Ahmed Abumossalam | Mansoura University (original) (raw)

Papers by Ahmed Abumossalam

Egyptian Journal of Bronchology, 2016

Pleural lipoma is a rare clinical pleural dilemma that needs suspicious sense and a feasible radi... more Pleural lipoma is a rare clinical pleural dilemma that needs suspicious sense and a feasible radiological diagnosis as soon as a strong evidence of malignant transformation is excluded.

Journal of Tuberculosis Research, 2020

Introduction: Tuberculosis still characterizes till now a major respiratory insult with concurren... more Introduction: Tuberculosis still characterizes till now a major respiratory insult with concurrent pulmonary manifestations and later disability. Aim of Work: To evaluate the level of exhaled fraction of nitric oxide (FENO) and fraction of exhaled carbon monoxide (FECO) as markers of pulmonary tuberculosis TB activity in patients under chemotherapy in comparison to healthy negative patients and latent TB patients. Patients and Methods: This cross-sectional study was conducted on 130 patients recruited from the outpatient clinic of Mansoura Chest hospital during the period from May 2019 to December 2019. They were categorized into the three groups: 1) Pulmonary tuberculous patients PTB (group1) which included 48 cases with positive sputum for TB bacilli in the initiation phase after 1 month of starting anti-tuberculous chemotherapy; 2) Latent patients (group 2): included 40 patients with positive tuberculin skin test (Mantoux test) > 10 mm. 3) Control patients (group 3) which included 42 healthy volunteers with negative sputum for TB bacilli. They were subjected to portable spirogram as well as exhaled fractional NO and CO measurement. Results: FECO and FENO levels prevailed in pulmonary TB patients followed by Latent TB patients and lastly healthy volunteers (42 ± 12.32/5 ± 0.16 & 38 ± 8.25/6 ± 2.25 and 23 ± 3.25/2 ± 0.40 respectively). Conclusion: Measurement of CO and NO level in expired air may correlate with active pulmonary TB infection in comparison to healthy negative tuberculous patients and latent tuberculous patients.

The Egyptian Journal of Chest Diseases and Tuberculosis, 2021

Background Lung cancer is a leading cause of cancer-related mortality in the world. Nonsmall cell... more Background Lung cancer is a leading cause of cancer-related mortality in the world. Nonsmall cell lung cancer (NSCLC) can be classified as nonsquamous cell carcinoma (non-SCC) and squamous cell carcinoma (SCC). NSCLC pathogenesis includes altered methylation patterns in multiple genes. Promotor methylation of death-associated protein kinase (DAPK) has been documented in various tumors. Aim To compare DAPK promoter methylation and clinical characteristics in patients of nonsquamous cell lung cancer with those of SCC. Patients and methods A case–control study was conducted on fresh-frozen tumor samples from 81 patients with primary NSCLC, including 43 non-SCC cases and 38 SCC cases, investigated in the Chest Department, Mansoura University Hospital, in the period from June 2017 to January 2020. A total of 40 patients matched for age and sex with nonmalignant lung lesions served as controls. Patients with age more than 18 years, radiological suggestions of lung cancer, and histological...

Current Respiratory Medicine Reviews, 2022

Background: COVID-19 has still been expressed as a mysterious viral infection with dramatic pulmo... more Background: COVID-19 has still been expressed as a mysterious viral infection with dramatic pulmonary consequences. Objectives: This article aims to study the radiological pulmonary consequences of respiratory covid-19 infection at 6 months and their relevance to the clinical stage, laboratory markers, and management modalities. Methods: This study was implemented on two hundred and fifty (250) confirmed positive cases for COVID-19 infections. One hundred and ninety-seven cases (197) who completed the study dis-played residual radiological lung shadowing (RRLS) on follow-up computed tomography (CT) of the chest. They were categorized by Simple clinical classification of COVID-19 into groups A, B and C. Results: GGO, as well as reticulations, were statistically significantly higher in group A than the other two groups; however, bronchiectasis changes, parenchymal scarring, nodules as well as pleu-ral tractions were statistically significantly higher in group C than the other two grou...

Abstract: The present study was aimed at optimizing the transfusion security of the patients, we ... more Abstract: The present study was aimed at optimizing the transfusion security of the patients, we determined the seroprevalence of transferable infections by the blood transfusion notably the HIV, hepatitis B, hepatitis C and the syphilis among the blood donors at the blood bank of regional hospital of Bertoua to reduce meaningfully their impact in hospitable environment. We performed a prospective transversal survey on 429 Blood donors from the 1 st January 2013 to 1 st January 2014. We included 371 men (86.48%) and 38 women (13.52%). During this survey, we noted that, the most large part of blood donation was given by family members of patients with a seroprevalence of 58.04 % compared to volunteers donors (23.78%) and remunerated donors (18.18%). The infections seroprevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and Syphilis has been estimated to 5.13%, 6.76%, 4.2 % and 0.46 % respectively. These results showed that it was necessa...

The Egyptian Journal of Chest Diseases and Tuberculosis, 2019

© 2019 The Egyptian Journal of Chest Diseases and Tu Background Airway hyperresponsiveness (AHR) ... more © 2019 The Egyptian Journal of Chest Diseases and Tu Background Airway hyperresponsiveness (AHR) is an overstated constrictor response of the airways to a diverse types of specific plus nonspecific stimuli, and it is a major, but not necessarily unique, feature of asthma. Aim This study aims to detect the presence or absence of AHR in patients with pulmonary tuberculosis (TB). Patients and methods This study included 40 patients with TB and 20 healthy age-matched and sexmatched volunteers. They were divided into three groups: group A included 20 patients with pulmonary TB under anti-TB medication after the initial phase (2 months) of treatment with successful sputum conversion, group B included 20 cured cases with past history of pulmonary TB that completed the full supervised course, and group C included 20 volunteers with matched age and sex. They were subjected to spirometry as well as methacholine bronchial challenge test and computed tomographic chest examination. Results There...

