O. Mansour, R. El-Helbawy, Tarek Elzeary, Asmaa Abdel Tawab
Background Transthoracic ultrasound (US) is useful in the evaluation of a wide range of peripheral, parenchymal, pleural, and chest-wall diseases. Aim To evaluate the role of chest US in the diagnosis of peripheral thoracic lesions. Patients and methods A prospective interventional analytical study was included: 40 adult patients with peripheral thoracic lesions. Transthoracic US (Philips Affinity 50 G U/S, made in Germany) was performed using a linear 5–10-MHz probe for examination of the thoracic wall and the parietal pleura, whereas a 2–5-MHz convex probe was used to examine the visceral pleura, pleural effusion, and lung parenchyma. US-guided core biopsy (Tru cut needle 16 G×10 cm), fine-needle aspiration, or both were performed. Different diagnostic procedures such as bronchoscopy, thoracoscopy, or computed tomography-guided biopsy were done to approach the final confirmatory histopathological diagnosis. Results The final confirmatory diagnosis was approached in 38/40 (95%) patients, while 2/40 (5%) patients were undiagnosed due to morbidity or discharge. The frequent transthoracic US findings were pleural effusion (82.5%), pleural thickening (52.5%), and lung collapse (47.5%). While lung abscess (2.5%) and lung nodules (2.5%) were less-frequent findings. Regarding the diagnostic procedure, 11/38 patients of the studied population were diagnosed by US-guided biopsy, 16/38 cases were diagnosed by US-guided aspiration, and 2/38 cases were diagnosed by both US-guided biopsy and aspiration. Moreover, 1/38 cases were diagnosed by computed tomography-guided biopsy because the result of US-guided biopsy was inconclusive. Fiber-optic bronchoscopic biopsy was carried out in 2/38 patients who had endobronchial central lesion. Another 5/38 cases were diagnosed by thoracoscopic biopsies after a trial of US-guided biopsy failure. Transthoracic US had a diagnostic utility of 83, 67, 97, and 25% sensitivity, specificity, positive, and negative predictive value, respectively. Conclusion Transthoracic US is a practical, cheap, and safe method for diagnosis of peripheral lung lesions and pleural diseases.
{"title":"Role of chest ultrasound in patients with peripheral thoracic lesions","authors":"O. Mansour, R. El-Helbawy, Tarek Elzeary, Asmaa Abdel Tawab","doi":"10.4103/ecdt.ecdt_52_22","DOIUrl":"https://doi.org/10.4103/ecdt.ecdt_52_22","url":null,"abstract":"Background Transthoracic ultrasound (US) is useful in the evaluation of a wide range of peripheral, parenchymal, pleural, and chest-wall diseases. Aim To evaluate the role of chest US in the diagnosis of peripheral thoracic lesions. Patients and methods A prospective interventional analytical study was included: 40 adult patients with peripheral thoracic lesions. Transthoracic US (Philips Affinity 50 G U/S, made in Germany) was performed using a linear 5–10-MHz probe for examination of the thoracic wall and the parietal pleura, whereas a 2–5-MHz convex probe was used to examine the visceral pleura, pleural effusion, and lung parenchyma. US-guided core biopsy (Tru cut needle 16 G×10 cm), fine-needle aspiration, or both were performed. Different diagnostic procedures such as bronchoscopy, thoracoscopy, or computed tomography-guided biopsy were done to approach the final confirmatory histopathological diagnosis. Results The final confirmatory diagnosis was approached in 38/40 (95%) patients, while 2/40 (5%) patients were undiagnosed due to morbidity or discharge. The frequent transthoracic US findings were pleural effusion (82.5%), pleural thickening (52.5%), and lung collapse (47.5%). While lung abscess (2.5%) and lung nodules (2.5%) were less-frequent findings. Regarding the diagnostic procedure, 11/38 patients of the studied population were diagnosed by US-guided biopsy, 16/38 cases were diagnosed by US-guided aspiration, and 2/38 cases were diagnosed by both US-guided biopsy and aspiration. Moreover, 1/38 cases were diagnosed by computed tomography-guided biopsy because the result of US-guided biopsy was inconclusive. Fiber-optic bronchoscopic biopsy was carried out in 2/38 patients who had endobronchial central lesion. Another 5/38 cases were diagnosed by thoracoscopic biopsies after a trial of US-guided biopsy failure. Transthoracic US had a diagnostic utility of 83, 67, 97, and 25% sensitivity, specificity, positive, and negative predictive value, respectively. Conclusion Transthoracic US is a practical, cheap, and safe method for diagnosis of peripheral lung lesions and pleural diseases.","PeriodicalId":46359,"journal":{"name":"Egyptian Journal of Chest Diseases and Tuberculosis","volume":"98 1","pages":"225 - 230"},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83121384","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}
Youssef Habib, M. Ahmed, H. Salem, Hossam Abdel-hamed
