Protocol for the EARCO Registry : a pan-European observational study in patients with α1-antitrypsin deficiency

Rationale and objectives Alpha-1 antitrypsin deficiency (AATD) is a genetic condition that leads to an increased risk of emphysema and liver disease. Despite extensive investigation, there remain unanswered questions concerning the natural history, pathophysiology, genetics and the prognosis of the lung disease in association with AATD. The European Alpha-1 Clinical Research Collaboration (EARCO) is designed to bring together researchers from European countries and to create a standardised database for the follow-up of patients with AATD. Study design and population The EARCO Registry is a non-interventional, multicentre, pan-European, longitudinal observational cohort study enrolling patients with AATD. Data will be collected prospectively without interference/modification of patient's management by the study team. The major inclusion criterion is diagnosed severe AATD, defined by an AAT serum level <11 µM (50 mg·dL−1) and/or a proteinase inhibitor genotype ZZ, SZ or compound heterozygotes or homozygotes of other rare deficient variants. Assessments at baseline and during the yearly follow-up visits include lung function testing (spirometry, body plethysmography and diffusing capacity of the lung), exercise capacity, blood tests and questionnaires (symptoms, quality of life and physical activity). To ensure correct data collection, there will be designated investigator staff to document the data in the case report form. All data will be reviewed by the EARCO database manager. Summary The EARCO Registry aims to understand the natural history and prognosis of AATD better with the goal to create and validate prognostic tools to support medical decision-making

Yaşlılarda astım tanısı farklı mıdır?

Yaşlı popülasyonda astım yetersiz tanı ve tedavi almaktadır, ancak bu yaş grubunda mortalite oldukça yüksektir. Yaşlanmaya bağlı akciğerlerde gelişen fizyolojik değişiklikler, komorbid durumlar ve ilaç kullanımları tipik astım tablosunu yaş- lılarda değiştirebilmekte ve tanıda zorluk yaratmaktadır. Bu nedenle başta kronik obstrüktif akciğer hastalığı olmak üzere tüm ayırıcı durumları göz önüne alarak doğru tanı konulmalıdır, çünkü doğru hasta yönetimi hastalık morbidite ve mortalitesini değiştirecektir.Asthma is mis-diagnosed, under-diagnosed and under-treated in older populations but has a high mortality rate. The physiological changes due to aging of lung, the co-morbid situations and poly pharmacy may change the typical presentation of asthma in older people and cause diagnostic difficulties. But it therefore should be diagnosed properly by taking of all differential situations especially chronic obstructive pulmonary disease into consideration since the appropriate management of the disease will alter the morbidity and mortality

Plevral efüzyonların ayırıcı tanısında serum ve plevral sıvı N-Terminal-Pro-B-Tip natriüretik peptid konsantrasyonunun yeri

