Background: A consensus about the best weaning procedure, haven't been reached. Patient–ventilator dyssynchrony can lead to considerable patient distress, prolongs mechanical ventilation and (ICU) length of stay. PAV+ delivers positive pressure ventilation in proportion to instantaneous inspiratory effort, reduces ventilator dyssynchrony and the duration of weaning from the ventilator.
Aim: Evaluate weaning outcome for COPD patients using PAV+ versus PSV, assess patient ventilator asynchrony during weaning, compare ICU outcome (hospital length of stay, ICU and hospital mortality).
Patients & Methods: 150 mechanically ventilated COPD patients were enrolled in this prospective, parallel randomized clinical trial and assigned to either PAV+ or PSV spontaneous breathing trial for weaning (after meeting specific eligibility criteria). Asynchrony was detected with bedside waveform interpretation of flow and airway pressure for 30 minutes.
Results: Weaning success was recorded in 73.3% PAV+ vs. 66.7% PSV (P= 0.373). Asynchrony events was significantly less in PAV+ vs. PSV; ineffective triggering (14.9 ± 10.3 vs. 37.6 ± 26.6, p
Severe acute respiratory syndrome coronavirus 2 (SARS‐COV‐2) is mostly associated with upper and lower respiratory tract manifestations. However, coronavirus disease 19 (COVID-19) can result in a wide range of other systemic symptomatology, including neuropsychiatric, psychological, and psychosocial impairments. Literature regarding neurological compromise, including neuropathy and sensory and motor affection associated with COVID-19, is still limited.
This study aims to evaluate the sensory, motor neuropathy, and secondary neurological impairment among patients with mild to moderate coronavirus disease associated with peripheral neuropathy within 1 month.
Forty participants, including 20 mild to moderate COVID-19 patients with peripheral neuropathy and 20 age and gender-matched healthy volunteers, were recruited in this case/control study. Laboratory evaluation focused on C-reactive protein (CRP) and D-dimer levels. Oxygen saturation for all participants was recorded. The neurophysiological study included motor nerve study, sensory nerve study, and F wave study for upper and lower limbs were done.
The two groups were similar regarding baseline data. Neurological symptoms’ onset in the COVID-19 group ranged from 4 to 24 days. Levels of CRP and D-dimer levels were significantly higher in patients versus the control group. Motor nerve conduction (MNC) amplitude and latency for the median nerve were significantly compromised among the COVID-19 group. The MNC latency and F wave latency for the posterior tibial nerve were significantly higher in the COVID-19 group. The CRP and D-dimer levels were associated with a significant positive correlation with a latency of median nerve MNC, sensory nerve conduction (SNC), and f-wave; latency of MNC and F wave of the posterior tibial nerve; and SNC latency for sural nerve.
neurological involvement can occur in mild to moderate cases of SARS-COV-2 infection and add to the burden of the disease. Neurological symptoms in the course of COVID-19 disease should be interpreted cautiously, and appropriate diagnosis, including nerve conduction studies and management, should be considered.
SARS‐COV‐2 infection reframed medical knowledge in many aspects, yet there is still a lot to be discovered. Coronavirus disease 19 (COVID-19) can cause neuropsychiatric, psychological, and psychosocial impairments. Literature regarding the cognitive impact of COVID-19 is still limited.
This study aims to evaluate cognitive function, anxiety, and depression among patients with coronavirus disease 19.
Sixty COVID-19 patients were recruited and sub-grouped according to the site of care into three groups, home isolation, ward, and RICU, and compared with 60 matched control participants. Entire clinical history, O2 saturation, mini-mental state examination (MMSE), Hamilton’s anxiety (HAM-A), and depression rating scales (HAM-D) were assessed.
MMSE showed significantly lowest results for the ICU group, with a value of 21.65 ± 3.52. Anxiety levels were the highest for the ICU group, with a highly significant difference vs. the home isolation group (42.45 ± 4.85 vs. 27.05 ± 9.52; p< 0.001). Depression values assessed showed a highly significant difference in intergroup comparison (44.8 ± 6.64 vs. 28.7 ± 7.54 vs. 31.25 ± 8.89; p<0.001, for ICU vs. ward vs. home group, respectively).
MMSE revealed a significant negative correlation with age and education level, anxiety level had significant negative correlations with severity of illness and male gender, and depression level had highly significant negative correlations with severity of illness and male gender.
Both cognitive and neuropsychiatric symptoms were affected in COVID-19 cases, especially in ICU-admitted patients. The impact of these disorders was significant in older age, lower oxygen saturation, and severe disease.
Chronic obstructive pulmonary disease (COPD) is ordinarily associated with social and economic burden. Pulmonary hypertension attributed to COPD varies greatly among studies; and accounts for worse quality of life and hence increased morbidity and mortality.
Aim
This study aimed to evaluate impact of pulmonary hypertension on exercise capacity, and possible predictors for exercise intolerance among COPD patients.
Patients suffering from COPD (73 patients) were grouped according to echocardiographic assessment for the presence of pulmonary hypertension into two groups. The assessment included full clinical history, mMRC dyspnea scale, COPD assessment test, arterial blood gases before and after exercise testing, and assessment of resting pulmonary function test. Also transthoracic echocardiography, cardiopulmonary exercise testing (CPET) using incremental treadmill exercises protocol was done for all participants.
