Diagnostic performance of F-18 FDG PET/CT in patients with cancer of unknown primary: additional benefit over CT-based conventional work up

Background: In the era of well-developed site-specific treatment strategies in cancer, identification of occult primary is of paramount importance in CUP patients. Furthermore, exact determination of the extent of the disease may help in optimizing treatment planning. The aim of the present study was to investigate additional value of F-18 FDG PET/CT in patients with cancer of unknown primary [CUP] as an appropriate imaging tool in early phase of initial standard work up

Materials and Methods: Sixty-two newly diagnosed CUP patients with inconclusive diagnostic CT scan of chest, abdomen and pelvis referring for F-18 FDG PET/CT were enrolled in this study. Standard of reference was defined as histopathology, other diagnostic procedures and a 3-month formal clinical follow up. The results of PET/CT were categorized as suggestion for primary site and additional metastasis and classified as true positive, false positive, false negative and true negative. The impact of additional metastasis revealed by F-18 FDG PET/CT on treatment planning and the time contribution of F-18 FDG PET/CT in diagnostic pathway was investigated

Results: Sixty-two patients with mean age of 62 [30 men, 32 women], PET/CT correctly identified primary origin in 32% with false positive rate of 14.8%. No primary lesion was detected after negative PET/CT according to standard of reference. Sensitivity, Specificity and accuracy were 100%, 78% and 85%, respectively. Additional metastatic site was found in 56% with 22% impact on treatment planning. Time contribution for PET/CT was 10% of total diagnostic pathway

Conclusion: Providing higher detection rate of primary origin with excellent diagnostic performance, shortening the diagnostic pathway and improving treatment planning, F-18 FDG PET/CT may play a major role in diagnostic work up of CUP patients and may be recommended as an alternative imaging tool in early phase of investigation

Smoking knowledge, attitude and behavior of child labor who live in Tehran during 2013-2014

Children and adolescent smoking is one of the most important health problems in the world. There is a major concern that child labor may generate a pseudo maturity syndrome, including smoking. The current survey focus on smoking behavior, knowledge and attitude of child labor are working in Tehran. The study adopted a cross-sectional design, based on a primary pilot descriptive cross sectional study, using GYTS self-administered questionnaire. 816 child labor, which were student of work labor schools or worked as child labor on Tehran parks and crossing roads, were randomly selected using multi stage cluster sampling. DATA analyzed using SPSS v.22 [IBM statistic] software and chi square test to compare the frequency of variables in different groups. 50.6% of our participants were boy and child laboring age varied from 11 to 17 years old. 18.6% of child labor had smoking experience [Confident Interval 95%=17.3-20.1]. 9.8% of them were current smoker [CI 95%=8.6-10.9] and 1.2% were current regular smoker [CI 95%=0.9-2.1]. Child labor smoking hazard knowledge was evaluated by considering the minimum and maximum score of 10 to 30. Results demonstrated that the mean score of knowledge, attitude and behavior were 17.1 +/- 6.2, 36.5 +/- 16.1 [range 15-45] and 46.1 +/- 3.0 [range 25-75], respectively. Considering to our findings, planning tobacco control program for these specific groups is required, aiming at preventing cigarette smoking by increasing the knowledge and correcting their attitude

Evaluation of maximum o[2] consumption: using ergo-spirometry in severe heart failure

Although sport-physiologists have repeatedly analyzed respiratory gases through exercise, it is relatively new in the cardiovascular field and is obviously more acceptable than standard exercise test, which gives only information about the existence or absence of cardiovascular diseases [CVDs]. Through the new method of exercise test, parameters including aerobic and anaerobic are checked and monitored. 22 severe cases of heart failure, who were candidates of heart transplantation, referring to Massih Daneshvari Hospital in Tehran from Nov. 2007 to Nov. 2008 enrolled this study. The study was designed as a cross-sectional performance and evaluated only patients with ejection fraction less than 30%. O[2] mean consumption was 6.27 +/- 4.9 ml/kg/min at rest and 9.48 +/- 3.38 at anaerobic threshold [AT] exceeding 13 ml/kg/min in maximum which was significantly more than the expected levels. Respiratory exchange ratio [RER] was over 1 for all patients. This study could not find any statistical correlations between VO2 max and participants' ergonomic factors such as age, height, weight, BMI, as well as EF. This study showed no significant correlation between VO[2 max] and maximum heart rate [HR [max]], although O[2] maximum consumption was rationally correlated with expiratory ventilation. This means that the patients achieved maximum ventilation through exercise in this study, but failed to have their maximum heart rate being led probably by HF-induced brady-arrhythmia or deconditioning of skeletal muscles

