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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

Pulmonary arterial hypertension is defined as a group of diseases characterized by a progressive increase in pulmonary vascular resistance, leading to right ventricular failure and premature death. Pathobiologic mechanisms of the disease include pulmonary endothelial dysfunction, which leads to impaired production of vasodilators, such as nitric oxide and prostacyclin, and overexpression of vasoconstrictors, such as endothelin-1. Sildenafil inhibits phosphodiesterase type 5, an enzyme that metabolizes cyclic guanosine monophosphate, thereby enhancing the cyclic guanosine monophosphate-mediated relaxation and growth inhibition of vascular smooth-muscle cells, including those in the lung. Methods: In this prospective study 139 patients with symptomatic pulmonary arterial hypertension (2ry to COPD) received placebo or sildenafil (20 mg) orally three times daily for 12 weeks. The end point was the change from baseline to week 12 in the distance walked in six minutes. The change in mean pulmonary-artery pressure and the incidence of clinical worsening were also assessed, but the study was not powered to assess mortality. Results: The distance walked in six minutes increased from baseline in sildenafil group; the mean placebo-corrected treatment effects were 51 m (+13.0 percent), for 20 mg of sildenafil, (P

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.

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.