Investigation of Inspiratory Muscle Training Efficiency Before Bronchoscopic Lung Volume Reduction: A Randomized Controlled Trial.

INTRODUCTION: Pulmonary rehabilitation (PR) is recommended prior to bronchoscopic lung volume reduction (BLVR) procedures to optimize patient outcomes. However, there's a lack of clear guidance on PR content. The aim of our study is to examine the effect of adding inspiratory muscle training (IMT) to standard PR before BLVR on exercise capacity, dyspnea, fatigue level and quality of life. METHODS: Sixty-four patients were randomly assigned to either the PR Group (PRGr) or the PR with IMT group (IMTGr). Both groups underwent an 8-week standard PR program, including breathing exercises, muscle strengthening, and walking. Additionally, IMTGr received IMT sessions. Outcome measures comprised six-minute walking distance (6MWD), maximal inspiratory and expiratory pressures (MIP, MEP), peripheral muscle strength, modified Medical Research Council dyspnea score, fatigue symptom scale, spirometric parameters, Saint George Quality of Life Questionnaire (SGRQ), International Physical Activity Questionnaire Short Form (IPAQ-SF), and Hospital Anxiety and Depression Scale. RESULTS: Our study found no significant difference in exercise capacity improvement between IMTGr and PRGr. However, IMTGr showed significant improvement in MIP compared to PRGr. Both groups experienced improvements in dyspnea, fatigue, and depression scores, as well as enhancements in 6MWD, MEP, peripheral muscle strength, IPAQ-SF and SGRQ scores. CONCLUSION: Adding IMT to PR did not show a significant difference between groups among BLVR-eligible patients. However, improved respiratory muscle strength may have positive clinical implications. Further research is needed to explore short and long-term effects.

Investigation of respiratory muscle strength and its influence on exercise capacity and quality of life in patients with idiopathic pulmonary fibrosis.

BACKGROUND: Adequate respiratory muscle strength is required to meet the increased ventilatory demand during physical activities. However, it is not well known whether respiratory muscle strength is impaired in patients with idiopathic pulmonary fibrosis (IPF). OBJECTIVES: This study aimed to investigate the relationship between respiratory muscle strength and exercise capacity, quality of life, physical activity level, and fatigue in IPF patients. METHODS: The study comprised 30 individuals with idiopathic pulmonary fibrosis (IPF) and 30 healthy controls. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured to assess respiratory muscle strength. The International Physical Activity Questionnaire-Short Form, 6-minute walk test distance (6MWD), St George Respiratory Questionnaire (SGRQ), and Fatigue Severity Scale (FSS) were employed to evaluate physical activity level, exercise capacity, quality of life, and fatigue severity, respectively. RESULTS: MIP (81±29 vs.73±20 cmH2O) and MEP (93±31 vs. 93±34 cmH2O) did not differ significantly between IPF patients and controls (p>0.05). In patients with IPF, MIP was significantly correlated with 6MWD (r=0.533), SGRQ (r=-0.428), and FSS (r=-0.433). Multivariate models including MIP, MEP, FEV1, FVC, and PA level explained 74% of the variance in the 6MWD (p<0.001), and MIP, FEV1, and PA level were independent predictors of the 6MWD, with FEV1 being the strongest predictor (ß=0.659). Multivariate models predicting SGRQ revealed none of MIP, FEV1 or PA level was directly influencing the SGRQ score. CONCLUSIONS: This study suggests that patients with IPF do not have respiratory muscle weakness. Inspiratory muscle strength has a direct influence on exercise capacity but an indirect effect on quality of life, probably by influencing exercise capacity.

Handgrip Strength in Lung Transplant Candidates and Recipients.

