Pub Date : 2024-07-30DOI: 10.1186/s43168-024-00310-0
Jiang Chong-hui, Su Ying-ying, Fan Wen-ding, Wu Zhi-xin, Su Yi, Chen Qiao, Huang Shao-Juan, Chen Ping
The survival benefit of venovenous extracorporeal membrane oxygenation (VV-ECMO) in adult patients with severe acute respiratory distress syndrome (ARDS) remains controversial. This study aimed to investigate the efficiency and potential prognostic factors of VV-ECMO for severe ARDS in adults by evaluating our institutional experience and results. This research studied ARDS patients receiving VV-ECMO between June 2011 and May 2023. The inclusion criteria were PaO2/FiO2 < 100 mmHg at FiO2 of 1.0. Retrospective data was analyzed to identify factors associated with successful ECMO weaning and hospital discharge survival. A total of 18 patients were included in this study, with 7 cases (38.9%) successfully weaned from ECMO and 5 cases (27.8%) surviving hospital discharge. The overall complication rate was 77.8%. After treatment with VV ECMO, there were statistically significant improvements in both PaO2 and PaCO2 (P < 0.05). Patients in the successful weaning group had a lower pTB value, less accumulative volume of sodium bicarbonate during ECMO, and lower accumulative volume of intravenous immunoglobulin in the hospital compared to the unsuccessful weaning group (all P < 0.05). Furthermore, compared to the non-survivors, the survivors had less severe acidosis, higher mean arterial pressure before ECMO, a lower level of pCr, and a lower pTB value during ECMO (all P < 0.05). ECMO can effectively promote oxygenation and carbon dioxide (CO2) removal in patients with severe ARDS. Early initiation of ECMO with appropriate management could benefit in reducing comorbidities and mortality.
{"title":"Venovenous extracorporeal membrane oxygenation (VV-ECMO) for severe acute respiratory distress syndrome (ARDS) in adults—a single-center experience","authors":"Jiang Chong-hui, Su Ying-ying, Fan Wen-ding, Wu Zhi-xin, Su Yi, Chen Qiao, Huang Shao-Juan, Chen Ping","doi":"10.1186/s43168-024-00310-0","DOIUrl":"https://doi.org/10.1186/s43168-024-00310-0","url":null,"abstract":"The survival benefit of venovenous extracorporeal membrane oxygenation (VV-ECMO) in adult patients with severe acute respiratory distress syndrome (ARDS) remains controversial. This study aimed to investigate the efficiency and potential prognostic factors of VV-ECMO for severe ARDS in adults by evaluating our institutional experience and results. This research studied ARDS patients receiving VV-ECMO between June 2011 and May 2023. The inclusion criteria were PaO2/FiO2 < 100 mmHg at FiO2 of 1.0. Retrospective data was analyzed to identify factors associated with successful ECMO weaning and hospital discharge survival. A total of 18 patients were included in this study, with 7 cases (38.9%) successfully weaned from ECMO and 5 cases (27.8%) surviving hospital discharge. The overall complication rate was 77.8%. After treatment with VV ECMO, there were statistically significant improvements in both PaO2 and PaCO2 (P < 0.05). Patients in the successful weaning group had a lower pTB value, less accumulative volume of sodium bicarbonate during ECMO, and lower accumulative volume of intravenous immunoglobulin in the hospital compared to the unsuccessful weaning group (all P < 0.05). Furthermore, compared to the non-survivors, the survivors had less severe acidosis, higher mean arterial pressure before ECMO, a lower level of pCr, and a lower pTB value during ECMO (all P < 0.05). ECMO can effectively promote oxygenation and carbon dioxide (CO2) removal in patients with severe ARDS. Early initiation of ECMO with appropriate management could benefit in reducing comorbidities and mortality.","PeriodicalId":22426,"journal":{"name":"The Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141868268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patients with malignant central airway obstruction often present with dyspnea and sometimes with frank respiratory failure. Airway stenting has become a routine modality in the management of these patients. A correctly placed airway stent will give good relief in dyspnea and respiratory failure and will even improve the patient's ECOG (Eastern Cooperative Oncology Group) performance score. The common complications associated with stents are migration, fracture, infection, and obstruction by tumors, granulation tissue, and secretions. These complications are more pronounced with metallic stents. Surveillance bronchoscopy should ideally be done in these patients at least 4–6 weeks post-stent insertion. Removal of granulation tissue has been attempted with modalities like lasers, Argon plasma coagulation, cryotherapy, and snare electrocautery. Here, we present a novel case of post-stent granulation tissue, which was removed and debulked with the help of electrocoagulation bronchoscopy biopsy forceps (hot biopsy forceps). Conclusion Hot biopsy forceps can be safely and easily used for the removal of granulation tissue in patients post-tracheobronchial stent insertion.
