Small airway resistance in obese and nonobese patients with obstructive sleep apnea syndrome using impulse oscillometry.

Background/aim: There is limited information on the pathologic changes in the small airways among obese and nonobese patients with obstructive sleep apnea syndrome (OSAS). Impulse oscillometry (IOS) measures airway resistance and reactance independently of patient effort. This study aimed to compare airway resistance in small airways using IOS between obese and nonobese patients with OSAS. Materials and methods: In this real-life cross-sectional study, demographic information was collected from obese and nonobese subjects diagnosed with moderate and severe OSAS without any other underlying diseases. Spirometry and IOS measurements were conducted, and the values of both groups were statistically analyzed. Results: The nonobese group had a mean age of 45.6 ± 11.7 years (median 45), while the obese group had a mean age of 48.4 ± 9.5 years (median 47.5). The mean body mass index (BMI) for the nonobese group was 26.2 ± 2.1 kg/m2 (median 27 kg/m2), and for the obese group, it was 35.6 ± 6.4 kg/m2 (median 33 kg/m2). Statistically significant differences were observed between the two groups in R5 - R20 percentage, reactance area (AX), and resonant frequency (Fres) values (p < 0.05). Conclusion: Among obese OSAS patients, there is an increase in resistance in small airways as indicated by IOS values. IOS shows promise as a potential screening tool for diagnosing OSAS.

Effect of Continuous Positive Airway Pressure Therapy on Pro-Brain Natriuretic Peptide, C-Reactive Protein, Homocysteine, and Cardiac Markers in Patients with Obstructive Sleep Apnea.

OBJECTIVE: Obstructive sleep apnea is associated with increased morbidity and mortality, especially cardiovascular and cerebrovascular, and affects a significant proportion of the population. The study was aimed to determine the levels of pro-brain natriuretic peptide, C-reactive protein, homocysteine, and cardiac markers (creatine kinase, creatine kinase isoenzyme MB, troponin T) and evaluate the effectiveness of continuous positive airway pressure therapy in patients with obstructive sleep apnea. MATERIAL AND METHODS: Pro-brain natriuretic peptide, C-reactive protein, homocysteine, and cardiac markers (creatine kinase, creatine kinase isoenzyme MB, troponin T) were assessed in blood samples collected before and after continuous positive airway pressure treatment from the 30 patients included in the study, and their results were compared. RESULTS: There was a significant decrease between the baseline pro-brain natriuretic peptide and the 6-month pro-brain natriuretic peptide values after continuous positive airway pressure therapy (P < .05). There was a significant increase in creatine kinase-MB and troponin T values 6 months after continuous positive airway pressure therapy compared to baseline values (P < .05). CONCLUSIONS: A significant decrease was observed in pro-brain natriuretic peptide values after continuous positive airway pressure therapy in obstructive sleep apnea patients without cardiac failure, while a more significant decrease was especially observed among hypertension patients. This finding suggests that pro-brain natriuretic peptide may be used as an early indicator of cardiac dysfunction in obstructive sleep apnea patients without any heart diseases except for hypertension.

Evaluation of Sleep Quality, Work Stress and Related Factors in Hospital Office Workers.

BACKGROUND:  Occupational factors, working conditions, age, gender, exercise, acquired habits, and stress affect a person's sleep quality. The aim of this study was to investigate sleep quality, work stress, and related factors among office workers in a hospital. METHODS:  This cross-sectional study was conducted with office workers actively working in a hospital. A questionnaire consisting of a sociodemographic data form, the Pittsburgh Sleep Quality Index (PSQI), and Swedish Workload-Control-Support Scale were used to assess the participants.    Results: The mean of PSQI score was 4.32±2.40 and 27.2% of the participants had poor sleep quality. In the multivariate backward stepwise logistic regression analysis, it was found that shift workers were 1.73 times (95% CI: 1.02-2.91) more likely to have poor sleep quality, and a one-unit increase in work stress score increased the risk of having poor sleep quality by 2.59 times (95% CI: 1.37-4.87). An increase in age was found to decrease the risk of poor sleep quality in workers (OR =0.95; 95% CI: 0.93-0.98). CONCLUSION:  This study suggests that reducing workload and increasing work control as well as enhancing social support will be effective in preventing sleep disturbances. It is important, however, in terms of providing guidance for hospital employees in planning future measures to improve working conditions.

