Tanaffos Respiration Journal
Volume:18 Issue: 3, Summer 2019

The nucleolus is an intranuclear membrane-less organelle. It is involved in ribosome biogenesis and protein synthesis. When the demand for protein synthesis increases in cell growth and proliferation (e.g., tumors), the cell upregulates ribosome biogenesis. Changes in nucleolar size and number have been recognized as known features of many tumor types. Recent evidence suggests that overproduction of ribosome, decreased ribosome biogenesis, and quantitative and qualitative changes in the nucleolus function, may result in oncogenesis. Today, it is clear that the nucleolus is involved in processes other than ribosome biogenesis. Other functions of the nucleolus include detecting and responding to endogenous and exogenous stress, maintaining genome stability, and regulating cell cycle progression, telomere function, cellular senescence, gene expression, and chromatin structure. Alterations in many of these fundamental nucleolar processes may contribute to the formation of cancer cell phenotypes. This phenomenon suggests that normal nucleolar functions are a safeguard against the development of malignancies and have potential therapeutic effects, as reported in non-small-cell lung carcinoma and other malignancies.

Pulmonary hypertension (PH) is a condition associated with high morbidity and mortality. Patients with PH who require critical care usually have severe right ventricular (RV) dysfunction. Although different groups of PH have different etiologies, pulmonary vascular dysfunction is common in these groups. PH can lead to increased pulmonary artery pressure, which can ultimately cause RV failure. Clinicians should be familiar with the presentations of this disease and diagnostic tools. The contributing factors, if present (e.g., sepsis), and coexisting conditions (e.g., arrhythmias) should be identified and addressed accordingly. The preload should be optimized by fluid administration, diuretics, and dialysis, if necessary. On the other hand, the RV afterload should be reduced to improve the RV function with pulmonary vasodilators, such as prostacyclins, inhaled nitric oxide, and phosphodiesterase type 5 inhibitors, especially in group 1 PH. Inotropes are also used to improve RV contractility, and if inadequate, use of ventricular assist devices and extracorporeal life support should be considered in suitable candidates. Moreover, vasopressors should be used to maintain systemic blood pressure, albeit cautiously, as they increase the RV afterload. Measures should be also taken to ensure adequate oxygenation. However, mechanical ventilation is avoided in RV failure. In this study, we reviewed the pathophysiology, manifestations, diagnosis, monitoring, and management strategies of PH, especially in intensive care units.

In this study, we aimed to determine the effects of cromolyn on the clinical outcomes and neutrophilic inflammation in patients with resistant cough-variant asthma.

Patients with cough-variant asthma, with normal physical examination and spirometry results, were treated by inhaled corticosteroids, antileukotrienes, antibiotics, and proton-pump inhibitors according to the Global Initiative for Asthma (GINA) guidelines. Seventy patients, who were resistant to these treatments, were enrolled in this doubleblind randomized clinical trial. After randomization, eligible subjects received a cromolyn metered dose inhaler (MDI) or a placebo MDI, which was completely similar in appearance to the cromolyn inhaler. The primary outcomes included cough and Asthma Control Test (ACT) score.

Based on the findings, cough significantly decreased with cromolyn therapy, compared to the placebo group. Other clinical findings, including dyspnea, sputum production, and nocturnal symptoms, also improved. The ACT score significantly improved to a nearly normal level (23.53±2.25) in the cromolyn group. Moreover, fractional exhaled nitric oxide (FeNO) significantly decreased with cromolyn treatment (14±9.31 ppm after treatment vs. 28.88±27.39 before treatment). The neutrophil count significantly decreased in the cromolyn group (from 44±24.2% before the trial to 34.08±16.7% after the trial), while it increased in the placebo group (from 39.67±26.47% to 56.71±27.22%).

Cromolyn improved the clinical findings of resistant cough-variant asthma and could suppress neutrophilic inflammation.

Ventilator-Associated Pneumonia (VAP) occurs in hospitalized patients who have undergone intubation and mechanical ventilation for more than 48 hours. Patients referred to the Intensive Care Unit (ICU) are also affected by VAP due to specific conditions, especially by Gram-negative pathogens with advanced drug resistance. In this study, the pattern of antibiotic resistance of gram negative bacteria isolated from tracheal culture of VAP patients was investigated in ICU.

In this cross-sectional study, tracheal samples were collected from VAP patients admitted in the hospital's ICU from March 2017- February 2018. After isolation, bacterial isolates were identified using biochemical tests. Then, antimicrobial resistance pattern of these isolates was investigated using standard disc diffusion and E-test methods. Multiplex PCR were used to detect the blaOXA-23-like, blaOXA-51-like, blaOXA-24-like, and blaOXA-58-like genes among Acinetobacter baumannii (A. baumannii) isolates.

