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Escalation to invasive mechanical ventilation in noninvasive ventilation failure: some insights about methodology 无创通气失败升级为有创机械通气:关于方法的一些见解
IF 0.1 Pub Date : 2023-07-01 DOI: 10.4103/ecdt.ecdt_55_22
B. Lazovic, R. Dmitrović, A. Esquinas
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引用次数: 0
The role of ultrasound in assessment of positive end-expiratory pressure-induced lung recruitment in acute respiratory distress syndrome patients 超声在评估急性呼吸窘迫综合征患者呼气末正性压力诱导的肺补充中的作用
IF 0.1 Pub Date : 2023-07-01 DOI: 10.4103/ecdt.ecdt_92_22
A. Youssef, T. Essawy, Koot Mohammad, Shaimaa Abo-Youssef
Background In the case of critically sick patients, acute respiratory distress syndrome (ARDS) may be life-threatening and necessitates the need for ICU admission. Continuous monitoring is required for mechanical ventilation and recruitment movements as necessary. In this research, the goal is to investigate the use of ultrasonography in the evaluation of positive end exhalatory pressure-induced lung recruitment in ARDS patients. Patients and methods A total of 25 ARDS patients were included in this research, which was done in the hospital’s respiratory care unit. All of the patients were seen by a doctor, had a chest radiograph, and had laboratory tests. Mechanical ventilation was used in the care of all patients. Using positive end-expiratory pressure (PEEP) values of 5 and 15, we measured pressure–volume (PV) and lung ultrasound tracings. The PV curve approach was used to assess PEEP-induced lung recruitment. Between PEEP 5 and PEEP 15, there was an extremely strong positive connection between reaeration score and the change in lung volume (r=0.737, P=0.001). Results Between PEEP 5 and PEEP 15, there was a substantial (r=0.577, P=0.003) positive association between the reaeration score and the decrease in PaO2. There was a substantial negative association between reaeration score and mortality (rpb=-0.842, P=0.001), in which mortality reduces as the score increases. Conclusion For quantitative evaluation of PEEP-induced lung recruitment, bedside lung ultrasound is equal to the PV curve approach. In patients with ARDS, PEEP-induced lung recruitment may be assessed using ultrasonography.
在危重症患者中,急性呼吸窘迫综合征(ARDS)可能危及生命,需要进入ICU治疗。需要对机械通气和必要的招募运动进行持续监测。在本研究中,目的是探讨超声在评估ARDS患者正端呼气压诱导的肺再募集中的应用。患者与方法本研究共纳入25例急性呼吸窘迫综合征(ARDS)患者,研究在该院呼吸监护室进行。所有的病人都接受了医生的检查,拍了胸片,做了实验室检查。所有患者均采用机械通气治疗。使用呼气末正压(PEEP)值5和15,我们测量了压力-体积(PV)和肺部超声示图。采用PV曲线法评估peep诱导的肺再募集。在PEEP 5和PEEP 15之间,再通气评分与肺容量变化呈极强正相关(r=0.737, P=0.001)。结果在PEEP 5和PEEP 15之间,再通气评分与PaO2下降有显著正相关(r=0.577, P=0.003)。再通气评分与死亡率呈显著负相关(rpb=-0.842, P=0.001),评分越高,死亡率越低。结论定量评价peep诱导的肺再募集,床边肺超声等于PV曲线法。对于急性呼吸窘迫综合征(ARDS)患者,peep诱导的肺再生可通过超声检查进行评估。
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引用次数: 0
Obstructive sleep apnea in type 2 diabetes mellitus patients 2型糖尿病患者的阻塞性睡眠呼吸暂停
IF 0.1 Pub Date : 2023-07-01 DOI: 10.4103/ecdt.ecdt_14_23
N. Morsy, Amany E. Sheta, Mohammed El Desoky Abo Shehata, Raed El Metwally Ali, Hala Samaha
Objective The study aims to identify the prevalence and risk factors for OSA in a group of Egyptian patients with type 2 diabetes. Methods 125 type 2 diabetes mellitus patients visited Mansoura University Hospital (Diabetes Mellitus Outpatient Clinic (OPC) at Specialized Medical Hospital and the Sleep Disordered Breathing Unit of the Chest Department), all of them exposed to history taking, the patients underwent anthropometric measurements (weight, height, body mass index, neck circumference), a test of their tonsillar size, Malampati score, Friedman OSA score, Epworth sleepiness scale (ESS), Berlin questionnaire, STOP BANG questionnaire, full-night polysomnography, fasting, and postprandial blood sugar. Results The study included 125 T2DM Egyptian patients with a mean age of 54.63 ± 9.47 years. Males accounted for 35.2 percent of patients, while females accounted for 64.8%. According to the study of co-morbidity, hypertension constituted 77 (61.1%), ischemic heart disease 28 (22.4%), other cardiac diseases 11 (8.8%), bronchial asthma 6 (4.8%), liver diseases 6 (4.8%), hypothyroidism 3 (2.4%), and renal diseases 3 (2.4%). A total of seven patients (5.6%) had no OSA symptoms, 87 had borderline