National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran TANAFFOS (Respiration) 1735-0344 24 2 2025 04 01 The Secret of Iran's Success in Overcoming the COVID-19 Challenge 111 113 734841 EN Mohammad Bakhtiari Department of Anesthesiology, Samen Alhojaj Hospital, School of Medicine, Sirjan University of Medical Sciences, Sirjan, Iran 0000-0002-1104-0281 Reza Sadeghi Department of Public Health, School of Medicine, Sirjan University of Medical Sciences, Sirjan, Iran 0000-0002-5162-6316 Journal Article 2023 12 30 Dear Editor Coronavirus disease 2019 (COVID-19) has spread rapidly worldwide since its emergence in December 2019. During the pandemic of an emerging infectious disease, it is very important to prevent and control outbreaks (1). The public health response to the onset of the COVID-19 pandemic required minimizing the baleful spread of the disease and changing the health education approach from traditional to new combinatorial approaches (2). During the waves of the coronavirus, with its various strains, timely actions by health authorities significantly reduced both the incidence and mortality of COVID-19 (3). The control of the COVID-19 pandemic in the world depends on several factors, and these factors can be explained in the form of the Swiss cheese model. The measures will be effective if all aspects related to prevention are taken into account. Of course, these factors should be sought in health promotion strategies (1). The key to Iran's success in the waves was related to three health promotion strategies: health education, social marketing, and legal obligation (legal-regulatory measures). Regarding health education, the strategy of the health campaign and extensive information were on the agenda of the Ministry of Health and the country's media, such as television, radio, newspapers, the internet, Instagram, Telegram, WhatsApp, and virtual education. In campaigns, multiple targeted messages were sent to the specific population in a certain period, in line with the objectives of the health campaign program (4). Health campaigns invite the target group, participants, and key people to pay attention to the common good, and campaigns have the highest penetration rate among all intervention strategies (5). Social marketing is one of the behavioral patterns that is designed based on the view of the audience, which is proposed along with two approaches of education and coercion to change the behavior of society. The foundation of social marketing involves creating a product or intervention tailored to the audience's needs and desires. It considers the material and immaterial costs of the target behavior and is placed in suitable locations to provide the product or intervention. The goal is to generate awareness of the product and encourage its continued use within the target group. The above four components, which include product, price, place, and promotion, are the basis for designing interventions based on the needs of the community (6). In relation to social marketing, one effective strategy was to ensure that protective equipment, such as masks and shields, was made accessible to the public at reasonable prices, and in some cases, provided for free. Installing hand sanitizers in offices, banks, and other public places also contributed to this effort. Additionally, extending operating hours helped to reduce crowding during peak times. By focusing on providing the right products at the right price, in the right places, and with appropriate promotional strategies, based on the 4P marketing framework, we were able to make significant progress in controlling the spread of COVID-19 (7). Coercion is an important strategy in promoting public health, particularly when social acceptance is low or the health issue is highly sensitive (8). COVID-19 is one of the diseases that requires coercion and regulation to control it (9). The subsequent strategy, involving legal coercion and surveillance, appears to have been a key factor in controlling the third wave of COVID-19. In this strategy, several legal measures were implemented, including the targeted closure of businesses based on the necessity and needs of the people at four levels. One of these levels was the level of essential businesses, which effectively met the needs of the people by maintaining intelligent service protocols. Other businesses were shut down or restricted in accordance with the development protocol. Another solution was to ban traffic from 9 pm to 4 am, to prevent periods or family parties. Violators were also fined in this regard. Surveillance was also intensified, and individuals were not allowed to enter places and offices without masks. Religious places and mosques were closed, and any gatherings were prevented. The remarkable point in this part was the seriousness and decisive treatment of the violators. In any case, it is necessary to observe the protocol, its executive and legal guarantee. In general, these three strategies were essential in managing the third wave of COVID-19 and must be consistently implemented and monitored to control the disease. One of the concerns for both the public and those responsible for addressing economic and livelihood issues among the poor is the allocation of livelihood and support packages. These resources can help mitigate the challenges faced by impoverished individuals and families. To effectively control the coronavirus pandemic, it is essential to adhere to all aspects of health education, social marketing, and legal measures. We must continue these efforts until herd immunity is reached and vaccination coverage is fully achieved (10). The principle of precedence is to keep in mind that prevention precedes treatment. Acknowledgments The authors would like to thank the Sirjan School of Medical Sciences. Competing interests None References 1. Noh JY, Song JY, Yoon JG, Seong H, Cheong HJ, Kim WJ. Safe hospital preparedness in the era of COVID-19: The Swiss cheese model. Int J Infect Dis 2020;98:294-6. 2. Lucey CR, Johnston SC. The Transformational Effects of COVID-19 on Medical Education. JAMA 2020;324(11):1033-4. 3. Jafari H, Heidari M, Sadeghi R, Heidari-Jamebozorgi M. Factors affecting the resilience of hospital medical staff during the COVID-19 pandemic. Family Medicine & Primary Care Review 2023;25(1):50-4. 4. Sadeghi R, Mazloomy Mahmoodabad SS, Fallahzadeh H, Rezaeian M, Bidaki R, et al. Hookah is the enemy of health campaign: a campaign for prevention of hookah smoking among youth. Health Promot Int 2020;35(5):1125-36. 5. Yousuf H, Corbin J, Sweep G, Hofstra M, Scherder E, van Gorp E, et al. Association of a Public Health Campaign About Coronavirus Disease 2019 Promoted by News Media and a Social Influencer With Self-reported Personal Hygiene and Physical Distancing in the Netherlands. JAMA Netw Open 2020;3(7):e2014323. 6. Hine DW, Sharp T, Driver AB. Using audience segmentation and targeted social marketing to improve landholder management of invasive animals. Community-Based Control. of Invasive Species; Martin, P., Ed. 2019:183-209. 7. Odigbo B, Eze F, Odigbo R. COVID-19 lockdown controls and human rights abuses: the social marketing implications [version 1; peer review: awaiting peer review]. Emerald Open Research 2020; 45:1-13 8. Gostin LO, Hodge JG Jr. US Emergency Legal Responses to Novel Coronavirus: Balancing Public Health and Civil Liberties. JAMA 2020;323(12):1131-2. 9. Sadeghi R, Khanjani N, Masoudi MR. Investigating the predictive factors of protective behaviors against COVID-19 among bank employees. Iran Occupational Health 2020;17(1):90-100. 10. Sadeghi R, Masoudi MR, Khanjani N. The commitment for fair distribution of COVID-19 vaccine among all countries of the world. Res Nurs Health 2021;44(2):266-267. https://www.tanaffosjournal.ir/article_734841_30286704964f22160789defdae88894d.pdf

