Pub Date : 2023-07-01DOI: 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。
{"title":"High-velocity nasal insufflation success assessment using ROX index in patients with acute respiratory failure","authors":"H. Shalaby, Hoda S. Mohamed","doi":"10.4103/ecdt.ecdt_105_22","DOIUrl":"https://doi.org/10.4103/ecdt.ecdt_105_22","url":null,"abstract":"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.","PeriodicalId":46359,"journal":{"name":"Egyptian Journal of Chest Diseases and Tuberculosis","volume":"63 1","pages":"393 - 400"},"PeriodicalIF":0.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84291445","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}
Pub Date : 2023-07-01DOI: 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.
{"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":"17 1","pages":"374 - 381"},"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}
Background Coronavirus disease 2019 (COVID-19) binds to angiotensin-converting enzyme through a viral spike protein prompting an inflammatory cascade. Baricitinib, an oral drug, is a selective inhibitor of Janus kinase (JAK) 1 and 2 and interferes with the intracellular signaling pathway of many cytokines and in combination with remdesivir may give good results in severe COVID-19 infection. Aim The aim was to assess the effect of baricitinib in severe COVID-19 pneumonia. Patients and methods A total of 30 patients with SARS-CoV-2-confirmed positive cases by nasopharyngeal swab/reverse transcriptase PCR with severe pneumonia received oral baricitinib 4 mg daily, and patients were followed for at least 14 days, unless previously discharged or dead. Results Patients were admitted to the ICU, with a mean duration of 11 days. All patients received high-flow oxygen with nonrebreathing mask. A total of 18 (60%) patients improved and 12 (40%) patients died. Moreover, 15 patients had comorbidities, and mortality was high in this group (10 patients). No serious adverse effects of baricitinib were detected in our study. All patients were hypoxic at admission. The mean oxygen saturation on room air was 70%. There was a statistically significant improvement in oxygenation on discharge after receiving treatment, with mean oxygen saturation of 90% on room air. Conclusion Baricitinib with remdesivir improves clinical status and oxygen saturation in patients with severe COVID-19 pneumonia with no serious adverse effects.
{"title":"Efficacy of baricitinib in severe coronavirus disease 2019","authors":"Ahmed Amer, Doaa Mousa, Azza Ahmed","doi":"10.4103/ecdt.ecdt_83_22","DOIUrl":"https://doi.org/10.4103/ecdt.ecdt_83_22","url":null,"abstract":"Background Coronavirus disease 2019 (COVID-19) binds to angiotensin-converting enzyme through a viral spike protein prompting an inflammatory cascade. Baricitinib, an oral drug, is a selective inhibitor of Janus kinase (JAK) 1 and 2 and interferes with the intracellular signaling pathway of many cytokines and in combination with remdesivir may give good results in severe COVID-19 infection. Aim The aim was to assess the effect of baricitinib in severe COVID-19 pneumonia. Patients and methods A total of 30 patients with SARS-CoV-2-confirmed positive cases by nasopharyngeal swab/reverse transcriptase PCR with severe pneumonia received oral baricitinib 4 mg daily, and patients were followed for at least 14 days, unless previously discharged or dead. Results Patients were admitted to the ICU, with a mean duration of 11 days. All patients received high-flow oxygen with nonrebreathing mask. A total of 18 (60%) patients improved and 12 (40%) patients died. Moreover, 15 patients had comorbidities, and mortality was high in this group (10 patients). No serious adverse effects of baricitinib were detected in our study. All patients were hypoxic at admission. The mean oxygen saturation on room air was 70%. There was a statistically significant improvement in oxygenation on discharge after receiving treatment, with mean oxygen saturation of 90% on room air. Conclusion Baricitinib with remdesivir improves clinical status and oxygen saturation in patients with severe COVID-19 pneumonia with no serious adverse effects.","PeriodicalId":46359,"journal":{"name":"Egyptian Journal of Chest Diseases and Tuberculosis","volume":"1 1","pages":"355 - 357"},"PeriodicalIF":0.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83914872","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}
Dalia Abd El Sattar El Embaby, Mai Azab, H. Shalaby
