Tanaffos Respiration Journal
Volume:8 Issue: 2, Spring 2009

Although chronic obstructive pulmonary disease (COPD) is traditionally associated with polycythemia, its systemic inflammatory components can interfere with erythropoietin and result in anemia of chronic disease. We assessed the frequency of anemia and its relation to serum erythropoietin (EPO) levels and severity of the disease in a group of COPD patients. Eighty patients with the mean age of 66.48 ± 11.55 years and mean forced expiratory volume in first second (FEV1) of 45.14 ± 16.88 % predicted were enrolled in this study. Severity of the disease was defined according to the global initiative for chronic obstructive lung disease (GOLD) guidelines. Hemoglobin and erythropoietin levels were assessed in all patients. Anemia of chronic disease was present in 13 of 80 patients (16%). The mean serum levels of EPO were 59 ± 203 (SD) µ/l and 70.3 ± 255 (SD) µ/l in anemic and nonanemic COPD patients, respectively. There was no significant difference between the two groups (p=0.13). A significant correlation was seen between hemoglobin and serum EPO in all COPD and nonanemic patients (r = - 0.86, p<0.001 and r = - 0.28, p = 0.02). No significant correlation was seen between hemoglobin and serum erythropoietin levels in the anemic group (r = 0.07, p = 0.82). This study showed that anemia occurred relatively frequently in COPD patients. In addition to erythropoietin resistance, other factors are probably involved in the pathogenesis of anemia in these patients. (Tanaffos 2009; 8(2): 11-16)

Despite the advances in diagnosis and treatment of lung cancer، its survival rate has only improved in those with early stages of disease. Telomerase is a tumor marker that has been focused on recently as a novel tool for early diagnosis of lung cancer. This study aimed to compare telomerase activity in cases with malignant and benign pleural effusions. Telomerase activity was assessed in 28 consecutive cases of pleural effusions (19 cases with malignant and 9 cases with benign histopathologic diagnosis) with telomeric repeat amplification protocol (TRAP) between Apr. 2006 and Sep. 2007. Data analysis was performed by using Chi-square test and t-test. Twenty (71. 4%) out of 28 cases with pleural effusions were positive for telomerase activity. Telomerase activity was positive in all 19 malignant effusions، while only one case with effusion due to a benign condition (TB) had positive telomerase activity (p<0. 0001). The sensitivity، specificity and diagnostic accuracy of telomerase activity for detecting malignant pleural effusions were 100%، 88. 9% and 96. 4%، respectively. Positive and negative predictive values of telomerase activity were 95% and 100%، respectively. Mean relative telomerase activity was not significantly different in malignant and benign effusions (24. 3±5. 2% vs. 15. 05%; p>0. 05) Telomerase activity is a highly sensitive and specific diagnostic biomarker for malignancy and may be used as an adjunct to other diagnostic tools such as cytology for malignant pleural effusions. (Tanaffos 2009; 8(2)

The most sensitive parameter for evaluation of airway hyper-responsiveness is PC35 (35% decrease in specific airway conductance). But assessment of this parameter requires expensive equipments. This study aimed to evaluate mid expiratory flow and dysanapsis parameters in standard spirometry for possible substitution of PC35. Thirty-seven subjects with clinical findings suggestive of asthma who had normal standard spirogram were entered in this case-control prospective study. Thirty- seven healthy volunteers were also included in this study as controls. Airway responsiveness was examined by methacholine challenge test and measurement of PC20 and PC35. In addition, concentration of methacholine needed for 20% reduction in FEF25-75%, MEF50%, and FEF25-75%/FVC was determined and compared with PC35 as the gold standard. FEF25-75%/FVC ratio was used for evaluation of dysanapsis. PC35 was more sensitive than PC20 and was obtained in 93% (68/73) of patients in both groups. Although PC35 and new parameters could be positive in both groups, the concentrations in two groups were significantly different. Regression model showed that in asthmatic patients all the conventional and new parameters had good and comparable correlations with PC35. But in the control group alone and in both asthmatic and control groups, PC 20 of FEF25-75%/FVC showed a significant correlation with PC35. PC20 of FEF25-75/FVC was also significantly correlated with PC20 of FEV1 in asthmatic and control groups. PC20 of FEF25-75/FVC and MEF50% revealed the best accuracy. An equation was determined for calculation of PC35 according to PC20 of FEF25-75 /FVC and MEF50% when PC35 was unavailable. PC20 of FEF25-75/FVC ratio and MEF50% are sensitive parameters for diagnosis of airway responsiveness. PC20 of FEF25-75/FVC is the best substitution for PC35.

