Comparison of serum N-terminal pro-brain natriuretic peptide levels, conventional echocardiography, exercise parameters, and dyssynchrony measurements in Fontan patients.

INTRODUCTION: Little data are available concerning the methods used in the long-term follow-up of Fontan patients. We analyzed the association between serum N-terminal pro-brain natriuretic peptide levels, conventional echocardiography findings, exercise parameters, and dyssynchrony measurements in patients who underwent Fontan surgery. METHODS: This study included 28 patients who underwent Fontan surgery (mean age 12.8 ± 4.36 years) and 27 healthy controls (mean age 12.5 ± 3.76 years). Echocardiography examinations and exercise tests were performed in both groups. The systemic ventricle was examined via echocardiography, dyssynchrony measurement was performed, the systemic ventricular myocardial performance index was calculated, and serum N-terminal pro-brain natriuretic peptide levels were measured for all subjects. RESULTS: Lower cardiac output, stroke volume, maximal work, chronotropic index, maximal oxygen uptake, and higher N-terminal pro-brain natriuretic peptide levels were observed in the Fontan group than in the control group (p < 0.05). A negative correlation was found between physical exercise parameters and N-terminal pro-brain natriuretic peptide levels and dyssynchrony measurements. CONCLUSION: Measurements of exercise capacity, serum N-terminal pro-brain natriuretic peptide levels, and dyssynchrony measurement were more valuable than conventional methods for assessing patients' clinical and functional status. Dyssynchrony measurements provided better information about ventricular status than did conventional echocardiography studies. While patients' systolic function determined by conventional echocardiography was normal, dyssynchrony measurements showed the opposite result. The negative relationship between serum N-terminal pro-brain natriuretic peptide levels, dyssynchrony measurements, and exercise capacity suggests that these parameters should be investigated further in Fontan patients.

Has the pandemic changed the test quality of the pulmonary function test laboratory?

Introduction: Pulmonary function tests are used in the evaluation of the respiratory system. Maneuvers during spirometry can create aerosols and spread viruses such as SARS-CoV-2. Measures due to the pandemic can negatively affect both the number and the quality of the spirometry tests. There are no comparative studies on this subject. Materials and Methods: The tests conducted in the spirometry laboratory between November 2019 and November 2021 were evaluated. Result: Four hundred forty patients were included in the study. 50.5% of the patients were male and the mean age was 61.8 ± 16.5 years. The age, gender, height, and weight of the patients were similar. 75.2% (331) of the tests were evaluated as successful. The most common errors in tests were early termination (84.1%), uncooperative patients (29%), and poor effort (22.4%). The types of errors were not different between the two periods. The median number of tests performed for each patient was six. The total number of spirometry tests performed were 262 and 178 for 2019 and 2021 (p= 0.011), but test success remained unchanged over the years (p= 0.513). There was no significant difference between the three operators and the test success (p= 0.909), which was similar for both periods. However, the number of tests performed until the successful maneuver varied significantly (p= 0.009), and fewer maneuvers were required before the pandemic. Conclusions: According to this study, the measures taken during the pandemic did not affect the quality of spirometry, but they did lead to more tests being done up until the successful maneuver was performed.

Cross-sectional analysis of tobacco addiction in hospitalized COVID-19 patients.

