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Papers by rana El-Helbawy

International Journal of Health Sciences (IJHS), Jun 12, 2023

The prevalence of lung cancer has shown an increase over the last few years which cause both heal... more The prevalence of lung cancer has shown an increase over the last few years which cause both health and economic burden. The biopsy is the gold standard tool for disease diagnosis, but it is usually not accepted by the patients due to its invasive nature. The use of non-invasive biomarkers is now attaining a great interest in diagnosis. Aim of the work: Assess the role of Annexin A1 in bronchoalveolar lavage and serum in the early diagnosis of lung cancer. Patients and methods: This study included 39 patients into two groups; group A (cases with lung cancer) and group B (cases with non-malignant lung lesions). All subjects were submitted to history taking and thorough full physical examination and laboratory analysis. Bronchoalveolar lavage (BAL) was performed in the cases within the two groups. Both serum and BAL levels of annexin A1 were assed in all cases. Results: In the current study, the level of annexin A1 in the serum and BAL were statistically significantly higher in the malignant group as compared with the non-malignant group (P 0.001). The diagnostic parameters were higher in annexin A1 in the BAL as compared to the serum annexin A1 in differentiating lung cancer from suspicious non-malignant lung lesions.In the current study, the best cutoff point of Annexin A1 in BAL in identifying the cases with malignant lesions was > 10.75 with 85% sensitivity and 57.9% specificity. The best cutoff point of Annexin A1 in serum in identifying the cases with malignant lesions was 9.464 with 85% sensitivity and 57.9% specificity. Conclusion: Annexin A1 could be a sensitive marker in the diagnosis of lung cancer especially the BAL annexin A1 which revealed higher diagnostic accuracy compared to the serum annexin A1.

Menoufia Medical Journal, 2018

Objective The objective of this study was to assess serum albumin and base deficit as prognostic ... more Objective The objective of this study was to assess serum albumin and base deficit as prognostic factors for mortality in major burn patients. Background Hypoalbuminemia is a common clinical deficiency in burn patients and is associated with complications related to increased extravascular fluid, including edema, abnormal healing, and susceptibility to sepsis. Base deficit is routinely calculated on blood gas analysis, and it provides the best estimate of the degree of tissue anoxia and shock at the whole body level, particularly in hemorrhagic shock. A rising base deficit indicates increasing metabolic acidosis, and may stratify mortality in patients after major trauma. Some prognostic scales do not include biochemical parameters, whereas others consider them together with comorbidities. The purpose of this study was to determine whether serum albumin and base deficit can predict mortality in burn patients. Patients and methods This study included 42 patients. All patients were admitted to the burn ICU at Menoufia University Hospital. Serum albumin and base deficit were estimated in patients at admission, after 3 days, and after 1 week. Results The mean of serum albumin on admission was 3.33 ± 0.44 g/dl, after 3 days it was 2.85 ± 0.54 g/dl, and after 1 week it was 2.46 ± 0.67 g/dl, and the mean of base deficit was 5.75 ± 2.40, 5.24 ± 2.05, and 5.45 ± 2.76, respectively. These results were significant (P < 0.001). Conclusion Statistically, serum albumin and base deficit can be used as prognostic factors for mortality, and colloid therapy should be continued for the first week, not only for the first 3 days.

Alternative & Integrative Medicine, Aug 5, 2016

In real practice Chronic Obstructive Pulmonary Diseases (COPD) is often diagnosed at a late stage... more In real practice Chronic Obstructive Pulmonary Diseases (COPD) is often diagnosed at a late stage as its clinical manifestations pass unnoticed and spirometry is almost not utilized. Objective: To clarify the role of family physicians in early detection of COPD at the primary care level. Methodology: The study was conducted during winter season 2015 in Al-Shohadaa family health center, Al-Shohadaa city, Menoufia governorate, Egypt. All patients ≥ 40 years, smoking ≥ 10 pack-years attending the center with respiratory symptoms were subjected after their consent to a spirometry to check for early COPD diagnosis. Results: Based on spirometry only, 18 (9.4%) and 15 (7.8%) had GOLD I and ≥ II COPD respectively however 159 out of 192 (82.8%) targeted patients did not have COPD. There was no significant difference in the type and number of respiratory symptoms between non-COPD and COPD patients. Conclusion: As all primary health care centers did not have an access to spirometry, training of family physicians and implementation of spirometry in these centers as a simple gold standard test, that recommended in all guidelines to confirm COPD diagnosis is a mandatory challenge for early detection of the disease. Biography Mohammad Alkot has completed his PhD and Post-doctoral studies from Menoufia University School of Medicine. He is the Vice-director of Family Medicine department and Manshea University Hospital. He has published more than 25 papers in reputed journals.

PubMed, Sep 30, 2020

Hypoalbuminemia as seen in major burn injury results in widespread endothelial dysfunction. Base ... more Hypoalbuminemia as seen in major burn injury results in widespread endothelial dysfunction. Base deficit provides the best estimate for degree of tissue anoxia. Acute blood loss describes anemia present in burn patients. Controversy focuses on the administration of protein-based colloids: whether to provide them, which solutions to use, and when to begin? The aim of this study was to determine whether alteration of gas exchange, excess base deficit, hypoalbuminemia and anemia could predict mortality in major burn patients, whether to provide protein-based colloids, and when to begin fluid resuscitation. The prospective study included 42 major burn patients. All the patients were admitted to the burn intensive care unit at Menoufia University Hospital. Serum albumin level, hemoglobin concentration, arterial blood gases and base deficit were measured at admission, third day and after one week. Average serum albumin on admission was 3.33 ± 0.44, after 3 days 2.85 ± 0.54 and after 1 week 2.46 ± 0.67 gm./dL, while hemoglobin concentration was 14.79 ± 2.13, 12.25 ± 1.99, and 10.24 ± 2.47 gm./dl respectively. However, base deficit was 5.75 ± 2.40, 5.24 ± 2.05 and 5.45 ± 2.76 respectively, with significant statistical difference (p<0.001) between the death and survivor groups. Binary logistic regression analysis for independent predictors of mortality declared that base deficit, albumin and hemoglobin serum levels were independent predictors for mortality with an odds ratio of 2.23, 95% CI, 1.66-16.75 for base deficit, 3.56, 95% CI, 1.88-12.59 for albumin and 2.21, 95% CI, 1.56-13.54 for hemoglobin. Hypoalbuminemia, anemia and excess base deficit can be used as prognostic factors for mortality in major burn patients.

