Comparative study between using Lowenstein Jensen, Bio-FM media and mycobacteria growth indicator tube (MGIT) system in identification of Mycobacterium tuberculosis

Background/aim: Tuberculosis (TB) continues to be one of the most important infectious diseases threatening the human health. Culture systems are used for isolation of tuberculous bacilli as they are more sensitive than smear microscopy. The aim of the work was to evaluate the detection rate and time of Mycobacterium tuberculosis by using the Bio FM system and mycobacteria growth indicator tube (MGIT) system in comparison with the Lowenstein–Jensen medium. Methods: This study was carried out on a total 60 smear acid fast bacilli positive sputum samples obtained from patients attending the Chest Department and Outpatient Clinic of Benha University Hospital, Benha Chest Hospital, from June 2012 to September of the same year. Patients were classified into three groups: Group I: included 40 patients with fresh sputum smear +ve (new cases), Group II: included 13 relapsed cases and Group III: included 7 treatment failure cases. All sputum samples were cultured in parallel on Bio-FM, MGIT and LJ media. The mycobacterial detection rate and time were compared. Results: The mycobacteria recovery rate on MGIT, Bio-FM and LJ was not significantly different (respectively 98.3%, 95% and 93%, P > 0.05). The growth of M. tuberculosis bacilli was faster on MGIT than on Bio-FM (mean 10.7 ± 2.9 days, 11.1 ± 4.3 days, respectively vs. 23.6 ± 8.1 days for LJ), there was statistically significant difference between LJ and Bio-FM and LJ and MGIT. However there was no statistical significance when comparing MGIT and Bio-FM. Conclusion: MGIT and Bio-FM are good culture systems for accurate and rapid detection of M. tuberculosis

Evaluation of serum interleukin-1 beta as an inflammatory marker in COPD patients

Background: COPD is a chronic disease of the lungs characterized by increased obstruction to airflow that does not change markedly over periods of several months. Low-grade systemic inflammation is considered a hallmark of COPD that potentially links COPD to increased rate of systemic manifestations of the disease. Evaluation of systemic inflammation in COPD particularly when the disease is severe and during exacerbation can be measured either as increased circulating cytokines, chemokines and acute phase proteins, or as abnormalities in the circulating cells and markers. One of these inflammatory mediators is IL-1B which demonstrated recent reports in significantly high levels of IL-1β in serum of the COPD patients as compared to the healthy controls. Aim of the study: To assess the level of serum IL-1B in chronic obstructive pulmonary disease patients during acute exacerbation and in stable conditions and also, to determine if the changes in its level correlated with changes in the ventilatory functions. Methods: 80 cases were included in this study: 60 COPD patients and 20 healthy subjects as a control. There were 48 males and 12 females in COPD groups and 17 males and 3 females in the control group. Their age ranged from 41 to 79 years with a mean age of 59 years. The subjects were classified into 3 groups. Group I includes (30) patients with acute exacerbation of COPD. Group II includes (30) patients with stable controlled COPD. Group III includes (20) healthy persons as a control. Results: There was a highly statistically significant difference in serum IL-1B (pg/ml) between studied groups, which indicates that IL-1B plays a role in systemic inflammatory process. There was a highly statistically significant difference in serum IL-1B concentration (pg/ml) and severity of COPD cases. Conclusions: IL-1β correlated with clinical aspects of disease severity, suggesting that IL-1β may play a critical role in COPD

Study of effect of inhaled versus oral corticosteroids on sputum granzyme B in patients with moderate persistent bronchial asthma

Background: Asthma is a major public health problem with a high economic burden. It involves several inflammatory cells and multiple mediators. Granzyme B is an inflammatory mediator expressed and secreted by both immune and non immune cells. Recently it was found to play a role in the pathogenesis of asthma. The aim of this work: was to evaluate the effect of both inhaled and oral corticosteroids on sputum granzyme B in asthmatic patients with moderate severity. Methods: The study included 25 patients with moderate persistent asthma plus 15 healthy subjects as a control group. Granzyme B was measured before treatment with corticosteroids then after inhalation therapy and oral therapy. Results: It was found that expected pulmonary function parameters were significantly lower in asthmatic patients than in controls. Sputum granzyme B levels were significantly higher in asthmatic patients than in controls. Sputum granzyme B levels were significantly lower after treatment with inhaled corticosteroids than basal levels. Oral corticosteroids further significantly lowered granzyme B, but the lowering effect of inhaled steroids was significantly higher than that of oral drugs. There was no statistically significant correlation between granzyme B and PFTs in asthmatic patients. Conclusion: Granzyme B levels are elevated in bronchial asthma. Granzyme B could play a role in the pathogenesis of bronchial asthma. Both inhaled and oral corticosteroids lowered granzyme B levels significantly. The lowering effect of inhaled corticosteroids on sputum granzyme B is more than that of the oral corticosteroids

