Bronchoscopy Unit Research Articles

Diagnostic Yield and Outcome Of Bronchoscopy Unit at Ain Shams University Hospital in Current Clinical Practice (Including Recent Modalities and Interventional Pulmonolgy) Marwa S Daif, Ragy Mamdouh Ghaly Lecturer of Chest Diseases, Lecturer of Ches

Diagnostic Yield and Outcome Of Bronchoscopy Unit at Ain Shams University Hospital in Current Clinical Practice (Including Recent Modalities and Interventional Pulmonolgy) Marwa S Daif, Ragy Mamdouh Ghaly Lecturer of Chest Diseases, Lecturer of Ches

Retrospective study of congenital airway malformations detected by flexible fiberoptic bronchoscopy in Alexandria University Children’s Hospital

BackgroundCongenital airway malformations affect the quality of life and increase the family burden. The care of children who have these lesions requires considerable expenditures of time and other resources within a tertiary care center.AimThis work aims to determine the incidence of congenital airway malformations in children with airway-related manifestations detected by flexible fiberoptic bronchoscopy at the bronchoscopy unit of Alexandria University Children Hospital during the period from 1st of January 2019 to 31st of December 2019.Patients and methodsThis retrospective study includes symptomatic children who underwent flexible fiberoptic bronchoscopy from 1st of January 2019 to 31st of December 2019.ResultsThe incidence of congenital airway malformations in the studied population was 32%. The mean age of patients at time of diagnosis was 7 months and the most common congenital anomaly was laryngomalacia.ConclusionWe concluded that congenital airway malformations are not uncommon in newborns and their early detection can be beneficial for optimum management.

Adoption of Improved Reprocessing Decreased Microbiological Non-Compliance for Bronchoscopes.

In the past few decades, the inadequate reprocessing of bronchoscopes has been associated with several serious outbreaks caused by multidrug-resistant microorganisms. In this study we evaluated the improvement in the quality of reprocessing in a Bronchoscopy Unit (BU), after the introduction of a new procedure. In 2019, observational and clinical audits were conducted in the BU. After the introduction of an improved procedure in 2020, a microbiological surveillance plan was implemented in 2021. In 2019, 13 of 22 bronchoscopes (59%) resulted as non-compliant, 18% as high concern organisms (HCO) and 36.4% as high microbial count (≥100 CFU/all channels) and HCO. The most frequent microorganisms were Staphylococcus aureus (38.5%) and NDM-producing Klebsiella pneumoniae (15.4%). The bronchoscopes were stored inside their transport cases, which in some cases were found to be contaminated by the same strains isolated on the bronchoscopes (Enterobacter gergoviae and Vibrio alginolyticus). In 2021, all 31 bronchoscopes were sampled at least three times and 13/99 (13.1%) resulted as non-compliant, mostly K. pneumoniae (4.04%). Contamination level increases weakly in bronchoscopes in use for more than 14 years (R = 0.32). The adoption of an improved reprocessing procedure decreased the non-compliance of bronchoscopes, increasing the quality of the process and patient safety.

Fungal culture results and clinical effects of bronchoscopy specimens.

Early isolation of the fungal pathogen and early initiation of treatment affect mortality and morbidity rates. The purpose of this study was to reveal the frequency of determination of fungal pathogens in bronchoscopy unit patients. The study was designed retrospectively. All patients who underwent bronchoscopy for any reason were enrolled. The patients with suspected fungal infection were divided into three groups after the procedure: 1) Proven fungal infection, 2) Colonization, 3) Without infection. One thousand one hundred and twenty-eight patients were included in the study. Fungal infection was suspected in 188 (16.7%) patients before bronchoscopy. After the examination of the bronchoscopic materials, it was determined that 59 (5.2%) patients had proven fungal infection, 148 (13.1%) patients had colonization, and 921 (81.7%) patients did not have fungal infection. The radiological findings of the patients that were indicative of fungal infection before bronchoscopy were observed as consolidation in 391 (34.7%) and nodule in 413 (36.6%). Fungal growth in bronchoscopic cultures was found in 186 (16.4%) patients, and the most common fungus was Candida albicans (C. albicans) in 110 (9.7%). The treatment was not changed according to the culture results in the patients. No treatment was initiated in the other 108 (98.2%) patients with C. albicans. One hundred and sixty-five (88%) of all fungal growths were detected in the BAL/bronchial lavage fluid. While 29 (45%) of them had not received antifungal treatment before, antifungal treatment was started after bronchoscopy. C. albicans was isolated the most among all bacterial and fungal agents in all patient groups that were immunosuppressed or not at a routine bronchoscopy unit. Diagnostic bronchoscopic sampling should be performed at the early stages of clinically or radiologically suspected fungal illness.