Egyptian Journal of Chest Diseases and Tuberculosis, Jul 1, 2013

ABSTRACT

Background Fiberoptic bronchoscopy (FOB) is standard as a pre-eminent technique for diagnostic, p... more Background Fiberoptic bronchoscopy (FOB) is standard as a pre-eminent technique for diagnostic, palliative, and curative purposes in variable pulmonary insults. Objectives The objectives of this study were to identify the causation, technical aspects, pathophysiological impacts, and complications of FOB in critically ill patients, to discover the correlation between FOB outcomes and independent risk factors, and ultimately to anticipate predictors of mortality in critically ill patients who underwent FOB. Patients and methods This prospective cohort study was carried out in ICUs on 52 critically ill patients who were subjected to FOB for diagnostic or therapeutic purposes. They were grouped into the mechanical ventilation (MV) (28/52) and non-MV (24/52) groups. FOB outcomes and complications were encountered. Results Diagnostic indication of FOB was seen in 40/52 (77%) cases, while the therapeutic purposes of FOB were seen in 12/52 (23%) cases. FOB had a particular indication in the management of 12/52 cases (13.6%) for both pneumonic and inhalation lung injury cases, 10/52 (19.2%) cases for underlining focal lung lesion, 8/52 (15.4%) cases for hemoptysis, and 5/52 (9.6%) cases for either acute respiratory distress syndrome or atelectasis condition. There was a highly considerable variation between the MV and non-MV groups. Hypoxemia, bleeding, arrhythmia, bronchospasm, and laryngospasm were the most prevalent side effects of FOB, with unremarkable differences between both groups. FOB outcomes were as follows: 31/52 (59.6%) cases improved, 11/52 (21.2%) died, and 10/52 (19.2%) were referred to a tertiary health unit. There were significant negative correlations between outcomes and reasons for admission, time of onset of FOB, and radiological pattern. Older age, respiratory insult, immune-compromised state, nonventilatory assessment, and less frequency of FOB performance were predictors of mortality among critically ill patients who underwent FOB. Conclusion Flexible bronchoscopy is a safe and effective procedure for the diagnosis and treatment of pulmonary pathology in critically ill patients.

Egyptian Journal of Chest Diseases and Tuberculosis, 2015

Background: Sleep-disordered breathing (SDB) is highly prevalent in patients with advanced chroni... more Background: Sleep-disordered breathing (SDB) is highly prevalent in patients with advanced chronic kidney diseases (CKDs). Objective: To describe and compare the prevalence, severity, and patterns of SDB and associated nocturnal hypoxia among patients with advanced CKD, hemodialysis (HD) patients, and control group. Methods: Forty patients were recruited from outpatient nephrology clinics and hemodialysis units. Patients were stratified into two groups: conservative (n = 25), and HD (n = 15). 30 healthy individual enrolled as the control group. All participants completed polysomnography (PSG). Results: Case control study of forty CKD patients (15 HD and 25 conservative) [13(86.7%) and 20 (80%) men, mean age 62.73 ± 5.43 and 55.76 ± 9.03 year, BMI 40.83 ± 8.75 and 36.12 ± 16.53 kg/m, mean ESS 18.46 ± 3.20 and 17.84 ± 2.79), respectively, and 30 healthy participants served as the control. The prevalence of SDB in CKD was 33/40(82.5%). In the conservative group, AHI was 148.84 ± 147/h, [80% obstructive, 13% central, and 5% mixed apnea]. Among these conservative groups with OSA patients, 56% had severe, 31% moderate, and 12.5% mild OSA. While in the HD group, AHI 133.26 ± 111/h, [84.6% obstructive, 7.7% central, and 7.7% mixed apnea]. Among these HD groups with OSA, 63% had severe, 27% moderate, and 9% mild OSA. GFR was significantly correlated with AHI and ODI (r = À0.315, P < 0.05, r = À0.506, P < 0.001) respectively. AHI correlated with urea concentration (r = À0.094, P < 0.05). Increased creatinine, and decreased eGFR were significant risk factors of severe OSA. Predictors that reduced renal function were, decreased TST, delayed latency to REM sleep, and increased AHI. Conclusions: Severe OSA was highly prevalent among CKD. Urea was the stronger predictor of increased AHI.

Egyptian Journal of Bronchology, Mar 20, 2023

Background Inhalation lung injury occurs in almost one-third of all serious burns and is responsi... more Background Inhalation lung injury occurs in almost one-third of all serious burns and is responsible for a considerable proportion of burn patient fatalities each year. History of closed space fire or unconsciousness at the accident site, occurrence of pharyngeal or facial burns, hoarseness, and wheezing, and laboratory tests that include blood gas abnormalities or Carboxyhemoglobin levels in blood ˃ 10% are used to diagnose inhalation lung injury. It is also characterized by radiological findings of alveolar or interstitial edema, atelectasis, and/or consolidations, as well as the presence of erythema with laryngeal or tracheal edema in the bronchoscope. Objectives To study the diagnostic and prognostic efficacy of radiologist score and bronchial wall thickening as radiological CT findings in inhalation lung injury. Methods This prospective case-control study included 48 patients with inhalation lung injury (ILI) as a case group and 10 patients without ILI were selected as the control group, all recruited from the burn and plastic department. Within the first 12 h of suspected ILI, a fiberoptic bronchoscope was done to confirm the diagnosis. An initial chest X-ray was done followed by computed tomography through which the radiologist score (RADS) together with bronchial wall thickening (BWT) was done. Results Duration of ventilation was higher in cases than in controls (8.50 ± 3.94 vs 3.25 ± 0.50). The hospital duration was higher in cases than in controls (13.6 ± 4.68 vs9.50 ± 4.52). The BWT was 2.12 ± 0.66 (mean ± SD) in the ILI group while the control group was 1.32 ± 0.48 (mean ± SD). Correlating between baseline PaO2 and RADS score and BWT, it was found that there was a highly significant negative correlation between PaO2 and RADS score and BWT among inhalation lung injury patients (P value 0.001). The sensitivity of BWT in the detection of the need for mechanical ventilation was 83% at a cutoff point of 1.65. Its specificity was 78% and accuracy 75%. Conclusion CT done within 24 h of burn patients has a good role in the diagnosis and management of ILI from the burn.

International Journal of Health Sciences (IJHS), Dec 10, 2022

Determining and classifying predictors of mortality of COVID 19 is of great importance for the mo... more Determining and classifying predictors of mortality of COVID 19 is of great importance for the most efficient use of healthcare resources and public health guidance and will yield improvement in clinical management and outcomes. Aim of the work: To assess Predictors of mortality among COVID 19 patients. Patients and method: 299 patients of confirmed COVID 19 by PCR rolled in our study each patient underwent detailed history, laboratory investigation, CT chest and treated according to severity regarding to Egyptian Ministry of Health Protocol (MOHP). Result: Univariate analysis revealed that old age (OR 1.061 and P value <0.001) ,ICU admission, (OR 10.052 P value <0.001) HTN (OR 2.412 P value 0.002) ,cardiac diseases (OR 2.687 P value 0.014) tachypnea(OR 1.126 P value 0.002),fever (OR 2.118 P value 0.023) hypoxiemia (OR 0.896 P value <0.001), increased inflammatory markers WBCS(OR 1.080 P value <0.001), CRP(OR 1.015 P value 0.002) ,D-dimer (OR 1.540 P value 0.001) S. Ferritin (OR 1.002 P value 0.002), ESR (OR 1.019 P value <0.001)and corad5 (OR 2.308 P value .250) were predictors for motility while in multivariate analysis elderly patients, tachypnea , hypoxiemia and increased ESR are independent factors of mortality. Anosmia found to be a predictor of good prognosis. P values 0.05 in all previous parameters. Conclusion: Old age, hypoxemia, elevated ESR, 6136 tachypnea and lack of anosmia are independent risk factors of mortality in COVID 19.

