Tanaffos Respiration Journal
Volume:20 Issue: 3, Summer 2021

Despite the fact that about two years have passed since the onset of the  COVID-19 pandemic, there is still no curative treatment for the disease. Most cases of COVID-19 have mild or moderate illness and do not require hospitalization. This   guideline   released   by   the   National   Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital COVID-19 Expert Group to provide a treatment guide for outpatient management of COVID-19.

Tuberculosis (TB) and non-small cell lung cancer (NSCLC) are two major contributors to mortality and morbidity worldwide. In this regard, TB and NSCLC have similar symptoms, and TB has symptoms that are identical to malignancy; therefore, sometimes it is mistakenly diagnosed as lung cancer. Moreover, patients with active pulmonary TB are at a higher risk of dying due to lung cancer. In addition, several signaling pathways involved in TB and NSCLC have been identified. Also, the miRNAs are biological molecules shown to play essential roles in the above-mentioned diseases through targeting the signaling pathways’ genes. Most of the pathways affected by miRNAs are immune responses such as autophagy and apoptosis in TB and NSCLC, respectively. Several studies have separately investigated the expression of miRNAs profile in patients with NSCLC and infectious TB. In this critical review, we attempted to gather common miRNAs between TB and NSCLC and to explain the involved-pathways, which are affected by miRNAs in both TB and NSCLC. Results of this critical review show that the expressions of miR-155, miR-146a, miR-125b, miR-30a, miR-29a, and miR-Let7 have significantly changed in TB and NSCLC. The data suggest that miRNAs expression may provide a new method for screening or differential diagnosis of NSCLC and TB.

The current systematic review aimed to determine the effect of telemedicine services on adherence in patients with chronic obstructive pulmonary disease (COPD) and to describe the type of adherence and applied devices and modules.

We reviewed PubMed, Scopus, Web of Science, and Embase databases to identify relevant studies from the time of inception of these databases to March 10, 2019, using three groups of keywords. The first group comprised words describing COPD, the second group included words describing types of telemedicine interventions, and the third group contained words describing adherence. The reference list of identified articles was also hand-searched to retrieve possibly relevant articles.

In total 21 articles were included, in which 13 reported a positive effect for telemedicine on patients’ adherence. Adherence to treatment was classified under six categories. The highest frequency belongs to the adherence to performing exercises and participation in training sessions, using the system, using devices, measuring (like blood pressure, oxygen saturation, heart rate, weight, temperature, sputum volume) and reporting symptoms and the results of measurements, completing tasks, and medication.

This study demonstrated the effectiveness of telemedicine services on adherence to treatment plans in patients with COPD. The following factors contribute to the effectiveness of telemedicine services: patient support by healthcare professionals and easy access to them, uninterrupted execution of telemedicine programs, follow-up and supervision of providers, creating and maintaining motivation in patients, and provision of different self-management modules.

The aim of our study is to determine the clinical availability accessibility of cancer ratio and cancer ratio plus formulations, previously validated and reported to have clinical value in distinguishing malignant pleural effusion from tuberculosis pleurisy and parapneumonic effusion.

Retrospective study of patients hospitalized with Malignant Pleural Effusion (MPE), tuberculosis (TPE) and pararapneumonic effusion (PPE) between 2009 and 2018.

Totally 232 patients, 101(43.5 %) having MPE, 86 (37.1 %) having PPE and 45 (19.4 %) TPE were examined. When compared with each other, ‘’serum LDH / PS Lymphocyte %’’, ‘’Cancer ratıo’’ and ‘’Cancer ratıo plus’’ values were statistically different between the groups (p = 0.021, p <0.001 and p = 0.015, respectively). In multivariate logistic regression analysis, cancer ratio, serum LDH: pleural fluid lymphocyte count ratio was in positive correlation with MPE. The sensitivity and specificity of ‘’cancer ratio’’, “cancer ratio plus” and ‘’ratio of serum LDH: pleural fluid lymphocyte count’’ were 84.2 % (95% CI 75.6– 90.7) and 52.7 (95% CI 43.8– 61.5), and 82.2 % (95% CI 73.3– 89.1) and 45.8 (95%CI 37.1– 54.7), 53.5% (95% CI 43.3– 63.5) and 67.2% (95% CI 0.68–0.94) at the cut-off level of >14.25, >28.7, and >636, respectively. When considering only MPE and TPE patients, the specificity of cancer ratıo and cancer ratıo plus increased.

