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Giriş: Alt solunum yolu enfeksiyonları (ASYE) hastaneye ayaktan başvurularda ve yatan hastalarda önemli mortalite ve morbidite nedenidir. Hastane yatışı gerektiren ASYE vakalarında antibiyoterapinin zamanında başlanması önemlidir. Enfeksiyon tablosuna yol açan etkeni belirlemek için solunum yolu kültürleri alınmadan başlanan ampirik antibiyoterapi ve “en geniş” spekturumlu antibiyotikleri kullanma eğilimi enfeksiyon hastalıklarının yönetimini zorlaştırmakta, antibiyotik direnci gibi ciddi bir sorunu karşımıza çıkarmaktadır. Bu çalışmada hastaneye yatırılan ASYE olgularında izole edilen etkenler, antibiyotik direnç oranları, hastaların önceden hastaneye yatış ve antibiyotik kullanım durumları araştırılmıştır. Yöntem: Bu çalışmada 2013-2018 yılları arasında hastanemize ASYE tanısı ile yatırılan ve solunum yolu örneği kültürlerinde üreme saptanan olguların demografik özellikleri, hastane yatış sayıları, antibiyotik kullanım öyküleri ile kültürle elde edilmiş etkenleri ve antibiyotik dirençleri kesitsel tanımlayıcı metotla araştırılmıştır. Bulgular: 469 hastadan izole edilen 484 etkeni ve bu etkenlerin antibiyotik direnç profillerini inceledik. Hastaların etkenleri balgam ya da bronkoskobik aspirasyon örneklerinden elde edildi. Olguların çoğu erkek cinsiyette ve 63 yaşın üzerinde idi. En fazla izole edilen etken Pseudomonas aeruginosa (n= 220; %44) idi. Hastaların 451 (%96) tanesine yatışta ampirik antibiyotik başlanmış ve 247 tanesine (%65) başlanan antibiyotik ortalama 7,9 gün sonra değiştirilmişti. Hastalarımızın 228’i (%49) son bir yıl içinde en az iki kez hastaneye yatırılmış; 43 (%9.2) hasta son bir ay içinde antibiyotik almıştı. Son hafta içinde antibiyotik kullanmış ve halihazırda kullanmakta olan 19 hastanın 8’inde P. aeruginosa (%42) izole edildi. İzole edilen 17 S. pneumonia kökeninde bir (%6) penisilin, üç (%17) makrolid dirençli izolat saptandı. H. influenza 33 olguda izole edildi. Üç olguda (%8) ampisilin ve dört (%12) kinolon direnci rapor edildi. Tartışma ve Sonuç: Ampirik antibiyotik tedavisi başlanırken, artan kinolon direncinin ve olguların yarısından fazlasında P. aeruginosa etken olduğunun göz önüne alınması, özellikle daha önce hastaneye yatış sıklığı ve antibiyotik kullanma öyküsünün sorgulanması ve lokal antibiyotik direnç paternlerinin göz önüne alınmasının gerekli olduğu sonucuna vardık.

Pulmonary hydatid cyst (PHC) can imitate many diseases. Sometimes, positron emission tomography/computed tomography (PET/CT) is performed in terms of malignancy exclusion for complicated cysts. Although some specific findings (doughnut sign) have been identified in hydatid cyst of the liver, there is no specific sign described for PHC. The aim of this study is to investigate the presence of a common finding in PHC patients scanned with PET/CT inadvertently.From January 2015 to 2020, patients proven to have PHC were analyzed retrospectively. From all the patients, only 17, having a previous PET/CT, were included the study. Lesions were evaluated in three groups according to FDG uptake: A, negative; B, focal; C, doughnut sign.The total number of patients was 17. Nine of the patients were male and the median age was 41.94 + 14.68 (16-65) years. SUV max of the lesions ranged from 0.5 to 15.8 (mean ± SE: 4.68). According to the FDG uptake of the lesions, five were in Group A, two in Group B, and the remaining ten (58.8%) in Group C with doughnut sign. To correlate the CT findings with PET/CT findings, doughnut sign, which is a typical finding of hydatid cysts of liver, is seen in only four patients in Group 1-classified cysts which are non-complicated. But in Group 2 (n = 3) and 3(n = 4), the finding of doughnut sign is three in both groups.PET/CT is not a recommended imaging technique for PHC, but in cases where a definitive diagnosis is difficult, interpreting PET/CT findings is significant. This study demonstrates that previously described doughnut sign for liver hydatid cysts is also common for perforated pulmonary cysts. According to our knowledge, this is the first largest series of determining PET/CT findings of PHC. Further larger series will contribute to the literature.

