[Sedation for fiberoptic bronchoscopy: review of the literature]. / Fiberoptik bronkoskopide sedasyon: Literatürün gözden geçirilmesi.

Fiberoptic bronchoscopy (FOB) is a procedure which has an important role in the diagnosis and treatment of lung diseases and is widely used in clinical practice. It is an invasive procedure and can cause cough, shortness of breath, nose and throat irritation. Stress during bronchoscopy can cause release of catecholamines, which may lead to tachycardia, vasoconstriction and possible myocardial ischemia in patients with impaired cardiopulmonary function. Current guidelines for bronchoscopy recommend offering sedation to patients, with the aim of improving patient comfort and reducing complications. For this purpose, the most frequently used sedatives are benzodiazepines, opioids, propofol and fospropofol which are either administered alone or in combination. In this review, we aimed to evaluate various drugs used for sedation during bronchoscopy.

The effect of octreotide, an analog of somatostatin, on bleomycin-induced interstitial pulmonary fibrosis in rats.

In this study, octreotide (OCT), a synthetic somatostatin analog, was tested for its beneficial effects in the prevention of interstitial pulmonary fibrosis (IPF) induced by bleomycin (BLM) in rats by histological examination and by evaluating tissue OH-proline levels. Thirty male Wistar rats were divided randomly into three groups: group I: intratracheal (i.t.) BLM (7.5 mg/kg, single dose) + saline solution [0.9% NaCl, subcutaneously (s.c.), once-daily for 7 days]; group II: i.t. BLM (7.5 mg/kg, single dose) + OCT acetate (82.5 µg/kg, s.c., once-daily for 7 days); and the control group. At the end of the 7 days, lung tissues were excised and examined by histopathological methods. Levels of tissue hydroxyproline (OH-proline) were determined. BLM administration resulted in prominent histopathologic findings, such as diffuse alveolar damage and interstitial pulmonary fibrosis, as well as a significant increase in OH-proline level, as compared to controls. OCT application explicitly attenuated the histopathologic changes to a significant extent. OCT decreased paranchymal fibrosis and structural deformities in BLM-induced lung fibrosis. These results suggest that OCT administration to rats with BLM-induced IPF has a protective effect. Further studies are necessary to reveal the molecular mechanism(s) of OCT-induced protective effect.

[Could plasma D-dimer levels be a predictive marker for prognosis in lung cancer?]. / Plazma D-dimer düzeyleri akciger kanserinde prognoz için bir belirteç olabilir mi?

INTRODUCTION: Plasma concentrations of circulatory markers of hemostatic activation which may be associated with tumor growth and dissemination have been shown to predict prognosis in malignancy. The present study was designed to investigate the prognostic value of plasma D-dimer level in lung cancer. MATERIALS AND METHODS: Plasma levels of the D-dimer in 138 lung cancer patients [98 non-small cell lung cancer (NSCLC), 40 small cell lung cancer (SCLC)] were measured before the initiation of any therapy and each chemotherapy. RESULTS: There were 124 (89.9%) men and 14 (10.1%) women with a mean age of 62.8 years (range 38-84). There were no statistically significant differences among the histopathologic types for NSCLC patients. Stage IIIA NSCLC group had statistically significant higher D-dimer level than stages I-II and IV. D-dimer levels were increased significantly after 4 cycles of chemotherapy in progressive disease. The median survival times in NSCLC patients were 26.6 months (95% CI, 17.6-35.6) and 15.9 months (95% CI, 4.2-27.7; p= 0.037) respectively, for patients with a low D-dimer level (≤ 1.2 ng/L) and a high D-dimer level (> 1.2 ng/L).With the cox-regression analysis, the plasma level of D-dimer and tumour stage were identified as independent predictive factors of the survival. CONCLUSION: These results suggest that plasmalevel of D-dimer can act as a predictive factor of decreased survival and a poor response to the treatment in lung cancer.

Risk factors for the development of interstitial lung disease following severe COVID-19 pneumonia and outcomes of systemic corticosteroid therapy: 3-month follow-up.

