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WOS: 000439590300008, PubMed ID: 30083405, OBJECTIVES: The primary aim of The Turkish Sleep Apnea Database (TURKAPNE) study is to generate a cross-sectional nationwide database for defining the clinical and polysomnographic characteristics of the patients with obstructive sleep apnea (OSA) in Turkey. MATERIALS AND METHODS: In this ongoing project, all consecutive adults with suspected OSA are recruited from the sleep centers of the university and research hospitals in Turkey. Information on anthropometric data, educational status, driving license, smoking habits, alcohol use, comorbidities, drug use, questionnaires, polysomnographic, and/or cardiorespiratory polygraphic findings are recorded in a systematized Web-based report form. Blood glucose, lipids and other biochemical markers, lung function, and echocardiography measurements are optionally included. Follow-up data regarding treatment modality and compliance is assessed. Cross-sectional and longitudinal associations between OSA phenotypes and metabolic, pulmonary, and cardiovascular comorbidities as well as traffic accidents, and the impact of treatment will be further explored. We target a total sample of 10,000 participants. RESULTS: The study was registered with ClinicalTrials.gov (NCT02784977) in May 2016 and the first patient was recruited in October 2017. A total of 1911 participants from 19 centers have been enrolled in the study by May 31, 2018. CONCLUSION: The TURKAPNE study will contribute to a better understanding of the health-related burden of OSA phenotypes and its association with the comorbidities and adverse outcomes, including traffic accidents in Turkey. The results may also contribute to a more personalized approach and better management of varying OSA phenotypes with concomitant disorders., Turkish Thoracic Society, The foundation and infrastructure of the database was supported by grants from the Turkish Thoracic Society with no influence on the design of the study, the analysis of the data, the data collection, drafting of the manuscript, or the decision to publish.

WOS: 000450066500001 PubMed ID: 30427696 Objectives: This study aims to investigate the effects of T'ai Chi and Gigong (TCQ) training on severity of obstructive sleep apnea (OSA). Design: A prospective, 12-week, single-center, double-blinded, randomized controlled trial. Setting: Sleep Disorders Center of Medical Faculty in Istanbul, Turkey. Subjects: Fifty adult patients with mild and moderate OSA. Interventions: Patients were randomly allocated into either an intervention group or a control group. The intervention group (n=25) received TCQ training under physiotherapist supervision for 1h, three times per week, for 12 weeks and a home exercise program was provided for another 2 days. The control group (n=25) received only a home exercise program for 12 weeks, 5 days per week. Outcome measures: All patients were assessed before and after the exercise program. Objective parameters of sleep were measured by polysomnography, while subjective parameters of sleep were assessed using the Epworth Sleepiness Scale (ESS) and the 3-factor Pittsburgh Sleep Quality Index (PSQI). Pulmonary functions were assessed with a pulmonary function test; health-related quality of life was evaluated through the Short Form-36. Results: In the intervention group, there was a statistically significant decrease in the apnea-hypopnea index (AHI) (p=0.001) and percentage and duration of stage N2 sleep (p=0.041 and p=0.037, respectively), while there was a statistically significant increase in percentage and duration of stage N3 sleep when compared with the controls (p=0.048 and p=0.043, respectively). There was a statistically significant decrease in the ESS, PSQI sleep efficiency, and total scores (p=0.001, p=0.003, and p=0.003, respectively). Conclusions: Our study results suggest that TCQ training may reduce AHI and daytime sleepiness, while improving subjective sleep quality, in patients with mild and moderate OSA. Research Fund of Bezmialem Vakif University [12.2015/5] The authors would like to thank Melih Zeren, PhD (PT), for his support in writing the manuscript. The authors are indebted to Esra Pehlivan, PhD (PT), and Arif Balci (PT), for their assistance with data collection. They also thank Tai Chi and Qi Gong Healing Institute Board member Master (instructor) Tarik Tekman for his valuable contribution to the TCQ training program. Patients' PFT and PSG expenses were supported by the Research Fund of Bezmialem Vakif University (Project No: 12.2015/5).

