Irreversible dilatation of airways, known as bronchiectasis is a significant global health issue with a wide range of clinical presentations and an extensive list of etiologies. The use of radiology to assess the severity of bronchiectasis has evolved from radiographs to computed tomography. Replacing subjective assessment by objective scoring systems has gained popularity in the context of unifying the understanding and management of the disease. This review aims to elucidate the bronchiectasis radiologically indexed computed tomography score with an attempt to untangle the labyrinthine radiological appearances and assist management.
BackgroundMalignant pleural effusion (MPE) is a common problem in neoplastic diseases. Studies showed that 42-77% of exudative effusions result from malignancy. Pleural fluid cytology revealed positive results in 60% of carcinomatous effusions and 30% of mesotheliomas. However, a pleural biopsy is performed for inconclusive cases.AimTo evaluate the diagnostic yield of pleural fluid cytology and image-guided percutaneous needle biopsy among patients with MPE.Patients and methodsOur descriptive study included 56 patients. Pleural fluid analysis, including pleural fluid cytology and image-guided percutaneous needle pleural biopsy, was performed. Cytological and histopathological findings were evaluated.ResultsPatients had a median age of 63 years. Males represented 55.4%. Smoking history was noted at 53.6%. Effusion characteristics varied; most effusions were right-sided, yellow or hemorrhagic, and mainly consisted of lymphocytes. The effectiveness of the two diagnostic methods - cytology and image-guided biopsy - was compared. Among those tests, cytology detected malignancy at 37.5%, while image-guided biopsy identified malignancy at 87.5%. Five cases showed atypical infiltrates, and immunohistochemistry was performed to confirm malignancy. The diagnostic yield of pleural fluid cytology was evaluated in comparison with that of pleural biopsy.ConclusionCytological examination of pleural fluid is a common initial diagnostic procedure in patients with suspected MPE. However, image-guided pleural biopsy is significantly more sensitive in detecting malignancy and is crucial for inconclusive cases.
Background Obstructive sleep apnea (OSA) is basically related to upper airway collapse. Diaphragmatic ultrasound provides a safe, easy, and available tool for the assessment of diaphragm in OSA patients.AimTo determine ultrasonographic features of the diaphragm, such as thickness and excursion in patients with OSA and the validity of using these features for screening of those patients. Patients and methods This prospective, nonrandomized, controlled study was conducted in the Chest Department, Faculty of Medicine, Tanta University Hospitals on 75 participants presenting with symptoms of OSA. The study included 15 controls with normal sleep studies and 60 patients with newly diagnosed OSA. All participants underwent overnight polysomnography and diaphragmatic ultrasound to evaluate thickness, excursion, time to peak inspiratory amplitude, and contraction speed in supine and semirecumbent positions during tidal and deep breathing. Results Patients with OSA had significantly greater diaphragmatic thickness (DT) than controls (P=0.001). In the patient group, the semirecumbent position demonstrated higher DT and mobility than supine position (P=0.001). Apnea-hypopnea index positively correlated with Epworth Sleepiness Scale, neck circumference, and DT in both positions during tidal and deep breathing (P=0.001). The Epworth Sleepiness Scale score, the DT difference during deep breathing, and the DT at end expiration in the semirecumbent position were significant predictors of OSA (P<0.05). DT during deep breathing in both positions provided cutoff values for OSA diagnosis with high sensitivity and specificity. Conclusion DT measurements were significantly higher in the OSA group than the control group and correlated with severity. DT and excursion were significantly higher in the semirecumbent than the supine position in the OSA group.
