H. El-Komy, Mohammed M. Awad, W. Mansour, E. Elsayed
Background Dyspnea, cough, fatigue, functional limitation, and low quality of life (QOL) are manifestations of almost all interstitial lung diseases (ILDs), with little effective and may be well-tolerated pharmacotherapy in most of its subtypes. The application of pulmonary rehabilitation (PR) may have some benefits in patients with ILDs. Aim The aim of this study was to evaluate the effect of PR program on ILD patients’ QOL, exercise capacity, dyspnea, and spirometry. Settings and design This was a single-center experimental randomized controlled study. Patients and material This study initially enrolled 62 patients previously diagnosed as having ILD at the Chest Department according to American Thoracic Society (ATS)/European Respiratory Society (ERS) diagnostic criteria; however, 12 patients were excluded, and only 50 patients were included and completed the study, and they were classified randomly into the control group (n=25, received conventional treatment only) and the PR group (n=25, received conventional treatment and PR). Pre-PR and post-PR program assessment of QOL by the 36-item short-form health survey (SF36) questionnaire, exercise capacity by the 6-min walk test, dyspnea by the modified Medical Research Council and spirometry were carried out. Statistical analysis used All data were collected, tabulated and statistically analyzed using SPSS 16.0 for Windows. Results This study showed a statistically significant difference for the PR group over the control group at the end of the PR program, wherein all components of the SF36Q score had a P value less than 0.05, dyspnea score by modified Medical Research Council (P=0.02) and exercise tolerance by 6 min walking distance test (P=0.005). Moreover, the maximum voluntary ventilation (MVV%) showed a statistically significant improvement (P=0.003) in contrast to the other measured spirometric parameters measured in this study (forced vital capacity, forced expiratory volume in 1 s, forced expiratory volume in 1 s/forced vital capacity %, forced expiratory flow25–75) wherein P value was more than 0.05. A negative correlation was found between the baseline physical functioning item of SF36Q and the change (Δ) in 6 min walk distance test. Conclusion PR could be considered as an adjuvant method in the treatment of patients with stable ILDs and could provide improvement in their dyspnea perception, exercise tolerance, and health-related QOL.
背景呼吸困难、咳嗽、疲劳、功能受限和生活质量低下是几乎所有间质性肺部疾病（ILD）的表现，在大多数亚型中，药物治疗效果不佳，耐受性良好。肺康复（PR）的应用可能对ILD患者有一些好处。目的评价PR项目对ILD患者生活质量、运动能力、呼吸困难和肺活量测定的影响。设置和设计这是一项单中心实验性随机对照研究。患者和材料根据美国胸科学会（ATS）/欧洲呼吸学会（ERS）的诊断标准，本研究最初招募了62名既往在胸科诊断为ILD的患者；然而，12名患者被排除在外，只有50名患者被纳入并完成了研究，他们被随机分为对照组（n=25，仅接受常规治疗）和PR组（n=25，接受常规治疗和PR）。通过36项简式健康调查（SF36）问卷对PR前和PR后项目的生活质量进行评估，通过6分钟步行测试对运动能力进行评估，采用改良医学研究委员会对呼吸困难进行评估，并进行肺活量测定。统计分析使用所有数据均使用SPSS 16.0 for Windows进行收集、制表和统计分析。结果本研究显示，在PR项目结束时，PR组与对照组相比存在统计学显著差异，其中SF36Q评分的所有组成部分的P值均小于0.05，呼吸困难评分由改良医学研究委员会评定（P=0.02），运动耐量为6 min步行距离测试（P=0.005）。此外，与本研究中测量的其他肺活量测量参数（肺活量、1 s、 用力呼气量为1 s/用力肺活量%，用力呼气流量25-75），其中P值大于0.05。SF36Q的基线身体功能项目与6 最小步行距离测试。结论PR可作为稳定型ILD患者的辅助治疗方法，可改善患者的呼吸困难感、运动耐受性和健康生活质量。
{"title":"Impact of pulmonary rehabilitation on patients with interstitial lung diseases: an Egyptian experience","authors":"H. El-Komy, Mohammed M. Awad, W. Mansour, E. Elsayed","doi":"10.4103/ejb.ejb_64_18","DOIUrl":"https://doi.org/10.4103/ejb.ejb_64_18","url":null,"abstract":"Background Dyspnea, cough, fatigue, functional limitation, and low quality of life (QOL) are manifestations of almost all interstitial lung diseases (ILDs), with little effective and may be well-tolerated pharmacotherapy in most of its subtypes. The application of pulmonary rehabilitation (PR) may have some benefits in patients with ILDs. Aim The aim of this study was to evaluate the effect of PR program on ILD patients’ QOL, exercise capacity, dyspnea, and spirometry. Settings and design This was a single-center experimental randomized controlled study. Patients and material This study initially enrolled 62 patients previously diagnosed as having ILD at the Chest Department according to American Thoracic Society (ATS)/European Respiratory Society (ERS) diagnostic criteria; however, 12 patients were excluded, and only 50 patients were included and completed the study, and they were classified randomly into the control group (n=25, received conventional treatment only) and the PR group (n=25, received conventional treatment and PR). Pre-PR and post-PR program assessment of QOL by the 36-item short-form health survey (SF36) questionnaire, exercise capacity by the 6-min walk test, dyspnea by the modified Medical Research Council and spirometry were carried out. Statistical analysis used All data were collected, tabulated and statistically analyzed using SPSS 16.0 for Windows. Results This study showed a statistically significant difference for the PR group over the control group at the end of the PR program, wherein all components of the SF36Q score had a P value less than 0.05, dyspnea score by modified Medical Research