Caglar Cuhadaroglu

Endothelial Function in Patients with Obstructive Sleep Apnea Syndrome but without Hypertension

Background: Obstructive sleep apnea syndrome (OSAS) influences endothelial function and causes hypertension. Objectives: Our aim was to evaluate the role of endothelial dysfunction in the pathogenesis of hypertension in OSAS. Methods: Twenty-three patients with OSAS but without hypertension and 15 healthy normotensive subjects were investigated. The presence or absence of OSAS was evaluated with a sleep study. Endothelial function was investigated with brachial artery ultrasound examination. Results: Baseline characteristics were equivalent between the two groups. Minimal oxygen saturation and apnea-hypopnea indexes in the OSAS and control groups were 62.9 ± 16.5 versus 94.9 ± 1.1% (p < 0.0001) and 53.1 ± 20.3 versus 3.8 ± 0.9 (p < 0.0001), respectively. There was not statistically significant difference between basal brachial artery diameters measured in the morning and in the evening in all groups. Flow-mediated dilation (FMD) values measured in the morning were lower than those measured in the evening in both OSAS patients and the control group: FMD of OSAS patients was 6.04 ± 3.18% in the morning and 10.38 ± 4.23% in the evening hours (p = 0.001), and FMD of control subjects was 10.9 ± 2.6% in the morning and 13.9 ± 2.32 in the evening hours (p = 0.002). Differences in FMD values measured both in the morning and evening hours in OSAS patients were lower compared with those in control subjects (p < 0.0001 in the morning hours and p = 0.003 in the evening hours). Conclusions: We detected a prominent diurnal deterioration in endothelial function in normotensive OSAS patients compared with healthy subjects. This deterioration may occur due to ongoing hypoxemia during the night and it may be a possible cause of hypertension and atherosclerotic cardiovascular diseases in patients with OSAS.

Increased risk of tuberculosis in health care workers: a retrospective survey at a teaching hospital in Istanbul, Turkey

BackgroundTuberculosis (TB) is an established occupational disease affecting health care workers (HCWs). Determining the risk of TB among HCWs is important to enable authorites to take preventative measures in health care facilities and protect HCWs. This study was designed to assess the incidence of TB in a teaching hospital in Istanbul, Turkey. This study is retrospective study of health records of HCWs in our hospital from 1991 to 2000.ResultsThe mean workforce of the hospital was 3359 + 33.2 between 1991 and 2000. There were 31 cases (15 male) meeting the diagnostic criteria for TB, comprising eight doctors, one nurse and 22 other health professionals. Mean incidence of TB was 96 per 100,000 for all HCWs (relative risk: 2.71), 79 per 100,000 for doctors (relative risk: 2.2), 14 per 100,000 for nurses and 121 per 100,000 (relative risk: 3.4) for other professionals. The mean incidence of TB in Turkey between 1991 and 2000 was 35.4 per 100,000. Incidence of TB was similar in the Departments of Chest Diseases and Clinical Medicine but there were no TB cases in the Basic Science and Managerial Departments.ConclusionHCWs in Turkey who work in clinics have an increased risk for TB. Post-graduate education and prevention programs reduce the risk of TB. Control programs to prevent nosocomial transmission of TB should be established in hospitals to reduce risk for HCWs.

Evaluation of clinical parameters in patients with obstructive sleep apnea and possible correlation with the severity of the disease

Abstract Obstructive sleep apnea (OSA) is a complex disease whose etiology is multifactorial and incompletely understood. This article focuses on upper airway anatomy evaluation and the standardization of different physical findings in patients with OSA and on the possible correlation of these physical findings with the severity of the disease. All patients underwent a physical examination and polysomnography. The physical examination included tonsil size, modified Mallampati grade, neck circumference, lateral clinical craniofacial assessment and body mass index (BMI). The study group consisted of 85 patients. A statistically significant correlation between tonsil size and BMI and with the respiratory disturbance index (RDI) was detected (P = 0.004 and 0.03 respectively). Also patients with a craniofacial anomaly have a higher RDI level than the patients without this anomaly (P = 0.03). This study has identified some standardized physical findings for predicting the severity of OSA. We aim to benefit from these findings in the selection of a rational treatment modality selection for patients with OSA.

Aortic elastic properties and left ventricular diastolic dysfunction in patients with obstructive sleep apnea.

