Tanaffos Respiration Journal
Volume:9 Issue: 4, Autumn 2010

Borage (Borago officinalis) is an herb originating in Iran and some Mediterranean countries of West Asia but found almost all over the world. It grows to a height of 60–100 cm. It has blue, star-shaped flowers. The anti-inflammatory properties of borage are attributed to gamma linolenic acid (GLA) which is found in its seeds. GLA converts to a hormone-like substance called prostaglandin E1 which has anti-inflammatory and vasodilator properties. Borage is the highest known plant-based source for GLA (17-28%). Other substances found in borage seed are linoleic acid (35-38%), oleic acid (16-20%), palmitic acid (10-11%), stearic acid (3.5-4.5%), eicosenoic acid (3.5-5.5%), erucic acid (1.5-3.5%), and nervonic acid (1.5%).Historical reports show that borage has been used in different populations and cultures due to its known properties. Avicenna provided many guidelines for the usages of borage in different medicinal preparations. Though he had described the conduct of a controlled research, it was not until very recently that borage was used in different trials. Some pharmaceutical companies have been using its extract as a base to provide enteral feeding formula for critically ill patients. Borage is indicated in treatment of bronchitis and respiratory infections due to its anti-inflammatory effects. The flowers can be prepared in infusion to take advantage of their medicinal properties. In Iran, it is a common tradition to brew the flower and take it like tea in servings.The guideline of Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition states that patients with severe Acute Lung Injury (ALI) and Acute Respiratory Distress Syndrome (ARDS) should be placed on enteral formulations to provide an anti-inflammatory lipid profile like borage oil (Grade A).Recently, more and more studies on the clinical uses of borage are being published in prestigious journals. Borage is currently used for the treatment of patients with respiratory problems in NRITLD. It seems that this forgotten heritage in Iran merits much more attention considering the present competition in the conduction of research projects.

Incidence of post-intubation tracheal stenoses is relatively high in Iran and the majority of tracheal surgeries are performed to treat these strictures. Therefore, it is important to become familiar with the nature of tracheal stenoses and know their treatment methods. Most surgeons learn different methods of tracheal surgery through operating on cases of post-intubation tracheal stenoses and apply these methods for surgical operation of tracheal tumors. We mainly focused on the technique of tracheal surgery, patient selection, and pre-op and post-op equipments required. Other related fields such as anatomy of the trachea, bronchoscopy, imaging, laser therapy and stenting are mentioned when necessary.

Recent studies have documented an association between some cytokines’ gene polymorphisms and chronic inflammation of the respiratory tract which leads to asthma susceptibility. This study was conducted to investigate if there were any differences in IFN-γ +874 (A/T) and IL-4 -590 (C/T) single nucleotide variations in asthmatic patients compared to normal controls among West Azerbaijani population. IFN-γ +874 (A/T) and IL-4 -590 (C/T) polymorphisms were amplified by ASO-PCR and RFLP-PCR from genomic DNA of 173 individuals including 64 asthmatic patients and 109 control subjects from West Azerbaijani population. The allele or genotype frequencies of IFN-γ +874 A/T in patients were not different from those of controls (p>0.05). The differences between allelic or genotypic frequencies of IL-4 -590 C/T in patients and controls were not statistically significant (p>0.05). These findings showed that IL-4 -590 (C/T) and IFN-γ +874 (A/T) polymorphisms were not associated with asthma susceptibility.

Incidence of post-intubation tracheal stenoses is relatively high in Iran and the majority of tracheal surgeries are performed to treat these strictures. Therefore, it is important to become familiar with the nature of tracheal stenoses and know their treatment methods. Most surgeons learn different methods of tracheal surgery through operating on cases of post-intubation tracheal stenoses and apply these methods for surgical operation of tracheal tumors. We mainly focused on the technique of tracheal surgery, patient selection, and pre-op and post-op equipments required. Other related fields such as anatomy of the trachea, bronchoscopy, imaging, laser therapy and stenting are mentioned when necessary.

