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The main purpose of chemotherapy of tuberculosis is to ensure the noninfectiousness of patients with active pulmonary tuberculosis. For this reason, the sputum of smear-positive pulmonary tuberculosis patients is examined at the end of the first and second month of therapy to determine the conversion rate, which is expected to be 85% at the end of the second month. The patients whose sputum has converted to smear-negative are considered noninfectious. The aim of this study was to challenge the theory that negative sputum smear test results always indicate the absence of Mycobacterium tuberculosis bacilli in respiratory secretions from patients with active pulmonary tuberculosis after treatment. In order to achieve this goal, 46 patients with pulmonary tuberculosis whose sputum was positive for M. tuberculosis at the first visit were followed until they gave two consecutive negative smears. The bronchoalveolar lavage fluid of these patients was then examined for M. tuberculosis bacilli. It was observed that eight (17.5%) and five (10%) of these patients, who had already undergone sputum conversion, gave positive smear and culture results respectively. It could be concluded that a negative sputum result is not an appropriate index for evaluating the infectiousness of patients with pulmonary tuberculosis, and, since a few Mycobacterium tuberculosis bacilli can cause tuberculosis, especially in an immunocompromised host, it is mandatory that complementary studies to assess the transmission and virulence of Mycobacterium tuberculosis bacilli after sputum conversion be conducted.

The aim of this cross-sectional observational study was to address the health care situation in regard to smoking cessation efforts and expenditure, and to provide a basis for future studies and for implementing tobacco control programmes throughout the Eastern Mediterranean Region of the World Health Organization. Information collected included methods and cost of services for tobacco cessation from all 16 participating countries. In 10 countries, cessation programmes were directed by primary physicians. In 13 countries, nicotine gum and in 14 countries nicotine patches were accessible in pharmacies. Bupropion was available at pharmacies (with a written prescription) in 6 countries and varenicline in 7 countries. However, the mean cost of each service was significantly higher than the price of a pack of cigarettes. In countries with support services for tobacco cessation, directors need to provide care at the society level that is considerably less costly and widely accessible.

Background: Despite many prospective and retrospective studies about the association of dietary habit and lung cancer, the topic still remains controversial. So, this study aims to investigate the association of lung cancer with dietary factors. Method: In this study 242 lung cancer patients and their 484 matched controls on age, sex, and place of residence were enrolled between October 2002 to 2005. Trained physicians interviewed all participants with standardized questionnaires. The middle and upper third consumer groups were compared to the lower third according to the distribution in controls unless the linear trend was significant across exposure groups. Result: Conditional logistic regression was used to evaluate the association with lung cancer. In a multivariate analysis fruit (Ptrend < 0.0001), vegetable (P = 0.001) and sunflower oil (P = 0.006) remained as protective factors and rice (P = 0.008), bread (Ptrend = 0.04), liver (P = 0.004), butter (Ptrend = 0.04), white cheese (Ptrend < 0.0001), beef (Ptrend = 0.005), vegetable ghee (P < 0.0001) and, animal ghee (P = 0.015) remained as risk factors of lung cancer. Generally, we found positive trend between consumption of beef (P = 0.002), bread (P < 0.0001), and dairy products (P < 0.0001) with lung cancer. In contrast, only fruits were inversely related to lung cancer (P < 0.0001). Conclusion: It seems that vegetables, fruits, and sunflower oil could be protective factors and bread, rice, beef, liver, dairy products, vegetable ghee, and animal ghee found to be possible risk factors for the development of lung cancer in Iran. Keyword: Lung cancer, Nutrition, Cancer risk

Background : Venous thromboembolism is a serious complication among hospitalized patients. Infectious diseases are known as a risk factor for thrombo-embolic events Objectives: The aim of the study is to evaluate incidence, characteristic pattern, and risk factors for thrombo-embolic events among patients hospitalized with pulmonary and extra-pulmonary tuberculosis . Patients and Methods: This cohort study was performed among 1,153 new cases of tuberculosis. Suspected patients for DVT (deep venous thrombosis) or PTE (pulmonary thromboembolism) were investigated by Doppler sonography and pulmonary CT angiography. Another 100 tuberculosis patients without thromboembolism were also observed as control group. Results: The incidence of diagnosed thrombo-embolic complication was 32 of 1,153 admitted patients (2.8%; 95% confidence interval: 1.9 to 3.9) with a median interval of 14 days after anti-TB treatment initiation. The incidence of DVT and PTE was 2% and 1%, respectively. Thrombo-embolic events and DVT were more common in men than in women: 4.2% versus 1.3% (P = 0.003) and 3.5% versus 0.4%, respectively (P < 0.001). Hypertension and opium addiction were significantly correlated with thromboembolism . Conclusions: Incidence of DVT and PTE is noticeable among patients with tuberculosis

