Moldy Hazelnut Husk and Shell Related Hypersensitivity Pneumonitis: A Possible Novel Occupational Causative Agent.

Hypersensitivity pneumonitis (HP) is a complex immune-mediated interstitial lung disease (ILD) triggered by inhalation exposure to environmental or occupational antigens in genetically susceptible individuals. Novel exposure sources and antigens are frequently identified. However, the causative agent remains unidentified in nearly half of HP cases. Early diagnosis for nonfibrotic-HP and quitting the exposure may prevent the disease progression to fibrotic forms and related complications. Here, we present two cases of HP associated with mold exposure in hazelnut husks, leaves, and shells in hazelnut agriculture.

Can Serum Chitotriosidase Levels, Immune, and Oxidative Stress Parameters Be Early Diagnostic Indicators in Patients With Silicosis?

OBJECTIVE: We aimed to evaluate the enzyme activity of chitotriosidase as a biomarker in early diagnosis silicosis and to investigate immune system response and oxidative stress caused by silica exposure. MATERIALS AND METHODS: Silicosis patients (n = 116), exposed to silica without disease (n = 76), and healthy individuals (n = 55) were included. Serum levels of chitotriosidase, proinflammatory cytokines, oxidant-antioxidant, and immune parameters were measured. RESULTS: Serum chitotriosidase enzyme levels in the silicosis group were statistically significantly higher than the exposure and control groups. Inflammatory biomarkers and 8-hydroxy-2-deoxyguanosine levels were found to be statistically significantly higher in the silicosis and exposure group compared with the controls, while superoxide dismutase and glutathione peroxidase were lower. CONCLUSIONS: Increased serum chitotriosidase level emerged as a biomarker that can not only distinguish silicosis from exposure and healthy controls but also indicate early pulmonary effects of silica.

Evaluation of Oxidative Stress Parameters and Genotoxic Effects in Patients With Work-Related Asthma and Silicosis.

OBJECTIVE: To determine the mechanistic roles of oxidative stress, inflammation, and genotoxicity parameters in patients with work-related asthma (WRA) and silicosis. METHODS: Thirty-eight healthy office workers, 27 employees with a history of exposure and no disease, 24 employees with WRA, and 23 employees with silicosis were included in this study. Superoxide dismutase, catalase, glutathione peroxidase, malondialdehyde, and interleukins (IL) 17, 23, and 27 levels were measured in the serum. Genotoxic damage was evaluated by calculating the frequency of micronuclei in swab samples and 8-hydroxy-2'-deoxyguanosine in serum. RESULTS: Serum superoxide dismutase, catalase, glutathione peroxidase, malondialdehyde, 8-hydroxy-2'-deoxyguanosine, and IL-17, IL-23, and IL-27 levels were found to be statistically significantly higher in the exposure, WRA, and silicosis groups compared with the control group. The frequency of micronuclei in buccal epithelial cells of the patient group was found to be significantly higher than that of the control group. CONCLUSION: These results may provide information for molecular mechanisms and early diagnosis of WRA and silicosis and will be a guide for taking precautions in the early period.

Occupational Exposure to Metals and Solvents: Allergy and Airway Diseases.

PURPOSE OF REVIEW: Occupational allergic diseases (OAD) such as occupational contact dermatitis (OCD), occupational asthma (OA), and occupational rhinitis (OR) are the most prevalent occupational diseases in industrialized countries. The purpose of this review is to provide an update about the main occupational metal and solvent exposures related to allergy and airway diseases and to discuss newly defined causative agents and industries in this field. RECENT FINDINGS: Currently for over 400 causative agents for OA and OCD, several hundreds of agents for OR have been identified. Although many studies have reported an overall decline in OAD related to known agents after implementation of efficient and effective workplace preventive measures, the constant development of new products continuously introduces to the market potential unknown respiratory hazards. Workplace allergens are often high molecular weight (HMW) agents that are > 10 kDa molecular weight and capable of eliciting IgE sensitization. Sensitizing low molecular weight (LMW) agents are often reactive chemicals. Metals and solvents are two large causative agent groups related to OADs that mainly behave as LMW (< 10 kDa) sensitizers and/or irritants. Avoidance of causative exposures through control strategies is the primary prevention approach for OADs. These strategies must be applied and covered for all known and newly defined causative agents. This review aims to summarize current status of known occupational metal and solvent exposures related to allergy and airway diseases and to discuss newly defined causative agents and industries in this field.

