Bülent Özbay

WHO Rapid Advice Guidelines for pharmacological management of sporadic human infection with avian influenza A (H5N1) virus

Summary Recent spread of avian influenza A (H5N1) virus to poultry and wild birds has increased the threat of human infections with H5N1 virus worldwide. Despite international agreement to stockpile antivirals, evidence-based guidelines for their use do not exist. WHO assembled an international multidisciplinary panel to develop rapid advice for the pharmacological management of human H5N1 virus infection in the current pandemic alert period. A transparent methodological guideline process on the basis of the Grading Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to develop evidence-based guidelines. Our development of specific recommendations for treatment and chemoprophylaxis of sporadic H5N1 infection resulted from the benefits, harms, burden, and cost of interventions in several patient and exposure groups. Overall, the quality of the underlying evidence for all recommendations was rated as very low because it was based on small case series of H5N1 patients, on extrapolation from preclinical studies, and high quality studies of seasonal influenza. A strong recommendation to treat H5N1 patients with oseltamivir was made in part because of the severity of the disease. Similarly, strong recommendations were made to use neuraminidase inhibitors as chemoprophylaxis in high-risk exposure populations. Emergence of other novel influenza A viral subtypes with pandemic potential, or changes in the pathogenicity of H5N1 virus strains, will require an update of these guidelines and WHO will be monitoring this closely.

Functional and radiological impairment in women highly exposed to indoor biomass fuels

Objective: The aim of this study was to describe the lung function and the computed tomographic features in a selected group of non‐smoking women with chronic obstructive pulmonary disease and biomass fuel exposure.

Evaluation of diaphragmatic movement with MR fluoroscopy in chronic obstructive pulmonary disease

The aim of this study was to show reduction of the diaphragmatic excursion with MR fluoroscopy in patients with chronic obstructive pulmonary disease (COPD) and to compare the results with pulmonary function test (PFT). The study included 13 men and 10 women (average age 56.2) with COPD, and 9 men and 6 women (average age 55.8) as a control group. MR fluoroscopy images with Spoiled Gradient-echo pulse sequence was obtained during deep inspiration and expiration. After examination, over cine-loop display, the highest and lowest positions of the diaphragm were identified and the distance of excursion was measured. Differences in the diaphragmatic excursion between patient and healthy subjects were compared. We have also compared MR fluoroscopy results with PFT. In each person of both groups, excursion of the diaphragm was demonstrated clearly in cine-loop display. Differences of excursion between deepest and highest point of diaphragm were on average 26 and 20 mm, respectively, in the right and left side in patients and 69 and 56 mm in healthy group. Significant correlation was found between expiratory volume in 1 s and MR fluoroscopy results. MR fluoroscopy study showed that there were significant statistical differences in diaphragmatic excursion between patients with COPD and healthy subjects. Expiratory volume in 1 s is closely associated with the diaphragmatic excursion. MR fluoroscopy would seem to be a useful method for showing diaphragmatic excursion.

Prevalence of chronic bronchitis-asthma symptoms in biomass fuel exposed females

ObjectivesWe investigated whether exposure to biomass fuel is a potential risk factor for chronic bronchitis and asthma among females in rural area in Van (east Turkey).MethodsThe effect of indoor pollution producing various respiratory symptoms was studied in 177 females. Of these, 90 were those who used biomass fuel and 87 were nonusers of biomass fuel. A part of the European Community Respiratory Health Survey quastionnaire and British Medical Research Council questionnaire were used.ResultsAsthma related symptoms (AS) (wheezing, and combination of wheezing without a cold and wheezing with breathlessness) were reported in 63.3% of those who used biomass fuel, and in 12.9% of nonusers (p<0.0001). The use of asthma medication was reported as 3.3% of biomass fuel users, and in 2.7% of nonuser (p>0.05). Long term cough and/or morning cough together with sputum (chronic bronchitis symptoms (BS) was reported as 58.9% in the user group, and 29.4% in the nonuser group (p<0.0001). Significant differences in AS and BS were found between biomass fuel user and nonuser groups in the rural area.ConclusionsThe results of this study showed a significant association between symptoms of chronic bronchitis-asthma and biomass fuel usage in females living in a rural area.

