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Context Exudative pleural effusion is a diagnostic dilemma that includes many steps; one of them is obtaining a definite diagnosis through pleural biopsy. Cryoprobes are being increasingly used for obtaining larger specimens with fewer crush artifacts. However, the safety and feasibility of cryoprobe biopsy compared with standard forceps for pleural biopsy have not been fully assessed. Aims To evaluate the diagnostic value, size, and quality of the specimens obtained by flexible cryoprobe in comparison with those obtained by flexible forceps probe during medical thoracoscopy in patients with exudative pleural effusion and to assess the possible complications from the procedure. Settings and design This interventional prospective study was carried out at the endoscopy unit at Chest Department and Tuberculosis Assiut University Hospital. Patients and methods This study included 60 patients with undiagnosed exudative pleural effusion. Medical thoracoscopy was carried out for all the patients, and pleural biopsies were taken from the parietal pleura using a conventional rigid forceps probe and flexible cryoprobe in the same settings. Results Cryoprobe biopsy established a definite diagnosis in 55/60, with 91.6% diagnostic yield, whereas forceps biopsy had a definite diagnosis in 53/60, with 88.3% diagnostic yield. The size of cryoprobe biopsy was significantly larger in comparison with the forceps biopsy (26.56 ± 22.16 vs. 17.38 ± 12.08 mm2; P<0.001). The depth of pleural biopsy was evaluated by the presence of extrapleural fat cells, which were significantly higher in cryoprobe biopsy in comparison with forceps biopsy [21 (35%) vs. 11 (18.3%); P=0.03]. There were no significant complications or procedure-related deaths. Conclusions Cryobiopsy is a possible safe and effective alternative to conventional forceps probe biopsy in the diagnosis of exudative pleural effusion with a larger, deeper, and less number of biopsies. It was also found that cryoprobe biopsy had a better diagnostic yield, sensitivity, and accuracy. [ABSTRACT FROM AUTHOR]

Background Early release of patients from mechanical ventilation and intubation associated with significant decrease in mortality and morbidities. Aim Evaluation of echocardiography and oxidative stress markers in the prediction of weaning failure. Patients and methods In all, 120 mechanically ventilated patients were included in the study. Patients were evaluated by tissue Doppler transthoracic echocardiography before and during the spontaneous breathing trial (SBT). In addition to ventilatory parameters, blood samples were obtained for the measurement of lipid peroxidase, glutathione oxidase, and nitric oxide. Different parameters were compared between failed and successful weaning groups. Results During SBT, respiratory rate, heart rate, and rapid shallow breathing index (RSBI) were significantly increased compared with before SBT. The serum level of nitric oxide before SBT was significantly decreased in the failed group. All cardiac dimensions significantly increased during SBT compared with before SBT; moreover, the left ventricular dimensions increased significantly in the failed group during SBT. There was significant decrease in right ventricular systolic function during SBT as estimated by tricuspid annular plane systolic excursion (TAPSE) and myocardial performance index. Weaning success was positively correlated with tidal volume, TAPSE, and nitric oxide, while negatively correlated with lipid peroxidase, respiratory rate, left ventricular end-diastolic dimension, and E/E' of lateral mitral valve annulus. Tidal volume more than or equal to 493 ml before SBT had the highest sensitivity for predicting successful weaning; on the other hand, during SBT left ventricular end-diastolic dimension less than or equal to 5.05 cm had 100% sensitivity and TAPSE more than or equal to 1.65 had 88.9% sensitivity. Respiratory rate less than or equal to 27.5 during SBT had the highest specificity (72.7%). Conclusion In comparison to oxidative stress markers, clinical assessment and bedside transthoracic echocardiography have higher sensitivity, so they can be considered valuable and cheap predictors of successful weaning. [ABSTRACT FROM AUTHOR]

Background Several millions of humans all over the world were affected by the novel coronavirus that emerged in Wuhan, Hubei, China, at the end of December 2019, known as severe acute respiratory syndrome coronavirus 2. The epidemic has gradually spread to 208 countries, leading to the death of more than two million and a half people, and this number is rapidly increasing. The rationale of the current study was to assess the role of some simple blood markers in suspecting the outcome of patients with severe infection. Patients and methods A cohort retrospective study was carried out that included critically ill coronavirus disease 2019-infected patients with positive PCR test result who were admitted to the critical care unit within 2 months. Information concerning clinical presentation, laboratory, and radiological findings was collected; moreover, the outcome and the length of critical care stay were documented. Statistical analysis was done, where collected data were compared between survivors and nonsurvivors. Receiver operating characteristic curve was used for the assessment of sensitivity and specificity of blood markers in predicting mortality. Results The number of patients included in the present study was 103. Most patients presented with fever and cough, and the main radiological finding was bilateral ground-glass lesions. On comparing both groups, the group that survived had elevated baseline values of PaO2/FiO2 ratio and lymphocyte count. However, the number of neutrophils, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, D-dimer, and serum level of ferritin were lower in this group; nonsurvivors had longer ICU stay. The following parameters were predictors for mortality: older age; increased neutrophil count, NLR, and D-dimer levels; and lower values of PaO2/FiO2 ratio. D-dimer and NLR had the highest sensitivity (81.3 and 87.5%, respectively) with area under the curve of 0.82 and 0.76, respectively. Conclusion Simple blood markers are sensitive parameters for suspecting outcome of severe coronavirus disease 2019 infection. [ABSTRACT FROM AUTHOR]