Primary multi-drug resistant extrapulmonary tuberculosis is an uncommon form of the disease, but it seems that by increasing the number drug resistant tuberculosis around the world, the number of cases of primary multidrug resistant tuberculosis with extrapulmonary presentation also is going to rise. In this report, we describe a 19- year old, HIV negative man with primary multi-drug resistant TB lymphadenitis, presented with cervical lymphadenopathy and sinus discharge at the site of involved lymph nodes. The Acid Fast Bacilli (AFB) smear of sputum was negative but the AFB smear of discharged fluid as well as the excisional biopsy of the lymph nodes confirmed the M. tuberculosis infection. The patient underwent the treatment with a combination of isoniazide, clofazimine, pyrazinamide, ofloxacin and amikacin with promising results. By increasing the number of drug resistant tuberculosis patients around the world, appropriate diagnosis and treatment of different presentations of the disease need a special attention.

Acremonium spp. cause human superficial infections including mycetoma, onychomycosis and keratitis. There are a few reports of systemic involvement in immunocompromised patients. However, isolated pulmonary infection in otherwise healthy hosts has never been reported in the literature. Herein, we report a 59 year-old diabetic man with non-resolving pneumonia due to Acremonium spp. and provide a consensus review of the published clinical cases of systemic and respiratory tract infections.

Asthma and allergic diseases present a major health burden. Information on the prevalence of these diseases indicates that these diseases are increasing in various parts of the world. It was hoped that this study would be helpful to health system policy-makers in planning allergy prevention programs in the region.The prevalence of asthma and allergic diseases and relation between the various risk factors involved were assessed among schoolchildren in the city of Bushehr, Iran. The ISAAC Phase I and III questionnaires were completed by parents of 1280 children aged 6-7 years and self-completed by 1115 students aged 13-14 years.The prevalence of atopic eczema, allergic rhinitis and asthma among 6-7 year-old students were 12.1%, 11.8% and 6.7%, respectively. While, the prevalence of these diseases among 13-14 year-old students were found to be 19%, 30% and 7.6%, respectively. There was an association between asthma and allergic rhinitis as well as eczema (p

Central airway stenosis may be a manifestation of benign or malignant lesions and can be a life threatening condition. There are different surgical and endoscopic modalities for treatment of these lesions. Balloon bronchoscopy is an interventional pulmonologic modality and can be performed under direct vision or fluoroscopic guidance. This technique can be used along with other interventional modalities for treatment of patients with tracheal stenosis. In this study we report balloon bronchoscopy as an interventional modality in a series of patients with tracheal stenosis and assess the outcome.

This study aimed to determine whether 99mTc-methoxyisobutylisonitrile (MIBI) scanning could improve diagnostic accuracy of pulmonary tuberculosis (PTB) and help clinical decision making for an accurate management.99mTc-MIBI scintigraphy was performed in 62 cases of PTB 34 cases had active pulmonary tuberculosis (APTB) and were at the beginning of antituberculosis medication (group 1) as well as 28 cases had inactive pulmonary tuberculosis (IPTB) and were post antituberculosis medication (group 2). The qualitative and semiquantitative findings of both scanning methods were assessed. For semiquantitative evaluation, regions of interest (ROIs) were drawn over the lesion (L), non-lesion (NL) and neck soft tissue (NST). The mean count values of ROIs were obtained and L/NL and L/NST were calculated.Thirty-four patients with APTB (15 males and 19 females; mean age of 47.85 +/- 1.91 yrs) and 28 cases with IPTB (9 male and 19 females; mean age of 53.96 +/- 2.33 yrs) were included in this study. The sensitivity, specificity, accuracy, positive and negative predictive (PPV and NPV) values of 99mTc-MIBI were 88.2%, 75%, 82.2%, 81.1% and 84% respectively. The mean value of L/NL in the APTB for 99mTc-MIBI was 1.45 +/- 0.18 and L/NST was 1.57 +/- 0.26 which was significant statistically (p0.00).The study demonstrated that 99mTc-MIBI scanning can be complementary to other diagnostic techniques especially in patients with indeterminate APTB and those in whom recurrent disease is suspected. In addition, because of its availability, rather low costs, easy performance, and objective semiquantitative information supplied, 99mTc-MIBI scanning might be establish in routine imaging center to assess the pulmonary tuberculosis. However, further exploration is needed to validate its clinical role.

