Comparison of BAP65, DECAF, PEARL, and MEWS Scores in Predicting Respiratory Support Need in Hospitalized Exacerbation of Chronic Obstructive Lung Disease Patients

OBJECTIVE

Prognostic models aid clinical practice with decision-making on treatment and hospitalization in exacerbation of chronic obstructive lung disease (ECOPD). Although there are many studies with prognostic models, diagnostic accuracy is variable within and between models.

SUBJECTS AND METHODS

We compared the prognostic performance of the BAP65 score, DECAF score, PEARL score, and modified early warning score (MEWS) in hospitalized patients with ECOPD, to estimate ventilatory support need.

RESULTS

This cross-sectional study consisted of 139 patients. Patients in need of noninvasive or invasive mechanical ventilation support are grouped as ventilatory support groups (n = 54). Comparison between receiver operating characteristic curves revealed that the DECAF score is significantly superior to the PEARL score (p = 0.04) in discriminating patients in need of ventilatory support. DECAF score with a cutoff value of 1 presented the highest sensitivity and BAP65 score with a cutoff value of 2 presented the highest specificity in predicting ventilatory support need. Multivariable analysis revealed that gender played a significant role in COPD exacerbation outcome, and arterial pCO2 and RDW measurements were also predictors of ventilatory support need. Within severity indexes, only the DECAF score was independently associated with the outcome. One-point increase in DECAF score created a 1.43 times higher risk of ventilatory support need. All severity indexes showed a correlation with age, comorbidity index, and dyspnea. BAP65 and DECAF scores also showed a correlation with length of stay.

CONCLUSION

Objective and practical classifications are needed by clinicians to assess prognosis and initiate treatment accordingly. DECAF score is a strong candidate among severity indexes.

Does attention deficit hyperactivity disorder worsen family functioning and parenting styles? A case control study

OBJECTIVE

A bidirectional relationship between family functioning and parenting styles and Attention Deficit and Hyperactivity Disorder (ADHD) is proposed. The aim of this study is to examine the effect of ADHD symptoms on parenting styles and the general functionality of the family as well as symptoms of depression and anxiety.

METHODS

73 children with ADHD (56%) and 56 controls (43%) (a total of 129 participants, 31% female, 69% male) with a mean age of 11.3 (7-17, n: 129) were included in the study, which was conducted in Gaziantep University Hospital Child Psychiatry Department in 2022. The participants completed psychometric scales.

RESULTS

Parents of children with ADHD showed higher positive parenting scores than the control group (p < 0.05). Inconsistent discipline scores were substantially higher in the ADHD combined subtype (14.38 ± 5.2) than in the attention deficit dominant group (17.59 ± 3.96) In addition, a strong correlation was found between familial functionality scores and ADHD severity in the ADHD attention deficit dominant subtype (r:0.601; p:0.027) and as ADHD severity increased, family functionality decreased.

CONCLUSIONS

This study shows that parents of children with ADHD have different parenting styles and ADHD affects the overall functionality of the family in the Turkish sample.

Pulmonary Physician Consultancy in Emergency Services in Turkiye (PuPCEST) - a cross-sectional multicenter study

Pulmonology is one of the branches that frequently receive consultation requests from the emergency department. Pulmonology consultation (PC) is requested from almost all clinical branches due to the diagnosis and treatment of any respiratory condition, preoperative evaluation, or postoperative pulmonary problems. The aim of our study was to describe the profile of the pulmonology consultations received from emergency departments in Turkiye. A total of 32 centers from Turkiye (the PuPCEST Study Group) were included to the study. The demographic, clinical, laboratory and radiological data of the consulted cases were examined. The final result of the consultation and the justification of the consultation by the consulting pulmonologist were recorded. We identified 1712 patients, 64% of which applied to the emergency department by themselves and 41.4% were women. Eighty-five percent of the patients had a previously diagnosed disease. Dyspnea was the reason for consultation in 34.7% of the cases. The leading radiological finding was consolidation (13%). Exacerbation of preexisting lung disease was present in 39% of patients. The most commonly established diagnoses by pulmonologists were chronic obstructive pulmonary disease (19%) and pneumonia (12%). While 35% of the patients were discharged, 35% were interned into the chest diseases ward. The majority of patients were hospitalized and treated conservatively. It may be suggested that most of the applications would be evaluated in the pulmonology outpatient clinic which may result in a decrease in emergency department visits/consultations. Thus, improvements in the reorganization of the pulmonology outpatient clinics and follow-up visits may positively contribute emergency admission rates.

Development and validation of a simple risk scoring system for a COVID-19 diagnostic prediction mode

Introduction

In a resource-constrained situation, a clinical risk stratification system can assist in identifying individuals who are at higher risk and should be tested for COVID-19. This study aims to find a predictive scoring model to estimate the COVID-19 diagnosis."

Materials

Patients who applied to the emergency pandemic clinic between April 2020 and March 2021 were enrolled in this retrospective study. At admission, demographic characteristics, symptoms, comorbid diseases, chest computed tomography (CT), and laboratory findings were all recorded. Development and validation datasets were created. The scoring system was performed using the coefficients of the odds ratios obtained from the multivariable logistic regression analysis."

Result

Among 1187 patients admitted to the hospital, the median age was 58 years old (22-96), and 52.7% were male. In a multivariable analysis, typical radiological findings (OR= 8.47, CI= 5.48-13.10, p< 0.001) and dyspnea (OR= 2.85, CI= 1.71-4.74, p< 0.001) were found to be the two important risk actors for COVID-19 diagnosis, followed by myalgia (OR= 1.80, CI= 1.08- 2.99, p= 0.023), cough (OR= 1.65, CI= 1.16-2.26, p= 0.006) and fatigue symptoms (OR= 1.57, CI= 1.06-2.30, p= 0.023). In our scoring system, dyspnea was scored as 2 points, cough as 1 point, fatigue as 1 point, myalgia as 1 point, and typical radiological findings were scored as 5 points. This scoring system had a sensitivity of 71% and a specificity of 76.3% for a cut-off value of >2, with a total score of 10 (p< 0.001).

Conclusions

The predictive scoring system could accurately predict the diagnosis of COVID-19 infection, which gave clinicians a theoretical basis for devising immediate treatment options. An evaluation of the predictive efficacy of the scoring system necessitates a multi-center investigation.

Electric scooters as a silent source of danger in increasing use among young people: a single-center in-depth accident analysis

BACKGROUND

The reasons for the increase in accidents involving shared stand-up e-scooters in recent years may be the wide-spread use of e-scooters among young people, especially in metropolitan areas with heavy traffic, non-compliance with traffic rules, and insufficient legal regulations. In this study, we analyzed in detail the typical features of rider-sharing e-scooter-related injuries brought to the emergency department of our hospital in the light of current literature.

METHODS

The clinical and accident characteristics of 60 patients with surgical requirements who were brought to the emergency department of our hospital due to e-scooter-related accidents between 2020 and 2020 were analyzed using statistical methods ret-rospectively.

RESULTS

The majority of the victims were university students and the number of victims of the male gender was slightly higher and the mean age was 25.3±13.0 years. Most e-scooter accidents occur on weekdays. Most of the e-scooter-related accidents happen on weekdays and are non-collision type accidents. The majority of e-scooter-related accident victims were in the minor trauma group (injury severity score <9), predominantly had extremity and soft-tissue injuries and needed radiological examination (44 patients, 73.3%), and only eight victims (13.3%) required surgical operation and also all of the e-scooter victims were discharged fully healed.