Background Mechanical ventilation is typically required for ICU patients as part of their care. This recommends the use of analgesia and sedation in a balanced strategy to alter patients’ comfort and assist synchronization with mechanical ventilation while avoiding the downsides of excessive sedation. Objective The aim of the study was to compare between deep sedation and light sedation, analgesia, and no sedation strategies and their effects on the length of mechanical ventilation, and their effects on patients’ prognosis. Patients and methods This cohort prospective pilot study was conducted at the medical respiratory ICU at Ain Shams University Hospital in Cairo, Egypt, on 54 patients separated into four groups according to the type of sedation and analgesia suited for each patient’s severity condition. Results In this study, 54 mechanically ventilated patients in respiratory ICU were recruited. The patients were divided into group 1: no sedation or analgesia, group 2: analgesia only, group 3: light sedation, and group 4: deep sedation. There was a significant difference in Acute Physiology and Chronic Health Evaluation score and severity%, although the Acute Physiology and Chronic Health Evaluation score and severity % were the highest in group 1 (25.53, 55.11%) and group 4 (23.40, 47.68%), but the prognosis was poorer in group 4 and was affected by deep sedation (100% death rate) than that in group 1 (60.0%). The average infusion rate of fentanyl and the total dose were significantly different between groups, the highest being in the deep sedation group. ICU length of stay was nonsignificant between groups but it was lower in group 4 (median: 9 days) than other groups. The average rate of dormicum infusion in the deep sedation group was 5 µg, while there was no daily vacation period; so, it can be explained that higher doses of sedation and analgesia in group 4 affected their prognosis to be poorer than other groups. Delirium occurred in 80% of group 4 patients, but only in 6.7% of subgroups, indicating a highly significant difference. Complications either metabolic, cardiac, or hematologic in the postextubation period were higher in group 4 (60%), than in group 1 (47.7%), group 2 (40%), and group 3 (15%). Conclusion Light sedation and analgesia strategies with daily sedation interruption would have a better survival outcome and cause fewer issues in patients, who were on mechanical ventilation than a heavy sedation approach.
{"title":"Analgesia and sedation strategy for mechanically ventilated patients in the respiratory ICU","authors":"Dalia Abd El Sattar El Embaby, Mai Azab, H. Shalaby","doi":"10.4103/ecdt.ecdt_81_22","DOIUrl":"https://doi.org/10.4103/ecdt.ecdt_81_22","url":null,"abstract":"Background Mechanical ventilation is typically required for ICU patients as part of their care. This recommends the use of analgesia and sedation in a balanced strategy to alter patients’ comfort and assist synchronization with mechanical ventilation while avoiding the downsides of excessive sedation. Objective The aim of the study was to compare between deep sedation and light sedation, analgesia, and no sedation strategies and their effects on the length of mechanical ventilation, and their effects on patients’ prognosis. Patients and methods This cohort prospective pilot study was conducted at the medical respiratory ICU at Ain Shams University Hospital in Cairo, Egypt, on 54 patients separated into four groups according to the type of sedation and analgesia suited for each patient’s severity condition. Results In this study, 54 mechanically ventilated patients in respiratory ICU were recruited. The patients were divided into group 1: no sedation or analgesia, group 2: analgesia only, group 3: light sedation, and group 4: deep sedation. There was a significant difference in Acute Physiology and Chronic Health Evaluation score and severity%, although the Acute Physiology and Chronic Health Evaluation score and severity % were the highest in group 1 (25.53, 55.11%) and group 4 (23.40, 47.68%), but the prognosis was poorer in group 4 and was affected by deep sedation (100% death rate) than that in group 1 (60.0%). The average infusion rate of fentanyl and the total dose were significantly different between groups, the highest being in the deep sedation group. ICU length of stay was nonsignificant between groups but it was lower in group 4 (median: 9 days) than other groups. The average rate of dormicum infusion in the deep sedation group was 5 µg, while there was no daily vacation period; so, it can be explained that higher doses of sedation and analgesia in group 4 