The Egyptian Journal of Chest Diseases and Tuberculosis, 2018
Objective The aim was to assess the role of glycemic gap as a biomarker of pulmonary embolism sev... more Objective The aim was to assess the role of glycemic gap as a biomarker of pulmonary embolism severity and outcome in diabetic patients. Patients Diabetic patients who were 18 years of age or older admitted with confirmed diagnosis of pulmonary embolism (n=280) were included in the study. Methods On admission, blood glucose level was measured. HbA1c was measured. To convert HbA1c levels to the estimated long-term average glucose levels (eAG) for the previous 3 months, the equation AG = 28.7×HbA1c-46.7 was used. From the glucose level at ED admission minus the eAG, the glycemic gap was calculated. The severity of pulmonary embolism was assessed by the pulmonary embolism severity index (PESI). Results There was a significant positive correlation between glycemic gap and the severity of pulmonary embolism and length of hospital stay. There was a significant difference of the glycemic gap between nonsurvivors and survivors (110.3±35.6 vs.48.8±31.3; P< 0.001), patients with and withou...
International journal of chronic obstructive pulmonary disease, 2018
The diaphragmatic rapid shallow breathing index (D-RSBI), which is the ratio between respiratory ... more The diaphragmatic rapid shallow breathing index (D-RSBI), which is the ratio between respiratory rate (RR) and the ultrasonographic evaluation of diaphragmatic displacement (DD), is a new and promising tool to predict weaning outcome. Its accuracy in predicting weaning failure, in ready-to-wean acute exacerbation COPD (AECOPD) patients, needs to be evaluated. A prospective observational study was carried out on ready-to-wean AECOPD patients. During a T-tube spontaneous breathing trial (SBT) evaluation of the right hemidiaphragm displacement (ie, DD), M-mode ultrasonography to calculate the D-RSBI, as well as the RSBI (RR/tidal volume [VT]) were carried out simultaneously. Outcome of the weaning trial was recorded. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic accuracy of D-RSBI and RSBI. A total of 50 AECOPD patients requiring mechanical ventilation for more than 48 h who were ready to perform a SBT were included. Of these, 37 (74%) were success...
Background The challenge in treating severe COVID-19 in the absence of targeted medication is enf... more Background The challenge in treating severe COVID-19 in the absence of targeted medication is enforcing physicians to search carefully for clinical predictors of severity. Aim To define the profile of patients at risk of severe COVID-19 and to assess for certain predictors. Methods Confirmed COVID-19 cases were classified into the following: group A: mild/moderate cases and group B: severe/critical cases according to the selected criteria. History, radiological assessment, complete blood count, lactate dehydrogenase (LDH), myocardial enzymes, serum ferritin, and D dimer were assessed. Patients were followed for the need of ICU and mechanical ventilation. Duration till conversion, length of stay, and mortality were recorded. Results A total of 202 patients were analyzed. Group B had higher age (53.2 ± 12.6 vs 40.3 ± 10.3, P < 0.001), more prevalence of DM (60.61% vs 16.57% P < 0.001), hypertension (51.52% vs 20.12%, P < 0.001), ischemic heart (27.27% vs 3.55%, P < 0.001),...
The Egyptian Journal of Chest Diseases and Tuberculosis, 2019
Background Unplanned extubation (UE) is associated with prolonged duration of mechanical ventilat... more Background Unplanned extubation (UE) is associated with prolonged duration of mechanical ventilation and ICU and hospital stay. Although UE has been studied regularly, many questions about incidence, determinants, and outcomes have not been answered in details. Moreover, inconsistent findings exist regarding outcomes. This study aimed at defining risk factors associated with UE with respect to consequences in relation to reintubation and mortality. Patients and methods Invasively mechanically ventilated patients were enrolled and classified into planned extubation and UE groups according to the type of extubation. All patients were subjected to calculation of Simplified Acute Physiology Score on admission and Glasgow Coma Score, observed for presence of agitation, wrist restrains, use of sedation, and degree of sedation using Ramsay Sedation Score. Duration of mechanical ventilation before UE, patient-to-nurse ratio, timing of UE, total ICU length of stay, and mortality were recorded. Satisfaction question was applied to both responsible nurse and resident. Results Overall, 11.02% of the studied patients experienced UE. UE was more prevalent in patients who were physically restrained, agitated, less sedated, with lower Ramsay score, and with unsatisfied loaded nurses and junior resident who were unsatisfied. In all, 55.6% of UE occurred in night shifts. UE had prolonged length of stay (13.28±3.92 days), higher reintubation rate (44.5%), and higher mortality (29.6%). Conclusion This work identified four independent risk factors for UE: agitated patient, managed by a junior resident and loaded nurse particularly in a night shift.
