Diagnostic accuracy and temporal impact of ultrasound in patients with dyspnea admitted to the emergency department

OBJECTIVE: Few studies have prospectively evaluated the diagnostic accuracy and temporal impact of ultrasound in the emergency department (ED) in a randomized manner. In this study, we aimed to perform a randomized, standard therapy controlled evaluation of the diagnostic accuracy and temporal impact of a standardized ultrasound strategy, versus standard care, in patients presenting to the ED with acute dyspnea.METHODS: The patients underwent a standardized ultrasound examination that was blinded to the team caring for the patient. Ultrasound results remained blinded in patients randomized to the treating team but were unblinded in the interventional cohort. Scans were performed by trained emergency physicians. The gold standard diagnosis (GSDx) was determined by two physicians blinded to the ultrasound results. The same two physicians reviewed all data >30 days after the index visit.RESULTS: Fifty-nine randomized patients were enrolled. The mean±standard deviation age was 54.4±11 years, and 37 (62%) were male. The most common GSDx was acute heart failure with reduced ejection fraction in 13 (28.3%) patients and airway diseases such as acute exacerbation of asthma or chronic obstructive pulmonary disease in 10 (21.7%). ED diagnostic accuracy, as compared to the GSDx, was 76% in the ultrasound cohort and 79% in the standard care cohort (P=0.796). Compared with the standard care cohort, the final diagnosis was obtained much faster in the ultrasound cohort (mean±standard deviation: 12±3.2 minutes vs. 270 minutes, P<0.001).CONCLUSION: A standardized ultrasound approach is equally accurate, but enables faster ED diagnosis of acute dyspnea than standard care.

Role of N-terminal pro B-type natriuretic peptide in acute exacerbation of chronic obstructive pulmonary disease

Acute exacerbation of chronic obstructive pulmonary disease [AECOPD] is a major public health problem. Recognition of comorbid heart dysfunction in such patients is often difficult. The aim of this work is to evaluate the role of N-terminal pro B-type natriuretic peptide [Nt-pro BNP] in AECOPD with respiratory failure. This study was conducted on 20 patients with AECOPD and respiratory failure. All patients were subjected to history taking, clinical examination, routine laboratory investigations, arterial blood gases analysis, echocardiography and estimation of plasma level of NT-pro BNP. Patients were classified into 3 groups: Group I: those without heart dysfunction [40%], Group II: those with diastolic heart failure [40%], and Group III: those with systolic heart failure [20%]. NT-pro BNP mean +/- SD in group I was 673.38 +/- 416.02, in group II 1962 +/- 847.88, and in group III 6776.75 +/- 1433.59 pg/ml. There was a statistically significant difference between the three groups [p = 0.001] NT-pro BNP showed a statistically significant inverse correlation with pH [p = 0.005], ejection fraction [p = 0.007] and a direct one with both left ventricular systolic[p = 0.008] and diastolic [p = 0.016] dimensions and E/A [p = 0.016]. The NT-pro BNP significantly decreased after recovery from AECOPD [p = 0.030]. The receiver operating characteristic curve demonstrated a ruling out of LV dysfunction in AECOPD of a sensitivity of 100% and a specificity of 60%; and a ruling in of a sensitivity of 48% and a specificity of 67%. Plasma BNP is usually elevated in AECOPD and is related to right or left ventricular systolic or diastolic dysfunction

Detection of cyclooxygenase-2 [COX-2] expression in non-small cell lung carcinoma. An immunohistochemical and computerized image analysis study

Lung cancer is the leading cause of cancer death all over the world. Evidence is accumulating to suggest that cyclooxygenase-2 [COX-2] is involved the pathogenesis and progression of some types of lung cancer. COX-2 is one of the novel targets under evaluation for non-small cell lung carcinoma [NSCLC] therapy and chemoprevention. The aim of the present study was to detect COX-2 expression in non-small cell lung carcinoma [NSCLC] and to determine its correlation with various clinic pathological parameters. The expression of COX-2 was assessed in 30 patients with NSCLC using immunohistochemistry, followed by quantitative assessment of the immunostaining using computerized image analysis. The present work was conducted on 30 patients with NSCLC: squamous cell carcinoma [15 patients], adenocarcinoma [10 patients], and undifferentiated large cell carcinoma [5 patients]. Overall, 70% of studied NSCLC expressed COX-2. 60% of squamous cell carcinoma [SCC], 80% of adenocarcinoma [ADC] and 80% of undifferentiated large cell carcinoma [ULCC] showed positive immunostaining for COX-2. No significant correlation was found between tumor histological type and each of frequency and degree of COX-2 expression [p=0.569 and p=0.094 respectively]. Though the expression of COX-2 increased with tumor grade, the relation between COX2 expression [both the frequency and degree of expression] and tumor grade was not significant [p=0.778 and p=0.247 respectively for SCC, and p=0.641 and p=0.067 respectively for ADC]. A statistically significant difference was found between node positive and node negative cases as regards the degree of COX2 expression [p=0.05]. No significant relationship was found between COX-2 expression and age and sex of patients, smoking and tumor stage. COX-2 is frequently overexpressed in NSCLC especially in adenocarcinoma and undifferentiated large cell carcinoma. Expression was higher in node-positive tumors and tended to increase with tumor grade, suggesting that COX-2 might play a role in the pathogenesis and/or progression of these tumors. COX-2 appears to be a potentially promising target for therapy and chemoprevention of NSCLC

Evaluation of prognostic value of adhesion molecules in septic critically Ill patients

Septic shock is the most frequent cause of death in intensive care units. Despite major advances in antimicrobial therapy, critical care and surgical techniques, there has been little improvement in morbidity or mortality due to sepsis or septic shock. The aim of this study was to evaluate the role of vascular cell adhesion molecule-1 [VCAM-1] and intercellular adhesion molecule-1 [ICAM-1] in sepsis, septic shock, haemodynamic changes and outcome. Thirty intensive care unit patients suffering from sepsis with or without shock were subjected to blood culture, culture from the site of infection if possible, blood gases analysis, acute physiology and chronic health evaluation score [APACHE II] at baseline, multiple organ failure score on day one [MOF1], cummulative organ failure score [MOFC] on day 5, haemodynamic measurements, as well as serum VCAM-1 and ICAM-1 levels for 5 days after admission. Ten healthy control subjects were also included in the study. The most common site of infection was the chest, the isolates were mostly Gram negative [60%of cases], 9 patients [30%] had positive blood cultures. Serum ICAM-1 and VCAM-1 levels gradually increased from a baseline till day 5 of the study and were significantly higher in patients on admission [62 +/- 20.21, 404.67 +/- 130.85 ng/ml, respectively] than in the control group [14.0 +/- 4.71, 128.0 +/- 34.9 ng/ml respectively], [P=0.00]. They were higher in shocked than in non-shocked patients, and significantly so in non-survivors than in survivors and in patients with positive blood cultures than in those with negative blood cultures, throughout the study period [P=0.00]. A significant positive correlation was observed between serum ICAM-1 and VCAM-1 levels on one hand, and APACHE II as well as both organ failure scores for the 1st day or cumulative on the other hand. We conclude that these adhesion molecules could be measured in critically ill septic patients to predict prognosis and guide therapy