The cancer ratio plus rate ( the ratio of ‘’cancer ratio’’formulation  to the percentage of differential pleural lymphocyte count ) was almost the same as the cancer ratio in separating the malignant pleural effusion from the TPE and PPE, while it has better specificity only in differentiating malignant effusions from tuberculosis effusions.

The purpose of this study was to investigate the prognostic factors in hospitalized COVID-19 pneumonia patients according to the baseline clinical, laboratory, and imaging manifestations.

In this retrospective study on the SARS-CoV-2 laboratory-confirmed cases, clinical and laboratory data were collected from 156 hospitalized patients during August to October, 2020. Baseline chest CT was assessed, and the CT severity score was then calculated. Data were compared between the two groups of patients with moderate and severe/critical conditions.

Of the 156 participants with the age range of 25-95 years (56.87±16.88), 70 and 86 patients were in the moderate and severe/critical groups, respectively. Most patients had typical imaging features on chest CT. Compared to the moderate group, the severe/critical group were older and were mainly suffering from underlying comorbidities. The rate of confusion on admission (P=0.008) and pulse rate≥100 (p=0.04) were significantly higher in the severe/critical group. According to the CT manifestations, consolidation, central and diffuse peripheral and central distribution, patchy/segmental morphology, crazy paving pattern, pleural effusion, aorta, and coronary artery calcification were more likely to emerge in the severe/critical group (p<0.05). In contrast, round/nodular morphology mainly appeared in the moderate group (p= 0.002). The chest CT severity scores were 10.24±7.91 and 6.13±4.42 in the severe/critical and moderate groups, respectively, indicating statistically significant values.

The clinical, laboratory, and chest CT findings can be used for the prognosis of COVID-19 pneumonia. Predicting the outcomes for the patients on admission can play a critical role in decision making.

Ventilation system besides other prevention strategies such as surface disinfecting and personal protective equipment (PPE) decrease the risk of coronavirus disease 2019 (COVID-19) infection. This study aimed to examine the ventilation system of an intensive care unit (ICU) in a hospital in Tehran, Iran to evaluate the potency of heating, ventilation, and air conditioning system (HVAC) for COVID-19 spread.

Contamination of air turnover caves was evaluated in supplier diffuser and extractor grills of negative pressure HVAC by ten samples. Severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) in the samples was evaluated by the real time reverse transcription-polymerase chain reaction (PCR). Moreover, air conditioning and sick building syndrome (SBS) was assessed according to MM040EA questioning from health care workers.

In the health care workers, respiratory effects were more prevalent compared to other signs. Despite suitable air conditioning, this study highlighted carrier potency of ICU workers for SARS-COV-2.

According to our results, although the HVAC of ICU ward had an appropriate air movement, it was not safe enough for health care workers.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) spread widely all around the world and has infected too many healthcare workers (HCWs) as the pioneers combating coronavirus disease 2019 (COVID-19). This study aims to evaluate the symptoms and outcome of medical staff from a tertiary hospital in Tehran, Iran. The diagnoses of 29 HCWs presenting COVID-19 symptoms were confirmed by molecular and imaging studies. Epidemiologic and disease-related data were collected via phone calls and filling a questionnaire and then analyzed descriptively. Eighteen (62.1%) of the affected HCWs were males. The mean age of them was 41.86 years with a lower average (38.27) for females than males. Nurses comprised 41.4% of our population. Only 2 (6.9%) patients were admitted to the respiratory care unit (RCU) (), marked as critical patients. The most presented symptoms were fever (79.3%) and dyspnea (79.3%).  Overall, 55.2% of them had a longer exposure time (more than a week), which was more frequent in men than women. Fever was the most prevalent symptom among the study group. Even though the clinical features of COVID-19 among HCWs cannot be copiously determined by this study, it highlights the requirement for comparative studies to illustrate differences among HCWs and the general population. There might be an association between the duration of the exposure and the risk of the infection in men.

