Prognostic value of red cell distribution width and echocardiographic parameters in patients with pulmonary embolism

Introduction: Pulmonary embolism (PTE) is a common cardiovascular emergency. We aimed to predict mortality in the acutephase and to assess the development of pulmonary hypertension in the chronic period with the combined use of red cell distributionwidth (RDW) and echocardiography (ECHO) for the prognosis of PTE. Material and methods: Cases diagnosed with acute PTE were prospectively monitored in our clinic. The initial data of 56 patientswere evaluated. The subjects were separated into two groups basing on RDW; group 1 had RDW ≥ 15.2%, while group 2 hadRDW < 15.2%. Results: Ninety-eight patients were enrolled in the study. We established the sensitivity (73.3%) and the specificity (73.2%) ofRDW to determine mortality in the cases with PTE. RDW ≥ 15.2% value was significant as an independent risk factor for predictingmortality (OR:7.9 95% CI, 1.5–40.9 p = 0.013) in acute PTE. The mean tricuspid annular plane systolic excursion (TAPSE) valuewas significantly different between the group-1 (RDW ≥ 15.2%, 2.20 cm (± 0.43)) and group-2 (RDW < 15.2%, 1.85 cm (±0.53))(p = 0.007). The threshold value for tricuspid jet velocity was > 2.35m/s, the sensitivity and specificity were 76.9% and61.9%, respectively for predicting mortality (AUC: 0.724, 95% CI: 0.591–0.858, p = 0.033). Conclusion: Our results indicate that high RDW levels are an independent predictor of mortality in acute PTE. Lower TAPSElevels show right heart failure in PTE patients; this may also be indicative of right ventricular systolic function. We believe thatdeveloping new scoring systems, including parameters such as RDW, TAPSE, and tricuspid jet velocities, may be effective indetermining the prognosis of pulmonary embolism

Intensive Care Management of Critical and Severe SARS-CoV-2 Infection in Pregnancy: A Retrospective Observational Study

Objective: This study examined the clinical consequences of pregnancy coexisting with severe acute respiratory syndrome coronavirus 2 in the intensive care unit (ICU). Materials and Methods: The study was designed as a retrospective observational study. After the ethical approval of the local ethics committee, the study was conducted for a period when the number of young coronavirus disease-2019 (COVID-19) cases increased in our country. The patients enrolled in the study were pregnant/puerperal patients followed up in our third-level ICU. Results: The mean age of 35 pregnant women included in the study was 29.57±4.36 years. Twenty-one of the births (80.8%) were preterm births. Twelve (34.3%) patients received invasive mechanical ventilation (IMV), and 5 (41.7%) of these patients were deceased. Twenty-six (74.3%) underwent a cesarean section (C/S). There were 5 (14.3%) patients who needed extracorporeal membrane oxygenation and 3 (8.5%) patients who needed continuous renal replacement therapy. The 28-day neonatal mortality rate for 26 births was 3.8%. The maternal mortality rate in the ICU was 14.3%. Conclusion: The preterm birth rate was high in our pregnant patients followed up in the ICU with a diagnosis of COVID-19. Because of clinical and radiological progression in pregnant women, it is difficult to indicate any gestational week in which maternal outcomes are better to undergo C/S. IMV mortality is not higher than in non-pregnant patients, so endotracheal intubation should not be avoided in appropriate patients, whether pregnancy continues or not. The absence of fully vaccinated patients in the study group revealed the protective effect of vaccination during pregnancy