The role of ultrasound in assessment of positive end-expiratory pressure-induced lung recruitment in acute respiratory distress syndrome patients

Background In the case of critically sick patients, acute respiratory distress syndrome (ARDS) may be life-threatening and necessitates the need for ICU admission. Continuous monitoring is required for mechanical ventilation and recruitment movements as necessary. In this research, the goal is to investigate the use of ultrasonography in the evaluation of positive end exhalatory pressure-induced lung recruitment in ARDS patients. Patients and methods A total of 25 ARDS patients were included in this research, which was done in the hospital’s respiratory care unit. All of the patients were seen by a doctor, had a chest radiograph, and had laboratory tests. Mechanical ventilation was used in the care of all patients. Using positive end-expiratory pressure (PEEP) values of 5 and 15, we measured pressure–volume (PV) and lung ultrasound tracings. The PV curve approach was used to assess PEEP-induced lung recruitment. Between PEEP 5 and PEEP 15, there was an extremely strong positive connection between reaeration score and the change in lung volume (r=0.737, P=0.001). Results Between PEEP 5 and PEEP 15, there was a substantial (r=0.577, P=0.003) positive association between the reaeration score and the decrease in PaO2. There was a substantial negative association between reaeration score and mortality (rpb=-0.842, P=0.001), in which mortality reduces as the score increases. Conclusion For quantitative evaluation of PEEP-induced lung recruitment, bedside lung ultrasound is equal to the PV curve approach. In patients with ARDS, PEEP-induced lung recruitment may be assessed using ultrasonography

Study of serum Granzyme B in heavy cigarette smokers with and without chronic obstructive pulmonary disease

Background: Inflammation of the airways is present in COPD with increased number of inflammatory cells including killer cells that lyse their target cells by two mechanisms; membranolysis in which secreted molecules such as granzymes form pores in the membrane of target cells; and apoptosis. Granzyme B has the strongest apoptotic activity of all granzymes. Aim of this work: Aim of this work was to study the relation between Granzyme B, tobacco smoking and chronic obstructive pulmonary disease. Methods: The study included 40 clinically stable COPD patients classified according to GOLD (2013) criteria into two groups; moderate (GOLD II) and severe (GOLD III) plus 40 apparently healthy control subjects (20 smokers and 20 nonsmokers). Pulmonary function results and serum levels of Granzyme B (measured by ELISA) were recorded. Results: Granzyme B levels are elevated in COPD. Cigarette smoking appears to be a direct stimulus to Granzyme B production. Granzyme B could play a role in the pathogenesis of COPD. Aging seems to be a risk factor for Granzyme B production and pathogenesis of COPD. Conclusion: Granzyme B levels are elevated in COPD. Cigarette smoking appears to be a direct stimulus to Granzyme B production. Granzyme B could play a role in the pathogenesis of COPD. Aging seems to be a risk factor for Granzyme B production and pathogenesis of COPD

Evaluation of primary health care service participation in the National Tuberculosis Control Program in Menofya Governorate

To evaluate the primary health care (PHC) services performance in National Tuberculosis Control Program (NTP) in Menofya Governorate this study was created. Methods: A questionnaire based on 6 parameters was used to evaluate the PHC system performance: I – Physicians basic knowledge about TB (causative agent, methods of spread, clinical picture, essential steps in investigations: X-ray and sputum smear). II – Facilities for primary investigation (sputum examination and chest X-ray). III – Communication with the central health authorities or a TB specialist. IV – Proper recording systems needed for proper patient management and follow up. V – Follow up schedules available for the detected/recorded patients. VI – Role in community education about the disease. Results: The studied area included 10 health territories and 46 primary health care units (34.8% were urban and 65.2% were rural) with one physician in each unit. The mean percent of the correct answers of the basic knowledge score was 54.5% and was higher in rural units physicians than urban units physicians. There were lack of proper facilities (laboratory for sputum analysis and X-ray apparatus), and availability of DOTS in 32 units (69.6%). Communication with central health authorities in urban areas and rural areas was nearly equal (87.5–86.7%). Case recording was lower in urban than rural areas (6.25% vs. 43.3%). Patient follow up after referral to central health units was higher in rural than urban areas (23.3% vs. 6.25%). Participation in community education was higher in rural than urban areas (80% vs. 20%). Conclusion: In the Menofya Governorate, PHC physicians lack proper knowledge about TB and their units lack proper equipment. The PHC system needs to be empowered by the health care authorities through training and equipment for better performance in NTP

