Publications by authors named "Majid Mirsadraee"

23 Publications

  • Page 1 of 1

Effect of Propolis on moderate persistent asthma: A phase two randomized, double blind, controlled clinical trial.

Avicenna J Phytomed 2021 Jan-Feb;11(1):22-31

Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran.

Objective: The aims of this study was to determine the effect of Propolis (resinous mixture that honey bees produce by mixing saliva and beeswax) on clinical and physiological findings of moderate persistent asthma.

Materials And Methods: Fifty-two subjects aged 44.6±18.5 years old with moderate asthma and Forced expiratory volume in 1 second (FEV1) 60-79% of predicted, were enrolled in this clinical trial. We randomly allocated subjects to receive either propolis (75 mg three times a day) or a matched placebo for one month. Primary outcome was Asthma control test (ACT) score and secondary outcomes included dyspnea, spirometry, fractional exhaled nitric oxide (FENO) and sputum cytology including inflammatory cell. Sputum induction was done by hypertonic saline and cytology slides were stained by Papanicolaou stain.

Results: Clinical findings significantly improved after the treatment. ACT scores significantly increased by using propolis (12.8±5.5 before and 18.1±4.99 after the trial), which was significantly higher than the placebo group (14.4±6.6 after the trial). The most significant physiological improvements were significant increases in FEV1, FV1/Forced vital capacity and expiratory flows. FENO showed significant decreases in the propolis group but increases in the placebo group. Cytological examination of sputum showed that the pattern of inflammation was eosinophilic in 44% subjects with an average eosinophil of 7.2±1.01%. Eosinophilia significantly decreased (p<0.05) by using propolis (7.2±1.01 and 4.3±3.1%, before and after treatment, respectively), but it significantly increased (p<0.04) in the placebo group (5.5±2.8, and 11.1±6.6%, before and after treatment, respectively).

Conclusion: Propolis improved the clinical and physiological findings of moderate persistent asthma, and it was able to suppress eosinophilic inflammation.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7885004PMC
February 2021

A Randomized, Doubled-Blind Clinical Trial on the Effect of Zataria multiflora on Clinical Symptoms, Oxidative Stress, and C-Reactive Protein in COPD Patients.

J Clin Pharmacol 2020 07 23;60(7):867-878. Epub 2020 Mar 23.

Department of Physiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

The effects of Zataria multiflora on clinical symptoms, pulmonary function tests, oxidative stress, and C-reactive protein levels in chronic obstructive pulmonary disease (COPD) patients were evaluated. Forty-five patients were allocated to 3 groups: placebo group and 2 groups that received 3 and 6 mg/kg/day Z. multiflora extract (Z3 and Z6) for 2 months. Clinical symptoms, pulmonary function tests, oxidative stress, and serum C-reactive protein levels were evaluated pretreatment (step 0) and 1 (step I) and 2 (step II) months after treatment. Clinical symptoms including breathlessness and chest wheeze in Z3- and Z6-treated groups and sputum production only in the Z6-treated group were significantly improved 1 and 2 months after treatment compared with baseline values (P < .01 to P < .001). The FEV was significantly increased after 2 months of treatment with Z3 and Z6 (P < .05 to P < .01). Malondialdehyde and nitrite levels were significantly decreased after a 2-month treatment with Z6 compared with step 0 (P < .05 to P < .01). The thiol contents in the Z6 group as well as superoxide dismutase and catalase activities in both groups treated with the extract were significantly increased in step II compared with step 0 (P < .05 to P < .01). The C-reactive protein level at the end of the study was significantly reduced compared with the step 0 in both treated groups (P < .05 for both cases). Two-month treatment with Z. multiflora improved clinical symptoms, pulmonary function tests, oxidative stress, and C-reactive protein in COPD patients. The results suggest that this herbal medicine could be of therapeutic value as a preventive drug for the treatment of COPD.
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http://dx.doi.org/10.1002/jcph.1586DOI Listing
July 2020

Long-term effect of antifungal therapy for the treatment of severe resistant asthma: an active comparator clinical trial.

Curr Med Mycol 2019 ;5(4):1-7

MSc in Cell and Molecular Biology, Innovative Research Center, Faculty of Medicine, Islamic Azad University, Mashhad Branch, Mashhad, Iran.

Background And Purpose: Itraconazole therapy has been reported to control asthma in severe therapy-resistant asthma with fungal sensitization. The aim of this study was to investigate the impact of anti-fungal therapy on the treatment of severe asthma, irrespective of sensitization.

