National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IranTANAFFOS (Respiration)1735-034415420161201Breathlessness from the Perspective of the Persian Medicine191196240204ENAli AbdolahiniaDepartment of Iranian Traditional Medicine, Faculty of
Medicine, Shahed University, Tehran, Iran,Mohsen NaseriTraditional
Medicine Clinical Trial Research Center, Shahed
University, Tehran, IranAlireza EslaminejadChronic Respiratory Disease
Research Center, National Research Institute of
Tuberculosis and Lung Disease (NRITLD), Shahid
Beheshti University of Medical Sciences, Tehran, Iran,Farzaneh GhaffariSchool of Traditional Medicine, Shahid Beheshti
University of Medical Sciences, Tehran, IranAli Akbar VelayatiChronic Respiratory Disease
Research Center, National Research Institute of
Tuberculosis and Lung Disease (NRITLD), Shahid
Beheshti University of Medical Sciences, Tehran, Iran,Journal Article20201225Dyspnea is one of the most complaints in the pulmonary diseases. Shortness of breath as a subjective symptom can decrease the quality of life of patients. Although symptomatic treatment of the patients with chemical drugs is efficient in sign reduction, drugs side effect and allowing the disease to become chronic are risky for patients. Nowadays, traditional medicine is considered as an effective strategy in patients' treatment by World Health Organization. This study discusses the causes of shortness of breath from the view of Iranian traditional medicine and describes some suggestion for treatment of causes of this problem. Persian medicine prioritizes prevention of diseases by offering some strategies. In case of disease occurrence, life style modifications and herbal pharmaceutical therapy are recommended.National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IranTANAFFOS (Respiration)1735-034415420161201Tuberculosis in Sulaimaniyah, Iraqi Kurdistan: A Detailed Analysis of Cases Registered in Treatment Centers197204240205ENKamaran KaradakhySchool of Medicine, University of Sulaimani,
Sulaimaniyah, Iraq,Nasih OthmanKurdistan Institution for Strategic
Studies & Scientific Research, Sulaimaniyah, Iraq,Faredun IbrahimmShar
Hospital, Sulaimaniyah, Iraq,Akam Ali SaeedSulaimani Teaching
Hospital,Ari Abdul-Adheem Hama AminCenter for the Respiratory and Chest Disease
Sulaimaniyah, IraqJournal Article20201225Background: Tuberculosis (TB) remains a major public health problem especially in low and middle-income countries. The current study was undertaken to estimate the incidence of the disease and describe its epidemiological characteristics in Iraqi Kurdistan. Materials and Methods: A retrospective study was carried out on cases registered in the directly observed treatment-short course (DOTS) centers in Sulaimaniyah province. Information was collected from the summary reports of all cases registered in 2010 and detailed information was obtained from 307 cases in the main center. Results: During 2010, a total of 530 new and relapsed cases were registered in the DOTS centers amounting to an annual incidence of 31 per 100,000. Over 73% of cases were pulmonary TB and 45% of all cases had positive smear. Most common symptoms were cough (58%), sweating (49%) and fever (48). Almost 43% of patients were diagnosed by direct swab examination, 30% by biopsy and 23% through clinical and radiologic examination. In relation to outcome, 89% of patients were treated successfully, 7% died and 3% defaulted. Mortality rate was 8% in pulmonary infection and 4% in extrapulmonary infection. Old age (65 years and over) was significantly associated with higher odds of death compared to people aged 34 years and younger (OR 6.7, 95% CI 1.3-36.1, P=0.03). Conclusion: The incidence of TB is still high in the Iraqi Kurdistan. The DOTS has been successful in treating the majority of cases but there are areas needing improvement especially record-keeping and patient follow-up during and after treatment.National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IranTANAFFOS (Respiration)1735-034415420161201Role of C-reactive Protein and Tumor Necrosis Factor-Alpha in Differentiating between Ventilator-Associated Pneumonia and Systemic Inflammatory Response Syndrome without Infectious Etiology205212240206ENEbrahim SalehifarDepartment of Pharmacotherapy, Faculty of Pharmacy,
Mazandaran University of Medical Sciences, Sari, Iran,Shima Tavakolian ArjmandDepartment of Pharmacotherapy, Faculty of Pharmacy,
Mazandaran University of Medical Sciences, Sari, Iran,Masoud AliyaliDepartment of Internal Medicine, Faculty of Medicine,
