A New Formula for Confirmation of Proper Endotracheal Tube Placement with Ultrasonography

Background Endotracheal intubation is an important procedure in critical care and emergency medicine settings. Optimal depth of the tube placement has been a serious concern because of several complications associated with its malposition. Objective: The aim of the current study was to find a new formula to estimate the proper endotracheal tube depth when using ultrasonography or lighted stylet device in order to increase the accuracy of determining Endotracheal tube (ETT) depth and decrease the side effects of ETT misplacement. Method: Patients older than 18 years of age admitted to Imam emergency department who needed tracheal intubation were included. Tube’s length at the angle of the mouth while the tube passed the suprasternal notch, ETT depth after insertion and the distance from ETT’s tip to carina were recorded. Ultrasonography and portable chest x-ray were used as tools for measuring these lengths. Results: A total number of 91 patients including 55 men and 36 women were eligible for inclusion in the study. Not placing the tube at proper depth was considered as failure of intubation. This failure rate was 9.9% in the standard method which would have been 1.1% if our proposed formula was used. Conclusion: The findings of this study suggest that the use of this new formula may help in predicting the proper intubation tube placement. Further studies are warranted to confirm these findings

Primary ciliary dyskinesia in six patients with bronchiectasis

INTRODUCTION: Primary ciliary dyskinesia [PCD] is generally considered as a rare autosomal recessive disorder. Previous studies reported various prevalence of PCD among patients with bronchiectasis. MATERIAL AND METHODS: Six PCD patients who were diagnosed during the investigation of 40 patients with bronchiectasis were enrolled in this study. Ultra structural studies for both epithelium and cilia were performed, and the deformities in detailed electron microscopic images confirmed the diagnosis of PCD. RESULTS: Four patients experienced the first symptoms shortly after the birth, 1 by the age of 1 and 1 by the age of 4 years. Except of 1 case that was diagnosed 2 months after the onset of disease, diagnosis delay was longer than 5 years in all patients. Consanguineous marriage was observed in the parents of all patients. Upper respiratory tract infections were documented for all patients. CONCLUSIONS: PCD should be considered as a probable underlying disorder in patients with bronchiectasis. Past medical history of otitis media and history of similar clinical findings in family members should raise suspicion toward PCD.INTRODUCTION: Primary ciliary dyskinesia [PCD] is generally considered as a rare autosomal recessive disorder. Previous studies reported various prevalence of PCD among patients with bronchiectasis. MATERIAL AND METHODS: Six PCD patients who were diagnosed during the investigation of 40 patients with bronchiectasis were enrolled in this study. Ultra structural studies for both epithelium and cilia were performed, and the deformities in detailed electron microscopic images confirmed the diagnosis of PCD. RESULTS: Four patients experienced the first symptoms shortly after the birth, 1 by the age of 1 and 1 by the age of 4 years. Except of 1 case that was diagnosed 2 months after the onset of disease, diagnosis delay was longer than 5 years in all patients. Consanguineous marriage was observed in the parents of all patients. Upper respiratory tract infections were documented for all patients. CONCLUSIONS: PCD should be considered as a probable underlying disorder in patients with bronchiectasis. Past medical history of otitis media and history of similar clinical findings in family members should raise suspicion toward PCD

Therapeutic targeting of Toll-like receptors in cutaneous disorders

INTRODUCTION: The role of skin, as a part of the immune system has long been elucidated. Toll-like receptors (TLRs), a group of pattern recognition receptors, are involved in the recognition of invading pathogens, initiation of immune responses and regulation of both innate and adaptive immune systems. There is a growing body of evidence supporting the role of TLRs in the pathophysiology of several skin conditions, which mandates the development and study of therapeutic strategies that target TLRs. AREAS COVERED: With regards to the role of TLRs in pathogenesis of diverse cutaneous conditions, recent advances, as well as the future prospects of therapeutic implications of TLRs in cutaneous disorders is reviewed in this article. EXPERT OPINION: Although non-specific therapeutic strategies seem to reduce the symptoms in majority of patients, a considerable proportion remain untreated or have to deal with inevitable adverse effects of such therapies. Since TLRs regulate many patholophysiological processes, they could be good candidates for more specific therapeutic approaches. TLR targeting as the first recipient of invading pathogens is a growing concept in this field

A New Formula for Confirmation of Proper Endotracheal Tube Placement with Ultrasonography

