Search

Introduction: COVID-19 pneumonia typically presents with high fever, cough, and shortness of breath and on thorax computed tomography (CT) peripheral ground glass opacities help the diagnosis. Although typical imaging findings for COVID-19 pneumonia are specified in thorax CT, these findings can be confused with other diseases. The aim of this study is to investigate the roles of radiological imaging and laboratory findings in the differential diagnosis of COVID-19 pneumonia and acute heart failure (AHF). Materials and Methods: In the present study, 74 patients who admitted to the emergency department with respiratory distress during the pandemic period and received a diagnosis of COVID-19 pneumonia and AHF were included. Laboratory data and radiological findings of the patients, at the time of admission, were evaluated. Result: On admission, there was no difference in age, gender between two groups. However, COVID-19 exposure history was found significantly higher in COVID-19 pneumonia patients group (p

Aim: Treatment rates of multidrug-resistant tuberculosis (MDR-TB) vary from clinic to clinic. In this study, the characteristics of MDR-TB patients followed in two clinics of our hospital and their relationship with treatment results were investigated. Material and Method: This observational retrospective cohort study performed in a government hospital which is one of the important reference center for management of tuberculosis in Turkey. Seventy-nine adult MDR-TB cases who'm diagnosed and treated between 2004-2014 were retrospectively enrolled into the study. Results: Of the patients with MDR-TB, 58 were male, 21 were female, mean age was 36.24 ± 13.75 and all of them were HIV (-). 64 patients completed treatment, 15 patients still under treatment. The average hospitalization time was 162.76. Radiologically, 11 patients had diffuse disease and 68 patients had limited disease. The mean number of patients who received second-line drugs were 5.18 ± 0.5 and drug-related side effects developed in 36 patients. Cure was achieved in 84.4% of the patients, 7.8% discontinued the treatment, 7.8% died during the treatment and there wasn’t any treatment failure. Conclusion: In our study, we think that the factors that increase the success of MDR-TB treatment are: young age, low resistance to second line medication, prolongation of hospitalization, good compliance with treatment, low rate of ofloxacin use in previous treatment, use of fluoroquinolones in new patients, surgery in selected patients.

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

Background/Aim With the COVID‐19 pandemic, managing the process of solid organ transplantation has become a significant matter for transplant centres. In this study, we report our experiences on evaluating the effects of COVID‐19 in patients with recent liver transplants. Materials and Methods We evaluated patients who received liver transplants during three close consecutive periods of time. For transplants conducted between October 1 and December 31, 2019, January 1 and March 10, 2020 and March 11 and June 22, 2020, the lung tomographies of patients were inspected for radiological signs of viral pneumonia. For patients after March 11, 2020, the hospital's electronic database system was scanned for preoperative and postoperative SARS‐CoV‐2 testing from Real‐time Polymerase Chain Reaction (RT‐PCR) of the respiratory tract samples. Results A total of 149 patients over the age of 18 who received liver transplants at our centre between October 1, 2019 and June 22, 2020 were evaluated. During this time span, our centre conducted liver transplants on patients from 34 different provinces and also abroad. Within this time period, a total of nine patients had respiratory samples with a positive SARS‐CoV‐2 RT‐PCR test. PCR of respiratory tract samples was performed in 21 (14%) patients to identify the other potential infective agents in the respiratory tracts; Rhinovirus and Influenza A were detected in two and respiratory syncytial virus (RSV) was detected in one patient. During the transplant periods, 99 (67.1%) patients were evaluated with computed tomography (CT). The CT findings of 18 (12%) patients were consistent with viral pneumonia. There was a statistically significant difference between the groups only in terms of air bronchogram findings (P = .012). Conclusion The clinical status of our short‐term liver transplant patients was far better than we originally anticipated, but it remains obvious that the necessary precautions should continue to be taken.

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

Introduction: Cytomegalovirus (CMV), is the most common opportunistic infection, remains a cause of life-threatening disease and allograft rejection in liver transplant (LT) recipients. The purpose of this case series is to state that CMV may lead to severe pneumonia along with other bacteria. Methodology: CMV pneumonia was diagnosed with the thoracic computed tomography (CT) scan findings, bronchoscopic biopsy, real time quantitative Polymerase Chain Reaction (qPCR) and clinical symptoms. For extraction of CMV DNA from the clinical sample, EZ1 Virus Mini Kit v2.0 (Qiagen, Germany) was used, and aplification was performed with CMV QS-RGQ Kit (Qiagen, Germany) on Rotor Gene Q 5 Plex HMR (Qiagen, Germany) device. Results: All recipients had severe pneumonia, leukopenia, thrombocytopenia and at least two-fold increase in transaminases on seventh, twenty-eighth and twenty-second days after surgery, respectively. Thoracic CT scan revealed as diffuse interstitial infiltration in the lung parenchyma. Bronchoscopy, Gram-staining and culture from bronchoalveolar lavage (BAL) fluid were performed in all of them. During bronchoscopy, a bronchial biopsy was administered to two recipients. One recipient could not be performed procedure because of deep thrombocytopenia. PCR results were positive from serum and BAL fluid. Bronchial biopsy was compatible with CMV pneumonia. However, Pseudomonas aeruginosae was found in two cases and Klebsiella pneumoniae in one case BAL fluid cultures. Conclusions: CMV pneumonia can be seen simultaneously with bacterial agents due to the indirect effects of the CMV. It should be kept in mind that CMV pneumonia may cause severe clinical courses and can be mortal.

Medical therapy is recommended in various situations such as multiple cysts, high risk surgery , presence of small cyst and perioperative phase in the treatment of hydatid cyst. Present study was designed to determine the features of disseminated hydatid cyst cases, outcome of albendazole treatment , diagnosis and management of complications and patients outcome. Methods: 21 patients who had the diagnosis of hydatid cyst based on clinical, radiological, and pathological findings with multiple hydatid cyst in a single organ and/or more than one organ were retrospectively analyzed. The mean age was 34±17.9 (range, 7-71) and F/M was 17/4. Hydatid disease was detected as multiple cysts in the lung in four patients, as multiple cysts in the lung and pleura in one case, and as multiple organ involvement in 16 cases. The most common presentation was the involvement of both lung and liver. The most common symptom was cough. Four asymptomatic patients were detected during family screening. In six patients, Albendazole was started before the operation and the remainders were started after the operation. Cure was achieved in eight patients at the end of medical and/or surgical treatment. Convenient medical treatment with albendazole treatment in appropriately selected patients is an effective treatment option with minimal side effects in hydatid cyst disease. [Med-Science 2018; 7(4.000): 935-9]

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.