Introduction: The COVID-19 pandemic has become an important health issue with consequences for special populations since 2019. Tobacco use is an important public health issue and tobacco users are a risk group for lung infections. Materials and Methods: The aim of this study is to obtain information about disease prevalence and severity, laboratory parameters, and changes in radiological findings between smokers and non-smokers who were hospitalized, followed up, and treated for COVID-19, and to find answers to critical questions regarding the response to antiviral and supportive therapy. Two hundred eighty-six patients who were hospitalized and treated between March 2020-February 2021 in the COVID-19 Isolation Ward of Baskent University Hospital were included in the study. The patients were grouped as current smokers, non-smokers, and ex-smokers. The groups were compared in terms of symptoms, laboratory findings, radiological findings, and treatment response. Result: The median age of the patients included in the study was 59 (IQR= 32). Of the patients, 40.6% were female and 59.4% were male. In our study, we discovered that there were fewer female smokers (p<0.001). When the current smokers (n= 56), non-smokers (n= 159), and ex-smokers (n= 71) were compared based on their findings, it was found that dyspnea was more common in current smokers (p= 0.009). Lung involvement was found to be more common (p= 0.002) and multifocal in the current smokers group (p= 0.038). The levels of oxygen saturation at the times of admission and discharge were lower in current smokers (p= 0.002 and p= 0.038). The need for nasal oxygen and noninvasive mechanical ventilation was also found to be higher in current smokers (p= 0.008 and p= 0.039). Systemic steroid requirement was higher in current smokers (p= 0.013). There was no statistically significant difference in terms of mortality between current smokers, ex-smokers, and non-smokers (p= 0.662). Conclusions: The analysis of the findings of the patients hospitalized in the COVID-19 isolation ward indicated that COVID-19 leads to a more serious course in patients with a history of smoking.

Nowadays COVID underestimates the other suspects.

The whole world has been facing the pandemic of SARS-CoV-2 infection and every day we still find out new knowledge regarding the disease. COVID-19 which is the name given to the clinical syndrome related to this infection has been shown to own a wide diversity of clinical presentations which challenges the healthcare workers and makes difficult the diagnosis and management of patients. Pulmonary embolism is also an entity that accompanies this type of infection and sometimes it is difficult to differentiate between the two. Here we present a patient who was admitted inward with typical lesions on chest tomography for COVID-19, but that turned out to be a submassive pulmonary embolism case without any infection. This case is remarkable because it shows that patients suspected for COVID-19 should be carefully examined and that pulmonary embolism can per se mimick the parenchymal lesions caused by viral infections.

The methods other than spirometry in the early diagnosis of COPD.

Chronic obstructive pulmonary disease (COPD) is a major cause of mortality and morbidity around the world. The diagnosis od COPD is based on the presence of clinical symptoms and the fact that the ratio of post-bronhodilator forced expiratory volume in 1 second to forced expiratory vital capacity(FEV1/FVC) is less than 0.70. Persistent limitation of airflow which is a characteristics of COPD is reproducible and most common lung function test that is why it is usually measured by spirometry. The small airway diseases and the parenchymal destruction play a role in the pathogenesis of COPD at different rates over time resulting in chronic airflow limitation. These pathologies are not always together at the same time and the contribution of those to the development of COPD differ from one individual to another. The pathophysiological involvement of small airways in COPD has been confirmed. When the obstruction of the small airways occur either by mucus, smooth muscle hypertrophy, inflammatory infiltration or air wall thickening; then the consequence is the increased resistance and ventilation impairment. The parenchymal destruction can be estimated via scanning and at the initial assessment of a COPD patient, it gives information about the concomitant pulmonary diseases and/or differential diagnosis. There is an increasing interest on symptomatic individuals whose whose COPD diagnosis has not been confirmed yet with spirometry but diagnosis is based on alternative methods and approaches. Although these methods nowadays are commonly used for the clinical research, they will offer an opportunity to the clinician to find out the COPD patients at an early stage. Herein we will discuss the available methods other than spirometry in the early diagnosis of COPD before the overt disease is confirmed.

Value of cardiopulmonary exercise testing in the diagnosis of coronary artery disease.

