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2015| January-June | Volume 9 | Issue 1
Online since
March 20, 2015
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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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6
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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4
Evaluation of nasal optiflow device in the management of chronic obstructive pulmonary disease patients with acute excerbations
Adel M Saeed, Khaled M Wagih, Nasra A Hussein
January-June 2015, 9(1):34-42
DOI
:10.4103/1687-8426.153593
Background
A new form of therapy that provides humidified high-flow oxygen through a nasal cannula has been introduced recently as an alternative in the treatment of spontaneously ventilating patients with high oxygen requirements.
Objective
The aim of the study was to evaluate the efficacy of a nasal optiflow device in the management of chronic obstructive pulmonary disease (COPD) patients with acute exacerbations in comparison with a conventional venturi mask.
Patients and methods
Forty-five COPD patients with respiratory failure type II admitted to the RICU at Abbasia Chest Hospital were recruited and divided into two groups: group 1 included 20 randomly selected COPD patients with acute exacerbations connected to a venturi mask; group 2 included 25 randomly selected COPD patients with acute exacerbations connected to nasal high flow (NHF) oxygen with an optiflow system. All patients were subjected to full history taking, thorough clinical examination, and routine laboratory investigations with chest X ray (CXR) and repeated analyses of arterial blood gases (ABGs).
Results
No statistically significant difference was observed between the two groups with respect to baseline ABG variables (on admission). In both methods (NHF and venturi mask) there was statistically significant improvement in ABG variables in the form of raised pH, PO
2
, and O
2
saturation and reduced PCO
2
when compared with baseline ABG values. Although there was no significant difference in weaning results between the two groups, there was significant decline in PCO
2
in the NHF group. There was no significant difference in the outcome and end result between the two groups; successful weaning was achieved in 70% of patients in the venturi group and in 64% of the NHF group, whereas failure was reported in 30% of patients in the venturi group and in 36% in the NHF group.
Conclusion
The nasal optiflow device is highly expensive compared with the venturi mask, although both are approximately equally successful in the treatment of COPD patients with respiratory failure type II.
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PLEURAL DISEASES
Role of ultrasound in the management of pleural diseases in respiratory intensive care patients
Leila A Helala, Ashraf Madkour, Nehad M Osman, Waleed M Hetta, Inas Hakim
January-June 2015, 9(1):79-91
DOI
:10.4103/1687-8426.153658
Introduction
Ultrasonography (US) has become an invaluable tool in the management of critically ill patients.
Objectives
This study aimed to evaluate the role of US in the diagnosis and treatment of pleural diseases in patients in the respiratory intensive care unit.
Patients and methods
This study recruited 55 patients who presented with suspected clinical and/or radiological evidence of pleural disease in whom US and chest radiography were performed. In addition, US-guided interventions were carried out whenever needed and computed tomography scans of the chest where obtained whenever possible.
Results
Pleural effusion was the most common pleural disease encountered (54.5%). US correctly predicted the nature of most pleural effusions, whether transudative or exudative (84%). US was significantly more sensitive than chest radiography in the diagnosis of pleural effusion and pleural thickening (
P
= 0.00 and 0.004, respectively) and had significantly better sensitivity for unilateral effusions and for septations compared with computed tomography (
P
= 0.004). There was almost perfect agreement between US results and the final diagnosis in all pleural diseases, with κ values ranging from 0.9 to 0.98. A total of 67 US-guided interventions were carried out, with a success rate of 94%, and only one (1.5%) complication was encountered in the form of partial pneumothorax. US affected the diagnosis and altered the treatment policy, with recorded favorable outcomes. Short-term training programs enable pulmonologists to acquire US examination skills after 30 examinations.
Conclusion
US is an efficient and suitable method for evaluating pleural disease in the respiratory intensive care unit, especially pleural effusion. US-guided pleural interventions have been successful and have shown favorable outcomes and minimal complications. Short-term training could enable mastering of US use.
