Can the ADO Index Be Used as a Predictor of Mortality from COVID-19 in Patients with COPD?

Background: Several studies have shown that the risk of mortality due to COVID-19 is high in patients with COPD. However, evidence on factors predicting mortality is limited. Research Question: Are there any useful markers to predict mortality in COVID-19 patients with COPD?. Study Design and Methods: A total of 689 patients were included in this study from the COPET study, a national multicenter observational study investigating COPD phenotypes consisting of patients who were followed up with a spirometry-confirmed COPD diagnosis. Patients were also retrospectively examined in terms of COVID-19 and their outcomes. Results: Among the study patients, 105 were diagnosed with PCR-positive COVID-19, and 19 of them died. Body mass index (p= 0.01) and ADO (age, dyspnoea, airflow obstruction) index (p= 0.01) were higher, whereas predicted FEV1 (p< 0.001) and eosinophil count (p= 0.003) were lower in patients who died of COVID-19. Each 0.755 unit increase in the ADO index increased the risk of death by 2.12 times, and each 0.007 unit increase in the eosinophil count decreased the risk of death by 1.007 times. The optimum cut-off ADO score of 3.5 was diagnostic with 94% sensitivity and 40% specificity in predicting mortality. Interpretation: Our study suggested that the ADO index recorded in the stable period in patients with COPD makes a modest contribution to the prediction of mortality due to COVID-19. Further studies are needed to validate the use of the ADO index in estimating mortality in both COVID-19 and other viral respiratory infections in patients with COPD.

The impact of deep venous thrombosis on 90 day mortality in chronic obstructive pulmonary disease patients presenting with pulmonary embolism.

BACKGROUND: There are a limited number of studies investigating the effect of deep venous thrombosis (DVT) in patients presenting with both pulmonary embolism and chronic obstructive pulmonary disease. The aim of this study is to investigate the prevalence and prognostic significance of DVT in patients with PE-COPD. METHODS: COPD patients admitted with a diagnosis of PE to our tertiary hospital between January 2016 and January 2021 were retrospectively evaluated with an electronic hospital database. Univariate and multivariate Cox regression analyses were performed to reveal independent prognostic factors. RESULTS: Two hundred thirty-three patients (mean age 65.1 ± 12.2, 158 men (67.5 %)) were included. DVT was present at the time of diagnosis in 45 (19.31 %) of the patients. Patients with DVT tend to have more comorbidities, central pulmonary embolism, higher CRP and d-dimer levels, and SPESI score (p<0.05). After performing multivariate analyses, the presence of DVT (HR=3.48, CI: 1.02- 11.88, p = 0.046), ischemic heart disease (HR=3.82, CI: 1.38- 10.80, p = 0.01), and malignancy (HR=4.85, CI: 1.53- 15.41, p = 0.007) were found to be independent factors in predicting 90-day mortality. CONCLUSIONS: In PE-COPD patients, co-existing DVT may predict a worse outcome.

Late Diagnosis of Foreign Body Aspiration in Adults: Case Series and Review of the Literature.

BACKGROUND: Tracheobronchial foreign body (FB) aspiration (FBA) is a life-threatening emergency mostly observed in childhood and advanced age. With early diagnosis, the FB can be removed using bronchoscopic methods without causing irreversible damage. METHODS: This was a single-center, retrospective observational study. Subjects diagnosed with FBA via either bronchoscopic methods and/or radiological findings, having no medical history of aspirated FB, and who were detected to have aspirated FB for longer than 30 days were included in the study. Medical records and radiological and bronchoscopic findings of the subjects were investigated from the hospital information database system. RESULTS: Of the 255 patients with FBA, 17.6% (N = 45) were diagnosed late. The mean age was 53 y; 28% were female, and 60% of the subjects had a history of ever smoking. The estimated residence time of the FB in the bronchial system was 22.8 months. The most common complaints were cough and shortness of breath. Forty-two percent of the aspirated FBs were organic material. FB artifact could be observed in 6.7% of posteroanterior chest radiographs and 65% of thorax computed tomography (CT) scans. Rigid bronchoscopy had been primarily preferred as therapeutic interventional procedure. It was also found that the artifact most frequently resided in the right bronchial system and was most commonly found in the right lower lobe, while granulation tissue was formed in 85% of the subjects. CONCLUSIONS: The findings of the present study demonstrate that subjects tended to forget the FBA, leading to insidious respiratory system symptoms, with recurrent infections. In cases with an endobronchial mass lesion image on thorax CT, clinicians should consider the possibility of FBA. Delayed diagnosis of both organic and inorganic FB may cause granulation tissue.

