Tanaffos Respiration Journal
Volume:10 Issue: 1, Winter 2011

Oseltamivir-resistant cases were reported during the 2009 pandemic influenza outbreak and therefore, widespread emergence of oseltamivir-resistant 2009 H1N1 virus is imaginable. Underlying medical conditions like immunosuppression increase the chance of oseltamivir resistance. In a retrospective cross-sectional study, respiratory tract specimens of confirmed cases of 2009 H1N1 influenza referred to the Masih Daneshvari Hospital were analyzed for presence of H275Y mutation. From November 2009 through March 2010, oseltamivir- resistant 2009 H1N1 infection was observed and confirmed in 4 patients (including 2 immunocompromised patients) by performing H275Y mutation molecular testing. Close monitoring of resistance to neuraminidase inhibitors is essential in tertiary care centers. The H275Y mutation (oseltamivir-resistant genotype) could appear in the absence or presence of selective drug pressure.

Differential diagnosis between tuberculous pleurisy (TBP) and non- tuberculosis pleural effusion represents a critically important clinical problem. In recent years, several noninvasive methods have been found for diagnosis of tuberculous pleurisy. This study aimed to evaluate the value of detection of the genome of Mycobacterium tuberculosis (MTB) by polymerase chain reaction (PCR) method for the diagnosis of tuberculous pleurisy and compare the results with those of conventional methods. In this cross-sectional study, we studied 62 patients (42 men and 20 women) with pleural effusion in Ghaem Hospital, affiliated to Mashhad University of Medical Sciences from January 2006 to June 2007. A total of 20 patients had tuberculous pleurisy (45.4%), 15 patients had malignant pleural effusion (34%), 3 patients had pleural effusion with various “non-tuberculosis non-malignant” etiologies (6.8%) and 6 patients had transudative pleural effusion (13.6). The sensitivity, specificity, positive predictive value and negative predictive value of PCR in tuberculous pleurisy were 85%, 100%, 100% and 88.8%, respectively.

Obstructive lung disease is a growing health problem, especially in developed countries. This study aimed to compare Impulse Osillometry System (IOS) and Spirometry for evaluation of Chronic Obstructive Pulmonary Disease and asthma. The study groups contained 87 healthy people, 87 asthmatic patients and 56 COPD patients. Spirometry (FVC, FEV1, FEV1/FVC) and IOS (R5, R20, X5) measurements were performed for all the healthy subjects and patients. The results of IOS were compared with spirometric results. Significant differences were detected among the 3 groups (control, COPD and asthma) in terms of all the spirometric parameters (FVC, FEV1, FEV1/FVC) and some parameters of IOS (R5,R20,X5) measurements (p<0.05). Among COPD patients, sensitivity for X5 (the best value of IOS measurements in the COPD group) was 76%. Also, in asthmatic patients, sensitivity for R20 (the best value of IOS measurements in the asthma group) was 77%. We found a correlation between R5, R20 and X5 with FEV1 in asthmatic patients, but only R5 had this correlation with FEV1 in COPD patients. We concluded that IOS can be an alternative for spirometry in the diagnosis of obstructive lung disease in patients with minimal cooperation. R5 can represent COPD severity.

Early tracheostomy can reduce the time required for mechanical ventilation, the duration of ICU stay, and treatment expenses. Choosing the optimal time for tracheostomy in patients with severe head injury is therefore important. The purpose of this study was to find the optimal time for tracheostomy according to Glasgow Coma Scale (GCS). In this prospective study, patients with severe head injury (GCS<8) admitted to the ICU of Kerman Shahid Bahonar Hospital were evaluated every day according to their GCS, and possible need for tracheostomy. Seventy-four patients were enrolled. The GCS of 49 patients on day 5 following ICU admission was <9. Forty-two patients (85.7%) eventually needed tracheostomy, and tracheostomy was not required in the remainder (14.3%). The prevalence of tracheostomy in patients with GCS >9 was 50%, and this difference was statistically significant. The present study showed that GCS of patients with severe head injury on day 5 following ICU admission may be used for decision-making regarding the time of tracheostomy. Tracheostomy should be carried out on day 5 following ICU admission if the GCS is ≤8, but it can be delayed if the GCS on the 5th day is >9.

Recently, research of indirect evidence suggested a possible association between Helicobacter pylori and pulmonary disease. This study aimed to determine if H. pylori could be detected in endobronchial specimens collected from patients undergoing bronchoscopy. This prospective study was conducted on 34 consecutive patients with any type of lung disease undergoing bronchoscopy in which biopsy was required for their diagnosis. A written informed consent was obtained from all participants. Three bronchial mucosa biopsy samples were obtained using fenestrated biopsy forceps. One sample was used to determine urease activity, the second one for histopathological examination, and the third one for diagnosis. All subjects were fully informed regarding the gastroesophageal reflux disorder (GERD) Questionnaire. There were 34 patients with pulmonary diseases (12 males and 22 females, mean age 58.2±18.2 years) out of which, 11 (32.4%) had GERD. No significant difference was found between the histopathological assay and GERD. Our study found no direct evidence supporting the theory that H. pylori may cause pulmonary disease and no relation with GERD was detected. However, a possible indirect role could not be excluded. Further studies in patients with GERD and lung disease may reveal a potential pathogenic link between H. pylori and pulmonary disease.