BackgroundOne essential component of managing patients with respiratory failure in critical care is mechanical ventilation (MV). Weaning off MV is still a difficult procedure, so identifying predictors of successful weaning is crucial for optimizing patient outcomes.ObjectiveThis study aimed to assess the predominance of hypophosphatemia among mechanically ventilated patients admitted to the respiratory intensive care unit, and assess the relationship between hypophosphatemia and MV weaning outcome.Patients and methodsThis prospective cohort study was applied to 54 mechanically ventilated patients in the Respiratory Critical Care Unit at Ain Shams University Hospital. History taking, full clinical examination, serum phosphorus measurement at initiation of intubation, after 2 days of intubation, and within 1 day after extubation, and follow-up of weaning outcome were taken from the included patient. They were divided into two groups according to their phosphate levels during ICU admission: (1) hypophosphatemia with a serum phosphate level less than or equal to 2.5 mg/dl. (2) nonhypophosphatemia with a serum phosphate greater than 2.5 mg/d.ResultsOut of 54 patients, 34 were males and 20 were females. The ages of them ranged from 23 to 80 years, with a mean age was 57.17 +/- 10.53 years. Pneumonia with septic shock was the most common cause of ICU admission. The mean phosphate level at initiation of intubation in the studied patients was 2.17 +/- 0.79 mg/dl that changed to 2.15 +/- 0.81 mg/dl after 2 days of intubation, then to 3.04 +/- 0.62 mg/dl within 1 day after extubation. Patients with failed weaning had a significantly higher rate of hypophosphatemia in comparison with the successful weaning group at initiation of intubation, after 2 days of intubation, and within 1 day after extubation. There is a significant association between hypophosphatemia and the failure of the trial of extubation.ConclusionPneumonia was the most common cause of MV in respiratory intensive care units. The level of hypophosphatemia affects weaning outcome, especially when it occurs during MV and within 24 h following weaning. The recommended cut-off value predictor for weaning failure is less than 1 mg/dl within 2 days and less than 2.8 mg/dl within 24 h following extubation.
IntroductionAtopic illnesses are multifactorial chronic disorders that may progress from one type to another with overlapping pathogenetic mechanisms. Atopic dermatitis (AD) severity was the most powerful predictor of atopic comorbidities. This study was planned to assess the effect of AD on the severity and response to allergen-specific immunotherapy in patients with airway allergies.Patients and methodsThe study was retrospective. Patients who were included patients diagnosed with airway allergic disorders and were managed in our allergen immunotherapy outpatients' department. Diagnosis, demographic data, symptoms, medication scores, and the presence of AD were recorded.ResultsComorbid AD was detected in 12% of patients. Baseline symptom score of airway allergies was significantly higher among patients who had AD (median score was 3 compared with 2 among those who did not have AD, P:0.02). After allergen immunotherapy, a significant association between AD and symptom score was detected (P=0.05).ConclusionThe AD is associated with the severity of airway allergies and may deteriorate the underlying airway allergic symptoms.
BackgroundAcute kidney injury (AKI) is a frequent complication in patients with severe coronavirus disease 2019 (COVID-19), contributing to increased mortality and longer hospital stays. This study investigates the effects of tocilizumab (TCZ) on renal function in such patients.Patients and methodsA retrospective analysis was conducted on 250 patients with confirmed severe COVID-19. Daily monitoring of renal indicators was performed. Those with suspected cytokine storm-indicated by raised interleukin-6 or C-reactive protein levels greater than 75 mg/l-received TCZ at 4-8 mg/kg (up to 800 mg), either once or in repeated doses.ResultsRenal impairment and electrolyte disturbances were significant after admission (P=0.001). AKI developed in 52% of patients, and 8% required continuous renal replacement therapy. Urine analysis revealed hematuria in 10%, proteinuria in 28%, and normal findings in 62%. Comorbidities included diabetes and hypertension (each in 40% of patients), CKD (16%), ischemic heart disease (14%), asthma (6%), and hypothyroidism (4%). TCZ administration led to marked improvement in renal parameters and electrolytes (P=0.001).ConclusionAKI is common in severe COVID-19 cases and may signal worse outcomes. Routine monitoring of kidney function is crucial. TCZ may offer indirect renal protection in COVID-19-associated AKI, especially when used early in cytokine storm.
