Background Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, and fatal disease, with a median survival of ∼2–5 years. The main target of treatment was to stabilize or reduce the rate of disease progression. Nintedanib and pirfenidone are new drugs that could be considered a breakthrough in the management of IPF as anti-inflammatory and antifibrotic agents. Aim The aim was to evaluate the efficacy, tolerability, and adverse effects of pirfenidone and nintedanib in the management of IPF. Patients and methods A total of 50 patients (38 males and 12 females) were included in our study. IPF diagnosis was established according to the international guidelines. The patients were started on antifibrotic therapy with either pirfenidone or nintedanib. Clinical, functional, and radiological follow-ups were done for all patients prospectively at baseline, at 6 months, and at 12 months of therapy. Result The mean age of nintedanib group was significantly higher (78.41±6.8 vs 62.34±6.3 years for pirfenidone group; P<0.0001). Male sex was more prevalent (72% for pirfenidone group and 80% for nintedanib group). No significant differences in forced expiratory volume in the first second, forced vita capacity (FVC), forced expiratory volume in the first second/FVC, total lung capacity, and diffusion capacity of carbon monoxide % of predicted were found at baseline. At 6 months, High-resolution computed tomography showed significant regression of the disease in 33% of nintedanib group. At 12 months, there were significant improvements in FVC and diffusion capacity of carbon monoxide % predicted for nintedanib group. Skin rash, weight loss, and vomiting were the most frequent in pirfenidone group (28% for each), whereas 64% developed diarrhea in the nintedanib group. Drug discontinuation was significantly higher in the nintedanib group (24 vs 8% for pirfenidone group). Exacerbation on therapy was significantly higher in the pirfenidone group (36 vs 16% for nintedanib group). Conclusion Both pirfenidone and nintedanib appeared to stabilize a disease typically associated with progressive deterioration in the clinical, functional, and radiological parameters. Nintedanib had better clinical, functional, and radiological outcomes but also had lower tolerability and more serious AE than pirfenidone.

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Background The GeneXpert MTB/RIF assay is a new diagnostic test that depends on a real-time PCR analysis of the sample for diagnosis of tuberculosis (TB) and detection of rifampicin resistance. Aim The aim was to evaluate the role of role of GeneXpert in the diagnosis of sputum-negative pulmonary TB. Patients and methods This study included 30 patients suspected to have TB, with mean age being 45.5±17.7 years. All patients had clinical and radiological signs consistent with TB, positive tuberculin test results, and three negative Ziehl–Neelsen sputum smears. Patients having no or incomplete data were excluded from the study. Results This study included 30 patients suspected to be have TB, comprising 24 (80%) males and six (20%) females. Their age ranged from 18 to 70 years, with a mean age of 45.5±17.7 years. They were selected from the Chest Departments of Bab El-Sha’eria, Al-Hussein University, and El-Abbasia Chest Hospitals in the period from February 2017 to December 2017. All patients have clinical and radiological signs consistent with TB, positive tuberculin test results, and three negative Ziehl–Neelsen sputum smears. Our study showed that GeneXpert was positive in 11 (36.7%) patients and negative in 19 (63.3%) patients. Conclusion The GeneXpert assay can be used as a gold standard to diagnose TB. As it is sensitive and specific for diagnosing smear-negative pulmonary TB, the assay is faster than culture.

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Background Studies that validate new antituberculous regimens take much more time to complete as mycobacteria tend to be cleared slowly with absence of valid biomarkers to monitor treatment and outcomes. Aim To assess whether erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level would evaluate the patient’s response toward antituberculosis medication. Patients and methods A prognostic cohort study was conducted on 25 newly diagnosed multidrug-resistant patients with positive smear admitted to Abbasia Chest Hospital. Sputum Ziehl–Neelsen, culture, and GeneXpert were done. CRP and ESR were tested monthly till sputum conversion while other active illnesses were excluded with each assessment to avoid false results. Results The mean age of patients was 34.80±12.33 years; 56% of them were men and 52% were smokers. All patients presented with cough, expectoration, and toxic manifestations; 44% presented with hemoptysis. All patients received ethionamide, cycloserine, and levofloxacin. Pyrazinamide was used in 96% of patients; amikacin and kanamycin were used in 52 and 44% of patients, respectively. Eighty-eight percent of patients showed sputum conversion (80% in the second month and further 8% in the third month of treatment. The reported mortality rate was 12%. ESR and CRP showed a significant decrease within the period of treatment (P=0.03 and 0.02, respectively), with a significant decrease after sputum conversion (P=0.02 and 0.03, respectively). Conclusion CRP and ESR showed equal capabilities of monitoring response to therapy in multidrug-resistant-tuberculosis. None of them was superior to the other in monitoring response to therapy.

