The relationship between the heart-type fatty acid binding protein levels, carotid intima media thickness and epicardial fat thickness in patients with obstructive sleep apnea syndrome.

INTRODUCTION: In this study, we aimed to evaluate the relationship between carotid artery intima-media thickness, epicardial fat thickness measurement and the levels of heart-type fatty acid binding protein (hFABP) in patients with obstructive sleep apnea syndrome (OSAS). MATERIALS AND METHODS: Ninety-nine newly diagnosed OSAS patients and fifty non-OSAS control subjects were enrolled in this study. In both groups, demographic data such as age, sex, body mass index (BMI) were recorded and carotid intima-media thickness (CMIT) and epicardial fat thickness (EFT) were measured. hFABP levels were determined using the enzyme-linked immunosorbent assay (ELISA) method according to the manufacturer's protocols. RESULT: Patients with OSAS 67% male, 33% female gender is determined. The mean age of control group was 43.28 ± 12.12 years and group of OSAS was 47.85 ± 11.55 years (p= 0.026). In OSAS group; 38 mild OSAS (38.38%), 23 moderate OSAS (23.23%) and 38 severe OSAS (38.38%) patients were identified. In OSAS patients, average of apnea hypopnea index (AHI) was 29.83/hours. A positive correlation was observed between BMI with EFT and CMIT (p< 0.05). hFABP levels in OSAS group average was 2.65 ± 2.1 ng/mL and in control group average was 1.62 ± 0.90 ng/mL and this was statistically significant (p= 0.002). EFT, in the control group average was 5.3 ± 2.04 mm, while the average was 4.3 ± 1.79 mm in the OSAS group (p= 0.019). The correlation was observed between the CMIT and EFT (p< 0.001). There was no significant difference in BMI and gender between OSAS and control groups. No accompanying cardiovascular disease was detected in patients with OSAS. CONCLUSIONS: This study suggests EFT and hFABP can be used as a predictive value in determining cardiovascular risk in OSAS patients.

Prognostic value of the lymphocyte-to-monocyte ratio and other inflammatory markers in malignant pleural mesothelioma.

OBJECTIVES: Inflammation plays a role in malignant pleural mesothelioma (MPM) prognosis and symptoms. We investigated the roles of the new and old inflammatory indexes and markers in MPM prognosis. METHODS: Two hundred and ninety-two MPM patients (167 male and 125 female) were included in this retrospective study. Demographic parameters were collected from the patients' files. Kaplan-Meier curves and multivariate Cox regression analyses were used for the analysis of prognosis. RESULTS: The mean age of the patients was 58.4 years. The mean survival time was 14.6 ± 13.0 months. Twenty-four potential prognostic factors associated with a poor outcome were calculated in the univariate analysis, and 16 potential prognostic factors were associated with a poor prognosis. These 16 potential prognostic factors were also analyzed in multivariate analysis. Multivariate analysis showed that increased age, stage 3-4 disease, the non-epithelial type, a low Karnofsky performance score, a high white blood cell count, and a low lymphocyte-to-monocyte ratio (LMR) were associated with a poor prognosis. The results of the multivariate analysis showed that a decreased LMR was associated with poor survival. Patients with LMR ≤2.6 had poor survival compared with those with LMR >2.6 (mean 9.6 vs. 17.0 months, respectively; p = 0.004). CONCLUSIONS: LMR is an independent marker of prognosis in patients with MPM and is superior to the other inflammation-based markers. The inexpensive nature and easy reproducibility of the hemogram should encourage the use of the LMR in clinical practice.

High-risk mesothelioma relation to meteorological and geological condition and distance from naturally occurring asbestos.

