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Background: The therapeutic options for patients with interstitial lung disease (ILD) are limited. On the other hand, the role of noninvasive ventilation (NIV) in ILD management is not clear. This study investigated the effect of nighttime NIV in hypercapnic ILD patients. Materials and Methods: In this unblinded randomized clinical trial, we included a total of 20 ILD patients admitted in a specialized center with hypoxia, PaCO2>45, and HCO3>27. Participants were randomly allocated into two groups; intervention (nighttime NIV plus standard treatment) and control (standard treatment). The severity of dyspnea and the quality of life (QoL) was evaluated at beginning of the trial and after 30 days through Modified medical research council (mMRC) dyspnea scale and the SF-36 health survey questionnaire. Paired or Wilcoxon Signed rank tests and independent samples t-test or Mann-Whiney U test were used for between and within groups analyses, respectively. Results: The mean age of 20 patients enrolled was 62.57±6.67 and 40% were male. Although, a clinical significant improvement of dyspnea was detected in NIV group (P=0.046) after intervention, it was not statistically different from control group. Significant improvement was observed in physical functioning (P<0.001), social functioning (P=0.004) and pain (P=0.003) detected after 30 days in NIV group and the observed improvement in QoL was significantly higher than control group for physical functioning (P=0.042) and general health (0.049). Conclusion: Our results suggest NIV treatment in patients with ILD and hypercapnic respiratory failure could be advised in order to improve physical functioning. [ABSTRACT FROM AUTHOR]

Background: COVID-19, with its high transmission and mortality rates and unknown outcomes, has become a major concern in the world. Among people with COVID-19, severe cases can quickly progress to serious complications, and even death. So, the present study aimed to examine the relationship between the severity of the disease and the outcome in patients afflicted by COVID-19 during hospitalization. Methods: A total of 653 patients with COVID-19 aged 18 years or older were included from Khorshid hospital in Isfahan, Iran and followed for a mean of 22.72 days (median 23.50; range 1--47). Severe COVID-19 was defined by respiration rate ≥ 30 times/min, oxygen saturation level ≤ 88% in the resting position, and pulse rate ≥ 130/min. The primary outcome was mortality. The secondary outcomes included need for mechanical ventilation and intensive care unit (ICU) admission. Results: During 4233 person-days of follow-up, 49 (7.5%) deaths, 27 (4.1%) invasive ventilation and 89 (13.6%) ICU admissions in hospital were reported. After adjustment for potential confounders, severity of the disease was positively associated with risk of mortality, invasive ventilation and ICU admissions (hazard ratio [HR]: 5.99; 95% CI: 2.85, 12.59; P < 0.001, HR: 7.09; 95% CI: 3.24, 15.52; P < 0.001 and HR: 4.88; 95% CI: 2.98, 7.98; P < 0.001, respectively). In addition, greater age (HR = 1.04; 95% CI = 1.02-1.07; P = 0.002), chronic kidney disease (HR = 3.05; 95% CI = 1.35, 6.90; P = 0.008), blood urea nitrogen (BUN) (HR = 1.04; 95% CI = 1.03--1.05; P < 0.001) and creatinine (HR = 1.44; 95% CI = 1.26-1.65; P < 0.001) were probably significant risk factors for mortality in severe COVID-19 patients. Conclusion: More intensive therapy and special monitoring should be implemented for patients with older age, hypertension and kidney disease who are infected with COVID-19 to prevent rapid worsening. [ABSTRACT FROM AUTHOR]

The COVID-19 is rapidly scattering worldwide, and the number of cases in the Eastern Mediterranean Region is rising. Thus, there is a need for immediate targeted actions. We designed a longitudinal study in a hot outbreak zone to analyze the serial findings between infected patients for detecting temporal changes from February 2020. In a hospital-based open-cohort study, patients are followed from admission until one year from their discharge (the 1st, 4th, 12th weeks, and the first year). The patient recruitment phase finished at the end of August 2020, and the follow-up continues by the end of August 2021. The measurements included demographic, socio-economics, symptoms, health service diagnosis and treatment, contact history, and psychological variables. The signs improvement, death, length of stay in hospital were considered primary, and impaired pulmonary function and psychotic disorders were considered main secondary outcomes. Moreover, clinical symptoms and respiratory functions are being determined in such follow-ups. Among the first 600 COVID-19 cases, 490 patients with complete information (39% female; the average age of 57±15 years) were analyzed. Seven percent of these patients died. The three main leading causes of admission were: fever (77%), dry cough (73%), and fatigue (69%). The most prevalent comorbidities between COVID-19 patients were hypertension (35%), diabetes (28%), and ischemic heart disease (14%). The percentage of primary composite endpoints (PCEP), defined as death, the use of mechanical ventilation, or admission to an intensive care unit was 18%. The Cox Proportional-Hazards Model for PCEP indicated the following significant risk factors: Oxygen saturation < 80% (HR = 6.3; [CI 95%: 2.5,15.5]), lymphopenia (HR = 3.5; [CI 95%: 2.2,5.5]), Oxygen saturation 80%-90% (HR = 2.5; [CI 95%: 1.1,5.8]), and thrombocytopenia (HR = 1.6; [CI 95%: 1.1,2.5]). This long-term prospective Cohort may support healthcare professionals in the management of resources following this pandemic. [ABSTRACT FROM AUTHOR]

