TANAFFOS
Year:2021 | Volume:20 | Issue:2|Papers Count:14

The role of prone positioning (PP) in the improvement of the oxygenation in patients with acute respiratory distress syndrome (ARDS) is well known. PP contributes to the improvement of the oxygenation by recruitment of collapsed alveoli, redistribution of inflation/ventilation, and by alteration of chest wall elastance (1). It is mainly recommended and applied in intubated patients with severe ARDS (PaO2/FiO2<100 mmHg) (1, 2). There is a paucity of data regarding the efficacy of PP in combination with non-invasive ventilation (NIV). Ding L and colleagues recently showed the beneficial role of PP when combined with NIV. They demonstrated the PaO2/FiO2 increased in more than 75% of patients under NIV when PP was applied and the PaO2/FiO2 increment was more significant in severe patients, in whom NIV finally failed (3). Gattinoni et al. (4) and Marini and Gattinoni (5) highlighted the atypical features of ARDS in coronavirus disease 2019 (COVID-19) and suggested the PP might facilitate the oxygenation in COVID-19 patients mainly through redistribution of pulmonary perfusion. Although the data regarding the efficacy of NIV in the setting of ARDS remained still non-conclusive, an early trial of NIV has been suggested to be helpful in selected subpopulation of patients with pneumonia e. g. COVID-19 (5-7). . .

Background: In cystic fibrosis patients, the mucus is an excellent place for opportunistic bacteria and pathogens to cover. Chronic infections of upper and lower airways play a critical role in the mortality of cystic fibrosis. This study aimed to introduce the microbiota profiles in patients with cystic fibrosis. Materials and Methods: In this study, a comprehensive literature search was done for studies on upper and lower airway microbiota in cystic fibrosis patients. International and national databases were searched for the following MeSH words: microbiota, microbiome, upper airway, lower airway, cystic fibrosis, cystic fibrosis, upper airway microbiome, lower airway microbiome, microbiome pattern in cystic fibrosis, microbiome pattern in cystic fibrosis, upper airway microbiota, lower airway microbiota, and microbiota pattern. Results: Streptococcus spp. are in significantly higher relative abundance in infants and children with cystic fibrosis,however, Pseudomonas spp. are in higher relative abundance in adults with cystic fibrosis. Molecular diagnostic techniques can be remarkably accurate in detecting microbial strains. Conclusion: For the detection and isolation of most bacterial species, independent-culture methods in addition to the standard culture method are recommended, and sampling should include both upper and lower airways.

Background: Pulmonary embolism (PE) can be a possibly mortal disease,therefore, an immediate risk assessment would be imperative to ensure accurate decisions on proper treatment plans. The focus of the present study was to evaluate the prognostic value of clinical, echocardiographic, and helical pulmonary computed tomography angiography findings for adverse outcomes and mortality. Materials and Methods: A total of 104 patients with PE were retrospectively entered in the present study. Patients were categorized into five groups, including patients who faced an adverse outcome (group 1), patients who expired in 30 days (group 2), patients who expired in 30-90 days (group 3), patients who expired in 90-180 days (group 4), and patients who survived without facing an adverse outcome (group 5). Comorbidities (e. g., malignancy) were obtained from medical records. Logistic regression analysis was performed to detect mortality predictors. Results: In this study, 16 patients were faced with an adverse outcome. Furthermore, 10, 5, and 2 deaths occurred within 30, 30-90, and 90-180 days, respectively. The most frequent presentation was dyspnea (89%). The mean intensive care unit stay (OR=1. 202,P=0. 036), the predicted 30-day mortality, and a history of kidney transplantation (OR=0. 011,P=0. 002) were related to less probability of death within 30 days. Conclusion: The results of this study revealed that a history of kidney transplantation is independently accompanied by a lower occurrence of expiration in 30 days. Moreover, there was a significant correlation between the pulmonary embolism severity index, heart rate of > 100 beats per minute, chest pain, hypoxia, and pulmonary arterial pressure with the pulmonary artery obstruction index (PAOI).

