Long-term lung perfusion changes related to COVID-19: a dual energy computed tomography study

PURPOSE: Although the findings of acute new coronavirus disease (COVID-19) infection on dual-energy computed tomography (DECT) have recently been defined, the long-term changes in lung perfusion associated with COVID-19 pneumonia have not yet been clarified. We aimed to examine the longterm course of lung perfusion in COVID-19 pneumonia cases using DECT and to compare changes in lung perfusion to clinical and laboratory findings. METHODS: On initial and follow-up DECT scans, the presence and extent of perfusion deficit (PD) and parenchymal changes were assessed. The associations between PD presence and laboratory parameters, initial DECT severity score, and symptoms were evaluated. RESULTS: The study population included 18 females and 26 males with an average age of 61.32 ± 11.3 years. Follow-up DECT examinations were performed after the mean of 83.12 ± 7.1 (80-94 days) days. PDs were detected on the follow-up DECT scans of 16 (36.3%) patients. These 16 patients also had ground-glass parenchymal lesions on the follow-up DECT scans. Patients with persistent lung PDs had significantly higher mean initial D-dimer, fibrinogen, and C-reactive protein values than patients without PDs. Patients with persistent PDs also had significantly higher rates of persistent symptoms. CONCLUSION: Ground-glass opacities and lung PDs associated with COVID-19 pneumonia can persist for up to 80-90 days. Dual-energy computed tomography can be used to reveal long-term parenchymal and perfusion changes. Persistent PDs are commonly seen together with persistent COVID-19 symptoms.

Assessment of the optic nerve, macular, and retinal vascular effects of COVID-19.

OBJECTIVE: To evaluate the effects of SARS-CoV-2 infection on the optic nerve, macula, and retinal vascular structures. METHODS: This study included 129 participants recovering from COVID-19 and 130 healthy control subjects aged 18 to 55 years. The study was designed as observational and cross-sectional and was conducted between June 2020 and February 2021. The average thicknesses of the retinal nerve fibre layer (RNFL), ganglion cell complex (GCC), and macula also were measured using a spectral domain optical coherence tomography analysis. The vessel densities of the superficial and deep capillary plexuses of the macula, foveal avascular zone, and radial peripapillary capillary plexus of the optic disc were quantified by optical coherence tomography angiography. RESULTS: In all quadrants, the RNFL and GCC were thinner in patients with neurologic symptoms of COVID-19 (p < 0.05). None of the measurements of the Early Treatment Diabetic Retinopathy Study regions significantly differed between patients with and without COVID-19 symptoms (p > 0.05). The foveal avascular zone area, perimeter, circularity index, and vessel densities (%) of the global and inner and outer circles of superficial capillary plexuses and deep capillary plexus and global and superior and inferior halves of the radial peripapillary capillary plexus measurements were found to significantly differ between the symptomatic COVID-19 group and the asymptomatic COVID-19 and control groups (p < 0.05). CONCLUSION: RNFL and GCC thickness evaluation with optical coherence tomography and vessel density evaluation with optical coherence tomography angiography can be considered remarkable diagnostic methods for retinal neurovascular abnormalities and a biomarker for microvascular abnormalities after infection with SARS-CoV-2.

The role of polymorphonuclear leukocytes in distant organ (lung) oxidative damage of liver ischemia/reperfusion and the protective effect of rutin.

BACKGROUND: Ischemia/reperfusion (I/R) can cause damage to distant organs. Rutin is known to have antioxidant and anti-inflammatory properties, and inhibits cytokine and polymorphonuclear leukocyte (PMNL) infiltration. It may prevent the development of reperfusion injury. OBJECTIVES: This study aimed to examine the role of PMNLs in distant organ (lung) injury after a liver I/R procedure, and to evaluate the protective effects of rutin in rats using biochemical and immunohistochemical methods. MATERIAL AND METHODS: In this study, 18 Wistar albino male rats (255-275 g) were used. Experimental animals were divided into 3 groups: a liver I/R (LIR) group, a 50 mg/kg rutin+liver I/R (RLIR) group and a sham operation (SG) control group. Experimental results obtained from the RLIR group were compared with the LIR and SG groups. RESULTS: Blood malondialdehyde (MDA) levels in the RLIR and SG groups were significantly lower compared to the LIR group (p < 0.001). Blood myeloperoxidase (MPO) activity in the RLIR and SG groups was significantly lower compared to the LIR group (p < 0.001). Total glutathione (tGSH) levels in the RLIR and SG groups were significantly higher compared to the LIR group (p < 0.001). CONCLUSIONS: Rutin can be used to prevent distant organ (lung) damage due to liver I/R. However, more extensive studies are needed on this issue.