The clinical and paraclinical symptoms of COVID-19 differ across age groups. This study investigated the differences between these parameters and their outcomes in young, middle-aged, and elderly patients admitted to a COVID-19 referral center. This retrospective study encompassed patients with COVID-19 hospitalized at Khorshid Hospital (Isfahan, Iran) during February 23 to April 30, 2020. The patients' predisposing conditions, clinical and paraclinical findings, and outcomes were compared among three young, middle-aged, and elderly groups. Of the 1185 hospitalized patients with suspected COVID-19, 1065 were discharged or died at the end of the study. Among these 1065 patients, 654 patients with the mean age of 57.7 years had positive PCR results or typical CT scans and were included in the study, of whom 77 (11.8%), 353 (54%), and 234 (34.2%) patients were assigned into the young, middle-aged, and elderly groups, respectively. There was no statistically significant difference among the three groups regarding the prevalence of clinical symptoms. Moreover, CRP, ESR, WBC, BUN, Cr, and lymphocytes were higher in the elderly group. The ground-glass opacity (GGO) (24.1%), GGO-consolidation (27.4%), and consolidation (10.3%) were the most common CT scan findings in the young, middle-aged, and elderly groups, respectively. Fifty-three patients (8.1%) died, and the mortality rates were 10.36%, 7.27%, and 3.8% in the elderly, middle-aged, and young groups, respectively. COVID 19 symptoms do not depend on age; however, paraclinical findings differ across young, middle-aged, and elderly patients.

The aim of this study is to evaluate the clinical pattern of thunderstorm asthma (TA) and the possible environmental hypotheses involved in the escalation of these epidemics.
This retrospective descriptive study examined patients with respiratory problems referred to the clinics and emergency departments in Ahvaz, Iran during 2013-2016 periods following the first episodes of rainfall in autumn. The seasonal profile of airborne pollens and fungal spores in Ahvaz were characterized and clinical and spirometry findings of 443 patients were evaluated.
Of 56,000 people referred to the emergency department due to respiratory problems associated with the first rainfall in Khuzestan province, 91.4% displayed asthma-like symptoms and 71.3% had a history of allergic rhinitis. According to the results of spirometry test 38%, 52.9%, and 9.1% of patients had normal, obstructive, and restrictive patterns, respectively. Our results highlight the importance of allergic rhinitis as risk factors of TA epidemics. In terms of pollen, seasonal pollen integral was much higher in autumn than in winter.
Our results highlight the importance of seasonal allergy and rhinitis as risk factors for thunderstorm asthma epidemics.

Chronic obstructive pulmonary disease (COPD) is a progressive airflow limitation and decline in lung function. Although tobacco smoke is the leading risk factor for COPD, air contamination by wood-burning smoke is also of great concern. About half of the world's populations, especially in developing countries such as Iran, exploit this energy source for cooking and heating. It is remained unknown if COPD induced by wood smoke from baking bread (COPD-B) and COPD induced by tobacco smoke (COPD-S) have different symptoms and clinical presentations. To fill this gap, the present study was to describe such differences.

This retrospective cohort study was performed in Afshar COPD clinics affiliated with the Shahid Sadoughi University of Medical Sciences, Yazd, Iran. The clinical records of 231 patients with the COPD diagnosis were reviewed. After considering inclusion and exclusion criteria, 91 patients (46 with COPD-B and 45 with COPD-S) underwent physical examination and para-clinical assessments (i.e., respiratory function tests, Chest X-ray, and quality of life test).

The COPD-B patients were mainly women at older age and had higher FEV1/FVC and FEF-75; however, they had fewer post-bronchodilator positive responses to FEV1 (suggesting a restriction pattern) and sputum production, compared to the COPD-S patients. Regarding the other parameters, there were no statistically significant differences between the two groups.

This was the first study evaluating and revealing some differences in the clinical and paraclinical characteristics of the COPD-B patients (with prolonged exposure to wood smoke from bread baking; >100 hours per year, for at least 10 years) and COPD-S patients (>10 packs per year of exposure to tobacco smoke).

