Ashraf Madkour - Academia.edu (original) (raw)

Papers by Ashraf Madkour

Egyptian Journal of Bronchology, 2019

Introduction In treatment of pneumonia, new drugs besides antibiotics are investigated; especiall... more Introduction In treatment of pneumonia, new drugs besides antibiotics are investigated; especially statins with their antiinflammatory, immunomodulatory, and antioxidant effects. Objective The aim was to determine whether or not adjuvant atorvastatin could improve 30-day mortality, and clinical and inflammatory outcomes of community-acquired pneumonia (CAP). Patients and methods This is a prospective study, in which 47 CAP patients were randomized into: statin naive, n=23 (received antibiotics according to guidelines) and statin users, n=24 (received antibiotics according to guidelines +atorvastatin 40 mg daily for 30 days). Total leukocytic count and C-reactive protein (CRP) were measured, pneumonia severity index was estimated on the first day and on the seventh day, and length of hospital stay and mortality were also recorded. Results Statin users showed statistically significant reduction of CRP (P=0.049) and significantly shorter hospital stay (P<0.001). No statistically significant difference on comparing both groups as regard the reduction magnitude of total leukocytic count (P=0.406), pneumonia severity index (P=0.325), and mortality (P=0.489). Conclusion Incorporating atorvastatin therapy with antibiotics compared to antibiotics alone in the treatment of CAP showed significantly lower CRP levels, shorter hospital stay, but no impact on mortality reduction.

The Egyptian Journal of Chest Diseases and Tuberculosis, 2022

Egyptian Journal of Bronchology, 2015

Introduction Ultrasonography (US) has become an invaluable tool in the management of critically i... more Introduction Ultrasonography (US) has become an invaluable tool in the management of critically ill patients. Objectives This study aimed to evaluate the role of US in the diagnosis and treatment of pleural diseases in patients in the respiratory intensive care unit. Patients and methods This study recruited 55 patients who presented with suspected clinical and/or radiological evidence of pleural disease in whom US and chest radiography were performed. In addition, US-guided interventions were carried out whenever needed and computed tomography scans of the chest where obtained whenever possible. Results Pleural effusion was the most common pleural disease encountered (54.5%). US correctly predicted the nature of most pleural effusions, whether transudative or exudative (84%). US was significantly more sensitive than chest radiography in the diagnosis of pleural effusion and pleural thickening (P = 0.00 and 0.004, respectively) and had significantly better sensitivity for unilateral...

Egyptian Journal of Bronchology, 2018

Background Implementing point-of-care multiorgan ultrasound (POCUS) to the initial assessment of ... more Background Implementing point-of-care multiorgan ultrasound (POCUS) to the initial assessment of ICU patients allows intensivists to immediately integrate ultrasound findings with the patient history, physical, and laboratory results, yielding a powerful clinical synergy, improving diagnostic accuracy, and ameliorating further management plans. The aim of this work was to assess the diagnostic performance and therapeutic effect of POCUS in patients admitted to respiratory ICU (RICU). Patients and methods A prospective study was carried out on patients admitted to the RICU. POCUS examination was performed to the patients within 12 h of admission that included echocardiography, lung ultrasound, abdominal ultrasound including inferior vena cava assessment and lower limb venous duplex. Results A total of 102 patients were included. The total number of sonographic findings was 320, of which 94 (29.3%) were new findings. This resulted in confirmation of the admitting diagnosis, modification of the admitting diagnosis, prompted further testing, change in medical therapy prescribed, and prompted invasive procedures in 35, 51, 11, 41, and 14% of patients, respectively. However, it was ineffective in confirming or modifying diagnosis, provided wrong diagnosis, and missed a diagnosis in 29.4, 2, and 11.7% of patients, respectively. Conclusion Integrating POCUS in the initial assessment of critically ill RICU patients together with standard diagnostic tests lead to diagnostic and therapeutic changes in most of patients which affected the management of these patients. Thus, it seems reasonable to consider the routine use of POCUS as a new respiratory examination option in the armamentarium of the intensivists.

