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Background Recent reports have indicated the beneficial role of strain measurement in COVID‐19 patients. Hypothesis To determine the association between right and left global longitudinal strain (RVGLS, LVGLS) and COVID‐19 patients' outcomes. Methods Hospitalized COVID‐19 patients between June and August 2020 were included. Two‐dimensional echocardiography and biventricular global longitudinal strain measurement were performed. The outcome measure was defined as mortality, ICU admission, and need for intubation. Appropriate statistical tests were used to compare different groups. Results In this study 207 patients (88 females) were enrolled. During 64 ± 4 days of follow‐up, 22 (10.6%) patients died. Mortality, ICU admission, and intubation were significantly associated with LVGLS and RVGLS tertiles. LVGLS tertiles could predict poor outcome with significant odds ratios in the total population (OR = 0.203, 95% CI: 0.088–0.465; OR = 0.350, 95% CI: 0.210–0.585; OR = 0.354, 95% CI: 0.170–0.736 for mortality, ICU admission, and intubation). Although odds ratios of LVGLS for the prediction of outcome were statistically significant among hypertensive patients, these odds ratios did not reach significance among non‐hypertensive patients. RVGLS tertiles revealed significant odds ratios for the prediction of mortality (OR = 0.322, 95% CI: 0.162–0.640), ICU admission (OR = 0.287, 95% CI: 0.166–0.495), and need for intubation (OR = 0.360, 95% CI: 0.174–0.744). Odds ratios of RVGLS remained significant even after adjusting for hypertension when considering mortality and ICU admission. Conclusion RVGLS and LVGLS can be acceptable prognostic factors to predict mortality, ICU admission, and intubation in hospitalized COVID‐19 patients. However, RVGLS seems more reliable, as it is not confounded by hypertension.

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The Coronavirus Disease 2019 (COVID-19) pandemic has killed many people worldwide since December 2019, and Iran has been among the most affected countries. In this retrospective study, we aimed to determine the prognostic factors associated with mortality in COVID-19 patients by analyzing 396 survived and 63 non-survived patients in Shahid Modarres Hospital, Tehran, Iran, from January 30th until April 5th, 2020. As the results, the BMI > 35 (p = 0.0003), lung cancer (p = 0.007), chronic kidney disease (p = 0.002), Immunocompromised condition (p = 0.003), and diabetes (p = 0.018) were more frequently observed in the expired group. The history of statins use was more common in the discharged group (p = 0.002), while there was no significant difference in the drug history of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, nonsteroidal anti-inflammatory drugs, aspirin, and/or steroids, and in the past-year influenza vaccination. Multivariable regression demonstrated rising odds of in-hospital death related with age (odds ratio (OR) = 1.055, p = 0.002), levels of C-reactive protein (CRP) (OR = 2.915, p < 0.001), creatinine (OR = 1.740, p = 0.023), lymphocyte count (OR = 0.999, p = 0.008), and magnesium level (OR = 0.032, p < 0.001) on admission. In conclusion, the patients with older age and higher BMI with lymphopenia, hypomagnesemia, elevated CRP and/or raised creatinine on admission are at higher risk of mortality due to the COVID-19 infection, which requires the physicians to use timely and strong therapeutic measures for such patients.

