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The COVID-19 pandemic has brought countries’ health services into sharp focus. It was drawn to our group’s attention that healthcare workers (HCWs) had a lower mortality rate against higher COVID-19 incidence compared to the general population in Turkey. Since risk of exposure to tuberculosis bacillus among healthcare workers are higher than the population, we aimed to investigate if there is a relationship between BCG and Mycobacterium tuberculosis exposure history with COVID-19 severity in infected HCWs. This study was conducted with 465 infected HCWs from thirty-three hospitals to assess the relationship between COVID-19 severity (according to their hospitalization status and the presence of radiological pneumonia) and BCG and Mycobacterium tuberculosis exposure history. HCWs who required hospital admission had significantly higher rates of chronic diseases, radiological pneumonia, and longer working hours in the clinics. Higher rates of history of contact and care to tuberculosis patients, history of tuberculosis, and BCG vaccine were observed in hospitalized HCWs. HCWs who had radiological pneumonia had a significantly increased ratio of history of care to tuberculosis patients and a higher family history of tuberculosis. The findings from our study suggest that the lower mortality rate despite the more severe disease course seen in infected HCWs might be due to frequent exposure to tuberculosis bacillus and the mortality-reducing effects of the BCG vaccine.

The COVID-19 pandemic has put a significant strain on human life and health care systems, however, little is known about its impact on tuberculosis (TB) patients.To assess the impact of COVID-19 pandemic on pulmonary tuberculosis (PTB) diagnosis, treatment and patient outcomes, using the WHO definitions.A cross-sectional study was conducted in Malatya region, Turkey (population 800 000). Data on regional PTB test numbers, case notification rates and PTB patients' clinical characteristics and treatment outcomes were collected. Data from the first pandemic year (2020) were compared to data from the previous 3 years (2017-2019). The attitudes and experiences of patients were analysed.Despite a non-significant 22% decrease in annual PTB case notifications (P = 0.317), the number of TB tests performed (P = 0.001) and PTB patients evaluated (P = 0.001) decreased significantly during the pandemic year compared with the previous 3 years. The proportion of patients with high (3/4+) sputum acid-fast bacilli grades (P = 0.001), TB relapse (P = 0.022) and treatment failure (P = 0.018) increased significantly. The median 64.5-day treatment delay detected in 2017-2019 increased significantly to 113.5 days in 2020 (P = 0.001), due primarily to patients' reluctance to visit a health care facility.In addition to the problems with case detection, this study shows notable deterioration in several indicators related to the severity, contagiousness and poor outcomes of TB, which had already been suppressed for decades.نتائج التشخيص والعلاج لمرضى السل الرئوي في السنة الأولى من جائحة كوفيد-19.يوسف ياكوبوجلاري، هلال إرميس، زينب كازجان، باريس أوتلو، يسار بايندير، غازي جلباس، إلف تانربفردي، إيميك جولدوجان.تسببت جائحة كوفيد-19 في ضغط كبير على حياة البشر ونُظُم الرعاية الصحية، إلا أننا لا نعرف إلا القليل عن تأثيره على مرضى السل.هدفت هذه الدراسة الى تقييم أثر جائحة كوفيد-19 على تشخيص السل الرئوي وعلاجه والنتائج المتحققة للمرضى، باستخدام تعريفات منظمة الصحة العالمية.أُجريت دراسة مقطعية في منطقة ملاطيا بتركيا (عدد السكان 800 ألف نسمة). وجمع الباحثون بيانات المنطقة عن عدد اختبارات السل الرئوي، ومعدلات الإخطار بالحالات، والخصائص السريرية لمرضى السل الرئوي، ونتائج العلاج. وبعد ذلك، قارن الباحثون بيانات السنة الأولى من الجائحة (2020) ببيانات السنوات الثلاثة السابقة (2017–2019)، مع تحليل مواقف المرضى وتجاربهم.على الرغم من الانخفاض غير الكبير بنسبة 22٪ في العدد السنوي للإخطارات بحالات الإصابة بالسل الرئوي (القيمة الاحتمالية = 0.317)، فإن عدد اختبارات السل التي أُجريَت (القيمة الاحتمالية = 0.001) وعدد مرضى السل الرئوي الذين أُجريَ لهم تقييم (القيمة الاحتمالية = 0.001) قد انخفض انخفاضًا كبيرًا خلال السنة الأولى للجائحة مقارنةً بالسنوات الثلاث السابقة. وحدثت كذلك زيادة كبيرة في نسبة المرضى الذين لديهم تشبُّع عالٍ بالعصيات الصامدة للحمض في عينات البلغم (3/4+) (القيمة الاحتمالية = 0.001)، ونسبة انتكاس السل (القيمة الاحتمالية = 0.022) وفشل العلاج (القيمة الاحتمالية = 0.018). وزادت القيمة الوسطى لمدة تأخر العلاج، التي كانت 64.5 يومًا في الفترة من 2017 إلى 2019، زيادة كبيرة لتصل إلى 113.5 يومًا في عام 2020 (القيمة الاحتمالية = 0.001)، ويرجع ذلك في المقام الأول إلى إحجام المرضى عن زيارة مرافق الرعاية الصحية.بالإضافة إلى المشكلات المتعلقة باكتشاف الحالات، تُظهِر هذه الدراسة تدهورًا ملحوظًا في العديد من المؤشرات المتعلقة بشدة مرض السل والعدوى به وضعف النتائج بين المصابين به، وذلك بعد أن نجحت برامج المكافحة في قمع تلك المؤشرات لعقود من الزمن.Résultats diagnostiques et thérapeutiques des patients atteints de tuberculose pulmonaire au cours de la première année de la pandémie de COVID-19.La pandémie de COVID-19 a mis à rude épreuve la vie humaine et les systèmes de soins de santé, mais on sait peu de choses sur son impact sur les patients atteints de tuberculose.Évaluer l'impact de la pandémie de COVID-19 sur le diagnostic, le traitement et les résultats des patients atteints de tuberculose pulmonaire (TBP), en utilisant les définitions de l'OMS.Une étude transversale a été réalisée dans la région de Malatya, en Turquie (population de 800 000 habitants). Des données sur le nombre de tests régionaux de tuberculose pulmonaire, les taux de notification des cas, les caractéristiques cliniques des patients atteints de tuberculose pulmonaire et les résultats des traitements ont été collectées. Les données de la première année de la pandémie (2020) ont été comparées aux données des trois années précédentes (2017-2019). Les attitudes et les expériences des patients ont été analysées.Malgré une diminution non significative de 22 % des notifications annuelles de cas de tuberculose pulmonaire (p = 0,317), le nombre de tests de dépistage de la tuberculose effectués (p = 0,001) et de patients atteints de tuberculose pulmonaire évalués (p = 0,001) a considérablement diminué pendant l'année pandémique par rapport aux trois années précédentes. La proportion de patients présentant des niveaux élevés (3/4+) de bacilles acido-alcoolo-résistants dans les expectorations (p = 0,001), de rechute tuberculeuse (p = 0,022) et d'échec thérapeutique (p = 0,018) a augmenté de manière significative. Le retard médian du traitement de 64,5 jours détecté en 2017-2019 a considérablement augmenté pour atteindre 113,5 jours en 2020 (p = 0,001), principalement en raison de la réticence des patients à se rendre dans un établissement de santé.Au-delà des problèmes de détection des cas, la présente étude montre une détérioration notable de plusieurs indicateurs liés à la gravité, à la contagiosité et aux mauvais résultats de la tuberculose, que les programmes de lutte avaient déjà supprimés depuis des décennies.

