Tanaffos Respiration Journal
Volume:7 Issue: 2, Spring 2008

Prevention and treatment of drug-resistant clones is important in guiding TB control strategies. The simultaneous rapid detection of the type of mutation conferring resistance and the genotype reflect the extent of drug resistant TB transmission within the communities.Mutations conferring resistance to rifampin in rifampin-resistant clinical Mycobacterium tuberculosis isolates occur mostly in the 81 bp rifampin-resistance-determining region (RRDR) of the rpoB gene. Spoligotyping, IS6110- restriction fragment length polymorphism (RFLP) typing and sequencing of the rpoB gene were performed for 30 rifampin resistant M. tuberculosis isolates from patients referred to "Iranian National TB Laboratory" from 2006 to 2007. Mutations in the RRDR of the rpoB gene were identified in 96.6% of rifampin-resistant isolates. The spoligotyping analysis identified one (3.3%) East African-Indian (EAI) family, 7 (23.3%) Haarlem family, 9 (30.0%) Beijing family and 12 (40.0%) Central Asia (CAS) family isolates. Sixty- six percent of CAS isolates carried a mutation in codon 516, 37% of Beijing isolates carried a mutation in codon 531 and 33% of Haarlem isolates carried a mutation in codon 526. Overall, there appeared to be a correlation between the genotype and specific mutations conferring resistance to rifampin in the Beijing and Haarlem families.

Angiotensin converting enzyme (ACE) plays an important role in cardiovascular regulation. Since the initial report regarding the association of insertion/deletion gene polymorphism and serum concentration of ACE, there have been investigations in different populations with contradicting results. The aim of this study was to assess the association of the ACE polymorphism and serum level in Iranians. The study recruited 88 healthy individuals (70 males and 18 females; mean age: 30.07 yrs.) who were candidates for kidney donation. To investigate the association of ACE serum level and polymorphism, the serum concentration of ACE was measured spectrophotometrically and ACE genotyping was determined by polymerase chain reaction. The genotype distribution of DD, ID and II was 31, 24 and 33 respectively. The mean ACE serum concentration for DD, ID and II genotypes was 50.68, 36.65 and 32.06 IU/L, respectively. There was a significant difference in ACE serum level among the three genotypes (p < 0.05). While the highest ACE serum concentration was seen in DD group (nearly 1.5 times of that of ID and II genotypes, respectively), it was the lowest in the II group. Our study showed that insertion/deletion polymorphism of ACE gene was strongly associated with plasma ACE levels in the Iranian population.

Transbronchial needle aspiration (TBNA) is a safe and effective technique for the diagnosis of mediastinal lesions. The aim of this study was to evaluate diagnostic yield of TBNA in patients with benign and malignant lesions involving mediastinal and hilar lymph nodes. TBNA procedures were performed using a flexible bronchoscope and a 22-gauge cytologic needle in 22 patients with mediastinal or hilar adenopathy identified on CT of the chest. Based on the clinical diagnosis or presence of endobronchial lesions, other procedures such as bronchoalveolar lavage, bronchial biopsy, and transbronchial lung biopsy were performed. Among 22 patients with a mean age of 50±18 years, 13 were males (59%) and 9 were females (41%). Adequate lymph node samples were obtained in 16 patients (72.7%). Among 9 patients with malignancy, TBNA provided diagnostic results in 5 patients (55.5%). TBNA provided adequate specimen in 10 out of 13 patients with sarcoidosis, but in 2 patients (15.4%) diagnosis was made by TBNA. Overall, TBNA yield was 31.8%. There was no complication during TBNA procedures. TBNA is a minimally invasive technique for diagnosis of intrathoracic lymphadenopathy, especially in malignant diseases. The procedure also can be used as a diagnostic tool in patients with sarcoidosis, although the yield is low.

Generic and disease-specific health-related quality of life (HRQoL) questionnaires are commonly used in subjects with chronic obstructive pulmonary disease (COPD). However, it is not clear whether generic and disease-specific measures should be used in parallel, as they focus on different aspects of life. This study aimed to investigate the association between two most commonly used generic and disease specific HRQoL measures: Medical Outcomes Study Short Form 36-Item (SF-36) and St George''s Respiratory Questionnaire (SGRQ). In a cross-sectional study, 58 subjects were selected through non-randomized systematic sampling from all COPD patients admitted to the "Respiratory Clinic of Baqiyatallah Hospital" during 2006. Each subject completed both SF-36 and SGRQ forms. Spirometry was also performed for each patient. The correlations between SGRQ total score and its subscores, including symptoms, activity and impacts, and SF-36 total score and its subscores, including physical functioning (PF), role-physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role-emotional (RE) and mental health (MH), were assessed. No significant correlation was found between the total score or subscores of SF-36 and the total score or subscales of SGRQ (p>0.05). The generic SF-36 and the disease specific SGRQ questionnaires assess different aspects of HRQoL in COPD patients and each should be used separately. The optimal approach appears to be the application of generic and disease-specific measures together, at least in the research setting. Further studies are recommended with larger sample size.

