Efficacy of neuromuscular electrical stimulation in patients with COPD followed in intensive care unit.

INTRODUCTION: Serious problems on muscle strength and functional status can be seen in bedridden-patients with chronic obstructive pulmonary diseases (COPD) receiving mechanical ventilation. We aimed to investigate the impact of active extremity mobilization and neuromuscular electrical stimulation (NMES) on weaning processes, discharge from hospital and inflammatory mediators in COPD patients receiving mechanical ventilation. METHODS: Thirty conscious COPD patients (F/M:15/15) hospitalized in the intensive care unit (ICU) with diagnosis of respiratory failure were enrolled to this study. Patients were randomized into three groups, including 10 patients for each. Active extremity-exercise training and NMES were applied to Group-1, only NMES was applied to Group-2 and active extremity exercise training was applied to Group-3. Muscle strengths, mobilization duration and weaning situation were evaluated. Serum cytokine levels were evaluated. RESULTS: Lower extremity muscle-strength was significantly improved in Group-1 (from 3.00 to 5.00, P = 0.014) and 2 (from 4.00 to 5.00, P = 0.046). Upper extremity muscle strength was also significantly improved in all three groups (from 4.00 to 5.00 for all groups, P = 0.038, P = 0.046 and P = 0.034, respectively). Duration of mobilization and discharge from the ICU were similar among groups. There was a significant decrease in serum interleukin (IL)-6 level in Group-1 and in serum IL-8 level in Group-1 and Group-2 after rehabilitation. CONCLUSION: This study indicates that pulmonary rehabilitation can prevent loss of muscle strength in ICU. Nevertheless, we consider that further studies with larger populations are needed to examine the impact of NMES and/or active and passive muscle training in bedridden ICU patients who are mechanically ventilated.

Impact of multimedia information on bronchoscopy procedure: is it really helpful?

AIM: In this study, we aimed to investigate the effect of written informed consent and comprehensive multimedia information on the anxiety level of patients, consumption of sedatives, difficulties during bronchoscopy, complications and duration of procedure. METHODS: 150 patients undergoing bronchoscopy were included to this study. They were randomized into two groups Multimedia information group (MIG, n = 75) and written-informed consent group (WICG, n = 75)). Signed written informed consent was obtained from all patients. Patients in MIG group watched comprehensive multimedia presentation. State anxiety scores of all patients were evaluated with State and Trait anxiety inventory (STAI-S). RESULTS: STAI-S score of patients in MIG (40.31 ± 8.08) was lower than patients in WICG (44.29 ± 9.62) (P = 0.007). Satisfaction level was higher in MIG (P = 0.001). Statistically higher difficulties during passage through vocal cords and interventions during bronchoscopy were present in WICG group (P = 0.013 and P = 0.043, respectively). Total midazolam dose during bronchoscopy, and duration of bronchoscopy were statistically lower in MIG patients (P < 0.001 and P = 0.045, respectively). Difficulties during waiting period, passage through nasal/oral route, applications of local anesthesia and complication frequency were similar in both groups. CONCLUSION: Besides reducing the state anxiety, multimedia information can reduce the dose of sedation, shorten the processing duration and reduce the difficulties during bronchoscopy.

Assessment of inflammatory biomarkers and oxidative stress in pulmonary thromboembolism: follow-up results.

Instability in circulation, hypoperfusion, hypoxia, and ischemia in pulmonary thromboembolism (PTE) may occur as a result of failure in pulmonary circulation. All these conditions cause inflammation and oxidative stress. We aimed to investigate inflammatory markers, asymmetric dimethylarginine (ADMA) levels, and the oxidant-antioxidant balance in patients with PTE. This study was conducted as a prospective case-control study. Thirty-eight patients with PTE enrolled to the study. Age- and gender-matched 38 healthy subjects without risk factors for pulmonary embolism were selected as control group. Venous blood samples were obtained from the PTE patients during the initial diagnosis and at the first month of treatment and from the control subjects. Interleukine-6 (IL-6), tumor necrosis factor alpha (TNF-α), total antioxidant status (TAS), total oxidant status (TOS), and ADMA levels were measured for all the samples. The results of patients and healthy subjects were compared. The mean age of the control group was 51.81 ± 15.18 years, and the mean age of the patients was 52.90 ± 18.22 years (p = 0.770). Deep venous thrombosis was present in 68 % of the patients. While we found significant differences between the patient and control groups in terms of IL-6, TAS, TNF-α, ADMA and oxidative stress index (OSI) values (p = 0.001, p = 0.011, p = 0.038, p = 0.028, and p = 0.024, respectively), the TOS value was not different between the groups (p = 0.080). The ADMA, TNF-α, TAS, TOS, and OSI values of the patients during the initial diagnosis and at the first month of treatment were not different (p > 0.05). The results of this study indicate an increased inflammation, endothelial damage, and oxidative stress in PTE. No difference at the first month of therapy suggests ongoing processes. We consider that these markers may be useful in the diagnosis and follow up of PTE.