symptoms, and 31 had positive symptoms. There were 51 (40.8%) normal patients, 12 (9.6%) borderline patients, and 62 (49.6%) sleepy patients on the Epworth scale. According to the Stop-Bang questionnaire, 121 (96.8%) patients answered positively. It was determined that 122 patients (97.6%) were at high risk based on the Berlin questionnaire. There were 17 patients (13.6%) with OSA on polysomnography, of which six were moderate (35.3%) and 11 were severe (64.7%). Among moderate and severe OSA patients, glycosylated hemoglobin levels differed significantly. Multivariate logistic regression analysis for independent predictors of OSA, chronic renal disease patients is the most common associated risk factor (OR = 14.3, CI = 1.2–67) then hypertension (OR = 5.6,CI=1.2–25.5) and heart failure (OR = 4.4). Conclusions OSA affects 13.6% patients with type 2 diabetes patients who are hypertensive are at higher risk of OSA, chronic renal failure is considered another risk factorFurthers studies are needed on a big scale of Egyptian diabetic patients to detect the prevalence of OSA
目的本研究旨在确定埃及2型糖尿病患者OSA的患病率及危险因素。方法125例2型糖尿病患者就诊于曼苏拉大学附属医院(专科医院糖尿病门诊(OPC)和胸科睡眠障碍呼吸科),均接受病史调查,测量体重、身高、体质指数、颈围、扁桃体大小、Malampati评分、Friedman OSA评分、Epworth嗜睡量表(ESS)、Berlin问卷、STOP BANG问卷,通宵多导睡眠仪,禁食和餐后血糖。结果纳入埃及T2DM患者125例,平均年龄54.63±9.47岁。男性占35.2%,女性占64.8%。合并症中,高血压77例(61.1%),缺血性心脏病28例(22.4%),其他心脏病11例(8.8%),支气管哮喘6例(4.8%),肝脏疾病6例(4.8%),甲状腺功能减退3例(2.4%),肾脏疾病3例(2.4%)。无OSA症状7例(5.6%),边缘性症状87例,阳性症状31例。Epworth量表正常51例(40.8%),边缘12例(9.6%),困倦62例(49.6%)。根据Stop-Bang问卷,121例(96.8%)患者的回答是肯定的。根据柏林问卷,确定122例(97.6%)患者为高危人群。多导睡眠图显示OSA患者17例(13.6%),其中中度6例(35.3%),重度11例(64.7%)。在中度和重度OSA患者中,糖化血红蛋白水平差异显著。多因素logistic回归分析OSA的独立预测因素,慢性肾脏疾病是患者最常见的相关危险因素(OR = 14.3, CI= 1.2-67),其次是高血压(OR = 5.6,CI= 1.2-25.5)和心力衰竭(OR = 4.4)。结论13.6%的2型糖尿病高血压患者发生OSA的风险较高,慢性肾功能衰竭被认为是另一个危险因素,需要在埃及糖尿病患者中进行更大规模的研究来检测OSA的患病率
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引用次数: 0
Prevalence of hypothyroidism in newly diagnosed patients with obstructive sleep apnea syndrome: a prospective cross-sectional study 新诊断的阻塞性睡眠呼吸暂停综合征患者甲状腺功能减退的患病率:一项前瞻性横断面研究
IF 0.1 Pub Date : 2023-07-01 DOI: 10.4103/ecdt.ecdt_103_22
Lucy El-Maboud Suliman, Raed El Metwally Ali, Magda Ahmed, Maged Aboelazm
Introduction: One of the most common presentations of OSAS is daytime sleepiness, which is also seen in patients with hypothyroidism. We hypothesized that hypothyroidism is one of contributing factors in the development of OSAS; thus, adequate management of hypothyroidism can simply help to alleviate OSAS symptoms. Aim of the Study: The aim of this study was to evaluate the prevalence of hypothyroidism in OSAS patients in our locality and to compare respiratory polysomnographic parameters of OSAS patients with hypothyroidism versus those without hypothyroidism. Patients and Methods: In a descriptive prospective cross-sectional study, our patients attending Sleep Disordered Breathing Clinic at Sleep Disordered Breathing Unit, Chest Medicine Department, Mansoura University Hospital. All patients were subjected to full history taking with stress on sleep questionnaires, pulmonary complaints, physical examination, anthropometric measures, diagnostic PSG, laboratory evaluation (serum TSH and free T4 levels), and chest radiology and echocardiography. Results: There were two groups of OSAS participants (hypothyroid and euthyroid). Hypothyroidism was evident in 12% of patients;they were classified according to AHI, 13, 15, and 60 of Euthyroid patients had mild, moderate, and severe OSAS, respectively. hypothyroid patients, 2 mild OSAS, 1 moderate OSAS and 9 severe OSAS. Epworth sleepiness scale scores were significantly higher in the hypothyroid group with a mean score of 18 ± 4.8 vs 12.47 ± 6 in the euthyroid group (P = 0.003). Different PSG parameters showed no difference between the two groups. AHI, serum TSH level, and T4 levels were positively correlated but with insignificant P values. Conclusion: Hypothyroidism is thought to be one of the key players in the development of sleep-breathing disorders. It was evident in 12% of OSAS patients; however, the a proven insignificant difference in PSG parameters in OSAS with hypothyroidism versus euthyroid group, except for affection of daytime sleepiness.