National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran TANAFFOS (Respiration) 1735-0344 24 2 2025 04 01 Traditional and Short Course Treatment for Multidrug-Resistant Tuberculosis: A Comparative Study in National Referral Centers 114 127 734842 EN Parvaneh Baghaei Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 0000-0002-6361-315X Johnathon R Campbell Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine, McGill University, Montreal, Canada 0000-0003-2341-2166 Amirmohsen Mahdavian Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Zahra Abtahian Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 0000-0001-7167-8503 Majid Marjani Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 0000-0003-1466-8645 Afshin Moniri Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 0000-0001-7237-8940 Mohammad Varahram Mycobacteriology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran 0000-0002-8033-1867 Mehdi Kazempour Department of Biostatistics, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran 0000-0002-6673-9006 Payam Tabarsi Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran. 0000-0002-8932-5420 Journal Article 2024 03 07 Background: Treatment of multidrug-resistant tuberculosis (MDR-TB) is difficult, expensive, and requires prolonged periods of time. Recent studies recommended short-course therapy (shorter regimen) for 9 months to one year. This study aimed to evaluate the response of the short-course therapy compared with traditional treatment in MDR-TB patients. Materials and Methods: From all 94 referred MDR-TB cases, 48 patients were included in this study. Shorter regimen consisted of Moxifloxacin, Prothionamide, Amikacin, Clofazimine, Linezolid, Ethambutol, Pyrazinamide, and Cycloserine, and longer regimens consisted of the mentioned drugs, except Clofazimine and Linezolid, were prescribed randomly: in equal (24 in each group). The patients were monitored and evaluated for any complications and were followed for five years for relapse. Results: The median age was 39 years. The median interval for smear conversion was 30 days (20- 58 days) and was shorter in the short-course group (36 vs. 49 days). Also, the mean interval of sputum culture conversion in the shorter group and standard was 32 and 56 days, respectively, which is not related to the outcome of treatment. Eight of twelve patients who developed severe adverse effects were in shorter regimen. There was no difference between the two groups for the outcome of TB treatment. There is no relation between the outcome and other factors. None of them relapsed after three years following the end of the treatment. Conclusion: Shorter treatment can increase the cure rate and cooperation and adherence of the patients. It would be better to consider a shorter regimen in the national TB program for strengthening favorable treatment.

https://www.tanaffosjournal.ir/article_734842_8915462194ed0901fe05b7564c384ba0.pdf