Generally, non-smokers have healthier lifestyles compared to smokers. Typical foods eaten more by non-smokers are fruits and vegetables, whereas smokers eat more meat and fat and drink more alcoholic beverages. We aimed to compare nutritional knowledge, attitude and practice (KAP) of smokers participating in smoking cessation clinics with their non-smoker family members. Two hundred twenty-six smokers and 260 non-smokers aged 18 years and over were compared in a cross-sectional study. A Likert type KAP questionnaire including 36 items was used. Knowledge and attitude scores were compared between smokers and non-smokers using the Mann-Whitney test. Practice patterns were compared by the Chi-square test. Differences were significant at p =0.05. The mean age of male smokers and non-smokers were 38.5±11 and 33.5±14 years respectively and in women these rates were 42±10.4 and 31.3±15 yrs. respectively (p<0.0001). In males, the mean percentage of knowledge in non-smokers was higher than smokers (2.41 vs. 1.85) and the average score of attitude in smokers was less than that of non-smokers (37.5 vs. 37.9; the differences were not significant). Sixty (26.5%) smokers and 93 (35.8%) non-smokers reported having regular physical activity (p=0.005). In women, the mean percentage of knowledge in non-smokers was higher than smokers (3.37 and 2.93 respectively; the difference was not significant). Attitude score of female non-smokers was higher than smokers (40.3 vs. 37.1; p=0.001). Among female non-smokers, 68 (46.9%) reported daily meat consumption; this rate for female smokers was 41 (56.2%; p=0.001). Female non-smokers consumed daily breakfast more than female smokers (107, 73.8% vs. 35, 47.9%; p=0.001). Our data showed a significant difference in nutritional KAP between smokers and non-smokers.

Tuberculosis (TB) remains a major health problem across the world and most commonly involves the lungs. Diagnosis of TB is based on finding acid-fast bacilli (AFB) in sputum or a positive sputum culture. The sensitivity of sputum smear is only 40-70% and it takes 4-8 weeks for sputum culture results. We decided to measure adenosine deaminase (ADA) activity in bronchoalveolar lavage (BAL) fluid and compare it with sputum and BAL fluid cultures. A descriptive study was performed at the shahid sadoughi Hospital in Yazd, from 2005 to 2006. Sixty-three patients suspected for pulmonary TB with negative sputum smear for AFB or had other indications for bronchoscopy, were included in the study. Then, fiberoptic bronchoscopy was done and BAL fluid was obtained from all patients. The study patients were divided into three groups as follows: Group 1: patients with positive sputum culture or BAL fluid culture for AFB who were considered as pulmonary TB group. Group 2: patients with negative results for TB, having lung diseases other than TB, (considered as non-tuberculous lung disease group). Group 3: those without pulmonary disease and TB which considered as the control group. Mean ADA levels in BAL fluids were measured in these groups and then compared with each other. Sixty-three patients were enrolled in the study among which 15 cases (mean age:64.06±19.37 yrs) had pulmonary TB, 33 (mean age: 56.18±18.60 yrs) had pulmonary diseases other than TB and 15 cases (mean age: 42.13±21.45 yrs) were considered as controls. Mean ADA level in BAL fluid was 4.13±2.55 IU/L, 2.42±1.06 IU/L and 1.93±0.88 IU/L in TB group, non-tuberculous lung disease group and control group, respectively. This rate was significantly higher in the pulmonary TB group compared to the other two groups (p=0.00). Using Roc curve with a cut-off value of 3.5 IU/L,, the highest sensitivity (57%) and specificity (84%) were obtained in diagnosis of TB. The results showed that although ADA activity in BAL fluid of pulmonary TB patients was higher than those seen in other diseases, a negative test does not rule out pulmonary TB. Thus, more research is required to find more precise diagnostic methods in this regard.

Pulmonary embolism (PE) is one of the most important emergencies in internal medicine. Wells criteria are used to predict the presence of pulmonary embolism on the basis of clinical manifestations. The aim of this study was to assess Wells criteria in patients with pulmonary embolism. Ninety-nine patients with the diagnosis of PE underwent anticoagulant therapy during 2002-2006. Data were collected using a questionnaire and then analyzed by using SPSS software. The most common symptoms were dyspnea (70.7%) and chest pain (60.6%). Wells criteria included “an alternative diagnosis less likely than PE" (84%), hemoptysis (34%), leg pain or swelling (30%), tachycardia (29%), recent surgery or immobilization (27%), previous deep vein thrombosis (22%) and malignancy (2%). Eight percent, 69% and 23% of patients had Wells scores less than 2 points, 2-6 and >6 points, respectively. Among the patient group with modified Wells criteria, 36 patients (36.4%) had scores <4 points and 63 (63.6%) had scores greater than 4 points. The majority of patients with PE had Wells score of 2-6 points and those patients with Wells score less than 4 had a positive CT-angiogram.

