Esmat Abd Elnaby, Samah Abd Elnaiem, A. Mostafa, D. Sabry, A. Alnaggar, Mohamed Haswa
Background Chronic obstructive pulmonary disease (COPD) is a common disease that can be prevented and even treated. It leads to high morbidity and mortality rates. Pro-inflammatory cytokines and oxidative radicals were found to be implicated in COPD pathogenesis. Objectives To measure serum level of interleukin 6 (IL-6) in patients with stable COPD and also to detect the relationship of IL-6 levels with COPD severity. Patients and methods A total of 50 patients having stable COPD, in addition to 20 healthy control individuals, were included in the study. History taking and clinical examination, BMI calculation, spirometry (postbronchodilator spirometry in COPD group), and 6-min walk test were done for all patients. Measurement of serum level of IL-6 was done by using the enzyme-linked immunosorbent assay. Results Serum level of IL-6 showed significantly higher concentrations among patients with COPD compared with healthy individuals [359.87±106.99 and 188.92±77.97 pg/ml, respectively; P<0.001]. An inverse nonsignificant correlation was found between serum level of IL-6 and 6-min walk test distance, forced expiratory volume in the 1 s, forced vital capacity, and maximum expiratory flow 25–75% predicted values. Mean IL-6 level was higher in the patients with severe and very severe COPD (371.75±103.12 pg/ml) compared with those with mild and moderate COPD (336.82±113.72 pg/ml) (P=0.291). Conclusion Serum level of IL-6 showed significant higher concentrations in patients with COPD when compared with control ones, but IL-6 level did not show significant correlation with the disease severity.
{"title":"Assessment of serum interleukin 6 level in patients with chronic obstructive pulmonary disease: is it related to disease severity?","authors":"Esmat Abd Elnaby, Samah Abd Elnaiem, A. Mostafa, D. Sabry, A. Alnaggar, Mohamed Haswa","doi":"10.4103/ejb.ejb_50_19","DOIUrl":"https://doi.org/10.4103/ejb.ejb_50_19","url":null,"abstract":"Background Chronic obstructive pulmonary disease (COPD) is a common disease that can be prevented and even treated. It leads to high morbidity and mortality rates. Pro-inflammatory cytokines and oxidative radicals were found to be implicated in COPD pathogenesis. Objectives To measure serum level of interleukin 6 (IL-6) in patients with stable COPD and also to detect the relationship of IL-6 levels with COPD severity. Patients and methods A total of 50 patients having stable COPD, in addition to 20 healthy control individuals, were included in the study. History taking and clinical examination, BMI calculation, spirometry (postbronchodilator spirometry in COPD group), and 6-min walk test were done for all patients. Measurement of serum level of IL-6 was done by using the enzyme-linked immunosorbent assay. Results Serum level of IL-6 showed significantly higher concentrations among patients with COPD compared with healthy individuals [359.87±106.99 and 188.92±77.97 pg/ml, respectively; P<0.001]. An inverse nonsignificant correlation was found between serum level of IL-6 and 6-min walk test distance, forced expiratory volume in the 1 s, forced vital capacity, and maximum expiratory flow 25–75% predicted values. Mean IL-6 level was higher in the patients with severe and very severe COPD (371.75±103.12 pg/ml) compared with those with mild and moderate COPD (336.82±113.72 pg/ml) (P=0.291). Conclusion Serum level of IL-6 showed significant higher concentrations in patients with COPD when compared with control ones, but IL-6 level did not show significant correlation with the disease severity.","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":"42165109","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}
Mediastinal abscess is a rare yet emergent infectious complication of the thoracic cavity following balloon dilatation of the esophagus. Early diagnosis and management could avoid its poor outcome. A 20-year-old man with esophageal stricture underwent balloon dilatation. A mediastinal abscess developed 2 weeks after procedure. Computed tomographic chest helped in diagnosis and guiding approach of management. Surgical drainage and debridement of the abscess were performed. Surgical treatment combined with systemic antibiotics was effective, leading to remission of the abscess. Mediastinal abscess should be considered as a possible infectious complication after upper endoscopy. Computed tomographic scan is a mandatory imaging modality to enable early diagnosis. Aggressive treatment including surgical drainage combined with medical management is the treatment of choice that may prevent catastrophic outcome.