Study of the Helicobacter pylori infection in chronic obstructive pulmonary disease

Background: COPD may be associated with other systemic diseases including cardiovascular diseases, diabetes, osteoporosis and peptic ulceration and Helicobacter pylori infection seems to be the main cause of PUD. Aims: The aim of this work is to study the association of H. pylori infection in chronic obstructive pulmonary disease (COPD). Subject and methods: This study was performed on 80 subjects. They were classified into two groups: Group I: 65 COPD patients. Group II: 20 healthy control subjects. COPD was diagnosed according to the Global Initiative for chronic obstructive pulmonary disease admitted at chest department of Benha University Hospital. Results: It shows that seropositivity of anti-H. pylori IgG and anti-CagA IgG was higher in COPD patients than in controls with a highly statistically significant difference (p = 0.009 and 0.047 respectively). Also the IgG level of H. pylori positive cases and CagA positive cases was higher in the COPD group than in the control group with a highly statistically significant difference (p = 0.027 and 0.0001 respectively). Conclusion: The present study suggests that patients with COPD have an increased seroprevalence of Hp infection

Study of anti nuclear and anti smooth muscle antibodies in patients with chronic obstructive pulmonary disease

Background/aim: Autoimmunity is a disease in which the immune system mistakenly attacks the body’s own cells and tissues. Sometimes the whole body is attacked, and sometimes only one organ. The aim of the work: The aim of this study was to evaluate antinuclear and anti smooth muscle antibodies, two common markers of autoimmunity, in COPD and their relation with different components of the disease and disease severity. Methods: The study included 50 clinically stable COPD patients classified into two groups mild to moderate (group A) and severe to very severe (group B) according to GOLD (2009) [13] criteria plus 30 healthy control subjects (15 smokers and 15 non smokers). Blood levels of ANA and ASMA (measured by ELISA) were recorded. Results: Levels of both ANA and ASMA were significantly higher in patients than in controls as a whole group but smoker controls showed significantly higher levels of both antibodies than mild to moderate COPD group (group A) indicating that not only smoking is responsible for COPD but other factors also play a role. Also high levels of these antibodies in smoker controls than in non smokers indicate a role of smoking in their development which is augmented by the direct relation with smoking index both in patients and controls. Conclusion: Both ANA and ASMA levels are elevated in COPD patients compared to controls (smokers and non smokers) and levels elevated in healthy smokers compared to group A COPD patients. Autoimmunity plays a role in the pathogenesis of COPD

Evaluation of Primary Health Care service participation in the National Tuberculosis Control Program in Qalyubia Governorate, Egypt

Objective: The aim of this work was to evaluate the Primary Health Care service performance in National Tuberculosis Control Program in Qalyubia Governorate. Methods: The studied area (Qalyubia Governorate) includes 8 health territories (each contains 5 primary care units/centers). A questionnaire based on 6 parameters was used to evaluate the PHC system performance: I – Physicians with basic knowledge about TB (causative agent, methods of spread, clinical picture, essential steps in investigations: X-ray and sputum smear), II – Facilities for primary investigation (sputum examination and chest X-ray), III – Communication with the central health authorities or a TB specialist, IV – Proper recording systems needed for proper patient management and follow up, V – Follow up schedules are available for the detected patients, VI – Have a role in community education about the disease. The data obtained were tabulated and statistically analyzed. Results: Studied area included 8 health territories and 40 primary care units (35% were urban and 65% rural) with one physician in each unit. The mean percent of the correct answers of the basic knowledge score was 48.2% (range = 18%–100%), higher in urban units physicians than rural units physicians, with lack of proper laboratory (for sputum analysis) or X-ray apparatus. Communication with central health authorities in urban areas was higher than rural areas (65.4% versus 57.1%). Case recording was lower in urban than rural areas (42.9% versus 46.2%). Patient follow up after referral to central health units was higher in rural than urban areas (11.5% versus 7.1%). Participation of community education was 78.6% in urban units and 76.9% in rural units. Conclusion: In Qalyubia Governorate, PHC physicians lack proper knowledge about TB and their units lack proper equipments (Lab and CXR). The PHC system needs to be empowered by the health care authorities through training and equipments for better performance in NTP