Should the cut-off value of D-dimer be elevated to exclude pulmonary embolism in acute exacerbation of COPD?

Objective: The aim of this study was to evaluate the D-dimer levels in patients with chronic obstructive pulmonary disease (COPD) exacerbation with and without pulmonary embolism (PE) and to attempt to define a new cut-off value for D-dimer to exclude the diagnosis of PE in patients with COPD exacerbation. Methods: This cross-sectional study was performed between the June 2012 and January 2013. The COPD patients who were admitted to the emergency department with acute exacerbation were consecutively included. D-dimer levels were measured upon admission. All patients underwent computed tomography angiography (CTA) and Doppler ultrasonography (US) of the lower extremities. Results: A total of 148 patients were enrolled. Fifty-three patients (36%) who did not have PE had higher than normal (>0.5 pg/mL) D-dimer levels. The D-dimer levels of the COPD patients with PE were significantly higher than those of the patients without PE (2.38±2.80 vs. 1.06±1.51 pg/mL) (P<0.001). The cut-off value for D-dimer in diagnosing PE in the COPD patients was 0.95 pg/mL. The area under the receiver operating characteristic (ROC) curve was 0.752±0.040 (95% CI: 0.672-0.831) (P<0.001). Conclusions: This study showed that the D-dimer concentrations of COPD patients who are in the exacerbation period may be higher than normal, even without PE. The cut-off level for D-dimer was 0.95 pg/mL (sensitivity 70%, spesificity 71%) for the exclusion of PE in the patients with COPD exacerbation. The D-dimer cut-off value that is used to exclude PE in patients with acute exacerbation of COPD should be reevaluated to prevent the excessive use of further diagnostic procedures

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

Patient and physician delay in the diagnosis and treatment of non-small cell lung cancer in Turkey

Aim: The early diagnosis and treatment of lung cancer are important for the prognosis of patients withlung cancer. This study was undertaken to investigate patient and doctor delays in the diagnosis andtreatment of NSCLC and the factors affecting these delays.Materials and methods: A total of 1016 patients, including 926 (91.1%) males and 90 (8.9%) females with amean age of 61.5 10.1 years, were enrolled prospectively in this study between May 2010 and May2011 from 17 sites in various Turkish provinces.Results: The patient delay was found to be 49.9 96.9 days, doctor delay was found to be 87.7 99.6 days,and total delay was found to be 131.3 135.2 days. The referral delay was found to be 61.6 127.2 days,diagnostic delay was found to be 20.4 44.5 days, and treatment delay was found to be 24.4 54.9 days.When the major factors responsible for these delays were examined, patient delay was found to be morefrequent in workers, while referral delay was found to be more frequent in patients living in villages(p < 0.05). We determined that referral delay, doctor delay, and total delay increased as the number of doctorswho were consulted by patients increased (p < 0.05). Additionally, we determined that diagnostic andtreatment delays were more frequent at the early tumour stages in NSCLC patients (p < 0.05)

Galectin-3: a novel blood test for the classification of patients with COPD. An observational study

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is one of the major causes of mortality and mortality affecting the whole world. In the inflammatory process, lectin is elevated and consequently, Galectin-3 expression is increased. This relation has been revealed by studies on coronary diseases. However, studies on the association of Galectin-3 with COPD and even other pulmonary diseases have been limited, although it has been studied and described on cardiologic patients. For this reason, in this study Galectin-3 levels in different stages of COPD patients were investigated and whether Galectin-3 could be a guide clinically.  MATERIAL AND METHODS: This is an observational prospective study, approved by local ethic committee (30112015-12), which included three groups of patients, COPD exacerbation, COPD stable and control group, admitted to tertiary healthcare between 01.09.2016 and 01.09.2017.  RESULTS: 137 subjects were included in the study. The mean age of patients in the study was 70.6. Galectin- 3 level in the group of COPD (exacerbation and stable) was significantly lower than the control group (p &lt; 0.001). The Galectin-3 level was significantly lower in COPD exacerbation group than groups of stable COPD and control. And also, Galectin-3 level was significantly lower in stable COPD group than the control group (p values: 0.034, 0.001 and 0.013, respectively). The ROC analysis for the Galectin-3 levels between the COPD patients (exacerbation and stable) and the control group is shown in Figure 2 (AUC = 0.784). When the cut-off points of Galectin-3 is selected as 11.4; for this cut-off point, sensitivity is 83% and specificity is 71% for this cut-off point (AUC: 0.79 %95 GA: 0.70–0.86 p &lt; 0.001).  CONCLUSIONS: COPD is a disease with high mortality and morbidity and efforts are being made to identify its severity and exacerbations with various biomarkers. In this study, Galectin-3 levels were found to be lower in patients with stable COPD group according to the control group. In addition, galactin-3 levels were found to be lower in COPD exacerbation group according to both Stable COPD group and control group. Although a certain threshold value was found in this study, more studies are needed to determine this threshold value more precisely. However, it is clear that these data are promising