Background and objectives Cost-effectiveness is a significant concern in a developing economy. As a result, the purpose of this work was to study the efficiency and safety of using mini bronchoalveolar lavage (mini-BAL) samples to diagnose recently developed lung infiltrates in mechanically ventilated patients. Aims This work aims to evaluate the role of BAL cultures sampled using the mini-BAL maneuver to diagnose recently developed lung infiltrates in patients who are being ventilated mechanically. Patients and methods Mini-BAL and microbiological cultures were to evaluate 30 mechanically ventilated patients with recently developed lung infiltrates. The outer protective catheter was a Nelaton catheter size 18 FG, while the inner catheter was an infant ryle catheter size FG-10. Instead of using the prepackaged catheters, the outer protective catheter was blocked by sterile K-Y gel. Results Klebsiella spp. are the most commonly isolated bacterial (44.4%) while Candida spp. (23.3%) are the most commonly isolated fungal organism in mechanically ventilated patients. Some patients had more than one isolated organism: Bimicrobial 16.7% and polymicrobial 26.7% while unimicrobial 46.7%. There was a statistically significant relationship between microbiology and clinical pulmonary infection score among the included patients at P value of 0.003. Conclusion The new mini-BAL is an effective bedside maneuver for obtaining uncontaminated lower respiratory secretions in patients with recently developed pulmonary infiltrates and suspected ventilator-associated pneumonia. It is also safe, affordable, easy, noninvasive, and readily available.
{"title":"Value of bronchoalveolar lavage in the diagnosis of newly developed lung infiltrates in mechanically ventilated patients","authors":"Youssef Habib, M. Ahmed, H. Salem, Hossam Abdel-hamed","doi":"10.4103/ecdt.ecdt_94_22","DOIUrl":"https://doi.org/10.4103/ecdt.ecdt_94_22","url":null,"abstract":"Background and objectives Cost-effectiveness is a significant concern in a developing economy. As a result, the purpose of this work was to study the efficiency and safety of using mini bronchoalveolar lavage (mini-BAL) samples to diagnose recently developed lung infiltrates in mechanically ventilated patients. Aims This work aims to evaluate the role of BAL cultures sampled using the mini-BAL maneuver to diagnose recently developed lung infiltrates in patients who are being ventilated mechanically. Patients and methods Mini-BAL and microbiological cultures were to evaluate 30 mechanically ventilated patients with recently developed lung infiltrates. The outer protective catheter was a Nelaton catheter size 18 FG, while the inner catheter was an infant ryle catheter size FG-10. Instead of using the prepackaged catheters, the outer protective catheter was blocked by sterile K-Y gel. Results Klebsiella spp. are the most commonly isolated bacterial (44.4%) while Candida spp. (23.3%) are the most commonly isolated fungal organism in mechanically ventilated patients. Some patients had more than one isolated organism: Bimicrobial 16.7% and polymicrobial 26.7% while unimicrobial 46.7%. There was a statistically significant relationship between microbiology and clinical pulmonary infection score among the included patients at P value of 0.003. Conclusion The new mini-BAL is an effective bedside maneuver for obtaining uncontaminated lower respiratory secretions in patients with recently developed pulmonary infiltrates and suspected ventilator-associated pneumonia. It is also safe, affordable, easy, noninvasive, and readily available.","PeriodicalId":46359,"journal":{"name":"Egyptian Journal of Chest Diseases and Tuberculosis","volume":"82 1","pages":"167 - 174"},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85856945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction Endotracheal intubation is an important technique in airway management. Although, little experience is present in the use of ultrasound in endotracheal intubation, studies suggest that it is reliable and fast as other usual methods and is a simple, feasible, portable, and noninvasive tool. Aim To assess the usefulness of ultrasonography compared with capnography and chest radiography in confirmation of correct endotracheal tube position in ICU patients. Patients and methods Fifty patients in need for intubation were included in this study. All patients were subjected immediately after intubation to the following to confirm correct endotracheal intubation: clinical evaluation, neck ultrasound, chest ultrasound, and chest radiographs. All methods were compared with capnography, the gold standard method for confirmation. Results Successful endotracheal intubation was confirmed by the presence of three successive waves in the capnography. This was achieved in 48 (96%) of cases (endotracheal tube), and in two (4%) cases, the tube was falsely placed in the esophagus. Direct localization of intubation by neck ultrasound had 97.7% sensitivity and 100% specificity to confirm correct intubation. On the contrary, indirect localization of the tube by chest ultrasound had 93.7% sensitivity and 100% specificity. Although localization of the tube by chest radiography has 97.8% sensitivity, it took longer time to be done in such critical casas (29236.44 ± 768.27 s). Clinical evidence of intubation had 95.8% sensitivity and 100% specificity. Conclusion Ultrasonography is a feasible, fast, and cost-effective method for the confirmation of the correct endotracheal tube placement.
