Transbronchial lymph node forceps biopsy as a novel tool in diagnosis of mediastinal lymphadenopathy: a pilot study.

BACKGROUND: Differential diagnosis of mediastinal lymphadenopathy is an issue of debate. Lymph nodes may be enlarged due to a variety of inflammatory, infectious, or malignant reasons. Therefore, obtaining samples from the affected nodes is crucial for the diagnosis. Usually, these patients are subjected to TBNA (EBUS or conventional) or mediastinoscopy if TBNA is not conclusive. This study evaluated the safety and feasibility of this new technique of transbronchial forceps biopsy for the diagnosis of mediastinal lymphadenopathy. METHODS: The study included 18 patients with confirmed mediastinal lymphadenopathy who were admitted in Chest Department, Cairo University in the period from December 2019 to December 2020. All patients were subjected to flexible bronchoscopy with conventional transbronchial needle aspiration (C-TBNA) and transbronchial forceps biopsy (LN-TBFB) from the enlarged mediastinal lymph node in the same procedure. RESULTS: we found the technique of LN-TBFB safe with no serious complications. We were able to reach a diagnosis in 7/7 (100%) cases of sarcoidosis, 6/7 (85.7%) cases of malignant lymph nodes. We had three cases where the histopathology showed hyperactive follicular hyperplasia, and a single case of tuberculous lymphadenitis. C-TBNA was diagnostic in 71.4% of sarcoidosis cases, 42.9% of malignant cases, but failed to diagnose the one patient with tuberculous lymphadenitis. CONCLUSION: Lymph node transbronchial forceps biopsy (LN-TBFB) was found to be safe and effective in the diagnosis of mediastinal lymphadenopathy. We strongly advocate the use of this minimally invasive technique for diagnosing pathologically enlarged mediastinal lymph nodes, as a last step before mediastinoscopy.

Evaluating circulating cell-free DNA and DNA integrity index as biomarkers in non-small cell lung cancer.

BACKGROUND: Analysis of free DNA molecules shed from tumour cells in plasma of patients referred as circulating tumour DNA (ctDNA) with reference to physiological circulating cell-free DNA (cfDNA) is nowadays exploited as liquid biopsy and is considered a new emerging promising biomarker for diagnosis, selection of proper treatment, and prognosis of cancer. DNA integrity index (DII) is assessed by calculating the ratio between the concentration of long cfDNA strands released from tumour cells (ALU247) and the short strands released from normal cells (ALU115). The aim of the current study was to evaluate DII as a potential diagnostic and prognostic biomarker of NSCLC. METHODS: Our study included 48 NSCLC patients diagnosed as primary NSCLC before starting treatment, 30 COPD patients diagnosed clinically, radiologically, and subjected to chest high-resolution computerized tomography, and 40 healthy controls. cfDNA concentration and DII were measured by quantitative real-time polymerase chain reaction (qPCR). RESULTS: ALU115, ALU247, and DII were significantly higher in NSCLC compared to COPD patients (p < 0.0001) and controls (p < 0.0001) and in COPD patients compared to control subjects (p < 0.0001). DII positively correlated with the stage of tumour (p = 0.01), tumour metastasis (p = 0.004), and with adenocarcinoma compared to other histopathological types (p = 0.02). To evaluate clinical utility of DII in NSCLC, ROC curve analysis demonstrated an AUC of 0.91 at a cut-off value of 0.44 with total accuracy = 85.6%, sensitivity = 90%, specificity = 83%, PPV = 78.1%, and NPV = 92.1%. CONCLUSION: cfDNA and DII represent a promising diagnostic and prognostic tool in NSCLC. This type of noninvasive liquid biopsy revealed its chance in the screening, early diagnosis, and monitoring of NSCLC.

Coronavirus disease 19 (Covid-19): A comparative study of pattern of liver injury in adult patients in different waves of Covid-19 infection.