Evaluation of cardiovascular changes in patients with gastric wall fat halo sign.

BACKGROUND: This study aims to investigate the relationship between gastric wall fat halo sign and potentially associated cardiovascular disease (CVD) in thoracic computed tomography (CT). METHODS: Between October 2020 and January 2021, 62 patients with gastric wall fat halo sign and 62 controls were evaluated with thorax CT. Patient's height, weight, body mass index (BMI), sex, age, comorbidities, laboratory parameters, diameters of cardiac axes, aorta and pulmonary artery; aorta and coronary artery calcium scores were recorded for the two groups. RESULTS: No significant differences were found in sex, age, height, body weight or BMI between the two groups (p > 0.124). Patients with gastric wall fat halo sign had significantly larger diameters of the ascending aorta, the descending aorta, the main pulmonary artery, the right and left pulmonary arteries, and the short and long cardiac axes and a higher cardiothoracic ratio (CTR) than the control group (p < 0.001). Additionally, the calcium scores of the ascending, arcus, and descending aortas and the coronary arteries were significantly higher detected in patients group (p < 0.001). Patient group had significantly higher lipid profile, frequencies of diabetes mellitus (DM) and hypertension (HT) than control group (p<0.026). DISCUSSION: Patients with a gastric wall fat halo may show higher cardiovascular risk because of increased visceral fat tissue, vascular diameters, CTR, heart sizes, presence of DM, HT, increased lipid profile and calcium scores.

Effect of age on computed tomography findings: Specificity and sensitivity in coronavirus disease 2019 infection.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a pandemic caused by the severe acute respiratory syndrome coronavirus in 2019. Although the real-time reverse tr-anscription PCR test for viral nucleic acids is the gold standard for COVID-19 diagnosis, computed tomography (CT) has grown in importance. AIM: To evaluate the sensitivity and specificity of thoracic CT findings of COVID-19 pneumonia according to age groups. METHODS: PCR and CT results from 411 patients were reviewed. The diagnosis of COVID-19 pneumonia was made by three radiologists. Lymphadenopathy, pericardial effusion, pleurisy, pleural thickening, pleural effusion, location features of the lesions, ground glass, consolidation, air bronchogram, vascular enlargement, bronchial dilatation, halo finding, inverted halo sign, nodularity, air bubble, subpleural band (curvilinear density), reticular density, crazy paving pattern, and fibrosis findings were recorded. The patients were divided into nine groups by decades while calculating the sensitivity, specificity, and diagnostic efficacy for CT positivity. RESULTS: The mean age of the cases was 48.1 ± 22.7 years. The CT finding with the highest diagnostic power was ground glass. Vascular enlargement and bronchial dilatation followed ground glass. Peri-cardial effusion was the finding with the lowest diagnostic accuracy. The incidence of lymphadenopathy, pleurisy, pleural thickening, peripheral localization, bilateral, ground glass, vascular enlargement, bronchial dilatation, subpleural band, reticular density, crazy paving appearance, and fibrosis all increased increase significantly with age in patients with positive real-time reverse transcription PCR test. CONCLUSION: There are few publications comparing sensitivity and specificity of thoracic CT findings according to age. In cases of COVID-19 pneumonia, there is an increase in the variety and frequency of CT findings with age, and parallel to this the sensitivity and specificity of the findings increase. COVID-19 cases in the pediatric age group have fewer lung findings than adults, and this situation decreases the diagnostic value of CT in pediatric patients.