Diagnostic utility of flexible bronchoscopy in elderly patients.

BACKGROUND: In the elderly population, diagnosis and initial treatment should be considered as soon as possible because of high disease incidence and complications. We aimed to evaluate the findings of flexible bronchoscopy (FB) and determine the diagnostic utility of FB in patients 65 years old and older. METHOD: We retrospectively evaluated FB results. Demographic data, clinical and bronchoscopic findings, diagnostic procedures during FB and incidence of accurate diagnosis with FB both in patients 65 years old and older and in younger patients were determined. RESULTS: A total of 745 patients [younger patients (<65 years, n = 378, F/M: 120/258) and older patients (≥65 years, n = 367, F/M: 88/279)] who underwent FB at our clinic between 2009 and 2012 were included. The mean age of older patients was 72.6 ± 5.8 years, while the mean age of younger patients was 50.9 ± 11.7 years. Overall, 188 older patients (51.2%) had an accurate diagnosis with the procedures used during bronchoscopy, and 179 younger patients (47.3%) had a final diagnosis with these procedures. The diagnostic utility of FB did not differ significantly between study groups (P = 0.291). During FB, 326 older patients (88.8%) had no complication, and 343 younger patients (90.7%) had no complications. No statistically significant difference was found between older and younger patients in terms of complications during FB (P = 0.389). CONCLUSION: The results of this study indicate the high diagnostic value of FB together with low complication rates in patients aged 65 years and older.

Neutrophil-to-lymphocyte ratio in chronic obstructive pulmonary disease: a retrospective study.

Chronic obstructive pulmonary disease (COPD) is a common chronic inflammatory disease of the lung with a high mortality and morbidity rate. Some of the inflammatory markers such as C-reactive protein (CRP), leukocyte count are associated with COPD. In this study, we aimed to evaluate the role of neutrophil-to-lymphocyte ratio (NLR) in COPD patients comparing with the other well-known inflammatory markers. We retrospectively enrolled the laboratory results of 269 COPD patients of which 178 patients at stable period and 91 patients during acute exacerbation and 50 sex- and age- matched healthy controls. We found that NLR values of the stable COPD patients were significantly higher than those of the controls (P < 0.001). During acute exacerbation of the disease there was a further increase compared to stable period (P < 0.001). NLR values were also positively correlated with serum CRP levels and red cell distribution width (RDW) and negatively correlated with mean platelet volume (MPV) in both COPD groups. In conclusion, NLR could be considered as a new inflammatory marker for assessment of inflammation in COPD patients with its quick, cheap, easily measurable property with routine complete blood count analysis.

Predictive value of Berlin Questionnaire and Epworth Sleepiness Scale for obstructive sleep apnea in a sleep clinic population.

