Tanaffos Respiration Journal
Volume:4 Issue: 1, Winter 2005

Apoptosis can be stimulated or inhibited by different signals or cell-cycle arrest proteins, each plays a specific role during Mycobacterial infection. This study analyses the expression and co-relation of apoptotic and anti- apoptotic proteins (P53, FAS, BAX and BCL-2) in human Tuberculosis granulomatous tissue reactions by immunohistochemistry. The formalin fixed paraffin embedded blocks of different biopsy specimens from 40 documented TB patients were studied by immunohistochemical staining for expression of P53, FAS, BAX and BCL-2 proteins; 28, 26, 12, 32 paraffin blocks, respectively. In epithelioid macrophages of TB granulomas, high positivity for P53 (100%), BAX (83.3%), and FAS (57.7%) was associated with down regulation of BCL-2 (12.5%). Although, the reaction of surrounding small lymphocytes was vice versa. The multinucleated giant cells also revealed positive reaction for P53 (92.8%) and BAX (83.3%) proteins. In comparison to previous findings, our studies revealed immunolocalization of P53, FAS, and BAX in MTB granulomas by a simple routine pathological method. These findings also re-emphasize the value of immunohistochemical studies in regard to the role of apoptotic proteins in MTB infection pathogenesis. These studies may lead to further effective and better therapeutic strategies in TB patients.(Tanaffos 2005; 4(13): 11-19)

Fiberoptic bronchoscopy is occasionally associated with significant hemodynamic complications such as hypertension, tachycardia and arrhythmia. The ability of a2 adrenoreceptor agonists to inhibit central sympathic outflow may benefit the patients undergoing bronchoscopy by reducing the incidence and severity of hemodynamic abnormalities. We designed this study to examine whether clonidine given as an oral premedication would attenuate the hemodynamic stress response during fiberoptic bronchoscopy. We performed a prospective,randomized, double blind study on one hundred patients scheduled for bronchoscopy to evaluate the effects of 300mg oral clonidine premedication on the hemodynamic alteration and incidence of ECG changes. During the procedure, patients receiving placebo exhibited a significant increase in mean arterial pressure (97±18 to 120±17mmHg) and heart rate (90±16 to 109±17) compared with the clonidine group (mean arterial pressure 100±15 to 110±17 and heart rate 89±19 to 97×19, P < 0.05). Pretreatment with oral clonidine significantly attenuates MAP and HR changes following bronchoscopy. It is especially beneficial in patients with cardiac disease. (Tanaffos 2005; 4(13): 21-25)

Bronchial asthma is characterized by airways inflammation and hyperreactivity of tracheobronchial tree. Magnesium (Mg) deficiency leads to increased airways hyperreactivity. This study was performed on patients with chronic stable asthma to determine their blood serum magnesium values and compare them with general healthy population to assess whether there is a difference between them. This was a prospective, case-control study which was performed on patients with chronic stable asthma in Loghman Hakim Hospital. Forty-two consecutive volunteer patients with chronic stable asthma according to the definite criteria and healthy sex and age-matched subjects were chosen. Secondary causes of hypomagnesemia were found out by the questionnaire and were ruled out. Serum blood sample for measuring magnesium value was obtained. Normal values were 1.8 mg/dl in males and 1.9 mg/dl in females. In the final exam, significant difference between two groups was noted (P<0.001). Hypomagnesemia was detected in 40.5% of the chronic stable asthmatic patients. Overall mean age was 40.16±12.8 yrs. and the mean Mg value was 1.85±0.28. Male to female ratio was 23/19. Hypomagnesemia was confirmed in chronic stable asthma in Iranian patients. It may be due to the quality and quantity of using therapeutic agents and type of diets which are low in magnesium supply. However, further evaluation is needed. (Tanaffos 2005; 4(13): 27- 32)

