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Background: Cryptogenic organizing pneumonia (COP) is a rare lung condition affecting the bronchioles and alveoli. This study aimed to determine the course of the disease and response to treatment in a group of COP patients. Materials and Methods: In a cohort study, patients' data including demographic features, chest imaging, spirometry, and blood tests, were recorded. Inclusion criteria were radiological features compatible with COP, confirmed tissue biopsy, and the absence of underlying diseases at the time of presentation. All patients received the same steroid-based regimen (oral prednisolone with a dosage of 1 mg/kg tapered to none within 6 months). They were followed for 3 years. Results: Sixteen patients were included, 43.75% were male. The mean age was 56 ± 15 years. Nobody experienced recurrence. Reversed halo sign and groundglass opacity were the most common radiological findings. ESR decreased significantly after treatment (P<0.005). Forced vital capacity increased significantly after treatment (P<0.005), the same was true for oxygen saturation (P<0.005). On three years of follow-up, 5 patients developed signs and symptoms of connective tissue diseases and malignancy. There was no significant association between the final diagnosis and radiological findings at presentation (P>0.05). Conclusion: Standard treatment in patients with early diagnosis of COP was associated with an appropriate therapeutic response and no recurrence of pulmonary symptoms. Proper treatment can lead to optimized oxygenation parameters and a decreased inflammatory index. Lower response to treatment among corticosteroid-treated COP patients may suggest secondary causes of organizing pneumonia. [ABSTRACT FROM AUTHOR]

Flexible bronchoscopy is employed to diagnose a range of respiratory disorders. Local airway anesthesia is mandatory to facilitate tracheal intubation. It is commonly done by injection of diluted lidocaine through working channel of bronchoscope via Spray-as-you-go (SAYGO) method. Other methods such as airway nerve block (ANB) by direct injection of lidocaine are also used to increase patient comfort. The aim of this study was to compare patient and physician satisfaction during bronchoscopy in two groups receiving SAGO alone versus combination of SAYGO and ANB. In a double-blinded randomized clinical trial, 68 patients undergoing bronchoscopy were divided into two groups. The first group received local anesthesia solely through the SAYGO method, while the second group received a combination of SAYGO and ANB. Both groups received intravenous sedation. The anesthesia level was assessed using Ramsay score. Patient and physician satisfaction with bronchoscopy was evaluated on a numeric scale of 1 to 5. Combination of ANB and SAYGO resulted in significantly higher satisfaction score both in physician [3.4±1.6 and 4.6±0.8] and patients [3.5±1.3 and 4.9±0.4] (P<0.001). Thirteen individuals (38.2%) in the SAYGO and four individuals (11.8%) in SAYGO+ANB experienced a drop in oxygen levels (P=0.023). Additionally, sedation levels (Ramsay sedation scale score) were significantly higher in the first group (4) compared to the second group (3) (P=0.001). Combining ANB with SAYGO resulted in higher patient and physician comfort during bronchoscopy in comparison to SAYGO alone with no increase in complications. [ABSTRACT FROM AUTHOR]

World Health organization (WHO) has reported that out of more than 10,000 of 250,000 tuberculosis afflicted children die annually. Pulmonary tuberculosis is a research priority in our country, and diagnos-ing this disease especially in children who are known as the major transmitter of the disease is rather difficult. As a result, it was decided to conduct an overall assessment on this age group in order to determine the importance of the findings of chest radiography and skin test in diagnosing the disease. The present descriptive study was carried out based on the findings of a health plan in Fasa , a Iranian town, during 1995 and 1996, on 2 groups: first-grade students of Fasa elementary schools. Among 2263 students, 102 (4.5%) cases had a positive skin test. According to the radiographic findings, tuberculosis was reported in seven (6.9%) of them. The diagnosis of tuberculosis is more difficult in children; this is because taking sputum samples for laboratory examination is rather difficult especially in children lower than 10 years. In this group, diagnosis is made based on the symptoms like cough, weight loss, history of contact with a TB patient and other diagnostic procedures including chest radiographies and skin test.

