The Respiratory Microbiome in Paediatric Chronic Wet Cough: What Is Known and Future Directions.

Chronic wet cough for longer than 4 weeks is a hallmark of chronic suppurative lung diseases (CSLD), including protracted bacterial bronchitis (PBB), and bronchiectasis in children. Severe lower respiratory infection early in life is a major risk factor of PBB and paediatric bronchiectasis. In these conditions, failure to clear an underlying endobronchial infection is hypothesised to drive ongoing inflammation and progressive tissue damage that culminates in irreversible bronchiectasis. Historically, the microbiology of paediatric chronic wet cough has been defined by culture-based studies focused on the detection and eradication of specific bacterial pathogens. Various 'omics technologies now allow for a more nuanced investigation of respiratory pathobiology and are enabling development of endotype-based models of care. Recent years have seen substantial advances in defining respiratory endotypes among adults with CSLD; however, less is understood about diseases affecting children. In this review, we explore the current understanding of the airway microbiome among children with chronic wet cough related to the PBB-bronchiectasis diagnostic continuum. We explore concepts emerging from the gut-lung axis and multi-omic studies that are expected to influence PBB and bronchiectasis endotyping efforts. We also consider how our evolving understanding of the airway microbiome is translating to new approaches in chronic wet cough diagnostics and treatments.

A Short Review on the Relationships Between Nephrolithiasis and Myocardial Infarction.

The interaction between organs is a crucial part of modern medicine. As a very prerequisite to manage a disease, practitioners should have a full awareness of the related organs. Kidney and heart are two vital organs that are closely interconnected in various fields. These two organs have a lot of common risk factors for making a person unhealthy; therefore, if you prevent the disease in one of them, the other's morbidity might be alleviated as well. Among them, nephrolithiasis and myocardial infarction (MI) have more risk factors in common, and both could be fatal. Also, these two diseases are important regarding the prevalence, incidence, and burden of disease. Some studies confirm the relationship between MI and nephrolithiasis; however, further researches are needed to discover the exact direction of their relationship. The present review aims to explain the mechanism of MI and nephrolithiasis; clarify the relationship between these two disease based on physiological, pathological, and clinical studies; and propose some solutions for the prevention and treatment of such diseases.

Association of anatomic variations with antrochoanal polyps in paranasal sinus computed tomography scan.

BACKGROUND: This study was designed to determine the prevalence of concomitant anatomic variation of paranasal sinuses in patients with antrochoanal polyp (ACP). MATERIALS AND METHODS: Among patients referred by their clinicians for standard computed tomography scan of paranasal sinuses septal deviation, concha bullosa, and retention cyst were evaluated in both patients with ACP as well as in a control group. RESULTS: Of the 17 patients with ACP, fifteen patients (88.2%) had septal deviation and two patients (11.8%) had concha bullosa. None of the patients with ACP had retention cyst or hypertrophic turbinate. Of the 78 patients in control group, twenty-nine (37.2%) had septal deviation, six (7.7%) had concha bullosa, seven (8.9%) had retention cyst, and one (1.2%) had hypertrophic turbinate. Septal deviation in patients with ACP has higher incidence (P < 0.001). CONCLUSION: This study showed that septal deviation is an anatomic variation which is significantly concomitant with ACP. Larger studies are needed to show the role of other anatomic variations in patients with ACP.

Comparison of Nasal Mucociliary Function before and after Septorhinoplasty Surgery Using Saccharin Test.