Background Adult respiratory distress syndrome (ARDS) and acute cardiogenic pulmonary edema (CPE) are common clinical issues. Based on clinical data, it is a big challenge to differentiate between both. Secondary to many limitations of computed tomography, chest ultrasound (CUS) provides pleuropulmonary signs that help in differentiation. Objective The current work aimed to assess the accuracy of CUS in differentiating CPE from ARDS. Patients and methods This is a cross-sectional study conducted on patients admitted to different ICUs with pulmonary edema, comprising 25 patients with CPE and 35 patients with ARDS. CUS, ECG, echocardiography, and chest radiograph were done for all patients. Results The mean age of patients with ARDS was 48.90±11.23 years, whereas the mean age of patients with CPE was 49.10±10.10 years. The majority of both groups were males. Systolic dysfunction and pneumonia were the most frequent etiology in CPE and ARDS, respectively. All patients in both groups had alveolar-interstitial syndrome. Pleural line, absence of lung sliding, and the spared area were presented in all cases with ARDS and absent in those with CPE. Moreover, none of those with CPE had lung pulse, but this finding was presented in 18 (51.4%) patients with ARDS. Conclusion CUS can help in differentiating ARDS from CPE in clinical practice. Based on CUS findings, absent or reduced lung sliding, pleural line abnormalities, and spared areas are diagnostic of ARDS. [ABSTRACT FROM AUTHOR]

Background Predicting mortality and outcome of critically ill patients is an interesting point for research, so different acuity scores, such as Acute Physiology and Chronic Health Evaluation II, Simplified Acute Physiology Score II (SAPS II), Mortality Probability Model II (MPM II), and Sequential Organ Failure Assessment (SOFA), and biochemical markers are under investigation for its assessment. Aim The aim of this study were to compare between different ICU scores, for predicting mortality and to assess validity of some biochemical markers such as C-reactive protein (CRP), neutrophil-lymphocytic ratio (NLR), platelet to lymphocyte ratio, red cell distribution width, and mean platelet volume in the assessment of ICU outcome. Patients and methods This prospective cross-sectional study included 104 patients. The patients were subdivided into survivor and nonsurvivor groups. Acute Physiology and Chronic Health Evaluation II and SAPS II scores of the patients were recorded on the first day of admission to respiratory ICU, while SOFA and MPM II scores were recorded on the first and third (SOFA72, MPM72) days of ICU admission, where both groups were compared in terms of different ICU acuity scores as well as some biochemical markers. Sensitivity and specificity of each parameter for predicting mortality were calculated. Results The nonsurvivor group included 41 (39.4%) patients. All model scores as well as CRP and NLR were significantly higher in the nonsurvivor group; SOFA72 score had the highest sensitivity of 94.8% with an area under the roc curve (AUR) of 0.94 while the MPM72 score had the highest specificity of 91% with an AUR of 0.81 with a cutoff value of 5 and16, respectively. Conclusion While SOFA72 score has the highest sensitivity, MPM72 score has the highest specificity for predicting ICU mortality. NLR and CRP values are independent prognostic factor for hospital mortality in critically ill patient. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although hypothyroidism has an insidious onset and relatively asymptomatic, exertional dyspnea and fatigue can be the presenting complaints. OBJECTIVES: The aim is to assess functional lung impairment in hypothyroid patients both at rest and during exercise. METHODS: A case-control study was carried out on 42 patients with newly diagnosed hypothyroidism and 12 control subjects. Hypothyroidism was diagnosed based on high value of thyroid stimulating hormone (TSH) ≥6 μIU/ml, and low value of free thyroxin (FT4) ≤0.8 ng/dl, both groups had chest X-ray, spirometry, diffusing capacity of the lungs for carbon monoxide (DLCO), arterial blood gases (ABGs) and symptom-limited exercise testing using treadmill. RESULTS: Both groups were comparable as regard age, sex, and body mass index. Although ABG and spirometry were within normal in both groups, forced vital capacity %, and forced expiratory flow (FEF25–75) % were significantly reduced in the hypothyroid group (P = 0.014, 0.000, respectively), DLCO significantly reduced in hypothyroidism (P = 0.005). As regard exercise testing parameters, maximum oxygen consumption %, minute ventilation, tidal volume, and oxygen pulse were significantly reduced in hypothyroidism (0.005, 0.000, 0.000, and 0.02 respectively). TSH significantly negatively correlated with forced expiratory volume in 1 s %, FEF25–75%, and DLCO while they significantly positively correlated with FT4. CONCLUSION: Even with the presence of normal chest X-ray, arterial blood gases, and spirometry in patients with hypothyroidism DLCO and exercise testing parameters can be significantly reduced. [ABSTRACT FROM AUTHOR]