Amaç: Literatürde “büyük taklitçi” olarak anılan inflamatuar bir hastalık olan sarkoidoz olgularında semptomlar ve tutulan organlar açısından cinsiyete göre farklılıklar bildirilmiştir. Bu çalışmada sarkoidoz olgularındaki semptom ve bulguların cinsiyete ve hastalığın evrelerine göre farklılıkları araştırıldı.Gereç ve Yöntemler: Bu retrospektif gözlemsel kohort çalışmamızda sarkoidoz tanılı olgular başvuru semptomlarına göre; asemptomatik, pulmoner semptomlar, ekstrapulmoner semptomlar, pulmoner ve ekstrapulmoner semptom birlikteliği olarak gruplandırıldı. Her iki cinsiyet bulguların sıklığı açısından karşılaştırıldı.Bulgular: Çalışmaya alınan 338 hastanın %71’i kadın olup yaş ortalaması 42,5±11,6 idi. Olguların %86’sı başvuru anında semptomatik olup, semptomların %31’i yalnız pulmoner, %23’ü yalnız ekstrapulmoner, %32’sinde ise hem pulmoner hem de ekstrapulmoner semptomlar birlikte idi. Kadın ve erkeklerde öksürük (sırasıyla %45; %42; p=0,620), balgam çıkarma (sırasıyla %9; %11; p=0,535), hemoptizi (sırasıyla %2; %1; p=0,678), ateş (sırasıyla %4; %4; p=0,999) bulguları açısından cinsiyete göre anlamlı farklılık bulunamadı. Dispne kadınlarda erkek olgulara göre anlamlı olarak daha sık izlendi (sırasıyla %33; %22; p=0,048). Kadın hastalarda erkeklere kıyasla göğüs ağrısı anlamlı olarak daha az görüldü (sırasıyla %7; %20; p=0,001). Aşırı terleme erkeklerde kadınlara göre anlamlı olarak daha fazla görülürken (p=0,004), eritema nodosum kadınlarda erkeklere göre fazla bulundu (p=0,003). Terleme dışındaki konstitüsyonel yakınmalarda cinsiyet farkı izlenmedi.Sonuç: Sarkoidozlu kadınlar daha yaşlıdır ve nefes darlığı ile eritema nodosum, kadınlarda erkeklere göre anlamlı oranda sık bulunmuştur. Erkeklerde ise terleme ve göğüs ağrısı belirgin yüksek tespit edilmiştir., Aim: Sarcoidosis is known as the ‘great imitator’ for its versatile manifestations which differ among genders. The objective of this study is to investigate the signs and symptoms and differences in respect to gender and phases of disease.Material and Methods: This cohort study includes patients with sarcoidosis classified as asymptomatic, with pulmonary symptoms only, extrapulmonary symptoms only and those with both together. The frequency, prevalence, and severity of the signs and symptoms were compared between gender identities.Results: This study enrolled 338 patients, of which 71% were female, and mean age was 42.5±11.6. Most patients (86%) were symptomatic on presentation, and pulmonary symptoms were noted in 31%, extrapulmonary symptoms in 23% and both in 32%. There were no significant differences between genders regarding cough (45% in women, 42% in men, p=0.620), sputum (9%, 11%, respectively, p=0.535), hemoptysis (2%, 1%, respectively, p=0.678), fever (4%, 4%, respectively, p=0.999). Dyspnea was reported significantly more common in women (33% and 22%, respectively, p=0.048) whilst chest pain was more common in men (7%, and %20 respectively, p=0.001). Excessive perspiration was significantly more common in men, and erythema nodosum in women (p=0.004 and p=0.003, respectively). Frequencies of constitutional symptoms other than perspiration did not differ between sexes.Conclusion: Women with sarcoidosis were older than men and dyspnea and erythema nodosum were seen more commonly in women. Frequencies of other symptoms were similar between sexes.

Objective: Sarcoidosis is a multisystemic disease, exact cause of disease is unknown but it is assumed that genetic predisposition and ethnic factors play a role in etiology. Studies related with familial sarcoidosis is limited and only case reports about familial sarcoidosis is available from our country. We aimed to evaluate the prevelance of familial sarcoidosis and clinical findings of cases with familial sarcoidosis. Methods: We retrospectively documented file records of 678 patients diagnosed with sarcoidosis and followed up in outpatient clinic of sarcoidosis from January 1996 to February 2016. 28 familial sarcoidosis cases in 14 families were enrolled into the study. Their demographic findings, family relationship, symptoms, laboratory and pulmonary function test results, radiological apperances, diagnostic methods, treatments were recorded. Results: Twenty-eight sarcoidosis patients out of 678 reported as familial cases, giving a prevelance of familial sarcoidosis as 4%. There were 8 sarcoidosis sib, 4 sarcoidosis mother-child, 1 sarcoidosis father-child and 1 sarcoidosis cousin relationship. Female/male ratio was 1.8, mean age of the study population was 43, most freguent symptoms were cough and dyspnea, stage 2 was mostly seen according to chest X-ray, most common CT appearance was mediastinal lymphadenopathy and mediastinoscopy was the most freguent diagnostic method. Conclusion: This study is important to lead interrogation of family in patients with suspected sarcoidosis and future studies investigating familial aggregation in sarcoidosis.

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.