Patients in the intensive care unit (ICU) are susceptible to develop electrolyte imbalance resulting in increased mortality rate. Electrolyte measurements especially for sodium and potassium are frequently required in critically ill patients. The purpose of the present study was to compare sodium and potassium concentrations between serum from venous blood and plasma from arterial blood in order to decrease the number of needle punctures required in children admitted to the ICU. Thirty-five patients admitted to the pediatric intensive care unit (PICU) were enrolled in this study; hypotensive patients were excluded. Two cc venous and 1cc arterial blood samples were taken for serum and plasma measurement of sodium and potassium. Venous samples were analyzed within 15 minutes in the hospital laboratory and arterial samples were immediately auto-analyzed in the PICU for sodium and potassium concentrations. Mean serum concentrations of sodium (NaV=137.1±5.5) and potassium (KV=4.1±0.7) were higher than plasma concentrations of sodium (NaA=133.1±11.1) and potassium (KV =3.1±0.7); (p<0.02 and p<0.001 respectively). Linear regression showed NaV=106+0.23 Na A for sodium; (p=0.005), and KV= 1.96+0.69 KA; (p<0.001) for potassium. Serum concentrations of sodium and potassium were higher than their plasma levels and could be calculated using the plasma sample and the formula given above.

This study aimed to compare the inflammatory effects of water pipe smoke with cigarette smoke on inducing exacerbation in asthmatic murine model, under similar conditions of exposure. Thirty-six BALB-C mice in six different groups (one control group, one asthmatic group and four groups of asthmatic exposed to smoke) were entered the study. Animals were exposed to cigarette and water pipe smokes and samples were obtained after 6 and 24 hours. Bronchoalveolar lavage fluid (BALF) was collected and analyzed for neutrophils, eosinophils, nitric oxide, Interferon-γ (IFN-γ) and Interleukin-4 (IL-4). Serum Interferon-γ and IL-4 were also evaluated. Both lungs were sent for histopathological examination. In all sensitized animals, BALF cytology showed a significant decrease in neutrophils and lymphocyte percentage and significant increase of eosinophils. The level of nitric oxide in all smoke exposed animals was significantly higher than sensitized controls. Water pipe smoke did not affect the IL-4 level, but cigarette smoke decreased IL-4 after 6 hours. The level of IFN-γ in BALF decreased after 6 hours of exposure in both exposed groups and returned to baseline after 24 hours. Exacerbation of asthma by water pipe smoke is comparable to that of cigarette smoke. The mechanism of action may be through the suppression of the type 1 T helper cells.

At present, cigarette smoking results in the death of more than 5 million people annually and if the current trend of smoking continues in the 21st century, tobacco-related deaths are projected to grow to one billion. Pictorial warning labels on cigarette packaging are amongst the most effective tools for educating smokers and non-smokers alike about the health risks of tobacco use. Article 11 of the International Tobacco Control Treaty and article 5 of the National Comprehensive Law on Tobacco Control in Iran have discussed this issue. This study aimed at evaluating the correlation between pictorial warning labels on cigarette packaging and quit intention in smokers. In this cross sectional study, 581 smokers presenting to a smoking cessation clinic (affiliated to the Tobacco Control Society) in the year 2009 were evaluated. Smokers were asked to fill out a questionnaire including personal information, history of smoking, number of cigarettes smoked per day, brand of cigarette smoked, whether or not the cigarette used had pictorial warning label, smoking rate before the placement of pictorial warnings compared to after, whether or not they support the placement of such images, and role of these pictures in their quit intention. Data were analyzed using SPSS ver.15 software. A total of 581 smokers participated in this study out of which 512 were males with a mean age of 41±14 yrs and 69 were females with a mean age of 42±9.9 yrs. The mean history of smoking was 20 yrs. Six months after placement of pictorial warning labels on some cigarette packets, 67.6% of smokers still purchased packets with no such labels. A total of 62% of smokers supported the placement of pictures and 8% stated that seeing the pictorial warning motivated them to quit smoking. Pictorial warning labels play a role in motivating smokers to quit. Although most smokers presenting to the clinic used packets without pictorial warnings, most of them supported the placement of these pictures.

