Urinary uric acid excretion as an indicator of severe hypoxia and mortality in patients with obstructive sleep apnea and chronic obstructive pulmonary disease.

OBJECTIVE: Uric acid (UA) is the end product of adenosine triphosphate degradation, and could increase due to hypoxia. We investigated the association of UA metabolites with nocturnal hypoxemia, apnea-hypopnea index (AHI), noninvasive mechanical ventilation (NIMV) usage and five-year mortality. MATERIALS/SUBJECTS AND METHODS: We obtained urinary specimen before and after the night polysomnography in order to measure UA excretion and overnight change in urinary UA/creatinine ratio (ΔUA/Cr) in 75 subjects (14 controls, 15 chronic obstructive pulmonary disease (COPD) without nocturnal hypoxemia (NH), 15 COPD with NH, 16 obstructive sleep apnea syndrome (OSAS) without NH, 15 OSAS with NH). Percentage of time spent below SaO2 of 90% (T90%) for >10% of sleep time was considered as nocturnal hypoxemia. Patients were contacted after 5 years with a questionnaire including information on the use of NIMV treatment (n: 58) and urinary specimen analysis (n: 35). RESULTS: T90% was found to be significantly correlated with UA excretion (coefficient: 0.005, 95%CI: 0.003-0.007) and ΔUA/Cr (coefficient: 0.8, 95%CI: 0.3-1.2) after adjustments for age, gender, body mass index and apnea-hypopnea index. Median and IQR (interquartile range) of baseline UA excretion were 0.79 (0.51-0.89) and 0.41 (0.31-0.55) in 10 deceased and 58 surviving patients, respectively (p=0.001). UA excretion median and IQR of baseline and 5 years of NIMV treatment were 0.41 (0.36-0.57) and 0.29 (0.23-0.37), respectively (p=0.01). CONCLUSION: UA excretion, as a marker of tissue hypoxia, may be useful in the management of OSA and COPD patients.

Integration of GARD Turkey national program with other non-communicable diseases plans in Turkey.

For the prevention and control of non-communicable diseases (NCD), an action plan on NCDs is intended to support coordinated, comprehensive and integrated implementation of strategies and evidence-based interventions across individual diseases and risk factors, especially at the national and regional levels by World Health Organization (WHO). The Global Alliance against Chronic Respiratory Diseases (GARD) is making every attempt to align with WHO's non-communicable diseases action plan. GARD activities have been commenced in over 40 countries and in 11 countries an integrated NCD action plan is being prepared or has already been initiated. This integrated approach of GARD has also targeted to GARD Turkey project. The Turkish Ministry of Health has decided to apply this national control program in conformity with other NCD action plans. This article is intended to summarize these integration efforts of GARD Turkey (the National Control Program on Chronic Airway Diseases) with other NCD national programs.

Molecular identification and characterization of rifampicin-resistant Mycobacterium tuberculosis isolates by line probe assay: an approach for rapid diagnosis of multidrug-resistant tuberculosis.

AIM: Early identification and characterization of rifampicin-resistant (R(r)) Mycobacterium tuberculosis isolates recovered from the samples of tuberculosis (TB) patients in the Aegean (West Anatolian) Region was intended. METHODS AND RESULTS: Sixty isolates [47 (78.3%) multidrug-resistant (MDR)], which were identified as M. tuberculosis complex and phenotypically resistant to rifampicin by both BACTEC mycobacteria growth indicator tube (MGIT) 960 and 460 systems were analysed by a commercial line probe assay (INNO-LiPA Rif TB). The concordance of LiPA with the in vitro susceptibility test was found as 98.3%. Among the isolates, S531L (R5 pattern; 46.7%) and L511P/R, S512T, Q513L/K (DeltaS1 pattern; 11.7%) were the most frequent mutation patterns. As compared with the BACTEC systems and conventional techniques for cultivation, identification and in vitro susceptibility testing, INNO-LiPA Rif TB after cultivation in BACTEC MGIT 960 system provided an average of 20 days early diagnosis of R(r)M. tuberculosis isolates. CONCLUSIONS: Rapid molecular identification and characterization of R(r)M. tuberculosis isolates after BACTEC MGIT 960 cultivation would be useful for faster diagnosis, infection control and planning of accurate treatment in MDR-TB patients. SIGNIFICANCE AND IMPACT OF THE STUDY: Patients with MDR-TB need a specified treatment and efficient follow-up strategies. Rapid and practical methodologies to diagnose and follow these patients should be applied in routine use.

Spinal cord compression due to costal Echinococcus multilocularis.

We present computerized tomography (CT) and magnetic resonance imaging (MRI) findings of a costal hydatid cyst (Echinococcus multilocularis) causing spinal cord compression. The hydatid disease was proved histologically. MRI was not only very useful for determining the spinal extension of the disease by its multiplanar imaging capability, but also gave important information about the texture of the cyst, thus aiding the preoperative diagnosis.

Varix of the inferior pulmonary vein: computed tomography and magnetic resonance angiography findings.

A 37-yr-old male presented with a 2-week history of intermittent episodes of mild haemoptysis. Computed tomography and magnetic resonance imaging revealed a varix of the inferior pulmonary vein. The diagnosis was confirmed using magnetic resonance angiography and conventional angiography. This condition is relatively rare, and few cases have previously been demonstrated by means of magnetic resonance imaging and angiography.

Corynebacterium parvum pleurodesis and survival is not significantly influenced by pleural pH and glucose level.

This study was carried out in the pulmonary department of a referral training hospital for thoracic medicine and surgery, with the aim of assessing the effects of pH and glucose level of a pleural effusion (PE) on survival and the response to pleurodesis (PD) with Corynebacterium parvum. A prospective study was carried out in 204 patients with recurrent, symptomatic PEs (73 benign, 131 malignant). Fifty eight per cent of 204 PEs had low pH (< 7.20; 7.01 +/- 0.14) nd glucose levels (< 60 mg.dL-1; 36 +/- 14 mg.dL-1), whereas the remaining 42% had higher pH (> or = 7.20; 7.36 +/- 0.07 and glucose levels (> or = 60 mg.dL-1; 79 +/- 16 mg.dL-1). PD was attempted twice with 7 mg of C. parvum injected through chest tube in all patients, who were then followed up for the outcome of PD and for survival from the time of PD until death or the closure of the study (August 1996). Of 204 cases, 201 were evaluable for survival and outcome of PD. In 91% of the low-and 82% of the high-pH/glucose benign PEs, complete PD was achieved while the corresponding values for the malignant PEs were 79% and 87%, respectively (p > 0.05). Six per cent of low-and 8% of high-pH benign PEs, and 13% of low- and 9% of high-pH malignant PEs were palliated with partial PD. Failures were 3% and 10% in the low- versus high-pH benign groups, and 8% and 4% in the low- versus high-pH malignancies, respectively. All 201 cases maintained the immediate post-PD outcome throughout the follow-up. Average survival was 21.8 months in high-pH benign PEs versus 21.1 months in low-pH benign PEs, and 9.9 versus 8.7 months, in high- and low-pH malignant PEs, respectively (p > 0.05). We deduce that, regarding survival and the response to pleurodesis with Corynebacterium parvum, there is no significant difference between low- and high-pH/glucose pleural effusions in malignant, or benign cases.