Comparison of Predictor of Desaturation Disorders and Daytime Sleepiness Based On Epworth Sleepiness Scale and STOP-BANG Questionnaires in Mild to Moderate Obstructive Sleep Apnea Patients

BACKGROUND: Obstructive sleep apnea (OSA) is characterised by recurrence in upper airway obstruction during sleep. AIM: This study aimed to compare the predictive values of the Epworth Sleepiness Scale (ESS) and STOP-BANG in the desaturation of patients with mild to moderate obstructive apnea based on the apnea-hypopnea index (AHI) scale. METHODS: A group of 79 patients (43 male and 36 female) were selected. The suspected patients were introduced to the sleep clinic, and the ESS and STOP-BANG questionnaires were filled up, then subjected to polysomnography test, and the scores of the disease were also determined based on an apnoea-hypopnoea index (AHI). Finally, the desaturation rate (SO2 < 3% based on the baseline) and desaturation index were determined in patients. Consequently, the finding was compared with the results of the questionnaires. RESULTS: Patients with STOP-BANG score above 3 had significantly higher weight, oxygen desaturation index (ODI) index and average desatu, while peripheral capillary oxygen saturation (SpO2) base and average SpO2 were lower than those with scores below 3 (P < 0.05). However, there was no significant difference between the patients with the ESS questionnaire score above 10 and below 10 (P > 0.05). CONCLUSION: The results of these two questionnaires reflect the unsaturated oxygen index in the blood, and can be considered for the evaluation of the severity of the disease

Quality evaluation of groundwater resources of Ardabil aquifer for agricultural and drinking uses

In this study, groundwater of Ardabil aquifer quality in terms of drinking and agricultural, was evaluated. For this purpose, 76 wells including 32 drinking wells and 44 agricultural wells were considered. The results indicated that groundwater quality on the Water Quality Index (WQI) is in good condition. Based on the standards of the World Health Organization (WHO) and Institute of Standard and Industrial Research of Iran (ISIRI), 10.5 percent of the wells have nitrate levels above the limit in the wet season; but in the dry season, about 29 percent of the wells had nitrate values higher than allowable level. In order to assess the quality of groundwater for agricultural use, as well as the Wilcox diagram and other parameters of sedimentation and corrosion including: Langelier saturation index (LSI), Ryznar Index (RSI) and Puckorius (POR), magnesium hazard (MH), permeability (I), the remaining sodium percentage (RSC), sodium adsorption ratio (SAR) and the percentage of sodium and chlorine were used. The results showed groundwater of this aquifer are corrosive and use it in urban water supply systems, causing illness and various problems caused by corrosion of pipes and the, the human will. The use of these waters, for agricultural purposes will cause problems in metal fittings of sprinkler irrigation systems

Sensitivity And Specificity of FEF25–75/Forced Vital Capacity for Diagnosing Restrictive Lung Disease

Introduction and objective: The role of spirometry in the diagnosis of restrictive lung diseases is unclear. This study investigated the sensitivity and specificity of the forced expiratory flow 25–75 (FEF25–75)/forced vital capacity (FVC) parameter in diagnosing restrictive lung disease. Methods: In this study, the records of all restrictive patients who were referred to the pulmonary centre of Imam Khomeini Hospital, Tehran, Iran, from March 2021–March 2022 have been reviewed, and the indexes in the body box and spirometry have been recorded. Results: A total of 527 people were included in the study. Among them, 134 people (25.4%) had restrictive lung disease. The average area under the graph of the FEF25–75/FVC index is 0.648±0.028. It can be said that the area under the graph for the FEF25–75/FVC index is between 0.594–0.703. The FEF25–75/FVC index at values above 79.90 has a sensitivity of 70.9% and a false positive rate (1- specificity) of 53.2%. Conclusions: According to the result of this study, the ratio of FEF25–75/FVC index in spirometry at above 79.90 has a sensitivity of 70.9% and a false positive rate (1- specificity) of 53.2%. Therefore, it can be used as a screening test for restrictive lung diseases

Therapeutic Options and Critical Care Strategies in COVID-19 Patients; Where Do We Stand in This Battle?

