Could the HALP score serve as a biomarker of bronchiectasis exacerbation?

Introduction: Bronchiectasis is a chronic inflammatory lung disease and patients may occasionally experience acute exacerbations. Our study aims to determine the relationship between exacerbation periods and HALP (hemoglobin, albumin, lymphocyte, platelet) scores in patients with bronchiectasis. Materials and Methods: Adult patients diagnosed with bronchiectasis and followed up in our clinic between 02.2020-12.2022 were retrospectively evaluated. After the examinations, the effect of bronchiectasis exacerbation on the HALP score was investigated. Result: A total of 84 patients diagnosed with non-cystic fibrosis bronchiectasis were included in our study. 42 of the patients were male (50%), and 42 were female. The average age of all patients was 52.37 ± 16.2. 35 patients (41.7%) were in the exacerbation period, and 49 patients (58.3%) were in the stable period. The median values of leukocytes, neutrophils, and C-reactive protein (CRP) were significantly higher in patients during the exacerbation period compared to the stable period (respectively p= 0.00, p= 0.00, p= 0.00). The average values of FEV1% and FVC% in patients during the exacerbation period were significantly lower compared to the stable period (p= 0.03, p= 0.00, respectively). The HALP score was significantly lower in patients during the exacerbation period compared to the stable period (p= 0.00). A significant negative correlation was found between the HALP score and leukocytes, neutrophils, and CRP (p= 0.00, p= 0.00, p= 0.00, respectively). Also, a significant positive correlation was found between the HALP score and FEV1% and FVC% (p= 0.00, p= 0.00, respectively). Conclusions: Our study revealed that the HALP score is associated with infectious and pulmonary functional parameters in bronchiectasis patients in the exacerbation period. We propose that the HALP score could serve as a valuable biomarker during exacerbations.

Can the ADO Index Be Used as a Predictor of Mortality from COVID-19 in Patients with COPD?

Background: Several studies have shown that the risk of mortality due to COVID-19 is high in patients with COPD. However, evidence on factors predicting mortality is limited. Research Question: Are there any useful markers to predict mortality in COVID-19 patients with COPD?. Study Design and Methods: A total of 689 patients were included in this study from the COPET study, a national multicenter observational study investigating COPD phenotypes consisting of patients who were followed up with a spirometry-confirmed COPD diagnosis. Patients were also retrospectively examined in terms of COVID-19 and their outcomes. Results: Among the study patients, 105 were diagnosed with PCR-positive COVID-19, and 19 of them died. Body mass index (p= 0.01) and ADO (age, dyspnoea, airflow obstruction) index (p= 0.01) were higher, whereas predicted FEV1 (p< 0.001) and eosinophil count (p= 0.003) were lower in patients who died of COVID-19. Each 0.755 unit increase in the ADO index increased the risk of death by 2.12 times, and each 0.007 unit increase in the eosinophil count decreased the risk of death by 1.007 times. The optimum cut-off ADO score of 3.5 was diagnostic with 94% sensitivity and 40% specificity in predicting mortality. Interpretation: Our study suggested that the ADO index recorded in the stable period in patients with COPD makes a modest contribution to the prediction of mortality due to COVID-19. Further studies are needed to validate the use of the ADO index in estimating mortality in both COVID-19 and other viral respiratory infections in patients with COPD.

Long-acting B-2 agonists (LABA) or long-acting muscarinic antagonists (LAMA): which one may be the first option in group A COPD patients?

INTRODUCTION: Long-acting muscarinic antagonists (LAMA) or beta-2 agonists (LABA) have been recommended for symptom control in group A COPD patients as a first-line bronchodilator treatment in GOLD guidelines. However, there is no mention of priority/superiority between the two treatment options. We aimed to compare the effectiveness of these treatments in this group. METHODS: The study cohort was formed of all subjects from six pulmonology clinics with an initial diagnosis of COPD who were new users of a LAMA or LABA from January 2020 to December 2021. Seventy-six group A COPD patients, in whom LABA or LAMA therapy had been started in the last 1 month as a first-line treatment, were included in our study. Participants were evaluated with spirometry, COPD Assessment Test (CAT), mMRC scale, and St. George Respiratory Questionnaire (SGRQ) for three times (baseline, 6-12th months). RESULTS: There were 76 group A COPD patients with LAMA (67.1%) and LABA (32.9%). The number of patients who improved in CAT score at the end of the first year was significantly higher in patients using LAMA than those using LABA (p = 0.022); the improvement at minimum clinically important difference (MCID) in CAT score of LAMA group at 1st year was also significant (p = 0.044). SGRQ total and impact scores were found to be statistically lower at 1st year compared to baseline in patients using LAMA (p = 0.010 and 0.006, respectively). Significant improvement was detected in CAT and SGRQ scores at the 6th month visit in the LAMA group having emphysema (p = 0.032 and 0.002, respectively). CONCLUSION: According to significant improvements in CAT and SGRQ score, LAMA may be preferred over LABA as a bronchodilator agent in group A COPD patients, especially in emphysema-dominant phenotype.

