Background Tuberculous pleurisy and malignancy are two of the most common causes of pleural effusion. IL-33 is expressed in the epithelial lining and endothelial cells and is released after cell damage; it is proposed to have an essential role in sensing damage in various infectious and inflammatory diseases. This work aimed to determine the diagnostic role of IL-33 in pleural effusions. Methods One hundred seventeen patients with pleural effusions of different etiologies had a quantitative measurement of IL-33 in their pleural effusion and serum samples by ELISA technique. Results The concentrations of IL-33 (mean ± SD) in tuberculous pleural effusion (TPE) group (22.5 ± 0.90 ng/l) were significantly higher than that of malignant pleural effusion (MPE) group (14.6 ± 2.35 ng/l; P < 0.001). There is no significant difference between the serum levels of IL-33 in (TPE) group and (MPE) group ( P > 0.05). The concentrations of IL-33 in the pleural effusions were significantly correlated to that of the serum concentrations in each group (TPE: r = 0.848, P = < 0.001; MPE: r = 0.881, < 0.001) and pleural ADA in patients with tuberculous pleural effusions, ( r = 0.38, P < 0.001). The cut-off value of pleural IL33 for (TPE) was 19.16 ng/l, with a sensitivity of 91.7%, a specificity of 96.4%. The cutoff point of a pleural/ serum IL-33 ratio for the diagnosis of TPE was > 1.4 with a sensitivity of 91.7% and specificity of 100% while for the determination of (MPE) was < 0.9 with a sensitivity of 83.3% and specificity of 96.4%. Conclusion IL-33 level may serve as a novel biomarker to differentiate pleural effusions, especially tuberculous from malignant effusions.
Background: There is bidirectional relationship between obstructive sleep apnea and metabolic disease. Sleep apnea results in intermittent hypoxia and sleep fragmentation, which lead to and exacerbate obesity and type 2 diabetes by increasing sympathetic activity, oxidative stress, inflammation and lipolysis. Moreover, metabolic disease can lead to or exacerbate sleep apnea through weight-dependent and physiology-dependent mechanisms.Objective: The study aimed to explore the association between metabolic syndrome and obstructive sleep apnea (OSA). Patients and Methods: This study was conducted at Sleep Unit of Chest Department Benha University Hospitals. This study enrolled 100 patients that were divided into two groups: Group A, which included 80 patients with metabolic syndrome as cases and group B that included 20 patients without metabolic syndrome as control group. All patients included in this study were subjected to lipid profile, HbA1c, overnight polysomnography (PSG). Results: There was highly statistically significant positive correlation between apnea hypopnea index (AHI) and waist circumference, TG, HbA1C, systolic blood pressure, diastolic blood pressure and sum all night desaturation. There was highly statistically significant negative correlation between AHI and HDL and minimal SPO2. TG, HDL, Hb A1C and systolic and diastolic blood pressure were significant predictors for increase AHI and increase OSA severity. Conclusion: OSA was highly prevalent in patients with metabolic syndrome, which is associated with increasing severity of OSA. Also, it is associated with poorer control of diabetes, hypertension, and dyslipidemia, which are all components of metabolic syndrome.
The elimination of TB requires early, rapid and accurate diagnosis and treatment. TB mortality is mainly due to delayed diagnosis or misdiagnosis which also increases the possibility of TB transmission. Xpert MTB/RIF assay is a new rapid pointof-care test that can in 2 hours, simultaneously detect, Mycobacterium tuberculosis and rifampicin resistance and is capable of overcoming many of the current operational problems in TB diagnosis. Objective: to evaluate the usefulness of Xpert MTB/RIF test for early, rapid, and accurate diagnosis of pulmonary tuberculosis and to determine the added value of the assay to address patients' transmission potential in a fast, accurate and reliable manner. Methodology: Spot sputum samples collected at hospital presentation from fifty patients with symptoms and signs suggestive of pulmonary TB and / or who have suggestive TB chest x-ray, during the period from August 2017 to July 2018. All microbiological analyses were performed on the same sample after splitting it into two aliquots. One aliquot was tested by ZN staining and Xpert MTB/RIF assay and the other was cultured for isolation of TB bacilli by conventional method. Diagnostic performance was done for both ZN stained smear and XPERT MTB/RIF assay using culture as a reference standard. Results: Compared with culture, the sensitivity and the specificity of XPERT MTB/RIF assay were 100% and 75% respectively, PPV was 95.5%, NPV was 100% and there was very good (kappa = 0.834) agreement between both methods. Two samples tested positive by XPERT MTB/RIF though negative by culture and there was significant negative correlation between semi-quantitative results of XPERT MTB/RIF test expressed in cycle threshold values against grade of smear positivity. Conclusion: Xpert MTB/RIF assay had a very high sensitivity and specificity when compared to the reference standard method. It is a single test that is more effective than smear dependent strategies for both T.B diagnosis and evaluation of patient transmission potential. It can detect M. tuberculosis complex and rifampicin resistance in two hours. The assay is rapid, easy to perform with no technical difficulties. This new diagnostic method can lead to more cases of active TB to be detected, avoiding treatment delay, reduction in the transmission risk and improvement in TB control.
