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Introduction Airway hyper-responsiveness (AHR) is a characteristic feature of asthma. The aim of this study was to compare the impulse oscillometry (IOS) and spirometry to methacholine for AHR detection among individuals with clinically hyper-reactive airway disease suggestive of bronchial asthma and baseline spirometry were normal. Materials and methods Adults with symptoms suggestive of AHR and normal baseline spirometry test were selected. The short protocol of methacholine challenge test (MCT) was performed for all subjects using IOS and spirometry simultaneously. The primary endpoint was to compare the methacholine dosage causing a 20% drop in forced expiratory volume in one second (FEV1), with methacholine dosage that causing 40% increasing the baseline respiratory resistance at 5 hertz (R5), as measured by IOS. Result A total of 235 participants were analyzed, 184 (78.2%) had positive test results with R5, while 81 (34.4%) had positive MCT results with FEV1.The sensitivity and specificity of MCT with R5were 87.3%, 64.6%, and MCT with FEV1 were 39.1%, 85.4%, respectively. The area under the receiver operating characteristic (ROC) curve was greater at lower doses of MCT at R5, (AUROC: 0.653; p= 0.01). Conclusions The results showed higher sensitivity, negative predictive value, and earlier response of the short protocol of MCT with IOS, compared to MCT with spirometry. Our study suggested the utility of IOS in addition to conventional spirometry as a method of choice in MCT for detection of AHR.

Background Chronic obstructive pulmonary disease (COPD) is a common lung disease during middle age which one of its complications is depression. Depression is considered one of the major causes of severe disability worldwide. One of the factors that affect the severity and incidence of this disease is a lifestyle, especially dietary pattern. On the other hand, some studies showed the relationship between dietary patterns and depression. The present study aims to investigate the dietary patterns of people with chronic obstructive pulmonary disease and its association with depression. Methods The present cross-sectional study was performed on 220 patients (mean ± SD age = 54.58 ± 5.08) with chronic obstructive pulmonary disease (56.6% men, 43.4% women) from Tabriz, Iran. Questionnaires of general information, food frequency, Beck depression and physical activity were completed. The dominant dietary patterns were determined by factor analysis, and their relationship with depression was discussed by regression analysis. Results Three dominant dietary patterns were identified as healthy, unhealthy, and mixed dietary patterns. An inverse relationship was found between healthy and mixed dietary patterns with depression. There is no meaningful connection between unhealthy dietary patterns and depression. Depression had a significant inverse relationship with physical activity. There was no relationship between dietary patterns and Forced Expiratory Volume for 1 s (FEV1) and Forced Vital Capacity (FVC) criteria. A positive and significant relationship was observed between mixed dietary patterns with FEV1/FVC. Conclusion Inverse relationships exist between healthy dietary patterns and depression in patients with COPD, and improves the function of the lungs. Further studies are needed to show the exact relationship between diet and COPD depression.

Aim In recent years, mobile applications have been developed for health education purposes. The aim of this study was to determine whether Telegram‐based virtual education versus in‐person education can be effective for improving the quality of life in adolescents with moderate‐to‐severe asthma. Design A single‐blind randomized trial. Methods Participants were 64 adolescents aged 12–19 years and were equally assigned randomly to group A (Telegram‐based education) and group B (in‐person education) during 22 June 2017–19 February 2018. The educational contents were similar for both groups. The Mini Pediatric Asthma Quality of Life Questionnaire was used prior to intervention and 5 weeks postintervention for both groups of adolescents. Results A statistically significant increase was observed in the quality of life in both groups (p

Background Controversy exists regarding the drug selection in hypertension (HTN) management in patients with COVID‐19. This study aimed to compare the effects of losartan and amlodipine in patients with primary HTN and COVID‐19. Methods In this randomised clinical trial, hospitalised patients with COVID‐19 and primary HTN were enrolled in the study. One arm received losartan, 25 mg, twice a day and the other arm received amlodipine, 5 mg per day for 2 weeks. The main outcomes were compare 30‐day mortality rate and length of hospital stay. Results The mean age of patients treated with losartan (N = 41) and amlodipine (N = 39) was 67.3 ± 14.8 and 60.1 ± 17.3 years, respectively (P value = .068). The length of hospital stay in losartan and amlodipine groups was 4.57 ± 2.59 and 7.30 ± 8.70 days, respectively (P value = .085). Also, the length of ICU admission in losartan and amlodipine group was 7.13 ± 5.99 and 7.15 ± 9.95 days, respectively (P value = .994). The 30‐day mortality was two and five patients in losartan and amlodipine groups, respectively (P value = .241). Conclusions There was no priority in losartan or amlodipine administration in COVID‐19 patients with primary HTN in decreasing mortality rate, hospital and ICU length stay. Further studies need to clarify the first‐line anti‐HTN medications in COVID‐19.

