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Objectives: The present study was designed to evaluate the role of chest ultrasound in the diagnosis of acute pulmonary embolism (PE) and determine its accuracy using multi-detector CT-pulmonary angiography (MD-CTPA) as a gold standard technique for PE diagnosis. Patients and methods: A prospective case-control study was performed with 75 patients who presented to the emergency department of Minia Cardiothoracic University Hospital with clinical suspicion of PE. All patients were evaluated clinically and by laboratory tests to assess the risk of PE. Thoracic ultrasound (TUS) was then performed for all patients for signs suggestive of PE. Finally, MD-CTPA was performed to confirm or exclude the presence of PE. Results: Patients were subdivided into two groups according to the result of MD-CTPA; group I (patients with PE) and group II (control group without PE). In our study, PE was present in the lower lobe in 75% of cases, then in the middle in 13% and in the upper lobe in 3.8% of cases. The majority of lesions in TUS were wedge-shaped lesions. No vascular flow was detected in 83% of PE-confirmed patients. The current study revealed that TUS has 81.25% sensitivity, 95% specificity, 98.3% positive predictive value, 77.2% negative predictive value and 87% accuracy in the diagnosis of PE. Univariate regression analysis revealed that the presence of wedge-shaped pleural-based lesions in grayscale US and the absence of flow signals by colour Doppler sonography (CDS) increase the possibility of PE. Wedge-shaped pleural-based lesions increase the possibility of PE by 1.48 times (P=0.0001), and the absence of flow signals by CDS increases the possibility of PE by 92.89 times (P=0.00001). Multivariate regression analysis revealed that adding absent flow signals by CDS to wedge-shaped pleural-based lesions by grayscale US increases the possibility of a PE diagnosis by 50.28 times (P=0.001). Conclusion: Chest ultrasound is a simple, safe, noninvasive, inexpensive, bedside diagnostic radiological technique that can be used in the emergency department for suspected PE or as an alternative to MD-CTPA when CTPA is contraindicated. Wedge-shaped lesions and the absence of flow signals by CDS increase the diagnostic value of ultrasound for PE.

The aim of this study is to measure the degree of compliance with hand hygiene practices among health-care workers (HCWs) in intensive care facilities in Aseer Central Hospital, Abha, Saudi Arabia, before and after a multimodal intervention program based on WHO strategies. Data were collected by direct observation of HCWs while delivering routine care using standardized WHO method: “Five moments for hand hygiene approach”. Observations were conducted before (February–April 2011) and after (February–April 2013) the intervention by well-trained, infection-control practitioners during their routine visits. The study included 1182 opportunities (observations) collected before and 2212 opportunities collected after the intervention. The overall, hand hygiene compliance increased significantly from 60.8% (95% CI: 57.9–63.6%) before the intervention to reach 86.4% (95% CI: 84.9–97.8%) post-intervention (P = 0.001). The same trend was observed in different intensive care facilities. In logistic regression analyses, HCWs were significantly more compliant (aOR = 3.2, 95% CI: 2.6–3.8) after the intervention. Similarly, being a nurse and events after patient contact were significant determinants of compliance. It is important to provide sustained intensified training programs to help embed efficient and effective hand hygiene into all elements of care delivery. New approaches like accountability, motivation and sanctions are needed.

Background Secondary polycythemia is linked to cigarette smoking and chronic obstructive pulmonary disease (COPD). However, the prevalence of polycythemia and its possible risk factors in patients with COPD have not been widely studied. In the past, it was known that patients with COPD had a high prevalence of polycythemia.However, owing to the advances in the management of patients with COPD and the use of long-term oxygen therapy to correct hypoxemia in patients with advanced COPD, its frequency is decreasing. Aim The current research was done to evaluate the frequency of polycythemia and its effects in patients with COPD in Minia Cardiothoracic University Hospital. Patients and methods A total of 100 patients with COPD were included within the study. They were assessed for complete demographic and clinical data. Spirometry and arterial blood gases were evaluated. Complete blood count, serum iron, total iron-binding capacity, and erythropoietin level were measured.Patients were divided into two groups: group I, nonpolycythemic patients (86 patients), and group II, polycythemic patients (14 patients). Results Polycythemia was present in 14 (14%) patients. Polycythemic patients had a higher modified Medical Research Council dyspnea grade (P=0.001) and a higher number of exacerbations per year (0.02). There was also a significant increase in serum iron level (170.9 ± 9.6 µg/dl) and total iron-binding capacity (377.1 ± 14.8 µg/dl) with lower erythropoietin (24.04 ± 3.8 mU/ml) in group II compared with group I (134.4 ± 27.4 µg/dl, 310.9 ± 40.1 µg/dl, and 41.9 ± 10.3 mU/ml, respectively) (P=0.001, 0.001, and 0.001, respectively). Conclusion Polycythemia was present in 14% of the studied patients. It was associated with a significantly higher grade of dyspnea and an increased number of exacerbations.

Introduction Predicting ICU outcome in community-acquired pneumonia (CAP) is important for effective clinical decision making. CAP is associated with coagulation abnormalities even in patients with nonsevere illness, and these parameters may improve the ability of simple clinical scores to expect mortality in severe CAP. Patients and methods A prospective study was conducted on 100 patients with a primary diagnosis of CAP and who needed admission to ICU Minia University Hospital between the period of September 2018 and October 2019. The study aimed to evaluate the value of clinical scoring systems and coagulation parameters to predict prognosis of severe CAP. Results The overall ICU mortality was 41%. Following multivariable regression, male sex, Simplified Acute Physiological Score II score, diagnosis of cancer, and prothrombin time (PT) were significantly associated with ICU mortality. Apart from Acute Physiologic Assessment and Chronic Health Evaluation III score, all other severity scores, including the CURB-65 score, can differentiate between ICU survivors and nonsurvivors when calculated at the time of admission to ICU (P

Introduction To investigate the changes in platelets indices in patients with pulmonary embolism (PE) and to examine the correlation of these parameters with the extent of vascular occlusion. Patients and methods The present study was conducted on 70 patients who were admitted because of clinical suspicion of PE. For all patients, complete history taking and examination, routine laboratory investigations, chest radiography, ECG, and transthoracic echocardiography were done. For patients with low and intermediate clinical probability, assessment of d-dimer level was done. For patients with high clinical probability and those with positive d-dimer finding, pulmonary computed tomography angiography was performed with measurement of pulmonary artery obstructive index (PAOI) and right ventricle to left ventricle (RV/LV) ratio. Results Fifty patients were confirmed to have PE and the remaining 20 patients were negative for PE. The group of patients without PE served as a control group. The differences in platelet count, mean platelet volume (MPV), platelet distribution width (PDW), red cell distribution width, and other parameters were compared between both the groups. MPV and PDW were significantly higher in patients with acute PE than in other patients (P=0.0002 and 0.0001). A significant correlation was found between MPV and both PAOI (P=0.049) and RV/LV ratio (P=0.0004). Moreover, significant correlation between PDW and PAOI (P=0.001) and between PDW and RV/LV (P=0.044) was found. The best cutoff value for MPV for the prediction of RV dysfunction was more than 9.4 fl (sensitivity 46.7%; specificity 94.7%). The best cutoff value for PDW for the prediction of RV dysfunction was more than 15.85 fl (sensitivity 75%; specificity 65.9%; P=0.006).