The aim of this study was to compare the responses of colistin treatment alone vs. a combination of colistin and rifampicin in the treatment of ventilator-associated pneumonia (VAP) caused by a carbapenem-resistant A. baumannii strain. Forty-three patients were randomly assigned to one of two treatment groups. Although clinical (P = 0·654), laboratory (P = 0·645), radiological (P = 0·290) and microbiological (P = 0·597) response rates were better in the combination group, these differences were not significant. However, time to microbiological clearance (3·1 ± 0·5 days, P = 0·029) was significantly shorter in the combination group. The VAP-related mortality rates were 63·6% (14/22) and 38·1% (8/21) for the colistin and the combination groups (P = 0·171), respectively. Our results suggest that the combination of colistin with rifampicin may improve clinical and microbiological outcomes of VAP patients infected with A. baumannii.

Background: Chronic obstructive pulmonary disease (COPD) is a disease of increasing significance in terms of economic and social burden due to its increasing prevalence and high costs. Direct costs of COPD are mostly associated with hospitalization expenditures. In this study, our objective was to investigate the costs of hospitalization and factors affecting these costs in patients hospitalized due to acute exacerbation of COPD (AECOPD).Methods: A total of 284 patients hospitalized AECOPD were included in the study. Data were examined retrospectively using the electronic hospital charts.Results: Mean duration of hospitalization was 11.38 ± 6.94 days among study patients. Rates of admission to the intensive care unit, initiation of non-invasive mechanical ventilation (NIMV) and invasive mechanical ventilation (MIV) were 37.3% (n=106), 44.4% (n=126) and 18.3% (n=52) respectively. The rate of mortality was 14.8% (n=42). Mean cost of a single patient hospitalized for an AECOPD was calculated as $1765 ± 2139. Mean cost of admission was $889 ± 533 in standard ward, and $2508 ± 2857 in intensive care unit (ICU). The duration of hospitalization, a FEV1% predicted value below 30%, having smoked 40 package-years or more, the number of co-morbidities, NIMV, IMV, ICU, exitus and the number of hospitalizations in the past year were among the factors that increased costs significantly. Hospital acquired pneumonia, chronic renal failure and anemia also increased the costs of COPD significantly.Conclusion: The costs of treatment increase with the severity of COPD or with progression to a higher stage. Efforts and expenditures aimed at preventing COPD exacerbations might decrease the costs in COPD.

PCT was better than CRP and the N/L ratio for predicting a bacterial infection in hospitalized patients with AECOPD. However, we find PCT not so reliable in predicting bacterial infection in AECOPD due to sensitivity and specificity of less than 80 % and a low AUC value.

PurposeSyncope is an atypical presentation for acute pulmonary embolism (APE). There are conflicting data concerning syncope and prognosis of APE.Patients and methodsOne hundred and seventy-nine consecutive patients aged 22–96 years (median, 68 years) with APE were retrospectively enrolled in the study.ResultsPrevalence of syncope was 13% (n=23) at the time of presentation. Compared to patients without syncope, those with syncope had a higher rate of central embolism (83% vs 43%, respectively, P=0.002), right ventricular dysfunction (91% vs 68%, P=0.021), and troponin positivity (80% vs 39%, P=0.001) but not 30-day mortality (13% vs 10%, P=0.716). Multivariate analysis showed that central localization (odds ratio: 9.08) and cardiac troponin positivity (odds ratio: 4.67) were the independent correlates of the presence of syncope in the patients with APE. Frequency of cardiopulmonary disease was lower, and duration from symptom onset to hospital admission was shorter in patients with syncope (P=0.138 and 0.118, respectively), although not significant.ConclusionSyncope most likely represents an intermediate condition between massive APE and hypotension. In APE patients with syncope, the prognosis seems to depend on the underlying pathology, the patient’s age, comorbidities and duration from symptom onset to hospital admission, and the use of thrombolytic therapy.

The tru-cut biopsy complications are similar to those of FNAB. In the centers where cytologic examination is insufficient in the diagnosis of lung lesions, tru-cut biopsy should be routinely performed as it is a reliable biopsy technique compared to FNAB.

