The Effects of Budesonid that Added to Tiotropium Therapy on Health Related Quality of Life, Exercise Capacity and Pulmonary Functions in COPD Patients

Objective: The aim of this study was to evaluate the effects of adding inhaled budesonide to the tiotropium treatment on the pulmonary function tests, health-related quality of life and exercise capacity of patients with chronic obstructive pulmonary disease (COPD). Methods: Forty study subjects with COPD were randomized to two groups. The patients in the first group was treated with 1x1 18 mcg of Tiotropium and the patients in the second group was treated with the combination of tiotropium (18 mcg 1x1) and budesonide (400 mcg 2x1) for three months. Pulmonary function tests, six minute walk test, body mass index and Saint George Respiratory Questionnaire (SGRQ) scores were recorded both at the beginning and 3 months later and the results at the begining and third month were compared with each other. There were no statistically significant difference in all basline parameters between the two groups. Results: At the end of the study, no statistically significant differences were obtained between two groups in terms of pulmonary function tests (p>0.05). Significant improvements were observed on the parameters of walking distance (p=0.023) and SGRQ scores (symptom score: p<0.001, activity score: p=0.001, impact score: p=0.003 and total score: p<0.001) in Group 2 when compared with Group 1. Conclusion: These results show that, in patients with COPD, tiotropium/budesonide combination is more effective than alone tiotropium inhalation in quality of life and exercise performance. But this combination is not more effective in improving lung functions

Impact of Restless Legs Syndrome on the Sleep Quality in Chronic Obstructive Pulmonary Disease

Objective: It is well known that various sleep disorders are common in cases of chronic obstructive pulmonary disease (COPD). However, restless legs syndrome (RLS) has not been extensively studied in these patients. The aim of the current study was to investigate the prevalence of RLS and its impact on sleep quality in patients with COPD. Methods: The study included a total of 50 patients with COPD with a mean age of 67.2±7.7 years; 39 (78%) were male. The RLS diagnosis was made based on the questionnaire items standardized by the International RLS study group. Dyspnea severity (mMRC), quality of life (CAT), sleep quality [Pittsburgh sleep quality index (PSQI)], and daytime sleepiness [Epworth sleepiness scale (ESS)] were evaluated using certain specific questionnaires. The subjects were studied in two groups: RLS-positive and RLS-negative groups. Results: In the study population, RLS was detected in 17 (34%) patients. It was found that the RLS-positive subjects had a longer disease duration (p=0.006), a higher hospital admission rate (p=0.008), and lower spirometric values (p=0.023 for FVC; p=0.001 for FEV1). The CAT score was significantly higher in the RLS-positive group (p=0.019). The RLS-positive group had higher PSQI and ESS scores (p<0.001 for both). There were negative correlations between PSQI, ESS scores, and spirometric measures (FVC and FEV1), whereas PSQI and ESS scores had positive correlations with disease duration, mMRC, and CAT scores. Conclusion: In our study, it was observed that RLS is a common condition in patients with COPD. As the duration and severity of COPD increases, RLS becomes more prevalent and sleep quality deteriorates

