Comorbidities: assessment and treatment

COPD is an umbrella term that is associated with several systemic manifestation, lung involvement, and comorbidities [1, 2]. Currently, the description of comorbidity is complicated and has three different domains: “(1) the coexistence of one or more diseases with no other causation, (2) coexistence of diseases that share common risk factors and pathogenic pathways, (3) coexistence of diseases that are complicated by the interaction with the lung and systemic manifestation of COPD” [3]. In a very recent study, BODE Investigator Group suggested that COPD is interlinked with several comorbidities larger than non-COPD controls indicating common pathobiological process [4]. The importance of comorbidities is their impact on clinical outcomes of a patient life. COPD is a life-threatening and disabling disease and comorbidities cause additional impact revealing impairment in quality of life and increasing mortality [3]

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

Coexistence of three malignancies: Two different lung cancers synchronous with lymphoma

Epithelial tumors synchronous with hematologic malignancies are very rare. The hystopathologic type and stage of synchronous tumors are very important for prognosis. A 77-year-old male patient was diagnosed with lymphoma after an excisional biopsy was taken from the retroauricular region. Positron emission tomography, performed for lymphoma staging, revealed a positive solid nodule (SUVmax: 24.3) in the posterobasal segment of the right lower lobe and a negative subsolid nodule in the anterior segment of the upper lobe. Right lower lobectomy and wedge resection for subsolide nodule in the upper lobe were performed. Histopathological examination revealed mildly differentiated squamous cell carcinoma for the solid nodule and mildly differentiated adenocarcinoma with lepidic pattern for the subsolid nodule. The patient was treated for only lymphoma according to the decision of the tumor board, and his condition is stable for 1 year without any evidence of lung cancer recurrence. This case presents the treatment approach and the fact that triple synchronic malignant cases are rare in the literature

Cryptogenic and secondary organizing pneumonia: Clinical presentation, radiological and laboratory findings, treatment, and prognosis in 56 cases

OBJECTIVES: Organizing pneumonia is an important disease that is associated with non-specific clinical findings and radiographic appearance. Our aim was to examine the clinical and radiological features, laboratory findings, diagnostic approach, and response to therapy in subjects with cryptogenic (COP) and secondary organizing pneumonia (SOP). MATERIALS AND METHODS: Patients’ medical records were retrospectively reviewed between 2010 and 2016 in our hospital. We analyzed the symptoms, radiological features, pulmonary function tests, laboratory data, bronchoalveolar lavage findings, treatment, and prognosis. RESULTS: Thirty-seven patients were diagnosed with COP and 19 patients with SOP. The most common causes of SOP were determined as rheumatologic diseases. The most common symptoms were cough (71.4%) and dyspnea (66.1%). Bilateral symmetrical consolidations were the most prominent radiological appearance in both COP and SOP. The general radiographic findings were not different in COP and SOP. However, pulmonary lesions were located rather in the central (p=0.023) and middle (p=0.001) zones in patients with SOP. Corticosteroid (CS) therapy was administered to 34 (60.7%) patients. Two patients showed deterioration despite CS therapy. CONCLUSION: The clinical and radiographic findings, treatment response, prognosis were similar in patients with COP and SOP

Cryptogenic and secondary organizing pneumonia: Clinical presentation, radiological and laboratory findings, treatment, and prognosis in 56 cases

OBJECTIVES: Organizing pneumonia is an important disease that is associated with non-specific clinical findings and radiographic appearance. Our aim was to examine the clinical and radiological features, laboratory findings, diagnostic approach, and response to therapy in subjects with cryptogenic (COP) and secondary organizing pneumonia (SOP). MATERIALS AND METHODS: Patients’ medical records were retrospectively reviewed between 2010 and 2016 in our hospital. We analyzed the symptoms, radiological features, pulmonary function tests, laboratory data, bronchoalveolar lavage findings, treatment, and prognosis. RESULTS: Thirty-seven patients were diagnosed with COP and 19 patients with SOP. The most common causes of SOP were determined as rheumatologic diseases. The most common symptoms were cough (71.4%) and dyspnea (66.1%). Bilateral symmetrical consolidations were the most prominent radiological appearance in both COP and SOP. The general radiographic findings were not different in COP and SOP. However, pulmonary lesions were located rather in the central (p=0.023) and middle (p=0.001) zones in patients with SOP. Corticosteroid (CS) therapy was administered to 34 (60.7%) patients. Two patients showed deterioration despite CS therapy. CONCLUSION: The clinical and radiographic findings, treatment response, prognosis were similar in patients with COP and SOP