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.

Objectives: The major scores associated with the mortality after COPD exacerbations were; DECAF, CURB-65, PSI and BAP-65 scores. We aimed to compare these scores in predicting 30- and 90-day mortality in patients hospitalized with exacerbation of COPD.Methods: The data of 141 patients who were hospitalized with the diagnosis of COPD exacerbation between January 2018 and March 2019 and accepted to participate in the study were prospectively recorded.Results: Age, mean modified-medical-research-council (mMRC) dyspnea score, pleural effusion, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), presence of atrial fibrillation (AF), PaCO2 pressure values were found to be significantly higher at both 30 and 90-days deceased group, while hemoglobin, albumin and pH values were significantly lower (all p < 0.05). DECAF, CURB-65, PSI and BAP-65 scores were significantly higher for both 30 and 90-days mortality (all p < 0.05). DECAF, CURB-65, PSI, BAP-65 scores, PLR, NLR predicted to 30 day and 90 day mortality. But, CURB-65 found (OR 2.968 and 2.284, respectively) superior to others in predicting 30 and 90-days mortality.Conclusions: CURB-65 score is a significant, simple and feasible score for predicting 30 and 90 days mortality in COPD exacerbation and may be routinely used in all patients hospitalized with COPD exacerbation.

Coronavirus disease 2019 (COVID-19) related chronic lung changes secondary to severe disease have become well known. The aim of this study was to determine the risk factors that affect the development of interstitial lung disease in subjects with COVID-19 pneumonia who were hospitalized.Patients hospitalized with COVID-19 pneumonia between June 2020 and March 2021 were retrospectively analyzed. Smoking histories, comorbidities, reverse transcriptase polymerase chain reaction test results, laboratory parameters at the time of the diagnosis, oxygen support, the use of corticosteroids with dosage and duration data, the need for ICU care were recorded. High-resolution computed tomographies (HRCT) were obtained for study population in their 3-6 months follow-up visit. The subjects were classified as having residual parenchymal lung disease if a follow-up HRCT revealed parenchymal abnormalities except pure ground-glass opacities (the residual disease group). The control group consisted of the subjects with normal chest radiograph or HRCT in their follow-up visit or the presence of pure ground-glass opacities. Two groups were compared for their demographic and clinical abnormalities, laboratory parameters, treatment regimens, and the need for ICU care.The study included 446 subjects. The mean ± SD age was 58.4 ± 13.87 years, with 257 men (57.6%). Although 55 subjects had normal HRCT features on their follow-up HRCT, 157 had abnormal lung parenchymal findings. Univariate logistic regression analysis revealed statistically significant results for age, sex, corticosteroid treatment, and the need for ICU care for predicting interstitial lung disease development (Residual parenchymal disease was observed 3-6 months after discharge in one third of the subjects hospitalized with COVID-19 pneumonia. It was observed that interstitial lung disease developed more frequently in older men and in those subjects with more-severe disease parameters.

Comorbidity frequency and mortality rates are higher in elderly patients with COVID-19. The disease is also more severe in elderly patients. This study aims to examine the characteristics of the COVID-19 disease, severity, comorbidities, and mortality rates in elderly patients by comparing them with nonelderly patients.This study was designed as a retrospective study. 469 patients who were followed up in outpatient, inpatient, and intensive care units with the diagnosis of COVID-19 between March 11, 2020, and June 01, 2020, were retrospectively included in the study. Patients were divided into two groups who were ≥65 years named as the "elderly group" and65 years referred to as "nonelderly". Survival data was generated from the death notification system on August 02, 2020.A total of 469 patients including elderly(n=101) and nonelderly(n=368) were included in the study retrospectively. The inci- dence of severe pneumonia(31%/12.6%) and critical illness(16%/5.8%), comorbidity (85%/37.2%) and hospitalization time(8/5 days) were significantly higher in the elderly group(p0.05). 23 (22.8%) of elderly patients and 27(7.3%) of nonelderly patients died (p=0.000). Mortality was found to be 3.5 times higher than in the non-elderly group. The expected survival time was 145.85 days(CI 95%:133- 158.66) in the elderly patients and 170.36 days(CI 95%:166-174.6) in the nonelderly patients (p0.000). In ROC analysis, the sensitivity of age was 86%(73.3-94.2), specificity was 66.83%(62.1-71.3), and the cut-off56 (AUC:0.775; p0.001) in predicting mortality.Mortality is high, comorbidities are more frequent, and the disease is more severe in elderly patients with COVID-19. Age above 56 can be used as a cut-off to predict mortality.

