Erişkin yabancı cisim aspirasyon şüpheli olguların yönetimi

Objective: Although foreign body aspiration (FBA) in adulthood is not as common as in childhood, it can sometimes be encountered with clinical situations that require urgent interventions. Removal of foreign bodies (FBs) is crucial in all cases of aspiration, even if they seem trivial and symptoms have resolved. Unremoved FBs cause chronic lung pathologies such as postobstructive pneumonia, bronchiectasis, atelectasis and scar formation which can be definitely treated only by FB removal. The treatment of choice is either fiberoptic or rigid bronchoscopy. The aim of our study was to create an algorithm for the management of patients presenting to our bronchology and interventional pulmonology unit with suspected FBA by reviewing their radiologic findings, the bronchoscopic methods used in their management and outcomes. Methods: We retrospectively reviewed the medical records of 70 patients who underwent fiberoptic bronchoscopy (FOB) and rigid bronchoscopy (RB) for suspected FBA in our bronchology and interventional pulmonology center between January 2010 and December 2019. Results: There were 70 patients with suspected FBA, who had an average age of 47.22±20.76 years, and 62.8% were males. Twenty-nine (41.4%) were treated with FOB and 25 (35.7%) with RB. A FB was detected initially by FOB in 16 (22.9%) who subsequently had to undergo RB for FB removal. Fifteen (33.3%) FOB and 9 (21.9%) RB procedures were performed on an emergent basis. A total of 86 bronchoscopic treatments were performed on 70 patients. FBs were detected with FOB in 29 patients. The FB was removed in 13 (28.8%) patients with the help of FOB, while 16 (35.5%) patients in whom FB removal was not possible were referred to the interventional pulmonology unit for RB. In the remaining 16 (35.5%) patients, no FB was found during FOB. A total of 41 patients were treated with RB, including 16 patients who had initially undergone FOB. FB was detected and removed in 38 (92.6%) patients, 2 (4.8%) patients had no FB detected and received no further treatment after being consulted with thoracic surgery. One (2.4%) patient in whom FB was detected but could not be removed was referred to surgery and was operated. Rates of FB detection were high for both chest x-ray and unenhanced thoracic computerized tomography (CT) in favor of CT (p=0.038 and 0.022 respectively). Thirty-three (58.9%) of the FB removed were in the right bronchial system and composition of FBs (organic or inorganic) was equal. Conclusion: When thoracic CT is not available chest x-ray can also be helpful in cases of suspected FBA. Because the possibility of FBA should be considered in many chronic pulmonary conditions, physicians choose FOB for their initial evaluation, especially if transfer to an interventional pulmonology unit is not feasible. RB performed by interventional pulmonologists is a safe therapeutic option in critical patients and cases when FOB fails.Amaç: Erişkinlik çağında çocukluk çağındaki kadar sık rastlanmasa da erişkinlerde de bazen acil müdahale gerektirecek tablolarla yabancı cisim aspirasyonları (YCA) karşımıza çıkabilmektedir. Semptomlar kaybolsa, önemsiz görünseler de YC’lerin tüm aspirasyon vakalarında çıkarılması çok önemlidir çünkü çıkarılmamış YC'ler, postobstrüktif pnömoni, bronşektazi, atelektazi ve skar oluşumu gibi kronik akciğer patolojilerine neden olabilir. Terapötik yaklaşımda ilk tercih fiberoptik ya da rijid bronkoskopik uygulamalardır. Çalışmamızın amacı YCA şüphesi ile bronkoloji ve girişimsel pulmonoloji birimimizde işlem uygulanan hastaların radyolojik bulgularını, tedavide kullanılan bronkoskopik yöntemleri ve sonuçlarını gözden geçirilerek bu hastaların yönetimine yönelik bir algoritma oluşturmaktır. Yöntemler: Bronkoloji ve girişimsel pulmonoloji merkezimizde Ocak 2010 ile Aralık 2019 tarihleri arasında YCA şüphesi nedeniyle fiberoptik bronkoskopi (FOB) ve rijid bronkoskopi (RB) yapılan 70 hastanın tıbbi kayıtlarını geriye dönük olarak incelendi. Bulgular: Ortalama yaşları 47.22 ± 20.76 yıl olan ve % 62.8'i erkek olan 70 YCA şüphesi olan hasta değerlendirildi. Yirmi dokuzu (% 41.4) FOB ile, 25 (% 35.7)’i RB ile tedavi edilmişti. 16 (%22.9) hastada ise FOB ile YC saptanmış ancak çıkarılamayınca RB’ye geçilmişti. FOB uygulanan olguların 15 (%33.3)’i, RB uygulanaların ise 9 (%21.9)’u işleme acil olarak alınmıştı. 70 hastaya toplam 86 bronkoskopik tedavi uygulanmıştı. 29 hastada FOB ile FB'ler tespit edilmişti. 13 (% 28,8) hastada FOB yardımı ile YC çıkarılabilirken, çıkarılması mümkün olmayan 16 (% 35,5) hasta RB için girişimsel pulmonoloji ünitesine refere edilmişti. Geri kalan 16(%35.5) hastada ise FOB’de yabancı cisime rastlanmamıştı. Başlangıçta FOB uygulanan 16 hasta dahil toplam 41 hasta RB ile tedavi edilmişti. RB ile 38(%92.6) hastada YC saptanmış ve çıkarılabilmiş, 2(%4.8) hastada YC saptanamayarak, göğüs cerrahisi ile konsültasyon sonrası hastalar takipe alınmıştı. Bir (%2.4) hastada ise RB ile YC çıkarılamamış göğüs cerrahisine refere edilmiş ve opere olmuştu. YC saptama oranları toraks bilgisayarlı tomografide (BT) daha yüksek olmakla beraber hem akciğer grafisi hem de kontrastsız toraks BT’de yüksekti (sırasıyla p = 0.038 ve 0.022). Çıkarılan YC’in 33 (% 58.9)’ü sağ bronşiyal sistemdeydi ve YC'lerin bileşimi (organik veya inorganik) eşitti. Sonuç: YCA şüphesinde toraks BT’ye ulaşım imkanı olmayan durumlarda akciğer grafisi de yol gösterici olabilir. Birçok kronik pulmoner patolojide YCA olasılığının göz önünde bulundurulması gerektiğinden, hekimler, özellikle bir girişimsel pulmonoloji ünitesine transfer mümkün değilse, ön değerlendirme amaçlı FOB'yi seçebilirler. Girişimsel pulmonologlar tarafından gerçekleştirilen RB, kritik hastalarda ve FOB'nin başarısız olduğu durumlarda güvenli bir tedavi seçeneğidir