The Egyptian Journal of Chest Diseases and Tuberculosis, 2019

© 2019 The Egyptian Journal of Chest Diseases and Tu Background Respiratory complications are the... more © 2019 The Egyptian Journal of Chest Diseases and Tu Background Respiratory complications are the chief causes of morbidity plus mortality in patients with neuromuscular diseases (NMD). The diaphragm acts as the main inspiratory muscle during regular breathing, and its weakness predisposes to respiratory failure. Aim The aim was to explore the role of transthoracic diaphragmatic ultrasonography compared with respiratory pressures measured by spirometer in assessing respiratory muscle strength in patients with NMD. Patients and methods A prospective observational cross-sectional study was conducted in Chest Department, Mansoura University Hospital. Patients with NMD (n=50) who were spontaneously breathing and could understand and cooperate with the sonographic maneuvers, maximal inspiratory pressure, and maximal expiratory pressure (Pi Max and Pe Max) were recruited. They were classified into group I (n=35), which included myopathic patients with NMD owing to muscle disease or neurom...

The Egyptian Journal of Chest Diseases and Tuberculosis, 2021

Background Promotion of central control of respiration might contribute in minimization of chroni... more Background Promotion of central control of respiration might contribute in minimization of chronic obstructive lung disease disability. Objectives Our study was done to evaluate the effect of oral supplementation of piracetam tablets in low dose (400 mg twice daily) versus high dose (1200 mg twice daily) in patients with chronic obstructive pulmonary disease grade IV with type II respiratory failure, on respiratory parameters (spirometric, respiratory muscle strength, and diaphragmatic echographic measurements; velocity and excursion), in addition to neuropsychiatric parameters (cognitive functions and brain changes with MRI). Patients and methods This randomized controlled study was conducted on 126 patients who were subjected to oral piracetam and classified into group A (42 patients received 800 mg daily for 3 months), group B (44 patients received 2400 mg daily for 3 months) for 3 months, and group C (40 patients) as a control group. Pulmonary evaluation, by spirometry and respi...

The Egyptian Journal of Chest Diseases and Tuberculosis, 2019

Background Epidemiological data have linked statin use with improvements in lung health and asthm... more Background Epidemiological data have linked statin use with improvements in lung health and asthma-related hospitalizations and/or emergency room visits. Aim The aim was to evaluate the effect of statin therapy on airway inflammation and clinical outcome in moderate and severe asthma. Patients and methods This study was conducted on 61 cases, but only 40 cases completed the study. Patients were recruited from outpatient clinic and general ward of Thoracic Medicine Department of Mansoura University Hospitals from May 2015 to June 2016. They were categorized into statin group, which included 20 asthmatic cases that received statin (atorvastatin with a dose of 20 mg daily for 3 months), serving as the study group, which was further subdivided into two subgroups: moderate and severe subgroups, and nonstatin group, which included 20 asthmatics cases that did not receive statin, serving as a control group, and they were further subdivided into two subgroups: moderate and severe subgroups....

The Journal of respiratory diseases, 2020

Background: toxic gases and fumes prompted from petrol and gas stations imply their disabling and... more Background: toxic gases and fumes prompted from petrol and gas stations imply their disabling and deadly risks on human lungs. Aim of Work: The aim of this work was to assess the pulmonary function derangements in petrol pump workers at Al-Medina Al-Munawara city. Patients and Methods: This cross sectional study was conducted on 189 cases out of them in control group (group I) with age and sex matched healthy adult males gathered from nonsmokers students and employees in Taibah University. The study group (group II) comprised of 89 males who were working in different petrol pump stations. History, clinical examination and pulmonary functional assessment were carried out by using portable spirometry, Co detector and puls oximeter. Results: The study’s results showoed that the lung function parameters (FEV1, FVC, PEFR, FEFR25% - 75%) were significantly reduced in petrol pump workers (Group II) as compared to the values for these parameters in subjects belonging to Group II (Control gr...

The Egyptian Journal of Chest Diseases and Tuberculosis, 2020

Background Obesity still implies health hazards on human presented in actual increment on respira... more Background Obesity still implies health hazards on human presented in actual increment on respiratory complaints and subsequent pulmonary derangement. Objective This study aimed to evaluate the effect of obesity on bronchial airway hyper-responsiveness and on the inflammatory markers of the airways. Participants and methods This was an observational cross-sectional study that included 98 nonasthmatic individuals who were divided into two groups according to their BMI: normal BMI and overweight or obese, with their ages ranging from 14 to 59 years. We compared the two groups on the bronchial challenge test with hypertonic saline solution 4.5%, fractional exhaled nitric oxide level, and serum level of high-sensitivity C-reactive protein. Results Positive bronchial hyper-reactivity was significantly more in overweight and obese participants compared with those with normal BMI (P=0.004). Also, bronchial hyper-reactivity was found to be significantly more common in females (P=0.025). There were statistically significant differences between the two groups in spirometry measurements, with lower lung volumes in obese participants. Moreover, statistically significant differences were observed between the two groups in fractional exhaled nitric oxide (P=0.022) and high-sensitivity C-reactive protein (P=0.043). Conclusion Obese individuals have dissimilar bronchial hyper-reactivity compared with individuals with normal BMI. Local airway and systemic inflammatory marker levels differ in obese individuals compared with those with normal BMI.

The Egyptian Journal of Chest Diseases and Tuberculosis, 2020

Background Fractional exhaled nitric oxide (FeNO) is recognized as an airway inflammatory indicat... more Background Fractional exhaled nitric oxide (FeNO) is recognized as an airway inflammatory indicator for various respiratory insults like asthma, cystic fibrosis, and chronic obstructive pulmonary disease exacerbation. Aim To study the relation between FeNO level in exhaled breath and pneumonia types, nonventilator-associated pneumonia (VAP) [including community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), and aspiration pneumonia (AsP)] and VAP, as well as relation to arterial oxygen tension/FiO2 ratio and the extent of radiological affection. Patients and methods A prospective cross-sectional study was conducted on 88 patients admitted to Mansoura University Children’s Hospital with pneumonia, either mechanically ventilated or not. FeNO level was measured during end-expiration via spirometry calibration syringe in VAP and by direct measurement in CAP, HAP, and AsP. Levels of FeNO were compared between patients in relation to different characteristics such as age, sex, arterial oxygen tension/FiO2 ratio, extent of radiological affection, and to a clinically modified PIRO (predisposition, insult, response, and organ dysfunction) score. Results FeNO level was higher in the expired air in VAP followed by AsP then HAP and lastly CAP (37.6, 33.4, 31.9, and 29.1 ppb, respectively; P=0.001). A statistically significant difference was detected among the four groups regarding FeNO level. Radiological grading of pneumonia was informative; grades III and IV showed higher percentage in total studied patients. There was statistically significant weak positive effect of modified PIRO score on FeNO level (r=0.255, P=0.017). Conclusion FeNO could be used as a beneficial airway inflammatory marker that is related to modified PIRO score in children but cannot identify pneumonia type.