{"title":"Novel use of hot biopsy forceps for removal of tracheobronchial stent-related granulation tissue","authors":"Sourabh Pahuja, Pradeep Bajad, Arjun Khanna, Satyam Agarwal","doi":"10.1186/s43168-024-00305-x","DOIUrl":"https://doi.org/10.1186/s43168-024-00305-x","url":null,"abstract":"Patients with malignant central airway obstruction often present with dyspnea and sometimes with frank respiratory failure. Airway stenting has become a routine modality in the management of these patients. A correctly placed airway stent will give good relief in dyspnea and respiratory failure and will even improve the patient's ECOG (Eastern Cooperative Oncology Group) performance score. The common complications associated with stents are migration, fracture, infection, and obstruction by tumors, granulation tissue, and secretions. These complications are more pronounced with metallic stents. Surveillance bronchoscopy should ideally be done in these patients at least 4–6 weeks post-stent insertion. Removal of granulation tissue has been attempted with modalities like lasers, Argon plasma coagulation, cryotherapy, and snare electrocautery. Here, we present a novel case of post-stent granulation tissue, which was removed and debulked with the help of electrocoagulation bronchoscopy biopsy forceps (hot biopsy forceps). Conclusion Hot biopsy forceps can be safely and easily used for the removal of granulation tissue in patients post-tracheobronchial stent insertion.","PeriodicalId":22426,"journal":{"name":"The Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141754004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pulmonary vein thrombosis is a rare condition with a non-specific presentation with multiple underlying etiologies such as malignancy or lung surgery. In rare instances, no etiology could be encountered. Instead, it has a broad spectrum of clinical manifestations, from dyspnea to lung infarction with a compromise to hemodynamics. A 71 years old male with a history of shortness of breath. The patient tested positive for COVID-19; the prolonged exertional fatigue led to undergoing CTPA (CT pulmonary angiography), which revealed pulmonary vein thrombosis. This case emphasizes the importance of maintaining a high index of clinical suspicion in the absence of other possible diagnoses. Furthermore, diagnostic work-up and treatment strategies depend highly on the patient’s presentation and risk factors. Pulmonary vein thrombosis is an infrequent entity reported in the medical literature and underdiagnosed because of its ambiguous presentation. Early diagnosis is paramount to prevent complications.
{"title":"Pulmonary vein thrombosis in COVID-19 patient with chronic obstructive pulmonary disease: a case report","authors":"Noora Hamad Alaazmi, Khalifa Abdulrahman Yusuf, Abdulrahman Hasan Al-Madani, Ghada Hassan Shehata, Hani Ebrahim Al-Fadhel","doi":"10.1186/s43168-024-00308-8","DOIUrl":"https://doi.org/10.1186/s43168-024-00308-8","url":null,"abstract":"Pulmonary vein thrombosis is a rare condition with a non-specific presentation with multiple underlying etiologies such as malignancy or lung surgery. In rare instances, no etiology could be encountered. Instead, it has a broad spectrum of clinical manifestations, from dyspnea to lung infarction with a compromise to hemodynamics. A 71 years old male with a history of shortness of breath. The patient tested positive for COVID-19; the prolonged exertional fatigue led to undergoing CTPA (CT pulmonary angiography), which revealed pulmonary vein thrombosis. This case emphasizes the importance of maintaining a high index of clinical suspicion in the absence of other possible diagnoses. Furthermore, diagnostic work-up and treatment strategies depend highly on the patient’s presentation and risk factors. Pulmonary vein thrombosis is an infrequent entity reported in the medical literature and underdiagnosed because of its ambiguous presentation. Early diagnosis is paramount to prevent complications.","PeriodicalId":22426,"journal":{"name":"The Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141739796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-20DOI: 10.1186/s43168-024-00306-w
Gehan Hamdy, Ahmed Gharib, Nahed Abdel Moneim Emara, Eman Mahmoud Hassan Attia, Mohamed Fathy Hussein, Reem Ibrahim Elkorashy, Nada Ezzeldin Gomaa
