The relationship between vertebral deformities and thoracic arthropathy with back pain in Chronic Obstructive Pulmonary Disease.

OBJECTIVES: The aim of the study was to investigate the relationship between back pain and thoracic vertebral deformities and arthropathy in patients with COPD who underwent thorax CT scans to screen for lung nodules and cancer. MATERIALS AND METHODS: The data of patients who underwent thoracic CT and pulmonary function tests (PFTs) between July 2019 and February 2020 were retrospectively reviewed. The patients were divided into two groups: the COPD (n = 64) and control groups (n = 101), according to the PFT results. The CT images were evaluated for vertebral deformities, osteoporosis and thoracic vertebral joint arthropathy, and the Spinal Deformity Index (SDI) was calculated. RESULTS: Back pain was detected in 43.7% of the COPD patients and 20.9% of the controls. The patients with COPD had significantly higher rates of costotransverse, intervertebral, facet joint arthropathy, and osteoporosis than did the control group (P < .001). The OR analyses showed that the presence of a vertebral deformity (OR 4.42, 95% CI 2.26 - 8.63, P < .001), of facet joint arthropathy (OR 3.6, 95% CI 2.83-4.58, P < .001), and of costotransverse arthropathy (OR 2.20, 95% CI 1.47-2.77, P < .001) were associated with the presence of back pain. Although a strong positive correlation was found between the SDI and pain score, a moderate negative correlation was found between the FEV1% values and pain score. CONCLUSIONS: Back pain was present in patients with COPD and was related to vertebral deformities and facet and costotransverse joint arthropathy. Additional studies are required to clarify the relationships of back pain with musculoskeletal system diseases, including cervical and lumbar spine arthropathy and vertebral deformities.

Assessment of Renal and Hepatic Tissue-Protective Effects of N-Acetylcysteine via Ammonia Metabolism: A Prospective Randomized Study.

BACKGROUND The present study sought to assess the renal and liver protective effect of N-acetylcysteine through NH3 and urea metabolism in patients with chronic obstructive pulmonary disease who were scheduled for coronary artery bypass grafting surgery. MATERIAL AND METHODS Patients with chronic obstructive pulmonary disease (COPD) who were scheduled for coronary artery bypass grafting were divided into 2 groups so as to receive (Group 1, n=35) or not receive (Group 2, n=35) 900 mg/day of n-acetylcysteine for 7 days before the operation starting from their admission to the service by a pulmonologist with the purpose of treating COPD until the day of surgery. Both groups were subjected to the same anesthesia protocol. Blood samples were taken preoperatively, within the first 15th minute following cessation of the cardiopulmonary bypass, at postoperative 24th hour, and at postoperative 48th hour. Blood tests included ammonia (NH3), lactate, blood urea nitrogen, creatinine, aspartate transaminase (AST), alanine transaminase (ALT), alkaline phosphatase (ALP), troponin I (Tn I), and creatinine kinase-muscle brain (CKMB). RESULTS There was a significant difference between the groups' NH3 and lactate levels after cardiopulmonary bypass, postoperative 24th hour, and postoperative 48th hour (respectively, NH3: 39.0±8.8 vs. 55.4±19.6 and 40.1±8.4 vs. 53.2±20.2 mcg/dl, lactate: 1.7±0.9 vs. 2.1±1.2 and 1.2±0.5 vs. 1.8±1.4 mmol/L; p<0.01). Creatinine and BUN levels in Group 2 were found to be significantly higher at the postoperative 48th hour compared to the levels of Group 1 (P<0.05). CONCLUSIONS N-acetylcysteine pretreatment appears to improve renal and hepatic functions through regulation of ammonia and nitrogen metabolism and reduction of lactate in patients with chronic obstructive pulmonary disease who undergo coronary artery bypass grafting surgery. We found that N-acetylcysteine improved kidney and/or liver functions.

Effects of Anatolian Propolis and Hypertonic Saline Combination Nasal Spray on Allergic Rhinitis Symptoms: A Prospective, Multicenter Study.

Objectives: This study aimed to evaluate how Rhinapi nasal spray affects symptoms of allergic rhinitis. Methods: In this prospective, multicenter, observational study, 10,000 patients (comprising 5028 males and 4972 females) exhibiting symptoms of allergic rhinitis (namely, nasal discharge, sneezing, nasal itching, and nasal obstruction) from different centers in different regions of Turkey were enrolled in the study between March 2022 and March 2023. All the patients wanted to participate in the study and were administered Rhinapi one puff to each nostril three times a day, for a period of 3 weeks. Total symptom scores, quality of life (QoL) scores, and otolaryngological examination scores were evaluated before and 3 weeks after treatment. Results: The scores for discharge from the nose, sneezing, nasal pruritus, and blockage of the nose all indicated improvement when compared to pre-medication and post-medication. This difference achieved statistical significance (P < .001). The mean total symptom score fell following treatment (P < .001): whilst the score was 11.09 ± 3.41 before administering Rhinapi; after administration, the average score was 6.23 ± 2.41. The mean QoL scores also altered after medication (P < .001), improving from a mean value of 6.44 ± 1.55 to a mean of 7.31 ± 1.24. Significant improvement was also noted in the scores for conchal color and degree of edema after the treatment had been administered (P < .001). Conclusion: The study demonstrates that Rhinapi nasal spray decreases total symptom scores, and results in improved QoL and otolaryngological examination scores. Propolis spray may be recommended for patients with allergic rhinitis alongside other treatments.

