Cardiopulmonary Exercise Test Parameters among Dialysis Patients with End-Stage Renal Disease.

Background: The current study aimed to assess some parameters of the cardiopulmonary exercise test (CPET) among end-stage renal disease patients who underwent dialysis. The ultimate goal is to improve disease management to achieve optimal quality of life and exercise capacity in this group of patients. Materials and Methods: Through a cross-sectional design, the current study enrolled 46 dialysis patients by simple sampling between Jan 2019 and Jan 2020. Some CPET parameters such as AT, VO2, VO2/kg, SPO2, minute ventilation CO2 production/O2 consumption ratios (VE/VCO2 and VE/VO2, respectively), O2 pulse, heart rate reserve (HRR), breathing reserve (BR) and end-tidal carbon dioxide pressure (PETCO2) were focused. Results: Although a limited sample size, the current study showed that VO2/Kg, VE/VCO2, PETCO2, and SPO2 are the main parameters affected by dialysis as expected. Conclusion: The current study suggests using cardiopulmonary rehabilitation for all chronic medical conditions such as chronic kidney disease and end-stage renal disease that increase the rate of metabolic acidosis.

Inflammatory Serum Biomarker Pattern in Emphysema and Chronic Bronchitis Phenotypes of Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

Background: COPD exacerbation is characterized by both airway and systemic inflammation. The present study aimed to investigate the relationship between serum levels of some inflammatory biomarkers and the phenotypes of COPD exacerbation. Materials and Methods: This study includes known COPD patients, presenting to a hospital with acute exacerbation of COPD. Serum levels of CRP, ESR, CBC, TNF-α, IL-8, and IL-6 were measured at the time of admission. According to the previously done HRCT, the patients were divided into two groups including emphysema and chronic bronchitis. Levels of serum biomarkers were compared in the two groups. The relationships between biomarkers and duration of hospitalization were assessed too. Results: Comparison of quantitative CRP levels, WBC, and platelet counts did not show a statistically significant difference between emphysema and chronic bronchitis but it was significantly higher than control subjects. Although not statistically significant, ESR level was higher in emphysema. TNF-alpha was 6.0±1.5 ng / ml and 1.5 ng / ml in the emphysema and chronic bronchitis groups, respectively. TNF-α had no significant difference compared to the groups. Although higher than the control group, IL-6 and IL-8 did not show significant differences between emphysema and chronic bronchitis. The two groups did not statistically differ in terms of hospital stay but patients with higher serum TNF-α tended to have longer hospitalization and ICU admission. Conclusion: The present study showed predictably higher inflammatory biomarkers in COPD exacerbation but no significant difference between the two phenotypes of COPD and these two entities could not be discriminated based on inflammatory bio-factors.

Photobiomodulation Improves Serum Cytokine Response in Mild to Moderate COVID-19: The First Randomized, Double-Blind, Placebo Controlled, Pilot Study.

Background: Because the major event in COVID-19 is the release of pre- and inflammatory cytokines, finding a reliable therapeutic strategy to inhibit this release, help patients manage organ damage and avoid ICU admission or severe disease progression is of paramount importance. Photobiomodulation (PBM), based on numerous studies, may help in this regard, and the present study sought to evaluate the effects of said technology on cytokine reduction. Methods: This study was conducted in the 2nd half of 2021. The current study included 52 mild-to-moderately ill COVID-19, hospitalized patients. They were divided in two groups: a Placebo group and a PBM group, treated with PBM (620-635 nm light via 8 LEDs that provide an energy density of 45.40 J/cm2 and a power density of 0.12 W/cm2), twice daily for three days, along with classical approved treatment. 28 patients were in Placebo group and 24 in PBM group. In both groups, blood samples were taken four times in three days and serum IL-6, IL-8, IL-10, and TNF-α levels were determined. Results: During the study period, in PBM group, there was a significant decrease in serum levels of IL-6 (-82.5% +/- 4, P<0.001), IL-8 (-54.4% ± 8, P<0.001), and TNF-α (-82.4% ± 8, P<0.001), although we did not detect a significant change in IL-10 during the study. The IL-6/IL-10 Ratio also improved in PBM group. The Placebo group showed no decrease or even an increase in these parameters. There were no reported complications or sequelae due to PBM therapy throughout the study. Conclusion: The major cytokines in COVID-19 pathophysiology, including IL-6, IL-8, and TNF-α, responded positively to PBM therapy and opened a new window for inhibiting and managing a cytokine storm within only 3-10 days.

