فهرست مطالب

  • Volume:18 Issue:1, 2019
  • تاریخ انتشار: 1398/06/03
  • تعداد عناوین: 13
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  • Shahin Salarvand, Mitra Goli, Mandana Sarokhani, Reza Ghanei Gheshlagh * Pages 1-10
    Background
    Sleep apnea is a common sleep disorder which is associated with cardiovascular diseases, diabetes and stroke. Different studies conducted in Iran have reported different prevalence for sleep apnea. The aim of the present study was to determine the prevalence of sleep apnea in Iran.
    Materials and Methods
    In this study, 42 studies that have been published in Farsi and English languages were selected with no time limit up to the March of 2018. Article search was conducted using “prevalence”, “frequency”, “sleep apnea” and “obstructive sleep apnea” keywords in Scientific Information Database (SID), MagIran, Google Scholar, Science Direct, PubMed and Scopus databases. Data were analyzed using meta-analysis and random effect model methods. Heterogeneity between the studies was evaluated using I2 test. Data were analyzed using Stata software version 11.2.
    Results
    The total prevalence of metabolic syndrome was 44% (95% CI: 35% to 53%). The highest prevalence of sleep apnea distinguished by the disease belonged to patients with sleep disorders (74%, 95% CI: 66%-82%), diabetes mellitus (61%; 95% CI: 46%-76%) and cardiovascular disease (55%; 95% CI: 47%-63%).
    Conclusion
    Given high prevalence of sleep apnea in Iran, identifying people at risk and providing instructional materials for controlling and treating sleep apnea is necessary.
    Keywords: Sleep apnea, Meta-analysis, Iran, Prevalence
  • Khalil Ansarin, Parviz Saleh *, Mahan Amraii, Jafar Farhadi, Sepehr Sadeghifard, Masoud Nouri, Vaskeh Pages 11-17
    Background
    Vitamin D deficiency or insufficiency has been conducted with increased risk for tuberculosis (TB). Despite this association, discrepancies exist among different studies in different regions. The aim of this study was to evaluate the prevalence of vitamin D deficiency and its predictors in tuberculosis among the Iranian-Azari population.
    Materials and Methods
    A total of 60 participants were enrolled in this study, 30 of which were newly diagnosed TB patients and 30 were healthy volunteers. At least two serum samples were collected, the first sample before the start of anti-TB treatment and the second sample 3 months after the effective treatment.
    Results
    The prevalence of vitamin D deficiency (25 patients vs. 2 healthy individuals; P<0.001) and serum levels of the vitamin D (22.66±15.17 vs. 73.03±25.6 ng/mL; P<0.001) were significantly higher in patients with TB than healthy subjects. Likewise, the prevalence of vitamin D deficiency in the extrapulmonary TB group was higher than that of the pulmonary TB, but this difference was not statistically significant (P=0 .397). Moreover, there was no significant difference between mean levels of vitamin D in patients with tuberculosis before and after treatment (P = 0.787). Linear regression analysis showed there was no significant relationship between vitamin D levels after treatment and age, gender, body site of tuberculosis, and vitamin D levels before treatment, P≥0.68.
    Conclusion
    Vitamin D deficiency is higher in patients with tuberculosis than healthy individuals.
    Keywords: Vitamin D Deficiency, 25-hydroxyvitamin D, Mycobacterium Tuberculosis, Epidemiology, Pulmonary
  • Salman Khazaei, Shahrzad Nematollahi, Amin Doosti, Irani, Ali Zahiri, Arash Mofarrah, Zat, Erfan Ayubi, Elham Hooshmand, Ensiyeh Jenabi, Mohammad Saatchi * Pages 18-24
    Background
    Tuberculosis (TB) despite being preventive and treatable still imposes a huge burden of morbidity and mortality in developing and developed countries. We aimed to investigate the spatial and geographical distribution of TB in Hamadan province during 1992-2013.