{"title":"Mediastinal abscess complicating esophageal dilatation: a case report","authors":"D. Magdy, S. Farghaly, A. Metwally","doi":"10.4103/ejb.ejb_10_19","DOIUrl":"https://doi.org/10.4103/ejb.ejb_10_19","url":null,"abstract":"Mediastinal abscess is a rare yet emergent infectious complication of the thoracic cavity following balloon dilatation of the esophagus. Early diagnosis and management could avoid its poor outcome. A 20-year-old man with esophageal stricture underwent balloon dilatation. A mediastinal abscess developed 2 weeks after procedure. Computed tomographic chest helped in diagnosis and guiding approach of management. Surgical drainage and debridement of the abscess were performed. Surgical treatment combined with systemic antibiotics was effective, leading to remission of the abscess. Mediastinal abscess should be considered as a possible infectious complication after upper endoscopy. Computed tomographic scan is a mandatory imaging modality to enable early diagnosis. Aggressive treatment including surgical drainage combined with medical management is the treatment of choice that may prevent catastrophic outcome.","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":"45423714","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 Zinc is an important micronutrient in humans. Globally, pneumonia represents 18% of mortality in children under 5 years of age and the main infectious purpose of early life mortality. There is a higher pneumonia risk in a population with zinc deficiency. The aim of our study is to compare the level of serum zinc in children with pneumonia with age, sex, and nutritional matched healthy controls. Patients and methods Serum zinc level in 90 children admitted with pneumonia was compared with the matched controls. Results The mean level of serum zinc in children with pneumonia (67.5±21.8) is significantly lower than that of controls (91.8±19.94) with (P<0.001). Conclusion Children with pneumonia has a significantly lower serum zinc levels than matched healthy controls.
{"title":"Serum zinc levels in hospitalized children with pneumonia: a hospital-based case–control study","authors":"A. Hamed, Y. Kassem, Hamada Fayed, A. Solaiman","doi":"10.4103/ejb.ejb_30_19","DOIUrl":"https://doi.org/10.4103/ejb.ejb_30_19","url":null,"abstract":"Background Zinc is an important micronutrient in humans. Globally, pneumonia represents 18% of mortality in children under 5 years of age and the main infectious purpose of early life mortality. There is a higher pneumonia risk in a population with zinc deficiency. The aim of our study is to compare the level of serum zinc in children with pneumonia with age, sex, and nutritional matched healthy controls. Patients and methods Serum zinc level in 90 children admitted with pneumonia was compared with the matched controls. Results The mean level of serum zinc in children with pneumonia (67.5±21.8) is significantly lower than that of controls (91.8±19.94) with (P<0.001). Conclusion Children with pneumonia has a significantly lower serum zinc levels than matched healthy controls.","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":"70714303","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 Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Exacerbations of COPD are heterogeneous and have significant effect on the socioeconomic burden. The value of eosinophils (Eos) in predicting response to corticosteroids is documented in bronchial asthma exacerbation, but this value is not clear in COPD exacerbation. The aim of the study is to assess the prognostic value of blood Eos and C-reactive protein (CRP) in severe COPD exacerbations. Patients and methods A total of 120 patients with COPD with severe exacerbations were subjected to complete blood count picture analysis with differential count, including Eos and CRP. Cases were divided into eosinophilic and nonesinophilic groups using 2% as a threshold, and the outcomes were observed. Results The inpatient mortality rate was 10%, and it significantly correlated with noneosinophilic group (≤2%) (P=0.02). The length of stay in hospital and ICU was significantly lower in patients with eosinophilia more than or equal to 2%, with P value less than 0.001 for both. CRP and length of stay in hospital and ICU showed significant positive correlation. Conclusion Higher blood Eos and lower CRP levels can be used as predictors for better outcome in severe COPD exacerbations.