National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran TANAFFOS (Respiration) 1735-0344 24 2 2025 04 01 Introducing Critical Genes Related to X-ray Radiation in Human Bronchial Epithelial BEAS-2B Cells 128 135 734843 EN 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 0000-0003-1466-8645 Farideh Razi Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran 0000-0003-2350-9574 Alireza Ahmadzadeh Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran Department of Lab Sciences, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran 0000-0002-5474-6997 Fatemeh Bandarian Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran 0000-0003-0359-3043 Babak Arjmand Cell Therapy and Regenerative Medicine Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran Iranian Cancer Control Center (MACSA), Tehran, Iran 0000-0001-5001-5006 Mostafa Rezaei-Tavirani Proteomics Research Center, System Biology Institute, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran 0000-0003-1767-7475 Journal Article 2024 08 09 Background: X-ray radiation application in radiology is a challenging subject for patients. Understanding the molecular events triggered by X-ray radiation can provide a suitable protocol for maintaining patient health. The primary aim of this study is to explore crucial affected genes in this regard. Materials and Methods: Extraction and validation of data from the Gene Expression Omnibus (GEO) database is the first step in identifying significantly differentially expressed genes (DEGs). Analysis of gene expression profiles of human bronchial epithelial BEAS-2B cells through a directed protein-protein interaction (PPI) network was used to identify the key targeted genes affected by X-ray radiation. Results: Results of the analyzed directed PPI networks, based on expression, activation, inhibition, and reaction actions, and considering outdegree values, showed that IL1B, CCND1, RAC2, NDC80, and MIB1 are the crucial genes targeted by X-ray. Conclusion: <span lang="EN-US" style="font-size: 9.0pt; font-family: 'Book Antiqua','serif'; mso-fareast-font-family: Calibri; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi; mso-font-kerning: 1.0pt; mso-ligatures: standardcontextual;">In conclusion, upregulation of IL1B, RAC2, and CCND1, which are associated with cellular damages and downregulation of <span lang="EN-US" style="font-size: 9.0pt; font-family: 'Book Antiqua','serif'; mso-fareast-font-family: Calibri; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi; mso-font-kerning: 1.0pt; mso-ligatures: standardcontextual;">NDC80 and MIB1, which protect the treated cells, were pointed out as the major molecular events in response to X-ray radiation.

https://www.tanaffosjournal.ir/article_734843_8a06ac5e44bceadf693198eb0c348a07.pdf

National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran TANAFFOS (Respiration) 1735-0344 24 2 2025 04 01 Bronchoscopy Procedures Implemented During the Pandemic Period in a University Hospital 136 140 734844 EN Fatih Uzer Department of Pulmonology, Akdeniz University, Antalya, Türkiye 0000-0001-9318-0458 Eminenur Topcu Department of Pulmonology, Akdeniz University, Antalya, Türkiye 0000-0002-6522-6532 Omer Ozbudak Department of Pulmonology, Akdeniz University, Antalya, Türkiye 0000-0001-9516-8129 Aykut Cilli Department of Pulmonology, Akdeniz University, Antalya, Türkiye 0000-0001-9985-3502 Journal Article 2024 02 06 Background: Our objective was to review the bronchoscopy procedures conducted at our hospital during the pandemic, with a focus on the potential risks of COVID-19 transmission associated with these interventions. Materials and Methods: This comprehensive study included all patients who underwent bronchoscopy in the Department of Pulmonology at Akdeniz University from March 15 to December 31, 2020. A retrospective review of medical records covered demographic information, procedure indications, urgency, procedure type, diagnostic results, and the patient's COVID-19 history. Data collection also recorded the number of personnel involved in bronchoscopy during the pandemic, along with their COVID-19 history. Results: A total of 250 bronchoscopy procedures were performed during the study period. The majority of patients were male (74.8%), with a mean age of 58 ± 13.5 years. The most common indication for bronchoscopy was lung cancer (39.2%), followed by other causes like interstitial lung diseases and sarcoidosis. No patients with a positive pre-procedural COVID-19 PCR test were included in the procedure. All patients who underwent the procedure had a negative PCR test result. No post-procedural COVID-19 cases were observed among healthcare workers or patients following the procedures. All procedures were conducted with appropriate personal protective equipment (PPE), and SARS-CoV-2 RT-PCR testing was performed on 76.8% of patients before the procedure. No complications, other than minor hemorrhages, were reported. <span lang="EN-US" style="font-size: 9.0pt; font-family: 'Book Antiqua','serif'; mso-fareast-font-family: 'Times New Roman'; mso-bidi-font-family: 'Times New Roman'; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">Conclusion: <span lang="EN-US" style="font-size: 9.0pt; font-family: 'Book Antiqua','serif'; mso-fareast-font-family: 'Times New Roman'; mso-bidi-font-family: 'Times New Roman'; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">Bronchoscopy performed with appropriate PPE, in a negative pressure room, and with pre-procedural SARS-CoV-2 RT-PCR testing, is a safe and effective diagnostic and therapeutic procedure during the COVID-19 pandemic. The safety protocols implemented in this study successfully minimized the risk of COVID-19 transmission to healthcare workers and patients.

https://www.tanaffosjournal.ir/article_734844_be8c0021787769544ac33381a57742f9.pdf

