Review of chronic obstructive airway disease patients admitted at Maamoura Chest Hospital from 2009 to 2012

Background: Chronic obstructive pulmonary disease (COPD) is an important cause of morbidity and mortality worldwide. However, it is often under diagnosed and under treated, resulting in underestimation of the burden of this disease. COPD is defined as a preventable and treatable disease with some significant extra pulmonary effects that may contribute to the severity in individual patients. Its pulmonary component is characterized by airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lung to noxious particles or gases. Objective: To review the COPD cases who were admitted at Maamoura Chest Hospital during the period from 2009 to 2012 as regards distribution of the disease, risk factors of the disease, severity and complications of the disease. Patients and methods: This was a retrospective study that was based upon collecting the data of all COPD patients who were admitted at Maamoura Chest Hospital during the period from 2009 till 2012. The data included the following: personal data, clinical data, methods of diagnosis, intensive care unit admission, management and morbidity and mortality. Results: In the present study, 77.3% of the patients’ age ranged between 35 and 70 years, 11.4% were 70 years. Also, 97.4% were males and 2.6% were females, 75.6% lived in urban areas and 24.4% lived in rural areas. 86.5% of the studied cases were smokers and 13.5% were non smokers. 12.8% of the studied cases were addicts and 87.2% were not. 57.1% of the addicted persons were addicted to cannabis, 19% were intravenous addicts and 23.8% were addicts to tramadol. The most common co morbidities in COPD patients were respiratory infections in 53.9% of cases, heart failure in 44.5% of cases, IHD in 37.9% of cases, AF in 30.5% of cases, HTN in 26.9% of cases and DM in 19.5% of cases respectively. The overall mortality rate was 5.7%, 8.5% among the patients who received O2 therapy, 85.1% among the patients who were put on CPAP, 63.8% among the patients who were put on invasive mechanical ventilation and 44.7% among the patients who were admitted to the ICU. Conclusions: COPD is a very dangerous disease that affects the lives of many people. The overall aim of management of stable COPD is to ensure good control of symptoms, to slow down the progression of the disease and to prevent further deterioration or complications. The sooner the diagnosis is made and interventions implemented, the more the long-term prognosis is improved

Diagnostic yield of medical thoracoscopy in cases of undiagnosed pleural effusion in Kobri El-Kobba Military Hospital

Background: Recurrent and persistent pleural exudates are common in clinical practice, and in a large number of patients, thoracocentesis and blind pleural biopsy procedures do not provide a definitive diagnosis. In the Western world, the majority of these exudates are malignant. Thoracoscopy today remains the gold standard technique in providing diagnosis and management in these cases. Objectives: Diagnostic yield of medical thoracoscopy was evaluated in cases of undiagnosed pleural effusion. Patients and methods: Semi flexible medical thoracoscopy was done for 40 patients in the period between March 2010 and October 2012 in Kobri El-Kobba Military chest Hospital through double points of entry. Results: Medical thoracoscopy gave a definitive diagnosis in 38 out of 40 patients with diagnostic yield 95%. Malignancy was diagnosed in 28 patients (70%), one patient was diagnosed as empyema (2.5%), tuberculosis was found in 9 patients (22.5%), and it was non diagnostic in 2 patients (5%). The post-thoracoscopic complications in the studied group have occurred only in 4 patients (10%). Conclusion: Medical thoracoscopy is a valuable tool in the diagnosis of undiagnosed exudative pleural effusion. It is a simple and safe method with high diagnostic yield and with low complication rates