Evaluation of the effectiveness of Tadalafil on improving pulmonary function and asthma severity in severe asthmatic patients: a randomized controlled trial study

Phosphodiesterase inhibitors elevate the levels of cyclic adenosine monophosphate and cyclic guanosine monophosphate, which have been associated with various anti-inflammatory effects that can help alleviate asthma symptoms. This study aims to assess the impact of Tadalafil, a selective phosphodiesterase inhibitor, on pulmonary function in patients with asthma. This study was a randomized, double-blind clinical trial conducted in 2021 at Imam Khomeini Hospital in Ahvaz, Iran. The study enrolled 44 patients with severe asthma, who were divided equally into a Tadalafil group and a placebo group. The Tadalafil group received 20 mg/day of Tadalafil, while the placebo group received a placebo at the same dose. The patients' spirometry tests, asthma quality of life questionnaire, 6-minute walk distance, and quality of life were measured at the beginning of the study and one month later. The study results indicated that there was no statistically significant difference between the Tadalafil group and the placebo group in terms of pulmonary parameters (p>0.05). Furthermore, the scores for patients' quality of life (p=0.167) and the 6-minute walk test (p=0.148) at the end of the study did not show any statistically significant improvement compared to the placebo group. Results showed that the use of Tadalafil (20 mg) once daily for one month in patients with severe asthma did not affect clinical and laboratory outcomes.

Assessing the prevalence and severity of asthma, rhinitis, and eczema among schoolchildren (6-7 and 13-14 years old) in Khuzestan, Iran: a cross-sectional survey.

BACKGROUND: Asthma and allergic complications are the most common chronic disorders in children and adolescents. This study aimed to determine the prevalence and severity of asthma, allergic rhinitis, eczema among schoolchildren, and some related risk factors. METHODS: The cross-sectional study was performed in 2019 and involved 4000 students aged 6-7 years and 4000 students aged 13-14 years (both girls and boys) from urban schools in Khuzestan Province, southwestern Iran. We used the multi-stage sampling method. Data were collected using the Persian version of the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. RESULTS: The prevalence of current wheeze, wheeze ever and asthma ever in the age group of 6-7 years was 3.8, 4.5, and 1.8%, respectively; in the age group of 13-14 years, it was 4.4, 5.9, and 3.4, respectively. In terms of gender, males (4.9, 6.0, and 2.7 percent, respectively) had substantially higher rates of current wheeze, wheeze ever, and asthma ever compared to the girls (2.8, 3.6, and 2.0 percent, respectively) (p < 0.001). The prevalence of rhinitis, Hay fever, and eczema among young people was 5.3%, 3.5%, and 1.0%, respectively. Current wheeze was more common in children with allergic rhinitis in the last 12 months (30.3% vs. 2.7%, p < 0.001), Hay fever (32.8% vs. 0.3%, p < 0.001) and eczema (27.8% vs 3.8%, p < 0.001), compared to children who did not. CONCLUSIONS: The prevalence and severity of asthma symptoms were significantly associated with allergic rhinitis, eczema, and gender.

The Probable Protective Effect of Photobiomodulation on the Inflammation of the Airway and Lung in COVID-19 Treatment: A Preclinical and Clinical Meta-Analysis.

