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Objective We evaluated the association between the triglyceride–glucose (TG) index, a marker of insulin resistance, and obstructive sleep apnoea (OSA) severity in patients without diabetes mellitus, obesity, and metabolic syndrome.

Introduction: Alpha-1 antitrypsin (AAT) deficiency, characterized by reduced synthesis of a serine protease inhibitor in liver cells, has been recognized to contribute to the development of emphysema and liver disease. Additional clinical manifestations encompassing respiratory disorders and dermatological issues have also been documented. Case: A 56-year-old male patient presented with dyspnea. Despite being a non-smoker, he had a diagnosis of chronic obstructive pulmonary disease (COPD) five years ago. Utilizing inhaled corticosteroids (ICSs) - long-acting β2-agonists (LABAs)- long-acting muscarinic antagonists (LAMAs) inhalers, the patient's medical treatment had ceased for the past four months due to inhaler depletion. High-resolution thoracic computed tomography unveiled bilateral emphysematous regions, predominantly located in the lower pulmonary lobes. In light of the absence of smoking history, the suspicion of AAT deficiency was raised, prompting the assessment of serum AAT levels. Subsequent analysis indicated diminished AAT levels, prompting the collection of a dried blood sample for genetic evaluation. Genomic DNA amplification was performed using polymerase chain reaction (PCR), succeeded by allele-specific hybridization via Luminex XMAP Technology. This analysis disclosed a Q0amersfoort (Exon 2 Y160TAC > Ter TAG) (+/+) variant linked with AAT deficiency, originating from a frame-shift mutation that triggers a null (Q0amersfoort) stop codon. Conclusion: The presentation of COPD-related emphysema in a non-smoker underscores the necessity to consider AAT deficiency in the differential diagnosis.

Introduction:Transthoracic needle biopsy (TNB) is a common, safe and inexpensive procedure used in the diagnosis of intrathoracic lesions. Until today, there is still no study about the influence of standardized uptake value (SUVmax) in positron emission tomography/computed tomography (PET/CT) on the diagnostic success of TNB in intrathoracic lesions. We aimed to analyze the factors, one of which was the SUVmax value influencing the diagnosis success of CT-guided TNB in pulmonary, mediastinal and pleural lesions. Secondary aim was to investigate the predictive clinical factors of complications.Methods:A retrospective study of 403 patients who underwent CT-guided TNB at a reference chest diseases hospital between February 2019 and February 2021 was conducted. A pulmonologist had performed the procedure with a 20-gauge fine-needle (Spinal) or a 14-gauge automated needle (tru-cut). Data of pathology, microbiology and clinical follow-up of the patients were collected. A chi-square and Student’s t-test were used to evaluate the patient-related factors (gender and smoking), lesion-related factors (type, side, location, size, presence of necrosis observed by CT, SUVmax value in PET/CT), and procedure factor (type of needle) on the diagnostic success. Additionally, associations between clinical characteristics of patients and the complications were assessed.Results:A total of 403 patients underwent CT-guided TNB were enrolled and overall success was 70% (284/403). Smoking history (75% vs 43%, p=0.02) was predictor for diagnostic success. Lesion size and SUVmax value were significantly high in diagnosed patients (for both p

Introduction:Proinflammatory cytokines, produced as an immune response in severe acute respiratory syndrome-coronavirus 2 infection, activate the coagulation cascade as well. In this study, we investigated the difference in the clinical course of patients who had been already using anti-thrombotic therapy before coronavirus disease-2019 (COVID-19) for any reason compared to the group who had not.Methods:In this retrospective, multicenter study; patients who were hospitalized between March 11 and July 1, 2020 were divided into two main groups as who had been on anti-thrombotic therapy for any indication use previously at the time of admission or who had not been on anti-thrombotic therapy at the time of admission, and their selected clinical parameters were compared.Results:After analyzing the study population of 124 patients with a homogeneous distribution in terms of age and gender, the comparison of anti-thrombotic users and non-users showed no significant difference in hospitalization. There was a statistically significant decrease in mechanical ventilation apply rate, intensive care unit duration and mortality rate between the group using anti-thrombotic compared to the group not using it (p

