Tanaffos Respiration Journal
Volume:13 Issue: 3, Summer 2014

Chronic Obstructive Pulmonary Diseases (COPD) is estimated to rank fifth in burden of disease and third in terms of mortality by 2020 worldwide. It is characterized by chronic inflammation and non-fully reversible airflow obstruction, causing structural changes in the lungs that can be demonstrated by a post bronchodilator FEV1/FVC ratio <70%. The sampling frame of the current study was the population of Tehran, the capital of Iran with the current population of nearly 8.1 million. A stratified cluster sampling strategy with proportional allocation within strata was used in this study. The target population was all Tehran residents, aged 18 to 40 in one group and over 40 in another, in the year 2013. The stratification process of the sample according to the 22 municipal districts of Tehran city has been incorporated in the sampling process. Proportional to the number of households in the 22 districts, the appropriate number of clusters is weighted according to each district. The decision about the number of clusters is based on total sample size; mean household members; and logistical facilities for subject enumeration, transport, and examination. The overall COPD prevalence defined by the spirometric functional criteria was 10%, higher in men 12 (11.9%) than in women 15 (8.8%); the prevalence was significantly higher in subjects aged over 55 years (P =0.001). Only 10(3.7%) of these COPD patients had already been diagnosed by a physician. Of all subjects fulfilling the criteria for COPD according to the Burden of Obstructive Lung Disease (BOLD) guidelines (post bronchodilator FEV1/FVC<70%), 90(33.3%) had chronic productive cough, and 262(96.7%) had either long-standing cough, sputum production, recurrent wheeze, dyspnea, or attacks of shortness of breath. Due to the small sample size at this stage of project, conclusions should be drawn with caution. In this first epidemiological report in Tehran about COPD, a moderate prevalence of the disease was determined, and a high percentage of this figure had not been diagnosed before by a physician.

Pulmonary thromboembolism (PTE) is among the leading causes of death following surgery and/or hospital admission. Role of thrombophilic risk factors in the etiology of PTE is well known; But not much data is available on their role in severity of PTE. The aim of this study was to investigate the role of thrombotic risk factors especially PLA2 polymorphism of platelet glycoprotein IIb/IIIa in the severity of PTE. Genotyping from Factor-V (FVL) and prothrombin 20210A (PT20210A) mutations were shown to be significant risk factors for PTE and recurrent PTE. The plasma concentrations of platelet glycoprotein IIb/IIIa PLA2 polymorphism,presence of FVL and PT20210A mutations were studied in 37 patients with PTE. Eleven of these patients had recurrent PTE. Lung perfusion scans were scored according to the percentage of vascular obstruction. Patients who had a pulmonary vascular obstruction (PVO) score >50%were compared to those with PVO score<50%. There was no significant difference between patients with PVO score>50% and those with PVO score<50% with regard to the presence of FVL and PT20210A mutations. However,patients with PVO score>50% had a significantly higher frequency of platelet glycoprotein IIb/IIIaPLA2 polymorphism than those with PVO score <50%. Our data suggest that presence of PLA2 is associated with an increased risk of PTE in the Iranian population. The association between recurrent events and coinheritance of more than one thrombophilic genetic risk factor shows that such carriers are at a higher risk of PTE.

Treatment of patients with chronic conditions requiring hospitalization requires patient acceptance and cooperation and adoption of coping strategies. Inappropriate coping strategies such as substance abuse are concerning in the course of treatment. This study sought to explore the association of coping strategies with suicidal behavior in substance abusers and non substance abuser patients with chronic pulmonary diseases namely asthma and chronic obstructive pulmonary disease (COPD). This comparative study was performed on 100 patients with asthma and COPD selected via convenience sampling. Subjects with and without substance abuse were separated into two groups of 50 patients each. Ways of Coping Questionnaire of Lazarus (WOCQ) and Suicide Behavior Questionnaire-Revised (SBQ-R) were completed by them. Five Persian speaking patients rated this questionnaire to be easily understandable in the pre-test stage. Cronbach''s alpha was calculated to measure the internal consistency. The mean (±standard deviation) age of participants was 40 (±14) years; 58% of individuals were men; 62% had chosen problem-focused coping. The most abused substances were cigarettes (78%) and opium (42%); 6% of substance abusers had thought about suicide five times or more in the past year; 5% of substance abusers had seriously attempted suicide. Tendency to commit suicide was greater in men,substance abusers and participants who had chosen emotion-focused coping strategies,based on a regression model. Average score of suicide tendency was significantly higher in substance abusers (B=2.196,P =0.007). Chronic disease is a crisis and patients need to acquire appropriate coping strategies to deal with it,especially in substance abusers and suicidal patients. Precise recognition of coping strategies in chronic pulmonary patients with substance abuse is necessary via a team cooperation among psychiatrics,psychologists and an internal physician in hospitals because medical treatment alone is not sufficient in such cases.

