Masih Daneshvari Hospital Research Articles

Noninvasive Positive-Pressure Ventilation: A Cross Sectional Descriptive Study of Our First Experience in Iran

Background: Noninvasive positive-pressure ventilation (NIPPV) has been safely used in selected patient populations. The purpose of this study was to determine the safety and efficacy of NIPPV outside the intensive care unit (ICU) in a tertiary hospital. This descriptive, cross sectional study was performed at Masih Daneshvari Hospital, Tehran, Iran during 2011 - 2015. Methods: Between March 2011 and June 2015, patients requiring NIPPV were enrolled in the study. The study population included all eligible patients. Census sampling was applied in this study. The patients’ medical history (including comorbidities), age, sex, and hospital ward in which NIPPV was delivered were assessed retrospectively. Moreover, venous pH, partial pressure of carbon dioxide (PCO2), and bicarbonate (HCO3-) were analyzed before and after the intervention (NIPPV application). Results: A total of 946 patients, including 598 (63.2%) men and 348 (36.8%) women, received NIPPV for inpatient hospital care. The mean age of the patients was 61.92 ± 15.5 years (range, 3 - 102 years). Indications for NIPPV included exacerbation of chronic obstructive pulmonary disease (COPD; 55.4%), obstructive sleep apnea (OSA; 6%), bronchiectasis (7.8%), concurrence of COPD and OSA (4.8%), neuromuscular disorders (1.7%), congestive heart failure (4%), postthoracotomy pain (0.6%), thoracic malignancy (2.1%), pulmonary thromboembolism (1.1%), pneumonia (7.3%), asthma (1.5%), interstitial lung disease (2.5%), tuberculosis (4%), and cystic fibrosis (1.3%). We found significant improvements in venous pH and PCO2 with no significant changes in HCO3- (P > 0.05). Conclusions: NIPPV could be safely used under the supervision of trained pulmonologists in non-ICU settings. This method was effective in treating acute abnormalities in venous blood gas, including pH and PCO2.

High-resolution computed tomography findings in chronic eosinophilic vs. cryptogenic organising pneumonia.

The similar clinical and computed tomography (CT) characteristics of cryptogenic organising pneumonia (COP) and chronic eosinophilic pneumonia (CEP) make precise diagnosis challenging. To help differentiate between COP and CEP using high-resolution CT (HRCT). Clinical data and HRCT images of COP and CEP patients referred to Masih Daneshvari Hospital, Tehran, Iran, from 2007 to 2015 were reviewed. Diagnosis of COP or CEP was confirmed using open lung biopsy or a combination of transbronchial biopsy, bronchoalveolar lavage fluid (BALF) analysis, peripheral eosinophilia and a favourable response to corticosteroids. Ground-glass opacity, a dominant ground-glass pattern, upper-lobe pneumonia, increased thickness of bronchial walls and a mosaic pattern in the lungs were more frequent in CEP. Lower-lobe pneumonia, subpleural reticulation, a dominant consolidation pattern, nodules and masses, non-septal linear opacities, bronchial dilation and a reverse halo sign were more frequent in COP. History of asthma, wheezing and peripheral eosinophilia was significantly more common in CEP than in COP. Distinguishing between CEP and COP based on HRCT alone is not always possible. However, in many cases, especially if the correct diagnosis cannot be established by other means, certain HRCT features can be very helpful.

Evidence for M2 macrophages in granulomas from pulmonary sarcoidosis: A new aspect of macrophage heterogeneity

BackgroundSarcoidosis is a granulomatous disease of unknown etiology. Macrophages play a key role in granuloma formation with the T cells, having a significant impact on macrophage polarization (M1 and M2) and the cellular composition of the granuloma. This study evaluates macrophage polarization in granulomas in pulmonary sarcoidosis. Materials and MethodsTissue specimens from the Department of Pathology biobank at the Masih Daneshvari Hospital were obtained. Paraffin sections from 10 sarcoidosis patients were compared with those from 12 cases of tuberculosis using immunohistochemical staining. These sections consisted of mediastinal lymph nodes and transbronchial lung biopsy (TBLB) for sarcoidosis patients versus pleural tissue, neck, axillary lymph nodes and TBLB for tuberculosis patients. The sections were stained for T-cells (CD4+, CD8+) and mature B lymphocytes (CD22+). CD14+ and CD68+ staining was used as a marker of M1 macrophages and CD163+ as a marker for M2 macrophages. ResultsImmunohistochemical staining revealed a 4/1 ratio of CD4+/CD8+ T-cells in sarcoidosis granuloma sections and a 3/1 ratio in tuberculosis sections. There was no significance difference in single CD4+, CD8+, CD22+, CD14+ and CD68+ staining between sarcoidosis and tuberculosis sections. CD163 expression was significantly increased in sarcoidosis sections compared with those from tuberculosis subjects. ConclusionEnhanced CD163+ staining indicates a shift towards M2 macrophage subsets in granulomas from sarcoidosis patients. Further research is required to determine the functional role of M2 macrophages in the immunopathogenesis of sarcoidosis.

