Purpose:To assess the role of diffusion-weighted singleshot echo-planar magnetic resonance imaging (MRI) in patients with mediastinal tumors. Methods:Prospective study was conducted on 45 consecutive patients (29 male, 16 female, age 22-66 years, mean 41 years) with mediastinal tumor. They underwent diffusion-weighted single-shot echo-planar MRI of the mediastinum with a b-factor of 0, 300, and 600 sec/mm 2 . The apparent diffusion coefficient (ADC) value of the mediastinal tumor was correlated with the histopathological findings. Results:The mean ADC value of malignant mediastinal tumors was 1.09 Ϯ 0.25 ϫ 10 Ϫ3 mm 2 /sec, and of benign tumors was 2.38 Ϯ 0.56 ϫ 10 Ϫ3 mm 2 /sec. There was a significant difference in the mean ADC value between malignant and benign tumors (P ϭ 0.001) and within different grades of malignancy (0.001). When an ADC value of 1.56 ϫ 10 Ϫ3 mm 2 /sec was used as a threshold value for differentiating malignant from benign tumor, the best results were obtained with an accuracy of 95%, sensitivity of 96%, specificity of 94%, positive predictive value of 94%, negative predictive value of 96%, and area under the curve of 0.938. Conclusion:The ADC value is a noninvasive parameter that can be used for differentiation of malignant from benign mediastinal tumors and grading of mediastinal malignancy.

Background: Intubated patients experience an intensified need to communicate while their ability to do so is compromised as the endotracheal tube prevents speech which creates patient agitation.Aim: To determine the impact of using augmented alternative communication methods on outcome of intubated COPD patients.Patients and methods: Sixty male COPD intubated patients at the pulmonary critical care unit Mansoura University hospital were randomly assigned into two groups of 30 patients for each. The control group involved patients receiving the routine nursing communication practices while the study group involved patients who utilized modified communication board and paper/pen as an augmented alternative communication methods. Unconscious patients, visual and/or hearing impairment were excluded. Patient satisfaction questionnaire (PSQ), Patient Communication level, duration of intubation and mortality were adopted as endpoints.Results: Based on PSQ, 10% in the study group were very dissatisfied compared to 53.33% in the control group the difference was statistically significant. On the other hand, 40% in the study group were very satisfied compared to 6.66% in the control which was a statistically significant increase p < 0.001. However, the mortality did not differ significantly in both groups 16.66% in the control group compared to 13.33% in the study group.Conclusion: Alternative communication methods can improve the level of satisfaction and decrease distress but it did not change mortality in intubated COPD patients.

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Background: ARDS mortality is still high, many biomarkers had been used to predict the mortality but they may have many drawbacks because of its validity, complications and cost.Study design: Observational study was planned to evaluate the predictive role of serum uric acid level in ARDS outcome. Mortality was the primary end-point while secondary endpoints included total ICU stay, duration of mechanical ventilation and the presence or absence of complications.Aim: The aim of this work is to study the role of serum uric acid level as an outcome predictor in ARDS patients.Patients and methods: Thirty three ARDS patients were enrolled in this study according to Berlin 2012 definition. Patients with diabetes mellitus, chronic renal failure, cardiovascular disorders, decompensated liver disease and known malignancies were excluded from the study. On admission to ICU serum uric acid level was investigated.Results: Sensitivity and specificity of uric acid as an outcome predictor at a cut off of 8.4 mg/dl were 89% and 80% respectively; the area under curve was 0.88 with p value <0.001, mortality in a high uric acid group that reported to be 86.7% was statistically significant higher than the normal uric acid group 38.9%. Conclusion: Serum uric acid level at 8.4 mg/dl cut off point predicts mortality in ARDS patients with 89% sensitivity and 80% specificity.

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