Background Systemic sclerosis (SSc) is a connective tissue disease and one of the manifestations associated with this disease is pulmonary involvement. Studies showed that endothelin 1 (ET-1) plays a role in pulmonary dysfunction due to SSc. The aim of this study was to determine the level of ET-1 in SSc patients and to evaluate its association with the early stages of pulmonary fibrosis. Methods In this cross-sectional study, 48 patients with SSc were enrolled in the study. The stiffness of the skin was evaluated based on the modified Rodnan skin score. CT records, lung function tests and echocardiography were done. The samples were divided into two groups of patients with and without pulmonary parenchymal involvement. Blood sample was taken to measure the serum levels of ET-1 by ELISA method. ANOVA and Tukey HSD tests were used for statistical analysis. Results According to pulmonary CT scan, 68.2% of patients had pulmonary involvement. There was no significant difference in the presence of honeycomb lesions and fibrosis in lung CT scan of the patients in case of gender (P = 0.819 and P = 0.356, respectively). There was no statistical difference between the results of spirometry in patients with anti-Scl-70 and anti-centromere test. The mean serum level of ET-1 in the studied population was 0.55 ± 0.232 pg/mL, in the men was 0.47 ± 0.14 pg/mL and in the women was 0.55 ± 0.24 pg/mL. There was no significant difference between the two groups in the case of gender and type of the disease (P = 0.475 and P = 0.150, respectively). The ROC diagram of serum level of ET1 in patients based on the type of the disease shows that the serum level of ET-1 of 55% has 50% sensitivity and 52.2% specificity. Conclusion Serum level of ET-1 could not be used for screening of pulmonary involvement in SSc because its sensitivity and specificity is related to pulmonary fibrosis, honeycomb lesions and disease form. Anti Scl-70 with low levels, DLCO, FVC, FEV1, TLC can be used to assess the possibility of pulmonary involvement and response to treatment.

Background Chronic obstructive pulmonary disease (COPD) has been introduced as a major public health problem. It has been suggested that disruption in function or some adipokines and serum proteins' signaling could play crucial roles in lung diseases. This study's purpose was to investigate the association between serum levels of S100A1, ZAG, and adiponectin with FEV1 in COPD patients. Methods In this cross-sectional study, 90 clinically stable outpatient males with age ranging from 40 to 70 years with COPD diagnosis - FEV1/FVC Results In the present study, lower FEV1 was significantly associated with increased risk of cachexia (OR = 5.76, 95% CI: 2.28-14.54). The serum level of ZAG was significantly higher in the mild-moderate COPD patients in comparison with the severe-very severe COPD patients (p 0.800, p Conclusion In the present study, we found that low FEV1 was associated with increased risk of cachexia in COPD patients. Additionally, lower serum level of ZAG and higher RMR were observed in patients with severe-very severe COPD as compared to mild-moderate COPD. Therefore, it could be claimed that there is a mechanistic chain of causality between FEV1, serum ZAG, RMR, and cachexia.

Introduction: Pleural effusion (PE) is a common manifestation of pulmonary and non–pulmonary diseases, and the first step for diagnosing the etiology is analysis of pleural fluid. The aim of this study was to determine the epidemiology of PE in a tertiary referral hospital in the North-West of Iran. Methods: All patients with PE who referred to the department of pulmonary diseases in tertiary centre of Tabriz University of Medical Sciences between 2015 and 2016 were enrolled. Complete enumeration method used for selection of patients. Required information including clinical findings, PE location, fluid appearance, and biochemical characteristics were recorded using a checklist and analyzed via appropriate statistical methods. Results: A total of 223 patients were included in this study. Congestive heart failure (CHF) was the most common cause of PE (n=67), followed by pulmonary thromboembolism and malignant diseases. PE fluid in all patients with CHF was transudative. Conclusion: According to the findings of this study, CHF was the most prevalent cause of PE.

BACKGROUND: Epithelial malignancy in lung cancer, which is initiated with myofibroblast differentiation and remodeling, promotes hypoxia and intracellular ROS generation most affected by the prototypical enzyme, NADPH oxidase 4 (NOX4). In addition, nuclear factor erythroid 2-related factor 2 (Nrf2) acts as a critical transcription factor by stimulating antioxidant proteins as redox homeostasis regulators. The aim of this study was to investigate a possible correlation between lung tissue NOX4 and Nrf2 genes (NOX4 and Nrf2) mRNA expression and bronchoalveolar lavage fluid (BALF) protein expression in non-small-cell lung carcinoma (NSCLC) patients. METHODS: Samples from 25 patients with various NSCLC types and stages and 20 healthy controls were collected. NOX4 and Nrf2 mRNA were measured by qRT-PCR, and protein by western blot analysis. RESULTS: NOX4 mRNA and protein expression was significantly up-regulated in NSCLC patients’ lung tissues and BALFs (p= 0.03 and 0.01, respectively). In addition, by adjusting for age, sex, and NSCLC types and stages, a significant and positive correlation was observed between NOX4 and Nrf2 mRNA expression (r= 0.927, p= 0.001). This was also true when not adjusted as above (r= 0.944, p< 0.001). CONCLUSION: NOX4 mRNA and protein expression is significantly up-regulated in NSCLC patients’ lung tissues and BALFs, and NOX4 and Nrf2 mRNA expression is positively correlated in NSCLC tissues.