Considering the rising trend of tuberculosis (TB) and cigarette smoking, an evaluation of the clinical manifestations and drug resistance patterns in TB patients with regard to smoking status seemed beneficial. Clinical manifestations and drug resistance patterns were studied in 872 new pulmonary TB patients classified as non-smokers, ever-smokers, and passive smokers during 3 years at the National Research Institute of Tuberculosis and Lung Disease. Both univariate and multivariate analyses were performed. Ever-smokers were mostly male (p<0.001), Iranian (p<0.001), and drug and alcohol users (p<0.001). They were found to have a longer patient delay (15.9 versus 8.7 and 6.3 days, p=0.008), shorter diagnostic delay (106.8 versus 132.6 and 156 days, p=0.01), greater weight loss (p=0.01), and higher sputum expectoration (p<0.001). Notably, the degree of smear positivity was associated with smoking (p<0.001) in both univariate and multivariate analyses. No statistical significance was found for the aforementioned factors among non-smokers and passive smokers. Some of the clinical manifestations of TB are significantly different with regard to the patient's smoking status. The degree of sputum smear positivity for acid fast bacilli was higher and patient delay was longer in ever-smoker patients.

Epstein-Barr virus (EBV) is one of the most important causes of hemophagocytic syndrome. We report a 76-year-old man who presented with pneumonia like symptoms and pleural effusion following upper respiratory tract infection. He underwent thoracentesis and pleural fluid cytology revealed large number of histiocytic macrophages that had phagocytosed RBCs and other inflammatory cells like lymphocytes and neutrophils.Pleural fluid analysis showed Epstein-Barr virus Antigen (EBNA) as the causing agent and corticosteroid therapy was initiated. A few days later, pleural effusion subsided and further cytologic examinations revealed no trace of hemophagocytosis.

Primary neurogenic tumors of trachea are extremely uncommon and account for only about 9% of all neoplasms of trachea.Tracheal schwannoma is among the rarest of them and there is no unanimity of opinion regarding its treatment.We report a 30 year-old woman with symptoms of airway obstruction due to primary tracheal schwannoma. She was suffering from cough and exertional dyspnea. She was admitted to the thoracic surgery ward with stridor and hemoptysis and underwent rigid bronchoscopy and biopsy. The patient then underwent primary tracheal resection and anastomosis through a cervicomediastinal approach. The diagnosis was made through histopathological examination as schwannoma.

We report a 33 year-old woman presented with signs and symptoms of severe uncontrolled diabetes mellitus and chronic renal failure (diabetic nephropathy). She was prepared for emergency simultaneous pancreas and kidney transplantation (SPK) using hemodialysis and after compensating for the acid – base abnormality. She was discharged from the hospital about 3 week after the surgery with good renal and pancreatic function. A 2-month follow-up revealed no complication and a good renal and pancreatic function. Due to the importance of this kind of treatment and several anesthetic considerations of SPK we present this case report along with some pearls about related anesthetic view points.

A 2-month–old female infant was referred to our center with disseminated lymphadenopathy and hepatosplenomagaly. At birth, she was presented with fever and respiratory distress and underwent sepsis workup. Antibiotic therapy was initiated for her but the fever continued despite administration of broad spectrum antibiotics. Abdominal sonography was performed which revealed paraaortic lymphadenopathy and hepatosplenomegaly. Biopsy of para-aortic lymph nodes showed necrotizing granulomatosis inflammation and polymerase chain reaction (PCR) became positive for Mycobacterium tuberculosis complex. (Mycobacterium tuberculosis, bovis, avium, and BCG). Her parents were evaluated for TB for which the results were negative. She had a history of BCG vaccination at birth. An anti-tuberculosis regimen (INH, RIF, ETB, PZA and Amikacin) was initiated for her. She showed no improvement during two months and therefore, she was referred to our center for further evaluation. On arrival her physical examination showed hepatosplenomegaly and cervical lymphadenopathy. On laboratory tests, CBC and Liver function tests were normal. Tripled gastric aspirate test for M.tuberculosis was negative. Parahillar lymphadenopathy and parenchymal lung involvement were detected in spiral chest CT-scan (Figure 1). Her parents were evaluated for tuberculosis for the second time. Their CXR, chest CT-scan, sputum culture and PPD results were unremarkable. No history of TB was reported in her family and relatives. Her treatment regimen was altered. After 6 months, she became totally symptom free. Lymphadenopathies were diminished and chest CT-scan result was normal (Figure 2). During this period her mother developed diarrhea and a month later she was diagnosed with ascites for which she underwent diagnostic tests.