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

Prolonged air leak in secondary spontaneous pneumothorax (SSP) patients remains one of the biggest challenges for thoracic surgeons. This study investigates the feasibility, effectiveness, clinical outcomes, and economical benefits of the autologous blood patch pleurodesis method in SSP.First-episode SSP patients undergoing autologous blood patch pleurodesis for resistant air leak following underwater-seal thoracostomy, between January 2010 and June 2013 were taken into the study. Timing and success rate of pleurodesis, recurrence, additional intervention, hospital length of stay, and complications that occurred during follow-up were examined from medical records, retrospectively.Thirty-one (27 male, 4 female) SSP patients with expanded lungs on chest X-ray and resistant air leak on the 3(rd) post-interventional day were enrolled. Mean age was 53.7 ± 18.9 years (range: 23-81). Twenty-four patients were treated with tube thoracostomy, 2 with pezzer drain, and 5 with 8 F pleural catheter. 96.8% success was achieved; air leak in 29 of 31 patients (93.5%) ceased within the first 24 hours. No procedure-related complication such as fever, pain or empyema was seen. Late pneumothorax recurrence occurred in 4 (12.9%) patients; 1 treated with talc pleurodesis where the other 3 necessitated surgical intervention.Autologous blood patch pleurodesis is a safe, effective, and easily performed procedure with no need of any additional equipment or extra cost. This method can be applied to all patients with radiologically expanded lungs and continuous air leak after 48 hours following water-seal drainage thoracostomy, to reduce hospital stay duration, unnecessary surgical interventions, and the expenses.Długotrwały wyciek powietrza u pacjentów z wtórną, samoistną odmą opłucnową pozostaje nadal jednym z największych wyzwań dla chirurgów klatki piersiowej. Prace badawcze mają na celu określenie skuteczności, korzyści oraz powikłań wynikających ze wstrzyknięcia autologicznej krwi do jamy opłucnej (pleurodeza).Badania zostały przeprowadzone na grupie pacjentów z wtórną, samoistną odmą opłucnową, którzy w okresie między styczniem 2010 r. a czerwcem 2013 r. przeszli nieefektywną torakotomię, a następnie pleurodezę polegającą na wstrzyknięciu autologicznej krwi do jamy opłucnej. W badaniach uwzględniono retrospektywną analizę dokumentacji medycznej, przebieg czasowy oraz pomyślność zabiegu pleurodezy, nawrót problemu, konieczność dodatkowej interwencji, długość pobytu pacjenta w szpitalu oraz wszelkie komplikacje wynikłe podczas kontynuacji leczenia.Grupa 31 pacjentów z długotrwałym wyciekiem powietrza spowodowanym wtórną, samoistną odmą opłucnową (27 mężczyzn oraz 4 kobiety) została zakwalifikowana do badania na 3 dni po wykonaniu zabiegu. Średnia wieku pacjentów to 53,7 roku (grupa wiekowa od 23 do 81 lat). Dwudziestu czterech pacjentów leczono za pomocą drenażu opłucnowego, 2 za pomocą cewnika Pezzera, a 5 za pomocą cewnika opłucnowego 8 F. Średni czas między pierwszą interwencją a pleurodezą krwi wyniósł 6,9 dnia (od 4 do 15 dni). Sukces został osiągnięty w 96,8%; wyciek powietrza u 29 z 31 pacjentów (93,5%) ustąpił w ciągu pierwszych 24 godzin, a pacjenci zostali wypisani ze szpitala. U żadnego z pacjentów nie zaobserwowano komplikacji związanych z zabiegiem, takich jak gorączka, ból czy ropniak. Późniejszy nawrót odmy zaobserwowano u 4 pacjentów (12,9%); 1 pacjenta wyleczono za pomocą pleurodezy talkiem, stan 3 pozostałych pacjentów wymagał interwencji chirurgicznej oraz pleurodezy mechanicznej.Pleurodeza autologiczną krwią to bezpieczna, efektywna i łatwa do przeprowadzenia procedura, niewymagająca dodatkowego sprzętu czy też kosztów. Metoda ta może być zastosowana w celu skrócenia czasu hospitalizacji i uniknięcia zbędnych interwencji chirurgicznych czy też wydatków u wszystkich pacjentów ze zmianami radiologicznymi płuc oraz ciągłym wyciekiem powietrza w ciągu 48 godzin po przeprowadzeniu drenażu opłucnej i torakotomii.

Nosocomial pneumonia (NP) and ventilator associated pneumonia (VAP) have been associated with financially significant economic burden and increased case fatality rate in adult intensive care units (ICUs). This study was designed to evaluate case fatality rate among patients with NP and VAP in a respiratory ICU. In 2008–2013, VAP and NP in the ICUs were included in this retrospective single-centre cohort study. Data on demographics, co-morbidities, severity of illness, mechanical ventilation, empirical treatment, length of hospital stay and laboratory findings were recorded in each group, as were case fatality rate during ICU admission and after discharge including short-term (28-day) and long-term (a year) case fatality rate. A total of 108 patients with VAP (n = 64, median (IQR) age: 70 (61–75) years, 67.2 % were men) or NP (n = 44, median (IQR) age: 68 (62–74) years, 68.2 % were men) were found. Appropriate empirical antibiotic therapy was identified only in 45.2 and 42.9 % of patients with VAP and NP, respectively. Overall case fatality rate in VAP and NP (81.3 vs 84.1), ICU case fatality rate (42.2 vs 45.5 %), short-term case fatality rate (15.6 vs 27.3 %) and long-term case fatality rate (23.4 vs 11.4 %) were similar between VAP and NP groups along with occurrence 50 % of case fatality rate cases in the first 2 months and 90 % within the first year of discharge. Multivariate analysis showed that chronic obstructive pulmonary disease (COPD) (HR: 3.15, 95 % CI: 1.06–9.38; p = 0.039) and presence of septic shock (HR: 3.83, 95 % CI: 1.26–11.60; p = 0.018) were independently associated with lower survival. In conclusion, our findings in a retrospective cohort of respiratory ICU patients with VAP or NP revealed high ICU, short- and long-term case fatality rates within 1 year of diagnosis, regardless of the diagnosis of NP after 48 h of initial admission or after induction of ventilator support. COPD and presence of septic shock are associated with high fatality rate and our findings speculate that as increasing compliance with infection control programs and close monitoring especially in 2 months of discharge might reduce high-case fatality rate in patients with VAP and NP.