Egyptian Journal of Chest Diseases and Tuberculosis, 2023

Egyptian Journal of Chest Diseases and Tuberculosis, 2020

Background Uric acid (UA) contributes to beneficial extracellular antioxidant defense activities ... more Background Uric acid (UA) contributes to beneficial extracellular antioxidant defense activities in the airways. However, pro-oxidant powers of UA can be a potential risk factor for gouty arthritis in chronic obstructive airway disease (COPD). Objectives To investigate the proper causation (antioxidant/pro-oxidant) and correlation between UA indices and COPD and whether the associations were modified by smoking. Is serum uric acid (SUA) concentration a reliable biomarker to predict COPD severity? Patients and methods A prospective cohort study enrolled 45 male patients, who were divided into COPD smoker group I, cigarette smoker group II, and apparently healthy participants, serving as a control group III. SUA concentration and creatinine (Cr) level, arterial blood gases, radiographic imaging, and postbronchodilator spirometric measurements were performed. Results SUA was significantly elevated in COPD smoker and cigarette smoker groups than control one. SUA/Cr ratios were significantly increased in COPD smoker than in other groups. Overall, 8/20 (40%) patients were diagnosed with gouty arthritis in COPD smoker group, 1/15 (6.7%) in non-COPD cigarette smoker group, and none in control group. There were statistical significant differences among three groups (P=0.010). There were significantly higher number of patients with severe to very severe COPD (6/8) than patients with mild to moderate COPD (2/8) (P=0.028). There were significant positive correlations between SUA and smoking index (P=0.033), COPD grading (P=0.011), and partial arterial carbon dioxide tension (P=0.028) and also negative correlations with forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) (P=0.029), partial arterial oxygen tension (P=0.001), and O2 saturation (P=0.001) in COPD smoker group I. In cigarette smoker group II, there were statistically significant positive correlations between SUA level and FVC% (P=0.033), FEV1 (P=0.017), and FEV1/FVC (P=0.010). Receiver operating characteristic curves for the evaluation of performance of serum uric acid/serum creatinine ratio in the diagnosis of severity of chronic obstructive airway disease. Conclusion SUA had pivotal antioxidant and pro-oxidant inflammatory effects (gouty arthritis) in COPD. Cigarette smoking is an independent risk factor that influences SUA in COPD. SUA and SUA/Cr ratio increase with rising severity of COPD. UA/Cr ratio is the proper biomarker in the assessment of COPD grading, with higher sensitivity and specificity.

Background: There are multiple connections between sleep and lung cancer. Both of them impacting ... more Background: There are multiple connections between sleep and lung cancer. Both of them impacting each other lung cancer can make it difficult to sleep well due to symptoms and treatment side effects(20-70% of cancer patients suffer of insomnia) .Also there is possible relationship between lung cancer and nocturnal intermittent hypoxia, apnea and daytime sleepiness, progression of lung cancer considered as risk factor of obstructive sleep apnea severity. Aim of the work: to evaluate sleep pattern changes in patients with lung cancer. Patients and methods: 26 patients with non small cell lung cancer were interviewed for assessment of histopathological subtypes and stages according to TNM classification and treated at Department of Clinical Oncology and Nuclear Medicine (chemotherapy, radiotherapy, targeted therapy and surgical treatment were scheduled), they underwent to sleep questionnaire and Epworth Sleepiness Score (ESS).overnight full polysomnography was done. Results: A prospective cohort study 26 lung cancer patients were enrolled in this study, 84.6% of the studied patients were on 4073 chemotherapy, 34.6% were on targeted therapy, 19.2% on radiotherapy and 7.7% received surgical treatment.38.5% of the studied patients were stage 3, 23.1% were stage 2, 38.5% were stage 4. After had ESS 42.3%of the studied patients were excessively situational sleepy and 15.4% of them were normal sleep. Sleep latency was 52.535± 60.077 min; the mean of sleep efficiency was 45.9% ±18.5%; the mean of wakefulness after sleep onset /minute (WASO) was 107.06± 0.61.94. The mean of total apnea-hypopnea Index/hour (AHI) was 27.61± 27.45 all reading are (OSA), Desaturation Index/hour was 23.44± 23.075, Arousal Index/ hour was 27.25± 14.72; Snoring Episodes was 27.25± 46.05. PLMS/ hour (periodic limb movements) was 54.71± 69.50. 23 ∕26 patients (88.5%) were obstructive sleep apnea (OSA), 8/23 (34.9) were mild OSAS, 9/23(39.1%) were moderate OSAS and 6/23 (26.1%) were sever OSAS. 21 ∕ 26 patients (80.8%) had sleep maintenance insomnia. The mean of OAS (overall survival) was 18.38±11.426, there is a positive correlation between OAS and sleep efficiency, % in the studied patients (r = 0.435, P = 0.026), there is a negative correlation between OAS and total AHI hour in the studied patients, ESS and snoring episodes (r = 0.622, P = 0.001), (r = 0.411, P = 0.037), (r = 0.637, P = 0.001). Conclusion: Patients with lung cancer had inefficient sleep, delay sleep latency (insomnia) and had sleep respiratory breathing disorders (OSAS). Tumor size and tumor staging affect OSA severity. OAS inversely correlated to OSA severity.

European Respiratory Journal, Sep 1, 2013

Body: Background Pneumonia is common among critically ill burned patients. It is a major cause of... more Body: Background Pneumonia is common among critically ill burned patients. It is a major cause of morbidity and mortality in burn victims. Prediction of mortality in severely burned patient remains unreliable. Objective: The aim of this research is to study the incidence, early diagnosis and management of nosocomial pneumonia and to discuss the relationship between pneumonia and death in burn patients. Methods This study was carried out on 80 burn patients (35 males and 45 females) admitted to Menoufiya University Hospital Burn Center and Chest Department (Egypt) from September 2011 to Mars 2012. Results Our study found an overall burn patient mortality rate of 26.25 %(21/80). The incidence of pneumonia was 15% (12/80). The mortality rate among patients of pneumonia was 50% (6/12) compared with 22 %(15/68) for those without pneumonia. The pneumonia was two times higher in the subset of patients with inhalation injury compared with group of patients without inhalation injury (P< 0.001).It was found that the presence of pneumonia, inhalation injury, increased burn size, and advanced age were all associated with increased mortality (P< 0.001). There were attributed mortality associations with late onset pneumonia. Severity of disease, severity of illness (APACHE score), presence of organ failure, underlying comorbidity, VAP PIRO score have significant correlation with mortality rate. Conclusions Pneumonia was an important factor for predicting burn patient mortality. Early detection and management of pneumonia are absolutely essential.

