Ekstra-torasik maligniteli hastalarda EBUS-TBİA tanı değeri ve PET-BT ile ilişkisi

Bu çalışma, 2019 yılında Bodrum[Türkiye]'da düzenlenen TRS Kongresi'nde bildiri olarak sunulmuştur.Introduction: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a well-established diagnostic tool for lung cancer, sarcoidosis, and suspected metastatic extra-thoracic malignancy (ETM). Patients with primary ETM often have hypermetabolic mediastinal/hilar lymph node enlargement in the PET-scan done for initial staging or post treatment follow-up. We aimed to determine the diagnostic performance of EBUS-TBNA and the relationship between PET-SUV values and diagnosis of malignancy metastasis in patients with ETM. Materials and Methods: Results of EBUS-TBNA in ETM patients with suspected MLN metastasis were retrospectively analysed (May 2016 to July 2019). Non-malign results were confirmed for surgery or clinical/radiological follow-up. Lymph nodes with a high FDG-uptake (SUV > 2.5, MLN) were reported as suspicious for metastasis. Results: Of the 588 EBUS procedures, 109 were included in the analysis. Patient' mean age was 62.5 +/- 10.1 years; there were 35 men and 74 women. Primary malignancies were breast cancer in 33, gastrointestinal in 23, female genital tract in 17, head and neck in 14, genitourinary cancer in 13, malignant melanoma in 6, sarcoma in 2 and kaposi sarcoma in 1. According to EBUS-TBNA smear and cell block histopathologic evaluations, 16 patients' results (14.7%) were malignant compatible with metastasis of ETM. Among the 93 patients with non-malignant diagnosis, EBUS-TBNA revealed a granulomatous lympadenitis compatible with sarcoid reaction in 7 and tuberculosis in 2. A total of 9 patients underwent surgical procedures after EBUS-TBNA, with a definitive histological diagnosis of granulomatous lymphadenitis in 2, malignancy in 5 and, reactive lymph node in 2. Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of EBUS-TBNA were 76.19% (95% CI 52.83-91.78), 100% (95% CI 95.89-100.00), 100%, 94.62% (95% CI 89.12-97.12) and 95.4%, respectively. Conclusion: EBUS-TBNA sampling has high diagnostic performance. Histopathological confirmation requirement for MLN should be kept in mind in patients with ETM, even they have negative EBUS results.Giriş: Endobronşial ultrason-kılavuzluğunda transbronşial iğne aspirasyonu (EBUS-TBİA), akciğer kanseri, sarkoidoz ve metastatik ekstra-torasik malignitelerde (ETM) iyi tanımlanmış bir tanı yöntemidir. Primer ETM evrelemesi ve tedavi sonrası takipte, mediastinal/ hiler lenf nodu (MLN) genişlemesi sık görülmektedir. ETM tanısı olan hastalarda EBUS-TBİA tanı performansı, PET-SUV değerleri ile malign metastaz tanısı arasındaki ilişkiyi araştırmayı hedefledik. Materyal ve Metod: Şüpheli malign metastaz olan ETM hastalarında yapılan EBUS-TBİA sonuçları retrospektif olarak analiz edildi (Mayıs 2016-Temmuz 2019). Malign olmayan sonuçlar cerrahi veya klinik/radyolojik takip ile konfirme edildi. Yüksek FDG-uptake olan (SUV > 2.5, MLN) lenf nodları metastaz şüpheli olarak raporlandı. Bulgular: Toplam 588 EBUS işleminden 109'u analize dahil edildi. Hastaların ortalama yaşı 62.5 ± 10.1; 35'i erkek, 74'ü kadın idi. Primer malignitelerin, 33’ü meme kanseri, 23'ü gastrointestinal, 17'si kadın genital sistem, 14'ü baş-boyun, 13’ü genitoüriner kanser, 6'sı malign melanom, 2'si sarkom ve 1'i kaposi sarkomu idi. EBUS-TBİA yayma ve hücre bloğu histopatolojik sonuçlarına göre 16 hastada (%14.7) ETM metastazı ile uyumlu malignite saptandı. Malign olmayan 93 hastadan 7'sinde sarkoid reaksiyon ile uyumlu granülomatöz lenfadenit, 2'sinde tüberküloz, 5'inde malignite bulundu. EBUS-TBİA sonrası cerrahi ile toplam 9 hastanın 2'sinde granülomatöz lenfadenit, 5'inde malignite ve 2’sinde reaktif lenf nodu saptandı. EBUS-TBİA için toplam duyarlılık, özgüllük, pozitif prediktif değer, negatif prediktif değer ve tanı doğruluğu, sırasıyla %76.19 (%95 GA 52.83-91.78), %100 (%95 GA 95.89-100.00), %100, %94.62 (%95 GA 89.12-97.12) ve %95.4 olarak saptandı. Sonuç: EBUS-TBİA örneklemesi tanı performansı yüksek bir yöntemdir. Negatif EBUS sonuçları olsa da, MLN genişlemesi olan ETM tanılı olgularda histopatolojik doğrulama gerekliliği akılda tutulmalıdır

