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He S, Xie L, Liu J, Zou L. Single-use flexible bronchoscopes vs traditional reusable flexible bronchoscopes: a prospective controlled study. BMC Pulm Med 2023; 23:202. [PMID: 37296389 DOI: 10.1186/s12890-023-02478-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Single-use flexible bronchoscopes(SFB) eliminate the risk of bronchoscopy-related infection compared with traditional reusable flexible bronchoscopes(RFB). At present, there is no comparative study between SFB and RFB in the aspects of biopsy and interventional therapy. This study aims to explore whether SFB can perform complex bronchoscopic procedures such as transbronchial biopsies just like RFB. METHODS We conducted a prospective controlled study. A total of 45 patients who required bronchoscopic biopsy in our hospital from June 2022 to December 2022 were enrolled. The patients were divided into the SFB group and the RFB group, and routine bronchoscopy, bronchoalveolar lavage, and biopsy were performed respectively. Data on the time of routine bronchoscopy, the recovery rate of bronchoalveolar lavage fluid(BALF), biopsy time, and bleeding volume were collected. Then we used the two-sample t-test and the χ2 test to assess the performance differences between SFB and RFB. We also designed a questionnaire to compare the performance between SFB and RFB by different bronchoscope operators. RESULTS The routine examination time of SFB and RFB was 3.40 ± 0.50 min and 3.55 ± 0.42 min, respectively. There was no significant difference between the two groups (P = 0.308). The recovery rate of BALF was (46.56 ± 8.22) % in the SFB group and (47.00 ± 8.07) in the RFB group, without a significant difference between the two groups(P = 0.863). The biopsy time was similar(4.67 ± 0.51 min VS 4.57 ± 0.45 min) in both groups, with no significant difference(P = 0.512). The positive biopsy rate was 100% in both groups, with no significant difference. Overall, the bronchoscope operators were generally satisfied with SFB. CONCLUSION SFBs are non-inferior to RFBs in routine bronchoscopy, bronchoalveolar lavage, and biopsy. It is suggested that SFBs have a wider clinical application.
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Affiliation(s)
- Shuzhen He
- Department of Pulmonary and Critical Care Medicine, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Lihua Xie
- Department of Pulmonary and Critical Care Medicine, The Third Xiangya Hospital of Central South University, Changsha, China.
| | - Jianming Liu
- Department of Pulmonary and Critical Care Medicine, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Lijun Zou
- Department of Pulmonary and Critical Care Medicine, The Third Xiangya Hospital of Central South University, Changsha, China
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Orlandi M, Meliante LA, Damiani A, Tofani L, Bruni C, Guiducci S, Matucci-Cerinic M, Bellando-Randone S, Tomassetti S. The Role of Bronchoalveolar Lavage in Systemic Sclerosis Interstitial Lung Disease: A Systematic Literature Review. Pharmaceuticals (Basel) 2022; 15:ph15121584. [PMID: 36559035 PMCID: PMC9781787 DOI: 10.3390/ph15121584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
The role of Bronchoalveolar Lavage (BAL) in the evaluation of systemic sclerosis (SSc) interstitial lung disease (ILD) is still controversial. The aim of this systematic literature review was to investigate the use of BAL in SSc-ILD, and to focus on the pros and cons of its real-life application. Methods: PubMed, Cochrane, and Embase were questioned from inception until 31 December 2021. Results: Eighteen papers were finally analyzed. A positive correlation was observed between lung function and BAL cytology; in particular, BAL neutrophilia/granulocytosis was related to lower diffusing capacity for carbon monoxide (DLCO) values and lower forced vital capacity (FVC). Moreover, a positive correlation between BAL cellularity and high-resolution computed tomography (HRCT) findings has been reported by several authors. Cytokines, chemokines, growth factors, coagulation factors, and eicosanoids have all been shown to be present, more often and in higher quantities in SSc-ILD patients than in the health control and, in some cases, they were related to more severe pulmonary disease. There was no consensus regarding the role of BAL cellularity as a predictor of mortality.
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Affiliation(s)
- Martina Orlandi
- Scleroderma Unit, Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, 50134 Florence, Italy
| | - Laura Antonia Meliante
- Scleroderma Unit, Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, 50134 Florence, Italy
| | - Arianna Damiani
- Scleroderma Unit, Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, 50134 Florence, Italy
| | - Lorenzo Tofani
- Scleroderma Unit, Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, 50134 Florence, Italy
| | - Cosimo Bruni
- Scleroderma Unit, Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, 50134 Florence, Italy
| | - Serena Guiducci
- Scleroderma Unit, Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, 50134 Florence, Italy
- Correspondence: ; Tel.: +39-055-794-7066
| | - Marco Matucci-Cerinic
- Scleroderma Unit, Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, 50134 Florence, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, 20132 Milan, Italy
| | - Silvia Bellando-Randone
- Scleroderma Unit, Department of Experimental and Clinical Medicine, Division of Rheumatology AOUC, University of Florence, 50134 Florence, Italy
| | - Sara Tomassetti
- Department of Clinical and Experimental Medicine, University of Florence, and Division of Interventional Pulmonology, Careggi University Hospital, 50134 Florence, Italy
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Li L, Zhang M, Wei Y, Tu X, Lu Z, Cheng Y. Clinical significance of procalcitonin in critically ill patients with pneumonia receiving bronchoalveolar lavage. Sarcoidosis Vasc Diffuse Lung Dis 2022; 39:e2022031. [PMID: 36791032 PMCID: PMC9766852 DOI: 10.36141/svdld.v39i3.12164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 07/11/2022] [Indexed: 02/16/2023]
Abstract
Background As a useful tool in intensive care units (ICU), fiberoptic bronchoscopy (FOB) may cause a deterioration of infection. This study is to investigate the clinical significance of procalcitonin (PCT) in critically ill patients with severe pneumonia receiving bronchoalveolar lavage (BAL). Methods A retrospective case-control study was performed in a single respiratory ICU (RICU) with 6-bed. Critically ill patients with severe pneumonia admitted to RICU were consecutively reviewed from March 2017 to October 2019. Chi-square test, Wilcoxon test, Mann Whitney U-test, Kaplan-Meier survival analysis or Cox's proportional hazards regression model was used as appropriate. Results A total of 72 eligible patients were included in the final analysis, 51 of which received BAL performed by FOB. Serum levels of PCT in group received BAL is markedly increased at 24 hours after FOB (p<0.001). Forty-eight hours later, BAL group with decreased serum levels of PCT had less SOFA score and decreased mortality compared with those with increased serum levels of PCT. Furthermore, Kaplan-Meier analysis indicated that patients with decreased serum levels of PCT had improved survival rate during hospital (Breslow test, p=0.041). However, increased PCT after BAL was not an independent risk factor for in-hospital mortality (hazard ratio: 1.689, 95% CI(0.626 ,4.563), p=0.301). Conclusions BAL performed by FOB increased serum levels of PCT. However, PCT levels decreased at 48 hours after BAL predicted a good prognosis of patients with severe pneumonia.
