Objectives: The blood pressure (BP) has circadian rhythm and fluctuates over a 24-hour period. A ≥10% decrease in average blood pressure at night according to daytime BP was defined as dipper ...hypertension (DHT), and decrease less than 10% was defined as non-dipper hypertension (NDHT). The aim of our study was to investigate the prevalence of obstructive sleep apnea syndrome (OSAS) in NDHT patients. Methods: Twenty-three patients with NDHT and 12 patients with DHT according to ambulatory blood pressure monitoring were included in the study between October 2017 and October 2018. Demographic characteristics, Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI) and polysomnography scores were recorded. Results: Fifteen of the participants were female (42,9%) and 20 (57,1%) were male. The mean age was 56,1±12,03 years. Age, gender, demographic characteristics, smoking history and ESS scores were similar between NDHT and DHT groups. The presence of HT in the family, the use of general preventive strategies and the therapeutic options in the management of hypertension were similar. While there was no difference between the groups in terms of other comorbidities, cardiovascular comorbidities were significantly higher in the NDHT group (p=0.04). As expected in the NDHT, the mean night systolic blood pressure was high. Furthermore, the mean diastolic blood pressure at night was also higher in NDHT group than DHT group (p=0,004). According to PSQI score, 54,3% of the patients had poor sleep quality. Twelve (63,2%) of the patients with poor sleep quality were in the NDHT group and 7 (38,8%) were in the DHT group, but the difference was not significant. In addition, subjective sleep quality was found to be worse in NDHT group (p=0,013). OSAS was detected in 32 (91,4%) of the study population. The prevalence of OSAS was higher in NDHT patients than in DHT group, but the difference was not significant (95,7% vs 83,3%, p=0,2). The median apnea-hypopnea index (AHI), the mean oxygen desaturation index and desaturation time were similar between the groups. Conclusion: Overall OSA prevalence was found to be over 90% in our study population, and OSAS prevalence was higher in NDHT patients than in DHT group, but the difference was not statistically significant. Moreover, the rate of poor sleep quality was higher and subjective sleep quality was significantly lower in NDHT patients. A large number of multicenter prospective studies are needed to assess OSAS prevalence and sleep quality in NDHT patients.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Objectives: Several cross-sectional studies have shown that low serum levels of Vitamin D are linked to impaired lung function. It is thought that vitamin D may affect the course of asthma by effects ...such as anti-inflammatory effect, prevention of respiratory infections and reduction of steroid resistance. Vitamin D has been suggested to alter chemokine expression of human airway smooth muscle cells and additionally inhibit the expression of the steroid resistance gene. Methods: Thirty-five healthy controls and 60 patients with asthma were included in the study between December 2016 and February 2017. Demographic characteristics and pulmonary function tests (PFT) were recorded and laboratory tests (serum vitamin D, calcium, phosphate, parathormone and alkaline phosphatase) were measured. Asthma control test (ACT) was performed to asthmatics. Partipicians with decreased vitamin D level were consulted with Endocrinology Department for vitamin D replacement therapy. ACT and PFT were repeated after three months therapy in asthmatics. Results: There were 95 individuals; 76 females and 19 males, There were no significant difference between age, gender and demographic characteristics between asthmatics and control group. Smoking status and passive smoking rates were similar. Vitamin D levels were similar in paticipants with turban user and nonusers. There was no significant difference between daily sun exposure, calcium containing diet and menauposal status. Serum phosphate, calcium, alkaline phosphatase, parathormone and 25(OH)D vitamin levels were similar in both groups. Vitamin levels were low in about 90% of both groups. On the first admission, 71,7% of asthmatics were uncontrolled, while the rate of uncontrolled patients decreased to 13,2% after the post-replacement evaluation. There was a significant increase of ACT with respect to vitamin D replacemet therapy (22.4±2.7 vs 16±5.4, p=0.001). There was also significant increase in PFT parameters including FVC (L), FVC (%), FEV1/FVC after replacement therapy and p values were respectively p=0.007; p=0.014 and p=0.008. The mean BMI were high in both groups (≥30 kg/m2). The mean ACT score was lower in obese asthmatics than in non-obese patients, but the difference was not significant (15.3±5.4 vs. 17.5±4.8, p=0.1). Presence of controlled or uncontrolled disease was similar between the obese and non obese groups (p=0.7). Conclusion: It is suggested that vitamine D replacement therapy had positive effects on asthma control and pulmonary functions but further multicentre, prospective studies with large number of cases are needed to evaluate the effect of vitamine D replacement therapy on these parameters.