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Up-to-date review of the role of lung ultrasound (US) in early diagnosis of COVID-19 disease associated pneumonia, based on the recent publications at the 2019/2020 pandemic of nCoV-19. Further, highlighting the advantages of lung US over the other imaging modalities as regard early diagnosis, cost and potency of its use as a screening tool in pandemics. The COVID-19 tends to be bilateral with patchy pattern. More frequent in the posterior and inferior fields of the lung. This infiltration is usually irregular and extends to the pleural line. Diffuse B-lines are noticed with air bronchogram sign. Sometimes localized pleural thickening is seen or localized pleural effusion. Occasionally, impaired blood flow in the consolidation patch was detected.In novel COVID-19 era lung US is a bedside, practical, safe and useful emergency tool for diagnosis. It is operator dependent and this drawback can be avoided by providing proper training.Keyword: Lung ultrasonography, COVID-19 Pneumonia and Corona virus

Background:adherence to medication is a growing issue and there aremany factors affecting adherence in bronchial asthma and COPD. Objectives:This study was designed to determine the factors affectingadherence to inhalation therapy in asthma and chronic obstructivepulmonary disease. Patients and Methods: The present study included 300 patients (164males and 136 females and 156 COPD and 144 asthma also 189 werealready on inhaler therapy and 111 were naive(no previous inhaler)whoattended Sohag university hospital (inpatient department and outpatientclinic of chest diseases)during the period from April 2016 to May 2017using morisky questionnaire to determine factors affecting adherence toinhaled therapy. Results: 300 patients 164cases (54.67%) were males and 136 cases(45.73)were female, Good adherence to inhaled therapy was observed in 124 (35.3%) patients and both intermediate and good adherence was observed in 227 ( 64.6% ) patients. Most of the naive patients were poor adherent to inhaled therapy.There was no relationship between demographic data and adherence in asthmatic patients. However, there was significant relation between adherence and socioeconomic status and residence in COPD patients. Patients with bronchial asthma had better adherence to inhaled therapy than patients with COPD, However good adherence was frequently encountered in patients with COPD who had 2-4 emergency visits in the last year. Good adherence was observed frequently in patients who had ENT diseases as comorbidity, while poor adherence was observed frequently in patients who had cardiac disease. Good adherence was frequently encountered among asthmatic patients whoused inhaler twice daily, who used drugs its onset of action 5- 20 minutes, whoused aerolizer and turbohaler devices and who used budesonide and budesonide/formetrol. Good adherence was frequently encountered among patients with COPD who used inhaler twice daily, who used aerolizer and handihaler devices and who used formetrol and tiotropium Conclusion: This study confirmed that many factors affect adherence toinhaled therapy,so the interventions to maintain adherence contain fivecategories should be joint together(patient related factors, condition related factors, drug related factors, healthcare system related and socioeconomic status)to improve adherence and thus quality of life.

Colorectal cancer is the second leading cause of death due to malignancy in industrialized counties. It is argued that most large bowel malignancies arise from preexisting adenormas. Computed tomographic (CT) colonography is a noninvasive, rapidly evolving technique that has been shown in some studies to be comparable with conventional colonoscopy for the screening of colorectal cancer. However, widespread colorectal screening and preventive efforts aimed at detecting disease in this early stage are opposed by several practical obstacles, including limited resources, and poor patient acceptance and therefore poor compliance (1-2). Patients and methods

