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Background/aim: Our aim is to determine the caregiver burden of chronic obstructive lung disease (COPD) patient's caregivers, and to determine whether there is a workday loss. Materials and methods: 252 COPD patients and their caregivers were included. Disease information of the patients were recorded and a questionnaire was applied. Socio-demographic characteristics of the caregivers were recorded and a questionnaire consisting of 24 questions including COPD disease, treatment and loss of working days, and the Zarit Scale were used. Results: 128(50.8%) of the patients according to GOLD were group-D, 97(38.5%) of the patient's relatives were working, 62(24.7%) were not able to go to work for 1-14 days, and 125(57.1%) spent outside the home from 1-14 nights, because those accompanied to patients. In univariate analysis were detected modified medical research council (mMRC) (p < 0.001), CAT (p < 0.001), the number of comorbidities of patients (p = 0.027), forced expiratory volume in 1 FEV1cc (p = 0.009), FEV1% (p < 0.001), the presence of long term oxygen therapy (LTOT), and the number of comorbidities of the patient's relatives (p = 0.06) increased the care load. In multiple linear regression analysis, age (p = 0.03), COPD assessment test (CAT) score (p = 0.001), FEV1% (

Purpose This study was performed to assess symptom variability and its impact on morning activities in stable patients with severe COPD in the Middle East and Africa (MEA) countries. Patients and methods Non-interventional, cross-sectional study (NCT03425760) in patients with severe COPD (GOLD 2015, C, or D categories). Symptom variability was assessed directly by interviewing the patient and using the Global Chest Symptoms Questionnaire (GCSQ). The impact on morning activities was assessed using the Capacity of Daily Living during the Morning (CDLM) and the Morning Activities and Symptoms Questionnaire (MASQ). Results A total of 3253 patients (mean±SD age: 64.1±9.5 years, 90.3% males) were enrolled. Overall, 81.6% and 83.4% of patients reported weekly and daily symptom variability, respectively. The number of exacerbations in the previous year, smoking cessation, and COPD GOLD D were the most consistent factors associated with symptom variability. The GCSQ score was significantly higher (p

Chronic obstructive pulmonary disease (COPD) is an important public health problem that manifests with exacerbations and causes serious mortality and morbidity in both developed and developing countries. COPD exacerbations usually present to emergency departments, where these patients are diagnosed and treated. Therefore, the Emergency Medicine Association of Turkey and the Turkish Thoracic Society jointly wanted to implement a guideline that evaluates the management of COPD exacerbations according to the current literature and provides evidence-based recommendations. In the management of COPD exacerbations, we aim to support the decision-making process of clinicians dealing with these patients in the emergency setting.

Aim: Our aim is to determine the risk factors for patients whose clinical stability can not be reached or whose can not be discharged with the optimal care. Material-Method: It is a multicenter, prospective observational study. 434 patients who were hospitalized (non-ICU) with severe exacerbation were included in the study. The primary endpoint for "difficult-to-manage COPD exacerbation" is prolonged hospitalization (PH). Hospitalizations of >8 days accepted as PH. To identify risk factors and to develop a scoring system that predicts PH. Results: 361 (83.2%) of the patients are male and the mean age is 69.2±9.3 year. 285 (67.2%) of the patients are in the GOLD-D group. There was prolonged hospitalization in 237 patients (54.6%). The factors related with PH are smoking,pathological X-ray,GOLDgroup C/D,high CRP, HAP,requiriment of NIV/parenteral nutrition,delaying examination. A combined scoring system that can predict the odds of PH is shown in Table1. The risk of PH increases 4 times in patients who score ≥3 (OR:3.9, 95%GA 2.5-61,P>0.001). Conclusion: Factors that can be related with PH for the COPD exacerbations should be evaluated in terms of patient, disease and hospital dynamics. We think that the scoring system developed in this study can be used to predict PH and therefore diffucult to manage COPD.

In this study,we aimed to evaluate the habits of all tobacco products,age of onset of smoking,duration of use,knowledge and awareness about tobacco products9 harm,level of addiction,health problems and desire to quit of Ege University Faculty of Health Sciences students. A cross-sectional,face-to-face survey with students studying in all classes of Ege University Faculty of Health Sciences students in 2018-2019 academic year.Of the 1137 (72.1% female) students,64.2% were never used tobacco products. Among the responders,14% of them were regular users,11.2% of occasional users,10.7% of them were quitters at the ages of 16-20(77%). The type of tobacco product was mostly filtered cigarettes (73.6%), 14.1% unfiltered cigarettes,8.2% hookah,3.1% cigar-pipe,1.0% electronic cigarettes. 60.9% of the students reported that they wanted to quit and 52.3% of them tried at least once.Nicotine addiction levels of students were very low (67.7%) and low (17.7%),and the dependency rate of male students was found to be significantly higher(p = 0.002).It was observed that 22.4% of them were moderate to severely depressed. The students stated that exposure to tobacco smoke was most frequently in cafes and secondly in the school canteens.85.4% of our students have very low/low level nicotine addiction and male students have a significantly higher dependency rate than female students.As a very important result, it is thought that all universities should be pioneer institutions to protect our youth from the epidemic of tobacco use with the goal of 9Smoke-Free University9.