Materials And Methods: This active comparator clinical trial was performed on 110 therapy-resistant asthmatic patients who were randomly assigned into two groups of case and control. The patients in the case group were administered 200 mg itraconazole twice a day and the control group received 10 mg prednisolone after breakfast for 4 months. The asthma control test (ACT) which was used as a marker for the global evaluation of treatment effectiveness (GETE) was applied as the primary endpoint parameter. Cough, dyspnea, and sleep disturbance were measured on a scale of 1-4, with 1 representing no symptom and 4 indicating severe exhausting disturbance.

Results: Based on the obtained results, 71% of the itraconazole group demonstrated a marked improvement in the GETE score after a four-month treatment. Itraconazole was able to suppress clinical symptoms, including cough, dyspnea, and night symptoms, and their physical exam was indicative of normalization in 60% of the patients. On the other hand, the patients in the parallel group "prednisolone" were only able to control dyspnea. The ACT score represented a notable improvement with itraconazole (mean: 14 before the trial and >20 after the trial) and spirometry parameters underwent a considerable change from obstructive pattern to normal. Furthermore, adverse effects were only detected in 6% of itraconazole users.

Conclusion: The results of this clinical trial indicted the effectiveness of antifungal therapy for the control of the clinical condition of a subgroup of patients with severe steroid-refractory asthma.
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http://dx.doi.org/10.18502/cmm.5.4.1986DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7034786PMC
January 2019

Effect of Salmeterol-Fluticasone Combination and Tiotropium on Clinical and Physiological Improvement of Bronchial Anthracofibrosis: a Double Blind Randomized, Cross Over, Placebo Controlled, Clinical Trial.

Tanaffos 2018 Mar;17(3):163-171

Department of Urology, Akbar Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.

Background: Bronchial anthracosis is the black discoloration of bronchial mucosa that exhibits similar manifestations to Chronic Obstructive Pulmonary Disease ( COPD). The etiology of this obstructive lung disease has not been elucidated and standard therapy for this disease has not been introduced in the literature. The objective of this study is to determine the efficacy of the salmeterol-fluticasone inhaler and tiotropium as two safe treatments of obstructive lung disease for the treatment of symptomatic subjects of anthracofibrosis of the lung.

Materials And Methods: Twenty anthracofibrosis subjects who suffered from dyspnea were enrolled in this three-phase, cross over, placebo-controlled clinical trial. The primary outcome variable was quality of life (evaluated with the CAT questionnaire). Clinical findings and spirometry were the secondary outcome variables. Both of these drugs were delivered by an inhaler and were made identically by the reference manufacturer. Salmeterol-fluticasone was prescribed with a spacer and tiotropium by its special device, and the method of utilization was taught to the patients.

Results: Twenty anthracofibrosis subjects were enrolled in this three-phase, five-month course of treatment with either salmeterol-fluticasone or tiotropium inhalers. The response to therapy was not good; neither for salmeterol-fluticasone nor for tiotropium in the short course of the treatment. However, the overall results of 5 months of therapy with both of the drugs have shown improvement in 57% of the subjects. The most prominent results were found in the CAT score [25.1±5.54 before the trial, which decreased to 19.2±5.14 (Z score=2.7, P=0.007)] and clinical findings especially sputum, chest pain, and wheezing (81, 94 and 92% before the trial and 50, 56, 54% after the trial, respectively). Neither clinical findings nor spirometry was able to predict a good response to salmeterol-fluticasone or tiotropium.

Conclusion: The combination of salmeterol-fluticasone and tiotropium inhaler was able to improve the clinical findings of symptomatic anthracofibrosis patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6428379PMC
March 2018

Cromolyn, a New Hope for Limited Treatment of Neutrophilic Asthma: a Phase II Randomized Clinical Trial.

Tanaffos 2019 Mar;18(3):208-214

Department of Pathology, Taleghani Medical Institute and Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

Background: In this study, we aimed to determine the effects of cromolyn on the clinical outcomes and neutrophilic inflammation in patients with resistant cough-variant asthma.

Materials And Methods: Patients with cough-variant asthma, with normal physical examination and spirometry results, were treated by inhaled corticosteroids, antileukotrienes, antibiotics, and proton-pump inhibitors according to the Global Initiative for Asthma (GINA) guidelines. Seventy patients, who were resistant to these treatments, were enrolled in this double-blind randomized clinical trial. After randomization, eligible subjects received a cromolyn metered dose inhaler (MDI) or a placebo MDI, which was completely similar in appearance to the cromolyn inhaler. The primary outcomes included cough and Asthma Control Test (ACT) score.

Results: Based on the findings, cough significantly decreased with cromolyn therapy, compared to the placebo group. Other clinical findings, including dyspnea, sputum production, and nocturnal symptoms, also improved. The ACT score significantly improved to a nearly normal level (23.53±2.25) in the cromolyn group. Moreover, fractional exhaled nitric oxide (FeNO) significantly decreased with cromolyn treatment (14±9.31 ppm after treatment vs. 28.88±27.39 before treatment). The neutrophil count significantly decreased in the cromolyn group (from 44±24.2% before the trial to 34.08±16.7% after the trial), while it increased in the placebo group (from 39.67±26.47% to 56.71±27.22%).

