Pulmonary neuroendocrine neoplasms are very rare comprising about 2% of all malignancies. They are a heterogeneous group of malignancies and are further subdivided based on tumour type, and proliferation index. These malignancies have characteristics of neural and endocrine properties. Their resemblance with small cell carcinoma may result in misdiagnosis and treatment-associated side effects. Here we present two cases of carcinoid tumours.

Background Airway microbial colonization (AWC) can complicate lung cancer via mechanical obstruction and altered airway clearance, and possibly several other factors. Consensus over these predictors is lacking. This study explores several potential predictors of AWC in a group of lung cancer patients. Patients and methods Bronchial wash samples of 103 lung cancer patients were obtained and sent for microbiological analysis. AWC was considered positive if the culture methods yielded growth for bacterial organisms (s) that was (were) subsequently identifiable. Demographic, clinical, radiological, and histopathological profiles of the patients were examined for the potential predictability of AWC. Results Data from all enrolled patients (103) were analyzed. The oldest patients were ex-smokers (median age 70 years; IQR: 61–72). Sex significantly influenced smoking status, where ex-smokers were exclusively males ( P <0.001). AWC was detected in 25 (24.3%) patients. Though multiple factors demonstrated high odds ratio for AWC, C-reactive protein level was the only statistically significant predictor on univariate regression analysis ( P <0.001). A multivariate regression model, however, demonstrated that female sex and adenocarcinoma type were statistically significant predictors of AWC, predicting a 3.8 and 3.3-fold increase in AWC risk ( P =0.043, P =0.038, respectively). Conclusion C-reactive protein-level was a statistically significant predictor of AWC when considered in isolation, but not when considered with other more clinically relevant factors. When considered together, both female sex and adenocarcinoma type of lung cancer were statistically significant and independent predictors of AWC in lung cancer patients.

Background Chronic obstructive pulmonary disease (COPD) represents a respiratory muscle dysfunction model. The diaphragm is the primary respiratory muscle, and its evaluation is essential in assessing cases with COPD. Ultrasound (US) may evaluate diaphragmatic excursion and thickness. Objective Ultrasonographic evaluation of the diaphragm in cases that had COPD and examining its association with spiromertric variables. Patients and methods This case-control research performed: 40 cases of clinically stable COPD ( Stable COPD indicates to COPD in cases who are not presently undergoing an exacerbation of their illness. Nevertheless, these cases can have recently undergone exacerbations followed by recovery to a new baseline or having COPD symptoms of different severity .) and 10 healthy controls. All participants have, radiography of chest, clinical investigation, detailed history taking, spirometry [assessment of forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC), FVC, FEV1, and maximum voluntary ventilation percentage of predicted], and US investigation to calculate thickness of diaphragm (TD) at various lung volumes and excursion, and capacities. Results The thickness of the diaphragm at various lung capacities and volumes (total lung capacity, functional residual capacity, and residual volume) assessed by US has been found to decrease progressively with increasing severity of COPD. Diaphragm thickness has been significantly reduced in cases of COPD compared with controls. A highly statistically significant variance among cases had COPD and controls according to FEV1, FEV1/FVC and a statistically significant variance among two groups according to FVC% of predicted have been observed. There was a highly statistically significant variance between cases had COPD with various degrees of severity according to TD (TDFRC, TDTLC, and TDRV), and diaphragmatic excursion. Conclusion US is a simple, reliable, and noninvasive technique that can be used to assess diaphragmatic kinetics and function, including excursion and thickness. There is a negative correlation between diaphragmatic function, as measured by US, and the severity of COPD.

Eosinophilic granulomatosis with polyangiitis (EGPA) is one of the antineutrophils cytoplasmic antibodies (ANCA)-associated vasculitis syndromes which is characterized by extravascular necrotizing granulomas formation, peripheral blood eosinophilia, and extensive tissue infiltration by eosinophils. 30–40% of EGPA patients had positive perinuclear antineutrophilic cytoplasmic antibodies P- ANCA serology; they frequently presented with vasculitis features, e.g., neuropathy, glomerulonephritis, and purpura, whereas ANCA negative patients more frequently presented with pulmonary involvement and cardiomyopathy. We present a case of 36 years old, male patient who presented with atypical presentation of EGPA in form of perforated viscus, followed by sensorimotor polyneuropathy of both Upper and lower limbs. Histopathological evidence of resected bowel showed evidence of small and medium-sized vasculitis with excessive eosinophilic infiltration and granuloma formation. Induction remission by Steroids and Intravenous cyclophosphamide showed a dramatic response in relieving patient’s symptoms. EGPA, ANCA, Blood eosinophilia, vasculitis, Intestinal perforation.