BACKGROUND: This study was carried out to compare mucociliary function (MCF) of nasal cavity before and after septorhinoplasty surgery by saccharin test. MATERIALS AND METHODS: This study was carried out on 70 patients who needed septorhinoplasty surgery in Kashani and Alzahra Hospital during 2013-2014 to measure MCF. Saccharin test was performed on the patients before surgery and on three more intervals 1 day, 1 week, and on month after ward and the readings were recorded. Saccharin test is performed by placing saccharin granules on the anterior part of inferior turbinate and the time the patient feels the sweet taste is recorded the normal range is below 30 min. RESULTS: Mean of test for each time interval was obtained and comparison of measurements was made reading were mean of saccharin test before surgery (7.74 ± 1.65 min) the day after surgery (7.75 ± 1.7 min), on week after surgery (15.04 ± 3.4), and 1 month after surgery (8.49 ± 2.08 min). The readings before surgery did not have statistically significant difference with the readings 1 day after surgery P = 0.99, but comparison of test results at other time intervals were significant (P < 0.001). A relative increase in saccharin test time was seen in a period of 1 month after surgery the rise was more noticeable in the 1st week compared to 1 month after surgery. CONCLUSION: This study in the period after septorhinoplasty surgery MCF undergoes slight impairment that gradually progresses to normal values during 1 month after surgery.

Cigarette smoking effect on human cochlea responses.

BACKGROUND: Smoking is one of the most important risk factor in increasing of non-communicable disorders, especially chronic diseases such as cancer, stroke, heart and respiratory diseases. Cigarette smoking could damage the cochlea and causing hearing loss. The otoacoustic emission (OAE) is a source of information for determining cochlear responses to sound stimuli and how to change the response of the auditory system in some diseases. OAE test was sensitive to outer hair cells (OHCs) activity. MATERIALS AND METHODS: In this study, tried to evaluate a hearing threshold of the smoker group versus non-smoker ones through pure tone audiometery, transient evoked otoacoustic emission (TEOAE) and distortion product otoacoustic emission (DPOAE) tests. RESULTS: The results indicated that significant decrement of 8000 Hz threshold, reduced DPOAE/TEOAE amplitude in the smoker group than non-smoker one (P < 0.05). DPOAE amplitudes decline reflects the cochlear damage caused by smoking. CONCLUSION: OAEs test was clinically non-invasive, accurate, and objective evaluation of the performance of cochlear OHCs.

Effectiveness of itraconazole on clinical symptoms and radiologic findings in patients with recurrent chronic rhinosinusitis and nasal polyposis.

BACKGROUND: This study was done to evaluate the effect of itraconazole on clinical symptoms and radiologic findings in patients with chronic rhinosinusitis and nasal polyposis after surgery. MATERIALS AND METHODS: In a clinical trial which was conducted in Alzahra and Kashani hospitals, from November 2011 to December 2012, 22 patients with recurrent postsurgical chronic sinusitis and polyposis entered the study. At the start of the study demographic data, subjective clinical symptoms (severity of rhinorrhea, nasal obstruction, hyposmia, and dyspnea), quality of life (QoL) by sinonasal outcome test-20 (SNOT-20), serum immunoglobulin E (IgE), and score of computed tomography (CT) scan (by Lund-Mackay) were recorded. Itraconazole (100 mg, twice per day) prescribed for 3 months and patients were followed in the 1(st), 3(rd), and 6(th) months. Liver enzyme tests and side effects were evaluated monthly. RESULTS: Severity of rhinorrhea, nasal obstruction, hyposmia, dyspnea, and QoL (by SNOT-20) improved during 3 months of treatment. Serum IgE was 265 (±277) at the start of the study, and decrease to 193 (±183) after 3 month. After 3 month, Lund-Mackay score of CT scan lowered from 19 (±4) to 15 (±6) (P < 0.05). At the 6(th) month, severity of clinical symptoms except dyspnea and QoL were better than first evaluation. CONCLUSION: This study showed the beneficial effect of 3-month itraconazole treatment on clinical symptoms and radiologic findings and QoL in patients with recurrent postsurgical chronic rhinosinusitis and nasal polyposis.

Preventive effects of zinc sulfate on taste alterations in patients under irradiation for head and neck cancers: A randomized placebo-controlled trial.

