Background Chemical pleurodesis is frequently indicated to relieve symptoms imposed by large/recurrent malignant pleural effusion (MPE). Traditionally, a drain is left in the pleural space till the cessation of fluid accumulation before pleurodesis. Chest ultrasound can detect an amount of pleural fluid as less as 50 ml and can confirm apposition of the pleural surfaces which is required for successful pleurodesis. This work assessed the efficiency and safety of ultrasound-guided, single-session pleurodesis in cases with MPE. Results Seventeen of the patients completed a 2-month follow-up. The technique demonstrated a high success rate (88.2%). The mean duration from the start of pleural drainage till pleurodesis was 1.65 ± 0.70 h ranging from 1 to 3 h. A duration of 2.5 h or less was statistically proposed as a cutoff value not to exceed to predict success (sensitivity 100%, specificity 100%). The mean time for total hospital stay related to pleurodesis was 9.88 ± 3.12 h (range 4–12 h). No complications attributed to the procedure were recorded. Pleural Adherence Score and Absent Sliding Score (ASS) had a highly statistically significant correlation (p value < 0.001). Conclusions An ultrasound-guided completion of the process of pleurodesis in a single session with a shorter duration of pleural fluid drainage and shorter hospital stay (can be done on a day-care basis) is efficient, safe, and cost-effective. This technique is strongly recommended to replace the traditional practice of keeping the indwelling pleural drain for several days waiting for the cessation of pleural fluid reaccumulation. An ultrasound-derived ASS can be used as early as day 1 and day 15 to confirm pleural adherence and to expect the outcome of pleurodesis.

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Diffusion lung capacity for carbon monoxide correlates with HRCT findings in patients with diffuse parenchymal lung disease. Background Diffuse parenchymal lung diseases (DPLDs) affect the alveolar epithelium, pulmonary capillary endothelium, basement membrane, and perivascular and perilymphatic tissues. High-resolution computed tomography (HRCT) of the chest is the gold standard modality for diagnosing DPLD. Pulmonary function tests usually show a restrictive defect in spirometry. Single breath diffusion lung capacity for carbon monoxide (DLCO-SB) technique is used to assess the diffuse parenchymal lung diseases, as there is thickening of the alveolar membrane and diminished total lung capacity due to interstitial processes with severe decline in the transfer factor. The aim of this work was to correlate between Warrick’s HRCT fibrosis score and DLCO-SB in DPLD and to assess the possibility of using DLCO as an only tool to follow up DPLD to avoid repeated radiation exposure of the patients in HRCT chest (decrease need for radiological follow-up) or vice versa. Results This work recruited 89 patients over a period of 10 months duration, 74.2% of them were females. The Warrick’s score, ground-glass opacity, irregular pleural margin, subpleural cyst, honeycombing, and septal and subpleural lines were represented as 96.6%, 70.8%, 55.1%, 49.4%, and 48.3% respectively in HRCT of DPLD. Warrick’s score and its subscores (severity score, extent score, alveolitis score, and fibrosis score) were associated with a highly significant decrease in different pulmonary function indices (FVC, FEV1, TLC, and DLCO) with P value 0.001. A highly significant correlation between DLCO grades and total score grades was found with P value 0.001, and 86.8% of the patients with severe DLCO affection showed severe degree of total fibrosis score. Conclusions Both DLCO-SB and HRCT fibrosis scores were significantly correlated. Lifelong follow-up of function and structure of the lung in DPLD is needed by HRCT and DLCO. In an attempt to minimize repeated radiation exposure and reduce cost, we suggest DLCO to be used alone for longer follow-up periods rather than HRCT chest.

Context Anxiety disorders are underestimated comorbid conditions in patients with chronic obstructive pulmonary disease (COPD). The Global Initiative for Chronic Obstructive Lung Disease (GOLD; updated 2019) has given wide importance on assessment of underdiagnosed comorbid conditions to evaluate patients with stable COPD. Aims To investigate the occurrence of anxiety as a hidden comorbid disease among patients with stable COPD and their effect on 6-min walk distance (6MWD) and COPD assessment test (CAT) score. Settings and design This is a descriptive cross-sectional study. Patients and methods Patients with COPD who were attending the outpatient chest clinic for follow-up at Ain Shams University Hospitals were included in the study during the period between January 2019 and July 2019. Patients were classified according to GOLD criteria 2019. The validated questionnaire for anxiety (State Trait Anxiety Inventory) was fulfilled. The patients were functionally assessed by 6MWD and CAT score. Statistical analysis Statistical Package for Social Sciences program software, version 18.0, was used for statistical analysis. Results Anxiety among Patients with COPD was 54.5%. The lower the forced expiratory volume in the first second % predicted, the greater the anxiety (P=0.027). A positive significant correlation was found between anxiety state and GOLD staging (P=0.042). 6MWD showed a statistically significant negative correlation with the degree of anxiety (P=0.018). CAT scoring had an apparent positive correlation with the anxiety state but unfortunately did not reach the statistically significant difference (P=0.081). Conclusion The underestimated comorbid anxiety disorders are found to be common in patients with COPD. It adds to patients’ dyspnea, especially with high CAT scores and decreased exercise tolerance.