Attitudes and behaviors of family physicians regarding occupational diseases.

OBJECTIVES: The incidence of occupational diseases (ODs) is below expectations. The approaches of family physicians are very important. In this study, we aimed to evaluate attitudes and behaviors of family physicians about ODs. METHODS: The questionnaire was first sent to family physicians via e-mail. Of 3663 responders, 3090 replies were included to study. RESULTS: 44.1% of them stated they obtained detailed occupational history. In logistic regression analysis, physicians who obtained detailed occupational history, discussed their patient's health with an occupational physician, had education about ODs and those who stated that they wanted to receive training in ODs were more likely to refer their patient. CONCLUSION: In this study, it was determined that those who received education on ODs and those who have worked as workplace physician obtained occupational history, knew occupational diseases hospitals and wanted to receive further education.

DNA damage assessment with buccal micronucleus cytome assay in Turkish coal miners.

The aim of this study was to assess DNA damage in Turkish coal miners with the buccal micronucleus cytome (BMCyt assay as the least invasive and therefore most practical method that may find wider application in coal miner biomonitoring. Buccal epithelial cell samples were taken from 54 coal miners and 42 controls from Zonguldak, Turkey to establish their micronucleus (MN), binucleus (BN), condensed chromatin (CC), karyorrhectic (KHC), karyolytic (KYL), nuclear bud (NBUD), and pyknotic (PYC) frequencies. We also analysed the effects of confounding factors such as age, years of work at the mine, smoking, alcohol drinking, and use of protective equipment on differences in MN frequencies. Two miners had confirmed and three suspect pneumoconiosis, whereas 49 displayed normal chest radiographs. MN, BN, KHC, and NBUD frequencies were significantly higher in coal miners than controls. Years of work at the mine also showed a significant effect on buccal MN frequencies in coal miners, but we found no correlation between MN frequencies and age, smoking, and alcohol consumption. In conclusion, BMCyt assay proved itself an accurate and practical screening method, as it can detect DNA damage much earlier than pneumoconiosis develops.

Occupational Risk Factors and the Relationship of Smoking with Anxiety and Depression.

OBJECTIVES: The aim of the present study was to evaluate the relation of smoking with anxiety and depression in workers who were exposed to occupational risk factors. For this purpose, working time, smoking status, nicotine dependence, and respiratory functions of the workers who were exposed to physical and/or chemical harmful substances were evaluated and the presence of anxiety/depression was investigated. MATERIAL AND METHODS: Male workers who were exposed to occupational risk factors such as solvents, heavy metals, and dust and visited the outpatient clinic for occupational diseases within a one-year period were included. Pulmonary Function Test and Fagerström Test for Nicotine Dependence were performed. Anxiety and depression statuses of the workers were assessed using the Hospital Anxiety and Depression Scale. RESULTS: The mean age of 665 male workers was 45 y (range, 38-48 y), and they were most commonly exposed to solvents (45.9%), followed by heavy metal fume/dust (20.9%). Of the workers, 252 (37.9%) had anxiety, 294 (44.2%) had depression, and 171 (25.7%) had both. More than half of the workers in each occupation/exposure group were smokers. Respiratory complaints were present in 34% of the workers. According to the regression analysis, the presence of respiratory system complaints was found to be a significant risk factor for anxiety, depression, and anxiety plus depression. CONCLUSION: In conclusion, smoking and anxiety/depression were found to be the conditions affecting more than half of the workers with occupational exposure.

Can the ceramic industry be a new and hazardous sector for work-related asthma?