Ventilator-associated pneumonia (VAP) is the commonest infection in critically ill patients. The definite mortality rate of VAP is still controversial but may exceed 50% when the initial treatment is not appropriate. Objective: was to compare the performance of quantitative real-time PCR with semi-quantitative culture for diagnosis of VAP caused by P. aeruginosa using two sample types bronchoalveolar lavage and endotracheal aspirates (BAL and ETA) and to phenotypically determine some of P. aeruginosa virulence factors associated. Methodology: Two samples were collected from every patient on the day of suspected VAP, one is endotracheal aspirate sample and the other is bronchoalveolar lavage sample. Each sample (BAL and ETA) was divided into two aliquots, one for conventional microbiological analysis and the other was frozen at −80°C for molecular detection and quantification of P. aeruginosa. Isolates were phenotypically tested for the expression of some of the virulence factors frequently associated with human infections. Results: There was excellent concordance correlation between qPCR and conventional culture for detection of P. aeruginosa in BAL samples, between both methods for detection of P. aeruginosa in ETA samples and between the two types of samples (BAL and ETA) for the two investigated methods. The most frequently associated virulence factor was alkaline protease production in 81.25% of isolates, followed by biofilm forming capacity in 75% of the isolates. Conclusion: Our study revealed that qPCR can afford rapid and reliable quantitative microbiological data, with very high sensitivity and specificity for P. aeruginosa involved in VAP. It also tended to verify that the same pathogen can be detected and quantified from the two sample types using conventional or molecular method. These results decrease the utility of BAL sample, which is difficult to perform, more invasive, expensive and more time consuming than ETA.
Psychological issues, particularly anxiety and depression, have received growing attention in chronic disease patients and should not be overlooked when assessing patient's quality of life (QoL). This is a significant objective in the clinical administration of an incessant irreversible illnesses, for example, ceaseless obstructive pneumonic ailment (COPD) A case control investigation of incorporate 100 patients with cutting edge constant respiratory maladies including serious persevering asthma, extreme COPD, broad bronchiectasis and interstitial lung infections. Patients were chosen arbitrarily from those going to inpatient ward and outpatient center at Chest office in Benha University Hospitals. 20 age and sex coordinated evidently ordinary subjects will be incorporated as negative controls just as 20 mellow ceaseless respiratory issue as positive controls.There was high huge FEV1 was in negative control than positive control than the contemplated gathering, Anxiety and wretchedness more in female than guys .Also nonappearance of uneasiness was fundamentally high in negative control than in positive control than in study gathering. profoundly noteworthy melancholy scores in the examination bunches than control group.no critical. the Prevalence of tension and wretchedness more in patients without respiratory disappointment than those have respiratory failure.Prevalence of uneasiness and melancholy progressively regular in ceaseless respiratory diseases.Many factors influence predominance and seriousness of both nervousness and despondency as gender,FEV1 PAP, dyspnea.
PURPOSE: Epigenetic gene silencing due to promoter hypermethylation & histone acetylation influence various molecular pathways in leukemogenesity of Acute Myeloid Leukemia (AML). Combined use of DNA methyltransferases & histone deacetylases inhibitors proved to reverse the methylomic phenotype of myeloid blasts & improve patient's prognosis. The study recruited 68 Adults patients 45 received novel combination of the HDACi valproic acid +/-the Dnmt1 inhibitor; epigallocatechingallate "EGCG" parallel to standard chemotherapy for 2 successive cycles. RESULTS: We recorded; 37/45 (CR), 7 (PR) &1 (RF), 60% MRD elimination. Decreased Dnmt1 & HDAC1 activities (p<0.001). Reversed P15 INK4B gene methylation & expression states 58 %, (p<0.02) & decreased levels of VEGF, bfgf, IL-6, NF-KB, TNF, COX-2 & P65 cytokines levels in a harmonized orchestra (p<0.01). Survival analyses showed high significant 2 years DFS (P<0.01). CONCLUSION: The used epi-drug combination distinctively exerted a destructive impact on AML blasts interpreted to tumor regression, better hematological & clinical response.
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