Evaluation of hepatoprotective effect of silymarin among under treatment tuberculosis patients: a randomized clinical trial

Hepatic toxicity is the most serious adverse effect of anti tuberculosis drugs. This study was performed to evaluate efficacy of silymarin as a hepatoprotective herbal agent. In a randomized double blind clinical trial 70 new cases of pulmonary tuberculosis were divided into two groups. The intervention group was assigned to receive silymarin and the control group received placebo. Tuberculosis was treated by classic regimen consisting isoniazid, rifampin, pyrazinamide and ethambutol. No statistically significant difference was found between the two groups concerning the frequency of drug induced liver injury or mild elevation of liver enzymes. Silymarin was safe without any major side effect. Our results showed no significant hepatoprotective effect of silymarin among patients on tuberculosis treatment

Comparison of polymerase chain reaction single-strand conformation polymorphism with DNA sequencing to detect drug resistance of mycobacterium tuberculosis isolates

Advancements in molecular technology increased our understanding of genetic mechanism of drug resistance. Nowadays, the chance of rapid detection of resistant Mycobacterium tuberculosis [M. tuberculosis] strains is increased. In the present study, we aimed to investigate the sensitivity and specificity of PCR-SSCP for detecting susceptible and resistant strains of M. tuberculosis compared with DNA sequencing. To calculate the sensitivity and specificity of PCR-SSCP assay to detect drug resistance in M. tuberculosis, respiratory samples were collected from suspected patients referred to Mycobacteriology Research Center [Masieh Daneshvary Hosptial] since 2002. Susceptibility testing against first line drugs was performed on 74 culturepositive specimens. Consequently, PCR-SSCP and DNA sequencing were performed on katG, inhA, ahpC and rpoB genes. Drug-susceptibility testing by the proportional method in selected samples revealed 16 MDR [21.6%], 23 mono-drug resistant [31%] and 35 susceptible strains [47.3%]. In comparison with DNA sequencing as a gold standard for molecular methods, the sensitivity of PCR-SSCP assay for detecting of mutation in 315 codon of katG gene was 94.74% [CI=73.97%-99.87%] with 100% [CI=93.51%-100%] specificity. In contrast, the sensitivity and specificity of this assay in detecting of rpoB gene were 70.8% [CI=48.91%-87.38%] and 88% [CI=75.69%-95.47%], respectively. PCR-SSCP in combination with DNA sequencing can be used as screening method to detect MDR-TB and mono-drug resistant cases

Smoking effects on clinical manifestations and drug resistance patterns in pulmonary TB patients

Considering the rising trend of tuberculosis [TB] and cigarette smoking, an evaluation of the clinical manifestations and drug resistance patterns in TB patients with regard to smoking status seemed beneficial. Clinical manifestations and drug resistance patterns were studied in 872 new pulmonary TB patients classified as non-smokers, ever-smokers, and passive smokers during 3 years at the National Research Institute of Tuberculosis and Lung Disease. Both univariate and multivariate analyses were performed. Ever-smokers were mostly male [p<0.001], Iranian [p<0.001], and drug and alcohol users [p<0.001]. They were found to have a longer patient delay [15.9 versus 8.7 and 6.3 days, p=0.008], shorter diagnostic delay [106.8 versus 132.6 and 156 days, p=0.01], greater weight loss [p=0.01], and higher sputum expectoration [p<0.001]. Notably, the degree of smear positivity was associated with smoking [p<0.001] in both univariate and multivariate analyses. No statistical significance was found for the aforementioned factors among non-smokers and passive smokers. Some of the clinical manifestations of TB are significantly different with regard to the patients' smoking status.The degree of sputum smear positivity for acid fast bacilli was higher and patient delay was longer in ever-smoker patients

