D. Ramachandran, Rajesh Venkitakrishnan, Jolsana Augustine, Melcy Cleetus
Cervical lymphadenopathy is common in all age groups. Persistently enlarged cervical lymph nodes often pose a diagnostic challenge and necessitate focused clinical evaluation with targeted investigations. Pathological examination of excised node yields conclusive answer in the vast majority of cases with unsettled diagnosis. We present a case of a young man with persistent posterior cervical lymphadenopathy which on excision biopsy turned out to be Kikuchi–Fujimoto disease. With watchful follow-up, he had a self-limiting clinical course in the next few months.
{"title":"Spontaneous resolution of persistent lymphadenitis: a case of Kikuchi–Fujimoto disease","authors":"D. Ramachandran, Rajesh Venkitakrishnan, Jolsana Augustine, Melcy Cleetus","doi":"10.4103/ejb.ejb_26_19","DOIUrl":"https://doi.org/10.4103/ejb.ejb_26_19","url":null,"abstract":"Cervical lymphadenopathy is common in all age groups. Persistently enlarged cervical lymph nodes often pose a diagnostic challenge and necessitate focused clinical evaluation with targeted investigations. Pathological examination of excised node yields conclusive answer in the vast majority of cases with unsettled diagnosis. We present a case of a young man with persistent posterior cervical lymphadenopathy which on excision biopsy turned out to be Kikuchi–Fujimoto disease. With watchful follow-up, he had a self-limiting clinical course in the next few months.","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":"44280870","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. Laz, Mohammad Mohammad, S. Abdelsalam, Radwa Abdelwahab
Background Lung ultrasonography is a beneficial tool for evaluation of the extent of lung aeration through measurement of the amount of extravascular lung water. Lung ultrasonography offers some advantages over other methods of assessment of lung aeration including the lack of ionizing radiation and the possibility of use at patient’s bedside. It facilitates dynamic assessment of the lung during mechanical ventilation and during weaning. Aim To assess lung aeration by lung ultrasonography in patients ready for weaning and to validate the significance of its use as a predictor of weaning outcome in comparison with rapid shallow breathing index. Patients and methods A prospective observational study was conducted on 30 critically ill mechanically ventilated patients for 48 h or more, and ready to undergo spontaneous breathing trial (SBT), according to the readiness criteria. It was conducted in Beni-Suef University Hospital from October 2017 to May 2018. Rapid shallow breathing index was measured before initiation of SBT, and lung ultrasound was done, before, during, and after SBT [lung ultrasound score (LUS) 1, 2, and 3] and were used as predictors for SBT outcome. Patients were divided, according to outcome, into successful weaning group (group A) and failed weaning group (group B). Results In the failed weaning group, LUS1, LUS2, and LUS3 were significantly higher than those of the successful weaning group. At cutoff value of 8.5, LUS3 could be used for prediction of weaning failure with sensitivity 85% and specificity 100%. Moreover, there was a statistically significant relation between LUS and the other variables including hospital stay, mechanical ventilation duration, and mortality. Conclusion Lung ultrasound is useful as a bedside tool that can help physicians in their weaning decisions.