OBJECTIVES Community-acquired pneumonia (CAP) accounts for an important part of hospital admissions and health expenses worldwide. The cost increases when treated in a hospital, and reports on this issue are limited in Turkey. This study aimed to investigate direct hospital costs and factors affecting these costs for patients who were hospitalized in our clinic because of the diagnosis of CAP. MATERIAL AND METHODS The records of patients who had been hospitalized for the diagnosis of CAP were retrospectively reviewed. Demographic features, radiological features, pneumonia severity index (PSI), CURB-65 scorings, duration of hospitalization, treatments, and the results of treatments were examined. Total hospitalization costs and the expenses for intervention, medication, examinations, and additional services were recorded. The effect of data on the cost was evaluated. RESULTS The study was conducted with 87 patients with CAP. The mean duration of hospitalization was 15.6 days and nine patients (10.3%) were exitus. The median total hospital cost was 2062 (451-11690) TL [952 euros (€), 1305 dollars ($)], and the median hospitalization expense per day was 148 Turkish Lira (TL) (68.3 €, 93.7 $). Medication expenses and total cost were higher in male patients than in female patients. Abscess/necrotizing pneumonia increased the cost depending on the infiltration that occurred either alone or with parapneumonic pleurisy. Whereas an increase in the PSI stage increased the total cost and expenses for intervention and medication, medication expenses increased in patients with CURB-65 score of 3 and 4 (p

Sarcoidosis is a systemic inflammatory disease with unknown etiology involving several organs. Myocardial involvement, pericarditis, severe rhythm abnormalities, and heart valve disease due to papillary muscle dysfunction are some of the cardiac manifestations. Conventional echocardiographic methods remain insufficient for the determination of subclinical myocardial dysfunction in patients with sarcoidosis. In our study, we investigated the impact of sarcoidosis on bi-ventricular and atrial functions using two-dimensional (2D) speckle tracking echocardiography (STE). Forty patients with sarcoidosis and 20 age and sex-matched controls were recruited into study. All subjects underwent a transthoracic echocardiography for the evaluation of ventricular and atrial functions with 2D STE. Left ventricular (LV) dimensions, LV ejection fraction, and right ventricular (RV) systolic velocity were similar between the two groups. Left atrial (LA) diameter was significantly higher in sarcoidosis patients than controls. Eighteen (45 %) patients in the sarcoidosis group and 1 (5 %) patient in the control group had LV diastolic dysfunction. LV global longitudinal, radial, circumferential strain, twist, untwists, and RV global longitudinal strain values were significantly lower in sarcoidosis patients compared to controls. LA and RA reservoir functions were also significantly lower in sarcoidosis patients than controls. Although impaired LV diastolic function was detected using conventional parameters, only novel advanced echocardiographic modalities demonstrated impaired bi-ventricular and atrial mechanical functions in patients with sarcoidosis.

Currently, there are no objective criteria to determine sarcoidosis activity. The present study aimed to discover a sensitive serum marker that would determine the activity of sarcoidosis and can be used during disease follow-up.Forty-eight patients with sarcoidosis and twenty healthy volunteers as a control group were included in the study. On their control visits, the patients were divided into active and inactive groups based on their clinical, physiological, and radiological status. Angiotensin converting enzyme (ACE), adenosine deaminase (ADA), total IgE (T-IgE), C-reactive protein (CRP), serum amyloid-A (SAA), and soluble interleukin-2 receptor (sIL2R) serum levels and classical findings of activity were compared, and the utilization of these parameters as markers of activity was investigated.Thirty-nine cases were female (female/male: 39/9) and the mean age was 44.29±10.9years. Thirty-seven cases were active and 11 cases were inactive. Serum ACE, ADA, sIL2R, and SAA levels were significantly higher while T-IgE levels were lower in the sarcoidosis cases. A comparison of the markers between active and inactive cases showed that only SAA was significantly higher (p0.001). sIL2R was elevated in cases with extra-pulmonary involvement (p0.014). The area under the curve value was rather high for ADA (0.98 CI: 0.96-1.0); it also had high sensitivity (93.8%) and specificity (100%), and therefore had the highest diagnostic value (96.6%).The current study showed that SAA wil be helpfull for detecting the activity of srcoidosis, IL2R measurement in exploring the extra-pulmonary organ involvement.

WOS: 000447618800009, PubMed: 30322437, OBJECTIVES: We aimed to obtain information about the characteristics of the ICUs in our country via a point prevalence study. MATERIAL AND METHODS: This cross-sectional study was planned by the Respiratory Failure and Intensive Care Assembly of Turkish Thoracic Society. A questionnaire was prepared and invitations were sent from the association's communication channels to reach the whole country. Data were collected through all participating intensivists between the October 26, 2016 at 08:00 and October 27, 2016 at 08:00. RESULTS: Data were collected from the 67 centers. Overall, 76.1% of the ICUs were managed with a closed system. In total, 35.8% (n=24) of ICUs were levels of care (LOC) 2 and 64.2% (n=43) were LOC 3. The median total numbers of ICU beds, LOC 2, and LOC 3 beds were 12 (8-23), 14 (10-25), and 12 (8-20), respectively. The median number of ventilators was 12 (7-21) and that of ventilators with non-invasive ventilation mode was 11 (6-20). The median numbers of patients per physician during day and night were 3.9 (2.3-8) and 13 (9-23), respectively. The median number of patients per nurse was 2.5 (2-3.1); 88.1% of the nurses were certified by national certification corporation. CONCLUSION: In terms of the number of staff, there is a need for specialist physicians, especially during the night and nurses in our country. It was thought that the number of ICU-certified nurses was comparatively sufficient, yet the target was supposed to be 100% for this rate.

