Enhanced Kidney Damage Induced by Increasing Nonylphenol Doses: Impact on Autophagy-Related Proteins and Proinflammatory Cytokines in Rats.

Nonylphenol (NP) is an organic pollutant and endocrine disruptor chemical that has harmful effects on the environment and living organisms. This study looked at whether kidney tissues subjected to increasing doses of nonylphenol generated alterations in histopathologic, pro-inflammatory, and autophagic markers. Fifty rats were divided into five groups of ten each: group I: healthy group, II: control (corn oil), group III: 25 µl/kg NP, group IV: 50 µl/kg NP, group V: 75 µl/kg NP. The kidney tissue samples were obtained for histopathological, immunohistochemical, and biochemical analyses. The histological deteriorations observed in all NP groups included tubular epithelial cell degeneration, inflammation areas, and hemorrhage. The immunohistochemical investigations showed that NP significantly elevated the autophagy markers (Beclin-1, LC3/2, p62), pro-inflammatory cytokines (TNF-α, IL-6), HIF-1α, and eNOS in group III, IV and V compared with group I and II. The biochemical analysis also revealed that pro-inflammatory cytokines (TNF-α, IL-1ß, and IL-6) increased in correlation with the NP doses, but only IL-1ß reached statistical significance in NP treated rats kidney tissue. The biochemical findings have been confirmed by the histological studies. The damage to renal tissue caused by NP exposure may worsen it by increasing inflammatory and autophagic markers.

Protective Effects of Boric Acid Taken in Different Ways on Experimental Ovarian Ischemia and Reperfusion.

Ovarian ischemia is a gynecological emergency that occurs as a result of ovarian torsion, affects women of reproductive age, and reduces ovarian reserve. The current study was designed to investigate the effect of boric acid taken in different ways on histopathological changes, autophagy, oxidative stress, and DNA damage caused by ischemia and reperfusion in the ovary of adult female rats. We established seven groups of 70 adult female rats: untreated control, intraperitoneal boric acid group (IpBA), oral boric acid group (OBA), ischemia/reperfusion group (ischemia/2 h reperfusion; OIR), ischemia/reperfusion and local boric acid group (OIR + LBA), ischemia/reperfusion and intraperitoneal boric acid group (OIR + IpBA), and ischemia/reperfusion and oral boric acid group (OIR + OBA). On the 31st day of the experimental procedure, both ovaries were harvested for histologic (hematoxylen and eosin and Masson trichrom), biochemical (ELISA and AMH, MDA, SOD, and CAT analyses), and comet evaluation. In the OIR group, hemorrhage, edema, inflammation, and diminished follicle reserve were seen in the ovary. Boric acid treatment reduced the ovarian ischemia/reperfusion damage, and the follicles exhibited similar morphological features to the control group. Moreover, boric acid treatment decreased the levels of Hsp70, NF-KB, COX-2, and CD31, which increased as a result of OIR. On the other hand, SCF and AMH levels, which decreased as a result of OIR, increased with boric acid treatment. The levels of autophagy markers (Beclin-1, LC3, and p62) reached values close to those of the control group. According to the biochemical findings, it was concluded that boric acid is also effective on oxidative stress, and the AMH level was particularly high in the OIR + OBA group, consistent with the immunohistochemical staining result. In addition, it was observed that the DNA damage caused by OIR reached values close to those of the control group, especially in the OBA after OIR. This study showed the therapeutic effects of boric acid on OIR injuries; thus, boric acid may be a potential therapeutic agent for ovarian protection and fertility preservation in cases that may cause ovarian torsion.

Nonylphenol Exposure-Induced Oocyte Quality Deterioration Could be Reversed by Boric Acid Supplementation in Rats.

