فهرست مطالب fariba rezaeetalab

The Coronavirus disease 2019 (COVID-19) pandemic has posed significant challenges to healthcare systems worldwide. This cross-sectional study aimed to investigate the relationship between inflammatory markers, liver enzymes, lung involvement severity, and mortality in 841 COVID-19 patients admitted to Imam Reza Hospital affiliated to the Mashhad University of Medical Sciences, Mashhad, Iran.The study included demographic information, physical and clinical symptoms, laboratory findings, computed tomography (CT) scan scores, and final outcomes. The mean age of the patients was 58.23±16.44 years, and 39.2% were female. The most common underlying disease was hypertension (51.3%), and the most frequent symptom at presentation was shortness of breath (87.1%). The mortality rate was 33.8%. The results showed a significant direct correlation between CRP levels and LDH levels (r=0.129, p<0.001), as well as between CRP levels and CT scores (r=0.322, p<0.001). There was also a significant inverse correlation between CRP levels and patients' SPO2 (r=-0.309, p<0.001). ESR levels had no significant correlation with SPO2, LDH, AST, ALT, or CT scores. Expired patients had significantly lower SPO2 levels (p<0.001) and ALT (p=0.044), while CRP (p<0.001), LDH (p<0.001), and CT scores (p<0.001) were significantly higher compared to discharged patients.The findings suggest that serum CRP levels at admission can be used as a predictive factor for the severity of lung involvement and mortality in COVID-19 patients. Liver damage was also associated with worse clinical outcomes. ESR levels had no significant relationship with lung involvement severity and mortality, possibly due to the delay in ESR elevation in response to inflammation.

Gamma-glutamyl transferase (GGT) is a liver enzyme that is involved in inflammation and oxidative stress. It has been hypothesized that elevated GGT may occur secondary to oxidative stress in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and can be used as an indicator of inflammation in these patients. The present study aimed to determine the relationship between serum GGT and arterial blood gas (ABGs) on the one hand and COPD severity in AECOPD patients on the other hand. Patients with AECOPD were evaluated for disease severity based on the global initiative for chronic obstructive lung disease (GOLD), Modified British Medical Research Council (mMRC), COPD Assessment Test (CAT), and spirometry assessment upon admission at the hospital. Moreover, the GGT level in patients was analyzed based on the severity of the disease. The data were analyzed using SPSS software (version 25.0) by proper statistical tests. The significance level was P˂0.05. The mean±SD of the CAT score in the patients was obtained at 19.6± 4.6. According to the mMRC scale, most patients were grade 2 (n=29, 52.7%) and grade 1 (n=17, 30.9%), respectively. In addition, according to GOLD criteria, most patients (n=34, 61.8%) had moderate and severe (n=16, 29.1%) disease, respectively. The median (IQR) GGT levels in patients with mMRC 0-1 were 28.7 (12.98) IU/L, and those with mMRC 2-4 were 21 (33) IU/L (P=0.770). Additionally, the median (IQR) of GGT levels in patients in GOLD A-B were obtained at 26(18) IU/L, and in patients in GOLD C-D were reported as 18 (23.80) IU/L (P=0.222). The results showed a significant positive relationship between GGT level and AECOPD severity (r=+0.277, P=0.04). Moreover, a significant negative relationship was observed between GGT level and forced vital capacity (FVC) (r=-0.268, P=0.04). According to the Pearson correlation test, There was no significant correlation between GGT level with arterial HCO3 (P=0.123), PCO2 (P=0.511), PO2 (P=0.888), FEV1 (P=0.356), and FEV1/FVC (P=0.975). In conclusion, while a significant positive relationship was found between GGT levels and AECOPD severity, the study suggests that serum GGT levels may not have clinical efficacy in differentiating between patients with varying intensities of AECOPD periods. Further research with larger sample sizes and consideration of additional factors is warranted to confirm these findings.

