Aim To explore the changes regarding the incidence, risk factors, and outcome of bronchial asthma (BA) exacerbation in pregnancy in the setting of advancements in the management and pharmacotherapy of asthma compared with that previously reported. Patients and methods A prospective cohort study recruited 308 pregnant asthmatic patients in the period from January 2015 to January 2018. All patients received asthma health education (adherence to medications, proper usage of inhalers, written action plan, trigger avoidance, and smoking cessation counseling) and a monthly revision and adjustment of asthma medications according to its control together with treatment of exacerbation when present until 36 weeks of gestation. BA exacerbation was the primary outcome of the present study. Results Seventy-seven (25%) patients experienced exacerbations, and 25 of them were hospitalized, with ICU admissions in 11 (3.5%) patients. Exacerbation was evident in those with higher;Deg;BM;Deg;I (32.86±3.53 kg/m2, P=0.01), current smoker (28.6%, P<0.001), low education level (42.9%, P=0.01), and severe baseline asthma (57.1%, P<0.001). Multivariate logistic analysis identified certain independent predictors of exacerbation and hospitalization in pregnant asthmatics. Pregnant asthmatic with;Deg;BM;Deg;I more than 32.5 kg/m2 [odds ratio (OR), 1.6; 95% confidence interval (CI), 1.67–3.99; P=0.026) and current smoker (OR, 1.4; 95% CI, 1.39–4.79; P=0.03) were more likely to have exacerbation. Moreover, those with baseline severe asthma (OR, 1.2; 95% CI, 1.12–2.31; P=0.028) were at increased risk of hospitalization owing to exacerbation. There was no association between adverse perinatal outcomes and;Deg;BA;Deg; exacerbation in pregnant asthmatics. Conclusion The incidence of BA exacerbation during pregnancy is observed to be reduced in the present study compared with the previously reported. Being smoker and having higher BMI were predictors of exacerbation, whereas severe baseline asthma was predictor of hospitalization in pregnant asthmatics.
Background High-flow nasal oxygen therapy (HFNOT) may be a suitable alternative for noninvasive ventilation (NIV) in chronic interstitial lung disease (ILD) during an episode of acute respiratory failure (ARF). Patients and methods Consecutive ILD patients who had ARF and a ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO2/FiO2) of 300 mmHg or less were randomly assigned to NIV or HFNOT. The primary outcome was the need for intubation. Secondary outcomes were in-hospital mortality and ventilator-free days. Results A total of 70 patients with ILD were included. The rate of intubation was 20.6% (seven of 34 patients) in the HFNOT group and 22.2% (eight of 36) in the NIV group (P=0.87). The ventilator-free days at day 28 was higher in the HFNOT group (20±5 vs. 16±7 days in the NIV group; P=0.008). The rate of in-hospital mortality was 26.5% in the HFNOT group versus 30.6% in the NIV group (P=0.71). Conclusion HFNOT improved patient comfort and the ventilator-free days in patients with ILD and ARF, despite no difference in the rate of intubation when compared with NIV.
Introduction Bronchial asthma and chronic obstructive pulmonary disease (COPD) are airway diseases with different etiology and a different presentation. Sometimes, asthma and COPD are present within the same patient as asthma–COPD overlap syndrome (ACOS). Aim To assess the role of fractional exhaled nitric oxide (FeNO) in the diagnosis of ACOS. Patients and methods A total of 60 patients with newly diagnosed stable COPD (n=20), bronchial asthma (n=20), and ACOS (n=20) were included from May 2016 to May 2017. COPD, asthma, and ACOS diagnosis depended on clinical history and examination and spirometric criteria according to GINA guidelines (2015). FeNO was measured and compared between the studied patients groups. The cutoff value for FeNO which can help in differentiating ACOS from COPD was determined. Results In the current study, the level of FeNO was significantly higher in the studied patients with ACOS in comparison with patients with COPD alone, and FeNO had significant positive correlation with sputum eosinophils % in patients with ACOS (P=0.013). Moreover, this study showed that the cutoff value of FeNO to differentiate ACOS from COPD was 20 parts per billion (with 80% sensitivity and 85% specificity and area under the curve=0.84). Conclusion This study showed that the measurement of FeNO can be used for early differentiation of ACOS from COPD alone for helping their proper management as early as possible.
