Effect of the presence of pneumonia on noninvasive ventilation success in chronic obstructive pulmonary disease cases with acute hypercapnic respiratory failure

Aim: To investigate the effect of the presence of pneumonia on the success of noninvasive mechanical ventilation (NIMV) in chronic obstructive pulmonary disease (COPD) cases with acute respiratory failure. Materials and methods: Sixty patients admitted to the intensive care unit (ICU) due to COPD exacerbation were included. The patients were divided into 2 groups as those with pneumonia (Group 1) and without pneumonia (Group 2). According to initial pH values, cases were also divided into 3 subgroups based on pH values. C-reactive protein (CRP), APACHE II scores, requirement of endotracheal intubation, mortality, and duration of ICU and hospital stay were also recorded. Results: NIMV success was found to be 85.5% in Group 1 and 51.1% in Group 2. Endotracheal intubation rates were higher in Group 2 (P = 0.008). NIMV failure was 70.1% in Group 2 and 10% in Group 1 in patients with severe acidosis. The APACHE II scores and CRP levels were significantly higher and independent risk factors in patients with NIMV failure (P < 0.002, P < 0.001). A significant difference was not found between groups in terms of duration of hospital and ICU stays and mortality. Conclusion: The presence of pneumonia in COPD cases is a factor that reduces NIMV success, but this does not affect mortality and the duration of ICU and hospital stay

Clinical importance of serum neopterin level in patients with pulmonary tuberculosis

Objective: Neopterin is a sensitive marker for cell-mediated immune response. Because of this, the neopterin levels of body fluids show cell-mediated immune response in different infectious diseases which involve T cells and macrophages. The aim of this study was to determine the clinical importance of neopterin levels in patients with tuberculosis and compare with those levels of healthy subjects. Methods: Seventy patients with tuberculosis (46 newly diagnosed cases, 15 relapse cases, and 9 multidrug-resistant tuberculosis cases) and 18 healthy adult individuals were included in the study. Neopterin concentrations were measured by the ELISA method according to the protocol of the manufacturer. Chi-square test was used in statistical analysis; p≤0.05 was considered statistically significant. Results: Serum mean neopterin levels were 23.74±21.8nmol/L (median: 18.3) in newly diagnosed patients with pulmonary tuberculosis; 28.69±21.2nmol/L (median: 21.2) in relapse patients and 31.28±14nmol/L (median: 25.4) in multidrug-resistant tuberculosis cases, respectively. Serum mean neopterin levels were 4.03±5.12nmol/L (median: 5.1) in healthy subjects. The serum neopterin levels were found to be significantly higher in patients with tuberculosis than the control group. There was a statistically significant correlation between neopterin positivity (neopterin level ≥10nmol/L was accepted to be positive) and clinical symptoms of hemoptysis and weight loss. Besides statistically significant correlations between neopterin positivity and hemoglobin level, sedimentation rate, mean leukocyte count and radiological involvement (localized or diffuse) were determined. Conclusion: Serum neopterin levels can be used as a helper laboratory finding for the diagnosis of patients with tuberculosis. For this aim, further controlled studies are needed