B-lines: Transthoracic chest ultrasound signs useful in assessment of interstitial lung diseases

This prospective study was conducted to evaluate the value of sonographic B-lines [previously called ''comet tail artifacts''], which are long, vertical, well-defined, hyperechoic, dynamic lines originating from the pleural line in assessment of interstitial lung diseases [ILD] and compare them with the findings of chest high-resolution computed tomography [HRCT] and pulmonary function tests [PFTs]. Sixty-one patients with ILD underwent transthoracic lung ultrasound for assessment of the presence of B-lines and the distance between them. These findings were compared with that of chest HRCT [ground glass, reticular, nodular or honey combing] and PFT as forced vital capacity [FVC], total lung capacity [TLC], diffusion capacity for carbon monoxide [DLCO] and partial arterial oxygen pressure [PaO[2]]. All patients had diffuse bilateral B-lines. The distance between each of the two adjacent B lines correlated with the severity of the disease on chest HRCT where B3 [the distance was 3 mm] correlated with ground glass opacity and B7 [the distance was 7 mm] correlated with extensive fibrosis and honey combing. Also, the distance between B-lines inversely correlated with FVC [r = -0.848, P < 0.001], TLC [r = -0.664, P < 0.001], DLCO [r = -0.817, P < 0.001] and PaO2 [r = -0.902, P < 0.001]. B-lines that are lung Ultrasound signs seem to be useful in the assessment of ILD.

golden factor in adherence to inhaled corticosteroid in asthma patients

Adherence to therapy is very important and many factors could be responsible for this issue. Suboptimal adherence to asthma therapy is a major contributor to poor asthma outcomes. Our aim is to find out the most important factor responsible for adherence to therapy in bronchial asthma patients. The study included 143 patients with persistent bronchial asthma. Factors that may affect adherence to therapy were studied. These factors included age, sex, residence, level of education, proper asthma education and whether inhaled corticosteroid [ICS] was taken alone, with long acting p2 agonist [LABA] in separate devices or with LABA in a combined form. Adherence to ICS was determined according to Medication Rating Scale. We found that 55.3% of patients that received asthma education were adherent to ICS while only 21% of patients that did not receive asthma education were adherent to ICS therapy. The difference was statistically highly significant [p = 0.003]. Other factors do not significantly affect adherence to ICS. Patients that used combined ICS with LABA in the same device were significantly more adherent to therapy [60.25%] than patients that used the same combination in 2 separate devices [34.5%]. All patients with well controlled asthma were adherent to ICS, while 47.5% of uncontrolled patients was adherent. Comparison between level of control and adherence to ICS was highly significant [p = 0.003]. This study showed how different factors may modulate adherence to asthma treatment and confirmed the importance of patient education in increasing adherence to asthma therapy

Discrimination between pleural thickening and minimal pleural effusion using color Doppler chest ultrasonography

The discrimination of pleural thickening from minimal pleural effusion may be difficult as both lesions appear as anechoic on grayscale ultrasound, hence, free of [echoes] does not confirm the presence of pleural fluid. To evaluate the value of color Doppler ultrasound in differentiating minimal pleural effusion that could be aspirated from pleural thickening and to compare it with grayscale ultrasound. This analytic cross-sectional study was done prospectively on 40 patients who presented with pleural based opacity in their chest radiographs compatible with minimal pleural effusion. Gray scale ultrasound was done for all patients then color Doppler ultrasound examination was applied to detect the presence or absence of fluid color sign. The presence or absence of pleural effusion was confirmed by aspiration of pleural fluid. The sensitivity of real time gray scale ultrasound in detecting minimal pleural effusion and differentiating it from pleural thickening was 95.5% while, specificity was 33%, and accuracy was 67%. The ability of ultrasound in discrimination of minimal pleural effusion from pleural thickening improved greatly by application of the color Doppler examination where the specificity of the method reached 100% while the sensitivity was 91% and accuracy was 95%. Application of color Doppler examination increases the accuracy of real time chest ultrasound to discriminate pleural thickening from minimal pleural effusion and hence color Doppler examination proved to be a useful diagnostic tool to real-time gray-scale ultrasound for diagnosis of minimal pleural effusion