Background Chronic obstructive pulmonary disease (COPD) is a lung disease defined by chronic respiratory symptoms, and airway limitation in the form of obstruction. Cardiovascular abnormalities are highly linked to COPD and they often complicate the disease, many correlations between the two are yet to be explored. In COPD patients left ventricular diastolic dysfunction (LVDD) is a recurrent finding, few studies suggest that it is associated with disease severity. Objectives This study evaluates the association between LVDD and severity of COPD. Patients and methods 62 patients were included in this cross–sectional study. They were included from pulmonology departments at university hospitals. All patients underwent clinical evaluation, spirometry, and echocardiography. The patients were also categorized into COPD group B and E, there was no group A patients. Results The findings revealed high incidence of LVDD (62%), independent of disease severity. There was a highly significant relation between age and LVDD. 11% of the patients had segmental contractility abnormality, which was associated with low forced vital capacity% values. There was a statistically significant difference in forced expiratory volume in the 1st second %, and forced vital capacity% values between the two groups, they were lower in group E. Conclusion COPD patients has a high prevalence of LVDD, independent of disease severity.

Background Malignancy is a well-known etiology of exudative pleural effusion and unfortunately, malignant pleural effusion (MPE) is characterized by high recurrence hence, the patient becomes upset mainly from progressive dyspnea until occurring at rest and indeed, this impairs the quality of life enforcing the patient to frequently seek medical advice to exterminate the problem and prevent or significantly decrease the recurrence Aim The current study aims to compare pleurodesis by a combination of bleomycin and tranexamic acid solution via chest tube instillation and medical thoracoscopic talc poudrage in MPE. Patients and methods A randomized controlled clinical trial included 60 patients with MPE, eligible for pleurodesis, who were divided into two groups: group I included 30 patients who underwent medical thoracoscopic pleurodesis by talc powder and group II included 30 patients who underwent pleurodesis by bleomycin–tranexamic acid combination through injection into siliconized intercostal tube 26 F. Results There was no significant difference between the two groups regarding dyspnea scale improvement and hospital stay, but talc poudrage had a higher success rate than bleomycin–tranexamic acid solution regarding the recurrence. Conclusion The combination of bleomycin–tranexamic acid mixture is comparable to talc powder regarding the improvement of dyspnea and postprocedure hospital stay days.

Background Mechanical ventilation is vital for managing respiratory failure, but long-term use can lead to complications. Weaning may be difficult due to muscle weakness, impaired drive, and patient–ventilator asynchrony. Timely weaning helps reduce morbidity and ICU stay. Aim This study aimed to evaluate and compare the effectiveness of pressure support (PS) and volume support (VS) modes regarding weaning success. The primary endpoint was the weaning success rate. At the same time, additional endpoints included weaning duration, reintubation rates, ICU stay length, and variations in clinical parameters, lung mechanics, and vital signs. Patients and methods This prospective, randomized, controlled study included 102 adult ICU patients at Menoufia University Hospitals. Patients eligible for simple weaning were randomized to either the PS or VS groups. Clinical and ventilatory data were collected and analyzed. Results Successful weaning occurred in 74.5% of PS and 78.4% of VS patients ( P =0.641). Postextubation noninvasive ventilation (NIV) was needed in 23.5% of PS and 19.6% of VS patients ( P =0.630). Sedation was required in 17.6% (PS) and 15.7% (VS) ( P =0.790). Median weaning duration was slightly shorter in the VS group (2 h, interquartile range: 2–5) compared with the PS group (3 h, interquartile range: 2–6), as was the duration of postextubation NIV (3.0 vs. 4.0 days), though neither difference was statistically significant. Initial spontaneous breathing trial failure occurred in 9.8% (PS) and 5.9% (VS) ( P =0.715). Conclusion VS ventilation showed a trend toward better weaning performance, including shorter weaning time and reduced need for sedation and NIV. However, invasive mechanical ventilation duration and ICU stay were slightly shorter with PS ventilation. Further research with larger sample sizes is necessary to validate these results.

