Mathematical surface function-based design and 3D printing of airway stents

Background: Three-dimensional (3D) printing is a method applied to build a 3D object of any shape from a digital model, and it provides crucial advantages especially for transferring patient-specifc designs to clinical settings. The main purpose of this study is to introduce the newly designed complex airway stent models that are created through mathematical functions and manufactured with 3D printing for implementation in real life. Methods: A mathematical modeling software (MathMod) was used to design fve diferent airway stents. The highly porous structures with designated scales were fabricated by utilizing a stereolithography-based 3D printing technology. The fne details in the microstructure of 3D printed parts were observed by a scanning electron microscope (SEM). The mechanical properties of airway stents with various designs and porosity were compared by compression test. Results: The outputs of the mathematical modeling software were successfully converted into 3D printable fles and airway stents with a porosity of more than 85% were 3D printed. SEM images revealed the layered topography of high-resolution 3D printed parts. Compression tests have shown that the mathematical function-based design ofers the opportunity to adjust the mechanical strength of airway stents without changing the material or manufacturing method. Conclusions: A novel approach, which includes mathematical function-based design and 3D printing technology, is proposed in this study for the fabrication of airway stents as a promising tool for future treatments of central airway pathologies

Incidental lung findings in coronary computed tomography angiography

OBJECTIVE: In coronary computed tomography angiography, a part of the lung parenchyma also enters the image area which is called the field of view. The aim of this study was to evaluate the rate of pulmonary abnormalities and document their association with demographic features in subjects undergoing multislice coronary computed tomography angiography obtained for the assessment of coronary artery disease. METHODS: This was a retrospective observational study evaluating the coronary computed tomography angiography scans of 1,050 patients (58.5% males and 47.3% smokers) with a mean age of 52.2 +/- 11.2 years, obtained between January 2018 and March 2020. Pulmonary abnormalities were reported as nodules, focal consolidations, ground-glass opacities, consolidations, emphysema, cysts, bronchiectasis, atelectasis, and miscellaneous. RESULTS: In total, 274 pulmonary abnormalities were detected in 266 patients (25.3%). The distribution of incidental lung findings was as follows: pulmonary nodules: 36.4%, emphysema: 15.6%, bronchiectasis: 11%, ground-glass opacities: 7.2%, atelectasis 7.2%, focal consolidations: 5%, cysts: 6%, consolidations: 2.5%, and miscellaneous: 9.1%. The patients with pulmonary pathology were older (55.5 +/- 11.4 versus 51.0 +/- 10.9 years), and the percentage of smokers was higher (60.1 versus 43.2%). The possibility of the presence of any incidental lung findings in field of view of coronary computed tomography angiography increases significantly over the age of 40.5 years (p<0.001, AUC 0.612, 95%CI 0.573-0.651). CONCLUSION: Multislice coronary computed tomography angiography can give important clues regarding pulmonary diseases. It is essential for the reporting radiologist to review the entire scan for pulmonary pathological findings especially in patients with smoking history and over the age of 40.5 years. Keyword

Pnömoni tanısı ile hospitalize edilen demanslı hastalarda direkt maliyetin değerlendirilmesi