BackgroundToll-like receptors (TLRs) identify the very early signs of cell damage or infection. They play essential roles in host immunity response against severe acute respiratory syndrome coronavirus 2 infection. The current study investigated the association between the TLR 3, 7, and 9 and the outcome and severity of coronavirus disease 2019 (COVID-19) pneumonia.Patients and methodsDemographic characteristics, clinical presentations, radiological, and laboratory data were registered and analyzed. Real time polymerase chain reaction quantification (qRT-PCR) of TLRs on peripheral blood mononuclear cells in blood samples collected from COVID-19 patients.ResultsThe study involved 74 hospital-admitted COVID-19 pneumonia patients. The majority of cases were critically ill (62.2%), while 2.7% were moderate and 35.1% were severe cases. Median TLR7 and TLR9 were significantly higher among critically ill cases in comparison to moderate and severe cases (3.3 and 4.5 vs. 2.2 and 2.7, P=0.001 and 0.002, respectively). Nonsurvivors (48.6%) showed significantly higher levels for TLR3, TLR7, and TLR9 (P=0.000 for all). TLR7 and TLR9 had significant correlation with TLR3 (r=0.697, 0.705, and P=0.000 for both) while TLR7 showed a significant correlation with TLR9 (r=0.845 and P=0.000). TLR3, TLR7, and TLR9 had significant positive correlation with lymphocyte count, serum ferritin, C-reactive protein, D-Dimer (P <= 0.001 for all). TLR7, TLR9, C-reactive protein, and D-Dimer were predictors for the severity of COVID-19 pneumonia.ConclusionTranscript levels of TLR3, TLR7, and TLR9 may be considered promising markers for estimating the clinical severity and outcome in COVID-19 patients.
BackgroundAlthough ultrasonography (US) may detect pulmonary pleural-based thoracic masses, it is still rarely used as a diagnostic biopsing tool for peripheral pulmonary lesions, which are found at the subsegmental bronchi and are usually not detected with routine transbronchial biopsy. We aimed to compare computed tomography (CT) guidance with US guidance for peripheral lung and pleural-based biopsies, and to determine which method is more beneficial in terms of safety, efficacy, and selection criteria.ResultsThis study included 80 patients whose CT chest revealed peripheral parenchymal lesions and pleural-based lesions. All patients were subjected to laboratory investigations in the form of: complete blood count, prothrombin time, prothrombin concentration, preprocedural imaging, and postprocedural chest radiography. The mean age among the US guidance group was 58.9, which was near to the mean age in the CT guidance group 58.65. 54% of the US guidance group were males and 45% were females, while in CT guidance group, 34% of them were males and 65% were females. Regarding the lesion size (mm) as categorical and numerical variable, in the US guidance group 12 (28.6%) cases, their lesion was more than (50 mm) while in the CT guidance group 14 (36.8%) cases was less than 10 mm as well as the mean values of the lesion size were higher among US guidance group with nonstatistically significant difference as patients are randomly selected.ConclusionUS-guided biopsy is a safe method that produces good diagnostic yield in peripheral pulmonary and pleural-based lesions. It avoids needless radiation exposure for patients and may also be conducted at the bedside with a lower complication rate.
PurposeMultiple scores are present to predict pneumonia severity and outcome. Pneumonia with airspace consolidation is generally associated with elevated intra-alveolar fluid. Electrical cardiometry (EC) measures thoracic fluid content (TFC). This work aimed to evaluate the role of EC in predicting the severity and mortality of community-acquired pneumonia.MethodologyThis study included 86 patients with community-acquired pneumonia. Baseline pneumonia severity scores (pneumonia severity index, confusion, urea (blood urea nitrogen), respiratory rate, blood pressure, and 65 (age 65 or older), and shock index and hypoxemia) and EC parameters were recorded. Outcome parameters (hospital stay and mortality) were assessed.ResultsTFC was significantly higher in ICU admitted patients than ward admitted patients. Area under the curve for TFC was good in differentiating between Ward and ICU admitted patients and survivors from nonsurvivors (mortality) with the best detected cut off points were 32.5, and 37.5, respectively, and sensitivity was 78.5%, and 72.3, respectively.ConclusionsEC is a noninvasive, practical, simple, and safe method for predicting the severity of pneumonia. TFC parameter is helpful in the prediction of pneumonia severity and mortality.