OSAS最常见的表现之一是白天嗜睡,这也见于甲状腺功能减退症患者。我们假设甲状腺功能减退是OSAS发生的因素之一;因此,甲状腺功能减退症的适当管理可以简单地帮助减轻OSAS症状。研究目的:本研究的目的是评估本地区OSAS患者甲状腺功能减退的患病率,并比较伴有甲状腺功能减退的OSAS患者与无甲状腺功能减退的OSAS患者的呼吸多导睡眠图参数。患者和方法:在一项描述性前瞻性横断面研究中,我们的患者在曼苏拉大学医院胸内科睡眠呼吸障碍科睡眠呼吸障碍门诊就诊。所有患者都进行了完整的病史调查,包括睡眠问卷、肺部疾患、体格检查、人体测量、诊断性PSG、实验室评估(血清TSH和游离T4水平)、胸部x线和超声心动图。结果:OSAS患者分为两组(甲状腺功能减退和甲状腺功能正常)。12%的患者有明显的甲状腺功能减退,根据AHI分类,13、15、60的甲亢患者分别有轻度、中度、重度OSAS。轻度OSAS 2例,中度OSAS 1例,重度OSAS 9例。甲状腺功能减退组Epworth嗜睡量表得分显著高于正常组,平均得分为18±4.8分,正常组平均得分为12.47±6分(P = 0.003)。两组间PSG参数差异无统计学意义。AHI与血清TSH、T4水平呈正相关,但P值不显著。结论:甲状腺功能减退被认为是睡眠呼吸障碍发生的关键因素之一。在12%的OSAS患者中表现明显;然而,除了白天嗜睡的影响外,OSAS伴甲状腺功能减退组与甲状腺功能正常组的PSG参数差异不显著。
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引用次数: 0
Changes in eotaxin-2 and periostin levels in patients with bronchial asthma according to their smoking status: a cross-sectional study 支气管哮喘患者吸烟状况对eotaxin-2和periostin水平的影响:一项横断面研究
IF 0.1 Pub Date : 2023-07-01 DOI: 10.4103/ecdt.ecdt_91_22
Mohammed Abdelghany, A. El-Karn, M. Sherif, M. Seddik, S. Eid, S. Youssif
Background Smoking influences the nature of airway inflammation in patients with bronchial asthma though synthesis of certain cytokines. Patterns of bronchial asthma are differentiated clinically, functionally, and regarding inflammatory biomarkers. Aim The research aimed to study the clinical, functional, sputum cytological differences, and serum eotaxin-2 and periostin levels in asthmatic patients regarding smoking status. Patients and methods The research was a cross-sectional study. The collection of cases began in August 2018 and ended in January 2020 at the Chest Department, Assiut University Hospital. We studied 117 asthmatic patients who were classified regarding their smoking status (45 nonsmokers, 42 smokers, and 30 former smokers) for serum eotaxin-2 and periostin by enzyme-linked immunosorbent assay. The effects of smoking were analyzed on inflammatory cells including eosinophilic and neutrophilic percentages in sputum and serum eotaxin-2 and periostin levels. Results Smokers with asthma had worse clinical and functional outcomes. Asthmatic smokers had mainly neutrophilic phenotype. Serum eotaxin-2 level was higher in smokers compared with nonsmokers and former smokers. However, serum periostin level was higher in nonsmokers compared with smokers and former smokers. Serum eotaxin-2 had a positive correlation with smoking index and eosinophilic and neutrophilic count in sputum, whereas serum periostin was correlated negatively with smoking index and positively with eosinophilic count. Conclusion Asthmatic smokers had worse clinical and functional outcomes with increased neutrophils in the sputum. The inflammatory biomarkers seen in smokers with asthma showed low serum periostin and increased serum eotaxin-2 levels.
背景吸烟通过某些细胞因子的合成影响支气管哮喘患者气道炎症的性质。支气管哮喘的模式在临床、功能和炎症生物标志物方面是有区别的。目的探讨吸烟对哮喘患者临床、功能、痰细胞学及血清eotaxin-2、periostin水平的影响。本研究为横断面研究。病例收集始于2018年8月,于2020年1月在阿西尤特大学医院胸科结束。我们研究了117例吸烟的哮喘患者(45例不吸烟,42例吸烟,30例曾经吸烟),用酶联免疫吸附法检测血清eotaxin-2和骨膜蛋白。分析吸烟对炎性细胞的影响,包括痰中嗜酸性粒细胞和中性粒细胞百分比和血清eotaxin-2和骨膜素水平。结果吸烟者合并哮喘的临床和功能预后较差。哮喘吸烟者以嗜中性粒细胞表型为主。吸烟者血清eotaxin-2水平高于非吸烟者和前吸烟者。然而,不吸烟者的血清骨膜蛋白水平高于吸烟者和前吸烟者。血清eotaxin-2与吸烟指数、痰中嗜酸性粒细胞和中性粒细胞计数呈正相关,而血清periostin与吸烟指数呈负相关,与嗜酸性粒细胞计数呈正相关。结论哮喘吸烟者的临床和功能预后较差,痰中中性粒细胞增高。哮喘吸烟者的炎症生物标志物显示血清骨膜素水平低,血清eotaxin-2水平升高。
{"title":"Changes in eotaxin-2 and periostin levels in patients with bronchial asthma according to their smoking status: a cross-sectional study","authors":"Mohammed Abdelghany, A. El-Karn, M. Sherif, M. Seddik, S. Eid, S. Youssif","doi":"10.4103/ecdt.ecdt_91_22","DOIUrl":"https://doi.org/10.4103/ecdt.ecdt_91_22","url":null,"abstract":"Background Smoking influences the nature of airway inflammation in patients with bronchial asthma though synthesis of certain cytokines. Patterns of bronchial asthma are differentiated clinically, functionally, and regarding inflammatory biomarkers. Aim The research aimed to study the clinical, functional, sputum cytological differences, and serum eotaxin-2 and periostin levels in asthmatic patients regarding smoking status. Patients and methods The research was a cross-sectional study. The collection of cases began in August 2018 and ended in January 2020 at the Chest Department, Assiut University Hospital. We studied 117 asthmatic patients who were classified regarding their smoking status (45 nonsmokers, 42 smokers, and 30 former smokers) for serum eotaxin-2 and periostin by enzyme-linked immunosorbent assay. The effects of smoking were analyzed on inflammatory cells including eosinophilic and neutrophilic percentages in sputum and serum eotaxin-2 and periostin