Pub Date : 2023-11-08DOI: 10.1186/s43168-023-00239-w
Ahmed Sameh Sayed, Mona Mansour Ahmed, Khaled Mohamed Wagih, Haytham Samy Diab, Ahmed Mohamed Hussein
Abstract Background Patients with pneumonia exhibit similar clinical presentations despite having different causative organisms; thus, a rapid and easy test is needed to differentiate between the diseases. Here, we use lung ultrasound to discriminate between causative organisms in correlation with other diagnostic modalities. Methods This descriptive cross-sectional study was carried out on 67 patients diagnosed with atypical pneumonia admitted at Ain-Shams University hospitals in the period from July 2019 to June 2021. Study population was divided into three groups according to the causative agent based on the results of PCR: Group 1 included 23 patients (influenza A), group 2 included 30 patients (COVID-19), and group 3 included 14 patients (atypical organisms). Included patients underwent lung ultrasound scan via a 12-zone scanning protocol and CT scan with 24 h in between. The present study was approved by the ethical committee at our institution. Results The mean age ranged from 39.93 ± 19.26 SD to 60.3 ± 13.02 SD years; 64.17% of them were males. There was also a highly statistically significant difference between the three groups as regard B-lines and thickened pleural line being higher among group 2; 100% of cases had B-lines in their chest ultrasound assessment, while thickened pleural line was found in 53.3% of cases. Dynamic air bronchogram was found with higher percentage in group 3 (71.4%) with a highly significant association. Higher mean Soldati score was associated with more severe disease among cases with viral pneumonia. Conclusions Lung ultrasound may be used as an aiding tool to estimate the etiology of atypical pneumonia. It can be useful during pandemics of acute respiratory diseases for rapid triage and stratification of patients as through calculation of modified Soldati score and detection of the most common finding. Also, modified Soldati score correlates with disease severity.
{"title":"Assessment of atypical pneumonia by chest ultrasonography","authors":"Ahmed Sameh Sayed, Mona Mansour Ahmed, Khaled Mohamed Wagih, Haytham Samy Diab, Ahmed Mohamed Hussein","doi":"10.1186/s43168-023-00239-w","DOIUrl":"https://doi.org/10.1186/s43168-023-00239-w","url":null,"abstract":"Abstract Background Patients with pneumonia exhibit similar clinical presentations despite having different causative organisms; thus, a rapid and easy test is needed to differentiate between the diseases. Here, we use lung ultrasound to discriminate between causative organisms in correlation with other diagnostic modalities. Methods This descriptive cross-sectional study was carried out on 67 patients diagnosed with atypical pneumonia admitted at Ain-Shams University hospitals in the period from July 2019 to June 2021. Study population was divided into three groups according to the causative agent based on the results of PCR: Group 1 included 23 patients (influenza A), group 2 included 30 patients (COVID-19), and group 3 included 14 patients (atypical organisms). Included patients underwent lung ultrasound scan via a 12-zone scanning protocol and CT scan with 24 h in between. The present study was approved by the ethical committee at our institution. Results The mean age ranged from 39.93 ± 19.26 SD to 60.3 ± 13.02 SD years; 64.17% of them were males. There was also a highly statistically significant difference between the three groups as regard B-lines and thickened pleural line being higher among group 2; 100% of cases had B-lines in their chest ultrasound assessment, while thickened pleural line was found in 53.3% of cases. Dynamic air bronchogram was found with higher percentage in group 3 (71.4%) with a highly significant association. Higher mean Soldati score was associated with more severe disease among cases with viral pneumonia. Conclusions Lung ultrasound may be used as an aiding tool to estimate the etiology of atypical pneumonia. It can be useful during pandemics of acute respiratory diseases for rapid triage and stratification of patients as through calculation of modified Soldati score and detection of the most common finding. Also, modified Soldati score correlates with disease severity.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135342363","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 : 2023-11-08DOI: 10.1186/s43168-023-00243-0
Mohammed A. Ibrahim, Magdy Emara, Mohammed Shehta
Abstract Context High flow nasal canula is usually used for management of acute hypoxemic failure; however, it may have a potential therapeutic benefits in hypercapnia as it can alter tidal volume, end expiratory volume, positive end expiratory pressure, and respiratory rate. Aim Evaluate safety and efficacy of application HFNC (high flow nasal canula) for patients with mild hypercapnia. Settings and design A prospective interventional study. Patients and methods Over six months, thirty eight patients were enrolled, with mild hypercapnia and PH level not less 7.30 and PaCo2 not more 60 mmhg; with applying HFNC, serial checking of arterial blood gases was done. Checkpoints were at 2 h, 12 h, 24 h, and 48 h post application of HFNC. HFNC can be shifted to NIV or invasive MV at any time whenever indicated. Results Primary pulmonary disorder was chronic obstructive pulmonary disorder in (22 patients) and (16 patients) had interstitial lung disease. For PH in overall, mean values had changed from 7.33 until reached 7.37 at 48 h post HFNC with calculation of P value at each checkpoint from baseline value; significant changes were recorded at 24 h and 48 h post HFNC application. A similar observation was observed for PaCO2. No significant changes were observed at any checkpoint for HCO3. Conclusion High flow nasal canula is safe in cases with mild hypercapnia with a considerable success rate and a proven high efficacy. Trial registration Clinicaltrials.gov/NCT05948527, Registered 14 July 2023—Retrospectively registered, https://www.clinicaltrials.gov/NCT05948527 .
