Drug resistance in pulmonary tuberculosis in new and previously treated cases: Experience from Turkey

SummaryThe emergence of drug resistance is a major problem for tuberculosis (TB) control. The aim of this study was to determine the rates of resistance against TB drugs in patients with pulmonary tuberculosis (PTB). Data from 387 patients with active PTB between the years of 1999 and 2004 from the Research and Education Hospital for Chest Diseases and Chest Surgery were evaluated retrospectively. The patients were categorized as new, re-treatment, extrapulmonary and chronic cases. The study group consisted of 268 (69%) new, 57 (14.7%) re-treatment, 49 (12.6%) extrapulmonary and 13 (3.3%) chronic TB cases. The rates of resistance to isoniazid (INH), rifampicin (R), ethambutol (E) and streptomycin (S) were calculated separately for each group. The resistance to any of the drugs was 7.8% in the new cases, 58.5% in the re-treatment cases and 100% in the chronic cases. The multidrug-resistance (MDR)-TB rates were found to be 2.16%, 11.3% and 92.3% among the new, re-treatment and chronic cases, respectively. These data are important as they reflect the drug resistance rates during the pre-notification time period in western Turkey

The impact of chemotherapy on the EORTC QLQ-C30 and LC-13 quality of life scales in patients with lung cancer

Objective: The concept of quality of life (QoL) in lung cancer includes many physical, psychological and social components. We aimed to assess the effect of chemotherapy (CT) on QoL of lung cancer patients using QoL scales. Methods: Fifty inoperable lung cancer patients who were newly diagnosed and taken into a CT plan were included. Patients were followed in terms of responsiveness and toxicity. Turkish versions of the EORTC QLQ-C30 and LC13 scales were used before every cycles. Results: The average age was 60.1 years. There was no difference between QoL and age/income levels. The assessment of physical, social and occupational functions and overall health status of the male patients was better than female. Overall health status without comorbidity was better in the first cycle CT. Chemotherapy led to deterioration in social functions and economic status together with increase in neuropathy, constipation and hair loss. Patients with complete or partial response to treatment were observed to have better physical, occupational, emotional, cognitive and social functions, economic status and overall health; less fatigue, pain, shortness of breath, neuropathy and better appetite. Toxicities were found to affect the QLQ C30 and LC13 scales adversely. Conclusion: Presence of comorbidity, low education levels, socioeconomic status and CT induced hematologic/ gastrointestinal toxicities are the major parameters affect QOL in lung cancer. Chemotherapy leads to deterioration in social functions, increase in adverse events as well as worsening in economic status. Radiologic complete or partial response and small cell carcinoma are states in which parameters of QoL are affected positively by chemotherapy

The Assessment of Oncological Emergencies Of Chest Diseases

Amaç: Göğüs hastalıkları hastanesi acil servisine başvuran onkoloji hastalarının genel özelliklerini ortaya koymak amaçlandı. Yöntem: Bir aylık dönemde acil servise başvuran malignite tanılı hastaların sosyodemografik verileri ile birlikte başvuru semptomları ve acil tanıları retrospektif olarak incelendi.Bulgular: Çalışmaya alınan 118 hastanın 105 (%84.7)’si erkek, 13 (%15.3)’ü kadın ve yaş ortalaması 61.2 yıl idi. En sık başvuru yapan yaş aralığı 50-59 idi. Hastalarımızda saptanan en sık semptomlar nefes darlığı (%50), ağrı (%27.9), ateş (%14.4) ve hemoptizi (%10.1) idi. Daha az sıklıkta bulantı (%9.3), öksürük-balgam çıkarma (%7.6) ve halsizlik (%5.9) izlendi. Küçük hücreli dışı akciğer karsinomlu hastaların %87.5’i ve küçük hücreli akciğer karsinomunun %23.5’i ileri evre kansere sahip idi. En sık rastlanan acil tanı 49 (%41.5) hastada solunum yetmezliği, 14 (%11.8) hastada kemik metastazı, 13 (%11) hastada beyin metastazı idi.Sonuç: Göğüs hastalıkları acil servisine başvuran hastaların en sık yakınmaları nefes darlığı ve ağrı, en sık acil tanıları solunum yetmezliği ve metastatik hastalıktır. Genel talep palyatif tedaviler içindir, ölüm oranı düşüktür.Objective: It was aimed to reveal the general characteristics of oncology patients referred to emergency service of chest diseases training hospital. Method: A retrospective analysis was performed on the socio-demographic data, the referral symptoms and emergency diagnoses of the subjects diagnosed with malignity who referred to emergency service along one month. Results: Of 118 subjects included in the study, 13 (84.7 %) were women and 105 (84.7 %) were men and the average age was 61.2 years. Frequent age interval was between 50-59. The symptoms most often seen in our cases were dypnea (50 %), pain (27.9 %), fever (14.4 %) and hemoptysis (10.1 %), whereas nausea (9.3%), cough-expectoration (7.6%) and weakness (5.9%) were observed less frequently. 87.5% of non-small cell lung carcinoma and 23.5% of small cell lung carcinoma had advanced stage lung cancer. The most frequent encountered emergency diagnoses were respiratory insufficiency in 49 (41.5%) cases, bone metastasis in 14 (11.8%) and brain metastasis in 13 (11%). Conclusion: It was observed that the most frequent complaints for emergency deferral were dyspnea and pain and the most frequent emergency diagnoses were respiratory insufficiency and metastatic disease. General requirement was for palliative treatments and the mortality was lower