Council (P=0.02) and exercise tolerance by 6 min walking distance test (P=0.005). Moreover, the maximum voluntary ventilation (MVV%) showed a statistically significant improvement (P=0.003) in contrast to the other measured spirometric parameters measured in this study (forced vital capacity, forced expiratory volume in 1 s, forced expiratory volume in 1 s/forced vital capacity %, forced expiratory flow25–75) wherein P value was more than 0.05. A negative correlation was found between the baseline physical functioning item of SF36Q and the change (Δ) in 6 min walk distance test. Conclusion PR could be considered as an adjuvant method in the treatment of patients with stable ILDs and could provide improvement in their dyspnea perception, exercise tolerance, and health-related QOL.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2019-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47793750","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}
Background Sexual dysfunction is a neglected area among patients with idiopathic interstitial pneumonias (IIPs). Hence, the aim of this study is to identify the prevalence of erectile dysfunction (ED) and its predictors in male patients with IIPs. Patients and methods A total 65 male patients (45 IIPs and 20 controls) were assessed; clinical data, testosterone levels, pulmonary function tests, arterial blood gases, and self-reported questionnaires on erectile function. Results The prevalence of ED was 66.7 and 11.1% of them presented with severe ED. The mean age of the patients was 33.4±5.9 years. Of the patients, 60% were smokers and 17.8% were nonsmokers. Regarding comorbid manifestations, 26.7% was hypertensive, 51.1% had diabetes mellitus, 42.2% with dyslipidemia, and 17.8% had ischemic heart disease. The mean duration since the diagnosis of IIPs was 7.46±2.77 years, whereas the mean time since evolution of ED was 2.17±1.3 years. A significant decrease in mean arterial oxygen tension (PaO2) and oxygen saturation (SaO2) were observed in the IIPs group. Also, the mean diffusion lung capacity for carbon monoxide (DLCO%) and testosterone level were decreased. A significant decrease in testosterone level among patients with severe diffusion defect was observed (P=0.000). The most predictors for ED were PaO2 (≤60 mmHg), SaO2 (≤88%), and DLCO≤60%. Conclusion ED is a common problem in patients with IIPs. Thus, physicians should keep in mind that IIPs patients need a comprehensive sexual evaluation. This is the first study to report that low PaO2, SaO2, and DLCO≤60% were the predictor risk factors.
{"title":"Predictors of erectile dysfunction among male patients with idiopathic interstitial pneumonias","authors":"D. Magdy, A. Azouz, Randa A. El Zohne","doi":"10.4103/ejb.ejb_66_18","DOIUrl":"https://doi.org/10.4103/ejb.ejb_66_18","url":null,"abstract":"Background Sexual dysfunction is a neglected area among patients with idiopathic interstitial pneumonias (IIPs). Hence, the aim of this study is to identify the prevalence of erectile dysfunction (ED) and its predictors in male patients with IIPs. Patients and methods A total 65 male patients (45 IIPs and 20 controls) were assessed; clinical data, testosterone levels, pulmonary function tests, arterial blood gases, and self-reported questionnaires on erectile function. Results The prevalence of ED was 66.7 and 11.1% of them presented with severe ED. The mean age of the patients was 33.4±5.9 years. Of the patients, 60% were smokers and 17.8% were nonsmokers. Regarding comorbid manifestations, 26.7% was hypertensive, 51.1% had diabetes mellitus, 42.2% with dyslipidemia, and 17.8% had ischemic heart disease. The mean duration since the diagnosis of IIPs was 7.46±2.77 years, whereas the mean time since evolution of ED was 2.17±1.3 years. A significant decrease in mean arterial oxygen tension (PaO2) and oxygen saturation (SaO2) were observed in the IIPs group. Also, the mean diffusion lung capacity for carbon monoxide (DLCO%) and testosterone level were decreased. A significant decrease in testosterone level among patients with severe diffusion defect was observed (P=0.000). The most predictors for ED were PaO2 (≤60 mmHg), SaO2 (≤88%), and DLCO≤60%. Conclusion ED is a common problem in patients with IIPs. Thus, physicians should keep in mind that IIPs patients need a comprehensive sexual evaluation. This is the first study to report that low PaO2, SaO2, and DLCO≤60% were the predictor risk factors.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2019-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42815519","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}
Y. Ahmed, S. Farghly, Mohamed Seddic, Shimaa Farghaly