Pneumonia is an indisputable cause of morbidity and mortality in elderly patients especially if they have dementia. We aimed to compare the cost of pneumonia for hospitalized patients with and without dementia and to investigate the factors affecting the direct cost of hospitalization. Material and Methods: The study group consisted of 58 dementia patients hospitalized for pneumonia compared with a matched cohort of 54 patients without dementia. The data were collected from the hospital record system between May 2017 and June 2019. Demographic features, comorbidities, characteristics of pneumonia and factors contributing to the total cost of hospitalization were analysed retrospectively. Results: The total mean cost of all patients for hospitalization of pneumonia was 653.1±1,059.9 American Dollars. The mean cost in the dementia group is 976.14±1,433.83 and 339.01±180.81 American Dollars for the control group per episode (p=0.001). The mean length of stay is 10.24±6.97 days and 7.24±2.89 days in the dementia and control groups, respectively (p<0.05). The number of consultations, pharmacy costs, examination costs and the total costs of patients with dementia were significantly higher than those without dementia and independent of the parameters associated with the characteristics of pneumonia. Conclusion: This study shows that pneumonia in elderly patients with dementia produces a burdensome financial cost which is lower in a matched population of patients without dementia. Advances in elderly care, precautions for pneumonia and assessment of aspiration risk in dementia patients might be rational solutions for decreasing the cost of pneumonia.Amaç: Pnömoni, özellikle yaşlı hastalarda tartışılmaz bir morbidite ve mortalite nedenidir. Çalışmamızın amacı, pnömoni tanısı ile hospitalize edilen demansı olan ve olmayan hastaların, hastanede yatış maliyetini karşılaştırmak ve direkt maliyete etki eden faktörleri değerlendirmektir. Gereç ve Yöntemler: Çalışmaya, pnömoni tanısı ile interne edilip, tedavi edilen demans tanılı 58 hasta ve benzer özellikteki demans tanısı olmayan 54 hasta dâhil edildi. Hastane kayıt sistemine Mayıs 2017 ile Haziran 2019 tarihleri arasında kaydedilen hasta verileri incelendi. Hastaların demografik özellikleri, komorbiditeleri, pnömoniye ait özellikler ve direkt hastane maliyetine etki eden faktörler retrospektif olarak değerlendirildi. Bulgular: Pnömoni tanısı ile hospitalize edilen hastaların toplam direkt maliyeti 653,1±1.059,9 Amerikan Doları olarak değerlendirildi. Demansı olan hastalarda, yatış başına ortalama maliyet 976,14±1.433,83 Amerikan Doları iken demansı olmayan hastalarda maliyetin 339,01±180,81 Amerikan Doları olduğu gözlendi (p=0,001). Ortalama yatış süresi demanslı hastalarda ve kontrol grubunda sırasıyla 10,24±6,97 gün ve 7,24±2,89 gün idi (p<0,05). Konsültasyon sayısı, ilaç maliyetleri, muayene ücretleri ve toplam maliyetin, demanslı hastalarda pnömoninin klinik özelliklerinden bağımsız olarak kontrol grubuna göre anlamlı ölçüde daha yüksek olduğu gözlendi. Sonuç: Bu çalışmanın sonuçları, pnömoni tanısı ile interne edilen demanslı hastaların, benzer özellikteki demansı olmayan hastalara göre anlamlı oranda fazla direkt finansal maliyeti olduğunu göstermiştir. Yaşlı bakımındaki gelişmeler, pnömoni gelişiminin önlenmesi için alınacak tedbirler ve aspirasyon riskinin değerlendirilmesi ile demanslı hastalarda aşırı maliyet yükünden kaçınılması mümkün olabilmektedir

Rate of history of tuberculosis among healthcare workers in Turkey: A cross-sectional study

OBJECTIVES: Healthcare workers (HCWs) possess a high risk for both latent tuberculosis infection (LTBI) and active disease. This study aimed to investigate tuberculosis (TB) disease history in hospital staff working in healthcare institutions in the Eastern Black Sea Region of Turkey. MATERIAL AND METHODS: This study included 460 HCWs employed in 5 hospitals in the Eastern Black Sea Region of Turkey. Between May 01 and July 31, 2016, the participants were asked to answer a questionnaire, including data about TB history. The data about family TB history, Bacilli Calmette-Guerin (BCG) vaccination, or tuberculin skin test (TST) application before starting work were also evaluated. RESULTS: Of the 460 participants, 69.3% were women (n=319) and 30.7% (n=141) were men. The mean age was 32 (17-63) years. A total of 8 participants (1.7 %) had TB history. There was no statistically significant relationship between TB history and age, sex, body mass index (BMI), smoking habits, or presence of comorbidities (p>0.05 for all variables); family history of TB (p0.05). The duration of work (years) was higher in participants with a TB history. The p value was very close but did not reach the limits of significance (p=0.059). CONCLUSION: In this study, the rate of TB among HCWs was 1.7% (8 of 460 HCWs). Family history of TB and TST positivity are strong predictors of TB in HCWs

