Baran Balcan

Effects of biomass smoke on pulmonary functions: a case control study

Background Biomass smoke is the leading cause of COPD in developing countries such as Turkey. In rural areas of Turkey, females are more exposed to biomass smoke because of traditional lifestyles. Aim The aim of this study was to determine the adverse effects of biomass smoke on pulmonary functions and define the relationship between duration in years and an index (cumulative exposure index) with altered pulmonary function test results. Participants and methods A total of 115 females who lived in the village of Kağizman (a borough of Kars located in the eastern part of Turkey) and were exposed to biomass smoke were included in the study. The control group was generated with 73 individuals living in the same area who were never exposed to biomass smoke. Results Twenty-seven (23.8%) females in the study group and four (5.5%) in the control group had small airway disease (P=0.038). Twenty-two (19.1%) females in the study group and ten (13.7%) in the control group had obstruction (P=0.223). Twenty (17.3%) females in the study group who were exposed to biomass smoke had restriction compared with ten (13%) in the control group (P=0.189). The duration needed for the existence of small airway disease was 16 years, for obstructive airway disease was 17 years, and for restrictive airway disease was 17 years. The intensity of biomass smoke was defined in terms of cumulative exposure index; it was calculated by multiplying hours per day, weeks per month, and total years of smoke exposure and dividing the result by three. Conclusion Exposure to biomass smoke is a serious public health problem, especially in rural areas of developing countries, because of its negative effects on pulmonary functions. As the duration and the intensity of exposure increase, the probability of having altered pulmonary function test results is higher.

Altered pulmonary functions due to biomass smoke in a rural population of Turkish women: a descriptive study

Introduction Wood or other organic sources of fuel are used as source of energy for heating or cooking particularly in developing countries. The aim of the current study was to evaluate the association between biomass exposure time and parameters of pulmonary function tests. Materials and Methods Four hundred twenty-four consecutive women who lived and exposed to biomass smoke in a small province in Eastern Turkey were involved. This study was performed with women who had come to pulmonology out-patient clinic with symptom of dyspnea. Result The independent variables assessed in the study patients were age, BMI, starting age of cooking, hours per day and weeks per month spent cooking, and cooking years; the dependent variables were PFT parameters. Ninety-two (21.6%) patients had an obstructive PFT pattern. Sixty-seven (73%) of these patients were classified as GOLD 2 and 25 (27%) patients were classified as GOLD 3. Seventy-five (17.6 %) of the patients had restrictive lung disease; 54 (72%) of these patients were found to have a mild and 21 (27%) had a moderate restrictive pattern. Increased number of years in cooking and to start cooking at younger ages were a risk factors for the development of obstructive and restrictive disease. There was a statistically significant and negative correlation between increased number of years and the value of FEV1 (r= -0.917; p=< 0.001), FEV1/FVC (r= -0.739; p< 0.001), and FVC (r= -0.906; p< 0.001). The median time of cooking required was 23 years for the development of obstruction, and 25 years for restriction, respectively. Conclusions Cumulative biomass exposure time is associated with impairment in PFT parameters; results in both obstructive and restrictive lung disease. Biomass exposure is a public health problem and pre-cautions should be taken in order to prevent impaired pulmonary functions.

Results of Polysomnographies and Treatment Strategies in Elderly Patients with Symptoms of Obstructive Sleep Apnea Syndrome

OBJECTIVES In this study, we evaluated data regarding the management of geriatric patients with symptoms of obstructive sleep apnea syndrome (age, >65 years) who were admitted to our sleep clinic. MATERIAL AND METHODS Symptoms and sleep data of the patients were retrospectively evaluated, and the patients were reevaluated after treatment. RESULTS A total of 85 patients with a median age of 69 years were included. Snoring and fatigue were the most common symptoms. Cardiovascular diseases were the most frequently listed comorbidity. The median Epworth sleepiness scale was 10, and based on Berlin sleep questionnaire findings, 63.5% of the participants were in the high-risk group. Eighty-seven percent were diagnosed with obstructive sleep apnea (2/3 of them were positional), and moderate-to-severe obstructive sleep apnea was observed more in women than in men. Only one patient was diagnosed with central sleep apnea. There were positive and linear correlations between increased age and the apnea-hypopnea index, arousal index, Epworth sleepiness scale, and being in a high-risk group according to the Berlin sleep scale; however, there was no correlation between increased age and the number of hypopnea and apnea events. There were also positive and linear correlations between the apnea-hypopnea index and the Epworth sleepiness scale, being in a high-risk group according to the Berlin sleep questionnaire, an increased number of known medical conditions, and increased body mass index. We were able to contact 72 of the 85 patients via phone calls. Patients who adjusted to treatment had positive feedbacks. CONCLUSION Sleep disorders are observed more in the elderly, and an increasing age is an independent factor for sleep disorders. Besides the usual signs and symptoms of sleep disorders, it should be considered in elderly who have cognitive dysfunction and dementia.