PubMed, Sep 30, 2013

Pneumonia is common among critically ill burn patients and is a major cause of morbidity and mort... more Pneumonia is common among critically ill burn patients and is a major cause of morbidity and mortality among them. Prediction of mortality in patients with severe burns remains unreliable. The aim of this research is to study the incidence, early diagnosis and management of nosocomial pneumonia, and to discuss the relationship between pneumonia and death in burn patients. This prospective study was carried out on 80 burn patients (35 males and 45 females) admitted to Menoufiya University Hospital Burn Center and Chest Department, Egypt, from September 2011 to March 2012. Our findings showed an overall burn patient mortality rate of 26.25 % (21/80), 15% (12/80) incidence of pneumonia, and a 50% (6/12) mortality rate among patients with pneumonia compared to 22 % (15/68) for those without pneumonia. The incidence of pneumonia was twice as high in the subset of patients with inhalation injury as among those without inhalation injury (P< 0.001). It was found that the presence of pneumonia, inhalation injury, increased burn size, and advanced age were all associated with increased mortality (P< 0.001). In the late onset pneumonia, other associated factors also contributed to mortality. Severity of disease, severity of illness (APACHE score), organ failure, underlying co-morbidities, and VAP PIRO score all have significant correlations with mortality rate. Pneumonia was an important factor for predicting burn patient mortality. Early detection and management of pneumonia are absolutely essential.

Egyptian Journal of Chest Diseases and Tuberculosis, 2019

Objectives To assess the serum level of vitamin D and mean platelet volume (MPV) in patients with... more Objectives To assess the serum level of vitamin D and mean platelet volume (MPV) in patients with obstructive sleep apnea syndrome (OSAS) and whether their levels correlate with OSAS severity or not. Background OSAS is a clinical disorder characterized by recurrent episodes of upper airway collapse during sleep. Studies show a link between low levels of vitamin D ‘25(OH) D’ and obstructive sleep apnea. Some studies showed that patients who have OSAS also have raised platelet aggregation and activation. MPV is considered an indicator of activation of platelet and its size. Limited studies have informed a relationship between MPV and sleep apnea. Patients and methods A total of 65 patients with OSAS and 24 age-matched controls with completed Epworth sleepiness scale were included. OSAS diagnosis was based on polysomnography. Vitamin D was measured by ELISA, and MPV was measured by Sysmex xn-10 machine. Results A prospective case–control study was done on 65 OSAS cases and 24 age-matched and sex-matched controls. Vitamin D level was significantly lower among OSAS cases than controls, with lowest 25(OH) D in severe OSAS cases, whereas MPV showed nonsignificant difference between them, and the higher MPV was among severe cases. There was a significant negative correlation between vitamin D level and neck circumference (NC), apnea–hypopnea index (AHI), and desaturation index. There was a significant positive correlation between MPV level and each of NC and AHI. NC was an independent predictor for both vitamin D and MPV levels. NC, AHI, and vitamin D level are the independent risk factors for obstructive sleep apnea, with odds ratios of 2.09 and 1.6, respectively. Conclusion Patients with OSAS have decreased vitamin D level. Patients with severe OSAS have lower vitamin D level and higher MPV than other groups. Obesity may be the cause that explains this relation regarding high NC.

Egyptian Journal of Chest Diseases and Tuberculosis, 2020

Background GeneXpert Mycobacterial tuberculosis (MTB)/rifampicin (RIF) is a standard primary test... more Background GeneXpert Mycobacterial tuberculosis (MTB)/rifampicin (RIF) is a standard primary test for early diagnosis of pulmonary tuberculosis (PTB) and RIF resistance. The GeneXpert technique provides a useful tool for tuberculosis control in endemic areas. Objective To assess the diagnostic performance of GeneXpert and rule out the independent risk factors that influence the outcomes. Patients and methods In all, 452 presumed PTB patients were enrolled in this prospective study. Three consecutives morning sputum samples underwent decontamination and liquefaction. Smear microscope, conventional solid culture media (Lowenstein–Jensen media as reference standards), and GeneXpert were performed in sputum specimens. Results A total of 452 test results uploaded from GeneXpert machine 112/452 (24.7%) showed MTB detection and RIF resistance detected in 9/112 (8%). GeneXpert had a sensitivity of 91.1% and a specificity of 100%, with total accuracy of 97.31%. The percentage of GeneXpert positive outcomes in watery phlegm was highly significant in comparison to mucoid phlegm (odds ratio: 61.30; 95% confidence interval: 14.653–88.01; P<0.01); also GeneXpert MTB detection was significantly higher in sputum smear positive than negative cases (odds ratio: 14.474; 95% confidence interval: 0.086–0.456; P<0.01). Conclusion GeneXpert MTB/RIF is a useful qualitative and quantitative test for early detection of PTB and RIF resistance; moreover, watery sputum and acid-fast bacilli smear positive cases are powerful predictors of Xpert MTB/RIF detection.

DOAJ (DOAJ: Directory of Open Access Journals), 2018

Background Lung cancer is a leading cause of cancer-related death worldwide. The main lines of tr... more Background Lung cancer is a leading cause of cancer-related death worldwide. The main lines of treatment of lung cancer are chemotherapy, radiotherapy, and surgery. Objective The aim was to identify pulmonary complications following the administration of chemotherapy and radiotherapy in the treatment of lung cancer. Patients and methods This prospective cohort study included 50 adult patients with diagnosed lung cancers, who were scheduled to undergo chemotherapy and/or radiotherapy. Patients were divided into three groups (group 1: patients with no complications at the end of follow-up, group 2: patients who developed pulmonary complications, and group 3: patients with extrapulmonary complications). Baseline and post-treatment laboratories and radiological data were recorded for all patients during the 6-month follow-up period. Results A 64% of participants were men, and the mean age was 54.2±10.2 years. Interestingly, 54% of the included participants were never smokers and 8% were ex-smokers. The majority of patients (80%) received either chemotherapy or radiotherapy. The most commonly administrated chemotherapy was gemcitabine carboplatin. By the end of follow-up, 28% of the patients developed pulmonary infection, whereas 10% of the patients developed pulmonary embolism (one patient developed pulmonary embolism with respiratory failure). The mortality rate was 18%. There was a statistically significant difference between the complicated and noncomplicated groups in terms of basic characteristics pulmonary function test (P<0.05). Conclusion In conclusion, the incidence of pulmonary complications among adult patients with lung cancer who receive different modalities is high. The most commonly encountered complications are pulmonary infections and pulmonary embolism.

