Chronic obstructive pulmonary disease (COPD) can negatively affect patients’ employment and work-life activities with a significant indirect economic impact. The current study aimed to measure ...unemployment, work productivity, activity impairment, and their associated factors among COPD patients. A cross-sectional study was conducted in the Chest outpatient clinic, Mansoura University Hospital, Egypt. COPD patients completed an interviewer-administered questionnaire including sociodemographic, occupational data, clinical history, medical research council (mMRC) dyspnea scale, the COPD assessment test (CAT), and work productivity and activity impairment Questionnaire (WPAI-COPD). A total 140 patients were included in the study and 22.1% of them gave up their jobs because of their COPD. Due to COPD, the mean percentage of daily activity impairment was 39.8 among all patients. The mean percentages of absenteeism, presenteeism, and overall work impairment among the 84 working patients were 0.07, 24.4, and 24.5. The CAT score was the significant predictor of all components of WPAI. In conclusion, COPD causes early retirement, high work productivity loss, and impaired daily activities. Higher CAT scores and increased disease severity significantly increase absenteeism, presenteeism, overall work, and activity impairment. Thus, timely diagnosis of COPD with appropriate management can help improve outcomes and lower the disease burden and economic impact.
Abstract Context Pulmonary tuberculosis (TB) is still one of the most common infectious diseases in the world. It is the second leading cause of death from an infectious disease worldwide, after the ...human immunodeficiency virus (HIV). WHO estimated TB incidence in Egypt in 2019 at 12 000. Purpose The aim of this study was to make a re-look at the epidemiological characteristics, clinical presentations, and radiological findings of patients with smear-negative pulmonary tuberculosis (SNPT) in non-HIV infected patients. Methods Retrospective analysis was performed including non-HIV patients with smear negative TB, with studying of demographics, symptoms, radiological patterns, and radiological distribution and the used diagnostic methods. Statistical analysis The demographic, clinical, and radiological data were gathered together, tabulated, and statistically analyzed. Data analysis was performed by Statistical Package for Social Science (SPSS – version 22). Results 74 smear-negative TB, non-HIV, age mean 47.17 ± 12.8 SD, 72.2% were males, DM was present in (39.2%), fever in (83.3%), weight loss in (61.1%), cough in (59.7%), consolidation pattern in (63.8%), cavities in (36.1%), an apical segment of right upper lobe in (41.9%), bronchoscopic lavage with Ziehl–Neelsen stain (BAL ZN) diagnosed (52.7%) of sputum negative cases. Conclusion Common variables among recorded cases were male sex, middle-aged individuals, Diabetes Mellitus (DM), toxic manifestation, an involved right apical segment of the upper lobe, consolidation and cavitary patterns, and most cases were diagnosed by bronchoscopic lavage with Ziehl–Neelsen.
Context Fluvoxamine may have a potential immune-regulatory action and a therapeutic role in severe acute respiratory syndrome-coronavirus (SARS-CoV-2) infection that may prevent progression and/or ...hospitalization. Aims Trial that compared fluvoxamine versus placebo in nonhospitalized adults with confirmed SARS-CoV-2 infection (mild and moderate coronavirus disease 2019 cases). Settings and design This is a double-blinded, randomized clinical trial. Patients and methods The study enrolled 162 cases with positive PCR assay for SARS-CoV-2 infection and who were symptomatic within 7 days of the first dose of study medication. Statistical analysis The demographic, clinical, and laboratory data gathered together will be tabulated and statistically analyzed. The statistical analysis of data was carried out using Excel and the SPSS programs statistical package for AQ8 Social Sciences, version 17. Quantitative data were described as median (minimum-maximum). An analysis of the data was carried out to test statistically significant differences between groups. Quantitative data were presented as mean±SD and the Student's t test was used to compare between two groups. Results In all, 162 patients completed the study; 72 patients were of mild severity; 90 patients were moderate cases and each group was randomized to receive fluvoxamine or placebo besides standard care. In the mild group, no significant difference was recorded while slight significance exists in the moderate severity group. Conclusions Fluvoxamine may have an added value besides the current standard care in reducing the need for hospitalization in outpatient cases, especially pneumonic ones; however, more larger studies are needed.