Background Pleural effusion is considered an interesting clinical problem that is commonly faced by physicians and is caused by several diseases. The ability of computed tomography (CT) to differentiate transudate effusion from exudate effusion is still under research. Objective The aim of this study was to assess the accuracy of the CT in diagnosing the nature of the pleural effusion. Patients and methods In this prospective cross-sectional analytic study, laboratory biochemistry markers were used to classify pleural effusion into exudate or transudate based on Light’s criteria. Chest CT without contrast had been done for all patients, and CTs were diagnosed by the radiologist. Measurement of the pleural fluid density was done and shown using the CT attenuation values [Hounsfield unit (HU)]. Results Of 79 patients with pleural effusion, 60 patients had exudate effusion and 19 patients had transudate. The mean attenuation values were significantly higher in exudate effusion (20.11±7.11 HU) versus transudate effusion (13.8±4.11 HU), with P value of 0.03. Receiver operating characteristic curve analysis showed that the cutoff for exudate effusion was optimal at greater than or equal to 15.33 versus less than 15.33 HU for transudate (area under the curve=0.57; 95% confidence interval: 0.45–0.68). This point had 85.71% sensitivity and 46.55% specificity. Conclusion We reasoned the CT attenuation values of the pleural fluid may replace the laboratory tests in characterizing the pleural effusion, either exudate or transudate. However, there was an overlapping HU values in most effusions. So correlation of the CT results with the clinical findings is essential, and further CT studies are highly recommended to confirm and validate these findings.
{"title":"Is computed tomography scan able to replace laboratory tests to differentiate transudate effusions from exudate effusions? that is a question","authors":"Y. Ahmed, S. Farghly, Mohamed Seddic, Shimaa Farghaly","doi":"10.4103/ejb.ejb_37_18","DOIUrl":"https://doi.org/10.4103/ejb.ejb_37_18","url":null,"abstract":"Background Pleural effusion is considered an interesting clinical problem that is commonly faced by physicians and is caused by several diseases. The ability of computed tomography (CT) to differentiate transudate effusion from exudate effusion is still under research. Objective The aim of this study was to assess the accuracy of the CT in diagnosing the nature of the pleural effusion. Patients and methods In this prospective cross-sectional analytic study, laboratory biochemistry markers were used to classify pleural effusion into exudate or transudate based on Light’s criteria. Chest CT without contrast had been done for all patients, and CTs were diagnosed by the radiologist. Measurement of the pleural fluid density was done and shown using the CT attenuation values [Hounsfield unit (HU)]. Results Of 79 patients with pleural effusion, 60 patients had exudate effusion and 19 patients had transudate. The mean attenuation values were significantly higher in exudate effusion (20.11±7.11 HU) versus transudate effusion (13.8±4.11 HU), with P value of 0.03. Receiver operating characteristic curve analysis showed that the cutoff for exudate effusion was optimal at greater than or equal to 15.33 versus less than 15.33 HU for transudate (area under the curve=0.57; 95% confidence interval: 0.45–0.68). This point had 85.71% sensitivity and 46.55% specificity. Conclusion We reasoned the CT attenuation values of the pleural fluid may replace the laboratory tests in characterizing the pleural effusion, either exudate or transudate. However, there was an overlapping HU values in most effusions. So correlation of the CT results with the clinical findings is essential, and further CT studies are highly recommended to confirm and validate these findings.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44087522","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}
Azza Farag El-toney, B. Mohamed, Emad Allam Abd-Elnaeem, A. Ismail
Background Chronic obstructive pulmonary disease (COPD) has many extrapulmonary comorbidities, and metabolic syndrome (MetS) is one of them. Scant data are available on MetS in Egyptian patients with COPD. Objective The purpose of the current research was to determine the frequency and clinical characteristics of MetS among Egyptian patients with stable COPD. Patients and methods A prospective study including 70 (64 males and six females) patients with stable COPD was conducted. Clinical assessment, pulmonary function, and other laboratory studies were performed. Results MetS was present in 31 patients with COPD (44.3%). BMI and high-sensitivity C-reactive protein were significantly higher in patients with COPD with MetS than those without MetS (P=0.02 and 0.01, respectively). Age of the patients, duration of COPD, grade of dyspnea, and pulmonary function tests had no significant difference between those with MetS versus those without it. There was a significant negative correlation between plasma triglyceride level, as the only one of the variables of MetS, and some of parameters of pulmonary function test. Conclusion MetS is relatively frequent among patients with COPD. Plasma triglyceride level is the only parameter of MetS to have a significant correlation with pulmonary function tests. Apart from BMI and high-sensitivity C-reactive protein, no other parameter among patients with COPD has a significant relationship with MetS.