Single-Use or Disposable Flexible Bronchoscopy in Advanced Bronchoscopy Procedures: Experience in a Quaternary Referral Centre.

The development of single-use flexible or disposable bronchoscopes (SUFBs) has accelerated in recent years, with the reduced risk of infectious transmission and reduced need for endoscopy staffing particularly advantageous in the COVID-19 pandemic era. The objective of this study was to assess the performance of a novel single-use bronchoscope in an academic quaternary referral centre with on-site interventional pulmonology programme. With ethical approval in a quaternary referral centre, we prospectively collected data on sequential bronchoscopy procedures using The Surgical Company Broncoflex© range of SUFBs. Data collected included demographic, procedural, scope performance, user satisfaction, and complication parameters in a tertiary bronchoscopy service. 139 procedures were performed by five pulmonology faculty from January to July 2021. The majority were carried out for infection (45%) and malignancy (32%). Most were performed in the endoscopy suite and 8% were COVID positive or suspected. Most procedures reported the highest score in satisfaction (85%) with technical limitations reported in 15% (predominately related to scope suction or inadequate image quality) reverting to a reusable scope in 2.8 %. In our subset of patients in a bronchoscopy unit, SUFBs are safe, and both routine and advanced bronchoscopy procedures can be performed with high satisfaction reported.

Determination of Anxiety and Comfort Levels of Patients Who Underwent Fiberoptic Bronchoscopy: A Cross-sectional Study

Objective: The aim of this study was to determine the anxiety and comfort levels of outpatients who underwent fiberoptic bronchoscopy. Method: This cross-sectional study was performed between January-December 2018 in a bronchoscopy unit of a Training and Research Hospital in Ankara. A total of 173 patients who underwent bronchoscopy for the first time were included in the study by purposeful sampling method. The data were obtained by using ”Personal Information Form”, “State Trait Anxiety Inventory (STAI-I)” and Perianesthesia Comfort Scale (PACS)”. The Personal Information Form and the STAI-I were filled out before the bronchoscopy and the PACS after the bronchoscopy procedures by face-to-face interviews. Results: Study population with a mean age of 54.68±16.64 years consisted mostly (72.8%) of male patients. In the present study, mean STAI-I, and PACS scores of the patients were 43.51±5.67, and 5.20±0.43 points, respectively. Mean STAI-I scores of female, and male participants were 41.93±5.73 and 44.06±5.56 points, respectively with a statistically significant intergroup difference (p=0.03). The PACS scores of female, and male participants were 4.99±0.57 and 5.24±0.37 points, respectively with a statistically significant intergroup difference (p=0.001). After the procedure, choking, cough and sore throat were the most common symptoms. Conclusion: It was determined that patients who underwent bronchoscopy had generally experienced anxiety but their comfort was good. Male patients had more anxiety, but female patients had lower levels of comfort. To reduce the level of anxiety due to bronchoscopy; nursing interventions should be planned according to the individual characteristics of the patients