Does Pulmonary Embolism Differ Between Genders in Terms of Clinical, Laboratory Findings, Prognosis and Mortality?

Amaç: Pulmoner Tromboemboli (PTE) mortal ve tanı konulması zor bir hastalıktır. Bulgularınınnonspesifik olması nedeniyle zaman zaman tanıya ulaşmak oldukça zor olmaktadır. Malignite,immobilite, geçirilmiş cerrahi, trombofili, ilerlemiş yaş, genetik faktörler majör risk faktörleridir.PTE’de cinsiyetin prognoz ile ilişkisi hakkında yapılan çalışmalarda oldukça farklı sonuçlar bulunmaktadır. Biz bu çalışmada prognoz, yoğun bakım yatışı, laboratuvar ve radyolojik testler açısından cinsiyet farklılıklarını değerlendirmeyi amaçladık.Yöntem: Ocak 2012 ve Aralık 2015 tarihleri arasında Akut PTE tanılı toplam 348 hastanın verileri retrospektif olarak tarandı. Bu hastaların tümü 3. basamak bir göğüs hastalıkları hastanesiolan merkezimizin acil servisine başvurmuş hastalardı. Prognoz sınıflandırılmaları yapılırkenAvrupa Kardiyoloji Topluluğu (ESC) ve Avrupa Solunum Topluluğu (ERS) tarafından ortak tasarlanan PTE kılavuzu temel alındı.Bulgular: Hastaların yaş ortalaması 62,7 iken erkek hastalar daha genç olarak bulundu. Yaş ortalamasının kadınlarda daha yüksek olmasıyla uyumlu olarak kadınların basitleştirilmiş PulmonerEmboli Ciddiyet Endeksi (sPESI) skoru daha yüksek olarak gözlemlendi. Kadınların kötü prognostik faktörleri daha fazla olmasına rağmen her iki cinsiyet arasında erken mortalite açısındananlamlı bir fark bulunmadı.Sonuç: Yaş ortalamaları ve sPESI skorları arasında fark olmasına rağmen; kadınlarla erkekler arasında erken mortalite farkı bulunmadı. PTE’de cinsiyet çalışması farklı çalışmalarda farklı sonuçlarvermesi ve izlem protokollerini etkileyebilecek olmasından dolayı yeni çalışmalara açık bir alandır.Objective: Pulmonary thromboembolism (PTE) is a disease that mortal and hardly diagnosed. Since findings of PTE are nonspesific diagnosed can be so hard sometimes. Major risk factors are malignancy, immobility, previous surgery, thrombophilia, advanced age, and genetic factors. Studies on the relationship between gender and prognosis in PTE have very different results. In this study, we aimed to evaluate gender differences in terms of prognosis, intensive care admis- sion, laboratory, and radiological tests. Method: We retrospectively analyzed the data of 348 patients diagnosed with Acute PTE between January 2012 and December 2015. All of these patients were patients who applied to the emergency department of our center, which is a third step chest diseases hospital. We used the PTE guideline jointly designed by the European Society of Cardiology (ESC) and the European Respiratory Society (ERS) for prognosis classifications. Results: The mean age of the patients was 62.7, while the male patients were younger. Women’s sPESI scores and mean ages were observed higher than men. Although women had more bad prognostic factors, no significant difference was found between both genders in terms of early mortality. Conclusion: Although there is a difference between mean age and simplified Pulmonary Embolism Severity Index (sPESI) scores; no difference in early mortality between men and women. Gender studies in PTE are an area that is open to new studies, since the studies conducted on this subject give quite different results and these results may affect the follow-up protocols

Can the Progression of COVID-19 Pneumonia be Predicted?