OBJECTIVES: Very few studies have investigated the incidence and risk of malignant mesothelioma (MM) associated with distinct sources of asbestos exposure, especially exposure to naturally occurring asbestos (NOA). METHODS: Subjects were MM, lung, and breast cancer patients who were diagnosed and followed in Diyarbakir Province between 2008 and 2013. The birthplaces of patients were displayed on a geologic map. Geological and meteorological effects on MM were analyzed by logistic regression. RESULTS: A total of 180 MM, 368 breast, and 406 lung cancer patients were included. The median distance from birthplace to ophiolites was 6.26 km for MM, 31.06 km for lung, and 34.31 km for breast cancer (p < 0.001). The majority of MM cases were seen within 20 km from NOA areas. The MM incidence inside of NOA was 1059/100.000, and out of NOA was 397/100.000; this difference was significant (p = 0.014). The largest concentration of MM residential areas was within ± 30° (34 residential areas 36.6%) of the dominant wind direction. Most MM patients were found in or near the dominant wind direction, especially in the acute angle defined by the dominant wind direction. MM incidence was directly proportional to {[area of NOA (km(2))] * [cosine α of wind direction angle]} and was inversely proportional to the square of the distance (R = 0.291, p = 0.023). CONCLUSIONS: MM was higher near NOA and in the downwind direction. MM incidence and risk were affected by geological and meteorological factors.

Relationship between hepcidin levels and periodic limb movement disorder in patients with obstructive sleep apnea syndrome.

PURPOSE: This study was aimed to assess potential correlations between periodic leg movement (PLM) index, hepcidin levels, and iron status in patients with obstructive sleep apnea syndrome (OSAS). METHODS: Forty-four newly diagnosed OSAS patients and 49 non-apneic controls were enrolled in this study. All patients underwent polysomnographic evaluation. The hepcidin, iron, ferritin, total iron binding capacity, and C-reactive protein levels were measured. RESULTS: The mean age was 47.4 ± 7.2 years (18-68) in the OSAS group and 44.9 ± 11.1 years (23-65) in the control group. There were no differences in age, gender, and smoking between OSAS patients and controls. Mean apnea-hypopnea index (AHI) was 25.1 events/h. Mean serum hepcidin levels were significantly higher in OSAS subjects (725.9 ng/ml) than in control subjects (646.0 ng/ml) (p < 0.001). Serum iron levels were significantly lower in the OSAS and PLM disorder groups than in control subjects (p < 0.001). Serum hepcidin levels were significantly correlated with AHI (r = 0.453) and PLM index (r = 0.114). Serum iron levels were significantly negatively correlated with AHI (r = -0.169) and PLM index (r = -0.180). CONCLUSIONS: In our study, the level of hepcidin was increased in patients with OSAS. Our study indicates that levels of hepcidin correlate with the AHI and PLM index severity of OSAS.

Carvacrol and pomegranate extract in treating methotrexate-induced lung oxidative injury in rats.

BACKGROUND: This study was designed to evaluate the effects of carvacrol (CRV) and pomegranate extract (PE) on methotrexate (MTX)-induced lung injury in rats. MATERIAL AND METHODS: A total of 32 male rats were subdivided into 4 groups: control (group I), MTX treated (group II), MTX+CRV treated (group III), and MTX+PE treated (group IV). A single dose of 73 mg/kg CRV was administered intraperitoneally to rats in group III on Day 1 of the investigation. To group IV, a dose of 225 mg/kg of PE was administered via orogastric gavage once daily over 7 days. A single dose of 20 mg/kg of MTX was given intraperitoneally to groups II, III, and IV on Day 2. The total duration of experiment was 8 days. Malondialdehyde (MDA), total oxidant status (TOS), total antioxidant capacity (TAC), and oxidative stress index (OSI) were measured from rat lung tissues and cardiac blood samples. RESULTS: Serum and lung specimen analyses demonstrated that MDA, TOS, and OSI levels were significantly greater in group II relative to controls. Conversely, the TAC level was significantly reduced in group II when compared to the control group. Pre-administering either CRV or PE was associated with decreased MDA, TOS, and OSI levels and increased TAC levels compared to rats treated with MTX alone. Histopathological examination revealed that lung injury was less severe in group III and IV relative to group II. CONCLUSIONS: MTX treatment results in rat lung oxidative damage that is partially counteracted by pretreatment with either CRV or PE.

