Effect of Therapy on Choroidal Thickness in Patients With Obstructive Sleep Apnea Syndrome.

BACKGROUND AND OBJECTIVE: To evaluate effect of continuous positive airway pressure (CPAP) therapy on choroidal thickness in patients with obstructive sleep apnea syndrome (OSAS). PATIENTS AND METHODS: Thirty distinct eyes of 30 patients with OSAS were evaluated right before and 12 months after CPAP treatment in this prospective observational study. Choroidal thickness was measured at the fovea and with periodic intervals of 500 µm from the foveal center in both temporal and nasal directions using spectral-domain optical coherence tomography in enhanced depth imaging mode. RESULTS: The patients' mean age was 45.33 years ± 7.74 years, and there were eight females and 22 males. After CPAP therapy, the choroidal thicknesses were increased significantly at the subfoveal, 500 µm nasal to the fovea, 500 µm temporal to the fovea, and 1,000 µm temporal to fovea points (P < .05). However, none of retinal macular parameters were significantly different in statistical terms between the two measurements (P > .05). CONCLUSIONS: CPAP therapy had a significant influence on choroidal thickness in patients with OSAS, providing an increase in choroidal thicknesses after 12 months. The determination of an increase in choroidal thickness may be useful to reveal the effects of CPAP therapy and also may be one of the mechanisms to improve choroidal function. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:846-851.].

Continuous positive airway pressure therapy is associated with improvement in overactive bladder symptoms in women with obstructive sleep apnea syndrome.

INTRODUCTION: To evaluate the impact of continuous positive airway pressure (CPAP) therapy on overactive bladder (OAB) symptoms in women with obstructive sleep apnea syndrome (OSAS). MATERIAL AND METHODS: One-hundred and fifty women underwent an overnight polysomnography study between May 2014 and September 2014. Their voiding symptoms were evaluated using the OAB symptom score (OABSS) and International Consultation on Incontinence Questionnaire Short-Form at OSAS diagnosis and approximately 3-months after CPAP therapy. OSAS severity was assessed according to the apnea-hypopnea-index. RESULTS: We evaluated 140 women and 111 of them (79.3%) reported symptoms consistent with OAB. There were no statistically significant differences between OSAS severity with a prevalence of OAB (p = 0.92). The prevalence of urinary incontinence (UI) was 35.7% (n = 50) and 39.6% (n = 44) in all patients and patients with OAB, respectively. There were no statistically significant differences between UI with OAB (p = 0.58). Baseline OABSS is comparable between OSAS severity (p = 0.143). After 3-months CPAP therapy, OABSS and ICIQ-SF sum scores were significantly decreased in patients with severe and moderate OSAS (p <0.01), however, change of OABSS sum score was insignificant in patients with mild OSAS (p = 0.44). CONCLUSIONS: CPAP therapy improves the OAB, OABSS and ICIQ-SF scores in women with severe and moderate OSAS. OSAS-induced OAB may be alleviated following CPAP therapy.

Management of and risk factors related to hepatotoxicity during tuberculosis treatment.

