Silicoproteino-tuberculosis: Three distinct entities or a unique entity: A case report and review of the literature.

Silicosis is considered to be among the occupational lung diseases and associated with sandblasting, mining, quarrying and tunneling. Acute silicosis is usually progressive diseaseand despite treatment with corticosteroids it leads to cardio-respiratory failure and death. Alveolar silicoproteinosis is one of it's acute presentations due to exposure to silica dust and lungs filling with proteinaceous material. Here, we have presented a 29 year old male sandblaster with the three conditions of acute silicosis, secondary alveolar proteinosis and pulmonary tuberculosis on four anti tuberculous medications who presented with respiratory distress.

Nonspecific Interstitial pneumonia (NSIP)/ Overlap or Distinct Entity: A case report from the National Research Institute of Tuberculosis and Lung Disease (NRITLD).

BACKGROUND: In many cases of ILD (interstitial lung disease), overlap diagnosis is considered. Here, a few cases with diagnosis of a variety of ILDs, where eventual open lung biopsy has been performed are selected. Reference will be made to reliable sources to show that NSIP can still be a variant of UIP (Usual interstitial pneumonia) with better treatment response and prognosis. CASE PRESENTATION: In case 1, there is a difference between the HRCT(High Resolution Computed Tomography) result (NSIP pattern without fibrosis) and pathologic result (which includes fibrosing NSIP more closely related to UIP).Case 2 shows obvious discord between HRCT result (UIP pattern) and pathologic result (NSIP pattern). In case 3, there is again a discrepancy between HRCT report (very mild architectural distortion suggestive for ILD like NSIP) and pathology report (destructed lung tissue with interstitial fibrosis suggestive of HP (Hypersesitivity Pneumonitis) and not NSIP. CONCLUSION: In this paper, we demonstrate that although NSIP can be a distinct diagnosis in most cases, but in rare cases the distinction between the other kinds of ILD especially UIP and NSIP in spite of full workup including tissue assessment can be very difficult.

A case of chronic granulomatous disease with a necrotic mass in the bronchus: a case report and a review of literature.

Chronic granulomatous disease is a rare phagocytic disorder with recurrent, severe bacterial and fungal infections. We describe an unusual case of chronic granulomatous disease manifesting as an invasive pulmonary aspergillosis with an obstructive necrotic mass at the right middle bronchus. The patient was successfully treated with a bronchoscopic intervention for the removal of the obstructive mass and a medical therapy.

Case of missing left lung.

Here we present a young female with missing left lung and history of upper respiratory infections in childhood. The lungs have ability to grow and regenerate in children. She has had no major complications into adulthood. It is important to know diagnosis in recurrent pulmonary infections and here bronchoscopy was diagnostic.

Mediastinal lymphangioma in a child.

We report a case of a male child with a cystic mass in his left side of the neck with extension to the mediastinum. This article highlights the clinical and para-clinical findings and management of these cases. In conclusion, it is necessary to evaluate the mediastinum for extension of the cyst in cases with cystic hygromas of the neck. Surgical resection of the tumor through a cervical incision can be considered.

Chronic productive cough and extensive cysts in left lung.

Bronchiectasis refers to dilated and thickened airways due to chronic inflammation and infections, with anatomic distortion of the bronchi. Here, we describe a 29-year-old man with a history of multiple hospitalizations for lung infection who presented to the pulmonary clinic with a complaint of worsening chronic productive cough in the previous year. This case presentation prompted a review of the etiologies of bronchiectasis in 291 recent cases admitted to Masih Daneshvari Hospital, Tehran.

Validity and specificity of the Persian version of the Saint George Respiratory Questionnaire.

INTRODUCTION: The Saint George Respiratory Questionnaire (SGRQ) is a well-known questionnaire for evaluating the quality of life in asthmatic patients. It has been translated to Persian and its validity and specificity should be evaluated for chronic obstructive pulmonary disease patients. In this study, we attempted to improve the questionnaire's adaptability to Persian culture and also evaluate its validity, specificity, and applicability among asthmatics at our tertiary referral center. MATERIALS AND METHODS: Previously translated and psychometrically evaluated SGRQ for chronic obstructive pulmonary disease patients was made more adaptive to Persian. Upon acceptability of the questionnaire by a small group of patients, 301 asthmatics referred for spirometry and completed the form. Consistency was evaluated using Cronbach's α coefficient and validity was assessed by comparison of scores with other measures of asthma exacerbation. These measures included FEV1, patient's clinical presentation, visual analog scale (used to assess difficulty breathing), Katz activity index and section scores of the General Health Questionnaire, anxiety, depression, and social impact. RESULTS: The study group included 165 female and 139 male asthmatics with a mean age of 44.4 ± 1.0 years. Measurement of consistency for the SGRQ revealed Cronbach's α to be 0.699 for symptoms, 0.805 for activity, 0.879 for impact, and 0.916 for the total questionnaire. By omitting question 8, time of wheezing during the day increased Cronbach's coefficient of the symptoms section to 0.719. Omitting "uselessness of respiratory drugs" from the impact section increased Cronbach's α to 0.881. However, scoring of the section then varied from the original questionnaire. A statistically significant correlation was found between the SGRQ sections and total score (using Katz index and General Health Questionnaire, p < .001). CONCLUSION: Our study showed good validity and reliability for the Persian version of SGRQ for a population of asthmatics referred to our tertiary pulmonary clinic.

