utility of the interferon gamma-inducible protein-10 [IP-10] level in bronchoalveolar lavage and blood in the diagnosis of tuberculosis

Introduction: Control of TB depends on early detection and treatment of active cases

Aim of the work: Investigating the utility, sensitivity and specificity of interferon gamma inducible protein IP-10 in both blood and bronchoalveolar lavage [BAL] in the diagnosis of TB infection in clinically suspected patients

Methods: Thirty patients with clinical and/or radiological suspicion of pulmonary tuberculosis and negative sputum smear for AFB with Z-N stain were included in the study. BAL and blood samples were sent for the estimation of the level of interferon gamma inducible protein IP-10

Results: IP-10 levels in both blood and BAL were significantly higher in TB patients [P = 0.005 and 0.007 respectively]. Sensitivity of IP-10 in blood was 100% and specificity was 60%. Positive predictive value was 56%, negative predictive value was 100% and accuracy was 73%. Sensitivity of IP-10 in BAL was 100% and specificity was 35%. Positive predictive value was 44%, negative predictive value was 100% and accuracy was 57%. Sensitivity of IP-10 in blood and BAL were similar [100%] and both were more sensitive than tuberculin skin test [TST] [sensitivity 67%]. Detection of IP-10 in blood [specificity = 60%] was more specific than its detection in BAL [specificity = 35%]. On the other hand, specificity of detection of IP-10 in blood [60%] was comparable to the tuberculin test [specificity = 62%]

Conclusion: Interferon gamma inducible protein IP-10 may help in detecting M. tuberculosis infection and monitoring disease activity and efficacy of therapy

Quality of life in COPD patients

Quality of life [QOL] can be severely impaired in patients with COPD. They usually show an accelerated decline in lung function and progressive impairment of physical performance. To study quality of life in patients with COPD and to examine its relationship with the severity of the disease. Quality of life was determined in 40 COPD patients using the St. George's Respiratory Questionnaire for COPD patients [SGRQ-C]. Mild COPD patients differed significantly from other grades of COPD in their total SGRQ-C score, symptoms score, activity score and impact score [p

Sleep pattern changes in patients with liver cirrhosis

Liver cirrhosis is considered as a major cause of mortality worldwide and is the most common non-neoplastic cause of death among hepatobiliary and digestive diseases. One of the least studied complications of liver cirrhosis is the disturbed sleep pattern, which is being increasingly recognized as a major health problem affecting the quality of life. This study included two groups; the first group consisted of 30 patients diagnosed as liver cirrhosis based on abdominal ultrasound and liver biopsy and the second group consisted of 10 healthy subjects served as controls. ESS was calculated for every patient and all patients were subjected to complete overnight polysomnography to detect sleep disturbances among all participants. Our results showed that cirrhotic patients had ESS, AHI and OSA significantly higher than the control group [16.4 +/- 2.6 vs 11.1 +/- 1.8, P = 0.0001; 10.9 +/- 8.5 vs 2.4 +/- 1.6, P = 0.005 and 3.1 +/- 3.1 vs 1.1 +/- 0.9, P =0.03, respectively]. The percentage of sleep efficiency was significantly lower in cirrhotic patients than the control group [61.9 +/- 12.9 vs 73.1 +/- 7.6 [P = 0.02]]. Also, the percentages of S1, S3-S4 and REM sleep in relation to the total sleep time were significantly higher in the cirrhotic patients than the control group [P = 0.01, 0.02 and 0.06, respectively] while the percentage of S2 was significantly lower [P = 0.02]. Cirrhotic patients of Child class C had ESS, AHI and OSA significantly higher and sleep efficiency significantly lower than cirrhotic patients of classes A and B [P = 0.001 for all]. Cirrhotic patients with tense ascites had ESS, AHI and OSA significantly higher and sleep efficiency lower than patients with mild, moderate, or no ascites. This study revealed that cirrhotic patients had disturbed sleep pattern, correlating with the degree of cirrhosis

