Fatma Evyapan

Effects of CPAP on right ventricular myocardial performance index in obstructive sleep apnea patients without hypertension

ObjectivesObstructive sleep apnoea (OSA) might cause right ventricular dysfunction and pulmonary hypertension. We aimed to determine the effects of nasal continuous positive airway pressure (CPAP) therapy on right ventricular myocardial performance index (MPI) in OSA patients without hypertension.Methods49 subjects without hypertension, diabetes mellitus, any cardiac and pulmonary disease had overnight polysomnography and echocardiography. In 18 moderate-severe OSA (apnea-hypopnea index ≥ 15) patients, right ventricular free wall diameter (RVFWD) was measured by M-mode, and right ventricular MPI was calculated as (isovolumic contraction time+ isovolumic relaxation time) / pulmonary ejection time using Doppler at baseline and after 6 months CPAP therapy.ResultsMean age was 46.5 ± 4.9 year. Patients had high body mass index (BMI: 30.6 ± 4,0 kg/m2), but there was no change in either BMI or blood pressures after 6 months. Right ventricular end-diastolic and end-systolic diameters were in normal limits at baseline, and did not change after CPAP usage. Baseline RVFWD (7.1 ± 2.1 mm) significantly decreased after CPAP therapy (6.2 ± 1.7 mm, p < 0.001). 15 of patients (83%) had right ventricular diastolic dysfunction at baseline, and it was completely improved in 11 of them (73%) by CPAP usage. Right ventricular global dysfunction was shown in 11 patients (61%) with a high MPI (62.2 ± 9.3%) at baseline; and MPI was significantly decreased after CPAP therapy (47.3 ± 8.4%, p < 0.0001), and it was completely corrected in 4 of them (36%).ConclusionCPAP therapy significantly decreases RVFWD and improves right ventricular diastolic and global functions (MPI) in OSA patients without hypertension.

Peripheral neuropathy in chronic obstructive pulmonary disease.

ABSTRACT The aim of this study was to evaluate the frequency and characteristics of peripheral nervous system involvement in chronic obstructive pulmonary disease and its relation with proinflammatory cytokines such as TNF-α, IL-6, IGF-1 and CRP. Forty chronic obstructive pulmonary disease patients with a mean age 62.8 ± 5.5 years and 33 healthy controls with a mean age of 61.8 ± 7.4 were included into this study. All subjects were evaluated with standard motor and sensory nerve conduction studies. Serum TNF-α, IL-6, CRP and IGF-1 were measured. The muscle strengths of three muscle groups (knee extensors, shoulder abductors and flexors) were assessed with a hand-held dynamometer. Peripheral neuropathy was detected at 15%% of chronic obstructive pulmonary disease patients. Ulnar motor and sensory nerves, left sural nerve distal latencies were found significantly prolonged than healthy volunteers (p == 0.011), peroneal nerve conduction velocities was found lower in patients than in healthy controls (p == 0.021), tibial nerve amplitudes was found lower in patients than healthy controls (p == 0.046). CRP and TNF-α were found significantly higher in chronic obstructive pulmonary disease patients and IGF-1 was found significantly lower in chronic obstructive pulmonary disease patients. There was no correlations between proinflammatory cytokines, CRP and electrophysiological findings. Left sural nerves sensory nerve action potential amplitude was correlated positively with FEV1%% (r == 0.425; p == 0.009). Muscle strength at the shoulder and knee were significantly reduced in patients with COPD when compared with controls. The frequency of neuropathy was higher in chronic obstructive pulmonary disease when compared with the healthy controls. Chronic obstructive pulmonary disease patients have subclinical peripheral nerve involvements.

Respiratory Symptoms and Pulmonary Functions of Workers Employed in Turkish Textile Dyeing Factories

Dyes are known to be a causative agent of occupational asthma in workers exposed to them. We have evaluated respiratory symptoms among textile workers. The study population comprised 106 exposed workers and a control (unexposed) group. Data were collected by a questionnaire. PFTs (Pulmonary Function Test) were performed. Among the exposed workers 36.8% defined phlegm. Respiratory symptoms were not significantly different between two groups. The employment duration of the exposed workers with phlegm was longer than those without phlegm (p = 0.027). The mean % predicted of FEF25–75 of the exposed workers was found to be significantly lower than the control (unexposed) group (p = 0.01). Our study suggests that textile dyeing might cause respiratory symptoms in workers.

