evaluation of diastolic hypertension in sleep overlap syndrome

Introduction: The overlap syndrome, consisting of obstructive sleep apnea hypopnea syndrome [OSAHS] and chronic obstructive pulmonary disease [COPD] is a major problem in COPD patients. OSHAS corresponds to the likelihood of systemic hypertension. The present study was aimed to evaluate the association between apnea-hypopnea index and diastolic blood pressure [DBP] in overlap patients

Materials and Methods: We conducted a cross-sectional study involving overnight polysomnography after measurement of resting diastolic blood pressure [DBP] in patients with overlap syndrome in Sleep Laboratory of Imam Reza Hospital, Mashhad, Iran from November 2010 to July 2012. Participants were divided into four subgroups regarding to their Apnea-Hypopnea Index [AHI] [AHI <5, AHI: 5-15, AHI: 15-30 and AHI >30]. Descriptive statistics included age, body mass index [BMI], OSA, Apnea-Hypopnea Index [AHI], DBP, and neck circumference

Results: Sixty participants ranged between from 46 to 82 years old were entered into this study. There was statistically significant difference in mean DBP among different AHI subgroups [80 +/- 0.50, 95 +/- 0.60, and 105 +/- 0.65, respectively] [P<0.001]. Additionally, there was statistically significant correlation between AHI and DBP [r= 0.60, P=0.01]

Conclusion: According to the findings of our study, DBP is an important cardiovascular concern in COPD patients with OSAHS and has a direct correlation with AHI

six-minute walk test [6MWT] for the evaluation of pulmonary diseases

The six-minute walk test [6MWT] is a well-tolerated test which reflects daily activities and can be easily used in clinical practice. The 6MWT provides information about functional capacity, response to therapy and prognosis across a range of chronic cardiopulmonary conditions. Moreover, the 6MWT is sensitive to the common therapies used for chronic obstructive pulmonary disease, such as pulmonary rehabilitation with supplemental oxygen, long-term use of inhaled corticosteroids and lung volume reduction surgery. Several studies have investigated the role of 6MWT in the evaluation of pulmonary disease and cardiac disorders. This article aimed to review the significance of 6MWT in pulmonary disease

Chronic asthma and gastro-esophageal reflux disease: the treatment plans

Gastro-esophageal reflux disease [GERD] regularly occurs when stomach acid moves up from the stomach into the esophagus. GERD might be associated with chronic asthma symptoms such as coughing and breathlessness. According to several studies on children and adults, GERD is proven to have a close relationship with asthma. Medication treatment via proton-pump inhibitors [PPIs], such as Omeprazole, H[2] receptor blockers [Ranitidine], and other antireflux medications, is appropriate for ameliorating GERD and asthma. Moreover, surgery is another useful approach to GERD and asthma treatment. In this regard, Nissen fundoplication [laparoscopic] is a principal surgery method. Medical and surgical antireflux therapies are recognized as effective methods in the treatment of GERD-associated asthma. Our review included studies that evaluated treatment of GERD-associated asthma. These studies accentuated the critical role of acid reflux suppression in relieving the patients suffering from a difficult to control asthma

correlation between the six minute walk test and spirometric parameters in patients with systemic lupus erythematosus

Introduction: Systemic Lupus Erythematosus [SLE] is an autoimmune disease affect nearly every organ system. Pulmonary involvement, which is a common manifestation of SLE, can remain undiagnosed if asymptomatic. This study aimed to evaluate the efficiency of spirometric findings in early detection of silent pulmonary involvement and examine its correlation with the six minute walk test in SLE patients

Materials and Methods: In this cross-sectional study fifty patients, who met the American College of Rheumatology criteria for SLE, were recruited from the outpatient rheumatology clinic at the Imam Reza Hospital of Mashhad between July 2013 and September 2014. First, a checklist including demographic information and previous medical documents was completed. Then, spirometry and 6MWT was performed to evaluate subclinical pulmonary involvement and assess patients' exercise capacity

Results: Based on the results of pulmonary function tests, patients were divided into two groups. A total of 40 patients with normal pattern were placed in one group and 10 patients with restrictive pattern in the other. The difference between SLE patients with and without abnormal spirometry were statistically significant in regard to anti-RNP positivity but total distance walked in six minute, was not significantly different between two groups [p=0.356]. Additionally, there were no significant correlations between 6MWD and FVC in SLE patients in the either group as determined by Pearson's correlation coefficient testing. [R=0.439,P=0.205 in SLE patients with normal spirometry and R=0.191,P=0.237 in those with abnormal pattern] Conclusion: Considering the impact of anti-U1RNP positivity with restrictive pattern on spirometry, it can be deemed as a pulmonary involvement predictor in SLE patients. However, lack of correlation between 6MWT and spirometric parameters is suggestive of restrictive lung involvement, which in turn, demonstrates a multifactorial basis for limited exercise capacity in patients with SLE. Thus, the application of the 6MWT as a measure of pulmonary function is called into question

comparison of HTLV-1 infection frequency in patients with or without tuberculosis