The results of several studies assessing the effect of the glutathione S-transferase class Mu 1 (GSTM1) null variant on the genetic susceptibility of tobacco-related cancers have been conflicting. In this work, we aim to identify the impact of the deletion of GSTM1 on lung cancer risk among smokers. This study was conducted on 20 patients diagnosed with primary lung cancer and 20 healthy individuals as a control group. They were subject to full medical history taking, complete clinical examination, and GSTM1 genotyping by PCR. Both studied groups were matched for age, sex, and smoking status. No statistically significant difference was exhibited between the frequency of GSTM1 positive and GSTM1 null in the studied population. No risk of lung cancer associated with GSTM1 null genotype was demonstrated between the patients and control group (n = 14/20 cases) (p = 0.110, OR = 2.852, 95% CI 0.777–10.467). Additionally, there was no association between the risk of lung cancer and the presence of the gene either in smokers (p = 1, OR = 1.8 and 95% CI 0.124–26.196) or non-smokers; (p = 0.063, OR = 4.4 and 95% CI 0.889–21.78). No statistically significant risk was found between the frequencies of GSTM1 null and the various histopathological types of lung malignancy. The results of this work demonstrated no association between the occurrence of the GSTM1 null variant, even when stratified for smoking status, and the risk of lung cancer.
{"title":"Impact of the deletion glutathione S-transferase (class Mu) on lung cancer risk among smokers","authors":"Gehan Hamdy, Ahmed Gharib, Nahed Abdel Moneim Emara, Eman Mahmoud Hassan Attia, Mohamed Fathy Hussein, Reem Ibrahim Elkorashy, Nada Ezzeldin Gomaa","doi":"10.1186/s43168-024-00306-w","DOIUrl":"https://doi.org/10.1186/s43168-024-00306-w","url":null,"abstract":"The results of several studies assessing the effect of the glutathione S-transferase class Mu 1 (GSTM1) null variant on the genetic susceptibility of tobacco-related cancers have been conflicting. In this work, we aim to identify the impact of the deletion of GSTM1 on lung cancer risk among smokers. This study was conducted on 20 patients diagnosed with primary lung cancer and 20 healthy individuals as a control group. They were subject to full medical history taking, complete clinical examination, and GSTM1 genotyping by PCR. Both studied groups were matched for age, sex, and smoking status. No statistically significant difference was exhibited between the frequency of GSTM1 positive and GSTM1 null in the studied population. No risk of lung cancer associated with GSTM1 null genotype was demonstrated between the patients and control group (n = 14/20 cases) (p = 0.110, OR = 2.852, 95% CI 0.777–10.467). Additionally, there was no association between the risk of lung cancer and the presence of the gene either in smokers (p = 1, OR = 1.8 and 95% CI 0.124–26.196) or non-smokers; (p = 0.063, OR = 4.4 and 95% CI 0.889–21.78). No statistically significant risk was found between the frequencies of GSTM1 null and the various histopathological types of lung malignancy. The results of this work demonstrated no association between the occurrence of the GSTM1 null variant, even when stratified for smoking status, and the risk of lung cancer.","PeriodicalId":22426,"journal":{"name":"The Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141739803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-19DOI: 10.1186/s43168-024-00302-0
Tamer Awad Elsayed, Nesrine Saad Farrag, Taha Taha Abdelgawad
Critically ill patients, especially those with respiratory failure associated with multiple comorbidities, are at risk of recurrent ICU admission and consuming a significant portion of medical resources. To study the risk factors and common etiologies of readmission among surviving patients with acute respiratory failure in Mansoura University’s respiratory intensive care unit during the year 2023. This was a retrospective cohort study. This study included all patients with acute respiratory failure who were admitted to Mansoura University’s respiratory intensive care unit (RICU), from January 2023 to December 2023. Deceased patients after initial admission or those with incomplete data were not included in the study. All data related to patient’s demographics, type of respiratory failure, type of respiratory support, associated comorbidities, length of ICU stay, and causes of readmission were collected from the registration system database. Eight-hundred-thirty (830) cases that were admitted to the Mansoura University’s RICU with respiratory failure in the year 2023 were enrolled in the study, and 84 cases (10.1%) of them were readmitted. COPD exacerbation was the most common cause of readmission (35.7%) followed by pneumonia (21.4%) and OSA exacerbation (20.2%). Results showed that the significant independent predictors of readmission were being male [AOR (95% CI): 1.8 (1.01–3.1), p: 0.046], having organ failure (renal/liver) [AOR (95% CI): 29.9 (7.9–113.4), p ≤ 0.001], and length of ICU stay more than 12 days [AOR (95% CI): 4.8 (2.6–8.6), p ≤ 0.001]. Also, the type of