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.

Chronic obstructive pulmonary disease phenotypes in Turkey: the COPET study-a national, multicenter cross-sectional observational study.

BACKGROUND: While mortality rates decrease in many chronic diseases, it continues to increase in COPD. This situation has led to the need to develop new approaches such as phenotypes in the management of COPD. We aimed to investigate the distribution, characteristics and treatment preference of COPD phenotypes in Turkey. METHODS: The study was designed as a national, multicenter, observational and cross-sectional. A total of 1141 stable COPD patients were included in the analysis. RESULTS: The phenotype distribution was as follows: 55.7% nonexacerbators (NON-AE), 25.6% frequent exacerbators without chronic bronchitis (AE NON-CB), 13.9% frequent exacerbators with chronic bronchitis (AE-CB), and 4.8% with asthma and COPD overlap (ACO). The FEV1 values were significantly higher in the ACO and NON-AE than in the AE-CB and AE NON-CB (p < 0.001). The symptom scores, ADO (age, dyspnoea and FEV1 ) index and the rates of exacerbations were significantly higher in the AE-CB and AE NON-CB phenotypes than in the ACO and NON-AE phenotypes (p < 0.001). Treatment preference in patients with COPD was statistically different among the phenotypes (p < 0.001). Subgroup analysis was performed in terms of emphysema, chronic bronchitis and ACO phenotypes of 1107 patients who had thoracic computed tomography. A total of 202 patients had more than one phenotypic trait, and 149 patients showed no features of a specific phenotype. DISCUSSION: Most of the phenotype models have tried to classify the patient into a certain phenotype so far. However, we observed that some of the patients with COPD had two or more phenotypes together. Therefore, rather than determining which phenotype the patients are classified in, searching for the phenotypic traits of each patient may enable more effective and individualized treatment.

Airflow patterns in the trachebronchial tree of a patient with an accessory cardiac bronchus: A rare congenital anomaly.

Accessory cardiac bronchus (ACB) is a rare congenital anomaly mainly located in the medial wall of the intermediate bronchus. This anomaly can present with dyspnea, recurrent infections, and hemoptysis. It usually has a blind ending, which may have an impact on airflow patterns and lobar distribution regardless of its diameter and depth. There have been very few cases with ACB. However, the airflow pattern and lobar distribution have not been well studied. In our case with ACB, the proportion of airflow in the right lung was higher than in the model without ACB, while mean airflow velocities were similar in both models. In this regard, quantitative lung ventilation scintigraphy could be better than the anatomical formula in predicting postoperative forced expiratory volume 1 in patients with accessory cardiac bronchus who will undergo lung resection.

The comparison of favipiravir and lopinavir/ritonavir combination in COVID-19 treatment

Background/aim: SARS-CoV-2, a ribonucleic acid coronavirus, rapidly spread worldwide within a short timeframe. Although different antiviral, antiinflammatory, and immunomodulatory drugs are used, current evidence is insufficient as to which drug is more efficient. Our study compared favipiravir and lopinavir/ritonavir (LPV/RTV) therapies in inpatient care for coronavirus disease 2019 (COVID-19) pneumonia. Materials and methods: Demographic data, test results, treatments, and latest status of patients receiving inpatient COVID-19 pneumonia therapy were recorded. The initial favipiravir and LPV/RTV receiving groups were compared regarding the need for intensive care units (ICU) and mortality. Logistic regression analysis was performed by including variables showing significant differences as a result of paired comparisons into the model. Results: Of the 204 patients with COVID-19 pneumonia, 59 (28.9%), 131 (64.2%), and 14 were administered LPV/RTV, favipiravir, and favipiravir with LPV/RTV, respectively. No difference was found in age, sex, presence of comorbidity, and tocilizumab, systemic corticosteroid, and plasma therapy use between patients administered with these three different treatment regimens. The mean mortality age of the patients was 71 ± 14.3 years, which was substantially greater than that of the survivors (54.2 ± 15.5 years). Compared with patients administered with LPV/RTV, ICU admission and mortality rates were lower in patients administered with favipiravir. CK-MB, AST, CRP, LDH, and creatinine levels were higher, whereas lymphocyte counts were lower in patients who died. Age, AST, CRP, LDH, and neutrophil counts were higher in patients needing ICU, and eosinophil and lymphocyte counts were significantly lower. Logistic regression analysis showed that favipiravir use independently decreased mortality (p = 0.006). Conclusion: The use of favipiravir was more effective than LPV/RTV in reducing mortality in hospitalized patients with COVID-19.

