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This paper focuses on applying the Marshall-Olkin approach to generate a new bivariate distribution. The distribution is called the bivariate exponentiated Lomax distribution, and its marginal distribution is the exponentiated Lomax distribution. Numerous attributes are examined, including the joint reliability and hazard functions, the bivariate probability density function, and its marginals. The joint probability density function and joint cumulative distribution function can be stated analytically. Different contour plots of the joint probability density function and joint reliability and hazard rate functions of the bivariate exponentiated Lomax distribution are given. The unknown parameters and reliability and hazard rate functions of the bivariate exponentiated Lomax distribution are estimated using the maximum likelihood method. Also, the Bayesian technique is applied to derive the Bayes estimators and reliability and hazard rate functions of the bivariate exponentiated Lomax distribution. In addition, maximum likelihood and Bayesian two-sample prediction are considered to predict a future observation from a future sample of the bivariate exponentiated Lomax distribution. A simulation study is presented to investigate the theoretical findings derived in this paper and to evaluate the performance of the maximum likelihood and Bayes estimates and predictors. Furthermore, the real data set used in this paper comprises the scoring times from 42 American Football League matches that took place over three consecutive independent weekends in 1986. The results of utilizing the real data set approve the practicality and flexibility of the bivariate exponentiated Lomax distribution in real-world situations, and the bivariate exponentiated Lomax distribution is suitable for modeling this bivariate data set.

In this paper Chen-Burr XII distribution is constructed and graphical description of the probability density function, hazard rate and reversed hazard rate functions of the proposed model is obtained. Also, some statistical characteristics of the Chen-Burr XII distribution are discussed and some new models as sub-models from the Chen-Burr XII distribution are introduced. Moreover, maximum likelihood estimation of the parameters, reliability, hazard rate and reversed hazard rate functions of the Chen-Burr XII distribution are considered. Also, the asymptotic confidence intervals of the distribution parameters, reliability, hazard rate and reversed hazard rate functions are presented. Finally, three real life data sets are applied to prove how the Chen-Burr XII distribution can be applied in real life and to confirm its superiority over some existing distributions.

Background Diaphragm is a necessary respiratory muscle. In cases with pleural effusion, abnormal diaphragmatic functions may be observed. Thoracic ultrasound is a simple, accurate, and noninvasive method to investigate the relation between the quantity of pleural effusion and diaphragmatic functions. Aim The work was done to clarify the relation between the quantity of pleural effusion and diaphragmatic functions using ultrasound. Patients and methods A prospective case–control study, where patients were divided into two groups: GI (cases), 20 patients with pleural effusion for ultrasound evaluation of the relation between the quantity of pleural effusion and diaphragmatic functions, and GII, (controls) 20 healthy volunteers without pleural effusion for ultrasound assessment of diaphragmatic functions. Between 2019 and 2020, clinical assessment, routine investigations, and demographic and radiological data were reviewed for the two groups. Results Thoracic ultrasound for GI at different quantities of pleural effusions revealed significant differences in diaphragmatic functions such as thickness at the end of inspiration, diaphragm thickening fraction, excursion at deep breathing, and excursion at quiet breathing. The statistical comparison of sonographic findings between GI and GII showed significant differences in the thickness at the end of expiration, thickness at the end of inspiration, diaphragmatic thickening fraction, excursion at quiet breathing, and excursion at deep breathing. These changes are proportionate to the quantity of pleural effusion. Conclusion There is an adverse effect of pleural effusion at different quantities on diaphragmatic functions as observed by thoracic ultrasound.

Background Transthoracic ultrasound (US) is useful in the evaluation of a wide range of peripheral, parenchymal, pleural, and chest-wall diseases. Aim To evaluate the role of chest US in the diagnosis of peripheral thoracic lesions. Patients and methods A prospective interventional analytical study was included: 40 adult patients with peripheral thoracic lesions. Transthoracic US (Philips Affinity 50 G U/S, made in Germany) was performed using a linear 5–10-MHz probe for examination of the thoracic wall and the parietal pleura, whereas a 2–5-MHz convex probe was used to examine the visceral pleura, pleural effusion, and lung parenchyma. US-guided core biopsy (Tru cut needle 16 G×10 cm), fine-needle aspiration, or both were performed. Different diagnostic procedures such as bronchoscopy, thoracoscopy, or computed tomography-guided biopsy were done to approach the final confirmatory histopathological diagnosis. Results The final confirmatory diagnosis was approached in 38/40 (95%) patients, while 2/40 (5%) patients were undiagnosed due to morbidity or discharge. The frequent transthoracic US findings were pleural effusion (82.5%), pleural thickening (52.5%), and lung collapse (47.5%). While lung abscess (2.5%) and lung nodules (2.5%) were less-frequent findings. Regarding the diagnostic procedure, 11/38 patients of the studied population were diagnosed by US-guided biopsy, 16/38 cases were diagnosed by US-guided aspiration, and 2/38 cases were diagnosed by both US-guided biopsy and aspiration. Moreover, 1/38 cases were diagnosed by computed tomography-guided biopsy because the result of US-guided biopsy was inconclusive. Fiber-optic bronchoscopic biopsy was carried out in 2/38 patients who had endobronchial central lesion. Another 5/38 cases were diagnosed by thoracoscopic biopsies after a trial of US-guided biopsy failure. Transthoracic US had a diagnostic utility of 83, 67, 97, and 25% sensitivity, specificity, positive, and negative predictive value, respectively. Conclusion Transthoracic US is a practical, cheap, and safe method for diagnosis of peripheral lung lesions and pleural diseases.