Colorectal cancer is the third most common cancer and the second leading cause of cancer-related death in Western countries. As with other malignancies, screening and early detection is fundamental for successful management of colorectal cancer. Computed tomographic (CT) colonography is a noninvasive, rapidly evolving technique that has been shown in some studies to be comparable with conventional colonoscopy for the screening of colorectal cancer. CT colonography is being increasingly applied as a routine screening method for the detection of colorectal cancer in last few years as it is more convenient and less invasive than colonoscopy. In addition, it has an upper hand in diagnosis of small lesions less than 10mm (Choi, et al., 2011). Patients and methods:This prospective double blind comparative study will be conducted on 23 patients with colorectal symptoms and signs as altered bowel habits, bleeding per rectum, abdominal pain, weight loss, unexplained fatigue and loss of appetite.An informed written consent was obtained from all patients and approval of the faculty research ethics committee was obtained. Results: Total of 108 colonic lesions were analyzed in 23 patient; Seven colonic masses were diagnosed in 6 patients, 41 polyps in 8 patients and 60 diverticulae in 5 patients. Six patients had incomplete colonoscopy. Of them, 2 patients had a large polypoidal mass that prevents further colonoscopic introduction. Using CT colonography we were able to evaluate those polypoidal masses. Moreover, we could complete the examination and evaluation of the proximal colon and one of them had a polypoidal sigmoid colon mass and showed another proximal annular mass. Four patients presented with colonic obstruction and good preparation to the proximal parts of the colon failed, So completing the colonoscopy was difficult. After undergoing CT colonography, 2 patients were normal and 2 patients had annular masses causing proximal obstruction and marked distension. ConclusionCT Colonography (Virtual Colonoscopy) is a reliable tool and more sensitive for detecting colonic mass lesions larger than 5 mm, polyps larger than 5 mm, strictures and diverticulosis. CTC is of value in evaluating the colonic segment lying proximal to colonic cancers including those with occlusive growths or strictures. Contrast-enhanced CTC is also useful in identifying extra-colonic findings.Virtual Colonoscopy is a good screening tools for malignant or premalignant lesions in patients presented with colorectal symptoms.

Objective Tuberculosis (TB) is one of the main health issues in Egypt. Nationwide collective data on the current trends of infection are scarce. The aim of the study was to evaluate the patterns and trends of extrapulmonary tuberculosis (EPTB) cases in Sohag, Upper Egypt. Methods Cross-sectional study involving a retrospective review of all TB cases registered as extra-pulmonary TB (EPTB) from 2010 to 2014, the age and sex of the patients and the categories and types of EPTB registered their treatment outcomes. Results From 2010 to 2014, 500 patients were registered with EPTB, of whom 36.6% were male, and 85% were new EPTB cases. TB lymph node enlargement and pleural effusion were the two most common types of EPTB, accounting for 58%, followed by spinal/bone, abdominal TB and kidney disease. The overall treatment success rate was 90%, and was generally similar with respect to sex, age and different types of EPTB. Conclusions Sohag has a high proportion of patients registered as having EPTB, for whom treatment outcomes are satisfactory. Frequency of severe forms of EPTB is more often in younger ages in lower social economical condition areas.

NLR has also been evaluated as diagnostic and prognostic marker in COPD. Chronic inflammation in COPD resulting in the recruitment of the lymphocytes and neutrophils. Which, once activated, release neutrophil elastase, cathepsin G, proteinase-3, matrix metalloproteinase (MMP)-8 and MMP-9, and myeloperoxidase (MPO), which contribute in the pathophysiological mechanisms of emphysema and COPD. Aim of study Evaluate the NLR as a biomarker that can detect the severity and duration of COPD in patients with acute exacerbation and frequency of future exacerbation; we thus monitored NLR in COPD to evaluate it as a biomarker in patients and investigated its association with a variety of clinical aspects of COPD. Methodology It was a prospective observational study that was carried out among COPD patients with acute exacerbation and asymptomatic persons (controls). The study included 67 participants, 38 cases were COPD patients while 39 cases were healthy controls who were older than 40 years. The study was conducted among patients who admitted to chest department of Sohag University Hospital during period between February 2019 to January 2020, after the approval of the ethical committee and written consents where taken from the participants. Patients were diagnosed to have COPD according to the GOLD. The following laboratory investigations were done: complete blood count (CBC) inflammatory markers as neutrophil-lymphocyte ratio (NLR), were evaluated. Results The mean age of the studied COPD cases was 63.5(7.8) years and the mean age of the controls was 60(6.5) years. All the studied COPD cases and the matched controls were males. Compared to controls the levels of neutrophil, lymphocyte, basophil, eosinophil, NRL and platelet were significantly higher among the studied COPD cases. There was significant positive correlation between levels of leucocytes, neutrophils and NLR and duration of exacerbation. While, lymphocytes level was inversely associated with duration of exacerbation. Conclusions The present study demonstrates that NLR is associated with mortality and duration exacerbations, in COPD patients. For predicting exacerbations, we estimated the threshold of NLR to be 1.3 at baseline.

