What do we know about energy drinks?

Energy drinks are popular among young individuals andmarketed to college students, athletes, and active individualsbetween the ages of 21 and 35 years. In the beginningconsumption of energy drinks can significantlyimprove physical and mental performance. Energy drinkscontain a mixture of compounds, of which caffeine, guarana,and herbal supplements such as ginkgo and ginsengare major components. Unfortunately, the body ofliterature is limited and it is not known whether these improvementsare due to the caffeine other herbal ingredients.Severe clinical manifestations may occur after useof energy drinks with alcohol The aim of this article is risingawareness about the ingredients of energy drinks andclinical manifestations that may occur after usage and updateabout knowledge.Key words: Energy drinks, energy drinks ingredients,clinical manifestation

Working Conditions of Pulmonologists Working in State Hospitals

Amaç: Devlet hastanelerinde (DH) görev yapan Göğüs Hastalıkları Uzmanları'nın çalışma şartlarını ve göğüs hastalıkları hastanesinde (GHH) çalışıyor olmanın bu şartlarda meydana getirdiği farklılıkları ortaya koymak. Yöntemler: Otuz altı ilde görev yapan 130 göğüs hastalıkları uzmanına anket formları iletildi. Anket formları demografik bilgiler, çalışma yılları, çalışma yükleri, hastanede göğüs hastalıkları branşı ile ilgili olan donanımların mevcut olup olmadığı, konsultasyonlar ve sevk zinciri ile ilişkili 30 sorudan oluşuyordu. Bulgular: Cevap oranı %65 idi. Katılımcıların %54,1'i GHH'nde çalışmakta idi. %67,1'i çalışma şartlarını iyi buluyordu. Yaz döneminde GHH'nde DH'ne göre daha fazla sayıda poliklinik muayenesi ve yatan hasta takibi yapılıyordu. GHH'de çalışanların %43,5'i, DH'nde çalışanların %73,7'si çalıştıkları hastanedeki göğüs hastalıkları yatak sayısını; GHH'de çalışanların %24,4'ü, DH'nde çalışanların %55,3'ü göğüs hastalıkları ile ilişkili donanımları yetersiz buluyordu (p0,005 ve p0,004). Doktorların %51,8'i invaziv mekanik ventilatör, %23,8'i kangazı, %20,2'si noninvaziv mekanik ventilatör, %3,6'sı spirometri, %11,9'u bronkoskopi bulunmayan hastanelerde çalışıyordu. Maligniteler ve yoğun bakım ihtiyacı en sık sevk gerekçelerini oluşturuyordu. Ankete katılanların %35,7'si sevk ettikleri hastanın akıbetinden haberdar değildi. En çok konsültasyon istenen bölüm kardiyoloji, en çok konsültasyona gidilen bölüm ise cerrahi klinikleriydi. Sonuç: Göğüs Hastalıkları ile ilişkili sağlık hizmeti verilen birimin adı ne olursa olsun; hizmet verilen hasta grubunun yüksek mortalite ve morbidite oranlarına sahip olduğu ve belirgin olarak mevsimsel yoğunlukların yaşandığı dikkate alınarak; yeterli yatak sayısı ve ekipmana sahip olunması gerekmektedir. Göğüs Hastalıkları uzmanlık eğitimi taşrada karşılaşılacak sorunlarla başa çıkabilecek düzeyde ve yeterli donanımı sağlayacak şekilde standardize edilmelidirObjective: To examine working conditions of pulmonologists working in State Hospitals (SH) and to determine the differences caused by working in a Chest Diseases Hospital (CDH). Methods: Questionnaires was sent to 130 pulmonologist working in 36 provinces. The questionnaire consisted of 30 questions about demographic data, years of work, daily work-load, equipment, consultations and referral priorities. Results: Response rate was 65%. Of the participants 54.1% were working in a CDH. 67.1% of the pulmonologists were found to have good working conditions. The number of outpatient polyclinics and hospitalized patients were higher in CDH than SH in summer period. 43.5% of the participants working in CDH and 73.7% of the participants working in SH reported that the number of pulmonary department beds were insufficient (p0.005). 24.4% of the participants working in CDH and 55.3% of the participants working in SH reported that equipment was insufficient (p0.004). Percentages of the doctors working in hospitals who do not have invasive mechanical ventilation, arterial blood gas anaysis, noninvasive mechanical ventilation, spirometry and bronchoscopy were 51.8%, 23.8%, 20.2%, 3.6%, and 11.9%; respectively. Malignancies and the necessity of an intensive care unit were the most common reasons for transfer of patients. 35.7% of the participants were not informed about the outcome of these patients. Most of the consultations obtained from both cardiology and surgical departments, respectively. Conclusion: Chest disease related health services; regardless of the name of the unit of service; taking high morbidity and mortality rates of the patients and seasonal workload into account; must have adequate equipment and number of beds. Pulmonologist training should be standardized to provide adequate features to deal with problems encountered in the province

