Low Ang-(1-7) and high des-Arg9 bradykinin serum levels are correlated with cardiovascular risk factors in patients with COVID-19.

It is predictable that the renin-angiotensin-aldosterone and kinin-kallikrein systems are dysregulated in COVID-19 (COV) patients because SARS-CoV-2 requires ACE2 to cause an infection. This study aimed to assess the serum levels of des-arg(9)-bradykinin (DABK) and angiotensin 1-7 (ang-(1-7)) in patients with COV who had the above-mentioned cardiovascular disease risk factors. In a cross-sectional study, 69 COV patients were selected among patients referred to the main referral center for these patients, in Kerman, Iran, and 73 matched control (non-COV) individuals among individuals who participated in the KERCARD cohort study. Serum levels of DABK and ang-(1-7) were measured by ELISA in the groups of CTL (healthy), HTN, DM, OB, COV, COV + HTN, COV + DM, and COV + OB. Ang-(1-7) levels were lower in the COV + HTN group compared to the HTN group. DABK levels were higher in the COV, HTN, and OB groups and in DM + COV subjects compared to their corresponding control group. The levels of ang-(1-7) and DABK were related to HTN and OB, respectively. According to the findings, we can infer that an increase in DABK production in those with the cardiovascular disease risk factors of diabetes, obesity, and hypertension or a decrease in ang-(1-7) in those with hypertension may contribute to the adverse outcomes of SARS-CoV-2 infection.

The effects of antihypertensive medications on severity and outcomes of hypertensive patients with COVID-19.

In Covid-19 pandemic, specific comorbidities are associated with the increased risk of worse outcomes and increased severity of lung injury and mortality. the aim of this study was to investigate the effects of antihypertensive medications on the severity and outcomes of hypertensive patients with COVID-19. This retrospective observational study conducted on patients with COVID-19 who referred to Afzalipour Hospital, Kerman, Iran during the six months from 19 February 2020 to 20 July 2020. The data were collected through medical chart reviews. We assessed 265 patients with Covid-19 and they stratified based on hypertension and type of antihypertension medications. The data were described and Student's t-test, Mann-Whitney U and Fisher exact test were run to compare the patients 'demographical and clinical information. The qualitative variables were compared using the by SPSS software version 23. The results of the present study showed that hypertension was a prevalent comorbidity among patients with COVID-19 and hypertensive patients compared to other patients without any comorbidity who were older (P-value: 0.03). The oxygen saturation was higher for the patients in the control group than hypertensive patients (P-value: 0.01). The severity of COVID-19 and its outcome were not different between the patients who took or did not take antihypertensive medications and also the type of antihypertensive medications. Hypertensive patients did not show any significant difference in survival, hospital stay, ICU admission, disease severity, and invasive medical ventilation in other normotensive patients with COVID-19.

Pharmacokinetics and therapeutic efficacies of fenbendazole in comparison with levamisole in helminth-infected Caspian turtles (Mauremys caspica).

The pharmacokinetics and bioavailability of fenbendazole and levamisole were determined in Caspian turtles after a single intravenous (i.v.) and subcutaneous (s.c.) administration. Thirty turtles diagnosed as naturally infected with Serpinema microcephalus and Falcaustra armenica nematodes received fenbendazole (50 mg/kg) or levamisole (10 mg/kg) by i.v. and s.c. administrations. Blood samples were collected at time 0, 0.125, 0.25, 0.5, 1, 2, 4, 8, 12, 24, and 48 h after drug administration. Plasma drug concentrations were determined by a validated high-performance liquid chromatography method. Data were analyzed by noncompartmental methods. The mean elimination half-life of levamisole was 5.16 h and 12.03 h for i.v. and s.c. routes, respectively, and for fenbendazole, the mean elimination half-life was 25.38 h (i.v.) and 29.77 h (s.c.). The total clearance and volume of distribution at steady-state for levamisole and fenbendazole following i.v. administration were 0.22, 0.44 ml/g/h, and 1.06 and 7.35 ml/g, respectively. For the s.c. route, the peak plasma concentration of levamisole and fenbendazole was 10.53 and 5.24 µg/mL, respectively. The s.c. bioavailability of levamisole and fenbendazole was complete. Considering high anthelmintic efficacy and bioavailability after s.c. administration of levamisole and fenbendazole, and the absence of adverse effects, this route of administration is an easy and efficacious way of treating nematodes in Caspian turtles.

