Tanaffos Respiration Journal
Volume:16 Issue: 2, Spring 2017

Neuraminidase (NA) is one of the surface proteins of influenza A virus, which plays an important role in immunization against influenza infection and is recognized as an important therapeutic target. Genetic and antigenic changes and substitutions can influence the efficacy of vaccine and change viral sensitivity to NA inhibitors (NAIs). In this study, we performed phylogenetic and molecular analyses of NA changes in influenza A(H1N1)pdm09 virus, compared them with the corresponding vaccine strain, and examined drug resistance mutations in isolates from patients.
The complete sequence of NA genes from 34 pandemic H1N1 isolates (identified in 2009-2010, 2010-2011, and 2013) was determined and analyzed both genetically and antigenically. The phylogenetic tree was plotted relative to the corresponding vaccine strain, using MEGA6 software package, based on the maximum likelihood method and JTT matrix (bootstrap value of 1000).
The phylogenetic analysis of pandemic isolates showed 31 amino acid substitutions in NA genes, compared to the vaccine strain . Some of these substitutions (N248D, V241I, N369K, N44S, and N200S) were important in terms of phylogenetic relationship, while the rest (D103N, V106I, R130T, N200S, G201E, and G414R) influenced the antigenic indices of B-cell epitopes. The catalytic sites, framework sites, and N-glycosylation remained unchanged in the studied samples. Meanwhile, H275Y substitution, related to oseltamivir resistance, was detected in 3 isolates. The average nucleotide identity of NAs with the corresponding vaccine strain was 99.415%, 98.607%, and 98.075% in 2009-2010, 2010-2011, and 2012-2013, respectively.
In this study, we provided basic information on the genetic and antigenic changes of NA genes in influenza A(H1N1)pdm09 virus from patients in 3 different seasons in Tehran, Iran. Considering the viral NAI resistance and changes in NA gene sequences of the isolates in comparison with the vaccine strain, further studies should be performed to monitor genetic changes in Iran. Moreover, the efficacy of vaccines should be examined.

The tracheal cartilage plays an important role in maintaining the mechanical stability of the trachea, as it keeps the trachea open and prevents its collapse under the negative pressures of the respiratory cycle. This study aimed to evaluate and compare the mechanical properties of cartilage specimens from the cranial and caudal regions of the human trachea and compare the results with respect to age and sex of the subjects.
After obtaining human trachea samples from braindead, organ-donating patients and storing them in appropriate conditions, the prepared cartilage samples from the cranial and caudal regions of the trachea were subjected to uniaxial tension and stress relaxation experiments to obtain the corresponding Young’s modulus and relaxation percentage values, respectively. The results were compared in terms of the position (cranial or caudal) in the trachea, and age and sex of the patients.
Based on the results, no statistically significant effect of the position in the trachea on the Young’s modulus of the human tracheal cartilage samples was observed, despite the generally stiffer behavior of cartilage samples from the cranial region compared to those from the caudal region of the trachea. For both the cranial and caudal regions, no significant effect of sex on the stiffness of the tracheal cartilage was observed; further, the cartilage samples of the human trachea (from both cranial and caudal regions) of the old subjects were significantly stiffer than those of the young subjects. Based on the stress relaxation data, no significant effect of age, sex, or position on the relaxation percentage was observed.
The tracheal cartilage samples of the old patients are significantly stiffer than those of the young patients. Sex and position in the trachea (cranial vs caudal) do not significantly influence the mechanical properties of the human tracheal cartilage samples. The results of this study can be useful in designing tracheal tissue-engineered scaffolds, which should be mechanically compatible with the native trachea.

Today, a host of veterans who were exposed to mustard gas suffer from substantially poor quality of life (QoL). However, factors that influence these patients’ QoL have not been yet scrutinized. QoL is deemed as a crucial construct that demands careful attention during evaluation as well as intervention. The present study aimed to delve into the physical, mental, and social factors that affect the QoL of mustard gas victims.
All the physical, mental, and social parameters that influence the QoL of mustard gas victims were scrutinized through a systematic review. We searched for Persian and English scientific databases, i.e., PubMed, Scopus, and Google Scholar, and national databanks, namely SID, IranMedex, and Magiran to identify studies related to chemical victims conducted up to the end of 2015. Next, the quality of 21 articles and studies were assessed using the checklist of the National Institute of Health (NIH), and subsequently, 13 articles were selected for the stages of data extraction and analysis.
Findings revealed that, among the physical factors, coexistence of several medical conditions caused by chemical injury and the severity of the chemical injury had the greatest impact on the QoL of chemically injured veterans. Besides, suffering from psychological and neurological disorders, along with educational level and employment status, were the most influential psychosocial parameters that influenced veterans’ QoL.
The review conducted herein identified the physical and psychosocial factors affecting the QoL of mustard gas victims. In fact, it is the first to present a large collection of descriptive information on QoL contributors in a systematic and orderly fashion.