Assessing the performance of two clinical severity scoring systems in the ICU of a tertiary respiratory disease center

The aim of this study is to compare the performance of five applied general severity scoring systems and their ability to predict mortality rate for the intensive care unit patients: Simplified Acute Physiology Score II [SAPS II], Mortality Probability Model II at admission [MPM II[0]], at 24 hours [MPM II[24]], at 48 hours [MPM II[48]] and over time [MPM II[over time]]. These scoring systems have been developed in response to an increased emphasis on the evaluation and monitoring of health care services; and also making cost-effective decisions. In this historical cohort study, all of the scoring systems were applied to 114 patients and the predicted mortality rate and the Standardized Mortality Ratio [SMR] were calculated for them. Calibration of each model and discriminative powers were evaluated by using Hosmer-Lemeshow goodness of fit test and ROC curve analysis, respectively. The predicted mortalities were not significantly deviated from the main systems [SMR for SAPS II: 0.79, MPM II[0]: 1.10, MPM II[24]: 1.32, MPM II[48]: 1.08 and MPM[Over time]: 1.02]. The Hosmer-Lemeshow statistics had the least value for MPM II[48] [C=2.922, p-value=0.939]; and the discrimination was best for MPM II[24] [AUC=0.927] followed by SAPS II [AUC=0.903], MPM II[0] [AUC=0.899], MPM II[48] [AUC=0.848] and MPM II[over time] [AUC=0.861]. All five general ICU morality predictors showed accurate standardized mortality ratio. MPM II[24] had the best discrimination, MPM II[0] had the best SMR before 24 hours and MPM[over time] had the best SMR after 24 hours. Performance of MPM II and its ease of use make it an efficient model for mortality prediction in our study

Ventilator-associated pneumonia: evaluation of etiology, microbiology and resistance patterns in a tertiary respiratory center

Ventilator-associated pneumonia [VAP] has been reported as the most common hospital-acquired infection among patients requiring mechanical ventilation. This study aimed to determine the incidence of ventilator-associated pneumonia in a cardiopulmonary tertiary center, and to evaluate its etiology, resistance patterns, and outcome of admitted patients. In a retrospective study, patients admitted to the Masih Daneshvari Hospital, a tertiary cardiopulmonary center, were evaluated in a 7-month period. A total of 530 patients were admitted to the ICU out of which, 40 acquired VAP. Overall, 99 patients were evaluated [male 57, female= 42] including 40 VAP and 59 non- VAP cases. The incidence of VAP was estimated to be 7.5% in this unit. The underlying conditions included respiratory diseases [COPD, asthma, etc], and cardiac problems [post "coronary artery bypass graft" CABG, etc]. Also, patients in the thoracic surgery ward and those with renal, gastrointestinal, neurologic and other medical problems were evaluated. The patients were divided into two groups of VAP and non-VAP cases. The micro-organisms were recovered from the patients' bronchoalveolar lavage fluid. The most common micro-organisms recovered were Pseudomonas aeruginosa [17 cases] and Staph. aureus species [15 cases]. In VAP patients in whom S. aureus was recovered, 80 percent of species were methicillin-resistant [MRSA] but all were sensitive to Vancomycin. Moreover, resistance to two, three or four antibiotics was seen in 12, 10, and 5 patients, respectively, in whom P. aeruginosa was recovered. The prevalence of S. aureus in patients with respiratory problems was more than other groups [including MRSA species], but the prevalence of recovered P. aeruginosa was the lowest in respiratory patients, compared to other groups. Also the mortality rate in drug resistant S. aureus and P. aeruginosa groups were 42 and 47 percent, respectively. Length of stay for MRSA group was 80% and death rate was 50%. In P. aeruginosa group, there was a positive relationship between resistance to multiple drugs and mortality and also ICU stay. VAP is a common infection in ICU setting and certain interventions may affect its incidence. In our study, P. aeruginosa and S. aureus were more common in ICU patients. Pseudomonas species were associated with the highest mortality rate and were resistant to four antibiotics in the antibiogram testing. S. aureus species were more common in patients with underlying respiratory problems, compared to those with other conditions