Treatment adherence and anxiety levels of bronchiectasis patients in the COVID-19 pandemic.

It has been reported that during the coronavirus disease-2019 (COVID-19) pandemic, bronchiectasis patients were adversely affected due to their limited respiratory functions and acute exacerbations which were triggered by viral infections. The increased concern in the population during the pandemic has affected the attitudes of people toward avoiding disease and patients' treatment compliance. It is unclear whether treatment adherence and anxiety levels of bronchiectasis patients have changed during the pandemic. We aimed to evaluate treatment adherence and anxiety levels in patients with bronchiectasis. A cross-sectional survey was conducted between May and November 2021. A total of 123 patients with bronchiectasis and 110 adults without chronic diseases were included in the control group. Patient demographic information, bronchiectasis follow-up data, and COVID-19 history were recorded. Then, patients filled out "MARS-5 Index" (Medical Adherence Report Scale-5), Beck Anxiety Scale and the Effect of Events Scale (IES-R). Responses of questionnaires were statistically analyzed. Our results showed that the majority of patients with bronchiectasis had high Medical Adherence Report Scale-5 index total scores during the COVID-19 pandemic (86.2%). The total scores on the Beck Anxiety Scale of bronchiectasis patients who did not have COVID-19 were significantly higher than those who had COVID-19 (P = .04). The total scores on the IES-R were found to be significantly higher in the control group (P < .001). No significant difference was found in the total scores on the Beck Anxiety Scale between the patients and the control group. The bronchiectasis patients had high adherence to their current treatment during the COVID-19 period and were less affected by the pandemic and its psychological effects compared to the healthy population. Furthermore, individuals diagnosed with bronchiectasis who were not infected with COVID-19 demonstrated increased levels of anxiety compared to those who were infected with COVID-19 which may be due to their concern about contracting the disease.

Evaluation of real-life data on the use of inhaler devices, including satisfaction and adherence to treatment, by community pharmacists in partnership with pulmonary disease specialists.

OBJECTIVE: The use of inhaler device (UID) and the satisfaction and adherence of patients to treatment were evaluated by Istanbul city community pharmacists to obtain real-life data from patients with asthma or chronic obstructive pulmonary disease (COPD). METHODS: Pharmacists educated by pulmonary disease specialists asked patients who combined medications with inhaler devices to fill out a questionnaire prepared by the specialists. Each patient's UID was checked, and their errors were corrected by showing them the already prepared standard video of their inhaler device. Afterward, the UID was repeated and rechecked. The visual analog scale (VAS), feeling of satisfaction with the inhaler (FSI-10) questionnaire, and the Morisky Green Levine (MGL) scale were used for symptom control, satisfaction, and adherence, respectively. Then, we compared the results of three different types of inhalers: metered dose inhalers (MDI), dry powder inhalers (DPI), and dry powder inhalation capsules (DPI Caps). RESULTS: Twenty-seven (19.3%) patients used MDI, 42 (30%) used DPI caps, and 71 (50.7%) used DPI. UID before training was better in patients with DPI than in those with MDI and DPI Cap (p < 0.001). After training, the UID increased in all three groups (p < 0.001). The VAS scores were high in the DPI Caps group than the other groups (p < 0.001). The FSI-10 score was not significantly different among the groups (p > 0.05). Full-adherence was observed in 36.8% of the MDI group, 39.1% of the DPI Caps group, and 21.7% of the DPI groups (p > 0.05). CONCLUSION: The partnership between community pharmacists and pulmonary disease specialists improved patients' UID.

Does occupational ionizing radiation exposure in healthcare workers affect their hematological parameters?