Retinopathy of prematurity (ROP) is the most common reason behind surgical procedures in premature newborns. Anesthesia in these patients is life-threatening due to post-operative apnea of prematurity (POA). This study aimed to determine the predisposing factors to POA in premature infants and to explore the role of prophylactic aminophylline in decreasing the incidence of POA. Fifty patients with prematurity who were candidates for elective eye surgery (less than one hour) were selected and received aminophylline (3 mg/kg) 5 minutes after the induction of anesthesia with sevoflurane. Patients were kept in the recovery room for 2 hours post-operation in an incubator and were monitored for SPO2, apnea, bradycardia and other signs of desaturation and apnea. There were no statistically significant differences in the gestational age and weight, sex, postconceptual age and weight and other demographic characteristics between the experimental and control groups. Gestational age<28 weeks, postconceptual age<60 weeks, birth weight, operation weight and anemia (OR=1.91; 95% CI: 1.24-3.73; P=0.012) were the predisposing factors associated with postoperative apnea. Treatment with aminophylline as compared with the placebo was associated with a significantly decreased risk of post-operative apnea (OR=0.53; 95% CI 0.28–0.98; P=0.034). Aminophylline can be used prophylactically to decrease the risk of postoperative apnea with no major adverse effects.

In recent years, some studies have tried to improve Phase Contrast Microscopy (PCM) for counting asbestos fibers. Due to the lack of a universally accepted alternative method, this study aimed to improve PCM for better counting of asbestos fibers. Confirmed asbestos standards were applied using a dust generator for sampling. Sampling from the dust generator was carried out according to the Occupational Safety and Health Administration (OSHA) ID-160 method and 95 samples with diverse densities were prepared to be counted using conventional and modern PCM. All samples were counted single blindly by a co-author of this study and the obtained data were analyzed by paired t-test, correlation coefficient and Bland-Altman analysis. Duplicate samples were prepared for qualitative analysis by Fourier transform infrared spectroscopy (FT-IR), scanning electron microscopy (SEM) and X ray. Asbestos densities on filters were in the range of less than 100 to 600 fibers/mm2. Statistically, significant differences were observed for the count density of the 95 samples counted by the two phase contrast microscopes (P<0.001). Nikon microscope demonstrated higher counts compared to conventional microscope and had a lower coefficient of variation. Samples were analyzed qualitatively using FT-IR and SEM, and the presence of asbestos fibers was confirmed. The improved PCM and FT-IR methods presented in this study demonstrated more precise and accurate determination of personal exposure to airborne asbestos fibers and subsequent risk assessment.

The surgical approach to hydatid cyst of the lung is based on complete removal of the parasite,and management of the residual pericyst cavity. For the latter,capitonnage is a recognized method,by which the walls of the evacuated pericyst cavity are approximated with multiple sutures. Capitonnage without suturing and ligation of bronchial openings individually may lead to postoperative air leakage with resultant pneumothorax or pneumatocele. The pulmonary parenchyma may also become distorted. Herein,we report another complication of capitonnage: presence of large amounts of unabsorbed suture material acting as foreign body within the residual pericyst cavity,leading to chronic infection and hemoptysis.

Tuberculous or tubercular liver abscess (TLA) is a rare manifestation of extrapulmonary tuberculosis (TB) and it should be considered in the differential diagnosis of mass or cystic lesions of the liver especially in a high TB prevalence country like Iran. We report an immunocompetent 48 year-old woman with TLA and peritoneal infection. Although hepatic TLA is very rare, it should be considered in the differential diagnosis of mass or cystic lesions of the liver especially in a high TB prevalence country.

One Lung Ventilation (OLV) is the preferred method of anesthesia in the vast majority of thoracic operations, especially thoracoscopic procedures. Although double lumen endotracheal tubes are usually used to conduct OLV during thoracic operations, in patients with permanent tracheostomy, because of short trachea, keeping these tubes safe in place is usually difficult. Thus, OLV in patients with permanent tracheostomy may be challenging or even impossible. Herein, we report a patient with permanent tracheostomy who underwent successful OLV and thoracoscopic lobectomy.