TANAFFOS
Year:2021 | Volume:20 | Issue:1|Papers Count:15

Dear Editor, To establish effective vaccines and developing appropriate therapeutic interventions in COVID-19, a full understanding of the immune response against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is critical. The host immune system is dramatically perturbed by SARS-CoV-2 infection and the integrity of the host’, s homeostatic response plays an important role in the pathogenesis of COVID-19 (1). Immune checkpoint inhibitors (ICIs) are suggested to play an important role in the pathogenesis COVID-19 disease. ICIs have been used extensively in the treatment of cancers where they upregulate the host immune response against cancer cells. Important side effects include pneumonitis (2). Programed cell dead-1 (PD-1) is an important target of ICIs as it inhibits immune cell functions and is an exhaustion marker for immune cells. PD-1 is expressed on activated CD8+ T cells, B cells and NK cells in the setting of chronic antigen exposure. Binding of PD-1 and its ligand PD-L1 or PD-L2 on host tissues leads to the inhibition of T cell receptor (TCR) signaling and CD28 costimulation (3, 4). In chronic infections disease, PD-1 is expressed in exhausted TCD8 cells following demethylation of its promoter allowing DNA binding and gene activation by the FOXO1 transcription factor (5). In cancer, due to increasing the tumor cells changes and tumorigenic pattern, PD-1 expression is enhanced by activation of the c-FOS subunit of AP-1 (6). Aberrant PD-1 expression and activity, as a regulator of the immune response, may have both a beneficial and harmful impact on the immune system during cancer pathogenesis (7). . .

The outbreak of the novel coronavirus has become an international concern worldwide since late 2019 (1). Due to its respiratory nature, this infection has spread very quickly and has affected a large number of people (more than 30 million people) (2). Cough is considered as a major feature of clinical symptoms in patients with SARS-COV-2 (3). This causes aerosols containing infectious particles to be released into the air (4). Although all people are exposed to this infection, the medical staff and people who work in hospitals somehow are at more risk, in terms of dealing with patients (5). In the meantime, staff who somehow participate in airway management such as endotracheal intubation and suction are at more risk because of close contact with the patients airway especially when they are bucking during intubation (6). Nowadays, it is signified that anesthesiologists and intensivists who work in operating rooms or Intensive Care Units(ICUs) are more susceptible to infection and some of them have passed away around the world during the recent pandemic. . .

Although lung is the most common organ involved in COVID-19 disease, involvement of other organs such as blood (Lymphopenia), liver, central nervous system, kidney (acute renal failure) and heart (myocardial injury) have been observed in various studies (1). Involvement of the musculoskeletal system in COVID-19 is in the form of rhabdomyolysis. Three symptoms (muscle weakness, muscle pain and dark urine) are the hallmark of this syndrome (2). Involvement of the cardiovascular system has been seen as diastolic dysfunction and acute myocardial infarction (3). The basis of rhabdomyolysis treatment is the administration of intravenous fluid to increase the volume of urine to more than 100 cc per hour. Treatment of hyperkalemia, acidosis (sodium bicarbonate), and hypocalcemia is of great importance (2). Treatment of heart failure is fluid restriction (4). This causes a decrease in urine output and a further increase in LDH and CK, which makes patients more ill. Therefore, the decision is challenged when these two complications are present in the disease at the same time. . .

Background: Obstructive sleep apnea (OSA) is a chronic breathing disorder during sleep. It is prevalent among patients with cardiovascular disease (CVD) and can increase its severity and mortality. Various studies have reported different results in Iran. This systematic review and meta-analysis aimed to determine the prevalence of OSA in Iranian patients with CVD. Materials and Methods: In this study, eight papers published in Persian and English languages were reviewed. The articles were searched using the following keywords and all their possible combinations: “, obstructive sleep apnea”, , “, sleep-disordered breathing”, , “, sleep apnea”, , “, OSA”, , “, cardiovascular disease”, , “, hypertension”, , and “, Iran”, . Scientific databases, including the Scientific Information Database (SID), Magiran, Web of Science, PubMed, and Scopus, were searched with no time limitations. Data were analyzed using a meta-analysis and a random effects model. Besides, heterogeneity was assessed using the I2 statistic. Data analysis was performed in Stata version 11. Results: The review of eight studies, with a total sample size of 1646 patients, showed that the prevalence of OSA was 59. 21% (95% CI: 53. 11-65. 32) among CVD patients. Also, the prevalence of OSA was higher in men (60. 12%,95% CI: 60. 12-82. 54) than in women (41. 01%,95% CI: 16. 08-65. 94). Besides, it was estimated to be higher based on the STOP and STOP-BANG questionnaires (63%,95% CI: 52. 89-73. 10) as compared to the Berlin questionnaire (56. 63%,95% CI: 49. 20-64. 06). Conclusion: More than half of Iranian CVD patients have OSA. Therefore, identifying high-risk patients to reduce the adverse effects of sleep apnea seems necessary.