PURPOSE: This study aims to investigate whether there is a significant difference between typical and atypical parenchymal patterns in the development of fibrosis, which is the most crucial factor affecting morbidity in pulmonary sarcoidosis. METHODS: In our hospital, 145 cases with Siltzbach Types 2 and 3 sarcoidoses diagnosed by clinical, radiological, and histopathologic were retrospectively investigated. Perilymphatic nodules, accompanying mosaic attenuation, and interlobular septal thickening and central peribronchovascular bunch-like thickening on high-resolution computed tomography were assessed as typical. Solid nodules, galaxy finding, consolidation, ground-glass opacity, isolated mosaic attenuation, and interlobular septal thickening, and pleural fluid were accepted as atypical findings. Findings indicating fibrosis were fine and rough reticular opacity, traction bronchiectasis, volume loss, and cystic changes. For the analysis of variables, SPSS 25.0 program was used. RESULTS: Ten (16%) of the 61 cases with typical findings and 16 (19%) of the 84 with atypical findings developed fibrosis (P = 0.827). The mean age of cases with fibrosis was higher. With the cut-off of 50 years, sensitivity was 61.5%, and specificity was 68.9%. The highest fibrosis rate was in cases with ground glass pattern (n = 7/17), whereas higher reversibility rates were in those with miliary pattern (n = 9/12) and galaxy sign (n = 5/6). CONCLUSION: The incidence of fibrosis is higher in the atypical group with no significant difference. The incidence of fibrosis differs in each atypical pattern, being highest in ground-glass opacity and lowest in the miliary pattern.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a disease caused by airway and/or parenchymal pathology. Therefore, some patients inevitably have chronic bronchitis and some patients have emphysema. The current thinking is that exercise affects these two major phenotypes differently. In this study, we investigated the benefits of pulmonary rehabilitation (PR) in chronic bronchitis- and emphysema-predominant COPD patients. METHODS: Retrospective data of chronic bronchitis- and emphysema-predominant COPD patients who completed an outpatient 8-week PR program between the years 2013 and 2017 in the PR unit of our hospital were examined. Demographic data (age, sex, body mass index, smoking history, long-term oxygen therapy, noninvasive ventilation, emergency admissions, and number of hospitalizations) were recorded. The patients were divided into two groups: chronic bronchitis predominant and emphysema predominant. Patients were assigned to the emphysema-predominant group based on radiology results. Patients were assigned to the chronic bronchitis-predominant group according to clinical description. The two groups were compared using the recorded data cited above. RESULTS: Of the 146 patients, 85 (58.2%) were assigned to the emphysema-predominant group and 61 (41.8%) were assigned to the chronic bronchitis-predominant group. There was no difference between the two groups in age and gender. Pulmonary function test (PFT) parameters (forced expiratory volume in 1 s and diffusing capacity of the lungs for carbon monoxide (DLCO)), arterial blood gas values (pO2, PCO2, and SpO2), 6 min of walking time, and quality of life scores were significantly improved after PR. However, there was no difference between the emphysema- and chronic bronchitis-predominant groups in terms of the improvements after PR. CONCLUSION: In this study, it was observed that the improvement due to PR seen in COPD patients was independent of phenotype. Therefore, all COPD patients should be encouraged to participate in PR programs regardless of their phenotypes.