Background: Asthma is one of the most severe and life-threatening health problems, the better control of which is one of the main goals in asthma management to be achieved by patients’,balanced participation in the treatment process. This study aimed to investigate asthma control, perceived care, and health care participation in patients with asthma. Materials and Methods: This descriptive-analytical study included 221 asthmatic patients, who were selected using the convenience sampling method from those referring to pulmonary clinics in Kerman, Iran. The required data were collected using three questionnaires including Asthma Control Test (ACT), Perceived Care of Asthma Questionnaire (PCAQ), and Partners in Health Scale (PIH). The linear regression test was used to analyze the collected data with SPSS software version 21. Results: In this study, 14. 31, 42. 22, and 87. 33% of the patients had a favorable condition in asthma control, perceived asthma care, health participation, respectively. The disease duration was significantly associated with the level of perceived asthma care. Moreover, perceived asthma care had a significant relationship only with occupation. From another perspective, the relationship between marital status, level of education, city of residence, disease duration, and occupation with health care participation was significant. Conclusion: Patients would have more control over asthma if there were training programs underpinned by disease-based strategies and educational content regarding the risk factors of the disease, and the patients’,experience and knowledge of the disease were promoted. Furthermore, reinforcing selfcontrol and perceived asthma care skills and involving patients in healthcare process would also enhance the disease control.

Background: This study aimed to determine the prevalence of sleep apnea and its associated factors in patients with chronic kidney disease (CKD). Materials and Methods: This population-based cross-sectional study included 47 CKD patients, referred to the dialysis unit of Kosar Hospital in Semnan, Iran, in 2017. Two questionnaires were used for data collection. The first questionnaire included demographic and clinical variables, and the second questionnaire (STOP-BANG questionnaire) was used to measure sleep apnea in CKD patients. Also, the Apnea-Hypopnea Index (AHI) was calculated for all patients and was considered as the gold standard. To determine the factors associated with sleep apnea, univariate and multiple logistic regression models were used. Finally, the area under the receiver operating characteristic curve (ROC) was determined for assessing the discriminative ability of the model, as well as the accuracy of STOP-BANG questionnaire. STATA version 14 was used for data analysis. Results: The prevalence of sleep apnea in CKD patients was 53. 2%. Also, its prevalence in women and men was 52% and 48%, respectively. In the multiple logistic regression model, body mass index (BMI) (OR: 1. 21, 95% CI: 1. 04-1. 31) and blood urea nitrogen (BUN) (OR: 0. 94, 95% CI: 0. 91-0. 98) had significant associations with sleep apnea in CKD patients,the area under the ROC curve was 0. 7982 for this model. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the ROC curve of STOP-BANG questionnaire for AHI≥, 15 were 71. 43, 61. 54, 60, 72. 73, and 0. 6932, respectively. Conclusion: This study showed that the prevalence of sleep apnea in CKD patients was high. Given the acceptable validity of STOP-BANG questionnaire, this scale can be used to screen sleep apnea in CKD patients.

Background: Dopamine and serotonin receptors are present in lymphocytes, macrophages, and neutrophils, and have a mediating role in the immune system to respond to infections, including bacterial tuberculosis. Materials and Methods: In this study, at first, the changes in the expression pattern of 5 dopamine and 2 serotonin (5HTR2B & 5HTR2C) gene receptors were examined in the two groups of healthy and Tuberculosis patients using Real-Time PCR. Then pharmacogenetic studies aimed to induce autophagy on a lung monocyte cell line (THP1) infected with the standard strain of Mycobacterium tuberculosis (H37RV) were performed. Stimulation of the proinflammatory pathway by secreting cytokines before and after drug efficacy was investigated. Results: According to the result, dopamine receptor 2 genes showed decreased expression in patients with tuberculosis compared to normal individuals, and serotonin receptor genes showed increased expression. Additionally, with the effects of Bromocriptine and Fluoxetine, pro-inflammatory pathways were activated in macrophages infected with H37RV, and ELISA results showed that the levels of IL6 and TNFα,secreted in these cells were significantly increased. Conclusion: According to the results, these receptors agonists or antagonists can activate the autophagy pathway to kill TB bacteria.