The Egyptian Journal of Chest Diseases and Tuberculosis, 2019
Background and objective Obstructive sleep apnea (OSA) and type 2 diabetes mellitus (T2DM) common... more Background and objective Obstructive sleep apnea (OSA) and type 2 diabetes mellitus (T2DM) commonly coexist. Both could be associated with a number of pathophysiological derangements involved in the development of diabetic retinopathy (DR). So, the aim of this study was to assess the possible association between OSA and DR. Patients and methods This is a cross-sectional observational study that was conducted on patients with T2DM. Two-field 45°-digital retinal images for each eye were used to evaluate DR and graded according to the English National Screening Program guidelines. OSA was evaluated on the basis of an inpatient overnight sleep study (polysomnography) using a computerized polysomnogram device. Results This work recruited 110 patients. OSA was observed in 60% (66 patients). OSA was found to be independently associated with both advanced DR [preprolifrative (R2) or proliferative (R3)] (odds ratio=6.29; 95% confidence interval: 1.08–6.65; P=0.04) and maculopathy (odds ratio=12.92; 95% confidence interval: 3.97–4.79; P<0.001). Moreover, OSA severity was directly related to DR grade (r=0.5, P<0.001). Conclusion OSA was independently associated with advanced DR and maculopathy in T2DM patients. Moreover, severity of OSA was directly related to DR grade
The Egyptian Journal of Chest Diseases and Tuberculosis, 2019
Objective No published studies have analyzed the possible link between vitamin D receptor (VDR) g... more Objective No published studies have analyzed the possible link between vitamin D receptor (VDR) gene FokI polymorphism and obstructive sleep apnea (OSA). To better highlight this knowledge gap, we conducted this study to assess the linkage between VDR gene FokI polymorphism with OSA as a main objective and to assess the vitamin D (VD) level in patients with OSA, with stress on its severity subtypes. Patients and method A total of 240 patients with OSA and 120 matched controls were enrolled. All participants were subjected to full history taking, particularly sleep-disordered breathing symptoms, Epworth Sleepiness Scale assessment, measurement of serum VD, and assessment of FokI VDR gene polymorphism. Results OSA had a lower VD than controls (21.44±5.56 vs. 35.63±8.5, P<0.001). Moreover, 80% of controls had optimal VD status, whereas in OSA, 47.5% had VD deficiency. There was an indirect correlation between VD level and OSA severity (P<0.001). In OSA, the frequencies of ff, Ff, and FF genotypes were 42.2, 40.0, and 18.8%, respectively, and in controls were 50.0, 40.0, and 10%, respectively. There was an increased risk of OSA with the Ff (odds ratio=2.66, P<0.03), and the ff had a highly significant association with an increased risk of OSA (odds ratio=10.59, P<0.001). Conclusion This work introduces for the first time a possible association between VDR gene FokI polymorphism and Egyptian population with OSA. Lower VD was significantly observed in OSA and correlates with disease severity.
International Journal of Chronic Obstructive Pulmonary Disease, 2019
Background: Pulmonary hypertension (PH) is one of the most common complications developed during ... more Background: Pulmonary hypertension (PH) is one of the most common complications developed during the course of chronic obstructive pulmonary disease (COPD). Platelet activation plays an important role in its pathophysiology, and mean platelet volume (MPV) is considered a respectable index of platelet activation. The aim of this work is to assess the ability of MPV in predicting PH secondary to COPD as well as its severity. Methods: A cross-sectional study was conducted on 228 stable COPD patients. CBC, echocardiography, and pulmonary function tests were performed. Results: The prevalence of PH in stable COPD patients was high (63%), and the majority of patients had a mild degree (33%). There was no significant association between PH presence with different COPD grade, but, in very severe COPD, severe PH was significantly presented. MPV in COPD patients with PH was significantly higher than those without (9.02±1.14 vs 7.11±0.98, P<0.001). Moreover, a significant statistical rising of MPV with increased severity of PH. Multivariate regression analysis of predictors of PH demonstrated that; MPV is a real predictor of PH in such patients. The likelihood probability of PH increased up to 7-times with increasing one unit of MPV; (OR=6.7). A cut-off value of MPV >7.25 had 96% sensitivity and 76% specificity in predicting PH. Conclusion: MPV was higher in COPD patients with PH and positively correlated with PH severity. If the data are to be confirmed, MPV may be taken into consideration in decision-making and management of COPD patients.
Objective The aim was to assess the role of glycemic gap as a biomarker of pulmonary embolism sev... more Objective The aim was to assess the role of glycemic gap as a biomarker of pulmonary embolism severity and outcome in diabetic patients. Patients Diabetic patients who were 18 years of age or older admitted with confirmed diagnosis of pulmonary embolism (n=280) were included in the study. Methods On admission, blood glucose level was measured. HbA1c was measured. To convert HbA1c levels to the estimated long-term average glucose levels (eAG) for the previous 3 months, the equation AG = 28.7×HbA1c-46.7 was used. From the glucose level at ED admission minus the eAG, the glycemic gap was calculated. The severity of pulmonary embolism was assessed by the pulmonary embolism severity index (PESI). Results There was a significant positive correlation between glycemic gap and the severity of pulmonary embolism and length of hospital stay. There was a significant difference of the glycemic gap between nonsurvivors and survivors (110.3±35.6 vs.48.8±31.3; P< 0.001), patients with and without clinical deterioration (108±34.1 vs. 48.1±31.1; P< 0.001), and patients who needed ICU admission and those who did not need ICU admission (107.3±31.9 vs. 46.2±29.7; P< 0.05). At a cutoff value of glycemic gap of greater than or equal to 79, sensitivity, specificity, positive predictive value, and negative predictive value were 100, 82, 23, and 100%, respectively. Multivariate logistic regression of potential predictors of mortality identified two independent predictors: PESI (P<0.001) and glycemic gap (P=0.042). Conclusion Elevated glycemic gap between serum glucose levels upon admission and the HbA1c-derived average glucose was associated with increased severity and mortality in diabetic patients with pulmonary embolism.