CONCLUSION

Among the more common collision-free e-scooter-related accidents that have a lower trauma severity score or cause minor soft-tissue injury, mono-trauma occurs more commonly than multisystem trauma; likewise, radius and nasal-weighted monofractures occur more commonly than multiple fractures, according to this study. Besides, effective measures and legal regulations should be put in place to prevent e-scooter-related accidents.

Tocilizumab treatment in COVID-19: A prognostic study using propensity score matching

BACKGROUND

The potential role of interleukin-6 (IL-6) in coronavirus disease 2019 (COVID-19) pneumonia provides the rationale for investigating IL-6 signaling inhibitors.

OBJECTIVES

To evaluate and report treatment responses to tocilizumab (TCZ) in COVID-19 patients and compare mortality outcomes with those of standard care.

MATERIAL AND METHODS

Patients hospitalized with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, diagnosed with reverse transcription polymerase chain reaction (RT-PCR) between March 2020 and April 2021, were enrolled in this single-center retrospective cohort study. Propensity score matching was performed in order to reduce confounding effects secondary to imbalances in receiving TCZ treatment.

RESULTS

A total of 364 patients were included in this study. Two hundred thirty-six patients received standard care, while 128 patients were treated with TCZ in addition to standard care (26 (20.3%) patients received a dose of 400 mg intravenously once, while 102 (79.7%) patients received a total dose of 800 mg intravenously). In the propensity score-matched population, less noninvasive mechanical ventilation (p = 0.041) and mechanical ventilation support (p = 0.015), and fewer deaths (p = 0.008) were observed among the TCZ-treated patients. The multivariate adjusted Cox regression model showed a significantly higher survival rate among TCZ patients compared to controls (hazard ratio (HR): 0.157, 95% confidence interval (95% CI): 0.026-0.951; p = 0.044). The hazard ratio for mortality in the TCZ group was 0.098 (95% CI: 0.030-0.318; p = 0.0001 using log-rank test).

CONCLUSIONS

This study determined that TCZ treatment in COVID-19 patients was associated with better survival, reduced need for mechanical ventilation and reduced hospital-associated mortality.

Polisomographic Investigation of Sleep Disorders in Patients with Sickle Cell Anemia and Evaluation of the Effect on the Prognosis

objective:

The aim of this study is to identify sleep disorders in adults with sickle cell disease and to examine the effects of accompanying sleep disorders on the prognosis of sickle cell disease.

MATERIAL AND METHODS:

Twenty-eight patients followed up with a diagnosis of sickle cell disease and 22 healthy volunteers were included in our study.

Results:

Both groups had similar characteristics in terms of age, gender, and body mass index. More obstructive sleep apnea syndrome was detected in the sickle cell group than in healthy volunteers. Statistically, the sickle cell patient group had higher apnea–hypopnea index and lower nighttime oxygen desaturation. As the degree of obstructive sleep apnea syndrome increased in the sickle cell group, it was found that there were more emergency admissions and hospitalization due to painful crises and/or acute chest syndrome in the last 1 year. Also, lower sleep efficiency was found in the sickle cell disease patient group. In the sickle cell group, it was found that the restless leg syndrome severity was statistically significantly more.

Conclusion:

As hypoxia deepens in sickle cell patients, mortality and morbidity due to the disease increase significantly. Comorbid sleep disturbances in sickle cell patients exacerbate nocturnal hypoxia and negatively affect the prognosis of the disease. Therefore, patients with sickle cell disease should be questioned in detail in terms of obstructive sleep apnea syndrome and, if necessary, polysomnographic evaluation should be performed to provide treatment for sleep disorders in the early period.

Prognostic factors for COVID-19 patients

Introduction: Determining prognostic factors in patients with coronavirus disease (COVID-19) can have great impact on treatment planning and follow-up strategies. Herein, we aimed to evaluate prognostic factors and clinical scores for confirmed COVID-19 patients in a tertiary-care hospital in the Bursa region of Turkey. Methodology: Patients who had been diagnosed with COVID-19 microbiologically and/or radiologically between March and October 2020 in a tertiary-care university hospital were enrolled retrospectively. Adult patients (≥ 18 years) with a clinical spectrum of moderate, severe, or critical illness were included. The dependent variable was 30-day mortality and logistic regression analysis was used to evaluate any variables with a significant p value (< 0.05) in univariate analysis. Results: A total of 257 patients were included in the study. The mortality rate (30-day) was 14.4%. In logistic regression analysis, higher scores on sequential organ failure assessment (SOFA) (p < 0.001, odds ratio (OR) = 1.86, 95% CI = 1.42-2.45) and CURB-65 pneumonia severity criteria (p = 0.001, OR = 2.60, 95% CI = 1.47-4.57) were found to be significant in predicting mortality at admission. In deceased patients, there were also significant differences between the baseline, day-3, day-7, and day-14 results of D-dimer (p = 0.01), ferritin (p = 0.042), leukocyte (p = 0.019), and neutrophil (p = 0.007) counts. Conclusions: In our study of COVID-19 patients, we found that high SOFA and CURB-65 scores on admission were associated with increased mortality. In addition, D-dimer, ferritin, leukocyte and neutrophil counts significantly increased after admission in patients who died.

Long‐term oxygen treatment need is less frequent in eosinophilic COPD patients

Introduction

Methods

Results

Conclusion

Serum Krebs von den Lungen-6: promising biomarker to differentiate CPFE from IPF

Background   Combined pulmonary fibrosis and emphysema (CPFE) has been recognised as a phenotype of pulmonary fibrosis. We aimed to compare serum surfactant protein-A (SP-A), surfactant protein-D (SP-D) and Krebs von den Lungen-6 (KL-6) levels, functional parameters, in CPFE and  IPF (idiopathic pulmonary fibrosis) patients. Methods Patients diagnosed with 'CPFE' and 'IPF' were consecutively included in 6 months as two groups. The patients with connective tissue diseases are excluded. Results           In this study, 47 patients (41 males, 6 females) with CPFE (n = 21) and IPF (n = 26) with a mean age of 70.12 ± 8.75 were evaluated. CPFE patients were older, had more intense smoking history, had lower DLCO/VA, lower FVC, and worse six-minute walking distance than the IPF group (p=0.005, p=0.027, p=0.02, p<0.001, p=0.001, respectively). Serum KL-6 levels were higher in CPFE group compared to IPF group [264.70 U/ml (228.90-786) vs 233.60 (101.8-425.4), p<0.001]. Serum KL-6 levels of 245.4 U/ml and higher have 81% sensitivity and 73% specificity for the discrimination of CPFE from IPF. Conclusions   Our study has shown that serum KL-6 level is a promising biomarker to differentiate CPFE from IPF. In CPFE cases respiratory and functional parameters are worse than those of pure fibrosis cases.

Reliability and Validity Study of the Turkish Version of the COVID-19 Peritraumatic Distress Index

OBJECTIVE

The Coronavirus Disease 2019 (COVID-19) pandemic, affecting people worldwide, negatively affects the mental health of people. During this situation, accurate and reliable tools are needed to evaluate mental state. The aim of this study was to translate the COVID-19 Peritraumatic Distress Index (CPDI) into Turkish, and analyze it for validity and reliability.

METHODS

The original form of the CPDI was translated into Turkish using the back translation method. It was then applied to over 400 individuals, randomly selected from patients and their relatives, between the ages of 18 and 70, who presented to the outpatient clinics of Mustafa Kemal University Research Hospital. Data were collected with a demographic data form. Exploratory and confirmatory factor analyses were done. Construct validity, item content validity index, and content validity were analyzed. Cronbach's alpha vs. Spearman-Brown reliability analyses were done.