Preliminary studies also show that many of the fatalities of COVID-19 are due to over-activity of the immune system, and photobiomodulation (PBM) therapy mainly accelerates wound healing and reduces pain and inflammation. Therefore, this systematic review and meta-analysis was conducted to evaluate the probable effect of the PBM therapy on the lung inflammation or ARDS and accelerate the regeneration of the damaged tissue. We systematically searched major indexing databases, including PubMed/Medline, ISI web of science (WOS), Scopus, Embase, and Cochrane central, using standard terms without any language, study region, or type restrictions. Of the 438 studies found through initial searches, 13 met the inclusion criteria. After applying the exclusion criteria, the main properties of 13 articles on 384 animals included in this meta-analysis with a wide range of species include rat (n = 10) and rabbit (n = 3). The analysis revealed that PBM therapy reduced TNFα (SMD:-3.75, 95% CI: -4.49, -3.02, P < 0.00001, I2 = 10%), IL-1ß (SMD:-4.65, 95% CI: -6.15, -3.16, P < 0.00001, I2 = 62%), and IL-6 (SMD:-4.20, 95% CI: -6.42, -1.97, P = 0.0002, I2 = 88%) significantly compared with the model controls. Hence, PBM therapy increased IL-10 significantly compared with the model controls (SMD:-4.65, 95% CI: -6.15, -3.16, P < 0.00001, I2 = 62%). PBM therapy also reduced MPO activity (SMD:-2.13, 95% CI: -3.38, -0.87, P = 0.0009, I2 = 64%) and vascular permeability (SMD:-2.59, 95% CI: -4.40, -0.77, P = 0.0052, I2 = 71%) in the lung using the Evans blue extravasation technique significantly compared with the model controls. This systematic review and meta-analysis revealed that the PBM therapy does utilize beneficial anti-inflammatory effect, modulation of the immune system, lung permeability, or bronchoalveolar lavage on lung damage in both animal models and clinical studies. However, animal model and clinical studies appear limited considering the quality of the included evidences; therefore, large clinical trials are still required.

Efficacy and safety of colchicine treatment in patients with COVID-19: A prospective, multicenter, randomized clinical trial.

Colchicine has shown clinical benefits in the management of COVID-19 via its anti-inflammatory effect. However, the exact role of colchicine in COVID-19 patients is unknown. The current clinical trial was performed on 202 patients with moderate to severe COVID-19. Patients were randomly assigned in a 1:1 ratio to receive up to a 3-day course of 0.5 mg colchicine followed by a 12-day course of 1 mg colchicine in combination with standard care or a 15-day course of standard care. Among 202 randomized patients, 153 completed the study and received colchicine/standard care or continued standard care (M age, 54.72 [SD, 15.03] years; 93 [63.1%] men). On day 14, patients in the colchicine/standard care group had significantly higher odds of a better clinical status distribution on chest CT evaluation (p = .048). Based on NYHA classification, the percentage change of dyspnea on day 14 between groups was statistically significant (p = .026), indicating a mean of 31.94% change in the intervention group when compared with 19.95% in the control group. According to this study, colchicine can improve clinical outcomes and reduce pulmonary infiltration in COVID-19 patients if contraindications and precautions are considered and it is prescribed at the right time and in appropriate cases.

Role of CRP as a marker for discrimination of exudative and transudative pleural effusion.

Differentiation between exudative and transudative pleural effusion is sometime problematic. This study aimed to evaluate the diagnostic value of C-reactive protein (CRP) in differentiation of exudative and transudative pleural effusion. This is an analytical epidemiologic cross-sectional study that evaluates the role of CRP in differentiating transudative and exudative pleural effusion. Patients were divided into two groups of exudates and transudates, based on Light's criteria. The pleural effusion CRP levels were compared between the two groups. SPSS software version 16 was used for statistical analysis. The significance level was considered p<0.05. A total of 169 patients with pleural effusion enrolled in the study. Based on Light's criteria, 108 patients (63.9%) had exudative pleural effusion and 61 (36.1%) had transudative pleural effusion. The level of CRP in the pleural fluid of patients in the exudative and transudative groups was 13.3±37.1 and 3.5±4.3mg/dl, respectively (p=0.008). The 3.31 mg/dl cut-off point of CRP level of pleural effusion had the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 96.3%, 72.1%, 86% and 91.7% respectively.  The results obtained in our study shows that the level of CRP in the effusion fluid can be helpful in differentiating exudative from transudative pleural effusions.