The Egyptian Journal of Chest Diseases and Tuberculosis, 2018
Objective The aim was to assess the role of glycemic gap as a biomarker of pulmonary embolism sev... more Objective The aim was to assess the role of glycemic gap as a biomarker of pulmonary embolism severity and outcome in diabetic patients. Patients Diabetic patients who were 18 years of age or older admitted with confirmed diagnosis of pulmonary embolism (n=280) were included in the study. Methods On admission, blood glucose level was measured. HbA1c was measured. To convert HbA1c levels to the estimated long-term average glucose levels (eAG) for the previous 3 months, the equation AG = 28.7×HbA1c-46.7 was used. From the glucose level at ED admission minus the eAG, the glycemic gap was calculated. The severity of pulmonary embolism was assessed by the pulmonary embolism severity index (PESI). Results There was a significant positive correlation between glycemic gap and the severity of pulmonary embolism and length of hospital stay. There was a significant difference of the glycemic gap between nonsurvivors and survivors (110.3±35.6 vs.48.8±31.3; P< 0.001), patients with and without clinical deterioration (108±34.1 vs. 48.1±31.1; P< 0.001), and patients who needed ICU admission and those who did not need ICU admission (107.3±31.9 vs. 46.2±29.7; P< 0.05). At a cutoff value of glycemic gap of greater than or equal to 79, sensitivity, specificity, positive predictive value, and negative predictive value were 100, 82, 23, and 100%, respectively. Multivariate logistic regression of potential predictors of mortality identified two independent predictors: PESI (P<0.001) and glycemic gap (P=0.042). Conclusion Elevated glycemic gap between serum glucose levels upon admission and the HbA1c-derived average glucose was associated with increased severity and mortality in diabetic patients with pulmonary embolism.
The Egyptian Journal of Chest Diseases and Tuberculosis, 2018
Background Chronic obstructive pulmonary disease (COPD) is a well-recognized multicomponent disea... more Background Chronic obstructive pulmonary disease (COPD) is a well-recognized multicomponent disease, but its influences on cognitive function and other associated psychological disorders were poorly identified. Systemic inflammation is considered as a key link between these diseases. Aim To assess the cognitive impairment, anxiety, and depression among stable COPD patients using different neuropsychological tests, in relation with serum interleukin-6 (IL-6). Patients and methods A study was conducted upon 100 stable COPD patients and 25 controls. All the participants were subjected to neurological and psychiatric assessment, such as The Generalized Anxiety Disorder-7 scale, Beck Depression Inventory-II scale, and Montreal Cognitive Assessment scale. Serum IL-6 was measured for all participants. Results COPD patients had more frequent anxiety disorders, depression, cognitive dysfunction, and higher serum IL-6 than control group. Visual-spatial/executive and delayed recall domains of cognitive dysfunction were significantly affected in COPD than controls (P<0.001), whereas other domains (Naming, Attention, Language, Abstraction, and Orientation) did not reach a significant level of statistical difference. Generalized Anxiety Disorder-7 anxiety score showed a significant positive correlation with modified medical research council and serum IL-6 and a significant negative correlation with forced expiratory volume in the first second%. Beck Depression Inventory-II score showed a significant positive correlation with BMI. Montreal Cognitive Assessment score showed a significant positive correlation with forced expiratory volume in the first second% and a significant negative correlation with serum IL-6. A cutoff value of serum IL-6 more than 2.6 pg/ml had sensitivity and specificity for prediction of cognitive dysfunction in COPD patients (86.1 and 66.7%, respectively; P<0.001). Conclusion Anxiety, depression, and cognitive impairment were significantly more prevalent between COPD patients. Serum IL-6 was a valid predictor for cognitive dysfunction in COPD patients.
Introduction: The incidence of post-intensive care unit admission complications is high; some of ... more Introduction: The incidence of post-intensive care unit admission complications is high; some of these complications are inevitable and often leads to medical emergencies. Among these complications is the extubation failure whether resulted from planned extubation which is prepared and performed by the medical team or unplanned extubation (UE). Unplanned extubation (UE) is a real event in all ICUS worldwide and is considered as one of the major complications in mechanically ventilated patients. However, its impact on mortality, duration of mechanical ventilation (MV) as well as predictors of UE and need for reintubation had not been adequately defined. Objective: To define the profile of the patients at risk of unplanned extubation and establish predictive criteria for extubation outcome. Patients and methods: This study was carried out in the Respiratory Intensive Care Unit of Chest Department, Zagazig University Hospitals during the period from March 2010 to January 2011. Sixty-seven invasively mechanically ventilated patients who were admitted to the RICU were enrolled in the study. They were (47) males and (20) females with mean age (51.56 ± 6.28) years. Patients were admitted to the RICU because of one of the following diagnostic categories; acute exacerbation of chronic obstructive pulmonary disease (AECOPD) (41 patients), Pneumonia (6 patients), Bronchial asthma (2 patients), Pulmonary edema (5 patients), Bronchiectasis (6 patients), Systemic lupus erythematosus (1patient), interstitial lung disease (ILD) (1 patient), Infected cystic lung (1 patient), Overlap syndrome (4 patients). Patients were classified into two groups according to the way of extubation: Group I: Unplanned extubation group (they were 27 patients who underwent UE either self inflicted (13 patients) or accidental extubation (14 patients) and Group II: Planned extubation group (they were 40 patients who fulfilled weaning criteria and tolerated 2-h
Background: It was reported that nearly twenty percent of all initial weaning trials in mechanica... more Background: It was reported that nearly twenty percent of all initial weaning trials in mechanically ventilated chronic obstructive pulmonary disease patients failed, which may lead to prolonged mechanical ventilation and expose the patient to hazardous complications such as ventilator associated pneumonia, critical illness neuromuscular abnormalities and ICU psychosis rather than the complications of mechanical ventilation itself. Methods: This study was carried out at the Respiratory Intensive Care Unit of Chest Department , Zagazig University Hospitals from May 2013 to May 2015. It included Mechanically ventilated chronic obstructive pulmonary disease patients due to acute respiratory failure who underwent first weaning trial using two hours of spontaneous breathing trial through T piece. They were 60 patients, 44 males and 16 females with an age range from 41 to 65 years and a mean age of 54.23 ± 6.41 years. At the end of the first weaning trial, patients were classified into two groups according to weaning outcome: Group I: (successful weaning) as a control group they were (20) patients and Group II: (failed weaning) they were (40) patients. Various risk factors were assessed including electrolyte imbalance, nutritional state, delirium, weaning induced myocardial ischemia and impaired thyroid function beside calculation of APACHE II score to assess illness severity. Results: This study reported significant risk factors for weaning failure including: malnutrition (62.5%), electrolyte imbalance (42.5%), myocardial ischemia (37.5%), hypoalbuminemia (32.5%), hypothyroidism (25%), delirium (20%) and overfeeding (17.5%) while in 5% of the studied patients no identified risk factor was observed. In this work, multiple regression analysis isolated two independent risk factors for weaning failure in COPD patients including, TSH level >2.65 mIU/ml and impaired nutritional status, with P value = (0.018, 0.048) respectively. Conclusions: 1-Myocardial ischemia, delirium, hypomagnesemia, hypophosphatemia and VAP could be considered as important risk factors for weaning failure, however high TSH level >2.65 mIU/ml and abnormal nutritional state were the most valuable independent predictors for weaning failure. 2-An increase in the degree of severity of illness on ICU admission (guided by APACHE II score), previous mechanical ventilation and longer duration of mechanical ventilation could intensify the risk for weaning failure. 3-RSBI below 85 breaths/min/L may increase the rate of weaning success.
