The Evaluation of Serum Pentraxin-3 and High-Sensitivity C-Reactive Protein Levels in Patients with Acute Attack of COPD.

BACKGROUND: Acute exacerbations of chronic obstructive pulmonary disease (COPD) are characterized by the release of inflammatory mediators. The aim of this study was to compare serum levels of pentraxin 3 (PTX3) and high-sensitivity C-reactive protein (hs-CRP) in patients with acute exacerbations of COPD with those of a healthy control group. METHODS: The study included 107 men and 19 women, with mean age of 66.5 (32 - 87) years who were diagnosed with acute COPD exacerbations and 48 healthy individuals as a control group. The serum PTX3 and hs-CRP levels were measured and pulmonary function tests were performed. RESULTS: The mean serum level of the hs-CRP was 39.56 mg/L (10.10 - 262), and it was higher in the COPD group than in the control group (p < 0.0001). The hs-CRP levels increased in accordance with the severity of the COPD (p < 0.0001). The serum PTX3 level was 0.52 pcg/dL (0.42 - 0.56) in acute exacerbations. There was a correlation between the PTX3 levels and the pulmonary function tests, including FEV1, FVC, and FEV1/FVC (r = 0.317, p < 0.001; r = 0.385, p < 0.0001, and r = 0.248, p = 0.001, respectively). CONCLUSIONS: The short pentraxin hs-CRP is elevated in COPD patients with acute exacerbations and correlates with the severity of the disease compared with the long pentraxin PTX3. These results support the idea that hs-CRP can be used as an earlier determinant of inflammation in COPD acute exacerbations and that PTX3 cannot be used as a marker of acute exacerbation and disease severity.

Effects of leptin and leptin receptor gene polymorphisms on lung cancer.

Leptin (LEP), an adipocyte-derived cytokine, has been reported to participate in carcinogenesis. Elevated levels of systemic and pulmonary LEP are associated with diseases related to lung injury and lung cancer. The purpose of the present study was to investigate if the LEP and leptin receptor (LEPR) gene polymorphisms are associated with lung cancer in a cohort of Turkish population. One hundred and sixty-two lung cancer patients and 130 healthy controls were included in the study. The genotypes of LEP gene -2548G > A and LEPR gene Q223R polymorphisms were determined using polymerase chain reaction (PCR) based restriction fragment length polymorphism (RFLP) analysis. The genotype frequencies of LEP -2548G > A polymorphism showed statistically significant differences between lung cancer patients and controls (p = 0.007). GA + AA genotypes and A allele of LEP -2548G > A polymorphism was found to be susceptibility factors for lung cancer (p = 0.003, odds ratio (OR) 2.32, 95 % confidence interval (CI) 1.32-4.10; p = 0.003, OR 1.65, 95 % CI 1.18-2.29, respectively). The genotype and allele frequencies of LEPR Q223R polymorphism did not show any statistically significant differences between lung cancer patients and controls (p = 0.782 and p = 0.762, respectively). Although AA-QQ and AA-QR combined genotypes of LEP -2548G > A-LEPR Q223R loci were significantly higher in lung cancer patients (p = 0.020 and p = 0.047, respectively), GG-QQ, GG-QR, and AA-RR combined genotypes were significantly higher in control group. As a result, susceptibility effects of LEP -2548G > A polymorphism alone or in combination with LEPR Q223R polymorphism on lung cancer were observed. Further studies are necessary to prove the association of LEP and LEPR gene polymorphisms with lung cancer.

Can TERT rs2853669 polymorphysm indicate fibrosis in sarcoidosis?