Objective:We aimed to investigate the importance of mean platelet volume (MPV) as a marker for the activation and severity of disease in patients with pulmonary sarcoidosis.Methods:The data of 84 patients diagnosed with pulmonary sarcoidosis in our clinic between 2011 and 2014 were evaluated retrospectively. Patients were divided into groups according to the activation status (active or in remission), acute or chronic disease, stage according to chest X-ray, and extrapulmonary involvement. The correlation of the initial MPV and ACE levels was evaluated.Results:Sixty-three of the patients were female, with an average age of 44 (38–52) years. Fifty-two of the patients (62%) were in stage 1, and 32 (38%) were in stage 2. The median ACE level was 59.6 (42.6–92), and the MPV level was 10.1 (9.7–10.7). Bronchoalveolar lavage was applied to 24 patients; all of these had predominant lymphocytes, and the median CD4/CD8 rate of the patients was 4.8 (3.2–12.5). A significant negative correlation was detected between ACE and MPV independently of the groups (p0.05 for all).Conclusion:According to our data, MPV is not a significant marker for inflammation or activation of disease and is not suitable for use as a diagnostic and follow-up indicator in pulmonary sarcoidosis.

Hafif obstrüktif uyku apneli hastalarda REM ile ilişkili obstrüktif uyku apne sıklığı ve özellikleri Giriş: REM ile ilişkili obstrüktif uyku apne (OUA), “Hafif ve orta OUA olgularında daha fazla görülmesi nedeniyle uykuda solunum bozuklukları spektrumunun erken bir işareti midir?” yoksa “Tamamen ayrı bir antite midir?” sorusuyla araştırmacıların son zamanlarda oldukça dikkatini çekmektedir. Bu çalışmada, hafif OUA tanılı hastalar arasında REM ile ilişkili OUA hastalarının sıklığını ve diğer hafif OUA tanılı hastalardan farkını görmek; ayrıca REM ile ilişkili OUA hastalarında gündüz aşırı uykululuk ile apne ilişkisini değerlendirmek amaçlanmıştır. Materyal ve Metod: 1 Ağustos 2010 ile 29 Şubat 2012 tarihleri arasında Bezmialem Vakıf Üniversitesi Uyku Laboratuvarında polisomnografi tetkiki yapılan toplam 1267 hasta arasından, 134 hafif OUA [Apne hipopne indeksi (AHİ)= 5-15] tanılı hasta retrospektif olarak değerlendirildi. REM AHİ/non-REM AHİ ≥ 2 olan ve non-REM AHİ < 15 olanlar; REM ile ilişkili OUA olarak kabul edildi. Bulgular: Toplam 134 hafif OUA tanılı hastadan 80 (%59)’i REM ile ilişkili OUA olarak değerlendirildi. REM ilişkili OUA ve diğer hafif OUA’lılar yaş, cinsiyet, gündüz aşırı uykululuk, beden kitle indeksi, boyun çevresi ve ek hastalık varlığı açısından karşılaştırıldığında; REM ile ilişkili OUA grubunda yalnızca yaş ortalaması anlamlı olarak düşük bulundu. REM ile ilişkili OUA grubunun %87.3’ünde REM AHİ 15’in üzerinde; %39.3’ünde 30’un üzerindeydi. REM ile ilişkili OUA olgularında; REM AHİ ile gündüz aşırı uykululuk semptomu arasında anlamlı ilişki saptanmadı (p= 0.81). Sonuç: Hafif OUA olguları arasında, REM ile ilişkili OUA grubunun yaş ortalamasının daha düşük olması, REM OUA’nın “uykuda solunum bozuklukları spektrumunun erken bir işareti” olabileceğini düşündürebilir. Bu grup hastaların klinik takibinin bu sorunun cevabı açısından yararlı olacağı kanısındayız.

A 68 years old male farmer referred with cough, expectorating sputum, intermittant fever, night sweats, fatigue and anorexia persisting for two weeks. There was a history of 80 packs each year of smoking and he was still an active smoker. Pneumonectomy was performed because of pulmonary epidermoid cancer and he received chemotherapy. He was diagnosed lung tuberculosis and using anti-tuberculous treatment for 4 months. He had a weight loss of 8 kg in last month. His body tempereature was 38.5 °C. Heart rate was 100/min. ESR was 51mm/h and CRP was 5.6 mg/dL. There was no proliferation in blood and sputum cultures. Three sputum specimens were examined and AFB wasn't detected. Fibronodular infiltration was seen in right lower zone of chest X-ray. In thorax CT, fibronodular densities were seen in lower lobe anterior and posterior segments. Brucella melitensis was isolated in blood culture. Second bronchoscopy was performed with suspect of brucellosis pneumonia. Brucella tube agglutination test was positive at titer 1/320 in the bronchial lavage fluid and 1/640 in concurrent serum sample. In cases with chronic cough or pneumonia which is irresponsive to nonspecific antibiotherapy, respiratory brucellosis must be rememberred in endemic areas. © 2013 Asian Pacific Tropical Medicine Press.

