Tanaffos Respiration Journal
Volume:7 Issue: 3, Summer 2008

Chronic obstructive pulmonary disease (COPD) is characterized by decreased expiratory flow rates, increased pulmonary resistance and hyperinflation. Cytochrome C Oxidase (COX) as a key oxidative enzyme modulates oxygen uptake and catalyzes the oxidation of reduced cytochrome C by molecular oxygen. In vitro studies indicate that the activity of COX can be directly regulated by the presence of molecular oxygen. Thus, a better understanding of the role of COX in patients with COPD can provide an important link between the availability of oxygen to tissues and the regulation of oxygen uptake and energy production in these patients. We studied 42 COPD patients (36 males, 6 females) with clinically stable conditions and 50 (42 males, 8 females) healthy sedentary volunteers of similar age. Whole blood was collected by venipuncture in sodium citrate tubes and WBCs were separated by Ficoll according to standard protocol and lysed with microtube pestle homogenizer. The homogenates were centrifuged and the supernatants were used as a cell extract for COX activity determination. Aliquots of this were assayed for total protein content and COX activity. Analysis of COX activity was performed using COX assay kit. Absolute specific COX activity was normalized for total protein. Relative activities were determined by dividing absolute specific COX activity on absolute specific citrate synthase activity. Mitochondrial COX activity and specific activity (absolute and relative) significantly increased in WBCs of patients with COPD in comparison with control samples (p< 0.05). These results indicated that the activity of COX was increased in WBCs of patients with COPD but whether this is a primary or secondary change relevant to hypoxic condition in these patients is not clear and needs further investigation. (Tanaffos 2008; 7

Chronic obstructive pulmonary disease (COPD) is a common disease and concomitant occurrence with obstructive sleep apnea (OSA) has been reported in some studies. This coincidence can result in exacerbation of common complications like exacerbated hypoxemia, hyperpnea and right-sided heart failure. Thus, we decided to evaluate and compare respiratory disturbance index (RDI) and sleep apnea in COPD patients. For this purpose, 50 COPD patients with OSA were studied between 2003 and 2004. OSA criteria included obstructive apnea and clinical symptoms of snoring, sleep disorder and RDI≥5. The patients were divided in to two groups: group 1 consisted of 11 patients (22%) with FEV1/FVC<70 with the mean age of 36.18±14 and group 2 was included 39 patients (78%) with FEV1/FVC≥70 with the mean of 84.75±6.6%. RDI was compared between the two groups using independent sample t-test. Multiple regression analysis was also used for comparing other variables like height, weight, age, etc. The understudy patients were included 19 females (38%) and 31 males (62%) with the mean age of 53.7±14.8 yrs. There were statistically significant differences in RDI and height between the two groups (p=0.028 and p=0.00, respectively). However, no significant difference was detected between the two groups in terms of weight and body mass index (BMI). The possibility of concomitant occurrence of COPD and OSA should be considered due to co-occurrence of significant respiratory symptoms (like dyspnea, sleepiness, etc.) and assessed by adding RDI to important indices like height and so on.

Chronic Obstructive Pulmonary Disease (COPD) is a chronic and plenty disease and one of the important causes of morbidity and mortality in the world with restrict available medical treatments. The objective of this study was to assess whether psycho-educational plans (self management and behavior modification) administered in primary care have beneficial effects on symptoms of patients with COPD. The study was a prospective, unblinded, randomized controlled trial of usual care vs. usual care plus structured education on the use of 8 sessions of “self management and behavior modification” group education: a simple educational package on life style modification and assumption of special behaviors in different situations of disease. The study was conducted in two educational hospitals (Khorshid & Alzahra) in Isfahan, Iran. Participants were 42 patients with COPD randomized into control or intervention groups. The primary outcome measure was change in severity of COPD symptoms that measured with "Clinical COPD Questionnaire" (CCQ). The data were analyzed with SPSS software and statistic examination called Ancova- Repeated measure and Mancova-Repeated measure. Self management and behavior modification education were associated with significant higher decrease in mean score of CCQ in symptom, functional state and mental state domains but had no effect on change in mean score of CCQ-Total. Mean score of CCQ in symptom, functional state and mental state domains was lower in the intervention group but there was no difference in mean score of CCQ-Total due to “self-management and behavior modification” plans. (Tanaffos 2008;

