Tanaffos Respiration Journal
Volume:6 Issue: 4, Autumn 2007

Chronic obstructive pulmonary disease (COPD) is a major public health problem that needs greater attention. Variability in the susceptibility to develop COPD is related to both genetic and environmental factors. Oxidative stress and inflammation are the major hallmarks of COPD and antioxidant status can be used as a biomarker to assess the risk of chronic diseases. We used the FRAP (ferric reducing ability of plasma) assay as a simple and powerful test for determination of the total antioxidant capacity of plasma of patients and normal subjects. The patients were selected by cross-sectional method. The mean average age ±SD of normal subjects and patients was 56 ± 4 and 60±2 years respectively. The spectrophotometeric method was used for this assay. The means of the FRAP assays in the patients were higher (about twice) than those of normal subjects. The differences were significant (p<0.01). The high levels of antioxidant capacity in the patient group indicated that the antioxidant defense system had been activated due to the oxidative stress and hypoxic condition. A though, FRAP assay can probably be used for demarcation of severity and risk of developing COPD, clinical follow-up and further investigation are required for the assessment of this hypothesis.:

Impairment of exercise tolerance in chronic respiratory disorders and in particular, chronic obstructive pulmonary disease (COPD), has important implications on health-related quality of life, hospitalization rate and survival. Although COPD patients have shortness of breath, programmed exercise can increase the activity tolerance in these patients. Maximal oxygen uptake (VO2 peak) is a fundamental measure of exercise physiology. It is an index of cardiovascular performance as well as a measure of aerobic capacity. VO2 max can be measured by expensive devices or predicted by a valid formula. The objective of this study was to determine the effect of treadmill exercise training (TET) on patients with chronic obstructive pulmonary disease after a 4-week program. Thirty-eight subjects with COPD were recruited in the study and were randomly divided into two groups of control (n=18) and treatment (TET, n=20). The control group did not do any treadmill exercise training (TET). The treatment group exercised on a treadmill three times a week. VO2 max was assessed in each group before and after the training period by using a modified formula. After 4 weeks of training, VO2 peak was significantly greater in the TET group. Considering the increase in VO2 peak, It was concluded that TET benefits exercise performance, inspiratory muscle strength, dyspnea and health-related quality of life.

The most effective treatment in chemical warfare victims (CWV) suffering from severe long-term obstructive pulmonary disease is inhaled corticosteroids (ICS) and long acting beta-2 agonists. Study results on adverse effects of ICS on bone were conflicting. In the present study, we evaluated the effect of ICS on bone mineral density (BMD) of CWV and possible effects of chemical warfare agents on BMD. Thirty-five CWVs entered this study. Demographic and spirometric data (including staging of severity of lung disease) and BMD results as shown by z-score and t- score measured in lumbar and femoral regions were evaluated in this group of patients. In comparison, 75 normal subjects as controls were included in this study and their BMD results were compared with those of the case group. The mean age in CWVs was 41.40 ± 7.74 years, which showed no significant difference with that of the control group. According to spirometric data, CWVs had obstructive lung disease. BMD in lumbar and femoral regions in the case group was 1.14 ± 0.14 and 0.93 ± 0.13 g/cm2 respectively, which showed no significant difference with that of the control group. Regression analysis showed that BMD in the femoral region was correlated with forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) and t-score in lumbar region was correlated with FEV1. BMD in the femoral region decreased as the severity of bronchial obstruction increased (0.99 ± 1.07 g/cm2 in mild form to 0.75 ±0.27 in severe form; F= 3.91, P=0.03) but in the lumbar region BMD had no significant correlation with severity of bronchial obstruction. BMD did not decrease during long-term therapy with ICS in CWVs. Severity of bronchial obstruction can be an important risk factor.

This study aimed to investigate the serum level of triglyceride, cholesterol, high density lipoprotein, low density lipoprotein, and very low density lipoprotein during administration of propofol and comparing it with infusion of remifentanil in patients undergoing sedation in ICU of Masih Daneshvari Hospital during 2005-2007. All patients with pulmonary disease, undergoing intubation and mechanical ventilation were enrolled in our study. The patients were randomly divided into two groups, first receiving propofol and second receiving remifentanil as the sedative agent. Lipid profile (triglyceride, cholesterol, high density lipoprotein, low density lipoprotein, and very low density lipoprotein) was checked before, immediately after, and the day after drug administration. A total of 40 patients were enrolled in this study, 20 of which took propofol and the remaining took remifentanil. The mean age of the patients was 58.67±18.57 yrs. Triglyceride and very low density lipoprotein(VLDL) were the two factors with statistically significant rise after infusion of propofol (p<0.002). Such a change was not detected in the remifentanil group. The other understudy factors did not show similar changes. Propofol infusion can induce dramatic rises in triglyceride and VLDL concentration even after low dose infusions and therefore special attention must be paid to patients prone to hyper-triglyceridemia and pancreatitis.

