Pub Date : 2024-07-01DOI: 10.4103/ecdt.ecdt_101_23
Faiza Keriou, Souhir Chaibi, Nedjma Talbi, A. Ketfi
Chronic obstructive pulmonary disease (COPD) is a common disease, yet it is often overlooked by the general public, patients themselves, and doctors due to its slow and insidious progression. Changing the natural history of COPD requires first of all the diagnosis of the disease, so its early detection seems an important element. It then becomes possible to set the objectives and criteria for the assessment of management and to choose the most appropriate treatments for each individual according to his characteristics. A prospective observational study in COPD patients who were hospitalized in the Department of Pneumology, University Hospital Center of Setif from January 2017 to March 2020 to analyze the quality of outpatient management of these patients. In all, 349 patients were included in the study of which 82.2% were men with an average age of 62 years. On admission, only 28.6% or 100 patients were diagnosed and confirmed to have COPD. The general practitioner received COPD patients first in more than 1/3 of cases (37.5%). Pneumologists received 34.6% of patients and diagnosed 99 cases out of 121 consultations, so the diagnosis was made in 81.8% of cases. Spirometry is essential for the diagnosis of COPD. It is simple, inexpensive, and safe; however, it was only performed for 100 patients or 28.6% of cases, confirming the sub-diagnosis of COPD in outpatients. In terms of therapeutic management, the differences between international recommendations and current practice are significant, particularly those concerning the prescription of inhaled or systemic corticosteroid therapy, as well as antibiotic therapy, without forgetting the underestimated therapies in these COPD patients, such as vaccinations (influenza vaccination rate at 27.2% of cases, pneumococcal at 8.26%), Long-term oxygen therapy, and the initiation of smoking cessation (4.1% of cases). The publication of recommendations reviewed by experts enables updating the diagnostic management of COPD. We can hope that the recommendations will be followed up and that practices will be harmonized. However, differences between international recommendations and current practice are significant for COPD patients. Early diagnosis and effective therapeutic management of COPD remain, particularly current issues; they would reduce disability and improve the quality of life of the patient.
{"title":"Management of chronic obstructive pulmonary disease in Algeria and implementation of international recommendations","authors":"Faiza Keriou, Souhir Chaibi, Nedjma Talbi, A. Ketfi","doi":"10.4103/ecdt.ecdt_101_23","DOIUrl":"https://doi.org/10.4103/ecdt.ecdt_101_23","url":null,"abstract":"\u0000 \u0000 Chronic obstructive pulmonary disease (COPD) is a common disease, yet it is often overlooked by the general public, patients themselves, and doctors due to its slow and insidious progression. Changing the natural history of COPD requires first of all the diagnosis of the disease, so its early detection seems an important element. It then becomes possible to set the objectives and criteria for the assessment of management and to choose the most appropriate treatments for each individual according to his characteristics.\u0000 \u0000 \u0000 \u0000 A prospective observational study in COPD patients who were hospitalized in the Department of Pneumology, University Hospital Center of Setif from January 2017 to March 2020 to analyze the quality of outpatient management of these patients.\u0000 \u0000 \u0000 \u0000 In all, 349 patients were included in the study of which 82.2% were men with an average age of 62 years. On admission, only 28.6% or 100 patients were diagnosed and confirmed to have COPD. The general practitioner received COPD patients first in more than 1/3 of cases (37.5%). Pneumologists received 34.6% of patients and diagnosed 99 cases out of 121 consultations, so the diagnosis was made in 81.8% of cases. Spirometry is essential for the diagnosis of COPD. It is simple, inexpensive, and safe; however, it was only performed for 100 patients or 28.6% of cases, confirming the sub-diagnosis of COPD in outpatients. In terms of therapeutic management, the differences between international recommendations and current practice are significant, particularly those concerning the prescription of inhaled or systemic corticosteroid therapy, as well as antibiotic therapy, without forgetting the underestimated therapies in these COPD patients, such as vaccinations (influenza vaccination rate at 27.2% of cases, pneumococcal at 8.26%), Long-term oxygen therapy, and the initiation of smoking cessation (4.1% of cases).