Comparison of clinical and radiological characteristics of COVID-19 patients with and without pneumothorax and/or pneumediastinum.

Introduction: Pneumothorax (PTX) and pneumomediastinum (PM) are frequently encountered in patients with Coronavirus disease 2019 (COVID-19) and complicate the management of these patients. In this study, we aimed to evaluate the risk factors that cause PTX/PM complications in patients hospitalized due to COVID-19 pneumonia and the effects of these complications on the course of the disease. Materials and Methods: A total of 503 patients with COVID-19 hospitalized in the COVID-19 ward or intensive care unit (ICU) between September 2020 and December 2020 were included in the study. Result: The median age of patients was 65 (min-max, 21-99) years. Of the patients 299 (59.4%) were male and 204 (40.6%) were female. Of the cases, 26 (5.2%) developed PTX or PM. The patients who developed PTX/PM were older than patients who did not [58.5 (min-max, 21-96) vs 65 years (min-max, 22-99), p= 0.029]. The percentage of PTX/PM development was significantly higher in male patients [F/M= 4/22 (2/7.4%) vs 200/277 (98/92.6%), p= 0.007]. Hypertension as a comorbidity was more commonly seen in the group without PTX/PM (p= 0.007). Ground-glass opacity was the most common tomographic finding in both groups, it was significantly higher in those who did not develop PTX/PM (p<0.001). The length of hospital stay was shorter in patients with PTX/PM (p<0.001), but mortality was higher (p= 0.04). Conclusions: PTX/PM were relatively more common in COVID-19 patients. These complications may negatively affect the prognosis of the disease.

Development and validation of nomogram to predict severe illness requiring intensive care follow up in hospitalized COVID-19 cases.

BACKGROUND: Early identification of severe COVID-19 patients who will need intensive care unit (ICU) follow-up and providing rapid, aggressive supportive care may reduce mortality and provide optimal use of medical resources. We aimed to develop and validate a nomogram to predict severe COVID-19 cases that would need ICU follow-up based on available and accessible patient values. METHODS: Patients hospitalized with laboratory-confirmed COVID-19 between March 15, 2020, and June 15, 2020, were enrolled in this retrospective study with 35 variables obtained upon admission considered. Univariate and multivariable logistic regression models were constructed to select potential predictive parameters using 1000 bootstrap samples. Afterward, a nomogram was developed with 5 variables selected from multivariable analysis. The nomogram model was evaluated by Area Under the Curve (AUC) and bias-corrected Harrell's C-index with 95% confidence interval, Hosmer-Lemeshow Goodness-of-fit test, and calibration curve analysis. RESULTS: Out of a total of 1022 patients, 686 cases without missing data were used to construct the nomogram. Of the 686, 104 needed ICU follow-up. The final model includes oxygen saturation, CRP, PCT, LDH, troponin as independent factors for the prediction of need for ICU admission. The model has good predictive power with an AUC of 0.93 (0.902-0.950) and a bias-corrected Harrell's C-index of 0.91 (0.899-0.947). Hosmer-Lemeshow test p-value was 0.826 and the model is well-calibrated (p = 0.1703). CONCLUSION: We developed a simple, accessible, easy-to-use nomogram with good distinctive power for severe illness requiring ICU follow-up. Clinicians can easily predict the course of COVID-19 and decide the procedure and facility of further follow-up by using clinical and laboratory values of patients available upon admission.

Comparison of the diagnostic efficacy and complications of transbronchial biopsy in elderly and young patients.

INTRODUCTION: Among bronchoscopic procedures, transbronchial biopsy (TBB) is considered a high-risk procedure. In this study, we aimed to investigate the indications, diagnostic efficacy and complications of TBB in the elderly, which is accepted as a sensitive group. MATERIALS AND METHODS: The study was designed as a multicenter retrospective observational study. Data of 4226 patients who underwent diagnostic bronchoscopy were scanned for this study. 791 patients who underwent transbronchial biopsy were included in this study. All patients were evaluated in terms of lung regions, diagnosis, and complications. RESULT: A total of 791 patients, 329 (41.6%) female patients, who underwent TBB were included in the study. Mean age of the patients was 54.54 ± 14.94 years. The most common indications were ILD (45.6%), malignancy (24.0%) and sarcoidosis (9.9%). Mean age of the elderly patients (n= 263) was 69.89 ± 4.83 years, and mean age of the young patients (n= 528) was 46.90 ± 11.28 years (p<0.001). In both age groups, the most common indication was ILD. Complications developed during and after the procedure in 51 of the young patients (9.7%) and in 21 of the elderly (8.0%) (p= 0.441). The most common complication was pneumothorax with 4.6% in the elderly, and pneumothorax with 5.9% in the young (p= 0.441). The most common diagnosis was malignancy (12.2%) in the elderly, as the most common diagnosis was malignancy (7.2%) in the young (p = 0.020). While anthracosis, ILD and organized pneumonia were the other common diagnoses in the elderly, sarcoidosis, anthracosis and organized pneumonia were the other common diagnoses in the young. The diagnosis of sarcoidosis was achieved more frequently in the young (6.6%) than in the elderly (0.8%) (p<0.001). CONCLUSIONS: Transbronchial biopsy can be performed safely in elderly patients, with similar diagnostic success and complication rates to younger patients.

