Factors Influencing Diagnostic Success of Computed Tomography-guided Transthoracic Needle Biopsy in Intrathoracic Lesions: An Experience of a Reference Chest Disease Hospital

Introduction:Transthoracic needle biopsy (TNB) is a common, safe and inexpensive procedure used in the diagnosis of intrathoracic lesions. Until today, there is still no study about the influence of standardized uptake value (SUVmax) in positron emission tomography/computed tomography (PET/CT) on the diagnostic success of TNB in intrathoracic lesions. We aimed to analyze the factors, one of which was the SUVmax value influencing the diagnosis success of CT-guided TNB in pulmonary, mediastinal and pleural lesions. Secondary aim was to investigate the predictive clinical factors of complications.Methods:A retrospective study of 403 patients who underwent CT-guided TNB at a reference chest diseases hospital between February 2019 and February 2021 was conducted. A pulmonologist had performed the procedure with a 20-gauge fine-needle (Spinal) or a 14-gauge automated needle (tru-cut). Data of pathology, microbiology and clinical follow-up of the patients were collected. A chi-square and Student’s t-test were used to evaluate the patient-related factors (gender and smoking), lesion-related factors (type, side, location, size, presence of necrosis observed by CT, SUVmax value in PET/CT), and procedure factor (type of needle) on the diagnostic success. Additionally, associations between clinical characteristics of patients and the complications were assessed.Results:A total of 403 patients underwent CT-guided TNB were enrolled and overall success was 70% (284/403). Smoking history (75% vs 43%, p=0.02) was predictor for diagnostic success. Lesion size and SUVmax value were significantly high in diagnosed patients (for both p<0.001). Diagnostic success was high in peripheral and central lesions, more notably in central lesions (p=0.004, p=0.016, respectively). The 9.2 SUVmax cut-off value had sensitivity of 79%, specificity of %53, success of 79% (p<0.01). Cardiovascular diseases, anti-coagulants, vitamin K antagonists, and salicylate induced complications (p=0.031, p=0.022, p=0.011, p=0.04, respectively). Low-molecular-weight-heparin was associated with hemorrhage (p=0.016).Conclusion:We observed that type, size and SUVmax value of lesion and smoking status were the predictive factors for a diagnostic biopsy

Impact of Nosocomial COVID-19 Infection Among Hospitalized Patients with Respiratory Diseases

Objective: There are very few studies concerning the frequency and course of nosocomial Coronavirus disease-2019 (COVID-19) infection among patients hospitalized having diseases other than COVID-19. In our study, patients who were admitted to the pulmonology inpatient clinic from the emergency room due to non-COVID-19 diseases and later diagnosed with COVID-19 (index cases) and the nosocomial transmission caused by these patients and the clinical outcomes were analyzed. Method: This study was carried out on 44 inpatients without COVID-19 at a pulmonology inpatient clinic during the first wave of COVID-19 pandemic. Oro-nasopharyngeal swab samples were taken at the time of hospitalization to detect COVID-19 by reverse transcription-polymerase chain reaction (RT-PCR) test. The test results of four patients were found to be positive. Due to the risk of nosocomial transmission, the remaining patients were re-evaluated for COVID-19 disease by clinical, radiological, and RT-PCR tests (1 to 3 times, and/or if symptoms developed). All patients were followed up for 30 days after discharge. Results: Thirty-six males (81%) and 8 females (19%) with a mean age of 65.6±13.6 (31-93) years were included in the study. Twenty-five of these patients had cancer, six had chronic obstructive pulmonary disease exacerbation, four had an aggravation of idiopathic pulmonary fibrosis, three had infected bronchiectasis, two had pulmonary embolisms, and four had other disorders. The RT-PCR test results were found positive in 4 patients. In about two weeks, COVID-19 infection emerged in 16 of the remaining 40 patients, and 10 of them (63% of the infected) died. The RT-PCR test results of patients with COVID-19 infection were found to be positive on day 8.2 averagely (6-13). Conclusion: Nosocomial transmission of COVID-19 may create a risk of severe illness and death among vulnerable patients. It is crucial to take necessary measures in order to reduce the risk of COVID-19 transmission in hospitals

Immunomodulatory Effect of Exercise in Patients with Asthma

Objective: Immune responses can change with exercise. We aimed to show the changes in cytokine levels pre- and post-exercise in patients with asthma. Methods: In this prospective control trial, data of 32 patients with asthma that was under control were classified into two groups, pre- and post-exercise. Serum IL-1β and monocyte IL-1β, IL-2, and IL-10 expressions were evaluated using enzyme-linked immunosorbent assay. The patients were advised to walk for at least 30 min for 4 days/week for 12 weeks. Results: There was no significant difference in demographic properties of the participants. Monocyte IL-1β levels in the pre- and post-exercise groups were 1.99±0.35 and 1.01±0.22 pg/mL, respectively (p=0.003). IL-10 levels in the pre- and post-exercise groups were 1.64±0.02 and 1.21±0.03 pg/mL, respectively (p=0.04). IL-2 levels in the pre- and post-exercise groups were 0.64±0.045 and 0.32±0.09 pg/mL, respectively (p=0.001). However, there was a significant difference in serum IL-1β and monocyte IL-1β, IL-2, and IL-10 levels between the groups (p=0.02, p=0.003, p=0.04, and p=0.001, respectively). Conclusion: Systemic inflammatory parameters that are commonly elevated in asthma may improve by exercise. The elucidation of the mechanism of immune control in patients with asthma is useful for the future treatment of asthma

Predictive value of the tuberculin skin test and QuantiFERON-tuberculosis Gold In-Tube test for development of active tuberculosis in hemodialysis patients

