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

Spirometric parameters: hemodialysis compared to peritoneal dialysis

Introduction: Renal failure affects the mechanical and the ventilatory function of the lungs. A few studies have evaluated the ventilatory and pulmonary function in dialysis patients. The present study aimed to compare pulmonary function test [PFT] results in patients undergoing hemodialysis [Hd] and peritoneal dialysis [PD]

Materials and Methods: We conducted a cross-sectional study on 50 patients with hemodialysis [HD] and 50 cases with PD who underwent PFT in Ghaem and Imam Reza Hospital, Mashhad, Iran from November 2010 to July 2012. Spirometric parameters including forced expiratory volume in 1s [FEV1], FEV1/forced vital capacity [FVC], forced expiratory flow 25-75% [FEF] and peak expiratory flow [PEF] were compared between the two groups of patients

Results: Approximately 68% of the HD patients, 66% of the PD patients, and 67% of all the studied cases showed a normal spirometric pattern. Moreover, there were no significant differences between the two groups considering the mean of the a forementioned spirometric parameters[restrictive ,obstructive pattern] [P=0.969]. However, an insignificant inverse correlation was observed between the duration of dialysis with FEV1 [r=0.381, P=0.008], FVC [r=-0.298, P=0.04], FEF 25-75% [r=0.43, P=0.003], PEF [r= 0.349, P=0.02] and FEV1/FVC [r=-0.363, P=0.01,] in the HD patients and between the patients' age with FEV1/FVC [r=0.03, P=0.02] in the PD patients

Conclusion: This study showed no significant difference in pulmonary function in hemo and peritoneal dialysis,so according this result ,both of the dialysis had the same affect on the lung function

Lipid profile status in mustard lung patients and its relation to severity of airflow obstruction

Introduction: Chronic obstructive pulmonary disease [COPD] secondary to sulfur mustard gas poisoning, known as mustard lung, is a major late pulmonary complications in chemical warfare patients. Serious comorbidities like dyslipidemia are frequently encountered in COPD. The aim of this study was to measure the serum lipid profile and evaluate the relation of lipid parameters with the severity of airway obstruction in mustard lung patients

Materials and Methods: Thirty-six non-smoker mustard lung patients with no history of cardiovascular disease, diabetes mellitus, and dyslipidemia were entered into this cross-sectional study. Control group consisted of 36 healthy non-smoker men were considered in this study. Serum lipid profile was performed in the patients and the controls. Spirometry was done in mustard lung patients

Results: The mean age of the patients was 47 +/- 6.80 SD years. The mean duration of COPD was 18.50 +/- 7.75 SD years. There were statistically significant differences in mean serum triglycerides and total cholesterol levels between patients and controls [P=0.04 and P=0.03, respectively].The mean levels of lipid parameters were not statistically significant different among the 4 stages of COPD severity [P>0.05]

Conclusion: The current study revealed that the serum levels of triglycerides and cholesterol are elevated in mustard lung patients compared with the healthy controls. Since lipid profile abnormalities are considered as a major risk factor for cardiovascular disease, especial attention to this matter is recommended in mustard lung patients

Renal fractional excretion of sodium in relation to arterial blood gas and spirometric parameters in chronic obstructive pulmonary disease

Introduction: Arterial gas derangement could change urinary sodium excretion in Chronic Obstructive Pulmonary Disease [COPD] patients. There are very few and conflicting data in regards to the measurement of fractional excretion of sodium in COPD patients. The main aim of this study was to assess the relationship between renal fractional excretion of sodium [FeNa] with arterial blood gas and spirometric parameters in COPD

Materials and Methods: This study was a cross-sectional study performed on 40 consecutive stable COPD outpatients in 2 main general hospitals [Emam Reza, Ghaem] in Mashhad/Iran between 2011 and 2012. We investigated the relationship of renal FeNa with arterial blood gas parameters including HCO3, PH, PaCO2 and PaO2, and spirometric parameters. Analysis was done by SPSS v16 with a statistically meaningful p value of less than 0.05

Results: Mean age was 65.97 +/- 10.77 SD years and female to male ratio was 0.26. A renal FeNa of less than 1% was presented in 27% patients. There was a significant, positive relationship between renal FeNa and PaO2 [P=0.005, r=0.456]. The correlations between PaCO2, HCO3, PH and spirometric parameters were not seen [P>0.05], but there was a significant relationship between Urine Na and PaO2. Outstanding, it seems likely that kidneys of COPD patients are responsible for sodium retaining state particularly in the presence of hypoxemia