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Introduction Extubation failure significantly increases duration of mechanical ventilation and ICU length of stay with increased risk of mortality. So validating certain parameters to predict extubation outcome and avoid extubation failure is necessary. This study aimed at assessing the usefulness of the dead space addition (DSA) test and swallowing evaluation in predicting extubation outcome in mechanically ventilated patients with chronic obstructive pulmonary disease (COPD). Patients and methods Invasively mechanically ventilated patients with COPD considered as candidates for extubation were enrolled and subjected to simplified acute physiology score II calculation, assessment of cough strength, endotracheal secretions quantity, delirium, cuff-leak test, DSA test, and swallowing before extubation. Results A total of 90 patients with mean age of 62.26±7.01 years were enrolled. Overall, 76.9% of patients who failed the DSA test compared with 20.8% of those who accomplished it had failed extubation, and 57.1% of patients with defective swallowing compared with 10.9% of those with efficient swallowing had failed extubation, with a highly significant association between extubation outcome and both DSA fate and swallowing efficiency. Sensitivity, specificity, positive predictive value, and negative predictive value for DSA test were 38.5, 95.3, 76.9, and 79.2%, respectively, and for swallowing were 76.9, 76.6, 57.1, and 89.1%, respectively. An increase of simplified acute physiology score II by one unit increases extubation failure 1.25 times. Moreover, patients who tolerated DSA test whereas had defective swallowing had a likelihood of extubation failure 10 times. Conclusion DSA can predict extubation success and failure by the same power, but swallowing assessment can predict extubation success more than failure. Combined DSA intolerance and defective swallowing increase the prediction of extubation failure by 31 times.

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Objective This study aimed to evaluate the prevalence and type of anemia in patients with different chronic pulmonary diseases and its impact on the quality of life. Patients and methods The current study is a prospective observational study that was conducted at Chest Department, Minia University Hospital during the period from November 2015 to January 2017. A total of 247 patients with chronic pulmonary diseases (97 chronic obstructive pulmonary disease, 45 idiopathic pulmonary fibrosis, 80 bronchial asthma, 25 bronchiectasis) were included in our study. For all included patients the following were done,full history taking, assessment of the grade of dyspnea using modified medical research council dyspnea scale, assessment of BMI, chest ꞉ X ray (CXR), ECG and when indicated echocardiography, pulmonary functions tests, routine laboratory investigations, including complete blood count, liver function test, renal function test, serum electrolytes, erythrocyte sedimentation rate, C-reactive protein, measurement of arterial blood gases, measurements of serum erythropoietin, iron and total iron binding capacity, St George’s Respiratory Questionnaire was used for all patients to assess the health-related quality of life. Results Anemia occurs in 36.4% of all patients. It occurs in 46.4% of chronic obstructive pulmonary disease patients, 37.8% of idiopathic pulmonary fibrosis patients, and 12.5% of patients with asthma and in 68% of patients with bronchiectasis. Normocytic normochromic anemia was the predominant type of anemia in the studied patients. There was a significant difference between anemic patients and patients with normal hemoglobin (Hb) with respect to smoking index, comorbidities, forced expiratory volume 1, forced vital capacity, and PO₂. C-reactive protein and erythrocyte sedimentation rate were significantly higher in the anemic group. Serum iron and total iron binding capacity were significantly lower in the anemic patients, whereas erythropoietin was significantly lower in patients with normal Hb. Anemic patients had significantly higher medical research council dyspnea scale and number of exacerbation than patients with normal Hb. Anemic patients had significantly higher score in all the components of St George’s Respiratory Questionnaire. Conclusion Anemia is commonly associated with comorbidity in patients with chronic pulmonary diseases. The presence of anemia has a negative impact on the patient’s quality of life. Anemia was significantly associated with; the severity of impairment of lung functions, level of systemic inflammatory markers, presence of other comorbidities, and the smoking index. It was also associated with increased severity of dyspnea and frequent exacerbations.

