bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-term changes in forest cover in a global biodiversity hotspot in southern Mozambique
Authors: Tokura Wataru , Matimele Hermenegildo , Smit Julian , Hoffman Michael Timm
Published: September 2023

Background: Deforestation is a complex and dynamic process of widespread concern in sub-Saharan Africa which is influenced by a range of social, economic and biophysical factors. Objectives: The aim of this study was to analyse patterns of deforestation and its potential drivers in the Licuáti Forest Reserve, a biodiversity hotspot in southern Mozambique between 1990 and 2016. Method: We performed image classification on Landsat imagery at six time steps and interviewed local community members to understand the spatial pattern and rate of forest cover loss over time. We also examined changes in the incidence of fire. Results: A substantial increase in the rate of deforestation since 1990 was detected in this vulnerable thicket vegetation. The probability of deforestation was significantly higher near the major roads, where houses are located. This suggests that the proximity of human settlements to the forest, and access to charcoal markets in urban areas, influenced the spatial pattern. Two key factors 1) charcoal production, and 2) the establishment of settlements and agricultural lands were identified as proximate causes of deforestation. In addition, fires associated with these two causes might amplify the loss of forests in the area. Conclusions: Complex interactions between the drivers of deforestation and socio-economic factors were suggested, as most of the charcoal produced in the region is transported to Maputo. Ongoing road improvements and infrastructural development in the region will likely accelerate the decline in forest cover in the future. This has implications for the biodiversity of the region as well as for the sustainability of local livelihoods, as they often depend on forest products for their daily uses.
INSTITUTIONAL QUALITY, INCOME LEVEL, AND DEBT SUSTAINABILITY: NEW EVIDENCE USING DYNAMIC PANEL THRESHOLD REGRESSION
Authors: Lee Chee Loong , Ahmad Riayati , Karim Zulkefly Abdul , Khalid Norlin
Published: September 2023

Most countries have suffered from prolonged budget deficits over the past two decades. This situation has made researchers and policymakers aware of the challenges to debt sustainability. This study investigates the threshold effect of institutional quality on debt sustainability in a panel of 82 countries, focussing on various threshold effects at different income levels. All the countries selected for this study fell under the categories of high income (HI), upper middle income (UMI), and lower-middle and low income (LMLI) based on the World Bank classifications. The dynamic threshold panel regression results indicate the presence of a threshold effect of institutional quality on the fiscal reaction function (including debt sustainability and cyclical fiscal policy) in all the countries with different income levels. In HI countries, fiscal adjustment weakens if institutional quality surpasses the threshold value of institutional quality. The fiscal adjustment in UMI countries is similar to that in HI countries but statistically insignificant. By contrast, governments in LMLI countries can promote sustainable debt if their institutional quality exceeds the threshold value. Thus, policymakers in LMLI countries need to prioritise their efforts to raise the level of institutional quality to promote debt sustainability.
Snake shed skin consumed by Kinosternon vogti: a case of interspecific keratophagy
Authors: Cupul-Magaña Fabio G. , López-González Nadin E. , Barraza-Soltero Ilse K. , Blanck Torsten , Praschag Peter , Diruzzo Shannon , Butterfield Taggert G. , Escobedo-Galván Armando H.
Published: September 2023

Some reptile species can consume their own shed skin or that of conspecifics; despite its prevalence, the benefits of eating shed skin remain poorly understood. Here, we report a field observation in which a Vallarta Mud Turtle (Kinosternon vogti) consumed a snake shed skin of Masticophis lineatus (Bocourt, 1890) in Bahía de Banderas, Nayarit, Mexico. This type of record could allow us to understand the keratophagous behaviour between and within reptile species.
Cost-effectiveness of treatment intervention in prediabetic patients in Bulgaria
Authors: Yordanova Stanislava , Mitov Konstantin , Kamusheva Maria
Published: September 2023

Introduction: The study aims to evaluate the cost-effectiveness (CE) of an early intervention in prediabetes (metformin) in order to prevent or slow down the onset of diabetes in those at high risk compared with the current “do nothing” approach.

Materials and methods: An Excel-based model was developed. The results of the CE and cost-utility analyses are presented as an ICER (incremental cost-effectiveness ratio) and ICUR (incremental cost-utility ratio), respectively. Markov model of the cost or potential savings from the perspective of the National Health Insurance Fund in Bulgaria was performed.

Results: The ICER of the metformin intervention in prediabetes patients compared with “do nothing” routine shows that metformin treatment produced more health benefits (number of prevented diabetes cases) on a lower cost for the public payer. The ICER calculated is -7,122.32 BGN per number of prevented diabetes cases and it confirms cost-savings are possible when metformin is applied compared with the “do nothing” approach. The ICUR per quality-adjusted life years (QALYs) gained also shows the metformin preventive intervention as a dominant and cost-saving alternative. The Markov model simulation confirms the intervention with metformin is less costly in a long-term and leads to higher QALYs.