TNF alpha gene polymorphism in idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis [IPF] is characterized by a chronic inflammatory process and abnormal wound healing. Tumor Necrosis Factor alpha [TNF alpha] is considered to play a key role in fibroblast proliferation and increased collagen synthesis. It appears that there is a genetic predisposition to IPF. The genetic associations of TNF-alpha with IPF have been reported in different cohorts and revealing conflicting results. This study was conducted to evaluate the association of TNF- alpha-308 G/A polymorphism with IPF in Iranian patient by PCR-RFLP method. Materials and Methods: TNF alpha gene polymorphism at position 308 G/A was examined on DNA extract of 41 cases with IPF defined clinically, radiologically and histologically and compared with 82 unrelated healthy controls who were kidney donors. Results: The understudy population included 20 males and 21 females with the mean age of 50.4 yrs. Data showed that the frequencies of G allele [NO:72] and A allele [NO:10] were 87% and 12% respectively. The frequency of G/G genotype [NO:31] was 76%, followed by G/A [No:10] being 24%.we had no A/A genotype. Conclusion: There was no association between TNF alpha-308 G/A polymorphism and IPF in Iranian patients

Esophagogastroduodenoscopy and O2 saturation in COPD patients

Diagnostic upper gastrointestinal [GI] endoscopy without sedation in selected patients has become more common over the past few years, none-the-less sedatives are avoided in the elderly. We studied the effect of rapid esophagogastroduodenoscopy [EGD] without sedation on patients with COPD to determine the critical hypoxemia during endoscopy. In a prospective study, easy EGD was performed electively in 74 patients with COPD [FEV1, FVC, and FEV1.FVC < 60%] during 25 months in Masih Daneshvari Hospital. All patients had continuous monitoring and recording of arterial oxygen saturation with pulse oximeter. Patients had similar characteristics concerning age, gender, cardiopulmonary function and other interventional factors. Hypoxemia during the procedure was also registered. It is noticeable that easy endoscopy refers to performing EGD in less than 10 minutes without sedation. This study showed that during non-sedated EGD, SaO2 dropped to less than 90% in 23% [16 cases] of patients with COPD. None-the-less following administration of oxygen during the procedure, PaO2 tended to normal values and therefore the procedure was continued without interruption in all cases. This study showed that easy endoscopy in COPD patients with normal cardiac function may be considered as a safe procedure with no complication

CT-guided percutaneous fine-needle aspiration biopsy of pulmonary lesions

Transthoracic CT-guided percutaneous fine-needle aspiration biopsy [FNAB] has become a well- established diagnostic technique and been useful in differentiating malignant and benign pulmonary lesions. 505 patients [311 men and 194 women] aged 7-90 years old [mean age 56.2 years] with pulmonary lesions underwent CT-guided transthoracic fine-needle aspiration biopsy. Cytopathologic evaluation of FNAB samples was performed in all patients. In addition, each case was reviewed for complications, including pneumothorax and hemoptysis. Data were analysed using SPSS software for windows ver. 11.5. FNAB samples were adequate for diagnosis in 410 [81.2%] of 505 patients. Two hundred and forty-nine lesions [60.7%0] were malignant, and 161 [39.3%] were benign or atypical. Thirty-four [6.7%] patients had pneumothorax out of which none of them required thoracostomy tube placement. Additionally, hemoptysis was noted in 9 [1.8%] patients and follow-up was carried out. No further complications were reported. CT-guided FNAB of pulmonary lesions can yield well-established diagnoses and it can be useful in the management of patients with suspected lung cancer