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AIRWAYS IN HEALTH AND DISEASE
Study of serum C-reactive protein level and sputum eosinophils in patients with bronchial asthma
Abdelsadek H Al-Aarag, Abeer M Rawy, Mona M EL-Behissy, Marwa M Abdelraheem
January-June 2015, 9(1):43-47
DOI
:10.4103/1687-8426.153597
Background
Asthma is a chronic inflammatory disorder of the airways in which many cells play a role, in particular mast cells, eosinophils, and lymphocytes. It is a major chronic airway disorder that poses a serious public health problem worldwide. C-reactive protein (CRP) is used mainly as a marker of inflammation.
Aim of the work
This study aims to clarify the relationship between serum CRP, sputum eosinophils, and the degree of airway inflammation in asthmatic patients (stable or in exacerbation) for use as a prognostic marker in detecting the severity of the disease.
Participants and methods
The study was carried out on 60 patients who were admitted to the chest department, Benha University Hospital. They were divided into two groups: 40 patients with bronchial asthma (20 patients with controlled asthma and 20 patients with exacerbated asthma) and 20 apparently healthy individuals. Patients and controls were subjected to a full assessment of history and clinical examination. Spirometry, serum CRP level, and sputum eosinophil count were measured in asthmatic patients and in healthy control individuals.
Results
Serum CRP was significantly increased in 85% of patients with acute exacerbation, whereas only 30% of patients with controlled asthma showed increased serum CRP. Its level was markedly increased during exacerbation. The sputum eosinophil count was highly increased in the exacerbated asthma group and 25% of patients in the controlled asthma group. There was a negative correlation between CRP, forced expiratory volume in the first second (FEV
1
), FVC, and FEV
1
/FVC and a highly significant positive correlation with sputum eosinophils.
Conclusion
There is an association between airway inflammation in bronchial asthma and elevated level of CRP and sputum eosinophils.
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PLEURAL DISEASES
The diagnostic utility of pleural fluid viscosity in lymphocytic pleural effusion
Sayed Labiba, Ibraheem Dwidar, Eman Riad, Basma B Hasan
January-June 2015, 9(1):73-78
DOI
:10.4103/1687-8426.153656
Context
The first step in the diagnostic work up of pleural effusion is the distinction between transudative and exudative pleural effusions (TPEs and EPEs). This discrimination is based on some biochemical tests that are relatively costly and time consuming. Lymphocyte-predominant EPE is the result of many diseases with malignancy, tuberculosis being the most common among them.
Aims
The aim of this study was to assess the role of pleural fluid viscosity in the differentiation between exudates and transudates and to identify the cause of pleural effusion.
Patients and methods
The study comprised 10 patients with TPE and 48 patients with EPE: 18 of them had tuberculous (TB) effusion, 25 patients had malignant pleural effusion (MPE) (patients with MPE included 10 with lung cancer and 15 with other known or unknown cancers) and five patients had connective tissue disease (CTD)-associated effusion. Pleural fluid protein, albumin, lactic dehydrogenase, and viscosity were measured in all patients.
Results
Pleural fluid viscosity was higher in patients with EPE with a highly significant difference (
P
< 0.01), and a cutoff value of 1.01 cP could distinguish between TPE and EPE with a sensitivity of 97.7%, a specificity of 93.9%, a positive predictive value of 97.5%, and a negative predictive value of 92.5%. It also showed significant positive correlation with protein, albumin, and lactic dehydrogenase. It was also higher in TB effusion than in MPE, with a highly significant difference (
P
< 0.01), and in CTD-associated effusion with a significant difference (
P
< 0.05). At a cutoff value of 1.5 cP, pleural fluid viscosity could discriminate between TB effusion and MPE with a sensitivity of 67%, a specificity of 84%, a positive predictive value of 75%, and a negative predictive value of 77%. There was also a nonsignificant difference between MPE secondary to lung cancer versus other known or unknown primary cancer (
P
> 0.05).