Obstructive sleep apnea syndrome (OSAS) is a common form of sleep-related respiratory disease characterized by recurrent blockages in the upper airway. Rapid eye movement (REM)-related OSAS is a condition in which apneas and hypopneas are more common during REM sleep. We investigated whether there was any difference between REM-related mild OSAS group and NREM-related mild OSAS group in terms of anxiety, depression, and daytime sleepiness. A total of 166 patients with mild OSAS (72 patients with REM-related and 94 NREM-related OSAS) participated in the study. Hospital Anxiety-Depression Scale (HADS) and Epworth Sleepiness Scale (ESS) questionnaires were completed by both groups. Anxiety and depression scores were significantly higher in patients with REM-related OSAS in comparison to the NREM-related OSAS group (p = 0.01, p = 0.02 respectively). There was no statistically significant difference between the two groups in terms of ESS scores (p = 0.60). The results of our study suggest that patients with REM-related OSAS have higher rates of depression and anxiety compared to non-REM-related OSAS patients and this may adversely affect quality of life. It may be possible to prevent psychiatric complications, such as depression and anxiety, by administering treatments that reduce REM sleep duration and intensity in patients with REM-related OSAS.

Background: We aimed to compare the physical activity, kinesiophobia, and fatigue levels of obstructive sleep apnea syndrome (OSAS) patients and healthy individuals in terms their somatotypes. Methods: A total of 165 individuals were enrolled referred to the Department of Chest Diseases Sleep Disorders Center Outpatient Clinic of Inonu University, Malatya, Turkey in 2018. The somatotype analysis was conducted using the Heath- Carter method, the fatigue level was assessed using the Functional Assessment of Chronic Illness Therapy (FACIT) fatigue scale, the kinesiophobia level was assessed using the Tampa Scale for Kinesiophobia (TSK), and the physical activity level was assessed using the International Physical Activity Questionnaire (IPAQ). Results: The results of the somatotype analysis revealed 3 different somatotypes in the healthy individuals and the OSAS patients' mesomorph endomorph, endomorphic mesomorph, and mesomorphic endomorph. When comparing the somatotypes of the healthy individuals and the OSAS patients, statistically significant differences were found in the FACIT scores of the mesomorph endomorphs, the IPAQ and FACIT scores of the endomorphic mesomorphs, and the TSK and FACIT scores of the mesomorphic endomorphs (P