International Journal of Health Sciences (IJHS), Jun 12, 2023

The prevalence of lung cancer has shown an increase over the last few years which cause both heal... more The prevalence of lung cancer has shown an increase over the last few years which cause both health and economic burden. The biopsy is the gold standard tool for disease diagnosis, but it is usually not accepted by the patients due to its invasive nature. The use of non-invasive biomarkers is now attaining a great interest in diagnosis. Aim of the work: Assess the role of Annexin A1 in bronchoalveolar lavage and serum in the early diagnosis of lung cancer. Patients and methods: This study included 39 patients into two groups; group A (cases with lung cancer) and group B (cases with non-malignant lung lesions). All subjects were submitted to history taking and thorough full physical examination and laboratory analysis. Bronchoalveolar lavage (BAL) was performed in the cases within the two groups. Both serum and BAL levels of annexin A1 were assed in all cases. Results: In the current study, the level of annexin A1 in the serum and BAL were statistically significantly higher in the malignant group as compared with the non-malignant group (P 0.001). The diagnostic parameters were higher in annexin A1 in the BAL as compared to the serum annexin A1 in differentiating lung cancer from suspicious non-malignant lung lesions.In the current study, the best cutoff point of Annexin A1 in BAL in identifying the cases with malignant lesions was > 10.75 with 85% sensitivity and 57.9% specificity. The best cutoff point of Annexin A1 in serum in identifying the cases with malignant lesions was 9.464 with 85% sensitivity and 57.9% specificity. Conclusion: Annexin A1 could be a sensitive marker in the diagnosis of lung cancer especially the BAL annexin A1 which revealed higher diagnostic accuracy compared to the serum annexin A1.

Menoufia Medical Journal, 2018

Objective The objective of this study was to assess serum albumin and base deficit as prognostic ... more Objective The objective of this study was to assess serum albumin and base deficit as prognostic factors for mortality in major burn patients. Background Hypoalbuminemia is a common clinical deficiency in burn patients and is associated with complications related to increased extravascular fluid, including edema, abnormal healing, and susceptibility to sepsis. Base deficit is routinely calculated on blood gas analysis, and it provides the best estimate of the degree of tissue anoxia and shock at the whole body level, particularly in hemorrhagic shock. A rising base deficit indicates increasing metabolic acidosis, and may stratify mortality in patients after major trauma. Some prognostic scales do not include biochemical parameters, whereas others consider them together with comorbidities. The purpose of this study was to determine whether serum albumin and base deficit can predict mortality in burn patients. Patients and methods This study included 42 patients. All patients were admitted to the burn ICU at Menoufia University Hospital. Serum albumin and base deficit were estimated in patients at admission, after 3 days, and after 1 week. Results The mean of serum albumin on admission was 3.33 ± 0.44 g/dl, after 3 days it was 2.85 ± 0.54 g/dl, and after 1 week it was 2.46 ± 0.67 g/dl, and the mean of base deficit was 5.75 ± 2.40, 5.24 ± 2.05, and 5.45 ± 2.76, respectively. These results were significant (P < 0.001). Conclusion Statistically, serum albumin and base deficit can be used as prognostic factors for mortality, and colloid therapy should be continued for the first week, not only for the first 3 days.

Alternative & Integrative Medicine, Aug 5, 2016

In real practice Chronic Obstructive Pulmonary Diseases (COPD) is often diagnosed at a late stage... more In real practice Chronic Obstructive Pulmonary Diseases (COPD) is often diagnosed at a late stage as its clinical manifestations pass unnoticed and spirometry is almost not utilized. Objective: To clarify the role of family physicians in early detection of COPD at the primary care level. Methodology: The study was conducted during winter season 2015 in Al-Shohadaa family health center, Al-Shohadaa city, Menoufia governorate, Egypt. All patients ≥ 40 years, smoking ≥ 10 pack-years attending the center with respiratory symptoms were subjected after their consent to a spirometry to check for early COPD diagnosis. Results: Based on spirometry only, 18 (9.4%) and 15 (7.8%) had GOLD I and ≥ II COPD respectively however 159 out of 192 (82.8%) targeted patients did not have COPD. There was no significant difference in the type and number of respiratory symptoms between non-COPD and COPD patients. Conclusion: As all primary health care centers did not have an access to spirometry, training of family physicians and implementation of spirometry in these centers as a simple gold standard test, that recommended in all guidelines to confirm COPD diagnosis is a mandatory challenge for early detection of the disease. Biography Mohammad Alkot has completed his PhD and Post-doctoral studies from Menoufia University School of Medicine. He is the Vice-director of Family Medicine department and Manshea University Hospital. He has published more than 25 papers in reputed journals.

PubMed, Sep 30, 2020

Hypoalbuminemia as seen in major burn injury results in widespread endothelial dysfunction. Base ... more Hypoalbuminemia as seen in major burn injury results in widespread endothelial dysfunction. Base deficit provides the best estimate for degree of tissue anoxia. Acute blood loss describes anemia present in burn patients. Controversy focuses on the administration of protein-based colloids: whether to provide them, which solutions to use, and when to begin? The aim of this study was to determine whether alteration of gas exchange, excess base deficit, hypoalbuminemia and anemia could predict mortality in major burn patients, whether to provide protein-based colloids, and when to begin fluid resuscitation. The prospective study included 42 major burn patients. All the patients were admitted to the burn intensive care unit at Menoufia University Hospital. Serum albumin level, hemoglobin concentration, arterial blood gases and base deficit were measured at admission, third day and after one week. Average serum albumin on admission was 3.33 ± 0.44, after 3 days 2.85 ± 0.54 and after 1 week 2.46 ± 0.67 gm./dL, while hemoglobin concentration was 14.79 ± 2.13, 12.25 ± 1.99, and 10.24 ± 2.47 gm./dl respectively. However, base deficit was 5.75 ± 2.40, 5.24 ± 2.05 and 5.45 ± 2.76 respectively, with significant statistical difference (p<0.001) between the death and survivor groups. Binary logistic regression analysis for independent predictors of mortality declared that base deficit, albumin and hemoglobin serum levels were independent predictors for mortality with an odds ratio of 2.23, 95% CI, 1.66-16.75 for base deficit, 3.56, 95% CI, 1.88-12.59 for albumin and 2.21, 95% CI, 1.56-13.54 for hemoglobin. Hypoalbuminemia, anemia and excess base deficit can be used as prognostic factors for mortality in major burn patients.