\u0000 \u0000 \u0000 \u0000 The publication of recommendations reviewed by experts enables updating the diagnostic management of COPD. We can hope that the recommendations will be followed up and that practices will be harmonized. However, differences between international recommendations and current practice are significant for COPD patients. Early diagnosis and effective therapeutic management of COPD remain, particularly current issues; they would reduce disability and improve the quality of life of the patient.\u0000","PeriodicalId":519530,"journal":{"name":"The Egyptian Journal of Chest Diseases and Tuberculosis","volume":"20 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141711853","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}
Islam M. Mostafa, G. Salem, Maryam A. A. Kader, Dina Ruby
Occupational lung diseases include a wide variety of respiratory diseases with clinical manifestations and diagnostic test results that have features similar to nonoccupational diseases. To determine the prevalence of occupational Interstitial lung diseases (ILD) among confirmed ILD patients admitted to the chest department of Egyptian Railway Medical Centre and the assessment of the outcome. A total of 155 patients with confirmed ILD, were subdivided into two groups: group (A) 79 patients with occupational exposure and group (B) 76 patients with nonoccupational exposure. Both groups were subjected to a detailed history, radiological assessment, arterial blood gases, and Spirometry. Data of days of hospital stay were also recorded. The prevalence of confirmed cases of ILD among occupational exposure was 1.49% versus 1.1% in the nonoccupational. Range of age in occupational group was between (31and 68 years). Chest X ray (CXR) findings were positive in 58.2% and 30.2% of occupational and nonoccupational group, respectively. Among group (A), 47.1% of the patients stayed between 11 and 15 days), 15.76% admitted to ICU, and 5.2% were mechanically ventilated. While 48% of hospitalized nonoccupational patients stayed between 6 and 10 days, 8% were admitted to ICU and 4% were mechanically ventilated. The prevalence of interstitial lung diseases with occupational exposure was 1.49%, higher than non-occupational interstitial lung diseases. They were younger in age, had history of domiciliary oxygen therapy, frequent exacerbations, and previous hospital admissions. They had prolonged length of hospital stay, particularly those not using protective measures.
{"title":"‘Evaluation of occupational and nonoccupational interstitial lung disease in railway workers’","authors":"Islam M. Mostafa, G. Salem, Maryam A. A. Kader, Dina Ruby","doi":"10.4103/ecdt.ecdt_37_23","DOIUrl":"https://doi.org/10.4103/ecdt.ecdt_37_23","url":null,"abstract":"\u0000 \u0000 Occupational lung diseases include a wide variety of respiratory diseases with clinical manifestations and diagnostic test results that have features similar to nonoccupational diseases.\u0000 \u0000 \u0000 \u0000 To determine the prevalence of occupational Interstitial lung diseases (ILD) among confirmed ILD patients admitted to the chest department of Egyptian Railway Medical Centre and the assessment of the outcome.\u0000 \u0000 \u0000 \u0000 A total of 155 patients with confirmed ILD, were subdivided into two groups: group (A) 79 patients with occupational exposure and group (B) 76 patients with nonoccupational exposure. Both groups were subjected to a detailed history, radiological assessment, arterial blood gases, and Spirometry. Data of days of hospital stay were also recorded.