Background: Most of patients with Obstructive Sleep Apnea (OSA) are at risk of metabolic syndrome. The treatment of choice for OSA patients is the Continuous Positive Airway Pressure (CPAP). Reports about the effect of CPAP on metabolic parameters are controversial. So, we aimed to evaluate the effect of CPAP therapy on blood pressure, Fasting Blood Sugar (FBS), and serum lipids including: Triglycerides (TG), total cholesterol (Chol), High Density Lipoproteins (HDL), and Low Density Lipoproteins (LDL). Materials and Methods: This study included 35 OSA patients. Initially, their baseline demographic and clinical characteristics were recorded. Then, the patients underwent CPAP therapy on average 4-7 hours for 8 weeks. The level of FBS, TG, Cholesterol, HDL, LDL, and blood pressure were measured and recorded before and after treatment. Finally, the collected data were analyzed with SPSS version 22. Results: This study included 35 OSA patients [24 men (68.6%)], with mean age of 45.58±8.02 years. Results indicated that CPAP therapy led to decrease of 9.76 and 3.49 mmHg in systolic and diastolic blood pressures, respectively. Also, LDL decreased to 6.27mg/dl and HDL increased to 0.75 mg/dl (P<0.001) with treatment. The changes of other variables were not significant (P>0.05). Conclusion: Treatment of OSA with CPAP has beneficial effects on blood pressure and some items of lipid profile. Regarding the importance of metabolic disturbances in OSA complications, choosing an appropriate treatment for OSA patients can play an important role in improvement of patients status as well as prevention of these complications. [ABSTRACT FROM AUTHOR]

Introduction: There are studies about polysomnographic (PSG) characteristics of patients with either obesity hypoventilation syndrome (OHS) or addiction. We aimed to investigate the PSG characteristics of obstructive sleep apnea (OSA) patients with opium addiction, those on methadone maintenance treatment (MMT), and non-addicts for the treatment of addiction. Methods: In this cross-sectional study, we enrolled 75 patients with OHS in the Bamdad Respiratory and Sleep Research Center affiliated with the Isfahan University of Medical Sciences between January 2020 and February 2021. The patients were categorized into three groups: Opium addicts (OA), MMT, and non-addicts (NA). All patients completed screening questionnaires for OSA. This included the Epworth sleepiness scale (ESS), stop-bang questionnaire, and Berlin questionnaire and the data analyzed by SPSS software, version 24. Results: A total of 75 OHS patients (54 men [72%] and 21 women [28%]) were studied in three groups, including OA (n=30), MMT (n=15), and NA (n=30). The apnea hypopnea index was not significantly different between the three groups. The longest apnea duration was higher in the OA than in other groups (P=0.001). Central apnea index (P=0.01), longest hypopnea duration (P=0.04), PaCO2 (P=0.04), and time with SpO2?90% (T90) (P=0.009) were higher in the MMT than in other groups. Furthermore, the minimum SpO2 was lower in the MMT than in other groups (P=0.03). Conclusion: Some of the sleep disturbances were worse in the MMT than in the OA group. This suggests the need for further studies to compare the effects of opium and methadone on sleep in OHS patients. [ABSTRACT FROM AUTHOR]

