فهرست مطالب leila ghofraniha

To compare the cosmetic outcome and acute cutaneous, cardiac, and pulmonary toxicity profile of accelerated hypofractionated and conventional whole breast radiotherapy (WBRT).This was a blocked randomized, clinical trial on women with early-stage node-negative invasive breast cancer after breast conservation surgery (BCS) with clear margins randomly assigned to receive WBRT either at a conventional dose of 50.0 grays (Gy) in 25 fractions (the conventional group) or at a dose of 42.5 Gy in 16 fractions (the hypofractionated group). Boost irradiation was permitted in both groups. Data were analyzed by SPSS V21.0 using Mann–Whitney U, independent-samples t- and Chi-Square/Fisher's exact tests at the level of P≤0.05.The median follows up was 16 months. Forty-one patients in the conventional WBRT arm and 45 patients in the hypofractionated WBRT group were enrolled. No significant difference was observed in terms of left and right ventricle systolic dysfunction and diastolic dysfunction. Pulmonary function tests after 6 and 12 months follow up, were comparable in both groups (P=0.2). Skin toxicity during and after treatment was acceptable in both groups. Breast size change in the conventional and the hypofractionated WBRT groups was 14.3% and 7.1%, respectively (P=0.6). Excellent or good cosmetic outcome was similar in both groups.The results of our study support the use of accelerated hypofractionated WBRT in women with invasive breast cancer less than five cm and node-negative after breast-conserving surgery, which provides a more convenient shorter course of radiotherapy with a comparable cosmetic outcome and cutaneous, cardiac, and pulmonary toxicity profile.

In recent decades, the relation of carotid artery intima-media thickness (IMT) as a marker of atherosclerosis with snoring and sleep disorders has been drawing attention. The aim of this study was to evaluate the relation of carotid arteries IMT with snoring in type 2 diabetic patients. This cross-sectional study was performed on type 2 diabetes patients referring to Mashhad University of Medical Science's clinics. The stop Bang, Epworth sleepiness scale, and Stanford questionnaires were used for evaluation of daily sleepiness and snoring. For assessment of carotid artery thickness, Madison X8 ultrasound with 10 MHz superficial probes was utilized. The data were entered into SPSS software, and then the ANOVA test with Turkey, chi-square comparison technique, and Kruskal Wallis with Mann-Whitney U technique was used. The level of significance was considered P≤0.05. In total 80 patients (37 snorers and 43 non-snorers) entered the study. The mean carotid artery IMT in the group of snoring patients (0.72±0.17) was significantly higher than non-snorers (0.56±0.17) (P

The effects of serum vitamin D levels on the evolution or severity of asthma have been widely researched; however, conflicting results have been achieved. This study was designed to evaluate the relationship between serum vitamin D levels and pulmonary function tests in asthmatic and non-asthmatic people with vitamin D deficiency. This was a prospective cross-sectional study on healthy adults and asthmatic patients. Standard spirometry and serum 25-hydroxyvitamin D test were performed for all participants. Forty asthmatic patients and 40 healthy controls were tested. The mean age of participants was 42.86 ± 1.6. High prevalence of vitamin D deficiency was found in both the asthmatic and control groups. No significant correlation was found between serum vitamin D levels and spirometry parameters in either of the groups (P = 0.83).
Serum levels of 25-hydroxyvitamin D were not correlated with the severity of asthma as evaluated by pulmonary function tests in asthmatics.

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.

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.

Systemic Lupus Erythematosus (SLE) is an autoimmune disease affect nearly every organ system. Pulmonary involvement, which is a common manifestation of SLE, can remain undiagnosed if asymptomatic. This study aimed to evaluate the efficiency of spirometric findings in early detection of silent pulmonary involvement and examine its correlation with the six minute walk test in SLE patients. In this cross-sectional study fifty patients, who met the American College of Rheumatology criteria for SLE, were recruited from the outpatient rheumatology clinic at the Imam Reza Hospital of Mashhad between July 2013 and September 2014. First, a checklist including demographic information and previous medical documents was completed. Then, spirometry and 6MWT was performed to evaluate subclinical pulmonary involvement and assess patients’ exercise capacity. Based on the results of pulmonary function tests, patients were divided into two groups. A total of 40 patients with normal pattern were placed in one group and 10 patients with restrictive pattern in the other. The difference between SLE patients with and without abnormal spirometry were statistically significant in regard to anti-RNP positivity but total distance walked in six minute, was not significantly different between two groups (p=0.356). Additionally, there were no significant correlations between 6MWD and FVC in SLE patients in the either group as determined by Pearson’s correlation coefficient testing. (R=0.439,P=0.205 in SLE patients with normal spirometry and R=0.191,P=0.237 in those with abnormal pattern) Considering the impact of anti-U1RNP positivity with restrictive pattern on spirometry, it can be deemed as a pulmonary involvement predictor in SLE patients. However, lack of correlation between 6MWT and spirometric parameters is suggestive of restrictive lung involvement, which in turn, demonstrates a multifactorial basis for limited exercise capacity in patients with SLE. Thus, the application of the 6MWT as a measure of pulmonary function is called into question.

