فهرست مطالب

Tanaffos Respiration Journal
Volume:12 Issue: 3, Summer 2013

  • تاریخ انتشار: 1392/08/12
  • تعداد عناوین: 11
|
  • Atefeh Fakharian, Nicholas S. Hill Pages 6-8
  • Dean E. Schraufnagel Pages 9-10
  • Seyed Sajad Razavi, Reza Amin Nejad, Seyed Amir Mohajerani, Mahshid Talebian Pages 11-16
    Background
    Unplanned extubation (UE) is an unprecedented happening in pediatric intensive care unit (PICU); which may lead to severe complications in patients. The risk factors of UE have been discussed but much details are still required in this regard. This study aimed to evaluate predisposing and risk factors of unplanned extubation in PICU.
    Materials And Methods
    Patients intubated in PICU who had UE were compared to a control group without UE in a retrospective study. Fifty-nine patients with UE matched with 180 controls were enrolled. Factors including age, gender, use of cuffed endotracheal tube (ETT), duration of intubation, patient agitation, and ETT fixation method were analyzed.
    Results
    A total of 59 UEs occurred in 239 intubated patients in a total of 1631 intubated patient-day. This represents UE incidence rate of 1.95% per patientday and 3.6% per intubated patient-day. In multivariate analysis, risk factors for UE included age younger than 2 years (OR: 1.34, 95% CI: 1.13-3.61, P=0.001), male gender (OR: 2.53, 95% CI: 1.35-4.23, P=0.005), agitation (OR: 1.83, 95% CI: 1.54-5.36, P=0.001), high saliva secretion (OR: 4.42, 95% CI: 2.35-5.45, P=0.007), and duration of intubation (OR 1.39, 95% CI: 1.22-2.58, P=0.01).
    Conclusion
    Unplanned extubation can be a catastrophic incident if enough attention is not paid to the patients at risk in PICU. These risk factors are age younger than 2, male gender, agitation, high salivary secretion and duration of intubation.
    Keywords: Unplanned extubation, Pediatric ICU, Risk factors, Incidence, Mortality
  • Majid Mirsadraee, Saeed Nazemi, Ali Hamedanchi, Saeed Naghibi Pages 17-22
    Background
    Pulmonary artery hypertension (PAH) is difficult to diagnose because of its nonspecific symptoms. Although echocardiography can reliably and rapidly recognize the presence of pulmonary hypertension, chest X ray (CXR) is more widely used because of its availability. The objective of this study was to find a parameter, which, by changing the scale of CXR, is still useful for detection of PAH.
    Materials And Methods
    This case control prospective study included 100 subjects with a clinical finding of dyspnea. Additionally, thirty healthy volunteers (control group) were included in this study. Systolic pulmonary artery pressure (SPAP) was determined by echocardiography. Widening of pulmonary hilum, projection of the right side of the heart border (PRHB) and the ratio of these parameters to the chest diameter were compared to SPAP using the regression method. A cut-off point was determined for parameters that showed significant correlation.
    Results
    The most prevalent disease in the dyspnea group was COPD (28%).Average SPAP was 41.8±17.3 (ranging from 10 to 87 mmHg). Multivariate analysis of the covariance revealed significant correlation between SPAP, age, sex and hilar widening (r=0.44, P=0.0001) that was higher than PRHB and hilar widening + PRHB (r= 0.374. and r= 0.438, respectively). The ROC curve showed that the area under the curve was not significantly different for all parameters and the best cut-off point with sensitivity of more than 80% was as follows: hilar size more than 112 mm, PRHB more than 44 and hilum/chest ratio more than 0.44.
    Conclusion
    Hilum/chest ratio is the proper substitution for the hilar size in case of changing the scale of the chest X ray. Evaluation of hilar widening and PRHB could lead to identifying more subjects suffering from undiagnosed PAH.
    Keywords: Pulmonary artery pressure, Pulmonary artery hypertension, Echocardiography, Chest X-ray, Chest roentgenogram
  • Taraneh Yazdanparast, Seyed Mohammad Seyedmehdi, Soheila Khalilzadeh, Sousan Salehpour, Mohammad Reza Boloursaz, Nooshin Baghaie, Maryam Hassanzad, Ali Akbar Velayati Pages 23-28
    Background
    Knowledge and practice about air pollution are essential subjects in special groups such as cardio-pulmonary patients. For children with air pollution-related diseases, knowledge and attitude of parents play a determining role in this respect. Since providing a coherent curriculum needs evidence-based information, this survey was conducted to assess the knowledge and practice of asthmatic children’s parents about daily air quality since asthmatic children are among the most vulnerable at-risk groups when it comes to air pollution.
    Materials And Methods
    All parents of asthmatic children referred to the Pediatric Clinic of Masih Daneshvari Hospital during one year period (250 people) completed knowledge and practice questionnaire on air pollution. Knowledge questions consisted of familiarity with pollution standard index (PSI), ways to find out about it, respiratory effects of air pollution and etc. Practice questions consisted of reducing outdoor presence and activity of children and actions taken to reduce air pollution in polluted days.
