Coronavirus Disease 2019 Pneumonia Scoring System Comparison and Risk Factors.

OBJECTIVE: Coronavirus disease 2019 is a disease caused by severe acute respiratory syndrome coronavirus 2, a novel type of coronavi- rus, which causes pneumonia in some hosts. No specific scoring method exists for mortality evaluation in novel coronavirus pneumonia. The aim of this study was to investigate factors affecting coronavirus disease 2019 mortality and comparison of pneumonia scoring sys- tems, pneumonia severity index, CURB-65, and MuLBSTA. MATERIAL AND METHODS: In this single-center clinical study, 151 patients who had been diagnosed with coronavirus disease 2019 infection and pneumonia between March 11 and May 31, 2020, were evaluated retrospectively. Correlation between patients' symptoms, comorbidities, drugs in use, radiological findings, and mortality was investigated. Parameters were also evaluated regarding their contribution to additional treatment requirements and days of fever response. RESULTS: A correlation between mortality and higher scores of pneumonia severity index, CURB-65, and MuLBSTA was found. When parameters were investigated separately, elevated glucose and urea levels, presence of diabetes, renal failure, hypertension, chronic obstructive pulmonary disease, cerebrovascular events and known malignancies, lymphocyte count, smoking history, radiological find- ings, and age correlated with mortality. In addition to these parameters, elevated calcium, potassium, brain natriuretic peptide, troponin, d-dimer, C-reactive protein, HC03, and lactate dehydrogenase levels were found significant regarding mortality. These parameters were not found statistically relevant regarding additional treatment requirement, fever response day, and total treatment duration. CONCLUSION: A modified version of present pneumonia scoring systems will be required to rigorously evaluate the severity of a patient's condition. A new scoring system that uses components of the present ones may prove useful and with further studies, a similar follow-up algorithm may be created.

Is there a relationship between sleep apnoea and microalbuminuria?

INTRODUCTION: Obstructive sleep apnoea (OSA) is a cause of hypoxia, and the correlation between hypoxia and microvascular complications is well known. Microalbuminuria (MAU) is a marker for endovascular dysfunction and an indicator of cardiovascular events and all-cause mortality in the general population. The aim of this study was to investigate the relationship between microvascular damage and the metabolic complications of OSA based on the presence of MAU. MATERIAL AND METHOD: Urinary albumin/creatinine ratio (ACR) and microalbumin level were examined in patients with an apnoea-hypopnoea index (AHI) greater than 5/h (study group) and in patients with an AHI less than 5/h (control group). The exclusion criteria were other possible causes of MAU (hypertension, nephropathy, coronary artery disease, and severe thyroid dysfunction). RESULTS: Of 103 patients enrolled, 80 formed the group with OSA and 23 served as controls. According to the AHI values, the patients were divided into four groups as normal, mild, moderate and severe. There was no significant difference between the four groups in terms of the microalbumin level and urinary albumin/creatinine ratio. CONCLUSION: In this study, no significant relationship was found between MAU and sleep apnoea.

Ultrasonographic evaluation of abdominal wall fat index, carotid intima-media thickness and plaque score in obstructive sleep apnea syndrome.

AIMS: Obstructive sleep apnea syndrome (OSAS) is strongly related with increased risk of cardiovascular diseases andvisceral obesity. Abdominal wall fat index (AFI) is an indicator of visceral fat accumulation determined by ultrasonography(US). Carotid intima-media thickness (C-IMT) and carotid plaque score (C-PS) are the indicators of cardiovascular risk. Theaim of this study was to investigate the relation between OSAS and AFI, C-IMT or C-PS. MATERIALS AND METHODS: One-hundred and four subjects (31 females, 73 males) between 23-73year-old, candidate for polysomnography (PSG) with suspect of OSAS and without other atherosclerotic risk factor, were evaluated by US. AFI, C-IMTmean and C-PS values were determined and the subjects were grouped according to their apnea-hypopnea index (AHI) values as follows: no OSAS (<5), mild OSAS (5-15), moderate OSAS (15-30) and severe OSAS (>30). RESULTS: There was a statistically significant correlation between AFI and AHI (p=0.019). The C-IMTmean values of subjects with OSAS (AHI >5) were significantly higher than those without OSAS (AHI <5) (p=0.035). C-PS was not correlated with AHI (p=0.345) and also there was not a statistically significant difference between OSAS groups in terms of C-PS (p=0.775). CONCLUSIONS: This study revealed that AFI correlates with AHI and C-IMT increases in OSAS. The two parameters could be used as indicators of risk of metabolic disorders and atheroscleroticdiseases in subjects with sleep apnea in the future.

