Chest Department

Background: Rapid and accurate diagnosis and management can be lifesaving for patients with acute dyspnea. However, making a differential diagnosis and selecting early treatment for patients with acute dyspnea in the emergency setting are a clinical challenge that requires complex decision-making in order to achieve hemodynamic balance, decrease unnecessary usage of antibiotic therapy, and decrease mortality.

Background: To determine the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of thoracic ultrasound (TUS) in patients with moderate to high clinical suspicion of pulmonary embolism (PE). Twenty-five patients with moderate or high clinical suspicion of PE were enrolled in a prospective study. The patients' ages were 20 to 50 years (mean age = 36 years). They were evaluated by TUS and standard contrast-enhanced CT pulmonary angiography (CTPA). Results: In comparison to and in correlation with CTPA, TUS was found true positive in 12 patients (48%), false positive in one patient (4%), true negative in eight patients (32%), and false negative in four patients (8%), with an overall sensitivity (75%), specificity (89%), positive predictive value (92%), negative predictive value (67%), and accuracy (80%). Conclusion: TUS with its high specificity and diagnostic accuracy is a noninvasive, widely available, cost-effective method which can be rapidly performed. A negative TUS study cannot rule out PE with certainty, but positive TUS findings with moderate/high suspicion for PE may prove a valuable bedside tool in the diagnosis of PE especially for critically ill and immobile patients, facilitating their immediate treatment.

In this study, we evaluated the gender diVerences in body mass index (BMI), age and their eVects on apnea-hypopnea index during total sleep time (AHI TST) in the Turkish population who were diagnosed with obstructive sleep apnea syndrome (OSAS) and compared them with data from the literature. A computerized database of 244 Turkish patients (194 males, 50 females) who had undergone overnight polysomnography (PSG) and diagnosed with OSAS at BayÂndÂr Hospital sleep laboratory between October 2004 and January 2007 was reviewed. The male:female ratio of the patients was 3.88:1. Male patients were signiWcantly younger compared to females (48.87 § 10.82 vs 52.94 § 12.14 years, respectively, P = 0.003). The BMI and AHI TST were similar in male and female patients (BMI = 29.52 § 4.63 vs 31.17 § 6.08 kg/ m 2 , respectively, P = 0.083) (AHI TST = 27.45 § 22.97 vs 24.77 § 23.83, respectively, P = 0.149). For the male and female groups, AHI TST increased as BMI increased (P = 0.03, 0.04). The median values of AHI TST in male group, for the normal, overweight and obese + pathological obese groups were 12.45, 20.20 and 23.50, respectively, whereas the median values of AHI TST in female group were 11.10, 10.95 and 26.20, respectively. In the normal and obese + pathological obese groups, there was no statistically signiWcant diVerence according to gender, whereas in the overweight group, male patients had signiWcantly higher AHI TST (P = 0.02). There was no statistically signiWcant diVerence between the male and female patients regarding the severity of OSAS (P = 0.358). However, there was a male tendency to moderate and severe OSAS in the normal and overweight BMI groups. In Turkish patients with OSAS, there was no gender diVerence in BMI and AHI TST and female patients were signiWcantly older than the males. The OSAS was diagnosed in men nearly four times more often than in women.

Background Conducted studies showed that the ADC (apparent diffusion coefficient) values of malignant mediastinal lesions are significantly lower than those of benign lesions. Investigators determined cut-off ADC values to differentiate the two; concluding that ADC value is a promising noninvasive, imaging parameter that helps assess and characterize mediastinal tumors. Taking this a step forward, the primary objective of our prospective study was to investigate the potential of DW-MRI (diffusion-weighted magnetic resonance imaging) to characterize malignant mediastinal lesions using their ADC values. Thirty-three patients that underwent MRI of the chest with DWI and latter pathologically diagnosed with a malignant mediastinal lesion were included in this study. Lesions’ ADC values were measured and correlated with the histopathological results. The statistical significance of differences between measurements was tested using the one-way ANOVA (analysis of variance) test; p values e...

