Diagnostic utility of sonar guided biopsy in tuberculous effusion

Tuberculous pleural effusion remains the commonest cause of exuda tive effusions in areas with a high prevalence of tuberculosis and histological examination of pleural tissue is the gold standard for its diagnosis. This study was to assess the diagnostic utility of sonar guided biopsy in tuberculous pleural effusion. 50 patients [34 men] of mean +/- SD age 38.7 +/- 16.7 years with pleural effusions and a clinical suspicion of tuberculosis were enrolled in the study. Transthoracic ultrasound was performed on all patients, who were then randomly assigned to undergo 4 Abrams needle biopsies followed by 4 Tru-Cut needle biopsies or vice versa. Pleural tuberculosis was diagnosed in 31 patients, alternative diagnoses were established in 16 patients and 3 remained undiagnosed. Pleural biopsy specimens obtained with Abrams needles contained pleural tissue in 29 patients [92.0%] and were diagnostic for tuberculosis in 26 patients [sensitivity 82%], whereas Tru-Cut needle biopsy specimens only contained pleural tissue in 21 patients [78%] and were diagnostic in 21 patients [sensitivity 64%] Ultrasound-assisted pleural biopsies performed with an Abrams needle are more likely to contain pleural tissue and have a significantly higher diagnostic sensitivity for pleural tuberculosis

Effect of a disintegrin and metalloprotease 33 [ADAMSS] gene polymorphisms and smoking in COPD

COPD is characterized by air flow limitation that is not fully reversed and associated with an influx of neutrophils, macrophages and CD8 T lymphocytes in the airways. The disease is characterized by airflow limitation and is associated with an abnormal inflammatory response of the lungs in response to noxious particles or gases and associated with systemic manifestation. Sixty consecutive patients with COPD and 40 normal healthy individuals were included. All cases and controls were subjected to detection of 2 polymorphic loci [S1 AND Q1] of ADAM33 by PCR-RFLP technique. The percentage of S1 and Q1 AA genotype and A allele were significantly increased in control than in COPD patients while there was significant increase in S1 and Q1 GG genotype and G allele in COPD patients than in control [p < 0.001]. No significant difference was found between smoker and non-smoker among the two studied groups in genotype and alleles distribution of ADAM33 SNPs S1 and Q1 p > 0.05, whereas there was significant increase in ADAM33 S1 G allele and Q1 G allele in smoker and non-smoker in COPD patients as compared to their corresponding fellows in control group [p < 0.05]. As regard to Pulmonary function test there was significant decrease in% of FEV1 in COPD patients as compared to control group for both smokers and non-smokers [p < 0.001]. Within both control and COPD groups smokers had significant decrease in FEV1% as compared to non-smokers [p < 0.001]. There was a significant decrease in FEV1% among all genotypes in smoker as compared to non-smoker COPD patients [p < 0.001], the most prominent decrease was found in smoker GG genotype for both ADAM33 S1 and Q1 in COPD patients. In conclusion, we found that polymorphisms in the SNPs [Q1 and S1] of ADAM33 gene are associated with COPD in the general population. In addition, smoker patients with GG genotype in [S1 and Q1] ADAM33 will have more pronounced decline in the pulmonary function test [FEV1]

Effect of obstructive sleep apnea syndrome on left ventricular function

The link between OSAS, left ventricular dysfunction, and congestive heart failure is less known, although OSAS is frequent in both systolic and diastolic heart failure patients. To study left ventricular function in patients with obstructive sleep apnea syndrome and to assess the correlation between the severity of OSA and the degree of ventricular dysfunction. This study was conducted on 45 subjects [22 males and 23 females] in Chest Department, Tanta University Hospitals, they were classified into two groups: Group A included 15 apparently healthy subjects, by sleep study they were normal as apnea hypopnea index [AHI] < 5/h and oxygen desaturation index [ODI] < 5/h. Group B included 30 patients with obstructive sleep apnea diagnosed by sleep study [AHI > 5/h and ODI > 5/h]. Eight [26.66%] out of the 30 OSAS patients [group B] were hypertensive and have left ventricular dysfunction. The mean value of AHI was [2.53 +/- 1.06] and [24.6 +/- 14.35] in groups A and B, respectively. The mean value of AHI was significantly higher in group B than group A [p=0.001]. Significant correlation was found between AHI, diastolic and systolic dysfunctions, respectively [r= 0.324; p= 0.019 and r=0.288; p=0.049]. Obstructive sleep apnea syndrome may predispose in left ventricular diastolic dysfunction, AHI is correlated with the degree of left ventricular diastolic dysfunction

Immunologic parameters and lung functions in asthmatic children after antioxidants supplementation

There is ample evidence that allergic disorders such as bronchial asthma are mediated by oxidative stress. Antioxidants were established to have beneficial effects on immunity in generalized basis, but its role in decreasing severity of asthma and increasing immunity in atopic persons is of great debate. Compared to adults, infants and young children demonstrate differences in their immune response indicating that there is maturation process or change overtime that may be reflected in cytokine production which is due to T helper [Th] 1 and 2 like immunity based on mitogen stimulation, T cell clones or both. In this study, 15 asthmatic children aged 2-10 years were given daily supplementation of vitamin E and vitamin C in double blind manner. They were investigated for pulmonary function tests, determination of total IgE serum level and interleukins 2 and 4 in addition to interferon-y plasma level. All parameters were reevaluated 12 weeks later. Results of the study revealed positive correlation between lL-4 and total IgE levels and positive correlation between IL-2 and IFN-y because both were secreted by the same cell type [Th-1]. Also, results of the study found a highly significant increase of total IgE level in patients group as compared to controls. Also the results proved improved both pulmonary functions and immunologic parameters as compared to before treatment and as compared to placebo group. On the basis of cytokine profile in asthmatic children, cytokines can be used as a guide of therapy by reducing Ag-specific IL-y synthesis and enhancing Ag-specific IFN-y synthesis in targeted T cell, an effect which could be enhanced by antioxidants. lgE level estimation must be routine in asthmatic children evaluation