Is serum iron responsive protein-2 level associated with pulmonary functions and frequent exacerbator phenotype in COPD?

INTRODUCTION: Chronic Obstructive Pulmonary Disease (COPD) exacerbations contribute to the overall severity in individual patients because they are associated with airway inflammation, pulmonary function loss, decreased quality of life and increased mortality. Although, identifying frequent exacerbator patients is important due to severe outcomes associated with frequent exacerbator phenotype in COPD patients there is no single biomarker which can differentiate this phenotype. Iron responding protein-2 (IRP2) is the protein product of IREB2 gene, which is a COPD susceptibility gene that regulates cellular iron homeostasis and has a key role in hypoxic conditions. Previous research indicates that IREB2 expression in lung tissue is associated with spirometric measurements and emphysema in COPD. In this study, our aim was to investigate whether serum IRP2 levels were associated with frequent exacerbator phenotype, to evaluate whether IRP2 levels in serum are associated with pulmonary functions and selected systemic inflammation biomarkers. MATERIALS AND METHODS: Designed as a single tertiary care center based, crosssectional study, included high risk (GOLD C, D) COPD patients who admitted to outpatient clinic consecutively between December 2015 and July 2016. RESULT: The study included 80 COPD patients. Serum IRP2 levels were negatively correlated with FEV1 ml (r= -0.25, p= 0.02) and body weight (r= -0.35, p= 0.002) but not with markers of systemic inflammation. COPD patients with at least one exacerbation history in the last year tended to have higher IRP2 levels than patients without any exacerbation [12.3 (IQR 25-75: 10.4- 17.1) vs 10.5 (IQR 25-75: 8.8-18.5), p= 0.06]. CONCLUSIONS: Serum IRP2 level is significantly correlated with FEV1 mL but not with FEV1 % predicted and cannot be used to differentiate frequent exacer bator patients. Although IREB2 gene expressions in lung tissue and bronchoalveolar lavage results have significant associations with emphysema and FEV1/FVC, FEV1 %predicted in COPD patients, our results suggests serum IRP2 level is not as promising.

ACE gene I/D polymorphism and risk of sarcoidosis development in Turkish patients.

INTRODUCTION: Etiology of sarcoidosis is unknown but the prevalence of disease in different ethnic groups and identical twins, family characteristics indicate that genetic predisposition is a possible factor. The angiotensin-converting enzyme (ACE) has been implicated in the pahophysiology of sarcoidosis. The aim of this study is to investigate the influence of a polymorphism in I/D (Insertion/Deletion) of the ACE gene on the susceptibility to sarcoidosis. PATIENTS AND METHODS: Our study included 70 Turkish patients who had histopathological diagnosis of sarcoidosis and 69 healthy age and sex matched control subjects. Polymerase chain reaction was used for analysing an I/D polymorphism in the gene coding for ACE. Genotyping was done according to bands that were formed on the agarose gel electrophoresis. Chi-square test was used for statistical analysis and p< 0.05 was accepted as significance. RESULTS: Although the D allele was more frequent in the sarcoidosis patients group, the frequency of the D allele was 67% and 54% respectively in the sarcoidosis and the control group. No significant difference in allele frequencies of I/I, I/D, D/D polymorphisms was observed between the sarcoidosis and control group (p> 0.05). Similarly allele frequencies of I/I, I/D, D/D polymorphisms was not different between sarcoidosis patients with extrapulmonary involvement and sarcoidosis patients without extrapulmonary involvement (p> 0.05). CONCLUSION: Our findings have showed that contribution of ACE gene polymorphisms to susceptibility of disease development in Turkish sarcoidosis patients is not different from the healthy control subjects.

Clinical effectiveness of nebulised budesonide in the treatment of acute asthma attacks.

Nebulized budesonide (NB) might offer topical anti-inflammatory activity and be an alternative to systemic corticosteroid (SC) in the treatment of acute asthma. The aim of this study was to compare the effect of NB with SC on lung function and clinical findings of adult patients with acute asthma. Thirty patients admitted to clinic with asthma attack (F/M: 26/4; mean age: 47.1 +/- 2.1 years) were enrolled to the study. The patients were randomized into three groups; Group I were treated with NB alone (4 mg/day), Group II SC alone (1 mg/kg/day methylprednisolone), Group III NB plus SC. Pulmonary functions and respiratory symptom scores were measured and recorded before and during 7 days of study. Spirometric parameters significantly improved in all groups at 7th day significantly (p< 0.05) without a difference among groups (p> 0.05). FEV(1) % levels increased significantly at the first day of study in Group I and III (p< 0.05), but didn't change in Group II until 5th day of study. The mean symptom scores decreased significantly at the second day in Group I (p< 0.05), and at the 4th day in other groups. NB with or without SC improved successfully airway obstruction and symptoms in patients hospitalized with acute asthma attack as the 1st treatment day in comparison with SC alone and this effect lasted for 7 days. Regarding the superior safety profile and comparable efficacy with SC, NB might be an alternative to the patients with moderate-severe asthma attacks.

Tuberculosis presenting as immune thrombocytopenic purpura.

BACKGROUND: Although various hematologic abnormalities are seen in tuberculosis, immune thrombocytopenic purpura is a rare event. CASE PRESENTATION: We report a case of a 29 year-old male who was presented with immune thrombocytopenia-induced hemoptysis, macroscopic hematuria and generalized petechiae. The patient was found to have clinical, microbiological and radiological evidence of active pulmonary tuberculosis. The immune thrombocytopenic purpura was successfully treated with anti-tuberculous drugs combined with corticosteroids and high dose immune globulin therapy. CONCLUSION: Immune thrombocytopenic purpura can be one of the hematological manifestations of tuberculosis which has a global prevalence with increasing incidence secondary to HIV infection.