Drug resistance in pulmonary tuberculosis in new and previously treated cases: Experience from Turkey

SummaryThe emergence of drug resistance is a major problem for tuberculosis (TB) control. The aim of this study was to determine the rates of resistance against TB drugs in patients with pulmonary tuberculosis (PTB). Data from 387 patients with active PTB between the years of 1999 and 2004 from the Research and Education Hospital for Chest Diseases and Chest Surgery were evaluated retrospectively. The patients were categorized as new, re-treatment, extrapulmonary and chronic cases. The study group consisted of 268 (69%) new, 57 (14.7%) re-treatment, 49 (12.6%) extrapulmonary and 13 (3.3%) chronic TB cases. The rates of resistance to isoniazid (INH), rifampicin (R), ethambutol (E) and streptomycin (S) were calculated separately for each group. The resistance to any of the drugs was 7.8% in the new cases, 58.5% in the re-treatment cases and 100% in the chronic cases. The multidrug-resistance (MDR)-TB rates were found to be 2.16%, 11.3% and 92.3% among the new, re-treatment and chronic cases, respectively. These data are important as they reflect the drug resistance rates during the pre-notification time period in western Turkey

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

PNEUMOLOGISTS' APPROACH TOWARDS EUTHANASIA

Introduction: With the legalization of active euthanasia in the Netherlands and Belgium in recent years, euthanasia has become a subject of discussion again. It is important that physicians, particularly oncologists express their opinion about euthanasia. The aim of this study was to reveal what pneumologists who worked in oncology clinics thought about euthanasia

The eighth staging system of non-small cell lung cancer and its practical implications

Staging is an essential part of the approach to patients with lung cancer. The primary goal of the tumor classification is to correctly describe the anatomic extent of the disease. The anatomic extent of the tumor has a major impact on the treatment selection and prognosis. The general approach to patients with non-small cell lung cancer include mediastinal staging and non-thoracic staging methods, history and physical examination, imaging, minimally invasive techniques, and invasive surgical techniques. The current lung cancer staging system is the eighth edition of the tumor, node, and metastasis (TNM) classification, which was took effect in January 2017. In this article, staging methods and the definitions for current T, N, M descriptors and the stage groups in non-small cell lung cancer are reviewed. New definitions of T, N, and M factors seem to better indicate the most optimal treatment option for an individual patient and to better predict the survival in patients

The diagnostic efficiency of QuantiFERONTB®-Gold test in the diagnosis of tuberculous pleurisy

Background: Diagnosis of tuberculous pleurisy is difficult and better diagnostic tools are needed. Interferon gamma release assays (IGRAs) are in vitro immunologic diagnostic tests used to identify Mycobacterium TB infections. They cannot differentiate between latent and active infections. As IGRA tests have recently been approved for the differential diagnosis of active TB, the diagnostic accuracy of the latest generation of IGRA were assessed to detect tuberculous pleurisy in this study. Methods: The QuantiFERONTB®-Gold (QFT-G) test was used in pleural fluid from 100 immunocompetent patients (23 patients for the tuberculous group and 77 patients for the non-tuberculous group). Clinical data were recorded. Adenosine deaminase activity (ADA) analysis and TB culture were performed on pleural fluid. Results: The QFT-G in pleural fluid was positive in 10 (43.5%) patients and indeterminate in 13(56.5%) patients in the tuberculous pleurisy group. There was not a single patient with a negative test result in the tuberculous pleurisy group. The ADA levels were detected as 46.2 ± 12.6 in patients with tuberculous pleurisy and18.6 ± 39.8 in patients with non-tuberculous pleurisy. The sensitivity, specificity, positive predictive value and negative predictive value of QFT-G in pleural fluid for tuberculous pleurisy were 43.5%, 54.5%, 30.3% and 100%; and of ADA in pleural fluid (>40IU/ml) for tuberculous pleurisy the results were 82.6%, 96.1%, 90.5% and 92.5% respectively. Conclusion: While the value of the QFT-G test in exclusion of tuberculous pleurisy was found to be higher in this study, its other diagnostic efficiency values were detected to be low. It is recommended that a new cut-off value be established while diagnosing active TB in prospective clinical studies and that it is also essential to do the same for the studies in various regions with high and low prevalence of TB

Iterative surgical resections in non-small cell lung carcinoma

[Abstract Not Available

Correlation between chest CT severity scores and clinical and biochemical parameters of COVID‐19 pneumonia

Abstract Background The COVID‐19 pandemic, which first appeared in Wuhan, China, in December 2019 and spread rapidly around the globe, continues to be a serious threat today. Rapid and accurate diagnostic methods are needed to identify, isolate and treat patients as soon as possible because of the rapid contagion of COVID‐19. In the present study, the relation of the semi‐quantitative scoring method with computed tomography in the diagnosis of COVID‐19 in determining the severity of the disease with clinical and laboratory parameters and survival of the patients were investigated along with its value in prognostic prediction. Material and method A total of 277 adult patients who were followed up in the chest diseases clinic because of COVID‐19 pneumonia between 11.03.2020 and 31.05.2020 were evaluated retrospectively in the present study. Both lungs were divided into five regions in line with their anatomical structures, and semiquantitative radiological scoring was made between 0 and 25 points according to the distribution of lesions in each region. The relations between semiquantitative radiological score and age, gender, comorbidity, and clinical and laboratory parameters were examined. Results A significant correlation was detected between advanced age, lymphopenia, low oxygen saturation, high ferritin, D‐dimer, and radiological score in the univariate analysis performed in the present study. The cut‐off value of the semiquantitative radiology score was found to be 15 (AUC: 0.615, 95% CI: 0.554–0.617, p = 0.106) in ROC analysis. The survival was found to be better in cases with a radiology score below 15, in Kaplan–Meier analysis (HR: 4.71, 95% CI: 1.43–15.46, p < 0.01). In the radiological score and nonparametric correlation analyses, positive correlations were detected between CRP, D‐dimer, AST, LDH, ferritin, and pro‐BNP, and a negative correlation was found between partial oxygen pressure and oxygen saturation (p = 0.01, r = 0.321/0.313/0.362/0.343/0.313/0.333/−0.235/−0.231, respectively) Conclusion It was found that the scoring system that was calculated quantitatively in thorax HRCTs in Covid‐19 patients is a predictive actor in determining the severity and prognosis of the disease in correlation with clinical and laboratory parameters. Considering patients who have a score of 15 and above with semiquantitative scoring risky in terms of poor prognosis and short survival and close follow‐up and early treatment may be effective to reduce mortality rates

Evaluation of curative and palliative radiotherapy efficacy in extensive stage small cell lung cancer

Objectives: To evaluate the efficacy of curative and palliative radiotherapy in the treatment of extensive stage small cell lung cancer (E-SCLC), and compare therapy effect on survival with or without metastatic disease