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BACKGROUND AND OBJECTIVES: Pleural effusion is seen in around half of the cases of pulmonary embolism (PE). There are no data on the incidence of pleural effusion in cases of PE in the Kingdom of Bahrain. This study was done to determine the frequency and radiological features of pleural effusion in cases of acute PE and also to characterize the pleural fluid biochemistry and cell type in patients subjected to diagnostic thoracentesis. METHODS: This was a retrospective, observational single-center study. All the data of patients subjected to computed tomography pulmonary angiography (CTPA) in suspected cases of acute PE over a 4-year period were analyzed. RESULTS: A total of 1756 patients were subjected to CTPA from January 2013 to December 2016. A diagnosis of acute PE was made in 200 patients (11.4%). Pleural effusion was identified in 70 cases (35%). Majority of the effusions were small to moderate in size, bilateral, and associated with peripheral emboli. Consolidation, atelectasis, and ground glass attenuation were common associated findings on CTPA in these patients. Consolidation was more common in patients of PE associated with pleural effusion as compared to those with PE alone (62.85% and 33.8%, respectively, odds rato: 3.279 and 95% confidence interval: 1.798-6.091, P < 0.001). Diagnostic thoracentesis was done in 6 (8.6%) of the cases. All the patients had an exudative effusion with normal glucose values and neutrophil predominance. CONCLUSION: PE was associated with pleural effusion in around one-third of the patients in Bahrain. The effusions were mainly small and bilateral. The emboli in cases associated with pleural effusion were mostly peripheral. Consolidation was the parenchymal abnormality detected on CTPA which was significantly associated with the presence of pleural effusion. Most of the pleural effusions were not suitable for thoracentesis. In patients subjected to fluid analysis, the effusions were exudative, neutrophilic predominant, and associated with normal glucose levels.
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BACKGROUND INFORMATION: Aspergillosis is an alarming complication in asthma, leading to worsening symptoms and irreversible lung damage. It is underdiagnosed among asthmatics worldwide, especially in our geographical region. AIM: This research was aimed to shed some light on the prevalence of Aspergillus sensitization and allergic bronchopulmonary aspergillosis (ABPA) in asthmatic patients in the Kingdom of Bahrain. IMPORTANCE: This project has never been conducted in the region and hopefully will lead to a better care for asthmatics. METHODOLOGY: Our study population consisted of adult outpatients visiting the pulmonary and chest diseases clinic at Al-Salmaniya Medical Complex (SMC); the main inclusion condition was manifesting respiratory distress symptoms related to one or more respiratory tract diseases. 152 individuals were selected; the study group consisted of 119 asthmatic patients manifesting respiratory distress. The control group consisted of 33 nonasthmatic patients that manifested pulmonary distress symptoms due to respiratory tract diseases other than asthma like chronic obstructive pulmonary disease, bronchitis, among others. Sera samples were collected in SMC and analyzed via Phadia-250 fluoro-enzyme-immunoassay to determine the levels of Aspergillus fumigatus-specific IgE. The rAsp f1 antigen was used against IgE. RESULTS: Our results indicated a 16% prevalence of A. fumigatus sensitization in asthmatics; also, 75.6% of asthmatics were sensitized to pollen grains, and 22.3% reported one or many food allergies. Furthermore, details of patients with significant levels of A. fumigatus- specific IgE were analyzed, and ABPA prevalence was estimated to be 10.1% in asthmatics. CONCLUSION: Increasing awareness toward these indolent diseases is required, as well as, more efforts in determining the burden of aspergillosis in other parts of the region.
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Pulmonary embolism is an important cause of undiagnosed pleural effusion http://ow.ly/HDLx30bVVa7.
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Limited data are available on the epidemiology, clinical manifestations and outcomes of patients with invasive aspergillosis in Bahrain. This study was conducted retrospectively to determine the epidemiology of invasive aspergillosis and its risk factors, clinical presentation, underlying conditions, and outcomes over the past five years in a major hospital. The medical records of patients with positive Aspergillus cultures admitted to a major tertiary care hospital in Bahrain during 2009-2013 were reviewed. Cases were classified according to (1) the European Organization for the Research and Treatment of Cancer/Mycoses Study Group (MSG) criteria (proven, probable, possible IA or not classifiable) and (2) "validated" criteria to distinguish Aspergillus colonization from IA (putative or proven IA). Demographic, microbiologic and diagnostic data were collected, and outcomes were recorded. A total of 60 patients were included, of whom 44 were colonized (73.3%), and 16 had probable IA (26.7%); no proven or possible IA cases were identified according to the EORTC/Mycoses Study Group (MSG) criteria. In comparison, with the alternative "validated" criteria, 32 were colonized (53.3%), 28 had putative IA (46.7%), and none had proven IA (0%). The lung was the most common site of infection, and Aspergillus fumigatus was the most commonly isolated species (53%). Mortality was 25% among colonized patients, 44% in probable cases and 32% in those with putative IA. All patients were immunocompromised or had one or more predisposing factors. Independent risk factors for death among patients with IA included older age, history of mechanical ventilation, renal replacement therapy and higher sequential organ failure assessment scores at diagnosis.
