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Background: Fractional exhaled nitric oxide is a method of assessing inflammation in the airway and its level may affected by some factors such as age, gender, and body mass index. This study was performed to assess the relationship between "Body Mass Index" (BMI) and FeNO.

Materials and methods: This was a cross-sectional study on 879 adult subjects participating in the Shahedieh Cohort Study. BMI and FeNO were measured for each participant. Participants were divided into five BMI groups: underweight, normal, overweight, obese, and morbid obese FeNo level was compared between groups. The data were analyzed by SPSS (ver. 20) using Kolmogorov-Smirnov, Kruskal-Wallis, Mann-Whitney U tests, Spearman's correlation, and multivariate logistic regression tests.

Results: The mean FeNO in all participants was 7.87±8.28 ppb. There was a significant positive correlation between age and FeNO. FeNO was declined by increasing BMI, so the highest FeNO was observed in underweight and the lowest FeNO was observed in morbid obese individuals. However, there was not a significant difference in FeNO level between different BMI categories (P =0.28). The mean FeNO level was significantly correlated to BMI only in participants younger than 48 years.

Conclusion: The results of this study showed that BMI is probably negatively correlated with FeNO level in middle-aged people younger than 48 years, but not in older people.

Background: The neutrophil to lymphocyte ratio (NLR) is an inflammatory biomarker that could be used as an indicator of systemic inflammation (sepsis) and could also be used to predict the prognosis of some diseases, such as solid cancer, community pneumonia, as well as cardiovascular diseases. This study aimed to assess the potential role of NLR and eosinopenia in patients with acute exacerbation of COPD (AECOPD) compared to those in the stable phase of the disease.

Materials and methods: NLR was assessed and compared in patients with AECOPD (n=92) and those in the stable phase of COPD (n=240). Patients under the age of 18, those who used inhaled corticosteroids, or those with any condition affecting the neutrophil (NEU) or lymphocyte (LYM) count in peripheral blood, such as hematological illnesses, pregnancy, or a history of medication use, were excluded from the study. The NLR was determined using NEU and LYM counts from regular blood tests. We defined the cut-off value for eosinopenia as the percentage of eosinophils≤1%.

Results: We included 332 inpatients with COPD diagnosed in our hospital from April to October 2021. AECOPD was discovered in 92 patients. Patients with exacerbation had considerably lower levels of BMI (24.32±4.38 vs 26±4.02), FEV1/FVC (55.38±9.14 vs 60.54±6.95), and NLR ratio, except for the first NLR quartile (39.13 %), the second was 20.65 %, the third was 18.48 %, and the fourth was 21.74 %. Eosinopenia was detected in 79 (85.87 %) of AECOPD patients.

Conclusion: We found that the NLR was lower in patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD), except for those in the first NLR quartile.

Background: Pulmonary arterial hypertension (PAH) is a progressive and fatal disease. Studies have shown a link between sleep disorders and pulmonary hypertension; however, sleep disorders generally remain undiagnosed. This study aimed to investigate the types of sleep disorders and their prevalence among patients with pulmonary hypertension.

Materials and methods: A total of 68 patients with a definitive diagnosis of pulmonary hypertension were examined for the existence of sleep disorders. The STOP-BANG, ISI, ESS, RLS, and parasomnia questionnaires were used to evaluate sleep disorders, including obstructive sleep apnea, insomnia, excessive sleepiness, and movement disorders, such as restless leg syndrome and parasomnia, respectively. The data were analyzed using SPSS software.

Results: The average age of the patients was 48.0 ± 14.2 years while 64.7% were women. The most prevalent (45.6%) sleep disorder among the patients was probable obstructive sleep apnea (STOP-BANG positive). Among STOP-BANG positive and negative groups, the ratios of men were 48.4% and 24.3%, respectively (P=0.046). In addition, there was a significant difference between STOP-BANG positive and negative groups regarding the variables of gender, age, having high systemic blood pressure, insomnia index, and daytime sleepiness (P values= 0.020, 0.046, 0.011, 0.023, and 0.011, respectively). The prevalence of parasomnia (P= 0.039) and daytime sleepiness (P=0.072) was significantly higher in people suffering from insomnia. The body mass index was significantly higher in people with idiopathic pulmonary hypertension than in those with thromboembolic pulmonary hypertension (P= 0.001). There was a significant association between age and the functional class of the patients (P= 0.003).

