Adel Salah Bediwy

L-Carnitine Improves the Asthma Control in Children with Moderate Persistent Asthma

The objective. was to investigate L-Carnitine level and the effects of its supplementation in children with moderate persistent Asthma. Methods. Free and total serum carnitine levels were measured in 50 children having moderate persistent asthma and 50 healthy control children. The patients group was randomly divided into two subgroups. Subgroup A was supplemented with L-carnitine for 6 months while subgroup B was used as a placebo controls. Both subgroups were assessed by pulmonary function tests (PFT) and childhood-asthma control test (C-ACT) before and 6 months after carnitine supplementation. Results. Total and free carnitine levels were significantly lower in patient group than in control group. PFT and C-ACT showed significant improvements in asthmatic children supplemented with L-carnitine than in those who were not supplemented. Conclusion. L-carnitine levels were initially lower in moderate persistent asthmatic children as compared to healthy control children. Asthmatic children who received L-carnitine supplementation showed statistically significant improvement of C-ACT and PFT.

Induced Sputum Substance P in Children with Difficult-to-Treat Bronchial Asthma and Gastroesophageal Reflux: Effect of Esomeprazole Therapy

Objectives. To assess the induced sputum substance P (ISSP) levels in children having difficult-to-treat asthma (DA) with and without gastroesophageal reflux (GER). We aimed also to evaluate the association of GER with childhood DA, relationship of GER severity with childhood asthma control test (C-ACT), FEV1, peak expiratory flow (PEF) variability, and ISSP. Finally, we tried to evaluate esomeprazole treatment effect on C-ACT and FEV1 in children with DA. Methods. Spirometry, C-ACT, upper gastrointestinal endoscopy, and ISSP measurement were done for children with DA compared to healthy controls. Results. ISSP was high in DA with higher levels in the group having associated GER. In the latter group, ISSP and C-ACT improved significantly after esomeprazole treatment while FEV1 and PEF variability did not improve. Reflux severity was positively correlated with ISSP and negatively correlated with FEV1. Conclusions. GER was found in 49% of our patients with childhood DA. Very high ISSP levels in children with DA may be used as a marker for presence of GERD. Esomeprazole therapy improved asthma symptoms but did not improve lung function.

Sleep apnea in children with refractory monosymptomatic nocturnal enuresis.

Background Children with nocturnal enuresis (NE) are believed to have deep sleep with high arousal threshold. Studies suggest that obstructive sleep apnea–hypopnea syndrome (OSAHS) and NE are common problems during childhood. We sought to assess the prevalence of OSAHS in children with refractory NE and whether its severity is associated with the frequency of bedwetting. Methods The study group comprised 43 children with refractory monosymptomatic NE and a control group of 30 children, both aged 6–12 years. All subjects underwent thorough neurological examination, one night of polysomnography only for the patient group, and a lumbosacral plain X-ray to exclude spina bifida. Results The groups were well matched. Two subjects of the control group had mild OSAHS. The mean age of the patients was (9.19±2.4 years), 26 were boys, and 67% showed frequent NE (>3 days bedwetting/week). Patients with NE had significantly higher rates of OSAHS (P<0.0001); three patients had mild, 12 had moderate, and eleven showed severe OSAHS. There was no significant statistical difference among patients having OSAHS in relation to age, sex, or family history of NE. The frequency of bedwetting was statistically significantly higher in patients with severe OSAHS (P=0.003). Conclusion Patients with refractory NE had a significantly higher prevalence of OSAHS with no sex difference. The frequency of bedwetting was higher in patients with severe OSAHS.