Conclusion: The investment in a preventive intervention with metformin offers an excellent value for money. The ICER of the metformin intervention in prediabetes patients compared with “do nothing” routine shows that metformin preventive intervention produced more health benefits on a lower cost for the public payer in Bulgaria.
Prevalence of potentially inappropriate medications among elderly patients with diabetes – study based on STOPP/START criteria
Authors: Milushewa Petya , Kosanova Kristina , Nikolov Petar
Published: September 2023

Objective: The prevalence of drug-related problems in elderly patients is a concerning issue that can lead to elevated morbidity, mortality, and health care resource utilisation. This study focuses on the significance of addressing diabetes in the context of an ageing population, where elderly individuals face higher risks of comorbidities and mortality. The main objective of this study was to assess potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) among patients with diabetes in Bulgaria, using the explicit STOPP/START criteria, version 2. By evaluating the appropriateness of drug prescriptions in this specific patient population, this study aims to shed light on areas that require optimisation to enhance patient safety and treatment outcomes.

Materials and methods: A national prospective questionnaire study was conducted in Bulgaria among patients aged over 65 years. The research was conducted in 25 randomly selected pharmacies. The study supports the use of the STOPP/START criteria based on the clinical information provided. A total of 133 patients with T1DM or T2DM participated in the study. The evaluation of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) was performed in 131 patients. sStatistical differences in demographics and medication numbers between patients with and without PIMs or PPOs were assessed using a Chi-square test, with a p-value of ≤ 0.05 considered statistically significant.

Results: The pharmacotherapy of 131 patients with diabetes was assessed, and it was found that 57% of them had polypharmacy. Among the study population, 90 PIMs were identified, indicating that 66% of the patients had inappropriate prescribing. Notably, inappropriate prescribing concerning diabetes was associated with the use of long-acting sulfonylureas (n=10) and beta-blockers (n=13). Applying the START criteria revealed 67 PPOs among 67 patients, representing a prevalence of 50% in the study population. However, no PPOs were detected in the context of diabetes pharmacotherapy. Furthermore, a significant relationship was observed between the number of medications and PIMs, as evidenced by the chi-square test result with a p-value close to zero, indicating statistical significance.

Conclusion: The study revealed a high prevalence of PIMs in elderly patients with diabetes in Bulgaria. Endocrine disorders contribute to 26% of PIMs. As Bulgaria’s ageing population faces increasing diabetes challenges, effective management strategies are crucial. These findings underscore the significance of addressing prescribing practises to enhance disease control and prevent complications.
Polymethylmethacrylate and Corneal Allogenic Intrastromal Ring Segments: Same Cornea, Different Optical Zones
Authors: Bteich Yara , Ibrahim Perla , Gendy Jeremiah , Assaf Jad F. , Barake Karim , Awwad Shady T.
Published: September 2023

Purpose:

To present the first report of corneal allogenic intrastromal ring segment (CAIRS) insertion in a cornea with an existing polymethylmethacrylate (PMMA) segment each at a different optical zone.

Methods:

A 29-year-old man with severe keratoconus treated with PMMA ring segment implantation at a 7-mm optical zone and 375-µm depth presented with moderate improvement in visual acuity and topography. An allogenic segment was implanted at a depth of 260 µm and an optical zone of 5 mm without explantation of the existing segment.

Results:

There was additional topographic regularization and significant corneal flattening, with improvement in corrected distance visual acuity from 20/60 following PMMA insertion to 20/30 following CAIRS insertion. Corneal topography showed improvement in corneal regularity with centration of the cone on the corneal vertex and improvement in coma (from 1.69 diopters [D] @ 75° to 0.51 D @ 56° at 6-mm optical zone) and keratometric cylinder (from −6.47 D × 35° to −3.59 D × 18°).

Conclusions:

The implantation of CAIRS in an eye that has previously undergone synthetic segment implantation at a different optical zone was demonstrated to be a promising method for regularizing topography and improving vision in this case.

[
Journal of Refractive Surgery Case Reports.
2023;3(3):e38–e41.]
Valued-inverse Dombi neutrosophic graph and application
Authors: Hamidi Mohammad , Smarandache Florentin
Published: September 2023

Utilizing two ideas of neutrosophic subsets (NS) and triangular norms, we introduce a new type of graph as valued-inverse Dombi neutrosophic graphs. The valued-inverse Dombi neutrosophic graphs are a generalization of inverse neutrosophic graphs and are dual to Dombi neutrosophic graphs. We present the concepts of (complete) strong valued-inverse Dombi neutrosophic graphs and analyze the complement of (complete) strong valued-inverse Dombi neutrosophic graphs and self-valued complemented valued-inverse Dombi neutrosophic graphs. Since the valued-inverse Dombi neutrosophic graphs depend on real values, solving the non-equation and the concept of homomorphism play a prominent role in determining the complete, strong, complementarity and self-complementarity of valued-inverse Dombi neutrosophic graphs. We introduce the truth membership order, indeterminacy membership order, falsity membership order, truth membership size, indeterminacy membership size and indeterminacy membership size of any given valued-inverse Dombi neutrosophic graph, which play a major role in the application of valued inverse Dombi neutrosophic graphs in complex networks. An application of a valued-inverse Dombi neutrosophic graph is also described in this study.
The pullback attractor for the 2D g-Navier-Stokes equation with nonlinear damping and time delay
Authors: Wang Xiaoxia , Jiang Jinping
Published: September 2023

In this article, the global well-posedness of weak solutions for 2D non-autonomous g-Navier-Stokes equations on some bounded domains were investigated by the Faedo-Galerkin method. Then the existence of pullback attractors for 2D g-Navier-Stokes equations with nonlinear damping and time delay was obtained using the method of pullback condition (PC).
Complementary label learning based on knowledge distillation
Authors: Ying Peng , Li Zhongnian , Sun Renke , Xu Xinzheng
Published: September 2023