Changes in serum levels of apelin and nitric oxide in hospitalized patients with COVID-19: association with hypertension, diabetes, obesity, and severity of disease.

BACKGROUND: COVID-19 is an infectious disease currently spreading worldwide. The COVID-19 virus requires angiotensin-converting enzyme 2, an enzyme that plays a vital role in regulating the apelinergic system for entry into target cells. The underlying diseases of hypertension, diabetes mellitus, and obesity are risk factors for the severity of COVID-19 infection. This study aimed to compare the serum levels of apelin and nitric oxide in hospitalized COVID-19 patients and non-COVID-19 subjects with and without the mentioned risk factors. METHODS: Serum samples were taken from 69 COVID-19 patients and 71-matched non-COVID-19 participants enrolled in the Kerman coronary artery disease risk factors cohort study. Study participants were divided into eight groups of control (healthy), hypertension, diabetes mellitus, obesity, COVID-19, COVID-19 + hypertension, COVID-19 + diabetes mellitus, and COVID-19 + obesity (n = 15-20 in each group). Serum apelin and nitrite were measured by the enzyme-linked immunosorbent assay and colorimetric methods, respectively. RESULTS: Hypertensive and obese patients had lower serum apelin compared to the control group. In addition, apelin content was lower in the COVID-19 and COVID-19 + diabetes mellitus groups compared to the non-COVID-19 counterpart groups. Serum apelin levels were positively associated with arterial O2sat. and negatively with the severity of lung involvement. Nitric oxide metabolites were significantly lower in the COVID-19, COVID-19 + diabetes mellitus, and COVID-19 + obesity groups. CONCLUSIONS: The lower apelin and nitric oxide levels in patients with hypertension and obesity or their reduction due to infection with COVID-19 or concomitant COVID-19 + diabetes mellitus may make them vulnerable to experiencing severe diseases.

Prevalence of Micro-Aspiration of Bile Acids in Patients with Primary Lung Cancer: A Cross-Sectional Study.

Background: Lung cancer remains a serious public health problem and is the first cause of cancer-related death worldwide. There is some evidence suggests that bile acid micro-aspiration may contribute to the development of lung diseases. This study aimed to assess the prevalence of micro-aspiration of bile acids in patients with primary lung cancer. Methods: In a cross-sectional study, 52 patients with primary lung cancer referred to a teaching hospital affiliated with Kerman University of Medical Sciences, Kerman, Iran were enrolled. Patients with pathology-confirmed lung cancer who did not receive specific treatment were included in the present study. All patients underwent bronchoscopy and the levels of bile acid was assessed in their Broncho-Alveolar Lavage (BAL) samples. Results: According to the results, 53.85% of patients were in the age group of 40 to 59 years. Of the participants, 88.46% were male, 82.69% were smokers, and 69.23% were opium addicted. The most common presenting clinical symptoms of patients were heartburn (61.55%), hoarseness (17.31%), and epigastric pain (9.61%), respectively. Ninety-two point thirty-two percent of patients had endobronchial lesions in bronchoscopy. Squamous cell carcinoma, small-cell lung carcinoma and adenocarcinoma accounts for 48.08%, 34.61% and 17.31% of all cases of lung cancer, respectively. Bile acids were found in the BAL sample of all patients with primary lung cancer. The mean Bile acids levels in patients were 63.42 (SD=7.03) µmol/Lit. Conclusion: According to the results of present study, there was a micro-aspiration of bile acids in all patients with primary lung cancer that may participate in shaping early events in the etiology of primary lung cancer. It seems that developing clinical strategies preventing the micro-aspiration of bile acids into the lungs could remove a key potential trigger in this process.

