The Effect of Training Inhalation Technique with or without Spacer on Maximum Expiratory Flow Rate and Inhaler Usage Skills in Asthmatic Patients: A Randomized Controlled Trial.

BACKGROUND: The most common treatment for asthma is transferring the drug into the lungs by inhaler devices. Besides, correct use of inhaled medication is required for effectiveness of pharmacotherapy. Thus, it is necessary to train the patients how to use Metered Dose Inhaler (MDI). This study aimed to determine the effect of training about MDI usage with or without spacer on maximum expiratory flow rate and inhaler usage skills in asthmatic patients. METHODS: This randomized clinical trial was conducted on 90 asthmatic patients who were randomly divided into inhalation technique group with spacer, inhalation technique group without spacer, and a control group. Then, the Peak Expiratory Flow Rate (PEFR) was measured using a peak flow meter, as a basic test. In addition, the patients' functional skills of inhalation technique were assessed using two checklists. Afterwards, 3 sessions of training were arranged for both groups. PEFR and the ability to use the MDI were evaluated immediately and 1 month after the intervention. Finally, the data were entered into the SPSS statistical software (v. 18) and analyzed using independent t-test and repeated measures ANOVA. RESULTS: After the intervention, MDI usage skills improved in the two intervention groups compared to the control group (P<0.001). In addition, a significant difference was found between the intervention groups and the control group regarding the mean of PEFR after the intervention (P<0.001). However, no significant difference was observed between the two intervention groups (P=0.556). CONCLUSION: According to the results, providing appropriate training for asthmatic patients increased MDI usage skills, and both methods of inhalation (with or without spacer) could improve the PEFR among the patients. TRIAL REGISTRATION NUMBER: IRCT2013091514666N1.

Genetic Polymorphisms of CCL22 and CCR4 in Patients with Lung Cancer.

BACKGROUND: An association between lung cancer and chemokines has been advocated in the recent years. This study aims at investigating the association between lung cancer and 16C/A single nucleotide polymorphism (SNP) (rs. 4359426) in C-C motif chemokine 22 (CCL22) as well as C1014T SNP (rs. 2228428) in C-C chemokine receptor type 4 (CCR4), which serves as the receptor for CCL22. METHODS: Genotyping was performed in 148 lung cancer patients and 148 normal controls using Polymerase Chain Reaction-Restriction-Fragment Length Polymorphism (PCR-RFLP). The data were verified by direct automated sequencing. RESULTS: Frequencies of CC, CA and AA genotypes of 16C/A SNP in CCL22 gene were 112 (75.7%), 33 (22.3%) and 3 (2.0%) in patients, and 119 (80.4%), 24 (16.2%) and 5 (3.4%) in controls respectively. No significant differences were observed in genotype frequencies at this position between cases and controls (P=0.34). Moreover, there was no significant association between CCL22 polymorphism and types of lung cancer in patients. The distribution of CC, CT and TT genotypes of C1014T SNP in CCR4 gene, was 76 (51.4%), 60 (40.5%) and 12 (8.1%) in patients, and 80 (54.1%), 49 (33.1%) and 19 (12.8%) in controls respectively. No statistically significant differences were observed in genotypes frequencies of CCR4 gene between patients and controls (P=0.24). The genotype inherited by patients observed not to be associated with the type of lung cancer (P>0.05). CONCLUSION: RESULTS reveal that CCL22 gene polymorphism at position 16C/A and CCR4 gene polymorphism at position C1014T, appear not to be associated with susceptibility to lung cancer.

Eosinophilic pleural effusion: a rare complication of extracorporeal shock wave lithotripsy.

Background. Extracorporeal shock wave lithotripsy has been widely used to treat renal stones. The procedure is relatively safe with minor complications. Case. The patient is a 32-year-old man who presented with left sided pleural effusion after extracorporeal shock wave lithotripsy. Results. The pleural effusion study revealed an exudative fluid rich in eosinophils (30%). So, the diagnosis of eosinophilic pleural effusion as a complication of lithotripsy was made. Conclusion. Extracorporeal shock wave lithotripsy should be regarded as an etiology of unexplained eosinophilic pleural effusion after this procedure.

Increase of regulatory T cells in metastatic stage and CTLA-4 over expression in lymphocytes of patients with non-small cell lung cancer (NSCLC).

