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Background: Coronavirus disease 2019 (covid-19), which causes a pandemic in the world, has started to appear in turkey since March 2020. Healthcare workers are at the top of the groups most at risk for covid-19 infection, which can have a negative impact on psychological state. Objectives: It was aimed to evaluate anxiety and depression levels among healthcare workers. Methods: this cross-sectional study performed via an online survey in april 2020. Participants answered questions about sociodemographic features, personal views and experiences about covid-19 and the hospital anxiety and depression scale (hads). Results: A total of 300 healthcare workers,193 men and 107 women, participated in the survey. According to hads, 44.6% of participants scored above anxiety and 68.2% scored above depression cut-off points. Being younger than 50 and taking care of covid-19 patients in hospitals were independently associated with anxiety risk. Female gender, young age (less than 50) and having comorbidity were independent risk factors for depression. Conclusion: Healthcare workers were at high risk of anxiety and depression during covid-19 outbreak. For this reason, psychological support should be given, especially to the group with high risk. Keywords: Healthcare workers; anxiety; depression; covid-19

BACKGROUND: Sedation is recommended during fiberoptic bronchoscopy, which is a common procedure in clinical pulmonary practice. However, there is no consensus or a standard approach globally. The present study aimed to assess the approaches of pulmonologists to sedation before bronchoscopic procedures in Turkey. MATERIALS AND METHODS: The study is designed as a cross-sectional study, based on survey-generated data. Pulmonologists working in Turkey were sent a 23-item survey via E-mail. The recipients were sent three reminders to complete the survey, and the responses were analyzed. The data analysis was carried out using the Statistical Package for the Social Sciences for Windows 15.0 package program. RESULTS: A total of 79 pulmonologists participated in the survey, with a mean age of 43.8 ± 7.7 years. Among the respondents, 92.4% stated that they applied sedation before bronchoscopic procedures. Of the total, 92% of the respondents stated that they used midazolam for sedation, while 20% used propofol, 18.7% used fentanyl and 9% used diazepam. All of the respondents reported using local anesthesia before the bronchoscopic procedure, with lidocaine being preferred by all. CONCLUSIONS: It was determined that most of the pulmonologists applied sedation during bronchoscopy usually in the form of mild-to-moderate sedation, with midazolam being the preferred medication. Of the respondents, 75% believed that the applied sedation was sufficient. Surveys like this could play a role in improving the implementation and application of international guidelines in Turkey.

Following the first reported cases of pneumonia of unknown etiology at the end of 2019 in Wuhan city, Hubei province, China, the causative agent was demonstrated to be a new coronavirus that has not been defined in humans before. The World Health Organization (WHO) named this virus as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the disease caused by the virus as coronavirus disease-19 (COVID-19). The disease spread rapidly to other countries through human-to-human transmission, and WHO declared a pandemic on March 11, 2020. As of April 2020, the number of individuals infected with SARS-CoV-2 and COVID-19 related deaths continue to increase rapidly worldwide. The main reason for the increase in the rate of infection is person-to-person transmission, while the main reason for the increase in mortality rate is the lack of a proven medical treatment specific to COVID-19 and the severe course of the disease in the elderly with low immunity. While a vast majority of individuals infected with SARS-CoV-2 are asymptomatic or recover after displaying mild symptoms, hospitalization is required in 14% of cases and severe disease requiring intensive care admission is seen in 5% of the infected individuals. WHO and national guidelines do not make clear recommendations regarding treatments for symptomatic patients. Currently, there is no vaccine or specific antiviral treatment for COVID-19, however supportive care, isolation and protective measures and experimental drugs/treatments are being used for the management of COVID-19. Medical treatments being used for COVID-19, aim to prevent the entry of the virus into the cell, to inhibit or reduce its replication, and to suppress the increased inflammatory response. In addition, “convalescent” plasma, which includes antibodies of patients who were completely recovered from the infection, is among the treatment options.

OBJECTIVES: In patients with chronic obstructive pulmonary disease (COPD), the inspiratory capacity–to–total lung capacity (IC/TLC) ratio has been found to be correlated with mortality and a reduced exercise capacity. Pulmonary rehabilitation (PR) is known to improve the exercise capacity and respiratory functions of patients with COPD. Our study aims to examine the impact of PR on the IC/TLC ratio in patients with COPD. MATERIALS AND METHODS: We included a total of 122 patients with COPD who received PR therapy twice a week over a period of 8 weeks in an outpatient clinic. RESULTS: Patients’ mean age was 62.5 (±8.2), and 15 patients (12.3%) were female. Post-PR FEV(1), TLCO, and pO(2) values, and the 6mWD, dyspnea, and quality-of-life (QoL) scores indicated a statistically significant improvement (p0.25 as Group 1 and IC/TLC ≤0.25 as Group 2. Both groups exhibited a significantly increased post-PR 6 mWT distance (375–420, 336–400 meters) with no difference between the groups. We observed a significantly increased FEV(1)% in both groups after the PR (p=0.007, 0.004). Again, QoL questionnaires and Modified Medical Research Council scores significantly improved for both groups (p0.25.