    Results
    In general, 3.2% of parents were familiar with PSI, 12.5% were aware of ways to find out about daily air quality, 65.2% were aware of air pollution respiratory effects, 65.6% were aware of air pollution effects on asthmatic children and 4.4% were aware of ineffectiveness of surgical masks in prevention of air pollution health effects. The obtained practice score ranged from 4 to 16, and the participants’ mean score was equal to 11.79.
    Conclusion
    This study revealed that parents of asthmatic children were aware of air pollution hazards for their children and wanted to prevent them but they did not know how. Therefore, asthmatic children in Tehran are still exposed to risks of air pollution.
    Keywords: Knowledge, Practice, Air pollution, Asthmatic children, Parents
  • Mahmoud Asle Mohammadizadeh, Mohsen Ghanbarzadeh, Abdolhamid Habibi, Saeed Shakeryan, Masoud Nikbakht Pages 29-43
    Background
    Exercise-induced bronchoconstriction (EIB) describes airway narrowing that occurs in association with exercise. Exercise in hot and cold environments has been reported to increase exercise-induced bronchoconstriction (EIB) in subjects with asthma. However, to our knowledge, the effect of hot and cold environment on pulmonary function and EIB intrained males has not been previously studied. The main goal of this research was to examine the influence of environmental temperature and high intensity interval exercise on pulmonary function in trained teenage males. Also, this study sought to assess the influence of exercise and environmental temperature on EIB.
    Materials And Methods
    Thirty trained subjects (mean age 16.56±0.89 yrs, all males) underwent high intensity interval exercise testing (22 minutes) by running on a treadmill in hot and cold environments under standardized conditions (10 ºC and 45 ºC with almost 50% relative humidity in random order in winter and summer). Lung function (flow volume loops) was measured before and 1, 5, 15, 30 and 60 min after the exercise by digital spirometer. Data was analyzed using SPSS software and P<0.05 was considered significant. The diagnosis of EIB was made by 10% fall in FEV1 post-exercise.
    Results
    The post-exercise maximal reduction in forced expiratory volume in 1s (FEV1), peak expiratory flow (PEF) and average forced expiratory flow rate over the middle 50% of the FVC (FEF25-75) increased significantly compared to pre-exercise at 10 ºC with almost 50% relative humidity (cold air). The obtained values were: -15.93(15min post-exercise), -22.53 (1 min post-exercise) and -18.25%(5min post-exercise). Post-exercise maximal reduction in FEV1, PEF and FEF25-75 increased significantly compared to pre-exercise value at 45 ºC with almost 50% relative humidity (hot air). Obtained values were: -10.35 (1 min post-exercise), -9.16 (1 min post-exercise) and -7.39 (5 min post-exercise). Changes in FEV1, PEF and FEF25-75 reduction in cold air was significantly greater than in hot air (P<0.05). Maximal prevalence of exercise-induced bronchoconstriction (EIB) in cold and hot air was 60% (18 of 30 subjects) and 40% (12 of 30 subjects), respectively.
    Conclusion
    This study demonstrated that pulmonary function in hot and cold air was influenced by temperature (in the same relative humidity (50%) and also high intensity interval exercise. Prevalence of EIB after high intensity exercise in hot and cold air increased in trained adolescent males; however, these changes in cold air were greater than in hot air among trained adolescent males. Therefore, results of this study suggest that adolescents (although trained) should avoid high intensity (95% maximal heart rate) exercise in winter (extremely low temperature) and summer (extremely high temperature) to prevent EIB.
    Keywords: Temperature, Exercise, Induced Bronchoconstriction, Exercise
  • Naseh Sigari, Hooman Ghasri Pages 44-48
    Background
    Local and systemic inflammation occur at the same time in asthma and high sensitive CRP may play a role in the pathogenesis of this disease. Conventional approaches to monitor and control asthma involve no direct assessment of airway inflammation. There are some recent data postulating a discrepancy between the markers of airway and systemic inflammation and asthma control test (ACT) scores. In this study we evaluate the correlation between the serum levels of hs- CRP in patients with different levels of asthma control based on ACT scores and spirometric indices.
    Materials And Methods
    The validated Persian version of ACT was administered to one-hundred asthmatic patients. Spirometry was performed and prebronchodilatory FEV1 was measured. Blood samples for CRP measurement were taken and hs-CRP levels were analyzed. Fifty age- matched healthy volunteers comprised the control group.
    Results
    A total of 100 asthmatic patients (57 females and 43 males) and 50 controls were participated. hs-CRP in asthmatics was higher than in controls. No significant differences were found in hs-CRP levels in patients with different levels of asthma control based on ACT (≥20, 16–19, ≤15), GINA classification of asthma control (well controlled, partly controlled, uncontrolled) or FEV1.
    Conclusion
    We found no correlation between degree of systemic inflammation estimated by hs-CRP and other clinical indices of asthma control such as ACT scores, FEV1 and GINA classification of asthma control and even in patients with clinical and spirometric indices of controlled asthma, markers of systemic inflammation were still present.
