[Efficiency of nebulised magnesium sulphate in infective exacerbations of chronic obstructive pulmonary disease]. / Kronik obstrüktif akciger hastaligi enfektif alevlenmelerinde nebül magnezyum sülfatin etkinligi.

INTRODUCTION: Conflicting results has been achieved in a small number of clinical studies evaluating the efficiency of magnesium sulphate (MS) in COPD exacerbations. We aimed to investigate the efficiency of nebulised MS in COPD exacerbations. PATIENTS AND METHODS: Twenty patients who met the study criteria were randomized into two groups. All patients were treated with O2, antibiotics and oral corticosteroids. Additionally one group received ipratropium bromide (IB) 500 µg together with MS 151 mg/dose, while the other group received IB together with placebo. The patients were followed-up with forced expiratory volume in 1 second (FEV1) and visual analogue scale dyspnea scores for 48 hours. Peak expiratory flow rates (PEFRs) were measured before and 10, 30, 60 and 120 minutes after each nebule treatment. RESULT: The baseline characteristics of the patients in both groups were similar. The FEV1 values measured at 24 and 48 hours did not show significant changes compared to baseline in both groups. Dyspnea scores in both groups decreased significantly in the first day, and in only MS group in the second day. The % change in the dyspnea score at the end of first day was significantly more in the MS group [-23.8% (13.6)] compared with the placebo group [-9.4% (12.9)] (p= 0.002). The % changes in PEFRs at 10 minutes [4.7 (7.5) and -3.5 (6.0), p= 0.005] and 30 minutes [8.2 (6.7) and 1.3 (5.5), p= 0.03] were significantly greater in the MS group compared with the placebo group on the first day. No side effects developed due to MS. CONCLUSION: Nebulised MS is a cheap, feasible and safe drug that can be added to the standart bronchodilator treatment since it provides additional relief of dyspnea in patients with COPD exacerbations. This needs to be evaluated in future clinical studies including greater number of patients.

Evaluation of anxiety levels and factors associated with positive test results in patients with drug hypersensitivity.

BACKGROUND: High anxiety has been reported in patients with drug hypersensitivity reaction (DHR); however, its relationship with the test results was not studied previously. OBJECTIVE: We aimed to investigate the association of patient anxiety with the results of drug tests together with the other contributing factors. METHODS: Sixty-seven patients were included in the study between November 2012 and April 2013, in whom drug tests were performed after clinical evaluation and application of the Penn State Worry Questionnaire (PSWQ). RESULTS: The mean ± standard deviation (SD) age was 43.5 ± 12.9 years, and 73.1% of the patients were females. The patient group had significantly higher mean ± SD PSWQ score than 35 control subjects without histories of DHRs and major psychiatric disorders (47.95 ± 14.64 versus 40.22 ± 11.86, p = 0.008). However, the mean ± SD. PSWQ score of the patients with positive drug test results was not significantly different from the patients with negative drug test results (46.06 ± 13.41 versus 50.47 ± 18.02, p = 0.32). Panic attack symptoms were more common in the reactions with positive test results than in the reactions with negative test results (74.0% versus 48.9%, p = 0.01). However, presence of panic attack symptoms [odds ratio (OR): 1.25, 95% confidence interval (CI): 0.44-3.54; p = 0.67] was not found independently associated with positive test results in the multiple logistic regression model. CONCLUSION: Patients with DHR have high levels of anxiety; however, this is not related to the results of drug tests. Because panic reaction symptoms may accompany the objective symptoms of DHR, a complete clinical work-up is required before deciding whether the reaction is related to panic or a "true DHR."

Minimum prick test panel for adult patients with asthma and rhinitis in Ankara, Turkey.

