Aliae Mohamed-Hussein

Risk of lung cancer in patients with preinvasive bronchial lesions followed by autofluorescence bronchoscopy and chest computed tomography

OBJECTIVES To assess risk of lung cancer (LC) in patients with preinvasive bronchial lesions and to identify factors associated with higher risk. METHODS 124 patients with one or more preinvasive bronchial lesions and normal chest computed tomography (CT) (mean age 66.7 years, 121 males and 3 females), followed-up by white light and autofluorescence bronchoscopy (AFB) every 4-6 mo and chest CT every 6-12 mo, end points were development of carcinoma in situ (CIS) or LC. RESULTS Among 124 patients with 240 preinvasive bronchial lesions, 20 CIS or LC lesions were detected during follow-up in 20 (16%) patients, 7 were detected as new endobronchial lesions, 10 as new peripheral lesions and 3 as local progression from severe dysplasia to CIS. Median time to progression from the same site or development of CIS/LC elsewhere was 24 months (range: 6-54 mo). The Cumulative risk of development of CIS/LC was 7% at one year, 20% at three years and 44% at 5 years. Among detected lung cancers, 80% were stage 0 or stage I and underwent treatment with curative intent. Diagnosis of new SD during follow-up (p=0.0001), chronic obstructive pulmonary disease (COPD) (p=0.001) or smoking index >52 pack-year (p=0.042) was associated with higher risk. Even after controlling for other risk factors, COPD was associated with risk for lung cancer. Baseline lesion grade was not predictive of patient outcome (p=0.146). CONCLUSION Patients with preinvasive bronchial lesions, especially those with new SD during follow-up, COPD or smoking >52 pack-year are at high risk of LC, AFB and CT follow-up facilitated early detection and treatment with curative intent.

Epidemiology of bronchial asthma among preparatory school children in Assiut district

Background: The prevalence of asthma and allergies is increasing in both Western and developing countries. Few studies evaluated asthma prevalence in Egypt . Objectives: Determination of the prevalence and risk factors of asthma among preparatory school children in Assiut district, in Upper Egypt. Methods: A cross sectional study was conducted among preparatory school students in Assiut city and two rural areas in Assiut district in Upper Egypt. Twelve schools were selected randomly from different regions in Assiut city and two rural areas one to the North and the other to the South of Assiut city. The total coverage of the students included was 1048 (482 boys and 566 girls). Data were collected by self-administered questionnaire (in Arabic Language) which was filled by the participants. Results: Of the 1048 positively responding subjects, 65 fitted the diagnosis of asthma with over all prevalence of 6.2%. No significant difference was found between urban and rural areas (P = 0.075). Using logistic regression analysis: a positive family history of allergy and the presence of other one or more allergic diseases were significantly associated risk factors for asthma. Exposure to dust, cigarette smoke, playing and physical activity, common cold attacks, and special food or drinks were the most common triggering factors for asthma exacerbations . Conclusion: Bronchial asthma is a significant health problem among children and adolescents in Assiut district and needs special medical care. Wider scale multi-center studies in upper Egypt and other localities of Egypt are needed to outline the profile of bronchial asthma among children and adolescents in the whole country. Keywords: prevalence of asthma, preparatory school children, Assiut district Egypt J Pediatr Allergy Immunol 2012;10(2):109-117

Lean BMIs as markers of malnutrition in chronic obstructive pulmonary disease patients

Background Malnutrition is common in chronic obstructive pulmonary disease (COPD) and a relevant concern that may even affect prognosis. A significant number of COPD patients with normal weight also suffer muscle wasting. Objective The aim of this study was to assess the nutritional status of COPD patients with chronic respiratory failure. Patients and methods The present prospective analytic case-control study was conducted in the Chest Department, Assiut University Hospital, during the period from January 2013 to February 2014. Sixty-seven COPD patients with chronic respiratory failure and 68 controls were studied according to their nutritional status and body composition using creatinine height and fat-free mass indices. Results The majority of COPD patients were found to be overweight. As regards body composition, the lean body mass using the fat-free mass index and the creatinine height index was significantly decreased in COPD patients compared with controls. Conclusion Malnutrition is a common feature among COPD patients. COPD patients have significantly decreased lean body mass.

