Durdu Karasoy

Predicting outcomes of oral aspirin challengesin patients with asthma, nasal polyps, andchronic sinusitis

BACKGROUND A definitive diagnosis of aspirin-exacerbated respiratory disease (AERD) requires a positive oral aspirin challenge (OAC), but predicting which patients will have positive challenges is often difficult. OBJECTIVE To analyze information about historical aspirin- and nonsteroidal anti-inflammatory drug (NSAID)-associated respiratory reactions and clinical characteristics as potential markers to predict positive OACs. METHODS A total of 243 patients underwent OACs. Data related to previous reactions and clinical characteristics of patients were correlated with the result of the OACs. RESULTS Without prior exposure to aspirin or NSAIDs, the chance of a positive OAC was 5 in 12 (42%) but was 198 in 231 (86%) for those with a history of aspirin- and NSAID-associated asthma attacks. Sex, atopy, number of sinus infections per year, and number of sinus surgical procedures were not associated with positive OACs. Patients with 2 or more prior aspirin- and NSAID-associated respiratory reactions had an 89% chance of having a positive OAC vs single reactors (80%; P = .04). Mild or moderate prior reactions were associated with 84% or 80% positive OACs, whereas 100% of the 45 patients with severe prior reactions had positive OACs (P = .007). Except for hospitalizations, treatment locations of prior reactions (home or emergency department) did not seem to make any difference. Logistic regression identified age, sense of smell, and multiple prior reactions as independent risk factors associated with positive OACs. CONCLUSIONS Age younger than 40 years, poor sense of smell, multiple prior respiratory reactions, and severe prior asthmatic reactions associated with aspirin and NSAIDs significantly increased the chances of a positive OAC.

The expression of MMP-2, MMP-7, MMP-9, and TIMP-1 in chronic rhinosinusitis and nasal polyposis

OBJECTIVES: To investigate the expression and clinical significance of MMP-2, MMP-7, MMP-9, and TIMP-1 in patients with nasal polyposis (NP) and chronic rhinosinusitis (CRS). STUDY DESIGN: Prospective study. SUBJECTS AND METHODS: This study involved 54 patients. There were three groups: nasal polyposis group, chronic rhinosinusitis group, and control group. Specimens were collected during endoscopic sinus surgery. Each sample was immunohistochemically examined. RESULTS: Expression of MMP-2 was found significantly increased in NP, whereas MMP-7 expression was found significantly increased in CRS (P < 0.001). TIMP-1 was significantly high in control group compared to CRS and NP (P < 0.001 and P = 0.002, respectively). CONCLUSIONS: Different regulation type of activation of MMPs has been found in these two diseases. If MMP-2 expression is intense in the mucosa, then this ends with polyp formation; if MMP-7 expression is intense, it ends with CRS or stays as CRS.

The Prevalence of Aspirin Hypersensitivity in Patients with Nasal Polyposis and Contributing Factors

Background Aspirin (acetylsalicylic acid [ASA]) hypersensitivity is frequent in patients with nasal polyps (NPs) and is called aspirin exacerbated respiratory disease, previously known as Samters syndrome. However, studies evaluating the prevalence of ASA hypersensitivity in patients with NPs using the oral aspirin provocation test (APT) are quite limited. This study was designed to determine the prevalence of ASA hypersensitivity and factors associated with ASA hypersensitivity in patients with NPs. Methods Sixty-eight patients with NPs with or without asthma were recruited. Extension of NPs was evaluated by endoscopic examination/paranasal CT. A 2-day, single-blind placebo-controlled APT was used to detect ASA hypersensitivity. Results APT was performed in 53 (21 women/ 32 men) patients (mean age, 39.34 ± 1.76 years). APT resulted positive in 12 patients (22.6%) of whom 3 (25%) had no history of ASA hypersensitivity. Of the positive APTs, three were isolated rhinitis and nine had classic responses. APT was negative in 41 patients (77.4%) although three (7.3%) had a history of ASA hypersensitivity. History of ASA hypersensitivity and prolonged duration of NPs were associated with positive APT (p < 0.05). Advanced NP with multiple operations was also correlated with APT positivity but was not statistically significant. Presence of asthma was associated with age, female gender, NP duration, and ASA hypersensitivity history (p < 0.05), but not with smoking, atopy, NP extension, and positive APT. Conclusion ASA hypersensitivity is quite common in patients with NP. Patients with extensive and long-term NP with multiple polyp operations require evaluation for the presence of ASA hypersensitivity in terms of chronic management and future risks of the disease.

A new Bayes estimate of the change point in the hazard function

An efficient estimate for the change point in the hazard function is obtained. This is based on a Bayesian estimator which uses equations concerning the parameters of a recently proposed hazard function. It is found through a simulation study that the proposed estimator is more efficient than the traditional estimators in many cases. Furthermore, experimental results that use data of breast cancer patients and some lymphoma data show that the proposed estimator is also practical in applications.