Influence of Statin Therapy on Exacerbation Frequency in Patients with Chronic Obstructive Pulmonary Disease

OBJECTIVES Chronic obstructive pulmonary disease (COPD) is an inflammatory disease, in which chronic and systemic inflammation plays an important role. By decreasing neutrophil infiltration and cytokine production, statins have anti-inflammatory mechanisms. MATERIALS AND METHODS Fifty-seven patients who had diagnosis of chronic obstructive pulmonary disease according to GOLD guideline were included in the study; 20 of them were statin users. Statin users group were patients being under medication with regular simvastatin, atorvastatin or rosuvastatin 20 mg per day for at least the past 1 year. RESULTS There was statistically no significant difference between patients with or without statin treatment with respect to; age, female-male ratio, COPD severity level, medication used for COPD, pulmonary function tests results and smoking habits. COPD exacerbation frequency in patients using statins was significantly less than patients not using statins (p<0.05). Patient number with COPD exacerbation, antibiotic treatment and outpatient clinic administration and outpatient clinic administration frequency was significantly lower in statin using patients (p<0.05). CONCLUSION COPD patients receiving statins have a lower frequency of COPD exacarbations, hospital administration and antibiotic treatment compared to patients not receiving statins.

Sirolimus induced diffuse alveolar hemorrhage: A case report

Sirolimus, mammalian targets of the Rapamycin, is responsible for inhibition of T and B cell proliferation, and usually. Recently we treated a 33 year old renal transplant reciepent with sirolimus induced diffuse alveolar hemorrhage. She was first diagnosed with pneumonia and underwent antibiotic therapy. In her radiological images there was bilateral diffuse patchy infiltration. In the 48th hour of antibiotic treatment her fever and inflammatory markers were still high, and afterwards, bronchoscopy was performed. Pathology result of the patient was reported as hemosiderin-loaded macrophages, eosinophil predominancy and few lymphocytes . Our final diagnosis was diffuse alveolar hemorrhage due to sirolimus. We discontinued sirolimus and started pulse steroid (1 gr/day methylprednisolon) for three days. In the following period her oxygen supply declined immediately and clinical condition of the patient got better. After two weeks we disharged the patient, continued methylprednisolon treatment in 1mg/kg/day dosage. By tapering the dose slowly we planned 6 months of steroid treatment. During her follow ups, pulmonary symptoms and radiological images got better.

Sirolimus-Induced Diffuse Alveolar Hemorrhage: A Case Report.

Sirolimus is a mammalian target of the rapamycin, a protein kinase, which is responsible for inhibition of T cell and B cell proliferation. Sirolimus has side effects on lugs, and may cause cryptogenic organizing pneumonia, diffuse alveolar hemorrhage, lymphocytic pneumonitis, hypersensitivity pneumonitis, desquamative interstitial pneumonia, and pulmonary alveolar proteinosis. Diagnosis is based on the combination of clinical, radiological, histological, and pathological investigation. We report a case of diffuse alveolar hemorrhage in a 33-year-old, female renal transplant recipient. After discontinuation of sirolimus, radiological images and clinical condition of the patient got better. We also planned steroid therapy for 6 months by tapering the dosage slowly. After steroid therapy, full recovery of pulmonary functions achieved, and the patient is observed in our outpatient clinic with lack of any pulmonary symptoms.

Kriptojenik organize pnömoni tanısında tru-cut biyopsi

Kriptojenik organize pnomoni (KOP) ilk kez 1983 yilinda Davison ve ark. tarafindan tanimlanmasindan once yakin gecmise kadar bronsiolitis obliterans organize pnomoni (BOOP) ismiyle literaturde kullanilmistir. Etyolojisinde viral enfeksiyon, aspirasyon pnomonisi, toksik gaz inhalasyonu, transfuzyon ve radyoterapi yer almaktadir, ancak idiopatik olarak da gelistigi bilinmektedir. Hastalar klinik olarak ust solunum yolu enfeksiyonuna veya pnomoniye benzer bir tabloyla basvurabilir, ancak akciger goruntulemesinde yaygin yama tarzinda plevraya oturan konsolide sahalarin yer degistirmesi daha spesifiktir. Tedavisinde kortikosteroidler birinci basamak tedavidir ve genelde bu tedaviye iyi yanit alinmaktadir, ancak bazen yeterli olmaz ve diger immunosuppressif ilaclara ihtiyac olur, bunun yaninda steroid dozu azaltildiginda relapslar gorulebilir. Transbronsiyal biyopsi ile tani konulabilmesi olasiligi dusuktur. Gunumuzde kesin KOP tanisini koyabilmede en ideal yontem goruntuleme esliginde yapilan tru-cut biyopsidir. Biz bu yazimizda, kesin tani koymak icin tru-cut akciger biyopsisi uyguladigimiz iki hastamizi literatur esliginde tartistik.