Continuing practice is needed to maintain competency in endobronchial ultrasound-guided transbronchial needle aspiration

BACKGROUND: It has been accepted that after training, a competent endobronchial ultrasound (EBUS) operator should perform at least twenty procedures per year. However, the literature supporting this subject is scarce. This study focuses on the return performance of an experienced bronchoscopist after a 5-year long break. The aim of this study is to reveal a possible decrease in the diagnostic performance after discontinued practice. MATERIALS AND METHODS: The data of patients who have undergone EBUS-guided transbronchial needle aspiration (EBUS-TBNA) for mediastinal or hilar lesions (lymphadenopathies and masses) between April and September 2016 were reviewed retrospectively. All consecutive patients were involved in the study. All EBUS-TBNA procedures were performed by a single experienced bronchoscopist who have returned after a 5-year long break and restarted to perform EBUS. The patients were divided into two groups: first twenty cases and subsequent eighty cases. The diagnostic performance of EBUS was compared between the two groups. RESULTS: One hundred consecutive patients were included (2.89 lesions per patient) in the study. Demographic and sonographic data were not different between the two groups. In overall, EBUS-TBNA was diagnostic in 281 (97.2%) of 289 lesions. The sensitivity values of EBUS-TBNA in the first and second groups were 92.9% and 98.3%, respectively. The difference was statistically significant (P = 0.048). CONCLUSIONS: This study shows the need for continuing practice in EBUS. An operator should perform at least twenty procedures per year to maintain competency

Comparison of national early warning score 2 and quick sepsis-related organ failure assessment score in predicting severe coronavirus disease 2019: A validation study

BACKGROUND AND AIM: Coronavirus disease 2019 (COVID-19) has imposed a heavy burden on the intensive care unit and health care systems worldwide. Therefore, early detection of high-risk patients in terms of poor prognosis is crucial. We aimed to compare the diagnostic yield of the two most reliable scoring systems (National Early Warning Score 2 [NEWS 2] and quick Sepsis-related Organ Failure Assessment [qSOFA]) when repeatedly performed during the COVID-19 course. METHODS: The data of 403 COVID-19 patients admitted to our hospital between March 1, 2020, and November 30, 2020, were retrospectively reviewed. The demographic, comorbidity, and clinical data of the patients were recorded in the evaluation. NEWS2 and qSOFA score were retrospectively calculated at the time of admission, 24th hour, and 48th hour. We compared the effectiveness of qSOFA and NEWS2 for predicting the prognosis of COVID-19. RESULTS: The mean NEWS2 at the time of admission, 24th hour, and 48th hour was significantly higher in patients with poor outcomes than in patients with good outcomes. The 48th-hour NEWS2 was found to be the most successful score in predicting the poor outcome (AUC: 0.854; 95% CI: 0.81-0.88; p<0.001). NEWS2 at 0th, 24th, and 48th hours were found to be superior to qSOFA scores at the same time points. CONCLUSIONS: NEWS2 was superior to qSOFA in determining the need for intensive care support and/or mortality. A high NEWS2 at the 48th hour seems to be more valuable to predict worse outcomes

Starry Sky Sign: A Prevalent Sonographic Finding In Mediastinal Tuberculous Lymph Nodes

Background and Objectives: We report a prevalent finding in tuberculous lymphadenitis (TL): Starry sky sign, hyperechoic foci without acoustic shadows over a hypoechoic background. Materials and Methods: We retrospectively searched the database for a possible relationship of starry sky sign with a specific diagnosis and also the prevalence and accuracy of the finding. Results: Starry sky sign was found in 16 of 31 tuberculous lymph nodes, while none of other lymph nodes (1,015 lymph nodes) exhibited this finding; giving a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 51.6%, 100%, 100%, 98.5%, and 98.5%, respectively. Conclusion: Bacteriologic and histologic findings are gold standard in the diagnosis of tuberculosis, but this finding may guide the bronchoscopist in choosing the more pathologic node within a station and increase the diagnostic yield as it may relate to actively dividing mycobacteria.PubMedWo

Diagnostic value of pleural fluid lactate dehydrogenase/adenosine deaminase ratio in differentiating parapneumonic effusion from tuberculous pleurisy

Objective The purpose of this study was to determine the diagnostic value of pleural fluid lactate dehydrogenase (LDH)/pleural fluid adenosine deaminase (ADA) ratio in differentiating pleural effusions owing to tuberculous pleurisy (TBP) and parapneumonic effusion (PPE). Patients and methods The data of 272 patients (140 patients with TBP and 132 patients with PPE) between January 2012 and October 2018 were analyzed retrospectively. Demographic data of all patients; concurrent serum glucose, albumin, protein, and LDH values; and pleural fluid pH, glucose, albumin, protein, and ADA results have been reviewed. Results Pleural fluid ADA values were statistically significantly higher in the TBP group than PPE (P<0.001). The median values of pleural fluid LDH/ADA ratio between TBP and PPE groups were 16.10 (12.53) and 32.90 (34.45), respectively, which was found to be significantly lower in TBP group (P<0.001). Pleural fluid LDH/ADA ratio's sensitivity, specificity, positive predictive value, and negative predictive value were 90, 59.85, 70.4, and 84.9%, respectively, in the diagnosis of TBP for values less than 28 (P<0.001). Conclusion The ratio of pleural fluid LDH/ADA determined from routine biochemical analysis predicts TBP at value of 28. Measurement of this parameter may help clinicians distinguish between TBP and PPE