BACKGROUND AND AIM: Sarcoidosis is a systemic inflammatory disease of unknown cause, characterized by the presence of non-caseating granulomas, which can affect all organs in the body, especially the lung. The fibrotic stage 4 of sarcoidosis usually does not respond adequately to treatment and may cause respiratory distress in the patient. Some telomerase gene polymorphisms have been significantly associated with lung cancer and idiopathic pulmonary fibrosis. In our study, we aimed to investigate the relationship between telomerase mutation and progression to fibrosis in patients with sarcoidosis. METHODS: A total of 93 patients, including 18 males and 73 females, who were clinically and histopathologically diagnosed with sarcoidosis were included in the study. The 78 patients included in the study were classified as non-fibrotic and 15 as fibrotic sarcoidosis. In telomerase rs2853669 single nucleotide polymorphism, three genotypes, homozygous TT, homozygous CC and heterozygous TC, were determined as the genotypes of the patients. RESULTS: When non-fibrotic and fibrotic sarcoidosis groups were compared, no significant difference was found in terms of genotypes (p=0.76).  The FEV1 (forced expiratory volume in the first second) % of the CC genotype was lower than that of the other genotypes (p=0.01). CONCLUSIONS: In sarcoidosis patients, telomerase rs2853669 polymorphism does not indicate progression to fibrosis, but since FEV1% was found to be lower in individuals with homozygous CC polymorphism, it is thought that it may predict loss of respiratory function. Further studies are needed to evaluate the association of telomerase polymorphisms with fibrosis in sarcoidosis.

Lung cancer from suspicion to treatment: An indicator of healthcare access in Turkey.

BACKGROUND: Lung cancer is the leading cause of cancer-related deaths worldwide. Before beginning lung cancer treatment, it is necessary to complete procedures such as suspecting lung cancer, obtaining a pathologic diagnosis, and staging. This study aimed to investigate the processes from suspicion of lung cancer to diagnosis, staging, and treatment initiation. METHODS: The study was designed as a multicenter and cross-sectional study. Patients with lung cancer from various health institutions located in all geographic regions of Turkey were included in the study. The sociodemographic and clinical characteristics of the patients, the characteristics of the health institutions and geographic regions, and other variables of the lung cancer process were recorded. The time from suspicion of lung cancer to pathologic diagnosis, radiologic staging, and treatment initiation, as well as influencing factors, were investigated. RESULTS: The study included 1410 patients from 29 different medical centers. The mean time from the initial suspicion of lung cancer to the pathologic diagnosis was 48.0 ± 52.6 days, 39.0 ± 52.7 days for radiologic staging, and 74.9 ± 65.5 days for treatment initiation. The residential areas with the most suspected lung cancer cases were highly developed socioeconomic zones. Primary healthcare services accounted for only 0.4% of patients with suspected lung cancer. The time to pathologic diagnosis was longer in the Marmara region, and the wait time for staging and treatment initiation was longer in Eastern and Southeastern Anatolia. Patients who presented to chest disease referral hospitals with peripheral lesions, those with early-stage disease, and those who were diagnosed surgically had significantly longer wait times. CONCLUSION: The time between pathologic diagnosis, staging, and treatment initiation in lung cancer was longer than expected. Increasing the role of primary healthcare services and distributing socioeconomic resources more equally will contribute to shortening the time to diagnosis and improve treatment processes for lung cancer.

Effect of Asbestos Exposure on the Frequency of EGFR Mutations and ALK/ROS1 Rearrangements in Patients With Lung Adenocarcinoma: A Multicentric Study.

OBJECTIVE: The aim of this study is to investigate the effect of asbestos exposure on cancer-driver mutations. METHODS: Between January 2014 and September 2018, epidermal growth factor receptor (EGFR), anaplastic lymphoma receptor tyrosine kinase (ALK), and c-ros oncogene 1 receptor tyrosine kinase gene (ROS1) alterations, demographic characteristics, asbestos exposure, and asbestos-related radiological findings of 1904 patients with lung adenocarcinoma were recorded. RESULTS: The frequencies of EGFR mutations, ALK, and ROS1 rearrangements were 14.5%, 3.7%, and 0.9%, respectively. The rates of EGFR mutations and ALK rearrangements were more frequent in asbestos exposed non-smokers (48.7% and 9%, respectively). EGFR mutation rate was correlated to female gender and not-smoking, ALK rearrangement rate was correlated to younger age, not-smoking, and a history of asbestos exposure. CONCLUSIONS: The higher rate of ALK rearrangements in asbestos-exposed lung adenocarcinoma cases shows that asbestos exposure may most likely cause genetic alterations that drive pulmonary adenocarcinogenesis.