Taşrada görev yapan gö?üs hastalıkları uzmanlarının sürekli tıp e?itimi İle İlgili tutumları

Aim: Continuing medical education (CME) including the life long post-graduate training considered very important and serious work done in this direction worldwide. In Turkey, CME workshop was done by the Turkish Medical Association in 1991 firstly and CME credit board has been created in 1994. We aimed to determine approachments and status of the pulmonologists on CME, in Turkey. Material and Method: The cross-sectional, questionnairebased study was carried out among pulmonologists working in state or chest disease hospitals in Turkey. 130 pulmonologists in 36 provinces those did not work in training hospitals invited to participate to study. Results: Response rate was 54.6%. 28.2% of the participants had been participating to post-graduate education activities regularly. The participants that followup a publication and a web site about their specialty on a regular basis were 58.8% and 63.5%; respectively. 58.8% of the physicians sometimes feel themselves regressed in their profession and 72.9% of them request for rotation to training and research hospitals to develop themselves in professional respect. Discussion: In conclusion, not yet fully evolved concept of CME in our country threatens the quality of healthcare, and indirectly, safety of the physician. There are needs to be done as well as those made of

Digital clubbing may be an indicator of systemic atherosclerosis even at microvascular level

WOS: 000314345000014Background: Presence of any relationship between digital clubbing and microvascular atherosclerosis was tried to be understood. Methods: Cases with digital clubbing and controls were studied. Results: The study included 104 cases with clubbing and 120 controls. Mean age of clubbing cases was 49.2 years, and there was a male predominance (81.7%) among them. There were significantly higher prevalences of smoking and chronic obstructive pulmonary disease (COPD) in the clubbing group (69.2 versus 41.6% and 27.8 versus 10.8%, respectively, p<0.001 for both). Although body mass index (BMI), weight, and fasting plasma glucose (FPG) were lower in the clubbing group, the differences were nonsignificant probably due to the small sample sizes. Although the negative effect of small sample sizes, prevalence of type 2 diabetes mellitus (DM) and mean value of systolic blood pressure (BP) were significanlty lower in the clubbing group (12.5 versus 21.6% and 127.6 versus 136.9 mmHg, respectively, p<0.05 for both). On the other hand, prevalence of coronary heart disease (CHD) and/or peripheric artery disease (PAD) were significantly higher in the clubbing group (7.6 versus 0.0%, p<0.01). Conclusions: There are significant relationships between digital clubbing and smoking, COPD, and CHD and/or PAD probably due to strong atherosclerotic effects of smoking with highly suspected atherosclerotic background of COPD. Whereas the BMI, weight, FPG, systolic BP, and prevalence of DM are inversely related with digital clubbing probably due to suppressor effects of smoking on appetite. So clubbing may be a significant indicator of systemic atherosclerosis even at microvascular level

Chronic obstructive pulmonary disease may be one of the terminal end points of metabolic syndrome