Triple rule-out computed tomography angiography: Evaluation of acute chest pain in COVID-19 patients in the emergency department.

BACKGROUND: The aim of this study was to define clinical evidence supporting that triple rule-out computed tomography angiography (TRO CTA) is a comprehensive and feasible diagnostic tool in patients with novel coronavirus disease 2019 (COVID-19) who were admitted to the emergency department (ED) for acute chest pain. Optimizing diagnostic imaging strategies in COVID-19 related thromboembolic events, will help for rapid and noninvasive diagnoses and results will be effective for patients and healthcare systems in all aspects. AIM: To define clinical evidence supporting that TRO CTA is a comprehensive and feasible diagnostic tool in COVID-19 patients who were admitted to the ED for acute chest pain, and to assess outcomes of optimizing diagnostic imaging strategies, particularly TRO CTA use, in COVID-19 related thromboembolic events. METHODS: TRO CTA images were evaluated for the presence of coronary artery disease, pulmonary thromboembolism (PTE), or acute aortic syndromes. Statistical analyses were used for evaluation of significant association between the variables. A two tailed P-value < 0.05 was considered statistically significant. RESULTS: Fifty-three patients were included into the study. In 31 patients (65.9%), there was not any pathology, while PTE was diagnosed in 11 patients. There was no significant relationship between the rates of pathology on CTA and history of hypertension. On the other hand, the diabetes mellitus rate was much higher in the acute coronary syndrome group, particularly in the PTE group (8/31 = 25.8% vs 6/16 = 37.5%, P = 0.001). The rate of dyslipidemia was significantly higher in the group with pathology on CTA while compared to those without pathology apart from imaging findings of the pneumonia group (62.5% vs 38.7%, P < 0.001). Smoking history rates were similar in the groups. Platelets, D-dimer, fibrinogen, C-reactive protein, and erythrocyte sedimentation rate values were higher in COVID-19 cases with additional pathologies. CONCLUSION: TRO CTA is an effective imaging method in evaluation of all thoracic vascular systems at once and gives accurate results in COVID-19 patients.

Effect of tocilizumab on ischemia-reperfusion-induced oxido-inflammatory renal damage and dysfunction in rats.

Ischemia-reperfusion-induced (I/R) renal damage is a pathogenic process that starts with ischemia, then progresses through oxidative stress and inflammation. Tocilizumab (TCZ), a recombinant human monoclonal antibody produced against the IL-6 receptor, will be tested against renal I/R injury. TCZ is known to lower the levels of proinflammatory cytokines and oxidant mediators while raising the amounts of antioxidant molecules. Our purpose is to evaluate the biochemical and histological effects of TCZ against I/R-induced oxido-inflammatory kidney damage and dysfunction in rats. Animals were divided into 3 groups as renal I/R (RIR), I/R+ TCZ (IRT), and healthy group (HG). TCZ was administered at a dose of 8 mg/kg to the IRT group (n=6) of the animals, and distilled water as a solvent was administered intraperitoneally (ip) to the RIR (n=6) and HG (n=6) groups. Then, two hours of ischemia and six hours of reperfusion were applied to the left kidneys of IRT and RIR animals. TCZ significantly inhibited the increase in the levels of malondialdehyde (MDA), nuclear kappa B (NF-κB), tumour necrosis factor alpha (TNF-α), interleukin 1-ß (IL-1ß), IL-6, creatinine (Cr) and blood urea nitrogen (BUN) and decrease in total glutathione (tGSH) with I/R in renal tissue. TCZ also attenuated severe histopathological damage due to I/R in renal tissue. TCZ protected renal tissue from I/R-induced oxidative and inflammatory damage. These results indicate that TCZ may be useful in the treatment of renal I/R injury.

Case report: cerebral thromboembolism in an unconscious COVID-19 patient in intensive care.

