Esra Uzaslan

Bronchoalveolar lavage in drug-induced lung disease.

Given the varying histologic reactions and differ-ent mechanisms of action, it is not surprising that no uniform constellation of BAL changes is seen in drug-induced lung disease. BAL findings are not specific for any drug-induced lung disease and the definitive diagnosis cannot rely solely on the BAL findings. BAL findings can, however, contribute to the expected clinicopathologic pattern of a given drug-induced lung disease. BAL also is helpful in the differential diagnosis, primarily in the exclusion of an infective cause and of involvement of the lungs by the underlying disease (eg, metastatic cancer or malignant lymphoma).

Prevalence and risk factors of allergies in Turkey: Results of a multicentric cross-sectional study in children

The Prevalence And Risk Factors of Allergies in Turkey (PARFAIT) study was planned to evaluate prevalence and risk factors of asthma and allergic diseases and also to find out which geographical variables and/or climatic conditions play a role determining the prevalence of allergic diseases in Turkish school children. Study was planned as cross‐sectional questionnaire‐based. About 25,843 questionnaires from 14 centers were appropriate for analysis. Parental history of allergy, having an atopic sibling and other atopic disease in index case was significant risk factors for all allergic diseases. Breast feeding decreased the risk of current asthma (OR: 0.92, CI: 0.86–0.99) and wheezing (OR: 0.93, CI: 0.87–0.99) but not allergic rhinitis and eczema. Respiratory infection in the past was an important risk factor for the occurrence of allergic diseases especially for asthma which was increased 4.53‐fold. Children exposed to household smoke were significantly at higher risk of asthma, wheezing, and allergic rhinitis (OR: 1.20, CI: 1.08–1.33; OR: 1.21, CI: 1.09–1.34; and OR: 1.32, CI: 1.21–1.43, respectively). All allergic diseases were increased in those children living in areas which have altitude of below 1000 m and mean yearly atmospheric pressure above 1000 mb. The study has suggested that household and country‐specific environmental factors are associated with asthma, wheezing, allergic rhinitis, and eczema risk during childhood in Turkey.

Prevalence and Risk Factors of Allergies in Turkey (PARFAIT): results of a multicentre cross-sectional study in adults

The Prevalence and Risk Factors of Allergies in Turkey (PARFAIT) study was planned to evaluate the prevalence of and risk factors for asthma and allergic diseases in Turkey. The present analysis used data from 25,843 parents of primary school children, obtained from a cross-sectional questionnaire-based study. A total of 25,843 questionnaires from 14 centres were evaluated. In rural areas, the prevalences asthma, wheezing, allergic rhinitis and eczema in males were: 8.5% (95% confidence interval (CI) 7.9–9.1%), 13.5% (95% CI 12.8–14.2%), 17.5% (95% CI 16.7–18.2%) and 10.8% (95% CI 10.2–11.4%), respectively; and in females were: 11.2% (95% CI 10.9–11.8%), 14.7% (95% CI 14.3–15.1%), 21.2% (95% CI 20.4–22.0%) and 13.1% (95% CI 12.4–13.8%), respectively. In urban areas, the corresponding prevalences in males were: 6.2% (95% CI 5.8–6.6%), 10.8% (95% CI 10.3–11.3%), 11.7% (95% CI 11.4–12.0%) and 6.6% (95% CI 6.2–7.0%), respectively; and in females were: 7.5 % (95% CI 7.9–7.1%), 12.0% (95% CI 11.7–12.3%), 17.0% (95% CI 16.4–17.6%) and 7.3% (95% CI 6.9–7.7%), respectively. Having an atopic first-degree relative or any other atopic diseases had significant effects on the prevalence of allergic diseases. Housing conditions, such as living in a shanty-type house, visible moulds at home and use of wood or biomass as heating or cooking material were associated with one or more allergic diseases. Although genetic susceptibility is strongly associated, country- and population-based environmental factors may contribute to increased prevalence rates of allergic diseases.

Epidemiology and distribution of interstitial lung diseases in Turkey

There is very few data on the epidemiological features of interstitial lung diseases (ILD) in the literature. These studies on this subject suffer from limited number of patients.

Increased Pleural Soluble Fas Ligand (sFasL) Levels in Tuberculosis Pleurisy and Its Relation with T-helper Type 1 Cytokines

Tuberculosis (TB) pleurisy is accepted to be the best model for evaluating the local protective cellular immune response to Mycobacterium tuberculosis (MTB) since it can be spontaneously self-cured. Therefore, we aimed to evaluate the involvement of cytokines and the soluble apoptosis-modulating factors sFas and sFasL in local protective cellular immunity to MTB. Pleural fluid samples were collected from 35 patients with TB pleurisy, 39 patients with malignant pleurisy, and 14 patients with non-TB nonmalignant (n-TB n-M) pleurisy and were evaluated for the levels of several cytokines, soluble Fas (sFas), and sFas ligand (sFasL) by using ELISA. The levels of IFN-γ, IL-12p40, IL-18, IL-8, and sFasL in TB pleurisy were significantly higher in comparison to those in the malignant pleurisy and n-TB n-M pleurisy groups. In addition, pleural sFasL levels were increased and positively correlated with IFN-γ and IL-18 levels in TB patients. In conclusion, this study demonstrates that Th1-type-specific cellular immunity is responsible for protective immunity in TB and suggests that Fas-mediated apoptosis may be at least a part of protective immunity to tuberculosis and could be regulated by type 1 T-cell response. IFN-γ and sFasL levels can be used as diagnostic markers for differing TB pleurisy from other pleurisies.