affected their prognosis to be poorer than other groups. Delirium occurred in 80% of group 4 patients, but only in 6.7% of subgroups, indicating a highly significant difference. Complications either metabolic, cardiac, or hematologic in the postextubation period were higher in group 4 (60%), than in group 1 (47.7%), group 2 (40%), and group 3 (15%). Conclusion Light sedation and analgesia strategies with daily sedation interruption would have a better survival outcome and cause fewer issues in patients, who were on mechanical ventilation than a heavy sedation approach.","PeriodicalId":46359,"journal":{"name":"Egyptian Journal of Chest Diseases and Tuberculosis","volume":"152 1","pages":"386 - 392"},"PeriodicalIF":0.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79602659","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 Robust data on interleukin-6 (IL-6) is available in bacterial infection, and now it can be utilized in the currently ongoing coronavirus disease 2019 (COVID-19) pneumonia pandemic to guide treatment strategy as a marker of inflammation. Patients and methods Prospective, observational, and 12 weeks follow-up study, included 1000 COVID-19 cases confirmed with reverse transcription PCR. All cases were assessed with lung involvement documented and categorized on high-resolution computed tomography thorax, oxygen saturation, IL-6 at the entry point, and follow-up. Age, sex, comorbidity, and bilevel positive airway pressure/noninvasive ventilation (BIPAP/NIV) use and outcome as with or without lung fibrosis as per computed tomography severity. Statistical analysis is done by χ2 test. Results In the study of 1000 COVID-19 pneumonia cases, age (<50 and >50 years) and sex has a significant associations with IL-6. High-resolution computed tomography severity score at entry point has significant correlation with IL-6 level (P<0.00001). IL-6 level has a significant association with duration of illness (P<0.00001) comorbidities has a significant association with IL-6 level (P<0.00001). IL-6 level has a significant association with oxygen saturation (P<0.00001). BIPAP/NIV requirement has a significant association with IL-6 level (P<0.00001). Timing of BIPAP/NIV requirement during the course of hospitalization has significant association with IL-6 level (P<0.00001). Follow-up IL-6 titer during hospitalization as compared with entry point abnormal IL-6 has a significant association in post-COVID lung fibrosis (P<0.00001). Follow-up IL-6 titer during hospitalization as compared with entry point normal IL-6 has a significant association in post-COVID lung fibrosis (P<0.00001). Follow-up IL-6 titer during hospitalization as compared with entry point abnormal IL-6 has a significant association in predicting cytokine storm irrespective normal or abnormal of IL-6 at entry point (P<0.0001). Conclusion IL-6 has documented a very crucial role in COVID-19 pneumonia in predicting the severity of illness, progression of illness, and ‘cytokine storm.’ Sequential IL-6 titers will help assess response to treatment during hospitalization and analyze post-COVID lung fibrosis.
{"title":"Role of interleukin-6 in coronavirus disease 2019 pneumonia: sensitive marker of inflammation, a predictor of ventilatory support and early marker of post-coronavirus disease lung fibrosis. A single center experience","authors":"S. Patil, G. Gondhali, Abhijith G. Acharya","doi":"10.4103/ecdt.ecdt_48_22","DOIUrl":"https://doi.org/10.4103/ecdt.ecdt_48_22","url":null,"abstract":"Background Robust data on interleukin-6 (IL-6) is available in bacterial infection, and now it can be utilized in the currently ongoing coronavirus disease 2019 (COVID-19) pneumonia pandemic to guide treatment strategy as a marker of inflammation. Patients and methods Prospective, observational, and 12 weeks follow-up study, included 1000 COVID-19 cases confirmed with reverse transcription PCR. All cases were assessed with lung involvement documented and categorized on high-resolution computed tomography thorax, oxygen saturation, IL-6 at the entry point, and follow-up. Age, sex, comorbidity, and bilevel positive airway pressure/noninvasive ventilation (BIPAP/NIV) use and outcome as with or without lung fibrosis as per computed tomography severity. Statistical analysis is done by χ2 test. Results In the study of 1000 COVID-19 pneumonia cases, age (<50 and >50 years) and sex has a significant associations with IL-6. High-resolution computed tomography severity score at entry point has significant correlation with IL-6 level (P<0.00001). IL-6 