Background Women may have a wide range of symptoms in the menopausal period, which includes vasomotor, mood changes, and disturbances of sleep. Disturbance of sleep leads to adverse health problems with poor quality of life. This study researched the comparison of polysomnographic parameters between menopausal and childbearing women. Patients and methods This study was carried out on 47 women (divided into two groups of premenopausal and postmenopausal), who attended for polysomnography in the Unit of Sleep in the Department of Chest Diseases in Menoufia University Hospital from the period of September 2021 to September 2022. After taking informed written consent, all participants were subjected to history taking, full examination, Epworth sleepiness scale, STOP-Bang questionnaire, and polysomnography. Results This study was carried out on 47 women who were divided into two groups: group I (29 participants) in menopause with an age of 58.9 ± 6.3 (mean±SD) and group II (18 participants) in the childbearing period with an age of 37.28 ± 8.064 (mean±SD). Polysomnographic parameters showed statistically significant differences between both groups regarding sleep latency (min) (P=0.026), sleep efficiency% (P=0.019), apnea–hypopnea index (P

Background Obstructive sleep apnea (OSA) is a prevalent sleep disordered breathing in geriatrics but still frequently undiagnosed. Sleep architecture changes with ageing. Geriatrics spend more time in the N1, N2 than in N3, REM. Also, there are more frequent awakenings, arousals and sleep stage shifts. This leads to decrease in sleep efficiency. Geriatric patients with OSA have more affected sleep architecture than middle-aged adults. The aim This work aimed to assess and compare sleep architecture changes in geriatrics versus middle-aged adult patients with OSA syndrome. Patients and methods This comparative study conducted in chest department Menoufia University Hospitals included 50 patients divided to two equal groups; geriatric group age 65 years old or more and middle-aged adult group aged from 18 to 50 years old. All patients were complaining of symptoms suggestive of OSA. All patients underwent sleep questionnaires and Polysomnography using model; Philipsrespironic alice6. Results There was no statistically significant difference between the studied groups regarding sex, smoking, co morbidities, BMI and symptoms. Regarding changes in sleep architecture, geriatric group showed a significantly higher Sleep latency and wakefulness after sleep onset in comparison to middle-aged adults (P=0.004 and 0.039, respectively) versus significantly lower Sleep efficiency, N3%, REM% (P=0.009,0.011 and 0.001, respectively). The median Total Apnea-Hypopnea index was 40.2 (/h sleep) in geriatric group and 35.4 in middle-aged adult group. Regarding severity of OSA; geriatric group showed mild OSA in five (20%) patients, moderate in five (20%) patient and severe in 15 (60%) patients. Middle-aged adults showed mild OSA in 10 (40%) patients, moderate in two (8%) patients, and severe in 13 (52%) patients. Conclusions Sleep architecture is affected in all OSA patients, but these changes are more obvious in geriatric patients. Geriatric patients have higher wakefulness after sleep onset and sleep latency. On the other hand, they have a lower N3%, REM% and sleep efficiency.

Melanoma is a lethal form of skin cancer. Immunotherapeutic agents such as anti-PD-1 (pembrolizumab and nivolumab) and anti-CTLA-4 (ipilimumab) have revolutionized melanoma treatment; however, drug resistance is rapidly acquired. Several studies have reported an increase in melanoma rates in older patients. Thus, the impact of ageing on transcriptional profiles of melanoma and response to immunotherapy is essential to understand. In this study, the bioinformatic analysis of RNA seq data of old and young melanoma patients receiving immunotherapy identifies the significant upregulation of extra-cellular matrix and cellular adhesion genes in young cohorts, while genes involved in cell proliferation, inflammation, non-canonical Wnt signaling and tyrosine kinase receptor ROR2 are significantly upregulated in the old cohort. Several Treg signature genes as well as transcription factors that are associated with dysfunctional T cell tumor infiltration are differentially expressed. The differential expression of several genes involved in oxidative phosphorylation, glycolysis and glutamine metabolism is also observed. Taken together, this study provides novel findings on the impact of ageing on transcriptional changes in melanoma, and novel therapeutic targets for future studies.