BackgroundToday, COVID-19 pandemic has brought countries’ health services into sharp focus. Despite the low incidence of cases(1.2%) and high mortality rate(2.4%) among Turkish population, the low mortality rate(0.3%) despite the high incidence(11.5%) declared in healthcare workers drew our group’s attention. Therefore, we aimed to report the characteristics of infected health-care workers and investigate the relationship between BCG vaccine and tuberculosis history with COVID-19 mortality in infected health-care worker population.MethodThis study was conducted in three hospitals to assess the clinical presentations, disease severity and correlation with BCG vaccine and tuberculous history in COVID-19 positive health-care workers by an online questionnaire platform. The relationship between characteristics and tuberculosis history were investigated according to hospitalization status of the patients.ResultTotal of 465 infected healthcare workers included in the study. The rate of history of direct care and contact to tuberculosis patient, presence of previous tuberculosis treatment and BCG scar, presence of radiological infiltrations was significantly higher in hospitalized healthcare workers. The ratio of direct care and direct contact to the patient with tuberculosis, and presence of family history of tuberculosis were statistically significantly higher in patients with radiological infiltrations.ConclusionAlthough COVID-19 risk and incidence are higher among healthcare workers compared to the normal population due to higher virus load, this study brings evidence for the fact that the lower mortality rate seen in infected healthcare workers might be due to healthcare workers’ frequent exposure to tuberculosis bacillus and the mortality-reducing effects of BCG vaccine, despite the higher hospitalization rate and radiological infiltrations due to over-triggered immune system.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a extremely infectious disease, and the current outbreak has been declared by WHO as a global public health threatening. Researches have showed that transmission of SARS-CoV-2 is mainly from person to person via airborne droplets. It is unclear whether SARS-CoV-2 can be shed into human milk and transmitted to a child via breastfeeding. Here we investigated SARS-CoV-2 RNA in breast-milk samples of three mothers with SARS-CoV-2 and their infant. The human milk sample of one mother for SARS-CoV-2 RNA was positive. By contrast, SARS-CoV-2 RNA was not detected in human milk of two mothers.The throat swab sample was also positive in the infant of the mother whose SARS-CoV-2 RNA was detected in human milk. By contrast, throat swab of others infants was negative. Because the mother with SARS-CoV-2 RNA detected in human milk sample is not breastfeeding, the risk of contagion from the infant to the mother is eliminated. To date, in the literature, the presence of SARS-CoV-2 RNA has only been detected in the breast milk of two mothers with SARS-CoV-2. To the best of our knowledge, our case is third case with SARS-CoV-2 RNA detected in human milk. On the other hand, this is first case with SARS-CoV-2 RNA detected in human milk of mother who does not breastfeed her infant.The existing data indicates that SARS-CoV-2 can be rare transmitted through human milk.

Obstructive sleep apnea (OSA) can cause local and systemic inflammation due to hypoxia, asphyxia, hypercapnia, respiratory acidosis. Searching for new inflammatory markers in OSA may facilitate the prediction of OSA-related conditions. Therefore, we aimed to investigate the relationship between OSA severity and serum gamma‑glutamyl transferase (GGT) levels. In the study, the GGT levels of the patients were compared according to the degree of OSA determined by polysomnography. The patients' demographic, polysomnographic, and laboratory parameters were evaluated with SPSS 25 program. A total of 500 patients, 299 (59.8%) male and 201 (40.2%) female, were included in the study. The mean age of the patients was 47.9±13.1, and body mass index (BMI) was 32.2±6.6. There were 98 (19.6%) patients in the control group, 100 (20%) in the mild OSA group, 103 (20.6%) in the moderate OSA group, and 199 (39.8%) in the severe OSA group. When the BMI and desaturation index of the groups were compared, there was a statistical difference (respectively, p

