National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran TANAFFOS (Respiration) 1735-0344 19 4 2020 10 01 Update on Immunology of COVID-19 Disease and Potential Strategy for Controlling 274 290 243443 EN Neda K. Dezfuli Department of Immunology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Department of Immunology, School of Medicine, Dezful University of Medical Sciences, Dezful, Iran Ian M Adcock Airways Disease Section, National Heart and Lung Institute, Imperial College London, London, UK Nooshin Montazami Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Esmaeil Mortaz Department of Immunology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran Aliakbar Velayati Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Journal Article 2021 04 14 Coronavirus disease 2019 (COVID-19) is caused by a novel form of the coronavirus that caused severe acute respiratory syndrome (SARS). SARS-CoV-2 raised in China and has broadcast to 261 countries globally. SARS-CoV-2 a member of β-coronavirus family and has an almost matching genome sequence to a bat coronavirus, pointing to the bat as the natural host before it was transmitted to humans. SARS-CoV-2 uses the same receptor, angiotensin-converting enzyme 2 (ACE2) as that used by SARS-CoV and principally infects the respiratory tract. The clinical symptoms of COVID-19 patients include fever, cough and fatigue whilst small populations of patients have gastrointestinal symptoms. The old people and people with underlying metabolic and cardiovascular diseases are more affected to infection and have worse outcomes. These may be associated with acute respiratory distress syndrome (ARDS) and a cytokine storm. In this review, we discuss the pathogenesis and clinical characteristics of disease and the pharmacologic approaches that may control COVID-19.

https://www.tanaffosjournal.ir/article_243443_4fc057f9a358a4586fdb178dd5a4f41d.pdf

National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran TANAFFOS (Respiration) 1735-0344 19 4 2020 10 01 Blood Purification Techniques, Inflammatory Mediators and Mortality in COVID-19 Patients 291 299 243444 EN Seyed Mohammadreza Hashemian Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran 0000-0002-0768-9168 Navid Shafigh Department of Anesthesiology and Critical Care Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Golnaz Afzal Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran Hamidreza Jamaati Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Esmaeil Mortaz Clinical Tuberculosis and Epidemiology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran Payam Tabarsi Clinical Tuberculosis and Epidemiology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran Majid Marjani Clinical Tuberculosis and Epidemiology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran Majid Malekmohammad Tracheal Diseases Research Center (TDRC), NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran Farzaneh Dastan Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran Seyed Mehdi Mortazavi Department of Nursing, Shahid Beheshti University of Medical Sciences, Tehran, Iran Makan Sadr Virology Research Center (VRC), NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran Esmaeil Idani Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Batoul Khoundabi Iran-Helal Institute of Applied-Science and Technology, Research Center for Health Management in Mass Gathering, Red Crescent Society of the Islamic Republic of Iran, Tehran, Iran Abdolreza Mohamadnia Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Atefeh Abedini Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Arda Kiani Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Afshin Moniri Virology Research Center (VRC), NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran Seyed Alireza Nadji Virology Research Center (VRC), NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran Fatemeh Yassari Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Mojtaba Mokhber Dezfuli Lung Transplantation Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mohammad Varahram Mycobacteriology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran Faezeh Eshaghi Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Mahdi Malekpour Geisinger Medical Center, Danville, PA , USA Aliakbar Velayati Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Journal Article 2021 04 14 Background: Inflammatory mediators are an important component in the pathophysiology of the coronavirus disease 2019 (COVID-19). This study aimed to assess the effects of reducing inflammatory mediators using hemoperfusion (HP) and continuous renal replacement therapy (CRRT) on the mortality of patients with COVID-19. Materials and Methods: Twelve patients with confirmed diagnosis of COVID-19 were included. All patients had acute respiratory distress syndrome (ARDS). Patients were divided into three groups, namely, HP, CRRT and HP+CRRT. The primary outcome was mortality and the secondary outcomes were oxygenation and reduction in inflammatory mediators at the end of the study. Results: Patients were not different at baseline in demographics, inflammatory cytokine levels, and the level of acute phase reactants. Half of the patients (3 out of 6) in the HP+CRRT group survived along with the survival of one patient (1 out of 2) in the HP group. All four patients in the CRRT group died. Serum creatinine (SCr), Interleukin-1 (IL1), Interleukin-6 (IL6), Interleukin-8 (IL8), partial pressure of oxygen (PaO2), O2 saturation (O2 sat), and hemodynamic parameters improved over time in HP+CRRT and CRRT groups, but no significant difference was observed in the HP group (All Ps > 0.05). Conclusion: Combined HP and CRRT demonstrated the best result in terms of mortality, reduction of inflammatory mediators and oxygenation. Further investigations are needed to explore the role of HP+CRRT in COVID-19 patients.