Short outcome and evaluation of hemoptysis in patients with old pulmonary TB

Data concerning the evaluation of hemoptysis in patients affected by Tuberculosis backs to 1940-1960. Remarkable advances in anti TB agents together with effective treatment strategies such as DOTS [Directly Observed Treatment Short Course] has made the feature of the disease to be less associated with severe complications like hemoptysis due to bronchiectasis or fibrocavernous lesions. The objective of this study was to evaluate the short outcome of the patients with hemoptysis due to old tuberculosis and also the relation of the severity of hemoptysis with length of stay [LOS] in hospital and the severity of the pulmonary lesion in high quality imaging techniques. Forty-five patients with old TB and cardinal sign of hemoptysis were evaluated and after excluding the mycetoma and suggestive tumor formation, the coefficient correlation between the severity of hemoptysis and the LOS and also the correlation of the severity of hemoptysis and different pictures of pulmonary lesions in CT- scan were evaluated with Spearman's rho statistical analysis. All patients were discharged except one who had died because of the reasons other than asphyxia due to hemoptysis. One patient had undergone bronchial artery embolization. Pulmonary resection had been performed in none of the patients. According to the non-parametric coefficient correlation analysis, there were significant correlations between age and the first evidence of residual TB in the lung parenchyma [P=0.00, Spearman rho 0.00] and also between severity of hemoptysis and pulmonary lesions in CT scan at the level of 0.05; but no correlation was observed between the LOS and the severity of hemoptysis [P=0.0769] Hemoptysis due to old destructive pulmonary TB usually has a benign course. This is probably due to lung fibrosis and scarring caused by a prolonged inflammatory process which has led to an increase in vascular anastomosis. In old TB the source of bleeding is usually brochiectatic lesions which are directly correlated with the radiologic features found in chest- x- ray. The authors believe that although pulmonary resection in patients with life threatening hemoptysis is of considerable attention, conservative management of hemoptysis associated with arrested pulmonary TB is the first option

Expertise of the resuscitation team, personnel network, equipment and drug availability during cardiopulmonary resuscitation in emergency wards

Requirements of cardiopulmonary resuscitation must be always prepared and available in emergency ward as the result of acute condition of patients hospitalized in this ward and risk of possible exacerbation in them. Equipping the emergency ward and recruiting expert personnel can effectively reduce the rate of hospital related morbidity and mortality. This was a descriptive cross sectional study conducted to evaluate the expertise of the resuscitation team staff, personnel network, and availability of drugs and equipments during cardiopulmonary resuscitation. A questionnaire was used including two main parts. The first part included the data regarding age, sex and underlying diseases and the second part consisted of 67 questions in terms of expertise of the resuscitation team while resuscitating and had 71 scores. The nurse in the resuscitation team was spending an obligatory period of work [Tarh] in 64.4% and the physician was a resident in 91% of the cases. Defibrillator apparatus was in a good condition and working properly in all cases and the period of time using defibrillator from the moment of cardiopulmonary arrest to performing the first shock, was 0.5 to 4 minutes. Regarding availability, amiodarone was least available during resuscitation. According to this study, resuscitation team members in emergency wards of selected centres were not optimally expert in this regard. More researches are recommended in the field of resuscitation and training courses must be held every six months for all members of the treatment team

Pain relief methods after thoracotomy

Thoracotomy is one of the surgical operations which causes severe pain. In fact, this pain is one of the most excruciating pains caused by surgical operations. Different procedures are performed to decrease this pain which is associated with significant physiologic, mental and pathologic complications. Each of these procedures has its own advantage and disadvantages. In many centers, the most common treatment method used, is considered as the first choice. In this study, common methods of analgesia after thoracotomy were compared. During this meta-analysis, "Visual Analogue Scale" [VAS] of patients in epidural group was compared with those in four groups of systemic opioids, intercostal block, para- vertebral block and intrapleural infusion in the first 24 hours after surgery. Data obtained from 28 randomized clinical trials [RCT] which compared the procedures in 1697 patients after thoracotomy were gathered using random effect model, effect size index and the standardized difference average. Statistical values were evaluated and the results obtained using standard error, 5% maximum confidence limit and 5% minimum confidence limit. The obtained data were evaluated using studies performed between 1987 and 2005. After evaluating 314 titles and 185 abstracts, 28 articles were entered in the meta- analysis considering inclusion criteria. Four groups of epidural with systemic opioids, epidural with para-vertebral, epidural with intercostal and epidural with intrapleural analgesia were studied. It was noticed that the epidural method in total 24 hours with 95% CI= -0.9802 to -0.3844 was a better procedure compared with systemic opioids. Epidural method did not show any difference with intercostal method in 24 hours mean with 95% CI= -0.2171 to +0.5906. Epidural method was also better than intrapleural in 24 hours mean with 95% CI= -1.1166 to -0.0106. When comparing epidural with para-vertebral, epidural was better with 95% CI= +0.1744 to -0.4527. According to the evaluations performed, epidural method is recommended as the method of choice to reduce pain after thoracotomy