MicroRNA (miRNA)-21 and miRNA-155 are important regulators of gene expression of different immunological molecules. This study aimed to investigate the role of miRNA-21 and miRNA-155 as biomarkers in asthma by comparing their serum expression levels in asthmatic patients to those in healthy controls and correlating their levels with serum IL-4. The expression levels of miRNA-21 and miRNA-155 were evaluated by quantitative RT-PCR. Serum levels of IL-4 were determined using ELISA. Asthmatic patients showed significantly higher serum miRNA-21 and miRNA-155 expression levels compared to controls. A statistically significant positive correlation between the expression levels of miRNA-21 and IL-4 serum levels in asthmatic patients was detected. Nonetheless, no correlation was detected between miRNA-155 expression and each of IL-4 and miRNA-21. A receiver operating characteristic curve analysis showed that at a cut-off value of 1.37, the sensitivity of miRNA-21 as an asthma biomarker was 100% and the specificity was 95%. At a cut-off value of 1.96, the sensitivity of miRNA-155 as an asthma biomarker was 100% and the specificity was 100%. It can be concluded that miRNA-21 and miRNA-155 are potential non-invasive biomarkers in the diagnosis of eosinophilic asthma and its response to therapy.

Add-on devices that are attached to metered-dose inhalers (MDIs) were introduced to improve aerosol delivery. The objective of this study was to determine the efficacy of drug delivery from an MDI when attached to different add-on devices at different inhalation volumes.The total emitted dose (TED) of salbutamol was estimated for the MDI alone and the MDI connected to five different add-on devices (Able valved holding chamber, Tips-haler valved holding chamber, Aerochamber plus flow Vu valved holding chamber, Dolphin chamber, and a handmade water bottle spacer), at inhalation flow of 28.3 L·min−1 with flow volume of 1, 2 and 4 L, assuming young child (aged <6 years), old child (>6 years) and adult inhalation volumes, respectively.The TED% ranged between 84.1% and 87.2% at all inhalation volumes from the MDI alone, which was significantly greater than all MDI add-on device combinations (p<0.05). The TED% delivered to MDI sampling apparatus by a homemade water bottle spacer and Dolphin chamber, as non-antistatic add-on devices, ranged between 30.5% and 35.3%. However, washing these non-antistatic add-on devices with a light detergent before use improved their TED to range between 47.6% and 51.2%. Non-antistatic add-on devices had significantly lower TED (p<0.05) than that delivered by most antistatic add-on devices, which ranged from 51.3% to 71.6%.This study suggests that antistatic add-on devices delivered much more aerosol than non-antistatic add-on devices. However, it may be advised to still use a non-antistatic add-on device, for the sake of solving the coordination problem, and wash it with light detergent before use to improve TED.

Background Hypersensitivity pneumonitis (HP) is an immune-mediated disorder that causes inflammation of interstitial lung, bronchioles, and alveoli. Although corticosteroids have been used as first line treatment for HP for many years, it does not provide satisfactory results in all patients. The aim of this study is to compare the effect of oral methylprednisolone on different radiological patterns of HP to identify the most adequate candidates for corticosteroids. Patients and Methods Fifty-three patients with confirmed diagnosis of HP were divided into two groups according to their radiological patterns based on high resolution computed tomography (HRCT) findings. The first group included 21 patients with fibrotic HP (fHP), the second group included 32 patients without fibrosis; non-fibrotic HP patients (nfHP). The second group is divided into 3 subgroups: mosaic, attenuation, centrilobular nodules and finally, ground-glass opacities. All patients were administered methylprednisolone by dose 0.5mg/kg/day for eight consecutive weeks. HRCT was performed at the beginning of the study. Spirometry, six-minute walk and oximetry were performed periodically to assess the patients’ progress. Results Upon finalizing the treatment process, a significant improvement was noticed in FEV1 ( p < 0.001), FVC ( p <0.001), six-minute walk test ( p =0.001) and oximetry ( p <0.05) in nfHP compared to the fHP patients. However, there was a significant improvement in ( p <0.01), FVC ( p <0.01), oximetry ( p <0.01) and six-minute walk test ( p <0.01) in fibrotic patients after receiving the treatment. There was no significant difference in the response of FEV1 ( p =0.82), FVC ( p =0.15), six-minute walk test ( p =0.36) and oximetry ( p =0.27) among the subgroups of nfHP patients. Conclusion It was accordingly concluded that corticosteroid treatment is more effective in treatment of nfHP than fHP patients but still has effect on fibrotic patients. There is no significant difference in the response to corticosteroids among nfHP patients’ subgroups.

Aims: With an escalating mortality rate reaching 50%, ventilator associated pneumonia (VAP) continues to pose an enormous threat to ICU patients worldwide. Study Design: Prospective cohort study.

27 patients diagnosed as chronic obstructive pulmonary disease (COPD) came with acute hypercapnic respiratory failure due to COPD and met the inclusion and exclusion criteria. They were managed by non invasive positive pressure ventilation (NIPPV). 21 cases showed success and 6 cases showed failure and were put on invasive mechanical ventilation within the first 24 h. It was shown that before initiation of NIPPV, the failed cases had significantly higher Body Mass Index (BMI) 34.7 compared to 28.1 in successful cases and significantly lower pH 7.20 ± 0.05 compared with 7.27 ± 0.04. After 1 h of initiation of NIPPV, the successful group showed improvement regarding pH and PaCO 2 , while the failed group showed worsening of the same parameters, with a significant difference (p value <0.001, 0.005), respectively. After 4 h, there was improvement in both groups regarding pH which reached normalization in the successful group, PaCO 2 , and PO 2 , with no statistical significant difference. There were significant differences in the respiratory rate (p value < 0.001), and the expiratory positive airway pressure (EPAP) (p value 0.024) between the two groups. Thus we can conclude that the use of NIPPV in such patients can be successful in around 78% of cases, however failure can be predicted by high BMI, initial lower pH and higher PaCO 2 , insignificant response to NIPPV after 1 h. They also show increased respiratory rate and need for higher expiratory positive airway pressure.