Hashimoto’s Thyroiditis (HsT) is one of the most frequently occurring autoimmune diseases, characterized by lymphocytic infiltration, destruction and fibrosis of thyroid tissue and the presence of antibodies to thyroid peroxidase and thyroglobulin. The effects of euthyroid Hashimoto’s thyroiditis (eHsT) on cardiovascular system are unclear. We aimed to identify if any deteriorations in LA and LV myocardial functions in patients with eHsT by 3D-STE in the current study. Fifty eight patients with eHsT and 60 age- and gender-matched controls were enrolled into the study. All participants underwent laboratory analyses which included thyroid hormones and thyroid autoantibody levels; and conventional 2D echocardiographic and 3D-STE analyses were performed. The mean age of the study patients was 34.5 ± 9 years, and 68.6% were female. Left ventricular global longitudinal strain (LV-GLS) was significantly depressed in the eHsT (+) group than in the control group (? 15.3 ± 3.6 vs. ? 22.8 ± 3.8, p

Coronary artery tortuosity (CAT) is a common finding in coronary angiography, and is defined as three fixed bends during both systole and diastole in at least one epicardial coronary artery, with each bend showing a 45° change in vessel direction. The impact of CAT on the myocardial deformation has not been completely evaluated using 3D-STE. As a result of this, we aimed to assess the effects of CAT on LV functions using 3D-STE in the present study. Eighty-two patients with CAT and 80 age- and gender-matched controls who proved to have normal coronary angiograms were enrolled into the study. 3D-STE was performed and LV-GLS, LV-GCS, LV-GAS, and LV-GRS were obtained for every patient after coronary angiography. The LV-GLS was significantly depressed in the CAT (+) group than in the control group (p = 0.001). ROC analysis was performed to find out ideal LV-GLS cut off value to predict the presence of CAT. A LV-GLS value of > ? 17 has 81.3% sensitivity, 56.7% specificity to detect the presence of CAT. The present study is the first to focus on the assessing LV myocardial functions in patients with CAT by 3D-STE. CAT has a considerable negative effect on LV myocardial longitudinal deformation as evaluated by 3D strain parameters. Our results support that patients with CAT may have subclinical LV longitudinal deformation abnormalities even though they are apparently healthy. © 2020, Springer Nature B.V.

[No Abstract Available]

It has been more than 3 months now since the first case of COVID-19 was reported in Turkey. Globally, the number of confirmed cases and deaths reached 9,653,048 and 491,128 respectively, as reported by 216 countries by June 27, 2020. Turkey had 1,396 new cases, 194,511 total cases, and 5,065 deaths by the same date. From the first case until today, the Turkish Thoracic Society (TTS) has been very proactive in educating doctors, increasing public awareness, undertaking academic studies, and assisting with public health policies. In the present report, social, academic, and management perspectives of the pandemic are presented under appropriate subtitles. During this critical public health crisis, TTS has once again demonstrated its readiness and constructive stance by supporting public health, healthcare workers, and the environment. This review summarizes the perspective of TTS on each aspect of the COVID-19 pandemic and casts light on its contributions. C1 [Kokturk, Nurdan] Gazi Univ, Sch Med, Dept Pulm Med, Ankara, Turkey. [Itil, Bahriye Oya; Ergan, Begum; Kilinc, Oguz; Simsek, Gokcen Omeroglu; Ucan, Eyup Sabri] Dokuz Eylul Univ, Sch Med, Dept Pulm Med, Izmir, Turkey. [Altinisik, Goksel] Pamukkale Univ, Sch Med, Dept Pulm Med, Denizli, Turkey. [Adiguzel, Nalan; Karkurt, Zuhal] Univ Hlth Sci, Istanbul Sureyyapas Chest Dis Training & Res Hosp, Dept Intens Care Unit Pulm Med, Istanbul, Turkey. [Akgun, Metin] Ataturk Univ, Dept Pulm Med, Sch Med, Erzurum, Turkey. [Akyildiz, Levent] Mem Dicle Hosp, Clin Pulm Med, Diyarbakir, Turkey. [Altin, Sedat; Akyil, Fatma Tokgoz] Univ Hlth Sci, Yedikule Chest Dis & Chest Surg Training & Res Ho, Dept Pulm Med, Istanbul, Turkey. [Arikan, Huseyin] Yuzuncu Yil Univ, Dursun Odaba Med Ctr, Med Intens Care Unit, Van, Turkey. [Ates, Gungor] Sultan Hosp, Dept Pulm Med, Diyarbakir, Turkey. [Ay, Pinar] Marmara Univ, Sch Med, Dept Publ Hlth, Istanbul, Turkey. [Aykac, Nilufer] Gayrettepe Florence Nightingale Hosp, Clin Pulm Med, Istanbul, Turkey. [Babayigit, Cenk] Mustafa Kemal Univ, Sch Med, Dept Pulm Med, Antakya, Turkey. [Bostan, Pinar] Istanbul Bilgi Univ, Sch Hlth Sci, Istanbul, Turkey. [Cinel, Guzin] Ankara Yildirim Beyazit Univ, Sch Med Ankara, Dept Pediat Pulmonol, Ankara, Turkey. [Calisir, Haluk Celaleddin] Yapi Kredi Hlth & Retirement Fdn, Istanbul, Turkey. [Celik, Pinar; Gultekin, Okkes; Havlucu, Yavuz; Yorgancioglu, A. Arzu] Celal Bayar Univ, Sch Med, Dept Pulm Med, Manisa, Turkey. [Cetinkaya, Pelin Duru] Univ Hlth Sci, Adana City Training & Res Hosp, Dept Pulm Med, Adana, Turkey. [Dagli, Elif] Turkish Thorac Soc, Ankara, Turkey. [Demir, Ahmet Ugur] Hacettepe Univ, Sch Med, Dept Pulm Med, Ankara, Turkey. [Demir, Canan; Sandal, Abdulsamet] Occupat & Environm Dis Hosp, Clin Occupat Dis, Ankara, Turkey. [Dikensoy, Oner] Acibadem Univ, Sch Med, Dept Pulm Med, Istanbul, Turkey. [Edis, Ebru Cakir] Trakya Univ, Sch Med, Dept Pulm Med, Edirne, Turkey. [Elbek, Osman] Kadikoy Florence Nightingale Hosp, Clin Pulm Med, Istanbul, Turkey. [Erdinc, Munevver; Goksel, Tuncay; Gurgun, Alev; Basoglu, Ozen K.; Sayiner, Abdullah] Ege Univ, Sch Med, Dept Pulm Med, Izmir, Turkey. [Eyuboglu, A. Fusun Oner] Baskent Univ, Sch Med, Dept Pulm Med, Ankara, Turkey. [Gemicioglu, Bilun] Istanbul Univ Cerrahpasa, Cerrahpasa Sch Med, Dept Pulm Dis, Istanbul, Turkey. [Gulhan, Erkmen] Ataturk Chest Dis & Thorac Surg Training & Res Ho, Dept Thorac Surg, Ankara, Turkey. [Gurkan, Canan Gunduz; Yildiz, Tekin] Univ Hlth Sci, Sureyyapasa Chest Dis & Thorac Surg Training & Re, Dept Pulm Med, Istanbul, Turkey. [Karakurt, Sait] Marmara Univ, Sch Med, Dept Intens Care Unit Pulm Med, Istanbul, Turkey. [Kocabas, Ali] Cukurova Univ, Sch Med, Dept Pulm Med, Adana, Turkey. [Kul, Seval] Gaziantep Univ, Sch Med, Dept Biostat, Gaziantep, Turkey. [Nayci, Sibel] Mersin Univ, Sch Med, Dept Pulm Med, Mersin, Turkey. [Ozkan, Metin] Ankara Mem Hosp, Clin Pulm Med, Ankara, Turkey. [Pinarer, Ozgun] Galatasaray Univ, Sch Engn, Istanbul, Turkey. [Salturk, Cuneyt] Istanbul Yeni Yuzyil Univ, Sch Med, Dept Pulm Med, Istanbul, Turkey. [Sen, Elif] Ankara Univ, Sch Med, Dept Pulm Med, Ankara, Turkey. [Karadag, Bulent Taner] Marmara Univ, Sch Med, Dept Pediat Pulmonol, Istanbul, Turkey. [Toreyin, Zehra Nur] Hlth Sci Univ, Adana City Training & Res Hosp, Dept Occupat Dis, Ankara, Turkey. [Varol, Ayhan] Kepez State Hosp, Clin Pulm Med, Antalya, Turkey. [Yasin, Yesim] Acibadem Univ, Sch Med, Dept Publ Hlth, Istanbul, Turkey. [Bayram, Hasan] Koc Univ, Sch Med, Dept Pulm Med, Istanbul, Turkey.

