Tanaffos Respiration Journal
Volume:21 Issue: 1, Winter 2022

Mycobacterium tuberculosis is the cause of tuberculosis in humans and is responsible for more than 2 million deaths per year. Despite the development of anti-tuberculosis drugs (Isoniazid, Rifampicin, Ethambutol, pyrazinamide, streptomycin, etc.) and the TB vaccine, this disease has claimed the lives of many people around the world. Drug resistance in this disease is increasing day by day. Conventional methods for discovering and developing drugs are usually time-consuming and expensive. Therefore, a better method is needed to identify, design, and manufacture TB drugs without drug resistance. Bioinformatics applications in obtaining new drugs at the structural level include studies of the mechanism of drug resistance, detection of drug interactions, and prediction of mutant protein structure. In the present study, computer-based approaches including molecular dynamics simulation and molecular docking as a novel and efficient method for the identification and investigation of new cases as well as the investigation of mutated proteins and compounds will be examined.

Globally, lung cancer represents a major cause of cancer-related deaths. The regulation of gene expression is modulated by small noncoding RNAs called miRNAs that can act as both tumor suppressors and oncogenes. The maturation, expression and binding to target mRNAs is affected by single nucleotide polymorphisms (SNPs) in miRNA genomic regions thereby contributing to cancer susceptibility. SNPs Rs11614913 in miR196a and Rs3746444 in miR-499 are implicated in the development of cancers such as non-small cell lung cancer (NSCLC) in non-Arabic subjects. A small cohort of 204 participants including 104 lung cancer patients and 100 non-cancer controls subjects were enrolled into the study. The allele frequencies were determined by Polymerase Chain Reaction–Restriction Fragment Length Polymorphism (PCR-RFLP) and their correlation with lung cancer risk was determined. The miR-196a rs11614913 polymorphism increased the risk of NSCLC (CC vs. TT+TC: OR= 2.26, 95%CI= 1.28 – 3.98, P= 0.0046) in a dominant genetic model. No statistically significant association was found between the miR-499 rs37464444 polymorphism and NSCLC. The rs11614913 polymorphism in miR-196a, but not the miR-499 rs37464444 polymorphism, increased the risk of NSCLC. Further studies with larger sample sizes in correlation with functional outcomes at the cellular level should be undertaken.

Due to the critical condition of COVID-19, it is necessary to evaluate the efficacy of administrating convalescent plasma to COVID-19 patients. Therefore, we decided to design a clinical trial to investigate the effect of convalescent plasma of patients recovered from COVID-19 on the treatment outcome of COVID-19-infected patients.
In this parallel randomized controlled clinical trial, patients in the intervention group received standard treatment plus convalescent plasma of patients recovered from COVID-19. We allocated 60 patients to each treatment group through balanced block randomization. Then, COVID-19 outcomes, vital signs, and biochemical parameters were compared between the two treatment groups by the independent t test and ANCOVA.
The mean age (SD) of the patients in the intervention and standard treatment groups was 52.84 (15.77) and 55.15 (14.34) years, respectively. Although patients in the intervention group reported more hospitalization days (11.45±5.86 vs. 10.42±6.79), death rates (26.67% vs. 18.13%), ICU admission (45 vs. 41.67%), and ARDS (11.67% vs. 3.33%), these differences were not statistically significant (P>0.05). Moreover, the two groups were homogenous in vital signs and biochemical parameters before and after treatment (P>0.05).
The present study indicated that convalescent plasma therapy has no significant effect on the survival, hospitalization, and ICU admission of COVID-19 patients.

It is widely accepted that concerns have been recently raised regarding the impact of air pollution on the health of children with cystic fibrosis (CF). Air pollution probably affects the exacerbation of CF and its laboratory findings. On the other hand, the World Health Organization (WHO) has asked all countries to update their data and reports on the distribution and prevalence of CF in different areas. The purpose of the present study was to investigate the distribution and prevalence of CF based on the levels of atmospheric pollutants, such as PM10, PM2.5, SO2, NO2, CO, and O3 in 22 zones of Tehran, and to report the abnormal laboratory findings that might indicate the exacerbation of CF.