Gastro-esophageal reflux disease (GERD) regularly occurs when stomach acid moves up from the stomach into the esophagus. GERD might be associated with chronic asthma symptoms such as coughing and breathlessness. According to several studies on children and adults, GERD is proven to have a close relationship with asthma. Medication treatment via proton-pump inhibitors (PPIs), such as Omeprazole, H2 receptor blockers (Ranitidine), and other antireflux medications, is appropriate for ameliorating GERD and asthma. Moreover, surgery is another useful approach to GERD and asthma treatment. In this regard, Nissen fundoplication (laparoscopic) is a principal surgery method. Medical and surgical antireflux therapies are recognized as effective methods in the treatment of GERD-associated asthma. Our review included studies that evaluated treatment of GERD-associated asthma. These studies accentuated the critical role of acid reflux suppression in relieving the patients suffering from a difficult to control asthma.

The six-minute walk test (6MWT) is a well-tolerated test which reflects daily activities and can be easily used in clinical practice. The 6MWT provides information about functional capacity, response to therapy and prognosis across a range of chronic cardiopulmonary conditions. Moreover, the 6MWT is sensitive to the common therapies used for chronic obstructive pulmonary disease, such as pulmonary rehabilitation with supplemental oxygen, long-term use of inhaled corticosteroids and lung volume reduction surgery. Several studies have investigated the role of 6MWT in the evaluation of pulmonary disease and cardiac disorders. This article aimed to review the significance of 6MWT in pulmonary disease

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.

Pulmonary hyperinflation in patients with chronic obstructive pulmonary disease (COPD) can increase the breathing rate and reduce diaphragmatic movements by pushing the diaphragms downward and limiting their movements; this, in fact, can affect the breathing process. The purpose of this study was to compare diaphragmatic movements in COPD patients and healthy ones and to evaluate the relation of diaphragmatic movements and COPD severity in patients. This cross- sectional study was performed in Ghaem hospital,Mashhad Iran. Twenty-five COPD patients (case group) were selected, based on the inclusion and exclusion criteria. The patients’ demographic and clinical characteristics along with factors related to pulmonary function were recorded. Patients were referred for sonography after pulmonary evaluation. The status of the left portal vein or one of its branches at the end of a deep expiration and a deep inspiration was considered as a marker. Twenty-five healthy non-smoker subjects, who were matched with the patients in terms of age and sex, were studied as the control group for the comparison of sonographic findings of the diaphragms. The current study included 25 healthy subjects and 25 COPD patients, with the mean age of 59.2±12 years; approximately 84% of the subjects were males. Evaluation of the rate of diaphragmatic movements by sonography showed the mean of 42.08±12.15mm and 73.28±15.19mm in the case and control groups, respectively, which showed a statistically significant difference between them (P=0.02). Statistical analysis indicated the relationship between the rate of diaphragmatic movements with factors related to airway obstruction. However, no relationship was observed between the rate of diaphragmatic movements and the factors associated with pulmonary hyperinflation or air retention. The rate of diaphragmatic movements as a parameter for determining exercise capacity in COPD patients could help with a better understanding of activity limitations in these patients

To recognize the predisposing factors in tuberculosis as an endemic infection in Northeast province of Iran, this study was aimed to evaluate whether HumanT-lymphocyte type 1 (HTLV-I) as an immunosuppressive factor increases the risk of tuberculosis. A Case-control study was conducted in 278 tuberculosis patients from 2007 to 2010, in Mashhad, Iran. Tuberculosis has been diagnosed by gold standard tests like sputum culture, bronchoalveolar lavage (BAL) culture or cytology. For detection of HTLV-I antibody, Enzyme Linked Immunosorbant Assay method and western Blot as the confirming test were performed. Then 276 healthy cases were matched for gender and age. The mean age of tuberculosis patients was 49.67±21.36 years and for control cases was 48.36±20.74. In patients group, 114 (41.6%) were male, 160 (58.4%) were female and in controls 123 (44.6%) were male and 153 (55.4%) were female. Pulmonary tuberculosis was presented in 84.2% of the patients. The frequency of HTLV-1 was 2.9% and 3.3% in patients and controls, respectively.HTLV-I frequency was higher in male patients and it increased by age. Regarding to this study, HTLV-I infection is not stand-alone sufficient for increasing the risk of tuberculosis.

To assess the efficacy and safety of bronchial artery embolization in the treatment of massive hemoptysis. A retrospective study on 46 patients (26 males and 20 females) who were referred to the Razavi Hospital from April 2009 to May 2012 with massive hemoptysis and had bronchial artery embolization procedures. General characteristics of the patients including age, gender, etiology, and thorax computed tomograms, findings of bronchial angiographic, results of the embolization, complications related to bronchial artery embolization and clinical outcome during follow-up were reviewed. The etiology included previous pulmonary tuberculosis in 20 cases, previous tuberculosis with bronchiectasis in 16 cases, bronchiectasis in 6 cases, and active pulmonary tuberculosis in one case. No identifiable causes could be detected in three patients. Moreover, massive hemoptysis was successfully and immediately controlled following the embolization procedure in all patients. One patient developed recurrent hemoptysis during one month following the procedure and was treated by re-embolization. No major procedure–related complication such as bronchial infarction was identified However none of the patientsexperienced neurological complications. Bronchial artery embolization is a safe and effective means of controlling massive hemoptysis and should be regarded as the first-line treatment for this condition.