RESULTS

Cronbach's alpha coefficient for the CPDI was found to be 0.842, which is quite high. Cronbach's alpha coefficient for the subscales ranged from 0.670 to 0.780. The Spearman-Brown reliability coefficient was 0.730. The confirmatory factor analysis revealed good fit indices (χ2/df = 1.94; root mean square error of approximation = 0.05; Comparative Fit Index = 0.93; Adjusted Goodness of Fit Index and Tucker-Lewis Index = 0.91). The mean total score was 27.26 (SD = 12.28), while the mean subscale scores ranged from 4.83 to 10.26.

CONCLUSION

The Turkish version of the CPDI is valid and reliable, and can be used in studies evaluating the COVID-19 peritraumatic stress.

Reliability and Validity Study of the Turkish Version of the COVID-19 Peritraumatic Distress Index

OBJECTIVE

The Coronavirus Disease 2019 (COVID-19) pandemic, affecting people worldwide, negatively affects the mental health of people. During this situation, accurate and reliable tools are needed to evaluate mental state. The aim of this study was to translate the COVID-19 Peritraumatic Distress Index (CPDI) into Turkish, and analyze it for validity and reliability.

METHODS

The original form of the CPDI was translated into Turkish using the back translation method. It was then applied to over 400 individuals, randomly selected from patients and their relatives, between the ages of 18 and 70, who presented to the outpatient clinics of Mustafa Kemal University Research Hospital. Data were collected with a demographic data form. Exploratory and confirmatory factor analyses were done. Construct validity, item content validity index, and content validity were analyzed. Cronbach's alpha vs. Spearman-Brown reliability analyses were done.

RESULTS

Cronbach's alpha coefficient for the CPDI was found to be 0.842, which is quite high. Cronbach's alpha coefficient for the subscales ranged from 0.670 to 0.780. The Spearman-Brown reliability coefficient was 0.730. The confirmatory factor analysis revealed good fit indices (χ²/df = 1.94; root mean square error of approximation = 0.05; Comparative Fit Index = 0.93; Adjusted Goodness of Fit Index and Tucker-Lewis Index = 0.91). The mean total score was 27.26 (SD = 12.28), while the mean subscale scores ranged from 4.83 to 10.26.

CONCLUSION

The Turkish version of the CPDI is valid and reliable, and can be used in studies evaluating the COVID-19 peritraumatic stress.

Finally they are convinced and will release the cheque this upcoming sunday and verbally told to collect it

Background and objectives: Science congresses have begun to be recognized as a tourism model that named as congress tourism. The hotels where the National Emergency Medicine Congresses are hosted, which are held once a year, contribute to congress tourism.The aim of this study is to find out views of attendees of emergency medicine congresses about the congress and presentations. Methods: A survey form consisting of 16 questions (without demographic question) was shared with participants attending the 14th National Emergency Medicine Congress of the Association of Emergency Medicine Specialists (EPAT) by SMS, e-mail, and social media messenger programs (WhatsApp, etc.). Results: A total of 238 participants took part in the study of whcih73.9% (n = 176) were male. The age of the majority (68, 28.6%) participants was between 35 to 39 years. Maximum participants (n = 95, 39.9%) were specialist titleholders and the majority's (n = 81, 34.0%) length of service was 6-10 years. Of the total particinats, 73.1% and 65% expressed that curiosity about the scientific content and refreshing the knowledge respectively were the reasons for attending the conferences. Conclusion: Even if congresses are held in holiday hotels, participants are more interested in scientific content. Paramedical activities and visuals used in presentations are viewed positively. Although there are very intense programs in the congress, the majority of the participants stated that they would listen to eight presentations most efficiently. Ibrahim Med. Coll. J. 2021; 15(2): 38-43

Interleukin-21: A Potential Biomarker For Diagnosis and Predicting Prognosis in COVID-19 Patients

Interleukin-21: A Potential Biomarker For Diagnosis and Predicting Prognosis in COVID-19 Patients Abstract Introduction COVID-19 patients have a wide spectrum of disease severity. Several biomarkers were evaluated as predictors for progression towards severe disease. IL-21 is a member of common ?-chain cytokine family and creates some specific effects during programming and maintenance of antiviral immunity. We aimed to assess IL-21 as a biomarker for diagnosis and outcome prediction in patients hospitalized with COVID-19. Method Patients with a preliminary diagnosis of COVID-19 and pneumonia other than COVID-19 admitted to a tertiary care hospital were included consecutively in this comparative study. Results The study population consisted of 51 patients with COVID-19 and 11 patients with non-COVID-19 pneumonia. Serum IL-21 concentration was markedly higher and serum CRP concentration was significantly lower in COVID-19 patients compared to non-COVID-19 pneumonia patients. Within COVID-19 patients 10 patients showed radiological and clinical progression. Patients with clinical worsening had lower lymphocyte count and haemoglobin. In addition to that deteriorating patients had higher urea, LDH levels and elevated concentration of both IL-6 and IL-21. The cut-off value of 106 ng/L for IL-21 has 80.0% sensitivity, %60.9 specificity for discriminating patients with clinical worsening. Multivariable analysis performed to define risk factors for disease progression identified IL-6 and IL-21 as independent predictors. Odds ratio for serum IL-6 concentrations ? 3.2 pg/mL was 8.07 (95% CI: 1.37-47.50, p=0.04) and odds ratio for serum IL-21 concentrations ? 106 ng/L was 6.24 (95% CI: 1.04 ? 37.3, p=0.02). Conclusion We identified specific differences in serum IL-21 between COVID-19 and non-COVID-19 pneumonia patients. Serum IL-21 measurement has promising predictive value for disease progression in COVID-19 patients. High serum IL-6 and IL-21 levels obtained upon admission are independent risk factors for clinical worsening.

Understanding university students' smoking behaviors towards tobacco-free campus policy

Introduction

Tobacco-free college campuses refer to colleges and universities that have implemented policies prohibiting the use of tobacco products at all indoor and outdoor campus locations. We aimed to evaluate university students' smoking behaviors and their attitudes towards "Tobacco-Free Campus Policy".

Materials and Methods

A total of 10,383 university students were included in this cross-sectional study. The questionnaire was sent via web-based student information system. Demographical variables, the frequency of tobacco use, the addiction levels of the smoker students, and their perspective on the Tobacco-Free Campus Policy were evaluated.

Result

The study population consisted of 5461 (52.6%) males and their mean age was 22.1 ± 3.9 years. Among the students, 3992 (38.4%) were current smokers and the age of first smoking was 16.5 ± 2.78 years. According to FTND scores, 15.1% of participants have high dependence, and 7.5% of them have very high dependence. There was a significant difference among participants who finds unacceptable "Tobacco-Free Campus Policy" in terms of gender (70.7% males vs. 29.3% females, p<0.001) and smoking habit (7% never smoker, 4.1% ex-smoker, 88.9% current smoker, p<0.001).

Conclusions

The Tobacco-Free Campus Policy is important to fight against the tobacco industry in order to protect the right to health of all tobacco users and those who do not use it and should be considered as a goal to be achieved in order to live in a healthy environment.

