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 researchers

Healthcare resource utilization and medical costs for children with interstitial lung diseases (chILD) in Europe

Background No data on healthcare utilisation and associated costs for the many rare entities of children's interstitial lung diseases (chILD) exist. This paper portrays healthcare utilisation structures among individuals with chILD, provides a pan-European estimate of a 3-month interval per-capita costs and delineates crucial cost drivers. Methods Based on longitudinal healthcare resource utilisation pattern of 445 children included in the Kids Lung Register diagnosed with chILD across 10 European countries, we delineated direct medical and non-medical costs of care per 3-month interval. Country-specific utilisation patterns were assessed with a children-tailored modification of the validated FIMA questionnaire and valued by German unit costs. Costs of care and their drivers were subsequently identified via gamma-distributed generalised linear regression models. Results During the 3 months prior to inclusion into the registry (baseline), the rate of hospital admissions and inpatient days was high. Unadjusted direct medical per capita costs (euro19 818) exceeded indirect (euro1 907) and direct non-medical costs (euro1 125) by far. Country-specific total costs ranged from euro8 713 in Italy to euro28 788 in Poland. Highest expenses were caused by the disease categories 'diffuse parenchymal lung disease (DPLD)-diffuse developmental disorders' (euro45 536) and 'DPLD-unclear in the non-neonate' (euro47 011). During a follow-up time of up to 5 years, direct medical costs dropped, whereas indirect costs and non-medical costs remained stable. Conclusions This is the first prospective, longitudinal study analysing healthcare resource utilisation and costs for chILD across different European countries. Our results indicate that chILD is associated with high utilisation of healthcare services, placing a substantial economic burden on health systems

Diffuse alveolar hemorrhage in children with interstitial lung disease: Determine etiologies!

OBJECTIVE: Diffuse alveolar hemorrhage (DAH) in children is a rare condition resulting from different underlying diseases. This study aimed at describing characteristics and diagnostic measures in children with ILD (children\u27s interstitial lung disease, chILD) and DAH to improve the diagnostic approach by increasing clinician\u27s awareness of diagnostic shortcomings. PATIENTS AND METHODS: A retrospective data analysis of patients with ILD and DAH treated in our own or collaborating centers between 01/07/1997 and 31/12/2020 was performed. Data on clinical courses and diagnostic measures were systematically retrieved as case-vignettes and investigated. To assess suitability of diagnostic software-algorithms, the Human Phenotype Ontology (HPO) was revised and expanded to optimize conditions of its associated tool the Phenomizer. RESULTS: For 97 (74%) of 131 patients, etiology of pulmonary hemorrhage was clarified. For 34 patients (26%), no underlying condition was found (termed as idiopathic pulmonary hemorrhage, IPH). Based on laboratory findings or clinical phenotype/comorbidities, 20 of these patients were assigned to descriptive clusters: IPH associated with autoimmune features (9), eosinophilia (5), renal disease (3) or multiorgan involvement (3). For 14 patients, no further differentiation was possible. CONCLUSION: Complete and sometimes repeated diagnostics are essential for establishing the correct diagnosis in children with DAH. We suggest assignment of patients with IPH to descriptive clusters, which may also guide further research. Digital tools such as the Phenomizer/HPO are promising, but need to be extended to increase diagnostic accuracy

International management platform for children's interstitial lung disease (chILD-EU)

BACKGROUND: Children's interstitial lung diseases (chILD) cover many rare entities, frequently not diagnosed or studied in detail. There is a great need for specialised advice and for internationally agreed subclassification of entities collected in a register.Our objective was to implement an international management platform with independent multidisciplinary review of cases at presentation for long-term follow-up and to test if this would allow for more accurate diagnosis. Also, quality and reproducibility of a diagnostic subclassification system were assessed using a collection of 25 complex chILD cases. METHODS: A web-based chILD management platform with a registry and biobank was successfully designed and implemented. RESULTS: Over a 3-year period, 575 patients were included for observation spanning a wide spectrum of chILD. In 346 patients, multidisciplinary reviews were completed by teams at five international sites (Munich 51%, London 12%, Hannover 31%, Ankara 1% and Paris 5%). In 13%, the diagnosis reached by the referring team was not confirmed by peer review. Among these, the diagnosis initially given was wrong (27%), imprecise (50%) or significant information was added (23%).The ability of nine expert clinicians to subcategorise the final diagnosis into the chILD-EU register classification had an overall exact inter-rater agreement of 59% on first assessment and after training, 64%. Only 10% of the 'wrong' answers resulted in allocation to an incorrect category. Subcategorisation proved useful but training is needed for optimal implementation. CONCLUSIONS: We have shown that chILD-EU has generated a platform to help the clinical assessment of chILD. TRIAL REGISTRATION NUMBER: Results, NCT02852928

