Nurdan Kokturk

Expression of Transforming Growth Factor β1 in Bronchial Biopsies in Asthma and COPD

The role of transforming growth factor β1 (TGF β1) in airway remodeling in asthma and chronic obstructive pulmonary disease (COPD) has not been fully described. To evaluate the possible pathogenetic role of TGF β1 in asthma and COPD, immunohistochemical expression of TGF β1 was described in bronchial biopsies from patients with asthma and COPD compared with healthy individuals. Twelve subjects with asthma, 13 subjects with COPD, and 10 healthy individuals enrolled in the study. Bronchial biopsies were stained with hematoxylin and eosin and anti‐TGF β1 antibody. As a result, immunoreactive TGF β1 was mainly localized in association with connective tissue in all groups. The staining intensity was not statistically different among the groups in bronchial epithelium, whereas it was significantly higher in the group of asthma in the submucosa. Because there is evidence showing a significant increase of staining intensity in the submucosa from asthmatics but not from subjects with COPD, we may conclude that TGF β1 may play a significant role in pathogenesis of asthma but not in COPD.

Risk factors for fungal pulmonary infections in hematopoietic stem cell transplantation recipients: the role of iron overload

Fungal pulmonary infections (FPIs) are frequent causes of mortality in hematopoietic stem cell transplantation (HSCT) recipients. Determination of the specific risk factors may improve the prognosis. The aim of this study was to evaluate the risk factors of FPIs due to HSCT. Patient history, physical examination, chest X-rays and the consultation records of the pulmonary disease department which were a part of the routine evaluation before and at first, third, sixth, ninth and twelfth months of HSCT were retrieved in 148 adult HSCT recipients. Results of the high-resolution computed tomography, fiber-optic bronchoscopy and the microbiological data were also included. FPI was diagnosed in 22 patients (14.9%). Multivariate analysis showed that increased ferritin levels (>1000 ng/ml; OR: 3.42, 95% CI 1.03–11.42, P=0.045) and the development of sinusoidal obstruction syndrome (SOS; OR: 5.09, 95% CI 1.53–16.90, P=0.008) were significant risk factors for FPIs. The sensitivity and specificity of ferritin >1000 ng/ml for the prediction of FPIs were 67 and 70%, respectively. There was a positive correlation between the increased risk of FPIs and pretransplantation ferritin levels (r=0.413, P<0.001) and increased ferritin levels and SOS (r=0.331, P<0.001). Increased pretransplantation ferritin levels and development of SOS are predictive factors of FPIs during HSCT.

Survivin expression in pre-invasive lesions and non-small cell lung carcinoma

Survivin is an inhibitor of apoptosis protein, which is overexpressed in many carcinomas, including lung carcinoma. The aim of this immunohistochemical study was to investigate the role of survivin in the early steps of lung carcinogenesis and non-small cell lung carcinomas (NSCLC), and its relationship with expression of p53 protein, a tumor suppressor gene involved in cell cycle control. In the normal bronchial epithelium, low-grade atypical adenomatous hyperplasia (AAH) and non-neoplastic lung parenchyma adjacent to tumor, survivin was found completely negative. Expression of survivin was detected in the areas of squamous metaplasia and dysplasia as well as high-grade AAH lesions adjacent to tumor. Survivin was expressed in 50 (64%) and p53 in 41 (53%) NSCLC. Survivin expression was significantly correlated with lymph node metastasis (p=0.02). There was no correlation between survivin and p53 expression. The patients with expression of survivin had significantly worse prognosis (Log-rank test, p=0.003). Multivariate Cox regression analysis showed TNM stage (p<0.001) and survivin expression (p=0.003) as independent prognostic indicators. In conclusion, survivin expression might be an early step in lung carcinogenesis. Survivin expression might also be used as a prognostic indicator predicting the worse outcome in NSCLC, and might be a novel target for the treatment of patients with preinvasive lesions of lung and NSCLC.

Unsuspected risk factors of frequent exacerbations requiring hospital admission in chronic obstructive pulmonary disease

Severe exacerbations are the leading cause of fatal events in chronic obstructive pulmonary disease (COPD). The new Global Initiative for Chronic Obstructive Lung Disease strategy included the number of exacerbations in the grading of the disease. The primary aim of this study was to evaluate the potentially modifiable precipitating factors of frequent severe exacerbations requiring hospital admission in COPD. The secondary aim was to investigate the risk factors of readmission within 2 months following an exacerbation requiring hospitalisation.

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.

