Tanaffos Respiration Journal
Volume:23 Issue: 1, Winter 2024

Cryptogenic organizing pneumonia (COP) is a rare lung condition affecting the bronchioles and alveoli. This study aimed to determine the course of the disease and response to treatment in a group of COP patients.
In a cohort study, patients' data including demographic features, chest imaging, spirometry, and blood tests, were recorded. Inclusion criteria were radiological features compatible with COP, confirmed tissue biopsy, and the absence of underlying diseases at the time of presentation. All patients received the same steroid-based regimen (oral prednisolone with a dosage of 1 mg/kg tapered to none within 6 months). They were followed for 3 years.
Sixteen patients were included, 43.75% were male. The mean age was 56 ± 15 years. Nobody experienced recurrence. Reversed halo sign and ground-glass opacity were the most common radiological findings. ESR decreased significantly after treatment (P<0.005).  Forced vital capacity increased significantly after treatment (P<0.005), the same was true for oxygen saturation (P<0.005). On three years of follow-up, 5 patients developed signs and symptoms of connective tissue diseases and malignancy. There was no significant association between the final diagnosis and radiological findings at presentation (P>0.05).
Standard treatment in patients with early diagnosis of COP was associated with an appropriate therapeutic response and no recurrence of pulmonary symptoms. Proper treatment can lead to optimized oxygenation parameters and a decreased inflammatory index. Lower response to treatment among corticosteroid-treated COP patients may suggest secondary causes of organizing pneumonia.

Adult community-acquired pneumonia is the most common cause of hospitalization and a leading cause of death. Identification of microorganisms causing community-acquired pneumonia. A cross-sectional design was used. Information on adults hospitalized due to pneumonia in the cold seasons of 2018 and 2019 was collected. Results of microbiologic tests, other than serology and urinary antigen, were reviewed 205 patients had eligible criteria. The mean age was 52.4 and 62% were male. Microorganisms were identified in 117 (57%) patients. The most common etiologic agents were Influenza H1N1 2009 (n=39, 33.4%), Tuberculosis (n=21, 17.9%), Non-Albicans Candida Yeast (n=9, 7.8%), Methicillin Resistant Staphylococcus Epidermis (n=7, 6%) and Klebsiella Pneumonia (n=5, 4.3%). Streptococcus Pneumoniae had the 6th rank (n=3, 2.6%). A higher body mass index was associated with superimposed infections.  10 of 18 (56%) patients who died in hospital, got definite microbiologic diagnoses. The maximum mortality was due to staphylococci, with methicillin-resistant strains of Staphylococcus aureus (n=2, 66%) and Staphylococcus epidermis (n=2, 29%). H1N1 2009 was the first cause. Tuberculosis with rising incidence could cause acute pneumonia. Pneumococcal incidence had declined. Community-acquired staphylococcal pneumonia is the most dangerous; hence, specific protocol-based treatments should be applied promptly. Community-acquired Staphylococcus epidermis and Tuberculosis must be included in differential diagnosis of the disease. Antibiotics need to be individualized in managing the obese patients. A special focus on the epidemiology of virulence factors of Klebsiella pneumoniae is needed as it is common, severe, and lethal.

Rhinoviruses are known as the leading pathogens of respiratory diseases. Determining the prevalence and phylogeny of rhinoviruses plays a pivotal role in producing vaccines and medications and preventing virus complications. This study investigated the frequency, and genetic variation of rhinoviruses detected in patients referred to Masih Daneshvari Hospital.
It was a descriptive cross-sectional study. The samples were from all ages whose information was recorded in 2017 according to a clinical diagnosis of acute respiratory infection (ARI) and in 2015 based on a clinical diagnosis of community-acquired pneumonia (CAP) within the HIS system of Masih Daneshvari Hospital. Using a random number table, 202 patients diagnosed with ARI and 51 patients diagnosed with CAP were selected. The real-time PCR method was used for primary screening; nested PCR was performed in the VP2/VP4 gene region for phylogenetic investigations, and MEGA software drew a phylogenetic tree.
The highest level of rhinovirus infection was seen in subjects under 18 years of age, males, and during the spring season. In this study, the genotypes of HRV-A (including A15, A29, A40, A47, A58, A67, and A80) and HRV-C (including C39 and C44) and two samples of enterovirus D68 were found.
Like other studies conducted in Asia, the most detected genotypes were HRV-A and HRV-C. Conducting further studies with a larger sample size and in different geographical regions of Iran will provide us with more comprehensive information about the frequency of rhinoviruses and common genotypes.