Efficacy of mepolizumab and omalizumab combination therapy in uncontrolled asthma.

OBJECTIVE: Results of biological therapies are often encouraging for severe asthma who are phenotyped as Type 2 inflammation. Unfortunately, some patients do not achieve the desired responses. In this group of patients, there are often switches between anti Ig E and anti-IL-5s and partial improvements are often is deemed sufficient. METHOD: We planned to start combination therapy with mepolizumab and omalizumab in a 52-year-old patient with uncontrolled allergic asthma whose asthma could not be controlled with omalizumab and mepolizumab treatment, respectively. After complete asthma control was achieved, we aimed to discontinue mepolizumab and continue with omalizumab because it was allergic asthma. RESULT: The combination of omalizumab 300 mg/month and mepolizumab 100 mg/month was tried and emergency admissions and oral corticosteroids were stopped. At the same time, significant improvement was observed in asthma control test, pulmonary function test and comfort of life. CONCLUSION: Combined use of Anti-Ig E (omalizumab) and Anti IL 5 (mepolizumab) with a synergistic effect by acting through both pathways, especially in patients with allergic asthma and high levels of both total Ig E and eosinophilia, was found to be effective and no side effects were observed in long-term follow-up. Combination therapy with omalizumab and mepolizumab may become a safe option in patients with severe allergic asthma with a Type 2 inflammatory phenotype who cannot be controlled with each biologic agent.

An Alpha-1 Antitrypsin Deficiency Screening Study in Patients with Chronic Obstructive Pulmonary Disease, Bronchiectasis, or Asthma in Turkey.

Purpose: Alpha-1 antitrypsin deficiency (AATD) is a rare hereditary condition characterized by decreased serum alpha-1 antitrypsin (AAT) levels. We aim to identify AATD in patients with chronic obstructive pulmonary disease (COPD), bronchiectasis, or asthma and to report the frequency of AAT variants in Turkey. Patients and Methods: This non-interventional, multicenter, prospective study was conducted between October 2021 and June 2022. Adult patients with COPD, bronchiectasis, asthma, liver symptoms, or family members with AATD were included. Demographic and clinical characteristics, pulmonary diagnosis, respiratory symptoms, and AAT serum levels were assessed. Whole blood samples were collected as dried blood spots, and the most common AATD mutations were simultaneously tested by allele-specific genotyping. Results: A total of 1088 patients, mainly diagnosed with COPD (92.7%) and shortness of breath (78.7%), were assessed. Fifty-one (5%) were found to have AATD mutations. Fifteen (29.4%) patients had Pi*S or Pi*Z mutations, whereas 36 (70.6%) patients carried rare alleles Pi*M malton (n=18, 35.3% of mutations), Pi*I (n=8, 16%), Pi*P lowell (n=7, 14%), Pi*M heerlen (n=2, 4%), and Pi*S iiyama (n=1, 2%). The most common heterozygous combinations were Pi*M/Z (n=12, 24%), and Pi*M/M malton (n=11, 22%). Ten patients with severe AATD due to two deficiency alleles were identified, two with the Pi*Z/Z genotype, four with the genotype Pi*M malton/M malton, three with Pi*Z/M malton, and one with Pi*Z/M heerlen. Conclusion: Our results identified AATD mutations as a genetic-based contributor to lung disease in patients with COPD or bronchiectasis and assessed their frequency in a population of Turkish patients.

Clinical and radiological outcomes of longCOVID: Is the post-COVID fibrosis common?

