Bronchial anthracosis: a potent clue for diagnosis of pulmonary tuberculosis

Occupational exposure to carbon, silica, and quartz particles are predisposing factors for bronchial anthracosis. In some cases anthracosis may be associated with mycobacterium tuberculosis. This study aims to investigate the clinical, radiographic, and bacteriologic findings in bronchial anthracosis patients and its association with tuberculosis, This is a prospective study conducted between 1998 and 2001, A total of 919 patients underwent diagnostic bronchoscopy for pulmonary diseases. Of these, 71 patients showed evidence of bronchial anthracosis, 32 [45.8%] males and 39 [54.2%] females, age range, 30-92 years. The distinctive clinical features, nature of bronchoscopic lesions, and radiologic findings were analyzed prospectively and summarized, Bacteriologic studies and results of laboratory examinations were also assessed, Forty-one [57,8%] patients had positive smears or cultures for mycobacterium tuberculosis. Of 71 patients with bronchoscopic evidence of pulmonary diseases, 30 had previous occupational exposure, and 41 stated no previous exposure, Cavitary lesions on chest radiography, positive purified protein derivative tests and high ESR were more prevalent in tuberculous patients than the others. Bronchial anthracosis was caused by active or previous tuberculous infection. Detailed examinations for the presence of active tuberculosis should be performed in patients with such bronchoscopic findings in order to prevent the spread of tuberculosis and to avoid unnecessary invasive procedures

[Relationship between sleep quality and quality of life in chemical warfare victims with bronchiolitis obliterans referred to Baqiyatallah hospital of Tehran, Iran]

Decrease of quality of life and undesirable sleep in individual with bronchiolitis due to chemical exposure reported in previous studies. This study was applied to assess relationship between sleep quality and quality of life in chemical warfare victims with bronchiolitis obliterans. In this descriptive correlative study, 93 chemical warfare victims with bronchiolitis obliterans referred to respiratory clinic of Baqyatallah hospital were selected by convenience sampling method. Quality of life and sleep quality was measuring the St George's Respiratory Questionnaire and Pittsburgh sleep Quality Index [PSQI]. Pearson correlation coefficient was showed a positive and significant correlation between sleep quality and quality of life. Also it was revealed significant relationship between psychological disorders and undesirable sleep quality [P<0.05]. The findings suggest there is need to improve sleep quality in this population in order to enhance their heathed-related quality of life

Honey with coffee: a new finding in the treatment of persistent postinfectious cough

Persistent postinfectious cough [PPC] is a cough that persists longer than 3 weeks or perhaps for many months after a common cold oran upper respiratory tract infection [URTI]. PPC has poor response to routine treatment modalities, so it can be a vexing problem for the patient and the physician alike. Our hypothesis was that honey and/or coffee have some beneficial effects in the treatment of PPC. The aim of this study was to evaluate the therapeutic effects of coffee and/or honey in the treatment of patients with PPC. This was a double blind randomized clinical trial, conducted on adult patients during a 6-year period from 2003 to 2009. Included in this study were 84 adult participants that had experienced PPC longer than 3 weeks. All of them had the history of several referrals to different physicians and despite treatment, their cough had persisted. Patients with other causes of chronic cough, or systemic disease or with abnormal routine laboratory tests were excluded. All the included 84 participants were distributed into three groups. For all the participants, a jam-like paste was prepared. Each 600 grams of the product consisted of "70 grams original instant coffee" in the first regimen, "500 grams of honey" in the second regimen and "70 grams of instant coffee plus 500 grams of honey" in the third regimen. These participants were told to dissolve 25 grams of the prescribed product in about 200 [CC] of warm water [under 60° Degree[C]], and drink this solution every 8 hours for one week. All the participants were evaluated before and at the end of the first week of their treatment, to measure the frequency of their cough. In addition they were under observation for the first month. Comparing the effectiveness of all three treatment regimens, this study found "honey with coffee" as the most effective treatment modality for PPC[P< 0.001]. Combination of honey and coffee can successfully treat the PPC at a short time. Thus, it is recommended for the treatment of PPC

Correlation between the degree of air trapping in chest HRCT and cardiopulmonary exercise test parameters: could HRCT be a predictor of disease severity?