In this study, we reported boric acid's protective effects on the quality of nonylphenol (NP)-exposed oocytes. Female rats were classified into 4 groups: control, boric acid, NP, and NP+boric acid. Histopathological studies and immunohistochemical analysis of anti-müllerian hormone (AMH), mechanistic target of rapamycin (mTOR), Sirtuin1 (SIRT1), stem cell factor (SCF) studies were done. The comet assay technique was utilized for DNA damage. The ELISA method was used to determine the concentrations of oxidative stress indicators (SOD, CAT, and MDA), ovarian hormone (INH-B), and inflammation indicators (IL-6 and TNF-α). Boric acid significantly reduced the histopathological alterations and nearly preserved the ovarian reserve. With the restoration of AMH and SCF, boric acid significantly improved the ovarian injury. It downregulated SIRT1 and upregulated the mTOR signaling pathway. It provided DNA damage protection. Ovarian SOD, CAT levels were decreased by boric acid. Boric acid co-administration significantly reduced NP's MDA, IL-6, and TNF-activities. This results imply that boric acid has a protective role in ovarian tissue against NP-mediated infertility.

Turkish Thoracic Society's Statement Report on Electronic Cigarettes and Heated Tobacco Products.

Tobacco addiction, which causes the death of more than 8.5 million people in the world every year, is a preventable global public health problem. There are 1.1 billion adult smokers worldwide and 60% of them desire or intend to quit but unfortunately, the tobacco industry continues to profit at the expense of people's lives by marketing electronic cigarettes and heated tobacco products as a smoking cessation method and they continue to poison young people with new threat tobacco products, promising a "smoke-free future" Turkish Thoracic Society is actively involved in the implementation of the National Tobacco Control Program to protect public health and has warned and raised awareness of new threats to the youth, such as electronic cigarettes and heated tobacco products. The purpose of this report is to provide information about electronic cigarettes and heated tobacco products and to present TTJ's position on the subject.

Efficacy of stem cell-based therapies for colistin-induced nephrotoxicity.

The increase in infections with multidrug resistant bacteria has forced to return to the use of colistin, antibiotic with known nephrotoxicity. Mesenchymal stem cells (MSCs) are being extensively investigated for their potential in regenerative medicine. This study aimed to investigate the possible protective mechanisms of the MSCs against kidney injury induced by colistin. Forty adult female albino rats were randomly classified into 4 equal groups; the control group, the MSC-treated group (a single dose of 1 ×106 /ml MSCs through the tail vein), the colistin-treated group (36 mg/kg/day colistin was given for 7 days), and the both colistin and MSC group (36 mg/kg/day colistin and 1 ×106 /ml MSCs). Main outcome measures were histopathological alterations, kidney malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT) and immunohistological autophagy evaluation. MSC repressed the progression of colistin-induced kidney injury as evidenced by the improvement of histopathological alterations and the substantial increase MDA, and decrease SOD and CAT in serum levels. Moreover, MSC resulted in a profound reduction in oxidative stress as manifested by decreased MDA and increased SOD in serum. Notably, MSC suppressed colistin-induced autophagy; it reduced renal levels of Beclin-1, P62 and LC3A/B. Furthermore, MSC decreased renal levels of eNOS. Lastly, MSC efficiently decreased expression of the TUNEL positive cell number. MSC confers protection against colistin-induced kidney injury by alleviating oxidative stress, nitric oxide synthase besides modulating reducing autophagy and apoptosis.

Evaluation of Carbonmonoxide, Diffusion Capacity, Respiratory Muscle Strength Values, and Pulmonary Volume in Smoking Men over 40 Years Old.

