Bulent Ciftci

Changes in serum selenium, copper, zinc levels and Cu/Zn ratio in patients with pulmonary tuberculosis during therapy

The effectiveness and success of antituberculosis therapy is mainly measured by its ability to identify the organism in the sputum. In certain cases, available tuberculosis tests are not satisfactory and do not provide enough information on the effectiveness of antituberculosis therapy. Copper (Cu), zinc (Zn), and selenium (Se) are the essential elements that play a crucial role in the immune system. The serum levels of these elements vary in many diseases including tuberculosis. In this study, we investigate whether the serum levels of Cu, Zn, and Se change during antituberculosis therapy. We have included 22 pulmonary tuberculosis cases that were newly diagnosed with positive sputum and 18 healthy subjects. At the beginning and 2 mo after therapy, serum levels of Cu, Zn, and Se were measured by atomic absorption spectrometry. Despite Se and Cu levels not being affected during the treatment, we found that there was a significant increase in the levels of Zn and a decrease in the Cu/Zn ratio. Serum Zn levels and the Cu/Zn ratio could be used as a valuable laboratory tool for the clinicians to assess response to therapy or effectiveness of the ongoing antituberculosis therapy.

Effects of continuous positive airway pressure therapy on left ventricular function assessed by tissue Doppler imaging in patients with obstructive sleep apnoea syndrome

AIMS In this study, we aimed to assess left ventricular (LV) systolic and diastolic functions by tissue Doppler imaging (TDI) in patients with obstructive sleep apnoea syndrome (OSAS) and to investigate the effects of 6 month continuous positive airway pressure (CPAP) on LV systolic and diastolic functions. METHODS AND RESULTS We studied 28 new diagnosed moderate and severe OSAS patients (apnoea-hypopnoea index >15) and 18 control group. Exclusion criteria were the presence of structural heart disease, pulmonary disease, diabetes mellitus, dyslipidaemia, alcoholism, neuromuscular disease, renal failure, or malignancy. They were not previously considered or treated for OSA and were all free of drugs. Left ventricular lateral and septal wall early myocardial peak velocity (Em), late myocardial peak velocity (Am), Em to Am ratio, myocardial relaxation time (RTm), myocardial systolic wave (Sm) velocity, isovolumic acceleration (IVA), myocardial pre-contraction time (PCTm), contraction time (CTm), and PCTm to CTm ratio were measured. All echocardiographic parameters were calculated 6 months after CPAP therapy. No statistically significant difference was detected between the groups according to age, gender, body mass index, systolic and diastolic blood pressure, heart rate, fasting blood glucose, and serum lipid parameters. Left ventricular systolic parameters, such as LV septal and lateral wall IVA, CTm, and PCTm to CTm ratio, were significantly lower and Sm was similar in patients with the OSAS group compared with the controls. Left ventricular diastolic parameters, such as LV septal and lateral wall Em velocity and Em to Am ratio, were significantly lower; RTm was significantly prolonged; and Am velocity was similar in patients with OSAS compared with the controls. At the end of the treatment, 20 of 28 patients were compliant with CPAP therapy. Left ventricular septal and lateral wall Em velocity, Em to Am ratio, IVA and CTm, and PCTm to CTm increased significantly, PCTm, PCTm to CTm ratio, and RTm decreased significantly after the therapy, whereas Sm velocity and Am velocity did not change after CPAP therapy in compliant patients. CONCLUSION Left ventricular systolic and diastolic dysfunctions were determined in patients with OSAS, and it was demonstrated that LV systolic and diastolic dysfunctions improved with 6 month CPAP therapy.

Obstructive sleep apnoea, cigarette smoking and plasma orexin-A in a sleep clinic cohort.

Orexin-A is a neuropeptide involved in the regulation of food intake and the sleep-wake cycle. This study investigated plasma orexin-A levels in a sleep clinic cohort, adjusting for smoking habits, in 76 participants comprising 41 with obstructive sleep apnoea (OSA) (apnoea-hypopnoea index [AHI] 44.1 ± 19.1 events/h) and 35 without OSA (AHI 6.3 ± 4.7 events/h). Plasma orexin-A levels were significantly lower in OSA patients (15.0 ± 4.6 ng/ml) compared with those without OSA (31.4 ± 6.5 ng/ml). In non-OSA subjects, there was no significant difference between never smokers and ex/current smokers in plasma orexin-A levels (32.9 ± 9.5 versus 29.7 ± 8.9 ng/ml, respectively) whereas, in the OSA sub-group, orexin-A levels were significantly lower in never smokers than in ex/current smokers (4.0 ± 1.2 versus 21.4 ± 7.0 ng/ml). A significant inverse relationship was found between plasma orexin-A levels and AHI amongst never smokers, but there was no significant relationship amongst ex/current smokers. These results confirm previous studies demonstrating lower levels of plasma orexin-A in OSA patients and indicate that smoking may affect orexin-A levels and AHI.

