Safaa Wafy

Bronchial and Nonbronchial Systemic Artery Embolization in Management of Hemoptysis: Experience with 348 Patients

Background. We aimed to report our experience with bronchial artery embolization (BAE) in the management of moderate recurrent and/or life-threatening hemoptysis. Methods. We evaluated the demographics, clinical presentation, radiographic studies, short- and long-term efficacy, and complications in patients Who underwent BAE, at a tertiary university hospital, from 2003 to 2012. Results. Three hundred forty-one patients underwent BAE for the management of moderate recurrent or life-threatening hemoptysis. Pulmonary TB and bronchiectasis were the most common etiologies for hemoptysis in our locality. The most common angiographic signs for hemoptysis were hypervascularity and systemic-pulmonary artery shunt. BAE was successful in controlling hemoptysis immediately in 95% of patients and at 1 month in 90% of patients. Recurrence of hemoptysis was observed in 9.6% of patients, and reembolization was indicated in 85% of those cases. Complications of BAE were self-limited acute and subacute complications, while chronic complications were not recorded during this study. Conclusions. TB and bronchiectasis are the commonest etiologies for moderate recurrent or life-threatening hemoptysis in our locality. Hypervascular lesions from the bronchial arteries and nonbronchial systemic arteries represented the major vascular abnormalities. Bronchial and nonbronchial systemic artery embolizations were effective to control both acute and chronic hemoptyses, with no serious complications.

Risk factors for hospital mortality among mechanically ventilated patients in respiratory ICU

Background: The possible factors affecting hospital mortality among mechanically ventilated patients in respiratory ICU is still not fully studied. Objective: The aim of this study was to identify the predictors of hospital mortality among mechanically ventilated patients in respiratory ICU. Patients and methods: In a prospective descriptive study, all eligible patients of Assiut Chest Department who were mechanically ventilated for more than 1 day (247 patients) during the period from April 2010 to March 2012 were included in this study. Different clinical and laboratory variables were recorded at the time of admission and followed until hospital discharge and were compared between survivors (146 patients) and nonsurvivors (101 patients). Results: A total of 247 patients were included in the study. The mean age was 57.6 ± 13.3 years. Male patients represented 65.6% of the study cohort. The hospital mortality was 40.9%. On multivariate analysis, risk factors for hospital mortality were as follows: patients diagnosed with adult respiratory distress syndrome, interstitial lung diseases, and pulmonary embolism [odds ratio (OR) = 14.2 95% confidence interval (CI), P = 0.031]; hospital complications (OR = 9.17 95% CI, P = 0.000); reintubation (OR = 8.56 95% CI, P = 0.000); use of sedatives for 24 h or more (OR = 3.72 95% CI, P = 0.04); and comorbidity burden (OR = 2.36 95% CI, P = 0.006). Conclusion: The major independent risk factor for hospital mortality was patients diagnosed with adult respiratory distress syndrome, interstitial lung diseases, and pulmonary embolism. In addition, patients suffering from more comorbidities or hospital complications and patients requiring longer use of sedation (≥24 h) should be monitored closely in ICU because of their high risk for hospital nonsurvival.

'Vascular ring', the hidden congenital anomaly having symptoms that may mimic asthma: A case report

Introduction This is a case report of a double aortic arch forming a complete vascular ring, presenting with extrinsic tracheoesophageal obstruction. History A female patient spent a large part of her life being treated for bronchial asthma. Her complaint started early in childhood marked by repeated attacks of wheezy chest and difficulty in breathing up to stridor sometimes. The wheezes were marked and often associated with stridor. Multislice computed tomography of the chest with angiogram was performed for diagnosis. Summary Vascular rings, due to the double aortic arch, are an important cause of tracheoesophageal compression. Its presentation may mimic asthma attacks and thus the clinical suspicion and diagnosis of vascular rings can lead to early surgical intervention.

Automatic tube compensation versus pressure support ventilation as a weaning mode: does it make a difference?