The aim of this study was to determine the prevalence of asthma and related symptoms among 6–7- and 13–14-year-old school children in Tehran as a part of the International Study of Asthma and Allergies in Childhood (ISAAC) Phase III. We used a design of descriptive study. The ISAAC written questionnaire was given to a total of 6127 students of 72 schools in urban area of Tehran. Simple random sampling was performed with a uniform distribution throughout 12 clusters of twenty-two divisions of the municipality. All 1st and 7–8th graders were enrolled into the study. Results showed that 15% of the 6–7-yearolds and 17% of the 13–14-year-olds had positive history of wheezing, among which 8.6% and 10.6%, respectively, had had recent attacks. Physician confirmed asthma was reported in 2.1% of the 6–7-year-olds and 2.6% of the 13–14-year-olds. Severity of asthma assessed by frequency of speech limitation due to wheezing was positive in 1.5% of 6–7-year-olds and 3% of 13–14-year-olds. Exercise-induced wheezing was...

Nearly 18% of tuberculosis (TB) cases have only extrapulmonary manifestations. Breast tuberculosis is a rare type of extrapulmonary TB. This paper reports 4 cases of breast TB confirmed either pathologically or mycobacteriologically or both. These reports showed that TB should always be considered first in the differential diagnosis of granulomatous mastitis in TB-endemic areas. Therapy included at least 6 months of anti-TB medication and surgery when indicated.

Background Smoking cessation is an effective intervention for cancer prevention. For some reasons many smokers cannot attend quit programs and they prefer to have a consultation over the phone. In this study we share our experience regarding setting up a quit-line for smoking cessation for the first time in Iran. Materials and Methods Two general practitioners were trained to give consultation over the phone via quit line in Tehran. The quit program consisted of 4 sessions with 1 week interval. Our telephone counseling was both reactive and proactive from 8 AM till 5 PM during the years 2005 – 2008. In reactive counseling, the smoker initiates the call and speaks with a counselor about his/her current concerns. In proactive counseling, the counselor calls the smoker and provides counseling in a systematic manner. Smoking status was determined based on smokers’ self-report and regular follow-ups were conducted after quitting. Some cases were randomly selected for CO respiratory test in order to confirm their abstinence. Results A total of 480 cases entered the cessation program out of which, 80% were males. The mean age was 38.5±7.9 years, 72.7% of participants were married, 75.2% of subjects were educated and 51.3% of cases had high nicotine dependence. A total of 332 cases received a brief advice on quitting, 148 people continued their active participation to complete the course and 122 cases (82.4%) quitted smoking. The sustained abstinence rate after 1, 3, 6 and 12 months was 59%, 41%, 31% and 18%; respectively. Conclusion This method is an appropriate and accessible method which can be suggested to smokers during smoking cessation counseling.

The use of flow cytometry in the clinical laboratory has grown substantially in the past decade. Flow cytometric analysis provides a rapid qualitative and quantitative description of multiple characteristics of individual cells. For example, it is possible to detect the cell size and granularity, aspects of DNA and RNA content and the presence of cell surface and nuclear markers which are used to characterize the phenotype of single cells. Flow cytometry has been used for the immunophenotyping of a variety of specimens including whole blood, bone marrow, serous cavity fluids, (cerebrospinal fluid) CSF, urine and all types of body fluids. The technique has also been applied to human bronchoalveolar lavage (BAL) fluid, peritoneal fluids and blood. In this review, we describe the current status of the application of flow cytometry as a diagnostic tool in various lung diseases. We focus on the analysis of BAL cell composition in chronic obstructive lung disease (COPD), asthma, lung cancer, sarcoidosis, tuberculosis and idiopathic eosinophilic pneumonia (IEP).

