A novel biomarker in the diagnosis of parapneumonic effusion: neutrophil gelatinase-associated lipocalin

Background: The protein neutrophil gelatinase-associated lipocalin (NGAL) is a mediator synthesized and released by neutrophils. Its physiological function is as yet unclear. Levels in blood increase in several inflammatory diseases. High serum values indicate poor prognosis for several diseases. Pleural effusion may appear as the result of various pathologies. The most common cause is heart failure (HF). Other common causes include parapneumonic (PPE) and malignant (MPE) pleural effusions, and pulmonary embolism. Tubercular effusion (TE) is commonly encountered in Turkey and similar developing countries. The purpose of this study was to investigate the effectiveness of NGAL, a current inflammation marker, in discriminating between different etiological diseases that cause pleural effusion. Methods: The study was performed at the Recep Tayyip Erdoğan University Faculty of Medicine Chest Diseases Clinic. One hundred patients were included in the study, 25 with parapneumonic effusion, 25 with heart failure-related effusion, 25 with tubercular effusion and 25 with cancer-related effusion. NGAL was measured in patients' serum and pleural fluids. Results: Serum NGAL levels in PPE (171 ± 56 ng/ml) were significantly higher (p < 0.001) than those in HF (86 ± 31 ng/ml), CA (103 ±42 ng/ml) and TE (63 ± 19 ng/ml). Pleural NGAL levels were also significantly higher in PPE compared to HF, MPE and TE (p < 0.001). Serum NGAL levels exhibited a positive correlation with white blood cel (WBC), neutrophil, C-reactive protein (CRP), sedimentation, serum LDH, creatinine, pleural leukocyte and pleura neutrophil numbers. The most significant correlation was between NGAL level and WBC (p < 0.001, r= 0.579). Both serum and pleural NGAL levels are highly effective in differentiating patients with PPE from those without PPE (AUC: 0.910 and 0.790, respectively). Conclusions: NGAL can be used in the diagnosis of diseases with an acute inflammatory course. Serum and pleural NGAL levels can differentiate PPE from other diseases causing pleural fluid with high sensitivity and specificity. © 2014 Gümüs et al

Factors affecting patients' comfort during fiberoptic bronchoscopy and endobronchial ultrasound.

This study investigated the factors that can affect the comfort of patients who underwent diagnostic fiberoptic bronchoscopy (FOB) and diagnostic endobronchial ultrasonography (EBUS) for the first time and the effect of the patients' anxiety level on their comfort during the procedure

Akciğer kanserinin histopatolojik tipi zamanla değişiyor mu?

Akciğer kanseri, tüm dünyada kansere bağlı ölümlerde ilk sırayı almaktadır. Akciğer kanserinin histopatolojik tip dağılımda, geçen yıllar boyunca değişiklik olduğu bilinmektedir. Bu çalışma Ocak 1998 ile Aralık 2007 tarihleri arasında akciğer kanseri almış 1195 hastanın (%94 erkek, %6 kadın) epidemiyolojik özellikleri ile birlikte, hücre tipi dağılımındaki değişiklikleri retrospektif olarak incelemeyi amaçladık. Akciğer kanseri tanısı konulan hastaların yaş, cinsiyet, sigara içme durumları ve akciğer kanseri hücre tipleri değerlendirildi. Hastalar Ocak 1998 ile Aralık 2002 tarihleri arasında 1. Grup ve Ocak 2003 ile Aralık 2007 tarihleri arasında 2. Grup olarak iki gruba ayrıldı. En sık histopatolojik tip skuamoz hücreli kanser (% 59.1) idi, küçük hücreli akciğer kanseri ikinci en sık (%21.2) ve adenokarsinom (%13.6) idi. ‹ki grub incelendiğinde yıllar içinde skuamoz hücreli kanserde %60.1’den % 57.8’e azaldığı (% değişim % –4, p> 0.05) , küçük hücreli akciğer kanserinde %22.3’den %19.8’e azalma olduğu (% değişim % –11, p 0.05), that of small cell carcinoma decreased from 22.3% to 19.8% (a change of –11%, p< 0.05), and the incidence of adenocarcinoma increased from 11.8% to 15.9% (a change of +30%, p< 0.05). Although squamous cell carcinoma is still the most common type of lung cancer, there has been a significant increase in adenocarcinoma over time that would seem to be due to changes in the characteristics of cigarettes

Multisistemik tutulum izlenen bir tüberküloz hastası

Birden fazla sistemi tutan tüberküloz olguları, sıklıkla çocuklarda ve AIDS gibi immün sistemin baskılandığı hastalarda gö- rülmekle birlikte nadiren bildirilmektedir. Tüberküloz pek çok hastalığı taklit edebilir ve çok farklı klinik bulgularla karşı- mıza çıkabilir. On sekiz yaşında Gürcistanlı bir erkek hasta, çift görme, sağ el üçüncü parmakta şişlik ve yarayla başvur- du. Hastada orbital kemik ve yumuşak doku tüberkülozu, tüberküloz spondilit, tüberküloz daktilit, deri tüberkülozu ve ak- ciğer tüberkülozunu içeren multisistemik tutulum ile seyreden bir tüberküloz tanısı koyduk.Cases of tuberculosis with multisystemic involvement are rarely reported and these are often children and patients with AIDS whose and immune system is suppressed. Tuberculosis can mimic and present with various disorders. A 18-year-old Georgian male patient was admitted to the hospital with double vision, swelling and wound on the 3rd digit of the right hand. We defined the multisystemic tuberculous disease including orbital bone with soft tissue tuberculosis, tuberculosis spondylitis, tuberculosis dactylitis, scrofuloderma and pulmonary tuberculosis in these patient