INTRODUCTION: Respiratory and cardiac functions in association with skeletal and neurophysiologic systems can be evaluated with cardiopulmonary exercise testing (CPET). Compared to treadmill exercise test, CPET provides more comprehensive data about the hemodynamic response to exercise. MATERIALS AND METHODS: We aimed to evaluate the relationship with CPET findings and coronary lesions identified on angiography in patients with angina pectoris who underwent teradmill exercise, CPET and coronary angiography (CAG). By this way we sought to examine the CPET parameters that might be predictive for coronary artery disease (CAD) before diagnostic exercise test results and ischemia symptoms develop. Thirty patients in whom CAG was planned because of symptoms and exercise test results were enrolled in the study. Oxygen consumption (VO2), carbondioxide production (VCO2), minute ventilation (VE), maximum work rate (WR), DVO2/DWR and O2 pulse (VO2/HR) values were calculated. Significant CAD was defined as ≥ 50% narrowing in at least one of the coronary arteries. RESULT: The mean age was 60.4 ± 8.9 years ve 21 (65.6%) of subjects were male. On CAG, CAD was detected in 19 (59.4%) patients. Maximum heart rate, heart rate reserve (HRR), VE/VCO2 measured at anaerobic threshold (AT) and VO2(mL/kg/min) were significantly differed in patients with CAD than those without (p= 0.031; p= 0.041; p= 0.028; p= 0.03 respectively). Peak VO2, VO2/WR and O2 pulse values were higher in patients with normal angiographic results than those with CAD but the difference did not reach to statistical significance. CONCLUSIONS: The findings of our study indicate that among CPET parameters AT VE/VCO2, ATVO2 (mL/kg/dk) and HRR can have predictive value in the diagnosis of CAD. We think that these parameters might be used in the evaluation of patients with angina and dyspnea suspected of CAD. In conclusion parameters obtained during the test that are not influenced by patient's effort might increase the value of CPET in the diagnosis CAD.

[Turkish Thoracic Society national spirometry and laboratory standards]. / Türk Toraks Dernegi ulusal spirometri ve laboratuvar standartlari.

The application quality of pulmonary function tests (PFT) carries high importance since it affects the quality of health services. "Chronic Diseases and Risk Factors in Turkey Study," which was published in 2013 showed that only 22.6% of PFTs performed in the secondary care institutions in our country were compatible with the standards. This finding reveals the standardization problem in spirometry applications in our country. Currently, the criteria for the application and evaluation of spirometer measurements were defined by American and European Respiratory Societies standards. Several laboratories use these standards in our country as in the world. But, national laboratory standards that are suitable for the conditions in our country have not been defined yet. This report was prepared to ensure the application of spirometry in optimal conditions, to minimize intra-laboratory and inter-laboratory differences and mistakes, and to standardize in our country. In this report, we focused on the standards concerning laboratory conditions, equipment, and technician specifications, test application, evaluation of test quality, infection control, and reference values.

Evaluation of nephrotoxicity and prognosis in patients treated with colistin due to hospital-acquired pneumonia.

INTRODUCTION: Colistimethate sodium (CMS) is frequently used in the treatment of nosocomial multidrug-resistant gram-negative infections. Nephrotoxicity is the most important side effect. The aim of this study is to evaluate the effect of colistin on nephrotoxicity and to assess prognosis in patients treated with CMS due to hospital-acquired pneumonia (HAP). MATERIALS AND METHODS: Patients treated with CMS for HAP due to multidrug-resistant Pseudomonas aeruginosa or Acinetobacter baumannii were included in this cohort study. RESULT: We evaluated 281 patients treated with two different brands of CMS whose administration dose is different: imported (n= 58, low dose/kg) and domestic (n= 223, high dose/kg). Nephrotoxicity developed in 175 patients (62.3%). The median age (73 vs. 66 years, p= 0.004) and mortality rates were higher (66.9% vs. 52.8%, p= 0.022) in patients having nephrotoxicity. The patients receiving high dose/kg had higher nephrotoxicity rate (67.7% vs. 41.4%, p< 0.001). The clinical, bacteriological response and mortality rates of the whole group were 52.0%, 61.0%, 61.6%, respectively. The clinical and bacteriological response rates were similar in the different dose groups. Multivariate analysis showed that nephrotoxicity was associated with domestic brand depending on use of high dose (OR= 3.97), advanced age (ß= 0.29, p= 0.008), male gender (OR= 2.60), hypertension (OR= 2.50), red blood cells transfusion (OR= 2.54), absence of acute kidney injury (OR= 10.19), risk stage of RIFLE (OR= 11.9). CONCLUSIONS: Nephrotoxicity is associated with the use of high dose colistin, age, gender, hypertension, red blood cells replacement and RIFLE stage. The mortality rate is higher in patients developing nephrotoxicity.