Egyptian Journal of Bronchology, 2019

Background Determining the optimal moment to extubate a critically ill patient remains a challeng... more Background Determining the optimal moment to extubate a critically ill patient remains a challenge. The parameters of diaphragm sonography offer precious data in the evaluation and follow-up of critically ill patients on mechanical ventilation. Aim To evaluate the diaphragm role in the weaning outcome through the following objectives: detect the association between ultrasonographic parameters of diaphragm [thickness, excursion, and velocity of contraction (slope)] and weaning outcome, success, or failure, in addition to evaluation of the weaning process by measuring the total duration of ventilation, weaning duration, ICU stay, and reventilation. Patients and methods A longitudinal, observational, prospective study. The primary endpoint was weaning outcome (failed or successful), while the secondary endpoints included length of ICU stay, weaning duration, ventilation duration, presence or absence of complications, and mortality. It was conducted on 240 (138 men and 102 women) invasively mechanically ventilated patients aged between 20 and 78 years were chosen from our Respiratory ICU of Chest Department, Mansoura University Hospital. Results There were statistically significant higher values of all sonographic measurements in the survived compared with the died group (P<0.001). There was statistically significantly higher sonographic diaphragmatic measurements in the successful group compared with the failed group (P<0.001). Conclusion The measurement of percent change of diaphragmatic thickness as well as excursion and slope could be applied in correlation more with weaning outcome with a sensitivity of 100% and specificity of 97.4%.

Egyptian Journal of Chest Diseases and Tuberculosis, 2015

Background: Delayed resolving pneumonia represents a perplexing diagnostic dilemma. Many methods ... more Background: Delayed resolving pneumonia represents a perplexing diagnostic dilemma. Many methods can lend a hand in diagnosis; however prediction of such a problem wishes a more precision. Objectives: Define to what extent early anticipation of underlying causes of delayed resolving pneumonia via clinical, radiological and bronchoscopic markers would modify management plan and affect their outcomes. Patients and methods: Prospective clinical study was conducted on 122 patients with delayed resolving pneumonia. They underwent chest X-ray, thoracic ultrasound, chest computed tomography (CT) and fiberoptic bronchoscopy (FOB). Tissue biopsy was taken for pathological examination. Results: Studied cases were divided into two groups: group I included 58 patients with malignant etiology (49 cases with lung cancer and 9 cases with pulmonary metastasis) and group II included 64 patients with nonmalignant etiology (nonspecific pneumonia in 42 cases, specific forms of pneumonia in 14 cases, pulmonary sequestration in 4 cases and traction bronchiectasis in 4 cases). Sensitivity of clinical and CT chest markers of malignancy was 72.36% and 53.45% respectively however their specificities were 20.62% and 59.38% respectively. Thoracic ultrasound showed the highest sensitivity (75.86%) but lowest specificity (17.19%). FOB markers of malignancy were significantly higher in malignant than the non-malignant group (p = 0.001). Summation of clinical, FOB, CT chest and sonographic markers increased the probability of malignancy in 67.2% and excluded malignancy in 71.8% of cases with a success rate of 69.7%. Conclusion: Early anticipation of what beyond delayed resolution of pneumonia can assist in earlier verification of causes and supervising course and guard against consequences.

Egyptian Journal of Chest Diseases and Tuberculosis, 2016

Background: Pulmonary airspace containing cavities signify major dissuade that hold gas exchange ... more Background: Pulmonary airspace containing cavities signify major dissuade that hold gas exchange functions back and bring about recurrent suppuration. Purpose: The aim of this work is to evaluate the impact of percutaneous local inoculation of focal benign cavitary lung lesions with synthetic material (gelfoam) guided with chest computed tomography (CT) on the patient outcome based on clinical, laboratory, functional and radiological parameters. Patients and methods: A prospective simple randomized controlled trial was conducted on twenty eight patients with focal benign cavitary lung lesion less than 10 cm in diameter in whom surgical resection was contraindicated or refused. They were subdivided into two groups: group I (medically treated): 14 patients were followed up for three months with medical prophylaxis with quinolone plus clindamycin and group II (gelfoam inoculated): 14 patients percutaneous locally injected with gelfoam under CT guidance for a single session. Results: Gelfoam inoculated group (group II) presented more prevalence over medically treated group (group I) in the reduction of the frequency of infective exacerbations (71.42%), absence of leukocytosis (85.7%), functional improvement (42.85%), reduction of cavity size (57.14%) and cavitary obliteration (35.71%). Both groups were matched regarding the absence of hemoptysis and negative sputum cultures with high percentage (92.85%). However, reduction of the frequency of hospitalization predominated in group I. Significant statistical differences were present in radiological parameters only (reduction of size (0.042) and cavity obliteration (0.002). Success rate of procedure in the studied group was (35.71%). Conclusion: Percutaneous gelfoam injection may share in staged palliation and weeding out of pulmonary cavitary lesions with simple noninvasive image guided procedure.

Egyptian Journal of Chest Diseases and Tuberculosis, 2014

The aim of this study is to differentiate between the histopathological features of pleural tuber... more The aim of this study is to differentiate between the histopathological features of pleural tuberculosis both free and encysted forms of pleural effusion as regards pleural fluid cytology and pleural tissue granulomatous tissue reaction and assess the effects of combined microbial infection on histopathological and clinical residuals. Patients and methods: One hundred and ninety patients were confirmed to be tuberculous by pleural tissue biopsy. Pleural fluid cytopathology and TB granulomatous tissue biopsy samples were studied. Results: Within histopathological features in TB pleural effusion is typical granulomatous TB reaction that was prevalent in both free and encysted forms of pleural effusion with high percentage (97% and 87.5% respectively). On the other hand, lymphocytic exudative smear was predominant in the free TB effusion group than both inflammatory and hemorrhagic ones (74.7% versus 23.5% and 1.8% respectively) while the encysted effusion group presented higher predominance to inflammatory exudative smear than other types (54.2% versus 41.7% and 4.2% respectively). Moderate cellularity was higher in percentage in both free and encysted groups 77.7% and 62.5% respectively. Also, langerhans cells prevailed in both effusion types. Lastly, non TB culture was present in all cases of encysted pleural effusions but accounted only for 3% of free effusion cases. Conclusion: Differentiation between free and encysted forms of pleural tuberculous effusion as regards effusion cytopathological criteria and pleural tissue histopathological patterns represent an important support in understanding the pathogenesis of pleural tuberculous tissue reactions and other positive cultural diagnosis can aggravate TB granulomatous reactions.