{"title":"Metabolic syndrome; frequency and its relationship with variable parameters in chronic obstructive pulmonary disease","authors":"Azza Farag El-toney, B. Mohamed, Emad Allam Abd-Elnaeem, A. Ismail","doi":"10.4103/ejb.ejb_51_18","DOIUrl":"https://doi.org/10.4103/ejb.ejb_51_18","url":null,"abstract":"Background Chronic obstructive pulmonary disease (COPD) has many extrapulmonary comorbidities, and metabolic syndrome (MetS) is one of them. Scant data are available on MetS in Egyptian patients with COPD. Objective The purpose of the current research was to determine the frequency and clinical characteristics of MetS among Egyptian patients with stable COPD. Patients and methods A prospective study including 70 (64 males and six females) patients with stable COPD was conducted. Clinical assessment, pulmonary function, and other laboratory studies were performed. Results MetS was present in 31 patients with COPD (44.3%). BMI and high-sensitivity C-reactive protein were significantly higher in patients with COPD with MetS than those without MetS (P=0.02 and 0.01, respectively). Age of the patients, duration of COPD, grade of dyspnea, and pulmonary function tests had no significant difference between those with MetS versus those without it. There was a significant negative correlation between plasma triglyceride level, as the only one of the variables of MetS, and some of parameters of pulmonary function test. Conclusion MetS is relatively frequent among patients with COPD. Plasma triglyceride level is the only parameter of MetS to have a significant correlation with pulmonary function tests. Apart from BMI and high-sensitivity C-reactive protein, no other parameter among patients with COPD has a significant relationship with MetS.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41413263","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}
R. Elkolaly, Hoda M Bahr, Basem I. El-Shafey, A. Basuoni, E. Elber
Background Despite different ICU admission causes, ventilator-associated pneumonia (VAP) is still a common cause of mortality and morbidity in intubated patients and impedes obvious progression in diagnostic modalities and management of these infections. Aim of study The aim of this study was to estimate VAP incidence in Tanta University Hospitals ICUs. Settings and design This was a crossover observational study. Patients and methods This was a one-year study (April 2015 to March 2016), including patients on invasive ventilation who developed VAP, with evaluation of admission and ventilation causes, isolation of causative organisms, and study of used antibiotics and ventilation modes. Statistical analysis Data were statistically analyzed using the SPSS software for Windows (IBM SPSS Statistics 21.0). Results It is a statistics based study aimed to trace infection incidence in national hospital ICUs. Among 222 admitted patients, only 38.4% fulfilled the criteria of VAP. Admission was because of cardiovascular impairment, cardiac arrest, respiratory failure, or head trauma. The ventilation mode at VAP time was assisted control (75%) and synchronized intermittent mandatory ventilation (25%). The minimum intubation period was 7 days, whereas the maximum period was 37 days. Isolated organisms were Pseudomonas (37.5%), Klebsiella (25%), Staphylococcus (20.8%), and methicillin-resistant Staphylococcus aureus (4.2%). The antibiotics used were amikacin, imipenem, vancomycin, levofloxacin, ceftazidime, and teicoplanin (29, 25, 21, 12.5, 8.3, and 4.2%, respectively). The minimum period of antibiotic used was 5 days, whereas the maximum period was 35 days. The highest incidence of VAP occurred in February, whereas the lowest incidence occurred in July. Conclusion The incidence of VAP is still high and varies according to the intubation cause and period, and the underlying morbidity. More efforts must be made to prevent, diagnose, and manage infection early and properly to reduce patient suffering and to reduce the burden on the serving hospitals.