https://www.tanaffosjournal.ir/article_243444_be0ea06b1e464ef989cf0e3d72cd6693.pdf

National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran TANAFFOS (Respiration) 1735-0344 19 4 2020 10 01 Clinical Features and Outcomes of ICU Patients with COVID-19 Infection in Tehran, Iran: a Single-Centered Retrospective Cohort Study 300 311 243445 EN Arshia Vahedi Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Farhad Tabasi Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran Fateme Monjazebi Department of Medical-Surgical Nursing, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran Seyed Mohammad Reza Hashemian Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Payam Tabarsi Clinical Tuberculosis and Epidemiology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran Behrooz Farzanegan Tracheal Diseases Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran Majid Malekmohammad Tracheal Diseases Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran Alireza Salimi Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Department of Anesthesiology and Critical Care, Shahid Beheshti University of Medical Sciences, Tehran, Iran Morteza Salimi Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran Mohammad Reza Raoufy Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran Hamidreza Jamaati Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran 0000-0002-5402-1531 Ali Akbar Velayati Clinical Tuberculosis and Epidemiology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran Journal Article 2021 04 14 Background: The clinical characteristics of the novel coronavirus disease (COVID-19) were diverse and unspecific. Here, we identified the associated factors with surviving of COVID-19 ICU patients based on the clinical characteristics of patients admitted to one of the Corona Centre Hospitals of Iran. Materials and Methods: This cohort study was performed retrospectively from February to June 2020 on 133 COVID-19 patients admitted to 4 intensive care units of Masih Daneshvari Hospital in Tehran, Iran. Demographic, medical, clinical manifestation at admission, laboratory parameters and outcome data were obtained from medical records. Also the SOFA and APACHE II scores were calculated. All data were analyzed using SPSS (version 23, IBM Corp.) software. Results: The median (IQR) age of the patients was 62.0 (54.0-72.0) years in total. RT-PCR of throat swab SARS-CoV-2 in 80 patients (60.2%) was positive. Total mortality rate was 57.9 percent (77 patients). Dyspnea, hypertension and chronic pulmonary diseases were significantly common in non-survivors than survivors (p <0.05). Both SOFA and APACHE II scores were significantly higher in the non-survivors (p <0.05). Also other significant differences were observed in other parameters of the study. Conclusion: The mortality rate of COVID-19 patients admitted to ICU is generally high. Dyspnea as initial presentation and comorbidity, especially hypertension and pulmonary diseases, may be associated with higher risk of severe disease and consequent mortality rate. Also, higher SOFA and APACHE II scores could indicate higher mortality in patients admitted to ICU.

https://www.tanaffosjournal.ir/article_243445_d158b10c2c5d218391e80882071601a9.pdf

National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran TANAFFOS (Respiration) 1735-0344 19 4 2020 10 01 Effects of an Empowerment Program on Self-Care Behaviors and Readmission of Patients with Heart Failure: a Randomized Clinical Trial 312 321 243446 EN Mansour Dianati Trauma Nursing Research Center, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran Sara Rezaei Asmaroud Trauma Nursing Research Center, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, Iran Shadi Shafaghi Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Farah Farah Naghashzadeh Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran. 0000-0003-4655-0238 Journal Article 2021 04 14 Background: The prevalence of heart failure, as a serious health problem, is increasing around the world due to underlying factors, such as hypertension and diabetes. Although the patient’s cooperation in the treatment process plays a crucial role in treatment, only a few combinations of different approaches have been investigated so far. This study aimed to determine the effects of an empowerment program on the patients’ self-care behaviors and hospital readmission. Materials and Methods: In this randomized clinical trial, 120 patients with heart failure were divided into experimental and control groups. In the experimental group, the empowerment program, including face-to-face training, educational booklets, and follow-up via Telegram messaging application, was implemented, while the control group only received standard care. Data were collected before the intervention and six months after the intervention, using a researcher-made questionnaire. The Self-Care of Heart Failure Index (SCHFI) was completed for both groups. Results: The results indicated that all three self-care scales, namely, self-care maintenance, self-care management, and self-care confidence, significantly improved in the experimental group compared to the baseline (P=0.000), while the scores of these scales decreased in the control group (P=0.000). The frequency of hospital admission and the length of hospital stay also reduced in the experimental group (P=0.000 and P<0.001, respectively). There was no significant difference in terms of the demographic characteristics between the two groups. Conclusion: The empowerment program significantly improved the patients’ self-care behaviors and reduced the frequency and duration of hospitalization. Therefore, implementation of such programs is strongly suggested, especially in heart failure clinics.

