The impact of 17ß-estradiol and progesterone therapy on peripheral blood mononuclear cells of asthmatic patients.

There is a significant fluctuation in clinical symptoms of asthmatic females during their life course, suggesting that the reproductive status and the level of sex hormones may affect the development of asthma and its exacerbation. In this study, we aimed to assess the biological effects of 17ß-estradiol (E2) and progesterone (P4), alone or in combination form, on the transcription factors and production of cytokines in peripheral blood mononuclear cells (PBMCs). PBMCs of the mild-to-moderate asthmatic patients and healthy controls (HCs) were treated with equivalent serum levels of E2 or P4 maintained during hormone replacement therapy (HRT). The expression levels of T-bet, GATA-3, RORγt, PU.1, and Foxp3 were assessed by quantitative PCR. We also measured the concentration of IL-4, IL-9, IL-10, IFN-γ, and TGF-ß in cell culture supernatants using ELISA. IL-4 production and GATA-3 expression levels slightly increased when asthmatic PBMCs were treated with E2 (p < 0.01), P4 (p < 0.01), or E2 + P4 (p < 0.001) compared to the untreated cells. IL-9 secretion (p < 0.001) and PU.1 gene expression levels (p < 0.05) were slightly higher in asthmatic patients' PBMCs before treatment but hormone therapy did not affect the level of them. Although the untreated asthmatic PBMCs produced a lower amount of IFN-γ compared to HCs (p < 0.01), hormone treatment did not affect the levels of IFN-γ secretion in patient groups. Moreover, we did not observe any significant changes in IL-10 and TGF-ß secretion in the supernatant of hormone treated cells. We found that the common applied HRT may faintly increase GATA-3 expression and IL-4 production levels in PBMCs of asthmatic patients and can slightly increase asthma severity.

The effect of smoking on latent tuberculosis infection susceptibility in high risk individuals in Iran.

Tuberculosis has been declared as a global emergency. Latent tuberculosis infection (LTBI) is a state in which host immunity cannot completely eradicate Mycobacterium tuberculosis. Cigarette smoke increases the risk of respiratory infections, such a TB, as it has adverse effects on respiratory immune function. In this cross-sectional study, which was performed from 2016 to 2017, 31 patients with newly diagnosed lung cancer, 63 Chronic obstructive pulmonary disease (COPD), 46 with problems in respiratory system, and 40 healthy subjects were studied. Demographic data of all subjects were recorded via a questionnaire. IGRAs (Interferon-γ release assays) were used to determine LTBI. We showed that smoking has significant odds ratio for COPD patients (OR: 4.58, 95% CI: 1.93-10.87). Also, the concordance of smoking with COPD (OR: 22, 95% CI: 2.7-179.2), lung cancer (OR: 10, 95% CI: 1.03-97), and other respiratory diseases (OR: 4.54, 95% CI: 1.93-10.87) is a significant risk factor for the presence of LTBI whereas the existence of LTBI in the study groups did not show any significant odds ratio. This study is the first to analyze the relationship between smoking in patients with respiratory diseases and LTBI susceptibility in Iran by IGRAs, which proposes cigarette smoking as a powerful risk factor for LTBI.

Effect of Zafirlukast on improving lung function in patients with chronic obstructive pulmonary diseases.

BACKGROUND: There is little evidence about the role of Zafirlukast (a highly selective LTD4 antagonist) in Chronic Obstructive Pulmonary Disease (COPD). The Zafirlukast can reduce the need for short-acting rescue ß2 agonists, produce fewer exacerbations of asthma and increased quality of life as possible benefits treatment for asthma. The aim of our study was to evaluate the effects of Zafirlukast improvement of lung function in patients with COPD. METHODS: Twenty five patients with moderate to severe COPD, in stable phase of the disease, participated in this interventional, quasi-experimental study. All patients were received 40mg oral Zafirlukast per day for 2 weeks. Pulmonary function Test was performed both at the baseline and at the end of the study. Data were analyzed with paired t-test using SPSS v.16. RESULTS: The mean age of the patients was 67.29 (SD=5.56) years with the mean baseline for forced expiratory volume in first second (FEV1) equal to 41.79% (SD=14.96) of predicted value. After 2 weeks, the mean improvements in forced vital capacity (FVC), FEV1 and FEV1/FVC were 4.75% (SD=13.18), 3.71% (SD=9.19) and 9.33(SD=27.08), respectively. Zafirlukast produced a non-significant (p>0.05) bronchodilation, with maximum mean increase in FEV1 of 0.04 lit (3%) above baseline. CONCLUSION: Results showed that Zafirlukast has no considerable bronchodilatory effect in COPD. Present study consisted of a very short treatment period and it is possible that the extension of this period could possibly have more effects. Additional larger studies are needed to verify the impact of leukoterien receptor antagonists on improving the lung function in COPD patients.

Hypoxia symptoms during altitude training in professional Iranian fighter pilots.

