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To evaluate the utility of neutrophil–lymphocyte ratio (NLR) determined at initial diagnosis in predicting advanced disease stage and discriminating between active and stable disease in sarcoidosis. A total of 465 patients with biopsy-proven sarcoidosis (age: 47 years, 70.5% females) were included in this retrospective cross-sectional study. Data on patient demographics, sarcoidosis stage, clinical status (stable and active), anti-inflammatory treatments, complete blood count, and inflammatory markers including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR) and platelet/mean platelet volume (MPV) ratio were recorded. NLR values were compared by subgrouping the patients according to the stage of sarcoidosis and clinical status, while the receiver operating characteristics (ROC) curve was plotted to determine the role of NLR in the identification of disease activity with the calculation of area under the curve (AUC) and cutoff value via ROC analysis. Overall, active, and stable disease was evident in 36 (7.8%) and 427 (92.2%) patients, respectively. Median NLR values were significantly higher in patients with active disease compared with stable disease (3.31 (2.34–4.31) vs. 2.29 (1.67–3.23), p = 0.005). Advanced sarcoidosis stage was associated with significantly higher NLR values at stages 0, I, II, III and IV, respectively (p = 0.001). ROC analysis revealed an NLR cutoff value of ≥2.39 (AUC (95% CI): 0.70 (0.62–0.79), p < 0.001) to discriminate between active and stable clinic with a sensitivity of 72.0% and specificity of 52.0%. The significantly higher percentage of patients with active vs. stable disease had NLR values ≥2.39 (74.0 vs. 47.0%, p = 0.002). Our findings indicate the potential utility of on-admission NLR values to predict the risk of advanced disease stage and to discriminate between active and stable disease in sarcoidosis. Measured via a simple, readily available, and low-cost test, NLR seems to be a valuable marker for monitoring disease activity and progression.

BACKGROUND: Coronavirus disease 2019 (COVID-19) continues to cause major mortality and morbidity worldwide even after a year of its emergence. In its early days, hypertension, diabetes, and cardiovascular diseases were noted as poor prognostic factors, while obesity gained attention at a later stage. In the present study, unfavorable clinical outcomes (transfer to the intensive care unit, invasive mechanical ventilation, and mortality) were investigated in obese patients with COVID-19. MATERIALS AND METHODS: In this retrospective study we analyzed patients with positive polymerase chain reaction test in tertiary care hospital between March-May 2020. They were divided into 3 groups according to body mass index (BMI) as normal, overweight, and obese (BMI: 18.5 - 24.99 kg/m², 25 - 29.99 kg/m², and ≥ 30 kg/m², respectively). We compared clinical features and laboratory findings of these groups and recorded adverse clinical outcomes. Multivariate logistic analysis was performed for unfavorable outcomes. RESULTS: There were 99 patients (35%), 116 (41%), and 69 patients (24%) in the normal-weight, overweight, and obese group, respectively. Among all patients, 52 (18%) patients were transferred to the intensive care unit (ICU), 30 (11%) patients received invasive mechanical ventilation (IMV), and 22 patients (8%) died. Obese patients had minimum 1 more comorbidity than normal BMI patients (73% vs. 50%, P = 0.002), and a longer median (interquartile range [IQR]) duration of hospitalization (8 [5 - 12] vs. 6 [5 - 9]) days, P = 0.006). Obese participants had higher concentrations of serum C-reactive protein, procalcitonin, ferritin than non-obese patients (P

This study aimed to assess nutritional statuses of chronic obstructive pulmonary disease (COPD) patients in four categories of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2015 classification and to evaluate associations of body mass index (BMI) and fat-free mass index with respiratory and skeletal muscle strengths. This prospective observational study included COPD patients (≥40 years old) who were followed-up for at least 1 year. Medical histories, smoking status, and anthropometric, spirometry, and hand grip strength measurements were recorded. This study included 463 COPD patients. They were classified as Group A (n = 119), Group B (n = 58), Group C (n = 117), and Group D (n = 169) according to GOLD. Group D was older (p = 0.001) than other groups. No difference was found among the groups regarding sex (p = 0.163). Fat-free body mass was significantly decreased in Group D compared with Group A (p = 0.014) and BMI were lower in Groups C and D than in other groups (p = 0.001). Spirometry and hand grip strength showed a significant decreasing trend toward Group D (p