WOS: 000433492600005, PubMed ID: 29463455, Introduction: The long-term prognosis of patients with community-acquired pneumonia (CAP) has attracted increasing interest in recent years. The objective of the present study is to investigate the short and long-term outcomes in hospitalized patients with CAP and to identify the predictive factors associated with mortality. Patients and methods: The study was designed as a retrospective, multicenter, observational study. Hospitalized patients with CAP, as recorded in the pneumonia database of the Turkish Thoracic Society between 2011 and 2013, were included. Short-term mortality was defined as 30-day mortality and long-term mortality was assessed from those who survived 30 days. Predictive factors for short- and long-term mortality were analyzed. Results: The study included 785 patients, 68% of whom were male and the mean age was 67 +/- 16 (18-92). The median duration of follow-up was 61.2 +/- 11.8 (37-90) months. Thirty-day mortality was 9.2% and the median survival of patients surviving 30 days was 62.8 +/- 4.4 months. Multivariate analysis revealed that advanced age, the absence of fever, a higher Charlson comorbidity score, higher blood urea nitrogen (BUN)/albumin ratios and lower alanine aminotransferase (ALT) levels were all predictors of long-term mortality. Conclusion: Long-term mortality following hospitalization for CAP is high. Charlson score and lack of fever are potential indicators for decreased long-term survival. As novel parameters, baseline BUN/albumin ratios and ALT levels are significantly associated with late mortality. Further interventions and closer monitoring are necessary for such subgroups of patients. (C) 2017 Sociedade Portuguesa de Pneumologia. Published by Elsevier Espana, S.L.U.

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.

Introduction Almost 50% of all cancers and 70% of cancer deaths occur in cases aged 65 years and more. Thus diagnosis, treatment and follow up in old cases gain importance. Since there a limited number of study that show age-mortality relation in lung cancer cases aged 80 years and over, issues may arise in diagnosis and treatment process of these cases. In this study, we aimed to evaluate general characteristics of lung cancer cases aged 80 years or over and factors that affect survey. Materials and Methods Between 2010 and 2013, the retrospective cohort study was done in Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital and 100 cases of lung carcinoma were examined. Result In the study, 70% of the cases were male and 30% were female. Median age was 83 ± 2.91 (80-92) years. 71% of the cases were found to be suffering from a comorbid disease; 29% did not have any comorbid disease. Dyspnea (56%), cough (50%) and chest pain (41%) were the most frequent symptoms. Histopathologically, 41% of the patients diagnosed with adenocarcinoma and 40% were diagnosed with squamous cell carcinoma. Median survival time was 2.73 months (%95 CI 0.96-4.49) and 1-year survival rate was 17%. Length of time of the cases with smoking history was found shorter than of cases without smoking history (p= 0.013). Life expectancy of the cases with advanced disease and performance score of 3-4 was detected to be short (p= 0.006, p< 0.001). Compared to the cases who operated on and had chemoradiotherapy, length of life who had symptomatic treatment was shorter (p< 0.001). Conclusions Despite the comorbidity in lung cancer cases aged 80 years and over, life expectancy of the cases who had surgical and/or chemoradiotherapy treatment is longer. While deciding on treatment methods on these cases, patient's performance must be taken into consideration.

Introduction: One day point prevalence study to evaluate patient profile in ICUs was planned by Turkish Thoracic Society Respiratory Failure and Intensive Care Group. Methods: The study was cross-sectional and data were obtained by a questionnaire in participating ICUs on October 26th 2016 for 24 hours. A questionnaire evaluating characteristics of patients in ICU was prepared. A total of 78 units declared to participate in the survey. Results: Ten centers were excluded from the study because they couldn’t participate on study day. A total of 922 patients were enrolled from 68 units. The mean age was 64.8 ± 17.9 (17-99), 58.6% were male. The mean APACHE II, QSOFA and GCS scores on the study day were 18.5 ± 8.8, 1.4 ±1.4 and 10.2 ± 4.3, respectively, and mean length of stay (LOS) was 20 ± 70 days. The patients were admited from emergency room(44%[n=407]), clinics(39%[n=359]) and other ICUs(17%[n=156]).38.5% of patients had Type 1 respiratory failure(RF),35.6% had Type 2 RF. Comorbidity was seen in 80.6% and malignancy rate was 18.8%. On the study day it was found that 52.1% of the patients underwent invasive mechanical ventilation(IMV),12.3% of the patients had non-invasive ventilation(NIV) 29.1% of them had oxygen therapy. Tracheostomy was performed in 19.7% of patients. 70% of the patients had enteral, 20.7% had parenteral nutrition. The discharge rate was 7% while mortality was 1.1% on that day. Discussion: Most of the patients in ICUs are respiratory failure cases admited from emergency department and clinics. Advanced age, presence of comorbidities and cancer are thought to prolong LOS in ICU. For effective use of ICU beds further regulations for patient admission criteria is necessary.

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.

INTRODUCTION: We aimed to investigate of patient's knowledge, attitude and behavior about tuberculosis and society's attitude towards tuberculosis patients. MATERIALS AND METHODS: The patients were asked to answer a questionnaire regarding their knowledge about tuberculosis that is composed of 14 questions (general, infectivity, diagnosis, treatment; 3-3-3-5 questions respectively) in the first hours of their hospitalization and the answers were evaluated. RESULTS: 145 tuberculosis patients (female/male, 46/99; mean age 35, 6±13, 7) were enrolled in the study. The ratio of the patients who knew the disease was contagious, transmitted by saliva driblets and tuberculosis vaccine prophylaxis was 84%, 83%, and 95% respectively. Eighty-two percent of patients knew about the tests necessary for the diagnosis correctly. Eighty-one percent of patients knew the tuberculosis treatment would take 6-9 months with four different drugs. In society's attitude questions, 35% patients that declared they were struck professionally by their disease, 37% of patients answered as "my relations with my work friends went downhill ", 42.9% of patients answered as "I was afraid of getting fired", 14.3% of patients answered as " I got fired". CONCLUSION: The preliminary information of the participating patients was approved good enough by a total information score of 80.4±16.1%. Although the patients knowledge level were high, because of problems faced by the society suggests that education should be given more importance.