Physiological equivalent temperature (PET) and non-accidental, cardiovascular and respiratory disease mortality in Ahvaz, Iran.

Climate change may be associated with human morbidity and mortality through direct and indirect effects. Ahvaz is one of the hottest cities in the world. The aim of this study was to investigate the relation between physiological Equivalent Temperature (PET) and non-accidental, cardiovascular and respiratory disease mortality in Ahvaz, Iran. Distributed Lag Non-linear Models (DLNM) combined with quasi-Poisson regression were used to investigate the effect of PET on death. The effect of time trend, air pollutants (NO2, SO2 and PM10), and weekdays were adjusted.The results showed that in cold stress [1st percentile of PET (2.7 °C) relative to 25th percentile (11.9 °C)] the risk of total respiratory mortality, respiratory mortality in men, and mortality in people under 65 year olds, significantly decreased in the cumulative lags of 0-2, 0-6 and 0-13; but the risk of respiratory mortality increased in the elderly and in the final lags. In contrast, heat stress [99th percentile of PET (44.9 °C) relative to 75th percentile (43.4 °C)] significantly increased the risk of total cardiovascular mortality (CVD), cardiovascular mortality in men, ischemic heart disease and cerebrovascular disease mortality in lags 0 and 0-2. It seems that high PET values increase the risk of cardiovascular mortality, while low PET values increase respiratory mortality only among the elderly in Ahvaz.

A study to design minimum data set of COVID-19 registry system.

BACKGROUND: From the beginning of the COVID-19 pandemic, the development of infrastructures to record, collect and report COVID-19 data has become a fundamental necessity in the world. The disease registry system can help build an infrastructure to collect data systematically. The study aimed to design a minimum data set for the COVID-19 registry system. METHODS: A qualitative study to design an MDS for the COVID-19 registry system was performed in five phases at Ahvaz University of Medical Sciences in Khuzestan Province in southwestern Iran, 2020-2021. In the first phase, assessing the information requirements was performed for the COVID-19 registry system. Data elements were identified in the second phase. In the third phase, the MDS was selected, and in the four phases, the COVID-19 registry system was implemented as a pilot study to test the MDS. Finally, based on the experiences gained from the COVID-19 registry system implementation, the MDS were evaluated, and corrections were made. RESULTS: MDS of the COVID-19 registry system contains eight top groups including administrative (34 data elements), disease exposure (61 data elements), medical history and physical examination (138 data elements), findings of clinical diagnostic tests (101 data elements), disease progress and outcome of treatment (55 data elements), medical diagnosis and cause of death (12 data elements), follow-up (14 data elements), and COVID-19 vaccination (19 data elements) data, respectively. CONCLUSION: Creating a standard and comprehensive MDS can help to design any national data dictionary for COVID-19 and improve the quality of COVID-19 data.

Diagnostic sensitivity of impulse oscillometry in early detection of patients exposed to risk factors chronic obstructive pulmonary diseases.

Background: Impulse oscillometry (IOS) is a method that does not depend on the cooperation of the patient and can detect small airway diseases with higher sensitivity than spirometry. However, the clinical application value of IOS in the screening of patients exposed to risk factors COPD and early diagnosis remains unclear. The aim of this study is to evaluate diagnostic sensitivity of IOS in the early detection of patients exposed to risk factors COPD. Methods: A prospective cross-sectional study was conducted in Rasoul Akram Hospital, Tehran, Iran, from 2013 to 2015. 28 patients with COPD risk factors and normal spirometry participated in the study. The IOS was performed. We obtained the respiratory resistance and impedance of 5 Hz (R5) and 20 Hz (R20) and 5 Hz (Z5), respectively. The data were analyzed using SPSS version 17 using Chi-square and two independent sample t-test. Spearman correlation test was used to measure the correlation of oscillometry parameters in the diagnosis of COPD. P-value <0.05 was considered significantfor all statistical analyses. Results: The mean patient age was 55.50±11.27 years. In this study, the sensitivity of Z5, R5, and R20 was respectively 28.5%, 25%, and 31.5%. All oscillometry parameters were significantly correlated with each other but none of the oscillometry parameters showed significant correlations with FEV1/FVC (rZ5=0.018, rR5=0.082, rR20=0.041 and PZ5=0.932, PR5=0.711, P R20=0.850). According to the results, only 9 patients (32.5%) with normal values of FEV1/FVC had abnormal values of oscillometry. Conclusion: IOS has a low sensitivity and cannot be used in the screening of early-stage chronic obstructive pulmonary disease.