BackgroundEvaluation of diaphragm when combined with spirometry, can be useful to respiratory function assessment. Forced expiratory diaphragm excursion in the first second (FEDE1)/EDEmax % is a novel diaphragm kinetics index that is related to lung function assessed by diaphragm ultrasound.AimTo rate the credibility of FEDE1/EDEmax % as a screening test in the assessment of chronic obstructive pulmonary disease (COPD) and interestitial lung fibrosis (ILD) patients compared with healthy control.Patients and methodsThis case-control study included three groups: COPD, ILD, and control groups. All included patients were exposed to full spirometry and diaphragm ultrasound (to be done after and within 24 h from spirometry maneuver). Measures of spirometry included forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and FEV1/FVC%. Measures of ultrasound included FEDE1, EDEmax and FEDE1/EDEmax% (recorded during forced expiration maneuver). Results: FEV1, FVC and FEV1/FVC%. had significant positive correlations with FEDE1, EDEmax and FEDE1/EDEmax%, respectively. FEV1, FVC, and FEV1/FVC were crucially lower in COPD and ILD compared with control group. However, FEV1/FVC was comparable to the control group in ILD. Cut off values of FEDE1/EDEmax% less than or equal to 74.1 in COPD and greater than or equal to 78.7 combined with EDEmax less than or equal to 2.6 cm in ILD were detected on the receiver operating curve to discriminate them from the control group.ConclusionDiaphragm excursion evaluated by ultrasound during forced expiration is correlated with spirometeric values in both COPD and ILD patients. It can be used as an add-on screening tool for the diagnosis of both COPD and ILD patients.
Background Hemoptysis is a potentially life-threatening condition with variable etiology and severity. Tranexamic acid (TXA), an antifibrinolytic agent, has demonstrated efficacy in bleeding control. Nebulized TXA offers targeted pulmonary delivery with reduced systemic exposure, but clinical evidence remains limited. Objectives To evaluate the efficacy and safety of nebulized TXA in patients with nonmassive hemoptysis. Patients and methods This randomized, double-blind, placebo-controlled trial was conducted at Mansoura University Hospitals. Adult patients with nonmassive hemoptysis were randomized to receive either nebulized TXA (500 mg in 5 ml normal saline, three times daily) or nebulized placebo (normal saline). The primary outcome was hemoptysis cessation within 5 days. Secondary outcomes included length of hospital stay, recurrence rate within 3 months, and need for interventional procedures. Data were analysed using appropriate statistical tests, including logistic and linear regression to adjust for confounders. Results A total of 114 patients were enrolled (study group: n=36; control group: n=78). Both groups were comparable in baseline demographic and clinical characteristics. The mean time to hemoptysis cessation was significantly shorter in the TXA group compared with the control group (2.1 +/- 0.95 vs. 6.36 +/- 3.06 days; P<0.001). Hemoptysis recurrence was significantly lower in the TXA group (11.1%) versus the control group (66.7%; P<0.001). Multivariate logistic regression demonstrated that nebulized TXA significantly reduced the odds of recurrence (OR: 0.026; P=0.003). Linear regression showed that TXA use significantly shortened the time to cessation (beta=-4.088; P<0.001). No serious adverse events were reported. Conclusion Nebulized TXA is a safe and effective therapeutic option for nonmassive hemoptysis, significantly reducing both the time to bleeding cessation and recurrence rates. This targeted, noninvasive approach offers a promising first-line therapy, though further large-scale trials are warranted to confirm these findings and optimize treatment protocols.