The contribution of combined resection to survival in a patient with non-small cell lung carcinoma which has solitary synchronous cranial metastasis

Küçük hücreli dışı akciğer kanserli (KHDAK) hastaların üçte birinde beyin metastazı görülür. Beyin metastazlı hasta tedavi edilmezse nörolojik semptomlar hızla ilerler ve ortalama sağkalım iki aydır. Seçilmiş bir hasta grubunda akciğer ve beyne cerrahi tedavi yaklaşımı ile uzun sağkalım elde edilebileceğini gösteren yayınlar vardır. Bu makalede, beyin metastazı nedeniyle evre IV olan bir KHDAK?li olgumuzda kombine cerrahi tedavi yaklaşımını irdeleyerek, küçük bir hasta grubu da olsa, benzer hastalarda cerrahi tedavinin önemine dikkat çekmeyi amaçladık.Brain metastasis are seen in 1/3?rd of non-small cell lung carcinoma (NSCLC). If brain metastasis is not treated, neurologic symptoms rapidly progress and median survival is two months. It is reported that surgical resection of brain metastasis and primary lung tumor provides long survival. In this report, we aimed to emphasize the importance of surgical treatment in similar patients, by investigating the combined surgical treatment approach in a NSCLC patient who is stage IV due to brain metastasis

Smoking habits of university students and level of their knowledge about the topic

Amaç: Tütün kullanımı, dünyadaki en önemli önlenebilir ölüm nedenidir. Sigara içenlerin 1/3?ü 13 ya?ından, %90?ı ise 20 ya?ından önce sigaraya başlar. Bu nedenle sigara firmaları sistemli biçimde çocuklara ve gençlere yönelmektedir. Bu çalışmanın amacı, sigara firmalarının hedefleri içinde olan üniversite öğrencilerinin tütün kullanımı ile ilgili bilgi düzeyini ölçmek ve gençlerin tütün kullanımı ile ilgili tutumunu değerlendirmektir. Gereç ve yöntem: Çalışmaya Ufuk Üniversitesi Tıp Fakültesi (TF), Hukuk Fakültesi (HF) ve Hemşirelik Yüksek Okulu (HYO) öğrencileri arasından gönüllü olan 324 genç alındı. The Global Youth Tobacco Survey Collaborative Group tarafından hazırlanan ?Global Youth Tobacco Survey? (GYTS) adlı ankete nargile kullanımı ile ilgili sorular eklenip, üniversite etik kurulu onayıyla öğrencilere uygulandı. Bulgular: Öğrencilerin %38?i halen sigara içmekteydi. Sigara içme oranı en yüksek HF, en düşük TF öğrencilerinde bulundu (p<0.05). Sigaranın zararlarıyla ilgili ders alma oranı TF?de en yüksekti (p<0.001). Erkek öğrencilerde sigara ve nargile içme oranı kız öğrencilere göre daha yüksekti (p<0.05, p<0.001). Sigara içenlerin çoğu (%79) sigaraya üniversiteden önce ba?lamı?tı. Hukuk fakültesindeki öğrencilerde ve erkek öğrencilerin arkada?larında sigara içme oranı daha yüksek bulundu (p<0.001). Yüzde 15.4?ü hem sigara hem nargile içerken, %12.7?si sadece nargile içiyordu. Üç yüz bir öğrenci (%92.9) sigaranın, 234 öğrenci (%72.2) nargilenin zararlı olduğunu biliyordu. İki yüz seksen beş öğrenci (%85) pasif içiciliğin zararlı olduğunu belirtti. Öğrencilerin %76.2?si kapalı alanlarda sigara içme yasağını destekliyordu. Halen sigara içmekte olan 99 öğrencinin %62?si sigarayı hemen bırakmak istiyordu, ancak %59?u sigarayı bırakmaları için yardım veya tavsiye almamıştı. Sonuç: Çalı?mamızda, öğrencilerin %79?unun üniversite öncesi sigaraya başlaması, önlemlerin küçük yaşlarda alınması gerektiğini bir kez daha göstermiştir. Bu eğitim sırasında, özellikle bilgi düzeyi daha düşük olduğu için, nargilenin zararlarının da vurgulanması gerekmektedir. Sigaraya başlamış olan gençlerin çoğu sigarayı bırakmak istemektedir. Bu konuda yeterli desteğin verilmesi için gerekli düzenlemeler yapılmalıdır.Aim: Smoking is the most important preventable cause of death in the world. One third of the smokers start smoking before the age of 13 and 90% start before the age of 20. Therefore, cigarette companies systematically target young people. The aim of this study is to determine the level of knowledge of university students and to evaluate their attitude about smoking. Material and methods: Three hundred twenty four students from faculty of medicine (MF), faculty of law (LF) and nursing school (NS) of Ufuk University were included in the study. A questionnaire prepared by Youth Tobacco Survey Collaborative Group and named ?Global Youth Tobacco Survey? (GYTS) was performed after adding some questions about use of nargile (water-pipe). Results: Thirty eight percent of the students were current smokers. The smoking rate was highest in LF and lowest in MF (p&lt;0.05). The learning rate of the damage smoking can cause was highest among MF students (p&lt;0.001). Smoking and water-pipe use were more prevelant among males (p&lt;0.05, p,0.001). Most of the smokers (%79) had started smoking before university. Smoking rate was higher among LF students and friends of males (p&lt;0.001). Among the students,15.4% was smoking both cigarette and water-pipe, 12.7% only water-pipe. While, 92.9% of students had known that smoking was harmfull, only 72.2% of them was aware of the damage water-pipe can cause. Two hundred eighty five students (85%) indicated that passive-smoking was harmfull and 76.2% of them supported prohibition of smoking. Although, 62% of 99 current smokers wanted to stop smoking, 59% of them did not take any help or advice. Conclusion: Seventy nine percent of the students who were included in the study started smoking before university. This result showed once again that efforts to prevent smoking should start at early ages. Because of the low level of knowledge, the damages of water-pipe should be emphasized. Since most of the young people who are current smokers want to stop smoking, supportive preventions must be arranged