BACKGROUND Cardiac involvement by sarcoidosis may affect any part of the heart such as the pericardium, atriums, ventricles, and papillary muscles. In this regard, the use of two-dimensional speckle-tracking strain has been reported to be valuable in detecting heart sarcoidosis and its distinction from cardiomyopathy. The aim of this study was to investigate subclinical cardiac involvement using 2D speckle tracking and its associated factors in patients with normal systolic function by 2D transthoracic echocardiography (TTE). METHODS In this study, 55 patients with extra-cardiac sarcoidosis and 21 normal people were evaluated by 2D speckle tracking. The mean longitudinal global strain for the left ventricle was calculated as an average of 16 segments per patient. RESULTS The comparison of the mean 2D speckle-tracking indices including GCS (global circumferential strain) SAXA, GCSSAXM, Average GCS, AP2LS, AP3LS, AP4LS, and also Average GLS (global longitudinal strain) showed a significant difference between the two groups. Also, the evaluation of each of the above indices with a specific cutoff point as well as a high sensitivity and acceptable specificity predicted the presence of sarcoidosis. The occurrence of changes in the above indices was independent of ventricular function by 2D echocardiography in these patients. CONCLUSIONS The marked changes in the 2D speckle-tracking parameters in patients with extra-cardiac sarcoidosis can be of great value in the prediction of cardiac involvement. The occurrence of the abovementioned cardiac changes can be completely independent of the involvement of left ventricular function and is therefore predictable in patients with normal ventricular function.

Background: There is evidence of musculoskeletal and respiratory involvement in patients with chronic kidney disease (CKD). This is attributed to protein calorie imbalance that is caused by the disease process, and hemodialysis and is generally referred to as uremic myopathy. This results in calcification of respiratory muscles such as diaphragm and intercostal muscles. There are limited data about respiratory muscle strength in patients with CKD. We intended to evaluate the effect of kidney transplantation on respiratory muscles strength in patients with CKD. Materials and Methods: Spirometry was used to measure maximal inspiratory mouth pressure (PIMAX), which was calculated by using the lung residual volume and maximal respiratory pressures at the mouth (PEMAX), 2 days before and again 30 days after kidney transplantation in 26 patients with ESRD. PIMAX and PEMAX values less than 60% of the predicted value were considered abnormal. Results: Mean ± SD PIMAX values showed significant increase from 31.88 ± 8.58 cmH2O before kidney transplantation to 37.65 ± 13.39 cmH2O after transplant (P < 0.001). Similarly, a significant increase in PEMAX values was observed from 33.04 ± 16.12 cmH2O to 39.19 ± 20.34 cmH2O (P < 0.001). Nineteen patients (73.1%) showed significant increases in PIMAX and PEMAX values. Mean serum creatinine decreased from 6.94 to 1.32 (P < 0.001) after transplant. Conclusion: Although both PIMAX and PEMAX values increased significantly after kidney transplant, these measurements were still below lower limit of normal. This suggests that factors other than uremic myopathy may contribute to respiratory muscle weakness in patients CKD.

This present trial investigated the efficacy of supplementation with Chlorella vulgaris, a bioactive microalga rich in macro- and micronutrients, in the improvement of biochemical and clinical symptoms in patients with obstructive pulmonary disorders. Ninety-seven patients with chronic obstructive pulmonary disease (COPD) or asthma who were under conventional treatment regimens were randomly assigned to C. vulgaris extract (CVE) (n=48, 2700 mg/day) or no adjunctive therapy (n=49) for eight weeks. Serum levels of antioxidants along with spirometric parameters and clinical symptoms were evaluated pre- and post-trial. The magnitude of increases in the concentrations of glutathione, vitamin E, and vitamin C, and activities of glutathione peroxidase, catalase, and superoxide dismutase enzymes were all significantly greater in the CVE vs. control group (p&lt, 0.05). In spite of increases, none of the assessed spirometric parameters (FVC, FEV1, FEV1/FVC, and FEF25–75%) did significantly differ by the end of the trial in the study groups, apart from a significant elevation of FEV1 in the control group (p=0.03). The frequency of coughing, shortness of breath, wheezing, and sputum brought up were all significantly reduced in both CVE and control groups (p&lt, 0.05). The rate of improvement for sputum brought up and wheezing were significantly greater in the CVE group compared to the control group (p&lt, 0.05). Although CVE was found to ameliorate serum antioxidant status, its supplementation was not associated with any broncho-dilatory activity. The results of the present trial do not support any clinical efficacy for CVE in patients with obstructive pulmonary disorders.

