Bronchology

Leptin as a local inflammatory marker in chronic obstructive pulmonary disease acute exacerbation Hossam H Masoud, Ahmed M Abd El-Hafeez, Mohamed S Ismail, Naef G Baharetha Egyptian Journal of Bronchology 2019 13(2):139-147 Background Chronic obstructive pulmonary disease (COPD) is a disease of chronic inflammation affecting the lungs. Leptin is a pleiotropic cytokine thought to play a role in host inflammatory response. Aim This study aimed to investigate the role of leptin in sputum and serum as an inflammatory marker in acute exacerbation of COPD (AECOPD). Patients and methods Twenty patients with stable COPD, 20 patients with AECOPD, and 12 controls were included in this study. All participants were males. BMI, routine laboratory investigations, sputum and serum leptin levels, serum tumor necrosis factor (TNF-α), and C-reactive protein (CRP) levels were measured twice in patients with AECOPD (initially and after 7 days of management) and only once in stable patients and controls. Results In patients with patients with AECOPD, there were significant differences between sputum leptin and serum TNF-α, CRP, and leptin levels before and after treatment. Sputum leptin and serum CRP levels were significantly higher in the AECOPD group than other groups. Additionally, serum TNF-α levels were significantly higher in patients with AECOPD than the controls. Insignificant correlation was found between AECOPD and stable groups regarding serum leptin and TNF-α levels. Conclusion The present study highlights the role of leptin hormone as a local inflammatory marker in COPD acute exacerbation either in the sputum or the serum, together with serum TNF-α and CRP. These markers could be useful indicators of COPD acute exacerbation and its response to treatment.

Metabolic syndrome; frequency and its relationship with variable parameters in chronic obstructive pulmonary disease Azza Farag Said El-toney, Bahaa Ibrahim Mohamed, Emad Allam Abd-Elnaeem, Alaa Shaban Ismail Egyptian Journal of Bronchology 2019 13(2):148-154 Background Chronic obstructive pulmonary disease (COPD) has many extrapulmonary comorbidities, and metabolic syndrome (MetS) is one of them. Scant data are available on MetS in Egyptian patients with COPD. Objective The purpose of the current research was to determine the frequency and clinical characteristics of MetS among Egyptian patients with stable COPD. Patients and methods A prospective study including 70 (64 males and six females) patients with stable COPD was conducted. Clinical assessment, pulmonary function, and other laboratory studies were performed. Results MetS was present in 31 patients with COPD (44.3%). BMI and high-sensitivity C-reactive protein were significantly higher in patients with COPD with MetS than those without MetS (P=0.02 and 0.01, respectively). Age of the patients, duration of COPD, grade of dyspnea, and pulmonary function tests had no significant difference between those with MetS versus those without it. There was a significant negative correlation between plasma triglyceride level, as the only one of the variables of MetS, and some of parameters of pulmonary function test. Conclusion MetS is relatively frequent among patients with COPD. Plasma triglyceride level is the only parameter of MetS to have a significant correlation with pulmonary function tests. Apart from BMI and high-sensitivity C-reactive protein, no other parameter among patients with COPD has a significant relationship with MetS.

The role of medical thoracoscopic lung biopsy in diagnosis of diffuse parenchymal lung diseases Magdy M Omar, Ahmad S Alhalafawy, Nashwa M Emara, Mohammad A.E El-Mahdy, Etemad Abdelsalam Egyptian Journal of Bronchology 2019 13(2):155-161 Background Interstitial lung disease in the immunocompetent patient is often a difficult challenge for the clinician, especially when no diagnostic clues are present. A clear diagnosis confirmed by biopsy allows clinicians and patients to discuss fully the implications of the disease. Aim The aim was to evaluate the role of medical thoracoscopic lung biopsy in diagnosis of patients with diffuse parenchymal lung diseases. Patients and methods The study included 15 patients with diffuse parenchymal lung diseases of unknown etiology. They had undergone full history taking, complete clinical examination, ventilatory function tests (spirometry), arterial blood gases analysis, high-resolution computed tomography chest, coagulation profile, platelet count, collagen profile, and thoracoscopic lung biopsy by medical thoracoscopy for histopathologic examination. Follow-up of the patients in the inpatient unit was done by chest radiography and clinical evaluation. Results The pathological diagnosis of cases was six (40%) patients with extrinsic allergic alveolitis, five (33.3%) patients with malignancy, three patients with idiopathic interstitial pneumonias, one (6.7%) patient with tuberculosis, and one (6.7%) patient with sarcoidosis. Regarding complications, one (6.7%) patient had pneumothorax after intercostal tube (ICT) removal, and three (20%) patients had subcutaneous emphysema. The duration of the ICT drainage was 3.1±2.6 days. There was no wound infection, no bleeding, no persistent air leak after more than 24 h (Hs) from ICT insertion, no respiratory failure requiring ICU admission, and no mortality in the study sample. Conclusion Thoracoscopic lung biopsy by medical thoracoscopy is useful in diagnosis of cases with diffuse parenchymal lung diseases of unknown etiology when lung biopsy is needed for accurate diagnosis. The procedure is safe. The procedure carries some complications that are not life threatening and can be minimized by good selection of patients.