{"title":"Ultrasound confirmation of endotracheal tube placement","authors":"G. Agmy, S. Wafy, M. Adam, Amal Abdelrahman","doi":"10.4103/ecdt.ecdt_32_19","DOIUrl":"https://doi.org/10.4103/ecdt.ecdt_32_19","url":null,"abstract":"Introduction Endotracheal intubation is an important technique in airway management. Although, little experience is present in the use of ultrasound in endotracheal intubation, studies suggest that it is reliable and fast as other usual methods and is a simple, feasible, portable, and noninvasive tool. Aim To assess the usefulness of ultrasonography compared with capnography and chest radiography in confirmation of correct endotracheal tube position in ICU patients. Patients and methods Fifty patients in need for intubation were included in this study. All patients were subjected immediately after intubation to the following to confirm correct endotracheal intubation: clinical evaluation, neck ultrasound, chest ultrasound, and chest radiographs. All methods were compared with capnography, the gold standard method for confirmation. Results Successful endotracheal intubation was confirmed by the presence of three successive waves in the capnography. This was achieved in 48 (96%) of cases (endotracheal tube), and in two (4%) cases, the tube was falsely placed in the esophagus. Direct localization of intubation by neck ultrasound had 97.7% sensitivity and 100% specificity to confirm correct intubation. On the contrary, indirect localization of the tube by chest ultrasound had 93.7% sensitivity and 100% specificity. Although localization of the tube by chest radiography has 97.8% sensitivity, it took longer time to be done in such critical casas (29236.44 ± 768.27 s). Clinical evidence of intubation had 95.8% sensitivity and 100% specificity. Conclusion Ultrasonography is a feasible, fast, and cost-effective method for the confirmation of the correct endotracheal tube placement.","PeriodicalId":46359,"journal":{"name":"Egyptian Journal of Chest Diseases and Tuberculosis","volume":"4 1","pages":"217 - 220"},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87421506","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}
Sh. Abd El-Fattah,, Radwa El Hefny, Yosra Fathy, E. Farhat
Background Diaphragmatic evaluation is crucial in the diagnosis of patients with chronic obstructive pulmonary disease (COPD). Diaphragmatic ultrasound is a simple, noninvasive, and bedside method. Ultrasound can analyze the diaphragm’s location, structure, and motility, as well as excursion and thickness.The study’s goal is to assess the diaphragm by ultrasonography in patients with COPD and relationship to disease severity. During their follow-up at the outpatient chest clinic, 40 patients with stable COPD and 40 healthy controls were studied for a year. Results The diaphragmatic measurements (thickening at total lung capacity and residual volume, excursion, and diaphragm thickness percentage) detected by ultrasonography were observed to decrease with increasing COPD severity.Furthermore, in comparison with the control group, these parameters were shown to be considerably lower in patients with COPD. Conclusion Ultrasonography is a safe, noninvasive, and straightforward approach for determining diaphragmatic thickness and excursion.The thickness and excursion of the diaphragmatic function were found to have a negative relationship with COPD severity.