level has a significant association with duration of illness (P<0.00001) comorbidities has a significant association with IL-6 level (P<0.00001). IL-6 level has a significant association with oxygen saturation (P<0.00001). BIPAP/NIV requirement has a significant association with IL-6 level (P<0.00001). Timing of BIPAP/NIV requirement during the course of hospitalization has significant association with IL-6 level (P<0.00001). Follow-up IL-6 titer during hospitalization as compared with entry point abnormal IL-6 has a significant association in post-COVID lung fibrosis (P<0.00001). Follow-up IL-6 titer during hospitalization as compared with entry point normal IL-6 has a significant association in post-COVID lung fibrosis (P<0.00001). Follow-up IL-6 titer during hospitalization as compared with entry point abnormal IL-6 has a significant association in predicting cytokine storm irrespective normal or abnormal of IL-6 at entry point (P<0.0001). Conclusion IL-6 has documented a very crucial role in COVID-19 pneumonia in predicting the severity of illness, progression of illness, and ‘cytokine storm.’ Sequential IL-6 titers will help assess response to treatment during hospitalization and analyze post-COVID lung fibrosis.","PeriodicalId":46359,"journal":{"name":"Egyptian Journal of Chest Diseases and Tuberculosis","volume":"60 1","pages":"346 - 354"},"PeriodicalIF":0.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76590139","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}
Pub Date : 2023-07-01DOI: 10.4103/ecdt.ecdt_101_22
Mahmoud Al-Salahy, Mohammad El-Mahdy, Elsayed Sabry, Samar D. Ahmed, M. Elnaggar
Background Pulmonary embolism (PE) is an acute, significant, and life-threatening condition. Transthoracic ultrasound (TUS) is one of the noninvasive diagnostic modalities that has been presented for detection of numerous chest disorders as well as PE. Objectives The goal of this work was to estimate the accuracy, sensitivity, and specificity of bedside TUS in PE detection. Patients and methods Fifty patients with moderate-to-high clinical suspicion of PE were examined by TUS. Diagnosis of PE depended on clinical suspicion and was confirmed by computed tomography pulmonary angiography. Results Most of the lesions related to PE and detected by US examination were on the right side (60%) and posterior lower lobe (70%) with predominance of A profile. Sensitivity, specificity, accuracy, negative, and positive predictive values of TUS in diagnosis of PE were 93.3, 65, 82, 86.7, and 80%, respectively. Conclusion TUS is an important diagnostic tool as a noninvasive bedside test in detecting PE principally for critically ill or unmoving patients with high sensitivity and moderate specificity.
{"title":"Diagnostic performance of transthoracic ultrasound in patients with pulmonary embolism","authors":"Mahmoud Al-Salahy, Mohammad El-Mahdy, Elsayed Sabry, Samar D. Ahmed, M. Elnaggar","doi":"10.4103/ecdt.ecdt_101_22","DOIUrl":"https://doi.org/10.4103/ecdt.ecdt_101_22","url":null,"abstract":"Background Pulmonary embolism (PE) is an acute, significant, and life-threatening condition. Transthoracic ultrasound (TUS) is one of the noninvasive diagnostic modalities that has been presented for detection of numerous chest disorders as well as PE. Objectives The goal of this work was to estimate the accuracy, sensitivity, and specificity of bedside TUS in PE detection. Patients and methods Fifty patients with moderate-to-high clinical suspicion of PE were examined by TUS. Diagnosis of PE depended on clinical suspicion and was confirmed by computed tomography pulmonary angiography. Results Most of the lesions related to PE and detected by US examination were on the right side (60%) and posterior lower lobe (70%) with predominance of A profile. Sensitivity, specificity, accuracy, negative, and positive predictive values of TUS in diagnosis of PE were 93.3, 65, 82, 86.7, and 80%, respectively. Conclusion TUS is an important diagnostic tool as a noninvasive bedside test in detecting PE principally for critically ill or unmoving patients with high sensitivity and moderate specificity.","PeriodicalId":46359,"journal":{"name":"Egyptian Journal of Chest Diseases and Tuberculosis","volume":"90 1","pages":"427 - 432"},"PeriodicalIF":0.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78064886","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}
Pub Date : 2023-07-01DOI: 10.4103/ecdt.ecdt_106_22
Adel A. M. Saeed, Marwa Daif, A. Kamal
