Synchronous invasive or preinvasive bronchial lesions detected by autofluorescence bronchoscopy in patients with lung cancer

Objectives: In support with field cancerization theory, some patients with lung cancer [LC] will also have synchronous invasive or pre-invasive bronchial lesions. In this cross sectional - analytic study autofluorescence bronchoscopy [AFB] was used to assess the prevalence of synchronous lesions in patients with LC

Materials and methods: All patients with abnormal sputum cytology underwent white light and AFB. From 335 patients with abnormal sputum cytology referred for AFB, lung cancer was detected in 91 patients [89 male and 2 female] of age [mean +/- SD], 67 +/- 8 years. 77 had squamous cell carcinoma [SqCC], 13 had adenocarcinoma and one patient with small cell lung cancer [SCLC]

Results: Synchronous lesions detected in 26 [29%] patients, 25 [33%] of patients with SqCC, one with adenocarcinoma, no synchronous lesion detected in one patient with SCLC. The most severe detected synchronous lesion was adenocarcinoma in one patient, Carcinoma insitu [CIS] in 4 patients, severe dysplasia in 3 patients, moderate dysplasia in 10 patients, and mild dysplasia in 8 patients. Synchronous lesions were more frequently detected in current smokers [35%], than in ex-smokers [20%] and non-smokers [15%]

Conclusion: Synchronous preinvasive lesions are frequent in patients with LC and AFB should be included in pre-operative evaluation of these patients

Percutaneous transcatheter vascular embolization for life threatening hemoptysis

The aim of this study was to retrospectively evaluate 47 patients [37 males and 10 females, aged 37-72 years] with life threatening hemoptysis treated by bronchial artery embolization. Between April 2007 and April 2012 at the Assuit University Hospital, the cause of hemoptysis was tuberculosis and post TB bronchiectasis in 29 patients, bronchiectasis in 11, 3 arteriovenous malformation, 3 post infective fibrosis and one patient with chronic renal failure. Recurrence of hemoptysis after embolization occurred in 2 patients within the 6 month follow-up period, these cases underwent re-embolization with successful control of hemoptysis. There were no procedure-related major complications. Bronchial artery embolization is a safe and effective palliative treatment for patients with massive hemoptysis

Obstructive sleep apnea among patients with type 2 diabetes: prevalence and effect on glycemic control

Obstructive sleep apnea [OSA] is a highly prevalent comorbidity of type 2 diabetes. The aim of this work is to determine the risk of OSA in patients with type 2 diabetes and its effect on the glycemic control. This study was conducted at Assiut University Hospital Sleep Unit, 52 patients with type 2 diabetes were included, all patients underwent an overnight polysomnography [PSG] and glycosylated hemoglobin [HbAlc] measurement. A total of 62% [n 32] of patients with type 2 diabetes had OSA[apnea-hyponea index [AHI] >/= 5 events/hour]. 27% [n=14] of patients had mild OSA [5 /= 30]. There was a significant positive correlation of HhAlc levels with apnea hypopnea index, a widely accepted marker of the severity of OSA [P<0.001]. Also, we found that increasing OSA severity was correlated with increasing HbAlc levels [p<0.001]. The mean llbAlc values were 8.2% for those without OSA, 9.4% for mild OSA, 10.1% for moderate OSA and 10.6% for severe OSA. We concluded that the prevalence of OSA in this study was 62% and increasing severity of OSA is associated with poorer glycemic control. Therefore, identifying and treating OSA in patients with type 2 diabetes may improve their glycemic control

Re-emerging of colistin for treatment of nosocomial pneumonia due to gram negative multi-drug resistant pathogens in critically ill patients