An Alpha-1 Antitrypsin Deficiency Screening Study in Patients with Chronic Obstructive Pulmonary Disease, Bronchiectasis, or Asthma in Turkey.

Purpose: Alpha-1 antitrypsin deficiency (AATD) is a rare hereditary condition characterized by decreased serum alpha-1 antitrypsin (AAT) levels. We aim to identify AATD in patients with chronic obstructive pulmonary disease (COPD), bronchiectasis, or asthma and to report the frequency of AAT variants in Turkey. Patients and Methods: This non-interventional, multicenter, prospective study was conducted between October 2021 and June 2022. Adult patients with COPD, bronchiectasis, asthma, liver symptoms, or family members with AATD were included. Demographic and clinical characteristics, pulmonary diagnosis, respiratory symptoms, and AAT serum levels were assessed. Whole blood samples were collected as dried blood spots, and the most common AATD mutations were simultaneously tested by allele-specific genotyping. Results: A total of 1088 patients, mainly diagnosed with COPD (92.7%) and shortness of breath (78.7%), were assessed. Fifty-one (5%) were found to have AATD mutations. Fifteen (29.4%) patients had Pi*S or Pi*Z mutations, whereas 36 (70.6%) patients carried rare alleles Pi*M malton (n=18, 35.3% of mutations), Pi*I (n=8, 16%), Pi*P lowell (n=7, 14%), Pi*M heerlen (n=2, 4%), and Pi*S iiyama (n=1, 2%). The most common heterozygous combinations were Pi*M/Z (n=12, 24%), and Pi*M/M malton (n=11, 22%). Ten patients with severe AATD due to two deficiency alleles were identified, two with the Pi*Z/Z genotype, four with the genotype Pi*M malton/M malton, three with Pi*Z/M malton, and one with Pi*Z/M heerlen. Conclusion: Our results identified AATD mutations as a genetic-based contributor to lung disease in patients with COPD or bronchiectasis and assessed their frequency in a population of Turkish patients.

Analysis of post-COVID symptoms and predisposing factors for chronic post-COVID syndrome.

Introduction: While there is sufficient information about acute COVID-19, which can cause a multisystemic and fatal disease, post-COVID syndrome and risk factors for this condition remain poorly known. We aimed to identify postCOVID symptoms and risk factors for chronic post-COVID syndrome through this study. Materials and Methods: This prospective cross-sectional study was conducted on 254 out of 384 COVID-19 patients admitted to our COVID-19 polyclinic between February and April 2021. The patients were questioned with a list of 37 symptoms at the fifth and twelfth weeks after disease onset via phone review, and their acute post-COVID (APC) and chronic post-COVID (CPC) symptoms were recorded. Data on risk factors were collected from the hospital's medical records system. Associations between symptom count in the CPC phase and age, sex, hospitalization, RT-PCR result, specific radiological findings, comorbidities, and long-term medications were evaluated. Result: Two hundred twenty-one patients had APC symptoms, and 138 patients had CPC symptoms. While the most common symptom was fatigue at week five, it was hair loss at week 12. Symptoms were observed significantly less in the CPC phase than in the APC phase (Z= -12.301, p= 0.00). Female sex and the presence of specific radiological findings were significantly associated with the occurrence of CPC symptoms (p= 0.03, p= 0.00, respectively). Long-term use of angiotensin-2 receptor blockers (ARBs) was correlated with a low symptom count in the CPC phase (p= 0.00). Conclusions: Female sex and the presence of specific radiological findings were risk factors for developing CPC. Long-term use of ARBs was associated with a low chronic post-COVID symptom burden. A substantial cluster of multisystemic symptoms was observed in both phases, and this condition highlights the requirement for customized outpatient management that includes long-term follow-up and treatment of COVID-19 patients. Identifying the high-risk patients that will develop persistent symptoms can guide this management.

