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Background: Lobular capillary hemangioma is a benign vascular tumor commonly found within the skin and upper respiratory mucosa and has rarely been reported within the trachea. The first case was reported by Irani et al. in 2003 and since then, less than 20 cases have been described. That's why the characteristics and treatments remain relatively unknown.

Case presentation: A 53-year-old woman was symptomatic of recurrent episodes of hemoptysis associated with paroxysmal dyspnea. Physical examination, routine blood investigations, and chest x-ray were normal. The flexible bronchoscopy showed a polypoid bleeding lesion arising from the right lateral wall of the middle third of the trachea. Tumor biopsy was not performed considering an eventual bleeding risk. Computed tomography scanning showed a vascular, endotracheal budding tissue process without peritracheal or distant extension. A rigid bronchoscopy was performed for diagnostic and therapeutic purposes. A 10-millimeter bronchoscope was used. A rigid coring technique was performed to remove the tumor. A minimal bleeding was completely controlled after diode laser treatment. There were no complications during or after the procedure. Pathology revealed no malignancy and the diagnosis of lobular capillary hemangioma was confirmed. At a 6-month follow-up, the patient was asymptomatic and the endoscopic control did not show any tumor recurrence.

Conclusion: The lobular capillary hemangioma is a benign tumor rarely observed in the trachea. Clinical features are not specific and the short-term prognosis depends on tumor size. Considering its benign nature, tumor removal by interventional bronchoscopy should be proposed as the first-line treatment.

Primary small cell carcinoma of the trachea is a rare tumor fitting in the spectrum of neuroendocrine tumors. Due to the rarity and unspecific symptoms, the tumor is frequently misdiagnosed with other chronic lung diseases, and diagnosis is delayed. Here, we described a 52-year-old male presenting with dyspnea and cough. He had been treated with bronchodilators for months for suspected asthma or bronchiolitis without improvement. He had central wheezing on the general examination. Chest CT scan was unremarkable except for soft tissue prominence in the thoracic trachea. A large exophytic tumor was observed on bronchoscopy. A biopsy specimen was taken and revealed small cell carcinoma of the trachea. The patient succumbed to illness a short time after the bronchoscopy and before receiving any treatment. Our effort through this case report was to raise awareness of this rare tumor since a delay in diagnosis could lead to serious complications and even death.

Background: Given the increase in mortality from COVID-19 disease, understanding the causal chain leading to death in patients with this disease will be of particular importance. This study aimed to draw the death map of patients with COVID-19 in BESAT hospital (West of Iran), based on investigating the underlying, intermediate, and terminal causes of death in this group of patients.

Materials and methods: To draw the death map of patients with COVID-19 in this cross-sectional study, the death certificate and medical records of 183 COVID-19 patients who died at BESAT Hospital in Hamadan (West of Iran) in 2020 were reviewed. The cases in which the underlying cause of death was COVID-19 were reviewed. A checklist was used to collect the data. It was designed based on the international form of medical certificate of cause of death (issued by WHO). The collected data were analyzed by SPSS software version 23.

Results: The most prevalent underlying causes of death were COVID-19 (60.7%), COVID-19-related pneumonia (19.1%), acute respiratory distress syndrome (10.9%), and severe sepsis (9.8%). Hypertension (8.2%), diabetes (6.0%), seizures (3.8%), and ischemic heart disease (2.2%) were the most influential conditions affecting death. The number of deaths due to the terminal cause of acute respiratory distress syndrome in women (22.5%) was much higher than in men (7.1%) (P-value=0.041). Findings indicated that most patients died from four main pathways originating from COVID-19, leading to causes such as sepsis, ARDS, myocarditis, MI, and PTE.

Conclusion: The results indicate that health officials and healthcare providers should be able to identify and monitor patients with chronic diseases and implement effective plans to prevent COVID-19. Physicians should also take important steps in offices, clinics, and hospitals, such as conducting early echocardiography in children, providing respiratory support, and preventing deep vein thrombosis in adults during hospitalization. It is also essential to inform the public through audio and video media, including radio and television.

