Didem Derici Yildirim

The relation of innate and adaptive immunity with viral-induced acute asthma attacks: Focusing on IP-10 and cathelicidin

Abstract Background Despite growing evidence suggesting potential association between innate and adaptive immunity in viral-induced acute asthma, there is paucity of data in this area. Objective This study aimed to investigate the association of innate and adaptive immunity with acute asthma attacks by analysing the role of IFN-γ-inducible protein 10 (IP-10), TLR2, cathelicidin, vitamin D and cytokines. Material and methods This prospective study included 33 patients with viral-induced acute asthma and 30 children with controlled asthma. Nasopharyngeal swab samples were collected for virus identification and asthma attack scores assessed in acute asthma group. Blood sampling for IP-10, TLR2, cathelicidin, vitamin D levels, and spirometric indices were employed. Results Serum IP-10 and cathelicidin levels of acute asthma group were significantly higher and vitamin D levels were lower than controlled asthma group (IP-10; p =0.006, cathelicidin; p =0.002, vitamin D; p <0.001). Serum IP-10 levels showed a significant negative correlation with age (p =0.009), TLR2 (p =0.05) and spirometric indices (p =0.002) in all asthmatics and a significant positive correlation with parameters of asthma attack severity (p =0.03) in acute asthma group. Higher cathelicidin values showed significant positive relation to IP-10 (beta coefficient: 33, p =0.02). Serum IP-10 levels higher than 38.9pg/ml (sensitivity: 85%, specificity: 47%, p =0.002) were predictive of virus-induced asthma. Serum IP-10 and vitamin D levels were found to be significantly related to viral-asthma attacks (IP-10; aOR: 8.93, p =0.03 and vitamin D; aOR: 0.82, p =0.001). Conclusions Innate immunity biomarkers such as serum IP-10 and cathelicidin can be used to predict viral-induced acute asthma. These biomarkers may provide potential new treatment targets for acute asthma.

Opinions of nurses on the ethical problems encountered while working as a team in intensive care units

Background The intensive care unit entails working as a team in rescuing patients from life-threatening conditions. The care being given by the team could also be done by nurses and other health professionals through the coordinated use of all medical practices. Objective To determine the opinion of nurses on the ethical problems they experienced while working as a team in the intensive care units of a university hospital. Method The descriptive research was conducted on nurses working in intensive care units (n = 96). A 56-item data collection form consisting of two parts developed by the researchers was used. Frequency (percent) and median were evaluated, and statistical calculations were used for group comparisons. Results Out of the 82 (85.4%) nurses who participated in the study, 65 (82.3%) were university graduates. About 52 (66.7%) of the participants were female with a mean age of 28.12 ± 5.84; 26 (31.6%) had intensive care certification, and 54 (65.1%) had ethical training. The internal intensive care unit nurses were less satisfied with their jobs, able to use tools, said that they had the right to refuse the patient compared to the surgical intensive care unit nurses. Discussion and conclusions: It is a positive situation for the participants to score low with ethical problems based on suggestion as the probability of meeting with their teammates. However, it is important that the problems that affect the motivation of the nurses are different according to the intensive care unit and the employees.

Asthma predictive index in relation to respiratory mechanics by impulse oscillometry in recurrent wheezers

BACKGROUND The identification of children who will have persistent asthma has become a focus of recent research. The aim of this study was to assess whether impulse oscillometry (IOS) has a diagnostic value to predict modified API (asthma predictive index) in pre-schoolers with recurrent wheezing. METHODS Pre-school children aged 3-6 years with recurrent wheezing were enrolled. The study population was divided into two groups based on mAPI criteria. Lung function was assessed by IOS. RESULTS 115 children were assessed; 75 (65.2%) of them were male. The median age was 39 months (min: 36, max: 68 months). 64 (55.6%) of the children were mAPI positive. The R5-R20% levels of children with positive mAPI were significantly higher compared to negative mAPI. Also, R5-R20% levels of children with parental asthma and R20% pred and resonant frequency (Fres) levels of children with inhalant sensitization were higher than those without. No significant differences were found in IOS indices between groups based on the presence of atopic dermatitis, food sensitization, eosinophilia, inhaled corticosteroid usage or wheezing without colds. R5-R20% and total IgE values were found to be significantly related to positive mAPI (aOR: 1.40, p=0.022 and aOR: 1.02, p=0.001, respectively). In the ROC analysis, R5-R20% levels >14.4 had a sensitivity of 75% and specificity of 53% for predicting a positive mAPI (p=0.003). CONCLUSION IOS may help clinicians to identify the pre-school wheezers with a high risk of asthma.