Learning platform for smoking cessation project: From begining to date

Although 35% of the adults in Turkey are current smokers, the number of trained physicians and smoking cessation (SC) clinics are not enough to meet the demand. Aim: This national project aimed to create the necessary infrastructure for providing SC therapy all-around the country and to train physicians in this topic. This project was run by Turkish Thoracic Society Tobacco Working Group and supported by a grant from Pfizer Foundation. Methods: For this purpose, an organization network including field training teams was planned. The training materials were prepared and standardized. A website of the project including a wide e-learning platform was created (www.sigarabirakmadaogrenmezemini.org). Results: Firstly, a central training program was planned. Forty volunteers from all regions of Turkey were participated to this program. Afterwards, field training programs were started to perform by these trainers. From the beginning field training sessions were performed in 11 cities with more than 300 participants. The project website was visited by 10.369 visitors and 518 participants completed e-training module since April 2011. Conclusion: The SÖZ project enabled a training ground that will last for years; a professional website and a trainer staff to generalize the program. Through this project, the integration of SC intervention in all health service steps will be provided, the number of SC clinics in Turkey will increase, and in future smoking rate will reduce in our country

Etiology of benign mediastinal/hilar lymphadenopathy

Ulusal Akciğer Sağlığı Kongresi’nde poster bildiri olarak sunulmuştur (14-18 Mart 2018, Antalya).Çalışmamızda benign mediastinal/hiler lenfadenopati saptanan hastalar takip edilerek lenfadenopatiye neden olan hastalıkların dağılımı incelenmiştir. Çalışmamız, Mayıs 2015 ile Haziran 2016 tarihleri arasında prospektif olarak yürütüldü. Çalışmaya mediastinal/hiler lenfadenopati nedeni ile EBUS/ Mediastinoskopi/ Torakoskopi yapılan olgular alındı ve başlangıçta biyopside malignite saptanan hastalar çalışmadan çıkarıldı. Çalışmaya dahil edilen benign mediastinal/hiler LAP saptanan 93 hastanın %59.1 (55)’i kadın, %40.9 (38)’u erkek, yaş ortalaması 55.1 (±12.6) idi. Seksen üç hastaya Endobronşiyal Ultrason Eşliğinde Transbronşiyal İğne Aspirasyonu (EBUS TBİA), 7 hastaya mediastinoskopi, 2 hastaya Video-asiste torakoskopik cerrahi (VATS) ve 1 hastaya torakotomi yapıldı. Hastaların %53.8 (50)’inde sarkoidoz, %12.9 (12)’unda antrakoz, %5.1 (5)’inde tüberküloz, %4.3 (4)’ünde silikozis, %1.1 (1)’inde churg strauss sendromu, %1.1 (1)’inde hipersensitivite pnömonisi, %1.1 (1)’inde enfeksiyon, %1.1 (1)’inde kanser, %19.4 (18)’ünde nedeni bilinmeyen lenfadenopati bulundu. Çalışmamızdaki esas bulgu benign mediastinal/hiler lenfadenopatinin en yaygın nedeninin sarkoidoz olarak bulunmasıdır. Enfeksiyöz nedenlerden tüberküloz ise 3. sıklıkta LAP nedeni olarak bulunmuştur. Ayrıca granülomatöz lenfadenitin benign mediastinal/hiler lenfadenopatilerin yarısından fazlasını oluşturduğu görülmüştür. Mediastinel/hiler LAP’lerin büyük oranda EBUS TBİA yöntemiyle örneklenebildiği saptanmıştır. Ayırıcı tanının yapılamadığı olgularda takip ile tanıya gidilebileceği de anlaşılmaktadır.Our study was conducted as prospectively between May 2015 and June 2016. Cases that underwent EBUS/ Mediastinoscopy / Thoracoscopy with the diagnosis of mediastinal/hilar lymphadenopathy were included in the study and patients who were diagnosed to have malignancy in the initial biopsy were excluded from the study. The included 93 cases consisted of 40.9% men (38) and 59.1% women (55) with a median age of 55.1 (±12.6) years. Patients underwent Endobronchial Ultrasound Guided Transbronchial Needle Aspiration (EBUS TBNA) (83 patients), mediastinoscopy (7 patients), video-assisted thoracic surgery (2 patients) and thoracotomy (1 patient). The final diagnosis of the patients was accepted to be sarcoidosis in 50 (53.8%), anthracosis in 12 (12.9%), tuberculosis in 5 (5.1%), silicosis in 4 (4.3%), churg strauss syndrome in 1 (1.1%), hypersensitivity pneumonia in 1 (1.1%), infectious in 1 (1.1%), malignancy in 1 (1.1%) and uncertain in 18 (19.4%). The main findings of this study revealed that sarcoidosis was the most common cause for benign mediastinal/hilar lymphadenopathy. Tuberculosis was the third most common cause of benign mediastinal/hilar LAP. Furthermore, granulomatous lymphadenitis comprised more than half of benign mediastinal / hilar lymphadenopathy. It has been found that mediastinal/hilar LAP can be sampled by EBUS TBNA method to a large extent. In cases with impossible differential diagnosis, follow-up of patients may direct one to diagnosis in time

