Prognostic value of red cell distribution width and echocardiographic parameters in patients with pulmonary embolism

Introduction: Pulmonary embolism (PTE) is a common cardiovascular emergency. We aimed to predict mortality in the acutephase and to assess the development of pulmonary hypertension in the chronic period with the combined use of red cell distributionwidth (RDW) and echocardiography (ECHO) for the prognosis of PTE. Material and methods: Cases diagnosed with acute PTE were prospectively monitored in our clinic. The initial data of 56 patientswere evaluated. The subjects were separated into two groups basing on RDW; group 1 had RDW ≥ 15.2%, while group 2 hadRDW < 15.2%. Results: Ninety-eight patients were enrolled in the study. We established the sensitivity (73.3%) and the specificity (73.2%) ofRDW to determine mortality in the cases with PTE. RDW ≥ 15.2% value was significant as an independent risk factor for predictingmortality (OR:7.9 95% CI, 1.5–40.9 p = 0.013) in acute PTE. The mean tricuspid annular plane systolic excursion (TAPSE) valuewas significantly different between the group-1 (RDW ≥ 15.2%, 2.20 cm (± 0.43)) and group-2 (RDW < 15.2%, 1.85 cm (±0.53))(p = 0.007). The threshold value for tricuspid jet velocity was > 2.35m/s, the sensitivity and specificity were 76.9% and61.9%, respectively for predicting mortality (AUC: 0.724, 95% CI: 0.591–0.858, p = 0.033). Conclusion: Our results indicate that high RDW levels are an independent predictor of mortality in acute PTE. Lower TAPSElevels show right heart failure in PTE patients; this may also be indicative of right ventricular systolic function. We believe thatdeveloping new scoring systems, including parameters such as RDW, TAPSE, and tricuspid jet velocities, may be effective indetermining the prognosis of pulmonary embolism

Intensive Care Management of Critical and Severe SARS-CoV-2 Infection in Pregnancy: A Retrospective Observational Study

Objective: This study examined the clinical consequences of pregnancy coexisting with severe acute respiratory syndrome coronavirus 2 in the intensive care unit (ICU). Materials and Methods: The study was designed as a retrospective observational study. After the ethical approval of the local ethics committee, the study was conducted for a period when the number of young coronavirus disease-2019 (COVID-19) cases increased in our country. The patients enrolled in the study were pregnant/puerperal patients followed up in our third-level ICU. Results: The mean age of 35 pregnant women included in the study was 29.57±4.36 years. Twenty-one of the births (80.8%) were preterm births. Twelve (34.3%) patients received invasive mechanical ventilation (IMV), and 5 (41.7%) of these patients were deceased. Twenty-six (74.3%) underwent a cesarean section (C/S). There were 5 (14.3%) patients who needed extracorporeal membrane oxygenation and 3 (8.5%) patients who needed continuous renal replacement therapy. The 28-day neonatal mortality rate for 26 births was 3.8%. The maternal mortality rate in the ICU was 14.3%. Conclusion: The preterm birth rate was high in our pregnant patients followed up in the ICU with a diagnosis of COVID-19. Because of clinical and radiological progression in pregnant women, it is difficult to indicate any gestational week in which maternal outcomes are better to undergo C/S. IMV mortality is not higher than in non-pregnant patients, so endotracheal intubation should not be avoided in appropriate patients, whether pregnancy continues or not. The absence of fully vaccinated patients in the study group revealed the protective effect of vaccination during pregnancy

Kronik obstrüktif akciğer hastalarında BT akciğer dansitesinin solunum fonksiyon testleri ile korelasyonu