Introduction: COVID-19 survivors may take longer to regain full well-being. This study aimed to investigate clinical and functional evaluation and radiologic changes in the third month after COVID-19. Materials and Methods: A total of 126 patients were assessed in the third month for symptoms, pulmonary function, exercise capacity, radiologic imaging, and quality of life after being discharged following COVID-19 treatment. Two radiologists evaluated the initial and follow-up images. Result: At the third month follow-up visit, the most common persisting symptoms were shortness of breath (32.5%), cough (12.7%), and muscle pain (12.7%). At the follow-up visit, oxygen saturations at rest and after a sixmin walking test were lower in patients with prior intensive care hospitalization compared to those without (p<0.001, p= 0.004). Computed tomography (CT) scans revealed persisting pulmonary pathologies in 64.6% of patients at the third month follow-up. The most common pathologies on follow-up thoracic CT were fibrotic-like changes in 44.2% and ground-glass opacities (GGO) in 33.3%. Regression analysis unveiled that age [95% confidence interval (CI), 1.01 to 1.15; p= 0.020], male sex (95% CI, 4.06 to 95.3, p<0.001), first CT severity score (95% CI, 1.02 to 1.41, p= 0.028), duration of hospitalization (95% CI, 1.02 to 1.18, p= 0.012), oxygen saturation (95% CI, 0.86 to 0.96, p<0.001) were independent predictors of fibrotic-like changes. Conclusions: In the third month following COVID-19, the most common symptom was dyspnea, and the most common radiological findings were fibrotic-like changes and GGO. Longer follow-up studies of COVID-19 survivors are needed to observe lasting changes.

Chronic obstructive pulmonary disease phenotypes in Turkey: the COPET study-a national, multicenter cross-sectional observational study.

BACKGROUND: While mortality rates decrease in many chronic diseases, it continues to increase in COPD. This situation has led to the need to develop new approaches such as phenotypes in the management of COPD. We aimed to investigate the distribution, characteristics and treatment preference of COPD phenotypes in Turkey. METHODS: The study was designed as a national, multicenter, observational and cross-sectional. A total of 1141 stable COPD patients were included in the analysis. RESULTS: The phenotype distribution was as follows: 55.7% nonexacerbators (NON-AE), 25.6% frequent exacerbators without chronic bronchitis (AE NON-CB), 13.9% frequent exacerbators with chronic bronchitis (AE-CB), and 4.8% with asthma and COPD overlap (ACO). The FEV1 values were significantly higher in the ACO and NON-AE than in the AE-CB and AE NON-CB (p < 0.001). The symptom scores, ADO (age, dyspnoea and FEV1 ) index and the rates of exacerbations were significantly higher in the AE-CB and AE NON-CB phenotypes than in the ACO and NON-AE phenotypes (p < 0.001). Treatment preference in patients with COPD was statistically different among the phenotypes (p < 0.001). Subgroup analysis was performed in terms of emphysema, chronic bronchitis and ACO phenotypes of 1107 patients who had thoracic computed tomography. A total of 202 patients had more than one phenotypic trait, and 149 patients showed no features of a specific phenotype. DISCUSSION: Most of the phenotype models have tried to classify the patient into a certain phenotype so far. However, we observed that some of the patients with COPD had two or more phenotypes together. Therefore, rather than determining which phenotype the patients are classified in, searching for the phenotypic traits of each patient may enable more effective and individualized treatment.

Research Burden of Interstitial Lung Diseases in Turkey - RBILD.

Introduction: The aim of our study is to investigate the etiological distribution of ILD in Turkey by stratifying the epidemiological characteristics of ILD cases, and the direct cost of initial diagnosis of the diagnosed patients. Material-Method: The study was conducted as a multicenter, prospective, cross-sectional, clinical observation study. Patients over the age of 18 and who accepted to participate to the study were included and evaluated as considered to be ILD. The findings of diagnosis, examination and treatment carried out by the centers in accordance with routine diagnostic procedures were recorded observationally. Results: In total,1070 patients were included in this study. 567 (53%) of the patients were male and 503 (47%) were female. The most frequently diagnosed disease was IPF (30.5%). Dyspnea (75.9%) was the highest incidence among the presenting symptoms. Physical examination found bibasilar inspiratory crackles in 56.2 % and radiological findings included reticular opacities and interlobular septal thickenings in 55.9 % of the cases. It was observed that clinical and radiological findings were used most frequently (74.9%) as a diagnostic tool. While the most common treatment approaches were the use of systemic steroids and antifibrotic drugs with a rate of 30.7% and 85.6%, respectively. The total median cost from the patient's admission to diagnosis was 540 Turkish Lira. Conclusion: We believe that our findings compared with data from other countries will be useful in showing the current situation of ILD in our country to discuss this problem and making plans for a solution.

