Zeynep Ayfer Aytemur

Tobacco Control in Turkey

This report was prepared by WHO within the framework of the Bloomberg Global Tobacco Control Initiative in collaboration with the Ministry of Health and the Tobacco and Alcohol Market Regulatory Authority in Turkey. It outlines the current state of tobacco-smoking in Turkey, including the health and social aspects, epidemiological data and economic, legal and political issues. Turkey, until recently one of the major tobacco-producing countries of the world, has made substantial progress in tobacco control in a short time. The initial efforts of the Ministry of Health in the late 1980s received an impetus when Turkey ratified the WHO Framework Convention for Tobacco Control in 2004. Law No. 4207 of 1996 was substantially amended in 2008 and thus became one of the most advanced tobacco control laws in the world. Even so, smoking is still a serious health problem in the country, with one tenth of all the disabilityadjusted life-years lost due to smoking. About one third of the population smokes, despite a slight decrease over the last 15 years.

Relationship between vitamin D and lung function, physical performance and balance on patients with stage I-III chronic obstructive pulmonary disease

OBJECTIVES vitamin D is important for muscle function and it affects different aspects of muscle metabolism. This study aim to determine whether serum 25(OH) D levels are related to lung functions, physical performance and balance in patients with chronic obstructive pulmonary disease (COPD). METHODS in 90 patients with COPD and 57 healthy controls lung function tests, physical performance tests (time up and go, gait velocity test, sit-to-stand test, isometric strength, isokinetic strength), static (functional reach test) and dynamic (time up and go) balance tests and the association of 25(OH)D levels with lung functions, physical performance and balance were evaluated. RESULTS the COPD patients had significantly more deficit in physical function and balance parameters, and in dynamic balance test (p<0.005). Isokinetic knee muscle strength (flexor and extensor) in COPD patients was significantly lower than in the controls (p<0.05); FEV1 (p=0.008), FVC (p=0.02), FEV1/FVC (p=0.04), TLC (p=0.01) were lower in COPD patients with vitamin D deficiency [25(OH) D less than 15 ng/mL] than in COPD patients without vitamin D deficiency. Hand grip test (p=0.000) and isokinetic knee muscle strength (flexor and extensor) (p<0.05) were also lower in COPD patients with vitamin D deficiency. Vitamin D deficiency was more pronounced in patients with stage III COPD (p<0.05). CONCLUSION patients with COPD had worst physical functioning, poor balance and less muscle strength. Severe disturbed lung and peripheral muscle functions are more pronounced in COPD patients with vitamin D deficiency.

Effects of iloprost on bleomycin-induced pulmonary fibrosis in rats compared with methyl-prednisolone.

OBJECTIVE Prostacyclin (PGI2) has been shown to inhibit the expression of pro-inflammatory and pro-fibrotic mediators in pulmonary fibrosis. In this study, we aimed to test the preventive effects of intraperitoneally administered iloprost, a stable PGI2 analog, on bleomycin-induced pulmonary fibrosis in rats and to compare the effects of iloprost with the effects of methyl-prednisolone, a traditional therapy. METHODS Rats were randomly allocated into four groups: 1. Saline alone (n=6); 2. Bleomycin+placebo (n=7); 3. Bleomycin+methyl-prednisolone (n=7); 4. Bleomycin+iloprost (n=7). Fibrotic changes in the lungs were demonstrated by analyzing the cellular composition of bronchoalveolar lavage fluid, histological evaluation and lung hydroxyproline content. RESULTS Fibrosis was made in the lungs of rats by bleomycin experimentally. Fibrosis scores in the methyl-prednisolone and the iloprost groups were significantly lower than in the placebo group (p<0.05). Furthermore, the score of the iloprost group was significantly lower than the score of the methyl-prednisolone group. The hydroxyproline content was significantly less in the methyl-prednisolone and the iloprost groups (p<0.05). In the placebo group, the neutrophil percentage in bronchoalveolar lavage was significantly higher than in the other groups, whereas the macrophage percentage in placebo group was significantly lower (p<0.05). CONCLUSION Iloprost has protective effect on the pulmonary fibrosis induced by bleomycin and it may be more effective in decreasing fibrotic changes than methyl-prednisolone.

Acute amiodarone toxicity causing respiratory failure

A 66-year-old male patient was referred to our clinic with severe pneumonia. Bronchoscopy was performed due to clinical worsening despite antibiotics and diuretic therapy, respiratory failure and radiographic progression. Because bacterial cultures of the bronchoalveolar lavage fluid were negative and after using amiodarone for almost one month, we eliminated amiodarone from his medication regimen due to suspicion of amiodarone toxicity. Accordingly, we also initiated systemic steroid therapy. Chest X-ray done after 72 hours showed a significant resolution of lung consolidations and the patient exhibited significant clinical improvement, with decline of his oxygen requirements.

Ankilozan Spondilitli Hastalarda Yaş ve Cinsiyete göre Düzeltilmiş Göğüs Ekspansiyonunun Klinik Pratikte Kullanımı

Amaç: Bu çalışmanın amacı; ankilozan spondilit (AS)’li hastalarda yaş ve cinsiyete göre düzeltilmiş göğüs ekspansiyonunun klinik pratikte kullanımının uygun olup olmadığını ve göğüs ekspansiyonunun pulmoner fonksiyonlar ve hastalık şiddeti ile ilişkisini araştırmaktır. Gereç ve Yöntem: Çalışmaya 82 AS’li hasta ve 42 sağlıklı gönüllü alındı. Hastalar, yaş, cinsiyet ve düzeltilmiş göğüs ekspansiyonuna göre; göğüs ekspansiyonu kısıtlanmış ve kısıtlanmamış olmak üzere iki gruba ayrıldı. Hastalar, klinik parametrelere ek olarak, Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI) ve Bath AS Metrology Index (BASMI) ile değerlendirildi. Bulgular: Zorlu vital kapasite ve 1. saniyedeki zorlu ekspiratuar hacim; göğüs ekspansiyonu kısıtlanmış hastalarda, kısıtlanmamış hastalar ve kontrol grubuna göre anlamlı derecede azalmış bulundu. Ağrı, BASFI ve BASMI skorları, göğüs ekspansiyonu kısıtlanmış grupta istatistiksel olarak anlamlı düzeyde yüksekti. Göğüs ekspansiyonu, klinik parametreler ve solunum fonksiyon testleri ile anlamlı derecede korele idi. Sonuç: AS’li hastalarda yaş ve cinsiyete göre düzeltilmiş göğüs ekspansiyonunun klinik pratikte kullanılmasının daha uygun olduğu ve göğüs ekspansiyonunun pulmoner fonksiyonlar ve hastalık şiddeti ile ilişkili olduğu kanısına varıldı. Türk Fiz T›p Re hab Derg 2011;57:128-33. Anah tar Ke li me ler: Göğüs ekspansiyonu, ankilozan spondilit, yaş, cinsiyet, solunum fonksiyon testi Sum mary