Impact of neuraminidase inhibitors on influenza A(H1N1)pdm09‐related pneumonia: an individual participant data meta‐analysis

The impact of neuraminidase inhibitors (NAIs) on influenza‐related pneumonia (IRP) is not established. Our objective was to investigate the association between NAI treatment and IRP incidence and outcomes in patients hospitalised with A(H1N1)pdm09 virus infection.

Investigation of the Relationship between Serum Levels of Cotinine and the Renal Function in Active and Passive Smokers

Objective: We have investigated the effects of active and passive smoking on renal functions in terms of glomerular filtration rate, microalbuminuria, and β-2 microglobulin excretion. Design and method: The volunteers included in this study were classified into three groups as active smokers (n = 24), passive smokers (n = 20), and controls (n = 20). Blood and urine samples were collected from all groups. Serum glucose, urea, creatinine, and cotinine levels in the collected blood samples were measured. Also, microalbumin, β-2 microglobulin, and creatinine levels were measured in the collected urine samples. Results: Serum cotinine levels were found to be higher in both passive and active smokers when compared with controls ( p < 0.01), whereas urinary microalbumin and creatinine levels were significantly higher in active smokers ( p < 0.01). The urinary microalbumin/creatinine ratio was significantly increased in both active and passive smokers compared with controls. Conclusion: The kidney and the glomerular functions may be affected even by passive smoking. In addition, increased microalbumin/creatinine ratio may be a sign of increased atherosclerosis risk in these persons.

Influenza‐associated pneumonia in a Turkish area with endemic avian influenza

Background and objective:  The aim of the study was to describe the effects of influenza associated with community‐acquired pneumonia (CAP) on the outcome of patients in an area characterized by endemic avian influenza.

Bronchobiliary fistula due to hydatid disease of the liver: a case report.

Abstract As a complication of hydatid cyst disease of the liver, bronchobiliary fistula is a rare condition and manifests as bilioptysis. We report the case of a 34 year-old man with echinococcosis of the liver who developed a bronchobiliary fistula which manifested as chronic cough and bile stained sputum. A chest X-ray showed an unilateral infiltrate in the costodiaphragmatic angle. Bronchoscopy revealed bile filling the right basal bronchi. Magnetic resonance cystography revealed that the hepatic bile ducts communicated with the right basal pleural space. Percutaneous transhepatic drainage was applied. When the patient was reevaluated, the hydatid cyst had eroded into the pleural space, and a pleural effusion had developed. The condition of the patient deteriorated. Hence, surgical therapy was performed. After surgery, the condition of the patient improved. He was discharged from the hospital in good condition.

Reliability of symptoms suggestive of angina in patients with chronic obstructive pulmonary disease

