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Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) has the highest mortality rate and medical costs. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte (PLR) ratio are inflammatory markers that have been recently linked to the AECOPD severity and patient outcome.Therefore, the present study aimed at evaluating the diagnostic value of NLR and PLR in the prognosis of the in-hospital mortality in AECOPD patients.The present retrospective study was performed on 829 AECOPD patients. Age, gender and laboratory results of CBC tests including lymphocyte count, neutrophil count, platelet count, hemoglobin count, white blood cell count (WBC), eosinophil cell count, NLR, PLR and CRP as well as the mortality data were collected from the patients' records and subsequently recorded.The results of the present study revealed that NLR with the cut-off value of 6.90, sensitivity of 60.87%, and specificity of 73.29% had a significant diagnostic value in the prognosis of in-hospital mortality in AECOPD patients (P0.05). A similar significant finding regarding the diagnostic value in the prognosis of in-hospital mortality in AECOPD patients was obtained for CRP with the cut-off value of 30, sensitivity of 73.08%, and specificity of 60.26% (P0.05). However, the diagnostic value of PLR in the prognosis of in-hospital mortality in AECOPD patients was found to be insignificant (P = 0.18).According to the results of the present study, NLR6.90 can be considered as a valuable and accurate marker in the prognosis of in-hospital mortality in AECOPD patients.

Background: Recently, the prevalence of metabolic syndrome in societies is increasing. In this study, we investigated the association between metabolic syndrome and the severity of chronic obstructive pulmonary disease (COPD) based on the Global Initiative for Chronic Obstructive Lung Disease 2017 (GOLD 2017) criteria for outpatients. Methods: In this cross-sectional study, 96 patients with COPD to Alzahra hospital in Isfahan, Iran, during the years 2016 and 2018 were enrolled. The severity of COPD in patients was determined based on the GOLD 2017 criteria, as well as the frequency of metabolic syndrome. Other factors such as lipid profiles, anthropometric characteristics were evaluated, and the association between severity of COPD and metabolic syndrome with other variables were studied. Findings: The frequency of metabolic syndrome in patients with COPD was 86.5%. The mean of waist circumference, fasting blood sugar (FBS), systolic (SBP) and diastolic blood pressure (DBP), body mass index (BMI), and triglyceride in patients with metabolic syndrome and COPD were significantly higher than patients with COPD without metabolic syndrome (P < 0.050). Moreover, there was no significant relationship between COPD severity and metabolic syndrome (P > 0.050). Conclusion: Metabolic syndrome was not associated with severity of COPD based on our findings, and further studies are needed.

Purpose: Data on the link between adherence to low-carbohydrate diet (LCD) and odds of chronic obstructive pulmonary disease (COPD) are scarce. The current study aimed to investigate the relation between adherence to LCD and COPD in Iranian adults.Methods: In this hospital-based case-control study, we enrolled 84 newly-diagnosed COPD patients and 252 age and sex matched healthy controls in Alzahra University Hospital, Isfahan, Iran. COPD was defined based on findings of spirometry test (forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) < 70% or FEV1 < 80%). Dietary intakes of study participants were assessed using the validated Block-format 168-item FFQ. Data on potential confounders were also collected through the use of a pre-tested questionnaire. Results: Mean age of cases and controls were 57.7 and 55.07 years, respectively. Adherence to LCD was inversely associated with odds of COPD (0.35; 95% CI: 0.16-0.75). This inverse association did not alter after controlling for age, sex, and energy intake (0.42; 95% CI: 0.19-0.93). Adjustments for other potential confounders, including dietary intakes, smoking and educational status, did not affect these findings; such that those in the top quintile of LCD score were 64% less likely to have COPD than those in the bottom quintile (OR: 0.36; 95% CI: 0.13-0.99). Conclusion: We found an inverse association between adherence to LCD and odds of COPD. The association remained statistically significant even after taking other potential confounders, including socioeconomic characteristic and dietary intakes into account.

