This study aimed to evaluate the imaging findings of the chest flat panel detector computed tomography (FDCT) among coronavirus disease-2019 (COVID-19) positive patients during urgent/emergent interventional neuroradiologic procedures. Chest FDCT examinations were performed using a C-arm mounted FDCT within the interventional radiology (IR) suite if the reverse transcription polymerase chain reaction (RT-PCR) results were pending in patients with clinical findings suggestive of COVID-19. In those who already had positive RT-PCR results, FDCT was performed for acute evaluation only if an acute unexpected cardiopulmonary event occurred during the procedure. FDCT images were evaluated retrospectively by a thoracic radiologist based on Radiological Society of North America classification. Eleven patients (four males, four females, one boy and two girls) with positive RT-PCR test results were included. Six presented for acute ischemic stroke treatment, three children had retinoblastomas, and two patients had hemorrhagic strokes. One (9.1%) patient had typical CT findings of COVID19, whereas 4 (36.4%) patients had indeterminate findings. Six (54.5%) patients had no findings suggestive of COVID-19. The most common parenchymal finding was atelectasis (eight patients), followed by consolidation (five patients), pleural effusion (two patient) and pulmonary mass lesion (one patient). This study is the first in the literature utilizing C-arm FDCT for dedicated thoracic imaging at the IR suite. Ability to perform on-site chest CT without a need to transfer the patient to a regular CT scan may be helpful in both the management of acute pulmonary complications that occur during interventional procedures and pre-interventional assessment for pulmonary conditions like COVID-19 in the IR suite in emergent interventions. ÖZ Nörogirişimsel radyoloji işlemleri sırasında COVID-19 pozitif hastalarda elde edilen toraks flat-panel dedektör bilgisayarlı tomografi görüntüleme bulgularının değerlendirilmesi Giriş: Bu çalışmanın amacı, acil girişimsel nöroradyolojik işlemler sırasında koronavirüs hastalığı-2019 (COVID-19) pozitif hastalarda toraks flat-panel dedektör bilgisayarlı tomografi (FDBT) görüntüleme bulgularını değerlendirmektir Materyal ve Metod: COVID-19 düşündüren klinik bulguları olan hastalarda özellikle revers-transkriptaz polimeraz zincir reaksiyonu (RT-PCR) sonuçları mevcut değilse, girişimsel radyoloji odasında C-kollu bir FDBT kullanılarak toraks FDBT incelemeleri yapıldı. RT-PCR sonuçları pozitif olan hastalarda ise akut değerlendirme için FDBT yalnızca işlem sırasında akut beklenmedik bir kardiyopulmoner olay meydana gelmesi halinde gerçekleştirilmiştir. Flat-panel dedektör bilgisayarlı tomografi görüntüleri bir torasik radyolog tarafından Radiological Society of North America sınıflandırmasına göre retrospektif olarak değerlendirildi. Bulgular: RT-PCR test sonuçları pozitif olan 11 hasta (dört erkek, dört kadın, bir erkek çocuk ve iki kız çocuk) çalışmaya dahil edildi. Altı hasta akut iskemik inme endovasküler tedavisi için başvurdu, üç çocukta retinoblastom ve iki hastada hemorajik inme vardı. Bir (%9.1) hastada COVID-19’un tipik BT bulguları varken, 4 (%36.4) hastada belirsiz bulgular vardı. Altı (%54.5) hastada COVID-19'u düşündüren hiçbir bulgu yoktu. En sık görülen parankimal bulgu atelektazi (sekiz hasta) olup, bunu konsolidasyon (beş hasta), plevral efüzyon (iki hasta) ve pulmoner kitle lezyonu (bir hasta) takip etmektedir. Sonuç: Bu çalışma, literatürde girişimsel radyoloji odasında özel torasik görüntüleme için C-kollu FDBT kullanan ilk çalışmadır. Hastayı standart bir BT cihazına nakletmeye gerek kalmadan FDBT ile toraks BT tetkikinin elde edilebilmesi, hem girişimsel prosedürler sırasında ortaya çıkan akut pulmoner komplikasyonların yönetiminde hem de acil müdahalelerde girişimsel işlem odasında COVID-19 gibi pulmoner durumlar için girişim öncesi değerlendirmede yardımcı olabilir.