{"title":"Sonographic measurement of lung aeration versus rapid shallow breathing index as a predictor of successful weaning from mechanical ventilation","authors":"N. Laz, Mohammad Mohammad, S. Abdelsalam, Radwa Abdelwahab","doi":"10.4103/ejb.ejb_7_19","DOIUrl":"https://doi.org/10.4103/ejb.ejb_7_19","url":null,"abstract":"Background Lung ultrasonography is a beneficial tool for evaluation of the extent of lung aeration through measurement of the amount of extravascular lung water. Lung ultrasonography offers some advantages over other methods of assessment of lung aeration including the lack of ionizing radiation and the possibility of use at patient’s bedside. It facilitates dynamic assessment of the lung during mechanical ventilation and during weaning. Aim To assess lung aeration by lung ultrasonography in patients ready for weaning and to validate the significance of its use as a predictor of weaning outcome in comparison with rapid shallow breathing index. Patients and methods A prospective observational study was conducted on 30 critically ill mechanically ventilated patients for 48 h or more, and ready to undergo spontaneous breathing trial (SBT), according to the readiness criteria. It was conducted in Beni-Suef University Hospital from October 2017 to May 2018. Rapid shallow breathing index was measured before initiation of SBT, and lung ultrasound was done, before, during, and after SBT [lung ultrasound score (LUS) 1, 2, and 3] and were used as predictors for SBT outcome. Patients were divided, according to outcome, into successful weaning group (group A) and failed weaning group (group B). Results In the failed weaning group, LUS1, LUS2, and LUS3 were significantly higher than those of the successful weaning group. At cutoff value of 8.5, LUS3 could be used for prediction of weaning failure with sensitivity 85% and specificity 100%. Moreover, there was a statistically significant relation between LUS and the other variables including hospital stay, mechanical ventilation duration, and mortality. Conclusion Lung ultrasound is useful as a bedside tool that can help physicians in their weaning decisions.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42327000","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 An increase in serum lactate dehydrogenase (LDH) activity is commonly taken to support the presumptive diagnosis of some lung diseases and a variety of extrapulmonary disorders, but the role of LDH as an early prognostic factor in detecting outcome in patients with community acquired pneumonia (CAP) was not well studied before. Aim To assess the prognostic value of LDH and other laboratory markers [C-reactive protein (CRP), serum albumin, and neutrophil percentage] in patients with CAP. Patients and methods We compared levels of LDH and other laboratory markers (CRP, serum albumin, and neutrophil percentage) with each other and with CURB65 score, length of hospital stay, and worse outcomes (ICU admission, mechanical ventilation, and mortality) in 62 (33 males and 29 females) patients with CAP who were admitted to Pulmonology Department, Benha University Hospital, between March 2016 and March 2017 after ethical committee approval. Results Most of the patients with worse outcomes showed significant high levels of LDH, CRP, albumin, and neutrophil percentage early on admission. Conclusion LDH was a highly sensitive biomarker for early prediction of worse outcomes in patients with CAP.
{"title":"Role of lactate dehydrogenase and other biomarkers in predicting prognosis of community-acquired pneumonia","authors":"Rasha M. Hendy, M. Elawady, Heba M. Abd El Kareem","doi":"10.4103/ejb.ejb_22_19","DOIUrl":"https://doi.org/10.4103/ejb.ejb_22_19","url":null,"abstract":"Background An increase in serum lactate dehydrogenase (LDH) activity is commonly taken to support the presumptive diagnosis of some lung diseases and a variety of extrapulmonary disorders, but the role of LDH as an early prognostic factor in detecting outcome in patients with community acquired pneumonia (CAP) was not well studied before. Aim To assess the prognostic value of LDH and other laboratory markers [C-reactive protein (CRP), serum albumin, and neutrophil percentage] in patients with CAP. Patients and methods We compared levels of LDH and other laboratory markers (CRP, serum albumin, and neutrophil percentage) with each other and with CURB65 score, length of hospital stay, and worse outcomes (ICU admission, mechanical ventilation, and mortality) in 62 (33 males and 29 females) patients with CAP who were admitted to Pulmonology Department, Benha University Hospital, between March 2016 and March 2017 after ethical committee approval. Results Most of the patients with worse outcomes showed significant high levels of LDH, CRP, albumin, and neutrophil percentage early on admission. Conclusion LDH was a highly sensitive biomarker for early prediction of worse outcomes in patients with CAP.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43845946","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 Pneumonia is one of the most common diseases with a high hospitalization rate. Many studies have suggested that there is a correlation between pre-existing diabetes and the alterations in serum glucose levels in patients with community-acquired pneumonia (CAP) and high death rate. Aim To study the impact of admission blood glucose level on patients’ outcomes with CAP. Patients and methods Sixty (30 nondiabetic and 30 diabetic patients) consecutive hospitalized adult patients with CAP were recruited over a 1-year period. Data on patients’ outcomes including duration of hospital stay, duration of antibiotic treatment, increase in oxygen requirements, increase in antibiotics coverage, ICU admission, mechanical ventilation, and in-hospital mortality were collected. Results Admission blood glucose level was elevated in diabetic patients (the mean plasma glucose level was 258.86±116.15 mg/dl in diabetics and 151.13±51.23 mg/dl in nondiabetics). There were statistically significant increases in the duration of hospital stay (7.633±3.567 nondiabetic vs. 11.267±4.291 diabetic patients in days), duration of antibiotic treatment (7.633±3.567 nondiabetic vs. 11.267±4.291 diabetic patients in days), increase in O2 requirements (33.33 vs.70%), increase in antibiotics coverage (16.67 vs. 63.33%), and ICU admission (30 vs. 63.33%) in the diabetic group on comparing nondiabetic versus diabetic patients with CAP. Also, the previously mentioned outcomes increased significantly with increasing blood glucose levels among the entire study population. Conclusion On admission, CAP patients with increased blood glucose level, either diabetic or nondiabetic, are expected to have poor outcomes.
