Bronchial asthma control, quality of life, and psychiatric disorders vicious cycle: Asyut society point of view

Background Poorly controlled bronchial asthma limits patients’ quality of life (QOL), the condition which may potentiate the development of psychiatric disorders. The aim of this study was the assessment of anxiety and depression in bronchial asthma patients, and their interrelation with both level of asthma control and quality of life in our society. Results This study included 102 bronchial asthma patients, and 50 healthy control individuals. Patients had poorer QOL, and higher anxiety and depression scores compared to healthy control, moreover these scores were higher in uncontrolled asthma patients compared to controlled group. Poor QOL, frequent hospital admissions, and poor asthma control were the predictors for psychiatric disorders. Conclusion Depression and anxiety are frequently encountered in patients with bronchial asthma in our society; poor symptom control, poor QOL, and frequent hospital admissions are the main predictors for these psychiatric disorders.

Lifethreatening tracheal obstruction in a child caused by nodular fasciitis: case presentation

Background Nodular fasciitis (NF) is a rare non-neoplastic inflammatory tumor and usually presents as a painless, rapidly growing subcutaneous soft tissue mass. The head and neck are relatively common locations for nodular fasciitis, particularly in children. NF in the trachea is rare and may evolve to a fatal condition, especially due to its rapidly growing nature that can cause life-threatening tracheal obstruction. Case presentation We report the case of a 5-year-old child with NF in the trachea and subtotal tracheal obstruction. Bronchoscopy and biopsy proved the diagnosis, and bronchoscopic excision of the tumor was performed. Conclusions NF is a rare airway tumor, occurring mostly in adults, and may presenting with pneumonia-like symptoms. Early detection of the lesion is essential to avoid life-threatening airway obstruction.

Clinical and sonographic evaluation of the diaphragm after plication in adults with unilateral eventration: a retrospective study

Background We aim to assess the role of diaphragm ultrasonography in evaluating the outcome of surgical diaphragmatic plication in adults with symptomatic unilateral diaphragmatic eventration. Results Forty patients with symptomatic unilateral diaphragmatic eventration underwent surgical diaphragmatic plication between 2015 and 2020. The etiology was idiopathic in 34 (85%) cases, and 37 (92.5%) of them were suffering from dyspnea. Diaphragm ultrasonography showed no diaphragmatic movement on the affected side in 10 (25%) patients and a paradoxical movement in 30 (75%) patients. Surgical diaphragmatic plication was done successfully in all cases. Postoperative complications were reported in 3 (7.5%) cases, with no mortality. There was a highly significant improvement in dyspnea at 1 week and 6 months follow-up. CXR showed a highly significant decrease in the mean height of eventration at 1 week 3.7 ± 1.2 cm (P < 0.001), and 6 months 2.6 ± 0.9 cm (P < 0.001), compared to preoperative values (10.1 ± 2.8 cm). diaphragm ultrasonography showed normal motility of the plicated cupola in all cases, and there was a highly significant decrease in the mean height of eventration at 1 week (3.1 ± 1.1 cm, P < 0.001), and 6 months (2.3 ± 0.5 cm, P < 0.001) compared to preoperative values (10.3 ± 2.2 cm). There was a highly significant increase in the diaphragm thickness at 1 week (2.7 ± 0.3 mm, P < 0.001), and 6 months (2.9 ± 0.2 mm, P < 0.001), compared to the preoperative value. There was a highly significant improvement in the degree of excursion 1 week (25 ± 4.3 mm, P < 0.001), and 6 months (28 ± 5.2 mm, P < 0.001), compared to the preoperative value (15 ± 6.2 mm). No fluid collection or surroundings organ injuries were detected. The mean FVC and FEV1 showed a highly significant improvement at 1 week (66.7 ± 6%, 78.2 ± 9.8%), and 6 months (68.8 ± 5.7%, 80.4 ± 10.3%), compared to the preoperative value (58.8 ± 8% and 70.9 ± 10.3%). Conclusions Surgical diaphragmatic plication is an effective and safe procedure that can be performed to treat symptomatic adults with unilateral diaphragmatic eventration. Diaphragm ultrasonography can be used as a simple bedside test to evaluate unilateral diaphragmatic eventration cases and their postoperative follow-up.