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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.

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Digital clubbing is an important clinical sign that is usually associated with serious condition. Most of the diseases causing clubbing are thoracic, but it is sometimes seen in gastrointestinal or endocrinal disorders. In heavy smokers, thoracic malignancy is the most important entity that needs to be ruled out in patients who exhibit clubbing. Here, we will present a case in which a male heavy smoker who exhibited acute exacerbation of chronic obstructive pulmonary disease and had clubbing, neither had any malignancy on chest computed tomography nor any other medical explanation for the sign. Six months after the first presentation, the patient developed pleural effusion that turned out to be mesothelioma.

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Noninvasive positive pressure ventilation (NPPV) means application of ventilation through patient’s upper airway by an interface without an endotracheal tubeortracheostomy. The efficacy of NPPV depends on the selection of equipment and interface, good clinician experience,and meticulous monitoring during NPPV. Several interfaces are available with nasal and oronasal types are the most common. The most common troubleshooting of NPPV are leak, CO₂ rebreathing, mask problems, and asynchrony.

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Background Bronchoscopy is a well-established maneuver in pulmonary medicine. It is an important method in the diagnosis, staging, and treatment of lung cancer and other pulmonary diseases. Various diagnostic techniques such as bronchial biopsy, bronchial washing and brushing, and transbronchial lung biopsy are used during fiberoptic bronchoscopy to increase the diagnostic yield of the procedure. Rigid and fibreoptic bronchoscopes remain complementary techniques, and are usually used concurrently during many procedures. Aim The aim of this study was to study the indications and outcome of bronchoscopic workup in the Bronchoscopy Unit, Chest Department, Ain Shams University Hospital in the period from May 2013 to October 2013. Patients and methods All patients undergoing either fiberoptic bronchoscopy or rigid bronchoscopy were subjected to full history and clinical examination, and monitored regarding their preprocedure investigations, procedure details and sampling techniques, postprocedure complications, and finally the patients were followed up regarding their histopathological and bacteriological results. Results One hundred cases were monitored, 65 male patients and 35 female patients. The mean age of the patients was 50.92±20.099 years. Fifty-six patients were smokers, whereas 44 patients were nonsmokers. The most frequent presenting symptom was dyspnea in 50% of cases, followed by hemoptysis in 27% of cases. Adenocarcinoma was diagnosed in seven patients, squamous cell carcinoma was diagnosed in six patients, small-cell lung cancer was diagnosed in four patients, and large-cell lung cancer was diagnosed in three patients. In 15 (40.54%) cases, the histopathological results were inflammatory, nonconclusive to malignancy. All patients with lung cancer showed radiological abnormalities. Two cases were diagnosed as TB in spite of their workup of TB such as tuberculin test and sputum Z&N being negative. There were no mortalities. There was no bronchoscopy-related complications in 85% of cases, whereas four (4%) cases suffered bleeding during biopsy and debulking of the tumor, which was controlled by local hemostatic measures In eight (8%) cases most of whom were smokers, suffered desaturation, due to prolonged time of the procedure. They were not hypoxic before the beginning of bronchoscopy. Only two (2%) cases were mechanically ventilated due to bleeding and hypoxia during and/or after the procedure, and one case had surgical emphysema, which was managed conservatively. Conclusion Bronchoscope is a very effective and safe procedure; safety and effectiveness obviously depend on the accuracy of selection of the patients for the procedure, the experience of the bronchoscopist, and on the facilities available. Proper use of diagnostic techniques provides a high degree of success, and the treatment modality to be used depending on the type of the lesion is mostly satisfactory.