OBJECTIVE: To determine the effects of tobacco use on the lungs before respiratory symptoms or basic functional disorders occur. MATERIAL AND METHODS: Forty-six active smokers between June 2018 and June 2019 who did not have any respiratory complaints, had no lung or chronic disease affecting the respiratory system, and consumed at least 20 packs/year were prospectively evaluated. In addition, a control group consisting of 50 non-smokers was formed. After confirming that spirometry and chest radiographs were normal, volunteers were taken to measure carboxymetry, plethysmography, respiratory muscle strength, and diffusion capacity, respectively. The changes in the lungs caused by smoking were analyzed with the data obtained from the measurements. RESULTS: Carbon monoxide values measured by carboxymetry were higher in smokers than non-smokers. Plethysmography tests showed that TLC, TLC%, FRC, FRC%, and RV values were statistically higher in smokers. No significant difference was found between FVC%, FEV1%, PEF, PEF%, MEF75, MEF75%, MEF50, MEF50%, MEF25, MEF25%, sRaw (eff), sRaw (eff%), Raw (eff), Raw (eff%), Raw (tot), Raw (tot%), IC, IC%, ERV, ERV%, RV% values and FEV1/FVC, FEV3/FVC, IC/TLC, and RV/TLC ratios. MIP, MIP%, MEP, MEP% values which measured respiratory muscle strength were similar in smokers and non-smokers. DLCO%, DLCO/VA, DLCO/VA%, DLCOc%, DLCOc/VA, and DLCOc/VA% were found to be lower in the smoker subjects. DLCO and DLCOc values were similar in both groups. CONCLUSION: Smoking causes the accumulation of toxic gas in the lungs, contributes to the development of hyperinflation and disrupts gas exchange. In our study, there was no evidence that airway resistance developed or respiratory muscles were affected.

F-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Images of Severe Primary Lung Lymphoma.

Primary lung lymphoma is one of the rarest forms of lymphoma and pulmonary space-occupying lesions. This case report represents the F-18 fluorodeoxyglucose positron emission tomography/computed tomography images of the most severe form of the primary pulmonary lymphoma reported in the literature.

The impact of hypoxemia on serum total and free prostate-specific antigen levels in patients with chronic obstructive pulmonary disease.

Prostate-specific antigen (PSA) is the most important biochemical marker in the diagnosis and follow-up of patients with prostate cancer. In recent years, a relationship between PSA levels and hypoxic conditions has been described. However, no study has investigated the PSA levels in patients with chronic obstructive pulmonary disease (COPD). The aim of the present study was to investigate the impact of hypoxemia on serum total (tPSA) and free PSA (fPSA) levels in patients with COPD. Between January 2010 and January 2014, 95 male patients who hospitalized for acute exacerbations of COPD and 80 control subjects were enrolled in the study. Serum tPSA and fPSA levels and f/tPSA ratios were determined in all patients on the first day of hospitalization (exacerbation) and 7 days after the treatment (stable state). Statistical analysis included paired t test and Mann-Whitney U test. No statistically significant differences were found between COPD and control groups with regard to the baseline characteristics, except for smoking status. The levels of serum tPSA and fPSA during exacerbation of COPD were significantly higher than the levels of the stable period (p < 0.01), whereas f/tPSA ratio did not change (p > 0.05). Hypoxemia during acute exacerbation of COPD can cause a rise in serum tPSA and fPSA levels, but f/tPSA ratio is not affected. Acute exacerbation of COPD may be added to list of the events in which PSA measurements must be interpreted with caution.

Assessment of long-term omalizumab treatment in patients with severe allergic asthma long-term omalizumab treatment in severe asthma.