Murat Yalcinsoy,1 Cuneyt Salturk,2 Selahattin Oztas,2 Sinem Gungor,2 Ipek Ozmen,2 Feyyaz Kabadayi,2 Aysem Askim Oztim,2 Emine Aksoy,2 Nalan Adıguzel,2 Ozlem Oruc,2 Zuhal Karakurt2 1Department of Pulmonary Medicine, Inonu University Medical Faculty, Turgut Ozal Medical Center, Malatya, 2Department of Pulmonary Medicine, Sureyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey Purpose: Noninvasive mechanical ventilation (NIMV) usage outside of intensive care unit is not recommended in patients with COPD for severe acute respiratory failure (ARF). We assessed the factors associated with failure of NIMV in patients with ARF and severe acidosis admitted to the emergency department and followed on respiratory ward.Patients and methods: This is a retrospective observational cohort study conducted in a tertiary teaching hospital specialized in chest diseases and thoracic surgery between June 1, 2013 and May 31, 2014. COPD patients who were admitted to our emergency department due to ARF were included. Patients were grouped according to the severity of acidosis into two groups: group 1 (pH=7.20–7.25) and group 2 (pH=7.26–7.30).Results: Group 1 included 59 patients (mean age: 70±10 years, 30.5% female) and group 2 included 171 patients (mean age: 67±11 years, 28.7% female). On multivariable analysis, partial arterial oxygen pressure to the inspired fractionated oxygen (PaO2/FiO2) ratio

• Available online at www.eurasianjpulmonol.com A 58-year-old male patient was admitted to our clinic with complaints of productive cough and weight loss (6 kg) having begun with flu-like symptoms 15 days ago. His medical history included the use of acetylsalicylic acid after a cerebrovascular event from 9 years ago. The patient, who worked as a car mechanic, had 40 packs-year of smoking history. In the physical examination, his vital findings and oxygen saturation were within normal reference intervals, and no abnormality was observed, except limping in his right foot. Pulmonary function tests revealed mild obstructive dysfunction. The laboratory test value of C-reactive protein was 7.3, and the values of complete blood count and biochemistry were within normal intervals. The PPD test result was 10 mm.

Aim: Sarcoidosis is a multisystemic disease with typical or atypical pulmonary and extra-pulmonary symptoms or frequently without symptoms. Presence of typical clinical findings and symptoms contribute to rapid diagnosis, whereas asymptomatic progression leads to delays in the diagnosis. The aim of this study was to investigate the delay in diagnosis in between patients with pulmonary and/or extra-pulmonary involvement and related symptoms and those without symptoms. Material and Methods: Patients in the sarcoidosis clinics between 2010-2015, were retrospectively evaluated. The cases were grouped according to the presence or absence of symptoms (pulmonary and/or extra-pulmonary). The groups were compared with regard to the delay in diagnosis. Results: Among the 300 patients, 209 (69%) were female. The mean age was 43±11.68. The disease was stage I in 67.3%, stage II in 23.7%, stage III in 5.7% and stage 0 in 3.3% of the patients. No significant difference was observed between symptomatic and asymptomatic patients with regard to total duration until diagnosis (p=0.78). A statistically significant difference was observed between patients groups with regard to physician-related delayed diagnosis(p=0.026). The mean delay in physician-related diagnosis was observed to be longer in asymptomatic cases (21.44 days) compared to patients with pulmonary symptoms (13.66 days)(p=0.036). In asymptomatic cases, the mean duration of physician-related delayed diagnosis (21.44 days) was observed to be longer in comparison with patients with extra-pulmonary symptoms (12.79 days)(p=0.016). In patient-related delayed diagnosis, no difference was observed between groups with regard to the duration until diagnosis(p=0.78). Conclusion: Comparison of delayed diagnosis between patients with or without pulmonary and/or extra-pulmonary symptoms revealed a longer duration of delay in asymptomatic cases compared to symptomatic cases. The timing of diagnosis is very important in sarcoidosis in order to reduce morbidity and mortality; a suspicious approach to asymptomatic patients will increase the possibility of diagnosis and prevent delayed diagnosis.Keywords: Sarcoidosis; diagnosis; delay; extrapulmonary symptoms.

Cuneyt Salturk,1 Zuhal Karakurt,1 Huriye Berk Takir,1 Merih Balci,2 Feyza Kargin,1 Ozlem Yazıcıoglu Mocin,1 Gokay Gungor,1 Ipek Ozmen,1 Selahattin Oztas,1 Murat Yalcinsoy,3 Ruya Evin,1 Murat Ozturk,1 Nalan Adiguzel1 1Respiratory Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, 2Respiratory Intensive Care Unit, Kartal Kosuyolu Cardiovascular Disease and Surgery Teaching and Research Hospital, Istanbul, 3Respiratory Intensive Care Unit, Department of Chest Disease and Pulmonology, Inonu University Medical Faculty, Malatya, Turkey Introduction: The objective of this study was to compare the change in 6-minute walking distance (6MWD) in 1 year as an indicator of exercise capacity among patients undergoing home non-invasive mechanical ventilation (NIMV) due to chronic hypercapnic respiratory failure (CHRF) caused by different etiologies.Methods: This retrospective cohort study was conducted in a tertiary pulmonary disease hospital in patients who had completed 1-year follow-up under home NIMV because of CHRF with different etiologies (ie, chronic obstructive pulmonary disease [COPD], obesity hypoventilation syndrome [OHS], kyphoscoliosis [KS], and diffuse parenchymal lung disease [DPLD]), between January 2011 and January 2012. The results of arterial blood gas (ABG) analyses and spirometry, and 6MWD measurements with 12-month interval were recorded from the patient files, in addition to demographics, comorbidities, and body mass indices. The groups were compared in terms of 6MWD via analysis of variance (ANOVA) and multiple linear regression (MLR) analysis (independent variables: analysis age, sex, baseline 6MWD, baseline forced expiratory volume in 1 second, and baseline partial carbon dioxide pressure, in reference to COPD group).Results: A total of 105 patients with a mean age (± standard deviation) of 61±12 years of whom 37 had COPD, 34 had OHS, 20 had KS, and 14 had DPLD were included in statistical analysis. There were no significant differences between groups in the baseline and delta values of ABG and spirometry findings. Both univariate ANOVA and MLR showed that the OHS group had the lowest baseline 6MWD and the highest decrease in 1 year (linear regression coefficient -24.48; 95% CI -48.74 to -0.21, P=0.048); while the KS group had the best baseline values and the biggest improvement under home NIMV (linear regression coefficient 26.94; 95% CI -3.79 to 57.66, P=0.085).Conclusion: The 6MWD measurements revealed improvement in exercise capacity test in CHRF patients receiving home NIMV treatment on long-term depends on etiological diagnoses. Keywords: exercise capacity, non-invasive ventilation, 6-minute walking test, chronic respiratory failure

