Suzan Salama

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.

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.

Assessment of Human Natriuretic Peptides (B), Human N-Terminal Pro-BNP and Nor-epinephrine as Neurohumoral Markers in Sleep Disordered Breathing among Heart Failure Patients in Upper Egypt

Objective: The purposes of this study are to: (1) Measure neurohumoral activation in heart failure patients with and without Sleep Disordered Breathing; (2) Assessment of neurohumoral markers with the severity of sleep apnea and severity of heart failure.Patients and methods: In this case report study, we studied 100 patients with heart failure (64 male, 36 female). All patients underwent echocardiography and a full night-attended polysomnography, in addition to neurohumoral evaluation.Results: Group (1) sleep Disordered Breathing (SDB) had significant increase in the plasma concentration level of BNP (591.50 ± 165.75 vs. 298.33 ± 86.63 pg/ml, P=0.001*), NT-proBNP (1750.05 ± 773.15 vs. 686.98 ± 377.88 pg/ml, P=0.001*) and nor epinephrine (NE) (616.12 ± 139.57 vs. 203.80 ± 64.30 pg/ml, P=0.001*) when compared with No-SDB. A significant increase in plasma level of NT-proBNP and nor-epinephrine (NE) in OSA was observed when compared with central sleep apnea (CSA). Increased neurohumoral markers with different severity of apnea hypopnea index (AHI). Moreover, a significant increase was observed in neurohumoral markers with increased severity of left ventricular ejection fraction (LVEF). Based on echocardiographic etiology of heart failure, patients with dilated cardiomyopathy had a significant increase in plasma level of BNP and NT-pro BNP. On the other hand, plasma concentration level of norepinephrine (NE) was significantly increased in patients with hypertensive heart disease.Conclusion: Heart failure patients with sleep disordered breathing were associated with higher levels of neurohumoral activation. Moreover N-TproBNP (<300m pg/ml) and nor epinephrine (NE)<300 pg/ml were predictors of OSA among heart failure.

Predictor factors of sleep-disordered breathing in heart failure

Background Heart failure (HF) is characterized by its high mortality, frequent hospitalizations, and reduced quality of life. Sleep-disordered breathing (SDB), one of the common comorbidities, accelerates the progression of HF. Objectives The objectives of the study were (a) to investigate the prevalence and type of SDB in HF patients and (b) to determine the predictors of SDB. Materials and methods In a cross-sectional analytic study, all eligible patients of Assiut Chest and Cardiology Department admitted (100 patients) during the period from August 2015 to March 2016 were included in this study. Clinical assessment, full-night attended polysomnography, and echocardiography were recorded and compared between patients with (SDB) (85 patients) and those without SDB (15 patients). Results SDB was found in 85% of patients [53% had obstructive sleep apnea (OSA) and 32% had central sleep apnea (CSA)]. OSA patients are characterized by higher BMI and neck and waist circumference. There was a higher prevalence of hypertension, as well as mean blood pressure, systolic blood pressure, diastolic blood pressure, in OSA patients. Loud snoring was the only clinical symptom associated with OSA as compared with CSA. CSA patients had a significant reduction in PaCO2. OSA patients showed a significant increase in desaturation index and time spent with oxygen saturation less than 90%. Maximum heart rate and brady/tachy index were significantly increased in OSA. Cycle length was significantly increased in CSA. Conclusion The prevalence of sleep apnea was high in patients with stable HF (85%). OSA was the predominant type (53%). The predictors of SDB were BMI (≥30), systemic hypertension, neck circumference more than 40 cm, waist circumference more than 110 cm, and ejection fraction (left ventricular ejection fraction) (≤45%).

Sleep-disordered breathing in ischemic cardiomyopathy and hypertensive heart failure patients

Aims The aims of this study are to (a) detect the effect of different types of heart diseases [ischemic, cardiomyopathy, hypertensive heart failure (HF)] on the association with sleep disorders, and to (b) identify the relationship between Cheyne–Stokes respiration (CSR) and left ventricular dysfunction. Materials and methods In a cross-sectional study involving 100 HF patients, we performed echocardiography and a full-night attended polysomnography for all patients. Results In all, 47.9% of patients with ischemic heart disease had obstructive sleep apnea (OSA), whereas 37.5% had central sleep apnea (CSA). OSA was highly prevalent in patients with hypertensive heart disease (79.2%). On the other hand, 50.0% patients with dilated cardiomyopathy (DCM) had CSA, whereas 39.3% had OSA. Patients with DCM had a significant increase in the central apnea index (11.05±9.19 events/h), as well cycle length of CSR (68.14±13.26 s), as compared with other groups. There was an inverse increase of cycle length with reduction in left ventricular ejection fraction (LVEF) (LVEF≥50% had a cycle length of 41.55±10.84 s, whereas those with LVEF≤30% had a longer mean cycle length of 69.23±18.09 s). Conclusion Sleep-disordered breathing is a common disorder in different groups of HF. OSA was prevalent in ischemic and hypertensive heart disease, whereas CSA was prevalent in DCM. There was a significant increase in cycle length of CSR with a reduction in LVEF.

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.

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).