OBJECTIVE: Determination of the number and type of allergens needed to be tested in epidemiological studies is important in order to identify most of the sensitized subjects with a cost-effective approach. This study aimed to investigate the minimum skin prick test panel for the identification of at least 95% of the sensitized subjects with symptoms of asthma and/or allergic rhinitis (AR) in Ankara, Turkey. METHODS: Skin prick test results of 7492 patients who were referred to our outpatient clinic with clinical symptoms of asthma and/or AR between 1991 and 2005 were evaluated retrospectively. Seven allergens were tested in all and 13 allergens in 4202 patients. The allergen group needed for detection of 95% of the sensitized subjects was determined for both the 7 and 13 allergen panels. The study protocol was approved by the local ethics committee of Hacettepe University. RESULTS: The atopy prevalences in the whole study population and in 4202 patients tested with the 13 allergen panel were calculated as 32.2% and 42.6%, respectively. Three allergens (Phleum pratense, Dermatophagoides pteronyssinus and Artemisia vulgaris) within the 7 allergen panel were adequate for the identification of at least 95% of the sensitized subjects. Olea europae was added to the previous three allergens when the 13 allergen panel was applied. CONCLUSION: Three to four allergens are sufficient for identification at least 95% of sensitized subjects with asthma and/or AR in Ankara, Turkey.

Wraparound eyeglasses improve symptoms and quality of life in patients with seasonal allergic rhinoconjunctivitis.

BACKGROUND: Allergen avoidance is important for allergic rhinitis management. However, studies evaluating the efficiency of avoidance measures from pollens are lacking. We aimed to investigate the efficiency of wraparound eyeglasses in seasonal allergic rhinoconjunctivitis (SAR). METHODS: Eligible patients with a diagnosis of SAR (n = 70) rated their symptom scores, filled the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), and were randomized either to receive wraparound eyeglasses in addition to medical treatment (group 1, n = 39) or medical treatment only (group 2, n = 31) throughout the 3 pollen seasons in the years 2011, 2012, and 2013. Patients rated their symptom scores and checked the need for use of rescue medications in their diaries over a period of 4 weeks. RQLQ was reapplied 1 week and 4 weeks after randomization. RESULTS: The median (interquartile range [IQR]) change from baseline over 4 weeks in the eye itching (-2.51 [-3.65 to -1.36] vs -0.88 [-1.95 to 0.43], p < 0.001), eye watering (-2.31 [-3.09 to -1.24] vs -1.60 [-2.59 to -0.21], p = 0.02), sneezing (-2.26 [-3.19 to -1.51] vs -1.68 [-2.27 to -0.56], p = 0.03), and rhinorrhea (-2.48 [-3.74 to -1.49] vs -1.59 [-2.88 to -0.87], p = 0.04) scores were significantly higher in group 1 compared to group 2. There were significantly higher improvements in ocular symptoms domain score (-1.75 [-3.12 to -1.00] vs -0.50 [-2.31 to -0.31], p = 0.002), nasal symptoms domain score (-2.25 [-4.06 to -1.50] vs -1.25 [-2.37 to -0.68], p = 0.004), and total RQLQ score (-1.98 [-2.67 to -0.88] vs -1.10 [-2.06 to -0.25], p = 0.02) and reduced need for rescue medication use in group 1 compared to group 2 at the end of 4 weeks. CONCLUSION: Standard wraparound eyeglasses can provide a safe, convenient, and effective measure for protection from pollens in patients with SAR.

Development of rhinitis may be an indicator for the persistence of childhood asthma.

OBJECTIVES: Results of previous studies have established several factors related with the natural course of childhood asthma. The aim of this study is to investigate the prognosis of childhood asthma and to determine possible risk factors for disease persistence. METHODS: An outpatient cohort with a median (interquartile range) follow-up duration of 19.4 (17.7-21.8) years was re-evaluated. Current clinical remission (CR) was defined as no asthma symptoms and no use of controller medication within the past year. RESULTS: Out of 115 patients, 78 could be surveyed with questionnaire and 46 patients with a median age of 25.3 (23.9-27.0) years were further investigated with clinical work-up. Nineteen (24.4%) patients were in CR in both visits (adolescence and young adulthood). A further 7 patients (9.0%) who were not in CR at adolescence were in CR at the young adulthood visit. However, 21 patients (26.9%) who were in CR at adolescence were not in CR at the young adulthood visit. Thirty-one patients (39.7%) with persistent symptoms at adolescence were not in CR at young adulthood, either. In multivariate logistic models, the presence of obstructive pattern (forced expiratory volume in 1s (FEV1)/forced vital capacity (FVC) <80% vs. ≥80%) in pulmonary function tests during the adolescence period (odds ratio; [95% confidence interval] (6.71 [1.65-27.29]; p=0.008) and later-onset rhinitis (10.27 [1.18-89.13]; p=0.035) predicted the absence of CR at young adulthood. CONCLUSION: A substantial number of patients who were in CR during adolescence have re-emerging disease. The presence of obstructive pattern in adolescence and later-onset rhinitis were associated with the absence of CR in young adults with asthma. Awareness of risk factors along with early interventions may provide better results in childhood asthma.