{"title":"Evaluation of diaphragm in patients with chronic obstructive pulmonary disease using ultrasonography in relation to disease severity in Fayoum University Hospital","authors":"Sh. Abd El-Fattah,, Radwa El Hefny, Yosra Fathy, E. Farhat","doi":"10.4103/ecdt.ecdt_72_22","DOIUrl":"https://doi.org/10.4103/ecdt.ecdt_72_22","url":null,"abstract":"Background Diaphragmatic evaluation is crucial in the diagnosis of patients with chronic obstructive pulmonary disease (COPD). Diaphragmatic ultrasound is a simple, noninvasive, and bedside method. Ultrasound can analyze the diaphragm’s location, structure, and motility, as well as excursion and thickness.The study’s goal is to assess the diaphragm by ultrasonography in patients with COPD and relationship to disease severity. During their follow-up at the outpatient chest clinic, 40 patients with stable COPD and 40 healthy controls were studied for a year. Results The diaphragmatic measurements (thickening at total lung capacity and residual volume, excursion, and diaphragm thickness percentage) detected by ultrasonography were observed to decrease with increasing COPD severity.Furthermore, in comparison with the control group, these parameters were shown to be considerably lower in patients with COPD. Conclusion Ultrasonography is a safe, noninvasive, and straightforward approach for determining diaphragmatic thickness and excursion.The thickness and excursion of the diaphragmatic function were found to have a negative relationship with COPD severity.","PeriodicalId":46359,"journal":{"name":"Egyptian Journal of Chest Diseases and Tuberculosis","volume":"1 1","pages":"239 - 246"},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89919764","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 Interleukin-6 (IL-6) signal blockers have an important role in the management of Coronavirus Disease 2019 (COVID-19) and prevent progression of inflammation. Many studies have evaluated the efficacy of Sarilumab in severe COVID-19 pneumonia. Aim Evaluation of sarilumab efficacy in severe COVID-19 pneumonia. Patients and methods In all, 40 patients with severe acute respiratory syndrome coronavirus 2 severe pneumonia received intravenous sarilumab 400 mg. Results Patients were admitted to the ICU with a mean duration of 18.17 ± 8.75 days. Eighteen (45%) patients on high-flow oxygen with nonrebreather masks and 22 (55%) patients on mechanical ventilation received sarilumab. IL-6 level is with a mean of 62.50 ± 23.01 before sarilumab and a mean of 31.35 ± 33.30 after sarilumab. Thirteen (32.5%) patients improved and 27 (67.5%) patients died. No sarilumab serious adverse effects were detected in this study. Patient oxygen saturation on discharge mean was 95.75±.97%. Concerning serum IL-6 levels among the recruited patients, there was statistically significant difference between the mean baseline level compared with the follow-up levels, 62.50 ± 23.01 and 31.35 ± 33.30 ng/ml, respectively, with a P value of 0.001. Conclusion Sarilumab improves IL-6 level in COVID-19 patients with severe pneumonia with no serious adverse effects. Mortality rate increased in severe COVID-19 cases, so early use of sarilumab in moderate cases may decrease disease progression and decrease mortality rate.
{"title":"Sarilumab use in severe Coronavirus Disease 2019 pneumonia","authors":"Ahmed El Fattah Amer, Doaa Mousa","doi":"10.4103/ecdt.ecdt_77_22","DOIUrl":"https://doi.org/10.4103/ecdt.ecdt_77_22","url":null,"abstract":"Background Interleukin-6 (IL-6) signal blockers have an important role in the management of Coronavirus Disease 2019 (COVID-19) and prevent progression of inflammation. Many studies have evaluated the efficacy of Sarilumab in severe COVID-19 pneumonia. Aim Evaluation of sarilumab efficacy in severe COVID-19 pneumonia. Patients and methods In all, 40 patients with severe acute respiratory syndrome coronavirus 2 severe pneumonia received intravenous sarilumab 400 mg. Results Patients were admitted to the ICU with a mean duration of 18.17 ± 8.75 days. Eighteen (45%) patients on high-flow oxygen with nonrebreather masks and 22 (55%) patients on mechanical ventilation received sarilumab. IL-6 level is with a mean of 62.50 ± 23.01 before sarilumab and a mean of 31.35 ± 33.30 after sarilumab. Thirteen (32.5%) patients improved and 27 (67.5%) patients died. No sarilumab serious adverse effects were detected in this study. Patient oxygen saturation on discharge mean was 95.75±.97%. Concerning serum IL-6 levels among the recruited patients, there was statistically significant difference between the mean baseline level compared with the follow-up levels, 62.50 ± 23.01 and 31.35 ± 33.30 ng/ml, respectively, with a P value of 0.001. Conclusion Sarilumab improves IL-6 level in COVID-19 patients with severe pneumonia with no serious adverse effects. Mortality rate increased in severe COVID-19 cases, so early use of sarilumab in moderate cases may decrease disease progression and decrease mortality rate.","PeriodicalId":46359,"journal":{"name":"Egyptian Journal of Chest Diseases and Tuberculosis","volume":"129 9","pages":"191 - 193"},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72467690","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}