A pandemic of COVID-19 made an appearance in Wuhan, China, in late December 2019 and rapidly became a serious concern worldwide, with killing more than 238000 people until 3rd May 2020. Given the fact that a vaccine against the virus probably won’t be available anytime in the near future, the therapeutic strategies have become more prominent. Many supposedly effective drugs are under evaluation which may hinder the replication of SARS-CoV-2, and subsequently the infection. Lately on 1th may 2020, FDA authorized the use of experimental drug, Remdesivir for "emergency purpose" in COVID-19 cases. Chloroquine and hydroxychloroquine, among the very first under-trial drugs, have been revealed to have promising impacts in treatment of SARS-CoV2. Broad-spectrum antivirals as well as HIV protease-inhibitors are still subject to assessment. Particularly angiotensin-converting enzyme 2 (ACE2) inhibitors are increasingly taken into consideration because of ACE2 being recognized as a host-cell receptor for COVID-19. Immune-Enhancement therapy by Interferons and Intravenous immunoglobulin (IVIG) has been shown to be effective in some cases. Moreover, Convalescent Plasma Therapy and auxiliary blood purification were considered as the treatment of SARS-CoV2 infection. Among the critically ill patients, Oxygen-therapy, timely usage of inflammatory inhibitors, and controlling viral shedding by antivirals may reduce the mortality and morbidity of COVID-19

A Case Based-Shared Teaching Approach in Undergraduate Medical Curriculum: A Way for Integration in Basic and Clinical Sciences

To present a multiple-instructor, active-learning strategy in the undergraduate medical curriculum. This educational research is a descriptive one. Shared teaching sessions, were designed for undergraduate medical students in six organ-system based courses. Sessions that involved in-class discussions of integrated clinical cases were designed implemented and moderated by at least 3 faculties (clinicians and basic scientists). The participants in this study include the basic sciences medical students of The Tehran University of Medical Sciences. Students’ reactions were assessed using an immediate post-session evaluation form on a 5-point Likert scale. Six two-hour sessions for 2 cohorts of students, 2013 and 2014 medical students during their two first years of study were implemented from April 2014 to March 2015. 17 faculty members participated in the program, 21 cases were designed, and participation average was 60 % at 6 sessions. Students were highly appreciative of this strategy. The majority of students in each course strongly agreed that this learning practice positively contributed to their learning (78%) and provided better understanding and application of the material learned in an integrated classroom course (74%). They believed that the sessions affected their view about medicine (73%), and should be continued in future courses (80%). The percentage demonstrates the average of all courses. The program helped the students learn how to apply basic sciences concepts to clinical medicine. Evaluation of the program indicated that students found the sessions beneficial to their learning

Prevalence Study of Multi-drug Resistant Klebsiella pneumoniae Strains Isolated from Respiratory Tract Infections

Resistant strains of Klebsiella pneumonia are one of the most prevalent cause of nosocomial and especially respiratory tract infections al-around the world. The present investigation was carried out to study the prevalence of antibiotic resistance in K. pneumonia strains of hospitalized patients suffered from RTIs. Three-hundred and fifty respiratory samples were collected from hospitalized patients of both sexes and various ages. Samples were cultured and those that were K. pneumonia-positive were subjected to 16S rRNA based-PCR amplification and disk diffusion method. Of 350 samples studied, 25 samples were positive for K. pneumonia (7.14%). Distribution of K. pneumonia in male and female patients were 8.33% and 5.88%, respectively (P <0.05). Older than 60 years old and younger than 20 years old patients had the highest prevalence of K. pneumonia. Our K. pneumonia isolates had the highest levels of resistance against gentamycin (96%), ampicillin (92%), erythromycin (84%), ciprofloxacin (76%), sulfamethoxazole (76%). Primary identification of K. pneumonia-positive patients and their treatment with imipenem antibiotic based on the results of disk diffusion method can control distribution of K. pneumonia RTIs

Cement pulmonary embolism after percutaneous vertebroplasty in a patient with cushing's syndrome: A case report

