Manal R. Hafez, H. Eid, Sawsan B Elsawy, N. Eldin, Asmaa El Madbouly
Background Activated platelets and platelet indices have a vital role in bronchial hyper-responsiveness, bronchoconstriction, bronchial inflammation, airway remodeling, angiogenesis, allergic reactions, and repair and renewal of tissues; platelets contain mediators that lead to inflammatory response. Aim The aim was to assess the use of platelet indices [mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), and platelet large cell ratio (PLCR)] as cheap and readily available biomarkers for bronchial asthma exacerbation. Patients and methods A case–control study involved 45 bronchial asthma female patients during both stable and exacerbation phases, and 45 age-matched healthy female patients as a control group. Measurements of platelet counts, MPV, PDW, PCT, PLCR, C-reactive protein (CRP), spirometric indices, and arterial blood gases were performed for all participants. Results The MPV and PDW were significantly lower, whereas the PCT and PLCR were considerably higher in exacerbation phase compared with stable phase and in stable phase in comparison with controls (P<0.001). The MPV and PDW were negatively correlated with white blood cells, PaCO2, symptoms duration, and hs-CRP (high sensitive), with positive correlation with forced expiratory volume in the first second and PaO2 (P<0.001). PCT and PLCR were positively correlated with white blood cells, PaO2, and symptoms duration, and negatively correlated with forced expiratory volume in the first second, symptoms duration, and hs-CRP (P<0.001). Conclusion The platelet indices were altered in exacerbation phase compared with stable phase and control group. Therefore, clinicians should not ignore interpreting platelet indices during asthma exacerbation, especially as these tests are simple, readily available, and of lower cost. It appears that measurement of the platelet indices is a valuable indicator of asthma severity/activity and appears as a useful screening test for asthma exacerbation.
{"title":"Assessment of bronchial asthma exacerbation: the utility of platelet indices","authors":"Manal R. Hafez, H. Eid, Sawsan B Elsawy, N. Eldin, Asmaa El Madbouly","doi":"10.4103/ejb.ejb_69_19","DOIUrl":"https://doi.org/10.4103/ejb.ejb_69_19","url":null,"abstract":"Background Activated platelets and platelet indices have a vital role in bronchial hyper-responsiveness, bronchoconstriction, bronchial inflammation, airway remodeling, angiogenesis, allergic reactions, and repair and renewal of tissues; platelets contain mediators that lead to inflammatory response. Aim The aim was to assess the use of platelet indices [mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), and platelet large cell ratio (PLCR)] as cheap and readily available biomarkers for bronchial asthma exacerbation. Patients and methods A case–control study involved 45 bronchial asthma female patients during both stable and exacerbation phases, and 45 age-matched healthy female patients as a control group. Measurements of platelet counts, MPV, PDW, PCT, PLCR, C-reactive protein (CRP), spirometric indices, and arterial blood gases were performed for all participants. Results The MPV and PDW were significantly lower, whereas the PCT and PLCR were considerably higher in exacerbation phase compared with stable phase and in stable phase in comparison with controls (P<0.001). The MPV and PDW were negatively correlated with white blood cells, PaCO2, symptoms duration, and hs-CRP (high sensitive), with positive correlation with forced expiratory volume in the first second and PaO2 (P<0.001). PCT and PLCR were positively correlated with white blood cells, PaO2, and symptoms duration, and negatively correlated with forced expiratory volume in the first second, symptoms duration, and hs-CRP (P<0.001). Conclusion The platelet indices were altered in exacerbation phase compared with stable phase and control group. Therefore, clinicians should not ignore interpreting platelet indices during asthma exacerbation, especially as these tests are simple, readily available, and of lower cost. It appears that measurement of the platelet indices is a valuable indicator of asthma severity/activity and appears as a useful screening test for asthma exacerbation.