Caveolin-1 polymorphisms in patients with severe obstructive sleep apnea.

OBJECTIVE: To investigate the associations of G14713A and T29107A polymorphic variants of Caveolin-1 with severe obstructive sleep apnea (OSA). MATERIALS AND METHODS: This study was performed on 86 severe OSA patients and 86 controls. Genotyping was performed to investigate the association of G14713A and T29107A polymorphisms of Caveolin-1 with severe OSA. RESULTS: The distribution of genotypes of T29107A was significantly different between controls and OSA patients with a higher proportion of TT carriers in the OSA group. CONCLUSION: T29107A-specific genotype of Caveolin-1 may be linked with severe OSA pathogenesis.

Two-year survival of severe chronic obstructive pulmonary disease subjects requiring invasive mechanical ventilation and the factors affecting survival.

OBJECTIVE: To investigate two-year survival rates and the factors affecting survival in patients of severe chronic obstructive pulmonary disease requiring invasive mechanical ventilation. METHODS: The retrospective study was conducted at Yuzuncuy?l University, Van, Turkey, and comprised record of in-patients with moderate to severe chronic obstructive pulmonary disease who required invasive mechanical ventilation in the intensive care unit of the Pulmonary Diseases Department between January 2007 and December 2010. Correlation between survival and parameters such as age, gender, duration of illness, history of smoking, arterial blood gas values, pulmonary artery pressure, left ventricular ejection fraction, body mass index and laboratory findings were investigated. SPSS 19 was used for statistical analysis. RESULTS: Of the 69 severe COPD subjects available, 20 (29%) were excluded as they did not meet the inclusion criteria. Overall in-hospital mortality rate was 42% (n:29). Of the remaining 20 (29%) who comprised the study group, 14(70%) were men and 6(30%) were women. The mortality rates at the end of 3rd, 6th, 12th and 24th months were 61%, 76%, 84% and 85.5% respectively. There was no correlation between gender and survival in time point (p>0.05). The only factor that affected the rate of mortality at the end of the 3rd month was age (p<0.05). Mortality was high in subjects with advanced ages (p<0.05). Duration of illness affected the survival at the end of the six month (p<0.05). Survival rates were high in subjects with longer illness durations (p<0.05). Haematocrit level was the only factor that affected mortality rates at the end of 12th and 24th months (p<0.05). Subjects with higher haematocrit levels had higher survival rates (p<0.05). CONCLUSIONS: Age, duration of illness and haematocrit levels were the most important factors that affected survival in chronic obstructive pulmonary disease patients requiring mechanical ventilation.

Utility of computed tomography in assessment of pulmonary hypertension secondary to biomass smoke exposure.

BACKGROUND: The aim of this study was to investigate the feasibility of main pulmonary artery diameter quantification by thoracic computerized tomography (CT) in the diagnosis of pulmonary hypertension seconder to biomass smoke exposure. MATERIAL AND METHODS: One hundred and four women subjects with biomass smoke exposure and 20 healthy women subjects were enrolled in the prospective study. The correlation between echocardiographic estimation of systolic pulmonary artery pressure and the main pulmonary artery diameter of the cases were studied. RESULTS: The main pulmonary artery diameter was 26.9 ± 5.1 in the control subjects and 37.1 ± 6.4 in subjects with biomass smoke exposure. This difference was statistically significant (p<0.001). The systolic pulmonary artery pressure was 22.7 ± 12.4 in the control subjects and 57.3 ± 22 in subjects with biomass smoke exposure. This difference was statistically significant (p<0.001). Systolic pulmonary artery pressure was significantly correlated with the main pulmonary artery diameter (r=0.614, p<0.01). A receiver operating characteristic (ROC) curve analysis showed that a value of 29 mm of the main pulmonary artery diameter differentiated between pulmonary hypertension and non-pulmonary hypertension patients. The sensitivity of the measurement to diagnose pulmonary hypertension was 91% and specificity was 80%. CONCLUSIONS: Our results indicate that main pulmonary artery diameter measurements by SCT may suggest presence of pulmonary hypertension in biomass smoke exposed women.

