Case report of a novel alpha1-antitrypsin null variant in Türkiye: Q0RIZE.

BACKGROUND: Alpha1-antitrypsin (AAT) is a serine protease inhibitor that serves as a counterbalance to the activity of elastases, e.g., neutrophil elastase in lung tissue. AAT deficiency (AATD) is a rare disorder usually arising from mutations to the SERPINA1 gene that codes for AAT. The most common AATD alleles are S and Z which produce ~ 40% and ~ 90% reductions in serum AAT, respectively. Rare genetic variants (> 500 identified) can also be associated with mild to severe AATD. RESULTS: This report describes a novel mutation of SERPINA1 producing AATD, which we have designated, Q0RIZE. This mutation was identified in a 44-year-old woman admitted with massive hemoptysis and treated with bronchial artery embolization. Computed tomography revealed centriacinar and panacinar emphysema with prominent air entrapment, atelectasis, and localized bronchiectasis. Serum AAT was < 0.27 g/L (below detection limit). Genetic analysis showed homozygous deletion of exons I to III. CONCLUSIONS: Although many SERPINA1 variants have been identified, variants with large deletions and identified in a homozygous individual, as seen in this case with Q0RIZE, are uncommon. AATD is an underdiagnosed and undertreated disease. Wider screening of COPD patients could result in earlier diagnosis and treatment that could preserve lung function.

Giant lung cavity due to three different pathogens in a patient receiving inhaled salmeterol plus fluticasone propionate for asthma.

INTRODUCTION: High-dose and long-term use of inhaled corticosteroids may cause systemic and local side effects such as opportunistic infections. Here we report a patient with asthma who developed a giant cavity in the lung while using inhaled salmeterol plus fluticasone propionate. CASE STUDY: A 57-year-old female patient presented with a three-week history of cough, hemoptysis, and dyspnea. She had a diagnosis of asthma for 4 years and was using an inhaled salmeterol plus fluticasone treatment intermittently for 2 years. A giant cavity was detected in the patient's chest X-ray. As a result of further investigations, three different microorganisms were isolated from the samples of sputum, bronchial lavage and lung biopsy. RESULTS: Staphylococcus aureus was the first microorganism that was isolated from the sputum and the bronchial lavage. Afterwards, Candida albicans was detected in both the bronchial lavage fluid and the histologic examination of the tissue samples obtained by percutaneous lung biopsy. Appropriate antibiotics and antifungals were prescribed. Moderate clinical and radiological response to the treatment was obtained. During the outpatient follow-up, Mycobacterium tuberculosis growth which was sensitive to all of the major anti-tuberculosis drugs was reported in the mycobacterial culture, and the patient was started on anti-tuberculosis treatment. CONCLUSION: Tuberculosis and other opportunistic infections are a potential consequences of inhaled corticosteroids. Clinicians overseeing such patients need to be vigilant about the need for timely investigations about tuberculosis before and during prescribing medications containing inhaled corticosteroids.

Mediastinitis and subcutaneous abscess complicated after EBUS-TBNA of 2R mediastinal lymph node.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUSTBNA) is a minimally invasive diagnostic tool used for the evaluation of mediastinal lymphadenopathy. It is a safe procedure, but complications such as bleeding and infection may occur. We report a case of a patient who developed a subcutaneous abscess abscess and mediastinitis after EBUSTBNA. A 75-year-old male with a history of right nephrectomy due to renal cell carcinoma and lung adenocarcinoma history underwent EBUS-TBNA for the evaluation of a right upper paratracheal lymph node. Two weeks after the procedure, the patient presented to the emergency department with skin induration and erythema on the right clavicular area. A non-contrast neck and thorax CT scan was performed, which revealed an extensive subcutaneous abscess on the right clavicular area, extending to the supraclavicular region. The patient was hospitalized, and empirical intravenous antibiotics were initiated due to deep neck infection. Repeated drainage of the subcutaneous abscess was performed. Bacteriologic examination revealed Streptococcus mitis. The patient showed improvement with antibiotic treatment, and a follow-up ultrasound showed a decrease in the size of the abscess and was discharged approximately four weeks after hospitalization. Although very rare, serious infectious complications may develop after EBUSTBNA, and our case report is an important example regarding its management process.