Analysis of the contents of consultations requested by the emergency department

Background and objectives: Every year several thousand patients attend the hospital emergency department (ED). The aim of the present study was to evaluate the content of the consultations requested from the emergency department. Methods: The patients who had presented to the adult emergency department between January 1, 2020 and January 31, 2020, and who had undergone consultation by at least one clinic were included in the study. Age, gender, the number of consultation required at the same admission, the clinic from which the consultation sought, time required to respond to the request and the outcomes of the consultations were analyzed. Results: The total number of emergency department presentations was 8930 patients and at least one consultation had been requested for 6.64% (n = 593) patients. The mean duration of answering the consultation was 85.76 ± 90.33 minutes. Consultations were requested from the cardiology most frequently (n = 188, 19%), followed by the pulmonology department (n = 181, 18.3%). Discharge was recommended with prescription in 235 (39.6%) consultations. Internal medicine was the clinic, which recommended treatment at the emergency room most frequently (n = 45, 22.4%) and the most commonly recommended treatment was erythrocyte suspension replacement (n = 7). The clinic that demanded additional tests most commonly was determined to be the pulmonology department (n = 41, 22.9%) and arterial blood gases analysis was the most commonly demanded test (n = 16). Conclusion: In our study, the rate of consultations requested was seen to be lower and the rate of cases that required hospitalization was seen to be higher. The duration of answering consultations was found to be longer than desired and institutional protocols should be developed for shortening this duration. Ibrahim Med. Coll. J. 2021; 15(1): 9-15

Diagnostic performance of EBUS-TBNA and its interrelation with PET-CT in patients with extra-thoracic malignancies

Introduction

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a well-established diagnostic tool for lung cancer, sarcoidosis, and suspected metastatic extra-thoracic malignancy (ETM). Patients with primary ETM often have hypermetabolic mediastinal/hilar lymph node enlargement in the PET-scan done for initial staging or post treatment followup. We aimed to determine the diagnostic performance of EBUS-TBNA and the relationship between PET-SUV values and diagnosis of malignancy metastasis in patients with ETM.

Materials and Methods

Results of EBUS-TBNA in ETM patients with suspected MLN metastasis were retrospectively analysed (May 2016 to July 2019). Non-malign results were confirmed for surgery or clinical/radiological followup. Lymph nodes with a high FDG-uptake (SUV > 2.5, MLN) were reported as suspicious for metastasis.

Result

Of the 588 EBUS procedures, 109 were included in the analysis. Patient' mean age was 62.5 ± 10.1 years; there were 35 men and 74 women. Primary malignancies were breast cancer in 33, gastrointestinal in 23, female genital tract in 17, head and neck in 14, genitourinary cancer in 13, malignant melanoma in 6, sarcoma in 2 and kaposi sarcoma in 1. According to EBUS-TBNA smear and cell block histopathologic evaluations, 16 patients' results (14.7%) were malignant compatible with metastasis of ETM. Among the 93 patients with non-malignant diagnosis, EBUS-TBNA revealed a granulomatous lympadenitis compatible with sarcoid reaction in 7 and tuberculosis in 2. A total of 9 patients underwent surgical procedures after EBUSTBNA, with a definitive histological diagnosis of granulomatous lymphadenitis in 2, malignancy in 5 and, reactive lymph node in 2. Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of EBUS-TBNA were 76.19% (95% CI 52.83-91.78), 100% (95% CI 95.89-100.00), 100%, 94.62% (95% CI 89.12-97.12) and 95.4%, respectively.

Conclusions

EBUS-TBNA sampling has high diagnostic performance. Histopathological confirmation requirement for MLN should be kept in mind in patients with ETM, even they have negative EBUS results.

In-hospital and short-term predictors of mortality in patients with intermediate-high risk pulmonary embolism

Introduction: The aim of this study was to evaluate the in-hospital and short-term predictive factors of mortality in intermediate-high risk acute pulmonary embolism (PE) patients with right ventricle (RV)dysfunction and myocardial injury.

Methods: In this retrospective study, the medical records of 187 patients with a diagnosis of intermediate high risk acute PE were evaluated. A contrast-enhanced multi-detector pulmonary angiography was used to confirm diagnosis in all cases. All-cause mortality was determined by obtaining both in hospital and 30 days follow-up data of patients from medical records.

Results: During the in-hospital stay (9.5±4.72 days), 7 patients died, resulting in an acute PE related in-hospital mortality of 3.2%. Admission heart rate (HR), (Odds ratio (OR), 1.028 95% Confidence interval (CI), 0.002-1.121; P = 0.048) and blood urea nitrogen (BUN) (OR, 1.028 95% CI, 0.002-1.016; P = 0.044) were found to be independent predictors for in-hospital mortality in a multi variate logistic regression analysis. In total, 32 patients (20.9%) died during 30 days follow-up.The presence of congestive heart failure (OR, 0.015, 95%CI, 0.001-0.211; P = 0.002) and dementia (OR, 0.029, 95%CI,0.002-0.516; P = 0.016) as well as low albumin level (OR, 0.049 95%CI, 0.006-0.383; P = 0.049) were associated with 30 days mortality.

Conclusion: HR and BUN were independent predictors of in-hospital mortality and the presence of congestive heart failure, dementia, and low albumin levels were associated with higher 30 days mortality.

High Depression Symptoms and Burnout Levels Among Parents of Children with Autism Spectrum Disorders: A Multi-Center, Cross-Sectional, Case-Control Study

The diagnosis of autism spectrum disorder (ASD) in a child affects family processes, increases parenting stress and marital conflicts, and may lead to parental psychopathology. It may also affect the prognosis for their children. The aim of this study is to determine depression and burnout levels as well as their predictors among parents of children with ASD compared with those of healthy children. We also sought to evaluate rate of complementary and alternative medicine (CAM) interventions among parents and explore the associations of this phenomenon in an exploratory fashion. 145 children with ASD and 127 control children were enrolled along with their mothers and fathers. Beck Depression Inventory and Maslach Burnout Inventory were used to evaluate parents' depression symptoms and burnout levels. Symptoms of children with ASDs were evaluated according to the Childhood Autism Rating Scale by the clinicians. Family, child and CAM variables were screened by means of a sociodemographic data form. Descriptive, bivariate and correlation analyses were used in statistical evaluations. Predictors of burnout were evaluated with multiple regression analysis. Burnout and depression levels among parents of children with ASD were significantly elevated compared to controls. Burnout levels of mothers were significantly elevated compared to fathers while depression scores of fathers were significantly elevated compared to mothers. Maternal burnout was significantly predicted by presence of functional speech in child while paternal burnout was significantly predicted by paternal vocation. Maternal depression was associated with paternal depression, lack of speech in child and attendance of child to special education services. Paternal depression was associated with autistic symptom severity and maternal depression. More than half the parents sought CAM interventions. Education level did not affect search for CAM interventions while both maternal and paternal psychopathology and presence of epilepsy among children increased use of CAM methods. Psychological support should be provided to both mothers and fathers of a child receiving a diagnosis of ASD. Addressing parents' burnout and stress levels and facilitating their negotiation of knowledge on etiology and treatments for ASD may be beneficial for the family unit as a whole.

Is serum iron responsive protein-2 level associated with pulmonary functions and frequent exacerbator phenotype in COPD?

Introduction

Chronic Obstructive Pulmonary Disease (COPD) exacerbations contribute to the overall severity in individual patients because they are associated with airway inflammation, pulmonary function loss, decreased quality of life and increased mortality. Although, identifying frequent exacerbator patients is important due to severe outcomes associated with frequent exacerbator phenotype in COPD patients there is no single biomarker which can differentiate this phenotype. Iron responding protein-2 (IRP2) is the protein product of IREB2 gene, which is a COPD susceptibility gene that regulates cellular iron homeostasis and has a key role in hypoxic conditions. Previous research indicates that IREB2 expression in lung tissue is associated with spirometric measurements and emphysema in COPD. In this study, our aim was to investigate whether serum IRP2 levels were associated with frequent exacerbator phenotype, to evaluate whether IRP2 levels in serum are associated with pulmonary functions and selected systemic inflammation biomarkers.

Materials and Methods

Designed as a single tertiary care center based, crosssectional study, included high risk (GOLD C, D) COPD patients who admitted to outpatient clinic consecutively between December 2015 and July 2016.