Oxidative status and acute phase reactants in patients with environmental asbestos exposure and mesothelioma.

BACKGROUND AND OBJECTIVES: The aim of this study was to investigate inflammatory indicators and oxidative status in patients with asbestos exposure with and without mesothelioma and to compare results with data from healthy subjects. METHODS: Eighty people with exposure to environmental asbestos and without any disease, 46 mesothelioma patients, and a control group of 50 people without exposure to environmental asbestos were enrolled in this prospective study. Serum total oxidant level (TOL), total antioxidant capacity (TAC), and oxidative stress index (OSI), CRP, transferrin, ceruloplasmin, α-1 antitrypsin, ferritin, and copper levels were measured. RESULTS: Mesothelioma group exhibited higher TOL, OSI, α1-antitrypsin, ferritin and copper levels as compared to the other groups (P < 0.001, P = 0.007, P < 0.0001, P < 0.001, and P < 0.001, resp.). Transferrin was lower in the mesothelioma group than in the other two groups (P < 0.001). The asbestos group had higher TOL, TAC, α1-antitrypsin, and transferrin levels (P < 0.001, P < 0.001, P < 0.001, and P < 0.001, resp.), as well as lower OSI and ferritin levels as compared to the control group (P < 0.001 and P < 0.001). CONCLUSIONS: We believe that elevated acute phase reactants and oxidative stress markers (TOL and OSI) in the mesothelioma group can be used as predictive markers for the development of asbestos-related malignancy.

Clinical characteristics, treatment and survival outcomes in malignant pleural mesothelioma: an institutional experience in Turkey.

PURPOSE: To compare treatment modalities and investigate potential prognostic factors for survival in patients with malignant pleural mesothelioma (MPM). METHODS: The present study has investigated the data of 150 patients with MPM who were examined and treated in our center from 2005 to 2012. RESULTS: The study included 87 male (58% and 63 female (42) patients. Surgical resection (pleurectomy/decortications (P/D), and extrapleural pneumonectomy (EPP)) was performed in 32 (36.7%) patients; 87 patients (58%) received chemotherapy alone and 16 (10.7%) had surgery, chemotherapy and radiotherapy (trimodal treatment). The median progression free and overall survival (PFS and OS) for all patients were 10.6 and 14.8 months, respectively. No statistically significant difference was observed between the patients who received pemetrexed/cisplatin (N=54) and gemcitabine/cisplatin (N=28) in terms of PFS and OS (p=0.145, p=0.244, respectively). Also, no statistically significant difference was registered between operated and non operated patients (PFS and OS, p=0.416, p=0.095, respectively). There was no difference in both PFS and OS rates between patients who had P/D or EPP (p=0.87, p=0.652, respectively). Log rank analysis: Eastern Cooperative Oncology Group performance status (ECOG PS) (p=0.018), histology (p<0.001), stage (p<0.001) and leukocytosis (p=0.005) were found to be significant prognostic factors of OS. At multivariate analysis, ECOG PS (p=0.016) and stage (p<0.001) were independent prognostic factors for OS. CONCLUSION: Median OS was approximately 1 year. ECOG PS, histological type, stage and presence of leukocytosis were prognostic factors that affected both PFS and OS. EPP or P/D surgical options did not provide difference in terms of survival. Survival rates in patients who received a combination of platinum analogues with pemetrexed or gemcitabine as front-line chemotherapy were similar.

Risk factors for multidrug-resistant tuberculosis in Diyarbakir, Turkey.