Although the severity of coronavirus disease 2019 (COVID-19) being more frequently related to acute respiratory distress syndrome and acute cardiac and renal injuries, thromboembolic events have been increasingly reported. Acute respiratory distress syndrome due to SARS-CoV-2 (Severe Acute Respiratory Syndrome - Corona Virus 2) often requires intensive care follow-up. As well as respiratory failure, the SARS-CoV-2 may cause central nervous system (CNS) involvement. The pandemic has raised many challenges in managing critically ill older adults, a population preferentially killed by COVID-19. The mortality and morbidity rates are extremely high in critically ill patients with COVID-19. Recent studies have reported the potential development of a hypercoagulable state in COVID-19. Viral infections and hypoxia may cause these state. It is increasingly reported that thromboembolic events are associated with a poor prognosis. Due to these thromboembolic complications, COVID-19 patients often have neurological symptoms. These symptoms may not be observed in intensive care patients who are sedated. We report one case who was sedated COVID-19 pneumonia and who was later diagnosed with cerebral venous thrombosis with cranial imaging when he could not awaken even though sedation was discontinued. Since COVID-19 causes intense thrombotic susceptibility due to cytokine storm, cerebrovascular thromboembolic complications associated with COVID-19 infection should be considered first and foremost for unconsciousness ventilated patients. Severe and potentially cerebral thrombosis may prolong the patient´s stay in intensive care.

Lung perfusion changes in COVID-19 pneumonia: a dual energy computerized tomography study.

OBJECTIVE: There is limited and contradictory information about pulmonary perfusion changes detected with dual energy computed tomography (DECT) in COVID-19 cases. The purpose of this study was to define lung perfusion changes in COVID-19 cases with DECT, as well as to reveal any possible links between perfusion changes and laboratory findings. METHODS: Patients who had a positive RT-PCR for SARS-CoV-2 and a contrast-enhanced chest DECT examination were included in the study. The pattern and severity of perfusion deficits were evaluated, as well as the relationships between perfusion deficit severity and laboratory results and CT severity ratings. The paired t-test, Wilcoxon test, and Student's t-test were used to examine the changes in variables and perfusion deficits. p < 0.05 was regarded as statistically significant. RESULTS: Study population consisted of 40 patients. Mean age was 60.73 ± 14.73 years. All of the patients had perfusion deficits at DECT images. Mean perfusion deficit severity score of the population was 8.45 ± 4.66 (min.-max, 1-19). In 24 patients (60%), perfusion deficits and parenchymal lesions matched completely. In 15 patients (37.5%), there was partial match. D dimer, CRP levels, CT severity score, and perfusion deficit severity score all had a positive correlation. CONCLUSIONS: Perfusion deficits are seen not only in opacification areas but also in parenchyma of normal appearance. The CT severity score, CRP, D-dimer, and SpO2 levels of the patients were determined to be related with perfusion deficit severity. ADVANCES IN KNOWLEDGE: Findings of the current study may confirm the presence of micro-thrombosis in COVID-19 pneumonia.

Oxidative and pro-inflammatory lung injury induced by desflurane inhalation in rats and the protective effect of rutin.

BACKGROUND: Desflurane is a mainstay of general inhaled anesthetics with a methyl ethyl ether structure and is widely used in clinical practice. It has been reported to induce inflammation and lipid peroxidation in rat pulmonary parenchyma, to increase alveolar macrophages, and to cause peribronchial infiltration and edema. Rutin, a flavonoid vitamin P1, is known to have biological properties including acting as an antioxidant, an anti-inflammatory, and an inhibitor of bronchoalveolar polymorphonuclear leukocyte (PNL) infiltration. OBJECTIVES: The aim of this study is to examine the effects of rutin on desflurane-induced pulmonary injury using biochemical and histopathological methods. MATERIAL AND METHODS: The rats were divided into 3 groups (n = 6 each): healthy control (HC), rutin+desflurane-treated (DRT) and desflurane-only (DSF). Briefly, 50 mg/kg of rutin was given orally to the DRT group and an equal volume of normal saline was given to the DSF and HC groups. After 1 h, anesthesia was induced and maintained in the DRT and DSF groups for 2 h. After the rats had been sacrificed, the lungs were removed. Malondialdehyde (MDA), total glutathione (GSH), tumor necrosis factor alpha (TNF-α), and nuclear factor kappa B (NF-κB) levels were measured in the excised lung tissue. The removed tissues were also fixed in 10% formalin, and the obtained sections were stained with hematoxylin and eosin (H&E) and evaluated under light microscopy. The biochemical and histopathological results of the DRT group were compared with those obtained from the DSF and HC groups. RESULTS: Desflurane increased MDA, TNF-α and NF-κB, and decreased GSH in lung tissue. The PNL infiltration, alveolar macrophages, hemorrhage, alveolar damage, and edema were observed in the lung tissue of the DSF group. Rutin was histopathologically shown to protect lung tissue from oxidative stress by preventing an increase in oxidant parameters and a decrease in antioxidants. CONCLUSIONS: The results suggest that rutin may be useful in the treatment of desflurane-associated lung injury.

