The Effect of Prognostic Nutritional Index in Postoperative Infection Following Lobectomy in Non-Small Cell Lung Cancer Patients.

Background The prognostic nutritional index (PNI) is a valuable marker for evaluating the nutritional status associated with postoperative complications and the prognosis of patients with cancer. However, the role and clinical value of PNI in infection after lung cancer surgery remains unclear. This study examined the association between PNI and infection after lobectomy for lung cancer, focusing on the predictive value of PNI. Methods We conducted this retrospective cohort study on 139 patients with non-small cell lung cancer (NSCLC) who underwent surgery between September 2013 and December 2018. Two groups were composed according to their PNI values (≥ 50 or <50 ), and the relationship was assessed with infection after lobectomy. Results Only PNI values, atelectasis, and prolonged air leaks were significantly associated with the development of infection. The median preoperative PNI was 52.97±5.69. Postoperative infection was seen in patients (15.5%) with PNI≥ 50 and 38.1% in patients with PNI <50. The mean PNI in patients with postoperative infection, empyema, and prolonged air leakage was lower than in patients without these conditions. Conclusions Malnutrition is commonly seen in patients with malignancy. The overall malnutrition rate is 45% in lung cancer patients. Patients with metastatic diseases are malnourished in a 73% ratio compared to 5% for localized diseases. Furthermore, malnutrition increases the tendency of postoperative infection and reduces wound healing. We aim to determine whether PNI can be a predictive index marker for postoperative infection in patients with NSCLC who underwent lobectomy. Postoperative infection was seen in 15.5% of patients with PNI>50 and 38.1% in patients with PNI <50.

What are the factors that affect post COVID 1st month's continuing symptoms?

AIM: The aim of our research was to investigate retrospectively the relationship between the symptoms and general characteristics, initial laboratory values and treatments in patients who had COVID-19 and who applied to the chest diseases outpatient clinic for control after 1 month. METHOD: Three hundred fifteen patients who were diagnosed with COVID-19 and applied to the chest diseases outpatient clinic between May 2020 and August 2020 for control in the 1st month were included in the study. Patient information was collected from the hospital information system and the e-pulse system. RESULTS: Females accounted for 50.2% of our patients and their mean age was 47.9 ± 14.8 (19-88) years. About 14.3% (n: 45) of the individuals were 65 years of age and older, 20.6% (n: 65) of our patients were smoking and 70.2% (n: 221) of our patients were treated at home. A total of 133 patients had at least one comorbid disease. The patients most frequently reported cough, dyspnoea, weakness, myalgia and diarrhoea. The most common symptoms were cough, dyspnoea, weakness and myalgia in the 1st month. Initial D-dimer, initial CRP and the values of platelet, D dimer and CRP in the 1st month were detected to be higher in patients with persistent symptoms when the laboratory values of patients whose symptoms continue after 1 month were examined. It was determined that the symptoms had persisted in patients who had been hospitalised, had dual therapy, had comorbid diseases and had more common pathologies in their pulmonary imaging. CONCLUSION: Symptoms may persist for a long time in hospitalised patients, in patients with COVID-19-related pneumonia and concomitant chronic diseases and in patients with high D-dimer and high CRP at the time of admission. Patients are informed that their symptoms may last for a long time, unnecessary hospital admissions can be avoided.

The evaluation of lung involvement and functional capacities in patients diagnosed with primary Sjogren's syndrome.

INTRODUCTION: Sjögren syndrome (SS) is a chronic, systemic, inflammatory disease characterised with lymphocytic infiltration of the exocrine glands, frequently manifested by dryness in the region affected. Although the most common extraglandular involvement in SS is pulmonary involvement. Early diagnosis and treatment is considered to be important. It was aimed to evaluate the frequency of early lung involvement, high resolution computed tomography (HRCT) findings and data of pulmonary function test (PFT) in SS in this study. MATERIALS AND METHODS: Thirty-five patients diagnosed with SS and referred by the Department of Rheumatology to determine potential lung involvement to the eighth chest diseases outpatient clinic of our hospital between September 2015 and December 2018 were included in this study. Respiratory signs, demographic features, length of disease and treatment regimens, PFT, data of 6-minute walk test and findings of HRCT of the patients were retrospectively obtained from hospital information system and patient files. RESULTS: The mean age of the patients was 54.4 ± 9.2. The majority of the patients were women (94.3%). When the HRCT findings were evaluated, 28 (80%) patients had CT findings, while 7 (20%) patients had no CT findings. The most common HRCT findings found in patients were peribronchial thickening (48.6%), ground glass appearance (28.6%) and prominence in interstitial scars. CONCLUSION: We think that the evaluation of HRCT and PFTs in patients diagnosed with SS for assessing early pulmonary involvement will be guiding in terms of follow-up and treatment.