    Materials and Methods
    This cross-sectional study was performed in Hamadan province, West of Iran using the surveillance database. We examined the trend for incidence rates of all TB forms including Smear Positive Pulmonary TB (SPPT), Smear Negative Pulmonary TB (SNPT) and Extra pulmonary TB (EPT) per 100,000 populations. Poisson regression model was used to estimate the standardized rates for incidence rate of all types of TB per each county.
    Results
    In this study 3,602 TB patients including 1,359 SPPT, 987 SNPT, and 1,256 EPT were included during 1992-2013. Trend of all types of TB decreased from 1992 to 2013. The Average Annual Percent change (AAPC) for all types of TB was significantly (P<0.05) decreased, AAPC= -6.4 (95% CIs: -10.7, -1.9). Among SPPT, SNPT, and EPT incidence rates, the maximum change was related to SNPT (-11.6; 95% CIs: -24.2, 3), while it was -1.4 (-8.7, 6.4) for SPPT and -5.8 (-11.4, 0.1) for EPT.
    Conclusion
    Our results showed that the incidence of TB in Hamadan province during a 22-year period has decreased 6.4% on average, somehow higher than the national average. Furthermore, our study showed that the risk of extra-pulmonary occurrence in western parts of the province is higher than others parts.
    Keywords: Tuberculosis, Spatio-temporal analysis, Incidence, Hamadan
  • Fatih Uzer, Omer Ozbudak * Pages 25-33
    Background
    This is a retrospective study to investigate the effects of Carboxyhemoglobin (COHb) and Methemoglobin (MetHb) levels in the diagnosis and prognosis of Pulmonary Thromboembolism (PTE).
    Materials and Methods
    Cases that were confirmed with PTE diagnosis using CT Pulmonary Angiography (CTPA) or Ventilation/Perfusion Scintigraphy were accepted as pulmonary embolism. And patients which were excluded using the same methods were accepted as the control group. Patients with carbon monoxide poisoning, Chronic Obstructive Pulmonary Disease (COPD), sepsis, pneumonia, asthma, idiopathic pulmonary fibrosis, bronchiectasis, decompensated cardiac failure or those who used drugs that cause methemoglobinemia (sulphanomides, dapson, phenacetin, primacine,benzocaine) were not included in the study.
    Results
    In our study, 462 patients were examined with an initial PTE diagnosis. Among these patients, 107 patients who met the inclusion criteria were included in the study. The mean age of all patients was 56.44 ±17.3 years (21-86) and the mean age of patients with PTE diagnosis was 55.3 years and the mean age of excluded patients was 59 years (p:0.27). When the blood gas parameters of both groups were compared, COHb levels in the groups with PTE diagnosis were statistically significantly higher (p=0.001), and the PO2 levels in the group excluded for PTE diagnosis were statistically significantly higher (p=0.028). In our study, six of our patients (8.1%) died in the early stages because of PTE.
    Conclusion
    In our study, COHb level was found to be statistically significant in the group with PTE. However, this value was not higher than the normal COHb level in the blood. We found that MetHb and COHb levels were not statistically significant in the prognosis of PTE.
    Keywords: Carboxyhemoglobinemia, Methemoglobinemia, Pulmonary embolism
  • Seyed Reza Seyyedi, Babak Sharif, Kashani, Makan Sadr *, Mandana Chitsazan, Majid Malekmohammad, Atefeh Abedini, Fateme Monjazebi, Farah Naghashzadeh Pages 34-40
    Background
    The prognostic role of the electrocardiogram (ECG) in PH is not fully known. We aimed to evaluate ECG abnormalities in severe PH, the association of ECG patterns with known prognostic factors and to determine whether ECG abnormalities were associated with decreased survival in patients with severe PH.
    Materials and Methods
    Fifty-two patients with severe PH were included. Clinical assessment included basic demographics, complete physical examination, determination of WHO FC, measurement of N-terminal pro-BNP, 12-lead electrocardiography, transthoracic echocardiography, right heart catheterization (RHC) and six minute walk test (6MWT).