Blood cells are used as the most sensitive marker to determine the effects and intensity of ionizing radiation. This descriptive study aimed to evaluate the effect of radiation exposure on hematological parameters in healthcare workers who were exposed to radiation in a university hospital between May and June 2021. A total of 339 participants were included, of which 169 (49.9%) were radiation workers and 170 (50.1%) were in the control group. A decrease was observed in white blood cell and neutrophil counts in those exposed to ionizing radiation for less than 10 years; however, white blood cell, neutrophil, hemoglobin levels decreased, and red cell distribution width (RDW) levels increased in those exposed to ionizing radiation for 10 years or more (p < 0.005). A statistically significant increase was observed in the RDW and lymphocyte levels as the years of work experience in the profession increase in the group exposed to IR. The findings indicate that the effect of low-dose ionizing radiation on the hematopoietic system is related to the frequency and duration of the dose. Hematological parameters can be sensitive biomarkers of low-dose ionizing radiation; possible disturbances in the hematopoietic system can be recognized before the onset of symptoms, and necessary precautions can be taken promptly.

Development of in House ELISAs to Detect Antibodies to SARS-CoV-2 in Infected and Vaccinated Humans by Using Recombinant S, S1 and RBD Proteins.

(1) Background: The aim of this study was to produce in-house ELISAs which can be used to determine SARS-CoV-2-specific antibody levels directed against the spike protein (S), the S1 subunit of S and the receptor binding domain (RBD) of S in SARS-CoV-2 vaccinated and infected humans. (2) Methods: Three in-house ELISAs were developed by using recombinant proteins of SARS-CoV-2, namely the S, S1 and RBD proteins. Specificity and sensitivity evaluations of these tests were performed using sera from SARS-CoV-2-infected (n = 70) and SARS-CoV-2-vaccinated (n = 222; CoronaVac vaccine) humans in Istanbul, Turkey. The analyses for the presence of SARS-CoV-2-specific antibodies were performed using the in-house ELISAs, a commercial ELISA (Abbott) and a commercial surrogate virus neutralization test (sVNT). We also analyzed archival human sera (n = 50) collected before the emergence of COVID-19 cases in Turkey. (3) Results: The sensitivity of the in-house S, S1 and RBD ELISAs was found to be 88.44, 90.17 and 95.38%, while the specificity was 72.27, 89.08 and 89.92%, respectively, when compared to the commercial SARS-CoV-2 antibody test kit. The area under curve (AUC) values were 0.777 for the in-house S ELISA, 0.926 for the S1 ELISA, and 0.959 for the RBD ELISA. The kappa values were 0.62, 0.79 and 0.86 for the S, S1 and RBD ELISAs, respectively. (4) Conclusions: The in-house S1 and RBD ELISAs developed in this study have acceptable performance characteristics in terms of sensitivity, specificity, AUC and kappa values. In particular, the RBD ELISA seems viable to determine SARS-CoV-2-specific antibody levels, both in infected and vaccinated people, and help mitigate SARS-CoV-2 outbreaks and spread.

Association between presence of Bacillus Calmette-Guerin vaccine scar and coronavirus disease 2019.

Bacillus Calmette-Guerin vaccine is administered for protection against tuberculosis and may also have beneficial effects against some viral respiratory tract infections. In this study, it was aimed to investigate the relationship between Bacillus Calmette-Guerin vaccination which is confirmed by BCG scar, and the frequency and course of Coronavirus disease 2019 (COVID-19). Among 490 patients, 400 patients who accepted to participate in the study were included. After the consent of patients, age, gender, body mass index, comorbidities, smoking, history, and the progress of COVID-19 of these patients were investigated; the presence and number of Bacillus Calmette-Guerin scars were recorded by a physician. Data from groups with and without COVID-19 history were compared. There was no relation between presence and number of the BCG scar and COVID-19 related hospitalization and intensive care unit admission. When groups with and without COVID-19 history compared, no statistically significant difference was found with the presence and number of Bacillus Calmette-Guerin scars (P > 0,05). No association was found between the presence or number of BCG scars and the frequency and course of COVID-19 in individuals with Bacillus Calmette-Guerin vaccination history confirmed by the presence of Bacillus Calmette-Guerin vaccine scars. Currently, the most important protection against COVID-19 is the COVID-19 vaccine.

Diagnosis of pleuroparenchymal fibroelastosis: A review.