Endobronchial ultrasound: an unusual diagnostic tool for pulmonary embolism.

Pulmonary thromboembolism (PTE) is an emergent and common pulmonary vascular disease. The most common diagnostic method for PTE is computer-aided tomography angiography. Endobronchial ultrasonography (EBUS) is used in diagnosis and staging of lung cancer via transbronchial needle aspiration from mediastinal lymphadenopathies and central masses. Diagnosis of PTE with EBUS is not common, although this technique helps to monitor pulmonary vasculature. The present case, a 60-year-old female patient to whom EBUS was applied because of mediastinal lymphadenopathy, was diagnosed as incidental PTE.

[New bronchodilators and combinations in COPD treatment]. / KOAH tedavisinde yeni bronkodilatörler ve Kombinasyonlari.

Bronchodilator drugs are widely used therapeutic agents for treatment of asthma and chronic obstructive pulmonary disease (COPD). In order to mantain bronchodilation, both sympathetic system (particularly beta-2 receptors) activation and parasympathetic system inhibition (antimuscarinic effect) mechanisms are utilized. Over 20 years, there were no significant changes in bronchodilator therapy in obstructive pulmonary diseases. In recent years, however, after the development of new ultra long acting bronchodilator drugs, a single dose inhaler treatments per day in the treatment of stable COPD became a current issue. In this review, with the guidence of the current literature, the effects of new beta-2 agonists and anticholinergic bronchodilators will be discussed.

Pulmonary Langerhans cell histiocytosis; characteristics of 11 cases.

INTRODUCTION: Pulmonary Langerhans cell histiocytosis (PLCH) is a rarely seen disease of younger population. Almost all of the patients were smoker. In this study we aimed to evaluate the characteristics, diagnosis, treatment modalities and prognosis of 11 cases with PLCH. MATERIALS AND METHODS: We retrospectively reviewed our case series of eleven patients who were pathologically diagnosed as PLCH. The median age was 35 years (19-51) and male to female ratio (M/F) was 5/6. All of the patients were symptomatic. The most common symptoms were dyspnea (81.8%) and dry cough (72.7%). Mean duration of the symptoms was 10.8 months. All patients except two of them were smoker (81.8%). All patients were also passive smokers. RESULTS: Bilateral cystic appearance (n= 9, 81.8%), interstitial findings [septal and peribronchovascular thickening (72.7%) and nodular pattern (54.5%)] were common radiological findings. Spontaneous pneumothorax was present in two cases. All patients were diagnosed with surgical biopsies (90.9%) or transbronchial parenchymal biopsy (9.1%). Smoking cessation (81.8%) and immunosupression therapy (methylprednisolone) were the treatment modalities. Mean follow-up period was 5.40 ± 1.78 years. Generally, symptoms were improved with smoking cessation or methylprednisolone therapy. One patient was readmitted to our clinic with recurrent pneumothorax. In conclusion, it should be kept in mind that passive smoking is also responsible in the pathogenesis of PLCH. CONCLUSION: Exact consensus for PLCH treatment was not present except a few recommendations. In the future, with the understanding of the pathogenesis of the disease, new therapeutic agents will be discovered for this rare condition.

Risk factors for the development of interstitial lung disease following severe COVID-19 pneumonia and outcomes of systemic corticosteroid therapy: 3-month follow-up.

BACKGROUND: We aimed to evaluate the pulmonary involvement status, its related factors, and pulmonary function test (PFT) results in the first month follow-up in patients who were discharged for severe Covid-19 pneumonia, and to assess the efficacy of corticosteroid treatment on these parameters in severe pulmonary involvement patients. METHODS: We retrospectively analyzed all consecutive patients who applied to our COVID-19 follow-up clinic at the end of the first month of hospital discharge. Functional and radiological differences were compared after 3 months of corticosteroid treatment in severe pulmonary involvement group. Results We analyzed 391 patients with "pulmonary parenchymal involvement" (PPIG) and 162 patients with "normal lung radiology" (NLRG). 122 patients in the PPIG (corticosteroid-required interstitial lung disease group (CRILD)) had severe pulmonary involvement with frequent symptoms and required corticosteroid prescription. Pulmonary involvement was more common in males and elder patients (P<0.001, for both). Being smoker and elderly were associated with a higher risk-ratio in predicting to be in PPIG (OR:2.250 and OR:1.057, respectively). Smokers, male and elderly patients, and HFNO2 support during hospitalization were risk factors for being a patient with CRILD (OR:2.737, OR:4.937, OR:4.756, and OR:2.872, respectively). After a three-months of methylprednisolone medication, a good response was achieved on radiological findings and PFT results in CRILD. CONCLUSIONS: In conclusion, after severe COVID-19 pneumonia, persistent clinical symptoms and pulmonary parenchymal involvement would be inevitable in elder and smoker patients. Moreover, corticosteroid treatment in patients with severe parenchymal involvement was found to be effective in the improvement of radiological and functional parameters.

