Goksel Altinisik

Antacid therapy in idiopathic pulmonary fibrosis: more questions than answers?

Idiopathic pulmonary fibrosis (IPF) is a progressive parenchymal lung disease of complex cause. Gastro-oesophageal reflux (GER) and microaspiration have been proposed as risk factors for the development and progression of IPF, but robust definitive data are few. A recent international guideline conditionally recommended the use of antacid therapy (proton pump inhibitors or histamine-2-receptor antagonists) for patients with IPF, in the absence of oesophageal reflux or symptoms. In this Position Paper, we summarise the literature addressing the association between GER and IPF, and also identify future research priorities that could clarify this issue. We shed light on the process through which the guideline recommendation was achieved and aim to contextualise the recommendation for providers caring for patients with IPF.

Modeling pulmonary alveolar microlithiasis by epithelial deletion of the Npt2b sodium phosphate cotransporter reveals putative biomarkers and strategies for treatment

Epithelial deletion of Npt2b results in a tractable mimic of pulmonary alveolar microlithiasis. Casting the first stone for lung disease Pulmonary alveolar microlithiasis (PAM) is a rare lung disease characterized by spherical deposits of calcium phosphate. PAM is thought to be a genetic disorder, and mutations in the gene encoding the NPT2b sodium-dependent phosphate cotransporter have been implicated. Now, Saito et al. delete Npt2b in epithelial cells in mice and observe a disease that mimics human PAM. Whole-lung EDTA can reduce the burden of stones in the lungs, and a low-phosphate diet prevents stone formation. These data support a causative role of Npt2b in PAM and suggest strategies for treatment. Pulmonary alveolar microlithiasis (PAM) is a rare, autosomal recessive lung disorder associated with progressive accumulation of calcium phosphate microliths. Inactivating mutations in SLC34A2, which encodes the NPT2b sodium-dependent phosphate cotransporter, has been proposed as a cause of PAM. We show that epithelial deletion of Npt2b in mice results in a progressive pulmonary process characterized by diffuse alveolar microlith accumulation, radiographic opacification, restrictive physiology, inflammation, fibrosis, and an unexpected alveolar phospholipidosis. Cytokine and surfactant protein elevations in the alveolar lavage and serum of PAM mice and confirmed in serum from PAM patients identify serum MCP-1 (monocyte chemotactic protein 1) and SP-D (surfactant protein D) as potential biomarkers. Microliths introduced by adoptive transfer into the lungs of wild-type mice produce marked macrophage-rich inflammation and elevation of serum MCP-1 that peaks at 1 week and resolves at 1 month, concomitant with clearance of stones. Microliths isolated by bronchoalveolar lavage readily dissolve in EDTA, and therapeutic whole-lung EDTA lavage reduces the burden of stones in the lungs. A low-phosphate diet prevents microlith formation in young animals and reduces lung injury on the basis of reduction in serum SP-D. The burden of pulmonary calcium deposits in established PAM is also diminished within 4 weeks by a low-phosphate diet challenge. These data support a causative role for Npt2b in the pathogenesis of PAM and the use of the PAM mouse model as a preclinical platform for the development of biomarkers and therapeutic strategies.

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.

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

Effect of reduction mammoplasty on the pulmonary function tests

Introduction Bilateral breast reduction surgery is the surgical treatment of bilateral breast hypertrophy. This is one of the most common breast surgery requested by women, and performed by plastic surgeons. The reasons that patients want this surgery are to re-size sagging breasts aesthetically, and to get rid of somatic symptoms such as shoulder, chest, back, and neck pain. We believe that the objective positive effects of breast reduction surgery exist beside aesthetic. In our study, our aim is to elicit positive effects of surgery on lungs, if there are, by making pulmonary function test and carbon monoxide diffusion test before surgery and after 6 months of surgery. Materials and Methods Thirty patients agreed to participate in the study. Study is completed with 19 patients. Pulmonary function test and carbon monoxide diffusion test were made to all patients in preoperative and 6 months of postoperative period. Lung roentgenogram of all patients was performed and height, weight, body mass index were measured. Saturation level was measured. Result There was a meaningful increase in FEV1 and FVC values in the postoperative period in comparison with pulmonary function test performed in preoperative period. DLCO in postoperative period decreased meaningfully as compared to the preoperative period. Conclusions Breast reduction surgery seems to have positive effects on pulmonary function test values and relaxes patients clinically. Patients with big breasts should be evaluated from this perspective if they apply chest diseases clinic with shortness of breath.

