effect of adding body mass index [BMI] and neck circumference to Epworth sleepiness scale [ESS] for diagnosing obstructive sleep apnea hypopnea syndrome in sleep clinics

Objective: To study the effect of adding body mass index and neck circumference to Epworth Sleepiness Scale [ESS] for diagnosing obstructive sleep apnea hypopnea syndrome in sleep clinics

Study Design: Cross sectional validation study

Place and Duration of Study: Department of Pulmonology, Military Hospital Rawalpindi from 1st July 2013 to 01 September 2014

Material and Methods: The ESS and ESS plus body mass index [BMI] and neck circumference [NC] data was evaluated for 150 patients hospitalized in our hospital for polysomnographic evaluation of obstructive sleep apnea. Overnight polysomnography [PSG] was done for all patients and was considered the gold standard for diagnosis of OSA. ESS Scoring, BMI and NC data was done using pre-designated questionnaire. All the data was analyzed using SPSS version 19

Results: Age ranged from 18-74 years with mean age of the study group 53 [ +/- 12.1 SD] years. Out of study population 87 [58%] were males and 63 [42%] females. In study population 80 [55.3%] patients had ESS >10. while 102 patients had ESS>10 with BMI > 35 kg/m2 and NC>40 cm. Using an AHI >/= 5 for OSA, 136 patients [90.6%] had OSA. Sensitivity of ESS > 10 for OSA was 55.15% but increased to 72.79% when BMI > 35 kg/m2 and NC > 40 cm was added to patients with ESS > 10. Similarly specificity and predictive values of study population for diagnosing OSA also increased after adding BMI and NC to ESS

Conclusions: In this study adding body mass index [BMI] and NC to ESS score significantly increased the sensitivity and specificity and positive predictive value for diagnosis of OSA

Endobronchial ultrasound guided transbronchial needle aspiration [EBUS-TBNA] for diagnosis of mediastinal and hilar masses

Objective: To determine the sensitivity, specificity, negative and positive predictive values, and diagnostic accuracy of Endobronchial Ultrasound Guided Transbronchial Needle Aspiration [EBUS-TBNA]

Study Design: A cross-sectional validation study

Place and Duration of Study: Department of Histopathology, Army Medical College, in collaboration with Department of Pulmonology, Military Hospital Rawalpindi, from March 2014 to March 2015

Methodology: Cases of EBUS-TBNA comprised of both TBNAs and cell block/biopsy of the same patients. Diagnosis was made on the TBNA slides and cell block/biopsy material. Taking biopsy/cell block as the gold standard, the data was analysed to calculate the sensitivity, specificity, negative and positive predictive values, and diagnostic accuracy of EBUSTBNA

Results: The sensitivity of EBUS-TBNA was found to be 96.5%; whereas, specificity and positive predictive values were 100%. The negative predictive value was calculated at 50%. Diagnostic accuracy of the procedure was found to be 96.67%

Conclusion: EBUS-TBNA is a sensitive and a specific test and is accurate in diagnosing mediastinal and hilar pathologies

Frequency of positive tuberculin skin test in BCG-vaccinated asymptomatic adults in Pakistan

To determine the frequency of positive tuberculin skin test [TST] in BCG-vaccinated asymptomatic healthy Pakistani adults. Cross sectional study. The study was carried out in Military Hospital, Rawalpindi in 2008 over six months. One hundred and thirty six individuals fulfilling inclusion and exclusion criteria of study were recruited after consent. They were subjected to TST [Mantoux test] and results were interpreted after 72 hours of injection. Test was recorded as positive if the indurated area was >/= 10 mm, and strongly positive if >/= 15 mm. All participants were male with the mean age of 26.35 +/- 6.164 years. The overall frequency of positive TST was 41.2%. Out of these, 9.6% were strongly positive. In healthy, BCG-vaccinated adult Pakistani population, TST is found to be positive in high frequency, and even induration of more than 15 mm was seen in significant number. In view of low specificity, TST should not be relied upon for the diagnosis of active tuberculosis [TB]

Diagnostic yield of transbronchial needle aspiration analysis of 30 cases

In our clinical set up transbonchial needle aspiration of lymph node and parenchymal lesions is an underutilized technique. This study was done to highlight the usefulness of this technique in the pulmonologists armamentarium. Thirty procedures were performed on patients with intrathoracic lymphadenopathy or parenchymal lung lesions in this study from October, 2006 to April, 2007. Patients with an easily accessible peripheral lymph node, bleeding diathesis and an already confirmed diagnosis were excluded from the study as were patients with a well visualized biopsiable endobronchial lesion. Nineteen patients [63.3%] on whom transbonchial needle aspirations were performed had intrathoracic lymphadenopathy while 11 [36.6%] had parenchymal lesions without endobronchial lesions which could be biopsied. Adequate samples were obtained in 23 patients [76.6%] chronic granulomatous inflammations which was diagnosed as tuberculosis in corroboration with other clinical and laboratory evidence was seen in 3 cases [10%]. Carcinoma was diagnosed in 6 cases [20%]. Thirteen cases [43%] were reported as normal and inadequate samples were obtained in 7 cases [23%]. Transbronchial Needle Aspiration [TBNA] is an effective method of obtaining cytological material from intrathoracic lymph nodes and parenchymal lesions and can provide a safe alternative to invasive mediastinotomy/mediastinoscopy and open lung biopsya