Association between burnout, anxiety and insomnia in healthcare workers: a cross-sectional study.

All healthcare workers (HCWs) encounter stress during in their working lives, and are constantly exposed to adverse conditions. The present study evaluates the relationship between burnout syndrome, anxiety levels and insomnia severity among healthcare workers, who mostly work in shifts. The Maslach Burnout Inventory, the Insomnia Severity Index and the Beck Anxiety Inventory were used to measure burnout, insomnia severity and anxiety status, respectively. This cross sectional study included a total of 1,011 HCWs and 679 (67.2%) of the study respondents were women. The respondents were aged 20-72, with a mean age of 35.67 ± 8.61 years. Fifty-eight percent (n = 589) of the participants were rotating shift workers. Working on-call led to a significant difference in all burnout parameters (for each, <0.001). Age and on-call duty were seen to lead to a significant difference in the severity of insomnia (p = 0.028, p < 0.001, respectively). The total ISI score was found to be statistically significant positively correlated with the MBI subscales and the total BAI score (for each, <0.001). An increased awareness of the impact of sleep deprivation, burnout and anxiety among HCWs and meaningful interventions promoting change within the healthcare system are needed.

Is it important to know the predominant respiratory event in AHI for the management of patients with OSA?

Introduction: Obstructive sleep apnea (OSA) is a heterogeneous disorder. The apnea-hypopnea index (AHI) cannot fully reflect this heterogeneity on its own. In this study, the OSA patients were analyzed by grouping them based on the predominant type of respiratory event, and the distinctive findings of each group were evaluated. Materials and Methods: The records of 213 patients with OSA were evaluated retrospectively and the patients were divided into three groups as Group 1 (apnea-predominant OSA; apnea index (AI)≥ 2x hypopnea index (HI) and HI≤ 15/hour), Group 2 (hypopnea-predominant OSA; HI≥ 2xAI and AI≤ 15/ hour), and Group 3 [No Respiratory Event-Predominant OSA (NREP OSA)]. Result: There were 65 patients in Group 1, 58 patients in Group 2, and 90 patients in Group 3. There was no difference between the groups in terms of sex, age, body-mass index, the distribution of symptoms, and concomitant diseases (p> 0.05). Only witnessed apnea was more frequently described by Group 1 patients (p= 0.042). Except for the higher N2 percentage and arousal index (p= 0.009, p= 0.011, respectively) in those with apnea-predominant OSA compared to those with hypopnea-predominant OSA, there was no difference in sleep architecture. In the apnea-predominant group, while the AHI, apnea durations (p= 0.000, 0.000, 0.000, respectively), total oxygen desaturation index (tODI), NREM ODI and REM ODI were higher (p= 0.000, 0.000, 0.047, respectively), nocturnal minimum oxygen saturation (SpO2) was lower (p= 0.001). Conclusions: This study concluded that apnea-predominant OSA patients had more severe OSA in terms of AHI, respiratory event durations, and problems in oxygenation. These differences may guide the management of OSA.

[Management of obstructive sleep apnea during COVID-19 pandemic]. / COVID-19 pandemisi sirasinda obstrüktif uyku apne yönetimi.

Coronavirus disease 2019 (COVID-19) is an infectious disease that causes important mortality and morbidity all over the world caused by SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2), which started in China at the end of 2019. It spreads rapidly, mainly through droplets, and especially for all healthcare workers involved in aerosol producing procedures are at high risk. During COVID-19 pandemic , the health systems worldwide, along with the practice of chest diseases daily were affected. In our article, we aimed to give some clinical suggestions related to sleep practices according to current data.

Polysomnographic, demographic and clinic differences between male and female obstructive sleep apnea patients.