Acute kidney injury (AKI) requires continuous renal replacement therapy (CRRT), which is one of the most important problems in medical and surgical patients. Therefore, it is very important to identify the influencing factors to reduce the dimensions of the problem. This study was conducted to investigate the mortality rate in medical and surgical patients with AKI requiring CRRT treatment. In this observational study, which was conducted as a cross-sectional analytical study, 100 patients with AKI requiring CRRT treatment, including medical and surgical patients, were selected from 2018 to 2021 at Masih Daneshvari Hospital. The mortality rate was estimated. Also, the effective factors were investigated and compared between the dead and surviving patients. 85 cases (85%) of the patients died. Most underlying and demographic variables had no statistically significant difference between the dead and surviving patients (P>0.05). However, in the cases of primary calcium (P=0.001), primary leukocyte (P=0.037), bicarbonate during hospitalization (P=0.025), bicarbonate during AKI (P=0.028), magnesium during hospitalization (P=0.038), and magnesium at the end of CRRT (P=0.019), the differences were statistically significant. In conclusion, mortality is observed in 5 out of 6 patients with acute kidney failure who need CRRT treatment, which is related to risk factors such as bicarbonate, magnesium, leukocyte, and calcium levels. Therefore, multifaceted planning is needed to reduce its dimensions to improve the prognosis of this group of patients.

we aimed to investigate the physiological impact of facemasks use during a graded treadmill exercise test in male adolescents and young adults.

Twenty-one males aged 15 to 28 volunteered. Participants completed four sessions with a 72-hour gap between each session. They completed four visits: 1 rest and 3 graded treadmill exercise test sessions no mask, surgical mask, and FFP2/N95 mask. Pre- and post-graded treadmill exercise test, heart rate, systolic blood pressure, diastolic blood pressure, and blood oxygen saturation were measured. Repeated measures analysis of variance determined statistical differences (p<0.05).

There were no differences in exercise performance (e.g., time to termination, estimated VO2max) nor heart rate, systolic blood pressure, and diastolic blood pressure between conditions. FFP2/N95 mask resulted in lower blood oxygen saturation compared to no mask and surgical mask, and the surgical mask was lower than no mask at exhaustion.

Participants could safely complete the graded treadmill exercise test without detriment to exercise performance even though blood oxygen saturation decreased with facemask use.

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder associated with multisystem organ involvement. The STOP-BANG questionnaire is a short and valid questionnaire used to screen OSA. This study aimed to investigate the ability of the STOP-BANG questionnaire to predict postoperative OSA-related respiratory complications in patients undergoing bariatric surgery.
In this cross-sectional study, all the eligible patients were evaluated in preoperative visits using a predetermined checklist including demographic and clinical information related to OSA and the STOP-BANG questionnaire. After bariatric surgery, patients were assessed for postoperative OSA-related complications. The receiver operating characteristic (ROC) curve was used to determine the cut-off point of the STOP-BANG checklist score based on the patient’s postoperative outcomes.
In total, 115 subjects were included in the study. There were significant associations in terms of gender, age, body mass index (BMI), patient’s neck circumference, diabetes, heart diseases, and the mask ventilation grade variables between the two groups of patients with high risk and low risk according to the STOP-BANG questionnaire (P < 0.05 for all comparisons). In addition, airway obstruction and hypoxia (mild and moderate) were more prevalent in the high-risk group than in the low-risk one (P < 0.05 for all comparisons). A significant difference was reported with a cut-off score of 2 in the STOP-BANG questionnaire for those with and without airway obstruction. Moreover, the cut-off point of 4 in the STOP-BANG questionnaire was determined as a predictor for both airway obstruction and mild-to-moderate hypoxia.
STOP-BANG scores may be used as a preoperative risk stratification tool to predict the risk of intraoperative adverse events and postoperative complications in bariatric surgery.

