Adjuvant role of corticosteroids in the treatment of community-acquired pneumonia

AbstractBackgroundDespite progress in life-support measures and antimicrobial therapy, the mortality of severe pneumonia has not varied since the mid-1990s, suggesting that other factors are of crucial importance in the evolution of this respiratory infection.ObjectiveTo evaluate the impact of hydrocortisone infusion in community-acquired pneumonia (CAP) in the attenuation of systemic inflammation and reduction of sepsis-related complications.MethodsThe study enrolled 80 patients, clinically and radiolodically diagnosed as community-acquired pneumonia, admitted to Chest department, Respiratory Intensive Care Unit, General Medicine Department and General Medicine Intensive Care Unit of Zagazig University Hospitals. Sixty of them were randomized to receive hydrocortisone as a bolus dose of 200mg intravenously once (only at day 1) then 10mg/h IV infusion for 7days and twenty received placebo, along with antibiotics according to IDSA/ATS 2007 guidelines which were given for both groups. The following parameters were compared in both groups; PaO2 and PaO2/FiO2 ratio, length of hospital stay, duration of IV antibiotic treatment, duration of mechanical ventilation, weaning success from mechanical ventilation, pneumonia complication and hospital outcome.ResultsHydrocortisone treated patients showed a significant improvement in PaO2 and PaO2/FiO2 ratio, a significant reduction in White blood cell count, C-reactive protein levels, Erythrocyte sedimentation rate, a significant reduction in the duration of mechanical ventilation, duration of IV antibiotic treatment, pneumonia complications, and length of hospital stay. Also there was an improvement of hospital outcome, weaning success from mechanical ventilation and radiological resolution compared to the placebo group.ConclusionAdjunctive 7day course of low dose hydrocortisone IV in patients with CAP hastens clinical recovery and prevents the development of sepsis-related complications with a significant reduction in the duration of mechanical ventilation, duration of IV antibiotics and length of hospital stay with the improvement in hospital outcome and weaning success from mechanical ventilation

Effectiveness of Aromatherapy in Early Palliative Care for Oncology Patients: Blind Controlled Study

Background: Palliative care is the active holistic treatment of people of all ages who have serious health-related suffering as a result of severe illness, and especially of those who are close to the end of life. Palliative care is provided to cancer patients who experience serious suffering that cannot be relieved without professional intervention and that compromises physical, social, spiritual, and emotional functioning. A straightforward, low-risk, and affordable palliative care approach may be provided through aromatherapy, a type of complementary and alternative medicine. The study objective is to assess the comparative effectiveness of massage, aromatherapy massage, and massage combined with aromatherapy inhalation on cancer patients receiving palliative care. Methods: A total of 100 participants who were divided into four groups at random. The first group, designated as the control group, received standard hospital nursing care, the second group received massage only (using the odorless almond carrier oil), the third group received massage with lavender oil, and the fourth group received combined (inhalation and massage) aromatherapy. The Rotterdam Symptom Checklist (RSCL), given two weeks after aromatherapy, was used to examine participants’ perspectives of care. Results: On the RSCL, combined aromatherapy performed best. In terms of reported physical symptoms, psychological symptoms, and activities, there were statistically significant differences between the scores of the control group and each of the experimental groups. Nonetheless, the total quality of life score showed no significant difference between the control group and the massage only group (t = 0.529, p = 0.60). Conclusions: When paired with aromatherapy inhalation, massage has a positive effect on physical, psychological symptoms, activities, and overall quality of life for cancer patients receiving early palliative care. Nurses and other healthcare providers are recommended to support programs that provide message therapy to reduce reported bodily symptoms, psychological problems, and limited activities among cancer patients.Funding Statement This study was supported via funding from Prince Sattam Bin Abdulaziz University project number (PSAU/2023/R/1444)

Laparoscopic management of a giant trichobezoar causing Rapunzel syndrome: A case report

Trichobezoars are retained clusters of swallowed hairs seen most commonly in adolescent girls. Many of these patients have some underlying psychiatric problem and as this condition is often associated with few or no symptoms, the onset of this condition leads to a delayed presentation. Trichobezoars are most commonly managed by open surgical techniques and there are only a few reports that have used the laparoscopic method for its removal. This report presents the suc- cessful laparoscopic management with port site incision extension for the extraction of giant trichobezoar in a 16-year-old female patient. [Arch Clin Exp Surg 2017; 6(1.000): 41-44

