Association of Metabolic Syndrome and Asthma Status: A Prospective Study from Guilan Province, Iran.

INTRODUCTION: Asthma is defined as a chronic inflammatory airway disease. Recent studies have shown the association between metabolic syndrome and deterioration of lung functions in patients with asthma. The aim of this study was to evaluate the relationship between metabolic syndrome and asthma status. METHODS: In this prospective cross-sectional study, 160 asthmatic patients attending Razi hospital in Guilan province were divided equally into two groups of 80 patients. The case group comprised asthmatic patient with metabolic syndrome and the control group involved asthmatic patient without metabolic syndrome. Blood pressure, height, weight, waist circumferences, fasting blood glucose and lipid profiles were measured by standard methods. Asthma severity was determined based on clinical symptoms and GINA criteria. To evaluate pulmonary function parameters, spirometry was performed for the patients. RESULTS: Pulmonary function tests including FEF, FVC and FEV1 were significantly lower in the case group compared to the control group (P < 0.05). Also, a significant negative correlation was found between waist circumference, cardiovascular risk factors (including diabetes, hypertriglyceridemia, hypertension) with spirometric indices (P < 0.05). CONCLUSION: Metabolic syndrome causes major declines of pulmonary parameters in asthma patients; thus controlling metabolic syndrome might improve symptoms of asthma.

Results of the surgical treatment of pulmonary bleb and bullous disease: A retrospective study.

Objective: Bullous lung disease is characterised by the development of bullae within the lung parenchyma. Smoking is considered as a main risk factor of bullae formation. The clinical manifestation varies from asymptomatic bullae to severe respiratory distress. The exact medical approach is still controversial. Here, we aimed to evaluate the patient clinical characteristics and the indication of surgery in the patients. Methods: This study was an analytic cross-sectional study in Razi hospital, Rasht, Iran, in 2016-2020. A total of 110 patients with newly diagnosed lung bullae underwent evaluation based on a checklist, which assessed the variables as clinical characteristics, bullae features, the medical treatment, and its complication. Eventually, statistical analysis was performed by using SPSS v21.0. Results: : A total of 110 patients were enrolled. All the patients were smokers. In 72.9%, the primary presentation was respiratory distress, which needed surgical resection with no recurrence over 8 months. The clinical manifestation varies from asymptomatic bullae in 4.3% and pneumonia in 34.3% to respiratory distress in 61.4%. There was no statistical correlation between clinical manifestation and all the studied variables excluding respiratory distress (p value: 0.659). Seventy patients underwent surgical treatment, in which 20 cases were complicated by air leak that was managed by the chest tube in 16 patients and the Heimlich valve in four patients. No evidence of recurrence was detected. Conclusion: The main risk factor of bulla formation is smoking. Because of various clinical presentations, the appropriate medical approach is of paramount importance.

Incidence of symptomatic venous thromboembolism following hospitalization for coronavirus disease 2019: Prospective results from a multi-center study.

BACKGROUND: Thrombosis and pulmonary embolism appear to be major causes of mortality in hospitalized coronavirus disease 2019 (COVID-19) patients. However, few studies have focused on the incidence of venous thromboembolism (VTE) after hospitalization for COVID-19. METHODS: In this multi-center study, we followed 1529 COVID-19 patients for at least 45 days after hospital discharge, who underwent routine telephone follow-up. In case of signs or symptoms of pulmonary embolism (PE) or deep vein thrombosis (DVT), they were invited for an in-hospital visit with a pulmonologist. The primary outcome was symptomatic VTE within 45 days of hospital discharge. RESULTS: Of 1529 COVID-19 patients discharged from hospital, a total of 228 (14.9%) reported potential signs or symptoms of PE or DVT and were seen for an in-hospital visit. Of these, 13 and 12 received Doppler ultrasounds or pulmonary CT angiography, respectively, of whom only one patient was diagnosed with symptomatic PE. Of 51 (3.3%) patients who died after discharge, two deaths were attributed to VTE corresponding to a 45-day cumulative rate of symptomatic VTE of 0.2% (95%CI 0.1%-0.6%; n = 3). There was no evidence of acute respiratory distress syndrome (ARDS) in these patients. Other deaths after hospital discharge included myocardial infarction (n = 13), heart failure (n = 9), and stroke (n = 9). CONCLUSIONS: We did not observe a high rate of symptomatic VTE in COVID-19 patients after hospital discharge. Routine extended thromboprophylaxis after hospitalization for COVID-19 may not have a net clinical benefit. Randomized trials may be warranted.