Tuberculosis is still an important problem in developing countries. The tuberculin skin test (TST) is used for the identification of latent tuberculosis (TB) infection. This study aimed to evaluate the TST results of healthy employees of different departments in chaharmahal province, Iran. This study was done on 1,424 healthy employees from 49 different departments in Chaharmahal Province. The tuberculin skin test was done with Purified Protein Derivative (PPD) solution. The induration was evaluated 48-72 hours later. Negative PPD test was observed in 346 subjects. A 5-10 mm induration was seen in 276, a 10-15 mm in 292, a 15-20 mm in 212, a 20-25 mm in 72, and a 25-30 mm induration was observed in 14 cases. A total of 212 subjects were absent when reading the induration. Tuberculin skin test can be used for the identification of TB infection. Prevalence of latent TB infection was low in our study. There were no significant differences in PPD test results between medical and non-medical departments.

Cigarette smoking is considered the first preventable cause of death in the world. Social, familial, and personal factors play an important role in prevention or cessation of smoking. Educating the public in order to enhance their knowledge, change their attitude and improve their habits is also effective in this respect. In 2007, the executive protocol of the Comprehensive Law on Smoking Control was compiled in the Ministry of Health and according to the Article 5 of this law pictorial health warning labels had to be applied on cigarette packaging. This study was designed and conducted in 2 phases of before and 9 months after the implementation of this law and evaluated the effect of it on smokers’ knowledge, attitude and pattern of smoking. This was a cross-sectional descriptive study conducted to evaluate the effect of cigarette packs’ pictorial health warning labels on the knowledge, attitude and smoking pattern of smokers residing in Tehran. After calculating the size of understudy population and estimation of the exclusions, 1731 subjects were randomly selected using the multiphase cluster method from the 22 districts of Tehran. Data were collected using a questionnaire designed according to the standard questionnaire of the World Health Organization (WHO) and International Union Against Tuberculosis and Lung Disease (IUATLD). Qualitative and quantitative value and reliability of the variables including cigarette consumption, knowledge about the law, and pattern of smoking were evaluated in 2 phases and the quality of pictures and their effects on the mentioned variables were assessed in the 2nd phase. Before adopting the pictorial warning labels in the first phase of the study, 1731 respondents were evaluated out of which 71.8% were males and 28.2% were females. These cases had an average of 17.6±12.3 years history of smoking. A total of 38% (675 subjects) used Iranian cigarette brands and 39.5% were aware of the implementation of pictorial health warning labels on cigarette packs. In terms of smokers’ attitude towards the implementation of this law, they mostly had no opinion about it. A total of 33.3% stated that they may cut down on smoking as the result of this law. Men had a higher percentage of smoking a cigarette first thing in the morning before breakfast and women had a higher rate of consuming foreign cigarette brands (P<0.001). In the second phase of the study, 1590 cases of the phase 1 subjects participated. Subjects had a significantly higher knowledge about the implementation of pictorial health warning labels on cigarette packs (P<0.001). Attitude towards this law did not change significantly compared to the first phase although the mean score improved by 0.07%. Enforcement of this law resulted in decreased consumption in 7.6% of the participants. However, the Wilcoxon test did not show any significant difference. In terms of the quality of pictures, 61.6% had no opinion, and 28.7% expressed that the pictures had poor quality. No significant difference was observed between the Iranian or foreign brands in terms of smoking rate after applying the pictorial warning labels. We believed that the smoking rate would decrease after applying the pictorial health warning labels on cigarette packs. However, it did not happen. Also, adopting these labels did not have a significant effect on smokers changing their favorite brand from Iranian to foreign brands or vice versa. Type and quality of pictures require major revision and corrections.

Mulibrey nanism is a rare autosomal recessive disorder characterized by severe growth retardation and pericardial constriction associated with muscle, liver, brain, and eye abnormalities. More than 80% of previously reported cases are Finnish. We report a 35-year-old Iranian female who presented with classic phenotypic features of Mulibrey nanism with symptomatic constrictive pericarditis and underwent pericardiectomy. Our case is one of the rare examples of Mulibrey nanism outside Finland that has been reported so far.

A 15- year-old boy was referred to Imam Reza Hospital with a right chest tube and chylothorax for 40 days. The patient had respiratory distress and undergone refractory treatment for chylothorax. The fluid content was chyle-rich in lipids. Computed Tomography of the chest showed a large, incompletely evacuated cyst in the left posterior mediastinum with left pleural effusion. The cyst could not be resected through right thoracotomy, because of the left side location of the cyst. Ligation of the thoracic duct through right thoracotomy was not effective in reducing chylous effusion 4 days later. Left chylothorax exacerbated because of the complication of right thoracotomy. Laparatomy was performed to ligate the thoracic duct 6 days later. On exploratory laparatomy, chylous effusion was detected in the peritoneum.Thoracic duct with all the fibro-fatty tissues was ligated below the diaphragm over the spine at 12th to 2nd vertebral spaces. Right chylothorax was resolved after ligation of thoracic duct transabdominally 1-2 days later. Left chylous effusion was decreased and treated 46 days after laparatomy. One year follow up of the patient showed excellent result. In our knowledge, thoracic duct cyst occurring as a result of a delayed chylothorax and chyloperitoneum has not been reported in the literature. Surgical thoracic duct ligation can be the treatment of choice.