Result

The study included 80 COPD patients. Serum IRP2 levels were negatively correlated with FEV1 ml (r= -0.25, p= 0.02) and body weight (r= -0.35, p= 0.002) but not with markers of systemic inflammation. COPD patients with at least one exacerbation history in the last year tended to have higher IRP2 levels than patients without any exacerbation [12.3 (IQR 25-75: 10.4- 17.1) vs 10.5 (IQR 25-75: 8.8-18.5), p= 0.06].

Conclusions

Serum IRP2 level is significantly correlated with FEV1 mL but not with FEV1 % predicted and cannot be used to differentiate frequent exacer bator patients. Although IREB2 gene expressions in lung tissue and bronchoalveolar lavage results have significant associations with emphysema and FEV1/FVC, FEV1 %predicted in COPD patients, our results suggests serum IRP2 level is not as promising.

A New Risk Score to Predict In-Hospital Mortality in Elderly Patients With Acute Heart Failure: On Behalf of the Journey HF-TR Study Investigators

We aimed to predict in-hospital mortality of elderly patients with heart failure (HF) by using a risk score model which could be easily applied in routine clinical practice without using an electronic calculator. The study population (n = 1034) recruited from the Journey HF-TR (Patient Journey in Hospital with Heart Failure in Turkish Population) study was divided into a derivation and a validation cohort. The parameters related to in-hospital mortality were first analyzed by univariate analysis, then the variables found to be significant in that analysis were entered into a stepwise multivariate logistic regression (LR) analysis. Patients were classified as low, intermediate, and high risk. A risk score obtained by taking into account the regression coefficients of the significant variables as a result of the LR analysis was tested in the validation cohort using receiver operating characteristic curve analysis. In total, 6 independent variables (age, blood urea nitrogen, previous history of hemodialysis/hemofiltration, inotropic agent use, and length of intensive care stay) associated with in-hospital mortality were included in the analysis. The risk score had a good discrimination in both the derivation and validation cohorts. A new validated risk score to determine the risk of in-hospital mortality of elderly hospitalized patients with HF was developed by including 6 independent predictors.

Role of adiponectin and leptin in patients with alopecia areata with scalp hair loss

BACKGROUND/AIMS

Alopecia areata (AA) is considered an organ-specific autoimmune disease of hair follicles. Adipose tissue plays a role in lipid metabolism and glucose metabolism and secretes adipokines such as leptin and adiponectin. Dysregulation in the adipokine balance may be associated with metabolic syndrome. We aimed to determine serum adipokine levels in AA patients and compare them with healthy controls, and to determine whether there was metabolic syndrome and insulin resistance in the AA patients.

METHODS

A total of 70 participants were included in the study. Patients were divided into two subgroups: patients with scalp hair loss were in subgroup 1 (AA1). Patients with beard and eyebrow hair loss were in subgroup 2 (AA2). Serum adiponectin, leptin, TNF-α, insulin, fasting glucose, TG, and HDL were analyzed.

RESULTS

Thirty-six (25 male, 11 female) patients with AA and 34 (18 male, 16 female) healthy subjects were included in the study. Metabolic syndrome was detected in three of the AA patients and in two of the healthy subjects. Serum leptin, adiponectin, TNF-α, TG, HDL, and insulin levels and HOMA-IR scores were not statistically significant in patients compared with control subjects, except fasting glucose levels (p = 0.035). However, serum leptin and adiponectin levels were significantly higher in AA1 (n = 25) subgroup compared with the control group (p = 0.029, p = 0.026 respectively). There was a statistically significant increase in the fasting glucose level, while there were no differences in other parameters between the AA2 (n = 11) subgroup and the control group.

CONCLUSIONS

To our knowledge, this is the first report indicating that adiponectin and leptin probably has a role in the pathogenesis of AA with scalp hair involvement.

Examination of Emergency Medicine Physicians’ and Residents’ Twitter Activities During the First Days of the COVID-19 Outbreak

Introduction: Social media has become an important element of interaction and found itself a place in every aspect of our lives. This study examined the twitter activities of emergency medicine physicians and residents (EMP??R) about the COVID-19 outbreak. Methods: The study concentrated on Twitter, a major social media network. To identify accounts owned by EMP??R, followers of the official accounts of two emergency medicine physician associations in our country were reviewed. Results: In total, 251 accounts whose owners stated they were EMP??R in their biographies, were public, and had tweeted within the last year were identified. Among the 210 tweets posted about coronavirus, 42.4% contained comments and suggestions, 18.6% institutional announcements, 17.1% news, 14.8% scientific content, and 7.1% contained humor. Conclusion: This study examined the importance of Twitter posts during outbreaks and the attitudes of emergency medicine doctors on this issue. Based on the results, it is thought that EMP??R should share more.

Evaluation of the Golden Ratio in Nasal Conchae for Surgical Anatomy

PURPOSE

The golden ratio is reached by the fractal model of the number sequence which is known as the "Fibonacci series" and has a convergent ratio of approximately 1.618 between 2 consecutive Fibonacci numbers. Golden ratio relationships have been shown in several plants in the nature and several organs and structures in the human body. The conchae, which form an important part of the nasal valve, have a special geometric significant in terms of providing turbulence to the laminar airflow that passes to the nasal cavity.

METHODS

This study made golden ratio calculations on 34 adults aged 20 to 45 years over computed tomography (CT) images. Totally, 34 volunteers (male, n = 18 and female, n = 16) with no nasal pathologies participated in the study. Using Adobe Photoshop, golden ratio calculations were made by applying the Fibonacci spiral on the images that best showed the conchae and meatuses on the CT images.

RESULTS

The intersection points of the spiral that was projected on the inferior and middle nasal concha were determined as S0, S1, S2, S3, and S4. The distances of S0-S1, S1-S2, S2-S3, and S3-S4 were measured. The concha measurements of the women showed significantly similar values to the golden ratio constant of ∼1.618 in the RS3/S4 and LS3/S4 measurements.

CONCLUSION

We found that the S3/S4 region that captured the golden ratio in our study corresponds to the base part of the inferior nasal concha, and its place of spiraling in the nasal cavity is observed to have an important role in creating vortices.

Matrix Metalloproteinase-9 (MMP-9) Elevated in Serum but not in Bronchial Lavage Fluid in Patients with Lung Cancer

Aims and Background

Matrix metalloproteinase (MMP) family member MMP-9 degrades type IV collagen, which is one of the main constituents of the basement membrane. MMP-9 is closely associated with the invasive and metastatic potential of most types of lung cancer. In this study we investigated the levels of MMP-9 in serum and bronchial lavage fluid from lung cancer patients and compared them with the levels in patients with nonmalignant lung disease. We also attempted to clarify the possible relationship between serum and bronchial lavage fluid MMP-9 levels and histopathology, staging and metastasis of lung cancer.

Study Design

The study group consisted of 34 patients with lung cancer. The control group comprised 21 patients with nonmalignant lung disease. MMP-9 levels in serum and bronchial lavage fluid were evaluated by ELISA.

Results

MMP-9 levels in serum samples from the group with malignant disease were significantly higher than those from the control group (P <0.05). Bronchial lavage MMP-9 levels did not differ significantly between the two groups (P >0.05). Serum MMP-9 levels were two-fold higher than those in bronchial lavage, but there was no correlation between bronchial lavage and serum levels in both groups (r = 0.18, P >0.05). In the group with malignant disease, MMP-9 levels in serum and bronchial lavage fluid did not show any relationship with histopathological type and tumor stage. There was a statistically significant correlation between serum MMP-9 levels and local tumor stage in smoking nonsmall cell lung cancer (NSCLC) patients (r = 0.33, P <0.05). Karnofsky scores of lung cancer patients were inversely correlated with MMP-9 levels of serum (r = -0.39, P <0.05) but not of bronchial lavage fluid.