874. Pseudo-outbreak of Adenovirus in Bronchoscopy Suite

BackgroundAdenoviruses (Adv) are non-enveloped viruses that can survive for long periods on environmental surfaces. However, only 1 prior publication describes an adenovirus pseudo-outbreak associated with bronchoscopes. In 1/ 2020 infectious disease physicians noted a cluster of Adv PCR-positive bronchiolar lavage (BAL) samples, which prompted an outbreak investigation.MethodsWe reviewed medical charts, clinical microbiology, procedure logs, bronchoscope reprocessing logs, bronchoscope cleaning, and high-level disinfection (HLD) practices.ResultsOn 1/28/20 an infectious diseases physician alerted infection prevention to a cluster of 5 lung transplant patients diagnosed with Adv positive BAL samples. Four out of the 5 patients had the bronchoscopy in the same bronchoscopy suite. We reviewed BAL results from all bronchoscopies performed in this suite from 11/1/19 to 1/24/20 and found a total of 10 patients with positive Adv PCR results. Eight out of the 10 patients had bronchoscopies with one of two bronchoscopes. Of all patients who had a bronchoscopy with the bronchoscope from 11/1/19 to 1/24/20 and had respiratory viral panel sent at that time, 6 of 11 (55%) who underwent procedure with Scope A and 4 of 24 (17%) who underwent procedure with Scope B had positive Adv PCR results. Sham BALs were performed on both bronchoscopes and testing for Adv was negative. However, on inspection by the manufacturer, one scope failed both wet and dry leak tests and had several physical defects. Following removal of both bronchoscopes from service we did not find any positive Adv samples from the bronchoscopy unit.ConclusionPreviously, very few pseudo-outbreaks of Adv have been linked to bronchoscopes. We identified a pseudo-outbreak of Adv associated with 2 bronchoscopes in a hospital-based bronchoscopy suite that stopped once we removed the associated bronchoscopes from the procedural unit. Bronchoscopy-related pseudo-outbreaks occur despite standardized procedures for HLD. Bronchoscopy clinics, particularly those with a high volume of immunocompromised patients, should prospectively review BAL cultures to identify unusual pathogen trends. These trends may be a sign of damaged equipment that would otherwise go undetected.Disclosures All Authors: No reported disclosures

A pseudo-outbreak of Rhinocladiella similis in a bronchoscopy unit of a tertiary care teaching hospital in London, United Kingdom.

Outbreaks of fungal infections due to emerging and rare species are increasingly reported in healthcare settings. We investigated a pseudo-outbreak of Rhinocladiella similis in a bronchoscopy unit of a tertiary care teaching hospital in London, UK. We aimed to determine route of healthcare-associated transmission and prevent additional infections. From July 2018 through February 2019, we detected a pseudo-outbreak of R.similis isolated from bronchoalveolar lavage (BAL) fluid samples collected from nine patients who had undergone bronchoscopy in a multispecialty teaching hospital, during a period of 8months. Isolates were identified by MALDI-TOF mass spectrometry. Antifungal susceptibility testing was performed by EUCAST broth microdilution. To determine genetic relatedness among R.similis isolates, we undertook amplified fragment length polymorphism analysis. To determine the potential source of contamination, an epidemiological investigation was carried out. We reviewed patient records retrospectively and audited steps taken during bronchoscopy as well as the subsequent cleaning and decontamination procedures. Fungal cultures were performed on samples collected from bronchoscopes and automated endoscope washer-disinfector systems. No patient was found to have an infection due to R.similis either before or after bronchoscopy. One bronchoscope was identified to be used among all affected patients with positive fungal cultures. Physical damage was found in the index bronchoscope; however, no fungus was recovered after sampling of the affected scope or the rinse water of automated endoscope washer-disinfectors. Use of the scope was halted, and, during the following 12-month period, Rhinocladiella species were not isolated from any BAL specimen. All pseudo-outbreak isolates were identified as R.similis with high genetic relatedness (>90% similarity) on ALFP analysis. The study emphasises the emergence of a rare and uncommon black yeast R.similis, with reduced susceptibility to echinocandins, in a bronchoscope-related pseudo-outbreak with a potential water-related reservoir. Our findings highlight the importance of prolonged fungal culture and species-level identification of melanised yeasts isolated from bronchoscopy samples. Possibility of healthcare-associated transmission should be considered when R.similis is involved in clinical microbiology samples.

German bronchoscopy unit readiness for the COVID-19 pandemic: a nationwide survey