BACKGROUND: Work-related asthma (WRA) constitutes a significant proportion of all asthma cases and continues to be reported from different industries. The aim of the study was to identify the occupations that can be related to WRA and diagnostic steps used in suspected WRA patients. METHODS: We retrospectively reviewed the clinical records of WRA suspected patients who were referred to Ankara Occupational and Environmental Diseases Hospital, Turkey from January 2015 to January 2017. Detailed occupational history, the diagnostic steps such as pulmonary function testing (PFT), peak expiratory flow (PEF) monitoring and nonspecific bronchial provocation tests (NSBPT) were recorded. RESULTS: Among 160 patients, 148 were male and 12 were female. Only 2 of them were diagnosed as work-exacerbated asthma (WEA). Diagnosis of asthma was based on using reversible airflow limitation 28.8% (n = 46) or NSBPT 31.9% (n = 51). Toxicological analysis showed that 28 patients had heavy metal poisoning, 9 patients had solvent poisoning, 4 patients had both. According to occupations, 32 of them were ceramic workers (20.0%) and 27 of them were metal workers (16.9%). Plastic workers (4 ±â€¯2.8 years), cleaners (6.2 ±â€¯5.7 years), metal workers (7.4 ±â€¯5.4 years), painters (10 ±â€¯5.2 years), ceramic workers (10.8 ±â€¯5.9 years) had the shortest exposure durations for development of occupational asthma (OA). An analysis of variance showed that the effect of heavy metal and solvent poisoning on mean time for onset of OA was not significant. CONCLUSIONS: The results demonstrate that besides the sectors known to cause WRA, ceramic and metal industries can be related to important exposures related to WRA. Medical surveillance of employees in this sector is important in early detection.

Pulmonary health effects of air pollution.

PURPOSE OF THE REVIEW: Air pollution continues to be a major public health concern affecting nine out of 10 individuals living in urban areas worldwide. Exposure to air pollution is the ninth leading risk factor for cardiopulmonary mortality. The aim of this review is to examine the current literature for the most recent updates on health effects of specific air pollutants and their impact on asthma, chronic obstructive pulmonary disease, lung cancer, and respiratory infection. RECENT FINDINGS: A total of 52 publications were reviewed to establish new insights as to how air pollution is associated with pulmonary morbidity and mortality. Considerable past evidence suggests that air pollution is an important factor that enhances pulmonary disease, while also causing greater harm in susceptible populations, such as children, the elderly, and those of low socio-economic status worldwide. Asthma, chronic obstructive pulmonary disease, lung cancer, and respiratory infections all seem to be exacerbated because of exposure to a variety of environmental air pollutants with the greatest effects because of particulate matter, ozone, and nitrogen oxides. New publications reviewed reaffirm these findings. SUMMARY: Continued vigilance will be essential to lessen the effects of air pollution on human health and pulmonary disease. Cooperation at a multinational level will be required on the part of governments, industry, energy-based enterprises, and the public working together to solve our air quality issues at the local, national, and global level.

Pentraxin 3 as a novel biomarker of inflammation in chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is a complex chronic inflammatory disease of the lungs in which inflammatory markers are involved with significant extrapulmonary effects that may contribute to its severity and complications. Moreover, some of the inflammatory markers such as C-reactive protein (CRP) are associated with COPD. Pentraxin 3 (PTX3) is the member of long pentraxins. The aim of the present study was to investigate the level of PTX3 in patients with COPD. Fifty-four COPD patients and 31 controls were enrolled in this study. Demographical data such as age, sex, cigarette smoking status, comorbidities, drugs, habits, and modified Medical Research Council (MMRC) dyspnea scores were recorded. All patients were asked for COPD Assessment Test™ (CAT). The mean age was 65.7 ± 9.8 years, 92 % male. Plasma levels of PTX3 were found to be markedly higher in COPD patients [1.65 (0.32-12.72) ng/ml] than in controls [1.05 (0.43-3.26) ng/ml; p = 0.005]. On the other hand, PTX3 values did not differ between COPD stages [A, 1.73 (0.69-11.03); B, 1.49 (0.84-12.52); C, 0.79 (0.52-1.06); and D, 2.09 (0.32-12.72); p = 0.27]. The plasma PTX3 levels were positively correlated with MMRC scores. We conclude that circulating PTX3 levels are elevated in COPD patients. Plasma levels of PTX3 were correlated with dyspnea (MMRC scores). But PTX3 levels were not correlated with the severity of COPD.

The prevalence of obstructive sleep apnea in patients with difficult-to-treat asthma.