Please cite this paper as: Tavana et al. (2011) Influenza vaccination in patients with pulmonary sarcoidosis: efficacy and safety. Influenza and Other Respiratory Viruses DOI: 10.1111/j.1750-2659.2011.00290.x. Background Sarcoidosis is an inflammatory, granulomatous disorder of unknown etiology. The role of cellular and humoral immune systems in this disease is unclear, whereas dysregulation of the immune system is suggested. Patients with sarcoidosis show diverse responses while exposed to various antigens. Although influenza vaccination is recommended in pulmonary sarcoidosis, its efficacy and safety has not been investigated. Objectives To evaluate safety and immunogenicity of influenza vaccine in patients with sarcoidosis. Patients/Methods Influenza vaccination was performed in 23 eligible patients with sarcoidosis (SP) and 26 healthy controls (HC). Antibody titers against H1N1, H3N2, and B influenza virus antigens were evaluated just before and 1 month after vaccination. Patients were followed for 6 months to assess vaccine safety. Results Serological response and magnitude of changes in antibody titers against influenza vaccine antigens were comparable between SPs and HCs. Women showed a better serological response against B antigen (P = 0·034) than men. Twenty-four-hour urine calcium was associated with antibody response against H1N1 [correlation coefficient (CC) = 0·477, P = 0·003] and H3N2 (CC = 0·352, P = 0·028) antigens. Serum angiotensin-converting enzyme correlated negatively with antibody response against B antigen (CC = −0·331, P = 0·040). Higher residual volume was associated with fewer rises in antibody titer against H3N2 antigen (CC = −0·377, P = 0·035). No major adverse events or disease flare-up was observed during follow-up. Conclusions In this study, influenza vaccination did not cause any major adverse event in SPs, and their serological response was equal to HCs. Studies with larger sample size and a broader selection of subjects could help validate the results of this study.

Tavana S1, Nadi E1, Ansari M2, zeraati F3, Hashemi H1, Mani Kashani Kh4, Mavallat M5 1. Assistant professor, Department of internal, Faculty of medicine, Hamedan University of medical sciences 2. Associate professor, Department of internal, Faculty of medicine, Hamedan University of medical sciences 3. Associate professor, Department of Pharmacology, Faculty of medicine, Hamedan University of medical sciences 4. Instructor, Department of social medicine, Faculty of medicine, Hamedan University of medical sciences 5. General practitioner, Tuberculosis and lung research group, Faculty of medicine, Hamedan University of medical sciences Abstract Background: Asthma is an inflammatory and chronic disorder of trachobronchial tree that is associated with increased response to allergens. Treatment of acute attack of asthma is short acting b 2 agonist such as Albuterol that is used via a nebulizer or Metered-dose inhaler (MDI) with and attached spacer. Object of this study was evaluation of therapeutic effects of Albuterol via a nebulizer or MDI with an attached holding chamber in patients that had been referred to Emergency departement of Mobasher Hospital in Hamadan. Materials and methods: The present study was a clinical trial (before and after) in 60 patients that were suffered from acute attack asthma. Inclusion criterias were 16-65 years old age patients, FEV1, below 60% of predicted value, and cooperation for spirometry performance. Exclusion criterias were COPD, cardiovascular disorders, pneumonia, preumothorex, or their systemic or pulmonary disorders,severe respiratory failure with cyanosis or confusion, pregnancy and smoking. On arrival to the ED, all patients underwent spirometery and all of patients received oxygen and a single dose of 8 mg intravenous dexamethasone. Immediately thereafter patients were randomized to two groups.The study was designed as double blind trial. The first group patients received four puffs Albuterol attached to spacer and immediately distilled water via nebulizer. The second group patientts received 5 mg Albuterol solution via nebulizer after administration of placebo inhaler attached to holding chamber. All of the patients received a total of four treatment. The first dose was administered immediately after spirometry and then every 30 minutes. Spirometry was performed at entry between to the study and then 15 minutes after each treatment. Results: Analysis of comparison of bronchodilating effects of salbutamol via nebulizer or MDI with attached to spacer showed similar effects in two methods (P>0.05). FEV1, FVC, FEV1/FVC changes were significant among four treatments in every group (P