Molecular epidemiology analyses are frequently used in determining epidemiology of tuberculosis. Recently, Mycobacterial Interspersed Repetitive Unit Variable Number Tandem Repeat (MIRU-VNTR) and Spoligotyping has become an important method, as it allows high-through put, discriminatory and reproducible analysis of clinical isolate. The purpose of this study is to compare techniques of "MIRU-VNTR" versus "MIRU-VNTR and Spoligotyping" together for study of genetic pattern of Mycobacterium tuberculosis (M. tuberculosis) strains. Sixty M. tuberculosis (MTB) isolates were selected (30 susceptible, 30 multi-drug resistant) for this study. Thereafter, the "MIRU-VNTR and Spoligotyping" were performed to identify their genetic patterns. The frequency of unknown genetic pattern of MTB was compared using technique of "MIRU-VNTR" alone versus "MIRU-VNTR and Spoligotyping" together. The MIRU-VNTR allelic diversity at each of the loci was calculated by Hunter - Gaston Discriminatory Index (HGDI). Based on differentiation index of all strains 10, 16, 26, 31 and 40 loci were identified as the most distinctive (HGI ≥0.6) and 2, 4, 20 and 24 as the weakest distinctive locus (HGI ≤0.3). By using MIRU-VNTR technique 38% (n = 23) of isolates could not be typed, whereas by applying "MIRU-VNTR and Spoligotyping" together only 15% (n = 9) of isolates remained unknown (p = 0.004). For sensitive strains, the difference was significant (67% vs. 90%, p = 0.028), but only marginally significant for drug resistant strains (57% vs. 80%, p = 0.052). The discrimination power of 12-locus MIRU-VNTR and Spoligotyping was equal to that of MIRU-VNTR analysis. If appropriate loci are added to the standard MIRU analysis, MIRU-VNTR genotyping could be a valuable tool for strain typing and epidemiological research of M. tuberculosis. With this approach a more clear understanding about genetic pattern of MTB can be achieved.

Multidrug-resistant tuberculosis (MDR-TB) imposes a formidable burden on national health systems. There is still no consensus on the subject, with controversies regarding treatment protocols, treatment outcomes and the various treatment regimens.The present study describes Iran's second national cohort for treatment of MDR-TB. The study comprised all documented MDR-TB cases in Iran referred to our centre during the period 2002-2006. All patients received a standardised second-line regimen consisting of ofloxacin, cycloserine, prothionamide and amikacin. Based on drug susceptibility testing results, ethambutol and pyrazinamide were added to the regimen.Forty-three patients diagnosed with MDR-TB, with a mean age of 44.38 +/- 19.05 years, received treatment; of these, 27 (62.8%) were male. Twenty-three were (53.5%) Iranians and the remainder were Afghans. All patients were acquired MDR-TB cases. Of the 43 cases, 25 (58.1%) experienced severe clinically significant adverse effects; 29 (67.5%) had a successful outcome and 14 (32.5%) had a poor outcome (treatment failure in six [14%] and death in eight [18.6%]). Mortality was higher in Iranians (P = 0.039) and in patients whose initial regimen was changed due to adverse drug reactions (P = 0.01).Compared with previous studies, our study was able to obtain more favourable outcomes of MDR-TB treatment using a standardised regimen.