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49611193","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 Most patients with chronic obstructive pulmonary disease (COPD) have cardiovascular comorbidities (CVD), which significantly contribute to the mortality and morbidity in these patients. Objective The primary objective was to assess the prevalence of CVD in hospitalized patients with COPD. The secondary objectives were to study the risk factors associated with CVD in patients with COPD and to assess if the severity of COPD was related to the prevalence of CVD. Patients and methods The present study was a prospective observational study. The study period spanned from January 2013 to December 2014. All consecutive patients admitted with a diagnosis of COPD were included in the study. Patients with coexisting chronic respiratory illnesses, like obstructive sleep apnea, interstitial lung disease, and bronchiectasis, were excluded. The presence of various CVD was assessed with a history, physical evaluation, and limited tests [ECG, troponin levels, serum brain natriuretic peptide (BNP), and echocardiography). χ2 test was used to test the statistical significance. Clearance from ethical committee and consent from patients were obtained before the study. Results A total of 100 patients with COPD were included in the study. Overall, 60% of the patients had CVD. Common CVD were ischemic heart disease (21%), congestive heart failure (20%), stroke (5%), and arrhythmias (3%). The prevalence of CVD among patients with stages 1 and 2 COPD was 44.4%, stage 3 COPD was 61.5% and stage 4 COPD was 66.7% (P=0.298). Using multiple linear regression analysis, significant risk factors for CVD were serum BNP levels [P=0.001; odds ratio (OR), 17.5], dyslipidemia (P=0.037; OR, 3.6), and systemic hypertension (P=0.002; OR, 4.6). Patients with COPD and CVD had a lower BMI as compared with those without CVD. Conclusion Ischemic heart disease, congestive cardiac failure, and stroke were the most commonly identified CVD in patients with COPD. Systemic hypertension, dyslipidemia, and serum BNP levels were identified as important predictors for CVD in our study.
{"title":"Cardiovascular comorbidities associated with patients with chronic obstructive pulmonary disease – a hospital-based study","authors":"Amit S. Gupta, V. Rajesh, P. James","doi":"10.4103/ejb.ejb_64_19","DOIUrl":"https://doi.org/10.4103/ejb.ejb_64_19","url":null,"abstract":"Background Most patients with chronic obstructive pulmonary disease (COPD) have cardiovascular comorbidities (CVD), which significantly contribute to the mortality and morbidity in these patients. Objective The primary objective was to assess the prevalence of CVD in hospitalized patients with COPD. The secondary objectives were to study the risk factors associated with CVD in patients with COPD and to assess if the severity of COPD was related to the prevalence of CVD. Patients and methods The present study was a prospective observational study. The study period spanned from January 2013 to December 2014. All consecutive patients admitted with a diagnosis of COPD were included in the study. Patients with coexisting chronic respiratory illnesses, like obstructive sleep apnea, interstitial lung disease, and bronchiectasis, were excluded. The presence of various CVD was assessed with a history, physical evaluation, and limited tests [ECG, troponin levels, serum brain natriuretic peptide (BNP), and echocardiography). χ2 test was used to test the statistical significance. Clearance from ethical committee and consent from patients were obtained before the study. Results A total of 100 patients with COPD were included in the study. Overall, 60% of the patients had CVD. Common CVD were ischemic heart disease (21%), congestive heart failure (20%), stroke (5%), and arrhythmias (3%). The prevalence of CVD among patients with stages 1 and 2 COPD was 44.4%, stage 3 COPD was 61.5% and stage 4 COPD was 66.7% (P=0.298). Using multiple linear regression analysis, significant risk factors for CVD were serum BNP levels [P=0.001; odds ratio (OR), 17.5], dyslipidemia (P=0.037; OR, 3.6), and systemic hypertension (P=0.002; OR, 4.6). Patients with COPD and CVD had a lower BMI as compared with those without CVD. Conclusion Ischemic heart disease, congestive cardiac failure, and stroke were the most commonly identified CVD in patients with COPD. Systemic hypertension, dyslipidemia, and serum BNP levels were identified as important predictors for CVD in our study.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48079587","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. Ahmed, Iman Galal, H. Sakr, A. Gomaa, A. Osman, M. El-Assal