[Associations between TGF-ß1 G/A and TNF-α 308 G/A gene polymorphisms with airway resistance in chronic obstructive pulmonary disease]. / Kronik obstrüktif akciger hastaliginda TGF-ß1 G/A ve TNF-α 308 G/A gen polimorfizmleri ile hava yolu direncinin degerlendirilmesi.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is an important morbidity and mortality cause all over the world. Although specific gene region has not been defined in the pathogenesis of COPD, cytokine gene polymorphisms like tumor necrosis factor-alfa (TNF-α) and transforming growth factor-beta1 (TGF-ß1) may contribute to the development of COPD. The aim of the present study was to evaluate the associations between airway resistance with TGF-ß1 G/A and TNF-α 308 G/A gene polymorphisms in COPD patients. PATIENTS AND METHODS: 264 subjects were included to the study (Group 1; 75 COPD patients, Group 2; 139 subjects with at least 10 packet year smoking history without airflow obstruction, Group 3; 50 healthy subjects). Pulmonary function tests and body plethysmography to measure airway resistance were performed to the subjects. TGF-ß1 800 G/A and TNF-α 308 G/A gene polymorphisms were evaluated. Chi-square, Anova and correlation analysis were used for statistical analysis. RESULTS: There were significant difference among COPD stages in terms of TNF-α 308 G/A polymorphism (p< 0.05). Thirteen (23.6%) stage 1 COPD patients had TNF-α 308 G/A polymorphism and the other did not have. We did not find statistically significant difference among COPD stages in terms of TGF-ß1 800 G/A polymorphism (p> 0.05). TNF-α and TGF-ß1 genotypes and TNF-a 308 G/A and TGF-ß1 800 G/A polymorphisms were not different among study groups. Moreover, no significant differences betweeen subjects with and without increased airway resistance in terms of TNF-α 308 G/A and TGF-ß1 800 G/A polymorphisms were present. CONCLUSION: These results can suggest the lack of association between TNF-α 308 G/A and TGF-ß1 800 G/A gene polymorphisms with COPD development and airway resistance in Turkish population.

Understanding the Impact of Pulmonary Rehabilitation on Airway Resistance in Patients with Severe COPD: A Single-Center Retrospective Study.

Purpose: We investigated the effect of pulmonary rehabilitation (PR) on airway resistance in chronic obstructive pulmonary disease (COPD) patients with severe airway obstruction and hyperinflation. Patients and Methods: This retrospective cohort study was conducted with data from severe COPD cases with those who underwent an 8-week PR program. Main inclusion criteria were having severe airflow obstruction (defined as a forced expiratory volume in one second (FEV1) <50%) and plethysmographic evaluation findings being compatible with hyperinflation supporting the diagnosis of emphysema (presence of hyperinflation defined as functional residual capacity ratio of residual volume to total lung capacity (RV/TLC) >120%). Primary outcomes were airway resistance (Raw) and airway conductance (Gaw) which were measured by body plethysmography, and other measurements were performed, including 6-minute walk test (6-MWT), modified Medical Research Council dyspnea scale (mMRC) and COPD assessment test (CAT). Results: Twenty-six severe and very severe COPD patients (FEV1, 35.0 ± 13.1%; RV/TLC, 163.5 ± 29.4) were included in the analyses, mean age 62.6 ± 5.8 years and 88.5% males. Following rehabilitation, significant improvements in total specific airway resistance percentage (sRawtot%, p = 0.040) and total specific airway conductance percentage (sGawtot%; p = 0.010) were observed. The post-rehabilitation mMRC scores and CAT values were significantly decreased compared to baseline results (p < 0.001 and p < 0.001, respectively). Although there were significant improvements in 6-MWT value (p < 0.001), exercise desaturation (ΔSaO2, p = 0.026), the changes in measured lung capacity and volume values were not significant. Conclusion: We concluded that PR may have a positive effect on airway resistance and airway conductance in COPD patients with severe airflow obstruction.

