Evaluation of patients with fibrotic interstitial lung disease: Preliminary results from the Turk-UIP study

OBJECTIVE: Differential diagnosis of idiopathic pulmonary fibrosis (IPF) is important among fibrotic interstitial lung diseases (ILD). This study aimed to evaluate the rate of IPF in patients with fibrotic ILD and to determine the clinical-laboratory features of patients with and without IPF that would provide the differential diagnosis of IPF. MATERIAL AND METHODS: The study included the patients with the usual interstitial pneumonia (UIP) pattern or possible UIP pattern on thorax high-resolution computed tomography, and/or UIP pattern, probable UIP or possible UIP pattern at lung biopsy according to the 2011 ATS/ERSARS/ALAT guidelines. Demographics and clinical and radiological data of the patients were recorded. All data recorded by researchers was evaluated by radiology and the clinical decision board. RESULTS: A total of 336 patients (253 men, 83 women, age 65.8 +/- 9.0 years) were evaluated. Of the patients with sufficient data for diag-nosis (n=300), the diagnosis was IPF in 121 (40.3%), unclassified idiopathic interstitial pneumonia in 50 (16.7%), combined pulmonary fibrosis and emphysema (CPFE) in 40 (13.3%), and lung involvement of connective tissue disease (CTD) in 16 (5.3%). When 29 patients with definite IPF features were added to the patients with CPFE, the total number of IPF patients reached 150 (50%). Rate of male sex (p<0.001), smoking history (p<0.001), and the presence of clubbing (p=0.001) were significantly high in patients with IPE None of the women <50 years and none of the men <50 years of age without a smoking history were diagnosed with IPE Presence of at least 1 of the symptoms suggestive of CTD, erythrocyte sedimentation rate (ESR), and antinuclear antibody (FANA) positivity rates were significantly higher in the non-IPF group (p<0.001, p=0.029, p=0.009, respectively). CONCLUSION: The rate of IPF among patients with fibrotic ILD was 50%. In the differential diagnosis of IPF, sex, smoking habits, and the presence of clubbing are important. The presence of symptoms related to CTD, ESR elevation, and EANA positivity reduce the likelihood of IPF

Klinik ve subklinik alveolitis

Bu tezin, veri tabanı üzerinden yayınlanma izni bulunmamaktadır. Yayınlanma izni olmayan tezlerin basılı kopyalarına Üniversite kütüphaneniz aracılığıyla (TÜBESS üzerinden) erişebilirsiniz.ÖZET İnterstisyel akciğer hastalıklarının başlangıç dönemi olarak kabul edilen "alveolitis" son 10 yıl içinde tanımlanmış bir kavramdır. Alveolitis, alveol inflamasyonu anlamına gelmekte ve alveoller içinde, nötrofil, lenfosit ve eosinofil gibi infiamatuar hücrelerin sayı ve aktivitelerinin artışı ile karakterize edilmektedir. Bronkoalveoler Lavaj (BAL) sıvısı incelemeleri ile ortaya koyulan bu tanımlama, in- testisyel akciğer hastalıklarının patogenez, tanı ve izlenmelerine yeni ve önemli boyutlar getirmiştir. Daha yeni bir kavram olan "subklinik alveolitis" ise, akciğerlerin rutin radyolojik incelemeler, fizik muayene, solunum fonksiyon testleri ve arteryel kan gazlan an alizi ile normal bulunmasına rağmen, BAL incelemeleri ile alveolitis saptanması anlamına gelmektedir. Başka dokuları veya organları tu tan bir çok sistemik hastalıkta, akciğerlerin de olaya inflamasyon düzeyinde katıldığını gösteren "subklinik alveolitis" bulgusunun, ge lecekteki bir kronik interstisyel akciğer hastalığının ön belirtisi olup olmadığı henüz araştırma aşamasındadır. Kendi toplumumuzdaki, interstisyel akciğer hastalığı bulunan veya bu hastalığı oluşturma potansiyeline sahip bir sistemik hastalığı olan olgulardaki klinik ve subklinik alveolitis! göstermek amacıyla yapılan araştırmamızda ayrıca 12 sağlıklı kişinin BAL sıvısı hücre yüzdeleri saptanarak normal değerlerimize bir örnek verilmiştir. E.Ü.T.F. Göğüs Hastalıkları Ana Bilim Dalı ve Romatoloji bilim dalınca tetkik edilerek tanılan koyulan beş değişik hastalık grubunu 37(sarkoidosis, İAF, RA, SLE ve PSS) kapsayan olgular, BAL sıvısı hücre analizi ve beraberinde klinik, radyolojik ve fonksiyonel değerlendirmelerle incelenmişlerdir. Bu olgular arasında belirlenen 107 klinik ve 36 subklinik alveolitisli hastamızın BAL sıvısı hücre yüzdeleri bildirilmiştir. Ayrıca her iki grup arasında, hücre yüzdeleri karşılaştırılmıştır. Sonuçta alveolit tanısı koyduran inflamatuar hücre oranındaki artışın subklinik olgularda da hemen klinik alveo litisli olgular düzeyindeki kadar yüksek olduğu dikkati çekmiştir. immünolojik sistemik hastalığı bulunan kişilerde belirlene cek bir subklinik alveolitisin, gelecekte oluşacak interstisyel akciğer hastalığının habercisi olma potansiyeli vardır. Ancak bu ko nudaki kesin bilgiler, subklinik alveolitisli olguların yakından izlen mesi ile elde edilebilecektir. 3