Introduction Extubation failure significantly increases duration of mechanical ventilation and IC... more Introduction Extubation failure significantly increases duration of mechanical ventilation and ICU length of stay with increased risk of mortality. So validating certain parameters to predict extubation outcome and avoid extubation failure is necessary. This study aimed at assessing the usefulness of the dead space addition (DSA) test and swallowing evaluation in predicting extubation outcome in mechanically ventilated patients with chronic obstructive pulmonary disease (COPD). Patients and methods Invasively mechanically ventilated patients with COPD considered as candidates for extubation were enrolled and subjected to simplified acute physiology score II calculation, assessment of cough strength, endotracheal secretions quantity, delirium, cuff-leak test, DSA test, and swallowing before extubation. Results A total of 90 patients with mean age of 62.26±7.01 years were enrolled. Overall, 76.9% of patients who failed the DSA test compared with 20.8% of those who accomplished it had failed extubation, and 57.1% of patients with defective swallowing compared with 10.9% of those with efficient swallowing had failed extubation, with a highly significant association between extubation outcome and both DSA fate and swallowing efficiency. Sensitivity, specificity, positive predictive value, and negative predictive value for DSA test were 38.5, 95.3, 76.9, and 79.2%, respectively, and for swallowing were 76.9, 76.6, 57.1, and 89.1%, respectively. An increase of simplified acute physiology score II by one unit increases extubation failure 1.25 times. Moreover, patients who tolerated DSA test whereas had defective swallowing had a likelihood of extubation failure 10 times. Conclusion DSA can predict extubation success and failure by the same power, but swallowing assessment can predict extubation success more than failure. Combined DSA intolerance and defective swallowing increase the prediction of extubation failure by 31 times.
The Egyptian Journal of Chest Diseases and Tuberculosis, 2018
Objective The aim was to assess the role of glycemic gap as a biomarker of pulmonary embolism sev... more Objective The aim was to assess the role of glycemic gap as a biomarker of pulmonary embolism severity and outcome in diabetic patients. Patients Diabetic patients who were 18 years of age or older admitted with confirmed diagnosis of pulmonary embolism (n=280) were included in the study. Methods On admission, blood glucose level was measured. HbA1c was measured. To convert HbA1c levels to the estimated long-term average glucose levels (eAG) for the previous 3 months, the equation AG = 28.7×HbA1c-46.7 was used. From the glucose level at ED admission minus the eAG, the glycemic gap was calculated. The severity of pulmonary embolism was assessed by the pulmonary embolism severity index (PESI). Results There was a significant positive correlation between glycemic gap and the severity of pulmonary embolism and length of hospital stay. There was a significant difference of the glycemic gap between nonsurvivors and survivors (110.3±35.6 vs.48.8±31.3; P< 0.001), patients with and withou...
International journal of chronic obstructive pulmonary disease, 2018
The diaphragmatic rapid shallow breathing index (D-RSBI), which is the ratio between respiratory ... more The diaphragmatic rapid shallow breathing index (D-RSBI), which is the ratio between respiratory rate (RR) and the ultrasonographic evaluation of diaphragmatic displacement (DD), is a new and promising tool to predict weaning outcome. Its accuracy in predicting weaning failure, in ready-to-wean acute exacerbation COPD (AECOPD) patients, needs to be evaluated. A prospective observational study was carried out on ready-to-wean AECOPD patients. During a T-tube spontaneous breathing trial (SBT) evaluation of the right hemidiaphragm displacement (ie, DD), M-mode ultrasonography to calculate the D-RSBI, as well as the RSBI (RR/tidal volume [VT]) were carried out simultaneously. Outcome of the weaning trial was recorded. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic accuracy of D-RSBI and RSBI. A total of 50 AECOPD patients requiring mechanical ventilation for more than 48 h who were ready to perform a SBT were included. Of these, 37 (74%) were success...
Background The challenge in treating severe COVID-19 in the absence of targeted medication is enf... more Background The challenge in treating severe COVID-19 in the absence of targeted medication is enforcing physicians to search carefully for clinical predictors of severity. Aim To define the profile of patients at risk of severe COVID-19 and to assess for certain predictors. Methods Confirmed COVID-19 cases were classified into the following: group A: mild/moderate cases and group B: severe/critical cases according to the selected criteria. History, radiological assessment, complete blood count, lactate dehydrogenase (LDH), myocardial enzymes, serum ferritin, and D dimer were assessed. Patients were followed for the need of ICU and mechanical ventilation. Duration till conversion, length of stay, and mortality were recorded. Results A total of 202 patients were analyzed. Group B had higher age (53.2 ± 12.6 vs 40.3 ± 10.3, P < 0.001), more prevalence of DM (60.61% vs 16.57% P < 0.001), hypertension (51.52% vs 20.12%, P < 0.001), ischemic heart (27.27% vs 3.55%, P < 0.001),...