Background Endotracheal intubation is an important procedure in critical care and emergency medicine settings. Optimal depth of the tube placement has been a serious concern because of several complications associated with its malposition. Objective: The aim of the current study was to find a new formula to estimate the proper endotracheal tube depth when using ultrasonography or lighted stylet device in order to increase the accuracy of determining Endotracheal tube (ETT) depth and decrease the side effects of ETT misplacement. Method: Patients older than 18 years of age admitted to Imam emergency department who needed tracheal intubation were included. Tube’s length at the angle of the mouth while the tube passed the suprasternal notch, ETT depth after insertion and the distance from ETT’s tip to carina were recorded. Ultrasonography and portable chest x-ray were used as tools for measuring these lengths. Results: A total number of 91 patients including 55 men and 36 women were eligible for inclusion in the study. Not placing the tube at proper depth was considered as failure of intubation. This failure rate was 9.9% in the standard method which would have been 1.1% if our proposed formula was used. Conclusion: The findings of this study suggest that the use of this new formula may help in predicting the proper intubation tube placement. Further studies are warranted to confirm these findings

The Etiology of Bronchiectasis in Iran

BackgroundBronchiectasis is defined by permanent and abnormal widening of the bronchi. Although this process occurs in the context of chronic airway infection and inflammation, since there is no accurate estimation of the etiology of the disease. This study aimed to determine the most important cause of bronchiectasis in Tehran, Iran.Materials and MethodsIn this retrospective cohort study we used the information of 91 patients admitted to two subspecialty lung hospitals in Tehran-Iran, where a wide range of bronchiectasis patients from around the country referred during 2013to 2014 period. Patients referring with the manifestation of chronic productive cough who had not responded to conventional treatment with the evidences of bronchiectasis on high resolution computed tomography were included. Data were analyzed using SPSS-16.0.ResultsThe etiology of bronchiectasis was diagnosed in 73 of 91 patients (80.2%), the most important of which included cystic fibrosis, post infectious, and primary ciliary dyskinesia (PCD). The most common causes of bronchiectasis in the children group (Age ≤ 18 years), were cystic fibrosis (57.1%), allergic bronchopulmonary aspergillusis (14.3%) and PCD (9.5%), respectively. In the adults group (Age >18 years), the most common causes were post infectious (22.6%), PCD (15.7%) and cystic fibrosis (14.3%), respectively.ConclusionMain causes of bronchiectasis in this study were not significantly different from other studies. Special attention should be paid to the probable causes of bronchiectasis in order to effectively execute on-time diagnosis, proper treatment and management of complications

Primary Ciliary Dyskinesia in Six Patients with Bronchiectasis

Introduction: Primary ciliary dyskinesia [PCD] is generally considered as a rare autosomal recessive disorder. Previous studies reported various prevalence of PCD among patients with bronchiectasis. Material and methods: Six PCD patients who were diagnosed during the investigation of 40 patients with bronchiectasis were enrolled in this study. Ultra structural studies for both epithelium and cilia were performed, and the deformities in detailed electron microscopic images confirmed the diagnosis of PCD. Results: Four patients experienced the first symptoms shortly after the birth, 1 by the age of 1 and 1 by the age of 4 years. Except of 1 case that was diagnosed 2 months after the onset of disease, diagnosis delay was longer than 5 years in all patients. Consanguineous marriage was observed in the parents of all patients. Upper respiratory tract infections were documented for all patients. Conclusions: PCD should be considered as a probable underlying disorder in patients with bronchiectasis. Past medical history of otitis media and history of similar clinical findings in family members should raise suspicion toward PCD

Expression of Activation-Induced Cytidine Deaminase Gene in B Lymphocytes of Patients with Common Variable Immunodeficiency

Objective: Common variable immunodeficiency (CVID) is a heterogeneous disorder characterized by reduced serum level of IgG, IgA or IgM and recurrent bacterial infections. Class switch recombination (CSR) as a critical process in immunoglobulin production is defective in a group of CVID patients. Activation-induced cytidine deaminase (AID) protein is an important molecule involving CSR process. The aim of this study was to investigate the AID gene mRNA production in a group of CVID patients indicating possible role of this molecule in this disorder. Methods: Peripheral blood mononuclear cells (PBMC) of 29 CVID patients and 21 healthy controls were isolated and stimulated by CD40L and IL-4 to induce AID gene expression. After 5 days AID gene mRNA production was investigated by real time polymerase chain reaction. Findings: AID gene was expressed in all of the studied patients. However the mean density of extracted AID mRNA showed higher level in CVID patients (230.95±103.04 ng/ml) rather than controls (210.00±44.72 ng/ml; P=0.5). CVID cases with lower level of AID had decreased total level of IgE (P=0.04) and stimulated IgE production (P=0.02); while cases with increased level of AID presented higher level of IgA (P=0.04) and numbers of B cells (P=0.02) and autoimmune disease (P=0.02). Conclusion: Different levels of AID gene expression may have important roles in dysregulation of immune system and final clinical presentation in CVID patients. Therefore investigating the expression of AID gene can help in classifying CVID patients