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

Short-term variations of optic coherence tomography findings in mild and severe chronic obstructive pulmonary disease

Objective To evaluate the short-term changes in subfoveal choroidal thickness (SFCT), ganglion cell complex (GCC) analysis, and retinal nerve fiber length (RNFL) of patients with chronic obstructive pulmonary disease (COPD) in a 3-month follow-up. Materials and methods Forty-eight patients with COPD (96 eyes) and 40 control subjects (80 eyes) were enrolled in our study. COPD patients were grouped according to disease severity as Group 1 (mild–moderate) and Group 2 (advanced). GCC, RNFL, and SFCT analysis by Cirrus SD-OCT were obtained for all eyes, in two consecutive examinations with a 3-month interval. Results SFCT in Group 2 was lower than Group 1 and control group in the initial and 3rd month examination (p < 0.001, respectively). Inferior RNFL in Group 2 were lower than control group in the initial and 3rd month examination (p = 0.002, p < 0.001, respectively) Temporal RNFL were lower in Group 2 than Group 1 in 3rd month examination (p = 0.009). Average, superior, superotemporal, inferior, and inferonasal GCC analyses of the Group 2 were lower than control group both in the initial and 3rd month examination (p = 0.001, p < 0.001, respectively) SFCT, average, and superior GCC of Group 2 were significantly reduced during the 3-month follow-up (p < 0.001). Conclusion Hypoxia is thought to be the underlying mechanism in COPD, which may influence retinal and choroidal OCT parameters. Decrease in blood flow of optic nerve head, increased vascular resistance, and reduced blood flow in choroid may affect the visual ability in these patients, which should be kept in mind during their follow-u

Covid-19 The biggest threat of the 21st century in respectful memory of the warriors all over the world

Since the first case was diagnosed in China, the new coronavirus infection (COVID-19) has become the number one issue in the world and it seems to remain trend-topic for a long time. Until 17 April, it affected 210 countries, infected over 2 million people and caused approximately 150000 deaths. Although the course of the disease ranges from asymptomatic state to severe ARDS; the majority of patients reveal only mild symptoms. Though adults are the most commonly affected group; it can also be seen in newborns and elderly patients. Unfortunately, elderly patients are the most vulnerable group with higher mortality. Elderly patients, smokers and patients with comorbid conditions are most affected by the disease. In certain diagnostical tool is the real-time reverse transcription-polymerase chain reaction (real-time RT-PCR) test. However, it can be resulted in false-negative results and in this case the computed thorax tomography (CT) is one of the most important tools with high sensitivity. Besides the supportive treatment, most commonly used agents are immunomodulatory drugs such as plaquenil and azitromycin, and anti-virals including oseltamivir, ritonavir-lopinavir, favipiravir. Until a vaccine or a specific therapy invented, the most important intervention to control the disease is to fight against transmission. This is a real war and the doctors are the soldiers

Evaluation of COPD patient’s relatives assessment of disease awarness, load of care giving and loss of workforce: Turkish Thoracic Society COPD working group

Objective: Our aim is to measure the level of awareness of patient’s relatives COPD, to determine the caregiver burden of patient's relatives, and to determine whether there is a work day loss. Material and method: 252 COPD patients and 252 patient’s relatives from 11 centers were included in this questionnaire study. Ethics committee was approval. Disease information of the patients were recorded and a questionnaire was applied. Socio-demographic characteristics of the patient’s relatives were recorded and a questionnaire consisting of 24 questions including COPD disease, treatment and loss of working days and Zarit Scale used in chronic diseases were used. Results: 128(50.8%) of the patients according to GOLD were group-D.97(38.5%) of the patient's relatives were working. 253(94.4%) knew that COPD was a lung disease. 62(24.7%) were not able to go to work for 1-14 days. 125(57.1%) spent outside the home from 1 to 14 nights, because those accompanied to patients. In univariate analysis were detected mMRC(p<0.001), CAT(p<0.001), the number of comorbidities of patients(p=0.027),Conclusion: In COPD increases caregiving burden. This burden is greater in symptomatic patients and when comorbidities are present. Psycho-social and legal regulations should be investigated and solutions should be produced for the person who gives care to COPD patients

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