Background: The study aimed to evaluate the effectiveness and safety of BAE in TB patient with massive hemoptysis and evaluate the recurrence rate of hemoptysis after BAE. Materials and Methods: In this prospective study, 68 patients with moderate and severe hemoptysis due to active or old tuberculosis who underwent bronchial arteriography were included. CXR and CT scan were performed in all patients. Selective and nonselective bronchial artery angiography was performed in all patient and 62 patients underwent embolization. Results: Thirty-two patients (47. 1%) had active TB and 36 patients (52. 9%) had inactive TB (post-tuberculosis sequelae). Abnormality was detected in a single vessel in 30 (44. 1%) patients, in two vessels in 23 (33. 8%) and in more than two vessels in 13 (19. 1%) patients. Embolization was performed in 62 patients and overall 95 abnormal arteries were embolized. Hemoptysis control rate was 82. 3% at one month, 73. 5% at three months, 69. 1 % at 6 months, 63. 2% at one year and 60. 3% after two years. Conclusion: No major complication occurred as a result of BAE procedures. BAE is a safe and effective method for the management of hemoptysis in patient with tuberculosis. Only 20. 6% of the patients need to repeat BAE during 2 years of follow up.

Background: Epidemiological significance of echinococcosis is determined by the severe clinical progression leading to disability, incapacitation and death, a wide range of hosts, and formation of synanthropic and mixed lesions. The aim of the work was to analyze cases of combined echinococcosis of the chest and abdominal organs and the results of its surgical treatment in clinics of Almaty (Kazakhstan) from 1997 to 2019. Materials and Methods: In 413 patients, 534 lesions of echinococcosis were revealed: single and multiple cysts. Concurrent echinococcectomy of 2–, 3 organs was performed in 261 patients,meanwhile phased echinococcectomy was performed in several organs in 152 patients. Results: Performed surgical interventions in more than 70% of cases had a favorable outcome. Conclusion: The choice of rational surgical tactics for combined echinococcosis should be based on an individual approach, taking into account the general condition of the patient, risk analysis and the likelihood of complications.

Background: Asthma is a major source of global social and economic burden,thus, its early detection is important. Measurement of fractional exhaled nitric oxide (FENO) has been used recently considered a good indicator of asthma and also a sensitive and non-invasive method for monitoring airway inflammation. This study was conducted to determine the cut-off point of FENO for the diagnosis of asthma in the studied population. Materials and Methods: The subjects of this cross-sectional diagnostic study were assessed by the FENO test, spirometry, and methacholine challenge test. The best cut-off point of the FENO for the diagnosis of asthma was determined. The data were analyzed by SPSS 20 using student t-test, and Chi-square test and the ROC curves were also drawn. Results: The mean FENO in asthmatic and non-asthmatic subjects was 43. 5±, 33. 41 and 17. 5±, 21. 48 ppb, respectively (P <0. 001). The best cut-off point of the FENO based on the overall sensitivity and specificity was 39. 5 ppb. Conclusion: According to the results of this study, symptomatic patients with FENO higher than 39. 5 ppb could be considered as asthmatic.

Background: Coronavirus disease 2019 (COVID-19) has been pandemic and has caused a great burden on almost all countries across the world. Different perspectives of this novel disease are poorly understood. This study sought to investigate the clinical and epidemiological characteristics of COVID-19 to efficiently assist the health system of Iran to conquer the outbreak. Materials and Methods: This retrospective observational study was performed on 394 patients with a diagnosis of COVID-19. The patients should have a history of hospitalization at Loghman-Hakim hospital, Tehran, Iran, for 10 weeks, beginning from the first official report of the disease in Iran. In the subsequent step, the baseline demographic and clinical and paraclinical information of the patients was documented. Finally, the patients were assessed if they had exhibited any morbidity or mortality. Results: The epidemiological examination of the COVID-19 population suggested a bell diagram pattern for the hospitalization rate, in which the 4th week of the study was the peak. The highest rate of secondary adverse events ue to the virus was observed at the 6th and 7th weeks of the study course. On another note, clinical evaluations resulted in identifying specific abnormalities, such as bilateral opacity in chest computed tomography scans or low oxygen saturation in laboratory data. Conclusion: This study provides evidence concerning the clinical and epidemiological characteristics of COVID-19 in the first phase of the virus outbreak in Iran. Further studies comparing the disease features in the subsequent phases with findings of this study can pave the way for additional information in this regard.

