Critical evaluation of the overactive bladder and urgency urinary incontinence association with obstructive sleep apnea syndrome in a relatively young adult male population.

AIMS: To evaluate the prevalence of Overactive Bladder (OAB) and Urgency Urinary Incontinence (UUI) in males with Obstructive Sleep Apnea Syndrome (OSAS) using the OSAS grading system. METHODS: A total of 194 patients who underwent Polysomnography (PSG) were included in our prospective cross sectional study. Patients were divided into four groups according to Apnea-Hypopnea Index (AHI). Group 1, 35 patients with normal AHI (<5) as a control group; Group 2, 47 patients with mild OSAS (AHI ≥5 and <15); Group 3, 51 patients with moderate OSAS (AHI ≥15 and <30); Group 4, 61 patients with severe OSAS (AHI ≥30). Over Active Bladder (OAB-V8), ICIQ-SF, and IPSS questionnaires were filled out for all patients. Prevalence of OAB, UUI, nocturia, and scores of OAB-V8, ICIQ-SF, IPSS were compared between the study groups. The statistical analysis was adjusted by the demographics of age and BMI. RESULTS: The mean age was 44.6 ± 11.2 years, and the mean BMI was 29.9 ± 4.9 within the whole study group, and both were statistically different between the groups. The scores of OAB-V8 (P = 0.298), ICIQ-SF (P = 0.392), IPSS total, IPSS storage, and IPSS voiding (P = 0.268, P = 0.380, P = 0.167, respectively), the prevalence of OAB (P = 0.078), UUI (P = 0.423), and nocturia (P = 0.096) were not statistically different between the study groups. CONCLUSIONS: Our findings demonstrated that there is no increase in prevalence of OAB and UUI in relatively young adult male with OSAS. Furthermore, analysis revealed that the higher OSAS grade does not mean the higher prevalence of OAB.

The effect of obstructive sleep apnea syndrome and snoring severity to intima-media thickening of carotid artery.

INTRODUCTION: Intima-media thickening (IMT), which is the early finding of carotid artery atherosclerosis, has been shown to be associated with obstructive sleep apnea syndrome (OSAS). In our study, we aimed to assess prospectively the effect of severity of OSAS and snoring on carotid artery IMT. METHODS: A total of 102 patients who were admitted to sleep laboratory between May 2011 and May 2012 were included in the study. All patients were examined by polysomnography. Common carotid arteries (CCA) and internal carotid arteries (ICA) were evaluated for IMT by carotid Doppler ultrasonography. RESULTS: The mean age was 45.9 ± 11.1, with 40 (39.2 %) women and 62 (60.8 %) men. Of 88 OSAS patients who had an apnea-hypopnea index (AHI) of >5, 33 (37.5 %) had mild, 20 (22.7 %) had moderate, and 35 (39.8 %) had severe disease. Fourteen patients who had AHI <5 were designated as the habitual snoring group. IMT was detected in 17 (16.7 %) of all patients. In patients with severe OSAS, CCA walls were thicker (p = 0.040) and IMT ratios were higher (p = 0.019) compared to mild/moderate OSAS patients. In patients with IMT, age, AHI, oxygen desaturation index (ODI), and snoring index were higher compared to patients without IMT (p < 0.05). CONCLUSION: Carotid artery IMT, which is an early finding of atherosclerosis, was found to be highly correlated with OSAS and snoring severity.

The effect of postgraduate training in smoking cessation care on the clinical practice of pulmonologists.

INTRODUCTION: Many studies have shown that training in smoking cessation care (SCC) is important for increasing the number and quality of delivered interventions by health professionals, and various training methods are available. The study aimed to identify the relationship between receiving training on SCC and the frequency of providing outpatient-based SCC among pulmonologists who were members of the Turkish Thoracic Society (TTS). METHODS: For this cross-sectional study, a self-administered online questionnaire-based survey was conducted on a group of active pulmonologists who were members of the TTS, between April and October 2019. The survey included questions about demographics, smoking status, participation in SCC training, and providing outpatient-based SCC. RESULTS: A total of 199 (53%) pulmonologists were actively taking part in outpatient-based SCC. Compared to those that were not providing outpatient-based SCC, median age, median time since graduation, and the number of non-academics, non-current smokers and recipients of smoking cessation care training were significantly higher in the group providing outpatient-based SCC (p<0.001, p<0.001, p=0.002, p=0.001, respectively). It was observed that having SCC training increased more than 6-fold the likelihood of providing outpatient-based SCC (AOR=6.45; 95% CI: 3.96-10.49; p<0.001). CONCLUSIONS: The most crucial obstacle in providing smoking cessation is healthcare workers not providing smoking cessation to smokers. It is worthwhile to devote more tasks and resources to training physicians on smoking cessation care since this may increase their effective involvement in tobacco cessation.