OBJECTIVE: Several clinical studies have demonstrated the effectiveness of omalizumab in patients with severe allergic asthma but the treatment period has always been relatively short (4-12 months). In the literature, there are a few data about the long-term omalizumab therapy. We aimed to assess the long-term clinical and functional effectiveness of omalizumab treatment in severe allergic asthmatic patients, METHODS: Medical records describing the patients' status before the start of treatment, and also having been registered at the end of 4th, 12th, and 36th months from the commencement of treatment, and at the last visit where the patient was evaluated were used for omalizumab effectiveness assessments. Twenty-six patients (female/male: 21/5) with severe allergic asthma, uncontrolled despite GINA 2006 Step 4 therapy, were included in the study. Effectiveness outcomes included spirometry measurements, level of asthma control measured by asthma control test (ACT), systemic glucocorticosteroid (sGCS) use, emergency room (ER) visits, and hospitalizations for severe exacerbations. In addition, the quality of life was assessed using the quality of life questionnaire AQLQ(S) before, 4, and 36 months after treatment, RESULTS: The mean age was 47.6 ± 13.9 and duration of allergic asthma was 22.7 ± 10.1 years. Serum total IgE levels were 322.0 ± 178.1 IU/mL. Mean duration of omalizumab treatment was 40.81 ± 8.2 months. FEV1 improved significantly at all control points versus baseline (p < .05). The level of asthma control as evaluated by ACT improved significantly after treatment (p < .05). We determined significantly reduced numbers of exacerbation, emergency visits, hospitalizations, sGCS, and SABA use by the end of 36 months (p < .05). The proportion of patients with improvements larger than 1.5 points in AQLQ(S) total score was 80.7% at the 4th month and 96.1% at the 36th month of treatment, CONCLUSIONS: This study showed that long-term therapy with omalizumab for up to 3 years was well tolerated with significant improvement both in symptoms and lung functions. Accordingly, long-term omalizumab treatment may be recommended for responders.

Small cell lung cancer with metastasis to the thyroid in a patient with toxic multinodular goiter.

Thyroid metastasis of lung cancer is rarely observed in clinical practice. The primary cancers which metastasize to the thyroid gland are mostly renal cell carcinoma, lung cancer, and breast cancer. Transient destructive thyrotoxicosis is caused by massive metastasis of extrathyroid tumors. We herein present a case report of a patient with small cell carcinoma of lung with metastasis to the thyroid and thyrotoxicosis due to toxic multinodular goiter. A 66-year-old man complained of swelling around the right side of the neck, dyspnea, progressive weight loss, and palpitation starting since 3 months before his admission. The patient was diagnosed with small cell carcinoma of lung with metastasis to the thyroid and thyrotoxicosis due to toxic multinodular goiter. The case report presented here illustrates the challenge of making a definitive and adequate diagnosis, particularly if the patient presents with 2 potential causes of thyrotoxicosis. Thyroid scintigraphy is an important tool for differential diagnosis of thyrotoxicosis.

An integrated index combined by dynamic hyperinflation and exercise capacity in the prediction of morbidity and mortality in COPD.

BACKGROUND: Dynamic hyperinflation (DH) and exercise limitation develop in patients with COPD; however, there is lack of knowledge about their long-term clinical consequences. We aimed to assess the impact of DH and exercise capacity in predicting mortality and also morbidity, as evaluated by emergency visits and hospital admissions in COPD patients during a 4-year period. METHODS: We recruited 73 stable COPD patients. The relationships of different respiratory parameters (FEV(1)%, body mass index, 6 min walk test distance [6MWD], static hyperinflation as measured by the ratio of inspiratory capacity to total lung capacity (IC/TLC) at rest, DH as measured by the change between the post- and pre-exercise values of IC/TLC [ΔIC/TLC], P(aO(2)), and P(aCO(2))) with emergency visits and hospital admissions because of exacerbations and also with respiratory and all-cause mortality were assessed. RESULTS: The median follow-up period was 47 months (IQR 45-48 months, n = 73). During the follow-up there were 8 (11%) deaths. The ΔIC/TLC value was 3.9 ± 4.6%. The Kaplan-Meier survival curve showed that the cumulative survival rate was significantly lower in the patients with ΔIC/TLC > 4 and with 6MWD ≤ 439.56 m, using these values as thresholds. (The rates for sensitivity were 100% and 87.5%, and for specificity were 56.92% and 87.69%, respectively). The Cox proportional hazards model showed that DH (hazard ratio = 1.4, 95% CI = 1.09-1.84, P = .009) and 6MWD (hazard ratio = 0.98, 95% CI = 0.97-0.99, P = .006) were independent predictors of all-cause and respiratory mortality. 6MWD, FEV(1)%, IC/TLC, and ΔIC/TLC were found to be significantly related to emergency visits (r = -0.28, r = -0.41, r = -0.24, and r = 0.38, respectively) and hospital admissions (r = -0.41, r = -0.45, r = -0.36, and r = 0.28, respectively). CONCLUSIONS: DH and exercise capacity are reliable and independent predictors for mortality and morbidity in COPD patients. We propose that DH and exercise capacity be considered in the assessment of long-term clinical consequences of COPD patients.