Evaluation of smoking as an additional risk factor for cardiovascular diseases among hemodialysis patients by increased levels of II-6, TNFα, hs-CRP and Endothelin-1 / Evaluación del tabaquismo como factor de riesgo adicional de enfermedades cardiovasculares en pacientes en hemodiálisis según niveles elevados de II-6, TNFα, hs-CRP y Endotelina-1

INTRODUCTION: Cardiovascular diseases (CVD) are one of the most common causes of mortality in chronic kidney disease. Smoking is a well defined risk factor for atherosclerotic cardiovascular disease. Interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), high sensitive C-reactive protein (hsCRP) and endothelin-1 (Et-1) have found elevated in chronic inflammatory process. OBJECTIVE: We aimed to evaluate if IL-6, TNF-alpha, hsCRP and ET-1 are increased in smoker hemodialysis (HD) patient compared to non-smoker HD individuals to potentially refer us cardiovascular diseases noninvasively. MATERIAL AND METHODS: 80 smoker and 50 non-smoker maintenance hemodialysis male patients with similar demographic characters, dialysis and support treatment and metabolic profile. In addition to routine tests, we took samples for evaluating IL-6, TNF-α, hsCRP and endothelin-1. P values were In smoker HD patients, IL-6, TNF-alpha, hsCRP and endothelin-1 levels were found increased level statistically significant compared to non-smoker indiviuals. CONCLUSION: This study may refer us that smoking is an additional risk factor among HD individuals by increased levels of IL-6, TNF-α, hsCRP and Et-1

INTRODUCCIÓN: Las enfermedades cardiovasculares (EC) constituyen una de las causas más frecuentes de mortalidad en los casos de enfermedad renal crónica. El tabaquismo es un factor de riesgo bien definido para la enfermedad cardiovascular aterosclerótica. Se encontraron valores elevados de Interleucina-6 (IL-6), factor de necrosis tumoral alfa (TNFα), proteína C-reactiva de alta sensibilidad (hs-CRP) y Endotelina-1 (Et-1) en el proceso inflamatorio crónico. OBJETIVO: El objetivo fue analizar si los valores de IL-6, TNFα, hs CRP y Et-1 son más elevados en los pacientes fumadores en hemodiálisis que en los no fumadores para predecir una posible enfermedad cardiovascular de forma no invasiva. MATERIAL Y MÉTODOS: Se incluyeron pacientes masculinos en hemodiálisis de mantenimiento, 80 fumadores y 50 no fumadores, similares en cuanto a sus características demográficas, tratamiento de diálisis y de mantenimiento, y perfil metabólico. Además de los análisis de rutina, se tomaron muestras para evaluar los valores de IL-6, TNFα, hs CRP y Endotelina-1. Se midieron los valores de p. RESULTADOS: Se halló una diferencia estadísticamente significativa en los niveles de IL-6, TNFα, hs CRP y Endotelina-1: fueron más elevados en los pacientes sometidos a hemodiálisis que eran fumadores en comparación con los no fumadores.CONCLUSIÓN: Este estudio podría demostrar que el tabaquismo es un factor de riesgo adicional para los pacientes que se tratan con hemodiálisis según muestran los valores elevados de IL-6, TNFα, hs CRP y Et-1