Prevalence characteristics of COPD in never smokers

Chronic obstructive pulmonary disease [COPD] is currently the 4th leading cause of death all over the world. Smoking is by far the most important documented [and preventable] cause for COPD. However, COPD can still be recorded among a good percentage of non smoker patients, due to other different causes. This study was performed in the Chest Department, Menoufiya University, in the period from April 2009 to August 2011, on randomly selected 300 COPD patients, 230 patients [76.66%] were men and 70 patients [23.34%] were women. The mean age of the patients was 60.7 +/- 5.35 years [range 42-83 years], and all patients were diagnosed as having COPD [FEV1/FVC < 70%], with the use of spirometry [prebronchodilator and postbronchodilator inhalation], according to the GOLD criteria. For each patient, the personal history [including his or her education level], smoking history, health status, and exposure to risk factors for COPD, were assessed according to a prewritten questionnaire. Out of the 300 COPD patients included in this study, 120 [40%] were never smokers and 180 [60%] were ever smokers. Women made up 41.7% of the never smokers [50 of 120] and 11% of the ever smokers [20 of 180]. Never smokers were significantly older than smokers [65.08 +/- 5.03 years vs 56.33 +/- 5.67 years [P < 0.001]] and were more likely to be women [41.7% vs 11% [P < 0.001]]. Never smokers made up to 40% [120/300] of all COPD cases: 78% [70/90] of all GOLD stage II cases, 45.5% [50/110] of all GOLD stage III cases. Among never smokers, 58.3% [70/120] fulfilled the criteria for GOLD stage II and 41.7% [50/120] fulfilled the criteria for GOLD stage III and no patients fulfilled the criteria of either GOLD stage I or GOLD stage IV. Never smokers were shown to have more occupational exposure to organic and inorganic dust and irritant gases at work place [41.7% [50/120] vs 27.7% [50/180], P < 0.05], more biomass exposure [41.7% [50/120] vs 0% [0/180], P < 0.001], less education [41.7% [50/120] vs 72.2% [130/180], P < 0.001], more exposure to passive smoking [75% [90/120] vs 22.2% [40/180], P < 0.001]. When compared with never smoker patients with moderate COPD [GOLD stage II], never smokers with severe COPD [GOLD stage III] were older in age [70.6 +/- 2.44 years vs 61.14 +/- 1.25 years, P < 0.001], have a higher female percentage [60% vs 28.6%, P < 0.001], lower BMI [21.2 +/- 0.76 vs 26.14 +/- 2.43, P < 0.001], more occupational exposure [27.5 +/- 2.56 years vs 13.33 +/- 2.39 years, P < 0.001], more biomass exposure [35 +/- 4.15 years vs 20 +/- 10 years, P < 0.001], less education [0% vs 71.4 educated, P < 0.001], more exposure to passive smoking [29 +/- 2.02 years vs 13.75 +/- 4.19 years, P < 0.001]. This study revealed that never smokers constitute a significant proportion of the Egyptian COPD patients. When dealing with COPD management, clinicians must be oriented with the different risk factors, other than tobacco smoke, that play a key role in the development and pathogenesis of COPD, because despite smoking is the most important risk factor, its absence doesn't exclude COPD diagnosis