Caregiver Burden in Pulmonary Patients.

Caregiving has become an increasingly important medical and social issue in recent decades. We performed a cross-sectional study on pulmonary patients and accompanying informal caregivers who were hospitalized in the chest disease ward of a tertiary center in Turkey between January 2020 and April 2021. Informal caregivers were asked to complete the Zarit Caregiver Burden Interview. A total of 141 inpatients (39% female, mean age: 76.8 ± 10.2 years) and their informal caregivers (77% female, mean age: 54 ± 11.9 years) were evaluated. The caregivers were classified as light to medium burden (group 1, burden score ≤40) and medium to heavy burden (group 2, burden score >40). The mean burden score was 35.7 ± 13.3 points. The number of female caregivers was higher in group 2 (p = 0.025). There was a positive correlation between the burden score and female gender (p = 0.002) and the number of chronic diseases of caregivers (p = 0.020). Statistical analysis revealed a negative correlation between the burden score and the level of education (r = > -0.174, p = 0.040). Caregiver burden is related to the characteristics of the caregiver rather than those of the patient being cared for. Female caregivers with lower education and more than one chronic disease perceive a higher caregiver burden.

'COVID-Somnia' in healthcare workers during the pandemic.

OBJECTIVES: Sleep disorders associated with COVID-19 pandemic are termed as 'COVID-somnia.' In this study, we sought to assess the prevalence of COVID-somnia in healthcare workers, establish the factors that trigger this condition, and to investigate its relationship with anxiety and depression symptoms. METHODS: This cross-sectional study was conducted between April 2021 and June 2021, and it included healthcare workers who served during the pandemic. Participants' demographic data, Beck Depression and Anxiety Inventories, Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Insomnia Severity Index (ISI) were used, and the results were statistically analyzed. Multiple analyses of factors affecting ESS and ISI scores were evaluated using binary logistic regression model and PSQI score were analyzed using a multiple linear regression model. RESULTS: A total of 1,111 healthcare workers who served during the pandemic voluntarily enrolled to the study. The mean age was 37.3 ± 8.48 years, and 63.5% were females. Our study showed that the healthcare workers, evaluated with the PSQI, experienced a deterioration of sleep quality. Primary factors affecting this are working on the front line, the presence of chronic diseases, depression, and anxiety. Regression analyses identified depression and anxiety as the common factors affecting ESS, ISI, and PSQI scores. CONCLUSION: Raising awareness regarding COVID-somnia among healthcare workers, who play a leading role in curbing the pandemic, would reduce sleep disturbances, depression, and anxiety. It would also contribute to the planning and implementation of preventive and therapeutic mental health programs with a multidisciplinary approach.

Thyroid Gland Disease as a Comorbid Condition in COPD.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is one of the most common causes of morbidity and mortality worldwide. The disease is characterized by progressive airway inflammation, which not only affects the airways but also has systemic effects that are associated with comorbidities. Although comorbid conditions such as hypertension and coronary artery disease are very well-known in COPD patients, diseases of the thyroid gland have not been sufficiently studied. Therefore, thyroid diseases are not considered among the comorbid conditions of COPD. The purpose of this study was to determine the thyroid gland disease (TGD) prevalence in COPD and associated factors. Materials and Method. The study included 309 (297 (96%) male) patients. The patients were subjected to spirometry and thyroid function tests (TFT) in the stable period. The thyroid gland disease they were diagnosed with was recorded after face-to-face meetings and examining their files. RESULTS: The mean age of the patients who were included in the study was 65.9 ± 9.8 (40-90). Thyroid disease was determined in 68 (22%) individuals. There were hypothyroidism in 7 (2%), euthyroidism in 45 (15%), and hyperthyroidism in 16 (%5) patients. No relationship was found between the severity of airflow limitation and the prevalence of TGD. CONCLUSION: Thyroid abnormalities are commonly observed in COPD. The most frequently encountered TGDs are euthyroid multinodular goiter, euthyroid sick syndrome (ESS), and toxic multinodular goiter.

Rate of History of Tuberculosis Among Healthcare Workers in Turkey: A Cross-Sectional Study.