Background: The red cell distribution width (RDW) value has been recently recognized as a valuable biomarker in clinical practice. The RDW value has not been evaluated so far in patients with pleural effusion. Thus, this study aimed to investigate whether RDW could distinguish between exudative and transudative pleural effusions. Materials and Methods: We measured protein and lactate dehydrogenase levels on both pleural fluids and serum samples from 223 cases and classified them as transudates or exudates based on the classic Light’s criteria. We collected blood cell count elements such as RDW from the medical records. We also investigated the correlation between RDW and the nature of pleural effusion. Results: In 55.2% of the patients, pleural fluid was exudative. Although we found no significant association between RDW and the nature of the pleural fluid, we detected a significantly higher amount of RDW (14.9 ≤) in patients with exudative pleural effusion compared to transudate (66.7% vs. 33.3%; P= 0.01). In this category, neoplastic conditions were mostly observed in the patients (76.3%), followed by pulmonary thromboembolism (21.1%) and systemic lupus erythematous (2.6%). Conclusion: The findings could not reveal any noticeable correlation between RDW and the Light criteria. However, it appears that elevated RDW levels give insights into the valuable nature of RDW in different conditions such as neoplastic diseases.

Background. Risk scores are urgently needed to assist clinicians in predicting the risk of death in severe patients with SARS-CoV-2 infection in the context of millions of people infected, rapid disease progression, and shortage of medical resources.Method. A total of 139 severe patients with SARS-CoV-2 from China and Iran were included. Using data from China (training dataset, n = 96), prediction models were developed based on logistic regression models, nomogram and risk scoring system for simplification. Leave-one-out cross validation was used for internal validation and data from Iran (test dataset, n = 43) for external validation. Results. The NSL model (Area under the curve (AUC) 0.932) and NL model (AUC 0.903) were developed based on neutrophil percentage (NE), lactate dehydrogenase (LDH) with or without oxygen saturation (SaO2) using the training dataset. Compared with the training dataset, the predictability of NSL model (AUC 0.910) and NL model (AUC 0.871) were similar in the test dataset. The risk scoring systems corresponding to these two models were established for clinical application. The AUCs of the NSL and NL scores were 0.928 and 0.901 in the training dataset, respectively. At the optimal cut-off value of NSL score, the sensitivity was 94% and specificity was 82%. In addition, for NL score, the sensitivity and specificity were 94% and 75%, respectively.Conclusion. NSL and NL score are straightforward means for clinicians to predict the risk of death in severe patients. NL score could be used in selected regions where patients’ SaO2 cannot be tested.

Background: The relationship between dietary pattern and the risk of chronic obstructive pulmonary disease (COPD) has been described; however, the exclusive role of dietary factors remains controversial. Hence, we conducted this systematic meta-analysis to clarify the role of some nutrients and antioxidant vitamins in the risk of COPD. Materials and Methods: PubMed, Embase, and Scopus databases were searched for studies evaluating the associations between COPD outcome measures, symptoms, and mortality, and intake of fruits and vegetables, fiber, fish, n-3 or n-6 fatty acids, and antioxidant vitamins in adults. The random-effect model meta-analyses were used to pool the results. Results: Ten cohort, six case-control, and 20 cross-sectional studies were identified. The pooled relative risks (RRs) of the COPD and confidence intervals (CIs) for the highest intake group compared with the lowest intake group were 0.74 (95% CI: 0.65–0.85) for fruit, 0.65 (95% CI: 0.55–0.78) for dietary fiber, 0.71 (95% CI: 0.58–0.85) for fish, and 0.89 (95% CI: 0.76–0.99) for vitamin C. No association was observed between the risk of COPD and the intake of vegetables, n-3 fatty acids, vitamin E, and β-carotene; however, it was associated with n-6 fatty acids 1.06 (95% CI: 0.87–1.30). Conclusion: The results suggested that a higher intake of fruits, probably dietary fiber, and fish reduce the risk of COPD.

Introduction: Development of Ventilator-associated pneumoniae (VAP) presents an intricate chemistry comprising of intubation and invading bacteria which often are tied up with biofilm production. Aim: To assess the phenotypic and genetic basis of biofilm formation by gram negative bacilli isolated from mechanically ventilated and VAP developed patients. Materials and Methods: Endotracheal aspirate obtained from 40 mechanically ventilated patients was inoculated by a semi quantitative method. Isolation and identification of gram negative bacilli was done according to standard bacterial protocol followed by antibiotic susceptibility test and biofilm assessment by micro titer method. Presence of biofilm genes was studied by molecular method. Result: Amongst 40 enrolled hospitalized patients, 12.5% of them developed VAP. A. baumannii (n=68) was the commonest organism followed by P. aeruginosa (n=18), K. pneumoniae (n=32) and E. coli (n=12). Presence of multi drug (MDR) and extensive drug resistance (XDR) was evident in A. baumannii and P. aeruginosa comparative to K. pneumoniae and E. coli isolates. Moderate or strong biofilm production was an overt feature. Presence of bap gene was marked in 57.4% A. baumannii whereas, 11.1% P. aeruginosa displayed algC gene. Manifestation of genes fimH, ang43 and csgA was evident in 33.3%, 66.7% and 25% E. coli isolates respectively. Gene type 3 was present in all K. pneumoniae isolates while, mrkA and fimK genes were shown in 65.6% and 81.2% isolates respectively by multiplex PCR. Conclusion: Drug resistance phenotypes require specific national and regional therapeutic studies focusing on antimicrobial stewardship programs. Presence of biofilm requires routine surveillance of VAP, to track endemic VAPs.