https://www.tanaffosjournal.ir/article_243446_eda833dfd7238e2dafd208b82d846e3f.pdf

National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran TANAFFOS (Respiration) 1735-0344 19 4 2020 10 01 Effect of Vitamin D Supplementation on Improvement of Symptoms in Mild-to-Moderate Asthma Patients with Vitamin D Insufficiency and Deficiency 322 329 243447 EN Mohammad Emami Ardestani Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Azam Movahedi Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. Journal Article 2021 04 14 Background: In the current study, we assessed the effect of vitamin D supplementation on improvement of symptoms in mild-to-moderate asthma patients with vitamin D insufficiency and deficiency. Materials and Methods: This randomized, controlled clinical trial included 132 mild-to-moderate asthma patients with vitamin D insufficiency (n=66) and those with vitamin D deficiency (n=66). They were assigned randomly to two groups of cases (with two subgroups) and controls (with two subgroups). In the case subgroups, for patients with vitamin D deficiency, a dose of 50,000 U vitamin D supplementation was administered orally on a weekly basis and for six weeks followed by a maintenance dose of 1000 U daily. For patients with vitamin D insufficiency, a dose of 1000 U vitamin D supplementation was prescribed daily. In control group, we administered placebo. The information including asthma symptoms, parameters measured by spirometer (Forced Vital Capacity-FVC, Forced Expiratory Volume in one second-FEV1) and 25-hydroxyvitamin D [25(OH)D] concentration was collected at baseline and three months later and analyzed using SPSS, Version 20. Results: Improvement of FEV1/FVC ratios were found in both groups but this improvement in both case subgroups of patients with vitamin D insufficiency and deficiency suggested more appropriate results compared to control group (P-value=0.022). Moreover, the correlation between changes in 25(OH)D level and changes in FEV1 was positive and significant in patients receiving vitamin D supplementation within a three-month follow up (r=0.202, P-value=0.042). Conclusion: According to the results, vitamin D supplementation can be associated with the improvement of asthma symptoms and lung function in mild-to-moderate asthma patients with vitamin D insufficiency and deficiency.

https://www.tanaffosjournal.ir/article_243447_1d24ea0c935f8138832f121ee65c3838.pdf

National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran TANAFFOS (Respiration) 1735-0344 19 4 2020 10 01 Prediction of Patient’s Adherence to the Post-Intubation Tracheal Stenosis Follow-up Plan in Iran: Application of two Data Mining Techniques 330 339 243448 EN Behrooz Farzanegan Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Roya Farzanegan Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Mohammad Behgam Shadmehr Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Seyedamirmohammad Lajevardi Faculty of Health, York University, Toronto, Canada Sharareh R. Niakan Kalhori Department of Health information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran. Journal Article 2021 04 14 Background: Timely diagnosis of post-intubation tracheal stenosis (PITS), which is one of the most serious complications of endotracheal intubation, may change its natural history. To prevent PITS, patients who are discharged from the intensive care unit (ICU) with more than 24 hours of intubation should be actively followed-up for three months after extubation. This study aimed to evaluate the abilities of artificial neural network (ANN) and decision tree (DT) methods in predicting the patients’ adherence to the follow-up plan and revealing the knowledge behind PITS screening system development requirements. Materials and Methods: In this cohort study, conducted in 14 ICUs during 12 months in ten cities of Iran, the data of 203 intubated ICU-discharged patients were collected. Ten influential factors were defined for adherences to the PITS follow-up (P<0.05). A feed-forward multilayer perceptron algorithm was applied using a training set (two-thirds of the entire data) to develop a model for predicting the patients’ adherence to the follow-up plan three months after extubation. The same data were used to develop a C5.0 DT in MATLAB 2010a. The remaining one-third of data was used for model testing, based on the holdout method. Results: The accuracy, sensitivity, and specificity of the developed ANN classifier were 83.30%, 72.70%, and 89.50%, respectively. The accuracy of the DT model with five nodes, 13 branches, and nine leaves (producing nine rules for active follow-up) was 75.36%. Conclusion: The developed classifier might aid care providers to identify possible cases of non-adherence to the follow-up and care plans. Overall, active follow-up of these patients may prevent the adverse consequences of PITS after ICU discharge.

https://www.tanaffosjournal.ir/article_243448_c9140cbc444f0969a591716ddef32b64.pdf