National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran TANAFFOS (Respiration) 1735-0344 24 2 2025 04 01 Interleukin-1 and Interleukin-8 are Prominent Inflammatory Markers in Patients with Cystic Fibrosis and Non-Cystic Fibrosis 141 149 734845 EN Hosein Ali Ghaffaripour Pediatric Respiratory Diseases Research Center (PRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Maryam Hassanzad Pediatric Respiratory Diseases Research Center (PRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran 0000-0001-7164-0599 Mahsa Mirzendehdel Pediatric Respiratory Diseases Research Center (PRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran 0000-0002-1062-5341 Niloofar Esfahanian Pediatric Respiratory Diseases Research Center (PRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran 0000-0002-4183-2685 Journal Article 2024 01 05 Background: Bronchiectasis is characterized by pathological inflammation and infection that cause thickening and dilation of the airways. It is categorized into cystic fibrosis (CF) and non-cystic fibrosis bronchiectasis (NCFB). Given the disease's inflammatory nature, this study aimed to assess the levels of interleukin-1 (IL-1), IL-8, and tumor necrosis factor-alpha (TNF-α) in CF and NCFB patients compared to a healthy control (HC) group. Materials and Methods: A total of 35 bronchiectasis patients (18 with CF and 16 with NCFB) and 18 individuals in the HC group were selected based on specific inclusion and exclusion criteria. After receiving informed consent, the levels of IL-1, IL-8, and TNF-α in serum and broncho-alveolar lavage (BAL) fluid were measured using ELISA. Additionally, spirometry results for the study participants were recorded before and after bronchoscopy. Results: Significant differences were observed in serum IL-8 (p = 0.018) and in BAL IL-1 and IL-8 levels (p = 0.018 and p < 0.0001, respectively). A notable positive correlation was found between serum IL-1 and both serum and BAL IL-8 (p < 0.0001). Similarly, serum IL-8 showed a significant positive correlation with its BAL levels (p = 0.007). Conclusion: Findings from this study suggest that elevated IL-1 in the lungs is a key factor in bronchiectasis-related inflammation, and the increase in IL-8 may occur via an IL-1-dependent pathway. The heightened levels of IL-8 in BAL and serum among bronchiectasis patients align with known neutrophilia in these cases. Spirometry results showed no significant association with these cytokine increases, indicating that relying solely on spirometry may be insufficient for monitoring inflammation in bronchiectasis patients.

https://www.tanaffosjournal.ir/article_734845_5d647be4e8be6c7fd44182567c83dca7.pdf

National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran TANAFFOS (Respiration) 1735-0344 24 2 2025 04 01 Diagnostic Performance and Learning Curve of EBUS-Guided TBNA in Western India: A Retrospective Analysis 150 155 734846 EN Ram Niwas Jalandra Department of Pulmonary Medicine, All India Institute of Medical Sciences, Bathinda, Punjab, India 0000-0003-1168-1115 Aneesa Shahul S Ananthapuri Hospital and Research Institute Thiruvananthapuram, Kerala, India 0000-0003-2510-3199 Poonam Elhence Department of Pathology, All India Institute of Medical Sciences Jodhpur, Rajasthan, India 0000-0002-4660-389X Naveen Dutt Department of Pulmonary Medicine, All India Institute of Medical Sciences Jodhpur, Rajasthan, India 0000-0002-9517-4999 Nishant Kumar Chauhan Department of Pulmonary Medicine, All India Institute of Medical Sciences Jodhpur, Rajasthan, India 0000-0003-3491-0275 Shahir Asfahan Department of Pulmonary medicine, All India Institute of Medical Sciences, Jodhpur 0000-0002-4709-2200 Kunal Deokar Department of Pulmonary Medicine, All India Institute of Medical Sciences Rajkot, Gujarat, India 0000-0003-2603-1633 Journal Article 2023 07 05 Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as a minimally invasive and highly effective modality for evaluating mediastinal and hilar lymphadenopathy. This study aimed to assess the diagnostic performance and analyze the learning curve of EBUS-guided TBNA during the first two years of its implementation at a tertiary care center in Western India. Materials and Methods: Retrospective data of EBUS bronchoscopy procedures and their outcomes were collected from the bronchoscopy suite of a tertiary care hospital in Western India. Data were collected using a Google form for the first two years of EBUS operation. The percentage of diagnostic procedures conducted during each quarter was calculated over the two years. The difference in the distribution of determinate to indeterminate procedures between the first and the second year was assessed using the Chi-Square test. Statistical and graphical analyses were performed using Python 3.6. Results: Based on the cytology reports, out of 144 EBUS procedures conducted, 90 (62.5%) resulted in a diagnosis. Station 7 mediastinal node was the most frequently sampled. Among the determinate procedures, squamous cell carcinoma (31.1%) was the most frequently diagnosed. The average yield for the first four quarters was 57.4%, and for the next four quarters, it was 64.9%. There was a 7.5% increase in yield in the second year of EBUS operation; however, the difference was non-significant (p=0.46). Conclusion: In the first two years after acquiring EBUS equipment, EBUS-guided TBNA had a diagnostic yield of 62.5% in an academic institute. The diagnostic yield increased during the second year, likely due to a combination of improved operator skills and wise patient selection.

https://www.tanaffosjournal.ir/article_734846_6e4a0f59dd156ab1b71218d63cbae97d.pdf