Pattern of airway inflammation and remodeling in mild chronic obstructive pulmonary disease

Airway wall remodeling is present in the airways of patients with COPD and is considered the most important contributor to the airflow limitation. To study the airway structural abnormalities and the role of mast cells in mild COPD. Thirty patients having mild COPD were subjected to sputum analysis and fiberoptic bronchoscopic biopsies from the main and segmental bronchi. BAL was obtained from segmental bronchi. At the level of mucosa there was infiltration by macrophages, lymphocytes and few numbers of neutrophils. Congestion, epithelial shedding and squamous metaplasia were more prevalent than in the central airways. At level of the submucosa there was goblet cell hyperplasia in 70% of cases. The muscle layer had an increased thickness in 80% of cases in comparison to 56.7% in the central airways and 83.3% showed thick fibrosed wall and shed epithelium in comparison to 40.0% in central airway. The pathological hallmark of COPD was mainly at the level of the small airways both at the level of the cellular components of BAL and at the level of histopathology

Evaluation of some pulmonary physiological and mechanical parameters as weaning criteeria

Simple protocols can help selecting patients capable of sustaining spontaneous breathing. To evaluate the utility of some pulmonary physiological and mechanical parameters as weaning predictors.Twenty four patients were included, the following data were assessed: spontaneous respiratory frequency [/], spontaneous tidal volume [VT], peak inspiratory pressure [PIP],plateau airway pressure [P plat], maximum inspiratory pressure [PImax], rapid shallow breathing index [RSBI], dynamic compliance [Cdyn], static compliance [Cst], alveolar-arterial oxygen gradient [[A-a] O[2] and]], minute ventilation [VE], shunt fraction and arterial to inspired oxygen ratio [PaO[2]/FIO2].Eighteen patients were successfully weaned [GI] and six failed the T-piece trial [Gil]. Significant differences were found between both groups as regards RSBI, Cst, Cdyn, shunt fraction, p[A-a] O[2] Pplat and PaO2/FIO[2][p<0.05]. By testing cut off values for RSBI [49.78], PaO[2]/FIO[2][155].p [A-a] O[2] A [84] and shunt fraction [25%], they gave a diagnostic accuracy of 91.6%, 91.7%, 100% and 95.8% respectively. PImax, PIP and VE were not discriminating parameters.Simple bedside criteria can help triggering efficient weaning protocols which can be adopted in our intensive care units. The previous cut off values can also be helpful in taking weaning decisions

Epithelial-mesenchymal interaction in rhino-bronchial remodeling

The clinical phase and outcome of allergic diseases is related to the degree of bronchial and nasal remodeling. The present study aimed at assessing some features of both upper and lower airway remodeling in allergic patients as well as the role of epidermal growth factor and its receptor [EGFR] and transforming growth factor fi [TGF-fi] in this process.Twenty patients with mild persistent asthma according to G1NA guidelines and mild persistent allergic rhinitis [ARIA] were included in the present study. Fibreoptic bronchoscopy was done during stable disease. Forceps biopsy was taken from a segmental bronchus and from the nasal turbinates. The biopsies taken were stained by haematoxylin and eosin [H and E] for histopathologic evaluation and immunohistochemical detection of EGFR and TGF-ft was done.Abnormalities in nasal epithelium [ulceration, atypia, and basement membrane thickening] were detected in 50% of asthmatic patients and abnormalities in bronchial epithelium were detected in 40% of them. EGFR was expressed in all abnormal nasal and bronchial epithelium specimens. TGF-f$ was expressed in 90% of abnormal nasal epithelium and all abnormal bronchial epithelium. Both factors were expressed only in hypertrophied nasal and bronchial mucus glands and some inflammatory cells. They were positively correlated with both nasal and bronchial basement membrane thickness.Remodeling occurs even in mild allergic patients. Epithelial-mesenchymal interaction through EGFR and TGF-/3 release plays a major role in this process

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

Physicochemical and pathophysiologic effects of oscillating endobronchial positive expiratory pressure in acute exacerbation of COPD