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Context Hospital-acquired pneumonia (HAP) is one of the nosocomial infections with a high mortality rate. The CURB 65 score (confusion, urea, respiratory rate, blood pressure, age 65) in HAP and Ventilator-associated pneumonia (VAP) patients in Turkey had area under curve (AUC) 0.747, but research in Indonesia had AUC 0.376. Aims We evaluated the ability of CURB 65 score to predict early mortality in 14 days from HAP diagnosis. Settings and design This was a prospective cohort study at Cipto Mangunkusumo Hospital (RSCM) that was carried out during the period October 2017–April 2018. Patients and methods The outcome of the study was patient mortality within 14 days from HAP diagnosis. CURB 65 score was evaluated in the first 24 hours of diagnosis of HAP. Performance and discrimination of CURB 65 score was evaluated with AUC. Statistical analysis The statistical analysis is STATA. Results A total of 92 of the HAP patients were included in the study with mortality in 14 days being 43.48%. Survival analysis in the second, third, and seventh day were 95.66, 88.04, and 70.65%. Performance discrimination CURB 65 score with AUC was 0.811 [confidence interval (CI)95%: 0.72–0.89]. The CURB 65 score greater than or equal to 2 showed an increase of mortality probability in 14 days twice, which could be used to assess needs for high care/intensive care in HAP patients with a sensitivity of 95.24%, and specificity of 54.93%, Risk ratio (RR) of 2.21 (CI95%: 1.41–3.46), and AUC of 0.76 (CI95%: 0.66–0.87). Score greater than or equal to 3 could be used to assess needs for mechanical ventilation with a sensitivity of 77.78% and specificity of 77.11%, RR of 3.41 (CI95%: 1.60–7.25), and AUC of 0.86 (CI95%: 0.76–0.96). Conclusion A CURB 65 score can be used to predict 14-day mortality in HAP patients; a score greater than or equal to 2 needs special attention because it indicates an increase in mortality probability.

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This article is a small piece of mind intended to scrutinize the international asthma guidelines with a sprinkle of subtle criticism toward standard guidelines. As aspiring doctors, we must not always merely adopt international standards, but always stay armed with our knowledge and regional experience to improve, innovate, and revolutionize them to reach utmost efficiency and productivity. The aim of this work is to review old national and international clinical judgment and the recent guidelines of asthma management in an attempt to look at an alternate view on asthma medications. The article concludes that, in the context of escalation and de-escalation therapies for asthma, one should consider independent future risk factors in asthma control, based on clustering of asthma phenotypes and rather than upon patients’ symptoms.

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Background Burnout is considered an epidemic in modern society, and the issue of occupational stress and burnout is receiving increasing attention worldwide. Aim The aim was to detect the prevalence of burnout syndrome (BO) among ICU health care workers in Canal health sector and to clarify its determinants and consequences. Patients and methods A cross-sectional study was conducted on 147 physicians and 234 nurses. To detect the determinants of BO, data on sociodemographic variables, job-related issues, work environment, health problems, bad social habits as an outlet for job stress, committing unintended job-related mistakes, and infection control measures were collected. Burnout was assessed using the Maslach burnout inventory and its subscales. Results Regarding the total burnout scale, 68.2% of the study participants reported having a moderate level of burnout, with significant difference between physicians and nurses. More than half of the nurses had high emotional exhaustion compared with 38.8% of physicians. For the depersonalization subscale, 59.8% of nurses had higher scores compared with 70.1% of physicians (P<0.001). Approximately half the physicians experienced highly reduced feelings of personal accomplishment, and the rate was lower among nurses (P=0.001). Being resident physician, feeling unappreciated, and sleep deprivation were the predictors of burnout. Approximately one-third of them reported catching infection from patients. There was a negative correlation between loss of accomplishment subscale of BO and mortality. Conclusion Approximately one-quarter of nurses and physicians have high levels of BO syndrome. Being resident, sleep deprivation, and lack of appreciation were significant predictors of BO.

