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.

Relationship of Coping Styles with Suicidal Behavior in Hospitalized Asthma and Chronic Obstructive Pulmonary Disease Patients: Substance Abusers versus Non- Substance Abusers.

BACKGROUND: Treatment of patients with chronic conditions requiring hospitalization requires patient acceptance and cooperation and adoption of coping strategies. Inappropriate coping strategies such as substance abuse are concerning in the course of treatment. This study sought to explore the association of coping strategies with suicidal behavior in substance abusers and non substance abuser patients with chronic pulmonary diseases namely asthma and chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: This comparative study was performed on 100 patients with asthma and COPD selected via convenience sampling. Subjects with and without substance abuse were separated into two groups of 50 patients each. Ways of Coping Questionnaire of Lazarus (WOCQ) and Suicide Behavior Questionnaire-Revised (SBQ-R) were completed by them. Five Persian speaking patients rated this questionnaire to be easily understandable in the pre-test stage. Cronbach's alpha was calculated to measure the internal consistency. RESULTS: The mean (±standard deviation) age of participants was 40 (±14) years; 58% of individuals were men; 62% had chosen problem-focused coping. The most abused substances were cigarettes (78%) and opium (42%); 6% of substance abusers had thought about suicide five times or more in the past year; 5% of substance abusers had seriously attempted suicide. Tendency to commit suicide was greater in men, substance abusers and participants who had chosen emotion-focused coping strategies, based on a regression model. Average score of suicide tendency was significantly higher in substance abusers (B=2.196, P =0.007). CONCLUSION: Chronic disease is a crisis and patients need to acquire appropriate coping strategies to deal with it, especially in substance abusers and suicidal patients. Precise recognition of coping strategies in chronic pulmonary patients with substance abuse is necessary via a team cooperation among psychiatrics, psychologists and an internal physician in hospitals because medical treatment alone is not sufficient in such cases.

Study of effects of selective serotonin reuptake inhibitors on stages of sexual function in Iranian patients with major depressive disorder.

OBJECTIVE: Depression is one of the most common psychiatric disorders in the world. Lifetime prevalence is 15% among men and 25% among women. Selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants and monoamine oxidase inhibitor antidepressants are often used for depression, with their own side effects. This study was carried out since little information on sexual dysfunction due to these medications is available in Iran. METHODS: This observational cross-sectional study included 100 patients attending a university or private psychiatry clinic who, after an interview based on Diagnostic and Statistical Manual of Mental Disorders fourth edition criteria, were considered depressed. These patients had no history of depression, sexual dysfunction or use of psychiatric medications. Sexual functioning of patients was evaluated at the start of the study, and after 2, 4 and 8 weeks of treatment. Data were evaluated using SPSS software and t and χ(2) tests. RESULTS: A total of 75% of patients reported sexual dysfunction: 66.7% of men and 79.7% of women. A total of 74.1% of patients on fluvoxamine, 100% on fluoxetine, 75% on sertraline, 71.4% on citalopram and 100% on paroxetine reported sexual dysfunction. The most frequent sexual dysfunction was difficulty with orgasm, which affected 41.17% of women and 33.33% of men. CONCLUSION: The incidence of sexual dysfunction among users of SSRIs was highest in patients on fluvoxamine, but this was not statistically significant. Minimization of sexual side effects should be an essential consideration when prescribing antidepressants.

Clinical trial in the treatment of 80 Iranian patients with major depression disorder by the combination of omega 3 fatty acid and a selective serotonin reuptake inhibitor.

OBJECTIVES: Bipolar disorder type I is a disturbing psychiatric syndrome, which is treated by mood-stabilizing medications, psychosocial intervention and electroconvulsive therapy. As supplementation with omega 3 has been considered effective in the treatment of many diseases especially mental disorders, this study aimed at evaluating the effect of omega 3 with fluvoxamine compared with fluvoxamine alone in the treatment of the deep depression phase in bipolar patients type I. METHODS: A total of 80 patients in this clinical trial study were selected using a randomized controlled trial in two case and control groups by a psychiatrist. The case group took fluvoxamine and omega 3 tablets and the control group took only fluvoxamine. Patients completed the Hamilton Depression Rating Scale and demographic questionnaire at the beginning of the study and after 2, 4, 8 and 12 weeks. RESULTS: The mean scores in the Hamilton Depression Rating Scale in both groups under study after 2, 4, 8, 12 weeks decreased. Statistics showed a significant difference in scores in both groups before the treatment and after mentioned weeks. CONCLUSIONS: Since research findings showed the effectiveness of omega 3 and its harmlessness, it is suggested that omega 3 can be prescribed with other antidepressant medications.

Case of missing left lung.

Here we present a young female with missing left lung and history of upper respiratory infections in childhood. The lungs have ability to grow and regenerate in children. She has had no major complications into adulthood. It is important to know diagnosis in recurrent pulmonary infections and here bronchoscopy was diagnostic.