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:We evaluated mortality rate and factors related to short(30 days) and long term mortality of community-acquired pneumonia(CAP). Methods: Patients registered to “Pneumonia Data Base,TURCAP” that prepared by Turkish Thoracic Society Respiratory Infections Scientific Assembly between January 2009-2013 were included. Characteristics and clinical-laboratory findings, pneumonia indices were obtained. All cause mortality was recorded. Results: Of the 785 patients,68% were male, and the mean age was 66±16 years. The median follow-up was 38 months, With respect to all-cause mortality,71(9%) patients had died within 30 days, 29,6% within 1 year,349(44%) by study end. Median survival time was 51 months. Short-term mortality was higher in;older age, initial symptoms of chest pain, impaired consciousness, malignancy, serebrovascular diseases, high blood urea nitrogen level, low hematocrit level;parapneumonic effusion and abscess (compared to pneumonia) and extended infiltration,PSI and CURB-65 scores. In multivariate analysis;PSI scores and comorbid diseases were independent factors. For long term mortality, other than short term factors(except extended infiltration);male gender,presence of fever, chronic heart and renal failure, >2 hospitalisation in last 2 months, steroid/immunosuppresive therapy in last 3 months were found to related. Independent factors were PSI score,malignancy,frequent hospitalisation in the last 2 months and low hematocrit levels. Conclusion: Malignancy and PSI scores were the strongest predictors of short and long term mortality,whereas lower hematocrit levels and previous frequent hospitalisation were also strong long term mortality predictors.

WOS: 000339539100021, PubMed: 23621740, The aim of this letter was to present four more cases of tuberculosis (TB) in whom paradoxical response developed. These presented cases had not been mentioned in the manuscript namely "Paradoxical radiologic progression despite appropriate antituberculous therapy" published in Mikrobiyol Bul 2012; 46(2): 299-303. Paradoxical response was identified in these patients by exclusion of clinical deterioration during antituberculosis therapy such as secondary infections, inadequate anti-tuberculosis therapy as a result of drug resistance, poor compliance, and adverse reactions due to therapy. The first case had received treatment due to right paratracheal tuberculous lymphadenitis and lung TB, and who exhibited a progression in lymphadenopathy (LAP) in the 5th month of treatment. Upon the completion of treatment to one year, the lesions regressed however, right inguinal LAP developed after 20 months of initiation of therapy. Inguinal lymph node biopsy revealed tuberculous lymphadenitis and the adenopathy regressed without treatment. The second case was a patient with right paratracheal tuberculous lymphadenitis, whose lesions regressed at 3rd months of treatment. However, progression was detected in the lesions at 6th month of treatment and the treatment was prolonged to one year. The third case is the one to whom anti-TB treatment was initiated upon the diagnosis of right cervical tuberculous lymphadenitis. A new LAP developed at the left cervical site and the biopsy taken from the lesion revealed nothing diagnostic. The treatment was prolonged to one year and then ceased in this patient. The fourth case is the one to whom anti-TB treatment was initiated upon the diagnosis of lung TB and who developed right paratracheal LAP at the 4th month of treatment. The anti-TB treatment was prolonged to six months in this patient. These cases were presented to draw attention to paradoxical response which is originally known to occur primarily in HIV positive patients. However, it should be kept in mind that in TB endemic areas such as our country, paradoxical response can develop in HIV negative or non-immunocompromised TB patients.

Objectives. Autonomic dysfunction (AD) is frequent in sarcoidosis and considered a result of small fiber neuropathy. A non-dipper blood pressure (BP) pattern, which is also linked to AD, is associated with increased risk of cardiovascular and renal diseases. The aim of the present study was to evaluate the non-dipping BP pattern in normotensive patients with pulmonary sarcoidosis (PS). Methods. Sixty-three normotensive patients with PS (group 1) and 49 healthy subjects (group 2) were prospectively enrolled. Ambulatory BP monitoring was performed in all participants over a 24-h period. Results. The non-dipping BP pattern was significantly more frequent in patients with PS compared with the control group (80% vs 53%, respectively, p = 0.002). More advanced PS (grade 2) was an independent predictor of non-dipper BP pattern (odds ratio = 10.4, 95% confidence interval 1.1-95.4, p = 0.03). Masked hypertension and body mass index were also found to be other predictors of non-dipping BP pattern. Conclusions. The present study showed that non-dipping BP pattern is frequently observed in normotensive patients with PS. The probable mechanism underlying the non-dipping BP in PS is autonomic nervous system dysfunction. PS represents an independent risk factor for non-dipping BP and these patients have increased cardiovascular risk.

Acute respiratory failure (ARF) can necessitate mechanical ventilation and intensive care unit (ICU) admission in patients with COPD. We evaluated the reasons COPD patients are admitted to the ICU and assessed long-term outcomes in a retrospective cohort study in a respiratory level-III ICU of a teaching government hospital between November 2007 and April 2012. All COPD patients admitted to ICU for the first time were enrolled and followed for 12 months. Patient characteristics, body mass index (BMI), long-term oxygen therapy (LTOT), non-invasive ventilation (LT-NIV) at home, COPD co-morbidities, reasons for ICU admission, ICU data, length of stay, prescription of new LTOT and LT-NIV, and ICU mortality were recorded. Patient survival after ICU discharge was evaluated by Kaplan-Meier survival analysis. A total of 962 (710 male) patients were included. The mean age was 70 (SD 10). The major reasons for ICU admission were COPD exacerbation (66.7%) and pneumonia (19.7%). ICU and hospital mortality were 11.4%, 12.5% respectively, and 842 patients were followed-up. The new LT-NIV prescription rate was 15.8%. The 6-month 1, 2, 3, and 5-year mortality rates were 24.5%, 33.7%, 46.9%, 58.9% and 72.5%, respectively. Long-term survival was negatively affected by arrhythmia (p < 0.013) and pneumonia (p < 0.025). LT-NIV use (p < 0.016) with LTOT (p < 0.038) increase survival. Pulmonary infection can be a major reason for ICU admission and determining outcome after ICU discharge. Unlike arrhythmia and pneumonia, LT-NIV can improve long-term survival in eligible COPD patients.