OBJECTIVES: Handgrip strength is increasingly used to assess muscle strength in various conditions. In this review, we investigated handgrip strength in patients receiving or awaiting lung transplant. MATERIALS AND METHODS: For this integrative review, we searched 8 databases from inception through February 2023. Two keyword entries, "handgrip strength" and "lung transplantation," were matched using the Boolean operator, AND. No filters were applied for document type, age, sex, publication date, language, and subject. RESULTS AND CONCLUSIONS: The searched databases returned 73 citations. Nine articles considering 487 patients (49% female) were included in the final analysis; 7 studies were observational, and 2 were randomized controlled trials. In 7 of 9 studies, handgrip strength was measured with a hydraulic dynamometer. In candidates for lung transplant, handgrip strength ranged from 27.1 kg (before rehabilitation) to 31.2 kg (after rehabilitation). In lung transplant recipients, handgrip strength ranged from 21.1 kg (before rehabilitation) to 35.7 kg (after rehabilitation). Handgrip strength in lung transplant candidates with chronic obstructive pulmonary disease was higher (89 ± 18% predicted) versus patients with interstitial lung disease (79 ± 18% predicted). Improvements in maximal inspiratory pressure and maximal expiratory pressure were observed in those patients whose handgrip strength improved after rehabilitation. Nonsarcopenic patients walked longer distances for the 6-minute walking test (>450 m) versus sarcopenic patients (<310 m) and had higher handgrip strength (>20 kg) versus sarcopenic patients (<20 kg). Handgrip strength testing should be implemented both in preoperative and postoperative contexts to evaluate physical potential of patients and drive rehabilitative activities toward the most impaired domains.

Home-Based Physiotherapy and Rehabilitation in Patients with Idiopathic Pulmonary Fibrosis: A Review.

The objective of the study is to review the studies on home-based pulmonary rehabilitation practices in idiopathic pulmonary fibrosis patients in the last 5 years. Home-based randomized controlled trials in idiopathic pulmonary fibrosis patients published in the PubMed database within the previous 5 years were searched. As a result of the research, a total of 5 articles were included in the study. Five home-based rehabilitation practices used in these articles were reached. Totally, 176 patients were found to have participated in these programs. As a result, patients who have difficulty accessing hospital-based rehabilitation services due to various reasons will benefit from home-based rehabilitation services. However, the content of the home-based program and the method of follow-up and supervision affect the results.

The activity levels and quality of life of physically disabled children who continued or did not continue rehabilitation during the COVID-19 pandemic.

BACKGROUND: Social isolation during the COVID-19 pandemic had a harmful impact on the psychological and physical health of children and teenagers. It is known that interruptions in rehabilitation can cause soft tissue contractures, bone deformities and a decline in motor functions among other complications. OBJECTIVE: The aim of this study was to compare the quality of life and physical activity levels of physically disabled children who continued and did not continue rehabilitation during the COVID-19 pandemic. METHOD: The gross motor levels of 18 children who continued special education and rehabilitation during the COVID-19 pandemic and 18 children who did not continue were determined with the Gross Motor Function Classification System (GMFCS). The International Physical Activity Questionnaire Short Form (IPAQ) and Children's Quality of Life Scale (PedsQL) questionnaires were administered. RESULTS: The study participants comprised 54.1% females and 45.9% males with a mean age of 9.02 years. No significant differences were detected between the two groups in respect of demographic, clinical and functional characteristics (p > 0.05). The walking parameters of PedsQL (p = 0.02) and IPAQ-SF scores (p = 0.03) were determined to be statistically significantly better in the group that continued rehabilitation. CONCLUSION: The results of this study demonstrated that the quality of life and walking capacity of children who continued rehabilitation during the COVID-19 pandemic were better. Methods should be developed to ensure that rehabilitation is not interrupted during isolation periods of any future pandemic.

Does Preoperative Rehabilitation Influence the Quality of Life in Patients Who Are Candidates for Lung Transplant?

OBJECTIVES: Lung transplant is an excellent therapeutic option for patients with advanced/end-stage pulmonary disease. The purpose of this review was to define whether preoperative rehabilitation influences quality of life in patients who are candidates for lung transplant. MATERIALS AND METHODS: This was a scoping review conducted by searching 4 primary databases from inception until January 2022. Three keywords, "lung transplantation," "preoperative rehabilitation," and "quality of life," were matched using the Boolean operator AND. In each database, the following fields were searched: PubMed (all fields), Scopus (title, abstract, keywords), Cochrane Library (title, abstract, keywords), and Web of Science (topic). Filters were applied for age (adult only) and language (English only). No filters were applied for gender, publication date, and subject. The search process was completed in January 2022. RESULTS AND CONCLUSIONS: We retrieved 57 citations from these databases. After removal of duplicates, 41 documents were screened for eligibility. Two articles were included in the final analysis: 1 was a systematic review, and 1 was an observational prospective study. The rehabilitative interventions were mainly focused on motor and breathing exercises and were integrated by education programs. Preoperative rehabilitation was effective atimproving quality of life and mood status and reducing dyspnea in patients waiting for lung transplant. In addition, the 6-minute walking distance increased after patients participated in preoperative rehabilitation. Preoperative rehabilitation was composed of different types of exercise with variable duration (3-20 weeks) and frequency (3-6 times per week). Patients on the active wait list for lung transplant should be encouraged to attend preoperative rehabilitation in order to preserve and improve their quality of life.

