Methacoline challenge test as an evaluator of response to statins in bronchial hyperresponsiveness

3-hydroxy-3-methylglutaryl-CoA reductase inhibitors [statins], are effective serum cholesterol-lowering agents which also have anti-inflammatory properties. The objective of this study was to evaluate the effect of atorvastatin on bronchial hyperresponsiveness. Adult patients [age 14 to 65 years] with bronchial hyperresponsiveness [BHR] diagnosis based on the spirometry with methacholine challenge test were entered into the study. The study was conducted in the National Research Institute of Tuberculosis and Lung Disease. Patients were randomized to receive either atorvastatin 20 mg/day or placebo for 4 weeks. Spirometric parameters were determined at baseline and at completion of the study. Twenty two patients with the age of 32.95 +/- 10.30 years completed the trial. Changes in airway responsiveness categories [moderate to severe, mild, borderline, normal] after the intervention were not significant in atorvastatin group as in placebo group [p-value= 0.131 for atorvastatin group and p-value = 0.305 for placebo group]. Also, changes in methacholine solution number [different concentrations of methacholine] which caused at least 20% decrease in FEV1 were not significant between groups [p-value = 0.089]. Although we could not find a significant difference, the patients' fall in FEV1 in atorvastatin group was observed in higher concentrations of methacholine. Median before treatment versus after treatment in atorvastatin group was 1 versus 4 mg/mL, while those were 2 versus 1 mg/mL in placebo group. This study showed a better but not significant hyperresponsiveness control in the treatment group. The result might be presented more pronounced, if we could increase the sample size

Correlation between the pulmonary artery pressure measured in echocardiography and pulmonary artery diameter in the ct-scan of patients suffering from interstitial lung disease

Pulmonary hypertension [PH] is a significant cause of morbidity and mortality in patients suffering from pulmonary parenchymal diseases. Diagnosis of PH has always been a major clinical dilemma due to its non-specific clinical manifestations. However, diagnosing PH and determining its severity are essential for the prognosis and treatment planning in PH patients. This study aimed at evaluating the correlation between the pulmonary artery diameter [PAD] in the CT-scan and pulmonary artery pressure [PAP] in echocardiography of patients. PAD was evaluated in the CT-scan of 117 patients suffering from interstitial lung disease [ILD] and the correlation between PAD and PAP was studied. A receiver operating characteristic curve [ROC curve] which is indicative of the precision of the diagnostic test was drawn to find the cut off point for the MPAD representing PH. The area under the curve was also calculated in order to define the discriminative power of the test. PAP higher than 25 mmHg was considered as PH. PAD over 29 mm reported in the CT-scan for the diagnosis of PH in ILD patients had sensitivity of 63% and specificity of 41.5%. No significant linear correlation was found between PAD and PAP [P-value=0.17, r=0.15]. The area under the ROC curve was calculated to be 0.49 in the cutoff point of 29 mm for determining PH [CI 95%=0.38-0.60, P=0.89]. ROC curve showed a weak discriminative power. PAD had low sensitivity and specificity in the CT-scan for the diagnosis of PH. Therefore, we conclude that CT-scan alone is not helpful in finding PH cases and further examinations are required

Is mining the main cause of silicosis? case series

Silicosis is an irreversible progressive lung disease which leads to ultimate death. This study aimed to describe characteristics of individuals affected by silicosis, evaluate the prevalence of silicosis in miners and also introduce preventive policies. Cases with pathologic diagnosis of silicosis were retrieved from archive of pathology department of national research institute of tuberculosis and lung disease [NRITLD] during 2000-2009. All hematoxylin and eosin stained slides were reviewed by two pathologists independent of clinical and imaging findings. Occupational history, clinical information, imaging findings, history of associated disease, method of biopsy and pathologic diagnosis were reviewed. During 2000 and 2009, 29 cases had pathologic diagnosis of silicosis, 4 of them were excluded due to unavailable occupational history. The disease presented among patients in the age range of 22-80 years. The most common occupation was sandblasting while mining was in the second position. The male patients who were miners were old except for one who was a 28-year old car painter whose previous job was mining. Most sandblasters were young except one who was 55. The most prevalent radiologic finding was pulmonary nodules. Restrictive pattern was the most common finding in pulmonary function test [PFT]. Of patients, 28% had current tuberculosis. Transbronchial lung biopsy was the method of choice in 14 cases. The most prevalent pathologic finding was early silicotic nodules. Our study demonstrated that mining was not the main occupational history in our understudy cases. We also observed the change in the age range of patients suffering from silicosis which may be due to the prevalence of sandblasting and job demands in young patients. It is recommended that protective measures be applied not only in mining industries, but also in small workshops and studios. It is also necessary that working conditions in these workplaces be evaluated regularly by the occupational safety and health administration

