Chest Diseases Research Articles

Quality of life, fatigue and markers in sarcoidosis: A section from Turkey.

Sarcoidosis can affect every organ with varying frequency based on ethnicity, gender and age. We aimed to evaluate the health-related quality of life (HRQoL) and fatigue levels of our sarcoidosis patients. However, our second aim is to determine whether patient or disease markers correlate with quality of life assessment questionnaires. Pulmonary sarcoidosis patients who were followed up in the chest diseases outpatient clinic of our hospital were included in this prospective study. In the follow-up of 2023, routine blood tests, angiotensin-converting enzyme (ACE), posteroanterior lung (thorax computed tomography in patients with parenchymal involvement) were requested from the patients. Participants were asked to fill out the short-form 36-item questionnaire (SF-36), fatigue assessment scale (FAS) and fatigue severity scale (FSS) under the control of the outpatient clinic. A total of 189 patients, 139 (73.5%) female and 50 (26.5%) male, diagnosed with Sarcoidosis were included. The mean age of our patients was 53.1±13.6. ACE (IU/L) 68.5±44.5. Of the patients we followed up for pulmonary sarcoidosis, 111 (58.7%) had single organ involvement and 78 (41.3%) had additional organ involvement. FAS; It was high in 103 (64.3%) patients and 29 (15.3%) were very tired. FSS value was 4.45±0.7 (3-5.88). All SF-36 parameters were lower than expected; MH and SF was minimally lower, PF, RP, BP, GH, RE and VT were significantly lower. SF-36 scores were found to be lower in the women and additional organ involvement participating. We found a significant decrease in HRQoL and an increase in fatigue scores of our patients. These changes were more pronounced in women participating in the study than in men. In addition, the involvement of additional organs with the lung negatively affected the quality of life.

Spiritual Well-Being Levels, Severity of Disease and Mental Health Status of Individuals with Chronic Obstructive Pulmonary Disease

Objective: The aim of this study was to examine the effect of spiritual well-being levels on disease severity, depression, anxiety and stress levels of individuals diagnosed with Chronic Obstructive Pulmonary Disease (COPD). Method: This descriptive study was carried out with 192 individuals diagnosed with COPD who were treated in the chest disease service of a training and research hospital between April and December 2022. Data was obtained using the Spiritual Well-Being Scale (FACIT-Sp-12), COPD Assessment Test (CAT) and the Depression Anxiety Stress Scale (DASS-21). Results: Among all patients, 82.3% of the individuals experienced depression, 57.3% anxiety and 79.2% stress symptoms. There was a very weakly negative correlation between the mean FACIT-Sp-12 total score and the mean CAT total score, a moderately negative correlation between the mean FACIT-Sp-12 total score and the mean DASS-21 total score, and a weakly positive correlation between the mean CAT total score and the mean DASS-21 total score. Spiritual well-being was found to predict severity of illness by 0.48%, depression levels by 41.2%, anxiety levels by 0.56% and stress levels by 20.4%. Conclusion: Holistic care should be provided to COPD patients, considering the positive effect of spirituality on disease severity and mental states during the treatment and care process of the patient.

Bronchial artery embolization leading to acute myocardial infarction: a case report on bronchial artery-coronary artery fistula

A 22-year-old woman presented with hemoptysis for three days, averaging 150 ml of blood per day. She had no history of childhood chest disease. On admission, a chest scan suggested a potential lung infection, and laboratory results showed no significant abnormalities. Despite continuous infusion of posterior pituitary hormone, her symptoms persisted. We performed bronchial arteriography and embolization using 150–350 μm microsphere particles. During the procedure, the patient developed chest pain. An electrocardiogram (ECG) showed abnormal Q-waves and ST-T elevation, with vital signs indicating hypotension and elevated myocardial enzymes suggesting acute myocardial infarction (AMI). Repeated arteriography revealed a bronchial artery-right coronary artery fistula, likely worsened by a dislodged gelatin sponge blocking coronary microvessels. The embolization was halted, and treatment with low molecular weight heparin and aspirin was initiated. By the fifth postoperative day, the patient’s ECG indicated an abnormal Q wave in the inferior leads, and myocardial enzymes were gradually returning to normal. One week later, coronary angiography revealed no blockage, and the patient was discharged after stabilization. The cardiovascular magnetic resonance (CMR) indicated myocardial necrosis and edema in the inferior wall of the heart. During subsequent follow-up, the patient reported no significant chest pain or recurrence of hemoptysis.