Pigtail Catheter Use for Draining Pleural Effusions of Various Etiologies

Background. Use of small-bore pigtail catheter is a less invasive way for draining pleural effusions than chest tube thoracostomy. Methods. Prospectively, we evaluated efficacy and safety of pigtail catheter (8.5–14 French) insertion in 51 cases of pleural effusion of various etiologies. Malignant effusion cases had pleurodesis done through the catheter. Results. Duration of drainage of pleural fluid was 3–14 days. Complications included pain (23 patients), pneumothorax (10 patients), catheter blockage (two patients), and infection (one patient). Overall success rate was 82.35% (85.71% for transudative, 83.33% for tuberculous, 81.81% for malignant, and 80% for parapneumonic effusion). Nine cases had procedure failure, five due to loculated effusions, and four due to rapid reaccumulation of fluid after catheter removal. Only two empyema cases (out of six) had a successful procedure. Conclusion. Pigtail catheter insertion is an effective and safe method of draining pleural fluid. We encourage its use for all cases of pleural effusion requiring chest drain except for empyema and other loculated effusions that yielded low success rate.

Comparison between the effect of heated and humidified high-flow nasal oxygen and conventional oxygen during acute hypoxemic respiratory failure

Background Hypoxemia is the most serious threat to organ function. Therefore, the goal is to reverse tissue hypoxia. The aim of this study was to compare heated and humidified high-flow nasal cannula (HFNC) with conventional low-flow nasal cannula (LFNC) oxygen therapy in acute hypoxemic respiratory failure (RF). Patients and methods This prospective study was conducted on 60 patients with acute hypoxemic RF. Patients were randomly classified into two groups. Group I received LFNC oxygen therapy. Group II received heated humidified HFNC oxygen therapy. Comparison between the two groups was made using dyspnea scales, heart rate, respiratory rate, and oxygenation status. Results There were no statistically significant differences as regards age, sex, smoking status, causes of RF, and presence of comorbidities between the two groups. There was no statistically significant difference in the modified Borg scale and visual analog scale (VAS) score between the two groups at baseline (P>0.05). After 24 h, the HFNC group had a significant decrease in these scores (P<0.05). Respiratory rate and heart rate significantly decreased, whereas arterial oxygen saturation and tension increased significantly in the HFNC group compared with the conventional LFNC group (P<0.05). Only one patient in the HFNC group versus three patients in the LFNC group required mechanical ventilation. Two patients experienced nasal discomfort in the HFNC group versus five patients in the LFNC group. Conclusion Treatment of acute hypoxemic RF with HFNC was associated with better and rapid improvement in oxygenation when compared with LFNC, with fewer side effects, better convenience, and lesser need for mechanical ventilation.

Serum neopterin level in cases of pulmonary tuberculosis and pneumonia

Background: Pulmonary tuberculosis (TB) sometimes has diagnostic difficulties and a lot of differential diagnosis such as pneumonia. The aim of this work was to assess the role of serum neopterin in differentiating between pulmonary TB and pneumonia and to estimate the effect of antituberculous drugs for 2 months on serum levels of neopterin in patients with pulmonary TB. Patients and methods: We measured serum neopterin in patients with TB, pneumonia patients, and controls. Serum neopterin was measured again after 2 months of antituberculous therapy in patients with pulmonary TB. Results: Serum neopterin was significantly higher in tuberculous patients than in pneumonia patients, with a sensitivity of 90% and a specificity of 80% at an optimal cut-off value of 20.5 nmol/l. It decreased significantly after 2 months of antituberculous therapy in tuberculous patients. Conclusion: Serum neopterin levels significantly increase in pulmonary TB and correlate with the radiological extent of the disease. Combined anti-TB treatment decreases the levels of serum neopterin. Measurement of the serum neopterin levels may be useful in following up the drug response in pulmonary TB. Serum neopterin levels may also be helpful in discriminating pulmonary TB from pneumonia.

Doppler Echocardiographic Changes in Respiratory Diseases

The heart is one of the most important organs which can be affected by several systems including respiratory system. The in common function of both heart and lung is to provide tissues with oxygen and to get rid of the Carbon dioxide. So; they work in harmony and interact in a proper way with each other. This interaction may be neural, mechanical and/or humeral. The neural effects are either central through the brain stem centres in medulla oblongata or peripheral through baro-reflexes or lung-stretch reflexes. Being together inside the thoracic cavity; the heart can be affected by lung inflation and deflation. This is called mechanical heart–lung interactions (Figure 1).