National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran TANAFFOS (Respiration) 1735-0344 19 4 2020 10 01 Efficiency of Nebulizing Furosemide in the Treatment of Chronic Pulmonary Obstructive Disease: A Systematic Review and Meta-Analysis of Clinical Trials 340 349 243449 EN Abas Ghaysouri Department of Internal Medicine, School of Medicine, Shahid Mostafa Khomaeini Hospital, Ilam University of Medical Sciences, Ilam, Iran Gholam Basati School of Allied Medical Sciences, Zoonotic Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran Morteza Shams Zoonotic Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran Hamed Tavan Clinical Research Development Unit, Shahid Mostafa Khomeini Hospital, Ilam University of Medical Sciences, Ilam, Iran. Journal Article 2021 04 14 Background: Chronic obstructive pulmonary disease (COPD) is one of the most common chronic illnesses in humans. Among both oral and intravenous diuretics, nebulizing furosemide (Lasix) is the most commonly used agent. The purpose of this study was to ascertain the therapeutic effects of nebulizing furosemide compared with placebo in the treatment of COPD using a systematic review and meta-analysis of clinical trials. Materials and Methods: This review was performed based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) protocol. The databases of Web of Science, Google Scholar, PubMed, and Scopus were independently searched by two researchers using MeSH keywords. Studies published between 2002 and 2018 in different parts of the world were considered. The meta-analysis was performed through STATA 14 software and the heterogeneity was assessed using Q statistic or I2 index. Results: From 40 selected articles, 8 articles were finally included in the systematic review process. The analyses were performed considering two groups; nebulizing furosemide treatment (i.e. case) and placebo (i.e. control). Based on the forest plots, the average values of PaCO2 were 48.3 (39.04-57.56) and 46.56 (39.94 -53.18) in the case and control groups, respectively. Also, the mean forced expiratory volume in the first second (FEV1) was 49 (31.32-66.67) and 46.87 (31.44-62.30) in the case and control groups, respectively. Meta-regression analysis showed that both heart and pulse rates in the nebulizing furosemide group decreased by increasing the year of study and sample size (P <0.001). The heterogeneity among the studies was found to be 72.2%, which is classified as severe heterogeneity. Conclusion: nebulizing furosemide can improve and normalize the vital signs and other respiratory variables in patients with COPD.

https://www.tanaffosjournal.ir/article_243449_130126a53c6aebc2cc16939b126b1e5c.pdf

National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran TANAFFOS (Respiration) 1735-0344 19 4 2020 10 01 Beneficial Outcomes of Early Tracheostomy in Patients Requiring Prolonged Mechanical Ventilation 350 355 243451 EN Danial Samiei Nasr Chronic Respiratory Disease Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Batoul Khoundabi Iran Helal Institute of Applied-Science and Technology, Research Center For Health Management in Mass Gathering, Red Crescent Society of the Islamic Republic of Iran, Tehran, Iran Golara Monshizadeh Azar Shahid Beheshti University of Medical Sciences, Tehran, Iran Majid Malekmohammad Lung Transplantation Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran Hamidreza Jamaati Chronic Respiratory Disease Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Seyed Mohammadreza Hashemian Chronic Respiratory Disease Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran 0000-0002-0768-9168 Journal Article 2021 04 14 Background: Considering that tracheostomy is being done for huge amount of critically ill patients, the ideal time for this procedure is still controversial among different intensive care units (ICU). Materials and Methods: 70 intubated patients were included in our study which was sorted into two subgroups: half of our patients received an early tracheostomy (ET) within 1-10 days post intubation and the rest received late tracheostomy (LT) within 11-21 days after getting intubated. Results: 61.9% of the study population was male and the mean age was of 54 + 10.5 years. ET group mean Mechanical Ventilation (MV) duration was 8.11±4.9 days and was 16.3 ± 6.01 in the LT group (p <0.05) with a mean sedation duration of 6.1 ± 4.4 vs. 12.0 ± 6.5 (ET vs. LT) (p <0.05). Mean time of weaning process from ventilator was 2.7 ±2.3 for ET group and 5.5 ± 5.0 for LT group (p <0.05). The Mean ICU stay was 18.8 ± 2.2 in the ET group, and 22.1 ± 4.1 in the LT group (p: 0.98) at the same time. Length of stay at hospital for two group of patients did not show a meaningful difference (p= 0.279). Conclusion: Early tracheostomy decreases duration of mechanical ventilation and sedation use and more rapid weaning process in those patients who will require mechanical ventilation. Our findings revealed that tracheostomy timing has no significant impact on rate of hospital mortality and LOS at ICU and hospital.

