Pulmonary function and methacholine challenge tests in patients with ulcerative colitis

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. 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. 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. 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

new method for extubation: comparison between conventional and new methods

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. 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. 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]. The new extubation method improved some respiratory parameters and thus attenuated oxygenation complications and amplified oxygenation after extubation.

Prevalence of tuberculosis in patients with anthracosis: study on 150 subjects

A probable 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. 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. 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. 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

Logistic regression model for prediction of airway reversibility using peak expiratory flow

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 delta PEF% [PEF change relative to baseline], as a predictor for bronchodilator responsiveness [BDR]. PEF measurements of pre-bronchodilator, postbronchodilator and delta PEF% 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. Although delta PEF% 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. The LR is a reliable method that can be used clinically to predict BDR based on PEF measurements