{"title":"Safety and efficacy of high flow nasal canula in patients with mild hypercapnia","authors":"Mohammed A. Ibrahim, Magdy Emara, Mohammed Shehta","doi":"10.1186/s43168-023-00243-0","DOIUrl":"https://doi.org/10.1186/s43168-023-00243-0","url":null,"abstract":"Abstract Context High flow nasal canula is usually used for management of acute hypoxemic failure; however, it may have a potential therapeutic benefits in hypercapnia as it can alter tidal volume, end expiratory volume, positive end expiratory pressure, and respiratory rate. Aim Evaluate safety and efficacy of application HFNC (high flow nasal canula) for patients with mild hypercapnia. Settings and design A prospective interventional study. Patients and methods Over six months, thirty eight patients were enrolled, with mild hypercapnia and PH level not less 7.30 and PaCo2 not more 60 mmhg; with applying HFNC, serial checking of arterial blood gases was done. Checkpoints were at 2 h, 12 h, 24 h, and 48 h post application of HFNC. HFNC can be shifted to NIV or invasive MV at any time whenever indicated. Results Primary pulmonary disorder was chronic obstructive pulmonary disorder in (22 patients) and (16 patients) had interstitial lung disease. For PH in overall, mean values had changed from 7.33 until reached 7.37 at 48 h post HFNC with calculation of P value at each checkpoint from baseline value; significant changes were recorded at 24 h and 48 h post HFNC application. A similar observation was observed for PaCO2. No significant changes were observed at any checkpoint for HCO3. Conclusion High flow nasal canula is safe in cases with mild hypercapnia with a considerable success rate and a proven high efficacy. Trial registration Clinicaltrials.gov/NCT05948527, Registered 14 July 2023—Retrospectively registered, https://www.clinicaltrials.gov/NCT05948527 .","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135345880","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 : 2023-11-07DOI: 10.1186/s43168-023-00240-3
Sally Magdy, Reem Elkorashy, Eman Hany Elsebaie, Hebatallah Hany Assal, Hoda M. Abdel-Hamid
Abstract Background Identifying patients with comorbid pulmonary disease may guide prognosis and aid in developing strategies regarding who would benefit the most from vaccines. This study was designed to clarify the influence of comorbid lung disease on COVID-19 severity and outcome. Methods This is a retrospective cohort analysis of 587 COVID-19 patients. The clinical, laboratory, and imaging data and comorbidities as reported by the patients were obtained from the Kasr Alainy Hospital medical records. Also, data regarding whether the patient is hospitalized or not, the length of hospital stay, complications, and mortality are gathered from the records. Results The patients’ mean ages are 51 ± 15 years (63.9% are males with the remaining 36.1% which are females). Patients with chronic comorbid pulmonary diseases represented 113 patients among the whole study population. with the COPD being 11.4%. Patients with comorbid lung diseases associated or not with other comorbidities were at higher risk of acquiring severe COVID-19 and had higher complication and mortality rates compared to patients without comorbidities ( p-value < 0.001 ). Patients with preexisting diabetes, hypertension, COPD, and chronic kidney disease have a significantly higher risk of severe infection ( p-value < 0.001 , 0.001 , 0.001 , < 0.001 ), complications ( p-value 0.038 , 0.005 , < 0.001 , < 0.001 ), and mortality ( p-value 0.021 , 0.001 , < 0.001 , < 0.001 ), respectively. Conclusion This study provides a better understanding of COVID-19 patients with comorbid lung disease and highlights the importance of the data deduced from our study and similar studies in aiding the designation of vaccination programs for those patients if needed.
