Tanaffos Respiration Journal
Volume:9 Issue: 2, Spring 2010

Air pollution is one of the most important environmental problems affecting urban population with significant global, national and local consequences. Therefore, to guarantee the right of citizens to clean air, criminal fines and penalties have been set forth in order to confront and punish the transgressors. This study aimed to discuss and analyze the penalties for air pollution violations. In this study, the legal conception of air pollution and the right to clean air are discussed first, and then the Iranian and French legislations regarding air pollution control laws are reviewed. This study emphasizes the need for establishing and including civil and administrative penalties in the contemporary environmental law.

There are several studies on the effect of diabetes mellitus (DM) on clinical symptoms and radiological findings of multi- drug resistant tuberculosis (MDR-TB) and bacteriological findings in pulmonary tuberculosis patients. Considering the contradictory results of these studies, this study was conducted for further investigation in this regard. This was a case – control study conducted in Masih- Daneshvari Hospital in Tehran. Forty-seven patients with tuberculosis infection and diabetes type II were selected as the case group and 102 TB cases without diabetes were considered as controls. There were significant differences in hemoptysis, dyspnea and loss of appetite between the two groups, but no significant difference was found in cough, sputum production, chest pain, night sweat, fever or weight loss.Also, there was no significant difference between the 2 groups in terms of MDR-TB and bacteriological findings. On CXR, diabetic patients had a higher prevalence of typical presentations along with cavitary lesion(s) but no significant difference was found between the 2 groups in terms of radiological presentation. In this study, diabetes type II did not have much influence on clinical symptoms and bacteriological findings of TB patients. However, PTB–DM type II cases may be considered more contagious due to the higher prevalence of cavitary lesions compared to those without DM. Prevalence of MDR-TB was the same in both groups.

Bronchial anthracosis is defined as appearance of multiple dark anthracotic pigmentations on large airway mucosa with or without airway narrowing or obliteration. Since there has been vague and controversy regarding the relationship between bronchial anthracosis and pulmonary tuberculosis, we conducted this study to shed light on this matter. In this cross-sectional study, data was obtained from reviewing the files of 1,594 patients who underwent bronchoscopy in Afzalipour Hospital during 2003 to 2007. Those with dark pigmentation on their airways mucosa were considered as having bronchial anthracosis. During bronchoscopy, samples were collected from the airways in the form of bronchoalveolar lavage and then the smear and culture of these samples were examined for acid fast bacilli. Patients with both positive culture and smear and those with positive culture alone for acid fast bacilli were considered as having pulmonary tuberculosis. Of 1,594 cases studied in this research, 333 (20.8%) had bronchial anthracosis, out of which 158 (55.5%) were women. Risk of bronchial anthracosis was 0.4 times less in men (CI 95%=0.32-0.52) (p<0.001). In other words, bronchial anthracosis had a significantly less prevalence among men. Also, risk of tuberculosis in people with bronchial anthracosis was 2.6 times more than that of healthy people (CI 95%= 1.48-4.75) (p<0.001). This research revealed a significant correlation between bronchial anthracosis and pulmonary tuberculosis. Therefore, performing necessary tests and follow-ups for pulmonary tuberculosis is necessary in cases that undergo bronchoscopy for any reason and those with bronchial anthracosis.

Antiphospholipid antibodies are among the most important risk factors of arterial and venous thrombosis. Various studies have demonstrated that these antibodies are seen in patients with deep vein thrombosis (DVT) and pulmonary embolism (PE) more than normal individuals but there are a few studies about prevalence of these antibodies in patients younger than 50 years old with venous thromboembolism (VTE). This study aimed to evaluate these antibodies in this age group. This was a case-control study. Fifty patients younger than 50 years old with venous thromboembolism (DVT, PE or both) who were diagnosed according to the standard criteria were compared with 48 subjects in the control group. Subjects in the control group were age and sex matched with patients and had no history of venous thromboembolism. Both groups had no history of malignancy or other chronic diseases. Lupus anti-coagulant and serum anticardiolipin antibodies (IgG and IgM) were measured in both groups. Data were analyzed using SPSS version 11.5 software. Fifty VTE patients younger than 50 years of age enrolled in this study (28 males and 22 females; mean age: 38.14±6.5 yrs). Forty-eight subjects were selected as healthy controls (27 males and 21 females; mean age: 38.35±5.06 yrs). Mann –Whitney test showed a significant difference between serum IgM anticardiolipin antibody levels of VTE patients (8.04 MPL units/ml) and those of healthy subjects (1.85 MPL units/ml) (P=0.001).Also, a significant difference was found between serum IgG anticardiolipin antibody levels of VTE patients (8.29 GPL units/ml) and those of healthy subjects (3.51 GPL units/ml) (P=0.001). In VTE group, 7 patients (M/F = 4/3) had an IgG level >10 GPL units/ml and 6 patients (M/F =2/4) had an IgM level >10 MPL units/ml while none of the healthy subjects had IgG or IgM levels higher than 10 (PIgM=0.015 and PIgG=0.007). Lupus anti-coagulant was positive in four (8%) but negative in all healthy subjects (P=0.04). This study demonstrated that antiphospholipid antibodies were more prevalent in VTE patients younger than 50 years old compared to healthy subjects. Considering the fact that these patients need stronger and longer treatment, it seems necessary to evaluate every VTE patient younger than 50 yrs for antiphospholipid syndrome.