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Affiliation(s)
- Lingling Li
- Department of Respiratory and Critical Care Medicine, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China, These authors contributed equally to this work
| | - Min Zhang
- Department of Emergency, Yijishan Hospital, Wannan Medical College, Wuhu, Anhui, China., These authors contributed equally to this work
| | - Yuqing Wei
- Department of Respiratory and Critical Care Medicine, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China, These authors contributed equally to this work
| | - Xiongwen Tu
- Department of Respiratory and Critical Care Medicine, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Zhiwei Lu
- Department of Respiratory and Critical Care Medicine, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Yusheng Cheng
- Department of Respiratory and Critical Care Medicine, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China, These authors contributed equally to this work
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Agrawal S, Goel AD, Gupta N, Gonuguntla HK, Colt H. A systematic review and metanalysis of diagnostic yield of BAL for detection of SARS-CoV-2. Heart Lung 2021; 52:95-105. [PMID: 34929538 DOI: 10.1016/j.hrtlng.2021.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/24/2021] [Accepted: 11/30/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The gold standard for diagnosing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is microbiological confirmation by reverse transcriptase-polymerase chain reaction (RT-PCR)1 most commonly done using oropharyngeal (OP) and nasopharyngeal swabs (NP). But in suspected cases, where these samples are false-negative, bronchoalveolar lavage (BAL) may prove diagnostic. OBJECTIVES Hence, the diagnostic yield of BAL for detection of SARS-CoV-2 in cases of non-diagnostic upper respiratory tract samples is reviewed. METHODS Databases such as MEDLINE, Scopus, and Google Scholar were searched using a systematic search strategy. The current study has been in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and has been registered with the International Prospective Registry of Systematic Reviews (CRD42020224088). RESULTS 911 records were identified at initial database extraction, of which 317 duplicates were removed and, 596 records were screened for inclusion eligibility. We included total 19 studies in the systematic review, and 17 were included in metanalysis. The pooled estimate of SARS-CoV-2 positivity in BAL was 11% (95%CI: 0.01-0.24). A sensitivity analysis also showed that the results appear to be robust and minimal risk of bias amongst the studies. CONCLUSION The current study demonstrates that BAL can be used to diagnose additional cases primary disease and superadded infections in patients with severe COVID-19 lower respiratory tract infection.
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Morales-Gutiérrez JE, Silva-Medina MA, Cuadros-Moreno J, Cuevas-Bulnes JJ, Medina-García G, Espinoza JL, Reyes-Navarro GV, Vera-Lastra OL. [Pulmonary alveolar proteinosis. Report of a case]. Rev Med Inst Mex Seguro Soc 2021; 59:347-351. [PMID: 35019256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/24/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND The pulmonary alveolar proteinosis (PAP) is characterized by the accumulation of lipoprotein material in the alveoli. It is classified as primary, secondary and congenital. The primary form, of autoimmune origin, is characterized by antibodies against granulocyte-macrophage colony stimulating factor (GM-CSF). The aim of this article is to present a case of PAP with adequate response to treatment with bronchoalveolar lavage (BAL) and GM-CSF. CLINICAL CASE A 28-year-old female patient who started with mild to moderate effort dyspnea, distal cyanosis and lower respiratory tract infection. We found restrictive pattern respiratory function tests, chest X-ray with bilateral nodular reticulum pattern and high-resolution tomography with ground glass image and bronchiectasis, besides video bronchoscopy with inflammatory process. The open biopsy revealed data of alveolar proteinaceous material and mononuclear infiltrate. Treatment was given with BAL and GM-CSF which was suspended by dermal reaction. The patient had a satisfactory evolution and is currently asymptomatic. CONCLUSION The present case had clinical, imaging and histological manifestations for the diagnosis of autoimmune PAP with a satisfactory response to treatment. Although PAP is a low prevalence entity, the diagnosis and therapeutic options must be taken into account, including BAL and GM-CSF, since this factor is required for surfactant factor homeostasis.
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Affiliation(s)
- Joel Eduardo Morales-Gutiérrez
- Universidad Juárez Autónoma de Tabasco, Escuela de Medicina, División Académica de Ciencias de la Salud. Villahermosa, Tabasco, México
| | - Marco Antonio Silva-Medina
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret". Servicio de Medicina Interna. Ciudad de México, México
| | - Juan Cuadros-Moreno
- Instituto Mexicano del Seguro Social, Coordinación de Educación en Salud, División de Innovación. Ciudad de México, México
| | - Julian Jesús Cuevas-Bulnes
- Centro de Radiodiagnóstico Computarizado Médico de Tabasco S.A. de C.V., Servicio de Neumología Pediátrica. Villahermosa, Tabasco, México
| | - Gabriela Medina-García
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Unidad de Investigación en Medicina Traslacional en Enfermedades Hemato-oncológicas. Ciudad de México, México
| | - José Luis Espinoza
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Servicio de Neumología. Ciudad de México, México
| | | | - Olga Lidia Vera-Lastra
- Instituto Mexicano del Seguro Social, Centro Médico Nacional La Raza, Hospital de Especialidades "Dr. Antonio Fraga Mouret", Departamento de Medicina Interna. Ciudad de México, México
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Botelho AB, Ferreira RG, Coletta ENAM, Cerezoli MT, Martins RB, Gomes PS, Gimenez A, Ota LH, Soares MR, Pereira CAC. Transbronchial biopsy in chronic hypersensitivity pneumonitis. Sarcoidosis Vasc Diffuse Lung Dis 2021; 38:e2021018. [PMID: 34316258 PMCID: PMC8288203 DOI: 10.36141/svdld.v38i2.8998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 04/13/2021] [Indexed: 11/02/2022]
Abstract
Introduction The diagnosis of chronic hypersensitivity pneumonitis (CHP) is based on relevant exposure, tomographic findings and, in some cases, pathological data. The role of bronchoscopy is uncertain, especially in the fibrotic form of CHP. Aim To analyze the yield of transbronchial biopsy (TBBx) in patients with CHP according to tomographic findings and to evaluate the importance of bronchoalveolar lavage (BAL) in the diagnostic approach. Methods This retrospective study analyzed patients with CHP who underwent TBBx in São Paulo, Brazil. The TBBx findings were classified as characteristic (granulomas and/or multinucleated giant cells, associated or not with peribronchiolar infiltration of lymphocytes and plasma cells and bronchiolocentric distribution) and supportive (data indicative of small airway injury: peribronchiolar metaplasia, organizing pneumonia, and intra-alveolar foamy macrophages). Results One hundred nine patients were included. The presence of characteristic findings of HP was seen in 16 patients (14.7%), and supportive findings were seen in 32 patients (29.4%), with a total yield of 44%. Pathological characteristic findings were more common in cases without fibrosis on high-resolution computed tomography (HRCT) (27.3% vs. 9.2%, p= 0.014), whereas the presence of supportive findings was more common in fibrotic HP (38.1% vs. 9.1%, p= 0.002). Fifty-two patients had differential cytology in BAL fluid. Lymphocytosis (> 20%) was present in 51.9% of the patients. There was no difference in the median lymphocyte count according to nonfibrotic and fibrotic tomographic findings on HRCT. Conclusion TBBx and BAL fluid cytology have a role in CHP diagnosis.