ContextModerate to severe asthmatic children are usually hospitalized after a severe exacerbation. Neutrophils and eosinophils play a critical part in the pathophysiology of asthma. In those with uncontrolled asthma, the mean neutrophil-to-lymphocyte ratio (NLR) increases.The objective was to evaluate blood eosinophil count and NLR as potential indicators of hospitalization in severe exacerbations of pediatric asthma.ContextModerate to severe asthmatic children are usually hospitalized after a severe exacerbation. Neutrophils and eosinophils play a critical part in the pathophysiology of asthma. In those with uncontrolled asthma, the mean neutrophil-to-lymphocyte ratio (NLR) increases.The objective was to evaluate blood eosinophil count and NLR as potential indicators of hospitalization in severe exacerbations of pediatric asthma.Patients and methodsThe blood eosinophil count and NLR were assessed in 50 patients with moderate-to-severe asthma exacerbation.ResultsRegarding nonadherence to prescribed therapy, presence of atopic disease, and antibiotic therapy, they were statistically significantly higher in the hospitalized group (P=0.005, 0.001, and 0.001, respectively). Moreover, the mean total leukocyte count and C-reactive protein levels were statistically higher in the hospitalized group compared with the nonhospitalized group (P=0.034 and 0.0010, respectively). The mean blood neutrophil count (5.58 +/- 3.08 vs. 3.61 +/- 2.02, P=0.011), and the mean blood eosinophil count (0.37 +/- 0.32 vs. 0.19 +/- 0.13, P=0.031) were statistically substantially higher in hospitalized children than the nonhospitalized group. The mean NLR was higher in the hospitalized children than in the nonhospitalized children with no statistically significant difference (2.64 +/- 3.61 vs. 1.21 +/- 1.17, P=0.061).ConclusionsThe total leukocyte count, the mean neutrophil count, and the mean blood eosinophil count were elevated in asthma exacerbation children who required hospitalization and could be used as a predictor for uncontrolled asthma with high sensitivity and specificity. These are rapid, inexpensive, and simply applicable tests from standard complete blood count tests, making them a potential asthma exacerbation bedside test.
BackgroundResearchers discovered that microRNA 223-3p (miR-223-3p) was elevated in sepsis due to its dysregulation in infection, so the aim of our study was to identify the role of miR-223-3p expression as a potential biomarker and predictor of outcome in sepsis.Patients and methodsOur study was a prospective observational cohort model consisting of 46 patients diagnosed as either sepsis or septic shock according to sepsis score 3, who were admitted to ICU. Four healthy individuals participated as a reference group for the expression of miR-223-3p. Serum samples were obtained for miR-223-3p gene expression by real-time PCR technology.ResultsThe current study demonstrated that there was a higher mean value of miR-223-3p expression in sepsis cases (1.10 +/- 1.35) than in healthy persons (0.85 +/- 0.41). Pneumonia was the most common diagnosis in 24 (52.2%) cases. Klebsiella was the most predominant bacteria detected in this study 21 (45.7%) patients followed by 10 (21.7%) patients with Acinetobacter. There was a statistical significance difference between males and females, being higher in males (P0.046), also between smokers and nonsmokers, being higher in smokers than nonsmoker (P0.017). It was noticed that high expression of miRNA expression in Klebsiella and E coli infections. Correlation coefficient of miR-223-3p expression in relation to clinical and laboratory data showed the following: in spite of the expression being negatively correlated to body temperature, mean arterial blood pressure, white blood cells, platelet count, and liver functions but there was no statistically significant P value. Despite higher miRNA expression 223-3p in sepsis patients with disturbed consciousness, septic shock, nonsurvivors, and patients with positive fibrin degradation products, there was no statistically significant difference.ConclusionsMiR-223-3p could be considered a promising biomarker for both marker of severity and predictor of outcomes in sepsis, providing perspectives to the exact molecular mechanisms and potential therapeutic targets. MiR-223-3pp showed higher expression with bacterial infection especially E-coli and klebsiella. These findings pay attention to the potentiality of miR-223-3p as both a diagnostic modality and tool of differentiation between sepsis etiologies and leading precision management.