Risk Factors for Mortality in Denim Sandblasters Silicosis: Selecting Candidate for Lung Transplantation

OBJECTIVE: This study aimed to review the risk factors for silicosis together with survival analysis and a perspective for lung transplantation with data from a single center

Antibiotic resistance rates and penicillin MIC distribution in patients with streptococcal pneumonia between 2013-2019, and use of antibiotics in clinical practice

Purpose: The purpose of the present study is to investigate the antibiotic resistance rates and use of antibiotics in patients with streptococcal pneumonia in a reference tertiary care hospital for pulmonary diseases in Izmir, Turkey.Methods: A total of 1224 cases with streptococcal pneumonia between 2013 and 2019 were included in the study, retrospectively. Drug susceptibility testing for penicillin and other antibiotics were performed according to the recommendations of EUCAST criteria. Clinical data and general characteristics were collected and evaluated for each patient in accordance with the susceptibility testing report.Results: Totally, resistance rates for trimethophrim-sulfamethoxazole, penicillin (oxacillin), erythromycin, tetra-cycline, clindamycin and levofloxacin resistance were 63.5%, 39.8%, 37.7%, 37.6%, 28.8%, and 4.8%, respec-tively. Antibiotic resistance was not detected against vancomycin,teicoplanin and linezolid. Multidrug resistance rate was found to be 27.1%. It was observed that there was a statistically significant decrease in trimethophrim-sulfamethoxazole, penicillin (oxacillin), erythromycin, clindamycin and levofloxacin resistance rates by years (p: 0.000, 0.004, 0.000, 0.001, 0.010, respectively). The penicillin MIC distribution was higher at the range of 0.12-2 mu g/mL and there was statistical difference among the ranges of MIC values for the representative years (p:0.033). Among the antibiotics investigated, the most commonly used antibiotic was moxifloxacin.Conclusions: Trimethophrim-sulfamethoxazole resistance rate has been found higher than other antibiotics. As penicillin MIC values were at the range of 0.12-2 mu g/mL frequently, high doses of penicillin treatment might be required in some patients. It is noteworthy that significant decrease in resistance rates in penicillin, erythromycin, clindamycin and tetracycline could be due to the vaccination programme carried out since 2008 in Turkey. As the empiric use of quinolones is high it would be more appropriate to use it according to the susceptibility testing. It is important to determine the regional antimicrobial susceptibility for Streptococcus pneumoniae to select appropriate empirical antimicrobials in the clinical practice

Starry sky sign: A prevalent sonographic finding in mediastinal tuberculous lymph nodes

Background and Objectives: We report a prevalent finding in tuberculous lymphadenitis (TL): Starry sky sign, hyperechoic foci without acoustic shadows over a hypoechoic background. Materials and Methods: We retrospectively searched the database for a possible relationship of starry sky sign with a specific diagnosis and also the prevalence and accuracy of the finding. Results: Starry sky sign was found in 16 of 31 tuberculous lymph nodes, while none of other lymph nodes (1,015 lymph nodes) exhibited this finding; giving a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 51.6\%, 100\%, 100\%, 98.5\%, and 98.5\%, respectively. Conclusion: Bacteriologic and histologic findings are gold standard in the diagnosis of tuberculosis, but this finding may guide the bronchoscopist in choosing the more pathologic node within a station and increase the diagnostic yield as it may relate to actively dividing mycobacteria

Risk factors and maximum standardized uptake values within lymph nodes of anthracosis diagnosed by endobronchial ultrasound-guided transbronchial needle aspiration

Background/aim: Enlarged mediastinal lymph nodes can result from serious etiologies including granulomatous disease, neoplasia, etc., and a rare condition called anthracosis. The aim of this study was to determine the incidence of risk factors and the uptake values within the anthracotic lymph nodes. Materials and methods: 106 patients who underwent endobronchial ultrasound transbronchial needle aspiration and were diagnosed as having anthracosis were analyzed retrospectively. Patients with positive confirmation by surgical biopsies or a 1-year follow-up period were enrolled. Results: 201 lymph nodes were sampled from 106 patients. Subcarinal and interlobar lymph nodes were the most commonly affected stations (36.8\% and 34.3\%, respectively). The mean durations of exposure to biomass and cigarette smoke were 35.5 and 33 years, respectively. The mean maximum standardized uptake value (SUVmax) within the lymph nodes was 4.76. The SUVmax of the patients with associated malignancy was 4.19 and the SUVmax of nonmalignant patients was 5.28. This difference was statistically significant (P = 0.009). Conclusion: These findings suggest that anthracosis also affects the mediastinal and hilar stations; it should be considered in differential diagnosis in patients with mediastinal and hilar lymphadenopathies with intense uptake on positron emission tomography scans, especially when there is a history of exposure to known risk factors