Pneumomediastinum: retrospective analysis of 19 cases and an innovation proposal in classification

Background Guidelines to standardize treatment and follow-up strategies in pneumomediastinum cases are lacking. The aim of the study was to evaluate the etiology in pneumomediastinum cases and the results of treatment and follow-up. Results Nineteen patients with pneumomediastinum who were followed up in our clinic between 2015 and 2020 comprised the study population. Among the patients, 16 (84.2%) were male, and the mean age was 31.15 years. The chief presenting complaints were chest pain and dyspnea. Pneumomediastinum was spontaneous in 15/19 patients (including spontaneous pneumomediastinum with an underlying pathology in 3/15), traumatic in 3/19, and iatrogenic in 1/19. Spontaneous pneumomediastinum without underlying pathology was seen in younger adults (mean age: 23 years). Surgical intervention in traumatic and iatrogenic pneumomediastinum cases was compared with spontaneous cases and no statistically significant difference was observed (p=0.178). The mean hospital stay of all patients was 3.15 days. Only one patient had a recurrence and died, which was later determined to be a secondary spontaneous pneumomediastinum case. Conclusion Pneumomediastinum often occurs with an underlying pathology in advancing age and as spontaneous in younger patients. Therefore, “secondary spontaneous pneumomediastinum” subclass should be evaluated in the classification to facilitate to create a standard guideline and prevent overdiagnosis and overtreatment.

A novel differential diagnosis for diffuse cavitating nodules: primary pulmonary plasmacytoma

Background Extramedullary plasmacytoma is a rare monoclonal plasma cell neoplasm that originates from tissues other than the bone marrow and constitutes only 3%–5% of all plasma cell neoplasms. Most cases involve the upper respiratory tract. Extramedullary plasmacytoma involving the lung is extremely rare. Primary pulmonary plasmacytoma is a rare type of extramedullary plasmacytoma, usually presenting with a nodule or mass in hilar region. Literature search has shown very few cases of immunohistochemically confirmed cases of pulmonary plasmacytoma. Diffuse pulmonary infiltration is an unusual presentation. Case presentation We report the case of a 56 year old lady with history of cough and breathlessness since one month. Computed Tomography revealed diffusely scattered multiple cavitating nodules and consolidation in both lungs. Computed Tomography guided biopsy of one of the lung nodules was done. Histopathologic examination and immunohistochemistry showed features of pulmonary plasmacytoma .This is an unique case of primary pulmonary plasmacytoma with the rare presentation as diffusely scattered multiple cavitating nodules and consolidation. According to our literature search, primary pulmonary plasmacytoma manifesting as cavitating nodules is being reported for the first time. Conclusions Primary pulmonary plasmacytoma should be also be considered in the differential diagnosis of multiple diffusely scattered cavitating lung nodules.

Diabetes in COVID-19 patients: challenges and possible management strategies

Background The recent pandemic of coronavirus disease 19 (COVID-19) has been causing intense stress among the global population. In the case of hospitalized and ICU-admitted COVID-19 patients with comorbidities, it has been observed that a major portion of them are diabetic. Therefore, researchers had indicated a link between diabetes mellitus (DM) and COVID-19. Furthermore, DM is a potential risk factor for the severity of COVID-19 cases. Thus, in this study, the correlation existing between diabetic patients and COVID-19 was summarized. Main body of the abstract Diabetic patients have a weaker immune system, less viral clearance rate, malfunctions of metabolic activity due to their high blood glucose level, and other associated problems. This does not increase the susceptibility for the patients to be infected with COVID-19. However, the severity of COVID-19 can worsen due to the comorbidity of DM. Short conclusion Proper management, appropriate use of drugs that do not increase the ACE2 expression, lowering blood glucose level, decreasing the susceptibility of SARS-CoV-2, and maintaining a healthy lifestyle could be effective.