Telemedicine is a health service that provides diagnosis, treatment evaluation, preventive medicine by using information and communication technologies between distant locations and aims to improve the health of the individuals and society. Social restrictions were applied during the pandemic process caused by coronavirus disease-2019 due to the virus called severe acute respiratory syndrome coronavirus-2 which emerged in late 2019. Through remote communication and information technologies in the followup of asthma patients, there is a need for studies on the effectiveness of using telemedicine methods was seen. Our study included 328 patients aged 18 to 65 who were diagnosed with asthma and followed up by our team. The clinical evaluations and scale results of these patients were conducted at least three times by a single physician using telemedicine applications. In our study, the control group consisted of routine control results from asthma patients, who were reachable via hospital records before the pandemic, covering a one-year period. This file review includes data from October 1, 2019, to October 1, 2020. Three hundred and twenty-eight patients with asthma were included in the study. When the current data of the participants were compared with face-to-face data before follow-up with telemedicine, no statistically significant difference was found (p> 0.05). Although there was a slight decrease in asthma control test scores during the follow-up, it was not statistically significant (p> 0.05). A statistically significant difference was found in severe persistent asthma as a result of the comparison of the asthma control test results of the participants in follow-up according to disease severity (p<0.05). In this study, when the effect of the presence of comorbidity on asthma control test results in follow-up was examined, statistically significant results were obtained (p<0.05). It is predicted that telemedicine will have an important place in disease control since asthma is a disease that requires close monitoring. Disease follow-up with telemedicine was predicted to be a good alternative to traditional face-to-face follow-ups in selected patient groups. This study also supported the effectiveness of telemedicine. ÖZ COVID-19 pandemisi sürecinde astım takibinde teletıp hizmetlerinin etkinliği Giriş: Teletıp, günümüz teknolojilerini kullanarak uzak mekanlar arasında bilgi ve iletişimi sağlayan, tanı, tedavi değerlendirmesi ve önleyici hekimlik gibi sağlık hizmetlerini sunan bir yöntemdir. 2019’un sonlarında ortaya çıkan şiddetli akut solunum yolu sendromu koronavirüsü-2 (SARS-CoV-2) adlı virüse bağlı olarak koranavirüs hastalığı-2019 (COVID-19) pandemisi yaşanmıştır. Pandemi sürecinde, sosyal kısıtlamalar getirilmiş ve hastalarımızın hastane başvurularını azaltarak, COVID-19 maruziyeti riskinin yüksek olduğu hastanelere gitmelerinin azaltılması hedeflenmiştir. Uzaktan iletişim kanallarının kullanılmasıyla hasta-hekim işbirliği arttırılmış, hastaların hastaneye başvurmak zorunda kalmadan da etkin bir şekilde hastalık kontrolünün sağlanması amaçlanmıştır. Materyal ve Metod: Çalışmamıza, 18-65 yaş arasında astım tanısı kesinleşmiş ve tarafımızca takip edilen 328 hasta dahil edilmiştir. Bu hastaların klinik değerlendirmeleri ve ölçek sonuçları, teletıp uygulamalarıyla en az üç kez, tek bir hekim tarafından yapılmıştır. Çalışmamızda kontrol grubu olarak, pandemi öncesinde hastane kayıtları üzerinden ulaşılabilen, astım tanısı almış hastalarımızın bir yıl içindeki rutin kontrol sonuçları kullanılmıştır. Bu dosya taraması, 01.10.2019 ile 01.10.2020 tarihleri arasındaki verileri kapsamaktadır Bulgular: Katılımcıların teletıp ile takip öncesi yüz yüze alınan verileriyle karşılaştırıldığında, istatistiksel olarak belirgin bir fark saptanmamıştır (p> 0.05). Takiplerde, astım kontrol testi (AKT) puanlarında hafif bir azalma gözlemlense de, bu fark istatistiksel olarak anlamlı bulunmamıştır (p> 0.05). Katılımcıların takiplerindeki AKT sonuçları, hastalık şiddetine göre karşılaştırıldığında, ağır persistan astımlı hastalarda istatistiksel olarak anlamlı bir fark saptanmıştır (p< 0.05). Ayrıca, ek hastalık varlığının takiplerdeki AKT sonuçları üzerindeki etkisi incelendiğinde, bu fark istatistiksel olarak anlamlı bulunmuştur (p< 0.05). Sonuç: Astım takiplerinin teletıp yöntemleriyle yapılmasının ardından elde edilen verilerde istatistiksel olarak anlamlı bir farklılık gözlemlenmemesi, teletıp yöntemlerinin yüz yüze görüşmelere alternatif olabileceğini göstermektedir. Astım kontrol test puanlarının zamanla azalma eğiliminde olması, tamamen teletıp ile sürdürülecek takiplerin gerekliliği açısından önemlidir. Özellikle ağır persistan astımlı hastaların takibinde, yalnızca semptom takibi ve hasta beyanına dayalı anketlerin yeterli olmadığı anlaşılmaktadır. Komorbid hastalıkların astım kontrolünü olumsuz etkilediği görülmüştür. Bu nedenle, her görüşmede komorbiditelerin de değerlendirilmesi, tedavi düzenlemeleri ve gerekirse telekonsültasyonla multidisipliner bir yaklaşım önerilmektedir. Sonuç olarak, astım hastalığı sıkı takip gerektiren bir hastalık olduğundan, teletıpın hastalık kontrolünde önemli bir yer tutacağı öngörülmektedir. Teletıp, seçilmiş hasta grubunda geleneksel yüz yüze takiplere iyi bir alternatif olma potansiyeline sahiptir ve çalışmamız bu durumu desteklemektedir.
