Lipid profile status in mustard lung patients and its relation to severity of airflow obstruction

Introduction: Chronic obstructive pulmonary disease [COPD] secondary to sulfur mustard gas poisoning, known as mustard lung, is a major late pulmonary complications in chemical warfare patients. Serious comorbidities like dyslipidemia are frequently encountered in COPD. The aim of this study was to measure the serum lipid profile and evaluate the relation of lipid parameters with the severity of airway obstruction in mustard lung patients

Materials and Methods: Thirty-six non-smoker mustard lung patients with no history of cardiovascular disease, diabetes mellitus, and dyslipidemia were entered into this cross-sectional study. Control group consisted of 36 healthy non-smoker men were considered in this study. Serum lipid profile was performed in the patients and the controls. Spirometry was done in mustard lung patients

Results: The mean age of the patients was 47 +/- 6.80 SD years. The mean duration of COPD was 18.50 +/- 7.75 SD years. There were statistically significant differences in mean serum triglycerides and total cholesterol levels between patients and controls [P=0.04 and P=0.03, respectively].The mean levels of lipid parameters were not statistically significant different among the 4 stages of COPD severity [P>0.05]

Conclusion: The current study revealed that the serum levels of triglycerides and cholesterol are elevated in mustard lung patients compared with the healthy controls. Since lipid profile abnormalities are considered as a major risk factor for cardiovascular disease, especial attention to this matter is recommended in mustard lung patients

comparison of HTLV-1 infection frequency in patients with or without tuberculosis

Introduction: To recognize the predisposing factors in tuberculosis as an endemic infection in Northeast province of Iran, this study was aimed to evaluate whether HumanT-lymphocyte type 1 [HTLV-I] as an immunosuppressive factor increases the risk of tuberculosis

Materials and Methods: A Case-control study was conducted in 278 tuberculosis patients from 2007 to 2010, in Mashhad, Iran. Tuberculosis has been diagnosed by gold standard tests like sputum culture, bronchoalveolar lavage [BAL] culture or cytology. For detection of HTLV-I antibody, Enzyme Linked Immunosorbant Assay method and western Blot as the confirming test were performed. Then 276 healthy cases were matched for gender and age

Results: The mean age of tuberculosis patients was 49.67 +/- 21.36 years and for control cases was 48.36 +/- 20.74. In patients group, 114 [41.6%] were male, 160 [58.4%] were female and in controls 123 [44.6%] were male and 153 [55.4%] were female. Pulmonary tuberculosis was presented in 84.2% of the patients. The frequency of HTLV-1 was 2.9% and 3.3% in patients and controls, respectively. HTLV-I frequency was higher in male patients and it increased by age

Conclusion: Regarding to this study, HTLV-I infection is not stand-alone sufficient for increasing the risk of tuberculosis

Metabolic syndrome in chemical warfare patients with chronic obstructive pulmonary disease

Introduction: Sulfur mustard [SM], a toxic alkylating gas, can cause serious long-term pulmonary complications such as chronic obstructive pulmonary disease [COPD]. Metabolic syndrome [MetS] is one of the important comorbidities of COPD. This study was designed to evaluate the frequency of metabolic syndrome in Iranian chemical warfare patients [CWPs] with COPD

Materials and Methods: Thirty CWPs with a mean age of 46.93 +/- 6.8 were enrolled in this study. The following parameters were studied in: complete pulmonary function tests, health-related quality of life, serum triglycerides [TG], high density lipoprotein [HDL] and fasting blood sugar [FBS] levels. Additionally, 32 COPD patients and 56 healthy persons were considered as control groups who were matched to CWPs

Results: We found a statistically significant difference in the frequency of MetS between the COPD patients and the healthy control group [P=0.04]. Additionally, we observed a statistically significant difference in the mean HDL levels among these groups [P=<0.001]. In the CWPs, the frequency of MetS was significantly decreased in severe to very severe stages [P<0.001]

Conclusion: Our data indicate that metabolic syndrome is frequent in chemical warfare patients, and special attention to this condition in mild to moderate stages is recommended

diagnostic values of protein to lactate dehydrogenase ratio in serum and pleural fluid in exudate pleural effusions

Different etiologies of pleural effusion are diagnosed based on serum and plural fluid characteristics. The aim of this study was to assess and compare the serum and pleural fluid protein to lactate dehyrogenase [Pr/LDH] ratio in exudative pleural effusions. This study was conducted on 60 patients with exudative pleural effusion including: 20 cases with parapneumonic, 20 cases with Tuberculosis [TB], and 20 cases with malignancy. The serum and pleural Pr/LDH were measured and compared among 3 groups. The mean age of the patients was 55 +/- 19SD [years] and male to female ratio was 36/24. There was no statistically significant difference in mean age of the patients among 3 groups [p=0.08]. There were statistically significant differences in serum and pleural Pr. /LDH ratios among groups [p=0.04 and p= 0.1, respectively]. Additionally the comparisons of serum and pleural Pr. /LDH ratios between malignancy and tuberculosis groups were significant [p=0.02 and p=0.001, respectively]. The serum and pleural Pr. /LDH ratios were higher in TB group. The results of our study showed that serum and pleural Pr. /LDH ratio can be used in differentiating the etiology of exudative pleural effusion, but needs to be confirmed by larger study

case report of pegylated interferon and bronchiolitis oblitrans with organizing pneumonia