The effect of CPAP treatment on excessive daytime sleepiness and serum substance P levels in osas patients

Obstrüktif uyku apnesi sendromu (OUAS), uyku sırasında tekrarlayan üst solunum yolu obstrüksiyonları, intermittan hipoksi ve arousallar ile seyreden bir hastalıktır. Tekrarlayan uyanma, dinlendirici olmayan uyku, yorgunluk, konsantrasyon güçlüğü sık görülen yakınmalardır. Çalışmamızın amacı OUAS hastalarında devamlı pozitif havayolu basıncı (CPAP) tedavisinin gündüz uyku hali ve serum Substans P (SP) düzeyleri üzerine etkisinin araştırılmasıdır. Uludağ Üniversitesi Göğüs Hastalıkları Genel Polikliniği'ne başvuran horlama, tanıklı apne, gündüz aşırı uyku hali semptomları olan, hipertansiyon dışında ciddi medikal rahatsızlığı olmayan 90 hasta çalışmamıza dahil edildi. OUAS tanısını kesinleştirmek için tüm olgulara Uludağ Üniversitesi Tıp Fakültesi Göğüs Hastalıkları Uyku Laboratuarı'nda tekniker gözetimiyle polisomnografi (PSG) yapıldı. Hastalara PSG yapılmadan önce Epworth Uykululuk Ölçeği (ESS), Pittsburg Uyku Kalitesi Ölçeği (PSQI) ve Uykunun Fonksiyonel Sonuçları Ölçeği (FOSQ) anketleri uygulandı. AHİ ≥ 5 olan olgular çalışma grubu (n=19), basit horlama saptanan olgular (AHİ<5) kontrol grubu (n=71) olarak alındı. Çalışmaya katılan hastaların 71'i (%78,9) erkek, 19'u (%21,1) kadın idi. Yaş ortalamaları 45 [20-62] idi. Polisomnografi sonrası alınan kan örneklerinde daha önceki çalışmalarda olduğu gibi OUAS grubunun SP düzeylerinin kontrol grubuna göre istatistiksel anlamlı olarak düşük olduğunu ve SP düzeyinin AHİ ile negatif korele olduğunu saptadık. Ancak olgular ESS skorlarına göre ESS<10 ve ESS≥10 olarak iki grup halinde değerlendirildiğinde gruplar arasında serum SP başlangıç düzeyleri açısından anlamlı fark tespit edilmedi. Başlangıç SP değerleri ile ESS arasında korelasyon saptanmadı. Pozitif hava yolu basıncı tedavisi başlanan olgular 3 ay tedavi aldıktan sonra kullanım süreleri, serum SP değerleri, gündüz aşırı uyku hali, yaşam kalitesi ve uyku kalitesi açısından yapılan anketler ile değerlendirildi. Üç aylık tedavi sonrası olguların 3. ay ve başlangıç SP değerleri karşılaştırıldı. SP düzeylerinin tedavi sonrası anlamlı derecede azalığı tespit edildi. Üç yüz saat ve üzeri kullanım süresi olan tedavi uyumu iyi olarak değerlendirilen olgular ele alındığında bu olguların da 3. ay kontrol SP düzeylerinin başlangıç değerlerine göre belirgin olarak azaldığı saptandı. Kullanım süresine göre yapılan analiz sonuçlarına göre 3. ay ve başlangıç