Diagnostic value of pleural fluid lactate dehydrogenase/adenosine deaminase ratio in differentiating parapneumonic effusion from tuberculous pleurisy

Objective The purpose of this study was to determine the diagnostic value of pleural fluid lactate dehydrogenase (LDH)/pleural fluid adenosine deaminase (ADA) ratio in differentiating pleural effusions owing to tuberculous pleurisy (TBP) and parapneumonic effusion (PPE). Patients and methods The data of 272 patients (140 patients with TBP and 132 patients with PPE) between January 2012 and October 2018 were analyzed retrospectively. Demographic data of all patients; concurrent serum glucose, albumin, protein, and LDH values; and pleural fluid pH, glucose, albumin, protein, and ADA results have been reviewed. Results Pleural fluid ADA values were statistically significantly higher in the TBP group than PPE (P<0.001). The median values of pleural fluid LDH/ADA ratio between TBP and PPE groups were 16.10 (12.53) and 32.90 (34.45), respectively, which was found to be significantly lower in TBP group (P<0.001). Pleural fluid LDH/ADA ratio's sensitivity, specificity, positive predictive value, and negative predictive value were 90, 59.85, 70.4, and 84.9%, respectively, in the diagnosis of TBP for values less than 28 (P<0.001). Conclusion The ratio of pleural fluid LDH/ADA determined from routine biochemical analysis predicts TBP at value of 28. Measurement of this parameter may help clinicians distinguish between TBP and PPE

Risk Factors for Presence of Resistant Microorganisms in Sputum Cultures of Patients with Infectious Exacerbations of Chronic Obstructive Lung Disease

Introduction: Antibiotics reduce the risk of short-term mortality. Certain bacteria may be resistant to initial regimens which is related to mortality. The aim of this study was to find risk factors for the presence of resistant bacteria during exacerbation of Chronic Obstructive Pulmonary Disease (COPD). Materials and Methods: Ethics committee approval was obtained for the study. The patients hospitalized with an exacerbation of COPD between 2015 and 2020 were retrospectively ieviewed. The patients with a sputum culture result were divided into: Group A with conventional microorganisms (susceptible to initial antibiotic regimen) and Group B with non-conventional microorganisms (resistant to initial antibiotic regimen). The risk factors for Group B microorganisms were investigated. Results: One hundred and nineteen patients were included in the study. Median age was 68 (40-88) years. There were 22 patients in Group A and 97 in Group B. Most common microorganism in Group A was Haemophilus influenza (12.6%). Most encountered microorganisms in Group B were Pseudomonas aeruginosa (49.6%). Male sex (HR= 2.9; 95% CI= 0.9-9.5; p= 0.073), age >61 (HR=4.8; 95% CI= 1.7-13.6; p= 0.003), and >5 hospitalizations last year (HR= 8.2; 95% CI= 0.9-67.7; p= 0.051) were found to be independent risk factors for resistant microorganisms. Conclusion: Proposed risk factors for the isolation of multidrug resistant microorganism in patients hospitalized with COPD exacerbations should be considered when choosing the initial antibiotic regimen

Effect of host risk factors in identifying mortality in COVID-19 pneumonia and a new COVID-19 mortality index: Co-AMSCA

BACKGROUND AND AIM: The purpose of the study was to examine the host risk factors related to mortality in patients hospitalized with coronavirus disease 2019 (COVID-19) pneumonia and to find a COVID-19 mortality score based on these factors. METHODS: Subjects hospitalized with COVID-19 pneumonia between March 11, 2020, and October 1, 2020, were retrospectively analyzed. The age, gender, smoking status, body mass index, blood group, severity of pneumonia, comorbidity, reverse transcriptase-polymerase chain reaction positivity, use of angiotensin-converting enzyme (ACE) inhibitors, radiological changes, and mortality rates of the patients who had proven COVID-19 pneumonia were recorded. Patients were divided into two groups according to mortality status, and the two groups were compared. The cutoff values, sensitivity and specificity values, and odds ratios were calculated to predict mortality of the new scoring system. RESULTS: A total of 422 patients (51 mortal and 371 nonmortal) participated in the study. The univariate regression analysis showed that age, male gender, smoking, comorbidity, and using ACE inhibitors were prognostic host risk factors for COVID-19-related mortality. A new scoring model with the combination of risk factors named Co-AMSCA was created in the study. The cutoff value of the system was found to be 3.5 with 88.4% sensitivity and 65.5% specificity. The mortality risk in patients with a Co-AMSCA mortality score above 3.5 points was 7.8 times higher than that in patients whose score was lower than 3.5 points. In multivariate logistic regression analysis, older age and smoking were significant risk factors for mortality. CONCLUSIONS: A mortality score was created based on host risk factors, which are easy to calculate and do not need laboratory tests and do not waste the time of the clinicians. This study showed that by using Co-AMSCA scoring model, it is possible to achieve a mortality prediction in COVID-19 patients who are hospitalized due to pneumonia

Ratio And Regional Distribution Of Genetic Mutation In Lung Cancer In Turkey (REDIGMA)

28th International Congress of the European-Respiratory-Society (ERS) -- SEP 15-19, 2018 -- Paris, FRANCEWOS: 000455567103370…European Respiratory So