Relationship between the severity of airway obstruction and inspiratory muscles dysfunction in COPD patients

COPD is known as the main cause of morbidity and mortality in the world. Morbidity in COPD patients is mainly due to the respiratory muscle dysfunction especially diaphragm and chest wall muscles. Respiratory muscle dysfunction is mostly seen in severe and progressive stages of the disease. COPD results in increased functional residual capacity [FRC]. In severe cases of COPD, respiratory muscle dysfunction and FRC raise lead to the deterioration of hyperinflation. In our study, 30 COPD patients [28 males, 2 females] referred to Masih Daneshvari Hospital were evaluated. All cases were studied with the exact same body plethysmography equipment and the same technician. The average age, height, weight and BMI of cases were 53 +/- 11 yrs,168.86 +/- 6.33 cm, 65.44 +/- 16.78 kg and 23.56 +/- 6.32, respectively. The mean FEV1 according to the GOLD criteria was in the range of moderate to severe. Hyperinflation noted characterized by RV and reverse RV/TLC, was clearly noticed in our study [RV=225.9 +/- 82.11, RV/TLC%= 195 +/- 34.49]. Based on our study results, there was a significant correlation between FEV1, hyperinflation [RV/TLC, RV], respiratory muscle function [PImax/P1] and respiratory time cycle Ti/Ttot .It should be mentioned that there was a significant correlation between PImax and Tension Time Index as well

Predictive accuracy of revised Geneva score in the diagnosis of pulmonary embolism

Revised Geneva score is a clinical prediction rule used in determining the pre-test probability of pulmonary embolism [PE]. It has been recently introduced and is independent of the doctor's experience applying the rule. This study aimed to evaluate the predictive accuracy of revised Geneva score in the diagnostic protocol of pulmonary embolism and its role in decreasing the need for pulmonary imaging studies. In this study, we evaluated the medical records of 242 patients suspected for pulmonary embolism who underwent CT scan of the lung as part of their diagnostic protocol from October 2007 to February 2009. Six patients were excluded from the study due to their indeterminate CT scan results. The mean age of patients was 58 yrs and 62% of patients were males. The overall prevalence of pulmonary embolism was 24%. By increased scoring, the clinical probability of pulmonary embolism increased as well [P=0.011]. According to the classification of revised Geneva score, clinical probability of pulmonary embolism was evaluated to be low in 25% of patients, intermediate in 72% and high in 2%. Prevalence of pulmonary embolism based on the CT scan results was 7.7% ranged [0.5-14.9] in the low probability category, 22.5% ranged [15.6-29.4] in the intermediate, and 50% ranged [0.01-0.99] in the high-probability category which were comparable with the rates reported in the derivation set except for the prevalence rate for high probability patients [9%, 27.5% and 71.7%, respectively]. The area under the ROC curve was calculated based on continuous scoring to be 0.675. Revised Geneva score had an acceptable predictive accuracy in low and intermediate-probability groups. We could not reach a conclusion regarding high probability patients due to the small number of such cases in this study

Respiratory disturbance index and severity of airway obstruction in COPD patients

Chronic obstructive pulmonary disease [COPD] is a common disease and concomitant occurrence with obstructive sleep apnea [OSA] has been reported in some studies. This coincidence can result in exacerbation of common complications like exacerbated hypoxemia, hyperpnea and right-sided heart failure. Thus, we decided to evaluate and compare respiratory disturbance index [RDI] and sleep apnea in COPD patients. For this purpose, 50 COPD patients with OSA were studied between 2003 and 2004. OSA criteria included obstructive apnea and clinical symptoms of snoring, sleep disorder and RDI >/= 5. The patients were divided in to two groups: group 1 consisted of 11 patients [22%] with FEV1/FVC<70 with the mean age of 36.18 +/- 14 and group 2 was included 39 patients [78%] with FEV1/FVC >/= 70 with the mean of 84.75 +/- 6.6%. RDI was compared between the two groups using independent sample t-test. Multiple regression analysis was also used for comparing other variables like height, weight, age, etc. The understudy patients were included 19 females [38%] and 31 males [62%] with the mean age of 53.7 +/- 14.8 yrs. There were statistically significant differences in RDI and height between the two groups [p=0.028 and p=0.00, respectively]. However, no significant difference was detected between the two groups in terms of weight and body mass index [BMI]. The possibility of concomitant occurrence of COPD and OSA should be considered due to co-occurrence of significant respiratory symptoms [like dyspnea, sleepiness, etc.] and assessed by adding RDI to important indices like height and so on