Conclusion

From our data it can be concluded that MMP-9 levels of serum but not of bronchial lavage fluid can be helpful in differentiating between malignant and benign lung diseases, and are related to the local stage in NSCLC patients and general clinical status of lung cancer patients.

Diagnostic Accuracy of a Modified STOP-BANG Questionnaire with National Anthropometric Obesity Indexes

OBJECTIVES

Obstructive sleep apnea (OSA) is a very common sleep-related disorder and has many medical complications. Although the STOP-BANG questionnaire is an attractive screening tool because of high sensitivity, it lacks power in specificity. The aim of the present study was to evaluate and compare the diagnostic accuracy of standard STOP-BANG and a modified STOP-BANG questionnaire, using national cut-off values for neck circumference that determined OSA, in a sleep center population.

MATERIALS AND METHODS

One hundred eighty-five participants who were referred to the sleep-disordered breathing clinic were consecutively enrolled. We used 40 cm and 36 cm as the cut-off values for neck circumference, thus scoring patients accordingly and creating a modified STOP-BANG score with national anthropometric obesity indexes.

RESULTS

The median neck circumferences were 41 (39-44) cm, 40 (37-42) cm, and 43 (40-45) cm for total population, female gender, and male gender, respectively. The mean STOP-BANG score was 4.5±1.5, and the mean modified STOP-BANG score was 4.9±1.5. Discrimination of OSA measured by area under the curve for both questionnaires is comparable (p>0.05). Sensitivity to define OSA (apnea-hypopnea index (AHI)≥5) was 92.2% and 93.8% for original and modified STOP-BANG questionnaire, respectively. Sensitivity for moderate (AHI≥15) and severe OSA (AHI≥30) was identical for both questionnaires.

CONCLUSION

The STOP-BANG questionnaire has an excellent sensitivity, but modest specificity and adding national obesity indexes for neck circumference achieved similar results in terms of sensitivity and specificity with the original questionnaire.

The prevalence of childhood psychopathology in Turkey: a cross-sectional multicenter nationwide study (EPICPAT-T)

AIM

The aim of this study was to determine the prevalence of childhood psychopathologies in Turkey.

METHOD

A nation-wide, randomly selected, representative population of 5830 children (6-13 years-old) enrolled as a 2nd,3rd or 4th grade student in 30 cities were evaluated for presence of a psychiatric or mental disorder by a Sociodemographic Form, Kiddie Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL), and DSM-IV-Based Screening Scale for Disruptive Behavior Disorders in Children and Adolescents scales. Impairment criterion was assessed via a 3 point-Likert scale by the parent and the teacher independently.

RESULTS

Overall prevalence of any psychopathology was 37.6% without impairment criterion, and 17.1% with impairment criterion. Attention-deficit hyperactivity disorder was the most frequent diagnosis, followed by anxiety (19.5% and 16.7% without impairment, 12.4% and 5.3% with impairment, respectively). Lower education level and presence of a physical or psychiatric problem of the parents were independent predictors of any psychopathology of the offspring.

CONCLUSION

This is the largest and most comprehensive epidemiological study to determine the prevalence of psychopathologies in children and adolescents in Turkey. Our results partly higher than, and partly comparable to previous national and international studies. It also contributes to the literature by determining the independent predictors of psychopathologies in this age group.

[Evaluation of asthma awareness among teachers in Bursa]

Introduction

The purpose of this study was to elucidate the asthma knowledge level of primary-secondary school teachers in Bursa, and factors associated with this subject.

Materials and Methods

In our study 1812 teachers from 64 randomly selected primary schools in Bursa were included.

Result

It was known by the vast majority of participants that asthma symptoms, asthma is not a contagious disease and may be familial, medications taken by inhalation. It was known by 64.1% of the teachers that asthmatic children do not mind doing sports. Approximately one of the two teachers knew that the medication were not addictive.

Conclusions

The knowledge level of the teachers was related to female gender and age. We think that an asthma education program is needed for Turkish teachers to increase their understanding about what asthma is, its impact and how to meet the needs of a child with asthma to achieve improved wellbeing and school attendance.

Evaluation of the effects of adipose-derived mesenchymal stem cells on intraperitoneal adhesions

OBJECTIVES

The goal was to examine the efficiency of local implementation of adipose-derived mesenchymal stem cells, which have an anti-inflammatory effect, in preventing the intra-abdominal adhesions in rats.

MATERIAL AND METHODS

Twenty-one Wistar albino rats were randomly divided into 3 groups, 7 rats in each: Group 1 was defined as the control group, Group 2 as the sham group, and Group 3 as the adipose-derived mesenchymal stem cell group. A 6 cm mid-abdomen incision in the all the rats was performed. The cecum serosa and sub-serosa were injured by rubbing with a gauze. No agent was applied intraperitoneally for the rats in Group 1; 1.5 mL saline and 2x10⁶/kg allojenic adipose-derived mesenchymal stem cells in the 1.5 mL saline were injected into peritoneum of rats in Groups 2 and 3, respectively. Laparotomy was performed on the 14^th day. Adhesion scores, histopathological examination, E-cadherin expression, and the tissue hydroxyproline level were evaluated.

RESULTS

The general adhesion score and collagen deposition in Group 3 were found to be significantly higher than in Groups 1 and 2 (p=0.003 and p=0.009, respectively). In the inflammatory cell comparison, a significant decrease was found in Group 3 in proportion to Groups 1 and 2 (p=0.001, p=0.005, respectively). The E-cadherin levels were found to be higher in Group 3 (p=0.003).

CONCLUSION

Severe adhesion was observed in the adipose-derived mesenchymal stem cells group. Collagen intensity and E-Cadherin expression also increased in the adipose-derived mesenchymal stem cells group. The anti-inflammatory effect was also seen in the adipose-derived mesenchymal stem cells group.

Media-based clinical research on selfie-related injuries and deaths

BACKGROUND

The incidence of taking selfies and sharing them on social media as well as selfie-related behaviors is increasing, particularly among young people, possible leading to selfie-related trauma. Therefore, we performed this clinical study to draw attention to selfie-related injuries and deaths.

METHODS

We analyzed 159 selfie victims from 111 events or accidents, which were reported in the media sources. We evaluated vital results, demography, rhythmicity, preferences, event or accident types, selfie-related risk factors, affected body regions of victims with causes of injury, and death.

RESULTS

We found that the majority of selfie victims were students. Selfie-related injuries and deaths were reported most frequently in India, the US, and Russia. The most preferred site of taking selfies was the edge of the cliff. The most frequently reported event or accident type was falling from a height. Mostly multiple body parts were affected in selfie-related injuries and deaths. The most frequent causes of selfie-related deaths were multitrauma and drowning.

CONCLUSION

Selfie-related injuries and deaths have increased in the past years. Particularly, teenagers and young adults are at high risk for selfie-related traumas and deaths; therefore, drastic measures should be taken to reduce their incidence.