Background Malignant pleural effusion (MPE) is prevalent, and the number of patients will likely keep rising due to factors including ageing patients and improved long-term survival in instances with metastatic cancer. This work aimed to evaluate the role of transthoracic ultrasound scores in evaluating the success or failure of pleurodesis whether surgically or chemically in patients with MPE. Patients and methods This prospective interventional randomized study included 30 patients with MPE at the Chest Department, Tanta University Hospitals. The patients were randomly separated into two equal groups; group I where surgical pleurodesis was performed by mechanical irritation of the parietal pleura via thoracoscope and group П where pleurodesis was performed chemically using Iodopovidine. Results Regarding pleural thickness by lung ultrasound (LUS) after the procedure, there was a significant increase in both studied groups with higher significance in group II compared with group I (t= –2.201, P =0.036). Regarding lung sliding score by LUS after the procedure, there was a significant decrease in both studied groups with higher significance in group II compared with group I (t=2.235, P =0.034). Regarding pleural adherence score by LUS after the procedure, it was significantly higher in group II (t=−3.607, P =0.001). Conclusions Thoracic ultrasonography is a simple and effective method to evaluate the success or failure of pleurodesis.

Background Chronic obstructive pulmonary disease (COPD) ranks among the foremost contributors to global morbidity and mortality, with forecasts suggesting it will emerge as the third leading cause of death by 2030. Emerging evidence underscores a robust association between COPD, systemic inflammation, and ensuing cardiovascular complications. Microalbuminuria (MAB), a marker of endothelial impairment and cardiovascular jeopardy, holds potential as a tool for gauging disease intensity in COPD-affected individuals. Objective This study aimed to determine the frequency of MAB among COPD patients and explore its linkage to disease severity, as delineated by the global initiative for chronic obstructive lung disease classification, within an Egyptian cohort. Patients and methods A cross–sectional analysis was conducted involving 60 COPD patients, all over 40 years of age, enlisted from the Chest Department (wards and ICU) of Ain Shams University Hospitals. After securing informed consent, participants underwent clinical assessments, spirometry for disease staging, arterial blood gas evaluations, and MAB measurement via the urine albumin-to-creatinine ratio. Individuals with urinary tract infections, alternative pulmonary conditions, diabetes, hypertension, dyslipidemia or history of renal disease were excluded. Participants were categorized into MAB-positive or MAB-negative groups based on urine albumin-to-creatinine ratio outcomes. Results Of the 60 patients, males predominated (86.7%), with an average age of 58.73±10.75 years (range: 41–84). MAB was detected in 80% of cases (48 individuals), exhibiting urine microalbumin levels of 30–300 µg/l (mean: 103.8±91.8 µg/l). The MAB-positive group experienced a significantly higher annual rate of COPD exacerbations ( P =0.001) and ICU admissions ( P =0.005). Compared with their MAB-negative counterparts, MAB-positive patients displayed substantially lower forced expiratory volume in 1 s, forced expiratory volume in 1 s/forced vital capacity ratios, partial pressure of arterial oxygen (PaO₂), and SO₂, alongside elevated partial pressure of arterial carbon dioxide (PaCO₂) levels ( P <0.001). A urine albumin threshold of 95 µg/l effectively distinguished COPD severity (AUC = 0.787, sensitivity 80%, specificity 75%; P <0.001). Conclusion MAB exhibits a strong association with COPD severity, offering a cost-effective, non-invasive means to pinpoint patients at heightened cardiovascular risk. Routine MAB screening is recommended for COPD patients, particularly those with advanced disease. Further studies are warranted to elucidate its prognostic utility in COPD management.

Context ICU doctors offer 24-hour bedside care for critically ill patients. They may put established preventive methods into clinical practice and play a key role in preventing, controlling, and treating hospital-acquired infections in intubated patients. Healthcare providers must be aware of numerous techniques to follow best practices. Knowledge should increase doctors’ confidence in decision-making. Critical care workers should use evidence-based techniques to provide high-quality care. Aims The present study aims to evaluate doctors’ knowledge, practices, and skills in some respiratory (RICU), medical (MICU), coronary (CCU), and general (GICU) in Egypt. Settings and design Cross–sectional study in ICU. Methods and patient Questionnaire to 167 doctors working in different ICU in Egypt. Statistical analysis used: Pearson χ 2 test was used for detecting differences among data categories. Results There was a significant difference among the study groups regarding experience in the basic ventilator modes, newly developed modes, ventilator graphs, using chest ultrasound in ICU, using echocardiography, the psychic problems in the ICU patients, proper choice of vasopressors, interpreting arterial blood gases, basic interpretation of ECG, inserting endotracheal tube and central venous line placement. There was a significant increase in awareness of protective ventilator strategy and using special weaning protocols in RICU and GICU compared with MICU and CCU. Regarding pulmonary rehabilitation, infection control, and antibiotics use guidelines there was a significant decrease in MICU compared with other ICUs. Conclusions Most practice and knowledge were good in all ICUs in our study, with good awareness of protocols for each field, except for MICU and CCU participants showed some defects compared with other groups. RICU physicians were the most aware and best practiced with good general awareness.