Τρίτη, 12 Μαρτίου 2019

Chest Diseases and Tuberculosis

Dilemma of community-acquired pneumonia
Lamia H Shaaban

The Egyptian Journal of Chest Diseases and Tuberculosis 2019 68(1):1-4

The lungs are particularly susceptible to infection, owing to continuous direct interaction with the external atmosphere in the process of gas exchange, and many anatomical facts, such as the presence of the pharynx, which constitutes a common pathway for both of the lung and stomach. With the process of development of many new generations of antibiotics, pneumonia still continues to be an important unsolved problem worldwide. Community-acquired pneumonia is still considered a problem and is associated with significant morbidity and mortality with cost load, especially with the emergent pathogens that presented with aggressive pictures of community-acquired pneumonia. 


Prognostic values of neutrophilic count and neutrophil–lymphocyte ratio among chronic obstructive pulmonary disease patients admitted with acute exacerbation
Ibrahim Dwedar, Mohamed Ali, Hossam M Abdel-Hamid

The Egyptian Journal of Chest Diseases and Tuberculosis 2019 68(1):5-8

Introduction Chronic obstructive pulmonary disease (COPD) is characterized by chronic inflammatory pathway with neutrophils and lymphocytes representing the main cells of inflammation. Patients and methods A prospective study was designed to assess the neutrophilic count as well as neutrophil–lymphocyte ratio (NLR) as predictors of mortality among patients admitted in the hospital with acute exacerbation COPD. Fifty COPD patients were admitted to Ain Shams Hospital complaining of acute exacerbation. They were followed up during their course inside the hospital with routine blood tests assessment. Results From the 50 patients admitted, eight patients died along their in-hospital course. No differences regarding their ages and sex. Total leucocytic count (TLC), neutrophilic count, lymphocytes, and NLR were found to be significantly higher in the nonsurvival versus the survival groups. Mean C-reactive protein values showed no significant difference between both the subgroups. The nonsurvival group tend to stay more days in the respiratory care unit in comparison to the survival group. Conclusion The neutrophilic count and the NLR were strongly valuable inflammatory markers with reported higher sensitivity and specificity in predicting the mortality among COPD patients admitted for acute exacerbation. 


Does vitamin D deficiency worsen the hospital outcome in patients with acute exacerbation of chronic obstructive pulmonary disease?
Mohamed F Abdel Ghany, Hoda A Makhlouf, Aliae A.R.M Hussein, Amal A Mahmoud

The Egyptian Journal of Chest Diseases and Tuberculosis 2019 68(1):9-13

Background There are limited data about the hospital outcome in hospitalized patients diagnosed as chronic obstructive pulmonary disease (COPD) with concomitant deficiency of vitamin D. Objectives To assess the level of serum 25-hydroxyvitamin D in patients with severe exacerbation of COPD and to find if there is any correlations between vitamin D and clinical, functional parameters, as well as survival, days of hospital stay, and need for ICU admission. Patients and methods In this case–control study, 60 patients with acute exacerbation COPD requiring hospital admission were recruited and 24 healthy controls. Chest radiography, spirometry, arterial blood gases, 6 min walking distance, modified Medical Research Council dyspnea scale, and St George Respiratory Questionnaire were assessed. Serum 25-hydroxyvitamin D level was measured by enzyme-linked immunosorbent assay. Results About 90% COPD patients had vitamin D deficiency. Serum vitamin D levels were statistically significantly lower in COPD with and without comorbidities when compared with normal controls (P<0.001) but COPD with or without comorbidities did not differ statistically (P>0.05). No significant correlation was found between serum 25-hydroxyvitamin D and survival; days of hospital stay or need for mechanical ventilation. As well, no significant correlation between vitamin D and forced expiratory volume in the 1 s %, 6 min walking distance, modified Medical Research Council, or St George Respiratory Questionnaire scores was found. Conclusion Vitamin D deficiency is found in most COPD patients. However, in patients suffering from severe exacerbation, the presence of low vitamin D levels did not have any effect on survival, days of hospital stay, or need for mechanical ventilation. 


Assessment of prevalence of active pulmonary tuberculosis among patients with ocular tuberculosis
Heba A Eshmawey, Eiman M Abd El Latif, Hadir A.S Okasha