Conclusion: Cromolyn improved the clinical findings of resistant cough-variant asthma and could suppress neutrophilic inflammation.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7210571PMC
March 2019

Effects of Rosmarinus officinalis and Platanus orientalis extracts on asthmatic subjects resistant to routine treatments.

Avicenna J Phytomed 2018 Sep-Oct;8(5):399-407

Biologist, Shahid Hasehemi Nezhad Research center, Kavosh high school, Ministry of Education, Mashhad, Iran.

Objective: The present study aimed to determine the effects of ( and () extracts on asthma.

Materials And Methods: We conducted a randomized, double-blind, active-comparator study to evaluate the effect of and extracts on asthmatic patients resistant to routine treatment. The subjects were randomly divided into three groups receiving and extracts alone or in combination. The primary endpoints were clinical findings, spirometry, exhaled nitric oxide (FENO) and Asthma Control Test (ACT) assessed over the one-month treatment period.

Results: ACT score showed significant improvement after treatment with (p<0.05) but not with . Clinical evaluations showed that cough, sputum production and wheezing were significantly improved in group (p<0.05 to p<0.001) while in group only improvement of cough and chest tightness were shown. Spirometry results showed significant improving in FEV1/VC values for subjects treated with and those who received the combination of extracts as well as significant decrease in FEF25-75 value only for group (p<0.05 for all cases). FENO was decreased in both groups but the results were statistically significant only for group (p<0.05). Abdominal pain and skin rash were the most frequent side effects of the treatments which led to discontinuation of the intervention.

Conclusion: extract showed promising results in treatment of resistant asthma. Further studies to find the most effective components of these herbal medicines are recommended.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6190250PMC
October 2018

A Viewpoint on the Leaky Gut Syndrome to Treat Allergic Asthma: A Novel Opinion.

J Evid Based Complementary Altern Med 2017 07 22;22(3):378-380. Epub 2016 Dec 22.

1 School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Asthma is a common respiratory disease characterized by airway inflammation, airway hyperreactivity, and reversible airflow obstruction. Despite current treatments, the prevalence of asthma has increased markedly over decades. According to the theories proposed to explain the pathophysiology of autoimmune diseases in integrative medicine, leaky gut syndrome is a phenomenon of increased intestinal permeability due to the disruption of tight junctions and is thought to be related to many chronic diseases, such as food intolerance, inflammatory bowel disease, rheumatoid arthritis, asthma, and other autoimmune disease. One of the classical approaches used by integrative physicians to treat leaky gut syndrome is to repair intestinal permeability to prevent allergic cascade. Due to several mechanisms that have been mentioned in the protective effects of plant gums and plantain family seeds on the intestinal epithelium, we can propose an effective management for leaky gut syndrome to treat asthma.
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http://dx.doi.org/10.1177/2156587216682169DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5871166PMC
July 2017

Effect of Borago Officinalis Extract on Moderate Persistent Asthma: A Phase two Randomized, Double Blind, Placebo-Controlled Clinical Trial.

Tanaffos 2016 ;15(3):168-174

Shahid Hasehemi Nezhad Research Center, Ministry of Education, Mashhad, Iran.

Background: Borago officinalis and its derivatives are used in folk medicine to treat asthma because of its special effect on allergic disorders. It suppresses the tumor necrosis factor-alpha (TNF-alpha) and delivers gamma-linolenic acid. The objective of this clinical trial was to determine the effect of Borago officinalis on clinical and physiological findings in moderate persistent asthma.

Materials And Methods: This prospective, randomized, double blind, placebo-controlled, clinical trial was conducted on patients aged 15-90 years with moderate asthma and forced expiratory volume in one second (FEV1) of 60-79% of predicted who presented to a sub-specialty clinic of pulmonary medicine. We randomly allocated subjects to receive either Borago extract (5 mL three times a day) or a matched placebo for one month. The primary outcome was the asthma control test (ACT) score and fractional exhaled nitric oxide (FENO) test. Secondary outcomes included clinical findings, spirometry, and sputum cytology including inflammatory cells.

Results: Thirty-eight subjects with a mean age of 46.8±15.3 years and mean duration of asthma of 71±103 months were enrolled in our study. Cough, dyspnea, wheezing, nocturnal symptoms, and airway hyper-responsiveness reduced significantly in the Borago group after the treatment and ACT scores improved significantly (10.8±5.26 before and 15.4±5.12 after the trial). Flare up of asthma and emergency department visits in the Borago group also decreased significantly (3.6±2.33 to 2±1.86 flare ups per month and 0.62±0.9 to 0.05±0.23 for emergency department visits per month). Physiological parameters including spirometry, FENO, and sputum cytology including eosinophil and neutrophil did not change significantly.

