تنفس
سال:1394 | دوره: | شماره: |تعداد مقالات:8

Background: Obstructive Lung Diseases (OLDs), could lead to progressive hyperinflation of the lungs that cause increased work of breathing, impaired gas exchanges and functional limitations in patients. In this study, thoracic circumference of patients in upper and lower third were measured directly and the association of the upper to lower third width of chest with spirometric parameters was evaluated.Materials and Methods: In this cross-sectional study, five hundred twenty nine consecutive patients, with obstructive pattern in spirometry (FEV1/FEVC<70% and FEV1<80%), and 143 controls with normal spirometry were entered. Demographic and clinical data including age, sex, smoking, type, duration and severity of disease and spirometric characteristics were recorded. Upper Third circumference of Chest (UTCC) at axillary level, and Lower Third circumference of Chest (LTCC) at lower rib edge, were measured with an ordinary tape meter.Asthma Control Test (ACT) questionnaire for asthmatic and COPD Assessment Test (CAT) questionnaire in COPD patients were completed.Results: We found that in patients with UTCC/LTCC ratio>0.8, UTCC had significant correlation with FEV1 and FEV1/FVC (R: 0.069, 0.055); Moreover significant correlation was found in UTCC, LTCC and UTCC/LTCC ratio with ACT score in this subgroup (R: -0.123, -0.092, -0.124) On the other hand in patients with UTCC/LTCC ratio>0.9, UTCC and LTCC had significant correlation with FEV1 (R: 0.07, 0.051).Conclusion: UTCC/LTCC ratio>0.8, may be a predictor of obstructive pattern in patients. This is more important in some occations, for example during preoprative evaluation of a patient in an emergency conditions which there is no enough time for performing appropriate diagnostic tests such as spirometry to reveal the type and severity of obstructive pulmonary diseases.

Background: One of the most common indications for pleuroscopy is undiagnosed pleural effusion, which comprises about 25% of all cases of pleural effusions, which remain undiagnosed despite primary tests. Pleuroscopy was performed for the first time in Iran in Masih Daneshvari hospital located in Tehran. The aim of this study was to assess the diagnostic yield of pleuroscopy performed in this center in Iran.Materials and Methods: Three-hundred patients with undiagnosed pleural effusions were enrolled in this study. For all patients, primary tests including pleural effusion analysis, cytology and closed pleural biopsy (if needed) were conducted and all of them were inconclusive. The semirigid thoracoscopy (pleuroscopy) was performed for all patients for diagnostic purposes.Results: Eighty-seven percent of the peluroscopies were diagnostic and 67% of them were diagnosed as malignancy while the rest were diagnosed as tuberculosis. Only 11 patients developed minor complications.Conclusion: In conclusion, pleuroscopy is a safe procedure when performed by a skilled and experienced practitioner, it has a high diagnostic yield and results in only minor complications.

Introduction: Acquisition of chronic diseases such as asthma leads to psychological, mental and physical complications in adolescents, and hence their self-esteem may be compromised. Therefore, the present study was conducted to assess the effect of Orem’s self-care model on self-esteem of adolescents with asthma.Materials and Methods: This semi-experimental study enrolled 64 asthmatic adolescents referred to Shariati Hospital, Isfahan. Subjects were assigned to two groups of control and intervention consecutively. Then, the self-care training program was conducted according to Orem’s self-care model in eight two-hour sessions based on self-care needs, and self-esteem was measured in the two groups prior to and two months after the last training session. The data were collected by a questionnaire of demographic characteristics and the Coopersmith Self-Esteem Inventories (CSEI) and analyzed by SPSS version 20.Results: Independent t-test showed a significant difference in the mean score of self-esteem between the intervention and control groups after the training (P<0.05), but the difference was not statistically significant prior to the intervention. Paired t-test showed a significant difference in the mean score of self-esteem before and after the training in the intervention group (P<0.01), but this difference was not statistically significant in the control group (P>0.05).Conclusion: Regarding the effect of Orem’s self-care model on self-esteem of adolescents with asthma, we recommend the use of this model as a care intervention in healthcare centers to promote adolescents’ health.

Background: Smoking and physical inactivity are two major risk factors for non-communicable diseases (NCDs). Not only these factors have a causal effect on NCDs, but they can also affect each other. This study aimed to assess the relationship between these factors as well as their effect on NCDs.Materials and Methods: A total of 2, 602 healthy adults aged 30-60 years participated in this survey in 2010. Data on demographic characteristics, medical history, smoking status, physical activity and anthropometric measures including weight and height were collected and analyzed. The effect of smoking on physical activity was evaluated by logistic regression adjusting for potential confounders.Results: Among demographic characteristics, only age (P<0.001) and educational level (P<0.001) had a significant association with smoking status. Compared with nonsmokers, smokers had an odds ratio of 4.88 (95% CI, 3.34-7.13) for having unsatisfactory physical activity.Conclusion: The present study showed that cigarette smoking negatively affects the quality of physical activity.

