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

The role of video-fluoroscopy in the assessment of obstructive sleep apnea patients: comparative study

Abstract Background Pre-operative imaging tools play a crucial role in the anatomic assessment of the upper airway and adjacent structures in obstructive sleep apnea patients. The current study was aimed at comparing and correlating the results of videofluoroscopy in evaluating upper airway obstruction in surgically fit obstructive sleep apnea “OSA” patients with fiberoptic nasoendoscopic examination during the awake “Muller’s maneuver” and during sleep induced with propofol for better selection of the suitable surgical maneuver. The present study was an observational cross-sectional study of 69 surgically fit OSA patients (36 males and 33 females); their ages ranged between 29 and 65 years with mean age of 45.87 ± 9.68 years. The patients were selected from otorhinolaryngology, phoniatric, and pulmonology outpatient clinics during the period from February 2019 to January 2020. Results The present study demonstrated that no statistically significant difference was found between the three techniques (video-fluoroscopy, awake fiber-optic nasoendoscopy, and drug-induced sleep nasoendoscopy “DISE”) as regards the shape of upper airway collapse at retropalatal, retroglossal, and hypopharyngeal levels in OSA patient (P: 0.621, 0.669, and 1.0 respectively). Statistically, a significant difference was observed between video-fluoroscopy, awake fiber-optic nasoendoscopy on one hand, and DISE on the other one regarding the grade of upper airway collapse at all levels (P: 0.006, 0.037, and 0.003). It was a mild significant difference in favor of DISE. Conclusion Video-fluoroscopy is a good, reliable complementary preoperative assessment tool to identify obstruction patterns of the upper airway in OSA patients with quantitative measurements

Modelling obstructive sleep apnea susceptibility using non-invasive inflammatory biomarkers

Background: Obstructive sleep apnea (OSA) is considered systemic inflammatory disease but airway and systemic inflammatory markers roles in OSA prediction are not widely used in sleep clinics. Aims: To study some simple inflammatory markers in the serum or exhaled breath that may predict OSA diagnosis or severity. Methods: The study included 60 participants, 43 OSAS and 17 healthy control. Cases were recruited from Respiratory Sleep Disorders Clinic full night PSG was done, the next morning, fractional exhaled nitric oxide (FENO) was measured, blood sample were collected for measuring Erythrocyte sedimentation rate (ESR) and high sensitivity C- reactive protein (HS-CRP). Results: Statistically Significant increase in Basal and minimal oxygen saturation, arousal index, FENO, ESR (1st, 2nd hour), HS-CRP with in OSA patients versus controls. While significant increase of HS-CRP, basal, minimal oxygen saturation and arousal index were found in severe OSA no significant differences were founded in (FENO, or ESR (1st, 2nd hour)).The predicted cut off point of FENO, HS-CRP, ESR(1st, 2ndhrs) that can be used in OSA diagnosis were (8,5.5,6.5,13.5) with sensitivity (0.88,0.95,0.83,0.93) and specificity (0.77,0.88,0.63,0.63). While in severe OSA were (24.5, 19.4, 9, 18.5) with sensitivity (0.82, 0.91, 0.82, 0.82) and specificity (0.72, 0.72, 0.72, 0.68) respectively. Conclusion: OSA patients have increased level of HS-CRP, ESR, and Exhaled FENO which confirm association of inflammation in OSA. These simple inflammatory markers may be used also as simple non invasive predictors to diagnose OSA. Moreover, the HS-CRP may be used as a useful parameter to predict OSA severity

