Abstract Introduction: MDCT pulmonary angiography is the method of choice for the detection of pulmonary embolism (PE). The severity of PE as estimated by the obstruction index (OI) and right ventricular dysfunction (RVD) can be evaluated with MDCT. Objective:To investigate the correlation between the OI, RVD and clinical presentation in patients with acute PE. Methods:Among 70 patients with suspected PE, 35 patients proved to have PE with MDCT. The CT OI and the RV/LV diameter (RVD-ratio) using the four-chamber view of the heart were calcu-lated for PE patients. The cut-off for the OI to detect RVD was constructed using ROC curve. Results:Dyspnea and RVD (RVD-ratio >1) were significantly more common in patients with central pulmonary emboli. The mean OI (35%± 19%) was significantly higher in patients with dyspnea, tachycardia and obesity. A positive correlation was found between the OI and both the CT pulmonary artery diameter (r= 0.66,p 0.001) and the RVD-ratio (r= 0.628,p 0.001). The mean OI was significantly higher in patients with RVD (p 0.001). A CT OI > 43% identified more than 90% of patients with RVD (area under the curve on ROC analysis: 0.825;p 0.001). Conclusion:The mean OI correlated linearly with PA diameter and RVD-ratio. OI > 43% proved to be an independent predictor of RVD.

Abstract Background: The prevalence of Hepatopulmonary Syndrome (HPS) ranges from 5 to 32% from liver-transplantation centers. Egypt is considered as one of the highest countries in prevalence and incidence of bilharizial peri-portal fibrosis and Hepatitis C Virus (HCV) induced liver cirrhosis. Clinical, radiological and laboratory features of HPS were not widely assessed. Objectives: To determine the prevalence, clinical features and laboratory features of HPS among Egyptian cirrhotic patients. Patients and Methods: Our study included 570 cirrhotic patients. Arterial blood gases analysis, chest X-ray, pulmonary function tests and transthoracic contrast echocardiography for detection of pulmonary vasodilatation were done for patients with partial pressure of arterial O 2 80 mmHg. Also, clinical and laboratory features were assessed. Diagnostic criteria of HPS in cirrhotic patients include arterial hypoxemia and pulmonary vascular dilatation on contrast enhanced echocardiography. Results: The prevalence of HPS among patients with liver cirrhosis was 4.2%. Patients with HPS had more severe cirrhosis, as determined by advanced Child-Pugh Grade. The presence of dyspnea, platypnea, clubbing, and orthodoxia was significantly higher in patients with HPS when compared to cirrhotic patients (P value0 .001). In HPS, right pleural effusion and bilateral basal shadows were the commonest radiological findings (20.8% while chest X- ray of most patients with liver cirrhosis was normal (85%) (P value0.05). There was a significant decrease in PaO 2and O 2saturation (P0.001 for each) but a significant increase in P (A-a) O 2 in patients with HPS versus cirrhotic patients (P0.001). Patients with HPS showed a restrictive dysfunction in 59.3%. Conclusion: The prevalence of HPS among cirrhotic patients was 4.2%. The presence of dyspnea, platypnea, clubbing, orthodoxia and arterial hypoxemia were the commonest feature. Right pleural effusion and bilateral basal shadows were the commonest radiological findings.

Abstract Background: The prevalence of Hepatopulmonary Syndrome (HPS) ranges from 5 to 32% from liver-transplantation centers. Egypt is considered as one of the highest countries in prevalence and incidence of bilharizial peri-portal fibrosis and Hepatitis C Virus (HCV) induced liver cirrhosis. Clinical, radiological and laboratory features of HPS were not widely assessed. Objectives: To determine the prevalence, clinical features and laboratory features of HPS among Egyptian cirrhotic patients. Patients and Methods: Our study included 570 cirrhotic patients. Arterial blood gases analysis, chest X-ray, pulmonary function tests and transthoracic contrast echocardiography for detection of pulmonary vasodilatation were done for patients with partial pressure of arterial O 2 80 mmHg. Also, clinical and laboratory features were assessed. Diagnostic criteria of HPS in cirrhotic patients include arterial hypoxemia and pulmonary vascular dilatation on contrast enhanced echocardiography. Results: The prevalence of HPS among patients with liver cirrhosis was 4.2%. Patients with HPS had more severe cirrhosis, as determined by advanced Child-Pugh Grade. The presence of dyspnea, platypnea, clubbing, and orthodoxia was significantly higher in patients with HPS when compared to cirrhotic patients (P value0 .001). In HPS, right pleural effusion and bilateral basal shadows were the commonest radiological findings (20.8% while chest X- ray of most patients with liver cirrhosis was normal (85%) (P value0.05). There was a significant decrease in PaO 2and O 2saturation (P0.001 for each) but a significant increase in P (A-a) O 2 in patients with HPS versus cirrhotic patients (P0.001). Patients with HPS showed a restrictive dysfunction in 59.3%. Conclusion: The prevalence of HPS among cirrhotic patients was 4.2%. The presence of dyspnea, platypnea, clubbing, orthodoxia and arterial hypoxemia were the commonest feature. Right pleural effusion and bilateral basal shadows were the commonest radiological findings.