Conclusion
Pleural fluid viscosity can reliably differentiate between TPE and EPE. It can also help in the discrimination between TB effusion and MPE with moderate sensitivity and high specificity.
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EDITORIAL
Cancer-related medical emergencies
Gamal M Agmy
January-June 2015, 9(1):1-9
DOI
:10.4103/1687-8426.153509
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INTERSTITIAL LUNG DISEASES AND LUNG IN SYSTEMIC DISEASES
Does hepatitis C virus enhance prevalence of idiopathic pulmonary fibrosis and affect its severity? An Egyptian study
Elham A Hassan, Mohamed Abdel Malek, Ali A Hasan, Asmaa O Ahmed
January-June 2015, 9(1):69-72
DOI
:10.4103/1687-8426.153655
Background
Idiopathic pulmonary fibrosis (IPF) is the most common and severe form of pulmonary fibrosis characterized by gradual loss of pulmonary function. Despite rigorous research, the etiology of IPF has remained unknown. Viruses, for example, hepatitis C virus (HCV), had been implicated in IPF etiology; however, data on the prevalence of HCV infection in IPF patients were limited.
Aim
of the study Our aims were to assess the prevalence of HCV antibodies in IPF patients and to assess the relationship between severity of pulmonary and hepatic dysfunction.
Materials and methods
IPF patients were prospectively enrolled from Chest Department, Assiut University Hospital. HCV antibodies were detected using the third-generation enzyme-linked immunosorbent assay. Patients' pulmonary and hepatic functions were evaluated.
Results
HCV antibodies were significantly higher in IPF patients than in controls (29.4 vs. 14%,
P
= 0.04). Patients with HCV had significantly more severe hypoxemia and lower diffusing capacity for carbon monoxide than those without HCV (47.7 ± 11.3 vs. 54 ± 18.7,
P
= 0.03 and 52.7 ± 8.4 vs. 67.3 ± 9.5,
P
= 0.01, respectively). There was no significant difference between HCV-positive IPF patients and HCV-negative IPF patients regarding spirometric parameters and liver function parameters.
Conclusion
This higher prevalence of HCV and its effect on pulmonary functions in IPF patients may contribute in IPF pathogenesis, which hopefully will allow currently available antiviral drugs or novel therapeutic approaches to treat or modify the course of this devastating disease.
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AIRWAYS IN HEALTH AND DISEASE
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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Measurement of exhaled nitric oxide in healthy Egyptian population: normal ranges and factors affecting
Abeer M Rawy
January-June 2015, 9(1):48-54
DOI
:10.4103/1687-8426.153599
Background
Nitric oxide is an important regulatory mediator throughout the body. Naturally, the diagnostic applicability of fraction of exhaled nitric oxide (FeNO) depends on the availability of reference values that adequately take into account the major factors affecting FeNO. FeNO values are strongly influenced by several intraindividual factors, including age, atopy, high immunoglobulin E, height, weight, sex, and smoking habits. This study aimed to address the normal ranges of FeNO in healthy Egyptian adults and its relation to other personal factors.
Materials and methods
A total of 211 healthy Egyptian individuals were selected from pulmonary outpatient clinics and the Chest Department of University Hospital during the period between January 2014 and September 2014. Pulmonary function tests, FeNO measurement, and laboratory tests were carried out. The participants' demographic data were also recorded.
Results
There was significant negative correlation between measured FeNO and age, weight, BMI, and smoking index. A positive correlation was found between FeNO and height. Female participants had significantly lower levels of FeNO (20.4 ± 9.9) compared with male nonsmokers (28.2 ± 12.4).
Conclusion
FeNO is affected by sex, BMI, weight, height, and current smoking. The reference ranges for FeNO in healthy Egyptian adults were similar to those of the Caucasian population. In general, values of more than 50 parts per billion (ppb) in male participants and 40 ppb in female participants are considered abnormal in Egyptian populations.