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Bergbower EAS, Qureshi A, Sandhu H, Slack D. A 22-year-old man with fevers, chills, and a non-productive cough. J Community Hosp Intern Med Perspect 2021; 11:65-68. [PMID: 33552418 PMCID: PMC7850324 DOI: 10.1080/20009666.2020.1833821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Emily Anne Smith Bergbower
- Department of Internal Medicine, Greater Baltimore Medical Center, Baltimore, USA.,Department of Anesthesiology, University of Maryland Medical Center, Baltimore, USA
| | - Anum Qureshi
- Department of Internal Medicine, Greater Baltimore Medical Center, Baltimore, USA
| | - Hargeet Sandhu
- Department of Internal Medicine, Greater Baltimore Medical Center, Baltimore, USA
| | - Donald Slack
- Department of Pulmonology and Critical Care Medicine, Greater Baltimore Medical Center, Baltimore, USA
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Khan FY, Aladab AH. Role of Fiberoptic Bronchoscopy in the Rapid Diagnosis of Sputum Smear-negative Disseminated Tuberculosis with Pulmonary Miliary Infiltrates. Oman Med J 2020; 35:e87. [PMID: 31993225 PMCID: PMC6975253 DOI: 10.5001/omj.2020.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 03/18/2019] [Indexed: 12/03/2022] Open
Abstract
Objectives We sought to evaluate the role of bronchoscopy-related procedures such as bronchoalveolar lavage (BAL), bronchial wash (BW), bronchial brush (B brush), transbronchial biopsy (TBB), and post-bronchoscopy sputum (PBS), alone or in combination, in the rapid diagnosis of negative sputum smear disseminated tuberculosis (TB). Methods We performed a secondary post hoc analysis of data collected from our previous study entitled "Disseminated tuberculosis among adult patients admitted to Hamad General Hospital, Qatar: A five-year hospital-based study" with a modified objective. Results We identified 27 patients. BAL fluid was positive for acid-fast bacilli (AFB) smear in 7/27 (25.9%) patients and were culture-positive for Myobacterium tuberculosis in 17/27 (63.0%) cases, while BW collections were smear-positive in 9/27 (33.3%) cases and culture-positive for M. tuberculosis in 18/27 (66.7%) cases. TBB showed caseating granulomas in 10/16 (62.5%) cases and one case of non-caseating granuloma (6.3%). PBS was positive for AFB in 4/8 (50.0%) patients. The combination of these procedures enabled us to diagnose disseminated TB rapidly in 22 (81.5%) cases. Conclusions Bronchoscopy proved to be an effective method for the rapid diagnosis of disseminated TB in patients in whom sputum smear microscopy was negative.
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Farrokhpour M, Kiani A, Mortaz E, Taghavi K, Farahbod AM, Fakharian A, Kazempour-Dizaji M, Abedini A. Procalcitonin and Proinflammatory Cytokines in Early Diagnosis of Bacterial Infections after Bronchoscopy. Open Access Maced J Med Sci 2019; 7:913-919. [PMID: 30976333 PMCID: PMC6454165 DOI: 10.3889/oamjms.2019.208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 03/10/2019] [Accepted: 03/11/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND: Fiberoptic bronchoscopy (FOB) guided bronchoalveolar lavage (BAL) remains as the chief diagnostic tool in respiratory disorders. 1.2-16% of patients frequently experience fever after bronchoscopy. To exclude the need for multiple antibiotic prescribing in patients with post-bronchoscopy fever, the presence of the self-limiting inflammatory responses should be excluded. AIM: The current study was conducted to test the serum of patients undergoing bronchoscopy for some proinflammatory cytokines including Tumor Necrosis Factor-alpha (TNF-ɑ), Interleukin-1beta (IL-1β), Interleukin-8 (IL-8) and Interleukin-6 (IL-6) and the value of Procalcitonin (PCT). MATERIAL AND METHODS: Current case-control study was conducted at the National Research Institute of Tuberculosis and Lung Disease in Iran. Nineteen patients (48.72%) that attended with a reasonable sign for a diagnostic bronchoscopy from January 2016 to December 2017 were included in the case group. The control group consisted of 20 patients who underwent a simple bronchoscopy and without FOB-BAL. The laboratory findings for PCT concentrations and cytokine levels in the three serum samples (before FOB-BAL (t0), after 6 hr. (t1), and at 24 hr. past (t2) FOB-BAL) were compared between two groups. RESULTS: The frequency of post-bronchoscopy fever was 5.12, and the prevalence of post-bronchoscopy infectious fever was 2.56%. PCT level was considerably higher in the patient with a confirmed bacterial infection when compared to other participants (p-value < 0. 05). Interestingly, IL-8 level in the bacterial infection proven fever patient was higher than in other patients (p < 0.001). IL-8 levels displayed a specificity of 72.7% and a sensitivity of 100%, at the threshold point of 5.820 pg/ml. PCT levels had a specificity of 84% and a sensitivity of 81%, at the threshold point of 0.5 ng/ml. CONCLUSION: The present findings show that in patients with fever after bronchoscopy, PCT levels and IL-8 levels are valuable indicators for antibiotic therapy, proving adequate proof for bacterial infection. The current findings also illustrate that to monitor the serum levels of PCT and proinflammatory cytokines in the patients undergoing FOB-BAL, the best time is the 24-hour postoperative bronchoscopy.