Objectives The diagnosis of sarcoidosis is frequently challenging, requiring a search for less invasive, more reliable diagnostic methods. The bronchoalveolar lavage fluid (BALF) analysis has been used in the differential diagnosis of sarcoidosis for many years with a wide sensitivity and specificity rates. The objective of the study is to investigate whether diagnostic performance of the BALF analysis is altered by clinicoradiological findings of patients with sarcoidosis. Materials and methods The present study is a retrospective, single-center, observational study, designed in a sarcoidosis outpatient clinic in a training hospital. Patients who had undergone the bronchoalveolar lavage BAL procedure at diagnosis were included in the study. Demographics, clinical and detailed chest X-ray, and high-resolution computed tomography (HRCT) findings at diagnosis were recorded. According to the diagnostic performance, the BALF results were grouped as "diagnostic" and "non-diagnostic," and recorded parameters were compared between the groups. Results Considering the BALF analysis of all the 257 patients, the mean lymphocyte ratio was 41±17.5 (5-80), and the mean CD4/CD8 was 5.5±4.7 (0.1-24.7). The BALF analysis was diagnostic in 56% (n=145) of patients. Diagnostic performance of the procedure did not correlate with any of the demographic data, smoking status, spirometric findings, chest X-ray staging, HRCT findings, and tomography scoring. Extrapulmonary involvement was significantly more frequent in the diagnostic group (66% vs. 34%, p=0.006). Conclusion BALF results signal sarcoidosis in more than half of the patients. The diagnostic role of BALF is greater in patients with extrapulmonary involvement.

BACKGROUND Elevated red blood cell distribution width (RDW) levels were associated with mortality in patients with stable chronic obstructive lung pulmonary diseases (COPD). There are limited data about RDW levels in acute exacerbation of COPD (AECOPD). AIM/OBJECTIVE The association of the RDW levels with the severity of AECOPD was evaluated according to admission location, (outpatient-clinic, ward and intensive care unit (ICU)). METHODS Cross sectional retrospective study was designed in tertiary care hospital for chest diseases in 2015. Previously COPD diagnosed patients admitted to hospital outpatient-clinic, ward and ICU due to AECOPD were included in the study. Patients demographics, RDW, biomarkers (CRP, RDW, Neutrophil to lymphocyte ratio (NLR), platelet to mean platelet volume (PLT-MPV)) C-CRP, biochemistry values were recorded from hospital electronic system. RDW values were subdivided below 0.11% (low), above and equal 0.15% (high) and between 0.11%-0.15% (normal). Neutrophil to lymphocyte ratio (NLR) and platelet to mean platelet volume (PLT-MPV) were also calculated. Biomarker values were compared according to where AECOPD was treated. RESULTS 2771 COPD patients (33% female) and 1429 outpatients-clinic, 1156 ward and 186 ICU were enrolled in the study. The median RDW values in outpatients-clinic, ward and ICU were 0.16 (0.09-0.26), 0.07 (0.01-0.14) and 0.01 (0.00-0.07) respectively (P

Dysnatremia is reported to have a prognostic effect in various diseases. A limited number of studies have been published on dysnatremiarelated parameters and clinical outcome in patients with pneumonia. The aim of the study is to analyze the factors related to baseline dysnatremia and to evaluate the clinical outcome of dysnatremia on hospital stay, 30-day and 1-year mortality in hospitalized patients with community-acquired pneumonia (CAP).The study is a two-centre, retrospective, crosssectional study. According to the baseline corrected sodium values, hospitalized patients with CAP were grouped as hyponatremia (135 mmol/L), normonatremia (135-145 mmol/L) and hypernatremia (145 mmol/L).Of all the 471 patients included, 119 (25.3%) had hyponatremia and 25 (5.3%) had hypernatremia. Higher leucocytes and lower albumin values correlated with hyponatremia while female gender, higher leucocytes and urea levels correlated with hypernatremia. Baseline hyponatremia prolonged hospital stay (9.2 ± 5.6, vs. 7.5 ± 4.6, respectively, p= 0.001) and increased 1-year mortality. On the other hand, hypernatremia predicted 30-day (40%, vs. 10%, p0.001) and independently predicted 1-year mortality (p0.001).In hospitalized patients with CAP, baseline hyponatremia prolongs hospital stay while hypernatremia signals a worse outcome both in the short term and long term.

Background: Elevated red blood cell distribution width (RDW) levels were associated with mortality in patients with stable chronic obstructive lung diseases (COPD). There are limited data about RDW levels in COPD exacerbation. Aim/Objective: The association of the RDW levels with the severity of the acute exacerbation of COPD (AECOPD) were evaluated according to admission location, (outpatient-clinic, ward and intensive care unit (ICU). Methods: Cross sectional retrospective study designed in tertiary chest dieases hospital. COPD patients admitted to hospital outpatiens-clinic, ward and ICU due to AECOPD were included. Patients demographics, RDW, C-reactive protein (CRP), biochemistry values were recorded. RDW values were subdivided below 0.11% (low), above and equal 0.15% (high) and between 0.11-0.15% (normal). Neutrophile to lymphocyte ratio (NLR) and platelet to mean platelet volume (PLT-MPV) were also calculated. Recorded values were compared according to where AECOPD was treated. Results: 2771 COPD patients (33% female) and 1429 outpatients-clinic, 1156 ward and 186 ICU were enrolled in the study. The median RWD values in outpatients-clinic, ward and ICU were 0.16 (0.09-0.26), 0.07 (0.01-0.14) and 0.01 (0.00-0.07) respectively (p

