National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IranTANAFFOS (Respiration)1735-034491(winter)20100101Ali ibn Abbas al-Majusi and Medical Ethics241185ENMaryam JavanbakhtJournal Article20210101National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IranTANAFFOS (Respiration)1735-034491(winter)20100101Update on 2009 Pandemic Influenza A (H1N1) Virus814241186ENMajid MarjaniDepartment of Infectious DiseaseParvaneh BaghaeiDepartment of Infectious DiseasePayam TabarsiDepartment of Infectious DiseaseMycobacteriology Research Center, NRITLD, Shahid Beheshti University of M.C. TEHRAN-IRAN.Seyed Davood MansouriDepartment of Infectious Disease,Mycobacteriology Research Center, NRITLD, Shahid Beheshti University of M.C. TEHRAN-IRAN.Journal Article20210101The pandemic influenza A (H1N1/2009) virus as a new challenge for health care providers has caused significant morbidity and mortality worldwide. Although many aspects of this virus are similar to other human influenza viruses, there are some disparities. This article reviews different aspects of influenza H1N1/2009 virus with focus on clinical features and management of patients. (Tanaffos2010; 9(1): 8-14)National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IranTANAFFOS (Respiration)1735-034491(winter)20100101A Comprehensive Study of Mediastinal Goiters1520241187ENMohsen SokoutiDepartment of Thoracic Surgery, Imam Reza Hospital, Tabriz University of Medical Sciences, TABRIZ-IRAN.Vahid MontazeriDepartment of Thoracic Surgery, Imam Reza Hospital, Tabriz University of Medical Sciences, TABRIZ-IRAN.Journal Article20210101Background: Thyroid masses are common, especially in areas of iodine deficiency. Mediastinal goiter is defined by the presence of enlarged thyroid tissue below the level of the thoracic inlet. This study aimed to evaluate the presentation, diagnosis, treatment, histopathological findings and complications of patients with mediastinal goiter or masses. Materials and Methods: This was a descriptive cross-sectional chart review study of patients with substernal goiter or masses who underwent cervical and mediastinal thyroidectomy from March 2003 to February 2007. Results: From a total of 470 patients admitted for thyroid surgery, 60 cases (12.7%) presented with substernal extension of goiter or masses during the study period; 88% of patients were females with a mean age of 46.77±10.77 yrs. Cervical masses were the most common preoperative presentation (78%), followed by compressive symptoms (67.8%); 5.08% of cases were asymptomatic. In 10%, the goiter or masses were located in the posterior mediastinum. Total thyroidectomy was performed in 59% of patients mostly by low collar incision. Sternotomy or thoracotomy was required in three patients (5%) mainly because of mediastinal masses or invasion of carcinoma. Postoperative complications included transient hypocalcaemia (46%) and persistent recurrent nerve paralysis (3.4%). There was no mortality. Histopathologically, 18.5% of masses were malignant; mostly papillary carcinoma. Conclusion: Presence of substernal goiter or masses is an indication for early surgery, even in asymptomatic or elderly patients. These masses have progressive enlargements and carry a high risk of tracheal compression. (Tanaffos 2010; 9(1): 15-20)National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IranTANAFFOS (Respiration)1735-034491(winter)20100101Ventilator-Associated Pneumonia: Evaluation of Etiology, Microbiology and Resistance Patterns in a Tertiary Respiratory Center2127241188ENHamid Reza JamaatiDepartment of Pulmonary MedicineTobacco Prevention and Control Research CenterMajid MalekmohammadDepartment of Pulmonary MedicineLung Transplantation Research Center,Mohammad Reza HashemianDepartment of Chronic Respiratory Research Center, NRITLD, Shahid Beheshti University M.C., TEHRAN-IRAN.Mahnoosh NayebiDepartment of Pulmonary MedicineBasharzad NDepartment of Pulmonary MedicineJournal Article20210101Background: Ventilator-associated pneumonia (VAP) has been reported as the most common hospital-acquired infection among patients requiring mechanical ventilation. This