AlshaimaaW Erfan, Magdy Khalil, Ashraf A. ELMaraghy, Maryam Abd Elkader
Introduction Diaphragm is considered a key point in the prognosis of acute chronic obstructive pulmonary disease (COPD) exacerbations. Diaphragmatic performance is an issue that is not fully studied in different COPD phenotypes. Aim To assess diaphragmatic performance by chest ultrasound (US) in patients with two COPD phenotypes admitted to respiratory ICU with an acute exacerbation and to assess its relation to outcome. Patients and methods US assessment of diaphragm position, excursion, inspiratory time, velocity, thickening fraction, and excursion-time (E-T) index was done for 100 patients with COPD with two phenotypes, that is, chronic bronchitis (CB) and emphysema (E), who were admitted at the respiratory ICU of Abbassia Chest Hospital. Assessment was done for all patients within 24 h of admission. Primary end point was the need for mechanical ventilation (MV) and secondary end point was discharge or ICU mortality. Results Position of the diaphragm was at the –six to eight intercostal space, with mean of 7.114 ± 0.404, in the E group and at the –five to seven intercostal space, with a mean of 5.946 ± 0.524, in the CB group, with P value less than 0.001. There was a higher velocity in E (3.324 ± 1.151 cm/s) compared with CB (2.757 ± 1.023 cm/s), with P=0.011, and a higher expiratory thickness in CB (3.312 ± 0.806) versus E (2.584 ± 0.786 mm), with P value less than 0.001. Regarding the need for MV, 62 (62%) cases required MV (nine noninvasive mechanical ventilation and 53 invasive mechanical ventilation). The need for MV was higher in E compared with CB group (35/50 cases, 70%, and 27/50 cases, 54%, respectively; P<0.001). There was a significant shorter inspiratory time and a lower E-T index in both phenotypes among patients who required MV (P=0.007 and 0.045, respectively). The cutoff value of the inspiratory time and the E-T index in predicting the need to MV was less than 0.65 s and less than 1 cm/s, respectively. Conclusion US assessment of the diaphragm during acute COPD exacerbations may help anticipate the need for MV. The need of MV was related to a shorter inspiratory time (cutoff point <0.65 s) and a lower E-T index (cutoff point <1 cm/s). There was no difference between CB and E phenotypes in this aspect.
{"title":"Ultrasonographic assessment of diaphragmatic performance in two chronic obstructive pulmonary disease phenotypes admitted with acute exacerbation and its relation to outcome","authors":"AlshaimaaW Erfan, Magdy Khalil, Ashraf A. ELMaraghy, Maryam Abd Elkader","doi":"10.4103/ecdt.ecdt_57_22","DOIUrl":"https://doi.org/10.4103/ecdt.ecdt_57_22","url":null,"abstract":"Introduction Diaphragm is considered a key point in the prognosis of acute chronic obstructive pulmonary disease (COPD) exacerbations. Diaphragmatic performance is an issue that is not fully studied in different COPD phenotypes. Aim To assess diaphragmatic performance by chest ultrasound (US) in patients with two COPD phenotypes admitted to respiratory ICU with an acute exacerbation and to assess its relation to outcome. Patients and methods US assessment of diaphragm position, excursion, inspiratory time, velocity, thickening fraction, and excursion-time (E-T) index was done for 100 patients with COPD with two phenotypes, that is, chronic bronchitis (CB) and emphysema (E), who were admitted at the respiratory ICU of Abbassia Chest Hospital. Assessment was done for all patients within 24 h of admission. Primary end point was the need for mechanical ventilation (MV) and secondary end point was discharge or ICU mortality. Results Position of the diaphragm was at the –six to eight intercostal space, with mean of 7.114 ± 0.404, in the E group and at the –five to seven intercostal space, with a mean of 5.946 ± 0.524, in the CB group, with P value less than 0.001. There was a higher velocity in E (3.324 ± 1.151 cm/s) compared with CB (2.757 ± 1.023 cm/s), with P=0.011, and a higher expiratory thickness in CB (3.312 ± 0.806) versus E (2.584 ± 0.786 mm), with P value less than 0.001. Regarding the need for MV, 62 (62%) cases required MV (nine noninvasive mechanical ventilation and 53 invasive mechanical ventilation). The need for MV was higher in E compared with CB group (35/50 cases, 70%, and 27/50 cases, 54%, respectively; P<0.001). There was a significant shorter inspiratory time and a lower E-T index in both phenotypes among patients who required MV (P=0.007 and 0.045, respectively). The cutoff value of the inspiratory time and the E-T index in predicting the need to MV was less than 0.65 s and less than 1 cm/s, respectively. Conclusion US assessment of the diaphragm during acute COPD exacerbations may help anticipate the need for MV. The need of MV was related to a shorter inspiratory time (cutoff point <0.65 s) and a lower E-T index (cutoff point <1 cm/s). There was no difference between CB and E phenotypes in this aspect.","PeriodicalId":46359,"journal":{"name":"Egyptian Journal of Chest Diseases and Tuberculosis","volume":"78 1","pages":"139 - 146"},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80783330","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 : 2023-04-01DOI: 10.4103/ecdt.ecdt_111_22
