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Background: Gene polymorphisms and COPD susceptibility have been paid special attention and were explored in a large number of studies. The results varied between studies and populations. We aimed to analyze the relation between susceptibility to COPD and polymorphisms of Glutathione S-transferases (GST); GSTM1, GSTT1 and Microsomal epoxide hydrolase-1 (EPHX1) genes in a sample of Egyptian population.Methods: Genetic polymorphisms of GSTM1, GSTT1 and EPHX1 genes in 146 COPD patients and 130 controls were investigated using multiplex PCR for GSTM1 and GSTT1 genes and PCR-RFLP for EPHX1 genes.Results: The frequency of GSTM1-null genotype was higher in patients than in controls (72.6% versus 43.8%, P < 0.001). Carriers with both null GSTT1 and GSTM1 genes were at a higher risk of COPD (OR 3.45, 95% CI = 1.07-11.14). The frequency of EPHX1 exon 3 His allele was higher in patients than controls (19.2% versus 12.7%, P = 0.04). Carriers with exon 3 His allele were at a higher risk of COPD (OR 1.63, 95% CI = 1.02-2.6, P = 0.04). Carriers with both GSTM1-null and EPHX1 113Tyr/Tyr or EPHX1 113Tyr/His genotypes were at a higher risk of COPD (OR 3.33, 95% CI = 1.32-8.35 and OR 14.24, 95% CI = 3.02-67.17 respectively). Carriers with both GSTM1-null and EPHX1 139His/His genotypes were at a higher risk of COPD (OR 5.58, 95% CI = 2.14-14.52).Conclusions: EPHX1 exon 3 His allele in addition to the coexistence of other genetic variants, were significant risk factors in susceptibility to COPD in the Egyptian population.

Background: The accurate diagnosis of pleural effusion remains a challenging problem even after thoracentesis and closed pleural biopsy. Medical thoracoscopy has been established to have a greater diagnostic yield in the diagnosis of exudative pleural effusion. Forceps biopsy, pleural brush and lavage could be used through medical thoracoscopy to obtain pleural specimens.Objective: The aim of this study is to evaluate the role of thoracoscopic pleural lavage and brush in undiagnosed exudative pleural effusion.Patients and methods: This prospective study was carried out on 25 patients having undiagnosed exudative pleural effusion. All patients submitted to medical thoracoscopy, where forceps biopsy, pleural brush and pleural lavage specimens were taken for all patients and sent for histopathological and cytological examination.Results: Combined thoracoscopic pleural specimens were diagnostic in 24 patients (96%), and all of them were malignant. Forceps biopsy was positive in 23 patients (92%), while pleural brush and pleural lavage were positive in 18 patients (72%) and 15 patients (60%) respectively. Pleural brush was the only diagnostic modality in one patient. Minimal complications were recorded.Conclusion: Combined thoracoscopic pleural specimens (forceps biopsy, brush and lavage) increase the diagnostic yield of medical thoracoscopy for patients with undiagnosed exudative pleural effusion than separate them. Thoracoscopic pleural brushing is a safe diagnostic technique as it can brush certain dangerous areas of the pleura. Pleural lavage is more diagnostic than the initial thoracentesis.

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