Pneumonia is a common symptom of coronavirus disease-2019 (COVID-19), and this study aimed to determine how analyzing initial thoracic computerized-tomography (CT) scans using semi-quantitative methods could be used to predict the outcomes for hospitalized patients. This study looked at previously collected data from adult patients who were hospitalized with a positive test for severe acute respiratory syndrome coronavirus-2 and had CT scans of their thorax at the time of presentation. The CT scans were evaluated for the extent of lung involvement using a semi-quantitative scoring system ranging from 0 to 72. The researchers then analyzed whether CT score could be used to predict outcomes. The study included 124 patients, 55 being females, with a mean age of 46.13 years and an average duration of hospitalization of 11.69 days. Twelve patients (9.6%) died within an average of 17.2 days. The non-surviving patients were significantly older, had more underlying health conditions, and higher CT scores than the surviving patients. After taking age and comorbidities into account, each increase in CT score was associated with a 1.048 increase in the risk of mortality. CT score had a good ability to predict mortality, with an area under the curve of 0.857 and a sensitivity of 75% and specificity of 85.7% at a cut-off point of 25.5. Radiologic severity index, which is calculated using a semi-quantitative CT scoring system, can be used to predict the mortality of COVID-19 patients at the time of their initial hospitalization. ÖZ Radyolojik ağırlık indeksi COVID-19 hastalarında mortalite riskini tahmin etmek için kullanılabilir Giriş: Pnömoni, koronavirüs hastalığı-2019’un (COVID-19) yaygın bir semptomudur. Bu çalışmanın amacı, yarı kantitatif yöntemler kullanılarak yapılan ilk toraks bilgisayarlı tomografi (BT) taramalarının, hastaneye yatan COVID-19 hastalarının sonuçlarını tahmin etmede nasıl bir rol oynayabileceğini belirlemektektir. Materyal ve Metod: Bu çalışma, şiddetli akut solunum sendromu koronavirüs-2 testi pozitif olan ve başvuru anında toraks BT taraması yapılan yetişkin hastaların verileriyle yapılmıştır. Bilgisayarlı tomografi taramaları, akciğer tutulumunun kapsamını değerlendirmek için 0 ile 72 arasında değişen yarı niceliksel bir puanlama sistemi kullanılarak incelenmiştir. Araştırmacılar, BT puanının, hastaların sonuçlarını tahmin etmek için kullanılıp kullanılamayacağını analiz etmiştir. Bulgular: Çalışmaya, ortalama yaşı 46.13 yıl ve ortalama hastanede kalış süresi 11.69 gün olan 55’i kadın, toplam 124 hasta dahil edildi. On iki hasta (%9.6) ortalama 17.2 gün içinde hayatını kaybetmiştir. Hayatta kalmayan hastalar, hayatta kalan hastalara göre önemli ölçüde daha yaşlı, daha fazla altta yatan hastalığı olan ve daha yüksek BT puanlarına sahipti. Yaş ve eşlik eden hastalıklar göz önünde bulundurulduğunda, BT puanındaki her bir artışın ölüm riskini 1.048 kat arttırdığı tespit edilmiştir. Bilgisayarlı tomografi skoru, 0.857 eğri altındaki alan ve 25.5 kesme noktasında %75 duyarlılık ve %85.7 özgüllük ile mortaliteyi tahmin etme konusunda yüksek bir doğruluğa sahipti. Sonuç: Yarı kantitatif BT skorlama sistemi kullanılarak hesaplanan radyolojik ağırlık indeksi, COVID-19 hastalarının hastaneye ilk başvurularındaki mortaliteyi tahmin etmek için etkili bir şekilde kullanılabilir.
Tuberculosis (TB) remains one of the leading infectious causes of mortality worldwide. The interaction between lipid metabolism and immune response plays a crucial role in TB pathogenesis. High-density lipoprotein (HDL) and other lipid parameters have increasingly attracted attention for their associations with inflammatory markers and survival. This study aimed to investigate the relationship between serum lipid levels, inflammatory markers, and survival in patients with TB. Data from TB and non-tuberculous mycobacteria (NTM) patients followed at Ege University Faculty of Medicine Hospital between January 2017 and January 2024 were retrospectively analyzed. Lipid profile [HDL, low-density lipoprotein (LDL), total cholesterol, triglycerides] and inflammatory parameters (C-reactive protein, erythrocyte sedimentation rate, ferritin, albumin, lymphocyte count) were recorded at diagnosis. Lipid levels were categorized into tertiles based on interquartile distribution. Groups were compared in terms of inflammatory response, clinical features, and survival. A total of 148 patients were included in the study, comprising 127 TB and 21 NTM cases. Median age was 59.0 years [Interquartile range (IQR): 45.0-71.0] in the TB group and 64.0 years (IQR: 38.0-72.0) in the NTM group. Among TB patients, 62.2% were male (n= 79). Mortality among TB patients was 17.3% (n= 22). Patients with low HDL levels had significantly higher CRP and ferritin levels and lower albumin levels (p< 0.05). LDL and total cholesterol levels were similarly associated with CRP, albumin, and lymphocyte count. A significant association was observed between HDL levels and sex, with low HDL levels being more frequent among males (p< 0.001). Increasing HDL and triglyceride levels were associated with a trend toward improved survival (p= 0.063; linear trend p= 0.041). No significant associations were found between lipid levels and cavity formation, pulmonary versus extrapulmonary involvement, or acid-fast bacilli smear results (p< 0.05). In multivariable analysis, older age and lower serum albumin levels were independently and significantly associated with mortality (p< 0.005). In patients with TB, serum lipid profiles show significant associations with systemic inflammatory markers. Low HDL levels were accompanied by a more pronounced inflammatory response. However, lipid biomarkers were not independently associated with mortality, suggesting that they may serve as complementary markers in the assessment of the inflammatory process rather than as direct prognostic indicators.
Health literacy encompasses patients' abilities to access healthcare, comprehend health information, and make decisions based on that knowledge. We aimed to examine the relationship between dyspnea levels, acute exacerbations, hospitalizations, disease severity and comorbidities of chronic obstructive pulmonary disease (COPD) patients according to their health literacy levels. A total of 106 COPD patients were prospectively enrolled in our study. Demographic data, history, pulmonary function tests, COPD severity, comorbidities, health status, quality of life and the factors determining the course of the disease in the last year were collected. We also measured patients' health literacy using the Turkish version of the European Health Literacy scale. Our findings revealed that elderly COPD patients (p= 0.04) with advanced disease stages (p< 0.001), higher Charlson Comorbidity Index and Saint George Hospital Respiratory Questionnaire scores (p< 0.001), and lowincome (p= 0.02) had lower levels of health literacy. Moreover, patients with lower health literacy experienced more frequent exacerbations (p= 0.01), more severe exacerbations (p< 0.001), and higher rates of hospitalization (p< 0.001). Logistic regression analysis unveiled that GOLD stages (OR: 11.62, 95% CI: 3.36-26.25), and recent severe exacerbations within the last year (OR: 14.24, 95% CI: 5.41-38.13) stood out as the most strongly associated risk factors for poor health literacy. COPD patients with low health literacy have a higher risk of severe disease. Recognizing the concept of health literacy and identifying risk factors associated with low health literacy are crucial steps in enhancing education, care, and social support for COPD patients. It emphasizes the need for tailored interventions and support for COPD patients, especially those with lower health literacy.