study aimed to determine the incidence of ventilator-associated pneumonia in a cardiopulmonary tertiary center, and to evaluate its etiology, resistance patterns, and outcome of admitted patients. Materials and Methods: In a retrospective study, patients admitted to the Masih Daneshvari Hospital, a tertiary cardiopulmonary center, were evaluated in a 7-month period. A total of 530 patients were admitted to the ICU out of which, 40 acquired VAP. Overall, 99 patients were evaluated (male= 57, female= 42) including 40 VAP and 59 non-VAP cases. The incidence of VAP was estimated to be 7.5% in this unit. The underlying conditions included respiratory diseases (COPD, asthma, etc), and cardiac problems (post "coronary artery bypass graft" CABG, etc). Also, patients in the thoracic surgery ward and those with renal, gastrointestinal, neurologic and other medical problems were evaluated. The patients were divided into two groups of VAP and non-VAP cases. The micro-organisms were recovered from the patients’ bronchoalveolar lavage fluid. Results: The most common micro-organisms recovered were Pseudomonas aeruginosa (17 cases) and Staph. aureus species (15 cases). In VAP patients in whom S. aureus was recovered, 80 percent of species were methicillin-resistant (MRSA) but all were sensitive to Vancomycin. Moreover, resistance to two, three or four antibiotics was seen in 12, 10, and 5 patients, respectively, in whom P. aeruginosa was recovered. The prevalence of S. aureus in patients with respiratory problems was more than other groups (including MRSA species). But the prevalence of recovered P. aeruginosa was the lowest in respiratory patients, compared to other groups. Also the mortality rate in drug resistant S. aureus and P. aeruginosa groups were 42 and 47 percent, respectively. Length of stay for MRSA group was 80% and death rate was 50%. In P. aeruginosa group, there was a positive relationship between resistance to multiple drugs and mortality and also ICU stay. Conclusion: VAP is a common infection in ICU setting and certain interventions may affect its incidence. In our study, P. aeruginosa and S. aureus were more common in ICU patients. Pseudomonas species were associated with the highest mortality rate and were resistant to four antibiotics in the antibiogram testing. S. aureus species were more common in patients with underlying respiratory problems, compared to those with other conditions. (Tanaffos 2010; 9(1): 21-27)National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IranTANAFFOS (Respiration)1735-034491(winter)20100101Correlation of CRP and Serum Fibrinogen Levels with Disease Severity, Clinical Factors and Pulmonary Function Tests in COPD Patients2833241189ENMitra Samareh-FekriDepartment of Pulmonary Medicine,Syed Abdol-Rahim KhorasaniDepartment of Pulmonary Medicine,Maliheh Shadkam-FarokhiPhysiology Research Center, Kerman University of Medical Sciences, KERMAN-IRAN.Journal Article20210101Background: Chronic obstructive pulmonary disease (COPD) is a progressive chronic disease and C-reactive protein (CRP) and fibrinogen are considered as main systemic inflammatory biomarkers. This study aimed to evaluate the alterations of CRP and serum fibrinogen levels in COPD patients and their correlation with the severity of disease, arterial O2 saturation and opium or cigarette consumption. Materials and Methods: This was a descriptive case-control study conducted on 31 COPD patients and 29 healthy controls selected by using easy sampling method in Afzalipour Hospital. Serum levels of CRP and fibrinogen were measured by ELISA method and analyzed using SPSS software version 15. Results: The mean serum level of CRP in the understudy patients (13.15±13.72 mg/L) was significantly higher than that of the controls (3.53±1.12 mg/L)(P=0.000). However, no significant difference was found in the mean serum level of fibrinogen between cases (3.81±0.93 mg/dl) and controls (3.72±0.9 mg/dl)(p=0.82). Also, no significant correlation was detected between the serum level of CRP or fibrinogen and severity of the disease (P=0.92 and P=0.58, respectively). A statistically