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.

Neutrophil-mediated oxidative stress and albumin structural damage predict COVID-19-associated mortality.

Human serum albumin (HSA) is the frontline antioxidant protein in blood with established anti-inflammatory and anticoagulation functions. Here, we report that COVID-19-induced oxidative stress inflicts structural damages to HSA and is linked with mortality outcome in critically ill patients. We recruited 39 patients who were followed up for a median of 12.5 days (1-35 days), among them 23 had died. Analyzing blood samples from patients and healthy individuals (n=11), we provide evidence that neutrophils are major sources of oxidative stress in blood and that hydrogen peroxide is highly accumulated in plasmas of non-survivors. We then analyzed electron paramagnetic resonance spectra of spin-labeled fatty acids (SLFAs) bound with HSA in whole blood of control, survivor, and non-survivor subjects (n=10-11). Non-survivors' HSA showed dramatically reduced protein packing order parameter, faster SLFA correlational rotational time, and smaller S/W ratio (strong-binding/weak-binding sites within HSA), all reflecting remarkably fluid protein microenvironments. Following loading/unloading of 16-DSA, we show that the transport function of HSA may be impaired in severe patients. Stratified at the means, Kaplan-Meier survival analysis indicated that lower values of S/W ratio and accumulated H2O2 in plasma significantly predicted in-hospital mortality (S/W≤0.15, 81.8% (18/22) vs. S/W>0.15, 18.2% (4/22), p=0.023; plasma [H2O2]>8.6 µM, 65.2% (15/23) vs. 34.8% (8/23), p=0.043). When we combined these two parameters as the ratio ((S/W)/[H2O2]) to derive a risk score, the resultant risk score lower than the mean (<0.019) predicted mortality with high fidelity (95.5% (21/22) vs. 4.5% (1/22), log-rank χ2=12.1, p=4.9×10-4). The derived parameters may provide a surrogate marker to assess new candidates for COVID-19 treatments targeting HSA replacements and/or oxidative stress.

Management and Outcome of Coronavirus Disease 2019 (COVID-19) in Pediatric Cancer Patients: A Single Centre Experience from a Developing Country.

INTRODUCTION: Sufficient data pertaining to the impact of the Coronavirus disease 2019 (COVID-19) on pediatric cancer patients is still lacking. The aim of this prospective study was to describe clinical management and outcomes of COVID-19 in pediatric oncology patients. PATIENTS AND METHODS: Conducted between May 1, 2020 and November 30, 2020, this study included 76 pediatric oncology patients with confirmed COVID-19. Remdesivir (RDV) was the antiviral therapy used. RESULTS: The median age of patients was 9 years. Sixty patients were on first line treatment. Hematological malignancies constituted 86.8% of patients. Severe to critical infections were 35.4% of patients. The commonest symptom was fever (93.4%). Chemotherapy was delayed in 59.2% of patients and doses were modified in 30.2%. The 60-day overall survival (OS) stood at 86.8%, with mortalities occurring only among critical patients. Of sixteen acute leukemia patients in the first induction therapy, 13 survived and 10 achieved complete remission. A negative RT-PCR within 2 weeks and improvement of radiological findings were statistically related to disease severity (P = .008 and .002, respectively). Better OS was associated with regression of radiological findings after 30 days from infection (P = .002). Forty-five patients received RDV, 42.1% had severe and critical forms of infection compared to 25.7% in the No-RDV group and yet OS was comparable in both groups. CONCLUSION: Most pediatric cancer patients with COVID-19 should have good clinical outcomes except for patients with critical infections. Cancer patients can tolerate chemotherapy including induction phase, alongside COVID-19 treatment. In severe and critical COVID-19, RDV might have a potential benefit.

Endobronchial injection of botulinum toxin for the reduction of bronchial hyperreactivity induced by methacholine inhalation in dogs.

BACKGROUND: Airway smooth muscle contraction causes bronchial constriction and is the main cause of bronchospasm in response to stimulants in asthma patients. In this pilot study, we tested the possibility of using a commercially available neurotoxin-botulinum toxin A (BTX-A)-to reduce bronchial hyperreactivity in dogs. METHODS: Two bronchoscopic sessions were conducted in 6 healthy mongrel dogs. In the first session, BTX-A (concentration 10 U/mL) was injected in small aliquots submucosally in 1 caudal lobe and its subsegments, leaving the other side as control. During the second bronchoscopy conducted 2 weeks later, the airway calibers of the treated and untreated sides were measured in each animal before and after instillation of methacholine in the airways to induce bronchial hyperreactivity (concentration 25 mg/mL). RESULTS: The mean pretreatment diameter was 3.356 (± 1.294) mm and 2.765 (± 0.603) mm in the treated and untreated airways, respectively. After provocation with methacholine, the diameter of the treated airways was 1.985 (± 0.888) mm versus 0.873 (± 0.833) mm in the untreated airways (P=0.000). Local injection of BTX-A in the airway resulted in reduction of bronchial hyperreactivity by 58.6% (P=0.001). There were no complications resulting from the submucosal injection of BTX-A in the airways. CONCLUSIONS: Endobronchial injection of BTX-A reduces bronchial hyperreactivity in the airways of healthy dogs.

Goose-skin Pleura: A Thoracoscopic Finding in a Case of Recurrent Undiagnosed Pleural Effusion.

We present the case of a female patient who presented with undiagnosed pleural effusion. Thoracoscopy was performed and at the beginning of the procedure, the parietal pleura was rather uniformly congested but with a smooth surface. As time passed, the parietal pleura became roughened by bumpy areas of mucosal elevations, which looked soft and watery. This became evident during the biopsy procedure, as the pleura was markedly edematous. The biopsy specimens were nonspecific and the cause of the effusion remained unclear. This phenomenon, which we termed "goose-skin" pleura, showed that the origin of the pleural effusion formed was the parietal pleura, for unknown causes.

Safety and efficacy of using a surgivac pump for the drainage of chronic indwelling pleural catheters in malignant pleural effusions.

BACKGROUND AND OBJECTIVE: This descriptive study assessed whether a reusable commercially available surgivac pump was a safe and affordable method for draining chronic malignant pleural effusions with an indwelling pleural catheter. METHODS: Patients who were managed as outpatients using this technique were recruited over a 5-year period in Cairo, Egypt. The indwelling pleural catheters were inserted under local anaesthesia in a bronchoscopy suite. Patients were instructed by a trained nurse on how to drain the catheter using the surgivac pump. RESULTS: Fifty-five patients were included in the study. Successful pleurodesis was achieved in 42 (76.3%) over a mean period of drainage of 19.1 days (range 12-59 days). In all patients, the surgivac pump was successful in draining their pleural fluid and there were no complications related to the device itself. CONCLUSION: The use of a surgivac pump to drain malignant effusions via a chronic indwelling pleural catheter is safe and results in a pleurodesis comparable to the more commonly used negative pressure containers (vacuum bottles).