Factors Influencing Diagnostic Success of Computed Tomography-guided Transthoracic Needle Biopsy in Intrathoracic Lesions: An Experience of a Reference Chest Disease Hospital

Introduction:Transthoracic needle biopsy (TNB) is a common, safe and inexpensive procedure used in the diagnosis of intrathoracic lesions. Until today, there is still no study about the influence of standardized uptake value (SUVmax) in positron emission tomography/computed tomography (PET/CT) on the diagnostic success of TNB in intrathoracic lesions. We aimed to analyze the factors, one of which was the SUVmax value influencing the diagnosis success of CT-guided TNB in pulmonary, mediastinal and pleural lesions. Secondary aim was to investigate the predictive clinical factors of complications.Methods:A retrospective study of 403 patients who underwent CT-guided TNB at a reference chest diseases hospital between February 2019 and February 2021 was conducted. A pulmonologist had performed the procedure with a 20-gauge fine-needle (Spinal) or a 14-gauge automated needle (tru-cut). Data of pathology, microbiology and clinical follow-up of the patients were collected. A chi-square and Student’s t-test were used to evaluate the patient-related factors (gender and smoking), lesion-related factors (type, side, location, size, presence of necrosis observed by CT, SUVmax value in PET/CT), and procedure factor (type of needle) on the diagnostic success. Additionally, associations between clinical characteristics of patients and the complications were assessed.Results:A total of 403 patients underwent CT-guided TNB were enrolled and overall success was 70% (284/403). Smoking history (75% vs 43%, p=0.02) was predictor for diagnostic success. Lesion size and SUVmax value were significantly high in diagnosed patients (for both p<0.001). Diagnostic success was high in peripheral and central lesions, more notably in central lesions (p=0.004, p=0.016, respectively). The 9.2 SUVmax cut-off value had sensitivity of 79%, specificity of %53, success of 79% (p<0.01). Cardiovascular diseases, anti-coagulants, vitamin K antagonists, and salicylate induced complications (p=0.031, p=0.022, p=0.011, p=0.04, respectively). Low-molecular-weight-heparin was associated with hemorrhage (p=0.016).Conclusion:We observed that type, size and SUVmax value of lesion and smoking status were the predictive factors for a diagnostic biopsy

Turkish thoracic society early career members task force group’s virtual congress notes: european respiratory society international congress 2020

In this article, Early Career Task Force Group members of the Turkish Thoracic Society summarize the European Respiratory Society 2020 virtual congress. Current developments in the field of respiratory diseases were compiled with the addition of sessions specific to coronavirus disease 2019 this year. Almost all of the congress sessions were examined, and the important and striking results of the congress were highlighted. Congress sessions were attended by expert researchers, and the prominent messages of each session were highlighted in short summaries. They were then grouped under relevant titles and ranked in order of meaning and relation. It was finalized by a team of researchers

Impact of Nosocomial COVID-19 Infection Among Hospitalized Patients with Respiratory Diseases

Objective: There are very few studies concerning the frequency and course of nosocomial Coronavirus disease-2019 (COVID-19) infection among patients hospitalized having diseases other than COVID-19. In our study, patients who were admitted to the pulmonology inpatient clinic from the emergency room due to non-COVID-19 diseases and later diagnosed with COVID-19 (index cases) and the nosocomial transmission caused by these patients and the clinical outcomes were analyzed. Method: This study was carried out on 44 inpatients without COVID-19 at a pulmonology inpatient clinic during the first wave of COVID-19 pandemic. Oro-nasopharyngeal swab samples were taken at the time of hospitalization to detect COVID-19 by reverse transcription-polymerase chain reaction (RT-PCR) test. The test results of four patients were found to be positive. Due to the risk of nosocomial transmission, the remaining patients were re-evaluated for COVID-19 disease by clinical, radiological, and RT-PCR tests (1 to 3 times, and/or if symptoms developed). All patients were followed up for 30 days after discharge. Results: Thirty-six males (81%) and 8 females (19%) with a mean age of 65.6±13.6 (31-93) years were included in the study. Twenty-five of these patients had cancer, six had chronic obstructive pulmonary disease exacerbation, four had an aggravation of idiopathic pulmonary fibrosis, three had infected bronchiectasis, two had pulmonary embolisms, and four had other disorders. The RT-PCR test results were found positive in 4 patients. In about two weeks, COVID-19 infection emerged in 16 of the remaining 40 patients, and 10 of them (63% of the infected) died. The RT-PCR test results of patients with COVID-19 infection were found to be positive on day 8.2 averagely (6-13). Conclusion: Nosocomial transmission of COVID-19 may create a risk of severe illness and death among vulnerable patients. It is crucial to take necessary measures in order to reduce the risk of COVID-19 transmission in hospitals