Clinical Features of SARS-CoV-2 Infection in Patients Undergoing Solid-Organ Transplant: Baskent University Experience.

OBJECTIVES: The clinical features and treatment approaches, outcomes, and mortality predictors of COVID-19 in solid-organ transplant recipients have not been well defined. This study investigated the clinical features of COVID-19 infection in solid-organ transplant recipients at our center in Turkey. MATERIALS AND METHODS: Our study included 23 solidorgan transplant recipients and 336 nontransplant individuals (143 previously healthy and 193 patients with at least 1 comorbidity) who were hospitalized due to COVID-19 disease in our hospital between March 2020 and January 2021. Demographic, clinical, and laboratory data of patients were compared. We used SPSS version 20.0 for statistical analysis. All groups were compared using chi-square and Mann-Whitney U tests. P <.05 was considered statistically significant. RESULTS: Mean age of solid-organ transplant recipients was 49.8 ± 13.7 years (78.3% men, 21.7% women). Among the 23 recipients, 17 (73.9%) were kidney and 6 (26.1%) were liver transplant recipients. Among nontransplant individuals, 88.7% (n = 298) had mild/moderate disease and 11.3% (n = 38) had severe disease. Among transplant recipients, 78.3% (n = 18) had mild/moderate disease and 21.7% (n = 5) had severe disease (P = .224). Transplant recipients had greater requirements for nasal oxygen (P = .005) and noninvasive mechanical ventilation (P = .003) and had longer length of intensive care unit stay (P = .030) than nontransplant individuals. No difference was found between the 2 groups in terms of mortality (P = .439). However, a subgroup analysis showed increased mortality in transplant recipients versus previously healthy patients with COVID-19 (P <.05). Secondary infections were major causes of mortality in transplant recipients. CONCLUSIONS: COVID-19 infection resulted in higher mortality in solid-organ transplant recipients versus that shown in healthy patients. More attention on secondary infections is needed in transplant recipients to reduce mortality.

Association between cardiac functional capacity and parameters of tissue Doppler imaging in patients with normal ejection fraction.

OBJECTIVE: Patients with normal ejection fraction (EF) by conventional echocardiography may present with symptoms and findings of decreased cardiac functional capacity. We aimed to investigate the association between cardiac functional capacity determined by cardiopulmonary exercise test (CPET) and parameters of tissue Doppler (TD) imaging in patients with normal EF. METHODS: In all, 52 patients with normal EF were included. Conventional and TD imaging were performed. Peak systolic (S), early (E') and late (A') diastolic velocities were obtained from septal and lateral mitral annulus and tricuspid annulus by pulsed-wave TD. CPET was performed. Exercise time, peak oxygen consumption (peak VO2), anaerobic threshold (AT), metabolic equivalents (MET) values were determined and were compared with TD imaging parameters. RESULTS: We did not find any association between conventional echocardiographic measurements and cardiac functional capacity. However, peak S, E' and A velocity from the septal and tricuspid annulus and E' velocity from the lateral annulus correlated with exercise time, peak VO2, AT and MET (all P < 0.05). E/E' from the left ventricle correlated inversely with exercise time, peak VO2, AT and MET (all P < 0.05). S, E, A' velocities from septal and tricuspid annulus, E' velocity from lateral annulus were lower in patients with MET < or = 7 than in patients with MET > 7 (all P < 0.05). CONCLUSION: Systolic and diastolic velocities measured byTD imaging correlated with cardiac functional capacity as determined by CPET in patients with normal EF by conventional echocardiography. TD imaging could be more susceptible to determine cardiac functional capacity in these patients.