Spatial resolution enhancement using deep learning improves chest disease diagnosis based on thick slice CT

CT is crucial for diagnosing chest diseases, with image quality affected by spatial resolution. Thick-slice CT remains prevalent in practice due to cost considerations, yet its coarse spatial resolution may hinder accurate diagnoses. Our multicenter study develops a deep learning synthetic model with Convolutional-Transformer hybrid encoder-decoder architecture for generating thin-slice CT from thick-slice CT on a single center (1576 participants) and access the synthetic CT on three cross-regional centers (1228 participants). The qualitative image quality of synthetic and real thin-slice CT is comparable (p = 0.16). Four radiologists’ accuracy in diagnosing community-acquired pneumonia using synthetic thin-slice CT surpasses thick-slice CT (p < 0.05), and matches real thin-slice CT (p > 0.99). For lung nodule detection, sensitivity with thin-slice CT outperforms thick-slice CT (p < 0.001) and comparable to real thin-slice CT (p > 0.05). These findings indicate the potential of our model to generate high-quality synthetic thin-slice CT as a practical alternative when real thin-slice CT is preferred but unavailable.

Cardiovascular prognostic factors, gamma glutamil transferase levels and other biochemical parameters related to morbidity and mortality in COVID-19

Aims: COVID-19 may exacerbate cardiovascular risk factors and pre-existing cardiovascular disease or lead to the development of new cardiovascular complications. Gama glutamil transferaz (GGT) is an enzyme found in the cell membranes of many tissues, especially the liver, bile duct and kidneys. Recent studies have shown that increased GGT levels are strongly associated with prognosis in cardiopulmonary disorders. Studies to date have reported on the increased predictive value of serum GGT level for cardiovascular disease and have shown marginal improvements in risk estimation. In the light of all this information, in this study, it was aimed to investigate the effect of serum GGT level on the clinical classification of the disease, cardiovascular risk and morbidity and mortality in COVID-19, in addition to known cardiovascular prognostic markers. Methods: The study included 128 patients over the age of 18 who were found to have positive SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR) in the nasopharyngeal and oropharyngeal samples taken during their admission to Kahramanmaraş Sütçü İmam University (KSU) Medical Faculty Chest Diseases outpatient clinic and emergency department. According to the most recently published 2019 novel coronavirus pneumonia diagnosis and treatment program (version 7), COVID-19 disease is divided into groups as mild, moderate, severe and critical illness. Demographic data, comorbidities, symptoms and signs, laboratory findings, and chest computed tomography (CT) scans were reviewed. The presence of heart failure, coronary artery disease or arrhythmia in the included patients was defined as cardiovascular disease. Patients were excluded if they were younger than 18 years old, pregnant, had a history of hepatobiliary disorders, alcohol abuse or other acute illnesses, died at the time of admission, had incomplete baseline data, or were transferred to other designated hospitals during hospitalization. Results: Fifty-five (43%) of the participants were female and 73 (57%) were male, with a mean age of 55.6 years. When examined in terms of age, the difference between the groups was statistically significant. The difference between the individuals with and without hypertension and diabetes mellitus was found to be significant in terms of disease severity. When examined in terms of symptoms, 23 (71.9%) of the patients in the mild group were symptomatic, 9 (28.1%) were asymptomatic, and all of the patients in the moderate, severe and critical groups were symptomatic (100%). Cardiovascular biomarkers and GGT values were found to be significantly higher in the severe and critical disease group than in the mild and moderate disease group. However, having cardiovascular disease did not cause a significant difference in GGT levels fo the disease groups. GGT levels were found to be statistically similar in individuals with and without the disease. When blood gas parameters were analyzed in terms of disease severity, oxygen saturation (SpO2) and PO2 were found to be significantly lower in the severe and critical illness group than in the mild and moderate disease group. When the effect of blood parameters on mortality was analyzed by logistic regression analysis, only the effect of PO2 parameter on mortality was found to be statistically significant. In addition, the effects of cardiovascular diseases and age variables on mortality were found to be statistically significant (p=0.031, p=0.007; respectively). The effect of cardiovascular disease on mortality was 4,325 times (ODDS ratio) higher compared to individuals without cardiovascular disease. Conclusion: In this study, we determined two important findings. First, the serum level of GGT was found to be significantly higher in the severe and critical disease group than in the mild and moderate disease group. Second, cardiovascular disease, advanced age, and hypoxemia were associated with mortality from COVID-19 disease. Although GGT provides no increased benefit for predicting cardiovascular disease risk, its potential causal relationship with cardiovascular disease deserves attention.

