Assessment of osteoporosis using the FRAX method and the importance of vitamin D levels in COPD patients

Abstract Background The aim of this paper was to evaluate the availability of FRAX for assessing osteoporosis risk, and to demonstrate the importance of vitamin D levels in COPD patients. Methods Fourty-six males who fulfilled the COPD diagnostic criteria defined by GOLD were included. Age, race, BMI, physical activity frequency, smoking and dietary habits, age at COPD diagnosis, disease duration, fractures history, and medications use were determined. Levels of 25(OH)D were detected. BMD was measured by DXA at lumbar spine, femoral neck, and entire femur, and classified according to ISCD. FRAX score was calculated. Control group was composed of 40 non-smoker individuals without previous history of pulmonary diseases. Results 25(OH)D levels were significantly different between patients and controls. In the COPD group, a statistically significant difference in vitamin D levels was detected among the A, B, C, and D grades, while no such significant differences in FRAX scores were detected. 25(OH)D levels were significantly low in COPD patients with disease exacerbations and hospitalizations in the previous one year. No correlation was detected between vitamin D levels and the FRAX score. A positive correlation was observed between vitamin D levels and T-score. FRAX scores were higher and vitamin D levels were lower in osteoporotic COPD patients than in non-osteoporotic COPD patients. Conclusion Using FRAX for assessing osteoporosis in COPD can reduce fracture risk and allow adequate treatment. Since vitamin D levels are related to exacerbations and hospitalizations, vitamin D supplementation may be needed in COPD patients, especially in those with high FRAX scores

What are the Differences Between Smoker and Non-smoker COPD Cases? Is it a Different Phenotype?

OBJECTIVE: The most important risk factor for chronic obstructive pulmonary disease (COPD) is smoking. However, more than 25% of patients do not have a history of smoking. The intent of this study is to identify characteristics of COPD patients that are non-smokers.MATERIAL AND METHODS: The records of patients with COPD were retrospectively reviewed. Smoking history, comorbidities, exacerbations, biomass, and environmental tobacco smoke (ETS) exposures were identified. Also, age, gender, pulmonary function test (PFT) values, modified Medical Research Council (mMRC) dyspnea scores were recorded. Non-smokers exposed to any of the COPD risk factors above were grouped and the data were analyzed to determine the specific characteristics of COPD that applied to them.RESULTS: A total of 706 COPD patients were analyzed with a mean age of 67.2 ± 9.4. Of these patients, 93 (13.2%) were female and 613 (86.8%) were male. Of the 706 patients, 128 (18.1%) were non-smokers. The percentage of male patients having COPD was significantly lower in the non-smoker group (P < .001). However, biomass, ETS exposure in childhood, and a history of previous respiratory infection were significantly higher in the non-smoker group (P < .001). The mean body mass index (BMI) was greater in non-smokers than smokers.CONCLUSION: Non-smokers with COPD have more biomass, ETS exposure, and infection history in childhood. They also have less impairment of airflow limitation, better symptom scores, and greater BMIs. Smoking history can be used to determine a different phenotype

Clinical Characteristics and Transmission Routes of COVID-19 in the Early Period of the Pandemic in a Non-Covid Ward of Chest Diseases Hospital

Objective: In the early stages of the outbreak, Covid patients were followed-up in isolated Covid Wards, and the examinations of other pulmonary diseases continued in Non-Covid wards. Differential diagnosis between COVID-19 and infections caused by other pathogens is not adequately recognized. For this reason, it is even more difficult to identify patients who are infected with SARS-CoV2 or other pathogens. In the present study, the clinical characteristics and transmission routes of the Covid-19 cases in Non-Covid Wards within approximately 2 months’ time after the onset of the pandemic were analyzed speculatively. Method: In the early periods of the pandemic, quarantine wards were created for Covid patients in Chest Diseases Hospital, but there were also changes in Non-Covid patients and new Non-Covid hospitalizations. The clinical characteristics and transmission routes of the Covid cases in Non-Covid Ward were examined retrospectively and observationally between 10.03.2020 and 30.04.2020. Results: During this period, a total of 35 Covid cases were detected as a patient, companion and healthcare employees. The median age of the patients was 50 years (min-max 25-85). There were 17 patients (48.6%) who were not severe, and 18 severe patients (51.4%), and 10 (28.6%) patients died. A total of 25 (71,4%) of infected cases were verified with the SARS-CoV-2 Nucleic Acid Test, and 10 (28,6%) were diagnosed clinically and radiologically as possible COVID-19 cases. Being 65 years old or over, having comorbid diseases, especially COPD, the presence of dyspnea as a symptom and involvement on chest radiography were found to be significantly associated with survival (p0.027, 0.009, 0.038, 0.000 and 0.033, respectively). Lymphopenia, increase in neutrophil count, CRP and NLR value were found to be statistically related to survival (p 0.005, 0.001, 0.014 and 0.000, respectively). We found 4 super spreaders, one of whom was a companion, and 3 patients. Conclusion: Potential “super spreaders” can be the source of infection before the quarantine conditions are applied and comprehensive protection is implemented. For this reason, quarantine, use of personal protective equipment, application of social distancing, and the implementation of comprehensive preventive measures, such as disinfection, are crucial in controlling nosocomial infection

