Investigating the role of uric acid and uric acid-to-creatinine ratio as a predictive factor of chronic obstructive pulmonary disease exacerbation in 2019.

INTRODUCTION: Serum uric acid has been suggested as an independent marker of oxidative metabolism in chronic obstructive pulmonary disease (COPD), a disease with significant social, health, and economic burden. Therefore, we aimed to investigate the role of this factor in COPD exacerbation. METHODS: We investigated 20- to 70-year-old patients who were admitted due to COPD exacerbation (acute phase) or presented to the pulmonary clinic for follow-up (non-acute phase). Correlation of uric acid and uric acid-to-creatinine ratio (UCR) with multiple factors and their predictive performance for more exacerbations and acute phase of COPD was investigated (receiver operating characteristic [ROC] analysis). RESULTS: Overall, 63 patients were enrolled in this study, of whom 79.4% were men. Acute-phase group encompassed 79.4% of the population with a greater rate of heavy smoking and average exacerbation in a year (p-value = 0.009 and <0.001). The mean of uric acid and UCR was 5.6 (SD, 2.35) and 4.4 (SD, 1.9) in the total population, respectively, and were significantly higher in the acute phase and patients with frequent exacerbations (FE ≥ 3 exacerbations a year), p-value <0.05. The area under the curve (AUC) of ROC analysis showed a high performance of uric acid and UCR for predicting acute phase (0.84 [95%CI, 0.73-0.96] and 0.86 [0.74-0.98]), FE (0.72 [0.60-0.85] and 0.75 [0.63-0.87]), and FE among acute-phase patients (AUC, 0.63 [0.46-0.79] and 0.66 [0.50-0.81], respectively). CONCLUSION: Uric acid and UCR could be invaluable predictors of frequent exacerbation and the acute phase of COPD. Therefore, they might be applicable in evaluating the severity and progress of the disease.

Nephrologist, Pulmonologist Connection: From Bench to Bedside, Mini Review.

Whether working in intensive care unit or not as nephrologists we are all facing complicated cases with different sign and symptoms. Among them is a category of patients presenting with concomitant respiratory and kidney failure called pulmonary renal syndrome, which needs mutual connection between nephrologist and pulmonologist closely for the best decision-making. Although this is not a common entity, still associated with high rate of morbidity and mortality involving diffuse alveolar hemorrhage and glomerulonephritis. Understanding the updates in the field of management would benefit both the patients and caregivers providing clear answers to present obstacles.

Clinical features and short-term outcomes of COVID-19 in Tehran, Iran: An analysis of mortality and hospital stay.

Background The sudden outbreak of the COVID-19 disease originated in Wuhan, China, in December 2019. There have been few reports of the clinical course of the disease, but detailed information on the risk factors for increased hospital stay and mortality is not available. In this study, we aimed to present the details of 53 confirmed COVID-19 cases to share the clinical course and the risk factors for longer hospital stay and death. Methods In this study, we enrolled fifty-three patients with confirmed COVID-19 infection from a referral academic hospital in Tehran, Iran admitted between March and April 2020. Patients' demographics, laboratory tests, treatments, length of hospital stay (LOHS), and final outcome were recorded and analyzed. Results Fifty-three patients were included in this study. The higher LOHS was associated with clinical symptoms, including hemoptysis (IRR= 0.73, P-value= 0.02), diarrhea (IRR= 0.78, P-value= 0.01), headache (IRR= 0.81, P-value= 0.05), and dry cough (IRR= 0.82, P-value= 0.05). Mortality was associated with older age(Odds ratio=1.148, 95%CI=1.032-1.276), lower calcium level (Odds ratio=0.087, 95%CI=0.010-0.788), lower serum albumin (Odds ratio=0.036, 95%CI=0.002-0.655), as well as increased level of neutrophil/lymphocyte ratio (NLR) (Odds ratio=1.468, 95%CI=1.086-1.985), lactate dehydrogenase (LDH) (Odds ratio=1.004, 95%CI=1.000-1.007), and urea (Odds ratio=1.023, 95%CI=1.006-1.039).  Conclusion Our study identified that decreased levels of O2saturation, platelet count, calcium, albumin, and increased NLR, LDH, urea, and old age were correlated with mortality. Also, LOHS was significantly associated with clinical findings, such as hemoptysis and diarrhea.

Yellow Nail Syndrome: Report of a Case Successfully Treated with Octreotide.

Yellow nail syndrome (YNS) is an uncommon condition characterized by a triad of yellow nail coloration, lymphedema and respiratory tract involvement. This syndrome typically affects middle-aged persons. Although several etiologies have been described, to date; the exact etiology remains unclear. Different treatment plans have been suggested, but all data available emphasize the fact that treatment is mainly symptomatic and the underlying disease is not targeted. The most reported treatment protocol is chemical pleurodesis combined with alpha-tocopherol (vitamin E). Hereby, we describe a case of YNS in a 34 year-old woman with the onset of symptoms in childhood. The symptoms improved dramatically after treatment with octreotide.