This study is a part of the third phase of the "International Study of Asthma and Allergy in Childhood" (ISAAC) aiming to study the prevalence and severity of asthma symptoms among children of Rasht and Tehran. This analytical cross-sectional study assessed Rasht and Tehran students in two age groups (6-7 and 13-14 years) during 2001-2002. After performing statistical analysis, prevalence of asthma symptoms was compared between the students form the two cities and was evaluated in both sexes and age groups by using the Chi-square test. A total of 12,214 students from both Rasht and Tehran participated in this study. History of wheezing and asthma were significantly higher among Rasht students. Prevalence of wheezing, speech limitation due to wheezing, wheezing during exercise and dry nocturnal cough were higher among 13-14 year olds in both cities. History of wheezing and exercise wheezing were higher in 6-7 year-old girls living in Tehran. However, prevalence of the aforementioned symptoms and prevalence of asthma were higher in total boys residing in Rasht. Also, prevalence of asthma, wheezing during exercise and dry nocturnal cough were higher in 13-14 year old boys in Rasht. No significant difference was found in this regard between Tehran girls and boys in this age group. Prevalence of asthma and some of its symptoms was significantly higher among Rasht students compared to those residing in Tehran.

Pressurized metered dose inhalers (pMDIs) are commonly used in patients with asthma. However, the need to coordinate inhalation with inhaler actuation means that they are not suitable for use per se. Spacer devices were developed to overcome some of the problems of pMDIs. Several types of holding chambers of different sizes are available in Iran. This study was designed to compare spirometric parameters between Asmyarâ and Damyarâ spacers in asthmatic patients. This was an observational comparative study. Patients with mild to moderate asthma were entered in this study. The ease of use, convenience, and portability of the mentioned spacers were evaluated using a visual analogue scale (VAS). Lung function was assessed by using a portable spirometer (Spirolabâ Italy) and spirometric parameters of FEF50%, FEF25-75%, PEF, FEV1, FVC and FEV1/FVC were measured. Forty patients (25 females, 15 males) with a mean age of 43.10± 12.99 years were studied. Mean ± SD changes of FVC, FEV1, PEF, FEF25-75%, FEF50% and FEV1/FVC (as percentage of the predicted values) before and after using Asmyarâ were not significantly different from those of Damyarâ. However, patient satisfaction was significantly higher with Damyarâ (P<0.0001). Lung response after using salbutamol with either Damyarâ or Asmyarâ spacers was not significantly different.

Echinococcosis is a parasitic disease often seen in sheep and cattle raised in countries with unsanitary conditions. The disease is encountered endemically in northwest of Iran. Life-threatening hemoptysis due to a pulmonary hydatid cyst is a rare condition. This study assessed the prevalence and treatment of this condition. In a retrospective study, between 1993 and 2005, 520 patients with pulmonary hydatid cysts were operated at the Imam Khomeini Hospital in Tabriz, Iran. Ten (1.9%) cysts exhibited life-threatening hemoptysis (Group II). The remaining 510 patients with pulmonary hydatid cyst were studied (Group I) and compared with group II. Ten patients were included in group II, with a mean follow – up of 2.5 years. Four (40%) cases were males and six (60%) were females. The age ranged between 8 and 46 (mean 27.90 ± 13.86) years. The most common symptoms were cough (100%), massive hemoptysis (100%), respiratory distress (100%), and chest pain (90%). The amount of hemoptysis was between 600 and 1400 ml (mean 840 ± 249.66) a day. The origin of bleeding in six (60%) was from the cyst in the right lung and in four (40%) from the left lung. Bronchoscopy revealed the site of bleeding in all 10 patients, and the lobe in seven (70%). Chest x-ray and CT scan showed patchy infiltration in one or both lungs and a ruptured hydatid cyst in eight cases. Lobectomy was the most frequent applied procedure (100%). Two (20%) cases died due to blood aspiration and respiratory distress syndrome, one in the 3rd and the other in the 4th postoperative day. The postoperative hospital stay ranged between 7 and 25 (mean 11.30 ± 6.56) days. Two and a half years follow-up of patients was good. There was no recurrence. There were significant differences between the two groups In terms of complications and mortality (c2 =102.39, df=1, p<0.0005) and (c2 = 5.82, df=1, p<0.16). Massive life-threatening hemoptysis due to pulmonary hydatid cysts must be managed as an urgent clinical entity. It has serious symptoms, serious post-operative complications and a high mortality rate.