Increased Frequency of Febrile Seizures in Two Periodic Fever Syndromes: Familial Mediterranean Fever and PFAPA Syndrome.

OBJECTIVE: Our aim in this study is to reveal the frequency of febrile seizures in patients with Familial Mediterranean Fever and Periodic Fever, Aphthous stomatitis, Pharyngitis, cervical Adenitis syndrome and to compare it to normal population. MATERIALS AND METHODS: Patients with Familial Mediterranean Fever and Periodic Fever, Aphthous stomatitis, Pharyngitis, cervical Adenitis syndrome, who were diagnosed accord- ing to Turkish pediatric Familial Mediterranean Fever diagnostic criteria and Marshall criteria, were enrolled to the study. A form containing questions about febrile seizures history was pre- pared for Familial Mediterranean Fever and Periodic Fever, Aphthous stomatitis, Pharyngitis, cervical Adenitis syndrome patients. Demographic data and febrile seizures history of Periodic Fever, Aphthous stomatitis, Pharyngitis, cervical Adenitis patients were obtained by calling the parents by phone. Familial Mediterranean Fever patients were randomly selected during their routine follow-up. The frequency of febrile seizures in both disease groups was compared with the prevalence of previous febrile seizures studies in the general population in Turkey. RESULTS: A total of 417 Familial Mediterranean Fever and 152 Periodic Fever, Aphthous stomati- tis, Pharyngitis, cervical Adenitis subjects were recruited to the study. The frequency of febrile seizures in Familial Mediterranean Fever and Periodic Fever, Aphthous stomatitis, Pharyngitis, cervical Adenitis syndrome was similar (8.4% vs. 8.6%; P > .05). The frequency of febrile seizures in Familial Mediterranean Fever and Periodic Fever, Aphthous stomatitis, Pharyngitis, cervical Adenitis syndrome patients was found to be significantly higher than the frequency in general population (8.4% vs. 4.4%) [P < .0001, OR: 1.99 (CI: 1.4-2.8)]; (8.6% vs. 4.4%) [P < .01, OR: 2.03 (CI: 1.1-3.6)], respectively. CONCLUSION: The frequency of febrile seizures in patients with Familial Mediterranean Fever and Periodic Fever, Aphthous stomatitis, Pharyngitis, cervical Adenitis syndrome was found to be significantly higher than in the general population. This increased frequency of febrile seizures in both periodic syndromes seems to be a result of recurrent fever.

The effectiveness of POST-DISCHARGE telerehabilitation practices in COVID-19 patients: Tele-COVID study-randomized controlled trial.

AIMS: We aimed to investigate the effectiveness of a telerehabilitation exercise program performed without requiring any special equipment on the physical condition of COVID-19 subjects. SETTINGS AND DESIGN: This was a randomized controlled study. METHODS: This study included subjects with a history of hospitalization with a diagnosis of COVID-19 and discharged within 4 weeks. The subjects were divided into two groups randomly, namely telerehabilitation group (TeleGr, n = 17) or control group (CGr, n = 17). The TeleGr received breathing and range of motion exercises, active cycle of breathing technique, and an aerobic training 3 days a week for 6 weeks, while CGr received an exercise brochure with the same content. Subjects were evaluated using the modified Medical Research Council (mMRC) dyspnea score for dyspnea, 30 s sit-to-stand test (30STS) and short physical performance battery (SPPB) to determine their physical status, Saint George Respiratory Questionnaire (SGRQ) to assess quality of their life, and Beck Depression Inventory. All evaluations were carried out at home using videoconferencing. RESULTS: A significant improvement was observed in TelerGr in terms of mMRC (P= 0.035), 30STS (P= 0.005), 5 sit-to-stand time which is one of the subtests of SPPB (P = 0.039) and SGRQ scores. Significant improvement was observed only in the pain score in the CGr (P = 0.039). There was a statistically significant difference between the groups in SGRQ activity (P = 0.035) and total (P = 0.042) scores. In addition, more symptomatic improvement was found in TeleGr. CONCLUSION: Telerehabilitation exercise program with less technical equipment is a good alternative treatment method for COVID-19 subjects, which improves the quality of life and symptomatic status of subjects. Clinical Trial Registration Number: nct04402983.