Background: Vertebroplasty is a procedure most commonly used for vertebral compression fractures. Although it is a relatively safe procedure, complications have been reported. Cement embolism is seen in 2.1%–26% of patients after percutaneous vertebroplasty. Case presentation: a 38-year-old male who was diagnosed with cushing's syndrome, underwent percutaneous vertebroplasty for his thoracic osteoporotic compression fractures. 24-hours following vertebroplasty, he presented to emergency department with acute-onset dyspnea and chest pain. Chest radiography showed an opaque linear lesion in left pulmonary artery which was suggestive of cement embolism. Pulmonary spiral CT-scan further confirmed the diagnosis. The patient's symptoms improved over time, and warfarin was started with close cardiopulmonary assessments for indicators of cement embolus removal. Conclusion: in patients with pulmonary cement embolism, conservative treatment may be recommended rather than a surgical removal except when the obstruction is extensive enough to cause hemodynamic changes. Given that all the related studies have suggested that pulmonary thromboembolism can occur as a complication due to bone cement leakage, discovering new cement alternatives and/or injection devices, seems beneficial. Keywords: Percutaneous vertebroplasty, Cement embolism, Complications, cushing's syndrom

Changes in heart rate variability (HRV) in patients with severe and moderate obstructive sleep apnea before and after acute CPAP therapy during nocturnal polysomnography

Introduction: Obstructive sleep apnea is an important risk factor for cardiovascular disease. Noninvasive positive pressure ventilation is the standard treatment of this disease, and it can reduce mortality in patients. Dysfunction of the autonomic system is one of the reasons for an increased risk of cardiovascular disease in these patients. The purpose of the present study was to investigate the effect of positive airway pressure (PAP) therapy on heart rate variability (HRV) indices. Methods: The study population was comprised of 55 patients, who underwent nocturnal polysomnography for the diagnosis of obstructive sleep apnea and PAP titration on the same night. The levels of continuous positive airway pressure (CPAP) and bilevel positive airway pressure were adjusted to relieve obstructive sleep apnea, hypopnea, and desaturation. The patients’ heart changes and cardiac characteristics were recorded before and after the start of routine CPAP therapy. Finally, the cases’ sleep and polysomnography tests were analyzed and interpreted in collaboration with a sleep specialist and their cardiac changes with the aid of a cardiologist before and after treatment with CPAP. Results: The participants were 55 patients at a mean age of 57.04±12.9 years. There were 34 (61.8%) male and 21 (38.2%) female cases. PAP therapy on the same night resulted in a decreased standard deviation of the N-N interval index (p=0.036) and a low-frequency index (p=0.021), as well as increased high-frequency index (p<0.001) and low frequency / high frequency ratios (p=0.008). Conclusion: Our findings indicate a relative improvement in the activity of the autonomic system in patients with obstructive sleep apnea after 1 night of PAP therapy. Overwhelming evidence suggests that improvement in the sympathetic balance can reduce the risk of cardiovascular disease in patients

A survey of physicians’ opinions about the treatment of subsegmental pulmonary embolism

Introduction The aim of this study was to survey the attitudes of internists, cardiologists, and pulmonologists regarding treatment or no treatment of isolated subsegmental pulmonary embolism (ISSPE) with anticoagulant drugs. Methods Qualified physicians were asked to select their management options from a questionnaire that included a patient scenario with subsegmental pulmonary embolism (SSPE) and negative past medical history of thromboembolism. Results A total of 113 physicians responded to the survey. Of these, 8.8% preferred not to treat patients without further evaluation; 15% decided not to treat, but follow-up the patient with a serial lower-limb colour Doppler ultrasonography; 1.7% preferred anticoagulant treatment only during hospitalization and follow-up without medication; 5% preferred anticoagulant treatment for less than 3 months; and 34.5% chose a 3--6-month treatment with anticoagulation. Furthermore, 24% of physicians opted for anticoagulant treatment for more than 6 months, and 9.7% left the decision up to the patient. Opting not to treat was an option selected by more board-certified faculty members specialized in cardiology, internal medicine, and pulmonology compared with residents (p = 0.038). Willingness to provide anticoagulant therapy in the internal medicine, cardiology and pulmonology groups was 56.6%, 37.3% and 6%, respectively (p = 0.007). Conclusion The majority of physicians surveyed prefer anticoagulant therapy in patients with SSPE

Persistent cough and situs inversus in a middle‐aged female

Key message Kartagener syndrome, a rare genetic disorder, can present in adults with persistent respiratory symptoms and radiological changes, such as bronchiectasis and situs inversus. Clinicians should maintain a high clinical suspicion, as early recognition and appropriate management are crucial for preserving pulmonary function