levels. Results Smokers with asthma had worse clinical and functional outcomes. Asthmatic smokers had mainly neutrophilic phenotype. Serum eotaxin-2 level was higher in smokers compared with nonsmokers and former smokers. However, serum periostin level was higher in nonsmokers compared with smokers and former smokers. Serum eotaxin-2 had a positive correlation with smoking index and eosinophilic and neutrophilic count in sputum, whereas serum periostin was correlated negatively with smoking index and positively with eosinophilic count. Conclusion Asthmatic smokers had worse clinical and functional outcomes with increased neutrophils in the sputum. The inflammatory biomarkers seen in smokers with asthma showed low serum periostin and increased serum eotaxin-2 levels.","PeriodicalId":46359,"journal":{"name":"Egyptian Journal of Chest Diseases and Tuberculosis","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87332503","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}
引用次数: 0
Occult pneumothorax in patients with blunted polytrauma: an experience of Tanta University Hospitals 钝性多发伤患者隐匿性气胸:坦塔大学医院的经验
IF 0.1 Pub Date : 2023-07-01 DOI: 10.4103/ecdt.ecdt_110_22
Amr A Abdelwahab, Heba Salem
Aims The objective of this study was to retrospectively evaluate the incidence, management, and outcome of occult pneumothorax (OPTX) in patients with blunt chest trauma (BCT). Settings and design A retrospective observational study was performed. Patients and methods Over 9 years, cases with BCT were identified retrospectively from the database between 2012 and 2021. Data were evaluated and compared based on the first management (conservative vs. intercostal tube). Results Of the 2113 cases, 51 (2.4%) admitted with BCT during the study period were found to have OPTX. The mean age of patients was 37 ± 6.58 years, and there was a male predominance (78.43%). Intercostal tube intervention was done in 29 (53.8%) cases, and conservative management was done in 22 (43.13%) cases. Cases that needed tube thoracostomy had significantly higher rates of lung and chest contusions and high Abbreviated Injury Scale compared with those who were treated conservatively. However, pneumonia, rib fracture, hospital length of stay, and ventilatory days were insignificantly different between both groups. Overall mortality was 9.8%. Conclusions In cases with BCT that did not require major interventions or needed to be mechanically ventilated, their OPTX can be safely managed conservatively.
本研究的目的是回顾性评估钝性胸外伤(BCT)患者隐匿性气胸(OPTX)的发生率、治疗和预后。背景和设计进行回顾性观察性研究。患者和方法回顾性分析了2012年至2021年间9年的BCT病例。根据第一次治疗(保守与肋间管)对数据进行评估和比较。结果在2113例患者中,51例(2.4%)在研究期间接受BCT检查发现有OPTX。患者平均年龄37±6.58岁,男性居多(78.43%)。肋间管介入治疗29例(53.8%),保守治疗22例(43.13%)。气管开胸术患者的肺、胸部挫伤发生率明显高于常规开胸术患者。肺炎、肋骨骨折、住院时间、呼吸天数两组间差异无统计学意义。总死亡率为9.8%。结论:对于不需要重大干预或需要机械通气的BCT病例,其OPTX可以安全保守地管理。
{"title":"Occult pneumothorax in patients with blunted polytrauma: an experience of Tanta University Hospitals","authors":"Amr A Abdelwahab, Heba Salem","doi":"10.4103/ecdt.ecdt_110_22","DOIUrl":"https://doi.org/10.4103/ecdt.ecdt_110_22","url":null,"abstract":"Aims The objective of this study was to retrospectively evaluate the incidence, management, and outcome of occult pneumothorax (OPTX) in patients with blunt chest trauma (BCT). Settings and design A retrospective observational study was performed. Patients and methods Over 9 years, cases with BCT were identified retrospectively from the database between 2012 and 2021. Data were evaluated and compared based on the first management (conservative vs. intercostal tube). Results Of the 2113 cases, 51 (2.4%) admitted with BCT during the study period were found to have OPTX. The mean age of patients was 37 ± 6.58 years, and there was a male predominance (78.43%). Intercostal tube intervention was done in 29 (53.8%) cases, and conservative management was done in 22 (43.13%) cases. Cases that needed tube thoracostomy had significantly higher rates of lung and chest contusions and high Abbreviated Injury Scale compared with those who were treated conservatively. However, pneumonia, rib fracture, hospital length of stay, and ventilatory days were insignificantly different between both groups. Overall mortality was 9.8%. Conclusions In cases with BCT that did not require major interventions or needed to be mechanically ventilated, their OPTX can be safely managed conservatively.","PeriodicalId":46359,"journal":{"name":"Egyptian Journal of Chest Diseases and Tuberculosis","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87962917","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}
