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Aspiration of scarf pins is a common problem in specific geographical locations where the Muslim population is high, especially in countries like Egypt, Bangladesh, Middle Eastern countries, and certain regions in India. This condition is also referred to as hijab-pin syndrome. We discuss the largest experience of flexible bronchoscopic extraction of aspirated scarf pins from the tracheobronchial tree. A multicenter retrospective observational study was conducted on 146 patients from 4 different centers in Egypt, Bangladesh, India, and Germany. Flexible bronchoscopy was successful in the extraction of aspirated scarf pins in all 146/146 patients with a 100% success rate. 136/146 (93.15%) patients were females, with the most common age group between 12 and 18 years (34.24%). 132/146 (90.4%) remembered the aspiration event before coming to the hospital. Cough was the predominant presenting symptom. (71.22%). In all 146 cases, the foreign body was identified on a standard chest X-ray. The left main bronchus was the most common site of aspiration, 67/146 (45.89%), followed by the right main bronchus, 56/146 (38.35%). 14 patients (9.58%) had a history of unsuccessful attempts to remove by rigid bronchoscopy, and flexible bronchoscopy was successful in these 14 (100%) patients who had a prior unsuccessful attempt to remove. The current series is the largest in literature and demonstrated an excellent success rate in the removal of the aspirated scarf pin.

Abstract Background Differential diagnosis of mediastinal lymphadenopathy is an issue of debate. Lymph nodes may be enlarged due to a variety of inflammatory, infectious, or malignant reasons. Therefore, obtaining samples from the affected nodes is crucial for the diagnosis. Usually, these patients are subjected to TBNA (EBUS or conventional) or mediastinoscopy if TBNA is not conclusive. This study evaluated the safety and feasibility of this new technique of transbronchial forceps biopsy for the diagnosis of mediastinal lymphadenopathy. Methods The study included 18 patients with confirmed mediastinal lymphadenopathy who were admitted in Chest Department, Cairo University in the period from December 2019 to December 2020. All patients were subjected to flexible bronchoscopy with conventional transbronchial needle aspiration (C-TBNA) and transbronchial forceps biopsy (LN-TBFB) from the enlarged mediastinal lymph node in the same procedure. Results we found the technique of LN-TBFB safe with no serious complications. We were able to reach a diagnosis in 7/7 (100%) cases of sarcoidosis, 6/7 (85.7%) cases of malignant lymph nodes. We had three cases where the histopathology showed hyperactive follicular hyperplasia, and a single case of tuberculous lymphadenitis. C-TBNA was diagnostic in 71.4% of sarcoidosis cases, 42.9% of malignant cases, but failed to diagnose the one patient with tuberculous lymphadenitis. Conclusion Lymph node transbronchial forceps biopsy (LN-TBFB) was found to be safe and effective in the diagnosis of mediastinal lymphadenopathy. We strongly advocate the use of this minimally invasive technique for diagnosing pathologically enlarged mediastinal lymph nodes, as a last step before mediastinoscopy.

Background Cryotherapy has emerged as an effective modality to manage patients with central airway obstruction (CAO). The aim was to assess the outcomes of using cryotherapy for managing CAO and its effect on the symptoms, and pulmonary function testing (PFT) in patients with CAO. Patients and methods This prospective protocol was carried out at the Chest Department, Cairo University Hospitals, in collaboration with the Military Chest Hospital over 6 months. Patients with CAO underwent cryotherapy and were assessed by the following: grade of airway obstruction, dyspnea, hemoptysis and quality of life scales, and PFT. Outcomes and safety of cryotherapy were evaluated. Results A total of 30 patients with CAO were enrolled and were divided into two groups: the malignant obstruction group (n=20) and the nonmalignant obstruction group (n=10). Complete restoration of the airway patency was achieved in 53.3% of patients. Only three (10%) cases encountered complications. There were significant postprocedural improvements of dyspnea, cough, hemoptysis, quality of life scales, and PFT. Logistic regression analysis showed that smoking was associated with worse outcomes. Conclusions Cryotherapy is a safe and successful method for both endobronchial exophytic tumor debulking and nonmalignant CAO. These benefits were reflected in the postprocedural improvement of clinical pulmonary scales, PFT, the grade of airway obstruction, and quality of life. Further prospective, multicenter studies are recommended.