SP değişim yüzdesi ile kullanım süresi arasında korelasyon bulunmadığı tespit edildi.Obstructive sleep apnea syndrome (OSAS) is a commonly seen disorder characterized by repeated episodes of upper airway obstruction during sleep leading to intermittent hypoxemia or arousal. The aim of our study was the investigation of the effect of continuous positive airway pressure (CPAP) treatment on daytime sleepiness and serum Substance P (SP) levels in OSAS patients. Our study was carried out with 90 patients who were followed at Uludag University Faculty of Medicine Department of Pulmonary Disease. Patients who has symptoms as snoring, witnessed apnea, symptoms of excessive daytime sleepiness and without severe medical condition other than hypertension included the study. To confirm the diagnosis of OSAS, polysomnography (PSG) was performed under the supervision of a sleep technician in Uludag University Faculty of Medicine Department of Pulmonary Disease Sleep Laboratory. The Epworth Sleepiness Scale (ESS), Pittsburg Sleep Quality Scale (PSQI) and Sleep Functional Results Scale (FOSQ) were administered before the PSG was performed. Subjects with AHI ≥ 5 were considered to have OSAS. Subjects with AHI < 5 were included in the control group. Blood samples were drawn after the sleep study. 71 patients (78.9%) were male and 19 patients (21.1%) were female. Median age of population was 45 [20-62]. Serum substance P levels of the OSAS group were significantly lower than those of the control group. SP levels were negatively correlated with AHI as in previous stuies. However, when the cases were evaluated as ESS <10 and ESS≥10 according to ESS scores, no significant difference was found between the groups in terms of serum SP baseline levels. There was no correlation between initial SP values and ESS. After 3 months of treatment, patients was assessed by questionnaires from the point of view of cases, daytime sleepiness, quality of life and sleep quality and serum SP levels. After 3 months of treatment, 3rd month and initial SP values were compared. SP levels significantly decreased after treatment. When the cases with three hundred hours and over the period of use were taken into account, these cases were also found to be significantly decreased compared to the baseline values of the 3rd month control SP levels. The results of the analysis according to the duration of use showed that there was no correlation between the SP change percentage and duration of use