Objective Lung cancer is one of the most common leading causes of cancer related death in the worldwide, thus its early detection might be a critical strategy to improve patients’ prognosis and survival. The present study was designed to assess if microRNAs expression profiling of bronchoalveolar lavage cell fraction and sputum could help to non-small cell lung cancer early detection. Materials and methods Relative expression of 3 selected microRNAs (miR-10b, miR-1 and miR-30a) were quantified using Real-time polymerase chain reaction in bronchoalveolar lavage cell fraction and sputum samples from non-small cell lung cancer cases (n = 30) and cancer-free group (n = 30). Written informed consent from all enrolled individuals was obtained. So, the Ethical and Scientific Committees of the participating institution confirmed the present study in accordance with the ethical standards (as laid down in 1964 Declaration of Helsinki). Results miR-1 and miR-30a were significantly downregulated in non-small-cell lung cancer patients , bronchoalveolar lavage and sputum while miR-10b was significantly upregulated. Overexpression of miR-10b has a positive strong correlation with clinical stages of cancer. ROC curve analysis of miR-10b (as oncomir) and miR-1 (as tumor suppressor) in bronchoalveolar lavage and sputum samples showed that miR-10b with 0.931 and 0.927 AUC values and miR-1 with 0.786 and 0.788 AUC values, could be an excellent and a fair candidate microRNA to distinguish non-small-cell lung cancer patients from cancer-free subjects, respectively. Conclusion This study reported significant differences in microRNAs expression in bronchoalveolar lavage and sputum samples of lung cancer patients compared to cancer-free subjects which represent a potential role as a highly specific and sensitive test to Improved early detection of non-small cell lung cancer.

Background Chronic obstructive pulmonary disease (COPD) has been introduced as a major public health problem. It has been suggested that disruption in function or some adipokines and serum proteins' signaling could play crucial roles in lung diseases. This study's purpose was to investigate the association between serum levels of S100A1, ZAG, and adiponectin with FEV1 in COPD patients. Methods In this cross-sectional study, 90 clinically stable outpatient males with age ranging from 40 to 70 years with COPD diagnosis – FEV1/FVC < 70% – were divided into two groups: mild–moderate COPD patients; FEV1 ≥ 50 (n=52) VS severe and very severe COPD patients; FEV1 < 50 (n=38). The serum levels of ZAG, S100A1, and adiponectin were measured by the use of enzyme-linked immunosorbent assay. Results In the present study, lower FEV1 was significantly associated with increased risk of cachexia (OR = 5.76, 95% CI: 2.28–14.54). The serum level of ZAG was significantly higher in the mild–moderate COPD patients in comparison with the severe–very severe COPD patients (p0.800, p

Circulating microRNAs have been recognized as promising biomarkers for the detection of lung cancer. The objective of this study was to evaluate miR-10b, miR-1 and, miR-30a in the plasma samples of lung cancer patients to confirm any possible relevance in the early detection of lung cancer. Plasma samples from 47 non-small-cell lung cancer patients and 41 cancer-free subjects were evaluated for selected microRNAs using the real-time PCR method. To evaluate the tobacco smoking effects on microRNAs expression, the studied groups were categorized into two subgroups: never-smokers and smokers. MiR-1/miR-30a expression levels were significantly reduced in lung cancer, while the miR-10b level was significantly elevated. We found that smoking had significant effects on the levels of circulating microRNAs in the smokers of the cancer-free group (a significant up-regulation of miR-10b and significant down-regulation of miR-1/miR-30a), and lung cancer patients (a significant elevation of miR-10b). Receiver operating characteristic curve analysis showed that miR-10b with an area under the curve of 0.861, and miR-1/miR-30a with values of0.905 and 0.889 for the same parameter, could distinguish non-small-cell lung cancer patients from cancer-free subjects. Our findings demonstrated significant differences in the expression of microRNAs in lung cancer and the considerable effects of smoking on microRNAs levels. Area under curve analysis showed that miR-10b with 78% sensitivity/78% specificity, miR-1 with 95% sensitivity/80% specificity and miR-30a with 87% sensitivity/83% specificity,might be good (miR-10b/miR-30a) and excellent (miR-1) markers for lung cancer detection.