Background: Coronavirus disease-2019 (COVID-19) remains a major cause of morbidity and mortality. There are many parameters affecting the progression of the disease. The purpose of the present study was to evaluate and compare the initial data of patients hospitalized with the diagnosis of COVID-19 pneumonia, who progressed during the hospitalization period, with other patients who recovered or remained stable, and to investigate the risk factors that can be used to predict the disease progression. Materials and Methods: Patients, who received inpatient treatment with the diagnosis of COVID-19 pneumonia, were included in the study retrospectively. Two groups were created from all patients according to their progression in hospital follow-ups: Group 1: Progression group and group 2: Recovery/stabilization group. If patients had clinical, laboratory and/or radiological deterioration or died during follow-up, these patients were included in the progression group. If patients recovered or remained stable, these patients were also included in the recovery/stabilization group. The demographic data, initial hemogram, biochemical parameters and radiological data of the patients were recorded. Results: It was determined in the univariate analysis that the age, smoking status, comorbidity, heart disease, chronic obstructive pulmonary disease, cancer, dyspnea, fever, leukocytosis, lymphopenia, elevated neutrophil-lymphocyte ratio (NLR), C-reactive protein, albumin, lactate dehydrogenase, ferritin, D-dimer, troponin-T, pro-B-type natriuretic peptide (pro-BNP) were risk factors predicting disease progression all p-values3.545 [area under curve (AUC)=0.752; p332.8 (AUC=0.752; p4.58 (AUC=0.730; p<0.001) in predicting progression. Conclusion: The identification of risk factors predicting progression is important in reducing morbidity and mortality rates. Fever, NLR, D-dimer troponin-T and pro-BNP are important parameters that can be used to predict progression

Pulmoner Emboli Klinik, Laboratuvar Bulguları, Prognoz ve Mortalite Açısından Cinsiyetler Arasında Farklılık Gösterir mi?

Amaç: Pulmoner Tromboemboli (PTE) mortal ve tanı konulması zor bir hastalıktır. Bulgularınınnonspesifik olması nedeniyle zaman zaman tanıya ulaşmak oldukça zor olmaktadır. Malignite,immobilite, geçirilmiş cerrahi, trombofili, ilerlemiş yaş, genetik faktörler majör risk faktörleridir.PTE’de cinsiyetin prognoz ile ilişkisi hakkında yapılan çalışmalarda oldukça farklı sonuçlar bulunmaktadır. Biz bu çalışmada prognoz, yoğun bakım yatışı, laboratuvar ve radyolojik testler açısından cinsiyet farklılıklarını değerlendirmeyi amaçladık.Yöntem: Ocak 2012 ve Aralık 2015 tarihleri arasında Akut PTE tanılı toplam 348 hastanın verileri retrospektif olarak tarandı. Bu hastaların tümü 3. basamak bir göğüs hastalıkları hastanesiolan merkezimizin acil servisine başvurmuş hastalardı. Prognoz sınıflandırılmaları yapılırkenAvrupa Kardiyoloji Topluluğu (ESC) ve Avrupa Solunum Topluluğu (ERS) tarafından ortak tasarlanan PTE kılavuzu temel alındı.Bulgular: Hastaların yaş ortalaması 62,7 iken erkek hastalar daha genç olarak bulundu. Yaş ortalamasının kadınlarda daha yüksek olmasıyla uyumlu olarak kadınların basitleştirilmiş PulmonerEmboli Ciddiyet Endeksi (sPESI) skoru daha yüksek olarak gözlemlendi. Kadınların kötü prognostik faktörleri daha fazla olmasına rağmen her iki cinsiyet arasında erken mortalite açısındananlamlı bir fark bulunmadı.Sonuç: Yaş ortalamaları ve sPESI skorları arasında fark olmasına rağmen; kadınlarla erkekler arasında erken mortalite farkı bulunmadı. PTE’de cinsiyet çalışması farklı çalışmalarda farklı sonuçlarvermesi ve izlem protokollerini etkileyebilecek olmasından dolayı yeni çalışmalara açık bir alandır

Clinical Differences Between Elderly and Non-elderly Patients with COVID-19

OBJECTIVE: Comorbidity frequency and mortality rates are higher in elderly patients with COVID-19. The disease is also more severe in elderly patients. This study aims to examine the characteristics of the COVID-19 disease, severity, comorbidities, and mortality rates in elderly patients by comparing them with nonelderly patients. MATERIAL AND METHODS: This study was designed as a retrospective study. 469 patients who were followed up in outpatient, inpatient, and intensive care units with the diagnosis of COVID-19 between March 11, 2020, and June 01, 2020, were retrospectively included in the study. Patients were divided into two groups who were >= 65 years named as the elderly group and 56 (AUC:0.775; p <0.001) in predicting mortality. CONCLUSION: Mortality is high, comorbidities are more frequent, and the disease is more severe in elderly patients with COVID-19. Age above 56 can be used as a cut-off to predict mortality