Egyptian Journal of Bronchology, 2019

Background Conventional transbronchial needle aspiration (C-TBNA) is a unique technique that allo... more Background Conventional transbronchial needle aspiration (C-TBNA) is a unique technique that allows the sampling tissue from beyond the endobronchial tree, such as enlarged lymph nodes, peribronchial, or submucosal lesions. However, it remains underutilized and even unavailable in many countries and centers around the world including Egypt. Objective This study aimed to implement bronchoscopic C-TBNA service in a tertiary care chest hospital with special emphasis on the diagnostic yield, complications encountered, and learning experience. Patients and methods This cohort study was conducted on 60 patients with bronchoscopic nonvisible extraluminal lesions who have sought bronchoscopic C-TBNA service at the Bronchoscopy Unit of both Ain Shams University Hospital and Giza Chest Hospital during the period from June 2016 to February 2018. Results The overall C-TBNA had a diagnostic yield of 88.3% in which 68.3% were malignant and 20% had sarcoidosis without serious complications recorded except for minor nonlife-threatening bleeding in 21.7% of cases. After 6 months of C-TBNA learning experience, the diagnostic yield showed improvement in physicians without previous C-TBNA experience, but without reaching a statistical significance. Also, there were significant reduction in both duration and complications of C-TBNA. Conclusion Implementing C-TBNA service in a tertiary care chest hospital in bronchoscopically nonvisible extraluminal lesions seems to be a safe, easy technique with high diagnostic yield and its learning performance was able to be improved over time.

Iranian Journal of Radiology, 2012

Background: In the diagnosis of malignant lymph nodes (LNs) and staging of lung cancer, sampling ... more Background: In the diagnosis of malignant lymph nodes (LNs) and staging of lung cancer, sampling of mediastinal and hilar LNs is essential. Mediastinoscopy is known as the gold standard. Convex probe (CP) endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) is a noninvasive and highly sensitive diagnostic method in mediastinal and hilar LN sampling. Objectives: Evaluating the role of CP-EBUS-guided TBNA in the diagnosis of mediastinal and hilar LNs suspicious of malignancy. Patients and Methods: One hundred twenty patients with a known lung malignancy or hilar/mediastinal LNs detected by thoracic computed tomography (CT) and/or positron emission tomography (PET)-CT suspicious for malignancy were included in this prospective study. The procedure was performed by Olympus 7.5 MHz CP endoscope and EU C2000 processor by the oral route under topical anesthesia and conscious sedation. After visualization of LNs, their dimensions were recorded. Aspiration was considered as "insufficient" if there were inadequate lymphocytes on the smears. Diagnosis of "malignancy" on cytologic examination was considered as the "final diagnosis". If diagnosis was negative for malignancy, more invasive procedures were performed to confirm the diagnosis. Results: Twenty four females and 96 male patients (mean age, 57.8 ± 9.1) were included. A total of 177 LN stations were aspirated in 120 patients. In 82 patients, the diagnosis was malignant by EBUS-guided TBNA and in the remaining 38; the diagnosis was established by further invasive procedures. Of the 38 EBUS-guided TBNA negative patients, 28 were diagnosed as non-malignant and 10 were malignant. The sensitivity, diagnostic accuracy and negative predictive value of CP EBUS-guided TBNA were 89.1%, 91.6% and 73.6%, respectively. No major complications were seen. Conclusion: As an alternative method to mediastinoscopy, EBUS-guided TBNA is a safe and noninvasive procedure with high sensitivity in the diagnosis of malignant mediastinal LNs.