The choice of treatment according to the inflammation type in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) has been of recent interest. This study investigated the role of novel biomarkers, hospital outcomes, and readmission rates in the first month in patients with eosinophilic or neutrophilic AECOPD.We conducted a retrospective observational cohort study in a Chest Teaching Hospital with hospitalized AECOPD patients. Subjects' characteristics, hemogram results, C-reactive protein (CRP), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), platelet/mean platelet volume (PLT/MPV), length of hospital stay, mortality, and steroid use were recorded. Eosinophilic AECOPD defined as peripheral blood eosinophilia (PBE) was2% and neutrophilic AECOPD as PBE ≤2%. Readmission within 28 days of discharge was recorded.Of 2727(31.5% females) patients, eosinophilic AECOPD was found in 510 (18.7%) patients. Leucocytes, CRP, NLR, and PLR were significantly higher in neutrophilic AECOPD than in eosinophilic AECOPD (p0.001). Steroid use and mortality rate were 45% and 0.6% in eosinophilic AECOPD and 71%, and 1.4% in neutrophilic AECOPD, respectively (p=0.001, p=0.19). Age75 years, albumin2.5 g/dL, CRP50 mg/dL, and PLT/MPV20×103 were found to be risks factors for hospital mortality (p0.05 each). Readmission rates within 28 days of discharge were 5% (n=136), and this rate was higher in eosinophilic AECOPD patients not taking steroids (p0.001).NLR, PLR, and CRP levels were higher in neutrophilic AECOPD compared with eosinophilic AECOPD. These markers decreased with treatment in neutrophilic AECOPD. A PLT/MPV ratio of20×103 resulted in an increased mortality rate. Thus, appropriate steroid therapy may reduce readmission rates in the first 28 days after discharge in eosinophilic AECOPD.

Introduction We aimed to assess the relationship between peripheral eosinophilia and neutrophil/lymphocyte ratio with hospital admissions and re-admissions with chronic obstructive pulmonary disease (COPD) exacerbations. Materials and methods An observational cohort study was carried out in a tertiary teaching hospital. Subjects with previously diagnosed COPD and who were admitted as outpatients with acute exacerbations were included. The subjects' characteristics, complete blood count (CBC) parameters, neutrophil to lymphocyte rate (NLR), C-reactive protein (CRP), mean platelet volume (MPV) on admission and re-admission within the first 28 days. Patients were grouped according to their peripheral blood eosinophilia levels; group 1, > 2% (eosinophilic), group 2, ≤ 2% (non-eosinophilic or neutrophilic). The recorded data from the two groups were compared. Result 1490 eligible COPD subjects were enrolled. Approximately 42% were classified as eosinophilic. The non-eosinophilic group had a significantly higher leukocyte count, neutrophil percentage, and NLR than the eosinophilic group. The NLR value in patients with repeat re-admissions was higher than the average, i.e., 4.50 (p= 0.001). MPV and CRP measured on admission and re-admission were similar in both groups. The rate of hospital re-admission within 28 days was significantly higher in patients with a non-eosinophilic attack. Conclusions When a patient is admitted to outpatients with a NLR greater than 4.50 and with a non-eosinophilic exacerbation they have an increased risk of re-admission in the first month. Higher NLR values and non-eosinophilic exacerbations may be helpful for the early detection of potential acute attacks in COPD patients, and may be indicators for antibiotic management.

OBJECTIVES: To improve our knowledge and understand how to deal with non-adherence to the support programs and to determine the rate and possible factors related to non-adherence in subjects who attended our smoking cessation clinic. MATERIALS AND METHODS: This was a case-control study that included 550 subjects who applied to our smoking cessation clinic between June 1, 2011 and December 31, 2011. After a 1-year follow-up period, subjects were divided into two groups: adherent (controls) and non-adherent (cases). Sociodemographic and clinical parameters and smoking habits were evaluated. A p value

BACKGROUND Serum uric acid (sUA) levels were previously found to be correlated with hypoxic states. We aimed to determine the levels of sUA and sUA/creatinine ratios in stable COPD patients and to evaluate whether sUA level and sUA/creatinine ratio can be used as predictors of exacerbation risk and disease severity. MATERIAL AND METHODS This cross-sectional study included stable COPD patients and healthy controls. The sUA levels and sUA/creatinine ratios in each group were evaluated and their correlations with the study parameters were investigated. ROC analyses for exacerbation risk and disease severity were reported. RESULTS The study included 110 stable COPD patients and 52 healthy controls. The mean sUA levels and sUA/creatinine ratios were significantly higher in patients with COPD compared to healthy controls. The most common comorbidities in COPD patients were hypertension, diabetes, and coronary artery disease. While sUA levels were significantly higher in patients with hypertension (p=0.002) and malignancy (p=0.033), sUA/creatinine ratios was higher in patients with malignancy (p=0.004). The ROC analyses indicated that sUA/creatinine ratios can be more useful than sUA levels in predicting exacerbation risk (AUC, 0.586 vs. 0.426) and disease severity (AUC, 0.560 vs. 0.475) especially at higher cut-off values, but with low specificity. CONCLUSIONS Our study suggested that sUA levels and sUA/creatinine ratios increased in patients with stable COPD, especially among patients with certain comorbidities compared to healthy controls. At higher cut-off values, sUA levels and especially sUA/creatinine ratios, might be useful in predicting COPD exacerbation risk and disease severity. Also, their association with comorbidities, especially with malignancy and hypertension, may benefit from further investigation.