INTRODUCTION: Susceptibility to hypoxia is influenced by a multitude of factors, including fatigue, physical activity, illnesses, ambient temperature, rate of ascent, destination altitude, medications, and alcohol. Anecdotally, several reports have been made regarding changes in the form of hypoxia presentation in Iranian fighter pilots in the absence of these factors. This study focused specifically on the effect of pilot age on susceptibility to hypoxia and its initial presentation. We assumed that a pilot's age may increase his susceptibility to hypoxia and consequently reduce the amount of time it takes for hypoxia to present. Because our literature review did not reveal any previous study addressing the possible relationship between age and susceptibility to hypoxia, the purpose of this study is to address and clarify this relationship. METHOD: In this retrospective study, we collected information from Iranian fighter pilots (n = 30) through an anonymous questionnaire in 2000. The form of hypoxia presentation of each subject was evaluated during five altitude chamber training (ACT) sessions that were conducted routinely from 1972 to 1984. To enhance the accuracy of the study's results, confounding factors such as prior hypoxia experience in an ACT session have been taken into consideration. RESULTS: The results revealed a statistically significant relationship between age and a change in the form of hypoxia presentation in our subjects. Increased age reduced the amount of time before the first individual hypoxia symptom appeared (P < .000002). Although having previous hypoxia experience may help pilots to recognize their symptoms earlier, its effect was not statistically significant (P < .18). A few changes in the nature of individual symptoms were observed; however, we did not find a meaningful statistical correlation between pilot age and change in the nature of symptoms. CONCLUSION: Susceptibility ot hypoxia increases with pilot age.

The Effects of Vitamin D Supplementation on Pulmonary Function of Chronic Obstructive Pulmonary Disease Patients, before and after Clinical Trial.

Vitamin D has several extra calcemic effects. Vitamin D deficiency is highly prevalent in chronic obstructive pulmonary disease (COPD) patients but little is known about it's association with lung function. OBJECTIVE: To investigate whether supplementation with vitamin D could improve pulmonary function in COPD patients. DESIGN: Before and after, double center, clinical trial. SETTING: Hazrat Rasoul University Hospital, Tehran, and Imam Khomaini University Hospital, Ahvaz, Iran. PARTICIPANTS: 24 patients with mild to very severe COPD. INTERVENTION: Loading dose of 300,000-600,000 International Units (IU) of vitamin D, then 50000 IU weekly for 12 weeks. MEASUREMENTS: The outcomes included forced expiratory volume in one second (FEV1), forced vital capacity (FVC), vital capacity (VC), forced expiratory flow between 25%-75% of forced vital capacity (FEF 25%-75%), exercise capacity according to the six minute walk test(6MWT) and the saturation of oxygen during exercise. RESULTS: The mean FEV1 (p-value = 0.866), FVC (p-value = 0.475) and VC (p-value = 0.425) were not significantly different before and after intervention. FEF 25%-75% did not improve with this intervention (p-value = 0.555). The vitamin D supplementation did not have any significant effect on the exercise capacity (p-value=0.175) or the saturation of oxygen (p-value = 0.635). CONCLUSION: Pulmonary function and exercise capacity did not improve with vitamin D supplementation in COPD patients.

Unilateral pulmonary artery agenesis in an adult patient with cough and hemoptysis: a case report.

Unilateral pulmonary artery agenesis (UPAA) is an uncommon congenital anomaly and most patients present in neonatal period with respiratory symptoms. Left-sided pulmonary artery agenesis is less frequent than right-sided and is sometimes associated with cardiac anomalies. We report a patient with a history of repaired ventricular septal defect, who presented with cough and hemoptysis and the diagnosis of UPAA was made.

Evaluation of the Effects of Atorvastatin on the Treatment of Secondary Pulmonary Hypertension due to Chronic Obstructive Pulmonary Diseases: A Randomized Controlled Trial.

BACKGROUND: Since pulmonary hypertension (PH) in patients with chronic obstructive pulmonary diseases (COPD) causes poor prognosis and inflammatory process involved in PH, it is supposed that Statins with anti-inflammatory effects might be useful in the treatment of PH. OBJECTIVES: The aim of this study was to evaluate the influence of Atorvastatin on the treatment of pulmonary hypertension in patients with COPD. PATIENTS AND METHODS: A registered (IRCT201108257411N1), triple-blind, randomized controlled trial was performed in Rasoule Akram hospital, Tehran, from 2009 to 2011. Forty five patients with secondary pulmonary hypertension due to COPD were recruited and randomized to two groups receiving either Atorvastatin 40 mg/d or placebo in addition to their current treatment for 6 months. The outcomes including systolic pulmonary arterial hypertension (SPAH), cardiac output (CO), right ventricular size (RVS), CRP, 6 min walk distance test (6MWD), and spirometry parameters were measured after 6 months. RESULTS: Baseline characteristics were similar in both groups. After 6 months, pulmonary hypertension changed from 48.5 ± 6.9 to 42.9 ± 9.3 mmHg for Atorvastatin users and from 49.7 ± 11.4 to 48.2 ± 14.6 mmHg for Placebo users (P = 0.19, CI - 13.57 - 2.89), 6MWD after 6 months was 339 ± 155 meters in case group versus 340 ± 106 meters in control group (P = 0.98, CI - 92.58 - 91.15). There were no significant changes in other outcomes including CRP, RVS, CO and spirometry parameters. CONCLUSIONS: Although we found a trend towards decreasing SPAH and improving 6MWD, no statistically significant shift were detected in our outcomes due to inadequate sample size.