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Abstract Background Chronic obstructive pulmonary disease (COPD) is a significant global health concern characterized by growing rates of mortality and morbidity. The purpose of this work was to evaluate the serum YKL-40 level and its relationship to body mass index (BMI), obstruction of airflow, dyspnea, exercise capacity (BODE) index, and the extent of COPD. Methods This prospective work was carried out on 70 adult male patients, allocated into three groups: group A—36 smokers with stable COPD with different degrees of severity; group B—19 smokers without COPD; and group C—15 healthy non-smokers as a control group. Results The BODE index was 5.56 ± 2.52. Prebronchodilator forced expiratory volume in 1 s (FEV1) and FVC were substantially decreased in group A contrasted to group B and group C (P value 0.394 with 80.65% sensitivity, 41.03% specificity, 52.1% PPV, and 72.7% NPV. Conclusions Serum YKL-40 level was substantially greater in the COPD group contrasted to healthy non-smokers, no substantial association existed between serumYKL-40 and BODE index, O2 saturation, or smoking index. A substantial positive association existed between SerumYKL-40 and the degree of severity and WBCs.

Abstract Background Obstructive sleep apnea disrupts the normal sleep cycle and is associated with many adverse consequences such as cardiovascular disease, DM, psychological problems, depression, decreased cognitive function, reduced quality of life, structural brain changes, and fatigue. Purpose This work aimed to study the MRI structural brain changes and to assess the neurocognitive function, depression, and fatigue using multiple questionnaires (MoCA score, BDI-П, and FSS, respectively) in OSA patients. Methods We enrolled 30 patients > 18 years with moderate (severity groups І), severe (severity groups П), very severe or extremely severe OSA (severity groups Ш), and 10 control subjects that were matched. All patients and control subjects underwent full-night PSG. Patients underwent neuropsychological tests including the Montreal Cognitive Assessment, Beck’s Depression Inventory-II, and Fatigue Severity Scale (FSS) in addition to an MRI brain without contrast. Results The mean AHI among patients (56.7% were females and 43.3% were males) was 39.97 ± 20.26 event/h. Severity groups І (40% of studied patients), П (46.7%), and Ш (13.3%). Abnormal MRI findings (WMCs) were detected in 18 patients (60%), versus 4 subjects (40%) in the control group, showing no statistically significant difference, p = 0.300. Among different severity groups, the prevalence of abnormal MRI findings was 4 (33.3%), 11 (78.6%), and 3 (75%) patients in severity groups І, П, and Ш, respectively. There was a statistically significant difference between patients and control regarding affection of subcortical and corpus callosal regions, p = 0.007 and 0.38, respectively, but not periventricular or deep white matter hyperintensities. Montreal Cognitive Assessment, Beck’s Depression Inventory-II score, and Fatigue Severity Scale, all showed statistically significant differences between patient and control groups. There was a significant negative correlation between AHI and MoCA score and a significant positive correlation between AHI and BDI-П, and also between AHI and FSS, p = 0.005, 0.016, and 0.008, respectively. The Frontal lobe was the most affected lobe among our patients followed by the parietal lobe. The mean value of AHI in the group of patients with abnormal MRI findings was statistically significantly higher than that in the group with normal MRI findings (45.42 ± 19.29 versus 32.06 ± 19.82 event/h, respectively), p = 0.010. Comparing both groups showed: that the mean value of MoCA score in the group of patients with abnormal MRI findings was significantly lower than that in the group with normal MRI findings (17.89 ± 3.64 versus 24.08 ± 4.44, respectively), p < 0.001. Regarding both BDI-П and FSS, it was noted that the mean value in the group of patients with abnormal MRI findings was higher than that in the group with normal MRI findings (33.83 ± 7.94 versus 32 ± 7.39, and (58.39 ± 4.82 versus 55.17 ± 7.12 respectively), but this difference was not statistically significant, p = 0.529, p = 1.000, respectively. Conclusion There was no significant difference between patients and the control group regarding WMCs in general, but there was a significant difference regarding the presence of subcortical and corpus callosal white matter hyperintensities. The Frontal lobe was the most affected. Neurocognitive function, depression, and fatigue were significantly affected in OSA patients in comparison to the control group. OSA patients with WMCs had a significantly higher AHI and a significantly lower MoCA score.

Abstract Peripheral muscle dysfunction is a well-recognized complication of COPD associated with exercise (in)tolerance and worse prognosis. The evaluation of peripheral muscle integrity is an attractive marker in COPD patients. The aim of the study was to identify the correlation between the rectus femoris muscle cross-sectional area (RFCSA) and the severity of airway obstruction in COPD patients using ultrasound. The study enrolled 24 outpatients diagnosed with stable COPD (post-bronchodilator FEV1/FVC

Background Interstitial lung diseases (ILDs) are restrictive pulmonary disorders that make lungs unable to expand on inhalation. Persistent symptoms and/or limitation in usual efforties make pulmonary rehabilitation (PR) very helpful. Aim To assess the purpose of PR in improvement of dyspnea, quality of life, and functional capacity in patients with ILDs. Patients and methods A total of 20 adult patients with ILDs were selected from the ward of the Chest Diseases Department at Al-Maamora Chest Hospital. They were subjected to PR program (three sessions per week for 6 weeks). The program is composed of endurance, strengthening, and breathing exercises. Spirometry, arterial blood gas analysis, 6-min walking distance, aerobic capacity (VO2 peak) using Rockport formula, peripheral muscle strength assessment, dyspnea assessment (modified Medical Research Council), and health-related quality of life (HRQL) score using St George’s Respiratory Questionnaire were assessed before and after the sixth week of the program. Results There was crucial influence in modified Medical Research Council (P=0.001), 6-min walk test (P≤0.001), maximal inspiratory pressure (P=0.003), maximal expiratory pressure (P=0.003), VO2 peak (P=0.005), and HRQL (P≤0.001). However, arterial blood gas and spirometry showed no important advancement after the program. Conclusion PR improves exercise capacity, dyspnea, peripheral muscle strength, and HRQL in patients with ILD.