BACKGROUND: We aimed to evaluate the pulmonary involvement status, its related factors, and pulmonary function test (PFT) results in the first month follow-up in patients who were discharged for severe Covid-19 pneumonia, and to assess the efficacy of corticosteroid treatment on these parameters in severe pulmonary involvement patients. METHODS: We retrospectively analyzed all consecutive patients who applied to our COVID-19 follow-up clinic at the end of the first month of hospital discharge. Functional and radiological differences were compared after 3 months of corticosteroid treatment in severe pulmonary involvement group. Results We analyzed 391 patients with "pulmonary parenchymal involvement" (PPIG) and 162 patients with "normal lung radiology" (NLRG). 122 patients in the PPIG (corticosteroid-required interstitial lung disease group (CRILD)) had severe pulmonary involvement with frequent symptoms and required corticosteroid prescription. Pulmonary involvement was more common in males and elder patients (P<0.001, for both). Being smoker and elderly were associated with a higher risk-ratio in predicting to be in PPIG (OR:2.250 and OR:1.057, respectively). Smokers, male and elderly patients, and HFNO2 support during hospitalization were risk factors for being a patient with CRILD (OR:2.737, OR:4.937, OR:4.756, and OR:2.872, respectively). After a three-months of methylprednisolone medication, a good response was achieved on radiological findings and PFT results in CRILD. CONCLUSIONS: In conclusion, after severe COVID-19 pneumonia, persistent clinical symptoms and pulmonary parenchymal involvement would be inevitable in elder and smoker patients. Moreover, corticosteroid treatment in patients with severe parenchymal involvement was found to be effective in the improvement of radiological and functional parameters.

[Smoking habits of the elementary school teacher students in education faculty and related factors]. / Egitim fakültesi sinif ögretmenligi ögrencilerinde sigara içme aliskanliklari ve iliskili faktörler.

In this study we aimed to determine the smoking habits of the elementary school teacher students and to examine the factors affecting smoking. The prepared questionnaires were applied to 3rd and 4th year students by selecting randomly. The ratio of the students smoking regularly and occasionally was 45.8%. The smoking frequency was higher in male and fourth year students [63 (53.8%) of males, 85 (41.3%) of females (p< 0.05); 102 (52.3%) students in 4th year and 46 (35.9%) students in 3rd year (p< 0.01)]. The most common reason of not smoking was the harmful effect of smoking to life (45.8%), the most common reason of initiating smoking was to decrease their stress (43.1%) and the most common reason to keep on smoking was difficulty of quitting (56.7%). When compared to nonsmokers, the smoking frequency of mothers, brothers, all family members and close friends of smoker students were higher (p< 0.05). There was significant difference between depression symptom scores of the students who were smoking and the ones who were nonsmokers (14.9 +/- 7.6 in smokers, 9.8 +/- 6.3 in nonsmokers; p< 0.05). The smoking frequency among school teacher students was very high. The smoking habits of close friends, regular alcohol intake, and presence of depressive symptoms were increasing the risk of smoking. It will be beneficial for public health to plan and apply appropriate education program for students who will be the first teachers of the primary school students, not to start smoking.

The Relation between Pregnancy-Associated Plasma Protein A and Obstructive Sleep Apnea Syndrome.

Aim: We aimed to investigate the relationship between serum pregnancy-associated plasma protein A (PAPP-A) levels and obstructive sleep apnea syndrome (OSAS). Materials and Method: 44 patients with OSAS and 44 healthy adults were included in this study. The participants having rheumatic or systemic inflammatory disease, advanced liver or kidney failure, diabetes, heart failure, hypertension, pregnancy, prerenal azotemia, known history of coronary artery disease, any pulmonary disease, rhinitis, or atopy, history of major trauma or surgery within the last six 6 months, and inhaled nasal or systemic corticosteroid use or other anti-inflammatory medications and those with <18 years of age were excluded. Serum PAPP-A levels were determined by the Elisa method with the immune sandwich measuring method. Statistical analysis of the study was performed with SPSS 17.0 statistical analysis package program, and p < 0.05 was considered as significant. Results: Serum PAPP-A levels of patients with OSAS (2.350 ng/ml (0.641-4.796)) were significantly higher (p < 0.001) when compared with healthy controls (0.971 ng/ml (0.109-2.679)). There was a statistically significant difference in serum PAPP-A levels between groups of OSAS patients according to the classification of OSAS severity. Between the groups of patients with OSAS, serum levels of PAPP-A in moderate group was significantly higher when compared with severe OSAS group (p < 0.001). There was positive correlations between PAPP-A levels and night minimum (p=0.042, r=0.309), and average oxygen levels (p=0.006, r=0.407). There was a negative correlation between PAPP-A levels and AHI (p=0.002, r=-0.460). Conclusion: Higher PAPP-A levels in OSAS patients that were found in this study show inflammatory component in OSAS.

The evaluation of cognitive functions with P300 test for chronic obstructive pulmonary disease patients in attack and stable period.