Bronchial Anthracofibrosis and Tracheobronchomalacia.

BACKGROUND: Tracheobronchomalacia (TBM), presenting with the softening of the walls of trachea and bronchi, can cause respiration problems. Despite the importance of TBM, data on its prevalence and related factors are limited. In the current study, the prevalence and predictive factors of this illness were investigated. METHODS: This cross-sectional study was conducted on patients who were bronchoscopy candidates in the diagnostic department of pulmonary diseases in Afzalipour hospital in Kerman, Iran, from May 2017 to May 2018. First, all patients diagnosed with TBM were assessed based on their demographic variables, spirometry indices, anthracofibrosis and TBM severity. TBM was defined as a 50% or higher decrease in the diameter of the main tracheal and bronchial walls on expiration. These patients constituted the case group. Other patients for whom the bronchoscopy findings were not in concordance with TBM were selected through convenience sampling as control group to equal the number of patients in the case group. Data were analyzed using SPSS version 23. RESULTS: In this study, 132 (9.38%, 95% CI: 8-11) of the total 1406 cases who underwent bronchoscopy had tracheomalacia. Also, 22 patients (16.66%) had bronchomalacia, at the same time. Based on the multivariable logistic test results, age (P = 0.03, 95% CI: 1.00-1.04, OR = 1.02) and having anthracofibrosis (P<0.0001, 95% CI: 1.26-4.68, OR = 2.43) were identified as predictive factors for tracheomalacia. CONCLUSION: The findings of the present study suggest that the presence of anthracotic plaques can be considered as a possible predictive factor for TBM.

Biochemical and cytological analyses of pleural effusion in patients with lung anthracosis and antracofibrosis.

BACKGROUND: Anthracosis and anthracofibrosis are attributed to the deposition of carbon particles along with fibrosis, adhesion, narrowing, and collapse. There has been no study on the characteristics of the pleural fluid in anthracosis. The present study analyzed the biochemical characteristics of pleural effusion in patients with pulmonary anthracosis. PATIENTS AND METHODS: The study is a cross-sectional study which included patients who were referred to the Afzalipour Hospital in Kerman, eastern Iran. Between April 2018 and October 2019, patients who had undergone bronchoscopy and were diagnosed with anthracosis and pleural effusion were selected through the census method. The characteristics of the pleural fluid were analyzed for protein, albumin, LDH, PH, Triglyceride, cholesterol, glucose, and cytology. Concomitant blood samples were examined for LDH, albumin, total protein, and glucose. After it was specified whether the pleural effusion was transudative or exudative, patients with lymphocyte-dominant exudative pleural fluid became candidates for thoracoscopy. RESULT: 106 patients (6.21 %) of 1705 patients had anthracosis and anthracofibrosis; 37 of these patients (34.9 %) had coexisting pleural effusion. 31 patients gave written informed consent for thoracentesis. The mean age of the patients was 76.48 ± 8.81. In addition, 67.74 % of the patients were female. Pleural effusion was transudative in 29 (93.54 %). Except for one case, all patients had diffuse anthracofibrosis and 67.74 % of the patients had a history of baking bread. CONCLUSION: According to the findings of this study, most cases had transudative lymphocyte-dominant pleural fluid with mostly diffuse anthracofibrosis. In addition, this condition is more prevalent in women, with a prevalence of approximately twice that of men.

Association of Bile Acid and Pepsin Micro-aspiration with Chronic Obstructive Pulmonary Disease Exacerbation.