Background: Myeloid-derived suppressor cells (MDSC) are categorized as granulocytic (G-MDSCs) and monocytic (M-MDSCs) and their expansion play a role in cancer progression. Recruitment to the cancer site depends upon the presence of a chemoattractant. We aimed to investigate the presence of MDSC subtypes and of interleukin-8 (CXCL-8) in the peripheral blood in lung cancer subtypes including non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) patients. Materials and Methods: Peripheral blood samples of 26 NSCLC patients, 18 SCLC patients, and 8 healthy control donors (HDs) were harvested and the surface expression of CD14, CD15, CD11b, and HLA-DR on MDSCs was measured using flow cytometry. The level of serum CXCL8 was measured by the ELISA method. Results: The frequency of circulating M-MDSCs was significantly higher in patients with NSCLC than in SCLC and HDs. In contrast, there was no statistical difference concerning the frequency of circulating G-MDSCs between the three groups. The concentration of CXCL-8 was significantly higher in the NSCLC and SCLC patients than in HD control with no significant difference between NSCLC and SCLC groups. There was no correlation between serum CXCL8 and G-MDSC levels. Conclusion: Our data confirm a higher frequency of circulating M-MDSCs, but not G-MDSCs, in the blood of those suffering from NSCLC but not for SCLC cases. Measuring MDSC subtypes and serum chemotactic factors may have implications for the differential diagnosis of NSCLC.

Background: Endotracheal tube cuff pressure must be kept in an optimal range, but it might change during some nursing procedures. If the cuff pressure gets outside the normal range, it can cause mucosal damage, insufficient ventilation, and microaspiration. This study aimed to determine the effect of endotracheal suctioning on cuff pressure in patients during mechanical ventilation. Materials and Methods: This is a quasi-experimental study utilizing repeated measures with a within-subject design. Using a simple convenience sampling method, 61 patients were studied during intubation on mechanical ventilation. Baseline cuff pressure was adjusted to 25 cm H2O. Then, at 15, 30, and 60 minutes’,intervals, cuff pressures were measured once without suctioning and again after suctioning. Results: The results showed a significant change in the mean endotracheal tube cuff pressure during suctioning (p<0. 001, d=7. 47). During suctioning, cuff pressure exceeded the normal range in 64% of the patients. After suctioning, although endotracheal tube cuff pressure decreased in both conditions, it decreased more significantly (F (2. 17, 260. 55)=238. 19, p<0. 001, η, =0. 665, d=1. 37) in the suctioning condition. Conclusion: The results suggest that endotracheal tube cuff pressure increases suddenly and briefly during suctioning, but within 60 minutes after suctioning, it becomes more reduced in suctioning conditions than without suctioning. Therefore, patients are at risk of mucosal damage and microaspiration after and during suctioning, respectively. It is suggested that nurses use continuous cuff pressure regulation methods to prevent potential risks.

Background: The purpose of the present study was to isolate Candida species from individuals with the COVID-19 disease and evaluate the susceptibility pattern of Candida spp. to routine antifungal drugs. Materials and Methods: A total of 25 Candida spp. isolated from hospitalized patients with COVID-19, who were suspected to have pulmonary candidiasis, and 26 archived Candida spp. specimens were enrolled in this study. For the identification of Candida spp., PCR was performed to detect and amplify the ITS1 and ITS4 genes. Then the products were subjected to the Msp I restriction enzyme to precisely identify the species. The amplification of the WHP1 gene was conducted to identify Candida albicans species. The antifungal activities of routine drugs and the synthesize AuNPs against Candida spp. were assessed based on the protocols presented by the Clinical and Laboratory Standards Institute M60. Results: In the present study, C. albicans (24,96%) and C. parapsilosis (1,4%) were identified as the etiologic agents of the pulmonary candidiasis associated with the COVID-19 infection. Voriconazol and amphotericin B had superior activity against all the isolates in this study. Treatment with fluconazole and itraconazole did not significantly change the formation of colony-forming units (CFU). However, treatment with the AuNPs significantly decreased (within the range of 92-99. 1%,P<0. 05) the number of CFUs. Conclusion: The azole prophylaxis has likely been associated with the development of resistant isolates,the results of the present study suggested the promising role of novel antifungal agents such as AuNPs in overcoming drug resistant fungi.