Changes in Serum Cytokine Levels in Active Tuberculosis With Treatment

It has been reported that IFN-γ, TNF-α, and IL-12 stimulate, and that IL-10, TGF-β, and IL-4 suppress the protective immune response against tuberculosis. We aim to evaluate changes in the serum levels of pro and antiinflammatory cytokines in active pulmonary tuberculosis (APTB) and the possible effects of treatment on these changes. Serum IL-12p40, IL-4, IL-10, TNF-α, IFN-γ, and TGF-β1 levels were determined in 20 APTB cases (group 1) before and 2, 4, and 6 months after therapy. The same parameters were also determined in 9 inactive pulmonary tuberculosis (IPTB) cases (group 2) and 9 healthy controls (HC, group 3). Before treatment, the mean serum IFN-γ, TNF-α, and IL-10 levels in group 1 were statistically higher than those in group 2 (P=.001, P=.024, P=.016, resp) or group 3 (P=.003, P=.002, P=.011, resp). The levels in group 1 decreased significantly after treatment (P=.001 for IFN-γ, P=.004 for TNF-α, P=.000 for IL-10). The serum levels of IL-12p40 were significantly higher in group 1 than in group 3 (P=.012) and decreased insignificantly after treatment. There was no difference in serum IL-4 and TGF-β1 levels among the groups (P>.05). Because the serum IL-12p40, IL-10, TNF-α, and IFN-γ levels were high in APTB, we believe that these cytokines have important roles in the immune response to Mycobacterium tuberculosis (M tuberculosis). These parameters could be used in follow-up as indicators of the success of APTB therapy

The predictors of COVID-19 mortality in a nationwide cohort of Turkish patients

© 2021 Elsevier LtdThe COVID-19-related death rate varies between countries and is affected by various risk factors. This multicenter registry study was designed to evaluate the mortality rate and the related risk factors in Turkey. We retrospectively evaluated 1500 adults with COVID-19 from 26 centers who were hospitalized between March 11 and July 31, 2020. In the study group, 1041 and 459 cases were diagnosed as definite and highly probable cases, respectively. There were 993 PCR-positive cases (66.2%). Among all cases, 1144 (76.3%) were diagnosed with non-severe pneumonia, whereas 212 (14.1%) had severe pneumonia. Death occurred in 67 patients, corresponding to a mortality rate of 4.5% (95% CI:3.5–5.6). The univariate analysis demonstrated that various factors, including male sex, age ≥65 years and the presence of dyspnea or confusion, malignity, chronic obstructive lung disease, interstitial lung disease, immunosuppressive conditions, severe pneumonia, multiorgan dysfunction, and sepsis, were positively associated with mortality. Favipiravir, hydroxychloroquine and azithromycin were not associated with survival. Following multivariate analysis, male sex, severe pneumonia, multiorgan dysfunction, malignancy, sepsis and interstitial lung diseases were found to be independent risk factors for mortality. Among the biomarkers, procalcitonin levels on the 3rd-5th days of admission showed the strongest associations with mortality (OR: 6.18; 1.6–23.93). This study demonstrated that the mortality rate in hospitalized patients in the early phase of the COVID-19 pandemic was a serious threat and that those patients with male sex, severe pneumonia, multiorgan dysfunction, malignancy, sepsis and interstitial lung diseases were at increased risk of mortality; therefore, such patients should be closely monitored

The association of antiviral drugs with COVID-19 morbidity: The retrospective analysis of a nationwide COVID-19 cohort

