Ahmet Bircan

Habitual Snoring in Primary School Children: Prevalence and Association with Sleep-Related Disorders and School Performance

Objectives: To determine the prevalence of habitual snoring (HS) and its association with both day- and nighttime symptoms, school performance and behavioral disturbances in a sample of primary school children. Subjects and Methods: A cross-sectional study was performed on 1,605 children (819 boys and 786 girls) aged 7–13 years from 9 randomly selected primary schools located within the city limits of Isparta, Turkey. HS and sleep problems were assessed using a 55-item multiple-choice questionnaire. Results: Of the 1,605 questionnaires, 1,164 were fully completed and returned, giving a response rate of 72.5%. The overall prevalence of snoring was 38.9%, while HS accounted for 3.5%. The prevalence of HS among boys (25, 3.0%) was higher than among girls (16, 2.0%; χ2 for trend: p < 0.001, OR: 1.92, 95% CI: 1.01–3.66). There was an association between younger age and HS, as children aged 7–8 years had the highest prevalence (χ2 for trend: 0.054, OR: 1.85, 95% CI: 0.81–4.22). Habitual snorers had more daytime and nighttime symptoms. Allergic symptoms, daytime mouth breathing, shaking the child for apnea, restless sleep and hyperactivity were significant and independent risk factors and sleep-related symptoms for HS. A significant and independent association was found between poor school performance and hyperactivity, nocturnal enuresis, tooth grinding and low parental/maternal education in multivariate analysis. Conclusion: Children with HS were more likely to have sleep-related daytime and nighttime symptoms. No significant associ- ation was determined between HS and poor school performance.

C-Reactive Protein Levels in Patients with Chronic Obstructive Pulmonary Disease: Role of Infection

Objective: To investigate the value of C-reactive protein (CRP) as a marker of chronic obstructive pulmonary disease (COPD) exacerbations or specifically bacterial exacerbations and to evaluate a correlation between raised CRP levels and other markers of inflammation in patients with an acute exacerbation (AECOPD). Subjects and Methods: The medical records of patients with AECOPD were retrospectively analyzed. They were categorized according to the nature of sputum as mucoid or purulent and to the findings on chest radiographs as with pneumonia (PCOPD) or without pneumonia. Stable COPD (SCOPD) patients and a group of asymptomatic nonsmokers were also included in the study. Results: All COPD patients (SCOPD: 30; AECOPD: 51; PCOPD: 32) and control subjects (30) were male. The mean CRP levels and WBC counts of the groups were PCOPD: 108.1 ± 61.8 mg/l and 13.7 ± 6.8 × 109/l; AECOPD: 36.8 ± 43.9 mg/l and 11.4 ± 4.8 × 109/l; SCOPD: 3.9 ± 1.4 mg/l and 7.9 ± 1.9 × 109/l; control: 2.1 ± 0.9 mg/l and 7.7 ± 1.1 × 109/l. The mean CRP level of AECOPD was statistically different from those of PCOPD and SCOPD (p = 0.0001, p = 0.002, respectively). The sensitivity and specificity of CRP to determine an acute exacerbation were 72.5 and 100%, respectively. Among the patients with AECOPD, 25 had purulent sputum and a mean CRP level of 46.4 ± 48.6 mg/l, which is significantly higher than the CRP level (28.0 ± 44.5 mg/l) of the 18 patients with mucoid expectoration (p = 0.015). Among the mucoid-expectorating subgroup, the patients with leukocytosis had significantly higher CRP levels than the patients without leukocytosis (p = 0.034). Conclusion: A high serum CRP value may indicate an infectious exacerbation in COPD patients and it correlates with sputum purulence and increased serum WBC counts.

The attitude toward tobacco dependence and barriers to discussing smoking cessation: a survey among Turkish general practitioners

ObjectivesTo evaluate the general attitude of a sample of Turkish general practitioners (GPs) toward tobacco dependence and to assess their knowledge and behavior regarding smoking cessation (SC).MethodsA self-administered questionnaire modified from WHO, Global Health Professional Survey was distributed to GPs, working in our district, Isparta.ResultsAs much as 41% of GPs were current smokers. Ever smokers were generally less likely to agree with statements that would change their freedom to smoke in certain places. While 46% of GPs frequently inquired about tobacco use in their patients, 13.5% did not advise any of their patients to quit smoking during the month preceding the questionnaire. The most common barriers reported by GPs to discussing SC with their patients were as follows: considering the discussion not to be effective (57.8%), having low confidence in knowledge (48.1%), having unpleasant personal experience or considering it a thankless task (46.1%).ConclusionsIt appears essential to reduce the number of GPs who smoke and to improve GP training on SC procedures for integrating SC treatment into primary care in Turkey.

Effects of body weight supported treadmill training on cardiac and pulmonary functions in the patients with incomplete spinal cord injury.