OBJECTIVES: Hypoxia, in chronic obstructive pulmonary disease (COPD), leads to a decrease in cerebral perfusion and an impairment of some cognitive abilities. We aimed to investigate the relation between arterial blood gas analysis (ABA) and pulmonary function test (PFT) parameters with cognitive function of COPD patients during attack and stable period. PATIENTS AND METHODS: ABA, PFT, P300 tests of 30 patients in stabilized period and 30 patients in attack, and 17 healthy controls were evaluated. RESULTS: When both COPD groups and controls were compared, it was seen that latency of P300 was shorter in the control group (p<0.001), but there was no difference between COPD groups (p>0.05). P300 amplitude measures were lower in both COPD groups than control group, but it was not statistically significant (p>0.05). When we compared the measures of attack group, we saw that arterial oxygen tension (PaO(2)), arterial oxygen saturation (SaO(2)), forced expiratory volume in 1s (FEV(1)), FEV(1)/forced vital capacity (FVC) values increased (p<0.001), and P300 latency shortened (p<0.05) in attack group during stable period. P300 latency correlated significantly with PaO(2) (r=-0.557, p<0.001), SaO(2) (r=-0.424, p<0.001), FEV(1) (r=-0.441, p<0.001), FEV(1)/FVC (r=-0.477, p<0.001) values, and age (r=0.329, p<0.05). P300 amplitude is only correlated with PaO(2) (r=0.236, p<0.05). CONCLUSION: Longer latency of P300 appears to be an expected sequel of COPD. P300 test can be considered as a potential objective marker of cognitive impairment.

Tumor suppressor gene alterations in patients with malignant mesothelioma due to environmental asbestos exposure in Turkey.

BACKGROUND: Environmental asbestos exposure can cause the grave lung and pleura malignancies with a high mortality rate, and it is also associated with increased rate of other organ malignancies. Asbestos exposure can develop genotoxic effects and damage in the pleura and lungs. OBJECTIVE: In this study, we aimed to determine tumor suppressor gene (TSG) loss in genomic DNA which was isolated from pleural fluid and blood samples of patients with Malignant Pleural Mesothelioma (MPM) due to environmental asbestos exposure. DESIGN AND PATIENTS: Prospective study of period from 2001 to 2003 in 17 patients with MPM. METHODS: A total of 12 chromosomal regions were researched by comparing genomic DNA samples isolated from blood and pleural effusion (using PCR, and polyacrylamide gel electrophoresis denaturizing), on 2 different chromosomes which have 9 different polymorphic determinants at 6q and 3 different polymorphic determinants at 9p using molecular genetic methods on 13 patients clinico-pathologically diagnosed MPM. RESULTS: Loss of Heterozygosity (LOH) was determined at D6S275 in one patient, at D6S301 in another, at D6S474 in 2, at ARG1 in 2, at D6S1038 in 2 and at D6S1008 in 3 patients. In 7 (54%) of the 13 patients, we found LOH in at least one site. No LOH was determined at any informative loci in 6 patients. Of the 13 patients, no investigated markers were determined at 9p. CONCLUSION: In this study, genomic DNA samples obtained from MPM patients with asbestos exposure revealed that they contained important genotoxic damage. We found no other study on this subject at molecular level in pleural effusion either in Turkey or in the Med-line literature. We believe that this study will provide important support for other research into molecular-genetic variations, both on this subject and other malignancies, and may also constitute a base for early diagnosis and gene therapy research in the future.

[Nutritional status, pulmonary functions, and exercise performance in COPD cases]. / KOAH olgularinda beslenme durumu, solunum fonksiyonlari ve egzersiz performansi.

The aim of this study was evaluation of nutritional status in attack and stable chronic obstructive pulmonary disease (COPD) cases, and investigating the relation between nutrition parameters and pulmonary functions, exercise performance and general healthy status. Anthropometric measures of 10 cases with attack (group 1), 14 stabilized COPD cases (group 2) and 10 control cases (group 3) were evaluated by measuring serum albumin, transferrin, tumor necrosis factor-alpha (TNF-alpha) levels, and fat-free mass (FFM) levels. Six minutes walking test (mwt) and SGRQ questionnaire were performed. Body mass index (BMI) of group 1 and 2 were significantly lower than group 3 (p= 0.023, p= 0.008, respectively). Albumin levels were significantly lower in group 1 than group 2 (p< 0.001) and 3 (p= 0.001). Levels of transferrin were significantly lower in group 1 compared with group 3 (p= 0.015). TNF-alpha levels were significantly high in group 1 compared with group 2 (p= 0.002), and high in group 2 compared with group 3 (p= 0.001). FFM was significantly low in group 1 compared with group 2 (p= 0.003), and low in group 2 compared with group 3 (p< 0.001). Mean distance of 6 mwt was 225.80 +/- 40.35 m in group 1, it was 405.16 +/- 95.51 m in group 2 (p< 0.001). A positive relation was seen between FFM and BMI, 6 mwt (p= 0.006, r= 0.481 ve p< 0.001, r= 0.830, respectively), between albumin levels and 6 mwt (p< 0.001, r= 0.850). A negative correlation was observed between TNF-alpha and 6 mwt (p< 0.001, r= -0.745). There was no statistical difference in antropometric measures between groups. Total score and daily life were statistically high in group 1 than group 2 (p= 0.009, p= 0.013). Although no changes was seen in antropometric measures of COPD cases, a nutritional defect was seen and a significant relation was observed between nutrition parameters and effort capacity.