Mazandaran University of Medical Sciences, Sari, Iran,Siavash AbediDepartment of Internal Medicine, Faculty of Medicine,
Mazandaran University of Medical Sciences, Sari, Iran,Ali SharifpourDepartment of Internal Medicine, Faculty of Medicine,
Mazandaran University of Medical Sciences, Sari, Iran,Abbas AlipourDepartment of Epidemiology and Community Medicine,
Faculty of Medicine, Mazandaran University of Medical
Sciences, Sari, Iran,Shahram AlaDepartment of Pharmacotherapy, Faculty of Pharmacy,
Mazandaran University of Medical Sciences, Sari, Iran,Gohar EslamiDepartment of Pharmacotherapy, Faculty of Pharmacy,
Mazandaran University of Medical Sciences, Sari, Iran,Farzad BozorgiDepartment of Emergency
Medicine, Faculty of Medicine, Mazandaran University of
Medical Sciences, Sari, Iran,Mohammad Reza MahdaviDepartment of
Laboratory Tests, Mazandaran University of Medical
Sciences, Sari, Iran,Keith R. WalleyCentre for Heart Lung Innovation,
University of British Columbia, Vancouver, BC, CanadaJournal Article20201225Background: Differential diagnosis of systemic inflammatory response syndrome (SIRS) with or without infectious cause is critically important in terms of initiating antimicrobial agents in case of infectious etiology such as ventilator-associated pneumonia (VAP). The aim of this study was to determine the diagnostic and prognostic roles of C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-α) in differentiating between ventilator-associated pneumonia and SIRS without infectious etiology. Materials and Methods: In this prospective observational study, 91 adult intensive care unit (ICU) patients were enrolled. According to established diagnostic criteria, they were classified into three groups of “non-SIRS nonVAP”, “SIRS non-VAP” and “SIRS-VAP”. Serum CRP and TNF-α were measured on days 1, 3 and 7 of the study and compared using repeated measures ANOVA. Results: With respect to diagnosis, there was no significant difference in the values of these biomarkers between groups (P>0.05). There was no statistically significant “time trend” for C-reactive protein and TNF-α (P>0.05). Considering both group effect and Time effect, the changes were not significantly different for CRP (P= 0.86) and TNF-α (P=0.69). In contrast, the clinical score and the clinical pulmonary infection score (CPIS) 6, had 100% specificity for diagnosing VAP. With respect to prognosis, only an unchanged or decreasing TNF-α from day 1 to day 3 was marginally associated with 28- day survival. However, day 1 and day 3 acute physiology and chronic health evaluation II (APACHE II) scores were highly associated with 28-day survival. Conclusion: Unlike clinical scoring system including CPIS and APACHE II, TNF-α and CRP levels were not useful as diagnostic or prognostic biomarkers for differentiating between SIRS with VAP etiology and SIRS without infectious etiology.National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IranTANAFFOS (Respiration)1735-034415420161201Role of Transcranial Doppler Sonography in Diagnosis of Brain Death: A Single Center Study213217240207ENSeyed Mohammadreza HashemianClinical Tuberculosis and Epidemiology Research
Center, National Research Institute of Tuberculosis and
Lung Diseases (NRITLD), Shahid Beheshti University of
Medical Sciences, Tehran, Iran,Hosein DelavarkasmaeiDepartment of
Neurology, Shahid Beheshti University of Medical
Sciences, Tehran, IranKatayoun NajafizadehLung Transplantation Research
Center, NRITLD, Shahid Beheshti University of Medical
Sciences, Tehran, IranMeysam MojtabaeLung Transplantation Research
Center, NRITLD, Shahid Beheshti University of Medical
Sciences, Tehran, Iran,Seyed Hossein ArdehaliDepartment of Critical Care,
Shohadaye-Tajrish Hospital, Shahid Beheshti University
of Medical Sciences,Mohammad Reza KamranmaneshDepartment of Anesthesiology &
Critical Care and Pain Medicine, Shahid Beheshti
University of Medical Sciences, Tehran, Iran,Niloofar BasharzadDepartment of Pulmonology and Intensive Care
Medicine, Shahid Labbafinejad Hospital, Shahid Beheshti
University of Medical Sciences, Tehran, Iran,Fariba GhorbaniTracheal
Diseases Research Center, NRITLD, Shahid Beheshti
University of Medical Sciences, Tehran, Iran.Mohammad Reza KamranmaneshDepartment of Anesthesiology &
Critical Care and Pain Medicine, Shahid Beheshti
