Treatment outcomes and influencing factors on patients with pulmonary tuberculosis: a retrospective study

Introduction: Tuberculosis infection caused by Mycobacterium tuberculosis is one of the most common infectious diseases, especially in countries such as Iran. The course of treatment and the number of drugs used vary depending on the severity of the disease and the parts of the body involved. The resistant tuberculosis to treatment has increased in recent years. Thus, this study was conducted to investigate the frequency distribution of response to treatment of patients with tuberculosis in Sirjan, Iran. Methods: This descriptive cross-sectional study investigated all patients with tuberculosis in Sirjan city who had referred to health centers during the years 2011-2019. The data collection tool was a pre-prepared checklist that included information on age, sex, sputum smear results, sputum culture results, diabetes, patients' nationality, drug side effects, and response to treatment. Finally, data was entered into SPSS version 22, and analyzed. Results: In this study, the overall response rate was 83% and the mortality rate was 10%. Between the frequency distribution of response to treatment in terms of gender, age, sputum smear results, sputum culture results, patients' nationality and diabetes was not statistically significant difference. Also, no statistically significant difference was found between the frequency distribution of pulmonary TB treatment response in terms of drug allergy, drug hepatitis and other drug side effects. Conclusion: According to results, can be concluded that none of the variables: age, sex, smear and culture result, and history of diabetes have no an effect on response to treatment and mortality of tuberculosis (AU)

Comparison of the Factors Influencing Pulmonary Arterial Pressure in Smoker and Non-smoker COPD Patients with Pulmonary Hypertension.

BACKGROUND: There are several prognostic factors in patients with Chronic Obstructive Pulmonary Disease (COPD) that include Forced expiratory volume in one second (FEV1), Body Mass Index (BMI), dyspnea severity, exercise capacity and Pulmonary Hypertension (PH). PH is one of the most important factors. PH pathogenesis in patients with COPD has not been clarified thoroughly and factors such as alveolar hypoxemia, polycythemia, acidosis and pulmonary vessels obstruction have been suggested. The authors assessed some of these contributing factors in smoker and non-smoker patients with COPD. MATERIALS AND METHODS: This comparative-descriptive study included COPD patients suspected to have cor pulmonale without exacerbation in the last four weeks. Echocardiographic evaluation of Pulmonary Arterial Pressure (PAP) was done and Pulmonary Hypertension (PH) was defined as systolic Pulmonary Arterial Pressure (PAP) greater than 40 mmHg. Complete Blood Count (CBC) and Arterial Blood Gas (ABG) were also studied in all patients. RESULTS: Echocardiography was done for 142 patients who were suspected to have PH and 110 patients had measurable PAP. All of the patients were in stage II - IV of COPD according to GOLD criteria. 90 patients had PH of which 47 were smokers and 43 were non-smokers. In smoker patients, significant correlation between PAP and PaO2 was seen (r=-0.291, p-value=0.047). But in non-smoker patients, this correlation was absent. A significant correlation between PAP and FEV1 (r=-0.341, P value=0.025) was seen in non-smoker patients. This correlation was absent in smoker patients. There was no correlation between PAP and hemoglobin, hemoglobin and FEV, and also PaO2 and FEV1 in smoker and non-smoker COPD patients. CONCLUSION: In non-smoker patients with COPD, degree of pulmonary parenchymal lesions and bronchial obliteration plays a more important role than hypoxia in the pathogenesis of pulmonary hypertension.

Comparison of the effect of endoscopic sinus surgery versus medical therapy on olfaction in nasal polyposis.

Chronic rhinosinusitis is a common inflammatory condition in western countries. Nasal polyposis has different symptoms such as nasal obstruction, anterior or posterior nasal drip, reduced sense of smell, and facial pain. Medical and endoscopic treatments are the two main treatments for nasal polyposis. Our aim was to compare the efficacy of different methods on olfactory function. This is a non-randomized clinical trial study that was done on 60 patients who were divided into two groups (medical and surgical). Patients were matched based on age, history of smoking, and the severity of obstruction. The radiologist score of Lund-Mackay staging system was used to match patients in two arms of the trial based on the severity of nasal obstruction. Patients in surgery groups underwent functional endoscopic sinus surgery under general anesthesia and then received Fluticasone propionate nasal spray for 8 weeks (400 mcg bd). Patients in the medical group were only prescribed with Fluticasone propionate with the same duration and same dose as mentioned. As a result of treatment protocol, both medical and surgical group experienced improvement in olfactory function but statistical analyses revealed that surgery resulted in better resolution of symptoms. Our observation revealed that combined treatment had a better effect than medical treatment in restoring olfaction in patients with nasal polyposis.

Evaluation of exogenous melatonin administration in improvement of sleep quality in patients with chronic obstructive pulmonary disease.

BACKGROUND: COPD is primarily the disease of the lungs; nevertheless, multiple systemic manifestations including poor sleep quality and sleep disturbances have been linked to this illness. Administration of sedative hypnotics is not recommended in COPD patients, as these drugs suppress the ventilatory response and exacerbate sleep-related disorders. Melatonin is an alternative medication that has been widely used to treat sleep disturbances caused by aging and other specific conditions. We aimed to investigate the efficacy of melatonin administration in improvement of sleep quality in COPD patients. MATERIALS AND METHODS: A randomized, double-blind, placebo-controlled trial was conducted. A total of 54 patients were recruited and randomly assigned into either melatonin or placebo group. Sleep quality was evaluated by Pittsburgh Sleep Quality Index (PSQI); daytime sleepiness was assessed by Epworth Sleepiness Scale (ESS). For all patients, spirometry and pulse oximetry were preformed to evaluate lung function and oxygenation. RESULTS: Compared with placebo, melatonin administration significantly improved global PSQI score (p<0.001). Of PSQI individual components, sleep quality (p=0.001), sleep latency (p=0.001), sleep efficacy (p=0.003), and sleep duration (p=0.024) improved significantly. On the other hand, melatonin treatment did not significantly change indices of daytime sleepiness, lung function and oxygenation (p>0.05). CONCLUSION: Melatonin significantly improves sleep quality in COPD patients with sleep complaints. This improvement was in the absence of significant elevation in the indices of daytime sleepiness and lung function.