Egyptian Journal of Chest Diseases and Tuberculosis, Jul 1, 2013

ABSTRACT

Background Fiberoptic bronchoscopy (FOB) is standard as a pre-eminent technique for diagnostic, p... more Background Fiberoptic bronchoscopy (FOB) is standard as a pre-eminent technique for diagnostic, palliative, and curative purposes in variable pulmonary insults. Objectives The objectives of this study were to identify the causation, technical aspects, pathophysiological impacts, and complications of FOB in critically ill patients, to discover the correlation between FOB outcomes and independent risk factors, and ultimately to anticipate predictors of mortality in critically ill patients who underwent FOB. Patients and methods This prospective cohort study was carried out in ICUs on 52 critically ill patients who were subjected to FOB for diagnostic or therapeutic purposes. They were grouped into the mechanical ventilation (MV) (28/52) and non-MV (24/52) groups. FOB outcomes and complications were encountered. Results Diagnostic indication of FOB was seen in 40/52 (77%) cases, while the therapeutic purposes of FOB were seen in 12/52 (23%) cases. FOB had a particular indication in the management of 12/52 cases (13.6%) for both pneumonic and inhalation lung injury cases, 10/52 (19.2%) cases for underlining focal lung lesion, 8/52 (15.4%) cases for hemoptysis, and 5/52 (9.6%) cases for either acute respiratory distress syndrome or atelectasis condition. There was a highly considerable variation between the MV and non-MV groups. Hypoxemia, bleeding, arrhythmia, bronchospasm, and laryngospasm were the most prevalent side effects of FOB, with unremarkable differences between both groups. FOB outcomes were as follows: 31/52 (59.6%) cases improved, 11/52 (21.2%) died, and 10/52 (19.2%) were referred to a tertiary health unit. There were significant negative correlations between outcomes and reasons for admission, time of onset of FOB, and radiological pattern. Older age, respiratory insult, immune-compromised state, nonventilatory assessment, and less frequency of FOB performance were predictors of mortality among critically ill patients who underwent FOB. Conclusion Flexible bronchoscopy is a safe and effective procedure for the diagnosis and treatment of pulmonary pathology in critically ill patients.

Egyptian Journal of Chest Diseases and Tuberculosis, 2015

Background: Sleep-disordered breathing (SDB) is highly prevalent in patients with advanced chroni... more Background: Sleep-disordered breathing (SDB) is highly prevalent in patients with advanced chronic kidney diseases (CKDs). Objective: To describe and compare the prevalence, severity, and patterns of SDB and associated nocturnal hypoxia among patients with advanced CKD, hemodialysis (HD) patients, and control group. Methods: Forty patients were recruited from outpatient nephrology clinics and hemodialysis units. Patients were stratified into two groups: conservative (n = 25), and HD (n = 15). 30 healthy individual enrolled as the control group. All participants completed polysomnography (PSG). Results: Case control study of forty CKD patients (15 HD and 25 conservative) [13(86.7%) and 20 (80%) men, mean age 62.73 ± 5.43 and 55.76 ± 9.03 year, BMI 40.83 ± 8.75 and 36.12 ± 16.53 kg/m, mean ESS 18.46 ± 3.20 and 17.84 ± 2.79), respectively, and 30 healthy participants served as the control. The prevalence of SDB in CKD was 33/40(82.5%). In the conservative group, AHI was 148.84 ± 147/h, [80% obstructive, 13% central, and 5% mixed apnea]. Among these conservative groups with OSA patients, 56% had severe, 31% moderate, and 12.5% mild OSA. While in the HD group, AHI 133.26 ± 111/h, [84.6% obstructive, 7.7% central, and 7.7% mixed apnea]. Among these HD groups with OSA, 63% had severe, 27% moderate, and 9% mild OSA. GFR was significantly correlated with AHI and ODI (r = À0.315, P < 0.05, r = À0.506, P < 0.001) respectively. AHI correlated with urea concentration (r = À0.094, P < 0.05). Increased creatinine, and decreased eGFR were significant risk factors of severe OSA. Predictors that reduced renal function were, decreased TST, delayed latency to REM sleep, and increased AHI. Conclusions: Severe OSA was highly prevalent among CKD. Urea was the stronger predictor of increased AHI.

Egyptian Journal of Bronchology, Mar 20, 2023

Background Inhalation lung injury occurs in almost one-third of all serious burns and is responsi... more Background Inhalation lung injury occurs in almost one-third of all serious burns and is responsible for a considerable proportion of burn patient fatalities each year. History of closed space fire or unconsciousness at the accident site, occurrence of pharyngeal or facial burns, hoarseness, and wheezing, and laboratory tests that include blood gas abnormalities or Carboxyhemoglobin levels in blood ˃ 10% are used to diagnose inhalation lung injury. It is also characterized by radiological findings of alveolar or interstitial edema, atelectasis, and/or consolidations, as well as the presence of erythema with laryngeal or tracheal edema in the bronchoscope. Objectives To study the diagnostic and prognostic efficacy of radiologist score and bronchial wall thickening as radiological CT findings in inhalation lung injury. Methods This prospective case-control study included 48 patients with inhalation lung injury (ILI) as a case group and 10 patients without ILI were selected as the control group, all recruited from the burn and plastic department. Within the first 12 h of suspected ILI, a fiberoptic bronchoscope was done to confirm the diagnosis. An initial chest X-ray was done followed by computed tomography through which the radiologist score (RADS) together with bronchial wall thickening (BWT) was done. Results Duration of ventilation was higher in cases than in controls (8.50 ± 3.94 vs 3.25 ± 0.50). The hospital duration was higher in cases than in controls (13.6 ± 4.68 vs9.50 ± 4.52). The BWT was 2.12 ± 0.66 (mean ± SD) in the ILI group while the control group was 1.32 ± 0.48 (mean ± SD). Correlating between baseline PaO2 and RADS score and BWT, it was found that there was a highly significant negative correlation between PaO2 and RADS score and BWT among inhalation lung injury patients (P value 0.001). The sensitivity of BWT in the detection of the need for mechanical ventilation was 83% at a cutoff point of 1.65. Its specificity was 78% and accuracy 75%. Conclusion CT done within 24 h of burn patients has a good role in the diagnosis and management of ILI from the burn.

International Journal of Health Sciences (IJHS), Dec 10, 2022

Determining and classifying predictors of mortality of COVID 19 is of great importance for the mo... more Determining and classifying predictors of mortality of COVID 19 is of great importance for the most efficient use of healthcare resources and public health guidance and will yield improvement in clinical management and outcomes. Aim of the work: To assess Predictors of mortality among COVID 19 patients. Patients and method: 299 patients of confirmed COVID 19 by PCR rolled in our study each patient underwent detailed history, laboratory investigation, CT chest and treated according to severity regarding to Egyptian Ministry of Health Protocol (MOHP). Result: Univariate analysis revealed that old age (OR 1.061 and P value <0.001) ,ICU admission, (OR 10.052 P value <0.001) HTN (OR 2.412 P value 0.002) ,cardiac diseases (OR 2.687 P value 0.014) tachypnea(OR 1.126 P value 0.002),fever (OR 2.118 P value 0.023) hypoxiemia (OR 0.896 P value <0.001), increased inflammatory markers WBCS(OR 1.080 P value <0.001), CRP(OR 1.015 P value 0.002) ,D-dimer (OR 1.540 P value 0.001) S. Ferritin (OR 1.002 P value 0.002), ESR (OR 1.019 P value <0.001)and corad5 (OR 2.308 P value .250) were predictors for motility while in multivariate analysis elderly patients, tachypnea , hypoxiemia and increased ESR are independent factors of mortality. Anosmia found to be a predictor of good prognosis. P values 0.05 in all previous parameters. Conclusion: Old age, hypoxemia, elevated ESR, 6136 tachypnea and lack of anosmia are independent risk factors of mortality in COVID 19.