ABSTRACT Birt-Hogg-Dubé syndrome: A case series highlighting pulmonary manifestations, rare renal involvement and role of familial diagnosis Birt-Hogg-Dubé syndrome (BHDS) is a rare autosomal dominant disease characterized by cutaneous lesions and renal tumors, along with the presence of pulmonary cysts. In most cases, it is caused by a mutation in the folliculin (FLCN) gene. While normally evaluated as a triad, the isolated pulmonary presentation can still be expected, and repeated pneumothorax history should be evaluated for BHDS, especially if it is present in family members. In this case series, three patients with different clinical findings were reported. The first patient had a repeated pneumothorax history, along with angiomyolipoma, a relatively unexpected presentation of renal BHDS involvement. The incidental presence of pneumothorax in his mother had strengthened the diagnosis of BHDS, for which she also had renal cysts and additional cutaneous lesions. While these two patients were evaluated on an inpatient basis, the third patient, the son of the first patient, had been evaluated for BHDS presence, and pneumothorax, along with pulmonary cysts, was observed. All three patients were then later referred to a genetic center for confirmation of the FLCN mutation and tested positive for it. These case series illustrate the possibility of a different clinical presentation within the same family and at different ages, along with rare renal presentation and the possible asymptomatic indolent nature of the disease. Key words: Angiomyolipoma; autosomal dominant; Birt-Hogg-Dube syndrome; folliculin ÖZ Birt-Hogg-Dubé sendromu: Pulmoner semptomları, nadir böbrek tutulumunu ve ailesel geçisin rolünü vurgulayan bir vaka serisi Birt-Hogg-Dubé sendromu (BHDS), pulmoner kistlerin varlığı ile birlikte kutanöz lezyonlar ve böbrek tümörleri ile karakterize nadir otozomal dominant bir hastalıktır. Çoğu vakada, bu duruma folikülin (FLCN) genindeki bir mutasyon neden olur. Normalde bir triad olarak değerlendirilse de izole akciğer tutulumu görülebilir ve tekrarlayan pnömotoraks öyküsü, özellikle aile bireylerinde de benzeri klinik mevcutsa hasta BHDS açısından değerlendirilmelidir. Bu olgu serisinde farklı klinik bulgulara sahip üç hasta sunulmaktadır. İlk hastada, böbrek BHDS tutulumunun nispeten beklenmedik bir sunumu olan anjiyomiyolipomun yanı sıra tekrarlayan bir pnömotoraks öyküsü vardı. Annesinde tesadüfen pnömotoraks görülmesi, annede böbrek kistleri ve ek deri lezyonlarının da bulunması ile BHDS tanısını güçlendirmişti. Bu iki hastaya ek olarak, birinci hastanın oğlu olan üçüncü hastada BHDS için yapılan değerlendirilmede akciğer kistlerinin yanı sıra pnömotoraks da gözlendi. Daha sonra üç hasta da FLCN mutasyonunun doğrulanması için genetik merkeze yönlendirildi ve test sonuçları pozitif çıktı. Bu vaka serileri, aynı aile içinde ve farklı yaşlarda farklı klinik belirtilerin ortaya çıkma olasılığının yanı sıra, nadir görülen böbrek belirtilerini ve hastalığın olası asemptomatik yavaş seyrini göstermektedir. Anahtar kelimeler: Anjiyomiyolipom; otosomal dominant; Birt-Hogg-Dube sendromu; folikülin
The objective of this study was to investigate the impact of two different doses of alteplase, a thrombolytic therapy, specifically half-dose (50 mg) and full-dose (100 mg), on short-term (7 days) and long-term (1 year) mortality and morbidity in the treatment of pulmonary embolism (PE). A retrospective cohort study was conducted at the Department of Chest Diseases of Erciyes University Faculty of Medicine Hospital from January 1, 2010 to October 31, 2021. The study enrolled patients diagnosed with PE who underwent treatment with either 50 mg or 100 mg of alteplase. In total, 58 patients participated, with 41 receiving a 50 mg dose of alteplase and 17 receiving a 100 mg dose of alteplase treatment. Of the patients, 62.1% (n= 36) were female, with a mean age of 63 ± 14.5 years. Mean length of hospital stay was 9.2 ± 7.4 days. Mortality rate of the patients who had PE and received half-dose treatment was 36.5%, and mortality rate of the patients who received full-dose treatment was 17.6%. Mean time to mortality for non-survivors was 126.1 ± 355.4 days. Of the 18 patients who did not survive, 44.4% (n= 8) died within the first seven days, 50% (n= 9) between days eight and 365, and 5.6% (n= 1) after 365 days. In-hospital mortality occurred in 25.9% of the patients (n= 15), with no statistically significant relationship found between mortality status, time to death, in-hospital mortality, vasopressor use, ventilation support requirement, cardiopulmonary resuscitation, and the dose of alteplase treatment (p> 0.05). The comparison of survival rates by the administered alteplase treatment dose revealed no significant relationship (p= 0.187). Notably, there was no in-hospital mortality among the patients under the age of 65 who received a full dose of alteplase treatment, and this result was statistically significant (p= 0.010). Upon comprehensive evaluation of the data gathered from our study, short-term mortality was significant in favor of the group receiving full dose in patients under 65 years of age. However, it is worth noting that longterm mortality and bleeding rates were comparable in both groups.
