Pattern of community acquired pneumonia in pregnant ladies in Ain Shams University Hospitals

Community acquired pneumonia [CAP] is recognized as a common problem that carries a substantial morbidity and mortality. The burden of disease falls mainly on people at the extremes of age and while the occurrence of CAP in young adults is uncommon. Nevertheless, pneumonia in young adults can be severe and fatal. Pneumonia in the pregnant patient is the most frequent cause of fatal non-obstetric infection. The aim of this study was to assess the pattern of community acquired pneumonia among pregnant ladies in Ain Shams University hospitals. The present study included 168 pregnant ladies with community acquired pneumonia, who were selected from out patient's clinics of obstetrics and gynecology department, Ain Shams University [ASUH]. The present study included 168 pregnant ladies with community acquired pneumonia, who were selected from out patien's clinics of obstetrics and gynecology department, Ain Shams University [ASUH]. Their ages ranged from 18-42 years old with mean age of 25.32 years old [ +/- 4.20 SD]. Morbidity and mortality in pregnant patients with pneumonia continue to present a significant challenge. Early recognition of the diseases process and prompt treatment are required to ascertain an optimal outcome. The treatments in the gravid patients generally follow standard guide lines for the treatment of pneumonia in adults. Concern for fetal outcome should not delay treatment as improvement in maternal oxygenation and status is the best way to ensure fetal protection

Platelet derived growth factor and the extent of skin thickening as potential indicators of pulmonary affection in systemic sclerosis

Systemic sclerosis is a multisystem disease that has considerable variability in its presentation, course, and prognosis. The aim of this study was to determine serum levels of platelet-derived growth factor [PDGF A/B] in patients with systemic sclerosis [SSc] and to correlate these levels with the extent of skin sclerosis and presence of pulmonary affection. Moreover, the efficiency of PDGF and skin score in early detection of pulmonary affection were assessed. The study included 22 female patients with SSc [according to the American College of Rheumatology] [Masi et al., 1980] and 15 age-matched healthy control females. According to the classification by LeRoy et al. [1988], we divided our patients into limited SSc [10 patients-45.5%] and diffuse SSc [12 patients-54.5%]. The extent of skin sclerosis was assessed by the modified Rodnan total skin thickness scoring [TSS] system [Clements et al., 1995]. In our study, patients with limited SSc had a skin score <25, while those with diffuse SSc had skin score >25. Five diffuse SSc patients had associated pulmonary affection, diagnosed by history taking, clinical examination, chest x-ray, arterial blood gases, spirometry and diffusing capacity of the lung for carbon monoxide [DLCO]. Serum levels of PPGF were determined in SSc patients and healthy controls using quantitative sandwich ELISA technique. Serum PDGF mean and standard deviation in healthy subjects was 5.2 +/- 2.466 ug/l. PDGF values showed continuous significant increment with progression of the disease. Mean PDGF serum levels in limited SSc, diffuse SSc without pulmonary affection and with pulmonary affection were 15.8 +/- 2.3, 20.86 +/- 2.41 and 32 +/- 3.08 ug/l, respectively. Furthermore, the results revealed that PDGF value <10 ugh, tend to exclude the diagnosis of SSc with 100% sensitivity and specificity, respectively. Moreover, all patients with diffuse SSc and having pulmonary affection had PDGF values >25 ug/l. This value provided a diagnostic sensitivity and specificity of 100%. As regards the total skin score, a statistical significance was found between limited and diffuse SSc but did not show a statistically significant difference between SSc patients with [32.2 +/- 4.49] and without [29.71 +/- 3.25] pulmonary affection [p>0.05]. However, in patients with diffuse SSc, PDGF levels tended to correlate positively with the skin score [p=0.05]. ROC plot showed that skin score at a value of 29 was the best cut-off level to diagnose pulmonary affection in patients with diffuse SSc with a diagnostic sensitivity of 80% and specificity of 71.4%. PDGF is a simple and easy laboratory test that tends to exclude the presence of SSc at a cut-off value of 10ng/ml with 100% sensitivity and specificity, respectively. PDGF correlates positively with extent of skin involvement and significantly with pulmonary affection. PDGF and skin scoring system are simple laboratory and physical measures for evaluating patients with systemic sclerosis with cut-off levels of 25 ug/l, and 29 respectively in detecting pulmonary affection. However, further studies are recommended on larger population to ensure the diagnostic efficiency of PDGF and to test the applicability of our obtained cut-off values

Renal function reserve in chronic obstructive pulmonary disease with type II respiratory failure

Increase in renal blood flow in response to certain stimuli such as dopamine infusion, oral protein load, and amino acid infusion. Reduced or absent renal functional reserve [RFR] is an early index of renal impairment. Our work studies the [RFR] in Chronic Obstructive Pulmonary Disease [COPD] patients with chronic compensated type II respiratory failure. Our study included 15 COPD patients with compensated type II respiratory failure and 5 normal controls. The patient group had mean Pa O[2] 56.5 +/- 6.4 and Pa CO[2] 56.5 +/- 3.2, while in normal controls the mean Pa 02 was 97.4 +/- o.3 and Pa CO[2] was 42.3 +/- 1.2. Hypoxic patients [Pa O[2]< or =59mm Hg] allowed to receive low flow oxygen by nasal prongs to keep their Pa O[2] >or = 60 mm Hg and Sa O[2] > or = 90% without rise of Pa CO[2] within 2 hours before and during the study. The pulsatility index [PI], an index of reno-vascular resistance [RVR], was measured non invasively by Doppler Ultrasonograghy at baseline and 20 minutes after infusion of dopamine in diuretic dose. The baseline PT was nearly similar in the control group and in COPD patients [no significant difference], the PI fell significantly in the control group after dopamine infusion from 1.03 +/- 0.14 to 0.83 +/- 0.1[P< 0.05], but increased significantly in COPD patients from 1.02 +/- 0.12 tol.18 +/- 0.13 [P<0.05] after dopamine infusion. Renal functional reserve is impaired in hypercapnic COPD patients and this may be a factor in the development of edema frequently seen in these patients