Although the responsible mechanisms are not yet fully known, obstructive sleep apnea is associated with an increased risk for cardiovascular disease and events. The aorta is not only a conduit delivering blood to the tissues but is also an important modulator of the entire cardiovascular system, its elastic properties also affecting left ventricular function and coronary blood flow. The aim of this study was to determine left ventricular diastolic function and aortic elastic properties in patients with obstructive sleep apnea syndrome. Fourteen male patients with obstructive sleep apnea and 14 age- and body mass index-matched healthy male controls took part in the study as a control group. All subjects underwent echocardiographic examination; left ventricular cavity dimension, standard and tissue Doppler parameters, and aortic diameter (3 cm above aortic valve) at systole and diastole were measured. While the aortic stiffness index in patients with obstructive sleep apnea was significantly higher than that of the control group (4.5 ± 0.3 vs 2.1 ± 0.1, P = 0.001), the aortic distensibility index was found to be lower in this group compared with controls (2.4 ± 1.2 vs 3.9 ± 1.5 cm2 dynes−1 10−6, P = 0.009). Furthermore, peak velocity of myocardial systolic wave and peak velocities of myocardial diastolic waves in sleep apnea patients were lower than in controls. There was an association between aortic stiffness and the apnea hypopnea index (coefficient = 0.49, P = 0.002). We also found an inverse correlation between peak velocity of myocardial diastolic wave and aortic stiffness (coefficient = −0.43, P = 0.003), using multiple linear regression. Increased aortic stiffness that is associated with the severity of disease in patients with obstructive sleep apnea may lead to diastolic dysfunction of the left ventricle.

Sleep apnea in adult myotonic dystrophy patients who have no excessive daytime sleepiness

PurposeSleep apnea is common in myotonic dystrophy (MD) and may cause respiratory failure. Most of the sleep studies have been performed in patients with excessive daytime sleepiness (EDS), which is a characteristic and strong predictor of sleep apnea. Therefore, we investigated the prevalence of sleep apnea in adult MD patients who have no EDS.Materials and methodsEpworth Sleepiness Scale was used to exclude EDS and a score over 10 was accepted as an indicator of EDS. Sleep studies of 17 adult MD patients with the Epworth sleepiness scale score ≤10 were retrospectively reviewed. Spirometry (n = 16) and daytime arterial blood gasses were used to evaluate the relationship with nocturnal parameters.ResultsOn admission to the outpatient chest clinic, seven patients had normal spirometry, and ten had daytime hypercapnia and/or hypoxemia. All but one had sleep apnea (apnea–hypopnea index ≥5 events/h of sleep; mild in five, moderate in seven, and severe in four). Hypopneas were more common than apneas (16.9 ± 13.2 events/h vs. 4.6 ± 4.1events/h). Nocturnal desaturation episodes were very frequent (oxygen desaturation index, 19.7 ± 20.3/h of sleep). Three patients had central sleep apnea and 13 had obstructive sleep apnea. Body mass index, spirometry parameters (FVC and FEV1) and arterial oxygen tension were moderately correlated with nocturnal oxygenation parameters. Apnea–hypopnea index showed moderate correlation with spirometry parameters (FVC and FEV1).ConclusionSleep apnea and oxygen desaturations are very common in MD patients who report no excessive daytime sleepiness. Daytime lung function parameters are not sufficiently reliable for screening sleep apnea. Therefore, we recommend routine polysomnography in MD patients.

Pulmonary artery aneurysm in Behcet's disease: a case report.

The pulmonary artery is the second most common site of arterial involvement in Behcet’s disease. A 32-year-old man presented with bilateral ankle edema, abdominal discomfort, and hemoptysis. He had a history of recurrent oral and genital aphthous ulcerations for 1 year. The diagnosis of Behcet’s disease was made on the basis of the criteria published by the International Study Group for Behcet’s Disease. His chest X-ray revealed left hilar enlargement. A helical computed tomography (CT) scan showed a pulmonary aneurysm with intramural thrombosis in the left pulmonary artery and enlarged hepatic veins. Treatment with colchicine and cyclophosphamide was given for 24 months, and helical thoracic CT was performed again. Helical CT showed that the pulmonary aneurysm was reduced by treatment. Helical CT could be used in Behcet’s disease for the diagnosis and follow-up of pulmonary involvement.

