Potential Role for a Panel of Immunohistochemical Markers in the Management of Endometrial Carcinoma

Background In order to improve the efficacy of endometrial carcinoma (EC) treatment, identifying prognostic factors for high risk patients is a high research priority. This study aimed to assess the relationships among the expression of estrogen receptors (ER), progesterone receptors (PR), human epidermal growth factor receptor 2 (HER2), Ki-67, and the different histopathological prognostic parameters in EC and to assess the value of these in the management of EC. Methods We examined 109 cases of EC. Immunohistochemistry for ER, PR, HER2, and Ki-67 were evaluated in relation to age, tumor size, International Federation of Gynecology and Obstetrics (FIGO) stage and grade, depth of infiltration, cervical and ovarian involvement, lymphovascular space invasion (LVSI), and lymph node (LN) metastasis. Results The mean age of patients in this study was 59.8 ± 8.2 years. Low ER and PR expression scores and high Ki-67 expression showed highly significant associations with non-endometrioid histology (p = .007, p < .001, and p < .001, respectively) and poor differentiation (p = .007, p < .001, and p <. 001, respectively). Low PR score showed a significant association with advanced stage (p = .009). Low ER score was highly associated with LVSI (p = .006), and low PR scores were associated significantly with LN metastasis (p = .026). HER2 expression was significantly related to advanced stages (p = .04), increased depth of infiltration (p = .02), LVSI (p = .017), ovarian involvement (p = .038), and LN metastasis (p = .038). There was a close relationship between HER2 expression and uterine cervical involvement (p = .009). Higher Ki-67 values were associated with LN involvement (p = .012). Conclusions The over-expression of HER2 and Ki-67 and low expression of ER and PR indicate a more malignant EC behavior. An immunohistochemical panel for the identification of high risk tumors can contribute significantly to prognostic assessments

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

Three hundred and eleven honeybee samples from 12 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, which 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

High-flow nasal oxygen therapy versus noninvasive ventilation in chronic interstitial lung disease patients with acute respiratory failure

Background High-flow nasal oxygen therapy (HFNOT) may be a suitable alternative for noninvasive ventilation (NIV) in chronic interstitial lung disease (ILD) during an episode of acute respiratory failure (ARF). Patients and methods Consecutive ILD patients who had ARF and a ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO2/FiO2) of 300 mmHg or less were randomly assigned to NIV or HFNOT. The primary outcome was the need for intubation. Secondary outcomes were in-hospital mortality and ventilator-free days. Results A total of 70 patients with ILD were included. The rate of intubation was 20.6% (seven of 34 patients) in the HFNOT group and 22.2% (eight of 36) in the NIV group (P=0.87). The ventilator-free days at day 28 was higher in the HFNOT group (20±5 vs. 16±7 days in the NIV group; P=0.008). The rate of in-hospital mortality was 26.5% in the HFNOT group versus 30.6% in the NIV group (P=0.71). Conclusion HFNOT improved patient comfort and the ventilator-free days in patients with ILD and ARF, despite no difference in the rate of intubation when compared with NIV

Assessment of glycemic gap as a biomarker of severity and outcome of pulmonary embolism in diabetic patients

Objective The aim was to assess the role of glycemic gap as a biomarker of pulmonary embolism severity and outcome in diabetic patients. Patients Diabetic patients who were 18 years of age or older admitted with confirmed diagnosis of pulmonary embolism (n=280) were included in the study. Methods On admission, blood glucose level was measured. HbA1c was measured. To convert HbA1c levels to the estimated long-term average glucose levels (eAG) for the previous 3 months, the equation AG = 28.7×HbA1c-46.7 was used. From the glucose level at ED admission minus the eAG, the glycemic gap was calculated. The severity of pulmonary embolism was assessed by the pulmonary embolism severity index (PESI). Results There was a significant positive correlation between glycemic gap and the severity of pulmonary embolism and length of hospital stay. There was a significant difference of the glycemic gap between nonsurvivors and survivors (110.3±35.6 vs.48.8±31.3; P< 0.001), patients with and without clinical deterioration (108±34.1 vs. 48.1±31.1; P< 0.001), and patients who needed ICU admission and those who did not need ICU admission (107.3±31.9 vs. 46.2±29.7; P< 0.05). At a cut-off value of glycemic gap of greater than or equal to 79, sensitivity, specificity, positive predictive value, and negative predictive value were 100, 82, 23, and 100%, respectively. Multivariate logistic regression of potential predictors of mortality identified two independent predictors: PESI (P<0.001) and glycemic gap (P=0.042). Conclusion Elevated glycemic gap between serum glucose levels upon admission and the HbA1c-derived average glucose was associated with increased severity and mortality in diabetic patients with pulmonary embolism

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

Tuberculosis chemoprophylaxis in rheumatoid arthritic patients receiving tumor necrosis factor inhibitors or conventional therapy

Introduction: Patients with rheumatoid arthritis (RA) have increased susceptibility to infection. The risk of acquiring infection including tuberculosis (TB) in RA may be increased in patients receiving any immuno-suppressive medication including anti-TNF therapy, which is used successfully for treating patients with rheumatoid arthritis. The aim of this work was to assess the risk of TB in RA patients on anti-TNF therapy compared to conventional disease modifying anti rheumatic drugs when screening for latent TB and TB chemoprophylaxis was applied. Patients and methods: This study conducted on (235) RA patients indicated for either conventional therapy or anti-TNF therapy from 1-1-2010 to 1-10-2013. Assessment was done before RA treatment and included medical history, clinical examination, plain chest X-ray, HRCT chest QuantiFERON®-TB Gold in-tube (QFT-GIT) test and microbiologic investigations for tuberculosis when indicated. All patients with positive QFT-GIT received chemoprophylactic treatment for TB. Results: The studied rheumatoid arthritic patients were divided into two groups; group (A) included (105) RA patients on conventional disease modifying anti rheumatic drugs (DMARDs) with mean age (51 ± 12) and group (B) included (130) RA patients on anti-TNF therapy with mean age (48 ± 13). This study showed no significant increase of tuberculosis among patients on anti-TNF therapy (group B) compared to patients on (DMARDs) (group A). Chemo-prophylaxis in patients on anti-TNF therapy leads to prevention of reactivation of latent TB. Conclusion: There was no significant increased risk for tuberculosis among RA patients receiving anti-TNF therapy when screening and chemoprophylaxis was applied, so screening of RA patients before anti-TNF therapy for latent tuberculosis and TB chemoprophylaxis should be done

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