Value of the DECAF score in predicting hospital mortality in patients with acute exacerbation of chronic obstructive pulmonary disease admitted to Zagazig University Hospitals, Egypt

AbstractBackgroundAcute exacerbations of chronic obstructive pulmonary disease (AECOPD) are both common and often fatal. Lack of an accurate prognostic tool that can accurately predict inhospital mortality and help clinicians triaging patients to the appropriate level of care is a challenge. Toward this aim, the Dyspnea, Esinopenia, Consolidation, Acidemia and atrial Fibrillation (DECAF) Score is needed to be assessed against other available scores.Patients and methodsTwo hundred patients with primary diagnosis of AECOPD were included. They were subjected to thorough medical history taking, full clinical examination, plain chest X-ray, routine laboratory investigations, ECG, ABGs analysis, assessment of DECAF Score, Acute Physiology and Chronic Health Evaluation (APACHE II) score, COPD and Asthma Physiology Score (CAPS) and CURB-65 score. Inhospital mortality was recorded.ResultsTwenty-five (12.5%) patients died in hospital. The DECAF Score showed an excellent discrimination for inhospital mortality (AUROC=0.83) and performed significantly better for the prediction of inhospital mortality than: APACHE II Score (AUROC=0.68, DECAF vs APACHE II p=0.03); and the COPD and Asthma Physiology Score (CAPS) (AUROC=0.65, p=0.01). Furthermore, DECAF was a significantly stronger predictor of inhospital mortality than CURB-65 for the subgroup of patients with radiological consolidation (AUROC=0.87 vs 0.65, p=0.02).ConclusionThe DECAF Score is a simple and effective clinical tool that can risk stratify hospitalized patients with AECOPD and could therefore help clinicians managing this fatal condition

The Practice of Palliative Medicine in Developing Countries—Part Three (SA500)

Objectives Learn how physicians in specific countries provide palliative care to their patient populations, often with limited resources. Recognize specific cultural and political challenges to developing palliative care clinical, educational and research programs. Describe roles of different health care providers practicing palliative care and how they meet the needs of their local populations. Please join AAHPM\u27s International Scholars for a panel discussion. Each scholar will present for 10-15 minutes on the state of the practice of palliative care in their home country, with an emphasis on the roles of physicians, nurses, and other healthcare providers; the status of education and research in the field; and the unique challenges facing patients and providers. There will be time allotted after each presentation to field questions and dialogue from the audience. Prepare to be educated and inspired by these accomplished individuals who are leading and advancing the field of hospice and palliative medicine in their countries of origin