Egyptian Journal of Chest Diseases and Tuberculosis, 2023

Egyptian Journal of Chest Diseases and Tuberculosis, 2020

Background Uric acid (UA) contributes to beneficial extracellular antioxidant defense activities ... more Background Uric acid (UA) contributes to beneficial extracellular antioxidant defense activities in the airways. However, pro-oxidant powers of UA can be a potential risk factor for gouty arthritis in chronic obstructive airway disease (COPD). Objectives To investigate the proper causation (antioxidant/pro-oxidant) and correlation between UA indices and COPD and whether the associations were modified by smoking. Is serum uric acid (SUA) concentration a reliable biomarker to predict COPD severity? Patients and methods A prospective cohort study enrolled 45 male patients, who were divided into COPD smoker group I, cigarette smoker group II, and apparently healthy participants, serving as a control group III. SUA concentration and creatinine (Cr) level, arterial blood gases, radiographic imaging, and postbronchodilator spirometric measurements were performed. Results SUA was significantly elevated in COPD smoker and cigarette smoker groups than control one. SUA/Cr ratios were significantly increased in COPD smoker than in other groups. Overall, 8/20 (40%) patients were diagnosed with gouty arthritis in COPD smoker group, 1/15 (6.7%) in non-COPD cigarette smoker group, and none in control group. There were statistical significant differences among three groups (P=0.010). There were significantly higher number of patients with severe to very severe COPD (6/8) than patients with mild to moderate COPD (2/8) (P=0.028). There were significant positive correlations between SUA and smoking index (P=0.033), COPD grading (P=0.011), and partial arterial carbon dioxide tension (P=0.028) and also negative correlations with forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) (P=0.029), partial arterial oxygen tension (P=0.001), and O2 saturation (P=0.001) in COPD smoker group I. In cigarette smoker group II, there were statistically significant positive correlations between SUA level and FVC% (P=0.033), FEV1 (P=0.017), and FEV1/FVC (P=0.010). Receiver operating characteristic curves for the evaluation of performance of serum uric acid/serum creatinine ratio in the diagnosis of severity of chronic obstructive airway disease. Conclusion SUA had pivotal antioxidant and pro-oxidant inflammatory effects (gouty arthritis) in COPD. Cigarette smoking is an independent risk factor that influences SUA in COPD. SUA and SUA/Cr ratio increase with rising severity of COPD. UA/Cr ratio is the proper biomarker in the assessment of COPD grading, with higher sensitivity and specificity.

Background: There are multiple connections between sleep and lung cancer. Both of them impacting ... more Background: There are multiple connections between sleep and lung cancer. Both of them impacting each other lung cancer can make it difficult to sleep well due to symptoms and treatment side effects(20-70% of cancer patients suffer of insomnia) .Also there is possible relationship between lung cancer and nocturnal intermittent hypoxia, apnea and daytime sleepiness, progression of lung cancer considered as risk factor of obstructive sleep apnea severity. Aim of the work: to evaluate sleep pattern changes in patients with lung cancer. Patients and methods: 26 patients with non small cell lung cancer were interviewed for assessment of histopathological subtypes and stages according to TNM classification and treated at Department of Clinical Oncology and Nuclear Medicine (chemotherapy, radiotherapy, targeted therapy and surgical treatment were scheduled), they underwent to sleep questionnaire and Epworth Sleepiness Score (ESS).overnight full polysomnography was done. Results: A prospective cohort study 26 lung cancer patients were enrolled in this study, 84.6% of the studied patients were on 4073 chemotherapy, 34.6% were on targeted therapy, 19.2% on radiotherapy and 7.7% received surgical treatment.38.5% of the studied patients were stage 3, 23.1% were stage 2, 38.5% were stage 4. After had ESS 42.3%of the studied patients were excessively situational sleepy and 15.4% of them were normal sleep. Sleep latency was 52.535± 60.077 min; the mean of sleep efficiency was 45.9% ±18.5%; the mean of wakefulness after sleep onset /minute (WASO) was 107.06± 0.61.94. The mean of total apnea-hypopnea Index/hour (AHI) was 27.61± 27.45 all reading are (OSA), Desaturation Index/hour was 23.44± 23.075, Arousal Index/ hour was 27.25± 14.72; Snoring Episodes was 27.25± 46.05. PLMS/ hour (periodic limb movements) was 54.71± 69.50. 23 ∕26 patients (88.5%) were obstructive sleep apnea (OSA), 8/23 (34.9) were mild OSAS, 9/23(39.1%) were moderate OSAS and 6/23 (26.1%) were sever OSAS. 21 ∕ 26 patients (80.8%) had sleep maintenance insomnia. The mean of OAS (overall survival) was 18.38±11.426, there is a positive correlation between OAS and sleep efficiency, % in the studied patients (r = 0.435, P = 0.026), there is a negative correlation between OAS and total AHI hour in the studied patients, ESS and snoring episodes (r = 0.622, P = 0.001), (r = 0.411, P = 0.037), (r = 0.637, P = 0.001). Conclusion: Patients with lung cancer had inefficient sleep, delay sleep latency (insomnia) and had sleep respiratory breathing disorders (OSAS). Tumor size and tumor staging affect OSA severity. OAS inversely correlated to OSA severity.

European Respiratory Journal, Sep 1, 2013

Body: Background Pneumonia is common among critically ill burned patients. It is a major cause of... more Body: Background Pneumonia is common among critically ill burned patients. It is a major cause of morbidity and mortality in burn victims. Prediction of mortality in severely burned patient remains unreliable. Objective: The aim of this research is to study the incidence, early diagnosis and management of nosocomial pneumonia and to discuss the relationship between pneumonia and death in burn patients. Methods This study was carried out on 80 burn patients (35 males and 45 females) admitted to Menoufiya University Hospital Burn Center and Chest Department (Egypt) from September 2011 to Mars 2012. Results Our study found an overall burn patient mortality rate of 26.25 %(21/80). The incidence of pneumonia was 15% (12/80). The mortality rate among patients of pneumonia was 50% (6/12) compared with 22 %(15/68) for those without pneumonia. The pneumonia was two times higher in the subset of patients with inhalation injury compared with group of patients without inhalation injury (P< 0.001).It was found that the presence of pneumonia, inhalation injury, increased burn size, and advanced age were all associated with increased mortality (P< 0.001). There were attributed mortality associations with late onset pneumonia. Severity of disease, severity of illness (APACHE score), presence of organ failure, underlying comorbidity, VAP PIRO score have significant correlation with mortality rate. Conclusions Pneumonia was an important factor for predicting burn patient mortality. Early detection and management of pneumonia are absolutely essential.

