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.

Effect of home-based nursing pulmonary rehabilitation on patients with chronic obstructive pulmonary disease: a randomised clinical trial.

Fatigue is a common symptom of patients with chronic obstructive pulmonary disease (COPD), and results in a reduction of daily activity and quality of life in patients with the disease. The authors aimed to identify the effect of home-based nursing pulmonary rehabilitation on fatigue, activities of daily living (ADL) and quality of life (QOL) in patients with COPD. A block randomisation method was used to randomise participants into case and control groups. Fatigue, ADL and QOL were assessed before and after the intervention in both groups. Independent and paired t-tests, chi-squared tests and covariance analysis were used to analysing data. Findings showed the significant decrease in the mean scores of fatigue (p<0.001) and significant improvement in mean scores of ADL (p<0.001) and QOL (p<0.001) after home-based nursing pulmonary rehabilitation in the case group. Home-based nursing pulmonary rehabilitation can be an effective, inexpensive and accessible programme for decreasing fatigue and improving ADL and QOL for patients with COPD.

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.

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.

Churg Strauss Syndrome after polypectomy in asthmatic and allergic patients.

Churg Strauss Syndrome (CSS) is a form of primary vasculitis that is characterized by severe eosinophilia and often granulomatous inflammation as well as history of asthma or allergy. Previously, the association between cysteinyl leukotrien receptor antagonists (LTRAs), corticosteroid withdrawal or a sudden change in its used method and CSS had been established. We report three cases that have been referred because of dyspnea, wheezing and cough with a history of allergic rhinitis and nasal polypectomy. After polypectomy, disseminated skin purpuric rashes appeared on their forelegs, abdomen and all of them had experienced neuropathic signs in their extremities. Clinical findings, marked eosinophilia in blood and skin biopsies finally led to the diagnosis of CSS. The patients have been free of symptoms after receiving prednisolone; routine examinations and blood tests have rended regular results. Here, we report a probable occurrence of an association between nasal polypectomy and CSS on the basis of our findings. Further, extended researches are required to establish this correlation.

Churg Strauss syndrome after introducing oral steroid to inhaler: a report of three cases.

The tetrad of bronchial asthma, severe sinusitis, nasal polyp, eosinophilia, and systemic vasculitis is the main feature of allergic granulomatosis and angitis (Churg- Strauss Syndrome). This vasculitis is usually seen idiopathic in patients with a long history of asthma; oral steroids using steroid inhalers, vaccination and desensitization might be triggering factors. Drugs such as leukotriene receptor antagonists (LTRAS), penicillin, sulphonamides, anticonvulsants and thiazides have also been implicated. By presenting the cases in this article, the authors suggest that some cases of CSS may be partially or totally suppressed by corticosteroid therapy of asthma for long periods and replacing oral steroid by inhaler will reveal a pathologic condition of CSS, called frustes CSS forms. We report three subjects with asthma who had been receiving previously multiple corticosteroid courses for control, but when systemic corticosteroids were discontinued or switched over to steroid inhaler, the patients developed a similar syndrome.