Risk factors of chronic obstructive pulmonary disease in men and women in Sanandaj, Iran

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the world. While smoking has been identified as the main cause of COPD in many studies, other causes may include environmental pollution and genetic vulnerability in both genders. Considering lifestyle of rural women, and the old structure of Sanandaj (Kurdistan Province, Iran) which is different with other parts of the country, this study compared the risk factors for COPD in men and women. METHODS: In a descriptive, analytic study 400 subjects of both genders (200 female and 200 male) were evaluated. The files of patients with COPD admitted to Besat Hospital (Sanandaj, Iran) during 2006-11 were randomly selected using a systematic sampling method. The sampling continued until a total of 200 patient files were collected in each group. Eventually, data was analyzed with SPSS. RESULTS: Smoking was the major risk factor (56.5%) for COPD in both men and women (n = 226). While only 32.5% of women (n = 65) had a history of smoking, the rate was as high as 80.5% in men (n = 161). Most women (60.5%) were more exposed to fossil fuel smoke than men. Fisher’s exact test results showed a significant difference in the risk factors (including Smoking and tobacco use, Exposure to fossil fuel smoke and air pollution) and the type of jobs between the two genders. CONCLUSION: Based on the results of our study, it is better to obtain an accurate history of exposure to smoke of wood or biomass and a history of residing in rural areas as the main risk factors for developing COPD in patients who have no history of high-risk occupations or other risk factors of the disease (e.g. smoking)

Risk factors of chronic obstructive pulmonary disease in men and women in Sanandaj, Iran

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death in the world. While smoking has been identified as the main cause of COPD in many studies, other causes may include environmental pollution and genetic vulnerability in both genders. Considering lifestyle of rural women, and the old structure of Sanandaj (Kurdistan Province, Iran) which is different with other parts of the country, this study compared the risk factors for COPD in men and women. METHODS: In a descriptive, analytic study 400 subjects of both genders (200 female and 200 male) were evaluated. The files of patients with COPD admitted to Besat Hospital (Sanandaj, Iran) during 2006-11 were randomly selected using a systematic sampling method. The sampling continued until a total of 200 patient files were collected in each group. Eventually, data was analyzed with SPSS. RESULTS: Smoking was the major risk factor (56.5%) for COPD in both men and women (n = 226). While only 32.5% of women (n = 65) had a history of smoking, the rate was as high as 80.5% in men (n = 161). Most women (60.5%) were more exposed to fossil fuel smoke than men. Fisher’s exact test results showed a significant difference in the risk factors (including Smoking and tobacco use, Exposure to fossil fuel smoke and air pollution) and the type of jobs between the two genders. CONCLUSION: Based on the results of our study, it is better to obtain an accurate history of exposure to smoke of wood or biomass and a history of residing in rural areas as the main risk factors for developing COPD in patients who have no history of high-risk occupations or other risk factors of the disease (e.g. smoking)

The risk profile of patients with COVID-19 as predictors of lung lesions severity and mortality—Development and validation of a prediction model

ObjectiveWe developed and validated a prediction model based on individuals' risk profiles to predict the severity of lung involvement and death in patients hospitalized with coronavirus disease 2019 (COVID-19) infection.MethodsIn this retrospective study, we studied hospitalized COVID-19 patients with data on chest CT scans performed during hospital stay (February 2020-April 2021) in a training dataset (TD) (n = 2,251) and an external validation dataset (eVD) (n = 993). We used the most relevant demographical, clinical, and laboratory variables (n = 25) as potential predictors of COVID-19-related outcomes. The primary and secondary endpoints were the severity of lung involvement quantified as mild (≤25%), moderate (26–50%), severe (>50%), and in-hospital death, respectively. We applied random forest (RF) classifier, a machine learning technique, and multivariable logistic regression analysis to study our objectives.ResultsIn the TD and the eVD, respectively, the mean [standard deviation (SD)] age was 57.9 (18.0) and 52.4 (17.6) years; patients with severe lung involvement [n (%):185 (8.2) and 116 (11.7)] were significantly older [mean (SD) age: 64.2 (16.9), and 56.2 (18.9)] than the other two groups (mild and moderate). The mortality rate was higher in patients with severe (64.9 and 38.8%) compared to moderate (5.5 and 12.4%) and mild (2.3 and 7.1%) lung involvement. The RF analysis showed age, C reactive protein (CRP) levels, and duration of hospitalizations as the three most important predictors of lung involvement severity at the time of the first CT examination. Multivariable logistic regression analysis showed a significant strong association between the extent of the severity of lung involvement (continuous variable) and death; adjusted odds ratio (OR): 9.3; 95% CI: 7.1–12.1 in the TD and 2.6 (1.8–3.5) in the eVD.ConclusionIn hospitalized patients with COVID-19, the severity of lung involvement is a strong predictor of death. Age, CRP levels, and duration of hospitalizations are the most important predictors of severe lung involvement. A simple prediction model based on available clinical and imaging data provides a validated tool that predicts the severity of lung involvement and death probability among hospitalized patients with COVID-19