Objectives Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a new, minimally invasive, bronchoscopic technique used in the evaluation of inthrathoracic lymph nodes.Use of sedation drugs before the procedure differs among centres. There is no standardization about sedation before EBUS-TBNA.We used a policy decision to shift from use of propofol with midazolam vs midazolam alone in a large tertiary hospital to evaluate the diagnostic yield and safety of EBUS-TBNA procedure. Methods Files of all the patients who were performed EBUS-TBNA between the dates of September 2010 and May 2014 were surveyed. All the EBUS-TBNA cases were performed under sedation of propofol and midazolam with an accompanying anesthesiologist in the beginning, however, sedation is applied with midazolam without an accompanying anesthesiologist after April 2013 due to changes in sedation policy. The diagnostic yield and complication rates were compared by chi-squared analysis between two groups. Results The files of 340 EBUS-TBNA performed patients were evaluated. Of the patients 274 eligible patients were analysed. 152 patients who fulfilled the inclusion criteria were analysed in propofol-midazolam (P) sedated group and 122 patients were analysed in midazolam (M) group. There is no statistically significant difference between two different sedated groups in terms of age and gender. Diagnostic value was detected as 77.6% in P group and 85.7% in M group and the difference was not statistically significant. No difference between complication rates of both groups was observed. Conclusion Both sedation-types for performing EBUS-TBNA showed similar diagnostic value and complication rates in our study. Propofol with midazolam application requires with an accompanying anaesthesiologist, therefore, it increases cost. EBUS-TBNA procedures had been performed in safe with no decrease in diagnostic yield under moderate sedation.

Objective: We aimed to evaluate smoking habits of students, reasons of smoking and students’ level of knowledge on the adverse effects of smoking in a state high school in İstanbul. Methods: A 15-item questionnaire was administered to the students attending a state high school in İstanbul to evaluate their attitudes and behaviors towards cigarette smoking. The questionnaire was completed by each class of students at the same class period under the supervision of their teachers. Results: The questionnaire was completed by 415 students at the respective school. While 349 students (84%) never smoke, 66 (15.9%) students were either current smokers or quitters. Fifty five of the students (13.2%) were active smokers. When we looked at the reasons of smoking, they reported that 63.6% smoked cigarettes because their friends did; 47.2% smoked cigarettes due to exam-related stress; and 40% smoked cigarettes due to family problems. The rate of smoking friends in the smoker group was significantly higher than in the non-smoker group (p=0.0001). A logistic regression analysis showed that having smoking friends was associated with an 8-fold increase in the risk of smoking compared to having no smoking friends. Conclusion: The most common reasons of smoking at the school were friends who were smokers, exam-related stress and family problems. Having friends who smoke was associated with an 8-fold increase in the risk of smoking. We believe that counselling services’ close engagement with family problems of students and exam-related stress issues and helping them to cope with these problems may prevent their vulnerability to toxic substances.

While the incidence of sarcoidosis peaks between 20 and 39 years, it is comparatively low in elderly subjects. We sought to determine whether there are age-dependent differences in the demographic and laboratory characteristics of patients with sarcoidosis.We retrospectively collected information from our database using the International Classification of Disease (ICD) diagnostic code D86 between 2008 and 2014. Patients were divided into three groups: 20-39 years old (Group 1), 40-59 years old (Group 2), and 60-80 years old (Group 3).A total of 3988 patients with code of D86 were included in the study. After the exclusion of non-eligible patients, the number of cases in Groups 1, 2, and 3 were 276, 641, and 352, respectively. The groups were compared according to demographic characteristics, ICD diagnostic codes, and laboratory parameters. The ratio of female patients was significantly higher in Group 3 than in Groups 1 and 2 (p=0.000). There was no difference in diagnostic codes of the ICD subgroups between groups (p=0.19). While the level of blood-urea nitrogen was significantly higher in Group 3 patients than in other groups (p=0.000), serum angiotensin-converting enzyme (ACE) values were found to be significantly low in Group 3 (p=0.010). The mean ACE values did not differ between females and males (50.8±39.3 and 59.1±45.5 mg/dL, respectively) (p=0.18).The majority of patients with sarcoidosis were female in all age groups and pulmonary sarcoidosis was the most common presentation of the disease. Elderly patients (≥60 years) with sarcoidosis had lower serum ACE levels than younger patients.Sarkoidoz insidansı 20 ve 39 yaşları arasında pik yapmakta iken, yaşlı olgularda görece düşüktür. Çalışmamızda, sarkoidoz hastalarının demografik ve klinik özelliklerinde yaşa bağlı değişiklikler olup olmadığını belirlemeyi amaçladık.Hastane veritabanımızı kullanarak 2008 ve 2014 yılları arasında, Uluslar arası Hastalık Sınıflama (ICD) tanı kodu D86 olan hastalara ait verileri, retrospektif olarak topladık. Hastalar yaş aralığına göre üç gruba ayrıldı: 20–39 yaş (Grup 1), 40–59 yaş (Grup 2) ve 60–80 yaş (Grup 3).ICD tanı kodu D86 olan toplam 3988 hasta çalışmaya alındı. Uygun olmayan hastalar çalışma dışı bırakıldıktan sonra vaka sayıları Grup 1, 2 ve 3’de sırasıyla 276, 641 ve 352 oldu. Gruplar, demografik özellikleri, ICD tanı kodları ve laboratuar parametrelerine göre karşılaştırıldı. Kadın hasta oranı Grup 3’de Grup 1 ve 2’ye göre anlamlı oranda yüksekti (p=0,000). ICD tanı kodu alt kırılımlarına göre gruplar arasında farklılık yoktu (p=0,19). Kan üre azotu düzeyi Grup 3’de anlamlı oranda yüksek iken (p=0,000), serum anjiyotensin-konverting enzim (ACE) değerleri anlamlı oranda düşük bulundu (p=0,010). Kadın ve erkeklerde ortalama ACE düzeyleri arasında fark yoktu (sırasıyla, 50,8±39,3 ve 59,1±45,5mg/dL) (p=0,18).Tüm yaş gruplarında sarkoidoz hastalarında kadın oranı daha yüksek olup, akciğer sarkoidozu en sık saptanan prezentasyon şekli idi. Yaşlı hastalarda (≥60 yaş) gençlere göre serum ACE düzeyleri daha düşük bulundu.

