Demographic and clinical characteristics of patients with interstitial lung disease admitted to Razi Hospital, the North of Iran

Respiratory disease is the third cause of death, which accounts for one-seventh of all deaths worldwide and millions of people suffer from chronic lung disease in the world. Interstitial lung diseases (ILDs) are one of the most important lung diseases. So, we aimed to evaluate demographic data and clinical characteristics of ILD patients in our region. This cross-sectional descriptive study was conducted on patients diagnosed with ILD who were referred to Razi Hospital, Rasht, Iran during 2013-2018. Out of a total of 300 participants, 160 (53.3%) patients were non-occupational exposed. The most prevalent clinical symptoms and signs were coughs, dyspnea, and abnormal findings in lung auscultation. Totally, 113 (37.7%) of patients mostly consumed methotrexate. Among 158 patients with reported antinuclear antibody (ANA) status, 29 (18.4%) cases were positive. In 186 (71.3%) cases with available pathological findings, alveolar wall thickening, fibroblast deposition, and honeycomb pattern was reported. Also, granulomatous lung tissue and diffuse fibrosis were detected in 58 (22.2%) patients.  ILD patients with different clinical conditions may show regional differences in risk factors, patient exposure, access to medical facilities for diagnosis and treatment, and genetic differences, which require careful attention to these factors individually in each region.

Evaluation of Lung Function Tests in the Follow-up of COVID-19 Patients Discharged From Razi Hospital in Rasht, Iran

Background: The COVID-19 pandemic has been a significant concern for the global health community since its onset. This study aimed to evaluate lung function tests in the follow-up of COVID-19 patients discharged from Razi Hospital in Rasht, Iran, in 2020. Materials and Methods: This cross-sectional study evaluated lung functional tests, including spirometry and the six-minute walking test (6MWT), in the follow-up of 239 hospitalized COVID-19 cases. All demographical and clinical data, along with the lung performance test results of the patients, were recorded, and statistical data were analyzed using SPSS, version 24. Results: The mean age of the patients was 51.69±13.98 years, and most of them were females. About 60.25% of patients had underlying diseases. The frequency of positive 6 MWT tests during the first three, six, and nine months after discharge was 7.96%, 8.70%, and 14.29%, respectively. In the first trimester after discharge, the 6MWT test was more positive among females. In addition, forced expiratory volume (FEV1)/forced vital capacity (FVC) showed a significant positive relationship with diastolic blood pressure (DBP) and heart rate (HR). After six months, positive 6MWT results were significantly associated with older ages and underlying diseases. The amount of FVC was positively associated with DBP, distance traveled in the 6MWT test, and HR, but it was negatively related to age. Conclusion: The findings revealed that older age, female gender, and underlying diseases were associated with positive 6MWT results, decreased pulmonary function, and higher DBP and HR

Clinical characteristics and outcomes of COVID-19 patients with a history of cardiovascular disease

New emerging severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) primarily affects the lungs, but the virus may cause cardiovascular disease (CVD), and a history of CVD is usually associated with comorbidities, which could increase the severity of infections. In this study, we collected demographic and clinical characteristics data from 123 patients with a history of CVD, who were confirmed to have SARS-CoV-2 infection by polymerase chain reaction (PCR) test in Razi Hospital, Rasht, Iran, from March 2021 to June 2021. Chi-Square and Fisher's Exact test with a significance level of P less than 0.05 was performed. All statistical analysis was performed with SPSS software version 26.0. Among the studied patients, 99 patients were discharged and 24 of them died. 62 (50.4%) of the study population were female and 61 (49.6%) were male, and there is no significant association between gender and the outcome of patients (P = 0.159). The total mean age of patients was 68.35±12.41. Statistical analysis has represented a significant relation of death outcomes in CVD patients with age 60 years and older (P = 0.001), in comparison with patients younger than 60 years. In this present study, no significant relation between underlying disease and mortality rate was reported, but in COVID-19 patients with a history of CVD and age upper than 60 years, death outcome was more probable

Fetal pulmonary fibrosis due to Hermanski-Pudlak syndrome (HPS): a rare case report with open lung biopsy findings

