Background: Sulfur mustard (SM) is a chemical warfare agent that can cause serious pulmonary complications. This study was designed to determine serum highly sensitive C-reactive protein (hs-CRP) and evaluate its correlation with lung function parameters in patients with chronic obstructive pulmonary disease (COPD) due to SM poisoning. Methods: Fifty consecutive SM patients with stable COPD and a mean age 46.3 ± 9.18 years were enrolled in this cross sectional study. Thirty healthy men were selected as controls. Lung function parameters were evaluated. Serum hs-CRP by immunoturbidometry assay was measured in both the patients and controls. Results: In the case group, the mean forced expiratory volume in one second (FEV1) was 2.14 ± 0.76 L (58.98% ± 17.51% predicted). The mean serum hs-CRP was 9.4 ± 6.78 SD and 3.9 ± 1.92 SD mg/L in the cases and controls, respectively, with significant statistical differences (p < .001). There was negative correlation between the serum hs-CRP and FEV1 levels (p = .01). The serum hs-CRP levels were also correlated with Global Initiative for Chronic Obstructive Lung disease (GOLD) stages (r = .45, p < .001). Conclusions: Our findings suggest that the serum hs-CRP level is increased in SM patients with COPD and may have a direct correlation with disease severity. It may then be used as a marker for the severity of COPD in patients with SM poisoning.

Invasive candidiasis (IC) bears a high risk of morbidity and mortality in the intensive care units (ICU). With the current advances in critical care and the use of widespectrum antibiotics, invasive fungal infections (IFIs) and IC in particular, have turned into a growing concern in the ICU. Further to blood cultures, some auxil- REVIEW 102November 4, 2014|Volume 3|Issue 4| WJCCM|www.wjgnet.com iary laboratory tests and biomarkers are developed to enable an earlier detection of infection, however these test are neither consistently available nor validated in our setting. On the other hand, patients' clinical status and local epidemiology data may justify the empiric antifungal approach using the proper antifungal option. The clinical approach to the management of IC in febrile, non-neutropenic critically ill patients has been defined in available international guidelines; nevertheless such recommendations need to be customized when applied to our local practice. Over the past three years, Iranian experts from intensive care and infectious diseases disciplines have tried to draw a consensus on the management of IFI with a particular focus on IC in the ICU. The established IFI-clinical forum (IFI-CF), comprising the scientific leaders in the field, has recently come up with and updated recommendation on the same (June 2014). The purpose of this review is to put together literature insights and Iranian experts' opinion at the IFI-CF, to propose an updated practical overview on recommended approaches for the management of IC in the ICU. Core tip: The present consensus statement has attempted to summarize the practical highlights regarding the management of Invasive Candidiasis (IC) in critical care setting. This easy-to-follow clinical pathway is expected to be not only of interest but also of clinical use for those who deal with the management of invasive fungal infections in hospital setting and especially the intensive care units. The focus of this paper is the concept of timely management of IC in critically ill patients.

Background:Tuberculosis (TB) is the world's second most common infectious disease after Human Immunodeficiency Virus Infection/Acquired Immunodeficiency Syndrome (HIV/AID) and the most frequent cause of mortality especially in developing countries. T regulatory (Treg) cells, which have suppressive activity and express forkhead winged-helix family transcriptional repressor p3 (FoxP3), suppress the immune responses against pathogens such as Mycobacterium tuberculosis. There are controversial results regarding the role of FoxP3 expressing cells in the blood of patients with TB.Objectives:The aim of this study was to evaluate the frequency CD4+ CD25+ Treg cells, and FoxP3 and Cytotoxic T Lymphocyte Antigen 4 (CTLA-4) gene expressions in peripheral blood of patients with tuberculosis and patients with positive tuberculin skin test before and after Peripheral Blood Mononuclear Cells (PBMCs) activation with Purified Protein Derivative (PPD).Patients and Methods:In this cross-sectional study, Peripheral Mononuclear Cells (PBMCs) were isolated from peripheral blood of 29 patients with newly diagnosed pulmonary TB and 19 patients with positive tuberculin skin test. The PBMCs were activated with PPD for 72 hours. Activated cells were harvested, RNA was extracted and cDNA was synthesized. A real-time Taqman method was designed and optimized for evaluation of Foxp3 gene expression and SYBR Green method was used and optimized for evaluation of CTLA-4 gene expression. A flow cytometry analysis was used to evaluate the frequency of CD4+ CD25+ Foxp3+ regulatory T cells in both groups.Results:There was no significant difference in the frequency of CD4+ CD25+ FoxP3+ regulatory T cells between the two groups. Expression of FoxP3 and CTLA-4 in peripheral blood of patients with newly diagnosed TB was significantly lower than the control group after and before activation with PPD.Conclusions:The expression of FoxP3 and CTLA-4 in PBMCs of patients with newly diagnosed TB was low, which might suggest that Treg cells may be sequestered in the lungs.

Respiratory complication is one of the important postoperative complications of oesophageal cancer. The aim of this study was to evaluate whether neoadjuvant chemotherapy before surgery is effective for postoperative respiratory complications. In this study, patients with oesophageal cancer were divided into two group: one with neoadjuvant therapy and the other without neoadjuvant therapy. Before surgery, they all underwent bronchoscopy and bronchoalveolar lavage. We evaluated respiratory complications and the effects of preoperative neoadjuvant therapy. Forty patients (M/F = 23/17 and mean age 61 years) were enrolled in this study. Twenty-two cases had cancer in the middle part and 18 in the lower part of the oesophagus. Significant correlation was observed between the number of positive micro-organism and difficulty in weaning and receiving neoadjuvant therapy. But no significant correlation was found between neoadjuvant therapy and respiratory complications.