IntroductionNon-specific pleuritis (NSP) is a fibrinous or inflammatory pleurisy that is not attributable to a benign or malign etiology. The long-term follow-up results of patients diagnosed with NSP following video- assisted thoracoscopic surgery (VATS) were investigated in this study.Material and methodsThis investigation focused on 593 patients with exudative pleural effusion who underwent VATS between 2011 and 2014. Of the 137 patients diagnosed with NSP, a total of 39 patients were excluded from the study.ResultsOut of the 98 patients, 78 were male (80%) with their mean age being 52.2 ±15.9 years. The mean follow-up period was 1919 ±744 days. Of these patients, 70 (71.4%) had no specific diagnosis, while 28 patients (28.6%) did have specific diagnoses. Malignancy was detected in seven (7.1%) of those with specific diagnoses, with most of the diagnoses of malignancy detected within the first 36 months. Malignant diseases included mesothelioma (n = 2), lung cancer (n = 2), chronic lymphocytic leukemia (n = 1), soft tissue sarcoma (n = 1), and multiple myeloma (n = 1). Chest radiographs of malignant patients showed that statistically significantly larger amounts of fluid (40% vs. 6.9%, p = 0.026), pleural plaque (20% vs. 1.1%, p = 0.020) and nodules (20% vs. 7.7%, p = 0.020) were detected compared to patients with a benign course.ConclusionsMost patients diagnosed with NSP after VATS had a benign disease course. There was a probability of malignancy, although it was low. Mesothelioma and other malignancies could be seen within the first 36 months after the biopsy. Apart from mesothelioma, other malignancies should also be considered, and further follow-up recommended for patients with a large amount of fluid, plaque and nodules found in the initial VATS images.

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.

Birsen Ocakli, Eylem Acarturk, Emine Aksoy, Sinem Gungor, Fulya Ciyiltepe, Selahattin Oztas, Ipek Ozmen, Meltem Coban Agca, Cuneyt Salturk, Nalan Adiguzel, Zuhal Karakurt Department of Chest Diseases, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey Purpose: The aim of this study was to evaluate the impact of exposure to biomass smoke vs cigarette smoke on serum inflammatory markers and pulmonary function parameters in patients with chronic respiratory failure (CRF).Patients and methods: A total of 106 patients with CRF divided into age and gender-matched groups of cigarette-smoke exposure (n=55, mean [SD] age: 71.0 [12.0] years, 92.7% were females) and biomass smoke exposure (n=51, mean [SD] age: 73.0 [11.0] years, 94.1% were females) were included in this retrospective study. Data on patient demographics (age and gender), inflammatory markers, including neutrophil-to-lymphocyte ratio, C-reactive protein, platelet/mean platelet volume ratio, arterial blood gas analysis, and pulmonary function test findings, including forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC were obtained from medical records.Results: Carbon dioxide partial pressure levels were significantly higher in the biomass smoke exposure than in the cigarette smoke exposure group (mean [SD] 51.0 [8.0] vs 47.0 [8.0] mmHg, p=0.026, respectively). Spirometry revealed similarly low levels for FEV1 (%) (38.0 [16.0] vs 40.0 [12.0]%) and FVC (%) (45.0 [19.0] vs 39.0 [19.0]%) in cigarette-smoke and biomass smoke exposure groups, whereas biomass smoke exposure was associated with significantly higher FEV1/FVC (75.0 [14.0] vs 58.0 [12.0]%, p=0.001), lower FVC (mL) (mean [SD] 744.0 [410.0] vs 1,063.0 [592.0] mL, p=0.035) and lower percentage of patients with FEV1/FVC 70% and more prominent loss of vital capacity than cigarette smoke exposure seems to indicate the likelihood of at least 18 years of biomass exposure to be sufficiently high to be responsible for both obstructive and restrictive pulmonary diseases. Keywords: biomass exposure, cigarette smoke, inflammatory markers, spirometry, chronic respiratory failure

OBJECTIVE: Sarcoidosis is a multisystem chronic disease characterized by granulomatous inflammation. It is reported that the frequency of other inflammatory and malignant diseases increases. The primary objective of the study is to determine the types of comorbid diseases and their frequency, and whether the risk of malignancies and autoimmune diseases such as rheumatoid arthritis and thyroid increases. The secondary objective is to identify the factors related to the comorbidities frequently detected. METHODS: The files of 694 patients who had the diagnosis of sarcoidosis between1998-2016 were evaluated. The frequency of comorbid diseases recorded was compared to the data of our country. RESULTS: Among the patients, 487 (70%) were female, and the mean age at diagnosis was 42.9 ± 11.8 (18-87). In 490 patients (70%) at least one comorbidity was detected. The most frequently detected comorbidities were systemic hypertension (22%), hepatosteatosis (16.9%), diabetes mellitus (16.4%), thyroid diseases (13.1%), and asthma (12%). Malignancy was found in a ratio of 4.0%, rheumatoid arthritis in 2.2%. The comparison to the frequencies across the country showed that the prevalence of diabetes mellitus, thyroid diseases, asthma, malignancy, and rheumatoid arthritis was higher. Diabetes, thyroid diseases, asthma were more frequent in women. The mean age of patients in which diabetes, thyroid diseases, asthma, rheumatoid arthritis or malignancy was detected as a comorbidity was higher than those without comorbidities. CONCLUSION: Comorbidities frequently occur among sarcoidosis patients, and the frequency of diabetes mellitus, thyroid diseases, asthma, malignancy, and rheumatoid arthritis is higher than the data of the country.

