Comorbidity and clinical relationship and treatment evaluation of patients with Nonspesific interstitial pneumonia diagnosed at Pulmonology Department of Pamukkale University between 2012 and 2017.

Nonspesifik İnterstisiyel Pnömoni (NSİP), Difüz parankimal akciğer hastalıklarının (DPAH) idiyopatik alt grubuna dahil olan bir interstisyel akciğer hastalığı olup idiyopatik olmayan grubunda kollajen doku hastalıkları, çevresel ve mesleki maruziyet, ilaç öyküsü, immun yetmezlik durumları, enfeksiyon gibi sebeplerle de ortaya çıkan NSİP yer alır. Bu çalışmamızda 5 yıl boyunca polikliniğimizde tanı alan ve takiplerini yaptığımız NSİP tanılı hastaların başta kollajen doku hastalıkları olmak üzere, çevresel maruziyetler ve ilaç etkileşimiyle NSİP arasındaki klinik ilişkinin incelenmesi, aynı zamanda tedavi yanıtının klinik ve mortalite üzerine etkisinin değerlendirilmesi amaçlanmıştır Çalışmamıza 79 hasta (36 kadın; 43 erkek) dâhil edildi. NSİP tanılı hastaların verilerine hastanemiz veri sitemi HBYS'den J84.1 ICD kodlu 175 hastanın anamnezleri okunarak, NSİP tanısı alanlar belirlenerek ulaşıldı. Yaş aralığı genel olarak 41-87 yaş arası olup hastalığa en fazla 7.-8.dekatta rastlandığı görüldü. Polikliniğe en sık başvurma nedeni uzun süreli kuru öksürüktü (n=54, %68). Romatolojik hastalık tanısı olan hasta sayısı başlangıçta 11 kişiydi (%13); takiplerde 13 hastaya daha romatolojik hastalık tanısı konulduğu saptandı. En sık Romatoid Artrit ve Sjögren Sendromu tanıları eşlik ediyordu (Her ikisi için de n=7). Romatolojik semptomlar 34 hastada (%43) mevcuttu. En sık eklem ağrısı ve hareket kısıtlılığı (n=25 %31,6) görüldü. NSİP tanısı kliniğimizde genel olarak klinik ve radyolojiye göre konmaktaydı. Dışlama yapılamayan 17 hastaya bronkoalveoler lavaj, 10 hastaya akciğer biyopsisi yapılmıştır. Takiplerinde 59 (%74,6) hastaya tedavi uygulandı. En sık steroid tedavisi verildiği saptandı (n=34; %43). Tedavi alan hastaların 6'sı (%7) iyi seyir göstermiş, 21 hasta stabil seyretmiş (%26), 13 hastada (%16) ölüm gerçekleşmiştir. Solunum fonksiyon testine (SFT) uyum sağlayabilen 66 hastanın SFT bulguları normaldi, diğerlerinde obstrüktif patern görüldü, SFT ile restriksiyona rastlanmadı. Ancak CO difüzyon kapasitesine bakıldığında (DLCO), DLCO yapabilen 62 hastanın 43 'ünde (%69) difüzyon kısıtlılığı mevcuttu. Hastaların klinik seyri değerlendirildiğinde, 7 hasta (%8,9) iyileşme gösterdi ve tedavisiz takibe alındı. 29 hasta (%36,7) stabil olarak polikliniğimizde takip edilmektedir. Kaplan Meier analizi ile hastaların ortalama yaşam süresi değerlendirildiğinde 17 hastada (%21) ölüm gerçekleşti. Hastalarda sağ kalım süreleri ortalama 66 aydır (58,82-74,16; %95 GA). Hipoksemisi olan, akciğer volümleri, solunum fonksiyon kapasiteleri ve difüzyon kapasiteleri normalin altında bulunan hastalar ile sağ kalım arası ilişki incelendiğinde de anlamlı farka rastlanmadı. Sonuç olarak uzun süreli kuru öksürük ya da dispne şikâyeti olan SFT normal olsa bile semptomatik inhaler tedaviye yanıt vermeyen her hastanın DLCO ölçümleri mutlaka yapılmalı ve interstisyel akciğer hastalıklarına yönelik gerekirse HRCT veya toraks BT istenmelidir.Nonspesific interstitial pneumonia (NSİP) is an interstitial lung disease which is classified under idiopathic subgroup of diffuse parenchymal lung diseases. But it can also arise in the background of collagen tissue disorders, environmental and occupational exposure, drugs, immune deficiency, infections etc. In this study we aimed primarily to invastigate clinical relationship of NSIP with collagen tissue diseases, enviromental exposures and drug reaction and also effects on treatment response and mortality as well within patients diagnosed as NSIP and followed up for 5 years in our clinic. 79 patients (36 female, 43 male) were included in this study. The data about NSİP patients were reached with J84.1 ICD code via hospital database (HBYS) and 175 patients’ histories were read. Patients were between 41-87 ages. That showed us that the disease is seen in 7th and 8th decade mostly. Long term dry cough was the most frequent complaint when applying to the hospital (n=54, %68). At first 11 patients were diagnosed with a rheumatologic disease (%13). 13 patients were diagnosed with a rheumatologic disease afterwards. Rheumatoid arthritis (n=7) and Sjögren Syndrome (n=7) was most frequent ones. 34 patients (%43) had rhematologic symptoms. The most frequent ones were the joint pain and decrease in range of motion (n=25 %31.6). NSİP is usually diagnosed with clinical history and radiology in our clinic. Bronchoalveolar lavage was done to 17 patients in whom other diseases cannot be ruled out. Biopsy was taken from ten of them. 59 patients (%74.6) took treatment through their follow up. 34 (43%) of them took steroid treatment. 6 of them (7%) showed good prognosis, 21 of them (26%) remained stable and 13 of them (16%) developed mortality. Respiratory function tests were normal in 66 patients who were compliant for the tests. Rest of them had the obstructive pattern and the restriction pattern was not seen. 43 (69%) patients had diffusion restriction out of 62 patients who can do diffusion capacity test (DLco) When clinical progression was assessed, 7 patients (8,9%) showed recovery and were taken to a follow up program with treatment. 29 stable patients (36,7%) are still coming to their routine follow up appointments. 17 patients (21%) died of disease. Mean survival time of patients was 66 months with Kaplan Meier analysis (58.82-74.16; 95% GA Std. Error 6.9). There was no statistically significant relationship between survival rates and hypoxemia levels, lung volumes, respiratory function tests and diffusion capacities. In conclusion, DLCO measurements must be made and if necessary HRCT or thorax CT must be ordered for interstitial lung diseases in patients with long term dry cough and dyspnea who have otherwise normal respiratory function tests