respiratory failure and the type of respiratory support received were significantly associated with readmission in the univariate analysis; however, they were insignificant in the multivariate analysis. The rate of readmission was not high (only 10.3%). The most common causes of readmission were COPD exacerbation, followed by pneumonia and OSA exacerbation, respectively. Type of respiratory failure, male gender, the presence of other organ failure, and length of ICU stay are significant independent predictors of readmission in Mansoura University’s RICU during the year 2023. Therefore, higher-risk individuals should receive attention and careful assessment before discharge from the ICU to reduce the rate of readmission. ClinicalTrials.gov identifier: NCT06291636.
{"title":"Readmission rate among survived patients with acute respiratory failure: 1-year study","authors":"Tamer Awad Elsayed, Nesrine Saad Farrag, Taha Taha Abdelgawad","doi":"10.1186/s43168-024-00302-0","DOIUrl":"https://doi.org/10.1186/s43168-024-00302-0","url":null,"abstract":"Critically ill patients, especially those with respiratory failure associated with multiple comorbidities, are at risk of recurrent ICU admission and consuming a significant portion of medical resources. To study the risk factors and common etiologies of readmission among surviving patients with acute respiratory failure in Mansoura University’s respiratory intensive care unit during the year 2023. This was a retrospective cohort study. This study included all patients with acute respiratory failure who were admitted to Mansoura University’s respiratory intensive care unit (RICU), from January 2023 to December 2023. Deceased patients after initial admission or those with incomplete data were not included in the study. All data related to patient’s demographics, type of respiratory failure, type of respiratory support, associated comorbidities, length of ICU stay, and causes of readmission were collected from the registration system database. Eight-hundred-thirty (830) cases that were admitted to the Mansoura University’s RICU with respiratory failure in the year 2023 were enrolled in the study, and 84 cases (10.1%) of them were readmitted. COPD exacerbation was the most common cause of readmission (35.7%) followed by pneumonia (21.4%) and OSA exacerbation (20.2%). Results showed that the significant independent predictors of readmission were being male [AOR (95% CI): 1.8 (1.01–3.1), p: 0.046], having organ failure (renal/liver) [AOR (95% CI): 29.9 (7.9–113.4), p ≤ 0.001], and length of ICU stay more than 12 days [AOR (95% CI): 4.8 (2.6–8.6), p ≤ 0.001]. Also, the type of respiratory failure and the type of respiratory support received were significantly associated with readmission in the univariate analysis; however, they were insignificant in the multivariate analysis. The rate of readmission was not high (only 10.3%). The most common causes of readmission were COPD exacerbation, followed by pneumonia and OSA exacerbation, respectively. Type of respiratory failure, male gender, the presence of other organ failure, and length of ICU stay are significant independent predictors of readmission in Mansoura University’s RICU during the year 2023. Therefore, higher-risk individuals should receive attention and careful assessment before discharge from the ICU to reduce the rate of readmission. ClinicalTrials.gov identifier: NCT06291636.","PeriodicalId":22426,"journal":{"name":"The Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141739804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-19DOI: 10.1186/s43168-024-00304-y
Fatima Al Taher Taha Morsi, Marwan Elgohary, Ahmed A. Abdelmoaty, Maha E. Alsadik, Samah M. Shehata, Mohamed Ahmed EL Maghawry
Since the onset of the COVID-19 pandemic, multiple studies have reported a bidirectional between COVID-19 and dysfunction of the thyroid gland. These studies have identified various forms of thyroid dysfunction that have been found to affect the severity and outcome of COVID-19 infection. However, the data from these studies have been inconsistent and conflicting. Our objective was to assess the prevalence of various types of thyroid dysfunction among moderate to severe cases of COVID-19 pneumonia. In addition, the study aimed to evaluate the outcome of thyroid dysfunction after recovery from COVID-19 infection. In this observational prospective study data on the clinical features of individuals with moderate to severe COVID-19 pneumonia who were admitted to Zagazig University isolation hospitals from April to December 2022 and their laboratory results were gathered and examined. Thyroid function tests, including TSH, FT3, and FT4, were conducted for all patients upon admission. Follow-up