https://www.tanaffosjournal.ir/article_243451_eeebb83818b1b5dd82371898114bb5ae.pdf

National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran TANAFFOS (Respiration) 1735-0344 19 4 2020 10 01 Follow-Up of Coronavirus Infected Patients Using Telemedicine in a Referral Pulmonary Center 356 363 243452 EN Lida Fadaizadeh Telemedicine research center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti university of Medical Sciences, Tehran, Iran Hamidreza Jamaati Chonic Respiratory Diseases Research Center, NRITLD, Shahid Beheshti university of Medical Sciences, Tehran, Iran 0000-0002-5402-1531 Mohammad Varahram Mycobacteriology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mohammad Jafar Taheri Telemedicine research center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti university of Medical Sciences, Tehran, Iran Mohammad Sanaat Telemedicine research center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti university of Medical Sciences, Tehran, Iran Journal Article 2021 04 14 Background: Telemedicine is considered an innovative approach for management and follow up of communicable diseases, when person to person contact has the risk of disease dissemination, such as the situation being experienced with corona virus infection. The aim of this study was to evaluate the role of telemedicine in patient follow-up and patient compliance in different communication methods. Materials and Methods: All patients discharged from a referral pulmonary hospital dedicated to coronavirus infected patients were given instructions on follow-up of symptoms. One group received messages via short message system regarding the severity of their symptoms. For the other group a mobile application was specially designed for tracking their well-being on a daily basis. Severity of symptoms and course of disease were monitored in each group for a two-month period. Results: A total 1091 patients with mean age of 53.96± 17.95 years were enrolled in the study. In the first group 406 (60.14%) messages were successfully sent, from which 150 (36.94%) patients replied. Also, 243(35%) patients contacted us by making phone calls. Of the total patients in the second group, 153(64%) patients started using the mobile application. Chief complaint of patients was mainly cough, shortness of breath, fatigue, and myalgia. Deep vein thrombosis, hyperglycemia, post kidney transplant patient and bloody diarrhea were among the reported cases. Conclusion: Patient follow-up during epidemics, especially when the disease course is unknown, is an important step in both successful patient management and disease control. This study showed the role of telemedicine for patient follow-up, mostly in detecting special situations. But, in order to be successful patient education and active follow-up are important factors that must be considered.

https://www.tanaffosjournal.ir/article_243452_62b0746b6de88abdef6f51a36e34a1f7.pdf

National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran TANAFFOS (Respiration) 1735-0344 19 4 2020 10 01 Clinical Utility of Red Cell Distribution Width in Patients with Pleural Effusion 364 370 243453 EN Parisa Rezaeifar Tuberculosis and Lung Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Masoud Nouri-Vaskeh Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Masoud Nazemiyeh Tuberculosis and Lung Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Amir Dorraji Tuberculosis and Lung Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Akbar Sharifi Tuberculosis and Lung Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Journal Article 2021 04 14 Background: The red cell distribution width (RDW) value has been recently recognized as a valuable biomarker in clinical practice. The RDW value has not been evaluated so far in patients with pleural effusion. Thus, this study aimed to investigate whether RDW could distinguish between exudative and transudative pleural effusions. Materials and Methods: We measured protein and lactate dehydrogenase levels on both pleural fluids and serum samples from 223 cases and classified them as transudates or exudates based on the classic Light’s criteria. We collected blood cell count elements such as RDW from the medical records. We also investigated the correlation between RDW and the nature of pleural effusion. Results: In 55.2% of the patients, pleural fluid was exudative. Although we found no significant association between RDW and the nature of the pleural fluid, we detected a significantly higher amount of RDW (14.9 ≤) in patients with exudative pleural effusion compared to transudate (66.7% vs. 33.3%; P= 0.01). In this category, neoplastic conditions were mostly observed in the patients (76.3%), followed by pulmonary thromboembolism (21.1%) and systemic lupus erythematous (2.6%). Conclusion: The findings could not reveal any noticeable correlation between RDW and the Light criteria. However, it appears that elevated RDW levels give insights into the valuable nature of RDW in different conditions such as neoplastic diseases.

https://www.tanaffosjournal.ir/article_243453_686590db9fcc91b98f66ddf9e69d0dae.pdf

