Association of plasma fibrinogen level with the severity of obstructive sleep apnoea patients in a tertiary care hospital

Background: Obstructive sleep apnoea syndrome (OSAS) is a common sleep-related breathing disorder of multi-risk factorial pathogenesis and is characterized by recurrent, partial or complete upper airway obstruction resulting in intermittent hypoxia during sleep. It has been implicated in both cardiovascular and cerebrovascular diseases. Objective of the study was to determine the association of Plasma Fibrinogen levels with the severity of OSA patients in a tertiary care hospital. Methods: This cross-sectional observational study with group comparison was conducted among all the patients attending in the Department of Respiratory Medicine, BSMMU with suspicion of OSA within one year after the clearance of institutional review board (IRB) using STOP-BANG questionnaire and Epworth sleepiness scale (ESS) and confirmed by polysomnography. Plasma fibrinogen was measured in all OSA and non-OSA patients. Data were analyzed with the help of statistical package for the social sciences (SPSS) version 26. Results: Sociodemographic analysis found no significant differences in age, gender, area, occupation, or smoking between OSA and non-OSA groups (p>0.05). However, witnessed apnoea (p=0.002), breathlessness (p=0.005), higher ESS (p<0.001), and STOP-Bang scores (p<0.001) were associated with OSA. Plasma fibrinogen levels were significantly higher in OSA (319.2±63.7 mg/dl versus 242.5±20.33 mg/dl, p<0.001), positively correlating with AHI (r=+0.876, p=0.001). Positive correlations were also found between fibrinogen levels and daytime sleepiness (r= +0.393, p=0.002), waist circumference (r =+0.346, p=0.007), and BMI (r =+0.297, p=0.021) in OSA patients. Conclusions: In conclusion, this study establishes a notable connection between plasma fibrinogen levels and the severity of OSA. Elevated fibrinogen levels correlate with increased OSA severity, indicating a link between OSA, inflammation and coagulation.

Association of serum alpha-1 antitrypsin level with the severity of COPD

Background: Alpha-1 antitrypsin deficiency (AATD) is a hereditary disorder linked to early onset COPD, notably the emphysema variety, but often goes undetected. Low serum AAT levels may impact lung function and correlate with COPD severity. The aim of the study was to detect possible associations of serum AAT level with the severity of COPD patients on the basis of post bronchodilator FEV1 in Bangabandhu Sheikh Mujib Medical University (BSMMU). Methods: A cross-sectional study was conducted at the Department of Respiratory Medicine, BSMMU, Dhaka, from October 2022 to September 2023. Adult patients (?18 years) of both genders diagnosed with COPD based on spirometry were included. COPD was defined per GOLD guidelines, with a post-bronchodilator FEV1/FVC ratio <70%. Severity was categorized based on post-bronchodilator FEV1% predicted. Association between serum AAT level and COPD severity was analyzed using SPSS version 26, with significance set at p <0.05. Results: The study involved 80 COPD patients, with 1.25% showing low serum AAT levels and 98.75% normal. No significant differences in age, sex, or smoking status were observed among severity groups. Mean serum AAT levels varied across severity groups but were not statistically significant (p=0.377). Smoking was prevalent (66.3%), with common comorbidities like hypertension (26.3%), IHD (16.3%), and diabetes mellitus (15.0%). Shortness of breath (95.0%) and cough (92.5%) were common symptoms, with most patients having moderate disease severity (42.5%). Conclusions: The study indicates a weak association between serum AAT levels and COPD severity, with only 1.25% of 80 patients exhibiting low AAT levels.

Association of obesity with the clinical severity of COVID-19 among hospitalized patients in a tertiary care hospital in Bangladesh

Background: The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is increasingly drawing worldwide attention. Among multiple risk factors, obesity is one of the factors that can influence the disease severity. This study aimed to explore the impact of obesity on the severity of COVID-19 infection. Methods: This cross-sectional study was conducted in the Department of Respiratory Medicine, Bangabandhu Sheikh Mujib Medical University, Dhaka from September 2020 to February 2021. The Adult (Aged ?18 years) patients of both genders, who were COVID-19 positive, were included in this study. Ninety-one COVID-19 patients with BMI?25 kg/m2 were set as case and another ninety-one patients with BMI<25 kg/m2 were selected as control. The patient's BMI and waist circumference (WC) were recorded. Disease severity was evaluated by the management of COVID-19 disease guidelines by the World Health Organization (WHO) 2020. Results: The maximum patients were male (65.38%), in the sixth and seventh decades. The proportion of severe illness was higher in the obese group 69.2% compared to the non-obese 47.3%. Patients with obesity require more ICU support (15.4% versus 5.5%) and invasive mechanical ventilation (9.9% versus 2.2%) compared to non-obese patients. In multivariate logistic regression analysis, after adjusting age, diabetes mellitus, and hypertension, obesity (BMI>25 kg/m2) was an independent risk factor for severe illness. Conclusions: Obese patients are associated with severe COVID-19 pneumonia. As BMI increases, disease severity increases, needs more ICU support, and needs more invasive mechanical ventilation.