An Add-On Treatment for Moderate COPD with Squill-Oxymel (a Traditional Formulation from Drimia maritima (L.) Stearn): A Pilot Randomized Triple-Blinded Placebo-Controlled Clinical Trial.

Background: In traditional Persian medicine, Drimia maritima, with the popular name Squill, has been used to alleviate phlegm dyspnea. Squill has also been shown to have anti-inflammatory and anticholinergic properties. The goal of this research was to see how effective and safe Squill-Oxymel was in treating COPD patients. Method: Forty-two COPD patients were examined for eight weeks in two groups. Patients underwent a 6-minute walk test to assess the treatment's effectiveness at the beginning and conclusion of the intervention. We utilized St. George's Respiratory Questionnaire (SGRQ) to evaluate the subjective symptoms of patients in order to measure their quality of life. Results: Patients who received Squill-Oxymel showed a statistically significant increase in 6MWT distance (P=0.011). The mean O2 saturation at the end of the 6MWT before the intervention was significantly greater in the placebo group. (P=0.008). In terms of questionnaire variables, there was a significant difference between placebo and Squill-Oxymel groups in the mean presymptom score (P=0.009) and the mean post-symptom score (P=0.004). Conclusions: The findings of this research provide preliminary evidence for the effectiveness and safety of Squill-Oxymel as an add-on therapy in individuals with mild COPD.

National Research Institute of Tuberculosis and Lung Disease (NRITLD) Protocol for the Treatment of Patients with COVID-19.

More than a year after the onset of the coronavirus disease pandemic in 2019, the disease remains a major global health issue. During this time, health organizations worldwide have tried to provide integrated treatment guidelines to control coronavirus disease 2019 (COVID-19) at different levels. However, due to the novel nature of the disease and the emergence of new variants, medical teams' updating medical information and drug prescribing guidelines should be given special attention. This version is an updated instruction of the National Research Institute of Tuberculosis and Lung Disease (NRITLD) in collaboration with a group of specialists from Masih Daneshvari Hospital in Tehran, Iran, which is provided to update the information of caring clinicians for the treatment and care of COVID-19 hospitalized patients.

Transmission electron microscopy study of suspected primary ciliary dyskinesia patients.

Primary ciliary dyskinesia (PCD) is a rare autosomal recessive condition often presenting with chronic respiratory infections in early life. Transmission electron microscopy (TEM) is used to detect ciliary ultrastructural defects. In this study, we aimed to assess ciliary ultrastructural defects using quantitative methods on TEM to identify its diagnostic role in confirming PCD. Nasal samples of 67 patients, including 37 females and 30 males (20.3 ± 10.7 years old), with suspected PCD symptoms were examined by TEM. The most common presentations were bronchiectasis: 26 (38.8%), chronic sinusitis: 23 (34.3%), and recurrent lower respiratory infections: 21 (31.3%). Secondary ciliary dyskinesia, including compound cilia (41.4%) and extra-tubules (44.3%), were the most prevalent TEM finding. Twelve patients (17.9%) had hallmark diagnostic criteria for PCD (class 1) consisting of 11 (16.4%) outer and inner dynein arm (ODA and IDA) defects and only one concurrent IDA defect and microtubular disorganization. Also, 11 patients (16.4%) had probable criteria for PCD (class 2), 26 (38.8%) had other defects, and 18 (26.9%) had normal ciliary ultrastructure. Among our suspected PCD patients, the most common ultrastructural ciliary defects were extra-tubules and compound cilia. However, the most prevalent hallmark diagnostic defect confirming PCD was simultaneous defects of IDA and ODA.