National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran TANAFFOS (Respiration) 1735-0344 19 4 2020 10 01 Diagnostic Value of D-dimer in Detecting Pulmonary Embolism in Patients with Acute COPD Exacerbation 371 379 243454 EN Somayeh Sadeghi Acquired Immunodeficiency Research Center, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran Mohammad Emami Ardestani Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Elham Raofi Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Akbar Jalaie Esfandabadi Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Journal Article 2021 04 14 Background: Signs and symptoms of chronic obstructive pulmonary disease (COPD) exacerbation may overlap with pulmonary embolism. Patients with acute COPD exacerbations have higher level of D-dimer which may D-dimer lead to false detection of pulmonary thromboembolism (PTE). In this study diagnostic value of D-dimer for diagnosis of pulmonary embolism during acute exacerbation in patients with COPD was investigated. Materials and Methods: This study was performed on 112 patients with acute COPD exacerbations. In all patients, Wells criteria and D-dimer serum levels were evaluated. Then, all cases were subjected to CT angiography (CTA) and ultrasonography. The diagnostic value of serum D-dimer level and Wells criteria and also their combination for PTE was compared to the gold standard method. Results: Of 112 patients, 17%, diagnosed with PTE using CTA. The D-dimer cut-off value in COPD patients was higher than 990 μg/L, which was higher than 3 for the Wells score while D-dimer alone showed no good diagnostic value for PTE diagnosis, but Wells score was acceptable (P-value = 0.019). Moreover, the combination of cut-off values, Wells score, and D-dimer level, as a new criterion, with a sensitivity and specificity rate of 47.37% and 88.17% respectively, had an acceptable diagnostic value in PTE diagnosis (AUC=0.678, P value=0.004). Conclusion: It is suggested thatD-dimer concentration alone could not make a good PTE diagnosis, but the simultaneous combination of this test with the Wells criterion can detect the PTE risk with better confidence. To obtain more accurate findings and to get the best criterion, further studies are needed in this field.

https://www.tanaffosjournal.ir/article_243454_21a142b9ae625e6915166b65b2bf6fb9.pdf

National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran TANAFFOS (Respiration) 1735-0344 19 4 2020 10 01 Relationship between Pulmonary Artery Diameter and Pulmonary to Aortic Artery Diameter Ratio in High Risk Individuals for Obstructive Sleep Apnea without Pulmonary Artery Hypertension Based on the Berlin Questionnaire 380 384 243455 EN Amirreza Sajjadieh Khajouei Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran Fariborz Nikaeen Departments of Cardiovascular Diseases, School of Medicine, Najaf-Abad Branch, Islamic Azad University, Isfahan, Iran Kiana Arzani Departments of Cardiovascular Diseases, School of Medicine, Najaf-Abad Branch, Islamic Azad University, Isfahan, Iran Nizal Sarrafzadegan Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran Majid Nejati Anatomical Sciences Research Center, Kashan University of Medical Sciences, Kashan, Iran Mohaddeseh Behjati Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran Journal Article 2021 04 14 Background: A significant association has been found between the pulmonary artery (PA) diameter and obstructive sleep apnea (OSA) in patients with pulmonary artery hypertension (PAH). We aimed to evaluate the relationship between the diameters of the PA trunk and aortic artery with their ratio as PAH markers in high risk cases for OSA based on the Berlin questionnaire without PAH. Materials and Methods: This case-control study included 161 non-PAH patients admitted to a multi-slice CT scan ward. Filling out the Berlin questionnaire, the patients were divided into high and low risk cases for OSA. The diameters of the PA trunk and aortic ascending aorta and their ratio were assessed using the multi-slice CT scan. Results: The PA to aortic ratios in the case and control groups were 0.89±0.17 and 0.88±0.17, respectively, which all were non-significant. With regard to gender, the PA diameter was significantly lower among males in the control group than in the case group (P=0.034). The mean PA to aortic ratio was slightly higher but statistically non-significant in the case group than in the control group. The aortic diameter showed a statistically significant increase by age in the case group (r=0.374, P=0.003) compared to the other group. However, the PA diameter increased significantly by age in both groups (r=0.184, P=0.020). Conclusion: The PA diameter can be considered as a predicting factor for future cardiovascular diseases in high risk males for OSA based on the Berlin questionnaire without PAH. More studies are required to confirm these findings.

https://www.tanaffosjournal.ir/article_243455_351bc5445a1749906ed1b61cc4558ddc.pdf