Introduction: There is a high tendency for traffic accidents in patients with obstructive sleep apnea syndrome (OSAS). Thus it's recommended to investigate OSAS symptoms before certification of professional drivers. However, to what degree OSAS symptoms predict traffic accidents is not clear. We aimed to investigate the relationship between OSAS symptoms and traffic accidents. Materials and Methods: Five hundred twenty bus drivers working at Istanbul Electricity, Tramway and Tunnel (IETT) general management were randomly selected. Berlin questionnaire was applied which included demographic data, accident ratios, total duration in profession, duration of working in a day and OSAS symptoms. Epworth sleepiness score (ESS) test was applied to assess day time slepiness. Results: All drivers were male. Snoorring were present in 324 (65.7%) of participants. Traffic accident history were present in 259 (49.7%) of drivers. Significant relationship was present between traffic accident and only daytime sleepiness among the OSAS symptoms. The mean of accident/year ratio of all participants were 0.092. Mean of ESS was 7.3 ± 3.2 for all participants. There is a positive correlation between ESS and accident/year ratio (r= 0.57, p= 0.012). Conclusion: Only daytime sleepiness among OSAS symptoms is related with traffic accident. The questioning of OSAS symptoms alone is inadequate to estimate traffic accident risk. Thus further consideration more than symptom questioning is needed at phase of authorization of professional drivers to detect OSAS. Language: tr

The aim of this study was to identify the predictors of acute renal injury associated with colistin treatment. The patients who received treatment with colistin for more than 3 days were included in this retrospective cohort study. Acute renal injury was defined by the RIFLE (Risk Injury Failure Loss End stage renal disease) criteria. Patients whose serum creatinine levels increased at least 1.5-fold compared with baseline value were considered as cases with renal injury. The independent variables determining the development of acute renal injury were investigated by survival analysis. A total of 112 cases [67 (59.8 %) were male, median age 64 (range: 18–93) years] were included in the study. Acute renal injury occurred in 66 (58.9 %) patients. Renal injury developed in first 7 days of the colistin therapy in 52 (78.8 %) cases and at day 8–23 in 14 (21.2 %) cases. On the day with highest levels of creatinine, 25 (22.3 %), 17 (15.2 %), and 33 (29.5 %) cases were in ‘Risk’, ‘Injury’, and ‘Failure’ group, respectively, according to RIFLE criteria. We identified three independent risk factors predicting acute colistin-induced renal injury: advanced age, low serum albumin levels, and high serum total bilirubin levels [odds ratio (confidence interval) = 1.022 (1.006–1.037), 0.643 (0.415–0.994), and 1.129 (1.014–1.257), respectively]. The advanced age, low serum albumin levels, and high serum total bilirubin levels are independent risk factors for colistin-induced nephrotoxicity.

Fig. 1 – Chest X-ray imagination showing the borders of abscess which mimicks aortic aneurism. Drug resistance in tuberculosis is an exponential problem all around the world. Spondylodiscitis and osteomyelitis are other challenges for specialists to overcome. When the problem occurs due to multidrug-resistant tuberculosis (MDR), it appreciable grows. A 21-year-old man presented with sloping cervical mass. He was diagnosed with lymphadenitis caused by tuberculosis and taking antituberculosis drugs for 5 months. He received isoniazid, rifampin, ethambutol, and morfosinamide for 2 months and then continue with isoniazid and rifampin. At the end of second month the leakage stopped, but one month later, leakage from the lymphadenitis reoccurred. He had night sweats, and weight loss that never decreased with antibiotherapy. He presented with serious back pain since last year. He had no history of lung tuberculosis, but his family members presented with tuberculosis. His father had lung tuberculosis whereas his mother and sister had tuberculosis lymphadenitis. All of them received standard antituberculosis therapy and their therapy was successfully completed. In our patient computerized tomography (CT) scanning of thorax demonstrated a Pott abscess formation, nearly 15 cm length between thoracic vertebrae 5 and 11, which may be easily misdiagnosed as an aortic aneurism with the imagination on chest X-ray (Figs. 1 and 2). Microbiological sample was