INTRODUCTION: The differences between both genders with Obstructive Sleep Apnea Syndrome (OSAS) which is often seen in males can be explained by means of certain polysomnographical parameters and demographical and clinical features. The aim of this research study is to research the gender differences in Turkish population in terms of polysomnographical parameters and demographical and clinical features, and to compare and contrast the results of this research with the results of literature. MATERIALS AND METHODS: This study has been carried out by including 100 females and 116 males, 216 patients in total, who were diagnosed with OSAS in the Sleep Laboratory of the Medicine Faculty, Ankara University between the years of 2011 and 2014. The demographical information like the ages and the genders of all patients and the figures of the height, weight and body-mass index (BMI) have been recorded. The Epworth Sleepiness Scale (ESS) of patients have also been recorded. Acquired by the polysomnography equipment, the polysomnographical data of all patients having the criteria of this study have been evaluated. RESULT: The average age of female patients, which is 57.2 ± 9.1 (the lowestthe highest), has been found to be meaningfully high (p<0.05) when compared to the average age of male patients (50.9 ± 11.8). The body-mass index (BMI) averages of female patients, which are 35.4 ± 9.2, have been determined to be high (p<0.05) when compared to the body-mass index (BMI) average of male patients (32.5 ± 6.7). The total Apnea Hypopnea Index (AHI) of male patients have been found to be meaningfully higher than of the female patients (p<0.05). Mild and moderate OSAS in female patients have been observed at a higher rate than males. On the other hand, severe OSAS has been observed at a higher rate than females (p<0.05). Likewise, while the average obstructive apnea time in male patients has been for 17 ± 5.8 seconds, the same figure has been for 14.5 ± 4.4 seconds (p<0.05). CONCLUSIONS: As a result, in this study, we have observed that females suffering from OSAS are older and obese at a more rate and they have lower Apnea Hypopnea Index (AHI) than the males with OSAS. We have also distinguished that the symptoms related to OSAS of both genders are similar despite the lower Apnea Hypopnea Index of females. Meanwhile we want to emphasize that clinicians need to take these factors into consideration while focusing on the diagnosis of OSAS in female patients.

[The clinical and polysomnographic differences between obese and non-obese patients with obstructive sleep apnea]. / Obez ve non-obez obstrüktif uyku apneli hastalar arasinda klinik ve polisomnografik farkliliklar.

INTRODUCTION: Obesity has been considered to be one of the important risk factor for obstructive sleep apnea (OSA). We aimed to investigate the clinical and polysomnographic differences of obese and non-obese OSA patients and how these differences, if any, can be reflected in our daily clinical practice. MATERIALS AND METHODS: The polysomnographic data of 157 consecutive patients that underwent a sleep study were analyzed. Ninety-nine adult patients with a diagnosis of OSA [apnea-hypopnea index (AHI) ≥ 5/hour] were retrospectively assesed in two groups in respect of obese (BMI ≥ 30 kg/m2) or non-obese (BMI <30 kg/m2) according to body mass index (BMI). The clinical and polysomnographic results of the patients in both groups were compared. RESULT: Between 2010 and 2011, 99 (31 K/68 M) of 157 patients underwent polysomnography were diagnosed with OSA (AHI ≥ 5/hour). Thirthy six patients with OSA (36.4%) were non-obese and 63 patients (63.6%) were obese. There were no differences in the symptoms related to OSA between two groups (p> 0.05). Although there was no statistical significance, the age of the obese patients (50.5 ± 12.7 years) was lower than those of the non-obese (54.9 ± 10.0 years) in polysomnography their total sleep time was shorter and sleep latency later, and sleep efficiency, arousal index, N3%, and REM% were lower and N1% was higher (p> 0.05). While in the obese OSA patients the AHI and Epworth Sleepiness sclae were higher (respectively; p= 0.028, p= 0.01), average oxygen saturation at sleep was lower (p<0.001). While obese OSA patients had similar ratio of hypertension and atherosclerotic heart disease with non-obese OSA patients, whereas diabetes mellitus was higher in obese OSA group (p= 0.036). The use of antidepressant drug was more common in the non-obese patients than the obese patients (p= 0.011). CONCLUSIONS: Although obese OSA patients have a more severe disease compared to nonobese OSA patients, there were no significant differences in clinical and polysomnographics findings between two groups. Should be noted that OSA may occur in non-obese patients.