Clinical Effects of T790M Mutation in EGFR Tyrosine Kinase Inhibitor Resistant NSCLC Patients

INTRODUCTION: To compare patient characteristics between the T790M-positive and T790M-negative populations, and to analyze the post-progression survival (PPS) after initial tyrosine kinase inhibitor (TKI) failure in order to investigate the prognosis in patients undergoing rebiopsy. METHODS: We investigated the patient characteristics, including the initial EGFR-TKI response and T790M status at the time of rebiopsy or liquid biopsy, subsequent treatment after resistance to the initial EGFR-TKI (the presence of EGFR-TKI re-challenge), treatment just before biopsy and/or rebiopsy (EGFR-TKIs or chemotherapy), the timing of the rebiopsy (just after the initial EGFR-TKI failure or others). RESULTS: No difference was found between the two groups with T790M mutation positive and negative in terms of age, gender, and metastasis location. Only patients with positive T790M mutation had higher progression after TKI use compared to negative ones (p: 0.000). The progression-free median survival in patients using TKI was 19.33 months in the group with T790M mutation and 22.25 months in the negative group. Overall survival was found to be 75 months and 27.5 months in the T790M positive and negative group, respectively, and this was statistically significant. (p: 0.009). DISCUSSION AND CONCLUSION: Overall survival was significantly longer in the T790M positive group than in the T790M negative group. In addition, liquid biopsy can be performed several times for patients with progression after EGFR-TKI use and who do not want to undergo tissue biops

Bilgisayarlı Tomografi ile Hesaplanan Haunsfield Ünitesinin Plevral Sıvı Transüda-Eksüda Ayrımındaki Tanısal Değeri ve Plevral Sıvı Nötrofil/Lenfosit Oranı ile Karşılaştırılması

Amaç: Bu çalışmanın amacı, bilgisayarlı tomografide hesaplanan Haunsfield ünitesi (HU) değerinin plevral sıvı transüda-eksüda ayrımındaki değerini ortaya koymak ve ayrım açısından plevranın radyolojik özellikleri ve plevral sıvı nötrofil/lenfosit oranı (NLR) ile karşılaştırmaktır. Gereç ve Yöntemler: Çalışmada, 2008-2018 yılları arasında torasentez ile plevra sıvısı örneklemesi yapılan hastalar tek merkezde, retrospektif olarak incelendi. Toraks bilgisayarlı tomografide sıvının en fazla olduğu üç ayrı kesitten HU ölçümü yapıldı. HU için optimal cut-off değeri belirlendi. Plevranın bilgisayarlı tomografi görünümleri ve plevral sıvı NLR’nin transüda-eksüda ayrımındaki yeri karşılaştırıldı. Bulgular: Çalışmada 411 hasta incelendi. Tek taraflı plevra sıvılarının eksüda olma durumunun daha yüksek olduğu saptandı (p=0,001). Plevral nodül ve plevral lokülasyon özellikleri eksüda niteliğindeki sıvılarda daha sık görülmekle birlikte transüda-eksüda ayrımında istatistiksel olarak anlamlılık görülmedi. Plevral sıvı NLR ile transüda ve eksüda olma durumu arasında ve plevra sıvısı NLR ile HU değeri arasında bir ilişki izlenmemiş olup istatistiksel olarak anlamlı bir sonuca ulaşılamadı. Plevra sıvısı HU değeri ile transüda-eksüda ayrımında opaklı-opaksız çekimlerde anlamlı bir fark saptanmadı. Transüda-eksüda ayrımında HU için optimal cut-off değeri 7,9 olarak hesaplandı ve 7,9 değerine göre duyarlılık %45,8, özgüllük %86,3, pozitif prediktif değer %86,3, negatif prediktif değer %25,6 olarak saptandı. HU 7,9’un üzerinde olan hastaların; 7,9 ve altında olan hastalara göre 5,33 kat eksüda olma ihtimali fazla olarak bulundu (p=0,001). Sonuç: Çalışmamız plevra sıvısının bilgisayarlı tomografide HU değeri ile plevranın radyolojik özelliklerinin karşılaştırıldığı en geniş seridir. HU için optimal cut-off değeri 7,9 olup, HU değerinin 7,9’un altında olması transüda olma ihtimalini artırmaktadır. İnvaziv işlem yapılamayan ya da tanısal işlem öncesi transüda-eksüda ayrımında HU ölçümünün invaziv olmayan bir yöntem olarak kullanılabileceği düşünüldü

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

Do the Amount of Fluid, Histopathology, Radiology and Pleurodesis Status Affect the Survival in Malignant Pleural Effusions?