FEF25–75/FVC measurements and extrathoracic airway obstruction in obstructive sleep apnea patients

The aims of this study were to evaluate patients with obstructive sleep apnea syndrome (OSAS) with regards to dysanapsis (airway size relative to lung size) and to demonstrate the differences between the patients with and without extrathoracic airway obstruction. The study population consisted of 15 patients with OSAS and 14 age and body mass index (BMI) matched control subjects. OSAS patients and control subjects showed similar characteristics in FEV1, FEV1/FVC, FEF25–75, and FEF25–75/FVC ratios. Expiration reserve volume was significantly higher in the control group than in OSAS patients (p<0.01). Six patients exhibited extrathoracic airway obstruction while awake. Of these, three had also a sawtooth pattern in their flow–volume curves. The remaining nine patients had no extrathoracic airway obstruction and had lower apnea–hypopnea indexes (AHI) than the obstruction group (p<0.05). OSAS patients and age- and BMI-matched healthy controls had similar characteristics in terms of dysanapsis. In addition, there was no relation between the FEF25–75/FVC ratio and AHI, MinO2, and MeanO2. Extrathoracic airway obstruction may be a feature of only severe OSAS patients.

Role of Zafirlukast on skin prick test

BACKGROUND Some anti-allergic and anti-asthmatic drugs should be discontinued before skin prick test. But there is no knowledge about zafirlukast effects on skin prick test. We investigate the effects of zafirlukast on cutaneous response to histamine and specific allergens. MATERIAL AND METHODS 9 patients suffering from allergic mild asthma or allergic rhinitis and 8 healthy individuals were recruited to the study. All of them took 20 mg zafirlukast twice daily for at least 5 days. Skin prick test was performed before and after treatment by histamine and specific allergens. There was no significant difference between pre- and post-treatment skin prick tests in spite of zafirlukast treatment. CONCLUSION Zafirlukast does not affect skin reactions against histamine and specific allergens. Diagnostic skin prick test can be performed under zafirlukast treatment.

Evidence for the Efficacy of a Bioresonance Method in Smoking Cessation: A Pilot Study

Background: Since the 1970s, MORA bioresonance therapy has globally been applied in the context of complementary medicine for various indications. In this regard, practitioners also report successful application in smoking cessation. The present study aims to verify these reports in a controlled study setting. Methods: In order to achieve the aforementioned objective, we subjected the bioresonance method to a prospective, placebo-controlled, double-blind, parallel-group study involving 190 smokers. In both study groups (placebo n = 95; active bioresonance group; n = 95) the course of treatment and study conditions were standardized. Results: 1 week (77.2% vs. 54.8%), 2 weeks (62.4% vs. 34.4%), 1 month (51.1% vs. 28.6%), and 1 year (28.6% vs. 16.1%) after treatment, the success rate in the verum group differed significantly from the results in the placebo group. Also, the subjective health condition after treatment and subjective assessment of efficacy, polled after 1 week, were significantly more positive among participants in the active bioresonance therapy group than among those in the placebo group. Adverse side effects were not observed. Conclusion: According to the findings attained by this pilot study, bioresonance therapy is clinically effective in smoking cessation and does not show any adverse side effects.

Rare cause of diffuse lung fibrotic/nodular pattern in an asymptomatic child.

Accessible online at: www.karger.com/res A 7-year-old girl was admitted to our clinic in October 2000 for the evaluation of abnormalities seen on her chest X-ray taken prior to tonsillectomy. She was asymptomatic and had no significant past or family history. There had been no known exposure to toxic gases or animals. She appeared to be healthy. There was no digital clubbing. Her vital signs were normal. Thorax expansion and breath sounds were normal. No rales or rhonchi were heard. Blood biochemistry, rheumatologic markers and urinalysis were within normal limits. A chest X-ray demonstrated bilateral interstitial infiltrate with a predilection for the right paracardiac region (fig. 1a). A CT also demonstrated an interstitial fibrotic/nodular pattern (fig. 2). Respiratory function studies are shown below as measured values and percent of predicted: forced vital capacity (FVC) 1,220 ml, 106%; forced expiratory volume in 1 s (FEV1) 1,080 ml, 106%; FEV1/FVC ratio 89%; DLCO 8.4 ml/min/mm Hg, 76%, and DLCO/VA 8.4 ml/min/ mm Hg, 74%. The analysis of room air arterial blood gas revealed: PCO2: 38 mm Hg, PO2: 100 mm Hg, SAT: 98%, pH 7.39.