Attitudes toward and exposure to gender discrimination in work life by pulmonologists and thoracic surgeons: a questionnaire-based survey among Turkish thoracic society members.

This study aimed to evaluate attitudes toward and exposure to gender discrimination in work life by chest diseases specialists and thoracic surgeons. A total of 275 members of Turkish Thoracic Society (TTS) were included on a voluntary basis in this online cross-sectional questionnaire-survey using an internal member-only social media platform of TTS. The questionnaire form elicited items on sociodemographic characteristics, occupational characteristics and gender discrimination in work life (general opinions, attitudes and exposure). Female doctors (vs. males) were less likely to be a thoracic surgeon (13.8% vs. 34.5%, p < 0.05) and a professor of thoracic surgery (0.0% vs. 26.7% vs. p < 0.05), and more likely to consider housework as a considerable burden (89.8 vs. 73.6%, p = 0.02) and the significant role of discriminatory, negative and dissuasive attitudes of male physicians in their career choice (67.6 vs. 35.6%, p = 0.039). Male doctors were more likely to considered that men are more successful in specialties that require active physical strength (65.5 vs. 27.7%, p = 0.005) and those with very long working hours and heavy shifts (57.5 vs. 39.4%, p = 0.001). Female thoracic surgeons were more likely than males to consider that specialties with very long working hours and heavy shifts are more suitable for men (26.9 vs. 6.0%, p = 0.027) and men are given priority in academic career promotion (64.0 vs. 13.3%, p < 0.001). Younger (vs. older) females reported higher rate of exposure to gender discrimination (p = 0.041) and considerable impact of social roles on the specialty (p = 0.007), while female doctors working as a resident (33.8%) and a specialist (50.05%) indicated higher rate of exposure to gender discrimination during their career (p = 0.024). In conclusion, our findings revealed that exposure to gender discrimination in work life was more commonly expressed by female members of TTS, particularly in terms of burden of social roles, career advancement options and leadership positions, along with significant role of discriminatory, negative and dissuasive attitudes of male physicians in their career choice. Accordingly, women remain underrepresented in thoracic surgery, particularly in the academic rank of full professor and in leadership positions with inability to promote after a definite step in their careers.

Diagnostic Efficacy of Combined CT Guided Fine Needle Aspiration and Core Needle Biopsy Versus Either Technique Alone in Peripheral Lung Lesions