{"title":"Blood eosinophils and C-reactive protein as prognostic factors in severe chronic obstructive pulmonary disease exacerbations","authors":"H. Hafiz, H. Moussa","doi":"10.4103/ejb.ejb_42_19","DOIUrl":"https://doi.org/10.4103/ejb.ejb_42_19","url":null,"abstract":"Background Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide. Exacerbations of COPD are heterogeneous and have significant effect on the socioeconomic burden. The value of eosinophils (Eos) in predicting response to corticosteroids is documented in bronchial asthma exacerbation, but this value is not clear in COPD exacerbation. The aim of the study is to assess the prognostic value of blood Eos and C-reactive protein (CRP) in severe COPD exacerbations. Patients and methods A total of 120 patients with COPD with severe exacerbations were subjected to complete blood count picture analysis with differential count, including Eos and CRP. Cases were divided into eosinophilic and nonesinophilic groups using 2% as a threshold, and the outcomes were observed. Results The inpatient mortality rate was 10%, and it significantly correlated with noneosinophilic group (≤2%) (P=0.02). The length of stay in hospital and ICU was significantly lower in patients with eosinophilia more than or equal to 2%, with P value less than 0.001 for both. CRP and length of stay in hospital and ICU showed significant positive correlation. Conclusion Higher blood Eos and lower CRP levels can be used as predictors for better outcome in severe COPD exacerbations.","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":"42192853","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. Abdelhafiz, K. Khashab, A. Elessawy, R. Elhefny, Fatmaalzahraa Abdalrazik
Background The era of diagnosing pulmonary arterial hypertension is rapidly evolving. There are changes in the definition, screening, diagnostic modalities, and disease staging. Aim This study aims to assess pulmonary hypertension using computed tomography (CT) and echocardiography. Design This is a cross-sectional study. Participants and methods This study included 30 cases diagnosed with pulmonary artery hypertension according to the inclusion and exclusion criteria. All patients were subjected to a careful assessment of history, a skillful clinical examination, and investigations: (a) complete blood picture, liver kidney functions, bleeding profile, and arterial blood gases. (b) Spirometry. (c) Echocardiogram. (d) CT chest. Results The correlation between the ratio of main pulmonary artery and aorta to other study parameters was statistically significant. There was a negative statistically significant correlation between the mP/Ao ratio and oxygen saturation (P=0.001); however, we found a positive significant correlation between the mP/Ao ratio and ejection fraction (P=0.006), systolic pulmonary artery pressure (P<0.0001), and mean pulmonary artery pressure (P<0.0001). In contrast, the correlation was nonsignificant when the mP/Ao ratio was compared with other parameters (P>0.05), and a nonsignificant correlation was also found between systolic pulmonary artery pressure and duration of dyspnea (P>0.05). Conclusion This study has shown that combining CT and echocardiography in the diagnosis of pulmonary hypertension can be a reliable technique to measure mean pulmonary artery pressure than if any of both tests done separately.
{"title":"Assessment of the role of computed tomography versus echocardiography in pulmonary hypertension","authors":"A. Abdelhafiz, K. Khashab, A. Elessawy, R. Elhefny, Fatmaalzahraa Abdalrazik","doi":"10.4103/ejb.ejb_56_19","DOIUrl":"https://doi.org/10.4103/ejb.ejb_56_19","url":null,"abstract":"Background The era of diagnosing pulmonary arterial hypertension is rapidly evolving. There are changes in the definition, screening, diagnostic modalities, and disease staging. Aim This study aims to assess pulmonary hypertension using computed tomography (CT) and echocardiography. Design This is a cross-sectional study. Participants and methods This study included 30 cases diagnosed with pulmonary artery hypertension according to the inclusion and exclusion criteria. All patients were subjected to a careful assessment of history, a skillful clinical examination, and investigations: (a) complete blood picture, liver kidney functions, bleeding profile, and arterial blood gases. (b) Spirometry. (c) Echocardiogram. (d) CT chest. Results The correlation between the ratio of main pulmonary artery and aorta to other study parameters was statistically significant. There was a negative statistically significant correlation between the mP/Ao ratio and oxygen saturation (P=0.001); however, we found a positive significant correlation between the mP/Ao ratio and ejection fraction (P=0.006), systolic pulmonary artery pressure (P<0.0001), and mean pulmonary artery pressure (P<0.0001). In contrast, the correlation was nonsignificant when the mP/Ao ratio was compared with other parameters (P>0.05), and a nonsignificant correlation was also found between systolic pulmonary artery pressure and duration of dyspnea (P>0.05). Conclusion This study has shown that combining CT and echocardiography in the diagnosis of pulmonary hypertension can be a reliable technique to measure mean pulmonary artery pressure than if any of both tests done separately.","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":"45215131","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}
Introduction Granulomatosis with polyangiitis (GPA) is one of the forms of small vessel vasculitis. It is a rare condition that needs a high degree of suspicion to reach the diagnosis. It is one of the causes of diffuse parenchymal lung disease, with a very wide differential diagnosis. It is commonly misdiagnosed with malignant, granulomatous, and infectious lung diseases. Case presentation We report a case of a 31-year-old male who presented with productive cough, shortness of breath, hemoptysis, nasal obstruction, and epistaxis together with submandibular salivary gland swelling. Diagnosis of GPA was based on characteristic cavitary lung lesions, nasal and salivary gland involvement, pathological samples that revealed necrotizing granulomatous inflammation, characteristic positive Cytoplasmic- ANCA (C-ANCA), together with exclusion of malignancy and tuberculosis. Conclusion GPA is a rare condition. Salivary gland involvement should raise suspicion about GPA, in addition to other systemic manifestations.