{"title":"Incidence of ventilator-associated pneumonia: Egyptian study","authors":"R. Elkolaly, Hoda M Bahr, Basem I. El-Shafey, A. Basuoni, E. Elber","doi":"10.4103/ejb.ejb_43_18","DOIUrl":"https://doi.org/10.4103/ejb.ejb_43_18","url":null,"abstract":"Background Despite different ICU admission causes, ventilator-associated pneumonia (VAP) is still a common cause of mortality and morbidity in intubated patients and impedes obvious progression in diagnostic modalities and management of these infections. Aim of study The aim of this study was to estimate VAP incidence in Tanta University Hospitals ICUs. Settings and design This was a crossover observational study. Patients and methods This was a one-year study (April 2015 to March 2016), including patients on invasive ventilation who developed VAP, with evaluation of admission and ventilation causes, isolation of causative organisms, and study of used antibiotics and ventilation modes. Statistical analysis Data were statistically analyzed using the SPSS software for Windows (IBM SPSS Statistics 21.0). Results It is a statistics based study aimed to trace infection incidence in national hospital ICUs. Among 222 admitted patients, only 38.4% fulfilled the criteria of VAP. Admission was because of cardiovascular impairment, cardiac arrest, respiratory failure, or head trauma. The ventilation mode at VAP time was assisted control (75%) and synchronized intermittent mandatory ventilation (25%). The minimum intubation period was 7 days, whereas the maximum period was 37 days. Isolated organisms were Pseudomonas (37.5%), Klebsiella (25%), Staphylococcus (20.8%), and methicillin-resistant Staphylococcus aureus (4.2%). The antibiotics used were amikacin, imipenem, vancomycin, levofloxacin, ceftazidime, and teicoplanin (29, 25, 21, 12.5, 8.3, and 4.2%, respectively). The minimum period of antibiotic used was 5 days, whereas the maximum period was 35 days. The highest incidence of VAP occurred in February, whereas the lowest incidence occurred in July. Conclusion The incidence of VAP is still high and varies according to the intubation cause and period, and the underlying morbidity. More efforts must be made to prevent, diagnose, and manage infection early and properly to reduce patient suffering and to reduce the burden on the serving hospitals.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48482161","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}
M. E. El Nady, S. Kaddah, Yasmine Hamdy El Hinnawy, R. Halim, Reham Kandeel
Objectives Idiopathic pulmonary fibrosis (IPF) is a disease of an increasing burden. Its diagnosis is based on definite high-resolution computed tomography pattern and is associated with the histopathological and/or radiological pattern of usual interstitial pneumonia with exclusion of other causes of interstitial pneumonia. The surfactant protein-D (SP-D) level in the serum is measured in several lung diseases, including IPF. Aim of study The aim of the current study is to assess the serum level of SP-D as a potential biomarker to distinguish between IPF and other idiopathic interstitial pneumonia patients. Patients and methods This study was conducted in the Chest Department, Kasr Al Ainy Hospitals, Cairo University. The study population included 20 healthy controls, 20 IPF patients, and 18 other idiopathic interstitial pneumonia patients. All were subjected to full history taking, clinical examination, high-resolution computed tomography chest, spirometry, arterial blood gases, blood samples for measuring SP-D by enzyme-linked immunosorbent assay. Results There was no statistical significance between the serum level of SP-D in IPF and non-IPF patients, however, there was a significant increase in the serum level of SP-D in IPF patients diagnosed at a late stage compared with those diagnosed at an early stage and those on anti-fibrotic therapy. Also, there was a statistical significance between the degree of clubbing and gastroesophageal reflux disease and the serum level of SP-D with a P value of 0.005 and 0.029, respectively. Serum SP-D level had a negative correlation with more severe form of the disease regarding the duration of illness, forced vital capacity percent, and it had a significant negative correlation with oxygen saturation and 6 min walk distance with a P value of 0.023 and 0.005, respectively. Conclusion The level of serum SP-D level in IPF patients correlate well with the severity of the disease and could be a possible marker to use for the follow up of patients on anti-fibrotic drugs.
特发性肺纤维化(IPF)是一种负担日益加重的疾病。其诊断基于明确的高分辨率计算机断层扫描模式，并与常规间质性肺炎的组织病理学和/或放射学模式相关，排除了间质性肺炎的其他原因。血清表面活性剂蛋白- d (SP-D)水平在几种肺部疾病，包括IPF测量。本研究的目的是评估血清SP-D水平作为区分IPF和其他特发性间质性肺炎患者的潜在生物标志物。患者和方法本研究在开罗大学Kasr Al Ainy医院胸科进行。研究人群包括20名健康对照者、20名IPF患者和18名其他特发性间质性肺炎患者。所有患者均接受了完整的病史记录、临床检查、高分辨率胸部计算机断层扫描、肺活量测定、动脉血气测定、血液样本酶联免疫吸附法测定SP-D。结果IPF患者与非IPF患者血清SP-D水平差异无统计学意义，但晚期IPF患者血清SP-D水平较早期诊断及抗纤维化治疗组明显升高。棍状和胃食管反流病的程度与血清SP-D水平的差异有统计学意义，P值分别为0.005和0.029。血清SP-D水平与病程、强迫肺活量百分比与病情严重程度呈负相关，与血氧饱和度、6 min步行距离呈显著负相关，P值分别为0.023、0.005。结论IPF患者血清SP-D水平与病情的严重程度有较好的相关性，可作为抗纤维化药物随访的指标之一。