Conclusion: Borago improved the clinical findings of asthma, but it was not able to suppress the inflammation involved in asthma.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5304961PMC
January 2016

What Do We Know about Anthracofibrosis? A Literature Review.

Tanaffos 2017 ;16(3):175-189

Virology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Recently, the significance of anthracosis in the tracheobronchial tree, lung parenchyma, and even non-respiratory organs has been postulated and discussed in association with other diseases, especially tuberculosis. We reviewed the current literature by using the following key words in Medline/PubMed, Embase, and Google Scholar databases: anthracosis, anthracofibrosis, anthracotic bronchitis, biomass fuels, and mixed-dust pneumoconiosis. The bibliographies of eligible papers were also reviewed for further relevant articles. A total of 37 studies were assessed. The content of these studies was then divided into specific categories. Considering the pathogenesis, along with histopathological, radiological, and bronchoscopic results regarding anthracotic lesions, we suggest these findings be defined as "ANTHRACOSIS SYNDROME". For the first time, we describe a syndrome involving black pigmentation, which was previously thought to involve only the tracheobronchial tree. Until recently, it was not considered to be a single syndrome with different sites of involvement.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5960222PMC
January 2017

Value of the polymerase chain reaction method for detecting tuberculosis in the bronchial tissue involved by anthracosis.

J Bronchology Interv Pulmonol 2014 Apr;21(2):131-4

*Department of Internal Medicine, 22 Bahman Hospital, Islamic Azad University-Mashhad Branch ‡Department of Immunology and Zakaria Research Center, Medical School of Islamic Azad University-Mashhad Branch §Immunology Research Center, Buali Research Center, Mashhad University of Medical Sciences, Mashhad †Kerman University of Medical Sciences, Kerman, Iran.

Background: Anthracofibrosis is the black discoloration of the bronchial mucosa with deformity and obstruction. Association of this disease with tuberculosis (TB) was approved. The objective of this study was to find the additional benefit of assessment of TB by the polymerase chain reaction (PCR) method.

Methods: Bronchoscopy was performed on 103 subjects (54 anthracofibrosis and 49 control subjects) who required bronchoscopy for their pulmonary problems. According to bronchoscopic findings, participants were classified to anthracofibrosis and nonanthracotic groups. They were examined for TB with traditional methods such as direct smear (Ziehl-Neelsen staining), Löwenstein-Jensen culture, and histopathology and the new method "PCR" for Mycobacterium tuberculosis genome (IS6110).

Results: Age, sex, smoking, and clinical findings were not significantly different in the TB and the non-TB groups. Acid-fast bacilli could be detected by a direct smear in 12 (25%) of the anthracofibrosis subjects, and adding the results of culture and histopathology traditional tests indicated TB in 27 (31%) of the cases. Mycobacterium tuberculosis was diagnosed by PCR in 18 (33%) patients, but the difference was not significant. Detection of acid-fast bacilli in control nonanthracosis subjects was significantly lower (3, 6%), but PCR (20, 40%) and accumulation of results from all traditional methods (22, 44%) showed a nonsignificant difference.

Conclusions: The PCR method showed a result equal to traditional methods including accumulation of smear, culture, and histopathology.
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http://dx.doi.org/10.1097/LBR.0000000000000063DOI Listing
April 2014

Anthracosis of the lungs: etiology, clinical manifestations and diagnosis: a review.

Authors:
Majid Mirsadraee

Tanaffos 2014 ;13(4):1-13

Department of Internal Medicine, 22 of Bahman Hospital, Islamic Azad University, Mashhad Branch, Mashhad, Iran.

Anthracosis of the lungs is black discoloration of bronchial mucosa that can occlude bronchial lumen and is associated with bronchial anthracofibrosis (BAF). This disease usually presents with a chronic course of dyspnea and or cough in an elderly non-smoker woman or man. In addition, concomitant exposure to dust and wood smoke is the most postulated etiology for anthracosis. Pulmonary function tests usually show an obstructive pattern with no response to bronchodilators and normal DLCO, but some cases with restrictive pattern have also been seen. Computed tomography (CT) may show more specific findings such as lymph node or bronchial calcification and mass lesions. Final diagnosis can be made by bronchoscopy when obtaining samples for tuberculosis (TB), which is the most common disease associated with BAF. Endobronchial ultrasound shows a hypoechoic scattered nodular pattern in adjacent lymph nodes, which is unique to anthracosis. Treatment is very similar to that of chronic obstructive pulmonary disease (COPD) with a chronic course and low mortality. This review discusses this disease as a separate entity; hence, anthracosis should be added to the list of obstructive lung diseases and benign mass lesions and differentiated from biomass induced COPD.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4386010PMC
April 2015

Frequency of tuberculosis in anthracosis of the lung: a systematic review.

