Value of proton magnetic resonance spectroscopy of brain to study the cerebral metabolic abnormalities in COPD: Initial experience

AbstractBackgroundChronic obstructive pulmonary disease (COPD) patients were found to have cerebral metabolic abnormalities. Proton magnetic resonance spectroscopy (1H MRS) is a sensitive technique that detects metabolic changes of the brain.ObjectiveTo study the cerebral metabolic changes in COPD patients using 1H MRS.MethodsThis study was carried-out on twenty symptomatic COPD patients (16 male and 4 female) and age matched group of 20 healthy controls (11 male and 19 female). Pulmonary function tests, respiratory muscle strength, resting arterial blood gases, and 1H MRS of the brain were carried out on all subjects. The parieto-temporal and occipital regions were localized for 1H MRS. The metabolic ratios of N-acetyl aspartate to creatine (NAA/Cr) and choline to creatine (Cho/Cr) were calculated by the single voxel technique.ResultsIn comparison with healthy control subjects, the mean values of Cho/Cr in COPD patients were lower in parieto-temporal and occipital areas (0.99±0.21 vs. 1.10±0.31; P=0.22) (0.81±0.26 vs. 0.88±0.21; P=0.37), respectively while, the mean values of NAA/Cr in COPD patients were higher in both parieto-temporal and occipital areas of the brain (1.82±0.35 vs. 1.68±0.22; P=0.14) (1.59±0.31 vs. 1.39±0.39; P=0.08), respectively. In COPD patients, significant positive correlations were observed between maximal expiratory pressure (MEP) and NAA/Cr in parieto-temporal area of the brain.ConclusionsThe cerebral metabolites, arterial blood gases, respiratory muscle strength, and pulmonary function tests are altered in symptomatic COPD patients. 1H MRS is a non invasive technique that detects cerebral metabolic changes in COPD patients

Sleep disordered breathing in patients with chronic kidney diseases: How far the problem?

AbstractBackgroundSleep-disordered breathing (SDB) is highly prevalent in patients with advanced chronic kidney diseases (CKDs).ObjectiveTo describe and compare the prevalence, severity, and patterns of SDB and associated nocturnal hypoxia among patients with advanced CKD, hemodialysis (HD) patients, and control group.MethodsForty patients were recruited from outpatient nephrology clinics and hemodialysis units. Patients were stratified into two groups: conservative (n=25), and HD (n=15). 30 healthy individual enrolled as the control group. All participants completed polysomnography (PSG).ResultsCase control study of forty CKD patients (15 HD and 25 conservative) [13(86.7%) and 20 (80%) men, mean age 62.73±5.43 and 55.76±9.03year, BMI 40.83±8.75 and 36.12±16.53kg/m, mean ESS 18.46±3.20 and 17.84±2.79), respectively, and 30 healthy participants served as the control. The prevalence of SDB in CKD was 33/40(82.5%). In the conservative group, AHI was 148.84±147/h, [80% obstructive, 13% central, and 5% mixed apnea]. Among these conservative groups with OSA patients, 56% had severe, 31% moderate, and 12.5% mild OSA. While in the HD group, AHI 133.26±111/h, [84.6% obstructive, 7.7% central, and 7.7% mixed apnea]. Among these HD groups with OSA, 63% had severe, 27% moderate, and 9% mild OSA. GFR was significantly correlated with AHI and ODI (r=−0.315, P<0.05, r=−0.506, P<0.001) respectively. AHI correlated with urea concentration (r=−0.094, P<0.05). Increased creatinine, and decreased eGFR were significant risk factors of severe OSA. Predictors that reduced renal function were, decreased TST, delayed latency to REM sleep, and increased AHI.ConclusionsSevere OSA was highly prevalent among CKD. Urea was the stronger predictor of increased AHI