In this paper the exponentiated generalized xgamma distribution is introduced. Some of its properties are presented through some models of stress–strength, moments, mean residual life, mean past lifetime, and order statistics. The maximum likelihood estimators, confidence intervals for the parameters, and the reliability and the hazard rate functions of the exponentiated generalized xgamma distribution based on dual generalized order statistics are obtained. Bayesian estimators for the unknown parameters, reliability, and hazard rate functions of the exponentiated generalized xgamma distribution based on dual generalized order statistics are considered. The results based on lower record values are verified using simulations as well as three real sets of data are adopted to demonstrate the flexibility and potential applications of the distribution. [ABSTRACT FROM AUTHOR]

Background The concepts in lung fibrosis and increased lung cancer risk have arisen from clinical observations of the concurrent findings during the autopsy of lung cancer and pulmonary fibrosis. Scar carcinoma attributes the origin of carcinomas to abutting areas of scarring. The association between fibrosis and lung cancer risk immediately raises a query: whether lung fibrosis induces lung cancer?Aim The study was done to elucidate the incidence, risk factors, and clinical characteristics of lung cancer in diffuse lung fibrosis. Patients and methods A cohort study was done based on a prospective group of 50 patients with diffuse lung fibrosis to evaluate the incidence of lung cancer, as well as a retrospective group of 50 patients with lung cancer to search for background of pulmonary fibrosis between 2019 and 2020. Demographic, radiographic, and histologic characteristics were reviewed for both groups. Results Among 50 patients with interstitial lung disease, lung cancer developed in 2/50 (4%) during the follow-up, whereas in the retrospective group, 8/50 (16%) were diagnosed as having lung cancer with diffused lung fibrosis between 2019 and 2020. Lung cancer risk factors were male sex, smoking, and occupational dust exposure. Squamous carcinoma followed by adenocarcinoma was the commonest histologic form. Conclusion Evidence shows an association between interstitial lung diseases and lung cancer emergence. Epidemiological evidence differs owing to the various study designs and populations.

The Bayesian approach offers a flexible, interpretable and powerful framework for statistical analysis, making it a valuable tool to help in making optimal decisions under uncertainty. It incorporates prior knowledge or beliefs about the parameters, which can lead to more accurate and informative results. Also, it offers credible intervals as a measure of uncertainty, which are often more interpretable than confidence intervals. Hence, the Bayesian approach is utilized to estimate the parameters, reliability function, hazard rate function and reversed hazard rate function of a new competing risks model. A squared error loss function as a symmetric loss function and a linear exponential loss function as an asymmetric loss function are employed to derive the Bayesian estimators. Credible intervals of the parameters, reliability function, hazard rate function and reversed hazard rate function are obtained. Predicting future observations is important in many fields, from finance and weather forecasting to healthcare and engineering. Thus, two-sample prediction (as a special case of the multi-sample prediction) for future observation is considered. An adaptive Metropolis algorithm is applied to conduct a simulation study to evaluate the performance of the Bayes estimates and predictors. Moreover, two applications of medical and engineering data sets are used to test and validate the theoretical results, ensuring that they are accurate, applicable to real-world scenarios and contribute to the understanding of the world and inform decision-making. [ABSTRACT FROM AUTHOR]

This paper focuses on applying the Marshall-Olkin approach to generate a new bivariate distribution. The distribution is called the bivariate exponentiated Lomax distribution, and its marginal distribution is the exponentiated Lomax distribution. Numerous attributes are examined, including the joint reliability and hazard functions, the bivariate probability density function, and its marginals. The joint probability density function and joint cumulative distribution function can be stated analytically. Different contour plots of the joint probability density function and joint reliability and hazard rate functions of the bivariate exponentiated Lomax distribution are given. The unknown parameters and reliability and hazard rate functions of the bivariate exponentiated Lomax distribution are estimated using the maximum likelihood method. Also, the Bayesian technique is applied to derive the Bayes estimators and reliability and hazard rate functions of the bivariate exponentiated Lomax distribution. In addition, maximum likelihood and Bayesian two-sample prediction are considered to predict a future observation from a future sample of the bivariate exponentiated Lomax distribution. A simulation study is presented to investigate the theoretical findings derived in this paper and to evaluate the performance of the maximum likelihood and Bayes estimates and predictors. Furthermore, the real data set used in this paper comprises the scoring times from 42 American Football League matches that took place over three consecutive independent weekends in 1986. The results of utilizing the real data set approve the practicality and flexibility of the bivariate exponentiated Lomax distribution in real-world situations, and the bivariate exponentiated Lomax distribution is suitable for modeling this bivariate data set. [ABSTRACT FROM AUTHOR]

In lifetime tests, the waiting time for items to fail may be long under usual use conditions, particularly when the products have high reliability. To reduce the cost of testing without sacrificing the quality of the data obtained, the products are exposed to higher stress levels than normal, which quickly causes early failures. Therefore, accelerated life testing is essential since it saves costs and time. This paper considers constant stress-partially accelerated life tests under progressive Type II censored samples. This is realized under the claim that the lifetime of products under usual use conditions follows Vtub-shaped lifetime distribution, which is also known as log-log distribution. The log–log distribution is highly significant and has several real-world applications since it has distinct shapes of its probability density function and hazard rate function. A graphical description of the log–log distribution is exhibited, including plots of the probability density function and hazard rate. The log–log density has different shapes, such as decreasing, unimodal, and approximately symmetric. Several mathematical properties, such as quantiles, probability weighted moments, incomplete moments, moments of residual life, and reversed residual life functions, and entropy of the log–log distribution, are discussed. In addition, the maximum likelihood and maximum product spacing methods are used to obtain the interval and point estimators of the acceleration factor, as well as the model parameters. A simulation study is employed to assess the implementation of the estimation approaches under censoring schemes and different sample sizes. Finally, to demonstrate the viability of the various approaches, two real data sets are investigated. [ABSTRACT FROM AUTHOR]