\u0000 \u0000 \u0000 \u0000 The prevalence of confirmed cases of ILD among occupational exposure was 1.49% versus 1.1% in the nonoccupational. Range of age in occupational group was between (31and 68 years). Chest X ray (CXR) findings were positive in 58.2% and 30.2% of occupational and nonoccupational group, respectively. Among group (A), 47.1% of the patients stayed between 11 and 15 days), 15.76% admitted to ICU, and 5.2% were mechanically ventilated. While 48% of hospitalized nonoccupational patients stayed between 6 and 10 days, 8% were admitted to ICU and 4% were mechanically ventilated.\u0000 \u0000 \u0000 \u0000 The prevalence of interstitial lung diseases with occupational exposure was 1.49%, higher than non-occupational interstitial lung diseases. They were younger in age, had history of domiciliary oxygen therapy, frequent exacerbations, and previous hospital admissions. They had prolonged length of hospital stay, particularly those not using protective measures.\u0000","PeriodicalId":519530,"journal":{"name":"The Egyptian Journal of Chest Diseases and Tuberculosis","volume":"11 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141710507","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}
Radwa A. Yassin, Ehab Mostafa, Khaled Naguib, Hany Ammar, Diaa El Din Moussa
Acceleration of radiotherapy in five fractions for breast cancer can improve treatment accessibility, especially in low, middle-income countries and during pandemics. We report on acute toxicity after whole breast irradiation/chest wall irradiation±nodal irradiation, radiotherapy interruption and reported acute pneumonitis with an ultra-hypofractionation schedule compared to modest hypofractionation protocol during the coronavirus disease pandemic. Acute toxicity assessment using the RTOG acute toxicity scoring system. One of two specified doses was administered to the breast: 15 × 2.67 Gy (40.05 Gy) or 5 × 5.2 Gy (26 Gy), tumor boost when indicated prescribed dose 5 × 200 Gy with three-dimensional conformal radiotherapy technique. Inclusion criteria were: T1–T3 invasive breast cancer, N0–N1 and N2 after breast conserving or modified radical surgery. A total of 101 patients were included in the study. Median age was 53 ± 10.29 years, with median follow-up time 14 months (12–20 months). A significant difference was observed for acute skin toxicity after radiotherapy in favor of better tolerability for the ultrafractionation schedule (P<0.0001). None of the cases in ultra-hypofractionation had interrupted radiotherapy course for more than 2 days, on the other hand, 45.8% of the cases in modest hypofractionation had interrupted course with chest infection as the second most common cause. Regarding acute radiation pneumonitis none of the cases in both arms reported grades 3–4 acute radiation pneumonitis within the first 90 days postradiotherapy. Regarding initial toxicity and patient adherence to the radiation course, this single institute study suggests that hypofractionated breast irradiation in 15 fractions compares favorably to accelerated breast radiotherapy in five fractions over 5 days. However, a longer time for follow-up and larger enrolled numbers are needed to confirm noninferiority of this approach.
{"title":"Randomized prospective trial comparing two schedules of hypofractionated adjuvant radiotherapy 3 weeks against 1 week fractionation regimen in females with breast cancer","authors":"Radwa A. Yassin, Ehab Mostafa, Khaled Naguib, Hany Ammar, Diaa El Din Moussa","doi":"10.4103/ecdt.ecdt_18_24","DOIUrl":"https://doi.org/10.4103/ecdt.ecdt_18_24","url":null,"abstract":"\u0000 \u0000 Acceleration of radiotherapy in five fractions for breast cancer can improve treatment accessibility, especially in low, middle-income countries and during pandemics. We report on acute toxicity after whole breast irradiation/chest wall irradiation±nodal irradiation, radiotherapy interruption and reported acute pneumonitis with an ultra-hypofractionation schedule compared to modest hypofractionation protocol during the coronavirus disease pandemic.\u0000 \u0000 \u0000 \u0000 Acute toxicity assessment using the RTOG acute toxicity scoring system. One of two specified doses was administered to the breast: 15 × 2.67 Gy (40.05 Gy) or 5 × 5.2 Gy (26 Gy), tumor boost when indicated prescribed dose 5 × 200 Gy with three-dimensional conformal radiotherapy technique. Inclusion criteria were: T1–T3 invasive breast cancer, N0–N1 and N2 after breast conserving or modified radical surgery.