Occupational risk of dental personnel to microbial airborne contamination has been demonstrated through the increased prevalence of respiratory infections. The American Dental Association has suggested stringent protection for infectious agents present in dental aerosols. Occupational exposure of dentists to airborne microbial and mycological contamination in various locations of a dental school was monitored by sampling of air in close vicinity of their breathing zone. This sampler drew air at a flow rate of 10 liters/minute and for a 2-hour period and blew it at a high speed through a narrow slit over a solid nutrient agar plate. Immediately after sampling, the plates were placed in an incubator and incubated aerobically for 2 days at 370C. The total bacterial counts in the air of dental surgery rooms and in non-surgery rooms without direct involvements with dental operations were in the range of 120-280 cfu/m3 and 49-128 cfu/m3 respectively. Pathogenic Streptococcus haemolyticus and opportunistic Staphylococcus species were found in some locations of dental surgery rooms. There are no standards for acceptable levels of indoor air contamination with pathogenic microorganisms and since pathogenic Streptococcus haemolyticus and opportunistic Staphylococcus species were found in some areas of the dental school, the need for management of possible risk of infective hazards is recognized.

The role of the anaesthesiologist in the quality of care rendered to patients during the pre-operative period is well known. The role of pre-operative anesthesia clinics in providing better conditions for patients undergoing anesthesia is now well documented. This study was performed to evaluate the familiarity of Iranian physicians with the aims of anesthesia clinics 10 years after the establishment of such clinics in Iran. All physicians working in 2 university medical centers were selected. A questionnaire was given to them and answers were analyzed and interpreted by statistical methods. Three-hundred forty-four Iranian physicians were questioned about their knowledge regarding anesthesia clinics out of which, 38% were faculty members, about half of them had working experience more than 10 yrs., 57.3% of them were surgeons, 27.6% of them were non-surgical clinical physicians, 6.4% were paraclinicians and the remaining were general practitioners. Forty-one percent of physicians were familiar with the aims of anesthesia clinics. Only 34% of physicians had referred patients to such clinics. The most important goals of establishment of these clinics from the physicians’ point of view were to prepare the patients for operation (71%), reduce the complications of surgery (54%), reduce the time required for preparing patients for surgery (36%) and reducing the costs (34%). Considering the results, it seems that a great majority of Iranian physicians are still unfamiliar with the aims of anesthesia clinics. Direct communication between anaesthesiologists and medical staff and stressing the benefits of establishing such clinics in medical congresses are beneficial and highly recommended by the authors.

Pharyngocutaneous fistula is a serious complication after total laryngectomy. The reported incidence varies from 1% to 50%. There is still no agreement regarding when to begin oral feeding after total laryngectomy. The aim of this study was to demonstrate the safety of early oral feeding after total laryngectomy. In a prospective study, patients who underwent total laryngectomy were randomly divided into either the oral feeding or the nasogastric tube (NGT) groups. For patients in the oral feeding group, feeding was initiated orally with a clear liquid diet on the third postoperative day, whereas patients in the nasogastric tube group were fed through NGT and received nothing orally until the seventh postoperative day. Between September 2002 and October 2006, 25 patients were studied in this trial. There were 13 patients (52%) in the oral feeding group and 12 patients (48%) in the NGT group. Their ages ranged from 49 to 77 years (mean 66.07 ±7.22 and 63.83 ± 7.58 years in oral feeding and NGT groups, respectively). Mann-Whitney U and Chi-square tests showed that differences between the two groups were not statistically significant with regard to age, tumor location and tumor stage. One case of fistula occurred in each group. Our results indicate that in a selected group of patients, it is possible to initiate oral feeding much earlier in the postoperative period than what was formerly thought.

Postpneumonectomy syndrome reflects extrinsic compression of the distal trachea and main stem bronchus due to shifting of the mediastinum and hyperinflation of the remaining lung. The syndrome is characterized by development of progressive dyspnea, cough, inspiratory stridor, and recurrent pneumonia in patients at least 6 months after surgery. We report a case of late onset dysphagia secondary to post-pneumonectomy syndrome, nine years after right pneumonectomy. It is a rare complication and there are only two similar reports in the literature.

A common pulmonary complication due to the toxicity of amiodarone is chronic interstitial pneumonitis. Alveolar hemorrhage, with or without hemoptysis, is an exceedingly infrequent presentation of amiodarone toxicity. We report a 69-year old patient with dyspnea, hypoxemia and bilateral diffuse interstitial and alveolar infiltrates occurring four months after treatment with amiodarone. An initial and comprehensive work-up did not reveal the cause of infiltrates. Bronchoalveolar lavage (BAL) fluid demonstrated foamy macrophages and alveolar hemorrhage, not caused by either vasculitis or autoimmune diseases. We speculate that amiodarone may have been associated with BAL findings since cessation of the drug resulted in resolution of the infiltrates. In amiodarone-induced lung injury, diffuse interstitial and alveolar infiltrates can be suggestive of alveolar hemorrhage and should be further investigated by bronchoscopy and BAL