Thyroid function in respiratory failure patients

Background: The non thyroidal illness syndrome (NTIS) represents a risk factor for prolonged mechanical ventilation in mechanically ventilated, critically ill patients admitted to the ICU. It is unclear, whether the NTIS is only a biochemical prognostic marker or it actually contributes to the development and progression of respiratory failure. Aim: To assess the thyroid function in patients with respiratory failure and to evaluate the impact of thyroid dysfunction as well as thyroid hormone replacement therapy on patients’ outcome. Patients and methods: The study was conducted on 100 patients (51 females and 49 males), they were divided into two groups, Group A (respiratory failure group), who were admitted to the Respiratory ICU (RICU) and group B (non-respiratory failure group) who were admitted to the Inpatient Chest Department of Zagazig University Hospitals Egypt. The respiratory failure group (Group A) included sixty-four (64) patients with respiratory failure (according to ABG parameters) 30 males and 34 females. They included 30 patients with acute exacerbation of COPD, 5 patients with acute severe bronchial asthma, 5 patients with severe pneumonia, 4 patients with acute pulmonary embolism, 8 patients with ARDS and 12 patients with acute exacerbation of IPF. This respiratory failure group included 43 patients who were on invasive mechanical ventilation and 21 respiratory failure patients who were non-mechanically ventilated. Group (B) included thirty-six (36) patients without respiratory failure according to ABG parameters as a control group (19 males and 17 females). There were 11 patients with acute exacerbation of COPD, 10 patients with exacerbated bronchial asthma, 6 patients with exacerbated IPF, 6 patients with pneumonia and 3 patients with acute pulmonary embolism. All patients were subjected to calculation of APACHE Π score, PaO2/FiO2 ratio and estimation of thyroid hormones (TSH, free T3 and free T4) at the 1st, 3rd and 10th day of admission. Those who were still having ESS at the 10th day (16 patients) and were not improving clinically, were subdivided randomly into two subgroups. Each of them comprised 8 patients. One group was given l-thyroxin replacement therapy (The replacement group) beside conventional appropriate management. The other group (8 patients) was followed by conventional appropriate management only without replacement therapy (The non-replacement group). l-Thyroxine 100 μg daily is administered for 7 weeks. At the 7th week, a fourth set of thyroid hormone estimation was done for the patients of the replacement and non-replacement groups. Patients’ outcome was assessed after 7 weeks of admission and labeled as the following: 1-death, 2-successfully treated and discharged. Results: Respiratory failure patients showed evidence of euthyroid sick syndrome (ESS) at the 1st, 3rd and 10th days of admission with a frequency of 31.2%, 79.6% and 43.7% respectively while none of the control group showed evidence of (ESS) and the difference was statistically significant. There were highly significant negative correlation between serum levels of free T3 and TSH and each of the duration of mechanical ventilation and length of ICU stay. There was significant negative correlation between APACHE Π score and serum level of freeT3 in the respiratory failure group. There was non significant impact of thyroid hormone levels on patients’ outcome. There was non significant difference in the levels of thyroid hormones between replacement and non replacement groups at the 7th week of the study. Conclusion: A state of hypothyroidism or euthyroid sick syndrome (ESS) is commonly found among patients with respiratory failure and this is related to the severity of the disease. ESS represents a risk factor for prolonged mechanical ventilation and length of ICU stay. l-thyroxin replacement therapy has no significant impact on patients’ outcome

Reviewing treatment outcomes of tuberculosis patients at Zagazig Chest Hospital (2008–2012)

Background: Tuberculosis (TB) is one of major critical heath problem worldwide, where drug treatment is fundamental for controlling TB promoting cure of the patient and breaking the chain of transmission when treatment is completely and correctly followed. Aim of the study: Aim of the study is to assess the treatment outcomes of TB patients at Zagazig Chest Hospital and to identify factors associated with poor outcomes in a trial to achieve the national tuberculosis program (NTP) goals. Patients and methods: This is a cohort study that was carried out at Zagazig Chest Hospital which was in part retrospective and prospective in other part. Analysis of data of 290 tuberculous patients was done where 10 cases were excluded. Demographic, socioeconomic data were reported in addition to radiological, bacteriologic histopathological diagnostic data and history of previous treatment of TB and the used anti-tuberculous treatment regimens with application of directly observed therapy short course (DOTS) strategy. Treatment outcomes were assessed for all patients and were classified either as successful or unsuccessful. Results: Successful treatment outcome was reported in 231 (82.5%) TB cases versus 49 (17.5%) cases with unsuccessful treatment. Successful outcome was significantly associated with middle age (16–35 years) (51.5%) (P < .05), well education (78.8%) (P < .001), absence of history of contact with positive TB case (96.1%) (P < .001), mild to moderate advanced X-ray picture (95.5%) (P < .001) and absence of previous history of anti-tuberculous treatment (87.1%) (P < .01). Multivariate logistic regression analysis for risk factors for unsuccessful outcome revealed that illiteracy (P < .001), history of contact to positive TB cases (P < .001) and far advanced chest X-ray of pulmonary TB (P < .001) were considered as significant predictors. Conclusions: A high rate of successful treatment is reported with application of the NTP (2012) guidelines which was associated with middle age of the patients (16–35 years), well education, mild to moderate advanced X-ray picture and absence of either history of contact with positive TB case or previous history of anti-tuberculous treatment(new case). Illiteracy, history of contact to positive TB cases, far advanced chest X-ray of pulmonary TB and previously treated cases on CAT II regimen could be considered as predictors of unsuccessful outcome