Budesonide facilitates weaning from mechanical ventilation in difficult-to-wean very severe COPD patients: Association with inflammatory mediators and cells

IntroductionMechanical ventilatory support is life-saving therapy for patients with respiratory failure in intensive care units (ICU) but is linked to ventilator-associated pneumonia and other nosocomial infections. Interventions that improve the efficiency of weaning from mechanical ventilation may improve patient outcomes. ObjectiveTo determine whether inhaled budesonide decreases time-to-weaning in COPD stage 4 difficult-to-wean patients and reduces the release of pro-inflammatory cytokines in ICU patients. Materials and methodsWe recruited 55 difficult-to-wean COPD patients (Stage 4) within the ICU of the Masih Daneshvari Hospital. Subjects were randomly assigned to receive inhaled budesonide (0.5mg/day) or placebo (normal saline). Dynamic compliance and BAL cytokines were measured. ResultsBudesonide significantly reduced the number of days on MV (days-to-weaning=4.6±1.6days) compared to that seen in the control group (7.2±2.7days, p=0.014). Dynamic compliance was significantly improved in the budesonide group on days 3 (p=0.018) and 5 (p=0.011) The levels of CXCL-8 and IL-6 diminished on days 3–5 after start of budesonide (p<0.05). ConclusionIn COPD patients on MV, nebulized budesonide was associated with reduced BAL CXCL8 and IL-6 levels and neutrophil numbers as well as an improvement in ventilatory mechanics and facilitated weaning.

Breast Incidental Lesions at 18 F FDG PET/CT: Diagnostic Performance of PET-derived Metabolic Parameters

Background: Breast incidental lesion at 18 F FDG PET/CT are occasionally encountered in cancer patients, which may represent a second primary malignancy. The aim of the present study was to investigate the diagnostic performance of PET metabolic parameters to characterize breast incidentaloma. M aterials and Methods: All the images of patients with cancers other than breast with breast incidental lesion underwent PET/CT scan at Masih Daneshvari Hospital between May 2012 and May 2016 were retrieved and reviewed. SUVmax, SUVmean, MTV and TLG in addition to associated morphologic features on CT and demographics were recorded and correlated with final diagnosis defined by histophatologic confirmation or an at least 1-year clinical formal follow up. R es ults: Of a total 58 from 51 patients (51/5029, 1.01%), 10 (19.60%) were histopathologically verified as second primary breast cancers. There was a statistically significant difference in SUVmax, SUVmean, MTV and TLG between benign and malignant group (1.64 vs. 5.32 (p=0.009), 1.34 vs. 3.69 (p=0.027), 0.96 vs. 2.62 (p=0.035), 1.54 vs 8.89 (p=0.006). Using cut off 2, 1.35, 1.16 and 1.75, sensitivity and specificity of SUVmax, SUVmean, MTV and TLG were calculated as 77% and 62%, 92% and 66.5%, 77% and 75% 77% and 67%, respectively. C onclusion: Despite a significantly higher value in malignant breast incidental lesion, PET-derivative metabolic parameters provided only modest sensitivity and specificity and hence may not be considered as the sole criteria for risk stratification in this clinical setting.

Antifungal Resistant Gastrointestinal Basidiobolomycosis Without Eosinophilia: A Case Report

Introduction: Gastrointestinal basidiobolomycosis (GIB) is an emerging fatal infection in healthy individuals with limited known signs and symptoms. Case Presentation: A 42 years old labor man was admitted to the intensive care unit (ICU) of Masih Daneshvari hospital, Tehran, Iran, with chronic abdominal pain, a fever, and suspicion to post-operative abdominal infection. The patient had undergone an appendectomy as well as a colorectal surgery and a colostomy had been placed. The histopathological study of the colon was identical for gastrointestinal basidiobolomycosis. There was no eosinophilia in the peripheral blood sample. Patients’ treatment using itraconazole, voriconazole, and amphotericin B was not successful and unfortunately, he died because of septic shock. Conclusions: GIB is an emerging and fatal fungal infection with non-specific presentation such as abdominal pain, mass, and fever in healthy individuals. Persistent leukocytosis with or without eosinophilia, resistant fever, and other signs and symptoms after surgical resection, patients job and residents are important clue and insert the basidiobolomycosis in list of differential diagnoses is most important factor to early diagnosis and treatment.