Bu tezin, veri tabanı üzerinden yayınlanma izni bulunmamaktadır. Yayınlanma izni olmayan tezlerin basılı kopyalarına Üniversite kütüphaneniz aracılığıyla (TÜBESS üzerinden) erişebilirsiniz.ÖZET Özellikle hafif olgularda amfizemin klinik olarak tanınması ve ağırlığının belirlenmesi halen önemli bir sorundur. Bu amaçla kullanılan S3?T amfizemin küçük havayolları üzerindeki etkilerini yansıtmaktadır yani amfizem hakkında dolaylı bilgi vermektedir ve bulgular nonspesifiktir. BT çeşitli araştırmalarda amfizem tanısında konvansiyonel radyografilerden ve SFT den daha duyarlı bulunmuştur. BT nin dansitomet- rik ölçümlerle amfizem tarımında kullanımı hafif am- fizemli olguları normallerden ayırmada ve amfizemin derecelendirilmesinde objektif, noninvaziv ve kantitatif bir yöntem olarak son zamanlarda dikkati çek mektedir. Yöntemin esası amfizeme bağlı olarak akciğerlerde doku kaybı ve hava artışının yol açtığı dansite azalmasının BT attenüasyon sayılan ile uyum- ı lu olarak saptanabilme sidir* Bu yöntem amfizem hak kında dolaysız bilgi vermektedir. Çalışmamızda santral vasküler ve ana bronşial yapılardan kaynaklanması olası değişikliklerden kaçınmak için önceki, çalışmalardan farklı olarak akciğerin periferik kısmının dan- sitesi ayrıca ölçülmüş ve bu değerin amfizem tanısında total akciğer dansitesi değerine göre daha duyarlı olduğu gösterilmiştir. - 47

Addition of montelukast versus double dose of inhaled budesonide in moderate persistent asthma

Bayram, Hasan/0000-0002-5236-766X; Bulbul, Yilmaz/0000-0002-8488-3650WOS: 000224630500015PubMed: 15182276Background: Although current guidelines suggest the use of inhaled corticosteroids as the first line therapy in persistent asthma, the concerns about high-dose corticosteroids may limit their usage. We aimed to investigate the efficacy of inhaled budesonide plus oral montelukast versus a double dose of inhaled budesonide. Methodology: Thirty patients with moderate asthma took part in the study. Following a 2-week run in period, the patients were randomized into two groups to receive 400 mug/day of inhaled budesonide plus 10 mg/day of montelukast (BUD + M group) or 800 mug/day of inhaled budesonide (high BUD group). The patients were evaluated at 2-week intervals (during a total treatment period of 6 weeks) for symptom scores, asthma exacerbations, lung function, use of short-acting beta(2) agonist, blood eosinophil counts and adverse events. Results: At the end of the study, morning and daytime symptom scores were significantly reduced within the groups. Although there was a significant decrease in the frequency of short-acting beta(2) agonist use in the BUD + M group, the decrease in the high BUD group was not significant. During the study period, no patient in either group experienced an asthma exacerbation. Blood eosinophil levels significantly declined in both the BUD + M (0.87 +/- 0.31%) and high BUD groups (0.67 +/- 0.29%) as compared with baseline levels (BUD + M = 2.60 +/- 0.65%, high BUD group = 2.60 +/- 0.47%; P < 0.05). Conclusion: Our results suggest that the addition of montelukast to low-dose inhaled budesonide is as effective as a double dose of inhaled budesonide in asthma control