The affect of helicobacter pylori infection on hepcidin and il-6 levels; relationship with iron metabolism and hepcidin

Helicobacter pylori enfeksiyonunun önemli mide dışı bulgularından biri anemidir. Anemi bu grup hastada gastrointestinal kanama bulguları veya demir malabsorbsiyonu olmadan ortaya çıkmaktadır. Demir tedavisine dirençli olup; bazen sadece Helicobacter pylori'nin eradikasyonu aneminin düzelmesi için yeterli olmaktadır. Bu çalışmada Helicobacter pylori enfeksiyonlarında izlenen aneminin hepsidin ile ilişkisi araştırılmıştır. Hepsidin yeni keşfedilen bir peptit yapıda hormon olup; enterositlerin bazolateral bölgelerinde, makrofajlarda ve hepatositlerde bulunan ferroportine bağlanır. Böylece demir transportunu engeller. Çalışmamızda Helicobacter pylori enfeksiyonunun yol açtığı enflamasyonun IL-6 sentezini ve karaciğerde hepsidin sentezini artırdığı; böylece anemi ve hipoferremi oluşumuna yol açtığı hipotezinden yola çıkılmıştır. Anemi ve hepsidin ilişkisi araştırılmıştır. Çalışmaya 7-16 yaş arası tekrarlayan karın ağrısı şikayeti nedeniyle başvuran H. pylori pozitif gastriti olan 50 hasta, H. pylori negatif gastriti olan 50 hasta ve aynı yaş grubundaki 30 sağlıklı kontrol grubu alınmıştır. Hastaların tam kan sayımı, demir parametreleri, hepsidin ve IL-6 düzeylerine bakılmıştır. Helicobacter pylori pozitif gastriti olan 50 hastanın eradikasyon tedavisi sonrası üre nefes testi yapılmış ve kan örnekleri tekrarlanmıştır. Çalışmamızda, H. pylori pozitif gastriti olan hastaların yaş ortalaması anlamlı oranda yüksekti, ancak cinsiyetler arası farklılık saptanmadı. Helicobacter pylori gastriti olan hastaların başlangıç ferritin, hepsidin ve IL-6 düzeyleri anlamlı oranda düşük bulundu. Ancak tam kan sayımı parametrelerine bakıldığında gruplar arası farklılık mevcut değildi. Çalışmaya alınan; H. pylori pozitif gastriti olan 6 hastanın ve H. pylori negatif gastriti olan 5 hastanın anemisi saptandı. Helicobacter pylori pozitif gastriti olan hastaların; anemi olsun ya da olmasın hepsidin, ferritin ve IL-6 düzeyleri anlamlı oranda düşüktü. Helicobacter pylori pozitif gastriti ve anemisi olan hastalarda Hb, Htc, MCV, MCH düzeyleri anlamlı oranda düşüktü. Bu hastalarda demir eksikliği anemisine bağlı olarak demir ve ferritin düzeyleri anlamlı oranda düşük, demir bağlama kapasitesi anlamlı oranda yüksek bulundu. Çalışmamızda elde edilen bulgular hipotezimizi desteklememiştir. Helicobacter pylori enfeksiyonu hepsidin düzeyinde artışa yol açmamaktadır. Helicobacter pylori enfeksiyonunda görülen anemide hepsidin düzeyi demir eksikliğinde görüldüğü gibi düşük bulunmuştur. Helicobacter pylori pozitif gastriti olan hastaların eradikasyon tedavisi sonrası Hb, Htc, MCV değerlerinde anlamlı oranda artış bulundu. Tedavi sonrası ferritin, hepsidin ve IL-6 değerlerinde anlamlı farklılık bulunmadı. Bu sonuçlarla H. pylori enfeksiyonlarında ferritin, hepsidin ve IL-6 düzeylerinde düşüklük olduğu saptanmış; ancak bakterinin eradikasyon tedavisiyle bu değerlerde anlamlı bir değişiklik bulunmamıştır. Bulgular demir eksikliği anemisinde beklenilen hepsidin düzeyindeki düşmeyi desteklemektedir.Anemia consists one of the important extra gastric manifestations seen in Helicobacter pylori infections. In this group of patients, anemia presents without the signs of gastrointestinal bleeding or malabsorption and is resistant to iron therapy. This condition can occassionally be treated by the sole eradication of H. pylori. The aim of this study is to investigate the role of hepcidin in the development of anemia seen in H. pylori infections. Hepcidin is a fairly new discovered peptide hormone and is bound to ferroportin which is found in basolateral regions of enterocytes, macrophages and hepatocytes. In this way hepcidin inhibits the transportation of iron. In our study we set forward that the inflammation caused by H. pylori infection increases the synthesis of IL-6, thus enhances hepatic hepcidin synthesis which leads to hypoferremia and anemia. Patients aged between 7-16 years with complaints of recurrent