Adenosine deaminase activity in bronchoalveolar lavage fluid in patients with smear-negative pulmonary tuberculosis

Tuberculosis [TB] remains a major health problem across the world and most commonly involves the lungs. Diagnosis of TB is based on finding acid-fast bacilli [AFB] in sputum or a positive sputum culture. The sensitivity of sputum smear is only 40-70% and it takes 4-8 weeks for sputum culture results. We decided to measure adenosine deaminase [ADA] activity in bronchoalveolar lavage [BAL] fluid and compare it with sputum and BAL fluid cultures. A descriptive study was performed at the Shahid Sadoughi Hospital in Yazd, from 2005 to 2006. Sixty-three patients suspected for pulmonary TB with negative sputum smear for AFB or had other indications for bronchoscopy, were included in the study. Then, fiberoptic bronchoscopy was done and BAL fluid was obtained from all patients. The study patients were divided into three groups as follows: Group 1: patients with positive sputum culture or BAL fluid culture for AFB who were considered as pulmonary TB group. Group 2: patients with negative results for TB, having lung diseases other than TB, [considered as non-tuberculous lung disease group]. Group 3: those without pulmonary disease and TB which considered as the control group. Mean ADA levels in BAL fluids were measured in these groups and then compared with each other. Sixty-three patients were enrolled in the study among which 15 cases [mean age:64.06 +/- 19.37 yrs] had pulmonary TB, 33 [mean age: 56.18 +/- 18.60 yrs] had pulmonary diseases other than TB and 15 cases [mean age: 42.13 +/- 21.45 yrs] were considered as controls. Mean ADA level in BAL fluid was 4.13 +/- 2.55 IU/L, 2.42 +/- 1.06 IU/L and 1.93 +/- 0.88 IU/L in TB group, non-tuberculous lung disease group and control group, respectively. This rate was significantly higher in the pulmonary TB group compared to the other two groups [p=0.00]. Using Roc curve with a cut-off value of 3.5 IU/L, the highest sensitivity [57%] and specificity [84%] were obtained in diagnosis of TB. The results showed that although ADA activity in BAL fluid of pulmonary TB patients was higher than those seen in other diseases, a negative test does not rule out pulmonary TB. Thus, more research is required to find more precise diagnostic methods in this regard

Serum C-reactive protein level in COPD patients and normal population

Serum C-Reactive Protein [CRP] is increased in patients with chronic obstructive pulmonary disease [COPD]. It is used as a predictive factor for extra-pulmonary complications determining the prognosis of disease. It has not yet been defined whether this increase is due to the disease itself or is accompanied by ischemic heart disease and cigarette smoking. Thus, we decided to measure the serum CRP level in COPD patients without ischemic heart disease and also in healthy subjects by enzyme-linked immunosorbent assay [ELISA] and then we evaluated its relation with cigarette smoking, severity of dyspnea, exacerbation episodes, severity of disease and use of inhaled steroids. A comparative-descriptive study was performed on 45 stable COPD patients in 2006. All understudy patients were males. The exclusion criteria included ischemic heart disease and other causes of CRP increase. The control group consisted of 45 healthy men. The samples were selected consecutively. The serum CRP was measured by ELISA [high sensitive]. Data were analyzed by SPSS software version 13. Mann-Whitney test showed significant difference between serum CRP levels of COPD patients without ischemic heart disease [52.49 ng/ml] and healthy subjects [28.51 ng/ml] [p=0.01]. There was a significant difference between the serum CRP level and the severity of dyspnea in COPD patients [p=0.04]. No significant difference was detected between CRP level and the severity of disease, exacerbation episodes and use of inhaled steroids. Moreover, there was no significant difference between serum CRP and cigarette smoking in COPD patients and healthy subjects. The results showed that COPD itself can increase the serum CRP without ischemic heart disease and cigarette smoking. Since CRP is known as a systemic inflammatory marker and a major factor causing extrapulmonary complications, we hope this marker be applied for follow-up of patients, evaluation of treatment methods and their efficacy

Endobronchial chondroid hamartoma

Hamartomas are benign lung tumors with an incidence of 0.025-0.32%. Endobronchial hamartoma is very rare. Only 1.4% of these tumors are endobronchial and the remaining are paranchymal. We report a 40-year-old man admitted for dyspnea and cough present for 8 years. He was a non-smoker and had been treated for asthma. Computed tomography of the lung showed a mass within the right main bronchus. Fiberoptic bronchoscopy showed translucent hyperaemic polypoid mass in the orifice of the right main bronchus. Microscopic examination of the specimen revealed chondroid hamartoma. Rigid bronchoscopy was performed for the patient and the lesion was removed by Nd: YAG laser. He recovered completely