WOS: 000304543100007Objective: We tried to understand presence of any effect of excess weight on respiratory system by means of excessive adipose tissue functioning as an endocrine organ and causing a pulmonary inflammation. Methodology: Mild (stage 1), moderate (stage 2), and severe (stage 3 and 4) chronic obstructive pulmonary disease (COPD) patients were detected, and compared according to the metabolic parameters in between. Results: There were 145, 56, and 34 patients in the mild, moderate, and severe COPD groups, respectively. The mean age increased gradually (52.4, 56.4, and 60.0 years) from the mild towards the severe COPD groups, respectively (p<0.05 nearly in all steps). Similarly, the mean pack-years increased gradually and significantly (26.7, 34.8, and 36.8 pack-years) in the same direction (p<0.05 nearly in all steps). Parallel to them, the mean body mass index increased up to the moderate COPD cases (28.2 versus 29.6 kg/m2, p=0.039), and then decreased significantly (29.6 versus 26.8 kg/m2, p=0.006). Conclusion: The metabolic syndrome includes some reversible indicators such as overweight, hyperbetalipoproteinemia, hypertriglyceridemia, dyslipidemia, impaired fasting glucose, impaired glucose tolerance, and white coat hypertension for the development of terminal diseases including obesity, hypertension, diabetes mellitus, peripheral artery disease, coronary heart disease, and stroke. In our opinion, COPD may be one of the terminal end points of the syndrome

Endobronşiyal patolojinin olmadığı lezyonlarda BT bronş işareti ve floroskopi eşliğinde transbronşiyal biyopsinin tanısal değeri

Amaç: Fiberoptik bronkoskopi (FOB), soliter pulmoner nodül, kitle ve infiltrasyonlarda tanı koyma amacıyla kullanılmaktadır. FOB ile endobronşiyal lezyon izlenmeyen periferik akciğer lezyonlarında ise çeşitli görüntüleme yöntemlerinin kılavuzluğunda uygulanan bronş lavajı, firçalama, transbronşiyal biyopsi (TBB), transbronşiyal iğne aspirasyonları ve transtorasik iğne aspirasyon biyopsileri kullanılmaktadır. Biz çalışmamızda, diğer yöntemlere göre daha ucuz ve ulaşılabilir olan floroskopi kılavuzluğunda FOB ile TBB?nin endobronşiyal komponenti olmayan pulmoner lezyonların tanısındaki verimliliğini değerlendirdik. Gereç ve yöntem: Çalışmamıza 2006-2009 yılları arasında, akciğer grafisinde 2 cm?den büyük nodül ve kitle lezyonu ile infiltrasyonları olan, FOB ile endobronşiyal lezyon görülmeyen 32 hasta alındı. Hastalar retrospektif olarak değerlendirildi. Bilgisayarlı tomografilerdeki lezyonların özellikleri tek bir radyolog tarafından değerlendirildi. Hastaların video bronkoskop ve iki düzlemli floroskopi kullanılarak görüntülenen lezyonlarından dört adet TBB alındı. Floroskopi kılavuzluğunda uygulanan TBB?nin tanısal değeri, lezyon boyutu, anatomik ve radyolojik lokalizasyonu ve Tsuboi sınıflandırmasına göre hava yolu-lezyon ilişkisi ile karşılaştırmalı olarak değerlendirildi. Bulgular: Tsuboi 1 ve 2 grubundaki 13 olgudan 12?sine (%92.3) floroskopi eşliğinde alınan TBB ile tanı konuldu. Tsuboi 3 ve 4 grubunda yer alan 19 olgunun ise onuna (%52.6) tanı konulabildi. Bu iki grup, tanı koyma başarısı yönünden karşılaştırıldığında, aralarında istatistiksel olarak anlamlı fark bulundu (p=0.024). Sonuç: Floroskopi eşliğinde uygulanan TBB, özellikle BT görüntülerinde Tsuboi 1 ve 2 olarak sınıflandırılan ve FOB?da endobronşiyal patoloji saptanmayan olgularda tanıya ulaşmak için kullanılabilecek ucuz, güvenilir ve başarılı bir teknik olarak bulunmuştur

Anxiety and dyspnea relation in early stage COPD patients

WOS: 000449650900362

Alternations in Smoking Habits of Active Smoker Health Care Professionals after the 'Law on Prevention of Harmful Effects of Tobacco and Tobacco Products'