Deceased Organ Donation From Pediatric Donors: Does the Literature Really Help Us? Implication for More Powerful Guidelines

BackgroundBrain-dead pediatric donors have always been the focus of attention because of the higher quality, utility, and possibility of their organ donation. However, donors under the age of 5 years always necessitate making more challenging management efforts, which are not clearly implied in most parts of the guidelines. MethodsThe data obtained from 79 brain-dead pediatric donors of the Organ Procurement Unit of Masih Daneshvari Hospital, Tehran, Iran, were assessed. The donors were divided into 2 groups, including donors under 5 years of age (group A) and those between 5 and 12 years of age (group B). Metabolic, hemodynamic, hematologic, and electrolyte status as well as the suitability for donation were compared in the study groups. ResultsOf 1252 donors, 6.3% were under 12 years of age. Trauma and drug toxicity were the two primary causes of brain death in group A. In comparison, trauma and brain tumor were the leading causes of brain death in group B. The prevalence of both hyperglycemia and respiratory acidosis was significantly higher in group A (P < .05). However, severe anemia and coagulopathy were more prevalent in group B (P < .05). The high-dose inotropic administration was used for 42.4% of the donors in group A, whereas only 26% of the donors in group B needed a high dose of inotropes (P < .05). The mean quantity of organ harvested per donor was 2.1 and 2.25 in groups A and B, respectively. Furthermore, donor loss was not significantly different in both groups. ConclusionsThe occurrence of different complications in donors under the age of 5 years requires special treatment considerations that should be the center of attention in the related guidelines. Organ donation per donor indicates that donors under the age of 5 years are a valuable resource for organ procurement.

Can 6-minute walk test predict severity of obstructive sleep apnea syndrome?

BackgroundWhen considering the benefits of the 6-min walking test (6-MWT) in research fields and the need of treatment for moderate to severe obstructive sleep apnea (OSA) patients, research in this field is of great advantage and may have a significant role in therapeutic grounds.MethodsThis cross-sectional study was conducted on 47 patients with confirmed diagnosis of OSA in the National Research Institute of Tuberculosis and Lung Disease, Masih Daneshvari Hospital. The 6-MWT was performed the day after polysomnography. The correlation between the 6-MWT and paraclinical findings during polysomnography in OSA patients was investigated.ResultsIn cases with moderate to severe OSA, the male sex displayed correlation with high PCO2. Ages of patients examined displayed reversed correlation with the distance in the 6-MWT by observing the O2 saturation (Sat) at the end of the 6-MWT, displaying direct correlation with the duration of O2 Sat <90% during sleep. The BMI also showed reversed correlation with the distance in the 6-MWT. Similarly, the severity of the OSA had reversed correlation with the expected distance in the test. However, patients with higher duration of O2 Sat <90% during sleep had a higher reduction in O2 Sat during and after the 6-MWT. Patients with higher duration of O2 Sat <90% during sleep also completed less overall distance in the 6-MWT (P values <0.05 for all).ConclusionIt appears that the 6-MWT can be used in patients with OSA to predict severity of the desaturation in OSA beyond functional capacity. Also, it can help predict the severity of disease and assist in follow up of the OSA patients in terms of functional capacity and selection of the most appropriate treatment strategy to increase the physical ability of the patients.