University of Medical Sciences, Tehran, Iran,Journal Article20201225Background: Diagnosis of brain death relies on clinical and electroencephalographic (EEG) criteria. Waiting for 24 hours is mandatory to make definitive diagnosis of the condition in the Iranian protocol. Although it has been previously shown that oscillatory or spiked systolic or reversed diastolic flow patterns in transcranial Doppler sonography (TCD) are associated with faster brain death confirmation, it has not yet been approved in our protocol. Thus, the aim of this study was to assess the applicability of this method to our organ donation system. Materials and Methods: This study was performed in Masih Daneshvari Organ Procurement Unit from July to December 2009. TCD from the middle cerebral and basilar arteries was attempted in 35 patients who fulfilled the clinical and EEG criteria for brain death. Extensive skull defects and hypotension (blood pressure < 80 mmHg) were the exclusion criteria. Examinations were made for about 30 minutes via temporal and occipital windows as soon as possible after diagnosis of brain death. Results: The mean age of cases was 31.9±14.78 years and 18 (51.4%) were males. The most prevalent cause of brain death was trauma (in 19 or 54.2% of cases). We were unable to detect any intracranial artery in 2 (5.7%) cases. There were no false negative or false positive results in the remaining ones. Detected ultrasonic patterns of cerebral vascular flow were systolic spike and oscillating signal in 29 (87.9%) and 4 (12.1%) donors, respectively. Conclusion: Our study showed that TCD results in brain dead cases were concordant with clinical and EEG criteria. Therefore, TCD, as a confirmatory test, can be applied for rapid diagnosis of brain death.National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IranTANAFFOS (Respiration)1735-034415420161201Association of Homozygous Thrombophilia Polymorphisms and Venous Thromboembolism in Shahrekord, Iran218224240208ENHamid Rouhi-BroujeniClinical Biochemistry Research Centre, Shahrekord
University of Medical Sciences, Shahrekord, IranBatoul PourgheysariParamedical School and Cellular and Molecular
Research Centre, Shahrekord University of Medical
Sciences, Shahrekord, Iran,Ali-Mohammad HasheminiaSchool of Nursing and
Midwifery, Shahrekord University of Medical Sciences,
Shahrekord, IranJournal Article20201225Background: Venous thromboembolism (VTE) is a major cause of mortality. Factor V Leiden (FVL), methylenetetrahydrofolate reductase (MTHFR) C677T, and prothrombin (FII) G20210A polymorphisms are the main inherited risk factors for VTE. Since evidence is limited on homozygotes, the aim of this study was to investigate the association between homozygous variants of these polymorphisms and VTE in Shahrekord, southwest Iran. Materials and Methods: In this case-control study, blood samples of 72 VTE patients admitted to Hajar Hospital, Shahrekord and 306 sex- and age-matched healthy volunteers as controls were taken in EDTA Vacutainers. The polymorphisms of FVL, MTHFR C677T, and FIIG20210A were investigated by PCR-RFLP. The data were analyzed by descriptive statistics and independent ttest. Results: The frequency of all homozygous polymorphisms was found to be 16.77% in patients and 4.90% in controls with a significant difference (P=0.004). Homozygous FVL mutation was more frequent in patients than in controls with no significant difference. Regarding the frequency of homozygous MTHFR C677T, a significant difference was noted between patients and controls (P=0.03). There was no significant difference in homozygous FIIG20210A and heterozygous variants of the above-mentioned polymorphisms between the patients and controls. Conclusion: Homozygous MTHFR C677T polymorphism is associated with VTE in Shahrekord. Control of the acquired risk factors may be necessary in homozygous form of this polymorphism. VTE patients with this polymorphism may need to be managed differentlyNational Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IranTANAFFOS (Respiration)1735-034415420161201Effect of Dietary Supplementation on Body Composition, Pulmonary Function and Health-Related Quality of Life in Patients with Stable COPD225235240209ENNaushad Ahmad KhanDepartment of Medicine, Maulana Azad Medical College,
New Delhi, IndiaNaresh KumarDepartment of Medicine, Maulana Azad Medical College,
New Delhi, IndiaMradul K DagaDepartment of Medicine, Maulana Azad Medical College,
