سه شنبه ٠٤ مهر ١٣٩٦
 

Pulmonary emboli manifestations and prediction rules

Abstract: Pulmonary thrombus emboli (PTE) have a wide clinical spectrum, from asymptomatic small PTE to life-threatening one, which may cause cardiogenic shock. It is classified as acute/chronic and massive/sub massive. PTE risk factors and relative causes to elevate its mortality are present in this review article. At last, we have a brief recommendation for treatment. There are several diagnosing test such as D-dimer, echocardiography, electrocardiography, brain natriuretic peptide, laboratory tests, chest X-ray, ultrasound, and pulmonary angiography which are different in specificity and sensitivity. Finally, in the diagnostic approach, we explain relative studies to Wells rule, Geneva rule, pulmonary embolism (PE) severity index, and PE rule out criteria.

Extra-pulmonary Pneumocystis jiroveci infection: A case report

Abstract: In physical examination abdominal tenderness, gate disturbance and penile herpetic lesions were detected. Decreased disc height at T11-T12 level was detected in chest X-ray. Abdominal sonography and CT scan revealed hypo dense lesions in Lt left Lobe of liver and multiple hypo dense splenic and pancreatic lesions, ascitis, Lt left sided pleural effusion, thickening of jejuneal mucosa and edema of bowel wall. Vertebral body lesion and paravertebral abscess, bony calvarial involvement and adjacent extra axial brain lesion were observed in imaging were other findings. RNA analysis for HIV was positive. Vertebral lesion biopsy and aspiration of splenic lesion were performed and pathology revealed Pneumocystis jirovecii suggestive of extra pulmonary Pneumocystis carinii infection. © 2014 Elsevier Editora Ltda.

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The effect of garcin® in preventing AntiTB-induced hepatitis in newly diagnosed tuberculosis patients

Abstract: Adverse effects of antituberculosis agents such as hepatotoxicity may reduce treatment effectiveness, because they significantly contribute to nonadherence and eventually result in treatment failure, relapse or the emergence of drug resistance. Garlic is an ancient herbal substance, which its effectiveness on isoniazid and rifampicin-induced hepatic injury in animal models has been demonstrated (1). In the present study a randomized, double blind, placebo-controlled, parallel group clinical trial was designed to assess the effect(s) of garlic tablets (1000 mg daily) administered for two weeks orally. Fifty eight newly diagnosed, smear positive pulmonary tuberculosis patients, with age ranges between 18-65 years old, were randomly allocated into two groups. Each patient received either garlic or placebo tablets for the first two weeks of tuberculosis treatment. Of total 58 patients, 31 received garlic tablets while 27 received placebo. No significant difference was found between the two groups regarding age, sex, nationality, smoking, underlying diseases and opium usage. During 8 weeks of anti-TB (antituberculosis) treatment, 8 (13.0%) patients developed drug-induced hepatotoxicity (DIH). Of them, 6 (75%) occurred in the first two weeks of treatment. Fifty percent of the patients who developed DIH were in garlic group. Results indicated no significant difference between groups in developing DIH (p=1.000). We could not show a significant role in preventing DIH by 1000 mg daily garlic administration. © 2014 by School of Pharmacy.

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Human papillomavirus (HPV) prevalence and types among women attending regular gynecological visit in Tehran, Iran

Abstract: Background: Persistent infection by HPV is now recognized as the main cause of cervical cancer. HPV prevalence data is not yet available in Iran. This study is organized to evaluate type-specific HPV prevalence and to compare it with Pap smear results among Iranian women attending regular gynecological visits. Methods: A total of 851 women aged 18-65 years, attending regular gynecological visits, were retrospectively evaluated. HPV detection and genotyping was performed by use of Polymerase Chain Reaction (PCR) and Restriction Fragment Length Polymorphism (RFLP). Cytological evaluation was done by Papanicolaou method and the association between cytological results and HPV status was analyzed. Results: 19 different HPV types were detected in 265 of the 851 specimens (31.1%). Overall HPV infection as well as infection with High Risk (HR) HPV types was highest in women aged 18-25 years and decreased with age. Type-specific prevalence of HPV-16 and 18 was 7.3% and 2.8%, respectively, and a large number of women (20.2%) were infected by HR HPV types other than HPV-16 and/or HPV-18. There was also an upward trend in the prevalence of HR HPV infections as the abnormality in cytology increased. The prevalence of HPV co-infection was 29.1% of HPV positive patients and declined from LSIL (18.2%) to HSIL (3.9%). Conclusions: Our study indicated that the burden of HPV infection among Iranian females was higher in comparison with previous estimates reported from Iran. Furthermore, higher prevalence of premalignant changes in Iranian women infected with HR HPV types, other than vaccine types, should be considered in immunization programs and development of population-specific HPV vaccines. This remarkable difference in prevalence of HPV types among previous studies, confirms our need to further investigations on epidemiology of HPV infection in Iran.

