Zafer Kartaloglu

Pulmonary Function Tests and Thyroid Hormone Concentrations in Patients with Chronic Obstructive Pulmonary Disease

Objective: To evaluate the relationship between pulmonary function tests, arterial blood gases, and thyroid gland functions in patients with chronic obstructive pulmonary disease (COPD). Subjects and Methods: Thirty-two patients (mean age 64.1 ± 7.3 years, range 53–84 years) with stable COPD (mean duration of disease 11.1 ± 9.1 years, range 1–30 years) and 15 healthy control cases participated in the study. Pulmonary function, arterial blood gas, and thyroid hormone concentration were measured, and thyroid ultrasonography and scintigraphy were also performed. Results: The values of the pulmonary function tests (vital capacity, forced vital capacity, forced expiratory volume in 1 s and peak expiratory flow) and PaO2 were lower in the study than control group (p < 0.001), but the values of PaCO2 and concentration of free 3,5,3′-triiodothyronine (fT3) were higher in the study than control group (p < 0.01) although thyroid hormone concentrations were within normal limits in all cases. However, there was no difference between the values of thyroid-stimulating hormone and free thyroxine in both the study and control groups and therefore association could not be established between them on the one hand and pulmonary function test and arterial blood gases on the other hand. Only the values of PaCO2 and fT3 were positively associated; all other values were negatively associated with fT3. Conclusion: Changes in pulmonary function tests and arterial blood gases seem to be associated with fT3 concentrations in patients with COPD. Increased respiratory workload could affect thyroid functions.

Effect of Corticosteroids on Hemostasis and Pulmonary Arterial Pressure during Chronic Obstructive Pulmonary Disease Exacerbation

Background: Hemodynamic and hemostatic abnormalities are reportedly frequent in chronic obstructive pulmonary disease (COPD). Objectives: We investigated the changes in systolic pulmonary artery pressure (PAPs) and hemostatic status and the effects of systemic steroid treatment (SST) during COPD exacerbation. Methods: Consecutive 26 male and 4 female patients as well as 10 controls were enrolled. The nonsteroid treatment (NST) group received standard treatment without steroids, and the other group received additional SST. Initial values of blood gases, spirometry and PAPs, P-selectin, D-dimer and fibrinogen levels, activities of thrombocyte aggregation, antithrombin III (AT III), protein C (PC), protein S, activated PC resistance (APCR), prothrombin time and partial thromboplastin time were obtained and compared with values at day 10. Results: Improvement in spirometry and blood gases was more prominent with SST. At presentation, patients had higher PAPs, P-selectin, D-dimer and fibrinogen but lower AT III levels than controls. PAPs and fibrinogen levels significantly decreased in the SST group while P-selectin levels further increased in the NST group. The D-dimer level significantly decreased in both groups. Means of AT III, PC and protein S increased in the SST and decreased in the NST group, but only the decrease in PC in the NST group was meaningful. Compared with the controls, AT III levels in the NST group and activated PC resistance in the SST group were significantly decreased. Thrombocyte aggregation tests suggested an incline after 10 days in both groups. Conclusions: We suggest that in patients with COPD exacerbation, addition of systemic corticosteroids to treatment results in better outcome in normalization of PAPs, hemostasis, pulmonary functions and blood gases.

Primary Antituberculosis Drug Resistance at Turkish Military Chest Diseases Hospital in Istanbul

Objective: The aim of this study was to investigate the prevalence of primary drug resistance to tuberculosis. Methods: We evaluated the clinical data, radiological features and sputum samples from 365 newly diagnosed patients with a positive culture of pulmonary tuberculosis at the Turkish Military Chest Diseases Hospital, Istanbul, Turkey. No patients had taken antituberculosis drugs previously. The Bactec method was used to perform drug susceptibility testing for isoniazid, rifampicin, ethambutol, and streptomycin. Results: Primary resistance to one or more drugs was detected in 87 (23.8%) patients; resistance to isoniazid was most common (54 patients) followed by resistance to ethambutol (n = 39), rifampicin (n = 11), and streptomycin (n = 9). One-drug resistance was detected in 69 patients; two-drug resistance in 11, three-drug resistance in 6, and four-drug resistance in 1. Multidrug resistance (resistance to at least isoniazid and rifampicin) was detected in 10 patients. In logistic-regression analysis, primary drug resistance was associated with radiological advanced tuberculosis (p < 0.001). Conclusion: Primary resistance to one or more drugs used in treating tuberculosis is relatively high. It is necessary to regularly screen for and treat drug resistance among those who live in close quarters, such as army barracks, school dormitories and prisons. Regular surveillance of drug sensitivity patterns should be maintained to determine appropriate alternate drug regimens and detect the spread of resistant stains in the population.