A six-year sleep lab experience in an Egyptian University Hospital

Background: Sleep disorders are common and the gold standard for diagnosis is through polysomnography (PSG) with standard scoring criteria. Published clinical and polysomnographic data reporting sleep disorders among Egyptian patients are lacking. Aim: To study clinical and polysomnographic characteristics in Egyptian patients with suspected sleep disorders. Patients and methods: All patients’ polysomnographic records and sleep questionnaires were reviewed from November 2006: November 2012 at the Minoufiya University Hospital Sleep Disorders Unit. Results: 421 patients were recruited among which 229 were males (54.4%); excessive daytime sleepiness and obesity were major features (ESS = 16, BMI = 33). Most of the patients were referred by a chest physician (81%). The most common symptoms were snoring (84.6%), witnessed apneas (78.6%), insomnia (70.9%) while the least was parasomnia (15.4%). 337 patients were diagnosed as having obstructive sleep apnea OSA (80%) of them, 70 (21%) had mild OSA, 75 (22%) had moderate OSA and 192 (57%) had severe OSA, The most common diseases accompanying OSA were: systemic hypertension (77%), diabetes (63%), COPD (57%), and coronary heart disease (49%). Conclusions: Sleep medicine in Egypt is still lagging behind the developed world, awareness of sleep disorders among Egyptian physicians should be increased. Diabetes, HTN, IHD and COPD are the commonest predisposing factors for OSA among Egyptians especially snorers, obese and overweight patients

Utility

Background: Urinary lipoarabinomannan (LAM) detection is a promising approach for the rapid diagnosis of active tuberculosis (TB). Objective: To assess the diagnostic accuracy of urine LAM among TB patients either pulmonary or extra pulmonary. Methods: This study was carried out on 85 cases (46 male and 39 female) with active tubercular infection divided into three groups; pulmonary (n = 40), extra pulmonary (n = 30) and disseminated tuberculosis (n = 15). Twenty-five normal individuals were included as the control group. LAM level was measured in urine by enzyme-linked immunosorbant assay (ELISA). Results: TB Patients with disseminated disease had a higher urine LAM level (1.75 ± 1.65 ng/ml) than that for patients with pulmonary (0.58 ± 0.53 ng/ml) or extra pulmonary TB (0.17 ± 0.11 ng/ml) (P < 0.001). Patients with smear positive specimens had a higher urine LAM level (0.63 ± 0.54 ng/ml) than that of smear negative (0.040 ± 0.06 ng/ml) (P < 0.001). Quantitative urine LAM test results positively correlate with the degree of bacillary burden. Advanced age, immunosuppressant state and advanced radiological lesion were significant factors that were associated with higher quantitative urine LAM (P < 0.05). Conclusion: Urine LAM test is a simple, rapid, and reliable diagnostic modality for active pulmonary or extra pulmonary tuberculosis. Quantitative LAM detection results increased progressively with bacillary burden and immunosuppression. Patients with disseminated TB are target populations for urine LAM detection

Polysomnography in women: is there any difference between childbearing period and menopause?

Background Women may have a wide range of symptoms in the menopausal period, which includes vasomotor, mood changes, and disturbances of sleep. Disturbance of sleep leads to adverse health problems with poor quality of life. This study researched the comparison of polysomnographic parameters between menopausal and childbearing women. Patients and methods This study was carried out on 47 women (divided into two groups of premenopausal and postmenopausal), who attended for polysomnography in the Unit of Sleep in the Department of Chest Diseases in Menoufia University Hospital from the period of September 2021 to September 2022. After taking informed written consent, all participants were subjected to history taking, full examination, Epworth sleepiness scale, STOP-Bang questionnaire, and polysomnography. Results This study was carried out on 47 women who were divided into two groups: group I (29 participants) in menopause with an age of 58.9 ± 6.3 (mean±SD) and group II (18 participants) in the childbearing period with an age of 37.28 ± 8.064 (mean±SD). Polysomnographic parameters showed statistically significant differences between both groups regarding sleep latency (min) (P=0.026), sleep efficiency% (P=0.019), apnea–hypopnea index (P<0.001), O2 desaturation index, and lowest O2 saturation during sleep (P<0.001 and 0.01, respectively). Conclusion Women in menopausal women experience more sleep disturbance, insomnia, and sleep breathing disorders than they did during the childbearing years. Women in this age group, therefore, require a more thorough assessment of sleep difficulties and other relevant variables

Obstructive sleep apnea in pregnancy. Is it a new syndrome in obstetrics?