RESUMO Objetivo O objetivo deste estudo foi investigar os efeitos agudos e crônicos da vareniclina no tecido pulmonar em um estudo experimental. Métodos Um total de 34 ratos foi alocado aleatoriamente em grupos de estudo (vareniclina) e controle. Assim, os ratos foram divididos em dois grupos: (i) grupo controle e (ii) grupo vareniclina. A seguir, os ratos de cada grupo foram, por sua vez, subdivididos igualmente em agudos (C1; V1) e crônicos (C2; V2), e todos os ratos dos grupos agudos e crônicos foram sacrificados sob anestesia: no 45.º dia, para o grupo agudo [C1 (n=5) e V1 (n=12)], e no 90.º dia, para o grupo crônico [C2 (n=5) e V2 (n=12)], respectivamente. Em seguida, foram realizadas análises bioquímicas e histopatológicas. Resultados Trinta e quatro ratos completaram o estudo. Destes ratos, 24 estavam no grupo vareniclina e 10 no grupo controle. Na exposição crônica à vareniclina, os níveis de oxidante composto por malondialdeído (MDA) e mieloperoxidase (MPO) aumentaram, e os níveis de superóxido dismutase (SOD), catalase (CAT), glutationa (GSH) e glutationa peroxidase (GPx), nomeados como antioxidantes, diminuiram significativamente quando comparados com o grupo controle. Os níveis de MDA e MPO também foram significativamente mais elevados e os níveis de SOD, CAT, GPx e GSH foram significativamente mais baixos no grupo vareniclina crônico, quando comparado ao grupo vareniclina agudo. Estes achados também foram confirmados por observações histopatológicas. Conclusões Este é o primeiro estudo que avaliou os efeitos pulmonares da vareniclina experimentalmente em um modelo animal. Observamos que o tratamento crônico da vareniclina causa inflamação e lesão pulmonar. ABSTRACT Objective This study aimed to investigate acute and chronic effects of varenicline on lung tissue in an experimental study. Methods A total of 34 rats were randomly allocated into study (varenicline) and control groups. The rats were divided into two groups (i) control group, (ii) varenicline group. Then, the rats in the each group were sub-divided equally in turn as acute (C1; V1) and chronic (C2; V2) ; all rats of acute and chronic groups were sacrificed under the anesthesia on the 45th day for acute group [C1 (n=5) and V1 (n=12)] and the 90th day for chronic group [C2 (n=5) and V2 (n=12)], respectively. Thus, biochemical and histopathological analysis were carried out. Results Thirty four rats completed the study, 24 were in varenicline group and 10 were in control group. In chronic exposure to varenicline, oxidant levels comprising of malondialdehyde (MDA), and myeloperoxidase (MPO) increased and superoxide dismutase (SOD), catalase (CAT), glutathione (GSH) and glutathione peroxidase (GPx) levels, named as antioxidants, decreased significantly when compared to the control group. MDA and MPO levels were also significantly higher and SOD, CAT, GPx, GSH levels were also significantly lower in chronic varenicline group when compared to acute varenicline group. These findings were also supported by histopathological observations. Conclusion This is the first study, which evaluated pulmonary effects of varenicline experimentally on an animal model. It was observed that chronic varenicline treatments cause inflammation and lung cell injury.

This study aimed to investigate acute and chronic effects of varenicline on lung tissue in an experimental study.A total of 34 rats were randomly allocated into study (varenicline) and control groups. The rats were divided into two groups (i) control group, (ii) varenicline group. Then, the rats in the each group were sub-divided equally in turn as acute (C1; V1) and chronic (C2; V2) ; all rats of acute and chronic groups were sacrificed under the anesthesia on the 45th day for acute group [C1 (n=5) and V1 (n=12)] and the 90th day for chronic group [C2 (n=5) and V2 (n=12)], respectively. Thus, biochemical and histopathological analysis were carried out.Thirty four rats completed the study, 24 were in varenicline group and 10 were in control group. In chronic exposure to varenicline, oxidant levels comprising of malondialdehyde (MDA), and myeloperoxidase (MPO) increased and superoxide dismutase (SOD), catalase (CAT), glutathione (GSH) and glutathione peroxidase (GPx) levels, named as antioxidants, decreased significantly when compared to the control group. MDA and MPO levels were also significantly higher and SOD, CAT, GPx, GSH levels were also significantly lower in chronic varenicline group when compared to acute varenicline group. These findings were also supported by histopathological observations.This is the first study, which evaluated pulmonary effects of varenicline experimentally on an animal model. It was observed that chronic varenicline treatments cause inflammation and lung cell injury.O objetivo deste estudo foi investigar os efeitos agudos e crônicos da vareniclina no tecido pulmonar em um estudo experimental.Um total de 34 ratos foi alocado aleatoriamente em grupos de estudo (vareniclina) e controle. Assim, os ratos foram divididos em dois grupos: (i) grupo controle e (ii) grupo vareniclina. A seguir, os ratos de cada grupo foram, por sua vez, subdivididos igualmente em agudos (C1; V1) e crônicos (C2; V2), e todos os ratos dos grupos agudos e crônicos foram sacrificados sob anestesia: no 45.º dia, para o grupo agudo [C1 (n=5) e V1 (n=12)], e no 90.º dia, para o grupo crônico [C2 (n=5) e V2 (n=12)], respectivamente. Em seguida, foram realizadas análises bioquímicas e histopatológicas.Trinta e quatro ratos completaram o estudo. Destes ratos, 24 estavam no grupo vareniclina e 10 no grupo controle. Na exposição crônica à vareniclina, os níveis de oxidante composto por malondialdeído (MDA) e mieloperoxidase (MPO) aumentaram, e os níveis de superóxido dismutase (SOD), catalase (CAT), glutationa (GSH) e glutationa peroxidase (GPx), nomeados como antioxidantes, diminuiram significativamente quando comparados com o grupo controle. Os níveis de MDA e MPO também foram significativamente mais elevados e os níveis de SOD, CAT, GPx e GSH foram significativamente mais baixos no grupo vareniclina crônico, quando comparado ao grupo vareniclina agudo. Estes achados também foram confirmados por observações histopatológicas.Este é o primeiro estudo que avaliou os efeitos pulmonares da vareniclina experimentalmente em um modelo animal. Observamos que o tratamento crônico da vareniclina causa inflamação e lesão pulmonar.