Computed tomography at every step: Long coronavirus disease.

BACKGROUND: Some patients continue to experience symptoms related to Coronavirus disease (COVID-19) after the acute phase of infection. Imaging studies, especially computed tomography (CT) of the chest, have gained importance since the beginning of the pandemic. CT can help diagnose COVID-19, assess the extent of pulmonary involvement, and predict the disease severity. We aimed to define the frequency of persistent symptoms and correlate their presence with the results of laboratory findings and the severity of the disease based on the findings of chest CT. METHODS: We examined patients discharged from the hospital after treatment for COVID-19 and whose nasopharyngeal swab sample tested positive for severe acute respiratory syndrome coronavirus 2 after at least 4 weeks from the initial diagnosis. The patients were asked about the presence of persisting symptoms. In addition to the demographic data, laboratory results and severity levels seen on the chest CT were recorded. RESULTS: In all, 116 patients were included in the study, of which 61 reported at least one persisting symptom (52.5%). The mean age of the study population was 48.90 ± 17.74 years. The persistent symptoms included shortness of breath, chest pain, cough, muscle weakness, dizziness, headache, fatigue, and palpitations. The mean CT severity score was 3.80 ± 0.38 and it was lower in patients without any persistent symptoms. CONCLUSIONS: Levels of C-reactive protein and fibrinogen, anemia, and female sex were associated with some of the persistent symptoms., the severity of the disease seen on CT was a successful predictor for the disease severity/prognosis and was also correlated with prolonged COVID infection and more persistent symptoms.

Impact of coronaphobia on treatment and follow-up compliance of cancer patients.

The aim of this study was to assess the impact of coronaphobia on treatment and follow-up compliance in cancer patients. The records of 230 cancer patients were reviewed. Coronaphobia was assessed via the validated COVID-19 Phobia Scale (C19P-S). A total of 64% of the patients had a high coronaphobia score. Among them, 59% were noncompliant. In multivariate logistic regression analysis, low educational status, treatment type, following COVID-19 news, having knowledge about COVID-19 transmission and higher C19P-S score were associated with noncompliance (p = 0.006, p < 0.001, p = 0.002, p = 0.002 and p = 0.001, respectively). Multivariate analysis revealed that having knowledge about COVID-19 transmission was related to a higher C19P-S score (p = 0.001). The cancer patients studied had significant coronaphobia. Moreover, greater coronaphobia was significantly associated with noncompliance with follow-up and treatment.

Is taste and smell impairment irreversible in COVID-19 patients?