OBJECTIVES: Healthcare workers (HCWs) possess a high risk for both latent tuberculosis infection (LTBI) and active disease. This study aimed to investigate tuberculosis (TB) disease history in hospital staff working in healthcare institutions in the Eastern Black Sea Region of Turkey. MATERIAL AND METHODS: This study included 460 HCWs employed in 5 hospitals in the Eastern Black Sea Region of Turkey. Between May 01 and July 31, 2016, the participants were asked to answer a questionnaire, including data about TB history. The data about family TB history, Bacilli Calmette-Guerin (BCG) vaccination, or tuberculin skin test (TST) application before starting work were also evaluated. RESULTS: Of the 460 participants, 69.3% were women (n=319) and 30.7% (n=141) were men. The mean age was 32 (17-63) years. A total of 8 participants (1.7 %) had TB history. There was no statistically significant relationship between TB history and age, sex, body mass index (BMI), smoking habits, or presence of comorbidities (p>0.05 for all variables); family history of TB (p<0.001) and TST positivity (p<0.001) were significantly higher in participants with a TB history. Each participant was checked for the presence of both BCG scar and TST positivity. No difference was noted between positive TB history and negative HCWs (p>0.05). The duration of work (years) was higher in participants with a TB history. The p value was very close but did not reach the limits of significance (p=0.059). CONCLUSION: In this study, the rate of TB among HCWs was 1.7% (8 of 460 HCWs). Family history of TB and TST positivity are strong predictors of TB in HCWs.

Weight Loss as the First-Line Therapy in Patients with Severe Obesity and Obstructive Sleep Apnea Syndrome: the Role of Laparoscopic Sleeve Gastrectomy.

PURPOSE: The objective of this study is to investigate the effects of laparoscopic sleeve gastrectomy (LSG) on the polysomnographic parameters related to OSAS. MATERIALS AND METHODS: We conducted this 3-year prospective cohort study in a tertiary care center between December 2016 and December 2019. In total, we enrolled 31 patients with severe obesity who underwent full-night polysomnography (PSG) before LSG. Later, the patients were re-evaluated by full-night PSG 12 months after the surgery. RESULTS: The mean age of the patients was 44.1 ± 9.6 years. The mean body mass index (BMI) decreased significantly from a mean value of 49.8 ± 8.5 kg/m2 at baseline to 33.2 ± 8.2 kg/m2 and a percent BMI (%BMI) reduction of 33.8 ± 10.4% and a percent total weight loss (%TWL) of 35.4 ± 10.8% was achieved on the same day of the postsurgical PSG (p < 0.001). There was a remarkable improvement in the AHI (baseline: 36.1 ± 27.1, 12 months after the surgery: 10.3 ± 11.8; difference: 25.8 ± 22.8 events per hour) (p < 0.001). Importantly, there was a decrease in the percentage of non-rapid eye movement (NREM) 2 (p < 0.001), whereas NREM 3 and REM stages witnessed a significant increase (p = 0.001 and p < 0.001, respectively) after the surgery. CONCLUSION: The results of this study showed that weight loss after LSG yields improvement not only in AHI but also in many polysomnographic parameters such as sleep quality and desaturation indices.

The value of the platelet count and platelet indices in differentiation of COVID-19 and influenza pneumonia.

It is difficult to distinguish coronavirus disease-2019 (COVID-19) from other viral respiratory tract infections owing to the similarities in clinical and radiological findings. This study aims to determine the clinical importance of platelet count and platelet indices in the differentiation of COVID-19 from influenza and the value of these parameters in the differential diagnosis of COVID-19. The medical records of the patients and the electronic patient monitoring system were retrospectively analyzed. Demographic characteristics, admission symptoms, laboratory findings, radiological involvement, comorbidities, and mortality of the patients were recorded. Forty-three patients diagnosed with influenza and 54 diagnosed with COVID-19 were included in the study. The average age of the COVID-19 patients was lower than that of the influenza patients (influenza: 60.5 years, COVID-19: 52.4 years; pp = 0.024),.024), and the male gender was predominant in the COVID-19 group (influenza: 42%, COVID-19: 56%). According to laboratory findings, the mean platelet volume (MPV) and MPV/platelet ratio were statistically significantly lower, whereas the eosinophil count and platelet distribution width levels were significantly higher (p < 0.05) in the COVID-19 group. It was found that the most common symptom in both groups was dyspnea and that the symptom was more prevalent among influenza patients. In the diagnosis of COVID-19, the platelet count and platelet indices are easily accessible, inexpensive, and important parameters in terms of differential diagnosis and can help in the differentiation of COVID-19 from influenza during seasonal outbreaks of the latter.