Metabolic syndrome is the most common problem worldwide associated with numerous complications. Some studies indicated that metabolic syndrome is associated with asthma; therefore, this study aimed to investigate the possible relationship between metabolic syndrome components and severity of asthma in outpatients referring to Alzahra Hospital in Isfahan, Iran.This descriptive cross-sectional study was performed on 200 patients with asthma referring to Alzahra Lung Clinic in Isfahan, Iran, within 2018-2020. The severity of asthma was evaluated by the Guidelines for the Diagnosis and Management of Asthma by the National Institutes of Health. The association between different categories of asthma severity and metabolic syndrome was investigated.The patients were divided into four categories according to the severity of asthma, including intermittent (n=63), mild (n=63), moderate (n=56), and severe (n=18). Moreover, 38.5% (n=77) of patients had metabolic syndrome, and there was no significant relationship between different categories of asthma severity and metabolic syndrome (P=0.73).The prevalence of metabolic syndrome is high among patients with asthma; however, there was no significant relationship between metabolic syndrome and different categories of asthma severity.

The present study aimed at determining and comparing the prognostic value and the relationship of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios (PLRs) with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).The present case-control study was performed on 100 chronic obstructive pulmonary disease patients and 100 healthy subjects (controls). Age, gender, and laboratory results of complete blood count tests including lymphocyte count, neutrophil count, platelet count, hemoglobin level, neutrophil-to-lymphocyte ratio (NLR), PLR, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were obtained from the patient report and then recorded. The mentioned information was also completed for the control group. Following hospitalization, the patients that were discharged with clinically stable general status were re-examined, and the aforementioned laboratory information was rerecorded.The results of the present study revealed that NLR with the sensitivity and specificity of 83.00% (74.2%-89.8%) and 93.00% (86.1%-97.1%) (cutoff value of 2.3), PLR with the sensitivity and specificity of 56.00% (46.0%-66.3%) and 83.00% (74.2%-89.8%) (cutoff value of 135.8), white blood cell (WBC) with the sensitivity and specificity of 69.00% (57.7%-77.8%) and 78.00% (68.6%-85.7%) (cutoff value of 8.5 × 103 μl), ESR with the sensitivity and specificity of 84.00% (75.3%-90.6%) and 99.00% (94.6%-100.0%) (cutoff value of 7.8), and CRP with the sensitivity and specificity of 52.00% (41.8%-62.1%) and 81.00% (71.9%-88.2%) (cutoff value of 1.9), respectively, had a significant prognostic value of AECOPD (According to the results of the current study, NLR and PLR had a significant direct relationship with the two main markers of ESR and CRP, and both ratios had a significant prognostic value in AECOPD.

This case-control study was designed to investigate the association between adherences to the Dietary Approaches to Stop Hypertension (DASH) diet in patients with chronic obstructive pulmonary disease (COPD) in comparison to subjects without COPD.This is a case-control study. Usual dietary intake was assessed using a validated food frequency questionnaire. Lung function was evaluated with spirometry testing, and one of the researchers inquired about other respiratory symptoms, including chronic cough, sputum, and breathlessness. Adherence to the DASH dietary pattern was assessed according to the Fung method.This study was conducted at Alzahra University Hospital of Isfahan, Iran, in 2015.Eight-four patients with COPD and 80 subjects without a history of COPD participated in study.The mean age of participants was 57 years. Average smoking in the case group was about 27.5 pack-years. Spirometry tests including forced expiratory volume in 1 second (FEVWe observed that adherence to a DASH dietary pattern among patients with COPD was significantly lower compared to the control group. Cough was significantly decreased by increments in adherence to a DASH dietary pattern.