stomachache and dyspepsia that underwent upper endoscopic investigation in pediatric gastroenterology clinic were planned to be enrolled in this study. After endoscopic investigation, patients of group 1 with manifested H. pylori infection will be checked for complete blood count, serum iron levels, iron binding capacity, ferritin levels, hepcidin, and IL-6 values prior to the initiation of proton pump inhibitors combined with antibiotherapy which will last for 8 weeks and this will be followed by the C-13 breath urea test for evaluation of eradication and the initial tests will be re-performed. Patients of group 2 with H. pylori negative gastritis will only receive proton pump inhibitors. This group will just undergo the tests used for diagnosis which are mentioned above. Group 1 and 2 will consist of 50 patients and the control group will consist of 30 healthy individuals. In our study, the mean age of patients with H. pylori positive gastritis were significantly higher; but there was no statistically significant difference with the gender of patients. The initial levels of ferritin, hepcidin and IL-6 were found significantly lower in patients with H. pylori induced gastritis. However parameters of complete blood count were similar between the groups H. pylori positive gastritis, H. pylori negative gastritis and healthy inviduals. In this study group; anemia was present in six patients of H. pylori positive gastritis and five patients of H. pylori negative gastritis. The mean levels of hepcidin, ferritin, IL-6 were significantly lower in patients with H. pylori infection regardless of the presence of anemia. In patients with H. pylori positive gastritis and anemia; the mean levels of Hb, Htc, MCV, MCH were significantly low. In this group related to the iron deficiency anemia, serum concentration of iron and ferritin were found lower; and iron binding capacity was found significantly higher. The results of this study did not support our hypothesis that H. pylori infection increases hepcidin levels. Our findings suggest that serum hepcidin levels are related to the status of iron deficiency anemia, rather than to the presence of H. pylori infection. After eradication Hb, Htc, MCV levels increased significantly, but the levels of hepcidin, ferritin and IL-6 didn?t differ significantly. All of the results support the expected fall of hepcidin levels in iron deficiency anemia

Evaluation of blood and tooth element status in asthma cases: a preliminary case–control study

Abstract Background Asthma is a common respiratory disorder; some data were present on the correlation between increased levels of trace elements and the risk of asthma development. It was aimed to evaluate the levels of 13 selected blood and tooth elements (magnesium, phosphorus, calcium, chromium, manganese, iron, copper, zinc, strontium, molybdenum, cadmium, lead, mercury) in a well-controlled asthma group and the control group. Methods During the study period, 17 asthma patients and 26 age and gender-matched healthy children donated shed deciduous teeth having neither decay nor filling and enrolled for the study. The element levels in blood and teeth matrixes were analyzed with inductively coupled plasma mass spectrometry. Differences in blood and tooth elements in groups were evaluated with generalized linear models after adjusting confounding factors. Results After adjusting the child’s “z scores of body mass index for age”, history of iron deficiency anemia, and status of parental smoking, the generalized linear model revealed significantly lower tooth magnesium levels, lower blood zinc levels, and lower blood zinc/copper ratio in the asthma group than the control group (p = 0.042, p = 0.034, p = 0.002, respectively). Other studied elements for tooth and blood matrixes were similar in groups. Conclusion Our study revealed some differences in tooth and blood element levels in the asthma group. Further studies on zinc and magnesium levels of severe asthma cases are necessary for the interpretation of the results

