PurposeThis study was designed to evaluate errors in inhaler technique in COPD vs asthma patients and to investigate the association of poor inhaler technique with patient demographics and clinical variables.Patients and methodsA total of 509 adult patients with COPD (n=328) or asthma (n=181) who were currently using an inhaler device were included in this study. Data on patient demographics, duration of disease, type and duration of inhaler therapy, and assessment of inhaler technique were recorded.ResultsMetered dose inhaler (MDI) was the most common type of inhaler used by a similarly high percentage of patients in both COPD (83.2%) and asthma (77.3%) groups. Failure to exhale before inhaling through device (75.8% and 68.5% for MDIs; 73.2% and 71.8% for Aerolizer®/Handihaler®; 53.1% and 66.7% for Turbuhaler®) was the most common error in inhaler technique, in both COPD and asthma groups. Device-specific errors in inhaler techniques were more common in asthma patients as compared with COPD patients, particularly for MDIs (P-values ranged from 0.046 to 0.0005), as associated with female gender (failure to press the buttons on both sides of Aerolizer®/Handihaler®, P=0.006), shorter duration of disease (failure to hold MDI or head in a vertical position, P<0.001, and to keep Turbuhaler® upright, P=0.005), and shorter duration of inhaler usage (failure to hold head in a vertical position during MDI usage, P=0.006, and to keep Turbuhaler® upright, P=0.012).ConclusionIn conclusion, our findings revealed that errors in inhaler technique in terms of inhalation maneuvers and device handling were similarly common in COPD and asthma patients. Errors in certain device handling maneuvers, particularly with MDIs, were more common among asthma patients than among COPD patients and associated with female gender and shorter durations of disease and inhaler therapy.

th World Congress on Ultrasound in Obstetrics and GynecologyPoster abstracts outlet right ventricle, premature closure of the foramen ovale and a levoatrial cardinal vein draining into the innominate vein. In a prior study performed elsewhere the levoatrial cardinal vein had been interpreted as an aortic arch perfused retrogradely, and hypoplastic left heart syndrome had been diagnosed. Prenatal management, induction at 38 weeks and postnatal studies and treatment are presented. To the best of our knowledge, this is the first prenatal diagnosis of this embryological vessel, presenting a potential pitfall for prenatal echocardiography. P302A trial septal aneurysm in the fetus. Incidence, prenatal findings and postnatal significance

AimTo evaluate kyphoscoliosis patients with chronic hypercapnic respiratory failure (CHRF) using the six minute walk test (6MWT) distance (6MWD) and cardio-pulmonary function tests.MethodThis prospective cross-sectional study was carried out in a tertiary training and research hospital in Turkey. Kyphoscoliosis patients with CHRF on home mechanical ventilation (HMV) followed in a respiratory intensive care unit (RICU) out-patient clinic were enrolled. Patients' demographics were recorded as well as transthoracic echocardiography (ECHO), 6MWD, spirometry, arterial blood gas (ABG) values and high resolution chest computed tomography. 6MWT results were compared with other parameters.ResultsThirty four patients with kyphoscoliosis and chronic respiratory insufficiency admitted to our outpatient clinic were included in the study but 25 (17 M) patients underwent 6MWT (8 patients walked with oxygen supplement due to PaO2 < 60 mm Hg). The mean 6MWD was 274.4 ± 76.2 (median 270) m and median 6MWD predicted rate was 43.7% (inter quartile ratio, IQR, 37.6% to 47.7%). Median HMV use was 3 years (IQR 2-4). 6MWD predicted rate, body mass index (BMI), HMV duration were similar in male and female patients. 6MWD correlated well with age, BMI, dyspnea score for baseline 6MWT (r: - 0.59, p < 0.002, r: - 0.58, p < 0.003, r: - 0.55, p < 0.005 respectively) but modestly with forced expiratory volume in one second, pulse rate for baseline 6MWT, pulse saturation rate, fatigue and dyspnea score at end of 6MWT (r: - 0.44, p < 0.048; r: 0.44, p < 0.027; r: - 0.43, p < 0.031; r: - 0.42, p < 0.036; r: - 0.42, p < 0.034 respectively). 6MWD predicted rate was only correlated with dyspnea score at baseline (r: - 0.46, p < 0.022). The systolic pulmonary arterial pressure (PAPs) in 6 (24%) cases was more than 40 mmHg, in whom mean PaO2/FiO2 was 301.4 ± 55.4 compared to 280.9 ± 50.2 in those with normal PAPs (p > 0.40).ConclusionThe 6MWT is an easy way to evaluate physical performance limitation in kyphoscoliosis patients with chronic hypercapnic respiratory failure using home mechanical ventilation. Nearly 275 m was the mean distance walked in the 6MWT, but rather than distance in meters, the 6MWD predicted rate according to gender and body mass index equation might be a better way for deciding about physical performance of these patients. Dyspnea score at baseline before the 6MWT may be the most important point that affects 6MWD in this patient population.

Cachexia is known to be a deteriorating factor for survival of patients with chronic obstructive pulmonary disease (COPD), but data related to obesity are limited. We observed that obese patients with COPD prescribed long-term noninvasive mechanical ventilation (NIMV) had better survival rate compared to nonobese patients. Therefore, we conducted a retrospective observational cohort study. Archives of Thoracic Diseases Training Hospital were sought between 2008 and 2013. All the subjects were prescribed domiciliary NIMV for chronic respiratory failure secondary to COPD. Subjects were grouped according to their body mass index (BMI). The first group consisted of subjects with BMI between 20 and 30 kg/m 2 , and the second group consisted of subjects with BMI >30 kg/m 2 . Data obtained at the first month’s visit for the following parameters were recorded: age, sex, comorbid diseases, smoking history, pulmonary function test, 6-minute walk test (6-MWT), and arterial blood gas analysis. Hospital admissions were recorded before and after the domiciliary NIMV usage. Mortality rate was searched from the electronic database. Overall, 118 subjects were enrolled. Thirty-eight subjects had BMI between 20 and 30 kg/m 2 , while 80 subjects had BMI >30 kg/m 2 . The mean age was 65.8±9.4 years, and 81% were male. The median follow-up time was 26 months and mortality rates were 32% and 34% for obese and nonobese subjects ( P =0.67). Improvement in 6-MWT was protective against mortality. In conclusion, survival of obese patients with COPD using domiciliary NIMV was found to be better than those of nonobese patients, and the improvement in 6-MWT in such patients was found to be related to a better survival.

