evaluation of diastolic hypertension in sleep overlap syndrome

Introduction: The overlap syndrome, consisting of obstructive sleep apnea hypopnea syndrome [OSAHS] and chronic obstructive pulmonary disease [COPD] is a major problem in COPD patients. OSHAS corresponds to the likelihood of systemic hypertension. The present study was aimed to evaluate the association between apnea-hypopnea index and diastolic blood pressure [DBP] in overlap patients

Materials and Methods: We conducted a cross-sectional study involving overnight polysomnography after measurement of resting diastolic blood pressure [DBP] in patients with overlap syndrome in Sleep Laboratory of Imam Reza Hospital, Mashhad, Iran from November 2010 to July 2012. Participants were divided into four subgroups regarding to their Apnea-Hypopnea Index [AHI] [AHI <5, AHI: 5-15, AHI: 15-30 and AHI >30]. Descriptive statistics included age, body mass index [BMI], OSA, Apnea-Hypopnea Index [AHI], DBP, and neck circumference

Results: Sixty participants ranged between from 46 to 82 years old were entered into this study. There was statistically significant difference in mean DBP among different AHI subgroups [80 +/- 0.50, 95 +/- 0.60, and 105 +/- 0.65, respectively] [P<0.001]. Additionally, there was statistically significant correlation between AHI and DBP [r= 0.60, P=0.01]

Conclusion: According to the findings of our study, DBP is an important cardiovascular concern in COPD patients with OSAHS and has a direct correlation with AHI

Spirometric parameters: hemodialysis compared to peritoneal dialysis

Introduction: Renal failure affects the mechanical and the ventilatory function of the lungs. A few studies have evaluated the ventilatory and pulmonary function in dialysis patients. The present study aimed to compare pulmonary function test [PFT] results in patients undergoing hemodialysis [Hd] and peritoneal dialysis [PD]

Materials and Methods: We conducted a cross-sectional study on 50 patients with hemodialysis [HD] and 50 cases with PD who underwent PFT in Ghaem and Imam Reza Hospital, Mashhad, Iran from November 2010 to July 2012. Spirometric parameters including forced expiratory volume in 1s [FEV1], FEV1/forced vital capacity [FVC], forced expiratory flow 25-75% [FEF] and peak expiratory flow [PEF] were compared between the two groups of patients

Results: Approximately 68% of the HD patients, 66% of the PD patients, and 67% of all the studied cases showed a normal spirometric pattern. Moreover, there were no significant differences between the two groups considering the mean of the a forementioned spirometric parameters[restrictive ,obstructive pattern] [P=0.969]. However, an insignificant inverse correlation was observed between the duration of dialysis with FEV1 [r=0.381, P=0.008], FVC [r=-0.298, P=0.04], FEF 25-75% [r=0.43, P=0.003], PEF [r= 0.349, P=0.02] and FEV1/FVC [r=-0.363, P=0.01,] in the HD patients and between the patients' age with FEV1/FVC [r=0.03, P=0.02] in the PD patients

Conclusion: This study showed no significant difference in pulmonary function in hemo and peritoneal dialysis,so according this result ,both of the dialysis had the same affect on the lung function

Oxidative stress in COPD, pathogenesis and therapeutic views

Chronic obstructive pulmonary disease [COPD], characterised by partially reversible contracture of small respiratory airways seems to be among leading causes of death in the world. COPD is characterized by inflammation, protease/antiprotease imbalance, genetic variability and oxidative stress. The latter refers to a condition in which oxidative agents overcome against antioxidants. In this review literature, the consequences of oxidative stress in COPD, such as systemic and pulmonary neutrophil influx, hypersecretion, dual and reciprocal effects with inflammatory contributors and systemic manifestations are discussed. In addition, a review of oxidative stress biomarkers as well as therapeutic strategies based on recent researches for antioxidant supplementation therapy is provided

Renal fractional excretion of sodium in relation to arterial blood gas and spirometric parameters in chronic obstructive pulmonary disease

Introduction: Arterial gas derangement could change urinary sodium excretion in Chronic Obstructive Pulmonary Disease [COPD] patients. There are very few and conflicting data in regards to the measurement of fractional excretion of sodium in COPD patients. The main aim of this study was to assess the relationship between renal fractional excretion of sodium [FeNa] with arterial blood gas and spirometric parameters in COPD

Materials and Methods: This study was a cross-sectional study performed on 40 consecutive stable COPD outpatients in 2 main general hospitals [Emam Reza, Ghaem] in Mashhad/Iran between 2011 and 2012. We investigated the relationship of renal FeNa with arterial blood gas parameters including HCO3, PH, PaCO2 and PaO2, and spirometric parameters. Analysis was done by SPSS v16 with a statistically meaningful p value of less than 0.05