\u0000 \u0000 \u0000 \u0000 A total of 101 patients were included in the study. Median age was 53 ± 10.29 years, with median follow-up time 14 months (12–20 months). A significant difference was observed for acute skin toxicity after radiotherapy in favor of better tolerability for the ultrafractionation schedule (P<0.0001). None of the cases in ultra-hypofractionation had interrupted radiotherapy course for more than 2 days, on the other hand, 45.8% of the cases in modest hypofractionation had interrupted course with chest infection as the second most common cause. Regarding acute radiation pneumonitis none of the cases in both arms reported grades 3–4 acute radiation pneumonitis within the first 90 days postradiotherapy.\u0000 \u0000 \u0000 \u0000 Regarding initial toxicity and patient adherence to the radiation course, this single institute study suggests that hypofractionated breast irradiation in 15 fractions compares favorably to accelerated breast radiotherapy in five fractions over 5 days. However, a longer time for follow-up and larger enrolled numbers are needed to confirm noninferiority of this approach.\u0000","PeriodicalId":519530,"journal":{"name":"The Egyptian Journal of Chest Diseases and Tuberculosis","volume":"46 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141693403","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}
E. Hefzy, Doaa Y. Ali, Ahmed M. Magdy, Wafaa Y. Abdel Wahed, Ahmed F. El Khateeb, Mona Ahmed
During the coronavirus disease 2019 (COVID-19) pandemic, Egypt was among the minor epidemic areas. COVID-19 has wide variations in the clinical presentation manifesting as a heterogeneous disease severity varying from mild, moderate, and severe to critical illness. This study aimed to identify the potential clinical, radiological, and laboratory characteristics and prognosis of the COVID-19 patients obtained during the first peak of this pandemic at a University Hospital in Egypt, and to provide a reference for the pandemic management in the subsequent peaks. A single-center prospective study was done on patients with COVID-19 admitted to Fayoum University Hospital during the period from May to July 2020. All patients had full medical history taking, clinical examination, laboratory assessment, oxygen-saturation monitoring, chest computed tomography (CT), and reverse transcriptase-PCR testing. All the patients were treated with the treatment protocol accredited by the Egyptian Ministry of Health and accordingly disease outcome was determined. The study included 162 COVID-19 patients, 80 (49.4%) had mild cases, 40 (24.7%) had moderate cases, and 26 (16.0%) and 16 (9.9%) had severe and critical cases, respectively. The median CT-severity score was 10 (3.75–11.25). Significantly high serum levels of C-reactive protein, D-dimer, lactate dehydrogenase, and ferritin levels were observed in severe cases (P<0.01 for all) in comparison with mild/moderate cases. By comparing died cases with other severe cases, the proportion of cases with CURB 65 score (comorbidity, confusion, urea, respiratory rate, blood pressure, and 65 years of age or older score) more than or equal to 4, PaO2/FiO2 less than 300, hypoxemia less than 85%, higher levels of ferritin, D-dimer, alanine aminotransferase, aspartate aminotransferase, CT severity, and consolidation score were significantly higher in died cases than other severe cases. By regression analysis, among severe cases, predictors of death were the presence of comorbidity and increased consolidation size. All healthcare workers should understand the presentation of the disease, workup, and supportive care experienced from the first outbreak and offer an evidence-based management for succeeding outbreaks in our community.