A total of 39 (53.4%) COPD patients have pulmonary hypertension. COPD patients with pulmonary hypertension had significantly lower parameters of pulmonary function tests either pre or postbronchodilator; significantly lower pH, PaO2 and SaO2 either before or after CPET. It was found that all parameters of metabolic response during exercise were significantly lower among COPD-PH patients (P<0.001). Pulmonary artery systolic pressure (PASP) showed significant negative correlations with peak VO2 (r=−0.514, P<0.001), VO2/kg (r=−0.443, P<0.001), oxygen pulse (% predicted) (r=−0.459, P<0.001), oxygen saturation post exercise (r=−0.427, P<0.001). Also PASP showed significant positive correlation with VE/VO2 (at peak) (r=0.374, P=0.001), VE/VCO2 (at peak) (r=0.609, P<0.001). Predictors of poor exercise capacity among COPD patients included in the study were COPD-PH group (OR=8.84, 95%CI= 1.79–43.65), PASP (OR=1.11, 95% CI=1.02–1.15), forced expiratory volume (FEV1)% (OR=0.89, 95% CI=0.84–0.95) and mMRC (OR=3.10, 95% CI=1.13–8.47), CAT assessment (OR=1.37, 95% CI=1.14–1.65), MVV L/min (OR=0.91, 95% CI=0.86–0.96) and mean PAP (OR=1.16, 95% CI=1.11–1.29).
Pulmonary hypertension in patients with COPD is negatively correlated with exercise capacity, specifically peak VO2 percent predicted. Furthermore, pulmonary hypertension had a significant impact on gas exchange. Assessment of pulmonary hypertension using echocardiography among COPD patients is a valuable tool for predicting exercise impairment.
Behçet’s disease (BD) is a multi-organ disease with different systemic manifestations. While rare in the United States and Europe, it is more common in the Middle East and Asia. BD is one of the commonest encountered vasculitis in Egypt. This study aims to evaluate BD patients' sleep patterns, quality of life, and psychological aspects.
Patients suffering from Behçet’s disease (thirty patients) and 30 matched age and sex-healthy control participants were recruited in our study. The assessment included the entire clinical history and laboratory investigations, including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and Oxygen saturation level. Evaluation of sleep quality and presence of sleep-disordered breathing was done using the Pittsburgh Sleep Quality Index (PSQI), Insomnia severity index (ISI), and Epworth sleepiness scale (ESS). Hamilton’s anxiety (HAM-A) and depression rating scales (HAM-D) were used for psychological assessment. The Short Form 36 Quality Of Life Scale (SF-36 QOL) assessed participants' quality of life.
Behçet’s disease patients suffered significantly higher levels of anxiety and depression compared to the control group. The prevalence of insomnia and daytime sleepiness was significantly higher among BD patients. All components of PSQI, including the global score, were significantly higher among the BD group. Physical functioning, role limitation due to physical health, and emotional problems; also, general health indices were significantly lower for the BD group. Patients with active BD showed significantly higher levels of anxiety, depression, insomnia, day time dysfunction and significantly lower all domains of the SF-36 QOL Scale.
BD is associated with low sleep quality and high levels of anxiety and depression.
Disease activity directly impacts anxiety, depression levels, lower sleep quality, and lower quality of life among BD patients.
Severe asthma exacerbation can be a frightening experience to the patient and physician. Despite continuous efforts to frame management guidelines and advances in treatment, severe exacerbations still occur. In order to prevent and judicious management of asthma exacerbations, we should predict them first. This study aims to evaluate distinct clinical trajectories and management outcome of patients with severe asthma exacerbations and also evaluate predictors for poor outcome.
Patients suffering from acute asthma exacerbation and presented to emergency room (forty patients) were grouped into 2 groups (groups A and B) according to severity of exacerbation. Assessment included full clinical history, laboratory investigations (including eosinophil cell count and serum IgE level), Beck’s anxiety and depression inventory scales, assessment of asthma medication adherence and control level, and peak expiratory flow measurement (at presentation, 1 and 6 h after).
Fifty-five percent of patients suffered from severe and life-threatening asthma exacerbations, 63.6% of them were females. The most important predictors for severe exacerbations were SO2 < 90% at baseline (OR = 4.56; 95% CI = 3.45–7.56; P < 0.001), PEFR after 1 h (OR= 3.34; 95%CI = 1.90–4.90; P < 0.001), and uncontrolled asthma (OR= 3.33; 95%CI = 2.50–5.05; P < 0.001). Predictors for hospitalization were old age (OR = 1.11; 95%CI = 1.09–2.11; P < 0.001), uncontrolled asthma (OR = 2.34; 95%CI = 2.01–4.40; P < 0.001), PEFR after 1 h (OR= 4.44; 95%CI= 3.24–7.68; P < 0.001), and SO2 <90% at baseline (OR= 5.67; 95%CI= 3.98–8.50; P < 0.001).
Severe asthma exacerbations can be predicted by old age, previous history of mechanical ventilation, obstructive sleep apnea, overuse of SABA, uncontrolled asthma, moderate to severe depression, eosinophilia, SO2 <90%, and low peak expiratory flow rates.
can be identified with simple biomarkers. Studies are needed to validate the use of these biomarkers to direct therapy for AECOPD.
Aim of this study
to evaluate the use of blood eosinophilia (>2%) in directing steroids therapy in AE-COPD.
Patients and methods
In the preliminary retrospective analysis of 13297 admissions (2010-2014), AECOPD was the cause in 5016 events, COPD with bronchiectasis (1386) and α1 antitrypsin deficiency (264) were excluded and data of 3366 exacerbations were revised. 2442 (72.5%) were bacterial and 924 (27.5%) Eosinophilic ( Eosinophils>2%). All patients received standard therapy according to GOLD Guidelines. The baseline clinical, functional characteristics, days of hospital stay, side effects, treatment failure, number of exacerbation, need for ICU were recorded. The second phas
An invitation to participate in the seventeenth conference of the South Egypt Diabetes and Endocrinology Society in the eighth hall of the administrative building
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