Spontaneous pneumomediastinum and subcutaneous emphysema secondary to pulmonary alveolar microlithiasis.

Pulmonary alveolar microlithiasis (PAM) is a rare autosomal recessive disease characterized by intraalveolar accumulation of microliths. PAM is described as the formation and accumulation of calcium phosphate microliths in the alveoli after mutations in the SLC34A2 gene. The patients may be asymptomatic or present with heterogeneous signs such as dyspnea, cough, sputum, weakness, chest pain and hemoptysis. Recurrent pneumothoraces may occur over the course of the disease in advanced cases. Her, it was aimed to report a case of a 40-year-old female presenting with chest pain, sore throat, cough and green sputum for the past two months. Chest radiography and computed tomography showed pneumomediastinum and subcutaneous emphysema which have not been reported in previous studies due to PAM. Bronchoscopy with bronchoalveolar lavage (BAL) and mucosal biopsy were done after pneumomediastinum had cleared. BAL result was concordant with pulmonary alveolar microlithiasis. Diagnosis can be made with computed tomography but may necessitate histopathological verification for definitive diagnosis.

Does vitamin D deficiency in asthma affect clinical and functional parameters? A Turkish multicenter study.

Background: In recent years, interest in the effects of vitamin D on human health and the immune system has increased. Objective: This study aimed to investigate the relationship of vitamin D with asthma severity, attacks, and clinical and functional parameters in adult patients with asthma who were living in different geographic regions in Turkey. Methods: A total of 384 patients with stable asthma and 87 control subjects were included. A physical examination and a pulmonary function test were performed, and routine blood analyses and vitamin D levels were evaluated. Asthma Control Test was applied. The number of exacerbations in the previous year, asthma therapy, and medication adherence were recorded. Results: In our study, vitamin D levels were below the target values in both patients with asthma (median [minimum-maximum] 16.0 ng/mL [3.5-48 ng/ml]) and control subjects (median [minimum-maximum] 20.0 ng/mL [5.8-58.79 ng/mL]). However, it was lower in the patients with asthma than in the control subjects (p = 0.001). There was a negative relationship between the levels of vitamin D and the severity of asthma (Kendall τ = -0.146; p < 0.001). Furthermore, the patients with severe asthma were received The Global Initiative for Asthma (GINA) step 5 treatment showed significantly lower vitamin D compared with the patients who received GINA step 4 treatment (p = 0.037). Vitamin D levels correlated with forced vital capacity (FVC), forced expiratory volume in the first second of expiration (FEV1), and peak expiratory flow (r, 0.221-0.236; p ≤ 0.001). In addition, a positive relationship was found between Asthma Control Test and vitamin D (r = 0.229; p = 0.001). However, body mass index (BMI), asthma exacerbation, and hospitalization were inversely related to vitamin D (r, 0.198-0.233; p = 0.001). Multivariable regression analysis revealed that FVC (p = 0.002), FEV1 (p = 0.033), and BMI (p = 0.037) were independent determinants associated with vitamin D. Conclusion: This study suggested a high prevalence of vitamin D deficiency in adults with asthma living in different geographic areas in Turkey. Vitamin D deficiency is associated with asthma severity, poor control, and lower lung function.

Antiinflammatory effects of adalimumab, tocilizumab, and steroid on lipopolysaccharide-induced lung injury.

