Tanaffos Respiration Journal
Volume:4 Issue: 4, Autumn 2005

Genomic studies provide scientists with new techniques to quickly analyse genes and their products in mass. The post genomics era has brought ever increasing demands to observe and characterize variations within biological systems. These variations have been studied under Systems Biology. Systems biology is a multi disciplinary and multi-instrumental analysis of all molecules within the cell, tissue and organism. This technology includes studies regarding genomics (gene function), transcryptomics (mRNA function), proteomics (protein regulation) and the metabolomics (low molecular weight metabolites).The suffix “– omic “is added at the end of each part of the systems. Metabolomics/metabonomics has been labeled one of the new “– omics “joining genomics. It is rapidly becoming one of the platform sciences of the “omics “, with the majority of papers in this field having been published only in the past two years (Rochfort S, 2005)and the manufacture sale rose up to $230 million in 2005 (Lok C, 2005).Metabolomics is concerned with the measurement of global sets of low-molecular weight metabolites. It is the study of metabolites and their roles in various disease states and is a novel methodology which arose in the last 3-5 years. The concept, characteristics, technologies and history of metabolomics are introduced. The techniques used in data acquisition and data analysis including NMR, GC/MS, LC/MS, and others, as well as the possibilities and the limitation of techniques are introduced.Metabolomics made on lab- on – a – chips techniques to provide earlier, faster, and more accurate diagnoses for many diseases. The major application of metabolomics is in toxicology, clinical trial testing, pharmacology and drug phenotyping,nutrient industry and food /beverage tests, cancer research, clinical pathology tests, and many others which have been tabulated in the text. Metabolomics developed mostly in plants, which are easier to study compared to mammals. Although use of metabolomics in medicine is in its infancy, this approach is considered to have the potential to revolutionize medical practice in prevention, predicting and personalizing health care. (Tanaffos 2005; 4(16): 13-22)

Primary and secondary infections and malignancies are inflammatory causes of fluid accumulation in the pleural space. TB is one of the infective causes of pleural effusion and is similar to malignancies because of its subacute and chronic process; although their management is extremely different.CA-125 is a glycoprotein tumor marker with molecular weight of 200 KD, which is found on the surface of ovarian and some normal and inflammatory cells. In both malignancy and tuberculosis, this tumor marker increases in serum and consequently in pleural fluid. This study was conducted to evaluate and compare CA-125 tumor marker in pleural effusion resulting from malignancies and tuberculosis. twenty-seven TB patients (18 men and 9 women), with the mean (±SD) age of 37.3±13.9 yrs. and 23 patients affected by malignant tumors (16 men and 7 women) with the mean (±SD) age of 57.9±17.7 yrs. were evaluated during 2004-2005. In malignant cases, diagnosis was made through microscopic inspection of the biopsy samples and cytology of pleural fluid. For recognition of tuberculosis, culture and smear of sputum or gastric lavage, biopsy of pleura and pleural fluid and PCR methods were used. Pleural fluid samples were collected and the amount of their CA-125 was measured by CLIA method. The cut-off value of CA-125 was obtained from a ROC curve. The mean (±SD) level of CA-125 in pleural fluid was 159.1±214, and 2149.2±4513.6 U/ml in tuberculosis and malignancies, respectively; which showed a statistically significant difference between the two groups (p<0.01). CA-125 marker levels in pleural effusion may be used as a diagnostic index for differentiation of TB and malignancy induced pleural effusions. (Tanaffos 2005; 4(16):23-27)

Thoracotomy is one of the surgical operations which causes severe pain. In fact, this pain is one of the most excruciating pains caused by surgical operations.Different procedures are performed to decrease this pain which is associated with significant physiologic, mental and pathologic complications. Each of these procedures has its own advantage and disadvantages.In many centers, the most common treatment method used, is considered as the first choice. In this study, common methods of analgesia after thoracotomy were compared. During this meta-analysis, “Visual Analogue Scale” (VAS) of patients in epidural group was compared with those in four groups of systemic opioids, intercostal block, para- vertebral block and intrapleural infusion in the first 24 hours after surgery.Data obtained from 28 randomized clinical trials (RCT) which compared the procedures in 1697 patients after thoracotomy were gathered using random effect model, effect size index and the standardized difference average. Statistical values were evaluated and the results obtained using standard error, 5% maximum confidence limit and 5% minimum confidence limit. The obtained data were evaluated using studies performed between 1987 and 2005.After evaluating 314 titles and 185 abstracts, 28 articles were entered in the meta- analysis considering inclusion criteria. Four groups of epidural with systemic opioids, epidural with para-vertebral, epidural with intercostal and epidural with intrapleural analgesia were studied. It was noticed that the epidural method in total 24 hours with 95% CI= -0.9802 to -0.3844 was a better procedure compared with systemic opioids. Epidural method did not show any difference with intercostal method in 24 hours mean with 95% CI= -0.2171 to +0.5906. Epidural method was also better than intrapleural in 24 hours mean with 95% CI= -1.1166 to -0.0106. When comparing epidural with para-vertebral, epidural was better with 95% CI= +0.1744 to -0.4527. According to the evaluations performed, epidural method is recommended as the method of choice to reduce pain after thoracotomy. (Tanaffos 2005; 4(16): 29-39)