New Delhi, IndiaJournal Article20201225Background: Malnutrition is very common in patients with chronic obstructive pulmonary disease (COPD). Nutritional supplementation improves the patient’s nutritional status by increasing the energy intake and providing antiinflammatory elements which can relieve the patient’s symptoms and delay the disease progression. This study sought to determine if energy and protein supplementation improves physical function, pulmonary function and healthrelated quality of life (HRQL) in stable COPD patients. Materials and Methods: The study was carried out in an outpatient setting on 60 stable COPD patients over a period of one year. Patients were randomized to intervention group (n=30), receiving supplemental nutrition in the form of additional protein and carbohydrates or control group (n=30), receiving only the usual standard diet. Lung function, body mass index (BMI), exercise capacity (6-minute walk test or 6MWT), mid-upper arm circumference (MUAC) and skin fold thickness (SFT) were evaluated, and clinical assessment was carried out at baseline and after completion of 12 weeks. The HRQL was assessed using Seattle obstructive lung disease questionnaire. Results: Twelve weeks of dietary supplementation resulted in a significant increase in weight and BMI of patients in the intervention group in comparison to the control group (p <0.005). Significant improvement was also observed in 6MWT and HRQL scores after nutritional intervention (P=0.002 and P=0.001, respectively). However, difference in MUAC, SFT and serum protein level after 12 weeks of follow up was not significant in any of the two groups. There was a similar degree of lung function improvement in both groups although it was not statistically significant. Conclusion: Nutritional supplementation with high protein and energy diet during 12 weeks of intervention improved body weight and composition, exercise capacity and quality of life in stable COPD patients.National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IranTANAFFOS (Respiration)1735-034415420161201Prevalence and Geographic Distribution Pattern of Asthma in Tehran by ECRHS236242240210ENHooman SharifiTobacco Prevention and Control Research Center,
National Research Institute of Tuberculosis and Lung
Diseases (NRITLD), Shahid Beheshti University of
Medical Sciences ,Tehran, IranMostafa GhaneiBaqiyatallah Research
Center of Gastroentrology and Liver Diseases,
Baqiyatallah University of Medical Sciences, Tehran,
Iran,Makan SadrTracheal Diseases Research Center, NRITLD,
Shahid Beheshti University of Medical Sciences ,Tehran,
Iran,Habib EmamiTobacco Prevention and Control Research Center,
National Research Institute of Tuberculosis and Lung
Diseases (NRITLD), Shahid Beheshti University of
Medical Sciences ,Tehran, IranAtefeh FakharianChronic Respiratory Diseases Research Center,
NRITLD, Shahid Beheshti University of Medical
Sciences, Tehran, IranZahra HessamiTobacco Prevention and Control Research Center,
National Research Institute of Tuberculosis and Lung
Diseases (NRITLD), Shahid Beheshti University of
Medical Sciences ,Tehran, Iran,Mahshid AryanpurTobacco Prevention and Control Research Center,
National Research Institute of Tuberculosis and Lung
Diseases (NRITLD), Shahid Beheshti University of
Medical Sciences ,Tehran, Iran,Hamidreza JamaatiTobacco Prevention and Control Research Center,
National Research Institute of Tuberculosis and Lung
Diseases (NRITLD), Shahid Beheshti University of
Medical Sciences ,Tehran, Iran,Mohammad Reza MasjediTobacco Control Research
Center, Iranian Anti Tobacco Association, Tehran, IranJournal Article20201225Background: Asthma, involving 5-10% of global population, has a heterogeneous distribution in the community regardless of age and its prevalence and incidence tend to grow worldwide as reported by many recent epidemiologic surveys. Materials and Methods: The present study aimed to survey the prevalence of asthma symptoms in Tehran as the first attempt in terms of situation analysis of the disease in the Iranian society by using relevant parts of the European Community Respiratory Health Survey (ECRHS) questionnaire. Results: Wheezing was reported in 48% of males and 34% of females in the age range of 20-44 years, around 50% of which was associated with breathlessness or cold. , the people who answered “yes” to the questions 1 (wheezing), 4 (coughing), 5 (asthma history) or 7 (nasal allergy) were totally 211 among whom 124 (58.8%) were males and the rest (41.2%) were females. Conclusion: Asthma symptoms decrease the quality of life and impose high costs on the healthcare system in many countries. A