Background: Precise cytological and histological diagnosis is crucial in the era of targeted therapy for lung lesions. Both Fine Needle Aspiration Cytology (FNAC) and Core Needle Biopsy (CNB) are established diagnostic techniques, yet their individual and combined efficacy remains debated. Objective: To evaluate the diagnostic yield of combined CT-guided FNAC and CNB versus either technique alone in peripheral lung lesions. Methods: This prospective study enrolled 110 patients with undiagnosed peripheral lung lesions at the National Institute of Diseases of Chest and Hospital (NIDCH) during 2023. CT-guided FNAC was performed using a 22-gauge spinal needle, followed by CNB using an 18-gauge Trucut needle in the same setting. Six FNAC smears were prepared and stained with hematoxylin and eosin, while CNB specimens were processed as paraffin-embedded blocks. Results were classified into four categories: inadequate, negative, suspicious, and positive for malignancy. Results: The diagnostic yield of the combined approach was 99.1%, compared to 89.1% for FNAC alone and 98.2% for CNB alone. FNAC showed 85.1% sensitivity while CNB demonstrated 97.7% sensitivity. Both methods achieved 100% specificity and positive predictive value. The negative predictive value was 77.3% for FNAC versus 95.7% for CNB. Among malignant lesions (n=87), CNB provided definitive diagnosis in cases where FNAC showed suspicious findings (10 cases). For benign lesions (n=22), CNB showed superior diagnostic capability, particularly in granulomatous inflammation and chronic pneumonitis. Procedure-related complications were minimal (3.6%) with no major adverse events. Conclusion: Combined FNAC and CNB approach provides superior diagnostic yield compared to either technique alone. While CNB demonstrated higher individual diagnostic accuracy, the combined approach offered maximum diagnostic precision without significantly increasing complications. This strategy is particularly valuable for cases ...

The chest disease of Mór Jókai in 1858 and his "radical cure" "in the medical world literature"

The chest disease of Mór Jókai in 1858 and his "radical cure" "in the medical world literature"

Evaluation of nutritional parameters that may be associated with survival in patients with locally advanced non-small cell lung carcinoma receiving definitive concurrent chemoradiotherapy: retrospective study conducted in a tertiary pulmonary hospital.

Sarcopenia, defined as skeletal muscle loss, is thought to be a hallmark of cancer cachexia. It has an impact on mortality, especially in cancer patients. There are also opposing views regarding the relationship between definitive concurrent chemoradiotherapy (CRT) and sarcopenia in locally advanced lung cancer. Our aim was to investigate the prognostic effect of sarcopenia in our patients with locally advanced stage III non-small cell lung cancer (NSCLC) who received definitive concurrent CRT by using many markers, and to determine the overall survival (OS). The study was designed as a retrospective cohort. 54 patients with stage III NSCLC who received definitive concurrent CRT at the Radiation Oncology Unit of Health Sciences University Izmir Dr Suat Seren Chest Diseases and Surgery Training Hospital, between January 1, 2018 and December 31, 2019, were included in the study.92% of our patients were sarcopenic with international L3-skeletal muscle index (SMI) and Psoas muscle index (PMI) threshold values. The mean OS time was 32.4 months, and the 4-year survival rate was 38.9%. While the new threshold values specific to our patient group were 26.21 for SMI and 2.94 for PMI, SMI and PMI did not indicate OS with these values. Even with the new values, most proposed criteria for sarcopenia did not indicate OS. However, low BMI (≤21.30), low serum albumin (≤4.24 mg/dl) and low visceral fat tissue area (≤37) in univariate analysis, and low visceral fat tissue area (≤37) in multivariate analysis indicated OS. OS was poor in patients with low fat tissue area. In patients with stage III NSCLC who received definitive concurrent CRT, low visceral fat tissue area (≤37) indicated OS, rather than SMI, PMI and other sarcopenia indices.

Discovering the role of microRNAs and exosomal microRNAs in chest and pulmonary diseases: a spotlight on chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory condition and ranks as the fourth leading cause of mortality worldwide. Despite extensive research efforts, a reliable diagnostic or prognostic tool for COPD remains elusive. The identification of novel biomarkers may facilitate improved therapeutic strategies for patients suffering from this debilitating disease. MicroRNAs (miRNAs), which are small non-coding RNA molecules, have emerged as promising candidates for the prediction and diagnosis of COPD. Studies have demonstrated that dysregulation of miRNAs influences critical cellular and molecular pathways, including Notch, Wnt, hypoxia-inducible factor-1α, transforming growth factor, Kras, and Smad, which may contribute to the pathogenesis of COPD. Extracellular vesicles, particularly exosomes, merit further investigation due to their capacity to transport various biomolecules such as mRNAs, miRNAs, and proteins between cells. This intercellular communication can significantly impact the progression and severity of COPD by modulating signaling pathways in recipient cells. A deeper exploration of circulating miRNAs and the content of extracellular vesicles may lead to the discovery of novel diagnostic and prognostic biomarkers, ultimately enhancing the management of COPD. The current review focus on the pathogenic role of miRNAs and their exosomal counterparts in chest and respiratory diseases, centering COPD.

