Search

Objective: We aimed to investigate the success rate of non-invasive ventilation (NIV) in wards and the predictors of failure in cases of chronic obstructive pulmonary disease (COPD)-related acute hypercapnic respiratory failure (AHRF). Methods: The was a retrospective study conducted in a tertiary teaching hospital between May 2011 and 2013. Patients who were admitted to the emergency department (ED) because of COPD with AHRF were evaluated; 544 patients who initially received NIV in ED and were transferred to wards were included. Patient characteristics, baseline and follow-up pH values, and partial arterial carbon dioxide (PaCO2) values were recorded. Baseline pH values were categorized as severe (pH<7.26), moderate (pH≥7.26-7.30), and mild (pH≥7.30) acidosis. According to the in-hospital outcome, patients were classified in 2 groups: Group 1: home discharge, Group 2: death or intensive care unit transfer. Results: Treatment resulted in success in 477 (88%) patients. Albumin levels were significantly low and the mean Charlson index (CI) score was significantly high in Group 2. Admission pH and PaCO2 values did not affect the treatment outcome. Patients in Group 2 had higher PaCO2 and lower pH values as well as a lower level of decrease in PaCO2 values within 2 hours of treatment in ED. Similarly, higher PaCO2 and lower pH values at the end of the first day in wards were indicative of NIV failure (p<0.05). Conclusion: The success rate of NIV in wards in cases of AHRF is high. Patients with low albumin levels and higher CI scores have worse response to treatment. pH or PaCO2 values after a few hours of treatment and not the baseline pH or PaCO2 values are better predictors than the baseline pH and PaCO2 values. [ABSTRACT FROM AUTHOR]

Objective: Tuberculosis is a major public health concern worldwide, particularly in Turkey. Association between infection with tuberculosis (TB) and close contact is well known but ratio of tuberculosis pleurisy (TP) patients with close contact has not been clearly analyzed. This study was conducted to evaluate its clinical spectrum, close contact with tuberculosis cases and ways of diagnosis. Material and Methods: The Pulmonary Department supplied data on 137 TP diagnosed in Turkey from 2003 to 2006. Data regarding demographics, diagnostic parameters were obtained. Results: There were 67 women and 70 men with tuberculosis pleurisy cases. TP was more common among patients aged 15-35 years (69.3%). The most frequent symptoms were cough, chest pain and fever (48,9%, 46.7%, 35.03%). Among patients with TP, 43 have an close contact case (31,3%). ADA level was high in 123 (89.7%). Left or right sided involvement had similar frequency (52.5% left, 45.9%right). Additional pulmonary parenchymal disease (PPTP) was found in 13 patients (9.4%). There were skin test positivity in 89/114 cases (89.7%) Conclusion: We conclude that pleural fluid with high ADA content, positive tuberculin skin test and young age favors the diagnosis of tuberculous pleural effusion. In addition other parameters, history of contact with a tuberculosis case at diagnosis of TP is important. [ABSTRACT FROM AUTHOR]

Background: Bronchiectasis is a chronic lung disease characterized by permanent bronchial wall dilatation. Although it has been known as an orphan disease, it has recently gained attention because of registry-based studies and drug research. Aims: We aimed to use a multicenter database to analyze and compare data regarding the etiology, associated comorbidities, microbiological characteristics, and preventive strategies of bronchiectasis in Türkiye to those of other countries. Study Design: A multicenter prospective cohort study. Methods: The multicenter, prospective cohort study was conducted between March 2019 and January 2022 using the Turkish Adult Bronchiectasis Database, in which 25 centers in Türkiye participated. Patients aged > 18 years who presented with respiratory symptoms such as cough, sputum, and dyspnea and were diagnosed with non-cystic fibrosis bronchiectasis using computed tomography were included in the study. Demographic information, etiologies, comorbidities, pulmonary functions, and microbiological, radiological, and clinical data were collected from the patients. Results: Of the 1,035 study participants, 518 (50%) were females. The mean age of the patients was 56.1 ± 16.1 years. The underlying etiology was detected in 565 (54.6%) patients. While postinfectious origin was the most common cause of bronchiectasis (39.5%), tuberculosis was identified in 11.3% of the patients. An additional comorbidity was detected in 688 (66.5%) patients. The most common comorbidity was cardiovascular disease, and chronic obstructive pulmonary disease (COPD) and bronchiectasis was identified in 19.5% of the patients. The most commonly detected microbiological agent was Pseudomonas aeruginosa (29.4%). Inhaled corticosteroids (ICS) were used in 70.1% of the patients, and the frequency of exacerbations in the last year was significantly higher in patients using ICS than in nonusers (p < 0.0001). Age [odds ratio (OR): 1.028; 95% confidence interval (CI): 1.005-1.051], cachexia (OR: 4.774; 95% CI: 2,054-11,097), high modified medical research [ABSTRACT FROM AUTHOR]

