Is non-thyroidal illness syndrome a predictor for prolonged weaning in intubated chronic obstructive pulmonary disease patients?

INTRODUCTION: Non-thyroidal illness syndrome (NTIS) is considered to be associated with adverse outcomes in intensive care unit (ICU) patients. In this study, we evaluated the association between NTIS and prolonged weaning in chronic obstructive pulmonary disease (COPD) patients admitted to the ICU. MATERIALS AND METHODS: In total, 125 patients with COPD admitted to our ICU who underwent invasive mechanical ventilation (MV) were enrolled. We collected each patient's baseline characteristics including Acute Physiology and Chronic Health Evaluation (APACHE) II score, body mass index (BMI), and thyroid hormones 24 h after ICU admission. The presence of pulmonary infection was also recorded. The primary outcome was prolonged weaning, defined as patients who failed at least three weaning attempts or required > 7 days of weaning after the first spontaneous breathing trial. RESULTS: Of the 127 patients studied, 64 had normal thyroid function tests and 61 had NTIS. Patients with NTIS had significantly higher APACHE II scores, prolonged weaning, and pulmonary infection. Patients with NTIS had a higher risk for prolonged weaning (odds ratio, OR = 3.21; 95% CI = 1.31-7.83).The presence of pulmonary infection was also an independent risk factors for prolonged weaning. CONCLUSIONS: NTIS may be an independent predictor for prolonged weaning in intubated COPD patients.

Does CPAP therapy alter urinary albumin level in adult patients with moderate to severe obstructive sleep apnea syndrome?

BACKGROUND: Urinary albumin is a marker of cardiovascular morbidity and mortality, and also it has been viewed as a marker for vascular endothelial dysfunction in both the kidneys and systemic vasculature. Lowering urinary albumin is associated with fewer cardiovascular and renal diseases. We investigated the change in urinary albumin after 1 month of continuous positive airway pressure (CPAP) therapy in obstructive sleep apnea syndrome (OSAS). METHODS: Eighteen patients (four females) in the middle-age group with moderate to severe OSAS were enrolled, who received and were compliant to CPAP therapy. Patients did not have a systemic disease or use a medication that could influence urinary albumin. Blood and urine samples were obtained in the morning after polysomnography and after 1 month of CPAP therapy to measure urinary albumin excretion and urinary albumin-to-creatinine ratio. RESULTS: Urinary albumin excretion (UAE) and urinary albumin/creatinine ratio (UACR) decreased significantly after 1 month of CPAP therapy: UAE at baseline and 1 month, 50 (1.1-174.8) and 22.7 (4.1-55.9); UACR, 27 (18.5-51.6) and 10.6 (4.3-43.1). UAE alteration was significantly associated with proportion of sleep time spent below an SaO2 of 90%. Serum creatinine, serum total cholesterol, and creatinine clearance also decreased after 1 month of CPAP therapy. CONCLUSION: Albuminuria is not rare in patients with OSAS and can be corrected after CPAP therapy. Determination of urinary albumin level is a simple, inexpensive, and noninvasive method that could be a promising biomarker to identify a high-risk population in patients with OSAS who may benefit from closer medical follow-up and preventive therapy.

Markers of lower respiratory tract infections in emergency departments.

BACKGROUND: Acute respiratory tract infections are the common causes for admission to emergency department. Appropriate diagnosis and initiating treatment on time are important for reducing morbidity and mortality rate due to lower respiratory tract infection (LRTI). The aim of this study is to determine if C-reactive protein (CRP) levels and white blood cells (WBC) count are considerable markers to help rapid diagnosis and prediction of antibiotic need for lower respiratory infections in emergency departments. The relationships between infectious agents and those markers have also been evaluated. METHODS: Study subjects and control group were selected by defined criteria. Patients were analyzed and assessed for CRP and WBC, sputum Gram stain and culture besides routine laboratory tests and chest X-Rays. RESULTS: One hundred and ninety four episodes out of 175 patients were evaluated for the study. CRP level and WBC count were detected significantly higher in patients ofstudy group than in those of control group. Pseudomonas aeruginosa and Haemophilus influenzae were the pathogens most often isolated. CONCLUSION: In conclusion, CRP and WBC sputum are important markers for diagnosis of LRTI at the emergency departments and results of microbiological analysis of respiratory specimens were correlated with these markers. TRIAL REGISTRATION: Registation number of ethic committee of Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital: 28.04.2006/114.

Nontuberculous mycobacteria isolated from pulmonary specimens between 2004 and 2009: causative agent or not?

