Tanaffos Respiration Journal
Volume:14 Issue: 1, Winter 2015

The aim of this study was to compare the efficacy of ciclesonide (80 mg/day) and fluticasone propionate (200 mg/day) for mild to moderate persistent asthma. Female and male patients older than 12 years with a history of persistent bronchial asthma for at least 6 months were enrolled. Patients were eligible to enter into a 2-week run-in period before randomization (baseline) if they had received inhaled corticosteroids (fluticasone propionate 250 µg/day or equivalent) at a constant dose during the last 4 weeks before the run-in period. In order to enter into the double blind 18-week treatment period, patients had to have a forced expiratory volume in 1s (FEV1) of 61-90% of predicted and a decrease in FEV1 throughout the run-in period of more than 10%. Patients (n =230) were assigned to ciclesonide 80 mg once daily or fluticasone propionate 100 mg twice daily group. The primary outcome variable was change in FEV1 compared to its baseline value. Secondary outcome variables were asthma-specific quality of life and asthma control. Both drugs significantly increased FEV1 and other lung function parameters compared to baseline (P< 0.0001, both groups, all variables). Progress in the percentage of days with no asthma symptoms and no use of rescue medication and asthma-specific quality of life were similar in the two treatment groups. Ciclesonide at a dose of 80 µg once daily can provide efficient maintenance therapy for mild to moderate persistent asthma.

Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation that is not completely reversible by administration of inhaled bronchodilators. Many studies propose that telomere length shortening might have occurred in COPD patients. We aimed to determine the telomere length in COPD patients and compare the results of non-smoking and smoking control subjects.

In our case-control study, 84 clinically stable COPD patients were recruited on admission to Masih Daneshvari Hospital. Eighty-five healthy controls were also selected including 45 non-smokers and 40 smokers admitted for diseases other than COPD. Spirometry was done for all subjects. Telomere length was measured by quantitative real time PCR as described by Cawthon. The telomere repeat copy number (T) to single-gene copy number(S) ratio was calculated using the comparative Ct method.

The mean ±SD of age was 64.33±10.04 years in patients and 65.06 ±10.02 years in controls (P=0.693). The mean ±SD of FEV1 was 1.62±0.75 L in patients, 2.84±0.54 L in smoker controls and 2.83±0.56 L in non-smoker controls; significant differences were detected in this regard between cases and controls (P<0.001). T/S ratio was significantly lower in COPD patients (0.61±0.08) than in the control subjects (0.69±0.09) (P<0.001). However, telomere length was shorter in the patients than in controls in each age group (P<0.001). Additionally, there were no statistically significant differences in telomere length between the smoker and non-smoker control subjects. Regarding the correlation between BMI and telomere length, there were no significant differences among the patients and control groups.

In conclusion, we found that telomere length in COPD patients was shorter than that in smoker and non-smoker controls, irrespective of age, sex, spirometric variables, BMI and history of cigarette smoking.

Venous thromboembolism (VTE) exerts a considerable burden on the health care systems. Although many practice guidelines have been developed regarding prophylaxis and treatment of venous thromboembolism, there is a large gap between the recommendations and the medical practice in health care centers. In this study, we tried to assess adherence of the medical team to guidelines for venous thromboprophylaxis in medical and surgical wards of teaching hospitals affiliated to Shiraz University of Medical Sciences. In this cross-sectional descriptive study, a total number of 500 patients were recruited among hospitalized patients in neurosurgery, orthopedics, general surgery, internal medicine, and obstetrics & gynecology departments and surgical and medical intensive care units. Afterwards, adherence to thromboprophylaxis guidelines was assessed by comparing the medical records of patients with proper indications extracted from the American College of Chest Physicians Guidelines for VTE prophylaxis (ACCP, 9th edition). In other words, for each patient a comparison between proper indications of receiving thromboprophylaxis and the regimen used in practice was made. Out of 472 patients assessed with respect to the appropriateness of the administered prophylaxis, 212 (45.1%) had received proper type of thromboprophylaxis with regard to ACCP guidelines. Orthopedic surgical wards showed the highest rate of appropriateness while neurosurgical wards showed the lowest rate of adherence (76% vs. 1.8%). The overall rate of inappropriateness was 54.9% (260 patients). Inappropriateness was divided into 3 categories: 1) patients had absolute indications to receive thromboprophylaxis but were not provided with any type of prophylaxis in practice (171 patients, 36.2% of total), 2) in presence of absolute indications, incorrect type of prophylaxis was administered (52 patients, 11% of total), 3) in absence of indications for thromboprophylaxis, patients received some forms of prophylaxis (35 patients, 7.4% of total). The findings of the present study showed that prophylaxis are not properly utilized and physicians’ practices vary considerably among different specialties.

