correlation of serum brain natriuretic peptide and lnterleukin-6 with quality of life using the chronic obstructive pulmonary disease assessment test

Objective:The aim of this study was to determine the levels of serum pro-brain natriuretic peptide [pro-BNP] and inter-leukin [IL]-6 in patients with stable chronic obstructive pulmonary disease [COPD] and to correlate these markers with health-related quality of life using the COPD assessment test [CAT]

Materials and Methods: Serum pro-BNP and IL-6 levels were measured in 82 patients with stable COPD. Serum pro-BNP and serum IL-6 levels, pulmonary function, and oxygen saturation (Sp02) were measured according to the Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage and CAT score. Also, the associations of both pro-BNP and IL-6 with the clinical parameters of patients were tested

Results: The serum levels of IL-6 [7.57 [5-11.16] pg/mL] and pro-BNP [120.55 [92.89-144.20] pg/mL] were higher with enhancing disease severity based on the GOLD classification [p = 0.034 and 0.068, respectively]. Also, serum levels of pro-BNP [120.55 [89.50-147.90] pg/mL] and IL-6 [6.68 [4.40-11.97] pg/mL] were increased in patients with high CAT scores [p = 0.004 and 0.017, respectively]. There was a significant positive correlation between plasma pro-BNP and IL-6 levels [r = 0.332, p = 0.002]

Conclusion:The results demonstrated that with increased severity of obstruction based on the GOLD criteria both IL-6 and pro-BNP were elevated. This increase in inflammatory markers was associated with a reduced quality of life and the severity of hypoxia. These findings indicated that lowering IL-6 and pro-BNP could be useful in the management of COPD patients

Pulmonary artery agenesis with bronchial asthma

Unilateral Pulmonary Artery Agenesis [UPAA] is a rare congenital anomaly during the 4[th] week of gestational age. It is defined as an absence of pulmonary parenchyma and its supporting artery. A 9-year-old girl was admitted to our hospital because of chronic cough. Chest examination showed a decrement in lung sound of right hemi-thorax with expiratory wheeze. Chest radiography [CXR] revealed a semi-opaque right hemi-thorax. Chest CT with intra-venous contrast demonstrated absence of the right pulmonary artery and lung parenchyma with hyper-inflated left lung and dextro-position of mediastinum. This case emphasizes that in patients with respiratory compliant and chronic cough CXR must be done to rule out similar diagnosis other than asthma

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

evidence of hyperinflation on chest x ray and its correlation with air flow obstruction in COPD patients

Introduction: According to the latest statistical and epidemiological studies, chronic obstructive pulmonary disease [COPD] will become the fourth leading cause of death in 2030 worldwide. Scientists are studying on methods to diagnose COPD in the patients in early stages, because it is a curable and preventable disease in early stages. In this study, evidences of hyperinflation on chest X- ray [CXR] of COPD patients were compared with pulmonary function test [PFT] finding

Materials and Methods: This cross-sectional study was done on 100 patients who were referred to the pulmonary clinic with symptoms of chronic cough and dyspnea. After taking history and performing physical examination, demographic information, history of smoking and bakery and frequency of exacerbations were recorded. Standard spirometry was performed and the severity of COPD was determined by GOLD [Global initiative for chronic Obstructive Lung Disease] staging. Additionally, they underwent CXR examination [PA and lateral]. Collected data were analyzed in SPSS ver. 18

Results: In this study, there were 79 male and 21 female. The patients, 64% of whom were urban and 36% were rural dwellers. There was significant correlation between forced expiratory flow [FEF] 50% predict with sterno-diaphragmatic angle and retro-sternal lucency [p=0.01, r=-0.26 and p=0.01, r=-0.25 respectively]. Also there were significant correlations between the forced expiratory volume/forced vital capacity [FEV1/FVC] with retro-sternal lucency [p=0.006, r=-0.27] and FEV1% predict with sterno-diaphragmatic angle [p=0.002, r=-0.31]