{"title":"Analysis of clinical management and radiological affection of coronavirus disease 2019 patients under isolation: an experience from a University Hospital","authors":"E. Hefzy, Doaa Y. Ali, Ahmed M. Magdy, Wafaa Y. Abdel Wahed, Ahmed F. El Khateeb, Mona Ahmed","doi":"10.4103/ecdt.ecdt_4_21","DOIUrl":"https://doi.org/10.4103/ecdt.ecdt_4_21","url":null,"abstract":"\u0000 \u0000 During the coronavirus disease 2019 (COVID-19) pandemic, Egypt was among the minor epidemic areas. COVID-19 has wide variations in the clinical presentation manifesting as a heterogeneous disease severity varying from mild, moderate, and severe to critical illness.\u0000 \u0000 \u0000 \u0000 This study aimed to identify the potential clinical, radiological, and laboratory characteristics and prognosis of the COVID-19 patients obtained during the first peak of this pandemic at a University Hospital in Egypt, and to provide a reference for the pandemic management in the subsequent peaks.\u0000 \u0000 \u0000 \u0000 A single-center prospective study was done on patients with COVID-19 admitted to Fayoum University Hospital during the period from May to July 2020. All patients had full medical history taking, clinical examination, laboratory assessment, oxygen-saturation monitoring, chest computed tomography (CT), and reverse transcriptase-PCR testing. All the patients were treated with the treatment protocol accredited by the Egyptian Ministry of Health and accordingly disease outcome was determined.\u0000 \u0000 \u0000 \u0000 The study included 162 COVID-19 patients, 80 (49.4%) had mild cases, 40 (24.7%) had moderate cases, and 26 (16.0%) and 16 (9.9%) had severe and critical cases, respectively. The median CT-severity score was 10 (3.75–11.25). Significantly high serum levels of C-reactive protein, D-dimer, lactate dehydrogenase, and ferritin levels were observed in severe cases (P<0.01 for all) in comparison with mild/moderate cases. By comparing died cases with other severe cases, the proportion of cases with CURB 65 score (comorbidity, confusion, urea, respiratory rate, blood pressure, and 65 years of age or older score) more than or equal to 4, PaO2/FiO2 less than 300, hypoxemia less than 85%, higher levels of ferritin, D-dimer, alanine aminotransferase, aspartate aminotransferase, CT severity, and consolidation score were significantly higher in died cases than other severe cases. By regression analysis, among severe cases, predictors of death were the presence of comorbidity and increased consolidation size.\u0000 \u0000 \u0000 \u0000 All healthcare workers should understand the presentation of the disease, workup, and supportive care experienced from the first outbreak and offer an evidence-based management for succeeding outbreaks in our community.\u0000","PeriodicalId":519530,"journal":{"name":"The Egyptian Journal of Chest Diseases and Tuberculosis","volume":"279 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141692175","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}
COVID-19 is primarily a pulmonary disease, but with significant and frequent systemic manifestations. Our study aims to assess, which scoring system on admission—Confusion, Uraemia, Respiratory Rate > 30/min, Blood Pressure low, Age > 65 years (CURB-65) or SOFA, better correlates with COVID-19-positive patient mortality. This prospective observational study was conducted in COVID-positive adult patients. Upon admission, patient demographics, clinical condition and laboratory investigations were noted. SOFA and CURB-65 scores were calculated for each patient and the patient was followed up till the final outcome—transfer or expiry. Out of the 100 patients included in our study, the majority belonged to the age group of 41–60 years, with a mean age of 51 years. A significant proportion of patients (83%) had at least 1 pre-existing co-morbidity. The absence of co-morbidity showed an association with improved survival. The overall mortality rate was 46%. Baseline SOFA and CURB-65 scores showed a correlation with patient outcome, but SOFA showed a greater strength of association. It was found that at a cut-off of a total SOFA score of ≥4, it predicts patient expiry with a sensitivity of 89% and a specificity of 72%. CURB-65 is a scoring system used for severity assessment, guide therapy and prognostication of patients with lower respiratory tract infection or pneumonia. SOFA, on the other hand, is an ICU score used in multi-system diseases used for evaluating disease progression and prognostication. Many authors have found that SOFA score correlates well with patient outcome, and a high SOFA on admission usually indicates poor prognosis.