Pleuroparenchymal fibroelastosis (PPFE) is a rare lung disease with unprecedented features characterized by fibroelastotic changes in the subpleural lung parenchyma affecting the upper lobes. PPFE is usually idiopathic, but it can be caused by infection, autoimmunity, bone marrow or lung transplantation, or a genetic predisposition. Histopathologic examination of lung biopsy samples reveals homogenous subpleural fibrosis and abundant elastic fibers, allowing for a definitive diagnosis. As PPFE mimics many interstitial lung diseases, clinicians face significant difficulties in making a definitive final diagnosis. Since most disease-related comorbid conditions manifest at an advanced stage, invasive tissue sampling for histopathologic evaluation is consistently impossible. Such a patient presentation highlights the importance of an analysis based solely on clinical findings, which would provide a definitive diagnosis without the need for a biopsy. Because of its exceptional and inconceivable presentation, PPFE creates a diagnostic dilemma. In light of our two cases and the literature data, we present a diagnostic assessment score assay that relies solely on clinical manifestations without histopathological tissue verification to shed light on the diagnosis of PPFE. This review focuses on PPFE identification through the use of a diagnostic assessment analysis to improve early disease recognition without the use of invasive diagnostic interventions to obtain biopsy samples for histopathologic evaluation. This analytic approach, while not diagnostic in and of itself, may provide a useful pathway for differential diagnosis and may preclude redundant initiatives.

Dysbaric osteonecrosis in diving fisherman: a case report.

BACKGROUND: Dysbaric osteonecrosis (DON) is defined as avascular bone necrosis, usually involving specific parts of the long bones, which is seen in divers or compressed-air workers due to exposure to pressure. We describe a case of DON in an artisanal diving fisherman working underwater for many years. Methods: A 48-year-old male case was admitted to the occupational disease outpatient with left shoulder and arm pain for 1-2 years. Since the age of 20, he has been artisanal diving fishing with a hookah at a depth of 20-25 meters in the sea. In 2011, he received hyperbaric oxygen therapy for widespread pain in the whole body due to decompression sickness (DCS). In the case's left shoulder joint x-ray and magnetic resonance imaging, degenerative changes in the acromioclavicular joint and signal changes consistent with osteonecrosis starting from the subcortical area of the humeral head and extending to the proximal shaft of the humerus were observed. Conclusions: DON is among the most common long-term pathologies in professional divers. In Turkey, as in our case, not applying safe decompression procedures and unsafe diving practices are common among diving fishers. In studies, the frequency of exposure to pressure, duration and depth of dive, insufficient decompression, formation of DCS and increasing age were associated with DON. Today, DON remains an occupational hazard with significant medical and social consequences. Diving fishers should be informed about the sequelae of DCS and trained on the safety measures to be taken.

Low back pain and risk factors among Taxi drivers in Turkey: a cross-sectional study.

BACKGROUND: Taxi drivers have an increased risk of low back pain due to both physical and occupational conditions. This study aims to determine the prevalence of low back pain and occupational risk factors among taxi drivers working in Izmir, Turkey. METHODS: This study was conducted with 447 taxi drivers at randomly selected taxi stands between April and September 2021. The questionnaire included demographic, individual, and work-related questions; the Nordic Musculoskeletal Questionnaire; and the Back Pain Functional Scale (BPFS). RESULTS: The prevalence of low back pain in the last year was 49.7%. In multivariate logistic regression analyses, the risk factors for low back pain included having a body mass index of 25-29.9 kg/m2 (OR= 1.67, 95% CI 1.01-2.76) or ≥30 kg/m2 (OR= 2.15, %95 CI 1.19-3.87), no physical activity (OR= 1.66, 95% CI 1.06-2.62), years of work >10 (OR= 3.23, 95% CI 1.89-5.53), no weekly rest period (OR= 3.11, 95% CI 1.42-6.81), having no lumbar support on the driver's seat (OR:1.67, 95% CI:1.05-2.66), or undecisive job satisfaction (OR= 2.07, 95% CI 1.17-3.66). Being undecided about job satisfaction (OR= 2.34, 95% CI 1.15-4.92) and not having physical activity (OR= 2.10 CI 1.08-4.08) were found to be risk factors for reduced BPFS scores. CONCLUSION: A strong correlation was found between the frequency of low back pain and the BPFS score and occupational factors. Early detection and management of low back pain are critical to avoid increased low back pain and related injuries among taxi drivers.