Arch Iran Med 2013 Nov;16(11):661-4

Department of Internal Medicine, Medical School of Islamic Azad University, Mashhad Branch, Mashhad, Iran.

Introduction: Anthracosis of the lung is the blackening of bronchial tissues which can lead to chronic bronchial obstruction. Many studies have shown association of bronchial anthracosis and tuberculosis. The aim of this study was accumulation of scattered studies and getting the definite conclusion about the association between anthracosis and tuberculosis.

Matherials And Methods: We conducted a systematic search that included studies with sufficient information about the frequency of tuberculosis in anthracosis (anthracofibrosis) patients and non-anthracotic control group. Moreover, tuberculosis should be confirmed by microbiologic (smear or culture) or histopathological methods.

Results: Twelve studies (eight studies on anthracofibrosis and four studies on anthracosis as a general term) comprising of 6280 patients was entered into our meta-analysis. The frequency of tuberculosis in all anthracosis patients was 22.5 % (32.3 % for anthracofibrosis and 16.6 % for anthracosis), which was significantly higher than the control group. Determination of risk showed that the cumulated odds ratio of tuberculosis in all studies of anthracosis was 3.16 (95 % CI = 2.49 - 6.85), which revealed significantly higher risk than the control group. The analysis of the subgroups showed that the cumulated odds ratio of tuberculosis in subgroups of anthracofibrosis (3.28; 95 % CI = 2.16 - 9.12) was significantly higher than anthracosis as a general term (2.85; 95 % CI = 1.73 - 6.61).

Discussion: The association of tuberculosis with all types of anthracosis of the lung was confirmed and a proper mechanism should be defined.
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http://dx.doi.org/0131611/AIM.0010DOI Listing
November 2013

Diagnosis of chronic obstructive pulmonary disease earlier than current Global Initiative for Obstructive Lung Disease guidelines using a feasible spirometry parameter (maximal-mid expiratory flow/forced vital capacity).

Chron Respir Dis 2013 ;10(4):191-6

1Department of Internal Medicine, Islamic Azad University-Mashhad Branch, Mashhad, Islamic Republic of Iran.

Some patients suffer from clinical symptoms of chronic obstructive pulmonary disease (COPD) but their pulmonary function tests are in the normal range (at risk group). The objective of this study was to discover a practical test to distinguish these patients from non-COPD subjects. A total of 77 subjects including 40 COPD patients, 37 subjects at risk for developing COPD, and 32 control subjects were entered in this study. The accuracy of maximal-mid expiratory flow (MMEF)/forced vital capacity (FVC) for the diagnosis of COPD in at risk patients and its capability to differentiate from early COPD and normal patients were evaluated. Body plethysmography was used for measurement of lung volume as the Global Initiative for Obstructive Lung Disease standard. MMEF/FVC in the at risk group of COPD (0.73±0.19) was significantly lower than the normal control group (0.9±0.24, respectively), and also, it was significantly higher than the COPD group (0.31±0.17). There was significant correlation between the MMEF/FVC and amount of smoking measured by pack year (r2=0.112, p=0.005) and stages of COPD (Spearman's ρ=0.82, p=0.0001). Early stage COPD (smoker subjects without spirometry derangement) can be diagnosed by MMEF/FVC. Using this tool we may be able to detect this highly preventable disease at an earlier stage.
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http://dx.doi.org/10.1177/1479972313507461DOI Listing
March 2014

Preventive Effect of Novel Bacterial Polysaccharide and Animal Splenic Protein as Natural Adjuvants on Animal Model of Asthma.

Iran J Basic Med Sci 2012 Sep;15(5):1068-75

Department of Internal Medicine, Medical School of Islamic Azad University- Mashhad Branch, Mashhad, Iran.

Objectives: Two new adjuvants from natural animal lipids (G2) and bacterial polysaccharide extracts (PC) were previously prepared by our group and showed a reduction in tracheal responsiveness. The aim of this study was to evaluate the preventive effect of recently introduced natural products (G2 and PC) on the development of asthma.

Materials And Methods: Asthma was induced using a standard method in four groups of BALB/c mice. A non-sensitized control group was also included in order to be compared with treated groups. Three groups were premedicated with novel agents named G2, PC, and a combination of these two for 20 days before starting the induction of asthma. Bronchoalveolar lavage fluid (BALF) was collected and analyzed for inflammatory cells. Interferon-γ, and IL-4 and the histopathological of both lungs were also evaluated.