Chronic parotiditis is a rare disease of the parotid glands. Both infectious (e.g. tuberculosis) and non-infectious causes (e.g. sarcoidosis, autoimmune diseases, malignancy and duct stones) have been enumerated for this condition. Primary tuberculous parotiditis is a rare disease. It was diagnosed in a 20-year-old soldier after obtaining a biopsy and observing granuloma and caseous necrosis compatible with TB in histological examination of the specimen. Cultures of discharge and tissue were negative in regard to mycobacterium tuberculosis. Also, malignancy was ruled out by histopathological examinations. Therefore, the four drug anti-TB regimen was initiated. The patient was completely treated and there was no report of recurrence.The endemic condition of TB in developing countries such as Iran has increased the rate of extra-pulmonary TB. One of the extra pulmonary sites which is rarely involved in TB is parotid gland; presenting usually as chronic swelling or mass. Therefore, it is recommended to consider TB in the differential diagnosis of parotiditis and chronic swelling of this salivary gland especially in developing countries. (Tanaffos 2006; 5(1): 65-68)

Considering the increasing number of intravenous drug users (IDUs) and their frequent admissions to infectious disease wards, better understanding of their infections seems necessary. The purpose of this research was to study the epidemiology, prevalence and nature of pulmonary infections in admitted IDUs in these wards at Shaheed Beheshti University of Medical Sciences. A descriptive study was performed on 126 admitted IDUs in infectious wards of the Shaheed Beheshti University of Medical Sciences from May 2002 to Jan. 2004 and we classified their infections. Pulmonary infections were the most common infectious disease category after skin and soft tissue infections.. In 34 of 126 IDUs, pulmonary infection was the definite diagnosis which was investigated in 4 groups: pneumonia, tuberculosis, pleurisy, and lung abscess. Pneumonia was the second most common infection. The most prevalent causes of fever were pulmonary infections. Twenty seven percent (8 cases, 9 admissions) of pulmonary infections were smear positive TB. Frequency of HBS Ag, Anti HCV and HIV infection was 20%, 92% and 67% respectively. Mean duration of admission was 17 days and in average 6 antibiotics were used per patient. Mortality of pulmonary infections was 30% whereas the overall mortality was 17.7%. We found pulmonary infections to be the second most frequent cause of infection in IDUs with a high mortality rate. The high frequency of TB and concurrence with HIV was also noted.(Tanaffos 2005; 4(16): 47-50)

Metal working fluids (MWFs) sprayed through lathe machine operations in the air, are considered as hazardous chemical constituents of working room air. MWFs are detrimental for respiratory system and skin and are also suggested as a probable carcinogens. Occupational exposure of a representative group of lathe machine operators exposed to MWFs and a group of assembly workers without active exposure were monitored. Measurements of lung function parameters such as forced expiratory volume in one second (FEV1), forced volume capacity (FVC) and FEV1/FVC of exposed and control groups were obtained after cross-shift exposure to MWFs. Exposure of the majority of lathe machine operators was in excess of the occupational exposure limit for MWFs in the range of 0.1-19.0 mg/m3 with the mean of 8.51 and standard deviation of 2.80 mg/m3. Exposure of the control group (assembly workers) to MWFs was below the sensitivity of analytical method. Differences of predicted lung function parameters (FEV1, FVC) between the exposed and the control population were significant (p<0.001). Correlation coefficient of lung function parameters of FEV1 and FVC with cross-shift exposure was also significant (p<0.001). Considering occupational monitoring of lathe machine operators exposed to MWFs and depression of their lung function parameters, implementation of standard control measures along with periodic lung function monitoring should be done. (Tanaffos 2005; 4(16): 51-56)