Lung cancers associated with cystic airspaces (LCCAs) are a rare and relatively novel concept analyzed in various case reports and retrospective studies. In this review, it was our aim to investigate the morphologic, imaging, and clinicopathologic characteristics of this entity, as well as its natural course in light of the current literature. Literature search including the years 2000-2022 was conducted in PubMed. We analyzed the definition, morphological classification, pathogenesis and histopathology, imaging and clinical features, differential diagnosis and natural course and prognosis of LCCAs. LCCAs are increasingly being identified as missed or delayed diagnoses in lung cancer screening programs. Early recognition and intervention of this entity when cyst wall thickening or solid components appear can potentially improve outcomes. Nevertheless, the prognosis and survival of these patients are still poorly understood due to limited data, and further research is needed to better understand the behavior of these lesions and propose management guidelines. ÖZ Kistik hava boşluklarıyla ilişkili akciğer kanseri: Güncel bir derleme Kistik hava boşluklarıyla ilişkili akciğer kanserleri, çeşitli vaka raporlarında ve retrospektif çalışmalarda analiz edilen nadir ve nispeten yeni bir kavramdır. Bu derlemede, bu durumun morfolojik, görüntüleme ve klinikopatolojik özelliklerinin yanı sıra doğal seyrini güncel literatür ışığında araştırmayı amaçladık. PubMed'de 2000-2022 yıllarını kapsayan literatür taraması yapılmıştır. Kistik hava boşluklarıyla ilişkili akciğer kanserlerinin tanımını, morfolojik sınıflandırmasını, patogenezini ve histopatolojisini, görüntüleme ve klinik özelliklerini, ayırıcı tanısını, doğal seyrini ve prognozunu analiz ettik. Kistik hava boşluklarıyla ilişkili akciğer kanserleri akciğer kanseri tarama programlarında giderek daha fazla gözden kaçan veya gecikmiş tanı konulan durumlar olarak tanımlanmaktadır. Kist duvarı kalınlaşması veya katı bileşenler ortaya çıktığında bu varlığın erken tanınması ve müdahalesi potansiyel olarak sonuçları iyileştirebilir. Bununla birlikte, bu hastaların prognozu ve sağkalımı sınırlı veriler nedeniyle hala yeterince anlaşılmamıştır ve bu lezyonların davranışını daha iyi anlamak ve yönetim kılavuzları önermek için daha fazla araştırmaya ihtiyaç vardır.
Cat is a source of allergens that can cause allergic rhinitis (AR), conjunctivitis and/or asthma. This study aimed to compare demographic characteristics, frequency of asthma development, duration of asthma development, and characteristics of the patients with AR and with AR/asthma in adult patients who have adopted a cat in adulthood and have allergic symptoms after exposure to cats. Symptoms, physical examination findings, complete blood count, skin prick test (SPT) and/or specific immunoglobulin E (sp IgE) and pulmonary function test results of adult cat owners with allergic symptoms due to isolated cat allergy between January 2021 and February 2025 were retrospectively evaluated. Isolated cat allergy was detected by SPT and/or sp IgE measurement in 203 patients with allergic symptoms. Median age of the patients was 29 (18-69) years. A total of 71 patients (35%) experienced asthma and AR/ conjunctivitis symptoms upon exposure to cat allergens. Only patients with AR/conjunctivitis had been exposed to cat for median 24 (12-180) months. In patients with AR/conjunctivitis and asthma, median duration of cat exposure was 36 (12-300) months. Patients with AR/conjunctivitis developed allergic symptoms after a median of 13.5 (11-120) months following cat exposure. In patients with asthma, asthma symptoms developed after a median of 24 (11- 150) months. The severity of AR increased as the number of cats exposed to, cat sp IgE level, total IgE level and eosinophil count increased. Median eosinophil count in patients with a history of asthma attacks was 470 (110- 990) and was statistically significantly higher than in patients without a history of attacks (p= 0.014). Cats have become one of the major allergens in our country in recent years. The number of patients presenting to allergy clinics with allergic symptoms after having encountered cats is increasing day by day. These patients should be advised to stay away from cats, if possible, but patients who do not agree to stay away from cats should be closely monitored for the development of asthma.
The simplified pulmonary embolism severity index (sPESI) is extensively used for bedside risk assessment in acute pulmonary embolism (PE). Nevertheless, its effectiveness is constrained by the dichotomization of physiological variables and a primary validation focus on 30-day outcomes only. We developed a machine learning (ML) extension to enhance prognostic precision and extend risk stratification to 12 months, using only bedside data. In a retrospective cohort of 2547 adults with computed tomography pulmonary angiography confirmed PE, we developed logistic regression (LR), XGBoost, and multi-layer perceptron (MLP) models using a 10-item hybrid extension of sPESI that retained continuous age, heart rate, systolic blood pressure, and oxygen saturation alongside the six binary sPESI indicators. Models were trained and optimized using 12-month all-cause mortality as the target and were evaluated against 30, 180, and 365-day mortality on a held-out test set. Discrimination with the conventional sPESI attenuated over time (AUC= 0.727, 0.689, and 0.665 at 30 days, 180 days, and one year, respectively). The 10-item ML extension significantly enhanced prognostic performance compared with the conventional 6-item sPESI across all horizons (all p< 0.05). At the primary 12-month horizon, LR, XGBoost, and MLP achieved AUCs of 0.720, 0.726, and 0.712, respectively (vs. 0.665 for sPESI). At 30 days, the peak discrimination reached 0.796 (XGBoost). Moreover, ML increased 30-day specificity to 0.326-0.395 compared to 0.131 for sPESI, while maintaining high sensitivity (0.930-0.982). SHapley Additive exPlanations analyses demonstrated horizon-linked attribution shifts, with acute hemodynamic markers dominating early mortality predictions and age and malignancy emerging as the primary drivers at 12 months under horizonspecific evaluation. Preserving continuous physiological resolution within a familiar clinical framework enables ML to capture both acute instability and latent long-term vulnerability from the index presentation data alone. This bedsidefeasible pathway enhances long-horizon risk stratification and individualizes the management of patients.