Background: Sustained inflammation has been observed in the majority of severe COVID-19 cases. The impact of choice of opioid on perioperative inflammatory processes has not been assessed in the clinical setting. Materials and Methods: Patients with novel coronavirus (COVID-19) who referred to Masih Daneshvari and Noor-Afshar Hospitals in Tehran were included in the study after providing full explanations and obtaining written consent. Patients were then randomly divided into three groups: morphine, fentanyl and control. Patients in the morphine group received 3 mg of morphine intravenously every 6 hours for 5 days, whereas in the fentanyl group, 1. 5 mcg / kg / h of fentanyl was infused for 2 hours on 5 consecutive days. The results were evaluated based on the design of the questionnaire and its completion using t-test and SPSS25 software. Results: A total of 127 participants responded to the survey between 20 April and 20 June 2020, of whom 90 (70. 86%) with the average age 65. 2 years, provided complete data on variables included in the present analyses. 53 (58. 33%) of all individuals were men and 37 (41. 12%) were women. Accordingly, 22 (24. 4%) patients had a history of hypertension. However, diabetes with 16 (17. 77%) cases and kidney diseases with 12 (13. 33%), were the next most common underlying diseases. Evaluation of patients' clinical, laboratory and inflammatory conditions at different time intervals in both fentanyl and morphine groups did not show significant changes between these groups and the patients in the control one. Conclusion: The results of this study did not show any significant change in the use of fentanyl and morphine compared to patients with COVID 19. This may be due to the use of these drugs in the viral phase of the disease. The use of morphine and fentanyl in the viral phase of COVID 19 disease do not show significant benefits.

Background: The symptoms, severity, and prognosis of coronavirus disease 2019 (COVID-19) are surprisingly different in neonates versus adults or even children. Currently, there are few studies on neonatal and maternal COVID-19 with limited populations. Case Presentation: In this study, we present 13 Iranian symptomatic newborns with a positive nasopharyngeal COVID-19 test and their maternal data on COVID-19. All neonates were admitted to the hospital at the first day of life, mostly having symptoms at birth, except three cases that had symptoms at days 2, 11, and 22. Almost all cases had respiratory distress and were tachypneic, which needed respiratory support. Although most cases were discharged after recovery, two patients died at days 12 and 48. Conclusion: Neonatal COVID-19 cases mostly had respiratory symptoms and subsequent radiographic features of a viral pneumonia,thus, they had an effective response to oxygen therapy. The symptoms were by far less severe in newborns, although we lost two cases to this infection. This highlights the necessity for good COVID-19 prognosis in infants and neonates.

Looking at the recent data provided in literature, we can see an association between cardiovascular and cerebrovascular accidents in COVID-19 thought to be related to severe inflammation and prothrombotic environment caused by the virus. This article reports a patient presenting with typical signs and symptoms of SARS-CoV-2 infection including flu like symptoms and respiratory distress. Initially a chest CT was performed that showed characteristic findings of atypical pneumonia caused by SARS-CoV-2 virus which was later confirmed with a nasopharyngeal PCR positive for COVID-19. During the course of admission patient developed unstable angina. Further testing confirmed an acute ST elevation myocardial infarction. While on anticoagulant treatment, patient showed signs of cerebrovascular accident. An emergency brain CT was ordered which did not yield any significant changes supporting our clinical diagnosis. Further diagnostic workup using magnetic resonance imaging disclosed evidence of cerebral ischemia in medial cerebral artery territory. Our study suggests that prophylactic anticoagulant regiment is not reassuring in COVID-19 patients and close observation and vigilance, can help clinicians to act timely and can improve patient survival.

Pulmonary thromboembolism following spine surgery, although rare, could end into devastating outcome. Gold standard for it diagnosis is pulmonary CT angiography but in operating theatre, clinical suspicion is the key to diagnose. Here we report a case of pulmonary embolism with classic clinical findings which approved using pulmonary CT angiography and echocardiography.