Maha Ghanem

Home-based pulmonary rehabilitation program: Effect on exercise tolerance and quality of life in chronic obstructive pulmonary disease patients.

BACKGROUND: A key component in the management of chronic obstructive pulmonary disease (COPD) patients is pulmonary rehabilitation (PR), the corner stone of which is exercise training. AIM: This study aims to evaluate the effect of a two-months, home-based PR program with outpatient supervision every two weeks, on exercise tolerance and health-related quality of life (HRQL) using Arabic-translated standardized generic and specific questionnaires in COPD patients recently recovered from acute exacerbation, DESIGN: Randomized clinical trial. SETTING AND SUBJECTS: A total of 39 COPD patients who recovered from acute exacerbation were randomly allocated either a two-month home-based PR program in addition to standard medical therapy or standard medical therapy alone in the period between July 2008 and March 2009. METHODS: Pulmonary function tests (PFTs), six-minute walk distance (6-MWD) test, Arabic-translated chronic respiratory disease questionnaire-self administered standardized format (CRQ-SAS) and quality of life scale Short Form (SF-36) were compared between 25 patients with moderate to severe COPD who underwent a two-month PR program (group 1) and 14 COPD patients who did not (group 2). RESULTS: Group 1 showed significant improvement in the 6-MWD, and HRQL scores at two months compared with the usual care patients in group 2 (P less than 0.05). Improvement in both CRQ-SAS and SF-36 scores were statistically significant and comparable in group 1. CONCLUSION: The supervised, post discharge, two-month home-based PR program is an effective non pharmacological intervention in the management of stable patients with COPD. The 6-MWD is a simple, inexpensive and safe test to assess physical and functional capabilities among COPD patients. HRQL can be measured in patients with COPD either by disease-specific tools that have been specifically designed for use in patients with respiratory system disorders or by generic HRQL tools that can be used across populations with a variety of medical conditions. The Arabic-translated CRQ-SAS is a new tool for assessment of Arabic-speaking patients with chronic respiratory diseases.

Diagnostic value of ex vivo pleural fluid interferon-gamma versus adapted whole-blood quantiferon-TB gold in tube assays in tuberculous pleural effusion.

BACKGROUND: Noninvasive diagnosis of pleural tuberculosis (TB) remains a challenge due to the paucibacillary nature of the disease. As Mycobacterium tuberculosis (MTB)-specific T cells are recruited into pleural space in TB effusion; their indirect detection may provide useful clinical information. OBJECTIVES: Evaluation of pleural fluid interferon (INF)-γ levels vs Quantiferon–TB Gold In tube assay (QFT- IT) in blood and its adapted variants, using pleural fluid or isolated pleural fluid cells in the diagnosis of pleural TB. METHODS: Thirty-eight patients with pleural effusion of unknown etiology presented at Assiut University Hospital, Egypt, were recruited. Blood and pleural fluid were collected at presentation for INF-γ assays. Ex vivo pleural fluid INF-γ levels, QFT-IT in blood and its adapted variants were compared with final diagnosis as confirmed by other tools including blind and/or thoracoscopic pleural biopsy. RESULTS: The final clinical diagnosis was TB in 20 (53%), malignancy in 10 (26%), and effusion due to other causes in eight patients (21%). Ex vivo pleural fluid INF-γ levels accurately identified TB in all patients and were superior to the QFT-IT assays using blood or pleural fluid (70 and 78% sensitivity, with 60 and 83% specificity, respectively). QFT-IT assay applied to isolated pleural fluid cells had 100% sensitivity and 72% specificity. The optimal cut-off obtained with ROC analysis was 0.73 for TB Gold assay in blood assay, 0.82 IU/ml for the cultured pleural fluid assay, and 0.94 for isolated pleural cells assay. CONCLUSION: The ex vivo pleural fluid INF-γ level is an accurate marker for the diagnosis of pleural TB. QFT- IT assay in peripheral blood or its adapted versions of the assay using pleural fluid and/or washed pleural fluid cells had no diagnostic advantage over pleural fluid INF-γ in the diagnosis of pleural TB.

False-negative interferon-γ release assay results in active tuberculosis: a TBNET study

Tuberculosis is one of the leading causes of morbidity and mortality worldwide [1]. Rapid identification of contagious tuberculosis patients and effective treatment are necessary to prevent the spread of Mycobacterium tuberculosis, the causative bacterium of the disease. Although interferon-γ release assays (IGRAs) have been developed for the diagnosis of latent infection with M. tuberculosis, these assays are sometimes used as adjunctive tests in the diagnostic workup for active tuberculosis, despite poor specificity [2]. Advanced age was the only risk factor for false-negative IGRAs in this study of active tuberculosis http://ow.ly/Cvp5G

Acute Pulmonary Thromboembolism in Emergency Room: Gray‐ Scale versus Color Doppler Ultrasound Evaluation

Pulmonary thromboembolism (PTE) remains under‐diagnosed fatal disease at emergency units suggesting the need for alternative, easy, and noninvasive bedside diagnostic approaches.

Role of comorbidities in acquiring pulmonary fungal infection in chronic obstructive pulmonary disease patients

Background Bacteria and viruses have been implicated as a major cause of chronic obstructive pulmonary disease (COPD) exacerbations; however, the potential role of fungal colonization and infection is poorly understood. Objective The aim of this study was to assess the profile of pulmonary fungal infection among COPD patients with and without comorbidities to determine their prevalence, risk factors, and outcome among those patients. Patients and methods In this prospective cross-sectional analytic study, different samples (sputum, bronchoalveolar lavage, blood, and others) from 177 COPD patients at risk for pulmonary fungal infection were examined using mycological analysis (direct microscopy and culture). Bronchoalveolar lavage and blood samples were examined using the human 1,3-β-d-glucan and galactomannan ELISA tests. Results The prevalence of pulmonary fungal infection was significantly higher in COPD patients with comorbidities (77.8%) versus COPD patients without comorbidities (53.1%) (P < 0.001), with a predominance of Candida and Aspergillus spp. in both groups. Mechanical ventilation, corticosteroid therapy, ICU admission, and age were major risk factors for pulmonary fungal infection in COPD patients with comorbidities [P = 0.012, odds ratio (ODR) = 2.23; P = 0.028, ODR = 1.99; P = 0.025, ODR = 1.94; and P = 0.034, ODR = 2.60; respectively]. COPD patients with comorbidities had significantly higher mortality rate (12.3%) compared with COPD patients without comorbidities (3.1%; P < 0.05). Blood galactomannan antigen was positive in 16 (19.7%) COPD patients with comorbidities versus seven (7.3%) in COPD patients without comorbidities (P < 0.05). Conclusion COPD patients with comorbidities had a higher prevalence of pulmonary fungal infection and higher mortality rate compared with COPD patients without comorbidities. Age, mechanical ventilation, corticosteroid therapy, and ICU admission were independent risk factors for pulmonary fungal infection in COPD patients with comorbidities.