Egyptian Journal of Chest Diseases and Tuberculosis, 2017

Background: Respiratory derangement is a major health hazard in patients with neuromuscular disor... more Background: Respiratory derangement is a major health hazard in patients with neuromuscular disorders (NMD). This study aimed to compare spirometry results using facemask with that of conventional tube in patients with NMD and accordingly possible use of facemask instead of conventional tube in this group of patients. Methods: Thirty-six patients with NMD and fifty normal volunteers were recruited within 9 months. Assessment of patients included history and physical examination specially presence of respiratory symptoms, duration and stage of neuromuscular illness, bulbar symptoms, sensory, motor and cranial nerve assessment. Then all participants were subjected to spirometry and respiratory pressures assessment using both conventional tube and facemask. Results: Spirometry and respiratory pressure assessment using facemask versus tube measured in all participants. For patients with NMD; spirometric measures P Imax and P Emax were higher in tube than facemask. FEV 1 , FEV 1 %, FEV 1 /FVC %, and P Imax showed statistically significant difference. For patients with bulbar palsy; SVC was higher in facemask without statistically significant difference. For other spirometric measures, P Imax and P Emax ; using tube was higher than facemask with only FEV 1 , FEV 1 % showed statistically significant difference (p = 0.023 and 0.015 respectively). For patients without bulbar palsy; all spirometric measures, P Imax and P Emax were higher when using tube with only FEV 1 /FVC % showed statistically significant difference (p = 0.004). Also for control group; data were higher in tube with only FEV 1 showed statistically significant difference (p = 0.031). For patients with NMD; fractional functional defect (FFD) was very high for P Imax and P Emax. Conclusion: The use of facemask during assessment of spirometric and respiratory pressures measures in patients with NMD and more specifically in patients with bulbar palsy is promising and can be considered a good alternative to conventional tube assessment for functional screening rationale.

Egyptian Journal of Bronchology, 2017

Context Malignant pleural effusion is a common presentation of several malignancies. Chemical ple... more Context Malignant pleural effusion is a common presentation of several malignancies. Chemical pleurodesis is important in its management, but no consensus exists on the optimal agent or methods of pleurodesis. Aim This work aimed to evaluate the outcome of oral doxycycline capsules in a poudrage form through a medical thoracoscope as a therapeutic approach for pleurodesis in patients with malignant pleural effusion. Setting and design This study was a prospective quasiexperimental one. Patients and methods This prospective quasiexperimental study was conducted on 70 patients with metastatic pleural effusion. They underwent pleurodesis with thoracoscopic doxycycline poudrage. Results The success of doxycycline powder poudrage was complete in 75.7% of cases and partial in 10% of cases; however, failure was observed in 14.3%. Thus, total success rate was 85.7%. As regards complications, they were irrelevant; pain was the predominant feature in 81.4% of cases, fever in 11.4% of cases, and empyema in only 4.3% of cases. Conclusion Using oral doxycycline with thoracoscopic poudrage yielded a remarkable success rate and may alternate the need for talc powder with less complications and more safety.

Egyptian Journal of Chest Diseases and Tuberculosis, 2016

Background: Pleural malignancies disturb normal ways of protein metabolism deferring imbalance of... more Background: Pleural malignancies disturb normal ways of protein metabolism deferring imbalance of backside markers in body tissues and fluids and see the sights of muscle and protein derangement. Purpose: The aim of this work to study markers of protein depletion and muscle catabolism in cases with malignant pleural effusion. Patients and methods: Thirty patients with malignant pleural effusions not under chemotherapy were studied regarding markers of muscle and protein derangement (plasma albumin & potassium levels and creatinine height index) and radiological signs (the presence of pleural thickness by computed tomography (CT) of chest and muscle wasting by skeletal muscle ultrasound) plus thoracoscopic findings (plaques and adhesions). Results: Metastatic adenocarcinoma accounted for a higher percentage in smoking 66%, aging (59.06 ± 13.04) and duration of illness (13.13 ± 4.85) than other pleural malignancies. In the same way metastatic adenocarcinoma showed the major type in hypoalbuminemia, hypokalemia and CT pleural thickening than other malignancies (11.11%, 72.22% and 77.76% in that order). However, malignant lymphoma was prevalent in echographic features of muscle wasting, pleural plaques and pleural adhesions (66.7% for each marker). Lastly, squamous cell carcinoma prevailed in creatinine highest index than the previous three tumors (75%). Nevertheless, there were no statistical significant differences between the four diagnosed malignancies except for pleural plaques that were significant (p = 0.03). Conclusion: Pleural malignancy can enhance the body decomposition in particular muscular components and hastens protein catabolism with the help of feasible laboratory and radiological markers.

Egyptian Journal of Chest Diseases and Tuberculosis, 2016

Background: Endoscopic lung volume reduction maneuver using simple inexpensive reagents to remode... more Background: Endoscopic lung volume reduction maneuver using simple inexpensive reagents to remodel and shrivel damaged regions of the lung has been accomplished in managing human with pulmonary emphysema as a surrogate for surgical interference. Objectives: Evaluation of the safety and efficacy of hot saline versus dissolved doxycycline (vibramycin) for lung volume reduction of emphysematous lung in both adult and pediatric age groups. Patients and methods: Prospective clinical study was conducted on 21 patients with pulmonary emphysema. They were submitted to fiberoptic bronchoscopy (FOB), chest computed tomography (CT) and comprehensive respirometry. They were divided into two groups: group I underwent FOB instillation of hot saline with 50°C in two consecutive sessions and group II underwent FOB instillation with dissolved doxycycline in normal saline also in two consecutive sessions, and each procedure then repeated after one week. Results: The total success rate of the procedure in group I was 72.72% and in group II 70% however the total success rate in the studied cases was 71.43%. The procedure success in adult age group in group I represented 77.7% on the other hand in group II it reached 75% and the total therapeutic success rate was 76.74% while in the pediatric age group it accomplished an equal percentage (50%) in both groups.