Son yıllarda, plevral efüzyonların ayırıcı tanısında N-Terminal-Pro-B-Tip natriüretik peptid (NT-proBNP) gibi yeni belirteçlerin kullanımı gündemdedir. Çalışmamızda, NT-proBNP’nin özellikle kardiyak kaynaklı plevral efüzyonlarda tanısal değerini araştırmayı amaçladık. Plevral efüzyonu olan 45 hasta çalışmaya dahil edildi. Hastaların serum ve plevral efüzyonlarında NT-proBNP düzeyleri ve Light kriterlerinde yer alan biyokimyasal belirteçler analiz edildi. Klinik değerlendirmeye göre, gereken durumlarda plevral sıvının kültürü, ARB direkt muayenesi ve sitolojik tetkiki yapıldı. Kardiyak patoloji düşünülen hastalarda, kardiyolojik değerlendirme ve ekokardiyografi de yapıldı. Light kriterlerine göre plevral efüzyonların 38’i eksüda, yedisi transüdaydı. Hastaların 13’ünde son tanı malign efüzyon, 10’unda infeksiyon (tüberküloz/pnömoni), 21’inde konjestif kalp yetmezliği, birinde ise plevral efüzyonla ilgili diğer hastalıktı. Konjestif kalp yetmezliği ile ilişkili plevral sıvılarda, medyan (25-75. çeyrekler) NT-proBNP düzeyleri serumda 4747 pg/mL (931-15754), plevral sıvıda ise 4827 pg/mL (1290-12430) idi. Kardiyak olmayan nedenlere bağlı plevral sıvılarda ise bu düzeyler serumda 183 pg/mL (138-444), plevral sıvıda 245 pg/mL (187-556) olarak saptandı. Konjestif kalp yetmezliği olan hastalarda serum ve plevral sıvı NT-proBNP düzeyleri anlamlı olarak yüksekti (her ikisi için p< 0.001). Son tanılarına göre dört grup karşılaştırıldığında serum ve plevral sıvı NT-proBNP düzeyleri en yüksek konjestif kalp yetmezliğinde gözlendi, bunu malignite, infeksiyon ve diğerleri izlemekteydi (her ikisi için p< 0.001). Kardiyolojik değerlendirme ile konjestif kalp yetmezliği kabul edilen 21 hastanın 14’ünde Light kriterlerine göre eksüda mevcuttu. Transüdalarda serum ve plevral sıvı NT-proBNP düzeyleri istatistiksel anlamlı olarak yüksekti (p= 0.009). Plevral sıvı NT-proBNP düzeylerinin ölçümü iyi bir yaklaşımdır ve plevral sıvı NT-proBNP düzeyleri kardiyak kaynaklı sıvıları Light kriterleri ve serum NT-proBNP düzeylerine göre daha iyi yansıtır.Currently, new biomarkers like N-Terminal-Pro-B-Type natriuretic peptide (NT-proBNP) have been used in the differential diagnosis of pleural effusions. In our study, we aimed to investigate the diagnostic value of NT-proBNP, especially in cardiac originated pleural effusions. Forty-five patients with pleural effusions were included in the study. NT-proBNP levels and biochemical markers involved in the Light&amp;#8217;s criteria were analyzed in pleural fluid and serums of the patients. Pleural fluid culture, AFB smear, cytology were performed where they were indicated according to the clinical evaluation. In patients, to whom cardiac pathology was considered to be; cardiological evaluation and echocardiography were also done. Thirtyeight pleural effusions were exudative and, 7 were transudative according to the Light&amp;#8217;s criteria. Final diagnosis were malignant effusion in 13, infection (tuberculosis/pneumonia) in 10, congestive heart failure in 21, and other conditions related with pleural effusion in 1 of the patients. Median (25th to 75th percentiles) NT-proBNP levels of serum and pleural fluid due to congestive heart failure (CHF) were 4747 pg/mL (931-15754) and 4827 pg/mL (1290-12.430) while median NTproBNP levels of serum and pleural fluid related with non-cardiac reasons were 183 pg/mL (138-444) and 245 pg/mL (187- 556) respectively. NT-proBNP levels of serum and pleural fluid were significantly high in CHF (p&lt; 0.001 for both). When four groups were compared serum and pleural fluid NT-proBNP levels were highest in the CHF group which was followed by malignancy, infection and others (p&lt; 0.001 for both). Fourteen of 21 patients who were accepted to have congestive heart failure as the final diagnosis by a cardiological evaluation had an exudative pleural fluid according to the Light&amp;#8217;s criteria. Serum and pleural fluid NT-proBNP levels were higher in transudates and this reached statistically significance for pleural fluid (p= 0.009). We suggest that measurement of pleural fluid NT-proBNP is a smart approach and pleural fluid NTproBNP can reflect cardiac origin of effusions better than serum NT-proBNP and Light&amp;#8217;s criteri

Respiratory symptoms and occupational asthma in polyurethane foam production workers

Toluene diisocyanate (TDI) and methylene diphenyl diisocyanate (MDI) and hexamethylene diisocyanate (HDI) are heavily used in the production of polyurethane foams. Occupational asthma (OA) is reported in approximately 5% of chronically exposed workers. This study aimed to evaluate the effects of isocyanate exposure on lung function in foam production workers in two different factories. Respiratory status was evaluated by a questionnaire modified from the occupational asthma report of ATS, physical examinaton and pulmonary function tests. Pulmonary function was evaluated using a mobile spirometer. 107 workers (1 female, 106 male) were included in the study. 77 of these were working in polyurethane foam production (49 in one, 28 in a second factory), 18 in a dye department and 12 (the control group) were working in the offices (mean age, 26, 30, 27.5and 31, respectively). All 3 groups were comparable in age and smoking habits. There were also no significant differences in frequency of respiratory signs and symptoms. However, pulmonary function tests showed significantly lower forced expiratory volume (FEV) and forced vital capacity (FVC) values in the polyurethane group. Of the 32 workers who had respiratory findings suggestive of asthma and who underwent peak expiratory flow (PEE) meter follow-up, 17 were found to show positive variability. Non-specific bronchial provocation tests were performed on these 17 workers and 3 (all of them were polyurethane pro-duction workers) were diagnosed as occupational asthma (3.89%). The results of the study indicate a need for the screening and monitoring of all polyurethane foam workers for isocyanate-related respiratory disorders and OA

Allergic rhinitis and its impact on asthma update (ARIA 2008) The Turkish perspective