Complementary label learning (CLL) is a type of weakly supervised learning method that utilizes the category of samples that do not belong to a certain class to learn their true category. However, current CLL methods mainly rely on rewriting classification losses without fully leveraging the supervisory information in complementary labels. Therefore, enhancing the supervised information in complementary labels is a promising approach to improve the performance of CLL. In this paper, we propose a novel framework called Complementary Label Enhancement based on Knowledge Distillation (KDCL) to address the lack of attention given to complementary labels. KDCL consists of two deep neural networks: a teacher model and a student model. The teacher model focuses on softening complementary labels to enrich the supervision information in them, while the student model learns from the complementary labels that have been softened by the teacher model. Both the teacher and student models are trained on the dataset that contains only complementary labels. To evaluate the effectiveness of KDCL, we conducted experiments on four datasets, namely MNIST, F-MNIST, K-MNIST and CIFAR-10, using two sets of teacher-student models (Lenet-5+MLP and DenseNet-121+ResNet-18) and three CLL algorithms (PC, FWD and SCL-NL). Our experimental results demonstrate that models optimized by KDCL outperform those trained only with complementary labels in terms of accuracy.
The Macro Impact of Short‐Termism
Authors: Terry Stephen J.
Published: September 2023

R&D investment reduces current profits, so short‐term pressure to hit profit targets may distort R&D. In the data, firms just meeting Wall Street forecasts have lower R&D growth and subsequent innovation, while managers just missing receive lower pay. But short‐termist distortions might not quantitatively matter if aggregation or equilibrium dampen their impact. So I build and estimate a quantitative endogenous growth model in which short‐termism arises naturally as discipline on conflicted managers and boosts firm value by about 1%. But short‐termism reduces R&D, and the social return to R&D is higher than the private return due to standard channels including knowledge spillovers and imperfect competition. So at the macro level, short‐termist distortions slow growth by 5 basis points yearly and lower social welfare by about 1%.
Former des formateurs d’enseignants de mathématiques du secondaire : un besoin, une expérience et une question d’actualité
Authors: Abboud-Blanchard Maha , Robert Aline
Published: September 2023

It seems obvious that teacher educators should themselves be trained. Nevertheless, rare are research studies that consider this issue. In this paper we trace the history and present the theoretical background of a university program for training trainers of secondary mathematics teachers, established since 2004, grounded on a master degree of didactics of sciences. We first situate this experience in comparison to other similar ones and present its guidelines and discuss opinions of teachers who participated in it. We then develop the research that underpinned this program and its interrelation with the training hypotheses, including assumptions made on the development of teaching practices. We finally discuss why and how such training, made in a university context by researchers, could have an impact on teachers' professional development and what questions it raises for the research in this field.
Bède et ses sources irlandaises
Authors: Picard Jean-Michel
Published: September 2023

Leaving aside the debate concerning Bede’s attitude to the Irish – friendly according to some scholars, frankly hostile according to others –, this paper shows exactly which texts of Irish origin Bede did use and, more importantly, how he used them. Bede borrowed extensively from Irish sources in his early works, not only in his scientific treatises but also in his exegetical works. His respect for Irish grammarians sometimes leads him astray and he takes far too seriously the burlesque works of Virgilius Maro Grammaticus. He seemed to have appreciated the synthetic approach of the Irish masters, but did not hesitate to query their scholarship, supplementing their information with classical and Patristic texts. Through the borrowings, corrections, references and cross-references, one can sense a lively spirit of competition between scholars, which can only have been possible in a context of close contacts between Ireland and Northumbria, long after the synod of Streaneshalc/Whitby.
Bede’s in Ezram et Neemiam : A Document in Church Reform?
Authors: DeGregorio Scott
Published: September 2023

Le traité de Bède In Ezram et Neemiam est le premier et le plus achevé des commentaires qui aient été écrits au Moyen Âge sur les livres d’Ezra et de Nehémie. Qu’est-ce qui a poussé Bède à écrire un commentaire aussi développé sur ces livres de l’Ancien Testament jusqu’alors négligés ? La présente communication entend montrer que c’est leur implication dans la réforme religieuse qui a attiré Bède vers ces livres, et qu’il existe de nombreuses correspondances entre le commentaire qu’il en a donné et l’œuvre la plus explicitement réformatrice qu’il nous ait laissée – son Epistola ad Ecgberhtum episcopum. J’en conclus que, par le développement de thèmes tels que la prédication par la parole et l’exemple, la pastorale des évêques et des prêcheurs à destination des fidèles, ou encore la corruption de la vie religieuse par la sécularisation et l’avidité cléricale – tous thèmes qu’on retrouve au cœur de l’Epistola –, le traité In Ezram et Neemiam est un travail hautement réformateur, qui se singularise en tant que tel dans l’œuvre exégétique de son auteur.
Les effets de lumière comme moyen déterminant d’une esthétique théâtrale à travers deux mises en scène de La Belle Hélène de Jacques Offenbach
Authors: Routier Hélène
Published: September 2023

Le rôle de la lumière de La Belle Hélène de Jacques Offenbach dans deux mises en scène : Laurent Pelly (2000, Théâtre du Châtelet) et Giorgio Barberio Corsetti et Pierrick Sorin (2015, Théâtre du Châtelet).
Transcanal totally endoscopic stapes surgery: step-by-step procedure
Authors: Omran Ahmed A. , Habib Ahmed S.
Published: September 2023

Objectives

The purpose of the present work was to evaluate the role of otoendoscopy in performing stapedotomy in clinically otosclerotic patients.