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Background Chest tubes are cornerstone for draining fluid in empyema. Insertion of an intercostal tube is considered an invasive intervention with significant morbidity. In a trial to avoid potential complications, the use of pigtail catheter instead of conventional chest tube in pleural drainage has been tried. The aim of current study was to observe the benefit of pigtail drainage over chest tube for draining empyema. Methods It was an observational prospective study. A detailed history and clinical evaluation were done for all patients. Patients were treated by either intercostal tube or pigtail catheter insertion depending on judgment of treating physician. Sonography guided insertion was done when needed. Outcomes of interest were duration of drainage, duration of analgesics use and time of hospital stay. Results Sixty patients were included in present study. Thirty patients were subjected to conventional intercostal tube, Another 30 patients were subjected to pigtail catheters. There were no significant differences regarding outcome, duration of drains, duration of antibiotic use and time of hospital stay in two groups. Duration of analgesics use was significantly lower in pigtail group. Conclusions The pigtail catheter gives dependable treatment for empyema and is a safe and less traumatic option than chest tube. There was no significant difference regarding outcome, duration of drains and time of hospital stay in two groups.

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Background Neutrophil/lymphocyte percentage is a helpful test for evaluation of systemic inflammation. This study aimed to investigate neutrophil/lymphocyte percentage as an evidence of control status in bronchial asthma. Patients and methods The study included 45 (20 males and 25 females) patients and 45 apparently healthy subjects. Full clinical evaluation, complete blood count (CBC) with differential white blood cell count, Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and total IgE measurement were done for participants. Results Neutrophil/lymphocyte percentage and CRP were higher in asthmatics than controls (statistically significant difference), and they were significantly increased with uncontrolled asthma. Neutrophil/lymphocyte percentage could predict uncontrolled asthma with a sensitivity of 66.7%, specificity of 75.6%, positive predictive value of 73.2%, negative predictive value of 69.4% and accuracy of 71.1%. Neutrophil/lymphocyte percentage increased in asthmatics with asthma control test (ACT) less than 20 versus patients with ACT of at least 20 (statistically significant difference), whereas neutrophil/lymphocyte percentage did not differ significantly among the patients with asthma regarding sex and smoking. Neutrophil/lymphocyte percentage had direct proportional relation with CRP and ACT, whereas the relations between neutrophil/lymphocyte percentage and age, eosinophils, IgE, Forced expiratory volume in first second (FEV₁%), duration of the disease, or number of attacks per year were nonsignificant. No significant correlation was found between controlled and uncontrolled cases regarding total leukocyte count (TLC), duration, and onset of the disease. The number of attacks was significantly higher in uncontrolled cases than controlled ones. Conclusion Neutrophil/lymphocyte percentage could predict uncontrolled asthma with high sensitivity and specificity. Neutrophil/lymphocyte percentage is a rapid, inexpensive method with routine CBC analysis and could be a useful predictor of asthma control.

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Background Tuberculosis (TB) is an infectious disease of public health concern. Many reports pointed to the association between TB and thromboembolic diseases. The aim of the present study is to assess the prevalence of pulmonary embolism in patients with severe pulmonary TB. Patients and methods The study was done on 50 (35 males and 15 females) patients with severe pulmonary TB, and all patients were proved to have pulmonary TB by sputum or BAL examination and culture. In all patients, causes of hypercoagulability state were excluded, and computed tomography (CT) pulmonary angiography was done to search for evidence of pulmonary embolism. Results Eight of 50 (16%) patients had evidence of pulmonary embolism, six (12%) patients had pulmonary embolism on the segmental and subsegmental level, and two (4%) patients had pulmonary embolism in the main pulmonary artery branches. The diagnosis of pulmonary embolism was done only by CT pulmonary angiography, as clinical and chest radiography signs were masked by those for pulmonary TB. Patients with evidence of pulmonary embolism were more hypoxic and had higher levels of D-dimer, but the difference was not statistically significant. Conclusion Pulmonary embolism should be searched for in patients with severe pulmonary TB. CT pulmonary angiography is the standard method for diagnosis and can be performed in those patients who are more hypoxemic. Prophylactic anticoagulation management can be justified in these patients. Larger studies are needed to define the risk factors in patients with severe pulmonary TB who are at an increased risk of developing pulmonary embolism.