Evaluation of bronchoscopic signs of the patients working in coal mines

Amaç: Kömür madeninde çalışan ve progresif masif fibrosis (PMF) gelişen hastalarda tanı aşamasındaki bronkoskopik bulguları değerlendirmek için bu çalışmayı planladık.Gereç ve Yöntem: 2003-2006 yıları arasında kömür madeninde çalışma öyküsü olan 22 hastanın klinik, radyolojik ve bronkoskopik bulguları değerlendirildi.Bulgular: Hastaların hepsi erkek yaşları 43 ve 82 arasında ve ortalaması 66,4±9,37 idi. On beşi (% 68,2) sigara kulanıyordu. Kömür tozu maruziyet süreleri ortalama 21,5±9 yıldı . Hastaların 6'sında (% 27,3) klinik yakınma yoktu. Ağırlıklı olarak klinik yakınma nefes darlığı, öksürük ve balgam idi. Hastaların radyolojik bulgularına bakıldığında tamamında PMF (n:22, % 100), % 95,4'ünde fibrotik değişim (n:21), % 90'ında retikülonodüler görünüm (n:20), % 77,2'sinde kalsifiye hiler lenfadenopati (n:17), % 77,2'sinde mikronodül (n:17), % 72,7'sinde interstisyel görünüm (n:16), % 72,7'sinde plevral kalınlaşma (n:16), % 68,1'inde nodül (n:15), % 40,9'unda bül ve amfizematöz alanlar (n:9), % 27,2'sinde plevral kalsifikasyon, % 18,1'inde ise alveoler opasite (n:4) bulundu. Bronkoskopik bulgularda % 77,2'sinde bronşial stenoz, % 72,7'sinde bronşta antrakoid nedbe, % 63,6'sında bronşial mukozada solukluk, % 63,6'sında antrakotik plak, % 50'sinde diffüz bronşial inflamasyon, % 40,9'unda ana karena ve lob ayrım karenasında genişleme, % 31,8'inde trakea ve ana bronşlarda deformite, % 13,6'sında siyah-gri balgam, % 4,5'inde bronşial mukozada atrofi bulundu.Sonuçlar: Madenlerde çalışma öyküsü olan ve özellikle PMF olan hastalarda tanı aşamasında bronkoskopide indirekt tümör bulguları olabileceği akılda tutulmalıdır.Objective: The aim of the study is to evaluate fiberoptic bronchoscopic signs especially in mine workers with progressive massif fibrosis (PMF) during diagnostic work-up. Material and methods: We evaluated clinical examination, radiological and bronchoscopic data of 22 patients who had worked in coal mines between 2003 and 2006. Results: Medical files of 22 male patients aged between 43 and 83 with a mean age of 66.4±9.37 years were investigated. Fifteen (68.2 %) were smokers. Duration of coal mine exposure was 21.5±9 years. Six (27.3 %) patients were asymptomatic and the others had mainly coughs, expectoration of sputum and dyspnea. The radiological signs were as follows: PMF (n:22; 100 %), fibrotic pattern (n: 21; 95.4 %), reticular nodules (n:20; 90 %), micronodules (n:17; 77.2 %), calsificated hilus node (n:17; 77.2 %), interstitial pattern (n:16; 72.7 %), pleural thickening (n:16; 72.7 %), macro nodules (n:15; 68.1 %), bullae and emphysematous areas (n:9; 40.9 %), pleural calsifications (n:6; 27.2 %), and alveolar opacities (n:4; 18.1 %). The bronchoscopic signs were bronchial stenosis (77.2 %), scar antracotic deformity of bronchi (72.7 %), diffuse atrophy and pale bronchial mucosa (63.6 %), antracotic plaques (63.6 %), diffuse bronchial inflammatory appearance (50 %), enlarged main and/or lobe carina (40.9 %), black-gray sputum (13.6 %), and bronchial mucosa atrophy (4.5 %). Conclusion: You should keep in mind that during diagnostic work-up of mine workers with PMF, indirect tumor signs can be detected during broncoshoscopic procedures