Context
High flow nasal canula is usually used for management of acute hypoxemic failure; however, it may have a potential therapeutic benefits in hypercapnia as it can alter tidal volume, end ...expiratory volume, positive end expiratory pressure, and respiratory rate.
Aim
Evaluate safety and efficacy of application HFNC (high flow nasal canula) for patients with mild hypercapnia.
Settings and design
A prospective interventional study.
Patients and methods
Over six months, thirty eight patients were enrolled, with mild hypercapnia and PH level not less 7.30 and PaCo2 not more 60 mmhg; with applying HFNC, serial checking of arterial blood gases was done. Checkpoints were at 2 h, 12 h, 24 h, and 48 h post application of HFNC. HFNC can be shifted to NIV or invasive MV at any time whenever indicated.
Results
Primary pulmonary disorder was chronic obstructive pulmonary disorder in (22 patients) and (16 patients) had interstitial lung disease. For PH in overall, mean values had changed from 7.33 until reached 7.37 at 48 h post HFNC with calculation of
P
value at each checkpoint from baseline value; significant changes were recorded at 24 h and 48 h post HFNC application. A similar observation was observed for PaCO2. No significant changes were observed at any checkpoint for HCO3.
Conclusion
High flow nasal canula is safe in cases with mild hypercapnia with a considerable success rate and a proven high efficacy.
Trial registration
Clinicaltrials.gov/NCT05948527, Registered 14 July 2023—Retrospectively registered,
https://www.clinicaltrials.gov/NCT05948527
.
Background Pleural effusion is the accumulation of fluid in the pleural space, can be classified into transudative and exudative effusion. A parapneumonic effusion is a pleural effusion that forms ...adjacent to pneumonia. Para pneumonic effusion can be sub-typed into uncomplicated and complicated effusion. The aim of our work was to identify accuracy of pleural fluid lactate level to discriminate transudative from exudative effusion and uncomplicated from complicated parapneumonic effusion. Methods Thoracocentesis was done with subsequent evaluation of pleural fluid PH, protein, LDH, glucose and lactate. Also, gram stain, microbiological cultures, cytological examination was performed. Medical thoracoscopy was done whenever indicated. Results Our study included 52 males and 38 females with mean age 57.14 ± 11.69 years. Transudative effusions were detected in 22 patients (24.4%). Parapneumonic effusions accounted for 39 cases (43.3%), of these 23 cases were uncomplicated and 16 cases were complicated. The median pleural fluid lactate level in exudative effusion was significantly higher than transudative effusion (P value<0.001), in complicated parapneumonic effusion was significantly higher than uncomplicated parapneumonic effusion (P value<0.001). Pleural fluid lactate cut-off value of 2.68 mmol/l or more yielded 97% sensitivity, 90.9% specificity for detection of exudative effusion (Auc 0.968). A cut of value of 6.22 mmol/l had 87.5% sensitivity, 91.3% specificity for detection of complicated parapneumonic effusion. (Auc 0.971). Conclusion The pleural fluid lactate level has a high accuracy to discriminate transudative from exudative pleural effusion and uncomplicated from complicated parapneumonic effusion.
Context Widespread prevalence of Coronavirus Disease 2019 (COVID-19) infection with high rates of morbidity and mortality necessitates early case definition and severity grading to predict prognosis ...and improve disease outcome parameters. Purpose To correlate computed tomography severity score (CTSS) in COVID-19-infected patients with their clinical, laboratory, method of ventilation, and disease outcome parameters. Patients and methods A retrospective analysis was performed on 139 COVID-19-infected patients with typical or indeterminate COVID radiological patterns with a correlation between CTSS and their clinical, laboratory, ventilation, hospital stay, and survival data. Results A total of 139 cases were included, with a mean age of 59.81 ± 12.29 years, 63.3% males, 28.77% were noncomorbid, and oxygen saturation of 82.53 ± 6.58 SD. They were subgrouped based on CTSS. A significant correlation was found between high CTSS and oxygen saturation, C-reactive protein, ferritin, D-dimer, lymphopenia, diabetes comorbid patients, need for high-flow oxygen therapy, need for noninvasive or invasive ventilation, mortality, and number of hospital stay in days. Conclusion Different parameters are correlated with high CTSS, especially low oxygen saturation, high C-reactive protein or ferritin values, diabetes, and long hospital stay.