Absenteeism and Delay to Work Due to Sleep Disorders in the Turkish Adult Population: A Questionnaire-Based National Survey.

Sleep problems may have negative effects on work-life balance, overall health, and safety. We aimed to investigate the association between sleep disorders and absenteeism and delay to work (being late or tardy) among the working adult population. The study was conducted by using data from a large survey of working adults who participated in the Turkish Adult Population Epidemiology of Sleep Study (TAPES) managed by Turkish Sleep Medicine Society (TSMS). Secondary analyses was employed to examine absenteeism and delay to work and their associations with sleep problems, including sleepiness by Epworth Sleepiness Scale (ESS), parasomnias, sleep apnea (by Berlin Questionnaire), sleep quality (by Pittsburgh Sleep Quality Index), and restless leg. History of any absenteeism and delay to work was observed in 276 (18%) and 443 (29%) out of 1,533 working adults, respectively. In the multivariate analyses, absenteeism was associated with younger age, female gender and poor sleep quality, while delay to work was associated with younger age, poor sleep quality, parasomnia, and sleepiness. In the presence of absenteeism and delay to work, sleep disorders including sleepiness, poor sleep quality, and parasomnia should be considered. Such evaluation may improve worker well-being and provide some additional benefits in terms of increasing productivity and lowering work-related costs.

The Presence of Conjunctivochalasis in Obstructive Sleep Apnea Patients.

OBJECTIVES: The aim of our study was to detect the presence of conjunctivochalasis (CCh) in obstructive sleep apnea (OSA) patients. METHODS: We included 54 subjects (41 OSA patients and 14 control subjects) in the study. All the patients were assessed regarding the presence and stage of CCh. RESULTS: The patients were grouped according to their apnea-hypopnea index as determined during nocturnal polysomnography in our laboratory as mild (12 patients), moderate (16 patients), and severe (13 patients) OSA. The CCh rate was 87.8% in the OSA group and 57.1% in the control group (P=0.022). Mean CCh stage was 1.58±1.24, 2.38±0.88, and 2.15±0.98 in the mild, moderate, and severe OSA groups, respectively, and 0.71±0.72 in the control group (P=0.0001). CONCLUSIONS: The moderate and severe OSA groups were associated with higher rates and more advanced stages of CCh. We believe that detailed conjunctival assessment is necessary for patients with complaints such as burning, stinging, and foreign body sensation, which we frequently confront in daily practice. In particular, young patients diagnosed with CCh must be carefully assessed regarding sleep apnea. In light of the above findings, we suggest that patients with ocular surface symptoms that are not relieved by topical medical treatment should be assessed for CCh and OSA. Longitudinal studies monitoring the response of CCh to OSA treatment are needed to clarify the relationship between CCh and OSA.

Evaluation of sleep quality in patients with ankylosing spondylitis and efficacy of anti-TNF-α therapy on sleep problems: A polisomnographic study.