We aimed to investigate the effects of body weight supported treadmill training (BWSTT) on cardio-pulmonary functions and on depression in subjects with incomplete spinal cord injury (SCI). Eight subjects (2 female, 6 male) with incomplete SCI participated in this study. Heart rate (HR), blood pressure (BP) and resting pulmonary function parameters were obtained from each subject at baseline and after BWSTT. The training programme was scheduled five times per week for six weeks. The psychological status was evaluated by Beck Depression Inventory (BDI). The post-BWSTT HR value was lower than the pre-training HR value (p< 0.05). In comparison of pre- and post-BWSTT pulmonary parameters, there were only significant improvement in FVC and IC (p< 0.05). The mean BDI score was lower after BWSTT compared to before BWSTT value. As a conclusion, 6 weeks BWSTT had positive effect on heart rate and limited effect on pulmonary functions. There was an improvement in depression level of the SCI subjects.

Respiratory Symptoms, Pulmonary Function, and Reproductive History: Isparta Menopause and Health Study

OBJECTIVE We aimed to investigate the influence of reproductive factors on chronic respiratory symptoms and pulmonary function in a cross-sectional study of premenopausal and postmenopausal women 44-61 years of age. METHODS Self-reported data on respiratory symptoms were obtained from 1082 women. Usable forced expiratory volume in 1 second (FEV(1)) (2.27 +/- 0.44 L) and forced vital capacity (FVC) (2.75 +/- 0.55 L) measurements were obtained from 1070 women. The influence of reproductive factors on FEV(1), FVC, and chronic respiratory symptoms was assessed by linear and logistic regression analyses. RESULTS Menopause is associated with lower FEV(1) (p < 0.0001, r = -0.181) and FVC (p < 0.0001, r = -0.198) only in univariate analysis. The association disappears when age is adjusted for. However, association of menopause with increased odds of chronic cough plus phlegm is significant in multivariate analysis (odds ratio [OR] 1.84, 95% confidence interval [CI] 1.16-2.92, p = 0.0088). Among reproductive factors, only age at first birth is independently associated with FEV(1) (p = 0.01, r = 0.008) and FVC (p = 0.004, r = 0.013). Results were similar when restricting analyses to those who never smoked and after exclusion of asthmatics. CONCLUSIONS Postmenopausal status is independently associated with increased odds of chronic cough plus phlegm, whereas it does not appear to be independently associated with FEV(1) or FVC. Among the reproductive factors, age at first birth is the only independent predictor of FEV(1) and FVC. These findings suggest that reproductive factors may influence womens pulmonary health.

Maspin, VEGF and p53 Expression in Small Biopsies of Primary Advanced Lung Cancer and Relationship with Clinicopathologic Parameters

Maspin, one of the serine protease inhibitors, has been shown to inhibit tumor progression and metastasis. We aimed to investigate maspin, p53 and VEGF expression in patients with squamous cell carcinoma (SCC), adenocarcinoma (AC) and small cell lung carcinoma (SCLC). The study included 28 SCC, 18AC, 17 SCLC biopsy samples. We used the streptavidin biotin immunoperoxidase method to test for maspin, p53 and VEGF antibodies. Medical records of these patients were reviewed from archival files. Cytoplasmic maspin expression was detected in 89.3%, 77.8%, 52.9% of SCC, AC and SCLC, respectively. The rate was significantly higher in non-small cell lung cancer (NSCLC) and SCC than SCLC (p = 0.013, p = 0.021, respectively). The mean percentages of maspin expression were significantly higher in NSCLC, SCC and AC than in SCLC (p = 0.0001, p = 0.0001, p = 0.038, respectively). In ACs, maspin and p53 expressions were correlated, although this was not statistically significant (p = 0.053, r = 0.464), and maspin positive cases had a significantly higher T status compared to negative cases (p = 0.036). In SCC, the stage of disease was positively correlated with p53 (p = 0.007, r = 0.536) and negatively correlated with VEGF expression (p = 0.013, r = −0.498). Multivariate analysis demonstrated that stage of disease was a significant independent prognostic parameter in NSCLC (95% confidence interval: 1.067–3.969; p = 0.031). Although maspin expression is higher in SCC and AC, and is related with higher T status in AC, our data did not indicate its prognostic significance. Larger scale studies are needed to reveal the exact role of maspin in lung cancer pathogenesis.

Observations on environmental asbestos exposure in a high risk area

Background and objective:  Environmental asbestos exposure is causally associated with various pulmonary pathologies. In Turkey, one of the most important sources of asbestos exposure is dust originating from the walls of homes whitewashed with white stucco. The main asbestos types implicated are tremolite and, to a lesser extent, chrysotile. This study investigated the presence and effect of environmental asbestos exposure in a small village in Isparta, Turkey.