Egyptian Journal of Bronchology, 2016

Pleural lipoma is a rare clinical pleural dilemma that needs suspicious sense and a feasible radi... more Pleural lipoma is a rare clinical pleural dilemma that needs suspicious sense and a feasible radiological diagnosis as soon as a strong evidence of malignant transformation is excluded.

Journal of Tuberculosis Research, 2020

Introduction: Tuberculosis still characterizes till now a major respiratory insult with concurren... more Introduction: Tuberculosis still characterizes till now a major respiratory insult with concurrent pulmonary manifestations and later disability. Aim of Work: To evaluate the level of exhaled fraction of nitric oxide (FENO) and fraction of exhaled carbon monoxide (FECO) as markers of pulmonary tuberculosis TB activity in patients under chemotherapy in comparison to healthy negative patients and latent TB patients. Patients and Methods: This cross-sectional study was conducted on 130 patients recruited from the outpatient clinic of Mansoura Chest hospital during the period from May 2019 to December 2019. They were categorized into the three groups: 1) Pulmonary tuberculous patients PTB (group1) which included 48 cases with positive sputum for TB bacilli in the initiation phase after 1 month of starting anti-tuberculous chemotherapy; 2) Latent patients (group 2): included 40 patients with positive tuberculin skin test (Mantoux test) > 10 mm. 3) Control patients (group 3) which included 42 healthy volunteers with negative sputum for TB bacilli. They were subjected to portable spirogram as well as exhaled fractional NO and CO measurement. Results: FECO and FENO levels prevailed in pulmonary TB patients followed by Latent TB patients and lastly healthy volunteers (42 ± 12.32/5 ± 0.16 & 38 ± 8.25/6 ± 2.25 and 23 ± 3.25/2 ± 0.40 respectively). Conclusion: Measurement of CO and NO level in expired air may correlate with active pulmonary TB infection in comparison to healthy negative tuberculous patients and latent tuberculous patients.

The Egyptian Journal of Chest Diseases and Tuberculosis, 2021

Background Lung cancer is a leading cause of cancer-related mortality in the world. Nonsmall cell... more Background Lung cancer is a leading cause of cancer-related mortality in the world. Nonsmall cell lung cancer (NSCLC) can be classified as nonsquamous cell carcinoma (non-SCC) and squamous cell carcinoma (SCC). NSCLC pathogenesis includes altered methylation patterns in multiple genes. Promotor methylation of death-associated protein kinase (DAPK) has been documented in various tumors. Aim To compare DAPK promoter methylation and clinical characteristics in patients of nonsquamous cell lung cancer with those of SCC. Patients and methods A case–control study was conducted on fresh-frozen tumor samples from 81 patients with primary NSCLC, including 43 non-SCC cases and 38 SCC cases, investigated in the Chest Department, Mansoura University Hospital, in the period from June 2017 to January 2020. A total of 40 patients matched for age and sex with nonmalignant lung lesions served as controls. Patients with age more than 18 years, radiological suggestions of lung cancer, and histological...

Current Respiratory Medicine Reviews, 2022

Background: COVID-19 has still been expressed as a mysterious viral infection with dramatic pulmo... more Background: COVID-19 has still been expressed as a mysterious viral infection with dramatic pulmonary consequences. Objectives: This article aims to study the radiological pulmonary consequences of respiratory covid-19 infection at 6 months and their relevance to the clinical stage, laboratory markers, and management modalities. Methods: This study was implemented on two hundred and fifty (250) confirmed positive cases for COVID-19 infections. One hundred and ninety-seven cases (197) who completed the study dis-played residual radiological lung shadowing (RRLS) on follow-up computed tomography (CT) of the chest. They were categorized by Simple clinical classification of COVID-19 into groups A, B and C. Results: GGO, as well as reticulations, were statistically significantly higher in group A than the other two groups; however, bronchiectasis changes, parenchymal scarring, nodules as well as pleu-ral tractions were statistically significantly higher in group C than the other two grou...

Abstract: The present study was aimed at optimizing the transfusion security of the patients, we ... more Abstract: The present study was aimed at optimizing the transfusion security of the patients, we determined the seroprevalence of transferable infections by the blood transfusion notably the HIV, hepatitis B, hepatitis C and the syphilis among the blood donors at the blood bank of regional hospital of Bertoua to reduce meaningfully their impact in hospitable environment. We performed a prospective transversal survey on 429 Blood donors from the 1 st January 2013 to 1 st January 2014. We included 371 men (86.48%) and 38 women (13.52%). During this survey, we noted that, the most large part of blood donation was given by family members of patients with a seroprevalence of 58.04 % compared to volunteers donors (23.78%) and remunerated donors (18.18%). The infections seroprevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV) and Syphilis has been estimated to 5.13%, 6.76%, 4.2 % and 0.46 % respectively. These results showed that it was necessa...

The Egyptian Journal of Chest Diseases and Tuberculosis, 2019

© 2019 The Egyptian Journal of Chest Diseases and Tu Background Airway hyperresponsiveness (AHR) ... more © 2019 The Egyptian Journal of Chest Diseases and Tu Background Airway hyperresponsiveness (AHR) is an overstated constrictor response of the airways to a diverse types of specific plus nonspecific stimuli, and it is a major, but not necessarily unique, feature of asthma. Aim This study aims to detect the presence or absence of AHR in patients with pulmonary tuberculosis (TB). Patients and methods This study included 40 patients with TB and 20 healthy age-matched and sexmatched volunteers. They were divided into three groups: group A included 20 patients with pulmonary TB under anti-TB medication after the initial phase (2 months) of treatment with successful sputum conversion, group B included 20 cured cases with past history of pulmonary TB that completed the full supervised course, and group C included 20 volunteers with matched age and sex. They were subjected to spirometry as well as methacholine bronchial challenge test and computed tomographic chest examination. Results There...