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Aim of the work Studying the prevalence of latent TB infection among people infected with hepatitis C virus for preventing emergence of active tuberclous disease during treatment of hepatitis C virus with antiviral drugs that cause immunosuppression. Patients and method The study was performed on 75 patients who were divided into two groups ; group A (hepatitis C group) which was 45 patients and group B (control group) which was 30 patients. A written consent was taken from patents who underwent the study. Patients underwent: 1. History taking. 2. Examination: general and local chest examination. 3. Radiology: chest x-ray. 4. tuberculin skin test with (PPD) 5. QuantiFERON TB testing (interferon gamma release assay {IGRA}). Results The mean age of (54.9±10.23) in group A (hepatitis C group) and (61.1±9.2) in group B (control group). In group A there are 30 males (66.7%) and 15 females (33.3%) while in group B there are 16 males (53.3%) and 14 females (46.7%) with no significance difference between the two groups. In group A there are 9 patients (20%) with positive tuberculin test and 36 patients with negative test while in group B there are 4 patients (13.3%) with positive test and 26 patients (86.7%) with negative test . there is no significant difference between the two groups regarding tuberculin test. Regarding QuantiFERON TB Gold test, In group A there are 15 patients (33.3%) with positive test and 30 patients (66,7%) with negative test while in group B there is 4 patients (13.3%) with positive test and 26 patients (86.7%) with negative test. There is significant difference between the studied groups regarding QuantiFERON TB gold test. Summary and conclusion People infected with hepatitis C virus should undergo testing for latent TB for preventing emergence of active tuberculous disease during treatment of hepatitis C virus with antiviral drugs that cause immunosuppression. QuantiFERON test is preferred more than tuberculin test in detecting latent TB in patient with hepatitis C because tuberculin test may be falsely negative in patient with immunosuppression and hepatic patients which may give unreliable results.

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Background The diagnostic role of medical thoracoscopy and image-guided pleural biopsy in patients with undiagnosed exudative pleural effusion has increased over the last few years. Objective The aim was to compare the efficacy and safety of medical thoracoscopy versus image-guided [ultrasound (US) and computed tomography] pleural biopsy in the diagnosis of pleural lesions. Patients and methods A total of 40 patients with undiagnosed pleural lesions were divided into two groups. After full investigations, pleural biopsies were taken by medical thoracoscopy and the image-guided technique in groups I and II, respectively. Results In group I, the results of 19 (95%) patients yielded a positive diagnosis, whereas in group II, the results of 17 (85%) patients yielded a positive diagnosis (where results were positive in 80% of US-guided biopsies and 90% in computed tomography-guided biopsies), with no significant difference in the diagnostic yield of the two groups. The US-guided biopsy showed significantly the least duration (P=0.001). Complications were significantly fewer in the image-guided biopsy group (P=0.008). The mean duration of hospital stay was significantly less in the image-guided group than in the medical thoracoscopy group (P=0.001). In conclusion, the overall diagnostic yield is comparably high for medical thoracoscopy and image-guided pleural biopsies, and both are complementary techniques used in different clinical situations. Each diagnostic procedure has its own advantages and disadvantages. Image-guided biopsy is less invasive and can be carried out as an outpatient procedure, whereas medical thoracoscopy provides diagnostic and therapeutic capabilities in one setting.

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The lungs are particularly susceptible to infection, owing to continuous direct interaction with the external atmosphere in the process of gas exchange, and many anatomical facts, such as the presence of the pharynx, which constitutes a common pathway for both of the lung and stomach. With the process of development of many new generations of antibiotics, pneumonia still continues to be an important unsolved problem worldwide. Community-acquired pneumonia is still considered a problem and is associated with significant morbidity and mortality with cost load, especially with the emergent pathogens that presented with aggressive pictures of community-acquired pneumonia.

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Introduction Research into sleep practice of Egyptian youths is scanty and poorly disseminated, and therefore, relatively deficient data are available to put into practice. Adequate sleep practice is useful for both physical and mental health and improves the overall performance. It can also delay neurodegenerative changes in elderly. Aim The aim was to survey sleep practice and sleep-related problems among the Egyptian youths and to put the question of sleep education in practice. Participants and methods A cross-sectional study was conducted including 594 Egyptian youths randomly selected from university students and social club attendants in Mansoura, Egypt. An anonymous self-report questionnaire was prepared to elicit data on participants’ demography, sleep practice, and disorders. Results Of the 594 youths examined, 59.6, 29.5, and 12.1% reported insomnia, daily sleepiness, and sleep deprivation, respectively. Smoking was significantly associated with insomnia and high risk of obstructive sleep apnea. The median values for the time of getting into bed and sleep duration in working day and weekend were 1:00 a. m., 8 h, and 10 h, respectively. Approximately 50% reported afternoon naps with median duration of 2 h. Conclusion Sleep problems constitute a significant issue in youths. Sleep education and counseling for appropriate lifestyle and proper sleep practice may minimize the magnitude and effects of these problems.