What are the prognostic factors affecting 30-day mortality in geriatric patients with respiratory failure in the Intensive Care Unit?

OBJECTIVE: We aimed to investigate the prognostic factors related to 30 day mortality of elderly patients with respiratory failure in the intensive care unit (ICU). METHODS: We performed a single centre, retrospective study and analyzed the main variables and outcomes of 238 geriatric patients admitted to an ICU with ARF between December 2017- January 2019 in Chest Disease Hospital, were included and classified as survivors and nonsurvivors. Main characteristics, laboratory datas, severity and nutrition scores were evaluated and logistic regression analysis were used. RESULTS: The nonsurvivor group included 110 cases (40% female,) with a median age of 79, had higher scores in the followings; Acute Physiology Chronic Health Evaluation II score (APACHE-II) (p < 0.001), Charlson Comorbidity Index (CCI) (p < 0.001), Sequential Organ Failure Assessment score (p < 0.001). The inotropic support requirement was also higher in the nonsurvivor group (48,2%). As a comorbidity, malignancy and Type-I respiratory failure were higher in the nonsurvivor group (p=0.03, p < 0.001). The overall 30-day mortality was 46%. Blood urea nitrogen, procalsitonin, C-reactive protein and creatinine levels were higher in the nonsurvivor group (p < 0.001). However, albumin (p < 0.001), BMI (p=0.03) and longer hospital stay (p < 0.001) were higher in the survivor group. Inotropic support, APACHE-II score and CCI were independently related to increased mortality risk, whereas albumin was associated with decreased mortality risk. CONCLUSION: High APACHE II score, low CCI, low albumin levels and the requirement for inotropic support were found to be independently risk factors of 30-day mortality in the geriatric patients with respiratory failure in ICU.

The comparison of GNRI and other nutritional indexes on short-term survival in geriatric patients treated for respiratory failure.

BACKGROUND: There are several screening tools used in the detection of malnutrition to facilitate nutritional support and predict prognosis in the elderly. AIMS: We aimed to compare the prognostic predictive value of geriatric nutritional risk index (GNRI) with other nutritional indices on 1 month survival in geriatric patients hospitalized for respiratory failure in intensive care unit (ICU). METHODS: A total of 191 geriatric patients (> 65 years) admitted to a specialized chest hospital with respiratory failure between January 2018 and January 2019 were analyzed. Patients were classified into two category according to 30-day survival: Survivors and Non-survivors. Nutritional assesment was done via GNRI, OPNI, NRS 2002, Nutric Scores in ICU. RESULTS: Using GNRI, 146 (76.3%) geriatric patients found to be at risk of malnutrition (GNRI score: ≤ 92). GNRI < 86.9 showed significantly higher 30-day mortality rate and patients with malnutrition risk were older, had significantly lower BMI, OPNI, and higher SOFA score. The Age, NRS 2002, Nutric and SOFA score had negative correlation with GNRI. Nutric score, prealbumin and GNRI were detected as significant independent risk factors of 30-day mortality. GNRI had higher sensitivity (76.7%) but lower specificity (57.1%) compared to Nutric score and OPNI for the prediction of 30-day hospital mortality. CONCLUSIONS: Compared to others, Geriatric Nutritional Risk Index (GNRI) seems to be a good predictor of 30-day mortality and having a score of less than 86.9 increase the malnutrition risk in geriatric patients hospitalized for respiratory failure in ICU.

Is Onodera's prognostic nutritional index (OPNI) a prognostic factor in small cell lung cancer (SCLC)?

INTRODUCTION: We aimed to evaluate the prognostic value of Onodera's prognostic nutritional index (OPNI) in patients with Small-cell lung cancer (SCLC). MATERIALS AND METHODS: This study retrospectively examined 109 patients diagnosed with SCLC between January 2008 and October 2018 in our hospital. Patients were divided into two groups according to the median of OPNI values. RESULTS: A significant difference was observed between the groups in terms of neutrophil percentage, lymphocyte count, lymphocyte percentage, C-reactive protein (CRP), albumin, lactat dehidrogenase (LDH) and neutrophil to lymphocyte ratio (NLR) (P < 0.05). LDH, CRP, neutrophil percentage and NLR (P = 0.008, P < 0.001, P = 0.001, P < 0.001, respectively) were significantly higher and albumin, lymphocyte count and lymphocyte percentage (P < 0.001, P < 0.001, P = 0.001, respectively) were significantly lower in the low OPNI group. Survival analyses have shown that mortality rates and lifespan are similar in the two groups. CONCLUSION: The OPNI may be a helpful tool for determining the prognosis in SCLC.