The purpose of this study was to examine whether the degree of air trapping in high resolution computed tomography [HRCT] of patients with histories of sulfur mustard gas exposure during suspended full expiration correlated with various parameters of the cardiopulmonary exercise test as the gold standard for assessment of pulmonary function. In this analytic study 75 male patients, each with a history of sulfur mustard gas exposure, were investigated. Each participant underwent an incremental cardiopulmonary exercise test, pulmonary function test and arterial oxygen saturation for hemoglobin measurement. For HRCT examination, both lungs were divided into three parts [upper, middle, and lower] and in each part images were separately observed from the involved area point of view [<25% = 6/24; >/= 25%= >/= 6/24]. A total of 49.3% of the patients of >/= 25% or < 25% were 41.1 +/- 6.8 and 39.7 +/- 4.0 years, respectively [P=0.281]. In our study there was no significant difference in pulmonary function test findings [FEV1, FVC and FEV1/FVC] between the two groups. There was no significant correlation with air trapping of >/= 25% and any of the exercise test parameters. Also, no correlation was found between significant air trapping and exercise test finding in maximum exercise and anaerobic situations. No correlation was found between HRCT and cardiopulmonary exercise test findings. HRCT is neither pathognomic of the disease nor a good predictor of disease severity but it might be suggestive of mustard lung injuries

Conversion of tuberculin skin test in adults

Tuberculosis is a major public health hazard. The tuberculin skin test is one of the diagnostic tools in this regard. Since BCG vaccination is performed during infancy in Iran, a positive tuberculin skin test [PPD] may confuse the physician. For this reason we performed this study on adults. A descriptive study was performed on 433 soldiers between 2006 and 2007. Demographic data like age, level of education, family history of tuberculosis, place of residence, cigarette smoking, and chronic cough for more than 3 weeks, were collected from each patient. All patients had a history of BCG vaccination during infancy and its scar was detected in all of them. Purified protein derivative [PPD] test was performed. A 0.1 ml of 5TU PPD solution was injected intradermally into the volar face of the forearm and after 72h transverse diameter of the induration was measured in millimeters with a transparent ruler. Induration size greater than l0mm was considered a positive reaction. All patients were followed for one year and participated again in the second phase of PPD injection after one year. Data were analyzed by using SPSS software ver.13. Paired t-test and Chi-square test were used for statistical evaluation. All soldiers were male with a mean age of 23.2 +/- 1.8 yrs. Twenty-three cases [5.3%] had positive tuberculin skin tests after one year. The highest level of education was high school diploma in 288 soldiers [66.5%]. There was no significant correlation between the educational background and positivity of the tuberculin skin test [p = 0.219]. Twenty-two cases [5%] had a history of cigarette smoking which was significantly related to positive tuberculin skin tests [p=0.001]. There was chronic cough in 44 [10.6%] soldiers which did not have any significant correlation with tuberculin skin test results [p = 0.6]. This study showed that the prevalence of new cases of tuberculosis was more than 5% per year. Therefore, performing tuberculin skin test in BCG vaccinated adults is important

Health-related quality of life in chronic obstructive pulmonary disease: are disease-specific and generic quality of life measures correlated?

