Tanaffos Respiration Journal
Volume:6 Issue: 3, Summer 2007

The aim of this study was to investigate the significance of mutation in codon 315 of katG gene and its correlation with high-level of resistance to isoniazid, nuclotide and amino acid changes in mycobacterium tuberculosis (MTB) isolates randomly collected from sputums of 42 patients with active pulmonary tuberculosis in different regions of Belarus. Drug susceptibility testing was determined using the CDC standard conventional proportional method. DNA Extraction, katG gene amplification, and DNA sequencing analysis were performed. Six isolates (14%) bearing multi-mutations in three codons (309,315 and 316), 26 Isolates (61.9%) demonstrated multi-mutations in all or two of the above codons, and 8 (19%) were found to have a single mutation in 315. Four types of mutations were identified in codons 315: AGC→ACC (n=36)85%, AGC→AGG (n=1) 2.3%, AGC→AAC (n=2) 4.7%, AGC→GGC (n=1) 2.3%, one type of mutation in 316: GGC→AGC (n=18)41.4%, and four types of mutations in 309: GGT→GGT (n=7)16.1%, GGT→GCT (n=4)9.2%, GGT→GTC (n=3)6.9%, GGT→GGG (n=1)2.7%. In 2 (4.7%) isolates mutations were identified in codons 463, 357, and in codons 454, 357 respectively. MTB in patients from Belarus were found to have high-level resistance to isoniazid in the isolates with mutations in codon 315 (> 10 μg/mL). (Tanaffos 2007; 6(3): 11-19)

Klebsiella pneumoniae is a pathogenic bacterium causing nosocomial infections in particular severe respiratory tract infections. Little information is available on the antibiotic susceptibility of pulmonary isolates of Klebsiella spp. The aims of this study were to determine the antibiotic resistance patterns and prevalence of extended-spectrum b-lactamase (ESBLs) producing Kleb. Among the respiratory isolates and to detect the possible clonal outbreaks associated with them. The respiratory isolates of K. pneumoniae (n=33) received from two Tehran hospitals during 2002-2005 were evaluated. Disk diffusion was used to determine the susceptibility of isolates to 14 antibiotics. Phenotypic confirmatory and double disk synergy methods were used to detect extended spectrum b-lactamase producing isolates (ESBLs). Respiratory isolates were then analyzed by multilocus enzyme electrophoresis (MLEE). ESBL phenotype was detected in 75.75% of the isolates. The most effective antibiotic was imipenem followed by tazobactam/piperacillin. MLEE analysis revealed 13 electrophoretic types (ETs). The locus leucine-tyrosine peptidase showed the highest genetic diversity (0.733). These 33 respiratory isolates consisted of 16.5% Klebsiella pneumoniae. This rate is lower than the neighboring country, Turkey (35%). However, ESBL-producing strains belonging to different genetic lineages are serious concerns at Tehran hospitals. Carbapenem is still considered one of the most effective antibiotics against multi-drug resistant isolates. (Tanaffos 2007; 6(3): 20-25)

Pneumocystis Pneumonia (PCP) caused by Pneumocystis Jjirovecii (formerly called P.Carinii) is one of the most common opportunistic infections in patients with human immunodeficiency virus (HIV). The aim of this study was to assess PCP in HIV-infected patients at the "National Research Institute of Tuberculosis and Lung Disease" (NRITLD). A retrospective study was performed on 12 HIV-infected patients who were hospitalized at the Masih Daneshvari Hospital (NRITLD) and diagnosed as having PCP during 2003- 2007. In patients suspected of PCP with symptoms such as exertional dyspnea, fever, cough and related radiological findings, bronchoscopy including broncho-alveolar lavage (BAL) and transbronchial lung biopsy (TBLB) were performed and high resolution computed tomography (HRCT) was obtained from all patients. Mean age of the understudy patients was 32.8±5.02 yrs. The most common symptom was exertional dyspnea (91.7% of cases). Mean duration from the onset of symptoms until diagnosis was 27.4±18.7 days. All patients were treated with Co-Trimoxazole and no adverse effects were detected. Mortality rate was 25%. In Iran PCP is one of the common opportunistic infections in HIV-positive patients which is accompanied by a high mortality rate. (Tanaffos 2007; 6(3):26-29)