Resistance for anti-tuberculosis drugs in central Black Sea region of Turkey.

One of the primary aims in tuberculosis (TB) management is to detect new cases as early as possible, and instigate the most appropriate therapy, for which it is important to know the characteristics of TB drug resistance in society. The aim of our study was to determine the resistance status of tuberculosis in the Samsun region of Turkey. To achieve that, the medical records of 1,029 pulmonary tuberculosis patients admitted to Samsun Chest Diseases and Chest Surgery Hospital between 2004 and 2006 were analyzed for drug resistance characteristics. In order to define the problem, isolates were tested on Lowenstein-Jensen medium. For drug susceptibility testing, isoniazid (I), streptomycin (S), ethambutol (E), rifampicin (R) and the radiometric Bactec 460 TB system were used. Eighty-six percent (86%) of the cases (623/721) were new patients, and 13.5% (98/721) were previously treated cases. One hundred and thirty-four (134) of the 721 patients (18.6%) had resistance to one or more drugs. Resistance to any drug was determined in 16.9% (105/623) cases of new patients. I resistance was 13.2%, any R resistance was 2.9%, and multi-drug resistance (MDR) was 1.9%. In previously treated cases, resistance to any drug was 29.6%, any I resistance was 26.5%, any R resistance was 15.3%, and MDR was 13.3%. It was concluded that resistance to anti-tuberculosis drugs is an important problem in Samsun.

Smoking status and levels of knowledge regarding cigarettes among primary school teachers.

OBJECTIVES: Teachers are believed to be important role models for their students. This study's objective was to determine primary school teachers' smoking status, their level of knowledge regarding cigarettes and their attitude towards prohibition; and to obtain preliminary data that may contribute to the development of antismoking campaigns in schools. METHODS: In total, 468 teachers were recruited and given a questionnaire. RESULTS: The answers revealed that among respondents, 58.1% were current smokers, 36.1% were ex-smokers, and 5.8% had never smoked. The percentage of current smokers among females (71.7%) was significantly higher than among males (50.7%). The percentage of those who had begun smoking at age 15 or earlier was 32.0% in smoking males and 19.3% in females; this difference was also statistically significant. No significant difference regarding ideas about smoking and prohibitions on cigarettes was found among current smokers, ex-smokers, and nonsmokers. CONCLUSIONS: Due to the high number of smoking teachers and their role model status, students may also be at risk of starting smoking. It was concluded that it would be beneficial to deliver educational programs and seminars encouraging smoking cessation to this professional group.

Prevalence of asthma and respiratory symptoms by age, gender and smoking behaviour in Samsun, North Anatolia Turkey.

Asthma is a major health problem worldwide. This is the first study determining the prevalence of asthma among adults in Samsun which is situated in the centre of the Black Sea region of Turkey. The aim of our study was to assess the prevalence of asthma and asthmatic symptoms, and the relationships of these with age, gender and smoking behaviour in this region. A questionnaire interview adapted from the European Respiratory Community Health Survey (ERCHS) was performed by health centre officers with selected people between November-December, 2002. The study population included a total of 1.916 [810 men (42.3%) and 1.106 women (57.7%)] inhabitants of Samsun city center, aged 15 years of age or above. The mean age was 37.8 years+/-15.5, the prevalence of asthma was 2.7%, receiving asthma medicine was 2.2%, the prevalence of wheezing in the last 12 months was 15.5% and shortness of breath with wheezing was 11.6%. The frequency of symptoms was higher among the elderly population when compared to other groups (p<0.0001). Asthma diagnosis by a physician was more frequent among women (chi2=5.16, p<0.05). Morning cough, day time cough, chronic cough, phlegmy cough and waking up with cough symptoms were more frequent among the smokers (p<0.001). Asthma diagnosis and asthma treatment are at a very low level compared to reported asthma related symptoms.

