Nalan Demir

Association of serum KL-6 levels with interstitial lung disease in patients with connective tissue disease: a cross-sectional study

It was aimed to evaluate KL-6 glycoprotein levels to determine if it may be a diagnostic marker for the connective tissue diseases (CTDs) predicting CTD-related interstitial lung diseases (ILDs) (CTD-ILD) development and to examine if there was a difference between patients and healthy controls. The study included 113 patients with CTD (45 CTD without lung involvement, 68 CTD-ILD) and 45 healthy control subjects. KL-6 glycoprotein levels were analyzed with ELISA in patients and the control group. The relationship between KL-6 glycoprotein levels and CTD-ILD was assessed. In the comparison of all the groups in the study, significantly higher levels of KL-6 were determined in the CTD-ILD group than in either the CTD without pulmonary involvement group or the healthy control group (p < 0.008 and p < 0.001, respectively). There was no statistically significant difference between the KL-6 levels in the healthy control group and the CTD without pulmonary involvement group (p = 0.289). The KL-6 levels did not differ significantly according to the connective tissue diseases in the diagnostic groups (systemic lupus erythematosus, Sjögren’s syndrome, rheumatoid arthritis, mixed connective tissue disease, scleroderma, polymyositis/ dermatomyositis). In the healthy control group, there was a statistically significant difference between KL-6 levels in smokers and non-smokers. Smokers had significantly higher serum KL-6 levels compared with non-smokers (p < 0.05). There was no statistically significant difference between smoking status (pack-year) and serum KL-6 levels. There was no statistically significant correlation between serum KL-6 levels and time since diagnosis of CTD and CTD-ILD. The level of KL-6 as a predictive factor could be used to identify the clinical development of ILD before it is detected on imaging modality. Further prospective clinical studies are needed to define whether levels of KL-6 might have prognostic value or might predict progressive ILD.

Combination and comparison of two models in prognosis of pulmonary embolism: Results from TUrkey Pulmonary Embolism Group (TUPEG) study☆

BACKGROUND Clinical parameters, biomarkers and imaging-based risk stratification are widely accepted in pulmonary embolism(PE). The present study has investigated the prognostic role of simplified Pulmonary Embolism Severity Index (sPESI) score and the European Society of Cardiology (ESC) model. METHODS This prospective cohort study included a total of 1078 patients from a multi-center registry, with objectively confirmed acute symptomatic PE. The primary endpoint was all-cause mortality during the first 30days, and the secondary endpoint included all-cause mortality, nonfatal symptomatic recurrent PE, or nonfatal major bleeding. RESULTS Of the 1078 study patients, 95 (8.8%) died within 30days of diagnosis. There was no significant difference between non-low-risk patients ESC [12.2% (103 of 754;)] and high-risk patients as per the sPESI [11.6% (103 of 796)] for 30-day mortality. The nonfatal secondary endpoint occurred in 2.8% of patients in the the sPESI low-risk and 1.9% in the ESC low-risk group. Thirty-day mortality occurred in 2.2% of patients the sPESI low-risk and in 2.2% the ESC low-risk group (P=NS). In the present study, in the combination of the sPESI low-risk and ESC model low-risk mortality rate was 0%. CONCLUSIONS The sPESI and the ESC model showed a similar performance regarding 30-day mortality and secondary outcomes in the present study. However, the combination of these two models appears to be particularly valuable in PE.

Association of cadmium but not arsenic levels in lung cancer tumor tissue with smoking, histopathological type and stage.

BACKGROUND To evaluate association of lung cancer with arsenic and cadmium levels measured in tumor tissue. MATERIALS AND METHODS Ninety-five patients with lung cancer tumor tissue obtained surgically were included in this study. Arsenic and cadmium levels were measured and levels of metals were compared among types of lung cancer and with reference to patient data. RESULTS The histopathologic diagnoses of the 95 cases were SCC, 49, adenocarcinoma, 28, large cell, 11 and SCLC, 1. Mean tumor arsenic and cadmium levels were 149.3±129.1μg/kg and 276.3±219.3μg/kg, respectively. Cadmium levels were significantly associated with smoking (p=0.02), histopathologic type (p=0.005), and TNM staging (r=0.325; p=0.001), although arsenic was not related to any parameter (p>0.05). There was no relation between metal levels and mortality (p>0.05). CONCLUSIONS We found a significant association between tumor cadmium levels of patients with lung cancer and smoking, histopathologic type and staging, although there was no relation with arsenic levels.