Background Airway evaluation and its management remain an emerging clinical science. Ultrasound (US) provides point-of-care dynamic views of the airway in perioperative, emergency, and critical care settings. Identification of a difficult airway before intubation allows for optimal preparation, equipment selection, and participation of experienced personnel. Objective The aim of this study was to evaluate the role of US in the assessment of airways and to determine whether US has the potential to serve as an effective, noninvasive method for the diagnosis of tracheomalacia. Patients and methods A prospective cross-sectional study was carried out on patients admitted at the respiratory ICU. US examination of the airways and diaphragm was performed together with either fiberoptic bronchoscopy (FOB) or dynamic expiratory computed tomography chest. Dynamic expiratory computed tomography chest and FOB were done within 24 h of US examination. Results A total of 53 patients were included. US could successfully confirm endotracheal tube (ETT) placement in all patients. ETT was endotracheal in 30 (94%) patients, whereas it was esophageal in two (6%) patients. Hyomental distance at a cut-off of up to 4.51 cm was a good predictor of difficult intubation with 100% sensitivity and 87.5% specificity. Subglottic airway transverse diameter was used as a predictor of ETT size. Patients with tracheomalacia by FOB had a significantly longer duration of mechanical ventilation. Lateral pharyngeal wall thickness was used as a predictor of obstructive sleep apnea, a new cut-off point was used at more than 4.1 cm in the intubated group of patients with 87.5% sensitivity and 95.8% specificity, whereas a cut-off point more than 4.2 cm in the nonintubated patients had 100% sensitivity and 100% specificity. In the intubated group, out of the seven cases diagnosed with tracheomalacia by FOB, five patients were missed by US with 40% sensitivity, whereas in the nonintubated group, the results were significantly better, where only one case was missed by US with 80% sensitivity. Conclusion US has many advantages for imaging the airway; it is safe, quick, repeatable, portable, widely available, and provides real-time dynamic images relevant for several aspects of management of the airway. Thus, it seems reasonable to consider the routine use of airway US in the ICU.
{"title":"Role of ultrasound in airway assessment in the respiratory ICUs","authors":"M. Ahmed, Iman Galal, H. Sakr, A. Gomaa, A. Osman, M. El-Assal","doi":"10.4103/ejb.ejb_59_19","DOIUrl":"https://doi.org/10.4103/ejb.ejb_59_19","url":null,"abstract":"Background Airway evaluation and its management remain an emerging clinical science. Ultrasound (US) provides point-of-care dynamic views of the airway in perioperative, emergency, and critical care settings. Identification of a difficult airway before intubation allows for optimal preparation, equipment selection, and participation of experienced personnel. Objective The aim of this study was to evaluate the role of US in the assessment of airways and to determine whether US has the potential to serve as an effective, noninvasive method for the diagnosis of tracheomalacia. Patients and methods A prospective cross-sectional study was carried out on patients admitted at the respiratory ICU. US examination of the airways and diaphragm was performed together with either fiberoptic bronchoscopy (FOB) or dynamic expiratory computed tomography chest. Dynamic expiratory computed tomography chest and FOB were done within 24 h of US examination. Results A total of 53 patients were included. US could successfully confirm endotracheal tube (ETT) placement in all patients. ETT was endotracheal in 30 (94%) patients, whereas it was esophageal in two (6%) patients. Hyomental distance at a cut-off of up to 4.51 cm was a good predictor of difficult intubation with 100% sensitivity and 87.5% specificity. Subglottic airway transverse diameter was used as a predictor of ETT size. Patients with tracheomalacia by FOB had a significantly longer duration of mechanical ventilation. Lateral pharyngeal wall thickness was used as a predictor of obstructive sleep apnea, a new cut-off point was used at more than 4.1 cm in the intubated group of patients with 87.5% sensitivity and 95.8% specificity, whereas a cut-off point more than 4.2 cm in the nonintubated patients had 100% sensitivity and 100% specificity. In the intubated group, out of the seven cases diagnosed with tracheomalacia by FOB, five patients were missed by US with 40% sensitivity, whereas in the nonintubated group, the results were significantly better, where only one case was missed by US with 80% sensitivity. Conclusion US has many advantages for imaging the airway; it is safe, quick, repeatable, portable, widely available, and provides real-time dynamic images relevant for several aspects of management of the airway. Thus, it seems reasonable to consider the routine use of airway US in the ICU.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47414572","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}