testing was performed on patients who initially had aberrant thyroid lab results 90 days after recovering from COVID-19 infection. The study comprised a total of 136 patients who had moderate (44.1%) to severe (55.9%) COVID-19 infection. Sick euthyroid syndrome was the most prevalent form of thyroid dysfunction, accounting for 58.7% of patients with thyroid disorders on admission. After 90 days of post-COVID-19 examination, thyroid dysfunction recovery was observed in 61% of cases. A statistically significant correlation was noted between the severity of COVID-19 and the levels of TSH, free T3, and the ratio of free T3 to T4. A large percentage of patients who showed complete recovery had sick euthyroid syndrome. All patients diagnosed with primary hypothyroidism maintained their hypothyroidism condition, whereas those with hyperthyroidism showed complete recovery. COVID-19 patients may experience several patterns of thyroid dysfunction, including nonthyroidal illness syndrome. These dysfunctions are associated with the intensity of the inflammatory response and the severity of the COVID-19 infection. Nevertheless, these alterations are predominantly reversible upon recovery from a COVID-19 infection.
{"title":"Patterns of thyroid gland dysfunction among hospitalized patients with COVID-19 pneumonia","authors":"Fatima Al Taher Taha Morsi, Marwan Elgohary, Ahmed A. Abdelmoaty, Maha E. Alsadik, Samah M. Shehata, Mohamed Ahmed EL Maghawry","doi":"10.1186/s43168-024-00304-y","DOIUrl":"https://doi.org/10.1186/s43168-024-00304-y","url":null,"abstract":"Since the onset of the COVID-19 pandemic, multiple studies have reported a bidirectional between COVID-19 and dysfunction of the thyroid gland. These studies have identified various forms of thyroid dysfunction that have been found to affect the severity and outcome of COVID-19 infection. However, the data from these studies have been inconsistent and conflicting. Our objective was to assess the prevalence of various types of thyroid dysfunction among moderate to severe cases of COVID-19 pneumonia. In addition, the study aimed to evaluate the outcome of thyroid dysfunction after recovery from COVID-19 infection. In this observational prospective study data on the clinical features of individuals with moderate to severe COVID-19 pneumonia who were admitted to Zagazig University isolation hospitals from April to December 2022 and their laboratory results were gathered and examined. Thyroid function tests, including TSH, FT3, and FT4, were conducted for all patients upon admission. Follow-up testing was performed on patients who initially had aberrant thyroid lab results 90 days after recovering from COVID-19 infection. The study comprised a total of 136 patients who had moderate (44.1%) to severe (55.9%) COVID-19 infection. Sick euthyroid syndrome was the most prevalent form of thyroid dysfunction, accounting for 58.7% of patients with thyroid disorders on admission. After 90 days of post-COVID-19 examination, thyroid dysfunction recovery was observed in 61% of cases. A statistically significant correlation was noted between the severity of COVID-19 and the levels of TSH, free T3, and the ratio of free T3 to T4. A large percentage of patients who showed complete recovery had sick euthyroid syndrome. All patients diagnosed with primary hypothyroidism maintained their hypothyroidism condition, whereas those with hyperthyroidism showed complete recovery. COVID-19 patients may experience several patterns of thyroid dysfunction, including nonthyroidal illness syndrome. These dysfunctions are associated with the intensity of the inflammatory response and the severity of the COVID-19 infection. Nevertheless, these alterations are predominantly reversible upon recovery from a COVID-19 infection.","PeriodicalId":22426,"journal":{"name":"The Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141739797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-12DOI: 10.1186/s43168-024-00303-z
Ahmed Gharib, Mai S. Elsheikh, Iman Galal
