Can development of asthma and bronchial hyperreactivity be reduced by subcutaneous immunotherapy in adult patients with allergic rhinitis?

BACKGROUND: Allergic rhinitis can be associated with bronchial hyperreactivity (BHR) and create an increased risk for allergic asthma development. We aimed to investigate the effects of subcutaneous immunotherapy (SCIT) on BHR and asthma development in adult patients with allergic rhinitis. METHODS: The retrospective case-control study was carried out between November 2018 and May 2019 in Süreyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital. In this study, data was recorded for patients with a mite and/or grasses/cereals pollen allergy who were tested for BHR before planned SCIT, and who had allergic rhinitis, with or without asthma. The SCIT group was selected as those who received SCIT for at least one year. The control group was selected from those who were scheduled to receive SCIT but were waived and still receiving medication. Symptom scores, prick test results, PC20 levels (methacholine challenge that is a provocative concentration causing a 20% fall in FEV1), and the presence of asthma were recorded and compared with data from at least one year after treatment. RESULTS: A total of sixty-eight subjects (22 males, 46 females; mean age 40.54 ± 12.27 years; SCIT: 40, Control: 28) were enrolled.Although the changes in log PC20 levels were not statistically significant in both SCIT and control groups after an average of 30-35 months of treatment, it was found to be significant in favor of the SCIT group when two groups were compared in terms of the change in log PC20 (p = 0.026). The development and improvement of asthma were not significantly different between the SCIT and control group but tended to increase in the control group. The percentage of patients with progressed/BHR was significantly higher in the controls (70.6% vs. 38.1%, p = 0.046). DISCUSSION: In our real life study we have demonstrated the preventative effect of SCIT on BHR, but not on asthma developmen.

Progressive pulmonary fibrosis (PPF).

Progressive pulmonary fibrosis (PPF) is defined as the presence of at least two of the three criteria, which are worsening respiratory symptoms, functional decline, and radiological progression in patients with interstitial lung disease with radiological pulmonary fibrosis for known or unknown reasons other than IPF, within the previous year (1). A conditional recommendation has been made for nintedanib in the treatment of PPF, and further studies are needed for pirfenidone (1). In this review, the diagnostic and therapeutic approach to progressive pulmonary fibrosis with its new name, previously known as progressive fibrotic interstitial lung diseases, will be discussed, accompanied by updates.

Does eosinophilia and neutrophil to lymphocyte ratio affect hospital re-admission in cases of COPD exacerbation?

INTRODUCTION: We aimed to assess the relationship between peripheral eosinophilia and neutrophil/lymphocyte ratio with hospital admissions and re-admissions with chronic obstructive pulmonary disease (COPD) exacerbations. MATERIALS AND METHODS: An observational cohort study was carried out in a tertiary teaching hospital. Subjects with previously diagnosed COPD and who were admitted as outpatients with acute exacerbations were included. The subjects' characteristics, complete blood count (CBC) parameters, neutrophil to lymphocyte rate (NLR), C-reactive protein (CRP), mean platelet volume (MPV) on admission and re-admission within the first 28 days. Patients were grouped according to their peripheral blood eosinophilia levels; group 1, > 2% (eosinophilic), group 2, ≤ 2% (non-eosinophilic or neutrophilic). The recorded data from the two groups were compared. RESULT: 1490 eligible COPD subjects were enrolled. Approximately 42% were classified as eosinophilic. The non-eosinophilic group had a significantly higher leukocyte count, neutrophil percentage, and NLR than the eosinophilic group. The NLR value in patients with repeat re-admissions was higher than the average, i.e., 4.50 (p= 0.001). MPV and CRP measured on admission and re-admission were similar in both groups. The rate of hospital re-admission within 28 days was significantly higher in patients with a non-eosinophilic attack. CONCLUSIONS: When a patient is admitted to outpatients with a NLR greater than 4.50 and with a non-eosinophilic exacerbation they have an increased risk of re-admission in the first month. Higher NLR values and non-eosinophilic exacerbations may be helpful for the early detection of potential acute attacks in COPD patients, and may be indicators for antibiotic management.