Bilateral pneumothorax following acute inhalation injury.

Introduction. Inhalation injury can be thermal and/or chemical. We report bilateral pneumothorax following acute inhalation injury. Case report. A male worker in an upholstery factory was confined in the tanning machine for 15 min. The device was used to contain sodium sulfate, sulfur dioxide, and sulfuric acid. On admission, he was confused with Glasgow coma scale score as 9. His vital signs were as follows: blood pressure, 80/58 mmHg; pulse rate, 114 bpm; respiratory rate, 30 bpm; temperature, 37.1°C; and oxygen saturation, 48%. He was intubated. Physical examination disclosed extensive subcutaneous emphysema on the neck and pinkish foamy discharge from the mouth. Chest X-ray showed bilateral pneumothoraces and pneumomediastinum that warranted bilateral tube thoracostomy. Bronchoscopy demonstrated web-shaped hyperemic areas on the upper airway mucosa with aphtous lesions in the base. Extensive hemorrhage and edema were evident around epiglottis. The patient was admitted to the intensive care unit and mechanically ventilated. He was discharged without any sequelae on day 8. Conclusion. Exposure to irritant gases such as sulfuric acid and sulfur dioxide can cause severe pulmonary injury leading to pneumothorax and pneumomediastinum.

New aspect for systemic effects of COPD: eye findings.

Chronic obstructive pulmonary disease (COPD) has multisystemic implications and comorbidities. Hypoxia and systemic inflammation are thought to involve oculary structures. In this study, our aim is to evaluate retinal nerve fiber and choroidal thickness and retinal vessel diameter using the spectral‐domain optical coherence tomography (SD‐OCT) in COPD subjects.

Long Term Effects of Tear Gases on Respiratory System: Analysis of 93 Cases

Aim. This study aimed to assess the long-term respiratory effects of tear gases among the subjects with history of frequent exposure. Materials and Methods. A questionnaire by NIOSH and pulmonary function tests was performed in 93 males exposed to the tear gases frequently and 55 nonexposed subjects. Results. The mean numbers of total exposure and last 2 years exposure were 8.4 ± 6.4 times, 5.6 ± 5.8 times, respectively. Tear gas exposed subjects were presented with a higher rate for cough and phlegm more than 3 months (24.7% versus 11.3%, P > 0.05). Mean FEV1/FVC and % predicted MMFR in smoker exposed subjects are significantly lower than those in smoker controls (81.7% versus 84.1%, P = 0.046 and 89.9% versus 109.6%, P = 0.0004, resp.). % predicted MMFR in nonsmoker exposed subjects is significantly lower than that in nonsmoker controls (99.4% versus 113.1%, P = 0.05). Odds ratios for chest tightness, exercise dyspnea, dyspnea on level ground, winter morning cough, phlegm, and daily phlegm were increased almost 2 to 2.5 folds among tear gas exposed subjects. Conclusion. The rates for respiratory complaints were high in the case of the exposure to the tear gases previously. Tears gas exposed subjects were found to be under the risk for chronic bronchitis.

Symptom prevalence and risk factors for asthma at the rural regions of Denizli, Turkey

OBJECTIVE This study was conducted using a standardised method (ECRHS) to identify the prevalence of asthma symptoms and risk factors in adults who lives in the rural regions of Denizli province. METHODS This study was designed as a cross-sectional study to investigate the prevalence of asthma and asthma symptoms in adults older than 18 years old, around the rural regions of Denizli. Data were collected by personal interview and filling in questionnaires between July 2009 and September 2009. RESULTS A total of 1,343 individuals were enrolled. Prevalence of current asthma was 5.9%, having an asthma-like symptom was 34.0% and allergic rhinitis was 2.5%. Most common asthma symptoms were woken by an attack of breathlessness (20.5%, n=275), woken by attack of cough (19.9%, n=267) and wheezing (12.7%, n=171). CONCLUSIONS Asthma is an important disease that may occur not only in cities but also at country sides. In rural areas risk factors for asthma and asthma-like symptoms compared to urban areas may show some differences.