Cardiac involvement in sarcoidosis has been associated with poor prognosis. We evaluated myocardial contractility quantitatively in a cohort of pulmonary sarcoidosis (PS) patients with and without cardiac involvement. We also studied markers of fibrosis (tenascin-C [Tn-C] and galectin-3 [Gl-3]) as diagnostic tools for PS and cardiac sarcoidosis (CS).Forty ambulatory patients with PS of grades 1-2 and 26 healthy subjects were prospectively enrolled. All patients with PS underwent cardiac magnetic resonance (CMR) to explore the presence of CS. The study population was divided into three groups: controls (n = 26), non-CS patients (n = 34), and CS patients (n = 6). Speckle-tracking strain echocardiography (STE) was performed on all patients, and Gl-3 and Tn-C values were measured in all patients and controls.PS patients had higher levels of Gl-3 and Tn-C than did controls, and the STE parameters of PS patients, including global longitudinal strain (GLS) and global circumferential strain (GCS), were lower than those of controls (p0.001 for all comparisons). GLS values were lower in CS patients than in the other groups (p = 0.05).PS patients demonstrate reduced cardiac contractility, independent of CMR-proven structural cardiac lesions, while patients with structural lesions have a more pronounced drop in strain parameters. Tn-C and Gl-3 are promising markers for the diagnosis of PS, but they are not specific for cardiac involvement.

Acute internal problems in the respiratory intensive care unit (ICU) and risk factors affecting mortality in the acute treatment applications were investigated. All patients in 20-bed intensive care unit for chest diseases enrolled to this prospective observational cohort study during 2008. Patients were classified as living in group 1 and deaths in group 2. Demographics and acute internal problems (arrhythmias, acute kidney-liver failure, dopamine, doputamin, perlinganit infusion) were recorded. Multiple regression analysis was performed for factors affecting mortality. There were 603 patients during the study period, group 1, n= 503 (83.4%), group 2, n= 100 (16.6%). Both groups were similar in terms of age and gender. Odds ratio (OR), 95% confidence interval (CI), p value for internal problems of acute risk factors for mortality were found as; septic shock OR: 22.52, CI 8.11-62.57, p< 0.000; need of perlinganit infusion OR: 9.28, CI: 1.61-53.37, p< 0.012; the presence of arrhythmia, OR: 7.81, CI: 3.46-17.65, p< 0.000; acute renal failure, OR: 2.88, CI: 1.24-6.65, p< 0.013 and the need for dopamine OR: 2.83, CI: 1.06-7.65, p< 0.037, respectively. Internal problems such as cardiac and renal dysfunction can devolop in respiratory ICU patients with pulmonary diseases and these problems constitude additional risk factors for mortalitiy. While the number of ICU is increasing with new health policies, each internal requirement and personnel equipped to treat the problem quickly must be considered.

Breast tuberculosis is a rare form of extrapulmonary tuberculosis. Two sisters diagnosed with mammary tuberculosis and having a family history concerning pulmonary tuberculosis in other siblings were presented in this study; and thereby breast tuberculosis was discussed by evaluating similar cases of breast tuberculosis published in our country. The ultrasonography examinations of the cases (26/F, 27/F) with history of mass, enlargement, pain and discharge complaints were reported as being consistent with fibrotic mastopathy and inflammation. Patients having the diagnosis of breast tuberculosis after the excisional biopsy were undergone HRZE treatment. After the antituberculosis regimen, a complete resolution of the lesion in the breast was observed in our first case which had concurrent pulmonary tuberculosis. The lesion of our second subject who had isolated mammary tuberculosis showed marked improvement. Our cases are still being followed up without any complaints. In conclusion, breast tuberculosis should become a part of differential diagnosis of breast diseases in populations with high incidence of tuberculosis as our country.

This study may provide insights into the positive and negative perceptions of physicians and citizens in Turkey regarding the Transformation in Health Project.We aimed to evaluate the views of physicians and citizens regarding the changing healthcare system using different questionnaires.We interviewed 1190 actively working physicians and 1997 citizens using face-to-face questionnaires to determine how the changing healthcare system has affected the behaviours of physicians and citizens. When asked whether the behaviours of patients and relatives had improved, 495 physicians (41.6%) answered yes and 580 (48.7%) answered no. When citizens were asked whether the behaviours of physicians had improved, 1399 (70.1%) answered yes and 362 (18.1%) answered no. According to the results of this study, there have been some changes in our healthcare system associated with the Transformation in Health Project. [Med-Science 2016; 5(2.000): 505-18]

Symptoms of asthma can be intensified and/or mixed with depression since depression can cause asthmatic symptoms like complaints even in normal people. In the present study, depression index and its influencing parameters were examined in asthmatic patients. A questionnaire including sociodemografic features was applied to 120 patients, accepted as asthmatic according to the Thoracic Society Guidelines, who were following up in our asthma and allergy outpatient clinic. There were 98 female and 22 male patients and the mean age was 38.19 +/- 10.99. Physical examination, PEF and spirometric measures were made in all patients. Also daytime and nighttime symptom score, Q score, Beck depression score were applied to patients. Beck Depression Index (BDI) was in range of 0 and 37 and the mean was 11.26 +/- 8.54 (mild). According to the cut-off values, BDI scores were obtained as absent, mild, moderate and severe, 59%, 27%, 9%, 7% respectively. The mean BDI score was higher in female patients (12.32 +/- 8.77) than in male patients (6.55 +/- 5.41) and in married patients (11.91 +/- 8.77) than in unmarried ones (7.56 +/- 6.00). According to the results of FEV(1) values, PEF changes, there were no significant difference obtained between groups (p0.05). The mean value of BDI was found to be significantly high in patients with moderate and high daytime and nighttime score and Q score (p0.05). In conclusion, we think that, while evaluating the severity of asthma, if the spirometric results are not correlated with the symptoms then psychological conditions of the patients should be taken into consideration.