Mucociliary and airway functional impairment in COPD are partly due to abnormal sputum rheology determined by mucus glycoproteins [MGP]. To assess the short term effects of oscillating endobronchial positive expiratory pressure [PEP] on sputum viscosity [V], MGP, pulmonary function tests [PFT] in acute COPD exacerbation. Seventeen male COPD patients [mean age 66.1 +/- 12.7] receiving conventional therapy, except for mucolytics, entered the study during an acute exacerbation [group A]. Group B [control] included 10 male COPD patients [mean age 57.3 +/- 9.66 year] during a similar attack and they received the same treatment except for Flutter. An informed consent was obtained from all participants. Basal sputum viscosity [V], mucus glycoproteins [MGP], pulmonary function tests [PFT] and PaO[2] were assessed. Group A then performed physiotherapy using Flutter device which induces oscillations varying between 10-20 cm H[2]O in both intrabronchial pressure and flow of the exhaled air for 15 minutes 3 times a day and once more on the next morning. All parameters were repeated on the next morning for both groups. Values of FVC [%of predicted], FEV[1]/FVC and MMFR [%of predicted] were [55.9 +/- 28.1, 41.2 +/- 11.1 and 44.4 +/- 17.8] and significantly improved after flutter to reach [76.3 +/- 22.5, 51.3 +/- 13.9 and 50.8 +/- 25.9] respectively. Sputum viscosity [in poise] and MGP [in mg/dl] were 84.4 +/- 94 and 47.3 +/- 7.8 and showed significant decline after PEP [38.01 +/- 55 and 45 +/- 7]. There was also a significant change in PaO[2] before and after physiotherapy [50.7 +/- 21.2 and 66.6 +/- 15.6]. There was a significant positive correlation between MGP and V [p=0.001] and a significant negative one between MGP and FEV[1]/FVC [p=0.03]. In Group B, V [167.6 +/- 54.6] did not change significantly [166.4 +/- 55.6], FVC decreased from 64 +/- 4 to58 +/- 22 and FEV[1]/FVC from 78.9 +/- 21 to74.3 +/- 33.4 while MMFR increased from 59.5 +/- 45.9 to 66.2 +/- 40.7 [p=0.019]. Oscillating PEP significantly improves sputum viscosity. These changes are positively and significantly reflected on PFT and PaO[2] in acute exacerbation of COPD

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

Role of CD15 in the diagnosis of lung cancer

The poor prognosis associated with lung cancer is closely related to the fact that most patients are not identified until their malignancy has reached an advanced stage. The aim of this study was to assess the role, sensitivity and of CD15 in the diagnosis of bronchogenic carcinoma as well as its predictive value in smoker's lungs not harboring tumor tissues. Three groups were included: Group I: 15 patients with biopsy proved adenocarcinoma. Group II: 15 patients with biopsy proved squamous cell carcinoma. Group III: 12 smokers with no evidence of malignancy and for whom bronchoscopy was done for other reasons .GI and GII were then pooled into a single group [group of pulmonary malignancy [Gpm]. Patients were excluded if their biopsy proved to be small cell lung cancer. An informed consent was taken from all patients. In addition to complete history, clinical examination, laboratory investigations, chest X-rays and CT chest, all patients were subjected to fibreoptic bronchoscopy for biopsy. Then the biopsy was stained by H and E and immunostained for CD15. The majority of the bronchogenic carcinoma cases were smokers 60% with an incidence of squamous cell carcinoma and adenocarcinoma of [66.7%, 53.3% respectively]. Twenty percent, 50%, and 30% of the patients in group of pulmonary malignancy presented in stages IIIa, IIIb, and IV respectively. Immunostaining for CD 15 was detected in 60% of the biopsies from group of pulmonary malignancy and none of group III with a highly significant difference [P<0.05] and a sensitivity of 73.68%, while it stained 66.7% of adenocarcinoma and 53.3% of squamous cell carcinoma with no significant differentiating value. It stained 33.3%, 38.9%, and 27.8% of tissue specimens from group of pulmonary malignancy in stages IIIa, IIIb, IV respectively with a significant positive correlation between CD 15 positivity and the stage of lung cancer. Immunostaining for CD15 has an important and significant role in the diagnosis of non-small cell lung cancer but it is not able to differentiate between its types. Also, it gives an important and significant clue about the dissemination and prognosis of this type of malignancy