Increased vascular permeability is one of the main mechanisms in the production of pleural effusion (PE) and vascular endothelial growth factor (VEGF) has a significant role in its pathogenesis. This study aimed to compare pleural levels of VEGF in transudative and exudative PEs besides the other pleural markers.
In this prospective cross-sectional study, 80 patients with PE were divided into 4 groups as transudative (N=15), parapneumonic (N=15), tuberculosis (N=25), and malignant (N=25) PE. Biochemical tests measured the pleural protein, LDH, cholesterol, glucose, polymorphonuclear cell (PMN), and lymphocyte. ELISA measured the pleural VEGF level.
Out of 80 patients, 51 were male, and the total mean age was 55.34±18.53. There were significant differences in pleural VEGF between exudative and transudative effusion (P<0.001) and between malignant and benign effusion (P=0.014). The highest mean difference in pleural VEGF levels was seen in the comparison of transudative and malignant groups (Mean difference=-136.56; P<0.002). The VEGF level in 3 groups was not significantly different; transudative vs tuberculous, parapneumonic vs tuberculous, and parapneumonic vs malignant. Furthermore, VEGF higher than 73.09 pg/ml had a 64% sensitivity and 82% specificity for the diagnosis of malignancy. Among pleural markers (VEGF, protein, LDH, and glucose), VEGF had the highest area under curve (AUC=0.734). Moreover, pleural protein, LDH, and glucose levels significantly correlated with pleural VEGF; however, pleural cholesterol, PMN, and lymphocyte were not correlated.
VEGF is assumed as an important factor in the pathogenesis of exudative PE, especially malignant effusion. It can distinguish between lymphocytic exudative PEs.

  Periodontitis is an inflammatory disease of the tooth-supporting structures. Current data suggest that periodontal disease may be a risk factor for asthma. The present study aimed to assess the prevalence of periodontitis and its relationship with the severity of asthma in asthmatic patients.

  This study was conducted on 70 newly diagnosed asthmatic patients as the case group and 70 healthy subjects as the control group, aged 20‒50. The asthma was diagnosed by a pulmonologist according to Global Initiative for Asthma (GINA) guideline. All the participants underwent peri odontal examinations, which included measuring the pocket depth (PD), attachment loss (AL), gingi val index (GI), and plaque index (PI) in one tooth from each sextant, including the incisor/canine and left and right premolar/molar regions for both the maxillary and mandibular dental arches.

  Periodontal disease was significantly more prevalent in newly diagnosed asthma patients. Patients with asthma had significantly higher PI, GI, PD, and AL scores (P<0.001). Furthermore, dry mouth in asthmatic patients with cough and mucosal changes in asthmatic patients with wheeze were significantly more common than in non-asthmatic patients (P<0.05). The median AL in wheezing patients and the median AL and PD in participants who had asthma attacks within the previous month were significantly higher than in other patients. Furthermore, there was a significant negative correlation between AL with Forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) and PD with FEV1 and FVC.

  Our results showed that periodontal diseases were more prevalent in newly diagnosed asthmatic patients, and asthma was more severe in periodontitis patients.

Restless legs syndrome (RLS) has been associated with a variety of diseases, including chronic obstructive pulmonary disease (COPD), which can worsen the symptoms of underlying disease and correlates with co-morbidities. We aimed to investigateRLS in patients with chemical warfare-induced lung diseases.

This cross-sectional study recruited patients with sulfur mustard (SM) lung injury, their healthy family members, and patients with COPD from August 2018 to August 2019. COPD was confirmed by medical history, physical examination, and spirometry according to GOLD COPD guidelines. RLS diagnosis was recognized by the International Restless Legs Syndrome Study Group (IRLSSG) and severity was assessed using the International Restless Legs Scale (IRLS) rating scale. Other research measures were COPD Assessment Test (CAT), modified Medical Research Council (mMRC) scale for dyspnoea severity, and Epworth Sleepiness Scale (ESS) for daytime somnolence. Laboratory values included hemoglobin, ferritin, creatinine, and fibrinogen.

This study was conducted on 143 men in three groups: 40 (30.0%) SM-exposed veterans,73 (55.3%) patients with COPD, and 30 (20.9%) healthy cases.Due to the high prevalence of COPD and better comparison with the control group, more patients with COPD were selected. 20 cases (50%) of the veterans group had RLS, while 25 (32.9%) cases of COPD were affected by this disorder. One normal case (3.33%) suffered from RLS. The chemical veterans who suffered from cough, sputum production, chest pain, and hemoptysis had a higher incidence in proportion to patients with COPD (P < 0.001). The CAT score was significantly higher in SM-exposed veterans with RLS (P = 0.004).

RLS is more common in SM lung injuries with higher CAT scores; therefore, evaluation and treatment of RLS are recommended in mustard lung victims.