Etiology of benign mediastinal/hilar lymphadenopathy

Ulusal Akciğer Sağlığı Kongresi’nde poster bildiri olarak sunulmuştur (14-18 Mart 2018, Antalya).Çalışmamızda benign mediastinal/hiler lenfadenopati saptanan hastalar takip edilerek lenfadenopatiye neden olan hastalıkların dağılımı incelenmiştir. Çalışmamız, Mayıs 2015 ile Haziran 2016 tarihleri arasında prospektif olarak yürütüldü. Çalışmaya mediastinal/hiler lenfadenopati nedeni ile EBUS/ Mediastinoskopi/ Torakoskopi yapılan olgular alındı ve başlangıçta biyopside malignite saptanan hastalar çalışmadan çıkarıldı. Çalışmaya dahil edilen benign mediastinal/hiler LAP saptanan 93 hastanın %59.1 (55)’i kadın, %40.9 (38)’u erkek, yaş ortalaması 55.1 (±12.6) idi. Seksen üç hastaya Endobronşiyal Ultrason Eşliğinde Transbronşiyal İğne Aspirasyonu (EBUS TBİA), 7 hastaya mediastinoskopi, 2 hastaya Video-asiste torakoskopik cerrahi (VATS) ve 1 hastaya torakotomi yapıldı. Hastaların %53.8 (50)’inde sarkoidoz, %12.9 (12)’unda antrakoz, %5.1 (5)’inde tüberküloz, %4.3 (4)’ünde silikozis, %1.1 (1)’inde churg strauss sendromu, %1.1 (1)’inde hipersensitivite pnömonisi, %1.1 (1)’inde enfeksiyon, %1.1 (1)’inde kanser, %19.4 (18)’ünde nedeni bilinmeyen lenfadenopati bulundu. Çalışmamızdaki esas bulgu benign mediastinal/hiler lenfadenopatinin en yaygın nedeninin sarkoidoz olarak bulunmasıdır. Enfeksiyöz nedenlerden tüberküloz ise 3. sıklıkta LAP nedeni olarak bulunmuştur. Ayrıca granülomatöz lenfadenitin benign mediastinal/hiler lenfadenopatilerin yarısından fazlasını oluşturduğu görülmüştür. Mediastinel/hiler LAP’lerin büyük oranda EBUS TBİA yöntemiyle örneklenebildiği saptanmıştır. Ayırıcı tanının yapılamadığı olgularda takip ile tanıya gidilebileceği de anlaşılmaktadır.Our study was conducted as prospectively between May 2015 and June 2016. Cases that underwent EBUS/ Mediastinoscopy / Thoracoscopy with the diagnosis of mediastinal/hilar lymphadenopathy were included in the study and patients who were diagnosed to have malignancy in the initial biopsy were excluded from the study. The included 93 cases consisted of 40.9% men (38) and 59.1% women (55) with a median age of 55.1 (±12.6) years. Patients underwent Endobronchial Ultrasound Guided Transbronchial Needle Aspiration (EBUS TBNA) (83 patients), mediastinoscopy (7 patients), video-assisted thoracic surgery (2 patients) and thoracotomy (1 patient). The final diagnosis of the patients was accepted to be sarcoidosis in 50 (53.8%), anthracosis in 12 (12.9%), tuberculosis in 5 (5.1%), silicosis in 4 (4.3%), churg strauss syndrome in 1 (1.1%), hypersensitivity pneumonia in 1 (1.1%), infectious in 1 (1.1%), malignancy in 1 (1.1%) and uncertain in 18 (19.4%). The main findings of this study revealed that sarcoidosis was the most common cause for benign mediastinal/hilar lymphadenopathy. Tuberculosis was the third most common cause of benign mediastinal/hilar LAP. Furthermore, granulomatous lymphadenitis comprised more than half of benign mediastinal / hilar lymphadenopathy. It has been found that mediastinal/hilar LAP can be sampled by EBUS TBNA method to a large extent. In cases with impossible differential diagnosis, follow-up of patients may direct one to diagnosis in time

Evaluation of sarcoidosis cases in the last decade: Is there a seasonal difference?