Copyright © 2022 Babayigit, Kokturk, Kul, Cetinkaya, Atis Nayci, Argun Baris, Karcioglu, Aysert, Irmak, Akbas Yuksel, Sekibag, Baydar Toprak, Azak, Mulamahmutoglu, Cuhadaroglu, Demirel, Kerget, Baran Ketencioglu, Ozger, Ozkan, Ture, Ergan, Avkan Oguz, Kilinc, Ercelik, Ulukavak Ciftci, Alici, Nurlu Temel, Ataoglu, Aydin, Cetiner Bahcetepe, Gullu, Fakili, Deveci, Kose, Tor, Gunluoglu, Altin, Turgut, Tuna, Ozturk, Dikensoy, Yildiz Gulhan, Basyigit, Boyaci, Oguzulgen, Borekci, Gemicioglu, Bayraktar, Elbek, Hanta, Kuzu Okur, Sagcan, Uzun, Akgun, Altinisik, Dursun, Cakir Edis, Gulhan, Oner Eyuboglu, Gultekin, Havlucu, Ozkan, Sakar Coskun, Sayiner, Kalyoncu, Itil and Bayram.Background and objectives: Although several repurposed antiviral drugs have been used for the treatment of COVID-19, only a few such as remdesivir and molnupiravir have shown promising effects. The objectives of our study were to investigate the association of repurposed antiviral drugs with COVID-19 morbidity. Methods: Patients admitted to 26 different hospitals located in 16 different provinces between March 11–July 18, 2020, were enrolled. Case definition was based on WHO criteria. Patients were managed according to the guidelines by Scientific Board of Ministry of Health of Turkey. Primary outcomes were length of hospitalization, intensive care unit (ICU) requirement, and intubation. Results: We retrospectively evaluated 1,472 COVID-19 adult patients; 57.1% were men (mean age = 51.9 ± 17.7years). A total of 210 (14.3%) had severe pneumonia, 115 (7.8%) were admitted to ICUs, and 69 (4.7%) were intubated during hospitalization. The median (interquartile range) of duration of hospitalization, including ICU admission, was 7 (5–12) days. Favipiravir (n = 328), lopinavir/ritonavir (n = 55), and oseltamivir (n = 761) were administered as antiviral agents, and hydroxychloroquine (HCQ, n = 1,382) and azithromycin (n = 738) were used for their immunomodulatory activity. Lopinavir/ritonavir (β [95% CI]: 4.71 [2.31–7.11]; p = 0.001), favipiravir (β [95% CI]: 3.55 [2.56–4.55]; p = 0.001) and HCQ (β [95% CI]: 0.84 [0.02–1.67]; p = 0.046) were associated with increased risk of lengthy hospital stays. Furthermore, favipiravir was associated with increased risks of ICU admission (OR [95% CI]: 3.02 [1.70–5.35]; p = 0.001) and invasive mechanical ventilation requirement (OR [95% CI]: 2.94 [1.28–6.75]; p = 0.011). Conclusion: Our findings demonstrated that antiviral drugs including lopinavir, ritonavir, and favipiravir were associated with negative clinical outcomes such as increased risks for lengthy hospital stay, ICU admission, and invasive mechanical ventilation requirement. Therefore, repurposing such agents without proven clinical evidence might not be the best approach for COVID-19 treatment

The predictors of COVID-19 mortality in a nationwide cohort of Turkish patients

© 2021 Elsevier LtdThe COVID-19-related death rate varies between countries and is affected by various risk factors. This multicenter registry study was designed to evaluate the mortality rate and the related risk factors in Turkey. We retrospectively evaluated 1500 adults with COVID-19 from 26 centers who were hospitalized between March 11 and July 31, 2020. In the study group, 1041 and 459 cases were diagnosed as definite and highly probable cases, respectively. There were 993 PCR-positive cases (66.2%). Among all cases, 1144 (76.3%) were diagnosed with non-severe pneumonia, whereas 212 (14.1%) had severe pneumonia. Death occurred in 67 patients, corresponding to a mortality rate of 4.5% (95% CI:3.5–5.6). The univariate analysis demonstrated that various factors, including male sex, age ≥65 years and the presence of dyspnea or confusion, malignity, chronic obstructive lung disease, interstitial lung disease, immunosuppressive conditions, severe pneumonia, multiorgan dysfunction, and sepsis, were positively associated with mortality. Favipiravir, hydroxychloroquine and azithromycin were not associated with survival. Following multivariate analysis, male sex, severe pneumonia, multiorgan dysfunction, malignancy, sepsis and interstitial lung diseases were found to be independent risk factors for mortality. Among the biomarkers, procalcitonin levels on the 3rd-5th days of admission showed the strongest associations with mortality (OR: 6.18; 1.6–23.93). This study demonstrated that the mortality rate in hospitalized patients in the early phase of the COVID-19 pandemic was a serious threat and that those patients with male sex, severe pneumonia, multiorgan dysfunction, malignancy, sepsis and interstitial lung diseases were at increased risk of mortality; therefore, such patients should be closely monitored