Generic and disease-specific health-related quality of life [HRQoL] questionnaires are commonly used in subjects with chronic obstructive pulmonary disease [COPD]. However, it is not clear whether generic and disease-specific measures should be used in parallel, as they focus on different aspects of life. This study aimed to investigate the association between two most commonly used generic and disease specific HRQoL measures: Medical Outcomes Study Short Form 36Item [SF-36] and St George's Respiratory Questionnaire [SGRQ]. Materials and In a cross-sectional study, 58 subjects were selected through non-randomized systematic sampling from all COPD patients admitted to the "Respiratory Clinic of Baqiyatallah Hospital" during 2006. Each subject completed both SF-36 and SGRQ forms. Spirometry was also performed for each patient. The correlations between SGRQ total score and its subscores, including symptoms, activity and impacts, and SF-36 total score and its subscores, including physical functioning [PF], role-physical [RP], bodily pain [BP], general health [GH], vitality [VT], social functioning [SF], role-emotional [RE] and mental health [MH], were assessed. No significant correlation was found between the total score or subscores of SF-36 and the total score or subscales of SGRQ [p>0.05]. The generic SF-36 and the disease specific SGRQ questionnaires assess different aspects of HRQoL in COPD patients and each should be used separately. The optimal approach appears to be the application of generic and disease-specific measures together, at least in the research setting. Further studies are recommended with larger sample size

socioeconomic status and quality of life in patients with chronic obstructive pulmonary disease

The quality of life in patients with chronic obstructive pulmonary disease [COPD] is associated with poor pulmonary function, respiratory symptoms, incapacity to perform daily activities, as well as mental and cognitive disorders. Although there exists some evidence regarding the effect of socioeconomic status on the quality of life in the general population and those with chronic diseases, research is scarce on this issue in COPD patients. This study aimed to investigate the association between income and quality of life in COPD patients. In a case-control study, 131 subjects were selected through systematic sampling from all COPD patients admitted to the pulmonology Clinic of the Baqiyatallah Hospital during the year 2006. Subjects were then divided into three groups based on their household monthly income as follows: group I [n=52], income < 2,000,000 Rials; group II [n=62], income between 2,000,000 and 3,000,000 Rials; and group III [n=17], income > 3,000,000 Rials. The groups were matched with regard to gender, age, educational background, marital status, comorbidity burden, and insurance coverage. Spirometric measures and quality of life [SF-36] were compared between the groups. The overall quality of life and physical health subscale were significantly different between the groups [p < 0.05]. Other parameters of SF-36 including physical functioning, role limitation due to physical problems, bodily pain, social functioning, general mental health, role limitation due to emotional problems, vitality, and mental health exhibited no significant difference between the groups [p > 0.05]. Quality of life and physical function of COPD patients are significantly correlated with their socioeconomic status. Future prospective studies are needed to find potential causative associations between the level of income and life quality in these patients

Association of depression with body mass index in patients with chronic obstructive pulmonary disease

There are several reports on the association between body mass index [BMI] and depression in the general population and in patients with some chronic diseases. However, despite the established effects of weight changes and depression on the outcomes of patients suffering from respiratory disorders, little data exists on the topic in relation to chronic obstructive pulmonary disease [COPD]. This study assessed the relationship between BMI and depression in patients with COPD. This cross-sectional study was conducted on 148 COPD patients admitted to the chest clinic of Baqiyatallah Hospital from October 2006 to February 2007. Patients were selected by systematic sampling. Demographic data [gender, age, marital status, monthly income and level of education], clinical data [symptoms, and medications], spirometric findings [VC, FEV1, FVC, FEV1/FVC, PEF, MMEF, predicted VC, predicted FVC, and predicted FEV1], depressive symptoms assessed by "Hospital Anxiety Depression Scale" [HADS], and body mass index [BMI] were recorded for each patient. Patients were divided into three groups. Group I had [GOLD] stage I; FEV1 > /= 80%, group II had GOLD stage II, 50% < /= FEV1 < 80% and group III had GOLD stage III, FEV1 < 50%. The two-by-two correlations between BMI, depressive symptoms and pulmonary function indices were evaluated separately. A significant association was found between BMI and depressive symptoms [r=0.429, P < 0.001], but not between pulmonary indices and BMI or the severity of depressive symptoms. There was a significant correlation between BMI and depressive symptoms indicating the important effect of mental health on weight in COPD patients. A multidisciplinary approach by a team of specialists from different disciplines is mandatory to address these factors in COPD patients

Clinical differentiation between resistant asthma and chronic bronchiolitis: testing a practical approach