National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran TANAFFOS (Respiration) 1735-0344 24 2 2025 04 01 Mini-Nutritional Assessment Test and Fat-Free-Mass Depletion in Tunisian Chronic Obstructive Pulmonary Disease Patients 156 162 734847 EN Soumaya Khaldi Department of Pulmonary Function Tests, Abderrahmen Mami Hospital, Ariana, Tunisia 0009-0005-0301-8171 Khouloud Kchaou Department of Pulmonary Function Tests, Abderrahmen Mami Hospital, Ariana, Tunisia 0000-0001-7116-1336 Asma Chaker Department of Pulmonary Function Tests, Abderrahmen Mami Hospital, Ariana, Tunisia 0000-0002-6734-8437 Rim Kammoun Department of Physiology and Functional Explorations, Habib Bourguiba University Hospital, Sfax, Tunisia 0000-0001-6760-2709 Sahar Chakroun Department of Physiology and Functional Explorations, Habib Bourguiba University Hospital, Sfax, Tunisia 0000-0001-9054-3655 Faten Chaieb Vascular Exploration Unit, Department of Physiology and Functional Exploration, Farhat Hached Hospital, Sousse, Tunisia 0000-0002-6253-2788 Masmoudi Kaouther Department of Physiology and Functional Explorations, Habib Bourguiba University Hospital, Sfax, Tunisia 0000-0002-3710-8299 Saloua Ben Khamsa Department of Pulmonary Function Tests, Abderrahmen Mami Hospital, Ariana, Tunisia 0000-0001-7915-2741 Journal Article 2023 04 25 Background: Fat-Free Mass (FFM) depletion is one of the systemic manifestations of COPD, causing functional impairment. We aimed to evaluate the relevance of the Mini-Nutritional Assessment (MNA) test in predicting FFM depletion in Tunisian COPD patients and to determine the relationship between nutritional status and disease severity. Materials and Methods: This was a cross-sectional study of patients with stable COPD. Respiratory function was assessed. The MNA test and the COPD Assessment Test (CAT) questionnaire were also completed. FFM was measured by bioelectrical impedance analysis. Fat-Free Mass Index (FFMI) was calculated according to the following formula: FFM (kg)/height (m)². FFM depletion was defined as a FFMI < 16 kg/m². Results: The study population consisted of 160 patients with COPD. FFM depletion was higher in patients with more severe COPD. Patients with FFM depletion had a lower MNA score than patients without FFM depletion. The independent predictors of FFM depletion in COPD were MNA (p<0.0001; OR=0.333; CI: 0.2-0.552) and BMI (p<0.0001; OR=0.547; CI: 0.408-0.733). The MNA score was significantly correlated with FFMI, CAT score, and lung function. ROC curve analysis defined a value of 19.25 as the optimal cut-off value of the MNA score to discriminate COPD patients with FFM depletion from those without FFM depletion. By using this value, the sensitivity and specificity of the MNA test for detecting FFM depletion were 90% and 74%, respectively. Conclusion: Our results suggest that the MNA test, a simple and universally available tool, can predict FFM depletion in COPD.

https://www.tanaffosjournal.ir/article_734847_fe43b9a5ee883079e2cd6d457d02cc1e.pdf

National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran TANAFFOS (Respiration) 1735-0344 24 2 2025 04 01 Evaluation of Biofilm Formation, Alginate Production, Pattern of Drug Resistance, and the Presence of Efflux Pump MexAB-OprM, MexXY (-OprA), and AmpC Gene in Clinical Isolates of Pseudomonas aeruginosa 163 173 734848 EN Saeid Besharati Department of Microbiology and Microbial Biotechnology, Faculty of Life Sciences and Biotechnology, Shahid Beheshti University, Tehran, Iran Mohammad Rahbar Departments of Microbiology, Iranian Reference Health Laboratory Research Center, Ministry of Health and Medical Education, Tehran, Iran Neda Soleimani Department of Microbiology and Microbial Biotechnology, Faculty of Life Sciences and Biotechnology, Shahid Beheshti University, Tehran, Iran Journal Article 2024 11 16 Background: One of the most significant factors contributing to multidrug resistance in Pseudomonas aeruginosa infections is the formation of biofilms and the production of alginate. This study aimed to evaluate the overexpression of efflux pumps MexAB-OprM, MexXY (-OprA), and the AmpC gene and investigate biofilm and alginate in P. aeruginosa clinical isolates. Materials and Methods: One-hundred isolates of P. aeruginosa were collected two government-specialized hospitals from February 2024 to June 2024 in Tehran, Iran. The disk diffusion method was used for antimicrobial susceptibility and detecting the pattern of antibiotics. We used a microtiter plate and carbazole assay to investigate biofilm formation and alginate production, respectively. We investigated the efflux pump MexAB-OprM, MexXY (-OprA), and the AmpC gene expression with real-time PCR and its correlation with biofilm, alginate, and antibiotic resistance. Results: 30 multidrug-resistant (MDR) isolates were detected, and 27 antibiotic patterns were obtained. A significant relationship between biofilm formation and resistance to PRL was observed (P<0.01). All of the samples with more than 250µg/ml level of alginate production were resistant to Piperacillin-Tazobactam (PTZ), which was significant (P<0.05). Also, the relationship between alginate production and strong biofilm formation was significant. The expression of resistance-nodulation-division (RND) efflux pumps MexAB-OprM, MexXY (-OprA), and AmpC gene in MDR isolates of P. aeruginosa was significantly increased. Conclusion: High prevalence of MDR, along with high expression of efflux pump genes, was concerning. High production of biofilm formation and its relationship with alginate were observed in P. aeruginosa clinical isolates. To prevent the spread of antibiotic resistance, implementing monitoring methods and not overusing and abusing antibiotics is necessary.