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.

Pulmonary lymphangitic carcinomatosis (PLC) is defined as infiltration of the lymphatic vessels and perilymphatic connective tissue with tumor cells, which is secondary to malignancy. Therefore, it rarely appears as an initial finding preceding a diagnosis of malignancy. A 30-year-old male patient was hospitalized in our clinic with a pre-diagnosis of interstitial lung disease owing to the complaints of dry cough, progressive dyspnea, and acute respiratory insufficiency. He was diagnosed with signet ring cell carcinoma, which is a histologic subtype of adenocarcinoma, via gastroscopy, and lung involvement was consistent with PLC. Regardless of the patient age, PLC should be considered in differential diagnoses of progressive dyspnea, acute respiratory failure, and widespread interstitial lung involvement.

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

Introduction Noninvasive ventilation (NIV) during hospitalization for acute hypercapnic exacerbations of chronic obstructive pulmonary disease (COPD) has been shown to be effective, but data on the prognosis of such patients is limited. The aim of this study was to investigate in-hospital and long-term outcome in patients with COPD exacerbations requiring NIV treatment during hospitalization. Methods Between 2011 and 2013, hospitalized subjects with hypercapnic COPD exacerbations were included in this retrospective single-center cohort study. Subjects' clinical and laboratory data and survival status after a median of 27 months were recorded. The predictive factors of in-hospital and long-term mortality were analyzed. Results A total of 574 patients (357 men, mean age 68±11 years) were recorded. During hospitalization, 24 (4.1%) patients died. In-hospital mortality was negatively affected by lower baseline values of hematocrit, albumin, and pH, and by higher baseline leucocytes and higher 24h PaCO2. Median survival of the cohort was 27 months. Mortality at 3 and 6 months, and 1 year were 14.5%, 19.5%, and 30%, respectively. In the univariate analysis, reduction in long-term survival was found to be related to older age, higher Charlson score, lower baseline levels of hematocrit and albumin, and lower pH level after 24h. In the multivariate analysis, older age and lower albumin were identified as the strongest predictors of mortality. Conclusion Life expectancy after a COPD exacerbation requiring NIV treatment is short. Baseline blood counts and day 2 arterial blood gases levels may predict in-hospital mortality. The strongest indicators of poorer long-term outcome were advanced age and lower albumin. Such patients may need closer follow-up.

Introduction Noninvasive ventilation (NIV) during hospitalization for acute hypercapnic exacerbations of chronic obstructive pulmonary disease (COPD) has been shown to be effective, but data on the prognosis of such patients is limited. The aim of this study was to investigate in-hospital and long-term outcome in patients with COPD exacerbations requiring NIV treatment during hospitalization. Methods Between 2011 and 2013, hospitalized subjects with hypercapnic COPD exacerbations were included in this retrospective single-center cohort study. Subjects’ clinical and laboratory data and survival status after a median of 27 months were recorded. The predictive factors of in-hospital and long-term mortality were analyzed. Results A total of 574 patients (357 men, mean age 68±11 years) were recorded. During hospitalization, 24 (4.1%) patients died. In-hospital mortality was negatively affected by lower baseline values of hematocrit, albumin, and pH, and by higher baseline leucocytes and higher 24 h PaCO 2 . Median survival of the cohort was 27 months. Mortality at 3 and 6 months, and 1 year were 14.5%, 19.5%, and 30%, respectively. In the univariate analysis, reduction in long-term survival was found to be related to older age, higher Charlson score, lower baseline levels of hematocrit and albumin, and lower pH level after 24 h. In the multivariate analysis, older age and lower albumin were identified as the strongest predictors of mortality. Conclusion Life expectancy after a COPD exacerbation requiring NIV treatment is short. Baseline blood counts and day 2 arterial blood gases levels may predict in-hospital mortality. The strongest indicators of poorer long-term outcome were advanced age and lower albumin. Such patients may need closer follow-up.