Assessment of the risk of obstructive sleep apnoea syndrome among healthcare workers.

INTRODUCTION: Sleep deprivation is known to increase the risks for workplace accidents, neuro-behavioural symptoms and reduced quality of life. Shift work leads to sleep related problems, such as sleep deprivation, poor sleep quality and daytime sleepiness. The purpose of our study is to assess snoring prevalence and obstructive sleep apnoea risk among healthcare workers (HCWs) by using the Berlin Questionnaire. MATERIALS AND METHODS: HCWs employed at different centres that agreed to take part in this study were enrolled. Employing the Berlin Questionnaire, demographic characteristics, smoking histories, comorbidities, on-call shifts, number of on-call shifts and sleep durations of the participants were surveyed. RESULT: 604 HCWs including specialist, nurse, junior doctor, medical student, clinical academic, health technician and hospital staff were enrolled in this study. In terms of sleep apnoea, 92 (15.1%) participants were identified as high-risk and 512 (84.8%) as low-risk according to the findings of the questionnaire. When the two groups identified as high and low risk for sleep apnoea according to the Berlin Questionnaire were compared, significant differences were found between the two groups in terms of age, sex, height, weight, BMI value and hypertension (p< 0.001 for all variables). Multivariate logistic regression analysis has shown that on-call shifts (OR= 0.199, CI= 0.053-0.747, p= 0.017) are negative associated with sleep apnoea risk. CONCLUSIONS: With extended working hours and on-call shifts increasing the risk of sleep disorders among HCWs, surveys designed for screening can be used to identify the prospective cases in this population for further examination.

[Where do we perform sleep test: In the laboratory or at home?] / Uyku testi nerde yapilmali; laboratuvarda mi, evde mi?

Obstructive sleep apnea syndrome (OSAS) is an important public health problem seen in 14.3% of male, and 5% of female population which leads to higher morbidity, and mortality rates because of its outcomes effecting many organ systems including cardiovascular, and cerebrovascular systems. Despite its higher prevalence in community, sleep laboratories both in our country, and in the world remain incapable of diagnosing these patients, and 80-90% of the cases with OSAS can not be diagnosed. As an alternative to gold standard polysomnographic examinations this desperate condition revived the use of more practical, and less expensive portable monitorization devices which can be used at home without the need for help of a technician. In this article we will discuss whether application of sleep test on a patient with suspect OSAS in the laboratory or at home will be more appropriate regarding effectiveness, and reliability of the test in the light of the scientific data.

Does anticoagulation in combination with immunosuppressive therapy prevent recurrent thrombosis in Behçet's disease?

Vascular involvement in Behçet's disease (BD) occurs in up to 50% of patients. The main mechanism of thrombosis is inflammation. Thus, immunosuppressants (IS) are the mainstay of therapy, and adding anticoagulation (AC) is controversial. In daily practice, we observed that patients who received AC in combination with IS experienced less recurrent thrombosis and decided to investigate our BD patients retrospectively. We hypothesized that adding AC to immunosuppressive therapy may lower the risk of recurrent thrombosis. Treatment at the time of first or recurrent thrombotic events was recorded. Events under the only IS and IS + AC treatments were compared. There were 40 patients (33 males). The most common types of first vascular events were deep vein thrombosis (77.5%) followed by pulmonary embolism (PE) (52.5%). One patient did not receive any treatment. Among the 39 patients, 32 received glucocorticoid and at least one of the azathioprine, or cyclophosphamide, anti-TNF, 5 received monotherapy with azathioprine, 1 received monotherapy with corticosteroid, and the remaining 1 received monotherapy with cyclophosphamide. In total, 22 patients (55%) experienced 27 recurrent venous thromboembolism (VTE) events. Two (7.4%) events while only on AC, 2 (7.4%) events while on AC + IS, and 15 (55.5%) events occurred while on only IS. Eight (19.6%) patients were not receiving any treatment during relapses. The recurrence rate was statistically significantly lower in the IS + AC treatment group compared to IS alone. In conclusion, IS are the mainstay of treatment for BD, and adding AC may help to lower the recurrence risk of thrombotic events.

