Effect of Modifying Mechanical Ventilator Trigger Sensitivity on Arterial Blood Gases in ICU Patients

Background: Despite the fact that mechanical ventilation is an essential part in management of critically ill patients, mechanically ventilated patients have a higher risk of complications, which can lead to increased morbidity and mortality. Objective: This study aimed to study the effect of training inspiratory muscle through modifying mechanical ventilator (MV) trigger sensitivity on arterial blood gases in mechanically ventilated patients. Patients and Methods: Sixty adult patients diagnosed with acute respiratory failure, needed to be intubated and connected to mechanical ventilated. They were from both gender and their ages ranged from 50 to 70 years. The patient were chosen from Intensive Care Unit (ICU), Department of Chest Diseases, Cairo University Hospitals. They were randomly assigned into two equal groups. Group (A): included thirty patients who received training for inspiratory muscle through modifying MV trigger sensitivity plus usual physical therapy. Group (B): included thirty patients who received usual physical therapy only. Results: The results showed a significant increase in partial arterial pressure (PaO2) in both groups, this increasing was significantly higher in  patients who received training for the inspiratory muscle plus the usual chest physical therapy than patients who only received usual chest physical therapy (P-value < 0.001). The results showed no significant change in neither power of hydrogen (pH) nor partial pressure of carbon dioxide (PaCO2). Conclusion: Training to inspiratory muscles in mechanically ventilated patient through modifying mechanical ventilator trigger sensitivity can produce a significant increase in partial arterial pressure (PaO2). Although it has no effect in pH nor PaCO2

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Vitamin D deficiency in chronic obstructive pulmonary disease and bronchogenic carcinoma

Rationale Vitamin D has been known to have an important role as an anti-inflammatory agent and immune modulator. The aim of this work was to evaluate the impact of vitamin D deficiency on chronic obstructive pulmonary disease (COPD) and bronchogenic carcinoma. Patients and methods The study population consisted of 58 patients. All were male patients and were divided into two groups: group A consisted of patients with COPD (n=30) [diagnosed by history, examination and pulmonary function testing and further evaluated by BMI, 6 min walk test and oxygen saturation by pulse oximeter (SpO2)] and group B (n=28) consisted of patients with bronchogenic carcinoma not having COPD (diagnosed by history, examination, pulmonary function testing to exclude COPD, computed tomography chest and biopsy, which was obtained through fibreoptic bronchoscopy, ultrasound guided or computed tomography guided). All were tested for 25-OH vitamin D3/D2. Results The relation between vitamin D deficiency and COPD severity was studied, revealing no statistically significant correlation. The relation between vitamin D deficiency and bronchogenic carcinoma revealed a statistically significant correlation. Although vitamin D deficiency was not statistically significant among different histological types of bronchogenic carcinoma, vitamin D level (mean±SD: 53.15±17.61) was higher in squamous cell carcinoma than that found in small cell cancer (30.32±14.83) and adenocarcinoma (22.75±8.67). Conclusion Vitamin D deficiency has been known to have an impact on the respiratory system. We were not able to find a relation linking COPD to vitamin D deficiency. However vitamin D deficiency seemed to be more related to the development of bronchogenic carcinoma. Although the type of bronchogenic carcinoma did not show statistical significance regarding deficiency of vitamin D. Squamous cell carcinoma patients didn’t show deficiency in contrast to other types. Vitamin D deficiency seemed related to bronchogenic carcinoma more than it is to COPD

Final year medical students’ knowledge about smoking in Cairo University

Smoking is an important health problem in Egypt and seems to be increasing. Future physicians must be aware of smoking hazards and cessation methods to overcome this problem. Aim: Finding out about the medical students’ knowledge regarding smoking hazards and smoking cessation. Methodology: A questionnaire was designed with five main headings and answered by final year medical students at Cairo University during the academic year 2012–2013. Results: 1274 students participated with about 79–149 students (6.2–11.7%) not replying to the questions. 129 students (10.1%) of the participants were smokers. Awareness of students about hazards was more than 90% for respiratory and cardiovascular risks, while only 992 (77.9%) were aware of psychiatric disorders related to smoking. The main source of knowledge was considered the university by 868 students (68.2%) and friends were regarded as of no role by 603 students (47.3%). Although the majority were well acquainted with hazards: 1053 students (82.7%) only 179 (14.1%) knew about cessation methods and 133 students (10.4%) knew about the drugs that may help quit smoking. Also 382 (30%) considered one’s own will to be the strongest contributor to stopping smoking while 436 students (34.2%) considered medications to have no role. Finally most students: 1110 (87.2%) showed a positive attitude towards offering future advice against smoking. Conclusion: Although most students seemed quite aware of smoking hazards, knowledge about smoking cessation seemed to be insufficient. About 10% of the students did not answer any of the questions, a problem that should be studied further