Clinical, radiological, laboratory and bronchoscopic features characterizing each type of bronchogenic carcinoma

Background: To analyse the clinical, radiological, laboratory, and bronchoscopic findings characterizing each type of bronchogenic carcinoma.Methods: A cross-sectional study was conducted on 123 bronchogenic carcinoma patients. They were subjected to history taking, laboratory investigations, computed tomographic scan and fiberoptic bronchoscopy.Results: The mean age of the patients was 56.9±6.7 years, 76.4% were males and 78.9% were smokers. Most of them were symptomatic, adenocarcinoma (ADC) being the highest symptomatic one. Expectoration, fingers clubbing, and fever were common in ADC and small cell lung cancer (SCLC). Dyspnea, haemoptysis, dysphonia, dysphagia, vocal cord paralysis, anorexia and weight loss were common in SCLC and squamous cell carcinoma (SCC). Deep venous thrombosis was common in ADC and SCC. Mass lesion, atelectasis, chest wall invasion and elevated hemidiaphragm were common in SCLC and SCC. Ipsilateral mediastinal lymph nodes enlargement, cavitary lesion, and apical lesion were common in SCC and ADC. Contralateral mediastinal lymph nodes enlargement was common in SCLC. Nodular lesion, consolidation and pleural effusion were common in ADC. Hypercalcemia and hyponatremia were common in SCC. Malignant pleural effusion was common in ADC. Most of the patients had bronchoscopically-visible lesions; SCLC and SCC being the highest visible types. Most of the SCC and SCLC were centrally located, while LCC and ADC were mainly peripherally located. Most of cases were diagnosed via bronchoscopy. More than half of the studied cases were inoperable at presentation, especially SCLC and SCC.Conclusions: The 4 pathological types are distinguished from each other’s by certain clinical, radiological, laboratory and bronchoscopic features

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Sonographic Assessment of Diaphragm Thickness and Its Effect on Inspiratory Muscles' Strength in Patients with Chronic Obstructive Pulmonary Disease

Objective: To assess diaphragm thickness and to assess its effect on inspiratory muscles’ strength in patients with chronic obstructive pulmonary disease (COPD). Methods: Case-control study was conducted on 113 male patients with COPD compared to 114 age-matched non-COPD males. Spirometric indices, maximum inspiratory pressure (MIP%), maximum expiratory pressure (MEP%), 6-min walk distance (6MWD), PaO2, PaCO2, and ultrasound measurement of diaphragm thickness were performed for all participants. The studied COPD cases were classified according to the diaphragm muscle thickness into a group with normal diaphragm muscle thickness (thickness end expiration ≥1.8 mm) and a group with diaphragm muscle thinning (thickness end expiration <1.8 mm). Results: Thickening fraction (TF) on right side, spirometric indices, MIP%, MEP%, were significantly lower in patients with COPD than in controls. Patients with diaphragm muscle thinning represented 11.5% of patients with COPD which represent 21.7% of cases with severe-to-very severe COPD. In patients with diaphragm muscle thinning, age, smoking index, and PaCO2 were significantly higher, whereas body mass index (BMI), TF bilaterally, forced expiratory volume (FEV)1%, MIP%, MEP%, 6MWD, and PaO2 were significantly lower than those with normal diaphragm muscle thickness. Additionally, TF and MIP% showed a significant negative correlation with age, smoking index, and PaCO2 and a significant positive correlation with FEV1, PaO2, BMI, and 6MWD. By multiple logistic regression analysis, the most significant factors relevant to the diaphragm muscle thinning were forced vital capacity (FVC)%, smoking index, forced expiratory flow rate at 25-75% of vital capacity (FEF)25%–75%,, and FEV1%. Conclusion: Thinning of the diaphragm was related to COPD severity, smoking index, and older age. Reduced inspiratory muscles’ strength (MIP%) was related to diaphragm thickness (TF), FEV1/FVC ratio, smoking index, and FVC%. Assessment of diaphragm thickness in COPD patients is recommended with early implementation to pulmonary rehabilitation program

Atherosclerosis is Associated Comorbidity in Patients with Chronic Obstructive Pulmonary Disease: Ultrasound Assessment of Carotid Intima Media Thickness