{"title":"Impact of comorbid pulmonary disease on COVID-19 disease severity and outcome: a retrospective cohort study","authors":"Sally Magdy, Reem Elkorashy, Eman Hany Elsebaie, Hebatallah Hany Assal, Hoda M. Abdel-Hamid","doi":"10.1186/s43168-023-00240-3","DOIUrl":"https://doi.org/10.1186/s43168-023-00240-3","url":null,"abstract":"Abstract Background Identifying patients with comorbid pulmonary disease may guide prognosis and aid in developing strategies regarding who would benefit the most from vaccines. This study was designed to clarify the influence of comorbid lung disease on COVID-19 severity and outcome. Methods This is a retrospective cohort analysis of 587 COVID-19 patients. The clinical, laboratory, and imaging data and comorbidities as reported by the patients were obtained from the Kasr Alainy Hospital medical records. Also, data regarding whether the patient is hospitalized or not, the length of hospital stay, complications, and mortality are gathered from the records. Results The patients’ mean ages are 51 ± 15 years (63.9% are males with the remaining 36.1% which are females). Patients with chronic comorbid pulmonary diseases represented 113 patients among the whole study population. with the COPD being 11.4%. Patients with comorbid lung diseases associated or not with other comorbidities were at higher risk of acquiring severe COVID-19 and had higher complication and mortality rates compared to patients without comorbidities ( p-value < 0.001 ). Patients with preexisting diabetes, hypertension, COPD, and chronic kidney disease have a significantly higher risk of severe infection ( p-value < 0.001 , 0.001 , 0.001 , < 0.001 ), complications ( p-value 0.038 , 0.005 , < 0.001 , < 0.001 ), and mortality ( p-value 0.021 , 0.001 , < 0.001 , < 0.001 ), respectively. Conclusion This study provides a better understanding of COVID-19 patients with comorbid lung disease and highlights the importance of the data deduced from our study and similar studies in aiding the designation of vaccination programs for those patients if needed.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135475656","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 : 2023-11-07DOI: 10.1186/s43168-023-00242-1
Masoud Mahdavi Rashed, Mojtaba Haji Hosseini, Behnam Beizae, Seyed Ali Alamdaran, Anahita Alizadeh, Seyed Javad Seyedi, Ehsan Hassannejad, Nahid Tavakolizadeh
Abstract Background Oil aspiration pneumonia is an uncommon form of lung disease due to aspiration or inhalation of oil-containing products. The present study reports the changes process of radiological findings over time in four children. Case presentation For 2 years, four cases (17 months until 3.5 years) with aspiration oil-containing (petroleum or benzene) products were referred to a tertiary center, Akbar Children’s Hospital, Mashhad Medical University of Science. They presented with respiratory distress and fever. The radiography, low-dose CT scan, and ultrasound findings were evaluated. Assessment of serial imaging findings in our patients shows decreased volume, ground glass opacity, and septal thickening in the lower lobes of the lungs are a predominant pattern in the first and second days. Consolidation and nodular opacity appear after 48 h. In the second week, the nodular pattern (fluid-filled pneumatoceles) is the main pattern and persists for 1 month. CT scan images showed that opaque nodules are actually fluid-filled pneumatoceles. Finally, air-filled pneumatoceles gradually appeared from the third week and disappeared in 6–8 months. Conclusion Our results show that four radiological phases of oil pneumonia, including ground glass opacities, segmental consolidation, fluid-filled pneumatoceles (nodule), and finally air-filled pneumatoceles, could be seen in radiography, CT scan, and ultrasound.
{"title":"Imaging changes of oil aspiration over time in children: a case series","authors":"Masoud Mahdavi Rashed, Mojtaba Haji Hosseini, Behnam Beizae, Seyed Ali Alamdaran, Anahita Alizadeh, Seyed Javad Seyedi, Ehsan Hassannejad, Nahid Tavakolizadeh","doi":"10.1186/s43168-023-00242-1","DOIUrl":"https://doi.org/10.1186/s43168-023-00242-1","url":null,"abstract":"Abstract Background Oil aspiration pneumonia is an uncommon form of lung disease due to aspiration or inhalation of oil-containing products. The present study reports the changes process of radiological findings over time in four children. Case presentation For 2 years, four cases (17 months until 3.5 years) with aspiration oil-containing (petroleum or benzene) products were referred to a tertiary center, Akbar Children’s Hospital, Mashhad Medical University of Science. They presented with respiratory distress and fever. The radiography, low-dose CT scan, and ultrasound findings were evaluated. Assessment of serial imaging findings in our patients shows decreased volume, ground glass opacity, and septal thickening in the lower lobes of the lungs are a predominant pattern in the first and second days. Consolidation and nodular opacity appear after 48 h. In the second week, the nodular pattern (fluid-filled pneumatoceles) is the main pattern and persists for 1 month. CT scan images showed that opaque nodules are actually fluid-filled pneumatoceles. Finally, air-filled pneumatoceles gradually appeared from the third week and disappeared in 6–8 months. Conclusion Our results show that four radiological phases of oil pneumonia, including ground glass opacities, segmental consolidation, fluid-filled pneumatoceles (nodule), and finally air-filled pneumatoceles, could be seen in radiography, CT scan, and ultrasound.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135479593","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 : 2023-11-06DOI: 10.1186/s43168-023-00233-2
Rania Ahmed Sweed, Yehia Mohamed Khalil, Hany Amin Sharawy, Eman Sheta Ali Gawdat Alsawy, Mina Botros
Abstract Introduction Ultrasound (US) has become an integral tool for chest assessment as it provides crucial information on pleural pathologies and peripherally located lung lesions. Aim To assess the diagnostic yield of combined fine needle aspiration (FNAB) and core needle biopsy (CNB) versus each technique ultrasound-guided in peripheral lung and pleural lesions. Methodology The present study enrolled 30 patients presenting to Alexandria Main University Hospital, with CT scans showing undiagnosed peripheral lung or parietal pleural lesions with or without effusion. A full ultrasound chest assessment was done covering 12 regions. Assessment of the lesion of interest, vascularity was assessed via color Doppler, locating the safest entry site. Real-time US-guided FNAB was done using a spinal needle 22 gauge. Then real-time US-guided CNB using 18 gauge Trucut needle in the same setting. Duration and complications of each procedure were reported. In FNAB, three smears were prepared, fixed in alcohol, and stained with hematoxylin and eosin stain. The remaining sample was fixed in formalin and centrifuged to prepare cell blocks. On the other hand, Trucut needle biopsy specimens were fixed in formalin and processed as paraffin-embedded blocks. Immunohistochemical staining was done. The results were classified into four categories (inadequate, negative, suspicious, and positive for malignancy. Results The diagnostic yield of combined techniques was 96.7% versus 63.3% using FNAB and 96.7% using CNB. The sensitivity of FNAB was 86% while CNB was 95%. The specificity and positive predictive value of both methods were 100%. The negative predictive value of FNAB was 57% versus 80% for CNB in peripheral lung lesions. Duration of US-guided CNB was statistically significantly longer than that of FNAB in both peripheral lung and pleural lesions. No major complications were reported using either technique. Conclusion Combined FNAB and CNB were not superior to CNB alone regarding diagnostic yield but were superior to FNAB. Ultrasound-guided CNB has a superior diagnostic yield over FNAB, with no statistically significant difference regarding associated complications, both techniques are safe. FNAB provided sufficient material for ancillary molecular testing.