Aim: To evaluate kyphoscoliosis patients with chronic hypercapnic respiratory failure (CHRF) using the six minute walk test (6MWT) distance (6MWD) and cardio-pulmonary function tests. Method: This prospective cross-sectional study was carried out in a tertiary training and research hospital in Turkey. Kyphoscoliosis patients with CHRF on home mechanical ventilation (HMV) followed in a respiratory intensive care unit (RICU) out-patient clinic were enrolled. Patients’ demographics were recorded as well as transthoracic echocardiography (ECHO), 6MWD, spirometry, arterial blood gas (ABG) values and high resolution chest computed tomography. 6MWT results were compared with other parameters. Results: Thirty four patients with kyphoscoliosis and chronic respiratory insufficiency admitted to our outpatient clinic were included in the study but 25 (17 M) patients underwent 6MWT (8 patients walked with oxygen supplement due to PaO2 < 60 mm Hg). The mean 6MWD was 274.4 ± 76.2 (median 270) m and median 6MWD predicted rate was 43.7% (inter quartile ratio, IQR, 37.6% to 47.7%). Median HMV use was 3 years (IQR 2-4). 6MWD predicted rate, body mass index (BMI), HMV duration were similar in male and female patients. 6MWD correlated well with age, BMI, dyspnea score for baseline 6MWT (r: - 0.59, p < 0.002, r: - 0.58, p < 0.003, r: - 0.55, p < 0.005 respectively) but modestly with forced expiratory volume in one second, pulse rate for baseline 6MWT, pulse saturation rate, fatigue and dyspnea score at end of 6MWT (r: - 0.44, p < 0.048; r: 0.44, p < 0.027; r: - 0.43, p < 0.031; r: - 0.42, p < 0.036; r: - 0.42, p < 0.034 respectively). 6MWD predicted rate was only correlated with dyspnea score at baseline (r: - 0.46, p < 0.022). The systolic pulmonary arterial pressure (PAPs) in 6 (24%) cases was more than 40mmHg, in whom mean PaO2/FiO2 was 301.4 ± 55.4 compared to 280.9 ± 50.2 in those with normal PAPs (p > 0.40). Conclusion: The 6MWT is an easy way to evaluate physical performance limitation in kyphoscoliosis patients with chronic hypercapnic respiratory failure using home mechanical ventilation. Nearly 275 m was the mean distance walked in the 6MWT, but rather than distance in meters, the 6MWD predicted rate according to gender and body mass index equation might be a better way for deciding about physical performance of these patients. Dyspnea score at baseline before the 6MWT may be the most important point that affects 6MWD in this patient population.

SUMMARYAim: Pneumoconiosis is caused by inhaling dust. The aim of the study was to analyze 208 cases of workers' pneumoconiosis. Method: Patients' files were used for the descriptive study. Results: All patients were male aged 38.82 ± 13 years. The most important symptom was breathlessness. Patients were denim sandblasters (50.5%), dental technicians (12%), coal miners (6.7%), and others. The mean exposure time before pneumoconiosis occurred was shorter in denim sandblasters and teflon kitchenware producers compared to other occupations (5.4 ± 4.2 and 4.5 ± 3.3 years, respectively). Profusion (76.5%) was more than 1/2 by the International Labour Organization (ILO) classification. Pulmonary function tests were negatively correlated with profusion.Conclusion: Denim sandblasters and teflon kitchenware producers have less exposure time before pneumoconiosis occurs and they become symptomatic earlier. As Turkish workers suffering from pneumoconiosis are younger, measures to prevent pneumoconiosis must be the priority of the healthcare authorities.

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Autoantibodies against 52/60kD-Ro proteins, frequently present in patients with Sjoegren's Syndrome or systemic lupus erythematosus, are transmitted to the fetus during pregnancy. These autoantibodies can damage the cardiac conductive system of the fetus and cause a complete atrioventricular block, with a mortality of 30 %. We report the intrauterine therapy during four pregnancies of the same mother with high 52/60kD-Ro autoantibodies and the outcome of her infants. Our patient with primary Sjoegren's Syndrome suffered an early miscarriage during her first pregnancy. During the second pregnancy, a fetal atrioventricular block was observed at 23 weeks of gestation. Although subsequently dexamethasone therapy and daily plasmaphereses were started, a cesarean section was necessary at 26 weeks due to hydrops fetalis. The girl died from the atrioventricular block after two days. During the third and fourth pregnancies, dexamethasone therapy was begun already at 7 weeks, and regular plasmaphereses at 15 weeks. The children were delivered by cesarean section at 32 and 36 weeks because of growth retardation. Both had normal electrocardiograms after birth and after 2 and 4 years. In pregnant women with connective tissue diseases, monitoring of anti Ro-autoantibodies and fetal heart function is important. Intrauterine therapeutic options are dexamethasone therapy to suppress maternal and fetal inflammatory reactions and repeated plasmaphereses to reduce autoantibody levels. Postnatal follow up of the infants for atrioventricular block and rheumatic manifestations is necessary.