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is one of the most common chronic diseases all around the world. One of suggested risk factors for COPD is Gastroesophageal Reflux Disease (GERD). The aim of this study was investigation of the association between micro-aspiration of bile acid and pepsin with exacerbation attacks in COPD patients. MATERIALS AND METHODS: The present study was a descriptive cross-sectional study. Fifty-two COPD patients were selected by simple sampling from patients referring to the Bessat Lung Clinic. Participants were divided into two groups of with and without COPD exacerbation history in the past year. The severity of the disease was determined based on the GOLD criteria (mild, moderate, severe and very severe). Then, all patients underwent bronchoscopy and the concentrations of bile acid and pepsin were compared in Broncho-Alveolar Lavage Fluid (BALF) of two groups. RESULTS: The mean of bile acids in the group without COPD exacerbations was lower (27.38±3.26 µmol/Lit) than the group with COPD exacerbations (32.31±5.35 µmol/Lit) and this difference was not significant (P=0.436). The mean of pepsin in the first group was higher (118.46 ±15.44 ng/ml) than the second group (107.88±10.7 ng/ml) and this difference was also not significant (P=0.577). CONCLUSION: According to the results of this study, there is no association between disease severity and number of exacerbations with micro-aspiration of bile acid and pepsin in COPD patients.

Effect of Aerobic Exercises on Serum Levels of Apolipoprotein A1 and Apolipoprotein B, and Their Ratio in Patients with Chronic Obstructive Pulmonary Disease.

BACKGROUND: Cardiovascular disease is one of the most common disorders associated with chronic obstructive pulmonary disease (COPD). There are few studies on the effects of physical exercises, especially aerobic exercises, on serum levels of apolipoprotein A1 and apolipoprotein B in patients with COPD. The current study aimed at determining the effect of aerobic exercises on serum levels of apolipoprotein A1 and B and apo-A1/apo-B ratio. MATERIALS AND METHODS: In the current randomized, controlled, clinical trial, with a pretest posttest control group design, 22 males with COPD were randomly assigned to the aerobic exercise and control groups. The aerobic exercise program was performed within two months based on three 30-40-minute sessions per week. Serum levels were measured and evaluated before and after aerobic exercises. Data were analyzed using the paired samples t test. RESULTS: In the aerobic exercise group, the mean of Apo A1 and Apo B after the intervention (169.36±5.42 and 93.63±5.24 mg/dL, respectively) was significantly higher than that of before the intervention (146±6.09 and 83.27±4.44 mg/dL, respectively) (P-value=0.001). However, apoA1/Apo B ratio did not significantly change after the intervention compared with that of before the intervention (1.85±0.10 vs. 1.80±0.13) (P >0.05). There was no significant change in the mean Apo A1 and Apo B levels and Apo A1/Apo B ratio after the intervention in the control group. CONCLUSION: Regular aerobic physical exercises are effective in increasing the serum level of Apo A1 in patients with COPD. Due to the proven protective role of Apo A1 in patients with COPD, this biomarker can improve respiratory efficacy in such patients.

Detection of helicobacter pylori in bronchoalveolar lavage of patients with chronic obstructive pulmonary disease by real time polymerase chain reaction.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is one of the most important causes of disability and mortality in the world. Although cigarette smoking and environmental pollutants have been recognized as the major causes of COPD, the role of infection in the pathogenesis and progression of COPD has also been reported. OBJECTIVES: The aim of the present study was to find the relationship between Helicobacter Pylori infection and COPD through anti H. pylori IgG serology, real time PCR of bronchoalveolar lavage and trans bronchial biopsy urease tests. PATIENTS AND METHODS: This descriptive cross-sectional study was carried out on 60 adults with COPD. After obtaining the patient's history, physical examination, spirometry and confirmation of COPD diagnosis by pulmonologist, subjects were selected through convenience sampling. In order to determine the severity and prognosis of disease, the global initiative for chronic obstructive lung disease (GOLD) criteria and BODE index were used. Subjects underwent bronchoscopy for obtaining bronchoalveolar lavage (BAL) samples and biopsy was performed. Biopsy and BAL samples were investigated respectively by urease test and real time PCR. Moreover, patients' serum samples were serologically studied for detection of anti H. pylori IgG. RESULTS: Mean age of the participants was 60.65 ± 9.15 years, and 25% were female and 75% were male. The prevalence rate of H. pylori in COPD patients was 10% according to real time PCR, 88.3% according to the serology test and 0% based on the urease test. According to the results of PCR and considering the severity of disease based on the GOLD criteria, from those with a positive PCR, one patient (16.6%) had very severe obstruction, three (50%) had severe obstruction and two patients (33.3%) had moderate obstruction. The relationship between H. pylori presence (based on PCR) and disease severity and prognosis was not statistically significant. CONCLUSIONS: These findings can justify the hypothesis of direct injury and chronic inflammation via inhalation and aspiration resulting in H. pylori colonization. In fact, it is thought that H. Pylori infection, beside the host genetic vulnerability and other environmental risk factors might make the patient susceptible to COPD or lead to COPD worsening. Although we found H. pylori infection in some patients with COPD, the results of this study, could not explain the pathogenic mechanisms of COPD.

