Tanaffos Respiration Journal
Volume:16 Issue: 3, Summer 2017

Recently, the significance of anthracosis in the tracheobronchial tree, lung parenchyma, and even non-respiratory organs has been postulated and discussed in association with other diseases, especially tuberculosis. We reviewed the current literature by using the following key words in Medline/PubMed, Embase, and Google Scholar databases: anthracosis, anthracofibrosis, anthracotic bronchitis, biomass fuels, and mixed-dust pneumoconiosis. The bibliographies of eligible papers were also reviewed for further relevant articles. A total of 37 studies were assessed. The content of these studies was then divided into specific categories. Considering the pathogenesis, along with histopathological, radiological, and bronchoscopic results regarding anthracotic lesions, we suggest these findings be defined as “ANTHRACOSIS SYNDROME”. For the first time, we describe a syndrome involving black pigmentation, which was previously thought to involve only the tracheobronchial tree. Until recently, it was not considered to be a single syndrome with different sites of involvement.

Today because of immigration, HIV pandemic and spread of drug resistant tuberculosis, mortality caused by tuberculosis (TB) has increased. To control the disease it is essential to identify the sources of the infection and patterns of transmission. This becomes possible through using molecular epidemiology methods.
This research reviewed studies based on IS6110- restriction fragment length polymorphism (IS6110-RFLP) as a primary method to recognize the role of molecular epidemiology researches in managing TB in Iran. Within 1995-2015 all human population based studies which had use IS6110-RFLP as the primary method systematically reviewed.
At the end, 11 articles were selected. The mean clustering rate obtained was 28.1%. The rate of recent transmission was variable from 2% to 49% and the mean value was determined 17%.
The studies revealed that in Iran both reactivation and recent transmission were significant in developing new cases of TB. Yet, reactivation plays greater role. If the matter is supervised insufficiently and carelessly, because of increasing rate of drug resistant TB, immigration of HIV infected individuals, TB especially drug resistant TB will be problematic in the near future.

The risk of tuberculosis (TB) is greater for individuals with human immunodeficiency virus (HIV) who are on combined antiretroviral therapy (c-ART) than for the normal population. Therefore, the detection and treatment of latent tuberculosis infections is recommended for all HIV-positive persons with positive tuberculin skin tests (TSTs).
This retrospective cohort study included all HIV-positive individuals with CD4 lymphocyte counts greater than 200 cells/µL and negative TST results, who were taking antiretroviral drugs and had been referred to Imam Khomeini Teaching Hospital Consultation Centre for Clients with Risky Behaviors in Tehran, Iran, from 2008 to 2013. TST conversion to positivity is defined as an induration increase of at least 5 mm compared with a previously negative TST result within a 1-year period. Conversion rates are expressed in person-years of observation.
A total of 113 patients were included in our study. At 1 year, 9 of the 113 TST-negative patients taking c-ART became TST-positive (8%; 8 males and 1 female). The TST conversion incidence rate was 10.09/100 person-years. TST conversion was only found to be associated with sex (odds ratio: 8.64; 95% confidence interval: 1.04–7.56, p = 0.032).
Our results suggest that TSTs should be administered to all HIV-positive patients before beginning isoniazid preventive therapy in Iran.

Maintenance strategy has been used to improve survival in non-small cell lung cancer (NSCLC). We investigated whether switch maintenance therapy with vinorelbine improved progression free survival (PFS) after first-line chemotherapy with gemcitabine plus carboplatin.
In this single blind, parallel, phase 2, randomized trial, patients with NSCLC pathology, age >18 years, Eastern Cooperative Oncology Group (ECOG) performance status (PS) score of 0-2, and advanced stage (IIIB and IV) were treated with up to 6 cycles of gemcitabine 1250 mg/m2 (day 1 and 8) plus carboplatin AUC 5 (day 1) every 3 weeks. Patients who did not show progression after first-line chemotherapy were randomly assigned to receive switch maintenance with vinorelbine (25 mg/m2, day 1, 15) or the best supportive care until disease progression.
A total of 100 patients were registered, of whom 34 had a non-progressive response to first-line chemotherapy and randomly received maintenance vinorelbine (n=19) or best supportive care (n=15). The hazard ratio of PFS in the vinorelbine group relative to the best supportive care group was 1.097 (95% confidence interval = 0.479-2.510; P-value =0.827). There was no significant difference between the overall survival for the two groups (P=0.068).
Switch maintenance strategies are beneficial, but defining the right candidates for treatment is a problem. Moreover, the trial designs do not always reflect the real-world considerations. Switch maintenance therapy with vinorelbine, though had tolerable toxicity, did not improve PFS in patients with NSCLC. Therefore, other agents should be considered in this setting.

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. Despite its significant morbidities and mortality, the majority of patients with OSA remain undiagnosed. The epidemiology of OSA is well studied in Western countries, while there is scarce information on its epidemiology in other countries. We examined the prevalence of high-risk for OSA in a large urban region of Tehran, Iran.
We randomly selected 4021 individuals above 18 years in clusters from different districts of Tehran and surveyed them using the Stop-Bang questionnaire. The questionnaire also incorporated the demographic characteristics, education level, history of coronary artery disease and diabetes, and women’s menopausal status. A score of 3 or higher on the Stop-Bang questionnaire indicated the high risk of OSA.
The study population consisted of 2075 (51.6%) females and 1946 (48.4%) males, with the mean age of 40.88 years (SD, 15.4) and mean body mass index (BMI) of 26.18 kg/m2 (SD, 4.43). Overall, 51.4% of males and 26.5% of females (total, 1513; 38.6%) were classified in the high-risk group, according to the Stop-Bang questionnaire. The risk of OSA was directly correlated with BMI, advanced age, and history of cardiovascular diseases and diabetes.
According to the Stop-Bang questionnaire, almost 1 out of every 3 individuals was classified in the high-risk group for OSA. Considering the significant morbidity and mortality of this disorder, it is considered a major health problem. Therefore, further detailed studies with confirmatory tests are recommended in order to plan strategies for the diagnosis, treatment, and rehabilitation of these patients.