A rare disease; congenital pulmonary airway malformation in an adult.

Congenital pulmonary airway malformation (CPAM), is a rare disease known as a developmental abnormality of the lower respiratory tract. It may occur in the neonatal period due to respiratory distress and patients usually die in the first few months of life. Rarely, it may remain asymptomatic until adulthood. In this study we describe an adult case and present a review of the literature. A 19-year-old male with no relevant medical history was admitted to our clinic with cough and wheeze. The patient had a history of frequent lower respiratory tract infection during childhood. Chest radiograph revealed a diffuse opacity and volume loss in the right hemithorax. High resolution tomography showed hypoplasia of the right hemithorax, multiple cysts in all of the lobes and segments on the right side, ground glass opacity and interlobular septal thickening of the whole right lung parenchyma. Right pneumonectomy was performed with the pre-diagnosis of congenital pulmonary airway malformation and the pathological examination was compatible with CPAM. CPAM is a rare disease in adulthood. We should consider CPAM in the differential diagnosis of patients with frequent recurrent pulmonary infection and cystic lung lesions. In order to prevent infections and to eliminate the risk of malignancy, surgical treatment should be applied for definite diagnosis and treatment.

Immunization status in chronic obstructive pulmonary disease: A multicenter study from Turkey.

OBJECTIVE: The purpose of this study is to detect the prevalence and the factors associated with influenza and pneumococcal vaccination and outcomes of vaccination during 2013-2014 season in patients with chronic obstructive pulmonary disease (COPD) in Turkey. METHODS: This was a multicenter retrospective cohort study performed in 53 different centers in Turkey. RESULTS: During the study period, 4968 patients were included. COPD was staged as GOLD 1-2-3-4 in 9.0%, 42.8%, 35.0%, and 13.2% of the patients, respectively. Influenza vaccination rate in the previous year was 37.9%; and pneumococcus vaccination rate, at least once during in a life time, was 13.3%. Patients with older age, higher level of education, more severe COPD, and comorbidities, ex-smokers, and patients residing in urban areas had higher rates of influenza vaccination. Multivariate logistic regression analysis showed that advanced age, higher education levels, presence of comorbidities, higher COPD stages, and exacerbation rates were associated with both influenza and pneumococcal vaccination. The number of annual physician/outpatient visits and hospitalizations due to COPD exacerbation was 2.73 ± 2.85 and 0.92 ± 1.58 per year, respectively. Patients with older age, lower education levels, more severe COPD, comorbid diseases, and lower body mass index and patients who are male and are residing in rural areas and vaccinated for influenza had significantly higher rates of COPD exacerbation. CONCLUSIONS: The rates of influenza and pneumococcal vaccination in COPD patients were quite low, and the number of annual physician/outpatient visits and hospitalizations due to COPD exacerbation was high in Turkey. Advanced age, higher education levels, comorbidities, and higher COPD stages were associated with both influenza and pneumococcal vaccination.

The relation between retrobulbar blood flow and posterior ocular changes measured using spectral-domain optical coherence tomography in patients with obstructive sleep apnea syndrome.