Objective: Idiopathic chronic eosinophilic pneumonia (ICEP) is a rare eosinophilic lung disorder with an unknown etiology and is characterized by subacute or chronic respiratory and general symptoms, alveolar and/or peripheral eosinophilia, and the accumulation of eosinophils in the lungs. We aimed to present diagnostic test results and follow-up outcomes of 17 patients who were diagnosed with ICEP in our hospital in light of literature. Methods: Between 2008 and 2013, we examined 17 cases of ICEP. We evaluated clinical and laboratory findings together with the long-term follow-up data. Results: The patients had a mean age of 40.8 years at presentation, and the female/male ratio was 0.8. The most common symptoms were cough (94%), shortness of breath (76%), and high fever (35%). Bronchoalveolar lavage eosinophil percentages of the patients ranged from 3% to 80%. Nine (53%) patients experienced recurrence. Six patients were maintained on low dose steroid due to repeating relapses. Among these patients, 7 (77.7%) had a total IgE level of above 500/IU/mL. Conclusion: Relapses are common in ICEP after the withdrawal of corticosteroid treatment or during dose reduction. We point out the importance of the close monitoring of patients for identifying relapse. A higher total IgE level during diagnosis may serve as a predictor of recurrence.

Previous hypersensitivity reactions to contrast media (CM), atopy, atopic disease, drug allergy, and age (20–29 or >55) are risk factors for CM hypersensitivity reactions. Our aim was to evaluate whether these risk factors should prompt skin testing for diagnosing CM allergy. The study was conducted among patients referred for allergy testing with CM. Skin tests were performed with non ionic or gadolinium CM, recommended by a radiologist. After completion of tests patients were telephonically queried on their symptoms of reactions. 151 risk patients (53 men, 98 women; mean age 55.2) were included in the study. Only 13 (9 %) had a history of hypersensitivity reaction to CM. Compared with the other patients, atopy was significantly more common in patients with a history of CM hypersensitivity reactions. Female gender and mean age were also higher, but not significant. All of the tests with CMs were negative. Only one patient reported urticaria within 1–2 min after administration of CM (telephonically). Atopy can increase the risk of CM allergy. However, skin tests with CMs may be inefficient, unnecessary, and time-consuming, except in cases with a history of CM allergy. Premedication protocols appear to be beneficial in patients with a history of CM allergy and cannot be recommended for patients with well-controlled asthma, rhinitis, atopic dermatitis or history of drug allergy.

OBJECTIVE: The present study examines the clinical and radiological findings and pathological diagnoses of patients undergoing surgical biopsy with an multidisciplinary team (MDT) decision and investigates whether final diagnoses change on the reevaluated of pathological diagnoses at MDT meetings. MATERIALS AND METHODS: A total of 416 patients were discussed at MDT meetings held at the University of Health Sciences Istanbul Sureyyapasa Chest Diseases and Thoracic, Surgery Training and Research Hospital January between January 2016 and May 2019, with surgical biopsy decisions made for 50 (12%) patients. RESULTS: Among the 50 patients, 26 (52%) were female, with a mean age of 53 ± 12 years. The most common locations of the surgical biopsy were the right lung (n = 27, 54%), lower lobe (n = 38, 76%) and single lobe (n = 35, 70%). A definitive pathological diagnosis was established in 41 (82%) patients following the biopsy. The most common diagnoses were usual interstitial pneumonia (UIP; n = 19, 38%), sarcoidosis (n = 11, 22%), unclassifiable fibrosis (n = 9, 18%), (non-specific interstitial pneumonia; n = 5, 10%), (hypersensitivity pneumonitis; n = 2, 4%) and others (n = 4, 8%), respectively. Diagnoses of 13 (26%) such patients were revised. The revision was most common in the unclassifiable fibrosis and UIP subgroups. The radiological appearance was classified based on the high-resolution computed tomography parameters for idiopathic pulmonary fibrosis (IPF). The final diagnosis was IPF in eight of 14 patients with “probable” diagnoses, all four patients with “indeterminate” diagnoses and three of the 28 patients with “alternative” diagnoses. CONCLUSION: Diagnosing interstitial lung diseases is difficult, and while surgical biopsy provides the most definitive diagnosis, it is not enough by itself. IPF may vary in radiology. Patients diagnosed with UIP and unclassifiable fibrosis after biopsy should be reevaluated, and the final diagnosis should be established through a multidisciplinary approach.

Emine Aksoy, Zuhal Karakurt, Sinem Gungor, Birsen Ocakli, Ä°pek Ozmen, Elif Yildirim, Eylem Tuncay, Meltem Coban Agca, Nezihe Ciftaslan Goksenoglu, Nalan Adigüzel Respiratory Intensive Care Unit Clinic, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey Background: Complete blood count parameters provide novel inflammatory markers, namely neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR). We aimed to assess any differences in these novel inflammatory markers according to exacerbation severity in patients with COPD in both eosinophilic and neutrophilic endotypes. Method: This retrospective cross-sectional study was conducted at a tertiary education hospital. Previously diagnosed COPD patients admitted to the hospital with acute COPD exacerbation (AECOPD) were enrolled into the study. Patients were grouped according to COPD endotype, eosinophilic (peripheral blood eosinophil rate ≥2%) and neutrophilic (peripheral blood eosinophil rate

Pulmonary artery agenesis is a rare congenital abnormality in which atresia was encountered in the short segment of the right or left pulmonary arteries. It can be isolated or associated with cardiac abnormalities such as tetralogy of Fallot, septal defects or pulmonary stenosis. The majority of cases are diagnosed in childhood whereas some cases yield no symptoms until adulthood. We evaluated retrospectively 5 pulmonary artery agenesis cases diagnosed in our clinics between 1998-2010 with respect to the literature.

