Background:Pleural tuberculosis (TB) is one of the most common forms of extra-pulmonary TB. Since diagnosis is challenging through microbiological tests, discovering new diagnostic techniques with higher accuracy could help us improve early detection and lead to better outcomes. This study aims to investigate the sensitivity and specificity of interleukin 27 (IL27) as a diagnostic test for pleural Tuberculosis. Materials and Methods:The current study was conducted on 121 adult patients admitted to Masih Daneshvari Ho spital due to pleural effusion with an unknown cause. 36 cases had transudative, and 85 cases had exudative pleural effusions. Among them, TB (33.1%) and malignant pleurisy (23.1%) were the most common causes. In addition to routine studies for pleural effusion workups, pleural interleukin-27 concentrations were measured by ELISA and compared between groups of TB-affected patients and those without TB. Results:We found that the value 679 pg/ml was the most appropriate cut-off threshold for interleukin 27 in pleural fluid with 95% sensitivity, 69% specificity, 94% negative predictive value, and 73% positive predictive value (P value<0.001) for diagnosis of TB pleurisy. ADA levels were not significantly different between TB and non-TB cases. Conclusion:Compared to other groups, interleukin 27 levels in patients with a final diagnosis of TB-pleurisy were significantly higher, indicating the significant value of this interleukin as a diagnostic biomarker.
Background:The use of Acu-TENS is one of the physiotherapy methods to reduce shortness of breath and improve the quality of life of patients with chronic obstructive pulmonary disease (COPD). This study was conducted to evaluate the effectiveness of this method in respiratory parameters and the quality of life of patients with moderate to severe COPD. Materials and Methods:The present study was a controlled clinical trial on 40 patients with COPD. Patients with moderate to severe COPD were randomly divided into two treatment groups. Exercise therapy was used in one group, and Acu-TENS (12 sessions over three weeks, Burst TENS (Frequency: 2 Hz; pulse duration: 200 ms, time: 45 minutes)) was used in the other group. Shortness of breath was evaluated using the Borg criteria, functional capacity was assessed using the six-minute walking test, quality of life was evaluated using the St. George questionnaire, and respiratory parameters were measured using a spirometer and COPD Assessment Test (CAT) questionnaire. Results:According to the results, after 12 treatment sessions, a significant difference was observed in FVC, FEV1, activity, CAT, and impact domains of St George's questionnaire. In contrast, other variables had no significant difference between the control and the intervention groups. Conclusion:Using Acu-TENS three times a week and for 12 sessions can play a significant role in the respiratory function of moderate to severe COPD patients. Also, this method is effective in reducing shortness of breath and improving the quality of life of these patients.
Pulmonary arterial hypertension is a devastating disease that can lead to other serious comorbidities. Heart failure is a major problem in patients with pulmonary arterial hypertension. It usually begins with right-sided heart failure, but in severe or uncontrolled cases, it can progress to left-sided heart failure. Currently, available treatment options do not have desirable effects. Therefore, considering a new treatment strategy is a cardiology priority. Non-coding RNAs, including small interfering RNA and microRNA, are valuable treatment options to study. Several non-coding RNAs have been studied and even approved for treatment in other hard-to-treat diseases. However, deciding which to choose can be complex. That is because these non-coding RNAs can have multiple interaction processes. Therefore, a thorough understanding of pulmonary arterial hypertension's pathological pathways and our target non-coding RNA interaction pathways is crucial. Here, we discuss the potential benefits and harms of these options in treating patients with pulmonary arterial hypertension.