BACKGROUND AND STUDY AIMS: Liver dysfunction is a common manifestation of the COVID-19 infection. We aimed to study transaminase abnormalities through different waves of COVID-19 and their relations to disease severity or mortality. PATIENTS AND METHODS: A retrospective study included 521 Egyptian patients diagnosed with COVID-19. Data was retrieved from the medical records of patients who were admitted from April 2020 to October 2021 in Kasr Al-Ainy Hospitals, Cairo University, with categorization according to disease severity in correspondence to the four waves. RESULTS: The median age was lower in the first wave compared to other waves, with male predominance across all waves. The most commonly encountered comorbidity overall was hypertension, followed by diabetes mellitus. White blood cells, ferritin, and interleukin-6 showed the highest median values in the second wave, with significantly higher median C-reactive protein on day 1 in the first wave. Forty percent of the patients showed elevated hepatic transaminases on admission in four waves, with no statistically significant difference between waves. On day 5, around half of the patients had elevated transaminases, with no significant difference between waves. Most CT findings were of moderate severity. Clinical severity was higher in the second wave. It was observed that the higher the disease severity, the greater the proportion of patients with elevated hepatic transaminases. The mortality rate was markedly high in cases who had elevated ALT or AST on day 5. The association between elevated enzymes on admission and mortality was seen in the first wave only, with a fatality rate of 22.5% in cases with increased baseline ALT and AST versus 5% in those with normal baseline enzymes. CONCLUSION: There was no significant difference in transaminases between the four waves. Elevated transaminases were positively associated with increased mortality and severity, reflecting their prognostic value.

Endobronchial mucormycosis diagnosed by fiberoptic bronchoscopy.

Introduction: Endobronchial mucormycosis is very rare with only few cases reported in the literature. Here, we report a rare presentation of pulmonary mucormycosis in a diabetic patient who presented with left lung collapse. Bronchoscopy revealed an endobronchial growth, mimicking a tumor, causing complete occlusion of the left main bronchus. Histopathology confirmed the diagnosis of invasive mucormycosis. Case presentation: Male patient 35 years old with accidental discovered Diabetes Mellitus, complained of hoarseness of voice and dry irritating cough that didn't respond to antitussives and nonspecific treatment. CT chest was done and revealed left total lung collapse. Fiberoptic bronchoscopy was done and revealed total occlusion of the left main bronchus with whitish fungating glistening tissue from which biopsies were obtained. Histopathological examination was consistent with mucormycosis. A trial of medical treatment failed after which the patient was referred for surgical resection. Conclusion: Successful treatment of mucormycosis requires early diagnosis; prompt administration of antifungal therapy, and surgical intervention when applicable. Aggressive surgical intervention to remove necrotic tissue is generally accepted as the therapeutic mainstay for endobronchial obstructing mucormycosis.

Study of genetic variants in chromosome 5p15.33 region in non-smoker lung cancer patients.

INTRODUCTION: Genome-wide association studies have identified that genetic polymorphisms in the telomerase reverse transcrip-tase (TERT) and cleft lip and palate transmembrane 1-like (CLPTM1L) genes may play important roles in the development of lung cancer in never smokers. MATERIAL AND METHODS: This study was aiming to evaluate the associations between the risk of lung cancer in never smokers and single nucleotide polymorphisms in these genes by Real-Time Taqman assay, in forty lung cancer patients and forty apparently healthy age-matched controls selected from the chest department, Kasr Al-Ainy hospital from June 2018 to January 2019. RESULTS: Adenocarcinoma was the most common histopathological subtype of lung cancer in the study patients. Also, the prevalence of females having adenocarcinoma was more common than males. The heterozygous form of the CLPTM1L occurred more frequently in the subjects aged above 46 years (P=0.019). There was a significant association between (rs 2730100) (c. 1574-3777C>A) TERT and CLPTM1L (rs 451360) (c.1532+ 1051C>A) genotypes and the incidence of lung cancer in never smokers, especially adenocarcinoma, a subtype of non-small cell lung carcinoma (NSCLC). CONCLUSIONS: Polymorphism in the telomerase reverse transcriptase (TERT) and cleft lip and palate transmembrane 1 like (CLPT-M1L) genes may play an important role in the development of NSCLC, especially adenocarcinoma subtype. The two genes are located in the chromosome 5p15.33.

Role of ultrasonography in assessment of anatomic upper airway changes in patients with obstructive sleep apnea.

