Study of respiratory disorders in endoscopically negative and positive gastroesophageal reflux disease

The relation between respiratory disorders and reflux symptoms has been debated since the beginning of the last century and the interest in the question has increased during the last few decades. This study aims to investigate the relation between specified respiratory disorders and reflux symptoms and examine the correlation between respiratory disorders and endoscopic findings in patients with gastroesophageal reflux disease. This study included 515 patients evaluated for gastroesophageal reflux disease [GERD] by patient self-report symptom questionnaire; modified four grade Likert scale and endoscopic assessment using endoscopic Los Angeles Classification. All participants were asked about various respiratory symptoms experienced during the past six months and exposed to measuring body mass index [BMI], medical history, pulmonary physical examination, chest X-ray, respiratory function tests and available sleep studies. A total number of 515 patients were categorized according to endoscopic findings into two groups; [group 1] subjects with normal endoscopic studies [NERD] 118 [22.9%] patients and [group 2] subjects with abnormal endoscopic studies [ERD] 397 [77.1%]. The proportion of females was significantly higher in ERD group [80.1%] as compared with NERD group [62.7%] [P<0.02]. Duration of reflux symptoms found to be significantly prolonged in ERD group [P<0.03]. The cases of ERD group were more likely to be overweight [BMI>25] P<0.02. History of pulmonary symptoms preceding GERD symptoms was found in 15% of patients. There were 294 patients [57.1%] with different pulmonary manifestations. These manifestations were significantly higher among female group [P<0.01] and among obese, above 40 years old [P<0.001, 0.05 respectively]. Among all patients with respiratory manifestations the commonest disorders diagnosed were chronic pharyngitis [50.3%], chronic bronchitis [15.8%], bronchial asthma [12.6%] and recurrent pneumonia [3.3%]. Obstructive sleep apnea and recurrent hemoptysis were present in 2.7% and 1.5% of the studied patients respectively. There were three cases of chronic lung abscess. There was a significant difference between ERD and NERD groups in their relations to respiratory disorders [P<0.001]. There were statistically significant differences in FEV1,FVC and FEV1/FVD [P<0.02, P<0.05 and P<0.05] respectively in ERD group as compared with NERD group. The study confirms the strong link between gastroesophageal reflux symptoms and various respiratory disorders. Endoscopy of the upper digestive tract remains an important exam in the evaluation of GERD. Respiratory symptoms are more prevalent among erosive esophagitis patients with a positive correlation with degree of severity. These is direct relationship between the severity of airways obstruction as detected by FEV[1], and FEV1/FVC and GER symptoms

Induced sputum versus fiberoptic bronchoscopy in the diagnosis of pulmonary tuberculosis

Tuberculosis still constitutes a major health problem despite advances in diagnosis and treatment. The diagnosis of TB is difficult in patients who cannot produce sputum spontaneously. This study aimed to compare between sputum induction using nebulized hypertonic saline, and fiberoptic bronchoscopy in the diagnosis of pulmonary TB, in clinically and radiologically suspected cases. Thirty suspected pulmonary tuberculosis cases were subjected to: 1-Tuberculin skin test. 2-Sample collection: a. Three successive spontaneous morning sputum samples, b. Sputum induction for 3 successive mornings c. Fiberoptic bronchoscopy with bronchial washing, brushing and Post-bronchoscopic sputum collection. All samples were stained with Ziehl-Neelsen stain. Induced sputum [SI] and bronchial wash were also cultured on Lowenstein-Jensen [L.J] medium. According to L J cultures there were 25[83.3%] positive bronchial wash samples VS 22[73.3%] induced sputum samples. The diagnostic yields of sputum induction and post-bronchoscopic sputum were similarly significant. Also, the yields of bronchial washing and bronchial brushing were similarly highly significant .The differences between all these procedures was non significant. The third SI sample was the most sensitive in the detection of AFB There was no significant difference between SI and Bronchial washing whether by using Z-N stain or L-J culture. Sensitivity, specificity and predictive values of different methods of specimen collection in diagnosing pulmonary TB gave non-significantly different results. Sputum induction is an easy, cheap and non invasive procedure that has a significantly high diagnostic yield for clinically and radiologically suspected cases of pulmonary tuberculosis who have dry cough or whose sputum for three successive days are negative. The third SI sample is the most significant one. There is no significant difference between SI and FOB using any of its procedures