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Qualification study of two genomic DNA extraction methods in different clinical samples

Abstract: Introduction: The purity of genomic DNA (gDNA) extracted from different clinical specimens optimizes sensitivity of polymerase chain reaction (PCR) assays. This study attempted to compare two different DNA extraction techniques namely salting-out and classic phenol-chloroform. Materials and Methods: Qualification of two different DNA extraction techniques for 634 clinical specimens highly suspected of having mycobacterial infection was performed. Genomic DNA was extracted from 330 clinical samples using phenol-chloroform and 304 by non-toxic salting-out. Qualification of obtained gDNA was done through amplification of internal controls, β-actin and β-globin. Results: β-actin-positive was detected in 279/330 (84%) and 272/304 (89%) samples by phenol-chloroform technique and salting-out, respectively. PCR inhibitor was found for the gDNA of 13/304 (4%) patient samples were negative by β-actin and β-globin tests via salting-out technique in comparison with gDNAs from 27/330 (8.5%) samples extracted by phenol-chloroform procedure. No statistically significant difference was found between phenolchloroform technique and salting-out for 385 sputum, 29 bronchoalveolar lavage (BAL), 105 gastric washing, and 38 body fluid (P=0.04) samples. This illustrates that both techniques have the same quality for extracting gDNA. Conclusion: This study discloses salting-out as a non-toxic DNA extraction procedure with a superior time-efficiency and cost-effectiveness in comparison with phenol-chloroform and it can be routinely used in resource-limited laboratory settings. © 2014 NRITLD, National Research Institute of Tuberculosis and Lung Disease, Iran.

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Effect of pulmonary hypertension on outcome of pulmonary tuberculosis

Abstract: Background: This study performed at the National Research Institute of Tuberculosis and Lung Disease, Tehran, Iran, aimed to evaluate the effect of concomitant pulmonary hypertension on the outcome of pulmonary tuberculosis. Methods: New cases of pulmonary tuberculosis were recruited for the study. Pulmonary hypertension was defined as systolic pulmonary arterial pressure ≥35. mm Hg estimated by transthoracic Doppler echocardiography. We assessed the relationship between pulmonary hypertension and mortality during the six-month treatment of tuberculosis. Results: Of 777 new cases of pulmonary tuberculosis, 74 (9.5%) had systolic pulmonary arterial pressure ≥35. mm Hg. Ten of them (13.5%) died during treatment compared to 5% of cases with pulmonary arterial pressure less than 35. mm Hg (. p=. 0.007). Logistic regression analysis showed that pulmonary hypertension and drug abuse remained independently associated with mortality (OR. =. 3.1; 95% CI: 1.44-6.75 and OR. =. 4.4; 95% CI: 2.35-8.17, respectively). Conclusion: A significant association was found between mortality and presence of pulmonary hypertension and drug abuse among new cases of pulmonary tuberculosis. © 2014 Elsevier Editora Ltda.