Introduction: To recognize the predisposing factors in tuberculosis as an endemic infection in Northeast province of Iran, this study was aimed to evaluate whether HumanT-lymphocyte type 1 [HTLV-I] as an immunosuppressive factor increases the risk of tuberculosis

Materials and Methods: A Case-control study was conducted in 278 tuberculosis patients from 2007 to 2010, in Mashhad, Iran. Tuberculosis has been diagnosed by gold standard tests like sputum culture, bronchoalveolar lavage [BAL] culture or cytology. For detection of HTLV-I antibody, Enzyme Linked Immunosorbant Assay method and western Blot as the confirming test were performed. Then 276 healthy cases were matched for gender and age

Results: The mean age of tuberculosis patients was 49.67 +/- 21.36 years and for control cases was 48.36 +/- 20.74. In patients group, 114 [41.6%] were male, 160 [58.4%] were female and in controls 123 [44.6%] were male and 153 [55.4%] were female. Pulmonary tuberculosis was presented in 84.2% of the patients. The frequency of HTLV-1 was 2.9% and 3.3% in patients and controls, respectively. HTLV-I frequency was higher in male patients and it increased by age

Conclusion: Regarding to this study, HTLV-I infection is not stand-alone sufficient for increasing the risk of tuberculosis

relationship between diaphragmatic movements in sonographic assessment and disease severity in patients with stable chronic obstructive pulmonary disease [COPD]

Introduction: Pulmonary hyperinflation in patients with chronic obstructive pulmonary disease [COPD] can increase the breathing rate and reduce diaphragmatic movements by pushing the diaphragms downward and limiting their movements; this, in fact, can affect the breathing process. The purpose of this study was to compare diaphragmatic movements in COPD patients and healthy ones and to evaluate the relation of diaphragmatic movements and COPD severity in patients

Materials and Methods: This cross- sectional study was performed in Ghaem hospital, Mashhad Iran. Twenty-five COPD patients [case group] were selected, based on the inclusion and exclusion criteria. The patients' demographic and clinical characteristics along with factors related to pulmonary function were recorded. Patients were referred for sonography after pulmonary evaluation. The status of the left portal vein or one of its branches at the end of a deep expiration and a deep inspiration was considered as a marker. Twenty-five healthy non-smoker subjects, who were matched with the patients in terms of age and sex, were studied as the control group for the comparison of sonographic findings of the diaphragms

Results: The current study included 25 healthy subjects and 25 COPD patients, with the mean age of 59.2 +/- 12 years; approximately 84% of the subjects were males. Evaluation of the rate of diaphragmatic movements by sonography showed the mean of 42.08 +/- 12.15mm and 73.28 +/- 15.19mm in the case and control groups, respectively, which showed a statistically significant difference between them [P=0.02]. Statistical analysis indicated the relationship between the rate of diaphragmatic movements with factors related to airway obstruction. However, no relationship was observed between the rate of diaphragmatic movements and the factors associated with pulmonary hyperinflation or air retention

Conclusion: The rate of diaphragmatic movements as a parameter for determining exercise capacity in COPD patients could help with a better understanding of activity limitations in these patients

Bronchial artery embolization for massive hemoptysis: a retrospective study

To assess the efficacy and safety of bronchial artery embolization in the treatment of massive hemoptysis. A retrospective study on 46 patients [26 males and 20 females] who were referred to the Razavi Hospital from April 2009 to May 2012 with massive hemoptysis and had bronchial artery embolization procedures. General characteristics of the patients including age, gender, etiology, and thorax computed tomograms, findings of bronchial angiographic, results of the embolization, complications related to bronchial artery embolization and clinical outcome during follow-up were reviewed. The etiology included previous pulmonary tuberculosis in 20 cases, previous tuberculosis with bronchiectasis in 16 cases, bronchiectasis in 6 cases, and active pulmonary tuberculosis in one case. No identifiable causes could be detected in three patients. Moreover, massive hemoptysis was successfully and immediately controlled following the embolization procedure in all patients. One patient developed recurrent hemoptysis during one month following the procedure and was treated by re-embolization. No major procedure-related complication such as bronchial infarction was identified. However none of the patientsexperienced neurological complications. Bronchial artery embolization is a safe and effective means of controlling massive hemoptysis and should be regarded as the first-line treatment for this condition