[Comparing the effectiveness of different treatment modalities on the smoking cessation rates]. / Farkli tedavi yöntemlerinin sigara birakma basarisi üzerine etkileri.

The social patterns of smoking have changed significantly in the past two decades but smoking is still as prevalent in the lowest socioeconomic groups as it was widespread. For the solution of this enormous problem many kinds of treatment modalities have been proposed but there is no single successful method for quitting. To determine the smoking cessation rates with behavioural treatment, behavioural + pharmacological treatments and compare the differences between each approaches. 371 smokers were prospectively evaluated between 2004 and 2008. At the beginning subjects were classified into two groups: behavioral treatment group (I) and pharmacological + behavioural treatment group (II). Numbers of patients per group were 88 and 283 respectively. According to pharmacological therapy group II was also divided into three subgroups: nicotine replacement treatment (NRT) (regardless of the type and dosage) (IIa), bupropion (IIb) and combination treatment modalities group (IIc). Numbers of patients per subgroups were 185, 70 and 28 respectively. All of the patients were attended the one year follow up visits. According to the baseline characteristics there was no significant difference between the groups and subgroups. At the end of the fist year, in group I smoking cessation rate was 41% and in group II 51% and this was not statistically significant (p< 0.05). In the sub group analysis the success rates for group IIa, IIb and IIc; 44.8%, 62.8% and 64% respectively and bupropion is significantly superior to the NRT (p= 0.01). In study subjects, smoking cessation rates were less with comorbid diseases (p= 0.004), baseline airway obstruction (p= 0.04) and high CO levels (p= 0.008). Results of this analysis confirm that, there is a significant difference between pharmacological treatment and behavioral treatments. Additionally, in the pharmacological approaches, bupropion seems to be superior. Besides, comorbid conditions have been a huge problem to solve.

Clinical and polysomnographic features of hypertension in obstructive sleep apnea: A single-center cross-sectional study.

OBJECTIVE: Obstructive sleep apnea (OSA) is associated with elevated blood pressure (BP) and increases the risk of developing cardiovascular diseases. This study aimed to determine the clinical and polysomnographic features of OSA that are significantly associated with hypertension (HT). METHODS: This is a prospective study that enrolled patients diagnosed with OSA in Ankara University Faculty of Medicine from January 2015 to June 2016. The patients were categorized into normotensives (n=125) and hypertensives (n=141). BP was taken at the evening before and the morning after polysomnography (PSG). The polysomnographic findings of normotensive and hypertensive patients were compared, and independent risk factors that are associated with HT were analyzed. RESULTS: Hypertensive patients exhibited older age and higher Epworth sleepiness scale (ESS), apnea-hypopnea index (AHI), mean apnea duration, arousal index, and oxygen desaturation index (ODI) than normotensive patients. Nocturnal oxygen desaturation (NOD) was more frequent and the percentage of the duration of NOD to total sleep time (TST) was higher in hypertensive than normotensive patients. Multivariate analyses revealed that age (OR: 1.095, 95% CI 1.053 to 1.139, p<0.001), ESS (OR: 1.186, 95% CI 1.071 to 1.313, p=0.001), mean apnea duration (OR: 1.072, 95% CI 1.032 to 1.113, p=0.002), ODI (OR: 1.062, 95% CI 1.025 to 1.101, p=0.001), and NOD (OR: 2.439, 95% CI 1.170 to 5.086, p=0.017) were independent risk factors for HT in OSA. CONCLUSION: This study suggests that age, ESS, parameters of oxygenation, and apnea duration were associated with HT in patients with OSA. Hence, patients with OSA with these findings should be evaluated for HT. (Anatol J Cardiol 2020; 23: 334-41).