Diagnosis Of Cystic Fibrosis With Chloride Meter (Sherwood M926S Chloride Analyzer (R)) And Sweat Test Analysis System (Cf Delta Collection System (R)) Compared To The Gibson Cooke Method

Sweat test with Gibson Cooke (GC) method is the diagnostic gold standard for cystic fibrosis (CF). Recently, alternative methods have been introduced to simplify both the collection and analysis of sweat samples. Our aim was to compare sweat chloride values obtained by GC method with other sweat test methods in patients diagnosed with CF and whose CF diagnosis had been ruled out. We wanted to determine if the other sweat test methods could reliably identify patients with CF and differentiate them from healthy subjects. Chloride concentration was measured with GC method, chloride meter and sweat test analysis system; also conductivity was determined with sweat test analysis system. Forty eight patients with CF and 82 patients without CF underwent the sweat test, showing median sweat chloride values 98.9 mEq/L with GC method, 101 mmol/L with chloride meter, 87.8 mmol/L with sweat test analysis system. In non-CF group, median sweat chloride values were 16.8 mEq/L with GC method, 10.5 mmol/L with chloride meter, and 15.6 mmol/L with sweat test analysis system. Median conductivity value was 107.3 mmol/L in CF group and 32.1 mmol/L in non CF group. There was a strong positive correlation between GC method and the other sweat test methods with a statistical significance (r=0.85) in all subjects. Sweat chloride concentration and conductivity by other sweat test methods highly correlate with the GC method. We think that the other sweat test equipments can be used as reliably as the classic GC method to diagnose or exclude CF

Lessons learned so far from the pandemic a review on pregnants and neonates with COVID-19

There are concerns regarding the risk and the course of COVID-19 in pregnancy and in the neonates. In this review, we aimed to present the current understanding of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy and neonatal periods considering diagnosis, treatment, prognosis, and prevention. Few studies on pregnant women with COVID-19 have been conducted between December 2019 and April 2020. The majority of patients applied in the third trimester and presented with fever and cough. Ground-glass opacities and consolidation on computed tomography were reported to be common. COVID-19 was proposed to have a milder course than SARS and the Middle East respiratory syndrome coronavirus in pregnant women. Hydroxychloroquine and antiproteases (lopinavir/ritonavir) were reported to be safe; however, therapeutic efficacy and safety of remdesivir still lack evidence. As ribavirin and favipiravir have teratogenic effects, there are some debates on the use of ribavirin in severe cases. There is still no clear evidence of vertical transmission of SARS-CoV-2 during delivery. Occupational safety issues of pregnant healthcare workers on the frontline should be considered as their risk to develop severe pneumonia is higher because of altered maternal immune response. Knowledge about neonatal outcomes of COVID-19 was based on studies of the last trimester of pregnancy. There is much to be learnt about COVID-19 in pregnant women and in the neonates, especially concerning prognosis- and treatment-related issues

Assessment of Nutritional Status and Malnutrition in Patients with Cystic Fibrosis

