A greater degree of RV structural remodeling and higher systolic pulmonary pressure were observed in OSAS patients living at high altitude compared to healthy highlanders. The reversibility of these alterations with treatment remains to be studied.

Study Objectives: A recent study reported an association between obstructive sleep apnea (OSA) and low vitamin D levels. In this study, we measured vitamin D levels in patients referred for evaluation of suspected OSA and sought to identify associated risk factors for vitamin D deficiency. Our objective was to determine whether evaluations of patients with suspected OSA should include routine screening for vitamin D deficiency. Methods: Using a cross-sectional study design, we measured vitamin D levels in consecutively enrolled patients referred for an OSA evaluation to Dr. Lutfi Kirdar Kartal Training and Research Hospital in Istanbul, Turkey. We conducted full-night polysomnography and compared vitamin D levels both between patients with OSA and patients without OSA and across the various severity levels of OSA. We evaluated the association between vitamin D levels and various clinical and demographic characteristics, including the apnea-hypopnea index and body mass index. Results: From April 2014 to June 2015, 195 patients were referred for OSA evaluation. Of these, 181 patients (93%) consented to participate and underwent full polysomnography and measurement of vitamin D levels. The mean ± standard deviation age was 49 ± 12 years and body mass index of 31 ± 6 kg/m 2 . Polysomnography led to the diagnosis of OSA in 162 of the patients (89.5%): 52 (32%) were categorized as having mild OSA, 38 (23.5%) as having moderate OSA, and 72 (44.5%) as having severe OSA. Vitamin D level was 15.5 ± 11.6 ng/mL (95% confidence interval; 13-17 ng/mL) and 134 patients (74%) met the criterion for vitamin D deficiency (< 20 ng/mL). Sex, vitamin D levels, and percentage of patients with vitamin D deficiency were similar in patients with and without OSA (P > .05). Vitamin D levels were similar across OSA severity categories (P = .68). We found no association between vitamin D levels and the apnea-hypopnea index or body mass index. I NTRO DUCTI O NObstructive sleep apnea (OSA) is characterized by recurrent, partial, or complete upper airway obstruction resulting in intermittent hypoxia during sleep. OSA is associated with obesity and diabetes, and is also a risk factor for hypertension and coronary artery disease. 1 Recent reports have suggested that patients with OSA have a higher prevalence of vitamin D deficiency than healthy patients.2,3 Vitamin D plays a key role in calcium absorption and homeostasis, and is obtained both from dietary sources and through the skin via exposure to sunlight. The accepted definition of vitamin D deficiency is vitamin D levels less than 20 ng/ mL in serum [4][5][6] ; such deficiency can lead to additional comorbidities, including multiple bone disorders. 6 Obesity is a risk factor for vitamin D deficiency. Vitamin D is fat soluble and stored in adipose tissue. Obese individuals have more subcutaneous fat, which reduces the release of vitamin D from the skin into circulation. BRIEF SUMMARYCurrent Knowledge/Study Rationale: There are contradictory results about association between obstructive slee...

An increase in mean pulmonary artery pressure and right ventricular dimensions are observed in COPD patients living at high altitude. Despite this increase, systolic and diastolic functions of the right ventricle, as well as global right ventricular performance are similar in COPD patients living at high altitude and sea level. Altitude-related adaptation to chronic hypoxia could explain these findings.