PURPOSE: To investigate the effect of posterior ocular hemodynamics on the retinal nerve fiber layer (RNFL), choroid thickness (CT) and central macular thickness (CMT) in patients with obstructive sleep apnea syndrome (OSAS) and to reveal the association with glaucomatous optic neuropathy. METHODS: The research was planned as a prospective, randomized study. The ophthalmic, retinal and posterior ciliary artery pulsatile index (PI) and resistive index (RI) were measured by colored Doppler sonography. RNFL thickness, CMT and CT were then measured by spectral-domain optical coherence tomography. RESULTS: Sixty subjects were divided into four groups-mild, moderate and severe OSAS and a control group. There were 16 subjects in the control group, 14 in the mild OSAS group, 15 in the moderate OSAS group and 15 in the severe OSAS group. Ophthalmic artery and central retinal artery PI and RI values of the OSAS patients did not show statistically significant difference than those of the control group, but posterior ciliary artery (PCA) PI and RI values were significantly higher. In addition, mean, superior and inferior RNFL thickness values were significantly lower than those in the control group. Moreover, the glaucoma prevalence of the OSAS patients in this study was 6.8% and all of these patients were in the severe OSAS group. CONCLUSION: PI and RI values of the PCA, which supplies the optic nerve, show a linear increase as the apnea hypoxia index values in OSAS. As the grade of OSAS improves, this situation leads to a more serious ischemic optic neuropathy. Furthermore, the prevalence of glaucoma in this study is found to be higher in the severe OSAS group.

Factors Affecting Influenza Vaccination Rates among Patients with Chronic Obstructive Pulmonary Disease in Rize, Turkey.

OBJECTIVES: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are major components of COPD-related socioeconomic burden. Upper or lower respiratory tract infections, usually caused by respiratory viruses or bacteria, are common causes of AECOPD. Vaccination aganist influenza virus and Streptoccus pneumoniae, the most prevalent agents, is recommended by COPD guidelines. The aims of this study were to determine the factors affecting vaccination among patients with COPD and to assess the effect of vaccination status on AECOPD. MATERIALS AND METHODS: Patients with COPD were recruited from the outpatient clinic of a tertiary hospital between December 2014 and January 2015. Demographic data, vaccination status, and COPD-related hospital admissions triggered by tracheobronchial infections were evaluated. RESULTS: In total, 108 patients were enrolled; 102 (94%) subjects were male, and 6 (6%) subjects were female; the mean age was 65.6 years. The number of patients who had received pneumococcal and influenza vaccinations were 8 (0.07%) and 36 (33.3%), respectively. There was no significant correlation between the level of education and vaccination status. No significant difference was found between two groups in terms of exacerbation frequency, hospitalization rates, mMRC scores, and COPD stages. CONCLUSION: More efforts by both physicians and patients are needed to reach the ideal rates of vaccination for COPD.

Syncope as a subject of the risk assessment of pulmonary thromboembolism to be used for: A cross-sectional study.

INTRODUCTION: Syncope is infrequent in pulmonary thromboembolism (PTE) yet might be indicative of haemodynamic instability. The prognostic role of syncope in PTE has not been well documented. OBJECTIVES: In this study, the association between risk classification of the European Society of Cardiology and syncope was investigated in the normotensive PTE patients. METHODS: We retrospectively screened electronic medical records of patients who were admitted in 2 tertiary care hospital and diagnosis of PTE with computed tomography pulmonary angiography. Patients with hypotension (high risk) at the time of admission were excluded from the study. RESULTS: Of 5% patients (16/322) had syncope with the proportion of 81.3% (13/16) in the intermediate high risky group, 18.7% (3/16) in intermediate low risk group and 0% in low risk group. Mortality rate was higher in subjects with syncope (25% vs 11.1%) although it was not it was not statistically significant (P = NS). In those with syncope, the central venous thrombus was more frequent than those without it (78.6% vs 30.1%, P = .008). Only heart rate and intermediate high-risk group were retained as independent predictors of syncope selection in the multivariate logistic regression. CONCLUSION: Although syncope is positively correlated with the severity of PTE, it does not predict the prognosis alone. Nonetheless, syncope in patients with PTE can be considered as an important alarming stimulus for clinical course.

Treatment adherence and short-term outcomes of smoking cessation outpatient clinic patients.