Background Appropriate inhaler techniques can enhance drug effectiveness and reduce side effects. However, limited research has explored how healthcare workers (HCWs) use inhalers. Aim This study assessed inhaler techniques in adult patients and compared Pressurized metered-dose inhalers (pMDI) between patients and HCWs and identified predictors of improper inhaler use. Patients and methods Our studied group was two groups; first group included 199 patients [chronic obstructive pulmonary disease (COPD) and asthma], and second group included healthcare providers: 80 physicians and 61nurses. We evaluated the inhalers techniques used by adult patients and compared the pMDI technique between patients and their HCWs. Results COPD patients were older (57.35 +/- 10.25 years) than asthma patients (39.42 +/- 8.83 years). Pulmonologists and internists demonstrated the best pMDI usage, on the other hand, the step of inhalation slowly while activating the pMDI was done incorrectly in respiratory and internist nurses, respectively, (10, 22.6%) in comparison to only 3.7% of patients. After adjusting other variables in the multivariate model, years of experience were the only significant predictor of inhaler errors among HCWs (P<0.001), while hospital admissions (P=0.040) and illness duration (P=0.034) were the only significant predictors among patients using pMDI. Conclusion Inaccurate inhalation technique is prevalent among COPD and asthma patients. It is fundamental to ensure that healthcare providers, particularly nurses, are qualified to teach patients the proper inhaler technique. Ongoing monitoring and reassessment of patients' inhalation techniques by healthcare providers are also fundamental for effective patient management.
Acinic cell carcinoma (ACC) is salivary neoplasm of low grade of malignancy. It occurs most frequently in the parotid gland. Recurrences and metastases have been frequently reported in cases of ACC of the parotid gland. Brain, cavernous sinus, lungs, sternum, spine, liver, orbit, and skin remain the most frequent metastatic locations. Cases of metastatic ACC of the parotid gland to the pleura are extremely rare. We report the case of a 44-year-old male with a known history of ACC of the right parotid gland, who presented 5 years later, with dyspnea which revealed a pleural metastasis.
Background Entrapped lung, a complication of pleural disease, results from visceral pleural restriction and leads to significant respiratory morbidity. Current diagnosis relies on invasive pleural manometry (PM). While thoracic ultrasound is widely used for pleural effusion assessment, its role in diagnosing entrapped lung remains undefined. This study evaluates ultrasound parameters against manometry to establish a noninvasive diagnostic approach. Objectives To evaluate the diagnostic accuracy of transthoracic ultrasonography (TUS) for entrapped lung. Patients and methods In this prospective observational study, 84 patients with pleural effusion underwent TUS to assess lung motion, diaphragmatic excursion, pleural thickness, and pleural fluid characteristics before pleurocentesis. PM was performed, and patients were stratified by pleural elastance (PEL) into two groups-Entrapped lung (PEL>14.5 cmH(2)O/L; N=39) and nonentrapped (PEL <= 14.5 cmH(2)O/L; N=45) groups. Results In the entrapped lung, reduced lung motion [<9.55 mm; area under the curve (AUC) 0.77], diminished diaphragmatic excursion (<12.5 mm; AUC 0.851), and visceral pleural thickening (>1.10 mm; AUC 0.812) demonstrated moderate-to-high diagnostic accuracy (76.2, 76.2, and 75.0%, respectively). These parameters can exclude the presence of entrapped lung better than its detection, offering a valuable noninvasive tool to guide pleural intervention decisions. Conclusion TUS provides a practical, noninvasive method to exclude entrapped lung, potentially reducing reliance on PM and optimizing clinical management of pleural effusions.