This study evaluated whether subclinical myocardial dysfunction occurs in first-degree relatives of patients with idiopathic dilated cardiomyopathy (IDCM), using strain echocardiographic imaging, before apparent left ventricular (LV) failure is observed. The study comprised 77 subjects aged 16–63 years who had first-degree relatives with a previous or new diagnosis of IDCM. LV myocardial deformation parameters of the first-degree relatives with normal LVEF (≥55%) values, as assessed using 2D echocardiography, were evaluated. The findings of the first-degree relatives were compared with an age- and sex-matched control group (n = 86). No difference in terms of age, gender, and body surface area was detected between first-degree relatives and controls. First-degree relatives of IDCM patients had significantly lower LVEF (62.04 ± 5.8% vs. 65.65 ± 6.3%, p

Introduction We aimed to determine the smoking prevalence and related factors among 1,2,3 and 6th grade students at Ege University Faculty of Medicine. Methods This cross-sectional survey was a part of a multi-centre study throughout Turkey and the data were collected in May-June 2018. The target group of this study was 1537 medical students studying in the first, second, third and sixth grades. Questionnaires were applied to 1040 students (67.7%) who agreed to participate in the study. The coverage was 94.5%, 78.6%, 57.4%, 36.7% for the first, second, third and sixth grades, respectively. Results The overall prevalence of smoking was 18.4%, with 18.1%, 18.6%, 17.0% and 22.1% in the first, second, third and sixth grades, respectively. The mean age at starting to smoke was 16.5±2.3 yrs (min.8, max.23). Current smoking was more prevalent in males compared to females (24.3% vs. 11.7%, p

28th International Congress of the European-Respiratory-Society (ERS) -- SEP 15-19, 2018 -- Paris, FRANCE, WOS: 000455567105150, …, European Respiratory Soc

Efforts are made to define COPD patient subgroups who have distinct prognostic characteristics or who display distinct responses to treatments. Blood eosinophilia and neutrophil-to-lymphocyte ratio (NLR) are proposed as potential biomarkers that can be used to predict disease progression and/or responses to inhaled steroid treatment. There is little data regarding the stability of these two biomarkers over time. This study thus aimed to determine the repeatibility of these biomarkers and their relation to clinical outcomes. Fifty COPD patients who had regular assessments during two years were included in the study and their findings were retrospectively examined. As part of their regular visits, all patients had spirometry, blood counts; CAT scores and history of exacerbations were noted. Forty-four of the patients had full data from four visits and six patients from two visits. Blood eosinophilia was assessed at cut-off points of 2, and 3% and 200 and 300/mm3. Neutrophil-to-lymphocyte ratio was assessed at a cut-off point of 3.3. Repeatibility was defined as agreement of at least three of four measuements (patients with four visits) or of both measurements (patients with two visits). With a cut-off point of 2%, 44 and 40% of the patients were consistently eosinophilic and non-eosinophilic. Less than 20% of the patients had variable results over time when other cut-off points were used. Regarding NLR, 20 and 62% of the patients had consistently high and low values, respectively. Neither consistent eosinophilia nor elevated NLR were associated with the frequency of exacerbations, yearly FEV1 change or CAT scores. Both biomarkers are repeatable but are not associated with relevant clinical outcomes.

WOS: 000437792300011, PubMed ID: 31453507, Objectives: This study aims to compare the effects of pulmonary rehabilitation (PR) in patients with mild-to-moderate and severe-to-very severe chronic obstructive pulmonary disease (COPD). Patients and methods: Between January 2005 and December 2010, a total of 76 patients with mild-to-moderate (Global Initiative for Chronic Obstructive Lung Disease [ GOLD] Stages I+II, n=33, mean age 66.0 +/- 8.6 years) and severe-to-very severe (GOLD Stages III+IV, n=43, mean age 63.5 +/- 8.8 years) COPD completed an eight-week outpatient PR program. Incremental and endurance shuttle walk tests (ISWT, ESWT), St. George's Respiratory Questionnaire (SGRQ), Chronic Respiratory Questionnaire (CRQ), and Hospital Anxiety and Depression Scale were assessed before and after PR. Changes after the intervention were compared between two groups. Results: There were significant improvements in the ISWT and median 60 m [(-150)-(400)] in mild-to-moderate group and 70 m [(0)-(270)] in severe-to-very severe group (both, p