Predictors of mortality in mechanically ventilated COPD patients

Patients with chronic obstructive pulmonary disease [COPD] commonly require hospitalization and admission to intensive care unit. It is useful to identify patients at the time of admission who are likely to have poor outcome. This study was carried out to define the predictors of mortality in mechanically ventilated COPD patients and to advice a scoring system using the baseline physiological variables for prognosticating these patients. This study comprised 220 patients with acute respiratory failure [ARF] secondary to COPD, requiring mechanical ventilation [MV] and admitted to the intensive care unit [ICU] of Menoufiya Chest Department over a two-year period. Clinical and demographic data including APACHE III [Acute Physiology and Chronic Health Status Evaluation] score and Charlson co-morbidity score were recorded on MV, at the time of admission to the ICU. In addition, the acid base status, renal and liver functions, serum electrolytes, LDH, CRP and albumin were recorded at the time of presentation. The length of stay in-hospital, in the ICU, and mechanical ventilation were also recorded. The mean serum albumin level was 2.77 +/- 0.39 gm/dL and 2.11 +/- 0.19 for survivors and non-survivors, respectively [p < 0.05]. As regards ABGs; the mean PaCO2 was 54.8 +/- 6.39 mmHg and 76.1 +/- 11.1, PaO2 was 54.8 +/- 7.1 mmHg and 50.2 +/- 4.9, and HCO3 was 34.7 +/- 4.2 mEq/L and 41.6 +/- 4.8 in survivors and non-survivors, respectively [p < 0.05]. Charlson co-morbidity index demonstrated a cut off value of 1.4 +/- 0.3 and 2.6 +/- 0.6 and APACHE III score off value was 45.2 +/- 12.62 and 80.9 +/- 15, for survivors and non-survivors, respectively with statistically significant correlation for both indices [p < 0.05]. The present results indicate that the severity scores, like Charlson co-morbidity and APACHE III scores, are useful and reliable tools for predicting mortality in COPD patients requiring MV. Serum albumin level, renal functions as well as the oxygenation and ventilation parameters can also, predict mortality

Treatment outcomes among patients with multi-drug resistant tuberculosis in Abbasia chest Hospital from July 2006 to June 2010

Tuberculosis despite being treatable and preventable disease, it continues to be a major health challenge in many parts of the world. The emergence of drug-resistant tuberculosis has made the current epidemic worse. This retrospective study included 200 MDR-TB patients admitted to Abbassia Chest Hospital in the period between July 2006 and June 2010. Their files had been analyzed including medical history, chest examination and investigations. Drug regimens of resistance used for treatment and the fate of treatment were reported. Patients were 148 males [74%] and 52 females [26%]. Their ages ranged from 15 to 76 years [37.83 +/- 12.78 years]. 81.5% of them lived in rural areas, 2.5% were tobacco smokers and were diabetics. Defaulters were 44.5%, treatment failure patients were 44%, relapse patients were 4%, and new cases constituted 7.5% of the studied patients. Acquired resistance was 92.5% and primary resistance was 7.5%. The duration for sputum conversion ranged from 2 to 9 months [4.19 +/- 1.28 months]. The fate of MDR-TB treatment was favorable outcome in 132 cases [66%] and unfavorable in 68 cases [34%] [28 patients were defaulters [14%], 21 patients died [10.5%] and 19 patients had treatment failure [9.5%]]. The prevalence of defaulter patients was significantly higher among unfavorable outcome patients while the prevalence of treatment failure patients was significantly higher among favorable outcome. Successful treatment could be achieved in 66% of MDR-TB patients treated in Abbassia Chest Hospital between July 2006 and June 2010

Pleurodesis using different agents in malignant pleural effusion

Malignant pleural effusions [MPE] are characterized by rapid reaccumulation, after tapping, and many symptoms related. Pleurodesis, for the management of MPE, is intended to achieve symphysis between parietal and visceral pleura, and to prevent relapse of pleural effusion. Many chemical agents are tried to induce abrasion and damage of the pleural mesothelial layer to achieve this symphysis. The aim of this study is to compare the results of medical pleurodesis, using 4 different chemical agents in these cases, to reach an efficient one with minimal complications. Between July 2010 and July 2012, 40 patients with MPE, divided into 4 groups, underwent medical pleurodesis using 4 chemical agents in comparison: bleomycin, doxycycline, povidone iodine and 5-fluorouracil. Immediately and for 3 months after the procedure, the results of pleurodesis were assessed and the final reported success rates were 70% for bleomycin, 80% for doxycycline and 80% for povidone iodine, while 5 fluorouracil had the lowest success rate [50%] [P-value < 0.05]. Bleomycin, doxycycline and povidone iodine are nearly equally effective and safe pleurodetic agents when used in the optimal dose, while 5-fluorouracil had a much higher failure rate. Although povidone iodine and doxycycline are as effective and safe as bleomycin, they are cheaper alternatives and more available chemical agents for pleurodesis in cases with MPE