Comparative Study of Vascular Endothelial Growth Factor in Exudative and Transudative Pleural Effusion.

Background: Increased vascular permeability is one of the main mechanisms in the production of pleural effusion (PE) and vascular endothelial growth factor (VEGF) has a significant role in its pathogenesis. This study aimed to compare pleural levels of VEGF in transudative and exudative PEs besides the other pleural markers. Materials and Methods: In this prospective cross-sectional study, 80 patients with PE were divided into 4 groups as transudative (N=15), parapneumonic (N=15), tuberculosis (N=25), and malignant (N=25) PE. Biochemical tests measured the pleural protein, LDH, cholesterol, glucose, polymorphonuclear cell (PMN), and lymphocyte. ELISA measured the pleural VEGF level. Results: Out of 80 patients, 51 were male, and the total mean age was 55.34±18.53. There were significant differences in pleural VEGF between exudative and transudative effusion (P<0.001) and between malignant and benign effusion (P=0.014). The highest mean difference in pleural VEGF levels was seen in the comparison of transudative and malignant groups (Mean difference=-136.56; P<0.002). The VEGF level in 3 groups was not significantly different; transudative vs tuberculous, parapneumonic vs tuberculous, and parapneumonic vs malignant. Furthermore, VEGF higher than 73.09 pg/ml had a 64% sensitivity and 82% specificity for the diagnosis of malignancy. Among pleural markers (VEGF, protein, LDH, and glucose), VEGF had the highest area under curve (AUC=0.734). Moreover, pleural protein, LDH, and glucose levels significantly correlated with pleural VEGF; however, pleural cholesterol, PMN, and lymphocyte were not correlated. Conclusion: VEGF is assumed as an important factor in the pathogenesis of exudative PE, especially malignant effusion. It can distinguish between lymphocytic exudative PEs.

The effect of iodopovidone versus bleomycin in chemical pleurodesis.

Background Malignant pleural effusion continues to be a common problem in patients with metastatic disease. This study was conducted to compare the efficacy and safety of bleomycin pleurodesis with povidone-iodine pleurodesis through a chest drain as palliative treatment for recurrent malignant pleural effusion. Methods Sixty cancer patients (36 males and 24 females) with recurrent malignant pleural effusion were enrolled in a prospective randomized trial. Thirty patients received povidone-iodine pleurodesis and 30 received bleomycin pleurodesis. Age, sex, side of the primary pathology, treatment outcome (recurrence and relapse time), and complications were analyzed. Results The mean age was 59.63 ± 7.68 years in the povidone-iodine group and 57.97 ± 9.27 years in the bleomycin group ( p = 0.452). The complications were identical in both groups: 2 (6.7%) patients had chest pain, 2 (6.7%) had fever, and one (3.3%) had hypotension. There was a good response to therapy in 20 (66.7%) patients in the bleomycin group and 25 (83.3%) in the povidone-iodine group ( p = 0.136). Conclusion The results of this study indicate that povidone-iodine should be considered as a selective chemical agent to perform pleurodesis in patients with recurrent malignant pleural effusion because it has the same effect but costs less than bleomycin.

Relationship between periodontal variables and disease severity in patients with chronic obstructive pulmonary disease.

Background: The present study investigated the relationship between certain periodontal variables and severity of disease in COPD patients. Methods: The present cross-sectional study included 50 patients suffering from COPD. Lung function examination, forced expiratory volume in one second (FEV1), forced vital capacity (FVC), FEV1/FVC, SpO2, and Modified Medical Research Council (MMRC) Dyspnea Scale were performed. Periodontal clinical examination index included probing depth (PD), attachment loss (AL), gingival index (GI) and plaque index (PI). A quality of life validated index, the COPD assessment test (CAT index), was also calculated. Results: The FEV1 and FVC indices showed a significant negative correlation with PI and AL variables only. The COPD assessment test (CAT) index showed a significant but positive correlation with PI and AL variables only. The SpO2 index presented a significant negative correlation with GI and AL variables. The FEV1/FVC ratio was found to have a negative correlation with PD and AL variables. It is worth noting that MMRC exhibited no significant relationship with any of the periodontal variables. The only variable that was significantly different (P=0.022) among the three smoking groups was the FVC index. The FVC value was significantly higher in the group of subjects who smoked more than 10 cigarettes per day versus the non-smoking group (P=0.017). Conclusion: Based on the findings of this study, in view of the relationship between periodontal variables and respiratory indices in the course of COPD, early treatment of periodontal diseases, might considerably reduce the severity of COPD.