Evaluation of plasma antimicrobial peptide LL-37 and nuclear factor-kappaB levels in stable chronic obstructive pulmonary disease.

BACKGROUND: Antimicrobial peptides are effectors of host defence against infection and inflammation and can encourage wound repair. OBJECTIVES: The objectives of this study were to investigate the plasma antimicrobial peptide LL-37 and nuclear factor-kappaB (NF-κB) levels in patients with stable COPD compared with a control group and to highlight their importance in immune inflammation. METHODS: One hundred and thirty-eight stable COPD patients and 33 control subjects were enrolled in the study. The COPD patients were classified into four groups based on FEV1 (groups I-IV) and also divided into "low-risk and high-risk" groups (groups A-B [low risk], C-D [high risk]). RESULTS: Plasma LL-37 levels were significantly lower while plasma NF-κB levels of the COPD patients were significantly higher than those of the control subjects (P<0.001, both). LL-37 levels were significantly lower in group IV than in groups I, II, and III (P<0.01, all). NF-κB levels were significantly higher in groups III and IV than in groups I and II (P<0.05, both). There was a positive correlation between FEV1 and FEV1/FVC in all COPD patients (r=0.742, P<0.001) and in group D (r=0.741, P<0.001). Furthermore, there was an inverse correlation between LL-37 and NF-κB in both the groups C (r=-0.566, P<0.001) and D (r=-0.694, P<0.001) and group C+D combined (r=-0.593, P<0.001). Furthermore, in group C, LL-37 and FEV1 were positively correlated (r=0.633, P<0.001). CONCLUSION: Our study indicated that plasma LL-37 and NF-κB may play an important role in chronic immune inflammation. Decreased LL-37 levels may be particularly high risk for patients in stage IV disease. The role of LL-37 as a target for treatment of the immune system and COPD must be widely evaluated.

Burden of community-acquired pneumonia in adults over 18 y of age.

This study aimed to determine the economic burden and affecting factors in adult community-acquired pneumonia (CAP) patients (≥ 18 years) by retrospectively evaluating the data of 2 centers in Istanbul province, Turkey. Data of outpatients and inpatients with CAP from January 2013 through June 2014 were evaluated. The numbers of laboratory analyses, imaging, hospitalization days, and specialist visits were multiplied by the relevant unit costs and the costs of the relevant items per patient were obtained. Total medication costs were calculated according to the duration of use and dosage. The mean age was 61.56 ± 17.87 y for the inpatients (n = 211; 48.6% female) and 53.78 ± 17.46 y for the outpatients (n = 208; 46.4% male). The total mean cost was €556.09 ± 1,004.77 for the inpatients and €51.16 ± 40.92 for the outpatients. In the inpatients, laboratory, medication, and hospitalization costs and total cost were significantly higher in those ≥ 65 y than in those <65 y. Besides the hospitalization duration, specialist visit, imaging, laboratory, medication, and hospitalization costs and total cost were significantly higher in those hospitalized more than once than in those hospitalized once. While the specialist visit cost was higher in the inpatients with comorbidities, the imaging cost was higher in the outpatients with comorbidities. CAP poses a higher cost in inpatients, elders, and individuals with comorbidities. Costs can be decreased by rational decisions about hospitalization and antibiotic use according to the recommendations of guidelines and authorities. Vaccination may decrease medical burden and contribute to economy by preventing the disease, especially in risk groups.

The comparative value of pleural fluid adenosine deaminase and neopterin levels in diagnostic utility of pleural tuberculosis.