We report pulmonary thromboembolism (PTE) as the merely manifestation in a young man with covid 19. He had no any infectious presentation such as fever, headache, bone pain, cough, dyspnea and diarrhea. The Upsetting left pleuritic chest pain was the only compliant. Lung CT angiogram reported thrombus in the left and right pulmonary artery, but no any risk factor for PTE detected was found. According to high prevalence and world epidemic of the Covid 19, PCR was performed and then defined Corona virus 2.

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide. One of the most important events in the course of COPD is acute exacerbation. Acute exacerbation of COPD (AECOPD) is characterized by the aggravation of dyspnea, cough, and sputum. Chronic obstructive pulmonary disease exacerbation leads to respiratory failure, hospitalization, morbidity, and mortality. During and after the COPD attack, lung function dramatically decreased.  Bacterial pneumonia is an important and serious risk factor for AECOPD. However, there are other inflammatory and non-inflammatory causes of AECOPD. Antibiotic treatment is usually challenging in AECOPD. Procalcitonin is a non-hormone active protein and precursor to calcitonin that consists of 116 amino acids, and 13 kDa weight is produced by the neuroendocrine cells of the thyroid gland. However, procalcitonin is secreted in septic shock, metastatic cancers, bacterial and fungal infections; therefore, serum procalcitonin is increased in bacterial pneumonia of AECOPD. Some studies recommended procalcitonin serum measurement as a guide for antibiotic initiation in AECOPD.

Chronic obstructive pulmonary disease (COPD) is a disease of chronic diffuse irreversible airflow obstruction. Due to the relatively high prevalence of the disease, paying attention to the treatment of these patients helps a lot in controlling the disease and reducing its cost. This study aimed to investigate the presence of serum procalcitonin in patients with an acute attack of COPD.

Methods & Materials: 

This cross-sectional study was performed on 65 patients with an acute COPD attack in Imam Reza Hospital in 2019 by the convenience sampling method. Three ccs of blood samples were taken from patients to check serum procalcitonin levels from hospitalization to 24 hours after that. Patients with an acute COPD attack were selected based on American thoracic society criteria. Also, demographic information such as age, sex, hospitalization time, and duration of the disease was recorded. Patient complaints, disease exacerbation, and type of ventilation were recorded. Data were analyzed with SPSS software (version 16). Man-Whitney and Kruskal Wallis tests were used to analyze the data. The significance level was

According to data, 65 patients (36 men and 29 women) were examined and the mean age of the patients was 66.72 (±12.65) years. Dyspnea was the most common complaint in patients. Serum procalcitonin levels were higher in patients with invasive ventilation (P = 0.007). Also, serum procalcitonin levels were lower in patients with non-invasive ventilation (P = 0.008). Besides, serum procalcitonin levels increase with increasing disease exacerbation from mild to moderate (P <0.001). According to the results of the post hoc test, there was a significant difference between mild and severe (P <0.001) and moderate and severe groups (P <0.001). There is also a significant correlation between procalcitonin serum levels and Exacerbation (R=0.6, P <0.001) and age (R=0.2, P = 0.01). serum procalcitonin levels were higher in patients with the use of invasive ventilation

According to the results, serum procalcitonin levels are associated with acute COPD attacks. Measurement of procalcitonin levels in patients with acute COPD attacks can help diagnose and perform timely care.

Our report discusses a patient diagnosed with PAN since 3 years ago. He presented with fever, chills and nonproductive cough. He was a long time receiver of immunosuppressant drugs for his underlying condition. Upon examination he was febrile, had cushingoid appearance and cackles in both lungs. Lung CT scan showed opacities in right upper lobe lung and multiple bilateral nodules and ground glass opacity along with mild thickening of pleura. A bronchoscopy was ordered to asses PCP, and without hesitation empirical therapy was started. However, his clinical condition did not improve as expected. At this time, suspecting another infection at play, a PCR and BAL specimen was ordered for CMV. After receiving the result of BAL analysis, our suspicion was confirmed for both PCP and CMV pneumonia. CMV is an important opportunistic infection in immunocompromised individuals. This case highlights this importance in immunocompromising conditions. In this setting, presence of respiratory signs and symptoms point out to PCP as the first differential diagnosis; but at the same time it’s crucial for clinicians to consider the possibility of CMV as a co-infective agent.