Smoking Cessation Success and Affecting Factors in Geriatric Patients.

Background: There are difficulties in the treatment of smoking cessation in elderly patients. However, elderly smokers who gave up smoking had lower rates of death from heart attack, stroke, and cancer, as well as improved cognitive function. This study aimed to investigate the affecting factors and the success of smoking cessation rate in patients aged 60 and over in Turkey. Methods: Six smoking cessation outpatient clinics from four provinces were included in the study. The records of 1,065 patients who applied to a smoking cessation outpatient clinic between 2016 and 2019 and who were 60 yr of age or older were scanned. Overall, 917 cases that could be reached after treatment were included in the study. Smoking cessation rates at the first month, 3rd month, 6th month, 9th month and 12th month were given. Results: Of the 917 cases, 65.1% were male and 34.9% were female. Smoking cessation rates were 45.6% on the first month, 39% on the third month, 35.1% on the sixth month, 31.2% on the ninth month, and 30.3% at the twelfth month. Smoking cessation success was higher in men than in women. Conclusion: Since the success of smoking cessation in the elderly was similar to that of adults. Since smoking is an independent risk factor for death in the elderly, there should be greater willingness to provide elderly patients with smoking cessation treatment to reduce physical function loss and promote healthier aging.

Turkish Thoracic Society's Statement Report on Electronic Cigarettes and Heated Tobacco Products.

Tobacco addiction, which causes the death of more than 8.5 million people in the world every year, is a preventable global public health problem. There are 1.1 billion adult smokers worldwide and 60% of them desire or intend to quit but unfortunately, the tobacco industry continues to profit at the expense of people's lives by marketing electronic cigarettes and heated tobacco products as a smoking cessation method and they continue to poison young people with new threat tobacco products, promising a "smoke-free future" Turkish Thoracic Society is actively involved in the implementation of the National Tobacco Control Program to protect public health and has warned and raised awareness of new threats to the youth, such as electronic cigarettes and heated tobacco products. The purpose of this report is to provide information about electronic cigarettes and heated tobacco products and to present TTJ's position on the subject.

Sensitivity of convex probe endobronchial sonographically guided transbronchial needle aspiration in the diagnosis of granulomatous mediastinal lymphadenitis.

OBJECTIVES: The purpose of this study was to investigate the sensitivity and diagnostic value of convex probe endobronchial sonographically guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of granulomatous mediastinal lymphadenitis. METHODS: Patients clinically and radiologically suspected to have granulomatous mediastinal disease and followed in our clinic between October 2008 and July 2010 were included. Convex probe EBUS with local anesthesia and under conscious sedation and EBUS-TBNA from hilar and mediastinal lymph nodes were performed after physical examination, chest radiography, computed tomography of the thorax, and routine biochemical analysis. Detection of noncaseating/caseating granulomas was accepted as sufficient for diagnosis of sarcoidosis/tuberculosis in the presence of clinical and radiologic findings. For patients whose EBUS-TBNA results were nondiagnostic, a definitive diagnosis was reached by invasive procedures. The sensitivity of EBUS-TBNA in the diagnosis of granulomatous lymphadenitis and diagnostic accuracy in granulomatous hilar/mediastinal lymphadenopathies was calculated. RESULTS: Seventy-two patients were included in study (20 male and 52 female; mean age ± SD, 46.22 ± 13.94 years). In 72 cases, 121 lymph node aspirations were performed. The average lymph node short axis was 1.96 cm. With EBUS-TBNA among the 72 cases, 35 were diagnosed as sarcoidosis and 16 as tuberculous lymphadenitis. A definitive diagnosis could not be reached with EBUS-TBNA in 21 cases. As a result, 9 of these EBUS-TBNA-negative cases were diagnosed as reactive lymphadenitis, 9 as sarcoidosis, and 3 as tuberculosis by invasive procedures. The sensitivity values of EBUS-TBNA for diagnosis of sarcoidosis, tuberculosis, and granulomatous diseases were 79.5%, 84.2%, and 80.9%, respectively. The diagnostic accuracy of EBUS-TBNA for granulomatous diseases was 83.3%. No major complications occurred. CONCLUSIONS: In the diagnosis of granulomatous lymphadenitis, EBUS-TBNA, with high sensitivity and a minimum complication rate, is an alternative to mediastinoscopy.