Background: Pleurodesis fails in 10%-40% of patients with recurrent malignant pleural effusions malignant pleural effusion and dyspnea. This study aimed to assess the values of pleural elastance (P EL) after the aspiration of 500 mL of pleural fluid and their relation to the pleurodesis outcome, and to compare the pleurodesis outcome with the chemical characteristics of pleural fluid. Methods: A prospective study was conducted in Kasr El-Aini Hospital, Cairo University, during the period from March 2019 to January 2020. The study population consisted of 40 patients with malignant pleural effusion. The measurement of P EL after the aspiration of 500 mL of fluid was done with "P EL 0.5" (cm H 2 O/L), and the characteristics of the pleural fluid were chemically and cytologically analyzed. Pleurodesis was done and the patients were evaluated one month later. The P EL values were compared with pleurodesis outcomes. Results: After 4-week of follow-up, the success rate of pleurodesis was 65%. The P EL 0.5 was significantly higher in failed pleurodesis than it was in successful pleurodesis. A cutoff point of P EL 0.5 >14.5 cm H 2 O/L was associated with pleurodesis failure with a sensitivity and specificity of 93% and 100%, respectively. The patients with failed pleurodesis had significantly lower pH levels in fluid than those in the successful group (p<0.001). Conclusion: P EL measurement was a significant predictor in differentiating between failed and successful pleurodesis. The increase in acidity of the malignant pleural fluid can be used as a predictor for pleurodesis failure in patients with malignant pleural effusion.

Background Weaning failure is common in mechanically ventilated patients, and if ultrasound can predict weaning outcome remains controversial. The purpose of this study was to evaluate the diaphragmatic function (thickness and excursion) measured by ultrasound as a predictor of the extubation outcome. Methods We included 62 mechanically ventilated patients from the chest intensive care unit in this study. Sixty-two patients who successfully passed the spontaneous breathing trial (SBT) were enrolled. The transthoracic ultrasound of the diaphragm was performed during an SBT to the assess diaphragmatic function (excursion and thickness), and they were classified into the successful extubation group and the failed extubation group. Results There was a statistically significant increase in the successful extubation group in the diaphragmatic excursion and thickness fraction (p&lt;0.001), a statistically significant negative correlation between the diaphragmatic function and the duration ...

The superior vena cava (SVC) syndrome is a clinical entity caused by obstruction of the superior vena cava by infiltration, compression or thrombosis. Cancer is the most common underlying cause of superior vena cava obstruction. The incidence of catheter-induced superior vena cava obstruction is rapidly increasing. Fibrosing mediastinitis and Behçet disease are rare causes of SVC syndrome. Clinical presentation of SVC syndrome may include cough, dyspnea, dysphagia, and swelling or discoloration of the neck, face and upper extremities. Aim of this study is to evaluate the role of Multislice CT in study of superior vena cava obstruction syndromes and assessment of collateral circulation in different causes of superior vena caval

Background Routine administration of antibacterials in patients with Covid-19 has been a subject of debate, with no solid data about the true prevalence of respiratory coinfections in Covid-19 patients in different geographic areas. The aim of the current study was to identify respiratory coinfections in Covid-19 patients admitted to the hospital and to identify its genetic resistance pattern using the respiratory multiplex polymerase chain reaction (PCR). Results The study included 40 patients, 32 males (80%) and 8 (20%) females with a mean age of 59.3 ± 12.6. Half of the patients had respiratory bacterial coinfections documented by pneumonia (PN) panel. The most common isolate was Klebsiella pneumoniae (10/20, 50%), followed by Acinetobacter calcoaceticus baumanni complex (7/20, 35%). Regarding genetic resistance, thirteen (13/20, 65%) isolates were proven extended spectrum beta lactamase (ESBL)-producing Enterobacteriaceae. Thirteen (13/20, 65%) isolates were proven carbapenemase...

Background Due to limited capacity, health care systems worldwide have been put in challenging situations since the emergence of COVID-19. To prioritize patients who need hospital admission, a better understanding of the clinical predictors of disease severity is required. In the current study, we investigated the predictors of mortality and severity of illness in COVID-19 from a single center in Cairo, Egypt. Methods This retrospective cohort study included 175 patients hospitalized with COVID-19 pneumonia and had positive real-time polymerase chain reaction (RT-PCR) results for SARS-CoV-2 from 1 May 2020 to 1 December 2020. Severe COVID-19 was defined as requiring high-flow oxygen (flow rate of more than 8 L/min or use of high flow oxygen cannula), noninvasive ventilation, or invasive mechanical ventilation at any time point during the hospitalization. We used univariate and multivariate regression analyses to examine the differences in patient demographics and clinical and labora...

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Background & Aims: Coronavirus disease 2019 (COVID-19) is a global health problem, presenting with symptoms ranging from mild nonspecific symptoms to serious pneumonia. Early screening techniques are essential in the diagnosis and assessment of disease progression. This consensus was designed to clarify the role of lung ultrasonography versus other imaging modalities in the COVID-19 pandemic. Methods: A multidisciplinary team consisting of experts from different specialties (ie, pulmonary diseases, infectious diseases, intensive care unit and emergency medicine, radiology, and public health) who deal with patients with COVID-19 from different geographical areas was classified into task groups to review the literatures from different databases and generate 10 statements. The final consensus statements were based on expert physically panelists' discussion held in Cairo July 2021 followed by electric voting for each statement. Results: The statements were electronically voted to be either "agree," "not agree," or "neutral." For a statement to be accepted to the consensus, it should have 80% agreement. Conclusion: Lung ultrasonography is a rapid and useful tool, which can be performed at bedside and overcomes computed tomography limitations, for screening and monitoring patients with COVID-19 with an accepted accuracy rate.