Benzene, toluene, ethylbenzene and xylene (BTEX) compounds are components of motor vehicle fuel. BTEX are released from exhausts of vehicles and also evaporation from the fuel tank, carburetor and crank case of engines. BTEX are dangerous chemicals that participate in photochemical reactions and produce secondary air pollutants such as ozone, peroxyacethyl nitrate, free radicals and nitrogen oxides. BTEX in ambient air of metropolitan areas has been the subject of concern in many studies through elaborate "Environmental Protection Agency" (EPA) method. Level of BTEX in the ambient air of major Iranian cities, has not been measured in concentration range of part per billion (ppbv) due to the inadequate sensitivity of available gas chromatography systems. The aim of this study was to improve the sensitivity of gas chromatography by using a special sampler and thermal desorber (Micro-Packed Injector). Our sampler consisted of a 5-centimeter stainless steel tube one millimeter in diameter packed with carbopacked B heat-conditioned samplers utilized for sampling atmospheric BTEX. It was subsequently injected to a custom-made thermal desorber (225°C) which was assembled onto the injection port of a gas chromatography device for analysis. BTEX standard atmospheres were analyzed with a gas hromatograph flame ionization detector (GC-FID) with linear range detection of 27.5-275ppb, 23.1-223.6ppb, 20-320-ppb, and 20-320ppb respectively. The Micro-Packed Injector (MPI) installed on ordinary GC-FID improved linear range detection of BTEX from previous ppm detection to ppb range.

Smoking is the first cause of preventable morbidity and mortality in the world. This study aimed to compare different methods in reducing the students’ tendency towards smoking. This semi-experimental study comprised all 7th grade students studying in middle schools throughout Iran in the year 2005-2006. Students were divided into 4 groups: three study groups (social skills training, increasing knowledge and poster presentation) and 1 control group. Sampling method used was multi-phase cluster.The country was geographically divided into 5 districts (north, south, east, west and central) and the provinces were selected randomly. A questionnaire was used to collect the data. These questionnaires were designed to evaluate the attitude and knowledge of students with regard to smoking and complications. A total of 2911 students with the mean age of 13 years were studied out of which 7.4% were smokers. There were significant differences between the study groups and the control group regarding the attitude and knowledge about the hazards of smoking and abuse of illicit substances. In other words, among the study groups, social skills training, building knowledge and poster presentation had the best results, respectively. In evaluating the preventive methods, social skills training group had the most negative attitude and the highest level of knowledge concerning the disadvantages and hazards of smoking and use of illegal substances. The greatest decrease in smoking was also observed in this group. Social skills training can be an effective preventive measure to control smoking by emphasizing self-respect, problem-solving skills and self restraint.

