TANAFFOS
Year:2012 | Volume:11 | Issue:3|Papers Count:12

Chronic obstructive pulmonary disease (COPD) is a major health problem and cigarette smoke is the main risk factor for the development of COPD. The characteristic changes in airway morphology, inflammatory cell infiltration and mediator expression in COPD may result from direct effects of cigarette smoke (CS) on airway cells. CS causes lung damage through oxidative stress either by itself or due to oxidants released by inflammatory cells that are recruited as a result of smoke-induced injury. CS is a major source of oxidants/free radicals and a complex of over 4, 700 chemical compounds. This huge amount of oxidants from CS and those formed endogenously cause an imbalance between oxidants and antioxidants which are considered to be important in the pathogenesis of COPD.

Asthma and COPD are multidimensional diseases, with several systemic manifestations and associations with a number of comorbid diseases. The most likely link between asthma and COPD and these extrapulmonary conditions is the spillover of inflammatory mediators from the lung, as systemic inflammation is associated with skeletal muscle wasting and cachexia as well as with cardiovascular, metabolic, and bone diseases. Asthma is characterized by chronic airway inflammation, and infiltration of T-lymphocytes, mast cells, eosinophils and monocytes/macrophages. This is associated with the increased expression of several inflammatory proteins, including cytokines, enzymes, receptors and adhesion molecules.

Background: Tracheal stenosis is still a serious consequence of endotracheal intubation. Previous classification systems are commonly descriptive and are not intended to deal with management approach. The aim of this study was to present a classification system for post intubation tracheal stenosis and evaluate its efficacy in distinguishing critically ill patients who need surgical intervention.Materials and Methods: This classification system was developed based on size and type of stenosis and associated clinical signs and symptoms. Stenosis was graded based on the results of clinical examination and rigid bronchoscopy. All patients received surgical or conservative treatment based on the judgment of a surgeon experienced in management of post-intubation tracheal stenosis without considering their score. ROC curve analysis was done and cut-off point was established based on the greatest Youden index.Results: Sixty patients were studied. Resection and anastomosis were done for 49 patients. The mean score for all samples was 9.18 (range 8.77-9.45). Chosen cutoff point was 8.5 and calculated sensitivity and specificity were 89% and 42%, respectively. Positive and negative predictive values were 83.7% and 54.5%, respectively. A reasonable agreement between the estimated score and surgeon’s clinical judgment (kappa=0.78) was observed. A statistically significant relationship was observed between scores greater than 8.5 and need for surgical intervention (P=0.007).Conclusion: We presented a scoring system for post-intubation and tracheostomy tracheal stenosis using main factors influencing diagnosis and treatment and its efficacy was evaluated prospectively. It seems that this system would be capable of assimilating the treatment interventions and comparing them.

Background: Tuberculosis (TB) is a major cause of mortality affecting millions of people in third world countries. In DOTS monitoring of patients is facility-based and treatment supporter-based; by these two ways patients’ compliance to treatment is monitored. The aim of this study was to evaluate the role of treatment supporters and their impact on patients’ treatment outcomes.Materials and Methods: The study was a cross-sectional survey in the routine TB control program operational context. All sputum smear positive TB patients that were diagnosed and registered by the public sector in the urban and rural diagnostic centers in 2008 with available outcomes were included in the study. Data of 451 patients were collected during August-October 2010 from 15 health facilities.Results: The majority of patients (89.6%) were provided with treatment supporters. Of 404 (89.6%) cases with treatment supporters, in 203 (50.2%) the supporters were lady health workers, in 46 (11.4%) were community health workers and health facility workers, and in 155 (38.4%) were family members and community volunteers. A total of 384 (85.1%) were categorized as “treatment success”, 31 (6.9%), as “transferred out”, 17 (3.8%), as “expired”, 16 (3.5%) as “defaulted” and three (0.7%) as “treatment failure”. The treatment success rates in patients supervised by Lady health workers, community health workers and health facility workers, and family members and community volunteers were 93.1%, 89.1% and 73.5%, respectively.Conclusion: We found a significantly higher treatment success rate (93.1%) in patients supervised by lady health workers compared to others. The overall treatment success rate was 85.1%.