OBJECTIVES: Obstructive sleep apnea (OSA) occurs more commonly in asthma patients than in the general population and can complicate asthma management. The aim of this study was to evaluate the presence of OSA in patients with difficult-to-treat asthma (DTA) and to investigate the sleep quality in these patients. METHODS: Patients with DTA were recruited from the adult allergy clinic of a tertiary care hospital. After completing the Sleep Questionnaire and Epworth Sleepiness Scale, all participants underwent overnight polysomnography. The demographic and asthma severity assessments included the following measures: the age at diagnosis, duration of illness, smoking and atopy status, results of pulmonary function tests, number of asthma control medications used, and number of hospitalizations and emergency room visits because of asthma and analgesic hypersensitivity according to apnea-hypopnea index (AHI) scores. RESULTS: We analyzed 47 (M:9/F:38) DTA patients with a mean age of 48.74±9.45 years. The mean duration of asthma was 9.17±6.5 years. Twenty-four (51.1%) patients were atopic. The analgesic hypersensitivity rate was 27.7%. Fourteen patients (29.8%) were former smokers and 2 patients were current smokers. Sleep quality was impaired in all patients. Thirty-five patients (74.5%) had OSA, 11 of whom had mild OSA, and 24 patients had moderate-severe OSA. The presence of OSA was not statistically correlated with asthma characteristics. CONCLUSION: The study showed that there is a remarkably high prevalence of OSA in DTA. Although no statistically significant relationship between the presence of OSA and clinical asthma characteristics was identified, all DTA patients should be assessed for OSA.

Does gender affect asthma control in adult asthmatics?

Several studies have shown gender differences in prevalence of asthma but there is little information about asthma control. In this study, we aimed to evaluate the effect of gender on asthma control in adult asthmatics. Medical records of 242 patients older than 18 years of age who regularly visited the allergy unit were evaluated. Standardized asthma questionnaires like the asthma control test (ACT) were performed. ACT scores, clinical characteristics, and demographic data such as smoking status, education, duration and severity of asthma, atopic status, family history of asthma, analgesic hypersensitivity, number of emergency visits, and hospitalization in the previous year were compared based on gender. In this study, 77.3% of the patients were female. Mean age, body mass index, and duration of asthma were 39.0 ± 0.7, 27.3 ± 0.3, and 6.6 ± 0.4 years, respectively. Of the total, 14.9% of the patients were smokers. Also, 55.8% of them were graduated from middle school, 22.7% from high school, and 14% from university. Atopy rate was 57%. Analgesic hypersensitivity was found in 18.6% of them. There was 30.2% family history of asthma. The asthma severity was mild in 45.5%, moderate in 40.9%, and severe in 13.6% of the patients. One-third of the patients were admitted to emergency room; 1/10th were hospitalized due to asthma in the previous year. ACT scores indicated complete control in 67.8%, partial control in 17.8%, and uncontrolled asthma in 14.5%. Comparing the results of males with females having asthma, there was no statistically significant difference between the two gender according to ACT scores and clinical characteristics. Finally, the results conclude that there was no effect of gender on asthma control assessed with standardized questionnaire in adult asthmatics.

Serum omentin levels in patients with obstructive sleep apnea.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is associated with increased rates of cardiovascular diseases (CVD). The basic mechanisms involved in the increased cardiovascular risk of OSAS remain unclear. Recent discoveries of fat-secreted substances which serve endocrine roles improve our understanding of the relationship between OSAS, CVD, and the metabolic syndrome. In this study, we aimed to examine associations between omentin levels and OSA. METHODS: Forty-six newly diagnosed OSA patients and 35 non-apneic controls were enrolled in this study. Demographical data, cigarette smoking status, previous history of chronic diseases including CVD and metabolic diseases and drugs, and habits were obtained using a standardized questionnaire. All patients underwent polysomnographic evaluation. Omentin was measured the following morning. RESULTS: The mean age was 48.1 ± 12.5 (24-74) years in the OSA group and 42.8 ± 14.1 (21-69) years in the control group. Of the 81 patients, 46 (34 males and 12 females) were classified as having OSA and 35 patients (20 males and 15 females) as control. Plasma levels of omentin were found to be markedly higher in OSA patients (570.8 ng/ml) than in the control group (432.0 ng/ml; p < 0.001). In addition, plasma levels of omentin were found to be high in all OSA subgroups than in controls. The plasma omentin levels were significantly correlated only with age in patients with OSA. CONCLUSIONS: We conclude that circulating omentin levels are elevated in OSA patients. To the best of our knowledge, this is the first clinical study that demonstrated the association between omentin and OSA.

