Prevalence of inducible laryngeal obstruction among patients diagnosed as bronchial asthma

Introduction: Inducible laryngeal obstruction (ILO) is an important cause of a variety of respiratory symptoms and can mimic bronchial asthma (BA). This study was planned to measure the prevalence of ILO among patients diagnosed with BA and to detect its effect on BA control and severity. Material and methods: Patients aged 18 years or older who were previously diagnosed with BA were enrolled. Laryngeal obstruction was induced using the patient’s specific trigger (e.g. exercise). Visualization of vocal folds was accomplished using  a 70-degree rigid laryngoscope (Karl Storz). A visual grade score was utilized to determine the severity of laryngeal obstruction. Results: Results showed that 38.3% (n = 46) of the patients had ILO with the majority being classified as grade 2 (80.4%)  (n = 37). The most common subtype was glottic ILO (63%). Bronchial asthma duration, level of control, and severity were not associated with ILO (P values: 0.2, 0.3 and 0.8 respectively). Conclusion: Asthma and ILO commonly co-exist. An accurate classification of patients is very important and must be considered in order to determine whether the symptoms are directly related to ILO or whether they are caused by BA. Ceasing inappropriate treatment may be necessary. Objective diagnostic modalities of ILO are essential

ΔSpO2/distance ratio from the six-minute walk test in evaluation of patients with chronic obstructive pulmonary disease

Introduction: The six-minute walk test (6MWT) contains two independent components: walk distance (6MWD) and oxygen saturation (SpO2). 6MWD does not give detailed data on numerous COPD associated disorders. As oxygen desaturation plays a key role in exercise limita­tions, a few new parameters integrating oxygen desaturation during exercise along with walk distance are necessary. So, this study was conducted to assess the relationships between ΔSpO2/distance ratio and pulmonary function test in addition to extent of pulmonary emphysema in COPD patients. Material and methods: 57 stable COPD patients who attended the outpatient clinic of chest medicine department. Mansoura university. were enrolled. Included patients were classified according to GOLD airflow limitation. Age, sex, and modified Medical Research Council dyspnea score (mMRC) were recorded. furthermore, every patient completed the 6MWT and underwent a pulmonary function test and a CT scan to evaluate the degree of pulmonary emphysema. Results: ΔSpO2/distance ratio was moderately correlated with DLCO%, FVC % and GOLD classification. However, strong correlation was found with FEV1% and RV%. mMRC was weakly correlated with ΔSpO2/distance ratio. In addition, weak nonsignificant correlation was found between ΔSpO2/distance ratio and extent of pulmonary emphysema as measured by HRCT volumetry. A significant moderate cor­relation was noticed between the ΔSpO2/distance ratio and 6MWD (r = –0.5, P < 0.001). a significant strong cor­relation was observed between the ΔSpO2/distance ratio and ΔSpO2 (r = 0.87, P < 0.001). Conclusion: ΔSpO2/distance ratio could be a simple and valuable index for the evaluation of exercise capacity in COPD individuals and might be utilized to predict severity of airway obstruction, pulmonary diffusing capacity disorder and severe hyperinflation

Validity of ROX index in prediction of risk of intubation in patients with COVID-19 pneumonia

Introduction: One important concern during the management of COVID-19 pneumonia patients with acute hypoxemic respiratory failure is early anticipation of the need for intubation. ROX is an index that can help in identification of patients with low and those with high risk of intubation. So, this study was planned to validate the diagnostic accuracy of the ROX index for prediction of COVID-19 pneumonia outcome (the need for intubation) and, in addition, to underline the significant association of the ROX index with clinical, radiological, demographic data. Material and methods: Sixty-nine RT-PCR positive COVID-19 patients were enrolled. The following data were collected: medical history, clinical classification of COVID-19 infection, the ROX index measured daily and the outcome assessment. Results: All patients with severe COVID-19 infection (100%) were intubated (50% of them on the 3rd day of admission), but only 38% of patients with moderate COVID-19 infection required intubation (all of them on the 3rd day of admission). The ROX index on the 1st day of admission was significantly associated with the presence of comorbidities, COVID-19 clinical classification, CT findings and intubation (p ≤ 0.001 for each of them). Regression analysis showed that sex and ROX.1 are the only significant independent predictors of intubation [AOR (95% CI): 16.9 (2.4– 117), 0.77 (0.69–0.86)], respectively. Cut-off point of the ROX index on the 1st day of admission was ≤ 25.26 (90.2% of sensitivity and 75% of specificity). Conclusions: ROX is a simple noninvasive promising tool for predicting discontinuation of high-flow oxygen therapy and could be used in the assessment of progress and the risk of intubation in COVID-19 patients with pneumonia