Comparative Analysis of Three Different Drug Distribution Schemes for Smoking Cessation.

OBJECTIVE: This study aimed to compare the success rate of 3 different drug prescription policies: Free drugs with online system prescription, free drugs with doctor's prescription, and drugs paid for by patients with doctor's prescription. MATERIAL AND METHODS: The effect of 2 different Ministry of Health (MoH) projects with free-of-charge and self-payment pharmacotherapies for smoking cessation were compared. Patients who completed 6 months of pharmacotherapy and follow-up were evaluated. The first period was free-of-charge medication, which was determined by an online system, the following period was the self-payment period, and the third period was free medication, which was prescribed by a doctor. In all the groups, smoking habits in pack years and comorbidities of the patients were recorded, and pulmonary function tests (PFTs) and expiratory carbon dioxide (CO2) measurements were performed. Patients who had an expiratory CO2 level >5 ppm at the control visits were accepted as quitters. RESULTS: A total of 829 patients with 438 patients in the first free-of-charge period (group 1), 111 in the self-payment period (group 2), and 280 in the second free-of-charge period (group 3) were enrolled in the study. Smoking cessation rates were significantly higher in the self-payment medication group (25%) according to the MoH's free-of-charge project groups. There was no difference in smoking cessation rates between the 2 free-of-charge medication project groups (15% in group 1 and 11% of group 3). Among all the patients, we compared 124 patients who quit smoking with 705 patients who did not. The quitters were older, mostly male, and heavier smokers. In addition, the number of patients with chronic obstructive pulmonary disease and obstructive PFT rates were higher among the quitters. Their dependency score, PFTs, and the use of free medication was lower, and treatment duration was longer. Independent factors that increased smoking cessation success were longer treatment duration, lower dependency score, and self-payment of medication. CONCLUSION: Free medications provided via 2 different modalities did not increase the smoking cessation success. Paying for the medication, lower dependency score, and longer treatment duration increased smoking cessation success independently.

Is there a correlation between testosterone levels and the severity of the disease in male patients with obstructive sleep apnea?

OBJECTIVES: Obstructive sleep apnea (OSA) is a prevalent disease that can decrease quality of life. The aim of this study was to investigate the relationship between serum testosterone levels and the severity of the disease in patients with OSA. MATERIAL AND METHODS: Severity of OSA was quantified with apnea-hypopnea index (AHI) which was defined as the total number of apneas and hypopneas per hour of sleep. Thirty-six male patients with mild-to-severe stable OSA and thirty age-matched subjects without OSA were included in this study. Erectile function was assessed by the International Index of Erectile Function (IIEF)-5. The association between severity of OSA and selected comorbidities was evaluated and compared with findings reported in the literature. RESULTS: Mean serum testosterone levels of OSA and control patients were 462.8 +/- 160.3 ng/dL and 486.9 +/- 163.2 ng/dL, respectively (p > 0.05). There was a significant negative correlation between serum testosterone levels and AHI in patients with OSA (r = - 0,502, p < 0.01). Mean IIEF scores of OSA and control patients were 17.5 +/- 5.9 and 17.4 +/- 4.7, respectively (p > 0.05). Body mass index (BMI) of the OSA patients and control group were as 30.1 +/- 0.8 and 26.9 +/- 0.4, respectively (p < 0.01). CONCLUSIONS: Serum testosterone levels were negatively correlated with BMI and the severity of OSA. Measuring testosterone level may be an additional helpful indicator in diagnosis of severity and in follow-up of OSA.