Background Maintaining patent airway with tracheal intubation is frequently indicated at ICUs. Many tools can help to assure that the endotracheal tube (ETT) is properly placed, but each one of these tools has its limitations and cannot be applied in every patient. Aim of this study The aim of the study was to assess the role of tracheal ultrasonography in confirming ETT placement in ICU patients. Patients and methods This study included 200 patients (120 men and 80 women with a mean age of 49.1±12.4) with an indication of intubation at the respiratory ICU at Zagazig University Hospitals from January 2016 to March 2018. Ultrasonography of the trachea and capnography were done in addition to clinical assessment to confirm correct placement of ETT with taking capnography as the gold standard method for detecting the place of ETT. Sensitivity and specificity of ultrasonography against capnography in confirming proper endotracheal intubation were calculated. Results Of the 200 patients studied, 177 patients had confirmed ETT in the trachea by both capnography and tracheal ultrasonography; seven patients had confirmed ETT in the trachea by capnography only, and 16 patients had ETT outside the trachea by both capnography and tracheal ultrasonography. The sensitivity and specificity tracheal ultrasound were 96.2 and 100%, respectively. The time (s) needed to confirm the ETT position by clinical assessment, tracheal ultrasonography, and capnography was 19.21, 15.13, and 12.89, respectively, with highly significant statistical difference between them (P<0.001). Conclusion Tracheal ultrasound can be a rapid and safe tool to confirm correct endotracheal tube placement.
A parapneumonic effusion refers to the accumulation of exudative pleural fluid associated with an ipsilateral lung infection, mainly pneumonia. Parapneumonic effusions are mainly associated with bacterial infections.Parapneumonic pleural effusions are classified into: Uncomplicated parapneumonic effusions, which are exudative, neutrophilic effusion. Gram stain and culture are negative, glucose level greater than 60 mg/dl, pH above 7.20. Complicated parapneumonic effusions, resulting from a bacterial introduction into the pleura. In this type of parapneumonic effusion, there is a decreased glucose level, pleural fluid is below 7.20. Cultures of fluid from complicated parapneumonic effusions are negative and rapid bacterial clearance from the pleural space, or low bacterial count may explain this. The fluid termed as complicated because it necessitates drainage for resolution. Empyema thoracis in which there is frank pus in the pleural space, or there is evidence of bacterial infection of the pleural fluid by Gram stain or a positive culture. Pleural effusions are common in patients who develop pneumonia. At least 40-60% of patients with bacterial pneumonia will develop a pleural effusion of varying severity. Today, these parapneumonic effusions are not common because of prompt antibiotic therapy. However, in some patients the parapneumonic effusion becomes fibrinous and later develops an infection, resulting in an empyema.
Introduction Acute deterioration in a patient with chronic interstitial lung disease (ILD) may be owing to different causes like pneumonia and exacerbation of the underlying ILD. Recently, procalcitonin (PCT) has been introduced as a biomarker for diagnosing bacterial infection, but it is recommended to validate the specific cutoff value of PCT for diagnosing bacterial infection in various disease states. The aim of this study was to assess the performance of serum PCT for diagnosing bacterial pneumonia in patients with chronic ILD. Patients and methods This study included 50 patients with chronic ILD (21 male and 29 females, with mean age of 48.6±9.9 years) admitted to Chest Department Zagazig University Hospitals owing to acute respiratory deterioration in the period from September 2017 to July 2019. The underlying causes of the acute respiratory deterioration of the studied patients were determined. Serum calcitonin measured on admission was compared between patients with confirmed bacterial pneumonia and patients with other diagnosis. Results In the present study, PCT was significantly higher in the studied patients with diagnosed bacterial pneumonia than other causes of acute deterioration of ILD. Moreover, in this study, the cutoff value of PCT for diagnosing bacterial pneumonia was 0.3 ng/ml with area under curve 0.911, with sensitivity of 85%, specificity of 80%, positive predictive value of 73.9%, negative predictive value of 88.9% and accuracy of 82%. Conclusion This study showed that PCT is a helpful biomarker that can be added for differentiating bacterial pneumonia from other causes of acute deterioration of chronic ILD.