Delay in the Diagnosis of Turkish Servicemen with Pulmonary Tuberculosis

OBJECTIVE This study was designed to assess the time between the first appearance of symptoms and the start of treatment among Turkish servicemen with tuberculosis (TB). METHODS Ninety-seven patients with pulmonary TB were enrolled in the study. We surveyed their complaints and education levels, the opportunity to visit a health care facility, and the time elapsed until diagnosis and treatment. RESULTS Of the study group, 62 (63.7%) reported that they had visited an infirmary as soon as their complaints appeared. The median total delay in diagnosis was 21 days for all cases. Patient delay decreased among patients with hemoptysis (2.1 vs. 6.4 days, p = 0.013) and increased with night sweats (7.3 vs. 3.1 days, p = 0.042). Total delay was not correlated with any symptom. CONCLUSION We suggest that delays in diagnosis and treatment among Turkish soldiers with pulmonary TB arise from some factors related to both patients and health care facilities, and these factors should be taken into account by military health services.

Evaluation of quality of life with the chronic obstructive pulmonary disease assessment test in chronic obstructive pulmonary disease and the effect of dyspnea on disease-specific quality of life in these patients.

Purpose The chronic obstructive pulmonary disease (COPD) assessment test (CAT) was recently introduced for use in assessing disease-specific quality of life and follow-up of patients with COPD. The purpose of this study was to evaluate the effect of the dyspnea on disease-specific quality of life detected by CAT score in patients with COPD. Materials and Methods In this study, 90 stable patients with COPD as defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria were included. The level of dyspnea was assessed with the Medical Research Council (MRC) dyspnea scale, and disease-specific quality of life was assessed with CAT score. Results The mean±SD age was 68.5±10.9 (range 41-97) years. A significant relationship was established between CAT score, MRC dyspnea scale score and GOLD stage in patients with COPD. There was also a positive correlation between dyspnea scale scores and GOLD stage in the patients (p<0.001), as well as positive correlation between CAT score and dyspnea scale score (p<0.001). CAT score showed a significant correlation with hospitalization and exacerbations (p<0.05). Conclusion Dyspnea is an important symptom that may impact quality of life in patients with COPD. CAT was shown to be a simple, fast and intelligible measurement of disease-specific quality of life, and was correlated with levels of dyspnea in patients with COPD.

Relation between inflammatory cytokine levels in serum and bronchoalveolar lavage fluid and gene polymorphism in young adult patients with bronchiectasis.

AIM Bronchiectasis develops as a result of genetic and environmental factors and its etiopathogenesis is not still clear. Recent studies have revealed that inflammatory cytokines, which are formed as a result of chronic infection and inflammation, play a role in the pathogenesis of bronchiectasis. For this purpose, the level of inflammatory cytokines in bronchiectasis and the presence or absence of a genetic predisposition with the gene polymorphism of these cytokines was investigated. MATERIAL AND METHODS A total of 60 patients, 40 study cases and 20 controls, which were monitored with the diagnosis of bronchiectasis were included in the study. In these individuals, cytokine levels [interleukin (IL)-6, IL-8, IL-10, and tumor necrosis factor (TNF)-α] in serum and bronchoalveolar lavage (BAL) fluid, along with the routine blood tests, were determined. Furthermore, the polymorphism in IL-6, IL-8, IL-10, and TNF-α cytokine genes and its frequency were studied in the obtained DNA by the automatic sequence analysis method and the results were compared. FINDINGS It was found that in serum and BAL fluid of the patient group, the IL-8 level was high, whereas the IL-10 level was low (P<0.05). No significant difference was detected in the other cytokines (P>0.05). It was found that in cytokine gene polymorphisms IL-8 -251 A/T, IL-10 -592 A/C, and IL-10 -819 T/C genotypes are associated with increased risk of bronchiectasis. It was detected that the IL-8 -251 A/T genotype increased the risk of having the disease by 4.19 fold. (OR =4.19, 95% CI =1.24-14.17, P=0.021). The IL-10 -592 C/A genotype increased the risk of having the disease by 5.71 fold (OR = 5.71, 95% CI =1.35-24.06, P=0.017) and the IL-10 -819 T/C genotype increased the risk of having the disease by 5.06 fold (OR =5.06, 95% CI =1.20-21.27, P=0.048). No significant correlation was found between the other polymorphisms and bronchiectasis. CONCLUSIONS The IL-8, IL-10 levels and the gene polymorphism of these cytokines differ. In addition to detecting higher levels of pro-inflammatory IL-8 and lower levels of anti-inflammatory IL-10, detection of gene polymorphism related to these two cytokines in bronchiectasis gives rise to the thought that cytokines may have role in a predisposition to bronchiectasis. However, as the number of patients is small, precise remarks could not be made on this subject. There is need for further studies include a larger number of patients.