Thoracoscopic pleural cryobiopsy versus conventional forceps biopsy in diagnosis of exudative pleural effusion of unknown etiology Randa S.E Muhammad, Sabah A.M Hussein, Mohammad F Mohammad, Marwa M Ahmed, Gehad A Ali Egyptian Journal of Bronchology 2019 13(2):162-169 Background Rigid forceps is commonly used for pleural biopsies during medical thoracoscopy in undiagnosed pleural effusion, and recently, the use of cryoprobe for pleural biopsies was encouraged, as the procedure is effective and safe. Objective This study compared between rigid forceps and cryoprobe pleural biopsies regarding biopsy characteristics, diagnostic yield, and tissue viability in patients with undiagnosed exudative pleural effusion who underwent medical thoracoscopy. Patients and methods A total of 30 patients with undiagnosed exudative pleural effusion were selected for medical thoracoscopy, and pleural biopsies were taken by rigid forceps and cryoprobe in the same setting. All biopsies were processed for histopathology examination. Results Of the 30 patients, 18 (60%) were males and 12 (40%) were females, with mean age of 51.03 years. The most frequent diagnosis was mesothelioma (43.3%) followed by chronic nonspecific inflammation (23.3%), metastatic carcinoma (16.6%) and tuberculosis (16.6%). Biopsies of rigid forceps (mean: 0.8193 cm2) were larger than cryoprobe (mean: 0.3377 cm2) but with less depth. Tissue viability of cryoprobe biopsies was better than rigid forceps biopsies, and the diagnostic yield of both techniques was the same. Conclusion Cryobiopsies obtained during medical thoracoscopy is technically feasible and safe with high diagnostic value. Biopsies of cryoprobe were smaller than that of rigid forceps but were deeper and with better preserved cellular architecture. These results will encourage the use of cryotechnique for diagnosis of undiagnosed exudative pleural effusion.

Assessment of gradient between partial pressure of arterial carbon dioxide and end-tidal carbon dioxide in acute respiratory distress syndrome Fatmaalzahraa S Abdalrazik, Mohamed O Elghonemi Egyptian Journal of Bronchology 2019 13(2):170-175 Context End-tidal carbon dioxide (EtCO2) is used as a noninvasive bedside test to assess the adequacy of ventilation and physiologic dead space in mechanically ventilated patients. The gradient difference between EtCO2 and partial pressure of arterial carbon dioxide (PaCO2) is directly related to an increase in the physiologic dead space. Aim The aim of this study was to evaluate the role of measuring the gradient between EtCO2 and PaCO2 in adults with acute respiratory distress (ARDS). Settings and design This was a prospective consecutive enrollment study. Patients and methods Overall, 51 cases were recruited after the diagnosis of ARDS was made according to the Berlin definition. Patients were mechanically ventilated as per the lung-protective protocol. Daily arterial blood gases were collected and for every sample, the EtCO2 value was collected electronically by capnography using an endotracheal tube for the first 5 days. Results Cases were classified into survivors and nonsurvivors: 26 cases were because of extrapulmonary causes and 25 cases were because of pulmonary causes. The mean value of the APACHE II score for all cases on admission was 21.6. The mean length of ICU stay was 12.7 days. For all study cases, PaO2/FiO2 was the lowest at day 1 and the highest at day 5. We found a significant negative correlation between PaO2/FiO2 and the gradient at days 2, 4, and day 5, and a significant positive correlation between the gradient on admission and the APACHE II score (r=0.4, P≤0.05). Nonsurvivors had a significantly higher gradient and lower EtCO2 and PaO2/FiO2 levels at all time intervals, whereas PaCO2 alone was found to be nonsignificant. Conclusion In ARDS, EtCO2 and gradient are reliable indicators of severity.