Giriş: Bu çalışmada, obstrüktif uyku apne sendromu (OSAS)'nun değerlendirilmesinde kullanılan antropometrik ölçüm ve oranların ülkemize ait değerlerini belirlemek istedik. Materyal ve Metod: Çok merkezli prospektif olarak planlanan çalışmamıza 13 ilimizde yer alan, akredite olmuş 20 uyku merkezi katıldı. OSAS semptomları olan ve polisomnografik inceleme ile apne-hipopne indeksi (AHİ) ≥ 5 bulunan olgular OSAS çalışma grubu; AHİ < 5 ve STOP-Bang < 2 olan olgular ise kontrol grubu olarak alındı. Olgulara ait demografik özellikler [yaş, cinsiyet, beden kitle indeksi (BKİ)] ve antropometrik ölçümler (boyun, bel ve kalça çevresi, bel/kalça oranları) kaydedildi. Bulgular: Çalışmaya 20 merkezden yaş ortalaması 50.50 ± 0.21 yıl olan 2684 (%81.3’ü OSAS’lı) olgu alındı. Olgular, ülkemizin altı coğrafi bölgesinden (Akdeniz, Doğu Anadolu, Ege, İç Anadolu, Karadeniz ve Marmara Bölgesi) alındı. Olguların demografik özellikleri ve antropometrik ölçümleri; kontrol grubuna göre karşılaştırıldığında yaş, boyun, bel, kalça çevresi ve bel/kalça oranları ve BKİ özellikleri; bölgelere göre karşılaştırıldığında ise yaş, boyun, bel, kalça çevresi ve bel/kalça oranları istatistiksel olarak farklı bulundu (sırasıyla p< 0.001, p< 0.001, p< 0.05). Cinsiyetlere göre karşılaştırıldığında yaş, boyun ve kalça çevresi, bel/kalça oranı, boy, kilo ve BKİ özellikleri istatistiksel olarak farklı idi (sırasıyla, p< 0.001). Boyun çevresi ve bel/kalça oranı sırasıyla erkeklerde 42.58 ± 0.10 cm (cut-off 41; duyarlılık %61.2; özgüllük %68.3), 0.99 ± 0.002 (cut-off 0.97; duyarlılık %56.4; özgüllük %54.3); kadınlarda 39.24 ± 0.16 cm (cut-off 37; duyarlılık %66.5; özgüllük %63.4), 0.93 ± 0.004 (cut-off 0.89; duyarlılık %70.9; özgüllük %49.5) bulundu. OSAS fenotipleri; klasik OSAS, okült OSAS, REM bağımlı OSAS, pozisyon bağımlı OSAS, REM ve pozisyon bağımlı OSAS, overlap sendromu ve kompleks uyku apne sendromu olarak belirtildi. OSAS fenotiplerine göre karşılaştırıldığında yaş, boyun ve kalça çevresi, boy, kilo ve BKİ özellikleri istatistiksel olarak farklı iken (sırasıyla, p< 0.001) bel/kalça oranı farklı bulunmadı. Sonuç: Boyun çevresi erkeklerde standart değerin altında iken, kadınlarda üstünde bulundu. Bel/kalça oranı hem erkeklerde hem de kadınlarda ideal ölçülerin üzerinde idi. Bu bağlamda ülke değerlerinin tespiti OSAS olasılığı olan hastaların belirlenmesini ve polisomnografi için uyku merkezlerine yönlendirilmesini sağlayacaktır. Introduction: In this study, we aimed to determine the values of anthropometric measurements and rates used in the evaluation of obstructive sleep apnea syndrome (OSAS) in our country. Materials and Methods: Twenty accredited sleep centers in thirteen provinces participated in this multicenter prospective study. OSAS symptoms and polysomnographic examination and apnea-hypopnea index (AHI) ≥ 5 cases OSAS study group; patients with AHI < 5 and STOP-Bang < 2 were included as control group. Demographic characteristics (age, sex, body mass index-BMI) and anthropometric measurements (neck, waist and hip circumference, waist/hip ratio) of the subjects were recorded. Results: The study included 2684 patients (81.3% OSAS) with a mean age of 50.50 ± 0.21 years from 20 centers. The cases were taken from six geographical regions of the country (Mediterranean, Eastern Anatolia, Aegean, Central Anatolia, Black Sea and Marmara Region). Demographic characteristics and anthropometric measurements; age, neck, waist, hip circumference and waist/ hip ratios and BMI characteristics when compared with the control group; when compared according to regions, age, neck, waist, hip circumference and waist/hip ratios were found to be statistically different (p< 0.001, p< 0.001, p< 0.05, respectively). When compared by sex, age, neck and hip circumference, waist/hip ratio, height, weight and BMI characteristics were statistically different (p< 0.001, respectively). Neck circumference and waist/hip ratio were respectively 42.58 ± 0.10 cm, 0.99 ± 0.002, 39.24 ± 0.16 cm, 0.93 ± 0.004 were found in women. Conclusion: The neck circumference was lower than the standard value in men, but higher in women. The waist/hip ratio was above the ideal measurements in both men and women. In this context, the determination of the country values will allow the identification of patients with the possibility of OSAS and referral to sleep centers for polysomnography.