{"title":"Submandibular salivary gland involvement in granulomatosis with polyangiitis","authors":"M. Abdelghany, Mohammad Khalaf","doi":"10.4103/ejb.ejb_15_19","DOIUrl":"https://doi.org/10.4103/ejb.ejb_15_19","url":null,"abstract":"Introduction Granulomatosis with polyangiitis (GPA) is one of the forms of small vessel vasculitis. It is a rare condition that needs a high degree of suspicion to reach the diagnosis. It is one of the causes of diffuse parenchymal lung disease, with a very wide differential diagnosis. It is commonly misdiagnosed with malignant, granulomatous, and infectious lung diseases. Case presentation We report a case of a 31-year-old male who presented with productive cough, shortness of breath, hemoptysis, nasal obstruction, and epistaxis together with submandibular salivary gland swelling. Diagnosis of GPA was based on characteristic cavitary lung lesions, nasal and salivary gland involvement, pathological samples that revealed necrotizing granulomatous inflammation, characteristic positive Cytoplasmic- ANCA (C-ANCA), together with exclusion of malignancy and tuberculosis. Conclusion GPA is a rare condition. Salivary gland involvement should raise suspicion about GPA, in addition to other systemic manifestations.","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":"48839271","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}
N. M. A. Elsaid, A. Refaat, Lamiaa A. Fiala, Eman R. Hamed
Background Delayed diagnosis of tuberculosis (TB) can enhance the transmission of infection and worsen prognosis. Aim To identify the risk factors of delay in the management of TB cases for early management. Patients and methods A cross-sectional analytic study was performed to assess the proportion, duration of delay, and its determinants in the diagnosis and management of TB. To assess the risk factors of delay, the sample was dichotomized into ‘delay’ and ‘nondelay’ groups taking the median total delay in the diagnosis and management of TB as a cutoff point. The study included 183 TB patients, who were registered in TB records during the study period (first of January to end of June, 2017). Data were collected by an interview questionnaire. Results Nearly half of patients (49.20%) had unacceptable total delay in the diagnosis and management of TB. The median of total delay, patient delay, and health-care system delay were 65, 14, and 20 days, respectively. Significant risk factors of total delay in the diagnosis and management of TB were not consulting the health-care provider after onset of symptoms (P=0.002), visiting initially the health facility other than the chest hospital/TB clinics (P=0.019), not consulting a chest physician initially (P=0.043), negative sputum smear (P=0.001), more than two health visits before initial diagnosis (P<0.001), while low-degree TB stigma was protective (P=0.006). Conclusion Nearly half of patients had unacceptable total delay in the diagnosis and management of TB. The main determinants were seeking pharmacies instead of visiting health-care providers, not visiting initially chest hospital/TB clinics, not consulting a chest physician initially, negative sputum smear, and more than two health visits before initial diagnosis.