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.

Serum cardiotrophin-1 and IL-6 levels in patients with obstructive sleep apnea syndrome.

Obstructive sleep apnea syndrome (OSAS) is associated with increased rates of cardiovascular diseases (CVD). Basic mechanisms involved in the increased cardiovascular risk of OSAS remain unclear. Inflammation has been shown to potentially play a critical role in this association. The aim of the present study was to investigate the level of cardiotrophin-1 (CT-1) in patients with OSAS. Forty-eight newly diagnosed OSAS patients and 37 nonapneic controls were enrolled in this study. Demographic data, cigarette smoking status, previous history of chronic diseases including CVD and metabolic diseases and drugs, and habits were obtained by a standardized questionnaire. All patients underwent polysomnographic evaluation. The mean age was 48.3 ± 12.3 (24-74) years in OSAS group. Median apnea-hypopnea index was 23.6 (6-91.8) and median body mass index was 30.4 (24.2-49.4) in the OSAS group. Plasma CT-1 levels in OSAS and control groups, respectively, were 12.03 ± 1.08 and 11.85 ± 1.18 pg/ml. There was no significant difference in the plasma levels of CT-1 and IL-6 between the OSAS group and the controls.

The importance of laboratory parameters in patients with obstructive sleep apnea syndrome.

Platelet activation and inflammation are the related mechanisms of pathogenesis in obstructive sleep apnea syndrome (OSAS). Mean platelet volume (MPV) and platelet distribution width (PDW) are the markers of platelet activation. C-reactive protein (CRP) and red cell distribution width (RDW) in relation to the inflammation in OSAS might be increased. We aimed to investigate the correlation of the MPV, PDW, and RDW levels with the severity of OSAS. We included 98 patients with suspected OSAS, evaluated by polysomnography. According to their apnea-hypopnea index (AHI), patients were divided into group A (n = 20; 20.4%) with AHI below 5/h; group B (n = 15; 15.3%) with AHI 5-14.9/h; group C (n = 26; 26.5%) with AHI 15-29.9/h; and group D (n = 37; 37.8%) with AHI ≥30/h. Hemoglobin, MPV, PDW, and RDW were measured using an automated blood cell counter. BMI and age showed a statistically significant and gradual increase in AHI groups. Hemoglobin, platelet, CRP, MPV, and RDW values did not differ between AHI groups. PDW was significantly higher in group D (mean value 14.4 ± 1.8) than in group A (13.2 ± 0.5) (P < 0.001). Epworth sleepiness scale was significantly higher in group D (9.9 ± 5.5) than in group A (5.6 ± 3.5), B (9.2 ± 3.6) and C (6.6 ± 3.8) (P = 0.005). When the four groups were compared, group D had the lowest minimum SpO2 value [group A (89.4 ± 3.0), B (86.7 ± 4.2), C (81.2 ± 6.4), and D (68.2 ± 13.0)]. There was a statistically significant correlation between AHI and age (r = 0.35, P < 0.001), BMI (r = 0.31, P = 0.003), PDW (r = 0.28, P = 0.006), and Epworth sleepiness scale (r = 0.29, P = 0.007). However, AHI was not correlated with CRP, MPV, and RDW. PDW is higher in severe OSAS and is correlated with different parameters of breathing function during sleep. The severity of OSAS was not correlated with CRP, MPV, and RDW. These findings show an evidence for platelet activation in OSAS and suggest that PDW might be related markers of OSAS severity.

Hepatic granulomas: a clinicopathologic analysis of 86 cases.