{"title":"Diagnostic yield of combined ultrasound-guided fine needle aspiration and core needle biopsy versus either technique alone in peripheral lung and pleural lesions","authors":"Rania Ahmed Sweed, Yehia Mohamed Khalil, Hany Amin Sharawy, Eman Sheta Ali Gawdat Alsawy, Mina Botros","doi":"10.1186/s43168-023-00233-2","DOIUrl":"https://doi.org/10.1186/s43168-023-00233-2","url":null,"abstract":"Abstract Introduction Ultrasound (US) has become an integral tool for chest assessment as it provides crucial information on pleural pathologies and peripherally located lung lesions. Aim To assess the diagnostic yield of combined fine needle aspiration (FNAB) and core needle biopsy (CNB) versus each technique ultrasound-guided in peripheral lung and pleural lesions. Methodology The present study enrolled 30 patients presenting to Alexandria Main University Hospital, with CT scans showing undiagnosed peripheral lung or parietal pleural lesions with or without effusion. A full ultrasound chest assessment was done covering 12 regions. Assessment of the lesion of interest, vascularity was assessed via color Doppler, locating the safest entry site. Real-time US-guided FNAB was done using a spinal needle 22 gauge. Then real-time US-guided CNB using 18 gauge Trucut needle in the same setting. Duration and complications of each procedure were reported. In FNAB, three smears were prepared, fixed in alcohol, and stained with hematoxylin and eosin stain. The remaining sample was fixed in formalin and centrifuged to prepare cell blocks. On the other hand, Trucut needle biopsy specimens were fixed in formalin and processed as paraffin-embedded blocks. Immunohistochemical staining was done. The results were classified into four categories (inadequate, negative, suspicious, and positive for malignancy. Results The diagnostic yield of combined techniques was 96.7% versus 63.3% using FNAB and 96.7% using CNB. The sensitivity of FNAB was 86% while CNB was 95%. The specificity and positive predictive value of both methods were 100%. The negative predictive value of FNAB was 57% versus 80% for CNB in peripheral lung lesions. Duration of US-guided CNB was statistically significantly longer than that of FNAB in both peripheral lung and pleural lesions. No major complications were reported using either technique. Conclusion Combined FNAB and CNB were not superior to CNB alone regarding diagnostic yield but were superior to FNAB. Ultrasound-guided CNB has a superior diagnostic yield over FNAB, with no statistically significant difference regarding associated complications, both techniques are safe. FNAB provided sufficient material for ancillary molecular testing.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135635161","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 : 2023-11-06DOI: 10.1186/s43168-023-00238-x
Rami Naaman, Christopher M. Kapp, Odile David, Kevin Kovitz, Benjamin Aronson, Kevin Haas
Abstract Background Lung cancer remains the most common cause of cancer-related deaths in the USA. Successful implementation of lung cancer screening programs has led to increased detection of peripheral pulmonary lesions (PPL). Robotic-assisted bronchoscopy (RB) is a relatively novel tool used to safely diagnose PPN. Additionally, with the developing precision of personalized medicine and targeted therapy, obtaining adequate tissue for next-generation sequencing (NGS) has become critical to optimizing the medical management of lung cancer. Our aim is to assess the diagnostic yield of RB, identify patient and procedure characteristics associated with performing a diagnostic biopsy, and evaluate the adequacy of tumor cellularity for biomarker identification. Results We performed a retrospective observational study consecutively enrolling 54 adult patients who underwent RB between January 2022 and March 2023. Records were reviewed for medical comorbidities and smoking status. PPL characteristics included size, location, presence of a bronchus sign on mapping computed tomography (CT) scans, distance from airway and pleura on CT, and days between obtaining CT and the bronchoscopy. Procedural factors included the radial endobronchial ultrasound (r-EBUS) view obtained and the sampling method(s) with which a diagnosis was achieved. Records were reviewed for final pathology and the need for further procedures to establish a diagnosis. Samples that yielded non-small cell lung cancer (NSCLC) were sent for an NGS panel if deemed adequate. The panels were reviewed to identify potentially actionable mutations. Multivariable logistic regression was performed to assess patients and lesions characteristics associated with a diagnostic biopsy. We sampled 56 lesions, 45 (80.4%) were from current or former smokers. The overall diagnostic yield was 73.2% and 68.9% for nodules less than 3 cm. Lesions size ranged from 8 mm nodules to 70 mm masses, with an average size 20.3 mm. Mean nodule size from diagnostic procedures was 21.5 mm and 16.9 mm from non-diagnostic ones ( p = 0.04). Logistic regression analysis showed that the presence of a bronchus sign was associated with a diagnostic procedure (OR 19.4, p = 0.023), while lack of a r-EBUS view predicted a non-diagnostic bronchoscopy (OR 0.02, p = 0.013). 28 diagnostic biopsies (68.3%) yielded NSCLC and of the 25 cases that we followed, 22 samples (88%) were adequate for NGS. Conclusions The presence of a bronchus sign on CT and obtaining r-EBUS view during RB were associated with a higher diagnostic yield. RB successfully sampled PPL with adequate tumor cellularity for NGS.