INTRODUCTION: This study was conducted to investigate the relationship between sleep quality (SQ) and disease activity (DA) in patients with ankylosing spondylitis (AS) and to evaluate the response to anti-tumor necrosis factor α (anti-TNF-α) therapy on sleep disorders. MATERIALS AND METHODS: A total of 34 patients who met the modified New York classification criteria for AS were included in this prospective study. Patients were divided into two groups as follows: Group I (n = 15) with high DA and receiving anti-TNF-α therapy, and Group II (n = 19) in remission. DA was assessed by the Bath AS Disease Activity Index. Pittsburgh Sleep Quality Index (PSQI) and polysomnography (PSG) were used to determine disorders and patterns of sleep, respectively, in both groups at baseline as well as at the third month of anti-TNF-α therapy in Group I. RESULTS: Baseline evaluation revealed impaired SQ in 57.9% of all patients. PSG demonstrated obstructive sleep apnea syndrome, snoring and periodic leg movements in 73.7%, 74.4% and 26.3% of patients, respectively. Prior to anti-TNF-α therapy, PSQI and snoring score were significantly higher in Group I (P = 0.0001, P = 0.012, respectively). Although there was a significant reduction in PSQI scores in Group I (P = 0.005) at the third month of anti-TNF-α therapy, no change was observed in PSG parameters (P > 0.05). CONCLUSION: Sleep disorders increase in AS, particularly in patients with high DA. Anti-TNF-α therapy has improved SQ without any improvement in PSG. Therefore, it may be concluded that PSG parameters might be more associated with disease pathogenesis rather than DA in patients with AS.

Comparison of postoperative pain scores and dysphagia between anterior palatoplasty and uvulopalatal flap surgeries.

BACKGROUND: Dysphagia and pain are most common problems after soft palate surgery in obstructive sleep apnea (OSA) patients. OBJECTIVE: The aim of this study was to compare the postoperative pain scores and presence of dysphagia in patients who underwent anterior palatoplasty (AP) or uvulopalatal flap (UPF) surgeries. MATERIALS AND METHODS: In this prospective study, AP or UPF was performed on the patients with mild or moderate OSA. Daytime sleepiness of all patients was evaluated with Epworth sleepiness scale (ESS). Snoring, pain and dysphagia complaint of the patients was evaluated with visual analog scale (VAS). RESULTS: In both AP and UPF groups, VAS snoring and ESS scores decreased significantly after operation. VAS pain and dysphagia scores were determined to be significantly higher in UPF compared with the AP. CONCLUSION AND SIGNIFICANCE: Since the success rates of surgical interventions to the soft palate are similar, preferring surgical approaches with a less damage to the life quality of patients after operations is more rational. In this regard, AP, which is technically quite simple with a short operation time and fewer postoperative complaints affecting life quality such as pain or dysphagia may be preferred in selected patients with OSA.

The evaluation of sleep quality and response to anti-tumor necrosis factor α therapy in rheumatoid arthritis patients.

Poor sleep quality (SQ) is increasingly recognized as giving rise to decreased quality of life, and raising pain perception. Our aim is to evaluate the SQ in rheumatoid arthritis (RA) patients treated with anti-tumor necrosis factor alpha (anti-TNF-α) therapy. This was a prospective observational and open-label study of RA patients. A total of 35 patients with RA were enrolled in this study. Of the 35 patients, 22 had high disease activity (DA), and 13 were in remission. High DA group was initiated an anti TNF-α therapy. Clinical and objective parameters of SQ were assessed by using the Pittsburgh Sleep Quality Index (PSQI) and polysomnography (PSG). The total PSQI score and the frequency of poor SQ were high in 60 % of the RA patients. The median PSQI score was significantly higher in the high DA group than in the remission group (P = 0.026). Following an anti-TNF-α therapy initiation, significant improvements were observed in the high DA group by PSQI test (P = 0.012). However, no statistically significant difference was found by PSG (P > 0.05). Although an improvement in DA with anti-TNF-alpha therapy did not provide an amelioration in laboratory parameters, we found a significant improvement in SQ by subjective PSQI test. These findings may support that sleep disorders in RA are likely to be associated with a complex pathophysiology.

The effects of anterior palatoplasty on floppy eyelid syndrome patients with obstructive sleep apnea.