Alterations in energy consumption and plantar pressure distribution during walking in young adults with patellofemoral pain syndrome

Objective The aim of this study was to determine the alterations of walking energy expenditure and plantar pressure distribution in young adults with patellofemoral pain syndrome (PFPS). Methods Thirty five individuals (mean age: 21.31 ± 1.76) with PFPS constituted the patient group and forty healthy participants (mean age: 21.40 ± 2.11) the control group. Preferred walking speeds (PWS) were determined on the over ground. Individuals walked on a treadmill for 7 min at their PWS and 30% above PWS and oxygen consumption was recorded via a metabolic analyzer. Net oxygen consumption was calculated for each walking trial. Borg scale was applied to assess perceived exertion during walking trial. Plantar pressure distributions were measured by a pedobarography device. Plantar area was subdivided into six zones to evaluate the dynamic plantar pressure data. Results The mean PWS of PFPS and control groups were 4.69 ± 0.51 and 4.52 ± 0.60 km/h, respectively (p > .09). No significant difference was observed in energy expenditure during walking at PWS between 2 groups while oxygen consumption during 30% above PWS was higher in patient group (18.72 ± 3.75 and 16.64 ± 3.27) (p = .007). Net oxygen consumption was also found to be higher in PFPS group (15.12 ± 3.62 and 13.04 ± 3.24) (p = .005). The mean Borg scores were significantly higher in PFPS group at each walking trials (p < .001). No statistically significant difference was found between weight distribution (%) of symptomatic and nonsymptomatic extremity (50.45 ± 3.92% and 49.56 ± 3.93%, respectively) (p = .509). Dynamic pedobarography parameters were not different between 2 groups, and also between symptomatic and nonsymptomatic extremities (p > .05). Conclusion Although, rate of perceived exertion and energy expenditure during walking at 30% above PWS are affected negatively in young adults with PFPS, we may speculate that energy consumption and plantar pressure distribution can be compensated by a physiologic adaptation mechanism during walking at PWS. Level of evidence Level III, Therapeutic Study.

The airway hyperresponsiveness to methacholine may be predicted by impulse oscillometry and plethysmography in children with well-controlled asthma

ABSTRACT Objective: Airway hyperresponsiveness (AHR) is a hallmark of asthma. Methacholine challenge test which is mostly used to confirm AHR is not routinely available. The aim of this study was to investigate the predictive values of fractional exhaled nitric oxide (FeNO), impulse oscillometry (IOS), and plethysmography for the assessment of AHR in children with well-controlled asthma. Methods: 60 children with controlled allergic asthma aged 6–18 years participated in the study. FeNO measurement, spirometry, IOS, and plethysmography were performed. Methacholine challenge test was done to assess AHR. PC20 and dose response slope (DRS) of methacholine was calculated. Results: Mild to severe AHR with PC20 < 4 mg/ml was confirmed in 31 (51.7%) patients. Baseline FeNO and total specific airway resistance (SRtot)%pred and residual volume (RV)%pred levels in plethysmography were significantly higher and FEV1%pred, FEV1/FVC%pred, MMEF%pred values were lower in the group with PC20 < 4 mg/ml. FeNO, SRtot%pred, and RV%pred levels were found to be positively correlated with DRS methacholine. The higher baseline FeNO, frequency dependence of resistance (R5–R20) in IOS and SRtot%pred in plethysmography were found to be significantly related to DRS methacholine in linear regression analysis (β: 1.35, p = 0.046, β: 4.58, p = 0.002, and β: 0.78, p = 0.035, respectively). The cut-off points for FeNO and SRtot% for differentiating asthmatic children with PC20 < 4 mg/ml from those with PC20 ≥ 4 mg/ml were 28 ppb (sensitivity: 67.7%, specificity: 72.4%, p < 0.001) and 294.9% (sensitivity: 35.5%, specificity: 96.6%, p = 0.013), respectively. Conclusion: IOS and plethysmography may serve as reliable and practical tools for prediction of mild to severe methacholine induced AHR in otherwise “seemingly well-controlled’’ asthma.

