Banu Eris Gulbay

Health-Related Quality of Life in Patients with Sleep-Related Breathing Disorders: Relationship with Nocturnal Parameters, Daytime Symptoms and Comorbid Diseases

Background: Sleep-related breathing disorders (SRBD) are frequently encountered health problems in the general population. Habitual snoring and obstructive sleep apnea/hypopnea syndrome (OSAHS) constitute most SRBD diagnoses. Although the decrease in quality of life is a well-known entity in SRBD patients, there is not enough data regarding the underlying pathophysiological mechanisms to explain this deterioration. Objectives: The aim of this study was to investigate which parameters were affecting the quality of life in patients with SRBD. Methods: Medical Outcome Survey – Short Form 36 (SF-36) and Epworth Sleepiness Scale were used in 135 patients with SRBD (69 patients with OSAHS and 66 patients with habitual snoring), and Charlson comorbidity index was calculated. Acquired data were compared with leading symptoms and polysomnographic findings in these patients. Results: All SF-36 scores were significantly decreased in SRBD patients. However, there were no significant differences in the SF-36 scores of these patients. Also, no significant correlation was found between the severity of OSAHS and the SF-36 scores. Similarly, none of the polysomnographic parameters was found significantly correlated with SF-36 scores. In contrast, all SF-36 scores were influenced by body mass index, Epworth Sleepiness Scale score, mean nocturnal saturation and the presence of coexisting diseases. Conclusions: According to the results of multiple variance analysis, we concluded that the quality of life depends on a number of collaborative factors such as obesity, mean nocturnal saturation, symptoms related to SRBD and the presence of comorbid diseases, rather than only on one independent parameter in the patients with SRBD.

Evaluation of the relationship between radiological abnormalities and both pulmonary function and pulmonary hypertension in coal workers’ pneumoconiosis

Objective:  The aim of this study was to investigate the effect of the radiological evidence of emphysema, and the extent of interstitial involvement, on lung function and pulmonary arterial pressure (PAP) in patients with coal workers’ pneumoconiosis (CWP).

Uso precoz de la ventilación mecánica no invasiva en pacientes con insuficiencia respiratoria hipercápnica aguda ingresados en una sala de neumología: estudio prospectivo

BACKGROUND In recent years, the optimal location for noninvasive mechanical ventilation (NIMV) has been a matter of debate. Our aim was to detect the effectiveness of NIMV in acute hypercapnic respiratory failure (AHRF) in respiratory ward and factors associated with failure. METHODS 69 patients treated with NIMV in respiratory ward were prospectively evaluated. The success of NIMV was defined as absence of need for intensive care unit (ICU) transfer with patients discharge from hospital (group 1), failure of NIMV was defined as need for ICU transfer (group 2). RESULTS The mean age was significantly higher in group 2. The cause of respiratory failure was COPD in 51 patients, obesity-hypoventilation syndrome in 14 and kyphoscoliosis in 4 patients. NIMV was successful in 55 patients and unsuccessful in 14. There was no significant difference between the two groups for pretreatment pH, PaCO₂ and PaO₂/FiO₂. After 1h and 3h of NIMV there was significant improvement in group 1. After 3h of NIMV, in group 1 respiratory rate was significantly decreased. The pretreatment APACHE II score, respiratory rate, frequency of pneumoniae, associated complication and comorbid disease was significantly higher in group 2. The success rate was higher in patients with good compliance to NIMV. CONCLUSION NIMV can be successfully applied in patients with AHRF in respiratory ward. The associated factors with NIMV failure are absence of early improvement in blood gases and respiratory rate, bad compliance to NIMV, older age, presence of associated complication, comorbid disease, pneumonia and high baseline respiratory rate.

Microscopic polyangiitis with unusual lung involvement.

Abstract:  Microscopic polyangiitis (MPA) is a non‐granulomatous, systemic and small vessel vasculitis accompanied by segmental necrotizing glomerulonephritis with no evidence of other small vessel disease. We report a patient with weakness, fever, and arthralgia whose CXR and thoracic CT showed widespread nodular infiltration. His proteinase‐3 anti‐neutrophilic cytoplasmic antibody (c‐ANCA) was positive. The serum creatinine was increased and haematuria subsequently developed. Renal biopsy revealed a focal segmental necrotizing glomerulonephritis which was compatible with MPA. He was treated with high‐dose corticosteroid and cyclophosphamide. Because of a worsening CXR and hypoxaemia, mechanical ventilation was applied. Despite this he died of respiratory failure following 20 days of treatment. Nodular infiltration is an unusual radiological pattern in patients with MPA and is the reason for this report.

Vascular Endothelial Growth Factor in Benign and Malignant Pleural Effusions

OBJECTIVE Vascular endothelial growth factor (VEGF) is a potent inducer of capillary permeability and its role as a crucial mediator in pleural fluid formation has been established. This study was conducted to assess the usefulness of VEGF for diagnosing malignant and non-malignant pleural effusions of various causes. PATIENTS AND METHODS VEGF levels in pleural effusions collected from 52 patients (20 with malignant effusion, 12 with tuberculous effusion, 10 with transudative effusion, and 10 with parapneumonic effusion) were assessed by enzyme-linked immunosorbent assay. RESULTS The median level of VEGF was significantly higher (P = .001) in exudative effusions (10.16 pg/mL) than in the transudative effusions (3.82 pg/mL). Although malignant pleural fluids tended to have higher median and mean levels of VEGF compared to tuberculous effusions, the difference was not statistically significant. Pleural VEGF levels in subtypes of lung cancer and in malignant effusions of different origins were not significantly different. CONCLUSIONS In conclusion, although VEGF levels in pleural effusions of different origins vary, they were only able to discriminate exudates from transudates significantly in this study. Further studies in larger groups of patients are needed to establish the role of VEGF in diagnosing malignant and/or tuberculous effusions.