OBJECTIVES/HYPOTHESIS: To investigate the effects of anterior palatoplasty on the presence and stage of floppy eyelid syndrome (FES) among patients diagnosed with mild or moderate obstructive sleep apnea (OSA) according to the apnea-hypopnea index (AHI). STUDY DESIGN: Prospective controlled trial. METHODS: Those patients whose AHI scores were between 5 and 30 according to full-night polysomnography were included in the study. The patients in whom anterior palatoplasty was performed were included in the study group, whereas those refusing surgery comprised the control group. All patients were evaluated for the presence of FES. The sleep studies were repeated after the third postoperative month, and the results were statistically compared. RESULTS: Sixty-two patients were included in the study. Thirty-five patients who were treated with anterior palatoplasty comprised the study group, and 27 patients were included in the control group. In the surgically treated group, 60% (n = 21) had FES, whereas 55.5% (n = 15) of the control group had FES (P = .798). In the surgically treated group, the FES ratio decreased to 25.7% (n = 9) after the third postoperative month (P = .007). In surgically successful cases, the preoperative-postoperative oxygen desaturation index and preoperative-postoperative lowest oxygen saturation values were 11.755% ± 9.037% and 6.77% ± 5.362% (P = .04), and 86.1% ± 3.89% and 87.8% ± 2.85%, respectively (P = .124). These values were 12.166% ± 5.767% and 14.780% ± 9.924% (P = .385), and 86.13% ± 4.18% and 85.26% ± 4.26%, respectively (P = .579), in patients who underwent unsuccessful surgery. CONCLUSIONS: FES presence and stages were decreased following successful anterior palatoplasty surgery. This effect may have resulted from the correction of tissue hypoxia, which is common in the pathophysiology of both OSA and FES. LEVEL OF EVIDENCE: 2b Laryngoscope, 126:2171-2175, 2016.

Does CPAP treatment affect the voice?

BACKGROUND/AIM: The aim of this study was to investigate alterations in voice parameters among patients using continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea syndrome. MATERIALS AND METHODS: Patients with an indication for CPAP treatment without any voice problems and with normal laryngeal findings were included and voice parameters were evaluated before and 1 and 6 months after CPAP. Videolaryngostroboscopic findings, a self-rated scale (Voice Handicap Index-10, VHI-10), perceptual voice quality assessment (GRBAS: grade, roughness, breathiness, asthenia, strain), and acoustic parameters were compared. RESULTS: Data from 70 subjects (48 men and 22 women) with a mean age of 44.2 ± 6.0 years were evaluated. When compared with the pre-CPAP treatment period, there was a significant increase in the VHI-10 score after 1 month of treatment and in VHI- 10 and total GRBAS scores, jitter percent (P = 0.01), shimmer percent, noise-to-harmonic ratio, and voice turbulence index after 6 months of treatment. Vague negative effects on voice parameters after the first month of CPAP treatment became more evident after 6 months. CONCLUSION: We demonstrated nonsevere alterations in the voice quality of patients under CPAP treatment. Given that CPAP is a long-term treatment it is important to keep these alterations in mind.

The clinical utility of Memorial Symptom Assessment-Short Form and Condensed Memorial Symptom Assessment Scale in Turkish lung cancer patients.

INTRODUCTION: Symptom assessment is essential in the palliative care of patients with cancer. We studied the Memorial Assessment Scale Test-Short Form (MSAS-SF) and Condensed Memorial Assessment Test (CMSAS) in Turkish lung cancer patients. MATERIAL AND METHOD: Fifty-one patients with lung cancer (47 non-small, 4 small cell) were staged according to the International Association for the Study of Lung Cancer 2007 and filled the MSAS-SF. Karnofsky performance status, TNM staging, MSAS-SF and CMSAS scores were recorded. The study was approved by the local research ethics committee. RESULTS: The mean age of 51 patients was 61.7 ± 9. Fifty-one percent were staged as M1 while 49% were staged as M0. The mean values for global distress index, PHYS (physical symptom distress), PSYCH (psychological symptom score) and MSAS-SUM were 1.15 ± 0.8, 0.9 ± 0.8, 1.13 ± 1.03 and 0.82 ± 0.47 in order. The mean values for CPHYS (physical symptom distress for Condensed MSAS), CPSYCH (psychological symptom score for CMSAS) and CSUM (sum scores) were 1.2 ± 0.75, 1.22 ± 1.1 and 1.16 ± 0.69 in order. Cronbach's alpha coefficients for MSAS-SF and CMSAS were 0.861 and 0.728 in order. Summary scores for both MSAS-SF and CMSAS-SF were significantly higher in patients with M1 disease than from M0 disease. In addition, PHYS and MSAS-SUM in MSAS-SF were significantly correlated with T and N stage. The area under curve for MSAS-SF and CMSAS were 0.793 and 0.70 in order. CONCLUSION: MSAS-SF and CMSAS demonstrated significantly higher scores in lung cancer patients with M1 disease than patients with M0 disease. Further studies are needed to evaluate the usefulness of MSAS-SF and CMSAS in lung cancer patients.