Background: Obstructive sleep apnea (OSA) is defined by recurrent apnea and hypopnea during sleep. The main treatment of OSA is continuous positive airway pressure (CPAP). Adherence to CPAP is challenging and depends on multiple factors. This study was designed to evaluate the compliance with CPAP in patients with OSA. Materials and Methods: This was a prospective observational study including 106 patients with confirmed OSA by a standard polysomnography. We recorded CPAP usage hours after 7 and 90 days by a smart card. We compared the adherence of the patients with respect to body mass index (BMI), gender, smoking status, living area, and education level. Results: Patients in the 18-45 years' age group had higher compliance in mean (standard deviation) daily use of CPAP (0.93 [0.40] h) compared to the other age groups (P < 0.001). Patients with BMI >35 had better compliance (1.13 [0.44]) than the other patients (P < 0.001). Furthermore, nonsmokers and highly educated patients had better compliance compared to the others (P < 0.001). Conclusion: Age, BMI, education, and smoking are important factors in adherence to CPAP in patients with OSA. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) is a major cause of chronic morbidity and mortality throughout the world. Exacerbation of COPD has negative effect on quality of life. Therapeutic effect of nebulized antibiotics in pulmonary infections has been reported previously. Hence, we evaluated the effect of nebulized gentamicin in acute exacerbation of COPD (AECOPD). Materials and Methods: In this clinical trial study, 86 hospitalized patients with AECOPD were divided into two groups for using nebulized gentamicin twice daily (case group) and placebo (control group) for 5 days in addition to standard treatment. On admission and on the 6th day, respiratory rate (RR), white blood cell (WBC), spirometry, and SPO² (arterial O² saturation by pulse oxymetry) were measured in groups. The severity of dyspnea was evaluated by the Medical Research Council scale. Results: In both groups, changes of SpO2, RR, forced an expiratory volume of first second (FEV1), and forced vital capacity (FVC) were significant during the times of intervention (P < 0.05). However, changes of FEV1 and FVC were significantly different between two groups (P < 0.05). So that increments of FEV1 and FVC were higher in the case group than control group. WBC decreased significantly in the case group (P < 0.05) compared to control group. There was no significant difference between groups in severity of dyspnea after intervention (P > 0.05). Conclusion: Treatment with Nebulized Gentamicin in AECOPD exacerbation resulted in further improvement of FVC and FEV1 on the 6th day. [ABSTRACT FROM AUTHOR]

Background: There was the association between the metabolic syndrome (MS) and obstructive sleep apnea (OSA). Also, the genetic factors have been implicated in the OSA. Our aim was to compare the frequency of MS in first-degree relatives (FDRs) of OSA patients with healthy controls. Methods: 39 FDR (parents, siblings, and children) of patients diagnosed with OSA at Bamdad Respiratory and Research Center as cases and age- and sex-matched healthy controls were included in the current case-control pilot study. The sampling method was convenience sampling based on having inclusion criteria and consent to participate in the study. Demographic characteristics and essential criteria for diagnosing MS included blood pressure, anthropometric [weight (kg), height (cm), waist circumference (cm) and body mass index (BMI) (kg/m2)], and biochemical indices (lipid profile and blood glucose) were assessed based on standard protocols. Results: In the comparison of the demographic and clinical characteristics of two39 cases and control groups, weight and diastolic blood pressure were significantly higher in case group than controls (P < 0.05). Case and control groups were not significantly different in the frequency of MS (P > 0.05). Although, the frequency of hypertension as an important cardiovascular risk factor was higher in cases than controls (P < 0.05). Conclusions: The present study demonstrates that the frequency of MS is not significantly different between FDRs of OSA patients and controls. However, further large-scale studies are warranted to detect the frequency of MS in people with hereditary background for OSA compared to general population. [ABSTRACT FROM AUTHOR]

Background: Non‐invasive positive pressure ventilation (NIPPV) is known to enhance hypoventilation and is particularly adopted as a treatment for patients diagnosed with obesity hypoventilation syndrome (OHS). The augmented risk of cardiovascular morbidity is known as a side effect of OHS. Aims: In this paper, this inference is examined that hypoventilation and the increased risk of morbidity can be diagnosed via the assessment of changes in heart rate variability (HRV). More specifically, the study investigates the effect of NIPPV on both HRV and hypoventilation among OHS patients. The linear relationship between different HRV measures and ventilation parameters is also examined. Materials & Methods: The reported results are attained via an interventional clinical trial study. HRV measures are evaluated before and after treatment, in a group of patients which are newly diagnosed with OHS and receive bi‐level positive airway pressure (BiPAP) treatment for three months. Results: The results are compared and interpreted via statistical analysis. Discussion: Throughout the study, the relationship between hypoventilation and HRV is confirmed, as well as the effect of BiPAP on some HRV measures in both time and frequency domains. Particularly significant connections are observed between hypoventilation and low‐frequency components of HRV. Conclusion: The enhanced respiration due to the application of BiPAP can improve the performance of autonomous nervous and cardiovascular systems, in terms of HRV. Moreover, it is suggested to consider some HRV parameters to control the cardiovascular side‐effects of OHS and confine the resulting mortality rate in long term. [ABSTRACT FROM AUTHOR]

