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   Table of Contents - Current issue
Coverpage
September-December 2020
Volume 22 | Issue 3
Page Nos. 135-192

Online since Thursday, December 31, 2020

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REVIEW ARTICLE  

Chronic obstructive pulmonary disease: A review about gender differences p. 135
Carolina Santos, Tiago Pereira, Raquel Barros
DOI:10.4103/ejop.ejop_26_19  
The major risk factor for chronic obstructive pulmonary disease (COPD) is smoking. COPD is thought to be traditionally a male illness, but its prevalence in women is increasing because they are adopting lifestyle habits similar to men. A literature review of publications indexed in MEDLINE, Latindex, SciELO, and DOAJ databases was carried out. Were considered 44 articles with relevance to the topic addressed. The literature review aim was to characterize the gender susceptibility differences in COPD development as well as the changes that this disease may induce in the lung function. Through the present literature review, it was verified that there are multiple aspects that contribute to gender inequalities in COPD development. Among them are genetic predisposition, hormonal factors, tobacco smoke components metabolization, anatomical and physiological characteristics, bronchial hyperreactivity, and noxious agent's exposure. Gender differences in deleterious effects of tobacco smoke on lung function do not hold consensus, as there are authors reporting a greater lung functional decline in women even when less exposed to harmful substances, while others have found no differences in many of lung functional parameters. The studies analyzed were different regarding methodology and sample characteristics, which may contribute to results discrepancy obtained by the researchers. COPD affects men and women in increasingly similar proportions, so it is important to identify and characterize the particularities of tobacco smoke effects in both genders to improve the knowledge about the disease.
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ORIGINAL ARTICLES Top

How are radiological, spirometric and quality of life measures related to each other in cases of bronchiectasis p. 144
Burcu Arpinar Yigitbas, Celal Satici, Elif Yelda Niksarlıoğlu
DOI:10.4103/ejop.ejop_71_20  
Background: Radiological, spirometric, and quality-of-life (QoL) measures are essential parameters influencing the prognosis of patients with bronchiectasis (BE). However, to date, few studies have evaluated these measures together. OBJECTIVE: The study objective is to assess the relationships between high resolution computed tomography, spirometric and QoL scores considered in the steady and exacerbation states of BE. METHODS: We reviewed retrospectively patients who had been diagnosed with BE. Ninety-two cases were deemed eligible and completed the Short Form-36 (SF-36) and St George's Respiratory Questionnaire (SGRQ). A statistical assessment looking for correlations between HCRT, spirometry and QoL questionnaires was performed. Besides, factors for the modified Bhalla score (MBS) and clinical exacerbations were evaluated. RESULTS: İn the exacerbation state, patients' spirometric parameters and the domains of the SF-36 were even more strongly correlated with MBS, in particular, symptom duration, exacerbation and hospitalization rates in the previous year. Linear regression models for the steady and exacerbation state revealed SF-36 domains, forced expiratory volume in 1 s predicted and symptom duration were more related to MBS. In addition, the exacerbation rate was related to the domains of the SF-36, MBS and hospitalization within the previous year in both the steady and exacerbation state of BE. CONCLUSIONS: As a result of this study, SF-36, which is rarely used in clinical practice, has been demonstrated to be more correlated with radiological and pulmonary function test (PFT) scores than SGRQ. Assessing the patient's disease status can be performed more efficiently if MBS and SF-36 are combined with PFT.
