Comparison of diagnostic values of procalcitonin, C-reactive protein and blood neutrophil/lymphocyte ratio levels in predicting bacterial infection in hospitalized patients with acute exacerbations of COPD [Vergleich der diagnostischen Wertigkeit von Procalcitonin, C-reaktivem Protein und vom Neutrophilen/Lymphozyten Quotienten bei der Vorhersage von bakteriellen Infekten bei hospitalisierten Patienten mit akuter Exazerbation einer chronisch obstruktiven Lungenerkrankung]

Background: Viral or bacterial upper respiratory infections are the most common cause of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Based on available data, no reliable parameter has been presented to distinguish between bacterial and nonbacterial exacerbations. Therefore, we compared the diagnostic value of procalcitonin (PCT) level, which is a newer marker for predicting bacterial infections in patients with AECOPD, to routine parameters such as C-reactive protein (CRP) levels and the neutrophil/lymphocyte (N/L) ratio. Methods: This study included all consecutive patients who were admitted for a diagnosis of AECOPD between January 1 and March 31, 2014. PCT, CRP, and the N/L ratio were assessed in addition to cultures from tracheal aspirates or sputum on the first day of admission. Patients with a pneumonic infiltration on chest radiographs, or an extrapulmonary infection focus, or whose blood samples were not obtained for PCT and/or CRP at the same time as sputum culture were excluded from the study. Results: A total of 77 patients were included with a mean age of 71.7 ± 9.5 years. Bacteria were isolated in 37.4 % of the patients. Mean PCT levels were significantly higher in patients with positive sputum cultures than in patients with negative sputum cultures. The cut-off values for PCT, CRP, and the N/L ratio for predicting a bacterial infection were 0.40 ng/mL, 91.50 mg/L, and 11.5, respectively; sensitivity was 61, 54, and 61 % respectively; specificity was 67, 52, and 58 %, respectively; and the area under the curve (AUC) values were 0.64, 0.52, and 0.58, respectively. The AUC value of PCT was significantly better for predicting bacterial infection compared with the CRP level or the N/L ratio (p = 0.042). Conclusion: PCT was better than CRP and the N/L ratio for predicting a bacterial infection in hospitalized patients with AECOPD. However, we find PCT not so reliable in predicting bacterial infection in AECOPD due to sensitivity and specificity of less than 80 % and a low AUC value. © 2014, Springer-Verlag Wien

Emphysema and airflow obstruction in non-smoking coal miners with pneumoconiosis

Background: Accumulating evidence shows that functional impairment in subjects with coal workers’ pneumoconiosis (CWP) is principally due to emphysema and airflow obstruction, rather than underlying restrictive mechanisms. However, cigarette smoking has remained a major confounder. The aim of this study was to assess whether coal dust exposure was associated with emphysema and/or airflow obstruction in the absence of smoking history. Material/Method: The subjects evaluated for possible pneumoconiosis between 2013 and 2015 were retrospectively enrolled into this study. After excluding those with history of smoking, tuberculosis, or lung cancer, the study population was a total of 57 subjects. The emphysema severity and airflow obstruction were quantified by computed tomographic densitometry analysis and spirometry, respectively. For comparability regarding emphysema, 9 age- and sex-matched nonsmoker (n=9) control subjects without known lung disease were randomly selected from a radiology database. Results: Emphysema severity was significantly higher in the CWP group compared with the control group (15% vs. 4%, p<0.001). The median percent emphysema and percentage of those with FEV1/FVC <0.7 was 13% and 37% in subjects with simple CWP and 18% and 67% in subjects with complicated CWP, respectively. Percent emphysema and Perc15 (15th percentile of the attenuation curve) was correlated with FEV1/FVC (r=–0.45, r=–0.47) and FEF25–75 (r=–0.36, r=–0.56), respectively, but not with perfusion score. A linear regression analysis showed that factors associated with emphysema were FEV1/FVC (b=–0.24, p=0.009) and large opacity (ß=–3.97, p=0.079), and factors associated with FEV1/FVC were percent emphysema (ß=–0.51, p=0.018) and tenure (ß=–0.63, p=0.044). Conclusions: Our results support the observation that coal dust exposure is associated with emphysema and airflow obstruction, independent of smoking status. © Med Sci Monit, 2016

Evaluating the efficiency of long term oxygen therapy and mortality in chronic obstructive pulmonary disease [Kronik obstrüktif akciğer hastalığında uzun süreli oksijen tedavisi etkinliğinin ve mortalitenin değerlendirilmesi]