The Egyptian Journal of Chest Diseases and Tuberculosis 2019 68(1):14-23

Background Tuberculosis (TB) is considered a multisystemic disease showing many extrapulmonary presentations. TB uveitis is one of the common forms of extrapulmonary TB. The lung is still the first organ to be attacked by TB, and pulmonary TB is the only infectious form of the disease. Aim The aim of the study was to detect the prevalence of active pulmonary TB among patients with TB uveitis. Patients and methods The present study included 37 patients with diagnosis of ocular TB on the basis of previous history, ocular examination, and exclusion of other suspected causes of uveitis. In addition, positive tuberculin skin test, or positive interferon-gamma release assays were carried out. All included patients were subjected to sputum examination for acid-fast bacilli and plain radiography of chest P-A view, and certain cases had a bronchoalveolar lavage. Patients with active pulmonary TB were detected. Both groups (patients with active pulmonary TB and patients with free chest) were compared with regard to all the previously mentioned studied parameters. Results The mean age of the studied patients was 34.8±12.5 years. All the studied patients showed positive tuberculin test with a mean of 18.5±3.4 mm. With regard to the Quantiferon Gold test, 34 patients (91.9%) had positive results. Concerning radiography, only 10 (27%) patients had normal radiograph, the rest of the patients showed various radiological lesions. Thirty (81.1%) patients were diagnosed to have active pulmonary TB. Sputum examination for acid-fast bacilli revealed that 22 (59.5%) patients had positive results; an additional eight patients (who had negative results on sputum examination) showed positive results when they underwent a bronchoalveolar lavage. There was no statistically significant difference with regard to all the previously mentioned parameters between patients with active pulmonary TB and patients with a free chest. Conclusion The present study revealed that a considerable percentage of the patients with TB uveitis had active pulmonary TB. 


Treatment outcomes of patients on non-Revised National Tuberculosis Control Programme (private) anti-tuberculosis regimen from a tertiary-care centre in Kerala, India
Akhilesh Kunoor, Rakesh Purushothama Bhat Suseela, Mithula Raj, Rajesh Chemmarissery Thankappan, Ponneduthamkuzhi Thomas James

The Egyptian Journal of Chest Diseases and Tuberculosis 2019 68(1):24-27

Introduction Although standardised tuberculosis (TB) treatment in India is delivered by the public sector through the Revised National TB Control Programme (RNTCP), majority of patients in the country are treated with private anti-TB drugs. The objective of the study was to assess the treatment outcome of patients initiated on non-RNTCP regimen from a private tertiary-care centre from January to June 2016. Patients and methods A nonconcurrent cohort study was done which followed up the patients who have been initiated on private anti-TB regimen from a private tertiary-care centre in Kerala, India, during the first and second quarter of 2016. Details of further visits were sought from the hospital health management information system. A phone call interview was done with all patients, 9–12 months after treatment initiation. Results There were 81 patients who were initiated on private anti-TB regimen. Of them, 26 were of pulmonary TB and 55 were of extrapulmonary tuberculosis (EPTB). Among pulmonary TB, 17 (65.38%) cases and in EPTB, 41 (74.54%) cases had successful treatment outcome. The overall success of the non-RNTCP regimen was 71.6%. In pulmonary TB, six (23.1%) cases and in EPTB 11 (20%) cases came under lost to follow-up category. Conclusion The results calls for urgent actions to have a system in place for tracking patients initiated on private anti-TB drugs so as to ensure the standards of TB care. The national programme may further strengthen monitoring of treatment adherence in private sector with established ICT-based treatment support models. 


Raised dsDNA autoantibodies in tuberculosis patients
Faheem Shahzad, Atia Ali, Abid Mushtaq, Khursheed Javaid, Afzaal Nazir, Amna Pervez, Mohammad Kashif, Noman Bashir, Afia Abbas, Romeeza Tahir, Shah Jahan, Nadeem Afzal

The Egyptian Journal of Chest Diseases and Tuberculosis 2019 68(1):28-31

Background Tuberculosis (TB) is caused by Mycobacterium tuberculosis. M. tuberculosis can become dormant, resist the hostile environment of the phagosome, and trigger a delayed-type hypersensitivity reaction leading to chronic infection and granuloma formation. In granulomas, destruction of tissues results in the release of intracellular self-antigens that may provoke the development of autoantibodies. Therefore, the present cross-sectional study was conducted to detect anti-dsDNA antibodies in local TB patients. Patients and methods In all, 160 patients were recruited for this comparative study. Anti-dsDNA antibodies were detected by enzyme-linked immunosorbent assay. Independent Student’s t test was used to compare mean anti-dsDNA values between TB patients and healthy individuals. A p value less than or equal to 0.05 was considered as statistically significant. Results Anti-dsDNA antibodies were high in TB patients as compared with healthy controls and the difference between the two groups was statistically significant (P<0.0001). No significant association of dsDNA autoantibody between TB patients and healthy controls was obtained. Similarly, no significant association of dsDNA autoantibodies was obtained in drug resistance TB patients and TB patients without drug resistance. Conclusion Increased level of dsDNA autoantibody was detected in TB patients and its level was clinically significant in TB patients, but no association of this autoantibody was established with TB. 