Patients and methods

Twenty patients presenting with clinically diagnosed otosclerosis were randomly selected from the outpatient ENT clinic in a tertiary referral Institutional Hospital. All patients were subjected to transcanal totally endoscopic stapes surgery (TTESS) from early 2013 to the fall of 2014.

Methods

This prospective study demonstrated the detailed technique of TTESS using mainly 0° lens of 14 cm length rigid endoscope for elevating the tympanomeatal flap, handling the chorda tympani nerve, curettage of posterior bony canal wall, visualization of oval window niche structures, creation of stapedotomy, and accurate prosthesis insertion. Postoperative audiogram was performed after 2 months. Assessment of postoperative complications, especially change in taste sensation, was carried out.

Results

The chorda tympani nerve was preserved in all cases. Two cases had change in taste sensation that was improved within 6 months postoperatively. There was a significant improvement in hearing. The preoperative air-bone gap mean value was 40.30±6.38, and the postoperative mean value was 7.15±4.27 (P=0.001), with complete closure of air-bone gap in four cases. No facial paralysis or tympanic membrane perforation was encountered during the follow-up period.

Conclusion

Transcanal totally endoscopic stapes surgery is a feasible and safe technique for the surgical management of conductive hearing loss associated with otosclerosis, which is recommended in bilateral and revision cases.
Certainty of pretreatment apparent diffusion coefficient in the characterization of thyroid gland pathologies
Authors: Abd-Alhamid Tarek , Khafagy Ahmed G. , Al Sersy Hesham , Askora Anas , Rabie Tahany M. , Taha Mohamed S. , Ebrahim Amal , El Sayed Hoda M.
Published: September 2023

Introduction

One of the most recent techniques in imaging tumors is the diffusion-weighted MRI. It provides information regarding the metabolic, molecular, and pathophysiological aspects of tumors, especially thyroid gland cancer. Diffusion-weighted imaging (DWI) has also been proposed as a sensitive marker for monitoring treatment response in head and neck cancers. The biophysical mechanism of DWI is based on the translational motion of water molecules in tissues. The magnitude of this motion is characterized by its apparent diffusion coefficient (ADC) values.

Objective

The aim of the present study was to evaluate the certainty of ADC value in differentiating between benign and malignant thyroid lesions.

Materials and methods

Neck MRI with several sequences including DWI in the axial plane were carried out for 49 patients who presented with thyroid masses either benign or malignant. ADC maps were calculated by using the MRI machine software.

Results

A total of 49 patients (77.6%) were included in the present study. There were 11 men (22.4%) and 38 women patients (77.6%), with a mean age of 44.4 years. The lesions were benign in 31 cases (63.3%) and malignant in 18 cases (36.7%). The ADC values were significantly different (P<0.001) between benign and malignant lesions.

Conclusion

ADC value is a promising noninvasive imaging tool that can be used for characterization and differentiation of thyroid nodules.
Assessment the effect of noise on the sacculocolic pathway using vestibular evoked myogenic potential
Authors: Elbeltagy Reem , Galhom Dalia
Published: September 2023

Objective

The aim of this study was to detect the effect of noise on the sacculocollic pathway using cervical vestibular evoked myogenic potential (c-VEMP) and to check the correlation between the hearing thresholds and the c-VEMP responses in noise-induced hearing loss (NIHL) patients.

Patients and methods

The study included 40 (80 ears) participants. Their ages ranged between 30 and 45 years. They were divided into two groups: 20 (40 ears) participants with NIHL presenting with bilateral notched audiogram at 4kHz, and 20 (40 ears) participants as a control group. All participants in the study were subjected to basic audiological evaluation and VEMP tests.

Results

As the average pure-tone hearing threshold increased, the c-VEMP latencies prolonged and peak-to-peak amplitude reduced in NIHL patients. Of the 40 ears, c-VEMP was absent in 12 (30%) ears. The latencies prolonged and the peak-to-peak amplitude reduced in 16 (40%) ears. VEMP results were normal in 12 (30%) ears.

Conclusion

Noise can cause more damage to the vestibular system, especially the sacculocollic pathway.
Epley repositioning maneuver versus Gans repositioning maneuver on postural instability in elderly patients with benign paroxysmal positional vertigo
Authors: Omara Abir , Mosaad Dalia M. , Mohamed Ahmed S. , Abd El-Raoof Neveen A.
Published: September 2023

Introduction

Patients with benign paroxysmal positional vertigo (BPPV), especially the elderly, often experience a greater incidence of falls and postural instability. The Epley repositioning maneuver has been proven to be effective in improving the postural control, whereas Gans repositioning maneuver (GRM) is still lacking data.

Objective

The objective of this study was to compare between the effectiveness of GRM and Epley repositioning maneuver in improving postural stability in elderly patients with posterior canal BPPV.

Patients and methods

In this randomized controlled trial, patients were randomly assigned into two groups. Group A (study group) was assessed by side-lying test and treated by GRM, whereas group B (control group) was evaluated by Dix–Hallpike test and treated by the Epley repositioning maneuver. Postural stability was estimated by computerized dynamic posturography.