Cohort profile: The Hoveyzeh Cohort Study (HCS): A prospective population-based study on non-communicable diseases in an Arab community of Southwest Iran.

Background: The Hoveyzeh cohort study (HCS) is a population-based cohort study that conducted in Hoveyzeh County (South-west Iran). HCS focus on common chronic diseases, disorders and risk factors of NCDs in the Arab ethnicity. Methods: A total number of 10009 participants (35-70 years old) were recruited in this prospective cohort study from May 2016 to August 2018. The HCS data were gathered by trained interviewer through interviewer-administered questionnaires. Also anthropometric measurements, physical examinations, clinical assessments, ophthalmology evaluation, auditory examinations, respiratory and cardiovascular assessments was conducted by means of standard instruments. Biological samples including blood, urine, hair, and nail collected and stored in the biobank. Results: The overall participation rate was 82.7%. The prevalence of obesity was 27.4% in males and 47% in females. Cigarette smoking prevalence was 20.9% (40.6 % in men and 7.6 % in women). Prevalence of major non communicable diseases such as diabetes, hypertension, metabolic syndrome, cardiac ischemic, myocardial infarction and stroke was 22.2%, 26.4% 31.9 %, 13.6%, 1.85% and 1.6% respectively. Conclusion: Considering the high prevalence of obesity and smoking in the population of Hoveyzeh and since the important role of these risk factors in development of common non communicable diseases, this issue should be taken into consideration and the necessary interventions in this context must be considered to modify lifestyle. The HCS is the only comprehensive cohort in the region, enabling it to provide valuable evidence about NCDs for a wide geographical area covering millions of people in both Iran and Iraq.

Prevalence of asthma and other allergic conditions in adults in Khuzestan, southwest Iran, 2018.

BACKGROUND: Health information on the dimensions of asthma and allergic conditions in Khuzestan Province, as a major industrial and polluted area in Iran as and the Middle East, is inadequate. This study was performed to measure the prevalence of asthma and other allergic conditions in adults in Khuzestan Province. METHODS: This population-based cross-sectional study was carried out in 17 villages and 27 cities of Khuzestan Province during the years 2017-2018 on 20 to 65 year old respondents. Two-stage cluster sampling was used. The ECRHS (European Community Respiratory Health Survey) questionnaire was completed for individuals with additional questions regarding other allergic conditions. RESULTS: In the study, 5720 questionnaires were distributed of which 5708 were returned. The prevalence of current asthma was 8.5% and that of asthma-like symptoms was 19.0%. The most common symptoms of asthma were nocturnal cough (13.6%), chest tightness (12.3%) and wheezing (13.1%). The prevalence of allergic rhinitis (AR), eczema and airway hyperresponsiveness were 27.2, 10.7, and 38.7%, respectively. The prevalence of current asthma was strongly correlated with age, current location (city, village), and the smoking status of respondents (p < 0.05). CONCLUSION: The prevalence of current asthma and asthma-like symptoms in Khuzestan Province is almost twice as high as in Iran. Given the high prevalence of symptoms of airway hyperresponsiveness in the entire province, it is necessary to take environmental measures to mitigate the emergence of new cases of asthma among the residents. In addition, surveillance studies are necessary to monitor the trends in the prevalence of asthma in this province.