[A rare complication of port catheter]. / Nadir görülen port kateter komplikasyonu.

Central venous ports are used in long term therapies of cancer patients. The insertion technique and maintenance of central venous ports is very important to avoid catheter associated complications. Widely used central venous ports in cancer patients should be periodically maintained and evaluated by expert physicians. The most frequent complications of central venous ports are catheter obstruction, infection, venous thrombosis and extravasation. In this paper, a rare intrapulmonary catheter dislocation is presented.

Palatal Pillar implants for the treatment of simple snoring.

OBJECTIVES: In this study the efficacy of palatal implants for treatment of snoring was evaluated. PATIENTS AND METHODS: Seventeen patients (10 males, 7 females; mean age 49.2+/-7.8 years; range 31 to 66 years) with primary snoring and an apnea-hypopnea index of less than 15 were treated with palatal implants after clinical and endoscopic examination. Snoring-related symptoms were evaluated at baseline and 90 days after surgery and polysomnography was performed. Patients and their spouses completed questionnaires and visual analog scales (VAS) evaluating snoring, apneas, and the intensity, duration, and social effects of daytime sleepiness at baseline and 90 days after surgery. Pre- and postoperative assessment results were compared. RESULTS: Epworth sleepiness scale score was significantly decreased in the postoperative period (p<0.05). Postoperative mean VAS snoring, apnea, and daytime sleepiness scores were also significantly improved (p<0.01). No patients reported worsening of apnea, 5.9% of patients reported no change in apnea, and 94.1% of patients reported a marked decrease in apneas. In the postoperative period, 76.4% of patients reported reduced snoring, and 88.3% of patients reported reduced daytime sleepiness. CONCLUSION: Palatal implants have been demonstrated to be a safe and effective treatment for snoring with minimal patient discomfort. Establishing realistic pretreatment expectations can maximize patient satisfaction.

Ultrasonographic evaluation of lung parenchyma involvement in sarcoidosis.

PURPOSE: To use ultrasonography (USG) for the evaluation of lung parenchyma in patients with sarcoidosis, andto compare the USG findings with the results of a high-resolution computerized tomography (HRCT) and pulmonary function test-carbon monoxide diffusion test (PFT-DLCO), which are commonly used methods in the evaluation of parenchymal involvement in sarcoidosis. MATERIAL AND METHODS: Patients with sarcoidosis and healthy controls were enrolled in the study between January 2015 and December 2017. The clinical findings, HRCT and PFT-DLCO results of all subjects were recorded, and USG findings and comet tail artifact (CTA) measurements were recorded by another pulmonologist. The USG, HRCT and SFT-DLCO findings were compared between the two groups. Based on the findings of theclinical-radiologic investigations and PFT-DLCO, as the current gold standard in diagnosis, the sensitivity and specificity of USG in demonstrating lung parenchyma involvement in sarcoidosis patients were estimated. FINDINGS: The sarcoidosis group consisted of 79 patients and the control group included 34 subjects. The mean number of CTAs in the sarcoidosis and control groups was 33.4 and 25, respectively (p=0.001). In the sarcoidosis group, the number of CTAs in patients with DLCO% <80 and ≥80% was 37.4 and 29.7, respectively (p=0.011), and a negative correlation was identified between the number of CTAs and DLCO% (p=0.019 r=-0.267). The mean number of CTAs in patients with and without parenchymal involvement in HRCT was 36 and 25.5, respectively (p=0.001). The number of CTAs in the patients with sarcoidosis with a normal DLCO% value (≥80%) was higher than in the control group (p=0.014). The diagnostic sensitivity and specificity of thoracic USG were found to be 76% and 53%, respectively. CONCLUSION: The number of CTAs in patients with sarcoidosis was higher than that of the healthy controls. The number of CTAs in patients with sarcoidosis with parenchymal involvement in HRCT and/or a low DLCO (<80%) was also elevated. Thoracic USG has a high sensitivity (76%) in demonstrating parenchymal involvement in patients with sarcoidosis.