Does regional pollen load affect the prevalence of clinical allergy to those pollen groups

OBJECTIVE To test the association between clinical allergic sensitisation to pollens and the profile and load of those pollens, in Ankara, Turkey. MATERIALS AND METHODS Forty-three patients with seasonal allergic rhinitis were included. Clinical sensitisation to various pollens was compared with 10-year counts of the same pollens. The ratios of sensitisation to various pollen groups, and the association between clinical sensitisation and pollen load, were investigated. RESULTS Grass pollen allergy was the leading cause of seasonal allergic rhinitis, followed by tree pollen allergy. In Ankara, the most common type of airborne tree pollen was salicacea; however, the commonest clinical tree pollen allergies were due to the betulaceae and fagaceae families. CONCLUSIONS Higher concentrations of airborne pollens may not always result in a higher prevalence of clinical allergy to those pollens.

Does gender affect asthma control in adult asthmatics

Several studies have shown gender differences in prevalence of asthma but there is little information about asthma control. In this study, we aimed to evaluate the effect of gender on asthma control in adult asthmatics. Medical records of 242 patients older than 18 years of age who regularly visited the allergy unit were evaluated. Standardized asthma questionnaires like the asthma control test (ACT) were performed. ACT scores, clinical characteristics, and demographic data such as smoking status, education, duration and severity of asthma, atopic status, family history of asthma, analgesic hypersensitivity, number of emergency visits, and hospitalization in the previous year were compared based on gender. In this study, 77.3% of the patients were female. Mean age, body mass index, and duration of asthma were 39.0 ± 0.7, 27.3 ± 0.3, and 6.6 ± 0.4 years, respectively. Of the total, 14.9% of the patients were smokers. Also, 55.8% of them were graduated from middle school, 22.7% from high school, and 14% from university. Atopy rate was 57%. Analgesic hypersensitivity was found in 18.6% of them. There was 30.2% family history of asthma. The asthma severity was mild in 45.5%, moderate in 40.9%, and severe in 13.6% of the patients. One-third of the patients were admitted to emergency room; 1/10th were hospitalized due to asthma in the previous year. ACT scores indicated complete control in 67.8%, partial control in 17.8%, and uncontrolled asthma in 14.5%. Comparing the results of males with females having asthma, there was no statistically significant difference between the two gender according to ACT scores and clinical characteristics. Finally, the results conclude that there was no effect of gender on asthma control assessed with standardized questionnaire in adult asthmatics.

National Practice in Antibiotic Prophylaxis in Breast Cancer Surgery

Background Although breast cancer surgery is regarded as a “clean” surgery, surgical site infection (SSI) rates are higher than expected. There is no consensus regarding the use of antibiotic prophylaxis in elective breast surgery. The nationwide survey was conducted to determine the trend of antibiotic prophylaxis in breast cancer among Turkish surgeons. Methods The survey was sent to surgeons who are member of Turkish Surgical Association (TSA) via e-mail from TSA web address. A 15 item web-based survey consisted of surgeon demographics and the use of prophylactic antibiotic in patients with risk factors related to SSI. Results The number of completed questionnaires was 245. The most common antibiotic used was first generation of cephalosporins. A majority of respondents indicated that prophylaxis was preferred in patients with high risk of SSI including preoperative chemotherapy or radiotherapy, older age, diabetes mellitus, immunodeficiency, immediate reconstruction (P < 0.05). However, the use of drain did not significantly influence antibiotic prophylaxis (P = 0.091). Conclusions The use of prophylactic antibiotic was strongly dependent on the presence of some risk factors; however, the variation in current practice regarding antibiotic prophylaxis demonstrated a lack of its effect on preventing SSI after breast cancer surgery.

Vascular endothelial growth factor (VEGF)-C, VEGF-D, VEGFR-3 and D2-40 expressions in primary breast cancer: Association with lymph node metastasis

BACKGROUND Two members of the vascular endothelial growth factor (VEGF) family, VEGF-C and -D, are known as lymphangiogenic growth factors and play an important role in tumor lymphangiogenesis via activation of the VEGF receptor (VEGFR)-3, which is expressed in lymphatic endothelial cells. D2-40 is a specific antibody for lymphatic vessel density (LVD). OBJECTIVES In the present study, we have aimed to evaluate whether intraand peri-tumoral D2-40-positive lymphatic vessels affect lymph node metastasis and to investigate the relationship between LVD and lymph node metastasis in breast cancer. MATERIAL AND METHODS We have evaluated the relationships between lymph node metastasis and VEGF-C, VEGF-D, VEGFR-3 and D2-40 expressions in breast cancer cells using immunohistochemistry. VEGF-C, VEGF-D and VEGFR-3 expression were found in tumor cells in the majority of the cases (83.75, 97.5 and 95%, respectively). RESULTS There was a significant positive relationship between VEGF-D expression and lymph node metastasis (p < 0.05) however no significant association was found in VEGF-C and VEGFR-3 expressions. It was found that patients with high-expression of VEGF-D have a high level of both periand intra-tumoral LVD compared to those with low expression of VEGF-D (p < 0.05). CONCLUSIONS Our results support that examination of VEGF-D expression in breast cancer cells may be beneficial in the identification of lymph node metastasis.