significant relationship was found between the serum levels of CRP and fibrinogen and arterial O2 saturation (P=0.02). There was no significant difference in the serum levels of CRP and fibrinogen between the opium users (p=0.19) and other patients (p=0.15). Conclusion: According to our study results, COPD, per se, can increase the inflammatory biomarkers including CRP. Raised serum level of CRP is indicative of systemic inflammation which results in extra-pulmonary manifestations like cardiovascular diseases, cerebrovascular accidents, osteoporosis, and cachexia. Therefore, with routine measurement of this marker, we can evaluate the severity of systemic inflammation in these patients and choose the best treatment accordingly. (Tanaffos 2010; 9(1): 28-33)National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IranTANAFFOS (Respiration)1735-034491(winter)20100101Preoperative Assessment of Mechanical Ventilation Requirement after Surgical Treatment of Esophageal Cancer3441241190ENNavid NooraeiDepartment of Anesthesiology, Modarres HospitalSeyed Mohammad Reza HashemianDepartment of AnesthesiologyAli GolfamDepartment of AnesthesiologySeyed Reza SaghebiDepartment of Thoracic Surgery, NRITLD, Shahid
Beheshti University M.C., TEHRAN-IRAN.Golnar RadmandDepartment of AnesthesiologyJournal Article20210101Background: The risk of pulmonary complications after esophagectomy is higher than after any other common operation, including major lung resection. In this study, we sought to identify risk factors associated with the development of pulmonary insufficiency requiring mechanical ventilation to identify preoperative parameters involved in the estimation of the risk of pulmonary insufficiency. Materials and Methods: We performed a retrospective cohort study on consecutive patients undergoing esophagectomy for malignancy in the Thoracic Surgery Department of Modarres Hospital in Tehran from March 2002 to February 2006. Patients were assigned into two groups based on whether they required mechanical ventilation or not. Preoperative, operative, and postoperative data were compared among the two groups. To find predictive variables for requiring mechanical ventilation, backward stepwise regression analysis was carried out with risk factors as independent variables and the need for ventilatory support as the dependent variable. Results: The study population included 77 males and 43 females with a mean age of 60.16±12.04 years (range 29–79 years). Twenty-seven patients (27.7%) required mechanical ventilatory support. Multivariate analysis revealed sex (Odds ratio: 4.590, CI 95%: 1.248-16.411) as a confounder and duration of operation (Odds Ratio: 1.677, CI95% : 1.102-2.533) as a risk factor for requiring mechanical ventilation. Conclusion: Proper patient selection for esophagectomy is important for reducing the postoperative mortality and morbidity and benefiting from a radical resection. (Tanaffos 2010; 9(1): 34-41)National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IranTANAFFOS (Respiration)1735-034491(winter)20100101Severity of Nicotine Withdrawal Symptoms after Smoking Cessation4247241191ENZahra HesamiTobacco Prevention and Control Research Center,Anahita AlvanpourTobacco Prevention and Control Research Center,Babak Sharif KashaniTobacco Prevention and Control Research CenterDepartment of CardiologySaeed Fallah TaftiTobacco Prevention and Control Research Center,Department of Internal Medicine, NRITLD, Shahid
Beheshti University M.C., TEHRAN-IRAN.Gholam Reza HeydariTobacco Prevention and Control Research CenterJournal Article20210101Background: Smoking is among the most common preventable causes of early death in the world. Implementation of smoking cessation programs is among the effective strategies of tobacco control. More than half the smokers experience nicotine withdrawal syndrome after quitting and this could be one of the main reasons of unsuccessful smoking cessation. This study evaluated the severity of nicotine withdrawal symptoms 14 days after quitting (the last visit of smokers to the smoking cessation clinic). Materials and Methods: This was a cross sectional