Beliefs, attitudes, and activities of healthcare personnel about influenza and pneumococcal vaccines

ABSTRACT Objectives: Vaccination of healthcare personnel (HCP) is an effective measure for preventing the spread of influenza among at-risk patients. This study was conducted to determine influenza vaccination rates and activities among HCP working at a tertiary healthcare setting. Methods: This study included 470 HCP (85 physicians, 134 nurses, 53 healthcare assistants, 44 paramedics, 47 medical secretaries, and 107 auxillary staff members) working at the emergency, cardiology, chest diseases, and internal medicine departments with the largest volume of patients with vaccination indication of two large university hospitals with similar medical practices and work environment. Each participant completed an anonymous questionnaire form. Results: A total of 470 HCP participated in the survey. The compliance rate of the HCP to participate in the survey was 93.6%. Of these, 26.7% had been vaccinated against influenza. Vaccination in the survey year was significantly associated with having regular influenza vaccinations (OR 48.66; 95% CI:[25.09-94.369]; P<.01); having an educational level of college or higher (OR 2.07; 95% CI:[1.03-4.15]; P<.05); being a physician (OR 4.25; 95% CI:[1.28-14.07]; P< .05); and a professional experience of more than 5 years (OR 2.02; 95%CI:[1.13-5.62]; P< .05). Physicians recommended and prescribed the influenza vaccine significantly more frequently than the pneumococcal vaccine (37.6% vs 30.6%, P = .03, 25.9% vs 17.6%, P = .001, respectively). Among all HCP, the reasons for vaccination included having the opinion that the vaccine provides a partial protection against the infection (75.2%), reduces work force loss (48.8%), reduces the rates of death and severe conditions like pneumonia (43.2%), and reduces hospitalization (40.8%). The HCP had been vaccinated to protect family members (81.6%), people around (51.2%), herself/himself (47.2%), and patients (28%) fom infection. The reasons of not getting vaccinated against influenza among HCP included fear of vaccines adverse effects (31.0%), doubts about its efficacy (28.9%) and safety (22.3%), and lack of adequate knowledge about vaccination (16.2%). Conclusion: Our results indicated that influenza vaccination rates are low in our whole HCP sample, with physicians having a slightly better rate than other HCP. Getting regularly vaccinated, having an educational level of college or higher, being a physician, and having a professional experience of more than 5 years positively affects the rate of future vaccinations. Physicians significantly more commonly recommended and prescribed the influenza vaccine than the pneumococcal vaccine. The most important reasons for getting vaccinated included having the opinion that the vaccine provided partial protection and intending to protect family members from infection. In our whole HCP sample, the reasons of not getting vaccinated against influenza included fear of vaccines adverse effects and doubts about its efficacy and safety. Training meetings should be held for HCPs to underscore the importance of the influenza vaccine for protection of patients against the influenza.