https://www.tanaffosjournal.ir/article_734848_5a5430eebc41c37e27d399e2eaf7a89d.pdf

National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran TANAFFOS (Respiration) 1735-0344 24 2 2025 04 01 Role of Visual Biofeedback in COPD Patients on Structured Home-Based Pulmonary Rehabilitation Program: a Double-Blind, Parallel, Randomized Controlled Trial 174 180 734849 EN Mohd Rashid Department of Physical Medicine and Rehabilitation, King George’s Medical University, Shah Mina Road, Chowk, Lucknow, Uttar Pradesh, 226003 0000-0001-6484-5991 Sudhir R Mishra Department of Physical Medicine and Rehabilitation, King George’s Medical University, Shah Mina Road, Chowk, Lucknow, Uttar Pradesh, 226003 0000-0002-1606-6384 Ajay Kumar Verma Department of Respiratory Medicine, King George’s Medical University, Shah Mina Road, Chowk, Lucknow, Uttar Pradesh, 226003 0000-0002-2973-1793 Dileep Kumar Department of Physical Medicine and Rehabilitation, King George’s Medical University, Shah Mina Road, Chowk, Lucknow, Uttar Pradesh, 226003 0000-0003-2988-9096 Ganesh Yadav Department of Physical Medicine and Rehabilitation, King George’s Medical University, Shah Mina Road, Chowk, Lucknow, Uttar Pradesh, 226003 0000-0002-2440-091X Anil K Gupta Department of Physical Medicine and Rehabilitation, King George’s Medical University, Shah Mina Road, Chowk, Lucknow, Uttar Pradesh, 226003 0000-0002-7524-3635 Journal Article 2023 03 13 Background: Globally, COPD is the most common pulmonary disorder. Although Indoor Pulmonary rehabilitation (PR) programs increase exercise tolerance and improve quality of life in COPD, they also cause a significant escalation in the expenses of treatment. This study aimed to assess the effect of home-based PR programs in patients with mild to severely affected stable COPD, to determine the impact of visual biofeedback on pulmonary function and the quality of life of these patients. Materials and Methods: This Double-blind, parallel, randomized controlled study was conducted at a tertiary care center from April 2023 to June 2024. The study enrolled 70 patients, who were randomized into group A (Incentive spirometry plus conventional pulmonary exercise) and group B (Conventional pulmonary exercises). Pulmonary indices, FEV1 (Forced Expiratory Volume in 1 sec), FVC (Forced Vital Capacity), FEV1/FVC (%), and Quality of life indices, St. George’s Respiratory Questionnaire (symptoms score, activities score, impact score, and total score), were used as outcome measures. Data were recorded at baseline and after 4 weeks of a structured PR program and analyzed by SPSS version 24.0, and a p-value < 0.05 was chosen as the level of significance. Results: There were 44 males and 26 females. Inter-group assessment after 4 weeks of PR program showed improvement in FEV1 (p-value: 0.043), FVC (p-value: 0.032), Symptom score (p-value: 0.038), Impact Score (p-value: 0.005), and Total score (p-value < 0.001). Conclusion: Visual biofeedback can augment the PR program in stable COPD patients, and it can enhance the outcome even in a home-based rehabilitation program.

https://www.tanaffosjournal.ir/article_734849_22b4d7fe22f9f152cf044f14a1b31e6d.pdf

National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran TANAFFOS (Respiration) 1735-0344 24 2 2025 04 01 Effect of Antibiotic Therapy against Lophomonas blattarum in Asthmatic Subjects: A Phase 3 Clinical Trial 181 186 734850 EN Younos Ghaderi Department of Cardiology, Imam Reza hospital, Mashhad University of medical sciences, Mashhad, Iran 0000-0002-6475-7120 Majid Mirsadraee Department of Internal Medicine, Islamic Azad University- Mashhad Medical Sciences Branch, Mashhad, Iran 0000-0003-3420-9438 Fariba Berenji Department of Medical Parasitology, Imam Reza Hospital, Central Lab, Parasitology & Mycology Lab, Mashhad University of Medical Sciences, Mashhad, Iran 0000-0002-8412-8858 Zahra Naseri Anhaei Department of Gynecology and Obstetrics, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran 0000-0001-6353-3857 Shadi Ghafari Department of Physiology, Faculty of Biology, Islamic Azad University-Damghan Branch, Damghan, Iran 0000-0002-9176-8650 Journal Article 2023 10 03 Background: Lophomonas blattarum causes chronic non-specific respiratory symptoms, which can easily mask asthma symptoms. The study aimed to predict the benefits of eradicating Lophomonas on the course of asthma. Materials and Methods: Fifty subjects resistant to high-dose inhaled corticosteroid/long-acting beta 2 agonist and other controllers such as montelukast or tiotropium were enrolled in this phase 3 clinical trial. Lophomonas was evaluated using a direct wet smear of bronchial lavage or induced sputum. Random allocation was performed by drawing lots from identical envelopes, and concealment was achieved by repackaging Tinidazole and placebo (vitamin B1) tablets in identical bottles. The clinic staff were blind to the study, and the code was opened by a pharmacist. The primary outcome was the asthma control test (ACT) score. Results: Direct smear showed Lophomonas in 52% of the Tinidazole group and 28% of the control group. Other baseline parameters were not significantly different between the Tinidazole and control groups. Cough disappeared in 12 out of 25 (48%) in the Tinidazole group (P=0.001), and the scoring of cough and dyspnea showed significant improvement in the Tinidazole group. Post-nasal drip, sputum, wheezing, and airway hyper-responsiveness were other secondary parameters that showed significant improvement. The ACT score improved from 16.84±2.65 at baseline to 23.11±2.58, and FENO and FEV1 were other objective outcomes that showed significant improvement. Conclusion: <span lang="EN-US" style="font-size: 9.0pt; font-family: 'Book Antiqua','serif'; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi; color: black; mso-themecolor: text1; mso-font-width: 105%;">Lophomnas blattarum<span lang="EN-US" style="font-size: 9.0pt; font-family: 'Book Antiqua','serif'; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: major-bidi; color: black; mso-themecolor: text1; mso-font-width: 105%;"> was detected in a significant number of severe asthmatics, and treatment directed at this protozoan will cause a significant improvement in asthmatic subjects.