Conclusion: The prevalence of sleep disorders, especially obstructive sleep apnea, is relatively high in patients with PAH, and its presence seems to worsen the prognosis of PAH necessitating identifying at-risk people and properly treating them to improve their quality of life.

Background: Coronaviruses cause acute respiratory syndromes, e.g., SARS, MERS, and COVID-19, whose treatment depends on several factors, specifically the age of patients, adopted treatments, time of hospitalization, and timely diagnosis. The present study was conducted to investigate the interaction between the mentioned factors and treatment.

Materials and methods: Relevant full-text publications were indicated by searching in the five online databases MEDLINE, EMBASE, WOS, Science Direct, and Cochrane Library using MeSH terms during 2010-2024. Only original case reports (n=55) that worked on signs and treatments were selected and analysed according to age, gender, medical history, diagnostic methods, treatments, kind of respiratory syndrome, and transmission ways. Articles that met the inclusion criteria were evaluated by each of the reviewers independently, and non-agreements were solved by consulting with a fourth reviewer.

Results: According to the results, the severe respiratory syndromes occurred more in the elderly than younger people and in males than females (58% and 42%, respectively). Medical history of diabetes and heart disease showed the maximum effect on the person to get involved with the severe respiratory syndrome. Clinical methods were used more for the diagnosis of the diseases because of easy access and less time consumption. Combination therapy was better than single therapy. The most common route of transmission was human to human and nosocomial.

Conclusion: It can be concluded that these types of fatal respiratory illnesses can be controlled if the health care workers become familiar with the type of illness and apply the early and effective treatments.

Background: The occurrence of pneumomediastinum (PM) or pneumothorax (PTX) is a rare complication during COVID-19 pneumonia. The exact pathophysiological mechanisms remain unclear.

Materials and methods: This retrospective study was carried out between March and July 2021, including hospitalized patients with COVID-19 who presented a PM or PTX during their evolution.

Results: Thirty-three patients were included in our study. The PM was spontaneous in 41.4% of cases (prevalence of 1.2%) and iatrogenic in 58.6% of cases (prevalence of 1.71%). Spontaneous isolated PTX was noted in 4 cases (12.1%). The management of pneumomediastinum was clinical and radiological monitoring in 30.3% of cases, and chest drainage in 21.2% (40% for spontaneous PTX, 83.3% for iatrogenic PTX, p=0.1). An association was found between mortality and the occurrence of PM (p=0.01), age (p=0,00), severity of radiological damage (p=0.03), severity of respiratory infection (p=0.01), the presence of signs of compression (p=0.03), and the use of mechanical ventilation (p=0.03).

Conclusion: COVID-19 patients with PM-PTX seem to have a higher mortality. Further research is needed to better identify risk factors and establish a consensus for managing it.

COVID-19-associated pulmonary aspergillosis (CAPA) carries high mortality. Aspergillus niger is not commonly associated with CAPA. A middle-aged woman presented with cough, fever, and dyspnea for ten days and was subsequently diagnosed with COVID-19. She was mechanically ventilated and given methylprednisolone and broad-spectrum antibiotics. The initial computed tomography pulmonary angiogram (CTPA) was negative for pulmonary embolism, yet the patient's condition continued to worsen. A repeat CT scan of the thorax on day 17 revealed two new cavities. Ensuing tracheal culture was positive for Aspergillus niger, and later complicated with pneumothorax. She was treated with amphotericin B, but her clinical course was complicated by a pneumothorax, for which a chest tube was inserted. Despite all efforts, the patient eventually succumbed. Aspergillus niger infection can have devastating consequences in the setting of severe COVID-19 infection. It raises urgent questions about the need for antifungal prophylaxis. Pneumothorax is a potential complication of CAPA, especially when the cavities are very peripheral.