The Role of Metallic Nanoparticles in Inhibition of Mycobacterium Tuberculosis and Enhances Phagosome Maturation into the Infected Macrophage.

This review focuses on the role of gallium (Ga) nanoparticles (NPs) to enhance phagosome maturation into the Mycobacterium tuberculosis-infected macrophage and the role of magnetic iron NPs as nanocarriers of antituberculosis drugs. The literature shows that silver (Ag) and zinc oxide (ZnO) NPs with dimensions less than 10 nm can penetrate directly through the macrophage bilayer membrane. Ag NPs increase the permeability membrane by motiving the aggregation of proteins in the periplasmic space and forming nano-sized pores. ZnO NPs can interact with the membrane of M. tuberculosis, which leads to the formation of surface pores and the release of intracellular nucleotides. The colloidal Ag:ZnO mixture NPs with 1:1 ratio can eliminate M. tuberculosis and shows the lowest cytotoxicity effects on MCF-7 and THP-1 cell lines. Ag/ZnO nanocrystals are not able to kill M. tuberculosis alone ex-vivo. Hence, bimetallic gold (Au)/Ag NPs possessed high efficiency to inhibit M. tuberculosis in an ex-vivo THP-1 infection model. Co-delivery of mixed MeNPs into a polymeric carrier collaborated to selective uptake by macrophages through passive targeting, initial burst release of ions from the encapsulated metallic (Me) NPs, and eventually, reduction of MeNPs toxicity, and plays a pivotal role in increasing the antitubercular activity compared to use alone. In addition, Ga NPs can import drugs to the macrophage, inhibit M. tuberculosis growth, and reduce the inhibition of phagosome maturation. Magnetic encapsulated NPs exhibited good drug release properties and might be suitable as carriers of antituberculosis drugs.

Is latent tuberculosis infection challenging in Iranian health care workers? A systematic review and meta-analysis.

BACKGROUND: The high chances of getting latent tuberculosis infection (LTBI) among health care workers (HCWs) will an enormous problem in low and upper-middle-income countries. METHOD: Search strategies were done through both national and international databases include SID, Barakat knowledge network system, Irandoc, Magiran, Iranian national library, web of science, Scopus, PubMed/MEDLINE, OVID, EMBASE, the Cochrane library, and Google Scholar search engine. The Persian and the English languages were used as the filter in national and international databases, respectively. Medical Subject Headings (MeSH) terms was used to controlling comprehensive vocabulary. The search terms were conducted without time limitation till January 01, 2019. RESULTS: The prevalence of LTBI in Iranian's HCWs, based on the PPD test was 27.13% [CI95%: 18.64-37.7]. The highest prevalence of LTBI in Iranian's HCWs were estimated 41.4% [CI95%: 25.4-59.5] in the north, and 33.8% [CI95%: 21.1-49.3] in the west. The lowest prevalence of LTBI was evaluated 18.2% [CI95%: 3.4-58.2] in the south of Iran. The prevalence of LTBI in Iranian's HCWs who had work-experience more than 20 years old were estimated 20.49% [CI95%: 11-34.97]. In the PPD test, the prevalence of LTBI in Iranian's HCWs who had received the Bacille Calmette-Guérin (BCG) was estimated 15% [CI95%: 3.6-47.73]. While, in the QFT, the prevalence of LTBI in Iranian's HCWs in non-vaccinated was estimated 25.71% [CI95%: 13.96-42.49]. CONCLUSIONS: This meta-analysis shows the highest prevalence of LTBI in Iranian's HCWs in the north and the west probably due to neighboring countries like Azerbaijan and Iraq, respectively. It seems that Iranian's HCWs have not received the necessary training to prevent of TB. We also found that BCG was not able to protect Iranian's HCWs from TB infections, completely.

Waist Circumference and Spirometric Measurements in Chronic Obstructive Pulmonary Disease.