Results

Patients in both groups showed improvement within the groups in equilibrium scores subtest 4, 5, 6 (P<0.05), whereas there was no significant difference between groups (P>0.05) regarding equilibrium scores.

Conclusion

GRM is as effective as the Epley repositioning maneuver in improving postural stability in elderly patients with posterior canal BPPV.
Emergency management of an isolated sphenoidal mucopyocele with vision loss: a case report
Authors: Ramalingam Natarajan , Ganesan Sivaraman , Venkatesan Sithananda K. , Saxena Sunil K.
Published: September 2023

Isolated mucocele is very rare in sphenoid sinus. It presents with varied symptoms in the form of vision loss, proptosis, and headache. We report a case of isolated sphenoidal mucocele that presented with vision loss. Although the vision loss was not sudden, immediate evacuation of pus and marsupialization was done on an emergency basis based on the clinical and radiological findings rather than relying on the history of insidious vision loss. The patient’s vision improved immediately after surgery. This underscores the importance of emergency drainage of this condition.
Serum surfactant protein D as a prognostic factor in idiopathic pulmonary fibrosis
Authors: El-Miligy Dawalat , Zakaria Mohamed W. , Rashed Laila , Abu-Hussein Haidi
Published: September 2023

Background/aim

The aim of this study was to investigate the possible role of surfactant protein D (SP-D) in the pathogenesis and the prognosis of idiopathic pulmonary fibrosis (IPF).

Materials and methods

This study was performed on 10 healthy volunteers (group 1) and 30 patients from the Chest Diseases Department, Kasr El-Aini Hospital, who were divided into three groups: group 2 consisted of 10 patients with IPF receiving steroids; group 3 consisted of 10 patients with IPF not receiving steroids; and group 4 consisted of 10 patients with chronic chest diseases other than IPF and not receiving steroids. All patients underwent full history taking, thorough clinical examination, chest radiography and high-resolution computed tomography of the chest, pulmonary function testing, and estimation of SP-D by enzyme-linked immunosorbent assay.

Results

There was no statistical significance in the mean age of the four included groups. With regard to smoking in patients in groups 2, 3, and 4, there was no statistical significance in the duration or the number of cigarettes smoked per day. There was a significant decrease in FEV1, FVC, and FEV1/FVC in groups 2, 3, and 4 compared with the control group (group 1). SP-D shows a significant increase in groups 2, 3, and 4 compared with the control group, and also shows a significant increase in IPF patients not receiving steroids (group 3) compared with IPF patients receiving steroids (group 2) and patients with chronic chest diseases (group 4). A negative correlation was found between SP-D and FEV1, FVC, and FEV1/FVC. No correlation was found between SP-D, age, the duration of smoking, or the number of cigarettes smoked per day.

Conclusion

The SP-D assay may indicate the rate of decline in the pulmonary function in cases of IPF and in the follow-up of disease progress. It may also assist in making clinical choices for the therapeutic management of patients with IPF.
Study of cardiopulmonary rehabilitation versus cardiac rehabilitation in patients suffering from coronary artery diseases and chronic obstructive pulmonary disease
Authors: Mohamed Yasser M. , Salem Hala M. , Khorshid Hazem M. , Abdel Fattah Karim H.
Published: September 2023

Introduction

Chronic obstructive pulmonary disease (COPD) and coronary artery disease are common treatable and preventable chronic diseases. Rehabilitation is now considered an important part of the long-term management in both diseases and includes exercise, education, and smoking cessation.

Patients and methods

This study included 40 patients with COPD and coronary artery disease referred to the cardiac rehabilitation unit at Ain Shams University hospitals. Patients were assessed by clinical assessment, ECG, ECHO, modified Bruce protocol, spirometry, and St George’s Respiratory Questionnaire (SGRQ). Then, patients were divided into two groups: a cardiac rehabilitation group and a cardiopulmonary rehabilitation group. All patients received 8–12 weeks of rehabilitation and were reassessed by spirometry, the modified Bruce protocol, and SGRQ.

Results

Both groups improved in terms of spirometric parameters (forced expiratory volume in 1 s and forced expiratory volume in 1 s/forced vital capacity), SGRQ, and metabolic equivalents of tasks, but there was a statistically significant in resting heart rate in the cardiopulmonary rehabilitation group.

Conclusion

The inclusion of upper limb exercise and inspiratory muscles training in pulmonary rehabilitation improves exercise tolerance in patients suffering from both COPD and coronary artery disease compared with cardiac rehabilitation alone.
Serum adiponectin as a biomarker for chronic obstructive pulmonary disease and lung cancer and its relation to severity
Authors: Gayed Amany T. , Raafat Riham H.
Published: September 2023

Introduction

‘Chronic obstructive pulmonary disease’ (COPD) is an inflammatory disorder associated with airway narrowing and airflow limitation in response to air pollution, gases, and smoking and is associated with morbidity and mortality. Cancer is also considered as a systemic inflammatory disorder where pro-inflammatory cytokines and mediators are released.

Aim

To evaluate serum adiponectin level in COPD and lung cancer and its importance in detecting and predicting severity.

Patients and methods

A total of 40 patients were recruited in the study: 20 had stable COPD and 20 had lung cancer. Moreover, another 10 age-matched and sex-matched individuals were included as a control group. All were subjected to routine laboratory chest radiography, spirometry, and serum adiponectin level measurement.