Results: In all pretreated groups, the inflammatory cells infiltration especially eosinophils and smooth muscle hyperplasia decreased significantly. BALF cytology also showed significant decrease in eosinophil count in all pretreated groups. There was a significant increase in the BALF and serum INF-γ in all pretreated groups but the combination of G2/PC was more effective. BALF IL-4 decreased significantly in the group pretreated with a combination of G2 and G2/PC (4.11±0.86 and 4.02±0.52 pg/ml in G2 and G2/PC, respectively). Serum IL-4 in the PC group was significantly higher than the sensitized control.

Conclusion: G2 and PC may effectively prevent asthma development by activation of the type 1 T helper system.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3586916PMC
September 2012

Bronchial anthracosis: a new diagnosis for benign mass lesions of the lung.

Tanaffos 2013 ;12(4):10-8

Honorary Radiologist Consultant, Queen's Medical Research Institute, University of Edinburgh, UK.

Background: This study aimed to identify the most important new radiological presentations of anthracosis and anthracofibrosis and evaluate the risk ratio for accurate diagnosis of these conditions using computed tomography instead of bronchoscopy.

Materials And Methods: This prospective, case-control study evaluated three groups of 70 patients with a bronchoscopic diagnosis of simple anthracosis and anthracofibrosis and 40 patients with a non-anthracotic diagnosis (control group). Bronchoscopy, chest radiographs and computed tomography (CT) (parenchymal and mediastinal windows) were reviewed. Special attention was given to mass lesions, calcified lymph nodes, bronchi and bronchial stenosis.

Results: Abnormal chest x-rays were observed in 93% of patients with bronchial anthracofibrosis; patchy consolidation was the most prevalent finding. The most significant CT finding was lymph node calcification (80%, odds ratio = 22.9), followed by bronchial calcification and bronchial stenosis (odds ratio = 6 and 2.91, respectively). Other significant findings were mass-like lesions (14%) and collapse (20%). CT findings were unremarkable in less than 1/6 of subjects.

Conclusion: Lymph node and bronchial calcification can serve as accurate signs in diagnosing anthracosis of the lung. In addition, mass lesions, collapse and infiltration may be associated with a benign course.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153268PMC
September 2014

Simple screening of pulmonary artery hypertension using standard chest x ray: an old technique, new landmark.

Tanaffos 2013 ;12(3):17-22

Department of Radiology, Islamic Azad University, Mashhad Branch, Mashhad, Iran.

Background: Pulmonary artery hypertension (PAH) is difficult to diagnose because of its nonspecific symptoms. Although echocardiography can reliably and rapidly recognize the presence of pulmonary hypertension, chest X ray (CXR) is more widely used because of its availability. The objective of this study was to find a parameter, which, by changing the scale of CXR, is still useful for detection of PAH.

Materials And Methods: This case control prospective study included 100 subjects with a clinical finding of dyspnea. Additionally, thirty healthy volunteers (control group) were included in this study. Systolic pulmonary artery pressure (SPAP) was determined by echocardiography. Widening of pulmonary hilum, projection of the right side of the heart border (PRHB) and the ratio of these parameters to the chest diameter were compared to SPAP using the regression method. A cut-off point was determined for parameters that showed significant correlation.

Results: The most prevalent disease in the dyspnea group was COPD (28%). Average SPAP was 41.8±17.3 (ranging from 10 to 87 mmHg). Multivariate analysis of the covariance revealed significant correlation between SPAP, age, sex and hilar widening (r = 0.44, P = 0.0001) that was higher than PRHB and hilar widening + PRHB (r= 0.374. and r= 0.438, respectively). The ROC curve showed that the area under the curve was not significantly different for all parameters and the best cut-off point with sensitivity of more than 80% was as follows: hilar size more than 112 mm, PRHB more than 44 and hilum/chest ratio more than 0.44.

Conclusion: Hilum/chest ratio is the proper substitution for the hilar size in case of changing the scale of the chest X ray. Evaluation of hilar widening and PRHB could lead to identifying more subjects suffering from undiagnosed PAH.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153251PMC
September 2014

Prevalence of asthma in children of chemical warfare victims.

Iran J Pediatr 2011 Sep;21(3):294-300

Department of Pulmonary Medicine, Islamic Azad University of Mashhad, Iran.

Objective: Exposure of DNA to sulfur mustard gas may increase the inheritance of asthma in chemical warfare victims' (CWV) offspring. The objective of this study was to determine the prevalence of asthma in children of CWV and compare it to asthmatic children in the general population.

Methods: Four hundred and nine children from 130 CWV fathers and 440 children from 145 asthmatic parents from two cities in Iran participated in this study. The prevalence of asthma was determined by standard questionnaire released for epidemiological survey of asthma in children and compared between two groups.