肺炎是最常见的疾病之一，住院率很高。许多研究表明，社区获得性肺炎(CAP)患者的既往糖尿病与血清葡萄糖水平的改变和高死亡率之间存在相关性。目的研究入院时血糖水平对CAP患者预后的影响。患者和方法在1年的时间内招募60例连续住院的成年CAP患者(30例非糖尿病患者和30例糖尿病患者)。收集患者结局数据，包括住院时间、抗生素治疗时间、需氧量增加、抗生素覆盖率增加、ICU入院、机械通气和院内死亡率。结果糖尿病患者入院时血糖水平升高(糖尿病患者平均血糖为258.86±116.15 mg/dl，非糖尿病患者平均血糖为151.13±51.23 mg/dl)。糖尿病组住院时间(非糖尿病患者为7.633±3.567天，糖尿病患者为11.267±4.291天)、抗生素治疗时间(非糖尿病患者为7.633±3.567天，糖尿病患者为11.267±4.291天)、氧气需氧量增加(33.33 vs.70%)、抗生素覆盖率增加(16.67 vs. 63.33%)、ICU住院时间(30 vs. 63.33%)与非糖尿病患者相比均有统计学意义的增加。在整个研究人群中，前面提到的结果随着血糖水平的升高而显著增加。结论CAP患者入院时血糖升高，无论是糖尿病患者还是非糖尿病患者，预后均较差。
{"title":"The impact of admission blood glucose level on patients with community-acquired pneumonia","authors":"Tamer Ali, H. Salem, Dina Sultan","doi":"10.4103/ejb.ejb_58_19","DOIUrl":"https://doi.org/10.4103/ejb.ejb_58_19","url":null,"abstract":"Background Pneumonia is one of the most common diseases with a high hospitalization rate. Many studies have suggested that there is a correlation between pre-existing diabetes and the alterations in serum glucose levels in patients with community-acquired pneumonia (CAP) and high death rate. Aim To study the impact of admission blood glucose level on patients’ outcomes with CAP. Patients and methods Sixty (30 nondiabetic and 30 diabetic patients) consecutive hospitalized adult patients with CAP were recruited over a 1-year period. Data on patients’ outcomes including duration of hospital stay, duration of antibiotic treatment, increase in oxygen requirements, increase in antibiotics coverage, ICU admission, mechanical ventilation, and in-hospital mortality were collected. Results Admission blood glucose level was elevated in diabetic patients (the mean plasma glucose level was 258.86±116.15 mg/dl in diabetics and 151.13±51.23 mg/dl in nondiabetics). There were statistically significant increases in the duration of hospital stay (7.633±3.567 nondiabetic vs. 11.267±4.291 diabetic patients in days), duration of antibiotic treatment (7.633±3.567 nondiabetic vs. 11.267±4.291 diabetic patients in days), increase in O2 requirements (33.33 vs.70%), increase in antibiotics coverage (16.67 vs. 63.33%), and ICU admission (30 vs. 63.33%) in the diabetic group on comparing nondiabetic versus diabetic patients with CAP. Also, the previously mentioned outcomes increased significantly with increasing blood glucose levels among the entire study population. Conclusion On admission, CAP patients with increased blood glucose level, either diabetic or nondiabetic, are expected to have poor outcomes.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43215397","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, A. Farghaly, R. Raafat, Waleed Abd Elsattar
Background Fungal pneumonia is an infectious process in the lung caused by one or more endemic or opportunistic fungi. Fungal infection occurs following the inhalation of spores, after the inhalation of conidia, or by the reactivation of a latent infection. Hematogenous dissemination frequently occurs, especially in an immunocompromised host. Aim of the work To assess the prevalence of fungal pneumonias in a group of respiratory ICUs and identify their pattern. Patients and methods This study was carried out on 60 patients who were admitted in respiratory ICUs of different hospitals: Ain Shams University and Military Hospitals from March 2018 till February 2019 to assess the prevalence of fungal chest infection in that group of patients and furthermore to identify their pattern. All patients were subjected to the following: history, clinical examination, radiology (plain chest radiograph and computed tomography of the chest), routine laboratory investigations and finally mycological analysis including direct microscopic examination and culture examination of the collected respiratory samples. Results The mean age of all patients was 55.43 years. Regarding sex of the patients, the majority (76.67%) of patients were men, while 23.33% were women. Forty (66.67%) patients out of 60 patients with respiratory diseases had been culture positive for fungus and 20 (33.33%) patients had been culture-negative. The major fungal species encountered in this study were Candida species in 23 (57.5%) cases followed by Aspergillus species in 17 (42.5%) cases. Candida albicans was isolated in 23.33% of patients followed by Aspergillus nonfumigatus (18.33%) then Candida nonalbicans (15%), and finally Aspergillus fumigatus (10%). Conclusion From the current study, we can conclude that pulmonary fungal infection appears to be an important problem in patients with respiratory diseases especially patients who are admitted in respiratory ICUs regardless of their age or sex.