BACKGROUND: Coronavirus disease 2019 (COVID-19) has led to considerable morbidity and mortality worldwide and myocardial injury has been one of the most common findings in the affected patients. However, published evidence of cardiac evaluation by imaging techniques including echocardiography is rare. We aimed to evaluate myocardial involvement by echocardiography in patients with severe COVID-19. METHODS: We studied 64 patients with severe COVID-19 who were admitted in the intensive care unit (ICU) in Khorshid Hospital, Isfahan, Iran, from February 20, 2020 until May 20, 2020. Demographic characteristics, laboratory tests, and electrocardiography (ECG) data were collected and transthoracic echocardiography (TTE) using a focused time-efficient echocardiography protocol was performed. RESULTS: Mean age of the participating patients was 66.40 ± 14.14 years (range: 34.0-92.0 years), and 35 patients (54.7%) were men. Reduced left ventricular (LV) systolic function was seen in 20 (32%) patients. Only 4 patients had LV ejection fraction (LVEF) less than 40%. Cardiac troponin I (cTn-I) was elevated (over 15 pg/ml) in 39 (60.9%) patients and was significantly associated with higher mortality in these patients (P = 0.05). In addition, dynamic ST and T wave changes and new bundle branch blocks had a significant association with adverse clinical outcome (P = 0.05 and P = 0.02, respectively). CONCLUSION: New LV systolic dysfunction (LVSD) in patients with severe COVID-19 was mild to moderate and not uncommon and had no significant adverse effect on the prognosis of these patients, although elevation of cardiac biomarkers could predict mortality and had an adverse effect on clinical outcome. [ABSTRACT FROM AUTHOR]

Background: This study aimed to assess the outcomes of bi-level positive airway pressure (BIPAP) therapy among patients with obesity hypoventilation syndrome (OHS). Materials and Methods: In this prospective observational study, a total of 30 patients with OHS, who were subjected to BIPAP therapy, were included. The peripheral capillary oxygen saturation (SPO2), partial pressure of carbon dioxide (PCO2), body mass index (BMI), and body composition indices, including total body fat (TBF), total body protein (TBP), total body mineral (TBM), and total body water (TBW), were measured using standard procedures at baseline and one week, one month, and six months after the onset of treatment. Changes in the variables over time were evaluated using repeated measures analysis of variance (ANOVA). The correlation between changes in the body composition indices and changes in gas exchange was also assessed by Pearson's correlation coefficient test at three time points from the baseline. Results: The results revealed that all study variables, except for TBF, changed significantly during the study in both males and females (P<0.001). There was a significant positive association between changes in PCO2 and changes in TBM after six months (r=0.4, P<0.05), whereas a significant inverse correlation was found between changes in PCO2 and changes in TBW after six months (r=-0.39, P<0.05). However, no significant correlation was found between changes in gas exchange and changes in BMI or other body composition indices after six months. Conclusion: The present results indicated no significant association between the improvement of gas exchange and changes in BMI, TBP, and TBF during the study. However, further large-scale studies are required to examine the effects of BIPAP therapy on body composition in patients with OHS. [ABSTRACT FROM AUTHOR]

Background: Obstructive sleep apnea (OSA) is a common health issue with serious complications. Regarding the high cost of the polysomnography (PSG), sensitive and inexpensive screening tools are necessary. The objective of this study was to evaluate the predictive value of anthropometric and Mallampati indices for OSA severity in both genders. Materials and Methods: In a cross sectional study, we evaluated anthropometric data and the Mallampati classification for the patients (n = 205) with age >18 and confirmed OSA in PSG (Apnea--Hypopnea Index [AHI] >5). For predicting the severity of OSA, we applied a decision tree (C5.0) algorithm, with input and target variables considering two models (Model 1: AHI ≥15 with Mallampati >2, age >51 years, and neck circumference [NC] >36 cm and Model 2: AHI ≥30 with condition: gender = female, body mass index (BMI) >35.8, and age >44 years or gender = male, Mallampati ≥2, and abdominal circumference (AC) >112 then AHI ≥30). Results: About 54.1% of the patients were male. Mallampati, age, and NCs are important factors in predicting moderate OSA. The likelihood of moderate OSA severity based on Model 1 was 94.16%. In severe OSA, Mallampati, BMI, age, AC, and gender are more predictive. In Model 2, gender had a significant role. The likelihood of severe OSA based on Model 2 in female patients was 89.98% and in male patients was 90.32%. Comparison of the sensitivity and specificity of both models showed a higher sensitivity of Model 1 (93.5%) and a higher specificity of Model 2 (89.66%). Conclusion: For the prediction of moderate and severe OSA, anthropometric and Mallampati indices are important factors. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder and is associated with signiicant morbidity. We sought to present an updated systematic review of the literature on the accuracy of screening questionnaires for OSA against polysomnography (PSG) as the reference test. Using the main databases (including Medline, Cochrane Database of Systematic Reviews and Scopus) we used a combination of relevant keywords to ilter studies published between January 2010 and April 2017. Population-based studies evaluating the accuracy of screening questionnaires for OSA against PSG were included in the review. hirty-nine studies comprising 18 068 subjects were included. Four screening questionnaires for OSA had been validated in selected studies including the Berlin questionnaire (BQ), STOP-Bang Questionnaire (SBQ), STOP Questionnaire (SQ), and Epworth Sleepiness Scale (ESS). he sensitivity of SBQ in detecting mild (apnea-hypopnea index (AHI) ≥ 5 events/hour) and severe (AHI ≥ 30 events/hour) OSA was higher compared to other screening questionnaires (range from 81.08% to 97.55% and 69.2% to 98.7%, respectively). However, SQ had the highest sensitivity in predicting moderate OSA (AHI ≥ 15 events/hour; range = 41.3% to 100%). SQ and SBQ are reliable tools for screening OSA among sleep clinic patients. Although further validation studies on the screening abilities of these questionnaires on general populations are required. [ABSTRACT FROM AUTHOR]