Postintensive care syndrome in mechanically ventilated patients secondary to respiratory disorders Mohammed A Agha, Mahmoud M El-Habashy, Mohammed S Abdelshafy Egyptian Journal of Bronchology 2019 13(2):176-183 Background Patients admitted to ICU, especially those who are mechanically ventilated, are under the effects of many clinical, therapeutic, and emotional stress factors that usually lead to different physical, psychological, and cognitive disabilities. These acquired disabilities are called postintensive care syndrome (PICS). Objective the aim was to detect any component of PICS in mechanically ventilated patients at respiratory ICU (RICU) after being discharged from ICU. Patients and methods All recruited patients were assessed at three time points: first during admission to RICU, where all clinical and laboratory data were recorded; second following discharge from RICU, and third following 1 month of discharge from hospital. During the second and third points, cognitive, psychological, and physical components of PICS were assessed. Results A total of 20 (50%) patients developed one or more component of PICS. There were highly significant differences between patients with and without PICS regarding age, duration of mechanical ventilation, duration of ICU admission, level PaO2, acute physiology and chronic health evaluation (APACHE) IV score, the presence of co-morbidities, and the process of weaning. There were highly significant positive correlations between age of patients, duration of mechanical ventilation and ICU stay, and the score of APACHE IV and the development of PICS, whereas there was a highly significant negative correlation regarding the level of PaO2. Conclusion Patients with respiratory disorders admitted to the RICU should be evaluated and followed up for the detection of any components of PICS especially those who are old adult, have prolonged intubation or ICU stay, have co-morbidities, high APACHE IV score, and persistent hypoxemia.

Assessment of diaphragmatic mobility by chest ultrasound in patients with chronic obstructive pulmonary disease on different modes of mechanical ventilation Adel M Saeed, Ashraf A El Maraghy, Riham H Raafat, Ahmed M Abd Elsamad Egyptian Journal of Bronchology 2019 13(2):184-190 Background Chronic obstructive pulmonary disease (COPD) is a disease characterized by airway obstruction and air trapping that is not fully reversible. The diaphragm is the principal respiratory muscle, and its dysfunction can prolong the duration of mechanical ventilation. Ultrasonography is a fast, easy, and accurate method of bedside evaluation for diaphragmatic function. In the ICU population, it can quantify normal and abnormal movements in a variety of clinical conditions. Patients and methods A prospective observational study was carried on 32 patients with COPD admitted to the respiratory ICU. Diaphragmatic excursion had been assessed by chest ultrasonography in every mode of mechanical ventilation and was correlated with weaning off mechanical ventilation and other physiological parameters. Results Of 32 patients with COPD included in the study, 24 patients were successfully weaned versus eight patients failed to be weaned off mechanical ventilation. Diaphragmatic excursions in every mode of mechanical ventilation (noninvasive, volume control, bilevel positive airway pressure, and pressure support) were higher in weaned patients with best cutoff values of 1.4, 1.3, 1.5, and 1.6 cm, respectively. Moreover, the diaphragmatic excursions were directly correlated with tidal volumes and inversely correlated with days of mechanical ventilation and rapid shallow breathing index. Conclusion Diaphragmatic displacement assessed by ultrasound is a good predictor for weaning off mechanical ventilation in patients with COPD, as it is sensitive, specific, and accurate. Diaphragmatic excursions are directly related to tidal volumes and inversely related with rapid shallow breathing index and days of mechanical ventilation.

Diaphragm ultrasound as a predictor of successful extubation from mechanical ventilation Taher Abd El Hamid El Naggar, Ibrahim A Dwedar, Eman F.A Abd-Allah Egyptian Journal of Bronchology 2019 13(2):191-195 Background Ultrasonography can be used for assessment of diaphragmatic mobility and thickness. Diaphragm is the main muscle of respiration. Rationale To predict successful extubation from mechanical ventilation. Patients and methods Forty patients were involved in the present study. They were admitted in the ICU at Abbassia Chest Hospital. They received the conventional measurements for weaning and transdiaphragmatic ultrasonography after extubation. We assessed the diaphragmatic mobility and diaphragmatic thickening fraction. All ultrasonography findings were gathered and compared with some of the usual weaning tools such as arterial blood gas and respiratory mechanics. The findings were statistically analyzed. Results Thirty-one patients revealed successful liberation from mechanical ventilation. Diaphragmatic mobility and thickening fraction showed high sensitivity and specificity compared with other weaning tools. The cutoff value was 10 mm for mobility and 30% for diaphragmatic thickening fraction. Conclusion Diaphragmatic ultrasonography can be used as a new tool for prediction of weaning process.