Department of Family Medicine, ZonguldakKaraelmas University, Faculty of Medicine, Turkey-To assess the smoking status of coal workers, as coal dust exposure and concomitant cigarette smoking contribute to the increased prevalence of pulmonary interstitial fibrosis, chronic obstructive pulmonary disease and other pulmonary diseases. A survey was conducted to determine the smoking prevalence, behaviour and nicotine addiction in coal workers. The target population consisted of 475 underground coal workers who lived in Zonguldak city of Turkey, and we reached 389 of them. Each subject completed a detailed smoking history questionnaire (included 56 question). Chest X-rays and pulmonary function tests were performed to evaluate patients' related diseases and complications. Smoking status of the workers was as follows; Sixty-nine never smokers (17.7%), 62 ex-smokers (15.9%) and 258 current smokers (66.3%). The mean age of starting smoking was similar among ex and current smokers (15.9 ± 4.2 versus 15.0 ± 4.0). The most common reason for starting smoking was smoking interest (50%) and friends' influence (15.5%). The most frequent reason stated for successful smoking cessation was experience of smoking-related symptoms or development of a medical condition (51%). The most important reason given by current smokers for smoking cessation attempts was increased chance of developing lung cancer, pneumoconiosis and other diseases (22.9%). Nicotine addiction was assessed by the Fagerstroem test. Mild (0-3 points), moderate (4-6) and severe (7 or more) addiction ratios were Received Feb 18, 2004; Accepted May 28, 2004 Correspondence to: R. Altin, Department of Pulmonary Medicine, Zonguldak Karaelmas University, Faculty of Medicine, 67600 Kozlu, Zonguldak, found to be 39.1%, 44.2% and 16.7 % respectively. Ex-smokers had the highest prevalence of large and small airway obstruction on spirometry. Smoking prevalence is high in coal workers living in Zonguldak city of Turkey. Most of the smokers know that smoking is dangerous and want to quit smoking. A detailed smoking history during medical surveillance may help the occupational physician to develop a system in which such individuals can be referred to comprehensive smoking cessation programs. (J Occup Health 2004; 46: 289-295)

OSAS is associated with low serum omentin levels, and these levels can be reversed by effective CPAP treatment.

Objective: Sleep disorders are important public health issues that decrease the individuals' quality of life by affecting their productivity and performance in a negative way. The frequency of sleep disorders among people who work shifts with irregular sleep patterns is apparent. For healthcare providers, most of whom work shifts, the available data related to obstructive sleep apnea syndrome (OSAS) are insufficient. Also, this is the first study that has been conducted using an all-night polysomnography (PSG) for health staff in our country. In our study, we aimed to investigate the prevalence of snoring and OSAS among the nurses and resident doctors working at our hospital.Methods: Face-to-face interviews were performed with all nurses and resident doctors who worked at our hospital and agreed to participate in our study. All-night PSG examination was recommended to participants with concurrent witnessed apnea and/or excessive daytime sleepiness (EDS) with snoring. The frequency of OSAS was evaluated in cases exposed to polysomnography, and those with and without OSAS were compared in terms of shift rates. Results:The study included 257 participants. Of these, 63% were nurses and 37% were resident doctors; overall, 34.2% of the cases were male. The mean age was 28. 8±3.7 (19-39) years and the mean body mass index was 24.03±3.85 kg/m 2 . Among the participants, the mean number of monthly night shifts was 7.6±3.8. Also, 28.8% of the participants (n=74) experienced snoring, 2.7% (n=7) had witnessed apnea, and 7.8% (n=20) had EDS (Epworth sleepiness scale≥11). Four (1.6%) of the 20 participants who were proposed to undergo PSG refused this examination. Sixteen cases were exposed to PSG (6.2%). According to the PSG results, the prevalence of OSAS was 4.7% among all healthcare providers and 5.1% among the health staff working shifts. Of the cases with OSAS, 91.7% (11/12) were working shifts while 83.3% (204/245) of those without OSAS were working shifts (p=0.697). All of the cases diagnosed with OSAS were male, but 31% of the cases without OSAS were male (p<0.001). Conclusion:For those healthcare providers who are engaged in duties requiring significant amounts of attention and concentration, the symptoms related to sleep disorders should be questioned and diagnostic evaluation and treatment should be performed for suspected cases.Keywords: Health care providers, OSAS, sleep disorders, shift work INTRODUCTIONObstructive Sleep Apnea Syndrome (OSAS) is characterised by the episodes of complete or partial upper respiratory airway obstruction recurring during sleep and often a reduction in blood oxygen saturation (1). The gold standard diagnostic method for this syndrome is polysomnography (PSG).Although PSG is the final diagnostic method for OSAS, most OSAS prevalence studies have been conducted based on symptoms rather than PSG results. However, there are some studies in which symptoms and PSG test results have been evaluated together in order to estimate the prevalence of OSAS. In a widespread prevalence stu...