Background: Obstructive sleep apnea (OSA) is a common disorder characterized by snoring, daytime sleepiness, fatigue, and repeated termination of airflow (apnea). Standard polysomnography (PSG) is diagnostic gold standard for OSA. PSG is expensive and not available everywhere. To identify the best OSA questionnaire for screening in Persian population, we compared Berlin, STOP-BANG, and Epworth Sleepiness Scale (ESS). Methods: In a cross-sectional study conducted on 400 adult patients suspected of OSA in Bamdad Respiratory Research Center, patients completed three questionnaires. For each questionnaire, patients were divided into high risk and low risk. Then, PSG was performed for all patients. According to PSG, patients categorized into without OSA (apnea-hypopnea index [AHI] <5), mild OSA (15> AHI ≥5), moderate OSA (30> AHI ≥15), and severe OSA (AHI ≥30). Based on questionnaires and PSG results, predictive parameters for screening tests were calculated. Results: There were 234 (58.5%) males and 166 (41.5%) females in study population. Mean age of patients was 49.29 ± 9.75 standard deviation years. There was significant association between age with OSA (P = 0.005) and between body mass index (BMI) and neck circumference, with moderate and severe OSA (P < 0.001). Sensitivities of Berlin, STOP-BANG, and ESS were 86.42%, 81.46%, and 59%, respectively. Specificities of Berlin, STOP-BANG, and ESS were 52.94%, 82.35%, and 76.47%, respectively. Conclusions: This study suggested that Berlin and STOP-BANG are more sensitive and accurate than ESS for OSA screening in Iran. [ABSTRACT FROM AUTHOR]

Background: Acute kidney injury (AKI) has the most prevalent complications in COVID-19 patients. A variety of factors is involved in the disease progression and its associated outcomes. The present study aimed at both examining the correlated clinical features of COVID-19 disease and AKI and evaluating its clinical outcomes. Materials and Methods: In the present retrospective study, 102 COVID-19 patients that encountered AKI were enrolled and categorized into three AKI stages. Basic and clinical characteristics, clinical signs and symptoms, laboratory and imaging findings, and treatment approaches were examined. Then, clinical outcomes as well as the factors associated with the mortality of patients were evaluated. Results: Diabetes was the only significant clinical characteristic among the patients (P = 0.004). An increasing trend was observed for neutrophil-to-lymphocyte ratio (P = 0.027) and potassium (K) (P = 0.006), and a decreasing trend was seen for hemoglobin (P < 0.001), albumin (P = 0.005), and calcium (P < 0.001) factors at higher stages of AKI. Secondary infection (P = 0.019) and hypoproteinemia (P = 0.018) were the most significant clinical outcomes. Chronic obstructive lung disease (OR = 1.362, P = 0.007), renal replacement therapy (OR = 2.067, P = 0.005), lung consolidation (OR = 0.722, P = 0.032), and bilateral pulmonary infiltration (OR = 4.793, P = 0.002) were the factors associated with mortality rate of COVID-19 patients with AKI. Conclusion: AKI, as an important complication of COVID-19, that can predict the higher mortality rate as well as the laboratory and clinical characteristics should receive more due consideration in order to employ proper preventive or supportive treatment approaches that are the pivotal key to reduce the mortality rate in target patients. [ABSTRACT FROM AUTHOR]

The cumulative rate of death of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has necessitated better recognizing the risk factors of the disease and the COVID-19-induced mortality. This cross-sectional study aimed to determine the potential risk factors that predict COVID-19-related mortality concentrating on the initial recorded laboratory tests. We extracted admission's medical records of a total of 136 deaths related to COVID-19 and 272 discharged adult inpatients (≥18 years old) related to four referral centers from February 24th to April 12th, 2020, in Isfahan, Iran, to figure out the relationship between the laboratory findings and mortality beyond demographic and clinical findings. We applied the independent sample t test and a chichi square test with SPSS software to compare the differences between the survivor and non-survivor patients. A P value of less than 0.05 was considered significant. Our results showed that greater length of hospitalization (P≤0.001), pre-existing chronic obstructive pulmonary disease (P≤0.001), high pulse rate, hypoxia (P≤0.001), and high computed tomography scan score (P<0.001), in addition to high values of some laboratory parameters, increase the risk of mortality. Moreover, high neutrophil/lymphocyte ratio (OR, 1.890; 95% CI, 1.074-3.325, P=0.027), increased creatinine levels (OR, 15.488; 95% CI, 0.801-299.479, P=0.07), and elevated potassium levels (OR, 13.400; 95% CI, 1.084-165.618, P=0.043) independently predicted in-hospital death related to COVID-19 infection. These results emphasized the potential role of impaired laboratory parameters for the prognosis of fatal outcomes in adult inpatients. [ABSTRACT FROM AUTHOR]