Which factors effects patients belief and attitudes about influenza vaccination

Introduction Despite its proven efficacy, vaccination rates with influenza vaccine are considerably low. This study aimed to investigate the vaccination rates with influenza-vaccine and the factors affecting attitude toward vaccination. Materials and Methods A questionnaire was applied to patients presenting to outpatient clinic between October 2011-January 2012. Result Of these 1251 (671 F, 580 M) patients with a mean age of 47.7 ± 15.1, 61.9% had an indication for influenza-vaccination. The rate of vaccination was 33.4%. Among the vaccinated patients, the ratio of patients with an educational level of high-school or above (60.6%) was greater than that of patients with a lower educational level (39.4%) (p= 0.01). The vaccination rates were greater among those with chronic lung disease (43.6%), heart disease (21.2%), and diabetes (19.3%) (p< 0.001, p= 0.02, and p= 0.03, respectively). A multivariate regression analysis revealed that the independent variables associated with vaccination were considering the vaccine protective (OR, 2.13; CI, 1.85-4.24, p= 0.03), getting vaccinated to protect oneself (OR, 6.31; CI, 3.25-12.63, p< 0.001), getting vaccinated to protect ones family against influenza (OR, 5.42; CI, 3.11-9.54, p= 0.02), the vaccine being recommended by a physician (OR, 4.15; CI, 2.03-7.45, p< 0.001), being regularly-vaccinated (OR, 5.32; CI, 3.24-6.35, p< 0.001), and suffering from chronic lung disease (OR, 2.21; CI, 1.64-4.32, p< 0.001). The reasons of not getting vaccinated were considering the vaccine useless (OR, 2.46; CI, 0.77-3.98; p= 0.01),having concerns about side-effects (OR, 2.14; CI, 0.16-3.25; p= 0.02),and having inadequate knowledge (OR, 7.12; CI, 4.23-12.56; p< 0.001). Men, as compared to women, had a significantly greater rate of considering the vaccine useful (p< 0.001), getting vaccinated during campaigns held by workplaces (p= 0.002), and obtaining information through bills, brochures, or bulletins (p= 0.003). Patients vaccinated with the influenza-vaccine significantly more commonly consider the pneumococcal-vaccine useful (p= 0.02), and they had a significantly greater rateofvaccination with pneumococcal-vaccine (p< 0.001). Conclusions The vaccination rate remains low. Opinions about the vaccine that had favourable effect on vaccination rate were that the vaccine was beneficial and that it would protect ones family against the disease. The unvaccinated patients had inadequate knowledge of the vaccine. Obtaining information from a physician boosts vaccination rate. Men having a greater rate of vaccination through campaigns of workplaces as well as a greater rate of being informed can be explained by a higher employment rate in men.

Alpha-1 Antitrypsin Levels and Polymorphisms in Interstitial Lung Diseases

BACKGROUND/AIM Alpha-1 antitrypsin deficiency may be a potential predisposing factor for interstitial lung fibrosis. We investigated alpha-1 antitrypsin levels and its polymorphisms in patients with interstitial lung disease. MATERIALS AND METHODS A total of 103 interstitial lung disease patients were compared. RESULTS The mean alpha-1 antitrypsin level in idiopathic interstitial pneumonia patients was 1.67 ± 0.33 g/L, and it was 1.54 ± 0.37 g/L in patients with nonidiopathic interstitial pneumonia (P = 0.13). Low alpha-1 antitrypsin levels were more frequently observed in nonidiopathic interstitial pneumonia patients compared with idiopathic interstitial pneumonia, but the difference was not statistically significant (8.9% vs. 0%, respectively, P = 0.4). In 100 patients, the normal PiMM genotype was detected, while abnormal ones (PiMZ, n = 2, 1.9%; PiMS, n = 1, 0.97%) were determined in three cases. When the frequency of alpha-1 antitrypsin polymorphism in interstitial lung disease patients was compared with the data of the healthy population, no significant difference was detected for the PiMZ and PiMS variants (P = 0.15 and P = 0.44, respectively). CONCLUSION Lower levels of serum alpha-1 antitrypsin were more frequent in nonidiopathic interstitial pneumonia patients than idiopathic interstitial pneumonia without an increase in genetic polymorphism. The difference was not statistically significant.