Background: Readmission to the hospital is one of the most important problems in chronic obstructive pulmonary disease (COPD) patients receiving long-term oxygen therapy (LTOT) and noninvasive ventilation (NIV). The aim of this trial is to find out whether a structured discharge and follow-up protocol reduce the rate of unplanned, COPD-related hospital readmissions over 90 days in patients receiving LTOT and/or NIV. Herein the results of the interim analysis are presented. Method: The study was planned as Turkish Thoracic Society and GARD-Turkey project and carried out 10 centers throughout Turkey. COPD patients who were prescribed LTOT and/or NIV were included and randomized to either intervention or control arm. The intervention mainly consisted of detailed training before discharge and close follow-up strategy. Control patients received usual care, which consisted of basic education of the patient about the therapies. Results: A total of 112 patients were included in the study within the first year and data analysis was performed in 65 patients (control group 26, intervention group 39) who finished the study period. It was observed that there was no difference between the study groups for subjective outcomes and the median duration of LTOT/NIV use. The hospital readmission and hospitalization rates were 30.7% and 11.5% in control group and 15.4% and 5.1% in the intervention group, respectively. Conclusion: The preliminary results showed that structured discharge and follow up protocol might be a helpful approach for prevention of recurrent admissions in COPD patients with chronic respiratory failure

WOS: 000366030500001, PubMed ID: 26622176, Objective: To determine distribution of COPD assessment categories and physicians' adherence to Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2013 strategy in Turkish COPD patients. Methods: A total of 1,610 COPD patients (mean [standard deviation] age: 62.6 [9.9] years, 85.7% were males) were included in this multicenter, non-interventional, cross-sectional study. Patients were categorized via GOLD 2013 strategy document. Consistency between reported and re-classified GOLD categories, and measures used for symptom evaluation and exacerbation was analyzed. Results: Overall, 41.1% of patients were assigned to GOLD A, while 13.2% were assigned to GOLD C categories. Long-acting beta-2 agonist + long-acting muscarinic antagonist + inhaled corticosteroid regimen was the most common treatment (62.0%). Over-treatment was noted in > 70% of GOLD A, B, and C patients. A high consistency between measures of symptom evaluation (Kappa coefficient = 0.993, P < 0.0001) and a low-moderate consistency between exacerbation risk measures (Kappa coefficient = 0.237, P < 0.0001) were noted. Conclusion: Our findings revealed GOLD A as the most prevalent category in Turkish cohort of COPD patients. Group assignment was altered depending on the chosen measure for symptom and risk assessment. Physician non-adherence to treatment recommendations in GOLD 2013 document leading to over-treatment in patients assigned to GOLD A, B, and C categories was also detected., Novartis Pharmaceuticals Turkey, The study is funded by Novartis Pharmaceuticals Turkey. We thank Cagla Ayhan, MD and Prof Sule Oktay, MD, PhD from KAPPA Consultancy Training Research Ltd, Istanbul who provided editorial support and Mehmet Berktas, MD, MICR from KAPPA Consultancy Training Research Ltd, Istanbul who performed statistical analysis funded by Novartis Pharmaceuticals Turkey.

WOS: 000351491700014, PubMed ID: 24671901, Background: We evaluated the associations among the well-known atrial fibrillation (AF) predictors including P-wave dispersion (PWD), intra- and inter-atrial electromechanical dyssynchrony (EMD), left atrial (LA) phasic functions, and plasma N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) levels, in patients with hypertrophic cardiomyopathy (HCM). Methods: Seventy patients with HCM and age and sex matched 70 subjects were enrolled. PWD, LA total emptying fraction (LATEFr), active emptying fraction (LAAEFr), passive emptying fraction (LAPEFr), expansion index (LAEI) intra-and inter-atrial EMD were calculated. Levels of NT-proBNP of all subjects were determined. Results: Higher PWD (p = 0.006), significantly decreased LAEI (p < 0.001), LATEFr, and LAPEFr (both p values < 0.001) values and significantly increased inter-atrial (p < 0.001), LA (p = 0.001), and right atrial dyssynchrony (p < 0.001) were observed in the HCM group compared to controls. PWD was negatively correlated with LAEI (r = -0.236, p = 0.005) and LATEFr (r = -0.242, p = 0.04), however not with LAPEFr (p = 0.7), or LAAEFr (p = 0.3). Except for the LA lateral wall PA' (r = 0.283, p = 0.02), PWD was not correlated with any atrial EMD parameter. Inter-atrial dyssynchrony was related to LAEI (r = -0.272, p = 0.001), LATEFr (r = -0.256, p = 0.03), and LAPEFr (r = -0.332, p = 0.006), but not, however, to LAAEFr (p = 0.4). The plasma NT-proBNP levels of patients were not correlated with either PWD (p = 0.927) or inter-atrial dyssynchrony (p = 0.102). Conclusions: PWD and inter-atrial dysynchrony seem to independently promote AF, although both are associated with LA reservoir function in HCM populations. The NT-proBNP level is not associated with these two AF predictors in patients with HCM. NT-proBNP seems to be a poor marker of atrial electrical remodeling in HCM patients., Ege UniversityEge University [11-TIP-044], This study was supported by a grant from Ege University (11-TIP-044) and we would like to thank to Dr Raika Durusoy for her guidance in statistical analysis.