Investigation of the relationship between serum levels of cotinine and the renal function in active and passive smokers.

OBJECTIVE: We have investigated the effects of active and passive smoking on renal functions in terms of glomerular filtration rate, microalbuminuria, and ß-2 microglobulin excretion. DESIGN AND METHOD: The volunteers included in this study were classified into three groups as active smokers (n = 24), passive smokers (n = 20), and controls (n = 20). Blood and urine samples were collected from all groups. Serum glucose, urea, creatinine, and cotinine levels in the collected blood samples were measured. Also, microalbumin, ß-2 microglobulin, and creatinine levels were measured in the collected urine samples. RESULTS: Serum cotinine levels were found to be higher in both passive and active smokers when compared with controls ( p < 0.01), whereas urinary microalbumin and creatinine levels were significantly higher in active smokers ( p < 0.01). The urinary microalbumin/creatinine ratio was significantly increased in both active and passive smokers compared with controls. CONCLUSION: The kidney and the glomerular functions may be affected even by passive smoking. In addition, increased microalbumin/creatinine ratio may be a sign of increased atherosclerosis risk in these persons.

[Varicella pneumonia requiring invasive mechanical ventilation]. / Invaziv mekanik ventilasyon gerektiren suçiçegi pnömonisi.

We aimed to report a case of varicella pneumonia that resulted in respiratory failure requiring mechanical ventilation. The patient was a 40-year-old man whose rashes started after his childeren developed varicella and who had a high fever, sputum and sputum with blood, cough, cold and shiver four days before admission. A treatment was commenced by an antiviral acyclovir and ampiric ampicillin-sulbactam therapy. Although a supporting oxygen treatment, the patient whose oxygen saturation did not increase and respiratory rate was high was commenced by an invasive mechanical ventilation because of a respiratory failure. The patient that had a recovery in clinical symptoms after 36 hours was extubated and was discharged from hospital by the following week.

Management of complicated giant thoracic hydatid disease.

BACKGROUND: Hydatid disease is a parasitic infestation frequently seen in sheep- and cattle-raising areas of the world, and has been known since the time of Galen and Hippocrates. We retrospectively evaluated patients who underwent surgery in our department due to complicated giant intrathoracic hydatid cysts. MATERIAL/METHODS: Twenty patients with complicated giant intrathoracic hydatid cysts were operated on between May 2001 and May 2007 in our department. There were 14 male and 6 female patients, with an age range from 10 to 47 years (mean 23.7+/-11.2 years). RESULTS: The most common symptoms were cough, chest pain, fever, and dyspnea. The most common physical finding was decreased breathing sounds at the affected hemi-thorax. There were signs of cyst perforation of the bronchial space in 14 patients. The cysts were ruptured to the pleural space in 5 patients, with pleural effusion or localized empyema; 4 of them required decortication due to air trapping in the lung. The cyst was found to be intact but infected in 1 patient with cardiac cyst. Cystotomy plus capitonnage was the most frequently used surgical procedure, which was performed in 18 patients, while lobectomy was performed in 1 patient, and left ventriculotomy plus cystotomy plus capitonnage was performed in 1 patient. CONCLUSIONS: All thoracic hydatid cysts should be operated on as soon as they are diagnosed in order to avoid complications, and surgery should be as conservative as possible. Since preoperative medical therapy can lead to perforation, additional adjuvant medical therapy should only be administered postoperatively to avoid recurrences.

Influenza-associated pneumonia in a Turkish area with endemic avian influenza.