Background: Multi-drug-resistant tuberculosis (MDR-TB) has become a significant health problem worldwide. As per the Global Tuberculosis Report 2021, chemotherapy has only benefitted 59% of individuals. As many patients do not benefit from radical surgery due to their poor pulmonary reserve, bacterial overload, and prognosis, collapse therapy has an essential role in improving the effectiveness of complex anti-tubercular therapy.

Case presentation: A 35-year-old male with a low body mass index and persistent air leak on an intercostal tube not responding to medical management underwent thoracoscopic decortication. He was diagnosed with multi-drug-resistant tuberculosis (MDR-TB) according to the pleural specimen. Postoperatively, the lung did not seem to expand due to the extensive disease, and the air leak persisted. Hence, he received a short-term MDR-TB regimen and underwent open window thoracostomy followed by limited thoracoplasty for postoperative persistent infected pleural space.

Conclusion: Though pleural MDR-TB is a rare presentation, managing the infected pleural space is challenging as patients tend to have significant morbidity due to various factors.

Background: IgG4-related disease may initially present with pulmonary pseudotumor, making the diagnosis challenging particularly in patients prone to granulomatous inflammation. Here, we describe the first case of chronic granulomatous disease with associated lung IgG4RD.

Case presentation: An 8.5-year-old male was hospitalized two years ago with exertional dyspnea, mild cough, chest pain, and nocturnal sweating and was found to have a tumor-like mass in the right lung. The histopathologic findings were consistent with extensive peripheral fibrosis and infiltration of mixed inflammatory cells without any evidence of acid-fast bacilli/fungal elements. Treatment with prednisolone resulted in considerable symptom resolution. Following the discontinuation of prednisolone by the patient, symptoms recurred, gradually exacerbated, and he developed anorexia and weight loss. The next chest spiral computed tomography (CT) scan showed a larger mass in the right lung, right lung collapse, and mediastinal metastasis. The abdominal ultrasound and CT scan were normal. In laboratory evaluation, low counts of B and T cells, normal natural killer cells, high levels of IgG4, and high inflammatory markers were detected. The nitro blue tetrazolium test was zero in two consecutive evaluations. In virtue of high IgG4 level, organ-specific mass, notable tissue fibrosis, and mixed inflammatory cell infiltrate, he was diagnosed with concurrent CGD and IgG4RD, but progressed to respiratory failure and died despite the reinstitution of steroid therapy.

Conclusion: The overlap between inborn errors of immunity and IgG4RD is not common. Further studies to investigate IgG subsets among IEI patients can help elucidate clinicopathological correlations between these two immune-mediated disorders.

Background: The new coronavirus infectious disease, COVID-19, is constantly killing people around the world. The main clinical symptoms of COVID-19 include fever, cough, shortness of breath, weakness, fatigue, and sputum/discharge. Gastrointestinal (GI) impairments are often associated with respiratory manifestations in COVID-19 patients. The current study aimed to examine potential laboratory markers in COVID-19 patients with gastrointestinal impairments as prognosticators of disease severity.

Materials and methods: In the present study, hospitalized COVID-19 patients with respiratory symptoms as the main clinical manifestations and gastrointestinal symptoms were studied to evaluate relevant blood biomarkers including vitamins B12, D, and K in addition to albumin, pre-albumin, calcium, and magnesium.

Results: Sixty individuals (29 males and 31 females) participated in the study aged between 29 and 72 years, with a mean of 45.87 years. Our results showed a significant increase in albumin, pre-albumin, transferrin, and vitamin K and a significant decrease in magnesium and vitamin B12. Decreases in calcium and vitamin D were modestly associated with the clinical picture of the patient group.

Conclusion: Our findings suggest that monitoring laboratory markers such as transferrin, serum albumin, vitamin K, and magnesium-to-calcium ratio could be valuable prognosticators for COVID-19 infection. They could assist in better patient management and disease control.