Comparative evaluation of galactomannan optical density indices and culture results in bronchoscopic specimens obtained from neutropenic and non-neutropenic patients.

Aspergillus infections are major causes of morbidity and mortality among immunocompromised patients. This study was designed to investigate the galactomannan assay optical density (OD) indices relative to the culture results in bronchoscopic samples obtained from neutropenic and non-neutropenic patients. Galactomannan OD indices from 1427 samples from 2005 to 2012, which were sent from 839 patients and were composed of bronchial lavage (BL = 727) and bronchoalveolar lavage fluids (BAL = 700), were retrospectively analysed. The recovery rates of Aspergillus species from these specimens were 9.4% from the combined patient group and 13.3% from the neutropenic group. Aspergillus fumigatus complex was the most frequently isolated species. The mean and median OD indices of the positive and negative culture samples are approximately 5 and 1, respectively, and 91% of all culture-positive samples have ≥1 OD index value. The receiver-operating characteristics curve analysis demonstrated that the feasibility of the Aspergillus galactomannan assay and Aspergillus galactomannan test has superior accuracy in BAL compared to BL fluids, and the test is not affected by the immune status of the patient. We suggest that the Aspergillus galactomannan test, which uses bronchoscopic material, leads to an earlier diagnosis and if the OD index is found ≥1, fungal growth can be expected.

Diagnostic Accuracy of a Modified STOP-BANG Questionnaire with National Anthropometric Obesity Indexes.

OBJECTIVES: Obstructive sleep apnea (OSA) is a very common sleep-related disorder and has many medical complications. Although the STOP-BANG questionnaire is an attractive screening tool because of high sensitivity, it lacks power in specificity. The aim of the present study was to evaluate and compare the diagnostic accuracy of standard STOP-BANG and a modified STOP-BANG questionnaire, using national cut-off values for neck circumference that determined OSA, in a sleep center population. MATERIALS AND METHODS: One hundred eighty-five participants who were referred to the sleep-disordered breathing clinic were consecutively enrolled. We used 40 cm and 36 cm as the cut-off values for neck circumference, thus scoring patients accordingly and creating a modified STOP-BANG score with national anthropometric obesity indexes. RESULTS: The median neck circumferences were 41 (39-44) cm, 40 (37-42) cm, and 43 (40-45) cm for total population, female gender, and male gender, respectively. The mean STOP-BANG score was 4.5±1.5, and the mean modified STOP-BANG score was 4.9±1.5. Discrimination of OSA measured by area under the curve for both questionnaires is comparable (p>0.05). Sensitivity to define OSA (apnea-hypopnea index (AHI)≥5) was 92.2% and 93.8% for original and modified STOP-BANG questionnaire, respectively. Sensitivity for moderate (AHI≥15) and severe OSA (AHI≥30) was identical for both questionnaires. CONCLUSION: The STOP-BANG questionnaire has an excellent sensitivity, but modest specificity and adding national obesity indexes for neck circumference achieved similar results in terms of sensitivity and specificity with the original questionnaire.

Three-dimensional analysis of craniofacial shape in obstructive sleep apnea syndrome using geometric morphometrics / Análisis tridimensional de la forma craneofacial en el síndrome de apnea obstructiva del sueño mediante morfometría geométrica

SUMMARY: Craniofacial morphology is a risk factor for obstructive sleep apnea syndrome. The general aim of this study was to investigate the craniofacial shape differences in adults with and without obstructive sleep apnea syndrome, using geometric morphometric methods. A descriptive study conducted in 106 adult Turkish subjects, consisting of 50 patients with OSAS diagnosed by polysomnography and 56 non-OSAS controls. Three dimensional craniofacial scanning processes were performed on patient subjects on the same day as the PSG. Twelve standard craniofacial landmarks were collected from each subject's 3D craniofacial scan. Geometric morphometric analysis was used to compare the craniofacial shape differences between the OSAS and non-OSAS control groups. No statistically significant difference in terms of general shape in face shapes was found between the OSAS group and control group. However, local significance differences were found. There were significant differences between the groups in some of the interlandmark distances: 11 % of the interlandmark distances were greater in OSAS patients, and 29 % were greater in controls. Greater measured distances in OSAS are concentrated in the nasal region. In the control group, the difference is not concentrated in a specific region. Given the relationship of craniofacial structural alterations and sleep disordered breathing, we hypothesized that inter-landmark distance measurements in the craniofacial anatomy of patients might be predictive of OSA.

RESUMEN: La morfología craneofacial es un factor de riesgo para el síndrome de apnea obstructiva del sueño. El objetivo general de este estudio fue investigar las diferencias de forma craneofacial en adultos con y sin síndrome de apnea obstructiva del sueño utilizando métodos morfométricos geométricos. Un estudio descriptivo realizado en 106 sujetos turcos adultos, de 50 pacientes con SAOS diagnosticados mediante polisomnografía y 56 controles no SAOS. El proceso de escaneo craneofacial tridimensional se realizó en pacientes sujetos el mismo día que el PSG. Se recogieron doce puntos de referencia craneofaciales estándar del escaneo craneofacial 3D de cada sujeto. Se usó el análisis morfométrico geométrico para comparar las diferencias de forma craneofacial entre los grupos de control SAOS y no SAOS. No se encontraron diferencias estadísticamente significativas en términos de forma general en las formas de la cara entre el grupo SAOS y el grupo control. Sin embargo, se encontraron diferencias de significación local. Hubo diferencias significativas entre los grupos en algunas de las distancias interlandmark: el 11 % de las distancias interlandmark fueron mayores en los pacientes con SAOS y el 29 % en los controles. Las mayores distancias medidas en SAOS se concentran en la región nasal. En el grupo de control, la diferencia no se concentra en una región específica. Dada la relación de las alteraciones estructurales craneofaciales y la alteración de la respiración durante el sueño, planteamos la hipótesis de que las mediciones de distancias inter-hito en la anatomía craneofacial de los pacientes podrían ser predictivas de la SAOS.