Efficacy of iodopovidone pleurodesis and comparison of small-bore catheter versus large-bore chest tube.

BACKGROUND: To evaluate the efficacy of iodopovidone as an agent for pleurodesis in malignant pleural effusion (MPE) and to compare the efficacy of small-bore catheter (Pleuracan, Braun, Melsungen, Germany) and conventional large-bore chest tube in pleural fluid drainage and sclerotherapy. METHODS: Patients with MPE were prospectively consecutively randomized into two groups between August 2004 and February 2007: pleurodesis via conventional (32F) chest tube (group 1) and small-bore catheter (group 2), both using iodopovidone. After 3 months' follow-up, response rates (complete or partial), complication rates, and duration of procedures within whole group, group 1, and group 2 were compared. Statistical analyses were performed by Mann-Whitney U, chi(2), and Fisher's exact test. RESULTS: Forty-three pleurodeses were performed in 41 patients. The response was complete in 26 (60.5%) and partial in 12 (27.9%), and the overall success rate was 88.4%. The response rate was not associated with the type of inserted tube (P = .750), pleural fluid pH (P = .290), or pleural fluid lactate dehydrogenase (P = .727). In group 1 (n = 20), 12 demonstrated complete and 6 demonstrated partial response, with a 90% success rate; success was 86.9% in group 2, with complete response in 14 and partial response in 6 patients. Success rates were similar in the two groups (P = 1.000). Of 43 procedures, complications were observed in 14 (32.5%), and complication rates were 35% and 30.4% in groups 1 and 2, respectively (P = .750). The most frequent complication was pain (16.2%), followed by fever, subcutaneous emphysema, dyspnea, and hypotension. CONCLUSION: Iodopovidone is an effective, inexpensive, safe, and easily available alternative in chemical pleurodesis in MPE. The success rates of pleurodesis were found to be similar regardless of the type of the tube inserted.

[Prognostic factors in small cell lung cancer]. / Küçük hücreli akciger kanserinde prognostik faktörler.

In order to find out prognostic factors and treatment results in small cell lung cancer (SCLC), 40 patients diagnosed in one year period were prospectively analysed. Following history and physical examination, patients were grouped according to ECOG performance scale and underwent Chest X-ray and thoracic computerized tomography (CT). Complete blood count, biochemical analyses, tumor markers were taken. Abdominal USG or CT, bone scintigraphy, cranial CT or MRI and bone marrow biopsy were made for detection of metastases. Limited stage patients received chemotherapy and thoracic RT, whereas cases with extensive disease received chemotherapy. Nineteen cases had limited and 21 had extensive disease. When laboratory findings between 2 stages were compared, LDH, SGOT and GGT were significantly higher in extensive stage (p= 0.005, 0.015, 0.001, respectively). Overall median survival was 6 +/- 1 months, cumulative survival in 6 and 12 months were 39% and 20.72%, respectively. Median survival was 10 +/- 2 months in limited stage and 3 +/- 1 months in extensive stage, with a statististically significant difference. Univariate analyses showed that incresed LDH, CA15-3, GGT and SGOT levels, hipoproteinemia and poor performance scale were poor prognostic signs (p= 0.024, 0.032, 0.047, 0.013, 0.021 ve 0.013, respectively), however multivariate analyses revealed no significant difference. Other blood tests, pleural effusion, age, mediastinal lymph node metastases and weight loss had no prognostic effect. Stage was found to be progniostic factor with both univariate and multivariate analyses (p= 0.045).

Relationship of asymmetric dimethylarginine levels with disease severity and pulmonary hypertension in chronic obstructive pulmonary disease.