在美国，肺癌仍然是癌症相关死亡的最常见原因。肺癌筛查计划的成功实施导致周围性肺病变(PPL)的检测增加。机器人辅助支气管镜检查(RB)是一种相对较新的工具，用于安全诊断PPN。此外，随着个性化医疗和靶向治疗精度的提高，获得足够的组织进行下一代测序(NGS)已成为优化肺癌医疗管理的关键。我们的目的是评估RB的诊断率，确定与诊断性活检相关的患者和手术特征，并评估肿瘤细胞的充分性以进行生物标志物鉴定。我们进行了一项回顾性观察性研究，连续招募了54名在2022年1月至2023年3月期间接受RB治疗的成年患者。回顾了医疗合并症和吸烟状况的记录。PPL的特征包括大小、位置、CT上是否有支气管征象、CT上与气道和胸膜的距离、CT检查与支气管镜检查之间的间隔天数。程序因素包括获得的径向支气管内超声(r-EBUS)视图和获得诊断的采样方法。回顾了最终病理记录和进一步诊断的需要。产生非小细胞肺癌(NSCLC)的样本如果认为足够，则送至NGS小组。对这些小组进行了审查，以确定潜在的可操作突变。进行多变量逻辑回归来评估与诊断活检相关的患者和病变特征。我们取样了56个病变，其中45个(80.4%)来自当前或以前的吸烟者。小于3cm的结节的总诊断率分别为73.2%和68.9%。病灶大小从8mm结节到70mm肿块不等，平均20.3 mm。诊断方法的平均结节大小为21.5 mm，非诊断方法的平均结节大小为16.9 mm (p = 0.04)。Logistic回归分析显示，支气管体征的存在与诊断程序相关(OR 19.4, p = 0.023)，而缺乏r-EBUS视图预测非诊断性支气管镜检查(OR 0.02, p = 0.013)。28例活检诊断为NSCLC(68.3%)，在我们随访的25例病例中，22例样本(88%)足以进行NGS检查。结论CT上支气管征象的出现和RB时的r-EBUS检查具有较高的诊断率。RB成功地取样了具有足够肿瘤细胞的PPL用于NGS。
{"title":"Assessing the early returns of robotic-assisted bronchoscopy in a patient population at high risk for cancer: factors associated with a diagnostic procedure and pathologic outcomes","authors":"Rami Naaman, Christopher M. Kapp, Odile David, Kevin Kovitz, Benjamin Aronson, Kevin Haas","doi":"10.1186/s43168-023-00238-x","DOIUrl":"https://doi.org/10.1186/s43168-023-00238-x","url":null,"abstract":"Abstract Background Lung cancer remains the most common cause of cancer-related deaths in the USA. Successful implementation of lung cancer screening programs has led to increased detection of peripheral pulmonary lesions (PPL). Robotic-assisted bronchoscopy (RB) is a relatively novel tool used to safely diagnose PPN. Additionally, with the developing precision of personalized medicine and targeted therapy, obtaining adequate tissue for next-generation sequencing (NGS) has become critical to optimizing the medical management of lung cancer. Our aim is to assess the diagnostic yield of RB, identify patient and procedure characteristics associated with performing a diagnostic biopsy, and evaluate the adequacy of tumor cellularity for biomarker identification. Results We performed a retrospective observational study consecutively enrolling 54 adult patients who underwent RB between January 2022 and March 2023. Records were reviewed for medical comorbidities and smoking status. PPL characteristics included size, location, presence of a bronchus sign on mapping computed tomography (CT) scans, distance from airway and pleura on CT, and days between obtaining CT and the bronchoscopy. Procedural factors included the radial endobronchial ultrasound (r-EBUS) view obtained and the sampling method(s) with which a diagnosis was achieved. Records were reviewed for final pathology and the need for further procedures to establish a diagnosis. Samples that yielded non-small cell lung cancer (NSCLC) were sent for an NGS panel if deemed adequate. The panels were reviewed to identify potentially actionable mutations. Multivariable logistic regression was performed to assess patients and lesions characteristics associated with a diagnostic biopsy. We sampled 56 lesions, 45 (80.4%) were from current or former smokers. The overall diagnostic yield was 73.2% and 68.9% for nodules less than 3 cm. Lesions size ranged from 8 mm nodules to 70 mm masses, with an average size 20.3 mm. Mean nodule size from diagnostic procedures was 21.5 mm and 16.9 mm from non-diagnostic ones ( p = 0.04). Logistic regression analysis showed that the presence of a bronchus sign was associated with a diagnostic procedure (OR 19.4, p = 0.023), while lack of a r-EBUS view predicted a non-diagnostic bronchoscopy (OR 0.02, p = 0.013). 28 diagnostic biopsies (68.3%) yielded NSCLC and of the 25 cases that we followed, 22 samples (88%) were adequate for NGS. Conclusions The presence of a bronchus sign on CT and obtaining r-EBUS view during RB were associated with a higher diagnostic yield. RB successfully sampled PPL with adequate tumor cellularity for NGS.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135635321","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 : 2023-11-03DOI: 10.1186/s43168-023-00237-y
Hemant Kumar, Mohammad Arif, Sachin Kumar, Ved Prakash, Ajay Kumar Verma, Chanchal Rana, Saumya Shukla, R. A. S. Kushwaha
Abstract Background Medical thoracoscopy is an essential tool in the evaluation of patients with pleural effusion who remain undiagnosed despite a thorough pleural fluid workup. Malignancy and tuberculosis are the two most common etiologies in such patients having completely different prognoses. Therefore, correct diagnosis is very important before starting treatment. This study was planned to study the yield of rigid thoracoscopy in such patients and to observe its associated complications. Furthermore, the difference in the profile of patients with malignancy and tuberculosis was also evaluated. Methods This was a single-center, exploratory, observational study done between 1st May 2021 to 31st December 2022. Patients with undiagnosed exudative pleural effusion defined as exudative pleural effusions as per Light’s criteria with negative Gene X pert and twice negative pleural fluid cytology for malignancy, underwent rigid thoracoscopy for confirmation of their diagnosis. Results A total of 160 patients, who fulfilled our inclusion criteria, were included in our study. Male to female ratio was 1.25:1, with a mean age of 57.3 years. The most common etiology observed was malignancy, seen in 120 out of 160 patients (75%), followed by tuberculosis, which was seen in 27 (17%) patients. A final diagnosis could be made in 158 patients, giving a diagnostic yield of 98.8%. 