Bronchial hyper-reactivity in migraine without aura: is it a new clue for inflammation?

OBJECTIVE: We attempted to investigate the relationship between migraine without aura (MwoA) and bronchial hyper-reactivity to postulate inflammation as an underlying mechanism in migraine. BACKGROUND: Comorbidity of migraine and atopic diseases such as asthma has been an argument for suspected immune system dysfunction in migraineurs. METHODS: Twenty patients with MwoA and 5 control subjects without history of atophy and asthma were included in study. Subjects with abnormal physical examination and chest radiographs were excluded. After a normal spirometry, methacholine bronchoprovocation test was performed in all subjects and controls according to 5 breath dosimeter methods. RESULTS: Sixteen of 20 patients and 2 of 5 control subjects were women. Mean ages were 37.5 (19-56) and 33.8 (26-43) years, respectively. Methacholine bronchoprovocation test was positive in 3 patients (15%) but was normal in all controls (0%). CONCLUSIONS: The relationship between MwoA and bronchial hyper-reactivity may help to postulate the inflammation in migraine as an underlying mechanism.

[How exactly can we predict the prognosis of COPD]. / KOAH hastalarinin progresyonlarini ne ölçüde tahmin edebiliriz?

Predictive models play a pivotal role in the provision of accurate and useful probabilistic assessments of clinical outcomes in chronic diseases. This study was aimed to develop a dedicated prognostic index for quantifying progression risk in chronic obstructive pulmonary disease (COPD). Data were collected prospectively from 75 COPD patients during a three years period. A predictive model of progression risk of COPD was developed using Bayesian logistic regression analysis by Markov chain Monte Carlo method. One-year cycles were used for the disease progression in this model. Primary end points for progression were impairment in basal dyspne index (BDI) score, FEV(1) decline, and exacerbation frequency in last three years. Time-varying covariates age, smoking, body mass index (BMI), severity of disease according to GOLD, PaO2, PaCO(2), IC, RV/TLC, DLCO were used under the study. The mean age was 57.1 + or - 8.1. BDI were strongly correlated with exacerbation frequency (p= 0.001) but not with FEV(1) decline. BMI was found to be a predictor factor for impairment in BDI (p= 0.03). The following independent risk factors were significant to predict exacerbation frequency: GOLD staging (OR for GOLD I vs. II and III = 2.3 and 4.0), hypoxemia (OR for mild vs moderate and severe = 2.1 and 5.1) and hyperinflation (OR= 1.6). PaO2 (p= 0.026), IC (p= 0.02) and RV/TLC (p= 0.03) were found to be predictive factors for FEV(1) decline. The model estimated BDI, lung function and exacerbation frequency at the last time point by testing initial data of three years with 95% reliability (p< 0.001). Accordingly, this model was evaluated as confident of 95% for assessing the future status of COPD patients. Using Bayesian predictive models, it was possible to develop a risk-stratification index that accurately predicted progression of COPD. This model can provide decision-making about future in COPD patients with high reliability looking clinical data of beginning.

[Predictive factors associated with severity of asthma exacerbations]. / Astim ataklarinda agirligi belirleyici risk faktörleri.