{"title":"Plasma surfactant protein-D as a potential biomarker in idiopathic pulmonary fibrosis","authors":"M. E. El Nady, S. Kaddah, Yasmine Hamdy El Hinnawy, R. Halim, Reham Kandeel","doi":"10.4103/ejb.ejb_74_18","DOIUrl":"https://doi.org/10.4103/ejb.ejb_74_18","url":null,"abstract":"Objectives Idiopathic pulmonary fibrosis (IPF) is a disease of an increasing burden. Its diagnosis is based on definite high-resolution computed tomography pattern and is associated with the histopathological and/or radiological pattern of usual interstitial pneumonia with exclusion of other causes of interstitial pneumonia. The surfactant protein-D (SP-D) level in the serum is measured in several lung diseases, including IPF. Aim of study The aim of the current study is to assess the serum level of SP-D as a potential biomarker to distinguish between IPF and other idiopathic interstitial pneumonia patients. Patients and methods This study was conducted in the Chest Department, Kasr Al Ainy Hospitals, Cairo University. The study population included 20 healthy controls, 20 IPF patients, and 18 other idiopathic interstitial pneumonia patients. All were subjected to full history taking, clinical examination, high-resolution computed tomography chest, spirometry, arterial blood gases, blood samples for measuring SP-D by enzyme-linked immunosorbent assay. Results There was no statistical significance between the serum level of SP-D in IPF and non-IPF patients, however, there was a significant increase in the serum level of SP-D in IPF patients diagnosed at a late stage compared with those diagnosed at an early stage and those on anti-fibrotic therapy. Also, there was a statistical significance between the degree of clubbing and gastroesophageal reflux disease and the serum level of SP-D with a P value of 0.005 and 0.029, respectively. Serum SP-D level had a negative correlation with more severe form of the disease regarding the duration of illness, forced vital capacity percent, and it had a significant negative correlation with oxygen saturation and 6 min walk distance with a P value of 0.023 and 0.005, respectively. Conclusion The level of serum SP-D level in IPF patients correlate well with the severity of the disease and could be a possible marker to use for the follow up of patients on anti-fibrotic drugs.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47895691","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}
Context End-tidal carbon dioxide (EtCO2) is used as a noninvasive bedside test to assess the adequacy of ventilation and physiologic dead space in mechanically ventilated patients. The gradient difference between EtCO2 and partial pressure of arterial carbon dioxide (PaCO2) is directly related to an increase in the physiologic dead space. Aim The aim of this study was to evaluate the role of measuring the gradient between EtCO2 and PaCO2 in adults with acute respiratory distress (ARDS). Settings and design This was a prospective consecutive enrollment study. Patients and methods Overall, 51 cases were recruited after the diagnosis of ARDS was made according to the Berlin definition. Patients were mechanically ventilated as per the lung-protective protocol. Daily arterial blood gases were collected and for every sample, the EtCO2 value was collected electronically by capnography using an endotracheal tube for the first 5 days. Results Cases were classified into survivors and nonsurvivors: 26 cases were because of extrapulmonary causes and 25 cases were because of pulmonary causes. The mean value of the APACHE II score for all cases on admission was 21.6. The mean length of ICU stay was 12.7 days. For all study cases, PaO2/FiO2 was the lowest at day 1 and the highest at day 5. We found a significant negative correlation between PaO2/FiO2 and the gradient at days 2, 4, and day 5, and a significant positive correlation between the gradient on admission and the APACHE II score (r=0.4, P≤0.05). Nonsurvivors had a significantly higher gradient and lower EtCO2 and PaO2/FiO2 levels at all time intervals, whereas PaCO2 alone was found to be nonsignificant. Conclusion In ARDS, EtCO2 and gradient are reliable indicators of severity.
{"title":"Assessment of gradient between partial pressure of arterial carbon dioxide and end-tidal carbon dioxide in acute respiratory distress syndrome","authors":"Fatmaalzahraa Abdalrazik, M. Elghonemi","doi":"10.4103/ejb.ejb_90_17","DOIUrl":"https://doi.org/10.4103/ejb.ejb_90_17","url":null,"abstract":"Context End-tidal carbon dioxide (EtCO2) is used as a noninvasive bedside test to assess the adequacy of ventilation and physiologic dead space in mechanically ventilated patients. The gradient difference between EtCO2 and partial pressure of arterial carbon dioxide (PaCO2) is directly related to an increase in the physiologic dead space. Aim The aim of this study was to evaluate the role of measuring the gradient between EtCO2 and PaCO2 in adults with acute respiratory distress (ARDS). Settings and design This was a prospective consecutive enrollment study. Patients and methods Overall, 51 cases were recruited after the diagnosis of ARDS was made according to the Berlin definition. Patients were mechanically ventilated as per the lung-protective protocol. Daily arterial blood gases were collected and for every sample, the EtCO2 value was collected electronically by capnography using an endotracheal tube for the first 5 days. Results Cases were classified into survivors and nonsurvivors: 26 cases were because of extrapulmonary causes and 25 cases were because of pulmonary causes. The mean value of the APACHE II score for all cases on admission was 21.6. The mean length of ICU stay was 12.7 days. For all study cases, PaO2/FiO2 was the lowest at day 1 and the highest at day 5. We found a significant negative correlation between PaO2/FiO2 and the gradient at days 2, 4, and day 5, and a significant positive correlation between the gradient on admission and the APACHE II score (r=0.4, P≤0.05). Nonsurvivors had a significantly higher gradient and lower EtCO2 and PaO2/FiO2 levels at all time intervals, whereas PaCO2 alone was found to be nonsignificant. Conclusion In ARDS, EtCO2 and gradient are reliable indicators of severity.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41449714","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}