Deep vein thrombosis (DVT) and pulmonary embolism (PE) are currently defined as venous thromboembolism (VTE) since they share pathophysiological features and the treatment is similar in many respects. It has been determined that more than 90% of PE cases originate from DVT in the legs. PE, which is difficult to diagnose, has a mortality rate of 12% when untreated. The worldwide increase in obesity, cancer diseases, and average survival time also contribute to the increase in the incidence of VTE. Traditional treatment of VTE includes heparin, low-molecular-weight heparin, and warfarin. Despite availability for oral use, warfarin has a narrow therapeutic range and a wide range of food interactions. After many years of research, new oral anticoagulant agents (NOACs) are expected to overcome these handicaps in treatment. In this review, the use of NOACs in the treatment of VTE is investigated in the light of current guidelines.

Ankarali, Handan Camdeviren/0000-0002-3613-0523; Cakir, Munire/0000-0001-8650-3722 WOS: 000275067200005 PubMed: 20038208 The authors have previously demonstrated that apricot sulfurization workers develop asthma-like syndrome during apricot sulfurization due to exposure to sulfur dioxide (SO2) gas. The aim of the current study was to demonstrate if exposure to SO2 gas had any chronic effects on pulmonary functions and bronchial reactivity of the workers. Twenty-five apricot sulfurization workers and a control group were included in the study. Physical examination, skin prick tests, pulmonary function tests (PFTs), and bronchoprovocation tests (BPTs) were performed before and after the season of sulfurization in the worker group. Skin prick tests, PFTs, and BPTs were performed also in the control group without a history of exposure to SO2 gas. There was no statistically significant difference between PFT and BPT results of the workers and the control group. Comparison of the PFT results of the workers before and after the season of apricot sulfurization neither reveal a significant difference. Four (16%) out of 25 workers were positive for BPTs before the period. Only one worker who had a negative BPT result before the sulfurization season was positive afterwards. The lack of a chronic effect on pulmonary functions is consistent with the diagnosis of asthma-like syndrome in apricot sulfurization workers. Inonu University, Turgut Ozal Medical Center, Malatya, TurkeyInonu University The work was performed at Inonu University, Turgut Ozal Medical Center, Malatya, Turkey.

Phlegmasia cerulea dolens is a rare condition caused by complete venous occlusion and often results in tissue necrosis, limb amputation, or death. In this study, a 51 year old female presenting at our emergency department with leg edema, leg pain and cyanosis and was diagnosed with phlegmesia cerulea dolens, which is a life-threatening complication of deep venous thrombosis. Prompt diagnosis and treatment initiation are important to prevent pulmonary emboli, gangrene, amputation, and, ultimately, death.

We aimed to investigate the preventive and therapeutic effect of apocynin (APO) on bleomycin (BLC)-induced lung injury in rats. Rats were assigned into groups as follows: control group; APO group, 20 mg/kg APO was given intraperitoneal for 29 days; BLC-1 and BLC-2 groups, a single intratracheal injection of BLC (2.5 mg/kg); APO+BLC-preventive group, 20 mg/kg APO was administered 12 h before the intratracheal BLC injection and continued for 14 days; BLC+APO-treatment group, 20 mg/kg APO was given on the 14th day after the intratracheal BLC injection and continued to sacrifice. The BLC-1 group was sacrificed on the 14th day of BLC administration to validate BLC-induced lung inflammation and fibrosis on the 14th of study initiation. All other groups were sacrificed on the 29th day after BLC administration. The semiquantitative histopathological assessment, tissue levels of malondialdehyde (MDA), superoxide dismutase, catalase (CAT), glutathione peroxidase (GPx), reduced glutathione (GSH), total antioxidant capacity, total oxidant status (TOS), and oxidative stress index (OSI) were measured. An addition to the serum myeloperoxidase (MPO), the cell count and cytokines (IL-1β, IL-6, and IL-8) of bronchoalveolar lavage (BAL) fluid were assayed. BLC-provoked histological changes were significantly detected compared to the control group. APO restored these histological damages in different quantity in the treatment and prevention groups. BLC caused a significant decrease in GSH, CAT, and GPX, which were accompanied with significantly the increased MDA, TOS levels, and OSI in the lung tissue concomitant with increased levels of the cellular account and proinflammatory cytokines in the BAL fluid. Otherwise, APO administration, both before and after BLC, reversed all biochemical markers and cytokine as well as histopathological changes induced by BLC. Interestingly, APO treatment reversed MPO activity in serum increased by BLC. In this study, both protective and therapeutic effects of APO against BLC-induced lung fibrosis were demonstrated for the first time.