Conclusion: This study indicates that in COPD patients, PaO2 but not PaCO2 is related to renal FeNa which shows the probable role of hypoxemia on sodium output in COPD patients. However, some caution is needed for interpretation of the probable role of hypercapnia on sodium retention in COPD

The assessment of health-related quality of life in scleroderma-interstitial lung disease

Introduction: Pulmonary involvement is the most common cause of mortality and disability in patients with systemic sclerosis and it significantly affects the quality of life in these patients. Therefore, early diagnosis and treatment of pulmonary involvement seems necessary in patients with SSc. In this study, we aimed to assess the health-related quality of life [HRQoL] in patients with Scleroderma-Interstitial Lung Disease [SSc-ILD] and its relationship with pulmonary function parameters

Materials and Methods: Considering the inclusion and exclusion criteria, 25 patients with SSc-ILD were enrolled in this cross-sectional study from April 2012 to June 2013. Full tests of lung function, including body plethysmography and diffusing capacity of the lungs for carbon monoxide [DLCO], 6-minute walk distance [6MWD], and pulse oximetry were performed. The HRQoL was assessed using St. George's and CAT questionnaires; also, dyspnea was evaluated for all the patients, using modified medical research council [MMRC] scale. Afterwards, the relationship between the total scores of HRQoL questionnaires and the severity of lung disease was analyzed, based on the recorded variables

Results: The mean age of the patients was 40.36 +/- 9.50 years and the mean duration of the disease was 7.16 +/- 4.50 years. A statistically significant inverse correlation was observed between 6MWD [r=-0.50, P=0.01], DLCO [r=-0.67, P<0.001], and CAT total score. In addition, there was a statistically significant negative association between CAT score and total lung capacity [r=-0.46, P=0.01]. Finally, a significant direct relationship was observed between the total scores of CAT and St. George's questionnaires [r=0.75, P<0.001]

Conclusion: The results of this study showed that CAT questionnaire is a suitable tool for assessing the quality of life in SSc patients; moreover, it is significantly related to the factors associated with pulmonary function. Therefore, the CAT questionnaire may be used to track pulmonary function in SSc patients

relationship between serum pro-brain natriuretic peptide [Pro-BNP] levels and pulmonary arterial hypertension [PAH] in patients with limited scleroderma

Introduction: Pulmonary arterial hypertension [PAH] is a late progressive sclerodermarelated complication, which can lead to right heart failure and cor pulmonale. Given that cardiac catheterization is a diagnostic method of choice for PAH, and considering the high risks of this method, the purpose of this study was to evaluate the relationship between serum Pro-Brain natriuretic peptide [Pro-BNP] Levels and PAH in patients with limited scleroderma

Materials and Methods: In this cross sectional study, during June 2011- Dec 2013, referring patients to two major educational hospitals, Mashhad- Iran, with scleroderma, who were afflicted with the disease for at least two years [or more], were enrolled in the study if they met the inclusion and exclusion criteria. All the patients underwent echocardiography to determine the pulmonary artery pressure [PAP]. Afterwards, the subjects were referred to a lung center for performing body plethysmography, carbon monoxide diffusing capacity [DLCO], and 6-minute walk test [6MWT]. Pro-BNP Serum level was determined using flourescent immune assay method

Results: The present study included 20 patients [18 female subjects] with the mean age of 43.28 +/- 9.56 yrs, and the mean pro-BNP level of 138 pg/ml. The logarithmic correlation between PAP values, Forced Vital Capacity /DLCO ratio, and pro-BNP level, which was measured using Pearson's correlation coefficient, showed a significant association among these variables[ respectively, r=0.76, P=0.001; r=0.677, P=0.011]. Moreover, the DLCO decrease was associated with increasing pro-BNP level, though this relationship was not significant

Conclusion: This study showed that there was a significant relationship between the serum levels of pro-BNP marker and increased PAP in the echocardiography, DLCO reduction, and FVC/DLCO increase. In fact, this serum marker can be used in patients with systemic scleroderma [SSc] to evaluate the status of PAH

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

Metabolic syndrome in chemical warfare patients with chronic obstructive pulmonary disease

Introduction: Sulfur mustard [SM], a toxic alkylating gas, can cause serious long-term pulmonary complications such as chronic obstructive pulmonary disease [COPD]. Metabolic syndrome [MetS] is one of the important comorbidities of COPD. This study was designed to evaluate the frequency of metabolic syndrome in Iranian chemical warfare patients [CWPs] with COPD