Background:Despite limited research on high-flow nasal cannula (HFNC) alternating with noninvasive ventilation (NIV), this study investigates its effect on intensive care unit (ICU) patients. Materials and Methods:This clinical trial study at Masih Deneshvari Hospital (Tehran) compared NIV vs. alternating NIV with HFNC for ICU patients. It assessed intubation, mortality, and vitals. Patients were informed, and nurses were trained for optimal care. Daily follow-up ensured data collection. Results:The mean age of the patients was 66.3±19.7 years, which was 67.1±14.8 years in the NIV group and 65.5±14.9 years in the HFNC+NIV group, respectively. The distribution of patients in terms of APACHE and symptoms showed no significant difference (P=0.453). The mean HR in the two groups, NIV and HFNC+NIV, before the study was 113.30±5.25 and 112.43±5.80, respectively. At the end of the study, it was 94.78±17.53 and 94.48±17.47, respectively, with no significant difference found between the two groups. The mean RR before the beginning of this study was not significantly different between the two groups, while it was 16.61±4.23 and 17.91±1.78 in the NIV and HFNC+NIV groups, respectively, at the end of the study (P=0.043). PO2 created a greater distinction between the two groups based on the decision tree analysis, where the NIV group was more likely to have values of PO2<70. Conclusion:Based on the findings presented in our study, no difference was found between the use of NIV and NIV + HFNC, but HFNC + NIV was a more tolerable technique for patients.
Background:Electronic cigarettes produce aerosols that contain flavoring agents and nicotine, a drug that can lead to dependence, which users inhale. The widespread use of e-cigarettes has prompted research projects to investigate the safety or risks of e-cigarette smoke on human health. The present study aims to discover details of the e-cigarette smoke effect on the gene expression profile of human bronchial epithelial cells (HBECs) via network analysis. Materials and Methods:Data of GSE118431(GPL16791) from Gene Expression Omnibus (GEO) were extracted and pre-evaluated by GEO2R program. The differentially expressed genes (DEGs) were analyzed via protein-protein interaction PPI analysis, and the critical DEGs were introduced. Results:A total of 192 significant DEGs among the 17058 targeted genes were selected for PPI network analysis. The 177 recognized genes were interacted to construct a network. Six DEGs were common between the hubs and bottlenecks of the network. Conclusion:E-cigarettes target IL1B, PTGS2, SOD2, NFKBIA, TXNRD1, and DUSP1, the critical genes that are associated with progression of inflammation, cell proliferation and cell invasion in cancer, chromatin condensation, DNA fragmentation, and cell death.
Background:This study aimed to reconstruct ultra-high-resolution computed tomography (CT) and three-dimensional CT images of tracheostomy tubes, including the shaft, flange, inflation line, and cuff, with a particular focus on examining the degree and fold formation of the inflated tracheostomy tube cuffs within the human trachea. Materials and Methods:All ten patients were inserted with a cuffed tracheostomy tube, and the cuff pressure was maintained at approximately 25 cmH2O intra-cuff pressure using a pressure gauge. The levels of the inserted tracheostomy tube, the degree of inflation of the tracheostomy tube cuffs, the folds of the cuff, and the location of the distal tip of the tracheostomy tube. Results:In this study, the pressure of the tracheostomy tube cuff was managed at an intracuff pressure; however, the degree of inflation of the tracheostomy tube cuffs and the form of the cuff folds inserted into the human trachea differed in each case. The distance between the skin and the tracheal anterior wall and the BMI value were associated with the inflation of the tracheostomy tube cuffs. Conclusion:In cases with distances greater than 25 mm between the skin and the tracheal anterior wall, we think it may be better to use other methods, such as tracheal fenestration, rather than simple tracheostomy. Examination of the size of the tracheostomy tube inserted into the human trachea, the degree of inflation of the tracheostomy tube cuff, and the position of the distal tip of the tracheostomy tube may help in the selection of an appropriate tracheostomy tube clinically.