Background This study intended to evaluate the effect of smoking propensity on Coronavirus Disease 2019 (COVID-19) infection and the effect of COVID-19 infection on smoking propensity. The COVID-19 outbreak has forced people toward a better approach to life owing to limited developments, confinement in closed areas, and severe hygiene maneuvers for long periods. This period has been considered as a ‘transition’ stage and appears to require a look forward toward an altered life approach. Aim The aim of the work was to evaluate the effect of smoking on COVID-19 infection and the effect of COVID-19 infection on smoking propensity. Patients and methods A cross-sectional study was conducted through self-reported surveys. The study was conducted on 101 COVID-19-infected patients aged from 17 to 70 years old, who presented to the Department of Chest of Ain Shams University after approval of the Medical Ethical Committee. The study was conducted through self-reported surveys, which included data on risk factors such as diabetes mellitus, hypertension, ischemic heart disease, chronic obstructive pulmonary disease, interstitial lung disease, and the severity of COVID-19 infection. Results Regarding the associated comorbidities, hypertension was the most frequent disease found in 19.8% of patients followed by diabetes mellitus, which was found in 14.85, then ischemic heart diseases in 9.9%, and then chronic lung disease in 7.92%. Regarding general symptoms of COVID-19, fever was the most common symptom found in 42.57% of patients followed by anosmia in 19.8%, dyspnea in 13.86%, cough in 6.93%, bony aches in 6.93%, loss of taste in 6.94%, and then joint pain, fatigue, chest pain, and vomiting in 0.99% for each. Overall, 17.82% of COVID-19-infected patients required hospital admission, whereas 11.82% required oxygen therapy and 5.94% of patients required ICU admission. Only one COVID-19-infected patient had undergone spirometry after COVID-19. Overall, 47.56% experienced smoking cessation, 45.12% never tried to quit smoking, and 7.32% tried multiple times to quit. Multiple factors have affected smoking habit as follows: marriage has increased smoking in 61.9% of participants, and also work, depression, and happiness have increased smoking in 92.31, 95.12, and 64.63% of participants, respectively. Conclusion COVID-19 pandemic has led to unexpected changes in daily activities and alteration in health behaviors. The effects of smoking on human health are serious and profound. Smoking has increased the severity of COVID-19, symptoms, and hospital admission, especially in persons with multiple comorbidities. In the present study, there was a significant relation between admission to hospital and age, period of smoking, and frequency of smoking. Smoking cessation programs should be conducted for individuals, as they help smokers recognize and cope with problems that come up during quitting.
{"title":"Smoking habits among covid-19 patients","authors":"Adel A. M. Saeed, Marwa Daif, A. Kamal","doi":"10.4103/ecdt.ecdt_106_22","DOIUrl":"https://doi.org/10.4103/ecdt.ecdt_106_22","url":null,"abstract":"Background This study intended to evaluate the effect of smoking propensity on Coronavirus Disease 2019 (COVID-19) infection and the effect of COVID-19 infection on smoking propensity. The COVID-19 outbreak has forced people toward a better approach to life owing to limited developments, confinement in closed areas, and severe hygiene maneuvers for long periods. This period has been considered as a ‘transition’ stage and appears to require a look forward toward an altered life approach. Aim The aim of the work was to evaluate the effect of smoking on COVID-19 infection and the effect of COVID-19 infection on smoking propensity. Patients and methods A cross-sectional study was conducted through self-reported surveys. The study was conducted on 101 COVID-19-infected patients aged from 17 to 70 years old, who presented to the Department of Chest of Ain Shams University after approval of the Medical Ethical Committee. The study was conducted through self-reported surveys, which included data on risk factors such as diabetes mellitus, hypertension, ischemic heart disease, chronic obstructive pulmonary disease, interstitial lung disease, and the severity of COVID-19 infection. Results Regarding the associated comorbidities, hypertension was the most frequent disease found in 19.8% of patients followed by diabetes mellitus, which was found in 14.85, then ischemic heart diseases in 9.9%, and then chronic lung disease in 7.92%. Regarding general symptoms of COVID-19, fever was the most common symptom