Background: Already at hospital admission, clinicians require simple tools to identify hospitalized COVID-19 patients at high risk of mortality. Such tools can significantly improve resource allocation and patient management within hospitals. From the statistical point of view, extended time-to-event models are required to account for competing risks (discharge from hospital) and censoring so that active cases can also contribute to the analysis.Methods: We used the hospital-based open Khorshid COVID Cohort (KCC) study with 630 COVID-19 patients from Isfahan, Iran. Competing risk methods are used to develop a death risk chart based on the following variables, which can simply be measured at hospital admission: sex, age, hypertension, oxygen saturation, and Charlson Comorbidity Index. The area under the receiver operator curve was used to assess accuracy concerning discrimination between patients discharged alive and dead.Results: Cause-specific hazard regression models show that these baseline variables are associated with both death, and discharge hazards. The risk chart reflects the combined results of the two cause-specific hazard regression models. The proposed risk assessment method had a very good accuracy (AUC = 0.872 [CI 95%: 0.835-0.910]).Conclusions: This study aims to improve and validate a personalized mortality risk calculator based on hospitalized COVID-19 patients. The risk assessment of patient mortality provides physicians with additional guidance for making tough decisions. [ABSTRACT FROM AUTHOR]

Background: Obstructive sleep apnea (OSA) is a common health issue with serious complications. Regarding the high cost of the polysomnography (PSG), sensitive and inexpensive screening tools are necessary. The objective of this study was to evaluate the predictive value of anthropometric and Mallampati indices for OSA severity in both genders. Materials and Methods: In a cross-sectional study, we evaluated anthropometric data and the Mallampati classification for the patients (n = 205) with age >18 and confirmed OSA in PSG (Apnea–Hypopnea Index [AHI] >5). For predicting the severity of OSA, we applied a decision tree (C5.0) algorithm, with input and target variables considering two models (Model 1: AHI ≥15 with Mallampati >2, age >51 years, and neck circumference [NC] >36 cm and Model 2: AHI ≥30 with condition: gender = female, body mass index (BMI) >35.8, and age >44 years or gender = male, Mallampati ≥2, and abdominal circumference (AC) >112 then AHI ≥30). Results: About 54.1% of the patients were male. Mallampati, age, and NCs are important factors in predicting moderate OSA. The likelihood of moderate OSA severity based on Model 1 was 94.16%. In severe OSA, Mallampati, BMI, age, AC, and gender are more predictive. In Model 2, gender had a significant role. The likelihood of severe OSA based on Model 2 in female patients was 89.98% and in male patients was 90.32%. Comparison of the sensitivity and specificity of both models showed a higher sensitivity of Model 1 (93.5%) and a higher specificity of Model 2 (89.66%). Conclusion: For the prediction of moderate and severe OSA, anthropometric and Mallampati indices are important factors. [ABSTRACT FROM AUTHOR]

Background: Obstructive sleep apnea (OSA) is a common disorder characterized by snoring, daytime sleepiness, fatigue, and repeated termination of airflow (apnea). Standard polysomnography (PSG) is diagnostic gold standard for OSA. PSG is expensive and not available everywhere. To identify the best OSA questionnaire for screening in Persian population, we compared Berlin, STOP-BANG, and Epworth Sleepiness Scale (ESS). Methods: In a cross-sectional study conducted on 400 adult patients suspected of OSA in Bamdad Respiratory Research Center, patients completed three questionnaires. For each questionnaire, patients were divided into high risk and low risk. Then, PSG was performed for all patients. According to PSG, patients categorized into without OSA (apnea-hypopnea index [AHI] <5), mild OSA (15> AHI ≥5), moderate OSA (30> AHI ≥15), and severe OSA (AHI ≥30). Based on questionnaires and PSG results, predictive parameters for screening tests were calculated. Results: There were 234 (58.5%) males and 166 (41.5%) females in study population. Mean age of patients was 49.29 ± 9.75 standard deviation years. There was significant association between age with OSA (P = 0.005) and between body mass index (BMI) and neck circumference, with moderate and severe OSA (P < 0.001). Sensitivities of Berlin, STOP-BANG, and ESS were 86.42%, 81.46%, and 59%, respectively. Specificities of Berlin, STOP-BANG, and ESS were 52.94%, 82.35%, and 76.47%, respectively. Conclusions: This study suggested that Berlin and STOP-BANG are more sensitive and accurate than ESS for OSA screening in Iran. [ABSTRACT FROM AUTHOR]