Background:Pulmonary tuberculosis (TB) and invasive aspergillosis are distinct infectious diseases that rarely coexist in the same patient. The concurrent occurrence of these infections presents diagnostic and therapeutic challenges, resulting in complex clinical presentations and potentially adverse outcomes. We present a case report highlighting the diagnostic process, management strategies, and pertinent literature regarding the simultaneous occurrence of pulmonary TB and aspergillosis in a patient following COVID-19 infection. Case Presentation:A 55-year-old male with a history of occupational exposure as a farmer and welder presented with a complex medical condition. He had a previous COVID-19 infection and was hospitalized for three weeks, receiving appropriate treatment. Subsequently, he developed dyspnea and bilateral pleural effusion and underwent treatment with broad-spectrum antibiotics. Further investigations revealed consolidation in the left upper lobe, and biopsy confirmed the presence of Aspergillus species. The patient received voriconazole treatment for several months, but minimal improvement was observed. Recurrent hemoptysis prom pted bronchoscopy, which showed positive results for acid-fast bacilli smear and TB PCR testing, indicating concomitant pulmonary TB. Anti-tuberculosis treatment was initiated alongside ongoing management for aspergillosis. Conclusion:This case report ill ustrates the diagnostic and therapeutic complexities associated with the simultaneous occurrence of pulmonary TB and aspergillosis in a patient following COVID-19 infection. Clinicians should maintain a high index of suspicion for dual infections in similar clinical scenarios. Prompt recognition, accurate diagnosis, and individualized treatment strategies are crucial for optimal patient management. Further research is warranted to enhance our understanding of this unique clinical entity and improve patient outcomes.
The COVID-19 pandemic is a worldwide disaster in medicine, public health, and the economy. Many details of COVID-19 are currently unknown. This study aims to offer dysregulated metabolic profiles as potential biomarkers for SARS-CoV-2 infection by analyzing identified COVID-19 metabolites. We searched PubMed, Web of Science, EMBASE, and Scopus for metabolomics studies on COVID-19 patients. Studies investigating COVID-19 metabolite changes and utilizing mass spectrometry-based techniques are included. Two reviewers separately retrieved pertinent data for each selected publication. Differences of opinion among the reviewers were settled via conversation, and a final judgment was obtained. The online MetaboAnalyst 3.0 was used to conduct the pathway analysis of COVID-19. This study comprised 31 investigations with QUADOMICS quality evaluation. We isolated modified metabolites that have been found in at least three other investigations. The metabolomics data in response to SARS-CoV-2 alter at the metabolite expression level, leading to dysregulation of major metabolic pathways, including carbohydrates, amino acids, and lipids associated with COVID-19. The pathway analysis of metabolic reprogramming across different biological samples demonstrated a significant role in amino acid metabolism, including phenylalanine, tyrosine, and tryptophan production, in the severity of COVID-19. This review showed dysregulated metabolic profiling for identifying individuals with high severity of COVID-19. These results provide an understanding of metabolic pathways and how dysregulated metabolic profiling reflects the severity of COVID-19 in the general population. The high frequency of changed metabolites might be used as COVID-19 biomarkers for early detection, and significant metabolic routes could reveal new information about pathogenesis and lead to potential treatment targets.
Background:Multiple studies have reported an increased incidence of thrombosis in patients with COVID-19 pneumonia, contributing to higher mortality rates. This study aimed to investigate the ability of disease severity scores, the Pneumonia Severity Index (PSI), Pulmonary Embolism Severity Index (PESI), Disseminated Intravascular Coagulation (DIC), and End-Stage Liver Disease Model (MELD), to predict embolism and embolism-related mortality in patients with COVID-19 pneumonia. Materials and Methods:In this retrospective study, demographic data, comorbidities, hospitalization dates, length of stay in the intensive care unit, percentage of CT radiological involvement, presence of embolism, and biochemical and hematological test results of the patients were recorded. PSI, PESI, DIC, and MELD scores were calculated within the first 24 hours of hospitalization. Results:A total of 158 patients (82 males, 76 females) with a mean age of 53.47± 12.49 years were included. Embolism was detected in 24 cases (15%), and the mortality rate was 11% (18 cases) across all cases. The optimal threshold values for predicting mortality were 63 for PESI and 76 for PSI (AUC values of 0.802 and 0.747). The optimal threshold value for detecting pulmonary embolism was 4 for DIC (AUC: 0.740). In the univariate analysis, variables with a p-value less than 0.1 included radiological score, age, DIC, troponin levels, and D-dimer levels. The subsequent multivariate analysis indicated that both the DIC score (p = 0.047) and the radiological score (p = 0.043) were independently associated with pulmonary embolism. In another univariate analysis, the variables with a p- value less than 0.1 included age, radiological score, the presence of comorbidities, procalcitonin, CRP, troponin, PSI, and PESI score. The follow-up multivariate analysis suggested that the PESI score (p = 0.018) and PSI (p = 0.021) were independently linked to hospital mortality. Conclusion:The PESI score was found to be a significant predictor of mortality, while the DIC score was found to be a significant predictor of pulmonary embolism in patients with COVID-19 pneumonia.