A total of 29 bacterial isolates were isolated from ICU patients, which were A. baumannii, Pseudomonas aeruginosa (P. aeruginosa), Klebsiella pneumoniae (K. pneumoniae) and candida spp, with prevalence of 38, 27.5, 13.8, and 20.7%, respectively. Antibiotic susceptibility test of isolates indicated that almost all isolates showed Multi-Drug Resistance (MDR) pattern. The A. baumannii isolates were resistant to ciprofloxacin and piperacillin-tazobactam, but ampicillin-sulbactam and colistin had better results. Ciprofloxacin, meropenem and colistin were effective against P. aeruginosa isolates, but other antibiotics were less effective and Colistin, Levofloxacin (LVX) and Piperacilin/Tazobactam were the best antibiotics that were effective on the isolates of K. pneumonia.

According to the present study, high resistance to most antibiotics in gram negative bacilli showed that antibiotic therapy should be based on the type of bacteria isolated by tracheal culture and, as far as possible, combination therapies should be used to maximize the coverage of other possible pathogens, and antibiotic resistance in ICU.

Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. The aim of this study was to investigate the effects of inspiratory muscle training (IMT) and aerobic exercise on healthrelated quality of life of patients with COPD.

This randomized controlled clinical trial was conducted on 60 patients with moderate to severe COPD, who were referred to Imam Hossein Hospital of Tehran, Iran in 2016. The patients were randomly assigned to four groups and treated for eight weeks. Group 1 (n=16) participated in 16 sessions of IMT (15 minutes per session), group 2 (n=14) performed aerobic exercises twice a week (40 minutes per session), group 3 (n=15) performed IMT and aerobic exercises, and group 4 (n=15) received no intervention, except for routine treatments (control). Quality of life was evaluated based on the Saint George’s Respiratory Questionnaire (SGRQ) at baseline, week 4, and week 8 after the intervention.

After eight weeks, all four groups experienced a significant improvement in their quality of life (P<0.05), and group 3 (IMT and aerobic exercise) showed the greatest improvement. However, quality of life improvement in group 4 (control) was less than the other three groups (P<0.05).

Aerobic exercise and IMT were more effective than routine protocols in improving the quality of life of COPD patients. Furthermore, shortterm IMT plus aerobic exercise had the greatest impact on improving the health-related quality of life of COPD patients and could be used in the management of these patients.

In this study, we aimed to investigate the effects of aerobic exercise training on the serum IL-4/IFN-γ ratio (Th1/Th2 balance), testosterone/cortisol ratio, levels of cortisol, testosterone, estrogen, and progesterone, and body mass index (BMI) and to determine the relationship between changes in these variables in women with asthma.

Twenty-one women with mild to moderate asthma and regular menstrual cycles were selected in this study. Eleven women in the exercise group participated in the aerobic exercise program (60 min/day, three days a week in the evening). Peripheral blood samples were collected before (week 0) and after (week 12) the program. The samples were analyzed to determine the levels of sex hormones and cortisol via chemiluminescence assay, and cytokines were examined by ELISA assay.

The findings showed a significant increase in the Th1/Th2 ratio and a decrease in cortisol and BMI in the exercise group, compared to the control group (P<0.05). There was no significant correlation between changes in cortisol, sex hormones, and BMI and the increase in Th1/Th2 ratio.

The present results suggested that moderate aerobic exercise enhances the Th1/Th2 ratio, independent of changes in steroid hormone level and BMI in women with asthma.

To describe the clinical presentations, treatment regimen, and outcomes of Pneumocystis jiroveci pneumonia (PJP) among immunocompromised patients at King Faisal Specialist Hospital and Research Center in Saudi Arabia.

In this retrospective cohort study, patients with a laboratory-confirmed diagnosis of PJP were included.

During the study, 42 patients with confirmed PJP were identified. Twenty (48%) patients were HIV-infected, while 22 (52%) were HIV negative. The median T-cell count (CD4) was below 50 cells/mL in HIV patients with PJP at the time of HIV and PJP diagnoses. Graft rejection, cytomegalovirus (CMV) reactivation, and lymphopenia were associated with the development of PJP in transplant recipients; and high-dose steroids for non-transplant patients. The allcause mortality at 90 days was lower in individuals with HIV-related PJP, compared to those with other predisposing conditions (10% and 32%, respectively; P=0.085). No specific risk factors were independently associated with the increased risk of mortality.

PJP remains an important cause of morbidity and mortality in immunocompromised patients, with a higher mortality rate reported in non-HIV patients.

Venous thromboembolism (VTE) is one of the main causes ofmortality in patients with cancer. This study was conducted to assess theincidence of deep vein thrombosis (DVT) in breast cancer patients receivingoutpatient cancer therapy.Materials,

This multi-center prospective cohort study wasconducted on patients with breast cancer,initiating an outpatientchemotherapy regimen in five medical centers in Iran. Eligible patients wereenrolled in the study consecutively between January 2013,January 2015.The primary outcome was lower extremity DVT based on duplex,dopplerultrasonography two months after the first course of chemotherapy (visit 2) andafter the end of the course (visit 3). All patients were followed-up from theonset of chemotherapy until the first occurrence of lower extremity DVT,death,or the end of the course.