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Affiliation(s)
- Mohsen Farrokhpour
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arda Kiani
- Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mortaz
- Department of Immunology, Faculty of Medicine, Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kimia Taghavi
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Masoud Farahbod
- Mycobacteriology Research Center (MRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefeh Fakharian
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Kazempour-Dizaji
- Mycobacteriology Research Center (MRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefeh Abedini
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Kim EJ, Jung CY, Kim KC. Effectiveness and Safety of High-Flow Nasal Cannula Oxygen Delivery during Bronchoalveolar Lavage in Acute Respiratory Failure Patients. Tuberc Respir Dis (Seoul) 2018; 81:319-329. [PMID: 29926546 PMCID: PMC6148101 DOI: 10.4046/trd.2017.0122] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/29/2018] [Accepted: 04/22/2018] [Indexed: 11/24/2022] Open
Abstract
Background Bronchoalveolar lavage (BAL) is a necessary procedure for diagnosis of various lung diseases. High-flow nasal cannula (HFNC) oxygen delivery was recently introduced. This study aimed to investigate the safety and effectiveness of HFNC oxygen supply during BAL procedure in patients with acute respiratory failure (ARF). Methods Patients who underwent BAL while using HFNC at a partial pressure of oxygen in arterial blood/fraction of inspired oxygen (PaO2/FiO2; PF) ratio of 300 or below among patients who had been admitted from March 2013 to May 2017 were retrospectively investigated. Results Thirty-three BAL procedures were confirmed. Their baseline PF ratio was 166.1±46.7. FiO2 values before, during, and after BAL were 0.45±0.12, 0.74±0.19, and 0.57±0.14, respectively. Flow (L/min) values before, during, and after BAL were 26.5±20.3, 49.0±7.2, and 40.8±14.2, respectively. Both FiO2 and flow during and after the procedure were significantly different from those before the procedure (both p<0.001). Oxygen saturation levels before, during, and after BAL measured by pulse oximeter were 94.8±2.9, 94.6±3.5, and 95.2±2.8%, respectively. There were no significant differences in oxygen saturation among the three groups. Complications of BAL procedure included transient hypoxemia, hypotension, and fever. However, there was no endotracheal intubation within 24 hours. Baseline PF ratio in “without HFNC” group was significantly higher than that in “with HFNC” group. There were no differences in complications between the two groups. Conclusion The use of HFNC during BAL procedure in ARF patients was effective and safe. However, there were no significant differences in oxygen saturation level and complications comparing “without HFNC” group in mild ARF. More studies are needed for moderate to severe ARF patients.
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Affiliation(s)
- Eun Jin Kim
- Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Chi Young Jung
- Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Kyung Chan Kim
- Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu Catholic University School of Medicine, Daegu, Korea.
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Wahab A, Kesari K, Chaudhary S, Khan M, Khan H, Smith S, Boumber Y. Sequential occurrence of small cell and non-small lung cancer in a male patient: Is it a transformation? Cancer Biol Ther 2017; 18:940-943. [PMID: 29157085 DOI: 10.1080/15384047.2017.1394546] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Lung cancer is one of the leading causes of cancer-related mortality and is categorized into small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC). We present a patient with epidermal growth factor receptor (EGFR)-mutant-NSCLC who developed metastatic SCLC after initial therapy with second-generation EGFR-tyrosine kinase inhibitor, afatinib. A 65-year-old male non-smoker was diagnosed with adenocarcinoma of the right lung, stage IVA (M1a). Due to tumor positivity for EGFR-Exon 19 deletion, the patient was started on oral afatinib, which resulted in a partial response. After ten months of treatment, he presented in the office with abdominal pain, distension, weight loss and jaundice. He had diffuse skeletal and hepatic metastases on PET/CT scan with interval progression of his cancer. Although the recurrence of lung adenocarcinoma was suspected, the patient was diagnosed with SCLC on liver biopsy. He received two cycles of chemotherapy and died due to pneumonia and sepsis.
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Affiliation(s)
- Ahsan Wahab
- a Internal Medicine Department , McLaren - Flint/Michigan State University , Flint , MI , USA
| | - Kavitha Kesari
- a Internal Medicine Department , McLaren - Flint/Michigan State University , Flint , MI , USA
| | - Siddique Chaudhary
- a Internal Medicine Department , McLaren - Flint/Michigan State University , Flint , MI , USA
| | - Mahin Khan
- a Internal Medicine Department , McLaren - Flint/Michigan State University , Flint , MI , USA
| | - Hafiz Khan
- a Internal Medicine Department , McLaren - Flint/Michigan State University , Flint , MI , USA
| | - Susan Smith
- a Internal Medicine Department , McLaren - Flint/Michigan State University , Flint , MI , USA
| | - Yanis Boumber
- b Department of Hematology/Oncology , Fox Chase Cancer Center , Philadelphia , PA , USA.,c Program in Molecular Therapeutics, Fox Chase Cancer Center , Philadelphia , PA , USA
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Zaidi SR, Collins AM, Mitsi E, Reiné J, Davies K, Wright AD, Owugha J, Fitzgerald R, Ganguli A, Gordon SB, Ferreira DM, Rylance J. Single use and conventional bronchoscopes for Broncho alveolar lavage (BAL) in research: a comparative study (NCT 02515591). BMC Pulm Med 2017; 17:83. [PMID: 28476111 PMCID: PMC5420119 DOI: 10.1186/s12890-017-0421-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 04/25/2017] [Indexed: 12/05/2022] Open
Abstract
Background Broncho alveolar lavage (BAL) is widely used for investigative research to study innate, cellular and humoral immune responses, and in early phase drug trials. Conventional (multiple use) flexible bronchoscopes have time and monetary costs associated with cleaning, and carries a small risk of cross infection. Single use bronchoscopes may provide an alternative, but have not been evaluated in this context. Methods Healthy volunteers underwent bronchoscopy at a day-case clinical research unit using the Ambu® aScopeTM single-use flexible intubation bronchoscope. Broncho alveolar lavage was performed from a sub segmental bronchus within the right middle lobe; a total of 200 ml of warmed normal saline was instilled then aspirated using handheld suction. BAL volume yield, cell yield and viability were recorded. Results Ten volunteers, (mean age 23 years, six male) participated. Bronchoscopies were carried out by one of two senior bronchoscopists, experienced in the technique of obtaining BAL for research purposes. The results were compared to 50 (mean age 23, 14 male) procedures performed using the conventional scope by the same two bronchoscopists. The total volume yield was significantly higher in the disposable group median 152 ml (IQR 141–166 ml) as compared to conventional 124 ml (110–135 ml), p = <0.01. The total cell yield and viability were similar in both groups, with no significant differences. Conclusions With single use bronchoscopes, we achieved a larger BAL volume yield than conventional bronchoscopes, with comparable cell yield and viability. Better volume yields can potentially reduce post procedure side effects such as pleuritic chest pain and cough. The risk of cross infection can be eliminated, providing reassurance to researchers and participants. Reduced maintenance requirements can be cost effective. These could potentially be used for early phase drug development studies. Trial registration This trial was registered prospectively in July 2015 with the National Clinical Trials register, with the following registration number assigned: NCT 02515591.