    Results
    Heart rate was correlated with NT-proBNP (r=0.54; p-value: 0.0001) and was higher in patients with severe RV dysfunction (93±12 vs. 83±4 bpm in moderate RV dysfunction). P-pulmonale was present in 51.9% of the patients and was significantly associated with severe RV dysfunction. qR in V1 (48.1%) was significantly associated with 6MWT and severe RV dysfunction. Overall, 10 patients died. Based on Kaplan-Meier results, median survival time was 38 months and estimated survival at 1 year, 3 years, and 5 years was 88%, 80% and 71 % respectively. In Cox regression analysis WHO FC, 6MWT, pericardial effusion, NT-pro BNP, heart rate, ST depression in V1 to V3, and presence of qR in V1 were predictors of mortality. After controlling for covariates, only NT-proBNP was independently associated with decreased survival.
    Conclusion
    ECG changes including P-pulmonale, qR pattern in V1, and heart rate indicative of right ventricular dysfunction are associated with prognostic factors in severe PH and may be a useful tool in the follow-up.
    Keywords: Electrocardiography, Pulmonary hypertension, Prognosis, Pulmonary
  • Abolhasan Halvani *, Hamidreza Haddad Pages 41-46
  • Mohammad Emami Ardestani, Mohammad Modaemzadeh, Ali Reza Mohammadi * Pages 47-51
    Background
    Malignant Pleural Effusion (MPE) is a condition that mostly presents with dyspnea. There are some ways to distinguish it from Non-Malignant Pleural Effusion (NMPE).The aim of this study was to compare serum and pleural D-dimer levels between MPE and NMPE patients.
    Materials and Methods
    Patients diagnosed with Pleural Effusion (PE) were selected to participate in this study. They were allocated in 2 groups of MPE and NMPE according to the etiology. Serum and pleural fluid D-dimer level were measured and statistically analyzed between two groups.
    Results
    32 MPE patients and 32 NMPE patients participated in this study. The mean age was 61.3 ± 12 years and M/F ratio was 35/29. The mean pleural and serum D-dimer levels were 3472± 1312 ng/dl and 3259±1220 ng/dl in patients with MPE, and 3425 ± 32.5ng/dl and 2425 ± 1311ng/dl in patients with NMPE, respectively. The serum D-dimer levels were not statistically different between 2 groups; while the pleural D-dimer levels were higher in MPE group in comparison with NMP patients (P<0.05).
    Conclusion
    This study showed that pleural D-dimer levels were significantly different between two groups and therefore pleural D-dimer can be considered as a non-invasive tool for diagnosis of MPE.
    Keywords: Pleural effusion, Malignancy, D-dimer
  • Seyed, Mehdi Hashemi, Bajgani, Fatemeh Abbasi, Ahmad Shafahi, Rostam Yazdani *, Mitra Samareh Fekri Pages 52-57
    Background
    Chronic Obstructive Pulmonary Disease (COPD) is one of the most common chronic diseases all around the world. One of suggested risk factors for COPD is Gastroesophageal Reflux Disease (GERD). The aim of this study was investigation of the association between micro-aspiration of bile acid and pepsin with exacerbation attacks in COPD patients.
    Materials and Methods
    The present study was a descriptive cross-sectional study. Fifty-two COPD patients were selected by simple sampling from patients referring to the Bessat Lung Clinic. Participants were divided into two groups of with and without COPD exacerbation history in the past year. The severity of the disease was determined based on the GOLD criteria (mild, moderate, severe and very severe). Then, all patients underwent bronchoscopy and the concentrations of bile acid and pepsin were compared in Broncho-Alveolar Lavage Fluid (BALF) of two groups.
    Results
    The mean of bile acids in the group without COPD exacerbations was lower (27.38±3.26 μmol/Lit) than the group with COPD exacerbations (32.31±5.35 μmol/Lit) and this difference was not significant (P=0.436). The mean of pepsin in the first group was higher (118.46 ±15.44 ng/ml) than the second group (107.88±10.7 ng/ml) and this difference was also not significant (P=0.577).
