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One of the major toxic effects of exposure to ammonia is the resulting pulmonary acute and chronic effects. This study investigated the acute pulmonary effects of exposure to ammonia lower than the recommended threshold limit value (TLV). This cross-sectional study was conducted in 2021 in four chemical fertilizer production industries using ammonia as the main raw material. A total of 116 workers who were exposed to ammonia were investigated. The level of exposure to ammonia was measured by NMAM 6016, and the evaluation of pulmonary symptoms and function parameters was done using the American Thoracic Society and European Respiratory Society protocols in four sessions. The paired-sample t-test, repeated measures test, Chi-square, and Fisher's exact test were run to analyze the collected data. The prevalence rates of pulmonary symptoms, including cough, dyspnea, phlegm, and wheezing, were 24.14, 17.24, 14.66, and 16.38%, respectively, after one exposure shift. It was observed that all pulmonary function parameters were reduced after one exposure shift to ammonia. The results revealed that the parameters of vital capacity, forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), the FEV1/FVC ratio, and peak expiratory flow significantly decreased (p < 0.05) across four exposure shifts. The findings indicated that exposure to ammonia at concentrations lower than one-fifth of TLV could bring about acute pulmonary effects and reduce pulmonary function parameters, similar to the pattern observed in obstructive pulmonary diseases.

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OBJECTIVE: This study aimed to investigate respiratory disorders associated with exposure to low concentrations of ammonia. METHOD: This cohort study was conducted on 122 industrial workers. Data gathering were based on the officially registered data, the NMAM 6016 and the American Thoracic Society and European Respiratory Society protocols. RESULTS: The prevalence rate of respiratory disorders significantly increased in the exposure group over 5 years (P < 0.05). The frequencies of these symptoms in the exposure group were significantly higher than non-exposure group (P < 0.05). Respiratory functions were decrease significantly in the exposure group and were lower than non-exposure group (P < 0.05). Exposure and the amount of exposure to ammonia had a significant relationship with respiratory disorders and respiratory functions (P < 0.05). CONCLUSION: Exposure to ammonia lower than threshold limit value (TLV), can act as a risk factor of respiratory disorders.

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OBJECTIVE: To assess the effects of workplace exposure to hardwood dust on lung function and determine a prevalence of respiratory symptoms among wood workers. STUDY DESIGN: Cross-sectional observational study. SETTING: Tertiary referral center. SUBJECTS AND METHODS: Two hundred seventy-six, non-smoker male wood workers and equal number of non-smoker male office workers, referred to pulmonology clinic included in this study. Evaluation of study participants included completion of a questionnaire regarding respiratory symptoms and baseline spirometry was measured according to the actual recommendations. RESULTS: Respiratory symptoms including cough, phlegm, chest tightness, and wheezing were significantly higher in wood workers than office workers (40.2% versus 29.3% for cough, p = 0.0073; 40.6% versus 23.6% for phlegm, p<0.0001; 38.0% versus 23.1% for chest tightness, p = 0.0001; 25.3% versus 14.5% for wheezing, p = 0.0014). No statistically significant differences were observed for Dyspnea, and upper respiratory tract symptoms among wood workers compared to office workers. While wood workers were more likely to require spirometry test than office workers (21.4% versus 5.4%, p<0.001) the obstructive changes were more prevalent on spirometry test in wood workers (71.4% obstructive pattern versus 28.6% restrictive pattern). Spirometry test revealed the mean values of FEV1 and FEV1/FVC ratio were significantly lower in the wood workers, compared to their mean values in the control group. CONCLUSION: Respiratory symptoms associated with work, are more prevalent among wood workers than office workers. Our data revealed that workplace exposure to hardwood dust may compromise respiratory function, indicating the importance and the need for optimizing preventive measures in workplace to protect the respiratory health among exposed workers. Obstructive changes on pulmonary function test is a dominant pathologic pattern in pulmonary function test among wood workers. Further investigation is required by current available tools such as nasal cytology to detect influence of wood dust exposure on the upper respiratory airway.

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Lecture is the most common teaching method used in ethics education, while problem-based learning (PBL) and small group discussion (SGD) have been introduced as more useful methods. This study compared these methods in teaching medical ethics. Twenty students (12 female and 8 male) were randomly assigned into two groups. The PBL method was used in one group, and the other group was taught using the SGD method. Twenty-five open-ended questions were used for assessment and at the end of the course, a course evaluation sheet was used to obtain the students' views about the advantages and disadvantages of each teaching method, their level of satisfaction with the course, their interest in attending the sessions, and their opinions regarding the effect of teaching ethics on students' behaviors. The mean score in the PBL group (16.04 ± 1.84) was higher than the SGD group (15.48 ± 2.01). The satisfaction rates in the two groups were 3.00 ± 0.47 and 2.78 ± 0.83 respectively. These differences were not statistically significant. Since the mean score and satisfaction rate in the PBL group were higher than the SGD group, the PBL method is recommended for ethics education whenever possible.

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Background. Primary pulmonary artery sarcomas are very rare and their histologic type, called leiomyosarcoma, is even rarer. Case Report. A 64-year-old woman presented with progressive weakness, fatigue, malaise, and dyspnea, and a marked elevation of pulmonary artery pressure was admitted. She was initially diagnosed with chronic pulmonary thromboembolism and chest computed tomography (CT) scan revealed that lobulated heterogeneous left hilar mass extended to precarinal and subcarinal space. MRI demonstrated a polypoid lesion at trunk with extension to left main pulmonary artery and its first branch. She was operated, a yellowish-shiny solid mass in pulmonary trunk was seen intraoperatively, and pulmonary endarterectomy was performed. Her tumor was pathologically diagnosed as pulmonary artery leiomyosarcoma. She died 3 months later after one chemotherapy course. Conclusion. Initially, the patient underwent surgery due to pulmonary embolism but, during the operation, the observed mass increased the probability of pulmonary artery neoplasm. Clinicians must consider pulmonary artery sarcoma when making the differential diagnosis for patients with pulmonary arteries masses. In addition to clinical prediction scores and CT and MRI findings to identify the patients with pulmonary artery sarcoma, PET scanning is the diagnosis of choice in differentiating embolism and neoplasm and is strongly recommended in these patients.

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The purpose of this study was to examine how ethical approval and competing interests are addressed by medical journals in Iran. In a cross-sectional study, 151 journals accredited by the Publications Commission of the Ministry of Health and Medical Education were reviewed. Data collection was carried out by assessing journal guidelines and conducting structured phone interviews with journal managers, focusing on how ethical considerations and conflicts of interest (COI) are addressed. Overall, 135 of the 151 journals (89.4 percent) examined some aspect of ethical considerations of submitted articles. Authors were required to disclose their financial sponsors by 98 journals (64.9 percent), while COI disclosure was required by 67 journals (44.4 percent). We conclude that the rate of addressing ethical considerations is not far from ideal, but the requirement for COI disclosure needs more attention.

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