Objective: “Frequent hospitalization” is defined as at least 2 hospitalizations per year in chronic obstructive pulmonary disease (COPD). However, we witness hospitalizations at 2–3-month intervals in some patients in our clinical practice. In our study, the factors considered to be associated with frequent hospitalizations were investigated in a selected patient group. Methods: Thirty-four COPD patients being hospitalized at least twice per year were included in the study. The patients’ demographic features, laboratory findings, physical activity scores, comorbidities, and respiratory functions were recorded. They underwent transthoracic echocardiography and fiberoptic bronchoscopy (FOB). The patients were categorized as Group 1 (patients hospitalized twice per year) and Group 2 (patients hospitalized more than twice per year). These groups were compared with regard to parameters considered to increase the frequency of hospitalization. Results: Twenty-eight (82%) of the patients were male. The mean age was 65±8 (46-82) years, and the mean hospitalization number was 3.3±1.3 (2-6). There were 12 patients in Group 1 and 22 patients in Group 2. The rates of being in advanced age, showing lower physical activity, being in advanced stage, having disease for more than 10 years, and using a nebulizer and oxygen at home were found to be significantly higher in Group 2 than in Group 1. FEV1 (expected %) level was 47.9% in Group 2, while it was 56% in Group 1 (p=0.003). The number of comorbidities was approximately 1.5 in Group 1 and 2.7 in Group 2 (p=0.014). Pulmonary hypertension (n=11) and heart failure (n=10) were identified only in Group 2 (p=0.003, p=0.006). Excessive dynamic airway collapse (EDAC) was detected in 17 (50%) patients through FOB, and 16 of them were in Group 2. Logistic regression analysis revealed the existence of EDAC and a low level of FEV 1 (expected %) as the independent factors that affected the number of hospitalizations. Conclusion: It was suggested that the existence of EDAC and decreased FEV 1 can increase the frequency of hospitalization in COPD patients who are hospitalized frequently.

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.

Background: Elevated RDW levels were associated with mortality in patients with stable COPD. There are limited data about RDW levels in COPD exacerbation. Aim: We evaluated if there is any difference about the RDW levels in patients with COPD exacerbation in out patients clinic, ward and ICU. Methods: The study was designed as cross sectional observational retrospective, in a teaching chest disease hospital in 2014.Previously COPD diagnosed patients who admitted to hospital outpatients clinic, ward and ICU due to COPD exacerbation were included the study.Cancer, pneumonia, anemia, asthma, liver-renal diseases and rheumatologic-neurologic diseases patients were excluded.Demographics, hemogram values included RDW, CRP were recorded from hospital based electronic system. RDW were subdivided below 0.11% (low), above and equal 0.15% (high) and between 0.11-0.15% (normal).Recorded values were compared according to place where COPD exacerbation was treated. Results: 2771 COPD patients (33% female) and 1429 outpatients clinic, 1156 ward and 186 ICU were enrolled in the study. The median RWD values in outpatientsn clinic, ward and ICU were; 0.16, 0.07 and 0.01 respectively (p Conclusion: Patients with COPD exacerbation, lower RDW values should be considered carefully. Lower RDW can be used for decision of COPD exacerbation severity and follow up treatment response.

Objectives Organizing pneumonia (OP) is an interstitial lung disease characterized by granulation tissue buds in alveoli and alveolar ductus, possibly accompanied by bronchiolar involvement. Histopathologically, OP may signify a primary disease and be observed as a contiguous disease or as a minor component of other diseases. In this study, the clinical significance of histopathological OP lesions and clinical and radiological features of patients with primary OP were examined. Material and methods Between January 2011 and January 2015, of 6,346 lung pathology reports, 138 patients with OP lesions were retrospectively evaluated. According to the final diagnoses, patients were grouped as reactive OP (those with final diagnosis other than OP) and primary OP (those with OP). Patients with primary OP were classified according to etiology as cryptogenic and secondary OP. Radiological evaluation was conducted within a categorization of "typical," "focal," and "infiltrative." Results Of 138 patients, 25% were males and the mean age was 54±14 years. Pathologically, 61% of patients had reactive OP and 39% had primary OP. All reactive OP lesions were reported using surgical specimens, and the most frequent primary diagnoses were malignancy (65%), infection (15%), interstitial lung diseases other than OP (7%), and bronchiectasis (5%). Other diagnoses included bullae, foreign body, hamartoma, bronchogenic cyst, and bronchopleural fistula. Of all the primary OP patients, 48 had cryptogenic OP and six had secondary OP. Radiological involvement was consistent with typical OP in 30%, focal OP in 63%, and infiltrative OP in 7% of the patients. All focal OP lesions were defined using surgical resections. Positron emission computed tomography (PET-CT) was recorded in 28 patients. In 11 patients, lymphadenomegaly was comorbid. The mean widest diameter of focal opacity was 2.7±1.2 (1.2-4.9) cm, and the mean the maximum standardized uptake value (SUVmax was 6.1±3.9 (1.7-16.7). Conclusion OP lesions generally present as a minor component of other diseases. In patients with OP, cryptogenic OP and radiological focal OP is more frequently observed. Most focal OP lesions are detected using surgical resections because of malignant prediagnosis owing to elevated SUVmax.