引用次数: 0
Cryotherapy in Egyptian patients with central airway obstruction: impacts on clinical pulmonary scores, pulmonary function tests and quality of life, a single center experience 冷冻治疗在埃及中央气道阻塞患者:对临床肺评分、肺功能测试和生活质量的影响,单中心经验
IF 0.1 Pub Date : 2023-07-01 DOI: 10.4103/ecdt.ecdt_100_22
A. Halfawy, H. Amin, Muhammad Younis, U. Elhassan
Background Cryotherapy has emerged as an effective modality to manage patients with central airway obstruction (CAO). The aim was to assess the outcomes of using cryotherapy for managing CAO and its effect on the symptoms, and pulmonary function testing (PFT) in patients with CAO. Patients and methods This prospective protocol was carried out at the Chest Department, Cairo University Hospitals, in collaboration with the Military Chest Hospital over 6 months. Patients with CAO underwent cryotherapy and were assessed by the following: grade of airway obstruction, dyspnea, hemoptysis and quality of life scales, and PFT. Outcomes and safety of cryotherapy were evaluated. Results A total of 30 patients with CAO were enrolled and were divided into two groups: the malignant obstruction group (n=20) and the nonmalignant obstruction group (n=10). Complete restoration of the airway patency was achieved in 53.3% of patients. Only three (10%) cases encountered complications. There were significant postprocedural improvements of dyspnea, cough, hemoptysis, quality of life scales, and PFT. Logistic regression analysis showed that smoking was associated with worse outcomes. Conclusions Cryotherapy is a safe and successful method for both endobronchial exophytic tumor debulking and nonmalignant CAO. These benefits were reflected in the postprocedural improvement of clinical pulmonary scales, PFT, the grade of airway obstruction, and quality of life. Further prospective, multicenter studies are recommended.
冷冻治疗已成为治疗中央气道阻塞(CAO)患者的一种有效方法。目的是评估使用冷冻疗法治疗曹操的结果及其对曹操患者症状和肺功能测试(PFT)的影响。该前瞻性方案在开罗大学医院胸科与军事胸科医院合作进行,为期6个月。CAO患者接受冷冻治疗,并通过以下指标进行评估:气道阻塞程度、呼吸困难、咯血和生活质量评分,以及PFT。评估冷冻治疗的结果和安全性。结果共纳入30例曹操患者,分为恶性梗阻组(n=20)和非恶性梗阻组(n=10)。53.3%的患者完全恢复气道通畅。只有3例(10%)出现并发症。术后呼吸困难、咳嗽、咯血、生活质量量表和PFT均有显著改善。Logistic回归分析显示,吸烟与较差的预后相关。结论冷冻治疗对支气管内外生性肿瘤和非恶性曹化气均是安全有效的治疗方法。这些益处反映在术后临床肺评分、PFT、气道阻塞等级和生活质量的改善上。建议进一步开展前瞻性、多中心研究。
{"title":"Cryotherapy in Egyptian patients with central airway obstruction: impacts on clinical pulmonary scores, pulmonary function tests and quality of life, a single center experience","authors":"A. Halfawy, H. Amin, Muhammad Younis, U. Elhassan","doi":"10.4103/ecdt.ecdt_100_22","DOIUrl":"https://doi.org/10.4103/ecdt.ecdt_100_22","url":null,"abstract":"Background Cryotherapy has emerged as an effective modality to manage patients with central airway obstruction (CAO). The aim was to assess the outcomes of using cryotherapy for managing CAO and its effect on the symptoms, and pulmonary function testing (PFT) in patients with CAO. Patients and methods This prospective protocol was carried out at the Chest Department, Cairo University Hospitals, in collaboration with the Military Chest Hospital over 6 months. Patients with CAO underwent cryotherapy and were assessed by the following: grade of airway obstruction, dyspnea, hemoptysis and quality of life scales, and PFT. Outcomes and safety of cryotherapy were evaluated. Results A total of 30 patients with CAO were enrolled and were divided into two groups: the malignant obstruction group (n=20) and the nonmalignant obstruction group (n=10). Complete restoration of the airway patency was achieved in 53.3% of patients. Only three (10%) cases encountered complications. There were significant postprocedural improvements of dyspnea, cough, hemoptysis, quality of life scales, and PFT. Logistic regression analysis showed that smoking was associated with worse outcomes. Conclusions Cryotherapy is a safe and successful method for both endobronchial exophytic tumor debulking and nonmalignant CAO. These benefits were reflected in the postprocedural improvement of clinical pulmonary scales, PFT, the grade of airway obstruction, and quality of life. Further prospective, multicenter studies are recommended.","PeriodicalId":46359,"journal":{"name":"Egyptian Journal of Chest Diseases and Tuberculosis","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89861956","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}
引用次数: 0
Effect of physiotherapy and its frequency on the outcome of COVID-19 patients regarding acute care setting at isolation unit of Ain Shams University 艾因沙姆斯大学隔离病房急性护理环境中物理治疗及其频率对COVID-19患者预后的影响
IF 0.1 Pub Date : 2023-07-01 DOI: 10.4103/ecdt.ecdt_82_22