Efficacy of Noninvasive Positive Pressure Ventilation for Improving the Respiratory Function, Use of Accessory Respiratory Muscles, Quality of Sleep and Nutrition of Cystic Fibrosis Patients

Background: Respiratory failure secondary to recurrent respiratory infections is the most common cause of death in Cystic fibrosis (CF). Objectives: To assess the efficacy of noninvasive positive pressure ventilation (NIPPV) on respiratory function, use of accessory respiratory muscles, ease of physiotherapy for respiratory clearance, quality of sleep and nutritional status in CF patients with respiratory failure. Methods: All CF patients admitted to the pediatric department of Masih Daneshvari hospital, Tehran from March 2015 to January 2016 were studied. The inclusion criteria were clinical evidence of respiratory distress and signs of respiratory acidosis. The exclusion criteria were nausea and vomiting, not tolerating NIPPV, need for intubation, pneumothorax, presence of giant bullous emphysema or decreased level of consciousness. Baseline spirometry and venous blood gas (VBG) was obtained before and after NIPPV. A simple questionnaire was filled out for the nutritional status, sleep quality, ease of physiotherapy for airway clearance and the volume of secretions after NIPPV compared to baseline. Paired samples t-test and Wilcoxon Signed Rank test in SPSS version 16 were used for the before and after comparison of numerical and ordinal variables, respectively. Results: Out of a total of 53 CF hospitalized patients 17 met the inclusion criteria. There were 10 (58.8%) males and 7 (41.1%) females with a mean age of 11 ± 4.57 (10 - 25) years, mean weight of 31.85 ± 10.11 (13 - 48) kg and mean BMI of 14.16 ± 2.71 (5.9 - 18). The mean Saturation of peripheral oxygen (SPO2), respiratory rate (RR) and mean partial pressure of CO2 (PCO2) of patients before the intervention were 75 ± 13.25% (52 - 90%), 32 ± 11.17 (22 - 55) mmHg and 55.20 ± 17.62 (30.3 - 108), mmHg respectively. A significant difference was noted after the intervention in SPO2, venous PCO2 and RR compared to baseline (P < 0.05). The change in sleep quality (P = 0.001), nutritional status (P = 0.001) and ease of physiotherapy for respiratory clearance (P = 0.008) after NIPPV was statistically significant while the change in use of accessory respiratory muscles (P = 0.785) and the volume of secretions (P = 0.1) was not significant. Conclusions: NIPPV in CF patients with respiratory failure can improve the respiratory function, sleep quality and nutritional status of patients. Also, NIPPV enhances airway clearance during respiratory physiotherapy.

Low Bone Mineral Density and Associated Factors in Patients with Cystic Fibrosis: A Cross-Sectional Study

Background: Failure to maintain bone mass density is a major complication in patients with cystic fibrosis (CF). This study was conducted to evaluate the prevalence of low bone mineral density (BMD) and also identifying associated risk factors in CF patients. Materials and Methods: Present study conducted on 59 CF patients aged 5-35 years referred to respiratory clinic of Masih Daneshvari Hospital, Tehran-Iran. BMD was measured using dual energy X-ray absorptiometry (DXA) scan. Patients were divided in two groups: cases aged 5-18 years as group A and cases over 18 years as group B. Anthropometric variables, corticosteroid usage, pulmonary function test, serum calcium, phosphate and 25-OH vitamin D were assessed and correlation of them with BMD was investigated.Results: Low BMD (Z score < -2 standard deviation) was found in 72.8% (44) of patients. There was a positive correlation between malnutrition, Forced Expiratory Volume 1 (FEV1) and BMD (r=59 and 0.47, P<0.01, respectively). Steroid therapy and Pseudomonas aeruginosa colonization correlated significantly inversely with BMD (r = -0.34 and -0.32, P<0.05). Vitamin D deficiency was found in 36.7% (18) CF patients. No significant correlation was found between 25-OH vitamin D levels and BMD (r = 0.17; P=0. 23).Conclusion: In present study, the prevalence of low BMD was about 72.8% with significant correlation with low weight, BMI (poor nutritional status), FEV1,Pseudomonas aeruginosacolonization and the use of glucocorticoids.

Radiographic Manifestations of Tuberculosis in HIV Positive Patients: Correlation with CD4 Positive Tcell Count