Introduction:Acute pulmonary embolism (PE) is a disease with serious mortality and morbidity. Therefore, early diagnosis and treatment are important. A PE is a process accompanied by inflammation. Therefore, our study was designed to examine the relationship between hemogram parameters, which are easily accessible and indicative of inflammation, and late mortality from PE.Methods:Two hundred and two patients who were hospitalized in our hospital between January 1, 2017 and July 1, 2020 and who were diagnosed with pulmonary angio computed tomography were included. Demographic and clinical data, laboratory, radiology and echocardiography results of the patients were analyzed retrospectively from the hospital information system.Results:Seventy-eight of 202 patients included in the study were male (38.6%), 124 females (61.4%), mean age was 58.27±16.26 years. According to the results of univariate Cox regression analysis, age [hazard ratio (HR): 1,058, p=0.001], D-dimer (HR: 1,057, p=0.015), presence of malignancy (HR: 6,274, p=0.001), trauma history ( HR: 2,931, p=0.039), long travel history (HR: 0.163, p=0.003), C-reactive protein (HR: 1,004, p=0.021), PE severity index (HR: 1,033, p=0.001), EF (HR: 0.944 , p=0.001), red-cell distribution width (HR: 1,125, p=0.001), lymphocyte (HR: 0.999, p=0.001), platelet-lymphocyte ratio (PLR) (HR: 1.013, p=0.001) and neutrophil-lymphocyte ratio (NLR) (HR: 1,017, p=0.001) significantly and it was associated with mortality.Conclusion:Because of our study, we determined that NLR and PLR can be used as 12-month prognostic factors in patients with acute PE.

Introduction: Sarcopenia can be defined as the loss of skeletal muscle mass and strength, especially with aging. In total, 21.6% of patients with chronic obstructive pulmonary disease (COPD) have sarcopenia. In our study, we investigated whether the evaluation of respiratory muscles can be correlated with peripheral muscle measurement and what kind of relationship is between sarcopenia and pulmonary function tests. Methods: A retrospective observational study conducted in a single center included 75 male COPD patients admitted to the pulmonary rehabilitation unit. The data were obtained from the hospital information management system and patient files. Results: The mean age of 75 male patients included in the study was 65±9 years, 76% had a history of smoking, and 46% had comorbidities. Sarcopenia was detected in 20 patients, 16 of whom were over 65 years of age. While the mean Handgrip was 50, Quadriceps 36, and Pinchmeter 17 in all age groups, it was 58, 38, and 17 in the over 65 age group, and 21, 21, and 12 in the 65 age group with cachexia, respectively. There was no statistical relationship between sarcopenia and forced expiratory volume 1 (FEV1), forced vital capacity, FEV1/FEV, Global Initiative for Chronic Obstructive Lung Disease stages, modified Medical Research Council, and COPD assessment test scores in patients over 65 years of age (p>0.05). Conclusion: Although it was observed that the frequency of malnutrition and sarcopenia was higher than normal in the COPD patient group over 65 years of age, a decrease in pulmonary function tests and a decrease in effort capacity due to sarcopenia were observed, a statistically significant result was reached due to the insufficient number of cases.

Objective: There are very few studies concerning the frequency and course of nosocomial Coronavirus disease-2019 (COVID-19) infection among patients hospitalized having diseases other than COVID-19. In our study, patients who were admitted to the pulmonology inpatient clinic from the emergency room due to non-COVID-19 diseases and later diagnosed with COVID-19 (index cases) and the nosocomial transmission caused by these patients and the clinical outcomes were analyzed. Method: This study was carried out on 44 inpatients without COVID-19 at a pulmonology inpatient clinic during the first wave of COVID-19 pandemic. Oro-nasopharyngeal swab samples were taken at the time of hospitalization to detect COVID-19 by reverse transcription-polymerase chain reaction (RT-PCR) test. The test results of four patients were found to be positive. Due to the risk of nosocomial transmission, the remaining patients were re-evaluated for COVID-19 disease by clinical, radiological, and RT-PCR tests (1 to 3 times, and/or if symptoms developed). All patients were followed up for 30 days after discharge. Results: Thirty-six males (81%) and 8 females (19%) with a mean age of 65.6±13.6 (31-93) years were included in the study. Twenty-five of these patients had cancer, six had chronic obstructive pulmonary disease exacerbation, four had an aggravation of idiopathic pulmonary fibrosis, three had infected bronchiectasis, two had pulmonary embolisms, and four had other disorders. The RT-PCR test results were found positive in 4 patients. In about two weeks, COVID-19 infection emerged in 16 of the remaining 40 patients, and 10 of them (63% of the infected) died. The RT-PCR test results of patients with COVID-19 infection were found to be positive on day 8.2 averagely (6-13). Conclusion: Nosocomial transmission of COVID-19 may create a risk of severe illness and death among vulnerable patients. It is crucial to take necessary measures in order to reduce the risk of COVID-19 transmission in hospitals.

Introduction:To investigate the values of procalcitonin (PCT) and laboratory parameters in differentiating tuberculosis (TB) pneumonia from community-acquired pneumonia (CAP).Methods:Between 01.01.2018 and 01.01.2020, 4,133 patients diagnosed with CAP or TB pneumonia in a reference hospital for chest diseases and TB were retrospectively screened. Patients with a history of close contact with someone with TB, night sweats, weight loss, or cavitary infiltration that may be typical for TB in the chest X-ray were evaluated clinically and radiologically as high TB suspects and were excluded from the study. Demographic characteristics, comorbidities, medications, admission complaints, radiological findings, microbiology results, and laboratory parameters were recorded. CURB-65 and pneumonia severity index scores were calculated. Patients were grouped as TB (n=70) and CAP (n=506) based on the final diagnosis. The parameters of the two groups were compared.Results:The mean age of 576 patients was 55, and 423 (73%) were male. While sodium (Na) [95% confidence interval (CI): 0.716-0.914, p=0.001], blood urea nitrogen (BUN) (95% CI: 0.910-0.986, p=0.008), alanine aminotransferase (ALT) (95% CI: 0.913-0.998, p=0.043) and oxygen saturation (95% CI: 1.007-1.268, p=0.037) were found as independent biomarkers for differentiating TB and CAP, PCT had no significant influence on the differential diagnosis.Conclusion:Prompt differential diagnosis between TB and CAP is important for public health in endemic TB areas. We recommend the evaluation of Na, ALT, and BUN for this purpose.