The effect of adding gender item to Berlin Questionnaire in determining obstructive sleep apnea in sleep clinics.

BACKGROUND AND AIM: We aimed to validate the Turkish version of Berlin Questionnaire (BQ) and developped a BQ-gender (BQ-G) form by adding gender component. We aimed to compare the two forms in defining patients with moderate to severe obstructive sleep apnea (OSA) in sleep clinics. METHODS: Four hundred and eighty five consecutive patients, refered to our sleep clinic for snoring, witnessed apnea and/or excessive daytime sleepiness were enrolled to the study. All patients underwent in-laboratory polysomnography (PSG). Patients with sleep efficiency less than 40% and total sleep time less than 4 hours, chronic anxiolitic/sedative drug usage, respiratory tract infection within past two weeks were excluded from the study. All the patients fulfilled BQ. The test and retest for BQ were applied in 15-day interval in 30 patients. RESULTS: Totally 433 patients were enrolled to the study (285 male, 148 female). The mean age of the patients was 47,5 ± 10.5 (21-79). 180 patients (41.6%) had apnea-hypopnea index (AHI) ≤ 15, while 253 patients (58,4%) had AHI > 15. The κ value was 48-94 and the the truth value was 69-94% for the test-retest procedure. Sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and area under the curve AUC were 84.2%, 31.7%, 48.7%, 63.4%, and 0.579 in order for BQ and 79.9 %, 51.7%, 63.2% , 69.6%, and 0.652 for BQ-G. CONCLUSION: The results showed that BQ-G is relatively better than BQ in determining moderate to severe OSA in sleep clinics where most of the patients are sleep apneic but both of the tests were found to have insufficient validities in defining moderate to severe OSA in sleep clinics.

Vestibular evoked myogenic potential responses in obstructive sleep apnea syndrome.

Obstructive sleep apnea syndrome (OSAS) provokes oxidative stress and ischemia, which affects the central nervous system. The degeneration of neurons in the brainstem due to periodic hypoxia can be evaluated by vestibular and audiologic tests. The objective of this study is to determine brainstem damage in severe OSAS patients with the help of vestibular evoked myogenic potential (VEMP) responses. Prospective, randomize, double-blind. Research-training hospital. We compared cervical vestibular evoked myogenic potential (cVEMP) responses between severe OSAS patients and a control group. 54 patients were included and divided into the OSAS group, with severe OSAS (apnea-hypopnea index, AHI >70), and a control group with snoring without OSAS (AHI <5). Both groups underwent cVEMP. Bilateral recordings with simultaneous binaural logon stimulations were used during VEMP recordings. The existing p1n1 and n2p2 responses, p1, n1, n2, and p2 latencies and amplitudes, and p1n1 and n2p2 intervals were measured. Statistically significant differences were revealed between patients and controls for the response rate of the p1n1, n2p2 and p1n1, n2p2 amplitudes. There were no significant differences between the two groups with respect to the latencies of p1, n1, n2 and p2, or the p1n1 and n2p2 intervals. The VEMP response rate was lower in severe OSAS patients, and all amplitudes were shorter than in healthy subjects. VEMP recordings in severe OSAS subjects demonstrates abnormalities in brainstem pathways. It appears that brainstem damage in severe OSAS can be detected by cVEMP recordings.

Long-term effects of PAP on ocular surface in obstructive sleep apnea syndrome.