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Evaluation of paraoxonase-1 enzyme activity and oxidative stress relations in malignant mesothelioma cases p. 153
Didem Turgut Cosan, Güntülü Ak, Emine Çolak, Aylin Dal, Çağrı Öner, Ahu Soyocak, Ertuğrul Çolak, Hasan Veysi Güneş, Muzaffer Metintaş
DOI:10.4103/ejop.ejop_78_19  
BACKGROUND: Malignant pleural mesothelioma (MPM) is the most common cancer in the pleura and highly aggressive with a very poor prognosis. Asbestos, known as a carcinogenic mineral with fiber structures, is the main cause of MPM formation. Exposure to asbestos causes an increase in reactive oxygen species, deficiency of antioxidant enzyme levels, and DNA damage. As a result of asbestos pathogenesis, all of these changes cause pulmonary fibrosis, pleural diseases, and malignancies. The endogenous antioxidant paraoxonase-1 (PON-1) is a calcium-dependent esterase involved in the hydrolysis of lipid peroxides, and PON-1 has been shown to have protective properties in oxidative stress and inflammatory diseases in various studies. OBJECTIVE: The study aimed to examine the relationship of MPM with PON-1 enzyme activity and oxidative status using total oxidant status (TOS) and total antioxidant status (TAS). MATERIALS AND METHODS: The study population was formed of 33 retrospectively examined mesothelioma patients as MPM group and 33 age- and sex-matched healthy individuals as controls. PON-1 activity was measured spectrophotometrically by enzyme-linked immunosorbent assay method. Total antioxidant and oxidant status was determined using Rel Assay Diagnostics kit. Oxidative stress index (OSI) was estimated as the ratio of the TOS to the TAS levels. RESULTS: In the present study, PON-1, TOS, TAS, and OSI levels were adjusted by comorbidity and smoking. The results indicated that TOS and OSI of MPM patients increased compared to healthy controls (P < 0.001 for both). The results also demonstrated the decrease of PON-1 activity and TAS in MPM cases (P < 0.001, for both). CONCLUSION: These results suggested that oxidative stress occurring as a result of inhalation of asbestos fibers may reduce the level of PON-1.
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Antifibrotic treatment in patients with idiopathic pulmonary fibrosis: Our experience in 41 cases p. 158
Berna Akıncı Ozyurek, Derya Yenibertiz, Aslıhan Gürün Kaya, Sertaç Büyükyaylacı Özden, Yurdanur Erdoğan
DOI:10.4103/ejop.ejop_102_19  
INTRODUCTION: It has been shown that antifibrotic agents (pirfenidone and nintedanib), used in the treatment of idiopathic pulmonary fibrosis (IPF) in recent years, decelerate the worsening of pulmonary function tests and the progression of the disease and also reduce the frequency of acute exacerbations and hospitalizations. In this study, we aimed to evaluate the results of antifibrotic treatment that we have been using since 2013 in our clinic. MATERIALS AND METHODS: Forty-one patients diagnosed as IPF between August 1, 2013, and February 1, 2019, in the eighth clinic of our hospital were included in this study. The information of the patients was obtained from the patient files. Data were analyzed by descriptive statistical methods, Kolmogorov–Smirnov test, and Wilcoxon test. RESULTS: Thirty-eight patients were male and three patients were female. The mean age was 65.6 ± 7.0 years. The diagnosis of 34 patients was made clinically and radiologically, and 7 patients were diagnosed pathologically. The longest usage time of antifibrotic drugs was 5.5 years in 2 patients, and the minimum usage time was 6 months in 2 patients. Thirty-four patients were using pirfenidone and seven patients were using nintedanib according to the data of their last visit. There was no significant difference between the baseline 6-min walk test results and the 6th-month, 1st-year, 2nd-year, 3rd-year, and 4th-year results. A significant decrease was determined in diffusing capacity of the lungs for carbon monoxide (DLCO) test results of the 6th month and 1st year compared to baseline (baseline: 63%, 6th month: 57%, and 1st year: 43%) (P < 0.05). There was no significant difference in DLCO test results of the 2nd, 3rd, and 4th year compared to baseline (P > 0.05). A significant decrease was determined in forced vital capacity (FVC) results of the 2nd year compared to baseline (68% and 59%, respectively) (P < 0.05). There was no significant difference in the FVC results of the 6th month, 1st year, 3rd year, and 4th year compared to baseline (P > 0.05). CONCLUSION: Similar to the literature, we have experienced that antifibrotic drugs decelerate the progression of the disease, reduce the risk of developing exacerbations, and are more tolerable in terms of side effect profile compared to the previous treatments.