    Conclusion
    According to the results of this study, there is no association between disease severity and number of exacerbations with micro-aspiration of bile acid and pepsin in COPD patients.
    Keywords: COPD, Aspiration, Bile acid, Pepsin
  • Maher Maoua *, Olfa El Maalel, Imène Kacem, Sana Guedri, Maha BenKacem, Sana Aissa, MoniaGhammem, Aicha Brahem, Houda Kalboussi, Faten Debbabi, Souhaiel Chatti, Néjib Mrizak Pages 58-65
    Background
    Several studies demonstrated the negative impact of allergic rhinitis on Quality of Life (QOL) and occupational activities. Similar studies on allergic Occupational Rhinitis (OR) are rare. The aim of this study was to evaluate the QOL and work productivity of patients diagnosed with allergic occupational rhinitis.
    Materials and Methods
    We conducted a cross-sectional study from January 2005 to December 2015 at the Department of Occupational Medicine in Farhat Hached Teaching Hospital-Tunisia including patients diagnosed with allergic OR. QOL was assessed by the Mini-RQLQ (Rhinitis quality of life questionnaire) and Work impairment was measured by WPAI (Work Productivity and Activity Impairment) questionnaire.
    Results
    a total of 414 patients was enrolled in the study with a mean age of 37.82±8.08 years and a sex ratio = 0.33. Textile and clothing industry was the most represented sector (65.7%). The mean percent work time missed (absenteeism) due to allergic OR was 9.98±20.86% with a median of 0% and the mean presenteeism score was 46.7±32.67%. Overall QOL was 2.71±1.31. The most affected domains were practical problems and activity limitations. Absenteeism was positively correlated with age and eye symptoms scores. Both presenteeism and percent overall activity impairment were positively correlated with severe nasal obstruction and activity limitations score.
    Conclusion
    Allergic OR impairs QOL and work productivity. Although it doesn’t seem to be associated with an important absenteeism, work productivity is reduced by an important rate of presenteeism. QOL and work productivity seem to interact significantly.
    Keywords: Allergic occupational rhinitis, Quality of life, Productivity, Impairment
  • Omid Moradi Moghaddam, Mohammad Niakan Lahiji, Mahshid Talebi, Taher, Behnam Mahmoodiyeh * Pages 66-73
    Background
    Ventilator-Associated Pneumonia (VAP) is a hospital pneumonia that is considered in patients on mechanical ventilation for at least 48 hours with symptoms of new lower respiratory tract infections being reported in them. The present study reviews the effect of adding inhaled colistin in the treatment of ventilator-induced pulmonary infections in Intensive Care Unit (ICU) patients.
    Materials and Methods
    In this single blind clinical trial, patients admitted to the ICU with diagnosis of pulmonary infections caused by ventilator were investigated. In the treatment group, patients received 150 mg of colistin plus 1,000,000 units inhaled colistin every eight hours and in the control group only 300 mg of colistin every eight hours intravenously was given. Patients were followed up in terms of clinical findings for seven days after the initial diagnosis of infection.
    Results
    The results of this study showed that administration of inhaled colistin in patients admitted in ICU significantly improved culture indices, leukocyte, white blood cell count, chest X-ray, chest secretion, CPIS score and saccharification (SpO2) on the third and seventh days after treatment compared to the first day.
    Conclusion
    Considering the positive effect of adding inhaled colistin to the treatment of patients admitted to ICU with pulmonary infections caused by ventilator with multi-drug resistant Acinetobacter, the use of combination drug therapy is recommended.