Possible effect of Chlamydophila pneumoniae on COPD exacerbation

Chlamydophila pneumoniae is one of the common causative agents of respiratory infections. The present study aims to find the role of Chlamydophila pneumoniae infection in infectious exacerbation of chronic obstructive pulmonary disease [COPD] Sixty-five nasopharyngeal swab specimens of COPD patients were studied using fluorescent antibody staining with chlamydia specific conjugated antibody and with fluorescent microscopes. Data were analyzed by using SPSS software, version 13. A total of 65 COPD patients [as defined by the American Thoracic Society], 53 [81.5%] males and 12 [18.5%] females were included in the study. Forty-six [70.7%] subjects had exacerbated COPD while 19 [29.3%] were stable COPD patients. We found 4 positive cases of chlamydophila infection [6.15%], 3 of which [2 men and 1 woman] belonged to the exacerbation group and 1 had stable COPD. Data analysis revealed that there was no significant correlation between chlamydophila infection and COPD exacerbation

Clinical pattern of idiopathic pulmonary fibrosis: a retrospective study

IPF is the most common form of interstitial lung disease. IPF is a clinico-pathological syndrome characterized by cough, exertional dyspnea, basilar crackles, a restrictive pattern on pulmonary function test [PFT] and honey comb pattern on HRCT. Since there are no exact data on IPF in Iranian patients and also the controversy that exist in this regard we decided to study the IPF cases in regard to epidemiologic, clinical features, radiologic manifestations and diagnosis in Masih Daneshvari Hospital during 1998-2001. This study was a descriptive retrospective study on files of IPF patients in Masih Daneshvari Hospital during 1998-2001. Although the total number of patients was 98, only 50 cases that had clinical and pathological findings compatible with IPF were included in the study. Twenty-seven [54%] were males and 23 [46%] were females. Mean age was 56.25 +/- 15.86 yrs. The most common clinical signs and symptoms were dyspnea [100%], cough [90%] and crackle [90%]. HRCT findings were abnormal in all patients. Eighteen percent were smokers and the most common occupational exposure was through agriculture. 82.2% of patients had restrictive pattern on PFT. Seventy percent of patients had transbronchial lung biopsy [TBLB], 26% had open lung biopsy [OLB] and 4% had video-assisted thoracoscopy [VATS]. Age of patients with IPF in our study is one decade lower than in Western countries. HRCT and TBLB assist significantly in the diagnosis of IPF and limiting the surgical procedures to only a limited number of cases

Ascorbic acid concentration in plasma and white blood cells of patients with bronchial asthma

Asthma is an inflammatory disease of the airways. Oxidants are of the important factors damaging the airways. Moreover, an inappropriate correlation exists between oxidants and antioxidants in asthma. Vitamin C is one of the major protective antioxidants of the airways. Thus, we evaluated the concentration of Vit C in plasma and white blood cells of asthmatic patients. A case-control study was performed on 50 asthmatic patients referred to Masih Daneshvari Hospital. Data were collected through the general information and 24h dietary recall questionnaires and then the effect of independent variables on plasma and WBC ascorbic acid concentrations was evaluated by statistical analyses using biochemical tests. Data showed that plasma and WBC ascorbic acid deficiency exists in 38% and 92% of asthmatic patients, respectively. There was a significant difference in plasma and WBC Vit C concentrations between case and control groups [p < 0.0001]. There was a positive significant correlation between the level of plasma ascorbic acid and dietary Vit C intake [p=0.0001]. The present study showed a relationship between asthma and ascorbic acid levels in plasma and in WBCs. More precise studies are recommended for better determination of asthma and vitamin C correlation