Bronchiolitis obliteans organizing pneumonia (BOOP) is characterized clinically by a subacute or chronic respiratory illness. The purpose of this study was to describe clinical and radiologic features of Idiopathic (cryptogenic) bronchiolitis obliterans organizing pneumonia. We retrospectively reviewed 11 patients with biopsy proven BOOP at Masih Daneshvari Hospital, for whom well documented clinical and radiographic data were available. The final diagnosis of BOOP was validated if the followings were present:1) Negative sputum or bronchoalveolar lavage (BAL) analysis for Mycobacterium tuberculosis2) Open lung biopsy (OLB) or trans-bronchial lung biopsy (TBLB) findings characteristic of BOOP 3) Negative findings for systemic disorders or associated primary pulmonary lesions such as cancer 4) Prompt response to steroid therapy. The mean age of patients with BOOP in this case series was 46.3±24.6 yrs.(range 32-70); the male/female ratio was 7/4. The clinical pattern in BOOP presentation was more similar to classic sub-acute infectious process: dyspnea in 9 patients (81.8%), fever in 5 (45.4%), and cough in 6 (54.5%). The symptoms were usually mild. Physical examination showed sparse crackles in 5 patients (45.4%) and wheezing in 7 (63.6%). The most frequent radiologic patterns were ground glass appearances (63.6%) and diffuse infiltration associated with reticular pattern (27.2%). In 6 patients chest images showed bilateral distribution. The clinical and radiological manifestation of BOOP in our patients did not differ from other reports. BOOP cases may present a distinct entity like pneumonia. Physicians in charge of these patients were all surprised of BOOP diagnosis by tissue examination. Trans- bronchial lung biopsy specimens along with strongly suggestive clinical and radiologic findings in many cases were adequate for making the diagnosis. We suggest that the diagnosis of BOOP must be considered in any immunocompetent patient with pneumonia with poor or no response to antibiotic therapy.

The effect of mental status on physical conditions has been well established and it has been proven that psychosocial factors play an important role in physical diseases. There are numerous factors that may be involved in development of asthma. Emotional stress and anxiety attacks are of the factors responsible for initiation of asthmatic attacks. For evaluation of the personality traits of asthmatic patients, the Minnesota Multiphasic Personality Inventory (MMPI) test was used which had 8 clinical and 3 validity scales. It is one of the most frequently used personality tests in mental health. This study was performed on 300 asthmatic patients including 197 females and 103 males. Along with personality traits, we also evaluated demographic characteristics of patients including age, sex, level of education, marital status, and number of children. Level of education, age and marital status were significantly correlated with the severity of disease (P=0.001, P=0.007 and P=0.011, respectively). Our study results showed that people with low educational level, middle-aged and married individuals were at higher risk of developing severe asthma. Correlation coefficients between clinical scales of D (depression), Hs (hypochondriasis), Hy (hysteria), Pt (psychasthenia), Pa (paranoia) and Sc (schizophrenia) and severity of asthma were rD=0.301, rHs=0.306, rHy=0.159, rPt=0.161, rPa=0.1431 and rSc=0.136, respectively. All correlations were statistically significant indicating the presence of depression, excitability and anxiety symptoms in these patients. Signs and symptoms of mental disorders are usually disregarded and therefore, they often remain undiagnosed. However, such conditions are potential risk factors for psychosomatic diseases like asthma.

During the last decade of the 20th century, the number of new cases of tuberculosis (TB) in children increased worldwide. Pulmonary TB in adults is diagnosed by isolation of Mycobacterium tuberculosis. In children; the diagnosis is based on diagnostic criteria and characteristics of the disease. The aim of this study was to evaluate bacteriological specimens from children with TB hospitalized in the pediatric tuberculosis ward of Masih Daneshvari Hospital.We assessed the results of smears, cultures and polymerase chain reaction (PCR) of gastric aspirates for confirmation of clinical findings. A descriptive study was performed on126 medical records of children with TB during a 5-year period. Demographic data including age and gender, pulmonary and extra-pulmonary TB presentations and gastric washing smear, culture and PCR were collected and then analyzed by SPSS software. The study patients were divided into three groups of age: 0-5 yrs, 6-10 yrs and 11-15 yrs. The highest frequency (68.3%) was observed in the 11-15 years age group; 47.6% of the patients were males and 52.4% were females. The tuberculin skin test was positive in 73% of patients. Gastric aspirate smears, culture and PCR were positive for Mycobacterium tuberculosis in 55.6%, 58.7% and 53.2% of cases, respectively. Computed tomography (CT) scan showed evidence of TB in 94.4% of patients. In 34 patients, chest x-ray was normal and TB was diagnosed via CT-scan of the lung. The present study suggests that gastric lavage smears and cultures have high diagnostic value in TB diagnosis in children. In addition, chest CT-scan is recommended for diagnosis of TB in suspected children when other evaluations are normal.