Background: Asthma is recognized as a common cause of disability, of great economic cost, and of preventable deaths. In this study we aimed to test our hypothesis to evaluate the relationship between the Human Platelet Antigen-1(HPA-1) polymorphism and bronchial asthma and its severity, which would suggest genetic variances that may be responsible for expression or activation of these receptors, so play a role in explaining the suggested genotypic differences in the risk of bronchial asthma occurrence. Materials and methods: To investigate the relation between the HPA-1 polymorphism and bronchial asthma, we con‌ducted a case-control study of 110 patients with bronchial asthma and 129 non-asthmatic outpatient controls, which were participated voluntarily in this study. After the participants answered a questionnaire aimed at identifying their age, sex, clinical signs and symptoms to identify asthma severity, a trained observer assessed airway reversibility in asthmatic patients. To determine HPA-1 allele frequencies (Ia, Ib) and genotyping for Ia+Ia, Ia+Ib and Ib+Ib in both patients and controls, a blood sample was sent to the laboratory. Results: It was found that the dyspnea was the most common symptom in asthmatic patients, recurrent episodic wheezing (93.6%), cough (90%) and nocturnal symptom (89.1%) were other more common symptoms respectively. Assessment of HPA-1 allele frequencies (Ia, Ib) and genotyping for Ia+Ia, Ia+Ib and Ib+Ib showed no differences in both patients and controls (P>0.05). The rate of Ia allele frequency and Ia+Ia genotype had a direct relationship with asthma severity. Conclusion: We observed strong association between HPA-1a allele and asthma severity, but no association between the presence of HPA-1 polymorphism and bronchial asthma.

Background: Muscle weakness especially weakness of the respiratory muscles is a complication of chronic kidney disease. The cause of muscle weakness is the accumulation of excessive amounts of urea and other toxins. The aim of this study was to assess the effect of hemodialysis on respiratory muscle strength by measuring maximum inspiratory (PI max) and expiratory pressure (PE max). Materials and Methods: A cross sectional study was carried out on 31 patients with chronic kidney disease at Modarres hospital in 2012. Before hemodialysis, patients had their PI max and PE max taken by using a manovacuometer. After that, the patients were connected to the dialysis machine. At the end of the hemodialysis, the patients had their PI max measured again. Data were assessed by the multivariate regression test. Results: Before dialysis, PI max and PE max were lower than normal levels. After the hemodialysis session, repeat PFT revealed an increase in PE max and no significant change in PI max. There were strong correlations between hypoalbuminemia, anemia, hypercalcemia, hyperphosphatemia, hyperparathyroidism and decreased respiratory muscle strength. Also, the respiratory muscle strength decreased in the elderly and women. Conclusion: Respiratory muscle weakness is a complication of chronic kidney disease; hemodialysis can improve muscle strength and PI max.

Background: Silica is an element that accounts for 28 percent of the earth’s crust. Silicosis is a relatively common cause of lung disease that is associated with high morbidity and mortality. Some types of work, such as mining, stone cutting, pottery, and road and building construction are associated with an increased risk of silica exposure, which can lead to silicosis. Silicosis is divided into acute, chronic, and accelerated forms. Due to the high prevalence and lack of proper treatment, use and detection of new trophy and particular prophylaxis methods against this disease is needed. Objectives: In addition, due to the side effects of drugs and the lack of their complete efficacy, we studied the effects of the natural compound, Chlorella vulgaris, in addition to the other available treatments. This study provided insight into the effectiveness of chlorella. Patients and Methods: Chlorella vulgaris was prescribed in addition to the other available chemical drugs for 8 weeks to a group of patients, and its effects on the clinical symptoms, general appearance, and spirometry indices were studied. Because increase confidence outcome of study the other group spot as control group. These two groups assimilate from all aspects. Results: This study showed that Algomed improves cough, sputum, dyspnea and lung auscultation findings. Therefore, the evaluation of spirometry indices showed improvement in FEV 1 and FVC. Conclusions: We conclude that Chlorella vulgaris is effective for treating silicosis. However, due to the limited number of patients and the short duration of the study, longer time periods and an increased number of patients are required for more definitive results.