Hermanski-Pudlak Syndrome (HPS) is an extremely rare autosomal recessive disorder. Albinism, bleeding diathesis and other associated complications are the main manifestations of HSP. Here we report a 56-year-old woman who was referred with gradually increasing dyspnea. She had a past history of coughing, epistaxis, gums bleeding, easy bruising and severe sunburn in normal sun exposure. Her blood oxygen saturation was 87% in room air. Physical examination revealed oculocutaneous albinism, strabismus, horizontal nystagmus and fine inspiratory crackle. Laboratory studies showed prolonged partial thromboplastin time and PaO2 value of 39 mmHg. There was a reticulonodular pattern in chest radiography. Open lung biopsy confirmed the diagnosis of pulmonary fibrosis. Although the patient had been treated with Pirfenidone, she died because of respiratory failure. Although HPS is a rare syndrome, finding more about the pathophysiology of HPS and also developing new methods of treatment is indisputable

Is latent tuberculosis infection challenging in Iranian health care workers? A systematic review and meta-analysis.

BACKGROUND:The high chances of getting latent tuberculosis infection (LTBI) among health care workers (HCWs) will an enormous problem in low and upper-middle-income countries. METHOD:Search strategies were done through both national and international databases include SID, Barakat knowledge network system, Irandoc, Magiran, Iranian national library, web of science, Scopus, PubMed/MEDLINE, OVID, EMBASE, the Cochrane library, and Google Scholar search engine. The Persian and the English languages were used as the filter in national and international databases, respectively. Medical Subject Headings (MeSH) terms was used to controlling comprehensive vocabulary. The search terms were conducted without time limitation till January 01, 2019. RESULTS:The prevalence of LTBI in Iranian's HCWs, based on the PPD test was 27.13% [CI95%: 18.64-37.7]. The highest prevalence of LTBI in Iranian's HCWs were estimated 41.4% [CI95%: 25.4-59.5] in the north, and 33.8% [CI95%: 21.1-49.3] in the west. The lowest prevalence of LTBI was evaluated 18.2% [CI95%: 3.4-58.2] in the south of Iran. The prevalence of LTBI in Iranian's HCWs who had work-experience more than 20 years old were estimated 20.49% [CI95%: 11-34.97]. In the PPD test, the prevalence of LTBI in Iranian's HCWs who had received the Bacille Calmette-Guérin (BCG) was estimated 15% [CI95%: 3.6-47.73]. While, in the QFT, the prevalence of LTBI in Iranian's HCWs in non-vaccinated was estimated 25.71% [CI95%: 13.96-42.49]. CONCLUSIONS:This meta-analysis shows the highest prevalence of LTBI in Iranian's HCWs in the north and the west probably due to neighboring countries like Azerbaijan and Iraq, respectively. It seems that Iranian's HCWs have not received the necessary training to prevent of TB. We also found that BCG was not able to protect Iranian's HCWs from TB infections, completely

Spontaneous tension pneumomediastinum with pneumothorax and subcutaneous emphysema as a complication of COVID‐19 disease

Key Clinical Message Recently spontaneous tension pneumomediastinum (STM), were reported as infrequent complications in coronavirus disease 2019 (COVID‐19) patients but pneumothorax (PT), and subcutaneous emphysema (SE) are more frequently seen in COVID‐19 patients. PT and SE may present after PTM in COVID‐19. The aim of this presentation is to show the complications of STM in an Iranian patients with COVID‐19 disease with PT and SE, who were hospitalized in Arya hospital, Rasht, Iran. For 3 months, we followed these patients and their condition was good. STM are uncommon complications in COVID‐19 patients and were reported frequently in male patients. Early diagnosis and treatment could save the patients as these complications are related to poor prognosis and prolonged hospitalization. Patients with mild COVID‐19 and mild pulmonary damage may have a favorable outcome

The association between subclinical hypothyroidism and exacerbation in patients with chronic obstructive pulmonary disease