Rajesh Gupta, Sharad Joshi, Ankit Bhatia, Nitesh Tayal, P. Pandey
Background Endobronchial ultrasound (EBUS) is useful in guiding needle biopsy of mediastinal lesions. Sonoelastography in latest generation machines have enabled mapping the elasticity of the lymph nodes (LNs) leading to potentially better guidance in taking samples. Aim We aim to assess the practical usefulness of elastography in assessing mediastinal lymphadenopathy by comparing the patterns seen on EBUS elastography with the final pathological diagnosis from EBUS-guided transbronchial needle aspiration. Patients and methods The EBUS scope (convex) was intubated via the oral route, and images were generated to evaluate the patterns produced during elastography according to color distribution: type 1 was taken as predominantly nonblue (yellow, red, and green); type 2 was less than 50% blue color, part nonblue (yellow, red, and green); type 3 predominant blue. Elastography patterns were subsequently compared with the eventual pathological results. Results In the study period, 105 LNs in 80 patients were studied, 79 were found to be of benign nature while 26 patients were diagnosed as malignancy. Type 1 LNs were of benign pathology in 42/46 (91.30%) cases and malignant in 4/46 (8.70%) cases; for type 2 LNs, 24/30 (80%) cases were benign and 6/30 (20%) cases were malignant. Type 3 nodes were found to be of benign nature in 13/29 (44.82%) cases and malignant in 16 (55.14%) cases. On classifying type 1 group and type 2 group as ‘benign’ and type 3 group as malignant in nature, the sensitivity, specificity, negative predictive value, positive predictive value, and diagnostic accuracy rates were found to be 83.54, 61.54, 86.84, 55.17, and 78.10%. Conclusions The addition of elastography while performing EBUS of mediastinal lymphadenopathy is a technique that may be helpful in selecting sites for EBUS-guided transbronchial needle aspiration; however, more studies are needed to access its practical usefulness.
{"title":"Qualitative role of endobronchial elastography with endobronchial ultrasound in differentiating malignant and benign lesions: a retrospective single-center study from India","authors":"Rajesh Gupta, Sharad Joshi, Ankit Bhatia, Nitesh Tayal, P. Pandey","doi":"10.4103/ejb.ejb_49_19","DOIUrl":"https://doi.org/10.4103/ejb.ejb_49_19","url":null,"abstract":"Background Endobronchial ultrasound (EBUS) is useful in guiding needle biopsy of mediastinal lesions. Sonoelastography in latest generation machines have enabled mapping the elasticity of the lymph nodes (LNs) leading to potentially better guidance in taking samples. Aim We aim to assess the practical usefulness of elastography in assessing mediastinal lymphadenopathy by comparing the patterns seen on EBUS elastography with the final pathological diagnosis from EBUS-guided transbronchial needle aspiration. Patients and methods The EBUS scope (convex) was intubated via the oral route, and images were generated to evaluate the patterns produced during elastography according to color distribution: type 1 was taken as predominantly nonblue (yellow, red, and green); type 2 was less than 50% blue color, part nonblue (yellow, red, and green); type 3 predominant blue. Elastography patterns were subsequently compared with the eventual pathological results. Results In the study period, 105 LNs in 80 patients were studied, 79 were found to be of benign nature while 26 patients were diagnosed as malignancy. Type 1 LNs were of benign pathology in 42/46 (91.30%) cases and malignant in 4/46 (8.70%) cases; for type 2 LNs, 24/30 (80%) cases were benign and 6/30 (20%) cases were malignant. Type 3 nodes were found to be of benign nature in 13/29 (44.82%) cases and malignant in 16 (55.14%) cases. On classifying type 1 group and type 2 group as ‘benign’ and type 3 group as malignant in nature, the sensitivity, specificity, negative predictive value, positive predictive value, and diagnostic accuracy rates were found to be 83.54, 61.54, 86.84, 55.17, and 78.10%. Conclusions The addition of elastography while performing EBUS of mediastinal lymphadenopathy is a technique that may be helpful in selecting sites for EBUS-guided transbronchial needle aspiration; however, more studies are needed to access its practical usefulness.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44265108","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}