M. El-Bably, A. Galal, Riham Rafat, Samia El Rehem
Background Severe acute respiratory syndrome coronavirus 2 is a new strain of coronavirus that started in 2019 and causes a pandemic disease called coronavirus disease 2019 (COVID-19). The present report result was 80% of cases are asymptomatic or mild; 15% of cases are severe; and 5% are critical needing ICU and mechanical ventilation. Physiotherapy (PT) provides airway clearance techniques and improves physical fitness. Aim The aim of this study is to assess the effect of PT and the frequency of PT session on the outcome of patients with COVID-19 infection at an isolation unit of Ain Shams University. Patients and methods This is randomized controlled clinical trial that was applied on 264 confirmed adult patients with COVID-19, who were admitted to isolation units at Ain Shams University Hospitals over 6 months since March 2021 with 134 females and 130 males in the age range from 31 to 82 years. The breathing method was room air, oxygen mask and nasal cannula, HFNC, and ventilated patients (both invasive and noninvasive). The patients were divided randomly into two groups: one group received two sessions of PT per day and the other group received one session of PT per day. Results The patients were divided clinically into mild, moderate, severe, and severe-critical patients. In mild cases, the range of incentive spirometer (ml) after one daily PT became 2300–2800 ml, and for twice daily PT it became 2300–3300 ml with highly statistical difference (P=0.005) before and after one or two PT sessions. Regarding 6-min walking test (m) the range became 420–740 m for one PT session per day and 420–880 m for two PT sessions per day with significant statistical difference (P=0.010). In moderate cases, the SPO2 (%) became 88–98% after one daily PT session and 90–98% after twice daily PT sessions with significant statistical differences between the one and two PT (P=0.032) sessions. Regarding the incentive spirometer (ml) at the moderate group, after one daily PT session it became 1200–2500 ml and for twice daily PT it became 1500–2500 ml with significant statistical differences between one and two PT sessions (P=0.032). Conclusion Patients with mild and moderate COVID-19 infection had significant improvement in SPO2 (oxygen saturation), dyspnea scale, and incentive spirometer after receiving two daily sessions of PT compared with patients who received one daily PT session. There was no difference in both groups for severe and severe-critical cases.
严重急性呼吸综合征冠状病毒2型是一种新的冠状病毒毒株,于2019年开始出现,导致一种名为2019冠状病毒病(COVID-19)的大流行疾病。本报告结果为80%的病例无症状或轻度;15%的病例是严重的;5%是危重患者,需要加护病房和机械通气。物理治疗(PT)提供气道清除技术并改善身体健康。目的本研究的目的是评估在艾因沙姆斯大学隔离病房进行PT治疗和PT治疗频率对COVID-19感染患者预后的影响。本研究是一项随机对照临床试验,对自2021年3月以来6个月内在艾因沙姆斯大学附属医院隔离的264例确诊成人COVID-19患者进行了研究,其中女性134例,男性130例,年龄31岁至82岁。呼吸方法为室内空气+氧气面罩+鼻插管+ HFNC +通气(有创和无创)。患者被随机分为两组:一组每天接受两次PT,另一组每天接受一次PT。结果临床将患者分为轻度、中度、重度、危重型。轻症患者每日1次运动后刺激肺活量(ml)范围为2300 ~ 2800 ml,每日2次运动后刺激肺活量(ml)范围为2300 ~ 3300 ml, 1次或2次运动前后有显著统计学差异(P=0.005)。对于6分钟步行测试(m),每天1次运动的步行距离为420-740米,每天2次运动的步行距离为420-880米,差异有统计学意义(P=0.010)。在中等情况下,每天进行一次PT治疗后,SPO2(%)达到88-98%,每天进行两次PT治疗后,SPO2(%)达到90-98%,一次和两次PT治疗之间存在显著统计学差异(P=0.032)。中度组的激励肺活量(ml),每日1次后为1200 ~ 2500 ml,每日2次后为1500 ~ 2500 ml,两组间差异有统计学意义(P=0.032)。结论轻中度COVID-19感染患者接受每日2次PT治疗后SPO2(血氧饱和度)、呼吸困难评分、激进性肺活量计较接受每日1次PT治疗的患者有显著改善。两组重症和危重型病例无差异。
{"title":"Effect of physiotherapy and its frequency on the outcome of COVID-19 patients regarding acute care setting at isolation unit of Ain Shams University","authors":"M. El-Bably, A. Galal, Riham Rafat, Samia El Rehem","doi":"10.4103/ecdt.ecdt_82_22","DOIUrl":"https://doi.org/10.4103/ecdt.ecdt_82_22","url":null,"abstract":"Background Severe acute respiratory syndrome coronavirus 2 is a new strain of coronavirus that started in 2019 and causes a pandemic disease called coronavirus disease 2019 (COVID-19). The present report result was 80% of cases are asymptomatic or mild; 15% of cases are severe; and 5% are critical needing ICU and mechanical ventilation. Physiotherapy (PT) provides airway clearance techniques and improves physical fitness. Aim The aim of this study is to assess the effect of PT and the frequency of PT session on the outcome of patients with COVID-19 infection at an isolation unit of Ain Shams University. Patients and methods This is randomized controlled clinical trial that was applied on 264 confirmed adult patients with COVID-19, who were admitted to isolation units at Ain Shams University Hospitals over 6 months since March 2021 with 134 females and 130 males in the