Prevalence of asthma, asthma-like and allergic symptoms in the urban and rural adult population in Eastern Turkey.

There is no study assessing the prevalence rates for asthma, asthma-like symptoms, and allergic symptoms in Eastern Turkey. In this study, we investigated these rates in the urban and rural adult population of Elazig Region in Eastern Turkey. A questionnaire was prepared based on the standard inquiry form of the European Community Respiratory Health Survey. The survey included 3,591 consented adults who were randomly selected. Each questionnaire was interviewed face-to-face by a physician. It was found that the cumulative prevalence rates of asthma and asthma-like symptoms of the rural and the urban respondent groups were 29.6% and 25.8%, respectively. The periodic prevalence rates of the same symptoms were 27.3% and 19.3%, respectively. The percentages of the patients living in rural and urban areas diagnosed as asthma by a physician were 5.5% and 3.1%, respectively. The proportions of patients with a history of at least one allergic disorder were 36.4% and 23.7% in the rural and urban groups, respectively. Asthma and asthma-like symptoms in patients with allergic rhinoconjunctivitis were significantly higher than those without (p < 0.01). The cumulative rates of a previous diagnosis of asthma among respondents with a history of asthma-like symptoms were 18.4% in the rural and 11.2% in the urban groups (p < 0.05). Among those who had had periodic asthma-like symptoms, the rural and urban rates of previous asthma diagnosis were 18.6% and 14.3%, respectively (p < 0.01). Unexpectedly, the prevalence rates for asthma, asthma-like and allergic symptoms in adults living in the rural areas of Elazig Region in Eastern Turkey were significantly higher than the rates in the urban population.

Intermediate to long-term follow-up results of INH chemoprophylaxis prior to anti-TNF-alpha therapy in a high-risk area for tuberculosis.

BACKGROUND: The use of anti-TNF drugs for rheumatic diseases has increased in recent years. Several studies have reported an increased risk of reactivation of tuberculosis (TB) with anti-TNF agents. OBJECTIVES: The aim of this study was to present the follow-up results of a single center from Turkey, a country with a high rate of active and latent tuberculosis infection (LTBI), for INH chemoprophylaxis in patients receiving anti-TNF-α therapy for rheumatic diseases infection. METHODS: In this prospective observational study, consenting patients who were to be administered an anti-TNF agent for a rheumatic disease were evaluated for the presence of active infection or LTBI by a chest X-ray and a tuberculin skin test. Patients with LTBI were given chemoprophylaxis 1 month prior to commencement of anti-TNF treatment. All patients were followed-up bimonthly for any signs of pulmonary or extrapulmonary TB. RESULTS: A total of 73 patients, 23 female (31.5 %) and 50 male (68.5 %), with a mean age of 41.0 ± 13.1 years (18-78) were enrolled in the study. Overall, 44 patients (60.3 %) had ankylosing spondylitis, 18 (24.7 %) had rheumatoid arthritis, 7 (9.6 %) had juvenile rheumatoid arthritis, and 3 (4.1 %) had psoriatic arthritis. LTBI was identified in 58 patients all of whom received chemoprophylaxis for 9 months. None of the patients in the study developed any signs of tuberculosis reactivation during follow-up. CONCLUSIONS: TST is a reliable and cost-effective method for the diagnosis of LTBI in patients prior to anti-TNF therapy. Moreover, chemoprophylaxis with INH seems to be effective for the prevention of TB reactivation in individuals with LTBI.

Protective effect of octreotide on intra-tracheal bleomycin-induced oxidative damage in rats.