Background: Chronic rhinosinusitis is associated with changes in quality of life (QoL). The present study intended to evaluate the QoL and risk of obstructive sleep apnea in individuals with chronic rhinosinusitis who were candidate for functional endoscopic sinus surgery. To determine the Quality of Life and the risk of sleep apnea in cases with chronic Rhinosinusitis. Materials and Methods: A total of 100 patients with drug-resistant chronic rhinosinusitis candidate for functional endoscopic sinus surgery referred to the ENT clinic of Masih Daneshvari Hospital, Tehran, Iran were recruited. SNOT22 and STOP-BANG questionnaires were filled before the surgery. Results: The mean SNOT-22 score was 40. 44, with a standard deviation of 19. 27 (ranged from 1 to 94). Also, according to the STOP-BANG questionnaire, 62% of participants were at increased risk of OSA. Based on the cut-off point of 30 for the SNOT-22 score (either larger or lower than 30), patients were categorized into two groups. Sixty-eight percent of participants were categorized in ≥,30 SNOT-22 score. Age below 50, female gender, and those at high risk of OSA were associated with lower QoL. Conclusion: Most patients with chronic rhinosinusitis had a low QoL and were mostly at increased risk of OSA. Being women younger than 50 years and the presence of OSA probably are associated with lower QoL in these patients.

Background: This study aimed to determine the effects of chlorine gas exposure and the associated factors on spirometric parameters among detergent industry workers in Semnan, Iran. Materials and Methods: This four-year cross-sectional study was concocted on 1 100 workers of two detergent factories in Semnan, Iran. Two questionnaires were used for data collection. The first questionnaire included demographic and occupational information, and the second questionnaire included spirometric parameters, such as forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC ratio, peak expiratory flow (PEF), and PEF 25-75%. The spirometric parameters were measured over four consecutive years by a trained technician. Next, to determine the effects of chlorine gas exposure and its associated factors on spirometric parameters, a generalized estimating equation (GEE) model was used. The correlation structure of GEE was considered to be autoregressive 1 (AR-1). Analyses were performed in STATA version 14. Results: All spirometric parameters showed a decreasing trend during 20122015. The GEE model showed a significant association between chlorine gas exposure and all spirometric parameters,the beta-coefficients for the effect of exposure (year) on FVC, FEV1, FEV1/FVC ratio, PEF, and PEF 25-75% were 4. 51,-6. 46,-4. 27,-6. 09, and-10. 29, respectively. Also, this model demonstrated a significant association between smoking and FEV1, PEF, and PEF 25-75%,the beta-coefficients for the effect of smoking on these parameters were-5. 64,-8. 88, and-5. 75, respectively. Additionally, the GGE model showed a significant association between the body mass index (BMI) and FVC and FEV1 (P<0. 05), the beta-coefficients for the effect of BMI on these two parameters were-0. 59 and-0. 48, respectively. Conclusion: The spirometric parameters showed a decreasing trend over time among detergent industry workers,this decline was more remarkable among individuals with a history of smoking. Therefore, it seems necessary to implement screening programs and periodic active examinations for these workers.

Background: Chronic obstructive pulmonary disease (COPD) has been the third leading cause of morbidity and the sixth leading cause of mortality in 2020. This chronic disease usually impairs health status and is an independent predictor of morbidity and mortality. The main objective of this study was to assess health-Related quality of life (HRQL) in a large sample of participants with and without COPD. Materials and Methods: The present study was based on the data obtained from the population-based BOLD study in Iran. The sampling frame in this study included the whole population of 31 provinces of Iran. Participants were recruited using a stratified cluster sampling strategy with proportional allocations within strata. All the participants were requested to fill the Short Form 12 (SF-12) Health Survey Questionnaire, an abbreviated version of the SF36. Results: A total of 1062 subjects, including 479 (45%) males and 583 (54. 7%) females, were enrolled in the study. The mean age of the participants was 40±, 15. 04 years. The overall COPD prevalence based on the post-bronchodilator spirometry functional criteria was 5. 0%. The mean PCS-12 and MCS-12 for all the subjects were 66. 61±, 22. 72 and 60. 79±, 23. 52, respectively. The mean scores of PCS and MCS were significantly lower in patients with COPD than those without COPD (P<0. 001). Conclusion: The findings of this study demonstrated that COPD, female gender, and an age above 40 years influenced HRQL, especially the physical dimension, as shown by the SF-12 instrument.