Hala Samaha, Aya El-Hadidy, Ahmad Younis, Mohsen El-Shafe, Shreif Saker, A. Elsaid
Objective Our study aimed to examine the frequency and variety of sleep-disordered breathing (SDB) in different types of chronic compensated heart failure (HF), evaluate the sensitivity and specificity of Epworth sleepiness scale (ESS), Berlin, and STOP-BANG Questionnaires in diagnosing SDB in patients with chronic compensated HF and to establish the relation between ejection fraction (EF) and type of SDB that may assist in identifying the population at riskPatients and methods Fifty-three chronic compensated HF adult patients were enrolled, but only 40 cases underwent full-night attended polysomnography and completed the study and were available for final analysis. HF is classified into three groups: HFpEF, HFmrEF, and HFrEF according to ESC. SDB is classified according to the central apnea–hypopnea index and obstructive apnea–hypopnea index and their proportions into total apnea and hypopnea index into: OSA, coexisting OSA-CSA (predominantly OSA or CSA), and CSA. Results Statistically significant higher Mallampati score in those with SDB versus those without SDB. STOP-BANG questionnaire was the most sensitive SDB prediction score followed by Berlin score and the least was ESS. Berlin score and ESS were more specific than the STOP-BANG score. Statistically significantly lower left ventricular EF was observed in SDB patients in comparison with patients without SDB. There was significantly higher NC in OSA patients versus coexisting OSA/CSA either predominantly OSA or CSA. Significant higher BMI and Mallampati score in OSA group in comparison to coexisting OSA/CSA predominantly CSA patients. Significant lower left ventricular EF was found in patients with coexisting OSA/CSA whether predominantly CSA or OSA versus LVEF in OSA patients. Significant association between SDB and HF types (OSA was significantly associated with HFpEF). Significant differences between OSA and coexisting OSA/CSA predominantly OSA as regards AF. Conclusions Despite optimized therapy, SDB was prevalent in chronic compensated HF patients (82.5%). Among all studied patients, 40% suffer from obstructive sleep apnea, while 42.5% suffer from coexisting OSA/CSA. SDB in HF patients was best predicted using the STOP-BANG questionnaire, while Berlin and ESS were most accurate. SDB in HF may be predicted by higher Mallampati scores and lower LVEF. OSA is more prevalent in chronic HF patients who have large BMIs, neck circumferences, and Mallampati scores. HFrEF and HFmrEF are the only two forms of HF that are associated with OSA/CSA. Central apnea and hypopnea events were predicted by lower LVEF and AF.
{"title":"Sleep-disordered breathing in chronic compensated heart failure","authors":"Hala Samaha, Aya El-Hadidy, Ahmad Younis, Mohsen El-Shafe, Shreif Saker, A. Elsaid","doi":"10.4103/ecdt.ecdt_111_22","DOIUrl":"https://doi.org/10.4103/ecdt.ecdt_111_22","url":null,"abstract":"Objective Our study aimed to examine the frequency and variety of sleep-disordered breathing (SDB) in different types of chronic compensated heart failure (HF), evaluate the sensitivity and specificity of Epworth sleepiness scale (ESS), Berlin, and STOP-BANG Questionnaires in diagnosing SDB in patients with chronic compensated HF and to establish the relation between ejection fraction (EF) and type of SDB that may assist in identifying the population at riskPatients and methods Fifty-three chronic compensated HF adult patients were enrolled, but only 40 cases underwent full-night attended polysomnography and completed the study and were available for final analysis. HF is classified into three groups: HFpEF, HFmrEF, and HFrEF according to ESC. SDB is classified according to the central apnea–hypopnea index and obstructive apnea–hypopnea index and their proportions into total apnea and hypopnea index into: OSA, coexisting OSA-CSA (predominantly OSA or CSA), and CSA. Results Statistically significant higher Mallampati score in those with SDB versus those without SDB. STOP-BANG questionnaire was the most sensitive SDB prediction score followed by Berlin score and the least was ESS. Berlin score and ESS were more specific than the STOP-BANG score. Statistically significantly lower left ventricular EF was observed in SDB patients in comparison with patients without SDB. There was significantly higher NC in OSA patients versus coexisting OSA/CSA either predominantly OSA or CSA. Significant higher BMI and Mallampati score in OSA group in comparison to coexisting OSA/CSA predominantly CSA patients. Significant lower left ventricular EF was found in patients with coexisting OSA/CSA whether predominantly CSA or OSA versus LVEF in OSA patients. Significant association between SDB and HF types (OSA was significantly associated with HFpEF). Significant differences between OSA and coexisting OSA/CSA predominantly OSA as regards AF. Conclusions Despite optimized therapy, SDB was prevalent in chronic compensated HF patients (82.5%). Among all studied patients, 40% suffer from obstructive sleep apnea, while 42.5% suffer from coexisting OSA/CSA. SDB in HF patients was best predicted using the STOP-BANG questionnaire, while Berlin and ESS were most accurate. SDB in HF may be predicted by higher Mallampati scores and lower LVEF. OSA is more prevalent in chronic HF patients who have large BMIs, neck circumferences, and Mallampati scores. HFrEF and HFmrEF are the only two forms of HF that are associated with OSA/CSA. Central apnea and hypopnea events were predicted by lower LVEF and AF.","PeriodicalId":46359,"journal":{"name":"Egyptian Journal of Chest Diseases and Tuberculosis","volume":"42 1","pages":"291 - 299"},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87388316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Hammad, H. Shalaby, M. Kamel, Dalia Abd El Sattar El Embaby