Instroduction: Obstructive sleep apnea is a common disorder, characterized by recurrent narrowing and closure of the upper airway accompanied by intermittent oxyhemoglobin desaturation and sympathetic activation. Ultrasound imaging of the airways has advantages of being safe, quick, repeatable, portable and widely available. Airway ultrasound can visualize and assess the mouth and tongue, oropharynx, hypopharynx, epiglottis, larynx, vocal cords, cricothyroid membrane, cricoid cartilage, trachea, and cervical esophagus. MATERIAL AND METHODS: This study assessed the role of ultrasonography in detecting the level and degree of obstruction of airway passages in patients with obstructive sleep apnea (OSA) and its relation to OSA severity. It included thirty-three patients diagnosed as OSA, and ten healthy subjects as a control group. All participants were ≥ 18 years and were subjected to full medical history, Epworth sleepiness score (ESS), thorough clinical examination, complete overnight polysomnography and neck ultrasonography. RESULTS: Ultrasonography findings showed a statistically significant increase in lateral parapharyngeal wall thickness (LPWT) (P < 0.001) and a significant increase in distance between lingual arteries (DLA) (P < 0.01) among OSA patients. Moreover, there was a significant statistical decrease in the retropalatal pharynx transverse diameter (RPD) (P < 0.05) in the OSA group compared to those without OSA. LPWT and DLA are parameters that can be used to predict the severity of OSA. Combination of LPWT and RPD can achieve a 100% sensitivity and specificity. CONCLUSIONS: Ultrasound is more objective and convenient than the questionnaire because it doesn't require overnight time consumption. It is also more relevant than pulse oximetry for examining pharyngeal airspace. Also, this study demonstrated that submental ultrasonography is sufficiently sensitive for differentiating OSA severity.

Evaluation of mediastinal lymphadenopathy by diffusion weighted MRI; correlation with histopathological results.

INTRODUCTION: Diffusion weighted imaging (DWI) has shown its potential as a reliable noninvasive technique for tissue characterization. DWI reflects the tissue specific diffusion capacity which can be used for tissue characterization. Hypercellular tissue (e.g; malignant tumors) had restricted diffusion capacity with increased signals on DWI and low ADC values. Non-tumoral tissues show low cellularity, and diffusion capacity is not restricted resulting in signal loss on DWI and high apparent diffusion coefficient (ADC). Differential diagnosis of mediastinal lymphadenopathy is an issue of debate, especially in malignant benign differentiation. Diffusion weighted imaging with magnetic resonance could improve the diagnostic accuracy in differentiation between benign and malignant mediastinal nodes. OBJECTIVES: to determine the efficacy of diffusion weighted MRI in evaluation of mediastinal lymphadenopathy with histopathological correlation to differentiate benign from malignant lymph nodes. MATERIAL AND METHODS: 30 patients with mediastinal lymphadenopathy underwent diffusion weighted MRI. ADCs of lymph nodes were derived and constructed from b = 0 and b = 1000 sec/mm2 values by drawing regions of interests (ROI). Consequently, mediastinal nodes were studied, biopsies and histopathological analysis were done after MRI examination. RESULTS: The best cutoff point of ADC to differentiate benign from malignant lesions was 1.15 mm/sec (sensitivity 77%, specificity 92% and AUC 81.4%). Significant negative correlation of ADC by DW MRI and the size of the LNs. The mean ADC values in the lymphoma group was lower than in the sarcoidosis group, and the difference was statistically significant. CONCLUSION: The study supports that MRI with diffusion weighted images can differentiate benign from malignant mediastinal lymphadenopathy and differentiate lymphoma from sarcoidosis non-invasively.

Jazzin' Healthy: Interdisciplinary Health Outreach Events Focused on Disease Prevention and Health Promotion.

OBJECTIVES: Health-related disparities are a significant public health concern. In conjunction with a university concert series, healthcare professionals and students provided education, clinical services, and preventive care using an interdisciplinary approach to a primarily African American cohort. The objective was to assess cardiovascular risk factors and readiness to change health-related behaviors. METHODS: Six outreach events were conducted over 3 years by an interdisciplinary team including pharmacy, medicine, nursing, nutrition, occupational therapy, public health, optometry, and health information technology. Clinical services, such as health screenings for glucose, blood pressure, cholesterol, and body fat along with counseling on the results and smoking cessation behavioral counseling, were provided. Education initiatives addressed bone health, heart disease, HIV risk, nutrition, and access to physician care. Preventative care included vaccinations and eye exams. RESULTS: There were 285 participants that were predominantly African American (95.8 %), female (71.5 %), and age within 55-64 years (45.1 %). Hypertension (50.8 %) and obesity (65.1 %) were the most common cardiovascular risk factors. Of those advised to make health behavior changes, 76.4 % reported they planned to make changes within 1 month. CONCLUSION: These interdisciplinary outreach events provided health information and access to care in a novel setting and led to a high rate of planned health behavior changes.