found in 42.57% of patients followed by anosmia in 19.8%, dyspnea in 13.86%, cough in 6.93%, bony aches in 6.93%, loss of taste in 6.94%, and then joint pain, fatigue, chest pain, and vomiting in 0.99% for each. Overall, 17.82% of COVID-19-infected patients required hospital admission, whereas 11.82% required oxygen therapy and 5.94% of patients required ICU admission. Only one COVID-19-infected patient had undergone spirometry after COVID-19. Overall, 47.56% experienced smoking cessation, 45.12% never tried to quit smoking, and 7.32% tried multiple times to quit. Multiple factors have affected smoking habit as follows: marriage has increased smoking in 61.9% of participants, and also work, depression, and happiness have increased smoking in 92.31, 95.12, and 64.63% of participants, respectively. Conclusion COVID-19 pandemic has led to unexpected changes in daily activities and alteration in health behaviors. The effects of smoking on human health are serious and profound. Smoking has increased the severity of COVID-19, symptoms, and hospital admission, especially in persons with multiple comorbidities. In the present study, there was a significant relation between admission to hospital and age, period of smoking, and frequency of smoking. Smoking cessation programs should be conducted for individuals, as they help smokers recognize and cope with problems that come up during quitting.","PeriodicalId":46359,"journal":{"name":"Egyptian Journal of Chest Diseases and Tuberculosis","volume":"93 1","pages":"443 - 451"},"PeriodicalIF":0.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86977189","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 Pleural effusion is the accumulation of fluid in the pleural space, can be classified into transudative and exudative effusion. A parapneumonic effusion is a pleural effusion that forms adjacent to pneumonia. Para pneumonic effusion can be sub-typed into uncomplicated and complicated effusion. The aim of our work was to identify accuracy of pleural fluid lactate level to discriminate transudative from exudative effusion and uncomplicated from complicated parapneumonic effusion. Methods Thoracocentesis was done with subsequent evaluation of pleural fluid PH, protein, LDH, glucose and lactate. Also, gram stain, microbiological cultures, cytological examination was performed. Medical thoracoscopy was done whenever indicated. Results Our study included 52 males and 38 females with mean age 57.14 ± 11.69 years. Transudative effusions were detected in 22 patients (24.4%). Parapneumonic effusions accounted for 39 cases (43.3%), of these 23 cases were uncomplicated and 16 cases were complicated. The median pleural fluid lactate level in exudative effusion was significantly higher than transudative effusion (P value<0.001), in complicated parapneumonic effusion was significantly higher than uncomplicated parapneumonic effusion (P value<0.001). Pleural fluid lactate cut-off value of 2.68 mmol/l or more yielded 97% sensitivity, 90.9% specificity for detection of exudative effusion (Auc 0.968). A cut of value of 6.22 mmol/l had 87.5% sensitivity, 91.3% specificity for detection of complicated parapneumonic effusion. (Auc 0.971). Conclusion The pleural fluid lactate level has a high accuracy to discriminate transudative from exudative pleural effusion and uncomplicated from complicated parapneumonic effusion.
{"title":"Could pleural fluid lactate level have an added diagnostic value in para pneumonic effusion?","authors":"Mohammed Shehta, A. Fathy, Mohammed Ibrahim","doi":"10.4103/ecdt.ecdt_8_23","DOIUrl":"https://doi.org/10.4103/ecdt.ecdt_8_23","url":null,"abstract":"Background Pleural effusion is the accumulation of fluid in the pleural space, can be classified into transudative and exudative effusion. A parapneumonic effusion is a pleural effusion that forms adjacent to pneumonia. Para pneumonic effusion can be sub-typed into uncomplicated and complicated effusion. The aim of our work was to identify accuracy of pleural fluid lactate level to discriminate transudative from exudative effusion and uncomplicated from complicated parapneumonic effusion. Methods Thoracocentesis was done with subsequent evaluation of pleural fluid PH, protein, LDH, glucose and lactate. Also, gram stain, microbiological cultures, cytological examination was performed. Medical thoracoscopy was done whenever indicated. Results Our study included 52 males and 38 females with mean age 57.14 ± 11.69 years. Transudative effusions were detected in 22 patients (24.4%). Parapneumonic