It has been shown that Long Term Oxygen Therapy (LTOT) improves polycythemia secondary to hypoxemia and right heart failure, decreases pulmonary hypertension, improves quality of life and increases life expectancy in COPD patients. In our study we aimed to evaluate clinical data, mortality, patient's adherence and efciency of the therapy in COPD patients receiving LTOT. Mean age was 70.5%±9.7 and 57% of the participiants were male. It was shown that one year hospital admission count after LTOT (0.56±0.79) was decreased according to one year hospital admission count before LTOT (1.14±1.64). When arterial blood gas values after LTOT compared to the values at the time prescription PaO2 was increased (47.9±4, 53.4±9) and PaCO2 was decreased (56.1±11, 50.5±11). Although there was no signifcant diference in pulmonary artery pressure after LTOT, a signifcant increase was determined in hematocrit (38.37±6, 40.14±6). 41.1% of the patients had at least once device maintanence, and after LTOT only 38.4% had a clinical control due to COPD. The most common reason for irregular use was lack of necessity. Mean daily oxygen usage was 13.88±4.35 hours/day and 68.8% of the patients were using 15 hours or more. Mean follow-up of the patients were 17.85±14.53 (1-55) months and mortality rate in this period was 67%. Mortality was higher in LTOT with 15hours/day or more compared to less than 15 hours (respectively 54.6%, 12.5%). In conclusion, all patients with an indication for LTOT should be followed by national registry system and monitored in terms of technical services. Patients adherence and routine controls should be provided. Key words: COPD, mortality, concentrator, oxygen, LTOT © 2015, TIP ARASTIRMALARI DERNEGI. All rights reserved

The neutrophil-to-lymphocyte ratio in patients with obstructive sleep apnoea syndrome and its relationship with cardiovascular disease

Objective: To investigate the association between the neutrophil-to-lymphocyte ratio (NLR) and obstructive sleep apnoea syndrome (OSAS) severity and whether the NLR predicts cardiovascular disease (CVD) in patients with OSAS. Background: OSAS is known as a risk factor for CVD. An increased NLR was strongly correlated with cardiovascular outcomes in several studies. Methods: We retrospectively examined the laboratory data for 289 patients with suspected OSAS evaluated using polysomnography. Results: The study included 171 OSAS patients and 118 controls. The NLR was higher in OSAS group than control group. The NLR was significantly higher in patients with CVD than in those without (3.31 ± 1.1 vs. 1.93 ± 0.8, p = 0.002). There were also significant correlations between the NLR and apnoea-hypopnoea index, mean SaO2, and oxygen desaturation index. Conclusions: There was a significant correlation between the NLR and OSAS severity and the NLR was independently associated with CVD in patients with OSAS. © 2016 Elsevier Inc

Bronchoalveolar lavage fluid characteristics of patients with sarcoidosis and nonsarcoidosis interstitial lung diseases: Ten-year experience of a single center in Turkey

Background: Bronchoalveolar lavage (BAL) is a noninvasive and useful technique for evaluating interstitial lung diseases (ILDs). Flow cytometric analysis of BAL fluid reveals specific diagnostic information in some unusual ILDs, and helps to narrow down the possible causes of interstitial diseases in most patients with more common disorders. A high BAL CD4/CD8 ratio is highly specific for sarcoidosis but can also be seen in other ILDs. Objectives: In this retrospective, descriptive, cross-sectional study, we compared BAL fluid characteristics and clinical variables in patients with sarcoidosis and non-sarcoidosis ILDs in a large cohort. Patients and Methods: The study was conducted in a tertiary university hospital in Zonguldak, the biggest city of the western Black Sea region of Turkey. Between 2004 and 2014, all patients who underwent both fiberoptic bronchoscopy and BAL with a suspicion of ILD were included in the study, retrospectively. Patients were divided into two main groups: sarcoidosis and non-sarcoidosis ILDs. Non-sarcoidosis ILDs were further divided into subgroups: pneumoconiosis, tuberculosis (TB), collagen vascular diseases, idiopathic interstitial pneumonias, malignancies, and unclassified ILDs. The clinical data of patients, including age, gender, smoking status, pulmonary function tests, and BAL flow cytometric analysis results, were compared among groups. Results: In total, 261 patients (119 sarcoidosis and 142 non-sarcoidosis ILDs) were enrolled. The median (interquartile range) BAL CD4/CD8 ratio and lymphocyte fraction were significantly higher in sarcoidosis than in non-sarcoidosis ILDs: 3.88 (3.76) versus 0.88 (1.01), respectively, and 20.6 (28.3) versus 6.0 (13.7), respectively. T cell receptor ? delta, CD16+56+, CD103+, CD8+103+, and CD3+16+56+ cells were significantly lower in sarcoidosis than in non-sarcoidosis ILDs. The median BAL CD4/CD8 ratios were significantly higher in patients with TB (1.87, P = 0.01) and malignancies (1.69, P = 0.03) than in other non-sarcoidosis ILDs. Conclusions: Among BAL fluid flow cytometric parameters, CD4/CD8 and lymphocyte fraction may be helpful for distinguishing sarcoidosis from other ILDs, but they are neither specific nor diagnostic for any lung disease. Thus, a multidisciplinary diagnostic discussion is required to differentiate various ILDs. © 2015, Iranian Red Crescent Medical Journa