Bu makalede, 2008 yılında güncellenen ve yayınlanan “Allergic Rhinitis and its Impact on Asthma (ARIA)” 2008’in bir özetini yapmak ve ulusal epidemiyolojik verileri bu çalışmaya eklemek hedeflenmiştir.In this article, it is aimed to summarize the newly updated and published version of &amp;#8220;Allergic Rhinitis and its Impact on Asthma (ARIA) 2008&amp;#8221; and add the recent Turkish epidemiological data on it

Attitudes of the high school teachers and students towards smoking: Two sides of the story (Smoking habit in teachers and students)

Objectives: To assess and compare the attitudes of high school students and teachers towards smoking, their knowledge about smoking-related diseases and their opinions on current legal restrictions. Methods: A questionnaire was administered to 1052 high school students and 172 teachers. The mean age of the student group (59.7% males) was 16.1 &plusmn;1.3 years and that of the teachers group (50.6% males) was 38.3&plusmn; 7.8 years. Results: Smoking prevalence was significantly higher among teachers (40.7%) than students (13.1%) (p=0.000) and higher in males than females in both groups. Mean age of starting smoking was 13.2&plusmn; 2.7 years for students and 18.9 &plusmn;5.2 years for teachers. As provoking factors, the effect of imitation of smokers was more significant in the teachers group, while the effects of environment were more significant among the students. Teachers had a greater awareness of the hazards of smoking than the students and they were also more sensitive to the legal restrictions. Conclusion: It was concluded that educators should be the first group to be addressed in education programs for prevention of smoking

Value of tumor necrosis factor-alpha in tuberculous pleural effusion

This study is planned to evaluate the diagnostic value of TNF-$alpha$ in serum and pleural fluid in patients with tuberculous pleurisy. 41 patients were included in the study. 18 had tuberculous effusion, 13 had parapneumonic pleurisy and empyema and 10 had malignant pleural effusion. Serum and pleural fluid TNF-$alpha$ levels were determined by enzyme immunoassay kit (Immunotech International) in 3 groups. The mean of the ranks in serum TNF-$alpha$ values was 21.58 in tuberculous group, 15.42 in parapneumonic group and 26.10 in malignant group and the difference between the 3 groups was not significantly different (p&gt;0.05).The mean of the ranks in pleural fluid TNF-$alpha$ values was 26.13 in tuberculous, 21.30 in parapneumonic and 11.35 in malignant group. The difference between the pleural fluid values of the tuberculous and parapneumonic effusion group was not significant (p&gt;0.05) but the difference between the tuberculous and malignant group was significant (p&lt;0.01) and also the difference between the parapneumonic and the malignant group was significant (p&lt;0.05). The serum values were lower than pleural fluid values in tuberculous and parapneumonic effusion group. These results suggest that TNF-$alpha$ is produced and selectively concentrated at the site of disease activity in infectious pleu-ral effusions but cannot be useful in the differential diagnosis of tuberculous and parapneumonic bacterial effusion

MASK (Mobile Airways Sentinel networK) in Turkey-the ARIA integrated mobile solution for allergic rhinitis and asthma multimorbidity

Akıllı cihazlarda kullanılan aplikasyonlar gibi mobil sağlık (mHealth) uygulamaları, sağlık hizmetlerinde giderek daha yaygınlaşmakta ve daha etkin olmaktadır. Allerjik rinit ve allerjik rinitin astım üzerinde etkisi (ARIA) rehberi kanıta dayalı bulfulara dayanarak hasta yaklaşımları sunan bir rehberden allerjik rinit (AR) ve astım morbiditesi olan olgularda gerçek yaşamda mobil teknoloji kullanan bir rehber olmaya doğru evrilmiştir. ARIA girişimi olan MASK (Mobile Airways Sentinel networK) allerji günlüğü, hekimler tarafından bu konuda bilgilendirilen kişiler tarafından, ücretsiz olarak internetten Allergy Diary by MACVIA-ARIA olarak aratılıp, Apple’da App Store, Google’da Play Store’dan indirilebilir. Türkiye’de bu aplikasyonun Türkçe validasyonu yapılmış ve kullanılmaya başlanmıştır.mHealth, such as apps running on consumer smart devices is becoming increasingly popular and has the potential to profoundly affect healthcare and health outcomes. Allergic Rhinitis and its impact on asthma (ARIA) has evolved from a guideline using the best evidence-based approach to care pathways suited to real-life using mobile technology in allergic rhinitis (AR) and asthma multimorbidity MASK-rhinitis (Mobile Airways Sentinel networK), the Phase 3 ARIA initiative, is based on the freely available app. The Allergy Diary is used by people who were informed by physicians, searched the internet, Apple App Store, Google Play. Turkish Validation has been available and currently in use