What We Learned about COVID-19 So Far? Notes from Underground

The novel coronavirus pandemic poses a major global threat to public health. Our knowledge concerning every aspect of COVID-19is evolving rapidly, given the increasing data from all over the world. In this narrative review, the Turkish Thoracic Society Early CareerTaskforce members aimed to provide a summary on recent literature regarding epidemiology, clinical findings, diagnosis, treatment,prevention, and control of COVID-19. Studies revealed that the genetic sequence of the novel coronavirus showed significant identityto SARS-CoV and MERS-CoV. Angiotensin-converting enzyme 2 receptor is an important target of the SARS-CoV-2 while entering anorganism. Smokers were more likely to develop the disease and have a higher risk for ICU admission. The mean incubation periodwas 6.4 days, whereas asymptomatic transmission was reported up to 25 days after infection. Fever and cough were the most commonsymptoms, and cardiovascular diseases and hypertension were reported to be the most common comorbidities among patients. Clinicalmanifestations range from asymptomatic and mild disease to severe acute respiratory distress syndrome. Several patients showed typicalsymptoms and radiological changes with negative RT-PCR but positive IgG and IgM antibodies. Although radiological findings may vary,bilateral, peripherally distributed, ground-glass opacities were typical of COVID-19. Poor prognosis was associated with older age, higherSequential Organ Failure Assessment score, and high D-dimer level. Chloroquine was found to be effective in reducing viral replicationin vitro. Likewise, protease inhibitors, including lopinavir/ritonavir, favipiravir, and nucleoside analogue remdesivir were proposed to bethe potential drug candidates in COVID-19 management. Despite these efforts, we still have much to learn regarding the transmission,treatment, and prevention of COVID-19WOS:0005409044000092-s2.0-8508693317