The incidence and microbiological characteristics of coronavirus disease-2019 (COVID-19) associated ventilator-associated pneumonia (VAP) remain a clinical concern. The present study investigates the risk factors associated with VAP and compares the clinical and microbiological characteristics between the patients with and without COVID-19. This retrospective case-control study was conducted in a tertiary intensive care unit (ICU) between March 2020 and February 2023. Patients with COVID-19 were identified through positive SARS-CoV-2 polymerase chain reactionresults, while non-COVID-19 patients served as controls. Demographic characteristics, comorbidities, clinical parameters, and microbiological data were analyzed. Risk factors for VAP were determined using multivariate logistic regression analysis. The Kaplan-Meier method was used to estimate the cumulative probability of VAP. A total of 327 mechanically ventilated patients were enrolled, of whom 154 developed VAP. COVID-19 emerged as an independent predictor of VAP, conferring a 2.47-fold increased risk (p= 0.008). COVID-19 VAP patients had a higher prevalence of acute respiratory distress syndrome (ARDS) (p< 0.001), increased corticosteroid use (p= 0.004) and lower APACHE scores (p< 0.001). Both ICU and hospital case fatality rates were significantly increased in COVID-19 VAP patients. Klebsiella pneumoniae was the predominant pathogen in COVID-19 VAP patients, followed by Acinetobacter baumannii as the second most common pathogen. COVID-19 is a significant risk factor for VAP, with distinct clinical and microbiological characteristics compared to non-COVID-19 VAP. The greater occurrence of ARDS, corticosteroid use, and multidrug-resistant organisms in COVID-19-associated VAP highlights the urgent need for individualized antimicrobial strategies aimed at reducing infection-related morbidity and mortality.
ABSTRACT Re-evaluating perioperative and neoadjuvant immunotherapy in early-stage lung cancer: Current evidence and discussions Hairy vocal cords and hemoptysis Early-stage lung cancer remains a challenging disease with a significant risk of recurrence despite treatment. In recent years, there has been growing interest in the application of neoadjuvant and perioperative immunotherapies. The success of immune checkpoint inhibitors in advanced stages has prompted their investigation in earlier disease stages. This editorial examines clinical trials comparing the efficacy of perioperative and neoadjuvant immunotherapies, focusing on their impact on survival, pathological response rates, and toxicity profiles. Furthermore, ongoing debates and the importance of patient-centered decision-making are discussed. Key words: Early-stage lung cancer; neoadjuvant immunotherapy; perioperative treatment; immune checkpoint inhibitors; non-small cell lung cancer ÖZ Erken evre akciğer kanserinde perioperatif ve neoadjuvan immünoterapinin yeniden değerlendirilmesi: Mevcut kanıtlar ve tartışmalar Erken evre akciğer kanseri, tedaviye rağmen tekrarlama riski taşıyan karma- şık bir hastalıktır. Son yıllarda neoadjuvan ve perioperatif immünoterapilerin kullanımına yönelik ilgi artmıştır. İmmün kontrol noktası inhibitörlerinin ileri evre hastalıklardaki başarısı, bu tedavilerin daha erken evrelerde uygulanabilirliğini gündeme getirmiştir. Bu editoryal, perioperatif ve neoadjuvan immünoterapilerin etkinliğini karşılaştıran klinik çalışmaları; bu yaklaşımların sağkalım, patolojik yanıt oranları ve toksisite profilleri üzerindeki etkilerini incelemektedir. Ayrıca tedaviye ilişkin mevcut tartışmalar ile hasta merkezli karar verme sürecinin önemi ele alınmaktadır. Anahtar kelimeler: Erken evre akciğer kanseri; neoadjuvan immünoterapi; perioperatif tedavi; İmmün kontrol noktası inhibitörleri; küçük hücreli olmayan akciğer kanseri
Pulse oximeter is commonly used by chronic obstructive pulmonary disease (COPD) patients for long-term oxygen therapy (LTOT) to monitor oxygen levels. This study investigated the association between oximeter use, anxiety severity, symptom burden, and healthcare utilization in this population. This prospective observational study included 110 individuals with COPD who underwent LTOT. Data were collected on pulmonary function, modified Medical Research Council (mMRC) scores, and daily pulse oximeter use. Anxiety severity was assessed using the Beck Anxiety Inventory (BAI). Healthcare utilization in the previous year, including outpatient-treated and inpatient-treated exacerbations, intensive care unit admissions, and non-exacerbation-related hospital admissions, was analyzed. Linear regression analysis was performed to identify the independent predictors of nonexacerbation-related hospital admissions. Among the participants, 68 (61.8%) reported using a home pulse oximeter. There were no significant differences in BAI scores (p= 0.678), oxygen therapy duration (p= 0.530), or mMRC scores (p= 0.251) between the groups. However, non-users had significantly higher rates of non-exacerbation-related hospital admissions than users (p< 0.001). In multivariable analysis, not using pulse oximeter independently predicted more non-exacerbationrelated admissions (B= 1.63, 95% CI: 0.94-2.32, p< 0.001), whereas anxiety and physiological measures were not significant. Pulse oximeter use was not associated with anxiety or symptom severity among the patients with COPD receiving LTOT. However, non-use of pulse oximeter was independently associated with increased non-exacerbation-related hospital admissions. These findings suggest that pulse oximeter may support patient self-management and reduce unnecessary healthcare utilization, without contributing to anxiety.