BACKGROUND AND OBJECTIVE: The aim of the study was to describe the effects of influenza associated with community-acquired pneumonia (CAP) on the outcome of patients in an area characterized by endemic avian influenza. METHODS: Sixty patients diagnosed with CAP and requiring hospitalization were studied for the presence of influenza. Based on the presence or absence of influenza, patients were divided into two groups: group 1 were CAP patients positive for influenza and group 2 included CAP patients negative for influenza. Laboratory investigations, CXR findings and prognosis were compared. RESULTS: Nasopharyngeal swabs or deep tracheal aspirates were tested for viral aetiology, and seven patients were positive for influenza AH3; one was positive for influenza AH1; seven were positive for influenza B; and one was positive for parainfluenza. Group 1 patients (n = 16) had a mean age of 56 years and group 2 patients (n = 45) had a mean age of 55 years. Significant increases in creatinine kinase and lymphopaenia were seen in group 1 patients. On CXR, interstitial infiltration was more marked in group 1. There was significantly higher mortality in group 1 than in group 2. CONCLUSION: CAP associated with influenza had a different clinical picture and outcome compared with patients without evidence of influenza.

[Evaluation of tuberculosis cases detected in our region between 1999 and 2003]. / Ilimizde 1999-2003 yillari arasinda saptanan tüberküloz olgularinin degerlendirilmesi.

This study investigates the extent of tuberculosis, its clinical features, the specification of the patients with tuberculosis, and evaluates diagnosis, treatment and their effectiveness in our region. The records of 645 patients admitted to the Tuberculosis Control Dispensary in our between January 1999 and December 2003 were evaluated retrospectively. The incidence of the disease was 0.012% and it was more common among young men and diagnosed mostly by individual examination. Twenty-six percent of the patients had a history of physical contact with a tuberculosis patient. The pulmonary and extra pulmonary involvement of the disease was 51.8% and 48.2%, respectively. Bacteriologic examination of the patients was as follows; 42.2% did not have a bacteriologic examination, 21.7% was smear and culture positive, 26.8% was smear and culture negative, and 8.7% was smear negative and culture positive. Diagnosis of tuberculosis by bacteriologic examination increased from 39.7% to 73.6% within years. Cure rates of the disease were between 12.5% and 34.4%. Completion rates of tuberculosis therapy were between 53.5% and 72.6% and treatment success rates were between 82% and 95% whereas mortality rates varied between 1.7% and 2.8%. In conclusion, we observed that new cases and smear positive cases of tuberculosis were more common among the young and among the people with low socioeconomic status, bacteriologic examination increased over time and the rate of successful treatment was high but the cure rate was low.

Serum levels of trace minerals and heavy metals in severe COPD patients with and without pulmonary hypertension.

Aim: The aim of the current study was to assess the serum levels of trace minerals/heavy metals in COPD patients with and without pulmonary hypertension (PH) and to investigate their correlations to demographic, clinical, and biochemical variables. Materials and methods: This cross-sectional study was performed in Van Yuzuncu Yil University Medical Faculty between April 2013 and July 2013. Cases were allocated into three groups: Group 1 consisted of severe COPD patients; Group 2 was made up of COPD patients with PH; and healthy controls constituted Group 3. Demographic, radiological, and biochemical variables, as well as the serum levels of trace minerals and heavy metals, were noted and compared in these three groups. Results: COPD patients were older and had higher rates of smoking habit, diabetes mellitus, and hypertension compared to the control group. Carotid intima-media thickness was increased bilaterally, and serum levels of Co, Cu, and Fe were higher in COPD patients. Left carotid intima-media thickness was increased, and serum levels of Cd, Co, and Fe were found to be higher in COPD cases with PH compared to COPD patients without PH. Conclusion: Our results show that serum levels of trace minerals and heavy metals may be altered in COPD and PH.

Transparent development of the WHO rapid advice guidelines.

Emerging health problems require rapid advice. We describe the development and pilot testing of a systematic, transparent approach used by the World Health Organization (WHO) to develop rapid advice guidelines in response to requests from member states confronted with uncertainty about the pharmacological management of avian influenza A (H5N1) virus infection. We first searched for systematic reviews of randomized trials of treatment and prevention of seasonal influenza and for non-trial evidence on H5N1 infection, including case reports and animal and in vitro studies. A panel of clinical experts, clinicians with experience in treating patients with H5N1, influenza researchers, and methodologists was convened for a two-day meeting. Panel members reviewed the evidence prior to the meeting and agreed on the process. It took one month to put together a team to prepare the evidence profiles (i.e., summaries of the evidence on important clinical and policy questions), and it took the team only five weeks to prepare and revise the evidence profiles and to prepare draft guidelines prior to the panel meeting. A draft manuscript for publication was prepared within 10 days following the panel meeting. Strengths of the process include its transparency and the short amount of time used to prepare these WHO guidelines. The process could be improved by shortening the time required to commission evidence profiles. Further development is needed to facilitate stakeholder involvement, and evaluate and ensure the guideline's usefulness.