WOS: 000417875700007, PubMed ID: 29145216, Objective: This study compared the efficacy and safety of warfarin in specialized international normalized ratio (INR) outpatient clinic (INR-C) and in general cardiology outpatient clinic (General-C). Methods: Herein, 381 consecutive patients with a regular follow-up at INR-C (n=233) or General-C (n=148) for at least 1 year were retrospectively included. While INR-C patients were followed by a single experienced trained nurse, General-C patients were followed by a different cardiologist who worked in a rotational principle every month. During controls, demographic characteristics, INR levels, bleeding events, ischemic stroke, and transient ischemic attacks in the last 1 year were recorded. Primary endpoint was defined as the evaluation of the combined major bleeding and ischemic event, and secondary endpoint was defined as the evaluation of them separately. Results: The mean age of the patients was 62 +/- 12.86 and 43.8% were male. Mean time in therapeutic range (TTR) level was statistically higher in INR-C than that in General-C (68.8%+/- 15.88 and 51.6%+/- 23.04, respectively; p

WOS: 000399794400008, PubMed ID: 29404162, Since the Global Initiative for Obstructive Lung Disease (GOLD) published its first guidelines on chronic obstructive pulmonary disease (COPD) in 2001, much has changed till 2017. Previous versions of GOLD guidelines mentioned the forced expiratory volume in one second (FEV1)-based approach for staging and treatment modalities. Since 2011, a composite multi-dimensional approach has been introduced to cover various aspects of the disease. Unfortunately, this approach was not found to be correlated with mortality as well as the FEV1 -based approach, despite the fact that it was better for estimating exacerbation rates. Although this assessment tool has been considered as a big step in personalized medicine, the system was rather complex to use in daily practice. In 2017, GOLD introduced a major revision in many aspects of the disease. This mainly includes a revised assessment tool and treatment algorithm. This new ABCD algorithm has excluded spirometry for guiding pharmacological therapy. Treatment recommendations are mainly based on symptoms and exacerbation rates. Escalation and de-escalation strategies have been proposed for the first time. The spirometric measurement has only been retained to confirm the diagnosis and lead to nonpharmacological therapies. In this report, the Turkish Thoracic Society COPD assembly aimed to summarize and give an insight to the Turkish interpretation of GOLD 2017.

European-Respiratory-Society (ERS) International Congress -- SEP 28-OCT 02, 2019 -- Madrid, SPAIN, WOS: 000507372403105, [No abstract available], European Respiratory Soc

Introduction Ventilator associated pneumonia (VAP) is one of the most important causes of mortality in patients treated with invasive mechanical ventilation (IMV) in intensive care unit (ICU). Microbiological examinations are required as clinical and radiological findings are usually insufficient in the diagnosis. Materials and methods Twenty four patients who were receiving IMV because of respiratory failure, had a Clinical Pulmonary Infection Score (CPIS) of ≥ 6 in the follow-up and died with the suspicion of VAP were enrolled in our study. Six patients were excluded as post-mortem biopsy could not be performed. The patients who had pre-mortem CPIS ≥ 6, in whom a causative organism was identified from the culture of post-mortem lung biopsy and/or histopathological examination of lung biopsy was compatible with pneumonia were diagnosed as VAP. In the 18 patients in whom a post-mortem lung biopsy was performed, quantitative culture results of endotracheal aspirate performed 48 hours prior to death were compared with microbiological and histopathological results of post-mortem lung biopsy specimens, and the role of endotracheal aspirate in the diagnosis of VAP was evaluated retrospectively. Results Out of 18 patients (12 men, mean age 67.0 ± 13.0 years) included in the study, 11 (61.1%) were diagnosed as VAP. The quantitative culture of endotracheal aspirate was positive in 9 (81.8%) out of 11 patients diagnosed as VAP. The sensitivity, specificity, positive and negative predictive values of endotracheal aspirate culture for identifying VAP were found to be 81.8%, 14.3%, 60.0% and 33.3%, respectively. Conclusion Our study shown that quantitative culture of endotracheal aspirate is a practical and reliable method that can be used for the diagnosis of VAP in patients receiving IMV in ICU and having CPIS ≥ 6.

Background and objective Nutritional depletion in chronic obstructive pulmonary disease (COPD) adversely affects health status and mortality. We aimed to evaluate the effects of nutritional supplementation (NS) with pulmonary rehabilitation (PR) on body composition, mid-thigh cross-sectional area (CSA), dyspnoea, exercise capacity, health-related quality of life, anxiety and depression in advanced COPD patients. Methods Forty-six patients were randomized to PR and nutritional support (PRNS), PR or the control group. Dyspnoea was measured with Medical Research Council and BORG scales. Exercise capacity was measured through 6-min walk test and shuttle tests; health-related quality of life was assessed with St. George's Respiratory Questionnaire. Psychological status was measured with Hospital Anxiety and Depression Scale. Body weight and body mass indexes (BMI) were also evaluated. Fat-free mass was measured through bioelectrical impedance analyser. The CSA of quadriceps was calculated in mid-level of the thigh with magnetic resonance imaging. Results Dyspnoea and total scores of St. George's Respiratory Questionnaire improved in both groups (P

An increase in intraocular pressure following cataract surgery is very common. The main reason for this condition is viscoelastic agent remaining in the eye, which leads to mechanical obstruction of the trabecular meshwork. Prophylaxis with oral acetazolamide is frequently practised to prevent this early rise in intraocular pressure in the preoperative and postoperative periods. We report a case of an 81-year-old man with acute pulmonary oedema due to prophylactic acetazolamide intake after cataract surgery. The case is presented in order to draw attention to this serious complication.

The present case-control study aimed to evaluate comparatively the salivary and serum levels of matrix metalloproteinases (MMP)-8 and- 13 and tissue inhibitor of matrix metalloproteinase-1 (TIMP-1) in patients with mild chronic obstructive pulmonary disease (COPD) and non-COPD controls.Clinical periodontal measurements were recorded before any periodontal intervention in 36 patients with mild COPD and 20 non-COPD controls admitted to Ege University Department of Chest Diseases COPD outpatient clinic (İzmir, Turkey). Salivary and serum levels of MMP-8, MMP-13, and TIMP-1 were determined by immunofluorometric assay (IFMA) and enzyme-linked immunosorbent assay (ELISA). Data were analyzed with non-parametric statistical tests.Patients with COPD were significantly older than the control group (p0.05). The COPD group showed significantly higher serum levels of MMP-8 IFMA, MMP-8/TIMP-1 IFMA than the control group (p0.005). By ELISA, serum MMP-8, MMP-8/TIMP-1, TIMP-1, and MMP-13 levels were similar in both groups (p0.05). Salivary MMP-8, MMP-13, and TIMP-1 levels were similar in both groups (p0.05).The present findings suggest that immunodetection of MMP-8 is dependent on the selected techniques and even with mild COPD some systemic inflammatory markers such as MMP-8 tend to increase. However, the present clinical periodontal and biochemical findings do not provide support for the previously proposed interaction between COPD and periodontal diseases.