Egypt J Broncho
2015 9:-0 ≥ 2015 Egyptian Journal of Bronchology.
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RESPIRATORY INFECTIONS
Incidence of tuberculosis before and after DOTS (direct observed therapy short course strategy) implementation in El-Behira Governorate, Egypt
Ali K Alwani, Abdelsadek H Al-Aarag, Magdy M Omar, Nabil A Abdelghaffar Hibah
January-June 2015, 9(1):101-108
DOI
:10.4103/1687-8426.153665
Aim
The aim of this work was to study the incidence of tuberculosis (TB) in El-Behira Governorate before and after application of DOTS (direct observed therapy short course strategy) to evaluate the National Tuberculosis Control Program in El-Behira Governorate as a representative part of Egypt.
Patients and methods
This work was a retrospective, descriptive, analytical study of the TB situation before and after DOTS, carried out at Chest Hospital, El-Behira Governorate, Egypt, and related dispensaries. All available data on registered TB cases from January 1996 until December 2010 (15-year duration) were collected, including demographic data, diagnosis of disease, sputum smear results, previous treatment history, and treatment outcome. A descriptive analysis of the data was performed using the SPSS statistical program. Data were described in absolute numbers and percentages. Statistical significance was set at
P
values less than 0.05.
Results
The incidence of TB (
n
= 10 035) was higher in age groups 15-29 and 30-45 years [
n
= 3829 (38.2%) and
n
= 2827 (28.1%), respectively], and in male patients [
n
= 6511 (64.8%)] compared with female patients [
n
= 3524 (35.2%)]. Pulmonary cases (78.8%) were more than extrapulmonary cases (21.2%). There was improvement in cure rate, treatment completion rate, treatment success rate, number of retreatment cases, and default rate after DOTS application (46-61.1, 16.1-18.6, 62.1-79.7, 29.1-12.4, and 20.4-6.8%, respectively).
Conclusion
TB is a burden of the productive age group of 15-45 years, with a higher incidence in men than in women, and DOTS is an effective tool for controlling TB in El-Behira Governorate. The implementation of this tool has led to significant increase in treatment success and decrease in default and failure rates.
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INTERSTITIAL LUNG DISEASES AND LUNG IN SYSTEMIC DISEASES
Pulmonary involvement in juvenile-onset systemic lupus erythematosus patients asymptomatic for respiratory disease
Hala M Lotfy, Eman F Halawa, Mohamed El Baz
January-June 2015, 9(1):59-63
DOI
:10.4103/1687-8426.153620
Objective
The aim of this study was to investigate the presence and frequency of abnormalities in subclinical pulmonary function tests (PFTs) in a group of Egyptian children with juvenile-onset systemic lupus erythematosus (jSLE) asymptomatic for respiratory manifestations.
Patients and methods
The study enrolled 20 children with jSLE followed up at the Pediatric Rheumatology Clinic, Cairo University. For all patients, pulmonary function testing was performed including measurement of lung volumes and lung flows using spirometry. Lung diffusion testing was performed using the transfer factor of the lung for carbon monoxide (DLCO) utilizing the single-breath method. Findings were correlated with clinical manifestations and lupus disease activity, and assessed using Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores.
Results
NAmong our study group, musculoskeletal, mucocutaneous, hematologic, renal, and neurological manifestations were the most frequent lupus manifestations throughout the course of disease, occurring in 85, 80, 65, 45, and 35% of the patients, respectively. The mean SLEDAI score was 21.3 9.515. Overall, 95% our patients had at least one PFT abnormality within a mean of 4.9 1.94 years after disease onset. Diffusion defect was the most frequent defect detected in 14 (70%) patients, restrictive pathology was found in seven (35%) patients, obstructive pathology was found in six (30%) patients, and mixed restrictive and obstructive pathology in one (5%) patient. In terms of the correlation between PFTs and the SLEDAI, DLCO was correlated positively (
r
= 0.37,
P
= 0.05) to a high SLEDAI, that is, a diffusion defect was significantly evident in patients with high disease activity even without symptoms.