The studied statistical population included children with CF referred to Masih Daneshvari Hospital from 2003 to 2020. Demographic data, location of living area, and laboratory findings were extracted from patient records. The geographic information system (GIS) was applied to indicate the distribution and dispersion of the disease. The information related to air pollutants was collected from all stations in Tehran during the studied period by the Department of Environment of Tehran Province, and the average levels were used for final reporting.

The analysis results on 287 CF patients demonstrated that the risk of disease exacerbation significantly increased by the presence of air pollutants. In areas with multiple air pollutants, more laboratory findings were observed to be abnormal, and the lower survival rate for patients with CF was recorded. Investigating the CF distribution pattern based on climatic layers and above mean sea level (AMSL) indicated that distribution of the disease was higher in dry areas with lower AMSL and the higher volume of the atmospheric pollutants, which were primarily centralized in southern and central Tehran.

Environmental factors, such as air pollution, can be considered vital parameters, along with high-risk factors, such as pure and integrated race, migration, and mutation, influencing the prevalence and exacerbation of CF symptoms. Considering the higher prevalence of CF in deprived areas of Tehran, households' cultural and economic level appears to be a factor in the lack of diagnostic screening and prevention of CF in these areas. On the other hand, continuous monitoring of the air pollution caused by traffic and giving warnings to CF patients and their parents is particularly important.

Due to the importance of recent published studies regarding the thrombotic events in COVID-19 patients, the purpose of this study was to evaluate the frequency of antiphospholipid antibodies in COVID-19 patients with coagulopathy.
The present cross-sectional study was conducted on COVID-19 patients with coagulopathy admitted to Imam Khomeini Hospital in Sari, Iran, between June and September in 2020. Later on, the levels of anti-phospholipid antibodies (aPL-ab) and biochemical factors were measured.
This study was performed on 40 patients. Individuals who were positive for at least one of the aPL-ab were classified in the group of aPL-ab positive; according to which 29 patients (72.5%) had no positive aPL-ab and 11 patients (27.5%) had at least one positive aPL-ab. 8 patients were only positive for lupus anticoagulant (LA) assay, one patient had B2GPI- IgM, one patient had aCL- IgG and only one patient had two positive simultaneous tests for LA and aCL- IgG. Thrombotic events have been found in 7 patients (17.5%) of which, three patients with deep vein thrombosis, one patient with pulmonary embolism, two patients with stroke, and one patient with myocardial infarction. The values of aPTT for the screening of Lupus anticoagulant assay were significantly different between the two groups, although there was no significant difference between the two groups in the co-morbidities, disease severity, death and laboratory tests (P> 0.05).
Despite the high incidence of thrombotic complications reported in COVID-19 patients in the current study, the levels of antiphospholipid antibodies had no significant correlation with the occurrence of thromboembolic events and disease outcome in COVID-19 patients with coagulopathy.

Unknown cases of pneumonia appeared in late 2019 in Wuhan, China. Following the worldwide spread of the disease, the World Health Organization declared it a pandemic on March 11, 2020. The total number of infected people worldwide as of December 16, 2020, was more than 74 million, more than one million and six hundred thousand of whom died from Coronavirus Disease 2019 (COVID-19). This study aimed to identify the risk factors for the mortality of COVID-19 in Hamadan, west of Iran.
This cross-sectional study used the information of all patients with COVID-19 admitted to Shahid Beheshti and Sina hospitals in Hamadan during January 2020-November 2020. Logistic regression model, decision tree, and random forest were used to assess risk factors for death due to COVID-19.
This study was conducted on 1853 people with COVID-19. Blood urea nitrogen change, SPO2 at admission, the duration of hospitalization, age, neutrophil count, lymphocyte count, number of breaths, complete blood count, systolic blood pressure, hemoglobin, and sodium were effective predictors in both methods of decision tree and random forest.
The risk factors identified in the present study may serve as surrogate indicators to identify the risk of death due to COVID-19. The proper model to predict COVID-19-related mortality is random forest based on sensitivity.