Introduction The occurrence of chronic obstructive airway disease and obstructive sleep apnea (OSA) is a popular syndrome called overlap syndrome. Aim To evaluate the prevalence of OSA in chronic obstructive pulmonary disease (COPD). Patients and methods A total of 86 patients with COPD (54.65% men, with a mean age of 62.065 years) were included in our study. Clinical criteria and biochemical tests were registered, and polysomnography was done. Results Overall, 38 patients with an apnea–hypopnea index more than 5 events/h were defined as having overlap syndrome (44.19%). Conclusion The results showed an OSA prevalence of 44.19% in patients with COPD. A sleep study should be considered in overweight patients with COPD, even in patients without symptoms of sleep apnea.

Objective To study the effect of gastroesophageal reflux disease (GERD) management by using high dose of proton pump inhibitors (PPIs) on the outcome of uncontrolled asthma. Study design The study included 100 patients with their ages ranging from 21 to 69 years. They presented with uncontrolled asthma (FEV1 less than 80%, with daily rescue medications and more than one urgent care visit/year). And all patients were on high dose of inhaled oral corticosteroid (more than 880 μg fluticasone). F-scale questionnaire was done for the diagnosis of GERD. Patients with GERD and bronchial asthma received PPIs (40 mg omeprazole) and inhaled oral corticosteroid (500 μg fluticasone with long acting beta-2 agonist 100 μg salmeterol) for 3 months. Results Thirty-one (31%) patients showed combined GERD and bronchial asthma. Twenty-three patients showed significant improvement in asthma control after combined therapy ( p value 0.01). Twenty-three patients showed significant improvement in lung function (FEV1 more than 80%), maintained moderate dose of inhaled corticosteroid without rescue medication ( p value 0.01). Conclusion GERD is an important cause of uncontrolled asthma and its management significantly improves the uncontrolled asthma and significantly reduces the inhaled oral corticosteroid.

Detection of a technique used for diagnosis of Community Acquired Pneumonia by chest ultrasound compared to chest radiograph. Study Sixty two patients presented with clinically diagnosed pneumonia (acute presentation of fever, cough, purulent expectoration and typical auscultation as rales and bronchial breath sound), patients with chronic chest and cardiac diseases are excluded from the study. Chest ultrasound and chest X-ray were done for all patients. Results Chest ultrasound showed a significant diagnostic value of consolidation, as it showed signs of consolidation in 46 patients (74.2%) (P value 0.01), while Chest X-ray showed signs of consolidation in 32 patients (51.6%) (P value more than 0.05). Conclusion Performance of chest ultrasound for the detection of pneumonia is excellent and superior to chest X-ray considering rapid access to bedside ultrasound and the excellent performance of this simple test. Clinical importance This study supports the routine use of chest ultrasound for the detection of community acquired pneumonia especially in cases in which chest X-ray is contraindicated or inaccessible.

Pulmonary dysfunction is a common feature in patients with long standing liver affection and up to 70% of patients with liver cirrhosis are complaining of dyspnea. Hypoxia has been seen in approximately one third of patients with chronic hepatic disease and the development of hypoxemia in patients with chronic liver disease may change the treatment.