Is it Possible to Use the Timed Performance Tests in Lung Transplantation Candidates to Determine the Exercise Capacity?

OBJECTIVES: Lung transplantation (LTx) candidates have severe exercise intolerance. This makes it difficult for them to complete the field tests used to determine the exercise capacity of patients. Therefore, there is a need for alternative tests that require less effort. We aimed to investigate the use of short-timed performance tests instead of 6-minute walk test (6MWT) in the determination of exercise capacity in LTx. MATERIALS AND METHODS: A total of 63 LTx candidates were included in the study. Ten-meter walking speed test (10MWT), 5-times sit-to-stand test (5XSST), 6MWT were performed at one-hour intervals within the same day, and by the same physiotherapist in all patients. Maximal inspiratory (MIP) and expiratory pressure (MEP), peripheral muscle strengths, pulmonary function tests, and body mass index (BMI) were recorded for each patient. RESULTS: The subjects' baseline mean 6-minute walking distance (6MWD) was 336m, 5XSST time was 11.59 sec, and 10MWT time was 8.45sec. There was a negative and moderate correlation between 6MWD and 10MWT (p<0.001, r=0.449). Similarly there was a negative but weak correlation between 6MWD and 5XSST (p=0.001, r=0.397). In addition, there was a strong relationship between 5XSST and 10MWT (p<0.001, r=0.767). CONCLUSION: This study showed that 6MWT and short-timed performance tests were correlated in terms of exercise capacity assessment. In contrast, there was a strong relationship between 6MWT and 10MWT according to 6MWT and 5XSST. The timed performance tests may be alternative tests to determine exercise capacity in LTx candidates.

Anemia after kidney transplantation: Does its basis differ from anemia in chronic kidney disease?

BACKGROUND: Although similar factors play a role in both PTA and anemia in patients with CKD, additional risk factors exist in the pathogenesis of PTA. The present study aimed at comparing anemia and inflammation-related parameters between RTx recipients and CKD patients and elucidating the risk factors of PTA. METHODS: This single-centered, cross-sectional study consisted of 68 participants: 48 were in the RTx group and 20 were in the CKD group. The CKD patients were comparable to the RTx recipients in terms of age, gender, and eGFR. Serum levels of EPO, hepcidin, and IL-6 were measured by enzyme-linked immunosorbent assays. The ratio of EPO/Hb was calculated to estimate endogenous EPO resistance. RESULTS: The prevalence of anemia was 46% in the RTx group and 30% in the CKD group (P = .23). RTx recipients had significantly lower Hb (P = .04), higher EPO (P < .001), and ferritin levels (P = .001), and higher EPO/Hb ratios (P < .001); however, CKD patients showed a higher frequency of absolute iron deficiency (P = .008). Neither hepcidin nor IL-6 levels differed between the two groups. Hb level of RTx recipients was correlated with only eGFR (r = .437, P = .002) but not with any of the transplantation-related factors, while Fe level was the only parameter to be correlated with Hb level of CKD patients (r = .622, P = .01). CONCLUSION: In the present study comparing GFR-matched RTx and CKD patients, lower GFR level appears to be the factor most strongly associated with anemia, and endogenous EPO resistance is among the contributing factors to PTA.

A comparative study of the effectiveness of hospital-based versus home-based pulmonary rehabilitation in candidates for bronchoscopic lung volume reduction.