Evaluation of patients with fibrotic interstitial lung disease: Preliminary results from the Turk-UIP study

OBJECTIVE: Differential diagnosis of idiopathic pulmonary fibrosis (IPF) is important among fibrotic interstitial lung diseases (ILD). This study aimed to evaluate the rate of IPF in patients with fibrotic ILD and to determine the clinical-laboratory features of patients with and without IPF that would provide the differential diagnosis of IPF. MATERIAL AND METHODS: The study included the patients with the usual interstitial pneumonia (UIP) pattern or possible UIP pattern on thorax high-resolution computed tomography, and/or UIP pattern, probable UIP or possible UIP pattern at lung biopsy according to the 2011 ATS/ERSARS/ALAT guidelines. Demographics and clinical and radiological data of the patients were recorded. All data recorded by researchers was evaluated by radiology and the clinical decision board. RESULTS: A total of 336 patients (253 men, 83 women, age 65.8 +/- 9.0 years) were evaluated. Of the patients with sufficient data for diag-nosis (n=300), the diagnosis was IPF in 121 (40.3%), unclassified idiopathic interstitial pneumonia in 50 (16.7%), combined pulmonary fibrosis and emphysema (CPFE) in 40 (13.3%), and lung involvement of connective tissue disease (CTD) in 16 (5.3%). When 29 patients with definite IPF features were added to the patients with CPFE, the total number of IPF patients reached 150 (50%). Rate of male sex (p<0.001), smoking history (p<0.001), and the presence of clubbing (p=0.001) were significantly high in patients with IPE None of the women <50 years and none of the men <50 years of age without a smoking history were diagnosed with IPE Presence of at least 1 of the symptoms suggestive of CTD, erythrocyte sedimentation rate (ESR), and antinuclear antibody (FANA) positivity rates were significantly higher in the non-IPF group (p<0.001, p=0.029, p=0.009, respectively). CONCLUSION: The rate of IPF among patients with fibrotic ILD was 50%. In the differential diagnosis of IPF, sex, smoking habits, and the presence of clubbing are important. The presence of symptoms related to CTD, ESR elevation, and EANA positivity reduce the likelihood of IPF

Country-based analysis of COVID-19 publications in the first few months of the pandemic

Dear Editor, Assisted by the advanced technology and trade, the novel coronavirus has swiftly diffused around the globe. In a matter of few months, by March 2020, the world was faced with a pandemic1 . The fatality rates have varied within a wide band according to countries. Hospital capacities have been tested severely as SARS-CoV-2 spread at unprecedented rates, causing COVID-19 patients to need heavy hospitalization and intensive care. In almost all countries, lockdowns have led to economic and psychological problems. The urgency and global scope of the pandemic created a lacuna to be filled by national and international information sharing. Almost all scientific journals have prioritized COVID-19 and published additional issues to share the knowledge and experience on COVID-19. The need for inter-disciplinary and multidisciplinary collaboration required a prompt adaptation of academics to the crisis management

How Successful is Non-Invasive Ventilation Treatment that is Initiated in the Emergency Department in Cases of COPD Exacerbations with Acute Hypercapnic Respiratory Failure? Can We Predict Treatment Failure?

Objective: We aimed to investigate the success rate of non-invasive ventilation (NIV) in wards and the predictors of failure in cases of chronic obstructive pulmonary disease (COPD)-related acute hypercapnic respiratory failure (AHRF). Methods: The was a retrospective study conducted in a tertiary teaching hospital between May 2011 and 2013. Patients who were admitted to the emergency department (ED) because of COPD with AHRF were evaluated; 544 patients who initially received NIV in ED and were transferred to wards were included. Patient characteristics, baseline and follow-up pH values, and partial arterial carbon dioxide (PaCO2) values were recorded. Baseline pH values were categorized as severe (pH<7.26), moderate (pH≥7.26–7.30), and mild (pH≥7.30) acidosis. According to the in-hospital outcome, patients were classified in 2 groups: Group 1: home discharge, Group 2: death or intensive care unit transfer. Results: Treatment resulted in success in 477 (88%) patients. Albumin levels were significantly low and the mean Charlson index (CI) score was significantly high in Group 2. Admission pH and PaCO2 values did not affect the treatment outcome. Patients in Group 2 had higher PaCO2 and lower pH values as well as a lower level of decrease in PaCO2 values within 2 hours of treatment in ED. Similarly, higher PaCO2 and lower pH values at the end of the first day in wards were indicative of NIV failure (p<0.05). Conclusion: The success rate of NIV in wards in cases of AHRF is high. Patients with low albumin levels and higher CI scores have worse response to treatment. pH or PaCO2 values after a few hours of treatment and not the baseline pH or PaCO2 values are better predictors than the baseline pH and PaCO2 values