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Evaluation of the sleep quality of patients admitted to the internal medicine outpatient clinic p. 163
İdris Kirhan, Fatih Üzer
DOI:10.4103/ejop.ejop_15_20  
AIM: This study aimed to determine the sleep quality and the factors affecting sleep quality in patients admitted to the internal medicine outpatient clinic. MATERIALS AND METHODS: The study was conducted between July 1, 2019, and July 15, 2019, with a face-to-face questionnaire administered to the patients who applied to the internal medicine outpatient clinic of Harran University. A descriptive questionnaire, Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale (ESS) were used in the study. RESULTS: One-hundred and twelve (48.0%) male and 121 (51.9%) female patients with a mean age of 38.5 ± 16.3 years (18–86 years) were included in the study. The total PSQI mean was 4.9 ± 3.0 and the score range was 0–15. The rate of those with poor sleep quality was 48.9%. The mean score of ESS was 5.0 ± 3.6, and 12 (30%) patients admitted to the outpatient clinic experienced excessive sleepiness during the day. Gender of the participants (P = 0.800), income level (P = 0.113), the size of the house they were living in (P = 0.783), body mass index (BMI) (P = 0.491), and comorbid diseases (P = 0.803) did not affect the sleep quality; the number of people living in the same house affected the sleep quality (P < 0.001). It was found that those with a high BMI (≥30) had significantly worse sleep quality than those without. Sleep quality decreased as the number of people living at home decreased. CONCLUSION: We found that almost half of the patients admitted to the internal medicine outpatient clinic had poor sleep quality. We also found that as the number of people living in the same home decreases, sleep quality deteriorates.
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Bronchodilator reversibility: What are the differences between asthma and chronic obstructive pulmonary disease? p. 169
Raquel Barros, Patrícia Araújo, Cláudia Mourato, Khrytyna Budzac, Ana Sofia Oliveira, Cristina Bárbara
DOI:10.4103/ejop.ejop_16_20  
INTRODUCTION: Currently, the bronchodilator reversibility is not recommended to differentiate asthma from chronic obstructive pulmonary disease (COPD); however, physiopathological specificities of each disease contribute to the differences in response to the drug. OBJECTIVES: The objective of this study is to evaluate the differences in bronchodilator response between asthmatic and COPD patients and to determine which of the bronchodilation criteria have the best ability to detect the positive response in these patients. MATERIALS AND METHODS: This was a cross-sectional study. The sample included 104 patients with asthma or COPD who performed lung function tests between January and March 2018. The whole sample was analyzed according to postbronchodilator variation (Δ) of lung function parameters, and the postbronchodilator reversibility was characterized using a multiple bronchodilation criteria. The drug used in reversibility test was salbutamol. RESULTS: In this study, Δ forced-expiratory volume in the 1st s (ΔFEV1) and a Δ Raw was statistically higher in the group with asthma compared with the group with COPD. In the asthma group, the criteria ↓ functional residual capacity (FRC) ≥10%, ↓Raw ≥ 35%, ↑ forced expiratory flow between 25% and 75% of vital capacity (FEF25%–75%) ≥20% and ↑ FEV1 and / or ↑ forced vital capacity ≥12% and 200 mL were those that presented a greater capacity of detecting a positive response to bronchodilator. The criteria ↑ FEF25%–75%≥20% and ↓ FRC ≥ 10% were those that had the greater ability of detecting airway reversibility in COPD group. CONCLUSION: The analysis of postbronchodilator FEV1 and raw modifications as well as the using of a combination of multiple bronchodilation criteria contribute to a deeper characterization of bronchodilator reversibility in asthma and COPD.
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Subclinical peripheral neuropathy in patients with chronic obstructive pulmonary disease without hypoxemia p. 175
Hatice Yurtgun, Baykal Tülek, Hakan Ekmekçi, Fikret Kanat, Mecit Süerdem
DOI:10.4103/ejop.ejop_21_20  
AIM: The aim of the study was to determine the prevalence of subclinical peripheral neuropathy (PNP) in stable chronic obstructive pulmonary disease (COPD) patients without severe hypoxemia. MATERIALS AND METHODS: Fifty-six (52 men and 4 women) patients with COPD without severe hypoxemia, 25 healthy smokers, and 24 healthy nonsmokers were included in the study. The latency, amplitude, and velocity measurements of right and left median motor nerve, tibial motor nerve, peroneal motor nerve, median sensory nerve, sural sensory nerve, right ulnar motor nerve, and right ulnar sensory nerve were performed. RESULTS: A high proportion of PNP was detected in the COPD group compared to the smoker and nonsmoker control groups (41.1%, 36.0%, and 33.3%, respectively). However, the difference between the groups was not statistically significant (P = 0.784). However, some of the electrophysiological measurements were statistically significantly worse in the COPD group (P < 0.05). In the COPD group, a correlation was not detected between PNP and duration of COPD, age, body mass index, smoking status (pack/year), forced vital capacity %, forced expiratory volume in 1 s %, SO2, and C-reactive protein values (P > 0.05). CONCLUSION: The present study demonstrates that the PNP may be an extrapulmonary manifestation of COPD. The physician should be aware of the possibility of PNP in COPD patients without severe hypoxemia.
