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Background: COPD exacerbation is characterized by both airway and systemic inflammation. The present study aimed to investigate the relationship between serum levels of some inflammatory biomarkers and the phenotypes of COPD exacerbation. Materials and Methods: This study includes known COPD patients, presenting to a hospital with acute exacerbation of COPD. Serum levels of CRP, ESR, CBC, TNF-a, IL-8, and IL-6 were measured at the time of admission. According to the previously done HRCT, the patients were divided into two groups including emphysema and chronic bronchitis. Levels of serum biomarkers were compared in the two groups. The relationships between biomarkers and duration of hospitalization were assessed too. Results: Comparison of quantitative CRP levels, WBC, and platelet counts did not show a statistically significant difference between emphysema and chronic bronchitis but it was significantly higher than control subjects. Although not statistically significant, ESR level was higher in emphysema. TNF-alpha was 6.0±1.5 ng / ml and 1.5 ng / ml in the emphysema and chronic bronchitis groups, respectively. TNF-a had no significant difference compared to the groups. Although higher than the control group, IL-6 and IL-8 did not show significant differences between emphysema and chronic bronchitis. The two groups did not statistically differ in terms of hospital stay but patients with higher serum TNF-a tended to have longer hospitalization and ICU admission. Conclusion: The present study showed predictably higher inflammatory biomarkers in COPD exacerbation but no significant difference between the two phenotypes of COPD and these two entities could not be discriminated based on inflammatory bio-factors. [ABSTRACT FROM AUTHOR]

Background: The current study aimed to assess some parameters of the cardiopulmonary exercise test (CPET) among end-stage renal disease patients who underwent dialysis. The ultimate goal is to improve disease management to achieve optimal quality of life and exercise capacity in this group of patients. Materials and Methods: Through a cross-sectional design, the current study enrolled 46 dialysis patients by simple sampling between Jan 2019 and Jan 2020. Some CPET parameters such as AT, VO2, VO2/kg, SPO2, minute ventilation CO2 production/O2 consumption ratios (VE/VCO2 and VE/VO2, respectively), O2 pulse, heart rate reserve (HRR), breathing reserve (BR) and end-tidal carbon dioxide pressure (PETCO2) were focused. Results: Although a limited sample size, the current study showed that VO2/Kg, VE/VCO2, PETCO2, and SPO2 are the main parameters affected by dialysis as expected. Conclusion: The current study suggests using cardiopulmonary rehabilitation for all chronic medical conditions such as chronic kidney disease and end-stage renal disease that increase the rate of metabolic acidosis. [ABSTRACT FROM AUTHOR]

Background: This study was done to determine the role of common variables, including age, gender, body mass index (BMI), rhinosinusitis, and smoking among a group of asthmatic and severe asthmatic patients in 2016. Materials and Methods: This retrospective study was carried out from mid-June to the end of September 2016. Of 678 patients with asthma referred to private asthma clinics in Tehran, 163 subjects were selected. Severe asthma (SA) cases were diagnosed according to the SA definition (severe shortness of breath, chest tightness or pain, and coughing or wheezing, low peak expiratory flow (PEF) using a peak flow meter, and more than two days of wheezing and coughing per week). Patients with the presence of concomitant diseases, such as gastroesophageal reflux disease, sleep apnea, hypo- and hyperthyroidism, as well as users of nonsteroidal anti-inflammatory drugs (NSAIDs) were excluded. According to the signs and symptoms and classic criteria of asthma, the subjects with SA were assigned to the case group and subjects with asthma to the control group. Besides, general information, including age, gender, BMI, smoking history, and the presence of Rhinosinusitis was collected. Results: Of 163 subjects, 92 patients (56.4%) were in the control, and 71 patients (43.6%) in the case group. The rate of SA among 678 patients was 10.47%. The mean age of the case group was 49.08 ±11.66 and the control group was 50.05 ±15.65 years. There was a significant difference in BMI between the case and control groups (p=0.034), especially among females in the case group (p=0.001). BMI was significantly higher in females than in males (p=0.002). Also, smoking status was not significant between the case and control groups (p=0.751). Rhinosinusitis was significantly higher in the case groups compared with the control groups (p= .014). Conclusion: Rhinosinusitis was higher in SA patients (case group). SA was more observed among females than males and those who were more overweight. It seems that rhinosinusitis and obesity are more important risk factors. Moreover, obese female patients require more serious attention. [ABSTRACT FROM AUTHOR]