Should patients with risk factors be tested for hypersensitivity to contrast media: a prospective study.

BACKGROUND: Previous hypersensitivity reactions to contrast media (CM), atopy, atopic disease, drug allergy, and age (20-29 or >55) are risk factors for CM hypersensitivity reactions. Our aim was to evaluate whether these risk factors should prompt skin testing for diagnosing CM allergy. METHODS: The study was conducted among patients referred for allergy testing with CM. Skin tests were performed with non ionic or gadolinium CM, recommended by a radiologist. After completion of tests patients were telephonically queried on their symptoms of reactions. RESULTS: 151 risk patients (53 men, 98 women; mean age 55.2) were included in the study. Only 13 (9 %) had a history of hypersensitivity reaction to CM. Compared with the other patients, atopy was significantly more common in patients with a history of CM hypersensitivity reactions. Female gender and mean age were also higher, but not significant. All of the tests with CMs were negative. Only one patient reported urticaria within 1-2 min after administration of CM (telephonically). CONCLUSIONS: Atopy can increase the risk of CM allergy. However, skin tests with CMs may be inefficient, unnecessary, and time-consuming, except in cases with a history of CM allergy. Premedication protocols appear to be beneficial in patients with a history of CM allergy and cannot be recommended for patients with well-controlled asthma, rhinitis, atopic dermatitis or history of drug allergy.

[A case of Takayasu's arteritis with endobronchial involvement]. / Endobronsiyal tutulum gösteren Takayasu arteriti olgusu.

Takayasu arteritis (TA) is a large vessel vasculitis especially seen in young women. Because of nonspecific symptoms diagnois is difficult and confused with other diseases. Delayed treatment increase morbidity and mortality. It effects primarly pulmonary artery in lung involvement. To our knowledge endobronchial involvement has not been reported previously in the literature. Due to rarity we present our patient whom we observed with the diagnosis of endobronchial tuberculosis and confirmed the diagnosis of Takayasu arteritis after 9 months.

Are Lymphocytes and Eosinophils Associated with the COVID-19 Severity: A Large, Retrospective Study.

OBJECTIVE: Coronavirus disease 2019 is an ongoing disease with high morbidity and mortality. We aimed to investigate the relationship between demographics, lymphocytes, eosinophils, and the coronavirus disease 2019 severity at hospital admission. MATERIAL AND METHODS: A retrospective, observational cross-sectional study was carried out with 5828 coronavirus disease 2019 patients between March 11, 2020, and November 30, 2020. Patients were divided into 3 groups according to where they were followed up as an indicator of disease severity, namely outpatients, inpatients, and critically ill patients. The patients' demographics and hemogram values on admission were recorded. The predictive accuracies of lymphocyte count, lymphocyte percentage, eosinophil count, and eosinophil percentage for predicting severity were determined using receiver operating characteristic curves. Logistic regression analysis was used to predict intensive care unit demand according to lymphocyte and eosinophil values. RESULTS: Of the 5828 coronavirus disease 2019 patients, 4050 were followed up as outpatients, 1581 were hospitalized in a ward, and 197 were hospitalized in the intensive care unit. Lymphocyte count and lymphocyte percentage were significantly different between the groups, but the difference for eosinophil count and eosinophil percentage was not significant as it was for lymphocytes. Cutoff values for lymphocyte count (1.0 × 109 /L), lymphocyte percentage (22%), eosinophil count (0.052 × 109 /L), and eosinophil percentage (0.08%) were found to indicate a high risk for intensive care unit admission. Coronavirus disease 2019 patients >55 years of age, with a lymphocyte count <1.0 × 109 /L, a lymphocyte percentage <22%, and an eosinophil percentage <0.08% had a 2-fold higher risk of requiring intensive care unit management. CONCLUSION: Lymphocyte counts and percentages are quick and reliable biomarkers for predicting coronavirus disease 2019 severity and may guide physicians for proper management earlier.

The utility of neutrophil-to-lymphocyte ratio determined at initial diagnosis in predicting disease stage and discriminating between active and stable disease in patients with sarcoidosis: a cross-sectional study.