Cancer is a disease caused by manifestation and abnormal gene expression. Many of the genes that inhibit cancer by the microRNAs. The aim of this study was to investigate the Expression of miR155 gene and CEA and VEGF proteins as Diagnostic Markers in Early Stages of Non-Small Cell Lung Cancer (NSCLC).

Fifty pairs of non-small lung cancer specimens of patients from healthy and tumors specimens were collected based on physical examination and diagnosis of an expert, that, in Masih Daneshvari Hospital. 50 healthy volunteers as a control group were volunteered by the physician after examination and filled out the consent form in this study. From all subjects, 6 ml of peripheral blood were taken and examined by Real-Time PCR (RT-PCR) and ELISA.

The expression level of miR-155 in patients was significantly increased compared to the control group (p<0.001). VEGF protein was positive in 34 of the 50 patients and in healthy subjects, 3 persons were positive. The statistical comparison of the amount of positive biomarker was performed in two groups and it was shown that there is a statistically significant difference between these two groups (P<0.001). CEA protein was positive in 38 of the 50 patients and 5 in healthy subjects were positive. The statistical comparison of the amount of positive biomarker was performed in two groups and it was shown that there is a statistically significant difference between these two groups (P<0.001).

This study showed that miR155 gene and CEA and VEGF proteins are relatively good markers for the diagnosis of non-small cell lung cancer patients in Iranian population.

Recently, genetic mutations in surfactant protein C (SFTPC) have been linked to diffuse parenchymal lung diseases (DPLD). The present study investigated SFTPC mutations among Iranian patients with DPLD for the first time. In this study, we examined 28 patients diagnosed with DPLD. Patients were divided into two groups: 23 cases (82.1%) had interstitial lung disease (ILD), 7 (30.4%) of which were categorized as familial ILD, and 5 cases (17.9%) had pulmonary alveolar proteinosis (PAP). Genetic variations in the SFTPC gene were detected by direct DNA sequencing. The mean (±SD) age of patients was 21.8 (± 17.1) years and 60.7% of the patients were male. Overall, 11 different mutations were detected in the SFTPC gene. Two novel mutations, c.202-43 G>A and c.416 G>C, were detected among patients. The c.201+49 C>T mutation showed a significant difference with the minor allele frequency (MAF) data. There was no significant difference between the most frequent mutations in Iranian patients and those of the general population in the world. The proximity analysis showed similarity between Iranian patients and patients of the African race. We did not find any correlation between SFTPC mutations and DPLD in the patients. It seems that the rs2070684 (c.201+49 C>T) mutation could be used as a specific genetic marker for distinguishing the Iranian population from other human races in the world. There was a correlation between some intronic variations and the development of disease. A new missense mutation, c.416 G>C that encodes Arg139Thr, could probably damage the protein structure and/or function and cause the signs and symptoms of DPLD.

Due to the high prevalence of COVID-19 and the prevention and control of adverse fetal and neonatal outcomes in pregnant women, including vertical transmission, this study was performed to describe the fetal and neonatal outcomes of pregnancy with a spectrum of COVID-19 disease during pregnancy in Iran.
In this cross-sectional study, we analyzed the medical records of 258 pregnant women admitted to the Forghani Hospital, Qom, Iran, from 18 February 2020, to May 10, 2021. PCR-RT or respiratory compromise in the presence of marked radiographic changes of COVID-19 in the lungs, or both COVID-19 disease confirmed COVID-19 disease. Then, we collected the disease spectrum of COVID-19 and fetal and neonatal outcomes from patient records.
The findings of our study showed that out of 258 pregnant women who were hospitalized due to COVID-19, 79.8% had mild to moderate disease, 16.7% had severe COVID-19, and 3.5% were in the critical stage. After adjusting for the confounding variables, the severity of the disease was significantly associated with adverse fetal and neonatal outcomes such as fetal distress, Intra Uterine Growth Restriction (IUGR), preterm delivery, and Low Birth Weight (LBW), and low first minute Apgar score. However, the severity of COVID-19 was not a predictor of spontaneous preterm delivery, admission to NICU, low Apgar scores at 5 minutes, vertical transmission, stillbirth, and neonatal death.
Neonates of mothers with the severe and critical stage of COVID-19 are exposed to higher potential risks such as fetal distress, IUGR, preterm delivery, LBW, and low Apgar scores at 1 minute than women with mild to moderate disease.