H. Masoud, A. Abd El-Hafeez, M. Ismail, Naef Baharetha
Background Chronic obstructive pulmonary disease (COPD) is a disease of chronic inflammation affecting the lungs. Leptin is a pleiotropic cytokine thought to play a role in host inflammatory response. Aim This study aimed to investigate the role of leptin in sputum and serum as an inflammatory marker in acute exacerbation of COPD (AECOPD). Patients and methods Twenty patients with stable COPD, 20 patients with AECOPD, and 12 controls were included in this study. All participants were males. BMI, routine laboratory investigations, sputum and serum leptin levels, serum tumor necrosis factor (TNF-α), and C-reactive protein (CRP) levels were measured twice in patients with AECOPD (initially and after 7 days of management) and only once in stable patients and controls. Results In patients with patients with AECOPD, there were significant differences between sputum leptin and serum TNF-α, CRP, and leptin levels before and after treatment. Sputum leptin and serum CRP levels were significantly higher in the AECOPD group than other groups. Additionally, serum TNF-α levels were significantly higher in patients with AECOPD than the controls. Insignificant correlation was found between AECOPD and stable groups regarding serum leptin and TNF-α levels. Conclusion The present study highlights the role of leptin hormone as a local inflammatory marker in COPD acute exacerbation either in the sputum or the serum, together with serum TNF-α and CRP. These markers could be useful indicators of COPD acute exacerbation and its response to treatment.
{"title":"Leptin as a local inflammatory marker in chronic obstructive pulmonary disease acute exacerbation","authors":"H. Masoud, A. Abd El-Hafeez, M. Ismail, Naef Baharetha","doi":"10.4103/ejb.ejb_75_18","DOIUrl":"https://doi.org/10.4103/ejb.ejb_75_18","url":null,"abstract":"Background Chronic obstructive pulmonary disease (COPD) is a disease of chronic inflammation affecting the lungs. Leptin is a pleiotropic cytokine thought to play a role in host inflammatory response. Aim This study aimed to investigate the role of leptin in sputum and serum as an inflammatory marker in acute exacerbation of COPD (AECOPD). Patients and methods Twenty patients with stable COPD, 20 patients with AECOPD, and 12 controls were included in this study. All participants were males. BMI, routine laboratory investigations, sputum and serum leptin levels, serum tumor necrosis factor (TNF-α), and C-reactive protein (CRP) levels were measured twice in patients with AECOPD (initially and after 7 days of management) and only once in stable patients and controls. Results In patients with patients with AECOPD, there were significant differences between sputum leptin and serum TNF-α, CRP, and leptin levels before and after treatment. Sputum leptin and serum CRP levels were significantly higher in the AECOPD group than other groups. Additionally, serum TNF-α levels were significantly higher in patients with AECOPD than the controls. Insignificant correlation was found between AECOPD and stable groups regarding serum leptin and TNF-α levels. Conclusion The present study highlights the role of leptin hormone as a local inflammatory marker in COPD acute exacerbation either in the sputum or the serum, together with serum TNF-α and CRP. These markers could be useful indicators of COPD acute exacerbation and its response to treatment.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48636660","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}
Background Ultrasonography can be used for assessment of diaphragmatic mobility and thickness. Diaphragm is the main muscle of respiration. Rationale To predict successful extubation from mechanical ventilation. Patients and methods Forty patients were involved in the present study. They were admitted in the ICU at Abbassia Chest Hospital. They received the conventional measurements for weaning and transdiaphragmatic ultrasonography after extubation. We assessed the diaphragmatic mobility and diaphragmatic thickening fraction. All ultrasonography findings were gathered and compared with some of the usual weaning tools such as arterial blood gas and respiratory mechanics. The findings were statistically analyzed. Results Thirty-one patients revealed successful liberation from mechanical ventilation. Diaphragmatic mobility and thickening fraction showed high sensitivity and specificity compared with other weaning tools. The cutoff value was 10 mm for mobility and 30% for diaphragmatic thickening fraction. Conclusion Diaphragmatic ultrasonography can be used as a new tool for prediction of weaning process.