WHO Rapid Advice Guidelines for pharmacological management of sporadic human infection with avian influenza A (H5N1) virus.

Recent spread of avian influenza A (H5N1) virus to poultry and wild birds has increased the threat of human infections with H5N1 virus worldwide. Despite international agreement to stockpile antivirals, evidence-based guidelines for their use do not exist. WHO assembled an international multidisciplinary panel to develop rapid advice for the pharmacological management of human H5N1 virus infection in the current pandemic alert period. A transparent methodological guideline process on the basis of the Grading Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to develop evidence-based guidelines. Our development of specific recommendations for treatment and chemoprophylaxis of sporadic H5N1 infection resulted from the benefits, harms, burden, and cost of interventions in several patient and exposure groups. Overall, the quality of the underlying evidence for all recommendations was rated as very low because it was based on small case series of H5N1 patients, on extrapolation from preclinical studies, and high quality studies of seasonal influenza. A strong recommendation to treat H5N1 patients with oseltamivir was made in part because of the severity of the disease. Similarly, strong recommendations were made to use neuraminidase inhibitors as chemoprophylaxis in high-risk exposure populations. Emergence of other novel influenza A viral subtypes with pandemic potential, or changes in the pathogenicity of H5N1 virus strains, will require an update of these guidelines and WHO will be monitoring this closely.

Obstructive sleep apnea related to rapid-eye-movement or non-rapid-eye-movement sleep: comparison of demographic, anthropometric, and polysomnographic features.

OBJECTIVE: To determine whether there are significant differences between rapid-eye-movement (REM)-related obstructive sleep apnea (OSA) and non-REM (NREM)-related OSA, in terms of the demographic, anthropometric, and polysomnographic characteristics of the subjects. METHODS: This was a retrospective study of 110 patients (75 males) with either REM-related OSA (n = 58) or NREM-related OSA (n = 52). To define REM-related and NREM-related OSA, we used a previously established criterion, based on the apnea-hypopnea index (AHI): AHI-REM/AHI-NREM ratio > 2 and ≤ 2, respectively. RESULTS: The mean age of the patients with REM-related OSA was 49.5 ± 11.9 years, whereas that of the patients with NREM-related OSA was 49.2 ± 12.6 years. The overall mean AHI (all sleep stages combined) was significantly higher in the NREM-related OSA group than in the REM-related OSA group (38.6 ± 28.2 vs. 14.8 ± 9.2; p < 0.05). The mean AHI in the supine position (s-AHI) was also significantly higher in the NREM-related OSA group than in the REM-related OSA group (49.0 ± 34.3 vs. 18.8 ± 14.9; p < 0.0001). In the NREM-related OSA group, the s-AHI was higher among the men. In both groups, oxygen desaturation was more severe among the women. We found that REM-related OSA was more common among the patients with mild-to-moderate OSA, whereas NREM-related OSA was more common among those with severe OSA. CONCLUSIONS: We found that the severity of NREM-related OSA was associated mainly with s-AHI. Our findings suggest that the s-AHI has a more significant effect on the severity of OSA than does the AHI-REM. When interpreting OSA severity and choosing among treatment modalities, physicians should take into consideration the sleep stage and the sleep posture.

Assessments of the associations of thrombus localization with accompanying disorders, risk factors, D-dimer levels, and the red cell distribution width in pulmonary embolism.