Obstructive sleep apnea in type 2 diabetes mellitus patients

Objective The study aims to identify the prevalence and risk factors for OSA in a group of Egyptian patients with type 2 diabetes. Methods 125 type 2 diabetes mellitus patients visited Mansoura University Hospital (Diabetes Mellitus Outpatient Clinic (OPC) at Specialized Medical Hospital and the Sleep Disordered Breathing Unit of the Chest Department), all of them exposed to history taking, the patients underwent anthropometric measurements (weight, height, body mass index, neck circumference), a test of their tonsillar size, Malampati score, Friedman OSA score, Epworth sleepiness scale (ESS), Berlin questionnaire, STOP BANG questionnaire, full-night polysomnography, fasting, and postprandial blood sugar. Results The study included 125 T2DM Egyptian patients with a mean age of 54.63 ± 9.47 years. Males accounted for 35.2 percent of patients, while females accounted for 64.8%. According to the study of co-morbidity, hypertension constituted 77 (61.1%), ischemic heart disease 28 (22.4%), other cardiac diseases 11 (8.8%), bronchial asthma 6 (4.8%), liver diseases 6 (4.8%), hypothyroidism 3 (2.4%), and renal diseases 3 (2.4%). A total of seven patients (5.6%) had no OSA symptoms, 87 had borderline symptoms, and 31 had positive symptoms. There were 51 (40.8%) normal patients, 12 (9.6%) borderline patients, and 62 (49.6%) sleepy patients on the Epworth scale. According to the Stop-Bang questionnaire, 121 (96.8%) patients answered positively. It was determined that 122 patients (97.6%) were at high risk based on the Berlin questionnaire. There were 17 patients (13.6%) with OSA on polysomnography, of which six were moderate (35.3%) and 11 were severe (64.7%). Among moderate and severe OSA patients, glycosylated hemoglobin levels differed significantly. Multivariate logistic regression analysis for independent predictors of OSA, chronic renal disease patients is the most common associated risk factor (OR = 14.3, CI = 1.2–67) then hypertension (OR = 5.6,CI=1.2–25.5) and heart failure (OR = 4.4). Conclusions OSA affects 13.6% patients with type 2 diabetes patients who are hypertensive are at higher risk of OSA, chronic renal failure is considered another risk factorFurthers studies are needed on a big scale of Egyptian diabetic patients to detect the prevalence of OS

Mirtazapine, an atypical antidepressant, mitigates lung fibrosis by suppressing NLPR3 inflammasome and fibrosis-related mediators in endotracheal bleomycin rat model

Idiopathic pulmonary fibrosis (IPF) is a progressive and irreversible lung disease with a poor prognosis. There is currently no definitive cure for IPF. The present study establishes a platform for the development of a novel therapeutic approach for the treatment of PF using the atypical antidepressant, mirtazapine. In the endotracheal bleomycin rat model, mirtazapine interfered with the activation of NLRP3 inflammasome via downregulating the NLRP3 on the gene and protein expression levels. Accordingly, the downstream mediators IL-1β and IL-18 were repressed. Such observation is potentially a direct result of the reported improvement in oxidative stress. Additionally, mirtazapine corrected the bleomycin-induced disparities in the levels of the fibrogenic mediators TGF-β, PDGF-BB, and TIMP-1, in consequence, the lung content of hydroxyproline and the expression of α-SMA were reduced. Besides, mirtazapine curbed the ICAM-1 and the chemotactic cytokines MCP-1 and CXCL4. This protective property of mirtazapine resulted in improving the BALF total and differential cell counts, diminishing LDH activity, and reducing the BALF total protein. Moreover, the inflammation and fibrosis scores were accordingly lower. To conclude, we reveal for the first time the efficacy of mirtazapine as a potential treatment for PF. The combination of social isolation, sleep problems, breathing difficulties, and fear of death can lead to psychological distress and depression in patients with IPF. Hence, mirtazapine is a promising treatment option that may improve the prognosis for IPF patients due to its antifibrotic effects, as well as its ability to alleviate depressive episodes

Bacterial etiology of community-acquired pneumonia in immunocompetent hospitalized patients and appropriateness of empirical treatment recommendations: an international point-prevalence study

An accurate knowledge of the epidemiology of community-acquired pneumonia (CAP) is key for selecting appropriate antimicrobial treatments. Very few etiological studies assessed the appropriateness of empiric guideline recommendations at a multinational level. This study aims at the following: (i) describing the bacterial etiologic distribution of CAP and (ii) assessing the appropriateness of the empirical treatment recommendations by clinical practice guidelines (CPGs) for CAP in light of the bacterial pathogens diagnosed as causative agents of CAP. Secondary analysis of the GLIMP, a point-prevalence international study which enrolled adults hospitalized with CAP in 2015. The analysis was limited to immunocompetent patients tested for bacterial CAP agents within 24 h of admission. The CAP CPGs evaluated included the following: the 2007 and 2019 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA), the European Respiratory Society (ERS), and selected country-specific CPGs. Among 2564 patients enrolled, 35.3% had an identifiable pathogen. Streptococcus pneumoniae (8.2%) was the most frequently identified pathogen, followed by Pseudomonas aeruginosa (4.1%) and Klebsiella pneumoniae (3.4%). CPGs appropriately recommend covering more than 90% of all the potential pathogens causing CAP, with the exception of patients enrolled from Germany, Pakistan, and Croatia. The 2019 ATS/IDSA CPGs appropriately recommend covering 93.6% of the cases compared with 90.3% of the ERS CPGs (p < 0.01). S. pneumoniae remains the most common pathogen in patients hospitalized with CAP. Multinational CPG recommendations for patients with CAP seem to appropriately cover the most common pathogens and should be strongly encouraged for the management of CAP patients.info:eu-repo/semantics/publishedVersio

Prevalence and risk factors for Enterobacteriaceae in patients hospitalized with community-acquired pneumonia