Background: Pulmonary hypertension (PH) is a known complication of hemodialysis (HD) but its pathogenesis and etiology is not completely clear. The purpose of the current study is to determine the prevalence and possible causes of PH among hemodialysis patients.

Material and methods: Demographic, clinical and laboratory data of 40 patients referred to hemodialysis ward of Masih Daneshvari Hospital during 12 months were recorded. Detailed echocardiography was performed for each patient within 24 hours of hemodialysis. PH was defined as systolic pulmonary artery pressure (SPAP) above 35 mmHg.

Results: 12 of 40 HD patients had PH (prevalence = 30%). The hemodialysis vintage in PH group was longer than patients without PH (No PH group) . Also, left atrium size, right ventricle size, left ventricle end diastolic diameter (LVEDD) and left ventricular mass index (LV mass index) were significantly higher in PH group; but ejection fraction (EF) was lower than No PH group. Left ventricle diastolic dysfunction and pericardial effusion were significantly associated with PH. The crude mortality rate was relatively similar in PH group and No PH group.

Conclusion: PH is prevalent in HD patients with multifactorial etiology. Increased pulmonary capillary wedge pressure (PCWP) is a very important factor to induce PH in these patients; on the other hand, chronic volume overload and left ventricle systolic and diastolic dysfunction are some of the predominant causes of increased PCWP in this population.

Background: Sarcoidosis is a systemic disease with unknown etiology that is characterized by the presence of granuloma in various organs with diverse pulmonary and extrapulmonary manifestations. Regarding differences in the presentation of sarcoidosis in different geographical areas, the present study aimed to determine clinical, laboratory, and radiologic findings of patients with sarcoidosis in the north of Iran.

Materials and methods: In a cross-sectional study, patients with sarcoidosis were enrolled, and demographic data in addition to disease manifestations including clinical, laboratory, and imaging findings were recorded.

Results: A total of 58 patients with sarcoidosis were enrolled in the study. The mean age and disease duration were 51.10±10.2 and 3.07±2.7 years, respectively. 62.1% of patients were female. Clinical manifestations were: cough and dyspnea (55.2%), fever and weight loss (11%), arthritis (15.5%), dermatologic presentation (15.5%), and ophthalmic involvement (17.2 %). Abnormalities in liver, renal, and calcium levels are found in approximately 1-8% of cases. The ACE level was increased in 56.9 % of patients, especially in those who presented in summer and autumn. Chest CT abnormalities were found in 94.8 % of patients, more predominantly hilar and paratracheal lymphadenopathy in 84.5% and 74.1%, respectively.

Conclusion: Although sarcoidosis presents with varying clinical, radiological, and laboratory features, knowledge of its epidemiology and the incidence of these features in different populations can aid in its diagnosis in a particular geographic area.

Background: The disease process involves the occurrences happening during the disease and treatment course for the patient. Investigating this process is a significant and necessary issue for all diseases, including coronavirus disease 2019 (COVID-19).

Materials and methods: Using the information of 4372 patients with COVID-19 referring to Dr. Masih Daneshvari Hospital in Tehran during the COVID-19 epidemic, being hospitalized, cared for, and home quarantined due to having mild symptoms, the COVID-19 process and its related occurrences were investigated during the treatment course.

Results: In the COVID-19 course, considering the disease severity, the likelihood of hospitalization in the general ward or the intensive care unit (ICU) ward, the likelihood of isolation or home quarantine, and the likelihood of occurrences such as recovery or death at the end of the disease course were taken into consideration. Based on the results of this study, the likelihood of hospitalization in the general ward, the ICU ward, and isolation or home quarantine was determined to be approximately 49.54%, 14.73%, and 35.73%, respectively. Also, for patients hospitalized in the general ward, the ICU ward, and isolated or home quarantined, the likelihood of recovery was estimated at approximately 64.79%, 10.82%, and 96.31%, respectively, and the likelihood of death was also estimated at about 35.21%, 89.18%, and 3.69% respectively.

Conclusion: Investigating the COVID-19 process and estimating the likelihood of incidence of its related occurrences during the treatment course both create an accurate prognosis and provide the possibility of achieving an efficient treatment for these patients.