Evaluation of depth of anesthesia is especially important in adequate and efficient management of patients. Clinical assessment of EEG in the operating room is one of the major difficulties in this field.This study aims to find the most valuable EEG parameters in prediction of the depth of anesthesia in different stages. EEG data of 30 patients with same anesthesia protocol (total intravenous anesthesia) were recorded in all anesthetic stages in Shohada-e-Tajrish Hospital. Quantitative EEG characteristics are classified into 4 categories of time, frequency, bispectral and entropy-based characteristics. Their sensitivity, specificity and accuracy in determination of depth of anesthesia were yielded by comparing them with the recorded reference signals in awake, light anesthesia, deep anesthesia and brain dead patients. Time parameters had low accuracy in prediction of the depth of anesthesia. The accuracy rate was 75% for burst suppression response. This value was higher for frequency- based characteristics and the best results were obtained in ß spectral power (accuracy: 88.9%). The accuracy rate was 89.9% for synch fast slow bispectral characteristics. The best results were obtained from entropy-based characteristics with the accuracy of 99.8%. Analysis of the entropy-based characteristics had a great value in predicting the depth of anesthesia. Generally, due to the low accuracy of each single parameter in prediction of the depth of anesthesia, we recommend multiple characteristics analysis with greater focus on entropy-based characteristics.

Smoking is the first preventable cause of death in the world. Regulating the production, import, distribution and sell of cigarettes is the most prominent action for implementation of tobacco control programs. In this regard, it is necessary to know the smoker''s choice in terms of different cigarette brands.This study has been designed before the implementation of Framework Convention of Tobacco Control (FCTC) and Iranian Comprehensive Tobacco Control Law. This cross-sectional study was conducted through questioning during the year 2006. Health-care personnel were chosen for conduction of this project and participated in training courses conducted with the cooperation of Health Departments of 3 major universities in Tehran.The Questionnaires were designed according to WHO and IUATLD questionnaires. Health-care workers distributed the questionnaires among smokers in specific areas. A total of 3026 people participated in this study among which 2413 (79.7%) were men. Consumption of foreign-made cigarettes was 65.5% whereas consumption of locally-made cigarettes was 34.5%. Also, the use of legally-imported cigarettes was 55.9% compared to the use of illegally-imported cigarettes which was 44.1%. Consumption of foreign-made and illegally-imported cigarettes was higher among women (78.4% and 72.5%, respectively). Also, consumption of foreign-made cigarettes among the age group of under 25 years old was less than any other age group (52%). Consumption of foreign-made and illegally-imported cigarettes was considerably high in our population and even higher among women. Therefore, it is recommended that the authorities make it hard for the people to access illegally-imported and smuggled cigarettes by complete implementation of tobacco control programs and by adopting effective anti-smuggling measures.

Hemangiopericytoma is a mesenchymal neoplasm originating from the pericyte, a cell type that surrounds the capillaries. Its primary localization in the lung is extremely rare. A 70-year-old woman was referred to our hospital complaining of cough and non-massive hemoptysis from 2 months earlier. She was a nonsmoker with a history of close contact with sheep and a dog. On physical examination, she had reduced respiratory sounds in the left upper zone. Her chest x- ray revealed a mass in the left middle and upper zones. CT-scan of the lungs revealed a parenchymal mass with -4 to 20 (HU) densities. Hemagglutination test was negative for hydatid cyst. Fiberoptic bronchoscopy was normal; therefore, the patient underwent surgical operation. The pathology of the mass was primary pulmonary hemangiopericytoma.

Pulmonary involvement in tuberous sclerosis is very rare and seems to be associated with a more benign course. We present a 21-year-old woman with bilateral angiomyolipoma. She developed spontaneous pneumothorax which was successfully managed by tube thoracostomy. No recurrence of pneumothorax has been observed up to the present (4 years follow-up).