{"title":"Comparative evaluation of baseline SOFA score and CURB-65 score in predicting patient severity and outcome in COVID-19 patients admitted to a tertiary care ICU","authors":"Anvita Vineet, Arin Choudhury, Bhavya Krishna, Santvana Kohli, Arun Kumar","doi":"10.4103/ecdt.ecdt_20_23","DOIUrl":"https://doi.org/10.4103/ecdt.ecdt_20_23","url":null,"abstract":"\u0000 \u0000 COVID-19 is primarily a pulmonary disease, but with significant and frequent systemic manifestations. Our study aims to assess, which scoring system on admission—Confusion, Uraemia, Respiratory Rate > 30/min, Blood Pressure low, Age > 65 years (CURB-65) or SOFA, better correlates with COVID-19-positive patient mortality.\u0000 \u0000 \u0000 \u0000 This prospective observational study was conducted in COVID-positive adult patients. Upon admission, patient demographics, clinical condition and laboratory investigations were noted. SOFA and CURB-65 scores were calculated for each patient and the patient was followed up till the final outcome—transfer or expiry.\u0000 \u0000 \u0000 \u0000 Out of the 100 patients included in our study, the majority belonged to the age group of 41–60 years, with a mean age of 51 years. A significant proportion of patients (83%) had at least 1 pre-existing co-morbidity. The absence of co-morbidity showed an association with improved survival. The overall mortality rate was 46%. Baseline SOFA and CURB-65 scores showed a correlation with patient outcome, but SOFA showed a greater strength of association. It was found that at a cut-off of a total SOFA score of ≥4, it predicts patient expiry with a sensitivity of 89% and a specificity of 72%.\u0000 \u0000 \u0000 \u0000 CURB-65 is a scoring system used for severity assessment, guide therapy and prognostication of patients with lower respiratory tract infection or pneumonia. SOFA, on the other hand, is an ICU score used in multi-system diseases used for evaluating disease progression and prognostication. Many authors have found that SOFA score correlates well with patient outcome, and a high SOFA on admission usually indicates poor prognosis.\u0000","PeriodicalId":519530,"journal":{"name":"The Egyptian Journal of Chest Diseases and Tuberculosis","volume":"9 15","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141700395","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 : 2024-07-01DOI: 10.4103/ecdt.ecdt_134_22
Shaimaa Saeed Mohamed, Mona Mansour Ahmed, T. M. Ali, R. Elkorashy, A M Osman, Maryam Aly Abd Elkader, Sameh Nabil Kamel
Evaluate the utility of cardiac magnetic resonance imaging to estimate the principle hemodynamic parameters that are measured by right heart catheterization in a noninvasive manner i.e. mean pulmonary artery pressure, pulmonary vascular resistance and pulmonary artery wedge pressure through cardiac magnetic resonance based numerical models. 29 pulmonary hypertension patients, fitting the inclusion criteria were randomly selected and included in the study. CMR Imaging and right side heart catheter (RHC) were performed within one month. 3 Cardiac MRI based models in literature that showed high accuracy were tested. Two equations for mPAP calculation; mPAP=-231.423 + 53.8(loge inter-ventricular septal angle)+log10(right ventricular mass divided by left ventricular mass) i.e ventricular mass index X 8.708+area of pulmonary artery in diastole X 0.009 and mPAP = –4.6+(0.32*septal angle)+(ventricular mass index × 16.3). One equation for PAWP; PAWP = left atrial volume index +6.43 × 0.22. The Altman and Bland correlation between mPAP invasively measured and CMR-estimated mPAP had good correlation with r= 0.594 and r=0.599 (P<0.001) for CMR based mPAP model 1 and 2, respectively. The calculated mean bias between the RHC-derived and CMR-estimated mPAP was 7.9 (agreement interval -24.8 to 40.6 mm Hg) and mean bias -3 (agreement interval -34.8 to 28.2 mm Hg) for CMR based mPAP model 1 and 2, respectively. There was no correlation between invasively measured and CMR-estimated PAWP with (P =0.092) for CMR based PAWP model. The mean bias between the RHC-derived and CMR-estimated PAWP was 2.4 (agreement interval –13.5 to 18.2 mm Hg). The correlation between invasively calculated and CMR-estimated PVR had good correlation with r=0.703 and r=0.704 (P<0.001) for CMR based PVR model 1 and 2, respectively. The mean bias between the RHC-measured and CMR-estimated mPAP was 0.6 (agreement interval -11.6 to 12.8 mm Hg) and mean bias -1.3 (agreement interval -12.1 to 9.5 mm Hg) for CMR based mPAP model 1 and 2, respectively. Our results showed good correlations between CMR findings and RHC as regard mPAP and PVR. Thus, estimation of mPAP, PAWP and PVR non-invasively using CMR is feasible but needs further studies to improve accuracy.