Objective: To evaluate tuberculosis frequency in patients who take tumor necrosis factor alpha (TNF-a) inhibitors for Collagen Vascular Disease (CVD). Materials and Methods:Patients who actively use or were planned to use TNF-a inhibitors for CVD between June 2007-February 2010 were prospectively included in the study.All patients had a physical examination, chest x-ray and the Tuberculin Skin Test (TST). Sputum smear and culture for acid fast bacilli (AFB) was performed in patients with a suspicious lesion on chest x-ray. During follow-up, physical examination, chest x-ray and sputum smear for AFB in indicated cases were performed every 3 months. Tuberculosis was diagnosed with microbiological, radiological and histopathological methods.In case of pulmonary or extrapulmonary tuberculosis,TNF-a inhibitor medication was stopped and anti-tuberculosis therapy was began.Results: A total of 179 patients were included in the study, 91 were female and 88 were male wth a mean age of 42.8±12.0. In 141 patients, TNF-a inhibitor therapy was begun in the study although 38 were taking TNF-a inhibitor medication at the beginning of the study. The median follow-up period was 17 months and 2 (1.1%) patients were diagnosed to have active tuberculosis during the study period. The TST was found to be 5-9 mm in 15% and >10 mm in 53.3% of the patients.There was a successful tuberculosis therapy history in 5 patients and at least 1 BCG scar was seen in 67 patients.In our series, 70.9% of the patients had chemoprophylaxis during the study period and new tuberculosis was diagnosed in 2 patients, consisting of one miliary tuberculosis and one pleural tuberculosis. Tuberculosis was diagnosed in 1.1% of TNF-alpha taking patients in our series. Conclusion: It is recomended that the patients taking anti TNF treatment should be evaluated and followed up regularly for tuberculosis during the treatment. (Turk Toraks Derg 2012; 13: 93-8) ÖZET Amaç: Kollojen doku hastalığı (KDH) nedeniyle anti tümör nekrozis faktör alfa (TNF-a) tedavisi alan hastalarda tüberküloz (Tb) sıklığını araştırmak. Gereç ve Yöntem: Temmuz 2007-Şubat 2010 tarihleri arasında KDH tanısı ile anti-TNF-a tedavisi alan veya anti-TNF-a tedavisi planlanan hastalar prospektif olarak çalışmaya dahil edildi. Tüm hastalarda çalışmanın başlangıcında fizik muayenenin ardından, posterio-anterior (PA) akciğer grafisi, tüberkülin deri testi (TDT) yapıldı. Akciğer grafilerinde lezyon olan hastalarda balgamda asidorezistan basil (ARB) direkt ve kültür yöntemleriyle bakıldı.Anti-TNF-a tedavisi sürecinde hastalar 3 aylık aralıklarla fizik muayene, akciğer grafisi ve endike olgularda balgam ARB tetkikleri ile takip edildi. Tüberküloz tanısı radyolojik, mikrobiyolojik ve histopatolojik yöntemlerle konuldu. Pulmoner ya da extrapulmoner tüberküloz varlığında TNF-a tedavisi kesilerek anti-tüberküloz tedavi başlandı. Bulgular: Çalışmaya dahil edilen 179 hastanın 91'i kadın, 88'i erkek olup yaş ortalaması 42.8±12 olarak hesaplandı. Hastaların 141'ine anti TNF-a tedavisi başlanması planlanırken, 38'si...

Background:Asymmetric dimethylarginine (ADMA) has emerged as a risk marker for many conditions related to pulmonary hypertension (PH); however, little is known about ADMA and symmetric dimethylarginine (SDMA) plasma concentrations in chronic obstructive pulmonary disease (COPD). Our interest centers on the role of ADMA in regulation of endothelial function in COPD and secondary PH. The aim of the present study was to evaluate the serum ADMA, SDMA, and L-arginine concentrations in COPD and its association with PH.Methods:Patients with diagnosis of COPD underwent pulmonary function tests, echocardiography, and laboratory investigations including ADMA, SDMA, and L-arginine.Results:Serum concentrations of ADMA, SDMA, and L-arginine tend to increase as COPD progresses. Patients with PH had higher concentrations of ADMA, SDMA, and L-arginine compared to cases with normal pulmonary arterial pressure (PAP); the difference was not statistically significant.Conclusions:Our results show that increased ADMA, SDMA, and L-arginine concentrations are associated with increased PAP measurements in patients with COPD, however, the relationship is not statistically significant.