Acute Respiratory Distress Syndrome (ARDS) is a potential complication of cardiac surgery, given that patients undergoing CABG frequently have hypoxemia and pulmonary dysfunction during initial hours after surgery. Thus, ARDS criteria in these patients are more likely to be positive while these criteria may not match the patient`s clinical picture. We aimed to investigate frequency of rapid onset hypoxemia in Pressure of Arterial Oxygen to Fractional Inspired Oxygen Concentration (PaO2/FiO2) less than 200 and diffuse pulmonary infiltrates as two diagnostic criteria forwards and compared these criteria with the clinical picture of the patients after Coronary Artery Bypass Graft (CABG) in this study. The study was prospective case series which carried out in about six months. All patients admitted to intensive care unit of Tehran Heart Center, who had undergone CABG on cardiopulmonary pump (CPB) recruited in the study. After considering inclusion criteria, age, sex, duration of intubation, arterial blood gas and chest radiography, on 24 hours and 48 hours after admission to the ICU were recorded. Then, patients with rapid onset of hypoxemia (PaO2/FiO2⩽200mmHg) and diffuse pulmonary infiltrates and without sign or symptoms of obvious heart failure (probable positive ARDS cases) criteria were recorded and comparison between these probable positive cases with clinician`s clinical diagnosis (blinded to the study) was performed. In this study, a total of 300 patients after on-pump coronary artery bypass surgery were included. Postoperatively, 2 (0.66 %) in the 24 hours and 4 (1.33%) patients in 48 hours after surgery were positive for the two ARDS criteria according to the checklists, but; nobody had saved persistently ARDS criteria persistently during 48 hours after surgery. At the same time, clinician did not report any case of ARDS among 300 patients. In this study patients with ARDS criteria had no significant differences in age (P.value=0.937) and sex (P.value=0.533). Duration of intubation in patients with ARDS (14.26 ± 4.25 hours) in the first 48 hours was higher but not statistically different from the group without ARDS (11.60 ± 5.45 hours) (P.value=0.236). ARDS diagnosis based on rapid onset of hypoxemia (PaO2/FiO2⩽200 mmHg) and diffuse pulmonary infiltrates and without signs or symptoms of obvious heart failure criteria in patients undergoing CABG could lead to overdiagnosis or misdiagnosis in less than 24 hours follow up. We recommend following patients for more than 24 hours and revise the current ARDS criteria for CABG patients. [ABSTRACT FROM AUTHOR]

Background: Extubation is associated with the risk of complications such as accumulated secretion above the endotracheal tube cuff, eventual atelectasia following a reduction in pulmonary volumes because of a lack of physiological positive end expiratory pressure, and intra-tracheal suction. In order to reduce these complications, and, based on basic physiological principles, a new practical extubation method is presented in this article. Methods: The study was designed as a six-month prospective cross-sectional clinical trial. Two hundred fifty-seven patients undergoing coronary artery bypass grafting (CABG) were divided into two groups based on their scheduled surgery time. The first group underwent the conventional extubation method, while the other group was extubated according to a new described method. Arterial blood gas (ABG) analysis results before and after extubation were compared between the two groups to find the effect of the extubation method on the ABG parameters and the oxygenation profile. Results: In all time intervals, the partial pressure of oxygen in arterial blood / fraction of inspired oxygen (PaO2 / FiO2) ratio in the new method group patients was improved compared to that in the conventional method; some differences, like PaO2 / FiO2 four hours after extubation, were statistically significant, however (p value = 0.0063). Conclusion: The new extubation method improved some respiratory parameters and thus attenuated oxygenation complications and amplified oxygenation after extubation. [ABSTRACT FROM AUTHOR]

Background: Ulcerative colitis is an inflammatory chronic disease which is believed to be a multi organ condition. The prevalence of ulcerative colitis is reportedly increasing in Iran presenting with the same clinical characteristics as in developing countries. Pulmonary manifestations of ulcerative colitis are increasingly reported. In this study, we investigated the incidence of bronchial hyper-responsiveness (BHR) in ulcerative colitis (UC) patients. Materials and Methods: Fifty-one UC patients with definite diagnosis referred to Shariati Hospital, Tehran, Iran, were selected to be evaluated with methacholine challenge test from October 2010 to October 2011. Patients were compared for their methacholine test outcome and its association with age, sex, diagnosis time, and disease activity. Results: The median age was 41 (range 15 to 65) years. The median time of diagnosis was 7 (range <1 to 16) years. Forty-five percent were females, 18% had active disease and 13% had comorbidity. Nine percent of patients with UC had abnormal PFT in our study. Three cases (5%) had bronchial hyperresponsiveness that was not correlated with sex, age, time of diagnosis, or disease activity. Conclusion: A small number of ulcerative colitis patients in our study had disturbed pulmonary function test which is in concord with the findings of other studies. However, higher rates of bronchial hyper-responsiveness have been reported in other studies. Confounding factors like cigarette smoking and medications, which were negative or minimal in our study, may influence the results. [ABSTRACT FROM AUTHOR]