Gram-negative [G-ve] bacilli, particularly Pseudomonas aeruginosa and Acinetobacter baumannii, are important opportunistic multidrug-resistant [MDR] pathogens in hospitalized patients, contributing to their morbidity and mortality. These organisms may still keep their sensitivity to colistin and allowed its use for these selective therapeutic indications. The aim of the present study is to evaluate and compare the effectiveness and safety of both combined intravenous [i.v.] colistin with aerosolized colistin versus i.v. colistin alone in nosocomial pneumonia due to MDR G-ve pathogens in critically ill patients. 40 Patients were hospitalized in ICU due to different etiologies. These patients experienced nosocomial pneumonia. The pathogenic organisms were G-ve MDR bacilli and only susceptible to colistin. The first group received both i.v. colistin with aerosolized colistin versus [vs] the second group who received i.v. colistin alone. Mortality was less in patients who received i.v. plus inhaled colistin. Colistin is a reasonable safe last-line therapeutic alternative for pneumonia due to MDR G-ve pathogens. Aerosolized colistin may be considered as a useful adjunctive to i.v. colistin

Pulmonary function changes in diabetic lung

Diabetes mellitus is a chronic and debilitating disease. Its complications give rise to micro and macrovascular diseases which affect eyes, kidneys, heart, blood vessels, nerves and also lungs. There may be a relationship between diabetes and reduced lung function, so this study was designed to evaluate the impairment of lung function on spirometry among diabetic patients. To study the effect of diabetes mellitus on the evolution of respiratory function parameters. Hundred subjects were enrolled in the study, 30 patients with type I, another 30 patients with type II and 40 subjects were controls. Mean age was 42.78 +/- 3.14 years, 45 were males and 55 were females. Mean HbAlC was 8.9 +/- 1.1%. 22 patients with diabetes duration from 5 to 10 years, 38 patients with a duration of more than 10 years. Spirometric tests were done for all groups by computerized Spirometry with six parameters Forced vital capacity [FVC], Forced expiratory volume in first second [FEV1], Peak expiratory flow rate [PEFR], Forced expiratory volume in first second to forced vital capacity [FEV1/FVC], Peak expiratory flow rate [FEFR 25-75] and Diffusing capacity for carbon monoxide [DLCO]. There was a predominant reduction in all the Spirometric parameters of diabetic patients toward the restrictive pattern as there was significant deterioration in DLCO in comparison with healthy controls. FVC [p < 0.01], and FEV1/FVC% [p < 0.001] were significantly lower in typel diabetic patients in comparison to those of type II. Impairment of lung functions was obvious with a longer duration of diabetes. Conclusion: Diabetes is associated with a significant impaired pulmonary function in a restrictive pattern as compared to non diabetics. The pulmonary function impairment was found to be more marked with diabetic duration especially after 10 years. Subjects with type I diabetes had lower FVC and FEV1/FVC% than predicted; it could be related to poor glycemic control

Assessment of carotid intima media thickness in obese children and adolescents

The objectives of the present study aimed to assess the endothelial function in obese children and adolescents by using a non invasive high resolution ultrasound assessment of the carotid intima media thickness [CIMT]. Case control study was conducted on 49 obese children and adolescents comparing them with 34 healthy sex and age matched control group in the New Pediatric Hospital, Cairo University. For all subjects, the following were done: full history tacking and clinical examination, anthropometric measurements of obesity in the form weight, height, BMI, skin fold thickness [SFT], waist circumference and hip circumference, laboratory investigations in the form of total cholesterol, triglycerides, HDL, LDL, C-peptide, fasting glucose and insulin. Ultrasound measurements of CIMT were done. Positive correlation was found between the CIMT and the anthropometric measurements including: weight, BMI, BMI SDS, waist circumference, hip circumference, triceps SFT, subscapular SFT and with the supra-cristal SFT. Also a positive correlation between the CIMT and the total cholesterol, triglycerides, LDL and fasting insulin were found but there were no significant correlation between the CIMT and fasting glucose or C-peptide, while negative correlation between CIMT and HDL was found. the present study conclude that obese children are at increased risk of having thickened CIMT, especially in relation to weight, BMI, skin fold thickness [SFT], waist circumference, hip circumference, total cholesterol, triglycerides, low-density lipoprotein [LDL] and insulin levels