Urinary uric acid excretion as an indicator of severe hypoxia and mortality in patients with obstructive sleep apnea and chronic obstructive pulmonary disease

OBJECTIVE

Uric acid (UA) is the end product of adenosine triphosphate degradation, and could increase due to hypoxia. We investigated the association of UA metabolites with nocturnal hypoxemia, apnea-hypopnea index (AHI), noninvasive mechanical ventilation (NIMV) usage and five-year mortality.

MATERIALS/SUBJECTS AND METHODS

We obtained urinary specimen before and after the night polysomnography in order to measure UA excretion and overnight change in urinary UA/creatinine ratio (ΔUA/Cr) in 75 subjects (14 controls, 15 chronic obstructive pulmonary disease (COPD) without nocturnal hypoxemia (NH), 15 COPD with NH, 16 obstructive sleep apnea syndrome (OSAS) without NH, 15 OSAS with NH). Percentage of time spent below SaO2 of 90% (T90%) for >10% of sleep time was considered as nocturnal hypoxemia. Patients were contacted after 5 years with a questionnaire including information on the use of NIMV treatment (n: 58) and urinary specimen analysis (n: 35).

RESULTS

T90% was found to be significantly correlated with UA excretion (coefficient: 0.005, 95%CI: 0.003-0.007) and ΔUA/Cr (coefficient: 0.8, 95%CI: 0.3-1.2) after adjustments for age, gender, body mass index and apnea-hypopnea index. Median and IQR (interquartile range) of baseline UA excretion were 0.79 (0.51-0.89) and 0.41 (0.31-0.55) in 10 deceased and 58 surviving patients, respectively (p=0.001). UA excretion median and IQR of baseline and 5 years of NIMV treatment were 0.41 (0.36-0.57) and 0.29 (0.23-0.37), respectively (p=0.01).

CONCLUSION

UA excretion, as a marker of tissue hypoxia, may be useful in the management of OSA and COPD patients.

Integration of GARD Turkey national program with other non-communicable diseases plans in Turkey

For the prevention and control of non-communicable diseases (NCD), an action plan on NCDs is intended to support coordinated, comprehensive and integrated implementation of strategies and evidence-based interventions across individual diseases and risk factors, especially at the national and regional levels by World Health Organization (WHO). The Global Alliance against Chronic Respiratory Diseases (GARD) is making every attempt to align with WHO's non-communicable diseases action plan. GARD activities have been commenced in over 40 countries and in 11 countries an integrated NCD action plan is being prepared or has already been initiated. This integrated approach of GARD has also targeted to GARD Turkey project. The Turkish Ministry of Health has decided to apply this national control program in conformity with other NCD action plans. This article is intended to summarize these integration efforts of GARD Turkey (the National Control Program on Chronic Airway Diseases) with other NCD national programs.

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.

Varix of the inferior pulmonary vein: computed tomography and magnetic resonance angiography findings

A 37-yr-old male presented with a 2-week history of intermittent episodes of mild haemoptysis. Computed tomography and magnetic resonance imaging revealed a varix of the inferior pulmonary vein. The diagnosis was confirmed using magnetic resonance angiography and conventional angiography. This condition is relatively rare, and few cases have previously been demonstrated by means of magnetic resonance imaging and angiography.

Spinal cord compression due to costal Echinococcus multilocularis

We present computerized tomography (CT) and magnetic resonance imaging (MRI) findings of a costal hydatid cyst (Echinococcus multilocularis) causing spinal cord compression. The hydatid disease was proved histologically. MRI was not only very useful for determining the spinal extension of the disease by its multiplanar imaging capability, but also gave important information about the texture of the cyst, thus aiding the preoperative diagnosis.

Corynebacterium parvum pleurodesis and survival is not significantly influenced by pleural pH and glucose level

This study was carried out in the pulmonary department of a referral training hospital for thoracic medicine and surgery, with the aim of assessing the effects of pH and glucose level of a pleural effusion (PE) on survival and the response to pleurodesis (PD) with Corynebacterium parvum. A prospective study was carried out in 204 patients with recurrent, symptomatic PEs (73 benign, 131 malignant). Fifty eight per cent of 204 PEs had low pH (< 7.20; 7.01 +/- 0.14) nd glucose levels (< 60 mg.dL-1; 36 +/- 14 mg.dL-1), whereas the remaining 42% had higher pH (> or = 7.20; 7.36 +/- 0.07 and glucose levels (> or = 60 mg.dL-1; 79 +/- 16 mg.dL-1). PD was attempted twice with 7 mg of C. parvum injected through chest tube in all patients, who were then followed up for the outcome of PD and for survival from the time of PD until death or the closure of the study (August 1996). Of 204 cases, 201 were evaluable for survival and outcome of PD. In 91% of the low-and 82% of the high-pH/glucose benign PEs, complete PD was achieved while the corresponding values for the malignant PEs were 79% and 87%, respectively (p > 0.05). Six per cent of low-and 8% of high-pH benign PEs, and 13% of low- and 9% of high-pH malignant PEs were palliated with partial PD. Failures were 3% and 10% in the low- versus high-pH benign groups, and 8% and 4% in the low- versus high-pH malignancies, respectively. All 201 cases maintained the immediate post-PD outcome throughout the follow-up. Average survival was 21.8 months in high-pH benign PEs versus 21.1 months in low-pH benign PEs, and 9.9 versus 8.7 months, in high- and low-pH malignant PEs, respectively (p > 0.05). We deduce that, regarding survival and the response to pleurodesis with Corynebacterium parvum, there is no significant difference between low- and high-pH/glucose pleural effusions in malignant, or benign cases.