Background Bronchoscopic lung volume reduction (LVR) is a promising and effective treatment option in severe chronic obstructive pulmonary disease. This study was conducted at Mansoura University ...Hospitals aiming to assess diagnostic accuracy of transthoracic ultrasound (US) in detection of lung bullae in LVR.
Patients and methods A total of 22 cases with emphysema were included in the study. They were divided into two groups: the study group included 12 cases who underwent US, whereas the control group included the remaining 10 cases that underwent computed tomography. All cases were subjected to history taking, examination, and routine investigations. Bronchoscopic LVR was performed for all cases.
Results Postintervention complications such as fever and pain were statistically better in study group, whereas modified Medical Research Council and GOLD did not differ between the two groups before or after treatment. No statistically significant difference was detected between the two groups regarding volumetry, oxygen saturation, 6 min walk test, and pulmonary functions. We found a significant improvement of GOLD classification, modified Medical Research Council, 6 min walk test, forced expiratory volume in 1 s, and forced vital capacity in the study group. Moreover, a significant decrease of oxygen saturation in study group was detected. Volumetry showed a significant decrease in both groups when comparing preintervention and postintervention values.
Conclusion Transthoracic US is valuable in detection of bullae during LVR, and ethanolamine oleate is safe and effective in LVR with minimal tolerable self-limited complications.
Background
Cancer and pulmonary tuberculosis are major global health concerns and are associated with substantial morbidity and mortality. The association between active tuberculosis and subsequent ...cancer development has been investigated for many years. This study was planned to determine the prevalence of latent tuberculosis infection in patients with recently diagnosed bronchogenic carcinoma.
Methods
Sixty-four newly diagnosed primary lung cancer patients were enrolled. Diagnosis of latent tuberculosis infection was performed with QuantiFERON-TB Gold In-Tube tests, with exclusion of active tuberculosis.
Results
Latent tuberculosis infection was detected in 16 (25%) patients, and 8 (12.5%) had indeterminate results of the QuantiFERON-TB Gold In-Tube test. Being a current smoker was associated with a higher prevalence of latent tuberculosis (p = 0.001). Comorbidities, tumor site, and histopathology were not associated with latent tuberculosis infection.
Conclusions
There is a considerable risk of concurrent latent tuberculosis in newly diagnosed primary bronchogenic carcinoma. The need for treatment of latent tuberculosis in these patients and its influence on the outcome and prognosis are issues for further investigations.
CRISPR (clustered regularly interspaced short palindromic repeats)-Cas (CRISPR-associated proteins) systems are considered as acquired immune mechanisms in Gram-positive and Gram-negative bacteria ...and also in archaea. They provide resistance/immunity to attacking bacteriophages or mobile genetic elements as integrative conjugative elements (ICE) as well as plasmid transformation. As an opportunistic pathogen,
Pseudomonas aeruginosa
has been held responsible for serious infections especially in hospitalized and immunocompromised patients. Three subtypes of type I CRISPR system (I-C, I-E, & I-F1) have been detected in
P. aeruginosa
genomes. In this work,
P. aeruginosa
isolates were collected from different clinical sources, and the three CRISPR/Cas subtypes (I-C, I-E, & I-F1) were detected via singleplex and multiplex PCR techniques using novel universal primers that were designed specifically in this study. CRISPR subtypes I-C, I-E, and I-F1 were detected in 10, 9, and 13 isolates, respectively. Furthermore, antimicrobial susceptibility of CRISPR/Cas-positive and negative isolates to different antibiotics and the capacity of biofilm formation were detected using disc diffusion method and tissue culture plate method, respectively. There was a significant correlation between the presence/absence of CRISPR/Cas system and both antimicrobial susceptibility to some antibiotics and biofilm-forming capacity among
P. aeruginosa
clinical isolates.
Key points
•
A novel multiplex–PCR for detection of CRISPR/Cas-positive strains of P. aeruginosa.
•
Understand the correlation between CRISPR/Cas systems and other characters of P. aeruginosa.
•
Correlation between antimicrobial susceptibility and CRISPR systems in P. aeruginosa.