11.8% showed procedure-related complications without any mortality. Conclusion Rigid medical thoracoscopy has a very high diagnostic yield with few complications. A significant proportion of patients with straw-colored effusion can present with malignancy and vice versa. A few with ADA above 40 were diagnosed as having malignancy. Therefore, tissue-based biopsy with thoracoscopy can be easily performed to make a correct diagnosis with huge future implications in such patients.
{"title":"The yield of rigid thoracoscopy in patients of undiagnosed exudative pleural effusion and comparison of pleural fluid and thoracoscopic findings between tuberculosis and malignancy","authors":"Hemant Kumar, Mohammad Arif, Sachin Kumar, Ved Prakash, Ajay Kumar Verma, Chanchal Rana, Saumya Shukla, R. A. S. Kushwaha","doi":"10.1186/s43168-023-00237-y","DOIUrl":"https://doi.org/10.1186/s43168-023-00237-y","url":null,"abstract":"Abstract Background Medical thoracoscopy is an essential tool in the evaluation of patients with pleural effusion who remain undiagnosed despite a thorough pleural fluid workup. Malignancy and tuberculosis are the two most common etiologies in such patients having completely different prognoses. Therefore, correct diagnosis is very important before starting treatment. This study was planned to study the yield of rigid thoracoscopy in such patients and to observe its associated complications. Furthermore, the difference in the profile of patients with malignancy and tuberculosis was also evaluated. Methods This was a single-center, exploratory, observational study done between 1st May 2021 to 31st December 2022. Patients with undiagnosed exudative pleural effusion defined as exudative pleural effusions as per Light’s criteria with negative Gene X pert and twice negative pleural fluid cytology for malignancy, underwent rigid thoracoscopy for confirmation of their diagnosis. Results A total of 160 patients, who fulfilled our inclusion criteria, were included in our study. Male to female ratio was 1.25:1, with a mean age of 57.3 years. The most common etiology observed was malignancy, seen in 120 out of 160 patients (75%), followed by tuberculosis, which was seen in 27 (17%) patients. A final diagnosis could be made in 158 patients, giving a diagnostic yield of 98.8%. 11.8% showed procedure-related complications without any mortality. Conclusion Rigid medical thoracoscopy has a very high diagnostic yield with few complications. A significant proportion of patients with straw-colored effusion can present with malignancy and vice versa. A few with ADA above 40 were diagnosed as having malignancy. Therefore, tissue-based biopsy with thoracoscopy can be easily performed to make a correct diagnosis with huge future implications in such patients.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135820323","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 : 2023-10-23DOI: 10.1186/s43168-023-00232-3
Islam Galal, Zeinab Rabie, Shazly Ahmed, Ahmed Hamdy Mhsb, Samah Kotb
Abstract Background COPD is a heterogeneous lung disorder with multiple phenotypes and endotypes. This study aimed to identify the diverse clinical, physiological, and radiological phenotypes of COPD. Moreover, to provide whether there was a possible relation between FEV1%, FVC%, and FEV1/FVC ratio, [both before and after broncho-dilation with the diameters of the airway at three diverse levels throughout both inspiratory and expiratory phases of respiration]. Results This study included 50 cases, that were classified according to the radiological phenotypes into 5 groups [29 cases (58%) were mild [centrilobular emphysema) CLE)], 8 cases (16%) were moderate CLE, 5 cases (10%) were [confluent emphysema (CON)], 5 cases (10%) were [advanced destructive emphysema (ADE)] and 3 cases (6%) were [para septal emphysema (PSE)]. There was no considerable variance in the frequency of COPD clinical phenotypes among the diverse radiological phenotypes. There was a moderate positive correlation between the predicted FEV1% and the corresponding inter-luminal diameter at the selected levels (RB1, and LB3) in the inspiratory phase of respiration ( P < 0.001 and p = 0.001 respectively) ( r = 0.58, 0.46 respectively). and there was a moderate positive correlation in the expiratory phase of respiration between the predicted FEV1% and the equivalent inter-luminal diameter at the selected levels (RB1, and LB3) ( P < 0.001 respectively) ( r = 0.62, 0.51 respectively). Conclusions We confirmed that COPD is a highly heterogeneous illness, with multiple diverse clinical, physiological, and radiological phenotypes. Furthermore, HRCT can well be allied with pulmonary function tests (PFT).