INTRODUCTION: The aim of the present study was to evaluate and compare the diagnostic accuracy of pleura levels of adenosine deaminase (ADA) and neopterin for the differential diagnosis of pleural tuberculosis (TP). PATIENTS AND METHODS: The study included 50 patients with TB, 27 patients with malignancies, and 24 patients with pleural effusion of non-tuberculous and non-malignant origin as controls. ADA and neopterin levels in pleural fluid were measured by spectrofotometric and ELISA method, respectively. RESULT: Pleural neopterin levels were significantly higher in patients with pleural TB than patients with malignancy (p< 0.001). Pleural ADA levels were significantly higher in patients with pleural TB than patients with malignancy (p< 0.001) and patients with benign non-tuberculosis effusions (p< 0.001). The mean levels of ADA and neopterin in pleural effusion were evaluated according to their underlying diseases for the diagnostic accuracy. As for pleural TB receiving operating characteristic curves identified the following results; The best cut-off value for pleural neopterin was 4.7 U/L and yielded a sensitivity and specificity of 86% and 72.55%, respectively. Taking a cut-off value of 42 U/L for pleural ADA, the sensitivity and the specificity were found to be 88% and 68.63%, respectively. CONCLUSIONS: In the diagnosis of pleural TB pleural neopterin level has a comparable sensitivity to pleural ADA activity. Both markers may find a place as a routine investigation in the coming days for early detection of TB. However, these tests should not be considered an alternative to biopsy and culture.

Application of non-invasive mechanical ventilation in an asthmatic pregnant woman in respiratory failure: a case report.

The use of non-invasive mechanical ventilation (NIV) during an asthma attack is controversial. We report a case of a 28-year-old female patient in her 16th week of pregnancy with community-acquired pneumonia who presented during an asthma attack, which led to hypoxic respiratory failure. She was successfully treated using NIV. This case is worth discussing as it includes two clinical conditions in which NIV is often considered contraindicated.

Central airway obstruction due to malignant fibrous histiocytoma metastasis in a case with Mounier-Kuhn syndrome.

Malign fibrous histiocytoma is one of the most observed soft tissue sarcomas seen in the adults. The most common metastasis region is the lung and metastasis. Mounier-Kuhn syndrome is characterized by the highly dilatation of the trachea and bronchi. We may encounter with the major airway obstruction in the endoluminal or extraluminal lung and mediastinal masses or those with both components together. In this article, we would like to highlight the occurrence of a rare seen clinical situation secondary to the giant mediastinal malign fibrous histiocytoma metastasis and the clinical difficulties experienced in resolving of the main airway obstruction caused by the mass. Since the lack of the similar studies conducted previously, we found the case worth presenting.

Can immune parameters be used as predictors to distinguish between pulmonary multidrug-resistant and drug-sensitive tuberculosis?

INTRODUCTION: Despite the development and wide implementation of Directly Observed Therapy Strategies (DOTS), multidrug-resistant tuberculosis (MDR-TB) remains a serious global health threat. In this study, the role of host immune response in patients with MDR-TB is investigated and compared with that of patients with smear-positive drug-sensitive tuberculosis (SP-TB). MATERIAL AND METHODS: 27 patients with SP-TB, 20 patients with MDR-TB, and 20 healthy controls were included in the study. Immune parameters were determined by flow cytometry using monoclonal antibodies in order to compare the percentage values of these markers in the two study groups and the control group. RESULTS: The levels of lymphocyte subgroups in the gate of CD45(+)/CD14(-) lymphocyte: CD45(+), CD3(+), CD4(+), NK, CD3/HLA-DR, CD 95(+) cells were significantly lower; by contrast CD23(+), CD25(+), CD19(+), CD4(+)/CD8(+), HLA-DR cells were found to be lower, but not significantly so in patients with MDR-TB, compared to levels in patients in the SP-TB and control groups. Besides these findings, the levels of NKT cells and (γ)δ TCR(+) cells were significantly higher in the MDR-TB than in the healthy control and SP-TB group. CONCLUSIONS: The lower levels of CD3/ HLA-DR, CD4 (+), Fas (+), and NK, and the higher level of NKT together with (γ)δ T cells in patients with MDR-TB compared to those in SP-TB may indicate a profound immune suppression in MDR-TB patients and thereby may denote an accumulation in the bacterial load. Our findings may shed light on the pathogenesis and prognosis of MDR tuberculosis, and may point towards the use of flow cytometry findings as an aid to early diagnosis in MDR-TB patients.