Investigation of the Presence of Glaucoma in Patients with Obstructive Sleep Apnea Syndrome Using and Not Using Continuous Positive Airway Pressure Treatment

Objectives: To evaluate the frequency of glaucoma in patients with obstructive sleep apnea syndrome (OSAS) using and not using continuous positive airway pressure treatment. Materials and Methods: This prospective study included 59 patients diagnosed with OSAS based on the Apnea-Hypopnea Index (AHI). OSAS patients were divided into 3 groups according to their AHI scores: 5-15 was considered mild (19 patients), 16-30 was considered moderate (16 patients), and >30 (24 patients) was considered severe. Twenty-eight (47.5%) of the OSAS patients had been using continuous positive airway pressure treatment. The control group included 19 healthy subjects. Retinal nerve fiber layer and ganglion cell complex (GCC) thickness analyses were performed. Results: Average GCC thickness in left eyes was significantly lower in the mild OSAS group than in the control group (p=0.013). The GCC was significantly thinner in the inferior and inferonasal sectors of both eyes in the mild OSAS group compared to the control group (p=0.029, p=0.022, p=0.037, and p=0.019 respectively). Minimum GCC thickness in the left eyes of all OSAS groups was significantly lower than in the control group (p<0.05). Conclusion: In OSAS patients, there may be changes in retinal nerve fiber layer and ganglion cell complex thickness before alterations in the visual field emerge.

Health-related quality of life in patients with sleep-related breathing disorders: relationship with nocturnal parameters, daytime symptoms and comorbid diseases.

BACKGROUND: Sleep-related breathing disorders (SRBD) are frequently encountered health problems in the general population. Habitual snoring and obstructive sleep apnea/hypopnea syndrome (OSAHS) constitute most SRBD diagnoses. Although the decrease in quality of life is a well-known entity in SRBD patients, there is not enough data regarding the underlying pathophysiological mechanisms to explain this deterioration. OBJECTIVES: The aim of this study was to investigate which parameters were affecting the quality of life in patients with SRBD. METHODS: Medical Outcome Survey - Short Form 36 (SF-36) and Epworth Sleepiness Scale were used in 135 patients with SRBD (69 patients with OSAHS and 66 patients with habitual snoring), and Charlson comorbidity index was calculated. Acquired data were compared with leading symptoms and polysomnographic findings in these patients. RESULTS: All SF-36 scores were significantly decreased in SRBD patients. However, there were no significant differences in the SF-36 scores of these patients. Also, no significant correlation was found between the severity of OSAHS and the SF-36 scores. Similarly, none of the polysomnographic parameters was found significantly correlated with SF-36 scores. In contrast, all SF-36 scores were influenced by body mass index, Epworth Sleepiness Scale score, mean nocturnal saturation and the presence of coexisting diseases. CONCLUSIONS: According to the results of multiple variance analysis, we concluded that the quality of life depends on a number of collaborative factors such as obesity, mean nocturnal saturation, symptoms related to SRBD and the presence of comorbid diseases, rather than only on one independent parameter in the patients with SRBD.

Predictive Value of STOP-BANG on OSAS-Related Complications Following Coronary Artery Bypass Grafting.

BACKGROUND: The time and conditions may not be suitable for performing polysomnography (PSG) before urgent or emergent surgeries, for example, a coronary artery bypass graft. Unavailability in many centers, critical clinical situation, and inability to arrange a timely scheduled appointment are other limitations for PSG. In this study, we aimed to investigate if the STOP-BANG Questionnaire may predict obstructive sleep apnea syndrome (OSAS) related postoperative pulmonary alterations during coronary artery surgery. METHODS: Sixty-one subjects who were scheduled to undergo elective isolated coronary artery bypass graft surgery and were consulted for preoperative pulmonary assessment were recruited to the study. The STOP-BANG Questionnaire was used with the subjects; then their relationship with postoperative complications was assessed. RESULTS: Results of the STOP-BANG Questionnaire revealed that 36.1% of subjects were at high risk for OSAS. Three groups were established according to the STOP-BANG Questionnaire (low risk, group 1; moderate risk, group 2; high risk, group 3) and study parameters, including PEEP value in ventilator, detection of apnea at ventilator, CPAP time after extubation, SpO2 1 h after extubation, postoperative hypoxemia, need for CPAP, and ICU length of stay revealed significant relationships among these groups. CONCLUSIONS: The STOP-BANG Questionnaire may predict the OSAS risk and OSAS-related pulmonary complications for patients who are candidates for a coronary artery bypass graft and unable to be evaluated with PSG before surgery due to technical or time-related limitations.