BACKGROUND: Asymmetric dimethylarginine (ADMA) has emerged as a risk marker for many conditions related to pulmonary hypertension (PH); however, little is known about ADMA and symmetric dimethylarginine (SDMA) plasma concentrations in chronic obstructive pulmonary disease (COPD). Our interest centers on the role of ADMA in regulation of endothelial function in COPD and secondary PH. The aim of the present study was to evaluate the serum ADMA, SDMA, and L-arginine concentrations in COPD and its association with PH. METHODS: Patients with diagnosis of COPD underwent pulmonary function tests, echocardiography, and laboratory investigations including ADMA, SDMA, and L-arginine. RESULTS: Serum concentrations of ADMA, SDMA, and L-arginine tend to increase as COPD progresses. Patients with PH had higher concentrations of ADMA, SDMA, and L-arginine compared to cases with normal pulmonary arterial pressure (PAP); the difference was not statistically significant. CONCLUSIONS: Our results show that increased ADMA, SDMA, and L-arginine concentrations are associated with increased PAP measurements in patients with COPD, however, the relationship is not statistically significant.

A New Modality for the Diagnosis of Bleomycin-induced Toxicity: Ultrasonography.

OBJECTIVE: To evaluate the role of ultrasonography (USG) in the diagnosis of bleomycin-induced pulmonary toxicity (BT). MATERIAL AND METHODS: The study included patients with suspected BT during treatment with bleomycin due to various oncologic diseases between June 2015 and May 2017. The patients initially underwent clinical and high-resolution computed tomography (HRCT) examinations and pulmonary function tests (PFT)-diffusing capacity of the lung for carbon monoxide (DLCO), followed by registration of USG findings-number of comet tail artifact (CTA) images by a different pulmonologist. We compared the findings from USG, HRCT, and PFT-DLCO tests between BT and non-BT groups. With the diagnosis based on clinical-radiologic and PFT-DLCO assessments taken as the gold standard, we determined the sensitivity and specificity of the USG outcomes for diagnosis of BT. RESULTS: The study included a total of 30 patients. Nine patients were diagnosed as having BT according to their clinical and radiologic findings and PFT-DLCO measurements. The mean number of CTA images was 68.7±22 in patients with BT vs 28.2±9.3 in those without BT (P<.001). The difference in CTA images between the patients with and without ground glass density was statistically significant (28.3±9.5 and 64.6±24.5, respectively, P<.001). In patients with BT, there was a negative correlation between the number of CTAs and DLCO% and FVC% values (P=.004; P=.016). USG had a sensitivity of 100%, and a specificity of 95% diagnosing BT in selected patients. CONCLUSION: In bleomycin-induced toxicity, USG findings are correlated with HRCT and PFT-DLCO findings, with a remarkably increased number of CTAs in BT. Thoracic USG examination is a diagnostic tool with a high sensitivity and specificity for diagnosing BT.

Endobronchial ultrasound-guided transbronchial fine needle aspiration: Determinants of adequacy.

BACKGROUND: This study aims to evaluate the factors influencing the adequacy of endobronchial ultrasound-guided transbronchial fine needle aspiration specimens. METHODS: A retrospective analysis of 1,700 endobronchial ultrasound-guided transbronchial fine needle aspiration samples obtained from 822 patients (500 males, 322 females; mean age 56±13 years; range 16 to 83 years) was performed between March 2011 and March 2014 at our center. Variables potentially associated with sampling adequacy, such as all cytological materials and procedure notes (lymph node and/or lesion size, localization, needle pass number, and slide number) were examined. RESULTS: The overall specimen adequacy was 79.8%. The specimen adequacy was associated with needle pass number (p≤0.001). Adequacy rate was 66.9% for one needle pass and 85.8% for three needle passes. According to the sampling regions, adequacy rates showed a difference [69.2%-85.8%; (p≤0.005)]. In the multivariate logistic regression analysis of subcarinal (7) lymph node station, patient age (odds ratio, 0.983; 95% confidence interval, 0.966-1.000; p=0.049) and number of slides (odds ratio, 1.240; 95% confidence interval, 1.062-1.448; p=0.006) were independent determining factors of specimen adequacy. While independent determinants of specimen adequacy for the right paratracheal (4R) region were lymph node size (odds ratio, 1.486; 95% confidence interval, 0.973-2.268; p=0.067) and number of slides (odds ratio, 1.418; 95% confidence interval, 1.146-1.756; p=0.001), they were lymph node size (odds ratio, 1.594; 95% confidence interval, 0.960-2.645; p=0.071) and number of needle passes (odds ratio, 2.277; 95% confidence interval, 1.360-3.811; p=0.002) for the right interlobar (11R) region. Independent determinant of specimen adequacy for the left paratracheal (4L) lymph node station was the number of needle passes (odds ratio, 1.656; 95% confidence interval, 0.955-2.869; p=0.072). CONCLUSION: During endobronchial ultrasound-guided transbronchial fine needle aspirations, particularly when rapid on site evaluation cannot be applied, consideration of factors affecting adequacy according to lymph node localizations may increase the chance for obtaining materials with suitable quality for cytologic evaluation.