{"title":"Delay in the diagnosis and management of tuberculosis among patients in the Suez Canal Area","authors":"N. M. A. Elsaid, A. Refaat, Lamiaa A. Fiala, Eman R. Hamed","doi":"10.4103/ejb.ejb_8_19","DOIUrl":"https://doi.org/10.4103/ejb.ejb_8_19","url":null,"abstract":"Background Delayed diagnosis of tuberculosis (TB) can enhance the transmission of infection and worsen prognosis. Aim To identify the risk factors of delay in the management of TB cases for early management. Patients and methods A cross-sectional analytic study was performed to assess the proportion, duration of delay, and its determinants in the diagnosis and management of TB. To assess the risk factors of delay, the sample was dichotomized into ‘delay’ and ‘nondelay’ groups taking the median total delay in the diagnosis and management of TB as a cutoff point. The study included 183 TB patients, who were registered in TB records during the study period (first of January to end of June, 2017). Data were collected by an interview questionnaire. Results Nearly half of patients (49.20%) had unacceptable total delay in the diagnosis and management of TB. The median of total delay, patient delay, and health-care system delay were 65, 14, and 20 days, respectively. Significant risk factors of total delay in the diagnosis and management of TB were not consulting the health-care provider after onset of symptoms (P=0.002), visiting initially the health facility other than the chest hospital/TB clinics (P=0.019), not consulting a chest physician initially (P=0.043), negative sputum smear (P=0.001), more than two health visits before initial diagnosis (P<0.001), while low-degree TB stigma was protective (P=0.006). Conclusion Nearly half of patients had unacceptable total delay in the diagnosis and management of TB. The main determinants were seeking pharmacies instead of visiting health-care providers, not visiting initially chest hospital/TB clinics, not consulting a chest physician initially, negative sputum smear, and more than two health visits before initial diagnosis.","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":"43492719","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 is a promising technique for structural and functional evaluation of the diaphragm. It is accurate, reproducible, and portable with no ionizing radiation. Multiple studies have reported ultrasonography as the modality of choice for evaluation of the diaphragm. Objective The aim was to assess the role of ultrasound (US) in the evaluation of the diaphragm, either normal or abnormal, through evaluating its morphology, integrity, and measuring different parameters such as diaphragmatic thickness, thickening fraction, and excursion with proper assessment of supra/infradiaphragmatic lesions that affect the diaphragm. Patients and methods In all, 118 patients were recruited from the Chest and Radiology Departments, Cairo University, in the period from January to July 2019. All patients were subjected to history taking, clinical examination, and ultrasonographic assessment of the diaphragm. High-frequency linear transducer of 7.5–12 MHz was used for imaging the diaphragm and measuring its thickness. A low-frequency curvilinear transducer with a frequency of 3.5–5 MHz was used for assessing diaphragmatic excursion. Results Cases were grouped into two groups, those with normal US findings of the diaphragm represented group A, while patients with any diaphragmatic abnormality represented group B. Group B included 41 patients with intrinsic (56.09%) and extrinsic diaphragmatic abnormalities (46.34%). Five (12.2%) cases have thickened diaphragm; two (4.9%) cases have thinned-out diaphragm; two (4.9%) cases showed congenital diaphragmatic defects; three (7.3%) cases showed acquired diaphragmatic defects; 10 (24.4%) cases showed diaphragmatic weakness; and nine (21.95%) cases showed diaphragmatic paralysis (7.6%). Conclusion US is the technique of choice for assessing diaphragmatic movement on suspicion of malfunctioning. Ultrasonography is a promising technique for structural and functional evaluation of the diaphragm.
{"title":"Ultrasonographic evaluation of the diaphragm","authors":"Y. Sabri, S. Hussein, Ahmed A. Baz, A. Aglan","doi":"10.4103/ejb.ejb_73_19","DOIUrl":"https://doi.org/10.4103/ejb.ejb_73_19","url":null,"abstract":"Background Ultrasonography is a promising technique for structural and functional evaluation of the diaphragm. It is accurate, reproducible, and portable with no ionizing radiation. Multiple studies have reported ultrasonography as the modality of choice for evaluation of the diaphragm. Objective The aim was to assess the role of ultrasound (US) in the evaluation of the diaphragm, either normal or abnormal, through evaluating its morphology, integrity, and measuring different parameters such as diaphragmatic thickness, thickening fraction, and excursion with proper assessment of supra/infradiaphragmatic lesions that affect the diaphragm. Patients and methods In all, 118 patients were recruited from the Chest and Radiology Departments, Cairo University, in the period from January to July 2019. All patients were subjected to history taking, clinical examination, and ultrasonographic assessment of the diaphragm. High-frequency linear transducer of 7.5–12 MHz was used for imaging the diaphragm and measuring its thickness. A low-frequency curvilinear transducer with a frequency of 3.5–5 MHz was used for assessing diaphragmatic excursion. Results Cases were grouped into two groups, those with normal US findings of the diaphragm represented group A, while patients with any diaphragmatic abnormality represented group B. Group B included 41 patients with intrinsic (56.09%) and extrinsic diaphragmatic abnormalities (46.34%). Five (12.2%) cases have thickened diaphragm; two (4.9%) cases have thinned-out diaphragm; two (4.9%) cases showed congenital diaphragmatic defects; three (7.3%) cases showed acquired diaphragmatic defects; 10 (24.4%) cases showed diaphragmatic weakness; and nine (21.95%) cases showed diaphragmatic paralysis (7.6%). Conclusion US is the technique of choice for assessing diaphragmatic movement on suspicion of malfunctioning. Ultrasonography is a promising technique for structural and functional evaluation of the diaphragm.","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":"47757056","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. Akl, Raef Emam, A. El-Habashi, M. Ismail, H. Abdallah