We hypothesized that the increased percentages of Regulatory T (Treg) cells, as well as over expression of Cytotoxic T Lymphocyte Antigen-4 (CTLA-4) by lymphocyte subsets might be associated with lung cancer. Accordingly, peripheral blood of 23 new cases with non-small cell lung cancer (NSCLC) and 16 healthy volunteers were investigated, by follow cytometry, for the prevalence of CD4+CD25+FoxP3+ Treg cells as well as surface (sur-) and intracellular (In-) expression of CTLA-4 by the main lymphocyte subsets (CD4+, CD8+ and CD19+). Results indicated that NSCLC patients had an increased percentage of Treg cells than controls (7.9±4.1 versus 3.8±1.8, P=0.001). The proportion of Treg cells was observed to be increased by stage increase in patients (stage II=5.2±2.4, stage III=7.9±4.4, stage IV=12.0±2.2), and also significantly higher in metastatic than non-metastatic stages (12.0±2.2 versus 6.8±3.9, P=0.023). Increase of SurCTLA-4- as well as InCTLA-4-expressing lymphocytes in patients were observed in nearly all investigated subsets, but significant differences between patients and controls were observed about InCTLA-4+CD4+ lymphocytes (8.6±7.1 and 3.8±5.3 respectively, P=0.006) as well as SurCTLA-4+CD8+ lymphocytes (0.3±0.2 and 0.2±0.1 respectively, P=0.047). In conclusion, the results suggest that immunotherapy regimen targeting CTLA-4 and Treg cells might be beneficial in lung cancer patients.

Th1 and Th2 cytokine profiles in malignant pleural effusion.

BACKGROUND: The alteration of Th1 and Th2 cytokine levels is the subject of controversy in pleural effusions caused by malignancy, a situation that favors a Th2 immune response. OBJECTIVE: To examine the different levels of IL-4 and IL-10 (Th2 cytokines), and IL-2 and interferon-γ (IFN-γ) (Th1 cytokines) in malignant and non-malignant pleural effusions. METHOD: The cytokine levels in pleural fluid of 62 patients with malignant pleural effusion (44 with lung cancer and 18 with extrathoracic tumors), 8 with tuberculous and 8 with congestive heart failure pleural effusion were analyzed using enzyme-linked immunosorbent assays. RESULTS: IL-2 was below the detectable concentration of the assay. A significant decrease in IFN-γ level was observed in malignant but not in congestive heart failure cases compared to tuberculous cases. IL-10 levels were higher in malignant and tuberculous pleural effusions than in congestive heart failure pleural effusions, however, this difference did not reach the significant level. IL-4 levels were also increased non-significantly in lung cancer pleural effusions compared to the other groups. CONCLUSION: Our results show a wide variation in IL-4, IL-10, and IFN-γ levels in malignant pleural effusions, a pattern which was not convincing enough to differentiate the cause of effusion.

CTLA4 gene variations and haplotypes in patients with lung cancer.

The CTLA4 protein downmodulates and terminates immune responses by sending inhibitory signals to activated T cells. In this study, six main single-nucleotide polymorphisms of the CTLA4 gene were investigated in 127 lung cancer patients and 124 healthy control subjects: -1722T/C, -1661 A/G, -318 C/T, +49A/G, +1822 C/T, and +6230 A/G (CT60). Statistical analyses revealed no significant differences in the frequencies of genotypes, alleles, and haplotypes between patients and control subjects. We also could not find significant association between CTLA4 variants and any defined lung tumor type. These six single-nucleotide polymorphisms in CTLA4 were not associated with susceptibility to lung cancer in Iranian population.

Interleukin-18 promoter polymorphism is associated with lung cancer: a case-control study.

BACKGROUND: Interleukin-18 (IL-18) is a multifunctional cytokine that augments IFN-gamma production and affects tumor immune response. In the present case-control study, we tested whether IL-18 promoter polymorphism contributes to lung cancer susceptibility in Iranian patients. MATERIAL AND METHODS: The study groups were 73 patients with lung cancer, including 53 with squamous carcinoma (SC) and 20 with small cell lung carcinoma (SCLC), and 97 healthy regional aged-matched individuals. The frequency of IL-18 promoter single nucleotide polymorphisms (SNPs) at positions -656 (G/T), -607 (C/A), and -137 (G/C) was determined by polymerase chain reaction analyses. RESULTS: There were significant differences in the IL-18 -607 allele and genotype distributions between the 73 lung cancer patients and controls. A significantly higher A allele frequency at position -607, which is associated with lower IL-18 production, was observed in lung cancer patients (48.6% vs. 35%; OR = 1.75; 95% CI 1.13-2.72). Also, patients with the -607 CA and the AA genotypes had a 2.60-fold (95% CI 1.26-5.36) and 3.15-fold (95% CI 1.16-8.55) increase in risk of lung cancer. Subdivision of the patients according to histological type revealed that SC was significantly associated with IL-18 -607 SNPs. Although the percentages of -607 alleles and genotypes in SCLC patients were similar to the results in SC patients, the differences compared to control individuals did not reach statistical significance. Analysis with Arlequin software identified eight haplotypes from three SNPs analyzed here. The distributions of IL-18 gene haplotypes were not significantly different between patients and controls after Bonferroni correction. DISCUSSION: This is the first report to investigate the association between IL-18 polymorphism and lung cancer. Our results suggest that IL-18 polymorphism contributes to the lung cancer risk, particularly among SC patients. Further studies with larger numbers of patients are required to determine the possible association between IL-18 polymorphisms and different histological types of lung cancer.

Lack of association between interleukin-13 gene polymorphisms (-1055 C/T and +2044 G/A) in Iranian patients with lung cancer.