{"title":"The use of cardiac magnetic resonance imaging for the evaluation of pulmonary hypertension","authors":"Shaimaa Saeed Mohamed, Mona Mansour Ahmed, T. M. Ali, R. Elkorashy, A M Osman, Maryam Aly Abd Elkader, Sameh Nabil Kamel","doi":"10.4103/ecdt.ecdt_134_22","DOIUrl":"https://doi.org/10.4103/ecdt.ecdt_134_22","url":null,"abstract":"\u0000 \u0000 Evaluate the utility of cardiac magnetic resonance imaging to estimate the principle hemodynamic parameters that are measured by right heart catheterization in a noninvasive manner i.e. mean pulmonary artery pressure, pulmonary vascular resistance and pulmonary artery wedge pressure through cardiac magnetic resonance based numerical models.\u0000 \u0000 \u0000 \u0000 29 pulmonary hypertension patients, fitting the inclusion criteria were randomly selected and included in the study. CMR Imaging and right side heart catheter (RHC) were performed within one month. 3 Cardiac MRI based models in literature that showed high accuracy were tested. Two equations for mPAP calculation; mPAP=-231.423 + 53.8(loge inter-ventricular septal angle)+log10(right ventricular mass divided by left ventricular mass) i.e ventricular mass index X 8.708+area of pulmonary artery in diastole X 0.009 and mPAP = –4.6+(0.32*septal angle)+(ventricular mass index × 16.3). One equation for PAWP; PAWP = left atrial volume index +6.43 × 0.22.\u0000 \u0000 \u0000 \u0000 The Altman and Bland correlation between mPAP invasively measured and CMR-estimated mPAP had good correlation with r= 0.594 and r=0.599 (P<0.001) for CMR based mPAP model 1 and 2, respectively. The calculated mean bias between the RHC-derived and CMR-estimated mPAP was 7.9 (agreement interval -24.8 to 40.6 mm Hg) and mean bias -3 (agreement interval -34.8 to 28.2 mm Hg) for CMR based mPAP model 1 and 2, respectively. There was no correlation between invasively measured and CMR-estimated PAWP with (P =0.092) for CMR based PAWP model. The mean bias between the RHC-derived and CMR-estimated PAWP was 2.4 (agreement interval –13.5 to 18.2 mm Hg). The correlation between invasively calculated and CMR-estimated PVR had good correlation with r=0.703 and r=0.704 (P<0.001) for CMR based PVR model 1 and 2, respectively. The mean bias between the RHC-measured and CMR-estimated mPAP was 0.6 (agreement interval -11.6 to 12.8 mm Hg) and mean bias -1.3 (agreement interval -12.1 to 9.5 mm Hg) for CMR based mPAP model 1 and 2, respectively.\u0000 \u0000 \u0000 \u0000 Our results showed good correlations between CMR findings and RHC as regard mPAP and PVR. Thus, estimation of mPAP, PAWP and PVR non-invasively using CMR is feasible but needs further studies to improve accuracy.\u0000","PeriodicalId":519530,"journal":{"name":"The Egyptian Journal of Chest Diseases and Tuberculosis","volume":"4 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141711039","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}
Biljana Lazovic, Radmila Dmitrovic, Isidora Simonovic, Nevena J. Jovičić, Dragan Vasin, Mohamed Elbagalaty, A. Esquinas
Historically, radiologists believed that ultrasound was ineffective for detecting lung and pleural diseases. Today, it is regarded as a diagnosis (imaging) that may be ‘equated’ with advanced methods such as radiography and computed tomography (CT) since it has comparable, if not greater, diagnostic accuracy for specific pathological substrates when compared with cross-sectional radiographic approaches such as CT. We have covered the basic anatomical points and lines, as well as their meanings in the interpretation of ultrasound findings, throughout this article. We have specifically highlighted conditions with high lung ultrasound (LUS) specificity and sensitivity, such as pleural effusion, pneumothorax, and pneumonia. It is also noteworthy that it’s recommended for coronavirus disease 2019 (COVID-19) patients in the diagnosis of interstitial pneumonitis. Following lines such as A, B, C, Z, and E would provide us with information on the patient’s current condition. We identified 15 papers that contained the following keywords: ‘A lines’, ‘B lines’, ‘C lines’, ‘Z lines’, ‘E lines’, ‘pleural effusion’, ‘pneumothorax’, ‘pneumonia’, and ‘coronavirus disease 2019’. The use of lung ultrasound will become more widespread. It is vital to train general practitioners and emergency doctors in its use since it provides a quick and reliable reference point for further diagnosis.
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