Objective The aim of this study was to compare the drug-eluting balloon with self-expanding interwoven nitinol stent deployment in patients with complex femoropopliteal lesions. Methods We retrospectively identified patients at our clinic with complex femoropopliteal artery lesions treated either with self-expanding interwoven nitinol stent or drug-eluting balloon. All patients had ankle-brachial index measured before and after the intervention, and regular clinical follow-up with Doppler ultrasonography was performed at six months and one year. Patients underwent peripheral angiography if needed. Results From April 2012 to July 2015, 107 patients with complex femoropopliteal lesions treated with using self-expanding interwoven nitinol stent ( N = 49, mean length 143.5 mm, mean follow-up of 14.1 ± 3.7 months) or drug-eluting balloon ( N = 58, mean length 140.6 mm, mean follow-up of 13.8 ± 4.1 months). The technical success rate was 100% in Supera® and 96.6% in drug-eluting balloon group. There were seven restenosis in self-expanding interwoven nitinol stent (SUS) group (84.8% patency) and 11 restenosis in drug-eluting balloon group (79.2% patency). A significant increase in the ankle-brachial index in both groups after intervention demonstrated a hemodynamic success (SUS group 0.45 ± 0.06, drug-eluting balloon group 0.43 ± 0.07). The mean Rutherford Becker Class significantly decreased in both groups after a follow-up of 12 months (SUS group 0.70 ± 0.73, drug-eluting balloon group 0.74 ± 0.75). Conclusion Deploying drug-eluting balloon or self-expanding interwoven nitinol stent in patients with complex femoropopliteal lesions are both safe and effective with high patency rates with no statistical difference for one-year primary patency rates between them.

To determine the prevalence of abdominal aortic aneurysm (AAA) in patients with chronic obstructive pulmonary disease (COPD) and to assess the characteristics of these patients.Stable COPD patients (age,40 years) were included in the study between January 2014 and June 2014. Patients with acute exacerbations and a previous lung resection were excluded. Data regarding demographic characteristics were recorded. The modified Medical Research Council (mMRC) dyspnea scale was used to assess the severity of breathlessness. The COPD Assessment Test (CAT) was performed. Abdominal aortic diameter was measured using abdominal ultrasonography (AUS), and AAA was diagnosed as an aortic diameter of ≥30 mm at the renal artery level.In total, 82 patients were examined. AAA was detected in five (6.1%) patients. Diabetes mellitus, hypertension, and coronary artery disease were present in four patients with AAA. The average mMRC score was 3.2±0.4, and the mean CAT score was 18.4±6.0. Aneurysmal diameter was50 mm in four patients and 37 mm in one patient. Statistically significant differences were found between patient with AAA and those without AAA with respect to the mean abdominal aortic diameters at the renal artery and iliac artery levels (p=0.012 and 0.002, respectively).Our findings suggest that AAA is associated with COPD, with a prevalence rate of 6.1%. AAA is usually asymptomatic until a clinical status of rupture, which is associated with a higher mortality risk. Early diagnosis of AAA is lifesaving. In COPD patients, AAA might be easily determined using AUS, which is a noninvasive and relatively cheap procedure.Kronik obstrüktif akciğer hastalığı (KOAH) olan hastalarda abdominal aort anevrizması (AAA) sıklığının ve hasta özelliklerinin değerlendirilmesi.Ocak ve Haziran 2014 tarihleri arasında başvuran, stabil dönemdeki KOAH hastaları (40 yaş) çalışmaya alındı. Akut alevlenme döneminde olan veya geçmişte akciğer rezeksiyonu olan hastalar çalışma dışı bırakıldı. Demografik veriler kaydedildi. Dispne şiddetini değerlendirmek için modified Medical Research Council (mMRC) skalası, semptomlar için ise COPD Assessment Test (CAT) kullanıldı. Abdominal Ultrasonografi (AUS) ile ölçülen abdominal aort çapı renal arter seviyesinde ≥30 mm ise AAA tanısı kondu.Çalışmaya toplam 82 hasta alındı. Beş (%6,1) hastada AAA saptandı. Bu hastaların 4’ünde diabetes mellitus, hipertansiyon ve koroner arter hastalığı mevcuttu. Ortalama mMRC skoru 3,2±0,4 iken CAT skoru 18,4±6,0 idi. Anevrizma çapı 4 hastada 50 mm üstü, 1 hastada ise 37 mm üstü saptandı. Abdominal aort çapları renal arter ve iliak arterler düzeyinde, AAA olan ve olmayan grupta istatistiksel olarak anlamlı farklı bulundu (sırasıyla, p=0,012 ve 0,002).Çalışmamızda KOAH hastalarında AAA prevelansı %6,1 bulunmuş olup AAA ile KOAH hastalığının ilişkili olabileceğini düşündürmektedir. AAA yüksek mortalite riski taşıyan ve rüptür gelişimine kadar genellikle asemptomatik seyreden bir hastalıktır. Erken tanı hayat kurtarıcıdır. KOAH hastalarında AAA tanısı non invaziv ve nisbeten ucuz bir yöntem olan AUS ile kolaylıkla konulabilir.