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Application of intra-aortic balloon pump in resection and anastomosis of trachea

Abstract:The intra-aortic balloon pump (IABP) is a mechanical device used to assist cardiac circulatory function in patients suffering from cardiogenic shock, congestive heart failure, refractory angina and complications of myocardial infarction. While using IABP in cardiac surgery is well established, there are few studies on the utility of IABP support in high-risk cardiac patients undergoing non-cardiac surgery. Major non-cardiac surgeries are associated with high rates of cardiac complications in patients with advanced coronary disease. Recent case studies have reported favorable outcomes with the use of IABP support in non-cardiac surgery in patients with severe cardiac compromise. Using IABP may reduce cardiac complications by providing hemodynamic stability. Here, we present five cases of IABP use in high-risk cardiac patients undergoing resection and anastomosis of the trachea. IABP was inserted prior to induction of anesthesia in four of the cases, while IABP insertion was withheld in one case. In the four cases where IABP support was utilized, the IABP was removed between 6-48 hours postoperatively with no complications. The patient who did not undergo IABP insertion died on the 8th postoperative day due to uncontrollable pulmonary edema and progressive myocardial infarction. We also review the literature and discuss the role of IABP use in non-cardiac surgery. © 2014 NRITLD, National Research Institute of Tuberculosis and Lung Disease, Iran.

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Immunopathology of sarcoidosis

Abstract:The immunopathology of sarcoidosis remains elusive despite years of research into this multiorgan disease.However, recent studies have provided new insights into the genetics and immune components involved in the clinical manifestation of the disease. Granulomatous inflammation is due to the host immune response to a persistent poorly degradable unknown antigen.Mycobacterium tuberculosis (MTB) is the major disease driver in many patients. The immune mechanisms that cause this disease start with the antigenic stimulus, followed by T-cell, macrophage and dendritic cell activation via a classic MHC II-mediated pathway. In addition, the profile of immune mediators reported in sarcoidosis indicates that the inflammasome pathway plays a critical role in disease pathogenesis. Increased understanding of the signal transductions pathways involved in the induction of inflammatory processes in sarcoidosis could give rise to new therapeutic approaches in future. Copyright© Autumn 2014, Iran J Allergy Asthma Immunol. All rights reserved.

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Massive hemoptysis, A presentation of invasion of aneurysm of descending aorta to bronchopulmonary tree

Abstract:Aortobronchial (AB) fistula is a rare disease, which is presented with massive hemoptysis; lethal if not treated. It should be suspected in any patient who presents with massive hemoptysis and had previous aortic thoracic surgery, but even it may be seen in patients without any history of operation on the thoracic aorta. Although, today in many centers endovascular therapy is done for these patients, but it is not the standard approach. Surgery in urgent situations has an essential role in saving the patients. Operative management consists of double lumen intubation and one lung ventilation, followed by femoral artery and vein cannulation. Then Posterolateral thoracotomy and achieving proximal and distal control on the aorta, applying cardiopulmonary bypass (CPB), separation the lesion, and bypass the segment of the diseased aorta by a synthetic graft. © 2014 Academy of Medical Sciences of I.R. Iran. All rights reserved.

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Thoracic imaging findings of collagen vascular diseases: A CT study

Abstract:Background: collagen vascular diseases (CVDs) are well known causes of pulmonary involvement, leading to significant morbidity. The purpose of this study was to identify several thoracic computed tomographic findings of CVDs. Materials and Methods: The study included 56 patients (15 males and 41 females) with histopathologically and clinically proven CVDs who were identified retrospectively. The presence, extent and distribution of various CT findings were evaluated by a radiologist. Results: Lung parenchyma (96.4%) was the most common area of involvement. The lower lobes (89.2%) were the most frequent sites of involvement. The predominant CT patterns were reticulation (55.3%), peripheral subpleural interlobular septal thickening (51.7%) and ground glass opacity (50%). The most common histopathological findings according to CT features were obliterative bronchiolitis (OB, 44.6%) and non-specific interstitial pneumonia (NSIP, 33.9%). Usual interstitial pneumonia was seen in 12.5% and organizing pneumonia in 26.7% of patients. Conclusion: A combination of reticular pattern, peripheral subpleural interlobular septal thickening and ground glass opacity is seen in the majority of patients with CVDs. The results indicate that OB is more prevalent than what has been reported in previous studies. The CT patterns of pulmonary fibrosis are similar to those in most other studies. © 2014 NRITLD, National Research Institute of Tuberculosis and Lung Disease, Iran.