Importance of pulmonary artery to ascending aorta ratio in chronic obstructive pulmonary disease

IntroductionRecent articles revealed that an increased main pulmonary artery to ascending aorta ratio (PA/A) in thorax computed tomography (CT) correlated with pulmonary hypertension, and might be linked to a high probability of chronic obstructive pulmonary disease (COPD) exacerbations

The awareness of chest physicians about nutritional assessment in chronic obstructive pulmonary disease

Introduction: The number of studies that target nonpharmacologic treatments for chronic obstructive pulmonary disease ( COPD) are increasing because no existing pharmacologic treatment modality for COPD leads to significant improvement in lung function. Positive effects can be observed in patients with COPD using nutritional support alone or as an adjunct to exercise. In this study, we aimed to evaluate the awareness of chest physicians about the nutritional state of patients with COPD

Does Short Message Service Increase Adherence to Smoking Cessation Clinic Appointments and Quitting Smoking?

Background: Using innovative and scientific methods increases the rate of quitting in smokers. Short message service (SMS) is a communication tool widely used and well integrated in many people’s daily lives. To increase adherence to appointments in smoking cessation clinics (SCC), it is thought that increased compliance could be achieved by falling outside the traditional methods. SMS has been shown to increase the compliance of patients with SCC appointments. Aims: In this study, we aimed to evaluate the effect of SMS in the compliance of patients with SCC follow-up visits and smoking cessation success. Study Design: Case-control study. Methods: Our study was a controlled, open, prospective study. We enrolled 436 cases applied to SCC of Yedikule Training and Research Hospital between 01.10.2013-30.06.2014 and agreed to follow-up with SMS. SMS was sent to the patients to remind them of appointments at the SCC and to query their smoking state. Results: Two hundred-and-eighty seven (65.8%) of the patients were male and 149 (34.2%) were female. The mean age was 45±12 years. In this study, 296 (67.9%) patients had graduated from primary school. Our patients’ smoking state was queried by telephone at the 6-month follow-up and we contacted 348 patients. According to this, 88 (25.3%) patients were not smoking, and 260 (74.7%) patients were smokers. Therefore, the smoking cessation rate was 24% (n=60) in patients who did not respond to SMS reminders at all, and 28.6% (n=28) in patients answering any SMS at least once (p=0.377). Smoking cessation rate of the patients invited by SMS but who did not attend any control visits was 19.1%, and it was 34.5% in patients coming to a control visit at least once. This difference was statistically significant (p=0.001). Conclusion: In our study, there was increased success of smoking cessation in patients coming to control visits. We think that this may result from the possibly increased compliance to SCC appointments following reminders by SMS, and that this may also increase smoking cessation success

