Colistin-induced renal toxicity may be attributable to oxidative damage. The combined treatment of colistin plus NAC seems to have a beneficial role in restoration of the oxidant injury which may be related to its antioxidant effect.

BackgroundCOPD affects millions of people worldwide. Poor treatment adherence contributes to increased symptom severity, morbidity and mortality. This study was designed to investigate adherence to COPD treatment in Turkey and Saudi Arabia.MethodsAn observational, cross-sectional study in adult COPD patients in Turkey and Saudi Arabia. Through physician-led interviews, data were collected on sociodemographics and disease history, including the impact of COPD on health status using the COPD Assessment Test (CAT); quality of life, using the EuroQol Five-Dimension questionnaire (EQ-5D); and anxiety and depression using the Hospital Anxiety and Depression Scale (HADS). Treatment adherence was measured using the 8-item Morisky Medication Adherence Scale (MMAS-8). Multivariate logistic regression analysis examined the predictors of non-adherence and the impact of adherence on symptom severity.ResultsFour hundred and five COPD patients participated: 199 in Turkey and 206 in Saudi Arabia. Overall, 49.2% reported low adherence (MMAS-8 <6). Of those, 74.7% reported high disease impact (CAT >15) compared to 58.4% reporting medium/high adherence (p=0.0008). Patients with low adherence reported a lower mean 3-level EQ-5D utility value (0.54±0.35) compared to those with medium/high adherence (0.64±0.30; p<0.0001). Depression with HADS score 8–10 or >10 was associated with lower adherence (OR 2.50 [95% CI: 1.43–4.39] and 2.43 [95% CI: 1.39–4.25], respectively; p=0.0008). Being a high school/college graduate was associated with better adherence compared with no high school (OR 0.57 [95% CI: 0.33–0.98] and 0.38 [95% CI: 0.15–1.00], respectively; p=0.0310). After adjusting for age, gender, and country, a significant association between treatment adherence (MMAS-8 score ≥6) and lower disease impact (CAT ≤15) was observed (OR 0.56 [95% CI: 0.33–0.95]; p=0.0314).ConclusionAdherence to COPD treatment is poor in Turkey and Saudi Arabia. Non-adherence to treatment is associated with higher disease impact and reduced quality of life. Depression, age, and level of education were independent determinants of adherence.

These data show that bronchiectasis can contribute to severe and difficult to control asthma with pulmonary complications like chronic respiratory failure.

ulmonary embolism (PE) is a major health problem associated with a significant morbidity and mortality particularly in older patients. The overall annual incidence is approximately more than 1 case per 1,000 person-years, 1 but this increases markedly with advancing age. [1][2][3][4] The incidence is distributed extremely unevenly over the ages: 1 case per 1,000,000 person-years for children aged less than 15 years, 72.4 cases per 100,000 person-years for adults aged 40-54 years and 2.8 cases per 1,000 personyears for those aged 85-89 years. 2,3,5 Autopsy series have shown that PE is responsible for, or at least accompanies, approximately 12% of inhospital deaths and this rate increases to 20% for the patients aged 70 years and over. 6,7 Kniffin et al reported a 1-year mortality for PE of 39% in patients older than 65 years, 3 and Sakuma et al reported that the relative risk of mortality from PE was 417.76 for the patients aged over 79 years. 8 The high incidence of PE requires physicians to maintain a high level of suspicion in order to make a prompt diagnosis and initiate appropriate treatment, which is even more important for elderly patients who have higher mortality rates. On the other hand, physicians have to deal with the challenge of diagnosing suspected PE in elderly because older patients with PE may present with atypical clinical features in the absence of the usual indices. However, the clinical presentation of PE in the elderly population has not been extensively investigated. In the present study, the Circulation Journal Vol.69, August 2005hospital records of patients with documented PE were analyzed according to age, and risk factors, presenting symptoms and signs, arterial blood gas (ABG) analysis, electrocardiographic (ECG) and echocardiographic (ECHO) findings and, pulmonary vascular obstruction scores (PVOs) as a marker of severity of the disease, were compared for a better definition of the disease characteristics in the older population. Methods Study Population and DesignThe study was carried out at Gazi University, a large teaching hospital in Ankara. Hospital records between 1998 to 2003 from the Chest Department's database were used to identify patients who had received a final diagnosis of PE, which was established according to the protocol previously published by Prospective Investigation of Pulmonary Embolism Diagnosis investigators. 9 Patients diagnosed with pneumonia were not included in the study.Patients who met the entry criteria were stratified into 2 groups as older (≥65 years old) or younger (<65 years old) patients. The risk factors for PE were defined as follows: 10,11 immobilization (at least 2 days' bed rest in the 2 weeks prior to admission), pregnancy (includes postpartum period within the 3 months prior to admission), estrogen or oral contraceptive use, stroke, obesity (body mass index >27 kg/m 2 ), trauma (within past 3 months), recent operation (within past 6 weeks), malignancy, recent history of long travel (>6 h within 1 week), chronic obstructive lung disease (COPD...