Pleural effusion may develop during various acute or chronic medical conditions. Despite different diagnostic workups, some cases of pleural effusion may remain undiagnosed. Pleuroscopy and closed biopsy are common diagnostic approaches used for the diagnosis of undiagnosed cases. The present research aimed to evaluate the diagnostic yield of medical pleuroscopy and closed biopsy in Iran. The present cross-sectional study was performed within 2016-2018, in the North-East of Iran. Patients who had undiagnosed lymphocytic predominance exudative pleural effusion were included in the present research. Every patient underwent medical pleuroscopy or closed pleural biopsy by an Abrams needle. The collected data were analyzed in SPSS software (version 12).Ap-valuelessthan0.05 was considered statistically significant. A total of 108 patients with the mean age of 58.73±18.13 years enrolled in the present study. Around 50 patients underwent needle biopsy,while the other 58 patients went through medical pleuroscopy. Chronic pleuritis, malignant pleural effusion, negative results, and tuberculosis were the common results. When pleuritis is regarded as negative results and malignant and tuberculosis pleural effusion as positive results, medical thoracoscopy provides more significant positive results and fewer negative results (P=0.024). No patient developed complications after the procedures. In contrast to other studies, both of these techniques had low diagnostic yield for the diagnosis of undiagnosed pleural effusion. Therefore, performing other diagnostic workups (e.g., imaging techniques) may decrease the rate of undiagnosed pleural effusion.

Obstructive sleep apnea is a disorder of repetitive complete or partial airway obstruction during sleep. The aim of this study was to assess the impact of alveolar cleft reconstruction on the obstructive sleep apnea (OSA) condition and apnea/hypopnea index (AHI).

In a double-blinded prospective quasi-experimental study, all healthy systemic children (n=30 female cleft patients) with unilateral alveolar cleft defects within the age range of 8-14 years and BMI less than 30 kg/m2 who admitted for alveolar cleft repair were enrolled. OSA monitoring was performed one week before surgery, and 3 months postoperatively by Apnea Link device. Sleep apnea indices such as AHI, respiratory disturbance index (RDI), oxygen desaturation index (ODI) and oxyhemoglobin saturation (SpO2) as well as pulse rate (PR) and respiratory rate (RR) were the variables.

The patients’ mean age was 11.0±1.4 years, and BMI average was 21.48±4.4 kg/m2. Mean AHI was 21.6±5.0 events/hour, preoperatively; which decreased significantly and reached 4.4±2.5 events/hour after alveolar cleft reconstruction surgery (p=0.005). Moreover, the other OSA variables (SpO2, RDI, and ODI), as well as vital signs (PR, and RR) improved postoperatively (p=0.005). In other words, the preoperative moderate OSA status relieved after alveolar cleft repair and reconstruction.

Our study showed that the OSA and AHI ameliorated after bone graft surgery in alveolar cleft repair. More clinical trials including larger sample sizes may be required for relevancy.

Covid-19 is a novel virus with high affinity to spread in the community. In December 2019, it was first identified in Wuhan, China. The symptoms are non-specific, so fever, cough, dyspnea, are prominent features. Respiratory failure and mortality have also been reported. The most common lung CT scan findings are bilateral ground glass opacities.

Hemoptysis is the rarest presentation of thoracic aortic aneurysm (TAA).This critical condition is one of the life-threatening medical emergencies. Even with prompt approaches, TAA can have highly terrible outcomes.   Although TAA is an almost asymptomatic condition that is accidentally discovered, imaging with contrast is the most useful modality to diagnosis it.

Pulmonary thromboembolism (PTE) is a fatal condition that may rarely occur due to complications of coronary catheter insertion. In this case report, a 41-year-old male was presented 48 hours after radiofrequency catheter ablation(RFCA) for the management of Wolf-Parkinson-White syndromewith acute onset of dyspnea, hemoptysis, and chest pain. The physical examination revealed coarse crackles in the base of left hemithorax and laboratory tests were normal. The patient was suspicious for PTE based on clinical symptoms and the history ofRFCA. Diagnosis was confirmed by computed tomography angiography of lungs. Patient symptoms improved after 3 months of treatment with warfarin