Health-care-associated pneumonia (HCAP) is defined as pneumonia that develops in patients with a history of recent hospitalization, hemodialysis as an outpatient, residence in a nursing home, outpatient intravenous therapy and home wound care. We aimed to compare the initial demographic characteristics, causative agents and prognosis between hospitalized HCAP and community-acquired pneumonia (CAP) patients. HCAP and CAP patients hospitalized between 01 September 2008-01 September 2009 were evaluated retrospectively. Out of 187 patients (131 males, mean age 66.3 ± 14.3 years) who were hospitalized during one-year period, 98 were diagnosed as HCAP and 89 as CAP. Among HCAP patients, 64 (65.3%) had a history of hospitalization in the last 90 days, 26 (26.5%) received outpatient intravenous therapy, 17 (17.3%) had home wound care, 6 (6.1%) were on hemodialysis program in the last 30 days and 4 (4.1%) lived in a nursing home. The causative pathogen was detected in 39 (39.8%) HCAP and 8 (9.0%) CAP patients. The most frequently isolated microorganisms were Pseudomonas aeruginosa and Acinetobacter baumannii in HCAP, and Streptococcus pneumoniae and Haemophilus influenzae in CAP patients. Inappropriate empiric antibiotic treatment was documented in 8 (25.8%) of 39 HCAP patients, in whom a causative agent was isolated whereas the antibiotic treatment was appropriate in all CAP patients. The duration of hospitalization (14.4 ± 11.4 vs. 10.7 ± 7.9 days, p= 0.011) and mortality rate (34.7% vs. 9.0%, p< 0.001) were higher in HCAP compared with CAP patients. As HCAP is different than CAP in terms of patients' characteristics, causative microorganisms and prognosis, it should be considered in all patients hospitalized as CAP. Potentially drug-resistant microorganisms should be taken into consideration in the empirical antibiotic treatment of these patients.

WOS: 000370844800007, PubMed ID: 29404083, Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality in the world. Research conducted over the past decade has contributed much to our current knowledge of the pathogenesis and treatment of COPD. Additionally, an evolving literature has recently accumulated information about the management of COPD and also about exacerbations. This article reviews a concise summary on the updates in COPD including 1) new pathogenic mechanisms and therapeutic targets, 2) management of patients in Group B, C and D according to GOLD 2014 report; 3) prevention and management of exacerbation; 4) monitoring of natural history; and 5) essential but usually forgotten parts of the management.

In this study, efficacy of the angiotensin II type 1 receptor blocker telmisartan given as monotherapy was compared with that of perindopril monotherapy in patients with mild-to-moderate hypertension. After a 2-week, single-blind, placebo run-in period, 60 patients were randomised to double-blind, once-daily treatment with telmisartan 80 mg or perindopril 4 mg for 6 weeks. Clinic and ambulatory blood pressure measurements and clinical laboratory evaluation were performed at the end of the placebo run-in and active treatment phases. Both telmisartan and perindopril significantly (p < 0.0001) reduced clinic systolic blood pressure (SBP) and diastolic blood pressure (DBP) compared with baseline values. Also, both drugs significantly (p < 0.0001) reduced 24-h mean ambulatory SBP and DBP compared with baseline. Comparison of the mean hourly antihypertensive activities showed that the reduction in mean ambulatory DBP for the last 8 h of the dosing interval was significantly greater (p < 0.05) in telmisartan-treated patients. A 24-h mean DBP of

Background: Secondary pulmonary hypertension (PH) and cor pulmonale are the major clinical cardiovascular complications affecting prognosis in patients with chronic obstructive pulmonary disease (COPD). It is also known that endothelin-1 (ET-1) is a potent vasoconstrictor peptide produced by the pulmonary vascular endothelium, and ET-1 may be implicated in the pathogenesis of PH. Objectives: The purpose of this study was to investigate the presence of ET-1 in patients with COPD and to assess the correlation of ET-1 levels in the plasma and bronchoalveolar lavage (BAL) fluid (BALF) in COPD patients with or without PH. Methods: Twenty-two patients with COPD and 15 healthy controls were enrolled in the study. Peripheral venous blood samples were collected in all patients and controls. BAL was obtained in COPD patients, and ET-1 levels were measured by radioimmunoassay in all plasma and BALF samples. Results: Plasma ET-1 levels were 2.46 ± 0.55 and 1.70 ± 0.42 pmol/dl in patients with COPD and controls, respectively (p < 0.0001). Sixteen of the 22 patients with COPD (73%) had PH established by echocardiography. The ET-1 level in these patients amounted to 2.59 ± 0.50 pmol/dl, and it was 2.10 ± 0.54 pmol/dl in 6 patients with COPD without PH. In COPD patients with and without PH, BALF ET-1 levels were 0.19 ± 0.08 and 0.24 ± 0.01 pmol/dl, respectively (p > 0.05). Conclusions: These results suggest that ET-1 is detectable in both the peripheral blood and BALF of COPD patients, but the levels do not statistically differ between patients with and without PH.

Left ventricular hypertrophy (LVH) increases the risk of ventricular arrhythmias and sudden death and has a significant effect on total cardiovascular mortality. QT dispersion (QTd) is a measure of inhomogeneous repolarization and is used as an indicator of arrhythmogenicity. In this study we detected QTd in patients with different etiologies of left ventricular hypertrophy and the effect of LVH in QTd on endurance athletes. The study group consisted of 147 white male subjects with 3 different etiologies of LVH and 30 healthy male individuals. The underlying etiologies of LVH were essential hypertension, valvular aortic stenosis and long-term training (athletic heart). QTd was measured by surface electrocardiogram and Bazett's formula was used to correct QTd for heart rate (QTcd). Left ventricular mass was determined by transthoracic echocardiography and left ventricular mass index was calculated in relation to body surface area. The QTcd was significantly higher in patients with pathological LVH (due to hypertension and aortic stenosis) than in the athletes' group (physiological LVH) and healthy subjects (P0.05). The magnitude of QTcd was similar between athletes and the control group (P=0.6). The difference of QTcd between the groups with pathological LVH was not statistically significant (P=0.1). In conclusion; the increasing of QT dispersion is associated with only pathological conditions of LVH. The left ventricular hypertrophy has not a negative effect in QT dispersion on endurance athletes. The measurement of QT dispersion may be a non-invasive useful method for screening additional pathological conditions in endurance athletes.