In some cases, apart from the evacuation of the pleural space, it is required to inject a medicine into it. This procedure through the ordinary chest tubes is not an easy task since it might cause some unwanted problems for the patient. A new chest tube designed and produced by a few researchers contains a catheter in its thickness, which enables it to be used for both pleural drainage and drug entrance simultaneously. Instead of the ordinary chest tube, the new chest tube(with catheter)was inserted in 50 patients suffering from various thoracic disorders which needed intrapleural drainage and injection due to different reasons. Amongst all,26 cases had traumatic hemothorax and pneumothorax. Following pleural drainage, bupivacaine was injected into the pleural space through the catheter of the new chest tube in order to reduce pain. In 10 patients suffering from malignant pleural effusion, bleomycin was introduced into the pleural cavity as sclerosing substance to create pleurodesis. Finally, irrigation of pleural space was performed by means of the catheter for the remaining 14 patients with empyema. In all cases, intrapleural injections were done easily without the need to detach the chest tube connections and the consequences were satisfactory to all the physicians. No serious complication was observed and merely mild and avoidable side effects took place in 4 patients. The new introductory tube provides a sterile and appropriate pathway to release different kinds of medications into the pleural space, without consuming any extra time or budget.(Tanaffos 2005; 4(13): 33-37)

Localized fibrous tumours of the pleura are very rare. The aim of this case series study is to define clinical feature and determine the optimal treatment and surgical outcome of these tumours. The records of 6 consecutive patients with localized fibrous tumours of the pleura, who were operated between 1994 and 2002, were retrospectively reviewed. Diagnostic procedure, clinical courses, surgical management and outcomes of these patients were studied. 6 patients were enrolled in the study (4 men, 2 women, mean age 41 yrs). All patients were symptomatic at the time. Chest pain, dyspnea and cough were the most common symptoms; CXR and CAT- scan were performed for all patients. Resection was performed through postero-lateral thoracotomy in all patients. Five cases had benign and one had malignant tumour. Local recurrence occurred in 1 patient. One case died because of malignant tumour during a 5-year follow-up. Although localized fibrous tumors of the pleura are histologically considered as benign tumors, because of the risk of recurrence and malignant transformation, complete resection is indicated and long-term follow-up is recommended in all patients. (Tanaffos 2005; 4(13): 39-45)

There is increasing evidence that environmental pollutants may be contributing to an increase in acute and chronic diseases in a wide range of general population, especially children. Benzene is considered as an important air pollutant of the metropolitan areas. The concentration of benzene was measured in four selected regions of Tehran (Bazaar, Dolat-Abad, Chizar, Gheitarieh & Darabad) during a 6-month period. Ambient concentration of benzene in Tehran was in correspondence to overall pollution levels in the air. Mean exposure levels of benzene for male students (10-12 years of age) of the above mentioned areas were 203, 98, 18, and 15 ppb respectively. This measurement for female students (of the same age group and regions) was calculated as 115, 98, 18, and 15 ppb respectively. Differences of peripheral blood cell parameters between male students in different regions were more significant than the differences among female students and this phenomenon could be attributed to lesser exposure of females to air- borne benzene. In general, correlation of peripheral blood contents of HCT, HGB, RBC and Fe of male group was significant in regard to the amount of airborne benzene in different regions of Tehran. Correlation of immune indicators of blood CD4/ CD8 of female group was also significant in regard to the amount of airborne benzene. Considering the results of this study and ambient standard of benzene in the European countries at 5 ppb, control of air pollution in Tehran should receive special consideration and the health of school children in polluted areas, must be under continuous surveillances. (Tanaffos 2005; 4(13): 47-55)