{"title":"Clinical, physiological, and radiological different phenotypes of COPD patients","authors":"Islam Galal, Zeinab Rabie, Shazly Ahmed, Ahmed Hamdy Mhsb, Samah Kotb","doi":"10.1186/s43168-023-00232-3","DOIUrl":"https://doi.org/10.1186/s43168-023-00232-3","url":null,"abstract":"Abstract Background COPD is a heterogeneous lung disorder with multiple phenotypes and endotypes. This study aimed to identify the diverse clinical, physiological, and radiological phenotypes of COPD. Moreover, to provide whether there was a possible relation between FEV1%, FVC%, and FEV1/FVC ratio, [both before and after broncho-dilation with the diameters of the airway at three diverse levels throughout both inspiratory and expiratory phases of respiration]. Results This study included 50 cases, that were classified according to the radiological phenotypes into 5 groups [29 cases (58%) were mild [centrilobular emphysema) CLE)], 8 cases (16%) were moderate CLE, 5 cases (10%) were [confluent emphysema (CON)], 5 cases (10%) were [advanced destructive emphysema (ADE)] and 3 cases (6%) were [para septal emphysema (PSE)]. There was no considerable variance in the frequency of COPD clinical phenotypes among the diverse radiological phenotypes. There was a moderate positive correlation between the predicted FEV1% and the corresponding inter-luminal diameter at the selected levels (RB1, and LB3) in the inspiratory phase of respiration ( P < 0.001 and p = 0.001 respectively) ( r = 0.58, 0.46 respectively). and there was a moderate positive correlation in the expiratory phase of respiration between the predicted FEV1% and the equivalent inter-luminal diameter at the selected levels (RB1, and LB3) ( P < 0.001 respectively) ( r = 0.62, 0.51 respectively). Conclusions We confirmed that COPD is a highly heterogeneous illness, with multiple diverse clinical, physiological, and radiological phenotypes. Furthermore, HRCT can well be allied with pulmonary function tests (PFT).","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135367010","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 : 2023-10-18DOI: 10.1186/s43168-023-00234-1
Yosri Akl, Ahmed Elkomy, Eman Kamal Ibrahim
Abstract Background Acute phase reactants (APR) are markers of inflammation that could be applied for the assessment of community-acquired pneumonia (CAP) severity in association with various pneumonia severity scores. So, the aim of the study was to assess levels of APR such as total leucocytic count (TLC), platelets, neutrophils, neutrophils-to-lymphocyte ratio (NLR), CRP, D-dimer, ferritin, and ESR in patients with CAP and to correlate between their values and disease severity. Methodology The study included 51 patients diagnosed as non-COVID-19 (CAP). Patients were classified into two groups group A (pneumonia only) and group B (pneumonia complicated with empyema/complicated para-pneumonic effusion). All patients underwent clinical evaluation, CURB65, radiological assessment, and blood sampling to measure APR. Results The mean age of patients was 47 ± 17 years. The main symptoms were productive cough (90.2%) and Fever (92.2%).TLC, platelets, neutrophils, CRP, D-dimer, ferritin, and ESR were elevated than normal values. Significant positive correlations were found between the duration of fever and CRP, D-dimer, and ferritin with p values = 0.024, 0.012, and 0.034 respectively. Significant positive correlations were found between CURB65 and both CRP and ferritin with p values = 0.007 and 0.020. A significant increase in platelet count and ESR values was found in group B than in group A. Conclusion APR are important markers that can be used in the assessment of CAP in collaboration with clinical evaluation and severity scores. CRP, D-dimer, and ferritin were positively correlated with CURB65, while ESR and platelets could be considered predictors of the development of complications. Trial registration Retrospectively registered, registration number NCT05926089 , date of registration is 06/29/2023.