COVID-19 Treatment at a Glance

As coronavirus disease 2019 (COVID-19) spreads across the world, the ongoing clinical trials are leading to a big race worldwide to develop a treatment that will help control the pandemic. Unfortunately, COVID-19 does not have any known effective treatment with reliable study results yet. In this pandemic, there is not a lot of time to develop a new specific agent because of the rapid spread of the disease. The process of developing a vaccine is long and requires hard work. Although the pathophysiology of the disease is not fully understood, some of the proposed treatment alternatives are based on old evidence and some have been used with the idea that they might work owing to their mechanism of action. The efficacy, reliability, and safety of the currently available treatment alternatives are therefore a matter of debate. Currently, the main therapies used in the treatment of COVID-19 are antiviral drugs and chloroquine/hydroxychloroquine. Other proposed options include tocilizumab, convalescent plasma, and steroids, but the mainstay of the treatment in intensive care units remains supportive therapies.WOS:0006000703000122-s2.0-8510314165

Transbronchial Biopsy: Our Experience in 5 Year

Objective: Transbronchial biopsy (TBB) is an old diagnostic method applied via fiberoptic bronchoscopy. The diagnostic value and complication rate of the procedure were found to vary in previous studies. In present study, the diagnostic value of TBB was analysed. Methods: All medical files of 308 patients who underwent TBB between May 2010-May 2015 in our clinic were reviewed retrospectively. According to the final diagnoses, the diagnostic value and complication rates of TBB, the contribution of the additional samples of the same bronchoscopic session to the diagnoses, and the requirement of any additional invasive procedure were investigated. Results: Of all the patients, 63% were female and the mean age was 51 (17-85). Bronchoalveolar lavage was taken in 257 patients. Ten percent of the procedures could not reach lung parenchyma. TBB was diagnostic in 105 (34%) patients. Fifty (16%) patients were diagnosed via other samples of the same session, 15 (5%) resolved spontaneously, 28 (9%) were diagnosed via other clinical findings, 41 (14%) did not accept further invasive method or were lost-to follow-up. Sixty-nine (22%) underwent an additional invasive procedure. The most frequent final diagnosis was sarcoidosis and the diagnostic value of TBB was 49%. Diagnostic rate of TBB was lower in fibrotic interstitial lung diseases (ILD) and malignancy whereas higher in non-fibrotic ILD. No mortality was seen related to TBB, pneumothorax was seen in 6%; non-massive bleeding in 3%, respiratory failure in 0.3%. Conclusion: Transbronchial biopsy is a procedure having a higher diagnostic value in certain diseases and has an acceptable morbidity. When combined with other bronchoscopic samples, the need for further invasive methods decreases significantly

Unclear issues regarding COVID-19

Scientists from all over the world have been intensively working to discover different aspects of Coronavirus disease 2019 (COVID-19) since the first cluster of cases was reported in China. Herein, we aimed to investigate unclear issues related to transmission and pathogenesis of disease as well as accuracy of diagnostic tests and treatment modalities. A literature search on PubMed, Ovid, and EMBASE databases was conducted, and articles pertinent to identified search terms were extracted. A snow-ball search strategy was followed in order to retrieve additional relevant articles. It was reported that viral spread may occur during the asymptomatic phase of infection, and viral load was suggested to be a useful marker to assess disease severity. In contrast to immune response against viral infections, cytotoxic T lymphocytes decline in SARS-CoV-2 infection, which can be partially explained by direct invasion of T lymphocytes or apoptosis activated by SARS-CoV-2. Dysregulation of the urokinase pathway, cleavage of the SARS-CoV-2 Spike protein by FXa and FIIa, and consumption coagulopathy were the proposed mechanisms of the coagulation dysfunction in COVID-19. False-negative rates of reverse transcriptase polymerase chain reaction varied between 3% and 41% across studies. The probability of the positive test was proposed to decrease with the number of days past from symptom onset. Safety issues related to infection spread limit the use of high flow nasal oxygen (HFNO) and continuous positive airway pressure (CPAP) in hypoxic patients. Further studies are required to elucidate the challenging issues, thus enhancing the management of COVID-19 patients.Turkish Thoracic Society (TTS)This study was supported by Turkish Thoracic Society (TTS) and is a product of the collaboration of TTS Early Career Members Taskforce Group