Pulmonary manifestations in a cohort of patients with inborn errors of immunity: an 8-year follow-up study

Background Inborn errors of immunity (IEIs) are a group of congenital diseases caused by genetic defects in the development and function of the immune system. The involvement of the respiratory tract is one of the most common presentations in IEIs.Methods Overall, 117 patients with diagnosed IEIs were followed-up within 8 years at the National Research Institute of Tuberculosis and Lung Diseases (NRITLD). Demographic, clinical, and laboratory data were collected in a questionnaire. Pulmonary function test (PFT), chest X-ray (CXR), and high-resolution computed tomography (HRCT) scans were obtained where applicable.Results Our study population consisted of 48 (41%) patients with predominantly antibody deficiencies (PADs), 39 (32%) patients with congenital defects of phagocytes, 14 (11.9%) patients with combined immunodeficiency (CID), and 16 (14%) patients with Mendelian susceptibility to mycobacterial diseases (MSMD). . Recurrent pneumonia was the most common manifestation, while productive cough appeared to be the most common symptom in almost all diseases. PFT showed an obstructive pattern in patients with PAD, a restrictive pattern in patients with CID, and a mixed pattern in patients with CGD. HRCT findings were consistent with bronchiectasis in most PAD patients, whereas consolidation and mediastinal lesions were more common in the other groups (AU)

Pulmonary manifestations in a cohort of patients with inborn errors of immunity: an 8-year follow-up study.

BACKGROUND: Inborn errors of immunity (IEIs) are a group of congenital diseases caused by genetic defects in the development and function of the immune system. The involvement of the respiratory tract is one of the most common presentations in IEIs. METHODS: Overall, 117 patients with diagnosed IEIs were followed-up within 8 years at the National Research Institute of Tuberculosis and Lung Diseases (NRITLD). Demographic, clinical, and laboratory data were collected in a questionnaire. Pulmonary function test (PFT), chest X-ray (CXR), and high-resolution computed tomography (HRCT) scans were obtained where applicable. RESULTS: Our study population consisted of 48 (41%) patients with predominantly antibody deficiencies (PADs), 39 (32%) patients with congenital defects of phagocytes, 14 (11.9%) patients with combined immunodeficiency (CID), and 16 (14%) patients with Mendelian susceptibility to mycobacterial diseases (MSMD). . Recurrent pneumonia was the most common manifestation, while productive cough appeared to be the most common symptom in almost all diseases. PFT showed an obstructive pattern in patients with PAD, a restrictive pattern in patients with CID, and a mixed pattern in patients with CGD. HRCT findings were consistent with bronchiectasis in most PAD patients, whereas consolidation and mediastinal lesions were more common in the other groups. CONCLUSIONS: Pulmonary manifestations vary among different groups of IEIs. The screening for lung complications should be performed regularly to reveal respiratory pathologies in early stages and follow-up on already existing abnormalities.

Combination therapy of IFNß1 with lopinavir-ritonavir, increases oxygenation, survival and discharging of sever COVID-19 infected inpatients.

Interferon Beta-1a (IFN-ß1-a), an immunomodulatory mediator with antiviral effects, has shown in vivo and in vitro activities especially on coronavirus including SARS-CoV-2. COVID-19 defined as the disease caused by infection with SARS-CoV-2. The virus has been illustrated inhibits the production of IFN-ß1-a from inflammatory cells. We conducted a retrospective study of all adult confirmed COVID-19 hospitalized patients who received combination of three doses of 12 million international units of IFN-ß1-a and Lopinavir 400 mg and Ritonavir 100 mg every 12 h (case group) for 14 days besides standard care and age- and sex- matched COVID-19 patients with receiving lopinavir/ritonavir (control group) at Masih Daneshvari Hospital as a designated hospital for COVID-19 between Feb 19 and Apr 30, 2020. Multivariate analysis was done to determine the impact of IFN-ß1-a on outcome and all-cause mortality. 152 cases in IFN-ß1-a group and 304 cases as control group were included. IFN-ß1-a group stayed at hospital longer and required noninvasive ventilation more than control group (13 vs. 6 days, p = 0.001) and (34% vs. 24%, p = 0.04), respectively. During treatment, 57 (12.5%) patients died. The death rate in case and control groups was 11% and 13% respectively. In multivariate analysis, not receiving IFN-ß1-a (HR 5.12, 95% CI: 2.77-9.45), comorbidity (HR 2.28, 95% CI: 1.13-4.60) and noninvasive ventilation (HR 2.77, 95% CI: 1.56-4.93) remained significantly associated with all-cause mortality. In this study, risk of death decreased by using IFN-ß1-a in COVID-19 patients. More clinical study will be necessary to measure efficacy of IFN-ß1-a in COVID-19 treatment.