Serum level of carbohydrate antigen 15-3 in patients with interstitial lung diseases and its correlation with pulmonary function and high-resolution computed tomography Randa Salah El-Din Mohamed, Mahmoud Mohammed El-Batanouny, Neveen Mahmoud Amin, Rasha Abdel Razek Mahmoud, Doaa A.A Abd-Elhalim Egyptian Journal of Bronchology 2019 13(2):196-203 Background Carbohydrate antigen 15-3 (CA15-3) is a central protein core of mucin-1, a high-molecular-weight glycoprotein, found in alveolar and extrapulmonary epithelial cells that increases in interstitial lung disease. It uses antibodies against different epitopes. It is also considered a tumor marker for breast cancer. Aim The aim was to evaluate the value of CA15-3 as a biomarker in patients with interstitial lung diseases and to evaluate the correlation between CA15-3 level and radiological findings in high-resolution computed tomography (HRCT) and pulmonary function in patients with interstitial lung diseases (ILDs). Materials and methods The study was performed on 60 adult patients with ILD and 20 healthy controls. We classified the patients into three groups according to HRCT findings: group I ground glass (18 patients), group II reticulation (27 patients), and group III honeycombing (15 patients). All patients were subjected to HRCT, spirometry, collagen markers, and serum CA15-3 level evaluation. Results CA15-3 level in patients with ILD was significantly higher than control (P<0.001). CA15-3 level in reticulation and honeycombing groups was significantly higher than ground glass group, and CA15-3 level in reticulation group was significantly higher than honeycombing group (P=0.003). This may be explained by that reticulation is active fibrosis, whereas honeycombing is established fibrosis. A significant negative correlation has been noticed between CA15-3 level and forced vital capacity in the three different groups (P<0.05, r=−0.304). Conclusion The serum level of CA15-3 is strongly elevated in patients with ILD. CA15-3 is a noninvasive, nonexpensive, rapid biomarker in ILD, being proportional to the extent of lung injury.

Fayoum experience in the ultrasonographic evaluation of diffuse parenchymal lung disease Sherif Refaat Abd El Fatah, Radwa Ahmed Elhefny, Randa Ibrahim Ahmed, Doaa Mohamed Abd El Tawab Egyptian Journal of Bronchology 2019 13(2):204-213 Objective Chest ultrasound has many uses, both diagnostic and interventional. It may be used for the diagnosis of multiple pleural diseases (pleural effusion, pleural masses, and pneumothorax). It is also used in the diagnosis of diseases caused by lung parenchymal lesions, such as neoplasms, pulmonary embolism, pneumonia, and lung abscesses. Aim This study aimed to evaluate the sonographic features of diffuse parenchymal lung disease (DPLD). Design This was a prospective study. Setting The study was carried out at Fayoum University Hospital in Egypt during the period spanning from January 2017 to June 2017. Patients and methods This study included 120 participants. Sixty of them were diagnosed as having DPLD. For the diagnosis of these cases, we need a full medical history, a detailed clinical examination, spirometry, 6 min walk test, arterial blood gases’ analysis, high-resolution computed tomography, and chest ultrasound. The other 60 were studied as controls. Statistical analysis The data were collected and coded to facilitate data manipulation, and they were double entered into Microsoft Access; the data analysis was performed by using SPSS software, version 18 in Windows 7. The simple descriptive analysis was carried out in the form of numbers and percentages for qualitative data and arithmetic means as central tendency measurement, SDs as measure of dispersion for the quantitative parametric data and the inferential statistic test. Results There was a female predominance with a wide range of age. Most of the cases were nonsmokers, breeding birds, and exposed to biomass. All cases had diffuse bilateral B-lines. There was a negative relation between the Warrick score on the one hand and the B-line number, PaO2, 6 min walk test, and forced vital capacity on the other hand. In contrast, a positive relation was demonstrated between the Warrick score and B-line distance and pleural thickness. Most of the studied patients (71.6%) had irregular and thickened pleura and (51.6%) had an abolished lung sliding. Conclusion Chest ultrasound has a significant role in the diagnosis of DPLD and also in estimating the severity of the disease according to the number and the distance between B-lines. Multiple B-lines in the combination of thickened and irregular pleural line are highly suggestive of DPLD.

ALEXANDROS SFAKIANAKIS ANAPAFSEOS 5 AGIOS NIKOLAOS CRETE 72100 GREECE +306932607174 +302841026182