The prevalence of obstructive sleep apnea in patients with difficult-to-treat asthma

OBJECTIVES Obstructive sleep apnea (OSA) occurs more commonly in asthma patients than in the general population and can complicate asthma management. The aim of this study was to evaluate the presence of OSA in patients with difficult-to-treat asthma (DTA) and to investigate the sleep quality in these patients. METHODS Patients with DTA were recruited from the adult allergy clinic of a tertiary care hospital. After completing the Sleep Questionnaire and Epworth Sleepiness Scale, all participants underwent overnight polysomnography. The demographic and asthma severity assessments included the following measures: the age at diagnosis, duration of illness, smoking and atopy status, results of pulmonary function tests, number of asthma control medications used, and number of hospitalizations and emergency room visits because of asthma and analgesic hypersensitivity according to apnea-hypopnea index (AHI) scores. RESULTS We analyzed 47 (M:9/F:38) DTA patients with a mean age of 48.74±9.45 years. The mean duration of asthma was 9.17±6.5 years. Twenty-four (51.1%) patients were atopic. The analgesic hypersensitivity rate was 27.7%. Fourteen patients (29.8%) were former smokers and 2 patients were current smokers. Sleep quality was impaired in all patients. Thirty-five patients (74.5%) had OSA, 11 of whom had mild OSA, and 24 patients had moderate-severe OSA. The presence of OSA was not statistically correlated with asthma characteristics. CONCLUSION The study showed that there is a remarkably high prevalence of OSA in DTA. Although no statistically significant relationship between the presence of OSA and clinical asthma characteristics was identified, all DTA patients should be assessed for OSA.

Management of Obstructive Sleep Apnea in an Edentulous Lower Jaw Patient with a Mandibular Advancement Device

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder with periodic reduction or cessation of airflow during sleep. It is associated with loud snoring, disrupted sleep, and witnessed apneas. Treatment of OSA varies from simple measures such as oral appliances and nasal continuous positive airway pressure (CPAP) to surgical procedures like uvulopalatopharyngoplasty and tracheostomy. Oral appliances are a viable nonsurgical treatment alternative in patients with OSA, of which mandibular advancement devices are most common. Edentulism which contributes to the worsening of OSA reduces the number of available therapeutic strategies and is considered a contraindication to oral appliance therapy. This clinical report describes the treatment of a 63-year-old edentulous OSA patient for whom a mandibular advancement device was designed.

Lack of association between OSAS and hypothyroidism

We read with great interest the article by Turkan Mete et al., entitled: ‘‘Relationship between obstructive sleep apnea syndrome and thyroid diseases’’. In this article, the authors studied 182 obese patients with different severity of OSAS, according to Apnea–hypopnea index (AHI), and observed no significant differences between the OSAS groups and the control group without OSAS, in terms of hypothyroidism [1]. These results are very consistent and similar to our previous study, in which we showed that the subclinical hypothyroidism and treatment with the levothyroxine do not influence the prevalence and severity of OSA, while sleep propensity is increased by the untreated subclinical hypothyroidism [2]. However, recent studies have documented in obese women a statistical association between OSAS and hypothyroidism [3]. The results of this study highlighted the increasing risk of women, who are 5–8 times more likely to have thyroid dysfunction than men, which might often to be associated with sleep disorders. Taken all the data together, we suggest to always perform further investigations about relationship between OSAS and thyroid diseases, as well as auto-immune thyroiditis, and to develop a screening schema for severeOSAS patients for early diagnosis of hypothyroidism. Furthermore, the evaluation for sleep disorders in women with hypothyroidism may lead to an early diagnosis of OSAS, to prevent long-term metabolic consequences.