Hurdle in the eradication of tuberculosis: delay in diagnosis
Jayasri H Gali, Harsha V Varma, Aruna K Badam

The Egyptian Journal of Chest Diseases and Tuberculosis 2019 68(1):32-38

Objective Identifying the factors responsible for the delay in the diagnosis of tuberculosis (TB). Patients and methods In this retrospective study, data on pulmonary and extrapulmonary forms of TB, registered for the treatment at the directly observed treatment, short course, centre were analysed. Results Of 163 patients, 34 (20.86%) were diagnosed at the first visit. The delay in seeking medical care ranged from 0 to 25 days from the diagnosis. A total of 110 (67%) patients started on the same day or the day after diagnosis, less than 1 month in 33 (20.25%) and 1–3 months in 83 (51%). Delay from patient and health services (both combined) ranged from half a month to 48 months; the mean±SD diagnostic delay was 4.09±4.19 days (range: 0–24 days), whereas the mean±SD treatment delay (n=162) was 2.19±3.89 days. of the 124 patients who received medical help, 90% of them did so within six months of onset of Symptoms. There was a statistically significant difference in patients’ delay in receiving the treatment/medical care by sex. Mean±SD delay for pulmonary and extrapulmonary TB was 48±24 and 240±386 days, respectively. Conclusion Delay in diagnosis is a preventable factor. Patient delay is longer compared with healthcare delays. Active surveillance, even in the urban areas by healthworkers, may help in reducing this delay. 


Role of echocardiographic tissue Doppler imaging in the assessment of myocardial diastolic dysfunction in children with diffuse lung diseases
Waleed Mohamed Elguindy, Maryam Ali Abdelkader

The Egyptian Journal of Chest Diseases and Tuberculosis 2019 68(1):39-43

Background Pulmonary arterial hypertension (PAH) is a common complication of prolonged diffuse lung diseases in children. It is considered a crucial factor of morbidity, mortality, and severity of the disease in these children. Conventional echocardiography is an indirect tool to assess pulmonary hypertension (PH) with a limited sensitivity compared with right heart catheterization and requires well-trained physicians. So, the aim of the current study was to determine the role of echocardiographic tissue Doppler imaging in the assessment of the effect of pulmonary hypertension on right ventricular functions in children with prolonged, diffuse lung diseases and if it can have a predictive role of the secondary right ventricular (RV) dysfunction in these children. Patients and methods This is a case–control study in which 40 children with diffuse lung diseases were recruited from the chest clinic, Ain Shams University Hospitals. The patients were classified into PH and non-PH groups according to the echocardiographic measurement of mean PAP greater than 25 mmHg. Results Patients with PAH had significantly higher RV stroke volume as well as indexed RV systolic and diastolic areas. Furthermore, these patients had significantly higher RV myocardial performance index and E/E′ ratio suggesting diastolic dysfunction as well as decreased compliance. Conclusion Although conventional echocardiography could detect changes in RV dimensions and stroke volume, tissue Doppler imaging could further highlight changes in RV diastolic functions as well as compliance secondary to PAH. 


Functional evaluation of patients with progressive systemic sclerosis-associated diffuse parenchymal lung disease
Ahmed A.A Hussieny, Yosri M.K Akl, Reem I Elkorashy, Amira I Mostafa, Doaa H Attia, Mohamed Faheem, Fatma E.-Z Ahmed

The Egyptian Journal of Chest Diseases and Tuberculosis 2019 68(1):44-49

Background Interstitial lung diseases are common features in scleroderma that seem to add to the morbidity and mortality of the disease. Other complications that may occur with scleroderma are pulmonary hypertension. Aim to evaluate the functional status of patients with progressive systemic sclerosis-associated diffuse parenchymal lung disease. Methodology A total of 44 adult patients with a confirmed diagnosis of scleroderma were included. The disease severity was assumed by using the grading of the inter-incisor distance and finger-to-palm distance. Assessment of the chest high-resolution computed tomography (HRCT) was performed, and then functional assessment in the form of arterial blood gas, spirometry, 6-min walk distance, and echocardiography was performed. Results There were no significant differences between the scleroderma with diffuse parenchymal lung disease and those with normal HRCT regarding the measured and calculated parameters, except for the pulmonary artery systolic pressure, which was significantly higher in the normal HRCT group than those with interstitial lung disease. 


Idiopathic pulmonary fibrosis and subclinical hypothyroidism: an underestimated comorbidity
Heba H AboElNaga, Alyaa A ElSherbeny, Emad A AbdelHady

The Egyptian Journal of Chest Diseases and Tuberculosis 2019 68(1):50-56

Background Idiopathic pulmonary fibrosis (IPF) is the most damaging and mysterious form of lung fibrogenesis, with worldwide growing prevalence and mortality. Subclinical hypothyroidism (SCH) is evidenced that its prevalence is still higher in patients with IPF. Objectives To study the incidence of SCH in patients with IPF in comparison with the controls with a focus on the different clinical characteristics and spirometry measurements. Patients and methods The research involved 50 patients who were diagnosed as IPF and 30 healthy participants, enrolled from the outpatient clinic departments of pulmonary medicine of October 6 University Hospital. The patients performed spirometry tests, high-resolution computed tomography chest, and thyroid function test. Results There were significant differences in spirometry data and thyroid-stimulating hormone level between the IPF and the control group, indicating more prevalence of SCH in IPF patients. IPF patients diagnosed with SCH have a significant decline in some spirometry measurements than those with IPF only. Conclusion The prevalence and clinical outcomes of SCH in patients with IPF certainly require advanced research, since the thyroid function tests were not done regularly for most patients with IPF. This study intensely proposes that in future encouraging management should be further studied to enhance the prognosis of IPF patients. 


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