Background: Malignant Pleural Effusion (MPE) is a condition that mostly presents with dyspnea. There are some ways to distinguish it from Non-Malignant Pleural Effusion (NMPE).The aim of this study was to compare serum and pleural D-dimer levels between MPE and NMPE patients. Materials and Methods: Patients diagnosed with Pleural Effusion (PE) were selected to participate in this study. They were allocated in 2 groups of MPE and NMPE according to the etiology. Serum and pleural fluid D-dimer level were measured and statistically analyzed between two groups. Results: 32 MPE patients and 32 NMPE patients participated in this study. The mean age was 61.3 ± 12 years and M/F ratio was 35/29. The mean pleural and serum D-dimer levels were 3472± 1312 ng/dl and 3259±1220 ng/dl in patients with MPE, and 3425 ± 32.5ng/dl and 2425 ± 1311ng/dl in patients with NMPE, respectively. The serum D-dimer levels were not statistically different between 2 groups; while the pleural D-dimer levels were higher in MPE group in comparison with NMP patients (P

Acute necrotic collections (ANC) and walled-off necrosis (WON), often performed at least two weeks after the onset of symptoms [1], become infected in about one-third of patients [2].

Background: Candida dubliniensis is a newly diagnosed species very similar to Candida albicans phenotypically and first discovered in the mouth of people with AIDS in 1995. Among the different phenotypic and genotypic methods, a cost-effective method should be selected which makes it possible to differentiate these similar species. Materials and Methods: Polymerase chain reaction (PCR)-restriction fragment length polymorphism with MspI enzyme and the Duplex-PCR method were done by DNA extraction using boiling. The sequencing of the amplified ribosomal region was used to confirm the C. dubliniensis species. Direct examination and colony count of the yeasts were applied for bronchoalveolar lavage (BAL) samples and the growth rate of the yeasts were studied at 45°C. To understand the ability formation of chlamydoconidia in yeast isolates, they were separately cultured on the sunflower seed agar, wheat flour agar, and corn meal agar media. Results: Fifty-nine (49.2%) yeast colonies were identified from the total of 120 BAL specimens. Twenty-nine isolated yeasts; including 17 (58.6%) of C. albicans/dubliniensis complex and 12 (41.4%) of nonalbicans isolates produced pseudohypha or blastoconidia in direct smear with a mean colony count of 42000 CFU/mL. C. albicans with the frequency of 15 (42.9%) were the most common isolated yeasts, whereas C. dubliniensis was identified in two nonHIV patients. Conclusion: Sequencing of the replicated gene fragment is the best method for identifying the yeasts, but the determination of the species by phenotypic methods such as the creation of chlamydoconidia in sunflower seeds agar and wheat flour agar media can be cost-effective, have sensitivity and acceptable quality.

Background: Chronic obstructive pulmonary disease (COPD) is a non-specific inflammation, which involves the airways, lung parenchyma and pulmonary vessels. The inflammation causes the activation of inflammatory cells and the release of various inflammatory mediators such as interleukin-8 (IL-8), IL-6 and tumor necoris factor alpha (TNF-a). The purpose of the present study was to measure serum IL-6, C-reactive protein (CRP) (as a positive phase reactant) and albumin level (as a negative phase reactant) in COPD patients (only due to cigarette smoking not bio-mass), non COPD smokers and healthy subjects using enzyme-linked immunosorbent assay (ELISA); we compared the differences in inflammatory factors among groups. Materials and Methods: A total of 180 males were enrolled in this study and divided into three equal groups. The first group was 60 smokers who had COPD. The second group included 60 smokers without COPD and the third group consisted of people who were not smokers and did not have COPD; 5 mL of venous blood was taken from all participants and it was collected in a test tube containing anticoagulant and then centrifuged at 3000 rpm for 10 minutes. Serum was separated and used to measure the amount of IL-6, CRP and albumin. Spirometry was performed according to the criteria set by the American Thoracic Society. Results: The mean serum level of IL-6 was 83.2±7.5 pg/mL in group I, 54.9±24.3 pg/mL in group II and 46.9±10.4 pg/mL in group III. There was a significant difference among the three groups (P