OBJECTIVE: To evaluate the utility of neutrophil-lymphocyte ratio (NLR) determined at initial diagnosis in predicting advanced disease stage and discriminating between active and stable disease in sarcoidosis. METHODS: A total of 465 patients with biopsy-proven sarcoidosis (age: 47 years, 70.5% females) were included in this retrospective cross-sectional study. Data on patient demographics, sarcoidosis stage, clinical status (stable and active), anti-inflammatory treatments, complete blood count, and inflammatory markers including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR) and platelet/mean platelet volume (MPV) ratio were recorded. NLR values were compared by subgrouping the patients according to the stage of sarcoidosis and clinical status, while the receiver operating characteristics (ROC) curve was plotted to determine the role of NLR in the identification of disease activity with the calculation of area under the curve (AUC) and cutoff value via ROC analysis. RESULTS: Overall, active, and stable disease was evident in 36 (7.8%) and 427 (92.2%) patients, respectively. Median NLR values were significantly higher in patients with active disease compared with stable disease (3.31 (2.34-4.31) vs. 2.29 (1.67-3.23), p = 0.005). Advanced sarcoidosis stage was associated with significantly higher NLR values at stages 0, I, II, III and IV, respectively (p = 0.001). ROC analysis revealed an NLR cutoff value of ≥2.39 (AUC (95% CI): 0.70 (0.62-0.79), p < 0.001) to discriminate between active and stable clinic with a sensitivity of 72.0% and specificity of 52.0%. The significantly higher percentage of patients with active vs. stable disease had NLR values ≥2.39 (74.0 vs. 47.0%, p = 0.002). CONCLUSION: Our findings indicate the potential utility of on-admission NLR values to predict the risk of advanced disease stage and to discriminate between active and stable disease in sarcoidosis. Measured via a simple, readily available, and low-cost test, NLR seems to be a valuable marker for monitoring disease activity and progression.

Research Burden of Interstitial Lung Diseases in Turkey - RBILD.

Introduction: The aim of our study is to investigate the etiological distribution of ILD in Turkey by stratifying the epidemiological characteristics of ILD cases, and the direct cost of initial diagnosis of the diagnosed patients. Material-Method: The study was conducted as a multicenter, prospective, cross-sectional, clinical observation study. Patients over the age of 18 and who accepted to participate to the study were included and evaluated as considered to be ILD. The findings of diagnosis, examination and treatment carried out by the centers in accordance with routine diagnostic procedures were recorded observationally. Results: In total,1070 patients were included in this study. 567 (53%) of the patients were male and 503 (47%) were female. The most frequently diagnosed disease was IPF (30.5%). Dyspnea (75.9%) was the highest incidence among the presenting symptoms. Physical examination found bibasilar inspiratory crackles in 56.2 % and radiological findings included reticular opacities and interlobular septal thickenings in 55.9 % of the cases. It was observed that clinical and radiological findings were used most frequently (74.9%) as a diagnostic tool. While the most common treatment approaches were the use of systemic steroids and antifibrotic drugs with a rate of 30.7% and 85.6%, respectively. The total median cost from the patient's admission to diagnosis was 540 Turkish Lira. Conclusion: We believe that our findings compared with data from other countries will be useful in showing the current situation of ILD in our country to discuss this problem and making plans for a solution.

Association of Inflammatory Markers with Mortality in Patients Hospitalized with Non-massive Pulmonary Embolism.