Background: Obstructive sleep apnea (OSA) is a common disorder characterized by snoring, daytime sleepiness, fatigue, and repeated termination of airflow (apnea). Standard polysomnography (PSG) is diagnostic gold standard for OSA. PSG is expensive and not available everywhere. To identify the best OSA questionnaire for screening in Persian population, we compared Berlin, STOP-BANG, and Epworth Sleepiness Scale (ESS). Methods: In a cross-sectional study conducted on 400 adult patients suspected of OSA in Bamdad Respiratory Research Center, patients completed three questionnaires. For each questionnaire, patients were divided into high risk and low risk. Then, PSG was performed for all patients. According to PSG, patients categorized into without OSA (apnea-hypopnea index [AHI] <5), mild OSA (15> AHI ≥5), moderate OSA (30> AHI ≥15), and severe OSA (AHI ≥30). Based on questionnaires and PSG results, predictive parameters for screening tests were calculated. Results: There were 234 (58.5%) males and 166 (41.5%) females in study population. Mean age of patients was 49.29 ± 9.75 standard deviation years. There was significant association between age with OSA (P = 0.005) and between body mass index (BMI) and neck circumference, with moderate and severe OSA (P < 0.001). Sensitivities of Berlin, STOP-BANG, and ESS were 86.42%, 81.46%, and 59%, respectively. Specificities of Berlin, STOP-BANG, and ESS were 52.94%, 82.35%, and 76.47%, respectively. Conclusions: This study suggested that Berlin and STOP-BANG are more sensitive and accurate than ESS for OSA screening in Iran. [ABSTRACT FROM AUTHOR]

Background: Nowadays, the most practical approaches used to treat sleep apnea, are Continuous Positive Airway Pressure (CPAP), Bi-level Positive Airway Pressure therapy (BPAP), supplemental O2, servoventilation and/or a combination of these approaches simultaneously. However, each leads to different consequences in opioid related Central Sleep Apnea (CSA) patients. Given the high prevalence of CSA and frequently use of opioids worldwide, it seems that evaluation of the condition in these patients is required to determine their responsiveness to the above mentioned treatments and to choose the most appropriate therapy. Materials and Methods: This longitudinal cross-sectional study included 41 opioid related CSA patients who underwent a step-by-step protocol (including CPAP, CPAP + O2 and BPAP) in which if the patient was nonresponsive to a treatment, the next therapy was applied. If the patient was nonresponsive to all of these approaches, only oxygen was administered. Finally, the collected data were analyzed with SPSS software (ver. 22). Results: Among 41 participants, the responsiveness to CPAP, CPAP+O2 and BPAP were 41.5%, 14.6% and 39%, respectively versus 4.9% nonresponsive patients to all above mentioned therapies. In patients with CSA and opium addiction, the CPAP and BPAP were the most effective treatments. In this group of patients, better response in the presence of higher Apnea-Hypopnea Index (AHI) was observed to BPAP, whereas better response in patients with lower AHI was to CPAP+O2. Conclusion: Accordingly, CPAP and BPAP are successful approaches to treat opioid related CSA patients in various medical conditions including long-run addiction course, concurrent smoking and addiction but it appears that further studies are essential. [ABSTRACT FROM AUTHOR]

Background: Several studies have showed an increased prevalence of airflow obstruction in first degree relatives of individuals with chronic obstructive pulmonary disease (COPD). Considering no specific research had evaluated airway resistance in off spring of patients with severe COPD, we utilized a spirometry and a impulse oscillometry (IO) to evaluate this population. Materials and Methods: In this case control study, from November 2011 to July 2012, we consecutively evaluated 54 off springs of severe COPD patients (case group) admitted in the pulmonary ward, affiliated to the Isfahan University of Medical Sciences and control group. Pulmonary function tests and the IO were obtained for both groups. Student's t-test was used for inter-group comparisons, and P values below 0.05 were taken as significant. Results: Abnormal increased airway resistance was seen in cases in comparison with controls (R5 Hz [46.29%, P = 0.01], R25 Hz [42.59%, P < 0.001]). Also, considering the spirometry, case group had pulmonary function parameters less than control group (forced vital capacity [FVC]; P = 0.02, forced expiratory volume in 1st s; P < 0.001, forced expiratory flow (FEF) 25-75; P < 0.001, FEF 25-75/FVC; P < 0.001) but they were in normal range. Conclusion: This study demonstrated increased airway resistance among the severe COPD off springs. The IO may be a sensitive tool for detection of high risk subjects in families with COPD. [ABSTRACT FROM AUTHOR]