Wilson’s disease is a rare genetic disorder, which is associated with clinical manifestations such as liver dysfunction, psychological and neurological issues, and specific laboratory findings demonstrating the increased urinary excretion of copper and copper accumulation in the body. Wilson’s disease is occasionally presented by atypical features, which delay the diagnosis of this rare disorder. This study aimed to describe the case of a patient with pulmonary and portal hypertension as a primary manifestation of Wilson’s disease. A young male patient was admitted to the emergency department due to the deterioration of respiratory symptoms and overall weakness. The patient had a history of dyspnea and fatigue, which was diagnosed as idiopathic pulmonary hypertension. In the previous admission, the liver function test of the patient was not disrupted, and serum/urinary copper and ceruloplasmin levels were normal. In the current admission, the patient had elevated bilirubin and enzyme levels, as well as abnormal copper and ceruloplasmin levels. Moreover, portal hypertensive gastropathy and Kayser-Fleischer ring were detected in further investigations, confirming the diagnosis of Wilson’s disease. To the best of our knowledge, this was the first report on Wilson’s disease initially presented with pulmonary and portal hypertension.

COPD is a common preventable disease characterized by airflow limitation that is not completely reversible.Acute exacerbation is prominent and serious features of COPD. Acute Exacerbation of COPD leads to hospitalization and concomitant with morbidity and mortality .The ventricular dysfunction increases serum Brain Natriuretic Peptide(BNP) . This study was conducted to evaluate the relationship between serum N-terminal pro b-type natriuretic peptide (NT-pro BNP) level and the severity of chronic obstructive pulmonary disease (COPD) exacerbation.
This cross-sectional study was performed among 140 patients with COPD exacerbation referred to Imam Reza Hospital affiliated to Mashhad University of Medical Sciences, Mashhad, Iran from March 2016 to December 2017 . The patients were asked about the number of exacerbations over the past year including the recent attack. The severity of COPD was determined by the measurement of forced expiratory volume in 1 second by spirometery and level of hypoxemia by pulse oximetery. Data analysis was performed using SPSS software, version 20.
Regarding the results, COPD was more prevalent in males. The mean age of the patients was 57.60±9.76years old. There was a significant direct correlation between mean serum level of NT-pro BNP and age (P=0.01). Although mean serum NT-pro BNP level was higher in females patients (5.70±0.96) than males (5.66±1.24), no significant correlation was observed between mean serum NT-pro BNP level and gender (P=0.8). The most common chief complaints of the patients were dyspnea (97.9%), cough (88.9%), and phlegm (81.9%). There was no significant relationship between serum NT-pro BNP levels and the length of stay in hospital (P=0.1). However, there was a significant relationship between mean serum level of NT-pro BNP and COPD exacerbation (P=0.004). The mean serum level of NT-pro BNP was higher in the patients with more than two exacerbations over the last year in comparison to the other patients. Additionally, there was a significant direct relationship between mean serum level of NT-pro BNP and the severity of COPD (P=0.009). Moreover, a significant direct relationship was found between serum NT-pro BNP level and hypoxemia ( SpO2 The serum NT-pro BNP level was a prognostic factor in the patients with COPD exacerbation.

The importance of flexible fiberoptic bronchoscopy (FFB) for diagnosis of pulmonary diseases is well known. The aim of this study was to evaluate the indications of 500 FFBs performed in Imam Reza hospital, Mashhad, Iran as well as examination of the histopathological and radiological findings.
Material and This was a retrospective analysis of the medical records and chest radiologic examinations of 500 patients who had undergone FFB using Olympus BFP20 instrument by local anesthesia in, Mashhad, Iran. The indications for procedures, demographic data, and clinical symptoms were recorded and analyzed in addition to radiological and histopathological findings.
The most common indication for FFB was found to be bronchogenic carcinoma (n=20), followed by tuberculosis (TB; n=16), sarcoidosis (n=2), and hydatid cyst (n=2). A total of 70 anthracosis cases were reported to be accompanied with other pulmonary disorders and findings such as chronic granulomatous bronchitis suspicious of TB (n=16), squamous cell carcinoma (SCC; n=5), non-specific macrophage cells in cytology (n=19), anthracotic pigment with no risk of lung cancer (n=20), anthracofibrosis (n=4), severe anthracotic pigment with undetectable mucus layer (n=2), anthracotic pigment with non-specific inflammation (n=1), mild squamous metaplasia (n=1), and chronic bronchitis with mild squamous metaplasia (n=2). Lung cancer showed higher frequency in women and patients in the sixth and seventh decades of their lives and was associated with smoking. It is worthy to note that SCC was the most prevalent cancer among the smokers. Twenty cases were diagnosed as bronchogenic carcinoma by clinical findings, eighteen of which also being confirmed by the histological examinations. Moreover, two cases of sarcoidosis diagnosis using FFB were approved by biopsy. Out of 297 bronchial biopsies, the most common indication for FFB were airway collapse and unknown pulmonary opacity.
Considering the important role of FFB in the diagnosis of pulmonary diseases, especially cancers, it seems that various diagnostic measures should be taken into consideration before disease progression. According to our evaluations, patient screening by the family physicians is recommended for the patients with cancer or TB as the two most prevalent diseases in our study.