Cystic fibrosis (CF) is a hereditary disease with a high mortality rate. The present study aimed to determine the effect of a physical activity program (PAP) on the life quality of children with CF at school age.

This study conducted on 70 children with CF, the samples were randomly divided into intervention and control groups. A demographic information questionnaire and the Pediatric Quality of Life Inventory were used for data collection. This study was conducted in three stages and 2 months after the last intervention. Finally, the data were analyzed in SPSS software version 22 using the Chi-square test, independent t-test, and paired t-test at a p-value of less than 0.05.

The results indicated that the two groups had no significant difference in terms of demographic variables before the intervention. Moreover, it was observed that the mean scores of life quality in the physical, emotional, social, and academic performance of children in both groups before the intervention in child and parent evaluations did not show significant differences. After the intervention in the experimental group, the mean scores of life quality in all aspects significantly increased, compared to those of the control group (P<0.001). Moreover, there were no significant differences between the mean scores of life quality in the control group before and after the intervention.

Given the effectiveness of the intervention to enhance life quality, PAP is feasible and possible in the field of CF. It has to be noted that this method is an effective way to improve life quality.

The success of treatment strategies to control the disease relapse requires determining factors affecting the incident short-time and long-time of disease relapse. Therefore, this study was aimed to identify the factors affecting of short-and long-time of occurrence of disease relapse in patients with tuberculosis (TB) using a parametric mixture cure model.

In this historical cohort study; the data was collected from 4564 patients with TB who referred to the Tuberculosis and Lung Diseases Research Center of Dr. Masih Daneshvari Hospital from 2005 to 2015. In order to evaluate the factors affecting of short-and long-time of occurrence of disease relapse, a parametric mixture cure model was used.

In this study, the estimation of the annual incidence of TB relapse showed that the probability of recurrence in the first year is 1% and in the third and tenth years after treatment is 3% and 5%, respectively. In addition, the results of this study showed that the variables of residence, exposure to cigarette smoke, adverse effects of drug use, incarceration, and pulmonary and extra- pulmonary tuberculosis were the factors affecting the short-time recurrence of TB. The variables of drug use, pulmonary and extra- pulmonary tuberculosis, and also incarceration affected the long-term recurrence of this disease.

Cure models by separating factors affecting the short-time occurrence from the long-time occurrence of disease relapse can provide more accurate information to researchers to control and reduce TB relapse.

Pulmonary artery pressure (PAP) is one of the most important and valuable markers in cardiovascular disease, measured by right heart catheterization (RHC) as the gold standard diagnostic modality. However, due to several limitations, such as invasiveness, lack of repeatability, and high health costs, echocardiographic estimation of PAP has been used to substitute RHC for diagnosis and monitoring of this disease. This study aimed to evaluate the correlation of echocardiographic and RHC estimations of systolic PAP.
In this study, patients, who were referred to Masih Daneshvari Hospital in Tehran, Iran, evaluated by RHC and echocardiography, were selected. The median PAP (mPAP) and systolic PAP (sPAP) for each modality, time interval between the two modalities, sex, and age were extracted from the patients' records. The RHC mPAP data was used for categorization of patients as pulmonary hypertension, while the sPAP data of two modalities was used to assess correlations and define a cut-off point by the ROC analysis. Data analysis was performed using SPSS version 24, and the level of statistical significance was less than 0.05.
Seventy-six patients, including 31 males (40.8%) and 45 females (59.2%) with the mean age of 45±14 years, were evaluated in this study. The mean sPAP was 71.98±30.22 mmHg when measured by RHC and 69.75±26.03 mmHg when measured by echocardiography (correlation coefficient=0.805; P<0.001). Agreement between the two measurements was 97%, and the accuracy of echocardiography was 43%. By considering 40 mmHg as the cutoff point, the sensitivity and specificity of echocardiography were estimated at 89.2% and 42.8%, respectively. Based on the ROC analysis, the highest sensitivity (86.7%) and specificity (87.5%) were achieved with an estimated sPAP of 57.5 mmHg.
Echocardiography showed a good correlation and agreement with RHC in estimating sPAP; therefore, it is appropriate for screening of patients because of high sensitivity. However, for diagnosis confirmation, monitoring, and follow-up of pulmonary hypertension via echocardiography, high specificity is needed, which can be achieved by considering sPAP of 57.5 mmHg as the cutoff value for pulmonary hypertension.