Tonsillar metastasis of small cell lung carcinoma.

Metastasis to palatine tonsils are rare, accounting from only 0.8% of all tonsillar tumors, so far only 100 cases reported in the English literature. Only a few cases have been reported for small cell and non-small cell lung cancer as a primary site. With a diagnosis of small cell lung cancer, a 68-year-old male patient relapsed after six cycles of chemotherapy in tonsilla palatina and cervical lymph nodes. Patients died 26 months after being diagnosed with lung cancer and 2 months after detection of tonsil metastasis. We present the current case report because of the rarity of metastasis to tonsil in lung cancer.

Pulmonary functions in pre-eclamptic women.

OBJECTIVE: The purpose of this study was to evaluate certain pulmonary function tests of the pre-eclamptic women in the early postpartum period. STUDY DESIGN: Forced vital capacity (FVC), forced expiratory volume in 1s (FEV(1)) and peak expiratory flow (PEF) were measured in 13 pre-eclamptic and 15 control subjects undergoing cesarean section (C/S); and 11 pre-eclamptic and 15 control subjects undergoing vaginal delivery (VD) on the postpartum third day. RESULTS: Pre-eclamptic women had significantly lower FVC, FEV(1) and PEF measurements than the control women (P<0.05). When the subjects were grouped according to the mode of delivery, FVC and FEV(1) values were observed to be significantly different between the pre-eclamptic and control groups undergoing C/S (P<0.05). None of these parameters were significantly different between the pre-eclamptic and control groups who had delivered vaginally (P>0.05). CONCLUSION: These data indicate that certain pulmonary functions might be impaired in the early postpartum period in pre-eclamptic women undergoing C/S.

Cisplatin and etoposide alternating ifosfamide, vincristine, epirubicin in small cell lung cancer.

OBJECTIVE: The aim of this study was to evaluate the effects and toxicity of alternating cisplatin+etoposide (EP) and ifosfamide+vincristine+epirubicin (IVE) combination regimen in patients with small cell lung cancer (SCLC). METHODS: We have treated 38 SCLC patients with 6 courses of alternating chemotherapy consisting of cisplatin 100 mg/m2 on day one and etoposide 80 mg /m2 on the first, second and third days in courses of first, third and fifth, alternating with ifosfamide 4 g/m2, vincristine 2 mg/day and epirubicin 60 mg/m2 intravenously on day one in courses of second, forth and sixth. The courses were administrated every 3 weeks. After the sixth course of chemotherapy the patients with limited disease (LD) who had a complete response (CR) received concomitant chest irradiation. None of the patients had prophylactic cranial irradiation. The study was conducted between January 1997 and July 1997 in the Department of Chest Disease at Ondojuz Mayis University Hospital, Samsun, Turkey. RESULTS: The mean age of the 3 female and 35 male patients was 59.5 (33-72) years. Eighteen of which had LD and 20 had extensive disease (ED). Twenty patients had Eastern Cooperative Oncology Group (ECOG) 1 and 18 had ECOG 2 performance status. Objective response (OR) was obtained in 26 (68%) of the patients. While 13 patients had a CR rate, 6 patients remained stable (16%). The OR rate was observed to be 100% (CR 61%, partial response [PR] 39%) in patients with LD, whereas it was 40% (CR 10%, PR 30%) in patients with ED. The median survival was 9 months in LD and 6 months in ED. Relapses after CR occurred in 11 patients with LD (local relapse in 8; one in the brain; one in the liver; one in the bone) and one patient with ED (in the brain). The observed toxicities were grade III-IV leukopenia 13%, grade III-IV nausea and vomiting 8%, and 39% alopecia. CONCLUSION: We conclude that the described regimen is a well-tolerated, less toxic therapy for SCLC.

