Global Initiative for Chronic Obstructive Lung Disease: can we do better? Vladimir Zugic, Sanja Hromis The Egyptian Journal of Chest Diseases and Tuberculosis 2019 68(3):267-269

Evaluation of GeneXpert as a new diagnostic tool for detection of pulmonary tuberculosis Mohamed A Tag Eldin, Hossam M Abdel Hamid, M. Masoud Elnady The Egyptian Journal of Chest Diseases and Tuberculosis 2019 68(3):270-273 Background Over the past decade, genotyping of Tuberculosis strains has become an increasingly valuable tool in tuberculosis (TB) control. Molecular epidemiology has helped to identify unsuspected transmission, determine likely locations of transmission, and measure the extent of transmission. Often traditional contact investigations focus on persons in the household and workplace. The Xpert Mycobacterium tuberculosis (MTB)/rifampin (Rif) assay is a rapid test that identifies both the presence of MTB and resistance to Rif in a single test. This can enable early and appropriate treatment initiation as well as accelerate the implementation of multi drug resistant (MDR)-TB control measures, and ultimately reducing TB case incidence. Patients and methods This descriptive study was carried out in Mansoura Chest Hospital from May 2015 to June 2016. A total of 165 subjects suspected to have active TB were included in the present study. Sputum samples of each case were divided into three methods of research: staining with Ziehl–Neelsen for acid-fast bacilli, GeneXpert (GX) MTB Rif assay, and culture. Results GX test has 97.6% sensitivity, 81% specificity, 84.5% positive predictive value, 97% negative predictive value, and 89.7% accuracy. Sensitivity, specificity, positive predictive value, and negative predictive value of GX MTB/Rif were 100, 89.3, 72, and 100%, respectively.

Treatment outcomes of tuberculosis among new smear-positive and retreatment cases: a retrospective study in two Egyptian governorates Fawzy El Emeiry, Safynaz Shalaby, Gehan H Abo El-Magd, Marwa Madi The Egyptian Journal of Chest Diseases and Tuberculosis 2019 68(3):274-283 Background Tuberculosis (TB) affects millions of people every year and is considered one of the top 10 causes of death worldwide, being more than HIV/AIDS. Objective The objective of this study was to investigate the effect of directly observed treatment–short course on treatment outcomes among new smear-positive and retreatment cases of TB in two Egyptian governorates: Gharbia and Menoufia. Patients and methods This retrospective study was carried out on the records obtained from TB Registration Unit in Gharbia and Menoufia governorates. The study included the diagnosed and registered cases of new smear-positive and retreatment cases of TB during the years 2008–2013 in the two governorates. Results The total number of studied TB cases was 916 (669 males and 247 females) and 825 cases (632 males and 193 females) in Gharbia and Menoufia governorates, respectively. TB was common in rural areas compared with urban areas. The highest rate of treatment outcomes was cure rate (85.8 and 88.2% in Gharbia and Menoufia governorates, respectively) with significant decrease of failure (4 and 1.3%), death (3.3 and 1.9%), default (0.8 and 2.1%) and transfer out (1.9 and 1.9%) rates in Gharbia and Menoufia governorates, respectively. The success rates were 825 (90.1%) in Gharbia and 765 (92.7%) in Menoufia governorates. Conclusion Treatment success rates among new smear-positive and retreatment cases were 90.1 and 92.7% in Gharbia and Menoufia governorates, respectively, with low poor outcomes, which in turn indicated high efficacy and successful application of directly observed treatment–short course.

Detection of drug-resistant mycobacterium tuberculosis using Geno Type MTBDRplus assay in smear-positive cases Aya M Abdel Dayem, Samar H Sharkawy, Rehab M Mohammed Fathy, Omayma M Hassanin, Asmaa Ali The Egyptian Journal of Chest Diseases and Tuberculosis 2019 68(3):284-289 Background Multidrug-resistance tuberculosis (MDR-TB) has become an annoying health problem with supreme concern in the developing countries. Several methods of detection of MDR-TB have developed over recent years. Objective To investigate the diagnostic accuracy of GenoType MTBDRplus assay in detection of rifampicin (RIF)- and isoniazid (INH)-resistant isolates from sputum specimens of patients with active TB. Patients and methods This is a cross-sectional study. Sputum samples from 50 cases with active TB were collected, and the drug sensitivity test was evaluated by two methods: the standard conventional culture method and the GenoType MTBDRplus assay as a newly developed genotypic (molecular) method. Results The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of GenoType MTBDRplus assay in detection of RIF resistance were 100, 97.5, 90, 100, and 98%, respectively versus 100, 94.4, 87.5, 100, and 96%, respectively, for detection of INH resistance. The prevalence of MDR-TB by genotypic method was 12 versus 8% by conventional culture. On the contrary, drug resistance to either RIF or INH was detected in 28% of cases by the molecular method versus 30% of cases by using conventional culture. Conclusion The diagnostic yield of GenoType MTBDRplus assay for detection of RIF and INH resistance was satisfactory enough to support its alternative use for rapid identification of MDR-TB isolates, facilitating early and proper anti-TB drug regimen.

