efficacy of fiberoptic bronchoscopy via laryngeal mask airway in pediatrics foreign body extraction

The use of fiber-optic bronchoscopy [FOB] via laryngeal mask airway [LMA] in children allows the use of adult size bronchoscope with its grasping tools, thus it may aid in foreign body [FB] extraction. To evaluate the efficacy of FOB via LMA in FB extraction in pediatrics. We prospectively recruited all children [< /= 16 years] presented or referred to Pulmonary Medicine Department, Ain Shams University Hospital with clinical suspicion of FB inhalation between June 2012 and June 2013. All the patients were subjected to FOB via LMA under general anesthesia. Rigid bronchoscopy [RB] was available to extract any FB failed to be removed. Of the 49 children suspected of having FBs, 41 FBs were identified in 28 boys and 13 girls with a mean age 5.9 years [9 months to 16 years]. FBs were more often lodged in the right side than in the left one [48% vs. 38%] and with predominance of organic FBs [75.6%] mainly seeds [60.9%].Successful extraction by current technique was in 34out of 41 [82.9%] FBs identified. RB succeeded in extraction of 6 out of 7 FBs that failed to be removed and open thoracotomy was required in 1 case. Non-critical complications related to FOB via LMA included laryngeal edema, transient hypoxia, gastric distension, mild hemoptysis and fever occurred in 5, 5, 4, 3 and 2 patients respectively. One critical complication [stridor] related to RB. FOB via LMA is safe and effective in pediatric FB retrieval under general anesthesia with RB backup

Drug susceptibility testing of pulmonary tuberculosis by nitrate reductase assay

Treatment of multidrug-resistance tuberculosis [MDR-TB] remains a challenge and its success depends on how quickly a case of TB is identified as drug resistant and whether an effective drug therapy is available. As a drug susceptibility test [DST], nitrate reductase assay [NRA] might help in management of MDR-TB patients. This study was conducted to evaluate NRA as a drug susceptibility test [DST] for the four primary anti-tuberculosis drugs [Isoniazide [INH], Rifampicin [RIF], Streptomycin [SM] and Ethambutol [EMB]]. A total of 30 isolates of M. tuberculosis were subcultured for 28 day to be fresh isolates and subjected to NRA. The results were recorded after 10 days of incubation and compared to that of the proportion method [PM] as a gold standard. Susceptibility testing for INH and RIF revealed relatively higher efficiencies when compared to that of the PM. For INH and RIF, the efficiencies were 93.3% and 90%, respectively. The sensitivity of the NRA as a DST for INH was 89.4%, while that for RIF was 93.3%. The specificities of NRA for INH and RIF were 100% and 86.6%, respectively. The predictive value of sensitivity for INH was 84.6% and that of RIF was 92.8%. The predictive value of resistance for INH was a high as 100%, while that of RIF was 87.5%. Susceptibility testing for SM and EMB showed relatively lower efficiency compared to PM. The efficiencies of NRA for SM and EMB were 86.6% and 76.6%, respectively. The sensitivity of the NRA as a DST for SM was 78.9%, while that for EMB was 40%. The specificity of the NRA for SM was 100% and that of EMB was 95%. The predictive values of sensitivity for SM and EMB were 73.3% and 76%, respectively. The predictive value of resistance for SM was 100% and that of EMB was 80%. NRA is a simple, rapid and inexpensive technique of high performance when used as susceptibility testing for both INH and RIF, but was not good for SM and EMB

Prevalence of class 1 ntegron-carrying enterobacteriaceae species and pseudomonas aeruginosa in intensive care units of ain shams original university hospitals