Tütün kontrolü

Tütün, artık hem gelişmiş hem de gelişmekte olan ülkelerdeki önlenebilir ölümlerin başlıca nedenidir. Tütün kullanımı ve buna karşı girişimler değişmezse, 2000'den 2030 kadar tütün kullananların sayısı 1.2 milyardan 1.6 milyara ve yıllık ölümler 4.9 milyondan 10 Milyona ulaşacaktır. Bu artışlar özellikle düşük ve orta gelirli ülkelerde yaşanacaktır. Sigara başlıca kanserler, kalp ve akciğer hastalıklarından olmak üzere ölümlere ve 50'den fazla sağlık problemine yol açar. Gebelikte anne karnında maruziyet düşük doğum ağırlığı, perinatal mortalite, konjenital defektler, çocukluk astımı ve diğer solunumsal sorunlara yol açar. Çevresel sigara dumanına pasif maruziyet akciğer kanseri ve kalp hastalıkları riskini arttırır. Tütünün kontrolü birçok sektörün birlikte hareketini gerektiren karmaşık bir sorundur. Çocukların sigara kullanmasının önlenmesi, içenlerin bırakmasının motivasyonu, bırakma tedavilerinin kolay ulaşılabilir hale getirilmesi, halka açık yerlerde ve iş yerlerinde sigara yasakları ve kapsamlı bir reklam ve promosyon yasağı başlıca tütün kontrol politikalarıdır. Sigara bırakma tedavisi, tütüne bağlı hastalıkların morbidite ve mortalitesini azaltmada tütün kontrol programlarının önemli öğelerinden birisidir. Bu makalede tütün kullanımının insana ve topluma zararları ve tütün kontrol önlemleri gözden geçirilmektedir

Evaluation of sarcoidosis cases in the last decade: Is there a seasonal difference?

Background: The sarcoidosis cases were emphasized to differ seasonally in previous studies. In particular, the seasonal distribution of Lofgren syndrome and sarcoidosis arthritis cases has been reported to vary. Aims and Objectives: In this study, the seasonal variability of sarcoidosis cases defined in the literature was investigated among the patients who applied to our outpatient clinic. Materials and Methods: The data of 582 patients referred to our outpatient clinic and had a preliminary diagnosis of sarcoidosis between January 2010 and March 2020 were evaluated retrospectively. Demographic information, admission dates to the hospital, diagnostic methods, organ involvement, and seasonal characteristics were determined and analyzed. Results: Of the 582 patients evaluated in the study, 359 had the diagnosis of sarcoidosis. The mean age of our patients was 50 years; 96 (26,7 %) were male, and 263 (73,3 %) were female. The number of patients diagnosed histopathologically was 338 (94,2 %), and the most common extrapulmonary involvement was skin involvement with 37 cases. In the last decade, a significant number of patients (134 (37.3%) cases) were referred to the physician during the spring. Conclusion: Sarcoidosis is a multisystem disease with unknown etiology. In our study, similar to other studies, there was an increase in the symptoms during spring. Therefore, sarcoidosis should be kept in mind in patients with symptoms such as cough and shortness of breath accompanied by skin findings during the spring months. However, the data to explain this condition are not sufficient. Therefore, prospective studies are needed to explain the seasonal relationship with the pathophysiology of sarcoidosis