The purpose of the present study is to investigate the antibiotic resistance rates and use of antibiotics in patients with streptococcal pneumonia in a reference tertiary care hospital for pulmonary diseases in Izmir, Turkey.A total of 1224 cases with streptococcal pneumonia between 2013 and 2019 were included in the study, retrospectively. Drug susceptibility testing for penicillin and other antibiotics were performed according to the recommendations of EUCAST criteria. Clinical data and general characteristics were collected and evaluated for each patient in accordance with the susceptibility testing report.Totally, resistance rates for trimethophrim-sulfamethoxazole, penicillin (oxacillin), erythromycin, tetracycline, clindamycin and levofloxacin resistance were 63.5%, 39.8%, 37.7%, 37.6%, 28.8%, and 4.8%, respectively. Antibiotic resistance was not detected against vancomycin,teicoplanin and linezolid. Multidrug resistance rate was found to be 27.1%. It was observed that there was a statistically significant decrease in trimethophrim-sulfamethoxazole, penicillin (oxacillin), erythromycin, clindamycin and levofloxacin resistance rates by years (p: 0.000, 0.004, 0.000, 0.001, 0.010, respectively). The penicillin MIC distribution was higher at the range of 0.12-2 ​μg/mL and there was statistical difference among the ranges of MIC values for the representative years (p:0.033). Among the antibiotics investigated, the most commonly used antibiotic was moxifloxacin.Trimethophrim-sulfamethoxazole resistance rate has been found higher than other antibiotics. As penicillin MIC values were at the range of 0.12-2 ​μg/mL frequently, high doses of penicillin treatment might be required in some patients. It is noteworthy that significant decrease in resistance rates in penicillin, erythromycin, clindamycin and tetracycline could be due to the vaccination programme carried out since 2008 in Turkey. As the empiric use of quinolones is high it would be more appropriate to use it according to the susceptibility testing. It is important to determine the regional antimicrobial susceptibility for Streptococcus pneumoniae to select appropriate empirical antimicrobials in the clinical practice.

Introduction: The Coronavirus Disease-2019(COVID-19) pandemic continues to upset the whole world with mortality. While CURB-65 (Confusion-Urea-Respiratory Rate-Blood Pressure- age ≥65 years) and GPS (The Glasgow Prognostic Score) are defined prognostic scores for pneumonia and malignancies, the CALL (Comorbidities, Age, Lymphocyte count, LDH) score is defined for COVID-19. Objective: We aimed to compare these scores in predicting mortality in hospitalized patients with COVID-19. Methods: The data of 408 hospitalized patients with COVID-19 were retrospectively recorded. Demographic, clinical, laboratory data, also CURB-65, GPS and CALL scores were compared between survivors(n:358) and non-survivors(n:50). Receiver operating characteristic(ROC) analysis was used to predict the mortality abilities of scores. Results: Mean age, male gender, smoker, dyspnea from symptoms, presence of any comorbidity, COPD and carcinoma were found to be significantly higher at non-survivor group(all p Conclusions: CURB-65 score is a simple and feasible score for predicting mortality in COVID-19 and may be routinely used in all patients hospitalized with COVID-19.

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. Result 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

Introduction The aim of this study was to evaluate the predictive power of LENT (LDH in pleural fluid, Eastern Cooperative Oncology Group [ECOG] performance status, neutrophil-lymphocyte ratio in the serum, and tumor type) score which is a current prognostic score in patients with MPE and to determine its effect on survival and its status in clinical decision making. In addition, it was aimed to compare LENT score with the conventional but subjective score ECOG. Materials and Methods A retrospective observational study was conducted reviewing the medical records of patients managed for MPE (malign pleural effusion) between 2008 and 2018. LENT prognostic score was calculated in the patients. The ECOG score calculated for the same patients was compared in terms of mortality. Result A total of 191 patients with malignant pleural effusion, 118 males (61.7%) and 73 females (38.2%), were included in the study. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for identifying overall survival were 69.8 %, 100%, 100% and 18.8%, respectively at the LENT score > 4 (p= 0.000). At ECOG PS >2, the sensitivity, specificity, PPV, NPV were as the same as the LENT score >4 for identifying overall survival. In all patients, overall median survival according to the LENT score was 662/119/33 days in low/moderate/high risk groups, respectively. Cox regression analysis indicated that having a moderate LENT score (p= 0.004, OR: 2.21, CI: 1.29 -3.78%) and high LENT score (p= 0.000, OR: 4, 50 CI: 2.57-7.89%) were predictors for overall survival in all patients due to MPE. In ROC analysis, there was no difference in mortality in erms of both LENT and ECOG at 1st, 6th and 12th months. Conclusions LENT is a better scoring system than ECOG in predicting early mortality, while both ECOG and LENT have almost the same power in predicting mortality. However, LENT is slightly more objective but more difficult to calculate because it contains laboratory findings. Thus, both scoring systems can be used to predict mortality in patients with malignant pleural effusions. Neither of them has superiority to each other.