Background ICU-acquired weakness (AW) is a common complication in the ICU, which needs more attention because it affects the patients’ outcome. It has subtypes that differ in its pathology. Many risk factors contribute to that problem through different mechanisms. ICU-AW is diagnosed clinically and by other investigations. Objective To assess whether early recognition of ICU-AW and early rehabilitation in respiratory ICU might improve patients’ functional recovery and outcomes. Patients and methods A randomized controlled study was conducted on 50 patients in the respiratory ICU, who were divided into two groups. Both groups received the same rehabilitation program, but the study group received neuromuscular electrical stimulation, whereas the control group received sham treatment. The program was 4 days per week for 2 weeks. All patients were assessed before and after treatment by measuring midthigh, midleg, and midarm circumferences and assessment of the muscle strength using the Medical Research Council sum score. Results Both groups were matched demographically and in the pretreatment assessment. There were posttreatment significant changes in both groups, but when comparing the changes, it was more significant in the study group. The outcomes for both groups regarding ICU-AW were similar. Conclusion ICU-AW can be ameliorated by focusing on early rehabilitation, especially with the usage of neuromuscular electrical stimulation.
{"title":"Early pulmonary and physical rehabilitation in cooperative patients in the respiratory ICU","authors":"A. Hammad, H. Shalaby, M. Kamel, Dalia Abd El Sattar El Embaby","doi":"10.4103/ecdt.ecdt_86_22","DOIUrl":"https://doi.org/10.4103/ecdt.ecdt_86_22","url":null,"abstract":"Background ICU-acquired weakness (AW) is a common complication in the ICU, which needs more attention because it affects the patients’ outcome. It has subtypes that differ in its pathology. Many risk factors contribute to that problem through different mechanisms. ICU-AW is diagnosed clinically and by other investigations. Objective To assess whether early recognition of ICU-AW and early rehabilitation in respiratory ICU might improve patients’ functional recovery and outcomes. Patients and methods A randomized controlled study was conducted on 50 patients in the respiratory ICU, who were divided into two groups. Both groups received the same rehabilitation program, but the study group received neuromuscular electrical stimulation, whereas the control group received sham treatment. The program was 4 days per week for 2 weeks. All patients were assessed before and after treatment by measuring midthigh, midleg, and midarm circumferences and assessment of the muscle strength using the Medical Research Council sum score. Results Both groups were matched demographically and in the pretreatment assessment. There were posttreatment significant changes in both groups, but when comparing the changes, it was more significant in the study group. The outcomes for both groups regarding ICU-AW were similar. Conclusion ICU-AW can be ameliorated by focusing on early rehabilitation, especially with the usage of neuromuscular electrical stimulation.","PeriodicalId":46359,"journal":{"name":"Egyptian Journal of Chest Diseases and Tuberculosis","volume":"1 1","pages":"221 - 224"},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82336142","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}
Magdy Marwa, Haytham Samy, L. Ashour, Sherif Abbas, Marwa Daif
Background High-resolution computed tomography (CT) is the most reliable sensitive noninvasive imaging procedure recommended in the diagnosis, assessment, the severity, and follow-up of coronavirus disease 2019 (COVID-19).It has a qualitative and quantitative role. The COVID-19 Reporting and Data System evaluates the probability of COVID-19 pulmonary involvement, and the corresponding CT severity score, which evaluates the approximate percentage of each of the five lobes’ involvement. Research question We aimed to illustrate chest CT typical and atypical manifestations in COVID-19 patients regarding their age, sex, patients’ symptoms, and CT severity score. Study design and methods We conducted a cross-sectional study on 120 patients more than or equal to 18 years with confirmed COVID-19 infection (PCR positive) during the period from April 2021 to October 2021, who were admitted to Ain Shams University Isolation Hospitals, where all patients’ clinical data and CT chest imaging for these patients will be collected.