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Relationship of coping styles with suicidal behavior in hospitalized asthma and chronic obstructive pulmonary disease patients: Substance abusers versus non- substance abusers

Abstract:Background: Treatment of patients with chronic conditions requiring hospitalization requires patient acceptance and cooperation and adoption of coping strategies. Inappropriate coping strategies such as substance abuse are concerning in the course of treatment. This study sought to explore the association of coping strategies with suicidal behavior in substance abusers and non substance abuser patients with chronic pulmonary diseases namely asthma and chronic obstructive pulmonary disease (COPD). Materials and Methods: This comparative study was performed on 100 patients with asthma and COPD selected via convenience sampling. Subjects with and without substance abuse were separated into two groups of 50 patients each. Ways of Coping Questionnaire of Lazarus (WOCQ) and Suicide Behavior Questionnaire-Revised (SBQ-R) were completed by them. Five Persian speaking patients rated this questionnaire to be easily understandable in the pre-test stage. Cronbachs alpha was calculated to measure the internal consistency. Results: The mean (±standard deviation) age of participants was 40 (±14) years; 58% of individuals were men; 62% had chosen problem-focused coping. The most abused substances were cigarettes (78%) and opium (42%); 6% of substance abusers had thought about suicide five times or more in the past year; 5% of substance abusers had seriously attempted suicide. Tendency to commit suicide was greater in men, substance abusers and participants who had chosen emotion-focused coping strategies, based on a regression model. Average score of suicide tendency was significantly higher in substance abusers (B=2.196, P =0.007). Conclusion: Chronic disease is a crisis and patients need to acquire appropriate coping strategies to deal with it, especially in substance abusers and suicidal patients. Precise recognition of coping strategies in chronic pulmonary patients with substance abuse is necessary via a team cooperation among psychiatrics, psychologists and an internal physician in hospitals because medical treatment alone is not sufficient in such cases. © 2014 NRITLD, National Research Institute of Tuberculosis and Lung Disease, Iran.

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Re: Interferon-gamma release assay agreement with tuberculin skin test in pretransplant screening for latent tuberculosis in a high-prevalence country

Abstract:Background: Treatment of patients with chronic conditions requiring hospitalization requires patient acceptance and cooperation and adoption of coping strategies. Inappropriate coping strategies such as substance abuse are concerning in the course of treatment. This study sought to explore the association of coping strategies with suicidal behavior in substance abusers and non substance abuser patients with chronic pulmonary diseases namely asthma and chronic obstructive pulmonary disease (COPD). Materials and Methods: This comparative study was performed on 100 patients with asthma and COPD selected via convenience sampling. Subjects with and without substance abuse were separated into two groups of 50 patients each. Ways of Coping Questionnaire of Lazarus (WOCQ) and Suicide Behavior Questionnaire-Revised (SBQ-R) were completed by them. Five Persian speaking patients rated this questionnaire to be easily understandable in the pre-test stage. Cronbachs alpha was calculated to measure the internal consistency. Results: The mean (±standard deviation) age of participants was 40 (±14) years; 58% of individuals were men; 62% had chosen problem-focused coping. The most abused substances were cigarettes (78%) and opium (42%); 6% of substance abusers had thought about suicide five times or more in the past year; 5% of substance abusers had seriously attempted suicide. Tendency to commit suicide was greater in men, substance abusers and participants who had chosen emotion-focused coping strategies, based on a regression model. Average score of suicide tendency was significantly higher in substance abusers (B=2.196, P =0.007). Conclusion: Chronic disease is a crisis and patients need to acquire appropriate coping strategies to deal with it, especially in substance abusers and suicidal patients. Precise recognition of coping strategies in chronic pulmonary patients with substance abuse is necessary via a team cooperation among psychiatrics, psychologists and an internal physician in hospitals because medical treatment alone is not sufficient in such cases. © 2014 NRITLD, National Research Institute of Tuberculosis and Lung Disease, Iran.