Waterpipe smoking is increasingly becoming the most common method of tobacco use among adolescents in the Eastern Mediterranean Region. This study was undertaken in Iraqi Kurdistan to estimate its prevalence among students and investigate attitudes and factors associated with it.
In a cross-sectional survey at Sulaimani Polytechnic University, 1160 students were approached in a two-stage design using a self-administered questionnaire. Data was entered into Epidata and analysis was done in Stata.
Prevalence of cigarette smoking was 10% and waterpipe smoking was 28% (male 49%, female 10%). Waterpipe smoking was initiated prior to joining the university in 74% of the cases and 22% of waterpipe smokers smoked every day. The most common place for smoking was coffee shops (52%) and 71% of smokers shared the pipe. The significant risk factors were smoking cigarettes (OR 10.3, 95% CI 7.0–15.0), male gender (OR 5.7, 95% CI 3.9–8.2), non-Kurdish ethnicity (OR 3.0, 95% CI 1.6–15.9), city residence (OR 1.5, 95% CI 1.0–2.1), and use of alcohol and other substances (OR 2.8 95% CI 1.4–5.6).
Waterpipe smoking is highly prevalent among students in Iraqi Kurdistan, especially among males, and is becoming a public health problem. Tobacco control interventions should be designed specifically to address this problem among adolescents and the youth.

To evaluate quality of life (QoL) and psychological score in adults with allergic rhinitis (AR) and to assess the possible risk factors.
A total of 110 adult patients with a define diagnosis of AR, who were referred to an outpatient clinic of allergy and immunology, were included in this study. The modified Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) was applied for the evaluation of QoL in these patients. The psychological score was also assessed, using the Esprint-15 questionnaire.
In a total of 110 patients (68 women, 42 men) with the mean±SEM age of 31.92±1.03 years, nasal congestion was the most common symptom (89.1%). Fifty-one (51%) out of 110 AR patients were found to have olfactory dysfunction (OD; hyposmia, 38%; anosmia, 13%). The relationship between nasal congestion and psychological score was significant (P= 0.005). OD had a significant relationship with QoL, as well as the psychological score (P= 0.001 and P= 0.003, respectively). Furthermore, psychological score had a significant relationship with reduction in QoL and sleep impairment (r, .654 and r, .591, respectively; P˂ 0.001). Statistical analysis showed that 54.5% of patients had a high psychological score, which was more common in females, although gender differences were not significant.
Considering the increasing prevalence of AR and the significant relationship of OD and sleep impairment with QoL and psychological score, early diagnosis and treatment of AR may be important in improving QoL.

A 46-year-old woman with a 12-year history of lymphangiomyomatosis (LAM) was admitted for lung transplantation in January 2017. We decided to apply veno-arterial extracorporeal membrane oxygenation (ECMO) to manage arrhythmia and hypotension during lung transplantation, since it was not controllable with inotropic drugs. After transplanting the right (first) lung and at the time of left pneumonectomy, the body of the Swan-Ganz catheter was suddenly observed to be protruding from the right ventricular (RV) wall. The catheter was found folded at part of its body and ran out 0.5 cm from the RV. The protruding part of the catheter was inserted before the perforated part of the cardiac muscle was repaired in order to control the bleeding. ECMO was used throughout the rest of the procedure and the patient was transferred to the intensive care unit (ICU) in good condition before being weaned from the ventilator after 16 hours. It seems that gentle manipulation, concurrent use of transesophageal echocardiography (TEE), insertion of the appropriate length of the catheter into the heart chambers, and a softer material in the structure of the catheters would be helpful to prevent these kinds of potentially fatal complications.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an effective and safe technique associated with a very low complication rate for the sampling of lymph nodes in those presenting with mediastinal and hilar adenopathy. We report a rare case describing the development of pneumomediastinum following EBUS-TBNA in a young patient with mediastinal lymphadenopathy secondary to non-Hodgkin s lymphoma. Conservative treatment led to spontaneous resolution of the pneumomediastinum. Pneumomediastinum is a rare but possible complication of EBUS-TBNA. Careful follow-up can reduce its severity and the associated morbidity.

Recurrent short episodes of bradycardia and hypotension are rarely reported as clinical manifestations of pulmonary thromboembolism (PTE). We report a case of acute massive PTE presenting with dyspnea, burning chest pain with physical activity, and recurrent transient bradycardia and hypotension at rest. Echocardiography showed a left ventricular ejection fraction of 45% with global hypokinesia. Computed tomography angiography showed a large pulmonary thromboembolism. Lytic therapy improved the right ventricular function, and the pulmonary artery pressure decreased to 38 mmHg. Recurrent bradycardia and transient hypotension at rest with syncope on activity and recovery without treatment are not common and may suggest a vasovagal mechanism. Evaluation of patients with these clinical findings could enable early diagnosis and treatment of acute PTE, with decreased morbidity and mortality.