BackgroundKartagener syndrome is a rare genetic disorder representing a subset of primary ciliary dyskinesia. It is classically defined by the triad of bronchiectasis, chronic sinusitis, and situs inverses. Early diagnosis is crucial to prevent disease progression and complications.Case presentationsWe report two cases of adult women, both aged 36, diagnosed with Kartagener syndrome. Both presented with chronic productive cough and recurrent lower respiratory tract infections dating back to childhood, alongside chronic rhinosinusitis. Thoracic computed tomography scans revealed bilateral bronchiectasis and situs inverses totalis. Sinus imaging confirmed chronic sinus disease. One patient developed chronic respiratory failure and died in intensive care from septic shock. The other responded well to antibiotic treatment following an exacerbation associated with Pseudomonas aeruginosa.DiscussionThese cases highlight the diagnostic challenges of Kartagener syndrome, especially in adult patients, often due to a lack of awareness and access to specialized diagnostic tools. The association with pulmonary tuberculosis, as observed in one of our cases, is uncommon but clinically significant. Imaging remains central to diagnosis in resource-limited settings.ConclusionKartagener syndrome should be considered in patients with unexplained bronchiectasis and sinus disease, particularly when associated with situs inversus. Early diagnosis and appropriate management can prevent severe complications and improve outcomes.
Context Severe acute respiratory syndrome coronavirus 2, a novel coronavirus first identified in Wuhan, China in late 2019, caused a global outbreak of viral pneumonia known as coronavirus disease 2019 (COVID-19). As the number of survivors increases, understanding the long-term consequences, referred to as postacute COVID-19 syndrome (PACS), becomes increasingly important. Aim To study the incidence, risk factors and predictors of PACS. Settings and design A descriptive analytical prospective longitudinal work. Patients and methods This work involved 669 participants confirmed COVID-19 infection by PCR then allocated into two groups (group I patient with PACS and group II patient without PACS), conducted at Mansoura University Emergency Hospitals at Respiratory Triage Zone over a period of 1 year from September 2021 to 2022. Four weeks later follow-up was done at Mansoura University post-COVID outpatient clinic or isolation center in Mansoura University Hospitals. Results There were 169 (25.3%) cases with PACS and 500 (74.7%) without PACS. There was significant increase in age, male sex, and ratio of patients with comorbidities in group I contrasted to group II. A highly significant rise in smokers, ex-smokers, and ratio of patients with diabetes mellitus existed in group I contrasted to group II. A highly significant decrease in number of vaccinated patients existed in group I contrasted to group II. The most frequent symptom was dyspnea in 143 (84.6%) cases then fatigue and (receiver operating characteristic) curve shows that the best cutoff point of hemoglobin (gm/dl), serum creatinine (mg/dl), C-reactive protein, D-dimer (mg/dl), lactate dehydrogenaze (U/L) and serum ferritin to detect group I was less than or equal to 11.9, greater than 1, greater than 24, greater than 0.3, greater than 256, and greater than 260, respectively. Conclusion “Older age, male sex, smoking history, and comorbidities—particularly diabetes—were associated with higher risk of PACS. Laboratory markers such as C-reactive protein, lactate dehydrogenaze, D-dimer, and ferritin may serve as practical tools for identifying at-risk patients.”