age range from 31 to 82 years. The breathing method was room air, oxygen mask and nasal cannula, HFNC, and ventilated patients (both invasive and noninvasive). The patients were divided randomly into two groups: one group received two sessions of PT per day and the other group received one session of PT per day. Results The patients were divided clinically into mild, moderate, severe, and severe-critical patients. In mild cases, the range of incentive spirometer (ml) after one daily PT became 2300–2800 ml, and for twice daily PT it became 2300–3300 ml with highly statistical difference (P=0.005) before and after one or two PT sessions. Regarding 6-min walking test (m) the range became 420–740 m for one PT session per day and 420–880 m for two PT sessions per day with significant statistical difference (P=0.010). In moderate cases, the SPO2 (%) became 88–98% after one daily PT session and 90–98% after twice daily PT sessions with significant statistical differences between the one and two PT (P=0.032) sessions. Regarding the incentive spirometer (ml) at the moderate group, after one daily PT session it became 1200–2500 ml and for twice daily PT it became 1500–2500 ml with significant statistical differences between one and two PT sessions (P=0.032). Conclusion Patients with mild and moderate COVID-19 infection had significant improvement in SPO2 (oxygen saturation), dyspnea scale, and incentive spirometer after receiving two daily sessions of PT compared with patients who received one daily PT session. There was no difference in both groups for severe and severe-critical cases.","PeriodicalId":46359,"journal":{"name":"Egyptian Journal of Chest Diseases and Tuberculosis","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75930153","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}
引用次数: 0
High-velocity nasal insufflation success assessment using ROX index in patients with acute respiratory failure 应用ROX指数评价急性呼吸衰竭患者高速鼻灌气成功率
IF 0.1 Pub Date : 2023-07-01 DOI: 10.4103/ecdt.ecdt_105_22
H. Shalaby, Hoda S. Mohamed
Background High-velocity nasal insufflation (Hi-VNI) in patients with acute respiratory failure (ARF) gives humidified, heated oxygen, with a higher velocity, and gas flow up to 40 l/min, and FiO2 up to 1.0 through more comfortable, relatively small nasal prongs. respiratory rate-oxygenation (ROX) index is an easy bedside test, variable with time, and helps in decision making in the daily follow-up of patients on Hi-VNI. Aim The aim was to validate the accuracy of ROX index in the early detection of patients with ARF who will fail using Hi-VNI and need early intubation without worsening their clinical prognosis. Patients and methods A prospective observational cohort study was performed on 40 patients with ARF who received Hi-VNI treatment. Application of Hi-VNI was done once indicated, and after 2, 6, and 12 h, intensivists calculated ROX indices. Then, follow-up patients was performed for the need for intubation, ICU length of stay, and 28-day mortality. Results Patients treated with Hi-VNI were divided into two groups: the successful group and the unsuccessful group. A total of 20 patients (50%) required intubation after Hi-VNI. Their median ROX indices were 4.25, 4.6, and 4.8 after 2, 6, and 12 h, respectively. The ROX index can predict the risk of intubation in patients with ARF. However, in the successful group, ROX indices were 6.35, 6.29, and 7.05 after 2, 6, and 12 h, respectively. The ROX index was an accurate predictor of success (area under the curve=1.00). Conclusion In patients with ARF treated by Hi-VNI, the ROX index is a bedside test, daily used in ICU, and can early predict patients who will fail using Hi-VNI and need intubation, thus avoiding delayed intubation and worse clinical outcome.
背景:在急性呼吸衰竭(ARF)患者中,高速鼻腔注入(Hi-VNI)通过更舒适、相对较小的鼻尖,以更高的速度给予湿化、加热的氧气,气体流量可达40 l/min, FiO2可达1.0。呼吸速率-氧合(ROX)指数是一个简单的床边测试,随时间变化,有助于Hi-VNI患者日常随访的决策。目的验证ROX指数在早期发现使用Hi-VNI治疗失败、需要早期插管且不影响临床预后的ARF患者中的准确性。患者和方法对40例接受Hi-VNI治疗的ARF患者进行了前瞻性观察队列研究。一旦有指示,应用Hi-VNI,在2、6和12小时后,强化师计算ROX指数。然后,随访患者插管需求、ICU住院时间和28天死亡率。结果Hi-VNI患者分为治疗成功组和治疗不成功组。共有20例患者(50%)在Hi-VNI后需要插管。术后2、6、12 h ROX指数中位数分别为4.25、4.6、4.8。ROX指数可预测ARF患者插管风险。而成功组在治疗2、6、12 h后ROX指数分别为6.35、6.29、7.05。ROX指数是成功的准确预测指标(曲线下面积=1.00)。结论在经Hi-VNI治疗的ARF患者中,ROX指数是一项床边测试,可在ICU日常使用,可早期预测Hi-VNI治疗失败而需要插管的患者,避免延迟插管和不良临床结局。
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引用次数: 0
Rapid antigen swab: a promising tool in scaling up coronavirus disease 2019 detection in a variety of pulmonary and extrapulmonary manifestations? 快速抗原拭子:在各种肺部和肺外表现中扩大2019冠状病毒病检测的有希望的工具?