{"title":"Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation","authors":"Taher El Naggar, Ibrahim A Dwedar, Eman Abd–Allah","doi":"10.4103/ejb.ejb_59_18","DOIUrl":"https://doi.org/10.4103/ejb.ejb_59_18","url":null,"abstract":"Background Ultrasonography can be used for assessment of diaphragmatic mobility and thickness. Diaphragm is the main muscle of respiration. Rationale To predict successful extubation from mechanical ventilation. Patients and methods Forty patients were involved in the present study. They were admitted in the ICU at Abbassia Chest Hospital. They received the conventional measurements for weaning and transdiaphragmatic ultrasonography after extubation. We assessed the diaphragmatic mobility and diaphragmatic thickening fraction. All ultrasonography findings were gathered and compared with some of the usual weaning tools such as arterial blood gas and respiratory mechanics. The findings were statistically analyzed. Results Thirty-one patients revealed successful liberation from mechanical ventilation. Diaphragmatic mobility and thickening fraction showed high sensitivity and specificity compared with other weaning tools. The cutoff value was 10 mm for mobility and 30% for diaphragmatic thickening fraction. Conclusion Diaphragmatic ultrasonography can be used as a new tool for prediction of weaning process.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45275547","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}
Context Ultrasound of the diaphragm is an evolving diagnostic modality with several techniques and measurements that can be used for structural and functional assessment of the diaphragm. Weight may have effects on pulmonary function tests including its impairment. Assessment of the diaphragm is one of these important measures of function by measuring the diaphragmatic thickness, excursion, and diaphragmatic thickness fraction (DTF). Aim Assessing the relation between these sonographic diaphragmatic indices with spirometry and BMI. Settings and design This was a prospective clinical study in which 107 normal healthy volunteers with different age, height, and weight were enrolled; most of them were coming for routine preoperative assessment at the Ain Shams University Chest Department Pulmonary Function Unit. Patients and methods It included 107 healthy persons who came for routine preoperative lung function assessment or normal volunteers. Full medical and smoking history, BMI, chest radiography spirometry, and diaphragmatic assessment by ultrasound for excursion, thickness, and DTF were done. All persons were divided into obese individuals of BMI more than or equal to 25 and nonobese individuals of BMI less than 25. Statistical analysis Statistical package for the social sciences program (SPSS) software version 18.0. Results In obese individuals, forced expiratory volume in the first second (FEV1%) and right diaphragmatic excursion show a significant decrease when BMI increases. There was a statistically significant increase in right and left diaphragmatic excursion and DTF in men rather than women. There was a highly significant increase in both right and left diaphragmatic thickness and excursion when forced vital capacity increases. There was a highly significant increase in right diaphragmatic excursion and both right and left diaphragmatic thickness when FEV1 increases. A significant increase in left excursion and DTF was also noticed with increased FEV1. However, there was a significant decrease in DTF with increased percent of forced vital capacity. Conclusion Spirometric parameters and right diaphragmatic excursion show a significant decrease when BMI increases. Different relations were found between spirometric parameters and ultrasonographic measurements regardless of the BMI.
{"title":"Assessment of diaphragmatic mobility by chest ultrasound in relation to BMI and spirometric parameters","authors":"S. Adel, Ezzelregal G. Hieba, Sayed Hossam","doi":"10.4103/ejb.ejb_73_18","DOIUrl":"https://doi.org/10.4103/ejb.ejb_73_18","url":null,"abstract":"Context Ultrasound of the diaphragm is an evolving diagnostic modality with several techniques and measurements that can be used for structural and functional assessment of the diaphragm. Weight may have effects on pulmonary function tests including its impairment. Assessment of the diaphragm is one of these important measures of function by measuring the diaphragmatic thickness, excursion, and diaphragmatic thickness fraction (DTF). Aim Assessing the relation between these sonographic diaphragmatic indices with spirometry and BMI. Settings and design This was a prospective clinical study in which 107 normal healthy volunteers with different age, height, and weight were enrolled; most of them were coming for routine preoperative assessment at the Ain Shams University Chest Department Pulmonary Function Unit. Patients and methods It included 107 healthy persons who came for routine preoperative lung function assessment or normal volunteers. Full medical and smoking history, BMI, chest radiography spirometry, and diaphragmatic assessment by ultrasound for excursion, thickness, and DTF were done. All persons were divided into obese individuals of BMI more than or equal to 25 and nonobese individuals of BMI less than 25. Statistical analysis Statistical package for the social sciences program (SPSS) software version 18.0. Results In obese individuals, forced expiratory volume in the first second (FEV1%) and right diaphragmatic excursion show a significant decrease when BMI increases. There was a statistically significant increase in right and left diaphragmatic excursion and DTF in men rather than women. There was a highly significant increase in both right and left diaphragmatic thickness and excursion when forced vital capacity increases. There was a highly significant increase in right diaphragmatic excursion and both right and left diaphragmatic thickness when FEV1 increases. A significant increase in left excursion and DTF was also noticed with increased FEV1. However, there was a significant decrease in DTF with increased percent of forced vital capacity. Conclusion Spirometric parameters and right diaphragmatic excursion show a significant decrease when BMI increases. Different relations were found between spirometric parameters and ultrasonographic measurements regardless of the BMI.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2019-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47871622","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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