INTRODUCTION: The primary objective of this study was to identify the most common pleural malignancies leading to malign pleural effusion (MPE). The secondary objective was to evaluate the relationship between the amount of fluid and radiological findings, etiologies, treatment methods and survival. METHODS: We retrospectively included cases of MPE with a tissue diagnosis. RESULTS: The most common causes of MPE were lung cancer (73%), breast cancer (8.3%) and mesothelioma (7%). In patients who were offered chemical pleurodesis, pleurodesis was successful in nearly 31.1%. No relation wasfound between the amount of pleural fluid and cell type,survival, pulmonary, extrapulmonary malignancy and mesothelioma, Patients live longer if pleurodesis was successful (p = 0.005). Median survival of patients with MPE due to pulmonary, extrapulmonary and mesothelioma, ORCID: 0000-0002-8939-336X respectively were 77 ± 12.8, 150 ± 48.4 and 365 ± 0 days. The survival of the patients with mesothelioma was significantly longer than others (P: 0.000). DISCUSSION AND CONCLUSION: The main cause of MPE was lung cancer, followed by breast cancer, unknown primary and mesothelioma. Chemical pleurodesis was a viable palliative measure for MPE. Successful pleurodesis had a significant contribution to the survival

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

Prognostic Effects of Neutrophil-Lymphocyte Rates in Serum and Pleural Fluids in Malignant Pleural Fluids

Objective: Various studies have reported that the neutrophil-to-lymphocyte ratio in the serum (sNLR) may serve as a cost-effective and useful prognostic factor in patients with various cancer types. We investigated the clinical impact of NLR as a prognostic factor in malign pleural effusion (MPE) and sNLR on prognosis in MPE. Method: We retrospectively reviewed all of the patients who were diagnosed MPE. The relationship between sNLR and neutrophil-to-lymphocyte ratio in the malign pleural effusion (mNLR) value, age, Eastern Cooperative Oncology Group (ECOG), histopathologic type, serum albumin and lactate dehydrogenase (LDH) with survival were investigated. Results: A total of 222 patients with a mean age of 65.7±11.5 were included in the study. Patients with a mNLR value ?0.42 and a serum NLR value ?4.75 had a shorter survival (p: 0.000). Multivariate analysis, which showed that survival was significantly related mNLR value > 0.42 and/or sNLR value > 4.75 (Odds Ratio (OR): 2.66, %95 CI, 1,65-4,3 p: 0.001), serum LDH > 210 (OR = 1.8, %95 CI, 1,33-2,46 p: 0.001) and age > 65 (OR = 1.9, %95 CI, 1,41-2,55 p = 0.001). Conclusion: sNLR and mNLR may act as a simple, useful, and cost-effective prognostic factor in patients with MPE. Furthermore, these results may serve as the cornerstone of further research into the mNLR in the future. Although further studies are required to generalize our results, this information will benefit clinicians and patients in determining the most appropriate therapy for patients with MPE

Detection of Pneumocystis jirovecii by PCR in patients with lung cancer: A preliminary study

Introduction: Infection complications in lung cancer (LC), one of the most common cancers in the world, are still among the most important causes of death. Of them, P. jirovecii, which is as an opportunistic infection, causes a life-threatening type of pneumonia in cancer patients. This preliminary study aimed to determine the incidence and clinical status of P. jirovecii by PCR in lung cancer patients compared to the conventional method. Material and methods: Sixty-nine lung cancer patients and fSorty healthy individuals were included in the study. After sociodemographical and clinical features were recorded, sputum samples were collected from attenders. Firstly, microscopic examination was made with Gomori's methenamine silver stain and then PCR was performed.Results: P. jirovecii was detected in three of 69 lung cancer patients by PCR (4.3%), but not by microscopy. However, healthy individuals were negative for P. jirovecii by both methods. Based on clinical and radiologi-cal findings, P. jirovecii was evaluated as probable infection in one patient and colonization in the other two patients. Although PCR is more sensitive than conventional staining methods, it cannot distinguish probable and proven infections from pulmonary colonization.Discussion: It is important to evaluate the decision of infection together with laboratory, clinical and radiolog-ical findings. Moreover, PCR may enable to know the colonization and to take precautions such as prophy-laxis, due to the risk of colonization turning into an infection in immunocompromised patient groups. Further studies involving larger populations and evaluating the colonization-infection relationship in patients with solid tumors are needed.(c) 2023 SFMM. Published by Elsevier Masson SAS. All rights reserved.Funding This work is supported by TUBITAK with Project No: 120N924.TUBITAK [120N924