Highlights • SARS-CoV-2 mainly enter to CNS via direct (neuronal and hematologic route) and indirect route. • SARS-CoV-2 can infect leukocytes within the bloodstream and then cross the blood-brain-barrier via diapedesis. • SARS-CoV-2 can invade the vascular endothelium by binding to ACE-2, leading to increased permeability of blood-brain-barrier and then infecting glial cells in the CNS. • Future research is desirable to confirm or disprove such hypothesis., SARS-CoV-2 mainly invades respiratory epithelial cells by adhesion to angiotensin-converting enzyme 2 (ACE-2) and thus, infected patients may develop mild to severe inflammatory responses and acute lung injury. Afferent impulses that result from the stimulation of pulmonary mechano-chemoreceptors, peripheral and central chemoreceptors by inflammatory cytokines are conducted to the brainstem. Integration and processing of these input signals occur within the central nervous system, especially in the limbic system and sensorimotor cortex, and importantly feedback regulation exists between O2, CO2, and blood pH. Despite the intensity of hypoxemia in COVID-19, the intensity of dyspnea sensation is inappropriate to the degree of hypoxemia in some patients (silent hypoxemia). We hypothesize that SARS-CoV-2 may cause neuronal damage in the corticolimbic network and subsequently alter the perception of dyspnea and the control of respiration. SARS-CoV-2 neuronal infection may change the secretion of numerous endogenous neuropeptides or neurotransmitters that distribute through large areas of the nervous system to produce cellular and perceptual effects. SARS-CoV-2 mainly enter to CNS via direct (neuronal and hematologic route) and indirect route. We theorize that SARS-CoV-2 infection-induced neuronal cell damage and may change the balance of endogenous neuropeptides or neurotransmitters that distribute through large areas of the nervous system to produce cellular and perceptual effects. Thus, SARS-CoV-2-associated neuronal damage may influence the control of respiration by interacting in neuromodulation. This would open up possible lines of study for the progress in the central mechanism of COVID-19-induced hypoxia. Future research is desirable to confirm or disprove such a hypothesis.

Introduction: Early maladaptive schemas (EMSs) that are being shaped through the early period of development of humans have been reported to affect the functions of asthmatic patients. This study focuses on the probable relationship between the personality schemas and areas with severity of asthma. Material and methods: Fifty asthmatic patients were entered this descriptive cross-sectional study in Tabriz University of Medical Sciences from March to August, 2016. We measured the personality schema of patients by using the Young Schema Questionnaire—Short Form (YSQ-SF; Young, 1994). On the other hand, patients’ clinical findings and severity of asthma were assessed by spirometry and the Asthma Control Test (ACT) questionnaire. Results: Uncontrolled (ACT score < 20) and controlled (ACT score ≥ 20) asthma had significant defect in ‘Disconnection domain’ (p = 0.001). Also, significant reverse linear correlation was found between FEV₁ and ‘Disconnection domain’, ‘Rejection’ schema area (r = –0.29, p = 0.03), and ‘Over vigilance domain’ (r = –0,36, p = 0.01). Whereas, significant reverse linear correlation was revealed between FEV₁/FVC and Over vigilance domain (r = –0.41, p = 0.003). Conclusion: EMSs possibly have potential effects on clinical characteristics and severity of asthma in asthmatic patients.

Amin Mokari-Yamchi,1 Akbar Sharifi,2 Sorayya Kheirouri1 1Department of Community Nutrition, Faculty of Nutrition and Food Science, Tabriz University of Medical Sciences, Tabriz, Iran; 2Tuberculosis and Lung Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Background: COPD is a common irreversible obstructive airway disease. S100A1, ZAG, and adiponectin are important regulators of energy metabolism and body weight. Therefore, the aim of this study was to assess resting metabolic rate (RMR) and its association with serum levels of S100A1, ZAG, and adiponectin in cachectic and noncachectic COPD patients. Patients and methods: Ninety men with COPD, aged 40–70 years, were enrolled in the study. Patients were divided into the following two groups based on the unintentional weight loss of .7.5% in previous 6 months: noncachectic (n=45) and cachectic (n=45). The groups were matched based on age and body mass index (BMI). RMR was measured by indirect calorimetry method. Anthropometric indices and body composition were also measured. Serum levels of S100A1, ZAG, and adiponectin were measured by ELISA. Results: Cachectic patients had significantly higher RMR than controls (P

Introduction: Early maladaptive schemas (EMSs) that are being shaped through the early period of development of humans have been reported to affect the functions of asthmatic patients. This study focuses on the probable relationship between the personality schemas and areas with severity of asthma. Material and methods: Fifty asthmatic patients were entered this descriptive cross-sectional study in Tabriz University of Medical Sciences from March to August, 2016. We measured the personality schema of patients by using the Young Schema Questionnaire—Short Form (YSQ-SF; Young, 1994). On the other hand, patients’ clinical findings and severity of asthma were assessed by spirometry and the Asthma Control Test (ACT) questionnaire. Results: Uncontrolled (ACT score < 20) and controlled (ACT score ≥ 20) asthma had significant defect in ‘Disconnection domain’ (p = 0.001). Also, significant reverse linear correlation was found between FEV₁ and ‘Disconnection domain’, ‘Rejection’ schema area (r = –0.29, p = 0.03), and ‘Over vigilance domain’ (r = –0,36, p = 0.01). Whereas, significant reverse linear correlation was revealed between FEV₁/FVC and Over vigilance domain (r = –0.41, p = 0.003). Conclusion: EMSs possibly have potential effects on clinical characteristics and severity of asthma in asthmatic patients.