Background: To assess the effect of preoperative smoking cessation on postoperative complications in patients undergoing herniorrhaphy. Materials and Methods: This prospective study was conducted on 163 consecutive patients, undergoing herniorrhaphy. Demographic characteristics and postoperative complications were compared between smokers (group A), patients who reduced smoking by 50% (group B), and patients who completely quit smoking (group C). Results: The mean age of the patients was 42. 9 (SD=10. 3) years. Group A (n=77), group B (n=27), and group C (n=59) were not significantly different in terms of age, body mass index (BMI), medical history, laboratory data, smoking habit, type of hernia, type of anesthesia, the American Society of Anesthesiologists (ASA) class, repair method, surgery approach, and duration surgery (P>0. 05 for all). However, significant differences were observed between group B and group A, group C and group A, and group C and group B regarding postoperative complications, such as wound healing complications and length of hospital stay (LOS) (P<0. 05 for all). Conclusion: Decreased preoperative smoking is associated with the reduced risk of respiratory, cardiovascular, and wound healing complications and decreased LOS in patients undergoing herniorrhaphy.

Background: The respiratory effects of fume exposure during spot welding may aggravate some environmental risk factors such as tobacco smoking. Fume exposure and smoking have negative effects on pulmonary function tests (PFTs). This study assessed the simultaneous effects of smoking and welding fume on spirometry tests in spot welders. Materials and Methods: This cross-sectional study was conducted on 667 spot welders and 1000 assemblers in an automotive manufacturing plant. Spirometry was carried out on all the participants under standard conditions and according to the American Thoracic Society Clinical Practice Guidelines and indices including FEV1, FVC, FEV1/FVC, FEF 25-75, and PEF were measured and compared between two groups of the study population including workers of spot welding and assembling. Results: It was found that the effect of simultaneous exposure to smoking and welding fume was aggravated on the PFT indices including the FEV1 percent, FEV1/FVC, the FEV1/FVC percent, the PEF percent, FEF25-75, and the FEF2575 percent, but not on indices such as FVC, the FVC percent, and PEF. Conclusion: Simultaneous exposure to smoking and welding fume resulted in a reduction in some spirometry indices, causing respiratory airway obstruction in the spot welders. Occupational safety and regular medical examinations with shorter intervals in smoking spot welders can prevent acute respiratory effects of exposure to smoking and welding fume.

COVID-19 pneumonia has invaded the world and continues to expand. The current evidence of the immune system reaction to this viral pneumonia shows that the post-infectious immunity against the virus may be temporary, and the virus may reinfect the patients after healing from the previous one. Here is presented a 55-year-old female patient, as a known case of Hodgkin lymphoma, diagnosed with COVID-19 reinfection during 40 days. Such evidence may be helpful in further understanding the immunology of the disease.

Since SARS-CoV-2 virus emerging in winter 2019 in Wuhan, Hubei, China, COVID-19 has spread among different countries. The novel corona virus has affected more than 15, 000, 000 people all around the world. Becoming pandemic, COVID-19 is a major concern for both people and health systems. Novel corona virus affects multiple organs such as lungs and kidneys which can lead to acute respiratory distress syndrome and acute kidney injury (AKI) ending to death. Furthermore, patients with COVID-19 may present different atypical symptoms making the diagnoses more complicated. The current patient presented to the emergency department with a 7-day history of hemoptysis and hematuria which are among the less common symptoms among patients infected with SARS-CoV-2 virus. In addition to delayed diagnosis, atypical symptoms and signs make management and treatment more difficult. Awareness of new, atypical symptoms and the effective treatment is associated with better outcome and prognosis.

Following aspiration of grass inflorescence, it often migrates to the peripheral part of the airway due to its unique shape. It often causes complications like chronic pneumonia, recurrent asthmatic attacks, lung abscess, recurrent hemoptysis, and bronchiectasis that may necessitate surgical intervention. In this case, we have reported a 13-year-old boy with grass inflorescence aspiration. The bronchoscopic procedure failed to remove the foreign body, so he underwent thoracotomy.