SARS-CoV-2 is a member of the coronavirus family that has caused infections in humans. Iran, as one of the countries in West Asia, is facing a high prevalence of this virus. In this study, we aimed to investigate the association between smoking and COVID-19 outcomes during the pandemic and sociodemographic characteristics.
This cross‐sectional survey was done to assess the frequency of tobacco smoking in COVID-19 patients hospitalized at Masih Daneshvari Hospital, Tehran, Iran. All patients’ basic and clinical characteristics, smoking status, and outcomes (ICU admission) were recorded.
A total of 254 participants, of whom 206 (81.10%) provided complete data on variables included in the present analyses. In the present study, 137 (66.5%) of all patients were men and 69 (33.5%) were women. Also, 63 (30.4%) of the study population had a family member with a current disease or history of COVID-19. Fourteen patients (6.79%) were ex-smokers and 34 (16.50%) were current smokers. We found significant relationships between Ex-smoking and ICU admission in COVID-19 patients.
Ex-smoker inpatients with COVID-19 require special attention since they are a vulnerable population with a much higher morbidity rate.

Primary cardiac tumors (PCT), such as myxoma, are rare and predominantly benign. Angiofibroma tumors are an extremely rare subtype of PCT, reported in less than ten cases. In this study, we presented a mixed tumor of myxoma and angiofibroma for the first time in the human heart.

This case report describes a 30-year-old man with a positive cerebrovascular accident (CVA) history who presented with syncope, aphasia, and right-side hemiparesis to the emergency department. The imaging assessment, including echocardiography and magnetic resonance imaging, revealed a suspected cardiac tumor in his left atrium extended to the interatrial septum. Therefore, during tumor resection surgery, the mass was removed entirely. Microscopical pathology and desmin immunohistochemical and trichrome staining findings confirmed the angiofibroma diagnosis with myxoma components.

According to our presentation, angiofibroma can be accompanied by myxoma and result in neurological symptoms. The best treatment for this dual-component tumor is surgical resection of the tumor and the affected margin.

Coagulation disorder is common among COVID-19 patients, particularly those afflicted with the severe form of the disease. Manifestations of thrombotic complications such as pulmonary embolism, deep vein thrombosis (DVT), ischemic stroke, cardiac infarction and arterial embolism is high in COVID-19 patients which have been assessed in various studies (5).It seems that COVID-19-related coagulopathy is a combination of low-grade DIC and pulmonary thrombotic microangiopathy which can have a significant effect on organ dysfunction in patients with severe COVID-19 (6). Numerous complications have been reported following COVID-19 disease. Although the disease often improves after going through various clinical phases, some people have short-term or long-term complications including coagulationdisorders.This case report presents an unusual instance of extensive left ventricular thrombosis in a patient who had recently recovered from COVID-19, despite being on anticoagulant prophylaxis.

WHAT IS YOUR DIAGNOSIS?A 67-year-old man with a history of COVID-19 infection was admitted to our hospital due to cough and hemoptysis. The patient was hospitalized with a COVID-19 diagnosis (positive PCR assay) 50 days ago in another hospital and had been treated with remdesivir and high dose steroid (methylprednisolone 500mg for three days followed by dexamethasone) after which he developed hyperglycemia and the creatinine level was increased. After improving from COVID-19, the patient has developed a productive cough, which has been exacerbated recently. During the last two weeks, the patient has become febrile. He had an episode of massive hemoptysis five days before. The patient had a history of hypertension and ischemic heart disease but he was not diabetic. On physical examination, the patient was ill with stable vital signs. On pulmonary examination crackles were heard on the right lung. Other physical exams were unremarkable. Laboratory tests are summarized in Table1. Abdominopelvic sonography was normal. In echocardiography, the patient had an ejection fraction (EF)=40%. Figure1 shows chest computed tomography (CT) on the first day of the second admission.