Background: Using peak expiratory flow (PEF) as an alternative to spirometry parameters (FEV1 and FVC), for detection of airway reversibility in diseases with airflow limitation is challenging. We developed logistic regression (LR) model to discriminate bronchodilator responsiveness (BDR) and then compared the results of models with a performance of >18%, >20%, and >22% increase in ΔPEF% (PEF change relative to baseline), as a predictor for bronchodilator responsiveness (BDR). Materials and Methods: PEF measurements of pre-bronchodilator, postbronchodilator and ΔPEF% of 90 patients with asthma (44) and chronic obstructive pulmonary disease (46) were used as inputs of model and the output was presence or absence of the BDR. Results: Although ΔPEF% was a poor discriminator, LR model could improve the accuracy of BDR. Sensitivity, specificity, positive predictive value, and negative predictive value of LR were 68.89%, 67.27%, 71.43%, and 78.72%, respectively. Conclusion: The LR is a reliable method that can be used clinically to predict BDR based on PEF measurements. [ABSTRACT FROM AUTHOR]

Background: Asthma is a life-threatening disease that can cause death due to bronchospasm. In addition to clinical symptoms such as wheezing, acute paroxysmal dyspnea, chronic cough after exposure to cold air or cough after exercise, spirometry is also necessary for the diagnosis of asthma. The association between respiratory symptoms and a positive methacholine challenge test (MCT) is still controversial. The aim of this study was to determine the association between methacholine test results and respiratory symptoms and allergy. Methods: One hundred and forty-six patients with respiratory symptoms and normal baseline pulmonary function tests were enrolled in this cross-sectional study. The participants were divided into two groups according to their positive or negative response to MCT. The association between MCT and the clinical symptoms and allergy was later evaluated statistically. Results: Out of 146 participants of the study 59 (40.4%) were female and 87 (59.6%) were male. The mean age of the participants was 33.8±13.8 years. Sixty-one patients (41.8%) had positive results for the test. There was an association between a history of allergy, wheezing and age with positive MCT results. The other clinical signs had no association with the test. Conclusion: Methacholine challenge test is the best diagnostic test for ruling out asthma in patients with normal pulmonary function tests in whom we cannot definitely rule out asthma based solely on clinical symptoms. Nevertheless, in adults with a history of allergy, wheezing and also in patients below 30, the probability for a positive MCT is high. [ABSTRACT FROM AUTHOR]

World Health organization (WHO) has reported that out of more than 10,000 of 250,000 tuberculosis afflicted children die annually. Pulmonary tuberculosis is a research priority in our country, and diagnosing this disease especially in children who are known as the major transmitter of the disease is rather difficult. As a result, it was decided to conduct an overall assessment on this age group in order to determine the importance of the findings of chest radiography and skin test in diagnosing the disease. The present descriptive study was carried out based on the findings of a health plan in Fasa , a Iranian town, during 1995 and 1996, on 2 groups: first-grade students of Fasa elementary schools. Among 2263 students, 102 (4.5%) cases had a positive skin test. According to the radiographic findings, tuberculosis was reported in seven (6.9%) of them. The diagnosis of tuberculosis is more difficult in children; this is because taking sputum samples for laboratory examination is rather difficult especially in children lower than 10 years. In this group, diagnosis is made based on the symptoms like cough, weight loss, history of contact with a TB patient and other diagnostic procedures including chest radiographies and skin test. [ABSTRACT FROM AUTHOR]

Background: concordance and association between pulmonary tuberculosis and anthracosis was observed in the published literature. We conducted this study to evaluate the clinical and radiologic characteristics of patients with bronchoscopic evidence of anthracosis as well as the prevalence of pulmonary tuberculosis in patients with anthracosis. Methods: Included in the study were 150 consecutive patients with evidence of anthracosis as evidenced by bronchoscopy. Pulmonary tuberculosis diagnostic work up which included bronchoalveolar lavage, sputum smears and cultures, or histologic examination of lung biopsies was performed on all patients. Patients' clinical, pathological, and radiological findings were also recorded and analyzed. Results: A total of 88 men and 62 women, ranging in age from 42 to 92 years were included in the study. Dyspnea (38.7%) and productive cough (35.3%) were among the most common chief complaints. The abnormal bronchoscopic findings were seen most frequently in the right middle lobe bronchus. In 42 patients pulmonary tuberculosis was confirmed either bacteriologically (n = 32) or histologically (n = 10). CT scans of 26 patients were examined, of which the most frequent findings were consolidation and a reticular pattern. Pleural involvement was observed in 14 patients. Conclusion: Prevalence of pulmonary tuberculosis was higher among those with bronchial stenosis (P < 0.05). These findings have suggested that bronchial anthracosis, especially cases of localized anthracosis, in patients with bronchial stenosis and in those without a history of smoking or occupational exposure may be caused by tuberculosis. [ABSTRACT FROM AUTHOR]