OBJECTIVE: To assess the long-term effects of positive airway pressure (PAP) therapy on the ocular surface and eyelid in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). DESIGN: Single-centred, prospective, and double-blinded study. PARTICIPANTS: Fifty-one patients with OSAHS. METHODS: Fifty-one patients with OSAHS were treated with PAP for a period of 18 months. The pre- and post-PAP values for eye examination scores (presence of floppy eyelid syndrome [FES], results of the Ocular Surface Disease Index [OSDI] questionnaire, Schirmer I test, tear film break-up time [TBUT] values, and corneal staining stages) were compared. RESULTS: Based on the apnea-hypopnea index, 17 patients were followed with moderate and 34 patients were followed with severe OSAHS. The presence of FES before and after PAP was 56.9% and 74.5% (p < 0.01). FES stage was determined as 1.41 ± 0.98 before PAP and 0.78 ± 0.78 after PAP (p < 0.01). Pre-PAP and post-PAP OSDI results were 47.79 ± 21.04 and 42.17 ± 19.97, respectively (p < 0.01). Schirmer values before and after PAP were 7.23 ± 1.95 and 8.49 ± 1.79 mm, respectively (p < 0.01). TBUT values before and after PAP were 7.11 ± 1.82 and 8.68 ± 1.76 seconds, respectively (p < 0.01). Scores of the corneal staining stages before and after PAP were 1.05 ± 0.75 and 0.68 ± 0.54, respectively (p < 0.01). CONCLUSIONS: OSAHS is associated with low Schirmer and TBUT values, and high scores in OSDI questionnaire, and high corneal staining stage. An appropriate PAP therapy helps to relieve both the systemic findings and the ocular surface problems most likely by providing a return to normal sleep patterns. We believe that long-term (at least 1 year) use of PAP improves the clinical picture of FES and can overcome the problem of ocular irritation that is encountered in the early stage of PAP.

The utility of neck/thyromental ratio in defining low-risk patients with obstructive sleep apnea in sleep clinics.

We aimed to evaluate the importance of neck/thyromental distance in the diagnosis of moderate to severe obstructive sleep apnea (OSA) in sleep clinics. 185 patients (122 males, 63 females) referred to our sleep clinic with OSA symptoms were enrolled to the study. The patients had level-1 polysomnography (PSG). The neck circumference (N), thyromental distance (T), and STOP test were recorded in all patients. Using an obstructive AHI > 15 event/h on PSG as the cut-off, the best N/T ratio to find patients with OSA was calculated with the receiver operator curve analyses. The best cut-off for N/T was chosen as 4.6. We used Modified STOP test: STO-NT test in which P (for hypertension item) was replaced with N/T ratio. N/T ratio >4.6 was scored as "positive". Two positives out of four questions in STO-NT were scored as high risk for OSA. The OSA prevalence was 60 % for AHI > 15. The mean ratio of N/T was significantly different between groups with AHI > 15 and AHI ≤ 15. N and N/T ratio were moderately correlated with AHI. Sensitivity, specificity, negative predictive value, positive predictive value, and negative likelihood ratio of STOP test for AHI > 15 were 88.5, 28.4, 61.8, 65.4 % and 0.40, whereas 97.3, 23, 85, 65.9 % and 0.12 for STO-NT test, respectively. STO-NT test seems better than STOP test in determining patients who do not likely to have moderate to severe OSA in sleep clinics so can be preferred to decide on therapies other than CPAP in a short time.

Gender difference in clinical presentation of Turkish patients with pulmonary tuberculosis.

The study was aimed to investigate the diagnostic differences between male and female patients in pulmonary tuberculosis in a tertiary 660 bedded Educational Respiratory Medicine Hospital, Istanbul, Turkey. A retrospective study was conducted with the new diagnosed, 50 men and 50 female pulmonary tuberculous patients. Age, symptoms, personal history, radiologic and sputum smear findings were collected from their files. 44 male and 42 female patients were enrolled to the study. Male patients tended to be older, smoke more, get alcohol more, lose weight more and have sputum smear positivity more than the female patients. Neither the time of diagnosis nor the radiologic appearance differed statistically. The radiologic appearance, not the clinic symptoms, help to diagnose tuberculosis in female patients; especially in those with no weight loss and sputum smear negativity.

Rapid eye movement dependent central apnea with periodic leg movements.