The most important advantage of positron emission tomography/computed tomography (PET/CT) imaging is its capability of quantitative analysis. The aim of the current study was to choose the proper standardized uptake value (SUV) threshold, when the time-of-flight (TOF) and point spread function (PSF) were used for respiratory artifact reduction in the liver dome in a new-generation PET/CT scanner.
The current study was conducted using a National Electrical Manufacturers Association International Electrotechnical Commission body phantom, with activity ratios of 2:1 and 4:1. A total of 27 patients, with respiratory artifacts in the thorax region, were analyzed. PET images were retrospectively reconstructed using either a high definition (HD) PSF (i.e., a routine protocol) algorithm or HD㴡繌 (PSF䳡; i.e., to reduce the respiratory artifact) algorithms, with various reconstruction parameters. The SUVmax and SUVmean, at different thresholds (i.e., at 45%, 50%, and 75%), were also assessed.
Although in comparison to the routine protocol a higher SUV was observed when using the PSF䳡 method, this approach was used to reduce the respiratory artifact. The appropriate threshold for SUV was strongly related to the lesion size, reconstruction parameters, and activity ratio. The mean of the relative difference between PSF䳡 algorithm and routine protocol for SUVmax varied from 10.58±14.99% up to 35.49±32.60% (which was dependent on reconstruction parameters).
In comparison with other types of SUVs, the SUVmax value illustrated its significant overestimation, especially at the 4:1 activity ratio. The poor agreement between SUVmax and SUV50% was also observed. When the TOF and PSF are utilized to reduce respiratory artifacts, the SUV50% can be an accurate semi-quantitative parameter for PET/CT images, for all lesion sizes. For smaller lesions, however, a smaller filter size was required to observe an accurate SUV.

The concentration of circulating catecholamine increases during exercise in healthy athletes, but the variation has not been studied much in athletes who develop exercise-induced bronchospasm. This study measured changes in circulating catecholamine levels using the induced maximal effort test in the laboratory in professional cyclists sensitive to bronchospasm.
This experimental study included 86 professional cyclists. They underwent two pulmonary function tests (to determine forced expiratory volume in one second [FEV1]) and two blood samples (to measure adrenaline and noradrenaline levels) were drawn before and after the stress test. Two subsets emerged: subjects whose FEV1 decreased by at least 10% from the resting value and non-sensitive subjects whose FEV1 do not meet this criterion.
A total of 51 cyclists (59%) were classified into the sensitive group. Resting catecholamine levels showed no significant difference (p > 0.05) between the two groups. In contrast, at the end of the exercise test, the adrenaline (581.9 ± 321.0 pg/mL versus 1783.5 ± 1001.0 pg/mL) and noradrenaline (4994.0 ± 2373.0 pg/mL versus 3205.0 ± 7714.4 pg/mL) levels were both lower in the sensitive group than those in the resting group (p The frequency of the occurrence of bronchospasm observed in the studied cyclists was one of the highest among professional sports environments and the circulating catecholamine level was low in cyclists susceptible to bronchospasm. A training protocol adapted to their respiratory physiological profile may be indicated.

Leprosy is a chronic infectious disease with permanent complications that mainly affect the skin, peripheral nerves, mucosal surfaces of the upper respiratory tract, and eyes. The aim of this study was to investigate the epidemiology and trends of leprosy in Iran from 2005 to 2015.
This was a cross-sectional study analyzing leprosy records from the Center for Communicable Disease Control, Ministry of Health and Medical Education, during 2005-2015.
Of the 433 cases of leprosy diagnosed from 2005 to 2014, 87.1% were Iranian, and 56.2% of the Iranian cases were male. Furthermore, 82.5% of cases were multibacillary. The paucibacillary leprosy cases had a better remission rate in most years of the study. The annual prevalence and case detection rates of leprosy (per 100,000 population) significantly decreased in Iran between 2005 and 2015: from 0.2 to 0.02 and from 0.11 in 2005 to 0.02, respectively. The geographical distribution of leprosy cases in 2014 showed that leprosy is more common in the west, north, northwest, and south of Iran.
Although Iran is currently an area in which leprosy is not a serious problem, new cases of leprosy are still diagnosed in Iran. Considering that Iran is attempting to eradicate the disease, careful attention to all aspects of the disease is essential.

