The efficiency of inspiratory muscle training in patients with ankylosing spondylitis.

Ankylosing spondylitis (AS) is an inflammatory rheumatic disease affecting mainly the axial skeleton and sacroiliac joints. The aim of the current study was to investigate the effects of inspiratory muscle training (IMT) on respiratory muscles and functional exercise capacity, as well as on the specific outcomes of the disease in AS patients. A total of 32 AS patients (mean age 37.37 ± 10.41 years) were randomly assigned as the Training Group (TG) (n = 16, mean age = 35.62 ± 8.18 years) who received IMT + conventional exercise, and the Control Group (CG) (n = 16, mean age = 39.12 ± 12.26 years) who only performed the conventional exercise program. All the subjects were evaluated at baseline and at the end of the 8th week. Respiratory muscle strength was assessed by measuring the maximal inspiratory pressure (PImax) and maximal expiratory pressure (PEmax). Functional exercise capacity was measured using the 6-min walk test (6MWT). The Bath AS Disease Activity Index (BASDAI), Bath AS Disease Function Index and Bath AS Metrology Index were used for activity, function and basic measurements of the disease. A statistically significant improvement was determined in the PImax (p = 0.000), PEmax (p = 0.002), 6MWT (p = 0.041) and BASDAI (p = 0.049) values in the TG after training. There was a significant difference between baseline and after conventional exercise in terms of PEmax (p = 0.017) in the CG. The PEmax (p = 0.001) and the 6MWT (p = 0.053) values were significantly better in the TG. The results of this study demonstrated that IMT in addition to conventional exercises increased inspiratory muscle strength, functional exercise capacity and positively affected the disease activity in AS.

Severity of coronary atherosclerosis in patients with COPD.

BACKGROUND AND AIMS: Chronic obstructive pulmonary disease (COPD) has many comorbidities such as coronary artery disease (CAD) and stroke. Chronic low-grade systemic inflammation and oxidative stress play a significant role in CAD and COPD. We analysed that impact of COPD on intensity and severity of coronary artery lesions on the angiogram in the groups of patients with COPD according to the Global Initiative for Obstructive Lung Disease (GOLD) grades updated in 2015. METHODS: The study included 102 COPD patients and 80 randomly selected subjects without any pulmonary disease who underwent coronary angiography. According to the GOLD grade for COPD, patients were divided into four groups: A, B, C and D. The severity and extent of CAD were determined using the Gensini score. RESULTS: There were no significant between-group differences in age, body mass index, smoking history, plasma lipids levels, frequency of hypertension, diabetes and CAD. The mean Gensini score in patients with COPD was significantly higher than those without (respectively, 25.7 ± 32.9 vs 17.5 ± 24.8, P = 0.01). While Gensini score was the highest level in the patient group D (64.9 ± 34.9), it was the lowest level in the patient group A (10.2 ± 19.4, P = 0.0001). The Gensini scores increased in accordance with increases in the GOLD grades. We observed that COPD was independently predictive for Gensini score after a multi-variate logistic regression analysis (odds ratio 1.374; 95% confidence interval 1.672-9.232; P = 0.001). CONCLUSION: Severity and intensity of coronary atherosclerosis increases in accordance with increases in the GOLD grades for COPD.

Evaluation of cardiac biomarkers and right ventricular dysfunction in patients with acute pulmonary embolism.

OBJECTIVE: Right ventricular dysfunction (RVD) with myocardial damage may lead to fatal complications in patients with acute pulmonary embolism (PE). Cytoplasmic heart-type fatty acid-binding protein (HFABP) and the N-terminal fragment of its prohormone (NT-proBNP) are sensitive and specific biomarkers of myocardial damage. We evaluated RVD and cardiac biomarkers for myocardial damage and short-term mortality in patients with acute PE. METHODS: We analyzed 41 patients (24 females, 17 males) with confirmed acute PE prospective. Three groups (massive, submassive, and non-massive) of patients were defined, based on systemic systolic blood pressure measured on admission and RVD by transthoracic echocardiography (TTE). Also, systolic (s) and mean (m) pulmonary artery pressures (PAPs) were recorded by TTE, and plasma concentrations of cardiac troponin T (cTn-T), NT-proBNP, and HFABP were evaluated 6 month follow-up. RESULTS: Seventeen (41.5%) patients experienced a complicated clinical course in the 6-month follow-up for the combined end-point, including at least one of the following: death (n=12, 29.3%; 3 PE-related), chronic PE (n=4, 9.8%), pulmonary hypertension (n=2, 4.9%), and recurrent PE (n=1, 2.4%). Multivariate hazard ratio analysis revealed HFABP, NT-proBNP, and PAPs as the 6-month mortality predictors (HR 1.02, 95% CI 1.01-1.05; HR 1.01, 95% CI 1.01-1.04; and HR 1.02, 95% CI 1.02-1.05, respectively). CONCLUSION: HFABP, NT-proBNP, and PAPs measured on admission may be useful for short-term risk stratification and in the prediction of 6-month PE-related mortality in patients with acute PE.

[Psychiatric evaluation in patients with obstructive sleep apnea syndrome]. / Obstrüktif uyku apne sendromlu hastalarin psikiyatrik açidan degerlendirilmesi.

INTRODUCTION: Obstructive sleep apnea syndrome (OSAS) might cause neuropsychiatric problems as well as cardiovascular and cerebrovascular complications. Daily life of the patients are effected and their quality of life decreases. In the present study, we aimed to evaluate anxiety and depression and to test their ability to cope with strees in patients with OSAS. MATERIALS AND METHODS: The patients with OSAS suspect admitting to our sleep laboratuary, were classed as simple snoring, mild-moderate and severe OSAS according to their apnea-hypopnea index (AHI). Hospital anxiety and depression, stres coping and skill loss scales were applied to the patients accepted to participate to the study. RESULTS: Fifty four patients participated into the study. Forty-one (75.9%) were OSAS and 13 (24.1%) were simple snoring (control group). Mean age was 52.3 ± 9.2 years in OSAS group, while it was 50.5 ± 9.9 years in control group. Snoring was found in every patient of two groups. Thirty-one (79.5%) patients with OSAS had witnessed apneas and 23 (60.5%) had exceesive OSAS patients had excessive daytime sleepiness. There was no significant differences in age, BMI, sleep efficency, HAD and skill loss scales between both groups. Autism was found higher in OSAS group with stres coping test (p= 0.031). Moreover, social support necessicity was found higher in moderate and severe OSAS patients. CONCLUSION: We found that neuropsyhiatric problems are highly seen in moderate and severe OUAS patients.