Abstract Background Tuberculosis (T.B) is one of the major infectious diseases in the developing countries. The diagnosis of extrapulmonary T.B (EPTB) remains problematic and emergence of resistant strains poses a significant threat. Improved diagnosis of tuberculosis is a global priority for proper control. The study aimed to assess the diagnostic accuracy of GeneXpert MTB/RIF assay for diagnosis of pulmonary TB (PTB) and EPTB and to evaluate the performance of GeneXpert system for demonstrating rifampicin resistance among the studied patients. Methods A total of 582 clinical samples (449 pulmonary; 430 sputum and 19 bronchoalveolar lavage (BAL) and 133 extra-pulmonary origins; 26 pleural fluid, 62 CSF, 19 ascetic fluid, 12 pus and 14 urine) were collected from patients under clinical and radiological assessment of either PTB or EPTB who were admitted to Menoufia Chest Hospital over a period of three years. Clinical samples were processed and investigated for detection of Mycobacterium tuberculosis (MTB) by both Xpert assay and the conventional methods including Ziehl-Neelsen (ZN)/acid-fast bacillus (AFB) smear microscopy and Lowenstein-Jensen (LJ) culture. Patients′ demographic, clinical characteristics and risk factors for acquiring rifampicin resistance were analyzed. Results The sensitivity, specificity, false- negative rate and total accuracy of AFB smear microscopy respectively were 72.1 %, 81.3 %, 27.9 and 78.8 % for PTB. However for EPTB, they were 63.2 %, 70.5 %, 36.8 and 68.4 % respectively in relation to LJ culture as the gold standard. GeneXpert MTB/RIF revealed better performance for PTB than EPTB. For PTB, it showed 90.2 % sensitivity, 86.9 % specificity, and 9.8 % false- negative rate. For EPTB, the assay showed a sensitivity of 81.6 %, specificity of 78.9 % and false- negative rate of 18.5 %. Multivariate regression analysis showed that presence of EPTB and contacts with known TB cases were independent risk factors for developing rifampicin resistance. Conclusions GeneXpert MTB/RIF assay is a rapid and highly sensitive technique for diagnosis of PTB or EPTB. Its simplicity and accuracy make this new method a very impressive tool for diagnosis of MTB and rifampicin resistance.

A state of a patient with heterotaxy syndrome with polysplenia was indiscriminately diagnosed through visualized estimation (computed tomography and pelviabdominal ultrasound) regardless of the pathological state. This syndrome depends on a diversity of anomalies of design and morphology of thoracoabdominal organ configuration. Imaging studies are the foundation in diagnosis.

Background Chronic obstructive pulmonary disease (COPD) is a serious issue of sickness and rise in global fatality rates. Noninvasive positive pressure ventilation is the first-line therapy in patients with COPD with respiratory fialure (RF). Tri-level positive airway pressure (Tri-PAP) is new challenging mode of noninvasive ventilation (NIV). Objectives To compare between two modes of noninvasive positive pressure ventilation [bi-level positive airway pressure (Bi-PAP) and Tri-PAP] and to spell out outcomes, complication, and predictors of favorable outcome of NIV in patients with COPD with respiratory failure. Patients and methods This prospective comparative study was accomplished on 30 patients with COPD with respiratory failure, who were subjected to NIV (Bi-PAP or Tri-PAP) and standard conventional therapy. Arterial-blood gases (ABGs) (initially, 6 h, and finally) were analyzed. NIV outcomes, complications, and predictors of success were encountered. Results Patients were categorized according to managerial therapeutic NIV into Bi-PAP (n=15) or Tri-PAP (n=15) groups. Initial, 6-h, and final ABGs analyses (pH, PO2, PCO2, HCO3, and O2 sat) and NIV outcomes (successful or failed weaning) were analogous, without considerable variation between both Bi-PAP and Tri-PAP groups. pH showed crucial advancement after 6 h of initiation of Tri-PAP NIV. Terminal ABG interpretation (pH, PaCO2, PaO2, and O2 sat) had better outcomes than initial and 6-h ABG analyses of Tri-PAP NIV group. Irritations and ulcerations of nasal bridge, dry nose or mouth, nasal congestion, hypotension, and PaCO2 increase were the most hazardous events in both Bi-PAP and Tri-PAP NIV groups. Shorter duration of NIV, lower BMI, higher pH, and lower PCO2 (initially, 6 h, and final ABGs) as well as higher O2 saturation (in final ABG) were predictors of successful weaning in NIV (Bi-PAP and Tri-PAP) groups collectively. Conclusion Bi-PAP and Tri-PAP are appropriate mode of NIV in patients with COPD with RF with minimal complication and better outcomes. Tri-PAP had no superiority of utilization than Bi-PAP mode. pH and PCO2 are the powerful predictors of favorable NIV outcomes.