    Keywords: Pulmonary infection, ICU, Inhaled colistin
  • Ahad Alizadeh, Adel Zarea, Narges Namarian, Fatemeh Spahbodi, Siavash Abedi, Ali Sharifpour, Masoud Aliyali * Pages 74-78
    Background
    Fluid balance,oliguria influence outcome in critically ill patients. Although,osmotic dieresis with hypernatraemia is a predictor of mortality in critically ill patients,the purpose of this study was to demonstrate the effect of polyuria as an independent predictor on weaning outcome in mechanically ventilated patients.Materials,
    Methods
    This retrospective,single center,cohort study was carried out at Imam Teaching Hospital Intensive Care Unit (ICU) on 263 adult mechanically ventilated patients. We collected data of these patients during the mean seven consecutive days before weaning from mechanical ventilator. Patients with polyuria (sustained urine output greater than 3000 ml,day) were compared with patients without polyuria. The primary endpoint was successful weaning,the secondary endpoints were the mechanical ventilation duration,post weaning length of ICU stay,post weaning length of hospitalization,rate of mortality.
    Results
    In 93 patients with polyuria,the mean age was 45.14±19.47 years in comparison of 170 patients without polyuria with mean age of 52.9±21.37 years (P,0.004). Fluid intake,urine output,temperature were significantly higher in patients with polyuria,but there were no statistical differences in systolic,diastolic blood pressure,serum electrolytes,urea,creatinine. No significant differences were found in primary,secondary endpoints including successful weaning,post weaning length of ICU stay,post weaning hospital duration,mortality,except for duration of mechanical ventilation (P,0.014). The area under the ROC curve for variables showed only seven days mean creatinine level before weaning which may act as a predictor of successful weaning (ROCAUC,0.67,95% CI 0.61-0.73,P,0.0002). Serum creatinine level of 0.8 provided best overall combination of sensitivity,specificity for successful weaning (sensitivity 72.22%,95% CI 54.8-85.8,specificity 61.19%,95% CI 54.1-68.0).
    Conclusion
    Polyuria cannot predict weaning outcome but maybe considered as a predictor of longer duration of mechanical ventilation,is probably associated with a subclinical renal dysfunction.
    Keywords: Fluid balance, Polyuria, Weaning, Mechanical ventilation
  • Kamran Mottaghi, Farhad Safari, Parisa Sezari, Alireza Salimi, Masoud Nashibi * Pages 79-83
    Background
    Post-operative pain after open cholecystectomy can result in increased oxygen consumption, atelectasis, pneumonia, decreased vital capacity, and increased morbidity and mortality. The aim of this study was to compare the analgesic effects of intrapleural meperidine and intravenous morphine in controlling post-cholecystectomy pain.
    Materials and Methods
    In a double-blinded randomized clinical trial, 72 patients who were candidate for elective open cholecystectomy, were divided randomly into two groups based on accidental randomized numbers. Anesthesia technique was precisely the same for all patients. At the end of surgery, 50 mg of meperidine (diluted in 20 cc normal saline) was injected intrapleurally for meperidine group patients; whereas, 0.1 mg/kg intravenous morphine was injected intravenously in control group. Onset of pain and total dose of rescue analgesic were measured.
    Results
    In order to obtain a Numerical Rating Scale (NRS) <3, the difference in morphine consumption up to 12 hours in two groups (4.4 ±1.7 mg in meperidine group & 5±2 mg in control group) was not statistically different. However, the first request for analgesia in meperidine group was delayed significantly longer than the control group (146.6 ±6.8 minutes in meperidine group & 40 ±1.8 minutes in control group).
    Conclusion
    A single injection of intrapleural meperidine can delay the first request for analgesia in open cholecystectomy compared to intravenous morphine.
    Keywords: Cholecystectomy, Pain, Intrapleural, Meperidine
  • Alireza Serati, Babak Sharif, kashani *, Zargham Hossein Ahmadi, Farah Naghashzadeh, Neda Behzadnia, Mandana Chitsazan, Payam Abbasi Pages 84-87
    Right heart catheterization is the main step in the evaluation of pulmonary hypertension including Chronic Thromboembolic Pulmonary Hypertension (CTEPH) and is considered a relatively safe procedure. Complications can occur including perforation, tamponade, bleeding, etc. requiring different types of interventions such as manipulation or surgery. Here, we have described a case of pigtail catheter entrapment and the method we used to free it without invasive measures.
    Keywords: Pulmonary artery catheterization, Cardiac catheter, Chordae tendineae