Role Of Expanded Curb-65 Score In Predicting The Severity Of Community Acquired Pneumonia

Introduction: Assessment of severity and site of care decisions for community-acquired pneumonia patients (CAP) are very important for patients’ safety and optimal use of resources. Late admission to the intensive care unit (ICU) leads to increase the rate of mortality in CAP. We aimed to evaluate the effectiveness of the new expanded CURB-65 score in comparison with CURB-65 in predicting CAP patient outcomes. Materials and Methods: This was a cross sectional study which includes 90 patients presented with CAP in Government hospital for chest and communicable disease, AMC, Visakhapatnam Results: The study included 90 patients hospitalized with CAP of which mean (SD) age distribution is 51.49±16.63 years, with 64.4% being men and 83.3% of CAP patients had associated comorbidities. All patients (100%) had elevated serum LDH (&gt; 230U/L), 87.8% had hypoalbuminemia, 8.9% had thrombocytopenia, and 4.44% had elevated BUN values within 24 hours of admission. Regarding outcomes, the ICU admission rate was 36.7%, the 30-day mortality rate was 14.4%, and 35.6% required mechanical ventilation. There was a significant association between tachypnea (respiratory rate &gt;30/min), confusion, and thrombocytopenia (Platelet Count &lt; 100×103/mm3) with 30-day mortality, according to univariate analysis. The current study found that as 30-day mortality for Expanded CURB score of (0-2), (3-4) and (5-8) is 0,4%and 9% respectively, requirement of mechanical ventilation and ICU admission rate were 2%,22%, 8% and2%,23%,8% respectively. Length of hospital stay increase as the score increase with median length of hospital stay being 7 days. Conclusion: Compared to CURB-65 and other assessment tools, the Expanded-CURB-65 score, which extends independent risk factors to 8 variables in assessing CAP severity, significantly improves identifying high-risk patients and thereby helps in early institution of appropriate therapy

Relationship between acute kidney injury and chest diseases in critically ill patients

Relationship between acute kidney injury and chest diseases in critically ill patients

COPD empowerment scale: a scale development and validatıon study

Abstract Background The fact that COPD symptoms seriously affect daily life makes it different from other chronic diseases. The purpose of this study was to develop the COPD Empowerment Scale and test its psychometric properties. Methods This study, carried out with a methodological design, was carried out in a Chest Diseases Hospital in Istanbul, Turkey, between June 2023 and March 2024. A scale item pool was created by literature review and semi-structured interviews with COPD patients, and opinions were obtained from 16 experts. The draft scale, consisting of 55 items, was applied to 30 COPD patients as a pilot study. The draft scale was applied to 275 COPD patients and its psychometric properties were tested. The validity of the scale was evaluated by Content Validity Index (CGI) and exploratory and confirmatory factor analysis. Its reliability was evaluated by internal consistency analysis (Cronbach Alpha coefficient), item-total score correlations and test-retest analyses. Statistical significance level was accepted as p &amp;lt; 0.05. Results The KGI of the scale was found to be 0.97. The draft scale was transformed into a scale with five sub-dimensions and 31 items as a result of exploratory factor analysis. Cronbach’s Alpha value of the total scale is 0.896, and its sub-dimensions Cronbach’s Alpha values are; knowledge and understanding was found to be 0.731, access to health services was 0.816, self-efficacy was 0.719, symptom management was 0.842, and psycho-social coping was 0.728. Factor loadings of all items were 0.40 and above. As a result of confirmatory factor analysis, χ2 /df (2.59), RMSEA (0.076), NFI (0.92), NNFI (0.95), SRMR (0.03) and CFI (0.95) measurements are within the desired fit values. In the test-retest reliability study of the scale, the Pearson moment correlation coefficient was found to be rᵪᵪ=.996 (p&amp;lt;.01). Conclusions The COPD empowerment scale was found to be psychometrically valid and reliable. Key messages • The developed scale is a valid and reliable tool to determine the reinforcement needs of COPD patients. • The scale can be used to evaluate the effectiveness of empowerment initiatives.

