Comparison of therapeutic response between asthma, COPD, and ACOS patients by evaluation of spirometric findings.

Asthma and Chronic obstructive pulmonary disease (COPD ) both are a common public health problem that affects a large portion of population. Nearly 20% of patients with obstructive lung disease have features of both asthma and COPD called ACOS that GOLD_GINA guidelines defines as persistent airflow limitation with several features of asthma and several features of COPD. Yet there is a little data available about diagnosis and treatment of this entity and current study aimed to compare therapeutic response between asthma, COPD and Asthma-COPD overlap syndrome (ACOS) subjects through spirometric data. In the present cross-sectional study, 30 known patients with mild to moderate asthma, 30 known patients with mild to moderate COPD and 30 known patients with mild to moderate ACOS according to GOLD_GINA guidelines were enrolled. We assessed post bronchodilator the ratio of the forced expiratory volume in the first one second to the forced vital capacity of the lungs (fev1) and the forced expiratory volume in the first one second to the forced vital capacity of the lungs (fev1/fvc) in all patients. Then they took standard treatment for 2 months and after this period spirometry was repeated. Spirometric data's changes was compared between the three groups by SPSS26 statistical software. Fev1 changes in response to treatment did not differ significantly between three groups (p > 0.05) but fev1/fvc changes differed significantly and this parameter in asthma was more than ACOS and in COPD was least. (In asthma, spirometric symbolized therapeutic response is more significant than ACOS, and in ACOS, it is more important than COPD in terms of fev1/fvc changes) and there was not any difference between the three groups regarding to FEV1 changes.

Relationship between chest CT scan findings with SOFA score, CRP, comorbidity, and mortality in ICU patients with COVID-19.

OBJECTIVE: This study aimed to investigate the relationship between chest computed tomography (CT) scan findings with sequential organ failure assessment (SOFA) score, C-reactive protein (CRP), comorbidity, and mortality in intensive care unit (ICU) patients with coronavirus disease 19 (COVID-19). METHOD: Adult patients (≥18 years old) with COVID-19 who were consecutively admitted to the Imam-Reza Hospital, Tabriz, East-Azerbaijan Province, North-West of Iran between March 2020 and August 2020 were screened and total of 168 patients were included. Demographic, clinical, and mortality data were gathered. Severity of disease was evaluated using the SOFA score system. CRP levels were measured and chest CT scans were performed. RESULTS: Most of patients had multifocal and bilateral ground glass opacity (GGO) pattern in chest CT scan. There were significant correlations between SOFA score on admission with multifocal and bilateral GGO (P = .010 and P = .011, respectively). Significant relationships were observed between unilateral and bilateral GGO patterns with CRP (P = .049 and P = .046, respectively). There was significant relationship between GGO patterns with comorbidities including overweight/obesity, heart failure, cardiovascular diseases, and malignancy (P < .05). No significant relationships were observed between chest CT scan results with mortality (P > .05). CONCLUSION: Multifocal bilateral GGO was the most common pattern. Although chest CT scan characteristics were significantly related with SOFA score, CRP, and comorbidity in ICU patients with COVID-19, a relationship with mortality was not significant.

Mortality Rate of Sepsis Patients in the Intensive Care Unit: The Prognostic Role of Ejection Fraction and Procalcitonin.

Sepsis is the second leading cause of death in the intensive care unit (ICU) and is one of the important causes of death for all hospitalized patients [1]. Evidence revealed procalcitonin as the critical risk factor for determining the prognosis of septic patients [2,3].Also, new studies indicated that diastolic dysfunction and low ejection fraction (EF) were identified as risk factors for death in septic patients [4]. Indeed, septic patients with lower EF had higher mortality rates than other septic patients [5]. Hence, in the pilot study, we determine the mortality rate of hospitalized patients in our clinic during 2020. Besides, EF was evaluated via echocardiography, and also serum PCT was measured on the first day of admission to ICU. Our results indicate that 35 % and 65 % of patients were expired and discharged, respectively. The association between EF and mortality is shown in Figure-1. There were no significant differences between EF and mortally among studied patients (P=0.79). The mean PCT in expired patients was 7.67 ±5.52 ng/ml, while in the discharged patients was 4.21±3.1 ng/ml. On the other hand, although the mean PCT level in the expired patients was higher than those discharged, this difference was not significant. Our study revealed that although PCT and EF statistically were not different in expired patients compared to those discharged, both PCT and EF could be considered important prognostic factors for mortality among sepsis patients in the ICU. However, more studies with larger sample sizes and more parameters for the determination of EF and PCT are recommended.

Tuberculin skin test conversion in patients under treatment with anti-tumor necrotizing factor alpha agents.

BACKGROUND: Despite successful clinical outcomes of biologic medications in patients with chronic rheumatic diseases, some considerable adverse effects such as infections remain a major concern. Possibility of tuberculosis (TB) reactivation over treatment with anti-tumor necrotizing factor (TNF) alpha agents has necessitated a screening test before initiation of treatment. However, screening over the course of treatment is not recommended in those patients with negative baseline screening tests. This study aimed to evaluate the efficacy of tuberculin skin test (TST) before treatment in patients with chronic rheumatologic diseases who were indicated to receive anti-TNF-alpha therapy and the necessity of repeating this test over the course of treatment. METHODS: In this prospective study, patients with chronic rheumatologic diseases receiving anti-TNF-alpha agents were studied in a two-year period. TST was performed before treatment and those with positive results were excluded from the study. Thereafter, treatment with anti-TNF-alpha agents was initiated with the indicated dose. TST was repeated before administration of biologic treatment until TST became positive or 16 weeks after the initiation of treatment with anti-TNF-alpha. RESULTS: A total of 51 cases were studied, of whom one patient (1.9%) was excluded due to positive TST before treatment. All participants received infliximab and the TST test became positive in one patient (2%) 2 weeks after receiving the first dose. Also, the results of further tests at weeks 6, 10, and 14 were all negative for the remaining patients. CONCLUSION: Due to the possibility of TST conversion after administration of anti-TNF-alpha therapy, it is important to consider TB monitoring in patients under treatment with these agents using available methods such as TST.

