Coskun Dogan

Vitamin D Deficiency in Patients Referred for Evaluation of Obstructive Sleep Apnea

STUDY OBJECTIVES A recent study reported an association between obstructive sleep apnea (OSA) and low vitamin D levels. In this study, we measured vitamin D levels in patients referred for evaluation of suspected OSA and sought to identify associated risk factors for vitamin D deficiency. Our objective was to determine whether evaluations of patients with suspected OSA should include routine screening for vitamin D deficiency. METHODS Using a cross-sectional study design, we measured vitamin D levels in consecutively enrolled patients referred for an OSA evaluation to Dr. Lutfi Kirdar Kartal Training and Research Hospital in Istanbul, Turkey. We conducted full-night polysomnography and compared vitamin D levels both between patients with OSA and patients without OSA and across the various severity levels of OSA. We evaluated the association between vitamin D levels and various clinical and demographic characteristics, including the apnea-hypopnea index and body mass index. RESULTS From April 2014 to June 2015, 195 patients were referred for OSA evaluation. Of these, 181 patients (93%) consented to participate and underwent full polysomnography and measurement of vitamin D levels. The mean ± standard deviation age was 49 ± 12 years and body mass index of 31 ± 6 kg/m2. Polysomnography led to the diagnosis of OSA in 162 of the patients (89.5%): 52 (32%) were categorized as having mild OSA, 38 (23.5%) as having moderate OSA, and 72 (44.5%) as having severe OSA. Vitamin D level was 15.5 ± 11.6 ng/mL (95% confidence interval; 13-17 ng/mL) and 134 patients (74%) met the criterion for vitamin D deficiency (< 20 ng/mL). Sex, vitamin D levels, and percentage of patients with vitamin D deficiency were similar in patients with and without OSA (P > .05). Vitamin D levels were similar across OSA severity categories (P = .68). We found no association between vitamin D levels and the apnea-hypopnea index or body mass index. CONCLUSION A large proportion of patients referred for OSA evaluation had vitamin D deficiency. Vitamin D levels did not differ by OSA diagnosis status or severity. Patients referred for polysomnography should undergo routine screening for vitamin D deficiency as well as clinically indicated treatment to prevent associated comorbidities.

The Demographic, Clinical, Radiographic and Bronchoscopic Evaluation of Anthracosis and Anthracofibrosis Cases

Background: The aim of the study was to evaluate the demographic features, clinical findings, radiological and bronchoscopical findings of patients with bronchial anthracosis. Methods: Among 1541 patients who underwent broncoscopy in our bronchoscopy unit between 2006-2008, 104 patients with anthrocosis were included in this prospective study. The patient’s geographical location, occupation, type of fuel used for cooking in the kitchen and for heating in their house, admission complaints, chest x-ray and thorax computed tomography (CT) findings, bronchoscopic images and the accompanying pathological diagnosis were recorded and evaluated. Results: A total of 104 (6.7%) patients with a mean age of 61.35±13.34 years were included in this study; 49 (47.1%) of which were female, 55 (52.9%) male.The most common complaints were cough, dyspnea and sputum production in 71.2%, 57.7% and 49.0% patients, respectively. In 48 (46.1%) patients history of cigarette smoking was found. While in 31 (38.3%) patients exposure to mineral dust or biomass in their job was observed, 37 (45.7%) patients were housewives. In all of the patients biomass exposure was found because of the fuel used for heating or in kitchens. Regarding geographical location, we found that the majority of the patients (38.5%) were from Black Sea region located in northern Anatolia. While the most common chest x-ray findings were consolidation (51.9%) and fibrosis (18.3%), consolidation (38.5%) and fibrosis (36.5%) were also found to be the leading thorax CT findings. The most common bronchoscopic findings were bilateral anthracosis, stenosis and bronchial torsion 67.3%, 40.4% and 23.1% patients, respectively. Among the anthracosis patients, with bronchoscopy 11 of them were found to have malignancy and 7 of them tuberculosis. Conclusion: Large scale, country-wide studies should be conducted for the determination of epidemiological data of bronchial anthracosis and anthracofibrosis in our country in which a high rate of biomass exposure is found.

The role of thoracic ultrasonography in the diagnosis of anterior mediastinal lesions

Ultrasonography (US) is an imaging modality based on the reflection of sound waves directed at tissues with the aid of a transducer. Since different tissues reflect sound waves at various frequencies, images also demonstrate variations. Soft tissues transmit sound waves better, they are hypoechoic, and appear as dark image. Pulmonary parenchyma contains air, which dissipates ultrasound energy, so it is not well visualized on US.[1]

Clinical, radiological and bronchoscopic evaluation of inhalation injury cases treated at the burn center

BACKGROUND We aimed to introduce inhalation injury, pulmonary complications and mortality-related factors on the basis of clinical, radiological and bronchoscopic findings in patients with inhalation burns. METHODS Between January 2009 and January 2010, patients hospitalized in the intensive care unit (ICU) of a burn center who were diagnosed as inhalation burn and underwent bronchoscopy were included in the study. Demographic findings, burn type, burn percentage, clinical-laboratory features, chest Xray findings on the first and fifth days, and bronchoscopic lesions were obtained from patient files. Bronchoscopic findings were classified, and bronchoscopic score for each patient was calculated. Clinical, laboratory and radiological findings, length of stay in the ICU, and bronchoscopic scores of patients who were discharged versus of those who died were compared, and mortality-related factors were investigated. RESULTS Twenty-nine patients (25 male, 4 female; mean age 40.1 +/- 3.4 years) were included. Radiological abnormalities were found in 41.3% and 65.5% of patients on the first and fifth days of hospitalization, respectively. There were no complications related to bronchoscopy. Percentage of burn and duration of stay in the ICU were higher in patients who died than in discharged patients (20.4%-48.5%, p = 0.003; mean: 7.0-13.7 days, p = 0.037, respectively). Of patients who died, 79.1% showed radiological abnormality and 50% had acute respiratory distress syndrome (ARDS) on the fifth day of hospitalization. There were no pathologic findings on chest X-ray and no ARDS was seen on the fifth day in patients who were discharged (p < 0.05). CONCLUSION Inhalation burns in patients with cutaneous burns cause a high percentage of pulmonary complications and increase mortality. Bronchoscopy must be performed early for diagnosis, and close follow-up of these patients is necessary.