BACKGROUND: Multidrug-resistant (MDR) tuberculosis (TB) is a serious public health problem. This study aimed to investigate probable risk factors for developing MDR in the patients treated for TB at Tuberculosis Control Dispensaries (TCD). MATERIAL/METHOD: The records of 34 patients with MDR-TB and 70 patients with TB sensitive to all first-line drugs (DS), who were treated at TCD between January 2002 and December 2008, were reviewed retrospectively in Diyarbakir, Turkey. RESULTS: The mean age was 34.47+/-16.99 (32.35+/-14.21 in MDR group and 35.50+/-18.19 in control group) with the range from 2 to 76 years. Of the patients, 63 were male and 41 were female. When risk factors for MDR were evaluated with univariate analysis methods, low socio-economic status, the presence of accompanying disease, previous TB history, previously administered TB treatment, inappropriate TB treatment, and noncompliance with TB treatment were all found to be significant risk factors. When these risk factors were analyzed with logistic regression analysis, regardless of other risk factors, MDR risk was significantly increased with previous TB history by 22.31, with previously taking TB medication by 13.19, and with low socio-economic status by 6.03. CONCLUSIONS: Socio-economic factors also play an important role in this issue. To minimize the effect of patients' risk factors, health workers should be able to reach all patients, and therapies must be given under direct observation.

[Factors affecting incidence of tuberculosis in Diyarbakir]. / Diyarbakir ilinde tüberküloz insidansini etkileyen faktörler.

Last decade, there have been important improvements about tuberculosis (Tbc) in the world. Today, 32% of world populations are infected by Tbc basil's, every year about 9 million people have been catching Tbc. We have purposed to determine the incidence of Tbc and the factors affect it, using rate of bacteriology in diagnosis, rate of treatment completion and to constitute an idea for innovation. Diyarbakir, standard monthly data forms used for informing of Tbc in tuberculosis control dispensary are investigated retrospectively among 1996-2004. The mean incidence of yearly Tbc is 37.77/100.000 and pulmonary Tbc is 30.11/100.000. In this period have been determined 3724 new Tbc patient; 2969 (79.7%) are pulmonary Tbc and 755 (20.3%) extrapulmonary Tbc. 842 patient (22.6%) of pulmonary Tbc are smear positive. Tbc pleurisy is the most common type of extrapulmonary Tbc in our series. 3354 (90.1%) of whole patients and 2624 (88.4%) with pulmonary Tbc had completed treatment. There is no data about the rate of cure. This is the most common problem Tbc control system. In 2005, cure rates will have been determined by the way of new form. 162 (4.4%) patient had abandoned treatment. Incidence of Tbc is higher than the incidence of Turkey. It was considered that at the first place highly growing population, the crowded family pattern sharing the same house and bad socioeconomic factors have been playing a major role. Furthermore, it was found that the rate of bacteriological diagnosis was low. In order to increasing of this rates should be carried out necessary studies, should be tried to diagnose all patients with bacteriological methods. End of the treatment cure should be tried to demonstrate by way of examination of sputum. The treatment process should be pursued by directly observed treatment strategy.

Alterations of the neutrophil-lymphocyte ratio during the period of stable and acute exacerbation of chronic obstructive pulmonary disease patients.

OBJECTIVES: We aimed to investigate the importance of neutrophil-lymphocyte ratio (NLR) in patients with chronic obstructive pulmonary disease (COPD) for identifying the severity of inflammation and recognition of acute exacerbation. METHODS: We retrospectively enrolled 100 patients with a diagnosis of COPD exacerbation who were admitted to our clinic. Complete blood count (CBC), measurement of C reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were determined within 2 h of hospital admission. Three months after an acute exacerbation, these measurements were obtained from the same patients during the stable period of COPD. The control group included 80 healthy subjects. NLR was calculated from CBC. RESULTS: NLR and other inflammatory markers, such as WBC, CRP and ESR were found to be significantly elevated in exacerbated COPD compared to stable COPD and control participants. There was a significant correlation of NLR with CRP (r = 0.415, P < 0.001), WBC (r = 0.304, P = 0.002) and ESR (r = 0.275, P = 0.035). For an NLR cutoff of 3.29, sensitivity for detecting exacerbation of COPD was 80.8% and specificity was 77.7% (AUC 0.894, P = 0.001). Some patients presenting with acute exacerbation of COPD and CRP, WBC or ESR levels lower than the optimal cut-off value had high NLR values. CONCLUSIONS: Elevated NLR can be used as a marker similar to CRP, WBC and ESR, in the determination of increased inflammation in acutely exacerbated COPD. NLR could be beneficial for the early detection of potential acute exacerbations in patients with COPD who have normal levels of traditional markers.