Determination of anthropometric measurements in obstructive sleep apnea syndrome in Turkish population

Giriş: Bu çalışmada, obstrüktif uyku apne sendromu (OSAS)'nun değerlendirilmesinde kullanılan antropometrik ölçüm ve oranların ülkemize ait değerlerini belirlemek istedik. Materyal ve Metod: Çok merkezli prospektif olarak planlanan çalışmamıza 13 ilimizde yer alan, akredite olmuş 20 uyku merkezi katıldı. OSAS semptomları olan ve polisomnografik inceleme ile apne-hipopne indeksi (AHİ) ? 5 bulunan olgular OSAS çalışma grubu; AHİ < 5 ve STOP-Bang < 2 olan olgular ise kontrol grubu olarak alındı. Olgulara ait demografik özellikler [yaş, cinsiyet, beden kitle indeksi (BKİ)] ve antropometrik ölçümler (boyun, bel ve kalça çevresi, bel/kalça oranları) kaydedildi. Bulgular: Çalışmaya 20 merkezden yaş ortalaması 50.50 ± 0.21 yıl olan 2684 (%81.3’ü OSAS’lı) olgu alındı. Olgular, ülkemizin altı coğrafi bölgesinden (Akdeniz, Doğu Anadolu, Ege, İç Anadolu, Karadeniz ve Marmara Bölgesi) alındı. Olguların demografik özellikleri ve antropometrik ölçümleri; kontrol grubuna göre karşılaştırıldığında yaş, boyun, bel, kalça çevresi ve bel/kalça oranları ve BKİ özellikleri; bölgelere göre karşılaştırıldığında ise yaş, boyun, bel, kalça çevresi ve bel/kalça oranları istatistiksel olarak farklı bulundu (sırasıyla p< 0.001, p< 0.001, p< 0.05). Cinsiyetlere göre karşılaştırıldığında yaş, boyun ve kalça çevresi, bel/kalça oranı, boy, kilo ve BKİ özellikleri istatistiksel olarak farklı idi (sırasıyla, p< 0.001). Boyun çevresi ve bel/kalça oranı sırasıyla erkeklerde 42.58 ± 0.10 cm (cut-off 41; duyarlılık %61.2; özgüllük %68.3), 0.99 ± 0.002 (cut-off 0.97; duyarlılık %56.4; özgüllük %54.3); kadınlarda 39.24 ± 0.16 cm (cut-off 37; duyarlılık %66.5; özgüllük %63.4), 0.93 ± 0.004 (cut-off 0.89; duyarlılık %70.9; özgüllük %49.5) bulundu. OSAS fenotipleri; klasik OSAS, okült OSAS, REM bağımlı OSAS, pozisyon bağımlı OSAS, REM ve pozisyon bağımlı OSAS, overlap sendromu ve kompleks uyku apne sendromu olarak belirtildi. OSAS fenotiplerine göre karşılaştırıldığında yaş, boyun ve kalça çevresi, boy, kilo ve BKİ özellikleri istatistiksel olarak farklı iken (sırasıyla, p< 0.001) bel/kalça oranı farklı bulunmadı. Sonuç: Boyun çevresi erkeklerde standart değerin altında iken, kadınlarda üstünde bulundu. Bel/kalça oranı hem erkeklerde hem de kadınlarda ideal ölçülerin üzerinde idi. Bu bağlamda ülke değerlerinin tespiti OSAS olasılığı olan hastaların belirlenmesini ve polisomnografi için uyku merkezlerine yönlendirilmesini sağlayacaktır.Introduction: In this study, we aimed to determine the values of anthropometric measurements and rates used in the evaluation of obstructive sleep apnea syndrome (OSAS) in our country. Materials and Methods: Twenty accredited sleep centers in thirteen provinces participated in this multicenter prospective study. OSAS symptoms and polysomnographic examination and apnea-hypopnea index (AHI) ? 5 cases OSAS study group; patients with AHI < 5 and STOP-Bang < 2 were included as control group. Demographic characteristics (age, sex, body mass index-BMI) and anthropometric measurements (neck, waist and hip circumference, waist/hip ratio) of the subjects were recorded. Results: The study included 2684 patients (81.3% OSAS) with a mean age of 50.50 ± 0.21 years from 20 centers. The cases were taken from six geographical regions of the country (Mediterranean, Eastern Anatolia, Aegean, Central Anatolia, Black Sea and Marmara Region). Demographic characteristics and anthropometric measurements; age, neck, waist, hip circumference and waist/ hip ratios and BMI characteristics when compared with the control group; when compared according to regions, age, neck, waist, hip circumference and waist/hip ratios were found to be statistically different (p< 0.001, p< 0.001, p< 0.05, respectively). When compared by sex, age, neck and hip circumference, waist/hip ratio, height, weight and BMI characteristics were statistically different (p< 0.001, respectively). Neck circumference and waist/hip ratio were respectively 42.58 ± 0.10 cm, 0.99 ± 0.002, 39.24 ± 0.16 cm, 0.93 ± 0.004 were found in women. Conclusion: The neck circumference was lower than the standard value in men, but higher in women. The waist/hip ratio was above the ideal measurements in both men and women. In this context, the determination of the country values will allow the identification of patients with the possibility of OSAS and referral to sleep centers for polysomnography