18F-FDG PET-CT features of primary primitive neuroectodermal tumor of the chest wall.

A case of primary primitive neuroectodermal tumor (PNET) of the chest wall in an adolescent is presented with imaging findings including 18F-fluorodeoxyglucose (18F-FDG) positron-emission computed tomography (PET-CT). To date, radiological description of the PNET of the chest wall has mainly been carried out by radiographic analysis, computed tomography (CT), and magnetic resonance imaging (MRI). We demonstrated that 18F-FDG PET-CT visualizes the active focus of glucose metabolism of PNET of the chest wall and is effective for the preoperative evaluation of patients with this tumor.

Gemcitabine and cisplatin as neo-adjuvant chemotherapy for non-small cell lung cancer: a phase II study.

The combination of gemcitabine and cisplatin is one of the most active chemotherapy regimens against non-small cell lung cancer (NSCLC). This study was designed to evaluate the efficacy and safety of gemcitabine combined with cisplatin in a 3-week cycle regimen for patients with operable, early stage NSCLC. Gemcitabine at a dose of 1000 mg/m(2) on days 1 and 8 of each 21-day cycle for 3 cycles, followed by cisplatin at a dose of 75 mg/m(2) on day 1 was administered to patients with previously untreated, operable, early stage (IB-IIIA) NSCLC. A total of 47 patients (46 male, mean age 56.0+/-8.0 years) who met the eligibility criteria were enrolled. The pathological complete response rate was 5.3% of operated patients and 4.3% of total patients. At visit 4, 57.1% of the patients had partial response, 38.1%, stable disease and 4.8%, progressive disease. The main toxicities - leukopenia, neutropenia and thrombocytopenia - were usually clinically asymptomatic and did not require hospitalization. Non-hematological toxicities were minimal and manageable. Disease free and 12-month overall survival rates were over 70% and 80%, respectively. This study demonstrates that the administration of gemcitabine and cisplatin combination for 3 cycles is effective and tolerable for patients with operable, early stage NSCLC. Low toxicity profile and promising survival outcome suggest that this regimen has an encouraging activity in this subset of patients.

Levels of tumour necrosis factor-alpha and IL-1alpha in newly diagnosed and multidrug resistant tuberculosis.

BACKGROUND: The pro-inflammatory cytokines tumour necrosis factor (TNF)-alpha and IL-1alpha play key roles in host defence against tuberculosis (TB) but there is little knowledge of their levels in multidrug resistant TB (MDR-TB). The aim of the present study was to investigate the levels of TNF-alpha and IL-1alpha and their relationship with the levels of T helper (CD4+), T suppressor (CD8+) and total lymphocytes (CD45+) in newly diagnosed TB (N-TB) and MDR-TB. METHODOLOGY: This study assessed 19 N-TB patients (M/F : 17/2) and 11 MDR-TB patients (M/F : 10/1). Serum TNF-alpha and IL-1alpha were assessed by ELISA. Lymphocyte expression of CD45, CD4, CD8, CD3, CD23, CD19 and CD95 were determined by flow cytometry. RESULTS: The levels of TNF-alpha, IL-1alpha, and CD4, CD4/CD8, CD45, CD19, CD23 and CD95 positive lymphocytes were lower in MDR-TB than in N-TB patients (P < 0.05). Statistically, there was a positive correlation between TNF-alpha and IL-1alpha (r = 0.92) for both MDR-TB and N-TB. For both groups, both TNF-alpha and IL-1alpha correlated with CD4+ lymphocytes (r = 0.48). TNF-alpha and IL-1alpha showed negative correlations with CD8+ lymphocytes (r = -0.81, r = -0.73) (P < 0.01) in MDR-TB patients. CONCLUSION: The lower levels of cytokines and numbers of T helper lymphocytes in MDR-TB compared with N-TB implies that the immune profiles of the two groups are different, and may be important in the natural history of the disease.