Egyptian Journal of Bronchology, 2017

Background Tranexamic acid (TA), a potent antifibrinolytic agent, has the potency to stop bleedin... more Background Tranexamic acid (TA), a potent antifibrinolytic agent, has the potency to stop bleeding in a variety of medical and surgical conditions. However, its role in controlling airway bleeding is not yet proven. This study aimed to evaluate the efficacy of endobronchial administration of TA in controlling bronchopulmonary bleeding. Materials and methods A prospective, comparative, observational study was carried out including 40 patients scheduled to undergo bronchoscopy. For management of hemoptysis or bronchoscopy-induced bleeding, patients were randomly subdivided into two groups of 20 patients each: the first group received endobronchial TA, whereas the second group received endobronchial cold saline±adrenaline. Results In the TA group, 19 patients were responders and only one patient was a nonresponder and was further managed with endobronchial adrenaline. All 20 patients of the cold saline±adrenaline group were responders. No significant statistical difference was found between both groups with regard to systolic and diastolic blood pressures, heart rate, and oxygen saturation either before or after bronchoscopy. However, heart rate significantly increased after bronchoscopy both in the first (P<0.001) and the second group (P=0.007). Systolic blood pressure increased significantly (P=0.001) after bronchoscopy in the second group only. The amount of bronchoscopy-induced bleeding as well as the time required for bronchoscopic hemostasis significantly and directly correlated with the dose of TA (r=0.535, P=0.015, and r=1.000, P<0.001, respectively) and cold saline±adrenaline (r=0.687, P=0.33, r=0.858, P<0.001, respectively). TA did not result in any intrabronchoscopic and postbronchoscopic drug-related complications in any of the patients. Conclusion Endobronchial installation of TA is an effective and safe modality of treatment for controlling nonlife-threatening bronchopulmonary bleeding.

Egyptian Journal of Bronchology, 2016

Conclusion PSP was more frequent compared with SSP in our study, with a higher incidence in young... more Conclusion PSP was more frequent compared with SSP in our study, with a higher incidence in younger and taller male population. Smoking is an important risk factor for spontaneous pneumothorax, and the most common lung disease found in our study to be associated with SSP was chronic obstructive pulmonary disease. We conclude that PSP carries a lesser risk for complications and better outcome compared with SSP. The risk for mortality or major complications from spontaneous pneumothorax in general was negligible in our study.

European Respiratory Journal, 2015

International Journal of Clinical Practice

Socioeconomically disadvantaged people are more frequent users of healthcare, as are the elderly.... more Socioeconomically disadvantaged people are more frequent users of healthcare, as are the elderly. This situation is now disrupted with the rapid onset COVID-19 pandemic and its effect on the health system. Amidst a great deal of uncertainty and mixed messages from the WHO, Ministries of health and scientific communities, a methodology to keep the standard operating procedures of the school needs to be in place in order to allow the hospital to respond to its catchment area requirements. A number of focus groups and planning sessions were conducted using a purposeful sample of service providers in Ain Shams University Hospitals. A set of three guiding documents were generated and tested for agreeability and utility. All hospitals need to join forces to systematically organize the chaotic situation we are living with this post COVID-19 pandemic.

Journal of Clinical Oncology

e17556 Background: Endobronchial obstruction is a common complication of advanced-stage lung canc... more e17556 Background: Endobronchial obstruction is a common complication of advanced-stage lung cancer. Patients presenting with severe bronchial obstruction are at a high risk for developing haemoptysis, post-obstructive pneumonia, or respiratory failure, this often leads to death in weeks to months.Tumor debulking and airway re-canalization has a considerable role in increasing survival in patients with inoperable non-small cell lung cancer (NSCLC). Bronchoscopic endobronchial intratumoral chemotherapy (EITC) is a new intervention to treat airway obstruction. This work aims to determine the efficacy of EITC in palliative care for patients with inoperable NSCLC. Methods: Between April 2009 and June 2011, patients with newly diagnosed non metastatic inoperable symptomatic non-life threatening airway obstruction secondary to NSCLC were selected for tumor debulking via EITC through flexible bronchoscopy. EITC of maximum 20mL cisplatin with the concentration of 50 mg/50 mL was injected in...