OBJECTIVE: It is known that the COVID-19 disease, which has affected the whole world, causes symptoms, such as cough, fever, shortness of breath, muscle pain, fatigue, diarrhea, headache and sore throat, in addition to various clinical findings, such as loss of smell and taste. In this study, we aimed to reveal the loss of sense of taste and smell in COVID-19 patients and to investigate whether these sensory losses are permanent in the healing process of the disease. METHOD: This prospective study included 94 COVID-19 patients. Smell and taste tests were applied to all patients. Ten days after the first test, a second test was applied to the patients with an impaired sense of smell to compare the results. RESULTS: Of the 94 patients, 55.3% were male, and the mean age was 53 ± 19.6 (21-90) years. There were 67 patients with smell and taste impairment, of whom 34 (50.7%) had smell impairment only, 3 (4.4%) had taste impairment only, and 30 (44.7%) had both smell and taste impairment. It was found that the smell scores of 55 patients with smell and taste impairment in the first evaluation were significantly higher at the second measurement; and their tasting period was significantly shortened compared to the first measurement (p˂0.001). CONCLUSION: COVID-19 patients may present to medical centers with a broad variety signs and symptoms. This study shows that impairment in the senses of smell and taste is common in this disease and strongly associated with COVID-19 infection. However, smell and taste impairment is mostly temporary and improves during the recovery period.

Effect of Rutin on Cytarabine-Associated Pulmonary Oedema and Oxidative Stress in Rats.

Cytarabine is effectively used in the treatment of adult acute leukemia, but it has a dose-limiting side effect of fatal pulmonary oedema because it increases the vascular permeability of the alveolar capillaries. The aim of the present study was to conduct a radiological, biochemical and histopathological investigation of the effect of rutin on cytarabine-associated pulmonary oedema in rats. Rats were treated with a combination of rutin+cytarabine by administering oral rutin at a dose of 50 mg/kg; other rat groups were orally administered the same volume of physiological saline. One hour after administration of rutin or saline, the rutin+cytarabine and cytarabine groups received an intraperitoneal injection of cytarabine (200 mg/kg). This administration procedure was repeated once a day for 14 days. Radiologically, 50% of the animals given cytarabine alone showed lung oedema, but the rutin+cytarabine group showed no oedema. The inclusion of rutin decreased the amounts of cytarabine-associated malondialdehyde, tumour necrosis factor-α, and nuclear factor-κB in the lung tissue. Rutin also inhibited the reduction of total glutathione by nitric oxide. These findings suggest that rutin may be a beneficial adjunct that can minimise the development of cytarabine-associated pulmonary oedema.

The Effect of Taxifolin on Cisplatin-Induced Pulmonary Damage in Rats: A Biochemical and Histopathological Evaluation.

The effect of taxifolin on cisplatin-induced oxidative pulmonary damage was investigated biochemically and histopathologically in male albino Wistar rats. There were four groups, with six animals in each group: 50 mg/kg of taxifolin plus 2.5 mg/kg of cisplatin (TC) group, 2.5 mg/kg of cisplatin only (CIS) group, 50 mg/kg of taxifolin only (TG) group, and a healthy control group (HG). In terms of the experimental procedure, the animals in the TC and TG groups were first treated via oral gavage. The CIS and HG groups received distilled water as solvent, respectively. One hour later, the TC and CIS groups received cisplatin at a dose of 2.5 mg/kg (injected intraperitoneally). Taxifolin, cisplatin, and the distilled water were administered at the indicated dose and volume, using the same method daily for 14 d. At the end of this period, the animals were killed with a high dosage of thiopental anaesthesia (50 mg/kg). Blood and lung tissue samples were taken for biochemical (malondialdehyde (MDA), myeloperoxidase (MPO), total glutathione (tGSH), and 8-hydroxy-2 deoxyguanosine (8-OHdG)) analyses and histopathological examinations. The biochemical and histopathological results in the TC and HG groups were then compared with those in the CIS group. Cisplatin increased the levels of MDA, myeloperoxidase, and 8-OHdG, a marker of oxidative DNA damage, and reduced the amount of tGSH in the lung tissue. Moreover, severe alveolar damage, including oedema and extensive alveolar septal fibrosis, in addition to infiltration of polymorphic nuclear leucocytes and haemorrhagic foci, was observed in the CIS group. These histopathological findings demonstrate that taxifolin provides protection against pulmonary oxidative stress by preventing increases in oxidant parameters and decreases in antioxidants.

Sensitivity to House Dust Mites Allergens in Patients with Allergic Asthma in Erzincan Province, Turkey.

