Tanaffos Respiration Journal
Volume:12 Issue: 2, Spring 2013

COPD is primarily the disease of the lungs; nevertheless, multiple systemic manifestations including poor sleep quality and sleep disturbances have been linked to this illness. Administration of sedative hypnotics is not recommended in COPD patients, as these drugs suppress the ventilatory response and exacerbate sleep-related disorders. Melatonin is an alternative medication that has been widely used to treat sleep disturbances caused by aging and other specific conditions. We aimed to investigate the efficacy of melatonin administration in improvement of sleep quality in COPD patients. A randomized, double-blind, placebo-controlled trial was conducted. A total of 54 patients were recruited and randomly assigned into either melatonin or placebo group. Sleep quality was evaluated by Pittsburgh Sleep Quality Index (PSQI); daytime sleepiness was assessed by Epworth Sleepiness Scale (ESS). For all patients, spirometry and pulse oximetry were preformed to evaluate lung function and oxygenation. Compared with placebo, melatonin administration significantly improved global PSQI score (p<0.001). Of PSQI individual components, sleep quality (p=0.001), sleep latency (p=0.001), sleep efficacy (p=0.003), and sleep duration (p=0.024) improved significantly. On the other hand, melatonin treatment did not significantly change indices of daytime sleepiness, lung function and oxygenation (p>0.05). Melatonin significantly improves sleep quality in COPD patients with sleep complaints. This improvement was in the absence of significant elevation in the indices of daytime sleepiness and lung function.

Acid suppressive medications are used to prevent stress ulcers in critically ill patients. Few studies have been done to evaluate the effect of ranitidine and pantoprazole on stress ulcers. We aimed to compare the effects of ranitidine and pantoprazole on Ventilator Associated Pneumonia (VAP). In this double-blind randomized controlled trial, we enrolled 120 traumatic patients with trauma admitted to the intensive care unit (ICU) of Besat Hospital in Hamadan Province located in northwest Iran. The patients were divided into two equal groups receiving either intermittent intravenous ranitidine or pantoprazole to prevent stress ulcers. The incidence of VAP, duration of tracheal intubation, length of ICU stay, duration of hospital stay, and the outcome of treatment including mortality or hospital discharge were compared in both groups. The incidence of VAP was 10% and 30% in patients receiving ranitidine and pantoprazole, respectively (P=0.006). There was no significant difference between the two groups with respect to the duration of tracheal intubation. However, the patients treated with pantoprazole stayed at the hospital two days longer than the other patients (P=0.027). Although patients with VAP stayed at the hospital for 12 more days, the two groups had almost equal mortality rates (P=0.572). ICU patients using pump inhibitors have a three-fold increased risk of developing VAP in comparison to H2-blocker receivers. Thus, prevention of stress ulcers should be limited to its own specific indications.

Halotherapy is a treatment modality suggested for patients with chronic pulmonary diseases. In this technique, inhalation of crystal salt stones extracted from mines improves patients’ pulmonary function tests and symptoms by facilitating the secretion or expulsion of phlegm and mucus and reducing the risk of bacterial infections. Bronchiectasis is chronic disease of the airways characterized by irreversible dilation of airways. It has a progressive course and despite the available treatments, many of these patients eventually enter the advanced phase of disease. The aim of this study was to evaluate the effect of halotherapy on pulmonary function tests and quality of life of non-CF bronchiectatic patients. This clinical trial evaluated the results of spirometry and 6-minute walk test as well as the quality of life (according to SF-36 questionnaire) of stable non-CF bronchiectatic patients presenting to the pulmonary clinic before and after the use of salt spray for 2 months. Of 40 study patients, 20 were excluded due to various reasons and 20 were evaluated. The mean age of patients was 35±11 years and the underlying cause of disease was chronic pulmonary infection in 65% of cases. Comparison of the results of pulmonary function tests and 6-minute walk test and quality of life indices in SF-36 questionnaire before and after the intervention showed no significant difference (P>0.05). However, 65% of patients were satisfied with halotherapy and requested to receive the medication again. Our study results indicated that 2-month halotherapy with Salitair inhaler containing salt crystals extracted from the Klodawa mine in Poland could not improve the pulmonary function tests or quality of life of non-CF bronchiectatic patients. No significant side effects were noted in understudy patients. Future studies with larger sample size and longer duration of treatment are recommended to better determine the efficacy of this treatment modality.

Spirometry is a physiologic test that measures the volume of air an individual inhales or exhales and the rate at which the volume is changed as a function of time. Bronchodilator response, as a beneficial test for diagnosis of bronchial responsiveness is measured using the percent change from baseline and absolute changes in forced expiratory volume in 1 second and/or forced vital capacity. In this study we aimed to assess the increase in spirometric parameters in patients with symptoms of asthma regardless of spirometric pattern. In this cross-sectional study bronchodilator test was performed in individuals with dyspnea, cough or wheezing and the mean increase in various spirometric parameters was measured and compared among individuals with different spirometric patterns. Among all individuals 24.5% responded to bronchodilator. Forced expiratory volume in 1 second was the parameter with the most frequent response to bronchodilator. Patients with mixed pattern had the highest frequency of response to bronchodilator. Response to bronchodilator was more than 50% in most mid flow volumes. Some patients with symptoms of asthma may show restrictive or mixed pattern in spirometry which may respond to bronchodilator administration.