Background: Observations on Tuberculosis HIV co-infection in addition to epidemiologic molecular studies have recently provided strong evidence for the state of immune system as the major determinant of the TB imaging spectrum. However, the presence of any correlation between radiographic findings and the degree of suppression in HIV positive patients still remains controversial. The present study aimed to investigate the TB radiographic manifestation in HIV positive patients and its relationship to the CD4 positive cell count. Methods: Chest radiography of 15 HIV positive patients with a definite diagnosis of pulmonary Tuberculosis in Masih Daneshvari hospital, between 2013 - 2014, were retrospectively reviewed. Radiographic findings and severity were categorized as typical (upper lobe infiltration/cavity) and atypical (middle/lower lobe opacity, adenopathy, pleural effusion and normal X-ray). Demographics and CD4 positive cell count were also recorded. Data analysis was performed using SPSS version 23 (frequency and mean for descriptive quantitative variables and Logistic regression analysis for correlation, P < 0.05). Results: Of a total 15 patients (86.7% men and 13.3% women), 78.6% had CD4 positive counts below 350 (mean SD; 229.15 199.45). The most common radiographic findings in descending order of frequency were adenopathy (53.3%), pleural effusion (26.7%) and cavitation (6.7%) with an overall atypical presentation of 93.3%. This study failed to reveal any statistically significant correlation between CD4 positive cell count and radiographic manifestation as well as severity. Conclusions: In CD4 positive cell count below 500, the dominant radiographic pattern of Tuberculosis is atypical presentation. At this level of immunity, CD 4 positive T cell dysfunction may play a deterministic role in TB radiographic manifestation.

The Role of 18F FDG PET/CT in Clinical Management of Breast Cancer; Additional Value Over Conventional Imaging Modalities

Background: The aim of the present study was to investigate the potential improvement in detection rate of nodal and distant metastasis and the resultant impact on clinical management by PET-based diagnostic work up in comparison with conventional imaging modalities in various clinical settings in patients with breast cancer. Methods: Of a total 256 patients with breast cancer who were referred to PET/CT division, MasihDaneshvari Hospital between May 2013 and Mar. 2016, 123 cases were included. Definitely-positive PET/CT findings in primary site as well as N1 (level I, II ipsilateral axillary nodes), N2 (ipsilateral internal mammary), N3 (ipsilateral internal mammary+ level I, II ipsilateral axillary, ipsilateral level II axillary, ipsilateral supraclavicular node) and distant metastasis (distant node and viscera) and related impact on clinical management (upstaging or downstaging) were retrospectively identified from the report archive and then compared with the results of baseline imaging modalities including CT scan, sonography, bone scan, C-X ray, MRI, MRM and mammography obtained from patient medical records. The most typical imaging pattern was considered as the reference standard. Indeterminant and equivocal PET positive lesion were not included in the study. Results: Fourteen (11.38%) and 109 (88.62%) out of 123 patients were referred for staging and restaging/recurrence/surveillance, respectively. Mean age were 51.42 (34 - 62) and 52.66 (29 - 79) for staging and restaging groups, respectively. In staging group, 18 F FDG PET/CT recognized definitely positive additional nodal involvement in 21.4% of patients all of them related to the supraclavicular level and hence result in change N staging to N3. Additional metastatic lesions on a per lesion-basis and a per organ-basis were identified as 28.6% and 14.3%, repsectively. A significant change in patient management occurred in 42.9% (35.7% upstaging, 7.2% down staging). In restaging group, locoregional detection rate in biopsy proved recurrence was 100%. Additional nodal detection and the resultant change in N staging were 29.6% and 28.7%, respectively. Supraclavicular node detection contribute in 53.12% of overall change in N staging followed by axillary node and internal mammary equally (15.62%). Additional metastatic lesions on a per lesion-basis and per organ-basis were identified in 53.2% and 44%, respectively. Ultimate change in patients management was found in 42.9%. Conclusions: 18 F FDG PET/CT is a valuable imaging tool in initial and subsequent treatment strategy in patients with breast cancer by providing additional nodal and distant metastasis and may have the promising future potential to be as the imaging modality of choice for accurate assessment of disease extension in breast cancer in routine clinical practice.

Role of FDG PET/CT Scan in Head and Neck Cancer Patients

: Background: PET/CT scan has emerging role in head and neck oncology with a few well-established indications, including: detection of unknown primary tumor site, tumor staging, radiotherapy planning, treatment response assessment and detection of recurrent disease. The purpose of this study is reporting PET/CT findings in head and neck cancer patients to emphasize on its role in head and neck oncology. Methods: We reviewed our PET/CT date-base retrospectively and found 94 patients, referred with primary head and neck cancer. This is a descriptive report of PET/CT scan findings in head and neck cancer patients referred to MasihDaneshvari hospital since 2013 to 2016. Results: The most common primary tumor sites were oral cavity (27%) and nasopharynx (22%). The most common indication for referral was tumor restaging (76%) including treatment response evaluation and differentiation between recurrence and post-treatment fibrosis. In 60% of patients with negative primary tumor site, PET/CT was able to detect evidence of regional or distant metastasis. PET/CT was able to localize the primary tumor site in 66% of patients with unknown primary tumor site. We had also 19 patients with primary head and neck cancer referred for initial staging, demonstrating evidence of metastasis in 66.2% of all cases. Conclusions: Most patients are referred for restaging and demonstrate evidence of regional or distant metastasis with significant value for further treatment planning. Providing insurance coverage and familiarizing referring physicians about appropriate indications of this relatively new diagnostic modality will be to the best interest of head and neck cancer patients in long term.