Conclusion
Occult pulmonary disease as shown by a PFT occurs frequently in our group of Egyptian patients with childhood-onset systemic lupus erythematosus.
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AIRWAYS IN HEALTH AND DISEASE
Evaluation of serum troponin I in patients with acute exacerbations of chronic obstructive pulmonary disease
Neveen Hasaneen, Ayman Abd Elrahman, Mohamed El Mahdy, Osama El Shaer, Mohamed Hassan, Mahmoud M El-Habashy
January-June 2015, 9(1):14-19
DOI
:10.4103/1687-8426.153551
Introduction
Chronic obstructive pulmonary disease is a common, preventable, and treatable disease. Troponin I is a component of the contractile proteins present in all muscles. The amino acid sequence of cardiac troponin I (cTnI) contains a section that is unique to cardiac muscle.
Aim
The aim of the study was to evaluate the incidence of cTnI elevation in patients with acute exacerbation of chronic obstructive pulmonary diseases (AECOPDs) and study the possible association of the level of cTnI with the severity of AECOPD, need for assisted ventilation, and length of hospital stay.
Patients and methods
This study was performed on 30 patients with AECOPD admitted to the Chest Department and Respiratory ICU at Benha University Hospital. On admission, all patients were subjected to full medical history taking and full clinical examination. We examined the patients for signs and symptoms of right ventricular (RV) failure. Echocardiography was performed for every patient. Serum troponin I levels (upon admission and 24 h later) were evaluated.
Results
The study showed 21 (70%) of 30 patients with positive troponin I versus nine (30%) with negative troponin I. There was a nonsignificant statistical difference among all studied AECOPD patients as regards smoking habits, as 89% of troponin I-negative patients were smokers versus 81% of troponin I-positive patients. When assessed on the basis of pulmonary function tests, 75% of troponin I-negative patients were found to be in moderate stage, 53% of troponin I-positive patients were in severe stage, and 33% of troponin I-positive patients were in very severe stage. There was a significant statistical difference in troponin elevation as regards pulmonary hypertension (71% of cTnI-positive patients vs. 11% of cTnI-negative patients), RV strain (90% of cTnI-positive patients vs. 33% of cTnI-negative patients), and tricuspid regurge (52% of cTnI-positive patients) but a nonsignificant difference as regards left ventricular dysfunction among all studied AECOPD patients.
Conclusion
cTnI in AECOPD patients is mostly positive in tachypneic, tachycardiac, hypoxemic, and hypercapnic patients with more severe pulmonary hypertension and RV dysfunction.
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RESPIRATORY INFECTIONS
Extrapulmonary tuberculosis situation in El-Behira Governorate, Egypt
Nabil A Abdelghaffar Hibah
January-June 2015, 9(1):96-100
DOI
:10.4103/1687-8426.153662
Aim
There have been little published data about extrapulmonary tuberculosis (EPTB) situation in Egypt. The aim was to throw some light over EPTB patterns in Egypt regarding demographics, sites of affection, and treatment outcome.
Methods
This work was a retrospective, descriptive analysis of EPTB cases, carried out at El-Behira Chest Hospital and 14 related dispensaries. All available data about registered EPTB cases from January 1996 to December 2010 (15 years duration) were collected including demographic data, site of EPTB, previous treatment history, treatment category, and treatment outcome. A descriptive analysis of the data was performed using the SPSS statistical program. Data were described in absolute numbers and percentages. Statistical significance was set at
P
value less than 0.05.