European Respiratory Journal, Sep 1, 2014

European Respiratory Journal, 2015

Egyptian Journal of Bronchology, 2015

Egyptian Journal of Bronchology, 2019

Introduction In treatment of pneumonia, new drugs besides antibiotics are investigated; especiall... more Introduction In treatment of pneumonia, new drugs besides antibiotics are investigated; especially statins with their antiinflammatory, immunomodulatory, and antioxidant effects. Objective The aim was to determine whether or not adjuvant atorvastatin could improve 30-day mortality, and clinical and inflammatory outcomes of community-acquired pneumonia (CAP). Patients and methods This is a prospective study, in which 47 CAP patients were randomized into: statin naive, n=23 (received antibiotics according to guidelines) and statin users, n=24 (received antibiotics according to guidelines +atorvastatin 40 mg daily for 30 days). Total leukocytic count and C-reactive protein (CRP) were measured, pneumonia severity index was estimated on the first day and on the seventh day, and length of hospital stay and mortality were also recorded. Results Statin users showed statistically significant reduction of CRP (P=0.049) and significantly shorter hospital stay (P<0.001). No statistically significant difference on comparing both groups as regard the reduction magnitude of total leukocytic count (P=0.406), pneumonia severity index (P=0.325), and mortality (P=0.489). Conclusion Incorporating atorvastatin therapy with antibiotics compared to antibiotics alone in the treatment of CAP showed significantly lower CRP levels, shorter hospital stay, but no impact on mortality reduction.

The Egyptian Journal of Chest Diseases and Tuberculosis, 2022

Egyptian Journal of Bronchology, 2015

Introduction Ultrasonography (US) has become an invaluable tool in the management of critically i... more Introduction Ultrasonography (US) has become an invaluable tool in the management of critically ill patients. Objectives This study aimed to evaluate the role of US in the diagnosis and treatment of pleural diseases in patients in the respiratory intensive care unit. Patients and methods This study recruited 55 patients who presented with suspected clinical and/or radiological evidence of pleural disease in whom US and chest radiography were performed. In addition, US-guided interventions were carried out whenever needed and computed tomography scans of the chest where obtained whenever possible. Results Pleural effusion was the most common pleural disease encountered (54.5%). US correctly predicted the nature of most pleural effusions, whether transudative or exudative (84%). US was significantly more sensitive than chest radiography in the diagnosis of pleural effusion and pleural thickening (P = 0.00 and 0.004, respectively) and had significantly better sensitivity for unilateral...

Egyptian Journal of Bronchology, 2018

Background Implementing point-of-care multiorgan ultrasound (POCUS) to the initial assessment of ... more Background Implementing point-of-care multiorgan ultrasound (POCUS) to the initial assessment of ICU patients allows intensivists to immediately integrate ultrasound findings with the patient history, physical, and laboratory results, yielding a powerful clinical synergy, improving diagnostic accuracy, and ameliorating further management plans. The aim of this work was to assess the diagnostic performance and therapeutic effect of POCUS in patients admitted to respiratory ICU (RICU). Patients and methods A prospective study was carried out on patients admitted to the RICU. POCUS examination was performed to the patients within 12 h of admission that included echocardiography, lung ultrasound, abdominal ultrasound including inferior vena cava assessment and lower limb venous duplex. Results A total of 102 patients were included. The total number of sonographic findings was 320, of which 94 (29.3%) were new findings. This resulted in confirmation of the admitting diagnosis, modification of the admitting diagnosis, prompted further testing, change in medical therapy prescribed, and prompted invasive procedures in 35, 51, 11, 41, and 14% of patients, respectively. However, it was ineffective in confirming or modifying diagnosis, provided wrong diagnosis, and missed a diagnosis in 29.4, 2, and 11.7% of patients, respectively. Conclusion Integrating POCUS in the initial assessment of critically ill RICU patients together with standard diagnostic tests lead to diagnostic and therapeutic changes in most of patients which affected the management of these patients. Thus, it seems reasonable to consider the routine use of POCUS as a new respiratory examination option in the armamentarium of the intensivists.