Many different methods and approaches have been applied for confirmation of tuberculosis in children. The diagnostic criteria being currently used for detection of childhood TB consist of clinical symptoms, history of close contact, radiological findings, PPD test and positive bacteriologic or pathologic findings. Since each of these methods may have false positive or negative results, it is necessary to find a better method for prompt diagnosis. This study was performed to determine the value of CT-scan as a sensitive method in detecting hilar, parenchymal and mediastinal involvements in early diagnsis of childhood TB and compare it with other diagnostic criteria. This cross-sectional comparative study was carried out on 100 children, suspicious of having primary pulmonary TB between September 1999 and September 2000 in Masih Daneshvari Hospital. All patients had prior history of close contact with smear-positive patients having active pulmonary TB. Epidemiological factors as well as radiological and microbiological findings were evaluated. Of total 100 patients, 43 were female and 57 were male. The mean age was 7.5 ± 3.6 yrs ranging from 4 months to 14 years. Forty two were Iranian and 58 were Afghan. Thirty nine children had a positive PPD test. Bacteriological and simple chest x ray findings compatible with TB were positive in 11 and 36 patients, respectively. Pulmonary CT-scan without contrast revealed lung lesions in 55 patients while 25 of them (45.4%) had normal chest x rays. In 12 patients positive CT-scan was the only positive diagnostic finding. Our results show the value of pulmonary CT-scan as a diagnostic criterion in pediatiric tuberculosis and we recommend it for early diagnosis in suspicious cases with no other positive findings. (Tanaffos 2005; 4(16): 57-62)

The medical community has a special role both in preventing and controlling smoking. According to research studies conducted in many countries, many medical staff members are smoker themselves and there is a significant correlation between the rate of smoking in physicians and smoking in the society.Considering the fact that we did not have such information in regard in our society, this study was conducted nationwide to evaluate smoking and its related diseases among members of the Iranian Medical Council. A cross sectional, descriptive study was done by sending questionnaires in accordance with standard criteria from World Health Organization (WHO) and International Union Against Tuberculosis and Lung Disease (IUATLD).The population under study were all Medical Council members, 80000 people in number. This study was conducted in 2003 by sending the questionnaires via the Journal of the Iranian Medical Council to all members. The answers were sent back by prepaid envelopes via express mail. Data obtained from 3270 returned questionnaires indicated that 13.1% of the population under study were smokers. This number did not show any significant difference compared to the rate of smoking in the society (12.5% in the year 2000). However, smoking in 19.6% of the male physicians and 5.5% of female physicians showed a significant difference as compared with the rate of smoking in males and females in the society (25.2% in males and 2.5% in females in the year 2000).Also, 16.6% of general physicians, 12.5% of pharmacists, 12.5% of dentists, 10.6% of specialists, 18.2% of nurses, 1.4% of midwives, and 4.7% of other medical personnel were smokers.The most common age at which smoking was started was 18 yrs in 31%. It must be mentioned that 10.5%of people had started smoking before the age of 15.In 39.6%, they were suffering from various related diseases. This rate was 37.2%, 46.4% and 45% in non-smokers, ex-smokers and smokers respectively (p=0.00). In smokers, the rate of smoking-related diseases increases with an increase in the number of cigarettes smoked daily; as 28.2% of the people who smoke less than 10 cigarettes per day are sick. This rate is 44.6% in persons who smoke more than 20 cigarettes a day (p=0.00).The obtained results are useful in smoking control training programs for the medical community and health priorities nationwide. (Tanaffos 2005; 4(16): 63-67)

A 73 year- old man with cough, dyspnea, generalized lymphadenopathy and left sided pleural effusion was admitted with primary impression of lymphoproliferative disorders. The precise evaluation showed systemic primary amyloidosis with the rare presentation of generalized lymphadenopathy and massive pleural effusion without any other organ involvement as the available tests showed. (Tanaffos 2005; 4(16): 69-71)

We describe a case of pulmonary epithelioid hemangioendothelioma (PEH), previously known as intravascular bronchoalveolar tumor, in a 48- year-old woman with an initial diagnosis made by CT-guided transthoracic needle biopsy. This is a rare disease, with approximately 50 cases described in the literature. To our knowledge, this has not been previously described in the English-language literature. This tumor can affect multiple organs. PEH is usually multifocal or small sized; hypertrophic osteoarthropathy is uncommon. This patient presented with hypertrophic osteoarthropathy and large solitary pulmonary mass, rare presentations of this uncommon tumor.(Tanaffos 2005; 4(16): 73-78)