Objective: To assess atherosclerotic comorbidity in chronic obstructive pulmonary disease (COPD) patients and its relationship to COPD severity, hypoxemia, and hypercapnia. Methods: A hospital-based observational case-control study was conducted on 86 male COPD patients, and 86 age-matched healthy subjects (non-COPD group). Carotid intima-media thickness (CIMT) was assessed by Doppler ultrasound; in addition, spirometry and arterial blood gas tests were done. Results: CIMT was significantly increased in the COPD group compared to the non-COPD group (0.84±0.15 vs. 0.63±0.076, p<0.001). When the CIMT value of ≥0.8 mm was defined as a cutoff value for a thickened CIMT complex, 64% of COPD patients versus 8.1% of non-COPD subjects had a thickened CIMT. COPD patients with a thickened CIMT were older and had a higher PaCO2, lower FEV1%, FVC, and FEF25–75% compared to COPD patients with a normal CIMT. Thickened CIMT in COPD patients was significantly associated with hypoxemia (p=0.008, OR=8.2), hypercapnia (p=0.04, OR=6.2), and airflow limitation (p=0.11, OR=2.1). There was no significant difference in CIMT in relation to COPD severity (p=0.83). Conclusion: Atherosclerosis is prevalent in COPD patients, even in the early stages of the disease. Hypoxemia, hypercapnia, and airflow limitation are risk factors of atherosclerosis in COPD patients

Bronchoalveolar lavage in lung cancer: does it increase the positive yield of bronchoscopy?

Background Cells obtained from bronchoalveolar space can give a definite diagnosis in malignancies. The present study aimed to assess the diagnostic yield of bronchoalveolar lavage (BAL) in lung cancer and to assess the relationship of its yield with radiology, endoscopy, and pathological subtypes. Patients and methods A retrospective study with re-revision of saved bronchoscopic video, computed tomography (CT) films, and pathology slides was conducted on 101 patients with definite bronchogenic carcinoma diagnosed over 4 years. Results BAL positive yield was found in 42.4% of cases, and its yield coincided with other bronchoscopic sampling methods in 43.6% of cases. Regarding CT findings, the BAL positive yield was significantly higher in peripheral lesions (79.1%), mass size more than or equal to 3 cm (62.8%), CT bronchus sign (46.5%), hilar and/or mediastinal adenopathy (86.0%), and consolidation (51.2%). The most common bronchoscopic abnormality in patients with BAL positive yield was submucosal lesions (83.3%). The adenocarcinoma (48.8%) and bronchoalveolar carcinoma (11.6%) were the histopathological types having significant BAL positive yield. The most significant predictive factors for BAL positive yield were mediastinal adenopathy, endobronchial lesions, nonvisible lesions, adenocarcinoma type, submucosal lesions, CT bronchus sign, mass size more than or equal to 3 cm, peripheral lesions, and concomitant use of bronchial brushing. BAL had 40.3% sensitivity, 51.7% specificity, 67.4% positive predictive value, 25.9% negative predictive value, and 43.6% diagnostic accuracy in bronchogenic carcinoma. Conclusion BAL increases the positive yield of bronchoscopy by 13.9% with fair diagnostic performance, especially in peripherally locating nonvisible lesions. Although tissue biopsy remains the gold standard sampling, clinicians might rely on BAL cytology for diagnosis of lung cancer in some patients

Assessment of osteoporosis in patients with chronic obstructive pulmonary disease

Background: COPD is a widely distributed disease with high morbimortality, associated with important pathologies, among which is osteoporosis. However, osteoporosis is often undiagnosed in these patients. Objectives: To evaluate the prevalence of osteoporosis among COPD patients and to determine its relation to demographic data and disease severity. Subjects and methods: This study was conducted on 30 male patients with severe to very severe COPD, in addition to 30 age and sex matched lifelong nonsmoker healthy volunteers. Spirometric indices, serum Ca, phosphorous, ALP, albumin, and PTH were measured. BMD was measured by broadband heel ultrasound method. Results: Corrected Ca was significantly decreased, PTH was significantly increased and ALP showed non-significant increase in the COPD group. As regards BMD; BUA, Z-score and T-score were significantly decreased while RRF was significantly increased in the COPD group. In addition 56.6% of COPD patients had low BMD. Both COPD group either with normal BMD or with low BMD were matched as regards all demographic data. VC%, FVC% and FEV1%, BUA, T-score, and Z-score were significantly decreased while PTH and RRF were significantly increased in the COPD group with low BMD. Z-score was negatively correlated with FEV1 and PTH while BUA was positively correlated with ALP and negatively correlated with FEV1/FVC. Conclusion: Low BMD is prevalent among men with COPD (GOLD stage III–IV) than age matched males. The degree of the loss of BMD has been found to be proportionate to the COPD severity. COPD patients with low BMD have threefold increase in fracture risk