Respiratory illnesses caused by occupational exposure have the most negative effects on the workers’ health status in workplaces. In occupations with a high likelihood of labor-induced pulmonary diseases, a periodic spirometry test is usually used to monitor occupational lung function and prevent occupational respiratory diseases. Monitoring workers exposed to occupational pulmonary diseases is widely done using forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) for early diagnosis of obstructive pulmonary and lung diseases. We assessed the usefulness of longitudinal data of periodic spirometry tests in a sulfate production industry.

In this longitudinal study, 212 individuals working in a sulfate production industry near Tehran were examined. Demographic data and information, such as FEV1, FVC, FEV1%, FVC%, and FEV1 / FVC ratio were obtained from 2009 to 2013. Data were analyzed using the SPSS software version 21. The one-way analysis of variance (ANOVA) and repeated measures ANOVA for data analysis.

The results showed that the variation of the spirometry parameters over 5 years was significant. The factors studied not only decreased in some years but also increased in comparison with the previous year. Also, the average FEV1 and FVC and also FEV1 / FVC significantly was different at different time points [F(2.864, 590.029)= 27.269, P < .0001], [F(2.910, 599.546)= 38.239, P < .0001], and [F(3.257, 671.019)= 13.351, P < .0001].

The best spirometry tests, not only acceptable tests, are important in longitudinal spirometry evaluations. There is no systematic supervision on spirometry tests in Iran and the results of this study reflect a serious need for such supervision.

Paradoxical reactions (PR) to benzodiazepines are well-known, but PR can also follow sedation by propofol, although this has been reported only in the context of operating room anesthesia. We report a rare case of paradoxical excitement induced by midazolam and propofol.

A 78-year-old patient presented with multiorgan failure secondary to infectious pneumopathy. During intensive care unit (ICU) stay, he experienced 2 episodes of ventilator-acquired pneumonia and 1 of acute kidney failure requiring renal replacement therapy. Throughout the stay, he showed restlessness, uncontrollable muscle spasms and stiffness without any neurological focus. Paradoxical reaction to midazolam and to propofol was diagnosed; difficult withdrawal was followed by favorable progression.

PR in the ICU context is exceptional. The present case is unique, with severe PR not only to midazolam but also to propofol. This etiology, with difficult withdrawal, should be considered after ruling out all classical etiologies for refractory agitation.

Pulmonary artery hypertension (PAH) occurs when mean pulmonary artery pressure (PAP) is higher than 25 mmHg in rest or 30 mmHg during activity. Idiopathic pulmonary artery hypertension (IPAH) is defined as PAH without a definite reason. The IPAH is a rare disease with a high mortality rate if left untreated. To date, there has been no definite cure for this entity, and most treatments are for symptom relief or improvement in the quality of life. For many years, decompressing the right heart through a hole in the interatrial septum has been advised to alleviate some of their symptoms, specifically syncope. Atrial flow regulator (AFR) is a device to make an iatrogenic interatrial hole and finally a unidirectional shunt. It has been used for some PAH patients for symptom relief. Herein, we report a 36-year-old female case with diagnosed IPAH for 6 years. In the last 3 years, the case had frequent syncope with shortening intervals. The AFR was implanted for her without any complications. Then, within 6 months of follow-up, she had only one syncope episode. A significant change was observed in her 6-minute walk and PAP.

Intrathoracic kidney is the rarest form of an ectopic kidney that is usually accompanied by left congenital diaphragmatic hernia (CDH) (Bochdalek hernia), the association of which with other anomalies is rare.
Herein, we describe a case with a diagnosis of an intrathoracic kidney associated with the ectopic spleen and diaphragmatic hernia diagnosed during imaging studies for urinary tract infections (UTIs). This study reports an 11-month-old male case with a history of CDH and several episodes of UTIs. A kidney ultrasound revealed that the left kidney and spleen were located in the thoracic cavity. Despite intrathoracic lying of the left kidney, there was no vesicoureteral reflux. Technetium-99m dimercaptosuccinic acid scan reported a highly positioned left kidney. 
With the consideration of a pediatric literature review among patients with intrathoracic ectopic kidney, our case was special and notable since it was the first neonate who had an association of intrathoracic spleen and kidney in the same side with a delayed diagnosis. The main point of this case was that radiologists should consider thoracic kidney a differential diagnosis of unilateral renal agenesis when there is a history of diaphragmatic hernia.