Nontuberculous mycobacteria were identified from 45891 samples of 19553 patients with a prediagnosis of pulmonary tuberculosis between November 2004 and January 2009. Among 10041 (21.9%) culture positive samples, 208 (2.1%) pulmonary samples recovered from 77 individual patients were differentiated as mycobacteria other than tuberculosis (MOTT). Proportion of mycobacteria evaluated as causative agent for clinical infection were found as 0.16% (n = 31), mostly M. avium complex, M. abscessus and M. kansasii. Additionally, M. fortuitum-peregrinum complex, M. simiae, M. szulgai / intermedium and M. scrofulaceum were found as causative agent in 2, 2, 2 and 1 patient, respectively. Identification of infections caused by environmental or opportunistic pathogen mycobacteria is required in rapid and accurate diagnosis, infection control and treatment planning of infections caused by M. tuberculosis complex and/or MOTT.

[Identification of atypical mycobacteria isolated from clinical specimens by line probe assay (LIPA)]. / Klinik örneklerden izole edilen atipik mikobakterilerin "line probe assay" (LIPA) yöntemiyle tanimlanmasi.

The aim of this study was the identification of atypical mycobacteria isolated from various samples of patients prediagnosed as tuberculosis between November 2004 and June 2006 by a commercial polymerase chain reaction (PCR) based reverse hybridization kit (INNO-LiPA Mycobacteria v2, Innogenetics NV, Belgium). A total of 21,060 samples obtained from 9660 patients were included to the study. After decontamination and homogenization processes, the samples were cultivated in automated MGIT Bactec 960 system and the diagnosis of atypical mycobacteria was performed in 4532 (21.5%) culture positive samples with NAP test by using Bactec 460 TB system. After DNA isolation, PCR method was performed by using the primers specific for mycobacterial 16S-23S spacer region. PCR products were then hybridized with the probes specific for Mycobacterium species on nitrocellulose strips according to the recommendations of the manufacturer and evaluated. Additionally, two different versions of another commercial Line Probe Assay (LiPA) kit [GenoType Mycobacterium and GenoType Mycobacterium AS (Additional Species), Hain Lifescience, Germany] were used for the detection of unidentified mycobacterial strains. In our study period, 10 different Mycobacterium species were identified from 44 (1%) respiratory tract samples (sputum, bronchial aspiration fluid, bronchoalveolar lavage) belonging to 30 patients. While repeated atypical mycobacterial growth was found in 13 patients on different days, 17 patients showed atypical mycobacterial growth only in one sample or in separate multiple samples taken within the same day. The species distribution among patients were as follows; M. fortuitum-M. peregrinum complex (n=5), M. intracellulare (n=4), M. avium complex (n=4), M. chelonae complex (n=4), M. gordonae (n=4), M. kansasii (n=3), M. szulgailintermedium (n=2), M. simiae (n=1) and M. scrofulaceum (n=1). Two of four samples which were unidentified by INNO-LiPA and GenoType MTBC were identified as M. szulgai/intermedium by GenoType Mycobacterium AS and the other two were found as unidentified atypical mycobacteria (Mycobacterium spp.). As a result, the frequency of atypical mycobacteria isolated in our hospital was thought to be low, however, species-level identification might be useful for the planning of therapy in such patients. In addition, after NAP test, INNO-LiPA and GenoType Mycobacterium were useful tests in microbiological identification of atypical mycobacteria, and GenoType Mycobacterium AS test could be applied in mycobacterial strains which were not identified by the former assays.

Successful treatment of invasive pulmonary aspergillosis in an immunocompetent host.

Immunocompromised individuals are susceptible to pulmonary Aspergillus infection, but invasive Aspergillus infection is extremely rare in the presence of normal immunity. A case of invasive pulmonary aspergillosis in an immunocompetent 57-year-old female who was successfully treated with liposomal amphotericin-B is reported here.

Multiple pulmonary arterial aneurysms in Behçet's disease: clinical and radiologic remission after cyclophosphamide and corticosteroid therapy.

Behçet's disease (BD) with pulmonary arterial aneurysm is rare and often associated with a poor prognosis. But there is also a chance that the aneurysm may completely resolve with medical therapy. A 39-year-old man presented with fever, malaise, bilateral chest pain, recurrent oral ulcers, and hemoptysis. The chest radiograph showed a round opacity in the right hilum. Computed tomography and magnetic resonance angiography (MRA) further revealed multiple, bilateral pulmonary arterial aneurysms consistent with the diagnosis of BD. The patient was started on a course of cyclophosphamide and corticosteroid therapy that resulted in cessation of his symptoms and complete resolution of radiologic findings. The chest radiograph and MRA reverted to normal on long-term follow-up. He is still alive and symptom-free 20 months after diagnosis.