Background: The high incidence of ventricular arrhythmias in patients with hypertension and left ventricular hypertrophy (LVH) is well documented. However, few studies have been conducted on the prevalence of ventricular arrhythmias in patients with isolated systolic hypertension without LVH. Objectives: The objectives of this study were to (1) determine the prevalence of ventricular arrhythmias in patients with systolic hypertension without LVH and (2) estimate the effect of a perindopril/indapamide combination, which does not have an antiarrhythmic effect, on the incidence of ventricular arrhythmias. Methods: Patients with newly diagnosed isolated systolic hypertension (systolic blood pressure [SBP] >160 mm Hg) and a control group of normotensive patients were enrolled. During the 2-week washout period, patients underwent physical examination (including blood pressure measurements), ambulatory electrocardiography monitoring, echocardiography, and laboratory urine and blood tests. Absence of LVH was confirmed by echocardiographic examination. The group of hypertensive patients received 1 tablet of 2 mg perindopril/0.625 mg indapamide per day for a total of 4 weeks. Physical examinations and ambulatory electrocardiographic monitoring were repeated after treatment. Results: A total of 60 hypertensive (mean age, 63.1 years; mean SBP, 176.8 ± 3.1 mm Hg; mean diastolic blood pressure, 82.6 ± 2.9 mm Hg) and 60 normotensive patients were enrolled. Ambulatory electrocardiographic monitoring indicated that 18 of the 60 hypertensive patients (30%) had ventricular arrhythmias: 17 had ventricular premature contractions (>100/24 h) and 1 had ventricular tachycardia plus ventricular premature contractions. In the control group, 7 of 60 subjects (11.7%) had ventricular premature contractions. The difference between the 2 groups in incidence of ventricular arrhythmias was significant ( P P Conclusions: The results of this study suggest that in patients with isolated systolic hypertension without LVH, (1) the prevalence of ventricular arrhythmia is higher than in normotensive patients and (2) treatment with perindopril/indapamide decreases the incidence of ventricular arrhythmias.

Behcet's disease is a chronic multi-system disease presenting with recurrent oral and genital ulceration, and relapsing uveitis. Cardiac involvement is an extremely rare manifestation of this disorder. We report an unusual case of Behcet's disease characterized by a mural cardiac thrombi in the right atrium and right ventricle along with transient protein C and S deficiency.

We retrospectively analyzed the blood pressure (BP) and cardiothoracic index (CTi) of 67 hemodialysis patients with hypertension who could be followed up for at least 8 months. A new treatment policy was adopted, aimed at strict volume control. Dietary salt restriction was strongly emphasized. Ultrafiltration (UF) was applied during regular dialysis sessions and sometimes in additional sessions, as long as BP and CTi remained at greater than normal values. All antihypertensive drugs were discontinued at the beginning of treatment. Average BP decreased from 173 ± 17/102 ± 9 to 139 ± 18/86 ± 11 mm Hg after 6 months and to 118 ± 12/73 ± 6 mm Hg after 36 months. Corresponding values for CTi were 52% ± 4%, 47% ± 3%, and 42% ± 4%, respectively. Conventional relatively short dialysis (three times weekly for at least 4 hours) can achieve normal BPs with prolonged effort in most patients, whereas improvement in heart condition facilitates this.

Spontaneous echo contrast (SEC) may be detected by ultrasonography in environments favoring blood stasis. It is most commonly seen through the use of transesophageal echocardiography in the left atrium of patients with rheumatic mitral valve disease especially in the presence of atrial fibrillation. We studied the predictors of SEC, such as cardiac rhythm, left atrium and left atrial appendage functions, and mitral and pulmonary vein flow parameters, in patients with rheumatic mitral valve disease. The relationship between these parameters and the severity of SEC and appearance of thrombus was evaluated.

A 56-year-old man with history of coronary bypass 6 years ago and ICD implantation 5 months ago was admitted to hospital after hearing a beeping from the ICD. On chest x-ray, the tip of the lead had migrated out of the heart silhouette. Percutaneous lead extraction was performed under close monitoring and fully equipped for pericardiosynthesis and resuscitation with on standby surgical backup. Although right ventricle perforation is a rare complication of pacemaker implants, regardless of the lead fixation mechanism, the possibility of perforation should always be considered.

Pentalogy of Cantrell is a rare syndrome characterized by defects involving the abdominal wall, lower sternum, diaphragm, pericardium, as well as congenital cardiac anomalies. Tetralogy of Fallot is a cardiac anomaly consisting of a ventricular septal defect (VSD), dextroposition of the aorta, obstruction to the pulmonary blood flow, and right ventricular (RV) hypertrophy. Addition of atrial septal defect (ASD) to these anomalies is called pentalogy …

To evaluate causes of noninvasive mechanical ventilation (NIMV) failure. The rate of NIMV failure in respiratory failure due to chronic obstructive pulmonary disease (COPD) exacerbations was reported as 5%-40%. Materials and methods: The necessity of endotracheal intubation was accepted as NIMV failure. The causes of NIMV failure were assessed in 54 patients (45 males; mean age: 67.7 ± 11.0 years) treated with NIMV because of COPD exacerbations and respiratory failure in an intensive care unit (ICU). Results: There was NIMV failure in 20 patients (37.0%). The rates of hospital-acquired pneumonia and in-hospital mortality were higher (P = 0.003 and P = 0.002, respectively) and the duration of ICU stay was longer (P < 0.0001) in patients with NIMV failure. On admission, arterial pH, serum albumin, and Glasgow Coma Scale levels were lower (P = 0.032, P = 0.024, and P = 0.013, respectively) in the NIMV failure group. Arterial pH was lower (P = 0.039) and respiratory rate was higher (P = 0.010) after 1 h, and the PaO2/FiO2 rate was lower (P = 0.017) and respiratory and heart rates were higher (P = 0.002 and P = 0.020, respectively) after 3 h in the NIMV failure group. Conclusion: The present data strongly suggest that baseline and follow-up clinical and arterial blood gas evaluations can give important clues about NIMV failure in COPD exacerbations.