MULTIDISCIPLINARY APPROACH IN THORACIC SURGERY: A 10 - YEAR STUDY

OBJECTIVE: The multidisciplinary approach is extremely important in the thoracic surgery department, as it is in every medical department. The aim of this study was to reveal the place of the department of thoracic surgery in the multidisciplinary approach and its relations with other departments through consultation records. MATERIAL AND METHODS: Consultations requested from the other departments (inbound) and by the thoracic surgery department (outbound) in a period of 10 years (January 1, 2013 and December 31, 2022) were obtained from the hospital information management system and analyzed by descriptive statistical methods. RESULTS: In the 10-year period, the department that requested the most consultations from thoracic surgeons was the emergency department, with 2793 (38.78%) consultations. In this period, thoracic surgery mostly requested consultation from the anesthesiology and infectious diseases departments (n = 1638 (29.97%) and 1104 (17.42%), respectively). CONCLUSIONS: Thoracic surgery is a part of the trauma team and is also the department that treats surgical diseases of the lung. Therefore, thoracic surgery consultation is requested especially by emergency services and chest diseases departments. The thoracic surgery department is in close contact with the anesthesiology, pulmonology, and cardiology departments and frequently requests consultation from these departments, especially for preoperative evaluation. With COVID-19, infectious diseases were also added to this preoperative team.

Study of CRP, ferritin, and D-dimer in COVID-19 RICU patients as per HRCT severity in assiut university hospitals

BackgroundInflammatory markers were found to be elevated in patients with coronavirus disease (COVID-19). C-reactive protein (CRP), serum ferritin, and D-dimer levels may predict morbidity and mortality in (COVID-19) patients. Radiology plays a key role in the diagnosis, management, and follow-up of this disease. This study aimed to describe the radiological features of (COVID-19) infection, measure C-reactive protein (CRP), D-dimer, and ferritin levels and to correlate them with patient’s outcome and to consider them as predictors of morbidity and mortality in (COVID-19) patients.MethodsThis prospective cross-sectional analytic study had been done on 159 patients aged ≥ 18 years old, admitted at Assiut University Hospital RICU from November 2021 to November 2022, diagnosed as COVID-19 by positive RT-PCR. All patients were categorized on bases of HRCT chest disease reporting and data system (CO-RADS) scoring system into non-severe (CO-RADS 1,2,3) and severe (CO-RADS 4,5) groups. Inflammatory markers such as CRP, ferritin, and D-dimer were measured. Age, sex, comorbidities, need to mechanical ventilation MV, and mortality rate were reported. Correlation between HRCT(CO-RADS) score, inflammatory markers, and patient’s outcome was assessed.ResultsHigher CRP and serum ferritin levels, lower lymphocytic count, and higher frequency of need for mechanical ventilation were significantly greater in the severe group (P < 0.0001). Predictors of morbidity and mortality were CRP ≥ 133 mg/dl, DM, presence of chronic chest disease (P < 0.0001). A higher mortality rate was in patients of the severe group (65%) versus (9%) in the non-severe group (P < 0.0001).ConclusionsHRCT scan and measurement of CRP and ferritin plasma levels can be considered significant predictors for future prognosis and can early identify patients at risk of death and need for MV. Male gender, presence of DM, and chronic chest diseases are risk factors for severe illness.