Introduction: Congestive heart failure (CHF) is a common disease and its prevalence is increasing in industrialized countries. NT-proBNP measurement is an established diagnostic test for diagnosis of CHF in patients who present to emergency room with acute dyspnea. The primary object of this study was to determine the relationship between levels of brain natriuretic peptide precursor and severity of lung function impairment in patients with chronic CHF. Methods: This cross-sectional and analytical study that performed in Tuberculosis and Lung Disease Research Center of Tabriz University of Medical Sciences on 95 patients with chronic heart failure, and relation between NT-proBNP levels and pulmonary function parameters were examined. Results: Sixty-four patients were male and 31 were female. The average age of male and females was 62.90 ± 11.54 and 61.61 ± 11.98 years, respectively. A significant inverse linear correlation was found between NT-proBNP and FEV1 (P < 0.001, r = -0.367), FVC (P < 0.001, r = -0.444), TLC (P = 0.022, r = -0.238), maximal midexpiratory flow (MMEF) (P = 0.047, r = -0.207) and left ventricular ejection fraction (LVEF) (P < 0.001, r = -0.461). A significant positive linear correlation was found between NT-proBNP and FEV1/FVC (P = 0.013, r = 0.257), RV/TLC (P = 0.003, r=0.303) and 5 Hz Raw (r = 0.231, P = 0.024). Conclusion: This study showed that, both restrictive and obstructive ventilator impairments can occur in chronic CHF and as NT-proBNP increases appropriate to hemodynamic deterioration, pulmonary dysfunction increases.

Introduction: Almost one third of patients with asthma have symptomatic evidence for coexisting gastroesophageal reflux disease (GERD), which is thought to be aggravating factor in asthma at least in some cases. We investigated the impact of coexisting GERD on asthma severity and parameters of lung function. Methods: Ninety two asthma patients diagnosed according to ATS criteria were studied. After full history and physical examination, asthma severity was measured in each patient using asthma control test (ACT). GERD symptoms was verified in each patient. Impulse oscillometry (IOS) and lung volume studies (using body-plethysmography and IOS) were performed. The difference between total airway resistance (TAWR) indicated by resistance at 5 Hz and central airway resistance (CAWR) as indicated by resistance at 20 Hz in oscillometry was calculated and considered as representative of resistance at peripheral airways (PAWR). The relationship between the presences of GERD symptoms, ACT score and parameters of lung function were analyzed. Results: PAWR and TAWR were both significantly higher in asthmatic patients with GERD symptoms than patients without GERD symptoms (256.64±161.21 versus 191.68±98.64; P=0.02, and 102.73±122.39 versus 56.76±71.43; P=0.01, respectively). However, no significant difference was noted in mean values of ACT, FEV1 (forced expiratory volume in 1 sec), FVC (forced vital capacity), PEF (peak expiratory flow), and CAWR in these two groups. Conclusion: These findings suggest that the severity of asthma as measured by ACT score is not different in patients with and without GERD symptoms. However, total and peripheral airway resistance measured by IOS is significantly higher in asthmatic patients with GERD symptoms.

Wstęp: Wczesne nieadaptacyjne schematy (EMSs, early maladaptive schemas), kształtujące się we wczesnym okresie rozwoju człowieka mogą mieć wpływ na funkcjonowanie chorego na astmę. Prezentowane badanie dotyczy prawdopodobnego związku pomiędzy schematami i obszarami osobowości a ciężkością astmy. Materiał i metody: Do niniejszego opisowego przekrojowego badania prowadzonego na Uniwersytecie Medycznym w Tabriz włączono w okresie od marca do sierpnia 2016 roku pięćdziesięciu chorych na astmę. Autorzy niniejszej pracy zbadali schematy osobowości za pomocą kwestionariusza Younga (YSQ-SF, Young Schema Questionnaire—Short Form, Young, 1994). Ocenę kliniczną i ocenę ciężkości astmy przeprowadzono za pomocą badania spirometrycznego i testu kontroli astmy (ACT, Asthma Control Test). Wyniki: U chorych na astmę niekontrolowaną (ACT < 20 punktów) i kontrolowaną (ACT ≥ 20 punktów) stwierdzono istotne upośledzenie w obszarze rozłączenia (Disconnection domain; p = 0.001). Stwierdzono również odwrotną korelację liniową pomiędzy wartością FEV1 i obszarem rozłączenia i odrzucenia (rejection schema; r = −0.29, p = 0.03) i obszarem nadmiernej czujności (over vigilance domain; r = −0.36, p = 0.01). Ponadto ujawniono ujemną korelację liniową pomiędzy wartością FEV1/FVC a obszarem nadmiernej czujności (r= −0.41, p = 0.003). Wnioski: Wczesne nieadaptacyjne schematy mogą wywierać wpływ na parametry kliniczne i ciężkość astmy.