Background: Sleep disordered breathing (SDB) is a frequent disorder and its severity superfats as pregnancy progresses. The exact prevalence or incidence of such disorder in pregnant women is still unknown. Objectives: To assess the incidence and severity of OSA in pregnant women and to discover the risk factors for OSA during pregnancy. Methods: A total of 30 pregnant women and 30 age matched controls completed Epworth Sleepiness Scale and Stop-Bang questionnaire. SDB diagnosis was based on polysomnography. Results: The incidence of OSA among our studied pregnant women was 36.7% and 53.3% of pregnant women were snorers. They demonstrated significantly higher AHI (4.38 ± 4.45) and ODI (3.72 ± 4.03). There was a significant positive correlation between gestational age and ESS, BMI, AHI and ODI, as they are of their highest levels among cases in the third trimester. Binary logistic regression analysis showed that gestational age and body mass index were independent risk factors with odds ratio (2.23 & 4.99) and 95% CI (1.05–5.32 & 1.75–33.28) respectively while the neck circumference and ESS were considered as dependent risk factors. Conclusion: Pregnancy is a risk condition for OSA which aggravated by neck circumference and base line BMI. The susceptibility and severity increase by increasing gestational age

Effect of obstructive sleep apnea syndrome on sleep architecture: comparative study between geriatrics and middle-aged adult patients

Background Obstructive sleep apnea (OSA) is a prevalent sleep disordered breathing in geriatrics but still frequently undiagnosed. Sleep architecture changes with ageing. Geriatrics spend more time in the N1, N2 than in N3, REM. Also, there are more frequent awakenings, arousals and sleep stage shifts. This leads to decrease in sleep efficiency. Geriatric patients with OSA have more affected sleep architecture than middle-aged adults. The aim This work aimed to assess and compare sleep architecture changes in geriatrics versus middle-aged adult patients with OSA syndrome. Patients and methods This comparative study conducted in chest department Menoufia University Hospitals included 50 patients divided to two equal groups; geriatric group age 65 years old or more and middle-aged adult group aged from 18 to 50 years old. All patients were complaining of symptoms suggestive of OSA. All patients underwent sleep questionnaires and Polysomnography using model; Philipsrespironic alice6. Results There was no statistically significant difference between the studied groups regarding sex, smoking, co morbidities, BMI and symptoms. Regarding changes in sleep architecture, geriatric group showed a significantly higher Sleep latency and wakefulness after sleep onset in comparison to middle-aged adults (P=0.004 and 0.039, respectively) versus significantly lower Sleep efficiency, N3%, REM% (P=0.009,0.011 and 0.001, respectively). The median Total Apnea-Hypopnea index was 40.2 (/h sleep) in geriatric group and 35.4 in middle-aged adult group. Regarding severity of OSA; geriatric group showed mild OSA in five (20%) patients, moderate in five (20%) patient and severe in 15 (60%) patients. Middle-aged adults showed mild OSA in 10 (40%) patients, moderate in two (8%) patients, and severe in 13 (52%) patients. Conclusions Sleep architecture is affected in all OSA patients, but these changes are more obvious in geriatric patients. Geriatric patients have higher wakefulness after sleep onset and sleep latency. On the other hand, they have a lower N3%, REM% and sleep efficiency

Utility of chest ultrasonography and pulmonary infection score in early diagnosis of ventilator-associated pneumonia