Multi-disease X-ray Image Classification of the Chest Based on Global and Local Fusion Adaptive Networks

Chest X-ray image classification for multiple diseases is an important research direction in the field of computer vision and medical image processing. It aims to utilize advanced image processing techniques and deep learning algorithms to automatically analyze and identify X-ray images, determining whether specific pathologies or structural abnormalities exist in the images. We present the MMPDenseNet network designed specifically for chest multi-label disease classification. Initially, the network employs the adaptive activation function Meta-ACON to enhance feature representation. Subsequently, the network incorporates a multi-head self-attention mechanism, merging the conventional convolutional neural network with the Transformer, thereby bolstering the ability to extract both local and global features. Ultimately, the network integrates a pyramid squeeze attention module to capture spatial information and enrich the feature space. The concluding experiment yielded an average AUC of 0.898, marking an average accuracy improvement of 0.6% over the baseline model. When compared with the original network, the experimental results highlight that MMPDenseNet considerably elevates the classification accuracy of various chest diseases. It can be concluded that the network, thus, holds substantial value for clinical applications.

Amikacin Liposomal Inhalation Suspension for Non-Tuberculous Mycobacteria Lung Infection: A Greek Observational Study.

Background and Objectives: Intravenous amikacin, recommended for severe or recurrent M. avium complex (MAC) infections and as initial treatment for M. abscessus lung disease, is often limited by serious adverse effects such as renal and auditory toxicities. Inhaled Amikacin Liposome Inhalation Suspension (ALIS) enhances pulmonary drug deposition while minimizing systemic adverse effects, and it has recently been introduced as an add-on therapy for refractory MAC infections or when other standard treatments are inadequate. This study aims to retrospectively describe the outcomes of Greek patients with difficult-to-treat non-tuberculous mycobacterial (NTM) lung disease following the addition of ALIS to guideline-based therapy. Materials and Methods: Seventeen consecutive patients (median age: 66 years) treated with ALIS as an add-on therapy to a standard regimen at "Sotiria" General Hospital of Chest Diseases (Athens, Greece) from 2020 to 2023 were enrolled in this study. These patients had recurrent or refractory NTM lung disease and/or limited treatment options due to prior treatment-related adverse effects. Clinical, radiological, and microbiological data on treatment response and overall outcomes after ALIS initiation were recorded for each patient. Results: By the end of 2023, 14 out of 17 patients had either successfully completed or were continuing their ALIS therapy. At 6 months, 85.7% (12/14) showed clinical, microbiological, and radiological improvement. However, 25% (3/12) of treated patients, primarily those with monomicrobial or combined M. abscessus lung disease, experienced disease relapse after therapy completion. The most frequent adverse effects related to ALIS were mild and localized to the respiratory tract, with only one patient discontinuing therapy due to hypersensitivity pneumonitis. Conclusions: Adding ALIS to standard regimens was effective and safe in a small group of Greek patients with refractory or recurrent NTM lung disease, particularly those who had discontinued intravenous aminoglycosides due to significant adverse effects, with notable responses observed in MAC lung disease. Further research is needed to validate these findings in clinical practice and to investigate ALIS's role in NTM lung disease caused by other species.

