Isıtılmış tütün ürünü ilişkili subakut akciğer hasarı

Heated tobacco products release nicotine without burning tobacco with an electronically controlled heating system. 56-year-old male patient admitted with sudden onset of chest pain and shortness of breath. He had been using a heated tobacco product (I quit ordinary smoking, IQOS) for 2.5 years. Thoracic computed tomography scan revealed pleural-based atelectasis and fibroatelectatic changes in the lower lobe of the right lung, pleural fluid in the right upper lobe, fibroatelectatic changes and pleural thickening in the left lung. Biopsy taken with video-assisted thoracic surgery (VATS) showed lymphoid aggregation in nodular form and widespread anthracosis around the lung, fibrillar material that double-refracting the light in the alveoli, hyaline membrane-like material in the alveoli, type 2 pneumocyte hyperplasia, an interstitial organization, and a subacute lung injury picture with exogenous lipoid material. These findings were evaluated in accordance with toxic substance-induced chemical pneumonia. It was thought that it might be related to 2.5 years of using heated tobacco product

Morphological overview of cardiovascular comorbidities in chronic obstructive pulmonary disease: Frank's sign

Objective: Cardiovascular diseases are the most common and important comorbidities in patients with chronic obstructive pulmonary disease (COPD). Literature indicates that there may be a relationship between diagonal earlobe crease (DELC) and coronary artery disease (CAD). Accordingly, the present study aimed to assess the relationship with DELC and cardiac comorbidities in patients with COPD during routine physical examination. Materials and Methods: In this prospective cohort study, we evaluated the demographic data, pulmonary function test (PFT) results, lipid profile, oxygen saturation, and the presence of DELC in patients with COPD and control subjects. Results: DELC was diagnosed in 155 (62%) of COPD patients and these patients had a higher prevalence of CAD (p = 0.044). Moreover, DELC was diagnosed in 135 men (68.5%) and 20 (37.7%) women in the COPD group (p<0.001) and in 39 (48.8%) men and 14 (56.0%) women in the control group (p = 0.527). On the other hand, CAD was diagnosed in 18% of patients with early-stage COPD (n = 104) and in 30.8% of patients with late-stage COPD (n = 146) (p = 0.041). The sensitivity and specificity of DELC positivity in predicting CAD were 80.65% and 44.15% in COPD patients, respectively. Conclusion: The presence of cardiac comorbidities in COPD patients may play a vital role in the severity of the disease, exacerbations, and may also reduce the treatment response. Accordingly, an earlobe examination of patients with COPD may be useful in predicting the presence of cardiac comorbidities with high sensitivity. (C) 2020 Elsevier Inc. All rights reserved

Do N-terminal pro-brain natriuretic peptide levels determine the prognosis of community acquired pneumonia?

Objective: Pneumonia is a leading cause of mortality worldwide, especially in theelderly. The use of clinical risk scores to determine prognosis is complex and thereforeleads to errors in clinical practice. Pneumonia can cause increases in the levels of cardiacbiomarkers such as N-terminal pro-brain natriuretic peptide (NT-proBNP). The prognosticrole of the NT-proBNP level in community acquired pneumonia (CAP) remains unclear.The aim of this study was to evaluate the prognostic role of the NT-proBNP level in patientswith CAP, as well as its correlation with clinical risk scores. Methods: Consecutiveinpatients with CAP were enrolled in the study. At hospital admission, venous bloodsamples were collected for the evaluation of NT-proBNP levels. The Pneumonia SeverityIndex (PSI) and the Confusion, Urea, Respiratory rate, Blood pressure, and age ? 65years (CURB-65) score were calculated. The primary outcome of interest was all-causemortality within the first 30 days after hospital admission, and a secondary outcomewas ICU admission. Results: The NT-proBNP level was one of the best predictors of30-day mortality, with an area under the curve (AUC) of 0.735 (95% CI: 0.642-0.828; p< 0.001), as was the PSI, which had an AUC of 0.739 (95% CI: 0.634-0.843; p < 0.001),whereas the CURB-65 had an AUC of only 0.659 (95% CI: 0.556-0.763; p = 0.006).The NT-proBNP cut-off level found to be the best predictor of ICU admission and 30-day mortality was 1,434.5 pg/mL. Conclusions: The NT-proBNP level appears to be agood predictor of ICU admission and 30-day mortality among inpatients with CAP, witha predictive value for mortality comparable to that of the PSI and better than that of theCURB-65 score