study conducted on volunteers for smoking cessation from Nov. 2006 to Nov. 2007. During a one month course, volunteers attended 4 sessions of treatment and training (1 session per week). Since the 2nd session, they stopped smoking with the aid of nicotine gum and behavioral therapy under the supervision of a physician. Fourteen days after quitting (4th session), the severity of nicotine withdrawal symptoms was evaluated using the Minnesota test and was compared between males and females using the Chi square test. Results: A total of 197 participants were studied, 65% of which were males, 76.6% were married, 49.2% successfully quit smoking during the study period, 12.2% cut down smoking, and 38.6% did not finish the course. The mean score for increase in appetite, irritability and depression was 4.6±3.4, 4.3±3.4 and 3.6±3.3, respectively. The mean score for severity of depression was 4.5±3.4 in women and 3.19±3.2 in men (p=0.03). The mean score for severity of anxiety was 4.6±3.6 in women and 2.6±2.9 in men (p=0.004). Also, the mean score for severity of irritability was 5.7±3.3 and 3.6±3.3 in women and men, respectively (p=0.002). Conclusion: The severity of symptoms related to nicotine withdrawal syndrome was considerably low 14 days following abstinence. However, the severity of nicotine craving was significantly higher compared to other symptoms. Severity of more than half the symptoms was significantly higher in women but further investigations are required in this regard. (Tanaffos 2010; 9(1): 42-47)National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IranTANAFFOS (Respiration)1735-034491(winter)20100101Trend of Smear Positive Pulmonary Tuberculosis in Sistan and Baluchestan Province (2005-2008)4853241192ENAlipasha MeysamieDepartement of Community Medicine, Medical Faculty, Tehran University of Medical Sciences, TEHRAN-IRANMasood SalehiDepartment of
Infectious Diseases, Zahedan Universiyt of Medical Sciences, ZAHEDAN-IRAN.Narges SargolzaeiDepartement of Community Medicine, Medical Faculty, Tehran University of Medical Sciences, TEHRAN-IRAN,Journal Article20210101Background: According to the World Health Organization (WHO) report in 2008, incidence of tuberculosis in Iran is 25- 49/100,000 cases per year. Based on the guidelines of the Ministry of Health, case detection index for smear positive pulmonary tuberculosis (SPP-TB) has reported to be 11/ 100,000 in Iran in the year 2006. Sistan and Baluchestan Province has the highest rate of SPP-TB in Iran. This study aimed to evaluate the trend of incidence of SPP TB from 2005 to 2008,taking into consideration the interventions (started in the beginning of 2006) implemented by the Zahedan University of Medical Sciences to reinforce the screening system and evaluate the case detection index in this province. Materials and Methods: The understudy population comprised of the whole community under medical coverage of Zahedan University of Medical Sciences. Screening was mainly conducted passively till the end of 2005. Since the early 2006, some interventions have been conducted to reinforce the active screening system. All the information regarding the new cases of SPP-TB from 2005 to 2008 was collected from the Center for Disease Control of Sistan and Baluchestan Province. Changes in trend of SPP-TB incidence were analyzed by using Time Series analysis considering the interventions and related effective factors. Results: As a result of interventions aiming at reinforcing active screening since 2006, there has been a significant increase in both the incidence rate and case detection index. However, the incidence rate decreased in 2007.By using "Time Series Analysis for evaluation of the trend of incidence during the study period, the incidence of TB was estimated to be 22.88 cases in 100,000 in 2009. Conclusion: If we overcome the existing shortcomings regarding the screening system of SPP TB, successful case detection index should be higher than 22.88 in 100,000. (Tanaffos2010; 9(1): 48-53)National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IranTANAFFOS (Respiration)1735-034491(winter)20100101Pulmonary