The correct placement of the endotracheal tube is a cornerstone of safe anesthesia. Different methods, such as auscultation, capnography, and ultrasound, have their own limitations regarding the confirmation of endotracheal intubation, reinforcing the idea that a single technique is not foolproof. This study proposes a new technique in this regard.
A total of 600 patients were enrolled in this study, and tracheal intubation was checked with palm pressure and disposable plastic glove inflation and pulsation.
The data were analyzed using the t-test and Mann-Whitney U test that indicate 94% and 94.8% sensitivity for palm pressure and bag pulsation, respectively, and a 100% positive predictive value for both tests.
Palm pressure and bag pulsation are accurate, inexpensive, and reliable techniques to confirm proper tracheal intubation.

Pain control after thoracoscopy is one of the important issues in patient health care. Pre-emptive analgesia can reduce acute postoperative pain and also prevent chronic pain. This study aimed to evaluate the effectiveness of gabapentin (GABA analog) as pre-emptive analgesia in reducing pain and reducing opiate consumption after video-assisted thoracoscopic surgery (VATS) surgery.
In this study, 67 patients undergoing thoracoscopic surgery were randomly divided into two groups (31 placeboes and 36 gabapentin). Patients received two capsules (300 mg gabapentin capsules or placebo) on the night before surgery and again one hour before surgery.  After completion of the operation, all patients were transferred to the recovery. Evaluation of postoperative pain was performed using the visual analog scale (VAS) every 30 minutes and then after 2, 4, 6, 10, 24 hours. If patients had pain (VAS above 3), intravenous morphine was injected to relieve pain and the number of injections and the total dose of morphine administered was recorded.
There was no significant difference between the two groups regarding VAS, blood pressure (BP), heart rate (HR), respiratory rate (RR) and saturated oxygen level (SaO2), urea, creatinine, and adverse effects.
Preoperative gabapentin administration did not affect postoperative pain reduction, but morphine consumption in the gabapentin group was decreased during the first 24 hours after VATS.

Self-management is becoming increasingly important in patients with chronic obstructive pulmonary disease (COPD) as it is associated with improved clinical outcomes. The aim of this study was to determine the effect of a self-management program on health status and dyspnea severity in patients with COPD.

This semi-experimental study was done on patients with COPD who were hospitalized at Ayatollah Kashani and Hajar hospitals from July 2017 to November 2019 in Shahrekord, Iran. Sixty patients with COPD were selected and completed three questionnaires, including a demographic questionnaire, COPD Assessment Test (CAT), and Dyspnea Scale (mMRC). The researcher educated the self-management skills to the intervention group, and the control group received routine care only. Three months after the intervention, the questionnaires were completed again by the control and intervention groups. Data were analyzed using descriptive and analytical statistics by SPSS version 24.

The results of this study showed that there was no significant difference in health status between the two groups before the intervention (p=0.827). Three months after the intervention, the health status score in the control and intervention groups were 20.93±5.00 and 18.00±5.18, respectively, which this difference was statistically significant (p=0.030). Also, at the beginning of the study, the difference in dyspnea score between the two groups was not statistically significant (p=0.593). However, three months after the intervention, the score of dyspnea in the control and intervention groups was 2.1±0.995 and 1.53±1.074, respectively, which this difference was significant (p= 0.038).

This study showed that self-management intervention could improve the health status and reduce the dyspnea of patients with COPD.

Bilharzia is a parasitic infection particularly affecting the digestive tract and urinary tract. Lung involvement is rarely reported. We report a case of pulmonary bilharzioma of nodular type surrounded by ground glass opacities diagnosed on CT-scan and associated with a hepatic nodule, in a 41-year-old woman. The disappearance of the pulmonary nodule under antischistosomal treatment made it possible to make the diagnosis a posteriori without going through an invasive process.