BACKGROUND: The Bronchoscopic Lung Volume Reduction (BLVR) is recommended in patients with severe Chronic Obstructive Pulmonary Disease (COPD) who are still symptomatic and have hyperinflation despite having received optimal medical therapy and Pulmonary Rehabilitation (PR). However, the small number of PR centers is insufficient to compensate for the need for existing hospital-based PR programs. OBJECTIVE: This article aimed to compare between hospital-based and home-based PR programs in terms of effectiveness on BLVR candidates. METHODS: This study is a prospective, controlled, nonrandomized clinical trial. Stable COPD patients who were referred to our PR clinic prior to BLVR were recruited consecutively. Patients were evaluated in two groups, hospital-based PR (Group 1) or home-based PR (Group 2). Both groups were admitted to the recommended PR for eight weeks. Pulmonary function tests, modified Medical Research Council (mMRC) dyspnea scale, COPD Assessment Test (CAT) and the 6-min walk distance (6MWD) were assessed for each patient before and after PR. RESULTS: A total of 67 patients were enrolled in the study. The max. age was 79 years and min. age was 49 years, with 65(±7.45) as a mean ±SD. Improvements in the mMRC and CAT scores after PR in both groups were significant and a similar level. Whereas, 6MWD was only significantly increased in Group 1. CONCLUSIONS: This study, demonstrated that both home-based and hospital-based PR provided significant and similar improvements in the mMRC and CAT scores but 6MWD was only significantly increased in the hospital-based PR. Since 6MWD after PR plays a major role in BLVR eligibility, our findings suggest that hospital-based PR may be the most appropriate method for BLVR candidates.

Effect of 8-week Pulmonary Rehabilitation Program on Dyspnea and Functional Capacity of Patients on Waiting List for Lung Transplantation.

OBJECTIVES: The aim of this study was to evaluate the effect of comprehensive, 8-week outpatient pulmonary rehabilitation (PR) programme consisting of 60-min sessions twice a week under supervision on dyspnea and exercise capacity of patients who were lung transplantation (LTx) candidates. MATERIALS AND METHODS: Between March 2012 and December 2014, medical data of 23 patients on the waiting list for LTx who were referred to our PR unit and completed 16-session outpatient under direct supervision were retrospectively analyzed. Data on exercise capacity as assessed by 6-minute walking test (6MWT) and the rate of perceived dyspnea as assessed by the Borg scale and Medical Research Council (MRC) dyspnea scale were recorded. RESULTS: Of 23 patients 57% were males; the mean age was 35±10 (range: 16-48) years. Four patients were operated early, as an appropriate donor was available. Diagnosis was as follows: bronchiectasis (n=10, 44%), silicosis (n=7, 30%), sarcoidosis (n=2, 9%), idiopathic pulmonary fibrosis (n=1, 4%), chronic obstructive pulmonary disease (n=1, 4%), and others (n=2, 9%). At the end of the program, there was a significant improvement (median: 60 m) in 6MWT scores (360 [70-254] m vs. 300 [139-489] m; p=0.018). In addition, a clinical improvement was observed in Borg (p=0.000) and MRC scores (p=0.008). CONCLUSION: Our study results suggest that 8-week outpatient PR programme consisting of training twice a week is effective to decrease perceived dyspnea and to improve exercise capacity in patients who are on the waiting list for LTx.

Comparison of Compliance Rates and Treatment Efficiency in Home-Based with Hospital-Based Pulmonary Rehabilitation in COPD.

OBJECTIVES: The aim of the present study was to compare the home-based pulmonary rehabilitation (PR) with the hospital-based PR with respect to exercise compliance rates and efficiency of therapy in stable chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: Patients with stable severe and very severe COPD who were admitted consequently to our PR clinic were prospectively included in the study. Patients who completed the home-based PR for at least 4 days/week for 2 months as recommended were classified as the study group. Patients who completed the hospital-based PR in our clinic before the present study were classified as the control group. RESULTS: Thirty-five patients were included in the home-based PR, but 10 patients were incompatible with the exercise training, and four patients were out of follow-up. Twenty-one patients successfully completed the home-based PR (study group), and compliance rate was 60%. Thirty-seven patients previously underwent the hospital-based PR, and 25 patients completed the exercise program (control group); thus, their compliance rate was 67%. There was no difference between the two groups with respect to treatment compliance rates. The significant improvement in six-minute walking distance, modified Medical Research Council dyspnea, and COPD Assessment Test scores were observed after PR in both groups, and there was no difference with respect to the levels of improvement. CONCLUSION: The present study showed that approximately two-thirds of patients with COPD successfully completed the home-based PR, and that this program also provided similar benefits with respect to the quality of life and exercise capacity compared with the hospital-based PR.