The effects of inhaled corticosteroid on insulin sensitivity in asthmatic patients.

Asthma is an inflammatory disease, which causes airflow limitation and increase insulin resistance. The present study was carried out in order to investigate insulin resistance and the effect of inhaled corticosteroid (ICS) on insulin sensitivity in asthmatic patients. A registered (IRCT201605247411N2) interventional, quasi-experimental trial was performed from 2014 to 2015 in Imam Khomeini hospital Ahvaz, Iran. Patients with mild to moderate asthma participated in this study. Spirometry, fasting blood sugar (FBS), blood sugar 2 hour post prandial (BS2HPP), HbA1C, low density lipoprotein (LDL), high density lipoprotein (HDL), Insulin Level, and C reactive protein (CRP) were measured. Then Homeostatic Model Assessment-Insulin Resistance [HOMA-IR] Index calculated. Data were analyzed using paired t-test and McNemar's test using SPSS 20.0 Software. The study consisted of 35 non-diabetic patients suffering from asthma (20 men and 15 women) with a mean age of 36.6 ±12.3 years. Inhaled corticosteroid had a significant effect on spirometric parameters, but it had no significant effect on other variables. At baseline, mean HbA1C, insulin level and HOMA-IR were 5.5%, 10.9 mIU/L and 2.7 respectively. None of these values changed significantly after treatment with inhaled corticosteroid for two months. The results indicated that there is no relationship between ICS and increased insulin resistance in asthmatic patients.

Association of esophageal dilatation in chest CT scan with gastroesophageal reflux disease: A case control study.

The presence of increased air bubble in the lumina of esophagus on a chest CT scan may be associated with esophageal disorders. The purpose of this study was to determine the association between the appearance of air bubbles on chest CT scan and gastroesophageal Reflux Disease (GERD). In this case-control study, thirty-two patients with endoscopically proved GERD and 32 subjects without GERD underwent chest computed tomography (CT) scanning. Esophageal dilatation (ED) was defined as the presence of air bubbles greater than 10 mm in the supra ventricle (SV) and ventricle (CV), and air bubbles >15 mm in the ventricle to the lower esophageal sphincter (V-LES). The results were compared between the two groups. The GERD patients included 16 (50%) males with a mean age of 58.5±11.2 years and the control group included 17 (54.8%) males and 14 (45.1%) females with a mean age of 66.7±10.5 years. There was a significant relationship between the presence of GERD and esophageal dilation (ED) in the V-LES sections on the CT scan (P=0.002). The mean size of the air bubbles in the V-LES section was 11.73 mm in the case group in comparison to 4.32 mm in the control group (P<0.001).  The size and location of the air bubbles in the esophagus can vary and be important. The possibility of GERD increases in the presence of esophageal dilation on CT scan.

Overuse and underuse of pulmonary CT angiography in patients with suspected pulmonary embolism.

Background: The aim of the present study was to evaluate the utilization and diagnostic yields of CT pulmonary angiography (CTPA)using the Revised Geneva score and Wells' criteria, in patients with suspected pulmonary embolism (PE). Methods: One hundred and twelve adult patients underwent CTPA for suspected PE were participated in this study. The outcome was positive or negative CTPA for PE. Revised Geneva and Wells' scores were calculated. The relationship between the results obtained rom these two scores and the available risk factors were compared. Descriptive analysis such as frequency and mean as well as analytical statistics including chi-square were done. The data analysis was performed using SPSS (v. 22). Results: In this study, according to the Wells' criteria calculated for the patients, 33.9% of the patients had low clinical, 56.3% intermediate and 9.8% high clinical probability. Among the 11 high clinical patients, 9(81.8%) were CTPA positive. Based on the revised Geneva score, 65 patients (58%) had low clinical, 36 (32.1%) intermediate and 11(9.8%) high clinical probability. Among the 1 high clinical patients, 8 were CTPA positive. Positive predictive value of the low clinical patients based on Wells' criteria and the revised Geneva score was 18.4% and 30.8%, respectively. Also, positive predictive value for high clinical probability of Wells' criteria and the revised Geneva score was 81.8% and 72.8% respectively. Conclusion: Under/overuse of CTPA in diagnosing PTE is a common problem especially in university hospitals. It is possible to avoid unnecessary CTPA requests using scholarly investigations and more accurate clinical risk assessments.