Hyperhomocysteinemia Prevalence Among Patients With Venous Thromboembolism

The aim of this study is to evaluate the plasma total homocysteine level in patients with venous thromboembolism (VTE) and to investigate the effect of different risk factors on plasma levels. Ninety-three-patients with VTE and 37-control participants diagnosed with other than VTE were included in the study. Plasma homocysteine levels and the factors affecting plasma homocysteine levels were evaluated. Plasma homocysteine level was higher among patients with VTE compared to the controls independent from vitamin B12 and folate levels. The prevalence of hyperhomocysteinemia in VTE was 63%. Plasma homocysteine level was higher in patients with PE than deep venous thrombosis (DVT; 23 ± 13.7 vs 16 ± 5.8 μmol/L, P = .018). With regression analysis hyperhomocysteinemia was found to be associated with a 4.8-fold increased risk of VTE. Hyperhomocysteinemia is a common and possibly modifiable risk factor that should be considered when screening patients with VTE. Secondary causes of hyperhomocysteinemia especially vitamin B12 deficiency should be monitored in patients with VTE to prevent recurrences.

Polymerase chain reaction in the diagnosis of invasive aspergillosis.

In the present study, we present a patient with invasive pulmonary aspergillosis caused by Aspergillus fumigatus diagnosed by polymerase chain reaction (PCR) technique on blood and bronchoalveolar lavage fluid samples of the patient. The value of PCR in the diagnosis of aspergillosis is discussed.

Fever in pulmonary embolism.

This study was planned to investigate the characteristics of clinical and laboratory findings of patients with fever diagnosed as pulmonary embolism (PE) in comparison with PE patients without fever and patients with community-acquired pneumonia (CAP). Thirty-nine PE patients with fever without other identifiable causes (18 received antibiotics and 21 did not receive antibiotics) (study groups) were included in the study. 22 patients with PE without fever and 21 patients diagnosed with CAP were retrospectively selected as control groups. Daily peak body temperature, risk factors for PE, symptoms, and physical and laboratory findings at admission were recorded. Patients with CAP demonstrated higher body temperature than PE patients with fever (38.5 ± 0.6 versus 37.8 ± 0.6°C, P = 0.0001). Fever patterns were similar between the three groups of patients who had fever. The leukocyte count and the erythrocyte sedimentation rate (ESR) were slightly higher in the group of PE with fever versus PE without fever (11 465.6 ± 4229.4/mm3, 51.1 ± 34.7/mm/h versus 10 777.3 ± 4927.6/mm3, 35.2 ± 30.1/mm/h, respectively) (P > 0.05). The group of CAP showed significantly highest values of leukocyte count and ESR (15 490.5 ± 5606.3/mm3, 69.1 ± 35.9/mm per h, respectively) (P < 0.05). This study suggested that fever might accompany with PE. The presence of slight leukocytosis and increased ESR may not securely differentiate PE patients with fever from patients with CAP.

Do females behave differently in COPD exacerbation

Introduction Little is known about whether there is any sex effect on chronic obstructive lung disease (COPD) exacerbations. This study is intended to describe the possible sex-associated differences in exacerbation profile in COPD patients. Methods A total of 384 COPD patients who were hospitalized due to exacerbation were evaluated retrospectively for their demographics and previous and current exacerbation characteristics. Results The study was conducted on 109 (28%) female patients and 275 (72%) male patients. The mean age was 68.30±10.46 years. Although females had better forced expiratory volume in 1 second and near-normal forced vital capacity, they had much impaired arterial blood gas levels (partial oxygen pressure [PO2] was 36.28 mmHg vs 57.93 mmHg; partial carbon dioxide pressure [PCO2] was 45.97 mmHg vs 42.49 mmHg; P=0.001), indicating severe exacerbation with respiratory failure. More females had two exacerbations and two hospitalizations, while more men had one exacerbation and one hospitalization. Low adherence to treatment and pulmonary embolism were more frequent in females. Females had longer time from the onset of symptoms till the admission and longer hospitalization duration than males. Comorbidities were less in number and different in women (P<0.05). Women were undertreated and using more oral corticosteroids. Conclusion Current data showed that female COPD patients might be more prone to have severe exacerbations, a higher number of hospitalizations, and prolonged length of stay for hospitalization. They have a different comorbidity profile and might be undertreated for COPD.

Disseminated cryptococcosis in a human immunodeficiency virus-negative patient: a case report.

Cryptococcus neoformans is a widely distributed saprophytic fungus that may cause opportunistic infections in normal and immunocompromised individuals particularly in patients with HIV infection. Disseminated infection in HIV‐negative individuals is occasionally seen: a 57‐year‐old HIV‐negative Turkish female initially presented with enlarged mediastinal lymph nodes and a large pulmonary parenchymal nodule, eventually diagnosed with disseminated cryptococcosis and tuberculosis.