OBJECTIVE: To investigate the sensitivity of allergic asthma (AA) patients to house dust mites (HDM) by conducting skin tests, measuring total and specific IgE antibodies to Dermatophagoides pteronyssinus and D. farinae mites, and examining HDM fauna in patients' homes. METHODS: The study included 25 patients with AA and 31 healthy controls, who were challenged with Der p and Der f allergens; serum levels of allergen-specific lgE and total IgE were measured. Dust samples were collected from the homes of all participants, and mite species and the number of mites per gram of dust were investigated. RESULTS: D. pteronyssinus was found in the homes of 94.7% patients with positive Der p reactions in the skin test (p<0.001). D. farinae was found in the homes of 22.2% patients with positive Der f reactions in the skin test (p>0.05). D. pteronyssinus-specific IgE was detected in 75% patients in whose homes D. pteronyssinus was also found, while D. farinae-specific IgE was detected in 16.6% patients in whose homes D. farinae was also found. CONCLUSION: A part of AA patients residing in Erzincan are sensitive to HDM allergens, and high numbers of mites leading to allergic sensitization are found in their homes.

Comparison of Living and Bedrooms in Terms of House Dust Mites in the Province of Erzincan, Turkey.

The most important factors in development of symptoms such as allergic asthma, rhinitis, conjunctivitis, and dermatitis in atopic persons are the allergens of house dust mites. The objective of this study was to compare living rooms and bedrooms, and woolen and spring mattresses in terms of the number and species of mites in houses in the province of Erzincan, Turkey. In total, 74 dust samples were collected from living rooms and bedrooms of 37 randomly selected houses from various districts of the city. All examined houses were positive for house dust mites. In total, 5,210 mites were isolated, 1,058 from the living rooms and 4,152 from the bedrooms, and the differences were statistically significant (P < 0.05). Of 4,152 mites detected in bedrooms, 1,330 (32%) were isolated from 31 spring mattresses and 2,822 (68%) from 6 woolen mattresses (P < 0.001). The study identified 14 families, 17 genera, and 16 species belonging to Astigmata, Prostigmata, and Oribatida. Of these, Dermatophagoides pteronyssinus (Trouessart) was the dominant species: living rooms, 63.3%; bedrooms, 74.4%; woolen mattresses, 84.6%; and spring mattresses, 52.8%. This was followed by Lepidoglyphus destructor (Schrank) (9.8%), Dermatophagoides farinae Hughes (5.1%), Tyrophagus putrescentiae (Schrank) (4.3%), and Acarus siro L. (2.5%) in living rooms; L. destructor (11.2%), Euroglyphus maynei (Cooreman) (4.2%), D. farinae (3.8%), and T. putrescentiae (1.0%) in bedrooms; L. destructor (11.8%), D. farinae (2.1%), E. maynei (0.3%), and T. putrescentiae (0.2%) in woolen mattresses; and E. maynei (12.5%), L. destructor (9.9%), D. farinae (7.5%), and T. putrescentiae (2.7%) in spring mattresses.

Serum YKL-40/chitinase 3-like protein 1 level is an independent predictor of atherosclerosis development in patients with obstructive sleep apnea syndrome.

OBJECTIVE: The inflammatory process plays an important role in the development of cardiovascular complications in patients with obstructive sleep apnea syndrome (OSAS). YKL-40/chitinase 3-like protein 1 is a novel biomarker of systemic inflammation. This study aimed to investigate whether carotid intima-media thickness (CIMT), a useful marker for early atherosclerosis, is associated with serum YKL-40/chitinase 3-like protein 1 levels in patients with normotensive and nondiabetic OSAS. METHODS: The study included 40 OSAS patients and 40 age- sex- and body mass index-matched healthy controls. Serum YKL-40 levels were detected by enzyme-linked immunosorbent assay. CIMT was measured by B-mode ultrasound. RESULTS: The patients with OSAS had significantly increased CIMT and higher YKL-40 and high sensitivity C-reactive protein (hsCRP) levels than those of the controls. CIMT was strongly correlated with serum YKL-40 levels (r=0.694, p<0.001), hsCRP (r=0.622, p<0.001), age (r=0.525, p=0.001), and weakly correlated with apnea-hypopnea index (AHI) (r=0.365, p=0.021) and the percentage of recording time spent (PRTS) of oxygen saturation<90% (r=0.488, p=0.001). Moreover, it was detected that serum YKL-40 levels were strongly correlated with AHI (r=0.617, p<0.001), and weakly correlated with SaO2<90% of PRTS (r=0.394, p=0.012) and hsCRP (r=0.486, p=0.001). In multiple regression analyses, age and serum levels of YKL-40 and hsCRP were found to be independent predictors of CIMT. CONCLUSION: In patients with OSAS, CIMT was increased. This increase was associated with serum YKL-40 level. Increased serum level of YKL-40 may be an early predictor of atherosclerosis development in patients with OSAS.