[Tuberculosis screening results made at primary schools in Cizre]. / Cizre'de ilkokul çocuklarinda tüberküloz taramasinin sonuçlari

Tuberculosis (Tbc) gained importance as a public health problem in the recent years. The course of the disease is more severe in childhood. Tbc screening was made by The Tuberculosis Control 11th Group Presidency on the primary school students in Cizre, in November 2005. A total of 2242 children have been taken to this study. Of the children, 1130 (50.4%) were boys and 1112 (49.6%) were girls. The mean age of the children was 6.9+/-0.8 (range, 4-14) years. Concerning Bacillus Calmette-Guerin (BCG) vaccine scar, 1676 (74.7%) children had no scar, 536 children (23.9%) had single scar, and 32 children (1.4%) had double scar. The mean diameter of the tuberculin skin test (TST) was 2.1+/-2.7 mm. Regarding sexuality and TST mean diameter, statistically significant relation was not detected between girls and boys (p=0.3). The mean diameter of TST were 1.5+/-1.4 mm, 3.5+/-4.0 mm and 11.2+/-3.3 mm in the children with no BCG scar, in those with single BCG scar, and in those with double BCG scar, respectively. Of the TST results of all children, 2065 (92.1%) were negative, 101 (4.5%) were attributed to BCG, and 76 (3.4%) were positive, respectively. The rate of positiveness of TST was 1.2% in the children with no BCG scar, 8.9% in the children with single BCG scar, and 50% in the children with double BCG scar, respectively. A statistically significant correlation between the increase in the BCG scar number and the increase in the TST mean diameter was detected (p<0.05). Of the children who were likely to have Tbc, 139 (6.2%) were advised to apply at the dispensary. Single BCG vaccination was inadequate in the children. We suggest encouraging the families about postpartal single BCG vaccination. Furthermore, school screenings should be paid greater attention.

Serum Apelin 13 Levels in Patients With Pulmonary Embolism.

INTRODUCTION AND AIM: Expression and peptide immunoreactivity of apelin messenger RNA have been described in a variety of tissues, including gastrointestinal tract, adipose tissue, brain, kidney, liver, cardiovascular system, and lungs. This study aimed to investigate the possible involvement of the endogenous apelin in the pathophysiological events that occur in patients with pulmonary embolism (PE). MATERIALS AND METHODS: In total, 53 patients with PE and 35 healthy volunteers were included the study. This cross-sectional study was conducted at a tertiary care university hospital and among patients diagnosed as having PE. The control group consisted of healthy volunteers who applied to hospital for a routine checkup examination. Serum apelin 13 levels were measured in both the groups and their results were compared. RESULTS: The median ages were 57 and 53 years, and female-male ratios were 30/23 and 20/15, in the PE and control groups, respectively. The mean serum apelin 13 levels were found to be significantly higher in the PE group (76.94 ± 10.70 ng/mL) than in the control group (50.01 ± 7.13 ng/mL; P < .001). CONCLUSION: This study demonstrated that apelin 13 levels are elevated in patients with PE. These results suggest that apelin may be a novel biomarker and a potential therapeutic target in patients with acute PE in the future.

Quantitative volumetric assessment of pulmonary involvement in patients with systemic sclerosis.