A. Sallam, M. Abo El Nasr, A. Elgebaly, Wael El Feky
Context Acute pulmonary embolism (PE) is a lethal sequela of venous thromboembolism (VTE). Surgical trauma injures the tissue directly, releasing a large number of tissue agent. The frequency of re-exploration owing to bleeding after lung surgery is between 1 and 3.7%, whereas the need of allogenic blood transfusion spans from 20 to 52%. Aims To assess the role of tranexamic acid (TXA) in reducing the need of allogenic blood transfusion in patients undergoing elective lung surgery. Patients and methods This retrospective study was conducted on 140 patients who underwent elective lung surgery. Patients were allocated into two groups. Group I patients received TXA at the end of procedure, and group II patients received blood and/or blood product transfusion. Statistical analysis Qualitative variables are expressed as mean±SD. Quantitative variables are compared by using the Student’s t test. Results The patients comprised 80 males and 60 females in our series. All cases in group II needed transfusion of one or more of the following: concentrated red blood cells, whole blood, fresh frozen plasma, and platelets. There was an obvious decrease in the postoperative hemoglobin level between groups, in favor of blood transfusion group (group II), and this was statistically significant. Conclusions Elective thoracic surgery patients have a low incidence of VTE and PE (2.85 and 2.14%, respectively). Hence, TXA helps in minimizing not only transfusion-related hazards but also operative cost.
{"title":"The use of tranexamic acid in elective lung surgery: a single-center experience","authors":"A. Sallam, M. Abo El Nasr, A. Elgebaly, Wael El Feky","doi":"10.4103/ejb.ejb_29_19","DOIUrl":"https://doi.org/10.4103/ejb.ejb_29_19","url":null,"abstract":"Context Acute pulmonary embolism (PE) is a lethal sequela of venous thromboembolism (VTE). Surgical trauma injures the tissue directly, releasing a large number of tissue agent. The frequency of re-exploration owing to bleeding after lung surgery is between 1 and 3.7%, whereas the need of allogenic blood transfusion spans from 20 to 52%. Aims To assess the role of tranexamic acid (TXA) in reducing the need of allogenic blood transfusion in patients undergoing elective lung surgery. Patients and methods This retrospective study was conducted on 140 patients who underwent elective lung surgery. Patients were allocated into two groups. Group I patients received TXA at the end of procedure, and group II patients received blood and/or blood product transfusion. Statistical analysis Qualitative variables are expressed as mean±SD. Quantitative variables are compared by using the Student’s t test. Results The patients comprised 80 males and 60 females in our series. All cases in group II needed transfusion of one or more of the following: concentrated red blood cells, whole blood, fresh frozen plasma, and platelets. There was an obvious decrease in the postoperative hemoglobin level between groups, in favor of blood transfusion group (group II), and this was statistically significant. Conclusions Elective thoracic surgery patients have a low incidence of VTE and PE (2.85 and 2.14%, respectively). Hence, TXA helps in minimizing not only transfusion-related hazards but also operative cost.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48287658","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}
A. Mohamed, M. Hantera, R. Sharshar, Amira Y Abdelnaby, Ayman El Saka
Background Non-small-cell lung cancer (NSCLC) represents 85% of lung cancer cases. Genotyping is now considered as a cornerstone in proper management and better results of such cancers, especially with targeted therapy. Cryobiopsy is a promising tool in NSCLC to obtain larger samples, with well-preserved tissue sufficient for accurate histopathological and gene detection. Aim To compare cryobiopsy and ordinary forceps results in detection of epidermal growth factor receptor (EGFR) amplification in NSCLC. Materials and methods Samples from 34 patients with proven NSCLC by cryobiopsy versus forceps biopsy were compared for size, quality, and diagnostic yield of EGFR gene amplification. Results The samples obtained by cryoprobe had larger size and better artifact-free areas with more diagnostic yield of EGFR gene amplification (29.4%) versus with forceps biopsy (8.8%), with gene amplification showing higher statistical significance in younger patients, never smokers, and women (P<0.001). Conclusion Cryobiopsy is an excellent tool for larger, better-quality sampling and for higher diagnostic yield of EGFR amplification in NSCLC.