Results

The results showed an increase of adiponectin level in both patients with COPD and those with lung cancer, and significant correlation was found between adiponectin level and forced expiratory volume in 1 s and performance status.

Conclusion

Adiponectin serum level is elevated in both COPD and lung cancer and significantly elevated in severe cases.
Pulmonary complications within the first year after bone marrow transplantation
Authors: Sadon Amal Abd El-Azem , El-Hagrasy Rehab S. , Saraya Mohamed A.
Published: September 2023

Background

Pulmonary complications (PCs) are a significant cause of morbidity and mortality in hematopoietic stem cell transplant (HSCT) recipients. Pulmonary infiltrates in such patients pose a major challenge for clinicians because of the wide differential diagnosis of infectious and noninfectious conditions. It is rare for the diagnosis to be made by chest radiograph, and commonly these patients will need further invasive and noninvasive studies to confirm the etiology of the pulmonary infiltrates.

Aim

The aim of this research was to study the pattern of lower respiratory tract infection within the first year after HSCT.

Patients and methods

This is a prospective study of 60 patients receiving HSCT (because of hematological and nonhematological malignancy) at Kuwait Cancer Center within the first year after transplantation for any suspicious respiratory tract infection. Patients were subjected to sputum and blood examination along with bronchoscopic examination and bronchoalveolar lavage if indicated, and all samples were subjected to microbiological examination for diagnosis of the causative organism.

Results

Sixty patients were studied for PCs either infectious or noninfectious within the first year after HSCT. The most common complications were infectious complications (70%). Severe PCs were the main causes of death in 13 (21.6%) cases. The PCs were more common and recurrent in allogeneic bone marrow transplantation (BMT) recipients, in whom PCs contributed to death in 12 cases. Bacterial infection, pulmonary edema, and diffuse alveolar hemorrhage were seen more in the early post-BMT period (<100 days), whereas viral, fungal infection, graft-versus-host disease, and bronchiolitis obliterans were seen more in the late post-BMT period (>100 days).

Conclusion

Lower respiratory tract infection is a serious complication after BMT transplantation. Mixed bacterial and opportunistic infections are the most common etiologies. Pulmonary infiltrates in such patients pose a wide differential diagnosis of infectious and noninfectious conditions. PCs are a significant causes of death in BMT recipients.
Role of bronchoscopy in diagnosis of smear-negative pulmonary tuberculosis
Authors: Prasad Rajendra , Singh Abhijeet
Published: September 2023

Tuberculosis (TB) remains an important cause of morbidity and mortality in many developing countries including India. Prompt and accurate establishment of diagnosis is one of the essential basic principles of care for persons with TB. Sputum smear microscopy and culture remain the cornerstone of diagnosis but can be negative in a substantial proportion of pulmonary TB patients (multiple smear-negative status or scanty sputum). Bronchoscopy has been proven to be a safe and effective method for those patients with varying diagnostic yields ranging from 30 to 90%. Various specimens are obtained from a fiber-optic bronchoscope such as smear and culture for mycobacteria from the bronchial aspirate or wash, bronchoalveolar lavage fluid, bronchial brushing, postbronchoscopy sputum, transbronchial needle aspiration, and transbronchial biopsy. The diagnostic yield is significantly enhanced when nucleic acid amplification testing is applied to bronchoscopic specimens. The role of bronchoscopy in TB diagnosis is likely to be limited because of availability, cost, and logistical challenges. Future studies are needed to better define the role of the newer diagnostic modalities to improve early TB diagnosis.
Efficacy and safety of intrapleural cisplatin versus silver nitrate in treatment of malignant pleural effusion
Authors: El Badrawy Mohammad K. , Ali Raed El-Metwally , Hewidy Asem A. , El-Layeh Mohamed A. , Akl Fatma M. F. , Shebl Abdelhadi
Published: September 2023

Introduction

Malignant pleural effusion is a frequent problem. Pleurodesis is performed to prevent its recurrence. New, effective, and safe sclerosing agents are needed.

Aim

The aim of this was to compare efficacy and safety of silver nitrate solution 0.5% versus cisplatin in achievement of pleurodesis in malignant pleural effusion.

Patients and methods

Prospective randomized single-blinded clinical trial performed at Chest, Clinical Oncology and Nuclear Medicine and Pathology Departments, Mansoura University, from February 2016 to March 2017. A total of 60 patients (26 male and 34 female) with malignant pleural effusion were divided into two groups: first group included 30 patients who were managed with silver nitrate pleurodesis, and second group included 30 patients who were managed by intrapleural cisplatin injection. The success rate of pleurodesis was considered if there was no clinical or radiological recurrence of effusion for 1 month after intervention.

Results

There were significant improvements in cough, chest pain, and dyspnea in the two groups after 1 month versus that before pleurodesis. The success rate of pleurodesis in silver nitrate group was 90 versus 76.7% in cisplatin group, without significant difference (P=0.166). Chest pain was reported in 26.7% in silver nitrate group and 13.3% in cisplatin group, and fever was reported in 33.3% in silver nitrate group and 20.0% in cisplatin group. Recurrence was reported in 10% in silver nitrate group and in 23.3% in cisplatin group.