BACKGROUND: Acute lung injury (ALI) is a major cause of death in the intensive care unit. Lipopolysaccharide (LPS) induced lung injury is the most widely used experimental ALI model and provides opportunities for new targeting therapy. In this study, we investigated the effects of tocilizumab, adalimumab, and methylprednisolone in LPS-induced acute lung injury. METHODS: Lung injury was established by intratracheal instillation of LPS. The rats were randomly divided into six groups: LPS, control, and treatment groups (adalimumab, tocilizumab, methylprednisolone, adalimumab + tocilizumab). Bronchoalveolar lavage (BAL) and lung tissues were collected at 48 h and 96 h following LPS administration from each group. For histological analysis, hematoxylin-eosin (H&E) staining was performed. The sections were obtained for immunohistochemical analysis. IL-6 and TNF-alpha immunoreactivity were measured. RESULTS: Intratracheal LPS application resulted in inflammatory cell infiltration of interstitial and alveolar spaces and thickening of the alveolar wall. All treatment groups showed significantly amelioration compared to LPS at 48 h. Interestingly, adalimumab and adalimumab + tocilizumab groups showed a significant amelioration of the lung histoarchitecture, compared to the prednisolone group at 96 h (p = 0.028, p = 0.025, respectively). Compared to the control group, LPS stimulation resulted in a significant increase in IL-6 and TNF-alpha immunoreactivity (p < 0.001). IL-6 and TNF-alpha expression were markedly reduced in all treatment groups at 48 h but the reduction was greater in the adalimumab and tocilizumab group than in the steroid. Administration with adalimumab and/or tocilizumab effectively decreased expression of TNF-alpha (p = 0.001) and IL-6 (p < 0.001) at 96 h, but prednisolone did not exert an effective decrease (p > 0.05). DISCUSSION: Adalimumab and/or tocilizumab significantly reduce the release of proinflammatory cytokines and improve the tissue inflammation in the experimental model of ALI. Our results suggest that adalimumab and/or tocilizumab have a more potent antiinflammatory effect on lung injury than the steroid.

Asthma and COVID-19: What do we know?

There are limited data about the coexistence of asthma and the Coronavirus disease-2019 (COVID-19). The COVID-19 pandemic is a new disease for the whole world. In this study, we aimed to examine the published case series with the COVID-19 and asthma coexistence, by reviewing existing studies and other publications. We discussed the suggestions of guidelines such as The Global Initiative for Asthma (GINA), The National Institute for Health and Care Excellence (NICE), and the Canadian Respiratory Guideline about the management of asthma during the COVID-19 pandemic and the experiences of different countries. We analyzed the publications, reports, and expert opinions about asthma and COVID-19, that were released and expressed from the onset of the disease in Wuhan. In this review, we aimed to summarize the approach to patients with asthma during the pandemic and to make recommendations concerning it.

Paraoxonase Activity and Phenotype Distribution in Patients with Chronic Obstructive Pulmonary Disease.

OBJECTIVE: Paraoxonase 1 (PON1) and arylesterase (ARE) enzymes have an important role in the prevention of oxidative stress which is related to the pathogenesis of chronic obstructive pulmonary disease (COPD). PON1 levels vary widely among individuals and ethnic groups, which is in part associated with polymorphisms. MATERIALS AND METHODS: We investigated PON1 and ARE activity and phenotype distribution in COPD patients and healthy individuals. Sixty six COPD patients and 59 control subjects were involved in the study. Serum PON1 and ARE activities were detected by spectrophotometric method. The ratio of salt-induced PON1 to ARE activity was used to determine phenotypes as QQ, QR, and RR. RESULTS: COPD patients exhibited higher PON1 activity (199.1 vs 129.2, p=0.002) but lower ARE activity compared to control (21.3 vs 33.5, p=0.021). There was a significant difference between COPD and control group with respect to PON1 phenotype characteristics. RR phenotypic distribution was more common in the COPD group than in control (60.6% [95% CI: 48.8 - 72.3] versus 22.0 % [95% CI: 12.0 - 31.9], p=0.001). We also found that smoking (95.0% CI: 0.001-0.036, p<0.001) and RR phenotype (95.0% CI: 0.006 - 0.59, p=0.016) are independent determinants in COPD. CONCLUSION: We found that RR phenotype was more common in COPD patients compared to control. Smoking and RR phenotype may be defined as independent factors associated with COPD.

Association between the ADAMTS proteinases and obstructive sleep apnea.