Evaluation of correlation between airway and serum inflammatory markers in asthmatic patients.

CONTEXT: Asthma is one of the most common chronic diseases all over the world, resulting from a state of persistent sub-acute inflammation of the airways. Beside local inflammation, systemic inflammation is also present, which can be shown by increased levels of C-reactive protein (CRP). One of the most important cells in this disease is eosinophil, and sputum eosinophilia is used for its diagnosis. AIMS: The purpose of the present study was to compare and evaluate the correlation between CRP level and sputum eosinophilia in asthmatic and control subjects. MATERIALS AND METHODS: A total of 61 patients suffering from mild-to-moderate asthma participated in this study. They were divided into two groups based on whether they used inhaled steroid or not. Sputum was induced by ultrasonic nebulizer, and then samples of peripheral venous blood were collected to measure peripheral cell count and CRP by Enzyme-linked immunosorbent assay (ELISA). Thirty-seven healthy subjects were selected and their blood samples were taken. Thirty-seven healthy subjects were selected and their blood samples were taken. RESULTS: Thirty asthmatic patients in user group (14 females/16 males) with the mean age of 39.4±9.37 years, 31 asthmatic patients in non-user group (13 females/18 males) with the mean age of 35.5±8.87 years, and 37 healthy controls (17 females/20 males) were included in our study. The mean serum concentration of CRP was 2.6 µg/mL, 3.32 µg/mL, and 1.16 µg/mL in user, non-user, and control groups, respectively. Compared to healthy controls, serum concentrations of high sensitivity-CRP (hs-CRP) significantly increased in the non-user group (P=0.0001), and user group as well. (P=0.016). The number of sputum eosinophils and peripheral blood eosinophils significantly increased in the non-users compared to the healthy controls (P=0.0001, P=0.003, respectively). In the non-user group, serum hs-CRP levels correlated negatively with FEV(1) and positively with numbers of sputum eosinophils, which was not statistically significant. Atopy status, age, and sex did not affect hs-CRP levels in both asthmatic groups. CONCLUSIONS: It was found that serum concentrations of hs-CRP significantly increased in asthmatic patients, and in the steroid-native group it partly correlated with FEV(1) and numbers of sputum eosinophils. It suggests that serum hs-CRP can indirectly indicate the degree of airway inflammation.

Lung contusion and cavitation with exudative plural effusion following extracorporeal shock wave lithotripsy in an adult: a case report.

INTRODUCTION: Among the complications of extracorporeal shock wave lithotripsy are perinephric bleeding and hypertension. CASE PRESENTATION: We describe the case of a 31-year-old Asian man with an unusual case of hemoptysis and lung contusion and cavitation with exudative plural effusion due to pulmonary trauma following false positioning of extracorporeal shock wave lithotripsy. Differential diagnoses included pneumonia and pulmonary emboli, but these diagnoses were ruled out by the uniformly negative results of a lung perfusion scan, Doppler ultrasound, and culture of bronchoalveolar lavage and plural effusion, and because our patient showed spontaneous improvement. CONCLUSIONS: False positioning of extracorporeal shock wave lithotripsy can cause lung trauma presenting as pulmonary contusion and cavitation with plural effusion.

Lymphomatoid granulomatosis with splenomegaly and pancytopenia.

Lymphomatoid granulomatosis (LG) is an angiocentric lymphoproliferative disease. It usually involves lung, skin, and central nervous system, but splenomegaly and pancytopenia are the rare manifestations of the disease. We report a 15-year-old boy presented with fever, dry cough and dyspnea from two months ago, after admission patient had nodular lesions on the left leg and hepatosplenomegaly. Then he manifested neurologic signs such as seizure, aphasia and right-sided hemiplegia. Chest X-ray and CT scan revealed bilateral pulmonary nodules predominantly in lower lobes and peripheral lung fields. Laboratory exams showed pancytopenia. Skin biopsy was done, and histopathological examination and immunohistochemistry evaluation confirmed lymphomatoid granulomatosis. He was treated with steroid and cyclophosphamide but succumbed by neurologic involvement.

Evaluation and comparison of respiratory symptoms and lung capacities in tile and ceramic factory workers of Yazd.

Tile workers are exposed to dust particles and are susceptible to multiple pulmonary complications. Problems like asthma, chronic obstructive pulmonary symptoms, and silicosis are more common among them. As there are many tile factories in Yazd, we decided to evaluate the respiratory symptoms and lung capacities in these workers and compare them with controls. This study included 176 tile and ceramic factory workers occupationally exposed to dust and 115 unexposed workers as controls. We recorded the respiratory symptoms using the British Medical Research Council questionnaire and measured lung capacities of the two groups.All study subjects were male, and the two groups were comparable in age and smoking. The exposed group had frequent respiratory symptoms and a significant relationship between them and duration of employment. In addition, lung capacities in ceramic workers with symptoms were lower than in workers without the symptoms. Even though the respiratory symptoms were more frequent in the exposed group than in controls, lung capacities of the two groups were similar.