BackgroundThe worldwide impact of the coronavirus disease 2019 (COVID-19) pandemic is unprecedented. Among the aerosol generating procedures, bronchoscopy in particular is an indispensable diagnostic and therapeutic tool that comes with a high risk of infection. Therefore, national societies have issued guidance statements. However, the individual ability of bronchoscopy units to follow these recommendations is largely unknown.MethodsWe conducted a nationwide survey from 1 April 2020 to 7 April 2020 to which 218 German endoscopy units, 105 solely bronchoscopy and 113 interdisciplinary, responded. The survey was distributed electronically via the German Respiratory Society.ResultsWhile 17% of units did not cancel any interventions, 16% cancelled >80% of their interventions. 73% were unable to completely separate high-risk patients. Most procedural measures, such as risk stratification in patients (95%), training to handle COVID-19 patients and personal protective equipment (PPE) (91%), risk adapted use of PPE (85%) and self-monitoring for staff (84%) were adopted well. Unit managers expected shortages in PPE (74%), staff shortages (68%) and severe financial losses (63%).ConclusionIn the short-term, PPE shortages are perceived to be the most imminent threat to bronchoscopic activity as a whole. In this era of uncertainty, sound evidence to guide bronchoscopy units and an international concerted effort are urgently needed to formulate recommendations on facts and adapted to local conditions as described in this study.

ROLE OF LUNG POINT NAVIGATION BRONCHOSCOPY IN THE DIAGNOSIS OF PULMONARY NODULE

Background: Pulmonary nodules are one of the most common thoracic imaging abnormalities. A revised estimate of over 1 million nodules are detected each year as an incidental finding, either on chest radiographs or thoracic computed tomography (CT) scans However, an accurate diagnosis from these small, peripheral lung lesions can still be challenging with the use of conventional procedures.The lung point navigation bronchoscopy seems safe and effective. Navigation support with fluoroscopic guidance more successful in sampling small Solitary Pulmonary Nodules, increasing the likelihood of a diagnosis and decreasing the need for surgical biopsy . Aim of the work: To detect the role of the lung point navigation bronchoscopy in diagnosis of pulmonary nodule. PATIENTS AND METHODS: This study was performed between January 2019 and October 2019 in the bronchoscopy unit of Chest hospital of Military Kobri Al-Kobba medical Complex, It was prospective cross-sectional analytic study conducted on 30 patients to detect the role of the lung point navigation system in diagnosis of pulmonary nodule. Conclusion: Diagnosis of pulmonary nodule by navigated bronchoscopy with the lung point system seems safe and effective. Navigation support with fluoroscopic guidance may be more successful in sampling small and peripherally located pulmonary nodule, increasing the likelihood of a diagnosis and decreasing the need for surgical biopsy.

Epidemiology of lung cancer in Northern Greece: An 18-year hospital-based cohort study focused on the differences between smokers and non-smokers.

INTRODUCTIONLung cancer remains a leading cause of cancer incidence, yet, in Greece, country-level registry-based data are limited. We have thus investigated the epidemiology of lung cancer and its trends in the George Papanikolaou Hospital, Northern Greece over 18 years (2000–2018).METHODSWe analyzed all the cases reported in the Bronchoscopy Unit of the Hospital for the period 2000–2018. In total, 15131 subjects (12300 males and 2831 females) that presented with a mass in the imaging, were submitted to bronchoscopy. Characteristics of patients such as age, sex, smoking history and occupation were collected. Statistical analysis was performed with SPSS 21.0 software package.RESULTSAmong all subjects, a total of 5628 (37.2%; mean age: 65.85 ± 9.6 years) cases of primary lung cancer were identified with a male to female ratio of 2:1 (41.1% to 20.4%) (p<0.001). Squamous cell lung cancer was the most common type of lung cancer identified in this population (44%) with a higher proportion in males compared to females (p<0.001). Furthermore, adenocarcinoma was mostly observed in female non-smokers compared to males (p<0.001). The majority of lung cancer cases were identified in patients occupied with agriculture and livestock breeding (41.1%). The mean age at lung cancer diagnosis was 66.13 ± 9.19 years for the whole study population. Lung cancer cases observed with a higher mean of 43.93 ± 10.84 years of smoking compared to cancer-free patients with 39.64 ± 13.23 years of smoking (p<0.001).CONCLUSIONSApart from smoking, demographic characteristics including age, sex and occupation appear to have an impact on lung cancer development in this population. Smoking history alone could not predict the development of lung cancer in the studied northern Greek population.