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Introduction: Sarcoidosis is a disease characterized by multisystem involvement, but bone and bone marrow involvement is rare. A case of sarcoidosis with bone marrow involvement is presented. Case ...Presentation: A 46-year-old woman presented to our outpatient clinic with complaints of fatigue and chest pain in 2016. There was no history of smoking. Chest X-ray showed an infiltration on the left upper zone. Thoracic CT revealed peripheral consolidation of the left lung upper lobe apicoposterior segment, infiltration on right upper lobe and bilateral hilar lymphadenopathies (11 mm). Bronchoscopy was performed with the preliminary diagnoses of tuberculosis and atypical sarcoidosis. Bronchial lavage AFB, mycobacterial culture and cytological examination were normal. BAL lymphocyte ratio was 10% and CD4/CD8 ratio was 2,5. Serum ACE level was normal. Diagnostic transthoracic fine needle aspiration was recommended but the patient refused the procedure and discontinued the follow-up. She was referred to the Hematology Department with a preliminary diagnosis of lymphoma after assessment of PET-CT results by an internal medicine specialist. There was an increase in her complaints in the last 3 months. Hemogram and peripheral smear were normal. In PET-CT, there were hypermetabolic activities in lung, mediastinal and abdominal lymphadenopathies, spleen and bones including right scapula glenoid process, vertebral colon (prominent in C6, C7, T4 and S1 vertebrae), right femur trochanter major, left ischium and both iliac wings. These findings were interpreted in favor of lymphoma. Bone marrow biopsy was performed by Hematology and the pathology result was non-necrotizing granulomatous inflammation. She had been receiving steroid therapy for 2 months with the diagnosis of sarcoidosis. Her clinical and pulmonary radiological findings showed significant regression. Conclusion: Sarcoidosis, a systemic disease, is frequently confused with lymphoma. It should be kept in mind that sarcoidosis may be presented with bone and bone marrow involvement and can be detected incidentally on PET-CT during the diagnosis.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Endobronchial metastases of extrapulmonary malignant tumors are quite rare. We present a patient with endobronchial metastasis previously operated for tongue carcinoma. A 71-year-old female patient ...presented with the complaint of cough. She had a history of tongue carcinoma operation 2 years before. Chest x-ray revealed an air-fluid level in the lower zone of the right hemithorax. There was a big cavitary lesion in the right lower lobe and bilateral multiple nodular lesions, some of which had cavity formation on computed tomography. Bronchoscopy re- vealed a polypoid lesion with necrotic appearance and pathologic examination showed squamous cell carcinoma. The lesion was accepted as a metastasis of tongue carcinoma after evaluation of the materials taken from the tongue on previous operation. There was no finding suggestive of local recurrence; however, the patient died from hemoptysis and respiratory insufficiency. In conclusion, endobronchial metastasis should be considered in patients with extrapulmonary malignancies and bronchoscopic examination should be performed in such cases, even in the presence of atypical radiological findings.
Endobronchial tuberculosis (EBTB) is defined as tuberculosis infection of the tracheobronchial tree with microbial and histopathological evidence. The clinical symptoms of the diseases are ...nonspecific. Chronic cough is the major symptom of the disease. The diagnosis is often delayed due to its nonspecific presentation and misdiagnosed as bronchial asthma. This case is presented to recall the notion that the endobronchial tuberculosis can mimic asthma and the importance of bronchoscopic evaluation in a patient with chronic cough and treatment resistant asthma.
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FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UL, UM, UPUK
Smoking prevalence in Kocaeli Bariş, Serap Argun; Yildiz, Füsun; Başyiğit, Ilknur ...