IF 0.1 Pub Date : 2023-07-01 DOI: 10.4103/ecdt.ecdt_107_22
M. Zamzam, Samy Eldahdouh, Mostafa Faheem, Asmaa Abdel Tawab
Background Coronavirus disease 2019 (COVID-19) is a severe infectious disease, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Regarding the ongoing spread of COVID-19 in Egypt, this study aimed to determine the sensitivity and specificity of rapid COVID antigen swab in the diagnosis of COVID-19 infection in pulmonary and extrapulmonary manifestations of COVID-19 and discuss the pulmonary and extrapulmonary symptoms of COVID-19. Patients and methods This is a cross-sectional study performed on 447 patients diagnosed with COVID-19 at the chest out-patient clinic or Department of Chest and ICU in Menoufia University Hospital during the period from July 2021 to March 2022. Detailed history, full laboratory data, high-resolution computed tomography, and rapid antigen swab were obtained. Results A total of 447 patients were included in this study. They were classified into two groups: group 1 included 105 patients with pulmonary symptoms and group 2 included 342 patients with extrapulmonary symptoms in the absence or presence of pulmonary symptoms. The current study showed a sensitivity of 88.6% and specificity of 100% regarding the rapid antigen swab in diagnosing COVID-19. Regarding the extrapulmonary symptoms, muscle ache was the most common symptom in 52% of the patients followed by loss of taste and smell in 39.8% of patients. Conclusion Rapid antigen tests are practical, are reliable, provide fast results (~15 min), and are cheap diagnostic methods with high sensitivity and specificity for COVID-19. Moreover, it showed a wide range of extrapulmonary symptoms of COVID-19, and every symptom revealed should be suspected and investigated.
冠状病毒病2019 (COVID-19)是由严重急性呼吸综合征冠状病毒2 (SARS-CoV-2)引起的一种严重传染病。针对2019冠状病毒病(COVID-19)在埃及持续传播的情况,本研究旨在确定快速COVID抗原拭子在COVID-19肺部和肺外表现中诊断COVID-19感染的敏感性和特异性,探讨COVID-19肺部和肺外症状。患者和方法本研究对2021年7月至2022年3月期间在梅努菲亚大学医院胸科门诊或胸科和ICU诊断为COVID-19的447例患者进行了横断面研究。获得了详细的病史、完整的实验室数据、高分辨率计算机断层扫描和快速抗原拭子。结果共纳入447例患者。他们被分为两组:组1包括105例有肺部症状的患者,组2包括342例无或有肺症状的肺外症状患者。本研究结果表明,快速抗原拭子诊断COVID-19的敏感性为88.6%,特异性为100%。肺外症状以肌肉疼痛最为常见(52%),其次为味觉和嗅觉丧失(39.8%)。结论快速抗原检测是一种实用、可靠、快速(~15 min)的新型冠状病毒肺炎诊断方法,具有较高的敏感性和特异性。此外,新冠肺炎的肺外症状非常广泛,每一个症状都应该被怀疑和调查。
{"title":"Rapid antigen swab: a promising tool in scaling up coronavirus disease 2019 detection in a variety of pulmonary and extrapulmonary manifestations?","authors":"M. Zamzam, Samy Eldahdouh, Mostafa Faheem, Asmaa Abdel Tawab","doi":"10.4103/ecdt.ecdt_107_22","DOIUrl":"https://doi.org/10.4103/ecdt.ecdt_107_22","url":null,"abstract":"Background Coronavirus disease 2019 (COVID-19) is a severe infectious disease, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Regarding the ongoing spread of COVID-19 in Egypt, this study aimed to determine the sensitivity and specificity of rapid COVID antigen swab in the diagnosis of COVID-19 infection in pulmonary and extrapulmonary manifestations of COVID-19 and discuss the pulmonary and extrapulmonary symptoms of COVID-19. Patients and methods This is a cross-sectional study performed on 447 patients diagnosed with COVID-19 at the chest out-patient clinic or Department of Chest and ICU in Menoufia University Hospital during the period from July 2021 to March 2022. Detailed history, full laboratory data, high-resolution computed tomography, and rapid antigen swab were obtained. Results A total of 447 patients were included in this study. They were classified into two groups: group 1 included 105 patients with pulmonary symptoms and group 2 included 342 patients with extrapulmonary symptoms in the absence or presence of pulmonary symptoms. The current study showed a sensitivity of 88.6% and specificity of 100% regarding the rapid antigen swab in diagnosing COVID-19. Regarding the extrapulmonary symptoms, muscle ache was the most common symptom in 52% of the patients followed by loss of taste and smell in 39.8% of patients. Conclusion Rapid antigen tests are practical, are reliable, provide fast results (~15 min), and are cheap diagnostic methods with high sensitivity and specificity for COVID-19. Moreover, it showed a wide range of extrapulmonary symptoms of COVID-19, and every symptom revealed should be suspected and investigated.","PeriodicalId":46359,"journal":{"name":"Egyptian Journal of Chest Diseases and Tuberculosis","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90286044","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}
引用次数: 0
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Egyptian Journal of Chest Diseases and Tuberculosis
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