BACKGROUND Due to overlapping symptoms and inadequate exercise capacity, noninvasive diagnosis of coronary artery disease (CAD) may be under- or overestimated in patients with chronic obstructive pulmonary disease (COPD). OBJECTIVE To assess outcomes of coronary angiography in COPD patients depending on baseline clinical characteristics. METHODS Medical records of 157 patients with COPD and 157 patients without COPD matched for baseline clinical characteristics who had undergone diagnostic coronary angiography for the first time were reviewed retrospectively. RESULTS The frequency of significant CAD was significantly lower in COPD patients than in the control group (52.8% vs. 80.2%, p<0.001). Frequencies of CAD risk factors (older age, hypertension, diabetes, smoking history) were significantly more frequent among COPD patients having significant CAD. Among patients reporting stable angina pectoris, significant CAD was detected in 32.7% of COPD patients and 71.0% of non-COPD patients (p<0.001). However, among the patients with a diagnosis of unstable angina pectoris, significant CAD was detected in 87.5% of COPD patients and 90.2% of non-COPD patients (p=0.755). CONCLUSION Diagnosis of CAD in COPD patients by symptomatology may be difficult. However, clinical diagnosis of CAD in the setting of unstable angina is accurate in most of the COPD patients. Therefore, further noninvasive diagnostic methods or careful follow up may be more appropriate for COPD patients reporting stable angina pectoris.FUNDAMENTO: A causa de la superposicion de sintomas e inadecuada capacidad de ejercicios, el diagnostico no-invasivo de la enfermedad arterial coronaria (EAC) se puede sub o superestimar en pacientes con enfermedad pulmonar obstructiva cronica (EPOC). OBJETIVO: Evaluar los resultados de angiografias coronarias en pacientes con EPOC dependiendo de las caracteristicas clinicas basales. METODOS: Se revisaron retrospectivamente los registros medicos de 157 pacientes con EPOC y 157 pacientes sin EPOC distribuidos en grupos segun caracteristicas clinicas basales, que se habian sometido a angiografia coronaria diagnostica por primera vez. RESULTADOS: La frecuencia de EAC era significantemente mas baja en pacientes con EPOC que en el grupo control (52,8% vs. 80,2%, p<0,001). Las frecuencias de los factores de riesgo para EAC (edad avanzada, hipertension, diabetes, historico de fumo) eran significantemente mas comunes entre los pacientes con EPOC que tenian EAC significante. Entre los pacientes que reportaban angina de pecho estable, se detecto EAC significante en un 32,7% de los pacientes con EPOC y el 71,0% de los pacientes sin EPOC (p<0,001). Sin embargo, para los pacientes con diagnostico de angina de pecho inestable, se detecto EAC significante en un 87,5% de los pacientes con EPOC y un 90,2% de los pacientes sin EPOC (p=0,755). CONCLUSIONES: El diagnostico de EAC pacientes con EPOC solamente mediante la sintomatologia puede ser dificil. Sin embargo, el diagnostico clinico de EAC en el cuadro de angina inestable resulta preciso en la mayoria de los pacientes con EPOC. Asi, otros metodos diagnosticos no-invasivos o seguimiento cuidadoso pueden ser mas apropiados para pacientes con EPOC que refieren angina de pecho estable.

Chronic effects of environmental biomass smoke on lung histopathology in turkish non-smoking women: a case series

Biomass is widely used for fuel in developing countries. Particles and gases of biomass burning may cause changes in the lung. In this prospective study we investigated histopathological changes in the lungs of 42 non-smoking women [mean age (59±10) years] caused by biomass smoke. We valuated exposure to biomass smoke, case histories, and the fi ndings of physical examination, radiology, bronchoscopy, and lung histopathology. Mean exposure to biomass smoke was (28±9) hour-year (1 hour-year equals 365 hours of exposure per year with average exposure of 1 hour a day). The radiological fi ndings were mass (42 %), reticulonodular opacities (31 %), mediastinal lymphadenopathy (26 %), pleuro-parenchymal fi brotic banding (19 %), widening of the pulmonary artery (14 %), ground glass (11 %), mosaic perfusion (9 %), consolidation (9 %), segmental or subsegmental atelectasis (7 %), and bronchiectasis (7 %). The patients were diagnosed with lung cancer (35 %), interstitial lung disease (31 %), sarcoidosis (9 %), tuberculosis (9 %), chronic obstructive pulmonary disease (4 %), chronic bronchitis (9 %), and metastasis (4 %). Bronchoscopy showed pilies, oedema, erythema, bronchus narrowing, endobronchial tumour, mucosal irregularity, increased vascularisation, blue-black anthracotic plaques, mucosal oedema, and purulent secretion. Transbronchial biopsies revealed neutrophil and lymphocyte leucocytes in the perivascular, peribronchiolar, and interalveolar septa, slightly enlarged connective tissue, thickening of the basal membrane, thickening of interalveolar septa, intimal and medial thickening of the vascular wall and vascular lumen narrowing, anthracosis between the cells and in the bronchiole epithelium. These fi ndings confi rm that biomass smoke has important toxic effects on the lung parenchyma, interstitium, and pulmonary vessels that may result in malignancies.