Background: Asthma is one of the most common chronic respiratory diseases. It is estimated that more than 400 million people will suffer from it by 2025. This study aims to determine the prevalence of asthma in East Azerbaijan and investigate the association between asthma and some environmental and demographic factors.

Materials and methods: This is a cross-sectional study based on a major Lifestyle Promotion Project (LPP) conducted in the districts of East Azerbaijan, including 2641 participants aged 15 to 65 years of the general population selected through probability proportional to size (PPS) multistage stratified cluster sampling. We used the World Health Survey questionnaire about doctor-diagnosed asthma to determine the prevalence of asthma. Age, smoking status, physical activity level, socioeconomic variables such as job and education level, and body mass index (BMI) were used as covariates in regression models. A questionnaire was used to obtain socio-demographic information and smoking status. The short form of the International Physical Activity Questionnaire was used to estimate the level of physical activity (IPAQ).

Results: The mean age of participants was 40.9 ± 12.05 years including 1242 (47 %) males and 1399 (53 %) females. The prevalence of asthma was 3.3 %. The frequency of smokers was significantly higher in the asthmatic group compared with the non-asthmatic group (OR=2.33 [1.76-3.31]; p=0.03). There was no significant association between asthma and other demographic and lifestyle characteristics. Obesity has also played a significant role in the development of asthma.

Conclusion: According to the results of this study, obesity and smoking have played a significant role in the development of asthma but there is no statistically significant relationship between socioeconomic and demographic factors.

Background: One important complication of the coronavirus disease 2019 (COVID-19) is COVID Associated Mucormycosis (CAM), especially in patients with conditions such as diabetes and in immunosuppressed patients. Systemic acidosis, hyperglycemia, and other biochemical factors such as free iron and β-hydroxybutyrate (BHB) can play a role in this complication.

Materials and methods: Rhizopus oryzae was isolated from a patient at Masih Daneshvari Hospital microbiology laboratory and sub-cultured on the Potato Dextrose Agar (PDA) for 48 hours at 37 °C. Subsequently, Roswell Park Memorial Institute (RPMI) 1640 Broth medium buffered to pH 7.0 with 3-N-morpholino-propane sulfonic acid. Macrodilution and microdilution methods were performed with 8.4% sodium bicarbonate. After 24 hours of incubation at 35°C, the minimum inhibitory concentration (MIC) and the minimum fungicidal concentrations (MFC) were evaluated.

Results: We found that the minimum inhibitory and fungicidal concentrations are at 1.05 % and 2.1 % respectively. Therefore, the minimum concentration is 2% sodium bicarbonate, which requires achieving the desired environmental pH for fungal inhibition and fungicidal effects.

Conclusion: Regulation of systemic acidosis by sodium bicarbonate could be used to decrease the chance of mucormycosis. In addition, According to our study and some others, an alkaline environment can prevent fungal growth. We found that a minimum concentration of 2% sodium bicarbonate is required to achieve the desired mucosal pH to inhibit the fungus. Therefore, sodium bicarbonate inhalation, as a cost-effective and well-tolerated medicine, is a good candidate for the prevention of mucormycosis. In this regard, extensive clinical and laboratory research is needed to achieve more accurate doses and appropriate administration intervals.

The pandemic outbreak of Coronavirus disease 2019 (COVID-19) which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), is a new viral infection in all countries around the world. An increase in inflammatory cytokines, fever, dry cough, and pneumonia are the main symptoms of COVID-19. A shared of growing clinical evidence confirmed that cytokine storm correlates with COVID-19 severity which is also a crucial cause of death from COVID-19. The success of anti-inflammatory therapies in the recovery process of COVID-19 patients has been well established. Over the years, phototherapy (PhT) has been identified as a promising non-invasive treatment approach for inflammatory conditions. New evidence suggests that PhT as an anti-inflammatory therapy may be effective in treating acute respiratory distress syndrome (ARDS) and COVID-19. This review aims to a comprehensive overview of the direct and indirect effects of anti-inflammatory mechanisms of PhT in ARDS and COVID-19 patients.