ABSTRACT
Background and Objectives: in a developing country, cost effectiveness is an important consideration. The aim of this study was to investigate the efficiency and safety of mini broncho-alveolar lavage [mini BAL] samples in the diagnosis of newly developed lung infiltrates in mechanically ventilated patients
Methods: fifty mechanically ventilated patients with newly developed lung infiltrates were assessed by mini-BAL and subsequent microbiological examination. An infant Ryle catheter FG-10 was used as the inner catheter, a Nelaton catheter size 18 FG was used as the outer protective catheter and was blocked by sterile K-Y gel instead of the pre-packaged catheters
Results: eighty six percent of samples collected by Mini-BAL technique from mechanically ventilated patients showed positive growth for culture and sensitivity. Thirty percent of patients had bi microbial infection while fourteen had polymicrobial infection. Fungal infection [Candida] was the most frequent isolated pathogen [32%] followed by Gram-negative bacteria [Klebsiella] [30%]. Legionella was the commonest isolated atypical bacteria
Conclusion: this study highlighted the mini-BAL technique as a simple, safe, cheap, available and non-invasive bedside procedure for acquiring uncontaminated lower respiratory secretions in patients with newly developed pulmonary infiltrates
ABSTRACT
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
Subject(s)
Humans , Hospitals, UniversityABSTRACT
Chlamydia pneumoniae [C. peumoniae], is a common pathogen found in the respiratory tract, it has a seroprevalence rate of > 70% in the adult population, and it is considered responsible for about 10% of the cases of community-acquired pneumonia. Owing to the difficulties in the laboratory diagnosis of C. pneumoniae infection, a routine diagnostic service for this pathogen is not currently available. Moreover, diagnostic differences between the various techniques are not fully resolved. The present study was conducted to evaluate the utility of Direct Fluorescent Antibody [DFA], Tissue Culture [TC], PCR and microimmunofluorescence [MIF] assays for the diagnosis of C. pneumoniae infection in patients having respiratory symptoms. A total of 45 throat and retropharyngeal swabs as well as broncho-alveolar lavage specimens -collected from patients suffering from respiratory tract infections [RTIs]- were tested for the presence of C. pneumoniae by Direct Fluorescent Antibody staining [DFA, Bio Merieux], tissue culture on Hep-2 cell monolayer [Vacsera], PCR using species specific primer pair HR-1/MH-1 [Dia-sorin], and their sera were tested for the presence of IgG antibodies against C. pneumoniae by microimmunofluorescence assays [Vircell, S.L]. PCR gave the highest positive detection rate [44.4%], followed by DFA [28.8%], then TC [22.2%], while MIF gave the least [15.5%]. According to the clinical conditions; acute exacerbation of bronchial asthma, acute bronchitis, pneumonia and asthmatic bronchitis gave positive results with DFA, TC and PCR. Acute exacerbation of chronic obstructive pulmonary disease [COPD] gave positive results with DFA and PCR. PCR is the only assay that gave positive results with chronic bronchitis. In conclusion the difference between the various techniques applied for the diagnosis of C. pneumoniae infection is not fully resolved and it is difficult to define a perfect gold standard
ABSTRACT
The aim of this study was to compare the effects of conventional thrice weekly dialysis versus daily hemodialysis on pulmonary function tests [PFTs]. Sixty subjects were included in this study: The first group included 20 healthy volunteers as controls, the second group included 20 patients maintained on thrice weekly hemodialysis [HD] and the third group included 20 patients maintained on daily HD [six days/week]. All studied personnel were subjected to perform PFTs [forced vital capacity [FVC], volume of air expired in the first second [FEV1], forced expiratory volume in the first second/forced vital capacity [FEV1/FVC], forced expiratory flow rates in the 25-27% range [FVF 25-75%], forced expiratory flow rates in the 50% range [FEV 50%], peak expiratory flow rate [PEFR] and diffusion capacity by measuring transfer factor [DLCO]]. The study concluded that although there was a deterioration in PFTs in both regimens of HD, these changes were much less in daily HD than thrice weekly HD, which indicates that daily HD is the method of choice in treating uremic patients, specifically in some patients who have underlying chest disease