Abstract Background:The discrimination of pleural thickening from minimal pleural effusion may be difficult as both lesions appear as anechoic on grayscale ultrasound, hence, free of ‘‘echoes’’ does not confirm the presence of pleural fluid. Aim of this study:To evaluate the value of color Doppler ultrasound in differentiating minimal pleural effusion that could be aspirated from pleural thickening and to compare it with grayscale ultrasound. Patients and methods:This analytic cross-sectional study was done prospectively on 40 patients who presented with pleural based opacity in their chest radiographs compatible with minimal pleu-ral effusion. Gray scale ultrasound was done for all patients then color Doppler ultrasound exam-ination was applied to detect the presence or absence of fluid color sign. The presence or absence of pleural effusion was confirmed by aspiration of pleural fluid. Results:The sensitivity of real time gray scale ultrasound in detecting minimal pleural effusion and differentiating it from pleural thickening was 95.5% while, specificity was 33%, and accuracy was 67%. The ability of ultrasound in discrimination of minimal pleural effusion from pleural thickening improved greatly by application of the color Doppler examination where the specificity of the method reached 100% while the sensitivity was 91% and accuracy was 95%.

Abstract Background:The discrimination of pleural thickening from minimal pleural effusion may be difficult as both lesions appear as anechoic on grayscale ultrasound, hence, free of ‘‘echoes’’ does not confirm the presence of pleural fluid. Aim of this study:To evaluate the value of color Doppler ultrasound in differentiating minimal pleural effusion that could be aspirated from pleural thickening and to compare it with grayscale ultrasound. Patients and methods:This analytic cross-sectional study was done prospectively on 40 patients who presented with pleural based opacity in their chest radiographs compatible with minimal pleu-ral effusion. Gray scale ultrasound was done for all patients then color Doppler ultrasound exam-ination was applied to detect the presence or absence of fluid color sign. The presence or absence of pleural effusion was confirmed by aspiration of pleural fluid. Results:The sensitivity of real time gray scale ultrasound in detecting minimal pleural effusion and differentiating it from pleural thickening was 95.5% while, specificity was 33%, and accuracy was 67%. The ability of ultrasound in discrimination of minimal pleural effusion from pleural thickening improved greatly by application of the color Doppler examination where the specificity of the method reached 100% while the sensitivity was 91% and accuracy was 95%.

Abstract Background:The discrimination of pleural thickening from minimal pleural effusion may be difficult as both lesions appear as anechoic on grayscale ultrasound, hence, free of ‘‘echoes’’ does not confirm the presence of pleural fluid. Aim of this study:To evaluate the value of color Doppler ultrasound in differentiating minimal pleural effusion that could be aspirated from pleural thickening and to compare it with grayscale ultrasound. Patients and methods:This analytic cross-sectional study was done prospectively on 40 patients who presented with pleural based opacity in their chest radiographs compatible with minimal pleu-ral effusion. Gray scale ultrasound was done for all patients then color Doppler ultrasound exam-ination was applied to detect the presence or absence of fluid color sign. The presence or absence of pleural effusion was confirmed by aspiration of pleural fluid. Results:The sensitivity of real time gray scale ultrasound in detecting minimal pleural effusion and differentiating it from pleural thickening was 95.5% while, specificity was 33%, and accuracy was 67%. The ability of ultrasound in discrimination of minimal pleural effusion from pleural thickening improved greatly by application of the color Doppler examination where the specificity of the method reached 100% while the sensitivity was 91% and accuracy was 95%.

Abstract Background:Idiopathic pulmonary fibrosis (IPF) is a chronic lung condition of uncer-tain etiology that causes progressive shortness of breath, cough, reduced exercise tolerance and quality of life. This may, at least in part, be due to daily physical inactivity. Therefore symptomatic patients with lung fibrosis may be good candidates for comprehensive pulmonary rehabilitation (PR) programs. Aim of work:To evaluate the role of PR program in improving the functional status and dysp-nea scale in patients with IPF. Patients and methods:Thirty patients had IPF, according to the recent consensus statement, were subjected to PR program that mainly consisted of three sessions per week for 8 week duration. The program basically consisted of upper and lower extremity exercises, breathing exercise, and chest physical therapy. Psychological support and patient education rounded out the program. Spirome-tery, diffusion capacity of the lung for carbonmonoxide [DLco], arterial blood gas analysis, 6-minute walking distance (6MWD), dyspnea rating with the Modified Borg Scale (MBS) and health-related quality of life (HRQL) score using the St. George’s Respiratory Questionnaire (SGRQ) score were evaluated at baseline, after 4 weeks and at the end of the eighth week of the program. Results:There were significant improvement in dyspnea score (P= 0.001), 6MWD (P= 0.001), % predicted of forced vital capacity (FVC% predicted) (P= 0.001) and HRQL (P= 0.001). However, arterial blood gas values and DLco showed no significant improvement at the end of the program.

Abstract Objectives:Adherence to therapy is very important and many factors could be respon-sible for this issue. Suboptimal adherence to asthma therapy is a major contributor to poor asthma outcomes. Our aim is to find out the most important factor responsible for adherence to therapy in bronchial asthma patients. Subjects and methods: The study included 143 patients with persistent bronchial asthma. Factors that may affect adherence to therapy were studied. These factors included age, sex, residence, level of education, proper asthma education and whether inhaled corticosteroid (ICS) was taken alone, with long actingb2 agonist (LABA) in separate devices or with LABA in a combined form. Adher-ence to ICS was determined according to Medication Rating Scale. Results:We found that 55.3% of patients that received asthma education were adherent to ICS while only 21% of patients that did not receive asthma education were adherent to ICS therapy. The difference was statistically highly significant (p= 0.003). Other factors do not significantly affect adherence to ICS. Patients that used combined ICS with LABA in the same device were sig-nificantly more adherent to therapy (60.25%) than patients that used the same combination in 2 separate devices (34.5%). All patients with well controlled asthma were adherent to ICS, while 47.5% of uncontrolled patients was adherent. Comparison between level of control and adherence to ICS was highly significant (p= 0.003). Conclusion:This study showed how different factors may modulate adherence to asthma treat-ment and confirmed the importance of patient education in increasing adherence to asthma therapy.