Assessment of Nurses’ Knowledge and Practice for Patients Undergoing a Bronchoscopy [Suggested Nursing Care Guidelines

Aim: to assess nurses’ knowledge and practice for patients undergoing bronchoscopy procedures and design suggested nursing care guidelines for those nurses. Design: descriptive research design was utilized in this study. Setting: The study was conducted on 40 nurses at bronchoscopy unit of the chest department, at Assiut University hospital. Tools: A structured interview questionnaire sheet for nurses. Including: Demographic data, an observation checklist for nurses and develop suggested nursing care guidelines. Results: Fifty two of studied nurses had poor knowledge score, and regarding the total score of nurses' practice, (87.5%) of them was satisfactory. In addition, there was no correlation between nurses' knowledge and practice total scores and their demographic data except between good knowledge level score and their ages and marital status. Conclusion: the studied nurse practice levelwas satisfactory while their knowledge scores were not in the same line.

Bronchoscopic lung volume reduction by histoacryl

Background Lung volume reduction can be accomplished by bronchoscopy, a procedure that represents a potential alternative to lung volume reduction surgery. The initial physical approach to bronchoscopic lung volume reduction (BLVR) was based on the simple concept that collapse of target regions could be initiated using a washout solution to disrupt the surfactant function and be maintained with a biocompatible ‘tissue sealant’ to prevent re-expansion. Aim The aim was to evaluate the safety and efficacy of BLVR using an adhesive material (histoacryl blue glue) in patients with emphysema and emphysematous bullae. Settings and design Prospective interventional analysis from two centers’ registry, namely The Bronchology Unit at Chest Department, Ain Shams University and The Bronchoscopy Unit of Kobry El Kobba Military Chest Hospital. Patients and methods The study included 40 patients having emphysema. All the patients had spirometry, arterial blood gases, 6 min walking test, and body plethysmography. All these tests were performed before and 90 days after the procedure. Results Residual volume decreased by 15.30% (P=0.567), forced expiratory volume in the first second increased by 11.43% (P=0.088), forced vital capacity increased by 22.92% (P=0.007), and 6-min walking distance increased by 70.39% (P=0.021). Postprocedure complications were minor with no mortality. Conclusion BLVR therapy using histoacryl blue glue is well tolerated and safe in patients with emphysematous bulla and diffuse emphysema. Treatment is associated with modest improvement in pulmonary function test values, increased exercise performance, and reduced dyspnea.

Pseudo-outbreak of Mycobacterium fortuitum in a hospital bronchoscopy unit

Mycobacterium fortuitum survive in different environmental conditions, biofilm formation and resistance to chlorinated disinfectants makes its isolation frequent in hospital environments, even being involved in outbreaks by contamination of medical equipment such as bronchoscopes. We describe a pseudo-outbreak by M fortuitum isolated in samples from 9 patients who underwent bronchoscopy in the pneumology bronchoscopy unit of the University Hospital Complex of the Canary Islands from December 2016 to March 2017. We proceeded to investigate the pseudo-outbreak with a combination of epidemiologic, environmental, and molecular typing data. The source/reservoir of pseudo-outbreak was the hospital water used by the bronchoscope automatic washing machine (without antibacterial filter), so control measures were taken. Molecular typing was performed on 7 strains from 7 patients, and a sample of water was collected from a tap in the pneumology bronchoscopy unit: all of which had the same pattern. Our study demonstrates the presence of nontuberculous mycobacteria in the hospital water supply, and thus the need to take measures against them because they compromise patients' health. We also suggest the need for hospital water quality guidelines in which methods to control and/or eliminate them are established.

Implementation of bronchoscopic conventional transbronchial needle aspiration service in a tertiary care chest hospital

BackgroundConventional transbronchial needle aspiration (C-TBNA) is a unique technique that allows the sampling tissue from beyond the endobronchial tree, such as enlarged lymph nodes, peribronchial, or submucosal lesions. However, it remains underutilized and even unavailable in many countries and centers around the world including Egypt.ObjectiveThis study aimed to implement bronchoscopic C-TBNA service in a tertiary care chest hospital with special emphasis on the diagnostic yield, complications encountered, and learning experience.Patients and methodsThis cohort study was conducted on 60 patients with bronchoscopic nonvisible extraluminal lesions who have sought bronchoscopic C-TBNA service at the Bronchoscopy Unit of both Ain Shams University Hospital and Giza Chest Hospital during the period from June 2016 to February 2018.ResultsThe overall C-TBNA had a diagnostic yield of 88.3% in which 68.3% were malignant and 20% had sarcoidosis without serious complications recorded except for minor non-life-threatening bleeding in 21.7% of cases. After 6 months of C-TBNA learning experience, the diagnostic yield showed improvement in physicians without previous C-TBNA experience, but without reaching a statistical significance. Also, there were significant reduction in both duration and complications of C-TBNA.ConclusionImplementing C-TBNA service in a tertiary care chest hospital in bronchoscopically nonvisible extraluminal lesions seems to be a safe, easy technique with high diagnostic yield and its learning performance was able to be improved over time.