This study aimed to investigate the association between subclinical hypothyroidism and exacerbation in patients with chronic obstructive pulmonary disease (COPD). This descriptive-analytical study was performed on patients with COPD that were diagnosed by spirometry and GOLD guides. A modified medical research council (mMRC) questionnaire was also used for grading dyspnea. The severity of the disease was determined according to the GOLD criteria. Patients were divided into mild, moderate, severe, and very severe COPD. Then, the patients were included in high-risk (C and D) and low-risk (A and B) groups. Thyroid-stimulating hormone (TSH), free thyroxine, triiodothyronine (T3), and T3 resin uptake tests were assessed. Out of 119 patients with COPD, about 74.8% were males and 25.2% were females. Overall, 50.4% of participants were in an exacerbation state and 49.6% were stable. A significant association was reported between the number and years of cigarette smoking and the exacerbation of COPD (P0.05). There was a significant association between severity in exacerbation and stable groups (P 0.05). The frequency of dyspnea grade with high mMRC scores in the exacerbation group was higher than in the stable group. The mean difference in FEV1, FVC, FEV1/FVC, and T3 variables was significant between the two studied groups. There was a significant difference between the variables of "one-year hospitalization", "one-year exacerbation" and "duration of illness" among the two groups of stable and exacerbation (P0.05). It’s suggested that the mean level of T3 could be used in the future to predict disease exacerbation in COPD.

Clinical characteristics and laboratory findings of patients with COVID-19 in Rasht, Iran

In December 2019, an epidemic of an unknown respiratory virus emerged in Wuhan, China, and put the whole world in crisis; a newly emerged coronavirus, called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We aimed to evaluate epidemiological and clinical characteristics of coronavirus disease 2019 (COVID-19) patients in the North of Iran. We extracted demographics and baseline clinical characteristics from 126 patients with polymerase chain reaction (PCR) confirmed COVID-19 in Razi Hospital, Rasht, Iran. The mean age of patients was 62 years, ranging from 28 to 92 years old. Overall, 57.1% of cases were male and 42.9% were female. Totally, 17.5% of patients had direct contact with a SARS-CoV-2 infected patient. The most common underlying diseases were diabetes (11.9%) and cardiovascular disease (CVD) (7.1%). The mean±SD of lactate dehydrogenase (LDH), creatine phosphokinase (CPK), creatine kinase MB (CK-MB), serum glutamic oxaloacetic transaminase (SGOT), and erythrocyte sedimentation rate (ESR) were remarkably higher than the normal range, (1231±866.4 U/L, 766.8±2288.6 U/L, 59.28±55.1 U/L, 112.28±213 U/L and 67.61±31 mm/hr), respectively. Also, the average O2 Saturation (O2Sat) was 61.4±26.3%. Male gender, advanced age, a higher level of the cardiac enzyme, and a lower level of O2Sat are associated with severity in COVID-19 patients.

Incidence of symptomatic venous thromboembolism following hospitalization for coronavirus disease 2019: Prospective results from a multi-center study

BACKGROUND Thrombosis and pulmonary embolism appear to be major causes of mortality in hospitalized coronavirus disease 2019 (COVID-19) patients. However, few studies have focused on the incidence of venous thromboembolism (VTE) after hospitalization for COVID-19. METHODS In this multi-center study, we followed 1529 COVID-19 patients for at least 45 days after hospital discharge, who underwent routine telephone follow-up. In case of signs or symptoms of pulmonary embolism (PE) or deep vein thrombosis (DVT), they were invited for an in-hospital visit with a pulmonologist. The primary outcome was symptomatic VTE within 45 days of hospital discharge. RESULTS Of 1529 COVID-19 patients discharged from hospital, a total of 228 (14.9%) reported potential signs or symptoms of PE or DVT and were seen for an in-hospital visit. Of these, 13 and 12 received Doppler ultrasounds or pulmonary CT angiography, respectively, of whom only one patient was diagnosed with symptomatic PE. Of 51 (3.3%) patients who died after discharge, two deaths were attributed to VTE corresponding to a 45-day cumulative rate of symptomatic VTE of 0.2% (95%CI 0.1%-0.6%; n = 3). There was no evidence of acute respiratory distress syndrome (ARDS) in these patients. Other deaths after hospital discharge included myocardial infarction (n = 13), heart failure (n = 9), and stroke (n = 9). CONCLUSIONS We did not observe a high rate of symptomatic VTE in COVID-19 patients after hospital discharge. Routine extended thromboprophylaxis after hospitalization for COVID-19 may not have a net clinical benefit. Randomized trials may be warranted