Introduction: Corticosteroids are routinely used in management of chronic obstructive pulmonary disease (COPD) exacerbation. The main purpose of present study was to compare the efficacy of methyl prednisolone (MP) and dexamethasone (DXM) for this purpose. Methods: Adult COPD patients entered the present clinical trial. All patients received standard treatment on admission and were then divided into 2 groups of intravenous MP and DXM. Patients were asked to rate their shortness of breath; sputum volume and viscosity; dyspnea; cough; and general wellbeing on a 0-5 scale. Baseline parameters such as O2 saturation, arterial blood gas parameters, and white blood cell (WBC) count were compared on admission and day 7 and 14 of therapy using SPSS 22. Results: 68 patients were randomly allocated to 2 groups of 34 (82.4% male). The baseline characteristics of the two groups were similar (p < 0.05). Comparison of treatment outcomes for the 7th day showed a significant difference between the 2 groups only regarding cough (p = 0.047), HCO3 (p < 0.001), and O2 saturation (p = 0.042). On day 14 the 2 groups were different only regarding cough (p = 0.048) and sputum viscosity (p = 0.011). There was a significant difference between the two groups regarding trend of changes in dyspnea (p = 0.02; DXM >> MP) and cough (p = 0.035; MP >> DXM). There were no significant differences between the two medications regarding side effects on 7th and 14th day after treatment. Conclusion: It seems that MP and DXM have similar efficacy and side effects in treatment of COPD exacerbation and selecting drug of choice would better be based on the most prominent symptoms of patients on admission.

Background: This study aimed to determine anthropometric indicators associated with dyspnea and spirometric parameters in patients with chronic obstructive pulmonary disease (COPD). Materials and Methods: A cross-sectional and observational study was carried out on 88 patients with COPD, who were visited in an outpatient respiratory clinic of a university hospital during two months. Patient height, weight, body mass index (BMI), waist circumference (WC), mid-upper arm circumference (MUAC), triceps skinfold thickness (TSFT) and subscapular skinfold thickness (SST) were recorded. Also, data on lung function and dyspnea were collected. The association between anthropometric indices and other parameters was studied. Results: Pearson’s correlation coefficient showed that forced expiratory volume in one second (FEV1)% predicted was positively correlated with BMI (R=0.239, P

Background: Candida dubliniensis is a newly diagnosed species very similar to Candida albicans phenotypically and first discovered in the mouth of people with AIDS in 1995. Among the different phenotypic and genotypic methods, a cost-effective method should be selected which makes it possible to differentiate these similar species. Materials and Methods: Polymerase chain reaction (PCR)-restriction fragment length polymorphism with MspI enzyme and the Duplex-PCR method were done by DNA extraction using boiling. The sequencing of the amplified ribosomal region was used to confirm the C. dubliniensis species. Direct examination and colony count of the yeasts were applied for bronchoalveolar lavage (BAL) samples and the growth rate of the yeasts were studied at 45°C. To understand the ability formation of chlamydoconidia in yeast isolates, they were separately cultured on the sunflower seed agar, wheat flour agar, and corn meal agar media. Results: Fifty-nine (49.2%) yeast colonies were identified from the total of 120 BAL specimens. Twenty-nine isolated yeasts; including 17 (58.6%) of C. albicans/dubliniensis complex and 12 (41.4%) of nonalbicans isolates produced pseudohypha or blastoconidia in direct smear with a mean colony count of 42000 CFU/mL. C. albicans with the frequency of 15 (42.9%) were the most common isolated yeasts, whereas C. dubliniensis was identified in two nonHIV patients. Conclusion: Sequencing of the replicated gene fragment is the best method for identifying the yeasts, but the determination of the species by phenotypic methods such as the creation of chlamydoconidia in sunflower seeds agar and wheat flour agar media can be cost-effective, have sensitivity and acceptable quality.