Manifestations of Hyper IgE Syndrome: Case Series and Literature Review5458241193ENMaryam HassanzadDepartment of Pediatrics,Soheila KhalilzadehDepartment of Pediatrics,Chronic Respiratory Disease Research Center, NRITLD, Shahid Beheshti University , MC, TEHRAN-IRAN.Sareh AminiDepartment of Pediatrics,Nooshin BaghaieDepartment of PediatricsAli Akbar VelayatiDepartment of PediatricsJournal Article20210101This study aimed to present four children suffering from recurrent pulmonary infections in the context of hyper IgE syndrome. All patients had recurrent pulmonary infections including pneumonia, bronchiectasis, pulmonary abscess and hydropneumothorax. Serum IgE level was greater than 2000 IU/ml in all cases. Microbial cultures showed Staphylococcus aureus and Pseudomonas aeruginosa in two cases. All responded well to the wide spectrum intravenous antibiotics. Extra-pulmonary manifestations included purulent lymphadenitis as well as skin and brain abscesses. Hyper IgE syndrome causes recurrent pulmonary and extra-pulmonary infections which respond fairly well to wide spectrum antibiotic therapy. (Tanaffos 2010; 9(1): 54-58)National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IranTANAFFOS (Respiration)1735-034491(winter)20100101A 65-Year-Old Woman with Granular Cell Tumor of the Lung5962241194ENMehrdad M. BehniaMedical College of Georgia, Augusta, Georgia-USAStephen AdamsMedical College of Georgia, Augusta, Georgia-USAPhilip W. CatalanoMedical College of Georgia, Augusta, Georgia-USAJournal Article20210101We present a case of a 65 year-old female who admitted with fever and a small infiltrate on the chest x-ray. CT-scan showed presence of a well-circumscribed solitary mass. She underwent surgical resection which showed presence of a granular cell tumor. Clinical and pathological features of granular cell tumor will be described in this report. (Tanaffos 2010;9(1): 59-62)National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IranTANAFFOS (Respiration)1735-034491(winter)20100101Loose Body in the Main Bronchus Due to Broncholithiasis6366242227ENMajid MirsadraeeDepartment of Pulmonary Medicine, Mashhad Islamic Azad University,Mehrdad KatebiDepartment of Clinical Anatomical Pathology, Razavi
Subspecialty Hospital, MASHHAD-IRAN.Journal Article20210211Anthracosis of the lung is black discoloration of bronchial mucosa that may distort and occlude the bronchial lumen and cause significant clinical findings named "Anthracofibrosis". In this article a rare presentation of this disease and related complications were reported. A 73 year-old woman with a 10-year history of chronic cough, dyspnea, weight loss and wheezing was referred to us for exacerbation of her symptoms in winter. She was a known case of anthracosis. Her previous bronchoscopy and sampling were inconclusive. Her recent computed tomography (CT) scan showed bilateral parenchymal infiltration, multiple lymph node calcifications and an intra-luminal calcified material in the left main bronchus. Bronchoscopy showed a floating foreign body in the left main bronchus and infiltration of the right and left main bronchi. Bronchial lavage showed plenty of acid fast bacilli and biopsy showed granulomatous reaction in favor of tuberculosis. In conclusion, we believe that broncholithiasis should be considered as a chronic complication of anthracosis. (Tanaffos 2010; 9(1): 63-66)National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, IranTANAFFOS (Respiration)1735-034491(winter)20100101A 49-Year-Old Man with Fever and Chronic Cough6769242228ENNahal MansouriDepartment of Internal Medicine, Division of Infectious Disease and Clinical Immunology,Pardis Ketabi MoghaddamDepartment of Internal Medicine, Division of Infectious Disease and Clinical Immunology,Mihan PourabdollahDepartment of Pathology,Nahid EtemadiDepartment of Internal Medicine, Division of Infectious Disease and Clinical Immunology,Seyed Davood MansouriDepartment of Internal Medicine, Division of Infectious Disease and Clinical Immunology,Mycobacteriology Research Center, NRITLD, Shahid Beheshti University MC, TEHRAN- IRAN.Journal Article20210211