Background: Obstructive sleep apnoea syndrome (OSAS) is a disorder characterized by repeated apnoeic episodes during sleep. Neurocognitive changes secondary to OSAS are likely to occur due to hypoxia in certain brain locations. Advances in magnetic resonance imaging technology, such as diffusion-weighted imaging (DWI), enable non-invasive and accurate identification of OSAS-induced changes. Objective: We aimed to use DWI to investigate changes in the brain secondary to hypoxia in OSAS. Methods: Eighty-eight patients underwent polysomnography and were classified as non-OSAS, mild-moderate OSAS and severe OSAS sufferers. DWI was used to evaluate 14 areas of the brain, and apparent diffusion coefficients (ADCs) were calculated. We investigated whether there were differences in the ADC values in specific areas of the brain between the non-OSAS and OSAS patients. Results: We measured the ADC values of the 68 newly diagnosed OSAS patients (21 mild, 15 moderate and 32 severe) and of 20 healthy controls. There were significant increases in the ADC values in the hippocampus, amygdala and putamen in OSAS patients. Compared to the non-OSAS subjects, the ADC values of the putamen in severe OSAS patients, those of the hippocampus in moderate or severe OSAS patients and those of the amygdala in moderate OSAS patients were significantly increased. A negative correlation between the lowest oxygen saturation during sleep and the ADC values of the hippocampus and amygdala was found. Conclusions: Increased ADC levels in the hippocampus, amygdala and putamen in OSAS patients indicate hypoxia and likely cause vasogenic oedema in specific regions of the brain.

Aims Type 2 diabetes mellitus and obstructive sleep apnea syndrome (OSAS) are serious comorbidities. Effects of OSAS on diabetic microvascular complications are ongoing research subjects. We evaluated the incidence of OSAS in Type 2 diabetes mellitus patients with nephropathy and with no renal involvement. Methods A total of 52 people with diabetes were enrolled in this study. Patients body mass indices were calculated and fasting glucose, glycosylated hemoglobin, urea, creatinine, total lipid profile, and urinary albumin excretion were evaluated. Full polysomnography was used to detect sleep disorders. Results Baseline characteristics and laboratory results of the patients were similar. Meeting criteria for OSAS was detected in 35 of the 54 patients (67.3%). 25 patients (48%) had mild, six patients (11.5%) had moderate, and four patients (7.7%) had severe sleep disorders. There was no significant relationship between respiratory obstructive parameters and microalbuminuria (R = 0.91, p = 0.362). Substantial correlation was detected between lower values of serum triglyceride levels and lower respiratory indices (R = 0.299, p = 0.031). Conclusions In type 2 diabetes accompanying OSAS affects glucose regulation but its effect on nephropathy development is currently a subject of research.

WOS: 000289216800003 PubMed: 21327675 Introduction: Transthoracic biopsy (TTB) is a well-defined and effective method used for pathologic sampling in the diagnosis of the pulmonary lesions. It is less invasive in comparison to surgical procedures. In addition, diagnostic rate of tru-cut biopsy is higher than that of fine needle aspiration biopsy (FNAB) especially for benign lesions. In this study, we presented tru-cut transthoracic biopsy (TTB) procedure results and the frequency of TTB complications with related risk factors. Material and methods:A total of 102 patients were evaluated by CT scan guided tru-cut TTB in the diagnosis of lung lesions between January 2003 and December 2007. The complications due to tru-cut TTB were recorded. The factors such as the lesion depth, the lesion size, and the emphysematous changes that accompany the lesion were evaluated through chi(2) test. Results: Among the samples, 51% malignancy and 49% benign pathology were observed. Pneumothorax developed in 15.7% of the 102 procedures. It was found that the lesion's distance from the pleura, the size of the lesion, and emphysematous changes around the lesion significantly increased the risk of pneumothorax. Discussion: The tru-cut biopsy complications are similar to those of FNAB. In the centers where cytologic examination is insufficient in the diagnosis of lung lesions, tru-cut biopsy should be routinely performed as it is a reliable biopsy technique compared to FNAB.