Background: Patients with COPD are frequently hospitalized for acute exacerbations (AECOPD), which may cause respiratory failure and death. Proportional assist ventilation (PAV) is a relatively new mode of ventilator-based, inspiratory support designed to assist spontaneous breathing in patients with intact neural drive. It is a form of synchronized partial ventilatory assistance with peculiar characteristic that ventilator generates pressure in proportion to patient’s instantaneous effort. Pressure support ventilation (PSV) is an attractive weaning mode, however at higher pressure support levels, many patients displayed expiratory muscle activation indicating that the patient is “fighting the ventilator”. Objective: To compare PAV and PSV in the weaning of AECOPD patients. Patients and methods: The study was conducted on 60 patients admitted to the Department of Critical Care Medicine, at the Alexandria Main University Hospital with the diagnosis of AECOPD. Exclusion criteria included those with severe cardiac or neurological disease, and those managed by non-invasive ventilation. All patients were subjected on admission to complete history taking, complete physical examination and laboratory investigations and were treated according to guidelines of treatment of AECOPD. At the time of weaning patients were randomly categorized into two equal groups; Group A: patients weaned using PAV and Group B: patients weaned using PSV and the two groups were assessed for weaning success, patient–ventilator dys-synchrony, MV days, ICU, and hospital stay. Results: The weaning success rate was 90% in group A, and 66.7% in group B. PAV was associated with less patient–ventilator dys-synchrony and was associated with 1.5 day reduction in the mean days of mechanical ventilation, 2 day reduction in the mean days of ICU stay, and 1.8 day reduction in the mean days of hospital stay in comparison to PSV group. Conclusion: PAV was associated with less patient–ventilator dys-synchrony and associated with reduction of days of mechanical ventilation, ICU, and hospital stay.

Introduction: Asthma is a continuous significant health problem. Strategies for treating exacerbations are best adapted and implemented at a local level. Severe exacerbations are potentially life threatening, and their treatment requires close supervision. The severity of the exacerbation determines the treatment administered. Indices of severity, particularly peak expiratory flow (PEF), pulse rate, respiratory rate, and pulse oximetry should be monitored during treatment. Aim of the work: The aim of this work was to assess the effect of the implementation of the Global Initiative for Asthma (GINA) guidelines in the prognosis and the outcome of asthma exacerbation in the emergency department. Subjects and methods: The study was conducted on one hundred asthmatic patients. All patients were informed about the study and gave their consents. Patients were subjected to full history taking and clinical evaluation. Investigations were done in the form of peak flow rate (PFR) measurement, pulse oximetry assessment, ABG analysis (for only 17 patients), chest X-ray (it is not routinely recommended) and complete blood count (if needed). Then patients were classified according to their attacks. All patients were managed according to GINA guidelines. Results: Older patients were significantly suffering from severe to life threatening attacks than younger patients. We found that 12% of patients had occupational related asthma in relation to 88% of patients had non-occupational related asthma. There were no statistical significant differences between classification of severity of current attack and previous emergency department (ED) visits/year. There were no statistical significant differences between the studied groups regarding temperature. Systolic and diastolic blood pressure had statistically significant lower values in patients with severe to life threatening attacks than those with mild to moderate attacks. Severe to life threatening group had respiratory rate higher than mild to moderate group. Mild to moderate group had PEF and SaO2% higher than severe to life threatening group. PEF was statistically higher post treatment than pre treatment. Three patients of 17 had PaCo2 >45 mmHg with hypoxemia and respiratory acidosis and they admitted to the intensive care unit (ICU). All patients in ED were assisted to determine the severity of asthma concomitant with administration of initial treatment (plan A), which is oxygen to achieve O2 saturation ⩾92%, inhaled B2 adrenergic bronchodilator and an oral or intravenous dose of corticosteroids. Five patients met a good response so they enter in (plan C1). Seventy-five patients met with the criteria of moderate episode they go to plan B1, 68 patients of them (about 90%) had a good response within 2 h so go to plan C1 and the rest 7 patients (10%) had an incomplete response go to plan C2. Twenty patients met with criteria of severe episode, 17 of them (85%) with incomplete response move to plan C2, and the rest 3 patients (15%) had a poor response and moved to plan C3, no improvement noticed so they were admitted to the ICU. Hospitalization was done to 11 patients who met a poor response (plan C2), 86 patients were discharged from the ED (73 patients from plan C1 and 13 patients from plan C2). Severe to life threatening group stayed in ED longer than mild to moderate group. Conclusions and recommendations: All patients presenting in the emergency department with asthma exacerbations should be evaluated and triaged immediately and must be treated according to their severity of classification using GINA guidelines. Measurements of airflow obstruction, using peak expiratory flow, can help to guide therapy for acute asthma. Continuous monitoring of oxyhaemoglobin saturation by pulse oximetry should be undertaken for all patients with acute exacerbation of asthma. We must; educate patients in ED about the nature of asthma and its therapy, educate patients how to use inhalers, encourage patients to use spirometer at home and discharge each patient with ED-asthma discharge plan.