Chronic obstructive pulmonary disease and cardiovascular system [Kronik obstrüktif akciger hastaligi ve kardiyovasküler sistem]

Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide killing nearly 3 million people annually. Even the most optimistic estimates suggest that COPD mortality rates will increase by 50% over the next 15 years. Individuals with COPD are at increased risk of cardiovascular diseases (CVD), lung cancer, osteoporosis and muscle wasting. Smoking is a well-described risk factor for both COPD and CVD, but CVD in patients with COPD is likely to be due to other factors in addition to smoking. Systemic inflammation may be an important common etiological cause between COPD and CVD, being well described in both diseases. This paper reviews the close relationship between COPD and cardiovascular diseases, principally atherosclerosis. The common pathogenetic mechanisms, relation between cardiovascular comorbidities and pulmonary function parameters, the treatment of pulmonary and systemic inflammation, the role medications in the treatment of both disorders, the effect of cardiovascular comorbidities on the prognosis of COPD and prediction of mortality is discussed. The anti-inflammatory effects of inhaled corticosteroids and statins, their effects on cardiovascular endpoints, all-cause mortality, and survival of COPD patients are rewieved as a new perspective to the treatment

Solunumsal yoğun bakım ünitesinde mekanik ventilasyon uygulanan olgularda üst gastro-intestinal sistem kanamaları

Aim: The aims of this study were to evaluate the frequency, risk factors and outcomes of upper gastro-intestinal system (GIS) bleeding in respiratory intensive care unit (ICU) patients who received mechanical ventilation. Material and Methods: Fifty-six patients (39 males, mean age 64.2;plusmn;16.6 years), who were treated in the respiratory ICU for more than 5 days were included in the study. Risk factors and clinical outcomes of patients with gastrointestinal bleeding were evaluated. Results: Out of 56 patients, 10 (17.9%) developed upper GIS bleeding and 30 (53.6%) had ventilator associated pneumonia (VAP) and 22 of them (39.3%) died. There was no relationship between stress ulcer prophylaxis, feeding type and upper GIS bleeding, VAP. In patients with upper GIS bleeding, the frequency of VAP was higher (p=0.011), the duration of mechanical ventilation, stay in ICU and hospital were longer (p=0.05, p=0.023 and p=0.038, respectively) and mortality rate was found to be higher (p=0.006). There was no relationship between upper GIS bleeding and disease severity on admission, use of systemic corticosteroid, anti-coagulant therapy and coagulation disorders. Conclusion: Upper GIS bleeding increases the risk of VAP and mortality; prolongs the durations of stay in the ICU and hospital. Therefore, we conclude that upper GIS bleeding is a poor prognostic factor for respiratory ICU patients.Amaç: Bu çalışmada, mekanik ventilasyon uygulanan solunumsal yoğun bakım ünitesi (YBÜ) olgularında gelişen üst gastro-intestinal sistem (GİS) kanaması sıklığının, risk faktörlerinin ve sonuçlarının araştırılması amaçlanmıştır. Yöntem ve Gereç: Çalışmaya, solunumsal YBÜ'de beş günden uzun süre izlenen 56 olgu (39'u erkek, yaş ortalaması 64.2±16.6) alınmıştır. Gastro-intestinal sistem kanaması gelişen olguların risk faktörleri ve klinik sonuçları değerlendirilmiştir. Bulgular: 54 olgunun, 10'unda (% 17.9) üst GİS kanaması, 30'unda (% 53.6) ventilatör ilişkili pnömoni (VİP) gelişmiş ve 22'si (% 39.3) eksitus olmuştur. Stres ülser profilaksisi ve beslenme tipi ile üst GİS kanaması ve VİP gelişmesi arasında ilişki saptanmamıştır. Üst GİS kanaması ortaya çıkan olgularda; VİP gelişme oranı daha fazla (p=0.011), mekanik ventilasyon (MV) uygulama, YBÜ ve hastanede yatış süreleri daha uzun (sırasıyla, p=0.05, p=0.023 ve p=0.038) ve mortalite oranı daha yüksek (p=0.006) bulunmuştur. Başvurudaki hastalık ciddiyeti, sistemik kortikosterod kullanımı, anti-koagülan tedavi ve koagülasyon bozuklukları ile üst GİS kanaması arasında ilişki saptanmamıştır. Sonuç: Üst GİS kanaması VİP gelişme ve mortalite oranlarını artırmakta, YBÜ ve hastanede yatış sürelerini uzatmaktadır. Bu nedenle, solunumsal YBÜ olguları için üst GİS kanamasının kötü prognostik faktör olduğu sonucuna varılmıştır