Tuberculosis (TB) and tobacco use are two major alarming global health issues that tend to be co-prevalent in many developing countries and various surveys have provided evidence on their entangled associations. Accordingly, it is strongly suggested that smoking cessation be incorporated in TB control programs. Therefore, we aimed to evaluate the effectiveness of two smoking cessation methods among newly-diagnosed pulmonary TB patients. A total of 210 newly-diagnosed pulmonary TB patients from Tehran, Iran with smoking habits were included in this randomized clinical trial during 2012–2013. Patients were assigned to three groups of control (just TB medical treatment), brief advice (TB medical treatment plus individualized counseling sessions of quitting behavioral therapy) and combined intervention (TB medical treatment plus individualized counseling sessions of quitting behavioral therapy plus medical treatment with slow release bupropion). Patients’ abstinence was followed at six time point during six months. Data were analyzed by SPSS v.22 using Generalized Estimating Equations (GEE) model. Abstinance rate at the end of six months were 71.7 % for combined intervention group, 33.9 % for brief advice group and 9.8 % for the control group (p

Purpose:This study aimed to assess the rate of tobacco consumption among professional athletes in Iran and assessing their knowledge and attitude in this regard. Methods: A total of 738 athletes from 10 different types of sports were evaluated. Athletes were all members of the priority leagues. After obtaining consent from the PhysicalEducation Organization and coordination with the related federations, athletes were asked to fill out the standard questionnaire. Results:All understudy subjects were males. The mean age was 28.4±2.7 yrs. The mean age of initiation of sport in these subj ects was reported to be 12.3±4.01 yrs. A total of 178 (24.6%) subjects had experienced cigarette smoking and 308 (42.3%) had experienced hookah smoking. Sixty four subjects (9%) were current smokers. The mean score of knowledge about hazards of smoking was 5.6±0.9among those who had experienced smoking. This score was 7.9±0.5among those with no smoking experience ( P=0.04). Conclusions:Rate of smoking among professional athletes is lower than general population average. So participation in organized s ports may be a protective factor against tobacco use in people.

Tuberculosis (TB) is a frequently encountered infection among organ transplant recipients in developing countries, and the incidence of infection after the first year of transplantation is considerably high. In this study, the impact of rifabutin treatment on organ transplant recipients with TB infection was evaluated with respect to the trend of infection, management and outcome. The medical records of 26 post-transplant patients who received an organ transplant between 2004 and 2012 and later diagnosed with TB of different organs were reviewed retrospectively. We retrieved data regarding clinical features as well as treatment and outcomes. The median time interval between transplantation and TB was 36 months (IQR 12-101 months). The most common form of infection was pulmonary/pleural TB. All our subjects received rifabutin instead of rifampin in the anti-TB treatment regime as rifabutin is a less-potent inducer of cytochrome P-450. All patients responded satisfactorily to the treatment and maintained excellent allograft function. Moreover, we did not have any mortality among our recipients. Drug-induced hepatitis was observed in nine (35%) patients. Rifabutin is an excellent alternative medication to rifampin in the setting of TB management. Hepatotoxicity is a potential risk for treatment because of the potential additive toxicity of immunosuppressive drugs.

This study in 2003 determined the prevalence of smoking and its associated factors among high-school students in Tehran, Islamic Republic of Iran. Out of 1095 students aged 14-18 years, 29% (31% boys, 26% girls) were occasional and 5% (6% boys and 2% girls) daily smokers. Among occasional smokers, 21% had family members who also smoked, whereas for students who had never tried smoking, no family members smoked. Of 316 occasional smokers, 12% lived with a single parent compared with only 5% of never smokers. Regression analysis showed that significant risk factors for daily smoking were: having a brother or sister who smokes (OR = 8.58) and having more than 1 family member who smokes (OR = 6.33). Prevalence du tabagisme chez les eleves du deuxieme cycle de l>enseignement secondaire a Teheran en 2003 RESUME Cette etude, menee en 2003, a determine la prevalence du tabagisme et des facteurs as- socies a celui-ci chez les eleves du deuxieme cycle de l'enseignement secondaire a Teheran (Re- publique islamique d'Iran). Sur 1095 eleves âges de 14 a 18 ans, 29 % (31 % de garcons, 26 % de filles) etaient des fumeurs occasionnels et 5 % (6 % de garcons, 2 % de filles) des fumeurs reguliers. L'entourage familial de 21 % des fumeurs occasionnels comptait au moins un membre fumeur, tandis qu'on ne recensait aucun fumeur dans celui des eleves n'ayant jamais fume. Sur les 316 fumeurs oc- casionnels, 12 % vivaient dans une famille monoparentale contre 5 % pour les eleves n'ayant jamais fume. Selon l'analyse de regression, les facteurs de risque significatifs du tabagisme regulier sont la presence d'un frere ou d'une sœur fumeurs (OR : 8,58) et la presence de plus d'un fumeur parmi les membres de la famille (OR : 6,33). E�e)bJ∂=�e>nJae=�πb£∫ �(i=f√{�o�O»«ae>N ∂=�le=bo=�Hy{�e 2003 AbRj∫�>uebaU�(� …jU�Œ´Ir∫�( ´»fm