A 46-year-old woman presented with progressive dyspnea and cough. She was a known case of chronic hepatitis C [HCV] treated with pegylated [PEG]-interferon. Complete pulmonary studies and biopsy were compatible with bronchiolitis oblitrans with organizing pneumonia [BOOP] secondary to PEGinterferon. She discontinued PEG-interferon and was given a short course of steroids, after which the condition completely resolved. This report has shown that particular attention to possible side effects of PEG-interferon is necessary in the clinical practice.

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

Evaluation of polymerase chain reaction for diagnosis of "tuberculous pleurisy"

Differential diagnosis between tuberculous pleurisy [TBP] and non-tuberculosis pleural effusion represents a critically important clinical problem. In recent years, several noninvasive methods have been found for diagnosis of tuberculous pleurisy. This study aimed to evaluate the value of detection of the genome of Mycobacterium tuberculosis [MTB] by polymerase chain reaction [PCR] method for the diagnosis of tuberculous pleurisy and compare the results with those of conventional methods. In this cross-sectional study, we studied 62 patients [42 men and 20 women] with pleural effusion in Ghaem Hospital, affiliated to Mashhad University of Medical Sciences from January 2006 to June 2007. A total of 20 patients had tuberculous pleurisy [45.4%], 15 patients had malignant pleural effusion [34%], 3 patients had pleural effusion with various "non-tuberculosis non-malignant" etiologies [6.8%] and 6 patients had transudative pleural effusion [13.6]. The sensitivity, specificity, positive predictive value and negative predictive value of PCR in tuberculous pleurisy were 85%, 100%, 100% and 88.8%, respectively. The value of PCR test and pleural biopsy was similar in the diagnosis of TBP. However, PCR detected MTB in pleural effusion when conventional pleural biopsy failed to do so

[Evaluation of gamma-interferon in diagnosis of tuberculosis pleurisy]

Differential diagnosis between Tuberculosis pleurisy and Non Tuberculoses pleural effusion can be sometimes difficult and needs invasive diagnostic methods. In recent years, several biological markers have been found to be diagnostic markers of Tuberculosis pleurisy. The aim of this study was assessment of the value of Gamma-Interferon in the diagnosis of TB pleurisy. We studied 70 patients with pleural effusion who had been admitted to Ghaem hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Interferon gamma level was measured by "ELISA' method. The diagnosis of tuberculosis was based on microbiologic study of pleural fluid plus pleural biopsy. Altogether Twenty patients had tuberculosis pleurisy [44.44%], 21 patients had malignant pleural effusion [46.67%] and 4 patients had pleural effusion with various non TB non malignant etiologies [8.9%]. The sensitivity, specificity of Gamma-Interferon in TB pleurisy were 60% and 96% respectively. INF gamma is a valuable indicative marker for diagnosis of tuberculosis pleurisies' but we should consider situations with high level of INF gamma without any evidence of TB and also Tuberculosis pleurisy patients with INF gamma level lower than diagnostic threshold

Anemia in COPD patients and its relation to serum levels of erythropoietin

Although chronic obstructive pulmonary disease [COPD] is traditionally associated with polycythemia, its systemic inflammatory components can interfere with erythropoietin and result in anemia of chronic disease. We assessed the frequency of anemia and its relation to serum erythropoietin [EPO] levels and severity of the disease in a group of COPD patients. Eighty patients with the mean age of 66.48 +/- 11.55 years and mean forced expiratory volume in first second [FEV1] of 45.14 +/- 16.88% predicted were enrolled in this study. Severity of the disease was defined according to the global initiative for chronic obstructive lung disease [GOLD] guidelines. Hemoglobin and erythropoietin levels were assessed in all patients. Anemia of chronic disease was present in 13 of 80 patients [16%]. The mean serum levels of EPO were 59 +/- 203 [SD] micro/l and 70.3 +/- 255 [SD] micro/l in anemic and nonanemic COPD patients, respectively. There was no significant difference between the two groups [p=0.13]. A significant correlation was seen between hemoglobin and serum EPO in all COPD and nonanemic patients [r = - 0.86, p < 0.001 and r = - 0.28, p = 0.02]. No significant correlation was seen between hemoglobin and serum erythropoietin levels in the anemic group [r = 0.07, p = 0.82]. This study showed that anemia occurred relatively frequently in COPD patients. In addition to erythropoietin resistance, other factors are probably involved in the pathogenesis of anemia in these patients