Background Ventilator-associated pneumonia (VAP) remains a morbid and prevalent problem throughout the world. Lung ultrasound (LUS) is increasingly being used at the bedside for assessing alveolar-interstitial syndrome, lung consolidation, pneumothorax, and pleural effusion. Purpose The aim was to focus on the use of bedside LUS alone and in association with the clinical pulmonary infection score (CPIS) in early diagnosis of VAP, to describe the sonographic features, to compare between LUS and portable chest radiography (CXR) in early diagnosis of ventilator-associated pneumonia (VAP), and weather LUS affects the prognostic outcomes of VAP. Patients and methods A total of 40 patients with suspected VAP were enrolled. Portable CXR, LUS, and computed tomography scan (gold standard) were performed. The CPIS was calculated for early and reliable diagnosis of VAP. The prognostic outcomes were highlighted. Results Among forty VAP-suspected cases, 30 (75%) were confirmed using computed tomography (gold standard). LUS imaging of VAP cases diagnosed 28 (70%) with consolidation, 89.3% of them with air bronchogram, and 32.5% of them with pleural effusion. Validity for early VAP diagnosis using portable CXR demonstrated 86.7, 100, 100, 71.4, and 90%; ultrasound 93.3, 100, 100, 83.3, and 95%; whereas CPI score 50, 90, 93.8, 62.5, and 60% regarding sensitivity, specificity, positive predictive value, negative predictive value, and accuracy, respectively. CPIS combined with LUS revealed higher sensitivity (96.7%) and accuracy (97.5%). Low CPIS less than or equal to 6, modes of mechanical ventilation (continuous positive airway pressure and biphasic positive airway pressure), shorter duration of respiratory support, LUS imaging of air bronchogram and simple pleural effusion were significantly associated with improved outcomes of VAP cases. The duration of mechanical ventilation and early detection of air bronchogram by LUS were the independent mortality predictors with odds ratio of 2.4 and 3.11 and 95% CI of 1.56–4.55 and 1.8–17.66, respectively. Conclusion LUS was a reliable tool for early VAP diagnosis at the bedside. Combination approach increases the prognostic and diagnostic accuracy of LUS in VAP

Comparative study between high flow nasal cannula, high velocity nasal insufllation and noninvasive ventilation in management of acute respiratory failure

Background: Evidene supporting the benefits of High velocity nasal insufflation (HVNI)and High flow nasal cannula (HFNC) in mangment of Acute respiratory failure in adults beside Non invasive ventilation (NIV) has been proved. The work aim was to evaluate the advantages, efficacy and the hazards of HVNI/HFNC in comparison to those of NIV with acute hypoxemic and hypercapnic respiratory failure. Patients and methods: A prospective analytical study of 60 patients with ARF were randomized to receive either non-invasive positive pressure ventilation (NIV) using an oronasal mask 30/60(50%), high-velocity nasal insufflation (HVNI) 17/60(28.3%), or High-flow nasal cannula (HFNC) 13/60(21.7%). Precision Flow® Hi-VNI Packaging(Vapotherm Inc., USA)&nbsp; as HVNI device which delivered air flows between 35 and 60 L/min. Temperature was set at 34°C or 37°C, whereas FiO2 was controlled to gain arterial oxygen saturation (SpO2) above 92%(that made PEEP from 1.7 to 5)

Role of annexin A1 in early diagnosis of lung cancer

Background: The prevalence of lung cancer has shown an increase over the last few years which cause both health and economic burden. The biopsy is the gold standard tool for disease diagnosis, but it is usually not accepted by the patients due to its invasive nature. The use of non-invasive biomarkers is now attaining a great interest in diagnosis. Aim of the work: Assess the role of Annexin A1 in bronchoalveolar lavage and serum in the early diagnosis of lung cancer. Patients and methods: This study included 39 patients into two groups; group A (cases with lung cancer) and group B (cases with non-malignant lung lesions). All subjects were submitted to history taking and thorough full physical examination and laboratory analysis. Bronchoalveolar lavage (BAL) was performed in the cases within the two groups. Both serum and BAL levels of annexin A1 were assed in all cases. Results: In the current study, the level of annexin A1 in the serum and BAL were statistically significantly higher in the malignant group as compared with the non-malignant group (P 0.001).&nbsp