Conclusion

Silver nitrate and cisplatin were nearly equally effective, safe, and less expensive agents in achievement of pleurodesis in patients with malignant effusion with high success rate and low complications.
Assessment of coronary artery diseases in COPD
Authors: Abdalrazik Fatmaalzahraa S. , El-Sorougi Waleed M.
Published: September 2023

Context

Chronic obstructive pulmonary disease (COPD) is associated with significant systemic inflammatory response, with downstream adverse clinical effects. This inflammatory response is referred to oxidative stress and inflammatory mediators, which play an important role in the development of atherosclerosis. Preclinical carotid atherosclerosis, characterized by increased intima-media thickness (IMT) on ultrasound imaging, is a surrogate marker for atherosclerosis burden and risk of cardiovascular diseases.

Aim

To evaluate carotid IMT, in relation to post-forced expiratory volume in 1 s (FEV1) (FEV1 after bronchodilator inhalation) in COPD.

Patients and methods

A total of 50 patients with COPD were clinically and functionally diagnosed. IMT was measured by B-mode ultrasonography. The correlations between IMT, C-reactive protein (CRP), serum lipids, and post-FEV1 were analyzed. The primary outcome was carotid arteries’ IMT in relation to post-FEV1.

Results

Cases were divided into three groups according to post-FEV1. In mild COPD severity, mean±SD IMT value was 1.0±0.2, whereas in moderate severity, it was 1.5±0.2, and in severe COPD, IMT was 1.75±0.05 (P<0.001). In mild group, mean±SD value of CRP was 5.2±1.7, in moderate group was 7.5±1.5, and in severe COPD group was 8.4±0.2 (P<0.001). When CRP was correlated with IMT, the correlation was found to be highly significant (P<0.001). In severe airway obstruction group, mean values of serum cholesterol and triglycerides were 239.5 and 189.5, respectively; in moderate group 219.4 and 161.9, respectively; and in mild group 184.2 and 125.6, respectively (P<0.000). Multinomial logistic regression analysis revealed low post-FEV1 as predictor of IMT (P<0.000).

Conclusion

Carotid duplex should be added to the standard investigations of COPD.
Effectiveness of pulmonary rehabilitation on pulmonary function parameters and dyspnea in patients with stable chronic obstructive pulmonary disease
Authors: Karn Atef F. Al , Hassan Wafaa A. , Fadl Abdel A. Abo El , Mahmoud Manal A.
Published: September 2023

Background

Chronic obstructive pulmonary disease (COPD) is a common preventable and treatable disease characterized by persistent airflow limitation that is usually progressive. The characteristic symptoms of COPD are chronic and progressive dyspnea, cough, and sputum production. Breathing exercises aim to reduce hyperinflation, improve respiratory muscle performance, and reduce dyspnea.

Aim

The aim of the study was to assess the effectiveness of breathing exercises among patients with stable COPD in improvement of pulmonary function parameters, 6-min walk distance, and dyspnea score.

Patients and methods

Randomized controlled design was used in this study. Patients recruited for this study were enrolled from the outpatient clinic of Department of Chest Diseases and Tuberculosis. Overall, 15 patients with stable COPD were enrolled in pulmonary rehabilitation group and underwent breathing exercises for 12 weeks. Moreover, 15 patients were enrolled in the control group. Statistical package for the social sciences (SPSS version 20) software was used for statistical analysis.

Results

In the breathing exercise group, there was a significant increase in the mean forced expiratory volume in first second (P=0.001), forced vital capacity (P=0.001), and inspiratory capacity (P=0.015). There was a significant decrease in the mean functional residual capacity (P=0.005), residual volume (P=0.001), and total lung capacity (P=0.001). There was no significant difference between the values of the previous parameters in the control group.

Conclusion

In stable COPD, breathing exercises improved pulmonary function parameters, 6-min walk distance, and dyspnea score.
Predictors and outcome of prolonged stay in the respiratory ICU
Authors: Khattab Adel M. , Elgawad El-Masry Ahmed Abd , El Maraghy Ashraf A. , Ahmed Noha O.
Published: September 2023

Introduction

Prolonged ICU stay is associated with high mortality, morbidity, and costs. Understanding the predictors of prolonged stay ICU patients is helpful in improving the patients’ outcomes, especially if some factors could be modified or useful in clinical decisions.

Aim

The aim of this study was to evaluate the characteristics, outcomes, and cost of ICU patients with a prolonged stay (≥15 days) and very long stay (≥30 days) in Ain Shams University Hospital Respiratory ICUs.

Patients and methods

This multidisciplinary prospective study was conducted on 213 patients admitted at the two respiratory ICUs at Ain Shams University Hospitals from May 2013 to May 2014. In addition, the relationships between residents, consultants, nurses, and patients’ families are evaluated through multiple surveys.

Results

A total of 213 patients met the inclusion criteria in both ICUs, with a mean age of 54.7 years (minimum: 20 years; maximum: 80 years) and mean ICU stay of 23.4 days (minimum: 15 days; maximum: 60 days). Mechanical ventilation, vasopressor support, type of nutrition, BMI, tracheostomy, and Acute Physiology And Chronic Health Evaluation II Score on admission had a significant association with prolonged ICU stay and mortality.

The surveys’ results showed that the nurse–physician relationship is of friendly stranger type. The residents’ pitfalls were mostly the grandiosity and lack of decision taking. Most of physicians of different medical degrees had highlightened the quality of leadership as the most important cause straining the relationship with colleagues. The family members’ satisfaction is correlated with the progression and length of stay of patients.