Tüberküloz ve toraks,
01/2011, Volume:
59, Issue:
2
Journal Article
Peer reviewed
Open access
A questionnaire was performed in order to determine smoking prevalence in the target population just before the initiation of a social responsibility project which is aimed to increase the smoking ...cessation rates in Kocaeli. The sample selection was made based on population numbers in 12 town of Kocaeli city and smoking habits of population over the age of 18 were evaluated by a questionnaire survey by phone. There was 2721 person included in the study. The overall prevalence of active smokers was 32.3% (n= 902) and ex-smokers was 21.5% (n= 587). There was no statistical significance of smoking prevalence among towns except the lower smoking rates in Gebze (25.7%). The percentage of the current smokers was 42.5% in male population which was significantly higher than females (21.8%). The highest smoking prevalence was found between the ages of 35-44 (41.2%) while the lowest prevalence was observed in the subjects older than 55 years (19.8%). The mean age for smoking initiation was 19 years (17-20) and daily cigarette consumption was 17 sticks. Previous attempts for quitting smoking were found in 67.7% of current smokers. The mean number of smoking cessation attempts was 3 times and the mean duration of cessation was 5 months. The most common reason for smoking cessation was health issues. Eighty percent of cases harnessed their willpower to stop smoking while only 5% of them received medical treatment. It is suggested that determination of demographic features of the smokers might constitute a corner stone for smoking cessation projects.
AIM: To determine induced sputum cell counts and interleukin-8 (IL-8), tumor necrosis factor alpha (TNF-α) and leukotriene B_4 (LTB_4) levels as markers of neutrophilic inflammation in moderate ...persistent asthma, and to evaluate the response to inhaled steroid therapy. Methods: Forty-five moderate asthmatic patients and 10 non-smoker controls were included in this study. All patients received inhaled corticosteroid (800 μg of budesonide) for 12 weeks. Before and after treatment pulmonary function tests were performed, and symptom scores were determined. Blood was drawn for analysis of serum inflammatory markers, and sputum was induced. Results: Induced sputum cell counts and inflammatory markers were significantly higher in patients with asthma than in the control group. The induced sputum eosinophil counts of 12 patients (26%) were found to be less than 5%, the non-eosinophilic group, and sputum neutrophil counts, IL-8 and TNF-α levels were significantly higher than the eosinophilic group (neutrophil, 50±14% versus 19±10%, p＜0.01). In both groups, there was a significant decrease in sputum total cell counts and serum and sputum IL-8, TNF-α and LTB_4 levels after the treatment. There was no change in sputum neutrophil counts. Although the sputum eosinophil count decreased only in the eosinophilic subjects, there was no significant difference in inflammatory markers between the groups. The symptom scores were significantly improved after treatment, while the improvement did not reach statistical significance on pulmonary function test parameters. Conclusion: Notably, in chronic asthma there is a subgroup of patients whose predominant inflammatory cells are not eosinophils. Sputum neutrophil counts and neutrophilic inflammatory markers are significantly higher in these patients. In the noneosinophilic group, inhaled steroid caused an important decrease in inflammatory markers; however, there was no change in the sputum eosinophil and neutrophil counts.
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DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
To evaluate the effects of montelukast in smoke-induced lung injury.
28 Wistar-Albino rats were enrolled into 4 groups with 7 rats per group. The healthy control group was exposed to fresh air while ...all rats in the 3 experimental groups were exposed to cigarette smoke for 20 weeks for 2 hours per day. After histopathological verification of smoke induced lung injury, montelukast (0.1 mg/kg) dissolved in Na2CO3 was given in one group (MON), Na2CO3 only was given in another group (MON control) and placebo was injected in the third group (COPD control) intraperitoneally for 21 days. At the end of this period blood samples were obtained for serum TNF-α assessment and light and electron microscopy analyses were performed on the lung tissues of sacrificed rats.
Serum TNF-α levels in the MON group were significantly lower than in the MON control and COPD control groups (38.84 ± 4.9 pg/ml, 77.5 ± 5.8 pg/ml and 79.2 ± 6.9 pg/ml respectively, p < 0.05). Furthermore there was no statistically significant difference between the MON group and healthy controls with respect to serum TNF-α levels (38.84 ± 4.9 pg/ml vs. 29.5 ± 3.6 pg/ml, p > 0.05). Light and electron microscopic evaluation of the lungs demonstrated that the total histopathological damage score of the lung samples was significantly lower in the MON group than in MON controls and COPD controls (5.14 ± 0.5, 8.4 ± 0.6 and 8.7 ± 0.4 respectively, p < 0.05), while there was no significant difference between the MON group and healthy controls (5.1 ± 0.6 vs 2.3 ± 0.2, p > 0.05).
These findings suggest that montelukast might have a protective effect on smoke-induced lung injury in rats both from a histopathological and inflammatory point of view.
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