"nThe latest American Heart Association (AHA) statement for preventing infectious endocarditis, has not recommended prophylactic antibiotic therapy prior to fiberoptic bronchoscopy (FB) except for patients with preexisting predisposing cardiac conditions. Our aim was to determine the incidence of bacteriemia and fever following FB in our experience and compare with those which have been mentioned in AHA guideline as well as other studies. Venous blood of 85 consecutive patients was evaluated for both aerobic and anaerobic cultures before (for detecting possible previous bacteriemia) and after FB. None of the patients were treated with antibiotics prior to the procedure. All the patients were examined during the first 24 hours after FB for detecting fever defined as temperature more than 38 °C. Positive hemocultures were noted in 7 (8.2 %) patients after FB examination. Coagulase negative Staphylococcus, coagulase positive Staphylococcus, beta haemolytic Streptococcus, Citrobacter freundii and Streptococcus viridans were found in 4, 1, 1 and 1 cultures of patients, respectively. By excluding 6 contaminated samples, the rate of bacteriemia reduced to 1 (1.1%) patient in whom the identical pathogen (Streptococcus viridans) was found both in bronchial lavage and venous blood culture. We also found fever in 9 (10.5 %) cases in the first 24 hours following the bronchoscopy. Our results were in consistent with AHA recommendations regarding prevention of infectious endocarditis as a practical gridline in patients who schedule for FB. Besides, transient fever following bronchoscopy is a common self-limited event which does not need medical intervention.

Introduction: Several species of non-tuberculosis mycobacteria (NTM) can affect humans and can cause either symptomatic or asymptomatic infection. This study aimed to determine the clinical and radiological manifestation, as well as the treatment, of M. simiae in patients in Masih Daneshvari Hospital, a TB referral hospital in Iran. Methodology: This retrospective study involved all patients presenting to our referral center from 2002 to 2009, with confirmation of M. simiae pulmonary infection. For all patients, sputum smear and culture for identification was performed, as was drug susceptibility testing. Additionally, PCR identification methods for NTM, and high-resolution CT scan were conducted. All patients were treated according to American Thoracic Society recommendations.Results: In total, 26 cases of M. simiae were identified in our center. The mean age of the patients was 58.23 ± 16.9years. Only one patient was HIV positive, and all but one were Iranian. The most frequent symptom was coughing (92.3%), and 100% of the patients had nodular lesions. In addition, bronchiectasis and cavitation were present in 84.6% and 88.5% respectively. All the patients were resistant to every first-line drug. Two patients failed the treatment, and twenty-four were cured, after which no recurrence of the disease was observed.Conclusion: M. simiae may present with clinical and radiological manifestations consistent with tuberculosis, and be resistant to anti-TB agents. A more efficient treatment for NTMs such as M. simiae is needed, to shorten the period of treatment and proved fewer adverse effects than current therapies.

Two children in the same family were infected with Mycobacterium bovis (“M. bovis”). The molecular typing showed an identical source of infection. Althoughon school of thought was that the route of transmission was by ingestion of contaminated dairy milk, in other it was thought to be by air-borne transmission. The presentation highlighted the possibility of M. bovis infection in the pediatrics populations through aerosols.

Tuberculosis (TB) and diabetes mellitus (DM) are both important health issues. A bidirectional association between them has been demonstrated by many researchers. The link of DM and TB is more prominent in developing countries where TB is endemic and the burden of diabetes mellitus is increasing. The association between diabetes and tuberculosis may be the next challenge for global tuberculosis control worldwide. Proper planning and collaboration are necessary to reduce the dual burden of diabetes and TB. One model similar to the TB-HIV program for prevention, screening and treatment of both diseases can be the best approach. In this paper, we review existing data and discuss the matters of controversy that would be helpful for determining research priorities in different countries.