Usefulness of pleural fluid cholesterol in the diagnosis of tuberculous pleural effusion

Background: Tuberculous pleural effusion (TPE) is the most common etiology of exudative pleural effusion in high tuberculosis burden countries like Bangladesh. The usefulness of pleural fluid cholesterol for the diagnosis of TPE is not evaluated yet. This study aimed to assess the usefulness of pleural fluid cholesterol for the diagnosis of TPE. Methods: This cross-sectional study was conducted at the department of respiratory medicine at Bangabandhu Sheikh Mujib medical university. A total of thirty-five TPE was included in this study. Pleural fluid aspiration followed by cytological (total count, differential count), and biochemical (protein, glucose, lactate dehydrogenase, adenosine deaminase, and cholesterol) investigations were done. At the same time, blood was sent for biochemical (protein, glucose, and lactate dehydrogenase) investigation. Pleural biopsy followed by a histopathological examination was done to confirm TPE. Ethical clearance was obtained from the institutional review board (IRB) prior to starting this study. Results: In our study, the mean age of the participants was 35.54±14.13 years, and male predominant (74.3%). The mean pleural fluid cholesterol was 99.87±23.82 mg/dl. With a cut of value 69.85, the sensitivity, specificity, and accuracy were 97.14%, 57.14%, and 77.14% respectively. Conclusions: Pleural fluid cholesterol has significant diagnostic usefulness for the diagnosis of tuberculous pleural effusion.

Pattern of bacterial infection in acute exacerbation of bronchiectasis according to the lobar distribution

Background: The pattern of bacterial infection in acute exacerbation of bronchiectasis is varied with geographical area and lobar distribution of bronchiectasis. The exact pattern of bacterial infection in acute exacerbation of bronchiectasis according to lobar distribution is not known in our country. This study aimed to investigate the pattern of bacterial infection in acute exacerbation of bronchiectasis according to lobar distribution. Methods: A total of eighty-four patients diagnosed with acute exacerbation of bronchiectasis were included in this cross-sectional study in the department of respiratory medicine, Bangabandhu Sheikh Mujib Medical University. Sputum culture and real-time polymerase chain reaction were used to characterize the bacterial profile and high-resolution computed tomography scans for the location of the bronchiectasis. Before enrolment, informed written consent was obtained from the participants. Results: The mean (SD) age of this study population was 47.89 (±14.95) years, 29.8% were female and 60.7% were a non-smoker. Bronchiectasis was more common in the right middle lobe (63.1%), followed by the right lower lobe (44%), and the left lower lobe (42%). Bacteria were isolated in 66% of patients and Gram-negative bacteria were predominant (78.6%). Pseudomonas aeruginosa (25%) and Klebsiella pneumoniae (17.9%) were the most common bacteria. Conclusions: Pseudomonas aeruginosa was identified predominantly in the right upper lobe, right middle lobe, left upper lobe, and bilateral upper lobe and Klebsiella pneumoniae was in the right lower lobe, left lower lobe, and bilateral lower lobe.

Pattern of bacterial infection in acute exacerbation of bronchiectasis according to the lobar distribution

Background: The pattern of bacterial infection in acute exacerbation of bronchiectasis is varied with geographical area and lobar distribution of bronchiectasis. The exact pattern of bacterial infection in acute exacerbation of bronchiectasis according to lobar distribution is not known in our country. This study aimed to investigate the pattern of bacterial infection in acute exacerbation of bronchiectasis according to lobar distribution. Methods: A total of eighty-four patients diagnosed with acute exacerbation of bronchiectasis were included in this cross-sectional study in the department of respiratory medicine, Bangabandhu Sheikh Mujib Medical University. Sputum culture and real-time polymerase chain reaction were used to characterize the bacterial profile and high-resolution computed tomography scans for the location of the bronchiectasis. Before enrolment, informed written consent was obtained from the participants. Results: The mean (SD) age of this study population was 47.89 (±14.95) years, 29.8% were female and 60.7% were a non-smoker. Bronchiectasis was more common in the right middle lobe (63.1%), followed by the right lower lobe (44%), and the left lower lobe (42%). Bacteria were isolated in 66% of patients and Gram-negative bacteria were predominant (78.6%). Pseudomonas aeruginosa (25%) and Klebsiella pneumoniae (17.9%) were the most common bacteria. Conclusions: Pseudomonas aeruginosa was identified predominantly in the right upper lobe, right middle lobe, left upper lobe, and bilateral upper lobe and Klebsiella pneumoniae was in the right lower lobe, left lower lobe, and bilateral lower lobe.

A study on demographical, clinical-radiological, and histopathological profile of bronchial carcinoma in a tertiary care hospital in Bangladesh

Background: Bronchial carcinoma has different demographical, clinico-radiological, and histopathological profiles depending on the environment, gender, and racial group. The purpose of this study was to explore the sociodemographical, clinical, radiological, and histopathological patterns of bronchial carcinoma in Bangladesh. Methods: This cross-sectional descriptive study was conducted at the respiratory medicine department of Bangabandhu Sheikh Mujib Medical University (BSMMU). The study period was one year from January 2021 to December 2021. Our study documented socio-demographic patterns, smoking habits, history of COPD, clinical features, radiological findings, histopathological patterns of the tumor, and participants' performance status. Results: One hundred histopathologically confirmed patients with bronchial carcinoma were included in this study. The mean age of the participants was 59.57±10.41 years. The majority of the participants were in the 5th and 6th decade, 35% and 34% respectively. Smokers were 80% in our study. The presenting complaints were cough (87%), shortness of breath (61%), and chest pain (58%). Mass lesions (83%) followed by collapse (8%) were the most common imaging findings. Adenocarcinoma (48%) and squamous cell carcinoma (35%) were the predominant histological types. Conclusions: The histopathological profiles of bronchial carcinoma are changing and adenocarcinoma is becoming the predominant type in Bangladesh.