Amaç: Kistik fibrozisli hastalarda malnütrisyon ve beslenme durumunun saptanmasıdır. Bireyler ve Yöntem: Kistik fibrozis tanısı ile izlenen 2-20 yaş arası 166 hastanın 24 saatlik geriye dönük besin tüketim kaydı BEBIS 7.2 programı, yaşa göre ağırlık (WAZ), yaşa göre boy (HAZ), boya göre ağırlık (WHZ) ve yaşa göre beden kütle indeksi (BKIZ) Z skorları WHO Anthro ve Anthro Plus programları kullanılarak değerlendirilmiştir. Bulgular: Hastaların %10.1inin WAZ, malnütrisyon olarak değerlendirilen -2SDnin altında, %21.0inin HAZ, bodur olarak tanımlanan -2SDnin altındadır. Hastaların %25.3ü sadece oral olarak normal besinler tüketmekte, %74.7si ise oral besinlere ek olarak oral enteral ürün kullanmaktadır. Hastaların %41inin sabah öğününü atladığı, en fazla atlanan öğünün her yaş grubunda sabah öğünü olduğu bulunmuştur. Hastaların %67sinin RDAya göre önerilen günlük enerji alımı yetersiz (%120), %69.5inin protein, %68.2sinin karbonhidrat ve %68.9unun yağ alımlarının yetersiz olduğu bulunmuştur. Hastaların enteral ürün ve besin alımı birlikte değerlendirildiğinde, %98.1inin A vitamini, %100ünün E vitamini, %82.3ünün K vitamini, %81inin folik asit alımı %55.4ünün niasin ve %50.6sının C vitamini alımlarının, %66.4ünün kalsiyum, %44.5inin demir ve %13.4ünün çinko alımlarının yetersiz olduğu saptanmıştır. Ayrıca hastaların %25.4ünün standart tedavi dışında bir hekim veya diyetisyenin önerisi olmadan besin desteği veya ürün kullandığı ve en yaygın kullanılan besin desteğinin omega-3 şurup (%9.0) olduğu saptanmıştır. Sonuç: Kistik fibrozisli hastalarda enerji dengesizliği, malabsorpsiyon, artmış metabolik hız nedeniyle malnütrisyon riski yüksektir.Aim: The aim of this study was to evaluate the nutritional status and malnutrition in children with cystic fibrosis. Subjects and Methods: A total of 166 patients with cystic fibrosis, aged 2-20 years were evaluated. A 24-hour dietary recall was calculated using BEBIS 7.2 programme, weight for age (WAZ), height for age (HAZ), weight for height (WHZ) and body mass index z scores (BMIZ) were evaluated using WHO Anthro and Anthro Plus programmes. Results: Out of total, 10.1% of patients were underweight (WAZ ≤-2SD), 21.0% of the patients were stunted (HAZ ≤2SD). 25.3% of the patients were on oral foods, 74.7% were on both oral foods and oral enteral feeds. 41% of the patients skipped the morning meal, the most skipped meal for all age groups was morning meal. When oral foods and enteral feeds were evaluated together, it was found that meeting the percentage of recommended dietay allowances (RDA) for energy, protein, carbohydrate and fat intakes were 67%, 69.5%, 68.2% and 68.9%, respectively (below the recommended level). Vitamin A, E and K intakes of 98.1%, 100%, and 82.3% of the patients were insufficient, respectively. It was found that 81%, 55.4% and 50.6% of the patients had insufficient dietary folic acid, niacin and vitamin C intakes. It was also seen that 66.4% of calcium intake, 44.5% of zinc intake and 13.4% of iron intake were inadequate. In addition, the standard of care of a physician or dietitian except it was found that 25.4% of patients using nutritional supplements or products without the advice. The most widely used feed supplement of omega-3 syrup (9.0%) were found to be. Conclusion: In patients with cystic fibrosis, malabsorption, energy imbalance, increased metabolic rate, are risks of malnutrition

A Case Of Tuberculous Meningitis With Paradoxical Response In A 14-Year-Old Boy

A clinical or radiological worsening of already existing lesions or an emergence of new lesions after beginning treatment in patients with tuberculosis (TB) is referred to as the paradoxical response. This has aroused suspicion regarding the accuracy of diagnosis, the possibilities of treatment failure, or the presence of another underlying disease, and thus it is an important topic for clinicians to understand. In this article, the development of a paradox reaction in a 14-year-old male patient diagnosed with and treated for tuberculosis meningitis is reported. This pediatric patient with a healthy immune system is treated with steroids successfully and reported to elucidate the importance of managing the paradox of TB progression in spite of the appropriate anti-TB medications.PubMe