The Egyptian Journal of Chest Diseases and Tuberculosis, 2019
Background Unplanned extubation (UE) is associated with prolonged duration of mechanical ventilat... more Background Unplanned extubation (UE) is associated with prolonged duration of mechanical ventilation and ICU and hospital stay. Although UE has been studied regularly, many questions about incidence, determinants, and outcomes have not been answered in details. Moreover, inconsistent findings exist regarding outcomes. This study aimed at defining risk factors associated with UE with respect to consequences in relation to reintubation and mortality. Patients and methods Invasively mechanically ventilated patients were enrolled and classified into planned extubation and UE groups according to the type of extubation. All patients were subjected to calculation of Simplified Acute Physiology Score on admission and Glasgow Coma Score, observed for presence of agitation, wrist restrains, use of sedation, and degree of sedation using Ramsay Sedation Score. Duration of mechanical ventilation before UE, patient-to-nurse ratio, timing of UE, total ICU length of stay, and mortality were recorded. Satisfaction question was applied to both responsible nurse and resident. Results Overall, 11.02% of the studied patients experienced UE. UE was more prevalent in patients who were physically restrained, agitated, less sedated, with lower Ramsay score, and with unsatisfied loaded nurses and junior resident who were unsatisfied. In all, 55.6% of UE occurred in night shifts. UE had prolonged length of stay (13.28±3.92 days), higher reintubation rate (44.5%), and higher mortality (29.6%). Conclusion This work identified four independent risk factors for UE: agitated patient, managed by a junior resident and loaded nurse particularly in a night shift.
The Egyptian Journal of Chest Diseases and Tuberculosis, 2019
Background and objective Obstructive sleep apnea (OSA) and type 2 diabetes mellitus (T2DM) common... more Background and objective Obstructive sleep apnea (OSA) and type 2 diabetes mellitus (T2DM) commonly coexist. Both could be associated with a number of pathophysiological derangements involved in the development of diabetic retinopathy (DR). So, the aim of this study was to assess the possible association between OSA and DR. Patients and methods This is a cross-sectional observational study that was conducted on patients with T2DM. Two-field 45°-digital retinal images for each eye were used to evaluate DR and graded according to the English National Screening Program guidelines. OSA was evaluated on the basis of an inpatient overnight sleep study (polysomnography) using a computerized polysomnogram device. Results This work recruited 110 patients. OSA was observed in 60% (66 patients). OSA was found to be independently associated with both advanced DR [preprolifrative (R2) or proliferative (R3)] (odds ratio=6.29; 95% confidence interval: 1.08–6.65; P=0.04) and maculopathy (odds ratio=12.92; 95% confidence interval: 3.97–4.79; P<0.001). Moreover, OSA severity was directly related to DR grade (r=0.5, P<0.001). Conclusion OSA was independently associated with advanced DR and maculopathy in T2DM patients. Moreover, severity of OSA was directly related to DR grade
The Egyptian Journal of Chest Diseases and Tuberculosis, 2019
Objective No published studies have analyzed the possible link between vitamin D receptor (VDR) g... more Objective No published studies have analyzed the possible link between vitamin D receptor (VDR) gene FokI polymorphism and obstructive sleep apnea (OSA). To better highlight this knowledge gap, we conducted this study to assess the linkage between VDR gene FokI polymorphism with OSA as a main objective and to assess the vitamin D (VD) level in patients with OSA, with stress on its severity subtypes. Patients and method A total of 240 patients with OSA and 120 matched controls were enrolled. All participants were subjected to full history taking, particularly sleep-disordered breathing symptoms, Epworth Sleepiness Scale assessment, measurement of serum VD, and assessment of FokI VDR gene polymorphism. Results OSA had a lower VD than controls (21.44±5.56 vs. 35.63±8.5, P<0.001). Moreover, 80% of controls had optimal VD status, whereas in OSA, 47.5% had VD deficiency. There was an indirect correlation between VD level and OSA severity (P<0.001). In OSA, the frequencies of ff, Ff, and FF genotypes were 42.2, 40.0, and 18.8%, respectively, and in controls were 50.0, 40.0, and 10%, respectively. There was an increased risk of OSA with the Ff (odds ratio=2.66, P<0.03), and the ff had a highly significant association with an increased risk of OSA (odds ratio=10.59, P<0.001). Conclusion This work introduces for the first time a possible association between VDR gene FokI polymorphism and Egyptian population with OSA. Lower VD was significantly observed in OSA and correlates with disease severity.
International Journal of Chronic Obstructive Pulmonary Disease, 2019
Background: Pulmonary hypertension (PH) is one of the most common complications developed during ... more Background: Pulmonary hypertension (PH) is one of the most common complications developed during the course of chronic obstructive pulmonary disease (COPD). Platelet activation plays an important role in its pathophysiology, and mean platelet volume (MPV) is considered a respectable index of platelet activation. The aim of this work is to assess the ability of MPV in predicting PH secondary to COPD as well as its severity. Methods: A cross-sectional study was conducted on 228 stable COPD patients. CBC, echocardiography, and pulmonary function tests were performed. Results: The prevalence of PH in stable COPD patients was high (63%), and the majority of patients had a mild degree (33%). There was no significant association between PH presence with different COPD grade, but, in very severe COPD, severe PH was significantly presented. MPV in COPD patients with PH was significantly higher than those without (9.02±1.14 vs 7.11±0.98, P<0.001). Moreover, a significant statistical rising of MPV with increased severity of PH. Multivariate regression analysis of predictors of PH demonstrated that; MPV is a real predictor of PH in such patients. The likelihood probability of PH increased up to 7-times with increasing one unit of MPV; (OR=6.7). A cut-off value of MPV >7.25 had 96% sensitivity and 76% specificity in predicting PH. Conclusion: MPV was higher in COPD patients with PH and positively correlated with PH severity. If the data are to be confirmed, MPV may be taken into consideration in decision-making and management of COPD patients.