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Pulmonary computed tomography scan findings in chronic granulomatous disease

Abstract:Background: Chronic granulomatous disease is a phagocyte defect, characterised by recurrent infections in different organs due to a defect in NADPH oxidase complex. This study was performed to investigate pulmonary problems of CGD in a group of patients who underwent computed tomography (CT) scan. Methods: Computed tomography scan was performed in 24 patients with CGD. The findings of the CT scan were documented in all of these patients. Results: Areas of consolidation and scan formation were the most common findings, which were detected in 79% of the patients. Other abnormalities in order of frequencies were as follows: small pulmonary nodules (58%); mediastinal lymphadenopathy (38%); pleural thickening (25%); unilateral hilar lymphadenopathy (25%); axillary lymphadenopathy (21%); bronchiectasis (17%); abscess formation (17%); pulmonary large nodules or masses (8%); and free pleural effusion (8%). Conclusion: The pulmonary CT scans of the patients with CGD demonstrated a variety of respiratory abnormalities in the majority of the patients. While recurrent respiratory infections and abscesses are considered as prominent features of CGD, early diagnosis and precise check-up of the respiratory systems are needed to prevent further pulmonary complications. © 2013 SEICAP.

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Evaluation of the relationship between smear positivity and high-resolution CT findings in children with pulmonary tuberculosis

Abstract:Background: The aim of this study is to find a relationship between the radiological manifestations of childhood tuberculosis on a high-resolution computed tomography (HRCT) and the results of sputum smear. This study aims to propose an alternative indicator of infectivity in terms of prevention of disease transmission through selective isolation policy in children whose clinical condition is highly suggestive of tuberculosis. Material/Methods: This retrospective comparative study was performed on 95 children under 15 years of age diagnosed with tuberculosis based on both WHO criteria and positive sputum culture for mycobacterium Tuberculosis. The children were admitted for TB screening in the pediatric department of national research institute of tuberculosis and lung disease (NRITLD) between 2008- 2012. Direct smear collected from sputum or gastric lavage, as well as HRCT were performed in all children prior to administration of medical therapy. Children were divided into 2 groups based on positive and negative smear results. HRCT abnormalities, as well as their anatomical distribution were compared between these 2 groups using multivariate analytic model. Results: The most prevalent abnormalities in the positive smear group were consolidation, tree-in-bud pattern, upper lobe nodular infiltration and cavitation. The negative smear group featured lymphadenopathy, consolidation, collapse and nodular infiltration in the upper lobe. Cavity, tree- in-bud pattern and upper lobe nodular infiltration were highly associated with smear positivity in children. Conversely, lymphadenopathy and collapse had significant association with a negative smear. Conclusions: This study revealed that cavity, tree-in-bud and upper lobe nodular infiltration has significant association with smear positivity in childhood tuberculosis. On the other hand, lymphadenopathy and collapse were closely associated with smear negativity in this age group. It was also demonstrated that children with a positive smear most likely presented with radiological features of post primary tuberculosis, while the negative smear group most often manifested with primary tuberculosis. © Pol J Radiol, 2014.

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Sarcoidosis: Role of non-tuberculosis mycobacteria and Mycobacterium tuberculosis

Abstract:Sarcoidosis is a granulomatous inflammatory disease that is induced by unknown antigen(s) in a genetically susceptible host. Although the direct link between Mycobacterium tuberculosis (MTB) infection and sarcoidosis can be excluded on the basis of current knowledge, non-infectious mechanisms may explain the causative role of mycobacterial antigens. Ever since sarcoidosis was first described, its relationship with tuberculosis (TB) has been under-investigated. Whereas some researchers consider sarcoidosis and TB as two examples of the same disease process, others have rejected mycobacteria as playing any causative role in sarcoidosis. Whether they are linked causally or not, clinical evidence makes a differential diagnosis between the two conditions very challenging, particularly in countries with high burden of TB. The present study analyzes the relationship between sarcoidosis and TB and its implications in clinical practice. The coincidence of TB and sarcoidosis and the higher incidence of mycobacterial DNA in biological samples of sarcoid patients have been reported by many authors. In addition, new evidence of a similarity in MTB phenotype in sarcoidosis is provided. Overall, these observations suggest that TB and sarcoidosis may not only share the same etiology, but may even be different aspects of one disease. © 2014 Asian-African Society for Mycobacteriology.

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