The Egyptian Journal of Chest Diseases and Tuberculosis, 2019

© 2019 The Egyptian Journal of Chest Diseases and Tu Background Respiratory complications are the... more © 2019 The Egyptian Journal of Chest Diseases and Tu Background Respiratory complications are the chief causes of morbidity plus mortality in patients with neuromuscular diseases (NMD). The diaphragm acts as the main inspiratory muscle during regular breathing, and its weakness predisposes to respiratory failure. Aim The aim was to explore the role of transthoracic diaphragmatic ultrasonography compared with respiratory pressures measured by spirometer in assessing respiratory muscle strength in patients with NMD. Patients and methods A prospective observational cross-sectional study was conducted in Chest Department, Mansoura University Hospital. Patients with NMD (n=50) who were spontaneously breathing and could understand and cooperate with the sonographic maneuvers, maximal inspiratory pressure, and maximal expiratory pressure (Pi Max and Pe Max) were recruited. They were classified into group I (n=35), which included myopathic patients with NMD owing to muscle disease or neurom...

The Egyptian Journal of Chest Diseases and Tuberculosis, 2021

Background Promotion of central control of respiration might contribute in minimization of chroni... more Background Promotion of central control of respiration might contribute in minimization of chronic obstructive lung disease disability. Objectives Our study was done to evaluate the effect of oral supplementation of piracetam tablets in low dose (400 mg twice daily) versus high dose (1200 mg twice daily) in patients with chronic obstructive pulmonary disease grade IV with type II respiratory failure, on respiratory parameters (spirometric, respiratory muscle strength, and diaphragmatic echographic measurements; velocity and excursion), in addition to neuropsychiatric parameters (cognitive functions and brain changes with MRI). Patients and methods This randomized controlled study was conducted on 126 patients who were subjected to oral piracetam and classified into group A (42 patients received 800 mg daily for 3 months), group B (44 patients received 2400 mg daily for 3 months) for 3 months, and group C (40 patients) as a control group. Pulmonary evaluation, by spirometry and respi...

The Egyptian Journal of Chest Diseases and Tuberculosis, 2019

Background Epidemiological data have linked statin use with improvements in lung health and asthm... more Background Epidemiological data have linked statin use with improvements in lung health and asthma-related hospitalizations and/or emergency room visits. Aim The aim was to evaluate the effect of statin therapy on airway inflammation and clinical outcome in moderate and severe asthma. Patients and methods This study was conducted on 61 cases, but only 40 cases completed the study. Patients were recruited from outpatient clinic and general ward of Thoracic Medicine Department of Mansoura University Hospitals from May 2015 to June 2016. They were categorized into statin group, which included 20 asthmatic cases that received statin (atorvastatin with a dose of 20 mg daily for 3 months), serving as the study group, which was further subdivided into two subgroups: moderate and severe subgroups, and nonstatin group, which included 20 asthmatics cases that did not receive statin, serving as a control group, and they were further subdivided into two subgroups: moderate and severe subgroups....

The Journal of respiratory diseases, 2020

Background: toxic gases and fumes prompted from petrol and gas stations imply their disabling and... more Background: toxic gases and fumes prompted from petrol and gas stations imply their disabling and deadly risks on human lungs. Aim of Work: The aim of this work was to assess the pulmonary function derangements in petrol pump workers at Al-Medina Al-Munawara city. Patients and Methods: This cross sectional study was conducted on 189 cases out of them in control group (group I) with age and sex matched healthy adult males gathered from nonsmokers students and employees in Taibah University. The study group (group II) comprised of 89 males who were working in different petrol pump stations. History, clinical examination and pulmonary functional assessment were carried out by using portable spirometry, Co detector and puls oximeter. Results: The study’s results showoed that the lung function parameters (FEV1, FVC, PEFR, FEFR25% - 75%) were significantly reduced in petrol pump workers (Group II) as compared to the values for these parameters in subjects belonging to Group II (Control gr...

The Egyptian Journal of Chest Diseases and Tuberculosis, 2020

Background Obesity still implies health hazards on human presented in actual increment on respira... more Background Obesity still implies health hazards on human presented in actual increment on respiratory complaints and subsequent pulmonary derangement. Objective This study aimed to evaluate the effect of obesity on bronchial airway hyper-responsiveness and on the inflammatory markers of the airways. Participants and methods This was an observational cross-sectional study that included 98 nonasthmatic individuals who were divided into two groups according to their BMI: normal BMI and overweight or obese, with their ages ranging from 14 to 59 years. We compared the two groups on the bronchial challenge test with hypertonic saline solution 4.5%, fractional exhaled nitric oxide level, and serum level of high-sensitivity C-reactive protein. Results Positive bronchial hyper-reactivity was significantly more in overweight and obese participants compared with those with normal BMI (P=0.004). Also, bronchial hyper-reactivity was found to be significantly more common in females (P=0.025). There were statistically significant differences between the two groups in spirometry measurements, with lower lung volumes in obese participants. Moreover, statistically significant differences were observed between the two groups in fractional exhaled nitric oxide (P=0.022) and high-sensitivity C-reactive protein (P=0.043). Conclusion Obese individuals have dissimilar bronchial hyper-reactivity compared with individuals with normal BMI. Local airway and systemic inflammatory marker levels differ in obese individuals compared with those with normal BMI.

The Egyptian Journal of Chest Diseases and Tuberculosis, 2020

Background Fractional exhaled nitric oxide (FeNO) is recognized as an airway inflammatory indicat... more Background Fractional exhaled nitric oxide (FeNO) is recognized as an airway inflammatory indicator for various respiratory insults like asthma, cystic fibrosis, and chronic obstructive pulmonary disease exacerbation. Aim To study the relation between FeNO level in exhaled breath and pneumonia types, nonventilator-associated pneumonia (VAP) [including community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), and aspiration pneumonia (AsP)] and VAP, as well as relation to arterial oxygen tension/FiO2 ratio and the extent of radiological affection. Patients and methods A prospective cross-sectional study was conducted on 88 patients admitted to Mansoura University Children’s Hospital with pneumonia, either mechanically ventilated or not. FeNO level was measured during end-expiration via spirometry calibration syringe in VAP and by direct measurement in CAP, HAP, and AsP. Levels of FeNO were compared between patients in relation to different characteristics such as age, sex, arterial oxygen tension/FiO2 ratio, extent of radiological affection, and to a clinically modified PIRO (predisposition, insult, response, and organ dysfunction) score. Results FeNO level was higher in the expired air in VAP followed by AsP then HAP and lastly CAP (37.6, 33.4, 31.9, and 29.1 ppb, respectively; P=0.001). A statistically significant difference was detected among the four groups regarding FeNO level. Radiological grading of pneumonia was informative; grades III and IV showed higher percentage in total studied patients. There was statistically significant weak positive effect of modified PIRO score on FeNO level (r=0.255, P=0.017). Conclusion FeNO could be used as a beneficial airway inflammatory marker that is related to modified PIRO score in children but cannot identify pneumonia type.