Background: Since the beginning of the coronavirus disease of 2019 (COVID-19) pandemic, concerns raised by the growing number of deaths worldwide. Acute respiratory distress syndrome (ARDS) and extrapulmonary complications can correlate with prognosis in COVID-19 patients. This study evaluated the association of systemic complications with mortality in severely affected COVID-19 patients. Materials and Methods: This retrospective study was done on 51 intensive care unit (ICU)-admitted COVID-19 adult patients who were admitted to the ICU ward of Khorshid hospital, affiliated with Isfahan University of Medical Sciences. Only the patients who had a definite hospitalization outcome (dead vs. survivors) were included in the study. Daily clinical and paraclinical records were used to diagnose in-hospital complications in these patients. Results: The sample was comprised of 37 males (72.5%) and 14 females (27.4%). The median age of patients was 63 years (Min: 20, Max: 84), with the mortality rate of 47.1%. In total, 70.6% of patients had at least one coexisting disorder. Chronic kidney disease was associated with the worse outcome (29.16% of dead patients against 3.70 of survived ones). Mechanical ventilation was used in 58.8% of patients. Patients who had received invasive ventilation were more likely to die (87.50% of dead patients against 7.40 of survivors), Complications including sepsis and secondary infections (odds ratio: 8.05, confidence interval: 2.11–30.63) was the strongest predictors of mortality. Conclusion: Complications including sepsis and secondary infections can increase the risk of death in ICU-admitted COVID-19 patients. Therefore, it is substantial that the physicians consider preventing or controlling these complications. [ABSTRACT FROM AUTHOR]

Background: In this study, we summarized the data on gastrointestinal (GI) involvement and the potential association with clinical outcomes among the patients admitted to Khorshid Hospital. Materials and Methods: We investigated 1113 inpatients (≥18 years old) diagnosed with coronavirus disease-2019 (COVID-19) from March to June 2020 in Khorshid Hospital. We collected demographic details, clinical information, vital signs, laboratory data, treatment type, and clinical outcomes from patients' medical records. The data of patients with GI symptoms were compared with those without GI symptoms. Results: A total of 1113 patients were recruited (male = 648). GI symptoms were observed in 612 (56.8%) patients (male = 329), the most common of which were nausea 387 (34.7%), followed by diarrhea 286 (25.7%), vomiting 260 (23.4%), and abdominal pain 168 (15.0%). The most prominent non-GI symptoms were cough 796 (71.5%), fever 792 (71.2%), shortness of breath 653 (58.7%), and body pain 591 (53.1%). The number of patients who were discharged, died, and were admitted to intensive care unit was significantly different in groups on the basis of GI and non-GI symptoms (P = 0.002, 0.009, 0.003). Conclusion: While COVID-19 was predominantly diagnosed in males, GI symptoms were more commonly reported by females. The results indicated that GI symptoms in COVID-19 patients are common, and the symptoms are not correlated with the severity of the disease. Moreover, the presence of GI symptoms was positively related to milder disease. Among COVID-19 positive patients, the clinical outcomes of the GI group were promising, compared to those of non-GI group. [ABSTRACT FROM AUTHOR]

Background: Pulmonary impairment in patients suffering ulcerative colitis (UC) has been suggested by several investigators using standard pulmonary function tests (PFTs). This changes in pulmonary function associated with minimal respiratory symptoms have been documented, especially in patients with active disease. The aim of this prospective study was to determine airway resistance and lung volumes in patients with UC who have no respiratory symptoms in comparisons to a healthy control group. Materials and Methods: We evaluated a total of 30 patients with UC by means of spirometry, body plethysmography, and impulse oscillometry. The patients were not complaining of any pulmonary symptoms and did not present any history of previous respiratory diseases. As controls we examined 30 healthy subjects matched for gender, age, and smoking status. The relationship between PFT, lung volume, and airway resistance; and the activity, localization, and duration of the UC disease were analyzed. Results: There was a significant difference between airway resistances (kPa/L/s) measured by body plethysmography in patients with UC and those of the controls (R5hz; 0.60 ± 0.44 vs. 0.39 ± 0.13; P < 0.001) and R20hz (0.37 ± 0.19 vs. 0.29 ± 0.1, P = 0.02). There were no correlation between PFT, airway resistance and site and scoring activity (P > 0.05). Conclusion: Despite the lack of pulmonary symptoms, increased airway resistance was found in UC patients. We also have not found correlation between PFT, lung volume and airway resistance values and scoring of UC activity. [ABSTRACT FROM AUTHOR]