Chronic productive cough and extensive cysts in left lung.

Bronchiectasis refers to dilated and thickened airways due to chronic inflammation and infections, with anatomic distortion of the bronchi. Here, we describe a 29-year-old man with a history of multiple hospitalizations for lung infection who presented to the pulmonary clinic with a complaint of worsening chronic productive cough in the previous year. This case presentation prompted a review of the etiologies of bronchiectasis in 291 recent cases admitted to Masih Daneshvari Hospital, Tehran.

Validity and specificity of the Persian version of the Saint George Respiratory Questionnaire.

INTRODUCTION: The Saint George Respiratory Questionnaire (SGRQ) is a well-known questionnaire for evaluating the quality of life in asthmatic patients. It has been translated to Persian and its validity and specificity should be evaluated for chronic obstructive pulmonary disease patients. In this study, we attempted to improve the questionnaire's adaptability to Persian culture and also evaluate its validity, specificity, and applicability among asthmatics at our tertiary referral center. MATERIALS AND METHODS: Previously translated and psychometrically evaluated SGRQ for chronic obstructive pulmonary disease patients was made more adaptive to Persian. Upon acceptability of the questionnaire by a small group of patients, 301 asthmatics referred for spirometry and completed the form. Consistency was evaluated using Cronbach's α coefficient and validity was assessed by comparison of scores with other measures of asthma exacerbation. These measures included FEV1, patient's clinical presentation, visual analog scale (used to assess difficulty breathing), Katz activity index and section scores of the General Health Questionnaire, anxiety, depression, and social impact. RESULTS: The study group included 165 female and 139 male asthmatics with a mean age of 44.4 ± 1.0 years. Measurement of consistency for the SGRQ revealed Cronbach's α to be 0.699 for symptoms, 0.805 for activity, 0.879 for impact, and 0.916 for the total questionnaire. By omitting question 8, time of wheezing during the day increased Cronbach's coefficient of the symptoms section to 0.719. Omitting "uselessness of respiratory drugs" from the impact section increased Cronbach's α to 0.881. However, scoring of the section then varied from the original questionnaire. A statistically significant correlation was found between the SGRQ sections and total score (using Katz index and General Health Questionnaire, p < .001). CONCLUSION: Our study showed good validity and reliability for the Persian version of SGRQ for a population of asthmatics referred to our tertiary pulmonary clinic.

Efficacy of telephone quit-line for smokers in iran: 12 months follow up results.

BACKGROUND: Smoking cessation is an effective intervention for cancer prevention. For some reasons many smokers cannot attend quit programs and they prefer to have a consultation over the phone. In this study we share our experience regarding setting up a quit-line for smoking cessation for the first time in Iran. MATERIALS AND METHODS: Two general practitioners were trained to give consultation over the phone via quit line in Tehran. The quit program consisted of 4 sessions with 1 week interval. Our telephone counseling was both reactive and proactive from 8 AM till 5 PM during the years 2005 - 2008. In reactive counseling, the smoker initiates the call and speaks with a counselor about his/her current concerns. In proactive counseling, the counselor calls the smoker and provides counseling in a systematic manner. Smoking status was determined based on smokers' self-report and regular follow-ups were conducted after quitting. Some cases were randomly selected for CO respiratory test in order to confirm their abstinence. RESULTS: A total of 480 cases entered the cessation program out of which, 80% were males. The mean age was 38.5±7.9 years, 72.7% of participants were married, 75.2% of subjects were educated and 51.3% of cases had high nicotine dependence. A total of 332 cases received a brief advice on quitting, 148 people continued their active participation to complete the course and 122 cases (82.4%) quitted smoking. The sustained abstinence rate after 1, 3, 6 and 12 months was 59%, 41%, 31% and 18%; respectively. CONCLUSION: This method is an appropriate and accessible method which can be suggested to smokers during smoking cessation counseling.

Churg-Strauss syndrome following cessation of allergic desensitization vaccination: a case report.

INTRODUCTION: Churg-Strauss syndrome is a vasculitis of medium to small sized vessels. Diagnosis is mainly clinical with findings of asthma, eosinophilia, rhinosinusitis and signs of vasculitis in major organs. CASE PRESENTATION: We present a case of a 19-year-old Persian male who developed signs and symptoms of this syndrome related to hyposensitization treatments for allergy control. CONCLUSIONS: No unifying etiology for the disease can be presented as it is found associated with environmental factors, medications, infections and is even considered a variant of asthma with predisposition to vasculitic involvement. Therefore, it is important to recognize this disease and be aware of underdiagnosis because of emphasis on pathologic evidence. Here, we present a case of allergic desensitization causing Churg-Strauss syndrome in the absence of other known factors.