Tuberculosis is considered a prevalent and hazardous disease in developing countries. Recognition and control of TB risk factors are of special significance. This study sought to determine the frequency of occupational silica exposure in TB patients residing in Lorestan Province. This cross-sectional study was conducted in 2012. List of registered TB patients was obtained from the Infectious Disease Control Center of Lorestan Province. Data were collected from 871 TB patients through interview and filling out a checklist. Also, 429 subjects presenting to Health Centers of Lorestan Province with respiratory complaints suspicious of TB (which was ruled out) were entered the study as the control group for comparison of frequency of silica occupational exposure. Understudy subjects based on the degree of silica exposure were categorized into 4 groups of no exposure, mild exposure, moderate exposure and severe exposure and compared in terms of frequency of TB incidence. Frequency of silica exposure was significantly higher in TB patients compared to controls (P<0.001, OR: 3.39, 95%CI=2.63-4.36). Additionally, frequency of TB was greater in patients with probable silicosis and silica exposed subjects compared to those with no history of silica exposure (P<0.05). Logistic regression analysis revealed significant associations between moderate and severe silica exposure and TB frequency. Significant correlations were also detected between age, work experience, level of education, male gender and cigarette smoking with TB frequency (P<0.05). The study results revealed that silica exposure was prevalent among TB patients and frequency of TB increased by increased intensity of silica exposure, older age, higher work experience, lower level of education, male gender and cigarette smoking. Provided that our study results are confirmed by prospective studies, TB screening is recommended for workers with occupational silica exposure particularly those with higher work experience.

Exposure to secondhand cigarette smoke is an important health hazard. This study was designed to assess the sociodemographic risk factors related to women’s exposure to secondhand smoke. A case-control analysis of data collected as part of a prospective cohort study was conducted. Participants were 340 female Tehran residents exposed to cigarette smoke. Women consented to participate in this study and completed a questionnaire containing socio-demographic characteristics, household characteristics and smoking status at home through a face-to-face interview. Factors related to women’s exposure to secondhand smoke were assessed using the multivariate logistic regression model. The final multivariate logistic regression model showed that lower levels of education (p=0.002) and social class (p=0.03) increase the risk of exposure to secondhand smoke in women. These results support the effect of women’s educational level and social class on their exposure to secondhand smoke.

Acute mediastinitis is a serious medical condition with a mortality rate of 30 to 40% or even higher. Early diagnosis with prompt and aggressive treatment is essential to prevent its rapid progression. We evaluated acute mediastinitis cases and analyzed the outcomes. A retrospective chart review was conducted on patients diagnosed with acute mediastinitis who were admitted to Mofid Children’s Hospital from January 2001 to January 2010. Seventeen patients aged 1 to 10 yrs. (mean =3.8 yrs) were evaluated including 12 (70%) boys and 5 (30%) girls. The most common symptoms were fever, dyspnea, cyanosis, tachycardia and tachypnea. The etiology of mediastinitis was iatrogenic esophageal perforation (EP), and related to manipulation in 13(77%), and leakage of esophageal anastomosis in 4 cases (33%). The underlying diseases were esophageal atresia in 2(12%), corrosive injury of the esophagus in 13(76%), congenital esophageal stenosis in one (6%), and gastroesophageal reflux esophagitis also in one (6%) patient. Patients with clinical symptoms were evaluated by immediate chest radiography, and gastrografin swallow. After early diagnosis, the patients received wide spectrum antibiotics and immediate mediastinal or thoracic drainage, followed by esophagostomy and gastrostomy. Only one case of endoscopic perforation was managed by NG tube. Fifteen patients (88%) survived successfully. We had 2(12%) cases of mortality in our study (one patient after esophageal substitution, mediastinal abscess and septicemia, and the other one developed esophageal perforation 6 months after early management and died of cardiac arrest during endoscopic dilation). Prevention of acute mediastinitis is still a difficult challenge. As the prognosis is not good and patients have high mortality, rapid management is mandatory.

Visceral Leishmaniasis (VL), a systemic infection of the reticuloendotherlial system, is caused by a parasitic infection.The co-occurrence of VL and hemophagocytic syndrome (HPS) has been previously reported in several studies. In this report we present two cases of HPS and VL among members of the same family.

Bronchial carcinoid tumor comprises 1 to 3% of lung neoplasms. The common age of onset is mainly post-puberty although atypical carcinoid tumors occur atages 44 to 55. Carcinoid tumors cause two groups of symptoms in patients: symptoms due to obstruction and symptoms due to the production and release of active neuropeptides. Histologically, carcinoid tumors are categorized into two groups of typical and atypical while in terms of location of lesion, they are grouped into central and peripheral types. Differentiation between malignant and benign carcinoid tumors is based on presence or absence of metastasis.Bronchoscopy and endobronchial biopsy are the best diagnostic measures in these patients. Serologic evaluation and assessment of active metabolites in case of liver metastasis also help the diagnosis. Surgical resection is the treatment of choice for this condition.This report discusses a patient with carcinoid tumor who was receiving bronchodilator treatment for a couple of months because of chronic cough with possible diagnosis of asthma and had received several courses of antibiotic therapy with possible diagnosis of lung infection until he eventually developed bronchiectasis in the right lower lobe. In patients with chronic pulmonary symptoms especially with localized bronchiectasis, diagnostic bronchoscopy must be included in the diagnostic work-up to rule out intrabronchial lesions.