Induced sputum versus fiberoptic bronchoscopy in the diagnosis of pulmonary tuberculosis

Tuberculosis still constitutes a major health problem despite advances in diagnosis and treatment. To compare between sputum induction using nebulized hypertonic saline, and fibreoptic bronchoscopy in the diagnosis of pulmonary TB, in clinically and radiologically suspected cases. 30 patients were subjected to: 1-Tuberculin skin test. 2-Microbiological examination of: a. Three successive spontaneous morning samples, b. Sputum induction for 3 successive mornings c. Fibreoptic bronchoscopy with Bronchial washing, brushing and post-bronchoscopic sputum collection. All samples were stained with Ziehl-Neelsen stain. Induced sputum [SI] and bronchial wash were also cultured on L.J medium. The diagnostic yields of sputum induction and post-bronchoscopic sputum were similarly significant. Also, the yields of bronchial washing and bronchial brushing were similarly highly significant. The differences between all these procedures was non significant. The third SI sample was the most sensitive in the detection of AFB. There was no significant difference between SI and Bronchial washing whether by using Z-N stain or L-J culture. Sensitivity, specificity and predictive values of different methods of specimen collection in diagnosing pulmonary TB gave non-significantly different results. Sputum induction is an easy, cheap and non invasive procedure that has a significantly high diagnostic yield for clinically and radiologically suspected cases of pulmonary tuberculosis who have dry cough or whose sputum for three successive days are negative. The third SI sample is the most significant one. There is no significant difference between SI and FOB using any of its procedures

Diagnostic and therapeutic implications of hypomagnesemia in respiratory intensive care unit

The present study aimed at determining: the frequency of serum Mg2 + abnormalities in respiratory ICU patients and its possible association with other electrolyte abnormalities or ECG changes; the possible effect of commonly used drugs in ICU on serum Mg2+ level and the impact of I.V. administration of MgSO4 in hypomagnesaemic patients on the course of severe asthma or COPD [chronic obstructive pulmonary diseases]. This study included 75 Patients divided into five groups: group I stable state of a] COPD [7 patients] and b] bronchial asthma [8 patients], group II acute exacerbation a] COPD [6 patients] and b] bronchial asthma [9 patients], group III [respiratory failure under mechanical ventilation], group IV [difficult weaning] and group V [status asthmaticus]. The following parameters were assessed: serum electrolytes [Mg[2] +, Na+, K+ and Ca[2] +],ECG, respiratory functions when possible [FEVI, FVC and PEFR] and arterial blood gases [PaO2 and PaCO2]. 77.33% of studied patients were normomagnesaemic, 16% were hypomagnesaemic and 6.6% were hypermagnesaemic. The incidences of hyponatraemia, hypokalaemia and hypocalcaemia in hypomagnesaemic patients were 25%, 33.33% and 25% respectively. ECG changes seemed to be more frequent in hypomagnesemia than in normomagnesaemic patient however, these differences were statistically insignificant. beta2 -agonists, diuretics, corticosteroids and parenteral glucose were accompanied with significantly lower serum Mg[2] + level as compared to an adjusted mean of normal range. Magnesium replacement therapy significantly improved serum Mg[2] + deficiency, ECG abnormalities and arterial blood gases in 4 out of 12 hypomagnesaemic patients as compared to their baseline. On the other hand, a single infusion of 2 gm MgSO4 over 20 minutes significantly improved clinical signs and symptoms as well as PaO2 and PaCO2 in 4 patients with severe acute asthma but not in COPD as compared to their baseline measurements. [1] A 16% incidence of hypomagnesemia was found, along with other electrolyte abnormalities in the respiratory ICU patients. [2] Because of its potential negative pathophysiologic effects on cardiac and respiratory functions, serum Mg2] + determination is recommended in such patients especially in those taking beta2 -agonists, diuretics, corticosteroids and parenteral glucose. [3] Mg[2] + replacement therapy significantly improved the clinical outcome in some hypomagnesaemic patients. [4] A single I.V. infusion of MgSO4 improved clinical outcome and arterial blood gases in some severe asthmatic patients but not in COPD