Human serum albumin (HSA) is the frontline antioxidant protein in blood with established anti-inflammatory and anticoagulation functions. Here, we report that COVID-19-induced oxidative stress inflicts structural damages to HSA and is linked with mortality outcome in critically ill patients. We recruited 39 patients who were followed up for a median of 12.5 days (1–35 days), among them 23 had died. Analyzing blood samples from patients and healthy individuals (n=11), we provide evidence that neutrophils are major sources of oxidative stress in blood and that hydrogen peroxide is highly accumulated in plasmas of non-survivors. We then analyzed electron paramagnetic resonance spectra of spin-labeled fatty acids (SLFAs) bound with HSA in whole blood of control, survivor, and non-survivor subjects (n=10–11). Non-survivors’ HSA showed dramatically reduced protein packing order parameter, faster SLFA correlational rotational time, and smaller S/W ratio (strong-binding/weak-binding sites within HSA), all reflecting remarkably fluid protein microenvironments. Following loading/unloading of 16-DSA, we show that the transport function of HSA may be impaired in severe patients. Stratified at the means, Kaplan–Meier survival analysis indicated that lower values of S/W ratio and accumulated H2O2 in plasma significantly predicted in-hospital mortality (S/W≤0.15, 81.8% (18/22) vs. S/W>0.15, 18.2% (4/22), p=0.023; plasma [H2O2]>8.6 μM, 65.2% (15/23) vs. 34.8% (8/23), p=0.043). When we combined these two parameters as the ratio ((S/W)/[H2O2]) to derive a risk score, the resultant risk score lower than the mean (

Background Hypersensitivity pneumonitis (HP) is an increasingly recognized form of diffuse parenchymal lung diseases that may lead to respiratory failure and increased risk for mortality. Red cell distribution width (RDW) is a parameter that is routinely reported with all blood counts and has been considered an important prognostic marker in many respiratory disorders. Aim The aim of this work was to evaluate the relation between RDW and severity of HP. Patients and methods Forty patients with HP were included within one year. The patients were subdivided into two equal groups according to their partial oxygen pressure (PO2) values: 20 nonhypoxemic patients (PO2 ≥60 mmHg) and 20 hypoxemic patients (PO2

Background: The COVID-19 pandemic has reached over 276 million people globally with 5.3 million deaths as of 22nd December 2021. COVID-19-associated acute and long-term neurological manifestations are well recognized. The exact profile and the timing of neurological events in relation to the onset of infection are worth exploring. The aim of the current body of work was to determine the frequency, pattern, and temporal profile of neurological manifestations in a cohort of Egyptian patients with confirmed COVID-19 infection. Methods: This was a prospective study conducted on 582 hospitalized COVID-19 patients within the first two weeks of the diagnosis of COVID-19 to detect any specific or non-specific neurological events. Results: The patients’ mean (SD) age was 46.74 (17.26) years, and 340 (58.42%) patients were females. The most commonly encountered COVID-19 symptoms were fever (90.72%), cough (82.99%), and fatigue (76.98%). Neurological events (NE) detected in 283 patients (48.63%) and were significantly associated with a severe COVID-19 at the onset (OR: 3.13; 95% CI: 2.18–4.51; p < 0.0001) and with a higher mortality (OR: 2.56; 95% CI: 1.48–5.46; p = 0.019). The most frequently reported NEs were headaches (n = 167) and myalgias (n = 126). Neurological syndromes included stroke (n = 14), encephalitis (n = 12), encephalopathy (n = 11), transverse myelitis (n = 6) and Guillain-Barré syndrome (n = 4). Conclusions: Neurological involvement is common (48.63%) in COVID-19 patients within the first two weeks of the illness. This includes neurological symptoms such as anosmia, headaches, as well as a constellation of neurological syndromes such as stroke, encephalitis, transverse myelitis, and Guillain-Barré syndrome. Severity of acute COVID-19 illness and older age are the main risk factors.

Background Asthma and chronic obstructive pulmonary disease (ACO) were considered two different diseases, but recently it was found that some patients have features of both asthma and chronic obstructive pulmonary disease (COPD), and they were defined as having ACO. Aim To study the characteristics features of ACO and its percentage among obstructive airway diseases and to assess sputum eosinophils in these patients. Patients and methods The study included 56 patient attending Kasr Al Aini outpatient clinic who were diagnosed as having obstructive airway diseases (asthma, COPD and ACO). Patients enrolled in the study were subjected to full history taking, clinical examination, full laboratory examination, plain chest radiography, spirometry before bronchodilator and after bronchodilator administration (reversibility test) and sputum analysis for counting eosinophils cells. Patients were classified into three groups (asthma, COPD and ACO). Results This study was conducted on 56 patients, including 47 (83.9%) males and nine (16.1%) females. Among the studied patients, 23 (41.1%) patients were diagnosed as ACO. The mean age of patients with ACO was 53.43±11 years. The age of onset of symptoms was below 40 years in 43.5% of patients with ACO and above 40 years in 56.5% of them. Eighty-seven percent of ACO group were smokers, 60.9% had history of atopy and 26.1% had sputum eosinophilia. Conclusion ACO represents a large percentage among patients with obstructive airway diseases. It shares some features of asthma such as atopy and positive sputum eosinophilia, and some features of COPD like old age of presentation and positive smoking history.

