Prevalence of concealed and overt chronic renal failure in patients with COPD

AbstractAimTo assess the prevalence of chronic renal failure (concealed and overt) in patients with COPD.Patients and methodsThis study was conducted on 150 patients who were classified into three groups: Group I: 67 patients with COPD, Group II: 33 COPD patients with co morbidities (diabetes mellitus, hypertension and or ischemic heart disease). Group III: (control group): 50 patients with other diseases such as diabetes mellitus, ischemic heart disease and or hypertension. All patients were subjected to: (1) Full history taking. (2) Complete clinical examination. (3) Anthropometric measurements (weight, height and body mass index). (4) Arterial oxygen saturation. (5) Radiological examination (Plain chest X-ray posterior–anterior view and Pelvi-abdominal ultrasound). (6) ECG and Echocardiography. (7) Spirometry. (8) Laboratory investigations (complete blood picture, erythrocyte sedimentation rate, Liver function tests, serum creatinine, blood urea and uric acid and GFR, total cholesterol, sodium, potassium and chloride concentration).ResultsIn group I, there were 8 patients who had CRF (11.94%), 5 patients had overt CRF (7.46%) and 3 patients had concealed CRF (4.48%). In group II, there were 11 patients with CRF (33.33%), 6 patients had overt CRF (18.18%) and 5 patients had concealed CRF (15.15%). In group III, there were 9 patients having CRF (18%), 6 patients had overt CRF (12%) and 3patients had concealed CRF (6%). In COPD (group I and II) the overall prevalence of CRF was 19%.ConclusionCRF either concealed or overt may be associated with COPD patients and should be screened, not only by serum creatinine level but also by the estimated GFR to recognize the cases of concealed CRF who have low GFR despite normal serum creatinine level

Study of mannose-binding lectin in smokers with and without COPD

Background: Deficiency of mannose-binding lectin (MBL) was claimed to increase susceptibility to and chronicity of microbial infections in different body systems. Tobacco smoking was also claimed to be associated with reduced blood levels of MBL in blood and defective efferocytosis in the airways. Both effects of smoking may be responsible for development of COPD in smokers and for frequent exacerbations in patients who get COPD. Aim: The aim of this study was to evaluate MBL in blood of smokers with and without COPD. Methods: The study included 70 subjects, classified into two groups; 35 smokers without COPD (group I: divided into 2 subgroups; 17 subjects mild to moderates smokers – group IA, and 18 heavy smoker subjects – group IB). 35 smokers with COPD (group II) also divided into 2 subgroups: 17 subjects with mild to moderate disease (group IIA) and 18 subjects severe to very severe disease (group IIB) according to GOLD (2013) [7] criteria. 20 healthy nonsmoker subjects were also included as a control group (group III). Blood levels of MBL (measured by ELISA) were recorded. Results: Levels of MBL were significantly higher in nonsmoker than smoker groups and in smokers without COPD than in those with it. Also a significant inverse relation was found between smoking index and MBL levels and a direct relation between it and FEV1%. These results indicate that smoking reduces levels of MBL and its deficiency might contribute to development of COPD in smokers. Conclusion: Levels of MBL decrease in smokers with and without COPD and this might play a role in the pathogenesis of lung inflammation in smokers with and without COPD

Tuberculosis situation in Ismailia governorate (2002–2012) before and after Direct Observed Therapy Short Course Strategy (DOTS)

Background: Tuberculosis (TB) is a major cause of illness and death worldwide, especially in Asia and Africa. In the early 1990s tuberculosis control in Egypt faced many problems. Major progress in global tuberculosis control followed the widespread implementation of the DOTS strategy. Aim: The objective of this work was to study the tuberculosis situation in the Ismailia governorate from 2002 to 2012 before and after Direct Observed Therapy Short Course Strategy (DOTS). Methods: This was a retrospective clinical cohort study carried out at the Ismailia governorate. The registered data about all TB cases over a period of 10 years (2002–2012) before and after the application of DOTS were collected from the chest hospital and TB registration units. Percentages of cure treatment significantly increased after DOTS (55.3%) than before (40.5%) (P  0.05) for all of them. The mean values of incidence rates (new and relapse cases, all cases and new smear positive pulmonary TB cases) of TB highly significantly (P  0.05). Also, the cure rate and treatment success rate significantly increased (P  0.05) for all of them except retreatment failure rate (chronic TB rate) (P < 0.05). Finally new pulmonary TB cases with no smear result significantly (P < 0.05) decreased after DOTS. Conclusion: The introduction of DOTS in the Ismailia governorate has led to a significant increase in the treatment success (88.07%) which is higher than the WHO target (85%), and a decrease in the default and failure rates

The role of tumor necrosis factor alpha in differentiation between malignant and non malignant pleural effusion