Triglyceride-glucose index as a predictor of obstructive sleep apnoea severity in the absence of traditional risk factors.

OBJECTIVE: We evaluated the association between the triglyceride-glucose (TG) index, a marker of insulin resistance, and obstructive sleep apnoea (OSA) severity in patients without diabetes mellitus, obesity, and metabolic syndrome. METHODS: This retrospective cohort study included 1,527 patients. We used univariate and multivariate analyses to identify the independent predictors associated with OSA. RESULTS: Most patients were males (81.5%) with a mean age of 43.9 ± 11.1 (15-90) years. Based on the apnoea-hypopnea index (AHI), 353 (23.1%) patients were included in the control group, whereas 32.4%, 23.5%, and 21% had mild, moderate, and severe OSA, respectively. The TG index values demonstrated significant associations with OSA patients compared with the control group (p = 0.001). In addition, the mean values of the oxygen desaturation index (ODI), AHI, minimum oxygen saturation, and total sleep time percentage with saturation below 90% demonstrated statistically significant differences among the TG index groups (p: 0.001; p:0.001; p:0.001; p:0.003). The optimal TG index cutoff value to predict OSA was 8.615 (AUC = 0.638, 95% CI = 0.606-0.671, p = 0.001). In multivariate logistic regression analysis, after adjusting for age, sex, and body mass index, the TG index was independently associated with OSA patients. CONCLUSION: The TG index is independently associated with increased risk for OSA. This indicates that this index, a marker for disease severity, can be used to identify severe OSA patients on waiting lists for PSG.

OBJETIVO: Avaliamos a associação entre o índice triglicerídeos-glicose (TG), um marcador de resistência à insulina, e a gravidade da apneia obstrutiva do sono (AOS) em pacientes sem diabetes mellitus, obesidade e síndrome metabólica. MéTODOS: Este estudo de coorte retrospectivo incluiu 1.527 pacientes. Utilizamos análises univariadas e multivariadas para identificar os preditores independentes associados à AOS. RESULTADOS: A maioria dos pacientes era do sexo masculino (81,5%) com idade média de 43,9 ± 11,1 anos (15-90). Com base no índice apneia-hipopneia (IAH), 353 (23,1%) pacientes foram incluídos no grupo de controle, enquanto 32,4%, 23,5% e 21% tinham AOS leve, moderada e grave, respectivamente. Os valores do índice TG demonstraram associações significativas com pacientes com AOS em comparação com o grupo de controle (p = 0,001). Além disso, os valores médios do índice de dessaturação de oxigênio (IDO), IAH, saturação mínima de oxigênio e porcentagem de tempo total de sono com saturação abaixo de 90% demonstraram diferenças estatisticamente significativas entre os grupos de índice TG (p = 0,001; p = 0,001; p = 0,001; p = 0,003). O valor de corte ideal do índice TG para prever a AOS foi de 8,615 (AUC=0,638, IC de 95% = 0,606­0,671, p = 0,001). Na análise de regressão logística multivariada, após o ajuste para idade, sexo e índice de massa corporal, o índice TG foi independentemente associado a pacientes com AOS. CONCLUSãO: O índice TG está independentemente associado a um maior risco de AOS. Isso indica que este índice, um marcador de gravidade da doença, pode ser usado para identificar pacientes com AOS grave em listas de espera para polissonografia.

Understanding the Impact of Pulmonary Rehabilitation on Airway Resistance in Patients with Severe COPD: A Single-Center Retrospective Study.

