Albuminuria in Pediatric Patients With Adenotonsillar Hypertrophy.

The relationship between intermittent nocturnal hypoxia and albuminuria in pediatric patients with adenotonsillar hypertrophy was evaluated in this prospective study. Fifty children with grade 3 to 4 adenotonsillar hypertrophy scheduled for adenoidectomy and/or adenotonsillectomy were selected for study group. Fifteen patients with adenotonsillar grade 1 to 2 or adenotonsillectomized subjects in a similar range of sex, age, and body mass index scheduled for other surgeries were selected for control group. All children were monitored using finger pulse oximeter during the night before surgery. At the day of surgery, first morning urine samples were sent to the laboratory for analysis of albuminuria.Albuminuria was determined in 8 (16%) patients in study group and 1 (6.7%) patient in control group. This difference between groups was determined not to be statistically significant (P > 0.05). None of the pulse oximetry parameters was also found to be associated with albuminuria statistically (P > 0.05). However, the adenoid grade was observed to be associated with albuminuria (P = 0.011).This study revealed no relationship between albuminuria and intermittent hypoxia in children, although previous studies have reported that intermittent hypoxia causes albuminuria in adults. On the contrary, the adenoid grade was found to be in association with albuminuria. The reason seems to be unclear because of the lack of studies investigating albuminuria in children with adenotonsillar hypertrophy. However, inflammatory mediators arising from adenoid tissue may cause increase in renal capillary permeability and urine albumin excretion.

The predictors of mortality in IPF - Does emphysema change the prognosis?

BACKGROUND: Combined idiopathic pulmonary fibrosis (IPF) and emphysema (CPFE) has been reported to be more common in male smokers. A number of studies comparing CPFE patients with fibrosis-only patients have reported a similar prognosis while others have reported a significantly shorter survival. OBJECTIVES: In present study, we aimed to compare baseline characteristics of patients with IPF according to emphysema presence. We asssessed the prognostic value of emphysema along with each other parameter. METHODS: We retrospectively reviewed the clinical, baseline radiological, laboratory and physiological parameters of 92 patients who were diagnosed with IPF. The patients were divided into two groups: those without emphysema (Group 1) and with emphysema (Group 2). All-cause mortality was recorded, and the impact of the variables on survival was evaluated. RESULTS: Emphysema was recorded in 23 patients, all of whom were male. While ever-smoker rate was higher in Group 2 laboratory and physiologic parameters were similar. Radiologically, the presence of honeycombing, ground glass opacity, the extension and symmetry of involvement did not differ between the Groups. The median survival time was 29±4 months. Patients in Group 1 and 2 had a median survival of 34 and 9 months, respectively. In univariate analysis; radiological presence of emphysema and honeycombing, male gender, lower baseline levels of albumin and oxygen saturation, forced vital capacity and carbon monoxide diffusing capacity were detected as predictors of mortality. CONCLUSION: In present study, IPF with emphysema was more common in male smokers. When emphysema accompanies IPF, life expectancy is remarkably worse, but not independently so.

Two Chronic Granulomatous Disease Diagnosed in Adult Age.

Chronic granulomatous disease (CGD) is a rare, inherited primary immunodeficiency that is usually diagnosed at adulthood and is presented with recurrent bacterial and fungal infections. In this case report, two adult cases of CGD have been presented. A 29-year-old woman was referred to our clinic with hypoxic respiratory failure, with a pre-diagnosis of multidrug resistant tuberculosis (TB). Her lung biopsy had been reported as granulomatous inflammation, she had not responded to a 5 month anti-TB treatment. A complete medical history consisted of 4 occasions of treatment with anti-TB drugs and that her sister and brother had undergone TB therapy. However, since childhood, a TB bacilli had never been isolated microbiologically in the siblings. Patient's parents were third degree consanguineous. The patient still had a purulent drainage around the operation site. Microbiological studies of the wound drainage and respiratory tract have not encountered any specific microorganism. Investigation of an immunodeficiency has proved CGD through nitroblue tetrazolium test. Her siblings has been diagnosed as CGD as well. Second case, a 19-year-old male, has been admitted to our clinic with complaints of fever, chest pain and an abscess lesion in the anterior chest wall. His medical history comprised 3 recurrences of pneumonia within last 2 years. In physical examination, a 3 × 5 cm fluctuant swelling lesion on the anterior chest wall. Radiologically, new pneumonic consolidations were detected. Sputum specimens did not provide any specific microorganism, cultures of the chest-wall abscess fluid grew aspergillus. His parents had been living in the same village but no consanguinity was known. Due to recurrent infections, immunodeficiency tests had been investigated. He was diagnosed as CGD due to dihydrorhodamin test. These two cases signify that, in our country where consanguinity is common, etiology of recurrent unexplained infections, abscesses and granulomas should be investigated and CGD should be in differantial diagnosis list.

Categorization of COPD patients in Turkey via GOLD 2013 strategy document: ALPHABET study.

OBJECTIVE: To determine distribution of COPD assessment categories and physicians' adherence to Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2013 strategy in Turkish COPD patients. METHODS: A total of 1,610 COPD patients (mean [standard deviation] age: 62.6 [9.9] years, 85.7% were males) were included in this multicenter, non-interventional, cross-sectional study. Patients were categorized via GOLD 2013 strategy document. Consistency between reported and re-classified GOLD categories, and measures used for symptom evaluation and exacerbation was analyzed. RESULTS: Overall, 41.1% of patients were assigned to GOLD A, while 13.2% were assigned to GOLD C categories. Long-acting beta-2 agonist + long-acting muscarinic antagonist + inhaled corticosteroid regimen was the most common treatment (62.0%). Over-treatment was noted in >70% of GOLD A, B, and C patients. A high consistency between measures of symptom evaluation (Kappa coefficient =0.993, P<0.0001) and a low-moderate consistency between exacerbation risk measures (Kappa coefficient =0.237, P<0.0001) were noted. CONCLUSION: Our findings revealed GOLD A as the most prevalent category in Turkish cohort of COPD patients. Group assignment was altered depending on the chosen measure for symptom and risk assessment. Physician non-adherence to treatment recommendations in GOLD 2013 document leading to over-treatment in patients assigned to GOLD A, B, and C categories was also detected.

Cases Diagnosed with Swyer James Macleod Syndrome in Adulthood.

Swyer-James-MacLeod syndrome or unilateral hyperlucent lung syndrome is a rare disease characterised by hypoplasia of the pulmonary artery, unilateral hyperlucent lung and usually bronchiectasis. The syndrome was first described by Swyer and James in 1953 in a child case, and in the following year 9 adult cases were reported by MacLeod. We retrospectively reviewed 6 adult cases, five female and one male, who were followed-up with the diagnosis of Swyer-James-MacLeod syndrome between 2005 and 2012 in our clinic. The clinical and radiological features of these 6 cases are presented in the light of the literature.