Pulmonary tuberculosis in the elderly

Despite the increased rate of tuberculosis [TB] in the elderly, few publications have presented the clinical characteristics of TB in this specific age group in our country. This study aimed to compare the clinical features, predisposing factors and imaging findings of pulmonary TB in the elderly and in young adults, and to determine if any difference exists between the two groups. We retrospectively reviewed the records of all patients with the diagnosis of pulmonary TB at Ghaem Hospital and outpatient clinics during a 6-year period. Ninety-five patients were studied and divided into two groups, 33 patients were in the young group [mean age, 29.3 yrs.] and 40 patients in the elderly group [mean age, 69.6 yrs.]. Patients aged 46-64 were excluded from the study. Predisposing factors were more prevalent in the elderly who had a significantly higher frequency of chronic obstructive pulmonary disease, ischemic heart disease, congestive heart failure, malignancy and diabetes mellitus. Pregnancy and postpartum status were the predisposing conditions in young females. The classic symptoms and signs of TB were noted in a higher proportion of the younger group. Fever [78% vs. 57.5%], and weight loss[94% vs. 80%] were significantly higher [p<0.05],while night sweats[24% vs. 22.5%],cough [100% vs. 92.5%] and hemoptysis[30% vs. 15%], were seen more in the younger group but with no significant differences .Lower lung infiltrates were higher in the elderly; whereas, cavitation was seen significantly more in the young age group[63% vs. 25%, p<0.05]. To prevent delay in diagnosis and treatment, TB should be considered among the differential diagnosis of any type of pulmonary infiltrates seen in the elderly, even when the clinical presentation is atypical

[Evaluation of body mass index and albumin in pts with COPD]

Chronic obstructive pulmonary disease [COPD] is characterized by chronic inflammation and progressive development of airflow limitation. Recently besides the typical pulmonary pathology of COPD, several effects occuring outside the lungs, for example weight loss and malnutrition have been described the so called systemic effects of COPD. In this study we evaluated body mass index [BMI], serum albumin and their relationship with pulmonary function. This descriptive study performed on 42 patients, referring to Ghaem Hospital Mashhad University of Medical Sciences, Mashhad, Iran at 2005, with the mean age of 62.82 +/- 10.54 years and the mean forced expiratory volume in the first second [FEV1] [1,38 +/- 0.76 lit.]. This study was approved by the local ethics. Severity of disease was defined by global initiative for chronic lung disease [GOLD] guideline. BMI and serum albumin were measured. BMI was lower than normal in 9.5% of patients. There was a significant negative correlation between the severity of disease and BMI [p=0.004, r= - 0.43]. Furthermore the correlation between the severity of disease and serum albumin was significantly negative [p= 0.02, r= - 0.35]. The results of this study indicate that BMI and serum albumin decreased as the severity of disease increased. Therefore, the nutritional status is closely linked to the severity of COPD

Inhaled corticosteroids and bone density in chemical warfare patients with pulmonary complications

The most effective treatment in chemical warfare victims [CWV] suffering from severe long-term obstructive pulmonary disease is inhaled corticosteroids [ICS] and long acting beta-2 agonists. Study results on adverse effects of ICS on bone were conflicting. In the present study, we evaluated the effect of ICS on bone mineral density [BMD] of CWV and possible effects of chemical warfare agents on BMD. Thirty-five CWVs entered this study. Demographic and spirometric data [including staging of severity of lung disease] and BMD results as shown by z-score and t- score measured in lumbar and femoral regions were evaluated in this group of patients. In comparison, 75 normal subjects as controls were included in this study and their BMD results were compared with those of the case group. The mean age in CWVs was 41.40 +/- 7.74 years, which showed no significant difference with that of the control group. According to spirometric data, CWVs had obstructive lung disease. BMD in lumbar and femoral regions in the case group was 1.14 +/- 0.14 and 0.93 +/- 0.13 g/cm[2] respectively, which showed no significant difference with that of the control group. Regression analysis showed that BMD in the femoral region was correlated with forced expiratory volume in 1 second [FEV1] and forced vital capacity [FVC] and t-score in lumbar region was correlated with FEV1. BMD in the femoral region decreased as the severity of bronchial obstruction increased [0.99 +/- 1.07 g/cm[2] in mild form to 0.75 +/- 0.27 in severe form; F=3.91, P=0.03] but in the lumbar region BMD had no significant correlation with severity of bronchial obstruction. BMD did not decrease during long-term therapy with ICS in CWVs. Severity of bronchial obstruction can be an important risk factor