Conclusion: The study showed some evidences of lung hyperinflation on CXR which significantly associated with PFT parameters. Sternodiaphragmatic angle and retro-sternal lucency can be used to predict the severity of airway obstruction in patients with COPD, although the CXR finding cannot be substituted for PFT and CT data

significance of BODE [BMI, obstruction, dyspnea, exercise] index in patients with mustard lung

Chronic Obstructive Pulmonary Disease [COPD] secondary to sulfur mustard exposure, known as mustard lung, is an important late pulmonary complication. The BODE [Body mass index, Obstruction, Dyspnea, and Exercise] index has been established as a valuable tool for determining the adverse consequences of COPD. The aim of this study was to evaluate the role of the BODE index in patients with mustard lung. Eighty-two consecutively stable patients with mustard lung with all levels of severity were entered this study. The following parameters were recorded in all patients: standard spirometry, pulse oximetry, health-related quality of life, the BODE index. Additionally, the severity of COPD was determined by GOLD [Global initiative for chronic Obstructive Lung Disease] staging. The correlation of the BODE index with pulmonary parameters was determined. The mean age of the patients was 47.30 -/+ 7.08 SD years. The mean BODE index was 3.16 -/+ 2.25 SD. There was a statistically significant inverse correlation between the BODE index and oxygen saturation [r=-0.30, p=0.007]. Also a statistically significant correlation was found between the BODE index and quality of life [r=0.80, p=0.001]. The BODE index was not correlated with age of the patients and duration of disease. The results of this study showed that the BODE index is correlated with important clinical parameters and can be used in clinical practice

relationship between COPD assessment test [CAT] scores and severity of airflow obstruction in stable

COPD is a major cause of morbidity in smokers. The COPD assessment test [CAT] is a validated test for evaluation of COPD impact on health status. CAT is not a diagnostic test and pulmonary function test [PFT] still remains the most important diagnostic test. However, its predictive value for evaluation of disease impact is weak. The purpose of this study was to determine the relationship between CAT score and PFT in COPD patients. We evaluated 105 patients with stable COPD. Demographic data were obtained at baseline. Severity of airflow obstruction was assessed by standard spirometry and classified by the Global initiative for Obstructive Lung Disease [GOLD] criteria. Then, the impact of COPD on health status was assessed using CAT. The CAT scores were categorized into four groups. We statistically compared the relationship between CAT score, COPD stages, CAT groups and PFT. The mean age of patients and mean period of smoking [p/y] were 59.60 +/- 11.93SD and 35.43 +/- 15.33 SD yrs, respectively. The mean FEV[1%predicted] was 71.01 +/- 26.70SD.The mean CAT score was 19.61 +/- 8.07 SD. The correlation between the severity of smoking and GOLD classification was significant [p=0.006].There was a significant association between the FEV[1%predicted] and total CAT score [r= -0.55, p< 0.001]. The correlation between mean FEV[1%predicted] and mean score of CAT groups 1, 2, 3, and 4 was statistically significant [p<0.001]. The relationship between CAT score and FEV[1%predicted] suggests that CAT is linked to severity of airflow limitation and GOLD classification in stable COPD patients. Health status as measured by CAT worsens with severity of airflow limitation

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

Myelomatous pleural effusion

Multiple myeloma [MM] is a common hematologic malignancy. Pleural effusion is a rare presenting feature of multiple myeloma which carries a poor prognosis. Few cases of multiple myeloma with pleural involvement have been reported in the medical literature. We report a patient with MM diagnosed by cytologic examination of pleural fluid. Our patient was a 64-year old man with multiple myeloma who was receiving chemotherapy. He had developed dry coughs and exertional dyspnea about a month prior to the admission. Radiographic examination showed left pleural effusion with mediastinal shift to the opposite side. Diagnostic thoracentesis of pleural fluid was performed for the patient. Pathologic examination of pleural fluid showed plasmocytes and plasmablast type mononuclear cells with atypical nuclei, consistent with the diagnosis of pleural effusion due to multiple myeloma. In view of multiple etiologies of pleural effusion in malignant diseases, rare etiologies should also be considered in order to treat the effusion appropriately