The present study is aimed at determining the effect of parenteral octreotide against oxidative damage caused by intra-tracheal bleomycin (BLM) administration. A total of 30 male Wistar rats randomly divided into three groups (control, bleomycin alone, and bleomycin and octreotide) were used in the study. A group of animals received a single dose of intra-tracheal bleomycin (7.5mg/kg). Animals in another group, which also received intra-tracheal bleomycin, were given 82.5 microg/kg octreotide via i.m. injection for a week. Animals in the control group received neither bleomycin nor octreotide. All animals were sacrificed at the end of the experiment. Serum levels of malondialdehyde, vitamins A, E, and C, selenium levels were determined. In addition, glutathion peroxidase activity levels in erythrocytes were also determined. Malondialdehyde levels and glutathion peroxidase activity were increased whereas antioxidant vitamin levels were decreased significantly in animals that received only bleomycin compared to control animals (p<0.05). The values in rats that received bleomycin and octreotide were found to be closer to the control group (p<0.05). Selenium levels in animals that received only bleomycin were determined to be reduced compared to controls (p<0.05). On the other hand, selenium levels in bleomycin and octreotide groups were similar to control values in (p<0.05). In conclusion, bleomycin induces a severe stress and more importantly increases the amount of free radicals whereas octreotide administration reduces this oxidative damage significantly.

Prevalence and risk factors of asthma and allergic diseases among schoolchildren in Bolu, Turkey.

AIM: In this study we aimed to detect the prevalence and risk factors of asthma and allergic diseases in children aged between 7 and 14 years old at rural and urban areas of Bolu, Turkey. METHODS: Questionnaire of International Study of Asthma and Allergies in Childhood (ISAAC) phase one and questionnaire including questions about family, demographic, socio-economic characteristics of children were applied to 931 schoolchildren who were selected by randomized sampling. RESULTS: In children, the prevalence of diseases and symptoms were as follows: wheeze ever: 15.5%, asthma: 5.6%, nasal symptoms ever: 41.4%, allergic rhinitis: 23.2%, itchy rash ever: 5.9% and eczema: 5.0%. In multivariate regression analysis, presence of allergic disease in the family was risk factor for wheezing (OR=1.74, 95% CI=1.19-2.76), asthma (OR=2.19, CI=1.06-4.52), allergic rhinitis (OR=2.68, CI=1.80-3.98) and eczema (OR=2.33, CI=1.17-4.65); living in shanties was risk factor for allergic rhinitis (OR=5.26, CI=2.1-13.16); a monthly income below $300 was risk factor for asthma (OR=2.54, CI=1.06-6.08). CONCLUSION: It was detected that the prevalence of allergic rhinitis and its symptoms was more common in schoolchildren living in Bolu. Presence of allergic disease in fathers or mothers and low socio-economic level increase the risk of asthma and other allergic diseases in children.

Antioxidant vitamins (A, C and E) and malondialdehyde levels in acute exacerbation and stable periods of patients with chronic obstructive pulmonary disease.

BACKGROUND: People with chronic obstructive pulmonary disease (COPD) undergo oxidative damage during exacerbations that continues in stable periods, gradually contributing to pathogenesis. Since serum concentrations of antioxidant vitamins in COPD patients have been little investigated, we studied antioxidant vitamin and lipid peroxidation concentrations in patients during acute exacerbations and stable periods. METHODS: We prospectively recruited 24 patients with COPD (mean age 51.8 yr, standard deviation [SD] 6.7 yr) in acute exacerbation. Serum concentrations of vitamins A, C and E and malondialdehyde (MDA) were determined before treatment and during stable periods with high-performance liquid chromatography, and in 23 healthy controls (mean age 48.0 yr; SD 5.9 yr) with established methods. RESULTS: The mean vitamin A level in patients during acute exacerbation was 0.8 (SD 0.2) microg/mL, rising to 1.0 (SD 0.2) microg/mL during stable periods, both significantly less than that of controls (1.0 [SD 0.2] microg/mL; p <0.01); vitamin C, 5.0 (SD 2.2) microg/mL acute and 7.5 (SD 2.7) stable, neither significantly differing from the mean level in controls (8.6 [SD 1.8] microg/mL; p > 0.05); vitamin E, 10.0 (SD 2.4) microg/mL acute and 11.1 (SD 2.6) stable, both lower than in controls (11.0 [SD 2.86] microg/mL; p <0.01); and MDA, 2.4 (SD 0.7) nmol/mL acute and 1.2 (SD 0.4) stable, both higher than in controls (0.9 [SD 0.2] nmol/mL; p< 0.01). CONCLUSIONS: Whereas patients with COPD undergo increased oxidative stress during exacerbations and in stable periods, their serum concentrations of antioxidant vitamins A and E decrease during exacerbations. Our findings suggest that the administration of vitamins A and E may be beneficial in the prevention and treatment of the harmful effects of COPD.