Beta 2 Adrenergic Receptor Genetic Polymorphisms in Bronchial Asthma: Relationship to Disease Risk, Severity, and Treatment Response

BackgroundThe β2-adrenergic receptor gene is one of the most extensively studied genes with respect to asthma prevalence and severity. The Arg16Gly and Gln27Glu polymorphisms in the β2-adrenergic receptor gene cause changes in the amino acids sequence of the receptor which may cause alteration in response to bronchodilators and the risk of asthma.ObjectiveThe purpose of the study was to determine the association between β2-adrenergic receptor gene polymorphisms and asthma risk, severity and response to therapy.Subjects and Methods58 asthmatic patients and 38 healthy subjects were included. The β2-adrenergic receptor polymorphisms genotyping was done using Real-Time polymerase chain reaction.ResultsThe allelic frequencies for the Arg16Gly polymorphism were 15.5%, 48.3%, and 36.2% for the homozygous A wild, heterozygous, and homozygous G mutant alleles in asthmatics (P < 0.01) and 5.3%, 47.4%, and 47.4% in healthy subjects (P < 0.01). For the Gln27Glu polymorphism, the allelic frequencies for the homozygous C wild, heterozygous and homozygous G mutant alleles were 51.7%, 41.4%, and 6.9% in asthmatics (P < 0.01) and 44.7%, 39.5%, and 15.8% in healthy subjects (P < 0.01). The heterozygous Arg16Gly and Gln27Glu were found in most of severe asthma cases (7/13, 53.8% each). While homozygous wild and mutant seemed to be protective and associated with mild disease in both alleles. Finally, 75% of Arg16Gly heterozygous group were good responders (P < 0.01), 81% of homozygous G mutant were bad responders. For Gln27Glu polymorphism, 60% of C wild group were good responders and 75% of G mutant group were bad responders.ConclusionsThe findings suggest that the Arg16Gly and Gln27Glu polymorphisms in the β2-AR gene are associated with asthma severity and response to therapy and might be used in personalized treatment for these patients in the future. This work is registered in ClinicalTrial.gov with ID: NCT03118869.

Association between hand grip strength with weaning and intensive care outcomes in COPD patients: A pilot study: XXXX

In COPD, weight loss and muscle wasting contribute significantly to morbidity, disability, and handicap. Dominant‐handgrip strength for evaluation of muscle strength has not been tested as a parameter to predict outcome of weaning from mechanical ventilation (MV).

Malnutrition in tuberculosis: value of fat-free mass and creatinine-height index

Background The association between tuberculosis (TB) and undernutrition has long been known. TB worsens undernutrition and undernutrition weakens immunity, thereby increasing the likelihood that latent TB will develop into active disease. Objective The aim of the study was to measure the fat-free mass, creatinine-height index (CHI) and other anthropometric measures, and serum albumin to assess the nutritional status of TB patients and to estimate the value of these indexes as prognostic factors of the disease. Patients and methods The present prospective analytic case-control study was conducted in the Chest Department, Assiut University Hospital. The nutritional status of 61 TB patients and 68 controls was assessed. Anthropometric measures such as ideal body weight (IBW), BMI, triceps skin-fold thickness, arm muscle area (AMA), fat mass index, and fat-free mass index (FFMI) were recorded, as well as laboratory assessment of CHI and serum albumin. Results There is significant decrease in BMI and IBW% (P < 0.01) in TB patients. The lean body mass using AMA and FFMI is significantly lower in TB patients than in controls (54.2 ± 6.9 vs. 61.9 ± 4.7 cm and 34.3 ± 5.0 vs. 35.8 ± 3.4 cm, respectively; P < 0.01). Loss of fat in TB patients is indicated by significant reduction in mid-arm circumference, skin-fold thickness, and fat mass index (P < 0.01 each). TB patients have significantly lower CHI and serum albumin compared with controls (76.5 ± 28.1 vs. 91.7 ± 24.2 and 37.4 ± 7.8 vs. 41.6 ± 4.2; P < 0.01). Using multiple regression, the significant determinants of malnutrition in TB patients are IBW, AMA, CHI, and serum albumin. Conclusion Tuberculous patients have significantly decreased body weight with loss of both lean body mass and fat mass. The loss of CHI is a more significant marker than FFMI in this group of patients. These indexes as well as serum albumin may play an important role as prognostic markers in TB.