Association between burnout, anxiety and insomnia in healthcare workers: A cross-sectional study Burnout, anxiety and insomnia in healthcare workers

All healthcare workers (HCWs) encounter stress during in their working lives, and are constantly exposed to adverse conditions. The present study evaluates the relationship between burnout syndrome, anxiety levels and insomnia severity among healthcare workers, who mostly work in shifts. The Maslach Burnout Inventory, the Insomnia Severity Index and the Beck Anxiety Inventory were used to measure burnout, insomnia severity and anxiety status, respectively. This cross sectional study included a total of 1,011 HCWs and 679 (67.2%) of the study respondents were women. The respondents were aged 20-72, with a mean age of 35.67 +/- 8.61 years. Fifty-eight percent (n = 589) of the participants were rotating shift workers. Working on-call led to a significant difference in all burnout parameters (for each, <0.001). Age and on-call duty were seen to lead to a significant difference in the severity of insomnia (p = 0.028, p < 0.001, respectively). The total ISI score was found to be statistically significant positively correlated with the MBI subscales and the total BAI score (for each, <0.001). An increased awareness of the impact of sleep deprivation, burnout and anxiety among HCWs and meaningful interventions promoting change within the healthcare system are needed

ERS international virtual congress 2021: Highlights from the Turkish thoracic society early career members

This review aimed to highlight some important points derived from the presentations of the European Respiratory Society 2021 Virtual International Congress by a committee formed by the Early Career Task Group of the Turkish Thoracic Society. We summarized a wide range of topics including current developments of respiratory diseases and provided an overview of important and striking topics of the congress. Our primary motivation was to give some up-to-date information and new developments discussed during congress especially for the pulmonologists who did not have a chance to follow the congress. This review also committed an opportunity to get an overview of the newest data in the diverse fields of respiratory medicine such as post-coronavirus disease 2019, some new interventional and technologic developments related to respiratory health, and new treatment strategies

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 researchersTurkish Thoracic Society (TTS

The Impact of CoronaVac Vaccination on 28-day Mortality Rate of Critically Ill Patients with COVID-19 in Türkiye

Background:Vaccines against coronavirus disease-19 (COVID-19) have been effective in preventing symptomatic diseases, hospitalizations, and intensive care unit (ICU) admissions. However, data regarding the effectiveness of COVID-19 vaccines in reducing mortality among critically ill patients with COVID-19 remains unclear.Aims:To determine the vaccination status and investigate the impact of the COVID-19 vaccine on the 28-day mortality in critically ill patients with COVID-19.Study Design:Multicenter prospective observational clinical study.Methods:This study was conducted in 60 hospitals with ICUs managing critically ill patients with COVID-19. Patients aged ≥ 18 years with confirmed COVID-19 who were admitted to the ICU were included. The present study had two phases. The first phase was designed as a one-day point prevalence study, and demographic and clinical findings were evaluated. In the second phase, the 28-day mortality was evaluated.Results:As of August 11, 2021, 921 patients were enrolled in the study. The mean age of the patients was 65.42 ± 16.74 years, and 48.6% (n = 448) were female. Among the critically ill patients with COVID-19, 52.6% (n = 484) were unvaccinated, 7.7% (n = 71) were incompletely vaccinated, and 39.8% (n = 366) were fully vaccinated. A subgroup analysis of 817 patients who were unvaccinated (n = 484) or who had received two doses of the CoronaVac vaccine (n = 333) was performed. The 28-day mortality rate was 56.8% (n = 275) and 57.4% (n = 191) in the unvaccinated and two-dose CoronaVac groups, respectively. The 28-day mortality was associated with age, hypertension, the number of comorbidities, type of respiratory support, and APACHE II and sequential organ failure assessment scores (p < 0.05). The odds ratio for the 28-day mortality among those who had received two doses of CoronaVac was 0.591 (95% confidence interval: 0.413-0.848) (p = 0.004).Conclusion:Vaccination with at least two doses of CoronaVac within six months significantly decreased mortality in vaccinated patients than in unvaccinated patients