Can positron emission tomography/computed tomography be predictive of diagnostic success in endobronchial biopsies performed through a fiber-optic bronchoscopy in lung cancer?

PURPOSE: The purpose of this study is to investigate the effect of homogeneous/heterogeneous (necrotic) involvement and maximum standardized uptake value (SUVmax) value of the lesion on positron emission tomography-computed tomography (PET-CT) of patients who underwent fiberoptic bronchoscopy (FOB) for prediagnosis of lung cancer and biopsy for endobronchial lesion on the diagnostic success of biopsy procedure. METHODS: Between January 2014 and December 2016, patients with final diagnosis of pulmonary malignancy as determined by FOB biopsy and patients who failed to be diagnosed by FOB biopsy and diagnosed with pulmonary malignancy by a different diagnostic method were examined. These patients were divided into two groups as those with diagnosis by FOB biopsy (Group 1) and those who failed to be diagnosed by this method and diagnosed with pulmonary malignancy by a different diagnostic method (Group 2). The SUVmax values of the two groups were compared with lesion characteristics of homogeneous, heterogeneous involvement/presence of necrotic component as shown by PET-CT. Group data were assessed by Chi-square test and Mann-Whitney U-test. In all tests, P < 0.05 was considered significant. FINDINGS: A total of 193 participants with a mean age of 61 ± 9.4 were included in the study. There were 128 (66.3%) cases in Group 1 and 65 (33.7%) cases in Group 2. The mean SUVmax value was 16.4 in Group 1 and 15.1 in Group 2. There was no statistically significant difference between the two groups (P = 0.329). Homogeneous involvement was present in 103 (80.3%) cases in Group 1 versus 42 (64.6%) cases in Group 2. In the presence of homogeneous PET-CT involvement, diagnosis rate by biopsy was significantly higher (P = 0.016). CONCLUSION: We concluded that the high SUVmax value of the mass lesion on PET-CT did not increase the diagnostic value of the biopsy procedure in patients prediagnosed with lung cancer and that the diagnostic success of FOB biopsy was poor in cases where PET-CT showed heterogeneous involvement of the mass lesion.

The effect of body mass index on functional parameters and quality of life in COPD patients.

Malnutrition increases dyspnea and exercise intolerance in chronic obstructive pulmonary disease (COPD) patients by effecting respiratory muscle strength (RMS) and thereby decreasing quality of life (QoL). This is a prospective study conducted to find out the differences due to pulmonary function tests (PFT), arterial blood gases (ABG), RMS, exercise capacity (EC) and QoL in COPD patients having low and normal body mass index (BMI). The study was carried out between April 2003-June 2004 and included 65 male COPD patients with a mean age of 63.4 +/- 9.6. The patients were grouped into 2: Low BMI group (BMI < 21) and normal BMI group (BMI= 21-28). All patients were investigated with PFT (spirometry, maximal inspiratory and expiratory pressures, diffusion capacity), ABG analyses, Modified Medical Research Council (MMRC) dyspnea scale, determination of EC by 6 minutes walking test (6 MWT) and determination of QoL by Turkish version of St. George Respiratory Questionnaire (SGRQ). Of these cases, 29 (44.6%) had low and 36 (55.4%) had normal BMI; MMRC was higher in the first group without statistical significance (p= 0.074). The first group demonstrated significantly lower diffusion capacity (DLco) and DLco%, PEmax, PEmax%, RMS and RMS% (p< 0.05). ABG analyses, 6 MWT results and SGRQ symptom scores revealed no significant difference. As a conclusion, BMI is closely related to dyspnea score, RMS and QoL in COPD patients, therefore in patients with low BMI pulmonary rehabilitation programs including nutritional support should accompany medical treatment.