High eerum YKL-40 level in patients with COPD is related to hypoxemia and disease severity

Ozkaya, Sevket/0000-0002-8697-4919; Kayhan, Servet/0000-0003-4226-2781WOS: 000320095300011PubMed: 23364142Chronic obstructive pulmonary disease (COPD) is a major health problem with increasing morbidity and mortality throughout the world. YKL-40 is a chitin-binding glycoprotein consisting of 383 amino acids, with a molecular mass of 40 kDa, and its serum level is elevated in inflammatory diseases. YKL-40 is a newly recognized biomarker of inflammation and has not been thoroughly investigated in COPD. the aim of the study is to investigate the relationship between serum YKL-40 levels and severity of COPD. the study population consisted of 52 patients with COPD with the mean age of 60.2 +/- 10.1 years. the serum YKL-40 level increased significantly with increasing age (p = 0.022, r = 0.346). in COPD patients, high serum YKL-40 level is correlated to low forced expiratory volume at 1 second (FEV1, percent of predicted) (r = -0.277, p = 0.047). Moreover, high serum YKL-40 level is correlated to low arterial oxygen pressure (PaO2, mmHg) (r = -0.387, p = 0.005). the mean serum YKL-40 level was found as 243.1 +/- 129.2 ng/ml in COPD patients with desaturation during 6-minute walk test (6MWT) and this value was higher than the mean serum YKL-40 level (155.8 +/- 59.1 ng/ml) of COPD patients without desaturation during 6MWT (p = 0.004). This study demonstrated that high serum YKL-40 levels were correlated to severity of COPD. We propose that circulating YKL-40 levels could be a biomarker for hypoxemia and decline in lung function

The CO-MIND study: Chronic obstructive pulmonary disease management in daily practice and Its implications for improved outcomes according to GOLD 2019 perspective

Purpose: GOLD 2019 proposed a novel treatment decision tool for follow-up based on the predominant trait (exacerbation or dyspnea) of patients, alongside treatment escalation and de-escalation strategies. This study was designed to provide an up-to-date snapshot of patient and disease characteristics, treatment pathways, and healthcare resource use (HRU) in COPD in real life, and comprehensively examine patients considering GOLD 2019 recommendations.Patients and Methods: This mixed design, observational, multicenter (14 pulmonology clinics) study included all patients with a documented COPD diagnosis (excluding asthma-COPD overlap [ACO]) for >12 months, aged >40 years at diagnosis who had a COPD-related hospital visit, spirometry test and blood eosinophil count (BEC) measurement under stable conditions within the 12 months before enrollment between February and December 2020. Data were collected cross-sectionally from patients and retro-spectively from hospital medical records. Results: This study included 522 patients (GOLD group A: 17.2%, B: 46.4%, C: 3.3%, D: 33.1%), of whom 79.5% were highly symptomatic and 36.2% had high risk of exacerbation. Exacerbations (n = 832; 46.6% moderate, 25.5% severe) were experienced by 57.5% of patients in the previous 12 months. Inter-rater agreement between investigators and patients regarding the reason for visit was low (Kappa coefficient: 0.338, p = 0.001). Inhaled treatment was modified in 88 patients at index, mainly due to symptomatic state (31.8%) and exacerbations (27.3%); treatment was escalated (57.9%, mainly switched to LABA+LAMA+ICS), inhaler device and/or active ingredient was changed (36.4%) or treatment was de-escalated (5.7%). 27% had >1 hospital overnight stay over 12 months. Emergency department visits and days with limitation of daily activities were higher in group D (p < 0.001). Conclusion: Despite being on-treatment, many patients with COPD experience persistent symptoms and exacerbations requiring hospital-related HRU. A treatable trait approach and holistic disease management may improve outcomes by deciding the right treatment for the right patient at the right time.GlaxoSmithKline 20843

Ottoman state finances in European perspective, 1500–1914

The early modern era witnessed the formation across Europe of centralized states that captured increasing shares of resources as taxes. These states not only enjoyed greater capacity to deal with domestic and external challenges, they were also able to shield their economies better against wars. This article examines the Ottoman experience with fiscal centralization using recently compiled evidence from budgets. It shows that due to high shares of intermediaries, Ottoman revenues lagged behind those of other states in the seventeenth and eighteenth centuries. Ottomans responded to military defeats, however, and achieved significant increases in central revenues during the nineteenth century

The Relationship between COVID-19 Severity and Bacillus Calmette-Guerin (BCG)/ Mycobacterium tuberculosis exposure history in healthcare workers: a multi-center study

The COVID-19 pandemic has brought countries' health services into sharp focus. It was drawn to our group's attention that healthcare workers (HCWs) had a lower mortality rate against higher COVID-19 incidence compared to the general population in Turkey. Since risk of exposure to tuberculosis bacillus among healthcare workers are higher than the population, we aimed to investigate if there is a relationship between BCG and Mycobacterium tuberculosis exposure history with COVID-19 severity in infected HCWs. This study was conducted with 465 infected HCWs from thirty-three hospitals to assess the relationship between COVID-19 severity (according to their hospitalization status and the presence of radiological pneumonia) and BCG and Mycobacterium tuberculosis exposure history. HCWs who required hospital admission had significantly higher rates of chronic diseases, radiological pneumonia, and longer working hours in the clinics. Higher rates of history of contact and care to tuberculosis patients, history of tuberculosis, and BCG vaccine were observed in hospitalized HCWs. HCWs who had radiological pneumonia had a significantly increased ratio of history of care to tuberculosis patients and a higher family history of tuberculosis. The findings from our study suggest that the lower mortality rate despite the more severe disease course seen in infected HCWs might be due to frequent exposure to tuberculosis bacillus and the mortality-reducing effects of the BCG vaccine