Background: Automatic tube compensation (ATC) is one of the newer weaning modes that seem promising to improve the weaning process. Objective: To evaluate the benefit of ATC in hastening and improving the weaning process. Patients and methods: In a prospective randomized-controlled trial, all eligible patients of Assiut Chest Department who were mechanically ventilated were included during the period from April 2010 to March 2012. They were divided into two groups, 88 patients weaned by pressure support ventilation (PSV) and 78 patients weaned by ATC. The primary outcomes measure was the ability to maintain spontaneous breathing for more than 48 h after extubation and weaning duration. Results: A total of 166 patients were included; the mean age was 58.6 ± 12.3 years; males represented 70%. The weaning duration was shorter in ATC than in PSV (19.7 vs. 29.9 h, respectively). Also, ATC had a higher trend toward successful extubation than PSV (88.5 vs. 78.4%). Patients who underwent weaning by ATC had a nonsignificant trend toward simple weaning. Moreover, hospital mortality was less in ATC (ATC 15.4% vs. PSV 22.7%). However, the difference did not reach significance in all primary and secondary outcomes. Conclusion: In respiratory ICU patients, the weaning process can be usefully performed by ATC (at least as effective as PSV) but without significant hastening of the weaning process. All primary and secondary outcomes were potentially improved (weaning duration, extubation outcome, predictive value of ATC-assisted ratio of respiratory rate and tidal volume, number of spontaneous breathing trials, weaning category, reintubation rate, complications, and hospital mortality).

Cyclosporine as a treatment in acutely exacerbated interstitial pneumonia: does it add value?

Objective The aim of this study was to evaluate the efficacy of combined therapy of cyclosporine A (CsA) with prednisolone for acutely exacerbated interstitial pneumonia. Patients and method Forty-eight patients who were diagnosed as having interstitial pneumonia were recruited in the study. These patients experienced clinical worsening as demonstrated by any one of the following within the past year: greater than 10% decrease in the percent predicted forced vital capacity, worsening high-resolution CT scan or clinical worsening of dyspnea at rest or on exertion. CsA was given at a dose range of 2 mg/kg/day in addition to corticosteroids. Patients were assessed at baseline and then at 1, 3, 6, and 9 months for response to therapy and for any adverse effect of the treatment. Results Patients were divided according to the underlying systemic disease into either patients with idiopathic pulmonary fibrosis (25 patients) or those with underlying collagen vascular diseases (CVDs; 23 patients). Those with underlying CVDs were divided into either UIP/CVDs (five patients) or nonspecific interstitial pneumonia (NSIP/CVDs) (18 patients). Our results showed an overall better response in the NSIP/CVD group of patients. Follow-up parameters in 14 patients with an improved response showed an improved grade of dyspnea, improved partial pressure of oxygen (PaO 2 ), %forced vital capacity, and diffusing capacity of carbon monoxide (%DL CO ); Krebs von den Lungen 6 (KL6) showed a significant decrease after initiation of CsA treatment when compared with baseline. Furthermore, a benefit of adding CsA to the treatment was the ability to reduce the dose of steroids during the course of treatment.

Can transthoracic ultrasound differentiate between simple and obstructed pneumonia

Background The advantages of low cost, bedside availability, and no radiation exposure have made ultrasound an indispensable diagnostic tool in modern pulmonary medicine. Color Doppler ultrasound demonstrates normal or increased flow in the normal vessels of the consolidated lung and may be helpful in distinguishing simple pneumonia from postobstructive pneumonia. Aim of the work The aim of this work was to describe sonographic features of simple and obstructed pneumonia and discuss the value of transthoracic ultrasound to differentiate between both diseases. Results The study included 18 patients with simple pneumonia and seven patients with obstructed pneumonia. The sonographic findings were as follows: positive air bronchogram recorded in 100% of the cases of simple pneumonia, but not found in any case of obstructed pneumonia; fluid bronchogram not found in any case of simple pneumonia and present in 100% of obstructed pneumonia ( P = 0.005). Oval and rounded shape, irregular shape, sharp well-demarcated, blurred-border, homogenous, heterogeneous, and hypoechoic echo patterns were found in 38.9, 61.1, 33.3, 66.7, 11.1, 88.9, and 100% of the cases of simple pneumonia and in 42.9, 57.1, 28.6, 71.4, 0, 100, and 85.7% of the cases of obstructed pneumonia, respectively. Pleural effusion was present in 44.4 and 42.9% of cases of simple and obstructed pneumonia, respectively. Fluid bronchogram was seen in the bronchial obstruction, as a result of either impacted secretions or a proximal tumor. Conclusion The presence of signs of fluid bronchogram in the appropriate clinical context should raise the suspicion of postobstructive pneumonitis. Transthoracic ultrasound helps in distinguishing the central obstructing tumor as a hypoechoic mass from distal more echogenic consolidations.