Glutathione-S transferase-pi expression in non small cell lung cancer in the assessment of response to chemotherapy.

OBJECTIVE: To determine the relation of glutathione-S transferase-pi (GST-pi) expression and cisplatin resistance in non small cell lung cancer (NSCLC). METHODS: This study was carried out on 61 patients who were admitted to Chest Diseases Clinic, Ondokuz Mayis University, Samsun, Turkey, from 1997 to 1999. Twenty-seven NSCLC patients out of 61 lung cancer cases whose biopsy specimens were evaluated for GST-pi, received multiagent chemotherapy including cisplatin. The correlations between GST-pi expression and age, sex, performance score, histology, stage of the disease and response to chemotherapy were investigated. RESULTS: There was a significant correlation between GST-pi expression and the histological type of the disease (p<0.05). However, no significant relation was found with age, sex, performance score or stage of the disease (p>0.05). Glutathione-S transferase-pi staining characteristics of the 27 patients receiving chemotherapy were: less than 10% in 3 patients (11.1%), 10-50% in 9 patients (33.3%) and more than 50% in 15 patients (55.5%). One of the 3 patients (33.3%) with GST-pi staining percentage of less than 10%, 3 of 9 patients (33.3%) with staining percentage of 10-50% and 4 out of 15 patients (26.6%) with staining percentage of more than 50% had an objective response to chemotherapy. No significant correlation was found between GST-pi expression and response to chemotherapy in the 3 groups (p>0.05). CONCLUSION: Glutathione-S transferase-pi expression might not always predict the response to combination chemotherapy regimens containing cisplatin. Several other mechanisms may play a role in cisplatin-resistance.

The antioxidant and antigenotoxic effects of pycnogenol(®) on rats treated with cisplatin.

Oxidative stress and inflammation are implicated in the pathogenesis of cisplatin-induced toxicity. Pycnogenol® is known for its strong antioxidant and anti-inflammatory effects. In this study, the possible protective effects of pycnogenol on kidney, bone marrow, and red blood cells in rats treated with cisplatin were investigated. The rats were divided into four groups. Group 1 was the control and groups 2, 3, and 4 were orally treated with pycnogenol (200 mg/kg bw, o.p) for 5 days, treated with cisplatin (7 mg/kg bw, i.p.) on the fifth day and treated with cisplatin plus pycnogenol, respectively. Antioxidative parameters in kidney and red blood cells were measured. Chromosome anomalies in bone marrow and renal histopathology were also investigated. Activities of pro-oxidant enzymes (myeloperoxidase and xanthine oxidase), malondialdehyde, and nitric oxide levels significantly increased but antioxidant enzymes activities decreased in the kidneys and red blood cells after cisplatin treatment. Pycnogenol treatment prior to the administration of cisplatin significantly decreased cisplatin-induced injury, as evidenced by its normalizing these parameters. Chromosomal aberrations decreased and mitotic index frequencies increased in bone marrow treated with cisplatin plus pycnogenol. These findings suggest that pycnogenol may be a useful protective agent against the toxicity associated with cisplatin therapy.

Pulmonary alterations in Behcet's disease.

PURPOSE: This study aims to demonstrate pulmonary alterations (PA) in patients with Behcet's disease by using CT. MATERIALS AND METHODS: CTs of 50 patients with Behcet's disease and 20 others in a control group have been evaluated retrospectively for PA (septal, reticular, nodular, atelectatic opacities). RESULTS: Eight out of 50 patients (16%) with Behcet's disease showed PA. Three out of 20 (15%) in the control group showed PA. No differences were observed between Behcet's disease patients and the control group regarding pulmonary alterations (p=0.917). No differences were observed in the disease duration, ages and sex in either group in those with and without PA. CONCLUSION: Pulmonary alterations can be seen in patients with Behcet's disease, but these alterations are not significant.