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Affiliation(s)
- Seher Raza Zaidi
- Respiratory Infection Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK. .,Respiratory Research Group, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, L7 8XP, UK.
| | - Andrea M Collins
- Respiratory Infection Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK. .,Respiratory Research Group, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, L7 8XP, UK.
| | - Elena Mitsi
- Respiratory Infection Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Jesús Reiné
- Respiratory Infection Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Kayleigh Davies
- Respiratory Research Group, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, L7 8XP, UK
| | - Angela D Wright
- Respiratory Infection Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.,Respiratory Research Group, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, L7 8XP, UK.,Clinical Research Network, Northwest Coast, Liverpool, UK
| | - Jessica Owugha
- Respiratory Infection Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Richard Fitzgerald
- Respiratory Research Group, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, L7 8XP, UK
| | - Amitava Ganguli
- Respiratory Research Group, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, L7 8XP, UK
| | - Stephen B Gordon
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Daniela Mulari Ferreira
- Respiratory Infection Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Jamie Rylance
- Respiratory Infection Group, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.,Respiratory Research Group, Royal Liverpool and Broadgreen University Hospital NHS Trust, Liverpool, L7 8XP, UK
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13
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Burnham EL, McNally A, Gaydos J, Brown LAS. The Relationship Between Airway Antioxidant Levels, Alcohol Use Disorders, and Cigarette Smoking. Alcohol Clin Exp Res 2016; 40:2147-2160. [PMID: 27627733 DOI: 10.1111/acer.13201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 07/27/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Alcohol use disorders (AUDs) and cigarette smoking are associated with pulmonary oxidative stress, likely related to antioxidant depletion. Pulmonary oxidative stress may adversely affect innate immunity, leading to increased pneumonia susceptibility and severity, including development of the acute respiratory distress syndrome. In people with AUDs, most of whom smoke, antioxidant therapy can potentially restore immune cell function and attenuate pneumonia development. Challenges to human investigations of antioxidant therapies include an inability to identify pulmonary oxidative stress noninvasively and the optimal route to deliver pulmonary antioxidants. We sought to determine whether bronchoalveolar lavage (BAL) measures of thiol antioxidants from a 50-ml upper airway aliquot approximated those in the alveolar space and to determine whether AUDs and/or smoking affected these relationships. METHODS Healthy human subjects with and without AUDs, including smokers and nonsmokers, underwent BAL. Samples obtained after the first 50-ml normal saline aliquot were analyzed as representing bronchial airways; subsequent 50-ml aliquots were analyzed as representative of the alveolar space. Reduced and oxidized (GSSG) glutathione, cysteine (Cys), and its oxidized species, cystine, along with mixed disulfides (MDs) were quantified using high-performance liquid chromatography. The percent of total thiols present in their oxidized forms, and thiol redox potentials, were calculated. RESULTS Positive correlations between upper and lower BAL fluid thiol species were observed that were most robust for GSSG (ρ = 0.85), Cys (ρ = 0.83), and MDs (ρ = 0.69), but poor for thiol redox potential measures. In contrast to nonsmokers (either with or without AUDs), in subjects with AUDs who smoked, upper BAL fluid %GSSG, Cys, and MD measures were relatively increased compared to lower. CONCLUSIONS A small volume BAL procedure may be suitable to assess intrapulmonary oxidative stress related to thiol depletion. Factors including AUDs and smoking may disproportionately increase upper airways oxidative stress that could be relevant for therapeutic interventions.
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Affiliation(s)
- Ellen L Burnham
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado.
| | - Alicia McNally
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Jeanette Gaydos
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado
| | - Lou Ann S Brown
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
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14
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Nuyts V, Vanhooren H, Begyn S, Nackaerts K, Nemery B. Asbestos bodies in bronchoalveolar lavage in the 21st century: a time-trend analysis in a clinical population. Occup Environ Med 2016; 74:59-65. [PMID: 27550908 DOI: 10.1136/oemed-2016-103710] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/22/2016] [Accepted: 08/02/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Asbestos bodies (AB) in bronchoalveolar lavage (BAL) can be detected by light microscopy and their concentration is indicative of past cumulative asbestos exposure. We assessed clinical and exposure characteristics, as well as possible time trends, among patients in whom AB had been quantified in BAL. METHODS BAL samples obtained from 578 participants between January 1997 and December 2014 were available for analysis. The processing of samples and the microscopic analysis were performed by a single expert and 76% of samples came from a single tertiary care hospital, allowing clinical and exposure data to be extracted from patient files. RESULTS The study population (95% males) had a mean age of 62.5 (±12.4) years. AB were detected in 55.2% of the samples, giving a median concentration of 0.5 AB/mL (95th centile: 23.6 AB/mL; highest value: 164.5 AB/mL). The AB concentration exceeded 1 AB/mL in 39.4% and 5 AB/mL in 17.8%. A significant decrease from a geometric mean of 0.93 AB/mL in 1997 to 0.2 AB/mL in 2014 was apparent. High AB concentrations generally corresponded with occupations with (presumed) high asbestos exposure. AB concentrations were higher among patients with asbestosis and pleural plaques, when compared with other disease groups. Nevertheless, a substantial proportion of participants with likely exposure to asbestos did not exhibit high AB counts. CONCLUSIONS This retrospective study of a large clinical population supports the value of counting AB in BAL as a complementary approach to assess past exposure to asbestos.
