03); total leukocyte count less than 4 or greater than 11×10
9
/(
P
=0.04); PaO
2
/FiO
2
less than 250 (
P
=0.03); serum urea greater than 30 mg/dl (
P
=0.04); presence of septic shock (
P
=0.003); mechanical ventilation requirement (
P
=0.02); and bilateral or multilobar infiltrate on chest radiograph (
P
=0.03). Multiple regression analysis identified high APACHE II score (>20) and septic shock as significant independent predictors of mortality in severe CAP. Microbiological identification was obtained in 52.6% of cases, with positive blood culture in 17.5%. The most frequently isolated pathogens were
Streptococcus pneumonia
(
S. pneumonia
) (19.3%) and
Staphylococcus aureus
(
S. aureus
) (15.8%).
Conclusion:
Mortality rate in patients with severe CAP was high as reported by most of the other studies. The presence of septic shock and high APACHE II were independent predictors of mortality. Heart disease and chronic obstructive pulmonary disease were the most common comorbidities. Microbiological identification was obtained in 52.6% of cases, and
S. pneumonia
and
S. aureus
were the most frequently isolated pathogens.
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2,536
245
SLEEP DISORDERS: CASE REPORTS
Primary pulmonary extraskeletal Ewing sarcoma/Primitive neuroectodermal tumor: Two case reports
Eman Sobh, Wael H El-Sheshtawy, Shady E Anis
April-June 2017, 11(2):161-164
DOI
:10.4103/ejb.ejb_48_16
Primary pulmonary extraskeletal Ewing sarcoma (EES)/primitive neuroectodermal tumor is an extremely rare tumor with only few cases reported in the literature. In this study, we present two cases of primary pulmonary EES diagnosed and treated at our institution. The median age was 20 years (range: 19–21). Cough, dyspnea, and hemoptysis were the predominant features at presentation, associated with a large lung mass on imaging. Image-guided core needle biopsies were the diagnostic modalities for both patients. Initial histopathology showed malignant small round cell tumor, which has been confirmed by immunohistochemistry as EES. Both patients received neoadjuvant chemotherapy followed by surgery; postoperative pathology for the first patient showed 98% tumor necrosis, whereas the second patient’s pathology showed no evidence of residual tumor after complete surgical excision.
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2,004
173
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© Egyptian Journal of Bronchology | Published by Wolters Kluwer -
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Online since 31st Dec, 2013