Materials and Methods: Thirty CWPs with a mean age of 46.93 +/- 6.8 were enrolled in this study. The following parameters were studied in: complete pulmonary function tests, health-related quality of life, serum triglycerides [TG], high density lipoprotein [HDL] and fasting blood sugar [FBS] levels. Additionally, 32 COPD patients and 56 healthy persons were considered as control groups who were matched to CWPs

Results: We found a statistically significant difference in the frequency of MetS between the COPD patients and the healthy control group [P=0.04]. Additionally, we observed a statistically significant difference in the mean HDL levels among these groups [P=<0.001]. In the CWPs, the frequency of MetS was significantly decreased in severe to very severe stages [P<0.001]

Conclusion: Our data indicate that metabolic syndrome is frequent in chemical warfare patients, and special attention to this condition in mild to moderate stages is recommended

impact of treatment on serum level of procalcitonin in patients with active pulmonary tuberculosis

Introduction: About one third of the world's population is infected with tuberculosis [TB] and each year, about 1.5 to 2 million people die from TB. Procalcitonin [PCT] is an inflammatory marker that its level has variable results. There are some discussions in the utilization of PCT as a diagnostic marker in active pulmonary TB. The aim of this study was to compare serum PCT before and after treatment in patients with pulmonary TB

Materials and Methods: This study was conducted on patients with pulmonary TB. Data were collected using a check list. The serum level of PCT was measured by ELISA test at the beginning and after six months of treatment. All data were analyzed using SPSS 16

Results: Forty-two patients with active pulmonary TB entered in this study. The mean age of the patients was 45.48 +/- 12.54 years and 54.8% of them were male. Most of the patients [59.5 %] were rural inhabitants. There was a family history of TB in 26% of patients. The most common symptom [45.2%] was cough. Mean PCT prior to treatment was 1.25 +/- 0.98 ng/ml. and 81% of the patients had PCT higher than 0.5 to 5. After treatment PCT level reduced significantly [P<0.001]. The mean erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP] before treatment were 45.88 +/- 21.87 and 7.16 +/- 3.98 respectively that were reduced significantly after treatment [P<0.001]. Neutrophil counts before treatment was 6221 +/- 3161 Cells per ml. and decreased statistically significant after treatment [P=0.01]

Conclusion: Our results showed that the PCT levels in pulmonary TB were high in active disease and reduced after treatment. PCT level may be used for follow-up as a discriminative marker between active and cured pulmonary TB and predict treatment response, although the PCT assay cannot be substituted for microbiological and pathological data

evaluation of pulmonary function tests in patients with polycystic ovary syndrome

Introduction: Recently a relation between female sex hormones and severity of asthma symptoms has been proposed. As a common endocrine dysfunction, polycystic ovary syndrome [PCOS] could significantly influence the level of sex hormones in PCOS patients. Regarding the possible role of sex hormones in airway physiology, the present study was conducted to survey the effects of PCOS on pulmonary function test parameters

Materials and Methods: In this cross-sectional study 30 recently diagnosed patients with PCOS without history of pulmonary disease were enrolled and 20 healthy women were considered as the control group according to their age, weight, and height. The patients and the controls underwent body plethysmography to measure pulmonary function tests

Results: The mean age of the patients and the controls were 29.43 +/- 7.8 and 30.0 +/- 7.6 years respectively. There were no statistically significant differences in all pulmonary function test parameters between the patients and the controls [p>0.05]. After dividing the patients into 2 groups based on their body mass index [BMI], BMI<25 and BMI>/=25, we found statistically significant differences only in expiratory reserve volume [ERV] and thoracic gas volume [p=0.01 and p=0.01, respectively].Moreover there was statistically moderate inverse correlation between BMI and ERV [r=-0.5, p=0.03]

Conclusion: Our results showed that pulmonary function test parameters are not different in PCOS patients comparing to healthy women. Only the deleterious effects of high BMI on pulmonary function can be occurred in these patients

diagnostic values of protein to lactate dehydrogenase ratio in serum and pleural fluid in exudate pleural effusions