Egyptian Journal of Bronchology, 2019

Background Conventional transbronchial needle aspiration (C-TBNA) is a unique technique that allo... more Background Conventional transbronchial needle aspiration (C-TBNA) is a unique technique that allows the sampling tissue from beyond the endobronchial tree, such as enlarged lymph nodes, peribronchial, or submucosal lesions. However, it remains underutilized and even unavailable in many countries and centers around the world including Egypt. Objective This study aimed to implement bronchoscopic C-TBNA service in a tertiary care chest hospital with special emphasis on the diagnostic yield, complications encountered, and learning experience. Patients and methods This cohort study was conducted on 60 patients with bronchoscopic nonvisible extraluminal lesions who have sought bronchoscopic C-TBNA service at the Bronchoscopy Unit of both Ain Shams University Hospital and Giza Chest Hospital during the period from June 2016 to February 2018. Results The overall C-TBNA had a diagnostic yield of 88.3% in which 68.3% were malignant and 20% had sarcoidosis without serious complications recorded except for minor nonlife-threatening bleeding in 21.7% of cases. After 6 months of C-TBNA learning experience, the diagnostic yield showed improvement in physicians without previous C-TBNA experience, but without reaching a statistical significance. Also, there were significant reduction in both duration and complications of C-TBNA. Conclusion Implementing C-TBNA service in a tertiary care chest hospital in bronchoscopically nonvisible extraluminal lesions seems to be a safe, easy technique with high diagnostic yield and its learning performance was able to be improved over time.

Iranian Journal of Radiology, 2012

Background: In the diagnosis of malignant lymph nodes (LNs) and staging of lung cancer, sampling ... more Background: In the diagnosis of malignant lymph nodes (LNs) and staging of lung cancer, sampling of mediastinal and hilar LNs is essential. Mediastinoscopy is known as the gold standard. Convex probe (CP) endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) is a noninvasive and highly sensitive diagnostic method in mediastinal and hilar LN sampling. Objectives: Evaluating the role of CP-EBUS-guided TBNA in the diagnosis of mediastinal and hilar LNs suspicious of malignancy. Patients and Methods: One hundred twenty patients with a known lung malignancy or hilar/mediastinal LNs detected by thoracic computed tomography (CT) and/or positron emission tomography (PET)-CT suspicious for malignancy were included in this prospective study. The procedure was performed by Olympus 7.5 MHz CP endoscope and EU C2000 processor by the oral route under topical anesthesia and conscious sedation. After visualization of LNs, their dimensions were recorded. Aspiration was considered as "insufficient" if there were inadequate lymphocytes on the smears. Diagnosis of "malignancy" on cytologic examination was considered as the "final diagnosis". If diagnosis was negative for malignancy, more invasive procedures were performed to confirm the diagnosis. Results: Twenty four females and 96 male patients (mean age, 57.8 ± 9.1) were included. A total of 177 LN stations were aspirated in 120 patients. In 82 patients, the diagnosis was malignant by EBUS-guided TBNA and in the remaining 38; the diagnosis was established by further invasive procedures. Of the 38 EBUS-guided TBNA negative patients, 28 were diagnosed as non-malignant and 10 were malignant. The sensitivity, diagnostic accuracy and negative predictive value of CP EBUS-guided TBNA were 89.1%, 91.6% and 73.6%, respectively. No major complications were seen. Conclusion: As an alternative method to mediastinoscopy, EBUS-guided TBNA is a safe and noninvasive procedure with high sensitivity in the diagnosis of malignant mediastinal LNs.