OBJECTIVES: The aim of this study was to evaluate whether the waist circumference of patients with chronic obstructive pulmonary disease (COPD), had an impact on lung function. METHODS: There were 180 patients with COPD recruited into this prospective cross-sectional study. The age, weight, body mass index and waist circumference (WC) were measured. Spirometry parameters including forced vital capacity (FVC), and forced expiratory volume in the first second (FEV1), were measured and FEV1/FVC calculated. RESULTS: The mean FEV1/FVC in both normal weight and overweight patients, did not statistically significantly correlate with WC. The COPD assessment test, positively correlated with WC ( p = 0.031). A positive correlation with body mass index ( p < 0.001), smoking ( p = 0.027), and global initiative for chronic obstructive lung disease score ( p = 0.009), were observed to positively associate with WC. WC, age, C-reactive protein, duration of disease, and gender (male), were observed to be statistically significant risk factors for the severity of COPD. CONCLUSION: WC was not observed to impact upon lung function in this study but it was a predictive factor for COPD severity in patients.

Sarcoidosis, a report from Guilan (an Iranian northen province) (2001-09).

BACKGROUND: Sarcoidosis is a chronic multiorgan autoimmune disorder that affects all racial and ethnic groups and occurs at all ages. OBJECTIVE: The aim of this study was to assess the clinical and epidemiological features of sarcoidosis patients in a referral clinic of pulmonary disease in city of Rasht (Guilan-Iran). METHOD: This retrospective study was done by reviewing sarcoidosis patient's records containing demographic, sign and symptom and clinical data in a pulmonary clinic in Rasht from 2001-09. All statistical analyses were achieved using SPSS. RESULTS: most common signs and symptoms were respiratory, systemic and musculoskeletal complaints. According to Chest X-Ray, 61.3% had bilateral hilar lymphadenopathy (BHL) alone (stage 1), and 24.2% had BHL plus parenchymal involvment (stage 2). The most common abnormal finding in spirometry was small airway disease (20.3%).The follow-up data showed that 178 patients (45.2%) had significant improvement clinically, radiologically or both. CONCLUSION: It seems many clinical and radiological aspects of sarcoidosis in our patients are similar to other series. However, presentation with Lofgren's syndrome is a common feature and skin (n=48, 12.3%) and eye (n=19, 4.8%) involvement are less frequent. There is significant difference between west and east of Guilan in relation to referred patients (12.9 % vs 78.5% respectively).Of course this may be due to referral issues of patients and medical teamwork connections

Upper third to lower third width ratio on chest x-ray may predict severity of obstruction in obstructive lung disease.

BACKGROUND: The symptoms and functional limitations due to obstructive lung disease (OLD) are the direct results of airway and lung parenchymal destruction. In these conditions, airflow obstruction leads to increased work of breathing, and gas exchange abnormalities. Hyperinflation, which is inferred from a standard chest radiograph (CXR), may imply increased total lung capacity that can be seen in patients with OLD. Based on experimental observations in OLD patients, we proposed that upper third width in posterioranterior (PA) CXR could be used as a rapid screening method for suggestion of OLD. MATERIALS AND METHODS: In this cross-sectional study, 99 patients admitted to the Respiratory Ward of Razi Medical Center, a teaching referral hospital affiliated to Guilan University of Medical Sciences (GUMS), were entered in the study. The inclusion criteria were any FEV1 with FEV1/FVC <70% or FEV1/FVC>70% with MMEF 75/25 <65%. All cases with diagnostic possibilities other than OLD were excluded. The PA and lateral CXR were performed and 13 measurements - including previous well-known measurements and our proposed new ones- were made by an ordinary ruler on the films. RESULTS: There was no significant correlation between the upper third width and superior/inferior (sup/inf) ratio with spirometric indices in patients. When considering only patients with FEV1/FVC <70%, middle third proportion width had a significant correlation with FEV1/FVC. In subgroup analysis when considering sup/inf ratio > 0.8, superior and inferior third widths were correlated with FEV1/FVC and when considering sup/inf ratio > 0.9, sup/inf ratio was significantly correlated with FEV1/FVC and FEV1. CONCLUSION: The sup/inf ratio >0.9 in PA CXR, may be a predictor of obstructive pattern in OLD patients. For better correlation determination, larger and more extensive studies are needed.