Many studies have suggested the role of vitamin D deficiency in both T-helper1 and T-helper2 diseases. The existence of associations of vitamin D with asthma and allergy remains uncertain. While some suggest that vitamin D may be protective, others suggest that vitamin D supplementation may increase the risk of allergy. The aim of the study was to evaluate the state of vitamin D in asthmatic patients and its potential relationship with asthma phenotypes. This study was conducted on 66 nonsmoker asthmatic patients and 30 healthy controls. Serum 25-hydroxy vitamin D3 levels were determined and compared between the two groups. The relationship between serum vitamin D levels and asthma phenotypes were examined. Vitamin D level was significantly lower in asthmatic patients than in control group, in asthmatic patients, vitamin D levels had a significant positive correlation with FEV1% predicted and a significant negative correlation with body mass index, the number of atopic patients was significantly higher in bronchial asthma patients with vitamin D insufficiency than those with sufficient vitamin D. Vitamin D deficiency was highly prevalent in asthmatic patients and it was associated with atopy and asthma severity.
Patients with rheumatoid arthritis (RA) have increased susceptibility to infection. The risk of acquiring infection including tuberculosis (TB) in RA may be increased in patients receiving any immuno-suppressive medication including anti-TNF therapy, which is used successfully for treating patients with rheumatoid arthritis. The aim of this work was to assess the risk of TB in RA patients on anti-TNF therapy compared to conventional disease modifying anti rheumatic drugs when screening for latent TB and TB chemoprophylaxis was applied. This study conducted on (235) RA patients indicated for either conventional therapy or anti-TNF therapy from 1-1-2010 to 1-10-2013. Assessment was done before RA treatment and included medical history, clinical examination, plain chest X-ray, HRCT chest QuantiFERON®-TB Gold in-tube (QFT-GIT) test and microbiologic investigations for tuberculosis when indicated. All patients with positive QFT-GIT received chemoprophylactic treatment for TB. The studied rheumatoid arthritic patients were divided into two groups; group (A) included (105) RA patients on conventional disease modifying anti rheumatic drugs (DMARDs) with mean age (51 ± 12) and group (B) included (130) RA patients on anti-TNF therapy with mean age (48 ± 13). This study showed no significant increase of tuberculosis among patients on anti-TNF therapy (group B) compared to patients on (DMARDs) (group A). Chemo-prophylaxis in patients on anti-TNF therapy leads to prevention of reactivation of latent TB. There was no significant increased risk for tuberculosis among RA patients receiving anti-TNF therapy when screening and chemoprophylaxis was applied, so screening of RA patients before anti-TNF therapy for latent tuberculosis and TB chemoprophylaxis should be done.
Although pneumonia is a leading cause of death, little consideration has been given to understanding the contributors to this mortality. Previous studies have suggested an increased mortality in pneumonia patients who develop cardiac complications. The aim of this study was to examine the risk factors and outcome of cardiac complications in admitted patients with community-acquired pneumonia. This study included 130 patients hospitalized with a primary diagnosis of community-acquired pneumonia. All patients were subjected to complete medical history, general and local chest examination, Laboratory investigations (complete blood count, renal and hepatic function tests, serum electrolytes, blood sugar, arterial blood gas analysis, CRP, procalcitonin, BNP, cardiac enzymes, blood and sputum Gram stain and culture, sputum PCR for Mycoplasma pneumoniae, Legionella pneumophila, Coxiella burnetii, and Chlamydophila species, urine antigen testing for S. pneumoniae and L. pneumophila, pharyngeal swabs for viral PCR.), radiological investigations, electrocardiographic studies (ECG) and echocardiography. Among the studied 130 patients, 32 patients (24.6%) had cardiac complications [new or worsening heart failure in16 patients (12.3%), arrhythmias in 12 patients (9.2%), and acute myocardial infarction in 4 patients (3.1%)]. In comparing patients who developed cardiac complications with those who did not they had a significantly higher age (mean ± SD 69 ± 17.3 versus 49 ± 19.1, p < 0.05), included a significantly higher percentage of patients with preexisting cardiovascular diseases (40.6% versus 5.1%, p < 0.05), had a significantly higher pneumonia severity index (PSI) (mean ± SD 130 ± 27 versus 73 ± 29, p < 0.05), a significantly longer hospital stay (mean ± SD 22 ± 7.1 versus 9 ± 4.3, P < 0.05) and a significantly higher mortality (21.8% versus 6.1%, P < 0.05). Cardiac complications are common in the admitted patients with pneumonia and they are associated with increased pneumonia severity and increased cardiovascular risk, these complications adds to the risk of mortality, so optimal management of these events may reduce the burden of death associated with this infection.