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CASE REPORTS Top

Isolated pulmonary artery vasculitis p. 180
Meltem Agca, Bedrettin Yildizeli, Emine Bozkurtlar, Simge Yavuz, Tulin Sevim
DOI:10.4103/ejop.ejop_93_19  
We present a unique case of a 26-year-old woman, which first evaluated as sarcoma or thromboembolic events with their clinical and radiological similarities of the pulmonary artery but diagnosed as isolated pulmonary artery vasculitis after endarterectomy with the help of histopathological examinations. After the endarterectomy procedure, the other causes that may lead to vasculitis had been excluded. The patient had the immunosuppressive therapy after the procedure, and her control computerized tomography revealed that the lumen of the pulmonary artery was wide open. Isolated pulmonary artery vasculitis must be considered as a differential diagnosis when a filling defect of the pulmonary artery had been detected without other systemic findings.
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A case of diffuse endobronchial metastasis of rectum carcinoma presenting with symptoms of diffuse airway obstruction and respiratory failure p. 184
Serap Argun Baris, Ece Sahinoglu, Ilknur Basyigit
DOI:10.4103/ejop.ejop_11_20  
Endobronchial metastases of extra pulmonary tumors are rare. This report presents a case with diffuse endobronchial metastases with rectum carcinoma. A 63-year-old non-smoker female was admitted to our outpatient clinic with dyspnea and dry cough for two months. She had a history of rectum carcinoma and resection surgery eight months ago. On physical examination, wheezing was remarkable. There was patchy consolidation in both lung fields on chest x-ray. PET-CT revealed widespread nodules in pulmonary parenchyma which were consistent with rectal cancer metastasis. Bronchoscopy was performed and revealed extensive mucosal infiltration and multiple various sizes of polypoid lesions in the distal trachea and both main lobar bronchus. The histopathological evaluation reported as metastasis of rectum carcinoma. The oncological medical treatment regimen and radiotherapy was also planned. She admitted to emergency department with chest pain and progressive dyspnea 2 months after the diagnosis. Thorax CT demonstrated that increased metastatic peribronchial infiltrates, septal thickening and endobronchial polypoid lesions which was consisted with lymphangitic carsinomatosis and endobronchial metastasis. There was hypercapnic respiratory failure according to arterial blood gases analysis. She was intubated and admitted to the intensive care unit (ICU) and died in ICU on 7th day of admission. This case indicates that the possibility of endobronchial metastasis should be considered in a patient with underlying malignancy. If available bronchoscopic intervention should be planned not to let misdiagnosis.
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Acute inhalation injury after marijuana use: A hidden cause p. 187
Selen Karaoglanoglu, Emine Serap Yilmaz, Irem Karaman, Sevket Ozkaya
DOI:10.4103/ejop.ejop_35_20  
Marijuana is one of the most extensively smoking substance all around the world, although not common in our society. Its effects on lung are similar to tobacco, causing increased cough, sputum, hyperinflation, and rapid bronchodilatation following with possible airway obstruction. Chronic usage of marijuana may cause a variety of conditions such as bronchitis, large bullae formation, and pneumonia. Here, we report an uncommon case of hidden marijuana smoking causing acute inhalation injury. A 39-year-old male had consulted clinics with sudden onset of dyspnea, cough, and nausea. His chest X-ray and thorax computed tomography have revealed peripheral opacities with ground-glass infiltrations. After a detailed review of history, he was diagnosed with acute inhalation injury due to hidden marijuana smoking. As a conclusion, clinicians who encounter with individuals who have concurrent inhalation damage need to take a careful exposure history and should be alert for the possibilities of further complications and a worsening clinical picture.
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LETTER TO EDITOR Top

Safety comparison between high-flow nasal cannula and noninvasive positive pressure ventilation for coronavirus disease 2019 patients p. 191
Deepak Kumar, Abhijit Kumar, Amit Kohli
DOI:10.4103/ejop.ejop_95_20  
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