Objective: The aim of this study was to evaluate the effect of hemiplegia on diaphragmatic movements using motion-mode ultrasonography. Methods: 23 hemiplegic patients who were diagnosed with a single-hemisphere lesion (mean age 60.5 years; 13 males and 10 females) and a control group of 20 patients (13 males and 7 females) were all evaluated by ultrasonography. Ultrasonography recordings were made of the amplitude of diaphragmatic movement during spontaneous and deep breathing. The patients underwent lung function tests. Results: When the hemiplegic and control groups were compared, the forced vital capacity, forced expired volume in 1 s, maximum inspiratory pressure and maximum expiratory pressure values were significantly lower in the groups with right and left hemiplegia (p,0.05). When a comparison was made between the right hemiplegic group and the control group and between the left hemiplegic group and the control group in terms of diaphragmatic excursions, for both groups, no significant difference was determined between the movements of the right hemidiaphragm during spontaneous and deep breathing and those of the left hemidiaphragm in spontaneous respiration. In contrast, for both hemiplegic groups, a significant decrease was noted in the movements of the left hemidiaphragm in deep respiration. Conclusion: The diaphragm is both contralaterally innervated and ipsilaterally innervated, and innervation exhibits marked variations from person to person. This provides an explanation for varying diaphragmatic movements in hemiplegic cases during deep respiration.

Premenstrual asthma (PMA) is a clinical picture with worsening of asthmatic symptoms and pulmonary functions in the late luteal phase of the menstrual cycle. The aim of this study was to evaluate the inflammatory changes in asthmatic women who complain of PMA. Forty asthmatic women attending our outpatient clinic were questioned about worsening of their asthma before menstruation. Eleven women (aged 17-40) who complained of PMA participated in the study. Subjects were asked to record peak expiratory flow rates, symptom scores, and beta-agonist use daily. After the first menses on the seventh day of their cycle, and before the onset of the next menstruation, on the 26+/-3rd day of the cycle, patients were evaluated with pulmonary function tests, methacholine challenge test, and fractionated exhaled nitric oxide (FE(NO)) levels. Eosinophils in peripheral blood and induced sputum were also evaluated. When comparing the two groups of results, the significant changes were in FENO levels, day-time symptom scores, and eosinophils in induced sputum (29.25 ppb/9.16 ppb p < 0.05, 1/0.45 p = 0.05, %6.63/%4.09 p < 0.01, respectively, before and after menstruation). These results show that PMA is not only a clinical picture with a decrease in airway calibre that can be related to the regulation of 2 receptors, but also a complex state with worsening of airway inflammation.

This study showed that an increased FE(NO) level may be used for identifying patients with IBD who need further pulmonary evaluation.

The 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 3 rd -5 th 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.