This study was conducted to study the prevalence of class 1 integron carrying Enterobacteriacae spp. and P.aeruginosa isolated from ICU patients and to determine factors associated with integron presence as well to determine the association between integron carriage and multidrug resistance [MDR] expression. Fifty urine and 70 respiratory specimens were collected from 100 lCU patients and processed for microbiological examination. The isolated pathogens were identified by standard techniques thereafter tested for antibiotic susceptibility by disk diffusion and broth microdilution methods. Class 1 integron was detected by PCR targeting a specific fragment in intl1 gene. Twenty five Enterobacteriaceae spp. and 17 P.aerugmnosa isolates were recovered. About 79% [33/42] of the tested organisms were integron positive. The presence of class 1 integron in Enterobacteriaceae spp. was significantly associated with resistance to 14 from the 18 tested antibiotics, while in P. aeruginosa significance was confined to resistance to 5 from 11 tested antibiotics. There was a strong association between wide range resistance expression [resistant >/= 7 antibiotics] and the presence of integron. A significant association between production of new beta-lactamases [ESBLs, AmpC, Carbapenemases] and the presence of integron has been found where 72.7% [24/33] of integron positive isolates were beta-lactamase producers. Hospital-acquired infections, prolonged hospital stay, invasive procedures and non responsiveness to antimicrobial therapy were significantly associated with infections with integron positive organisms. Prevalence of integron positive organisms with wide range antibiotic resistance in our ICUs is high that mandates proper implementation of infection control measures and antibiotic policy to control their presence and dissemination

Does addition of endobronchial ultrasound improves the classification of suspicious lesions detected by autofluorescence bronchoscopy?

Autofluorescence bronchoscopy [AFB] may improve sensitivity at the cost of specificity when it is used to identify suspicious bronchial mucosal lesions not seen by conventional white light bronchoscopy. Thus, it seems useful to study these lesions additionally with endobronchial ultrasound [EBUS] for further classification of dignity of suspicious lesions aiming in improving the positive predictive value [PPV] of AFB. This study aims to answer the following question: Does addition of EBUS improves the classification of suspicious lesions detected by AFB? Fifty five subjects with suspected lung cancer referred for AFB examination for different indications were recruited for this study. Rigid and Fiberoptic bronchoscopic examination were done followed by AFB then EBUS and finally samples from suspicious sites were taken for histopathological examination. The addition of EBUS to AFB improves PPV from 72.7% in AFB alone to 100% in AFB+EBUS in case of benign suspicious lesions detected by AFB with a negative predicted value [NPV] of 60% and with a sensitivity and specificity of 75% and 100% respectively for AFB+EBUS. While EBUS addition to AFB improves PPV from 60.6% in AFB alone to 95.2% in AFB+EBUS in case of malignant suspicious lesions detected by AFB with a NPV of 100% and with a sensitivity and specificity of 100% and 92% respectively for AFB+EBUS. Thus, the addition of EBUS improves the classification of suspicious lesions detected by AFB with its great implication on further patient management and combining AFB [for tumor localization] to EBUS [for depth estimation] may provide a reliable method of staging and choice of treatment modality of lung cancer

Interventional bronchoscopy: ain Shams University Hospital experience

Bronchoscopy has evolved considerably in our hospital. During recent years, we implemented the concept of interventional bronchoscopy [IB] for the first time in Egypt. IB is defined as a diagnostic and invasive therapeutic interventions that extend beyond routine Flexible bronchoscopy. In this article, we will review our clinical experience with IB during the last five years as regards methodology requirements, available equipments, clinical applications and presentation of selected research outcomes. We retrospectively reviewed all available reports of therapeutic IB performed in our bronchoscopy unit to determine the indications, application sites, methods of disobliteration and complications of therapeutic IB. In addition, recent interesting research work done on endobronchial ultrasound, autofluorescence bronchoscopy, Nd: YAG laser bronchoscopy and endobronchial electrocautery was reviewed. In order to perform an interventional procedure, well-equipped facilities, trained personnel, preprocedure evaluation, and monitoring are mandatory. More than 500 invasive therapeutic interventions were performed in the past 5 years. The results and analysis of these IB were reviewed. We concluded from the presented data that IB has quickly gained recognition and drawn interest with its promising results. Much effort is needed to overcome challenges facing IB awareness, financial concerns, training and verification of competency in our country