Outcome of community-acquired pneumonia with cardiac complications

Background: Although pneumonia is a leading cause of death, little consideration has been given to understanding the contributors to this mortality. Previous studies have suggested an increased mortality in pneumonia patients who develop cardiac complications. The aim of this study was to examine the risk factors and outcome of cardiac complications in admitted patients with community-acquired pneumonia. Patients and methods: This study included 130 patients hospitalized with a primary diagnosis of community-acquired pneumonia. All patients were subjected to complete medical history, general and local chest examination, Laboratory investigations (complete blood count, renal and hepatic function tests, serum electrolytes, blood sugar, arterial blood gas analysis, CRP, procalcitonin, BNP, cardiac enzymes, blood and sputum Gram stain and culture, sputum PCR for Mycoplasma pneumoniae, Legionella pneumophila, Coxiella burnetii, and Chlamydophila species, urine antigen testing for S. pneumoniae and L. pneumophila, pharyngeal swabs for viral PCR.), radiological investigations, electrocardiographic studies (ECG) and echocardiography. Results: Among the studied 130 patients, 32 patients (24.6%) had cardiac complications [new or worsening heart failure in16 patients (12.3%), arrhythmias in 12 patients (9.2%), and acute myocardial infarction in 4 patients (3.1%)]. In comparing patients who developed cardiac complications with those who did not they had a significantly higher age (mean ± SD 69 ± 17.3 versus 49 ± 19.1, p < 0.05), included a significantly higher percentage of patients with preexisting cardiovascular diseases (40.6% versus 5.1%, p < 0.05), had a significantly higher pneumonia severity index (PSI) (mean ± SD 130 ± 27 versus 73 ± 29, p < 0.05), a significantly longer hospital stay (mean ± SD 22 ± 7.1 versus 9 ± 4.3, P < 0.05) and a significantly higher mortality (21.8% versus 6.1%, P < 0.05). Conclusions: Cardiac complications are common in the admitted patients with pneumonia and they are associated with increased pneumonia severity and increased cardiovascular risk, these complications adds to the risk of mortality, so optimal management of these events may reduce the burden of death associated with this infection

Bi-level positive airway pressure ventilation for patients with stable hypercapnic chronic obstructive pulmonary disease

Background: The role of noninvasive positive pressure ventilation (NPPV) has been well established in the treatment of acute hypercapnic respiratory failure due to chronic obstructive pulmonary disease (COPD), however, its benefits in clinically stable hypercapnic COPD patients still not well known, so this trial aimed to assess the efficacy of NPPV in patients with stable hypercapnic COPD. Patients and methods: This study included 30 stable hypercapnic COPD patients hospitalized for long term stay from June 2012 to May 2014. The 30 patients who met the study criteria were randomized into the control group (15 patients: 13 males and 2 females with mean age 66 ± 6.2) maintained on standard treatment and the second group (15 patients: 12 males and 3 females with mean age 65 ± 7.3) received bi-level positive pressure ventilation added to their standard treatment after giving a written consent. The patients were evaluated and followed up after initiating this therapy. Results: After 6 months of NPPV, daytime PaCO2 (mmHg) during spontaneous breathing decreased from 55.2 ± 6.7 to 47.1 ± 3.1 mmHg and daytime PaO2 (mmHg) on room air increased from 48 ± 6.1 to 55.1 ± 8.3 with improvement of dyspnea scale and quality of life parameters. This was achieved with mean inspiratory pressures of 19.7 ± 2.41 cm H2O and mean expiratory pressures of 6.8 ± 1.7 cm H2O. Conclusions: NPPV is well tolerated and can improve blood gas levels, dyspnea and quality of life parameters in patients with stable hypercapnic COPD

Continuous positive airway pressure ventilation versus Bi-level positive airway pressure ventilation in patients with blunt chest trauma