Comparison of the diagnostic value of different lymphocyte subpopulations in bronchoalveolar lavage fluid in patients with biopsy proven sarcoidosis

Background: Bronchoalveolar lavage is considered a helpful tool in the diagnosis of diffuse parenchimal lung diseases such as sarcoidosis. CD4/CD8 ratio is higly specific but not sensitive to distinguish sarcoidosis and other intestitial lung diseases. We aimed to compare the diagnostic value of CD4/CD8 ratio and other lmphocyte subpopulations such as CD3+16+56, CD103+, CD4+CD103+, CD8+CD103+ in bronchoalveolar lavage to distinguish sarcoidosis and other nonsarcoidosis interstitial lung diseases. Methods: Using the bronchoscopy records from 2006 to 2013, we evaluated 68 patients with biopsy proven sarcoidosis and 72 patients with clinicoradiological and/or biopsy proven diffuse parenchimal lung diseases. Cut off values, sensitivity and specificity were given for aforementioned parameters. Results: Bronchoalveolar lavage CD4/CD8 ratio, CD4+ T lymphocyte percentage, CD4+103+, CD3+CD103-, CD8+CD103+/CD103+ ratio were significantly higher in sarcoidosis than other diffuse parenchimal lung diseases whereas CD3+103+, CD3+16+56+, CD8+, CD8+CD103+, CD8+CD103+/CD8+ were significantly lower. Best cut off value of CD4/CD8 was 1.34 with sensitivity and specificity 76.4%, 79.4% respectively. The cut off values of CD4/CD8 of >3.5 and >2.5 had specificity 95.9% and 95.3%, respectively and sensitivity 52%, 41 %, respectively. Conclusion: CD4/CD8 ratio is highly specific but not sensitive for sarcoidosis diagnosis. Thus, BAL flow cytometry is not diagnostic alone without appropriate clinicoradiological and/or histopathological findings. © Mattioli 1885

Evaluation of clinical data and mortality among COPD patients receiving domiciliary NIMV therapy

OBJECTIVES: Domiciliary non-invasive mechanical ventilation (NIMV) is presumed to decrease hospital admissions and mortality in very severe chronic obstructive pulmonary disease (COPD) patients. This study was aimed to investigate the clinical data and mortality among COPD patients receiving domiciliary NIMV treatment. MATERIAL AND METHODS: A total of 40 COPD patients who were prescribed domiciliary NIMV at discharge between January 2010 and December 2011 were contacted by phone regarding their current health status, and the electronic patient charts of 34 patients who used NIMV regularly were retrospectively reviewed. RESULTS: The mean age of the patients was 67±15 years and 59% of them were females. The mean length of hospital stay was 14.5±6.82 days. Rate of admission to intensive care unit and use of invasive mechanical ventilation was 56% and 27%, respectively. The median follow up duration was 17 months. The 6-months, 1-year, 2-years and overall mortality rates were 24%, 38%, 50% and 56%, respectively. For patients surviving at least one year after domiciliary NIMV initiation (n=21), the mean number of hospitalizations in the year before-and after-NIMV initiation were 1.38±1.28 and 0.57±0.93 (p=0.003), respectively. Mean daily NIMV use was 8.91±4.46 hours. Mean daily NIMV use of the patients with a lifespan ?2 years was higher than that of the patients with a lifespan >2 years (11.82±4.02 hours/day versus 6.0±2.62 hours/day, respectively) (p<0.001). Long term oxygen was prescribed for the first time to 62% of the patients using NIMV. CONCLUSION: Domiciliary NIMV may have numerous beneficial effects such as decreasing hospital admissions for acute COPD exacerbations and related costs. It is very important in the battle against COPD, a disease with significant morbidity, mortality and economic burden. © 2014 by Turkish Thoracic Society