Favipiravir Effects on the Control of Clinical Symptoms of Hospitalized COVID-19 Cases: An Experience with Iranian Formulated Dosage Form.

Coronavirus disease -19 (COVID-19) pandemic, caused by SARS-CoV-2, has gradually spread worldwide, becoming a major public health event. This situation requires designing a novel antiviral agent against the SARS-CoV-2; however, this is time-consuming and the use of repurposed medicines may be promising. One such medicine is favipiravir, primarily introduced as an anti-influenza agent in east world. The aim of this study was to evaluate the efficacy and safety of favipiravir in comparison with lopinavir-ritonavir in SARS-CoV-2 infection. In this randomized clinical trial, 62 patients were recruited. These patients had bilateral pulmonary infiltration with peripheral oxygen saturation lower than 93%. The median time from symptoms onset to intervention initiation was seven days. Favipiravir was not available in the Iranian pharmaceutical market, and it was decided to formulate it at the research laboratory of School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran. The patients received favipiravir tablet at a dose of 1600 mg orally twice a day for day one and then 600 mg orally twice a day for days 2 to 6. In the second group, the patients received lopinavir-ritonavir combination tablet at a dose of 200/50 mg twice a day for seven days. Fever, cough, and dyspnea were improved significantly in favipiravir group in comparison with lopinavir-ritonavir group on days four and five. Mortality rate and ICU stay in both groups were similar, and there was no significant difference in this regard (P = 0.463 and P = 0.286, respectively). Chest X-ray improvement also was not significantly different between the two groups. Adverse drug reactions occurred in both groups, and impaired liver enzymes were the most frequent adverse effect. In conclusion, early administration of oral favipiravir may reduce the duration of clinical signs and symptoms in patients with COVID-19 and hospitalization period. The mortality rate also should be investigated in future clinical trials.

Clinical Manifestations of Patients with Coronavirus Disease 2019 (COVID-19) in a Referral Center in Iran.

BACKGROUND: Following the recent epidemic of coronavirus disease 2019 (COVID-19) in Wuhan, China, a novel betacoronavirus was isolated from two patients in Iran on February 19, 2020. In this study, we aimed to determine the clinical manifestations and outcomes of the first confirmed cases of COVID-19 infection (n=127). MATERIALS AND METHODS: This prospective study was conducted on all COVID-19-suspected cases, admitted to Masih Daneshvari Hospital (a designated hospital for COVID-19), Tehran, Iran, since February 19, 2020. All patients were tested for COVID-19, using reverse transcription-polymerase chain reaction (RT-PCR) assay. Data of confirmed cases, including demographic characteristics, clinical features, and outcomes, were collected and compared between three groups of patients, requiring different types of admission (requiring ICU admission, admission to the general ward, and transfer to ICU). RESULTS: Of 412 suspected cases, with the mean age of 54.1 years (SD=13.4), 127 (31%) were positive for COVID-19. Following the patients' first visit to the clinic, 115 cases were admitted to the general ward, while ten patients required ICU admission. Due to clinical deterioration in the condition of 25 patients (out of 115 patients), ICU admission was essential. Based on the results, the baseline characteristics of the groups were similar. Patients requiring ICU admission were more likely to have multiorgan involvement (liver involvement, P<0.001; renal involvement, P<0.001; and cardiac involvement, P=0.02), low O2 saturation (P<0.001), and lymphopenia (P=0.05). During hospital admission, 21 (16.5%) patients died, while the rest (83.5%) were discharged and followed-up until March 26, 2020. Also, the survival rate of patients, who received immunoglobulin, was higher than other patients (60.87% vs. 39.13%). CONCLUSION: The mortality rate of COVID-19 patients was considerable in our study. Based on the present results, this infection can cause multiorgan damage. Therefore, intensive monitoring of these patients needs to be considered.