Several factors have been accused for asthma exacerbations, however, very few studies have evaluated whether different factors predict severity of asthma exacerbation. We aimed to determine the predictive factors for severity of asthma exacerbation. Retrospective analysis of data on 93 patients visited our emergency-department because of asthma exacerbation was reviewed. Hospitalization in intensive care unit and/or intubation because of asthma was accepted as the criteria for severe exacerbation. Logistic regression analysis estimated the strength of association of each variable, potentially related to severe asthmatic exacerbation, with severe/very severe as compared to mild/moderate asthmatic exacerbation. Independent variables included in the analysis were age, sex, smoking history, inhaler steroid using, compliance with medication, chronic asthma severity, presence of additional atopic diseases, prick test positivity, provocative factors, number of short-acting beta(2)-agonist using, number of visits to emergency department for asthma over one year period, previous severe exacerbation, pulmonary functions, and blood eosinophil count. 20 were severe/very severe and 73 mild/moderate asthmatic exacerbation. Frequent using of short-acting beta(2)-agonist (OR= 1.5, 95% CI= 1.08-5.3, p= 0.003), noncompliance with medication (OR= 3.6, 95% CI= 1.3-9.9, p= 0.013), previous severe asthmatic exacerbation (OR= 3.8, 95% CI= 1.48-10.01, p= 0.005) and recent admission to hospital (OR= 2.9, 95% CI= 1.07-8.09, p= 0.037) were found to be predictive factors for severe asthmatic exacerbation. Different predictive factors, in particular frequent using of short-acting beta(2)-agonist and noncompliance with medication may be associated with severe asthma exacerbations compared to milder exacerbations. This suggests different mechanisms are responsible for severity of asthma exacerbation.

Relationship between airway colonization, inflammation and exacerbation frequency in COPD.

RATIONALE: To evaluate bacterial colonization and the airway inflammatory response, and its relationship to the frequency of exacerbation in patients with stable chronic obstructive pulmonary disease (COPD). METHODS: Quantitative bacteriologic cultures, neutrophil elastase, myeloperoxidase (MPO), tumor necrosis factor alpha (TNF-alpha) and interleukin (IL)-8 were measured in bronchoalveoler lavage (BAL) in 39 patients with stable COPD [19 with frequent exacerbation (> or = 3/year), and 20 with infrequent] and in 18 healthy controls (10 smokers and 8 non-smokers). RESULTS: BAL revealed the microorganisms with potential pathogenicity above the established threshold (> or = 10(3)cfu/ml) in 68.4% of patients with frequent exacerbation, 55% of infrequent exacerbation, 40% of smokers and 12.5% of non-smokers controls (P=0.05). BAL MPO, IL-8 and TNF-alpha levels were found to be significantly higher in COPD as compared to controls (P=0.001). However, only IL-8 level was significantly higher in COPD patients with frequent exacerbation as compared to infrequent (P=0.001). Airway bacterial load correlated with levels of airway inflammation markers in COPD (P<0.05). CONCLUSION: The bacterial load and airway inflammation contributes to each other in stable COPD. However, there is a link only between interleukine (IL)-8 and frequent exacerbations. Clearly, the relationship between bacterial colonization, airway inflammation and frequent exacerbations is of major importance in understanding of the COPD pathogenesis.

Cognitive and functional deterioration in patients with severe COPD.

The objective of this study was to examine the association among the duration of COPD, degree of hypoxemia, and neurological abnormalities including cognitive functioning. Fifty-four patients with severe COPD and 24 age- and sex-matched controls, were included in the study. All patients and controls were administered pulmonary function tests, standardized Mini-mental State Examination (MMSE), Blessed Dementia Scale (BDS), Physical Self-maintenance Scale (PSMS), Modified Activities of Daily Living scale (MADL), Instrumental Activities of Daily Living scale (IADL), Cornell Scale for Depression in Dementia (CSDD), Global Deterioration Scale (GDS) and Clinical Dementia Rating (CDR). In addition, detailed physical and neurological examinations were performed. Sixty-four percent of patients with COPD showed abnormalities in MMSE, predominantly in recent memory, construction, attention, language, and orientation domains. Functional abnormalities were correlated with cognitive abnormalities. Although COPD patients did not show significant depression compared to controls, 77.7%. of the patients showed subjective and objective cognitive disturbance and 72.2% of the patients were classified as questionable or mild dementia. In conclusion, patients with COPD show significant cognitive and functional impairments that cannot be explained just by coincidence or by depression.

