The WHO global alliance against chronic respiratory diseases in Turkey (GARD Turkey)

In order to prevent and control non-communicable diseases (NCDs), the 61st World Health Assembly has endorsed an NCD action plan (WHA resolution 61.14). A package for essential NCDs including chronic respiratory diseases (CRDs) has also been developed. The Global Alliance against Chronic Respiratory Diseases (GARD) is a new but rapidly developing voluntary alliance that is assisting World Health Organization (WHO) in the task of addressing NCDs at country level. The GARD approach was initiated in 2006. GARD Turkey is the first comprehensive programme developed by a government with all stakeholders of the country. This paper provides a summary of indicators of the prevalence and severity of chronic respiratory diseases in Turkey and the formation of GARD Turkey.

Clearance of Tc-99m DTPA aerosol in mismatched and matched pulmonary perfusion defects

PURPOSE

To evaluate clearance changes of Tc-99m DTPA aerosol in mismatched and matched pulmonary perfusion defects.

MATERIALS AND METHODS

Twenty-one patients (14 women, 7 men; mean age, 51 +/- 14 years) with possible pulmonary embolism were included in the study. On the day after perfusion (Q) scintigraphy with 5 mCi Tc-99m MAA, radioaerosol inhalation scintigraphy was performed using 45 mCi Tc-99m DTPA. Immediately and 45 minutes after the inhalation, early and delayed inhalation images (EI and DI, respectively) were obtained. Group 1 included 11 patients with mismatched defects who had a high probability of pulmonary embolism according to the Q/EI scan results. Group 2 included 10 patients with matched defects who had a low probability of PE. Contralateral normal lungs of 7 patients in group 2 served as controls (group 3). In groups 1 and 2, regions of interest were drawn over the mismatched and matched perfusion defects where they were best visualized, and this region of interest was mirrored to the same region on EI and DI images. For the control group, this was done in the contralateral normal lung. Mean counts in each region of interest were used for quantitative analysis, and the percentage clearance ratio was calculated using the following formula: early counts - late counts/early counts x 100.

RESULTS

The average percentage clearances for the three groups were as follows: group 1, 37% +/- 10%; group 2, 21% +/- 4%; group 3, 24% +/- 7%. Differences between groups 1 and 3 were significant, as were those between groups 1 and 2 (P < 0.05). Patients with mismatched perfusion defects had increased DTPA clearance compared with the control group and those with matched defects.

CONCLUSIONS

Vascular occlusion may lead to impairment of the alveolar-capillary barrier and consequently an increase in the clearance of Tc-99m DTPA aerosol in embolized regions. Immediately after inhalation, Tc-99m DTPA imaging should be started in the projection where perfusion defects are best seen to avoid potential misinterpretation of pulmonary embolism.

Water-pipe smoking and pulmonary functions

Water-pipe smoking is a type of smoking habit, widely encountered in Turkey and Arabic and Middle East countries. However there is limited data about the effects of water-pipe smoking. The aim of this study is to investigate this habit with regard to the duration and amount of smoking and to analyse its characteristics and effects on pulmonary function by the correlation of the results with those of cigarette smokers and non-smokers. All cafés in Izmir city were visited for this purpose. A total of 397 males were studied in four groups: water-pipe smokers, water-pipe smokers who used to smoke cigarettes, active cigarette smokers and non-smokers. After recording a detailed history of smoking, pulmonary function tests on each person were performed. There were statistically significant differences between cigarette smokers and non-smokers within most of the parameters. The results of recent study have shown that the detrimental effects on pulmonary function of water-pipe smoking are not as great as cigarette smoking (FEV1, FEV1/FVC parameters were higher in water-pipe smokers), especially on the parameters for small airways (FEF50, MMEF parameters were higher in water-pipe smokers) (P < 0.05). It is difficult to explain the reasons exactly without estimating possible mechanisms in detail, but the most likely mechanisms arise from the smoking technique itself which involves a water filter and a long spout through which the smoke passes before reaching the lungs.