Does the 2017 revision improve the ability of GOLD to predict risk of future moderate and severe exacerbation?

INTRODUCTION: In 2017 update, GOLD separated spirometry from ABCD classification. OBJECTIVES: The aim was to investigate the predictive reliability of GOLD 2017 grading system in terms of future moderate and severe exacerbations. METHODS: COPD patients were classified into A to D groups according to GOLD 2011 and 2017. Patients who were assigned to C/D groups according to GOLD 2011 were divided into subgroups C 1/D1, C2/D2, C3/D3 according to FEV1 % of predicted and exacerbation history. C1/D1 patients defined as FEV1  < 50% predicted and without ≥2 exacerbations or hospitalization in the last year. RESULTS: A total of 225 patients were enrolled. Among them, 25.8% were in groups C1/D1 according to GOLD 2011. These patients shifted to A/B according to GOLD 2017. C1/D1 patients had a significantly higher risk of future moderate and severe exacerbation compared to A/B (P = 0.018). The risk of future moderate and severe exacerbation was significantly higher in patients with a FEV1  < 50% (P = 0.018).The risk of future moderate and severe exacerbation was higher in GOLD 2017 groups A and B compared to GOLD 2011 groups A and B. CONCLUSION: Low FEV1 was an important risk factor for future exacerbations. Downstaging of C1/D1 patients caused heterogeneity in A/B with including patients with low and high risk of future exacerbation. This resulted in a low discriminative power of GOLD 2017 regarding the risk of future exacerbation in groups A and B. This may cause underestimation of disease severity and inadequate treatment especially in A/B patients with low FEV1 .

Analysis of the factors related to mortality in patients with bronchiectasis.

BACKGROUND: Bronchiectasis is a common disabling but rarely fatal disease. However the long-term prognosis and risk factors for mortality are not well known. OBJECTIVE: The aim of this study was to determine prospectively the survival and predictive factors of mortality in patients with bronchiectasis, during 4-year follow-up. PATIENTS AND METHODS: From September 2000 to January 2005 survival of bronchiectasis (as evaluated by computed tomography) and predictors of mortality were assessed in 98 outpatients. Fifty-one of the patients had self-reported history of pulmonary infection including tuberculosis. Baseline data, reevaluated in every single year according to scheduled visits. RESULTS: The mean age was 61+/-10 and 74% of the patients were female. In total, 16 patients (16.3%) died; mean survival time was 44.06+/-1.6 months. The survival rates were 97%, 89%, 76%, 58% at 1, 2, 3 and 4 years, respectively. Cox proportional hazard model revealed that long-term mortality was significantly associated with age, body mass index (BMI), Medical Research Council (MRC) dyspnea scale, vaccination, radiographic extent, hypoxemia, hypercapnia and functional parameters. However, MRC and BMI had more significant effects on the mortality than the functional parameters. CONCLUSIONS: These results suggest that high BMI, regular vaccination and scheduled visits may have beneficial effects on the survival of bronchiectasis. Besides, presence of hypoxemia, hypercapnia, dyspnea level and radiographic extent were more closely correlated with mortality.

Side effects due to primary antituberculosis drugs during the initial phase of therapy in 1149 hospitalized patients for tuberculosis.