{"title":"Acute phase reactants in non-COVID-19 community-acquired pneumonia","authors":"Yosri Akl, Ahmed Elkomy, Eman Kamal Ibrahim","doi":"10.1186/s43168-023-00234-1","DOIUrl":"https://doi.org/10.1186/s43168-023-00234-1","url":null,"abstract":"Abstract Background Acute phase reactants (APR) are markers of inflammation that could be applied for the assessment of community-acquired pneumonia (CAP) severity in association with various pneumonia severity scores. So, the aim of the study was to assess levels of APR such as total leucocytic count (TLC), platelets, neutrophils, neutrophils-to-lymphocyte ratio (NLR), CRP, D-dimer, ferritin, and ESR in patients with CAP and to correlate between their values and disease severity. Methodology The study included 51 patients diagnosed as non-COVID-19 (CAP). Patients were classified into two groups group A (pneumonia only) and group B (pneumonia complicated with empyema/complicated para-pneumonic effusion). All patients underwent clinical evaluation, CURB65, radiological assessment, and blood sampling to measure APR. Results The mean age of patients was 47 ± 17 years. The main symptoms were productive cough (90.2%) and Fever (92.2%).TLC, platelets, neutrophils, CRP, D-dimer, ferritin, and ESR were elevated than normal values. Significant positive correlations were found between the duration of fever and CRP, D-dimer, and ferritin with p values = 0.024, 0.012, and 0.034 respectively. Significant positive correlations were found between CURB65 and both CRP and ferritin with p values = 0.007 and 0.020. A significant increase in platelet count and ESR values was found in group B than in group A. Conclusion APR are important markers that can be used in the assessment of CAP in collaboration with clinical evaluation and severity scores. CRP, D-dimer, and ferritin were positively correlated with CURB65, while ESR and platelets could be considered predictors of the development of complications. Trial registration Retrospectively registered, registration number NCT05926089 , date of registration is 06/29/2023.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135883443","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 : 2023-10-18DOI: 10.1186/s43168-023-00235-0
Mohamed Shaaban Mousa, Salwa Hassan Ahmed, Fatma Abdel Wahab Abdel Maksoud, Soliman Belal Soliman, Ahmed A. Tantawy
Abstract Background To study the potential role of the C2PAC index (a ratio of soluble type C lectin-like receptor 2 level sCLEC-2 and platelet count) in sepsis-induced coagulopathy with the possibility of using this index as an early predictor in sepsis and sepsis-induced coagulopathy. Methods Our case–control study included a total of 86 participants divided into 2 groups: group I is the case group consisting of 56 patients of sepsis or septic shock and group II (control group) of 30 healthy persons: sex and age-matched healthy individuals. All patients were subjected to assessment of C lectin domain family 2 receptor (sCLEC2), by enzyme-linked immunosorbent assay ELIZA kit, then C2PAC index (a ratio of soluble type C lectin-like receptor 2 level sCLEC-2 and platelet count) was calculated using the platelet count. Results Our study demonstrated that sCLEC-2 levels and C2PAC in group I were higher than in group II ( p value < 0.001), and Klebsiella was the most common organism detected in ICU septic patients; detected in 25 patients (44.6%), there is a statistical significance ( p value 0.045) between sCLEC2 levels and streptococcal infections. It was detected also that the SIC group was 17 patients (30.4%) and the sepsis without coagulopathy group was 39 patients (69.6%). Compared with the sepsis without coagulopathy group, the SIC group was significantly older and had a significantly higher SOFA score, sCLEC-2 levels, and C2PAC index. Lastly, the strong potentiality of using C2PAC as a diagnostic and prognostic marker for sepsis-induced coagulopathy with high statistical significance < 0. 001. Conclusions C2PAC index can be validated as an accurate marker of sepsis-induced coagulopathy with higher sensitivity when using the C2PAC index (82.4%) than using sCLEC-2 (58.8%) and both have the same specificity (89.7%). The C2PAC index is a useful predictor of SIC progression.
{"title":"The diagnostic role of C2PAC index in cases of sepsis-induced coagulopathy (SIC)","authors":"Mohamed Shaaban Mousa, Salwa Hassan Ahmed, Fatma Abdel Wahab Abdel Maksoud, Soliman Belal Soliman, Ahmed A. Tantawy","doi":"10.1186/s43168-023-00235-0","DOIUrl":"https://doi.org/10.1186/s43168-023-00235-0","url":null,"abstract":"Abstract Background To study the potential role of the C2PAC index (a ratio of soluble type C lectin-like receptor 2 level sCLEC-2 and platelet count) in sepsis-induced coagulopathy with the possibility of using this index as an early predictor in sepsis and sepsis-induced coagulopathy. Methods Our case–control study included a total of 86 participants divided into 2 groups: group I is the case group consisting of 56 patients of sepsis or septic shock and group II (control group) of 30 healthy persons: sex and age-matched healthy individuals. All patients were subjected to assessment of C lectin domain family 2 receptor (sCLEC2), by enzyme-linked immunosorbent assay ELIZA kit, then C2PAC index (a ratio of soluble type C lectin-like receptor 2 level sCLEC-2 and platelet count) was calculated using the platelet count. Results Our study demonstrated that sCLEC-2 levels and C2PAC in group I were higher than in group II ( p value < 0.001), and Klebsiella was the most common organism detected in ICU septic patients; detected in 25 patients (44.6%), there is a statistical significance ( p value 0.045) between sCLEC2 levels and streptococcal infections. It was detected also that the SIC group was 17 patients (30.4%) and the sepsis without coagulopathy group was 39 patients (69.6%). Compared with the sepsis without coagulopathy group, the SIC group was significantly older and had a significantly higher SOFA score, sCLEC-2 levels, and C2PAC index. Lastly, the strong potentiality of using C2PAC as a diagnostic and prognostic marker for sepsis-induced coagulopathy with high statistical significance < 0. 001. Conclusions C2PAC index can be validated as an accurate marker of sepsis-induced coagulopathy with higher sensitivity when using the C2PAC index (82.4%) than using sCLEC-2 (58.8%) and both have the same specificity (89.7%). The C2PAC index is a useful predictor of SIC progression.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135888622","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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