Tugba Goktalay

Does high-frequency chest wall oscillation therapy have any impact on the infective exacerbations of chronic obstructive pulmonary disease? A randomized controlled single-blind study:

Objective: To investigate the impact of high-frequency chest wall oscillation in chronic obstructive pulmonary disease patients with infective exacerbation. Design: Clinical randomized controlled trial. Setting: Patients received high-frequency chest wall oscillation therapy at the Department of Pulmonology. Subjects: Stage III-IV chronic obstructive pulmonary disease patients hospitalized with acute infective exacerbation who had received high-frequency chest wall oscillation therapy were studied. Interventions: Patients were randomized into two groups, which were classified as I and II. All patients have been treated with bronchodilators, antibiotics, if necessary oxygen and patient education, as part of acute chronic obstructive pulmonary disease exacerbation protocol. Group II patients received additional high-frequency chest wall oscillation therapy. Main measures: Body mass index (B), forced expiratory volume in the first second (O), modified Medical Research Council dyspnea scale (D) and 6-minute walking test (E) (BODE) index, forced expiratory volume in the first second, dyspnea, exercise capacity, oxygenation parameters and hospitalization of duration were recorded at baseline and at three-days and five-days follow-up. Results: From April 2009 to July 2011, a total of 99 patients were assessed for eligibility, 50 patients were enrolled and randomized into two groups. A total of 50 (100%) patients (25 in Group I and 25 in Group II) were followed up for five days. Application of high-frequency chest wall oscillation therapy resulted in no significant advantage in all outcomes (p > 0.05). Mean (SD) baseline BODE index value in Group I was 7.72 (1.76), in Group II was 7.72(1.89) (p = 0.55). On the fifth-day assessment, mean (SD) BODE index value in Group I was 7.24 (1.83), in group II was 6.44 (2.46) (p = 0.18). Conclusions: The application of high-frequency chest wall oscillation therapy offers no additional advantages on infective exacerbations in chronic obstructive pulmonary disease.

Varenicline disrupts prepulse inhibition only in high-inhibitory rats.

Varenicline, a widely used smoking cessation drug, has partial agonistic activity at α4β2 nicotinic receptors, and full agonistic activity at α7 nicotinic receptors. Thus it may interact with cognitive processes and may alleviate some of the cognitive disturbances observed in psychotic illnesses such as schizophrenia. We aimed to test the effects of varenicline on sensorimotor gating functioning, which is crucial for normal cognitive processes, especially for the integration of sensory and cognitive information processing and the execution of appropriate motor responses. Prepulse inhibition (PPI) of the acoustic startle reflex was used to test the sensorimotor gating functioning. First, the effects of varenicline and nicotine on rats having high or low baseline PPI levels were evaluated; then, varenicline was applied prior to apomorphine (0.5 mg/kg), and MK-801 (0.15 mg/kg), which are used as comparative models of PPI disruption. Varenicline (0.5-3 mg/kg) did not change PPI when given alone in naïve animals. When rats were selected according to their baseline PPI values, varenicline (1 mg/kg) significantly decreased PPI in high-inhibitory (HI) but not in low-inhibitory (LI) rats. Nicotine (1 mg/kg; tartrate salt) produced a similar activity in LI and HI groups. In combination experiments, varenicline did not reverse either apomorphine or the MK-801-induced disruption of PPI. These results demonstrate that the effects of both varenicline and nicotine on sensorimotor gating are influenced by the baseline PPI levels. Moreover, varenicline has no effect on apomorphine or the MK-801-induced disruption of PPI.

An unusual presentation of bronchial rupture.

Persistent hydropneumothorax was diagnosed in a 62-year-old female with a history of blunt trauma, although she was treated with chest tube and closed underwater seal drainage. Computed tomography and fiberoptic bronchoscopy findings were consistent with “fallen lung” syndrome. Fiberoptic bronchoscopy also found a cavitary lesion at the right tracheobronchial angle. Forceps biopsy of the cavitary lesion indicated bronchogenic carcinoma. Our final diagnosis was tracheobronchial complete rupture and fallen lung syndrome secondary to malignancy.

The Role of Endobronchial Biopsy in the Diagnosis of Pulmonary Sarcoidosis

Bronchofiberscopy (BFS) with endobronchial biopsy (EBB) was performed in 66 patients with pulmonary sarcoidosis (PS). Transbronchial biopsy (TBB) was made in 49 patients from this group to compare the diagnostic value of EBB and TBB. The normal endoscopic picture was observed in 19.6% of patients. Bronchial mucosal hypervascularization and thickening were found in 25.7% of cases; the signs of enlarged bronchopulmonary lymph nodes were detected in 13.6%; catarrhal endobronchitis in 10.6%, and tuberosity changes in 4.5%. Epithelioid granulomas in the bronchial mucosa were identified in 37.8% of cases (30.75 and 39.6% in the intact and abnormal mucosa, respectively). The diagnostic value of TBB was 65.3%. EBB could reveal epithelioid-cell granulomas in 4 of the 17 patients with negative TBB. The findings suggest that BFS with EBB should be included as a necessary diagnostic method for the examination of patients with PS.

Knowledge Level of the Primary Healthcare Providers on Chronic Obstructive Pulmonary Disease and Pulmonary Rehabilitation

Introduction. Awareness of the healthcare providers on chronic obstructive pulmonary disease (COPD), which is an important cause of mortality and morbidity in our country and all over the world, and on pulmonary rehabilitation (PR) which plays an important role in its nonpharmacological treatment will provide effectiveness in diagnosis and treatment of COPD. The present study aimed at determining knowledge level of the healthcare providers about COPD and PR. Materials and Methods. In this cross-sectional study, family practitioners and staff of home-care in central county of Manisa City were applied a questionnaire in order to determine their knowledge level on COPD and pulmonary rehabilitation during the in-service training on “pulmonary rehabilitation, home-care services for the pulmonary diseases, and respiratory exercises.” Results. 65.5% of the healthcare providers responded to the survey. Rate of those correctly knowing at least one of four items was 97.2%. No responder knew all items correctly. Average value for correct answers was 5.30 ± 2.1 (range: 1–10). The physicians, men, and those working in family health centers had higher level of knowledge on COPD compared to nonphysician healthcare providers (p = 0.006), women (p = 0.002), and those working in other practices (p = 0.019), respectively. Conclusion. Knowledge level of the primary healthcare providers on COPD and PR remains inadequate. Dynamic postgraduate training on this topic will be useful in referring the patients to centers giving service for this condition.

Effect of smoke-free legislation on smoking cessation rates in teachers in Manisa, Turkey

Objective: This study investigated the attitudes of Turkish adults towards the ban on smoking in public areas and compared annual smoking cessation rates before (pre-2009) and after (post-2009) the ban became law, using data from a survey of teachers. Methods: A self-reported questionnaire was used to collect data from teachers in Manisa, Turkey. Annual smoking rates were calculated. Joinpoint regression analysis was used to identify when a significant change occurred in the annual smoking cessation rate. Results: Questionnaire response rate was 79.6% (579/727); 47.8% (277) of respondents were male. Smoking prevalence among men and women was 32.7% and 24.7%, respectively, and 97.3% of nonsmokers and 75.5% of current everyday smokers supported the law changes. Results of the Joinpoint analysis showed no significant change in annual smoking cessation rate between 2001–2002 and 2006–2007; but there were significant reductions in smoking rates between 2007–2008 and 2010–2011. Conclusions: Teachers in Turkey have a positive attitude to the law on smoking. The smoking cessation rate in teachers was significantly increased by changes in legislation.