OBJECTIVES: 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. MATERIALS AND METHODS: 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) was >2% and neutrophilic AECOPD as PBE <2%. Readmission within 28 days of discharge was recorded. RESULTS: 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 (p<0.001). 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). Age >75 years, albumin <2.5 g/dL, CRP >50 mg/dL, and PLT/MPV <20x103 were found to be risks factors for hospital mortality (p<0.05 each). Readmission rates within 28 days of discharge were 5% (n=136), and this rate was higher in eosinophilic AECOPD patients not taking steroids (p<0.001). CONCLUSION: 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 of <20x103 resulted in an increased mortality rate. Thus, appropriate steroid therapy may reduce readmission rates in the first 28 days after discharge in eosinophilic AECOPD. [ABSTRACT FROM AUTHOR]

Objective: There are similarities in the symptoms and attacks of bronchiectasis and chronic obstructive pulmonary disease (COPD). Chronic systemic inflammation in COPD and destructive pulmonary inflammation in bronchiectasis lead to increases in inflammatory markers. The presence of peripheral blood eosinophil (PBE)(>2%) and the neutrophil-to-lymphocyte ratio (NLR) affect the type of attack and the treatment approach. The aim of this study was to investigate differences in inflammatory markers and the presence of PBE in COPD and bronchiectasis. Methods: A retrospective, cross-sectional study of patients diagnosed in 2014 with bronchiectasis (J47.0-ICD) or COPD (J44.0-J44.9-ICD) at the inpatient or outpatient clinics of a chest disease hospital was performed. Patients with cancer, hematological disease, renal disease, or COPD with bronchiectasis were excluded. Demographic details and the C-reactive protein (CRP) levels were recorded, and the NLR was calculated. The study groups were then sub-classified according to PBE. Results: In all, 2664 patients (outpatient bronchiectasis: n=1024, outpatient COPD: 775; inpatient bronchiectasis: n=180, inpatient COPD n=685) were included. The NLR was significantly lower in the bronchiectasis group. The median CRP level was lower in those with bronchiectasis than in the COPD inpatient group. The PBE values in the bronchiectasis and COPD inpatient groups was 24% and 40%, respectively and 18% and 40% in outpatient groups, respectively. The NLR in patients with PBE was lower than that observed in noneosinophilic patients. Conclusion: Inflammatory markers were lower in patients with bronchiectasis than in those with COPD. Continuous anti-inflammatory treatment may be recommended for patients with COPD. NLR and PBE may be able to indicate the nature of advisable treatment in further studies. [ABSTRACT FROM AUTHOR]

Good's syndrome is a rare disease which is characterized by association of a thymoma and immunodeficiency. A 66-year-old woman was admitted with the diagnosis of lower respiratory tract infection and hypoxemic respiratory failure. Twelve years ago, she was operated for a mediastinal mass, and a welldifferentiated thymic carcinoma was detected. She had a history of frequent recurrent lower respiratory tract infections. There were bronchiectasis, peribronchial thickening, and migratory nodules in past chest radiographs, suggesting recurrent pulmonary infections. Immunoglobulin (Ig) panel and lymphocyte activity were assessed with a preliminary diagnosis of immune deficiency. Decreased IgG levels and T lymphocyte activity were detected, and she was diagnosed with Good's syndrome. The patient showed clinical improvement at the end of a 14-day antibiotic therapy and was discharged to be referred to the immunology clinic. The infection episodes were reduced following intravenous immunoglobulin treatment, and prophylactic sulfamethoxazole trimethoprim treatment was initiated by the immunology clinic. She is still stable in the second year of followup. [ABSTRACT FROM AUTHOR]