COVID-19 symptoms may persist for more than 12 weeks in some infected patients, a condition described as long COVID-19 in these cases. These patients have symptoms attributed to impairment of multiple organs. Scientists have discovered the lengthy COVID-19 etiology, risk factors, and treatments. It has been observed that immunosuppression may prolong COVID-19 symptoms. Patients with multiple sclerosis (pwMS) are generally treated with disease-modifying treatments, which suppress the immune system and predispose patients to infections like COVID-19. Also, these drugs may increase not only the morbidity and mortality of infection but also the risk of developing long COVID-19 in these patients. We have described two cases of multiple sclerosis patients who were diagnosed with long COVID-19. Both patients were under treatment with rituximab, so we discussed treatment choices and strategies for pwMS patients under rituximab who had symptoms of long COVID. Our data would further add to the information on managing long COVID-19 in pwMS under treatment with rituximab.
Background:Bronchiectasis is a chronic pulmonary disease characterized by abnormal and permanent dilatation of the airways in the lung. This study was conducted to compare the effect of levofloxacin with azithromycin in improving the lung function of these patients. Materials and Methods:In this parallel double-blinded randomized clinical trial, 72 patients with exacerbated bronchiectasis were included and randomly divided into two intervention groups. One group was treated with levofloxacin (500 mg daily for two weeks at first and then 250 mg daily in the next four weeks), and the other group with azithromycin (500 mg daily in the first two weeks and then with a dose of 250 mg daily for the next four weeks) for 6 weeks. The pulmonary function tests were performed and analyzed at the beginning of the study, two, four, and six weeks after the intervention. Results:The mean expiratory volume in the first second (FEV1) and the percentage of oxygen saturation (O2Sat) in the levofloxacin group and the azithromycin group were not significantly different at the beginning of the study. Importantly, six weeks after the initiation, the mean FEV1 (61.02±8.54% vs. 56.88±7.13%, p=0.029) and O2Sat (91.00±1.72% vs. 85.44±1.77%, p=0.001) in the levofloxacin group were significantly higher than those in the azithromycin group. Conclusion:The present study showed that the favorable effect of six-week therapy with levofloxacin compared to azithromycin can significantly increase the pulmonary values of FEV1 and O2Sat in patients with exacerbated bronchiectasis.
Background:In patients with ILD, the static expiratory pressure-volume curve of the lung is generally shifted downward and to the right, and spirometry results reveal reduced vital capacity. However, decreased vital capacity may occur even in patients with obstructive lung diseases and in other situations, such as chest wall restriction, lung resection, inspiratory muscle weakness, or poor cooperation with spirometry. In addition, spirometry is sometimes difficult to perform with elderly, cognitively impaired patients or with severe respiratory distress. IOS is a simple, non-invasiv e method requiring only passive patient cooperation that allows for the evaluation of lung function through the measurement of both airway resistance and airway reactance. This study aims to assess the role of IOS in the evaluation of cases of interstitial lung diseases. Materials and Methods:This study included 53 patients with interstitial lung diseases of different causes. Pulmonary function test by spirometry was done to measure FEV1, FVC, FEV1/FVC, MEF25-75, and pulmonary function test by impulse oscillometry (IOS). We measured R5, R20, X5, RF. Results:Examining the indicators evaluated based on IOS shows that the numerical values of R5 have not increased significantly. Regarding R20 and R5-R20, exhalation values are more than two, and as a result, the interval (expinsp) is a positive number. The values of X5, AX, and Fres increased as expected (213%). Conclusion:X5 was lower in patients with ILD, indicating a restrictive pattern. Conversely, there is a negative correlation between X5 and FVC. Based on the numerical values of R5 and R20, it can be inferred that patients experience small airway obstruction.