Extrapulmonary involvement in patients with sarcoidosis in Turkey

Background and objective:  Extrapulmonary sarcoidosis is common, and is almost always associated with concomitant thoracic involvement. Extrapulmonary manifestations vary on the basis of gender, age at presentation and ethnicity. The aim of this study was to investigate extrapulmonary involvement in patients with sarcoidosis in Turkey.

Impaired left ventricular systolic and diastolic functions in patients with early grade pulmonary sarcoidosis

AIMS Cardiac sarcoidosis is symptomatic in only 5% of patients, and it is an independent predictor of mortality and carries a very poor prognosis. In our study, we aimed to assess left ventricle (LV) systolic and diastolic functions with tissue Doppler imaging (TDI) in patients with early grade pulmonary sarcoidosis. METHODS AND RESULTS The study population included 55 patients with Grade I-II sarcoidosis (41 females, 14 males, mean age: 47.9 ± 10.1) and 22 healthy subjects. LV lateral and septal wall early myocardial peak velocity (E(m)), late myocardial peak velocity (A(m)), E(m) to A(m) ratio, myocardial relaxation time (RT(m)), myocardial systolic wave (S(m)) velocity, isovolumic acceleration (IVA), myocardial pre-contraction time (PCT(m)), contraction time (CT(m)), and the PCT(m) to CT(m) ratio were measured. No statistically significant difference was detected between the groups according to age, gender, body mass index, systolic and diastolic blood pressure, or heart rate. LV systolic parameters, LV septal, and lateral wall IVA, were significantly lower, and the PCT(m) to CT(m) ratio (P = 0.026) was higher at the septal annulus as compared with control group. E(m), a LV diastolic parameter, was significantly lower at the septal annulus. CONCLUSION Cardiac sarcoid involvement is not rare and is treatable. It should be identified at an early stage. TDI, especially IVA, may be a suitable tool for the early detection of subclinical LV sarcoid involvement.

Mutation analysis of the FHIT gene in bronchoscopic specimens from patients with suspected lung cancer

Aims and Background Lung cancer is a leading cause of cancer death worldwide. However, despite recent advances in molecular biology that have revealed various genetic changes in lung cancer, the prognostic outcome of lung cancer patients has improved only minimally. This situation has changed fundamentally with the identification of molecular abnormalities that are characteristic of premalignant changes, such as changes in tumor suppressor genes, loss of heterozygosity at crucial sites, and activation of oncogenes. Inactivation of the tumor suppressor gene Fragile Histidine Triad (FHIT) is a frequent genetic change in lung cancer. The aim of this study was to identify FHIT gene alterations in bronchoscopy specimens of patients with suspected lung cancer and to determine the molecular relevance, if any, of FHIT alterations in the development of cancer. Patients and Methods Sixty-two patients with suspected lung tumors were screened for variations within exons 5-9 of the FHIT gene using intronic primer pairs and single-strand conformation polymorphism and sequencing analysis. Results FHIT gene alterations were detected in 27 out of 62 bronchoscopic specimens (43.54%). All of these alterations were identified as T to A alteration at position IVS8-17. This intronic variant also was identified in approximately half of control cases (45%). Conclusions Our findings showed that the FHIT IVS8-17 T to A alteration identified in bronchoscopy specimens from patients with clinically suspected lung cancer is a polymorphism found in the Turkish population. We think that this polymorphism does not affect gene function because it is located in the intron portion of the gene and is present in many cancer patients as well as healthy subjects. We suggest that the FHIT gene may be turned off in lung carcinogenesis via other genetic or epigenetic mechanisms rather than mutations.

The relationships of serum prealbumin levels with parameters that indicate severity of disease and emphysema pattern in patients with stable chronic obstructive pulmonary disease.