Short-term variations of optic coherence tomography findings in mild and severe chronic obstructive pulmonary disease

Objective To evaluate the short-term changes in subfoveal choroidal thickness (SFCT), ganglion cell complex (GCC) analysis, and retinal nerve fiber length (RNFL) of patients with chronic obstructive pulmonary disease (COPD) in a 3-month follow-up. Materials and methods Forty-eight patients with COPD (96 eyes) and 40 control subjects (80 eyes) were enrolled in our study. COPD patients were grouped according to disease severity as Group 1 (mild–moderate) and Group 2 (advanced). GCC, RNFL, and SFCT analysis by Cirrus SD-OCT were obtained for all eyes, in two consecutive examinations with a 3-month interval. Results SFCT in Group 2 was lower than Group 1 and control group in the initial and 3rd month examination (p < 0.001, respectively). Inferior RNFL in Group 2 were lower than control group in the initial and 3rd month examination (p = 0.002, p < 0.001, respectively) Temporal RNFL were lower in Group 2 than Group 1 in 3rd month examination (p = 0.009). Average, superior, superotemporal, inferior, and inferonasal GCC analyses of the Group 2 were lower than control group both in the initial and 3rd month examination (p = 0.001, p < 0.001, respectively) SFCT, average, and superior GCC of Group 2 were significantly reduced during the 3-month follow-up (p < 0.001). Conclusion Hypoxia is thought to be the underlying mechanism in COPD, which may influence retinal and choroidal OCT parameters. Decrease in blood flow of optic nerve head, increased vascular resistance, and reduced blood flow in choroid may affect the visual ability in these patients, which should be kept in mind during their follow-u

Evaluating the Correlation of Mortality and Biochemical Parameters in Community-acquired and Hospital-acquired Pneumonia

Objective: The associations of inflammation and immunity of host lead to higher mortality in both community-acquired and hospitalacquired pneumonia patients. Therefore, several inflammatory and immunological biomarkers are essential for diagnosis, prognosis, and survival. Among these inflammatory markers, such as older age, and higher blood urea nitrogen, creatinine, procalcitonin and C-reactive protein, and lower albumin levels have been shown to have strong correlations with worse outcomes and high mortality, especially in community-acquired pneumonia patients. In this study, we investigated the correlation between several biochemical markers, which are mostly involved in inflammation, and mortality in not only community-acquired but also hospital-acquired pneumonia patients. Material and Methods: This was a retrospective study of hospitalized community-acquired and hospital-acquired pneumonia patients in a third degree university hospital. In their initial blood tests (also used for diagnosis), blood urea nitrogen, creatinine, procalcitonin, C-reactive protein and albumin levels, and white blood cell, lymphocyte, neutrophil, platelet and erythrocyte counts, red blood cell distribution width and hemoglobin levels were measured. The outcome variable was mortality at 30 days. Statistical analysis included univariate comparisons of continuous variables between deceased and survivor groups, subject to mortality analysis and logistic regression in both community-acquired and hospital-acquired pneumonia patients. Results: 272 hospitalized community-acquired and 80 hospital-acquired pneumonia patients were included. Patients who died during follow-up had older age and higher levels of procalcitonin, blood urea nitrogen, creatinine, and red blood cell distribution width in community-acquired pneumonia group. Remarkably, logistic regression analysis showed a significant relationship between creatinine and mortality, regardless of age, severity of community-acquired pneumonia and comorbidities. Creatinine is a strong independent prognostic factor, subject to mortality in community-acquired pneumonia group. Conclusions: Older age, higher procalcitonin, blood urea nitrogen, creatinine and red blood cell distribution width levels are significant biomarkers for prediction of higher mortality in hospitalized communityacquired pneumonia patients