Egyptian Journal of Bronchology, 2017

Background Tranexamic acid (TA), a potent antifibrinolytic agent, has the potency to stop bleedin... more Background Tranexamic acid (TA), a potent antifibrinolytic agent, has the potency to stop bleeding in a variety of medical and surgical conditions. However, its role in controlling airway bleeding is not yet proven. This study aimed to evaluate the efficacy of endobronchial administration of TA in controlling bronchopulmonary bleeding. Materials and methods A prospective, comparative, observational study was carried out including 40 patients scheduled to undergo bronchoscopy. For management of hemoptysis or bronchoscopy-induced bleeding, patients were randomly subdivided into two groups of 20 patients each: the first group received endobronchial TA, whereas the second group received endobronchial cold saline±adrenaline. Results In the TA group, 19 patients were responders and only one patient was a nonresponder and was further managed with endobronchial adrenaline. All 20 patients of the cold saline±adrenaline group were responders. No significant statistical difference was found between both groups with regard to systolic and diastolic blood pressures, heart rate, and oxygen saturation either before or after bronchoscopy. However, heart rate significantly increased after bronchoscopy both in the first (P<0.001) and the second group (P=0.007). Systolic blood pressure increased significantly (P=0.001) after bronchoscopy in the second group only. The amount of bronchoscopy-induced bleeding as well as the time required for bronchoscopic hemostasis significantly and directly correlated with the dose of TA (r=0.535, P=0.015, and r=1.000, P<0.001, respectively) and cold saline±adrenaline (r=0.687, P=0.33, r=0.858, P<0.001, respectively). TA did not result in any intrabronchoscopic and postbronchoscopic drug-related complications in any of the patients. Conclusion Endobronchial installation of TA is an effective and safe modality of treatment for controlling nonlife-threatening bronchopulmonary bleeding.

Egyptian Journal of Bronchology, 2016

Conclusion PSP was more frequent compared with SSP in our study, with a higher incidence in young... more Conclusion PSP was more frequent compared with SSP in our study, with a higher incidence in younger and taller male population. Smoking is an important risk factor for spontaneous pneumothorax, and the most common lung disease found in our study to be associated with SSP was chronic obstructive pulmonary disease. We conclude that PSP carries a lesser risk for complications and better outcome compared with SSP. The risk for mortality or major complications from spontaneous pneumothorax in general was negligible in our study.

European Respiratory Journal, 2015

International Journal of Clinical Practice

Socioeconomically disadvantaged people are more frequent users of healthcare, as are the elderly.... more Socioeconomically disadvantaged people are more frequent users of healthcare, as are the elderly. This situation is now disrupted with the rapid onset COVID-19 pandemic and its effect on the health system. Amidst a great deal of uncertainty and mixed messages from the WHO, Ministries of health and scientific communities, a methodology to keep the standard operating procedures of the school needs to be in place in order to allow the hospital to respond to its catchment area requirements. A number of focus groups and planning sessions were conducted using a purposeful sample of service providers in Ain Shams University Hospitals. A set of three guiding documents were generated and tested for agreeability and utility. All hospitals need to join forces to systematically organize the chaotic situation we are living with this post COVID-19 pandemic.

Journal of Clinical Oncology

e17556 Background: Endobronchial obstruction is a common complication of advanced-stage lung canc... more e17556 Background: Endobronchial obstruction is a common complication of advanced-stage lung cancer. Patients presenting with severe bronchial obstruction are at a high risk for developing haemoptysis, post-obstructive pneumonia, or respiratory failure, this often leads to death in weeks to months.Tumor debulking and airway re-canalization has a considerable role in increasing survival in patients with inoperable non-small cell lung cancer (NSCLC). Bronchoscopic endobronchial intratumoral chemotherapy (EITC) is a new intervention to treat airway obstruction. This work aims to determine the efficacy of EITC in palliative care for patients with inoperable NSCLC. Methods: Between April 2009 and June 2011, patients with newly diagnosed non metastatic inoperable symptomatic non-life threatening airway obstruction secondary to NSCLC were selected for tumor debulking via EITC through flexible bronchoscopy. EITC of maximum 20mL cisplatin with the concentration of 50 mg/50 mL was injected in...

European Respiratory Journal, Sep 1, 2014

European Respiratory Journal, 2015

Egyptian Journal of Bronchology, 2015