Pulmonary Function Tests in Thunderstorm-associated Respiratory Symptoms: A Cross-sectional Study.

Background: Epidemic thunderstorm asthma is an observed increase in cases of acute bronchospasm following thunderstorms. This study aimed to compare the frequency of obstructive airway disease or bronchial hyperresponsiveness in subjects with thunderstorm-associated respiratory symptoms with subjects with similar symptoms presented at other times. Methods: A cross-sectional study from June to November of 2013 was conducted on subjects with thunderstorm-associated respiratory symptoms living in Ahvaz City, Iran. Thunderstorm-associated subjects were presented with asthmatic symptoms in thunderstorms, and other patients presented with similar symptoms at other times. Baseline spirometry was performed on patients to examine the presence of obstructive airway disease. In all patients with normal spirometry, a provocation test was applied. A comparison of qualitative and quantitative variables was made using the Chi-square and independent t test, respectively. All analyses were carried out using SPSS Statistics Version 22. A P value less than 0.05 was considered statistically significant. Results: Out of 584 subjects, 300 and 284 participants were in thunderstorm-associated and non-thunderstorm-associated groups, respectively. After the final analysis, 87 (30.6%) and 89 (33.3%) of the thunderstorm-associated subjects and non-thunderstorm-associated group, respectively, had pieces of evidence of airflow limitation (P=0.27). Among the patients with normal spirometry, 161 (81.72%) of the thunderstorm-associated patients and 100 (56.17%) patients of the non-thunderstorm-associated symptoms group had a positive methacholine challenge test result (P<0.001). Conclusion: Most of the patients with thunderstorm-associated respiratory symptoms had no obvious evidence of airflow limitation in spirometry.

The Efficacy of Daily Administration of Nebulized Heparin on the Prevention of Endotracheal Tube Blockage in Patients With Pneumonia.

OBJECTIVE: Nosocomial infections pose a significant public health concern, impacting over 100 million people worldwide annually. Within this research, we investigated heparin nebulization through the endotracheal tube and its effect on preventing blockage due to clots and mucus plugs compared to normal saline. METHODS: A double-blind clinical experiment was done on a cohort of 40 pneumonia patients who were intubated and hospitalized in the intensive care unit (ICU) at Imam Khomeini Hospital in Ahvaz, Iran. The individuals were randomly assigned to two groups of 20 patients using a random allocation technique. The initial cohort was administered 5000 IU of heparin diluted in 4 ccs of 0.9% normal saline every eight hours via a nebulizer through a tracheal tube. In contrast, the second cohort was given 5 ccs of normal saline as a nebulizer through a tracheal tube. The study compared the incidence of tracheal tube obstruction caused by mucus plug or clot, the occurrence of patient hypoxia resulting in emergency tracheal tube replacement, and the frequency of emergency tracheal tube suction due to partial obstruction caused by mucus plug in both the heparin and saline groups. RESULTS: According to our data, the number of patients in the heparin group who could avoid the need for emergency tracheal tube replacement owing to blockage was more significant than in the ordinary saline group (P=0.013). Heparin was significantly correlated with the number of times emergency suction was required to remove a tracheal tube occlusion (P=0.01). Heparin had no significant effect on coagulation factors (international normalized ratio [INR], platelet [PLT], and partial thromboplastin time [PTT]), Acute Physiology and Chronic Health Evaluation (APACHE) score, pneumonia severity index (PSI), saturation of patients, or tracheal tube secretions. There was no statistically significant difference in total time spent in the intensive care unit (P=0.91). CONCLUSIONS: Further studies are suggested to determine the effect of heparin nebulization on preventing endotracheal tube obstruction due to clots and mucus plugs in intubated ICU patients.