Results
EPTB [
n
= 2119 (21%) of all diagnosed tuberculosis] occurred more in age groups between 15 and 29 and 30 and 44 years [
n
= 965 (45.5%) and
n
= 572 (27%), respectively] and in male patients [
n
= 1233 (58%)] than in female patients [
n
= 886 (42%)]. Pleural [
n
= 1341 (63.3%)], bone [
n
= 157 (7.5%)], and renal [
n
= 34 (1.6%)] tuberculosis were more common in male patients [
n
= 856 (64%),
n
= 99 (63%),
n
= 22 (64.5%), respectively], whereas lymph node [
n
= 427 (20%)] and genital [
n
= 70 (3.3%)] tuberculosis were more common in female patients [
n
= 240 (56.5%),
n
= 42 (60%), respectively]. Regarding treatment outcomes, successful treatment was obtained in 1725 cases (81.5%), treatment failure in 13 cases (0.5%), defaulting in 179 cases (8.5%), death in 77 cases (3.5%), and transfer-out in 125 cases (6%). Number of cases diagnosed declined through the years of study and was the highest in winter months, peaking in March.
Conclusion
EPTB is a burden of reproductive age groups (15-44 years), with pleura being the commonest site of the disease that occurred more in male patients and age groups 15-44 years, followed by lymph nodes that occurred more in female patients and age group below 15 years. Successful treatment outcome was obtained in 81.5% of EPTB cases.
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INTERSTITIAL LUNG DISEASES AND LUNG IN SYSTEMIC DISEASES
Factors predicting pulmonary hypertension in idiopathic pulmonary fibrosis patients
Samiaa H Sadek, Soheir M Kasem
January-June 2015, 9(1):55-58
DOI
:10.4103/1687-8426.153607
Context
Pulmonary hypertension (PH) is a common complication of idiopathic pulmonary fibrosis (IPF) and an important pathophysiologic mechanism of exercise intolerance and poor quality of life in these patients.
Aims
The aims of this study were to assess predictors of PH in IPF from both resting pulmonary function test (PFT) and cardiopulmonary exercise testing (CPET) parameters and to establish cut-off values from resting PFT and CPET parameters for the prediction of PH.
Settings and design
This was a randomized, double-blind, and prospective study.
Patients and methods
Thirty-five patients with stable IPF were assessed in terms of resting pulmonary functions, arterial blood gases (ABG), echocardiography, and incremental CPET. Patients were classified into a PH group and a non-pulmonary-hypertension group.
Statistical analysis
Both groups were compared in terms of resting PFT and CPET parameters. A receiver operating characteristic curve was constructed to establish cut-off values for the prediction of PH.
Results
PH was observed in 13 (37.14%) patients. There were no significant differences between both groups in age and sex. forced vital capacity (FVC)%, forced expiratory volume in one second (FEV
1
)%, inspiratory capacity, resting and exercise partial arterial oxygen tension (PaO
2
) and arterial oxygen saturation (SaO
2
), and oxygen consumption (VO
2
%) were significantly reduced in the PH group, whereas the dyspnea score, resting and exercise PaCO
2
, respiratory frequency, and minute ventilation were significantly increased in the PH group. The receiver operating characteristic curve showed that resting SaO
2
of 92.9% or less and exercise SaO
2
of 87% or less had sensitivity of 84.6, and 100%, and specificity of 90.9 and 81.8%, respectively.
Conclusion
Marked deterioration in resting PFT, exercise parameters, and SaO
2
can predict PH in IPF patients.
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PLEURAL DISEASES
Ultrasound-assisted medical thoracoscopy
Amr Shoukri
January-June 2015, 9(1):92-95
DOI
:10.4103/1687-8426.153660
Introduction
Medical thoracoscopy is an important tool for the diagnosis and management of several pleural diseases. The presence of fibrous pleural adhesions may prevent medical thoracoscopy to access the pleural space properly, which may lower the diagnostic yield of the procedure and may also increase the risk for associated complications. The role of on-table chest ultrasound (US) before medical thoracoscopy is investigated in this study.
Aim of the study
The aim of this study was to evaluate the utility of on-table chest US before medical thoracoscopy and its ability to locate a safe point of entry, its impact on the facility of the procedure, and the risk for complications.