Cigarette smoking is among the main preventable causes of untimely death, morbidity and mortality in the world. Various reasons have been suggested for cigarette smoking among students which are mostly related to the culture and customs of a country. This study aimed to evaluate the factors associated with cigarette smoking among students. This cross-sectional analytical study was conducted in Tehran in 2008 and used "Global Youth Tobacco Survey" (GYTS) self-administered questionnaire for data collection. A total of 4,523 students (2,251 girls and 2,272 boys) were selected by using randomized multi-stage cluster sampling. SPSS version 16 software, chi-square test and logistic regression test were used for data analysis. A total of 4,523 students (50.2% boys and 49.8% girls) with a mean age of 14.69±2.09 yrs were evaluated. The prevalence of smoking experience, current smoking, and current regular smoking among students was 25.5%, 7.4%, and 1.9%, respectively. The score of knowledge was 5.29±1.29 for all students, 5.34±1.23 for nonsmoker students, and 4.57±1.74 for current smokers (P<0.01). The mean score of attitude towards smoking was 27.29±7.41 for all students, 27.56±7.20 for non smokers and 21.10±7.69 for current smokers. The difference between the scores of current smokers and nonsmokers was statistically significant (P<0.01). In evaluation of the correlation between cigarette smoking and different variables, several factors were found to increase the likelihood of smoking among students including the male gender, older age, low grades, having smoker friends, pocket money more than 300,000 Rials (~$30.00) per month, exposure to family members’ smoking, lack of parental advice, low scores for knowledge, low scores for attitude, passive smoking(exposure to secondhand smoke at home or outside),poor perception of anti-smoking messages broadcasting by the media, watching actors smoking (cigarette or hookah) in movies, and last but not least viewing smoking advertisements and cigarette commercials (OR=1.464-57.707). Considering our study findings, planning and implementation of educational tobacco control programs are required at schools aiming at preventing cigarette smoking by increasing the knowledge and correcting the attitude of students.

Determining the factors associated with secondhand smoke (SHS) exposure in children provides valuable information for smoking control strategies. This study aimed to assess factors related to SHS exposure in infants based on urinary cotinine measures. A cross-sectional analysis of the data that were collected as part of the randomized controlled trial was conducted. Participants were 130 smoking households with children under the age of 1 year attending a health care center in southern Tehran. Eligible parents consented to participate in this study and completed a questionnaire including demographic data, questions regarding smoking at home, smoking status and Fagerström test through face-to-face interview. The Infants’ urinary cotinine level was measured using gas chromatography, adjusted with urinary creatinine level and reported as cotinine (ng)/ creatinine (mg). Factors related to infants’ SHS exposure were assessed using the multivariate logistic regression model based on standard cut-point (30 ng of urinary cotinine/mg creatinine). The final multivariate logistic regression model showed that social status (p=0.002), home smoking restriction (p=0.05) and the infant''s age (p=0.01) were associated with the infants’ SHS exposure determined based on urinary cotinine levels. These results support the influence of social status, home smoking restriction and infant''s age on the exposure of infants to SHS. (Tanaffos2010; 9(2): 43-49)