Comparison of the Prevalence of Geographic Tongue in Asthmatic Patients and Healthy Subjects in Masih Daneshvari Hospital in 2014

Comparison of the Prevalence of Geographic Tongue in Asthmatic Patients and Healthy Subjects in Masih Daneshvari Hospital in 2014

Augmented Renal Clearance in Iranian Critically Ill Patients: Retrospective Study at Masih Daneshvari Hospital

Background: Patients admitted to intensive care units have different physiological parameters in comparison with other settings. Changes in cardiovascular and renal functions are characteristics of these patients. An augmented renal clearance (ARC) has been investigated in some groups of critically ill patients, but there are no studies on the occurrence and determinants of ARC in Iran. Objectives: Our goal was to determine the incidence and associated factors of ARC in Iranian critically ill patients. Methods: This retrospective cohort study was conducted on patients admitted to the mixed medical-surgical ICU of Masih Daneshvari hospital, Tehran, Iran, as a referral center, during a 3-year period (October 2010 to October of 2012). ARC was defined as creatinine clearance (CLCr) ≥ 130 mL/min/1.73 m2. Two groups were analyzed: medical and surgical admission in ICU. Results: Augmented renal clearance was present in 184 of 467 Iranian patients (39.4%), and they were young (42.1 ± 14.6 versus 58 ± 1 years, P value < 0.01). Conclusions: In this cohort of Iranian critically ill patients, 39.4% had ARC on admission to the ICU. Augmented renal clearance mainly developed in young Iranian patients.

Relationship between sleep quality and mental health according to demographics of 850 patients with chronic obstructive pulmonary disease.

We aimed to study sleep problems in hospitalized chronic obstructive pulmonary disease patients and assess the relationship of sleep quality with mental health and demographics of patients. Our study sample consisted of 850 chronic obstructive pulmonary disease patients hospitalized in Masih Daneshvari Hospital. Demographic data were collected and the Pittsburgh Sleep Quality and mental health questionnaires were filled out for patients. The results showed that 5.9 percent were suffering from severe sleep problems, while 4.7 percent had severe mental problems. A strong positive correlation was found between the total scores of mental health and sleep quality ( p < 0.01). The prevalence of sleep and mental health problems was higher in females compared to males. Mental health and sleep quality play important roles in quality of life of chronic obstructive pulmonary disease patients.

Two Molecular Markers of Early Non-Small Cell Lung Carcinoma Based on Gene Expression in Peripheral Blood

Background: Lung cancer is among the most common cancers. Search is ongoing to find biomarkers to improve the diagnosis lung cancer techniques in early stages. In this study we evaluate the sensitivity and specificity of the MUC1 and CEA gene expressions in the peripheral blood of non-small cell lung cancer (NSCLC). Material and Methods: This study was done in Masih Daneshvari Hospital, Tehran, Iran and was case/control study that conducted on 30 NSCLC patients and 30 healthy controls. Peripheral blood was collected and total RNA was extracted then cDNA was synthesized. Sample was separately assessed by real time PCR. Results: The expression of CEA gen was positive in 24 patients indicating 80% sensitivity for this marker. The expression of CEA gen was positive in 9 controls out of 30 each. A statistically significant difference was detected between patients and healthy controls with regard to CEA mRNA expression (P < 0.001). The MUC1 gen expressed in 20 out of 30 patients, while it expressed in 3 controls. The difference in MUC1 mRNA expression was statistically significant between NSCLC patients and healthy controls (P < 0.001). Conclusion: MUC1 and CEA are molecular biomarkers with relatively favorable sensitivity for primary diagnosis of NSCLC.