Comparison of clinic visits among children of smoking and non-smoking families

Complications of cigarette smoking are of the major obstacles of a society. Both active and passive smoking cause various forms of diseases in men, women and children. Since almost one third of the world's population are children under 14 years of age, preventing the unwanted health consequences of involuntary smoking can help in improvement of health as well as the health level of the society. In cooperation with the "Iran Statistics Center" and by using PPS method a number of families required for the study were selected among 22 districts of Tehran. After obtaining a consent, a questionnaire was filled out by a physician through interviewing the families randomly. In this study, 214 families were questioned out of which 129 had at least one smoker member in their family [60.2%]. A total number of 825 individuals were studied [including 270 men, 281 women and 274 children under the age of 14], out of which 87 men [32.2%], 42 women [14.9%] and overall 129 subjects [23.4% of the population over the age of 14 and 15.6% of the general population] were smokers. The mean number of visits to the physician by the children of all families was 3.7 +/- 1.8 per year. This number was 2 +/- 0.9 and 4.7 +/- 1.56 in the non-smoking and smoking families respectively [p=0.000]. Mean exhaled CO level of a non-smoker or passive smoker of a smoking family was 20.2 +/- 5.8; whereas this rate was 6.6 +/- 3.5 in a non-smoker member of a non- smoking family [p=0.000]. Comparison of the number of visits does not significantly indicate the disease-inducing role of passive smoking but only that these visits are more in families that smoke

Daily expenditure on cigarette smoking in Tehran

Smoking is the leading cause of preventable deaths worldwide. Since the price and expense of tobacco products are important factors relating to smoking and tobacco control, it is necessary to calculate the expense of daily smoking in order to enforce tobacco control programs. This study was done to assess the expense of daily smoking among smokers in Tehran. A cross-sectional study was done among a random population sample of 3026 smokers in different areas of Tehran. Data collection was done via WHO and IUATLD [International Union Against Tuberculosis and Lung Disease] questionnaires by questioning health-care workers. Finally data were analyzed by Chi-Square, Fischer's exact and logistic regression tests. Among 3026 participants, 2413 [80.9%] persons were male. The mean age of the population was 40 +/- 12.7 years. 49.2% of the population [1439 persons] had below diploma degrees and the maximum frequency distribution of occupation belonged to employees [36.7%]. The mean age of initiation of smoking was 21 +/- 8.19 yrs. and the mean number of cigarettes smoked daily was 16.81 +/- 10.61 cigarettes. 41.8% of population [1192 persons] had daily smoking expense of 2,510 to 4,500 Rials[*]. The mean was 4,680 +/- 388.78 Rials. In evaluation of daily smoking expense according to gender, over 6,500 Rials daily expenditure was more frequent among men [20.1%] in comparison with women [13.5%] [P=0.000]. Persons with daily income of less than 50,000 Rials, spent 9.3% of it for smoking. Because of the low price of cigarette in Iran, there is huge expenditure on smoking. Therefore, it is recommended to pay special attention to economical strategies in tobacco control programs and to coordinate with WHO Framework Convention on Tobacco Control [FCTC]

Pulmonary function and lung radiography of rockwool exposed workers

Synthetic fibers of rockwool are deciphered from Basalt stone. Chemical, physical and biological similarities with asbestos detain scientists to consider effects and complications caused by rockwool in lung. This historical cohort research was designed to state impact of rockwool on radiographic findings of lung and its spirometric changes. Encountered group, "Iran Rockwool Factory" was selected by simple random sampling technique and matched with comparison group, "Minoo Confectionery Factory", regarding age and cigarette smoking. Medical and occupational histories, clinical examinations and all spirometries were carried out in health centers of the two factories. Chest x-ray was taken for all subjects of the two groups. All data were gathered and registered in designed questionnaires. Although a significant discrepancy existed in dyspnea, non cardiac chest pain and wheeze, there was not any statistically significant difference in radiographic findings and spirometric parameters between the two groups. We do not have enough evidence to support the adverse effects of rockwool on respiratory function and significant observable radiographic changes in chest x-ray

Pulmonary carcinoid tumor

Pulmonary carcinoid tumor is a low-grade malignant neoplasm comprised of neuroendocrine cells. The aim of this study was to determine the clinical features; radiological and bronchoscopic findings, as well as treatment in patients. Material and Method: The hospital records of 21 patients with pulmonary carciniod tumor, who admitted to NRITLD between 1995 and 2001, were evaluated. 19 patients had typical and 2 had atypical carcinoid tumor. Male to female ratio was 1.1. The mean age