The local cellular immunity is responsible for the pathogenesis and development of disease in the affected organ. In tuberculous pleurisy lymphocytes are principally involved in cellular immunity. This immune response is specially mediated by Th1 and its related cytokines. In laboratory investigations all of the interleukins associated with Th1 axis, such as interferon gamma, are 20-60 times higher in pleural fluid as compared to blood. This significant increase in lymphocytes of the pleural fluid as compared to blood is a strong evidence for the compartmentalization of cytokines of Th1 axis in pleura, resulting in an appropriate and satisfactory immune response to mycobacterial infections. PPD reaction test (Mantoux test) is a delayed hypersensitivity reaction in skin in which cellular immunity and Th1 axis are responsible. It seems that compartmentalization of CD4+ T cells is effective in response to Mantoux test in patients suffering from tuberculous pleurisy.This study was conducted either to prove or refuse this hypothesis. This was a 2-year cross-sectional study in which we studied the status of lymphocyte subgroups by flowcytometry in peripheral blood and pleural fluid of patients with pleurisy in which lymphocytes are principally involved. We also evaluated and compared its relation with Mantoux reaction test. Overall, 36 patients with pleurisy in which lymphocytes were principally involved in their pleural fluid entered the study. Out of them, 25 suffered from tuberculous pleurisy. In the tuberculous pleurisy group (25), 17 (68%) had positive Mantoux test while in 8 cases (32%), this test was negative. There were 31 males (86%) and 5 females (14%) with the age range of 17 to 60 yrs and the mean age of 35 years. In the PPD negative group the CD4+ count was significantly high in the pleural fluid. However, in PPD positive cases the CD4+ count was less significant but was still significantly higher in pleural fluid as compared to peripheral blood (p< 0.05). In PPD negative group CD8+ lymphocytes were significantly in a higher level than in blood. This was not seen in PPD positive group. Cellular immunity is the main local response in these patients. As it is seen majority of cells present in the pleural fluid are CD4 and CD8 lymphocytes. CD19+ lymphocytes are in minority. The dominance of CD4+ lymphocytes in pleural fluid of PPD negative and PPD positive groups is a sign of Th1 compartmentalization in this disease. But, the important difference between these two groups is the dominance of CD8+ lymphocytes in peripheral blood of PPD negative cases and the CD4+/CD8+ ratio in pleura and blood of PPD positive cases are close to each other. It means that the difference between the CD4+ and CD8+ counts in the pleural fluid and blood is significantly higher in PPD negative group compared to the PPD positive one.This difference indicates the effective role of compartmentalization of active CD4+ lymphocytes of pleura in response to Mantoux test, as some studies suggest that cutaneous anergy is due to aggregation of active lymphocytes in pleural fluid. Secondly, according to the accumulation of lymphocytes in pleura and considerable difference in the type of lymphocytes in peripheral blood and pleura, obtaining Paraclinical data related to disease (specially ADA) only by evaluating the blood is not appropriate. This fact is confirmed in other studies as well. (Tanaffos 2005; 4(13): 57-62)

Tuberculosis is a major world health problem mainly in the developing countries. Early isolation of infected patients and application of chemotherapy are the main prevention strategies for tuberculosis control. Although acid-fast stained smears and culture of M.tuberculosis are the standard procedures of diagnosis, they are low in sensitivity and time consuming, respectively. Polymerase chain reaction (PCR) technique has simplified and boosted the direct detection of M.tuberculosis in a significantly shorter time than two conventional methods mentioned. In this study, which was conducted in 9 months, 211 clinical samples were collected from patients with suspected M.tuberculosis complex who had referred to NRITLD. They were tested by PCR assay, culture technique and Ziehl-Neelsen staining. Two pair oligonucleotides were used in PCR assay, detecting 245bp of IS6110 sequence. Results of PCR assay were compared with those of culture technique. One-hundred and forty five samples (68.7%) were sputum and the other 66 samples (31.3%) were bronchoscopy lavage. Twenty-five samples (11.8%) were positive by PCR assay out of which 21 (84%) were culture positive too.176 from 186 samples with PCR negative results were culture negative too. These 10 samples were examined for PCR inhibitor and identification of M.tuberculosis. Twenty percent (2 samples) of these had PCR inhibitor and 20% (2 samples) were not M.tuberculosis complex. Based on this study, after excluding the samples which had PCR inhibitor and non-tuberculosis complex, sensitivity and specificity of PCR assay in comparison with results of culture and Ziehl-Neelsen staining (as a gold standard) were 93.3% and 98.3%, respectively. Positive and negative predictive values were 84% and 94.6%, respectively. This study showed that there are no significant differences between cultures and PCR methods. For this reason, we can use PCR assay for direct detection of DNA from M.tuberculosis in clinical samples.(Tanaffos 2005; 4(13): 63-70)

A form of aspergillus involvement of respiratory system is aspergillus tracheobronchitis which is mainly seen in HIV positive or lung transplanted patients.This disease can result in a thick membrane caused by aspergillus and necrotic materials.The treatment is with amphotericin B or itraconazole. In cases with thick and large membrane, it is usually necessary to remove the membrane with a rigid bronchoscope. A 60-year old man who underwent right lung transplantation as the result of pulmonary emphysema developed cough and dyspnea 3 weeks after the operation. In bronchoscopy, mucosal inflammation and a white thick membrane were noted in the right intermedius bronchus. In biopsy of the membrane, aspergillar hypha and fibrinoleuckocytic exudates were observed. The patient underwent treatment with Itraconazole and membrane debridement. The symptoms were all vanished and there were no complications in the bronchus in the later bronchoscopies except the minimal scarring at the site of lesion. (Tanaffos 2005; 4(13): 71-75)