Prognostic Value of Red Cell Distribution width and Echocardiographic Parameters in Patients with Pulmonary Embolism

Introduction: Pulmonary embolism (PTE) is a common cardiovascular emergency. We aimed to predict mortality in the acute phase and to assess the development of pulmonary hypertension in the chronic period with the combined use of red cell distribution width (RDW) and echocardiography (ECHO) for the prognosis of PTE. Material and methods: Cases diagnosed with acute PTE were prospectively monitored in our clinic. The initial data of 56 patients were evaluated. The subjects were separated into two groups basing on RDW; group 1 had RDW ≥ 15.2%, while group 2 had RDW < 15.2%. Results: Ninety-eight patients were enrolled in the study. We established the sensitivity (73.3%) and the specificity (73.2%) of RDW to determine mortality in the cases with PTE. RDW ≥ 15.2% value was significant as an independent risk factor for predicting mortality (OR:7.9 95% CI, 1.5–40.9 p = 0.013) in acute PTE. The mean tricuspid annular plane systolic excursion (TAPSE) value was significantly different between the group-1 (RDW ≥ 15.2%, 2.20 cm (±0.43)) and group-2 (RDW < 15.2%, 1.85 cm (±0.53))(p = 0.007). The threshold value for tricuspid jet velocity was >2.35 m/s, the sensitivity and specificity were 76.9% and 61.9%, respectively for predicting mortality (AUC: 0.724, 95% CI: 0.591–0.858, p = 0.033). Conclusions: Our results indicate that high RDW levels are an independent predictor of mortality in acute PTE. Lower TAPSE levels show right heart failure in PTE patients; this may also be indicative of right ventricular systolic function. We believe that developing new scoring systems, including parameters such as RDW, TAPSE, and tricuspid jet velocities, may be effective in determining the prognosis of pulmonary embolism

Results of Turkish smoking cessation polyclinics data's analysis (TUSPA study)

Sengezer, Tijen/0000-0002-3200-8926; Er, Mukremin/0000-0001-6842-0587WOS: 000451979407230

Smoking status of pulmonologists who are members of Turkish thoracic society and factors related to their being a smoker = Türk toraks derneǧi üyesi göǧüs hastalıkları hekimlerinin sigara i̇çme durumu ve i̇lişkili faktörler

Objective: If smoking habit among physicians in a country is common as it is in the general population, it is a particular problem for national tobacco control studies. The study aimed to investigate the smoking status of pulmonologists who are members of the Turkish Thoracic Society (TTS), and factors related with being a smoker. Material and Methods: Web-questionnaires were e-mailed to members of TTS by the TTS secretary from June 2010-February 2011. Only pulmonologists were included in the study. To analyse possible predictors of smoking smokers were categorized as ever smokers and never smokers. Possible predictors were sex, being graduated before/after 2004, urban/suburban working place, being academician or not, having education on smoking cessation help, experienced in smoking cessation outpatient clinic or not. Results: Web questionnaires of 699 pulmonologists were reviewed. Of the participants, 65.2% were female and the mean age was 39.4±9.0 (25-72); 69% were non-smokers, 21.1% were ex-smokers, and 9.9% were current smokers. Never smokers were mostly included in the group of pulmonologists younger than 40 years old (p=0.001). The number of never smokers with experience in smoking cessation outpatient clinic was higher than the number without any experience (72.1% and 67.1%, respectively; p=0.03). Smoking was 1.8-fold more likely among males (95% confidence interval-CI 1.2-2.5) and 1.8-fold more likely among those graduated before 2004 (95% CI 1.1-3.1); 66.7% of current smokers were in the contemplation stage. The number of cases in contemplation stage were mostly among regular smokers (p=0.001). Conclusion: The results of this study suggesting relatively low prevalence of smoking among pulmonologists are important for tobacco control