Background and objective Enterobacteriaceae (EB) spp. family is known to include potentially multidrug-resistant (MDR) microorganisms, and remains as an important cause of community-acquired pneumonia (CAP) associated with high mortality. The aim of this study was to determine the prevalence and specific risk factors associated with EB and MDR-EB in a cohort of hospitalized adults with CAP. Methods We performed a multinational, point-prevalence study of adult patients hospitalized with CAP. MDR-EB was defined when >= 3 antimicrobial classes were identified as non-susceptible. Risk factors assessment was also performed for patients with EB and MDR-EB infection. Results Of the 3193 patients enrolled with CAP, 197 (6%) had a positive culture with EB. Fifty-one percent (n = 100) of EB were resistant to at least one antibiotic and 19% (n = 38) had MDR-EB. The most commonly EB identified were Klebsiella pneumoniae (n = 111, 56%) and Escherichia coli (n = 56, 28%). The risk factors that were independently associated with EB CAP were male gender, severe CAP, underweight (body mass index (BMI) < 18.5) and prior extended-spectrum beta-lactamase (ESBL) infection. Additionally, prior ESBL infection, being underweight, cardiovascular diseases and hospitalization in the last 12 months were independently associated with MDR-EB CAP. Conclusion This study of adults hospitalized with CAP found a prevalence of EB of 6% and MDR-EB of 1.2%, respectively. The presence of specific risk factors, such as prior ESBL infection and being underweight, should raise the clinical suspicion for EB and MDR-EB in patients hospitalized with CAP

Microbiological testing of adults hospitalised with community-acquired pneumonia: an international study

This study aimed to describe real-life microbiological testing of adults hospitalised with community-acquired pneumonia (CAP) and to assess concordance with the 2007 Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) and 2011 European Respiratory Society (ERS) CAP guidelines. This was a cohort study based on the Global Initiative for Methicillin-resistant Staphylococcus aureus Pneumonia (GLIMP) database, which contains point-prevalence data on adults hospitalised with CAP across 54 countries during 2015. In total, 3702 patients were included. Testing was performed in 3217 patients, and included blood culture (71.1%), sputum culture (61.8%), Legionella urinary antigen test (30.1%), pneumococcal urinary antigen test (30.0%), viral testing (14.9%), acute-phase serology (8.8%), bronchoalveolar lavage culture (8.4%) and pleural fluid culture (3.2%). A pathogen was detected in 1173 (36.5%) patients. Testing attitudes varied significantly according to geography and disease severity. Testing was concordant with IDSA/ATS and ERS guidelines in 16.7% and 23.9% of patients, respectively. IDSA/ATS concordance was higher in Europe than in North America (21.5% versus 9.8%; p<0.01), while ERS concordance was higher in North America than in Europe (33.5% versus 19.5%; p<0.01). Testing practices of adults hospitalised with CAP varied significantly by geography and disease severity. There was a wide discordance between real-life testing practices and IDSA/ATS/ERS guideline recommendations

Prevalence and Etiology of Community-acquired Pneumonia in Immunocompromised Patients

BACKGROUND: The correct management of immunocompromised patients with pneumonia is debated. We evaluated the prevalence, risk factors, and characteristics of immunocompromised patients coming from the community with pneumonia. METHODS: We conducted a secondary analysis of an international, multicenter study enrolling adult patients coming from the community with pneumonia and hospitalized in 222 hospitals in 54 countries worldwide. Risk factors for immunocompromise included AIDS, aplastic anemia, asplenia, hematological cancer, chemotherapy, neutropenia, biological drug use, lung transplantation, chronic steroid use, and solid tumor. RESULTS: At least 1 risk factor for immunocompromise was recorded in 18% of the 3702 patients enrolled. The prevalences of risk factors significantly differed across continents and countries, with chronic steroid use (45%), hematological cancer (25%), and chemotherapy (22%) the most common. Among immunocompromised patients, community-acquired pneumonia (CAP) pathogens were the most frequently identified, and prevalences did not differ from those in immunocompetent patients. Risk factors for immunocompromise were independently associated with neither Pseudomonas aeruginosa nor non-community-acquired bacteria. Specific risk factors were independently associated with fungal infections (odds ratio for AIDS and hematological cancer, 15.10 and 4.65, respectively; both P = .001), mycobacterial infections (AIDS; P = .006), and viral infections other than influenza (hematological cancer, 5.49; P &lt; .001). CONCLUSIONS: Our findings could be considered by clinicians in prescribing empiric antibiotic therapy for CAP in immunocompromised patients. Patients with AIDS and hematological cancer admitted with CAP may have higher prevalences of fungi, mycobacteria, and noninfluenza viruses