BACKGROUND: A disintegrin and metalloproteinase with thrombospondin type-1 motifs (ADAMTS) proteinases have important roles in degradation/repairing of extracellular matrix (ECM). They are thought to play a key role in pathogenesis of many diseases. We aimed to investigate the association between ADAMTS 2, 3, and 14 (procollagen) and obstructive sleep apnea (OSA). METHODS: Eighty-six individuals who were suspected of OSA were included. All cases underwent polysomnography. Participants were divided into 3 groups according to apnea-hypopnea index (AHI): control (n = 22), mild-to-moderate OSA (n = 36), and severe OSA (n = 28). ADAMTS proteinases 2, 3, and 14 were analyzed in serum samples. RESULTS: When compared with other groups, patients with severe OSA showed significantly higher body mass index (BMI) (p = 0.001), whereas they showed significantly lower ADAMTS 3 levels (p = 0.016). No difference was found between groups with respect to the levels ADAMTS 2 and 14. There was a negative relation between the levels of ADAMTS 3 and the severity of OSA (Kendall's tau = - 0.19, p = 0.021). The levels of ADAMTS 3 were also found to be positively correlated with minimum SpO2 (r = 0.31, p = 0.004) and negatively correlated with BMI, AHI, oxygen desaturation index (ODI), time duration with oxygen saturation < 90% (T90), and CRP (r = - 0.31 to - 0.49, p < 0.05). Multivariable regression analysis revealed that BMI (p = 0.013) and CRP levels (p = 0.005) were significantly associated with the levels of ADAMTS 3. CONCLUSIONS: ADAMTS 3, one of the procollagen proteinases, was decreased in severe OSA. Lack of ADAMTS 3 proteinase may contribute to process of sleep apnea due to insufficient collagen syntheses.

A Case of Immunoglobulin (Ig) G4-related Sclerosing Periaortitis Mimicking Mediastinal Malignant Tumor.

Sclerosing mediastinitis was first described by Oulmont in 1855. The aggressive fibro-inflammatory process that occurs in the mediastinum is the end result of a number of inflammatory processes. It is thought that hypersensitivity reactions to various antigens, autoimmune reactions, and idiopathic fibro-inflammatory responses play a role in the etiology of the disease. It has been shown in recent years that immonoglobulin (Ig) G4-related autoimmune diseases may lead to sclerosing mediastinitis. In this study, a rare case of Ig G4-related sclerosing periaortitis is presented in a 50-year male patient. The disease responded well to steroid treatment, but soon recurred following stoppage of the treatment. The treatment with deflazacort was started again; and he responded well. The lesion disappeared within six months of retreatment.

Association of human serum paraoxonase-1 with some respiratory drugs.

In this study, we investigated the effects of certain respiratory drugs, which are mainly used on human serum paraoxonase-1 (hPON1; EC 3.1.8.1). hPON1 was purified from human serum, with 354.91 fold and 45% yield by using two simple step procedures including, first, ammonium sulfate precipitation, then, Sepharose-4B-l-tyrosine-1-naphthylamine hydrophobic interaction chromatography. SDS-polyacrylamide gel electrophoresis showed a single protein band belonging to hPON1 with 43 kDa. All the pharmaceutical compounds inhibited the PON1 enzyme highly at the micromolar level. The obtained IC50 values for nine different pharmaceutics ranged from 0.219 µM (salbutamol sulfate) to 67.205 µM (montelukast sodium). So, all drugs could be considered as potent hPON1 inhibitors. Ki values and inhibition types were determined by Lineweaver-Burk graphs. While varenicline tartrate and moxifloxacin hydrochloride inhibited the enzyme in a noncompetitive manner, others inhibited it in a mixed manner.

Carotid intima-media thickness in chronic obstructive pulmonary disease and survival: A multicenter prospective study.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is associated with increased cardiovascular morbidity and mortality. Carotid intima-media thickness (CIMT) is a noninvasive method assessing atherosclerosis. OBJECTIVE: It was aimed to determine relationship and survival between COPD and CIMT. METHODS: CIMT was measured using Doppler ultrasound (USG) in 668 stable COPD patients at 24 centers. Patients were followed-up for 2 years. RESULTS: There were 610 patients who completed the study. There were 200 patients CIMT with <0.78 mm (group 1), and 410 with CIMT ≥ 0.78 mm (group 2). There was a significant difference at the parameters of age, gender, smoking load, biomass exposure, GOLD groups and degree of airway obstruction (FEV1) between groups 1 and 2. Our results revealed positive correlations between mean CIMT and age, smoking load (pack-years), biomass exposure (years), exacerbation rate (last year), duration of hypertension (years) and cholesterol level; negative correlations between CIMT and FEV1 (P < 0.05). According to logistic regression model, compared with group A, risk of CIMT increase was 2.2-fold in group B, 9.7-fold in group C and 4.4-fold in group D (P < 0.05). Risk of CIMT increase was also related with cholesterol level (P < 0.05). Compared with infrequent exacerbation, it was 2.8-fold in the patients with frequent exacerbation (P < 0.05). The mean survival time was slightly higher in group 1, but not significant (23.9 vs 21.8 months) (P > 0.05). CONCLUSION: This study is the first regarding CIMT with combined GOLD assessment groups. It has revealed important findings supporting the increase in atherosclerosis risk in COPD patients. We recommend Doppler USG of the carotid artery in COPD patients at severe stages.