National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran TANAFFOS (Respiration) 1735-0344 19 4 2020 10 01 Clinical Determinants of the Six-Minute Walk Test (6MWT) in Stable Non-Cystic Fibrosis Bronchiectasis Patients 385 391 243456 EN Ramin Sami Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Mohammadali Zohal Metabolic Disease Research Center, Qazvin University of Medical Sciences, Qazvin, Iran Navid Mohammadi Department of Community Medicine, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran Preventive Medicine and Public Health Research Center (PMPHRC), Iran University of Medical Sciences, Tehran, Iran Journal Article 2021 04 14 Background: The six-minute walk test (6MWT) is a suitable tool for the assessment of functional capacity in patients with chronic pulmonary diseases. This study aimed to assess the clinical determinants of the six-minute walk distance (6MWD), exercise-induced desaturation (EID), and pretest saturation of arterial oxygen (SataO2) in patients with diffuse non-cystic fibrosis (CF) bronchiectasis. Materials and Methods: In this cross-sectional study, a total of 57 clinically stable patients with diffuse non-CF bronchiectasis were enrolled. Anthropometric measurements (body mass index [BMI], mid-arm muscle circumference [MAMC], and triceps skinfold thickness [TSF]), spirometric indices (forced expiratory volume in one second [FEV1], forced vital capacity [FVC], and FEV1/FVC ratio), imaging assessment (CT scan), and bacteriological sputum studies were performed, and then, 6MWT was carried out. Results: The mean 6MWD was measured to be 447.11±94.59 m. The average walked distance in patients with severe, moderate, and mild bronchiectasis was 427.73±92.07, 439.63±102.65, and 485.87±80.47 m, respectively, with no significant difference. The pretest SataO2 was 88.92±5.59%, 93.75±3.36%, and 94.87±2.88% in the severe, moderate, and mild bronchiectasis groups (P<0.001). A significant inverse correlation was observed between the distance walked and BMI (r=-0.434, P=0.001). Conclusion: The predictors of 6MWD in stable non-CF bronchiectasis patients were FVC, SataO2 at rest, BMI, and MAMC. The FEV1, FEV1/FVC, and BMI were independent predictors of SataO2 at rest. The extension of bronchiectasis was the only predictor of EID during the test.

https://www.tanaffosjournal.ir/article_243456_bcf34a87c4596c0067ff2463cc0cbd25.pdf

National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran TANAFFOS (Respiration) 1735-0344 19 4 2020 10 01 Postural Balance Evaluation in Patients with Chronic Obstructive Pulmonary Disease 392 400 243457 EN Ali Molouki Physiotherapy Research Center, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran Mohammad Mohsen Roostayi Physiotherapy Research Center, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran 0000-0002-5866-6505 Mohsen Abedi Physiotherapy Research Center, Department of Physiotherapy, School of Rehabilitation, Shahid Beheshti University of Medical Sciences, Tehran, Iran Atefeh Fakharian Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Alireza Akbarzadeh Baghban Proteomics Research Center, Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Journal Article 2021 04 14 Background: The risk of falling in patients with chronic obstructive pulmonary disease (COPD) is higher than healthy people, imposing a great financial burden on patients due to clinical diagnosis and treatment.This study aimed to compare static balance between two groups of healthy people and COPD patients, based on cognitive tasks and vision tests, using linear and non-linear analyses. Materials and Methods: A total of 15 patients with COPD and 14 age- and gender-matched healthy individuals were recruited in this study. Variations in the center of pressure were recorded in both medial-lateral (ML) and anterior-posterior (AP) directions by implementing visual feedback and cognitive tasks, with the subject standing on a force plate. Data related to the center of pressure were analyzed in the AP and ML directions by linear methods (i.e., standard deviation of displacement, standard deviation of maximum velocity, average velocity, and phase plane). Also, the nonlinear method (Lyapunov exponents) was used in both directions. Results: The cognitive tasks improved the center of pressure variables in both groups. In association with the vision tests, only lack of vision had a significant effect on the patients. The results of the linear analysis in the ML direction were significantly higher in the COPD group as compared to the healthy group; however, the results were not significant in the AP direction. Also, the non-linear analysis showed significant differences between the groups. Conclusion: Use of both linear and non-linear analyses is necessary for evaluating the balance of patients with breathing difficulties. Balance disorders in COPD patients were mostly in the ML direction; therefore, postural deformities might be one of the reasons for balance problems in the AP direction.

https://www.tanaffosjournal.ir/article_243457_837bd559ef364dd2b6389ffdf20e63b9.pdf