El factor de crecimiento endotelial vascular en los derrames pleurales benignos y malignos

Objetivo El factor de crecimiento endotelial vascular (VEGF) es un potente inductor de la permeabilidad capilar y desempena un papel clave como mediador en la formacion del derrame pleural. Este estudio se ha realizado para evaluar la utilidad del VEGF en el diagnostico de los derrames pleurales malignos y no malignos de diversas causas. Pacientes y metodos Mediante la tecnica de inmunoabsorcion ligada a enzimas se determinaron las concentraciones de VEGF en los derrames pleurales correspondientes a 52 pacientes (20 con derrame pleural maligno, 12 con derrame de origen tuberculoso, 10 con derrame de tipo trasudado y 10 con derrame paraneumonico). Resultados La concentracion media del VEGF fue significativamente mayor (p = 0,001) en los derrames pleurales (10,16 pg/ml) de tipo exudado que en los derrames de tipo trasudado (3,82 pg/ml). Aunque los derrames pleurales malignos mostraron una tendencia a las concentraciones medianas y medias mayores de VEGF, en comparacion con los derrames de origen tuberculoso, la diferencia no fue estadisticamente significativa. Tampoco fueron significativamente diferentes las concentraciones pleurales de VEGF en los distintos subtipos de cancer pulmonar, y tampoco en los derrames malignos de distintos origenes. Conclusiones Aunque las concentraciones de VEGF son distintas en los derrames pleurales de origenes diferentes, en nuestro estudio no han permitido discriminar los exudados de los trasudados. Son necesarios nuevos estudios de investigacion sobre grupos mas numerosos de pacientes con objeto de establecer el papel que puede desempenar la concentracion de VEGF en el diagnostico de los derrames malignos, tuberculosos o ambos.

Body composition in patients with stable chronic obstructive pulmonary disease: comparison with malnutrition in healthy smokers.

OBJECTIVE Although malnutrition (body mass index (BMI)<18.5kg/ m(2)) has been associated with impaired health status in patients with chronic obstructive pulmonary disease (COPD), the effects of body composition (body fat and protein percentage) in patients with COPD have not been clearly demonstrated. MATERIALS AND METHODS A total of 180 stable patients with COPD at the stages of moderate, severe, very severe, and 50 healthy subjects were included in this prospective study. All subjects underwent a clinical evaluation, spirometry tests, anthropometric measurements and blood analysis. RESULTS Frequency of underweight was higher in COPD (11.7%) patients than the control group (8%). The frequency of underweight increased as the severity of COPD worsens. There was body decomposition (protein or fat depletion) in not only all underweight patients but also some normal/overweight COPD patients, as well as in the healthy subjects. Deterioration in FEV1 (L), and FEV1/FVC was more evident in underweight patients with protein and fat depletion compared to normal/overweight patients (p=0.004, and p=0.005). Inspiratory and expiratory respiratory muscle power was lower in under-weight patients with depletion than in normal/overweight patients (p=0.02, and p=0.01). DLCO and DLCO/VA were significantly lower in underweight patients than in normal/overweight patients (p=0.003, and p=0.004), they were also lower in normal/overweight patients with depletion than in normal/overweight patients with no depletion (p=0.01, and p=0.07). Normal/overweight patients with protein depletion had the most frequent number of exacerbations than others (p=0.04). CONCLUSION These results show that the body decomposition is important in patients with COPD. Assessment of body composition should be a part of nutritional assessment besides BMI in patients with COPD.

Predictive Value of STOP-BANG on OSAS-Related Complications Following Coronary Artery Bypass Grafting

BACKGROUND: The time and conditions may not be suitable for performing polysomnography (PSG) before urgent or emergent surgeries, for example, a coronary artery bypass graft. Unavailability in many centers, critical clinical situation, and inability to arrange a timely scheduled appointment are other limitations for PSG. In this study, we aimed to investigate if the STOP-BANG Questionnaire may predict obstructive sleep apnea syndrome (OSAS) related postoperative pulmonary alterations during coronary artery surgery. METHODS: Sixty-one subjects who were scheduled to undergo elective isolated coronary artery bypass graft surgery and were consulted for preoperative pulmonary assessment were recruited to the study. The STOP-BANG Questionnaire was used with the subjects; then their relationship with postoperative complications was assessed. RESULTS: Results of the STOP-BANG Questionnaire revealed that 36.1% of subjects were at high risk for OSAS. Three groups were established according to the STOP-BANG Questionnaire (low risk, group 1; moderate risk, group 2; high risk, group 3) and study parameters, including PEEP value in ventilator, detection of apnea at ventilator, CPAP time after extubation, SpO2 1 h after extubation, postoperative hypoxemia, need for CPAP, and ICU length of stay revealed significant relationships among these groups. CONCLUSIONS: The STOP-BANG Questionnaire may predict the OSAS risk and OSAS-related pulmonary complications for patients who are candidates for a coronary artery bypass graft and unable to be evaluated with PSG before surgery due to technical or time-related limitations.