Tanaffos Respiration Journal
Volume:8 Issue: 4, Autumn 2009

Revised Geneva score is a clinical prediction rule used in determining the pre-test probability of pulmonary embolism (PE). It has been recently introduced and is independent of the doctor''s experience applying the rule. This study aimed to evaluate the predictive accuracy of revised Geneva score in the diagnostic protocol of pulmonary embolism and its role in decreasing the need for pulmonary imaging studies. In this study, we evaluated the medical records of 242 patients suspected for pulmonary embolism who underwent CT scan of the lung as part of their diagnostic protocol from October 2007 to February 2009. Six patients were excluded from the study due to their indeterminate CT scan results. The mean age of patients was 58 yrs and 62% of patients were males. The overall prevalence of pulmonary embolism was 24%. By increased scoring, the clinical probability of pulmonary embolism increased as well (P=0.011). According to the classification of revised Geneva score, clinical probability of pulmonary embolism was evaluated to be low in 25% of patients, intermediate in 72% and high in 2%. Prevalence of pulmonary embolism based on the CT scan results was 7.7% ranged (0.5-14.9) in the low probability category, 22.5% ranged (15.6-29.4) in the intermediate, and 50% ranged (0.01-0.99) in the high-probability category which were comparable with the rates reported in the derivation set except for the prevalence rate for high probability patients (9%, 27.5% and 71.7%, respectively).The area under the ROC curve was calculated based on continuous scoring to be 0.675. Revised Geneva score had an acceptable predictive accuracy in low and intermediate-probability groups. We could not reach a conclusion regarding high probability patients due to the small number of such cases in this study. (Tanaffos 2009; 8(4): 7-13)

The management of bronchial asthma is an emerging problem for physicians. The introduction of guidelines has improved the diagnosis of asthma, but not the patient''s adherence. To resolve this problem, an educational ambulatory course called “The School of Asthma“was started in the year 2000 in the department of respiratory diseases of the 4th local health unit of Chiavari. A team comprised of a physician, a nurse and a psychologist informed a small group of patients (5-8) about the pathophysiology and clinical manifestations of asthma, its pharmacological therapy and the administration of inhalation drugs. Our statistical evaluation showed a reduction in necessary use of bronchodilators, a decrease in visits to the emergency department and an increase in use of inhaled corticosteroids. These figures suggest that an educational course improves the adherence of the patients and may reduce the health costs of the disease. (Tanaffos 2009; 8(4): 14-18)

Respiratory disorders are among the most common occupational diseases. Tile and ceramic industry is quite popular in Iran and workers in this industry are exposed to harmful dust particles affecting their respiratory system. This study was conducted in a tile and ceramic factory. The study group consisted of factory workers of the production units; whereas, the control group included the executive employees of the factory. A questionnaire was designed covering all the required data. There were a total of 411 workers. After considering the exclusion criteria, 243 workers in the study group were compared with 168 controls in terms of their respiratory status. Respiratory complaints were significantly higher in the study group compared to controls (p=0.023). Frequency of abnormal spirometric findings was significantly higher in the study group (p<0.001). A significant correlation was found between the occupational exposure to tile and ceramic dust and abnormal spirometric findings after adjusting for age, duration of employment and smoking habits (p<0.05). Our study results demonstrated that occupational exposure to ceramic and tile dust can harm workers’ respiratory system. Therefore, it is recommended to diminish workers’ exposure to tile dust by proper implementation of respiratory protection programs. Also, filling out the standard respiratory questionnaire and performing the pulmonary function tests are advised for workers in their periodic examination programs. (Tanaffos 2009; 8(4): 19-25)

The global tobacco epidemic is currently responsible for 5.2 million morbidity and mortality per year seventy percent of which occur in developing countries. Framework Convention on Tobacco Control (FCTC) is the first international public health treaty ratified by all countries in order to encounter the ever-growing tobacco epidemic. This study was designed to evaluate the public awareness of Tehran residents about FCTC. This was a cross-sectional study and sampling was performed in main city centers during the years 2007-2008 by using non-probability sampling method. The questionnaires were designed according to the World Health Organization (WHO) and IUATLD standard questionnaires and a total of 2053 individuals were questioned. Of the participants, 47.2% had experienced smoking (55.5% of men and 28.8% of women). The frequency of daily cigarette consumption was 22/7% (29/7% of men and 7% of women) (P<0.001). Forty-six percent of the participants had experienced hookah (50% of men and 36/8% of women) (P=0.0000). A total of 184 individuals (9%) were aware of FCTC among which, 35 individuals (19%) who comprised 1/7% of the total understudy population claimed to have a complete knowledge regarding some details. Awareness about FCTC was 5.1% among those with an educational level equal or below high school diploma. This rate was 14.9% in those with a bachelor’s degree and 33.3% (more than twice the rate) in those with higher educational levels (P<0.001). Prevalence of smoking was found to be higher in our study compared to similar studies. Higher level of education was significantly associated with greater awareness regarding FCTC. The overall public awareness was low and implementation of public awareness programs regarding FCTC is necessary. (Tanaffos 2009; 8(4): 26-32)

Mycobacterium tuberculosis can be transmitted via aerosols in hospital wards and affect medical students as well as other hospital personnel. This study aimed to assess the changes of tuberculin skin test in medical students compared to pharmacy students during their education. This was a natural multiple cohort study performed in the medical education system to assess the rates of TST conversion among students. Tuberculin skin tests were performed on 212 students, including 100 pharmacy students and 112 medical students before the initiation of their clinical rotations and repeated 36 months later after their exposure to hospital wards. Participants completed self-administered questionnaires. Tuberculin skin test (TST) conversion in medical and pharmacy students was 18.1% and 4.3%, respectively during the years 2003 and 2006. Although there was no significant difference between positive TST of the two groups at baseline, a significant difference (P=0.005) was observed after their exposure to hospital wards. There were no significant correlations between TST conversion and age or gender of students. Exposure of medical students to tuberculosis during their education is substantial in Iran and more attention should be paid to prevention strategies in medical students prior to and during their clinical training. (Tanaffos 2009; 8(4): 33-36)