Seizure is common after head trauma and neurosurgery. Phenytoin is the most common anti-convulsant drug used in epileptic patients and for prevention of seizure in patients with head trauma and stroke. This drug has unique pharmacokinetic and pharmacodynamic characteristics. Phenytoin administration along with enteral nutrition in ICU patients may be accompanied by decreased phenytoin absorption and inadequate therapeutic concentration. The present study was performed to assess the effect of enteral nutrition on the pharmacokinetic therapeutic parameters of phenytoin given to our patients. In a clinical trial, the study group was divided into two groups of 15 patients each. After obtaining steady-state phenytion serum concentration, two blood samples were obtained from each patient on 2 consecutive days and then analyzed. The mean was assessed on the basis of serum albumin level of the patient. Clearance and maximum metabolic capacity were also calculated. Serum phenytoin level was below the therapeutic range (10- 20 mg/l) in 70% of patients in group 1 and was higher than the therapeutic range in 70% of patients in group 2 who received oral phenytoin (by dissolving in water) 2h after enteral nutrition. Mean phenytion concentration was 6.3±4mg/l and 24.7±9.4mg/l in group 1 and group 2, respectively. We found oral phenytoin administration with enteral nutrition (gavage solutions) to result in a significant decrease in absorption and blood concentration of phenytoin. We recommend administration of phenytoin with water only.In addition, monitoring of phenytoin serum concentration is necessary for assessment of therapeutic concentration and prevention of side effects.

After Sistan and Balouchestan, Golestan province is ranked second in terms of TB prevalence in Iran. Therefore, a 5-year study was conducted to evaluate the alterations of TB epidemiologic indices in this province. This was a trend study. All patients suffering from various forms of pulmonary tuberculosis (smear positive, smear negative, extrapulmonary and miliary) during 1999-2003 in Golestan province were studied. Alterations of TB epidemiologic indices were evaluated by using Chi-square test. Out of a total of 3,417 registered TB patients during 1999-2003 in the Center for Communicable Disease Control in Golestan, 2,773 (81%) were available and entered the study; 47% were male. 62.7% of patients had smear positive, 16.4% had smear negative, 20.7% had extrapulmonary and 0.1% had miliary tuberculosis. The overall incidence of all forms of TB during the study period was 36 in 100,000 and no significant difference was detected while assessing the alterations of this index during the study period. Incidence of TB had an increasing trend among children; its prevalence among 0-14 year old females was higher than males during the study period. Although Golestan province is not adjacent to the provinces with high TB prevalence, it is ranked second in terms of incidence and prevalence of TB and various factors such as immigration can affect TB epidemiologic indices. An independent study is required to evaluate the distribution of TB among different ethnic groups. (Tanaffos

Microaspiration secondary to gastroesophageal reflux has been postulated to be a predisposing factor for development of bronchiolitis obliterans syndrome after lung transplantation. Esophageal manometry and ambulatory pH monitoring have been suggested as a screening test in patients with end-stage lung disease. We report a single lung transplant patient who developed allograft rejection presumed to be due to underlying achalasia as the patient’s clinical status and lung function improved markedly following the treatment of achalasia. The potential cause-effect association between esophageal disorder and allograft rejection and the clinical importance of the screening in this group to improve the survival rate after lung transplantation is proposed.

Tumor-to-tumor metastases are uncommon. Lung cancer is the most frequent donor tumor while renal cell carcinoma is the most common malignant, and meningioma the most common benign recipient of metastases. Other reported host benign lesions include thyroid adenoma, adrenocortical adenoma, ovarian cystoma, and hepatic cavernous angioma. A 41-year-old male smoker presented with a mass in the right axillary’s fossa, cough and weight loss. Chest x-ray showed left lung collapse. Fiberoptic bronchoscopy showed vegetation in the left main bronchus and biopsy revealed adenocarcinoma. Biopsy of the right axillary mass showed benign fibrous histiocytoma (BFH) with metastasis from adenocarcinoma. To our knowledge, this report represents the first case of tumor-to-tumor metastasis to BFH.

Tracheal stenosis is extremely rare during pregnancy and is frequently mistaken for and treated as asthma. We describe the management of anesthesia in a pregnant patient with severe subglottic stenosis requiring rigid bronchoscopy for dilation and laser treatment of the stenotic area.