Objective The aim was to assess the role of glycemic gap as a biomarker of pulmonary embolism sev... more Objective The aim was to assess the role of glycemic gap as a biomarker of pulmonary embolism severity and outcome in diabetic patients. Patients Diabetic patients who were 18 years of age or older admitted with confirmed diagnosis of pulmonary embolism (n=280) were included in the study. Methods On admission, blood glucose level was measured. HbA1c was measured. To convert HbA1c levels to the estimated long-term average glucose levels (eAG) for the previous 3 months, the equation AG = 28.7×HbA1c-46.7 was used. From the glucose level at ED admission minus the eAG, the glycemic gap was calculated. The severity of pulmonary embolism was assessed by the pulmonary embolism severity index (PESI). Results There was a significant positive correlation between glycemic gap and the severity of pulmonary embolism and length of hospital stay. There was a significant difference of the glycemic gap between nonsurvivors and survivors (110.3±35.6 vs.48.8±31.3; P< 0.001), patients with and without clinical deterioration (108±34.1 vs. 48.1±31.1; P< 0.001), and patients who needed ICU admission and those who did not need ICU admission (107.3±31.9 vs. 46.2±29.7; P< 0.05). At a cutoff value of glycemic gap of greater than or equal to 79, sensitivity, specificity, positive predictive value, and negative predictive value were 100, 82, 23, and 100%, respectively. Multivariate logistic regression of potential predictors of mortality identified two independent predictors: PESI (P<0.001) and glycemic gap (P=0.042). Conclusion Elevated glycemic gap between serum glucose levels upon admission and the HbA1c-derived average glucose was associated with increased severity and mortality in diabetic patients with pulmonary embolism.
The Egyptian Journal of Chest Diseases and Tuberculosis, 2018
Objective The aim was to assess the role of glycemic gap as a biomarker of pulmonary embolism sev... more Objective The aim was to assess the role of glycemic gap as a biomarker of pulmonary embolism severity and outcome in diabetic patients. Patients Diabetic patients who were 18 years of age or older admitted with confirmed diagnosis of pulmonary embolism (n=280) were included in the study. Methods On admission, blood glucose level was measured. HbA1c was measured. To convert HbA1c levels to the estimated long-term average glucose levels (eAG) for the previous 3 months, the equation AG = 28.7×HbA1c-46.7 was used. From the glucose level at ED admission minus the eAG, the glycemic gap was calculated. The severity of pulmonary embolism was assessed by the pulmonary embolism severity index (PESI). Results There was a significant positive correlation between glycemic gap and the severity of pulmonary embolism and length of hospital stay. There was a significant difference of the glycemic gap between nonsurvivors and survivors (110.3±35.6 vs.48.8±31.3; P< 0.001), patients with and without clinical deterioration (108±34.1 vs. 48.1±31.1; P< 0.001), and patients who needed ICU admission and those who did not need ICU admission (107.3±31.9 vs. 46.2±29.7; P< 0.05). At a cutoff value of glycemic gap of greater than or equal to 79, sensitivity, specificity, positive predictive value, and negative predictive value were 100, 82, 23, and 100%, respectively. Multivariate logistic regression of potential predictors of mortality identified two independent predictors: PESI (P<0.001) and glycemic gap (P=0.042). Conclusion Elevated glycemic gap between serum glucose levels upon admission and the HbA1c-derived average glucose was associated with increased severity and mortality in diabetic patients with pulmonary embolism.
The Egyptian Journal of Chest Diseases and Tuberculosis, 2018
Background Chronic obstructive pulmonary disease (COPD) is a well-recognized multicomponent disea... more Background Chronic obstructive pulmonary disease (COPD) is a well-recognized multicomponent disease, but its influences on cognitive function and other associated psychological disorders were poorly identified. Systemic inflammation is considered as a key link between these diseases. Aim To assess the cognitive impairment, anxiety, and depression among stable COPD patients using different neuropsychological tests, in relation with serum interleukin-6 (IL-6). Patients and methods A study was conducted upon 100 stable COPD patients and 25 controls. All the participants were subjected to neurological and psychiatric assessment, such as The Generalized Anxiety Disorder-7 scale, Beck Depression Inventory-II scale, and Montreal Cognitive Assessment scale. Serum IL-6 was measured for all participants. Results COPD patients had more frequent anxiety disorders, depression, cognitive dysfunction, and higher serum IL-6 than control group. Visual-spatial/executive and delayed recall domains of cognitive dysfunction were significantly affected in COPD than controls (P<0.001), whereas other domains (Naming, Attention, Language, Abstraction, and Orientation) did not reach a significant level of statistical difference. Generalized Anxiety Disorder-7 anxiety score showed a significant positive correlation with modified medical research council and serum IL-6 and a significant negative correlation with forced expiratory volume in the first second%. Beck Depression Inventory-II score showed a significant positive correlation with BMI. Montreal Cognitive Assessment score showed a significant positive correlation with forced expiratory volume in the first second% and a significant negative correlation with serum IL-6. A cutoff value of serum IL-6 more than 2.6 pg/ml had sensitivity and specificity for prediction of cognitive dysfunction in COPD patients (86.1 and 66.7%, respectively; P<0.001). Conclusion Anxiety, depression, and cognitive impairment were significantly more prevalent between COPD patients. Serum IL-6 was a valid predictor for cognitive dysfunction in COPD patients.