Introduction Smoking is one of the major causes of preventable diseases, disability and death in the globe and Turkey. In our study, the knowledge of students about smoking addiction and which organ in the body is damaged due to smoking are aimed to be determined. Materials and methods Surveys were applied to students of private university preparatory training center on the Anatolian side of Istanbul. In the conducted survey, the questions related with students' demographic characteristics, themselves, their families and friends smoking addiction, the reasons to start smoking, whether they want to quit smoking, whether they try to quit smoking and which of the organs that they know smoking is harmful were asked. The data obtained were transferred to the Statistical Package for the Social Sciences (SPSS) for Windows. Result Out of 358 students who answered the survey completely, 152 students (42.4%) were male, 206 (57.6%) were female. Students were between the ages of 16-20 and the mean age was 18 ± 1.15. When asked about their smoking addiction, 84 (23.5%) of total actively continued to smoke. Total of 14 students (3.9%) smoked and then stopped smoking, 260 students (72.6%) have never smoked. Curiosity was the most commonly reported reason to start smoking (39%) and for the second row, they indicated to start smoking due to tobacco user friends (30.6%). Conclusions More and more young people begin smoking at an earlier age and they transfer the problems of this bad addiction to the later years of their lives. There should be fight resolutely against actions and conditions encouraging smoking both as a state and society and in order to rescue young people from this bad addiction, it should continue to take steps which facilitate accessibility to supportive institutions.

OBJECTIVES: The diagnosis of pulmonary embolism (PE) is still a problem especially at emergency units. The purpose of study was to determine the diagnostic accuracy of thoracic ultrasonography (TUS) in patients with PE. METHODS: In this prospective study, 50 patients with suspected PE were evaluated in Department of Pulmonary Diseases of a Training and Reasearch Hospital between January 2010 and July 2011. At the begining, TUS was performed by a chest physician, subsequently for definitive diagnosis computed tomography pulmonary angiography were performed in all cases as a reference method. Other diagnostic procedures were examination of serum d-dimer levels, echocardiography, and venous doppler ultrasonography of the legs. Both chest physician and radiologist were blinded to the results of other diagnostic method. Diagnosis of PE was suggested if at least one typical pleural-based/subpleural wedge-shaped or round hypoechoic lesion with or without pleural effusion was reported by TUS. Presence of pure pleural effusion or normal sonographic findings were accepted as negative TUS for PE. RESULTS: PE was diagnosed in 30 patients. It was shown that TUS was true positive in 27 patients and false positive in eight and true negative in 12 and false negative in three. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of TUS in diagnosis of PE for clinically suspected patients were 90%, 60%, 77.1%, 80%, and 78%, respectively. CONCLUSIONS: TUS with a high sensitivity and diagnostic accuracy, is a noninvasive, widely available, cost-effective method which can be rapidly performed. A negative TUS study cannot rule out PE with certainty, but positive TUS findings with moderate/high suspicion for PE may prove a valuable tool in diagnosis of PE at bedside especially at emergency setting, for critically ill and immobile patients, facilitating immediate treatment decision.

Objective: We aimed to determine the levels of sUA and sUA /creatinine ratios in stable COPD patients and to evaluate whether they can be used as a predictor of exacerbation risk and the disease severity. Methods: The levels of sUA and sUA/creatinine ratio evaluated and their correlations with the parameters studied were investigated.ROC analyses of sUA and sUA/creatinine ratio for exacerbation risk and the diseases severity were done. Results: The mean sUA levels and sUA/creatinine ratio were significantly higher in the patient group (n=110) compared to healthy controls (n=52).In the cases with comorbidity, sUA levels were significantly high.While there was no association between sUA levels and all the parameters studied, a positive correlation was detected between sUA/creatinine ratio and smoking pack/years (r=0.21, p=0.038), body mass index (r=0.35, p=0.004) and with CAT scores (r=0.31, p=0.007), and a negative correlation was detected with FVC (r= -0.25, p=0.017).The ROC analyses indicated that sUA/creatinine ratio was more specific than sUA levels alone with a similar sensitivity in increased values and more sensitive with similar specificity in the lower values for both exacerbation and severity of disease. Conclusion: Serum UA levels and sUA/creatinine ratio were higher in patients with COPD compared to healthy controls.Their levels increase in the presence of certain comorbidities. However, serum UA/creatinine ratio appears to be more useful in predicting risky patients for exacerbation and disease severity with high sensitivity but low specificity.