Findings: The prevalence of asthma in the CWV group was 15%; this was not significantly different from the control group (12.5%). The children of the CWV group reported a significantly greater incidence of wheezing (1.2±3.1 attacks) per year, but the control group reported more severe attacks leading to speech difficulties (3%) and coughing (7%). Regression analysis showed that with increasing family size in the control group, the number of subjects suffering from asthmatic symptoms decreases significantly (r=0.86, P=0.001).

Conclusion: Chemical agents may increase the prevalence of asthma in the offspring of CWV.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3446181PMC
September 2011

Decreased levels of soluble Toll-like Receptor 2 in patients with asthma.

Rep Biochem Mol Biol 2012 Oct;1(1):30-6

Immunobiochemistry lab, Immunology Research Center, Bu-Ali Research Institute, Mashhad, Iran.

Background: Recently, reports have indicated a role for the membrane form of Toll-like Receptor 2 (TLR2) in asthma pathogenesis. In this study we examined soluble TLR2 levels in serum and sputum of asthmatic and healthy subjects.

Methods: Serum and sputum samples were obtained from 33 asthmatic and 19 healthy subjects. The asthmatics were classified into four groups according to the Global Initiative for Asthma. A sandwich ELISA was developed to measure soluble TLR2 (sTLR2) in serum and sputum. TLR2 mRNA expression was determined by semi-quantitative RT-PCR of all sputum samples.

Results: The mean sTLR2 levels from serum and sputum of asthmatics were significantly lower than those from healthy subjects. Moreover, sTLR2 concentration decreased concomitantly with asthma severity. The differences observed, however, were not statistically significant. TLR2/GAPDH mRNA of sputum leukocytes was also significantly lower in asthmatics than in healthy subjects.

Conclusion: This study demonstrated for the first time thatsTLR2 levels are lower in serum and sputum samples from asthmatic than from healthy subjects, and this could be an indicator of TLR2 expression. We also found that sTLR2 concentration in serum decreased concomitantly with an increase of asthma severity clinical score .
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4757078PMC
October 2012

Pattern of pulmonary function test abnormalities in anthracofibrosis of the lungs.

Tanaffos 2012 ;11(2):34-7

Department of Pulmonary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Background: The objective of this study was to discuss the spirometric characteristics of anthracofibrosis which is a from of bronchial anthracosis associated with deformity.

Materials And Methods: Forty anthracofibrosis subjects who were diagnosed with bronchoscopy were enrolled in this prospective study. Static and dynamic spirometry plus lung volumes and diffusion capacity were measured in this group and compared to a healthy control group.

Results: Dyspnea (95%), cough (86%) and wheezing (68%) were the most frequent clinical findings. Spirometry showed significant decrease in all parameters including VC (FVC), FEV1, FEV1/FVC, FEF25-75 and FEF25-75 /FVC. The low value of FEV1/FVC and FEF25-75 and the increment of RV were in favor of obstructive patterns in 95% of subjects. Improving the obstruction with bronchodilator was not significant and diffusion capacity was mostly normal.

Conclusion: Anthracofibrosis should be added to the list of chronic obstructive pulmonary diseases.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4153196PMC
September 2014

Effect of verapamil on bronchial goblet cells of asthma: an experimental study on sensitized animals.

Pulm Pharmacol Ther 2012 Apr 25;25(2):163-8. Epub 2011 Nov 25.

Zakaria Research Center, Medical School of Islamic Azad University-Mashhad Branch, Mashhad, Iran.

Introduction: Goblet cell hyperplasia (GCH) and mucus hypersecretion in the airway is recognized as an important contributor to morbidity and mortality in asthma and COPD. Verapamil is a calcium channel blocker that binds to the alpha-subunit of L-type calcium channels and inhibits the mucin gene via the calmodulin and CaM kinase pathway. The objective of this study was to determine the in vivo effect of verapamil on GCH and eosinophilic inflammation in sensitized mice.

Methods: Male BALB/c mice were sensitized to ovalbumin using the standard method. Two groups of animals were received verapamil via an intramuscular injection: 1-low dose (0.5 mg/kg/day for two weeks), 2-high dose (1.5 mg/kg/day for two weeks). Serum and bronchoalveolar lavage fluid (BALF) was collected and analyzed for inflammatory cells, interferon-γ and IL-4. The left lung was sent for histopathological evaluation, especially for periodic acid-Schiff (PAS), to identify goblet cells in the epithelium. The degree of inflammatory cell infiltration, including eosinophils, mucus plugging, and smooth muscle thickness of the airways were classified on a semi quantitative scale.