Pulmonary thromboembolism (PTE) is a clinically critical disease, misdiagnosis or delayed diagnosis of which can lead to increased rate of mortality. For prevention of recurrence of PTE, recognition of its risk factors or underlying diseases is of great importance. PTE is common in patients with cancer and has high morbidity and mortality rates. Although cancer is a lethal condition, PTE accelerates death in these patients. In the current study, we reported the case of a 50-year-old male presenting with dyspnea, pleuritic chest pain, and non-massive hemoptysis indicating pulmonary embolism. Anticoagulant therapy was initiated, but after 12 days of treatment, new deep vein thromboses in the left upper and right lower limbs were diagnosed. However, no specific risk factors or laboratory abnormalities were detected. History of weight loss during the recent months encouraged further investigation for ruling out malignancy, which led a diagnosis of gastric adenocarcinoma. He did not have any complaints of gastrointestinal disorders.

Restless legs syndrome (RLS) is a common chronic sensory motor disorder that prevents initiation and/or sleep staying. Patients with this syndrome have uncomfortable sensations in their legs (and sometimes arms or other parts of the body), with moving their legs to relieve this sensations. The symptoms of RLS are usually worse in the evening and at night. The diagnosis of RLS is primarily based on clinical evaluation and clinical history of the patient. International restless leg syndrome group study (IRLSSG) evaluates the symptoms and severity of RLS. RLS can be divided into two groups of primary and secondary. Iron deficiency, Parkinson’s disease, kidney failure, diabetes, peripheral neuropathy, and pregnancy may cause RLS. Antinausea, antipsychotic drugs, some antidepressants, and antihistamines may also worsen the symptoms. RLS is also observed in chronic obstructive pulmonary disease (COPD), which makes the outcomes worse. COPD is a main preventable health problem that can lead to morbidity and mortality. Thus, RLS in COPD causes excessive daytime hypersomnolence, fatigue, poor quality of life, disability and neuropsychological complications such as social isolation, frequent daytime headaches, anxiety and depression.

Chronic obstructive pulmonary disease (COPD) patients are at increased risk of sleep-disorders. The concomitant occurrence of COPD and obstructive sleep apnea hypopnea syndrome (OSAHS) is named overlap syndrome. This study aimed to evaluate the severity of OSAHS in overlap syndrome patients.
This cross-sectional study was conducted on adult patients with forced expiratory volume in 1 second (FEV1%)/forced vital capacity
Forty patients (62.5% male) with mean age of 59.7±8.3 years participated in the study. Severity of obstructive sleep apnea was low, moderate, and severe in 23 (57.5%), 14 (35%), and 3 (7.5%) cases, respectively and there was no statistical relation between OSAHS and FEV1% (P=0.55).
This study showed that there was no significant correlation between apnea–hypopnea index and FEV1% predicted in overlap syndrome patients.

Overlap syndrome, which is known as the coexistence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA), was first defined by Flenley. Although it can refer to concomitant occurrence of any of the pulmonary diseases and OSA, overlap syndrome is commonly considered as the coexistence of OSA and COPD. This disease has unique adverse health consequences distinct from either condition alone. Given the high prevalence of each solitary disease, overlap syndrome is also likely to be common and clinically relevant. Despite the fact that overlap syndrome has been described in the literature for nearly 30 years, paucity of evaluations and studies limited the discussion on diagnosis, prevalence, pathophysiology, treatment, and outcomes of this disease. This review article addresses these issues by reviewing several recent studies conducted in Iran or other countries. This review suggests that overlap syndrome has worse outcomes than either disease alone. Our findings accentuated the urgent need for further studies on overlap syndrome and all overlaps between OSA and chronic pulmonary disease to provide a deeper insight into diagnosis and non-invasive treatments of this disease.