BACKGROUND: Computed tomography (CT) is the gold standard for assessing interstitial lung disease (ILD) in patients with systemic sclerosis (SSc). In this study, we performed a quantitative calculation of ILD severity by examining the lung volume of SSc patients. METHODS: The present study was performed retrospectively on 38 patients with SSc who were referred to our clinic. Patients were divided into two groups based on high-resolution computed tomography (HRCT): patients with ILD and patients without ILD.The percentage of lower lobe volume (PLLV) was calculated using HRCT. In addition, we evaluated the PLLV in all patients according to age, diffusing capacity of the lung for carbon monoxide (DLCO) and spirometric findings, and assessed the relationships among these factors. RESULTS: PLLV of the right lung in patients with ILD was reduced when compared with patients without ILD (P=0.041). The PLLV of the right lung in patients with ILD was negatively correlated with age and forced vital capacity (FVC; P=0.01 and P=0.012, respectively). CONCLUSIONS: The PLLV of the right lung may decrease in SSc patients with ILD. In these patients, the PLLV may be a quantitative parameter indicating damage in the lung.

The relationship between inflammatory marker levels and pulmonary tuberculosis severity.

We aimed to investigate the correlation between red cell distribution width (RDW), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and other inflammatory markers with pulmonary tuberculosis (PTB) severity. Seventy patients with active pulmonary tuberculosis were compared with 50 age-matched and gender-matched healthy controls. The mean age of PTB patients was 50.4 ± 21.8 years. There were no differences in terms of age, gender, and smoking history between PTB patients and controls. Patients with advanced PTB had a significantly higher white blood cell count, neutrophil count, RDW, NLR, and C-reactive protein when compared to patients with mild to moderate PTB. RDW (17.7 versus 15.7 %, p=0.002) and NLR (4.7 versus 3.1, p=0.009) values were higher in patients with advanced PTB as opposed to patients with mild to moderate PTB. NLR and RDW levels may be used as markers of inflammation to help clinically manage patients with TB and to determine disease severity.

Alterations in platelet count and mean platelet volume as predictors of patient outcome in the respiratory intensive care unit.

INTRODUCTION: Thrombocytopenia is associated with increased mortality in intensive care unit (ICU) patients. Mean platelet volume (MPV) reflects platelet function and activation. Elevated MPV is associated with poor outcomes and increased mortality rate in diseases that are commonly encountered in the respiratory ICU. METHODS: We retrospectively enrolled 95 patients who died in the ICU (dead group), 80 patients who improved and were transferred from the ICU (survived group), and 80 healthy individuals as controls. Laboratory parameters including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), albumin, and complete blood count (CBC) were recorded within 24 h on admission and transfered from the ICU or died. White blood cell (WBC) count, hemoglobin (Hb), red cell distribution width, MPV, platelet distribution width (PDW), and platelet count (PC) were obtained from the CBC. RESULTS: Admission PC and MPV levels were not different in the survived and dead groups. But in the survived group, admission WBC, MPV and PDW levels decreased, while PC increased when compared with admission levels. In the dead group, admission MPV and PDW levels increased, while PC decreased with respect to admission levels. The admission mean PC of the dead group was 182 103, which was above the thrombocytopenia limit. The ratio of admission thrombocytopenia was 45.3% in the dead group, which was significantly higher than that of the survived group (13.8%) (P < 0.001) CONCLUSIONS: Increasing MPV and decreasing platelet count may alert intensivists to the worse course of disease in patients who had normal platelet counts at ICU admission. The development of thrombocytopenia may also be essential to assessing the outcome of ICU patients.

High social anxiety and poor quality of life in patients with pulmonary tuberculosis.

Pulmonary tuberculosis (PT) has been previously related with various psychosocial adverse consequences including stigmatization and social isolation.Social anxiety is a psychiatric condition that may be associated with social isolation and fear of social exclusion.To date no study has investigated social anxiety and its impact on quality of life (QoL) among patients with PT. Therefore, we aimed to determine the severity of social anxiety in a group of patients with PT.Among patients who were recently discharged from hospital with the diagnosis of PT 94 patients and 99 healthy control subjects who had similar demographical features have been included in the study. A psychiatrist interviewed all participants and a semistructured interview form, which was prepared by the authors, Liebowitz Social Anxiety Scale (LSAS), and Short Form-36 were administered to them.Patients with PT showed higher levels of performance avoidance and social avoidance than healthy control subjects. They reported lower QoL scores across all dimensions. Among patients women showed higher levels of LSAS subscale scores and total score. Fear of social exclusion was predicted by perceived illness severity and emotional role difficulty. On the other hand, perceived illness severity was predicted by fear of exclusion and sedimentation level.PT patients seem to experience higher levels of social anxiety and associated fear of social exclusion that add to their worse QoL during the earlier months of their disease. Among them fear of social exclusion is related with perceived illness severity.