{"title":"Study of the prevalence and pattern of fungal pneumonias in respiratory intensive care units","authors":"M. Ahmed, A. Farghaly, R. Raafat, Waleed Abd Elsattar","doi":"10.4103/ejb.ejb_37_19","DOIUrl":"https://doi.org/10.4103/ejb.ejb_37_19","url":null,"abstract":"Background Fungal pneumonia is an infectious process in the lung caused by one or more endemic or opportunistic fungi. Fungal infection occurs following the inhalation of spores, after the inhalation of conidia, or by the reactivation of a latent infection. Hematogenous dissemination frequently occurs, especially in an immunocompromised host. Aim of the work To assess the prevalence of fungal pneumonias in a group of respiratory ICUs and identify their pattern. Patients and methods This study was carried out on 60 patients who were admitted in respiratory ICUs of different hospitals: Ain Shams University and Military Hospitals from March 2018 till February 2019 to assess the prevalence of fungal chest infection in that group of patients and furthermore to identify their pattern. All patients were subjected to the following: history, clinical examination, radiology (plain chest radiograph and computed tomography of the chest), routine laboratory investigations and finally mycological analysis including direct microscopic examination and culture examination of the collected respiratory samples. Results The mean age of all patients was 55.43 years. Regarding sex of the patients, the majority (76.67%) of patients were men, while 23.33% were women. Forty (66.67%) patients out of 60 patients with respiratory diseases had been culture positive for fungus and 20 (33.33%) patients had been culture-negative. The major fungal species encountered in this study were Candida species in 23 (57.5%) cases followed by Aspergillus species in 17 (42.5%) cases. Candida albicans was isolated in 23.33% of patients followed by Aspergillus nonfumigatus (18.33%) then Candida nonalbicans (15%), and finally Aspergillus fumigatus (10%). Conclusion From the current study, we can conclude that pulmonary fungal infection appears to be an important problem in patients with respiratory diseases especially patients who are admitted in respiratory ICUs regardless of their age or sex.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42309175","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 (US) guidance of transthoracic needle biopsy of peripheral lung lesions is a useful diagnostic technique. It is a relatively easy and safe procedure under real-time US guidance and may give enough tissue sampling of lesions for histopathological examination. The aim of this study was to determine the diagnostic accuracy and safety of this technique in the diagnosis of peripheral lung lesions. Patients and methods A total of 60 patients underwent US-guided percutaneous needle biopsy of peripheral lung lesions from November 2017 to October 2018 in the Chest Department. The age of patients ranged from 27 to 79 years, with mean age of 58.4 years. Overall, 48 (80%) patients of the studied group were males, whereas 12 (20%) patients were females. Results According to the final diagnoses, 48 (80%) cases were malignant and 12 (20%) cases were benign. Diagnostic accuracy was 90%, sensitivity was 96%, both specificity and positive predictive value were 100%, and the negative predictive value was 60%. Pneumothorax and hemoptysis occurred in two (3.33%) patients each. Conclusion Chest US-guided biopsy in the diagnosis of peripheral lung lesions is a safe and fast procedure with high diagnostic yield and fewer complications.
