The relationship of thiol/disulfide homeostasis in the etiology of patients with obstructive sleep apnea: a case-control study.

AIM: Obstructive sleep apnea syndrome (OSAS) is a chronic and incapacitating disease that often requires lifelong care. This study aimed to evaluate the thiol/disulfide homeostasis in patients with OSAS, to compare the thiol/disulfide levels with the control group and to investigate their relationship with the severity of the disease. MATERIAL AND METHODS: Patients who were admitted to the department of chest diseases, and diagnosed with OSAS using polysomnographic analysis (n = 186) and 144 patients who underwent polysomnography due to some reasons but ruled out of having OSAS were included in the study. Serum total thiol (TT), native thiol (SH), and disulfide thiol (SS) levels were measured from the participants; SS/SH, SS/TT, and SH/TT percent ratios were calculated and compared between the patient and control groups. RESULTS: The mean (±SD) age of the patients and control participants was 52.0 ± 11.5 years and 44.9 ± 13.2 years, respectively. Compared to the control group, patients with OSAS had significantly lower SH (239.3 ± 56.3 µmol/L vs. 258.6 ± 65.3µmol/L, t = 2.70, p =.007) and TT levels (273.2 ± 60.1 µmol/L vs. 292.9 ± 67.5µmol/L, t = 2.64, p=.010). Age (OR = 1.04), serum albumin (OR = 12.67), ischemia-modified albumin (IMA) (OR = 0.12), SH (OR = 0.81), and TT (OR = 1.17) were independent predictors of OSAS. CONCLUSIONS: These results support the idea that decreased ST and TT levels are related to increased oxidative stress. On the other hand, impaired thiol balance may play a significant role in the pathogenesis of OSAS.

Moxifloxacin related thrombocytopeniae: A case report.

Drug-induced thrombocytopenia can be caused by various medications, most frequently, antibiotics. There have been reports of thrombocytopenia cases due to the usage of quinolone antibiotics, although moxifloxacin-related thrombocytopenia has been reported very rarely. The case is here presented of a 60-year old male with chronic obstructive pulmonary disease who presented with complaints of progressively worsening dyspnea. After hospitalization, progressive thrombocytopenia was detected which had started on the 3rd day of moxifloxacin treatment. Other causes of thrombocytopenia were excluded and the thrombocyte count returned to normal after discontinuation of moxifloxacin.

Association of Fragmented QRS with Subclinical Left Ventricular Dysfunction in Patients with Obstructive Sleep Apnea.

OBJECTIVE: We aimed to investigate whether fragmented QRS (fQRS) is associated with subclinical left ventricular (LV) dysfunction in patients with obstructive sleep apnea (OSA). SUBJECTS AND METHODS: A total of 141 patients with OSA who had normal LV ejection fraction (LVEF) were included in the study. The fQRS was defined as the presence of an additional R wave, notching of R or S wave or the presence of fragmentation in 2 contiguous electrocardiography (ECG) leads. Subclinical LV dysfunction was defined as the presence of a tissue Doppler-derived Tei index of ≥ 0.5 in the absence of impaired LVEF (<50%) as assessed by transthoracic echocardiography. RESULTS: Of the 141 patients, 71 (50.4%) had subclinical LV dysfunction. Overall, the prevalence of the fQRS was 61% (86/141). Patients with fQRS had significantly higher Tei indices than those without fQRS [median 0.66, interquartile range (IQR) 0.39 vs. median 0.40, IQR 0.15, p < 0.001]. The presence of fQRS on ECG predicted subclinical LV dysfunction in univariate logistic regression analysis [odds ratio (OR) 6.69, 95% confidence interval (CI) 3.10-14.43]. The association remained significant after adjusting for all potential confounders (OR 4.59, 95% CI 1.94-10.87). CONCLUSION: fQRS on ECG was an independent predictor of subclinical LV dysfunction in patients with OSA. This simple tool might help to identify OSA patients who could be at risk for developing overt cardiac dysfunction.

The association between aortic knob width on chest x-ray and obstructive sleep apnoea syndrome in patients referred for sleep testing.

OBJECTIVE: Obstructive sleep apnoea (OSA) has been linked with many forms of cardiovascular diseases. Aortic knob width (AKW) has increasingly been presented as a marker of diagnosis and prognosis of atherosclerotic coronary artery disease. We sought to determine whether AKW has an association with sleep apnoea syndrome in patients referred to sleep testing in order to provide baseline information for future studies on general population. METHODS: A total of 363 patients were included in this retrospective study. The capacity of AKW indexed by patients' height in predicting the presence of severe OSA was analysed using receiver operating characteristics curve analysis. The association of OSA severity with AKW indexed by height was tested with two separate models of ANCOVA (analysis of variance). RESULTS: Area under the curve for estimating severe OSA with AKW was 0.67 (95% CI, 0.60 to 0.73, P < 0.001). A cut-off value of 21.42 mm/m provided a sensitivity of 62.6% and a specificity of 70.7% for severe OSA. In both ANCOVA models, the association of OSA severity on AKW indexed by height was significant and the effect size was moderate (P < 0.001, partial eta squared: 0.09 and 0.05). CONCLUSIONS: Aortic knob width indexed by height has a significant association with the severity of OSA; however, the association is significantly influenced by gender and age.

Candida glabrata Pneumonia in a Patient with Chronic Obstructive Pulmonary Disease.

Pneumonia remains an important cause of morbidity and mortality among infectious diseases. Streptococcus pneumoniae and viruses are the most common cause of pneumonia. Candidiasis in such patients has been associated with haemodialysis, fungal colonization, exposure to broad-spectrum antibiotics, intensive care unit (ICU) hospitalization, and immunocompromised patients. The most common cause of infection is C. albicans. The case presented here is of a 66-year-old male patient diagnosed with C. glabrata. The patient suffered from chronic obstructive pulmonary disease.