Post-operative pain after open cholecystectomy can result in increased oxygen consumption, increased risk of myocardial ischemia, atelectasis, pneumonia, decreased vital capacity, and increased morbidity and mortality. In this study we compared the analgesic effects of intrapleural bupivacaine with intravenous morphine post-operatively. Sixty patients who were candidates for elective open cholecystectomy were randomly divided into two groups based on randomized numbers for a double-blinded randomized clinical trial. Anesthesia technique was precisely the same for all patients. At the end of surgery, 20 cc of 0.5% bupivacaine and epinephrine with a concentration of 1/200,000 was injected intrapleurally for group B patients; whereas, 0.1 mg/kg intravenous morphine and 20cc normal saline was injected intrapleurally for group M cases. In order to obtain a visual analog scale(VAS) <3, morphine consumption up to 12 hours post-op was 10.5±3.2 mg in group M which was much more than that of group B, in which this amount was 4.3±1.5 mg. This difference was statistically significant (P<0.05). The mean frequency of morphine injection was 3.7±1.3 times in group M and 1.2±0.7 times in group B and the difference in this regard was statistically significant. The patients’ first demand for morphine was 1.8±0.6 and 4.2±0.3 hours postoperatively for groups M and B respectively. The difference in this regard was statistically significant (P<0.05). In this study we realized that a single shot of intrapleural bupivacaine can provide an almost favorable analgesia for the management of post-operative pain due to open cholecystectomy compared to other current analgesic methods. It may reduce the related complications as well. We observed no complication due to the single shot of intrapleural bupivacaine.

ICU hospitalized patients usually need sedation. Common sedatives include benzodiazepines, opioids, barbiturates and etc. This study was conducted to compare the sedative, hemodynamic and respiratory effects of propofol and remifentanil in pulmonary disease patients requiring intubation and mechanical ventilation in intensive care unit of Masih Daneshvari Hospital during the years 2005-2007. This study was conducted as a randomized controlled clinical trial. All patients with pulmonary disease requiring mechanical ventilation in the ICU were randomly divided into two groups. The first group was given an initial 10 μg /kg/min infusion of propofol and the second group received an infusion of remifentanil starting with 0.05 μg /kg and the doses sequentially increased to reach a sedation state of 3-4 according to Ramsay sedation scale. The regimen was continued for 48 hours, during which blood pressure, heart rate, and respiratory rate were monitored every 3 hours. Data was analyzed using SPSS version 11 software. A total of 40 patients with a mean age of 58.67±18.57yrs (range 21-85 yrs) including 27 (67.5%) males and 13 (32.5%) females entered the study. The mean time to optimal sedation was 17.9±13.9 min and 20.16 ±16.11 min for remifentanil and propofol groups, respectively (p=0.09). The mean systolic and diastolic blood pressures of each group showed a small decrease after initiation of infusion but this decrease was not statistically significant (p= 0.26 for remifentanil and p=0.12 for propofol group). The heart rate and respiratory rate showed no dramatic change during the infusion period. Both remifentanil and propofol are suitable drugs for sedating patients with pulmonary disease and neither of them induces dramatic hemodynamic changes. Therefore, using each of them is effective for optimal sedation of patients.

Hydatid disease, still endemic in developing countries, involves the liver and the lungs of the vast majority of cases. We report a very rare presentation of hydatid disease in a 35 year-old man with a cervicomediastinal mass and vocal cord paralysis, suspected of thyroid tumor. Surgery was curative and dysphonia disappeared completely.

We report a 25-year-old female with a giant cell tumor originating from the anterior arc of the rib who presented with bilateral pulmonary metastases. She underwent extensive resection of the thoracic wall, attached right middle lobe and right upper lobe metastases. She was treated with Interferon-α-2b (INF) followed by systemic chemotherapy. After 23 months, she had no complaint and no significant disease progression was detected through imaging studies.

A 40 year-old taxi driver residing in Tehran presented with two episodes of massive hemoptysis following a 3-week period of productive cough, dyspnea on exertion, fever, night sweat, anorexia and weakness. He was a heavy smoker (40 packs per year), and an IV drug user since 5 years ago with a history of imprisonment 3 years ago. He had no history of alcohol consumption or unprotected sexual contact. His physical examination revealed poor oral hygiene, diffuse coarse crackles in lungs, edema of the lower extremities which was dominant in the left leg and no petechia, purpura or any other skin lesion. He had normal blood biochemistry, liver function tests and electrolytes. Complete blood count revealed a microcytic, hypochromic anemia with a PMN dominant leukocytosis and normal platelet count. Erythrocyte sedimentation rate was 87. PPD was non-reactive and 3 times sputum smear for acid fast bacilli was negative. Urinalysis was normal. Chest x-ray (Figure 1) and lung CT-scan (Figure 2) were performed. Transthoracic and transesophageal echocardiographies (TTE & TEE) were reported to be normal without vegetation or other abnormalities.