Mounier-Kuhn syndrome: A rare cause of severe bronchial dilatation with normal pulmonary function test: A case report

SummaryTracheobronchomegaly (TBM) (Mounier-Kuhn syndrome) is dilatation of the trachea and major bronchi because of atrophy or absence of elastic fibers and smooth muscle cells. We present a case of TBM with normal pulmonary function test (PFT).The patient was a 37-year-old man with increasing productive cough and without fever, wheezes, chest pain, weight loss or any respiratory disease. Chest helical computed tomography (CT) scan showed tracheomegaly with transversal diameters of the trachea of 44mm. CT scan showed collapse of the trachea. Few large diverticular out-pouching and openings in the trachea was seen in bronchoscopy. PFT results were normal.PFT in large airway disorders may be normal while abnormalities may indicate underlying small airway disorder. An underlying small airway disorders is responsible for abnormal reports in PFT of these patients. We may need to re-evaluate the role of PFT within follow-up of patients with large airway disorder

THE LINK BETWEEN ALLERGIC RHINITIS AND RHEUMATIC DISORDERS: FROM AVICENNA'S VIEW TO RECENT FINDINGS

Allergic rhinitis (AR) is one of the most prevalent allergic disorder across the globe which has significant socioeconomic costs. In addition to direct and indirect costs, the disease also has hidden direct costs related to comorbid conditions. AR can result in several complications such as pharyngitis, sinusitis, asthma, otitis media, eczema and lymphoid hypertrophy. Although associations between AR and other airway disorders have been investigated for years, less attention has been focused on the association of this disease with non-respiratory disorders. Cosidering the fact that AR is rarely found in isolation and reprts of traditional Persian medical literatures on the relationship between rhinitis and joint disorders, this study aimed to investigate the link between AR and rheumatic disorders. In this regard, Avicenna’s Canon of Medicine which was a well known medical textbook until 17th century was reviewed. Modern medical databases were searched as well. The results of this study showed that as mentioned in the teachings of Avicenna, allergic rhinitis may have association with some rheumatic disorders such as rheumatoid arthritis, low back pain and gout. Findings that support this hypothesis include the wide range of symptoms and complications of allergic rhinitis, emphasizing the association by prominent medical scholars of the past like Rhazes and Avicenna, studies found an association between AR or chronic rhnosinusitis with rheumatic diseases and common cytokines and inflammatory biomarkers that serve similar roles in both allergic rhinitis and rheumatic diseases like IL-4, IL-6, IL-8, IL-17 and TNF-alpha. It is suggested that studies be conducted with the main aim of investigating the relationship between these diseases and evaluating underlying mechanisms. The result of such research can be helpful in finding new treatment modalities in both groups. Keywords: allergic rhinitis; rheumatic disorder; comorbidity, traditional medicine; Persian medicine; Avicenn

Effect of Nebulized Morphine on Dyspnea of Mustard Gas-Exposed Patients: A Double-Blind Randomized Clinical Trial Study

Background. Dyspnea is one of the main complaints in a group of COPD patients due to exposure to sulfur mustard (SM) and is refractory to conventional therapies. We designed this study to evaluate effectiveness of nebulized morphine in such patients. Materials and Methods. In a double-blind clinical trial study, 40 patients with documented history of exposure to SM were allocated to two groups: group 1 who received 1 mg morphine sulfate diluted by 4 cc normal saline 0.5% using nebulizer once daily for 5 days and group 2 serving as control who received normal saline as placebo. They were visited by pulmonologist 7 times per day to check symptoms and signs and adverse events. Different parameters including patient-scored peak expiratory flow using pick flow meter, visual analogue scale (VAS) for dyspnea, global quality of life and cough, and number of respiratory rate, night time awaking for dyspnea and cough have been assessed. Results. The scores of VAS for dyspnea, cough and quality of life and also respiratory rate, heart rate, and night time awaking due to dyspnea and night time awaking due to cough improved significantly after morphine nebulization without any major adverse events. Also pick expiratory flow has been improved significantly after nebulization in each day. Conclusion. Our results showed the clinical benefit of nebulized morphine on respiratory complaints of patients due to exposure to SM without significant side effects

The Social Determinants of Health in Military Forces of Iran: A Qualitative Study

Providing effective health interventions and achieving equity in health need to apply the community-based approaches such as social determinants of health. In the military organizations, these determinants have received less attention from the military health researchers and policymakers. Therefore, this study aimed to identify and explain the social determinants affecting the health of military forces in Iran. This was a qualitative study which was conducted in 2014. The required data were collected through semistructured interviews and analyzed through Conventional Content Analysis. The studied sample consisted of 22 military health experts, policymakers, and senior managers selected using purposeful sampling method with maximum variation sampling. MAXQDA.2007 was used to analyze the collected data. After analyzing the collected data, two main contents, that is, “general social determinants of health” and “military social determinants of health,” with 22 themes and 90 subthemes were identified as the social determinants of military forces’ health. Main themes were religious rule, spirituality promotion policies, international military factors, military command, and so forth. Given the role and importance of social factors determining the military forces’ health, it can be recommended that the military organizations should pay more attention to these determinants in making policies and creating social, economic, and cultural structures for their forces