OBJECTIVE: Pulmonary embolism (PE) is a serious pathology with high rates of morbidity and mortality. Studies regarding the efficacy of new inflammatory markers as a predictor of mortality in PE have thus far been limited. This study aimed to evaluate the predictive value of platelet/lymphocyte ratio (PLR), neutrophil/lymphocyte ratio (NLR), platelet/mean platelet volume (PLT/MPV), and C-reactive protein (CRP) on short-term and long-term mortality in patients with PE. MATERIAL AND METHODS: A retrospective, observational cohort study was carried out in a tertiary teaching hospital. Patients with PE hospitalized in the pulmonology ward were enrolled. Their characteristics, hemogram parameters, PLR, NLR, CRP levels, PLT/MPV on admission, and mortality were recorded. The predictive accuracies of inflammatory markers were determined through receiver operating characteristic curves. The risk factors for mortality were further analyzed with Cox regression analysis. RESULTS: A total of 828 patients with PE were included in the study. The 1-month mortality was 1%, and the 1-year mortality was 8.5%. An NLR value above 6 was associated with an almost 13-fold increase in short-term (30-day) mortality. We found that an NLR above 3.15 and age were independent risk factors for long-term (1-year) mortality. The other inflammatory markers, namely PLR and CRP, were not found to be associated with long-term mortality. CONCLUSION: PE is a serious condition in the elderly. Elevated NLR values appear to be a good and feasible predictor of inflammation, which can be correlated with higher mortality over both the short-term and long-term periods.

Targeting the Small Airways with Inhaled Corticosteroid/Long-Acting Beta Agonist Dry Powder Inhalers: A Functional Respiratory Imaging Study.

Background: Peripheral deposition of inhaled medication is important as small airway disease has a key role in asthma. In this study, we compared the lung deposition at different mean flow rates of three inhaled corticosteroid (ICS)/long-acting beta2-agonist (LABA) combinations delivered by dry powder inhaler (DPI), that is, Foster NEXThaler® (extrafine formulation of beclomethasone/formoterol), Relvar Ellipta® (fluticasone furoate/vilanterol trifenatate), and Symbicort Turbohaler® (budesonide/formoterol). Materials and Methods:In vitro drug delivery parameters were applied to lung computerized tomography (CT) scans of 20 asthma patients by functional respiratory imaging (FRI). Aerosol airway deposition patterns were calculated as percentage (standard deviation) intrathoracic versus extrathoracic deposition, percentage peripheral deposition, and central-to-peripheral (C/P) ratio at different inspiratory mean flow rates. Results: At 60 and 40 L/min, intrathoracic deposition of ICS/LABA was significantly higher with NEXThaler versus Ellipta. Peripheral deposition (60 L/min) with NEXThaler was higher than Ellipta for ICS (24.7% [3.5%] vs. 5.0% [2.0%]; p < 0.001) and LABA (25.3% [3.5%] vs. 13.0% [3.0%]; p < 0.001). C/P ratio with NEXThaler was lower (indicating higher peripheral deposition) than Ellipta (ICS: 0.63 vs. 1.63; LABA: 0.63 vs. 0.99). Inspiratory flow rate did not impact lung deposition with NEXThaler or Ellipta. In contrast, Turbohaler performance was negatively impacted by decreasing inspiratory flow rate. In fact, although lung deposition with Turbohaler was similar to that of NEXThaler at 60 L/min, lung deposition with Turbohaler was significantly lower than NEXThaler at both 40 L/min (∼30%) and 30 L/min (∼50%). Conclusions: Using FRI, we demonstrated better peripheral deposition and C/P ratios of ICS/LABA with NEXThaler versus Ellipta. NEXThaler demonstrated inspiratory flow rate independency of lung deposition versus Turbohaler. These findings suggest that the extrafine formulation is superior to large particle formulations in delivering ICS/LABA consistently both to the large and small airways.

Use of Radiology, D-Dimer, and Mean Platelet Volume Combination as a Prognostic Marker in Hospitalized Coronavirus Disease-19 Patients.