Background Although there is well-proved association between type 2 diabetes mellitus (T2DM) and active tuberculosis, factors involved in the association between T2DM and latent tuberculosis infection (LTBI) are scarcely known. Aim The aim of this study was to study the prevalence and risk factors of LTBI in a cohort of Egyptian adults with T2DM including studying the effect of oral hypoglycemic drugs on this prevalence. Patients and methods All patients with T2DM were recruited from Menoufia University Endocrinology outpatient clinic during the period from June to December 2018. Demographic and clinical data, serum glucose and glycosylated hemoglobin (HbA1c) level, and QuantiFERON-TB Gold In-Tube and tuberculin skin test were assessed. Results In all, 102 patients were recruited, according to the QuantiFERON test; 22 (21.6%) patients were diagnosed with LTBI. Their mean age was 54.91±8.85, mean T2DM duration was 9.82±6.54/year, mean HbA1c% was 10.29±1.59, which is significantly higher than patients without LTBI. Patients on metformin-containing regimens were only 18% (four of 22 cases) among the LTBI patients, and 89.7% of the whole patients with metformin-containing regimen were without LTBI. Multivariant regression showed that age (odds ratio=1.178, P=0.041) and HbA1c% (odds ratio=2.789, P=0.008) were strong predictors for LTBI. Conclusion LTBI is prevalent in patients with T2DM especially among those with older age, longer duration of diabetes mellitus, uncontrolled diabetes mellitus, and on nonmetformin regimens. Age and HbA1c are strong predictors of LTBI in T2DM patients.

The nonlinear propagation of ion-acoustic Gardner solitons (GSs) and double layers (DLs) in electron-positron-ion (EPI) plasma in the presence of an external static magnetic field has been examined. The Korteweg–de Vries (KdV), modified KdV (mKdV), and Gardner equations have been derived by the reductive perturbation technique. It is seen that the amplitude, polarity, speed, width of such solitons are significantly modified by the species densities and by the obliquity angle. Compressive or rarefactive KdV solitons are obtained, but only compressive solitons are obtained in the mKdV case, wherever Gardner positive and negative DLs exist. The results of our present investigation may be useful for understanding the nonlinear wave propagation in dense quantum plasmas such as those existing in white dwarfs, neutron stars and intense laser-solid matter interaction experiments as an example of laboratory plasmas.

Background Laser acupuncture therapy has bioexcitation, tissue regenerative, antimicrobial, anti-inflammatory, and analgesic properties. Its impacts on pulmonary insults have offered gas exchange, ventilatory function, and immunity reinforcement. Objective The aim was to explore pre-effects and post-effects of laser puncture on serum immunoglobulin E (IgE) levels and ventilatory functions in atopic asthmatic patients. Patients and methods The prospective study was accomplished on 40 atopic bronchial asthmatic male patients, who were arbitrarily categorized into case and control groups; laser puncture therapy (24 sessions) was achieved in the study group. Conventional bronchial asthma (BA) therapy and breathing exercises were practiced for both groups. Serum IgE and forced expiratory volume in 1 s (FEV1) were evaluated before and after programmed therapy. Results Serum IgE was 198.3±31.39 IU and 157.37±24.2 IU/ml before and after treatment, respectively, in the study group. While in the control group it was 201.5±30.23 IU and 179.25±27.55 IU/ml, respectively, although there was considerable decline (P≤0.001) of IgE after treatment with 10.79% of advancement in the control group. There was no notable variations in IgE values among the study and control groups (P=0.772) prior to treatments, while remarkable distinction (P=0.011) with better improvement in study group was observed after treatment. FEV1 had a worthy rise sequential to treatment in the study group with 15.62% improvement and significant difference (P=0.014) than the control group. Conclusion Laser acupuncture had robust influences on IgE standard and FEV1 in BA patients.

Background Uric acid (UA) contributes to beneficial extracellular antioxidant defense activities in the airways. However, pro-oxidant powers of UA can be a potential risk factor for gouty arthritis in chronic obstructive airway disease (COPD). Objectives To investigate the proper causation (antioxidant/pro-oxidant) and correlation between UA indices and COPD and whether the associations were modified by smoking. Is serum uric acid (SUA) concentration a reliable biomarker to predict COPD severity? Patients and methods A prospective cohort study enrolled 45 male patients, who were divided into COPD smoker group I, cigarette smoker group II, and apparently healthy participants, serving as a control group III. SUA concentration and creatinine (Cr) level, arterial blood gases, radiographic imaging, and postbronchodilator spirometric measurements were performed. Results SUA was significantly elevated in COPD smoker and cigarette smoker groups than control one. SUA/Cr ratios were significantly increased in COPD smoker than in other groups. Overall, 8/20 (40%) patients were diagnosed with gouty arthritis in COPD smoker group, 1/15 (6.7%) in non-COPD cigarette smoker group, and none in control group. There were statistical significant differences among three groups (P=0.010). There were significantly higher number of patients with severe to very severe COPD (6/8) than patients with mild to moderate COPD (2/8) (P=0.028). There were significant positive correlations between SUA and smoking index (P=0.033), COPD grading (P=0.011), and partial arterial carbon dioxide tension (P=0.028) and also negative correlations with forced expiratory volume in the first second (FEV1)/forced vital capacity (FVC) (P=0.029), partial arterial oxygen tension (P=0.001), and O2 saturation (P=0.001) in COPD smoker group I. In cigarette smoker group II, there were statistically significant positive correlations between SUA level and FVC% (P=0.033), FEV1 (P=0.017), and FEV1/FVC (P=0.010). Receiver operating characteristic curves for the evaluation of performance of serum uric acid/serum creatinine ratio in the diagnosis of severity of chronic obstructive airway disease. Conclusion SUA had pivotal antioxidant and pro-oxidant inflammatory effects (gouty arthritis) in COPD. Cigarette smoking is an independent risk factor that influences SUA in COPD. SUA and SUA/Cr ratio increase with rising severity of COPD. UA/Cr ratio is the proper biomarker in the assessment of COPD grading, with higher sensitivity and specificity.