CASE REPORT PEER REVIEWED | OPEN ACCESS International Journal of Case Reports and Images (IJCRI) Sarcoidosis associated with pseudopapillary pancreatic tumor

International Journal of Case Reports and Images (IJCRI) is an international, peer reviewed, monthly, open access, online journal, publishing high-quality, articles in all areas of basic medical sciences and clinical specialties. Aim of IJCRI is to encourage the publication of new information by providing a platform for reporting of unique, unusual and rare cases which enhance understanding of disease process, its diagnosis, management and clinico-pathologic correlations. IJCRI publishes Revie

Recombinant human granulocyte colony stimulating factor versus bone marrow mononuclear cells in treatment of pulmonary emphysema model

Background: Stem cells therapy is a new therapeutic approach for pulmonary emphysema. Granulocyte colony-stimulating factor (G-CSF) is effective in tissue regeneration through mobilization of stem cells to different organs. So, in this study we compared the effect of filgrastim (175 amino acid recombinant human G-CSF) versus bone marrow mononuclear cells on apoptosis and repair of air spaces in lipopolysaccharide induced emphysema in C57Bl/6 mice. Methods: The mice were classified into 4 groups: group A: mice not received any treatment, group B: mice received intranasal instillation of lipopolysaccharide repeated three times per week for 8 weeks, group C: mice received a dose of intravenous bone marrow mononuclear cells (0.3 ml of cell suspension at a concentration of 2 × 106 cells/ml) after instillation and evaluated 5 weeks later and group D: mice received subcutaneous filgrastim three subcutaneous injections a week for 7 weeks (100 microgram/kg/injection) after lipopolysaccharide instillation. Imaging analysis was done using imagej program. Results: Concerning the mean of air space equivalent diameter (D0) and (D1), no differences were observed between the bone marrow mononuclear cells treated mice and filgrastim treated mice. As regard apoptotic index, no significant difference was found between filgrastim and BMMNCs treated groups. Conclusion: These results indicate nearly similar effectiveness of both filgrastim and BMMNCs in treatment of lipopolysaccharide induced pulmonary emphysema

Acetylsalicylic Acid Compared with Enoxaparin for the Prevention of Thrombosis and Mechanical Ventilation in COVID-19 Patients: A Retrospective Cohort Study

BACKGROUND AND OBJECTIVE: Low-dose acetylsalicylic acid (ASA, aspirin) is a well-known and frequently studied drug for primary and secondary prevention of disease due to its anti-inflammatory and coagulopathic effects. COVID-19 complications are attributed to the role of thrombo-inflammation. Studies regarding the use of low-dose ASA in COVID-19 are limited. For this reason, we propose that the use of low-dose ASA may have protective effects in COVID-19-related thromboembolism and lung injury. This study was conducted to assess the efficacy of low-dose ASA compared with enoxaparin, an anticoagulant, for the prevention of thrombosis and mechanical ventilation. METHODS: We conducted a retrospective cohort study on COVID-19-confirmed hospitalized patients at the Mansoura University Quarantine Hospital, outpatients, and home-isolated patients from September to December 2020 in Mansoura governorate, Egypt. Binary logistic regression analysis was used to assess the effect of ASA compared with enoxaparin on thromboembolism, and mechanical ventilation needs. RESULTS: This study included 225 COVID-19 patients. Use of ASA-only (81-162 mg orally daily) was significantly associated with reduced thromboembolism (OR 0.163, p = 0.020), but both low-dose ASA and enoxaparin, and enoxaparin-only (0.5 mg/kg subcutaneously (SC) daily as prophylactic dose or 1 mg/kg SC every 12 hours as therapeutic dose) were more protective (odds ratio [OR] 0.010, OR 0.071, respectively, p \u3c 0.001). Neither ASA-only nor enoxaparin-only were associated with a reduction in mechanical ventilation needs. Concomitant use of low-dose ASA and enoxaparin was associated with reduced mechanical ventilation (OR 0.032, 95% CI 0.004-0.226, p = 0.001). CONCLUSIONS: Low-dose ASA-only use may reduce the incidence of COVID-19-associated thromboembolism, but the reduction may be less than that of enoxaparin-only, and both ASA and enoxaparin. Concomitant use of ASA and enoxaparin demonstrates promising results with regard to the reduction of thrombotic events, and mechanical ventilation needs