AIM: One of the common complication of advanced malignancy is malign pleural effusion(MPE).MPE causes progressive dyspnea,chronic cough,chest pain and reduced physical activity resulting lower quality of life(QoL)in patients.To prevent the reaccumulation of MPE and to improve QoL,pleurodesis has been performed.In this study it was hypothesized that patients with small bore catheter have shorter length of hospital stay(LOS)post-catheterization than patients with large bore catheter. METHODS: Adult patients who have been performed pleurodesis for malignant pleural effusions between 1 January 2012 and 31 December 2014 were enrolled into the study.Patients were classified into two groups according to catheter type;small-bore and large-bore catheter. RESULTS: Of the eligible 221 patients,67 ot them in small bore group and 118 of them in large bore catheter group were remained.While LOS post-catheterization was significantly shorter in small bore catheter group than large bore group(p The overlap range of propensity scores was found to be acceptable between groups to compare them.Length of stay post-catheterization was 1.8 days shorter with small bore catheter than large bore catheter by linear regression analysis adjusted to propensity scores(95%CI:-0.9 to -2.8,p CONCLUSIONS: In this study it was found that LOS post-catheterization was significantly shorter with small bore catheter than large bore ones. Pleurodesis with small bore catheter is helpful to decrease post-procedure hospital stay which may be important for reducing costs and QoL in patients with advanced malignancy.

Introduction Malnutrition is a comorbidity oftenly seen in COPD patients who have progressive chronic inflammation and severity. In this prospective study, we aimed to determine the nutritional status of stable COPD patients and to investigate the impact of nutritional status on perception of dyspnoea, exercise capacity, body composition, hospitalisation and life quality. Materials and methods COPD patients were assessed using previous smoking story, physical examination and irreversible airway obstruction. This study was done with 50 COPD patients older than 65 years of age and 30 control subjects. Exclusion criteria were also the co-existance of malignancies, malabsorbtion, DM, neurological diseases, renal failure and unstable cardiac diseases known to influence the nutritional state. The obstruction degree was evaluated by spirometry, nutritional status was classified by the MNA questionnaire, perception of dyspnoea was assessed by the MMRC scale, exercise capacity was assessed by the 6MWT, life quality was assessed by the CAT scale. Body composition parameters FM, FFM and FMI were analyzed and hospitalisations during 6 months after discharge were recorded. Result The COPD patients were divided into three groups as without malnutrition (n= 25,%50), under risk of malnutrition (n= 19,%38) and malnourished (n= 6,%12). The COPD severity, MMRC dyspnoea score, CAT score and hospitalisations during 6 months following were higher among the malnourished patients. On the other hand, body mass index, 6MWT results, FM and FFM were lower in malnourished patients. A positive correlation between FFM and 6MWT and a negative correlation between FFM and hospitalisation were observed. Conclusions MNA is a well-developed questionnaire which evaluates malnutrition in COPD patients. We determined that malnourished COPD patients have higher airway obstruction degree, perception of dyspnoea, CAT score and lower exercise capacity and FFM. FFM is an independent predictor of exercise capacity and rehospitalisation during 6 months.

OBJECTIVES: Pleural effusion is a common diagnostic and clinical problem. The differential diagnosis of pleural effusion may be difficult and may require several procedures, including invasive ones. Certain studies have investigated biochemical parameters to facilitate the diagnosis of exudative pleural effusion; however, it remains a challenging problem in clinical practice. We aimed to investigate the potential role of the neutrophil-lymphocyte ratio, which can be easily obtained by determining the cell count of the pleural fluid, in the differential diagnosis of exudative pleural effusion. METHODS: Records from patients who underwent thoracentesis and pleural fluid analysis between May 1, 2013, and March 1, 2015, were obtained from the electronic database of our hospital. The patients who met the inclusion criteria were divided into five groups according to their diagnosis: malignant pleural effusion, para-malignant pleural effusion, para-pneumonic effusion, tuberculosis-related effusion or other. The neutrophil-lymphocyte ratio value was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count. The patient groups were compared according to the given parameter. RESULTS: A total of 465 patients who met the inclusion criteria among 1616 patients with exudative pleural effusion were included in the study. The mean neutrophil-lymphocyte ratio value was significantly lower in tuberculosis-related pleural effusion compared to malignant, para-pneumonic and para-malignant effusions (p=0.001, p=0.001, p=0.012, respectively). The areas under the curve for tuberculosis pleurisy compared to malignant, para-pneumonic and para-malignant effusions were 0.38, 0.36, and 0.37, respectively. Lower cut-off values had higher sensitivity but lower specificity for tuberculosis pleurisy, while higher cut-off values had higher specificity but lower sensitivity for this condition. CONCLUSION: The pleural fluid neutrophil-lymphocyte ratio, which is an inexpensive, reproducible, and easily calculated hematological parameter, may facilitate the differential diagnosis of pleural effusion.

Objective: To analyse the demographic, clinical, radiologic and pathologic features of the patients who underwent bronchoscopy for various diagnostic indications and detected anthracosis and/or anthracofibrosis. Material and Methods: A total of 1322 patients underwent bronchoscopy during a period of 15 month. Of these,only 107 patients with anthracosis and/or anthracofibrosis were included in the study. Results: The mean age of the patients was 66.12 ±12.57 years.57% of patients were male and 43% were female. 26.5% were current smokers, 22.5% were exsmokers and 51% were non-smokers. The most frequent occupation was found as beinghousewife (41.1 %).There was no occupational exposure at 10.7%of the patients. Biomass exposure was found in 88,5% of the patients because of the fuel used for heating or in the kitchen. Regarding geographical location,we found that 42.3% of patients were from Black Sea region,27% from East Anatolian Region.88.3% of the patients had complaints. Cough and dyspnea were the main complaints.Radiographic findings of the chest xray at presentation were variable as,follows: consolidation, atelectasia, pleural effusion and mass. Anthracofibrosis and deformation was seen at 21.6 % of the patients.Twelve patients were diagnosed as tuberculosis and 10 patients were diagnosed as lung cancer. Of these, 2 had smallcell cancer, 3 had squamouscell cancer, 4 had adenocarcinom and 1 had nontyped nonsmallcell ca. Conclusion: Indoor and occupational biomass exposure is frequently seen in our country. Anthracosis and/or anthracofibrosis detected cases should be evaluated and followed up closely especially in terms of tuberculosis and malignancy.