Chronic (3-Weeks) Treatment of Estrogen (17 beta-Estradiol) Enhances Working and Reference Memory in Ovariectomized Rats: Role of Acetylcholine

Recently there has been a growing interest in the effects of estrogen on cognitive functions. In this study, we aimed to examine 17 beta-estradiol treatment on working and reference memory in ovariectomized rats. We also examined the changes in the acetylcholine (ACh) levels in the brain areas associated with learning and memory. The study was performed on Sprague-Dawley type 3-month-old female rats. The rats were divided into four groups as control, ovariectomy (OVX), and OVX and estrogen treatment (10 A mu g/day i.p. 17 beta-estradiol) groups for 3 (OVX + E3) and 21 days OVX + E21). The rats were trained on eight arm radial maze task with eight arms baited to assess spatial memory, in addition four arms baited to assess both working and reference memory performances. The electron microscope images of the ACh vesicles in the frontal cortex, temporal cortex and hippocampus areas of the brain which are important regions for learning and memory were screened. Results showed that long term 17 beta-estradiol treatment has positive effects on both reference memory and working memory and that ACh vesicles increased in the examined brain areas, especially in hippocampus. Our results suggest that 3 weeks 17 beta-estradiol treatment may have an ameliorative effect on the memory through the central cholinergic system

Diagnosis and Treatment Patterns of Chronic Thromboembolic Pulmonary Hypertension in Russia, Kazakhstan, Turkey, Lebanon, and Saudi Arabia: A Registry Study

Background: Patients with chronic thromboembolic pulmonary hypertension (CTEPH) in countries with limited resources have, to date, been poorly represented in registries. Objective: This work assesses the epidemiology, diagnosis, hemodynamic and functional parameters, and treatment of CTEPH in Russia, Kazakhstan, Turkey, Lebanon, and Saudi Arabia. Methods: A prospective, cohort, phase IV, observational registry with 3-year follow-up (n = 212) in patients aged ≥ 18 years diagnosed with CTEPH was created. Clinical, hemodynamic, and functional parameters were obtained at an initial visit, follow-up visits, and a final visit at the end of 3 years’ observation or end of follow-up. Data were recorded on electronic case report forms. Parameters evaluated included 6-minute walking distance (6MWD), use of pulmonary endarterectomy (PEA), balloon pulmonary angioplasty (BPA), pulmonary hypertension (PH)-targeted therapy, and survival. All statistical analyses were exploratory and descriptive, and were performed in the overall population. Results: The most common symptoms were typical of those expected for CTEPH. Almost 90% of patients underwent right heart catheterization at diagnosis or initial study visit. In total, 66 patients (31%) underwent PEA before the initial visit; 95 patients (45%) were considered operable, 115 (54%) were inoperable, and two (1%) had no operability data. Only 26 patients (12%) had been assessed for BPA at their initial visit. PH-targeted therapy was documented at diagnosis for 77 patients (36%), most commonly a phosphodiesterase type 5 inhibitor (23%). Use of PH-targeted therapy increased to 142 patients (67%) at the initial visit, remaining similar after 3 years. Use of riociguat increased from 6% of patients at diagnosis to 38% at 3 years. Between baseline and end of observation, results for patients with paired data showed an increase in 6MWD. Survival at the end of observation was 88%. Conclusions: These data highlight the current diagnosis and management of CTEPH in the participating countries. They show that early CTEPH diagnosis remains challenging, and use of off-label PH-targeted therapy is common. ClinicalTrials.gov: NCT02637050; registered December 2015. Graphical Abstract: (Figure presented.)