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BackgroundPlatelets have a vital role in antimicrobial host defenses. The objective of this study was to evaluate if increased mean platelet volume to platelet count (MPV/PC) ratio in acute ischemic stroke patients complicated with pneumonia was associated with increased mortality risk.MethodsThe current study was conducted at Zagazig University Hospitals. It included 500 acute ischemic stroke patients classified as group 1 that included 51 patients complicated with pneumonia after admission and group 2 that included the remaining 449 patients. Clinical assessment was carried out to exclude comorbid medical illnesses likely to interfere with platelet function or morphology. Laboratory investigations including MPV/PC ratio and brain imaging were carried out for all patients.ResultsThere was a significant difference between both groups regarding age, National Institutes of Health Stroke Scale (NIHSS) score, and mortality within 30 days (p = 0.02, 0.03, 0.01). There was a significant difference between survivors and non-survivors of group 1 regarding to pneumonia severity index (PSI) classes IV and V (p = 0.01 and 0.02, respectively). Also, there was a significant difference regarding confusion, urea ≥ 7 mmol/L, respiratory rater ≥ 30 breaths/min, systolic blood pressure ≤ 90 mmHg or diastolic blood pressure ≤ 60 mmHg, and age ≥ 65 years at pneumonia occurrence (CURB-65) scores 3, 4, and 5 (p = 0.03, 0.02, and 0.01, respectively). Moreover, there was a significant difference regarding decreased GCS score at pneumonia occurrence, higher NIHSS scores, PSI, and higher MPV/PC ratio (p = 0.01, 0.01, 0.028, and 0.01, respectively). Age > 65 years, need for mechanical ventilation, GCS score of > 9, PSI class ≥ IV, CURB-65 scores ≥ 3, and increased MPV/PC ratio were all significantly associated with 30-day mortality in group 1 (p = 0.03, 0.01, 0.001, 0.04, 0.01, and 0.03, respectively). The predictors of 30-day mortality risk factors were GCS less than 9, increased MPV/PC ratio, and CURB-65 scores ≥ 3 (p = 0.001, 0.05, and 0.01, respectively).ConclusionsOnce pneumonia develops, MPV/PC ratio could be considered a significant laboratory indicator of 30-day mortality.

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Background:. Idiopathic pulmonary fibrosis (IPF) is a complicated disease in which histopathological abnormalities in the form of, proliferation of mesenchymal cell, fibrosis, overproduction and disorganization of collagen deposition, extra cellular matrix changes with distortion of pulmonary structure and the appearance of subpleural cysts , with accumulation of both myofibroblast and fibroblast. Pirfenidone has been available in Japan since 2008.In 2011, the approval by the European Medicine Agency (EMA) was indicated by the efficacy of pirfenidone in decreasing lung function deterioration in IPF patients. Aim of the Study: The aim of the study is to study the efficiency and safety of Pirfenidone in a group of IPF Patients. Ethical aspects: The thesis protocol was approved by IRB committee, Faculty of Medicine, Zagazig University. Subjects and Methods: This study was carried on 40 adult patients with IPF. Patients were divided into:  Group (A): 20 patients accepted to be treated with pirfenidone.  Group (B): also 20 patients they have been treated with conventional treatment for IPF Results: Mean change in distance walked during 6MWD test was 0.05 ± 56.24 for group (A) and −12.65 ± 67.86 for group (B). Mean decline in predicted FVC was −0.89 %± 14.55 for group (A) and −5.48% ± 10.89 for group(B) there were progression of the disease according to HRCT in 60% in group(A) and 70% in group(B), , while only 10% in group (A) showed regression of the disease with statistical significant differences between two groups. Conclusion: Pirfenidone didn't improve health related quality of life in IPF patients, Pirfenidone did not affect oxygenation in treatment group after 3 months therapy , Pirfenidone has good impact on radiological presentation of IPF patients. Pirfenidone not only slow loss in FVC but also improved it in one third of treated patients, GIT upset is the main adverse effects of pirfendone which are mild.