Inappropriate thromboprophylaxis is a serious problem in Iran. Venous thromboembolism (VTE) is one of the most important causes of morbidity in patients in surgical and obstetrics departments and intensive care units (ICUs). It is a leading preventable cause of mortality among in-patients. This study was designed to determine the prevalence of VTE and its epidemiology in an Iranian population for the first time. There is no national registry system for keeping VTE records in Iran. To statistically calculate the annual prevalence of VTE, we used the prevalence of VTE in presence of each VTE predisposing condition and the annual prevalence of each VTE predisposing condition in Iran. The average annual number of total adult patients with predisposing conditions of deep vein thrombosis (DVT) in Iran was 5,288,272 people. The mean annual prevalence of DVT in Iran was between 686,928 and 2,089,738 cases. The mean annual prevalence rate of DVT among the hospitalized Iranian adult patients with the risk of DVT was approximately between 129.90 and 395.16 cases per 1000 patients. The mean annual prevalence of DVT among the hospitalized Iranian adult patients not receiving prophylaxis is high. We also found that appropriate prophylaxis was provided for less than half the patients in need.

High sensitive CRP (hs-CRP) is used as a marker of systemic inflammation in chronic obstructive pulmonary disease (COPD). However, we hypothesize that the raised hs-CRP is not closely related to the multiple consequences of COPD. This study was undertaken to investigate the association of COPD assessment test (CAT) score with SpO2, FEV1, body mass index (BMI), obstruction, dyspnea and exercise capacity (BODE) index and COPD exacerbation rate and compare it with the association to serum hs-CRP level. Sixty patients with stable COPD referred to the pulmonology clinic of Ardabil Imam Khomeini Hospital were included in this study. SpO2, 6-minute walk distance (6MWD), body mass index, BODE index, and pulmonary function test as well as exacerbation rate were determined in COPD patients. Then, the CAT questionnaire was completed by patients. Serum level of hs-CRP was measured in all patients and 15 controls. We statistically compared the relationships and correlations among the variables. Hs-CRP level was significantly raised in patients (P=0.005). In these patients, the correlation of hs-CRP level with BODE index was significant (P=0.008). However, the correlation of hs-CRP with SpO2 and FEV1 was not significant (P=0.47 and P=0.17, respectively). Also, the correlation of CAT score with SpO2, FEV1, BODE index, and exacerbation rate in the previous year was significant (P<0.001, P<0.001, P<0.001 and P=0.017, respectively). SpO2, FEV1, BODE index and exacerbation rate are more correlated with CAT scores than with the serum level of hs-CRP in stable COPD patients. The findings of this study should be considered in management of stable COPD patients.