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

Idiopathic bronchiolitis obliterans organizing pneumonia: case review

Bronchiolitis obliteans organizing pneumonia [BOOP] is characterized clinically by a subacute or chronic respiratory illness. The purpose of this study was to describe clinical and radiologic features of Idiopathic [cryptogenic] bronchiolitis obliterans organizing pneumonia. We retrospectively reviewed 11 patients with biopsy proven BOOP at Masih Daneshvari Hospital, for whom well documented clinical and radiographic data were available. The final diagnosis of BOOP was validated if the followings were present. 1] Negative sputum or bronchoalveolar lavage [BAL] analysis for Mycobacterium tuberculosis 2] Open lung biopsy [OLB] or trans-bronchial lung biopsy [TBLB] findings characteristic of BOOP. 3] Negative findings for systemic disorders or associated primary pulmonary lesions such as cancer. 4] Prompt response to steroid therapy. The mean age of patients with BOOP in this case series was 46.3 +/- 24.6 yrs. [range 32-70]; the male/female ratio was 7/4. The clinical pattern in BOOP presentation was more similar to classic sub-acute infectious process: dyspnea in 9 patients [81.8%], fever in 5 [45.4%], and cough in 6 [54.5%]. The symptoms were usually mild. Physical examination showed sparse crackles in 5 patients [45.4%] and wheezing in 7 [63.6%]. The most frequent radiologic patterns were ground glass appearances [63.6%] and diffuse infiltration associated with reticular pattern [27.2%]. In 6 patients chest images showed bilateral distribution. The clinical and radiological manifestation of BOOP in our patients did not differ from other reports. BOOP cases may present a distinct entity like pneumonia. Physicians in charge of these patients were all surprised of BOOP diagnosis by tissue examination. Trans- bronchial lung biopsy specimens along with strongly suggestive clinical and radiologic findings in many cases were adequate for making the diagnosis. We suggest that the diagnosis of BOOP must be considered in any immunocompetent patient with pneumonia with poor or no response to antibiotic therapy

Spirometric improvements with two commonly used spacers in asthmatic patients

Pressurized metered dose inhalers [pMDIs] are commonly used in patients with asthma. However, the need to coordinate inhalation with inhaler actuation means that they are not suitable for use per se. Spacer devices were developed to overcome some of the problems of pMDIs. Several types of holding chambers of different sizes are available in Iran. This study was designed to compare spirometric parameters between Asmyar and Damyar spacers in asthmatic patients. Materials and This was an observational comparative study. Patients with mild to moderate asthma were entered in this study. The ease of use, convenience, and portability of the mentioned spacers were evaluated using a visual analogue scale [VAS]. Lung function was assessed by using a portable spirometer [Spirolab Italy] and spirometric parameters of FEF50%, FEF25-75%, PEF, FEV1, FVC and FEV1/FVC were measured. Forty patients [25 females, 15 males] with a mean age of 43.10 +/- 12.99 years were studied. Mean +/- SD changes of FVC, FEV1, PEF, FEF25-75%, FEF50% and FEV1/FVC [as percentage of the predicted values] before and after using Asmyar were not significantly different from those of Damyar. However, patient satisfaction was significantly higher with Damyar [P<0.0001]. Lung response after using salbutamol with either Damyar or Asmyar spacers was not significantly different

Generalized lymphadenopathy: a case report of rosai-dorfman disease

Sinus histiocytosis with massive lymphadenopathy [SHML], Rosai-Dorfman Disease, is a rare histiocytic syndrome first described by Rosai and Dorfman, seen predominantly in childhood and early adulthood. Even though it is considered a benign disease, fatalities may occur due to cellular infiltrates of SHML. We report a 16-year-old boy with signs of polydypsia, polyuria, weight loss and generalized lymphadenopathy. He had been receiving corticosteroid following the diagnosis of histiocytosis X. Due to hyperglycemia, the patient was admitted with the primary diagnosis of diabetic ketoacidosis and medications were initiated. All paraclinical and immunologic examinations were negative. Axillary lymph node biopsy revealed the diagnosis of Rosai-Dorfman disease