Conservative versus Liberal Oxygenation in Chest Diseases

Abstract Background Conservative oxygen therapy is a good alternative to liberal oxygen therapy, as it overcomes libral oxygen therapy induced hyperoxia and reduces its harmful and undesirable effects such as lung injury and, lung collapse, acute respiratory distress syndrome. Objective To systematically review the efficacy and safety of conservative versus liberal oxygen therapy, and to measure the caliber of trachea and main bronchi at the start and end of treatment by oxygen therapy to show if it has an effect on anteroposterior and transverse dimensions of trachea and main bronchi. Patients and Methods A prospective study was conducted on 72 subject were divided into 2 groups. 36 patients received liberal oxygen (group A), 36 patients received conservative oxygen (group B). Results In comparing the 2 groups, there was no statically significant difference between the two groups concerning hospital acquired infection but hospital acquired pneumonia was high in group A (p value &amp;lt; 0.05). Furthermore, length of hospital stay was statically significant higher in group A (p value &amp;lt; 0.001). Although arrhythmia was statically significant higher in group B (p value &amp;lt; 0.05). On other hand there was no statically difference between two groups as regarded vasopressor dose, new organ dysfunction, mechanical ventilation free days, attempts to lower use of mandatory MV mode which might indicate earlier attempts to wean patients, ARDS as a new complication, ICU mortality, hospital mortality and 30day mortality (p value &amp;gt; 0.05). Conclusion Both libral and conservative oxygen therapy have advantages and disadvantages, and we did not find a clear difference between both choices. Each of the two options is left to the physician, who decides to choose one of the two options according to his exeperience and the patient's condition.

The Role of Screening of Patient Proved to have Gastroesophageal Reflux Disease by Upper Gastrointestinal Endoscope for Early Detection of Interstitial Lung Diseases

Abstract Background Gastroesophageal reflux disease (GERD) is a common digestive disorder in North America, causing symptoms and complications. It affects 18.1-27.28% of people and is associated with decreased quality of life. Treatment improves quality of life, but treatment costs are higher. Aim and Objectives The study aims to assess the role of screening of patient proved to have gastroesophageal reflux disease by upper gastrointestinal endoscope for early detection of interstitial lung diseases. Subjects and Methods this study was Cross sectional study. The study will be conducted at Chest diseases Department of Ain Shams university hospitals. This prospective cross-sectional study will be conducted on 90 randomly selected patients diagnosed with GERD by upper gastrointestinal endoscopy. For one year. Result the findings of chest HRCT for enrolled patients is 15 patients (16.7%) showed positive CT findings suggestive of interstitial lung disease, whereas 75 patients (83.3%) had normal CT scan. The most common CT finding was atelectasis reported in nine patients (10%). a statistically significant correlation between age and fibrosis and reticular infiltration, female gender &amp; reticular infiltration. no statistically significant correlation between CT findings and each of chest symptoms and GERD symptoms. Conclusion The study found that gastrointestinal endoscopes are effective in early detection of interstitial lung diseases, with 16.7% of patients showing positive CT findings. Age, gender, hiatal hernia presence, cough, dyspnea, and wheezes were significant factors in fibrosis. and reticular infiltration

Comparative Study between Chest Radiography and Ultrasound Findings in ICU Patients with Respiratory Distress

Abstract Background Lung radiology is regularly done for the patients in intensive care units. Chest x-ray is considered one of the most easy imaging modalities. However, it may be not comfortable for critical patients in addition to the hazards of irradiation. The high variability of quality of the chest x-ray image makes its interpretation difficult. Nowadays bedside lung ultrasound is increasingly used in patients managed in intensive care units (ICUs) Objective To compare the diagnostic performance of lung ultrasound and bedside chest radiography for the detection of various pathologic abnormalities in unselected critically ill patients. Patients and Methods A prospective study done on 60 patients with respiratory distress admitted to the intensive care unit at our institute over 7 months. Chest X-ray and lung ultrasound were done to all the patients and then compared regarding the clinical diagnosis of pulmonary diseases and further radiological and laboratory methods. Results One Hundred Twenty hemithoraces were evaluated. The sensitivity, specificity, and diagnostic accuracy of CXR were 79.2, 94.4 and 88.3% for consolidation, 80, 100 and 98 % for pneumothorax, and 62.8, 96, and 76.7% for pleural effusion, respectively. The corresponding values for lung ultrasound were 87.5, 97, and 93.3% for consolidation, 100, 100, and 100 % for pneumothorax, and 91.4, 100, and 93.3% for pleural effusion, respectively. Conclusion Ultrasound is a bed side tool useful for rapid and early diagnosis of acute dyspnea in critical ill patients. It has higher sensitivity and higher specificity of diagnosis of chest diseases as pneumonia, pleural diseases and pneumothorax in comparison to CXR