Effect of Asbestos Exposure on the Frequency of EGFR Mutations and ALK/ROS1 Rearrangements in Patients With Lung Adenocarcinoma: A Multicentric Study.

OBJECTIVE: The aim of this study is to investigate the effect of asbestos exposure on cancer-driver mutations. METHODS: Between January 2014 and September 2018, epidermal growth factor receptor (EGFR), anaplastic lymphoma receptor tyrosine kinase (ALK), and c-ros oncogene 1 receptor tyrosine kinase gene (ROS1) alterations, demographic characteristics, asbestos exposure, and asbestos-related radiological findings of 1904 patients with lung adenocarcinoma were recorded. RESULTS: The frequencies of EGFR mutations, ALK, and ROS1 rearrangements were 14.5%, 3.7%, and 0.9%, respectively. The rates of EGFR mutations and ALK rearrangements were more frequent in asbestos exposed non-smokers (48.7% and 9%, respectively). EGFR mutation rate was correlated to female gender and not-smoking, ALK rearrangement rate was correlated to younger age, not-smoking, and a history of asbestos exposure. CONCLUSIONS: The higher rate of ALK rearrangements in asbestos-exposed lung adenocarcinoma cases shows that asbestos exposure may most likely cause genetic alterations that drive pulmonary adenocarcinogenesis.

Turkish Thoracic Society Experts Consensus Report: Recommendations for Pulmonary Function Tests During and After COVID 19 Pandemic.

The recommendation of conducting pulmonary function tests (PFTs) from different societies during and after the coronavirus disease (COVID-19) pandemic was rated by the experts of the Turkish Thoracic Society (TTS) and presented as the TTS experts consensus report. Information about the topic has been provided.Globally, as of mid-May 2020, there have been over 4.4 million confirmed cases of COVID-19. There are two main routes of transmission of COVID-19: respiratory droplets and contact transmission. PFTs are non-invasive tests that are commonly performed in routine assessment and follow-up of patients in the pulmonology units. However, PFTs may generate aerosols and require sharing common surfaces. With regard to the high prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the community, PFTs should not be performed routinely in confirmed or suspected patients with COVID-19 during the pandemic. Because of the risk of human-to-human transmission of COVID-19, PFTs should be restricted to a small patient population with selected indications. Triage for COVID-19 should be performed prior to testing. Only essential PFTs such as spirometry, diffusion capacity of the lungs for carbon monoxide (DLCO), arterial blood gas analysis, or pulse oximetry should be performed in the selected cases. Tests should be scheduled to allow sufficient time for donning and doffing of the technical personnel with the full personal protective equipment (PPE) (gown, a filtering respirator mask, goggles or full-face shield, and disposable gloves), ventilation of the room, and application of post-test cleaning and disinfection procedures of the equipment and the testing room.

Coronavirus Disease (COVID-19) in Kidney and Liver Transplant Patients: A Single-Center Experience.