INTRODUCTION: The search for biomarkers that could help in predicting disease prognosis in the Coronavirus Disease-2019 (COVID-19) outbreak is still high on the agenda. OBJECTIVE: To find out the efficacy of D-dimer and mean platelet volume (MPV) combination as a prognostic marker in hospitalized COVID-19 patients with bilateral infiltration. MATERIALS AND METHODS: Study design: Retrospective observational cohort. Patients who were presented to our hospital between March 16, 2020 and June 07, 2020 were reviewed retrospectively. The primary outcome of the study was specified as the need for intensive care, while the secondary outcomes were duration of treatment and hospitalization. Receiver operator curve (ROC) analyzes were carried out to assess the efficacy of D-dimer and MPV parameters as prognostic markers. RESULTS: Between the mentioned dates, 575 of 1,564 patients were found to be compatible with COVID-19, and the number of patients who were included in the study was 306. The number of patients who developed the need for intensive care was 40 (13.1%). For serum D-dimer levels in assessing the need for intensive care, the area under the curve (AUC) was found to be 0.707 (95% CI: 0.620-0.794). The AUC for MPV was 0.694 (95% CI: 0.585-0.803), when D-dimer was ≥1.0 mg/L. When patients with a D-dimer level of ≥1.0 mg/L were divided into two groups considering the MPV cut-off value as 8.1, the rate of intensive care transport was found to be significantly higher in patients with an MPV of ≥8.1 fL compared to those with an MPV of <8.1 fL (32.6 vs. 16.0%, p = 0.043). For the prognostic efficacy of the combination of D-dimer ≥ 1.0 mg/L and MPV ≥ 8.1 fL in determining the need for intensive care, following values were determined: sensitivity: 57.7%, specificity: 70.8%, positive predictive value (PPV): 32.0%, negative predictive value (NPV): 84.0%, and accuracy: 63.0%. When D-dimer was ≥1.0, the median duration of treatment in MPV <8.1 and ≥8.1 groups was 5.0 [interquartile range (IQR): 5.0-10.0] days for both groups (p = 0.64). The median length of hospital stay (LOS) was 7.0 (IQR: 5.0-10.5) days in the MPV <8.1 group, while it was 8.5 (IQR: 5.0-16.3) days in the MPV ≥ 8.1 group (p = 0.17). CONCLUSION: In COVID-19 patients with a serum D-dimer level of at least 1.0 mg/L and radiological bilateral infiltration at hospitalization, if the MPV value is ≥8.1, we could predict the need for intensive care with moderate efficacy and a relatively high negative predictive value. However, no correlation could be found between this combined marker and the duration of treatment and the LOS.

The treatment results of patients with multidrug resistant tuberculosis and factors affecting treatment outcome.

The treatment of multi-drug resistant tuberculosis (MDR-TB) is complicated and results are not always satisfactory. We aimed to investigate treatment results of our patients, relapse rates, factors affecting treatment outcome. We evaluated prospectively, 142 patients, who had been hospitalised with diagnosis of MDR-TB in our clinic between January 1995-December 2000 at Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital in Istanbul, Turkey. All patients were male and human immunodeficiency virus negative. The mean age was 39 + or - 11 (16-65) years. A mean number of 5.5 + or - 0.8 (4-8) second line drugs, including one parenteral drug, were administered. Of 142 patients, 102 (71.8%) were classified as cured, 16 (11.3%) patients were defaulters, failure was seen in 10 (7.0%) patients and 14 (9.9%) patients died during treatment. Surgical resection was applied in 35 patients and cure was achieved in 88.5% of them. Of 102 patients who were cured, 89 (87.2%) were available for follow up and mean duration of follow up was 19.2 + or - 10.3 (12-72) months. Relapse was not detected in any of them. Patients with unsuccessful outcomes had a higher incidence and higher mean number of second-line drugs usage in previous regimens, higher incidence of antecedent prothionamide and ofloxacin usage, higher incidence of extensive radiologic involvement and withdrawal of responsible drugs due to adverse effects. Limited radiologic involvement, non-usage of antecedent prothionamide and adjuvant surgery were found as significant independent factors effecting successful treatment outcome. MDR-TB is a complex but a treatable disease. To know much more about the factors effecting treatment results and to arrange the proper conditions, are expected to make increases in the success rates of MDR-TB treatment.