WOS: 000288208800009, PubMed ID: 21358222, Background: Pneumonia is a major cause of morbidity and mortality in immunocompromised patients. Bronchoalveolar lavage (BAL) is commonly used to help diagnose and characterize pneumonia in these patients. Mini-BAL is a less-invasive, less-costly and less-cumbersome diagnostic tool than BAL. Objectives: In this study, we compared the diagnostic value of BAL and mini-BAL in the evaluation of pneumonia in immunocompromised patients with respiratory failure. Methods: Sixty-four respiratory samples were collected from 32 immunocompromised patients admitted to our respiratory intensive care unit with a clinical diagnosis of pneumonia and respiratory failure requiring invasive mechanical ventilation. A single BAL sample and a single mini-BAL sample were collected from each patient. Samples were examined for bacteriologic, mycologic, mycobacteriologic, and viral organisms. Results: The mean age of the patients was 56.0 +/- 14.4 years. Of the 32 BAL samples, bacterial isolates were detected in 11 patients (34.4%) and on the other hand bacterial isolates were detected in 10 patients (31.3%) of the mini-BAL samples. Fungal isolates were detected in 11 patients (34.4%) from BAL samples and 13 patients (40.6%) from mini-BAL samples. Our analysis demonstrated a strong positive correlation between the results of BAL and mini-BAL testing (r = 0.850 and r = 0.821, respectively). Conclusion: In this study, we demonstrated a strong correlation between the isolation rates of bacteria and fungi in BAL and mini-BAL samples obtained from immunocompromised patients with pneumonia and respiratory failure. The data strongly support the use of mini-BAL sampling in such patients as a less-invasive, less-costly and simpler alternative to traditional BAL. Copyright (C) 2011 S. Karger AG, Basel

Cardiac cyst hydatic is a rare disease. Two cases with left and right ventricular involvement are presented that demonstrate the use of echocardiography in the diagnosis and during follow up of the disease.

WOS: 000285431300010, PubMed ID: 20952354, Objective: Any disease specific Health Related Quality of Life Instrument for Chronic Heart Failure (CHF) is lacking in Turkey. The aim of this study is to adapt the Chronic Heart Failure Questionnaire (CHQ) into Turkish and probe the reliability and validity of this questionnaire. Methods: There are four dimensions of this 20 items scale. These dimensions are: dyspnea (5 items), fatigue (4 items), emotional status (7 items) and mastery (4 items). Response options were evaluated using a 7 -point Liken type scale. Quality of life (QOL) improves as the score increases. A total of 205 CHF patients hospitalized in the Department of Cardiology of Ege University hospital were enrolled in this study. The CHQ was applied to the patients twice with a wash-out period of 15 days. Confirmatory approach was used during the reliability and validity analysis. Cronbach alpha test was used for the reliability analysis. Confirmatory factor analysis (CFA) was used for the construct validity testing. NYHA classification for testing the criterion validity; SF-36 and WHOQOL-100 General Health and QOL facet for convergent validity testing of the Turkish version of the CHQ were used. Responsiveness to change was evaluated by Effect Size analysis by using test-retest data. Results: The range of Cronbach alpha values is 0.72-0.94. A considerable ceiling and floor effects were observed for the dyspnea dimension of the scale but no problematic items were observed for the entire scale. The CFA results supported the original four factors scale structure. Criterion and construct validity rebuts were satisfactory. Effect sizes obtained among dimensions of the CHQ were between 0.13 and 0.56. Conclusion: Overall results revealed that Turkish version of the CHQ is a reliable and valid instrument to be used for the evaluation of CHF patients. (Anadolu Kardiyol Derg 2010; 10: 526-38)

WOS: 000282730600001, PubMed ID: 20704764, Background: Early surgery is recommended for asymptomatic severe mitral regurgitation (MR), because of increased postoperative left ventricular (LV) dysfunction in patients with late surgery. On the other hand, recent reports emphasized a "watchful waiting" process for the determination of the proper time of mitral valve surgery. In our study, we compared magnetic resonance imaging (MRI) and transthoracic echocardiography to evaluate the LV and left atrial (LA) remodeling; for better definitions of patients that may benefit from early valve surgery. Methods: Twenty-one patients with moderate to severe asymptomatic MR were evaluated by echocardiography and MRI. LA and LV ejection fractions (EFs) were calculated by echocardiography and MRI. Pulmonary veins (PVs) were measured from vein orifices in diastole and systole from the tangential of an imaginary circle that completed LA wall. Right upper PV indices were calculated with the formula; (Right upper PV diastolic diameter-Right upper PV systolic diameter)/Right upper PV diastolic diameter. Results: In 9 patients there were mismatches between echocardiography and MRI measurements of LV EF. LV EFs were calculated >= 60% by echocardiography, meanwhile < 60% by MRI in these 9 patients. Severity of MR evaluated by effective regurgitant orifice area (EROA) didn't differ with preserved and depressed EFs by MRI (p > 0.05). However, both right upper PV indices (0.16 +/- 0.06 vs. 0.24 +/- 0.08, p: 0.024) and LA EFs (0.19 +/- 0.09 vs. 0.33 +/- 0.14, p: 0.025) were significantly decreased in patients with depressed EFs when compared to patients with normal EFs. Conclusions: MRI might be preferred when small changes in functional parameters like LV EF, LA EF, and PV index are of clinical importance to disease management like asymptomatic MR patients that we follow up for appropriate surgery timing.