Objective: Our previous study demonstrated the presence of environmental tremolite and chrysotile asbestos fiber exposure in Hekimhan town in Malatya located in eastern Turkey. The aim of this study was to investigate whether environmental asbestos exposure increases the incidence of lung cancer and mesothelioma. Method: One hundred and forty-nine patients with mesothelioma and lung cancer living in the center or in the towns of Malatya were retrospectively analyzed. The Incidences of lung cancer and mesothelioma were calculated. Results: The incidences of lung cancer and mesothelioma were 3.39/100,000 and 0.21/100,000, respectively, for the whole population of Malatya; while they were 8.23/100,000 and 1.45/100,000 in Hekimhan. The incidences were strikingly high (22.39/100,000 for lung cancer and 7.46/100,000 for mesothelioma) in Arguvan, another town in Malatya where an analysis for asbestos could not be performed. The overall incidence in Turkey was reported as 5.9/100,000 by the Health Ministry in 1994. The incidences of lung cancer were nearly 1.3-fold higher in Hekimhan and fourfold higher in Arguvan then in the general population of Turkey. Conclusion: The incidences of mesothelioma and lung carcinoma in Hekimhan were higher than those of the general population in Turkey, suggesting a role of environmental asbestos exposure in lung cancer and mesothelioma.

Despite extensive studies, there is no effective treatment currently available other than pirfenidone for idiopathic pulmonary fibrosis. A protective effect of pantothenic acid and its derivatives on cell damage produced by oxygen radicals has been reported, but it has not been tested in bleomycin (BLM)--induced pulmonary fibrosis in rats. Therefore, we aimed to investigate the preventive effect of dexpanthenol (Dxp) on pulmonary fibrosis. Thirty-two rats were assigned to four groups as follows: (1) control group, (2) dexpanthenol (Dxp) group; 500 mg/kg Dxp continued intraperitoneally for 14 days, (3) bleomycin (BLM) group; a single intratracheal injection of BLM (2.5 mg/kg body weight in 0.25-ml phosphate buffered saline), and (4) BLM + Dxp-treated group; 500 mg/kg Dxp was administered 1 h before the intratracheal BLM injection and continued for 14 days i.p. The histopathological grades of lung inflammation and collagen deposition, tissue levels of malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), and myeloperoxidase (MPO) were measured. BLM provoked inflammation and collagen deposition (p0.0001), with a marked increase in myeloperoxidase (MPO) activity resembling increased inflammatory activity (p0.0001), which was prevented by Dxp (p0.0001, p = 0.02). BLM reduced tissue activities of SOD, GPx, and CAT compared to controls (p = 0.01, 0.03, 0.009). MDA was increased with BLM (p = 0.003). SOD (p = 0.001) and MDA (p = 0.016) levels were improved in group 4. The CAT levels in the BLM + Dxp group were close to those in the control group (p0.05). We showed that Dxp significantly prevents BLM-induced lung fibrosis in rats. Further studies are required to evaluate the role of Dxp in the treatment of lung fibrosis.

Many studies have focused on the systemic effects of chronic obstructive pulmonary disease (COPD), but none has examined neuromuscular junction transmission (NMT). We evaluated NMT dysfunction using single-fiber electromyography (SFEMG) in patients with COPD. Twenty patients with COPD and 20 age-matched healthy controls were included in the study. All patients and controls underwent SFEMG. Abnormal NMT was found in seven of 20 patients (35%), but in none of the control subjects. The COPD patients were subgrouped according to the presence of hypoxemia. The patients with normoxemia were classified as Group 1, and the patients with hypoxemia were classified as Group 2. Abnormal NMT was found in six patients in Group 2 and in one in Group 1. While there was significant difference in terms of abnormal NMT between Group 2 and the controls, there was none between Group 1 and the controls. Our results show that NMT abnormalities can be present in hypoxemic patients with COPD.

INTRODUCTION γ-glutamyltransferase (GGT) is a plasma membrane enzyme, which is involved in antioxidant glutathione resynthesis. OBJECTIVES The aim of the study was to compare the serum levels of GGT (which is considered a novel marker of oxidative stress) between patients with stable chronic obstructive pulmonary disease (COPD) and those with acute exacerbation of COPD, and the relationship of GGT with inflammation. PATIENTS AND METHODS The study involved 132 patients with exacerbated COPD and normal function of the liver and biliary tract (mean age, 66.6 ±10.1 years; men, 88.6%) and 147 patients with stable COPD (mean age, 65.4 ±8.8 years; men, 87.1%). Serum GGT and C-reactive protein (CRP) levels were measured and compared between the groups. RESULTS Serum GGT levels in patients with exacerbated COPD were significantly higher than in those with stable COPD (30 U/l; interquartile range [IQR], 18.8 vs. 25 U/l; IQR, 16; P

