[Reliability of Persian Version of COPD Assessment Test and its correlation with disease severity]

COPD is a common obstructive airway disease without complete reversal and is characterized by dyspnea, cough and sputum production. In spite of improvements in therapeutic measures, a considerable number of patients fail to achieve the treatment goals. Discrepancy between obstructive parameters and clinical manifestations is a possible cause of treatment failure. COPD Assessment Test [CAT] is a standard method for evaluation of clinical aspects of COPD. This test has been translated into Persian. The aim of this study was to determine the reliability of Persian Version of CAT and its correlation with disease severity. In a prospective descriptive analytic study, CAT scores were determined in 100 COPD patients. After 1to2 weeks 34 patients completed the questionnaire for the second time to evaluate the reliability of Persian Version of the test. Severity of obstruction was assessed by spirometry. Based on Global initiative of Lung Disease [GOLD] criteria, patients were categorized into 4 groups. Correlation between CAT scores and disease severity was evaluated. The mean age of the patients was 62 +/- 5.2SD years. Cronbach's alpha index of the Persian Version of CAT was.0 879. The mean score was 25.85[ +/- 8.93] at the test and 25.67[ +/- 8.73] at the retest session. The intragroup reliability of the test and retest and also correlation among all questions were significant. [P<0.001] There was a significant correlation between categorization based on severity of obstruction and categorization according to the test score. Persian version of CAT is a reliable tool for COPD assessment and has a good correlation with disease severity associated with the obstruction of the airways

[Brain death and unusual findings in brain CT scan: a case report]

Many finding in neuroimaging of brain death can mimic other disorders such as subarachnoid hemorrhage [SAH]. Here, we report a case of brain death with a CT scan mimicking SAH. Our patient was a 28 year old man who was transferred to Tohid Hospital because of decreased level of consciousness after drug overuse and also cardiopulmonary arrest. Brain CT scan at the stage of brain death showed increased density at the basal arteries of circle of Willis and deep venous structures which was suggestive of SAH and to lesser degree CVT. Lumbar puncture [L.P] revealed no RBC and WBC in CSF, and D-Dimer [a sensitive test for CVT] was less than 0.5mg/dl. Therefore the findings in the brain CT scan of our patient were associated with extensive thrombosis in the basal arteries and deep veins. Brain CT scan of a brain dead patient can mimic subarachnoid hemorrhage and cerebral vein thrombosis. Therefore history, clinical findings and paraclinical measures such as CT scan and LP can be useful for proper diagnosis

[ comparison of serum CRP levels measured by a highly sensitive method in healthy subjects and asthmatic patients]

C- reactive protein [CRP] is a plasma protein which is a marker of inflammation. Recently it has been shown that the increased level of CRP is associated with increased risk of MI, IHD, DM and hypertension. There are plenty of published articles in regard to the role of CRP in the pathogenesis of COPD. Also a potential role for CRP in the pathogenesis of asthma has been proposed. The local inflammation is an established pathology in the asthma however, little is known about role of systemic inflammation. We compared serum levels of highly sensitive CRP between steroid inhaling asthmatic patients and non asthmatic healthy controls. This case-control study, based on standard criteria, included fifty known cases of asthmatic patients who met the inclusion criteria and fifty non asthmatic subjects. Serum levels of CRP were measured and compared with each other in both groups by ELISA method. All asthmatics were at the same stage of treatment. The mean age of the asthmatic patients was 46.9 +/- 9.8 years and that of control group was 44 +/- 14.35 years. Durations of pulmonary symptoms were <3 years in 20%, 3-5 years in 36%, 6-12 years in 24% and >13years in 20% of the patients. HS-CRP levels were significantly higher in asthmatic patients than in control patients [34.79 mg/dl versus 12.8 mg/dl respectively] [P=0.001]. HS-CRP levels had no significant relation with age, gender and duration of asthma. In asthma inflammation is not limited to airways and like COPD, evidence of systemic inflammation such as increased CRP can be detected

[Comparative efficacy of deferrioxamin and combination of deferiprone and deferrioxamine on echocardiographic indices in beta thalassemic patients]

Regular blood transfusions in beta thalassemic patients can lead to accumulation of extra iron in the body which may result in cardiac complications and death. Deferrioxamin [DFO] is the standard treatment for this condition but 12-8 hours subcutaneous [SQ] injection of this drug per day can cause local pain which together with lack of patients' compliance, it is necessary to use another drug to improve the condition of the patients. Deferiprone [DFP], is an approved drug for this purpose and removes iron from cells including cardiac muscle cells. The aim of this study is to compare efficacy of deferrioxamin with that of combined deferiprone and deferrioxamin on echocardiographic indices in beta thalassemic patients. In this randomized clinical trial 40 thalassemic patients who met the inclusion criteria of this study were divided into two equal groups. Controls group received SQ deferrioxamin for six days/ week and intervention group received deferrioxamin for three days/week and deferiprone orally for four days/week. Cardiac indices were measured and compared before and after the study. Mean values of the age of the patients were 15.6 +/- 5.1 and 14.1 +/- 6 years in the intervention and control group respectively. Right ventricle diameter [RVD] indices in control group was 18.7 +/- 7.6 and 20.8 +/- 6.6 mm before and after treatment respectively [P<0.05]. In the intervention group RVD indices were 19.5 +/- 5.8 and 18.0 +/- 4.7 mm before and after treatment respectively [P>0.05]. Other indices such as LVEDD, LVESD, aortic root diameter, EF and Fs of left ventricle and also indices of the heart valves revealed no significant differences between the two groups. We didn't observe any side effect of the drugs in the patients. We concluded combined therapy with 4 days DFP and 3 days DFO per week did not lead to cardiac complications and deterioration of echocardiographic indices