Background: Ulcerative colitis is an inflammatory chronic disease which is believed to be a multi organ condition. The prevalence of ulcerative colitis is reportedly increasing in Iran presenting with the same clinical characteristics as in developing countries. Pulmonary manifestations of ulcerative colitis are increasingly reported. In this study, we investigated the incidence of bronchial hyper-responsiveness (BHR) in ulcerative colitis (UC) patients.Materials and Methods: Fifty-one UC patients with definite diagnosis referred to Shariati Hospital, Tehran, Iran, were selected to be evaluated with methacholine challenge test from October 2010 to October 2011. Patients were compared for their methacholine test outcome and its association with age, sex, diagnosis time, and disease activity.Results: The median age was 41 (range 15 to 65) years. The median time of diagnosis was 7 (range<1 to 16) years. Forty-five percent were females, 18% had active disease and 13% had comorbidity. Nine percent of patients with UC had abnormal PFT in our study. Three cases (5%) had bronchial hyper-responsiveness that was not correlated with sex, age, time of diagnosis, or disease activity.Conclusion: A small number of ulcerative colitis patients in our study had disturbed pulmonary function test which is in concord with the findings of other studies. However, higher rates of bronchial hyper-responsiveness have been reported in other studies. Confounding factors like cigarette smoking and medications, which were negative or minimal in our study, may influence the results.

Background: At present, air way support plays pivotal role in management of patients in the ICU (Intensive Care Unit) and also RCU (Respiratory Care Unit). Ventilator weaning is an important step in the care of ICU and RCU patients. It is the gradual removal of mechanical ventilatory support. Different predictors are used for initiation of weaning. This study was designed to investigate the rapid shallow breathing index (RSBI) as a predictor for successful weaning.Materials and Methods: This cross-sectional study was conducted on 70 patients who had mechanical ventilation for more than 48 hours in a respiratory care unit in Tehran Labbafi Nejad Hospital. They were clinically stable and had the criteria for weaning from the ventilator. We measured RSBI, and then evaluated the value of RSBI for successful extubation. RSBI was calculated when patients were on spontaneous breathing mode with PSV=0 and PEEP=0 for one minute.Results: A total of 70 patients were included in this study; 63 (90%) patients had RSBI ≤105 (breath/min/L), among them 49 (77%) patients had successful weaning and did not need re-intubation while the remaining had unsuccessful weaning (P=0.001). The mean weaning index for patients with successful extubation was 66±57.2 and 76.9±28.1 for patients with unsuccessful extubaion. We could not find a significant difference between the means (P=0.433).Conclusion: Although RSBI <105 is a helpful index for weaning, application of RSBI alone may mislead the physicians. General status of the patient, concomitant diseases and duration of hospital stay should all be considered for successful weaning.

Background: This cross-sectional study aimed to investigate the relationship between the levels of serum testosterone and the severity of chronic obstructive pulmonary disease (COPD).Materials and Methods: Using GOLD criteria, 140 male patients with COPD were categorized into mild, moderate, severe and very severe COPD groups of 35 each. Then, serum levels of testosterone, prolactin and LH of patients were compared and the data were analyzed using SPSS version 18 software.Results: Average age of patients was 67.4±10.1 years (range 41 to 90 years). The prevalence of the secondary hypogonadism was 58.6%. It was shown that the level of serum testosterone was directly correlated with the severity of COPD (P=0.04).Conclusion: This study found that the prevalence of the secondary hypogonadism in COPD patients was high. The forced expiratory volume in 1 second (FEV1) was correlated with the level of serum testosterone. Further investigations are required to better evaluate the pathology and treatment of secondary hypogonadism in COPD patients.