{"title":"Diagnostic yield of ultrasound-guided transthoracic biopsy in peripheral lung lesions","authors":"Fayed Kawshty, Ahmed Abd Elradi, A. Ahmed","doi":"10.4103/ejb.ejb_25_19","DOIUrl":"https://doi.org/10.4103/ejb.ejb_25_19","url":null,"abstract":"Background Ultrasonography (US) guidance of transthoracic needle biopsy of peripheral lung lesions is a useful diagnostic technique. It is a relatively easy and safe procedure under real-time US guidance and may give enough tissue sampling of lesions for histopathological examination. The aim of this study was to determine the diagnostic accuracy and safety of this technique in the diagnosis of peripheral lung lesions. Patients and methods A total of 60 patients underwent US-guided percutaneous needle biopsy of peripheral lung lesions from November 2017 to October 2018 in the Chest Department. The age of patients ranged from 27 to 79 years, with mean age of 58.4 years. Overall, 48 (80%) patients of the studied group were males, whereas 12 (20%) patients were females. Results According to the final diagnoses, 48 (80%) cases were malignant and 12 (20%) cases were benign. Diagnostic accuracy was 90%, sensitivity was 96%, both specificity and positive predictive value were 100%, and the negative predictive value was 60%. Pneumothorax and hemoptysis occurred in two (3.33%) patients each. Conclusion Chest US-guided biopsy in the diagnosis of peripheral lung lesions is a safe and fast procedure with high diagnostic yield and fewer complications.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43909031","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}
Rasha M. Abdelhafeez, A. Abumossalam, Eman O. Arram, M. Elshafey, Mohammed E. Abushehata
Background Determining the optimal moment to extubate a critically ill patient remains a challenge. The parameters of diaphragm sonography offer precious data in the evaluation and follow-up of critically ill patients on mechanical ventilation. Aim To evaluate the diaphragm role in the weaning outcome through the following objectives: detect the association between ultrasonographic parameters of diaphragm [thickness, excursion, and velocity of contraction (slope)] and weaning outcome, success, or failure, in addition to evaluation of the weaning process by measuring the total duration of ventilation, weaning duration, ICU stay, and reventilation. Patients and methods A longitudinal, observational, prospective study. The primary endpoint was weaning outcome (failed or successful), while the secondary endpoints included length of ICU stay, weaning duration, ventilation duration, presence or absence of complications, and mortality. It was conducted on 240 (138 men and 102 women) invasively mechanically ventilated patients aged between 20 and 78 years were chosen from our Respiratory ICU of Chest Department, Mansoura University Hospital. Results There were statistically significant higher values of all sonographic measurements in the survived compared with the died group (P<0.001). There was statistically significantly higher sonographic diaphragmatic measurements in the successful group compared with the failed group (P<0.001). Conclusion The measurement of percent change of diaphragmatic thickness as well as excursion and slope could be applied in correlation more with weaning outcome with a sensitivity of 100% and specificity of 97.4%.