Background Chronic obstructive pulmonary disease (COPD) ranks among the foremost contributors to global morbidity and mortality, with forecasts suggesting it will emerge as the third leading cause of death by 2030. Emerging evidence underscores a robust association between COPD, systemic inflammation, and ensuing cardiovascular complications. Microalbuminuria (MAB), a marker of endothelial impairment and cardiovascular jeopardy, holds potential as a tool for gauging disease intensity in COPD-affected individuals. Objective This study aimed to determine the frequency of MAB among COPD patients and explore its linkage to disease severity, as delineated by the global initiative for chronic obstructive lung disease classification, within an Egyptian cohort. Patients and methods A cross-sectional analysis was conducted involving 60 COPD patients, all over 40 years of age, enlisted from the Chest Department (wards and ICU) of Ain Shams University Hospitals. After securing informed consent, participants underwent clinical assessments, spirometry for disease staging, arterial blood gas evaluations, and MAB measurement via the urine albumin-to-creatinine ratio. Individuals with urinary tract infections, alternative pulmonary conditions, diabetes, hypertension, dyslipidemia or history of renal disease were excluded. Participants were categorized into MAB-positive or MAB-negative groups based on urine albumin-to-creatinine ratio outcomes. Results Of the 60 patients, males predominated (86.7%), with an average age of 58.73 +/- 10.75 years (range: 41-84). MAB was detected in 80% of cases (48 individuals), exhibiting urine microalbumin levels of 30-300 mu g/l (mean: 103.8 +/- 91.8 mu g/l). The MAB-positive group experienced a significantly higher annual rate of COPD exacerbations (P=0.001) and ICU admissions (P=0.005). Compared with their MAB-negative counterparts, MAB-positive patients displayed substantially lower forced expiratory volume in 1 s, forced expiratory volume in 1 s/forced vital capacity ratios, partial pressure of arterial oxygen (PaO2), and SO2, alongside elevated partial pressure of arterial carbon dioxide (PaCO2) levels (P<0.001). A urine albumin threshold of 95 g/l effectively distinguished COPD severity (AUC = 0.787, sensitivity 80%, specificity 75%; P<0.001). Conclusion MAB exhibits a strong association with COPD severity, offering a cost-effective, non-invasive means to pinpoint patients at heightened cardiovascular risk. Routine MAB screening is recommended for COPD patients, particularly those with advanced disease. Further studies are warranted to elucidate its prognostic utility in COPD management.
Background Positive end-expiratory pressure (PEEP) can affect the measurement of central venous pressure (CVP) through increased intrathoracic pressure. However, when PEEP is applied, CVP and pleural pressure often increase more than right atrial pressure, so transmural right atrial pressure (true filling pressure) decreases. Aim Primary end-point was to recognize the correlation between mean CVP and thoracic pressures on controlled mode and spontaneous modes in the same population of mechanically ventilated acute respiratory distress syndrome (ARDS) patients. The secondary end-point is to compare the correlation calculated R during both modes with parameters of ventilatory settings. Patients and methods A cohort observational prospective study were done enrolling twenty single groups of patients with ARDS caused by different etiologies, who necessitate mechanical ventilation more than 2 days after connection to ventilators. The patient population was seven (35%) females patients and 13 (65%) males with mean age of 57.20 +/- 11.92 years. Insertion of central venous catheter, in accordance with standard guidelines, for measuring CVP and the data collected included mean CVP, applied PEEP according to patient's needs, plateau pressure, PEEP intrinsic, mean airway pressure, PO2/FiO(2), rapid shallow breathing index, and R-correlation. Measurements were divided into R-measured and R-calculated according to noncalculated CVP and calculated CVP, which releases the influence of PEEP intrinsic. Results Twenty patients with a mean age of 57.20 +/- 11.92 years (40-80) were evaluated (65% male). There were statistically significant differences between the control and support groups regarding applied PEEP, plateau pressure, mean CVP, and mean airway pressure. The data were significantly higher in the control than the support group with P value less than 0.001, 0.002, and 0.004, respectively but no significant difference between R-calculated in both groups. A significant positive correlation between R-calculated and CVP in the control group with P value less than 0.001 and r0.918; and significant positive correlation between R-calculated and triangle PiT in the pressure support group with P value of 0.001 and r=0.926. A regression equation for CVP and R(calculated )among the control group was: R=0.028 + 0.032 x CVP (with P value <0.001), whereas a regression equation for triangle PiT and R-calculated among the support group was R=0.465 + 0.020x triangle PIT (with P=0.022). There was a significant increase in R-measured than R-calculated in pressure control and pressure support with P value of 0.015 and 0.001, respectively. Conclusion The relation between hemodynamics change of CVPs and other thoracic pressures is a new independent marker for evaluating ARDS mechanically ventilated patients. Values of R correlation were not statistically different in controlled mode relative to spontaneous mode during ARDS ventilated patients. R correlation was related to mean CVP in controlled mode but positively correlated with intrapleural pressure (triangle PiT) in spontaneous mode.