In the post coronavirus disease-2019 era, as the pandemic's impact diminishes, the state of our intensive care units (ICUs) remains as crucial as the well-being of individuals. While numerous studies have explored the pandemic's effects on patients, our focus is to examine its impact on ICUs. A total of 72 patients who were admitted to the chest diseases ICU due to hypercapnic or hypoxic respiratory failure between October 2018-April 2020 and December 2022-December 2024 and who developed ventilator-associated pneumonia during their follow-up were included in our study. While Klebsiella pneumoniae and Acinetobacter baumannii cogrowth was observed in 4 of 30 patients (13.3%) pre-pandemic, it increased to 16 of 42 patients (38.1%) post-pandemic. Extensively drug-resistant (XDR) cases rose from 6 (20%) pre-pandemic to 34 (81%) post-pandemic (p< 0.001). A significant post-pandemic decline in carbapenem and beta-lactam susceptibility was noted (p< 0.001 for all). Although susceptibility to ceftazidime-avibactam, the most effective antibiotic for K. pneumoniae, decreased, the change was not statistically significant (p= 0.09). Multivariate regression analysis identified advanced age, coronary artery disease, low ejection fraction, and XDR resistance as factors increasing mortality (p= 0.03, 0.04, 0.04, 0.001, respectively). During the pandemic, our ICU, where patients were treated with broad-spectrum antibiotics for a long time, has cured many patients but could not prevent the development of multi-drug resistance and XDR Acinetobacter and Klebsiella. Failure to take the necessary precautions will cause significant effects of the silent pandemic.
Recent studies have shown that Gene Xpert MTB/RIF (Xpert) and Gene Xpert MTB/RIF ultra (Xpert-U) tests outperform traditional microbiological methods in detecting tuberculosis (TB) and identifying rifampicin resistance. This research aimed to examine their diagnostic accuracy and clinical relevance. This retrospective cohort study included patients aged 18 years and older with pulmonary or extrapulmonary samples analyzed by Xpert, Xpert-U, and conventional diagnostic methods between January 2016 and June 2020. The diagnostic performance of Xpert and Xpert-U was compared across four patient groups: A) Microscopy-culture-positive pulmonary TB, B) Microscopy-negative, culture-positive pulmonary TB, C) Pulmonary TB cases, and D) Extrapulmonary TB cases. A total of 1.366 samples (1.280 pulmonary, 86 extrapulmonary) were analyzed using Xpert and Xpert-U, including 1.042 males (76.3%) and 324 females (23.7%), with an average age of 54 years. For pulmonary TB, Xpert showed an overall sensitivity of 99.29% and specificity of 49.23%. Xpert-U demonstrated similar sensitivity at 98.56%, with an improved specificity of 89.66%. In extrapulmonary TB, Xpert-U achieved 100% sensitivity with a specificity of 70.59%. Xpert and Xpert-U tests offer high sensitivity for detecting Mycobacterium tuberculosis, greatly improving the timely diagnosis and management of TB, especially in cases with low bacterial loads or drug resistance.
Early diagnosis with newborn screening programs and prolonged life expectancy with new treatment strategies have made cardiovascular disease (CVD) one of the important issues in cystic fibrosis (CF). In the early stages of CVD, it is difficult to recognize and follow-up increased arterial stiffness with conventional methods. Different measurement methods are needed. Therefore, in this study, we aimed to use arterial stiffness measurements in the follow-up of children with CF. This is a follow-up study examining the changes in arterial stiffness in children with CF by repeating hemodynamic measurements [augmentation index (AIx) and pulse wave velocity (PWV)]. We repeated hemodynamic measurements and CF-related CVD risk factors (Atherosclerosis risk factors: Fasting blood sugar, lipid profiles, and HbA1c) and systemic inflammation markers [C-reactive protein (CRP) and immunoglobulin G and pulmonary function tests] in children undergoing routine annual complication evaluation and examined changes during follow-up. Hemodynamic measurements could be repeated in 37 of 52 patients due to inclusion criteria. Mean age of the study group was 12 ± 4.5 years and 48.6% were female. There was a statistically significant increase in high density lipoprotein, HbA1c, and CRP and a decrease in low density lipoprotein and FEV1 at the follow-up. Heart rate, central blood pressure, augmented pressure, and PWV were similar. AIx, peripheral systolic blood pressure (SBP), and mean arterial pressure were increased significantly (p< 0.05). The increase in AIx was greater than expected for age and greater in female patients and in those with low body mass index, moderate-severe disease, and high CRP levels. Also, the change in AIx was positively correlated with changes in peripheral SBP and CRP. This is the first study to evaluate the use of PWV and AIx in the follow-up of children with CF and showed that arterial stiffness measured with AIx increased at follow-up. The use of markers of arterial stiffness in CF from childhood onwards may enable early detection and monitoring of CVD risk and future prevention.
This study aimed to describe the high-resolution computed tomography (HRCT) features of culture-confirmed hospital-acquired pneumonia caused by Enterococcus, an uncommon infection rarely characterized radiologically. We retrospectively reviewed HRCT scans of adults with microbiologically proven enterococcal pneumonia at two tertiary centers between 2019 and 2024. Patients with other pathogens, pulmonary malignancy, pulmonary edema or hemorrhage, or poor-quality images were excluded. Two thoracic radiologists independently evaluated predefined CT features, with consensus reached in cases of discrepancy. Interobserver agreement was measured using Cohen's kappa (κ). Among 105 patients screened, 20 met the inclusion criteria (12 males, 8 females; mean age 62.9 years). The most common CT findings were groundglass opacities and pleural effusions (each in 70%), followed by consolidation (60%), bronchial wall thickening (60%), and intralobular reticulations (50%). Centrilobular nodules were identified in 45%, interlobular septal thickening in 40%, bronchiectasis in 30%, mediastinal lymphadenopathy in 20%, and empyema in 5%. Abnormalities were usually bilateral with lower-lobe predominance, and mixed features were often observed within the same lobe. On follow-up, 10 (50%) patients improved radiographically, whereas 10 (50%) showed disease progression and died despite treatment. Interobserver agreement was high, ranging from κ= 0.68 to κ= 1.00, indicating substantial to almost perfect concordance across features. Enterococcal pneumonia occurs mainly in older, comorbid, and critically ill patients and is associated with high mortality. HRCT commonly demonstrates ground-glass opacities, consolidation, and pleural effusions. Although pleural effusion appeared more frequent than in other bacterial pneumonias, the imaging findings overall were nonspecific, and microbiological confirmation remains essential for diagnosis.