Influenza and Pneumonia Vaccination Rates and Factors Affecting Vaccination among Patients with Chronic Obstructive Pulmonary Disease.

BACKGROUND: Influenza and pneumococcal vaccinations are recommended in chronic obstructive pulmonary disease patients to decrease associated risks at all stages. Although the prevalence of chronic obstructive pulmonary disease is high in our country, as previously reported, vaccination rates are low. AIMS: To assess the vaccination rates of chronic obstructive pulmonary disease patients and factors that may affect these. STUDY DESIGN: Multi-centre cross-sectional study. METHODS: Patients admitted to the chest diseases clinics of six different centres between 1 February 2013 and 1 January 2014 with a pre-diagnosis of Chronic obstructive pulmonary disease according to the Global initiative for chronic obstructive lung disease criteria, who were in a stable condition were included in the study. The survey, which included demographic characteristics, socio-economic status, severity of disease and vaccination information, was first tested on a small patient population before the study. The survey was completed by the investigators after obtaining written informed consent. RESULTS: The average age of the 296 included patients was 66.3±9.3 years and 91.9% were male. Of these, 36.5% had the influenza vaccination and 14.1% had the pneumococcal vaccination. The most common reason for not being vaccinated was 'no recommendation by doctors': 57.2% in the case of influenza vaccinations, and 46.8% in the case of pneumococcal vaccinations. Both vaccination rates were significantly higher in those patients with comorbidities (influenza vaccination p<0.001; pneumococcal vaccination p=0.06). There was no significant correlation with age, gender, smoking and severity of disease (p>0.05). Vaccination rates were significantly higher in those with a white-collar occupation and higher education level, and who presented to a university hospital (p<0.001). CONCLUSION: Medical professionals do not request vaccinations as often as the International Guidelines suggest for chronic obstructive pulmonary disease patients. Awareness of the importance of these vaccinations among both doctors and patients needs to be addressed.

Vitamin D Deficiency in Patients Referred for Evaluation of Obstructive Sleep Apnea.

STUDY OBJECTIVES: A recent study reported an association between obstructive sleep apnea (OSA) and low vitamin D levels. In this study, we measured vitamin D levels in patients referred for evaluation of suspected OSA and sought to identify associated risk factors for vitamin D deficiency. Our objective was to determine whether evaluations of patients with suspected OSA should include routine screening for vitamin D deficiency. METHODS: Using a cross-sectional study design, we measured vitamin D levels in consecutively enrolled patients referred for an OSA evaluation to Dr. Lutfi Kirdar Kartal Training and Research Hospital in Istanbul, Turkey. We conducted full-night polysomnography and compared vitamin D levels both between patients with OSA and patients without OSA and across the various severity levels of OSA. We evaluated the association between vitamin D levels and various clinical and demographic characteristics, including the apnea-hypopnea index and body mass index. RESULTS: From April 2014 to June 2015, 195 patients were referred for OSA evaluation. Of these, 181 patients (93%) consented to participate and underwent full polysomnography and measurement of vitamin D levels. The mean ± standard deviation age was 49 ± 12 years and body mass index of 31 ± 6 kg/m2. Polysomnography led to the diagnosis of OSA in 162 of the patients (89.5%): 52 (32%) were categorized as having mild OSA, 38 (23.5%) as having moderate OSA, and 72 (44.5%) as having severe OSA. Vitamin D level was 15.5 ± 11.6 ng/mL (95% confidence interval; 13-17 ng/mL) and 134 patients (74%) met the criterion for vitamin D deficiency (< 20 ng/mL). Sex, vitamin D levels, and percentage of patients with vitamin D deficiency were similar in patients with and without OSA (P > .05). Vitamin D levels were similar across OSA severity categories (P = .68). We found no association between vitamin D levels and the apnea-hypopnea index or body mass index. CONCLUSION: A large proportion of patients referred for OSA evaluation had vitamin D deficiency. Vitamin D levels did not differ by OSA diagnosis status or severity. Patients referred for polysomnography should undergo routine screening for vitamin D deficiency as well as clinically indicated treatment to prevent associated comorbidities.