Renal failure affects the mechanical and the ventilatory function of the lungs. A few studies have evaluated the ventilatory and pulmonary function in dialysis patients. The present study aimed to compare Pulmonary Function Test (PFT) results in patients undergoing Hemodialysis (HD) and Peritoneal Dialysis (PD).

We conducted a cross-sectional study on 50 patients with hemodialysis (HD) and 50 cases with PD who underwent PFT in Ghaem and Imam Reza hospitals Mashhad, Iran from November 2010 to July 2012. Spirometric parameters including forced expiratory volume in 1s (FEV1), FEV1/forced vital capacity (FVC), forced expiratory flow 25-75% (FEF) and peak expiratory flow (PEF) were compared between the two groups of patients.

Approximately 68% of the HD patients, 66% of the PD patients, and 67% of all the studied cases showed a normal spirometric pattern. Moreover, there were no significant differences between the two groups considering the mean of the aforementioned spirometric parameters(restrictive, obstructive pattern) (P=0.969). However, an insignificant inverse correlation was observed between the duration of dialysis with FEV1 (r=0.381, P=0.008), FVC (r=-0.298, P=0.04), FEF 25-75% (r=0.43, P=0.003), PEF (r= 0.349, P=0.02) and FEV1/FVC (r=-0.363, P=0.01,) in the HD patients and between the patients’ age with FEV1/FVC (r=0.03, P=0.02) in the PD patients.

This study showed no significant difference in pulmonary function in hemo and peritoneal dialysis,so according this result, both of the dialysis had the same affect on the lung function.

The main outcome of systemic scleroderma is progression to pulmonary complications. Early diagnosis is important in treatment and management of patients with lung involvement. In this study we compared lung functional tests and high-resolution computed tomography scan’s results with each others، in order to find a reliable non-invasive modality instead of biopsy for detection of lung involvement in patients with systemic sclerosis. In this descriptive cross-sectional study، from 2012 to 2014، patients with systemic sclerosis that hospitalized in Imam Reza hospital in Mashhad were enrolled. Pulmonary function tests and high-resolution computed tomography scans were performed at the same time. Data were analysed by SPSS16. Overall 12 males (mean age: 35±10 years) and 31 females (mean age: 41± 16 years) were studied، 3 patients left the study. High-resolution computed tomography scan’s findings were abnormal in 32 patients (80%) and the most feature of lung involvement was ground glass pattern in 46. 9 %. We found significant correlation between disease duration and high-resolution computed tomography scan (r=0. 03، p=0. 04). these findings illustrate the potential role of high-resolution computed tomography scan in early detection of pulmonary involvement as a non-invasive modality for lung screening in patients with scleroderma. Acknowledgment: This study was supported by Rheumatic Diseases Research Center and Mashhad University of Medical Sciences، further more there was not any conflict of interest in doing this research.

The overlap syndrome, consisting ofobstructive sleep apnea hypopnea syndrome (OSAHS) and chronic obstructvie pulmonary disease (COPD) is a major problem in COPD patients. OSHAS corresponds to the likelihood of systemic hypertension.The present study was aimed to evaluate the association between apnea-hypopnea index and diastolic blood presssure (DBP) in overlap patients. We conducted a cross-sectional study involving overnight polysomnography after measurment of resting diastolic blood pressure (DBP) in patients with overlap syndrome in Sleep Laboartory of Imam Reza Hospital, Mashhad, Iran from October 2011 to December 2012. Participants were divided into four subgroups regarding to their Apnea-Hypopnea Index (AHI) (AHI <5, AHI: 5-15, AHI: 15-30 and AHI >30).Descriptive statistics included age, body mass index (BMI), OSA, Apnea-Hypopnea Index (AHI), DBP, and neck circumference. Sixty participants ranged between from 46 to 82 years old were entered into this study. There was statistically significant difference in mean DBP among different AHI subgroups (80±0.50, 95±0.60, and 105±0.65, respectively) (p<0.001).Additionally, there was statistically significant correlation between AHI and DBP (r= 0.60, p=0.01). According to the findings of our study, DBP is an imprtant cardiovascular concern in COPD patients with OSAHS and has a direct correlation with AHI.