The relationship between obstructive sleep apnea and diabetic retinopathy in type 2 diabetes patients, Zagazig University Hospitals, Egypt Sameh Embarak, Ahmad Abbas, Haitham Y Al-Nashar, Salama E Farag The Egyptian Journal of Chest Diseases and Tuberculosis 2019 68(3):290-295 Background and objective Obstructive sleep apnea (OSA) and type 2 diabetes mellitus (T2DM) commonly coexist. Both could be associated with a number of pathophysiological derangements involved in the development of diabetic retinopathy (DR). So, the aim of this study was to assess the possible association between OSA and DR. Patients and methods This is a cross-sectional observational study that was conducted on patients with T2DM. Two-field 45°-digital retinal images for each eye were used to evaluate DR and graded according to the English National Screening Program guidelines. OSA was evaluated on the basis of an inpatient overnight sleep study (polysomnography) using a computerized polysomnogram device. Results This work recruited 110 patients. OSA was observed in 60% (66 patients). OSA was found to be independently associated with both advanced DR [preprolifrative (R2) or proliferative (R3)] (odds ratio=6.29; 95% confidence interval: 1.08–6.65; P=0.04) and maculopathy (odds ratio=12.92; 95% confidence interval: 3.97–4.79; P<0.001). Moreover, OSA severity was directly related to DR grade (r=0.5, P<0.001). Conclusion OSA was independently associated with advanced DR and maculopathy in T2DM patients. Moreover, severity of OSA was directly related to DR grade.

Quality of life, fatigue, anxiety and depression among Egyptian patients with obstructive sleep apnea Hamdy M Mohammadien, Abd-elbaset M Saleh, Fatma H Mohamed, Fatma h Mohamed, Azza M Abdelrahman The Egyptian Journal of Chest Diseases and Tuberculosis 2019 68(3):296-302 Background Sleep disorders have their well-documented deleterious effect on quality of life (QoL). The QoL impairment cannot be detected by polysomnography, which is the gold standard diagnostic tool for diagnosis of obstructive sleep apnea (OSA). Objective This study aimed at the evaluation of QoL, fatigue, depression and anxiety in OSA patients. Relation of QoL to disease severity and sex differences was assessed. Correlation of QoL scores to each other was assessed. Patients and methods We used three disease-specific QoL tools, namely the functional outcome of sleepiness questionnaire-10, the sleep apnea quality of life index, and the OSA patient-oriented severity index. Fatigue, anxiety, and depression were estimated using fatigue severity scale and hospital depression and anxiety scale, respectively. Results A total 170 participants were included; of them, 100 were OSA patients and 70 were non-OSA. OSA patients showed significantly lower QoL and more fatigue, depression, and anxiety symptoms in comparison with the non-OSA group, with more impairment of QoL in severe OSA patients. Female patients with OSA showed more QoL impairment. The highest correlation was observed between the sleep apnea quality of life index and the OSA patient-oriented severity index: r=−0.90, P value less than 0.001. Conclusion This study highlighted the significance of QoL, fatigue, anxiety and depression assessment in OSA patients, especially in those with severe disease.

Study of serum adiponectin and resistin in patients with obstructive sleep apnea Mohamed H Zidan, Heba S Gharraf, Mona W Ayad, Heba S Gaid The Egyptian Journal of Chest Diseases and Tuberculosis 2019 68(3):303-309 Background The syndrome of obstructive sleep apnea (OSA) is a very common disorder with several important complications and is still underdiagnosed. Obesity is considered to be a chronic disease rather than a lifestyle disorder. Adipose tissue secretory function is disturbed by chronic intermitted hypoxia occurring in OSA. The aim of this study was to study the level of serum adiponectin and resistin in patients with OSA and we tried to assess their association to different parameters of sleep disordered breathing (SDB) as well as concomitant comorbidities in each patient. Patients and methods This study contained two groups: Patients of group 1 included 30 newly diagnosed OSA patients and controls (group 2) included 15 healthy volunteers. All patients were subjected to overnight polysomnography, routine laboratory investigations, spirometry, and fasting serum adiponectin and resistin. Results Patients had statistically significant lower serum adiponectin level than controls while serum resistin levels were statistically significant higher in patients than controls. Moreover, serum adiponectin levels were significantly decreased with increased severity of OSA while serum resistin levels were increased significantly with increased severity of OSA. Moreover, there was a statistically significant decrease in serum adiponectin levels in the patients’ group with increasing number of comorbidities existing in every patient. There was a statistically significant increase in serum resistin levels in the patients’ group with increasing number of comorbidities existing in every patient. Conclusion This highlights the possible relationship of these hormones with the metabolic complications seen in OSA patients.