Detection of airborne Mycobacterium tuberculosis complex in high-risk areas of health care facilities in Thailand.

<sec id="st1"> <title>SETTING</title> In high-risk areas (sputum collection room in a tuberculosis [TB] clinic, patient rooms in a TB ward, the emergency department and the bronchoscopy unit) in seven health care facilities located in central Thailand. </sec> <sec id="st2"> <title>OBJECTIVE</title> To detect airborne Mycobacterium tuberculosis complex and other environmental parameters using the liquid impinger and real-time quantitative polymerase chain reaction (real-time qPCR) technique in high-risk areas. </sec> <sec id="st3"> <title>DESIGN</title> Cross-sectional study. </sec> <sec id="st4"> <title>RESULTS</title> M. tuberculosis was detected in 3 of 99 (3.0%, 95%CI 0.6-8.6) areas: one sputum collection room and one TB in-patient room in one facility and one sputum collection room in another facility. In these three areas, the M. tuberculosis copy number/m³ ranged from 9.6 to 1671. Lower air change rate (<6 h-1), higher relative humidity (>65%), and contact with coughing patient(s) were more common in airborne M. tuberculosis-positive areas than in M. tuberculosis-negative areas. </sec> <sec id="st5"> <title>CONCLUSIONS</title> Air sampling using a liquid impinger followed by real-time qPCR is effective for quantitative detection of airborne M. tuberculosis in high-risk areas. Our findings indicate TB risk among health care workers, and suggest that improved ventilation, enhanced appropriate cough etiquette and respiratory protection are needed to mitigate M. tuberculosis transmission. </sec>.

Are flexible bronchoscopic cryoextraction practices an alternative to rigid bronchoscopy?

We aimed to evaluate the efficacy of flexible bronchoscopic cryoextraction in the treatment of airw ay obstruction arise from mucus plugs and blood clots and present our experience. The present study evaluated patients who previously underwent unsuccessful flexible bronchoscopy for the removal of secretions and blood clots in the central airway and who underwent flexible bronchoscopic cryoextraction between January 2013-November 2017. The study included seven patients with a mean age of 58.29 ± 18.56 years (28-76). Three patients underwent bedside intervention in the intensive care unit, and four patients underwent an intervention in the bronchoscopy unit. Seven patients underwent a total of nine sessions of cryoextraction. Severe complications or mortality did not occur during the cryoextraction sessions. Flexible bronchoscopic cryoextraction offers a safe treatment strategy as an alternative to rigid bronchoscopy in patients in whom airway patency cannot be achieved using other flexible bronchoscopic interventions. and accuracy of PET was higher compared to CT with this cut-off value.

Airborne acquisition of Pneumocystis in bronchoscopy units: a hidden danger to healthcare workers.

The possible presence of Pneumocystis in a bronchoscopy unit of a tertiary-hospital was examined by detecting Pneumocystis-specific DNA by polymerase chain reaction in prospectively obtained samples of oropharyngeal wash from seven healthcare workers (HCWs) and air from three areas of the unit at different time points (baseline, days +15,+30,+60,+90 after initiation of the study). Positive samples were genotyped at two genetic loci: the mitochondrial large subunit ribosomal RNA (mtLSUrRNA) fragment by direct sequencing and the gene for dihydropteroate synthase (DHPS) by restriction fragment-length polymorphism. Pneumocystis DNA was identified in 13/24 samples from HCWs, in 4/14 air samples and also in two patients with Pneumocystis pneumonia (PcP) and another with a Pneumocystis-associated disease subjected to bronchoscopy on days +15 and +60 after initiation of the study. The HCWs harbored a high rate of mtLSU-rRNA genotypes 1 and 3 and samples from air and patients with only genotype 3. DHPS mutations related to sulpha resistance were detected in three samples from HCWs and in one from air; 65% of the positive samples showed genotypic concordance. The study demonstrates that HCWs of bronchoscopy units represent a new dynamic reservoir and a possible source of infection for human Pneumocystis species, including DHPS genotypes related to sulpha resistance that could be transmitted within hospitals to immunosuppressed hosts in whom a PcP can develop. The results provide the first evidence of the risk of Pneumocystis transmission in the bronchoscopy units and arguments to improve prevention and control of this infection in nosocomial setting.