The Effect of Pulmonary Rehabilitation on the Physical Activity Level and General Clinical Status of Patients with Bronchiectasis.

OBJECTIVES: We aimed to investigate the effects of pulmonary rehabilitation (PR) on the level of physical activity (PA) and the general clinical status in adult patients with non-cystic fibrosis bronchiectasis. MATERIALS AND METHODS: The patients were included prospectively in the study and followed a home-based PR program for 2 months comprising breathing exercises, training in chest hygiene techniques, peripheral muscle strengthening training, and self-walking. The outcomes measurements were the following: 6-minute walking distance, pulmonary function test, peripheral and respiratory muscle strength measurements, International Physical Activity Questionnaire (IPAQ), Saint George Respiratory Questionnaire, and modified Medical Research Council dyspnea scores. RESULTS: Of the total 25 patients included in the study, six were excluded due to follow-up and adherence problems. A comparison of the outcome measures recorded before and after PR showed statistically significant improvements in the IPAQ total (p=0.015) and walking scores (p=0.011). While the proportion of patients in the low PA category was 73% (n=14) prior to PR, this rate decreased to 42% (n=8) post-PR. The proportion of patients in the moderate PA category was 26% (n=5) prior to PR and increased to 52% (n=10) post-PR. While positive improvements were seen in all clinically monitored parameters, aside from spirometric values, these changes did not reach a statistically significant level. CONCLUSION: The majority of patients with bronchiectasis have a low level of PA. PR ensures positive improvements in the level of PA and general physical clinical status of such patients.

Can functional inoperability in lung cancer patients be changed by pulmonary rehabilitation?

BACKGROUND: This study aims to investigate the effects of shortterm intense pulmonary rehabilitation on respiratory function in patients with lung cancer who were defined as inoperable due to insufficient pulmonary reserve. METHODS: A total of 25 patients (24 males, 1 female; mean age 62 years; range, 50 to 72 years) who were histologically diagnosed as non-small cell lung carcinoma, considered functionally inoperable due to high risk of an estimated postoperative complication, and suitable for surgical resection according to tumor stage were included in the study. Patients received chest physiotherapy, self-walking and inspiratory muscle training for two weeks. The forced expiratory volume in one second, forced vital capacity, modified Medical Research Council dyspnea scale, six-minute walking distance, maximal inspiratory and expiratory pressures for respiratory muscle strength measurements, and predicted peak maximal oxygen consumption were examined. RESULTS: After pulmonary rehabilitation, there was statistically significant improvement in the six-minute walking distance (53 m, p<0.001), dyspnea perception (p<0.001), maximal inspiratory pressure (12 cm H2O, p<0.001), forced vital capacity (p<0.001), predicted forced expiratory volume in one second (%) (p=0.001), forced expiratory volume in one second (Δ forced expiratory volume in one second= 150 mL, p=0.001; Δ maximum value of forced expiratory volume in one second: 650 mL), and predicted maximal oxygen consumption (p<0.001). At the end of the rehabilitation, 60% of the patients (n=15) reevaluated by the surgeons could be operated. CONCLUSION: Short-term intensive pulmonary rehabilitation improves lung functions and exercise capacity while decreasing dyspnea perception. In our study, thanks to the gains derived from the exercise, approximately more than half of the patients could be operated. Therefore, it may be useful to refer patients to rehabilitation before establishing a decision of inoperability.

The effects of inspiratory muscle training on exercise capacity, dyspnea and respiratory functions in lung transplantation candidates: a randomized controlled trial.