INTRODUCTION: Hepatotoxicity is one of the most frequent adverse events occurring during tuberculosis treatment that may negatively affect treatment compliance, clinical outcome. This study was designed to evaluate management, risk factors related to hepatotoxicity during tuberculosis treatment. PATIENTS AND METHODS: Hospitalized patients for tuberculosis treatment at Sureyyapasa Chest Diseases, and Chest Surgery Training and Research Hospital were included, between January 2004 and December 2007. Prevalence of hepatotoxicity, risk factors were evaluated among tuberculosis patients under anti-tuberculosis treatment according to World Health Organization (WHO) guideline. Hepatotoxicity was defined any elevated liver function tests with accompanying symptoms. Age, gender, past history of anti-tuberculosis treatment, extensity of radiological findings, co-morbid disorders and drug resistance were the risk factors evaluated in terms of development and recurrence of hepatotoxicity. RESULTS: Of 1443 patients (38.37 ± 16.74 years; 64.5% were males), 106 (7.3%) was identified to develop hepatotoxicity on an average of 20 days after beginning treatment and lasting an average of 14 days. Hepatotoxicity for once in 78.3% (n= 83) of patients and more than once in 21.7% (n= 23) patients. All anti-tuberculosis drugs was continued at full dosage after the normalization of liver enzyme in 76.4% (n= 81). In recurrence a step-by-step treatment was re-started by exclusion of responsible drug/s. Treatment was administered without modification of WHO regimes in 79.2%. Pyrazinamide was omitted in 15 cases while rifampicin only in one patient. Triple drug regimen with isoniazid, ethambutol and streptomycin was used in six cases. Quinolon was added to treatment only in one patient. Presence of a co-morbidity was determined to be significant predictor of hepatotoxicity development OR= 3.093 (CI= 1.95-4.89; p= 0.000) past history of anti-tuberculosis treatment was significantly associated with recurrence (p= 0.027). There was no hepatotoxicity dependent mortality. CONCLUSION: Hepatotoxicity can be successfully management of hepatotoxicity without second line tuberculosis drugs in ongoing treatment regime.

The outcome of tuberculosis cases with persistent smear positivity at the end of extended initial phase.

INTRODUCTION: To present the treatment outcome in tuberculosis patients with sputum smear positivity in the third month of category 1 treatment regimes. PATIENTS AND METHODS: A total of 1024 patients with tuberculosis treated in Ministry of Health Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital from January 2004 to December 2005 were included in this retrospective cohort study. Categorization and appropriate treatment of tuberculosis was performed according the World Health Organization guidelines. RESULTS: Of overall 1024 patients, 655 (64%) were determined to receive category 1 treatment while sputum smear positivity was identified in 11 of them [2%; mean (SD) age: 46 (17.9) years] in the third month. Continuation phase treatment was initiated in these 11 patients. Sputum conversion was evident in six of 10 cases in the 4th month, in three cases in the 5th month and in one case in the 6th month. None had culture positivity after the 3rd month. Of 11 cases, 10 completed therapy with major drugs in six months and treatment outcome was cure. No relapse was identified after five years later. CONCLUSION: Based on our data we recommend that the continuing phase should be started in cases with positive sputum smear at the end of the extended initial phase.

[The effect of acute internal problems for mortality in respiratory intensive care unit patients]. / Gögüs hastaliklari yogun bakim ünitesindeki akut dahili sorunlarin mortaliteye etkisi.

Acute internal problems in the respiratory intensive care unit (ICU) and risk factors affecting mortality in the acute treatment applications were investigated. All patients in 20-bed intensive care unit for chest diseases enrolled to this prospective observational cohort study during 2008. Patients were classified as living in group 1 and deaths in group 2. Demographics and acute internal problems (arrhythmias, acute kidney-liver failure, dopamine, doputamin, perlinganit infusion) were recorded. Multiple regression analysis was performed for factors affecting mortality. There were 603 patients during the study period, group 1, n= 503 (83.4%), group 2, n= 100 (16.6%). Both groups were similar in terms of age and gender. Odds ratio (OR), 95% confidence interval (CI), p value for internal problems of acute risk factors for mortality were found as; septic shock OR: 22.52, CI 8.11-62.57, p< 0.000; need of perlinganit infusion OR: 9.28, CI: 1.61-53.37, p< 0.012; the presence of arrhythmia, OR: 7.81, CI: 3.46-17.65, p< 0.000; acute renal failure, OR: 2.88, CI: 1.24-6.65, p< 0.013 and the need for dopamine OR: 2.83, CI: 1.06-7.65, p< 0.037, respectively. Internal problems such as cardiac and renal dysfunction can devolop in respiratory ICU patients with pulmonary diseases and these problems constitude additional risk factors for mortalitiy. While the number of ICU is increasing with new health policies, each internal requirement and personnel equipped to treat the problem quickly must be considered.