[ comparison of the clinical and para-clinical findings of antrachotic bronchitis patients with smoke induced COPD patients]

Previous studies in the developing countries showed that some of the presentations of chronic obstructive pulmonary disease [COPD] had been observed in the patients with no history of smoking or industrial or occupational exposure, but presence of anthracotic plaque had been reported in their bronchoscopy. The aim of this study was to compare the clinical and para-clinical findings in antrachotic bronchitis patients with those of smoke induced COPD patients. This was a cross- sectional study. Among 170 patients who had undergone bronchoscopy, 40 patients had antrachotic bronchitis and history of exposure to wood or other biomass smoke. The demographic characteristics, clinical and radiologic findings of these patients were compared with those of another 45 patients with diagnosis of smoke induced COPD [with exposure to wood an other biomass smoke], whose diagnosis had been based on clinical, spirometrical and radiological findings. Data were introduced into SPSS software and analyzed by means of descriptive statistics, Chi square, Fisher's exact test and t-test. Among patients with anthracotic bronchitis 70% were house wife, 75% female and 80% were from rural areas. But in COPD patients 40% were farmer, 84.4% men, and 57.8% were living in rural areas [P<0.05]. There were no significant differences in clinical findings such as cough, hemoptysis, sweating, and weight loss between the two lung infiltration [77/5%], right lung infiltration [67/5%], and reticular lung opacity [40%] and in COPD patients the most common finding were increased bronchovascular marking of the lung [100%], hyper airiation of lung [92.5%], and clacification of hilar lymph nodes [12.5%]. The most common findings and anthracotic plaques in bronchoscopy of anthracotic bronchitis patients were located in lobar bronchus [94.6%] and main bronchus [37.1%], but deformity was seen in 36.4% of them. Our results suggest that, in patients with clinical presentation of COPD who had not a clear-cut history of occupational or other risk factors, taking an exact history of exposure to wood or biomass smoke and also living in rural area as main risk factors for anthracotic bronchitis should be taken into consideration

[Comparison of sputum induction and bronchoalveolar lavage methods in diagnosis of pulmonary TB in patients with negative smear or without spontaneous sputum]

Sputum smear is recommended for microbiological confirmation of diagnosis of pulmonary tuberculosis. It has been reported that sputum induction is a safe and non-invasive method for confirmation of microbiological diagnosis of tuberculosis in smear negative patients. This study deals with the comparison of the value of sputum induction with that of bronchoalveolar lavage [BAL] in the diagnosis of TB. 56 patients suspected to have tuberculosis were admitted in the infectious ward of Tohid Hospital and entered into this study. Sputum induction and BAL were performed for two consecutive days according to a standard procedure. Smears obtained from induced sputum and BAL contents were stained for acid fast bacilli. Exclusion criteria were severe asthma or severe chronic obstructive pulmonary disease and pregnancy. Of 56 tuberculosis suspects with negative or absent sputum production, sputum induction led to positives smears in 8 [14.3%] patients [5 previously smear-negative, 3 unproductive] and BAL had positive results in 7 [12.5%] patients which revealed a significant difference [p = 0.000]. Sputum induction is safer, easier to accomplish and more sensitive than BAL technique for diagnosis of pulmonary TB. Our study suggests that sputum induction with aerosolized hypertonic saline is a useful technique for better detection of cases of tuberculosis in patients with negative smears or non-productive cough

Survey of normal indices of pulmonary function test by use of spirometry in the people of Kurdistan province

In the last three decades, spirometry has become one of the main diagnostic tools in pulmonology. But different nomograms in different references has brought about challenges. The aim of this study was to obtain normal ranges of spirometry parameters in the people living in Kurdistan province. This was a discriptive study, and included all 15 to 64 years old people of Kurdistan province. Sampling method was random and sample size encompassed 1589 people. Weight, height and demographic data of the subjects were recorded in check lists. Then spirometry was performed under standard conditions. Data were analyzed with SPSS soft ware using descriptive statistics including frequency, mean and standard deviation. The results of this study showed that the mean value for forced vital capacity [FVC] was 3.6 liters [CI=0.96%]; 4.33 Lit for men [CI=0.89%], and 3 Lit for women [CI=0.46%]. The mean FEV[1] values were 3.74 [CI=0.82] and 2.61[CI=0.53] for men and women respectively. According to the results of this study, it seems that the values for FEV[1] are as the same as those of other references, -but the values for FVC are lower. Therefore the normal ratio of FEV[1]/FVC increases, and should be considered while interpreting spirometry results