Objective: To evaluate the approaches of active-smoker health care workers to the law on 'Prevention and Control of Hazards of Tobacco Products', to determine behavioral changes in smoking and the factors associated with these changes after the law was enacted.Methods: The population of the study consisted of 1096 health care workers who were active smokers and worked at state hospitals and the 112 emergency service in çorum. Questionnaire forms were delivered by hand to the participants. The survey was designed with 32 closed-ended questions associated with demographic findings, smoking habits, and the smoking ban. Data were obtained through questionnaires filled out by participants. Statistical Package SPSS 16.0 was used for the analysis.Results: The response rate was 47.7%. Eighty-five percent of the participants had a positive opinion on the law. In the sociodemographic data, only a higher number of working years in health care was found to be associated with the negative opinion on the ban. As the number of years smoked, pack-years, and addiction level increased, the rate of a positive approach toward the law decreased. Participants who were ashamed of smoking outdoors, who had tried to quit, and who did not smoke in the same environment with children expressed more positive opinions. Conclusion: Approaches of active smoker health care workers to the smoking ban is similar to society. Health professionals whose role in the fight against tobacco is started by 'the responsibility of being a role model' should be taken to smoking control programs as a priority and with a holistic approach

Perspective of family physicians on chest diseases

Amaç: Son yıllarda ülkemizde sağlık sisteminde değişimler yaşanmış olup birinci basamak sağlık hizmetlerinde aile hekimliği sistemi önemli bir rol üstlenmiştir. Sağlık hizmeti sunumunda hastayı ilk ve en sık gören aile hekimleridir. Bu kapsamda aile hekimlerinin göğüs hastalıkları ile ilgili farkındalıklarını ve uygulamalarını araştırmayı amaçladık. Gereç ve Yöntem: Çalışmamıza Çorum il ve ilçe merkezlerinde görev yapan aile hekimleri katılmıştır. Anket formları il sağlık müdürlüğünün onayına müteakip aile hekimlerine iletilmiştir. Katılımcılardan göğüs hastalıklarına ilişkin 32 soruluk bir anket doldurmaları istenmiştir. Bulgular: Çalışmamıza Çorum il ve ilçe merkezlerinde görev yapan 128 aile hekiminden 122si katılmıştır, katılım oranı % 95dir. Göğüs hastalıkları ile ilgili en çok bilgi sahibi oldukları hastalıklar sorulduğunda astım ve Kronik Obstrüktif Akciğer Hastalığı (KOAH) ilk sıralarda, emboli ve plörezi ise son sıralarda yer almıştır. Hakkında bilgi edinmek istedikleri hastalıklar ise sırasıyla KOAH (%39,3), astım (%35,2), akciğer kanseri (%32,8), pnömoni (%24,6), tüberküloz (%23,8), pulmoner emboli (%20,5), plörezi (%17,2) olarak tespit edilmiştir. Katılımcıların %59u mezuniyet sonrasında göğüs hastalıkları ile ilgili eğitim almadığını belirtmiştir. Hastalar Göğüs hastalıkları ile ilgili sorular soruyor mu? sorusuna aile hekimlerinin %96,7 si evet cevabı verirken, İlaçlar ve cihazlar ile ilgili bilgi edinmek istiyorlar mı? sorusuna sırasıyla %95,9u ve %74,6sı evet cevabı vermiştir. Genel olarak bu sorulara cevap vermekte zorlanmadığını ifade eden hekim oranı %17,2 olarak bulunmuştur. Hekimlerin %89,3ü ölçülü doz inhalerler, %73ü diskus, %62,3ü turbuhaler, %49,2si aerolizer kullanımını hastaya anlatabilecek düzeyde bildiklerini belirtmiştir. Astım ve KOAH tedavi basamakları konusunda yeterli bilgiye sahip misiniz? sorusuna %27si evet demiştir. Katılımcıların %14,8i ilaç raporu olan hastada durum değerlendirmesi yapmadan 3 aylık ilacı reçete ettiğini belirtmiştir. Katılımcıların %52,5i Terminal dönem kanser hastası bakımında yeterli bilgiye sahip misiniz? sorusuna hayır cevabı vermiştir. Tüm aile hekimlerin %67,2si Yeni tüberküloz olgularında tedavi kaç aydır? sorusuna 6 ay cevabını vermiştir. Sonuç: Aile hekimlerinin göğüs hastalıkları açısından eğitime ihtiyaçlarının olduğu tespit edilmiştir. Bu konuda mezuniyet sonrası eğitim için Sağlık Bakanlığı, ulusal uzmanlık derneklerine ve Aile Hekimliği Anabilim Dallarına önemli görevler düşmektedirObjective: Our country has experienced changes in the health care system and and family medicine system has an important role in primary health care services. In the delivery of health care family physicians sees the patient first and most frequently. In this context we aimed to investigate the awareness of family physicians about chest diseases and their practices . Methods: Family physicians working in provincial and district centers of çorum attended our study. Subsequent to the approval of the provincial health directorate questionnaires were forwarded to family physicians. Participants were asked to complete a questionnaire with 32 questions about chest diseases. Results: 122 of 128 family physicians working in provincial and district centers of çorum completed our questionnaire, participation rate is 95%. Chronic Obstructive Chest Disease (COPD) and asthma took the first place when they were asked about the chest diseases they know about most, embolism and pleurisy took place in the last row. Diseases they want to learn about were respectively; COPD(39.3%) , respectively (39.3%), asthma (35.2%), lung cancer (32.8%), pneumonia (24.6%), tuberculosis (23.8%), pulmonary embolism (20.5%), pleurisy (17.2%) respectively. %59 of the participants stated that they havent had a post-graduate training in pulmonology. %96,7 of the physicians answered yes to the question Do the patients ask questions about chest diseases while %95.9 and %74,6 answered yes to the question Do the patients ask for information about drugs and devices ? respectively. %17.2 of physicians stated that they have difficulties in responding these questions in general. %27 of the physicians responded yes to the question Do you have sufficient information about the treatment steps of Asthma and COPD. %14,8 of the participants stated that they prescribe the reported drugs for three months interval without any evaluation. % 52,5 of the participants stated that they don't have sufficient information about terminal stage cancer patient care. And %62,7 of all family physicians stated that the duration of treatment for new tuberculosis cases is 6 months. Conclusion: Training of family physicians in chest diseases is needed. In this regard Ministry of Health, National Professional Assosiatons and Departments of Family Medicine have an important role for postgraduate education