Effect of Zafirlukast on improving lung function in patients with chronic obstructive pulmonary diseases.

BACKGROUND: There is little evidence about the role of Zafirlukast (a highly selective LTD4 antagonist) in Chronic Obstructive Pulmonary Disease (COPD). The Zafirlukast can reduce the need for short-acting rescue ß2 agonists, produce fewer exacerbations of asthma and increased quality of life as possible benefits treatment for asthma. The aim of our study was to evaluate the effects of Zafirlukast improvement of lung function in patients with COPD. METHODS: Twenty five patients with moderate to severe COPD, in stable phase of the disease, participated in this interventional, quasi-experimental study. All patients were received 40mg oral Zafirlukast per day for 2 weeks. Pulmonary function Test was performed both at the baseline and at the end of the study. Data were analyzed with paired t-test using SPSS v.16. RESULTS: The mean age of the patients was 67.29 (SD=5.56) years with the mean baseline for forced expiratory volume in first second (FEV1) equal to 41.79% (SD=14.96) of predicted value. After 2 weeks, the mean improvements in forced vital capacity (FVC), FEV1 and FEV1/FVC were 4.75% (SD=13.18), 3.71% (SD=9.19) and 9.33(SD=27.08), respectively. Zafirlukast produced a non-significant (p>0.05) bronchodilation, with maximum mean increase in FEV1 of 0.04 lit (3%) above baseline. CONCLUSION: Results showed that Zafirlukast has no considerable bronchodilatory effect in COPD. Present study consisted of a very short treatment period and it is possible that the extension of this period could possibly have more effects. Additional larger studies are needed to verify the impact of leukoterien receptor antagonists on improving the lung function in COPD patients.

Demographic features, laboratory findings and outcomes of ICU patients with COVID-19 in Ahvaz, Iran: A single-centered prospective study.

Background: COVID-19 can lead to severe acute respiratory syndrome so that some patients need to be admitted to the Intensive Care Unit (ICU). The aim of the current study is to investigate the frequency of demographic, laboratory and imaging findings and type of treatment and their relationship with disease outcomes in patients with COVID-19. Material and Methods: This prospective cross-sectional study was conducted on all patients with COVID-19 who were admitted in the ICU of Razi Hospital in Ahvaz, Iran from January 20 to February 20, 2021. Patient information including demographic features, laboratory and imaging findings and clinical outcomes was recorded. Results: One hundred and thirty-three patients were recruited in the present study, out of which 74 patients (55.6%) were males and 59 patients (44.4%) were females. The overall mortality rate of patients was 35.3% (47 patients) and was higher in patients over 65 years of age. There was a significant difference in terms of thrombocytopenia (P value: 0.001), lymphopenia (P value: 0.004), progression of lung involvement in imaging, shock, disseminated intravascular coagulation (DIC), sepsis and receiving invasive respiratory support in living and deceased patients (P value < 0.001). Furthermore, the difference in life status and the length of in-ICU stay in patients with hyperkalemia and renal failure was statistically significant (P value = 0.033, P value < 0.001 respectively). Conclusion: Mortality rate of patients with COVID- 19 admitted to ICU is generally high. According to the findings of this study, thrombocytopenia, lymphopenia, hyperkalemia and AKI are laboratory disorders associated with increased mortality. Moreover, the progression of pulmonary involvement in imaging, shock, DIC, sepsis, and need to invasive respiratory support is associated with low survival of patients.

Air column in esophagus and symptoms of gastroesophageal reflux disease.