Can L-Carnitine Supplementation Improve Cardiopulmonary Function? A Randomized Controlled Clinical Trial in Hemodialysis Patients.

INTRODUCTION: L-Carnitine is a cardioprotective agent which balances metabolism by promoting mitochondrial ß-oxidation and facilitating transportation of long chain fatty acids into the mitochondrial matrix. It has been shown that L-Carnitine level in plasma and tissue is lower in hemodialysis patients and they may lose the benefits of this substance. The aim of this trial was to evaluate the effects of L-Carnitine supplementation on cardiorespiratory Function in hemodialysis patients through ergospirometry. METHODS: The current study was conducted on 46 chronic hemodialysis patients. The patients were divided into two groups. In both groups ergospirometry parameters (VE Max, VO2-Max and VCO2 Max, AT, VE/VCO2 Slope) were recorded for a 3-month period of time. During this period, one group received L-Carnitine at doses of 2 g/d orally and the other group received only placebo. After three months, all of the mentioned parameters reevaluated and statistical analysis was done. RESULTS: Only CRP value was different between two group and in placebo group increased significantly after 3 months (P < .05). No significant difference was detected in Cardio-respiratory factors. In terms of ergospirometry, PET-CO2 was the only parameter which was significantly increased in the treatment group but decreased in placebo group (P < .05). CONCLUSION: Significant differences between our groups showed that L-Carnitine could help hemodialysis patients with cardiopulmonary problems to suffer lower rate of inflammation and poor life quality as shown at least in comparison of the two factors including CRP and PETCO2 at rest.

Promising effects of tocilizumab in COVID-19: A non-controlled, prospective clinical trial.

BACKGROUND: The clinical presentation of SARS-CoV-2 infection ranges from mild symptoms to severe complications, including acute respiratory distress syndrome. In this syndrome, inflammatory cytokines are released after activation of the inflammatory cascade, with the predominant role of interleukin (IL)-6. The aim of this study was to evaluate the effects of tocilizumab, as an IL-6 antagonist, in patients with severe or critical SARS-CoV-2 infection. METHODS: In this prospective clinical trial, 76 patients with severe or critical SARS-CoV-2 infection were evaluated for eligibility, and ultimately, 42 patients were included. Tocilizumab was administered at a dose of 400 mg as a single dose via intravenous infusion. Primary outcomes included changes in oxygenation support, need for invasive mechanical ventilation, and death. Secondary outcomes included radiological changes in the lungs, IL-6 plasma levels, C-reactive protein levels, and adverse drug reactions. The data were analyzed using SPSS software. RESULTS: Of the 42 included patients, 20 (48%) patients presented the severe infection stage and 22 (52%) were in the critical stage. The median age of patients was 56 years, and the median IL-6 level was 28.55 pg/mL. After tocilizumab administration, only 6 patients (14%) required invasive ventilation. Additionally, 35 patients (83.33%) showed clinical improvement. By day 28, a total of 7 patients died (6 patients in the critical stage and 1 patient in the severe stage). Neurological adverse effects were observed in 3 patients. CONCLUSIONS: Based on the current results, tocilizumab may be a promising agent for patients with severe or critical SARS-CoV-2 infection, if promptly initiated during the severe stage.

Determination of optimal time for reading of rapid urease test diagnosis of Helicobacter pylori.

AIM: The study aimed to find the best reading time for the best accuracy of RUT in optimal time to obtain faster results with lower false rates and consequently save time in commencing treatment of peptic ulcers. BACKGROUND: Rapid urease test is well known to be an accurate test for H.pylori detection in tissue biopsies. METHODS: Patients with GI problems referring to a university hospital in Tehran who underwent endoscopy and biopsy were entered in the project and three samples of mucosal tissue were captured from the lesser curvature, the antrum and the body of stomach. RESULTS: We found 39.6% sensitivity and 95% specificity for the named test in the first 5 minutes as well as PPV = 95.5% and NPV = 37.3% while the accuracy was 54.79%. Except for the specificity which was constantly 95% in all RUT reading times, other diagnostic parameters increased as time went on. The PPV was also higher than 97% after 10 minutes. The highest values of sensitivity, specificity, PPV, NPV and accuracy were achieved after 12 hours including 88.7%, 95%, 97.9%, 76% and 90.41%, respectively. CONCLUSION: To conclude, it seems that there are many different ideas with respect to the rapid urease test in H.pylori detection. However, the current study recommends reading the test optimally after 12 hours but it is suggested more multidisciplinary studies with bigger sample size be carried out to obtain better and more reliable results to be able to generalize in this regard.