{"title":"Comparison between cryobiopsy and forceps biopsy in detection of epidermal growth factor receptor amplification in non-small-cell lung cancer","authors":"A. Mohamed, M. Hantera, R. Sharshar, Amira Y Abdelnaby, Ayman El Saka","doi":"10.4103/ejb.ejb_40_19","DOIUrl":"https://doi.org/10.4103/ejb.ejb_40_19","url":null,"abstract":"Background Non-small-cell lung cancer (NSCLC) represents 85% of lung cancer cases. Genotyping is now considered as a cornerstone in proper management and better results of such cancers, especially with targeted therapy. Cryobiopsy is a promising tool in NSCLC to obtain larger samples, with well-preserved tissue sufficient for accurate histopathological and gene detection. Aim To compare cryobiopsy and ordinary forceps results in detection of epidermal growth factor receptor (EGFR) amplification in NSCLC. Materials and methods Samples from 34 patients with proven NSCLC by cryobiopsy versus forceps biopsy were compared for size, quality, and diagnostic yield of EGFR gene amplification. Results The samples obtained by cryoprobe had larger size and better artifact-free areas with more diagnostic yield of EGFR gene amplification (29.4%) versus with forceps biopsy (8.8%), with gene amplification showing higher statistical significance in younger patients, never smokers, and women (P<0.001). Conclusion Cryobiopsy is an excellent tool for larger, better-quality sampling and for higher diagnostic yield of EGFR amplification in NSCLC.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47740053","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}
Nasir Din Wani, Tasneem Muzaffar, S. Hussain, Yasir Wani, D. Zahoor, Aaliya Wani, F. Bashir
Over the past 10 decades, only five cases have been published of firearm injuries of the chest with conservative management, who in the follow-up expectorated the bullet. We report the first case in the history of gunshot injury chest, where a bullet was found near the posterior-lateral wall of the trachea of the patient who eventually expectorated the bullet with subsequent ingestion and excretion with stools. We try to emphasize the role of repeat morning radiograph in these patients.
{"title":"Tracheal bullet excreted with the stool: a rare course of events in airway gunshot injury","authors":"Nasir Din Wani, Tasneem Muzaffar, S. Hussain, Yasir Wani, D. Zahoor, Aaliya Wani, F. Bashir","doi":"10.4103/ejb.ejb_17_19","DOIUrl":"https://doi.org/10.4103/ejb.ejb_17_19","url":null,"abstract":"Over the past 10 decades, only five cases have been published of firearm injuries of the chest with conservative management, who in the follow-up expectorated the bullet. We report the first case in the history of gunshot injury chest, where a bullet was found near the posterior-lateral wall of the trachea of the patient who eventually expectorated the bullet with subsequent ingestion and excretion with stools. We try to emphasize the role of repeat morning radiograph in these patients.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44060315","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 Systemic corticosteroids (SCS) are effective in the management of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, they are not without adverse effects, especially hyperglycemia. Inhaled corticosteroids (ICS) showed satisfactory outcomes with good safety. These benefits were not evaluated in patients with AECOPD with diabetes mellitus. The aim was to compare the efficacy and safety of high dose of ICS vs SCS in the treatment of AECOPD in diabetic patients. Patients and methods A total of 126 patients with AECOPD were screened, and thirty of them were found to be eligible and were enrolled into two groups: group 1 (n=15) received 1 mg budesonide by jet nebulizer four times daily, and group 2 (n=15) received 40 mg prednisolone or equivalent systemically. Postbronchodilator forced expiratory volume in 1 s (FEV1%) of predicted was measured at day 1 and day 7, and random blood sugar (RBG) was measured twice daily in all patients. Results There was a significant increase in the mean FEV1 at day 7 as compared with mean FEV1 at day 1 in groups 1 and 2, with the increase in mean FEV1 being 19.6 and 21% in groups 1 and 2, respectively. There was a significant difference, with higher mean RBG in group 2 when compared with group 1, at day 4 of treatment and continued onward. Interestingly, there was a significant elevation in mean RBG among patients in group 2 (SCS) starting by day 3 of treatment and continued onward, with no significant rise in the first two days, although there was no evident effect of ICS on the mean RBG among patients in group 1 (ICS) during the follow-up days. Conclusion Both ICS and SCS improve airflow in patients with AECOPD, taking into consideration the existence of diabetes mellitus. ICS may be an excellent substitute to SCS in the treatment of AECOPD in diabetic patients.