Spontaneous bacterial empyema in cirrhotic patients: complements 3 and 4, opsonic power and C-reactive protein as pathogenic mechanisms and diagnostic tools

Hepatic hydrothorax occurs in approximately 5-12% of patients with cirrhosis and portal hypertension and may be complicated by spontaneous bacterial empyema [SBE]. Pathogenic mechanisms of SBE still need to be investigated. The present work assesses the role of complement components [C3, C4], opsonizing power and C-reactive protein in the pathogenesis of SBE in cirrhotic patients. Twenty five cirrhotic patients with hepatic hydrothorax were randomly selected and 10 patients with hydrothorax secondary to heart failure were included as controls in the study. Pleural fluid [PF] and serum samples were analyzed for: total protein [TP], albumin, lactic dehydrogenase [LDH], glucose, polymorph nuclear leukocytic count [PMNL], complement components [C3, C4], opsonic activity [on the basis of log-kill] and high sensitive C-reactive protein [CRP]. SBE was diagnosed when pleural fluid PMNL was > 250 cells/mm[3] with a positive culture or >500 cells/ mm[3] with a negative culture after exclusion of pulmonary infections. Thirteen patients [52%] [Group I] were diagnosed as SBE and 12 patients [48%] had no SBE [Group II]. There was no significant difference between patients and controls [GIII] as regards age, gender, serum proteins, serum C3, serum WBC and effusion CRP. Levels of serum albumin, total pleural effusion proteins, PT% and opsonic activity of groups I and II were significantly lower than in GIII with no significant difference between groups I and II. Levels of serum bilirubin and C4 of groups I and II were significantly higher than group III with no significant difference between groups I and II. Level of pleural effusion C3 in group I was significantly lower than in groups II and III and level of C3 in group II was significantly lower than in group III. Level of pleural effusion C4 in group I was significantly lower than group III, but there was no significant difference between groups I and II. In hepatic patients, 7 patients [28%] belonged to Child's class B and 18 [72%] to class C. Spontaneous bacterial empyema was detected in 56% of hepatic patients with Child's class C and in 43% of Child's class B. There was no significant difference between hepatic patients with and without SBE with regard to Child-Pugh's score. In patients with SBE, levels of C3 and C4 were significantly less in pleural fluid than in serum but there was no significant difference with regard to opsonic activity. Local complement defects [especially C3] and opsonic activity in cirrhotic patients predispose to SBE. Serum CRP increases, but effusion CRP level should be reassessed as a cheap diagnostic tool

Cytogenetic study of tuberculous patients before and after chemotherapy

Increased chromosomal aberrations [CA] is regarded as a biomarker of personal exposure to dangerous chemical agents. Cytogenetic analysis was performed on 40 tuberculous [TB] patients [before] and after receiving anti-TB drugs], to evaluate the possible genetic damage induced by Mycobacterium tuberculosis as well as by short term combined anti-TB drugs [pyrazinamide, rifampicin, INH and ethambutol]. For comparison, 40 controls were selected. The frequency of CA in both TB patients groups [before and after treatment] showed a significant increase as compared to controls. The mitotic index was significantly decreased in both TB patients groups. TB infection by itself as well as the short term combined anti-TB drugs had a chromosome damaging effect on human lymphocytes in vivo. These drugs should be used with caution. Alternative drug combinations that are equally efficient but less harmful to the genome have to be selected. Cytogenetic analysis for detection of cases with CA [i.e. susceptible for progression or victims of mycobacterial or drug effects] should be advised to all patients especially in the child bearing age