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Introduction Continuous positive airway pressure (CPAP) remains the gold standard treatment for obstructive sleep apnea (OSA). CPAP titration can be done using manual titration or using autotitrating continuous positive airway pressure (APAP) devices. Moreover, CPAP titration can be done using full-night or split-night protocol. The aim of the study was to compare between the use of APAP and manual titration to determine the needed CPAP pressure during split-night polysomnography for diagnosis and treatment of OSA. Patients and methods A total of 100 patients with severe OSA were enrolled after exclusion of patients with heart failure or respiratory failure. After diagnostic polysomnography, patients were divided into two groups: group 1 was offered manual CPAP titration and group 2 was offered APAP titration. The time for CPAP titration was at least 4 h in both groups. Results Both groups were matched regarding age, sex, BMI, sleep parameters, and apnea–hypopnea index (44.52±7.81/h in group 1 and 42.66±9.68/h in group 2 with no statistical significance). After CPAP titration, apnea–hypopnea index was significantly improved in both groups. The time needed to reach the therapeutic pressure was significantly lower in group 2 than in group 1. Moreover, attended technician was needed only in group 1. Conclusion The use of APAP was equal to manual titration in this group of patients with severe OSA, with decreased cost and lesser time to reach the therapeutic pressure. Large multicenter trials are needed to modify the guidelines in view of using APAP in split-night protocol for diagnosis and treatment of OSA.

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Context Acute cor pulmonale (ACP) is a common sequela in patients with acute respiratory distress syndrome (ARDS) and represents the most severe presentation of right ventricular dysfunction, secondary to pulmonary vascular dysfunction. Although most previous studies adopted transesophageal echocardiography in the diagnosis of ACP in patients with ARDS, transthoracic echocardiography (TTE) appears as a promising alternative, being noninvasive and more available with continuously improving expertise in its use by ICU physicians. Aims Our study aimed to test the accuracy of ACP risk score by TTE. Settings and design This is a prospective observational cross-sectional study that was carried out over 6 months in our department. Patients and methods Our study was carried out on 45 mechanically ventilated patients with ARDS, who had been subjected to lung-protective approach. TTE was performed within the first 72 h of ARDS diagnosis. ACP was diagnosed when the ratio of right ventricular/left ventricular end-diastolic area more than 0.6 on parasternal short-axis view or apical four chambers view associated with interventricular septum dyskinesia in a parasternal short-axis or long-axis view at end-systole. ACP risk score parameters were checked and scored; (one point for each parameter). It consisted of pneumonia, hypercapnia arterial carbon dioxide tension of at least 48 mmHg, driving pressure of at least 18 cmH₂O, and arterial oxygen tension/fractional inspired oxygen less than 150 mmHg. Qualitative data were described using number and percentage. Quantitative data were described using mean and SD, median, minimum and maximum. Comparison between different groups’ variables had been tested using χ²-test. Receiver operating characteristic curve expressed a recommended cutoff. The area under the receiver operating characteristic curve denotes the diagnostic performance of the test. Area of significance of the obtained results was judged at the 5% level (P<0.05). Results ACP risk score showed high sensitivity (100%), average specificity (51.43%), and good overall accuracy (62.2%) when score of at least 2 was used as a cutoff value. Hypercapnia, pneumonia, hypoxia, high plateau pressure, and positive end-expiratory pressure were associated with increased ACP incidence in patients with ARDS. Conclusion ACP risk score is a highly sensitive score in predicting and diagnosing ACP in patients with ARDS.