The Role of Fas-FasL Signaling Pathway in Induction of Apoptosis in Patients with Sulfur Mustard-Induced Chronic Bronchiolitis

Sulfur mustard (SM) is an alkylating agent that induces apoptosis and necrosis in cells. Fas-Fas ligand (FasL) interaction could induce apoptosis as well. In this study, it was hypothesized that apoptosis might play an important role in the pathogenesis of SM-induced lung injury via Fas-FasL signaling pathway. In a case-control study, Fas and FasL levels, caspase-3 activity and percent of apoptotic cells were measured in bronchoalveolar lavage (BAL) fluid of patients 20 years after exposure to sulfur mustard and compared with the control group. Results show that Fas and FasL levels were significantly higher in BAL fluid cells in patients group compared with the control (P = .001). No significant differences were observed between mild and moderate-severe groups. BAL fluid cells caspase-3 activity was not significantly different among the mild, moderate-severe, and control groups. The data suggest that Fas-FasL-induced apoptosis was impaired in BAL fluid cells of SM-exposed patients which might be one of the initiators of pathogenesis in SM-induced lung injury in these patients

Phosgene Toxicity Clinical Manifestations and Treatment: A Systematic Review

Exposure to phosgene, a colourless poisonous gas, can lead to various health issues including eye irritation, a dryand burning throat, vomiting, coughing, the production of foamy sputum, difficulty in breathing, and chest pain. Thissystematic review aims to provide a comprehensive overview of the clinical manifestations and treatment of phosgenetoxicity by systematically analyzing available literature. The search was carried out on various scientific online databasesto include related studies based on inclusion and exclusion criteria with the use of PRISMA guidelines. The quality ofthe studies was assessed using the Mixed Methods Appraisal Tool (MMAT). Thirteen articles were included in thisstudy after the screening process. Inhalation was found to be the primary health problem of phosgene exposure withrespiratory symptoms such as coughing and dyspnea. Chest pain and pulmonary oedema were also observed in somecases. Furthermore, pulmonary crackle was the most common reported physical examination. Beyond respiratory tracthealth issues, other organs involvements such as cardiac, skin, eye, and renal were also reported in some studies. Thesymptoms can occur within minutes to hours after exposure, and the severity of symptoms depends on the amount ofinhaled phosgene. The findings showed that bronchodilators can alleviate symptoms of bronchoconstriction causedby phosgene. Oxygen therapy is essential for restoring oxygen levels and improving respiratory function in casesof hypoxemia. In severe cases, endotracheal intubation and invasive mechanical ventilation are used for artificialrespiration, along with the removal of tracheal secretions and pulmonary oedema fluid through suctioning as crucialcomponents of supportive therapy

Evaluation of the Effect of Knowledge Concerning Healthy Nutrition and Nutrition Science on the Knowledge Development Approach

Background: Nutrition can be regarded as an important part of any preparation program, as well as an important part of life. It seems essential to develop nutritional science and improve eating habits with the purpose of developing a healthy diet and avoiding the outcomes that arise from a lack of nutrition. Proper nutrition is one of the important factors for the development of health. Lack of sufficient awareness about nutrition can result in improper eating habits. Objectives: The present study evaluated the effect of knowledge about healthy nutrition and nutrition science on the knowledge development approach. Materials and Methods: In this cross-sectional descriptive study, the statistical population consisted of 190 experts and other scholars in the area of nutritional science. A questionnaire based on demographic details, nutritional science, nutrition education, research, proper solutions to individuals’ nutritional problems, and a culture of nutrition was used for data collection. Results: A relatively strong positive correlation was found between the knowledge development approach, nutritional science, nutrition education and research, and proper solutions for individual nutritional problems and a culture of nutrition (P < 0.001). Conclusions: 1) Effective enhancement and participation in an academic community will be important in the future of food and nutrition security; however, major gaps and weaknesses also exist in this context; 2) The main weaknesses in relation to the lack of clear policies and procedures include focusing on only Tehran, Iran; the need to overcome bureaucracy; and problems related to motivation, capital, and international communications; 3) Qualitative and quantitative improvement of research is not possible without access to skilled experts and researchers; 4) To solve these problems, it will be beneficial to pay more attention to the role of universities, facilitate intellectual communication among professors in Tehran and other provinces, ensure that Iranian professors are employed abroad, develop educational and research cooperation with foreign countries, and ensure that facilities for international cooperation put in place by united nations (UN) agencies are used. Keywords: Nutritional Science, Knowledge Management, Foo