Bilateral pneumothoraces, pneumomediastinum, pneumoperitoneum, pneumoretroperitoneum, and subcutaneous emphysema after percutaneous tracheostomy -A case report-

We report a rare case of a 72-year-old female who developed extensive subcutaneous emphysema, bilateral pneumothoraces, pneumomediastinum, pneumoperitoneum, and pneumoretroperitoneum after a percutaneous dilatational tracheostomy. The patient's T-cannula was accidentally connected to the oxygen line with a non-perforated connector. The patient rapidly developed respiratory insufficiency and subcutaneous emphysema in the neck and both shoulders. The bilateral pneumothoraces were managed using a chest tube. CT scans of the chest, abdomen, and pelvis revealed an extensive distribution of air throughout the chest and abdomen. The patient was treated successfully with supportive care. This case illustrates the rare occurrence of air passing into multiple body compartments, highlighting the potentially serious complications of a tracheostomy and the importance of intensive care during the recovery period

Can the ADO Index Be Used as a Predictor of Mortality from COVID-19 in Patients with COPD?

Esra Ertan Yazar,1 Gulsah Gunluoglu,2 Burcu Arpinar Yigitbas,1 Mukadder Calikoglu,3 Gazi Gulbas,4 Nilgün Y&inodot;lmaz Demirci,5 Nurhan Sarioglu,6 Fulsen Bozkus,7 Nevin Taci Hoca,5 Nalan Ogan,8 Seda Tural Onur,2 Muzaffer Onur Turan,9 Filiz Kosar,2 Evrim Eylem Akpinar,8 Burak Mete,10 Can Ozturk5 1Department of Chest Diseases, Istanbul Medeniyet University, Medical Faculty, Istanbul, Turkey; 2Department of Chest Diseases, Yedikule Chest Disease and Chest Surgery Research and Training Hospital, Istanbul, Turkey; 3Department of Chest Diseases, Mersin University, Medical Faculty, Mersin, Turkey; 4Department of Chest Diseases, Inonu University, Medical Faculty, Malatya, Turkey; 5Department of Chest Diseases, Gazi University, Medical Faculty, Ankara, Turkey; 6Department of Chest Diseases, Balikesir University, Medical Faculty, Balikesir, Turkey; 7Department of Chest Diseases, Kahramanmaras Sutcu Imam University, Medical Faculty, Kahramanmaras, Turkey; 8Department of Chest Diseases, Ufuk University, Medical Faculty, Ankara, Turkey; 9Department of Chest Diseases, Prof Dr, Izmir Katip Celebi University, Atatürk Research and Training Hospital, Izmir, Turkey; 10Department of Public Health Çukurova University, Medical Faculty, Adana, TurkeyCorrespondence: Esra Ertan Yazar, Istanbul Medeniyet University, Medical Faculty, Department of Chest Diseases, Istanbul, Turkey, Email [email protected]: Several studies have shown that the risk of mortality due to COVID-19 is high in patients with COPD. However, evidence on factors predicting mortality is limited.Research Question: Are there any useful markers to predict mortality in COVID-19 patients with COPD?.Study Design and Methods: A total of 689 patients were included in this study from the COPET study, a national multicenter observational study investigating COPD phenotypes consisting of patients who were followed up with a spirometry-confirmed COPD diagnosis. Patients were also retrospectively examined in terms of COVID-19 and their outcomes.Results: Among the study patients, 105 were diagnosed with PCR-positive COVID-19, and 19 of them died. Body mass index (p= 0.01) and ADO (age, dyspnoea, airflow obstruction) index (p= 0.01) were higher, whereas predicted FEV1 (p< 0.001) and eosinophil count (p= 0.003) were lower in patients who died of COVID-19. Each 0.755 unit increase in the ADO index increased the risk of death by 2.12 times, and each 0.007 unit increase in the eosinophil count decreased the risk of death by 1.007 times. The optimum cut-off ADO score of 3.5 was diagnostic with 94% sensitivity and 40% specificity in predicting mortality.Interpretation: Our study suggested that the ADO index recorded in the stable period in patients with COPD makes a modest contribution to the prediction of mortality due to COVID-19. Further studies are needed to validate the use of the ADO index in estimating mortality in both COVID-19 and other viral respiratory infections in patients with COPD.Keywords: body mass index, COVID-19, eosinophils, FEV1, mortality, pneumonia, pulmonary disease, chronic obstructiv

ERS/EACTS statement on the management of malignant pleural effusions

Malignant pleural effusions (MPE) are a common pathology, treated by respiratory physicians and thoracic surgeons alike. In recent years, several well-designed randomized clinical trials have been published that have changed the landscape of MPE management. The European Respiratory Society (ERS) and the European Association for Cardio-Thoracic Surgery (EACTS) established a multidisciplinary collaboration of clinicians with expertise in the management of MPE with the aim of producing a comprehensive review of the scientific literature. Six areas of interest were identified, including the optimum management of symptomatic MPE, management of trapped lung in MPE, management of loculated MPE, prognostic factors in MPE, whether there is a role for oncological therapies prior to intervention for MPE and whether a histological diagnosis is always required in MPE. The literature revealed that talc pleurodesis and indwelling pleural catheters effectively manage the symptoms of MPE. There was limited evidence regarding the management of trapped lung or loculated MPE. The LENT score was identified as a validated tool for predicting survival in MPE, with Brims' prognostic score demonstrating utility in mesothelioma prognostication. There was no evidence to support the use of oncological therapies as an alternative to MPE drainage, and the literature supported the use of tissue biopsy as the gold standard for diagnosis and treatment planning.Management options for malignant pleural effusions have advanced over the past decade, with high-quality randomized trial evidence informing practice in many areas. However, uncertainties remain and further research is required http://ow.ly/rNt730jOxOS