THE FACTORS INFLUENCING DELAY OF DIAGNOSIS IN LUNG CANCER

Akciğer kanseri dünya çapında en önemli mortalite nedenlerinden biridir. Tanı gecikmesi, hastada emosyonel strese, kür ve etkili palyasyon sağlayacak tedavilerin gecikmesine neden olmaktadır. Bu çalışmada; akciğer kanserli hastalarda tanı ve tadavi gecikmesini etkileyen faktörlerin araştırılması amaçlanmıştır. Histopatolojik tanısı konmuş 106 akciğer kanserli hastanın semptomlarının başlangıcından doktora başvurusuna geçen süre (SB), başvurudan patolojik tanıya (BP), başvurudan tedavi başlangıcına (BT), semptom başlangıcından tedavi başlangı- cına (ST) geçen süre retrospektif olarak değerlendirildi. Semptom başlangıcından doktor başvurusuna kadar geçen süre ile hastaların cinsiyeti, mesleği, yaşadığı yer, lezyonun lokalizasyonu, malignite öyküsü, kronik akciğer hastalığı varlığının ilişkisi değerlendirildi. Semptom başlangıcından tedavi başlangıcına kadar geçen sürenin lezyonun lokalizasyonu, malignite öyküsü, kronik akciğer hastalığı olması ile ilişkisi değerlendirildi. Hastaların evrelerine göre SB, BP ve BT’ye geçen süre değerlendirildi. SB ve BP sırasıyla 42.5±61.6, 61.7±55.6 gündü. En hızlı başvuran vena kava süperior sendromlu hastayı, hemoptzisi ve nörolojik semptomları olan hastalar izlemekteydi. Hastanın cinsiyetinin, mesleğinin SB’yi, yaşadığı yerin, lezyon lokalizasyonunun, malignite öyküsünün ve kronik akciğer hastalığı varlığının SB ve ST’yi etkilemediği bulundu. Evreler arasında SB, BP, BT açısından fark izlenmedi. Çalışmamızda akciğer kanserli hastalarda semptom başlangıcından doktora başvuruya ve tedavi başlangıcına kadar geçen süreler önerilenden daha uzun bulundu. Bu gecikmeyi hastanın yaşadığı yer, mesleği, kronik akciğer hastalığı olması, kendisinde başka kanser, ailesinde akciğer kanseri olmasının ve lezyonun lokalizasyonunun etkilemediği görüldü. Semptomlar başladıktan sonra en kısa sürede akciğer kanseri tanısını koyup etkin tedavinin uygulanabilmesi için tanı gecikmesini etkileyen faktörleri belirlemeye yönelik ileri araştırmalara ihtiyaç vardır.Lung cance r is worldwide important cause of mortality. Diagnostic delay results emotional stress and treatment delay. The aim was to investigate factors influencing delay in diagnosis and treatment of lung cancer. Histopathologically proven 106 patients with lung cancer were enrolled.Time from initiation of symptom to reference to doctor (SR) and to treatment (ST), from reference to pathological diagnosis (RP) and to treatment (RT) were evaluated retrospectively. The relationship between SR and gender, profession, living place, localization of lesion, malignancy history, presence of chronic lung disease was evaluated. The relationship between ST and living place, localization of lesion, malignancy history, presence of chronic lung disease was evaluated. SR, RP and RT were evaluated according to stages of patients. SR and RP were respectively 42.5±61.6, 61.7±55.6 days. Most rapid reference was acquired to patient who had vena cava superior syndrome, was followed up by patients who had hemoptysis and neurologic symptoms. Gender and profession was not effective on SR. Localization of lesion, malignancy history, presence of chronic lung disease were not affective on SR and ST .There was no difference between stages of the disease in the means of SR, RP and RT. In this report SR and ST was found longer than suggested. It is shown taht this delay was not affected from living place, presence of chronic lung disease, malignancy history, localization of lesion. Further studies are nececcary to clarify reasons of diagnostic delay of lung cancer patients to apply appropriate treatment as soon as possible