Mineral Status of COPD Patients under Long‐Term Inhaled Corticosteroid Therapy

PURPOSE The aim of this study was to determine the mineral status of mandibles, femurs, and spines in chronic obstructive pulmonary disease (COPD) patients under long-term inhaled corticosteroid therapy. MATERIALS AND METHODS Pulmonary function tests were conducted on patients (n = 30) with COPD under inhaled corticosteroid therapy for at least 1 year. The results were compared to sex- and age-matched controls (n = 30). Analyses of blood gases were also carried out relative to COPD, and bone mineral densities (BMD) of the mandible, lumbar spine, femoral neck, trochanter, and Wards triangle were also measured by dual-energy X-ray absorptiometry (DEXA). Levels of serum osteocalcin, alkaline phosphatase, calcium, phosphorus, and cortisol were also assessed. RESULTS In accordance with the Global Initiative for Chronic Obstructive Lung Disease criteria, 8 of the COPD patients had moderate, 11 patients had severe, and 11 patients had very severe forms of the disease. All BMD measurements were lower in the COPD patients than in the control group. The serum osteocalcin levels in COPD patients were significantly lower than those in the control group (p < 0.0001). Serum calcium (p < 0.004) and cortisol levels (p < 0.026) in the COPD patients were also significantly lower than those in the control subjects. Although serum alkaline phosphatase level was higher and the phosphorus level was lower in the treatment group than in the control group, the differences were not statistically significant. CONCLUSION Regular evaluation of the biochemical markers of bone metabolism and BMD would be helpful for detecting any detrimental changes of bone in COPD patients under long-term inhaled corticosteroid therapy. In this study, mandibular BMD was observed to be lower in COPD patients under long-term inhaled corticosteroid therapy than in healthy subjects. Thus, dental implant treatment may require preventive measures in COPD patients under long-term inhaled corticosteroid therapy.

A Simple Clinical Model Composed of ECG, Shock Index, and Arterial Blood Gas Analysis for Predicting Severe Pulmonary Embolism

Background: Objective diagnosis of severe pulmonary embolism (PE) is obligatory because of its considerable mortality. Aim: To assess the abilities of electrocardiography (ECG) score (sECG) and the newly generated scoring system composed of the scores obtained from arterial blood gas (ABG) analysis and shock index (SI) in addition to sECG in predicting severe PE. Material and Methods: The degree of pulmonary vascular obstruction (sPVO) and the right ventricular dysfunction (RVD) were determined with spiral computed tomography (CT) in 53 consequent patients with PE. Twelve-lead ECG taken within a day of PE event and ABG values were evaluated according to ECG scoring system and original Geneva system, respectively. Results: The mean age of patients was 62.6 ± 13.4 years. Right ventricular dysfunction, sPVO ≥ 50%, hypoxemia, and SI were present in 34 (64.2%), 27 (50.9%), 50 (94.3%), and 22 (41.5%) patients, respectively. The mean sECG, 5.9 ± 5.1, was correlated with sPVO, maximum diameter of right ventricle (RV), and right ventricle to left ventricle (RV/LV) ratio (r = .385, r = .415, and r = .329, respectively). The mean newly generated score was 10.9 ± 5.5 and correlated with sPVO, maximum diameter of RV, and RV/LV ratio (r = .394, r = .483, and r = .393, respectively). Receiver operator characteristic (ROC) curve analyses revealed that sECG ≥ 3.5, s (ECG + SI) ≥ 4.5, and s (ECG + SI + ABG) ≥ 9.5 predict the severe PE patients with 70.6%, 61.8%, 58.8% sensitivities and 52.6%, 63.2%, 73.7% specificities, respectively. Conclusion: Adding the scores obtained from SI and ABG to the sECG enhances the specificity of sECG in predicting RVD (+) or severe PE patients, although a lesser degree decreasing in sensitivity may occur.

Patient and physician delay in the diagnosis and treatment of non-small cell lung cancer in Turkey.

AIM The early diagnosis and treatment of lung cancer are important for the prognosis of patients with lung cancer. This study was undertaken to investigate patient and doctor delays in the diagnosis and treatment of NSCLC and the factors affecting these delays. MATERIALS AND METHODS A total of 1016 patients, including 926 (91.1%) males and 90 (8.9%) females with a mean age of 61.5±10.1 years, were enrolled prospectively in this study between May 2010 and May 2011 from 17 sites in various Turkish provinces. RESULTS The patient delay was found to be 49.9±96.9 days, doctor delay was found to be 87.7±99.6 days, and total delay was found to be 131.3±135.2 days. The referral delay was found to be 61.6±127.2 days, diagnostic delay was found to be 20.4±44.5 days, and treatment delay was found to be 24.4±54.9 days. When the major factors responsible for these delays were examined, patient delay was found to be more frequent in workers, while referral delay was found to be more frequent in patients living in villages (p<0.05). We determined that referral delay, doctor delay, and total delay increased as the number of doctors who were consulted by patients increased (p<0.05). Additionally, we determined that diagnostic and treatment delays were more frequent at the early tumour stages in NSCLC patients (p<0.05). DISCUSSION The extended length of patient delay underscores the necessity of educating people about lung cancer. To decrease doctor delay, education is a crucial first step. Additionally, to further reduce the diagnostic and treatment delays of chest specialists, multidisciplinary management and algorithms must be used regularly.