Various ECG patterns have been associated with acute pulmonary embolism. However, there is no data regarding the association between QT interval measurements and pulmonary embolism. We aimed to investigate the association between QT dispersion and the severity of pulmonary embolism (PE).One hundred twenty-nine pulmonary embolism patients (mean age 58 ± 16.5 years) with ECGs obtained within the first 24 hours of hospital admission were included in the study. Patients were classified into low, intermediate and high-risk groups. We retrospectively measured ECG scores; maximum and minimum corrected QT intervals (QTc(max) and QTc(min)) and corrected QT interval dispersion (QTcd) in each risk group of patients.There was an increasing ECG score through from low to high-risk PE [3 (Interquartile Range, IQR: 2), 5 (IQR: 6) and 10 (IQR: 7) p0.0001]. QT interval analysis showed that QTcd was higher in high-risk group than in low and intermediate-risk groups (59.5 ± 23.4, 69.2 ± 21, 95.9 ± 33.2, p0.001 and p = 0.01, respectively). Patients who died after diagnosis had significantly higher QTcd values at baseline compared with the QTcd values of surviving patients (89.1 ± 45.5 to 65 ± 22.9, p = 0.001). The sensitivity of QTcd71.5 ms for prediction of mortality was 71% with a specificity of 73% (p = 0.001). We observed a strong correlation between QTcd and ECG score values (r = 0.69, p0.001). There was also a correlation between QTcd values and pulmonary artery pressure (PAP) (r = 0.27, p = 0.05).QTcd is significantly increased in high-risk PE patients compared to intermediate and low-risk patients. In addition, QTcd is significantly correlated with ECG score and PAP.

Background Hemodialysis patients are at high risk for tuberculosis, and a tuberculin skin test (TST) is not usually helpful in detecting tuberculosis infection because of anergic reactions. Prophylactic therapy against tuberculosis in dialysis patients is important to enhance transplantation success. Herein we evaluated the value of TST in screening for tuberculosis and analyzed any compounding factors that might affect the results of the test in hemodialysis patients in an endemic area of Turkey. Methods A total of 187 (96 female, 91 male) patients were screened using a 2-step TST. Test results were compared with clinical, radiologic, and laboratory data. Results None of the patients had active tuberculosis during the study and 55% had been vaccinated against tuberculosis. After the first purified protein derivative (PPD) test, 55.1% of the patients showed a positive reaction, ultimately reaching a total of 68.4% following the second test. Cumulative positive TST results were significantly correlated with male gender ( P = .001, r = .352), previous tuberculosis history ( P = .013, r = .183) positively, whereas with the ferritin level ( P = .001, r = −.233) negatively; but there were no significant relationships between TST results and other data. Conclusions Impairment of delayed-type hypersensitivity reaction is frequent in dialysis patients, but we observed high rates of positivity with the two-step TST which could be attributed to tuberculosis being endemic in Turkey. Further comparative studies with more specific diagnostic methods will be helpful to evalute the importance of TST positivity in identifying tuberculosis-infected HD patients.

We describe an unusual case of a patient with eosinophilic pleural effusion (EPE) associated with long-term propylthiouracil (PTU) administration. A 43-year-old woman was admitted to our hospital after complaining of chest pain. She had had Graves’ disease, which had been treated with PTU for 11 years. Right-sided pleural effusion was detected and the result of thoracentesis confirmed an EPE. The patient’s detailed medical evaluation failed to reveal any other cause of EPE. PTU was terminated since it was thought to be the cause. Despite withdrawal of the medication, however, the pleural effusion persisted for 6 weeks, and steroid therapy was planned for 15 days in decreasing dosages. During the control visit 10 days after the initiation of steroid therapy, no pleural effusion was observed, and the steroid was discontinued. Rechallenge with PTU produced recurrent pleural effusion. Therapy with PTU was again terminated, and treatment with methimazole and a brief course of low-dose corticosteroids were begun. Chest radiography revealed disappearance of the effusion within 10 days and it did not recur during a 1-year follow-up. To our knowledge, there is only 1 other case in the English-language literature describing EPE caused by PTU. Our report is of particular importance because it describes the development of that disorder in the 11th year of PTU treatment. It also shows that steroid therapy can be effective in treating drug-induced EPE.

Oxidative stress has been implicated in the pathogenesis of bleomycin-induced lung fibrosis and many antioxidant agents have been studied for prevention and treatment of the disease in animals and humans. We therefore examined whether Ginkgo biloba (Gb), a flavonoid-rich antioxidant, inhibits bleomycin-induced lung fibrosis in rats. Male Sprague-Dawley rats were given a single dose of bleomycin (2.5 mg/kg, intratracheally) in pulmonary fibrosis groups and saline in controls. First dose of Gb was given a day before the bleomycin injection and continued until sacrifice. At day 14, fibrotic changes in lung were estimated to occur by Aschoft's criteria and lung hydroxyproline content. Bleomycin challenge provoked severe pulmonary fibrosis with marked increase in hydroxyproline content of lung tissue and typical histological findings, which is prevented by Gb. Hydroxyproline level was significantly higher (13.51+/-0.87 mg/g dried tissue) in bleomycin treated rats than controls (9.2+/-1.33), and its level was remained to the control levels (7.38+/-0.76) in rats treated with prophylactic Gb. On the other hand, bleomycin injection significantly reduced activities of glutathione peroxidase, superoxide dismutase and catalase in lung tissue which is prevented by Gb. Also, bleomycin injection resulted in a marked increase of malondialdehyde and nitrite level which is attenuated by Gb. The data suggest that Gb has a potent antioxidant activity in the model of bleomycin-induced lung fibrosis in rats, and therefore has a potent antifibrotic activity against bleomycin-induced lung fibrosis model in rats.