Human Linguatulosis Caused by Linguatula serrata in the City of Kerman, South-eastern Iran- Case Report.

Human linguatulosis poses an important medical and veterinary concern in endemic countries. Animals, as reservoir host, play a major role in transmission of infestation and epidemiology of the disease. This study reports a case of human linguatulosis caused by Linguatula serrata in the city of Kerman, South-eastern Iran. A woman suffering from upper respiratory symptoms is presented. The patient consumed raw liver of sheep who was admitted to the Afzalipour University Hospital in Kerman for the symptoms of upper respiratory tract. In microscopic examination of the nasopharyngeal discharge, L. serrata was detected. This report has future medical implication in precise diagnosis of L. serrata in patients with complaints of nasopharyngeal symptoms.

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.

Adiponectin Level in Serum and BAL Sample of Patients with Chronic Obstructive Pulmonary Disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is the only cause of mortality and morbidity with an increasing incidence. Adiponectin has recently gained the spotlight for its possible association with COPD or its exacerbation. This study evaluated the association of serum and alveolar adiponectin levels with COPD-related variables. MATERIALS AND METHODS: This analytical cross-sectional study was carried out on 45 COPD patients. Number of cigarettes smoked (packs), years of smoking, number of disease exacerbations per year and BMI were all recorded. Patients underwent spirometry and their disease severity was determined based on BODE index. Venous blood sample was obtained to measure the adiponectin serum level, ESR and CRP. Bronchoscopy and BAL were performed as well and alveolar secretions were collected to assess the alveolar fluid level of adiponectin. RESULT: The mean serum level of adiponectin in COPD patients was significantly higher than the upper limit of normal range in healthy individuals (P = 0.000). Level of alveolar adiponectin in smoker patients was significantly higher than non-smokers (P = 0.043) but serum adiponectin was not significantly different between them. Serum adiponectin level had a significant reverse correlation with BMI and a direct correlation with number of exacerbations per year and CRP. Level of alveolar adiponectin had a direct association with number of exacerbations per year and number of smoked cigarettes. CONCLUSION: Based on the obtained results, smoking cessation is very important in COPD and more emphasis should be placed on patient's weight control especially those with low BMI as well as rehabilitation programs for these patients.

Helicobacter pylori in patients suffering from pulmonary disease.

BACKGROUND: Recently, research of indirect evidence suggested a possible association between Helicobacter pylori and pulmonary disease. This study aimed to determine if H. pylori could be detected in endobronchial specimens collected from patients undergoing bronchoscopy. MATERIALS AND METHODS: This prospective study was conducted on 34 consecutive patients with any type of lung disease undergoing bronchoscopy in which biopsy was required for their diagnosis. A written informed consent was obtained from all participants. Three bronchial mucosa biopsy samples were obtained using fenestrated biopsy forceps. One sample was used to determine urease activity, the second one for histopathological examination, and the third one for diagnosis. All subjects were fully informed regarding the gastroesophageal reflux disorder (GERD) Questionnaire. RESULTS: There were 34 patients with pulmonary diseases (12 males and 22 females, mean age 58.2±18.2 years) out of which, 11 (32.4%) had GERD. No significant difference was found between the histopathological assay and GERD. CONCLUSION: Our study found no direct evidence supporting the theory that H. pylori may cause pulmonary disease and no relation with GERD was detected. However, a possible indirect role could not be excluded. Further studies in patients with GERD and lung disease may reveal a potential pathogenic link between H. pylori and pulmonary disease.