Sotrovimab: is it effective in early treatment of mild and moderate COVID-19 infections? A retrospective study

Background The monoclonal antibody sotrovimab is manufactured to antagonize many types of coronaviruses including the SARS-CoV-2. It is used mainly to treat mild and moderate COVID-19 infection and to prevent the progression of the disease from critical disease to severe. Objectives To assess the effectiveness of sotrovimab in the early treatment of mild and moderate COVID-19 infections and prevention of disease progression to severe and critical disease. Methods This study was performed on 220 outpatients who have already received sotrovimab in Obaidullah Hospital, United Arab Emirates. All patients underwent the following before receiving sotrovimab: routine laboratory studies (CBC, liver function tests, and kidney function tests) and other laboratory tests (C reactive protein (CRP), D dimer, and chest x-ray). All patients received sotrovimab in a dose of 500 mg once intravenous infusion over 30 min. All laboratory studies and CXR are repeated after 1 week of receiving the dose of sotrovimab. Results The outcome was 43 patients deteriorated (19.5%) and 177 patients improved (80.5%). The progress of patients’ symptoms after receiving sotrovimab where the shortness of breath (SOB) deteriorated in 43 patients (19.5%) and improved in 177 patients (80.5%). The cough symptom deteriorated in 43 patients (19.5%), improved in 177 patients (80.5%). The progress of patients' radiology (chest x-ray) where it is deteriorated in 43 patients (19.5%) and improved in 177 patients (80.5%). The rate of hospitalization after receiving sotrovimab where 41 patients were hospitalized (18.6%) and 179 patients were not hospitalized (81.4%). There was a statistically significant difference before and after using sotrovimab in vital signs, inflammatory markers, kidney function tests, electrolytes, endocrine functions, and hepatic profile. Conclusion Among adults with mild and moderate COVID-19, the use of sotrovimab significantly improved resolution of symptoms, outcome, radiology, or laboratory marker and decreased hospitalization. The findings support using sotrovimab in the early treatment of mild and moderate COVID-19. Wide-scale studies may be required for clarifying the effects of sotrovimab in the treatment of mild and moderate COVID-19 infections.

Correction to: The role of diaphragmatic ultrasound as a predictor of successful extubation from mechanical ventilation in respiratory intensive care unit

An amendment to this paper has been published and can be accessed via the original article.

A case of tuberculosis of the rare azygos lobe of the right lung

Background The azygos lobe is a rare anatomical variant seen in the upper lobe of right lung. It occurs during embryological development due to the failure of posterior cardinal vein to migrate supero-medially. It is often an incidental finding on imaging and is asymptomatic in majority of cases. Tuberculosis involving the azygos lobe is extremely rare. Only a few cases of tuberculosis involving the azygos lobe have been reported in literature. Case presentation We present a rare case report of tuberculosis infection involving the azygos lobe in a 57-year-old male with history of chronic cough, fever, hemoptysis, and weight loss. Conclusions The azygos lobe is usually asymptomatic, but it may be misdiagnosed as bulla, lung cyst, or abscess. In rare cases it may be associated with certain pathology such as tuberculosis, other infections, and lung cancer. Hence, it is pertinent for a radiologist to be aware of this variant when reporting chest imaging cases.

The role of diaphragmatic ultrasound as a predictor of successful extubation from mechanical ventilation in respiratory intensive care unit

Background The diaphragm muscle whose dysfunction may be very common in patients undergoing mechanical ventilation (Ferrari G, De Filippi G, Elia F, Panero F, Volpicelli G, Aprà F. Crit Ultrasound J 6:8, 2014). Aim: To evaluate real-time ultrasound in the evaluation of diaphragmatic thickening, thickening fraction, and/or excursion to predict extubation outcomes. We aimed to compare these parameters with other traditional weaning measures is a fundamental. Results Out of 80 included patients, 20 (25%) have failed extubation. Diaphragmatic thickening (DT), thickening fraction (DTF), and/or excursion (DE) were significantly higher in the successful group compared to those who failed extubation (p < 0.05). Cutoff values of diaphragmatic measures associated with successful extubation (during tidal breathing) were ≥ 17 mm for DE; ≥ 2.1 cm for DT inspiration; ≥ 15.5 mm for DT expiration, functional residual capacity (FRC); and ≥ 32.82% for DTF %, giving 68%, 95%, 62%, and 90% sensitivity, respectively, and 65%, 100%, 100%, and 75% specificity, respectively. Cutoff values of diaphragmatic parameters associated with successful extubation (during deep breathing) were > 28.5 mm DT Insp, total lung capacity (TLC); >22.5mm DT Exp (RV); >37 DTF %; and > 31 mm DE, giving 100%, 73%, 97%, and 75% sensitivity and 65%, 75%, 100%, and 55% specificity, respectively. Rapid shallow breathing index (RSBI) had 47% sensitivity but 90% specificity. Conclusion Ultrasound evaluation of diaphragmatic parameters could be a good predictor of weaning in patients who passed the T-tube.