B-lines: Transthoracic chest ultrasound signs useful in assessment of interstitial lung diseases

Objective: This prospective study was conducted to evaluate the value of sonographic B-lines (previously called ′′comet tail artifacts′′), which are long, vertical, well-defined, hyperechoic, dynamic lines originating from the pleural line in assessment of interstitial lung diseases (ILD) and compare them with the findings of chest high-resolution computed tomography (HRCT) and pulmonary function tests (PFTs). Materials and Methods: Sixty-one patients with ILD underwent transthoracic lung ultrasound for assessment of the presence of B-lines and the distance between them. These findings were compared with that of chest HRCT (ground glass, reticular, nodular or honey combing) and PFT as forced vital capacity (FVC), total lung capacity (TLC), diffusion capacity for carbon monoxide (DLCO) and partial arterial oxygen pressure (PaO 2 ). Results: All patients had diffuse bilateral B-lines. The distance between each of the two adjacent B lines correlated with the severity of the disease on chest HRCT where B3 (the distance was 3 mm) correlated with ground glass opacity and B7 (the distance was 7 mm) correlated with extensive fibrosis and honey combing. Also, the distance between B-lines inversely correlated with FVC (r = −0.848, P <<i> 0.001), TLC (r = −0.664, P < 0.001), DLCO (r = −0.817, P < 0.001) and PaO 2 (r = −0.902, P < 0.001). Conclusion: B-lines that are lung Ultrasound signs seem to be useful in the assessment of ILD

Discrimination between pleural thickening and minimal pleural effusion using color Doppler chest ultrasonography

Background: The discrimination of pleural thickening from minimal pleural effusion may be difficult as both lesions appear as anechoic on grayscale ultrasound, hence, free of “echoes” does not confirm the presence of pleural fluid. Aim of this study: To evaluate the value of color Doppler ultrasound in differentiating minimal pleural effusion that could be aspirated from pleural thickening and to compare it with grayscale ultrasound. Patients and methods: This analytic cross-sectional study was done prospectively on 40 patients who presented with pleural based opacity in their chest radiographs compatible with minimal pleural effusion. Gray scale ultrasound was done for all patients then color Doppler ultrasound examination was applied to detect the presence or absence of fluid color sign. The presence or absence of pleural effusion was confirmed by aspiration of pleural fluid. Results: The sensitivity of real time gray scale ultrasound in detecting minimal pleural effusion and differentiating it from pleural thickening was 95.5% while, specificity was 33%, and accuracy was 67%. The ability of ultrasound in discrimination of minimal pleural effusion from pleural thickening improved greatly by application of the color Doppler examination where the specificity of the method reached 100% while the sensitivity was 91% and accuracy was 95%. Conclusions: Application of color Doppler examination increases the accuracy of real time chest ultrasound to discriminate pleural thickening from minimal pleural effusion and hence color Doppler examination proved to be a useful diagnostic tool to real-time gray-scale ultrasound for diagnosis of minimal pleural effusion

Downregulation of regulatory T cells in patients with chronic obstructive pulmonary disease: relation to disease severity

Bachground Chronic obstructive pulmonary disease (COPD) is a slowly progressing disease that has the characteristics of chronic inflammation of the airways and destruction of lung parenchyma; the pathogenesis of which is partially understood. COPD might have an autoimmune pathogenesis. It has been documented that disturbance of CD4+ T-regulatory (Treg) lymphocytes leads to breakdown of self-tolerance and development of many diseases. Limited data are available about the role of Treg cells in COPD. Objective To determine the role of Treg cells in the pathogenesis and severity of COPD. Patients and methods This prospective case–control study was conducted on 34 patients with COPD and 48 healthy controls (24 smokers and 24 never-smokers). Flow cytometry analysis for Treg cells was used. Results CD4+CD25high cells percentage and cytoplasmic forkhead box protein P3 expression were significantly lower in COPD compared with healthy controls, either nonsmokers or smokers (P<0.05). Accordingly, both the percentage of cytoplasmic forkhead box protein P3 expression and its mean fluorescent intensity were significantly lower in patients with COPD compared with the nonsmokers and smokers (P=0.011, 0.002 and 0.002, respectively). A significant positive correlation between CD4+CD25high percentage and either forced expiratory volume in one second percentage predicted and forced expiratory volume in one second/forced vital capacity ratio was detected (r=691, P<0.001; r=729, P<0.001). Conclusion There is downregulation of Treg cells in COPD, and this could play a role in the pathogenesis of COPD

Attitudes of lung cancer screening practice in chest physicians in middle-income countries: an update

Background In lung cancer, early diagnosis is the strongest predictor of survival and stage 1 is detected in only 15% of patients incidentally. To improve the outcomes, screening for cancer in the early stage in high-risk groups is a promising strategy. Aim The aim of this study was to assess the attitudes and knowledge of lung cancer screening practice in chest physicians. Patients and methods A self-administered questionnaire was distributed to a total of 75 chest physicians and the data were analysed. Results The survey illustrated that chest physicians believe that low-dose computed tomography (LDCT) is the most useful tool in screening for lung cancer in former and current smokers (31.3–62.5%) and it is a very effective screening test in reducing cancer mortality in never, former and current smokers (70%, 61.3 and 85%, respectively). Despite 90% of doctors having LDCT available in their geographic areas, 82.5% do not provide lung cancer screening for risk groups. Conclusion In Egypt, chest physicians believe that the use of LDCT screening for patients at high risk of lung cancer is an evidence-based recommendation by most programmes. Still most of them do not follow any screening program for risk groups. Education for doctors may increase the awareness, accuracy and efficacy of screening of high-risk patients

Role of sleep endoscopy in obstructive sleep apnea syndrome

Aim: There are limited data about the role of sleep endoscopy in obstructive sleep apnea syndrome (OSAS). The aim of this study was to evaluate the level, degree and shape of obstruction of the upper airway in patients with OSAS by sleep endoscopy and their relation to OSAS severity. Patients and methods: Fifty consecutive patients with OSAS were prospectively enrolled in this cross sectional analytic study. All patients underwent history, a full night-attended polysomnography and sleep endoscopy. The degree of pharyngeal narrowing (grades I–IV) was evaluated at retropalatal, retroglossal and hypopharyngeal levels. Shape of pharyngeal collapse was classified into circular, lateral or antero-posterior at retropalatal and retroglossal levels. Shape of the epiglottis was also observed. Results: All patients showed multisegmental levels of obstruction. Moderate OSAS had a higher percentage of grade II obstruction but a lower percentage of grade I at hypopharyngeal level compared to mild OSAS (P < 0.05). Also, in moderate OSAS, tongue base obstruction was 47.4% which was significantly higher comparing to mild OSAS (16.7%) (P < 0.05). There was no significant difference between different grades of obstruction at all anatomical levels in polysomnographic parameters. Omega shaped epiglottis was associated with the highest apnea hypopnea index, desaturation index, lowest average and minimum O2 level. Conclusion: Sleep endoscopy is a useful tool for the assessment of level, degree and shape of the upper airway obstruction during sleep in OSAS and this could be helpful in preoperative evaluation. Presence of obstruction at hypopharyngeal level or tongue base obstruction is an indicator of OSAS severity

Does vitamin D deficiency worsen the hospital outcome in patients with acute exacerbation of chronic obstructive pulmonary disease?

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 (P0.05). 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