The continuous positive airway pressure (CPAP) needed for the treatment of obstructive sleep apnea (OSA) can be determined after a manual titration study which is often expensive and time consuming. Hence, different predictive equations were suggested to simplify the treatment of OSA. The purpose of this work was to compare the CPAP identified with manual titration with that calculated using various equations in a cohort of patients with severe OSA. This work was conducted on patients diagnosed with severe OSA. Data collected included full medical history, demographic and anthropometric measures, polysomnography results, and the CPAP pressure obtained after manual titration which was further compared to 15 predictive equations retrieved from the literature. A total of 166 patients [137 (82.5%) males and 29 (17.5%) females] with severe OSA were recruited in the study. Their mean age was 55.91 ± 12.64, and their baseline diagnostic apnea hypopnea index was 71.75 ± 23.70. The mean CPAP manual titration pressure was 11.31 ± 2.9 cmH2O. Non-significant statistical difference was found (p > 0.05) when the mean titration pressure was calculated by Eqs. 2 (11.36 ± 2), 3 (11.55 ± 1.68), 10 (11.51 ± 2.29), 11 (11.14 ± 2.04), and 14 (11.71 ± 2.06), whereas the mean titration pressure calculated by Eqs. 1, 4, 5, 6, 7, 8, 9, 12, 13, and 15 differed significantly from the manual titration pressure (p < 0.05). Predictive equations suggested to calculate CPAP pressure, albeit simple and easy to apply, yielded variable results and should be investigated carefully before their use into clinical practice.
{"title":"The utility of various predictive equations in patients with severe Obstructive Sleep Apnea: a clinical practice viewpoint in settings with limited resources","authors":"Ahmed Gharib, Mai S. Elsheikh, Iman Galal","doi":"10.1186/s43168-024-00303-z","DOIUrl":"https://doi.org/10.1186/s43168-024-00303-z","url":null,"abstract":"The continuous positive airway pressure (CPAP) needed for the treatment of obstructive sleep apnea (OSA) can be determined after a manual titration study which is often expensive and time consuming. Hence, different predictive equations were suggested to simplify the treatment of OSA. The purpose of this work was to compare the CPAP identified with manual titration with that calculated using various equations in a cohort of patients with severe OSA. This work was conducted on patients diagnosed with severe OSA. Data collected included full medical history, demographic and anthropometric measures, polysomnography results, and the CPAP pressure obtained after manual titration which was further compared to 15 predictive equations retrieved from the literature. A total of 166 patients [137 (82.5%) males and 29 (17.5%) females] with severe OSA were recruited in the study. Their mean age was 55.91 ± 12.64, and their baseline diagnostic apnea hypopnea index was 71.75 ± 23.70. The mean CPAP manual titration pressure was 11.31 ± 2.9 cmH2O. Non-significant statistical difference was found (p > 0.05) when the mean titration pressure was calculated by Eqs. 2 (11.36 ± 2), 3 (11.55 ± 1.68), 10 (11.51 ± 2.29), 11 (11.14 ± 2.04), and 14 (11.71 ± 2.06), whereas the mean titration pressure calculated by Eqs. 1, 4, 5, 6, 7, 8, 9, 12, 13, and 15 differed significantly from the manual titration pressure (p < 0.05). Predictive equations suggested to calculate CPAP pressure, albeit simple and easy to apply, yielded variable results and should be investigated carefully before their use into clinical practice.","PeriodicalId":22426,"journal":{"name":"The Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141608307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-09DOI: 10.1186/s43168-024-00298-7
Ashok P. Arbat, Gauri Gadge, Sweta R. Chourasia, Parimal S. Deshpande, Swapnil I. Bakamwar
Catamenial hemoptysis (CH) is a rare, known disease for which diagnosis is crucial and treatment is indefinite. In this case report, CH was identified 2 years ago while taking medical history of the patient. It has disclosed hemoptysis at night with breathlessness that was concurrent with her menses every month for the past 6 months. A series of radiological tests followed by a bronchoscopic examination during menses confirmed the diagnosis. A complex fluid-filled cystic lesion with few air foci in the right lower lobe superior segment with ground glass opacity was seen by a CT scan test. Subsequent bronchoscopy examination showed an active bleeding site at the right lower lobe superior segment. The bronchial wash tests were negative for microbial infections as well as for malignancies. Bronchial artery embolization (BAE) was done and it ceased the hemoptysis. However, it recurred after 2 years of the BAE procedure. The symptoms and amount of hemoptysis were milder; hence, repeated BAE was not required. Earlier, the patient refused hormonal therapy (HT) owing to its side effects, but this time, she accepted HT. After 2 months of HT, hemoptysis gradually ceased. If complications arise in the future, then surgical treatment along with HT (combination therapy) would be the course of treatment. The diagnosis of CH is challenging, and treatment procedures vary from patient to patient; hence, they are customised. Hormones regulate the CH recurrence even though the symptoms have ceased after treatment. Therefore, regular follow-up and close vigilance are crucial requirements.