{"title":"Diaphragm and weaning from mechanical ventilation: anticipation and outcome","authors":"Rasha M. Abdelhafeez, A. Abumossalam, Eman O. Arram, M. Elshafey, Mohammed E. Abushehata","doi":"10.4103/ejb.ejb_13_19","DOIUrl":"https://doi.org/10.4103/ejb.ejb_13_19","url":null,"abstract":"Background Determining the optimal moment to extubate a critically ill patient remains a challenge. The parameters of diaphragm sonography offer precious data in the evaluation and follow-up of critically ill patients on mechanical ventilation. Aim To evaluate the diaphragm role in the weaning outcome through the following objectives: detect the association between ultrasonographic parameters of diaphragm [thickness, excursion, and velocity of contraction (slope)] and weaning outcome, success, or failure, in addition to evaluation of the weaning process by measuring the total duration of ventilation, weaning duration, ICU stay, and reventilation. Patients and methods A longitudinal, observational, prospective study. The primary endpoint was weaning outcome (failed or successful), while the secondary endpoints included length of ICU stay, weaning duration, ventilation duration, presence or absence of complications, and mortality. It was conducted on 240 (138 men and 102 women) invasively mechanically ventilated patients aged between 20 and 78 years were chosen from our Respiratory ICU of Chest Department, Mansoura University Hospital. Results There were statistically significant higher values of all sonographic measurements in the survived compared with the died group (P<0.001). There was statistically significantly higher sonographic diaphragmatic measurements in the successful group compared with the failed group (P<0.001). Conclusion The measurement of percent change of diaphragmatic thickness as well as excursion and slope could be applied in correlation more with weaning outcome with a sensitivity of 100% and specificity of 97.4%.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47804550","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 Post-ICU syndrome (PICS) is a common impairment that develops after critical illness and persists after discharge. It is considered when a new or worsening impairment in physical, cognitive, or mental status develops among survivors from critical illness. Aim To assess the prevalence of PICS and to define the profile of patients at risk of each domain. Patients and methods A total of 420 critically ill patients were assessed at the time of ICU discharge for presence of one or more domains of PICS: cognitive dysfunction, psychiatric impairment, and physical disability. Results A total of 220 (52.4%) patients without preexisting impairment developed one or more PICS forms. Half of the participants developed cognitive impairment, 14.29% developed depression, 26.19 developed anxiety, and 35.71% experienced both muscle weakness and impaired balance. PICS presented in three different patterns: pattern A, with one domain, in which 2.38% presented with either cognitive or psychiatric affection; pattern B, with two (19.05%) domains, where 80 patients had cognitive dysfunction, combined with physical affection in 30 patients and psychiatric impairment in 50 patients; and pattern C, with all PICS domains (28.57%). Multivariate analysis was used to detect independent predictors associated with each domain of PICS. Conclusion Survivors from critical illness should be screened for different domains of PICS. Cognitive impairment was evident in those with prolonged duration of mechanical ventilation (MV), delirium, stroke, and hypotension. Psychiatric impairment was evident in females with prolonged sedation and duration of MV, delirium, and hypoglycemia. Physical impairments were evident in those with sepsis, undernutrition, and prolonged duration of MV.
{"title":"Post ICU syndrome among survivors from respiratory critical illness. A prospective study","authors":"Ahmad Abbas, Niveen E Zayed, S. Lutfy","doi":"10.4103/ejb.ejb_35_19","DOIUrl":"https://doi.org/10.4103/ejb.ejb_35_19","url":null,"abstract":"Context Post-ICU syndrome (PICS) is a common impairment that develops after critical illness and persists after discharge. It is considered when a new or worsening impairment in physical, cognitive, or mental status develops among survivors from critical illness. Aim To assess the prevalence of PICS and to define the profile of patients at risk of each domain. Patients and methods A total of 420 critically ill patients were assessed at the time of ICU discharge for presence of one or more domains of PICS: cognitive dysfunction, psychiatric impairment, and physical disability. Results A total of 220 (52.4%) patients without preexisting impairment developed one or more PICS forms. Half of the participants developed cognitive impairment, 14.29% developed depression, 26.19 developed