Introduction: The incidence of post-intensive care unit admission complications is high; some of ... more Introduction: The incidence of post-intensive care unit admission complications is high; some of these complications are inevitable and often leads to medical emergencies. Among these complications is the extubation failure whether resulted from planned extubation which is prepared and performed by the medical team or unplanned extubation (UE). Unplanned extubation (UE) is a real event in all ICUS worldwide and is considered as one of the major complications in mechanically ventilated patients. However, its impact on mortality, duration of mechanical ventilation (MV) as well as predictors of UE and need for reintubation had not been adequately defined. Objective: To define the profile of the patients at risk of unplanned extubation and establish predictive criteria for extubation outcome. Patients and methods: This study was carried out in the Respiratory Intensive Care Unit of Chest Department, Zagazig University Hospitals during the period from March 2010 to January 2011. Sixty-seven invasively mechanically ventilated patients who were admitted to the RICU were enrolled in the study. They were (47) males and (20) females with mean age (51.56 ± 6.28) years. Patients were admitted to the RICU because of one of the following diagnostic categories; acute exacerbation of chronic obstructive pulmonary disease (AECOPD) (41 patients), Pneumonia (6 patients), Bronchial asthma (2 patients), Pulmonary edema (5 patients), Bronchiectasis (6 patients), Systemic lupus erythematosus (1patient), interstitial lung disease (ILD) (1 patient), Infected cystic lung (1 patient), Overlap syndrome (4 patients). Patients were classified into two groups according to the way of extubation: Group I: Unplanned extubation group (they were 27 patients who underwent UE either self inflicted (13 patients) or accidental extubation (14 patients) and Group II: Planned extubation group (they were 40 patients who fulfilled weaning criteria and tolerated 2-h
Background: It was reported that nearly twenty percent of all initial weaning trials in mechanica... more Background: It was reported that nearly twenty percent of all initial weaning trials in mechanically ventilated chronic obstructive pulmonary disease patients failed, which may lead to prolonged mechanical ventilation and expose the patient to hazardous complications such as ventilator associated pneumonia, critical illness neuromuscular abnormalities and ICU psychosis rather than the complications of mechanical ventilation itself. Methods: This study was carried out at the Respiratory Intensive Care Unit of Chest Department , Zagazig University Hospitals from May 2013 to May 2015. It included Mechanically ventilated chronic obstructive pulmonary disease patients due to acute respiratory failure who underwent first weaning trial using two hours of spontaneous breathing trial through T piece. They were 60 patients, 44 males and 16 females with an age range from 41 to 65 years and a mean age of 54.23 ± 6.41 years. At the end of the first weaning trial, patients were classified into two groups according to weaning outcome: Group I: (successful weaning) as a control group they were (20) patients and Group II: (failed weaning) they were (40) patients. Various risk factors were assessed including electrolyte imbalance, nutritional state, delirium, weaning induced myocardial ischemia and impaired thyroid function beside calculation of APACHE II score to assess illness severity. Results: This study reported significant risk factors for weaning failure including: malnutrition (62.5%), electrolyte imbalance (42.5%), myocardial ischemia (37.5%), hypoalbuminemia (32.5%), hypothyroidism (25%), delirium (20%) and overfeeding (17.5%) while in 5% of the studied patients no identified risk factor was observed. In this work, multiple regression analysis isolated two independent risk factors for weaning failure in COPD patients including, TSH level >2.65 mIU/ml and impaired nutritional status, with P value = (0.018, 0.048) respectively. Conclusions: 1-Myocardial ischemia, delirium, hypomagnesemia, hypophosphatemia and VAP could be considered as important risk factors for weaning failure, however high TSH level >2.65 mIU/ml and abnormal nutritional state were the most valuable independent predictors for weaning failure. 2-An increase in the degree of severity of illness on ICU admission (guided by APACHE II score), previous mechanical ventilation and longer duration of mechanical ventilation could intensify the risk for weaning failure. 3-RSBI below 85 breaths/min/L may increase the rate of weaning success.
Introduction Extubation failure significantly increases duration of mechanical ventilation and IC... more Introduction Extubation failure significantly increases duration of mechanical ventilation and ICU length of stay with increased risk of mortality. So validating certain parameters to predict extubation outcome and avoid extubation failure is necessary. This study aimed at assessing the usefulness of the dead space addition (DSA) test and swallowing evaluation in predicting extubation outcome in mechanically ventilated patients with chronic obstructive pulmonary disease (COPD). Patients and methods Invasively mechanically ventilated patients with COPD considered as candidates for extubation were enrolled and subjected to simplified acute physiology score II calculation, assessment of cough strength, endotracheal secretions quantity, delirium, cuff-leak test, DSA test, and swallowing before extubation. Results A total of 90 patients with mean age of 62.26±7.01 years were enrolled. Overall, 76.9% of patients who failed the DSA test compared with 20.8% of those who accomplished it had failed extubation, and 57.1% of patients with defective swallowing compared with 10.9% of those with efficient swallowing had failed extubation, with a highly significant association between extubation outcome and both DSA fate and swallowing efficiency. Sensitivity, specificity, positive predictive value, and negative predictive value for DSA test were 38.5, 95.3, 76.9, and 79.2%, respectively, and for swallowing were 76.9, 76.6, 57.1, and 89.1%, respectively. An increase of simplified acute physiology score II by one unit increases extubation failure 1.25 times. Moreover, patients who tolerated DSA test whereas had defective swallowing had a likelihood of extubation failure 10 times. Conclusion DSA can predict extubation success and failure by the same power, but swallowing assessment can predict extubation success more than failure. Combined DSA intolerance and defective swallowing increase the prediction of extubation failure by 31 times.