Background: Acute hypoxemia is the main characteristic of acute respiratory distress syndrome (ARDS), which is one of the most critical complications of coronary artery bypass grafting (CABG). Given the dearth of data on acute hypoxemia, we sought to determine its prevalence and risk factors among post-CABG patients. Methods: This cross-sectional study was conducted on on-pump CABG patients in Tehran Heart Center in 2 consecutive months in 2012. The effects of arterial blood gas variables, age, gender, the duration of the pump and cross-clamping, the ejection fraction, the creatinine level, and the body mass index on the prevalence of hypoxemia at the cutoff points of ARDS and acute lung injury were assessed. Results: Out of a total of 232 patients who remained in the study, 174 (75.0%) cases were male. The mean age was 60.60±9.42 years, and the mean body mass index was 27.15±3.93 kg/m 2 . None of the patients expired during the current admission. The ratio of partial pressure arterial oxygen to the fraction of inspired oxygen (PaO 2 /FiO 2 ) 1 hour after admission to the intensive care unit (ICU), before extubation, and at 4 hours after extubation was less than 300 mmHg in 66.6%, 72.2%, and 86.6% of the patients and less than 200 mmHg in 20.8% 17.7%, and 30.2% of the patients, respectively. Among the different variables, only a heavier weight was associated with a PaO 2 /FiO 2 ratio of less than 300 mmHg at 1 hour after ICU admission and at 4 hours after extubation (P=0.001). A rise in the cross-clamp time showed a significant association with the risk of a PaO 2 /FiO 2 ratio of less than 200 mmHg at 4 hours after extubation (P=0.014). Conclusion: This study shows that hypoxemia following CABG is very common in the first 48 postoperative hours, although it is a benign and transient event. The high prevalence may affect the accuracy of the ARDS criteria and their positive or negative predictive value., (Copyright © 2015 Tehran Heart Center, Tehran University of Medical Sciences.)

Background: Following coronary artery bypass graft (CABG), patients are at high risk (3.2%-8.3%) for developing hospital-acquired pneumonia (HAP) with mortality rate of 24% to 50%. Some of routine features in patients undergoing CABG are similar to clinical criteria of Center of Disease Control (CDC) for diagnosis of pneumonia. This may lead to over-diagnosis of pneumonia in these patients., Objectives: This study aimed to assess the frequency of CDC criteria for diagnosis of pneumonia in patients undergoing CABG., Patients and Methods: This study was performed on CABG candidates admitted to post cardiac surgery Intensive Care Unit (ICU) in a six-month period. Patient's records, Chest-X-Ray, and Laboratory tests were assessed for PNU1-CDC criteria for HAP diagnosis. At the same time, a physician who was unaware of the study protocol assessed the clinical diagnosis. Then the results were compared with CDC criteria-based diagnosis., Results: Of total 300 patients, 9 (3%) met CDC criteria for diagnosis of pneumonia while none of the cases were diagnosed as HAP according to the physicians' clinical diagnosis. All nine patients were discharged with proper general condition and no need of antibiotic therapy. This study showed that loss of consciousness, tachypnea, dyspnea, PaO2 < 60 mm Hg, PaO2/FiO2 < 240, and local infiltration in 24 hours of operation were misleading features of CDC criteria, which were not considered in physicians' clinical judgment to establish the diagnosis., Conclusions: Our findings suggest that in Post-CABG patients, physicians could judge the occurrence of HAP more accurately in comparison to making the diagnosis based on CDC criteria alone. Expert physician may intentionally do not take some of these criteria into account according the patients' course of disease. Therefore, it is suggested that the value of these criteria in special group of patients like those undergoing CABG should be re-evaluated.

Background: Extubation is associated with the risk of complications such as accumulated secretion above the endotracheal tube cuff, eventual atelectasia following a reduction in pulmonary volumes because of a lack of physiological positive end expiratory pressure, and intra-tracheal suction. In order to reduce these complications, and, based on basic physiological principles, a new practical extubation method is presented in this article., Methods: The study was designed as a six-month prospective cross-sectional clinical trial. Two hundred fifty-seven patients undergoing coronary artery bypass grafting (CABG) were divided into two groups based on their scheduled surgery time. The first group underwent the conventional extubation method, while the other group was extubated according to a new described method. Arterial blood gas (ABG) analysis results before and after extubation were compared between the two groups to find the effect of the extubation method on the ABG parameters and the oxygenation profile., Results: In all time intervals, the partial pressure of oxygen in arterial blood / fraction of inspired oxygen (PaO(2)/FiO(2)) ratio in the new method group patients was improved compared to that in the conventional method; some differences, like PaO(2)/FiO(2) four hours after extubation, were statistically significant, however (p value=0.0063)., Conclusion: The new extubation method improved some respiratory parameters and thus attenuated oxygenation complications and amplified oxygenation after extubation.