[Determination of anthropometric measurements in obstructive sleep apnea syndrome in Turkish population]. / Türk popülasyonunda obstrüktif uyku apne sendromunda rol oynayan antropometrik ölçümlerin belirlenmesi.

INTRODUCTION: In this study, we aimed to determine the values of anthropometric measurements and rates used in the evaluation of obstructive sleep apnea syndrome (OSAS) in our country. MATERIALS AND METHODS: Twenty accredited sleep centers in thirteen provinces participated in this multicenter prospective study. OSAS symptoms and polysomnographic examination and apnea-hypopnea index (AHI) ≥ 5 cases OSAS study group; patients with AHI < 5 and STOP-Bang < 2 were included as control group. Demographic characteristics (age, sex, body mass index-BMI) and anthropometric measurements (neck, waist and hip circumference, waist/hip ratio) of the subjects were recorded. RESULT: The study included 2684 patients (81.3% OSAS) with a mean age of 50.50 ± 0.21 years from 20 centers. The cases were taken from six geographical regions of the country (Mediterranean, Eastern Anatolia, Aegean, Central Anatolia, Black Sea and Marmara Region). Demographic characteristics and anthropometric measurements; age, neck, waist, hip circumference and waist/ hip ratios and BMI characteristics when compared with the control group; when compared according to regions, age, neck, waist, hip circumference and waist/hip ratios were found to be statistically different (p< 0.001, p< 0.001, p< 0.05, respectively). When compared by sex, age, neck and hip circumference, waist/hip ratio, height, weight and BMI characteristics were statistically different (p< 0.001, respectively). Neck circumference and waist/hip ratio were respectively 42.58 ± 0.10 cm, 0.99 ± 0.002, 39.24 ± 0.16 cm, 0.93 ± 0.004 were found in women. CONCLUSIONS: The neck circumference was lower than the standard value in men, but higher in women. The waist/hip ratio was above the ideal measurements in both men and women. In this context, the determination of the country values will allow the identification of patients with the possibility of OSAS and referral to sleep centers for polysomnography.

Intradermal Skin Testing in Allergic Rhinitis and Asthma with Negative Skin Prick Tests.

Taking medical history, physical examination, and performing some in vivo and in vitro tests are necessary for the diagnosis of allergy. Skin prick test (SPT) is considered as the standard method and first-line approach for the detection of allergic sensitization. Although mainly SPT is used for the detection of allergic sensitization, intradermal skin test (IDST) may be necessary, especially in patients with a negative SPT result. IDST is quite safe; however, is nowadays seldom used for detection of inhalant allergy and its value remains controversial. We aimed to investigate whether IDST is useful and necessary in diagnosis of respiratory allergies or not. This study involved 4223 patients with allergic rhinitis (AR) and/or bronchial asthma (BA). SPT results were positive in 2419 patients (57%) and negative in 1804 (43%). IDST was applied to 344 patients with marked allergic symptoms and with negative SPT results. Out of 344 patients, 152 (44%) showed allergic sensitization to IDST. The most commonly encountered allergic response was against the house dust mite (HDM) (32.6%). Allergic response against fungal spores was also relatively high (22%), while the pollen allergy rate (4.3%) was quite low. In BA patients with negative prick test, IDST made a significant contribution to the diagnosis of HDM allergy (p=0.003). To avoid missed diagnosis of AR and BA, particularly regarding  the HDM allergy, application of IDST may be beneficial; therefore, IDST should be considered as the next step after SPT for diagnosis of allergy prior to in vitro or provocation tests.