effusions accounted for 39 cases (43.3%), of these 23 cases were uncomplicated and 16 cases were complicated. The median pleural fluid lactate level in exudative effusion was significantly higher than transudative effusion (P value<0.001), in complicated parapneumonic effusion was significantly higher than uncomplicated parapneumonic effusion (P value<0.001). Pleural fluid lactate cut-off value of 2.68 mmol/l or more yielded 97% sensitivity, 90.9% specificity for detection of exudative effusion (Auc 0.968). A cut of value of 6.22 mmol/l had 87.5% sensitivity, 91.3% specificity for detection of complicated parapneumonic effusion. (Auc 0.971). Conclusion The pleural fluid lactate level has a high accuracy to discriminate transudative from exudative pleural effusion and uncomplicated from complicated parapneumonic effusion.","PeriodicalId":46359,"journal":{"name":"Egyptian Journal of Chest Diseases and Tuberculosis","volume":"57 1","pages":"340 - 345"},"PeriodicalIF":0.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82014489","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}
Pub Date : 2023-07-01DOI: 10.4103/ecdt.ecdt_120_22
T. Safwat, M. El-Sheikh, Amira El-Sayed, Dalia Abd-Elsattar
Background Peripheral blood eosinophil count is liable to many factors and has variability over time. There are few studies on the association between the rise of blood eosinophils and the exacerbation incidence in stable chronic obstructive pulmonary disease (COPD) patients. The association between the rise of blood eosinophils and the rate of exacerbation in stable COPD patients is controversial. Objective To study the relationship between the count of eosinophils in the peripheral blood and the incidence of COPD exacerbation in stable patients. Patients and methods This prospective inquiry was done on 46 patients diagnosed as suffering from stable COPD ‘on the report of the global initiative for chronic obstructive lung disease (GOLD) guidelines’ attending Ain Shams University hospital outpatient clinic. Results Forty-six stable COPD patients were classified into two groups (groups A and B) based on their median eosinophilic count of ‘250 cell/μl.’ Patients with high eosinophil count ‘group A’ (>250 cell/μl) had a significantly higher incidence of exacerbations (P=0.003), with a relative risk ratio of 2.77, as well as a higher number of exacerbations per patient (two exacerbations/patient) versus one exacerbation/three patients (P<0.001), and a shorter period to the first exacerbation (17 vs. 31 days) (P=0.024), compared with those with low eosinophil count ‘group B (≤250 cell/μl)’ during the study period. On the contrary, there was no significant difference between them in the incidence of pneumonia in relation to inhaled corticosteroid use. Conclusion The count of eosinophils in the peripheral blood is a reliable exacerbation biomarker in stable COPD patients.
{"title":"Peripheral blood eosinophil count as a biomarker of exacerbation in stable chronic obstructive pulmonary disease outpatients: a prospective observational study","authors":"T. Safwat, M. El-Sheikh, Amira El-Sayed, Dalia Abd-Elsattar","doi":"10.4103/ecdt.ecdt_120_22","DOIUrl":"https://doi.org/10.4103/ecdt.ecdt_120_22","url":null,"abstract":"Background Peripheral blood eosinophil count is liable to many factors and has variability over time. There are few studies on the association between the rise of blood eosinophils and the exacerbation incidence in stable chronic obstructive pulmonary disease (COPD) patients. The association between the rise of blood eosinophils and the rate of exacerbation in stable COPD patients is controversial. Objective To study the relationship between the count of eosinophils in the peripheral blood and the incidence of COPD exacerbation in stable patients. Patients and methods This prospective inquiry was done on 46 patients diagnosed as suffering from stable COPD ‘on the report of the global initiative for chronic obstructive lung disease (GOLD) guidelines’ attending Ain Shams University hospital outpatient clinic. Results Forty-six stable COPD patients were classified into two groups (groups A and B) based on their median eosinophilic count of ‘250 cell/μl.’ Patients with high eosinophil count ‘group A’ (>250 cell/μl) had a significantly higher incidence of exacerbations (P=0.003), with a relative risk ratio of 2.77, as well as a higher number of exacerbations per patient (two exacerbations/patient) versus one exacerbation/three patients (P<0.001), and a shorter period to the first exacerbation (17 vs. 31 days) (P=0.024), compared with those with low eosinophil count ‘group B (≤250 cell/μl)’ during the study period. On the contrary, there was no significant difference between them in the incidence of pneumonia in relation to inhaled corticosteroid use. Conclusion The count of eosinophils in the peripheral blood is a reliable exacerbation biomarker in stable COPD patients.","PeriodicalId":46359,"journal":{"name":"Egyptian Journal of Chest Diseases and Tuberculosis","volume":"77 1","pages":"313 - 319"},"PeriodicalIF":0.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89145098","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}
