significance of the relative lymphocyte count as an independent predictor of cardiovascular disease in patients with obstructive sleep apnea syndrome

Objective: The aim of this study was to determine whether or not relative lymphocyte count [RLC] is associated with cardiovascular disease [CVD] in patients with obstructive sleep apnea syndrome [OSAS]

Subjects and Methods: In this study, 141 patients diagnosed with OSAS using polysomnography were enrolled. Patients were classified according to the severity of OSAS as determined by the apnea-hypopnea index [AHI] and presence of CVD. Lymphocyte count and other hematological parameters at complete blood count were determined and compared between patients with and without CVD. Multivariate regression analysis was used to estimate the associated factors for presence of CVD

Results: Absolute and relative lymphocyte counts were lower in the OSAS patients with CVD compared to those without CVD [mean absolute lymphocyte counts: 2.0 × 103 vs. 2.5 × 103 microl, p = 0.004, and mean RLC: 28.3 vs. 33.9%, p = 0.001, respectively]. OSAS patients with CVD [14.2] had higher red cell distribution width values than the patients without CVD [13.4] [p = 0.005]. Multivariate analysis identified RLC as an independent predictor of CVD in patients with OSAS [odds ratio = 0.9, 95% CI: 0.85-1.0, p = 0.042]

Conclusion: RLC was identified as an independent predictor of CVD in patients with OSAS. Since RLC is a widely available diagnostic tool with no additional costs over the routinely performed complete blood count, it can be used for predicting CVD in patients with OSAS

Association of Fragmented QRS with subclinical left ventricular dysfunction in patients with obstructive sleep apnea

Objective: We aimed to investigate whether fragmented QRS [fQRS] is associated with subclinical left ventricular [LV] dysfunction in patients with obstructive sleep apnea [OSA]

Subjects and Methods: A total of 141 patients with OSA who had normal LV ejection fraction [LVEF] were included in the study. The fQRS was defined as the presence of an additional R wave, notching of R or S wave or the presence of fragmentation in 2 contiguous electrocardiography [ECG] leads. Subclinical LV dysfunction was defined as the presence of a tissue Doppler-derived Tei index of >/=0.5 in the absence of impaired LVEF [<50%] as assessed by transthoracic echocardiography

Results: Of the 141 patients, 71 [50.4%] had subclinical LV dysfunction. Overall, the prevalence of the fQRS was 61% [86/141]. Patients with fQRS had significantly higher Tei indices than those without fQRS [median 0.66, interquartile range [IQR] 0.39 vs. median 0.40, IQR 0.15, p < 0.001]. The presence of fQRS on ECG predicted subclinical LV dysfunction in univariate logistic regression analysis [odds ratio [OR] 6.69, 95% confidence interval [CI] 3.10-14.43]. The association remained significant after adjusting for all potential confounders [OR 4.59, 95% CI 1.94-10.87]

Conclusion: fQRS on ECG was an independent predictor of subclinical LV dysfunction in patients with OSA. This simple tool might help to identify OSA patients who could be at risk for developing overt cardiac dysfunction

Frequency and predictors of obesity hypoventilation in hospitalized patients at a tertiary health care institution

Patients with obesity hypoventilation syndrome [OHS] have significant morbidity and mortality. Early diagnosis and treatment is important and there are limited data on its prevalence and predictive factors. The objective of this observational study was to determine the frequency and predictors of OHS in hospitalized patients at a tertiary health care institution. All blood gas analyses of hospitalized adult [age over 18 years] patients were prospectively recruited from the biochemistry laboratory at a tertiary health care center between August 2009 and July 2010. Patients who had hypercapnia [PaCO[2] >/= 45 mmHg] while breathing room air were included and clinical and laboratory data were obtained from hospital records. A standard questionnaire was also filled by face-to-face interview with patients and/or relatives. A total of 9480 patients' arterial blood gases were evaluated and 330 patients [3.4%] who met the selection criteria were included in the analysis during the study period. Hypoventilation was associated with acute diseases in 64.2% and chronic diseases in 35.8% of the patients. Of the chronic hypoventilation patients, 24.4% had OHS. Univariate logistic regression analysis showed that, female gender, body mass index [BMI], smoking, PaO[2], SaO[2] and a PaCO[2]/BMI <1.5 were significantly related to OHS. In multivariate logistic regression analysis, BMI >35 kg/m[2], SaO[2] <91.4% and PaCO[2]/BMI <1.5 were significantly related to OHS. A PaCO[2]/BMI <1.5 was an independent variable strongly predictive of OHS [odds ratio: 36.9, 95% of the confidence interval: 2.75-492.95, P = 0.007]. OHS is a common cause of chronic alveolar hypoventilation. A careful examination PaCO[2]/BMI ratio may prevent misdiagnoses among hypercapnic patients.

Effect of early or delayed administration of warfarin with heparin on thrombosis in pulmonary thromboembolism

The aim of this study was to investigate the effect of early or delayed warfarin administration with unfrac-tionated heparin [UFH] on coagulation parameters in pulmonary thromboembolism [PTE]. This study was performed between November 2006 and July 2007. Thirty-three patients with PTE were sequentially slotted to early [n = 16] and delayed [n = 17] warfarin treatment groups. In the early group, both UFH infusion and warfarin were started simultaneously and in the delayed group, warfarin was added [1-3 days later] based on when partial thromboplastin time reached the therapeutic level with UFH. The proteins C and S, D-dimer, hematocrit levels, and platelet counts for all patients were studied prior to treatment and 6.24, and 48 h after warfarin treatment. In order to determine the overall effect of early and delayed warfarin treatment on clot formation, a thromboelastogram was performed simultaneously. In both groups, a similar chronological decrease in protein C levels reaching maximum at 24 h with warfarin treatment was observed. However, intragroup or intergroup decreases in protein S levels were not different. On thromboelastogram, INTEM and EXTEM clotting times were significantly prolonged chronologically, but this prolongation was not different between groups. The suppressor effect of warfarin on proteins C and S in the early period of double anticoagulant treatment did not appear to aggravate the risk of thrombosis in patients with PTE in whom warfarin was started simultaneously with UFH

Time course from first symptom to the treatment of lung cancer in the eastern black sea region of Turkey

To determine the delay between the onset and the diagnosis and treatment of patients with lung cancer in two cancer centres in the Eastern Black Sea Region of Turkey. Subjects and The records of 226 patients [217 males, 9 females] were evaluated retrospectively for the dates noted for the onset of symptoms, first presentation to a physician, histopathological diagnosis and start of treatment. The median time intervals from the appearance of the first symptom to definitive diagnosis and treatment were calculated. The patients presented to their physicians 30 [range 2-365] days after their complaints began. The time that elapsed between admission and histopathological diagnosis and between the diagnosis and initiation of therapy were 8 [range 1-210] and 17.5 days [range 0-206], respectively. The median time span from presentation to treatment was 30 days [range 1-253]. There were no significant time interval differences between onset of symptoms and first presentation and the subsequent diagnostic and therapeutic processes for histopathology, stage of the tumour and treatment procedures [p > 0.05]. Reasons for the delayed treatment of lung cancer patients were late presentation to the physician and the long time interval between tissue diagnosis and treatment. This delay was mostly associated with a large number of patients and delayed appointments for imaging procedures - the result of organisational problems within the health services of Turkey