Prevalence of pulmonary hypertension in patients undergoing hemodialysis.

INTRODUCTION: Pulmonary hypertension (PH) is one of the most important accompanying comorbidities with hemodialysis in patients with end-stage renal disease. The prevalence of hemodialysis-induced PH is still a subject of debate. The goal of the present work was to determine the prevalence of PH in patients undergoing hemodialysis. MATERIALS AND METHODS: This study was carried out on patients undergoing hemodialysis for at least 6 months. Pulmonary artery pressure (PAP) was measured by a cardiologist using echocardiography, and a value equal to or higher than 35 mm Hg was considered PH. The relationship of a high PAP with demographic and clinical characteristics of the patients was assessed. RESULTS: A total of 102 patients were included in the study. The mean of age was 59 +/- 18 years. The most common cause of end-stage renal disease was diabetes mellitus (35%). The mean duration of hemodialysis was 24 +/- 17 months. The mean ejection fraction and PAP were 57 +/- 5% (range, 44% to 73%) and 39 +/- 9 mm Hg (range, 25 mm Hg to 70 mm Hg), respectively. Overall, 66% of the patients had PH. These patients were more likely to be on dialysis for a longer duration and to have low ejection fractions. They were also older than other patients. CONCLUSION: Our findings show that PH is associated with duration of dialysis, age, and ejection fraction. Due to the high prevalence of PH among hemodialysis patients, it is necessary to screen this disorder and minimize its effects.

Assessment of rapid shallow breathing index as a predictor for weaning in respiratory care unit.

BACKGROUND: At present, air way support plays pivotal role in management of patients in the ICU (Intensive Care Unit) and also RCU (Respiratory Care Unit). Ventilator weaning is an important step in the care of ICU and RCU patients. It is the gradual removal of mechanical ventilatory support. Different predictors are used for initiation of weaning. This study was designed to investigate the rapid shallow breathing index (RSBI) as a predictor for successful weaning. MATERIALS AND METHODS: This cross-sectional study was conducted on 70 patients who had mechanical ventilation for more than 48 hours in a respiratory care unit in Tehran Labbafi Nejad Hospital. They were clinically stable and had the criteria for weaning from the ventilator. We measured RSBI, and then evaluated the value of RSBI for successful extubation. RSBI was calculated when patients were on spontaneous breathing mode with PSV=0 and PEEP=0 for one minute. RESULTS: A total of 70 patients were included in this study; 63(90%) patients had RSBI ≤105 (breath/min/L), among them 49 (77%) patients had successful weaning and did not need re-intubation while the remaining had unsuccessful weaning (P=0.001). The mean weaning index for patients with successful extubation was 66 ± 57.2 and 76.9 ± 28.1 for patients with unsuccessful extubaion. We could not find a significant difference between the means (P=0.433). CONCLUSION: Although RSBI <105 is a helpful index for weaning, application of RSBI alone may mislead the physicians. General status of the patient, concomitant diseases and duration of hospital stay should all be considered for successful weaning.

Association between COPD Assessment Test (CAT) and Disease Severity Based on Reduction of Respiratory Volumes in Chemical Warfare Victims.

BACKGROUND: This study aimed to find an association between the short validated patient-completed questionnaire, the COPD Assessment Test (CAT) and disease severity according to spirometric findings in chemical warfare victims. MATERIALS AND METHODS: A total of 55 patients referred to Sasan Hospital (special complex for chemical warfare victims) were included in this survey. They completed CAT questionnaire and then spirometry was performed. According to GOLD criteria, the subjects were divided into four severity groups. All candidates were non-smoker males. They all had FEV1/FVC < 70%. RESULTS: CAT scores varied from 5 to 39, with a mean score of 22.25. FEV1 varied from 17.5% to 89% with a mean of 53.14, and FVC ranged from 22.9% to100% with a mean of 61.12. Data analysis revealed a significant relationship between CAT and FEV1 (P = 0.01). There was also a significant relationship between CAT and FVC (P = 0.05). CONCLUSION: Our findings show a significant association between CAT and disease severity obtained by lung function in chemical warfare victims.

Intrathoracic kidney presented with chest pain.

Intrathoracic kidney is a rare congenital anomaly, with only about 50 cases reported in the literature to date. It comprises less than 5% of all ectopic kidney disorders. However, it should be included in the differential diagnosis of posterior mediastinal masses as confirmation of the diagnosis obviates the need for further clinical studies, further treatment, or unnecessary surgical operation. Chest computed tomography is an important and efficient tool in confirming the diagnosis. We report a case of a 72-year-old woman who suffered from nonspecific chest pain for 3 years. Chest radiography revealed a left posterior mediastinal mass which was later confirmed by chest computed tomography to be a congenital intrathoracic kidney.