Nicotine delivery of e-cigarettes

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Effect of the presence of pneumonia on noninvasive ventilation success in chronic obstructive pulmonary disease cases with acute hypercapnic respiratory failure

Aim: To investigate the effect of the presence of pneumonia on the success of noninvasive mechanical ventilation (NIMV) in chronic obstructive pulmonary disease (COPD) cases with acute respiratory failure. Materials and methods: Sixty patients admitted to the intensive care unit (ICU) due to COPD exacerbation were included. The patients were divided into 2 groups as those with pneumonia (Group 1) and without pneumonia (Group 2). According to initial pH values, cases were also divided into 3 subgroups based on pH values. C-reactive protein (CRP), APACHE II scores, requirement of endotracheal intubation, mortality, and duration of ICU and hospital stay were also recorded. Results: NIMV success was found to be 85.5% in Group 1 and 51.1% in Group 2. Endotracheal intubation rates were higher in Group 2 (P = 0.008). NIMV failure was 70.1% in Group 2 and 10% in Group 1 in patients with severe acidosis. The APACHE II scores and CRP levels were significantly higher and independent risk factors in patients with NIMV failure (P < 0.002, P < 0.001). A significant difference was not found between groups in terms of duration of hospital and ICU stays and mortality. Conclusion: The presence of pneumonia in COPD cases is a factor that reduces NIMV success, but this does not affect mortality and the duration of ICU and hospital stay

Kardiyotorasik dışı cerrahilerde postoperatif pulmoner komplikasyonlar

Purpose: Postoperative pulmonary complications (PPCs) are a major cause of mortality and morbidity. The aim of this study is to evaluate frequencies and determine risk factors of PPCs which developed subsequent to general surgery and orthopedic surgery in a tertiary university hospital.Materials-methods: Patients who were operated in Departments of General Surgery and Orthopedics and Traumatology were retrospectively included to the study.Results: 683 patients with a mean age of 59.43±18.77 years were included in the study. The ratio of PPC was 10.3%. Most frequent PPC was found to be pneumonia (6.3%). The prevelance of PPC was significantly higher in patients ?65 years than who were 4 h) were respectively as follows 2.8%, 9.5%, 25%, 75% and 100% (p<0.001). Multivariable logistic regression analysis showed that being ?65 years, having ASA?3 and hypoalbuminemia (<3g/dl) were independent risk factors for development of PPC (OR:2.45, 95% CI (1.14-5.25) p<0.05; OR: 44.5, 95% CI (5.13-386.1) p<0.05; OR:6.4, 95% CI (3.14-13.1) p<0.05).Conclusion: The clinicians should be aware of PPCs especially in patients who were ?65 years, had ASA?3 and hypoalbuminemia (<3g/dl)Amaç: Postoperatif pulmoner komplikasyonlar (PPK) önemli mortalite ve morbidite sebebidir. Çalışmamızın amacı ortopedi ve genel cerrahi operasyonlarından sonra gelişen PPK sıklığını ve risk faktörlerini belirlemektir. Gereç ve yöntem: Genel cerrahi, ortopedi ve travmatoloji kliniklerinde opere edilen hastalar retrospektif olarak değerlendirildi. Bulgular: Ortalama yaşı 59,43±18,77 yıl olan 683 hasta çalışmaya alındı.PPK %10,3 idi. Pnömöni (%6,3) en sık görülen PPK olarak tespit edildi. PPK sıklığı 65 yaş ve üstünde altında göre belirgin olarak yüksek saptandı. (%18,2 vs %4,4) (p<0,001). Acil cerrahi operasyonlarda elektif operasyonlara göre daha sık tespit edildi (%24,1 vs %8) (p4st) PPK gelişim oranı sırasıyla %2,8, %9,5, %25, %75 ve %100 olarak bulundu (p<0,001). Çok değişkenli logiistik regresyon analizine göre ASA≥3, hipoalbunemi (<3g/dl) ve 65 yaş üstü PPK gelişiminde bağımsız risk faktörü olarak saptandı (OR: 2,45, %95 CI (1,14-5,25) p<0,05; OR: 44,5, %95 CI (5,13-386,1) p<0,05; OR: 6,4, %95 CI (3,14-13,1) p<0,05). Sonuç: Klinisyenler preoperative değerlendirmede ASA≥3, hipoalbunemi (<3g/dl) ve 65 yaş üzerindeki hastalarda PPK açısından dikkatli olmalıdır