Calcification in lung lesions includes many differential diagnoses and usually indicates a benign course. However, its interpretation is challenging due to many etiologies. Radiological visualization of extensive calcification in bronchogenic carcinoma is not familiar and may cause confusion and misdiagnosis; however, it may be rarely seen and has also been rarely reported. We documented a case of lung adenocarcinoma with extensive calcification in computed tomography (CT) of chest and diagnosed as mucinous adenocarcinoma of the lung by bronchoscopic lung biopsy.

Crystalline silica inhalation causes silicosis, one of the ancient occupational lung diseases. It leads to an irreversible fibrotic response in the lung parenchyma and, consequently, causes diffuse interstitial lung disease. Asymptomatic to chronic irreversible forms are various presentations of silicosis, which has a high-risk predisposition to various comorbidities. We documented two cases of rare presentations of silica dust exposure alveolar silicoproteinosis and silicotuberculosis.

Background Cryotherapy has emerged as an effective modality to manage patients with central airway obstruction (CAO). The aim was to assess the outcomes of using cryotherapy for managing CAO and its effect on the symptoms, and pulmonary function testing (PFT) in patients with CAO. Patients and methods This prospective protocol was carried out at the Chest Department, Cairo University Hospitals, in collaboration with the Military Chest Hospital over 6 months. Patients with CAO underwent cryotherapy and were assessed by the following: grade of airway obstruction, dyspnea, hemoptysis and quality of life scales, and PFT. Outcomes and safety of cryotherapy were evaluated. Results A total of 30 patients with CAO were enrolled and were divided into two groups: the malignant obstruction group (n=20) and the nonmalignant obstruction group (n=10). Complete restoration of the airway patency was achieved in 53.3% of patients. Only three (10%) cases encountered complications. There were significant postprocedural improvements of dyspnea, cough, hemoptysis, quality of life scales, and PFT. Logistic regression analysis showed that smoking was associated with worse outcomes. Conclusions Cryotherapy is a safe and successful method for both endobronchial exophytic tumor debulking and nonmalignant CAO. These benefits were reflected in the postprocedural improvement of clinical pulmonary scales, PFT, the grade of airway obstruction, and quality of life. Further prospective, multicenter studies are recommended. [ABSTRACT FROM AUTHOR]

Calcification in lung lesions includes many differential diagnoses and usually indicates a benign course. However, its interpretation is challenging due to many etiologies. Radiological visualization of extensive calcification in bronchogenic carcinoma is not familiar and may cause confusion and misdiagnosis; however, it may be rarely seen and has also been rarely reported. We documented a case of lung adenocarcinoma with extensive calcification in computed tomography (CT) of chest and diagnosed as mucinous adenocarcinoma of the lung by bronchoscopic lung biopsy. [ABSTRACT FROM AUTHOR]

Crystalline silica inhalation causes silicosis, one of the ancient occupational lung diseases. It leads to an irreversible fibrotic response in the lung parenchyma and, consequently, causes diffuse interstitial lung disease. Asymptomatic to chronic irreversible forms are various presentations of silicosis, which has a high-risk predisposition to various comorbidities. We documented two cases of rare presentations of silica dust exposure alveolar silicoproteinosis and silicotuberculosis. [ABSTRACT FROM AUTHOR]

Aspiration of scarf pins is a common problem in specific geographical locations where the Muslim population is high, especially in countries like Egypt, Bangladesh, Middle Eastern countries, and certain regions in India. This condition is also referred to as hijab-pin syndrome. We discuss the largest experience of flexible bronchoscopic extraction of aspirated scarf pins from the tracheobronchial tree. A multicenter retrospective observational study was conducted on 146 patients from 4 different centers in Egypt, Bangladesh, India, and Germany. Flexible bronchoscopy was successful in the extraction of aspirated scarf pins in all 146/146 patients with a 100% success rate. 136/146 (93.15%) patients were females, with the most common age group between 12 and 18 years (34.24%). 132/146 (90.4%) remembered the aspiration event before coming to the hospital. Cough was the predominant presenting symptom. (71.22%). In all 146 cases, the foreign body was identified on a standard chest X-ray. The left main bronchus was the most common site of aspiration, 67/146 (45.89%), followed by the right main bronchus, 56/146 (38.35%). 14 patients (9.58%) had a history of unsuccessful attempts to remove by rigid bronchoscopy, and flexible bronchoscopy was successful in these 14 (100%) patients who had a prior unsuccessful attempt to remove. The current series is the largest in literature and demonstrated an excellent success rate in the removal of the aspirated scarf pin.

We present the case of a female patient who presented with undiagnosed pleural effusion. Thoracoscopy was performed and at the beginning of the procedure, the parietal pleura was rather uniformly congested but with a smooth surface. As time passed, the parietal pleura became roughened by bumpy areas of mucosal elevations, which looked soft and watery. This became evident during the biopsy procedure, as the pleura was markedly edematous. The biopsy specimens were nonspecific and the cause of the effusion remained unclear. This phenomenon, which we termed "goose-skin" pleura, showed that the origin of the pleural effusion formed was the parietal pleura, for unknown causes.