Background: Treatment non-adherence is a leading cause of rehospitalization among patients with chronic obstructive pulmonary disease. Motivational interviewing is a client-centered participatory counseling strategy which enhances motivation for change. The aim of this study was to examine the effects of motivational interviewing on treatment adherence among patients with chronic obstructive pulmonary disease. Materials and Methods: This randomized controlled clinical trial was done on 54 hospitalized patients using a two-group repeated measures design. Patients in the intervention group (n=27) received motivational interviewing and lifestyle-related educations, while their counterparts in the comparison group (n=27) solely received lifestyle-related educations. Treatment adherence was measured before, one month, and two months after the intervention. Results: At baseline, there was no significant difference between the groups regarding treatment adherence (P>0.05); however, one and two months after the intervention, between-group differences regarding treatment adherence were statistically significant (P<0.05). Conclusion: Motivational interviewing promotes treatment adherence among patients with chronic obstructive pulmonary disease. [ABSTRACT FROM AUTHOR]

Background: The differential diagnosis of tuberculous pleural effusion (TPE) and malignant pleural effusion (MPE) is difficult because the biochemical profiles are similar. The present study aimed to differentiate TPE from MPE, using a decision tree and a weighted sparse representation-based classification (WSRC) method, based on the best combination of routine pleural effusion fluid biomarkers. Materials and Methods: The routine biomarkers of pleural fluid, including differential cell count, lactate dehydrogenase (LDH), protein, glucose and adenosine deaminase (ADA), were measured in 236 patients (100 with TPE and 136 with MPE). A Sequential Forward Selection (SFS) algorithm was employed to obtain the best combination of parameters for the classification of pleural effusions. Moreover, WSRC was compared to the standard sparse representation-based classification (SRC) and the Support Vector Machine (SVM) methods for classification accuracy. Results: ADA provided the highest diagnostic performance in differentiating TPE from MPE, with 91.91% sensitivity and 74.0% specificity. The best combination of parameters for discriminating TPE from MPE included age, ADA, polynuclear leukocytes and lymphocytes. WSRC outperformed the SRC and SVM methods, with an area under the curve of 0.877, sensitivity of 93.38%, and specificity of 82.0%. The generated flowchart of the decision tree demonstrated 87.2% accuracy for discriminating TPE from MPE. Conclusion: This study indicates that a decision tree and a WSRC are novel, noninvasive, and inexpensive methods, which can be useful in discriminating between TPE and MPE, based on the combination of routine pleural fluid biomarkers. [ABSTRACT FROM AUTHOR]

Dyspnea is one of the most complaints in the pulmonary diseases. Shortness of breath as a subjective symptom can decrease the quality of life of patients. Although symptomatic treatment of the patients with chemical drugs is efficient in sign reduction, drugs side effect and allowing the disease to become chronic are risky for patients. Nowadays, traditional medicine is considered as an effective strategy in patients' treatment by World Health Organization. This study discusses the causes of shortness of breath from the view of Iranian traditional medicine and describes some suggestion for treatment of causes of this problem. Persian medicine prioritizes prevention of diseases by offering some strategies. In case of disease occurrence, life style modifications and herbal pharmaceutical therapy are recommended. [ABSTRACT FROM AUTHOR]

Background: Lung biopsy through the airways by using a flexible bronchoscope (transbronchial lung biopsy: TBLB) is a suitable method for obtaining tissue specimens. This study aimed at evaluating the factors influencing TBLB results in order to increase the diagnostic power of this method. Materials and Methods: This was a prospective double blind observational study. We had a total of 44 patients with pulmonary lesions who underwent biopsy and 4 specimens were obtained from each patient. A total of 176 specimens were obtained from all patients. Biopsy specimens were taken using cup and alligator forceps alternatively. Characteristics of the obtained specimens including size, floatation, alveolarity, and bleeding were thoroughly studied. After sending to the pathologist, specimens were divided into 2 groups of diagnostic and non-diagnostic specimens. Results: Of a total of 176 specimens, 37 (21%) were diagnostic and 139 (79%) were non-diagnostic. From 88 specimens obtained by the alligator forceps, 16 were diagnostic while from the same number of specimens taken by the cup forceps 21 had diagnostic value. However, this difference was not statistically significant (P>0.05). Of the small specimens (57 cases), 12 (21.1%) were diagnostic while among the 66 medium specimens, 12 (18.2%) and from the 53 large specimens, 13 (24.5%) were diagnostic. No statistically significant difference was detected in this respect (P>0.05). Among specimens floating on the surface of the liquid (48 cases), 6 (12.5%) had diagnostic value. Of the 12 specimens suspended in the liquid, 2 (16.7%) and among the 116 specimens precipitated at the bottom, 29 (25%) were diagnostic. These differences were not significant either (P>0.05). Of the 84 specimens with more than 20 alveoli, 31 (36.9%) were diagnostic. Among 26 specimens with less than 20 alveoli 5 (19.2%) were diagnostic. This correlation was statistically significant indicating that the higher the number of alveoli in the biopsy specimen, the greater the chance of being diagnostic. Conclusion: This study failed to find a significant correlation between the diagnostic power of TBLB and type of forceps, sample size or floatation of the specimen in the liquid. However, number of alveoli present in the tissue specimens was significantly correlated with its diagnostic value. Increasing the number of specimens to four can increase the chance of diagnosis. [ABSTRACT FROM AUTHOR]