OBJECTIVE: Pulmonary embolisms occur as a wide spectrum ranging from clinically asymptomatic thrombi to massive thrombi that lead to cardiogenic shock. The purpose of this study was to determine the associations of thrombus localization with risk factors, accompanying disorders, D-dimer levels and the red blood cell distribution width in patients with pulmonary embolism. MATERIAL AND METHODS: In 148 patients diagnosed with pulmonary embolism, the presence and anatomical localization of the thrombus were assessed via computed tomographic pulmonary angiography. The accompanying disorders, risk factors, serum D-dimer levels, and red blood cell distribution width of the patients were retrospectively evaluated. ClinicalTrials.gov: NCT02388841. RESULTS: The mean age of the patients was 54±16.0 years, and 48 patients were ≥65 years of age. The most frequent accompanying disorders were chronic obstructive pulmonary disease (22%) and malignancy (10.1%), and the most frequent risk factors were recent operation (14.1%) and immobilization (18.2%). Thrombi were most frequently observed in the right pulmonary artery (37.8%). In 31% of the patients, the thrombus was localized to the main pulmonary arteries. Immobile patients exhibited a higher proportion of thrombi in the main pulmonary arteries than mobile patients. The mean D-dimer level and the mean red blood cell distribution width in the patients with thrombi in the main pulmonary arteries were higher than those in the patients with thrombi in more distal pulmonary arterial branches. CONCLUSION: Significant associations of proximally localized thrombi with immobilization, the D-dimer levels, and the red blood cell distribution width were observed.

Extrapulmonary tuberculosis in high prevalence of tuberculosis and low prevalence of HIV.

The authors' data show a higher rate of pleural and meningeal involvement among extrapulmonary TB cases than expected by previous works. Special attention should be given to tuberculous meningitis cases among all extrapulmonary TB cases because of its high mortality rate. The most common extrapulmonary involvement is pleural. Pleural involvement is most common among the young male military service personnel. These data underscore the importance of determining pleural involvement among extrapulmonary TB cases and emphasize the need to consider clinic and epidemiologic differences in the diagnosis and evaluation of extrapulmonary TB. Finally, it seems unlikely that HIV infection currently has a role in the cause of extrapulmonary TB in the authors' region.

Frequency of sinusitis in the patients with pneumonia.

The aim of this study was to investigate the frequency of sinusitis in patients with pneumonia. Among 50 consecutive patients with pneumonia, 19 cases, which had Waters' roentgenograms in their files, were retrospectively reviewed in relation with sinusitis. Sixteen of them had sinusitis signs in their roentgenograms. The sinusitis frequency was 84% in patients with pneumonia who had paranasal sinus roentgenograms. These findings suggest that sinusitis may be an important causative factor for pneumonia and that it should be considered when evaluating a patient with pneumonia.

Evaluation of airway wall thickness via high-resolution computed tomography in mild intermittent asthma.

INTRODUCTION: This study aims to evaluate bronchial thickness via thorax high-resolution computed tomography (HRCT) in subjects with mild intermittent asthma in comparison with healthy control subjects. METHODS: A total of 37 out-patients (mean ± SD age = 36.7 years (9.7 years); 54.8% males) with mild intermittent asthma and 13 healthy control subjects (mean ± SD age = 25.0 years (2.9 years); 61.5% males) were included in this case control study. Data on demographics, pulmonary function test results, and segmental and subsegmental thorax HRCT results were recorded. The ratio of bronchial wall thickness to bronchial lumen diameter (T/D) and bronchial wall area percentage (WA%) were calculated for all cases. RESULTS: Subject and control groups were similar in terms of pulmonary function test results, and total and subsegmental T/D values. Mean ± SD subsegmental WA% values at the level of inferior pulmonary vein (55.6% [16.8%] vs. 41.7% [7.4%], P = .047) and 2 cm above the diaphragm (49.8% [15.8%] vs. 38.6% [10.4%], P = .046) were significantly higher in subjects than control subjects. No significant correlation of overall and subsegmental T/D and WA% values to age in both groups, and to asthma duration in subjects. CONCLUSION: Our findings revealed an increase in bronchial wall thickness in peripheral airways in subjects with mild intermittent asthma regardless of the duration of asthma. This may indicate a need to also administer anti-inflammatory or bronchodilator therapy, which is effective in peripheral airways during the early period of the disease.