Background: Despite the fact that Light’s criteria remain the gold standard approach in differentiating exudates from transudates, several fluid markers have been introduced for establishing the cause of pleural effusion to differentiate types of pleural exudate. Aim: The aim of this study was to explore means of discriminating between malignant and non malignant pleural effusions. Methods: The study conducted on 45 patients (28-males and 17 females) with pleural effusions of different etiologies. They were classified according to their final diagnosis into four groups: Group I: 10 cases (6 males and 4 females) with tuberculous pleural effusions. Group II: 15 cases (8 males and 7 females) with malignant pleural effusions. Group III: 10 cases (7 males and 3 females) with para-pneumonic effusion. Group IV: 10 cases (7 males and 3 females) with transudative pleural effusions included as a control group. The complete biochemical analysis of pleural fluid, pleural fluid culture, and pathological examination of pleural fluid and tissue was performed. Moreover, quantitative measurement of TNF-α in serum and pleural fluid using ELISA was performed. Results: Levels of TNF-α were significantly higher in the pleural fluid of exudative nature compared to transudative type. There was a significant increase in pleural fluid TNF-α level in non malignant effusions (tuberculous and parapneumonic) compared with malignant effusion. Also there was a significant increase in pleural fluid TNF-α level in tuberculous effusion versus malignant effusion. These results indicate that TNF-α may be considered a sensitive marker in differentiation between malignant and non malignant pleural effusions. Conclusion: Pleural fluid level of TNF-α can be used in differentiating malignant from non malignant effusion. Also levels of TNF-α in the serum and pleural fluid could be useful as a complementary marker in the differential diagnosis of two most common types of exudates (tuberculous and malignant)

Tuberculosis situation in Port Said governorate (1995–2011) before and after Direct Observed Therapy Short Course Strategy (DOTS)

Background: Tuberculosis (TB) is a major cause of illness and death worldwide, especially in Asia and Africa. In the early 1990s tuberculosis control in Egypt faced many problems. Major progress in global tuberculosis control followed the widespread implementation of the DOTS strategy. Aim: The objective of this work was to study the tuberculosis situation in Port Said governorate from (1995–2011) before and after Direct Observed Therapy Short Course Strategy (DOTS). Methods: This was a retrospective clinical cohort study carried out at the Port Said governorate. The registered data about all TB cases over a period of 16 years (1995–2011) before and after the application of DOTS were collected from the chest hospital and TB registration units. Results: Percentages of cure and complete treatment significantly increased after DOTS (48.7% and 29.3% respectively) than before (19.5% and 13.7% respectively) (P < 0.001). On the other hand, failure, death, default and transfer out decreased after DOTS (5.9%, 3.2%, 7.5% and 5.4% respectively) than before it (6.5%, 6.1%, 34.7% and 19.5% respectively), the results were significant (P < 0.05) for all of them except treatment failure. The mean values of incidence rates (new and relapse cases, all cases and new smear positive pulmonary TB cases) of TB significantly (P < 0.05) decreased after the application of DOTS. Also, the cure rate and treatment success rate significantly increased (P = 0.001), while retreatment TB cases rate, default rate, transfer out rate and retreatment failure rate significantly decreased (P < 0.05). Finally new pulmonary TB cases with no smear result significantly (P < 0.05) increased after DOTS. Conclusion: The introduction of DOTS in the Port Said governorate has led to a significant increase in the treatment success (82.7%) (Near the WHO target “85%”), and a decrease in the default and failure rates

Evaluation of erythropoietin hormone in chronic obstructive pulmonary disease patients during exacerbation and after remission

Introduction: It has long been known that COPD causes polycythemia secondary to erythrocytosis caused by hypoxia present in advanced cases of COPD. However, it was shown in several studies that some COPD patients had anemia rather than erythrocytosis Aim: The aim of this work was to assess the changes in erythropoietin in COPD patients during exacerbation and after remission. Subjects and methods: This work was done on 50 subjects, Group 1:40 COPD patients plus Group I 1: 10 age matched apparently healthy control subjects. For all history taking, full clinical exam, PFTs (spirometry), EPO hormone measurement on human serum by ELIZA (EPO hormone was measured during exacerbation and after remission), oxygen saturation and routine labs (CBC, Liver and Renal function) were performed. Results: Level of erythropoietin hormone was significantly higher in COPD patients with mean (21.92 ± 6.64 mU/ml) than control with mean (9.42 ± 1.5 mU/ml) and higher during remission (24.21 ± 6.58 mU/ml) than during exacerbation (21.92 ± 6.64 mU/ml), also was significantly higher during remission in grade (II, III) (25.68 ± 2.57, 33.71 ± 2.16 mU/ml) than grade (I, IV) (16.04 ± 0.89, 19.39 ± 1.28 mU/ml) COPD patients respectively. Erythropoietin hormone level was significantly higher in anemic than non anemic COPD patients. It was (27.94 ± 6.33 mU/ml) (20.84 ± 4.83 mU/ml) respectively, and it was significantly inversely related to oxygen saturation & both of HB and Hct in COPD patients. Conclusion: EPO hormone level was significantly higher in grade (II, III) than grade (I, IV) COPD patients (p = 0.005), and also COPD with anemia was higher in stage (II, III) than stage (I, IV), EPO hormone level significantly higher in anemic than non anemic COPD patients and was significantly higher (p = 0.005) during remission than during exacerbation