Role of Common Variables: Age, Gender, BMI, Rhinosinusitis, and Smoking among Asthmatic and Severe Asthmatic Patients.

BACKGROUND: This study was done to determine the role of common variables, including age, gender, body mass index (BMI), rhinosinusitis, and smoking among a group of asthmatic and severe asthmatic patients in 2016. MATERIALS AND METHODS: This retrospective study was carried out from mid-June to the end of September 2016. Of 678 patients with asthma referred to private asthma clinics in Tehran, 163 subjects were selected. Severe asthma (SA) cases were diagnosed according to the SA definition (severe shortness of breath, chest tightness or pain, and coughing or wheezing, low peak expiratory flow (PEF) using a peak flow meter, and more than two days of wheezing and coughing per week). Patients with the presence of concomitant diseases, such as gastroesophageal reflux disease, sleep apnea, hypo- and hyperthyroidism, as well as users of nonsteroidal anti-inflammatory drugs (NSAIDs) were excluded.According to the signs and symptoms and classic criteria of asthma, the subjects with SA were assigned to the case group and subjects with asthma to the control group. Besides, general information, including age, gender, BMI, smoking history, and the presence of Rhinosinusitis was collected. RESULTS: Of 163 subjects, 92 patients (56.4%) were in the control, and 71 patients (43.6%) in the case group. The rate of SA among 678 patients was 10.47%. The mean age of the case group was 49.08 ±11.66 and the control group was 50.05 ±15.65 years. There was a significant difference in BMI between the case and control groups (p=0.034), especially among females in the case group (p=0.001). BMI was significantly higher in females than in males (p=0.002). Also, smoking status was not significant between the case and control groups (p=0.751). Rhinosinusitis was significantly higher in the case groups compared with the control groups (p= .014). CONCLUSION: Rhinosinusitis was higher in SA patients (case group). SA was more observed among females than males and those who were more overweight. It seems that rhinosinusitis and obesity are more important risk factors. Moreover, obese female patients require more serious attention.

Effects of High-Dose Vitamin D Replacement on the Serum Levels of Systemic Inflammatory Biomarkers in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

Chronic Obstructive Pulmonary Disease (COPD) is associated with increased inflammatory responses to noxious particles, which can be further enhanced during Acute Exacerbation of COPD (AECOPD). Considering the important immunoregulatory function of vitamin D, high prevalence of Vitamin D Deficiency (VDD) in COPD patients and a negative link between vitamin D levels and inflammatory biomarkers, suggests the seemingly interesting mechanism of vitamin D effects on inflammation resolution during the conventional treatment of AECOPD. The admitted AECOPD patients with VDD were recruited and randomly allocated to receive either 300,000 IU of intramuscular vitamin D (n = 35) or placebo (n = 35). Primary outcomes included inflammation resolution dynamics, which were assessed by monitoring the serum levels of IL-6, IL-8, and hs-CRP. Symptom recovery was evaluated based on the modified Medical Research Council (mMRC) dyspnea scale on the 1st and 6th days of admission. Secondary outcomes included the length of hospital stay (LOS) and 30-day mortality rates. Inflammatory biomarkers were highest at Day 1. Baseline vitamin D levels were 11.25 ± 3.09 and 10.59 ± 3.90 ng/ml (P = 0.45), which reached 11.35 ± 3.16 and 18.17 ± 4.24 by Day 6 (P < 0.001) in the placebo and, vitamin-D groups, respectively. IL-6 levels significantly decreased in the vitamin-D vs. placebo group on the 6th day (P = 0.02); however, no significant differences were observed in IL-8 (P = 0.15) and hs-CRP (P = 0.24) levels, mMRC scale (P = 0.45), LOS (P = 0.20), and mortality rates (P = 0.61). Vitamin D replacement as adjunctive therapy may accelerate inflammation resolution in hospitalized AECOPD patients. Further studies were needed to establish vitamin D exact role on inflammation resolution in AECOPD.