Results: Inflammatory cell infiltration in peribronchial and perivascular areas was observed in all sensitized groups. Eosinophils percentage in the BALF significantly decreased in verapamil-treated mice compared with sensitized mice (from 19.8% in asthmatic to 5.4% for low dose and 4.4% for high dose). The ratio of airway goblet cells per epithelial cells were significantly lower in verapamil-treated mice versus sensitized mice (1.57±1.30% for low dose; 1.50±0.93% for high dose versus 12.93±7.55%, P<0.05, respectively). Mucus production of goblet cells decreased significantly in verapamil-treated mice versus sensitized mice (mean score was 1.45±0.30 for low dose; 0.81±1.00 for high dose versus 2.85±0.86 in the sensitized control group, P<0.05, respectively). The concentration of serum and BALF-IFN-γ in verapamil-treated mice markedly increased by the verapamil treatment when compared to sensitized mice (15.1±0.43 versus 4.7±0.96, P<0.05 and 91.8±47.7 versus 14.8±4.6, P<0.01, respectively).

Conclusion: Verapamil is a useful drug with therapeutic targeting on GCH and a potential way to limit mucous production and improve bronchial inflammation.
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http://dx.doi.org/10.1016/j.pupt.2011.11.001DOI Listing
April 2012

Endobronchial ultrasound in anthracosis.

J Bronchology Interv Pulmonol 2010 Apr;17(2):188-9

*Islamic Azad University, Mashhad Branch †Razavi Hospital, Mashhad, Iran.

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http://dx.doi.org/10.1097/LBR.0b013e3181da2af8DOI Listing
April 2010

Peripheral bronchopathia osteochondroplastica.

J Bronchology Interv Pulmonol 2010 Apr;17(2):155-7

*Department of Pulmonary Medicine, Islamic Azad University of Mashhad †Department of Pathology, Razavi Hospital, Mashhad, Iran.

Tracheobronchopathia osteochondroplastica refers to the abnormal presence of osseous and/or cartilaginous nodules in the submucosa of the trachea and/or bronchi. This disease presents with exophytic lesions that are covered by normal mucosa. In this study, we report the case of a 51-year-old man who complained of exertional dyspnea. Chest x-ray and computed tomography showed diffuse bilateral micronodular pulmonary infiltrate. Mucosal appearance during bronchoscopy was completely normal. Histologic examination of the biopsy taken by transbronchial lung biopsy showed discrete cartilaginous nodules in the walls of the bronchiole. According to our investigation, this presentation of peripheral bronchopathia osteochondroplastica has not been reported previously.
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http://dx.doi.org/10.1097/LBR.0b013e3181db95ddDOI Listing
April 2010

Is serum or sputum eosinophil cationic protein level adequate for diagnosis of mild asthma?

Iran J Allergy Asthma Immunol 2009 Sep;8(3):155-60

Zakaria Research Center, Islamic Azad University-Mashhad branch, Mashhad, Iran.

Spirometry has been used as a common diagnostic test in asthma. Most of the patients with a mild asthma have a FEV1 within normal range. Hence, other diagnostic methods are usually used. The aim of this study was to evaluate whether eosinophil Cationic Protein (ECP) could be an accurate diagnostic marker of mild asthma. In this study diagnosis of asthma was made according to internationally accepted criteria. Asthma severity was evaluated according to frequency of symptoms and FEV1.Adequate sputum samples were obtained in 50 untreated subjects. A control group of 12 normal subjects that showed PC20 more than 8 mg/dl was also examined. Sputum was induced by inhalation of hypertonic saline. Inflammatory cells in sputum smears were assessed semi-quantitatively. ECP and IgE concentrations, eosinophil (EO) percentage and ECP/EO ratio in serum and sputum were also determined. The results revealed that Cough and dyspnea were the most frequent clinical findings. Dyspnea and wheezing were the symptoms that correlated with staging of asthma. FEV1 was within normal range (more than 80% of predicted) in 22 (44%) subjects.Asthmatic patients showed significantly higher numbers of blood eosinophils (4.5+/- 3.1% vs. 1.2+/-0.2%, P=0.009), and higher levels of serum ECP than control group (3.1+/- 2.6 % and 22.6+/- 15.8 ng/ml, respectively). Sputum ECP level in asthmatics was significantly higher than non- asthmatics (55.3+/-29.8ng/mL vs. 25.0+/-24.7ng/mL, P=0.045). Regression analysis showed no significant correlation between spirometric parameters and biomarkers, the only exception was significant correlation between FEF(25-75) and serum ECP (r= 0.28, P 0.041). Regarding clinical symptoms, wheezing was significantly correlated with elevation of most of biomarkers. Since, serum and sputum ECP levels are elevated in untreated asthmatics, the ECP level could be used for accurate diagnosis of mild form of asthma in which spirometry is unremarkable.
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http://dx.doi.org/08.03/ijaai.155160DOI Listing
September 2009