OBJECTIVE: To investigate whether inspiratory muscle training would contribute to the improvement of exercise capacity, dyspnea perception and respiratory functions in lung transplantation candidates. DESIGN: Prospective randomized controlled trial. SETTING: Pulmonary Rehabilitation center. SUBJECTS: A total of 34 patients with severe lung disease requiring lung transplantation were randomly allocated to either pulmonary rehabilitation plus inspiratory muscle training group (PR + IMT group, n = 17) or pulmonary rehabilitation group (PR group, n = 17) before any lung transplantation operation. METHODS: All patients underwent supervised pulmonary rehabilitation program on two days per week for three months. The PR + IMT group received inspiratory muscle training in addition to the standard pulmonary rehabilitation program. The 6-minute walk test, maximal inspiratory pressure, modified Medical Research Concile dyspnea scores and spirometric parameters were measured for each patient. RESULTS: The PR + IMT group had statistically significantly increased in walking distance (100 m, P = 0.03), maximum inspiratory pressure (26 cmH2O, P = 0.001) and alveolar volume ratio of carbonmonoxide diffusion capacity (9%, P = 0.02) than PR group. Although both groups demonstrated a statistically significant decrease in the dyspnea score, no significant differences were found between the groups ( P = 0.075). There was no change in spirometric variables in both groups. CONCLUSION: A greater increase in exercise capacity was observed in the PR + IMT group. Our study showed that inspiratory muscle training improved exercise capacity even further and increased the benefits provided by pulmonary rehabilitation.

PFAPA Syndrome in a Population with Endemic Familial Mediterranean Fever.

We reviewed the medical records of patients with periodic fever, aphthosis, pharyngitis, and adenitis (PFAPA) to investigate the clinical course, treatment response, and association with MEFV gene mutation. Familial Mediterranean fever should be considered in patients with PFAPA who do not respond to adenotonsillectomy.

Preoperative Pulmonary Rehabilitation for Lung Transplant: Effects on Pulmonary Function, Exercise Capacity, and Quality of Life; First Results in Turkey.

OBJECTIVES: The frequency and success rates of lung transplant in patients with end-stage lung disease are increasing. In our study, we investigated the effects of preoperative pulmonary rehabilitation on pulmonary function, exercise capacity, and quality of life in patients who are candidates for lung transplant. MATERIALS AND METHODS: This prospective study included 39 consecutive patients who were candidates for lung transplant. All patients underwent preoperative pulmonary rehabilitation for at least 3 weeks. RESULTS: Our patient group included 25 male and 14 female patients with a mean age of 36 years (range, 15 -68 y). Although no significant improvement was shown in the forced expiratory volume in 1 second after pulmonary rehabilitation, significant improvements were observed in the Modified Medical Research Council dyspnea scores (P = .001) and 6-minute walk distance (P = .001). We also observed statistically significant improvements in the Short-Form 36 Quality of Life Questionnaire's physical function (P = .01) and emotional role (P = .02) subparameters. We also found a significant improvement in the Beck Depression Inventory score (P = .004). There was no correlation between Beck Depression Inventory scores before and after rehabilitation and 6-minute walk distance, Short-Form 36, and Modified Medical Research Council dyspnea scores. CONCLUSIONS: Our results suggest that preoperative pulmonary rehabilitation improves exercise capacity, reduces the sensation of dyspnea and muscle strength loss, and has a positive effect on the psychologic state of patients who are candidates for lung transplant.

The effects of preoperative short-term intense physical therapy in lung cancer patients: a randomized controlled trial.

BACKGROUND: We planned to investigate the effect of preoperative short period intensive physical therapy on lung functions, gas-exchange, and capacity of diffusion, and ventilation-perfusion distribution of patients with non-small cell lung cancer. METHODS: Sixty patients with lung cancer, who were deemed operable, were randomly allocated into two groups. Intensive physical therapy was performed in patients in the study group before operation. Both groups received routine physical therapy after operation. RESULTS: There was no difference in pulmonary function tests between the two groups. Intensive physical therapy statistically significantly increased peripheral blood oxygen saturation. At least one complication was noted in 5 patients (16.7%) in the control group, and 2 (6.7%), in the study group. However, there was no statistically significant difference (p = 0,4). The hospital stay has been found to be statistically significantly shortened by intensive physical therapy (p <0.001). Ventilation-perfusion distribution was found to be significantly effected by intensive physical therapy. The change was prominent in the the contralateral lung (p <0.001). CONCLUSIONS: Intensive physical therapy appeared to increase oxygen saturation, reduce hospital stay, and change the ventilation/perfusion distribution. It had a significant, positive effect on the exercise capacity of patients.