{"title":"Assessment of high-dose inhalational corticosteroids vs systemic corticosteroids in acute exacerbations of COPD in diabetic patients","authors":"A. Magdy, Haytham S. Diab","doi":"10.4103/ejb.ejb_71_19","DOIUrl":"https://doi.org/10.4103/ejb.ejb_71_19","url":null,"abstract":"Background Systemic corticosteroids (SCS) are effective in the management of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). However, they are not without adverse effects, especially hyperglycemia. Inhaled corticosteroids (ICS) showed satisfactory outcomes with good safety. These benefits were not evaluated in patients with AECOPD with diabetes mellitus. The aim was to compare the efficacy and safety of high dose of ICS vs SCS in the treatment of AECOPD in diabetic patients. Patients and methods A total of 126 patients with AECOPD were screened, and thirty of them were found to be eligible and were enrolled into two groups: group 1 (n=15) received 1 mg budesonide by jet nebulizer four times daily, and group 2 (n=15) received 40 mg prednisolone or equivalent systemically. Postbronchodilator forced expiratory volume in 1 s (FEV1%) of predicted was measured at day 1 and day 7, and random blood sugar (RBG) was measured twice daily in all patients. Results There was a significant increase in the mean FEV1 at day 7 as compared with mean FEV1 at day 1 in groups 1 and 2, with the increase in mean FEV1 being 19.6 and 21% in groups 1 and 2, respectively. There was a significant difference, with higher mean RBG in group 2 when compared with group 1, at day 4 of treatment and continued onward. Interestingly, there was a significant elevation in mean RBG among patients in group 2 (SCS) starting by day 3 of treatment and continued onward, with no significant rise in the first two days, although there was no evident effect of ICS on the mean RBG among patients in group 1 (ICS) during the follow-up days. Conclusion Both ICS and SCS improve airflow in patients with AECOPD, taking into consideration the existence of diabetes mellitus. ICS may be an excellent substitute to SCS in the treatment of AECOPD in diabetic patients.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44061327","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 This study was carried out to validate the NoSAS score and assess its performance in predicting clinically significant sleep-disordered breathing (SDB) in patients referred for a sleep study and to compare its performance with the recent (No-Apnea score) and the STOP-BANG questionnaire. Patients and methods This is a retrospective study of an existing database of consecutive outpatients who were referred for suspected SDB at the sleep lab of Chest Department in Alexandria Main University Hospital from October 2012 to December 2018. We enrolled patients of at least 18 years who completed a full-night polysomnography. We defined clinically significant SDB as an apnea–hypopnea index (AHI) of at least 20 events/h. We assessed the validity of the NoSAS score and compared its performance with the No-Apnea score and the STOP-BANG questionnaire. Results After the exclusion of patients who did not fulfill our inclusion criteria, 362 out of 720 patients were enrolled. Only 5% were not diagnosed with SDB (AHI<5). Moderate-severe SDB was present in 82.4% of patients. Using a threshold of at least 8 at different AHI cut-offs (5, 10, 15, 20, 25, 30), the NoSAS score showed area under the curve (AUC) similar to the STOP-BANG Questionnaire only at AHI of at least 20 (AUC 0.77), whereas at the other AHI cut-offs (5, 10, 25, 30), the STOP-BANG Questionnaire showed higher AUC. At all AHI cut-offs, the NoSAS score was superior to the No-Apnea score. Conclusion Despite its simplicity, the NoSAS score is a valuable screening tool, especially when resources are limited.