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Affiliation(s)
- Valerie Nuyts
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, Leuven, Belgium
| | - Hadewijch Vanhooren
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, Leuven, Belgium
| | - Sarah Begyn
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, Leuven, Belgium
| | - Kristiaan Nackaerts
- Department of Respiratory Diseases, University Hospitals Leuven, University of Leuven, Leuven, Belgium
| | - Benoit Nemery
- Department of Public Health and Primary Care, Centre for Environment and Health, KU Leuven, Leuven, Belgium.,Department of Respiratory Diseases, University Hospitals Leuven, University of Leuven, Leuven, Belgium
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15
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Montilla D, Pérez M, Borges L, Bianchi G, Cova JA. Soluble Human Leukocyte Antigen-G in the Bronchoalveolar Lavage of Lung Cancer Patients. Arch Bronconeumol 2016; 52:420-4. [PMID: 27004472 DOI: 10.1016/j.arbres.2016.01.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 01/25/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The main function of the HLA-G molecule in its membrane-bound and soluble forms is to inhibit the immune response by acting on CD4+ T cells, cytotoxic T cells, NK cells and dendritic cells. Lung cancer is a leading cause of death worldwide, and annual incidence is high in both women and men. Some studies have reported an increase of HLA-G serum levels in lung cancer, probably generated by tumor cells escaping the antitumor immune response. In this study the concentration of soluble HLA-G in bronchoalveolar lavage (BAL) in patients with primary and metastatic lung cancer was measured to determine its relation with tumor histological type and overall patient status according to the Karnofsky scale. METHODS Thirty-one lung cancer patients were included. A tumor biopsy was obtained by bronchoscopy and the tumor type was determined by hematoxylin and eosin staining. BAL samples were obtained to measure soluble HLA-G concentrations in an ELISA sandwich assay. RESULTS The average value of soluble HLA-G was 49.04ng/mL. No correlation between soluble HLA-G levels and age, gender or smoking was observed. A highly significant difference was observed in the levels of soluble HLA-G in BAL from patients with different histological types of lung cancer, especially in metastatic tumors. The Karnofsky index showed a significant and inverse correlation with soluble HLA-G levels in BAL. CONCLUSIONS Soluble HLA-G protein is significantly associated with metastatic tumors and patients with lower Karnofsky index and may be useful as a prognostic marker in lung cancer.
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Affiliation(s)
- Dayana Montilla
- Servicio de Neumonología y Cirugía de Tórax, Instituto Autónomo Hospital Universitario de los Andes, Mérida, Venezuela
| | - Mario Pérez
- Servicio de Neumonología y Cirugía de Tórax, Instituto Autónomo Hospital Universitario de los Andes, Mérida, Venezuela
| | - Lérida Borges
- Instituto de Inmunología Clínica, Universidad de los Andes, Mérida, Venezuela
| | - Guillermo Bianchi
- Departamento de Mediciones y Evaluaciones, Facultad de Humanidades, Universidad de Los Andes, Mérida, Venezuela
| | - José-Angel Cova
- Instituto de Inmunología Clínica, Universidad de los Andes, Mérida, Venezuela.
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16
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Modaresi M, Dadkhah M, Sayedi SJ. Exogenous Lipoid Pneumonia: Dramatic Clinical and Radiological Improvement After Multiple Segmental Bronchoalveolar Lavages. Iran J Pediatr 2015; 25:e3172. [PMID: 26635940 PMCID: PMC4662840 DOI: 10.5812/ijp.3172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 08/12/2015] [Indexed: 11/24/2022]
Affiliation(s)
- Mohammadreza Modaresi
- Division of Pediatrics Pulmonary Disease, Children’s Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Minoo Dadkhah
- Department of Pediatrics, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Minoo Dadkhah, Department of Pediatrics, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, IR Iran. Tel: +98-9124990059, E-mail:
| | - Sayed Javad Sayedi
- Division of Pediatrics Pulmonary Disease, Children’s Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, IR Iran
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17
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Tanriverdi H, Erboy F, Altinsoy B, Uygur F, Arasli M, Ozel Tekin I, Tor MM, Atalay F. Bronchoalveolar Lavage Fluid Characteristics of Patients With Sarcoidosis and Nonsarcoidosis Interstitial Lung Diseases: Ten-Year Experience of a Single Center in Turkey. Iran Red Crescent Med J 2015; 17:e31103. [PMID: 26566455 PMCID: PMC4636855 DOI: 10.5812/ircmj.31103] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 08/05/2015] [Accepted: 09/19/2015] [Indexed: 12/13/2022]
Abstract
Background: Bronchoalveolar lavage (BAL) is a noninvasive and useful technique for evaluating interstitial lung diseases (ILDs). Flow cytometric analysis of BAL fluid reveals specific diagnostic information in some unusual ILDs, and helps to narrow down the possible causes of interstitial diseases in most patients with more common disorders. A high BAL CD4/CD8 ratio is highly specific for sarcoidosis but can also be seen in other ILDs. Objectives: In this retrospective, descriptive, cross-sectional study, we compared BAL fluid characteristics and clinical variables in patients with sarcoidosis and non-sarcoidosis ILDs in a large cohort. Patients and Methods: The study was conducted in a tertiary university hospital in Zonguldak, the biggest city of the western Black Sea region of Turkey. Between 2004 and 2014, all patients who underwent both fiberoptic bronchoscopy and BAL with a suspicion of ILD were included in the study, retrospectively. Patients were divided into two main groups: sarcoidosis and non-sarcoidosis ILDs. Non-sarcoidosis ILDs were further divided into subgroups: pneumoconiosis, tuberculosis (TB), collagen vascular diseases, idiopathic interstitial pneumonias, malignancies, and unclassified ILDs. The clinical data of patients, including age, gender, smoking status, pulmonary function tests, and BAL flow cytometric analysis results, were compared among groups. Results: In total, 261 patients (119 sarcoidosis and 142 non-sarcoidosis ILDs) were enrolled. The median (interquartile range) BAL CD4/CD8 ratio and lymphocyte fraction were significantly higher in sarcoidosis than in non-sarcoidosis ILDs: 3.88 (3.76) versus 0.88 (1.01), respectively, and 20.6 (28.3) versus 6.0 (13.7), respectively. T cell receptor γ delta, CD16+56+, CD103+, CD8+103+, and CD3+16+56+ cells were significantly lower in sarcoidosis than in non-sarcoidosis ILDs. The median BAL CD4/CD8 ratios were significantly higher in patients with TB (1.87, P = 0.01) and malignancies (1.69, P = 0.03) than in other non-sarcoidosis ILDs. Conclusions: Among BAL fluid flow cytometric parameters, CD4/CD8 and lymphocyte fraction may be helpful for distinguishing sarcoidosis from other ILDs, but they are neither specific nor diagnostic for any lung disease. Thus, a multidisciplinary diagnostic discussion is required to differentiate various ILDs.