Background: Cadavers are preserved in a fixing solution containing formalin. Formaldehyde (FA) released from formalin is inhaled by the personnel in the anatomy laboratory. Exposed personnel have reported respiratory problems and various symptoms. Due to the toxicity of FA as a strong irritant and carcinogen and also lack of a national study assessing occupational exposure to FA in gross anatomy labs in Iran, the present study aimed at occupational monitoring of personnel exposed to FA and evaluating relevant symptoms in them.Materials and Methods: A total of 20 subjects (all the staff) working in a gross anatomy lab and 20 library personnel were considered for occupational monitoring of exposure to FA during three months with various climatic conditions. They were also monitored for respiratory symptoms. Air sampling and analysis of its FA content were conducted according to the NIOSH method No.2016. Symptoms of cases and controls (library personnel) with active and passive exposure to formaldehyde were also studied by a self-report questionnaire.Results: In the first stage of monitoring with ventilation (supply-exhaust) system on, the exposure of personnel (Mean ± SE) was 306±21ppb. In the second stage of monitoring the personnel's exposure was 317±26ppb with only the ventilation supply system on and in the final monitoring stage this rate was 698±34ppb with the ventilation system (supply and exhaust) off. In this study, personal’s exposure level to FA was higher than the indoor concentration, and the individual exposure levels of instructors were higher than those of the students. Exposure of library personnel in the adjacent department (central library) was about 50ppb. Most important complaints reported by actively exposed staff members and library personnel were the unpleasant odor (68%), cough (64%), throat irritation and runny nose (56%), burning and itching of nose (52%) and irritating eyes (48%).Conclusion: Considering the level of exposure of all subjects in this study and existence of clinical symptoms, better control of the exhaust system in the gross anatomy lab and use of a more efficient ventilation system are recommended to protect the staff and instructors of the Anatomy Department.

Background: The present study aimed at comparing psychological problems between smoker and non-smoker students and also males and females.Materials and Methods: A total of 22 faculty members of public and private universities in Tehran were selected through random sampling and 913 students from the same universities were selected through convenient sampling and enrolled in this study with a 2-step sampling method. Hopkins Symptom Checklist was used for data collection.Results: Significant differences were detected between smoker and non-smoker students in Hopkins score, depression, anxiety and somatization. In addition, smoker women gained higher Hopkins scores, somatization, anxiety and interpersonal sensitivity scores compared to smoker males.Conclusion: Incidence of signs and symptoms of depression, anxiety and other psychological disorders was higher among smoker individuals. Therefore, smoking control strategies should further focus on this subject.

Herein a 46 year-old man is presented with intolerable severe pain of right shoulder radiating to right arm and fourth and fifth fingers. He had a history of right upper lobectomy due to complicated tuberculosis eight years ago. Based on the findings of clinical examination and computed tomography imaging, diagnosis of Pancoast tumor of the right chest apex was confirmed. However, Fine Needle Aspiration (FNA) under computed tomography (CT) guidance was not conclusive. By performing a limited thoracotomy, multiple biopsy specimens were obtained from the mass and destroyed ribs for histopathologic examination which consequently confirmed the diagnosis of squamous cell carcinoma. Eventually, the patient was referred to the radiotherapy ward for treatment of Pancoast tumor.

Echinococcosis remains a significant health hazard in endemic areas, including the Middle East, Mediterranean countries and Central Asia. Pulmonary disease appears more commonly in younger individuals but bilateral pulmonary involvement is relatively rare. Concomitant pulmonary and liver hydatid disease may occur in 4% to 25% of patients with hydatidosis.A previously healthy 20-year-old femal from north of Iran without any previous history of lung or liver disease presented with complaints of right upper quadrant and right side chest pain and a low grade fever for the past one month. In imaging studies, one cyst in the left lung, two cysts in the right lung and two cysts in the liver were found. Since the cysts were symptomatic, it was decided to treat these cysts surgically. The patient underwent bilateral anterolateral thoracotomies and phrenotomy under general anesthesia and all cysts were evacuated. The patient was discharged in good condition.

WHAT IS YOUR DIAGNOSIS?A 31 year-old female was admitted to the hospital with an acute episode of cough and hemoptysis, along with low grade fever. She was nonsmoker without any previous history of respiratory symptoms. Laboratory findings showed WBC count 12, 200, NEUT: 74%, LYM: 21%, and EOS: 5%.