Stabil KOAH'lı hastalarda sistemik inflamasyon ve metabolik sendrom Giriş: Kronik obstrüktif akciğer hastalığı (KOAH) sistemik inflamasyonla ilişkili gibi görünen ekstrapulmoner etkilere sahiptir. Genel popülasyonda sistemik inflamasyonun önemli belirleyicilerinden biri olan metabolik sendromla KOAH arasındaki ilişki henüz netleşmemiştir. Bu çalışmanın amacı; farklı evrelerdeki stabil KOAH'lı hastalarda ve yaş, cinsiyet açısından eşleştirilmiş kontrol grubunda metabolik sendrom frekansını ve sistemik inflamasyon belirteci olan C-reaktif protein (CRP) düzeylerini değerlendirmektir. Hastalar ve Metod: Çalışmaya 91 stabil KOAH'lı hasta ve 42 kontrol birey alındı. KOAH ağırlığı GOLD (Global Initiative for Chronic Obstructive Lung Disease) kriterlerine göre belirlendi. Metabolik sendrom tanısında ATP III (The National Cholesterol Education Program's Adult Treatment Panel III) kriterleri kullanıldı. Hasta ve kontrol grubunda alınan venöz kan örneğinde CRP düzeyleri ölçüldü. Bulgular: Metabolik sendrom frekansı hasta grubunda, özellikle GOLD I, II'de, kontrol grubundan daha yüksek bulundu (p= 0.004). Metabolik sendromun abdominal obezite, hipertansiyon ve hiperglisemi komponentlerinin frekansı hasta grubunda daha yüksek bulundu (p< 0.0001). Artmış CRP düzeyleri kontrol grubunda ve hasta grubun tüm evrelerinde, metabolik sendrom olanlarda, olmayanlara göre daha yüksek orandaydı (p= 0.047, p= 0.217, p< 0.001, p= 0.05, p= 0.467). Sonuç: Bu çalışma metabolik sendrom frekansının stabil KOAH'lı hastalarda, kontrol grubundan ve Türk popülasyonundan daha yüksek olduğunu göstermiştir. Abdominal obezite, hipertansiyon ve hiperglisemi hasta grubunda anlamlı derecede daha sıktı. Sistemik inflamasyon metabolik sendromu olan KOAH'lı hastalarda olmayanlara göre daha yoğundu.

OBJECTIVE:Because pulmonary embolism (PE) and COPD exacerbation have similar presentations and symptoms, PE can be overlooked in COPD patients. Our objective was to determine the prevalence of PE during COPD exacerbation and to describe the clinical aspects in COPD patients diagnosed with PE.METHODS:This was a prospective study conducted at a university hospital in the city of Ankara, Turkey. We included all COPD patients who were hospitalized due to acute exacerbation of COPD between May of 2011 and May of 2013. All patients underwent clinical risk assessment, arterial blood gas analysis, chest CT angiography, and Doppler ultrasonography of the lower extremities. In addition, we measured D-dimer levels and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels.RESULTS:We included 172 patients with COPD. The prevalence of PE was 29.1%. The patients with pleuritic chest pain, lower limb asymmetry, and high NT-pro-BNP levels were more likely to develop PE, as were those who were obese or immobile. Obesity and lower limb asymmetry were independent predictors of PE during COPD exacerbation (OR = 4.97; 95% CI, 1.775-13.931 and OR = 2.329; 95% CI, 1.127-7.105, respectively).CONCLUSIONS:The prevalence of PE in patients with COPD exacerbation was higher than expected. The association between PE and COPD exacerbation should be considered, especially in patients who are immobile or obese.

Several polymorphisms in cytochrome P-450s (CYP)s and Glutathione S-transferases (GST)s have been reported to be associated with survival rates of patients with non-small cell lung cancer (NSCLC) but the studies in this regard are scarce and the results are contradictory. In this study, CYP1A1 (Ile462Val), CYP1B1(Asn453Ser), GST M1, GSTP1 exon 5 (Ile105Val) and exon 6(Ala114Val) and GSTT1 polymorphisms were determined in 138 patients with advanced NSCLC to evaluate their role in survival. Of the studied CYP and GST polymorphisms only GSTP1 exon 6 variant significantly altered (improved) the survival compared to wild type (p=0.036) with median survival of 22.2 months and 16.1 months, respectively. Multivariate analysis also revealed a significant reduction of adjusted hazard ratio of death associated only with the GSTP1 exon 6 variant genotype of 0.45 (95% confidence interval (95% CI), 0.23-0.89, p=0.022). These results show that the GSTP1 exon 6 variant genotype is associated with improved survival in the patients with advanced NSCLC.

OBJECTIVE: Pulmonary embolism (PE) is an important complication of major orthopedic surgery. The aim of this study was to evaluate the incidence of venous thromboembolism (VTE) and factors influencing the development of VTE in patients undergoing major orthopedic surgery in a university hospital. METHODS: Patients who underwent major orthopedic surgery (hip arthroplasty, knee arthroplasty, or femur fracture repair) between February of 2006 and June of 2012 were retrospectively included in the study. The incidences of PE and deep vein thrombosis (DVT) were evaluated, as were the factors influencing their development, such as type of operation, age, and comorbidities. RESULTS: We reviewed the medical records of 1,306 patients. The proportions of knee arthroplasty, hip arthroplasty, and femur fracture repair were 63.4%, 29.9%, and 6.7%, respectively. The cumulative incidence of PE and DVT in patients undergoing major orthopedic surgery was 1.99% and 2.22%, respectively. Most of the patients presented with PE and DVT (61.5% and 72.4%, respectively) within the first 72 h after surgery. Patients undergoing femur fracture repair, those aged ≥ 65 years, and bedridden patients were at a higher risk for developing VTE. CONCLUSIONS: Our results show that VTE was a significant complication of major orthopedic surgery, despite the use of thromboprophylaxis. Clinicians should be aware of VTE, especially during the perioperative period and in bedridden, elderly patients (≥ 65 years of age).

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