Influence of comorbidities in long-term survival of chronic obstructive pulmonary disease patients.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of mortality and morbidity around the world, with comorbidities in COPD being common and having a negative effect on survival. We investigate the effects of comorbidities on long-term survival of COPD patients. METHODS: The study included patients with COPD who were hospitalized with an exacerbation. The demographic characteristics, hematological and biochemical parameters, pulmonary function test parameters and comorbidities of the patients were obtained from the hospital database and patient records, and the mortality of the patients was assessed at two years. The parameters considered to be related to mortality were analyzed using the Cox regression method. RESULTS: A total of 826 patients with COPD were included in the study, and the rate of patients with at least one comorbidity was 84.5%. The most common comorbidities were hypertension (n=394, 47.7%), heart failure (n=244, 29.5%) and DM (n=173, 20.9%). In a Cox regression analysis, the Charlson Comorbidity Index was strongly associated with mortality (P=0.000). In Kaplan-Meier analysis, a significant association was noted between the increasing number of comorbidities and long-term mortality, when compared to the patients without comorbidity (comorbidity numbers 1, 2 and ≥3; HR: 1.37, P=0.032, HR: 1.40, P=0.028 and HR: 1.65, P=0.000, respectively). CONCLUSIONS: Increasing number of comorbidities in COPD patients with severe exacerbation were found to negatively affect long-term survival. We consider both the evaluation and treatment of comorbidities to be important in the reduction of long-term mortality in patients with COPD.

Endobronchial Mucosal Neuroma with Sarcoidosis.

A first case of endobronchial mucosal neuroma with sarcoidosis is hereby reported. A 67-year female patient, who was diagnosed as sarcoidosis previously, was admitted to our hospital with symptoms of dyspnea, chest pain and fatigue. Middle lobe atelectasis and endobronchial lesion were observed in thorax computed tomography (CT). Fiberoptic bronchoscopy revealed polypoid lesions and histopathological examination of biopsy material showed clustered nerve bundles consistent with mucosal neuroma and non-necrotising granulomas consistent with sarcoidosis. Mucosal neuromas are pathognomonic features of multiple endocrine neoplasia (MEN) type 2B. But other components of MEN type 2B such as medullary tyroid carcinoma or pheochromocytoma were not detected in our patient. Hence, a diagnosis of solitary mucosal neuroma and sarcoidosis in the bronchi was made.

Cross-cultural Adaptation and Validation of Beliefs about Medicines Questionnaire on Asthma and Chronic Obstructive Pulmonary Disease Patients.

OBJECTIVES: Inadequate adaptation to long-term treatment of chronic illnesses is the most common reason for the inability to obtain the benefits medications can provide. Treatment compliance is influenced by several factors. Beliefs about Medicines Questionnaire (BMQ) developed by Horne et al. in 1999 to evaluate the cognitive representation of medicines have many validation studies, which resulted in good psychometric properties. The aim of the present study was to evaluate the reliability and validity of the BMQ Turkish translation in patients with asthma and chronic obstructive pulmonary disease (COPD). MATERIAL AND METHODS: Fifty asthma and 50 COPD patients participated in this methodological study. The scale was adapted to Turkish through translation, comparison with other language versions, back translation, and a pre-test. The structural validity was assessed using factor analysis. RESULTS: Similar to the original scale, factor analysis confirmed that BMQ had a four-factor structure that accounts for 58.23% of the total variance. The BMQ showed an acceptable internal consistency (Cronbach's alpha coefficient: specific-necessity, 0.832: specific-concerns, 0.722; general-harm, 0.792; and general-overuse, 0.682). The factor analysis revealed the same patterns for all questions between the Turkish and original scales. CONCLUSION: The psychometric properties of the BMQ were consistent with those reported in the original study. We found that the Turkish translation of BMQ is a valid and reliable tool for assessing medicine-related beliefs in patients with asthma and COPD.

A Revised Treatment Approach for Hospitalized Patients with Eosinophilic and Neutrophilic Exacerbations of Chronic Obstructive Pulmonary Disease.