Incidence, Etiology, and Clinicopathologic Features of Endobronchial Benign Lesions: A 10-Year Consecutive Retrospective Study.

Airways can be affected by non-neoplastic lesions leading to critical stenosis of the lumen. Incidence, etiology, and clinical significance of endobronchial benign lesions are not systematically characterized.This study aimed to assess the epidemiology of nonmalignant processes involving the bronchial tree on clinical, pathologic, endoscopic, and radiologic grounds. We retrospectively analyzed bronchoscopy procedures over 10 years at the Bronchoscopy Unit of Modena University Hospital. All the endoscopically growing benign lesions with histologic confirmation were considered. For each lesion, we evaluated demographics, clinical features and outcome, the endoscopic aspect and radiologic characteristics by means of computed tomography as assessed by 2 experienced radiologists blinded with regard to the diagnosis. Over the study period, we analyzed 10,431 bronchoscopies and identified 2075 cases of tracheobronchial alterations. Among these, 11.2% had a benign etiology with an average annual incidence of 23 new cases/year and a general incidence of 2.2%. Anthrachosis was the most prevalent bronchial lesion. In total, 22% of benign lesions presented airway stenosis >50% and required bronchoscopic treatment. Bronchial stenosis was most frequently observed in tuberculosis (P=0.031) and aspergillosis (P=0.020) when compared with sarcoidosis. Immunosuppressive status was significantly associated with endobronchial aspergillosis (P=0.0001) and the 1-year survival from diagnosis resulted significantly lower irrespectively to the immune system condition. A consistent proportion of endobronchial benign lesions are reported. One fifth of these are associated with critical stenosis of the airway lumen, requiring rigid bronchoscopy. Among these, aspergillosis is characterized by the poorest prognosis, regardless of host immunity status.

Indications and outcome of bronchoscopy in Bronchoscopy Unit, Chest Department, Ain Shams University Hospital: a 6-month report

Background Bronchoscopy is a well-established maneuver in pulmonary medicine. It is an important method in the diagnosis, staging, and treatment of lung cancer and other pulmonary diseases. Various diagnostic techniques such as bronchial biopsy, bronchial washing and brushing, and transbronchial lung biopsy are used during fiberoptic bronchoscopy to increase the diagnostic yield of the procedure. Rigid and fibreoptic bronchoscopes remain complementary techniques, and are usually used concurrently during many procedures. Aim The aim of this study was to study the indications and outcome of bronchoscopic workup in the Bronchoscopy Unit, Chest Department, Ain Shams University Hospital in the period from May 2013 to October 2013. Patients and methods All patients undergoing either fiberoptic bronchoscopy or rigid bronchoscopy were subjected to full history and clinical examination, and monitored regarding their preprocedure investigations, procedure details and sampling techniques, postprocedure complications, and finally the patients were followed up regarding their histopathological and bacteriological results. Results One hundred cases were monitored, 65 male patients and 35 female patients. The mean age of the patients was 50.92±20.099 years. Fifty-six patients were smokers, whereas 44 patients were nonsmokers. The most frequent presenting symptom was dyspnea in 50% of cases, followed by hemoptysis in 27% of cases. Adenocarcinoma was diagnosed in seven patients, squamous cell carcinoma was diagnosed in six patients, small-cell lung cancer was diagnosed in four patients, and large-cell lung cancer was diagnosed in three patients. In 15 (40.54%) cases, the histopathological results were inflammatory, nonconclusive to malignancy. All patients with lung cancer showed radiological abnormalities. Two cases were diagnosed as TB in spite of their workup of TB such as tuberculin test and sputum ZN safety and effectiveness obviously depend on the accuracy of selection of the patients for the procedure, the experience of the bronchoscopist, and on the facilities available. Proper use of diagnostic techniques provides a high degree of success, and the treatment modality to be used depending on the type of the lesion is mostly satisfactory.