Malnutrition is a common complication in multiple trauma patients because of the metabolic and catabolic increase and negative nitrogen balance. It may deteriorate patients'' outcome. Some clinical and paraclinical parameters are used for nutritional assessment. In this study our goal was evaluation of nutritional parameters in enteral and partial parenteral methods for detecting the better method of nutritional support. This prospective study had done during 30 months on 80 multiple trauma patients with 4th to 10th GCS (Glascow Coma Scale) at the end of the first day of admission. They divided into 2 groups randomly: we used partial parenteral nutrition in the first group (41 patients) and enteral nutrition in the second one (39 patients). We studied serum total protein, albumin, transferrin and total lymphocyte count during their first two weeks of hospitalization. In the first group, they received more protein and calorie during 14 days. Serum total protein, Albumin and transferrin were more statistically significant in this group (P<0.05). In partial parenteral nutrition patients will receive more protein and calorie, and they will have more total serum protein. It seems that parenteral-enteral nutrition prepares better paraclinical nutritional parameters.

According to several studies, asthma medications especially b2-agonists and corticosteroids have harmful effects on the dentition. This study was conducted to evaluate the prevalence of dental caries in asthmatic children in comparison with healthy controls. Some potential confounders of oral health were also evaluated. Asthmatic children aged 5-15 years under the care of the Pediatric Pulmonary Clinic of Masih Daneshvari Hospital were studied. DMFT index (decay, missing, filling teeth) was assessed in them by using the visual-tactile technique. Also, saliva samples were taken from each child and the number of Streptococcus mutans and Lactobacilli colonies in the samples was counted. Similar data were collected from the healthy controls. Forty-five asthmatic (mean age 10.90 ± 3.16 yrs) and 46 healthy children (mean age 11.03 ± 0.59 yrs) were studied. Mean DMFT was 3.98 ± 2.53 in the control group and 4.30 ± 2.81 in the study group which revealed a significant difference between the two groups regarding DMFT index. The number of Lactobacilli colonies was 8171.3 ± 11956.0 and 16078.4 ± 24305.5 in asthmatic and non-asthmatic groups, respectively which demonstrated no significant difference in this regard. Whereas, the number of Streptococcus mutans colonies was significantly different between the two groups (32331.7 ± 46258.9 colonies in the control group versus 80883.4 ± 74799.9 colonies in the study group; p-value < 0.05). Multivariable analysis revealed that asthmatic children receiving anti-asthmatic medication including b2-agonists and corticosteroids had a higher DMFT index. According to our study the prevalence of dental caries was higher in asthmatic children as compared to the healthy controls. Also, a significant correlation was detected between the saliva pathogens and dental caries. Dental caries were more prevalent in children receiving b2-agonists alone than in those receiving both corticosteroids and b2-agonists. Our study concluded that a more comprehensive precise oral health training program needs to be established by complete evaluation of the dental caries status in asthmatic children and also by training them regarding the technique of using inhalers with a spacer to lower the complications and costs of dental caries.

Smoking is considered the first preventable cause of mortality worldwide. There are many predictive factors on smoking cessation including social, family and individual issues. High nicotine dependency is one of the factors that make the cessation harder for the smoker. There are several methods for estimating the nicotine dependency rate in practice among which Fagerstrom test is one of the most suitable and non-invasive ones. This was a cross-sectional study. Data were collected from all smokers who had participated in the group therapy smoking cessation courses in Tehran smoking cessation clinic. The questionnaires were designed based on these data and nicotine dependency rate was evaluated via Fagerstrom test (FT). The smokers declared that they had quit smoking since the third session of the cessation course; this claim was confirmed by testing the expiratory carbon-monoxide rate. Finally, data were analyzed by using t-test and Chi-square test via SPSS software version 12. There were 986 cases in this study including 786 (79.7%) males. Evaluation of the nicotine dependency rate showed that more than half of the smokers (n= 544, 55.2%) had high dependency, 330 (33.5%) had moderate dependency and 112 (11.3%) had low dependency. At the end of the course, 642 subjects quit smoking successfully. The maximum rate of success in cessation was among the smokers with low nicotine dependency (79 cases, 70.5%) and the minimum rate of success was among the smokers with high nicotine dependency (323 cases, 59.4%) (P=0.00). According to the results of this study smokers with high nicotine dependency had a low chance to quit successfully. Therefore, it is recommended to follow them up for a longer period of time and use combination therapy for them.

Mediastinal hemangioma is a very rare tumor. It may occur at any age but the cavernous form shows a predilection in children and adolescents. Mediastinal hemangioma was diagnosed in a 15-year-old boy from Afghanistan. Cough and neck swelling were his chief complaints. Chest x- ray and CT-scan showed mediastinal widening and anterior mediastinal mass. After cervical biopsy, anterior cervicomediastinal surgery was performed. Pathological examination of the lesion revealed a mediastinal hemangioma.

Idiopathic subglotic stenosis (ISS) is a rare progressive condition affecting young females. The cause is unknown and in some reports relation with anti-cytoplasmic antibodies (ANCA) and gastroesophageal reflux disease (GERD) has been reported. Surgical resection of stenotic area or dilatation with laser ablation are the main treatment options. We report a case of ISS in a five-month pregnant woman with gradual deterioration who was treated with dilatation by rigid bronchoscopy and laser ablation of excessive tissue.