A total of 427 eligible breast cancer patients were recruited in thestudy,403 of whom attended at least one follow-up visit. The mean (SD)duration of follow-up was 4 (1.3) months. During the follow-up,only onepatient showed DVT on duplex,doppler ultrasonography in visit 2. Therefore,the two-month,overall cumulative incidence risk of DVT was 0.25% (95%CI: 0.00–0.74%). However,the mean D-dimer level showed no significantchange (P>0.05).

Our findings showed the low risk of DVT in breast cancer patientsreceiving outpatient cancer therapy.

Tuberculosis is one of the top 10 causes of mortality worldwide. It is also the leading cause of death in HIV-positive patients. In this study, we aimed to assess the educational needs of general practitioners regarding tuberculosis in the North Health Center of Tehran, Iran.

This quantitative and qualitative study was conducted in 2017. In the quantitative phase, 31 general practitioners from the North Health Center of Tehran were included. The educational needs assessment was performed using the knowledge assessment and self-assessment scales. Data were entered in SPSS version 21 and analyzed using descriptive tests and Pearson’s correlation coefficient test. In the qualitative phase, data were collected by interviewing six managers of tuberculosis monitoring program and analyzed using the content analysis method.

The mean score of the knowledge assessment scale was 22.8±6.4. The most and the least important educational needs were related to treatment and general information about tuberculosis, respectively. Moreover, tuberculosis treatment and general information about tuberculosis were the most and the least important educational needs in the self-assessment scale, respectively. There was a poor correlation between the mean scores of self-assessment scale and knowledge assessment scale regarding tuberculosis prevention (P=0.01, r=0.27). Also, a moderate correlation was found regarding tuberculosis screening (P=0.001, r=0.56). However, no significant correlation was found in terms of general information (P=0.31), diagnosis (P=0.43), and treatment (P=0.29) of tuberculosis. Five major themes were extracted in the qualitative phase of the study, including “training time”, “educational content”, “educational references”, “teaching method”, and “organizational factors”.

An appropriate educational program should be developed for general practitioners in form of continuing education and educational reform.

Pulmonary thromboembolism (PTE) is a serious and lifethreatening condition. Diagnosis of PTE can be challenging in emergency departments, as there is no absolutely reliable biomarker for the diagnosis of PTE. Copeptin (COP) is a new biomarker, which may be valuable in the diagnosis of PTE; however, its role has not been well studied. In this study, we aimed to investigate the diagnostic value of COP in the diagnosis of PTE.

This study was carried out on 102 patients suspected of PTE. The serum levels of D-dimer and COP were measured, and diagnosis of PTE was confirmed by CT angiography. Next, the prognostic value of D-dimer and COP was examined.

The area under the curve (AUC) of D-dimer was 0.581 with a standard error (SE) of 0.07 (P=0.34). Estimation of the validity of D-dimer showed that it is a highly sensitive (100%), but poorly specific (15.8%) test. Evaluation of the predictive value of this test showed that it has a positive predictive value of 20% and a negative predictive value of 100%. The AUC of COP was 0.423 with SE of 0.1 (P=0.44). Measurement of the validity of COP test showed that it is a poorly sensitive (50%) and specific (22.9%) test.

COP is a new cardiovascular biomarker. However, the present findings did not confirm the prognostic value of this biomarker for the diagnosis of PTE.

Cryptogenic Organizing Pneumonia (COP) can manifest like a collagen disorder or infectious diseases, or be caused by drug induced toxicity. This paper presents the case of a 24 year-old man diagnosed with classic seminoma, treated with chemotherapy scheme that included bleomycin (accumulated dose, 120 units). The patient was admitted at the hospital due to rapidly-progressing dyspnea and thoracic pain. The diagnostic approach revealed the presence of a spontaneous pneumothorax, while a lung biopsy documented COP. Despite treatment, the patient died from disease progression.

Tracheobronchopathia osteochondroplastica is a rare idiopathic disease of the trachea and the main bronchi, characterized by multiple submucosal osteocartilaginous nodules. Although the etiology of tracheobronchopathia osteochondroplastica remains unknown, several theories have been proposed. We report a case of a 47-year-old non-smoker woman with wheezing dyspnea over the past two years, which was treated as asthma without improvement. Investigations, including chest computed tomography scan, fiberoptic bronchoscopy, and endobronchial biopsy, indicated tracheobronchial amyloid light-chain (AL) amyloidosis. Thirteen years later, she was admitted for cough and wheezing. The bronchoscopic examination demonstrated nodular lesions distributed along the cartilaginous rings of the lower portion of the trachea and the main bronchi. Endobronchial biopsy confirmed tracheobronchopathia osteochondroplastica. We found tracheobronchopathia osteochondroplastica to be the end stage of amyloidosis.