{"title":"Recurrent catamenial hemoptysis: diagnostic challenges and management strategies—a case report","authors":"Ashok P. Arbat, Gauri Gadge, Sweta R. Chourasia, Parimal S. Deshpande, Swapnil I. Bakamwar","doi":"10.1186/s43168-024-00298-7","DOIUrl":"https://doi.org/10.1186/s43168-024-00298-7","url":null,"abstract":"Catamenial hemoptysis (CH) is a rare, known disease for which diagnosis is crucial and treatment is indefinite. In this case report, CH was identified 2 years ago while taking medical history of the patient. It has disclosed hemoptysis at night with breathlessness that was concurrent with her menses every month for the past 6 months. A series of radiological tests followed by a bronchoscopic examination during menses confirmed the diagnosis. A complex fluid-filled cystic lesion with few air foci in the right lower lobe superior segment with ground glass opacity was seen by a CT scan test. Subsequent bronchoscopy examination showed an active bleeding site at the right lower lobe superior segment. The bronchial wash tests were negative for microbial infections as well as for malignancies. Bronchial artery embolization (BAE) was done and it ceased the hemoptysis. However, it recurred after 2 years of the BAE procedure. The symptoms and amount of hemoptysis were milder; hence, repeated BAE was not required. Earlier, the patient refused hormonal therapy (HT) owing to its side effects, but this time, she accepted HT. After 2 months of HT, hemoptysis gradually ceased. If complications arise in the future, then surgical treatment along with HT (combination therapy) would be the course of treatment. The diagnosis of CH is challenging, and treatment procedures vary from patient to patient; hence, they are customised. Hormones regulate the CH recurrence even though the symptoms have ceased after treatment. Therefore, regular follow-up and close vigilance are crucial requirements.","PeriodicalId":22426,"journal":{"name":"The Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141573877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Laryngotracheal mucormycosis presents a rare but critical challenge, particularly in immunocompromised individuals. This report details the case of a 31-year-old diabetic male who experienced central airway obstruction due to mucormycosis. Despite the complexity of managing airway involvement, a multidisciplinary approach involving airway debridement surgery, liposomal amphotericin B, and posaconazole resulted in successful airway mucor treatment and resolution. This case underscores the importance of early recognition, aggressive intervention, and collaborative care in managing life-threatening conditions.