INTRODUCTION: Previous studies have shown that adherence to treatment is fundamental to success in smoking cessation. However, smoking cessation medication regimens are limited significantly by the struggle to adhere to them. This study was conducted to evaluate the factors associated with treatment adherence and quitting success in a group of patients that applied to our smoking cessation outpatient clinic (SCC). METHODS: Patients that applied to SCC between April 2015 and December 2016 who were evaluated, found suitable for smoking cessation interventions and started pharmacological treatment were included in this study. Only those who could be reached by phone three months after their first application became participants. Those who had used the prescribed treatment for at least 30 days were grouped as treatment-adherent. RESULTS: In total, data for 346 patients were evaluated. Mean (±SD) age was 44.3±13.9 years; most of them were male (63%), primary school graduated (36.1%), self-employed (43.7%), and had no comorbid diseases (71%). Bupropion was started in 52% of the patients, that rate was 35.8% for varenicline and 12.1% for a combination of the nicotine patch and gum. Mean days for treatment use was 20.9±18.5; 59% of the patients were non-adherent to their treatment and 51.7% had only one control visit number. Adverse reactions due to treatment were recorded in 25% of participants, and at their third month 37.9% of them had quit smoking. In multivariate logistic regression analysis, increase in control visit number, absence of adverse reaction, and varenicline use, were each associated with higher treatment adherence (p<0.001) and only being in the treatment-adherent group was associated with quit success (OR=3.01, 95% CI: 1.88-4.81, p=0.001). CONCLUSIONS: This study showed that most patients did not use their prescribed SC treatments adequately; a main factor that affects quit success is treatment adherence. There is a need for closer monitoring and follow-up to ensure adequate use of treatment of patients.

High sensitization to house-dust mites in patients with allergic rhinitis in the eastern Black Sea region of Turkey: A retrospective study.

OBJECTIVES: Identification of the most common aeroallergens to which patients are sensitized in a specific area is important in the diagnosis and treatment of allergic rhinitis (AR). We determined the distribution of aeroallergens, detected by skin-prick tests (SPT), in adult patients with AR in the Eastern Black Sea region of Turkey and compared the results with the other regions of Turkey and in the world. METHODS: The medical records of SPT performed on 1457 patients with symptoms of AR (with regard to the Allergic Rhinitis and its Impact on Asthma 2008 guidelines) between March 2010 and March 2013 were analyzed retrospectively. SPT were carried out with the same panel, which included grass; weeds; trees; mold; epidermal mixtures; and with two house-dust mite (HDM) extracts, Dermatophagoides pteronyssinus and Dermatophagoides farinae. RESULTS: In 1229 of 1457 patients (84.4%), there were positive reactions for at least one aeroallergen on the SPT. The most common aeroallergen was the HDM D. pteronyssinus (84% [n = 1033]) followed by D. farinae (78.2% [n = 962]). Grass pollen sensitivity (70.8% [n = 871]) was higher than tree or weed pollen sensitivity in this region. CONCLUSIONS: The most common aeroallergens in AR are HDMs of D. pteronyssinus and D. farinae in the Eastern Black Sea region in Turkey. Our study may help in developing environmental control strategies for AR.

Copeptin: a new predictor for severe obstructive sleep apnea.

INTRODUCTION: Copeptin which is the C-terminal fragment of antidiuretic hormone (ADH), is a biomarker that has been reported to be increased in various cardiovascular disorders, cerebrovascular diseases and associated with prognosis. Patients with obstructive sleep apnea syndrome (OSAS) have a tendency to develop coronary and cerebral atherosclerotic diseases. OBJECTIVES: The aim of the present study was to study copeptin levels in patients with obstructive sleep apnea and in a control group in order to determine whether copeptin could be used as a biomarker predicting the severity of OSAS and possible complications in this group. METHODS: A total of 116 patients with OSAS, diagnosed by polysomnography, and 27 controls were included in the study. Blood samples were collected after overnight fasting, and copeptin levels were measured with enzyme-linked immunosorbent assay. RESULTS: Copeptin levels were significantly higher in the OSAS group compared to control group (2,156±502; 1,845±500 pg/mL, respectively, P=0.004). Mean copeptin level of the patients having apnea-hypopnea index (AHI) ≥30 was significantly higher than that of the patients having AHI <30 (2,392±415; 2,017±500 pg/mL, respectively, P<0.001). A multivariate regression analysis showed that copeptin level, (hazard ratio: 1.58; 95% confidence interval: 1.09-2.30) was a predictor of severe OSAS (P=0.016). Copeptin levels showed significant positive correlation with AHI (r=0.32; P<0.001), desaturation index (r=0.23; P=0.012), arousal index (r=0.24; P=0.010) and CRP (r=0.26; P=0.011) respectively. CONCLUSION: Copeptin levels are high in OSAS patients and copeptin is a potential marker for identifying patients with a high risk of early cardiovascular complications of OSAS. Copeptin has modest sensitivity (84%) for discriminating severe OSAS patients who are candidates for severe cardiovascular complications.