The most important and difficult task when it comes to reducing tobacco-related morbidity and mortality is to convince smokers to quit and to maintain their abstinence. This study aimed to determine the smoking relapse rate and factors related to relapse in subjects who participated in a smoking cessation program and completed a 1-y follow-up in our center.The study included 550 subjects who applied to a smoking cessation clinic from June 1, 2011 to December 31, 2011 and completed the 1-y follow-up.After 1 y, 282 (51.4%) subjects had relapsed, 132 (24%) had quit smoking, and 135 (24.6%) could not be contacted. The mean age ± SD was 41.5 ± 10.8 y, and 52.5% were male. There was no difference between non-relapsed and relapsed subjects with regard to age, sex, average smoking duration and daily number of cigarettes, reason to quit, education level, presence of symptoms and concomitant diseases, Fagerström nicotine dependence score, Beck depression score, and frequency of pharmacotherapy administration. In the relapsed group, the age began smoking was younger (P = .05), and the longest prior duration of abstinence was shorter (P = .04). The average number of support contacts was found to be significantly higher in the non-relapsed subjects (P.001). Logistic regression analysis revealed alcohol intake to be a factor influencing relapse (odds ratio: 2.11, 95% CI: 1.13-3.93, P = .02), as was the number of support contacts (odds ratio: 2.06, 95% CI: 1.59-2.65, P.001). The presence of drug adverse effects was close to being significant (odds ratio: 1.96, 95% CI: 0.93-4.10, P = .07).The relapse rate in a 1-y period was 51.4%. Similar to previous studies, alcohol intake presented a relapse risk. In subjects receiving drug treatment, planning support meetings more frequently and paying attention to adverse effects may increase the success of smoking cessation.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a new, minimally invasive, bronchoscopic technique used in the evaluation of inthrathoracic lymph nodes.Use of sedation drugs before the procedure differs among centres. There is no standardization about sedation before EBUS-TBNA.We used a policy decision to shift from use of propofol with midazolam vs midazolam alone in a large tertiary hospital to evaluate the diagnostic yield and safety of EBUS-TBNA procedure.Files of all the patients who were performed EBUS-TBNA between the dates of September 2010 and May 2014 were surveyed. All the EBUS-TBNA cases were performed under sedation of propofol and midazolam with an accompanying anesthesiologist in the beginning, however, sedation is applied with midazolam without an accompanying anesthesiologist after April 2013 due to changes in sedation policy. The diagnostic yield and complication rates were compared by chi-squared analysis between two groups.The files of 340 EBUS-TBNA performed patients were evaluated. Of the patients 274 eligible patients were analysed. 152 patients who fulfilled the inclusion criteria were analysed in propofol-midazolam (P) sedated group and 122 patients were analysed in midazolam (M) group. There is no statistically significant difference between two different sedated groups in terms of age and gender. Diagnostic value was detected as 77.6% in P group and 85.7% in M group and the difference was not statistically significant. No difference between complication rates of both groups was observed.Both sedation-types for performing EBUS-TBNA showed similar diagnostic value and complication rates in our study. Propofol with midazolam application requires with an accompanying anaesthesiologist, therefore, it increases cost. EBUS-TBNA procedures had been performed in safe with no decrease in diagnostic yield under moderate sedation.

Study objectives To establish the diagnostic yield of transbronchial needle aspiration (TBNA) and its contribution to conventional diagnostic techniques (CDT) such as forceps biopsy, bronchial washing, and bronchial brushing in the diagnosis of malignant endobronchial lesions Design Retrospective clinical study Patients One hundred fifteen lung cancer patients Measurement and results We reviewed files of 115 lung carcinoma cases diagnosed in our clinic from 2001 to 2003 with endobronchial lesions sampled by CDT and TBNA. The lesions were classified into three groups: exophitic mass lesion (EML), submucosal disease, and peribronchial disease. The diagnostic yield of TBNA and CDT was compared to that of the combination of CDT and TBNA with respect to the type and location of the lesion and the histopathologic subgroups. Of the 115 cases, histology findings were confirmed by TBNA in 91 cases (79%), CDT in 75 cases (65%), and TBNA plus CDT in 105 cases (91%). The difference of the diagnostic yield of CDT vs TBNA plus CDT was statistically significant (p 0.05). Regarding localization, the addition of TBNA to CDT increased sensitivity in the trachea and main bronchi, and in right upper and middle lobe lesions (p Conclusion In the case of peribronchial disease, the addition of TBNA to CDT improves the diagnostic yield of the bronchoscopic examination