anxiety, and 35.71% experienced both muscle weakness and impaired balance. PICS presented in three different patterns: pattern A, with one domain, in which 2.38% presented with either cognitive or psychiatric affection; pattern B, with two (19.05%) domains, where 80 patients had cognitive dysfunction, combined with physical affection in 30 patients and psychiatric impairment in 50 patients; and pattern C, with all PICS domains (28.57%). Multivariate analysis was used to detect independent predictors associated with each domain of PICS. Conclusion Survivors from critical illness should be screened for different domains of PICS. Cognitive impairment was evident in those with prolonged duration of mechanical ventilation (MV), delirium, stroke, and hypotension. Psychiatric impairment was evident in females with prolonged sedation and duration of MV, delirium, and hypoglycemia. Physical impairments were evident in those with sepsis, undernutrition, and prolonged duration of MV.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42495005","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}
Purpose The purpose of this study was to compare four different scores [Acute Physiology and Chronic Health Evaluation (APACHE II); elevated blood urea nitrogen, altered mental status, pulse >109/min, age >65 years (BAP65); chronic obstructive pulmonary disease (COPD) and Asthma Physiology Score (CAPS); and 2008 score) to test their predictive properties for the need of mechanical ventilation (MV) and short-term mortality in patients with acute exacerbation COPD (AECOPD). Patients and methods This study enrolled 100 consecutive patients with acute exacerbation COPD, over a 6-month duration, admitted to the Emergency Department in Alexandria Main University Hospitals. The four scores were calculated for each patient, and clinical data and outcome (need for MV and mortality during hospitalization or within a week after discharge) were recorded. Results Their mean age was 61.1±10.7 years, and 88% were males. Duration of hospital stay was less than or equal to 20 days in 67%. Mortality rate was 4%. Overall, 40% required MV. Blood urea nitrogen, pulse, CO2, pH, altered consciousness, and white blood cell were significant predictors of mortality in univariate but not multivariate analysis. Previous MV, cyanosis, and paradoxical abdominal movement were significant predictors of need for MV. The highest area under the receiver operating characteristic curve was that of APACHE II score regarding either mortality prediction [area under the curve (AUC), 0.982; P=0.001] or need for MV (AUC, 0.959; P<0.001), followed by BAP65 score for mortality prediction (AUC, 0.967; P=0.002) and 2008 score for predicting the need for MV (AUC, 0.851; P<0.001). Conclusion All studied scores correlated significantly with mortality, but only APACHE II and 2008 score correlated significantly with the need for MV. The highest area under the receiver operating characteristic curve was that of APACHE II score regarding either mortality or need for MV prediction. Previous need for MV was the most important predictor for the need for MV. The routine use of these practical scores in triage of patients may direct early interventions to reduce mortality rate.
{"title":"Usefulness of different prognostic scores for AECOPD: APACHE II, BAP65, 2008, and CAPS scores","authors":"R. Sweed, M. Shaheen, Esraa El Gendy","doi":"10.4103/ejb.ejb_20_19","DOIUrl":"https://doi.org/10.4103/ejb.ejb_20_19","url":null,"abstract":"Purpose The purpose of this study was to compare four different scores [Acute Physiology and Chronic Health Evaluation (APACHE II); elevated blood urea nitrogen, altered mental status, pulse >109/min, age >65 years (BAP65); chronic obstructive pulmonary disease (COPD) and Asthma Physiology Score (CAPS); and 2008 score) to test their predictive properties for the need of mechanical ventilation (MV) and short-term mortality in patients with acute exacerbation COPD (AECOPD). Patients and methods This study enrolled 100 consecutive patients with acute exacerbation COPD, over a 6-month duration, admitted to the Emergency Department in Alexandria Main University Hospitals. The four scores were calculated for each patient, and clinical data and outcome (need for MV and mortality during hospitalization or within a week after discharge) were recorded. Results Their mean age was 61.1±10.7 years, and 88% were males. Duration of hospital stay was less than or equal to 20 days in 67%. Mortality rate was 4%. Overall, 40% required MV. Blood urea nitrogen, pulse, CO2, pH, altered consciousness, and white blood cell were significant predictors of mortality in univariate but not multivariate analysis. Previous MV, cyanosis, and paradoxical abdominal movement were significant predictors of need for MV. The highest area under the receiver operating characteristic