Prevalence of the Accessory Cardiac Bronchus on Multidetector Computed Tomography: Evaluation and Proposed Classification

WOS: 000383915400008PubMed: 27442525Purpose:Accessory cardiac bronchus (ACB) is a very rare congenital anomaly and may cause some clinical complications, such as recurrent episodes of both infection and hemoptysis. The purpose of this study was to assess the multidetector computed tomography (MDCT) characteristics of ACB and to classify this anomaly according to the MDCT aspects.Materials and Methods:The routine thoracic CT scans from 5790 patients were evaluated retrospectively. The prevalence, location, length, diameter, division angle, distance from the carina, and the type of ACB were evaluated.Results:A total of 12 ACBs were identified, with a prevalence of 0.2%. All ACBs originated from the intermediate bronchus. The median largest diameter of the ACBs was 7.75 mm (range: 5.8 to 10.30 mm), the median length was 12.1 mm (range: 8.6 to 35 mm), the median division angle was 61 degrees (range: 42 to 93 degrees), and the median distance from the carina was 16.95 mm (range: 5.7 to 22.20 mm). Six cases (50%) had a blind extremity (type 1: diverticulum or stump type), 3 cases (25%) had a mutiloculated cystic change at the end (type 2: cystic type), and 3 cases (25%) had a ventilated lobulus demarcated by an anomalous fissure (type 3: ventilated type).Conclusions:ACBs can be classified into 3 types according to their MDCT features. Recognition of ACB is important, as it is associated with clinical complications and is also salient in trauma cases