OBJECTIVE: Side effects of the most commonly used primary antituberculosis (anti-TB) drugs may be mild as well as fatal. The aim of this study was to evaluate the side effects of and the risk factors for developing side effects against anti-TB drugs. PATIENTS AND METHODS: Records of 1149 patients with established tuberculosis who initially received anti-TB therapy were evaluated retrospectively. The major side effects, which resulted in a definitive termination from 1 or more drugs related to anti-TB therapy, and the risk factors associated with these side effects, were analyzed. RESULTS: Ninety-five patients (8.3%), constituting 104 cases in total, experienced side effects. Although the frequency of drug reactions were increased from 0.6% at ages <20 to 5.2% at ages 20-40, no gender or age differences were observed between patients who did and did not have side effects. While asymptomatic liver function disturbance was established in 56 of the patients (4.9%) with initiation of anti-TB therapy, the rate of hepatotoxicity was found to be 2.4% in this present study. No age or gender differences were observed among those who had hepatotoxicity and who had not. The major side effects were ototoxicity (1.7%), hepatotoxicity (0.8%), neuropsychiatric manifestations (0.7%), and hyperuricemia (0.6%). CONCLUSIONS: It must be remembered that severe side effects associated with anti-TB drugs were encountered with different frequencies especially among patients hospitalized for pulmonary tuberculosis, and these patients should be followed up by closer monitoring for side effects related to anti-TB drugs.

The factors affecting survival in patients with bronchiectasis.

BACKGROUND/AIM: There is limited information about the rate and modifiers of mortality in noncystic fibrosis bronchiectasis. MATERIALS AND METHODS: This study enrolled a total of 56 bronchiectasis patients. Patients' body mass index, smoking habit, previous therapies, comorbid disorders, history of vaccination, bronchiectasis type and radiological extent, arterial blood gas analysis, respiratory function tests, and laboratory results were recorded. RESULTS: After a follow-up of 65.38 ± 18.62 months the overall mortality rate was 35.7%. The mean survival duration was 46.42 ± 8.25 months. Advanced age significantly increased mortality (HR: 2.031; CI: 0.991-4.072, P = 0.035). A significant correlation was found between mortality rate and the partial oxygen pressure level (HR: 0.886 (CI: 0.817-0.960); P = 0.039). Pulmonary artery pressure was directly proportional to mortality rate (HR: 9.015 (CI: 3.272-94.036); P = 0.03). There was also a significant correlation between Pseudomonas aeruginosa proliferation in sputum and mortality (HR: 7.014 (CI: 2.812-17.962); P = 0.00). Comorbidities increased mortality (HR: 1.984 (CI: 0.972-2.996); P = 0.04). CONCLUSION: Bronchiectasis is a disease with high mortality. Advanced age, comorbid conditions, reduced partial oxygen pressure, pulmonary hypertension, and Pseudomonas aeruginosa proliferation in sputum increase its mortality rate.

Pulmonary hypertension and acute pulmonary edema in a 23-year-old male with a history of an upper respiratory tract infection.

The pathophysiology of upper-airway obstruction (UAO) is complex. Possible causes of UAO that may lead to acute respiratory failure, are as follows: infections like acute epiglottitis and croup, obstructing tumors in the base of the tongue, larynx or hypopharynx, aspirated food or liquid contents, obesity and anatomical variations. Management changes according to the pathogenesis of the disorder. In patients with severe carbon dioxide retention or apnea, emergency endotracheal intubation must be carried out. Hereby, we describe a 23-year-old patient with susceptible upper-airway anatomy and UAO occurred following an upper respiratory infection and complicated with pulmonary hypertension and pulmonary edema. Our patient seems to be one of the complicated UAO cases, with an unusual but critical clinical presentation, evaluated in a wide spectrum and nicely returned to life.

[Hepatopulmonary syndrome]. / Hepatopulmoner sendrom.

Liver diseases affect lungs. Pulmonary vascular diseases are observed in hepatic diseases and portal hypertension have a wide spectrum that varies from intrapulmonary vascular dilatation to increased pulmonary vascular resistance with pulmonary hypertension. Hepatopulmonary syndrome is a syndrome characterized portal hypertension, intrapulmonary vascular dilatation and abnormal oxygenation (hypoxaemia). This review summarizes the clinicopathologic features, diagnostic criteria, and management of hepatopulmonary syndrome.