Intractable asthma is a challenging clinical problem. This study was conducted to determine whether a subset of patients with Intractable asthma may be misdiagnosed and have a form of bronchiolitis instead and also to determine the effectiveness of macrolide therapy in these patients. Seventy six patients with Intractable asthma were re-treated with recommended maximal doses of oral prednisolone for 5 days, beclomethasone, cromolyn sodium, salbutamol and ipratropium bromide for 30 days. Thirty five patients were considered as unresponsive and constituted the study group. They underwent high-resolution CT [HRCT] scan following which they were offered with video-assisted thoracoscopic surgical biopsy. Group 1 [n=27] refused biopsy and each was treated with macrolide therapy, while Group 2 [n=8] underwent biopsy, and then received macrolide therapy. The patients were treated and followed for three months. The study group consisted of 27 patients, with a mean age of 46.9 +/- 11.1 years. The mean duration of time between the onset of symptoms and the start of this study was 8.1 years. In group 2, no patient had pathologic findings of asthma, and 7/8 had a form of bronchiolitis. There was significant improvement in dyspnea, cough and pulmonary function indices at the end of the 3-month in both groups [p<0.001]. Our results suggest that patients with Intractable asthma could be misdiagnosed and some of them have some forms of chronic bronchiolitis. We believe that any patient who does not respond to standard treatments for Intractable asthma should be evaluated with expiratory HRCT; those with significant air trapping should be considered for a course of macrolide therapy or biopsy for better identification of the underlying disease

Primary tuberculous abscess of the parotid gland: a case report

Chronic parotiditis is a rare disease of the parotid glands. Both infectious [e.g. tuberculosis] and non-infectious causes [e.g. sarcoidosis, autoimmune diseases, malignancy and duct stones] have been enumerated for this condition. Primary tuberculous parotiditis is a rare disease. It was diagnosed in a 20-year-old soldier after obtaining a biopsy and observing granuloma and caseous necrosis compatible with TB in histological examination of the specimen. Cultures of discharge and tissue were negative in regard to mycobacterium tuberculosis. Also, malignancy was ruled out by histopathological examinations. Therefore, the four drug anti-TB regimen was initiated. The patient was completely treated and there was no report of recurrence. The endemic condition of TB in developing countries such as Iran has increased the rate of extra-pulmonary TB. One of the extra pulmonary sites which is rarely involved in TB is parotid gland; presenting usually as chronic swelling or mass. Therefore, it is recommended to consider TB in the differential diagnosis of parotiditis and chronic swelling of this salivary gland especially in developing countries

therapeutic effect of gamma interferon in chronic bronchiolitis due to mustard gas

Bronchiolitis has been known as one of the pathological features of lung injuries in mustard gas exposed patients The purpose of this research was to evaluate the efficacy of interferon gamma-1b on the lung function in mustard gas exposed patients with bronchiolitis. In multicenter research interferon gamma-1b was effective in pulmonary fibrosis with unknown reason, but assessment of effect of interferon gamma-1b in the chemical injured patients has not so far been reported. Thirty six patients with bronchiolitis whose lung lesion had been diagnosed through the chest high resolution computerized tomography [HRCT] and pathological study were divided into two eighteen member case and control groups. The case group was treated for 6 months with a combination of 200 µg of interferon gamma-1b [given three times per week subcutaneously] and 7.5mg of prednisolone [given once a day], while the control group received their previous medications [prednisolone 7.5mg/day + salbutamol and beclomethasone spray PRN]. In the two groups, FEV1 did not have statistical differences at base line [49.3 +/- 2.9 and 48.7 +/- 4.1, respectively, p = 0.6], whereas after treatment the data for FEV1 showed a significant increase in the case group [66.3 +/- 5.4] when compared with those in the control group [57.3 +/- 8.6, p=0.001]. The findings of this study indicate that a 6-month treatment with interferon gamma -1b plus a low-dose of prednisolone is associated with the improvement of the lung function in mustard gas exposed patients with bronchiolitis