Effects of haemodialysis on pulmonary clearance of Tc-99m diethylene triamine pentaacetate (DTPA)

OBJECTIVES

Hypoxaemia occurring during haemodialysis has long been known. Several mechanisms in the pathogenesis have been proposed. The present study was conducted to test whether changes in pulmonary alveolar permeability were among the operating mechanisms.

MATERIALS AND METHODS

Twenty haemodialysis patients (12 male, 8 female) were included in the study. The mean age was 49 years (age range: 18-85 years). Patients with known pulmonary disease, current smokers and those gaining more than 1 kg weight during the interdialytic period were excluded. Complete blood count, arterial blood gas analysis, pulmonary function tests and Tc-99m diethylene triamine pentaacetate (DTPA) inhalation scintiscan were carried out before and after haemodialysis. A bronchial provocation test was carried out after each session. A postero-anterior chest radiogram was taken for each patient.

RESULTS

When the results before and after haemodialysis were compared, it was observed that the pH and serum bicarbonate levels, haemoglobin and haematocrit values were significantly higher after haemodialysis. However, the platelet count was found to be decreased significantly. Bronchial hyperreactivity, tested by metacholine, Was positive in 5 of 19 patients (26%). No correlation between bronchial hyperreactivity and other factors could be identified. No significant difference was observed in pulmonary Tc-99m DTPA clearance after haemodialysis. All chest radiograms were interpreted to be within normal limits.

CONCLUSIONS

Since we observed no hypoxaemia following haemodialysis, we cannot comment as to whether the changes in pulmonary clearance play a role in the pathogenesis of haemodialysis-associated hypoxaemia. In order to reach reliable conclusions, additional studies are needed.

Behçet's disease with pulmonary involvement, superior vena cava syndrome, chyloptysis and chylous ascites

Behçet's disease is a chronic multisystem vasculitis of unknown aetiology. This case report describes a patient who applied to the hospital because of dyspnoea, ascites, oedema of lower extremities and recurrent episodes of haemoptysis. For the last 12 yr, he had superior vena cava syndrome (SVCS) and cardiac and pulmonary involvement of Behçet's disease, and biochemical examination of ascite fluid yielded a chylous effusion containing triglyceride 421 mg dl-1 and cholesterol 49 mg dl-1. Chyloptysis was also detected by Sudan III stain. The patient died from cardiac tamponade in spite of cardiac fenestration. To the authors' knowledge, this is the first reported case of Behçet's disease with chylous ascites and chyloptysis in the English literature.

High resolution computed tomographic findings in pulmonary tuberculosis

BACKGROUND

Although chest radiographs usually provide adequate information for the diagnosis of active pulmonary tuberculosis, minimal exudative tuberculosis can be overlooked on standard chest radiographs. The aim of the present study was to assess the findings of active pulmonary tuberculosis on high resolution computed tomographic (HRCT) scans, and to evaluate their possible use in determining disease activity.

METHODS

Thirty two patients with newly diagnosed active pulmonary tuberculosis and 34 patients with inactive pulmonary tuberculosis were examined. The diagnosis of active pulmonary tuberculosis was based on positive acid fast bacilli in sputum and bronchial washing smears or cultures and/or changes on serial radiographs obtained during treatment.

RESULTS

With HRCT scanning centrilobular lesions (n = 29), "tree-in-bud" appearance (n = 23), and macronodules 5-8 mm in diameter (n = 22) were most commonly seen in cases of active pulmonary tuberculosis. HRCT scans showed fibrotic lesions (n = 34), distortion of bronchovascular structures (n = 32), emphysema (n = 28), and bronchiectasis (n = 24) in patients with inactive tuberculosis.

CONCLUSIONS

Centrilobular densities in and around the small airways and "tree-in-bud" appearances were the most characteristic CT features of disease activity. HRCT scanning clearly differentiated old fibrotic lesions from new active lesions and demonstrated early bronchogenic spread. These findings may be of value in decisions on treatment.