Objectives: This study aimed to Examine psychometric properties of and geriatric depression scale. Methods & Materials: Method of This study is descriptive. Statistical population includes all aged over 60 years in the retirement centers of organizations and Nursing homes in shahrekord. 380 persons (113 females and 267 males) were selected through stratified random sampling method. In order to collect data, geriatric depression scale (Yesavage et al., 1982) and Composite International Diagnostic Interview (WHO, 1990) was used. Results: The results of the present study indicate satisfactory reliability and‬‬ ‫‪internal consistency and Cronbach’s alpha and Spearman split test was estimated 0.75 and 0.77 respectively. Also The ROC analysis showed that the best cutoff score for this scale is 16.5 with sensitivities of 0.88 and specificities of 0.87. Conclusion: The results showed that geriatric depression scale is a valid and reliable instrument and it can be used for diagnosing depression in the elderly.

The aim of the study was to determine the rela-tionship between Body Mass Index (BMI) and accelerated dental development. The dental developmental ages of 100 children aged between 8 and 12 years were determined using the Demirjian method and panoramic radiographs. BMI status was determined for each subject on the basis of the system developed by the International Obesity Task Force. There was a significant direct relationship between dental development and BMI (P < 0.01). Obese children have a higher rate of dental development compared to normal children. CLINICAL RELEVANCE: This is an important variable to be considered when planning for dental and orthodontic treatments in obese children. Brief objectives statement: Overweight or obesity can accelerate dental development. Accelerated dental development in overweight children is important to be considered in pediatric dentistry and orthodontics.

In order to find out the differences between asthmatic patients and normal adults on cognitive schemas data was collected from 50 asthmatic patients and 50 normal adults in the age range of 18 to 65 using YSQ-SF developed by Jeffery Young (1998). Data was subjected to statistical analysis, T- test showed that there is significant difference on early maladaptive schemas of disconnection and rejection (t=3.3, p

Inflammatory mechanism appears to play a major role in the pathogenesis of various types of human pulmonary hypertension such as idiopathic PAH (IPAH) and PAH associated" with connective tissue disease. Although we know that inflammatory factors such as IL6 and TNFα have an important role in IPAH, there is limited information about the relationship between acute phase reactants and pulmonary hypertension occurring secondary to pulmonary diseases such as chronic obstructive pulmonary diseases (COPD).This cross-sectional study was carried out on 94 patients who had COPD. Patients with a recent history of systemic steroid and acetylsalicylic acid (ASA) use, infection, trauma or surgery, gastrointestinal bleeding, coronary artery disease (CAD) and Hypertension were excluded. Body plethysmography and transthoracic echocardiography were done. Blood samples for each patient included were drawn for complete blood count (CBC), IL6, TNFα and highly sensitive C reactive protein (hs-CRP).Twenty patients (28.6%) had pulmonary hypertension. The difference between the mean IL6 and hs-CRP in patients with and without pulmonary hypertension was significant (7 pg/ml vs. 4.4 pg/ml and 13.04 pg/ml vs. 3.31 pg/ml) (p=0.006 and p=0.000). There was a correlation between IL6 and mean pulmonary arterial pressure (r=0.35, p=0.003). After adjustment forage, sex, serum Hemoglobin, Hematocrit, O2Sat, FEV1, FVC the relationship between the IL6, hs-CRP and the presence of pulmonary hypertension remained significant (p=0.022, p=0.026).Inflammatory factors such as IL6 and hs-CRP are independent risk factors for pulmonary hypertension in COPD patients.

In this article, the author describes the emergence of drug-related black economy in Akra state of Brazil. This state is located in the joint border with Bolivia and Peru. There is a long distance between this state and distribution/selling centers, so there is no industrial laboratories for manufacturing cocaine and drug traders export freebase to Peru and from where to Colombia. Regarding the long distance between Akra and Brazilian capital and its economy which is based on agriculture and trade of rubber and cocaine, the trade of cocaine is a cover for illicit drug traffic. The traders of this state have created a secure edge through their influence among the staff of airport, the police, judiciary and other relevant centers. However, broad social influence is based on family netwoks which have deep roots in the police. Well-known families which have relations not only with criminal organizations but also with police forces, control cocaine market and obtain huge wealth which spreads their power and influence over this state. In this article, the author reviews the effects of cocaine trade on emerging black money as well as the influnce of criminal groups over society.