We present a unique case of a 26-year-old woman, which first evaluated as sarcoma or thromboembolic events with their clinical and radiological similarities of the pulmonary artery but diagnosed as isolated pulmonary artery vasculitis after endarterectomy with the help of histopathological examinations. After the endarterectomy procedure, the other causes that may lead to vasculitis had been excluded. The patient had the immunosuppressive therapy after the procedure, and her control computerized tomography revealed that the lumen of the pulmonary artery was wide open. Isolated pulmonary artery vasculitis must be considered as a differential diagnosis when a filling defect of the pulmonary artery had been detected without other systemic findings.

A first case of endobronchial mucosal neuroma with sarcoidosis is hereby reported. A 67-year female patient, who was diagnosed as sarcoidosis previously, was admitted to our hospital with symptoms of dyspnea, chest pain and fatigue. Middle lobe atelectasis and endobronchial lesion were observed in thorax computed tomography (CT). Fiberoptic bronchoscopy revealed polypoid lesions and histopathological examination of biopsy material showed clustered nerve bundles consistent with mucosal neuroma and non-necrotising granulomas consistent with sarcoidosis. Mucosal neuromas are pathognomonic features of multiple endocrine neoplasia (MEN) type 2B. But other components of MEN type 2B such as medullary tyroid carcinoma or pheochromocytoma were not detected in our patient. Hence, a diagnosis of solitary mucosal neuroma and sarcoidosis in the bronchi was made.

Tularemia is a zoonotic infection which is caused by gram negative coccobacilli, Francisella tularensis. The disease occurs after contact with blood and body fluids of infected animals, bites and ingestion of infected food and water. Although it commonly presents with skin lesions, there may also be serious organ involvements. A55-year woman was consulted for presumptive diagnosis of tuberculosis. Multiple lymphadenopathy in right cervical area was present on physical examination. Pleural effusion on left side was detected with computed tomography. In detailed history, knowledge of a family member with the diagnosis of tularemia was obtained. Both of them had the history of contact with infected animals. Diagnosis of tularemia was confirmed with microagglutination test. With this patient who was initially presumptively diagnosed as tuberculosis, we aim to draw attention to diagnosis of tularemia in the presence of pleuropnemonia and peripheral lymphadenopathy and emphasize importance of detailed patient history.

Takayasu arteritis (TA) is a large vessel vasculitis especially seen in young women. Because of nonspecific symptoms diagnois is difficult and confused with other diseases. Delayed treatment increase morbidity and mortality. It effects primarly pulmonary artery in lung involvement. To our knowledge endobronchial involvement has not been reported previously in the literature. Due to rarity we present our patient whom we observed with the diagnosis of endobronchial tuberculosis and confirmed the diagnosis of Takayasu arteritis after 9 months.

Non-invasive ventilation(NIV) is known to be effective in acute hypercapnic respiratory failure(RF) in COPD exacerbations. In our study, we evaluated NIV treatment results in COPD acute hypercapnic RF and factors correlate with success. Between May 2011 and 2013, the first applications of COPD patients to our emergency department (ED) with acute hypercapnic RF were recorded. Demographic characteristics of the patients, laboratory values, arterial blood gas (ABG) parameters at presentation and follow-up and treatment results were recorded. Patients were divided into 2 groups;patients discharged from clinics with improvement were accepted as NIV success (Group 1) and patients died or transferred to intensive care unit(ICU) were accepted as failure(Group 2). Of all 574 patients enrolled in the study, 357(62.2%) were male,the mean age was 68±11(36-98). In 76% of patients had at least one additional diseases, 10,4% were active smokers. Average hospital stay WAS 9.9 days. 83% of the patients were discharged with clinical improvement (Group 1,n=477). 7% was transferred to ICU, 5% died, 4% left hospital and 1% were transferrd to other units due to non- COPD indications. Those who left hospital and transferred to other units were excluded in Grouping, The presence of malignancy (p=0.030), treatment without theophylline (p=0.002), low albumin (p=0.000)- protein(p=0.034), higher C-reactive protein(p=0.025) level, lower pH and higher pCO2 within the first 2 hours (ED), 24th and 48th hour ABG controls(p