Evaluation of Inflammatory Cells According to Phenotypes of Chronic Obstructive Pulmonary Disease

GİRİŞ ve AMAÇ: KOAH’da kronik hava akımı kısıtlanması,küçük hava yolu hastalığı (obstrüktif bronşiyolit) ile parenkimharabiyetinin (amfizem) ortak etkileri sonucundagelişmektedir. Amacımız stabil KOAH hastalarındainflamatuar hücrelerin KOAH fenotipleri arasında fark olupolmadığını araştırmaktır.YÖNTEM ve GEREÇLER: Stabil evrede KOAH'lı hastalar vekontrol grubu alındı. Her iki grubun demografik verileri, Creaktif protein (CRP) ve hemogram parametrelerikarşılaştırıldı. KOAH’lı hastaların solunum fonksiyon testleri(SFT), dispne skalaları ve alevlenme sayısı kaydedildi.İnflamatuar hücrelerin, kontrol grubu ile KOAH fenotipleriarasındaki ilişkisi analiz edildi.BULGULAR: Nötrofil-Lenfosit Oranı (NLO), Nötrofil-PlateletOranı (NPO), Platelet-Lenfosit Oranı (PLO) ve NötrofilEozinofil Oranı (NEO) KOAH grubunda kontrol grubuna göreanlamlı olarak daha yüksek bulundu. KOAH grubununfenotipleri arasında total eozinofil sayısı ile NEO ve ELOoranlarında Astım KOAH Overlap (AKO) grubunda anlamlıfarklılık saptanırken diğerleri benzerdi.TARTIŞMA ve SONUÇ: Stabil KOAH’da santral ve periferiksolunum yollarının tümünde inflamasyon söz konusudur.Özellikle eozinofil sayısı AKO grubunda belirgindir.INTRODUCTION: Chronic airflow limitation in COPD develops as a result of the common effects of small airway disease (obstructive bronchiolitis) and parenchymal destruction (emphysema). Our aim is to investigate whether there is a difference between COPD phenotypes of inflammatory cells in stable COPD patients. METHODS: Stable COPD patients and control group were included. Demographic data, C-reactive protein (CRP) and hemogram parameters of the two groups were compared. Pulmonary function tests (PFT), dyspnea scales and exacerbation number of COPD patients were recorded. The relationship between inflammatory cells and control group and COPD phenotypes was analyzed. RESULTS: Neutrophil-Lymphocyte Ratio (NLO), NeutrophilPlatelet Ratio (NPO), Platelet-Lymphocyte Ratio (PLO) and Neutrophil-Eosinophil Ratio (NEO) were significantly higher in COPD group than the control group. Total eosinophil count and NEO and ELR rates were significantly different between the phenotypes of the COPD group and asthma COPD overlap (ACO) group. DISCUSSION AND CONCLUSION: Inflammation is present in all central and peripheral airways in stable COPD, especially the eosinophil count is significant in the ACO group

Are Red Blood Cell Distribution Width and RDW/ Hemoglobin Ratio Predictable in Mortality Among Patients with Chronic Obstructive Pulmonary Disease?

Objective: Chronic obstructive pulmonary disease (COPD), the third most common cause of death in the world, is a multicomponentdisease with pulmonary and extrapulmonary manifestations. The red blood cell distribution width (RDW) conveysimportant information for short- and long-term prognosis through a variety of medical conditions. Anemia can be seen inpatients with COPD due to systemic inflammation and malnutrition. The aim of this study was to evaluate the role of RDWand RDW/Hgb in the prediction of mortality in patients with exacerbated COPD.Materials and Methods: Between December 2015 and December 2017, 97 patients admitted to the Department of ChestDiseases at the Ufuk University Medical Faculty, with a diagnosis of COPD exacerbation were evaluated retrospectively. Thedemographic, clinical, laboratory characteristics, pulmonary functional tests, and arterial blood gases were noted. The RDWvalues and RDW/Hgb ratios were compared between patients who had died and those who were still alive.Results: About 79.4% of the patients (n=77) were male and the rest of them 20 (20.6%) were female. The mean age was73.01±9.54 years. The RDW values of patients with mortality were higher than the living COPD patients (p<0.001). TheRDW/Hgb ratio was found to be higher in patients who had died than those who were living (p<0.001). The levels of CReactiveprotein were significantly higher in patients with COPD with mortality (p=0.034).Conclusion: The elevated RDW levels and the RDW/Hgb ratio were associated with an increased annual number of attacks,comorbidities, and an increased PO2 and PCO2 mortality risk in patients with COPD

