BackgroundLung cancer has a very poor prognosis and high mortality. Positive sputum for malignant... more BackgroundLung cancer has a very poor prognosis and high mortality. Positive sputum for malignant and/or atypical cells warrants the need for fibreoptic bronchoscopy. White light bronchoscopy (WLB) is usually unable to detect preinvasive lesions; therefore, autofluorescence bronchoscopy (AFB) was introduced as a gold standard for detecting such lesions. The aim of this work was to investigate the role of I-scan as a screening tool for cancer in smoker patients showing positive sputum cytology.ResultsNew suspicious findings under I-scan occurred in 11 patients (36.7%). The overall sensitivity of WLB alone to diagnose malignancy is 23.3%, in contrast to an added sensitivity of 50% when I-scan was combined with white light (pvalue < 0.05). The specificity of I-scan could not be assessed in the absence of control cases (true negatives). No major complications or deaths occurred. Haemorrhage and bronchospasm were the commonest minor complications.ConclusionsThe addition of I-scan to t...
Background Medical thoracoscopy (MT) under conscious sedation can be a painful procedure. A pilot... more Background Medical thoracoscopy (MT) under conscious sedation can be a painful procedure. A pilot study reported reduction in procedural pain with lidocaine application via chest tube before procedure. This study aimed at assessing the extent of effect of intrapleural lidocaine on pain during MT in a double-blind randomised trial. Results Thirty patients (mean age 48.3 years) were recruited, 14 randomised to the lidocaine group and 16 to the saline group. In four patients (two from each group), chest tube insertion prior to MT failed, and they were excluded from the final analysis. The mean (SD) visual analogue scale (VAS) pain score during procedure was 49 ± 33.2 for the lidocaine group and 57.4 ± 27.6 for the control group (mean difference − 8.4 points, p = 0.49). The VAS pain score as assessed by operator was 45.6 ± 19.8 for the lidocaine group and 46.6 ± 29.8 for the control group (p = 0.97). There was no difference in the VAS pain score at 120 min post MT or in the doses of sed...
Introduction: Extra-pulmonary manifestations of the Coronavirus disease of 2019 (COVID-19) have b... more Introduction: Extra-pulmonary manifestations of the Coronavirus disease of 2019 (COVID-19) have been increasingly reported, especially gastrointestinal and hepatic system dysfunction. The concern of faecal-oral transmission for COVID-19 was raised. Aim: To study the trend of faecal calprotectin in COVID-19 patients with intestinal symptoms. Material and methods: Forty confirmed cases of COVID-19 infection presenting with diarrhoea were subjected to a thorough history taking, clinical examination, and routine laboratory investigations. They were treated according to the Egyptian MOH guidelines. Faecal calprotectin (FC) concentration was measured at initial presentation and after 3 months. Those who had persistently elevated levels ≥ 200 μg/g were subjected to colonoscopic examination and histopathological examination. Forty confirmed cases of COVID-19 without diarrhoea were recruited as a control group in the initial FC evaluation. Results: Faecal calprotectin was found to be significantly elevated in the studied COVID-19 patients who presented with diarrhoea, with a mean value 260 ±80 μg/g compared to the those without diarrhoea, with a mean value of 31.6 ±12.9 μg/g (p < 0.001). Moreover, 20% (8 patients) had an elevated level exceeding 200 μg/g 3 months after recovery; among them, 5 patients showed mild colonoscopic changes whereas 3 patients showed severe ileocolitis. Out of the 3 patients with marked ileocolitis, 2 showed histopathological changes raising the diagnosis of Crohn's disease. Conclusions: Faecal calprotectin was found to be elevated in COVID-19 patients with intestinal symptoms, especially diarrhoea, with or without colonoscopic and histopathological changes.
Egyptian Journal of Chest Diseases and Tuberculosis, 2013
Blind percutaneous dilational tracheotomy (PDT) holds a lot of peri-operative complications. A lo... more Blind percutaneous dilational tracheotomy (PDT) holds a lot of peri-operative complications. A lot of assisting tools have long been used to facilitate guidance during PDT, e.g., laryngeal mask airway (LMA), ultrasound (US) imaging of the neck, light wand for trans-illumination of the soft tissues of the neck, and flexible fiberoptic bronchoscopy. The aim of this work was to compare between blind and fiberoptic bronchoscopic guided PDT as regards ease of the technique and complications of the procedure. Design: A randomized prospective comparative trial. Setting: Critical care department, main Alexandria university hospital. Patients: Thirty adult patients, requiring elective PDT, and need to maintain a secure airway. Methods: They were randomly assigned to 2 groups; blind PDT group I and fiberoptic bronchoscopic guided PDT group II. Both groups used Griggs' forceps technique for PDT. Post-operative complications were recorded. End point was 48-h after the procedure. Results: Number of trials was 1.27 ± 0.46 and 1.00 ± 0.00 for groups I and II, respectively. Success rate was 100% in both groups. Procedural duration (in minutes) was 2.93 ± 1.10 in group I versus 3.93 ± 1.10 in group II. Bleeding was found in 3 patients and 1 patient for groups I and II. Subcutaneous emphysema occurred in one patient in each group, while tube misplacement was recorded in 2 patients in group I and none in group II. Aspiration pneumonia was found in 2 patients in group I and none in group II.