The value of inflammatory parameters in the prognosis of malignant mesothelioma.

OBJECTIVE: This study investigated the relationship between potential prognostic parameters that may be associated with increased inflammation and survival in patients with malignant mesothelioma (MM). METHODS: This retrospective study assessed potential prognostic parameters measured at the time of MM diagnosis. Data on asbestos exposure, histopathological subtype of MM and laboratory parameters were collected. RESULTS: In 155 patients with MM (90 male), mean survival time was 13.9 months. In univariate analysis, age ≥ 60 years and neutrophil-to-lymphocyte ratio (NLR) ≥ 3 were associated with significantly shortened median survival times. In multivariate analysis, nonepithelial subtype, red cell distribution width (RDW) ≥ 20% and NLR ≥ 3 were associated with significantly shortened median survival times. Mortality rate was increased 2.77-, 1.67- and 1.52-fold in patients with RDW ≥ 20%, NLR ≥ 3 and nonepithelial subtype, respectively. Nonepithelial subtype, white blood cell count ≥ 11 200 µl and platelet-to-lymphocyte ratio ≥ 300 at baseline were associated with a heightened NLR value. CONCLUSIONS: The NLR and RDW were significant predictive factors for MM prognosis.

Adult diagnosis of Swyer-James-Macleod syndrome: retrospective analysis of four cases.

Swyer-James-Macleod syndrome (SJMS) is a rare constrictive bronchiolitis with air-flow obstruction and a decreased number and diameter of ipsilateral peripheral pulmonary vessels. This syndrome is characterized by unilateral hyperlucency on chest radiography. Computed tomography provides useful additional information. The diagnosis is usually made in childhood but sometimes occurs in adulthood. The disease often presents with dyspnea, decreased exercise tolerance, cough, hemoptysis, and recurrent pulmonary infections. SJMS may be confused with asthma or pulmonary embolism due to similar symptoms and may result in inappropriate therapy. This case series examined the clinical and imaging spectrum of four patients who were diagnosed with SJMS in adulthood.

Is a complete blood cell count useful in determining the prognosis of pulmonary embolism?

BACKGROUND: Pulmonary embolism (PE) is the third cardiovascular cause of hospital admission, following acute coronary syndrome and stroke. Despite high-tech diagnostic methods and new treatment modalities, PEs continue to have a high mortality rate within the first 3 months. This study was designed to assess the additional prognostic value of a complete blood cell count, renal function markers, C-reactive protein, and simplified pulmonary embolism severity index (sPESI) scoring system in PE 100-day mortality. MATERIALS AND METHODS: The study retrospectively enrolled 208 consecutive patients who were hospitalized with the diagnosis of an acute PE. The patients' demographic characteristics and clinical and laboratory parameters were recorded from the hospital electronic database and patient's case notes. The primary end point of the study was an adverse 100-day outcome, defined as death from any cause. RESULTS: The all-cause mortality in the first 100 days was 14.42 %. The mean age was 57.87 ± 18.17 (range: 16-93) years. We included 79 (38 %) male and 129 (62 %) female individuals. Red cell distribution width (RDW) and sPESI were found to be statistically significant predictors of PE mortality by multivariate regression analysis. On multivariate regression analysis, RDW was associated with a 4.08-fold (95 % confidence interval: 1.229-13.335, P = 0.021) increase in PE mortality. CONCLUSION: The results of this study demonstrated that RDW and sPESI may be a useful guide in predicting 100-day mortality. The elevated RDW may alert physicians to possible poor prognosis.