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Papers by Ahmad Abbas
Patients and methods Invasively mechanically ventilated patients were enrolled and classified into planned extubation and UE groups according to the type of extubation. All patients were subjected to calculation of Simplified Acute Physiology Score on admission and Glasgow Coma Score, observed for presence of agitation, wrist restrains, use of sedation, and degree of sedation using Ramsay Sedation Score. Duration of mechanical ventilation before UE, patient-to-nurse ratio, timing of UE, total ICU length of stay, and mortality were recorded. Satisfaction question was applied to both responsible nurse and resident.
Results Overall, 11.02% of the studied patients experienced UE. UE was more prevalent in patients who were physically restrained, agitated, less sedated, with lower Ramsay score, and with unsatisfied loaded nurses and junior resident who were unsatisfied. In all, 55.6% of UE occurred in night shifts. UE had prolonged length of stay (13.28±3.92 days), higher reintubation rate (44.5%), and higher mortality (29.6%).
Conclusion This work identified four independent risk factors for UE: agitated patient, managed by a junior resident and loaded nurse particularly in a night shift.
Patients and methods This is a cross-sectional observational study that was conducted on patients with T2DM. Two-field 45°-digital retinal images for each eye were used to evaluate DR and graded according to the English National Screening Program guidelines. OSA was evaluated on the basis of an inpatient overnight sleep study (polysomnography) using a computerized polysomnogram device.
Results This work recruited 110 patients. OSA was observed in 60% (66 patients). OSA was found to be independently associated with both advanced DR [preprolifrative (R2) or proliferative (R3)] (odds ratio=6.29; 95% confidence interval: 1.08–6.65; P=0.04) and maculopathy (odds ratio=12.92; 95% confidence interval: 3.97–4.79; P<0.001). Moreover, OSA severity was directly related to DR grade (r=0.5, P<0.001).
Conclusion OSA was independently associated with advanced DR and maculopathy in T2DM patients. Moreover, severity of OSA was directly related to DR grade
Methods: A cross-sectional study was conducted on 228 stable COPD patients. CBC, echocardiography, and pulmonary function tests were performed.
Results: The prevalence of PH in stable COPD patients was high (63%), and the majority of patients had a mild degree (33%). There was no significant association between PH presence with different COPD grade, but, in very severe COPD, severe PH was significantly presented. MPV in COPD patients with PH was significantly higher than those without (9.02±1.14 vs 7.11±0.98, P<0.001). Moreover, a significant statistical rising of MPV with increased severity of PH. Multivariate regression analysis of predictors of PH demonstrated that; MPV is a real predictor of PH in such patients. The likelihood probability of PH increased up to 7-times with increasing one unit of MPV; (OR=6.7). A cut-off value of MPV >7.25 had 96% sensitivity and 76% specificity in predicting PH.
Conclusion: MPV was higher in COPD patients with PH and positively correlated with PH severity. If the data are to be confirmed, MPV may be taken into consideration in decision-making and management of COPD patients.
Patients and methods Invasively mechanically ventilated patients were enrolled and classified into planned extubation and UE groups according to the type of extubation. All patients were subjected to calculation of Simplified Acute Physiology Score on admission and Glasgow Coma Score, observed for presence of agitation, wrist restrains, use of sedation, and degree of sedation using Ramsay Sedation Score. Duration of mechanical ventilation before UE, patient-to-nurse ratio, timing of UE, total ICU length of stay, and mortality were recorded. Satisfaction question was applied to both responsible nurse and resident.
Results Overall, 11.02% of the studied patients experienced UE. UE was more prevalent in patients who were physically restrained, agitated, less sedated, with lower Ramsay score, and with unsatisfied loaded nurses and junior resident who were unsatisfied. In all, 55.6% of UE occurred in night shifts. UE had prolonged length of stay (13.28±3.92 days), higher reintubation rate (44.5%), and higher mortality (29.6%).
Conclusion This work identified four independent risk factors for UE: agitated patient, managed by a junior resident and loaded nurse particularly in a night shift.
Patients and methods This is a cross-sectional observational study that was conducted on patients with T2DM. Two-field 45°-digital retinal images for each eye were used to evaluate DR and graded according to the English National Screening Program guidelines. OSA was evaluated on the basis of an inpatient overnight sleep study (polysomnography) using a computerized polysomnogram device.
Results This work recruited 110 patients. OSA was observed in 60% (66 patients). OSA was found to be independently associated with both advanced DR [preprolifrative (R2) or proliferative (R3)] (odds ratio=6.29; 95% confidence interval: 1.08–6.65; P=0.04) and maculopathy (odds ratio=12.92; 95% confidence interval: 3.97–4.79; P<0.001). Moreover, OSA severity was directly related to DR grade (r=0.5, P<0.001).
Conclusion OSA was independently associated with advanced DR and maculopathy in T2DM patients. Moreover, severity of OSA was directly related to DR grade
Methods: A cross-sectional study was conducted on 228 stable COPD patients. CBC, echocardiography, and pulmonary function tests were performed.
Results: The prevalence of PH in stable COPD patients was high (63%), and the majority of patients had a mild degree (33%). There was no significant association between PH presence with different COPD grade, but, in very severe COPD, severe PH was significantly presented. MPV in COPD patients with PH was significantly higher than those without (9.02±1.14 vs 7.11±0.98, P<0.001). Moreover, a significant statistical rising of MPV with increased severity of PH. Multivariate regression analysis of predictors of PH demonstrated that; MPV is a real predictor of PH in such patients. The likelihood probability of PH increased up to 7-times with increasing one unit of MPV; (OR=6.7). A cut-off value of MPV >7.25 had 96% sensitivity and 76% specificity in predicting PH.
Conclusion: MPV was higher in COPD patients with PH and positively correlated with PH severity. If the data are to be confirmed, MPV may be taken into consideration in decision-making and management of COPD patients.