Obstructive sleep apnea syndrome (OSAS) is characterized by recurrent apnea/hypopneas that cause a decrease in oxygen saturation during sleep. Male sex, greater age, obesity, large neck circumference (NC) and hypertension (HT) increase the tendency to OSAS. Diagnosis is important in terms of prognosis and selection of appropriate treatment. Polysomnography (PSG), which is the gold standard diagnostic method, is expensive, time-consuming and requires special equipment, therefore care must be taken in selecting patients for PSG. In this study, we aimed to investigate the effectiveness of Berlin, STOP-BANG and Epworth Sleepiness Scale (ESS) in predicting the diagnosis of OSAS by comparing with PSG. In our study, 136 patients who underwent PSG at the Sleeping Unit in Department of Chest Diseases, Ankara University Faculty of Medicine, and sleep questionnaires were applied to patients at their admissions. Apnea-hypopnea index values of the patients were compared with the questionnaires. Of the patients, 82 (60.3%) were males, and mean age of the patients who participated in the study was 50.9 years. Mean body-mass index (BMI) of all patients was 31.9 kg/m2. It was observed that 56 (41.2%) of the patients had a diagnosis of HT. Mean NC was 41.9 cm. The most effective questionnaire for predicting the diagnosis of OSAS was determined as STOPBANG Questionnaire (%98), was followed by the Berlin Questionnaire (%88). ESS (%63) was found to be the least effective questionnaire. OSAS is a common syndrome with high morbidity in the population; it is important to suspect and diagnose the disease. It was concluded that the STOP-BANG Questionnaire, which includes parameters such as symptoms, age, BMI, NC and HT, is highly effective in patient selection for PSG and may help clinicians to predict the diagnosis of OSAS.
This study aimed to examine and compare the characteristics of post tuberculosis (PTB) and non-tuberculosis (NTB) bronchiectasis patients of Central India retrospectively. Bronchiectasis patients who underwent bronchoscopy were diagnosed by high resolution computed tomography (CT) scans, and PTB versus NTB were assessed clinically, radiologically, microbiologically and on the basis of spirometry. Mean age of the total 90 patients was 52.54 ± 16.33 years. Maximum patients were in the age group above 60 years old. Overall major symptoms were cough (n= 78, 86.66%), dyspnea (n= 65, 72.22%) and fever (n= 44, 48.88%). The proportion of the male population was more in the PTB group (n= 26, 59.09% vs. n= 18, 40.91%, p= 0.387). Bilateral and unilateral bronchiectasis were predominantly present in NTB (n= 34, 73.91%) and PTB (n= 18; 40.91%) respectively. The most common radiological variant of bronchiectasis found in all patients was a cystic type (n= 52, 89.66%); however, the presence of varicose was significantly higher in PTB than NTB group (n= 8, 18.18% vs. n= 2, 4.35%, p= 0.037). Body mass index in NTB (21.79 ± 4.93 kg/m2) was significantly higher than that of PTB group (18.89 ± 3.60 kg/m2) with p-value of 0.004. The proportion of patients with Pseudomonas aeruginosa infection in bronchoalveolar lavage (BAL) of PTB group (n= 12, 27.27%) was more than the NTB group (n= 10, 21.74%). 22.73% (n= 10) patients had a reactivation of TB in the PTB and 8.70% (n= 04) in NTB group. On spirometry, the proportion of patients with obstructive findings was significantly higher in NTB than PTB group (30.43% vs. 6.82%, p= 0.004). The most prominent underlying cause of bronchiectasis was PTB, with unilateral, varicose subtype being significantly more prevalent on thorax CT. Re-infection was the primary cause of exacerbations in bronchiectasis patients, with Pseudomonas being the most common infectious agent. Our study also contributes to the data pool on bronchiectasis patients in India.
Previous studies have reported that diaphragm atrophy and dysfunction might occur during mechanical ventilation (MV), but the frequency, effect on mortality, underlying causes and functional outcomes of diaphragm and lung parenchymal changes during routine MV have not yet been fully understood. The lung parenchyma and diaphragm of 50 patients were investigated using ultrasound (USG) on day 1, 5, and 10 of MV therapy. Mean age of the patients was 64.90 ± 15.96 years. Mean MV duration was 90.18 ± 21.09 days. Mean thickening fraction (TFdi) on day 1, 5, and 10 was 40.77 ± 15.42, 39.85 ± 16.85, and 43.57 ± 19.10, respectively. Mean diaphragm amplitude on day 1, 5, and 10 was 1.70 ± 0.74, 1.76 ± 0.74, and 1.70 ± 0.71, respectively. Mean diaphragmatic thickness at the end of expiration (Tde) on day 1, 5, and 10 was 0.18 ± 0.08, 0.17 ± 0.06, and 0.16 ± 0.05, respectively. There was no significant change between measurement days by TFdi, diaphragmatic amplitude (DA), and Tde values. On admission, TFdi was less than 20% in 8% of the patients, DA was less than 1 cm in 12%, and Tfde was less than 0.2 cm in 52%. There was no significant difference by the TFdi, DA and lung ultrasonography (LUS) scores of the non-surviving and surviving patients. An analysis of imaging results and LUS scores indicated that LUS values were measured higher in patients with infiltration on chest radiography. In addition, LUS scores significantly decreased from day 1 to day 5 and day 10, and from day 5 to day 10. Diaphragm dysfunction may occur as a result of MV therapy or associated with an inflammatory process, including sepsis. Assessment of diaphragmatic function by USG on admission to the intensive care unit may help to better recognize and manage diaphragmatic dysfunction. LUS provides information about the lung parenchyma as important as chest X-ray and facilitates bedside patient evaluation.