Results: Mean age was 65.97 +/- 10.77 SD years and female to male ratio was 0.26. A renal FeNa of less than 1% was presented in 27% patients. There was a significant, positive relationship between renal FeNa and PaO2 [P=0.005, r=0.456]. The correlations between PaCO2, HCO3, PH and spirometric parameters were not seen [P>0.05], but there was a significant relationship between Urine Na and PaO2. Outstanding, it seems likely that kidneys of COPD patients are responsible for sodium retaining state particularly in the presence of hypoxemia

Conclusion: This study indicates that in COPD patients, PaO2 but not PaCO2 is related to renal FeNa which shows the probable role of hypoxemia on sodium output in COPD patients. However, some caution is needed for interpretation of the probable role of hypercapnia on sodium retention in COPD

[Evaluation of relationship between apnea-hypopnea index and body mass index in chronic obstructive pulmonary disease]

Chronic Obstructive pulmonary disease [COPD] is an important disease with high mortality rate worldwide. Nocturnal ventilatory changes and gas exchange disorder are common in COPD patients. These disorders do not correlate with bronchial spasm and airway resistance. Apnea - hypopnea Index [AH] represent the total Apnea and hypopnea in one hour. There are several risk factors for sleep Apnea. Obesity is the common causes. The aim of this study is the relationship between apnea-hypopnea index and body mass index in COPD patients. We assessed 40 COPD patients with sleep disorder in sleep laboratory. Exclusion criteria were pneumonia, Ischemic heart disease, lung cancer, congestive heart failure, Diabetes mellitus, systemic hypertension, hypothyroidism, central respiratory disorders, sedative drugs and opium usage. Body mass index [BMI] and neck circumference were assessed. Next, in this cross-sectional study, patients were evaluated with total nocturnal polysomnography. AHI was recorded. The data were gathered and analyzed with standard statistical method. Median BMI, AHI were 30.77 +/- 5.85110 and 15.05 +/- 16.50571 respectively. No significant correlation was found between BMI and AHI. There were no correlation between increasing weight and apnea - hypopnea in COPD patients. Thus, in Iranian population, sleep apnea may be occur in higher level of BMI

[Investigation of diagnostic values of hsCRP in pleural fluid for differentiation tuberculosis and malignant pleural effusion pulmonary and TB research center]

Pleural effusion is one of the most common and important complications in pulmonology. When the absorption of pleural fluid is less than its secretion, effusion happens and diagnosis between TB and malignant pleural fluid is important. C reactive protein with high sensivity[hsCRP] is secreted by tissue when inflammations is present. The aim of this study was hsCRP evaluation could help to differentiate between TB and malignant pleural effusion. 100 patients with TB or Malignant pleural effusion who referred to Emam Reza hospital, Mashhad in 2009 underwent thoracocentesis; then hsCRP with photometry methods were analyzed. All data were analyzed by SPSS 11 and cutoff point for hsCRP with ROC curve was found. Mean age was 53.41 years 19.63 SD. Mean concentration of hsCRP was 9.53 [mg/lit] with SD 5.78 [mg/lit]. hsCRP concentration in TB group was 13.6 +/- 5.6 and in malignant pleural effusion group was 6.00 +/- 3.93 [mg/lit]. They had significant different with statistical analysis [P<0.001]. Sensitivty of hsCRP to differentiate between TB and malignancy with cutoff point of 8.35[mg/lit] is 92% and specificity is 78%. They had significant different with statistical analysis [P<0.001]. hsCRP cloud help us to differentiate between TB and malignant pleural effusion

Evaluation of the clinical features, diagnostic procedures and mortality of acute pulmonary thromboembolism

Acute pulmonary Thromboembolism from deep venous thrombosis is an extremely important cause of morbidity and mortality. The aims of this study were evaluation of clinical features, diagnostic approaches and especially, mortality of pulmonary thromboembolism. In this descriptive study, 142 patients with thromboembolism evaluated from 2003 to 2007 at Internal Medicine Department, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. This study was approved by the local ethics. Demographic characteristics, diagnostic approaches and mortality of pulmonary thromboembolism recorded. Data analyzed with Spss 11/5 software. In 142 patients, dyspnea 80/3%, chest pain 38/7%, cough 31/7%, fever 30/3%, hemoptysis 18/3%, deep vein thrombosis in right lower limb 20/4%, deep vein thrombosis in left lower limb in 17/6% were recorded. Among 142 patients, mortality was seen in 25 cases. The results of this study are the same as others, in spite of fever that is the fourth manifestation. Longstanding bed rest is the most risk factor for pulmonary thromboembolism. So this risk factor is preventable. Lung perfusion and Doppler sonography were diagnostic. Unfortunately, mortality in our study is more than other studies and it is estimately, doubled

Mediastinal hemangioma: a case report

Mediastinal hemangioma is a very rare tumor. It may occur at any age but the cavernous form shows a predilection in children and adolescents. Mediastinal hemangioma was diagnosed in a 15-year-old boy from Afghanistan. Cough and neck swelling were his chief complaints. Chest x- ray and CT-scan showed mediastinal widening and anterior mediastinal mass. After cervical biopsy, anterior cervicomediastinal surgery was performed. Pathological examination of the lesion revealed a mediastinal hemangioma