Relationship between coronary artery disease and pulmonary arterial pressure in patients with chronic obstructive pulmonary disease.

The aim of the present study was to determine whether there is a relationship between coronary artery disease and pulmonary hypertension and whether pulmonary hypertension is an additional risk factor for the presence and extent of coronary artery disease in patients with chronic obstructive pulmonary disease. Patients diagnosed with chronic obstructive pulmonary disease and pulmonary hypertension, and undergone diagnostic coronary angiography for evaluation of suspected coronary artery disease constituted the study group. Patients were divided into two groups according to the presence or absence of coronary artery disease and compared for age, gender, accompanying chronic disease, and pulmonary function tests. A total of 95 patients were recruited in the study. Comparison of the groups revealed that two groups were significantly different on gender (p=0.029), presence of hypertension (p=0.027), and biomass (p=0.040). Correlation analysis of variables revealed that male gender (rs=0.224, p=0.029), hypertension (rs=0.227, p=0.07) were positively correlated with the presence of coronary artery disease. FEV1/FVC ratio (rs=-0.253, p=0.013) and sPAP (rs=-0.215, p=0.037) were negatively correlated with the presence of coronary artery disease. High prevalence of coronary artery disease in patients with pulmonary hypertension secondary to chronic obstructive pulmonary disease was found. However, no correlation between the presence and severity of coronary artery disease and pulmonary hypertension was detected.

Chronic effects of environmental biomass smoke on lung histopathology in Turkish non-smoking women: a case series.

Biomass is widely used for fuel in developing countries. Particles and gases of biomass burning may cause changes in the lung. In this prospective study we investigated histopathological changes in the lungs of 42 non-smoking women [mean age (59±10) years] caused by biomass smoke. We valuated exposure to biomass smoke, case histories, and the findings of physical examination, radiology, bronchoscopy, and lung histopathology. Mean exposure to biomass smoke was (28±9) hour-year (1 hour-year equals 365 hours of exposure per year with average exposure of 1 hour a day). The radiological findings were mass (42 %), reticulonodular opacities (31 %), mediastinal lymphadenopathy (26 %), pleuro-parenchymal fibrotic banding (19 %), widening of the pulmonary artery (14 %), ground glass (11 %), mosaic perfusion (9 %), consolidation (9 %), segmental or subsegmental atelectasis (7 %), and bronchiectasis (7 %). The patients were diagnosed with lung cancer (35 %), interstitial lung disease (31 %), sarcoidosis (9 %), tuberculosis (9 %), chronic obstructive pulmonary disease (4 %), chronic bronchitis (9 %), and metastasis (4 %). Bronchoscopy showed pilies, oedema, erythema, bronchus narrowing, endobronchial tumour, mucosal irregularity, increased vascularisation, blue-black anthracotic plaques, mucosal oedema, and purulent secretion. Transbronchial biopsies revealed neutrophil and lymphocyte leucocytes in the perivascular, peribronchiolar, and interalveolar septa, slightly enlarged connective tissue, thickening of the basal membrane, thickening of interalveolar septa, intimal and medial thickening of the vascular wall and vascular lumen narrowing, anthracosis between the cells and in the bronchiole epithelium. These findings confirm that biomass smoke has important toxic effects on the lung parenchyma, interstitium, and pulmonary vessels that may result in malignancies.

A case of viral myocarditis presenting with acute asthma attack.

UNLABELLED: Acute viral myocarditis is one of the causes of heart failure. Cardiac asthma is commonly observed in elderly patients with left heart failure. If the pulmonary manifestations are prominent it can mask the involvement of heart. We report a young case of viral myocarditis mimicking acute asthma attack. CASE PRESENTATION: A 27-year-old young man with a history of asthma presented to the pulmonary department of our hospital with dyspnea, left sided chest pain, cough, wheezing. Asthma was diagnosed and treated, however his respiratory complaints have persisted. Laboratory evaluations revealed that elevated cardiac enzymes, Echocardiogram showed global hypokinesia in the left ventricle and a decrease of ejection fraction. We concluded that viral myocarditis can present itself like an acute asthma attack.