Vitamin D level and mean platelet volume in patients with obstructive sleep apnea syndrome Nourane Y Azab, Rabab A El-Wahsh, Rana H El-Helbawy, Yasser A El-Ghobashy, Hebatallah A Sharaf El-Din The Egyptian Journal of Chest Diseases and Tuberculosis 2019 68(3):310-316 Objectives To assess the serum level of vitamin D and mean platelet volume (MPV) in patients with obstructive sleep apnea syndrome (OSAS) and whether their levels correlate with OSAS severity or not. Background OSAS is a clinical disorder characterized by recurrent episodes of upper airway collapse during sleep. Studies show a link between low levels of vitamin D ‘25(OH) D’ and obstructive sleep apnea. Some studies showed that patients who have OSAS also have raised platelet aggregation and activation. MPV is considered an indicator of activation of platelet and its size. Limited studies have informed a relationship between MPV and sleep apnea. Patients and methods A total of 65 patients with OSAS and 24 age-matched controls with completed Epworth sleepiness scale were included. OSAS diagnosis was based on polysomnography. Vitamin D was measured by ELISA, and MPV was measured by Sysmex xn-10 machine. Results A prospective case–control study was done on 65 OSAS cases and 24 age-matched and sex-matched controls. Vitamin D level was significantly lower among OSAS cases than controls, with lowest 25(OH) D in severe OSAS cases, whereas MPV showed nonsignificant difference between them, and the higher MPV was among severe cases. There was a significant negative correlation between vitamin D level and neck circumference (NC), apnea–hypopnea index (AHI), and desaturation index. There was a significant positive correlation between MPV level and each of NC and AHI. NC was an independent predictor for both vitamin D and MPV levels. NC, AHI, and vitamin D level are the independent risk factors for obstructive sleep apnea, with odds ratios of 2.09 and 1.6, respectively. Conclusion Patients with OSAS have decreased vitamin D level. Patients with severe OSAS have lower vitamin D level and higher MPV than other groups. Obesity may be the cause that explains this relation regarding high NC.

What’s the burden of osteoporosis on Egyptian patients with chronic obstructive pulmonary disease? Tarek M Nasrallah, Ismail M Alwakil, Mohammad S.E Radwan, Mohamed S.A Aziz Shehata The Egyptian Journal of Chest Diseases and Tuberculosis 2019 68(3):317-321 Background Chronic obstructive pulmonary disease (COPD) is a complex disease, where the initial symptoms are often cough and dyspnea. patients with moderate to severe COPD have often multiorganic disease and a decreased quality of life. Osteoporosis identified as one of the commonest systemic effects of COPD. Aim The aim of this study is to delineate the association of chronic obstructive pulmonary disease (COPD) and Osteoporosis in Egyptian patients. Patients and Methods We wanted to investigate the prevalence of osteoporosis in patients with COPD as well as to correlate risk factors that increase prevalence of osteoporosis. Results Fifty patients with COPD manifestation were investigated after taking written consent for the presence of osteoporosis by spirometry examination, X-ray of the spine (for vertebral fractures), and bone mineral density (BMD) of lumbar spine and hips, parathyroid hormone luteinizing hormone follicular stimulating hormone, calcium, phosphorus, vit. D, and other lab. to exclude other secondary causes were performed. In 12 patients, X-ray revealed compression fractures previously not diagnosed. Bone density measurements showed osteoporosis in 16 patients and osteopenia in 29. Thus 80% of the patients had osteoporosis or osteopenia. Conclusion There is a significant need to initiate early prophylaxis and prevention from osteoporosis in patients with Chronic Obstructive Pulmonary Disease (COPD).

Refractory asthma in Qena Governorate, Egypt: a single-center study Mohamed Shahat, Mosaab Mamdouh, Ibtehal Donkol, Alaa Rashad Mahmoud Mohamed The Egyptian Journal of Chest Diseases and Tuberculosis 2019 68(3):322-327 Background Refractory asthma is defined as asthma with persistent symptoms or asthma with frequent or serious exacerbations accompanied by persistent airflow obstruction despite high doses of corticosteroids. Patients and methods This study included 88 patients with asthma at Qena University Hospital. All participants in this study underwent full medical history, physical examination, chest radiography, and spirometry with reversibility test. Then patients were classified into controlled and uncontrolled groups according to asthma control test. Results We found that poorly controlled asthma was significantly associated with older age, (33.03±14.3 years for controlled group versus 42.81±12.8 years for uncontrolled group, P<0.001), higher BMI (24.9±4.07 years for controlled group versus 28.05±5.3 for uncontrolled group, P<0.006), history of smoking (P<0.0001), and exposure to dust (P<0.0001), smoke (P<0.00001) and domestic animals (P<0.011), whereas there were no significant differences regarding sex (P=0.617), residence (P<0.805), or exposure to perfumes (P=0.072), soap (P=0.195), pollens (P=0.364), or chemicals (P<0.064). Poor asthma control was significantly associated with poor forced expiratory volume in 1 s (P<0.0001), forced vital capacity (P<0.0001), and forced expiratory volume in 1 s/forced vital capacity (P<0.007). Conclusion Difficult-to-control asthma is more predominant in patients with asthma with elder age, obesity, smoking history, and poor pulmonary functions.