Toplum kökenli pnömönide serum albümin ve CRP/albümin oranının hastalık seyrine etkisi

Community-acquired pneumonia (CAP) is a common type of respiratory tract infections with high morbidity and mortality. Prognostic role of CRP/Albumin ratio in CAP patients still is unknown. The aim of this study was to investigate the role the CRP/albumin ratio in predicting 30-day mortality and ICU requirement in hospitalized patients with CAP. Material and Method: The study included patients with CAP.Clinical records and plain radiographic images of the patients were retrieved from hospital database and were reviewed for each patient. Results: The 179 CAP patients who were hospitalized were included. CRP level and the CRP/albumin ratio were found to have no significant effect on mortality and ICU requirement (p=0.728, p=0.232, and p=0.110, respectively), whereas low albumin level was associated with high mortality and ICU requirement (p<0.001 for both). Conclusion: Increased albumin concentration was associated with a lower risk of 30-day mortality. The CRP/albumin ratio was found to have no significant role in predicting short-term mortality and morbidity in CAP patients. Further large-scale, multicenter studies are needed to investigate the prognostic value of the CRP/albumin ratio in predicting long-term prognosis in CAP patients.Toplum kökenli pnömöni (TKP) solunum yolu enfeksiyonları içinde yüksek mortalite ve morbiditeye sahiptir. Tanı, tedavi, prognoz takibinde çeşitli biokimyasal markerlar kullanılmaktadır. CRP, albümin rutin uygulamada sıklıkla kullanılan biokimyasal markerlardır. İnflamasyon temellli CRP/albümin oranı çeşitli hastalıklarda prognoz tahmininde kullanılmaktadır. Bu çalışmanın amacı TKP nedeniyle hastaneye yatırılan CRP/albümin oranının 30 günlük mortalite tahminindeki rolünü belirlemekti. Çalışmanın ikincil sonlanım noktası ise yoğun bakım ihtiyacı idi. Gereç ve Yöntem: Göğüs hastalıkları ve yoğun bakım servisine yatırılan TKP’li hastalar çalışmaya dahil edildi. Retrospektif olarak hasta dosyaları, radyolojik incelemeleri ve laboratuvar bulguları tarandı. Bulgular: Yüz (%55,9)’ü göğüs hastalıkları servisinde 79’u yoğun bakımda yatmakta olan 179 TKP’li hasta çalışmaya dahil edildi. Hastaların yaş ortalaması 72,027±12,88 yıldı; %61,5’i erkek, %38,5’i kadındı. CRP değeri ve CRP/albümin oranı 30 günlük mortalite ve yoğun bakım ihtiyacını tahmin etmede anlamlı bulunmazken (sırasıyla p:0,728, p:0,232, p:0,110), düşük albümin değerlerinin mortalite ve yoğun bakım ihtiyacı riskini anlamlı derecede artırdığı bulundu (p<0,001, p<0,001). CURB-65, PSI ve albümin 30 günlük mortalite ve yoğun bakım ihtiyacını tespit etmede anlamlı bulunan değişkenlerdir. Sonuç: Albümin değerinin yüksek olması TKP’de 30 günlük mortalite ve yoğun bakım ihtiyacı riskini azaltmaktadır. CRP, CRP/albümin oranının TKP’de kısa dönem mortalite ve morbiditeyi tahmin edememektedir. TKP’li hastalarda serum albümin, CRP düzeyleri ve CRP/ albümin oranının uzun dönem prognozu tahmin gücünü ortaya koymak için geniş kohortlarda, çok merkezli çalışmalara ihtiyaç vardır