Determination of sub-groups in reference interval calculations and an application

Abstract Objective: The main objective of this study is to determine the methods used for dividing reference data into sub-groups and propose a new solution. Therefore, the newly proposed method is used to determine age sub-groups while calculating the reference interval of AST variable. Methods: The data of this study are composed of the registered patients who applied only once to the polyclinics at the Health Research and Application Hospital, Clinical Bio-Chemistry Laboratory of Mersin University. The main variables selected for the study are sex, age and aspartate transaminase (AST). MARS 2.0 package software was used for the statistical analysis. Harris&Boyd method was used for sex and age while the MARS method was used for the determination of age sub-groups. Results: According to the Harris&Boyd method, it was concluded that it is not necessary to create sub-groups for sex and age variables. Age sub-groups are determined with the MARS method by taking into account the correlations between AST variables and age. Age sub-groups are calculated as 5-9, 10-18 and 19+. Correlation between the age and AST variable is investigated for these sub-groups. It is obtained that the correlation is statistically not significant for the 5-9 age group (p=0.3189), significant for the 10-18 age group (p<0.001) and significant for 19 and above (p<0.001). Conclusion: The selection of transformation and outlier value elimination method and especially determination criteria for separation of sub-groups are made according to researcher’s subjective desicions in the application of many studies. Because of this reason, MARS can be used as an alternative and objective method for determining subgroups. In addition, results of MARS method being parallel with the findings of the producing company supported the usage of this method for determination of sub-groups. Özet Amac: Bu calışmanın amacı referans verilerini alt gruplara ayırmada kullanılan yontemleri belirlemek ve yeni bir yontem onermektir. Bu amacla yeni onerilen yontem, AST değişkeninin referans aralığı hesaplanırken yaş alt gruplarının belirlenebilmesi amacı ile kullanılmıştır. Metod: Calışmaya ait veriler, Mersin Universitesi Sağlık Araştırma ve Uygulama Hastanesi Klinik Biyokimya Laboratuvarında sadece bir kez polikliniğe başvuran hastaların kayıtlı verileri ile oluşturulmuştur. Bu calışmada secilen değişkenler cinsiyet, yaş ve aspartat transaminaz (AST)’dır. İstatistik analizlerde MARS 2.0 paket programı kullanılmıştır. Harris&Boyd yontemi cinsiyet ve yaş, MARS yontemi yaş alt grubunun belirlenmesinde kullanılmıştır. Bulgular: Harris&Boyd yontemine gore cinsiyet ve yaş değişkeninde ayırmanın yapılmasına gerek olmadığı sonucu cıkmıştır. AST değişkeni ile yaş arasındaki ilişkilere bakılarak MARS yontemi ile yaş alt grupları belirlendi. Yaş alt grupları 5-9; 10-18 ve 19 ve uzeri olarak hesaplandı. Bu alt gruplardaki yaş ile AST değişkeni arasındaki ilişkilere bakıldı. 5-9 yaş grubunda ilişki anlamsız (p=0.3189), 10-18 yaş grubunda ilişki anlamlı (p<0.001), 19 ve uzerinde ise ilişki istatiksel olarak anlamlı (p<0.001) bulunmuştur. Sonuç: Uygulamada referans aralık hesaplaması yapılırken, dağılımın şekline ve orneklem buyukluğune bağlı olarak hangi uc değer ve transformasyon yonteminin kullanılması gerektiği, ozellikle alt gruplara ayırma kriterinin nasıl belirlendiği, bircok calışmada araştırmacının subjektif kararlarına gore yapılmaktadır. MARS yontemi, alt grup belirleme yontemi icin, alternatif bir yontem olarak kullanılabilir. Uretici firma ile MARS analizi sonucları icin belirlenen yaş alt grupları paralel cıkmıştır.