INTRODUCTION: The Berlin Questionnaire (BQ) and Epworth Sleepiness Scale (ESS) are two of the widely used screening instruments for subjects suffering from sleep disorders. OBJECTIVES: To determine the predictive accuracy of the BQ and ESS in the subjects who were admitted to our sleep clinic, using overnight polysomnography as the 'gold standard'. METHODS: The BQ and ESS were performed to 1450 subjects hospitalized in our sleep clinic for polysomnographic evaluation. RESULTS: One thousand two hundred thirty of 1450 subjects (84.8%) had apnea-hypopnea index (AHI) ≥ 5, and 70.5% of them were classified as being at high risk of sleep apnea with BQ and 45.9% of them were classified as having excessive daytime sleepiness with ESS. Being in the high-risk group with the self-reported, BQ predicted an AHI ≥ 5 with a sensitivity of 0.73 and a specificity of 0.44, vs a sensitivity of 0.46 and a specificity of 0.60 with the self-reported ESS. Sensitivity of BQ (0.80) was highest when we selected the cut-off value of AHI as 30. When we evaluated the predictive accuracy of BQ and ESS together, specificity of both instruments as 0.72 at AHI cut-off value of 5 was found. AHIs were significantly correlated with the scores in each category and the total scores of BQ (P < 0.0001). CONCLUSIONS: The BQ is a poor predictor of obstructive sleep apnea (OSA) in subjects admitted to our sleep clinic. BQ and ESS together may be used to detect patients with low risk for OSA.

Association analyses of oxidative stress, aerobic capacity, daily physical activity, and body composition parameters in patients with mild to moderate COPD.

BACKGROUND/AIM: To investigate total oxidant and antioxidant status, maximal aerobic capacity, daily physical activity, pulmonary functions, and body composition changes, as well as the associations among these parameters, in patients with mild to moderate chronic obstructive pulmonary disease (COPD) versus healthy controls. MATERIALS AND METHODS: The study included 30 male patients newly diagnosed with COPD and 30 body mass index-matched, nonsmoker male controls. Maximal aerobic capacity, daily physical activity, total oxidant and antioxidant status, pulmonary function tests, body composition, and anthropometric parameters were measured. RESULTS: Maximal aerobic capacity and total antioxidant values were lower in patients with COPD compared to the controls. The total oxidant value, body fat percentage, and waist/hip ratio were higher in patients with COPD than in the healthy controls. There was a moderately negative correlation between the total oxidant value and the maximal aerobic capacity, while there was a moderately positive correlation between the total antioxidant values and maximal aerobic capacity in patients with COPD. CONCLUSION: Low aerobic capacity, increased oxidative stress, and adiposity are related to impaired pulmonary functions in patients with mild to moderate COPD and might have a role in the pathogenesis of COPD.

[Effects of COPD on cognitive functions: a case control study]. / KOAH'in kognitif fonksiyonlar üzerine etkisi: Bir olgu kontrol çalismasi

INTRODUCTION: Assessment of disease severity, effects of disease on health status and future events should be considered to direct treatment strategies in chronic obstructive pulmonary disease (COPD) management. Although extrapulmonary effects of COPD are well known, effects of COPD on cognitive functions have not been evaluated sufficiently. therefore we aimed to determine cognitive functions of copd patients in the present study. MATERIALS AND METHODS: 112 COPD patients with moderate, severe and very severe irreversible airway obstruction and 44 age matched healthy subjects without COPD and systemic diseases as control group were enrolled to the study. Mini mental state examination (MMSE) was performed to evaluate cognitive functions. MMSE results were compared between patient and control groups. Moreover relationship between exacerbation frequency and cognitive functions was evaluated. RESULTS: Total 156 subjects as 112 COPD patients and 44 healthy subjects were included to the study. Mean age of COPD patients was 65.03 ± 7.63 years, and mean age of control group was 63.63 ± 8.96 years (p= 0.364). Mean score of MMSE in COPD patients was 23.8 ± 4.39, and mean score of MMSE in control group was 26.7 ± 2.88. We determined a significant difference in terms of MMSE scores betweeen patient and control group (p< 0.0001). MMSE scores and FEV1 values were significantly different among patients with moderate, sevre and very severe airflow obstruction (p= 0.001; p< 0.0001 respectively). We found a significant negative correlation between MMSE results and exacerbation frequency during last year (p= 0.003; r= -0.239). CONCLUSION: Lower MMSE scores of COPD patients than subjects in control group indicates the impairment of cognitive functions in COPD patients. Moreover a negative relationship between MMSE scores with exacerbation frequency during last year suggests that prevention from exacerbation can decrease cognitive impairment in COPD patients. We believe that assessment of cognitive functions and preventive strategies should be considered in COPD management.