Protective effect of heart rate variability biofeedback on stress-induced lung function impairment in asthma.

Psychological stress can provoke airway constriction in asthmatic patients, which may be because of autonomic nervous system dysfunction in asthma. We investigated the effect of enhancing respiratory sinus arrhythmia using heart rate variability biofeedback (HRV-BF) on spirometry performance and HRV indices during stress induced by Stroop Color-Word interference test in asthmatic patients and healthy volunteers. Stress caused decrease in FEV1%, FVC%, and PEF% compared to baseline in asthmatic patients, but not in healthy subjects. A single short duration episode of HRV-BF not only had a protective effect on stress-induced airway constriction, but also significantly augmented the level of FEV1% and FVC% as compared with their own baseline. Also, there was a significant correlation between HRV changes and the augmentation of spirometry performance in asthmatic patients receiving HRV-BF. Our findings indicated that even a single short duration episode of HRV-BF can decrease susceptibility to stress-induced lung function impairment in patients with asthma, which may be through the modulation of respiratory sinus arrhythmia.

Spirometry, cardiopulmonary exercise testing and the six-minute walk test results in sarcoidosis patients.

Background: The 6-minute walking test, cardiopulmonary exercise testing, and spirometry are useful tools for evaluation of respiratory impairment and functional capacity in patients with lung disease. Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Objectives: Since the pulmonary involvement can affect the quality of life in sarcoidosis patients, this study is aimed to evaluate the tests mentioned above in order to examine the functional capacity of sarcoidosis patients in different stages as well as the cause of exercise intolerance. Methods: This cross-sectional study was carried out on 50 Iranian patients with sarcoidosis. Patients were classified into three groups based on the findings of the chest radiography as well as the pulmonary CT scan, reported by an expert radiologist. Pulmonary, cardiac, and activity function have been evaluated in the patients, using cardiopulmonary exercise testing, the 6-minutes walking test, and spirometry. Results: In cardiopulmonary exercise testing, percent-predicted peak VO2 (57.75±15.49, p=0.015) and percent-predicted O2 pulse (70.54±17.37, p=0.013) were significantly lower in the third group, in comparison with the others. Also, VE/CO2 (AT) (34.99±5.67, p=0.000) was significantly higher in the third group, in comparison with the other ones. Percent-predicted VO2 showed a strong positive correlation with age (r=0.377, p=0.009), TSH (r= 0.404, p=0.007), and percent-predicted FVC (r=0.443, p=0.002). In addition, O2 pulse had a positive correlation with BMI (r=0.324, p=0.026), percent-predicted FVC (r=0.557, p= 0.000), and percent-predicted FEV1 (r=0.316, p=0.032). Conclusions: According to this study, ventilatory limitation, pulmonary involvement, and deconditioning are the main causes of activity limitations in sarcoidosis patients.

Prevalence of Asthma and Asthma-like Symptoms: a Study in Five Provinces of Iran.

BACKGROUND: Asthma is a complex chronic inflammatory airway disease affecting millions of people worldwide. The prevalence of asthma attacks in most regions of the world, including the developing countries, increases due to urbanization, industrialization, and lifestyle. MATERIALS AND METHODS: The present study aimed at investigating the prevalence of asthma and asthma symptoms in five provinces of Iran using the stratified cluster sampling method and the European Community Respiratory Health Survey (ECRHS) questionnaire. RESULTS: A total of 4918 subjects were enrolled in the study. The prevalence of nocturnal cough was 27.4% (95% confidence interval (CI): 26%-28%); it was the most common asthma symptom followed by nocturnal shortness of breath (19.6%; 95%CI: 18-21%). For participants aged 20-44 years, the most prevalent symptoms were coughing attacks (37.7%), shortness of breath (26.5%), and nasal allergies (22.7%), respectively. CONCLUSION: There was a significant association among gender, age, and nasal allergy. Relevant studies should be conducted to figure out the countrywide distribution and the real burden of the disease.