Value of real-time endobronchial ultrasound-guided transbronchial needle aspiration

<b>Aim :</b> The diagnostic value of real-time convex-probe endobronchial ultrasound (CP-EBUS)-guided transbronchial needle aspiration (TBNA) in mediastinal pathologies, and the factors influencing it are not clearly known. This study has been designed to examine factors affecting the efficacy and diagnostic value of CP-EBUS-TBNA. <b>Methods :</b> Patients (<i>n</i> = 321) with mediastinal mass or enlarged lymph node in the mediastinum, participated in this study, conducted between April 2007 and May 2009. Samples were obtained from the lesions using the TBNA method, with the guidance of CP-EBUS. Histopathologic (in all samples) and microbiologic (in 151 patients&#x2032; samples) evaluations were carried out. Biopsy using an appropriate surgical method was taken when the result of the TBNA procedure was nondiagnostic. Thirty-four patients were excluded from the analysis due to several reasons. The diagnostic efficacy of the procedure was analyzed in the remaining 287 patients. <b>Results :</b> The diagnostic rate was 92&#x0025; (89.7&#x0025; for the benign diseases and 92.6&#x0025; for the malignant diseases (<i>P</i> = 0.59)). In granulomatous diseases, the rate was 96&#x0025; for sarcoidosis and 79&#x0025; for tuberculosis (<i>P</i> = 0.002). Patients in whom only one lymph node was sampled and in whom two or more lymph nodes were sampled had a diagnostic rate of 85&#x0025; and 95&#x0025;, respectively (<i>P</i> = 0.03). When left hilar nodes were sampled, a higher diagnostic rate was achieved (<i>P</i> = 0.01). <b>Conclusions :</b> CP-EBUS-guided TBNA has a high diagnostic rate. Sampling of at least two separate lymph nodes and the discovery of left hilar station in these lymph nodes increase the rate of diagnosis

Vascular endothelial growth factor and tumor necrosis factor genes polymorphisms in Turkish patients with sarcoidosis

Polymorphism at -857 locus of tumor necrosis factor (TNF)-alpha gene is considered to be a predisposition factor in sarcoidosis and held responsible for pathogenesis of the disease and polymorphism at +813 locus of vascular endothelial growth factor (VEGF) gene is thought to decrease predisposition to sarcoidosis. In our study, we examined and compared these polymorphisms in healthy Turkish control subjects and Turkish patients with sarcoidosis. We examined gene polymorphisms in 70 cases which were histopathologically diagnosed as sarcoidosis and 80 healthy subjects without any history of a chronic disease. 5 cc of blood were collected in tubes with EDTA from all of the cases. TNF-alpha-857 gene polymorphism and VEGF+813 gene polymorphism were determined using PCR + RFLP method after DNA isolation. TNF-alpha promoter polymorphism, at position -857, revealed no differences in genotype and allele frequency between patients and control subjects but more relapses were found in sarcoidosis patients who have this polymorphism. Considering the VEGF polymorphism at position + 813, we observed a significant increase in the frequency of rarer T allele at this position in healthy subjects compared with sarcoidosis patients. VEGF gene polymorphism at +813 locus may diminish susceptibility to sarcoidosis. TNF-alpha-857 gene polymorphism influence severity of the disease

Long-term follow-up and health-related quality of life in COVID-19 patients treated in hospital

Objective: To evaluate the persistence of symptoms and health-related quality of life of coronavirus disease-2019 patients. Method: The cross-sectional study was conducted from April to September 2020 at Health Sciences University, Yedikule Chest Hospital, Istanbul, Turkey, and comprised patients of either gender who had to be hospitalised and treated for coronavirus disease-2019. Those who had spent 3 months (46-90 days) post-discharge formed Group 1, those having spent 3-6 were in Group 2, while those with >6 months post-discharge were in Group 3. Data was collected over the telephone Using the European Quality of Life Scale with 5 dimensions and 5 levels. The variables likely to affect the persistence of symptoms and the quality of life questionnaire scores were analysed using SPSS 16. Results: Of the 225 subjects, 135(60%) were male and 90(40%) were female. The overall mean age was 55.7+/-19.91 years. There were 85(37.8%) participants in Group 1, 83(36.9%) in Group 2, and 57(25.3%) in Group 3. The age (p=0.09) and gender (p=0.23) distribution across the groups had no significant difference. Patients were called on an average 131.72+/-58.9 days after discharge (range: 46-279 days). Only 23.1% patients continued to show symptoms. Anxiety was the domain in which most patients 64(28.4%) reported deterioration. Conclusion: Most patients who have had coronavirus disease-2019COVID-19 after a long follow-up period did not show any symptoms or had any significant deterioration in their quality of life. Key Words: COVID 19, Post-discharge symptoms, Quality of life