Egyptian Journal of Bronchology, 2019

Background Determining the optimal moment to extubate a critically ill patient remains a challeng... more Background Determining the optimal moment to extubate a critically ill patient remains a challenge. The parameters of diaphragm sonography offer precious data in the evaluation and follow-up of critically ill patients on mechanical ventilation. Aim To evaluate the diaphragm role in the weaning outcome through the following objectives: detect the association between ultrasonographic parameters of diaphragm [thickness, excursion, and velocity of contraction (slope)] and weaning outcome, success, or failure, in addition to evaluation of the weaning process by measuring the total duration of ventilation, weaning duration, ICU stay, and reventilation. Patients and methods A longitudinal, observational, prospective study. The primary endpoint was weaning outcome (failed or successful), while the secondary endpoints included length of ICU stay, weaning duration, ventilation duration, presence or absence of complications, and mortality. It was conducted on 240 (138 men and 102 women) invasively mechanically ventilated patients aged between 20 and 78 years were chosen from our Respiratory ICU of Chest Department, Mansoura University Hospital. Results There were statistically significant higher values of all sonographic measurements in the survived compared with the died group (P<0.001). There was statistically significantly higher sonographic diaphragmatic measurements in the successful group compared with the failed group (P<0.001). Conclusion The measurement of percent change of diaphragmatic thickness as well as excursion and slope could be applied in correlation more with weaning outcome with a sensitivity of 100% and specificity of 97.4%.

Egyptian Journal of Chest Diseases and Tuberculosis, 2015

Background: Delayed resolving pneumonia represents a perplexing diagnostic dilemma. Many methods ... more Background: Delayed resolving pneumonia represents a perplexing diagnostic dilemma. Many methods can lend a hand in diagnosis; however prediction of such a problem wishes a more precision. Objectives: Define to what extent early anticipation of underlying causes of delayed resolving pneumonia via clinical, radiological and bronchoscopic markers would modify management plan and affect their outcomes. Patients and methods: Prospective clinical study was conducted on 122 patients with delayed resolving pneumonia. They underwent chest X-ray, thoracic ultrasound, chest computed tomography (CT) and fiberoptic bronchoscopy (FOB). Tissue biopsy was taken for pathological examination. Results: Studied cases were divided into two groups: group I included 58 patients with malignant etiology (49 cases with lung cancer and 9 cases with pulmonary metastasis) and group II included 64 patients with nonmalignant etiology (nonspecific pneumonia in 42 cases, specific forms of pneumonia in 14 cases, pulmonary sequestration in 4 cases and traction bronchiectasis in 4 cases). Sensitivity of clinical and CT chest markers of malignancy was 72.36% and 53.45% respectively however their specificities were 20.62% and 59.38% respectively. Thoracic ultrasound showed the highest sensitivity (75.86%) but lowest specificity (17.19%). FOB markers of malignancy were significantly higher in malignant than the non-malignant group (p = 0.001). Summation of clinical, FOB, CT chest and sonographic markers increased the probability of malignancy in 67.2% and excluded malignancy in 71.8% of cases with a success rate of 69.7%. Conclusion: Early anticipation of what beyond delayed resolution of pneumonia can assist in earlier verification of causes and supervising course and guard against consequences.

Egyptian Journal of Chest Diseases and Tuberculosis, 2016

Background: Pulmonary airspace containing cavities signify major dissuade that hold gas exchange ... more Background: Pulmonary airspace containing cavities signify major dissuade that hold gas exchange functions back and bring about recurrent suppuration. Purpose: The aim of this work is to evaluate the impact of percutaneous local inoculation of focal benign cavitary lung lesions with synthetic material (gelfoam) guided with chest computed tomography (CT) on the patient outcome based on clinical, laboratory, functional and radiological parameters. Patients and methods: A prospective simple randomized controlled trial was conducted on twenty eight patients with focal benign cavitary lung lesion less than 10 cm in diameter in whom surgical resection was contraindicated or refused. They were subdivided into two groups: group I (medically treated): 14 patients were followed up for three months with medical prophylaxis with quinolone plus clindamycin and group II (gelfoam inoculated): 14 patients percutaneous locally injected with gelfoam under CT guidance for a single session. Results: Gelfoam inoculated group (group II) presented more prevalence over medically treated group (group I) in the reduction of the frequency of infective exacerbations (71.42%), absence of leukocytosis (85.7%), functional improvement (42.85%), reduction of cavity size (57.14%) and cavitary obliteration (35.71%). Both groups were matched regarding the absence of hemoptysis and negative sputum cultures with high percentage (92.85%). However, reduction of the frequency of hospitalization predominated in group I. Significant statistical differences were present in radiological parameters only (reduction of size (0.042) and cavity obliteration (0.002). Success rate of procedure in the studied group was (35.71%). Conclusion: Percutaneous gelfoam injection may share in staged palliation and weeding out of pulmonary cavitary lesions with simple noninvasive image guided procedure.

Egyptian Journal of Chest Diseases and Tuberculosis, 2014

The aim of this study is to differentiate between the histopathological features of pleural tuber... more The aim of this study is to differentiate between the histopathological features of pleural tuberculosis both free and encysted forms of pleural effusion as regards pleural fluid cytology and pleural tissue granulomatous tissue reaction and assess the effects of combined microbial infection on histopathological and clinical residuals. Patients and methods: One hundred and ninety patients were confirmed to be tuberculous by pleural tissue biopsy. Pleural fluid cytopathology and TB granulomatous tissue biopsy samples were studied. Results: Within histopathological features in TB pleural effusion is typical granulomatous TB reaction that was prevalent in both free and encysted forms of pleural effusion with high percentage (97% and 87.5% respectively). On the other hand, lymphocytic exudative smear was predominant in the free TB effusion group than both inflammatory and hemorrhagic ones (74.7% versus 23.5% and 1.8% respectively) while the encysted effusion group presented higher predominance to inflammatory exudative smear than other types (54.2% versus 41.7% and 4.2% respectively). Moderate cellularity was higher in percentage in both free and encysted groups 77.7% and 62.5% respectively. Also, langerhans cells prevailed in both effusion types. Lastly, non TB culture was present in all cases of encysted pleural effusions but accounted only for 3% of free effusion cases. Conclusion: Differentiation between free and encysted forms of pleural tuberculous effusion as regards effusion cytopathological criteria and pleural tissue histopathological patterns represent an important support in understanding the pathogenesis of pleural tuberculous tissue reactions and other positive cultural diagnosis can aggravate TB granulomatous reactions.