Quality of life and related factors in patients with chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease [COPD] is a major cause of morbidity and mortality worldwide and is probable to be the third cause of death in the world in 2020. COPD is a highly prevalent, irreversible, and disabling disease with no definite cure which will stay with the patient for life affecting physical, mental and socioeconomic status as well as the quality of life. Therefore, creation of a positive perception of health and preserving the quality of life in these patients are of utmost importance and should be an essential goal in treatment and care of these patients. To reach this goal, first, the quality of life in these patients should be evaluated to assess the effects of mental, social and physical aspects of the disease on the life style of these patients. A descriptive case series study was undertaken. The understudy population comprised 80 COPD patients which were selected consecutively. They all filled out the standard respiratory disease questionnaire including: 1] Demographic specifications 2] the St George's Respiratory Questionnaire [SGRQ, includes symptoms, activities, and impact]. To collect the data, COPD patients who met the inclusion criteria were selected and questionnaires were filled through interviewing or selfreporting in 20 minutes. The questionnaire was scored from 0 to 100 points. The lower score indicated the better life quality and the higher score indicated deterioration. The collected data were analyzed using Microsoft Excel and SPSS 11.5 software. Mean and standard deviation of the SGRQ total score in understudy patients were 58.31 +/- 16.14 [63.09 +/- 19.52 for symptoms, 76.35 +/- 17.65 for activities and 46.41 +/- 17.79 for impact parts]. There were no significant differences between the SGRQ total score and sex, age, occupation and level of education. One sided variance analysis and Pearson's correlation coefficient demonstrated a significant difference between the total score and duration of disease [p=0.01], stages of disease [p=0.02] and also the causes of COPD [p=0.02]. Regarding the stages of disease, a significant difference was found between stages 2, 3 and 4 respectively according to SGRQ total score [p=0.02, P=0.04]. A significant difference was also seen between smoking and a combination of factors regarding the causes of the disease [p=0.02]. According to our study results, quality of life in COPD patients was moderate to low and this would deteriorate with duration of the disease and its severity. Also, high-risk occupations in addition to cigarette smoking deteriorate the quality of life considerably

Graves' disease as the initial manifestation of wegener's granulomatosis: a case report

Wegener's granulomatosis is a necrotizing granulomatous vasculitis with the prevalence of 3 in 100000. Pulmonary involvement is the most common form of disease manifestation detected in 95% of cases but onset of disease with other symptoms such as proptosis and hyperthyroidism is very rare. Our patient was a 29-year-old man who had been presented to the hospital with goiter, palpitation, fatigue, and proptosis in 1997. He underwent subtotal thyroidectomy and was treated with methimazole. After six years of treatment, he admitted to the hospital for the second time with arthritis, arthralgia, fever, hematuria and nodular pulmonary lesions. Open lung biopsy confirmed the diagnosis of wegener's granulomatosis

SICAM-1 as a serum marker for follow-up of pulmonary tuberculosis therapy

Background: Tuberculosis [TB] is one of the commonest infectious diseases of our era; it is the second cause of death due to infectious diseases after AIDS. Studies have shown the significant effect of leukocyte integrins such as LFA-1and ICAM-1 on the function of macrophages against TB bacilli; increasing their activity during the process of TB infection. The objective of this research is to evaluate the changes observed in serum levels of SICAM-1 in pulmonary TB patients that had received treatment

Materials and Methods: All new pulmonary TB cases that had not received any treatment, did not suffer from any kind of co-existing or underlying disorders such as hepatitis, sarcoidosis, lung cancer, HBV, HCV and HIV infections, chronic renal failure, cirrhosis, malnutrition, collagen vascular disorders and had not consumed immunosuppressive agents, were enrolled in this study. The SICAM-1 levels of the cases were measured by ELISA method before and 2 months after treatment with standard anti-TB drugs [Isoniazid, Rifampin, Ethambutol and Pyrazinamide] at the same time. T - test was used to compare the two sets of values of SICAM-1 levels before and 2 months after therapy

Results: A total of 28 patients; 23 [82.1%] male and 5[17.9%] female cases were enlisted .Meanwhile, 50% of the patients were Iranian and the remaining had Afghan nationality. All of them were sputum smear and culture positive for Mycobacterium tuberculosis. Regarding the extent of pulmonary involvement as shown on lung CT-Scan, 68% demonstrated diffuse pulmonary involvement. The mean SICAM-1 level before the initiation of treatment was 554.17 +/- 202.85 ng/ml. Considering age, sex ratio, ESR level, PPD test and severity of lung involvement, the SICAM-1 levels did not show any significant differences in different groups of patients. Among the patients enrolled in the study we were able to follow the seventeen patients [61%] who completed 2 months of treatment. The mean level of SICAM-1 before and after treatment in these patients were 573.9 +/- 204.4 and 481.2 +/- 103.2 ng/ml, respectively [P <0.05]

Conclusion: SICAM-1 is considered as one of the inflammatory mediators that undergoes fluctuations during TB disease; its level is very much related to the extent of lung involvement. Since the level of this marker declines after therapy, it could be used as a "Serum marker "in evaluating the therapeutic response observed during the follow- up. Abbreviations: SICAM: Soluble Intercellular Adhesion Molecule, ICAM: Intercellular Adhesion Molecule, LFA: Leukocyte Function Antigen