OBJECTIVES: The novel 2019 coronavirus (COVID-19) was first described in December 2019 in Wuhan, China and subsequently announced as a pandemic on March 12, 2020. In several studies, solid-organ transplant recipients were reported to have higher risk for COVID-19. Here, we aimed to determine the frequency of COVID-19 in our kidney and liver transplant patients. MATERIALS AND METHODS: Our study included 583 transplant patients who were admitted to our outpatient transplant clinics and emergency departments between March 1 and May 1, 2020. Seventy-four of them were liver transplant recipients (46 male, 28 female, of which 14 were pediatric and 60 were adult patients) and 509 of them were kidney transplant recipients (347 male, 162 female, of which 16 were pediatric and 493 were adult patients). We retrospectively evaluated demographic characteristics, currently used immunosuppressant treatment, present complaints, treatment and diagnosis of comorbid diseases, and results of COVID-19 tests. RESULTS: Of 583 transplant recipients, 538 were seen in our outpatient transplant clinics and 45 were seen in our emergency departments. Of these, 18 patients who had had cough and fever were evaluated by respiratory clinic doctors, and nasopharyngeal swab samples were taken. One kidney transplant recipient had a positive COVID-19 test; he was followed with home isolation. He received treatment with hydroxychloroquine (400 mg/day). The other 17 patients had negative tests. There were no mortalities due to COVID-19. CONCLUSIONS: Transplant patients also got affected during the COVID-19 pandemic. According to the data of our centers, this effect is not much more different from the normal population. We recommend that transplant recipients should be warned in terms of personal hygiene and should be closely monitored by organ transplant centers. If there is an indication for hospitalization, they should be followed in an isolated unit, with no aggressive changes made to immunosuppressive doses unless necessary.

The effects of cachexia and related components on pulmonary functions in patients with COPD.

Malnutrition is an important problem in patients with chronic obstructive pulmonary disease (COPD). It still remains unclear whether malnutrition contributes to poor pulmonary function through a loss of respiratory muscle mass, or if advanced disease and hypoxemia are the causes of weight loss and malnutrition in COPD patients. This study was made to examine the effects of malnutrition on pulmonary function tests (PFTs) in COPD patients. With this purpose 35 stable COPD patients were enrolled in this study. According to their body mass indexes, the subjects were divided in two groups (group 1: cachectic and group 2: non-cachectic). All subjects were performed PFTs, serum tumor necrosis factor-alpha (TNF-alpha) levels, resting energy expenditure (REE), nutrition parameters, and arterial blood gas tension. PFTs were impaired to a greater degree in cachectic than non-cachectic patients. Serum TNF-alpha levels and REE were higher in cachectic patients than in non-cachectic patients. Significant correlations were observed among PFTs, REE, and serum TNF-alpha level. Furthermore there was a significant correlation between serum albumin level and PFTs. This study demonstrated that cachexia had a negative effect on PFTs in patients with COPD. Additionally, our study showed that serum protein levels can affect airway function and diffusing capacity of lungs in COPD. Another result of this study was that; increased REE and serum TNF-alpha levels could contribute to weight loss in patients with COPD. Further studies are needed to demonstrate the effect of nutritional supplementation containing essential amino acids on PFTs in these patients.

[Assessment of relation among emotional status, pulmonary function test, exercise performance, and quality of life in patients with COPD]. / KOAH'li olgularda depresyon durumu, solunum fonksiyon testi, egzersiz performansi ve yasam kalitesi arasindaki iliskinin degerlendirilmesi.

Impaired pulmonary function tests, reduced exercise capacity and impaired quality of life are common problems in patients with chronic obstructive pulmonary diseases (COPD). Furthermore chronic respiratory disease is associated with increased risk for anxiety and depression. In the light of these data further studies investigating the effects of emotional status on quality of life and exercise performance in patients with COPD are needed in order to improve treatment modalities. This study was peformed to reveal emotional status on pulmonary function, quality of life, and exercise performance in patients with COPD. 52 (F/M = 13/39, mean age= 67 +/- 12 years) irreversible for bronchodilator test COPD patients (FEV(1)= 1.5 +/- 0.6 L) included to our study. Short form- 36, Beck's Depression Inventory (BDI), pulmonary function tests and 6-minute walking test (6-MWT) were performed to all patients. There was no significant difference between 17 patients with severe to very severe airway obstruction according to GOLD classification (mean FEV(1)= 0.95 +/- 0.2 L) and 35 patients with moderate airway obstruction (mean FEV(1)= 1.75 +/- 0.56 L) in terms of emotional status, exercise performance, and quality of life. Significant corelation was found between BDI and; FEV(1)(p= 0.02, r= -0.323), general health perception (p= 0.001, r= -0.451), vitality (p= 0.000, r= -0.619), general mental health (p= 0.000, r= -0.643), and physical function (p= 0.002, r= -0.426). No correlation was found between 6 MWT and emotional status, and quality of life. In this study it was demonstrated that airway obstruction has an important role for exercise limitation and emotional status related to impaired PFT and quality of life in patients with COPD. We conclude that respiratory intervention together with psychocologic interventions should be performed on patients with COPD by clinicians to achieve improved quality of life.