{"title":"Typical and atypical chest computed tomography manifestations in COVID-19 patients","authors":"Magdy Marwa, Haytham Samy, L. Ashour, Sherif Abbas, Marwa Daif","doi":"10.4103/ecdt.ecdt_56_22","DOIUrl":"https://doi.org/10.4103/ecdt.ecdt_56_22","url":null,"abstract":"Background High-resolution computed tomography (CT) is the most reliable sensitive noninvasive imaging procedure recommended in the diagnosis, assessment, the severity, and follow-up of coronavirus disease 2019 (COVID-19).It has a qualitative and quantitative role. The COVID-19 Reporting and Data System evaluates the probability of COVID-19 pulmonary involvement, and the corresponding CT severity score, which evaluates the approximate percentage of each of the five lobes’ involvement. Research question We aimed to illustrate chest CT typical and atypical manifestations in COVID-19 patients regarding their age, sex, patients’ symptoms, and CT severity score. Study design and methods We conducted a cross-sectional study on 120 patients more than or equal to 18 years with confirmed COVID-19 infection (PCR positive) during the period from April 2021 to October 2021, who were admitted to Ain Shams University Isolation Hospitals, where all patients’ clinical data and CT chest imaging for these patients will be collected.","PeriodicalId":46359,"journal":{"name":"Egyptian Journal of Chest Diseases and Tuberculosis","volume":"33 1","pages":"175 - 182"},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88368692","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}
Enass Rezk, Aya Abdeldayem, A. Farag, H. Abdelhamid
Background Adjuvant hypofractionated radiotherapy (RT) used in the management of breast cancer cases, although reduce time and cost, may have serious effects due to the increased dose of radiation. Radiation-induced lung injury is an important side effect of thoracic radiation. Aim In our study, patients assessed by spirometry to detect acute changes in lung functions resulted from radiation exposure during the treatment of breast cancer. Patients and methods In this prospective study, 31 patients with breast cancer, who received adjuvant RT in Ain Shams University Hospitals, were assessed by spirometry before and 8 weeks after the end of RT. Radiation pneumonitis (RP) was graded using the Common Terminology Criteria for Adverse Events, version 5. Pulmonary function was evaluated by spirometry before and 8 weeks after finishing RT to detect changes in forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/FVC ratio, forced expiratory flow at 25–75% of FVC (FEF25%–75%), and FEF50% of . Results Five (16.1%) patients developed symptomatic RP. Significant reduction was noticed in FVC and FEV1, while FEV1/FVC ratio, FEF25%–75%, and FEF50% were not significantly affected. It was also observed that FEV1 was sensitive in anticipating RP. Conclusion Spirometry parameters, FEV1 and FVC, significantly decreased after 8 weeks of RT ending, without significant decrease in other parameters, favoring restrictive lung injury pattern. Since most cancer breast patients who developed RP were asymptomatic, spirometry was found to be beneficial in identifying patients with risk of radiation-induced lung injury (RP).
{"title":"Effect of hypofractionated radiotherapy on lung functions in breast cancer patients","authors":"Enass Rezk, Aya Abdeldayem, A. Farag, H. Abdelhamid","doi":"10.4103/ecdt.ecdt_20_22","DOIUrl":"https://doi.org/10.4103/ecdt.ecdt_20_22","url":null,"abstract":"Background Adjuvant hypofractionated radiotherapy (RT) used in the management of breast cancer cases, although reduce time and cost, may have serious effects due to the increased dose of radiation. Radiation-induced lung injury is an important side effect of thoracic radiation. Aim In our study, patients assessed by spirometry to detect acute changes in lung functions resulted from radiation exposure during the treatment of breast cancer. Patients and methods In this prospective study, 31 patients with breast cancer, who received adjuvant RT in Ain Shams University Hospitals, were assessed by spirometry before and 8 weeks after the end of RT. Radiation pneumonitis (RP) was graded using the Common Terminology Criteria for Adverse Events, version 5. Pulmonary function was evaluated by spirometry before and 8 weeks after finishing RT to detect changes in forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), FEV1/FVC ratio, forced expiratory flow at 25–75% of FVC (FEF25%–75%), and FEF50% of . Results Five (16.1%) patients developed symptomatic RP. Significant reduction was noticed in FVC and FEV1, while FEV1/FVC ratio, FEF25%–75%, and FEF50% were not significantly affected. It was also observed that FEV1 was sensitive in anticipating RP. Conclusion Spirometry parameters, FEV1 and FVC, significantly decreased after 8 weeks of RT ending, without significant decrease in other parameters, favoring restrictive lung injury pattern. Since most cancer breast patients who developed RP were asymptomatic, spirometry was found to be beneficial in identifying patients with risk of radiation-induced lung injury (RP).","PeriodicalId":46359,"journal":{"name":"Egyptian Journal of Chest Diseases and Tuberculosis","volume":"151 1","pages":"75 - 79"},"PeriodicalIF":0.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77766563","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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