low rate of participants had been informed about their asthma by physicians and not all of them were taking medications. Risk factor analysis and control is strongly advised in order to lessen the prevalence of the disease and symptoms. Air pollution, smoking, unhealthy life style and many personal and social factors need to be assessed and eliminated. It seems that a- second phase- ECRH survey should be conducted to assess the situation of asthma through population of Tehran.National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IranTANAFFOS (Respiration)1735-034415420161201Multiple Phantom Tumor of the Lung: A Complex Appearance Resolving with Appropriate Intervention243245240211ENHaleh MikaeiliTuberculosis and Lung Diseases Research Centre,
Tabriz University of Medical Sciences, Tabriz, Iran.Jafar Mehdizadeh BaghbaniTuberculosis and Lung Diseases Research Centre,
Tabriz University of Medical Sciences, Tabriz, Iran.Journal Article20201225The term phantom tumor may be used to describe a well-demarcated opacity resulted from pleural effusion. Phantom tumors are commonly associated with congestive heart failure causing transudative pleural effusion within pulmonary fissures. The figure may bring about inaccurate invasive diagnostic interventions. We report a heavy smoker patient with multiple phantom tumors in the right lung resolved with medical management. This case report provides records for a timely management of similar patients.National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IranTANAFFOS (Respiration)1735-034415420161201Foreign Body Stocked between Vocal Cords246248240212ENKamran MottaghiDepartment of Anesthesiology, Shahid Beheshti
University of Medical Sciences, Tehran, IranFarhad SafariDepartment of Anesthesiology, Shahid Beheshti
University of Medical Sciences, Tehran, IranMasoud NashibiDepartment of Anesthesiology, Shahid Beheshti
University of Medical Sciences, Tehran, IranJournal Article20201225Foreign body (FB) aspiration is a rare event in adults and can mimic other pathologies such as refractory asthma. Most of the objects can be removed using a bronchoscope. Herein, we present a unique case of aspiration of a FB stocked between vocal cords for one week and the anesthetic considerations.National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IranTANAFFOS (Respiration)1735-034415420161201A 14-Year-Old Patient with Chest Pain249250240213ENMaryam HassanzadPediatric Respiratory Diseases Research Center,
National Research Institute of Tuberculosis and Lung
Diseases (NRITLD), Shahid Beheshti University of
Medical Sciences, Tehran, IranSeyed Amir MohajeraniPediatric Respiratory Diseases Research Center,
National Research Institute of Tuberculosis and Lung
Diseases (NRITLD), Shahid Beheshti University of
Medical Sciences, Tehran, IranNima HassanzadPediatric Respiratory Diseases Research Center,
National Research Institute of Tuberculosis and Lung
Diseases (NRITLD), Shahid Beheshti University of
Medical Sciences, Tehran, IranAli Akbar VelayatiPediatric Respiratory Diseases Research Center,
National Research Institute of Tuberculosis and Lung
Diseases (NRITLD), Shahid Beheshti University of
Medical Sciences, Tehran, IranJournal Article20201225WHAT IS YOUR DIAGNOSIS? A 14-year-old boy was referred to our hospital with pain in his left posterior chest wall, cough, exertional dyspnea, weight loss, shoulder pain and inability to move his left hand. He had a history of chest trauma two weeks ago. During the past two weeks, he had two episodes of nausea and vomiting. During his admission to emergency department, his vital signs including blood pressure, heart rate, respiratory rate and oxygen saturation rate were normal. On physical examination, coarse crackles were auscultated in basal left lung and breath sounds were normal in other areas. Laboratory tests showed leukocytosis (WBC: 12.2×103) and PLT 460×103. CRP was positive (3+) and ESR was 96 mm/h. Sputum culture was also positive for Candida. Chest X-radiography (CXR) showed that the patient had a left lower lobe (LLL) sub-pleural loculation. On chest computed tomography (CT), there was a subpleural mass like consolidation in LLL measured up to 45×44 mm associated with subtle ipsilateral pleural reaction. Right lung was intact (Figure 1 and 2). Ultrasound revealed a hypoecho mass of the size of 52×44 mm at inner part of the left lateral chest suggesting hematoma. One week later, the size of the mass decreased significantly to 43×36 mm on ultrasound.