Relationship between metabolic syndrome and epicardial fat tissue thickness in patients with chronic obstructive pulmonary disease.

OBJECTIVE: An increase in epicardial fat tissue (EFT) thickness was found to be associated with metabolic syndrome (MS) and ischemic heart disease. MS is a comorbidity of chronic obstructive pulmonary disease (COPD) resulting from the accompanying systemic inflammation. The aim of our study was to investigate the usefulness of EFT thickness to predict MS in COPD patients. METHODS: COPD patients admitted to our clinic during January-December 2014 and healthy controls were included in this prospective case control study. Patients with comorbidities, COPD exacerbation, and malignancies were excluded. Patients and controls were compared in terms of anthropometric measurements, MS-related examination and laboratory findings, pulmonary function tests, and EFT thickness. The correlations between EFT thickness and markers of MS in COPD were evaluated using the Student's t-test and logistic regression analysis. RESULTS: COPD patients and controls were composed of 82 and 84 individuals, respectively. MS was diagnosed in 31 (37.8%) COPD patients. The EFT thickness was significantly higher in COPD patients than in the controls and was also higher in COPD patients with MS than in those without MS (all p<0.001). Each 1-mm increment of EFT raised the risk of MS two-fold (p=0.011, OR=2.08, 95% CI: 1.18-3.68). Increase in triglyceride level (p=0.004, OR=1.02, 95% CI: 1.01-1.03) and reduction in forced vital capacity (p=0.025, OR=0.26, 95% CI: 0.08-0.84) were found to be associated with increased MS risk. The cut-off value for EFT thickness in the prediction of MS in COPD patients was 6.75 mm (sensitivity: 83%, specificity: 65%). CONCLUSION: EFT thickness is a non-invasive and easily available parameter, which is valuable in the prediction of increased MS risk in COPD patients. Early diagnosis of patients at risk of MS may help to prevent ischemic heart disease in these patients.

The impact of anti-smoking laws on high school students in Ankara, Turkey / O impacto das leis antifumo em alunos do ensino médio em Ancara, Turquia

ABSTRACT OBJECTIVE: To determine the factors affecting the smoking habits of high school students, their thoughts about changes resulting from anti-smoking laws, and how they are affected by those laws. METHODS: In this cross-sectional study, 11th-grade students at eight high schools in Ankara, Turkey, were invited to complete a questionnaire. RESULTS: A total of 1,199 students completed the questionnaire satisfactorily. The mean age of the respondents was 17.0  0.6 years; 56.1% were female, of whom 15.3% were smokers; and 43.9% were male, of whom 43.7% were smokers (p < 0.001). The independent risk factors for smoking were male gender, attending a vocational school, having a sibling who smokes, having a friend who smokes, and poor academic performance. Of the respondents, 74.7% were aware of the content of anti-smoking laws; 81.8% approved of the restrictions and fines; and 8.1% had quit smoking because of those laws. According to the respondents, the interventions that were most effective were the (television) broadcast of films about the hazards of smoking and the ban on cigarette sales to minors. The prevalence of smoking was highest (31.5%) among students attending vocational high schools but lowest (7.5%) among those attending medical vocational high schools. Although 57.1% of the smokers were aware of the existence of a smoking cessation helpline, only 3.7% had called, none of whom had made any attempt to quit smoking. CONCLUSIONS: Although most of the students evaluated were aware of the harmful effects of smoking and approved of the anti-smoking laws, only a minority of those who smoked sought professional help to quit.

RESUMO OBJETIVO: Determinar os fatores que afetam os hábitos de fumar de estudantes do ensino médio, seus pensamentos sobre as mudanças resultantes das leis antifumo e como eles são afetados por essas leis. MÉTODOS: Neste estudo transversal, alunos do 11º ano de oito escolas de ensino médio em Ancara, Turquia, foram convidados para preencher um questionário. RESULTADOS: Preencheram o questionário 1.199 estudantes de forma satisfatória. A média de idade dos participantes foi de 17,0  0,6 anos; 56,1% eram mulheres; das quais 15,3% eram fumantes; e 43,9% eram homens, dos quais 43,7% eram fumantes (p < 0,001). Os fatores de risco independentes para o tabagismo foram ser homem, frequentar escola técnica, ter um irmão/irmã que fuma, ter um amigo que fuma e ter baixo desempenho acadêmico. Dos participantes, 74,7% conheciam o conteúdo das leis antifumo; 8,1% aprovavam as restrições e multas, e 8,1% haviam cessado o tabagismo devido a essas leis. Na opinião dos participantes, as intervenções mais efetivas foram a exibição de curtas na TV sobre os malefícios do tabagismo e a proibição da venda de cigarros a menores. A prevalência do tabagismo foi maior (31,5%) nos estudantes de escolas técnicas, mas menor (7,5%) nos estudantes de escolas técnicas médicas. Embora 57,1% dos fumantes soubessem da existência de um serviço telefônico de ajuda para a cessação tabágica, somente 3,7% haviam ligado para esse serviço, mas nenhum tentou parar de fumar. CONCLUSÕES: Embora a maioria dos alunos avaliados conhecesse os efeitos deletérios do tabagismo e aprovasse as leis antifumo, apenas uma minoria dos fumantes procurou ajuda profissional para a cessação tabágica.