Headache in patients with chronic obstructive pulmonary disease: effects of chronic hypoxaemia.

The frequency and characteristics of headache in patients with chronic obstructive pulmonary disease (COPD) are not clear and there are only a few studies that have assessed the relationship between chronic hypoxaemia and headache. We performed this study in order to evaluate the frequency and characteristics of headache in COPD patients. A total of 119 patients, with a mean age of 63.4 +/- 8.2 years, diagnosed with moderate or severe stable COPD were included in the study. Overall 31.9% of the patients complained of headache and 45.4% were reported to have sleep disorders. There were significant effects of family history of COPD, having other systemic disorders or sleep disorders (snoring, bruxism, restless leg syndrome, etc.) and laboratory data of chronic hypoxaemia and airway obstruction on headache co-morbidity. In conclusion, possibly being a specific subtype of elderly headache, headache in patients with moderate or severe COPD is a common problem and future studies are needed to obtain more knowledge about its pathophysiological and clinical basis.

Cranial optic nerve involvements in patients with severe COPD.

OBJECTIVE: The relationship between neuropathy and increased morbidity in patients with COPD is clear, but few studies have assessed cranial neuropathies, especially optic nerve involvement, in COPD patients. We evaluated peripheral involvement of the optic nerve and determined factors influencing this condition in patients with severe COPD. METHODOLOGY: Twenty-eight patients, mean age 59.4 +/- 9.4 years, diagnosed with severe stable COPD according to the GOLD criteria, and 20 age- and gender-matched healthy individuals, mean age 55.6 +/- 8.5 years, were included in the study. All subjects underwent visual evoked potential (VEP) assessment together with detailed clinical and laboratory examination to exclude concurrent risk factors for neuropathy. RESULTS: VEP assessment showed significant abnormalities in COPD patients (82.1%) (commonly amplitude abnormalities) when compared with healthy controls. CONCLUSIONS: The optic nerve is often involved in patients with severe COPD, possibly as part of a polyneuropathy, and this is related to acidosis, hypercarbia and airway obstruction, independent of disease duration, smoking and age. These results should be taken into consideration when determining management strategies for these patients.

Cough headache: frequency, characteristics and the relationship with the characteristics of cough.

Cough headache (CH) is a relatively rare, but an important complication of cough. The aim of this cross-sectional clinical study was to evaluate the frequency, characteristics and etiology of CH among the patients referred to our Outpatient Department with the complaint of cough, and to investigate the relationship between their cough and headache characteristics. We evaluated 96 females and 69 males, a total of 165 patients with cough. Among those, 57 patients (34.5%) had one or more cough complications and 32 patients (19.3%) were diagnosed as CH. Although it was known that most of the patients with CH had benign headache characteristics, the ratio of the symptomatic CH was not low (37.5% of the CH patients and 7% of patients with cough). Also, there was a significant correlation between the frequency of cough and the severity of headache. Logistic regression analysis showed that the incidence of CH was increased 0.4-fold, when frequency of cough increased. Age, sex, tobacco use ad the duration of cough were not found to be predictive factors for CH. Logistic regression analysis showed that the rate of cough complications increased 2.08-fold, when the duration of cough was longer than eight weeks (p=0.03) and 0.4-fold when the frequency of cough increased (p=0.02). In conclusion, CH is a relatively rare, but an important complication of cough and it commonly has an effective treatment available. Radiological work-up was crucial in ruling out other causes of headache and to confirm that the CH was truly benign.