Conclusion

Patients with prolonged ICU stay consume the ICU resources. Studies identifying predictors of prolonged stay are essential to improve both resource utilization and the efficiency of ICU care. Personal relationship and communication skills have their impact on working environment.
The role of medical thoracoscopy in the management of empyema
Authors: El Gazzar Ahmad G. , El-Mahdy Mohammad A. E. , Al Mehy Gehan F. , El Desoukey Mohammad Asmaa
Published: September 2023

Background

Empyema thoracis is defined as accumulation of pus in the pleural space. Despite advanced medical diagnostic and therapeutic methods, thoracic empyema remains a common clinical entity and a serious problem all over the world with significant associated morbidity and mortality.

Aim

The aim of this work was to study the efficacy and safety of medical thoracoscopy (MT) in the management of empyema.

Patients and methods

This study included 30 inpatients with empyema. Included patients had frank pus on aspiration (turbid purulent fetid fluid) with or without positive Gram stain smear and microbiological culture findings or pH less than 7.20, with signs of sepsis. Patients were managed by MT. MT using rigid thoracoscopy was performed with evacuation of the purulent fluid, visualization of the pleural space, assessment of adhesions and purulent material, forceps adhesiolysis, and irrigation by normal saline with partial debridement of accessible parietal pleural surface.

Results

The present study included 30 patients with empyema (17 men, 13 women with a mean age of 47.4±14.5 years; range, 18–70 years); 19 (63.3%) patients had free-flowing empyema (by computed tomography/ ultrasonography) and 11 (36.7%) patients had multiloculated empyema. The etiology of empyema included pneumonia (parapneumonic effusion) (33.3%), malignancy (23.3%), tuberculosis (6.7%), lung abscess (6.7%), and no cause was identified in nine patients (spontaneous pleural infection) (30%). MT was considered successful without subsequent interventional procedures in 26 of 30 (86.7%) patients, including all patients with free-flowing empyema (19 patients), 63.6% of patients with multiloculated empyema (seven patients), and four (13.3%) patients required surgical intervention (surgical decortication). No procedure-related mortality or chronic morbidity occurred in this study.

Conclusion

MT is a simple, safe, minimally invasive, and effective modality in the management of empyema.
Experience in medical thoracoscopy: a 4-year retrospective study
Authors: Baess Ayman I. , Sweed Rania A.
Published: September 2023

Objective

The aim was to document our experience in rigid medical thoracoscopy in the diagnosis of pleural effusion of undetermined origin in a 4-year retrospective study regarding its safety, complications, and diagnostic yield.

Patients and methods

Data of 134 patients who underwent medical thoracoscopy in Alexandria Main University Hospital, Chest Department, for diagnosing pleural effusion of undetermined origin were reviewed to assess the diagnostic yield, safety, and complications of rigid medical thoracoscopy.

Results

We reviewed records of 134 patients [62 (46%) males and 72 (54%) females]. Their mean age was 54±13.43 years. On combining histopathological and bacteriological examination results of thoracoscopic pleural biopsies, all patients were finally diagnosed, except for 13 (10%) patients who remained idiopathic; 97 (72%) patients were diagnosed as having malignant pleural effusion and 24 (18%) patients were diagnosed as having benign pleural effusion. The commonest complication encountered was postprocedural pain (35%), followed by subcutaneous emphysema (19%). Overall, the procedure was safe even in elderly patients. No procedure-related mortality was reported.

Conclusion

Medical thoracoscopy, in our experience, is a safe and well-tolerated procedure even in elderly patients with high diagnostic yield.
Evaluation of the role of bronchoscopy in the intensive care units
Authors: Korraa Emad A. , Dwedar Ibrahim A. , Gomaa Ashraf A. , Shata Aalaa K.
Published: September 2023

Objectives

The aim of this study was to evaluate the role of bronchoscopy in the intensive care units (indications, advantages, disadvantages, results, and complications).

Patients and methods

Bronchoscopy (rigid or fibroptic) was performed in Ain shams University hospital and Ain Shams University Specialized Hospitals on 80 ICU patients requiring diagnostic and/or therapeutic indication. The patients were grouped into ventilated and nonventilated.

Results

A total of 50 (62%) fibroptic bronchoscopies and 30 (37%) rigid bronchoscopies were performed on 30 (37.5%) ventilated patients and 50 (62.5%) nonventilated. Overall, 90% of flexible bronchoscopies were done for ventilated patients and 54% of rigid bronchoscopies was done in nonventilated patients (54%). Moreover, 80% of the procedures were done for diagnostic purposes using fibroptic bronchoscopies in 98%, whereas 36.7% of bronchoscopies were done for combined indications and 13.3% of therapeutic indications bronchoscopies were done with rigid bronchoscopy. In addition, 51.25% of the procedures that were done with bronchoscopies were lavage followed by stent insertion (25%). In 83.3% of ventilated patients, lavage was done, whereas stent insertion was more in nonventilated patient group. Overall, 26.25% of the patients were diagnosed as having malignant disease and 20% had infections of lower respiratory tract. Complications occurred in 21.25%, with mortality rate of 0.0%, and hypoxia was the most common.

Conclusion

Safety is one of the most important issues when deciding to perform bronchoscopy in the ICU, which depends on the accuracy of selection of the patients for the procedure and the experience of the bronchoscopist and facilities available.