WOS: 000361523100004, PubMed: 26322873, Introduction: We aimed to describe the treatment outcomes in patients with bacteriologically confirmed pulmonary tuberculosis (PTB) and identify factors associated with successful treatment outcome. Methodology: The medical charts of patients with smear and/or culture-positive PTB who were treated between 2005 and 2011 at the Kocaeli Tuberculosis Dispensary, Turkey, were reviewed. Patients were categorized as having a successful (cured or with a completed treatment) or poor (treatment default, treatment failure, death) treatment outcome. The association of demographic and clinical factors, including gender, age, education, occupation, insurance, family size, living area, smear and culture positivity, retreatment, comorbidity, drug resistance, and cavity on radiography, with the success of treatment, was evaluated by univariate and multivariate analyses. Results: Of 738 patients (258 females, 480 males) with bacteriologically confirmed PTB, 683 (92.6%) had successful treatment outcomes. Of those with a poor outcome, 29 (3.9%) had treatment default, 18 (2.4%) died, and 8 (1.1%) had treatment failure. Young age, no previous treatment, no comorbidity, no drug resistance, and high education level were factors significantly associated with successful PTB treatment outcome (p < 0.05 for all). Conclusions: Treatment outcome was successful in young and educated PTB patients who had drug resistance, previous treatment history, and no comorbidities. Knowledge of the factors affecting treatment success will lead to the undertaking of specific measures in the management of PTB, which may help to decrease treatment failure.

Objectives We monitored increases in CO2 levels during sleep by measuring transcutaneous pCO2 (PtcCO2) to determine its relationship with polysomnographic data in normocapnic patients with obstructive sleep apnea syndrome (OSAS). Material and methods Between October 2011 and December 2012, 139 patients underwent PtcCO2 monitoring with polysomnography. All patients were evaluated with arterial blood gas (ABG) measurements and pulmonary function tests (PFTs). We excluded 13 patients with COPD and/or daytime hypercapnia and 29 patients whose PtcCO2 records could not be evaluated. Results The patients' mean age was 46.8±10.3 years. Fifty-nine patients (60.8%) were male, and 38 (39.2%) patients were female. The mean overnight PtcCO2 was ≤45 mm Hg in 84 (86.6%) patients and >45 mm Hg in 13 (13.4%) patients. In the group with PtcCO2>45 mm Hg, 10 patients had an apnea-hypopnea index (AHI) >15, and 3 patients had an AHI 15 (moderate to severe OSAS), and 37 (37.2%) had an AHI 45 mm Hg, whereas this ratio was 8.1% in the latter group. The difference was not statistically significant (p=0.359). In the group with an AHI>15, the highest PtcCO2 levels were significantly higher (p Conclusion We conclude that seemingly eucapnic OSAS patients may experience hypercapnia when sleeping, and PtcCO2 monitoring may be useful in the early diagnosis of hypercapnia.

Intima-media thickening (IMT), which is the early finding of carotid artery atherosclerosis, has been shown to be associated with obstructive sleep apnea syndrome (OSAS). In our study, we aimed to assess prospectively the effect of severity of OSAS and snoring on carotid artery IMT. A total of 102 patients who were admitted to sleep laboratory between May 2011 and May 2012 were included in the study. All patients were examined by polysomnography. Common carotid arteries (CCA) and internal carotid arteries (ICA) were evaluated for IMT by carotid Doppler ultrasonography. The mean age was 45.9 ± 11.1, with 40 (39.2 %) women and 62 (60.8 %) men. Of 88 OSAS patients who had an apnea–hypopnea index (AHI) of >5, 33 (37.5 %) had mild, 20 (22.7 %) had moderate, and 35 (39.8 %) had severe disease. Fourteen patients who had AHI

Dildar Duman, Emine Aksoy, Meltem Coban Agca, Nagihan Durmus Kocak, Ipek Ozmen, Ulku Aka Akturk, Sinem Gungor, Fatma Merve Tepetam, Selma Aydogan Eroglu, Selahattin Oztas, Zuhal Karakurt Sureyyapasa Chest Diseases and Thoracic Surgery Teaching Hospital, Istanbul, Turkey Background: COPD exacerbations requiring hospitalization increase morbidity and mortality. Although most COPD exacerbations are neutrophilic, approximately 10%–25% of exacerbations are eosinophilic.Aim: We aimed to evaluate mortality and outcomes of eosinophilic and non-eosinophilic COPD exacerbations and identify new biomarkers that predict survival.Methods: A retrospective observational cohort study was carried out in a tertiary teaching hospital from January 1, 2014 to November 1, 2014. All COPD patients hospitalized with exacerbations were enrolled in the study at their initial hospitalization and followed-up for 6months after discharge. Electronic data were collected from the hospital database. Subjects’ characteristics, hemogram parameters, CRP levels, neutrophil-to-lymphocyte ratio (NLR), platelet-to-mean platelet volume ratio on admission and discharge, length of hospital stay (days), readmissions, and mortality were recorded. Patients were grouped according to peripheral blood eosinophil (PBE) levels: Group 1, >2% PBE, eosinophilic; Group 2, non-eosinophilic ≤2%. Patient survival after hospital discharge was evaluated by Kaplan–Meier survival analysis.Results: A total of 1,704 patients hospitalized with COPD exacerbation were included. Approximately 20% were classified as eosinophilic. Six-month mortality was similar in eosinophilic and non-eosinophilic groups (14.2% and 15.2%, respectively); however, the hospital stay length and readmission rate were longer and higher in the non-eosinophilic group (P