Association between continuous positive airway pressure and circulating omentin levels in patients with obstructive sleep apnoea

Purpose: Inflammation and oxidative stress play important roles in the pathogenesis of obstructive sleep apnoea syndrome (OSAS). Omentin is expressed in visceral adipose tissue and is associated with the inflammatory response. The aim of this study was to assess the relationship between OSAS and omentin based on a comparison of its serum levels at baseline and after 3 months of continuous positive airway pressure (CPAP) therapy. Methods: Ninety-six newly diagnosed OSAS patients and 31 non-apnoeic controls were enrolled in this study. Blood samples were obtained in the morning after polysomnography. Within the OSAS group, 30 patients were started on CPAP therapy and then reassessed clinically, including a blood test for serum omentin and other biochemical analysis, at 3 months. Results: Serum omentin levels were significantly lower in the OSAS group than in the control group (27.7 ± 7.6 and 42.5 ± 5.2 ng/mL, P &lt; 0.001). In the subgroup analysis, omentin concentrations were significantly lower in patients with severe OSAS than in those with mild/moderate OSAS (P &lt; 0.001). Circulating omentin levels were significantly correlated with the apnoea–hypopnoea index (AHI), mean SaO2, oxygen desaturation index, and serum C-reactive protein levels. Treatment with CPAP resulted in a significant increase in circulating omentin levels after 3 months, from 22.7 ± 1.4 to 41.2 ± 3.3 ng/mL (P &lt; 0.001). Conclusions: OSAS is associated with low serum omentin levels, and these levels can be reversed by effective CPAP treatment. © 2016, Springer-Verlag Berlin Heidelberg

Lung cancer, brucellosis and tuberculosis: Remarkable togetherness

A 68 years old male farmer referred with cough, expectorating sputum, intermittant fever, night sweats, fatigue and anorexia persisting for two weeks. There was a history of 80 packs each year of smoking and he was still an active smoker. Pneumonectomy was performed because of pulmonary epidermoid cancer and he received chemotherapy. He was diagnosed lung tuberculosis and using anti-tuberculous treatment for 4 months. He had a weight loss of 8 kg in last month. His body tempereature was 38.5 °C. Heart rate was 100/min. ESR was 51mm/h and CRP was 5.6 mg/dL. There was no proliferation in blood and sputum cultures. Three sputum specimens were examined and AFB wasn't detected. Fibronodular infiltration was seen in right lower zone of chest X-ray. In thorax CT, fibronodular densities were seen in lower lobe anterior and posterior segments. Brucella melitensis was isolated in blood culture. Second bronchoscopy was performed with suspect of brucellosis pneumonia. Brucella tube agglutination test was positive at titer 1/320 in the bronchial lavage fluid and 1/640 in concurrent serum sample. In cases with chronic cough or pneumonia which is irresponsive to nonspecific antibiotherapy, respiratory brucellosis must be rememberred in endemic areas. © 2013 Asian Pacific Tropical Medicine Press

Is pneumoconiosis a factor of severity in acute exacerbation of chronic obstructive pulmonary disease?

Background and Aim: Although working in a coal mine is a wellknown risk factor for chronic obstructive pulmonary disease (COPD), there insufficient data explaining the association between acute exacerbation of COPD (AECOPD) and coal worker pneumoconiosis (CWP). This study aimed to evaluate the features of patients with complicated CWP admitted for AECOPD and whether complicated CWP has any effect on increasing the severity of this disease. Materials and Methods: This study was designed as a retrospective cohort study. A total of 106 hospitalized patients were identified to have CWP. Patients who did not perform spirometry and with simple CWP were excluded. A total of 51 patients with complicated CWP, was included in the study group. Comparison group was selected from the patients with AECOPD without pneumoconiosis. Results: Patients with complicated CWP, when compared to patients without pneumoconiosis, had longer hospitalization times (12.96±8.49 days, 9.67±5.21 days respectively, p=0.021), a higher cost of hospitalization (€2029±2724, €931±820 respectively, p=0.003), and higher rates of infective microorganisms in respiratory secretions and/ or blood cultures (61.3%, 29.6% respectively, p=0.016). We found that significance of high cost was dependent on duration of hospitalization and culture positivity. The most frequently encountered infective microorganism in both groups with complicated CWP and without pneumoconiosis was pseudomonas aeruginosa. Conclusions: Preventive measures for CWP in regions with high prevalence of coal mining have a very important role in the fight against COPD, which has significant morbidity and mortality rates. © Società Editrice Universo (SEU)