Binasal cannula versus face mask for oxygen therapy in patients with chronic pulmonary disease.

Oxygen therapy, which is ordered frequently for patients with chronic pulmonary disease, remains a cornerstone of modern medical practice. This study was conducted to compare the efficiency and comfort of a binasal cannula versus a face mask during oxygen therapy. Sixty hypoxemic patients participated in this randomized controlled study. While each patient was hypoxemic, arterial blood gas analysis was performed before oxygen supplementation was begun. Arterial oxygen saturation was continuously monitored during oxygen therapy with a face ask or a binasal cannula. Subjects were allowed to return to their oxygen saturation level in room air before the device for oxygen treatment was changed. The same procedure was then repeated with the other device. Patient comfort was evaluated through the use of a questionnaire that was completed after each treatment period. The mean age±standard deviation was 62±13 y. No statistically significant difference was noted in oxygen saturation levels achieved with the 2 devices. The binasal cannula reached target oxygen levels (P=.007) more quickly than the face mask. The binasal cannula was reported to be significantly more comfortable (P=.0001), and had significantly fewer reports of dyspnea and restlessness, and was less of a nuisance (P=.019, P=.0001, and P=.0001, respectively). The binasal cannula was preferred for oxygen therapy by 71% of study patients. Although the efficiency of the 2 devices did not differ remarkably, Transmission and reproduction of this material in whole or part without prior written approval are prohibited. the binasal cannula was regarded as a more comfortable and time-saving device for delivery of oxygen therapy to hypoxic patients.

Awareness about disease and pulmonary rehabilitation in chronic obstructive pulmonary disease: A survey study

Purpose: Superiority of pulmonary rehabilitation (PR) in patients with COPD have been entered the major guidelines of the disease and become gold standard of care in the management of COPD. Our aim is to evaluate the patients’ awareness about their own illness and PR which supports behavioral interventions by encouraging exercise training, cooperative self-management depending on the patients themselves. Materials and methods: The study was included 200 patients. Patients who are competent enough to complete the questionnaire and diagnosed as COPD according to Global Inıtıatıve for Chronic Obstructive Lung Disease(GOLD) criteria and at least 1 year on follow patients enrolled in the study. Questionnaire which is employed in our study is developed by a review of the current literature and consist of 3 parts. First part aims to investigate socio-demographics like age, gender, education and whereabouts. Second part (questions 1-9) evaluate the knowledge and awareness of COPD and 3rd part (10-22) investigate the awareness of PR. Results: Among the patients 93% (n=186) were male and 7% (n=14) were female. Mean age was 65.11±10.00 years. Mean duration of the disease was 7.8±6.69 years. Correct answer rates to the questions “is there another treatment modality for COPD other than medication” and “have you ever heard a treatment named pulmonary rehabilitation” were 14.5% and 7.5%, respectively. Conclusion: We found that the awareness of pulmonary rehabilitation is very low. Therefore, in our opinion it is essential to find out new methods, novel strategies to increase the awareness of pulmonary rehabilitation in COPD patients. Pam Med J 2018;11(2):151-156

Determination of Genotoxic Damage by Comet Assay in Smokers

ABSTRACT The clinical course of most diseases related to smoking has a strong relationship with genotoxicity. In this study, the researchers aimed to compare DNA damage of smokers and non-smokers to determine the genotoxic risk. In total, 50 volunteers were included in this study; 30 of them smokers and 20 of them forming the non-smoker control group. Peripheral blood samples taken from the volunteers were determined with comet assay. The researchers determined the DNA damage ratio as 12, 75 (± 7. 14) from smokers 10, 41 (± 3.41) from non-smokers (p> 0.05), and also higher DNA damage in male smokers than female ones (p<0. 05). There was no correlation between age and DNA damage. In conclusion, there was no significant difference between smokers and non-smokers in terms of DNA damage, but there were some important changes in the DNA of smokers and genomic instability was adversely affected.