National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran TANAFFOS (Respiration) 1735-0344 19 4 2020 10 01 Effects of a Comprehensive Care Program on the Readmission Rate and Adherence to Treatment in Elderly Patients with Chronic Obstructive Pulmonary Disease 401 412 243458 EN Ali Khosravi School of Nursing and Midwifery, Student Research Committee, Rafsanjan University of Medical Sciences, Rafsanjan, Iran Ali Ravari Department of Medical Surgical Nursing, School of Nursing and Midwifery, Geriatric Care Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran Tayebeh Mirzaei Department of Medical Surgical Nursing, School of Nursing and Midwifery, Geriatric Care Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran Mohammadreza Gholamrezapour Department of Internal Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran. Journal Article 2021 04 14 Background: The low treatment adherence of patients with chronic obstructive pulmonary disease (COPD) leads to the exacerbation of their symptoms and readmission. Comprehensive care programs are among interventions that can improve the patients’ adherence to treatment and prevent readmission. The present study aimed to evaluate the effects of a comprehensive care program on the adherence to treatment and readmission of COPD patients. Materials and Methods: This randomized clinical trial was performed in a hospital in Rafsanjan, Iran, in 2017. Sixty elderly patients with COPD were randomly enrolled in this study by pair-matching. The intervention group participated in a comprehensive care program, whereas the control group received routine care. The readmission rate and adherence to treatment were measured at one-, three-, and six-month intervals. To evaluate the patients’ adherence to treatment, an adherence-to-treatment questionnaire for chronic diseases was used. Data were analyzed using Chi-square test, independent t-test, and repeated measures ANOVA at a significance level of 0.05. Results: A significant difference was observed between the two groups in terms of readmission at the end of the study (P=0.03). In the intervention group, the mean level of adherence to treatment and its subscales improved as compared to the control group, and there was a significant difference between the two groups. Conclusion: Although most of the patients in this study were old, with a rather low educational level and socioeconomic status, the care program could improve their treatment adherence and reduce the readmission rate.

https://www.tanaffosjournal.ir/article_243458_5005bd89267a4d6c9cad0436bb42d702.pdf

National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran TANAFFOS (Respiration) 1735-0344 19 4 2020 10 01 Trisomy 21 as a Risk Factor for Severe Illness in COVID-19: Report of two Cases 413 417 243459 EN Abdolreza Babamahmoodi Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Afshin Moniri Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Makan Sadr Virology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences ,Tehran, Iran Seyed Mohammad Poorhosseini Department of Genetics, Faculty of Advanced Science and Technology, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran Mitra Rezaei Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Virology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences ,Tehran, Iran 0000-0003-1466-8645 Majid Marjani Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Ali Akbar Velayati Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Journal Article 2021 04 14 COVID-19 leads to mild symptoms within the majority of infected patients, but can cause severe multiple organ failure and death. There is only limited information regarding the consequences of this new emerging infection with congenital disorders. According to the previous studies, many people with Down syndrome are considered high risk for complications related to respiratory diseases. We report two trisomy 21 patients who suffered from COVID-19 and summarize the early experience with COVID-19 and Down syndrome. The course of the disease was severe in these two cases, and our concern is close monitoring of the patients with Down syndrome for early signs of COVID-19.

https://www.tanaffosjournal.ir/article_243459_cf39d7c6e60bf1bab4010147c987748c.pdf

National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran TANAFFOS (Respiration) 1735-0344 19 4 2020 10 01 Portable Chest Radiography Immediately after Post-Cardiac Surgery; an Essential Tool for the Early Diagnosis and Treatment of Atelectasis: a Case Report 418 421 243460 EN Masoud Tarbiat Department of Anesthesiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran 0000-0002-0025-9771 Mohammad Hossein Bakhshaei Department of Anesthesiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran Hamid Reza Khorshidi Department of Surgery, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. Babak Manafi Department of Surgery, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran. Journal Article 2021 04 14 Atelectasis after endobronchial intubation (ETT) is a known complication of general anesthesia. In-bed auscultation of lungs and use of the 21/23 rule are the two suggestive, but not reliable, methods for the early detection of this event; however, none of them guarantees its prevention. The portable chest radiograph (CXR) is a simple, quick method to detect atelectasis and proper placement of the endotracheal tube in the intensive care unit (ICU). A case of postsurgical, ICU-admitted patient was presented in the report, demonstrating left (LT) lung atelectasis in immediate portable CXR without any evidence of respiratory or hemodynamic abnormality. Portable CXR showed that the tip of the endotracheal tube was located in the lumen of the right main bronchus, leading to LT lung total atelectasis. After repositioning of ETT to the lumen of the trachea, atelectasis was disappeared in early follow-up CXR.

https://www.tanaffosjournal.ir/article_243460_18591d33c3a17610c0e9f583752238ad.pdf