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Affiliation(s)
- Hakan Tanriverdi
- Department of Chest Diseases and Tuberculosis, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
- Corresponding Author: Hakan Tanriverdi, Department of Chest Diseases and Tuberculosis, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey. Tel: +90-3722612685, Fax: +90-3722612001, E-mail:
| | - Fatma Erboy
- Department of Chest Diseases and Tuberculosis, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Bulent Altinsoy
- Department of Chest Diseases and Tuberculosis, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Firat Uygur
- Department of Chest Diseases and Tuberculosis, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Mehmet Arasli
- Department of Immunology, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Ishak Ozel Tekin
- Department of Immunology, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Muge Meltem Tor
- Department of Chest Diseases and Tuberculosis, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
| | - Figen Atalay
- Department of Chest Diseases and Tuberculosis, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
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18
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Nikbakhsh N, Bayani M, Siadati S. The Value of Bronchoalveolar Lavage in the Diagnosis of Sputum Smear-NegativePulmonary Tuberculosis. Iran J Pathol 2015; 10:35-40. [PMID: 26516323 PMCID: PMC4539783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 03/26/2014] [Indexed: 06/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Sputum smear staining for acid-fast bacilli is initial approach to the diagnosis of pulmonary tuberculosis (PTB) but more than 50% of cases are sputum smear-negative. This study was aimed to investigate the diagnostic value of fiberoptic bronchoscopy (FOB) guided bronchoalveolar lavage (BAL) in patients suspected to have tuberculosis. METHODS This prospective cross-sectional study was carried out on 290 sputum smear-negative patients who were clinically suspicious for PTB in 2006-12. All patients were subjected to FOB andBAL, then BAL specimens stained and cultured. RESULTS Of the 290 patients, 173 cases (59.7%) were men and 117 cases (40.3%) were women with the age of 52.6±19.1 years (ranged 20-76 years). Of the total 290 BAL specimens, 110 specimens (38%) were positive for acid-fast bacilli. Sensitivity, specificity, PPV and NPV was 60%, 91%, 89% and 64%, respectively. Also, LR (+) and LR (-) was 64.6% and 0.44%, respectively. CONCLUSION FOB guided BAL is a reliable, rapid and useful method for establishing the diagnosis of smear negative PTB with minimal complications.
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Affiliation(s)
- Novin Nikbakhsh
- Dept. of Surgery, Babol University of Medical Sciences, Babol, Iran.
| | - Masomeh Bayani
- Infectious and Tropical Disease Research Center, Babol University of Medical Sciences, Babol, Iran.
| | - Sepideh Siadati
- Dept. of Pathology, Babol University of Medical Sciences, Babol, Iran.
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19
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Zarrinfar H, Mirhendi H, Fata A, Khodadadi H, Kordbacheh P. Detection of Aspergillus flavus and A. fumigatus in Bronchoalveolar Lavage Specimens of Hematopoietic Stem Cell Transplants and Hematological Malignancies Patients by Real-Time Polymerase Chain Reaction, Nested PCR and Mycological Assays. Jundishapur J Microbiol 2014; 8:e13744. [PMID: 25763133 PMCID: PMC4344768 DOI: 10.5812/jjm.13744] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Revised: 10/15/2013] [Accepted: 11/10/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pulmonary aspergillosis (PA) is one of the most serious complications in immunocompromised patients, in particular among hematopoietic stem cell transplants (HSCT) and patients with hematological malignancies. OBJECTIVES The current study aimed to evaluate the incidence of PA and utility of molecular methods in HSCT and patients with hematological malignancies, four methods including direct examination, culture, nested polymerase chain reaction (PCR) and real-time PCR were performed on bronchoalveolar lavage (BAL) specimens in Tehran, Iran. PATIENTS AND METHODS During 16 months, 46 BAL specimens were obtained from individuals with allogeneic HSCT (n = 18) and patients with hematological malignancies (n = 28). Direct wet mounts with 20% potassium hydroxide (KOH) and culture on mycological media were performed. The molecular detection of Aspergillus fumigatus and A. flavus was done by amplifying the conserved sequences of internal transcribed spacer 1 (ITS1) ribosomal DNA by nested-PCR and the β-tubulin gene by TaqMan real-time PCR. RESULTS Seven (15.2%) out of 46 specimens were positive in direct examination and showed branched septate hyphae; 11 (23.9%) had positive culture including eight (72.7%) A. flavus and three (27.3%) A. fumigatus; 22 (47.8%) had positive nested-PCR and eight (17.4%) had positive real-time PCR. The incidence of invasive pulmonary aspergillosis (IPA) in these patients included proven IPA in 1 (2.2%), probable IPA in 10 (21.7%), possible IPA in 19 (41.3%) and not IPA in 16 cases (34.8%). CONCLUSIONS The incidence of IPA in allogeneic HSCT and patients with hematological malignancies was relatively high and A. flavus was the most common cause of PA. As molecular methods had higher sensitivity, it may be useful as screening methods in HSCT and patients with hematological malignancies, or to determine when empirical antifungal therapy can be withheld.
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Affiliation(s)
- Hossein Zarrinfar
- Allergy Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Department of Parasitology and Mycology, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Hossein Mirhendi
- Department of Medical Parasitology and Mycology, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Abdolmajid Fata
- Research Center for Skin Diseases and Cutaneous Leishmaniasis, Department of Parasitology and Mycology, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Corresponding author: Abdolmajid Fata, Research Center for Skin Diseases and Cutaneous Leishmaniasis, Department of Parasitology and Mycology, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel: +98-5118547255, Fax: +98-5118002385, E-mail:
| | - Hossein Khodadadi
- Department of Parasitology and Mycology, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Parivash Kordbacheh
- Department of Medical Parasitology and Mycology, Tehran University of Medical Sciences, Tehran, IR Iran
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20
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Izadi M, Jonaidi Jafari N, Sadraei J, Mahmoodzadeh Poornaki A, Rezavand B, Zarrinfar H, Abdi J, Mohammadi Y. The Prevalence of Pneumocystis jiroveci in Bronchoalveolar Lavage Specimens of Lung Transplant Recipients Examined by the Nested PCR. Jundishapur J Microbiol 2014; 7:e13518. [PMID: 25741434 PMCID: PMC4335549 DOI: 10.5812/jjm.13518] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 11/11/2013] [Accepted: 02/11/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The use of immune suppressive drugs for organ transplant recipients predisposes them to opportunistic infections, especially by fungal agents. Pneumocystis jiroveci, as an opportunistic pathogen, endangers the patients' life in those with immune system disorders. Early detection of latent Pneumocystis infection in susceptible patients may help choose the optimal treatment for these patients. OBJECTIVES The aim of this study was to identify and determine the colonization of latent P. jiroveci infection among lung transplant recipients. PATIENTS AND METHODS This cross-sectional descriptive study was conducted on lung transplant recipients. Bronchoalveolar lavage (BAL) specimens were collected from 32 patients undergoing bronchoscopy. The samples were aseptically homogenized by 10 mM dithiothreitol, and their DNA was extracted. The mtLSUrRNA gene of P. jiroveci was amplified using nested PCR in two stages. Nested PCR was performed using external primers of pAZ-102-E and pAZ102-H followed by using the PCR product of the first stage and internal primers of pAZ-102-E and pAZ102-L2. RESULTS The genome of P. jiroveci was revealed by a 346 bp PCR product in the initial amplification and a 120 bp product in the nested PCR. The results showed that seven BAL specimens (21.9%) from lung transplant recipients were positive for P. jiroveci. CONCLUSIONS In molecular epidemiology studies, nested PCR has higher sensitivity than PCR. Results of this study support the colonization of P. jiroveci in patients receiving lung transplantation. Patients who are carriers of P. jiroveci are at a higher risk of P. jiroveci pneumonia.