OBJECTIVES: The choice of treatment according to the inflammation type in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) has been of recent interest. This study investigated the role of novel biomarkers, hospital outcomes, and readmission rates in the first month in patients with eosinophilic or neutrophilic AECOPD. MATERIALS AND METHODS: We conducted a retrospective observational cohort study in a Chest Teaching Hospital with hospitalized AECOPD patients. Subjects' characteristics, hemogram results, C-reactive protein (CRP), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), platelet/mean platelet volume (PLT/MPV), length of hospital stay, mortality, and steroid use were recorded. Eosinophilic AECOPD defined as peripheral blood eosinophilia (PBE) was >2% and neutrophilic AECOPD as PBE ≤2%. Readmission within 28 days of discharge was recorded. RESULTS: Of 2727(31.5% females) patients, eosinophilic AECOPD was found in 510 (18.7%) patients. Leucocytes, CRP, NLR, and PLR were significantly higher in neutrophilic AECOPD than in eosinophilic AECOPD (p<0.001). Steroid use and mortality rate were 45% and 0.6% in eosinophilic AECOPD and 71%, and 1.4% in neutrophilic AECOPD, respectively (p=0.001, p=0.19). Age >75 years, albumin <2.5 g/dL, CRP >50 mg/dL, and PLT/MPV <20×103 were found to be risks factors for hospital mortality (p<0.05 each). Readmission rates within 28 days of discharge were 5% (n=136), and this rate was higher in eosinophilic AECOPD patients not taking steroids (p<0.001). CONCLUSION: NLR, PLR, and CRP levels were higher in neutrophilic AECOPD compared with eosinophilic AECOPD. These markers decreased with treatment in neutrophilic AECOPD. A PLT/MPV ratio of <20×103 resulted in an increased mortality rate. Thus, appropriate steroid therapy may reduce readmission rates in the first 28 days after discharge in eosinophilic AECOPD.

[Follow-up hemoglobin concentrations in ICU: relationship between diagnostic blood loss and daily fluid balance]. / Yogun bakimda hemoglobin takibi: tanisal kan kaybi ve günlük sivi dengesi ile iliskisi.

UNLABELLED: To evaluate DeltaHb (daily changes of hemoglobin concentrations) in nonbleeding critically ill patients, and to investigate its relation with diagnostic blood loss (DBL) and fluid balance (FB). Hospital records of 34 nonseptic patients who stayed in respiratory intensive care unit (RICU) at least 72 hours with no evidence of acute bleeding, renal failure and bleeding diathesis, were evaluated retrospectively. Demographics, clinical features, acute physiology assessment and chronic health evaluation (APACHE) II scores, daily Hb levels, DBL and FB were recorded. Correlation statistics was performed between DeltaHb and DBL and FB. We compared the patients with DeltaHb > or =0.5 g/dL/day (group A) and the patients with DeltaHb < 0.5 g/dL/day (group B) in the first three days. The mean age was 55 +/- 14, Hb level was 13.2 +/- 1.7 g/dL at admission and 12.6 +/- 2.3 g/dL at discharge from RICU. DBL was 25.2 +/- 7.4 mL/d, and FB was 251 +/- 1783 mL/d for the first day in intensive care unit. DBL was lesser in subsequent days than in the first day but it wasn't significant. DeltaHb was -0.54 +/- 1.5 g/dL for the first three days, while it was -0.23 +/- 1.5 g/dL for subsequent four days (p= 0.9). DeltaHb in the first three days has no correlation with DBL and FB. Age, sex, APACHE II score, clinical features, DBL and FB were not differed between Group A and Group B. CONCLUSION: No relation was found between DeltaHb and DBL, and also FB; but studies like this are important to indicate that Hb concentrations may decrease in critically ill patients without any reason such as bleeding.

Rare Cause of Pleuropnemonia: Tularemia Disease.

Tularemia is a zoonotic infection which is caused by gram negative coccobacilli, Francisella tularensis. The disease occurs after contact with blood and body fluids of infected animals, bites and ingestion of infected food and water. Although it commonly presents with skin lesions, there may also be serious organ involvements. A55-year woman was consulted for presumptive diagnosis of tuberculosis. Multiple lymphadenopathy in right cervical area was present on physical examination. Pleural effusion on left side was detected with computed tomography. In detailed history, knowledge of a family member with the diagnosis of tularemia was obtained. Both of them had the history of contact with infected animals. Diagnosis of tularemia was confirmed with microagglutination test. With this patient who was initially presumptively diagnosed as tuberculosis, we aim to draw attention to diagnosis of tularemia in the presence of pleuropnemonia and peripheral lymphadenopathy and emphasize importance of detailed patient history.