Patients and methods
Forty patients who underwent medical thoracoscopy for investigation of undiagnosed pleural effusion were included in this study. They were randomized into two groups. In group I, chest US was performed on table immediately before medical thoracoscopy and in group II, no chest US was performed.
Results
Computed tomography chest detected pleural adhesions in one patient (5%) in group I and in two patients (10%) in group II, whereas medical thoracoscopy detected five patients (25%) in group II and six patients (30%) in group I. Chest US was able to detect all cases with pleural adhesions in group I. Four patients (20%) in group II needed extra procedures to access the pleural cavity due to unsuccessful primary point of entry, and two (10%) had complications in the form of bleeding. All patients in group I had successful access to the pleural cavity with no needed extra procedures and no complications. The mean duration of the procedure in group I was 42 ± 5.4 versus 50 ± 10.4 min in group II.
Conclusion
Chest US performed before medical thoracoscopy can facilitate the procedure; it reduces the unsuccessful attempts to access the pleural cavity, minimizes the risk for complications, and reduces the duration of the procedure.
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CASE REPORT
Behηet's disease: case reports
Gamal M Agmy
January-June 2015, 9(1):109-112
DOI
:10.4103/1687-8426.153667
Behcet diseases is not only orogenital ulcerations but also it can have many systemic manifestations.In this article we presented 3 cases of Behcet disease associated with pulmonary artery aneurysms affecting the large branches. Pulmonary artery aneurysms are common and serious vascular complication of Behcet disease.These are usully large and accompanied with intramural thrombi and multiple pulmonary infarctions with a common presentation of haemoptysis. A detailed discussion of pulmonary manifesttions of Behcet disease was demonstrated.
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INTERSTITIAL LUNG DISEASES AND LUNG IN SYSTEMIC DISEASES
Serum surfactant protein D as a prognostic factor in idiopathic pulmonary fibrosis
El-Miligy Dawalat, Mohamed W Zakaria, Rashed Laila, Abu-Hussein Haidi
January-June 2015, 9(1):64-68
DOI
:10.4103/1687-8426.153654
Background/aim
The aim of this study was to investigate the possible role of surfactant protein D (SP-D) in the pathogenesis and the prognosis of idiopathic pulmonary fibrosis (IPF).
Materials and methods
This study was performed on 10 healthy volunteers (group 1) and 30 patients from the Chest Diseases Department, Kasr El-Aini Hospital, who were divided into three groups: group 2 consisted of 10 patients with IPF receiving steroids; group 3 consisted of 10 patients with IPF not receiving steroids; and group 4 consisted of 10 patients with chronic chest diseases other than IPF and not receiving steroids. All patients underwent full history taking, thorough clinical examination, chest radiography and high-resolution computed tomography of the chest, pulmonary function testing, and estimation of SP-D by enzyme-linked immunosorbent assay.
Results
There was no statistical significance in the mean age of the four included groups. With regard to smoking in patients in groups 2, 3, and 4, there was no statistical significance in the duration or the number of cigarettes smoked per day. There was a significant decrease in FEV
1
, FVC, and FEV
1
/FVC in groups 2, 3, and 4 compared with the control group (group 1). SP-D shows a significant increase in groups 2, 3, and 4 compared with the control group, and also shows a significant increase in IPF patients not receiving steroids (group 3) compared with IPF patients receiving steroids (group 2) and patients with chronic chest diseases (group 4). A negative correlation was found between SP-D and FEV
1
, FVC, and FEV
1
/FVC. No correlation was found between SP-D, age, the duration of smoking, or the number of cigarettes smoked per day.
Conclusion
The SP-D assay may indicate the rate of decline in the pulmonary function in cases of IPF and in the follow-up of disease progress. It may also assist in making clinical choices for the therapeutic management of patients with IPF.
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© Egyptian Journal of Bronchology | Published by Wolters Kluwer -
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Online since 31st Dec, 2013