Background Fiberoptic bronchoscopy (FOB) is standard as a pre-eminent technique for diagnostic, palliative, and curative purposes in variable pulmonary insults. Objectives The objectives of this study were to identify the causation, technical aspects, pathophysiological impacts, and complications of FOB in critically ill patients, to discover the correlation between FOB outcomes and independent risk factors, and ultimately to anticipate predictors of mortality in critically ill patients who underwent FOB. Patients and methods This prospective cohort study was carried out in ICUs on 52 critically ill patients who were subjected to FOB for diagnostic or therapeutic purposes. They were grouped into the mechanical ventilation (MV) (28/52) and non-MV (24/52) groups. FOB outcomes and complications were encountered. Results Diagnostic indication of FOB was seen in 40/52 (77%) cases, while the therapeutic purposes of FOB were seen in 12/52 (23%) cases. FOB had a particular indication in the management of 12/52 cases (13.6%) for both pneumonic and inhalation lung injury cases, 10/52 (19.2%) cases for underlining focal lung lesion, 8/52 (15.4%) cases for hemoptysis, and 5/52 (9.6%) cases for either acute respiratory distress syndrome or atelectasis condition. There was a highly considerable variation between the MV and non-MV groups. Hypoxemia, bleeding, arrhythmia, bronchospasm, and laryngospasm were the most prevalent side effects of FOB, with unremarkable differences between both groups. FOB outcomes were as follows: 31/52 (59.6%) cases improved, 11/52 (21.2%) died, and 10/52 (19.2%) were referred to a tertiary health unit. There were significant negative correlations between outcomes and reasons for admission, time of onset of FOB, and radiological pattern. Older age, respiratory insult, immune-compromised state, nonventilatory assessment, and less frequency of FOB performance were predictors of mortality among critically ill patients who underwent FOB. Conclusion Flexible bronchoscopy is a safe and effective procedure for the diagnosis and treatment of pulmonary pathology in critically ill patients.

This paper is concerned with applying the Bayesian and E-Bayesian approaches to estimating the unknown parameters of the modified Topp–Leone–Chen distribution under a progressive Type-II censored sample plan. The paper explores the complexities of different estimating methods and investigates the behavior of the estimates through some computations. The Bayes and E-Bayes estimators are obtained under two distinct loss functions, the balanced squared error loss function, as a symmetric loss function, and the balanced linear exponential loss function, as an asymmetric loss function. The estimators are derived using gamma prior and uniform hyperprior distributions. A numerical illustration is given to examine the theoretical results through using the Metropolis–Hastings algorithm of the Markov chain Monte Carlo method of simulation by the R programming language. Finally, real-life data sets are applied to prove the flexibility and applicability of the model. [ABSTRACT FROM AUTHOR]

In this paper Chen-Burr XII distribution is constructed and graphical description of the probability density function, hazard rate and reversed hazard rate functions of the proposed model is obtained. Also, some statistical characteristics of the Chen-Burr XII distribution are discussed and some new models as sub-models from the Chen-Burr XII distribution are introduced. Moreover, maximum likelihood estimation of the parameters, reliability, hazard rate and reversed hazard rate functions of the Chen-Burr XII distribution are considered. Also, the asymptotic confidence intervals of the distribution parameters, reliability, hazard rate and reversed hazard rate functions are presented. Finally, three real life data sets are applied to prove how the Chen-Burr XII distribution can be applied in real life and to confirm its superiority over some existing distributions. [ABSTRACT FROM AUTHOR]

Objectives To assess the serum level of vitamin D and mean platelet volume (MPV) in patients with obstructive sleep apnea syndrome (OSAS) and whether their levels correlate with OSAS severity or not. Background OSAS is a clinical disorder characterized by recurrent episodes of upper airway collapse during sleep. Studies show a link between low levels of vitamin D ‘25(OH) D’ and obstructive sleep apnea. Some studies showed that patients who have OSAS also have raised platelet aggregation and activation. MPV is considered an indicator of activation of platelet and its size. Limited studies have informed a relationship between MPV and sleep apnea. Patients and methods A total of 65 patients with OSAS and 24 age-matched controls with completed Epworth sleepiness scale were included. OSAS diagnosis was based on polysomnography. Vitamin D was measured by ELISA, and MPV was measured by Sysmex xn-10 machine. Results A prospective case–control study was done on 65 OSAS cases and 24 age-matched and sex-matched controls. Vitamin D level was significantly lower among OSAS cases than controls, with lowest 25(OH) D in severe OSAS cases, whereas MPV showed nonsignificant difference between them, and the higher MPV was among severe cases. There was a significant negative correlation between vitamin D level and neck circumference (NC), apnea–hypopnea index (AHI), and desaturation index. There was a significant positive correlation between MPV level and each of NC and AHI. NC was an independent predictor for both vitamin D and MPV levels. NC, AHI, and vitamin D level are the independent risk factors for obstructive sleep apnea, with odds ratios of 2.09 and 1.6, respectively. Conclusion Patients with OSAS have decreased vitamin D level. Patients with severe OSAS have lower vitamin D level and higher MPV than other groups. Obesity may be the cause that explains this relation regarding high NC.

