Comparison between bronchoscopic BAL and non-bronchoscopic BAL in patients with VAP

Background: The diagnosis of ventilator associated pneumonia (VAP) remains a challenge because the clinical signs and symptoms lack both sensitivity and specificity and the selection of microbiologic diagnostic procedure is still a matter of debate. Objective: To compare the diagnostic value of bronchoscopic BAL and non-bronchoscopic protected BAL in patients with VAP. Materials and methods: Twenty patients, clinically diagnosed with VAP, were involved in this research; they were evaluated by bronchoscopic and non-bronchoscopic BAL for diagnosis of VAP. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of bronchoscopic and non-bronchoscopic BAL were calculated, taking clinical pulmonary infection score (CPIS) of ⩾6 as reference standard. Results: There was a good microbiologic concordance and strong correlation between bronchoscopic BAL and non bronchoscopic BAL in diagnosis of VAP. There was a high concordance between CPIS score and both procedures’ results. Percentage of concordance between CPIS and bronchoscopic BAL was 97.5% and with non bronchoscopic BAL was 95%. Gram negative organisms were the commonest organisms isolated by both techniques. Conclusion: Non bronchoscopic BAL is an inexpensive, easy, and useful technique for microbiologic diagnosis of VAP. This finding, if verified, might simplify the approach for the diagnosis of VAP

Role of thoracoscopic pleural lavage and brush in undiagnosed exudative pleural effusion

Background: The accurate diagnosis of pleural effusion remains a challenging problem even after thoracentesis and closed pleural biopsy. Medical thoracoscopy has been established to have a greater diagnostic yield in the diagnosis of exudative pleural effusion. Forceps biopsy, pleural brush and lavage could be used through medical thoracoscopy to obtain pleural specimens. Objective: The aim of this study is to evaluate the role of thoracoscopic pleural lavage and brush in undiagnosed exudative pleural effusion. Patients and methods: This prospective study was carried out on 25 patients having undiagnosed exudative pleural effusion. All patients submitted to medical thoracoscopy, where forceps biopsy, pleural brush and pleural lavage specimens were taken for all patients and sent for histopathological and cytological examination. Results: Combined thoracoscopic pleural specimens were diagnostic in 24 patients (96%), and all of them were malignant. Forceps biopsy was positive in 23 patients (92%), while pleural brush and pleural lavage were positive in 18 patients (72%) and 15 patients (60%) respectively. Pleural brush was the only diagnostic modality in one patient. Minimal complications were recorded. Conclusion: Combined thoracoscopic pleural specimens (forceps biopsy, brush and lavage) increase the diagnostic yield of medical thoracoscopy for patients with undiagnosed exudative pleural effusion than separate them. Thoracoscopic pleural brushing is a safe diagnostic technique as it can brush certain dangerous areas of the pleura. Pleural lavage is more diagnostic than the initial thoracentesis

Role of glutathione S-transferase P-1 (GSTP-1) gene polymorphism in COPD patients

Background: COPD is a multifactorial disease. It is a widely distributed disease with high morbidity and mortality, associated with different pathologies. The link between glutathione S-transferase P-1 (GSTP1) polymorphism and COPD needs to be clarified. Objectives: To show the relationship between GSTP1 gene polymorphism and pathogenesis of COPD, and to clarify the role of smoking in GSTP1 gene polymorphism. Patients and methods: This study carried out on 30 COPD patients met the clinical criteria of COPD set by GOLD 2013 and 20 healthy controls. Blood was sampled for studying GSTP1 gene polymorphism by PCR-RFLP. Results: There was a significant difference between group A (COPD smokers) and group B (COPD non smokers) regarding the presence of non mutant and heterozygous mutation. GSTP1 mutation was significantly higher in group C (smoking controls) than group D (non smoking controls). There was a highly significant difference between smoking subjects than non smoking compared with mutation. There was no significant difference in mutation between smokers and ex-smokers. There was no significant difference between studied subjects having heterozygous mutation and subjects without as regards their spirometry results. Conclusion: There is a significant association between GSTP1 gene polymorphism and the development of COPD, and smoking have a role in GSTP1 gene polymorphism. The polymorphism has no relation to disease severity

Comparison between ultrasound-guided Abrams needle and medical thoracoscopic pleural biopsies in exudative pleural effusion

Background The actual diagnosis of pleural disease (especially for malignancy) depends on the histopathological finding obtained through pleural biopsy or positive pleural fluid cytology result. Pleural tissue biopsies can be obtained by several methods: blind, image-guided, thoracoscopic, or open surgical pleural biopsies. The diagnostic yield of image-guided sampling is increased owing to the ability to precisely target an abnormal area of the pleura. Aim The aim of this work was to compare between ultrasound-guided Abrams needle and medical thoracoscopic pleural biopsies (MT-PB) in exudative pleural effusion and see the diagnostic yield of ultrasound-guided pleural biopsy. Patients and methods This study included 40 patients with exudative pleural effusion admitted to Chest Department, Menoufia University Hospital, during the period from August 2015 to November 2017. All had pleural thickening in contrast-enhanced thoracic computed tomography scan. All patients underwent ultrasound-guided Abrams’ needle followed by MT-PB. Results Compared with MT-PB, the sensitivity and specificity of ultrasound-guided Abrams needle pleural biopsy were 81.58 and 100%, respectively. No difference was identified between the yields of the two methods. Conclusion Ultrasound-guided Abrams needle pleural biopsy considers an alternative to medical thoracoscopy in exudative pleural effusions associated with pleural thickening