Comparison of two systemic steroid regimens for the treatment of COPD exacerbations

WOS: 000333999800008PubMed ID: 23518215Rationale: Systemic steroids shorten recovery time, improve lung function and hypoxemia in COPD exacerbations. Although several studies have shown that both parenteral and oral steroids are effective and GOLD guideline recommends use of oral steroids at a dose of 30-40 mg/day, very little data exists as to whether any route of admininstration (parenteral vs oral) or any dose is more effective and/or safer. Methods: This was a randomized, parallel-group study aiming to compare the effectiveness and safety of orally administered lower dose of steroids with parenteral administration of higher doses. Thus, a total of 40 patients were included; one group (Group 1, n = 20) received methylprednisolone (MP) as recommended by the GOLD guideline (PO 32 mg/day for seven days) and the other (Group 2, n = 20) was given IV MP at 1 mg/kg/day for four days and 0.5 mg/kg/day for three days. Results: The two groups were similar with regards to age (69.0 +/- 10.5 vs 67.1 +/- 8.4 years), duration of COPD (11.8 +/- 8.3 vs 9.7 +/- 7.7 years), FEV1 (41.3 +/- 17.3 vs 34.0 +/- 12.0%), PaO2 levels (55.5 +/- 9.9 vs 59.1 +/- 11.0 mmHg) and dyspnea scores (9.4 +/- 1.1 vs 10.0 +/- 1.0). Worsening hypercapnic respiratory failure developed in two patients from Group 1 on days 1 and 2, these were intubated and thus excluded from the study. At day 7, both groups showed significant improvements in FEV1 levels (50.8 +/- 19.4 and 43.8 +/- 21.4%, respectively) (Table 2), PaO2 levels (66.5 +/- 12.5 and 65.3 +/- 10.6 mmHg, respectively) (Table 3) and dyspnea scores (3,5 +/- 2,8 and 4.2 +/- 2.8) (Fig. 1). The length of hospital stay was similar for the two groups (11.0 +/- 3.9 vs 12.7 +/- 6.4). Regarding adverse events, four patients in Group 1 vs 11 patients in group 2 developed hyperglycemia. Besides, three patients in group 2 had worsening of previously controlled hypertension. All events were treated and controlled with administration of proper medications. All patients were followed up for three months. Eight patients in group 1 and 15 patients in group 2 had unplanned visits to their physicians or to the emergency rooms for recurring exacerbations. Four patients in group 1 and five patients in group 2 were readmitted to hospital for recurrence (p = NS). During the follow-up two patients from group I died. Conclusion: These data show that oral administration of MP at a dose 32 mg/day for seven days significantly improves lung function, symptom scores and oxygenation in patients admitted to the hospital for COPD exacerbation and is as effective as and possibly safer than parenteral admininistration of higher doses. (C) 2013 Elsevier Ltd. All rights reserved

Barriers to adult immunization and solutions: Personalized approaches

WOS: 000394951100029PubMed ID: 27669411Immunization is an important component of preventive healthcare services aiming to prevent and eventually eradicate infectious diseases by immunizing people before they become infected. Although immunization is an integral part of children's healthcare, this fact is underrated, even ignored in adults. In Turkey, adult immunization is available only for certain high risk groups such as health care professionals and populations aged > 65y and under certain conditions including pregnancy, military service, travel-pilgrimage, and employment procedures. The fact that diseases such as pneumococcal pneumonia, influenza, rubeola, varicella, hepatitis A, and tetanus, which could be associated with severe complications in adults, are vaccine-preventable indicates the importance of adult immunization. In addition to the healthcare providers' knowledge about immunization, effective policies of related professional associations and the management of this issue by regulatory authorities, people's awareness in protecting their own health is of utmost importance in achieving the targeted level of adult immunization. This article focuses on the characteristics of the individuals as one of the 3 main cornerstones (individual, healthcare providers, regulatory authorities and supporting organizations) of immunization practices and discusses barriers to adult immunization and recommends solutions.PfizerPfizer; Sanofi PasteurDr. A. Sayiner received honoraria for lectures in meetings sponsored or organized by Pfizer and Sanofi Pasteur and has been a member of advisory board for Pfizer