As healthcare workers (HCWs), medical trainees are at a high-risk for acquisition of tuberculosis (TB) infection and disease. To our knowledge, there are no published data about TB infection among medical trainees in Tunisia. To determine the tuberculin skin test (TST) positivity and tuberculin conversion among a group of medical trainees in different departments at our institution.
We performed a prospective study using the TST. The study was conducted in two steps: 1) an initial TST survey and 2) an evaluation of the TST conversion rates.
Among 114 participants, the TST was positive (≥10 mm) in 26.3% and negative ( Despite the small number of participants, the high TB conversion rate among the trainees is alarming. This population represents an important target group for a latent tuberculosis infection screening program in countries with limited resources such as Tunisia.

The differential diagnosis of tuberculous pleural effusion (TPE) and malignant pleural effusion (MPE) is difficult because the biochemical profiles are similar. The present study aimed to differentiate TPE from MPE, using a decision tree and a weighted sparse representation-based classification (WSRC) method, based on the best combination of routine pleural effusion fluid biomarkers.
The routine biomarkers of pleural fluid, including differential cell count, lactate dehydrogenase (LDH), protein, glucose and adenosine deaminase (ADA), were measured in 236 patients (100 with TPE and 136 with MPE). A Sequential Forward Selection (SFS) algorithm was employed to obtain the best combination of parameters for the classification of pleural effusions. Moreover, WSRC was compared to the standard sparse representation-based classification (SRC) and the Support Vector Machine (SVM) methods for classification accuracy.
ADA provided the highest diagnostic performance in differentiating TPE from MPE, with 91.91% sensitivity and 74.0% specificity. The best combination of parameters for discriminating TPE from MPE included age, ADA, polynuclear leukocytes and lymphocytes. WSRC outperformed the SRC and SVM methods, with an area under the curve of 0.877, sensitivity of 93.38%, and specificity of 82.0%. The generated flowchart of the decision tree demonstrated 87.2% accuracy for discriminating TPE from MPE.
This study indicates that a decision tree and a WSRC are novel, noninvasive, and inexpensive methods, which can be useful in discriminating between TPE and MPE, based on the combination of routine pleural fluid biomarkers.

Hydatid cyst has a predilection to involve the liver and lungs. Most of the reported cases of intra-pleural hydatid cyst are secondary; primary involvement has rarely been reported in the English-language literature. Here, we report on a 33-year-old woman who presented with complaints of dyspnea, cough, lowgrade fever, and chills over the previous 3 months. Primary pleural hydatidosis was suspected on abdominopelvic CT; hence, right thoracotomy and cystectomy were performed. Albendazole was administered postoperatively for 6 months. During this period, liver function tests and abdominal sonography results were normal. Despite its rarity, our case emphasizes that general surgeons should suspect primary hydatidosis of the plural cavity when they detect large cystic masses in patients with mediastinal shifting and radiography findings such as white lung, especially in patients with fever and dyspnea.

A 55-year-old man underwent surgical replacement of a mitral valve 10 years earlier. In a retrospective evaluation of a chest radiograph, the diaphragm was intact at the time of initial surgery. He was then admitted to our emergency room with a complaint of vertigo. During evaluation, he developed decreased consciousness. Ventricular fibrillation was diagnosed, and external massage and full cardiopulmonary resuscitation were performed. After 20 minutes, his sinus rhythm returned and hemodynamic status stabilized with inotropic drugs. Transthoracic echocardiography showed normal valvular function and no evidence of left cardiac malfunction or clot. Electrocardiography showed ST elevation in inferior leads, and levels of cardiac enzymes were elevated. Angiography showed an embolic lesion in the mid right coronary artery that was treated with percutaneous coronary intervention (PCI) and insertion of a stent. After 24 hours, the patient was extubated in good condition, but had mild dyspnea that progressed to CO2 narcosis and subsequent reintubation. Postextubation chest radiography showed herniation of abdominal organs into the right hemithorax. The diaphragmatic defect was closed with a polytetrafluoroethylene patch by a thoracic surgeon, and the postoperative course was uncomplicated.