Alterations in Parafoveal and Optic Disc Vessel Densities in Patients with Obstructive Sleep Apnea Syndrome.

PURPOSE: To analyze the effects of obstructive sleep apnea syndrome (OSAS) on ocular parameters and determine the alterations in macular vasculature by optical coherence tomography-angiography (OCT-A) in patients with different stages of OSAS. METHODS: All the participants underwent a full ophthalmological examination. Using the macular OCT-A scans, the retinal peripapillary capillary plexus (RPCP), foveal avascular zone (FAZ), and superficial and deep vessel densities were recorded. RESULTS: A total of 77 patients (154 eyes) with OSAS and 27 control cases (54 eyes) were included in this prospective study. Of the OSAS patients, 27 had mild, 24 had moderate, and 26 had severe disease. The intraocular pressure (IOP) values were significantly higher in the severe OSAS group than the control cases (p = 0.001). The average retinal nerve fiber layer (RNFL) thickness and the RNFL thickness of the temporal and inferior quadrants were significantly lower in the severe OSAS group compared with the control cases (p = 0.001). The average retinal nerve fiber layer (RNFL) thickness and the RNFL thickness of the temporal and inferior quadrants were significantly lower in the severe OSAS group compared with the control cases (p = 0.001). The average retinal nerve fiber layer (RNFL) thickness and the RNFL thickness of the temporal and inferior quadrants were significantly lower in the severe OSAS group compared with the control cases (. CONCLUSIONS: Decreased vascular structures and increased FAZ may also be associated with the disease severity in OSAS and may be the main pathophysiological mechanisms in ocular alterations, which should be investigated in further studies.

Pressure vs. volume control in COPD patients intubated due to ARF: a case-control study.

To compare volume- and pressure- controlled ventilation (VCV-PCV) as an initial ventilatory mode in chronic obstructive pulmonary disease (COPD) patients. Case-control study conducted in respiratory intensive care unit (RICU) at a large teaching hospital, between January 2002 and January 2004. PCV was applied in 20 COPD patients with ARF more than 24 hours. Their outcomes were compared with those of a control group of 20 COPD patients matched on age, sex, Acute Physiology Assessment and Chronic Health Evaluation (APACHE) II score, pH and PaCO(2) at the time of intubation previously treated with VCV. The effectiveness of matching was 99%. Groups were compared according to complication and mortality rates, total duration of invasive mechanical ventilation (IMV) and length of RICU stay. Mortality and complication rates, and length of RICU stay were similar in groups but, the mean duration of MV was longer in PCV (198 +/- 177 h vs. 79 +/- 56 h, p< 0.003). PCV group spended significantly longer IMV hours for weaning period (138.6 +/- 164 vs. 34 +/- 33 h, p< 0.01), pre-weaning periods of IMV were found similar. These data suggest that both ventilatory approach have similar outcomes in COPD patients with ARF. Randomize-controlled trials are needed to confirm our results.

The importance of calprotectin levels in obstructive sleep apnea syndrome severity.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is mostly seen in adult populations. It is known that increased levels of several inflammatory mediators play roles in OSAS and related comorbidities. Calprotectin is an inflammatory mediator that increases in some diseases such as Behçet's syndrome, bowel diseases and cardiovascular and cerebrovascular diseases. AIMS: The purpose of this study was to investigate whether calprotectin can be used as a biomarker in OSAS by determining the relation between serum calprotectin levels and OSAS severity. STUDY DESIGN: Cohort study. METHODS: A prospective study was planned. Eighty-three patients undergoing polysomnography were included in the study and evaluated prospectively. Thirty patients were classified as non-OSAS (group 1), 18 as mild OSAS (group 2), 15 as moderate OSAS (group 3) and 20 as severe OSAS (group 4). Calprotectin values were measured in the non-OSAS patients (group 1) and in the patients with OSAS (groups 2, 3 and 4). The OSAS groups were also compared with each other. RESULTS: Serum calprotectin values ranged between 70.61 and 1468.04 ng/ml. No significant difference in calprotectin levels was found between the OSAS and normal groups. However, statistically significantly increased calprotectin values were determined in the severe OSAS group (group 4) when all groups were compared. CONCLUSION: Calprotectin values were elevated in OSAS patients and it can be used as a marker of severe OSAS. Future studies can support our study.

Pleural complications of pulmonary hydatid disease.

OBJECTIVE: The aim of this study was to determine the incidence and diagnostic features of pleural manifestations of pulmonary hydatid disease. METHODOLOGY: Patients with pleural pathology in association with surgery for pulmonary hydatid disease over an 8-year period were evaluated. RESULTS: Twenty-nine (6%) of 474 patients with histologically confirmed pulmonary hydatid disease had pleural abnormalities. The diagnosis was determined preoperatively in 22 patients and was based on radiographic, clinical, and/or serology findings. Bronchoscopic specimens were diagnostic in two of seven patients who had bronchoscopy. Five patients were not diagnosed until surgery. Radiographic abnormalities consisted of pleural thickening and/or free fluid without intrapleural rupture of the cysts in 21 patients. Eight patients had a hydropneumothorax. Sixteen patients had an exudative, uncomplicated effusion. The remaining patients had empyemas. All patients had resection of the pulmonary cysts, and 20 also underwent a pleurectomy. The mean length of hospital stay was 23 +/- 14 days. There was no hospital mortality. CONCLUSION: Pleural lesions associated with pulmonary hydatid disease are rare and have a variable radiographic appearance. In regions in which echinococcal disease is endemic, a high level of clinical suspicion is necessary for diagnosis and appropriate management of this condition.