Lung cancer stands among the leading causes of cancer-related death in the world. Although the molecular network implicated in lung cancer development is extensively revealed, the mortality rate is only slightly improved. MicroRNAs are small, endogenous single-stranded evolutionary conserved non-coding RNAs which involve in a wide variety of biological processes including cell growth, proliferation, metabolism, and differentiation. MicroRNAs, as novel biomarkers, have multiple functions in normal lung tissue development, and aberrant expression profiles of certain microRNAs could induce lung tumorigenesis. Similar to that of protein-coding genes, microRNA expression and function are regulated by multiple factors as well as the epigenetic network including DNA methylation and histone modification mechanisms. Furthermore, microRNAs can themselves regulate key enzymes which drive epigenetic modifications and have a pivotal effect on the cell biology. In this review, we will look into the regulatory loop linkage between microRNA expression and epigenetic modifications, and then, we will discuss the effects of epigenetics on the miRNome, as well as the role of epi-microRNAs in controlling the epigenome in human lung cancer. Better knowledge of reciprocal connection between microRNAs and epigenome will help to develop novel microRNA-orientated diagnostic, prognostic and therapeutic strategies related to human lung cancer in future.

Khalil Ansarin1, Babak Niroomand1, Farzad Najafipour2, Naser Aghamohammadzadeh2, Mitra Niafar2, Akbar Sharifi1, Mohammadali M Shoja11Tuberculosis and Lung Disease Research Center, 2Department of Endocrinology, Tabriz University of Medical Sciences, Tabriz, IranBackground: Hypoventilation is a frequently suspected complication of hypothyroidism.Objective: In this study we examined the hypothesis that changes in alveolar ventilation, as measured by end-tidal carbon dioxide (Et-CO2), differ between patients with mild (subclinical) and overt (clinical) thyroid hormone deficiency, and both differ from healthy control subjects.Methods: A total of 95 subjects, including 33 with subclinical hypothyroidism (an elevated thyroid-stimulating hormone (TSH) level and a normal thyroxin (fT4) level), 31 with overt hypothyroidism (elevated TSH and decreased fT4), and 31 healthy controls. All subjects were female and were evaluated clinically by an endocrinologist for evidence of thyroid disease and categorized on the basis of thyroid hormone levels. Et-CO2 was measured using a capnograph. Et-CO2 levels were measured three times and the mean value was considered as the mean level for the individual.Results: Mean Et-CO2 values of the subclinical hypothyroidism group were significantly lower than those of the healthy controls (31.79 ± 2.75 vs 33.81 ± 2.38; P = 0.01). Moreover, mean Et-CO2 values for the overt hypothyroidism group were significantly lower than those for healthy controls (32.13 ± 3.07 vs 33.81 ± 2.38; P = 0.04). There was a significant correlation between Et-CO2 values and TSH levels (r = -0.24; P = 0.01). However, Et-CO2 values were not correlated with fT4 levels (r = 0.13; P = 0.20).Conclusions: Alveolar ventilation, as inferred from lower Et-CO2 levels, is higher in subjects with subclinical hypothyroidism and overt hypothyroidism (lower Et-CO2) than in healthy controls. Furthermore, Et-CO2 levels have no relationship to the levels of TSH or fT4. The lower Et-CO2 in these patients with hypothyroidism, particularly at the subclinical stage, suggests presence of hyperventilation, which may be related to direct effect of TRH on respiratory center or to local changes within the lung.Keywords: end-tidal CO2, hypothyroidism, lung, respiratory, ventilation

Background and Objective: Many studies show that there is a relationship between asthma and obesity. Weight management is important in patients with asthma. In some countries, people used Portulaca oleracea seeds for lose weight. The experiment is designed to study the effect of Portulaca oleracea seeds on anthropometric measurements in asthmatic patients with overweight and obesity. Material and method: In a randomized clinical trial, 37 patients with asthma disease that refer to clinics of Tabriz University of medical sciences divided to intervention and control groups. First group (n=18) received protocol treatment and 10g/day Portulaca oleracea seeds in two doses with two glasses of water, while participants in second group (n=19) had only their protocol treatment and drank two glasses of water in every day for 8weeks. At the baseline and end of study, anthropometric measurements were obtained for each person and dietary intake and physical activity questionnaires were completed. Results: Mean age and history of asthma for participants at baseline was 45.13 ± 9.2 and 9.9 ± 8.1 years, respectively. Comparing of anthropometric measurements including weight, body mass index (BMI), waist circumference (WC) and hip circumference (HC), waist-to-hip ratio (WHR) between two groups indicated any significant differences between two groups after consumption of seeds (p>0.05). Conclusion: Administration of Portulaca oleracea seeds could not decrease anthropometric measurements in asthmatic patients with overweight and obesity.

Background: Obesity is commonly regarded as a risk factor for asthma development, poor asthma control, and poor response to asthma therapy. Methods: In a cross-sectional study, 85 asthmatics (37 male and 48 female) participated. Pulmonary function tests (PFTs) and anthropometric parameters were measured for each patient. Results: Mean age and median duration were 43.9 ± 10.61 and 6 (3-14) years, respectively. Among anthropometric parameters, only waist-to-hip ratio (WHR) indicated significant correlation with PFTs in both sex (P < 0.05). There were negative associations between waist circumference, hip circumference and WHR with PFTs only in overweight and obese women (P < 0.05). Conclusions: Some anthropometric parameters affected lung function, and it seems that gender differentially contributes to this effect.