Does nutritional risk screening 2002 correlate with the dyspnea status of patients with GOLD stage C-D chronic obstructive pulmonary disease?

OBJECTIVES: Dyspnea is a prominent symptom of chronic obstructive pulmonary disease (COPD). Patients with Global Initiative for Obstructive Lung Disease (GOLD) Stage C-D often complain of dyspnea, but the relationship between their level of dyspnea and their nutritional status has not yet been established. The aim of this study was to evaluate the dyspnea levels and nutritional status ofstable COPD patients in the out patient clinic. MATERIALS AND METHODS: Medical records including the Modified Medical Research Council (mMRC) Dyspnea Scale and the nutritional status of 41 patients were investigated in the study. The meanage of patients was 71.7 +/- 9.2 years. The Nutritional Risk Screening 2002 (NRS-2002) tool, body mass index (BMI), and mid-upper arm circumference were used to evaluate their nutritional status. We used correlation analysis to display the relationship between NRS-2002 score and MRC, COPD stage, and biochemical and anthropometric parameters indicating the nutritional status of patients. RESULTS: Out of the 41 COPD patients 87.8% (36) enrolled in the study were men and 12.2% (5) were women.The GOLD stages of the patients were 29.3% of patients with stage C and 70.7% with stage D.The risk of malnutrition (NRS >= 3) was detected in 48.8% of the patients, whereas 51.2% of patients (NRS<3) were risk-free. The mid-upper arm circumference of at risk patients was lower (25.6 +/- 3.2 vs 29.9 +/- 2.7 cm, p=0.032). The NRS-2002 score had a positive correlation with mMRC records (r=0.351, p=0.024). There was a statistically significant negative correlation between the NRS-2002 score and the mid-upper arm circumference (r=0.604, p<0.0001). Also, there was a negative correlation between BMI and mid-upper arm circumference (r=0.699, p<0.0001). CONCLUSION: The risk of malnutrition was common in stable COPD patients at the outpatient clinic, which seemed to adversely affect their dyspnea level. Therefore, while planning the treatment of COPD patients, evaluating their nutritional status and taking precautions accordingly contribute to the shortness of breath which is one of the most significant symptoms of the disease

The effect of serum electrolyte disturbances and uric acid level on the mortality of patients with acute exacerbation of chronic obstructive pulmonary disease

Objectives: The aim of the study was to determine the prevalence of electrolyte and uric acid disturbances and their effects on mortality in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Materials and methods: This study included all consecutive AECOPD patients who were managed at our Chest Diseases department between May 2017 and December 2017. Medical records of all the subjects were reviewed, and data were collected retrospectively. Eighty-one patients with AECOPD and 103 subjects in the control group were enrolled retrospectively. The association between the COPD and control groups and biochemical parameters in patients with and without long-term oxygen therapy and noninvasive mechanical ventilation treatment in COPD patients were compared with mortality. Results: Serum magnesium, phosphorus, potassium, sodium, and calcium (Ca levels were higher in control subjects than in COPD patients (p=0.006, p=0.015, and p<0.001, respectively). While serum levels of Ca and K were significantly lower and serum level of uric acid was higher in deceased COPD patients than in alive AECOPD patients (p=0.023, p=0.001, and p=0.033, respectively), serum levels of Mg, P, and other biochemical parameters were similar. Conclusion: Serum Ca, K, and uric acid levels during the exacerbation period were significant predictors of mortality in COPD patients. In conclusion, the levels of these parameters should be measured and corrected during AECOPD treatment to decrease mortality