https://www.tanaffosjournal.ir/article_734850_0287b326b2dd6d1b9fa8313391219bee.pdf

National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran TANAFFOS (Respiration) 1735-0344 24 2 2025 04 01 Observational Examination of Cerebral Perfusion Changes in Patients Diagnosed with Sepsis Using Transcranial Doppler Ultrasonography 187 193 734851 EN Payam Rahimi Department of Anesthesiology and Reanimation, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey 0000-0001-7201-3319 Remzi Işçimen Department of Anesthesiology and Reanimation, Faculty of Medicine, Bursa Uludağ University, Bursa, Turkey 0000-0001-8111-5958 Pınar Küçükdemirci Kaya Department of Anesthesiology and Reanimation, Faculty of Medicine, Bursa Uludağ University, Bursa, Turkey 0000-0002-8428-8245 Tutku Karaman Sağlam Department of Anesthesiology and Reanimation, Bursa City Hospital, Bursa, Turkey. 0009-0009-6598-7639 Journal Article 2025 07 29 Background: Sepsis-associated Brain Dysfunction (SABD) affects over 70% of septic patients, often manifesting early and increasing the risk of neurological sequelae if undiagnosed. Transcranial Doppler (TCD) ultrasonography is a non-invasive, bedside method to assess Cerebral Blood Flow (CBF). This study evaluates temporal changes in middle cerebral artery blood flow in septic patients using Pulsatility Index (PI), Resistance Index (RI), and CBFi at 0, 6, 24, and 48 hours. Materials and Methods: Forty-seven septic patients admitted to the Bursa Uludag University Intensive Care Unit were prospectively studied. Demographic data, comorbidities, Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation (APACHE) II scores, vital signs, laboratory parameters, and TCD measurements (PI, RI, CBFi) were recorded at baseline, 6, 24, and 48 hours. Results: No statistically significant changes were observed in PI, RI, or CBFi at 6, 24, or 48 hours compared to baseline (p>0.05), though slight increases in PI (2.13%) and CBFi (16.99%) were noted at 48 hours. A significant difference in PI was found at 48 hours in patients receiving vasoactive drugs (p<0.05), and in RI at 6 hours in those receiving sedoanalgesics (p<0.05). Stable systemic hemodynamics were maintained using advanced monitoring. Conclusion: In septic patients with optimized hemodynamic management, cerebrovascular resistance and perfusion indices (PI, RI, CBFi) remain largely stable within 48 hours, suggesting effective autoregulation. TCD shows potential as a tool to monitor cerebral perfusion and guide therapy in sepsis, warranting further research.

https://www.tanaffosjournal.ir/article_734851_a67256fa89cec405248fcc622e96bd7c.pdf

National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran TANAFFOS (Respiration) 1735-0344 24 2 2025 04 01 Smoking Rates and Disease Severity in COVID-19 Patients at Masih Deneshvari Hospital 194 197 734852 EN Zahra Hessami Tobacco Prevention and Control Research Center (TPCRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Maryam Vasheghani Chronic Respiratory Diseases Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Hooman Sharifi Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences ,Tehran, Iran 0000-0001-6448-046X Mahshid Aryanpur Tobacco Prevention and Control Research Center (TPCRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran Hakimeh Sheikhzade Clinical Tuberculosis and Epidemiology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran Journal Article 2024 11 18 Background: Considering that smoking is a major risk factor for respiratory diseases and viral infections, in this study, we investigated the smoking status in patients admitted with the diagnosis of COVID-19 at Masih Daneshvari Hospital. Materials and Methods: The information was obtained through the registration of patients' information in the hospital. Results: A total of 776 patients with COVID-19 who were admitted to Masih Daneshvari Hospital from April 2019 to June 2020 were examined, among whom 422 were men (54.4%), and 352 were women (45.5%). The mean age of the studied patients was 55.7 with a standard deviation of 15.9. The mean duration of hospitalization was 10.3 days with a standard deviation of 6.7 days. 178 (23.4%) patients were smokers. 45 smokers (25.3%) were hospitalized for more than 3 weeks, while 35 (6%) non-smokers were hospitalized for more than 3 weeks (p<0.05). There was no significant difference between smokers and non-smokers in terms of hospitalization in the intensive care unit and mortality. Conclusion: The significant finding is the high prevalence of smoking in the patient population, which should be taken into consideration. The higher length of hospitalization in smokers is also a notable finding that can cause problems for the health system and patients. Encouragement to quit smoking should be considered in health programs.