BACKGROUND: Taste abnormalities are common among cancer patients after starting radiotherapy or chemotherapy. Considering the role of zinc and reports on its beneficial effects in taste perception, we evaluated the preventive effects of zinc sulfate on radiation-induced taste alterations. MATERIALS AND METHODS: In a randomized, placebo-controlled trial, adult patients with head and neck cancers who were on schedule for radiotherapy, with or without chemotherapy, were allocated to receive zinc sulfate (50 mg, three times a day) or placebo; started with beginning of radiotherapy and continued for one month later. Taste acuity was determined by measuring detection and recognition thresholds for four taste qualities at baseline, at the end of radiotherapy, and a month later using the Henkin method. RESULTS: Thirty-five patients (mean age = 59.2 ± 16.5, 60% male) completed the trial. The two groups were similar at baseline. After radiotherapy, and one month later, there was a significant increase in taste perception threshold for bitter, salty, sweet, and sour tastes in the placebo group (P = 0.001). In those who received zinc, there was only slight increase in threshold for perception of the salty taste (P = 0.046). No relevant side effects due to zinc sulfate were reported. CONCLUSION: Zinc supplementation in head/neck cancer patients under radiotherapy can prevent radiation-induced taste alterations. Further studies with longer follow-ups and with different doses of zinc supplementation are warranted in this regard.

Hearing impairment in congenitally hypothyroid patients.

OBJECTIVE: Thyroid hormone is necessary for normal development of the auditory system. The aim of this study was to investigate the rate of hearing impairment in congenitally hypothyroid (CH) patients, and its relation with factors such as CH severity and age at starting treatment, during CH screening program in Isfahan. METHODS: Hearing acuity was assessed in two groups of children with (94 patients aged 4 months - 3 years) and without CH (450), between 2000-2006. Otoacostic emission (OAE) was performed by a two step method. After two tests without OAE signals bilaterally, they were referred for auditory brainstem response (ABR) test. Subjects with both OAE and ABR abnormal test results were considered to have hearing problem. Obtained data was compared in case and control group and also CH patients with and without hearing impairment. FINDINGS: Three (3.2%) of patients and 1 of control group (0.2%) were diagnosed with sensorineural hearing loss. The rate of hearing loss was not different significantly in two studied groups (P>0.05). There was no difference between age of starting treatment and first T4 and TSH level in CH patients with and without hearing loss (P>0.05). CH neonates with hearing impairment had thyroid dyshormonogenesis according to the follow up results. CONCLUSION: The rate of hearing loss was low among our studied CH patients. It may be due to proper management of CH patients. In view of the fact that all CH neonates were dyshormonogentic and considering the relation between certain gene mutations and hearing impairment in CH patients, further studies with larger sample size, with regard to different etiologies of CH should be investigated to indicate the possible gene mutations related to hearing loss in CH.

A study on body mass index, blood pressure, and red blood cell indices in new entering students of the university of isfahan.

OBJECTIVES: Obesity and increased blood pressure are identified as risk factors for cardiac and pulmonary disorders. On the other hand, iron deficiency (another preventable disease) is common in adolescence and considered as associated with health impairment. The present study evaluates body mass index (BMI) and its association with blood pressure and hematological indices in freshman students entering the University of Isfahan in 2009. METHODS: All the 1675 students who entered the University of Isfahan in September 2009 were examined. Height, weight, BMI, blood pressure, hemoglobin (Hb) and red blood cell (RBC) indices of these students were measured. The prevalence of high blood pressure, its association with BMI and the relation between BMI and anemia, iron deficiency and educational achievement were assessed. RESULTS: All participants, including 514 males and 1161 females, went under clinical observations. The average age was 20.7 ± 3.8. year Among the students, 18.2% of males and 20% of females were underweight. High systolic blood pressure was more common in the students with BMI > 25 kg/m(2) (p < 0.001). Anemia was seen in 8.7% of females. In males, however, a relation between anemia frequency and BMI < 18.5 kg/m(2) was more distinct (p = 0.002). There was no association between anemia and students' average test scores. CONCLUSIONS: High incidence of abnormal BMI in the study population, and its association with systolic blood pressure indicate the importance of nutritional guidelines and counseling programs for freshman students. On the other hand, high incidence of anemia in this population ascertains the necessity of anemia screening programs before academic studies.