Background: It has been suggested that platelet count(PLT) and mean platelet volume(MPV) can be used as inflammation marker in tuberculosis and pneumonia. Aims and objectives: PLT and MPV in sarcoidosis were not investigated. Objective of this study was to determine whether PLT and MPV can be used as a differiantial marker betweeen sarcoidosis and tuberculosis which are granulomatous diseases and presenting with similar symptoms. Methods: We performed prospective study with 100 patients with sarcoidosis (group 1), 83 patients with tuberculosis (group 2), 63 patients with pmoumonia (group 3) and 36 healthy control individuals (group 4). In this study we compared to inflammatory markers, platelet count and MPV values of four groups. Results: WBC, ESR, CRP and PLT values were lower in control group. Between sarcoidosis , tuberculosis and pnoumonia group, these values were significantly lower in sarcodosis group.MPV values was found significantly lower in tuberculosis group. PLT values of tuberculosis group was found significantly higher compared to sarcoidosis group (p

Introduction: Takayasu arteritis is a large vessel vasculitis especially seen in young women. Because of nonspecific symptoms diagnosis is difficult and confused with other diseases. Delayed treatment increase morbidity and mortality. It effects primarly pulmonary artery in lung involvement. Aims and Objectives: To our knowledge endobronchial involvement of takayasu arteritis has not been reported previously in the literature. Due to rarity we present our case. Material and Methods: Twentyeight years old , female patient was admitted with cough, night sweats, fatigue and anorexia. No pathology was observed in lung parenchyma and pulmonary arteries in Thorax CT. With fiberoptic bronchoscopy, diffuse micronoduler lesions were seen and histopathological examinations of these nodules revealed granulomatous inflammation. For differiantial diagnosis all examinations including ARB was found negative. PET CT screening revealed diffuse hypermetabolic appearance in archus aorta and descending thoracic aorta. Concentric thickening of aortic wall was detected in further screening with MR angiograhy. With these findings, diagnosis of Takayasu arteritis was established in 9 months. Results: Takayasu Arteritis can mimic other granulomatous diseases with nonspecific symptoms of cough, fever, fatigue and weight loss. Conclusion: Endobronchial involvement of Takayasu Arteritis can be seen with no involvement of pulmonary artery.

Objectives Eosinophilic lung diseases are a rare group of heterogeneous diseases characterized by the increase of the eosinophil ratio in airways and lung parenchyma. In our clinic, patients diagnosed with eosinophilic lung disease were evaluated with their clinical features and prognoses. Material and methods In our clinic, 12 cases that were diagnosed and followed up for eosinophilic lung disease [eosinophilic granulomatosis with polyangiitis (EGPA, Churg-Strauss syndrome) (n=4), chronic eosinophilic pneumonia (CEP) (n=7), and simple pulmonary eosinophilia (Loffler's syndrome) (n=1)] were retrospectively evaluated. Results Of the 12 cases, 8 were females, and the average age was 43 (28-72) years. All cases were undergoing bronchodilator therapy with asthma diagnosis (2 months-40 years). Additionally, 4 of the cases had sinusitis, and 1 had allergic rhinitis. The most common complaints of the patients were difficulty in breathing and coughing, and the duration of complaints was a median of 2 months. Peripheral eosinophilia and total IgE elevation were present during the admission of all cases; additionally, leucocyte elevation was recorded in 10 of them, anemia in 4 of them, and thrombocytosis in 4 of them. Moreover, 43% of the recorded DLCO values were lower than normal. Of the 10 cases that underwent bronchoalveolar lavage (BAL), the eosinophil ratio was above 25% in 7 subjects. Of the 8 cases that underwent transbronchial biopsy, eosinophil-involving infiltration was detected in 6 subjects. Additional findings in cases diagnosed with EGPA were nasal polyposis (n=1), sinusitis (n=2), polyneuropathy (n=1), cardiac involvement (n=2), and skin involvement in biopsy (n=1). Spontaneous recovery was observed in the patient diagnosed with simple pulmonary eosinophilia during the follow-up that was performed based on the history and laboratory and BAL results of the patient. Prednisolone treatment was started for all cases, except for simple pulmonary eosinophilia, and their controls were performed. Relapse was observed in eight cases (EGPA: 4, CEP: 4); during the relapse treatment of one case diagnosed with EGPA, exitus occurred. One case rejected treatment despite the presence of peripheral eosinophilia, and the other cases are being followed-up without medication. Conclusion Given that the clinical pictures in pulmonary eosinophilia syndromes are on a wide spectrum, a specific diagnosis is important. Progression may differ in each patient, and a close follow-up is necessary during and after the treatment.

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