Introduction: The use of positive pressure ventilation has decreased the overall morbidity and mortality associated with blunt chest trauma, but invasive mechanical ventilation (IMV) is associated with many complications. The role of noninvasive ventilation (NIV) for the management of patients with blunt chest trauma has not been well established. The aim of this study was to compare the efficiency of CPAP versus BiPAP in avoiding IMV. Patients and method: This study was carried out in the period between April 2011 and April 2103, on 40 patients admitted to ICU with blunt chest trauma with acute respiratory distress that had deteriorated despite aggressive medical management. Patients were randomly assigned to receive either continuous positive airway pressure ventilation (CPAP) (group 1) n = 15, Bi-level positive airway pressure ventilation (BiPAP) (group 2) n = 15 or IMV (group 3) n = 10. Results: Improvement in gas exchange and relieve of respiratory distress was noticed in the three studied groups after the start of assisted ventilation. Four patients in group 1 (26.7%) and three patients in group 2 (20%) required endotracheal intubation. There was no significant difference in the length of stay in ICU between the three groups (10 ± 5 days in group 1, 11 ± 4 in group 2 and 10 ± 6 in group 3. Pneumonia developed in one patient in group 1 (6.6%) and in 2 patients in group 2 (13.3%) and in 3 patients in group 3 (30.3%). Pneumothorax developed in one patient in group 1 (6.6%) and in no patients in group 2 (0%) and in one patient in group 3 (10%). As regards mortality no mortalities were observed in groups 1 and 2 but one patient in group 3 (10%) died. Conclusion: Both CPAP and BiPAP are safe and efficient techniques in managing respiratory failure and reducing the incidence of intubation in patients with blunt chest trauma

Diagnostic utility of soluble triggering receptor expression on myeloid cells-1 in complicated parapneumonic pleural effusion

Background: The differentiation between complicated parapneumonic effusions (CPPE) or empyema, which require chest tube drainage, and uncomplicated parapneumonic effusions (UCPPE), which respond to antibiotic therapy alone, is sometimes unclear. Delay in diagnosis results in substantial delay in the commencement of treatment and may contribute to the high mortality of this infection. The aim of the study: Evaluation of the utility of soluble triggering receptor expression on myeloid cells-1 (sTREM-1) as an early marker in the diagnosis and management of complicated parapneumonic effusions and empyema. Patients and methods: This study included 58 patients who were diagnosed as having PPE and admitted to the Chest Department, Zagazig University Hospitals during the period from March 2012 to March 2013. Patients were diagnosed PPE if they had a pleural effusion and showed one or more clinical manifestations typical of pneumonia, including acute febrile illness, sputum production, chest pain, leukocytosis and infiltrate(s) on chest X-ray. They were divided into two groups. Group (1): Complicated parapneumonic effusion (22 patients), according to at least one of the following criteria on pleural fluid examination: macroscopic pus, presence of organisms on Gram-stain or culture, fluid pH < 7.2 with normal peripheral blood pH, or fluid glucose concentrations <40 mg/dL. Group (2): Uncomplicated parapneumonic effusion (36 patients), according to the following criteria: pleural effusion associated with a non purulent pleural fluid, negative fluid microbiological studies; fluid pH > 7.2 with normal peripheral blood pH and fluid glucose >40 mg/dL. Exclusion criteria: A history of pleural disease or any underlying disease that could potentially cause pleural effusions, such as tuberculosis, malignancy, heart failure, systemic lupus erythematosus and chronic renal failure, were excluded. Pleural fluid samples were examined for level of sTREM-1, pH, LDH and glucose. The sTREM-1 levels were expressed as pg/mL. Microbiological studies included: Gram and Ziehl–Neelsen stains and cultures on conventional media for aerobic and anaerobic micro-organisms in the pleural fluid samples. Results: The median sTREM-1 level in pleural fluid was significantly higher in the bacterial PPE (688 ± 398 pg/mL) than in the non-bacterial PPE (45 ± 79 pg/mL). The cut-off value of pleural fluid sTREM-1 for diagnosis of bacterial PPE was 130 pg/mL with 93% sensitivity and 92% specificity, while it was 7.237 for pleural fluid pH with 91% sensitivity and 96% specificity and 640 mg/L for pleural fluid glucose with 92% sensitivity and 86% specificity and 800 IU/L for pleural fluid LDH with 81% sensitivity and 90% specificity. In conclusion: Combination of classical criteria with pleural fluid sTREM-1 could be useful in discrimination between nonpurulent complicated and non complicated parapneumonic pleural effusions and hence early pleural drainage in patients with complicated parapneumonic effusions which may affect disease outcome