    Keywords: hs, CRP, Asthma Control Test, Asthma
  • Zahra Mirfeizi, Donya Farrokh, Aida Javanbakht, Elahe Raufi Pages 49-52
    Background
    Lung disorders are important for prognosis of connective tissue disease (CTD). Thus, chest radiography, High Resolution Computed Tomography (HRCT) of the chest and ultrasonic echocardiogram are suggested after the diagnosis of these conditions. The purpose of this study was to evaluate chest HRCT findings in patients with CTD.
    Materials And Methods
    In this descriptive cross-sectional study, we evaluated HRCT findings in patients with (CTD) hospitalized in Imam Reza Hospital in Mashhad from 2006- 2011. Patients’ age, sex, type of rheumatic disease andHRCT results were collected and analyzed by SPSS version 16.0 software.
    Results
    out of 75 patients (78.67% females, 21.33% males with a mean age of 41.6 years), 56% had respiratory symptoms. Scleroderma was the most common disease (38.6%) followed by rheumatoid arthritis (26.6%) and systemic lupus erythematosus (14.6%). Interstitial tissue involvement of the lung was the most frequent finding in patients with scleroderma, dermatomyositis, polymyositis and Sjogren's syndrome (48.3%, 57.1%, 60% and 66.7%, respectively). Pleural thickening was the most common finding in patients with rheumatoid arthritis (45%). Pleural effusion was the most frequent finding in patients with systemic lupus erythematosus (45.4%). Lymphadenopathy and bronchiectasis had the lowest prevalence (1.3%).
    Conclusion
    Our data shows that interstitial tissue involvement, pleural thickening and pleural effusion are common in patients with rheumatic diseases which is consistent with some previous studies.
    Keywords: High resolution computed tomography, Connective tissue diseases, Interstitial tissue involvement
  • Rostam Yazdani, Mohammadreza Gholamrezapour, Tarlan Hassanaghaei Pages 53-57
    Background
    Chronic obstructive pulmonary disease (COPD) is the only cause of mortality and morbidity with an increasing incidence. Adiponectin has recently gained the spotlight for its possible association with COPD or its exacerbation. This study evaluated the association of serum and alveolar adiponectin levels with COPD-related variables.
    Materials And Methods
    This analytical cross-sectional study was carried out on 45 COPD patients. Number of cigarettes smoked (packs), years of smoking, number of disease exacerbations per year and BMI were all recorded. Patients underwent spirometry and their disease severity was determined based on BODE index. Venous blood sample was obtained to measure the adiponectin serum level, ESR and CRP. Bronchoscopy and BAL were performed as well and alveolar secretions were collected to assess the alveolar fluid level of adiponectin.
    Results
    The mean serum level of adiponectin in COPD patients was significantly higher than the upper limit of normal range in healthy individuals (P=0.000). Level of alveolar adiponectin in smoker patients was significantly higher than non-smokers (P=0.043) but serum adiponectin was not significantly different between them. Serum adiponectin level had a significant reverse correlation with BMI and a direct correlation with number of exacerbations per year and CRP. Level of alveolar adiponectin had a direct association with number of exacerbations per year and number of smoked cigarettes.
    Conclusion
    Based on the obtained results, smoking cessation is very important in COPD and more emphasis should be placed on patient’s weight control especially those with low BMI as well as rehabilitation programs for these patients.
    Keywords: Alveolar adiponectin, Serum adiponectin, Chronic Obstructive Pulmonary Disease (COPD)
  • Nashmia Riaz, Mehrdad M. Behnia, Phillip W. Catalano, James Davis Pages 58-61
    Posterior reversible encephalopathy Syndrome (PRES) is a rare syndrome that is reversible in most cases but can rarely lead to irreversible brain damage and death. Most cases occur after rapid rise in blood pressure. We report a 56 year-old Caucasian male with metastatic adenocarcinoma of the lung who presented with a pleural effusion for which thoracocentesis and thoracotomy were performed. He developed PRES on the third post-operative day following relatively moderate increase in blood pressure. It was diagnosed with diffuse weighted imaging (DWI) MRI. He eventually fully recovered from the event. PRES is a reversible syndrome, in most cases, that can be diagnosed with appropriate imaging studies such as MRI with DWI. This case report is of clinical importance to surgeons as well as neurologists. We speculate that post surgical patients are more prone to developing PRES at lower blood pressures than blood pressures required in healthy individuals to develop PRES. Patients’ post surgical blood pressure should be monitored closely and maintained at lower levels to prevent PRES. It is essential to control and diagnose PRES at an early stage since it can be easily prevented and some cases proceed to irreversible damage. It should also be differentiated from an acute cerebrovascular event since its treatment and prognosis are markedly different from PRES.
    Keywords: Posterior reversible encephalopathy syndrome
  • Ali Alavi, Manoucher Aghajanzadeh, Korosh Asgari, Sara Massahnia Pages 62-64
    Botryomycosis is a relatively rare disease found only in case reports. Most observed cases have been of cutaneous or visceral type. Given the prolonged duration and nature of symptoms, pulmonary botryomycosis may be mistaken for malignancy. We report the first case of pulmonary botryomycosis in Iran initially mimicking bronchogenic carcinoma.
    Keywords: Botryomycosis, Bronchogenic Carcinoma, Lung