Comparison of dexmedetomidine and propofol used for drug-induced sleep endoscopy in patients with obstructive sleep apnea syndrome.

UNLABELLED: Backround: Surgical operations are alternative treatments in persons with Obstructive Sleep Apnea Syndrome who cannot tolerate continuous positive airway pressure therapy. Drug-Induced Sleep Endoscopy is a method with which somnolence is pharmacologically induced and collapse is evaluated through nasal endoscopy in patients with Obstructive Sleep Apnea Syndrome. AIMS: We aimed to evaluate efficiency of dexmedetomidine or propofol used for sedation in patients undergoing drug-induced sleep endoscopy. METHODS: A total of 40 patients aged between 18 and 65 years old in the ASA STATUS I-II group were included in the study. After premedication with midazolam 0.05 mg/kg intravenously, patients were randomly divided into two groups and administered intravenous (iv) propofol with the loading dose of 0.7 mg/kg for 10 minutes, followed 0.5 mg/kg/h infusion (Group P); or dexmedetomidine with the loading dose of 1 mcg/kg for 10 minutes, followed by 0.3 mcg/kg/h infusion (Group D). Haemodynamic and respiratuary parameters, Bispectral index score, Ramsey sedation score, time to achieve sufficient sedation, surgeon's and patients' satisfaction, postoperative Aldrete score and side effects were recorded. RESULTS: Time to achieve sufficient sedation, Bispectral index scores at 5, 10 and 15th. minutes intraoperatively, first Aldrete score in the recovery room, SpO2 values and respiratory rates all over the surgical procedure and in the recovery room were found lower in Group P (P<0.05). Bispectral index scores, mean arterial pressure and heart rate in the recovery room were significantly lower in Group D (P<0.05). CONCLUSION: Dexmedetomidine may be preferred as a safer agent with respecting to respiratory function compared with propofol in obstructive sleep apnea patients who known to be susceptible to hypoxia and hypercarbia.

House Dust Mites in Erzincan Province.

OBJECTIVE: We aimed to determine the species of the house dust mites seen in Erzincan, the number of mites per gram of dust in the houses, and the relationship between temperature and the number of mite specimens. METHODS: For this purpose, 54 dust samples collected from 18 houses located in different districts of Erzincan province between November 2013 and January 2014. These samples were examined by a lactic acid precipitation method. RESULTS: Of the houses in which the dust samples were collected, 94.44% were found to be positive in terms of mites. A total of 844 mite specimens were isolated from the dust samples, and the mean number of mites per gram of dust was found to be 18.34. The most common species was found to be Acarus siro (55.55%) and was followed by Dermatophagoides pteronyssinus (50.00%), Tyrophagus putrescentiae (22.22%), Histiostoma sp. (22.22%), Lepidoglyphus destructor (16.66%), T. perniciosus(11.11%), Euroglyphus maynei (11.11%), Glycyphagus privatus (11.11%), Cheyletus sp. (11.11%), Tarsonemus sp. (11.11%), and Tetranychus sp. (11.11%). CONCLUSION: Mite-holding rate of the houses in Erzincan province was found to be 94.44%. The mean number of mites per gram of dust was found to be 18.34. The most common mite species was A. siro, which was followed by D. pteronyssinus.