About 8% of patients experience prolonged mechanical ventilation after cardiac surgery. Development of criteria for successful liberation of a patient from mechanical ventilation and extubation may be highly dependent on the clinical situation. Different criteria were used for ventilator weaning. We designed a clinical trial to determine the usefulness of rapid shallow breathing index (RSBI) as a predictor for successful weaning from mechanical ventilation. In a prospective observational study, 52 patients who had prolonged mechanical ventilation (> 72 h) after open cardiac surgery were studied. Patients had 60 – min spontaneous breathing trials and satisfied at least 5 weaning predictors and fulfilled the criteria for discontinuing mechanical ventilation. Traditional weaning criteria and RSBI were determined. According to the outcome assessment of weaning, patients were divided into failure or success groups. The mean RSBI values were significantly different between the failure (103.5±21.9 breath/min/L) and success groups (80.4±15.3 breath/min/L, p=0.0001). There was no significant difference regarding the values of other prediction criteria between the two groups. Using RSBI <105 (breath/min/L) as the threshold value for predicting successful weaning, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were 92.5%, 70%, 92.5%, 70% and 88% respectively. Although a small number of patients require prolonged ventilatory support after open cardiothoracic surgeries, growing experience in critical care settings and mechanical ventilation cause favorable outcomes. Ventilator weaning is more likely to be successful if RSBI is less than 105 (breath/min/L). This index is a more valuable and accurate predictor of weaning than other weaning predictors. (Tanaffos 2007; 6(3): 30-35)

A chest tube is used as a close system for drainage of fluid in the pleural space in trauma patients or after thoracic surgery. A chest bottle used at present is generally made from hard synthetic material with the possibility of breaking. Furthermore, some amounts of sterile solution (normal saline) should be always added into the chest bottle to prevent return of air back into the pleural cavity creating a vacuum and decreasing the mobility of the patient significantly.The purpose of this study was to use a drainage bag which is a new device made from soft and light synthetic materials like those used in urinary bag, so that drainage of fluid and air can be done through the pleural space without any complication related to the use of chest bottle. The present study was an interventional clinical trial. Fifty patients were selected among those who had been hospitalized in Hazrat Rasoul Akram Hospital between 2006 and 2007 and chest tubes were placed for them. After obtaining consent for participation in the study, they were divided into two groups (each comprising 25 patients) randomly. Chest bottle and drainage bag were used in groups 1 and 2, respectively. Both groups were compared for severity of chest pain, satisfaction from the device and duration of hospitalization. The study showed the mean pain severity in patients with a drainage bag to be 4.1 units compared to those with chest bottle as 5.4 units. Satisfaction of the patients regarding their ability to move and ease of replacement of the device was 81% in the group with drainage bag and 43%in the group with chest bottle. Mean hospitalization period was 4.8 days in patients with drainage bag and 8.5 days in patients with chest bottles. The present study showed that using drainage bags instead of chest bottles in all patients who have chest tubes, can result in decreased pain, more satisfaction, shorter hospitalization and acceleration of recovery provided that the patients do not need more negative pressure (suction) within the pleural space. (Tanaffos 2007; 6(3): 36-39)

Some histopathologic patterns of bronchiolar disease may be relatively unique to a specific clinical entity, such as respiratory bronchiolitis caused by cigarette smoking and toxic fumes i.e. sulfur mustard (SM).The aim of this study was to determine the trend of pulmonary function indices in SM-exposed patients with the diagnosis of bronchiolitis obliterans. In this retrospective cohort study, 407 cases were evaluated. Patients were divided into 4 groups according to the time period from performing PFT: 1-3, 4-6, 7-10 and more than 10 years. The amounts of these changes amongst four PFT interval groups were compared by analysis of variance test. In addition, we used linear regression analysis to create a linear model of changes for each PFT index. The following equations imply a correlation between decrease in PFT indices and interval between the two tests plus index value of baseline PFT. 1: (FVC %)= -2.23 - (0.76 T)-(0.23 FVC1 %), 2: (FEV1%)= -1.43 - (0.95 T)-(0.10 FEV11 %), 3: (PEF %)= -0.91 - (1.07 T)-(0.14 PEF1 %). Better understanding of the nature of bronchiolitis obliterans, helps improve the treatment of this disease. Our study suggests a pattern of decline in pulmonary function indices directly proportional to the percentage of each index in the baseline PFT which was apparent during a 10-year observation period. (Tanaffos 2007; 6(3): 40-46

There are several reports on the association between body mass index (BMI) and depression in the general population and in patients with some chronic diseases. However, despite the established effects of weight changes and depression on the outcomes of patients suffering from respiratory disorders, little data exists on the topic in relation to chronic obstructive pulmonary disease (COPD). This study assessed the relationship between BMI and depression in patients with COPD. This cross-sectional study was conducted on 148 COPD patients admitted to the chest clinic of Baqiyatallah Hospital from October 2006 to February 2007. Patients were selected by systematic sampling. Demographic data (gender, age, marital status, monthly income and level of education), clinical data (symptoms, and medications), spirometric findings (VC, FEV1, FVC, FEV1/FVC, PEF, MMEF, predicted VC, predicted FVC, and predicted FEV1), depressive symptoms assessed by "Hospital Anxiety Depression Scale" (HADS), and body mass index (BMI) were recorded for each patient. Patients were divided into three groups. Group I had (GOLD) stage I; FEV1³ 80%, group II had GOLD stage II, 50% £ FEV1<80% and group III had GOLD stage III, FEV1< 50%. The two-by-two correlations between BMI, depressive symptoms and pulmonary function indices were evaluated separately. A significant association was found between BMI and depressive symptoms (r=0.429, P<0.001), but not between pulmonary indices and BMI or the severity of depressive symptoms. There was a significant correlation between BMI and depressive symptoms indicating the important effect of mental health on weight in COPD patients. A multidisciplinary approach by a team of specialists from different disciplines is mandatory to address these factors in COPD patients. (Tanaffos 2007; 6(3): 47-53)