Background The course of hypersensitivity pneumonitis (HP) is characterized by variable patterns of disease progression. Refractory HP is defined as poor or lack of response to different modalities of treatment with worsening of the functional status. Aim To assess the causes of refractory HP and to evaluate the correlation between disease progression and different histopathologic findings in patients with HP. Patients and methods We included 20 patients who were diagnosed primarily as HP and proved to be refractory to treatment. All patients were subjected to the following: complete history taking and clinical examination, spirometry, 6-min walk test, high-resolution CT chest, echocardiography, and transbronchial lung biopsy. Results Female sex was predominant among the studied patients. The mean age of our patients was 39.9±13.49 years. Overall, 65% of these patients were raising birds, but the offending agent was not identified in 30% of patients. Almost all patients presented with restrictive lung functions (mean forced vital capacity=59±10%), and radiologically, they mainly presented with centrilobular ground-glass and nodular opacities. Histopathological results showed that there was isolated HP pathology in 40% of patients and HP with associated pathologies in 60% of cases without significant fibrotic changes. Conclusion HP is more common in women and middle ages. Histopathological findings revealed no significant fibrotic changes in most of the cases, so other mechanisms may be involved in disease progression and may affect treatment response.
{"title":"Histopathological findings in patients with refractory nonfibrotic hypersensitivity pneumonitis","authors":"Y. Akl, Raef Emam, A. El-Habashi, M. Ismail, H. Abdallah","doi":"10.4103/ejb.ejb_28_19","DOIUrl":"https://doi.org/10.4103/ejb.ejb_28_19","url":null,"abstract":"Background The course of hypersensitivity pneumonitis (HP) is characterized by variable patterns of disease progression. Refractory HP is defined as poor or lack of response to different modalities of treatment with worsening of the functional status. Aim To assess the causes of refractory HP and to evaluate the correlation between disease progression and different histopathologic findings in patients with HP. Patients and methods We included 20 patients who were diagnosed primarily as HP and proved to be refractory to treatment. All patients were subjected to the following: complete history taking and clinical examination, spirometry, 6-min walk test, high-resolution CT chest, echocardiography, and transbronchial lung biopsy. Results Female sex was predominant among the studied patients. The mean age of our patients was 39.9±13.49 years. Overall, 65% of these patients were raising birds, but the offending agent was not identified in 30% of patients. Almost all patients presented with restrictive lung functions (mean forced vital capacity=59±10%), and radiologically, they mainly presented with centrilobular ground-glass and nodular opacities. Histopathological results showed that there was isolated HP pathology in 40% of patients and HP with associated pathologies in 60% of cases without significant fibrotic changes. Conclusion HP is more common in women and middle ages. Histopathological findings revealed no significant fibrotic changes in most of the cases, so other mechanisms may be involved in disease progression and may affect treatment response.","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":"42932063","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}
Esmat Abd Elnaby, Samah Abd Elnaiem, A. Mostafa, D. Sabry, Mohamed Haswa
Introduction There is not much data about the effect of deficient vitamin D on stable chronic obstructive pulmonary disease (COPD) patients and its relation to the disease severity. Objective The aim was to measure the serum level of 25-hydroxy (OH) vitamin D in stable COPD patients, and to assess its relation to COPD severity and functional parameters. Patients and methods A prospective study that was carried out at Chest Department, Kasr El-Aini Hospital, Cairo University. It was carried out on 70 male individuals: 50 stable COPD patients and 20 healthy individuals. All persons were subjected to history taking, clinical examination, 6 min walk test (6MWT), spirometry, and measurement of 25(OH) vitamin D serum level. Results Our results showed a deficiency of vitamin D in 37 (74%) of the COPD patients. It showed a significant lower level of 25(OH) vitamin D in COPD cases who were severe and very severe, compared with those who were mild and moderate ones (P=0.017). There was also a positive significant correlation between vitamin D level and 6 min walk distance, basal oxygen saturation, post-6MWT oxygen saturation, and forced expiratory volume in the first second predicted, and an inverse correlation with basal heart rate and post-6MWT heart rate. Conclusion The study highlights the value of measurement of vitamin D level in COPD, as a potential therapeutic agent. Vitamin D serum level showed low values in COPD cases compared with healthy ones and was correlated significantly to forced expiratory volume in the first second predicted.
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