Background: In this study, we aimed to examine the effectiveness of pulmonary rehabilitation applied after resection in patients with lung cancer. Methods: Between October 2017 and December 2019, a total of 66 patients (53 males, 13 females; median age: 65 years; range, 58 to 70 years) who underwent lung resection for non-small cell lung cancer and who were not administered any chemotherapy or radiotherapy regimen were included in the study. An eight-week comprehensive outpatient pulmonary rehabilitation program was applied to half of the patients, while the other half received respiratory exercise training. After the intervention, the results of both groups were compared. Results: In the pulmonary rehabilitation group, forced vital capacity value (p=0.011), six-minute walking distance (p Conclusion: Pulmonary rehabilitation program applied after lung resection in patients with non-small cell lung cancer reduces dyspnea and psychological symptoms, increases exercise capacity, and improves quality of life. It should be ensured that patients with lung cancer who have undergone lung resection are directed to the pulmonary rehabilitation program and benefit from this program.

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

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.

Introduction The aim of this study is to investigate and report on the data regarding the clinical characteristics and outcomes of healthcare workers with COVID-19 at tertiary education hospitals from Turkey. Materials and methods This was a single center, retrospective, descriptive and observational study using cross-sectional data, which were collected from confirmed COVID-19 patients at a tertiary education hospital. Patients' demographic and clinical characteristics, mortality rates, and the factors associated with hospitalization were analyzed. Result By May 15, 2020, 480 patients were diagnosed with COVID-19 in our hospital where 49 (10.2%) of whom were HCWs. The mean age was 40.0 ± 8.45 (75.5% female). The most common symptoms were cough (32.7%), fever (30.6%), and myalgia (14.3%). Comorbidities were present in 32.7% of the patients. Most of the HCWs were nurses (53.1%) and physicians (18.4%), and the remaining 14 (28.6%) were cleaning and administrative staff. The severity of the disease was mild in 65.3% and severe in 34.7% HCWs. Leukocyte, neutrophil, lymphocyte and platelet values were statistically lower in hospitalized patients. There was a statistically significant relationship between the presence of infiltration on the chest X-ray, and the patient's symptoms with the severity of the disease (respectively p= 0.002 and 0.009). Conclusions In conclusion, the frequency of COVID-19 in healthcare workers is high. The study presents the characteristics of HCWs infected with coronavirus from a single center in Turkey.

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a disease caused by airway and / or parenchymal pathology. Therefore, some patients inevitably have chronic bronchitis and some patients have emphysema. The responses of these most prominent major phenotypes to exercise are also thought to be different. In this study we investigated the difference of benefits from PR in chronic bronchitis and emphysema. Material and Method: Retrospective data of patients with chronic bronchitis and emphysema who completed outpatient 8-week PR program between 2013 and 2017 in the PR unit were examined. Demographic data (age, sex, body mass index, smoking history, long term oxygen therapy (LTOT), noninvasive ventilation, emergency admissions, and number of hospitalizations in the last one year were recorded. The patients were divided into two groups as chronic bronchitis and emphysema. Emphysema was radiologically defined whereas chronic bronchitis according to clinical description. Two groups compared for the recorded data. Method: Of the 146 patients, 85 were in the emphysema group and 61 were in the chronic bronchitis group. There was no difference between the two groups in terms of age and gender. Pulmonary function test (PFT) parameters (FEV1, TLCO), arterial blood gas values (pO2, pCO2, SpO2), 6 MWT, and quality of life scores were significantly improved after PR. However, there was no difference between emphysema and chronic bronchitis groups in terms of gain after PR. Conclusion: In this study, it was observed that the gain from PR in COPD patients was independent of phenotype. Therefore, all COPD patients should be encoureged to participate in PR programs regardless of their phenotypes.