OBJECTIVE Malnutrition, which is a complication frequently observed in chronic obstructive pulmonary disease (COPD) and negatively affects prognosis, has become a parameter that must be monitored. Even though various methods are applied to assess malnutrition, biochemical parameters, especially serum prealbumin levels, are useful. MATERIALS AND METHODS The relationships between serum prealbumin levels, which we used as an indicator of malnutrition, with the severity of disease and the parameters predicting emphysema in stable COPD patients with no additional health problems were determined in this prospective study. RESULTS One hundred stable COPD patients were evaluated prospectively. Serum prealbumin levels had a negative correlation with the total number of hospitalizations due to acute exacerbation, total hospitalization time, and average number of annual hospitalizations, whereas it showed a positive correlation with FEV1 and FEV1/FVC% values. Serum prealbumin levels were positively correlated with the length of the line connecting the costophrenic sinus to the dome of the diaphragm, which is used to assess the presence of emphysema and was negatively correlated with retrosternal distance. Also, in COPD patients with low prealbumin levels, while the FEV1 and FEV1/FVC% values and the length of the line connecting the costophrenic sinus to the diaphragm dome significantly decreased, the retrosternal distance dramatically increased compared to COPD patients with normal prealbumin levels. CONCLUSION Serum prealbumin levels were convenient for monitoring malnutrition in COPD, were correlated with spirometric and anamnestic data indicating the severity of COPD, and were useful in distinguishing the subtype of COPD due to its decrease in the presence of emphysema.

Relationship between disease severity and D-dimer levels measured with two different methods in pulmonary embolism patients

Pulmonary embolism (PE) is diagnosed with increasing frequency nowadays due to advances in the diagnostic methods and the increased awareness of the disease. There is a tendency to use non invasive diagnostic methods for all diseases. D-dimer is a fibrin degradation product. We aimed to detect the relationship between disease severity and the D-dimer levels measured with two different methods. We compared D-dimer levels in cases of massive vs. non-massive PE. A total of 89 patients who were diagnosed between 2006 and 2008 were included in the study. Group 1 included patients whose D-dimer levels were measured with the immunoturbidimetric polyclonal antibody method (D-dimerPLUS®), while Group 2 patients made use of the immunoturbidimetric monoclonal antibody method (InnovanceD-DIMER®). In each group, the D-dimer levels of those with massive and non-massive PE were compared, using the Mann Whitney U test. The mean age of Group 1 (25 F/26 M) was 56.0 ± 17.9 years, and that of Group 2 (22 F/16 M) was 52.9 ± 17.9 years. There was no statistical difference in gender and mean age between the two groups (p > 0.05). In Group 1, the mean D-dimer level of massive cases (n = 7) was 1444.9 ± 657.9 μg/L and that of nonmassive PE (n = 34) was 1304.7 ± 350.5 μg/L (p > 0.05). In Group 2, the mean D-dimer level of massive cases (n = 6) was 9.7 ± 2.2 mg/L and that of non-massive PE (n = 32) was 5.9 ± 1.3 mg/L (p < 0.05). The mean D-dimer levels of massive cases as measured with the immunoturbidimetric monoclonal antibody method were significantly higher. Pulmonary embolism patients whose D-dimer levels are higher (especially higher than 6.6 mg/L) should be considered as possibly having massive embolism. Diagnostic procedures and management can be planned according to this finding.RiassuntoLa diagnosi di embolia polmonare (EP) viene posta oggi giorno con sempre maggiore frequenza grazie ai passi avanti della metodologia diagnostica e alla maggiore consapevolezza di malattia. In tutte le patologie si tende a ricorrere a metodi non invasivi per giungere alla diagnosi. Il D-dimero è un prodotto di degradazione della fibrina. Scopo di questo studio è valutare il rapporto tra gravità di malattia e livelli di D-dimero misurati con due metodiche differenti. Abbiamo comparato i livelli D-dimero in casi di EP massiva e in casi non gravi di EP. Sono stati selezionati 89 pazienti in cui è stata posta diagnosi di EP tra il 2006 e il 2008. Al Gruppo 1 sono stati allocati i pazienti ai quali il D-dimero era stato misurato mediante un metodo immunoturbidimetrico con anticorpi policlonali (D-dimer PLUS®), al Gruppo 2 i pazienti valutati mediante metodo immunoturbidimetrico con anticorpi monoclonali (InnovanceD-DIMER®). La comparazione tra i due gruppi è stata effettuata con il Mann Whitney U test. L’età media del gruppo 1 (25F/26M) era 56,0 ± 17,9 anni, nel Gruppo 2 (22F/16M) era 52,9 ± 17,9 anni. Non vi era una differenza statisticamente significativa tra i due gruppi per sesso o età (p > 0,05). Nei pazienti più gravi del gruppo 1 (n = 7) il livello medio di D-dimero era 1444,9 ± 657,9 μg/L, nei non gravi (n = 34) era 1304,7 ± 350,5 μg/L (p > 0,05). Nel gruppo 2 il livello medio di D-dimero nei gravi (n = 6) era 9,7 ± 2,2 mg/L e nei non-gravi (n = 32) era 5,9 ± 1,3 mg/L (p < 0,05). Il livello medio di D-dimero nei casi gravi in cui è stata utilizzata la metodica con anticorpo monoclonale è risultato significativamente più elevato rispetto ai pazienti meno gravi. Nei pazienti con embolia polmonare il cui D-dimero è più elevato (specie se superiore a 6,6 mg/L con la metodica ad anticorpi monoclonali) dovrebbe essere considerata la possibilità di una embolia massiva. I protocolli diagnostici e di gestione dei pazienti potrebbero perciò essere riformulati sulla base di questi risultati.