Exudative-pleural-effusion (ePE) is a common presentation in pulmonology clinics. Pleural biopsy is indicated for identifying the aetiology in undiagnosed ePE especially the ones with low adenosine-deaminase levels. The access to rigid and semi-rigid medical thoracoscopy is scarce and heterogeneous in a resource limited country like India. In such circumstances, using flexible bronchoscope via intercostal-chest-tube for visualization of parietal pleura and pleural biopsy offers a way out. Here, in this retrospective study, we have presented our experience of such practice on 25 cases. Mean age was 52.4±1 years. Adhesions were present in 40% of the subjects. Most common finding was presence of nodules. On an average 6.8 passes were taken with maximum of 10. In 32% cases only tiny tissue was obtained, hence requiring multiple passes. Large tissue could be obtained in 44% of the subjects. Mean duration of the procedure was 35.6±9.0 minutes. Tissue diagnosis was established in 80% with most common being malignancy (48%) followed by tuberculosis (20%). In 3 cases, the final diagnosis was made by exclusion. No major complications were recorded. In conclusion, medical thoracoscopy using flexible video bronchoscope via intercostal-chest-tube was a feasible alternative for the diagnosis of ePE effusion in resource limited settings.
Background:Thymoquinone (TQ) is one of the active components of Nigella sativa L. It has therapeutic properties in allergic diseases, such as the antihistamine effect on the airways of patients with asthma and inhibition of inflammatory changes. This systematic review was conducted to investigate the effect of TQ on T helper 2 (Th2) cytokines, including IL-4, IL-5, and IL-13, in the treatment of animal models of asthma. Materials and Methods:A comprehensive article search was conducted using Web of Science, Scopus, and PubMed to find articles published until 2022 regarding the efficacy of TQ in treating animal models of asthma. We found 399 articles in Scopus, 927 in Web of Science, and 790 in PubMed, from a total number of 2116 articles. After deleting duplicate articles, we read the remaining 1126 titles and abstracts. Finally, 37 articles were selected for full reading. After excluding papers without full text, duplicates, letters, case studies, and those whose topic did not meet the criteria of this study, 8 articles remained. In the manual search, we did not find any deviating articles from the systematic search. Results:Our results showed that TQ had a significant effect on the reduction of Th2 cytokines, including IL-4, IL-5, and IL-13, in animal models of asthma. Conclusion:Current evidence shows the anti-inflammatory effects of TQ on Th2 cytokines, but its association with the reduction of Th2 cytokines in animal models of asthma needs further studies.
Background:Echocardiography can be used for risk stratification in patients with acute pulmonary embolism (PE). While the severity of PE has been assessed through laboratory criteria in most studies, the Pulmonary Embolism Severity Index (PESI) scoring system was used in this study to evaluate the severity of echocardiographic criteria in acute PE patients. Materials and Methods:All PE patients admitted to Ghaem Hospital in Mashhad between 2021-2022 were included in the study. Clinical symptoms and echocardiographic markers were checked and recorded when the patients entered the study. Data were analyzed in SPSS version 24 at a significance level of 0.05 using the Chi-square test and t-test. Results:Of 40 patients, 80% were at a high risk of PESI. The most common clinical symptoms were dyspnea (97.5%) and pleuritic chest pain (75%). Right ventricle (RV) size enlargement and its dysfunction were recorded in 57.5% of patients. The average age of patients in the high-risk group was significantly (pvalue: 0.001) higher than the low-risk group. There was a significant correlation between MID-right ventricle and pulmonary artery pressure with the severity of embolism, so that mid-right ventricle and pulmonary artery pressure in the high-risk group were significantly higher (p-value: 0.000) than in the low-risk group. Also, the severity of PE was significantly related to RV size (P = 0.026) and function (P = 0.038). Conclusion:RV size, function, and dilatation, and pulmonary artery pressure variated significantly in different severities of PE.