PubMed, Sep 30, 2013

Pneumonia is common among critically ill burn patients and is a major cause of morbidity and mort... more Pneumonia is common among critically ill burn patients and is a major cause of morbidity and mortality among them. Prediction of mortality in patients with severe burns remains unreliable. The aim of this research is to study the incidence, early diagnosis and management of nosocomial pneumonia, and to discuss the relationship between pneumonia and death in burn patients. This prospective study was carried out on 80 burn patients (35 males and 45 females) admitted to Menoufiya University Hospital Burn Center and Chest Department, Egypt, from September 2011 to March 2012. Our findings showed an overall burn patient mortality rate of 26.25 % (21/80), 15% (12/80) incidence of pneumonia, and a 50% (6/12) mortality rate among patients with pneumonia compared to 22 % (15/68) for those without pneumonia. The incidence of pneumonia was twice as high in the subset of patients with inhalation injury as among those without inhalation injury (P< 0.001). It was found that the presence of pneumonia, inhalation injury, increased burn size, and advanced age were all associated with increased mortality (P< 0.001). In the late onset pneumonia, other associated factors also contributed to mortality. Severity of disease, severity of illness (APACHE score), organ failure, underlying co-morbidities, and VAP PIRO score all have significant correlations with mortality rate. Pneumonia was an important factor for predicting burn patient mortality. Early detection and management of pneumonia are absolutely essential.

Egyptian Journal of Chest Diseases and Tuberculosis, 2019

Objectives To assess the serum level of vitamin D and mean platelet volume (MPV) in patients with... more Objectives To assess the serum level of vitamin D and mean platelet volume (MPV) in patients with obstructive sleep apnea syndrome (OSAS) and whether their levels correlate with OSAS severity or not. Background OSAS is a clinical disorder characterized by recurrent episodes of upper airway collapse during sleep. Studies show a link between low levels of vitamin D ‘25(OH) D’ and obstructive sleep apnea. Some studies showed that patients who have OSAS also have raised platelet aggregation and activation. MPV is considered an indicator of activation of platelet and its size. Limited studies have informed a relationship between MPV and sleep apnea. Patients and methods A total of 65 patients with OSAS and 24 age-matched controls with completed Epworth sleepiness scale were included. OSAS diagnosis was based on polysomnography. Vitamin D was measured by ELISA, and MPV was measured by Sysmex xn-10 machine. Results A prospective case–control study was done on 65 OSAS cases and 24 age-matched and sex-matched controls. Vitamin D level was significantly lower among OSAS cases than controls, with lowest 25(OH) D in severe OSAS cases, whereas MPV showed nonsignificant difference between them, and the higher MPV was among severe cases. There was a significant negative correlation between vitamin D level and neck circumference (NC), apnea–hypopnea index (AHI), and desaturation index. There was a significant positive correlation between MPV level and each of NC and AHI. NC was an independent predictor for both vitamin D and MPV levels. NC, AHI, and vitamin D level are the independent risk factors for obstructive sleep apnea, with odds ratios of 2.09 and 1.6, respectively. Conclusion Patients with OSAS have decreased vitamin D level. Patients with severe OSAS have lower vitamin D level and higher MPV than other groups. Obesity may be the cause that explains this relation regarding high NC.

Egyptian Journal of Chest Diseases and Tuberculosis, 2020

Background GeneXpert Mycobacterial tuberculosis (MTB)/rifampicin (RIF) is a standard primary test... more Background GeneXpert Mycobacterial tuberculosis (MTB)/rifampicin (RIF) is a standard primary test for early diagnosis of pulmonary tuberculosis (PTB) and RIF resistance. The GeneXpert technique provides a useful tool for tuberculosis control in endemic areas. Objective To assess the diagnostic performance of GeneXpert and rule out the independent risk factors that influence the outcomes. Patients and methods In all, 452 presumed PTB patients were enrolled in this prospective study. Three consecutives morning sputum samples underwent decontamination and liquefaction. Smear microscope, conventional solid culture media (Lowenstein–Jensen media as reference standards), and GeneXpert were performed in sputum specimens. Results A total of 452 test results uploaded from GeneXpert machine 112/452 (24.7%) showed MTB detection and RIF resistance detected in 9/112 (8%). GeneXpert had a sensitivity of 91.1% and a specificity of 100%, with total accuracy of 97.31%. The percentage of GeneXpert positive outcomes in watery phlegm was highly significant in comparison to mucoid phlegm (odds ratio: 61.30; 95% confidence interval: 14.653–88.01; P<0.01); also GeneXpert MTB detection was significantly higher in sputum smear positive than negative cases (odds ratio: 14.474; 95% confidence interval: 0.086–0.456; P<0.01). Conclusion GeneXpert MTB/RIF is a useful qualitative and quantitative test for early detection of PTB and RIF resistance; moreover, watery sputum and acid-fast bacilli smear positive cases are powerful predictors of Xpert MTB/RIF detection.

DOAJ (DOAJ: Directory of Open Access Journals), 2018

Background Lung cancer is a leading cause of cancer-related death worldwide. The main lines of tr... more Background Lung cancer is a leading cause of cancer-related death worldwide. The main lines of treatment of lung cancer are chemotherapy, radiotherapy, and surgery. Objective The aim was to identify pulmonary complications following the administration of chemotherapy and radiotherapy in the treatment of lung cancer. Patients and methods This prospective cohort study included 50 adult patients with diagnosed lung cancers, who were scheduled to undergo chemotherapy and/or radiotherapy. Patients were divided into three groups (group 1: patients with no complications at the end of follow-up, group 2: patients who developed pulmonary complications, and group 3: patients with extrapulmonary complications). Baseline and post-treatment laboratories and radiological data were recorded for all patients during the 6-month follow-up period. Results A 64% of participants were men, and the mean age was 54.2±10.2 years. Interestingly, 54% of the included participants were never smokers and 8% were ex-smokers. The majority of patients (80%) received either chemotherapy or radiotherapy. The most commonly administrated chemotherapy was gemcitabine carboplatin. By the end of follow-up, 28% of the patients developed pulmonary infection, whereas 10% of the patients developed pulmonary embolism (one patient developed pulmonary embolism with respiratory failure). The mortality rate was 18%. There was a statistically significant difference between the complicated and noncomplicated groups in terms of basic characteristics pulmonary function test (P<0.05). Conclusion In conclusion, the incidence of pulmonary complications among adult patients with lung cancer who receive different modalities is high. The most commonly encountered complications are pulmonary infections and pulmonary embolism.