Central sleep apnea is a period of at least 10 s without airflow, during which no ventilatory effort is present. Most of the central apneas occur in Non-Rapid eye movement (NREM) sleep. Central apnea occuring in Rapid eye movement (REM) sleep is extremely rare. We present our patient who had a diagnosis of obstructive sleep apnea in another sleep center since 2003. His Auto Continuous Positive Airway Pressure (CPAP) machine was disrupted so he admitted to our center to renew his machine and for daytime sleepiness while using his machine. The polysomnography revealed central apneas ending with respiratory arousals and periodic leg movements in rapid eye movement (REM) stage. We found no cause for central apneas. The patient benefited from servo ventilator therapy. We present this case as an unusual form of central apnea with the review of the literatures. Even the patients diagnosed as obstructive sleep apnea should be analyzed carefully. The diagnosis and the therapeutic approach may change in the favor of the patient.

Chitinases and lung diseases.

Chitinase enzymes that hydrolize chitin and some articficial substrates are expressed in human despite lacking of the endogenous chitin within the body. Chitinases phatophysiological functions within human are not fully known. Recent evidence revealed that chitinases may have role into some processes of immune responses and inflammatory system. In this review, we discuss the role of chitinases in lung diseases based on the available information from the literature.

Reliability of the Watch-PAT 200 in detecting sleep apnea in highway bus drivers.

OBJECTIVE: To predict the validity of Watch-PAT (WP) device for sleep disordered breathing (SDB) among highway bus drivers. METHOD: A total number of 90 highway bus drivers have undergone polysomnography (PSG) and Watch-PAT test simultaneously. Routine blood tests and the routine ear-nose-throat (ENT) exams have been done as well. RESULTS: The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were 89.1%, 76.9%, 82% and 85.7% for RDI > 15, respectively. WRDI, WODI, W < 90% duration and Wmean SaO2 results were well correlated with the PSG results. In the sensitivity and specificity analysis, when diagnosis of sleep apnea was defined for different cut-off values of RDI of 5, 10 and 15, AUC (95%CI) were found as 0.84 (0.74-0.93), 0.87 (95%CI: 0.79-0.94) and 0.91 (95%CI: 0.85-0.97), respectively. There were no statistically significant differences between Stage1+2/Wlight and Stage REM/WREM. The percentage of Stage 3 sleep had difference significant statistically from the percentage of Wdeep. Total sleep times in PSG and WP showed no statistically important difference. Total NREM duration and total WNREM duration had no difference either. CONCLUSION: Watch-PAT device is helpful in detecting SDB with RDI > 15 in highway bus drivers, especially in drivers older than 45 years, but has limited value in drivers younger than 45 years old who have less risk for OSA. Therefore, WP can be used in the former group when PSG is not easily available.

[Vocal cord functions in patients with asthma attack]. / Astim atakli hastalarda vokal kord fonksiyonlari.

This study was planned to evaluate vocal cord functions and to establish underlying vocal cord dysfunctions (VCD) in patients with asthma attack. All patients admitted to emergency service of our hospital with asthma attack between February 01, 2007 and June 01, 2007 were included in the evaluation. After the evaluation, all patients regarded to have asthma attacks based on GINA 2006 guide were enrolled in the study. After first intervention, patients underwent endoscopic larynx examination for the evaluation of vocal cord functions. Twenty four (65.7%) male and 11 female (31.4%), overall 35 patients diagnosed with asthma and who did not have the history of another disease were included in the study. At endoscopic larynx examination carried out after first medical examination, at the moment of asthma attack, tongue, tongue base, epiglottis and arytenoid were observed to be within normal limits. In 9 (25.7%) patients, upper respiratory tract was hyperemic and in 2 (5.7%) odematous. One patient had nasal polyposis (p> 0.05). In the evaluation of vocal cord functions, restriction in adduction was observed in merely one patient. All other functions were normal. Rima opening width was established to be mean 8.34 + or - 0.725. VCD was deteced in none of the patients included in the study. Although we did not detect VCD in any patient, VCD should be borne in mind in cases which presents with the clinical picture of asthma and responds weakly to the treatment or in cases of unexplained shortness of breath. This may prevent many unnecessary procedures such as medication, entubation, tracheostomy and iatrogenic mortality. Further longutudial studies are required in order to shed light on the assocation of asthma with VCD.