Differences in evaluation between geriatric and adult patients requiring pulmonary consultation.

OBJECTIVE: The main aim of the study was to investigate the effects of age in pulmonary consultation and to evaluate differences between geriatric and adult patients. MATERIAL AND METHODS: Consultation referrals to the clinic of chest diseases for patients from emergency, inpatient and outpatient clinics of a tertiary care general hospital between December 2010 and April 2011 were examined retrospectively. The patients were divided into two groups, namely those aged 65 years and over (geriatric patients) and those under the age of 65 years (adults). RESULTS: Out of 272 patients 135 (49.6%) were geriatric patients and 137 (50.4%) were adult patients. The mean age of the geriatric patients and adults was 75.6±7.1 years and 49.7±11.8 years, respectively. While the geriatric patients showed a significantly higher presence of pathologies in chest radiography, respiratory complaints and concomitant diseases compared to the adult group, the respiratory function test results were lower. The complaint of shortness of breath was higher in the geriatric group compared to the adult group (71% in geriatric patients and 59.1% in adults). The most common diagnosis was chronic obstructive pulmonary disease (COPD, 37%) in the geriatric patients and asthma (27.7%) in the adult patients. As to the results of consultations, treatment-oriented recommendations were given for 63 (46.6%) geriatric patients and approval for operation was given for 75 (54.7%) adult patients. CONCLUSION: Consultants should take the age of patients into consideration during evaluation in order to achieve the most appropriate treatment plan for these patients and reduce the potential postoperative complications to a minimum.

The impact of anti-smoking laws on high school students in Ankara, Turkey.

OBJECTIVE: To determine the factors affecting the smoking habits of high school students, their thoughts about changes resulting from anti-smoking laws, and how they are affected by those laws. METHODS: In this cross-sectional study, 11th-grade students at eight high schools in Ankara, Turkey, were invited to complete a questionnaire. RESULTS: A total of 1,199 students completed the questionnaire satisfactorily. The mean age of the respondents was 17.0  0.6 years; 56.1% were female, of whom 15.3% were smokers; and 43.9% were male, of whom 43.7% were smokers (p < 0.001). The independent risk factors for smoking were male gender, attending a vocational school, having a sibling who smokes, having a friend who smokes, and poor academic performance. Of the respondents, 74.7% were aware of the content of anti-smoking laws; 81.8% approved of the restrictions and fines; and 8.1% had quit smoking because of those laws. According to the respondents, the interventions that were most effective were the (television) broadcast of films about the hazards of smoking and the ban on cigarette sales to minors. The prevalence of smoking was highest (31.5%) among students attending vocational high schools but lowest (7.5%) among those attending medical vocational high schools. Although 57.1% of the smokers were aware of the existence of a smoking cessation helpline, only 3.7% had called, none of whom had made any attempt to quit smoking. CONCLUSIONS: Although most of the students evaluated were aware of the harmful effects of smoking and approved of the anti-smoking laws, only a minority of those who smoked sought professional help to quit.

Carcinosarcoma of the lung associated with neurofibromatosis type 1: a case report.

Neurofibromatosis or von Recklinghausen's disease is the most common inherited syndrome predisposing to neoplasia. Carcinosarcoma is a rare malignant mixed tumor of the lung. Association of carcinosarcoma of lung with Neurofibromatosis-1 is not common. A 57-year-old man presented with history of fever, cough, hemoptysis, breathlessness, weight loss, chest pain. Multiple cutaneous neurofibromas and café au lait spots were revealed by physical examination. A homogeneous opacity was found in the right middle and right upper zone on posterior-anterior chest radiography. A 8x8x7 cm mass that had irregular borders in right upper posterior and apical segment was seen on contrast enhanced chest computed tomography. On bronchoscopy, the lumen of right upper apical segment was obstructed with vegetating tumoral lesion. The biopsy taken from this region was diagnosed as carcinosarcoma by histopathological and immunohistochemical examination.A rare case with carcinosarcoma of the lung and Neurofibromatosis-1 was reported.