In this case report, we evaluated the risk of pulmonary embolism in patients using new-generation anticoagulant drugs. Laboratory tests for follow-up and effective dose measurement of new-generation oral anticoagulants, which are very popular in the medical community today, are not available. Therefore, patients can be at risk for effective doses and drug selection. Although our cases received novel oral anticoagulant treatment, it was determined that they had thromboembolism. We emphasized that we do not have enough information about the complications and effective use of these drugs, which are advantageous in terms of use and side effects. This situation may lead us to negative situations that we cannot manage in the future.

Inflammatory myofibroblastic tumors (IMTs) are rare benign mesenchymal tumors that present diagnostic challenges due to their diverse clinical and radiological manifestations. We present a case of a 19-year-old female with a history of intermittent hemoptysis. Imaging studies suggested a mediobasal lung lesion, prompting further evaluation. Bronchoscopy revealed vascular changes, and PET imaging indicated high metabolic activity. A left lower lobectomy was performed for diagnostic and therapeutic purposes, confirming the diagnosis of IMT characterized by spindle cell proliferation and inflammatory infiltrates. Surgical resection remains the cornerstone treatment, offering favorable outcomes with rare recurrence. Follow-up underscores the importance of monitoring and assessing prognostic factors to optimize patient management.

Introduction:Chronic obstructive pulmonary disease (COPD) is a worldwide public health challenge because it affects more than 5% of the population. Early identification of the patients at risk of severe disease or death gives the clinician the chance to initiate rapid and aggressive treatment, and thereby save lives.Methods:This was a single-center observational retrospective study. We included all patients aged ≥40 years admitted to the respiratory intensive care unit with a diagnosis of acute exacerbation of COPD (AECOPD) between January 2014 and December 2018.Co-morbidities, hemogram and biochemistry values, and inflammatory markers were evaluated in both survivor and non-survivor groups. Results were evluated with SPSS.Results:A total of 1,454 patients were assessed, 315 (21.6%) patients died during the hospital stay, and 1,139 (78.3%) patients were discharged. In the non-survivor group, mean white blood cell counts were higher than in survivors [14.1 (9.7-20.3), vs 11.8 (8.5-16.1), p

Introduction: Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation and airway inflammation, with a prevalence of 10.1%. Among the many causes of COPD, Smoking is the leading and another big cause is (AATD α1-antitrypsin deficiency)’ an inherited disorder. Prevalence of COPD patients is 1.9%. World Health Organization (WHO) advice all COPD patients’ AATD rate to be screened at least once during their life.The prevalence of AATD in the general population ranges from 1:2,000–5,000 in parts of Europe and from 1 to 5,000–10,000 in the United States and Canada. Case 1: An 81-year-old male patient with COPD. In computed tomography (CT) of the thorax, mass in the right lower lobe and a nodule in the right upper lobe were detected. The biopsy from right bronchial entrance via fiberoptic bronchoscopy (FB) yielded squamous cell carcinoma (SCC). AAT level was 169 mg/dL (ref. range: 90–200 mg/dL). M/P lowell allele was detected in genetic analysis. Case 2: A 45-year-old male patient with COPD. Conglomerated lymhadenomegaly in the paratracheal area was detected in CT. The biopsy from mucosal infiltrates initiating from the entrance of the right upper lobe to the anterior segment revealed SCC. His AAT level was 190 mg/dL (ref. range: 90–200 mg/dL) and the genetic analysis demonstrated M/I mutation. Case 3: A 64-year-old male COPD patient. In thorax CT, a 24 mm diameter parenchymal nodule in the left lower lobe was detected. Transthoracic fine needle aspiration biopsy from the left lung nodule showed SCC. His AAT level was 196 mg/dL (ref. range: 90–200 mg/dL) and M/P lowell allele was detected in the genetic analysis. Discussion: AAT deficiency can cause early-onset of COPD, manifested with emphysema and chronic bronchitis. It has been suggested that AATD is associated with an increased risk of many types of cancer. Although the relationship between AATD or variant carriage and LC histopathology is not clear in the literature, it was detected as squamous cell carcinoma in our cases. We infer that unmeasurable lung damage is more prevalent in heterozygous patients and we believe that sharing our results may draw more attention in this regard.