Postanesthetic shivering is a distressing postoperative complication. Pharmacological control is an effective method for treatment and prevention of postoperative shivering. Pethidine prevents or manages shivering far better than equianalgesic doses of other opioids. However, buprenorphine is an opioid with a similar structure to morphine but approximately 33 times more potent. This study aimed to assess and compare the effects of these two opioids in preventing post-anesthetic shivering. This randomized double- blind clinical trial was designed to compare the efficacy of buprenorphine and pethidine in prevention of post anesthetic shivering. Sixty ASA grade I-II patients undergoing general anesthesia for elective Cesarean section entered the study. Patients received either buprenorphine 3mg/kg (n=30) or pethidine 0.5 mg/kg (n=30) intravenously 30 min before the end of surgery. Heart rate and blood pressure were measured 15 min after the injection. Occurrence of shivering was evaluated for one hour in the recovery room. Also, pain intensity was assessed by using a visual analog scale (VAS; 0-5). Shivering was significantly reduced in the pethidine group (5 of 30 versus 13 of 30, p<0.05). Visual pain scores were similar in both groups. There was no difference between the two groups regarding hemodynamics. Despite similar in pain control, pethidine is more effective than buprenorphine in prevention of post anesthetic shivering. (Tanaffos 2007; 6(3): 54-58)

In the past 10-15 years, the world has encountered a new type of organic dioxin-like pollutant from products of combustion and byproducts of industrial processes and activities of the municipality. Dioxins are very toxic substances. According to various studies, it is believed that these compounds have devastating impacts on the environment and public health. Since these pollutants are persistent and can remain in the environment for several decades, they may have global implications. Estimation of the amount of dioxin-like compounds has been done in 15 industrialized countries according to United Nations Environment Programme(UNEP). In this study, the amount of dioxin-like pollutants in Iran was estimated to be 1282gr TEQ/year compared with 100 to 4000gr TEQ/year in European countries, the USA and Japan. Iranian sources of dioxins are considerable comparing to that of industrialized countries. Therefore, a higher incidence of adverse health effects such as carcinogenesis and changes in liver function, thyroid hormone levels, immune cell levels, and decreased performance in learning and intelligence tests may be anticipated in polluted areas. The result of this study necessitates a sound national strategy for monitoring the release of these pollutants in Iran. Further studies are recommended on Dioxin-like compounds in polluted areas. (Tanaffos 2007; 6(3): 59-64)

Sinus histiocytosis with massive lymphadenopathy (SHML), Rosai-Dorfman Disease, is a rare histiocytic syndrome first described by Rosai and Dorfman, seen predominantly in childhood and early adulthood. Even though it is considered a benign disease, fatalities may occur due to cellular infiltrates of SHML. We report a 16–year–old boy with signs of polydypsia, polyuria, weight loss and generalized lymphadenopathy. He had been receiving corticosteroid following the diagnosis of histiocytosis X. Due to hyperglycemia, the patient was admitted with the primary diagnosis of diabetic ketoacidosis and medications were initiated. All paraclinical and immunologic examinations were negative. Axillary lymph node biopsy revealed the diagnosis of Rosai–Dorfman disease. (Tanaffos 2007; 6(3): 65-67)

Hamartomas are benign lung tumors with an incidence of 0.025-0.32%. Endobronchial hamartoma is very rare. Only 1.4% of these tumors are endobronchial and the remaining are paranchymal. We report a 40-year-old man admitted for dyspnea and cough present for 8 years. He was a non-smoker and had been treated for asthma. Computed tomography of the lung showed a mass within the right main bronchus. Fiberoptic bronchoscopy showed translucent hyperaemic polypoid mass in the orifice of the right main bronchus. Microscopic examination of the specimen revealed chondroid hamartoma. Rigid bronchoscopy was performed for the patient and the lesion was removed by Nd: YAG laser. He recovered completely. (Tanaffos 2007; 6(3): 68-70)

We report a 37-year-old woman presenting with recurrent respiratory infections since childhood. She was admitted due to persistent cough. The patient was evaluated by chest radiography and computed tomography scan which revealed multiple cystic cavities in the right upper lobe associated with a mass with air-fluid level. Complicated pulmonary bronchogenic cyst was suspected. After thoracic surgery, pathologic diagnosis was reported as mediastinal mature cystic teratoma with rupture into the lung. (Tanaffos 2007; 6(3): 71-73