Introduction: COPD is a major cause of morbidity and mortality worldwide. The major scores associated with the mortality after COPD exacerbations were; DECAF, CURB-65, PSI, BAP-65 and DOSE scores. Objective: We aimed to compare these scores in predicting 30- and 90-day mortality in patients hospitalized with exacerbation of COPD. Methods: The data of patients who were hospitalized with the diagnosis of COPD exacerbation between January 2018 and March 2019 and accepted to participate in the study were prospectively recorded. Results: Age, mean modified-medical-research-council (mMRC) dyspnea score, pleural effusion, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), presence of atrial fibrillation (AF), pCO2 pressure values were found to be significantly higher at both 30 and 90-days mortal group, while hemoglobin, albumin and pH values were significantly lower. DECAF, CURB-65, PSI and BAP-65 scores were significantly higher for both 30 and 90-days mortality, and the DOSE score was not significant.As the severity of DECAF, CURB-65, PSI, and BAP-65 scores increased, the mortality also increased. DECAF, CURB-65, PSI and BAP-65 scores predicted in-hospital, 30 day and 90 day mortality. But, In the multivariate analysis, CURB-65 found (OR 2.968 and 2.284, respectively) superior to others in predicting 30 and 90-days mortality. Conclusions: CURB-65 score is a significant, simple and feasible score for predicting 30 and 90 days mortality in COPD exacerbation and should be routinely used in all patients hospitalized with COPD exacerbation.

The aim of our study is to determine the clinical availability accessibility of cancer ratio and cancer ratio plus formulations, previously validated and reported to have clinical value in distinguishing malignant pleural effusion from tuberculosis pleurisy and parapneumonic effusion.Retrospective study of patients hospitalized with Malignant Pleural Effusion (MPE), tuberculosis (TPE) and pararapneumonic effusion (PPE) between 2009 and 2018.Totally 232 patients, 101(43.5 %) having MPE, 86 (37.1 %) having PPE and 45 (19.4 %) TPE were examined. When compared with each other, "serum LDH / PS Lymphocyte %", "Cancer ratıo" and "Cancer ratıo plus" values were statistically different between the groups (p = 0.021, p0.001 and p = 0.015, respectively). In multivariate logistic regression analysis, cancer ratio, serum LDH: pleural fluid lymphocyte count ratio was in positive correlation with MPE. The sensitivity and specificity of "cancer ratio", "cancer ratio plus" and "ratio of serum LDH: pleural fluid lymphocyte count" were 84.2 % (95% CI 75.6- 90.7) and 52.7 (95% CI 43.8- 61.5), and 82.2 % (95% CI 73.3- 89.1) and 45.8 (95%CI 37.1- 54.7), 53.5% (95% CI 43.3- 63.5) and 67.2% (95% CI 0.68-0.94) at the cut-off level of14.25,28.7, and636, respectively. When considering only MPE and TPE patients, the specificity of cancer ratıo and cancer ratıo plus increased.The cancer ratio plus rate (the ratio of "cancer ratio"formulation to the percentage of differential pleural lymphocyte count) was almost the same as the cancer ratio in separating the malignant pleural effusion from the TPE and PPE, while it has better specificity only in differentiating malignant effusions from tuberculosis effusions.

Aim: To evaluate Platelet-to-Lymphocyte Ratio (PLR) and Neutrophil-to-Lymphocyte Ratio (NLR) in patients with HP. Method: A sample of 140 total patients, 50 having chronic HP and 20 having acute HP, and a control group of 70 more patients were included in this retrospective study conducted with hospital Ethical Committee approval. Results: PLR and NLR values were significantly higher in all HP patients than in the control group ( p