Lung cancer is one of the leading causes of death from cancer. Both immune cells and tumor cells play a key role in lung cancer immunity by secretion of cytokines and developing type-2 cell-mediated immune response. IL-13 is an immunoregulatory cytokine affecting tumor immunosurveillance by deviation of immune response from Th1 to Th2. In the present study we sought to determine the association of single nucleotide polymorphisms (SNPs) of IL-13 gene at positions +2044 (G/A) and -1055 (C/T) and lung cancer. One hundred forty one patients and 113 controls were recruited; control group was subdivided into smoker and nonsmoker individuals for serum detection. Genotyping was carried out by PCR-RFLP assay and IL-13 detection by ELISA method. No statistically significant difference was found in the frequency of genotypes, alleles, and haplotypes at positions +2044 (G/A) and -1055 (C/T) of IL-13 gene between lung cancer patients and controls. Serum level of IL-13 was not detectable in both groups. The results of this study reveal that although +2044 (G/A) and -1055 (C/T) SNPs in IL-13 are implicated in some pulmonary processes, they do not confer susceptibility to lung cancer in Iranian population.

Exercise intolerance and chronotropic impairment-The long-term cardiovascular sequelae of mustard gas exposure: A paired-comparative study.

BACKGROUND: Although there are some data regarding the pulmonary manifestations of mustard gas exposure, little is known about its cardiovascular sequelae. METHODS: The spirometric and exercise tolerance test results of two groups of patients with chronic bronchitis one with (group A) and one without (group B) previous exposure to mustard gas and a group of veterans with no bronchitis (group C) were compared. RESULTS: The exercise capacity was similar in groups "A" and "B" patients. Both groups, showed a remarkable impairment of exercise capacity (p<0.001) compared to the group "C" individuals. Although the mean resting heart rate was significantly higher in group "A" patients than group "B" individuals (p=0.01), their mean peak exercise heart rate was significantly lower (p=0.01). Both groups, however, achieved a significant lower peak exercise heart rates, compared to the group "C" subjects (p<0.001). CONCLUSION: Mustard gas exposure can limit the exercise capacity and abolish the normally expected chronotropic response to exercise.

Familial pulmonary alveolar microlithiasis diagnosed by bronchoalveolar lavage. A case report.

BACKGROUND: Familial alveolar microlithiasis is a rare lung disease. In this study we describe the cytologic features of this disease in bronchoalveolar lavage. CASE: A 10-year-old girl and her uncle, a 50-year-old man, had dyspnea and diffuse interstitial pattern on chest radiograph with no defined cause at a period of 10 years apart. Open lung biopsy in the girl and transbronchial lung biopsy plus bronchoalveolar lavage (BAL) in the man were per-formed to determine the diagnosis. In cyopen lung biopsy the diagnosis was alveolar microlithiasis. BAL revealed rehtypical microliths (calcospherites), and th transbronchial lung biopsy performed in the same patient failed to disclose superficially reset any significant pathology. In cytologic a smears, extracellular and intracellular concentrically layered purple-brown, round-to-oval microliths were clearly seen. Cyanophilic periodic acid-Schiff positive intracytoplasmic amorphous material was also frequently seen in alveolar macrophages. CONCLUSION: Familial alveolar microlithiasis is a rare interstitial lung disease that can be easily diagnosed by BAL. This procedure is a very useful tool in diagnosing and classifying some interstitial lung diseases.

Comparison of biotyping and antibiotyping of Pseudomonas aeruginosa isolated from patients with burn wound infection and nosocomial pneumonia in Shiraz, Iran.

The objective of present study was to compare and determine the prevalence ofantibiotypes and biotypes of Pseudomonas aeruginosa isolated from patients with burn infection and nosocomial pneumonia in Shiraz, Iran. Thirty isolates from each group of patients were used. Antibiotyping (antibiotic sensitivity profiles) was performed by disk diffusion of Bauer-Kirby method using eleven antibiotics and biotyping (biochemical profiles) was done by standard biochemical procedures. High rate of multi-drug resistant isolates were observed by both groups of patients. P. aeruginosa isolated from burn infection were found more resistant (26.7%) to the all antibiotics used than those from nosocomial pneumonia (6.7%) p < or = 0.04. All P. aeruginosa (100%) isolates from burn infection were resistant to gentamycin, carbenicillin, cephtazidime and cephalothin. The lowest resistance rate was observed with meropenem. Antibiotic susceptibility profiles revealed 11 and 15 different antibiotypes among P. aeruginosa isolates from patients with burn infection and nosocomial pneumonia, respectively. The biochemical profiles consisting of 21 biochemical tests grouped P. aeruginosa into 8 different biotypes. Biotypes BVIII 15(50%) and BIII 11(36.7%) were the most prevalent isolates from burn infection and nosocomial pneumonia, respectively p < or = 0.04. Data obtained in this study revealed that different types of Pseudomonas aeruginosa are involved in burn wound infection and nosocomial pneumonia in this region.