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Background The diagnosis of the etiology of exudative pleural effusion is a great challenge in clinical practice. Aims To evaluate the diagnostic value of medical thoracoscope in unexplained exudative effusions and the frequency of various diagnoses in a multicenter study in Egypt. Patients and methods A retrospective analysis was done of all thoracoscopies done at our centers for diagnosis of the cause of the exudative pleural effusion. Results Among 542 thoracoscopies performed at our centers, definite diagnosis was reached in 476 (87.8%) cases. Malignancy was the most common diagnosis (60.7%) followed by tuberculosis (24.5%). Conclusion Thoracoscopy was a safe and efficient tool for diagnosis. Malignancy and tuberculosis were the most common etiologies.

Background Diaphragm motion during forced expiration can be analyzed using M-mode ultrasound in an anterior subcostal approach. Maximal expiratory diaphragmatic excursion and forced expiratory diaphragmatic excursion in the first second physiologically mimic forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1), respectively, and may be used as a marker of obstruction. Aim The aim of the work was to assess the role of the M-mode index of obstruction (MIO) as a screening test (tool) for chronic obstructive pulmonary disease (COPD). Patients and methods This case–control study involved 200 participants (100 patients with COPD and 100 age-matched and sex-matched healthy controls). The authors performed spirometry and the diaphragm ultrasonography, during forced expiration. MIO was calculated as the slope of diaphragmatic excursion in first second/slope of diaphragmatic excursion at end of expiration. Results Diaphragmatic excursion was significantly lower in COPD group than control group (4.27±1.49 vs 5.36±1.67 for slope in the first second of expiration, 4.82±1.55 vs 5.72±1.57 for maximum slope at the end of expiration, 4.42±1.53 vs 5.44±1.69 for velocity of diaphragm contraction in first second, and 2.40±1.04 vs 3.52±1.26 for velocity of diaphragm contraction at the end of expiration; P= Conclusion Diaphragmatic excursion during forced expiration is significantly decreased in COPD in comparison with the control group. MIO is significantly lower in COPD in comparison with control and significantly correlated with FEV1/FVC.

Background Pulmonary fungal infection (PFI) is increasing among patients with chronic obstructive pulmonary disease (COPD). Survival depends on rapid diagnosis and early treatment. Aims To assess the prevalence of PFI in acute exacerbation of chronic obstructive pulmonary disease (AECOPD), and to investigate the clinical, demographic, and radiological findings related to PFI in COPD patients. Patients and methods This observational cross-sectional study was conducted on 80 patients with AECOPD. High-resolution computed tomography, fiberoptic bronchoscopy with bronchoalveolar lavage, spirometry, sputum and bronchoalveolar lavage fungal culture and measurements of serum 1, 3 beta-D-glucan (BDG) were done for all patients. They were classified into possible PFI and probable PFI based on the Bulpa and colleagues criteria. Results Among the 80 studied patients, 19 patients had possible PFI, and 61 patients had probable PFI; of them 12 patients had positive BDG and 49 had negative BDG. The use of either systemic steroids and/or antibiotics in the last 3 months was higher in patients with probable PFI than those with possible PFI (P=0.003). The daily dose (mg/kg) and duration of systemic steroids were higher in patients with probable PFI (P=0.001). The use of inhaled corticosteroids (ICS), its dose, and its duration did not differ between both groups. Conclusion Probable PFI is prevalent among patients with AECOPD 61 (76.3%); of them 19.7% was invasive form. PFI in AECOPD is related to the use, dose, and duration of systemic steroids and antibiotic use in the last 3 months. Therefore, a lower dose or interrupted course of systemic steroid must be considered in COPD patients.

Background Chronic kidney disease (CKD) and dialysis may affect different body systems such as the cardiovascular, respiratory, and musculoskeletal system dysfunction. Pulmonary complications reported in patients with CKD include pulmonary edema, pleural effusion, pulmonary hypertension, respiratory infections, pulmonary fibrosis, and hypoxemia. Ultrasound (US) is a simple noninvasive method that is available at the bedside. It can be used to guide diagnostic and therapeutic decisions and monitor efficacy of treatment; in addition, sonographic signs are simple to learn. Aim The aim of the work was to evaluate thoracic ultrasound (TUS) findings in children of CKD and those on regular hemodialysis. Patients and methods This was a cross-sectional comparative study that was carried out on 90 children; their age ranged from 4 to 17 years. We included two groups: the first group comprised 60 patients with CKD: 30 of them on regular hemodialysis and the other 30 children with CKD not on hemodialysis. The second group was the control group (30 children). Medical history, clinical examination, anthropometric measurement, and routine laboratory studies were done. Chest radiograph and TUS were done for all patients. Computed tomography (CT) chest was done when indicated, whereas TUS in dialysis cases was done before and after dialysis. All groups were age and sex matched. Results Among the dialysis group patients, there was no significant difference between CT, US, and radiograph regarding lung congestion, consolidation, pericardial effusion, and pleural effusion. On the contrary, air trapping, cavity, granuloma, and calcified nodules were detected only with CT. US was sensitive to detect fluid overload even when body weight was below the estimated dry weight by 300 g, and B-lines more than 14 is a cutoff point with high sensitivity. In patients with CKD not on dialysis, there was no significant difference between radiograph, CT, and US chest findings regarding lung congestion, consolidation, pleural effusion, and atelectasis. Conclusion Chest US is a useful tool for the detection of pulmonary complications in pediatrics on regular hemodialysis. The technique is sensitive for detecting fluid overload and can be used for follow-up.