The aim of this study was to determine the prevalence and histopathological characteristics of hepatic granulomas. All records of liver biopsies/resections evaluated in our pathology department between 2002 and 2009 were retrospectively reviewed. Specimens with hepatic granulomas were reexamined by a designated pathologist. Type and localization of granulomas, size of granulomas and epithelioid histiocytes, and the morphological findings of surrounding liver tissue were recorded in an attempt to establish a correlation with relevant clinical, laboratory and radiological findings. Out of 1420 liver biopsy/resected specimens evaluated at our institution during the study period, 86 cases of epithelioid cell granulomas (6.05%) were observed. Of the 86 cases, 23 were men and 63 were women. The most common underlying etiology was PBC in 38 patients, infections in 34, malignancies in five, sarcoidosis in four, and foreign bodies in three patients. One case (1.2%) of a drug-induced hepatic granuloma was encountered, while another case was deemed idiopathic (of unknown etiology). Contrary to common belief, granulomas were observed not only in early stage PBC but also in cases with stage 3 disease. Out of all the PBC cases with granulomas, 55.6% had stage 3 disease, and besides periductal granulomas, intraacinar granulomas were also seen. For sarcoidosis, intra- and peri-granulomatous fibrosis was observed in as many as 75% of cases. A large majority of granulomas (82.4%) associated with infections were of the necrotizing type. Extensive evaluation of the morphological characteristics of hepatic granulomas and surrounding liver tissue along with clinical, radiological, and other laboratory findings may help arrive at an accurate diagnosis in a majority of cases. Rather than being a final diagnosis, the presence of hepatic granulomas entails the need for further investigations towards identifying the underlying etiology, with a pathologist being at the center of the diagnostic process.

Evaluation of a haemostatic agent in rabbits.

Topical hemostatic agents are applied locally to areas of injured vascular endothelium to control local bleeding. Ankaferd Blood Stopper (ABS) has gained approval in Turkey and Bosnia-Herzegovina as a topical haemostatic agent for external post-surgical and post-dental surgery bleeding. The safety of topical use of ABS has been demonstrated in numerous in vitro and in vivo animal models, as well as in a clinical Phase I trial in humans. ABS, besides its haemostatic activity, also has in vitro anti-infectious and anti-neoplastic effects. To assess potential detrimental effects of intravenous administration of ABS into intact systemic circulation in a rabbit experimental model, one milliliter of ABS was administered intravenously into the systemic circulation of twelve rabbits which were included in the study via the marginal ear vein. Animals were observed for 1 hr before euthanasia was performed by administering 40 mg of intracardiac suxamethonium chloride. In the event of death (cardiopulmonary arrest) before the end of the planned observation period of 60 minutes, time of death was recorded and histopathological examination of the liver and spleen was commenced. Ten rabbits were alive by the end of the planned observation period, without showing any clear signs of discomfort, whereas two animals died within five minutes after systemic administration of intravenous ABS. Postmortem histopathological examination of the livers and spleens of all animals' revealed findings consistent with hepatic venous outflow obstruction. Systemic intravascular administration of ABS into intact vascular endothelium should never be performed in any setting. Further experimental and clinical studies on this liquid hemostatic agent should proceed by accepting ABS as purely a topical haemostatic agent, to be applied solely to areas of injured vascular endothelium.

The diagnostic role of capnography in pulmonary embolism.

The aim of this study was to evaluate the diagnostic contribution of alveolar dead space fraction (AVDSf) measured using capnography in patients admitted with suspected pulmonary embolism (PE). A total of 58 patients who were admitted to our hospital with suspected PE between October 2006 and January 2008 were included in this study. All patients were assessed using the Wells clinical score, capnography, computed tomographic pulmonary angiography, D-dimer measurement, lower-extremity venous Doppler ultrasonography, and V/Q scintigraphy. Forty patients (69%) had PE based on computed tomographic pulmonary angiography findings. The AVDSf value with the highest sensitivity and specificity, which was at the same time statistically significant, was 0.09. This value was consistent with the AVDSf value obtained using receiver operating characteristic analysis. In our study, the sensitivity of capnography was 70%, with a specificity of 61.1%, positive predictive value of 80%, and negative predictive value of 47.8%. The use of AVDSf in combination with any of the several scoring systems that evaluate clinical likelihood of PE and D-dimer levels resulted in higher sensitivity and specificity rates for the diagnosis of PE.