Turkey National Mesothelioma Surveillance and Environmental Asbestos Exposure Control Program

Malignant mesothelioma (MM) is an important health problem due to ongoing asbestos exposure. Environmental asbestos exposure leads to a high risk of MM in Turkey. The Turkish Mesothelioma Working Group and the Turkish Public Health Institute designed and performed the Turkey National Mesothelioma Surveillance and Environmental Asbestos Exposure Control Program (TUNMES-EAECP). The aim of this study was to analyze the results of the TUNMES-EAECP. Patients diagnosed with MM (code C45.0-C45.9) between 2008 and 2012 were identified. The "from case to the field" method was used to determine the villages with current or previous asbestos exposure. Special public health teams took soil samples from these villages, which were then examined using an X-ray diffractometer. Direct Standardized Average Annual Mesothelioma Incidence Rate (AMIR) and relative risk (RR) of MM were calculated. Finally, a projection on the incidence of MM between 2013 and 2033 was made. The number of confirmed MM cases was 5617 with a male to female ratio of 1.36. Mean age was 61.7 ± 13.4 (20-96) years. The median survival was eight (95% CI 7.6-8.4) months. Asbestos exposure continues in 379 villages, with 158,068 people still living in high risk areas. The standardized AMIR was 2.33/100,000 per year. The risk of MM was higher in males, in both sexes over the age of 40, in asbestos-containing provinces, and in those where the TUNMES was organized. Among the population with continuing asbestos exposure in rural areas, the number of MM cases between 2013 and 2033 was estimated as 2511. As such, the incidence of MM in Turkey is as high as in industrialized countries. Asbestos exposure in rural areas continues to be a serious problem in Turkey, which obviates the necessity for effective preventive measures.

The reliability of SleepStrip as a screening test in obstructive sleep apnea syndrome

OBJECTIVES

This study aims to assess the reliability of SleepStrip as a screening test in obstructive sleep apnea syndrome (OSAS).

PATIENTS AND METHODS

Seventy-two patients (50 males, 22 females; mean age 51.4±11.1 years; range 20 to 74 years) with OSAS were included in this prospective, non-randomized double-blinded single cohort study between May 2008 and February 2009. Patients who underwent an attended overnight polysomnography (PSG) and consented to participate in the study were asked to use SleepStrip device within the week following PSG recording. The apnea-hypopnea index (AHI) was compared with the SleepStrip score (Sscore).

RESULTS

The mean body mass index of patients was 31.1±4.3. Both AHI and Sscore were obtained in 64 patients. There was a strong correlation between Sscore and AHI (r=0.76, p<0.001). The sensitivity and specificity of the SleepStrip were 94.4% and 93.5% when used to diagnose cases with AHI = or >40. The sensitivity and specificity of the SleepStrip was reduced to 80% and 87.2% when AHI threshold was chosen as = or >25 and 83.3% and 76.5% for AHI = or >15 respectively.

CONCLUSION

There is a strong correlation between SleepStrip and AHI. SleepStrip was found to be effective in diagnosing severe OSAS with AHI = or >40, however, its diagnostic capability was reduced in patients with lower AHI's who constitute the main target of screening.

Sleep breathing disorders in pregnancy

Snoring, upper airway resistance syndrome, sleep apnea syndrome and obesity hypoventilation syndrome are all defined as sleep-disordered breathing. Many changes occur in the respiratory system and sleep physiology during pregnancy due to physical and hormonal causes. Functional residual capacity, total sleep time, rapid eye movement (REM) sleep and stage 3-4 non-REM sleep are reduced during the third trimester of pregnancy. Snoring is more prevalent in pregnant women than nonpregnant women. Snoring during pregnancy may be associated with pregnancy induced hypertension, preeclampsia, intrauterine growth retardation and low APGAR scores in infant. The prevalence of sleep apnea syndrome during pregnancy is unknown. All pregnant women, especially obese and preeclamptic were asked to possibility of sleep disordered breathing. In this review we summarized, first normal physiological changes of respiratory system and sleep during pregnancy, second maternal and fetal outcome of sleep disordered breathing and finally treatment of sleep disordered breathing in pregnancy.

Evaluation of thyroid hormone levels and somatomedin-C (IGF-1) in patients with chronic obstructive pulmonary disease (COPD) and relation with the severity of the disease

Chronic obstructive pulmonary disease (COPD) has recently become a significant cause of mortality and morbidity. In the present study, we aimed to investigate the relationship between the severity of the disease and levels of serum thyroid hormones and somatomedin-C [Insulin-Like Growth Factor (IGF-1)]. Sixty one COPD cases (group 1) were enrolled. Control group (group 2) consisted of 20 healthy individuals. Blood samples were obtained for the analysis of arterial blood gases and hormone levels and respiratory function tests were performed on the same day. Measured hormone levels were compared between group 1 and group 2. Among thyroid hormone levels, there was no significant difference in thyroid stimulating hormone and free T3 between group 1 and 2 whereas free T4 levels were significantly higher in group 1 (p< 0.01). Additionally, mean IGF-1 levels were significantly lower in group 1 (p< 0.005). When three groups, classified according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria, were compared, significant differences were observed between mild-moderate COPD cases and severe patients with respect to free T3 and IGF-1 levels (p< 0.05). Hormone levels in COPD patients change depending on the severity of the disease. In the future hormone therapies can use for the COPD treatments. Further studies with larger sample sizes are required to confirm our conclusions.

[Homocysteine levels in patients with obstructive sleep apnea syndrome]

The exact mechanism of development of cardiovascular disease in patients with obstructive sleep apnea syndrome (OSAS) remains to be unknown. The role of homocysteine in atherosclerotic disease process has become well established over the past ten years. Our aim was to study to compare homoscysteine levels between OSAS and control levels. Sixty-two subjects with OSAS and twelve similar controls in age, gender, body mass index, smoking and coronary heart disease were included in this prospective study. Serum levels of homocysteine (13.5 +/- 6.0 micromol/L vs. 10.2 +/- 2.9 micromol/L, p= 0.03) in the OSAS group were significantly greater than those in the control group. Logistic regression analyses showed that OSAS (Odds ratio: 9.08 95% CI 2.347-35.120; p= 0.001) was independent risk factors for high levels of serum homocysteine in age, smoking status, diabetes mellitus and coronary heart disease. We conclude that homocysteine may be an important factor for development of cardiovascular disease in patients with OSAS.

[The evaluation to relationship between serum vascular endothelial growth factor (VEGF) level, metastases and other tumor markers in patients with lung cancer]

Vascular endothelial growth factor (VEGF) is a potent mediator of angiogenesis. Increased expression of VEGF may be associated with advanced stage and poor prognosis in patients with lung cancer. We investigated the relationship between serum VEGF level and lung cancer stage. We also studied the correlation between serum VEGF level and some other tumor markers. Forty newly diagnosed lung cancer (31 non-small cell, 9 small cell) patients and 25 age-matched controls were enrolled in this study. Serum VEGF levels of lung cancer group (345.16 +/- 159.36 pg/mL) were significantly higher than that of the control group (230.36 +/- 47.87 pg/mL) (p< 0.001). The area under the ROC curve was 0.727 (p< 0.05) for serum VEGF threshold of 249.8 pg/mL predictive sensitivity and specificity, for lung cancer were respectively 70.0% and 76.0%. There were no significant relationship between serum VEGF level and age, gender, histologic type, lung cancer stage, distant metastases and site of metastases. In addition, there were no correlation between serum VEGF level and other tumor markers (NSE, CYFRA 21-1, CEA, CA125, LDH).

Circulating ICAM-1 and VCAM-1 levels in patients with obstructive sleep apnea syndrome

BACKGROUND

Obstructive sleep apnea syndrome (OSAS)-induced hypoxic stress modulates circulating inflammatory mediators causing accelerated atherogenesis.

OBJECTIVES

We hypothesized that OSAS-induced hypoxia might result in cardiovascular disease due to increased expression of intercellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) on the endothelial surface.

METHODS

Thirty-nine subjects with moderate-to-severe OSAS and 34 non-apneic controls matched for age, gender, body mass index (BMI), smoking history, and cardiovascular disease were included in this prospective study. Overnight polysomnography was performed. Circulating ICAM-1 and VCAM-1 levels in the serum were measured by enzyme-linked immunosorbent assay.