Purpose: We investigated the effect of pulmonary rehabilitation (PR) on airway resistance in chronic obstructive pulmonary disease (COPD) patients with severe airway obstruction and hyperinflation. Patients and Methods: This retrospective cohort study was conducted with data from severe COPD cases with those who underwent an 8-week PR program. Main inclusion criteria were having severe airflow obstruction (defined as a forced expiratory volume in one second (FEV1) <50%) and plethysmographic evaluation findings being compatible with hyperinflation supporting the diagnosis of emphysema (presence of hyperinflation defined as functional residual capacity ratio of residual volume to total lung capacity (RV/TLC) >120%). Primary outcomes were airway resistance (Raw) and airway conductance (Gaw) which were measured by body plethysmography, and other measurements were performed, including 6-minute walk test (6-MWT), modified Medical Research Council dyspnea scale (mMRC) and COPD assessment test (CAT). Results: Twenty-six severe and very severe COPD patients (FEV1, 35.0 ± 13.1%; RV/TLC, 163.5 ± 29.4) were included in the analyses, mean age 62.6 ± 5.8 years and 88.5% males. Following rehabilitation, significant improvements in total specific airway resistance percentage (sRawtot%, p = 0.040) and total specific airway conductance percentage (sGawtot%; p = 0.010) were observed. The post-rehabilitation mMRC scores and CAT values were significantly decreased compared to baseline results (p < 0.001 and p < 0.001, respectively). Although there were significant improvements in 6-MWT value (p < 0.001), exercise desaturation (ΔSaO2, p = 0.026), the changes in measured lung capacity and volume values were not significant. Conclusion: We concluded that PR may have a positive effect on airway resistance and airway conductance in COPD patients with severe airflow obstruction.

Prognostic predictors for mortality of patients with COVID-19 in an intensive care unit.

INTRODUCTION: Fatality due to COVID-19 continues to be a challenge. Timely identification of critical COVID-19 patients is crucial for their close clinical follow-up and treatment. We aimed to identify the mortality predictors of critical COVID-19 patients. METHODOLOGY: We analyzed medical records of 232 out of 300 patients with COVID-19 hospitalized in the intensive care unit (ICU) whose medical records were available in the hospital database. Non-survivors and survivors were compared for parameters. Medical records of demographics, comorbidities, radiological signs, respiratory support, and laboratory tests on the first day of ICU admission were included. The durations of ICU stay and hospitalization were also evaluated. RESULTS: The patients with Acute Physiology and Chronic Health Evaluation II (APACHE-II) score above 28.5 and the patients with blood urea nitrogen (BUN) above 45.5 mg/dL were significantly more mortal (95% CI: 0.701, p = 0.0001; 95% CI: 0.599, p = 0.022; respectively). Partial oxygen pressure/fraction of inspired oxygen (P/F) ratio below 110.5 mmHg was a predictor for mortality (95% CI: 0.397, p = 0.018). Older age, smoking, crazy paving pattern on computed tomography (CT), and short duration of hospitalization were also predictors of mortality. The patients requiring invasive mechanical ventilation were significantly more mortal whereas the patients requiring high flow oxygen and non-invasive ventilation were significantly more likely to survive. CONCLUSIONS: We recommend evaluating APACHE-II score, BUN value, P/F ratio, age, smoking status, radiological signs on CT, length of hospitalization and modality of respiratory support upon ICU admission to identify critical patients with poor prognoses.

Interferon-Inducible Protein-10 as a Marker to Detect Latent Tuberculosis Infection in Patients with Inflammatory Rheumatic Diseases.

It is important to identify cases of latent tuberculosis infection (LTBI) who are at risk for tuberculosis (TB) reactivation. We aimed to evaluate the performance of interferon (IFN)-gamma-inducible protein 10 (IP-10) as a marker to detect LTBI in patients with inflammatory rheumatic diseases (IRD). This study comprised 76 consecutive subjects with IRD. Patients with a history of TB or having active TB were excluded. In all patients, IP-10 level was measured and tuberculin skin test (TST) and QuantiFERON-TB Gold In-Tube test (QFT-GIT) were performed. Seventy patients with complete test results were analyzed. Twenty-one (30%) QFT-GIT-positive patients were defined as having LTBI. IP-10 yielded 2197 pg/mL cut-off point. At this cut-off point, IP-10 showed 89% specificity with a sensitivity of 91% (AUC: 0.950, 95% CI 0.906-0.994). TST, QFT-GIT, and IP-10 were positive in 77.1%, 30%, and 44.3% of the patients, respectively. Concordance among the results of TST, QFT-GIT, and IP-10 tests was evaluated. Agreement was poor between IP-10 and TST (58.6%, κ = 0.19), whereas it was good between QFT-GIT and IP-10 (84.3%, κ = 0.65). The results of the present study demonstrated that sensitivity and specificity of released IP-10 were as high as those of QFT-GIT in indicating LTBI in IRD patient group.

Coexistence of Multiple Pulmonary Sclerosing Pneumocytoma and Scleroderma-Rheumatoid Arthritis Overlap Syndrome: A Case Report.

Pulmonary sclerosing pneumocytoma is a rare, low-grade pulmonary tumor observed as unilateral or bilateral multiple nodules at a rate of 4%-5%. Among the autoimmune connective tissue disorders, those most commonly associated with lung malignancies are sclero- derma and rheumatoid arthritis. In this study, we report a rare case of a 55-year-old middle-aged Asian woman with slow-growing bilat- eral multiple pulmonary sclerosing pneumocytoma and scleroderma-rheumatoid arthritis overlap syndrome. The autoimmune disorders and pulmonary fibrosis of this case might have led to the development of PSP.

Lifestyle Changes and Exacerbation Frequency of COPD in Times of the Pandemic.

OBJECTIVE: The objective of this study is to analyze chronic obstructive pulmonary disease exacerbation rates and the effect of patients' behavioral changes on the exacerbations during the pandemic. MATERIAL AND METHODS: This study was conducted in a reference hospital for chest diseases and patients who were hospitalized with an exacerbation of chronic obstructive pulmonary disease between March 11, 2019, and March 11, 2020, were designated. Patients' chronic obstructive pulmonary disease exacerbations requiring emergency department visits and/or hospitalization were com- pared between the pre-pandemic and pandemic periods. Each patient was surveyed with 25 questions using telemedicine. RESULTS: Of all the 256 patients, 203 (79%) were male and the mean age was 66 ± 10 years. Compared to the previous year, emer- gency department visits and hospitalizations in our hospital were significantly lower and less frequent (P < .0001, for both). Smoking habits decreased in 9% of patients, and 60% had hardly spent time outdoors. Only 3 patients reported to spend time indoors. The household mask-use rate while contacting the patient was 50%. As a chronic obstructive pulmonary disease patient, 33% expressed themselves as "feeling better." Overall, 92(36%) patients were recorded not to have any exacerbation, and 34 (13%) to have no attacks of worsening were managed at home. Novel exacerbation risk was found to independently correlate with younger age (odds ratio: 0.944, CI: 0.904-0.986, P = .010) and having more frequent episodes of exacerbation in the pre-pandemic period (odds ratio: 1.2, CI: 1.025-1.405, P = .023). CONCLUSION: Chronic obstructive pulmonary disease patients specifically benefited from confinements, restrictions, and lifestyle changes. Further studies are needed to better identify the most critical factors leading to these positive outcomes. A permanent patient management guideline for chronic obstructive pulmonary disease patients could be formulated where the weight of lifestyle factors is elevated.

The Role of Serum Galectin-3 Levels in Patients with Sarcoidosis.

INTRODUCTION: Galectin-3 is a multifunctional protein, the levels of which increase in the presence of diseases that progress with pulmonary fibrosis. This study investigated the role of galectin-3 levels in the staging and assessing of the severity of sarcoidosis. METHODS AND SUBJECTS: Seventy-three subjects were studied; 25 were healthy individuals and 48 patients had pathologically confirmed diagnosis of sarcoidosis in which other potential causes had been ruled out. Galectin-3 levels were measured and compared in terms of such parameters as hemogram, biochemistry, age, body mass index, and smoking status. RESULTS: The mean galectin-3 levels of the sarcoidosis patients (14.87 ± 5.57) were significantly higher than those in the healthy subjects (11.81 ± 2.67), and the mean galectin-3 levels differed significantly among different stages of the disease (p < 0.05). The serum galectin-3 level in patients with stage 2, 3, and 4 sarcoidosis was found to be higher than in patients with stage 0 and 1 sarcoidosis and the control group. In addition, serum galectin-3 levels in the sarcoidosis patients had significant positive correlations with blood urea nitrogen, alkaline phosphatase, white blood cells, red blood cell, hemoglobin, and neutrophil levels (34.9% [p < 0.05]; 40.1% [p < 0.05]; 41.2% [p < 0.01]; 43.3% [p < 0.01]; 34.7% [p < 0.05]; and 40.6% [p < 0.01], respectively) and a significant negative correlation with the platelet distribution width levels (p < 0.05). CONCLUSION: Serum galectin-3 levels are significantly elevated in sarcoidosis patients with parenchymal involvement at stage 2 or higher, suggesting that serum galectin-3 levels can be used to estimate disease severity in sarcoidosis.

Hyponatremia is an independent predictor of emergency department revisits in acute exacerbation of COPD.

INTRODUCTION: Hyponatremia is shown to prolong hospitalization and increase mortality. The role of hyponatremia in chronic obstructive pulmonary disease is widely studied with a focus on hospitalized patients. OBJECTIVES: To investigate whether hyponatremia increases the probability of re-exacerbations in non-hospitalized patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). METHODS: Patients with AECOPD who required an emergency department (ED) visit and who were discharged home were included in this single-center, retrospective study. Demographics and laboratory values were compared between patients with hyponatremia (<135 mmol/L) and normonatremia (135-145 mmol/L). The predictors of the patients' ED revisit in the course of one year were analyzed. RESULTS: Of all the 3274 patients, baseline sodium values were classified as hyponatremia in 720 (22%). Hyponatremia was most frequently present as mild (85%). Patients with hyponatremia had higher Charlson comorbidity scores, higher leucocytes, lower hemoglobin, lower platelet, higher neutrophil to lymphocyte ratios, lower eosinophilia, higher aspartate aminotransferase and C-reactive protein values (P < 0.001, for all), and higher frequency of 1-month revisit (36.7% vs. 31.5%, P = 0.009). Independent predictors of revisits within 1 year after the index visit were detected as long-term oxygen treatment requirement (HR: 0.768 CI: 0.695-0.848, P < 0.0001), higher urea levels (HR: 0.997 CI: 0.995-0.999, P = 0.003), and baseline hyponatremia (HR: 0.786 CI: 0.707-0.873, P < 0.001). Revisit interval was median 78 ± 3.4 days in patients with normonatremia and 51 ± 4.8 days in hyponatremia. CONCLUSION: In non-hospitalized AECOPD, hyponatremia is relatively frequent and correlates with inflammatory markers. The presence of hyponatremia is an independent predictor of an earlier ED return visit within 1 year. For patients with AECOPD, sodium values may present guidance on discharge versus longer observation decisions.

Could ferritin level be an indicator of COVID-19 disease mortality?

While the number of coronavirus disease-2019 (COVID-19) cases is increasing day by day, there is limited information known about the hematological and laboratory findings of the disease. We aimed to investigate whether serum ferritin level predicts mortality is a marker for rapid progression for inpatients. Our study included 56 patients who were died due to COVID-19 as the study group, and 245 patients who were hospitalized and recovered as the control group. The laboratory data of the patients were evaluated from the first blood tests (pre) taken from the first moment of admission to the hospital and the blood tests taken from before the patient's discharge or exitus (post) were evaluated retrospectively. The mean age of the nonsurvivor group was 62.0 ± 15.7 and the mean age of the control group was 54.34 ± 13.03. Age and length of stay are significantly higher in the nonsurvivor group. When comparing the pre- and postvalues of ferritin, according to the two groups separately, there was no significant difference in the control group and a high level of significance was observed in the nonsurvivor group (p < .01). COVID-19 disease caused by severe acute respiratory syndrome coronavirus-2 causes high mortality with widespread inflammation and cytokine storm. Ferritin is a cheap and widespread available marker, ferritin, which can be used for its predictivity of the mortality and hope it would be a useful marker for clinicians for the management of the disease.

Comparison of silicon and metallic bifurcated stents in patients with malignant airway lesions.

INTRODUCTION AND OBJECTIVE: Silicon and metallic are two types of stents in use. In this study, we compared complications and long-term survival among patients who received silicon or fully covered, bifurcated self-expandable metallic stents (SEMS) for a malignant tracheobronchial obstruction and/or tracheo/bronchial oesophageal fistulas. METHODS: Patients in whom Y-shaped stents were used from January 2013 to June 2017 in our interventional pulmonology unit were evaluated retrospectively from patient files. RESULTS: Of the 47 patients, 30 (23 males, 76.7%) were in the silicon stent group and 17 (14 males, 82.4%) were in the covered SEMS group. No differences between the groups were detected in ECOG status, pathological properties of the disease, radiotherapy or chemotherapy history before the procedure, symptoms at presentation, or comorbidities. The most common symptom was dyspnoea (96.7% and 100%), and the most common comorbidity was chronic obstructive pulmonary disease (26.7% and 23.5%). A total of 20 complications (42.6%) were seen, with no significant difference between the groups (silicon, 40%; SEMS, 47.1%; P = . 62). Mean survival was 164.51 ± 38.83 days for the silicon stent group and 254.45 ± 103.32 days for the SEMS group (P = .588). No differences were observed in 30-, 90- or 180-day mortality between the two groups (P = .966, .846 and .534, respectively). CONCLUSIONS: No significant differences in symptom palliation, insertion safety, complication rate or survival were detected between the two types of stent.

Are flexible bronchoscopic cryoextraction practices an alternative to rigid bronchoscopy?

INTRODUCTION: We aimed to evaluate the efficacy of flexible bronchoscopic cryoextraction in the treatment of airw ay obstruction arise from mucus plugs and blood clots and present our experience. MATERIALS AND METHODS: The present study evaluated patients who previously underwent unsuccessful flexible bronchoscopy for the removal of secretions and blood clots in the central airway and who underwent flexible bronchoscopic cryoextraction between January 2013-November 2017. RESULT: The study included seven patients with a mean age of 58.29 ± 18.56 years (28-76). Three patients underwent bedside intervention in the intensive care unit, and four patients underwent an intervention in the bronchoscopy unit. Seven patients underwent a total of nine sessions of cryoextraction. Severe complications or mortality did not occur during the cryoextraction sessions. CONCLUSIONS: Flexible bronchoscopic cryoextraction offers a safe treatment strategy as an alternative to rigid bronchoscopy in patients in whom airway patency cannot be achieved using other flexible bronchoscopic interventions. and accuracy of PET was higher compared to CT with this cut-off value.

T wave peak-to-end interval in COPD.

Introduction: The interval from the peak to the end of the electrocardiographic (ECG) T wave (Tp-Te) can estimate cardiovascular mortality and ventricular tachyarrhythmias. Objectives: In this study, we aimed to define a new ECG parameter in patients with COPD. Methods: This was a cross-sectional observational study that included COPD patients who were diagnosed previously and followed up in the outpatient clinic. All data of the patients' demographic features, history, spirometry, and electrocardiographs were analyzed. Results: We enrolled 134 patients with COPD and 40 healthy volunteers as controls in our study. Patients already known to be having COPD who were under follow-up for their COPD and diagnosed as having COPD according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria were included. Men comprised 82.8% of the COPD group and 73.2% of controls. The mean age in the COPD and control group was 60.2±9.4 and 58.2±6.7 years, respectively. There was no significant difference between the groups for age or sex (p=0.207, p=0.267, respectively). There were 46 (34.3%) patients in group A, 23 (17.2%) patients in group B, 26 (19.4%) patients in group C, and 46 (29.1%) patients in group D as COPD group. There was a significant increase in Tp-Te results in all precordial leads in the COPD group compared with the control group (p<0.05). Precordial V4 lead has the most extensive area under the curve (0.831; sensitivity 76.5%, specificity 89.6%). Conclusion: We present strong evidence that Tp-Te intervals were increased in patients with COPD, which suggests that there may be an association between COPD and ventricular arrhythmias and cardiac morbidity.

The Adverse Effects and Treatment Results of Smoking Cessation Pharmacotherapy During Fasting/Non-Fasting State.

BACKGROUND: Cigarette smoking is one of the most common addictions worldwide. Muslim smokers reduce the number of cigarettes they smoke during Ramadan due to the long fasting hours. OBJECTIVES: We aimed to share our experience in a smoking cessation clinic during Ramadan by analyzing the efficacy and adverse effects of once-daily dosing of bupropion or varenicline in a fasting group compared with conventional dosing in a non-fasting group. METHODS: We analyzed 57 patients who attended our smoking cessation clinic during Ramadan of 2014 and 2015, and at least one follow-up visit. For the fasting patients, we prescribed bupropion or varenicline after dinner (once daily) as the maintenance therapy. We recorded demographic characteristics of the patients, fasting state, drugs taken for smoking cessation, and the dosage of the medication. At the first follow-up visit, adverse effects seen with the treatment were recorded. We conducted telephone interviews 6 months after the first visits of the patients to learn the current smoking status of the groups. RESULTS: Of the total 57 patients, 20 (35.1%) were fasting and 37 (64.9%) were not fasting. Fasting and non-fasting patients were similar for sex, age, smoking pack-years, marital status, educational status, and mean Fagerström scores (p >.05). Adverse effects and quit rates after 6 months of follow-up were similar between the fasting and non-fasting groups (p >.05). CONCLUSION: Although our sample size was small, we found no difference in the rates of adverse effects or smoking cessation using a single daily oral dose of bupropion or varenicline between a fasting group and a non-fasting group that received conventional dosing.

Is silicone stent insertion a clinically useful option for tracheobronchomalacia?

BACKGROUND/AIM: Tracheobronchomalacia (TBM) leads to the obstruction of expiratory airflow and interference with secretion clearance. Stabilization of the airway wall using a silicon stent or laser coagulation of the posterior wall may be treatment options. This study aimed to retrospectively analyze which interventional bronchoscopic method could be used to provide airway stabilization and gain control of symptoms and for whom this method could be used. MATERIALS AND METHODS: Fifteen patients who had received treatment in our interventional pulmonology unit were analyzed. We analyzed the techniques used, stent duration, complications, and long-term treatment success retrospectively. RESULTS: Stents were used in 10 patients: 4 patients had silicon Y-stents and 4 patients had silicon tracheal stents. Stents were removed due to early migration in 3 patients. In 5 of the 7 cases, the stent was removed due to frequent obstructions of the stent due to recurrent severe mucostasis. A suitable stent was not found for one patient who had an extremely enlarged trachea. Good clinical results were achieved in just two cases. The frequency of admissions to the emergency room and hospitalizations were diminished during the follow-up time in these two patients. CONCLUSION: Silicon stents may be a good treatment option in selected patients with TBM and dynamic collapse. However, our patients were high-risk; thus, the criteria for candidates for bronchoscopic treatment should be carefully defined.