Background:Asthma impacts the quality of life (QOL) of patients and their families. The magnitude of this morbidity is influenced by several factors, including age, disease duration, and others. This study was conducted to determine the predictors of quality of life in patients with asthma in Ahvaz, Iran. Materials and Methods:This cross-sectional study was conducted among patients referred to the pulmonary clinics of Imam Khomeini and Golestan hospitals in Ahvaz in 2022. The quality of life was assessed using the SF-36v2 questionnaire. The effect of socio-demographic characteristics on quality-of-life scores was examined by t-test, one-way variance (ANOVA), Pearson's correlation coefficient, and regression models. Results:From a total of 204 studied asthmatic patients, the average age of patients was 43.22±15.17 years. The average QOL in patients was 57.69±22.97. Physical role and social functioning had the lowest and highest mean scores among SF-36 dimensions, respectively. A significant difference was observed between the average QOL score and the variables of age, gender, education level, employment status, illness costs, illness severity, daily exercise, and number of visits (P<0.05). Most clinical, socio-demographic, and economic variables were predictors of SF-36, PCS, MCS, and QOL dimensions (P<0.05). Conclusion:This study showed that the quality of life in asthmatic patients is affected by the severity of the disease, number of visits, age, sex, and education. By performing appropriate interventions on social and economic factors, the quality of life of asthmatic patients can be improved.
The evolution of anesthesia and anesthesiology represents a pivotal chapter in the history of medical science, significantly enhancing patient care and surgical outcomes. General anesthesia, defined as the deliberate induction of a temporary state of pain relief, muscle paralysis, memory impairment, and unconsciousness, has revolutionized medical procedures by inhibiting the normal functioning of the central nervous system. In Iran, the journey of anesthesiology began with early contributions from ancient scholars and practitioners, whose innovative techniques laid the groundwork for future advancements. The field witnessed significant progress in the mid-20th century, aligning with global developments in medical science. Initially focused on intraoperative care, anesthesiology in Iran expanded to encompass preoperative evaluations, postoperative assessments, and comprehensive patient monitoring, addressing complications related to surgery and anesthesia. In addition to analyzing the evolution of anesthesiology from solely surgical intervention to a broader field encompassing preoperative evaluation, postoperative care, and critical care management, this paper addresses the challenges and opportunities facing anesthesia and anesthesiology in Iran, including the need for wider access to safe and reliable services and the integration of advanced technologies.
Background:There are some controversies on surgical options for pulmonary hydatid cysts. We analyzed our experience in lung tissue preservation during the surgical treatment and optimal surgical options. Materials and Methods:This observational cohort analysis was conducted from July 2008 to July 2022. The Age, sex, clinical manifestation, recurrent rate, hospital length of stay, postoperative complications, and long-term results in each group were assessed. The American Society of Anesthesiologists Physical Status, Charlson Co-Morbidity Index (CCI), Complexity of surgery, and Clavien-Dindo score were also determined. Results:Out of 138 patients, 81case (53.5%) had intact cysts (G1), and the rest were infected cysts which in turn were subdivided into early infected (G2) and cavity suppurated=28 cases (18.4%) as (G3). Group G3 required special attention because the pericyst surface was severely inflamed, dirty, and had pus, so they were subdivided into 3 distinctive groups including G3a, undergone cystectomy, bronchial opening closure alone, G3b group, undergone cystectomy, capitonnage+bronchial opening closure and G3c group, in which pericystectomy also added to previously mentioned procedures. Major complications in the subgroups of G3a were 2 patients and G3b 3 patients, but in the subgroup of G3c, no considerable complications were seen. Cystectomy, closure of major bronchial opening, and capitonnage were done in intact, and early infected cysts. The results of both were the same, with no considerable major complication. Conclusion:Capitonnage significantly decreased the complication rate. The optimized approach in both G1 and G2 was: cystectomy, closure of major bronchial opening, and capitonnage. In G3, bronchial opening closure, pericystectomy, and capitonnage were the preferred procedures.