Thyroid gland disease as a comorbid condition in COPD

Introduction. Chronic obstructive pulmonary disease (COPD) is one of the most common causes of morbidity and mortality worldwide. The disease is characterized by progressive airway inflammation, which not only affects the airways but also has systemic effects that are associated with comorbidities. Although comorbid conditions such as hypertension and coronary artery disease are very well-known in COPD patients, diseases of the thyroid gland have not been sufficiently studied. Therefore, thyroid diseases are not considered among the comorbid conditions of COPD. The purpose of this study was to determine the thyroid gland disease (TGD) prevalence in COPD and associated factors. Materials and Method. The study included 309 (297 (96%) male) patients. The patients were subjected to spirometry and thyroid function tests (TFT) in the stable period. The thyroid gland disease they were diagnosed with was recorded after face-to-face meetings and examining their files. Results. The mean age of the patients who were included in the study was 65.9 +/- 9.8 (40-90). Thyroid disease was determined in 68 (22%) individuals. There were hypothyroidism in 7 (2%), euthyroidism in 45 (15%), and hyperthyroidism in 16 (%5) patients. No relationship was found between the severity of airflow limitation and the prevalence of TGD. Conclusion. Thyroid abnormalities are commonly observed in COPD. The most frequently encountered TGDs are euthyroid multinodular goiter, euthyroid sick syndrome (ESS), and toxic multinodular goiter

The effect of a single hemodialysis session on pulmonary functions in patients with end-stage renal disease

Objective: Changes in pulmonary functions have not been thoroughly investigated in patients undergoing hemodialysis (HD). The aim of this study was to determine the effect of a single HD session on pulmonary functions, measured by spirometry, in patients with end-stage renal disease (ESRD) undergoing chronic hemodialysis (CHD) treatment. Methods: Thirty patients with ESRD who were on CHD treatment for at least 12 months between January 2018 and January 2020 were enrolled. The pre-dialysis and post-dialysis spirometric measurements were recorded by a portable spirometry device. Results: The mean age and HD vintage of 30 patients (70% male, 20% diabetic, mean BMI: 26.0 +/- 4.7 (kg/m(2))) were 55.6 +/- 11.4 years and 117.6 +/- 66.3 months, respectively. Half of the patients (50%) were smokers (mean 11.5 +/- 13.59 packs/year). The spirometric measurements of most of the patients were abnormal (40% restrictive, 30% obstructive respiratory disorder, 30% normal). The FEV3(L), predicted FEV1(%), FEF25(L), and predicted FEF25(%) values were significantly increased after the HD session. A positive correlation between BMI and Delta FEV3 (L) values (r = 0.377, P =.04) was observed. A significant improvement in FEV3 values after a single HD session was recorded, which was independently related to higher BMI (beta = 0.501, P <.01) and non-smoking (beta = 0.495, P <.05). Conclusion: Spirometric measurements are abnormal in most CHD patients, and a considerable improvement in pulmonary functions is possible with a single HD session. Having a high BMI and being a non-smoker appear to have significant positive effects on amelioration in FEV3 (L). Larger trials are needed to evaluate pulmonary functions in CHD patients

Is it worth using thrombolytic therapy in elderly patients with pulmonary embolism