First Presentation of a Case of Pulmonary Alveolar Microlithiasis with Spontaneous Pneumothorax

Pulmonary Alveolar Microlithiasis (PAM) is a rare disease of unknown origin. It is characterized by the presence of small calculi within the alveolar spaces, and has various clinical manifestations. Some patients may be asymptomatic for a long period of time with subsequent occurrence of dyspnea, dry cough, chest pain, and eventually, respiratory failure. Recurrent spontaneous pneumothorax episodes are a late complication of the disease. We report the case of an alveolar microlithiasis episode in a 42-year-old male, admitted to Tohid Hospital, Iran, whose first clinical presentation was symptoms of pneumothorax. He was admitted with sudden onset dyspnea and right-sided pleuretic chest pain. Following treatment of pneumothorax after chest tube placement, the pulmonary function revealed normal indices, and chest radiograph demonstrated diffuse confluence of dense micronodular infiltrate. High-resolution computerized tomography scan showed diffuse ground glass attenuation and calcifications along the interlobular septa and subpleural regions. Transbronchial lung biopsy confirmed the diagnosis of PAM

DIAGNOSTIC UTILITY OF ADENOSINE DEAMINASE IN SERUM AND BRONCHOALVEOLAR LAVAGE FLUID FOR SCREENING LUNG CANCER IN WESTERN IRAN DIJAGNOSTI^KA KORIST ADENOZIN-DEAMINAZE U SERUMU I BRONHOALVEOLARNOM LAVA@U ZA SKRINING RAKA PLU]A U ZAPADNOM IRANU

Summary Background: This study aimed to determine adenosine deaminase (ADA) activity as a possible screening tool in lung cancer patients. Methods: Blood samples were collected from 30 subjects with positive pathological tests and 62 patients with negative pathological tests as a control group. The enzymatic activity of total ADA and its isoenzymes was determined. Results: tADA and ADA2 isoenzyme activity was significantly higher in cancerous patients compared to benign controls in serum and BAL fluid. Using a cut-off level of respectively 35.22 U/L and 31.80 U/L for BAL total ADA and ADA2, sensitivity and specificity were 100% and 81% for total ADA and 95% and 98% for ADA2. Conclusions: Adenosine deaminase may play important roles in the pathophysiology of lung cancer and because of it

Elevated interleukin (IL)-6 as a predictor of disease severity among Covid-19 patients: a prospective cohort study