Different etiologies of pleural effusion are diagnosed based on serum and plural fluid characteristics. The aim of this study was to assess and compare the serum and pleural fluid protein to lactate dehyrogenase [Pr/LDH] ratio in exudative pleural effusions. This study was conducted on 60 patients with exudative pleural effusion including: 20 cases with parapneumonic, 20 cases with Tuberculosis [TB], and 20 cases with malignancy. The serum and pleural Pr/LDH were measured and compared among 3 groups. The mean age of the patients was 55 +/- 19SD [years] and male to female ratio was 36/24. There was no statistically significant difference in mean age of the patients among 3 groups [p=0.08]. There were statistically significant differences in serum and pleural Pr. /LDH ratios among groups [p=0.04 and p= 0.1, respectively]. Additionally the comparisons of serum and pleural Pr. /LDH ratios between malignancy and tuberculosis groups were significant [p=0.02 and p=0.001, respectively]. The serum and pleural Pr. /LDH ratios were higher in TB group. The results of our study showed that serum and pleural Pr. /LDH ratio can be used in differentiating the etiology of exudative pleural effusion, but needs to be confirmed by larger study

case report of pegylated interferon and bronchiolitis oblitrans with organizing pneumonia

A 46-year-old woman presented with progressive dyspnea and cough. She was a known case of chronic hepatitis C [HCV] treated with pegylated [PEG]-interferon. Complete pulmonary studies and biopsy were compatible with bronchiolitis oblitrans with organizing pneumonia [BOOP] secondary to PEGinterferon. She discontinued PEG-interferon and was given a short course of steroids, after which the condition completely resolved. This report has shown that particular attention to possible side effects of PEG-interferon is necessary in the clinical practice.

Level of eosinophil cationic protein in sputum of chemical warfare victims

Considering fair response to inhaled corticosteroids and reports of severe air way hyper responsiveness in chemical warfare victims [CWV], a role for eosinophilic inflammation [i.e. asthma] was postulated. The objective of this study was to determine the presence of eosinophilic inflammation in CWV by evaluation of Sputum cellularity and eosinophil cationic protein [ECP]. Forty CWV and 15 control subjects entered this cross sectional study. Demographic data, dyspnea severity scale, spirometry results and 6 min walk test were determined. Sputum was collected with inducing by nebulizing hypertonic saline and analyzed for total inflammatory cell count, the cellular differential count and ECP level. Control group was normal volunteers with PC[20] more than 8 mg/ml. Mean +/- SD of eosinophil percentage [11.7 +/- 11.1%] and ECP level in sputum of CWV [46.1 +/- 19.5 ng/ml] were significantly more than control group. Regression analysis showed significant correlation between ECP level and percentage of eosinophils in sputum [r= +0.43, P< 0.01]. ECP level of CWV subjects with obstructive pattern did not show any significant difference from CWV with normal spirometry. ECP level in CWV subjects who revealed more than 12% improvement in forced expiratory volume in one second [FEV1] was significantly higher than CWV who had improvement less than 12% [P= 0.01]. BO and asthma as final clinical diagnosis of CWV did not show any significant difference of sputum ECP. Bronchial inflammation in different types of pulmonary complication of CWV is eosinophil dependent. ECP level of sputum in CWV could guide physician to select CWV who would respond to corticosteroids

Anemia in COPD patients and its relation to serum levels of erythropoietin

Although chronic obstructive pulmonary disease [COPD] is traditionally associated with polycythemia, its systemic inflammatory components can interfere with erythropoietin and result in anemia of chronic disease. We assessed the frequency of anemia and its relation to serum erythropoietin [EPO] levels and severity of the disease in a group of COPD patients. Eighty patients with the mean age of 66.48 +/- 11.55 years and mean forced expiratory volume in first second [FEV1] of 45.14 +/- 16.88% predicted were enrolled in this study. Severity of the disease was defined according to the global initiative for chronic obstructive lung disease [GOLD] guidelines. Hemoglobin and erythropoietin levels were assessed in all patients. Anemia of chronic disease was present in 13 of 80 patients [16%]. The mean serum levels of EPO were 59 +/- 203 [SD] micro/l and 70.3 +/- 255 [SD] micro/l in anemic and nonanemic COPD patients, respectively. There was no significant difference between the two groups [p=0.13]. A significant correlation was seen between hemoglobin and serum EPO in all COPD and nonanemic patients [r = - 0.86, p < 0.001 and r = - 0.28, p = 0.02]. No significant correlation was seen between hemoglobin and serum erythropoietin levels in the anemic group [r = 0.07, p = 0.82]. This study showed that anemia occurred relatively frequently in COPD patients. In addition to erythropoietin resistance, other factors are probably involved in the pathogenesis of anemia in these patients