SAT0625 The Role of Serum KL-6 Glycoprotein Levels in Lung Involvement Patients with Connective Tissue Diseases

Background Pulmonary involvement is one of the serious complications associated with connective tissue diseases (CTDs), resulting in significant morbidity and mortality.Since interstitial lung disease (ILD) is one of the most serious pulmonary complications associated with connective tissue diseases (CTDs), early diagnosis is important for prognosis and treatmant plan. Krebs von den Lungen-6 (KL-6), which is a glycoprotein secreted by type II alveolar pneumocytes and bronchiolar epithelial cells, which increases in ILDs. Objectives We aimed to evaluate KL-6 glycoprotein levels in order to find out if it may be a serum diagnostic marker for the CTDs for predicting CTD related ILD development and if there is a difference between pateints and healthy controls. Methods This study was carried out on the patients applying to the rheumatology polyclinics in Ankara University Faculty of Medicine. We analyzed 45 CTD without lung involvement, 68 CTD related ILD and 45 healthy controls. KL-6 glycoprotein levels were analyzed with ELISA in patients and control group. Demographic and clinic properties of patients were analyzed. The relationship between KL-6 glycoprotein levels and CTD related ILDs was assessed Results All groups in the study were compared, significantly higher levels of KL-6 were determined in CTD related IAH group, than both healthy control and CTD without pulmonary involvement groups (respectively p<0,001, p<0,008). There were no statistically significance difference between KL-6 levels in healthy control group and CTD without pulmonary involvement (p=0,289). Connective tissue diseases in the diagnostic groups (systemic lupus erythematosus, Sjogrens syndrome, rheumatoid arthritis, mixed connective tissue disease, scleroderma, polymyositis/ dermatomyositis) among them, KL-6 levels did not differ significantly. In the healthy control group, there was statistically signifiance difference between KL-6 levels in smokers and non-smokers. Smokers had significantly higher serum KL-6 levels compared with non-smokers (p<0,05). There was no statistically significance difference between smoking status (pack-year) and serum KL-6 levels. There was no statistically significant correlation between serum KL-6 levels and time since diagnosis of connective tissue diseases and CTD related IAH. Conclusions In this study, serum KL-6 levels were higher in patients with CTD related IAH than control groups. KL-6 glycoprotein may be used as a serum diagnostic marker for CTD related IAH. References Doishita S, Inokuma S, Asashima H, Nakachi S, Matsuo Y, Rokutanda R, et al. Serum KL-6 Level as an Indicator of Active or Inactive Interstitial Pneumonitis Associated with Connective Tissue Diseases. Intern Med. 2011;50 (23):2889–92. Hant FN, Ludwicka-Bradley A, Wang H-J, Li N, Elashoff R, Tashkin DP, et al. Surfactant protein D and KL-6 as serum biomarkers of interstitial lung disease in patients with scleroderma. J Rheumatol. 2009 Apr;36 (4):773–80. Disclosure of Interest None declared

Tuberculosis preventive treatment in a single medical center and evaluation of the results

The aim of the present study was to evaluate the application of tuberculosis preventive treatment (TB-PT). Demographic data, indications and results for cases that received TB-PT at the Ankara Tuberculosis Control Dispensary No. 7 between 2008 and 2011 were retrospectively evaluated. The ‘Prevention with Drugs’ registry at the dispensary was used. A total of 463 cases received TB-PT, with the indications including close contact with an active TB case (44%), positive tuberculin skin test (TST) in a child <15 years-old (25%) and immunosuppressive therapy (31%). The immunosuppressed group (n=144) were administered steroids (10%) or tumor necrosis factor (TNF)-α inhibitors (90%). Indications of TST conversion and sequela lesions were not observed among the cases. The male/female ratio was 106/98 for cases with TB close contact, 61/54 for TST-positive cases and 85/59 for immunosuppressed cases. The mean ages of these groups were 9±5.7, 9.5±3.8 and 38±14.9 years, respectively. TB-PT was completed in 364 cases (78.6%), and the rate of discontinuation due to adverse effects was 1% for TB close contact and 2% for TST-positive cases, but 5% for immunosuppressed cases. While the percentage of TB close contact cases receiving TB-PT decreased during the four-year study period, the percentage of cases with immunosuppression (in particular patients using TNF-α inhibitors) increased. Among the studied cases, only two subjects developed active TB. The first case involved a 1.5-year-old female that had close contact exposure to TB from a parent, while the other case involved a 14-year-old TST-positive male (induration size,16 mm). In conclusion, patients receiving TB-PT should be monitored and/or followed-up carefully to control any side-effects from the treatment and development of active TB.