Clinical Outcome of PCR-Negative COVID-19 Patients: A Retrospective Study

OBJECTIVE: To evaluate the clinical features and outcomes of patients who were admitted with a diagnosis of coronavirus disease 2019 (COVID-19) but who were not confirmed with polymerase chain reaction (PCR) positivity. MATERIAL AND METHODS: This is a retrospective analysis of all patients admitted to two tertiary care centers between March 15 and May 15, 2020, with a diagnosis of COVID-19. From a common database prepared for COVID-19, we retrieved the relevant data and compared the clinical findings and outcomes of PCR-positive patients with those of PCR-negative cases who had been diagnosed on the basis of typical clinical and radiographic findings. RESULTS: A total of 349 patients were included in the analysis, of which 126 (36.1%) were PCR-negative. PCR-negative patients were younger (54.6 +/- 20.8 vs. 60.8 +/- 18.9 years, P = .009) but were similar to PCR-positive patients in terms of demographics, comorbidities, and presenting symptoms. They had higher lymphocyte counts (1519 +/- 868 vs. 1331 +/- 737/mm(3), P= .02) and less frequently presented with bilateral radiographic findings (68.3% vs. 79.4%, P = .046) than PCR-positive patients. Besides, they had less severe disease and better clinical outcomes regarding admission to the intensive care unit (9.6% vs. 20.6%, P = .023), oxygen therapy (21.4% vs. 43.5%, P < .001), ventilatory support (3.2% vs. 11.2%, P= .03) and length of hospital stay (5.0 +/- 5.0 vs. 9.7 +/- 5.9 days, P < .001). CONCLUSION: This study confirms that about one-third of the COVID-19 patients are PCR-negative and diagnosed based on clinical and radiographic findings. These patients have a more favorable clinical course, shorter hospital stays, and are less frequently admitted to the intensive care unit

Across-shift lung function variation in cottonseed oil workers

WOS: 000240771500003PubMed ID: 16775023Background The effects of cotton dust on pulmonary function among workers employed in cotton-spinning mills are well known. However, little data exist on the prevalence of this disorder in 'non-textile' cotton industries, including cottonseed oil mills, where high levels of exposure to dust have been demonstrated. Aims This study was performed in order to determine the across-shift and across-week decline of FEV1 and respiratory symptoms among workers in a cottonseed oil mill. Methods Sixty-six exposed and 48 unexposed workers of a cottonseed oil mill in Turkey were investigated by questionnaire and lung function test (LFT). LFTs were performed before and after shift on all the working days of the week. Acute airway response was defined as an across-shift decline in FEV1 of 5% or more on the first working day. Results Smoking was the only risk factor for having respiratory symptoms. Acute airway response was more frequently observed in the exposed group as compared to the unexposed group (OR = 6.2, 95% CI = 2.3-16.7). The median across-shift decline in FEV1 on the first day (120 ml) significantly improved on the following days (10, 50, 60 and -30 ml). Conclusion Smoking appears to be the main risk factor for having respiratory symptoms. Cottonseed dust may cause an acute pulmonary function decline on the first working day, but not on the following days of the week. This decline is associated with respiratory symptoms in exposed workers

Stability of blood eosinophilia and neutrophil-to-lymphocyte ratio in COPD

28th International Congress of the European-Respiratory-Society (ERS) -- SEP 15-19, 2018 -- Paris, FRANCEWOS: 000455567107224European Respiratory So

The Role of Aerolized Colistin in the Treatment of Hospital-Acquired Pneumonia: Experience of Multicenter From Turkey

WOS: 000398383800007PubMed ID: 27083024National Institutes of HealthUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USADr. Sayiner received speaking and consultancy fees from GlaxoSmithKline, Astra Zeneca, Novartis, Boehringer Ingelheim, and Pfizer (unrelated to the content of article) and disclosed government work. Dr. Bacakoglu received support for this article research from the National Institutes of Health. The remaining authors have disclosed that they do not have any potential conflicts of interest