Critically ill patients may develop visible gastric mucosal injury and stress ulcer soon after admission to an intensive care unit causing upper gastrointestinal bleeding as an important complication. Histamine-2 receptor antagonist (H2RA) prophylactic therapy has been documented to significantly decrease the incidence of upper GI bleeding in critically ill patients. This study was carried out in order to compare the effects of intravenous doses of ranitidine and enteral form of omeprazole suspension on preventing GI bleeding among ICU patients. This study was a double-blind randomized clinical trial conducted on patients admitted to the ICU at the Imam Hossein Hospital in Tehran, Iran. The patients were randomly divided into two groups of A and B. In group A, ranitidine was used as the prophylactic drug against GI bleeding with the dosage of 50 mg two times a day accompanied by placebo gavages through nasogastric tube. In group B, 20 mg of a suspension of omeprazole two times a day was gavaged in addition to 2cc of a parenteral placebo drug. Of 198 patients admitted to the ICU, 69 patients did not meet the inclusion criteria and a total of 129 patients enrolled in this study. During the study 14(20.58%) cases in the ranitidine group and 3(4.9%) in the omeprazole group developed significant GI bleeding. Incidence of GI bleeding showed a significant difference between the two groups using the chi-square test. Of the 68 patients receiving ranitidine, 44 (67.7%) died. This rate was 38 in those receiving omeprazole (62%). Of the patients given ranitidine who faced overt GI bleeding, 12 (85.7%) died. This rate was 3 in the omeprazole group (100%). This study showed a statistically significant difference between omeprazole and ranitidine in preventing overt GI bleeding among ICU patients; but it failed to indicate any difference in prophylaxis of clinically important GI bleeding between the two drugs. (Tanaffos 2009; 8(4): 37-42

Goldenhar syndrome or oculo-auriculo-vertebral dysplasia (OAVD) is characterized by a wide range of congenital anomalies including ocular, auricular, facial, cranial, vertebral and cardiac abnormalities. It is associated with the anomalous development of the first and second branchial arches. Patients with this syndrome usually suffer from unilateral maxillary and mandibular hypoplasia and vertebral anomalies which often result in limitation of neck movement. For this reason, intubation is very difficult in these patients and anesthesiologists usually face difficulty in airway management. Newborns with this syndrome often have premature internal organs, low birth weight and airway disorders. As a result, a safe anesthesia in such patients requires a complete knowledge regarding the metabolism and side effects of anesthetic drugs.Our first case was a preterm 28-day old female with a fetal age of 28 weeks, birth weight of 1,200 g and gestational age of 32 weeks. At the time of admission, she weighed 1,500 g. She developed jaundice shortly after birth for which she underwent exchange transfusion. She was hospitalized in NICU for 14 days. Our second case was a 2 kg, 20-day old newborn with a fetal age of 37 weeks. Our third case was a full term 10-month old infant weighing 8 kg and our forth case was a 14 kg, 29- month old child who was a candidate for emergency surgery of dermoid cyst and bilateral upper lid coloboma.Anesthesia induction was performed by inhalation anesthesia with N2O/O2= 50% and sevoflurane (0.5-3.5%); and in BIS (Bispectral Index) = 43, the appropriate size LMA (laryngeal mask airway) was inserted. Anesthesia was maintained by using N2O/O2=50% and sevoflurane (1-2.5%). The BIS value was maintained in the range of 42-47. The surgical operations lasted for about 60-150 minutes. Patients regained consciousness 5 minutes after the completion of surgery and were transferred to the recovery room with stable vital signs. They were transferred to the ward 90 minutes later. Patients were discharged from the hospital the next morning with no post-up complications. (Tanaffos 2009; 8(4): 43-50)

The patient was a 35 year-old woman with a 10-month history of breathing difficulty, cough and chest pain. An anterior-posterior chest radiograph revealed opacification of the right hemithorax with reduced right lung volumes. As part of diagnostic evaluation, a computed tomography (CT) scan was performed which showed a huge mass in the right anterior mediastinum with extension to the right side of the pleural space. It was resected through postero-lateral thoracotomy. The patient was discharged in a good condition. The pathology report showed hyaline vascular variant of Castleman,s disease. (Tanaffos 2009; 8(4): 51-54

Post-transplant diabetes mellitus (PTDM), developing in almost one quarter of renal transplant patients within three years after the procedure, contributes to post-transplant morbidity and mortality by increasing the risk of infection and cardiovascular events. PTDM is considered a variant of diabetes mellitus (DM) type II and results in similar microvascular and macrovascular diabetic complications seen in non-transplant patients. In this article, we present a case of single lung transplant patient who developed PTDM with a severe DKA as the first manifestation of the disease. PTDM resolved rapidly after discontinuing tacrolimus. (Tanaffos 2009; 8(4): 55-59)

Foreign Body (FB) aspiration is a life threatening event. Long interval between aspiration and removal can result in formation of granulation tissue around the FB. It can significantly affect the lung structure and manifest as a medical problem requiring surgery and increasing the related complications. It may also limit the visual field and extraction maneuver by flexible bronchoscope.In this case series we report 4 cases of FB aspiration in which FB is covered with granulation tissue and we also discuss different strategies to successful removal of these objects. (Tanaffos 2009; 8(4):60-64)