BACKGROUND: During imaging of the normal esophagus, air is often detected. The purpose of this study was to determine the correlation between the appearance of air bubbles on imaging and Gastroesophageal Reflux Disease (GERD) symptoms. METHODS: The cross-sectional imaging study was conducted at Rasole Akram Hospital, Tehran, Iran. A total of 44 patients underwent X-ray computed tomography (CT) scanning; the presence of air in the esophagus and visible on CT imaging was scrutinized. RESULTS: The average age of the subjects was 59 and the male to female ratio was 0.83. We found a significant relationship between the presence of GERD symptoms, the size of air bubbles and esophageal dilation (ED) on the CT scan. CONCLUSIONS: Air bubbles in the esophagus may be seen frequently in CT scans, but their size and location can vary. The GERD symptoms can arise when a small diameter air column is present within the esophagus, especially in the middle and lower parts.

Investigation of asbestos concentration in ambient and lavage fluids of patients referred for bronchoscopy, Ahvaz.

Introduction: The amount of fibers in the lungs is considered to reflect the cumulative intensity of past asbestos exposure, and bronchoalveolar lavage (BAL) has been proposed to be a good indicator of the presence and quantity of asbestos particles in the lungs. This study evaluated the asbestos concentration in BAL fluids of asbestos-exposed and unexposed pulmonary patients and the environment of Ahvaz city. Methods: This prospective study was conducted on 80 patients underwent diagnostic fiberoptic bronchoscopy referred to Imam Khomeini Hospital in Ahvaz, Iran, in 2019. Patients with Lung diseases were divided into three groups based on CT scan results: normal (n = 32), lung cancer (n = 40) and Interstitial lung disease (n = 8). The analysis of asbestos fiber concentration in BAL fluid was carried out by Scanning Electron Microscope (SEM). Results: The positive asbestos test was detected in 69% of all subjects, including 64% of whom had asbestos-related jobs and 74.5% of those with non-related jobs (p = 0.240). The concentrations of asbestos fiber in the BAL in normal patients, lung cancer and interstitial fibrosis (ILD) were 8.13 ± 5.38, 9.66 ± 7.30 and 6.31 ± 1.98 f/ml, respectively (P = 0.492). There was no significant difference between the asbestos levels and exposure history (P = 0.877). The mean concentration of asbestos in the ambient air during the current year was 2.69 ± 0.57 f/ml (2.26-3.70), and the correlation between asbestos levels in BAL and the air was not significant (r = 0.147; P = 0.243). Conclusions: The exposure of different occupational and non-occupational groups to this carcinogenic substance indicates the need for environmental and individual control measures to reduce and prevent asbestos exposure.

The comparison of the mortality rates of plasmapheresis/hemoperfusion therapy with current treatment among Covid-19 patients.

Background: There is no definitive treatment for COVID-19. Hemoperfusion and plasmapheresis have only been studied in a few cases of COVID-19. In this study, plasmapheresis-hemoperfusion and current treatment for COVID-19 patients were compared for mortality. Methods: In this cross-sectional study, 103 patients with COVID-19 underwent hemoperfusion, plasmapheresis, and conventional medical treatment in educational hospitals in Ahvaz, Iran. A census method was used to include the patients in the study. The data from the hospital file were used to complete a checklist containing demographic information, clinical findings, and paraclinical findings for all patients. Results: There was not a statistically significant difference (P-value = 0.051) between the plasmapheresis group (78.8%), the hemoperfusion group (71.9%), and the current treatment group (52.6%) in mortality rates. Hemoperfusion had a median survival time of 18.9 days, plasmapheresis had a median survival time of 16.9 days, and current treatment had a median survival time of 13.5 days. In terms of patient survival time, there was no significant difference (P-value = 0.181). Multiple regression results showed that death rates in the hemoperfusion (P = 0.393) and plasmapheresis (P = 0.073) groups were not statistically different from those in the current treatment group. Conclusion: As a result of this study, there were no differences between the treatment groups in regard to death rates or patient survival times.