Anterior myocardial infarction in an adult patient with left ventricular hypertrabeculation/noncompaction [2]

PubMed ID: 16337050[No abstract available

The effect of short-term pulmonary rehabilitation on pulmonary function tests, blood gases, functional capacity, dyspnea, quality of life and psychological symptoms in chronic pulmonary diseases: A retrospective study [Kronik Pulmoner Hastali{dotless}klarda Ki{dotless}sa Dönem Pulmoner Rehabilitasyonun Pulmoner Fonksiyon Testleri, Kan Gazi{dotless}, Fonksiyonel Kapasite, Dispne, Yaşam Kalitesi ve Psikolojik Semptomlar Üzerine Etkisi: Retrospektif Çali{dotless}şma]

Objective: To establish the efficacy of short-term outpatient pulmonary rehabilitation in patients with chronic pulmonary diseases. Materials and Methods: Data from 65 outpatients [Chronic Obstructive Pulmonary Disease (COPD, Group 1, n=44) and non-COPD (Group 2, n=21)] who presented to the rehabilitation center were analyzed retrospectively. Respiratory functions, blood gases, functional capacity (peak oxygen consumption (pVO2), shuttle walk test (SWT), endurance shuttle walk test (ESWT), dyspnea [Medical Research Council (MRC) Dyspnea Scale], quality of life (Saint George's Respiratory Questionnaire, SGRQ), and psychological symptoms (Hospital Anxiety and Depression Scale, HADS) tests before and after an 8-week rehabilitation program were obtained from patients' medical records. Results: After the rehabilitation program, a significant improvement in pVO2, ESWT, SGRQ (symptom, activity, impact subscale and the total score), and MRC dyspnea scale (p<0.05) was observed in both groups, compared to the pre-rehabilitation period. In contrast, no significant improvement was observed in either groups following the rehabilitation program with respect to respiratory function tests (ZEV1 (ml,%), ZVK (ml,%), ZEV1/ZVK (%), blood gas measurements (paO2, paCO2, oxygen saturation), SWT, and HADS (p>0.05). On the other hand, in inter-group comparison, the significant low values of ZEV1 and ZEV1/ZVK in the pre-rehabilitation period in Group 1 compared to Group 2, also persisted after rehabilitation (p<0.05). The comparisons regarding the rest of parameters did not reveal any significant difference (p>0.05). Conclusion: Outpatient pulmonary rehabilitation improves functional capacity, dyspnea, and quality of life in patients with COPD and non-COPD. Whatever the dyspnea etiology was, a regular exercise program in the rehabilitation unit is recommended for patients with chronic pulmonary diseases. Turk J Phys Med Rehab 2010;56:6-10. © Turkish Journal of Physical Medicine and Rehabilitation, Published by Galenos Publishing. All rights reserved

Can impairments of thyroid function test affect prognosis in patients with respiratory failure?

PubMed ID: 18224499Thyroid function test (TFT) impairments can be detected in extrathyroidal dysfunction, primarily in chronic obstructive pulmonary disease (COPD) with acute respiratory failure (RF). The aims of this study were to: (i) evaluate TFT impairments in patients with RF, (ii) compare TFT results to a control group without RF and (iii) assess the effects of thyroid dysfunction on clinical outcome and prognosis of RF. The TFT parameters were assessed in 65 patients (65.0 ± 10.0 years, 49 males) with RF and compared to 18 patients (64.4 ± 9.8 years, 13 males) with lung disease and no RF (p> 0.05). Arterial blood I gas analysis, free T3 (FT3), free T4 (FT4) and TSH levels were all measured. The impairments of TFT were demonstrated in \ 34 (52.3%) patients with RF and 8 (44.4%) patients without RF (p> 0.05). The most common finding was a decrease in at least one of the TFT parameters in both groups (43.1% vs. 44.4%, respectively), in RF group, there was no significant association between TFT results and gender, age, diagnosis and co-morbid disease. However, need for invasive mechanical ventilation was higher both in patients with low FT3 and low FT4 when compared to those with normal TFT results (p= 0.001 and p= 0.003, respectively). In-hospital mortality rate was also higher both in the patients with low FT3 and low FT4 than the others (p= 0.006 and p= 0.07, respectively). We conclude that TFT impairments are not observed more frequently in patients with RF when compared to the patients without RF. However, low FT3 and FT4 levels increase the rates of invasive mechanical ventilation and mortality