Background Central airway obstruction is a problem facing all medical and surgical specialists caring for patients with chest diseases. Bronchoscopic cryotherapy (CRYO) and electrocautery (EC) are two different techniques used for the management of endobronchial lesions, and they have a role in palliative treatment of malignant central airway lesions. Aim The aim of the work was to compare between CRYO and EC in the management of malignant endobronchial neoplasms. Patients and methods A prospective study was conducted on 40 patients with malignant endobronchial mass who were selected for bronchoscopic CRYO and EC. Thirty-one men and nine women, with age range from 25 to 65years were included in this study. Bronchoscopic CRYO and EC were performed under local anesthesia using a flexible fiberoptic bronchoscope. Results CRYO and EC procedures provided significant improvement of dyspnea (P

Nonlinear ion-acoustic solitary and shock waves were analysed in a system of collisionless, dissipative and magnetised multicomponent plasma. The system was made up of a fluid of inertial ions, electrons that were distributed superthermally and positrons. Korteweg–de Vries–Burgers (KdVB) equation was produced when the reductive perturbation approach was used to evaluate the plasma system nonlinearly. The tanh method was used to find the analytical solution of the derived KdVB equation. The study demonstrated that the superthermal parameters, magnetic field direction, ion kinematic viscosity and positron and electron concentration all affect the oscillatory shock wave features such as speed, amplitude and width. On the other hand, the bifurcation analysis showed that the equilibrium point produces an unstable spiral source as the Burgers term increases and that it transforms into a nodal source with any further increase in the Burgers term. The present results are helpful for understanding collective phenomena and the stability criterion of ion-acoustic (IA) solitary and shock waves in magnetoplasmas with superthermal electrons and positrons, which are observed in some astrophysical environments, like the interstellar medium. [ABSTRACT FROM AUTHOR]

Background Pulmonary hypertension (PH) is a major predictor of exercise tolerance and mortality in chronic obstructive pulmonary disease (COPD). The confirmatory and gold standard is the right heart catheterization. Noninvasive, simple and readily available parameters to frequently monitor patients with COPD are much needed. Objective To evaluate various clinical and investigational parameters such as BMI, airway obstruction, dyspnea, and exercise [BODE index capacity by 6-minutes walking test (6MWT)], computed tomography (CT) pulmonary artery/ascending aorta ratio (PA/AO), and serum ghrelin in patients with COPD with elevated PA pressures in different disease stages. Patient and methods A total of 40 patients with stable COPD were classified into two groups, group I patients without PH and group II patients with PH, according to echocardiographic measures. All patients are subjected to calculation of BODE index, serum ghrelin levels, and CT PA/AO. Results There was a significant difference between both groups regarding BODE index, PA/AO, serum ghrelin level, and post-MWT O2 saturation. There were positive significant correlations between the mean PA pressure and BODE index, PA/AO ratio, and serum ghrelin level. However, there were negative significant correlations regarding resting PaO2, post-6MWT O2, and pulmonary function tests. The cutoff value of PA/AO ratio was 0.84 in diagnosing PH with 95% sensitivity and 80% specificity, and the cutoff value of serum ghrelin level was 1694 ng/l in diagnosing PH with 98% sensitivity and 88% specificity. Conclusion BODE index, CT PA/AO ratio, post-6MWT oxygen saturation, and serum ghrelin level are useful noninvasive predictors for PH. A cutoff point of PA/AO of 0.84 and ghrelin of more than 1712 ng/l can be used for detection of elevated PA pressures in those patients.