Turkish Thoracic Society Consensus Report: Interpretation of Spirometry.

ÖZET: Günümüzde spirometre ölçümlerinin uygulama ve yorumlama nitelik güvencesi "American Thoracic Society / European Respiratory Society" standartlari ile belirlenmistir. Dünyada oldugu gibi ülkemizde de birçok laboratuvar bu standartlari kullanmaktadir. Buna karsin, farkli laboratuvarlardan farkli degerlendirme sonuçlari görebilmek mümkündür. Bu rapor, ülkemizdeki solunum fonksiyon testi laboratuvarlarinda yapilan degerlendirmelerin standardizasyonunu saglamak amaci ile hazirlanmistir.

Evaluation of right ventricular functions and B-type natriuretic peptide levels by cardiopulmonary exercise test in patients with pulmonary regurgitation after repair of tetralogy of Fallot.

Impairment of right ventricular functions, especially due to chronic pulmonary regurgitation (PR), is a well-known entity in patients with tetralogy of Fallot (ToF) after repair. The aim of this study was to examine the relation between B-type natriuretic peptide (BNP) levels and right ventricular dysfunction by cardiopulmonary exercise test (ET) in patients after repair of ToF. Twenty-five patients with a mean age of 14.1 +/- 4.4 years at follow-up who underwent repair of ToF at a mean age of 4.9 +/- 5.1 years and 29 age- and sex-matched healthy children at a mean age of 13.1 +/- 2.8 years were enrolled in this study. Plasma BNP levels were measured at baseline and at maximal exercise. The volume of right ventricle (RV) and the degree of PR were assessed by two-dimensional echocardiography and color Doppler. Plasma BNP levels were significantly higher in patients with ToF than in controls (28.3 +/- 24.1 vs 7.4 +/- 2.3 pg/mL, p = 0.0001). Exercise was associated with increased plasma BNP levels in both groups. A greater increase in BNP was noted in patients with ToF than in controls (37.6 +/- 27.5 vs 11.3 +/- 4.5 pg/mL, p = 0.0001). Forced vital capacity (FVC%) (84.9 +/- 16.9 vs 98.4 +/- 18.2, p = 0.01) and forced expiratory volume during the 1st second (FEV1%) (91.5 +/- 19.3 vs 103.8 +/- 16.1, p = 0.02) were decreased, exercise duration (ED) (10.1 +/- 1.9 vs 11.4 +/- 1.7 min, p = 0.02), maximum heart rate (HRmax) (171.2 +/- 18.9 vs 186.4 +/- 13.9 /min, p = 0.004), and maximum oxygen uptake (VO(2)max) (1.56 +/- 0.53 vs 2.1 +/- 0.6 L/min, p = 0.007) were lower in patients with ToF. There were significant correlations between the degree of PR and ED (r =-0.3, p = 0.009), HRmax (r =-0.4, p = 0.001), and VO(2)max (r =-0.4, p = 0.001). The correlations were significant both before and after exercise, being more pronounced after exercise between BNP level and the degree of PR (r = 0.6, p = 0.0001). As a result, the severity of PR has a negative influence on right ventricular functions and there is significant relation between right ventricular functions and exercise capacity after repair of tetralogy of Fallot.