Pulmonary langerhans cell histiocytosis case with diabetes insipidus and tuberculosis

A 19-year-old male patient was observed due to having central diabetes insipidus (DI) for five years. He had a history of smoking 5–10 cigarettes a day for two years, but stopped smoking from the last month. The computerized tomography revealed thin-walled cystic lesions in different sizes more dominantly in the upper lobes and consolidated areas in the left upper and lower lobes. The wedge resection from the right lower lobe revealed pulmonary langerhans cell histiocytosis. Follow-up acid-fast bacteria (AFB) examinations revealed (+++) and antituberculous treatment was started. On the 40th day of the anti-tuberculosis treatment, the patient applied once again due to fever and chest pain. Although infiltrations persisted in the left upper and middle zones in the postero-anterior lung rontgenogram, right-sided pneumothorax was detected. The case is considered tuberculosis and the patient continued to receive anti-TB treatment under the close supervision.

Impaired Hemorheology in Exacerbations of COPD

Background Chronic obstructive pulmonary disease (COPD) is characterized by progressive airflow limitation. Cardiovascular-related comorbidities are established to contribute to morbidity and mortality especially during exacerbations. The aim of the current study was to determine alterations in hemorheology (erythrocyte aggregation, deformability) in newly diagnosed COPD patients and their response to medical treatment and to compare with values of COPD patients with exacerbations. Materials and Methods The study comprised 13 COPD patients, 12 controls, and 16 COPD patients with exacerbations. The severity of COPD was determined according to Global Initiative for Chronic Obstructive Lung Disease guidelines. Red blood cell (RBC) deformability and aggregation were measured by an ektacytometer. Results RBC deformability of COPD patients with exacerbations was decreased compared to the other groups. Erythrocyte aggregation and plasma fibrinogen of COPD patients determined during exacerbations were higher than control. Conclusion Decreased RBC deformability and increased aggregation associated with exacerbations of COPD may serve as unfavorable mechanisms to worsen oxygenation and thus clinical symptoms of the patient. Treatment modalities that modify rheological parameters might be beneficial.

What should be the appropriate minimal duration for patient examination and evaluation in pulmonary outpatient clinics

Introduction: Patient examinations performed in a limited time period may lead to impairment in patient and physician relationship, defective and erroneous diagnosis, inappropriate prescriptions, less common use of preventive medicine practices, poor patient satisfaction, and increased violent acts against health-care staff. Objective: This study aimed to determine the appropriate minimal duration of patient examination in the pulmonary practice. Methods: A total of 49 researchers from ten different study groups of the Turkish Thoracic Society participated in the study. The researchers were asked to examine patients in an almost ideal manner, without time constraint under available conditions. Results: A total of 1680 patient examinations were reviewed. The mean duration of patient examination in ideal conditions was determined to be 20.4 ± 9.6 min. Among all steps of patient examination, the longest time was spent for “taking medical history.” The total time spent for patient examination was statistically significantly longer in the university hospitals than in the governmental hospitals and training and research hospitals (P < 0.001). Among different patient categories, the patients with a chronic disorder presenting for the first time and were referred from primary or secondary to tertiary care for further evaluation have required the longest time for patient examination. Conclusion: According to our study, the appropriate minimal duration for patient examination is 20 min. It has been observed that in university hospitals and in patients with chronic pulmonary diseases, this duration has been increased to above 25 min. The durations in clinical practice should be planned accordingly.

THE EFFICACY AND SAFETY OF MEDICAL THORACOSCOPY IN DIFFERENTIAL DIAGNOSIS OF PLEURAL EFFUSIONS.

Erhan Ugurlu 1 , Goksel Altinisik 2 , Ali İhsan Yildiz 3 and Gokhan Yuncu 4 . 1. MD, Pamukkale University Medicine Faculty Chest Disease Department, Denizli, Turkey. 2. MD, Prof. Dr. Pamukkale University Medicine Faculty Chest Disease Department, Denizli, Turkey. 3. MD, Servergazi Hospital Chest Disease Deparment, Denizli, Turkey. 4. MD, Prof. Dr. Liv Hospital Thoracic Surgery Clinic, İstanbul, Turkey. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History