Vitamin D and phenotypes of bronchial asthma

Background: Many studies have suggested the role of vitamin D deficiency in both T-helper1 and T-helper2 diseases. The existence of associations of vitamin D with asthma and allergy remains uncertain. While some suggest that vitamin D may be protective, others suggest that vitamin D supplementation may increase the risk of allergy. Aim of the work: The aim of the study was to evaluate the state of vitamin D in asthmatic patients and its potential relationship with asthma phenotypes. Patients and methods: This study was conducted on 66 nonsmoker asthmatic patients and 30 healthy controls. Serum 25-hydroxy vitamin D3 levels were determined and compared between the two groups. The relationship between serum vitamin D levels and asthma phenotypes were examined. Results: Vitamin D level was significantly lower in asthmatic patients than in control group, in asthmatic patients, vitamin D levels had a significant positive correlation with FEV1% predicted and a significant negative correlation with body mass index, the number of atopic patients was significantly higher in bronchial asthma patients with vitamin D insufficiency than those with sufficient vitamin D. Conclusion: Vitamin D deficiency was highly prevalent in asthmatic patients and it was associated with atopy and asthma severity

Adjuvant role of lung ultrasound in the diagnosis of pneumonia in intensive care unit-patients

Background: Recently, sonography of the lung has been used in the diagnosis of pulmonary embolism and pneumothorax. However, little is known about whether it can also be used in the diagnosis and follow up of pneumonia. So, the aim of this study was to assess the role of bedside lung ultrasound (US) in the diagnosis of pneumonia in intensive care unit (ICU) patients. Patients and methods: The study was carried out on 100 cases clinically suspect of pneumonia who were admitted to respiratory ICU. Lung ultrasound, plain chest X-ray, then computed chest tomography (CT) scan were done for all cases. Results: Pneumonia was diagnosed by CT chest in 80 cases from 100 cases, 61 cases of them had US positive criteria of pneumonia and plain X-ray positive for pneumonia, 17 cases had US positive criteria of pneumonia and plain X-ray negative, 1 case had ultrasound negative and plain X-ray positive and 1 case had US negative and plain X-ray negative. So, most pneumonic cases were proved by lung US more than plain X-ray chest. Sensitivity and specificity of lung ultrasound were (94.5 and 75.0), respectively. Conclusion: Lung ultrasound has a valuable role in the diagnosis of pneumonia in ICU patients, as it is a bedside realtime, reliable, rapid and noninvasive technique

Distribution and variability of deformed wing virus of honeybees (Apis mellifera) in the Middle East and North Africa.

Three hundred eleven honeybee samples from twelve countries in the Middle East and North Africa (MENA) (Jordan, Lebanon, Syria, Iraq, Egypt, Libya, Tunisia, Algeria, Morocco, Yemen, Palestine and Sudan) were analyzed for the presence of deformed wing virus (DWV). The prevalence of DWV throughout the MENA region was pervasive, but variable. The highest prevalence was found in Lebanon and Syria, with prevalence dropping in Palestine, Jordan and Egypt before increasing slightly moving westwards to Algeria and Morocco Phylogenetic analysis of a 194 nucleotide section of the DWV Lp gene did not identify any significant phylogenetic resolution among the samples, although the sequences did show consistent regional clustering, including an interesting geographic gradient from Morocco through North Africa to Jordan and Syria. The sequences revealed several clear variability hotspots in the deduced amino acid sequence, that furthermore showed some patterns of regional identity. Furthermore, the sequence variants from the Middle East and North Africa appear more numerous and diverse than those from Europe. This article is protected by copyright. All rights reserved