Background: The sarcoidosis cases were emphasized to differ seasonally in previous studies. In particular, the seasonal distribution of Lofgren syndrome and sarcoidosis arthritis cases has been reported to vary. Aims and Objectives: In this study, the seasonal variability of sarcoidosis cases defined in the literature was investigated among the patients who applied to our outpatient clinic. Materials and Methods: The data of 582 patients referred to our outpatient clinic and had a preliminary diagnosis of sarcoidosis between January 2010 and March 2020 were evaluated retrospectively. Demographic information, admission dates to the hospital, diagnostic methods, organ involvement, and seasonal characteristics were determined and analyzed. Results: Of the 582 patients evaluated in the study, 359 had the diagnosis of sarcoidosis. The mean age of our patients was 50 years; 96 (26,7 %) were male, and 263 (73,3 %) were female. The number of patients diagnosed histopathologically was 338 (94,2 %), and the most common extrapulmonary involvement was skin involvement with 37 cases. In the last decade, a significant number of patients (134 (37.3%) cases) were referred to the physician during the spring. Conclusion: Sarcoidosis is a multisystem disease with unknown etiology. In our study, similar to other studies, there was an increase in the symptoms during spring. Therefore, sarcoidosis should be kept in mind in patients with symptoms such as cough and shortness of breath accompanied by skin findings during the spring months. However, the data to explain this condition are not sufficient. Therefore, prospective studies are needed to explain the seasonal relationship with the pathophysiology of sarcoidosis

Prognostic Value of Red Cell Distribution width and Echocardiographic Parameters in Patients with Pulmonary Embolism

Introduction: Pulmonary embolism (PTE) is a common cardiovascular emergency. We aimed to predict mortality in the acute phase and to assess the development of pulmonary hypertension in the chronic period with the combined use of red cell distribution width (RDW) and echocardiography (ECHO) for the prognosis of PTE. Material and methods: Cases diagnosed with acute PTE were prospectively monitored in our clinic. The initial data of 56 patients were evaluated. The subjects were separated into two groups basing on RDW; group 1 had RDW ≥ 15.2%, while group 2 had RDW &lt; 15.2%. Results: Ninety-eight patients were enrolled in the study. We established the sensitivity (73.3%) and the specificity (73.2%) of RDW to determine mortality in the cases with PTE. RDW ≥ 15.2% value was significant as an independent risk factor for predicting mortality (OR:7.9 95% CI, 1.5–40.9 p = 0.013) in acute PTE. The mean tricuspid annular plane systolic excursion (TAPSE) value was significantly different between the group-1 (RDW ≥ 15.2%, 2.20 cm (±0.43)) and group-2 (RDW &lt; 15.2%, 1.85 cm (±0.53))(p = 0.007). The threshold value for tricuspid jet velocity was &gt;2.35 m/s, the sensitivity and specificity were 76.9% and 61.9%, respectively for predicting mortality (AUC: 0.724, 95% CI: 0.591–0.858, p = 0.033). Conclusions: Our results indicate that high RDW levels are an independent predictor of mortality in acute PTE. Lower TAPSE levels show right heart failure in PTE patients; this may also be indicative of right ventricular systolic function. We believe that developing new scoring systems, including parameters such as RDW, TAPSE, and tricuspid jet velocities, may be effective in determining the prognosis of pulmonary embolism

Pneumococcal infections and protection with vaccination in adult chronic lung diseases

Pneumococcal infections are an important cause of mortality and morbidity in Chronic Lung Diseases. However, exacerbations, which make the treatment of diseases very difficult, and corticosteroids used during treatment carry a great risk of pneumococcal infection and adversely affect the treatment. The most rational way to reduce the negative impact of pneumococcal infections on the clinical and economic burden of Chronic Lung Diseases is vaccination of the risky population. Although, vaccination recommendations are well defined, recommended by national and international guidelines and are paid by health authorities, in Turkey, vaccination rates in adults with chronic lung disease is far below the expected. Since physicians are considered to be the most important and reliable resource that can guide their patients in vaccination, applying pneumococcal vaccination routinely in all patients with chronic lung diagnosis and making it a part of daily practice will greatly contribute to reducing the clinical and economic burden of pneumococcal infections in these patients. In this review, the effects of pneumococcal diseases on chronic lung diseases, the risk and clinical burden of pneumococcal diseases in chronic lung diseases are discussed in the light of guidelines and current literature, and the importance of protection from pneumonia in these patients is emphasized. In addition to general information and efficacy data about pneumococcal vaccines available in our country, application methods and access routes to vaccines are also described