Validation of the COPD Assessment Test in Patients with COPD in Iran

Background: Chronic obstructive pulmonary diseases (COPD) is among the most important causes of chronic disease in adulthood. COPD assessment test (CAT) and Saint George Respiratory Questionnaire (SGRQ) are two health related quality of life questioners validated for application in patients with COPD. Our purpose was to evaluate the validity and reliability of the short and easily translated CAT questionnaire for COPD patients. Material and Methods: Between December 2015 and November 2016, in a cross-sectional pilot study, COPD patients attending Masih daneshvari hospital were asked to complete the Farsi translation of the CAT questionnaire. The inclusion criteria were patient consent, having stable COPD, ability to respond to questions and lack of other pulmonary disease. The results of the questionnaire were compared with the SGRQ and frequency of visits to the emergency room. The Cronbach's alpha coefficient was calculated for the questionnaire. Result: 77 patients participated in this study with mean age of 63 ± 12 years (27-88). Sixty six subjects (85.7%) were male and eleven (14.3%) were female. Mean CAT score was 24/87 ± 7 (range 1-40). The Cronbach’s alpha coefficient for the CAT questionnaire was calculated to be 0.732. The correlation between CAT and SGRQ was significant (r=0.666, P=0.000). Correlation between CAT score and frequency of emergency visits and subjects’ being married were (r=0.627, P=0.017) and (r=0.58, P=0.024) respectively. Conclusion: CAT questionnaire is well accepted by patients as is correlated well with SGRQ and patients’ psychometric status. Trial registration number: IRCT2016102927929N3.

Relation between Cor Pulmonale Status and Metrics of Six Minute Walk Test in Patients with Chronic Obstructive Pulmonary Disease: A Cross Sectional Study

Background: Cor pulmonale is a complication of chronic obstructive pulmonary disease (COPD). The use of the six minute walk test (6MWT) to discriminate between COPD patients with and without cor pulmonale remains unclear. Objectives: To study whether the existence of cor pulmonale in COPD is related to characteristic findings in distance and desaturation in 6MWT. Material and Methods: Patients with confirmed COPD who were referred to rehabilitation unit of Masih Daneshvari hospital were studied. Subjects were categorized into cor pulmonale and non cor pulmonale according to physical examination and echocardiography findings. Standard 6MWT was performed according to published statements. The covered distance and the amount of oxygen desaturation were recorded. Comparisons between the two groups were conducted in two-tailed using Mann-Whitney tests. Result: A total of 101 patients were evaluated (78 male and 23 female). There were 49 cor pulmonale (48.5%) and 52 non cor pulmonale (51.5%) with a mean age of 59.98 ± 15.92 and 51.88 ± 19.04 (p>0.05), respectively. The mean of 6MWT distance in patients with and without cor pulmonale were 264.85 ± 114.1 meters and 344.13 ± 84.19 meters, respectively (p<0.05). Oxygen desaturation in cor pulmonale and non-cor pulmonale patients were 8.71 ± 6.41% and 7.90 ± 6.80%, respectively (p>0.05). Conclusion: The distance covered by cor pulmonale subjects in 6MWT is significantly less than non cor pulmonale. However, despite the oxygen desaturation in both groups, there is no significant difference between two groups.

Prevalence of snoring and the risk of sleep apnea in hospital staff.

Untreated Obstructive sleep apnea syndrome (OSAS) as a common breathing sleep disorder results in impaired work performance. The economic burden of untreated OSAS accounts for billions of dollars per year. The aim of this study was to evaluate the prevalence of snoring and the risk of OSAS in healthcare system staff. This cross-sectional study was performed on 715 staff of Dr. Masih Daneshvari Hospital in 2012. The Berlin questionnaire was used to identify the prevalence of snoring and the risk of sleep apnea. Additional information, including demographic characteristics, night work, night sleep less than 4 hours, smoking, underlying disease, and quality of sleep were evaluated as well. The information was analyzed using SPSS 15. 12.6% reported snoring. 6.9% and 93.1% were categorized into the high and low risk groups for OSAS respectively. There was an association between the risk of OSAS and age group (P-value = 0.007), gender (P-value = 0.028), marital status (P-value = 0.008), educational level (P-value = 0.035), chronic disease (P-value = 0.008), night sleep less than 4 hours (P-value = 0.001), difficulty in staying asleep (P-value = 0.000) and waking up too early (P-value = 0.006). Even logistic regression analysis demonstrated the relationship between the risk of OSAS and night sleep less than 4 hours (P-value = 0.019) and difficulty in staying asleep (P-value = 0.009). The results showed that the risk of OSAS is significant in healthcare system staff. Hope to provide a special screening program for OSAS in a regular occupational examination.