A novel bronchoscope method (saline injection method) for complete extraction of ruptured pulmonary hydatid cyst.

INTRODUCTION: Echinococcus granulosus is an important public health problem in the Mediterranean area. Today's surgery is the principal therapeutic approach for chronic ruptured hydatid cyst removal. OBJECTIVES: In this paper, a new bronchoscopic method using saline injection is explained as a safe method to remove ruptured pulmonary hydatid cysts. This non-invasive method has no complications and no need to anesthesia and admission. We hope that this novel bronchoscopic method can be a starting point for future advances in the field of pulmonary hydatid cyst treatment methods. METHODS: Saline injection method by bronchoscopy (M. E. Hejazi Method) RESULTS: We extracted the entire hydatid cysts of both patients by fiber optic bronchoscopy using saline injection method (M. E. Hejazi Method) for the detachment of underlying membrane from cavity wall. CONCLUSIONS: This bronchoscopic method is minimally invasive, without surgery, anesthesia and hospital admission, the least complication and morbidity as well as is cost benefit in comparison with surgery.

The Effect of Treatment of Vitamin D Deficiency on the Level of P-Selectin and hs-CRP in Patients With Thromboembolism: A Pilot Randomized Clinical Trial.

Despite the known role of vitamin D deficiency in development of thrombosis, no studies have evaluated the impact of treating of vitamin D deficiency on the markers of thrombosis. A pilot randomized clinical trial was done on 40 vitamin D-deficient patients with deep vein thrombosis (DVT) or pulmonary embolism (PE). The intervention group received an oral dose of 50,000 IU vitamin D3 every week for 8 weeks, followed by 1 pearl every 2 weeks for 4 weeks (a total of 3 months), while the control group did not receive vitamin D. Then, P-selectin and hs-CRP were measured at baseline and 1 and 3 months after the intervention. There was no significant decrease in hs-CRP in either group after 1 month (P = .955) or after 3 months (P = .525). Likewise, there was no significant decrease in P-selectin between the 2 groups after 1 month (P = .921) or 3 months (P = .795). The results indicated that treatment of vitamin D deficiency had no significant effect on hs-CRP or P-selectin after 3 months among DVT/PE patients. However, treatment of vitamin D deficiency in these patients resulted in the control of the international normalized ratio (INR) with the lower doses of warfarin. This observation is the first clinical report of enhancement of the anticoagulant effect of warfarin by the supplementing of vitamin D. Larger trials are needed to clearly show the effect of treating of vitamin D deficiency on thrombosis.

Role of Vitamin D in Cardiovascular Disease.

BACKGROUND: According to many studies, vitamin D deficiency has been linked to cardiovascular diseases (CV). Other than maintaining skeletal health, vitamin D has been shown to decrease the risk of developing CV disease such as hypertension, coronary artery disease (CAD) and thromboembolism. MATERIALS AND METHODS: To perform a comprehensive review of the current literature on vitamin D and CV disease, we searched the online database, including PUBMED, Scopus, and Google Scholar until data inception January 2016. The search term included "vitamin D", "blood pressure", "hypertension", "coronary artery disease "and "thrombosis". We only included human studies that were published in English. RESULTS: A majority of data indicate that there is no relationship between vitamin D and hypertension, but the association of vitamin D with thrombosis is yet to be determined. Vitamin D is a fair predictor of adverse outcomes in coronary artery disease (CAD), which highlights it for future studies. CONCLUSION: According to research, there is a high prevalence of vitamin D deficiency among patients with CV diseases, which needs to be diagnosed and treated.

A review of Vitamin D effects on common respiratory diseases: Asthma, chronic obstructive pulmonary disease, and tuberculosis.

Despite the classic role of Vitamin D in skeletal health, new aspects of Vitamin D have been discovered in tissues and organs other than bones. Epidemiological and observational studies demonstrate a link between Vitamin D deficiency and risk of developing respiratory diseases including asthma, chronic obstructive pulmonary disease (COPD), and tuberculosis (TB). To review the literature, we searched the terms "Vitamin D" (using the set operator) and "asthma," "COPD" and "TB" in electronic databases, including PubMed/MEDLINE, Scopus, and Google Scholar until July 2015. Non-English articles or articles with unavailable full text were excluded. Both in vivo and in vitro studies were included. All the reviewed articles state that Vitamin D deficiency is very common among patients with respiratory diseases. The present data regarding Vitamin D and asthma is still controversial, but data about COPD and TB are more encouraging. The relevant studies have been conducted in different populations therefore it is not particularly possible to compare the data due to genetic variations. In order to point out a role for Vitamin D, large clinical trials with Vitamin D deficient subjects and sufficient Vitamin D supplementation are needed.