Silent hypoxia: higher NO in red blood cells of COVID-19 patients

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) has spread to almost 100 countries, infected over 31 M patients and resulted in 961 K deaths worldwide as of 21st September 2020. The major clinical feature of severe COVID-19 requiring ventilation is acute respiratory distress syndrome (ARDS) with multi-functional failure as a result of a cytokine storm with increased serum levels of cytokines. The pathogenesis of the respiratory failure in COVID-19 is yet unknown, but diffuse alveolar damage with interstitial thickening leading to compromised gas exchange is a plausible mechanism. Hypoxia is seen in the COVID-19 patients, however, patients present with a distinct phenotype. Intracellular levels of nitric oxide (NO) play an important role in the vasodilation of small vessels. To elucidate the intracellular levels of NO inside of RBCs in COVID-19 patients compared with that of healthy control subjects. Methods: We recruited 14 COVID-19 infected cases who had pulmonary involvement of their disease, 4 non-COVID-19 healthy controls (without pulmonary involvement and were not hypoxic) and 2 hypoxic non-COVID-19 patients subjects who presented at the Masih Daneshvari Hospital of Tehran, Iran between March–May 2020. Whole blood samples were harvested from patients and intracellular NO levels in 1 × 106 red blood cells (RBC) was measured by DAF staining using flow cytometry (FACS Calibour, BD, CA, USA). Results: The Mean florescent of intensity for NO was significantly enhanced in COVID-19 patients compared with healthy control subjects (P ≤ 0.05). As a further control for whether hypoxia induced this higher intracellular NO, we evaluated the levels of NO inside RBC of hypoxic patients. No significant differences in NO levels were seen between the hypoxic and non-hypoxic control group. Conclusions: This pilot study demonstrates increased levels of intracellular NO in RBCs from COVID-19 patients. Future multi-centre studies should examine whether this is seen in a larger number of COVID-19 patients and whether NO therapy may be of use in these severe COVID-19 patients

Silent hypoxia: higher NO in red blood cells of COVID-19 patients

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes coronavirus disease 2019 (COVID-19) has spread to almost 100 countries, infected over 31 M patients and resulted in 961 K deaths worldwide as of 21st September 2020. The major clinical feature of severe COVID-19 requiring ventilation is acute respiratory distress syndrome (ARDS) with multi-functional failure as a result of a cytokine storm with increased serum levels of cytokines. The pathogenesis of the respiratory failure in COVID-19 is yet unknown, but diffuse alveolar damage with interstitial thickening leading to compromised gas exchange is a plausible mechanism. Hypoxia is seen in the COVID-19 patients, however, patients present with a distinct phenotype. Intracellular levels of nitric oxide (NO) play an important role in the vasodilation of small vessels. To elucidate the intracellular levels of NO inside of RBCs in COVID-19 patients compared with that of healthy control subjects. Methods: We recruited 14 COVID-19 infected cases who had pulmonary involvement of their disease, 4 non-COVID-19 healthy controls (without pulmonary involvement and were not hypoxic) and 2 hypoxic non-COVID-19 patients subjects who presented at the Masih Daneshvari Hospital of Tehran, Iran between March–May 2020. Whole blood samples were harvested from patients and intracellular NO levels in 1 × 106 red blood cells (RBC) was measured by DAF staining using flow cytometry (FACS Calibour, BD, CA, USA). Results: The Mean florescent of intensity for NO was significantly enhanced in COVID-19 patients compared with healthy control subjects (P ≤ 0.05). As a further control for whether hypoxia induced this higher intracellular NO, we evaluated the levels of NO inside RBC of hypoxic patients. No significant differences in NO levels were seen between the hypoxic and non-hypoxic control group. Conclusions: This pilot study demonstrates increased levels of intracellular NO in RBCs from COVID-19 patients. Future multi-centre studies should examine whether this is seen in a larger number of COVID-19 patients and whether NO therapy may be of use in these severe COVID-19 patients

Dopamine D4 Receptor Gene Exon III VNTR Variant Influences Smoking Status in Turkish Population

Introduction: Dopaminergic gene variants may affect nicotine dependence through their possible impact on the dopamine reward pathway. The purpose of this study is to investigate the relationship between the variable number tandem repeat (VNTR) variant in exon III of the Dopamine D4 receptor (DRD4) gene and genetic predisposition of smoking status in a Turkish population

COVID-19 in patients with pulmonary alveolar proteinosis: a European multicentre study

Adult PAP patients experience similar #COVID19 rates to the general population, and high rates of hospitalisation and deaths, underscoring their vulnerability and the need for measures to prevent infection. The impact of iGM-CSF must be considered. https://bit.ly/3M0wKnZ