This study aimed to evaluate the applicability of Cobra perilaryngeal airway (Cobra PLATM) for obese patients under general anesthesia and also to compare the results with those of classic laryngeal mask airway (LMATM). Seventy-three overweight and obese patients were included in this study. The patients were randomly assigned to LMATM or Cobra PLATM groups. Time required for intubation, successful intubation attempt, airway sealing pressure and incidence of complications including blood staining, sore throat and dysphagia were assessed and noted. Thirty-six and 37 patients were randomly allocated to LMATM and Cobra PLATM groups, respectively. Most patients were males and had Mallampati Class II airway in both groups. The first attempt and overall insertion success for Cobra PLATM was significantly higher compared to LMA (P<0.05). Airway insertion was more successful (P = 0.027; 94% vs. 77%) with Cobra PLATM. Insertion times were similar with Cobra PLATM and LMA™ (Cobra PLATM, 29.94±16.35s; LMA™, 27.00±7.88s). The oropharyngeal leak pressure in the Cobra PLATM group (24.80±0.90 H2O) was significantly higher than that in LMA™ group (19±1 H2O, p<0.001). Sore throat was more frequent in the LMA™ group although it did not reach statistical significance (Fisher’s exact test, P = 0.33). Blood staining on airway tube was seen in both groups with a higher incidence in the Cobra PLATM group (Fisher’s Exact test, P = 0.02). Incidence of dysphagia was not different between the two groups. CobraPLA™ was found to be safe with low complications. It provided better airway sealing with high rate of the first insertion success for use in obese and overweight patients. This study recommends the use of CobraPLA™ as a rescue device in emergency situations for obese and overweight patients.

Admission to the intensive care unit (ICU) is often complicated by early acute kidney injury (AKI). AKI is associated with high rates of mortality and morbidity. Risk factors and incidence of AKI have been notably high following non-cardiac surgery in the past decade. The aim of this study was to determine the hazard rate of AKI, the effect of risk factors of AKI and also to assess the changes in urine output (UO) as a predictor of AKI using joint modeling in patients undergoing non-cardiac surgery. In this retrospective cohort study, 400 non-cardiac-operated patients admitted during 3 years to the ICU of Masih Daneshvari Hospital were selected according to the consecutive sample selection method. Random mixed effect model and survival model were used to assess UO changes and the effect of UO and other risk factors on the hazard rate of AKI using joint analysis. AKI occurred in 8.8% of the Iranian non-cardiac-operated patients. Survival model showed that the risk of AKI in lower diastolic blood pressure (DBP), higher Acute Physiology and Chronic Health Evaluation II score (APACHE II score), emergency surgery, longer hospitalization and male patients was higher (P=0.001). Using joint modeling, an association was found between the risk of AKI and UO (-0.19, P=0.002). Several predictors were found to be associated with AKI in the Iranian patients after non-cardiac surgery. A relationship between longitudinal and survival responses was found in this study and joint modeling caused considerable improvement in estimations compared to separate longitudinal and survival models.

Energy crisis in 1973 led to smaller residential and office buildings with lower air changes. This resulted in development of Sick Building Syndrome (SBS). The objective of this study was to assess the association of SBS with individual factors and indoor air pollutants among employees in two office buildings of Petroleum Industry Health Organization in Tehran city. The association between personal and environmental factors and SBS symptoms was examined by a reliable and valid combined questionnaire. Environmental parameters were measured using calibrated instruments. The results suggested that SBS symptoms were more common in women than men. Malaise and headache were the most common symptoms in women and men. Throat dryness, cough, sputum, and wheezing were less prevalent among employees in both offices. Light-intensity was significantly associated with some symptoms such as skin dryness (P = 0.049), eye pain (P = 0.026), and malaise (P = 0.043). There were no significant differences in prevalence of SBS symptoms between female workers of the two offices (P>0.05) The main causes of SBS among the employees were recycling of air in rooms using fan coils, traffic noise, poor lighting, and buildings located in a polluted metropolitan area.

We report a 45 year-old woman who had bilateral breast masses with extradural involvement. Pathologic report revealed malignant high-grade lymphoblastic lymphoma. Systemic chemotherapy was performed but 3 months later, lesions indicating relapse in bone and breast re-appeared. She received salvage chemotherapy, but 4 months after that she was expired.