Background Ventilator-associated pneumonia (VAP) remains a morbid and prevalent problem throughout the world. Lung ultrasound (LUS) is increasingly being used at the bedside for assessing alveolar-interstitial syndrome, lung consolidation, pneumothorax, and pleural effusion. Purpose The aim was to focus on the use of bedside LUS alone and in association with the clinical pulmonary infection score (CPIS) in early diagnosis of VAP, to describe the sonographic features, to compare between LUS and portable chest radiography (CXR) in early diagnosis of ventilator-associated pneumonia (VAP), and weather LUS affects the prognostic outcomes of VAP. Patients and methods A total of 40 patients with suspected VAP were enrolled. Portable CXR, LUS, and computed tomography scan (gold standard) were performed. The CPIS was calculated for early and reliable diagnosis of VAP. The prognostic outcomes were highlighted. Results Among forty VAP-suspected cases, 30 (75%) were confirmed using computed tomography (gold standard). LUS imaging of VAP cases diagnosed 28 (70%) with consolidation, 89.3% of them with air bronchogram, and 32.5% of them with pleural effusion. Validity for early VAP diagnosis using portable CXR demonstrated 86.7, 100, 100, 71.4, and 90%; ultrasound 93.3, 100, 100, 83.3, and 95%; whereas CPI score 50, 90, 93.8, 62.5, and 60% regarding sensitivity, specificity, positive predictive value, negative predictive value, and accuracy, respectively. CPIS combined with LUS revealed higher sensitivity (96.7%) and accuracy (97.5%). Low CPIS less than or equal to 6, modes of mechanical ventilation (continuous positive airway pressure and biphasic positive airway pressure), shorter duration of respiratory support, LUS imaging of air bronchogram and simple pleural effusion were significantly associated with improved outcomes of VAP cases. The duration of mechanical ventilation and early detection of air bronchogram by LUS were the independent mortality predictors with odds ratio of 2.4 and 3.11 and 95% CI of 1.56–4.55 and 1.8–17.66, respectively. Conclusion LUS was a reliable tool for early VAP diagnosis at the bedside. Combination approach increases the prognostic and diagnostic accuracy of LUS in VAP.

Background Lung cancer is a leading cause of cancer-related death worldwide. The main lines of treatment of lung cancer are chemotherapy, radiotherapy, and surgery. Objective The aim was to identify pulmonary complications following the administration of chemotherapy and radiotherapy in the treatment of lung cancer. Patients and methods This prospective cohort study included 50 adult patients with diagnosed lung cancers, who were scheduled to undergo chemotherapy and/or radiotherapy. Patients were divided into three groups (group 1: patients with no complications at the end of follow-up, group 2: patients who developed pulmonary complications, and group 3: patients with extrapulmonary complications). Baseline and post-treatment laboratories and radiological data were recorded for all patients during the 6-month follow-up period. Results A 64% of participants were men, and the mean age was 54.2±10.2 years. Interestingly, 54% of the included participants were never smokers and 8% were ex-smokers. The majority of patients (80%) received either chemotherapy or radiotherapy. The most commonly administrated chemotherapy was gemcitabine carboplatin. By the end of follow-up, 28% of the patients developed pulmonary infection, whereas 10% of the patients developed pulmonary embolism (one patient developed pulmonary embolism with respiratory failure). The mortality rate was 18%. There was a statistically significant difference between the complicated and noncomplicated groups in terms of basic characteristics pulmonary function test (P

Background: Sleep disordered breathing (SDB) is a frequent disorder and its severity superfats as pregnancy progresses. The exact prevalence or incidence of such disorder in pregnant women is still unknown. Objectives: To assess the incidence and severity of OSA in pregnant women and to discover the risk factors for OSA during pregnancy. Methods: A total of 30 pregnant women and 30 age matched controls completed Epworth Sleepiness Scale and Stop-Bang questionnaire. SDB diagnosis was based on polysomnography. Results: The incidence of OSA among our studied pregnant women was 36.7% and 53.3% of pregnant women were snorers. They demonstrated significantly higher AHI (4.38 ± 4.45) and ODI (3.72 ± 4.03). There was a significant positive correlation between gestational age and ESS, BMI, AHI and ODI, as they are of their highest levels among cases in the third trimester. Binary logistic regression analysis showed that gestational age and body mass index were independent risk factors with odds ratio (2.23 & 4.99) and 95% CI (1.05–5.32 & 1.75–33.28) respectively while the neck circumference and ESS were considered as dependent risk factors. Conclusion: Pregnancy is a risk condition for OSA which aggravated by neck circumference and base line BMI. The susceptibility and severity increase by increasing gestational age.

Background: Interstitial lung diseases (ILD) are a heterogeneous group of diffuse parenchymal disorders characterized by different grades of fibrosis and inflammation. A number of proinflammatory and profibrotic extracellular mediators have been implicated in the pathogenesis of ILD. Transforming growth factor beta 1(TGF-β1) is one of these mediators. Objective: The study aimed to investigate the association between two common polymorphisms in the gene encoding TGF-β1 and the risk for the development of ILD and whether those polymorphisms affect the serum level of TGF-β1 or have a relation with disease prognosis. Subjects and methods: The study included 90 subjects who were classified into: 56 patients suffering from ILD and 34 healthy subjects served as controls. Pulmonary function tests, arterial blood gases, serum levels of TGF-β1 were determined for all subjects. Genotyping for codon 10 and codon 25 polymorphisms by PCR-RFLP analysis was performed to be correlated with the serum and bronchoalveolar lavage (BAL) levels of TGF β1 and disease prognosis. Results: The allele frequencies of both polymorphisms showed no significant differences between patients and controls. However the CC genotype of codon 10 polymorphism showed significant correlation with higher levels of serum and BAL TGF-β1 and worse prognosis of the disease. Conclusion: It could be concluded that there is no significant association between codon 10 and codon 25 polymorphisms of TGF-β1 and the risk for development of ILD while there was an association between the genetic variants of codon 10 polymorphism, the serum and BAL levels of TGF-β1 and the prognosis of the disease.