curve was that of APACHE II score regarding either mortality prediction [area under the curve (AUC), 0.982; P=0.001] or need for MV (AUC, 0.959; P<0.001), followed by BAP65 score for mortality prediction (AUC, 0.967; P=0.002) and 2008 score for predicting the need for MV (AUC, 0.851; P<0.001). Conclusion All studied scores correlated significantly with mortality, but only APACHE II and 2008 score correlated significantly with the need for MV. The highest area under the receiver operating characteristic curve was that of APACHE II score regarding either mortality or need for MV prediction. Previous need for MV was the most important predictor for the need for MV. The routine use of these practical scores in triage of patients may direct early interventions to reduce mortality rate.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44494045","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}
Mohammad El-badrawy, Eman O. Arram, D. Abdalla, Dina Al-Sagheer, A. Zahran, M. AboElEla, A. El-Badrawy, Wagdy Amin
Background Pulmonary tuberculosis (TB) lesion is acidic, and changing this acidic pH may affect growth of TB bacilli and response to therapy. We aimed to assess the effect of adjuvant inhalation of sodium bicarbonate (SB) 8.4% on clinical, radiological, and microbiological responses in patients with sputum-positive drug-sensitive pulmonary TB. Patients and methods One hundred and three patients with pulmonary TB completed the study, and they were classified into two groups: group I included 55 patients who received standard anti-TB regimen plus SB inhalation, and group II included 48 patients who received anti-TB regimen only. The responses in both groups were evaluated clinically, microbiologically, and radiologically. Results There was no statistically significant difference between both groups in baseline bacillary load, clinical picture, and radiology. Both groups improved clinically 1 month after start of therapy. In group I only, there was a statistically significant improvement in chest radiograph after 1 month (P<0.001). The median duration of smear conversion for group I was 3 weeks (1–8) compared with 9.5 (2–17) in group II, with a statistically significant difference (P<0.001). Moreover, the median duration of culture conversion for group I was 1 month (1–3) compared with 3 months (1–4) in group II, with a statistically significant difference (P<0.001). Conclusion Adjuvant inhalation of SB in smear-positive pulmonary TB to standard anti-TB drugs accelerates smear conversion, culture conversion, and clinical and radiological improvement.
{"title":"Effect of adding inhalation of sodium bicarbonate 8.4% to the usual treatment on smear-positive pulmonary tuberculosis: a prospective controlled study","authors":"Mohammad El-badrawy, Eman O. Arram, D. Abdalla, Dina Al-Sagheer, A. Zahran, M. AboElEla, A. El-Badrawy, Wagdy Amin","doi":"10.4103/ejb.ejb_18_19","DOIUrl":"https://doi.org/10.4103/ejb.ejb_18_19","url":null,"abstract":"Background Pulmonary tuberculosis (TB) lesion is acidic, and changing this acidic pH may affect growth of TB bacilli and response to therapy. We aimed to assess the effect of adjuvant inhalation of sodium bicarbonate (SB) 8.4% on clinical, radiological, and microbiological responses in patients with sputum-positive drug-sensitive pulmonary TB. Patients and methods One hundred and three patients with pulmonary TB completed the study, and they were classified into two groups: group I included 55 patients who received standard anti-TB regimen plus SB inhalation, and group II included 48 patients who received anti-TB regimen only. The responses in both groups were evaluated clinically, microbiologically, and radiologically. Results There was no statistically significant difference between both groups in baseline bacillary load, clinical picture, and radiology. Both groups improved clinically 1 month after start of therapy. In group I only, there was a statistically significant improvement in chest radiograph after 1 month (P<0.001). The median duration of smear conversion for group I was 3 weeks (1–8) compared with 9.5 (2–17) in group II, with a statistically significant difference (P<0.001). Moreover, the median duration of culture conversion for group I was 1 month (1–3) compared with 3 months (1–4) in group II, with a statistically significant difference (P<0.001). Conclusion Adjuvant inhalation of SB in smear-positive pulmonary TB to standard anti-TB drugs accelerates smear conversion, culture conversion, and clinical and radiological improvement.","PeriodicalId":34128,"journal":{"name":"Egyptian Journal of Bronchology","volume":null,"pages":null},"PeriodicalIF":1.3,"publicationDate":"2019-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46105373","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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