https://www.tanaffosjournal.ir/article_734852_f37d72acb1fce15b97744a5b1e4f2770.pdf

National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran TANAFFOS (Respiration) 1735-0344 24 2 2025 04 01 When Silica Returns-Erasmus Syndrome, a Rare Entity 198 201 734853 EN Parvathi B.L Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India 0000-0002-8960-1579 Aneesa Shahul Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India 0000-0003-2510-3199 Shahir Asfahan Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India 0000-0002-4709-2200 Naveen Dutt Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India 0000-0002-9517-4999 Ramniwas Jalandra Department of Pulmonary Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India 0000-0003-1168-1115 Journal Article 2024 01 03 Introduction: Systemic sclerosis (SS) is an autoimmune disease with vascular changes and diffuse tissue fibrosis. Silica exposure is one of the strongest recognized risk factors for the development of systemic sclerosis (relative risk 3.2). The co-occurrence of systemic sclerosis in a patient with silica exposure is termed Erasmus Syndrome. Few case reports are available in the literature. Case presentation: We report here a case of Erasmus syndrome in a 54-year-old stone worker. The patient presented with diffuse skin thickening, hyperpigmentation, Raynaud’s phenomenon, and arthralgia along with radiological features of silicosis. Serological markers of systemic sclerosis were strongly positive, and skin biopsy confirmed scleroderma. Hence, a diagnosis of Erasmus syndrome was made. The clinical, serological, and histopathological features of SA-SS in the patient were indistinguishable from those of idiopathic SS; however, a history of silica dust exposure and evidence of silicosis supported the diagnosis of SA-SS. Conclusion: Careful screening should be done in patients with silicosis along with systemic manifestations to rule out any associated connective tissue disorder. A detailed exposure history should be carefully obtained for all patients with systemic sclerosis.

https://www.tanaffosjournal.ir/article_734853_886317e007d03965bf4c7c1d2576463d.pdf

National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran TANAFFOS (Respiration) 1735-0344 24 2 2025 04 01 A 15-Year-Old Healthy Girl with Streaky Hemoptysis and Cavitary Lung Lesion 202 205 734854 EN 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 0000-0002-7242-5839 Sana Sadat Pourhoseini Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran 0009-0005-8308-0142 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 0000-0001-7237-8940 Forouzan Mohammadi Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran 0000-0002-3774-5650 Payam Tabarsi Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran 0000-0002-8932-5420 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 0000-0003-1466-8645 Journal Article 2025 08 19 WHAT IS YOUR DIAGNOSIS? A 15-year-old girl, otherwise healthy, presented with low-grade fever, cough, sputum with two episodes of streaky hemoptysis, and left side chest wall pain for a couple of months. Vital signs on admission included a respiratory rate of 18 breaths per minute, a temperature of 37°C, a heart rate of 110 beats per minute, and a blood pressure of 95/65 mmHg. Her physical exam was unremarkable. A chest X-ray showed suspected cavitary lesions in the left lung. A chest computed tomography (CT) scan showed bilateral nodular infiltrations (Figure 1A & 1B) along with cavitary lesions, especially in the left upper and left lower lobes (Figure 1C & 1D). In primary laboratory studies, the hemoglobin was 14 g/dL, the white blood cell count was 7200/µL, the platelet count was 165000/µL, and the erythrocyte sedimentation rate was 13 mm/hr. Liver and renal function tests and other biochemistry were normal. No microorganism was identified by blood and urine culture. The Inflammatory markers, such as Antinuclear Antibody (ANA), Cytoplasmic and Perinuclear Anti-Neutrophil Cytoplasmic Antibodies (C-ANCA & P-ANCA), Anti-Cyclic Citrullinated Peptide (Anti-CCP), and Rheumatoid Factor (RF), were all negative. <span lang="EN-US" style="font-size: 9.0pt; font-family: 'Book Antiqua','serif'; mso-fareast-font-family: 'Times New Roman'; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">Study of sputum and bronchoalveolar lavage for acid-fast bacilli (AFB), bacteria, and fungi was negative. Thus, CT-guided biopsy from the cavitary lesion was performed (Figure 2)<span lang="EN-US" style="font-size: 9.0pt; font-family: 'Book Antiqua','serif'; mso-fareast-font-family: 'Times New Roman'; mso-bidi-font-family: 'Times New Roman'; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">. https://www.tanaffosjournal.ir/article_734854_32af976a961e95999d11c40382c49fbd.pdf