Background: Hemodialysis (HD) patients are at increased risk of reactivation of latent tuberculosis infection (LTBI) compared with the general population. QuantiFERON-TB Gold (QFT-G) for LTBI detection is more promising than tuberculin skin test (TST) in HD patients. AIM: In our study, we evaluated the value of the TST and QFT-G In-Tube (QFG-IT) test in the development of active tuberculosis (TB), in the HD patients, and in healthy controls. Methods: The study enrolled 95 HD patients and ninety age-matched, healthy controls. The TST and QFG-IT were performed. All the subjects were followed up 5 years for active TB disease. Results: Compared to the healthy controls, a high prevalence of LTBI was found in the HD patients by QFG-IT (41% vs. 25%). However, no significant difference was detected by TST (32% vs. 31%). Four HD patients and one healthy control progressed to active TB disease within the 5-year follow-up. For active TB discovered subjects, QFG-IT was positive in all, but TST was positive in two (one patient and one healthy control). In HD patients; sensitivity, specificity, positive and negative predictive values of QFG-IT, and TST for active TB was 100% and 25%, 62% and 67%, 10%, and 3%, and 100% and 95%, respectively. Receiver operating curve analysis revealed that the results are significantly different (P = 0.04). Conclusion: QFG-IT test is a more useful diagnostic method than TST for detecting those who will progress to active TB in HD patients

Primary Tracheal B-cell Lymphoma Causing Recurrent Central Airway Obstruction

WOS: 000341804000010PubMed ID: 24766730

Evaluating Fluoroquinolone Use in Patients Admitted to the Tuberculosis Outpatient Clinic

Objective: Inelaborate use of new quinolones with strong anti-tuberculosis (TB) activity leads to difficulty in diagnosis and more importantly, quinolone-resistant Mycobacterium tuberculosis. We aimed to determine the frequency of quinolone use in patients who were referred to our hospital for suspected TB and to evaluate the association between quinolone use and different clinical laboratory parameters. Methods: Between November 15 and December 15, 2013, all patients who were admitted to the TB outpatient clinic with no previous diagnosis of TB were included in this study. Demographic and clinical laboratory findings and history of antibiotic use were recorded. Patients’ quinolone use were questioned by showing fluoroquinolone antibiotic boxes’ photographs available on the market. The departments of the doctors who prescribed quinolones were recorded. Results: The mean age of 179 patients included in the study was 37±16 (15–89) years. Among these, 113 patients (63.1%) were male. Seventy five patients (41.9%) were diagnosed as tuberculosis according to the clinical-radiological and/or bacteriological findings. Of 179 patients, 58.1% (n=104) had been prescribed antibiotics for current complaints before referral to our clinic. Sixteen patients (15%) had been recommended fluoroquinolones. Fluoroquinolones were prescribed by seven internal medicine specialists, five pulmonologists, three emergency medicine specialists, and one family medicine practitioner. Among 16 fluoroquinolones prescribed, nine were moxifloxacin, four were levofloxacin, and three were gemifloxacin. Quinolone use revealed a significant inverse relationship only with the presence of hemoptysis (p=0.04). Conclusion: Besides increased educational activities regarding the rational use of antibiotics in recent years, the quinolone group of antibiotics is still prescribed for suspected TB cases. To avoid quinolone-resistant M. tuberculosis strains, further education is required

Primary tracheal B-cell lymphoma causing recurrent central airway obstruction.

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Purpose. The purpose of this study is to evaluate the vision related quality of life in patients with keratoconus by using the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25). Methods. Thirty patients presented with keratoconus (keratoconus group) and 30 healthy patients(control group) were included in this study. Twenty patients were using rigid gas permeable and 10 patients were not using contact lenses inkeratoconus group. High and low contrast visual acuity and mean K values of the patients were recorded. Each subject completed the 25-item NEI-VFQ-25. Results. All subscales of NEI-VFQ-25 were lower in the keratoconus patients. The difference was more evident in the subscales of generalvision, ocular pain, near vision, vision-specific mental health, vision-specific role difficulties, and peripheral vision (P  0.4) in the better eye had lower distancevision, social functioning, mental health, and role difficulties. Meanwhile, patients with low visual acuity (logMAR > 0.4) in the worse eye had lower general health scores (P < 0.05). Conclusions. Vision related quality of life was worse in keratoconus patients. Success in the contact lens usage and maintaining higher visual acuity may improve vision related quality of life

Can neutrophil/lymphocyte ratio and platelet/lymphocyte ratio be used in differential diagnosis of Stage I sarcoidosis from tuberculosis lymphadenopathy?

OBJECTIVE: It is challenging to differentiate mediastinal lymph node enlargement caused by tuberculosis (TB) and sarcoidosis as both diseases may cause granulomatous inflammation. The objective of this study is to evaluate the use of neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) as possible markers in the differential diagnosis of Stage I sarcoidosis and TB lymphadenopathy in patients who present with mediastinal lymph nodes and no parenchymal involvement. MATERIALS AND METHODS: A total of 19 TB, 55 sarcoidosis, and 32 control patients, whose clinical records were available, were included in this retrospective study. All patients had a granulomatous reaction revealed on their lymph node biopsy specimen. The complete blood count at the time of diagnosis was included in the study. RESULTS: NLR and PLR were both significantly increased in Stage 1 sarcoidosis patients compared to controls while only PLR was significantly increased in the TB group (for sarcoidosis, NLR P < 0.001 and PLR P < 0.001; for TB, NLR P = 0.12; PLR P = 0.017). There were neither significant differences in serum NLR nor PLR between sarcoidosis and TB groups. CONCLUSION: Although NLR and PLR are useful tools to differentiate Stage 1 sarcoidosis from controls and PLR may be used to differentiate TB lymphadenopathy from controls, these parameters may not be used to differentiate between Stage 1 sarcoidosis and TB lymphadenopathy