Background: Following the recent epidemic of coronavirus disease 2019 (COVID-19) in Wuhan, China, a novel betacoronavirus was isolated from two patients in Iran on February 19, 2020. In this study, we aimed to determine the clinical manifestations and outcomes of the first confirmed cases of COVID-19 infection (n=127)., Materials and Methods: This prospective study was conducted on all COVID-19-suspected cases, admitted to Masih Daneshvari Hospital (a designated hospital for COVID-19), Tehran, Iran, since February 19, 2020. All patients were tested for COVID-19, using reverse transcription-polymerase chain reaction (RT-PCR) assay. Data of confirmed cases, including demographic characteristics, clinical features, and outcomes, were collected and compared between three groups of patients, requiring different types of admission (requiring ICU admission, admission to the general ward, and transfer to ICU)., Results: Of 412 suspected cases, with the mean age of 54.1 years (SD=13.4), 127 (31%) were positive for COVID-19. Following the patients' first visit to the clinic, 115 cases were admitted to the general ward, while ten patients required ICU admission. Due to clinical deterioration in the condition of 25 patients (out of 115 patients), ICU admission was essential. Based on the results, the baseline characteristics of the groups were similar. Patients requiring ICU admission were more likely to have multiorgan involvement (liver involvement, P<0.001; renal involvement, P<0.001; and cardiac involvement, P=0.02), low O 2 saturation (P<0.001), and lymphopenia (P=0.05). During hospital admission, 21 (16.5%) patients died, while the rest (83.5%) were discharged and followed-up until March 26, 2020. Also, the survival rate of patients, who received immunoglobulin, was higher than other patients (60.87% vs. 39.13%)., Conclusion: The mortality rate of COVID-19 patients was considerable in our study. Based on the present results, this infection can cause multiorgan damage. Therefore, intensive monitoring of these patients needs to be considered., (Copyright© 2020 National Research Institute of Tuberculosis and Lung Disease.)

Background: Chronic Obstructive Pulmonary Diseases (COPD) is estimated to rank fifth in burden of disease and third in terms of mortality by 2020 worldwide. It is characterized by chronic inflammation and non-fully reversible airflow obstruction, causing structural changes in the lungs that can be demonstrated by a post bronchodilator FEV1/FVC ratio <70%., Materials and Methods: The sampling frame of the current study was the population of Tehran, the capital of Iran with the current population of nearly 8.1 million. A stratified cluster sampling strategy with proportional allocation within strata was used in this study. The target population was all Tehran residents, aged 18 to 40 in one group and over 40 in another, in the year 2013. The stratification process of the sample according to the 22 municipal districts of Tehran city has been incorporated in the sampling process. Proportional to the number of households in the 22 districts, the appropriate number of clusters is weighted according to each district. The decision about the number of clusters is based on total sample size; mean household members; and logistical facilities for subject enumeration, transport, and examination., Results: The overall COPD prevalence defined by the spirometric functional criteria was 10%, higher in men 12 (11.9%) than in women 15 (8.8%); the prevalence was significantly higher in subjects aged over 55 years (P =0.001). Only 10(3.7%) of these COPD patients had already been diagnosed by a physician. Of all subjects fulfilling the criteria for COPD according to the Burden of Obstructive Lung Disease (BOLD) guidelines (post bronchodilator FEV1/FVC<70%), 90(33.3%) had chronic productive cough, and 262(96.7%) had either long-standing cough, sputum production, recurrent wheeze, dyspnea, or attacks of shortness of breath., Conclusion: Due to the small sample size at this stage of project, conclusions should be drawn with caution. In this first epidemiological report in Tehran about COPD, a moderate prevalence of the disease was determined, and a high percentage of this figure had not been diagnosed before by a physician.