Astımlı hastalarda depo akarı duyarlılığı ve ilişkili faktörler

Introduction: The aim of the study was to investigate the storage mite sensitivity and related factors in patients with asthma or asthma and rhinitis. Patients and Methods: 149 patients with asthma or asthma and rhinitis were included to the study. Prick test was performed after addition of Acarus siro (A. siro), Lepidoglyphus destructor (L. destructor), Glycophagus domesticus (G. domesticus) and Tyrophagus putrescentiae (T. putrescentiae) to the standart prick test. Living conditions, smoking history, allergic diseases status, seasonal variations in symptoms were evaluated by a questionnaire. Besides, respiratory screening spesific IgE, L. destructor spesific IgE was examined in a group of patients who were allergic to storage mites according to prick tests. Results: Prick test results showed that; 115 of the patients were sensitized while 34 of them were not. House dust mite sensitivity was detected as mite 58.3%.The storage mite sensitivity for at least one of the studied species was detected in 61.7% of patients. The sensitivity rates were 50.4%, 48.7%, 47%, %40 for A. siro, L. destructor, G. domesticus and T. putrescentiae, respectively. The storage mite sensivity was found higher in the patients from the rural areas (p< 0.05). L. destructor IgE positiveness was detected in 9.1% of the group that antibody levels were examined. Positive reaction was detected for at least one of the storage mite species in %22.7 of the patients who were considered as not sensitized according to the results of the standart prick tests. Conclusion: As a result, storage mites are important allergens in subjects who live in rural areas and close contact with barn, haymow, bin and pantry. Addition of storage mite allergens to the standart prick test panel of patients living in rural area is suitable

Do N-terminal pro-brain natriuretic peptide levels determine the prognosis of community acquired pneumonia?

Objective: Pneumonia is a leading cause of mortality worldwide, especially in theelderly. The use of clinical risk scores to determine prognosis is complex and thereforeleads to errors in clinical practice. Pneumonia can cause increases in the levels of cardiacbiomarkers such as N-terminal pro-brain natriuretic peptide (NT-proBNP). The prognosticrole of the NT-proBNP level in community acquired pneumonia (CAP) remains unclear.The aim of this study was to evaluate the prognostic role of the NT-proBNP level in patientswith CAP, as well as its correlation with clinical risk scores. Methods: Consecutiveinpatients with CAP were enrolled in the study. At hospital admission, venous bloodsamples were collected for the evaluation of NT-proBNP levels. The Pneumonia SeverityIndex (PSI) and the Confusion, Urea, Respiratory rate, Blood pressure, and age ? 65years (CURB-65) score were calculated. The primary outcome of interest was all-causemortality within the first 30 days after hospital admission, and a secondary outcomewas ICU admission. Results: The NT-proBNP level was one of the best predictors of30-day mortality, with an area under the curve (AUC) of 0.735 (95% CI: 0.642-0.828; p< 0.001), as was the PSI, which had an AUC of 0.739 (95% CI: 0.634-0.843; p < 0.001),whereas the CURB-65 had an AUC of only 0.659 (95% CI: 0.556-0.763; p = 0.006).The NT-proBNP cut-off level found to be the best predictor of ICU admission and 30-day mortality was 1,434.5 pg/mL. Conclusions: The NT-proBNP level appears to be agood predictor of ICU admission and 30-day mortality among inpatients with CAP, witha predictive value for mortality comparable to that of the PSI and better than that of theCURB-65 score