Antibiotic resistance rates and penicillin MIC distribution in patients with streptococcal pneumonia between 2013-2019, and use of antibiotics in clinical practice

Purpose: The purpose of the present study is to investigate the antibiotic resistance rates and use of antibiotics in patients with streptococcal pneumonia in a reference tertiary care hospital for pulmonary diseases in Izmir, Turkey.Methods: A total of 1224 cases with streptococcal pneumonia between 2013 and 2019 were included in the study, retrospectively. Drug susceptibility testing for penicillin and other antibiotics were performed according to the recommendations of EUCAST criteria. Clinical data and general characteristics were collected and evaluated for each patient in accordance with the susceptibility testing report.Results: Totally, resistance rates for trimethophrim-sulfamethoxazole, penicillin (oxacillin), erythromycin, tetra-cycline, clindamycin and levofloxacin resistance were 63.5%, 39.8%, 37.7%, 37.6%, 28.8%, and 4.8%, respec-tively. Antibiotic resistance was not detected against vancomycin,teicoplanin and linezolid. Multidrug resistance rate was found to be 27.1%. It was observed that there was a statistically significant decrease in trimethophrim-sulfamethoxazole, penicillin (oxacillin), erythromycin, clindamycin and levofloxacin resistance rates by years (p: 0.000, 0.004, 0.000, 0.001, 0.010, respectively). The penicillin MIC distribution was higher at the range of 0.12-2 mu g/mL and there was statistical difference among the ranges of MIC values for the representative years (p:0.033). Among the antibiotics investigated, the most commonly used antibiotic was moxifloxacin.Conclusions: Trimethophrim-sulfamethoxazole resistance rate has been found higher than other antibiotics. As penicillin MIC values were at the range of 0.12-2 mu g/mL frequently, high doses of penicillin treatment might be required in some patients. It is noteworthy that significant decrease in resistance rates in penicillin, erythromycin, clindamycin and tetracycline could be due to the vaccination programme carried out since 2008 in Turkey. As the empiric use of quinolones is high it would be more appropriate to use it according to the susceptibility testing. It is important to determine the regional antimicrobial susceptibility for Streptococcus pneumoniae to select appropriate empirical antimicrobials in the clinical practice

Salivary Lipids of Patients with Non-Small Cell Lung Cancer Show Perturbation with Respect to Plasma

A comprehensive lipid profile was analyzed in patients with non-small cell lung cancer (NSCLC) using nanoflow ultrahigh-performance liquid chromatography–electrospray ionization–tandem mass spectrometry. This study investigated 297 and 202 lipids in saliva and plasma samples, respectively, comparing NSCLC patients to healthy controls. Lipids with significant changes (>2-fold, p 2–3-fold) in plasma and saliva samples. Three specific TGs (50:2, 52:5, and 54:6) were significantly increased in NSCLC for both sample types. A common ceramide species (d18:1/24:0) and phosphatidylinositol 38:4 decreased in both plasma and saliva by approximately two-fold. Phosphatidylserine 36:1 was selectively detected in saliva and showed a subsequent decrease, making it a potential biomarker for predicting lung cancer. We identified 27 salivary and 10 plasma lipids as candidate markers for NSCLC through statistical evaluations. Moreover, this study highlights the potential of saliva in understanding changes in lipid metabolism associated with NSCLC

The relation between distant metastasis and genetic change type in stage IV lung adenocarcinoma patients at diagnosis

Introduction Brain metastasis prevalence is higher in patients with positive epidermal growth factor receptor (EGFR) mutation, anaplastic lymphoma kinase (ALK) and C-ROS oncogene 1 (ROS-1) fusion change in lung adenocarcinoma. Objectives The purpose of our study is to investigate the relation between the genetic change type and the initial distant metastasis in stage IV lung adenocarcinoma patients with genetic changes. Methods The study was conducted between January 2007 and December 2018 in a retrospective fashion with patients who had lung cancer diagnosed as stage IV adenocarcinoma. The relation between genetic mutation change (EGFR, ALK or ROS-1) and distant metastasis was analysed. Results A total of 845 patients were included in the study. The median age was 62 (28-88). It was determined that lung and pleura metastases were more frequent at a significant level in patients with positive EGFR mutation (P = 0.032,P = 0.004, respectively). In patients with positive ALK fusion change, pleura metastasis was determined to be more frequent (P = 0.001). Multiple metastases were determined to be significantly more in patients with positive ALK fusion change than single metastasis (P = 0.02). Conclusion In patients with EGFR mutant lung adenocarcinoma, lung and pleura metastasis is more frequent and pleura metastasis is more frequent in ALK positive adenocarcinoma. Additionally, multiple organ metastases are higher in ALK positive lung adenocarcinoma

Regional distribution of genetic mutation in lung cancer in Turkey (REDIGMA)

Introduction: The results of standard chemotherapy in lung cancer are not very satisfactory, so it is important to identify genetic mutations that provide targeted therapies. Recent reports have suggested influences of racial difference on the frequency of mutation in lung cancer. We aimed to determine the frequency and regional distribution of genetic mutations of non-small cell lung cancer (NSCLC) in Turkey