Comparison of Saffron and Fluvoxamine in the Treatment of Mild to Moderate Obsessive- Compulsive Disorder: A Double Blind, Randomized Clinical Trial

Objective: There are different pathophysiological mechanisms for obsessive- compulsive disorder (OCD) as suggested by the serotonergic, dopaminergic, and glutamatergic hypotheses. The present study aimed at comparing the efficacy and safety of saffron (stigma of Crocus sativus) and fluvoxamine in the treatment of mild to moderate obsessive- compulsive disorder. Method: In this study, 50 males and females, aged 18 to 60 years, with mild to moderate OCD, participated. The patients were randomly assigned to receive either saffron (30 mg/day, 15 mg twice a day) or fluvoxamine (100 mg/day) for 10 weeks. Using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Adverse Event Checklist, we assessed the patients at baseline, and at the second, fourth, sixth, eighth, and tenth week. Finally, the data were analyzed using general linear repeated measures. Results: In this study, 46 patients completed the trial. General linear repeated measures demonstrated no significant effect for time-treatment interaction on the Y-BOCS total scores [F (2.42, 106.87) = 0.70, P = 0.52], obsession Y-BOCS subscale scores [F (2.47, 108.87) = 0.77, p = 0.49], and compulsion Y-BOCS subscale scores [F (2.18, 96.06) = 0.25, P = 0.79]. Frequency of adverse events was not significantly different between the 2 groups. Conclusion: Our findings suggest that saffron is as effective as fluvoxamine in the treatment of patients with mild to moderate OCD

Pierwotna dyskineza rzęsek u sześciu chorych z rozstrzeniami oskrzeli

WSTĘP: Pierwotna dyskineza rzęsek (PCD) to rzadka choroba uwarunkowana genetycznie, o autosomalnym recesywnym dziedziczeniu. We wcześniejszych badaniach opisywano różną częstość występowania PCD u chorych z rozstrzeniami oskrzeli. MATERIAŁ I METODY: Do badania włączono 6 chorych z PCD rozpoznaną w czasie wcześniejszego badania obejmującego 40 chorych z rozstrzeniami oskrzeli. Przeprowadzono badania ultrastrukturalne nabłonka oddechowego oraz rzęsek. Deformacje widoczne w szczegółowych obrazach z mikroskopu elektronowego potwierdziły rozpoznanie PCD. WYNIKI: U 4 chorych pierwsze objawy pojawiły się krótko po urodzeniu, u jednego w wieku 12 miesięcy, a u kolejnego w wieku 4 lat. Poza jednym chorym, u którego ustalono rozpoznanie 2 miesiące od rozpoczęcia choroby, u wszystkich pozostałych diagnoza była opóźniona o ponad 5 lat. Rodzice wszystkich chorych byli spokrewnieni. U wszystkich uczestników badania stwierdzono zakażenia górnych dróg oddechowych. WNIOSKI: U chorych z rozstrzeniami oskrzeli należy podejrzewać PCD jako chorobę podstawową. Przebyte zapalenie ucha środkowego lub występowanie podobnych objawów u członków rodziny powinno wzbudzić podejrzenie w kierunku PCD.WSTĘP: Pierwotna dyskineza rzęsek (PCD) to rzadka choroba uwarunkowana genetycznie, o autosomalnym recesywnym dziedziczeniu. We wcześniejszych badaniach opisywano różną częstość występowania PCD u chorych z rozstrzeniami oskrzeli. MATERIAŁ I METODY: Do badania włączono 6 chorych z PCD rozpoznaną w czasie wcześniejszego badania obejmującego 40 chorych z rozstrzeniami oskrzeli. Przeprowadzono badania ultrastrukturalne nabłonka oddechowego oraz rzęsek. Deformacje widoczne w szczegółowych obrazach z mikroskopu elektronowego potwierdziły rozpoznanie PCD. WYNIKI: U 4 chorych pierwsze objawy pojawiły się krótko po urodzeniu, u jednego w wieku 12 miesięcy, a u kolejnego w wieku 4 lat. Poza jednym chorym, u którego ustalono rozpoznanie 2 miesiące od rozpoczęcia choroby, u wszystkich pozostałych diagnoza była opóźniona o ponad 5 lat. Rodzice wszystkich chorych byli spokrewnieni. U wszystkich uczestników badania stwierdzono zakażenia górnych dróg oddechowych. WNIOSKI: U chorych z rozstrzeniami oskrzeli należy podejrzewać PCD jako chorobę podstawową. Przebyte zapalenie ucha środkowego lub występowanie podobnych objawów u członków rodziny powinno wzbudzić podejrzenie w kierunku PCD