Aim: The aim of this study wass to compare the cytological features of pleural exudative fluids by conventional smear (CS) method and cell block (CB) method and also to assess the utility of the combined approach for cytodiagnosis of these effusions. Materials and Methods: In all, 113 pleural exudative fluid samples were subjected to evaluation by both CS and CB methods over a period of 2 years. Cellularity, architecture patterns, morphological features, and yield for malignancy were compared, using the two methods. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for diagnosis of malignancy were calculated for both the methods, using histology as a gold standard. Results: CB method provided higher cellularity, better architectural patterns, and additional yield for malignancy when compared with CS method. For 22 (40%) patients, histologic subtype was determined with CB especially for adenocarcinoma. The sensitivity, specificity, positive, and negative predictive values of cytology and CB were 48%, 100%, 100%, 67.8% and 59.2%, 100%, 100%, 72.8%, respectively. Conclusion: CB technique definitively increased detection of malignancy in pleural fluid effusion when used as an adjunct to CSs. Also, CB provides material suitable for molecular genetic analysis for targeted therapies especially in the treatment of adenocarcinoma.

INTRODUCTION Brain metastasis prevalence is higher in patients with positive epidermal growth factor receptor (EGFR) mutation, anaplastic lymphoma kinase (ALK) and C-ROS oncogene 1 (ROS-1) fusion change in lung adenocarcinoma. OBJECTIVES The purpose of our study is to investigate the relation between the genetic change type and the initial distant metastasis in stage IV lung adenocarcinoma patients with genetic changes. METHODS The study was conducted between January 2007 and December 2018 in a retrospective fashion with patients who had lung cancer diagnosed as stage IV adenocarcinoma. The relation between genetic mutation change (EGFR, ALK or ROS-1) and distant metastasis was analysed. RESULTS A total of 845 patients were included in the study. The median age was 62 (28-88). It was determined that lung and pleura metastases were more frequent at a significant level in patients with positive EGFR mutation (P = 0.032, P = 0.004, respectively). In patients with positive ALK fusion change, pleura metastasis was determined to be more frequent (P = 0.001). Multiple metastases were determined to be significantly more in patients with positive ALK fusion change than single metastasis (P = 0.02). CONCLUSION In patients with EGFR mutant lung adenocarcinoma, lung and pleura metastasis is more frequent and pleura metastasis is more frequent in ALK positive adenocarcinoma. Additionally, multiple organ metastases are higher in ALK positive lung adenocarcinoma.

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.

OBJECTIVES Among the nodule types, the most controversial group are indeterminate solid nodules from 1 to 2 cm in size with the first choice being transthoracic needle biopsy (TTNB) or positron emission tomography (PET-CT) or both methods together. However, no single diagnostic algorithm could be applied to all cases. This research discusses the diagnostic success of PET-CT and TTNB. MATERIALS AND METHODS 407 Patients who referred to our hospital for any reason, with solid nodules with the size from 1 to 2 cmincidentally identified on the thoracic CT tests were investigated. Among the patients who underwent biopsy, 312 cases had PET-CT, and maximum SUV (SUVmax) values of the nodules were examined. Values of ≥2.5 were accepted as hypermetabolic. RESULTS The mean age of the patients was 61 ± 10.8 years. 84 patients were female (20.6%) and 323 were male (79.4%). For TTNB; sensitivity, specificity and accuracy rates of all cases, who were correctly diagnosed, were 76.9%, 83.3% and 78.9%, respectively (P

28th International Congress of the European-Respiratory-Society (ERS) -- SEP 15-19, 2018 -- Paris, FRANCE, WOS: 000455567103370, …, European Respiratory Soc

Adiaspiromycosis is a world wide airborne infection and is a pulmonary disease in humans caused by the fungus Chrysosporium parvum var crescens (Emmonsia parva). It is caused by inhalation of spores of the saprophytic soil fungus. The spherules induce a granulomatous reaction, in which a single spherule is surrounded by a fibronecrotic and suppurative or fibrous granuloma. The disease can be localized and asymptomatic, or disseminated, occasionally severe, or even fatal. Reticulonodular infiltrates are the most common radiographic manifestations, with localized infiltrates occurring occasionally. We present a case with bilateral diffuse interstitial micronodular infiltration and granulomatous inflammation in the lung. The larvae of adiaspiromycosis visualized in the center of granulomatous inflammation by histopathologic examination of the lung biospy specimens. We aimed to discuss the very rare cause of diffuse interstitial and granulomatous inflammation of lung.