Background: Tracheal stenosis, which has received more emphasis recently, is a common post intubation complication and may develop due to different reasons. One important reason is the endotracheal tube cuff pressure. Therefore, this study sought to examine the accuracy of diagnostic test for palpation and minimal occlusive volume techniques to measure the endotracheal tube cuff pressure.Materials and Methods: In this cross sectional study, the accuracy of diagnostic tests for palpation and minimal occlusive volume techniques to measure the endotracheal tube cuff pressure was assessed in 101 patients aged over 18 years who had undergone open heart surgery and post-surgical mechanical ventilation in the ICU.Results: In the palpation technique, the cuff pressure of 27 patients (26.7%) was reported to be out of the permissible range and for the rest of them (74 patients, 73.3%) it was within the permissible range. Then, the cuff pressure was checked by the standard method using a manometer and after comparing the results it was found that the cuff pressure of 92 patients (91.1%) was not in the permissible range and only nine patients (8.9%) had a cuff pressure within the permissible range (20-30 cm H2O). In minimal occlusive volume method compared with the standard method, 22 patients (21.7%) had cuff pressure within the permissible range of 20-30 cm H2O, and 79 of them (78.2%) had cuff pressure out of the permissible range and higher than the upper limit.Conclusion: This study recommends that the best way to measure the endotracheal tube cuff pressure is to use a cuff manometer, and when it is not available, the minimal occlusive volume would be a better alternative compared to the palpation technique to keep the cuff pressure within a proper range to avoid tracheotomy complications such as tracheal stenosis.

Background: Fungi existing in hospital departments may grow and produce micro-colonies. The spores arising from these micro-colonies circulate easily and could be inhaled by patients and cause infections in immune-compromised subjects. Due to the lack of an acceptable method of sampling and evaluation of microbiological quality of air in the isolation units, the purpose of this study was to determine the concentrations of airborne fungi through active and passive sampling and also identify fungi genera in the air of the isolation unit.Materials and Methods: The air of the isolation unit was monitored through active and passive sampling. In passive sampling, the plates were placed in the room. The active sampling was performed in the hematology unit by using a slit-to-agar biological air sampler with a flow rate of 10 L/minute. Plates were incubated at 30°C for 10 days and were examined daily for fungal growth. Fungal species were identified on the basis of their macroscopic and microscopic morphological features.Results: In active samples, Penicillium spp. was the predominant genus (66.8%), followed by Aspergillus spp. (23.9%) and Cladosporium spp. (2.5%). Yeast spp. accounted for only 2.2% of the isolated fungi.In passive samples, Penicillium spp. (94.4%) was the most frequently found fungi, followed by Aspergillus spp (2.2%), Cladosporium spp. (1.1%) and Yeast spp. (0.5%). The identified genera included Penicillium, Aspergillus, Alternaria, Mucorales, Cladosporium, Yeasts and other filamentous fungi.Conclusion: Active and passive sampling can be used for monitoring the fungal content of air. Assessment of fungal contamination profiles in hospitals may provide important information about the level of fungal concentration in the hospitals and for the control of nosocomial infections. In addition, installation of special ventilation systems equipped with HEPA filters in hematology wards could enhance the quality of air. Also, observing sanitary protocols for disinfection of the surfaces is imperative for infection control.

Middle East respiratory syndrome coronavirus (MERS-CoV) Infection, has caused recurrent outbreaks worldwide. It is associated with severe morbidity and mortality, and is not treatable with the currently available antiviral therapies. We present a case of a 43 year-old male healthcare provider, who admitted with productive cough, dyspnea, myalgia, pleuritic chest pain and fever. Computed tomography (CT) showed bilateral ground glass opacities and consolidation. Sputum polymerase chain reaction (PCR) for MERS-coronavirus was positive.

Paecilomyces species are among the most frequent saprophytes. Two species namely Paecilomyces lilacinus and Paecilomyces variotii are the most frequently isolated species from humans. Fungemia, endocarditis peritonitis, osteomyelitis and rarely pneumonia have been reported.We report a 74-year old diabetic woman withPaecilomyces variotii pneumonia. Paecilomyces variotii is a rare cause of pneumonia and in our knowledge, our case is the first case of pleural effusion due to this fungus.