To demonstrate the safety, usefulness and feasibility of lung biopsy by medical thoracoscopy in patients with DPLDs on HRCT chest of unconfirmed diagnosis after evaluation with less invasive investigations. METHODS: The study included 10 patients with DPLDs of unknown etiology. Medical thoracoscopic lung biopsies were taken and sent for histopathologic examination. Follow up of the patients including chest X-ray for confirmation of lung expansion, observation of the intercostal tube for any complications after the procedure. RESULTS: Good biopsy specimens were obtained in all patients with average size 0.5 ×0.4 cm. Two patients (20%) had persistent air leak for 5 &7 days then resolved spontaneously. Two patients (20%) had pneumothorax after removal of the intercostal tube and resolved by administration of high flow oxygen, 6 patients (60%) had pain and one patient (10%) had minor bleeding. The duration of the intercostal tube was 3.1 + 2.6 days. There was no infection, no respiratory failure requiring ICU admission and no mortality (30 day post procedure). CONCLUSIONS: Thoracoscopic lung biopsy by medical thoracoscopy is useful in diagnosis of cases with DPLDs of unknown etiology when lung biopsy is needed for accurate diagnosis. CLINICAL IMPLICATIONS: The procedure is feasible and safe. It carries some complications that are not life threatening and can be minimized by good selection of patients. No need for surgical lung biopsy.

Background Knowledge about the outcome of COVID-19 on pregnant women is so important. The published literature on the outcomes of pregnant women with COVID-19 is confusing. The aim of this study was to report our clinical experience about the effect of COVID-19 on pregnant women and to determine whether it was associated with increased mortality or an increase in the need for mechanical ventilation in this special category of patients. Methods This was a cohort study from some isolation hospitals of the Ministry of Health and Population, in eleven governorates, Egypt. The clinical data from the first 64 pregnant women with COVID-19 whose care was managed at some of the Egyptian hospitals from 14 March to 14 June 2020 as well as 114 non-pregnant women with COVID-19 was reviewed. Results The two groups did not show any significant difference regarding the main outcomes of the disease. Two cases in each group needed mechanical ventilation (p 0.617). Three cases (4.7%) died among the pr...

PURPOSE: To assess the safety and efficacy of thoracoscopic doxycycline poudrage (TDP) for pleurodesis in malignant effusions. METHODS: Twenty seven patients were included in this study. Thoracoscopy was performed for diagnosis and subsequent doxycycline pleurodesis. At the end of thoracoscopy, a new method for Doxycycline delivery to the pleura was used through pneumatic atomizer insufflations where about 500-1000 mg of doxycycline were taken & prepared as a powder from the oral preparation (vibramycin 100 mg / capsule). RESULTS: 74.1 % had a successful pleurodesis, 18.5% had partial reponse and 7.4% had failed pleurodesis at one month. Adverse effects included pain (48.1%), fever (3.7%) and pain & fever (22.2%). The mean drainage time for intercostals tube was about 1.52 days CONCLUSIONS: TDP is an inexpensive, well tolerated, reasonably effective, comparatively simple, safe, and capable of alleviating respiratory symptoms. CLINICAL IMPLICATIONS: TDP in patients with malignant pleural effusions may be a suitable substitute for talc as an effective and well-tolerated pleural sclerosant.

Background Hypersensitivity pneumonitis (HP) is an immunologically induced inflammation of the lung parenchyma that occurs in susceptible individuals in response to a variety of antigens. Repeated exposures to the causative antigens lead to chronic HP. The condition could be complicated with pulmonary hypertension (PH). Methodology 60 patients with established diagnosis of HP were included, clinical examination, high resolution computed tomography (HRCT) of chest, arterial blood gases, six minute walking test (6MWT), desaturation index, spirometry, echocardiography were performed to all patients and right heart catheter was done for patients with high echo probability of PH. Results The mean age of patients was 41.67 ± 13.4 years with female predominance 83.3% of patients had history of raising birds. 71.7% of cases suffered from resting hypoxia with oxygen saturation 89 ± 11% with desaturation index 9% ± 8%, Echo probability of PH ranged from low to high 71.67, 21.67 and 6.67% resp...