BackgroundLung cancer has a very poor prognosis and high mortality. Positive sputum for malignant... more BackgroundLung cancer has a very poor prognosis and high mortality. Positive sputum for malignant and/or atypical cells warrants the need for fibreoptic bronchoscopy. White light bronchoscopy (WLB) is usually unable to detect preinvasive lesions; therefore, autofluorescence bronchoscopy (AFB) was introduced as a gold standard for detecting such lesions. The aim of this work was to investigate the role of I-scan as a screening tool for cancer in smoker patients showing positive sputum cytology.ResultsNew suspicious findings under I-scan occurred in 11 patients (36.7%). The overall sensitivity of WLB alone to diagnose malignancy is 23.3%, in contrast to an added sensitivity of 50% when I-scan was combined with white light (pvalue < 0.05). The specificity of I-scan could not be assessed in the absence of control cases (true negatives). No major complications or deaths occurred. Haemorrhage and bronchospasm were the commonest minor complications.ConclusionsThe addition of I-scan to t...
Background Medical thoracoscopy (MT) under conscious sedation can be a painful procedure. A pilot... more Background Medical thoracoscopy (MT) under conscious sedation can be a painful procedure. A pilot study reported reduction in procedural pain with lidocaine application via chest tube before procedure. This study aimed at assessing the extent of effect of intrapleural lidocaine on pain during MT in a double-blind randomised trial. Results Thirty patients (mean age 48.3 years) were recruited, 14 randomised to the lidocaine group and 16 to the saline group. In four patients (two from each group), chest tube insertion prior to MT failed, and they were excluded from the final analysis. The mean (SD) visual analogue scale (VAS) pain score during procedure was 49 ± 33.2 for the lidocaine group and 57.4 ± 27.6 for the control group (mean difference − 8.4 points, p = 0.49). The VAS pain score as assessed by operator was 45.6 ± 19.8 for the lidocaine group and 46.6 ± 29.8 for the control group (p = 0.97). There was no difference in the VAS pain score at 120 min post MT or in the doses of sed...
Introduction: Extra-pulmonary manifestations of the Coronavirus disease of 2019 (COVID-19) have b... more Introduction: Extra-pulmonary manifestations of the Coronavirus disease of 2019 (COVID-19) have been increasingly reported, especially gastrointestinal and hepatic system dysfunction. The concern of faecal-oral transmission for COVID-19 was raised. Aim: To study the trend of faecal calprotectin in COVID-19 patients with intestinal symptoms. Material and methods: Forty confirmed cases of COVID-19 infection presenting with diarrhoea were subjected to a thorough history taking, clinical examination, and routine laboratory investigations. They were treated according to the Egyptian MOH guidelines. Faecal calprotectin (FC) concentration was measured at initial presentation and after 3 months. Those who had persistently elevated levels ≥ 200 μg/g were subjected to colonoscopic examination and histopathological examination. Forty confirmed cases of COVID-19 without diarrhoea were recruited as a control group in the initial FC evaluation. Results: Faecal calprotectin was found to be significantly elevated in the studied COVID-19 patients who presented with diarrhoea, with a mean value 260 ±80 μg/g compared to the those without diarrhoea, with a mean value of 31.6 ±12.9 μg/g (p < 0.001). Moreover, 20% (8 patients) had an elevated level exceeding 200 μg/g 3 months after recovery; among them, 5 patients showed mild colonoscopic changes whereas 3 patients showed severe ileocolitis. Out of the 3 patients with marked ileocolitis, 2 showed histopathological changes raising the diagnosis of Crohn's disease. Conclusions: Faecal calprotectin was found to be elevated in COVID-19 patients with intestinal symptoms, especially diarrhoea, with or without colonoscopic and histopathological changes.
Egyptian Journal of Chest Diseases and Tuberculosis, 2013
Blind percutaneous dilational tracheotomy (PDT) holds a lot of peri-operative complications. A lo... more Blind percutaneous dilational tracheotomy (PDT) holds a lot of peri-operative complications. A lot of assisting tools have long been used to facilitate guidance during PDT, e.g., laryngeal mask airway (LMA), ultrasound (US) imaging of the neck, light wand for trans-illumination of the soft tissues of the neck, and flexible fiberoptic bronchoscopy. The aim of this work was to compare between blind and fiberoptic bronchoscopic guided PDT as regards ease of the technique and complications of the procedure. Design: A randomized prospective comparative trial. Setting: Critical care department, main Alexandria university hospital. Patients: Thirty adult patients, requiring elective PDT, and need to maintain a secure airway. Methods: They were randomly assigned to 2 groups; blind PDT group I and fiberoptic bronchoscopic guided PDT group II. Both groups used Griggs' forceps technique for PDT. Post-operative complications were recorded. End point was 48-h after the procedure. Results: Number of trials was 1.27 ± 0.46 and 1.00 ± 0.00 for groups I and II, respectively. Success rate was 100% in both groups. Procedural duration (in minutes) was 2.93 ± 1.10 in group I versus 3.93 ± 1.10 in group II. Bleeding was found in 3 patients and 1 patient for groups I and II. Subcutaneous emphysema occurred in one patient in each group, while tube misplacement was recorded in 2 patients in group I and none in group II. Aspiration pneumonia was found in 2 patients in group I and none in group II.
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Papers by Dr Ahmed Hady