喉气管粘液瘤病是一种罕见但严峻的挑战，尤其是在免疫力低下的人群中。本报告详细介绍了一例因粘孢子菌病导致中央气道阻塞的 31 岁男性糖尿病患者的病例。尽管气道受累的处理非常复杂，但通过气道清创手术、脂质体两性霉素 B 和泊沙康唑等多学科方法，成功治疗并解决了气道粘孢子虫问题。该病例强调了早期识别、积极干预和协作护理在治疗危及生命的疾病中的重要性。
{"title":"Surviving laryngotracheal mucormycosis: conquering central airway challenges","authors":"Satyam Agarwal, Pradeep Bajad, Sourabh Pahuja, Arjun Khanna","doi":"10.1186/s43168-024-00301-1","DOIUrl":"https://doi.org/10.1186/s43168-024-00301-1","url":null,"abstract":"Laryngotracheal mucormycosis presents a rare but critical challenge, particularly in immunocompromised individuals. This report details the case of a 31-year-old diabetic male who experienced central airway obstruction due to mucormycosis. Despite the complexity of managing airway involvement, a multidisciplinary approach involving airway debridement surgery, liposomal amphotericin B, and posaconazole resulted in successful airway mucor treatment and resolution. This case underscores the importance of early recognition, aggressive intervention, and collaborative care in managing life-threatening conditions.","PeriodicalId":22426,"journal":{"name":"The Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141573878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Obstructive sleep apnea (OSA) is a prevalent sleep breathing disorder affecting 9–25% of the general adult population. To assess airflow limitation by spirometric indices in patients with obstructive sleep apnea. This observational case–control study was conducted on 60 subjects who were divided into four groups: Group I (control group), included 20 subjects chosen from other departments, who had no respiratory complaints with apnea–hypopnea index (AHI < 5); Group II (mild group), included 11 patients with mild sleep apnea, 5 ≤ AHI < 15; Group III (moderate group), included 17 patients with moderate sleep apnea, 15 ≤ AHI < 30; and Group IV (severe group), included 12 patients with severe sleep apnea, AHI ≥ 30 at the Chest Department, Faculty of Medicine, Helwan University, from August 2021 until June 2022. There was no statistically significant relation found between the severity of AHI and all the previous pulmonary function parameters except a statistically significant decrease in FEF (25–75%) in the moderate group than the mild group and also in the severe group than the moderate group (p-value < 0.001). There was a statistically significant positive correlation found between AHI and BMI and NC and a negative correlation found between AHI and FEF (25–75%) while no statistically significant correlation was found between AHI and the other studied parameters. Obstructive sleep apnea (OSA) is associated with airflow limitation by spirometric indices, although this association is statistically insignificant. On the other hand, the severity of obstructive sleep apnea is directly proportional to the seriousness of the apnea–hypopnea index (AHI). Strong correlations were found between the severity of AHI and body mass index (BMI), neck circumference, and FEF (25–75%).
{"title":"Assessment of airflow limitation in patients with obstructive sleep apnea","authors":"Waleed Mohamed Kamal Eldin El-Sorougi, Mohamed Alaa Abdelhamid Ali, Fatmaalzahraa Saad Abdalrazik","doi":"10.1186/s43168-024-00300-2","DOIUrl":"https://doi.org/10.1186/s43168-024-00300-2","url":null,"abstract":"Obstructive sleep apnea (OSA) is a prevalent sleep breathing disorder affecting 9–25% of the general adult population. To assess airflow limitation by spirometric indices in patients with obstructive sleep apnea. This observational case–control study was conducted on 60 subjects who were divided into four groups: Group I (control group), included 20 subjects chosen from other departments, who had no respiratory complaints with apnea–hypopnea index (AHI < 5); Group II (mild group), included 11 patients with mild sleep apnea, 5 ≤ AHI < 15; Group III (moderate group), included 17 patients with moderate sleep apnea, 15 ≤ AHI < 30; and Group IV (severe group), included 12 patients with severe sleep apnea, AHI ≥ 30 at the Chest Department, Faculty of Medicine, Helwan University, from August 2021 until June 2022. There was no statistically significant relation found between the severity of AHI and all the previous pulmonary function parameters except a statistically significant decrease in FEF (25–75%) in the moderate group than the mild group and also in the severe group than the moderate group (p-value < 0.001). There was a statistically significant positive correlation found between AHI and BMI and NC and a negative correlation found between AHI and FEF (25–75%) while no statistically significant correlation was found between AHI and the other studied parameters. Obstructive sleep apnea (OSA) is associated with airflow limitation by spirometric indices, although this association is statistically insignificant. On the other hand, the severity of obstructive sleep apnea is directly proportional to the seriousness of the apnea–hypopnea index (AHI). Strong correlations were found between the severity of AHI and body mass index (BMI), neck circumference, and FEF (25–75%).","PeriodicalId":22426,"journal":{"name":"The Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141573879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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