Results of Turkish smoking cessation polyclinics data's analysis (TUSPA study)

Sengezer, Tijen/0000-0002-3200-8926; Er, Mukremin/0000-0001-6842-0587WOS: 000451979407230

Türkiye’de akciğer kanserinde genetik mutasyonların bölgesel dağılımı (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. Materials and Methods: Regional distribution of genetic mutations in lung cancer in Turkey (REDIGMA) study was carried out as a prospective, cross-sectional, observational study in a large number of centers in which lung cancer patients were followed and could perform genetic mutation analysis on patients’ biopsy materials. Results: The 703 patients (77.7% male, mean age 63.3 ± 12.5 years) who were diagnosed as NSCLC from 25 different centers were included in the study. Tumor samples from patients were reported as 87.1% adenocarcinoma, 6.4% squamous cell carcinoma and 6.5% other. Mutation tests were found to be positive in 18.9% of these patients. The mutations were 69.9% EGFR, 26.3% ALK, 1.6% ROS and 2.2% PDL. Mutations were higher in women and non-smokers (p< 0.000, p< 0.001). Again, the frequency of mutations in adenocarcinoma was higher in metastatic disease. There was no difference between the patient’s age, area of residence, comorbidity and clinical stage and mutation frequency. Conclusion: Our study revealed that the EGFR mutation rate in Turkey with NSCLC was similar to East European, African–American and Caucasian patients, and was lower than in East Asia.Giriş: Akciğer kanserinde standart kemoterapinin sonuçları çok tatmin edici değildir, bu nedenle hedefe yönelik tedavileri sağlayan genetik mutasyonları belirlemek önemlidir. Son raporlar, ırksal farklılığın ve bölgesel değişikliğin akciğer kanserinde mutasyon sıklığı üzerindeki etkilerini göstermiştir. Çalışmamızda küçük hücreli dışı akciğer kanseri (KHDAK)'nde genetik mutasyonların Türkiye'deki sıklığını ve bölgesel dağılımını belirlemeyi amaçladık. Materyal ve Metod: Türkiye'de akciğer kanserinde genetik mutasyonların bölgesel dağılımı (REDIGMA) çalışması, akciğer kanseri hastalarının takip edildiği ve hastaların biyopsisinde genetik mutasyon analizi yapılabilecek çok sayıda merkezde prospektif, kesitsel ve gözlemsel bir çalışma olarak gerçekleştirildi. Bulgular: Çalışmaya 25 farklı merkezden KHDAK tanısı konan 703 hasta (%77.7 erkek, ortalama yaş 63.3 ± 12.5 yıl) alındı. Hastalardan alınan tümör örnekleri %87.1 adenokarsinom, %6.4 skuamöz hücreli karsinom ve %6.5 diğer olarak bildirildi. Mutasyon testleri bu hastaların %18.9'unda pozitif bulundu. Mutasyonlar %69.9 EGFR, %26.3 ALK, %1.6 ROS ve %2.2 PDL idi. Mutasyonlar kadınlarda ve sigara içmeyenlerde istatistiksel olarak daha yüksek tespit edildi (p< 0.000, p< 0.001). Yine, adenokarsinomdaki mutasyonların sıklığı metastatik hastalıkta daha yüksekti. Hastanın yaşı, ikamet alanı, komorbiditesi, klinik evresi ve mutasyon sıklığı arasında farklılık saptanmamıştır. Sonuç: Çalışmamızın sonucunda Türkiye geneli mutasyon pozitifliği literatür ile karşılaştırıldığında Türkiye’de KHDAK'lı hastalarda EGFR mutasyon oranının Doğu Avrupa, Afrikalı-Amerikalı ve Kafkasyalı hastalara benzer ve Doğu Asya'dan daha düşük olduğu ortaya koyulmuştu