Isıtılmış tütün ürünü ilişkili subakut akciğer hasarı

Heated tobacco products release nicotine without burning tobacco with an electronically controlled heating system. 56-year-old male patient admitted with sudden onset of chest pain and shortness of breath. He had been using a heated tobacco product (I quit ordinary smoking, IQOS) for 2.5 years. Thoracic computed tomography scan revealed pleural-based atelectasis and fibroatelectatic changes in the lower lobe of the right lung, pleural fluid in the right upper lobe, fibroatelectatic changes and pleural thickening in the left lung. Biopsy taken with video-assisted thoracic surgery (VATS) showed lymphoid aggregation in nodular form and widespread anthracosis around the lung, fibrillar material that double-refracting the light in the alveoli, hyaline membrane-like material in the alveoli, type 2 pneumocyte hyperplasia, an interstitial organization, and a subacute lung injury picture with exogenous lipoid material. These findings were evaluated in accordance with toxic substance-induced chemical pneumonia. It was thought that it might be related to 2.5 years of using heated tobacco product

Should the cut-off value of D-dimer be elevated to exclude pulmonary embolism in acute exacerbation of COPD?

Objective: The aim of this study was to evaluate the D-dimer levels in patients with chronic obstructive pulmonary disease (COPD) exacerbation with and without pulmonary embolism (PE) and to attempt to define a new cut-off value for D-dimer to exclude the diagnosis of PE in patients with COPD exacerbation. Methods: This cross-sectional study was performed between the June 2012 and January 2013. The COPD patients who were admitted to the emergency department with acute exacerbation were consecutively included. D-dimer levels were measured upon admission. All patients underwent computed tomography angiography (CTA) and Doppler ultrasonography (US) of the lower extremities. Results: A total of 148 patients were enrolled. Fifty-three patients (36%) who did not have PE had higher than normal (>0.5 pg/mL) D-dimer levels. The D-dimer levels of the COPD patients with PE were significantly higher than those of the patients without PE (2.38±2.80 vs. 1.06±1.51 pg/mL) (P<0.001). The cut-off value for D-dimer in diagnosing PE in the COPD patients was 0.95 pg/mL. The area under the receiver operating characteristic (ROC) curve was 0.752±0.040 (95% CI: 0.672-0.831) (P<0.001). Conclusions: This study showed that the D-dimer concentrations of COPD patients who are in the exacerbation period may be higher than normal, even without PE. The cut-off level for D-dimer was 0.95 pg/mL (sensitivity 70%, spesificity 71%) for the exclusion of PE in the patients with COPD exacerbation. The D-dimer cut-off value that is used to exclude PE in patients with acute exacerbation of COPD should be reevaluated to prevent the excessive use of further diagnostic procedures

Morphological overview of cardiovascular comorbidities in chronic obstructive pulmonary disease: Frank's sign

Objective: Cardiovascular diseases are the most common and important comorbidities in patients with chronic obstructive pulmonary disease (COPD). Literature indicates that there may be a relationship between diagonal earlobe crease (DELC) and coronary artery disease (CAD). Accordingly, the present study aimed to assess the relationship with DELC and cardiac comorbidities in patients with COPD during routine physical examination. Materials and Methods: In this prospective cohort study, we evaluated the demographic data, pulmonary function test (PFT) results, lipid profile, oxygen saturation, and the presence of DELC in patients with COPD and control subjects. Results: DELC was diagnosed in 155 (62%) of COPD patients and these patients had a higher prevalence of CAD (p = 0.044). Moreover, DELC was diagnosed in 135 men (68.5%) and 20 (37.7%) women in the COPD group (p<0.001) and in 39 (48.8%) men and 14 (56.0%) women in the control group (p = 0.527). On the other hand, CAD was diagnosed in 18% of patients with early-stage COPD (n = 104) and in 30.8% of patients with late-stage COPD (n = 146) (p = 0.041). The sensitivity and specificity of DELC positivity in predicting CAD were 80.65% and 44.15% in COPD patients, respectively. Conclusion: The presence of cardiac comorbidities in COPD patients may play a vital role in the severity of the disease, exacerbations, and may also reduce the treatment response. Accordingly, an earlobe examination of patients with COPD may be useful in predicting the presence of cardiac comorbidities with high sensitivity. (C) 2020 Elsevier Inc. All rights reserved