A case of Behcet's disease with pulmonary artery aneurysm and thrombosis

A 22 year old patient with dyspnea, cough, chest pain, fatigue, mild fever and swelling of the lower extremities was hospitalized. Physical examination revealed bilateral decrease in respiratory sounds and end-inspiratory fine rales at the left posterobasal area. Circumferences of both legs were increased. During hospitalization period, oral aphthous and scrotal ulceration were appeared. Bilateral multiple peripheral and central pulmonary artery aneurysms at middle zones were found with dynamic computerized tomography of thorax and magnetic resonance angiography of the lungs. Patient was diagnosed as Behcets disease with lung involvement. Magnetic resonance angiography performed at the sixth month of the treatment revealed a significant regression in aneurysmatic changes, whereas a right ventricular thrombosis had been developed.

Serum prohepcidin in pulmonary tuberculosis.

Abstract Aim: Anemia of chronic disease is the second most encountered anemia following iron deficiency in patients who develop acute or chronic immune activation. Pulmonary tuberculosis is an infectious disease which results in an inflammatory response frequently causing anemia. We investigated whether prohepcidin can be used successfully to disclose the cause of anemia and to monitor the result of the therapy in patients with pulmonary tuberculosis. Material and methods: The study was performed in 40 male patients and 15 healthy controls that had a diagnosis of tuberculosis with a positive sputum smear and did not receive any previous treatment. They were treated for 6 months. Results: The study revealed a significant elevation of prohepcidin in patients with tuberculosis in comparison to those of healthy control subjects. Additionally, prohepcidin levels significantly decreased after treatment in the patient group but remained high in comparison to control group. Conclusion: We conclude that prohepcidin is high in pulmonary tuberculosis and might be a marker for monitoring the response to treatment.

Pyo-Pneumothorax in Patients with Active Pulmonary Tuberculosis: An Analysis of 17 Cases without Intrapleural Fibrinolytic Treatment

Objective: To review the medical records of patients with active pulmonary tuberculosis (TB) and pyo-pneumothorax (PPT). Subjects and Methods: Medical records of 17 patients (14 male, 3 female, mean age 23.8 years, range 20–52) with PPT and active pulmonary tuberculosis at Gulhane Military Medical Academia Haydarpasa Training Hospital, Istanbul, Turkey, were reviewed from January 1998 to December 2002. The patients were treated with chest tube drainage and chemotherapy. Intrapleural fibrinolytic agents or irrigation was not performed. Results: Pleural fluid samples were available in 14 patients and the mean levels of LDH, protein and glucose in the pleural fluid were 1,767 ± 944 U/l, 5.2 ± 1.4 g/dl and 31.7 ± 22.6 mg/dl, respectively. Mycobacterium tuberculosis was detected in the pleural effusion of 3 patients. The duration of chest tube drainage was longer in cases who underwent open drainage (p = 0.014). At the end of the treatment period 10 patients developed pleural thickening, 4 of them underwent decortication and pneumonectomy was also done in 1 patient. The development of pleural thickening was related to the level of pleural fluid glucose (p = 0.04). Conclusion: This study shows that while taking care of patients with pulmonary TB the physician must be aware of the complication of PPT and that adequate chemotherapy and drainage must be duly performed.

Angiopoietin 2 levels in serum and bronchial lavage fluids and their relationship with cancer stages in lung cancer patients

Background:  Angiopoietin 2 (Ang‐2) has an important role in tumor angiogenesis. In this study, Ang‐2 levels of serum and bronchioloalveolar lavage fluids (BALF) in patients with lung cancer were measured and correlated with clinical and biochemical parameters.