Split-Night Versus Full-Night Polysomnography: Comparison of the First and Second Parts of the Night

BACKGROUND AND OBJECTIVE In a split-night study, the first part consists of standard polysomnography (PSG) for the diagnosis of obstructive sleep apnea syndrome while the second part is used to establish a suitable level of continuous positive airway pressure. The aim of our study was to compare the sleep and respiratory parameters during the first 3 hours of the night with the values found during the remainder of sleep and during the whole night. PATIENTS AND METHODS Forty-five patients were included in the study. Each patient underwent a standard full-night PSG and the PSG data for each patient were divided into 2 periods: PSG1, defined as the initial 3 hours of the total sleep time and PSG2, defined as the remaining period. Sleep and breathing data from PSG1 and PSG2 were then separately computed and compared with each other and with data for the total sleep time (PSGt). RESULTS The percentage of total sleep time in stage III-IV and the apnea-hypopnea index (AHI) were significantly higher and the percentage of time in rapid eye movement (REM) sleep was significantly lower during PSG1 than during PSG2 (P< .001). Similarly, the percentage of time in stage III-IV sleep was significantly higher and the percentage of REM sleep was significantly lower during PSG1 than during PSGt (P< .001), but there was no significant difference in the AHI between PSG1 and PSGt. CONCLUSION The diagnosis for the first 3 hours of the night will give a reliable reflection of the whole night. In addition, optimal positive airway pressure titrated during the second half of the night is also optimal for the first half of the night.

Alternative technique to transfer jaw relations for custom mandibular advancement devices: A case report

Abstract Background: Oral appliance therapy for obstructive sleep apnea can be helpful in mild and moderate cases. This clinical report evaluates the efficacy of a protocol that predicts an optimal jaw position and describes the response of a young OSA patient to treatment. Clinical Presentation: A 27-year-old woman was diagnosed with moderate OSA and had an apnea–hypopnea index (AHI) of 25.8/hr. In order to fabricate a custom device, an alternative procedure to determine the optimal protrusion and vertical positioning of the jaw was applied. After a follow-up period of 14 months, her apnea-hypopnea index (AHI) significantly decreased from 25.8 to 1.0 per hr with the appliance. The total number of respiratory events decreased from 211 to 8. Conclusion: Improved polysomnographic parameters showed that the oral device was efficient in treatment. The advantages of the device in this study are that it is comfortable, economical, and simple to fabricate.

Exposure to Biomass Smoke and Anthracosis: Clinical, Radiological, Bronchoscopic and Histopathologic Findings

ABS TRACT Objective: Com bus ti on of bi o mass fu el, is the pri mary so ur ce of ex po su re in de ve lo ping co un tri es. The des crip ti on of the cli ni cal pic tu re of the pos sib le pul mo nary in vol ve ment in this form of in do or pol lu ti on is not well known. Our aim was to indoor air pollution de ter mi ne the cli ni cal and ra di o lo gi cal cha rac te ris tics of fe ma le pa ti ents ex po sed to bi o mass smo ke, to show bronc hos co pic fin dings and to de ter mi ne the as so ci a ti on of bronc hos co pic fin dings with the du ra ti on of ex po su re. Material and Met hods: The sub jects of this study con sis ted of 20 non-smo king fe ma le pati ents with a his tory of using bi o mass fu el com po sed of ani mal dung who un der went bronc hos co pic pro ce du res for va ri o us di ag nos tic in di ca ti ons. The dis tinc ti ve cli ni cal fe a tu res, ra di o lo gi cal fin dings and na tu re of bronc hos co pic le si ons we re analy zed ret ros pec ti vely. The bronc hos co pic fin dings we re gra ded as gra de I (ant hra co tic sta i ning on overl ying mu co sa) and gra de II (bronc hi al nar ro wing or ob li te ra ti on du e to ant hra co tic pla qu es). Re sults: Chi ef comp la int was dyspne a on exer ti on (85%). The most fre qu ent ra di o lo gi cal fin ding on chest X-ray was re ti cu lar and/or re ti culo no du lar in fil tra ti on (70%). The me an du ra ti on of bi o mass smo ke ex po su re was 37.70 ± 19.53 ye ars. Ele ven pa ti ents we re had gra de I whi le 9 pa ti ents had gra de II bronc hos co pic fin dings. A sta tis ti cally sig ni fi cant cor re la ti on was fo und bet we en the ex po su re du ra ti on and bronc hos co pic gra de (p< 0.005). Conc lu si on: The se fin dings sug gest that long-stan ding do mes tic ex po su re to bi omass smo ke con tri bu tes not only to ant hra co tic sta i ning on overl ying mu co sa, but al so to bronc hi al nar ro wing or ob li te ra ti on. To eva lu a te the ro le of bronc hos co pic gra de in dif fe rent lung di se a ses that may be re la ted with bi o mass fu el, pros pec ti ve re se arch is needed.