RESULTS

Circulating levels of both ICAM-1 (480.1 +/- 216.7 vs. 303.4 +/- 98.6 ng/ml, p < 0.0001) and VCAM-1 (1,156.6 +/- 79.8 vs. 878.8 +/- 71.1 ng/ml, p = 0.002) were significantly increased in the OSAS group compared to the control group. For an ICAM-1 cutoff level of 375 ng/ml, predictive sensitivity and specificity for OSAS were 69.2% (95% confidence interval, CI: 52.4-83.0%) and 82.4% (95% CI: 65.5-93.2%), respectively. For a VCAM-1 cutoff level of 859 ng/ml, predictive sensitivity and specificity for OSAS were 74.4% (95% CI: 57.9-86.9%) and 64.7% (95% CI: 46.5-80.2%), respectively. There was a significant positive correlation between circulating levels of ICAM-1 and ln of AHI (r = 0.276, p = 0.018). Multiple logistic regression analyses showed that OSAS was associated with high ICAM-1 and high VCAM-1 levels independent of age, gender, BMI, smoking status and cardiovascular disease.

CONCLUSION

We conclude that OSAS can independently increase circulating levels of adhesion molecules

Clinical effectiveness of nebulised budesonide in the treatment of acute asthma attacks

Nebulized budesonide (NB) might offer topical anti-inflammatory activity and be an alternative to systemic corticosteroid (SC) in the treatment of acute asthma. The aim of this study was to compare the effect of NB with SC on lung function and clinical findings of adult patients with acute asthma. Thirty patients admitted to clinic with asthma attack (F/M: 26/4; mean age: 47.1 +/- 2.1 years) were enrolled to the study. The patients were randomized into three groups; Group I were treated with NB alone (4 mg/day), Group II SC alone (1 mg/kg/day methylprednisolone), Group III NB plus SC. Pulmonary functions and respiratory symptom scores were measured and recorded before and during 7 days of study. Spirometric parameters significantly improved in all groups at 7th day significantly (p< 0.05) without a difference among groups (p> 0.05). FEV(1) % levels increased significantly at the first day of study in Group I and III (p< 0.05), but didn't change in Group II until 5th day of study. The mean symptom scores decreased significantly at the second day in Group I (p< 0.05), and at the 4th day in other groups. NB with or without SC improved successfully airway obstruction and symptoms in patients hospitalized with acute asthma attack as the 1st treatment day in comparison with SC alone and this effect lasted for 7 days. Regarding the superior safety profile and comparable efficacy with SC, NB might be an alternative to the patients with moderate-severe asthma attacks.

An unusual way of tracheal stoma cleaning could end up with foreign body aspiration in a laryngectomized patient

We report a case of a laryngectomized patient who accidentally aspirated a wooden stick through his tracheal stoma in highly unusual circumstances. He was in a habit of cleaning secretions of upper airway with a wooden stick covered with cotton on the tip soaked in olive oil, via tracheostomy. After applying topical aerolized lidocaine spray through the tracheostomy stoma a flexible video-brochoscopy was performed and a tree twig over 11 cm in length was removed. The patient's symptoms were resolved by a bronchoscopy. With experience and availability of accessories, the removal of the foreign body using flexible bronchoscope under local anesthesia can be performed safely and successfully. This case suggests that the physicians and otolaryngologists should educate their laryngectomized patients about stomal care and discuss any potential life-threatening situation they might encounter.

The evaluation of soluble Fas and soluble Fas ligand levels of bronchoalveolar lavage fluid in lung cancer patients

Fas-Fas Ligand (FasL) is one of the major mediator system that activates programmed cell death. Cleavage of membranebound FasL by a metalloproteinase-like enzyme resulted in the formation of soluble FasL (sFasL). sFasL as well as the transmembrane form of FasL binds to Fas and transduces apoptotic signal in Fas-expressing cells. It's suggested that soluble Fas (sFas) and sFasL has an impact on tumor progress and immune escape feature of tumor cells from the host immune system. Since Fas antigen expression in the lungs has been localized to alveolar and bronchial epithelial cells, in this study we aimed to investigate the sFas (pg/mL) and sFasL levels (pg/mL) of bronchoalveolar lavage (BAL) fluid in lung cancer patients. Study population was consisted of 27 patients with lung cancer (mean age 62.9 +/- 10.7 years, 25 control subjects (mean age 47.9 +/- 13.9 years). BAL was performed under local anesthesia, on the unaffected lung of patients; either subsegments of right middle or lingula. BAL sFas and sFasL were evaluated by using ELISA method. The mean levels of sFas was 60.8 +/- 56.8 in lung cancer patient and 39.5 +/- 25.9 in control subjects (p> 0.05). The mean levels of sFasL was 51.6 +/- 39.2 in cancer patient and 41.2 +/- 27.4 in control subjects (p> 0.05). In conclusion, although we did not observe any significant difference between two groups, higher BAL levels of sFas and sFasL levels in lung cancer patients than control subjects, made us thought that apoptosis might have a role development and progression of lung cancer.

Chromosomal fragile sites and relationship between genetic predisposition to small cell lung cancer

Fragile sites are non-staining gaps and breaks on mammalian chromosomes. Several investigators have pointed out that these sites may act as factors that predispose to specific chromosomal rearrangements that are present in some cancer cases. The expression of common fragile sites induced by aphidicolin (Apc) was evaluated on prometaphase chromosomes obtained from the peripheral blood lymphocytes of 15 patients with lung cancer, 20 of their clinically healthy family members, and 20 age-matched normal controls. As a result of cytogenetic evaluation carried out by the High Resolution Banding (HRB) technique, 1q21, 2q33, 3p14, 7q32, 13q13, 16q23, 17q21, and 22q12 are defined as fragile sites in patients and relatives. The rate of total fragile sites and 2q33, 3p14, and 16q23 are statistically significant in both patients and relatives when compared with the control group. Therefore, our results showed that common fragile sites might be unstable factors in the human genome and they can be used as suitable markers for genetic predisposition to lung cancer.

The expression of common fragile sites and genetic predisposition to squamous cell lung cancers

The chromosomal aberration rates (including gaps and breaks) and expression frequency of fragile sites were determined in peripheral blood lymphocytes cultured with TC 199 medium from 8 patients with squamous cell lung cancer, 10 of their first-degree relatives, and 12 healthy control subjects. As a result of cytogenetic evaluation, both the chromosomal aberration rates and expression frequencies of common fragile sites observed in patients and their relatives were significantly higher than those in healthy control subjects. Our results showed that common fragile sites might be unstable factors in the human genome, and their expression might be affected by some genetic and environmental factors. As a result of this they might play an important role in genetic predisposition to lung cancer. The high expression of fra(3)(p14) in patients and their relatives may be a valid marker for genetic predisposition to lung cancer.

Cigarette smoking, serum lipids, folate, and vitamin B12 in lung cancer

The purpose of our study was to evaluate the effects of cigarette smoking and serum lipids, folate, and vitamin B12 on the development of lung cancer in the Turkish population. The study group consisted of patients with histologically proven lung cancer and the control group comprised healthy smokers being followed in our smoking cessation outpatient department. Smoking history was obtained from all subjects and serum total cholesterol, HDL cholesterol, triglycerides, vitamin B12, and folate levels were measured. Pack/years of cigarettes smoked were significantly higher in the subjects with lung cancer than in the control group (p < 0.01). Serum total cholesterol, HDL cholesterol, triglyceride, serum folate, and vitamin B12 levels were within normal limits in both groups (p < 0.05), but serum vitamin B12 levels were statistically significantly higher (p < 0.01) in the cancer group than in the controls. In our study, we did not observe low levels of serum cholesterol, vitamin B12, or folate in the lung cancer patients.