Objective: Antithrombotic treatment is avoided in geriatric population owing to its side effects. Thus, we aimed to examine complication rates related to thrombolytic treatment in geriatric patients with pulmonary thromboembolism (PTE). Materials and Methods: The study included patients aged >65 years who received thrombolytic treatment for a diagnosis of PTE. Patient files were screened retrospectively to extract data on etiology, clinical risk scores, laboratory values, thrombolytic treatment-related complications, and early mortality development. Results: The study included 68 patients (female: 70.6%; mean age: 77.8 years). The Simplified Pulmonary Embolism Severity Index score was high in all patients. Early mortality risk classification at admission was high, medium-high, and medium-low risk in 64.7%, 23.5%, and 11.8% patients, respectively. In-hospital mortality was 30.9%. The causes of death were secondary to PTE in 85.7% patients, respiratory failure in 9.6%, and sepsis in 4.7%. Complication-related mortality was not observed. The only independent risk factor for mortality was change in consciousness. Conclusion: Mortality and complication rates in geriatric patients receiving thrombolytic treatment are not as high as expected

Evaluation of thiol/disulfide homeostasis in bronchiectasis

Purpose. Thiols are sulfhydryl-containing organic compounds that have an important role in preventing cellular oxidative stress. This study compares the blood oxidative stress marker levels in bronchiectasis cases during their stable periods with healthy controls. Materials and Methods. Seventy-seven patients (49 patients with stable bronchiectasis/28 healthy controls), followed up by the chest disease clinic, were included in the study. Peripheral blood thiol-disulfide parameters (NT: native thiol (-SH); TT: total thiol (-SH + SS); SS: disulfide (-SS); SS-SH: disulfide/native thiol index; SS-TT: disulphide/total thiol index; SH-TT: native thiol/total thiol index), and ischemia-modified albumin (IMA) levels were examined in the stable bronchiectasis group and the control group. Thiol-disulfide homeostasis was evaluated using a novel and automated assay. Findings and Result. Blood native thiol levels in patients with stable bronchiectasis were found to be significantly higher compared with healthy controls. A positive correlation between the total airway disease score and IMA levels was present. Our findings revealed that native thiol levels, which constitute a part of the antioxidant defense system, are increased in patients with stable bronchiectasis

Evaluation of patients with fibrotic interstitial lung disease: Preliminary results from the Turk-UIP study

OBJECTIVE: Differential diagnosis of idiopathic pulmonary fibrosis (IPF) is important among fibrotic interstitial lung diseases (ILD). This study aimed to evaluate the rate of IPF in patients with fibrotic ILD and to determine the clinical-laboratory features of patients with and without IPF that would provide the differential diagnosis of IPF. MATERIAL AND METHODS: The study included the patients with the usual interstitial pneumonia (UIP) pattern or possible UIP pattern on thorax high-resolution computed tomography, and/or UIP pattern, probable UIP or possible UIP pattern at lung biopsy according to the 2011 ATS/ERSARS/ALAT guidelines. Demographics and clinical and radiological data of the patients were recorded. All data recorded by researchers was evaluated by radiology and the clinical decision board. RESULTS: A total of 336 patients (253 men, 83 women, age 65.8 +/- 9.0 years) were evaluated. Of the patients with sufficient data for diag-nosis (n=300), the diagnosis was IPF in 121 (40.3%), unclassified idiopathic interstitial pneumonia in 50 (16.7%), combined pulmonary fibrosis and emphysema (CPFE) in 40 (13.3%), and lung involvement of connective tissue disease (CTD) in 16 (5.3%). When 29 patients with definite IPF features were added to the patients with CPFE, the total number of IPF patients reached 150 (50%). Rate of male sex (p<0.001), smoking history (p<0.001), and the presence of clubbing (p=0.001) were significantly high in patients with IPE None of the women <50 years and none of the men <50 years of age without a smoking history were diagnosed with IPE Presence of at least 1 of the symptoms suggestive of CTD, erythrocyte sedimentation rate (ESR), and antinuclear antibody (FANA) positivity rates were significantly higher in the non-IPF group (p<0.001, p=0.029, p=0.009, respectively). CONCLUSION: The rate of IPF among patients with fibrotic ILD was 50%. In the differential diagnosis of IPF, sex, smoking habits, and the presence of clubbing are important. The presence of symptoms related to CTD, ESR elevation, and EANA positivity reduce the likelihood of IPF

Factors affecting caregiver burden in pulmonary patients

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