BACKGROUND Smoking is among the established yet modifiable risk factors for cancers, cardiovascular diseases, and pulmonary disorders. Oxidative stress has been proposed as a key mechanism mediating the deleterious consequences of smoking. The present study evaluated the effect of supplementation with Chlorella vulgaris, a nutrient and bioactive green microalgae with proven antioxidant capacity, on the burden of oxidative stress in Iranian smokers. METHODS Thirty-eight smokers (mean age: 37.11 +/- 1.69 years; females: 18.4%) were administered C. vulgaris extract (3600 mg/day) for a period of 6 weeks. Fasted serum samples collected at baseline and after the completion of study were analyzed for the concentrations of vitamin C, vitamin E, glutathione, and malonedialdehyde (MDA) as well as activities of superoxide dismutase, glutathione peroxidase, and catalase. Total antioxidant capacity of serum was also determined by the ability of serum to inhibit the formation of ferryl myoglobin radical species. RESULTS Six-week supplementation with C. vulgaris extract in smokers was associated with marked elevation of all assessed serum antioxidant measures (p < 0.001) and significant reduction of MDA levels (p = 0.002). After gender segregation, a similar pattern of changes was observed for both male and female subjects apart from lack of significant change in serum vitamin E status in females. Although the magnitude of change in serum vitamin E was significantly greater in males compared to females (p = 0.014), there was no significant change in the magnitude of changes for other assessed parameters between the genders. CONCLUSIONS Supplementation with C. vulgaris extract significantly improves antioxidant status and attenuates lipid peroxidation in chronic cigarette smokers. Hence, C. vulgaris might prevent the disease burden and mortality rate associated with smoking.

Please cite this paper as: Tavana et al. (2011) Influenza vaccination in patients with pulmonary sarcoidosis: efficacy and safety. Influenza and Other Respiratory Viruses DOI: 10.1111/j.1750‐2659.2011.00290.x. Background Sarcoidosis is an inflammatory, granulomatous disorder of unknown etiology. The role of cellular and humoral immune systems in this disease is unclear, whereas dysregulation of the immune system is suggested. Patients with sarcoidosis show diverse responses while exposed to various antigens. Although influenza vaccination is recommended in pulmonary sarcoidosis, its efficacy and safety has not been investigated. Objectives To evaluate safety and immunogenicity of influenza vaccine in patients with sarcoidosis. Patients/Methods Influenza vaccination was performed in 23 eligible patients with sarcoidosis (SP) and 26 healthy controls (HC). Antibody titers against H1N1, H3N2, and B influenza virus antigens were evaluated just before and 1 month after vaccination. Patients were followed for 6 months to assess vaccine safety. Results Serological response and magnitude of changes in antibody titers against influenza vaccine antigens were comparable between SPs and HCs. Women showed a better serological response against B antigen (P = 0·034) than men. Twenty‐four‐hour urine calcium was associated with antibody response against H1N1 [correlation coefficient (CC) = 0·477, P = 0·003] and H3N2 (CC = 0·352, P = 0·028) antigens. Serum angiotensin‐converting enzyme correlated negatively with antibody response against B antigen (CC = −0·331, P = 0·040). Higher residual volume was associated with fewer rises in antibody titer against H3N2 antigen (CC = −0·377, P = 0·035). No major adverse events or disease flare‐up was observed during follow‐up. Conclusions In this study, influenza vaccination did not cause any major adverse event in SPs, and their serological response was equal to HCs. Studies with larger sample size and a broader selection of subjects could help validate the results of this study.