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Affiliation(s)
- Morteza Izadi
- Health Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | | | - Javid Sadraei
- Parasitology Department of Medical School, Tarbiat Modares University, Tehran, IR Iran
| | | | - Babak Rezavand
- Department of Parasitology, School of Medicine, Zanjan University of Medical Sciences, Zanjan,IR Iran
- Corresponding author: Babak Rezavand, Department of Parasitology, school of Medicine, Zanjan University of medical sciences, Zanjan, IR, Iran. Tel: +98-2414240301-3, E-mail:
| | - Hossein Zarrinfar
- Allergy Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IR Iran
| | - Jahangir Abdi
- Department of Parasitology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, IR Iran
| | - Younes Mohammadi
- Department of Epidemiology & Bio-statistics, School of Public Health, Tehran University of Medical Sciences, Tehran, IR Iran
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21
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Reesi MA, Al-Maani A, Paul G, Al-Arimi S. Primary Cytomegalovirus-Related Eosinophilic Pneumonia in a Three-year-old Child with Acute Lymphoblastic Leukaemia: Case report and literature review. Sultan Qaboos Univ Med J 2014; 14:e561-e565. [PMID: 25364562 PMCID: PMC4205071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 03/01/2014] [Accepted: 04/03/2014] [Indexed: 06/04/2023] Open
Abstract
A diagnosis of eosinophilic pneumonia (EP) is rare in patients with acute lymphoblastic leukaemia (ALL). We report a case of EP in association with a primary cytomegalovirus (CMV) infection in a three-year-old Omani child with ALL. The patient presented with fever while undergoing maintenance chemotherapy. He was admitted to the Child Health Department of Royal Hospital, in Muscat, Oman, in November 2011. He was initially thought to have sepsis but failed to respond to antibiotics. Chest computed tomography showed diffuse ground glass lung opacification. Bronchoalveolar lavage (BAL) cytology was consistent with the diagnosis of EP. Polymerase chain reaction tests for CMV were performed on the BAL and blood samples and were both markedly elevated. The patient made a full recovery after treatment with prednisolone and ganciclovir. The association between CMV infection and EP as well as the management of this combination in immunocompromised patients has never been reported in the English literature.
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Affiliation(s)
| | - Amal Al-Maani
- Department of Child Health, Royal Hospital, Muscat, Oman
| | - George Paul
- Department of Child Health, Royal Hospital, Muscat, Oman
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K Vejdan A, Khosravi M. BAL for pneumonia prevention in tracheostomy patients: A clinical trial study. Pak J Med Sci 2013; 29:148-51. [PMID: 24353528 PMCID: PMC3809188 DOI: 10.12669/pjms.291.1971] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Revised: 10/08/2012] [Accepted: 10/10/2012] [Indexed: 11/18/2022] Open
Abstract
Objective: To evaluate the role of flexible bronchoscopy (FB) and bronchoalveolar lavage (BAL) on pneumonia prevention of tracheostomy patients in intensive care unit. Methodology: This clinical trial was conducted on 67 head-injury patients who needed tracheostomy. The eligible patients were divided into two groups of different methods for removing the airway secretions. In intervention group, FB and BAL was added to routine conventional methods for airway clearance. Patients were followed for signs and symptoms of pneumonia. Results: The risk of nosocomial pneumonia decreased from 35% to 14% in intervention group. The days of hospital stay were significantly reduced with bronchoscopic method. Conclusions: Flexible Bronchoscopy is recommended to all ICU admitted patients that have tracheostomy tube and high volume of secretion in their airways. It can not only prevent the pneumonia formation decrease the morbidity and mortality rate but it can even shorten the ICU stay time and consequently reduce the costs of treatment.
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Affiliation(s)
- Amir K Vejdan
- Amir K Vejdan, Assistant Professor of General Surgery, University of Medicine, Master of Burn and General Surgery Wards, Imam Reza Hospital, Birjand, Iran
| | - Maliheh Khosravi
- Maliheh Khosravi, Resident of Anesthesiology, Department of Anesthesiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Park YS, Yoo CG. The clinical assessment of protease-activated receptor-2 expression in inflammatory cells from peripheral blood and bronchoalveolar lavage fluid in idiopathic pulmonary fibrosis. Tuberc Respir Dis (Seoul) 2013; 74:264-8. [PMID: 23814598 PMCID: PMC3695308 DOI: 10.4046/trd.2013.74.6.264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 04/01/2013] [Accepted: 04/01/2013] [Indexed: 11/24/2022] Open
Abstract
Background Idiopathic pulmonary fibrosis (IPF) is a lethal pulmonary fibrotic disease. In general, the exaggerated activation of the coagulation cascade has been observed during initiation or maintenance of the fibrotic disease. In our recent study, immunohistochemical expression of protease-activated receptor-2 (PAR-2), which plays a key role in coagulation cascade, was observed in surgical specimen of IPF patients, and associated with poor clinical outcome. The aim of this study was to evaluate the overexpression of PAR-2 in inflammatory cells from peripheral blood and bronchoalveolar lavage fluid in IPF patients. Methods From May 2011 to March 2012, IPF patients and controls were enrolled in Seoul National University Hospital. Peripheral blood and bronchoalveolar lavage fluid were collected for analysis of PAR-2 expression. Flow cytometry and reverse transcription polymerase chain reaction were used for PAR-2 receptor and mRNA assessment. Results Twelve IPF patients and 14 controls were included in this study. Among them, flow cytometry analysis was conducted from 26 peripheral blood (patient group, 11; control group, 13) and 7 bronchoalveolar lavage fluid (patient group, 5; control group, 2). The expression of PAR-2 receptor was not different between patient and control groups (p=0.074). Among all 24 population, PAR-2 mRNA assessment was performed in 19 persons (patient group, 10; control group, 9). The mRNA expression of PAR-2 was not significant different (p=0.633). Conclusion In IPF patients, PAR-2 receptor and mRNA expression were not different from control group.
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Affiliation(s)
- Young Sik Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine and Lung Institute, Seoul National University College of Medicine, Seoul, Korea
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