Egyptian Journal of Chest Diseases and Tuberculosis, 2017

Background: Respiratory derangement is a major health hazard in patients with neuromuscular disor... more Background: Respiratory derangement is a major health hazard in patients with neuromuscular disorders (NMD). This study aimed to compare spirometry results using facemask with that of conventional tube in patients with NMD and accordingly possible use of facemask instead of conventional tube in this group of patients. Methods: Thirty-six patients with NMD and fifty normal volunteers were recruited within 9 months. Assessment of patients included history and physical examination specially presence of respiratory symptoms, duration and stage of neuromuscular illness, bulbar symptoms, sensory, motor and cranial nerve assessment. Then all participants were subjected to spirometry and respiratory pressures assessment using both conventional tube and facemask. Results: Spirometry and respiratory pressure assessment using facemask versus tube measured in all participants. For patients with NMD; spirometric measures P Imax and P Emax were higher in tube than facemask. FEV 1 , FEV 1 %, FEV 1 /FVC %, and P Imax showed statistically significant difference. For patients with bulbar palsy; SVC was higher in facemask without statistically significant difference. For other spirometric measures, P Imax and P Emax ; using tube was higher than facemask with only FEV 1 , FEV 1 % showed statistically significant difference (p = 0.023 and 0.015 respectively). For patients without bulbar palsy; all spirometric measures, P Imax and P Emax were higher when using tube with only FEV 1 /FVC % showed statistically significant difference (p = 0.004). Also for control group; data were higher in tube with only FEV 1 showed statistically significant difference (p = 0.031). For patients with NMD; fractional functional defect (FFD) was very high for P Imax and P Emax. Conclusion: The use of facemask during assessment of spirometric and respiratory pressures measures in patients with NMD and more specifically in patients with bulbar palsy is promising and can be considered a good alternative to conventional tube assessment for functional screening rationale.

Egyptian Journal of Bronchology, 2017

Context Malignant pleural effusion is a common presentation of several malignancies. Chemical ple... more Context Malignant pleural effusion is a common presentation of several malignancies. Chemical pleurodesis is important in its management, but no consensus exists on the optimal agent or methods of pleurodesis. Aim This work aimed to evaluate the outcome of oral doxycycline capsules in a poudrage form through a medical thoracoscope as a therapeutic approach for pleurodesis in patients with malignant pleural effusion. Setting and design This study was a prospective quasiexperimental one. Patients and methods This prospective quasiexperimental study was conducted on 70 patients with metastatic pleural effusion. They underwent pleurodesis with thoracoscopic doxycycline poudrage. Results The success of doxycycline powder poudrage was complete in 75.7% of cases and partial in 10% of cases; however, failure was observed in 14.3%. Thus, total success rate was 85.7%. As regards complications, they were irrelevant; pain was the predominant feature in 81.4% of cases, fever in 11.4% of cases, and empyema in only 4.3% of cases. Conclusion Using oral doxycycline with thoracoscopic poudrage yielded a remarkable success rate and may alternate the need for talc powder with less complications and more safety.

Egyptian Journal of Chest Diseases and Tuberculosis, 2016

Background: Pleural malignancies disturb normal ways of protein metabolism deferring imbalance of... more Background: Pleural malignancies disturb normal ways of protein metabolism deferring imbalance of backside markers in body tissues and fluids and see the sights of muscle and protein derangement. Purpose: The aim of this work to study markers of protein depletion and muscle catabolism in cases with malignant pleural effusion. Patients and methods: Thirty patients with malignant pleural effusions not under chemotherapy were studied regarding markers of muscle and protein derangement (plasma albumin & potassium levels and creatinine height index) and radiological signs (the presence of pleural thickness by computed tomography (CT) of chest and muscle wasting by skeletal muscle ultrasound) plus thoracoscopic findings (plaques and adhesions). Results: Metastatic adenocarcinoma accounted for a higher percentage in smoking 66%, aging (59.06 ± 13.04) and duration of illness (13.13 ± 4.85) than other pleural malignancies. In the same way metastatic adenocarcinoma showed the major type in hypoalbuminemia, hypokalemia and CT pleural thickening than other malignancies (11.11%, 72.22% and 77.76% in that order). However, malignant lymphoma was prevalent in echographic features of muscle wasting, pleural plaques and pleural adhesions (66.7% for each marker). Lastly, squamous cell carcinoma prevailed in creatinine highest index than the previous three tumors (75%). Nevertheless, there were no statistical significant differences between the four diagnosed malignancies except for pleural plaques that were significant (p = 0.03). Conclusion: Pleural malignancy can enhance the body decomposition in particular muscular components and hastens protein catabolism with the help of feasible laboratory and radiological markers.

Egyptian Journal of Chest Diseases and Tuberculosis, 2016

Background: Endoscopic lung volume reduction maneuver using simple inexpensive reagents to remode... more Background: Endoscopic lung volume reduction maneuver using simple inexpensive reagents to remodel and shrivel damaged regions of the lung has been accomplished in managing human with pulmonary emphysema as a surrogate for surgical interference. Objectives: Evaluation of the safety and efficacy of hot saline versus dissolved doxycycline (vibramycin) for lung volume reduction of emphysematous lung in both adult and pediatric age groups. Patients and methods: Prospective clinical study was conducted on 21 patients with pulmonary emphysema. They were submitted to fiberoptic bronchoscopy (FOB), chest computed tomography (CT) and comprehensive respirometry. They were divided into two groups: group I underwent FOB instillation of hot saline with 50°C in two consecutive sessions and group II underwent FOB instillation with dissolved doxycycline in normal saline also in two consecutive sessions, and each procedure then repeated after one week. Results: The total success rate of the procedure in group I was 72.72% and in group II 70% however the total success rate in the studied cases was 71.43%. The procedure success in adult age group in group I represented 77.7% on the other hand in group II it reached 75% and the total therapeutic success rate was 76.74% while in the pediatric age group it accomplished an equal percentage (50%) in both groups.