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Background Ventilator-associated pneumonia (VAP) remains a morbid and prevalent problem throughout the world. Lung ultrasound (LUS) is increasingly being used at the bedside for assessing alveolar-interstitial syndrome, lung consolidation, pneumothorax, and pleural effusion. Purpose The aim was to focus on the use of bedside LUS alone and in association with the clinical pulmonary infection score (CPIS) in early diagnosis of VAP, to describe the sonographic features, to compare between LUS and portable chest radiography (CXR) in early diagnosis of ventilator-associated pneumonia (VAP), and weather LUS affects the prognostic outcomes of VAP. Patients and methods A total of 40 patients with suspected VAP were enrolled. Portable CXR, LUS, and computed tomography scan (gold standard) were performed. The CPIS was calculated for early and reliable diagnosis of VAP. The prognostic outcomes were highlighted. Results Among forty VAP-suspected cases, 30 (75%) were confirmed using computed tomography (gold standard). LUS imaging of VAP cases diagnosed 28 (70%) with consolidation, 89.3% of them with air bronchogram, and 32.5% of them with pleural effusion. Validity for early VAP diagnosis using portable CXR demonstrated 86.7, 100, 100, 71.4, and 90%; ultrasound 93.3, 100, 100, 83.3, and 95%; whereas CPI score 50, 90, 93.8, 62.5, and 60% regarding sensitivity, specificity, positive predictive value, negative predictive value, and accuracy, respectively. CPIS combined with LUS revealed higher sensitivity (96.7%) and accuracy (97.5%). Low CPIS less than or equal to 6, modes of mechanical ventilation (continuous positive airway pressure and biphasic positive airway pressure), shorter duration of respiratory support, LUS imaging of air bronchogram and simple pleural effusion were significantly associated with improved outcomes of VAP cases. The duration of mechanical ventilation and early detection of air bronchogram by LUS were the independent mortality predictors with odds ratio of 2.4 and 3.11 and 95% CI of 1.56–4.55 and 1.8–17.66, respectively. Conclusion LUS was a reliable tool for early VAP diagnosis at the bedside. Combination approach increases the prognostic and diagnostic accuracy of LUS in VAP.

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Vocal cord dysfunction (VCD) is the abnormal adduction of the vocal cords during inspiration or expiration that results in varying degrees of airway obstruction. VCD is more common in female patients and usually presents during childhood or adolescence and continues up to age 40 years. Studies have found an increased prevalence of VCD in female athletes and academic high-achievers compared with the general population. VCD is often misdiagnosed as asthma or exercise-induced bronchospasms because of similarities in clinical presentation. As misdiagnosis results in inappropriate pharmacotherapy, it is important for the pharmacist to have a thorough understanding of VCD to differentiate it from asthma and exercise-induced bronchospasms.

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Setting Tuberculosis (TB) still remains one of the major health problems facing humans. India accounts for almost a quarter of TB cases worldwide. The scenario is worsening owing to multidrug resistant-tuberculosis (MDR-TB). Assessment of local prevalence rates and detection of MDR-TB are important to rationalize therapy and prevent spread of resistant strains in community. Objective The study was undertaken to understand drug sensitivity patterns of tubercle bacillus and assess resistance trends in Meghalaya. Designs Specimens were screened for acid-fast bacilli, decontaminated by N-acetyl cysteine–sodium hydroxide method, and subsequently inoculated onto Lowenstein–Jensen media. Characteristic growth was biochemically identified as TB bacillus. Drug sensitivity assessment to first-line anti-TB drugs was performed by proportion method and sensitivity patterns noted. Results Among 103 specimens received, 23 showed acid-fast bacilli. Male to female ratio was 3 : 2. Fourteen (13.6%) pure isolates of Mycobacterium spp. were obtained. Biochemically 10 isolates were confirmed as M. tuberculosis. Drug sensitivity profile revealed highest mono resistance to isoniazid and streptomycin. Two (20%) isolates were MDR. Conclusion The study gives a brief overview of the menace of TB in Meghalaya. The study results provide valuable information about presence of primary MDR-TB and provide basis for future larger field surveys.

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The diagnostic ability and specificity of interventional bronchoscopy procedures has been renovated in the past decade. The evaluation of abnormal thoracic findings including lung nodules and masses, mediastinal lymphadenopathy, and pleural diseases has been revolutionized using these techniques, minimizing the need for more invasive procedure especially in patients with compromised lung functions.

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