{"title":"Validation of the NoSAS score for the screening of sleep-disordered breathing: a retrospective study in Egypt","authors":"R. Sweed, Mahmoud I. Mahmoud","doi":"10.4103/ejb.ejb_45_19","DOIUrl":"https://doi.org/10.4103/ejb.ejb_45_19","url":null,"abstract":"Background This study was carried out to validate the NoSAS score and assess its performance in predicting clinically significant sleep-disordered breathing (SDB) in patients referred for a sleep study and to compare its performance with the recent (No-Apnea score) and the STOP-BANG questionnaire. Patients and methods This is a retrospective study of an existing database of consecutive outpatients who were referred for suspected SDB at the sleep lab of Chest Department in Alexandria Main University Hospital from October 2012 to December 2018. We enrolled patients of at least 18 years who completed a full-night polysomnography. We defined clinically significant SDB as an apnea–hypopnea index (AHI) of at least 20 events/h. We assessed the validity of the NoSAS score and compared its performance with the No-Apnea score and the STOP-BANG questionnaire. Results After the exclusion of patients who did not fulfill our inclusion criteria, 362 out of 720 patients were enrolled. Only 5% were not diagnosed with SDB (AHI<5). Moderate-severe SDB was present in 82.4% of patients. Using a threshold of at least 8 at different AHI cut-offs (5, 10, 15, 20, 25, 30), the NoSAS score showed area under the curve (AUC) similar to the STOP-BANG Questionnaire only at AHI of at least 20 (AUC 0.77), whereas at the other AHI cut-offs (5, 10, 25, 30), the STOP-BANG Questionnaire showed higher AUC. At all AHI cut-offs, the NoSAS score was superior to the No-Apnea score. Conclusion Despite its simplicity, the NoSAS score is a valuable screening tool, especially when resources are limited.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46470376","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}
Tajik Shafi, N. Haridas, Preeti Belagundi, Asmita A. Mehta
Endotracheal tube stylets are still being used in many medical centres for difficult intubations. In rare cases, it may break inside the trachea during endotracheal intubation and may sometimes move unnoticed deep into the tracheobronchial tree. In this case report, the authors describe a rare complication after endotracheal tube (ETT) stylet intubation in a patient in whom a broken piece of metal guide remained in her tracheobronchial tree. A 69-year-old lady was admitted to our hospital for management of shortness of breath and cough with expectoration. The patient was a known case of chronic obstructive pulmonary disease, cor pulmonale and coronary artery disease. The authors report a case of an unrecognized broken piece of stylet in her tracheobronchial tree and left main bronchus, which was later detected by computed tomography scan and extracted. Despite precise evaluation before use, signs of breakage in the stylet may be missed, and, consequently, it may break inside the trachea and result in serious complications. It is strongly recommended that the intensivists pay attention to the sounds and movements of the instruments.
{"title":"A piece of broken intubation tube stylet as endobronchial foreign body","authors":"Tajik Shafi, N. Haridas, Preeti Belagundi, Asmita A. Mehta","doi":"10.4103/ejb.ejb_52_19","DOIUrl":"https://doi.org/10.4103/ejb.ejb_52_19","url":null,"abstract":"Endotracheal tube stylets are still being used in many medical centres for difficult intubations. In rare cases, it may break inside the trachea during endotracheal intubation and may sometimes move unnoticed deep into the tracheobronchial tree. In this case report, the authors describe a rare complication after endotracheal tube (ETT) stylet intubation in a patient in whom a broken piece of metal guide remained in her tracheobronchial tree. A 69-year-old lady was admitted to our hospital for management of shortness of breath and cough with expectoration. The patient was a known case of chronic obstructive pulmonary disease, cor pulmonale and coronary artery disease. The authors report a case of an unrecognized broken piece of stylet in her tracheobronchial tree and left main bronchus, which was later detected by computed tomography scan and extracted. Despite precise evaluation before use, signs of breakage in the stylet may be missed, and, consequently, it may break inside the trachea and result in serious complications. It is strongly recommended that the intensivists pay attention to the sounds and movements of the instruments.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42885391","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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