Pub Date : 2023-07-01DOI: 10.4103/ecdt.ecdt_109_22
A. Marwa, Korraa Emad, Madkour Ashraf, A. Noha
Introduction Data regarding the role of chest ultrasound (CUS) in thoracic tuberculosis (TTB) are deficient. If the diagnostic accuracy of CUS for pulmonary tuberculosis (PTB) is similar to that for CUS in the diagnosis of pneumonia, CUS could play an important role in its diagnosis. Aim This study aimed to describe the diagnostic features and use of CUS in TTB and compare CUS findings in PTB versus community-acquired pneumonia (CAP). Patients and methods Consecutive patients presenting with TTB and CAP were enrolled in this study. Computed tomography (CT) chest, CUS, mediastinal US, and abdominal US were performed. CUS lesion pattern in TTB, PTB, and CAP cases were recorded. Results CUS in patients with PTB uniquely and significantly detected pleural gap (28 patients, 27%), fragmented pleura (35 patients, 34%), subpleural fluid collection (three patients, 2.9%), and subpleural nodules (SPN) (97 patients, 95%), which were not detected by CT (P<0.05 for all). Moreover, CUS in patients with PTB uniquely and significantly detected absent sliding sign in a cavitary lesion, pleural gap, and SPNs, which were absent in CUS in CAP (P<0.05 for all) and highly significant more subpleural consolidations when compared with CUS findings in CAP. However, more significant air bronchogram CUS patterns were encountered in patients with CAP than in those with PTB. Conclusion CUS is a complementary tool in assessing TTB. It can report new PTB patterns (pleural gap, fragmented pleura, subpleural fluid collection, SPN, and subpleural consolidation) not detected by CT. CUS detects different sonographic patterns in PTB than CAP.
{"title":"The role of chest ultrasound in the diagnosis of thoracic tuberculosis","authors":"A. Marwa, Korraa Emad, Madkour Ashraf, A. Noha","doi":"10.4103/ecdt.ecdt_109_22","DOIUrl":"https://doi.org/10.4103/ecdt.ecdt_109_22","url":null,"abstract":"Introduction Data regarding the role of chest ultrasound (CUS) in thoracic tuberculosis (TTB) are deficient. If the diagnostic accuracy of CUS for pulmonary tuberculosis (PTB) is similar to that for CUS in the diagnosis of pneumonia, CUS could play an important role in its diagnosis. Aim This study aimed to describe the diagnostic features and use of CUS in TTB and compare CUS findings in PTB versus community-acquired pneumonia (CAP). Patients and methods Consecutive patients presenting with TTB and CAP were enrolled in this study. Computed tomography (CT) chest, CUS, mediastinal US, and abdominal US were performed. CUS lesion pattern in TTB, PTB, and CAP cases were recorded. Results CUS in patients with PTB uniquely and significantly detected pleural gap (28 patients, 27%), fragmented pleura (35 patients, 34%), subpleural fluid collection (three patients, 2.9%), and subpleural nodules (SPN) (97 patients, 95%), which were not detected by CT (P<0.05 for all). Moreover, CUS in patients with PTB uniquely and significantly detected absent sliding sign in a cavitary lesion, pleural gap, and SPNs, which were absent in CUS in CAP (P<0.05 for all) and highly significant more subpleural consolidations when compared with CUS findings in CAP. However, more significant air bronchogram CUS patterns were encountered in patients with CAP than in those with PTB. Conclusion CUS is a complementary tool in assessing TTB. It can report new PTB patterns (pleural gap, fragmented pleura, subpleural fluid collection, SPN, and subpleural consolidation) not detected by CT. CUS detects different sonographic patterns in PTB than CAP.","PeriodicalId":46359,"journal":{"name":"Egyptian Journal of Chest Diseases and Tuberculosis","volume":"27 1","pages":"452 - 460"},"PeriodicalIF":0.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85943995","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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