Abstract Background accompanied to the spreading of coronavirus disease 2019 (Covid-19) in the world, identifying factors related to the severity of the disease is one of the interests of physician and medical researchers. We hypothesized that interleukin 6 serum level is associated with severe outcome. Methods In this longitudinal prospective cohort study we enrolled 208 confirmed COVID-19 patients who were admitted to the Tohid Hospital (Sanandaj, Iran). Patients were classified into two groups based on IL-6 value in the first day of admission, elevated (n = 107) or not elevated/normal (n = 101), and followed until the occurrence of final outcome (death or discharge from the hospital). Data were analyzed using univariate methods, Chi-squared and independent two sample T test. The relationship between the independent variables and our interesting outcomes were investigated by multiple linear and penalized logistic regression modeling. Results A total of 208 patients, 51% female and mean age 53.6 ± 16.3 years, including 107 elevated and 101 non-elevated IL-6 patients, were followed. No significant difference was observed between the two groups in demographic and clinical characteristics. Although not significant, logistic regression results showed that the chance of death occurrence among patients with elevated IL-6 are 3.91 times higher. According to the multiple linear regression modeling, elevated IL-6 significantly increased the duration of hospital stay (P = 0.02). Frequency of ICU admission (P = 0.04) and mean of ICU stay (P = 0.8) are also higher in elevated IL-6 group. Conclusion This study revealed that elevated IL-6 is significantly related to prolongation of hospital stay in Covid-19 patients. Although not significant, the occurrence of death among patients who had increased IL-6 in the time of admission was higher than patients with normal or lower serum levels of IL-6

Comparative Network Analysis of Patients with Non-Small Cell Lung Cancer and Smokers for Representing Potential Therapeutic Targets

Abstract Cigarette smoking is the leading cause of lung cancer worldwide. In this study, we evaluated the serum autoantibody (AAb) repertoires of non-small cell lung cancer (NSCLC) patients and smokers (SM), leading to the identification of overactivated pathways and hubs involved in the pathogenesis of NSCLC. Surface- and solution-phase biopanning were performed on immunoglobulin G purified from the sera of NSCLC and SM groups. In total, 20 NSCLC- and 12 SM-specific peptides were detected, which were used to generate NSCLC and SM protein datasets. NSCLC- and SM-related proteins were visualized using STRING and Gephi, and their modules were analyzed using Enrichr. By integrating the overrepresented pathways such as pathways in cancer, epithelial growth factor receptor, c-Met, interleukin-4 (IL-4) and IL-6 signaling pathways, along with a set of proteins (e.g. phospholipase D (PLD), IL-4 receptor, IL-17 receptor, laminins, collagens, and mucins) into the PLD pathway and inflammatory cytokines network as the most critical events in both groups, two super networks were made to elucidate new aspects of NSCLC pathogenesis and to determine the influence of cigarette smoking on tumour formation. Taken together, assessment of the AAb repertoires using a systems biology approach can delineate the hidden events involved in various disorders

Redefining Cut-Points for High Symptom Burden of the Global Initiative for Chronic Obstructive Lung Disease Classification in 18,577 Patients With Chronic Obstructive Pulmonary Disease

Background: Patients with chronic obstructive pulmonary disease (COPD) can be classified into groups A/C or B/D based on symptom intensity. Different threshold values for symptom questionnaires can result in misclassification and, in turn, different treatment recommendations. The primary aim was to find the best fitting cut-points for Global initiative for chronic Obstructive Lung Disease (GOLD) symptom measures, with an modified Medical Research Council dyspnea grade of 2 or higher as point of reference. Methods: After a computerized search, data from 41 cohorts and whose authors agreed to provide data were pooled. COPD studies were eligible for analyses if they included, at least age, sex, post-bronchodilator spirometry, modified Medical Research Council, and COPD Assessment Test (CAT) total scores. Main outcomes: Receiver operating characteristic curves and the Youden index were used to determine the best calibration threshold for CAT, COPD Clinical Questionnaire, and St. Georges Respiratory Questionnaire total scores. Following, GOLD A/B/C/D frequencies were calculated based on current cut-points and the newly derived cut-points. Findings: A total of 18,577 patients with COPD [72.0% male; mean age: 66.3 years (standard deviation 9.6)] were analyzed. Most patients had a moderate or severe degree of airflow limitation (GOLD spirometric grade 1, 10.9%; grade 2, 46.6%; grade 3, 32.4%; and grade 4, 10.3%). The best calibration threshold for CAT total score was 18 points, for COPD Clinical Questionnaire total score 1.9 points, and for St. Georges Respiratory Questionnaire total score 46.0 points. Conclusions: The application of these new cut-points would reclassify about one-third of the patients with COPD and, thus, would impact on individual disease management. Further validation in prospective studies of these new values are needed. (C) 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine