Recurrent and More Severe COVID-19 Infection: Two Elderly Case Reports.

Although the sensitivity of reverse transcriptase-polymerase chain reaction (RT-PCR) is low in the diagnosis of coronavirus disease 2019 (COVID-19), it is the gold standard. Clinical improvement is prioritized in the follow-up of patients with COVID-19 who are followed as possible or definitive cases. Although the priority in the discharge decision is the resolution of complaints, it is also important to see radiological improvement and RT-PCR negativity. A total of 2 of our patients who were hospitalized and treated in our clinic with a diagnosis of COVID-19 were discharged after their complaints were resolved and their treatment was completed. The patients had 2 negative RT-PCR results at discharge. Both of them presented to the hospital with symptoms such as fever, cough, and shortness of breath after the discharge, and both showed positive RT-PCR results. Considering recurrent COVID-19 infection, we aimed to present treatment and the 2 cases we followed.

Comparison of generic and lung cancer-specific quality of life instruments for predictive ability of survival in patients with advanced lung cancer.

BACKGROUND: Our purpose is to examine the relationship of Health related quality of life measured by EORTC QLQc30, QLQ-LC13; FACT-L, LCSS, Eq5D) with survival in advanced lung cancer patients. A total of 299 Lung Cancer (LC) patients were, included in this national multicenter Project entitled of "the LC Quality of Life Project (AKAYAK). Baseline scores were analyzed by using Cox's proportional hazard regression to identify factors that influenced survival. Univariate and multivariate models were run for each of the scales included in the study. RESULTS: Mean and median survival were 12.5 and 8.0 months respectively. Clinical stage (as TNM), comorbidity; symptom scales of fatigue, insomnia, appetit loss and constipation were associated with survival after adjustment for age and sex. Global, physical and role functioning scales of QLQc30; physical and functional scales of LCS and TOI of the FACT-L was also associated with survival. Mobility and Usual activities dimensions of the Eq5D; Physical functioning and the constipation symptom scale of the QLQ-c30; and LCS and TOI scores of the FACT-L remained statistically significant after adjustment. LC13 and LCSS scales were not predictors of survival. CONCLUSIONS: HRQOL serves as an additional predictive factor for survival that supplements traditional clinical factors. Besides the strong predictive ability of ECOG on survival, FACT-L and the Eq5D are the most promising HRQOL instruments for this purpose.

Giovanni Battista Morgagni (1682-1771).

Giovanni Battista Morgagni (1682-1771) is considered the father of neuropathology and one of the most important innovators in the history of medicine. In his "opus magnum" De sedibus et causis morborum per anatomen indagatis (The Seats and causes of diseases investigated by anatomy), he established pathological anatomy as a science by correlating clinical histories with autopsy findings.

Potential utility of p63 expression in differential diagnosis of non-small-cell lung carcinoma and its effect on prognosis of the disease.

BACKGROUND: P63 is a gene located in chromosome 3q27-29, which has been implicated in regulation of stem cell commitment and promotion of squamous differentiation in various tissues. The aim of this study was to investigate whether there was a correlation between p63 expression, differential diagnosis of lung carcinoma, and prognosis. MATERIAL AND METHODS: Immunohistochemical expression of p63 in 62 lung carcinomas was investigated and mRNA analysis using RT-PCR method was done in 6 selected cases. RESULTS: When cases were evaluated for p63 staining, 24 of 25 (96%) squamous cell carcinomas were strongly positive. Six of 20 adenocarcinomas (25%) and 1 (100%) large cell carcinoma (except neuroendocrine carcinoma) were mildly positive. p63 staining was statistically significant in favor of squamous cell carcinoma than other tumors (p<0.001). Forty percent of squamous cell carcinomas had squamous carcinoma in situ, whereas adenocarcinomas had none. There was a significant statistical difference between squamous cell carcinoma and adenocarcinoma (p=0.002). p63 was strongly positive in all of 12 squamous carcinoma in situ cases. In 6 cases where mRNA analysis was performed by RT-PCR method, DNp63 was strongly positive in 3 squamous cell carcinomas, mildly positive in 1 adenocarcinoma, and negative in 1 carcinoid tumor. TAp63 was strongly positive in non-tumoral lung tissue but negative in all tumors, except 1 squamous cell carcinoma. CONCLUSIONS: Our data suggest that poorly differentiated squamous cell carcinoma had strong and widespread staining for immunohistochemical expression of p63. Therefore, p63 can be a useful marker in differentiating squamous cell carcinoma from poorly differentiated adenocarcinoma and squamous cell carcinoma from large cell neuroendocrine carcinoma.

Occupational exposure and thoracic malignancies, is there a relationship?

OBJECTIVES: The aim of this study was to evaluate the effect of occupational exposure in the occurrence of lung cancer. METHOD: Three-hundred lung cancer cases diagnosed between September 1, 1999, and September 31, 2007, and 300 healthy controls were enrolled in this case-control study. Life-long occupational history, gender, age, exposure to asbestos, comorbidities, and smoking status were collected. RESULTS: The mean age of the 300 lung cancer cases was 60.3 ± 9.9 year (91.7% male and 8.3% female), and the mean age of healthy control group was 60.4 ± 10.5 year (95.0% male and 5.0% female). The most frequent histological types were squamous (172, 57.3%), adeno (69, 23.1%), and small cell (37, 12.3%). There was an increased risk of lung cancer occurrence among agriculture workers (OR=1.89, 95% Cl=1.17-2.98) (p=0.009). Inorganic dust exposure (OR=1.81, 95% Cl=1.0-3.25) (p=0.049) and organic dust exposure (OR=1.89, 95% Cl=1.0-3.59) (p=0.05) were found to be related with high frequency of having lung cancer. CONCLUSION: Workers who had occupational exposure to organic and inorganic dust, especially in the agricultural field, had higher risk of lung cancer occurrence when compared with office workers.

Respiratory symptoms and pulmonary functions of workers employed in Turkish textile dyeing factories.

Dyes are known to be a causative agent of occupational asthma in workers exposed to them. We have evaluated respiratory symptoms among textile workers. The study population comprised 106 exposed workers and a control (unexposed) group. Data were collected by a questionnaire. PFTs (Pulmonary Function Test) were performed. Among the exposed workers 36.8% defined phlegm. Respiratory symptoms were not significantly different between two groups. The employment duration of the exposed workers with phlegm was longer than those without phlegm (p = 0.027). The mean % predicted of FEF(25-75) of the exposed workers was found to be significantly lower than the control (unexposed) group (p = 0.01). Our study suggests that textile dyeing might cause respiratory symptoms in workers.

Peripheral neuropathy in chronic obstructive pulmonary disease.

The aim of this study was to evaluate the frequency and characteristics of peripheral nervous system involvement in chronic obstructive pulmonary disease and its relation with proinflammatory cytokines such as TNF-alpha, IL-6, IGF-1 and CRP. Forty chronic obstructive pulmonary disease patients with a mean age 62.8 +/- 5.5 years and 33 healthy controls with a mean age of 61.8 +/- 7.4 were included into this study. All subjects were evaluated with standard motor and sensory nerve conduction studies. Serum TNF-alpha, IL-6, CRP and IGF-1 were measured. The muscle strengths of three muscle groups (knee extensors, shoulder abductors and flexors) were assessed with a hand-held dynamometer. Peripheral neuropathy was detected at 15% of chronic obstructive pulmonary disease patients. Ulnar motor and sensory nerves, left sural nerve distal latencies were found significantly prolonged than healthy volunteers (p = 0.011), peroneal nerve conduction velocities was found lower in patients than in healthy controls (p = 0.021), tibial nerve amplitudes was found lower in patients than healthy controls (p = 0.046). CRP and TNF-alpha were found significantly higher in chronic obstructive pulmonary disease patients and IGF-1 was found significantly lower in chronic obstructive pulmonary disease patients. There was no correlations between proinflammatory cytokines, CRP and electrophysiological findings. Left sural nerve's sensory nerve action potential amplitude was correlated positively with FEV(1)% (r = 0.425; p = 0.009). Muscle strength at the shoulder and knee were significantly reduced in patients with COPD when compared with controls. The frequency of neuropathy was higher in chronic obstructive pulmonary disease when compared with the healthy controls. Chronic obstructive pulmonary disease patients have subclinical peripheral nerve involvements.

[The characteristics of smoking habit among patients evaluated at our outpatient clinic]. / Gögüs hastaliklari poliklinigine basvuran olgularin sigara içme özellikleri.

To determine the prevalence of cigarette smoking, to examine the risk factors affecting smoking amongst adults and to assess the opinion of patients about quitting smoking who were evaluated at our outpatient clinic. Six hundred fifty-nine patients who were evaluated at our outpatient clinic between June 2005 and June 2006 were included in the study. This is a cross-sectional study that evaluates prevalence of smoking. Data gathered by applying face to face questionnaires. The mean age of 659 participants [417 (63.3%) males and 242 (36.7%) females] was 53.1 +/- 16.2 years. The prevalences were; 33% (n= 218) smokers, 39% (n= 258) ex-smokers and 28% (n= 183) non-smokers. Smoking prevalence under age of 50 was significantly higher (p= 0.0001). There was a positive significant relation between education and smoking amongst women, but this relationship was not significant amongst men. The most common reason for beginning smoking was because of friends (72%). 86% wanted to quit smoking. 48.9% tried to quit smoking but couldn't be successful. The prevalence of active smoking and quit smoking among patients who applied to pulmonary medicine outpatient clinic were 33% and 28%, respectively. The ratio of smoking and smoking pack-years was higher among men. Eighty-six percent of patients wanted to quit, 25% tried to quit but could not be successful, and 49% quit smoking but began smoking again. According to these findings, patients who were smoking wanted to quit but couldn't be successful without a professional help. We planned to found a smoking cessation outpatient clinic at our department.

[Differences between men and women in the clinical and laboratory findings of patients diagnosed with pulmonary embolism]. / Pulmoner emboli tanili olgularin klinik ve laboratuvar bulgularinda erkek-kadin farklari.

Pulmonary embolism (PE) could not be diagnosed correctly in 2/3 of patients saving of that pathology, and unfortunately mortality in them could be as high as 30%. In the present study, we aimed to investigate the gender differences in clinical, electrocardiography (ECG) and laboratory findings of PE patients diagnosed with contrast-enhanced helical computerized tomography of thorax. 31 patients (18 females, 58% and 13 males, 42%) were included into the study. Symptoms, risk factors, ECG and arterial blood gases were evaluated, and then Wells, Geneva and ECG scores were obtained in each subject. Alveolo-arterial (A-a) oxygen gradient was calculated as P(A-a)O2= 150-(PCO2/0.8)-PO2. Mean pulmonary artery pressure (PAP) was measured by echocardiography. In female and male patients, Wells score (4.8 +/- 1.9 and 3.2 +/- 2.2, p= 0.017); ECG score (5.9 +/- 3.6 and 3.1 +/- 1.8, p= 0.036) and mean PAP (33.5 +/- 12.3 mmHg and 23.2 +/- 10.0 mmHg, p= 0.017) were significantly different. However, between female and male patients Geneva score (4.8 +/- 1.7 and 5.0 +/- 1.6), A-a gradient (35.2 +/- 17.3 and 42.9 +/- 12.3) and PaCO2 (33.5 +/- 15.1 and 29.8 +/- 5.4) did not differ significantly (p> 0.05). Immobilization and surgical interventions as risk factors for PE were established significantly higher in females than males (50%-30.8%, p= 0.02 and 50%-23.1%, p= 0.01). In female patients with PE, Wells and ECG scores, immobilization, surgical interventions and mean PAP are significantly higher than male patients. So, in the clinical practice, these parameters may help to diagnose acute PE especially in females.

A squamous cell lung carcinoma with abscess-like distant metastasis.

This is a metastatic spread of squamous cell lung carcinoma to lungs, liver, lymph node, bone and subcutanous region as multiple abscess-like lesions. A fifty-five years old man admitted to the out-patient clinic with fever, cough, hemopthysis, night sweats, chest pain, abdominal pain and weight loss. In a short period of time abcess like lesions developed in his lungs, liver, lymph node, bone and subcutanous region. Though the clinical presentation is suggestive for an infectious condition, no success to antimicrobial treatment and negative results of microbiological studies have arised a need to further investigations. Histopathological studies of the abscess wall ultimately gave the definitive diagnosis as metastatic squamous cell carcinoma. We believe that case report is interesting because of the uncommon metastatic lesions masquerading the abscesses and also wide-spread multiple distant invasions of a squamous cell lung carcinoma in a short time period.

Pulmonary manifestations in patients with cutaneous T-cell lymphomas.

BACKGROUND: Lungs are among the most common organs of extranodal involvement by cutaneous T-cell lymphomas (CTCLs), yet the magnitude of lung involvement is not clear, and only a few case reports have addressed this issue to date. The objective of this study was to present the authors' observations on how to recognize lung involvement by CTCL and evaluate the clinical and radiologic differences between involvement of the lungs by CTCL and by pneumonia. METHODS: A retrospective analysis was conducted of all 710 patients with confirmed CTCL who presented to The University of Texas M. D. Anderson Cancer Center between January 1996 and January 2005. Demographics, tumor characteristics, respiratory symptoms, thoracic imaging, microbiology, and laboratory studies were reviewed. RESULTS: During the 9-year period that was studied, 122 patients presented with pulmonary radiologic abnormalities, including 67 patients who also had respiratory symptoms. Pneumonia (n = 27 patients) or lung involvement (n = 6 patients) in patients with CTCL were associated with high mortality rates (hazard ratio, 1.82; 95% confidence interval, 1.08-3.07%; P = .026). The pathogens that were isolated from lower respiratory cultures were Staphylococcus aureus (n = 4 patients), Aspergillus fumigatus (n = 2 patients), Mycobacterium avium-intracellulare (n = 2 patients), Pseudomonas aeruginosa (n = 1 patient), respiratory syncytial virus (n = 1 patient), and Candida parapsilosis (n = 1 patient). Most of the radiologic findings in patients with pneumonia were opacities. Six patients had involvement of lung by CTCL, and most common radiologic pulmonary findings were either a solitary nodule or multiple progressing pulmonary nodules. CONCLUSIONS: Pneumonia and lung involvement by CTCL are relatively rare but portend poor survival. Thus, patients with CTCL should be evaluated thoroughly with thoracic imaging when they experience respiratory symptoms.

Smoking cessation after diagnosis of lung cancer is associated with a beneficial effect on performance status.

STUDY OBJECTIVE: To evaluate the impact of smoking history and postdiagnosis smoking cessation on performance status (PS) and survival in patients with lung cancer. DESIGN: Patients with non-small cell lung cancer (NSCLC) who were referred to our pulmonary laboratory for evaluation for surgical resectability between January and November 2001 were reviewed. We investigated the association between smoking status after diagnosis and survival, as well as the change in PS from the initial status to status at 6 and 12 months after the diagnosis was established. RESULTS: The records were reviewed for 206 patients, of whom 93 (45%) were current smokers, 15 (7%) were never-smokers, and 98 (48%) were former smokers. Among the 93 smokers, 46 quit and 47 continued smoking after the diagnosis. Disease stage, patient demographics, treatment modalities, and comorbidities were similar between these two groups. While there was no significant association between smoking status after diagnosis and patient survival, those who quit smoking maintained a better PS at 0 to 6 months (odds ratio [OR], 7.09; 95% confidence interval [CI], 1.99 to 25.3; p = 0.002) and at 0 to 12 months (OR, 6.99; 95% CI, 1.76 to 27.7; p = 0.006) than those who continued smoking after the adjustment for disease stage, patient demographics, treatment modalities, and comorbidities. CONCLUSION: Patients who quit smoking after the diagnosis of NSCLC maintained a better PS at 6 and 12 months regardless of disease stage, age, race, sex, therapy types, and comorbidities than those who continued to smoke.

Pulmonary dysfunction as a major cause of inoperability among patients with non-small-cell lung cancer.

PURPOSE: We wanted to assess the prevalence of pulmonary dysfunction as the underlying reason for inoperability among patients with non-small-cell lung cancer (NSCLC) who were considered for surgical treatment at the time of diagnosis. PATIENTS AND METHODS: This is a retrospective analysis of all patients with NSCLC referred to our pulmonary function laboratory for preoperative evaluation between January 2001 and November 2001. Pulmonary function testing consisted of measurement of spirometric indices (forced expiratory volume in 1 second [FEV1]), lung volumes and diffusing capacity for carbon monoxide, Xenon-133 quantitative ventilation and perfusion studies, and exercise testing when indicated. Patient demographics and clinical characteristics at the time of the evaluation were reviewed. RESULTS: The group comprised 206 consecutive potential surgical candidates (mean age, 64.7 years +/- 10.1 years) with NSCLC. Nearly half (45.6%) of the patients had early-stage (I/II) disease, and the remainder had late-stage disease at the time of pulmonary evaluation. The average predicted FEV1 among all patients was 70.3% +/- 19.6% (range, 25%-123%). One hundred eight patients (52.4%) were deemed surgically inoperable after the preoperative assessment. Severe pulmonary function impairment was identified as the reason for surgical inoperability in more than one third of these patients (40 of 108). CONCLUSION: A substantial number of patients with anatomically resectable NSCLC are deemed surgically ineligible based on poor lung function. Recognition of the magnitude of this problem is fundamental to the development of effective treatment options, which might include preoperative management strategies that could better prepare patients for surgery or, alternatively, aggressive nonsurgical approaches.

Binasal cannula versus face mask for oxygen therapy in patients with chronic pulmonary disease.

Oxygen therapy, which is ordered frequently for patients with chronic pulmonary disease, remains a cornerstone of modern medical practice. This study was conducted to compare the efficiency and comfort of a binasal cannula versus a face mask during oxygen therapy. Sixty hypoxemic patients participated in this randomized controlled study. While each patient was hypoxemic, arterial blood gas analysis was performed before oxygen supplementation was begun. Arterial oxygen saturation was continuously monitored during oxygen therapy with a face mask or a binasal cannula. Subjects were allowed to return to their oxygen saturation level in room air before the device for oxygen treatment was changed. The same procedure was then repeated with the other device. Patient comfort was evaluated through the use of a questionnaire that was completed after each treatment period. The mean age+/-standard deviation was 62+/-13 y. No statistically significant difference was noted in oxygen saturation levels achieved with the 2 devices. The binasal cannula reached target oxygen levels (P=.007) more quickly than the face mask. The binasal cannula was reported to be significantly more comfortable (P=.0001), and had significantly fewer reports of dyspnea and restlessness, and was less of a nuisance (P=.019, P=.0001, and P=.0001, respectively). The binasal cannula was preferred for oxygen therapy by 71% of study patients. Although the efficiency of the 2 devices did not differ remarkably, the binasal cannula was regarded as a more comfortable and time-saving device for delivery of oxygen therapy to hypoxic patients.

Respiratory effects of chronic animal feed dust exposure.

AIM: The aim of our study was to assess the prevalence of chronic work related respiratory symptoms and to determine lung function abnormalities in animal feed industry workers. METHOD: 108 workers with a mean age of +/- SD: 32 +/- 7.11 yr employed in the animal feed industry and 108 unexposed subjects as a control group were enrolled in the study. All subjects filled out a questionnaire on their respiratory symptoms. Pulmonary function tests (PFTs) were conducted. Airborne dust (respirable fraction) was sampled during an 8-h work shift. Dust sampling was performed with a Casella AFC 123 machine. RESULTS: A significantly higher prevalence of work related upper and lower respiratory tract symptoms such as cough (12%), dyspnea (5.6%) and sinusitis (8.3%) were found among the workers than in the control group (p=0.001, p=0.04 and p=0.008 respectively). Irritation symptoms such as pruritus of the eyes (11.1%), skin lesions (7.4%) and nose symptoms (8.3%) were also significantly higher among workers that in the control group (p=0.001, p=0.014 and p=0.005 respectively). The mean PFTs (predicted %) of the workers; forced vital capacity (FVC)% +/- SD (85.23 +/- 12.06), 1-s forced expiratory volume (FEV1)% +/- SD (88.73 +/- 13.09), peak expiratory flow (PEF)% +/- SD (70.64 +/- 18.76) and forced expiratory flow rate at 25-75% of the FVC (FEF25-75)% +/- SD (88.42 +/- 25.94) were found significantly lower than in the control group (p<0.0001, p<0.0001, p<0.0001, p<0.0001 respectively). Our data indicate that exposure to animal feed dust is an important factor in the occurrence of respiratory symptoms and decline in lung functions.