Study of anti nuclear and anti smooth muscle antibodies in patients with chronic obstructive pulmonary disease

Background/aim: Autoimmunity is a disease in which the immune system mistakenly attacks the body’s own cells and tissues. Sometimes the whole body is attacked, and sometimes only one organ. The aim of the work: The aim of this study was to evaluate antinuclear and anti smooth muscle antibodies, two common markers of autoimmunity, in COPD and their relation with different components of the disease and disease severity. Methods: The study included 50 clinically stable COPD patients classified into two groups mild to moderate (group A) and severe to very severe (group B) according to GOLD (2009) [13] criteria plus 30 healthy control subjects (15 smokers and 15 non smokers). Blood levels of ANA and ASMA (measured by ELISA) were recorded. Results: Levels of both ANA and ASMA were significantly higher in patients than in controls as a whole group but smoker controls showed significantly higher levels of both antibodies than mild to moderate COPD group (group A) indicating that not only smoking is responsible for COPD but other factors also play a role. Also high levels of these antibodies in smoker controls than in non smokers indicate a role of smoking in their development which is augmented by the direct relation with smoking index both in patients and controls. Conclusion: Both ANA and ASMA levels are elevated in COPD patients compared to controls (smokers and non smokers) and levels elevated in healthy smokers compared to group A COPD patients. Autoimmunity plays a role in the pathogenesis of COPD

Combined serum and immunohistochemical differentiation between reactive, and malignant mesothelial proliferations

Background: Malignant mesothelioma (MM) carries a poor prognosis and response rates to palliative chemotherapy remain low. The diagnosis of malignant mesothelioma is frequently difficult, the most common differential diagnosis being reactive pleural conditions and metastatic adenocarcinoma. Several studies have used immunohistochemical markers to distinguish between reactive and neoplastic mesothelial cells. Soluble mesothelin levels in serum have recently been shown to be highly specific and moderately sensitive for mesothelioma. A combined detection of serum levels of mesothelin and immunohistochemical expression of desmin and EMA are used in order to differentiate between reactive mesothelial proliferations, and malignant mesothelioma of epithelioid type. Patients and methods: This prospective study includes 17 cases of reactive mesothelial proliferations, 6 cases of atypical mesothelial proliferations and 13 cases of MM. Cases were collected from the Chest Department, Faculty of Medicine, Benha University and International Medical Center (IMC), in the period 2012–2014. Desmin and epithelial membrane antigen (EMA) immunohistochemical staining were performed in all cases and the pattern of expression was analyzed. Soluble mesothelin related peptide (SMRP) was estimated for all cases. Results: Desmin expression was positive in 88.2%, 0%, and 7.7% of reactive mesothelial proliferations, atypical mesothelial proliferations and MM respectively. EMA was positive in 5.9% of reactive mesothelial proliferation, 100% of atypical mesothelial proliferations and 92.3% of MM cases (P < 0.01). The calculated mean SMRP was 6.6 nM. SMRP levels were higher than the calculated mean value in 17.6% of studied reactive mesothelial lesions, 66.7% and 76.9% of atypical mesothelial proliferations and MM respectively, which was statistically highly significant correlation (P < 0.01). Conclusion: Combined estimation of SMRP level and immunohistochemical detection of both EMA and desmin could be a useful tool for differentiation between reactive mesothelial proliferation and malignant mesothelioma

Evaluation of Primary Health Care service participation in the National Tuberculosis Control Program in Qalyubia Governorate, Egypt

Objective: The aim of this work was to evaluate the Primary Health Care service performance in National Tuberculosis Control Program in Qalyubia Governorate. Methods: The studied area (Qalyubia Governorate) includes 8 health territories (each contains 5 primary care units/centers). A questionnaire based on 6 parameters was used to evaluate the PHC system performance: I – Physicians with basic knowledge about TB (causative agent, methods of spread, clinical picture, essential steps in investigations: X-ray and sputum smear), II – Facilities for primary investigation (sputum examination and chest X-ray), III – Communication with the central health authorities or a TB specialist, IV – Proper recording systems needed for proper patient management and follow up, V – Follow up schedules are available for the detected patients, VI – Have a role in community education about the disease. The data obtained were tabulated and statistically analyzed. Results: Studied area included 8 health territories and 40 primary care units (35% were urban and 65% rural) with one physician in each unit. The mean percent of the correct answers of the basic knowledge score was 48.2% (range = 18%–100%), higher in urban units physicians than rural units physicians, with lack of proper laboratory (for sputum analysis) or X-ray apparatus. Communication with central health authorities in urban areas was higher than rural areas (65.4% versus 57.1%). Case recording was lower in urban than rural areas (42.9% versus 46.2%). Patient follow up after referral to central health units was higher in rural than urban areas (11.5% versus 7.1%). Participation of community education was 78.6% in urban units and 76.9% in rural units. Conclusion: In Qalyubia Governorate, PHC physicians lack proper knowledge about TB and their units lack proper equipments (Lab and CXR). The PHC system needs to be empowered by the health care authorities through training and equipments for better performance in NTP