Soluble urokinase-type plasminogen activator receptor is a novel biomarker predicting acute exacerbation in COPD.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory condition, and progresses with acute exacerbations. (AE). During AE, levels of acute phase reactants such as C-reactive protein (CRP) and inflammatory cells in the circulation increase. Soluble urokinase-type plasminogen activator receptor (suPAR) levels increase in acute viral and bacterial infections and in diseases involving chronic inflammation. The purpose of this study was to investigate the effectiveness of suPAR in predicting diagnosis of AE of COPD (AE-COPD) and response to treatment. METHODS: The study population consisted of 43 patients diagnosed with AE-COPD and 30 healthy controls. suPAR, CRP, and fibrinogen levels were measured on the first day of hospitalization and on the seventh day of treatment. RESULTS: We found that fibrinogen (P<0.001), CRP (P<0.001), and suPAR (P<0.001) were significantly higher in patients with AE-COPD than in healthy controls. Fibrinogen (P<0.001), CRP (P=0.001), and suPAR (P<0.001) were significantly decreased by the seventh day of treatment. However, the area under receiver operator characteristic curve showed that suPAR is superior to CRP and fibrinogen in distinguishing AE-COPD. There was a correlation between fibrinogen, CRP, and suPAR. However, only fibrinogen was a powerful predictor of suPAR in multiple linear regression. In multiple logistic regression, only suPAR and fibrinogen were strong predictors of AE-COPD (P=0.002 and P=0.014, respectively). Serum suPAR was negatively correlated with forced expiratory volume in 1 second (r=-478, P=0.001). CONCLUSION: suPAR is a marker of acute inflammation. It is well correlated with such inflammation markers as CRP and fibrinogen. suPAR can be used as a predictor of AE-COPD and in monitoring response to treatment.

A novel biomarker in the diagnosis of parapneumonic effusion: neutrophil gelatinase-associated lipocalin.

BACKGROUND: The protein neutrophil gelatinase-associated lipocalin (NGAL) is a mediator synthesized and released by neutrophils. Its physiological function is as yet unclear. Levels in blood increase in several inflammatory diseases. High serum values indicate poor prognosis for several diseases. Pleural effusion may appear as the result of various pathologies. The most common cause is heart failure (HF). Other common causes include parapneumonic (PPE) and malignant (MPE) pleural effusions, and pulmonary embolism. Tubercular effusion (TE) is commonly encountered in Turkey and similar developing countries. The purpose of this study was to investigate the effectiveness of NGAL, a current inflammation marker, in discriminating between different etiological diseases that cause pleural effusion. METHODS: The study was performed at the Recep Tayyip Erdogan University Faculty of Medicine Chest Diseases Clinic. One hundred patients were included in the study, 25 with parapneumonic effusion, 25 with heart failure-related effusion, 25 with tubercular effusion and 25 with cancer-related effusion. NGAL was measured in patients' serum and pleural fluids. RESULTS: Serum NGAL levels in PPE (171 ± 56 ng/ml) were significantly higher (p < 0.001) than those in HF (86 ± 31 ng/ml), CA (103 ± 42 ng/ml) and TE (63 ± 19 ng/ml). Pleural NGAL levels were also significantly higher in PPE compared to HF, MPE and TE (p < 0.001). Serum NGAL levels exhibited a positive correlation with white blood cell (WBC), neutrophil, C-reactive protein (CRP), sedimentation, serum LDH, creatinine, pleural leukocyte and pleural neutrophil numbers. The most significant correlation was between NGAL level and WBC (p < 0.001, r = 0.579). Both serum and pleural NGAL levels are highly effective in differentiating patients with PPE from those without PPE (AUC: 0.910 and 0.790, respectively). CONCLUSIONS: NGAL can be used in the diagnosis of diseases with an acute inflammatory course. Serum and pleural NGAL levels can differentiate PPE from other diseases causing pleural fluid with high sensitivity and specificity.