Churg-Strauss syndrome following cessation of allergic desensitization vaccination: a case report.

INTRODUCTION: Churg-Strauss syndrome is a vasculitis of medium to small sized vessels. Diagnosis is mainly clinical with findings of asthma, eosinophilia, rhinosinusitis and signs of vasculitis in major organs. CASE PRESENTATION: We present a case of a 19-year-old Persian male who developed signs and symptoms of this syndrome related to hyposensitization treatments for allergy control. CONCLUSIONS: No unifying etiology for the disease can be presented as it is found associated with environmental factors, medications, infections and is even considered a variant of asthma with predisposition to vasculitic involvement. Therefore, it is important to recognize this disease and be aware of underdiagnosis because of emphasis on pathologic evidence. Here, we present a case of allergic desensitization causing Churg-Strauss syndrome in the absence of other known factors.

Measurement of the validity and reliability of the persian translation of the saint george respiratory questionnaire for patients with chronic obstructive pulmonary disease.

BACKGROUND: One of the important tools in measuring the quality of life in patients having a chronic disease is using questionnaires in which the impact of disease and its different types of treatments on daily tasks and social activities are evaluated. MATERIALS AND METHODS: At first, the questionnaire was translated into Persian and some of the concepts were changed by the researchers. Next, it was back translated by a person living in an English-speaking area who was unaware of the subject. At the fourth stage, the concepts were revised by a group of 15 patients and then 55 patients filled out the questionnaire. Finally, it's internal consistency was evaluated by calculating the Cronbach's alpha coefficient. RESULTS: After translation of the questionnaire, the researchers modified 17% of the sentences and phrases according to the Iranian culture. Questions which were controversial and those for which appropriate proposals were made by the COPD patients were ultimately modified and were responded to by an additional group of 55 patients. Statistical analysis and internal consistency of the questions in the different sections were obtained. For the first section ("complaints") and following the deletion of the last question (which was in regards to wheezing), the Cronbach's alpha was equal to 0.74. In the second section, where the patients' physical activities and the impact of disease on them were evaluated, the Cronbach's alpha coefficient was equal to 0.93. The last question of this section concerning the impact of activity on the rate of respiratory difficulty was deleted due to heterogeneous choices and unresponsiveness of 5 patients (15%). As a result, the Cronbach's alpha coefficient rose to 0.95 on this section and the Cronbach's alpha coefficient for the entire questionnaire was calculated at 0.93. CONCLUSION: In addition to conformity with the concepts of the English version, the translated Persian version of this questionnaire approximately matches the Iranian culture and can be used for the evaluation of the quality of life in chronic respiratory patients.

Pheochromocytoma crisis due to glucocorticoid administration: a case report and review of the literature.

We report a patient who presented with two episodes of severe hypertension after intramuscular injection of betamethasone. The first attack was associated with pulmonary edema, while the second attack was associated with high anion gap metabolic acidosis, renal failure, hyperglycemia, and hypokalemia. The attacks led to the diagnosis of pheochromocytoma, which was confirmed by appropriate diagnostic tests. The tumor was excised successfully and the patient is presently asymptomatic.We believe that these episodes were initiated by glucocorticoid injection, an event reported in a few cases. We briefly review potential mechanisms resulted in hypertensive crisis in such patients.

Primary immune deficiencies presenting in adults: seven years of experience from Iran.

Primary immunodeficiencies (PIDs) are not solely diseases of childhood. We describe the clinical presentation and outcome for 55 adult patients with previously unrecognized PIDs. This series provides unique data regarding PIDs presenting in adulthood, and serves as a timely reminder that physicians must consider the diagnosis of PIDs in their adult patients. Using the experience gained from these patients, we outline key "warning signs" suggestive of an underlying PID. Only through increased physician awareness will patients with PIDs receive timely diagnosis and optimal management.