An extremely rare case of multiple calcifying tumor of the pleura.

Calcifying fibrous tumors are uncommon lesions. These lesions are made up of hyalinized collagenous fibrotic tissues interspersed with lymphoplasmacytic infiltrates and extensive dystrophic calcifications mimicking psammomatous features. Calcifying tumor of pleura is rarely presented. Multiple calcifying tumor of pleuras have been reported extremely seldom. Forty-year-old male patient was admitted to our clinic with complaints of dyspnea. Because of the multiple soft tissue formations at the pleural region with the largest diameter of 2 cm on thorax computed tomography, surgical intervention was planed. Frozen sections of pleural biopsies that were taken during video-assisted thoracoscopic surgery were reported as calcifying fibrous tumor. Because of the presence of multiple lesions and pleural adhesions, curative pleural decortication was performed. This case is presented with extremely rare entity of multiple calcifying tumor of plevras.

Atherogenic Indices Can Predict Atherosclerosis in Patients with Sarcoidosis.

BACKGROUND: Sarcoidosis, a multisystemic disease of unknown etiology, is characterized by non-caseating granulomatous inflammation. This study aimed to investigate the efficiency of atherogenic indices and ultrasonographic evaluation of carotid artery on predicting atherosclerosis in patients with sarcoidosis. METHODS: The study included 44 subjects followed with diagnosis of sarcoidosis and 53 age and gender matched healthy subjects as controls. Laboratory findings, pulmonary function tests and carotid artery ultrasonography of all participants were evaluated. RESULTS: Of the participants with sarcoidosis 70.5% was female and the mean age was 35.36±7.18 years, while 64.2% of the control group were female and the mean age was 33.58±8.13 years (P=0.511 and P=0.191, respectively). High-density-lipoprotein cholesterol level in the sarcoidosis group was significantly lower than that of the control group (P=0.017), while other cholesterol levels were higher than those of the controls (P<0.05). Intima-media thickness (IMT) and peak systolic velocity (PSV) of carotid artery were higher in patients with sarcoidosis (P<0.001 and P=0.009, respectively). Atherogenic indices (Atherogenic Index (AI), Atherogenic Coefficient (AC) and Cardiogenic Risk Ratio (CRR)) were higher in sarcoidosis group compared to the controls (P<0.001, for all parameters). IMT was positively correlated with PSV, AI, AC, and CRR. A positive correlation between PSV and atherogenic indices was also detected. CONCLUSIONS: Sarcoidosis may be a predisposing factor for atherosclerosis. Atherogenic indices, IMT of carotid artery and PSV might be considered predictors for atherosclerosis and cardiovascular diseases in asymptomatic sarcoidosis patients.

Effect of chronic lung diseases on mortality of prevariant COVID-19 pneumonia patients.

Background: The aim of the study is to assess the effect of chronic lung disease on mortality in patients hospitalized with the diagnosis of prevariant COVID-19 Pneumonia compared to patients without chronic lung disease. Research design and methods: A cohort of 1,549 patients admitted to the pandemic clinic with a COVID-19 Pneumonia diagnosis was analyzed. Group 1 and Group 2 were compared in terms of the treatment they received, admission to intensive care, mortality and follow-up parameters. Results: The patient group with COVID-19 and lung disease consisted of 231 participants (14.91%) (Group 1). The patient group with COVID-19 but without lung disease had 1,318 participants (85.19%). Group 1 cases were found to receive more oxygen therapy and mechanical ventilation than Group 2 cases (p ≤ 0.001), Following univariate and multiple logistic regression analyses, it was determined that patients with chronic lung disease had a 25.76% higher mortality risk [OR: 25.763, 95% CI (Lower-Upper) (2.445-271.465), p = 0.007]. Conclusion: It was found that chronic lung disease contributed significantly to mortality in this study. Among chronic lung diseases, Chronic Obstructive Pulmonary Disease (COPD), lung cancer and interstitial lung diseases (ILDs) were shown to be more effective than other chronic lung diseases in patients with prevariant COVID-19 population.

A different technique in the treatment of intraparenchymally located needle aspiration: turn it around-see-move out.

Although foreign body aspiration is common in children and the elderly, it is very rare in young people. However, headscarf needle aspiration is common in Muslim societies, especially in young people. In needle aspirations that cannot be removed by bronchoscopic methods, thoracotomy is frequently essential method due to the sliding of the needle to the distal part of the lung. A 21-year-old female patient was referred from our emergency department to our clinic with the preliminary diagnosis of needle aspiration. Needle was not visualized by fiberoptic bronchoscopy. Video-assisted thoracoscopic surgery (VATS) was performed and the needle was removed successfully by a maneuver which we encountered for the first time in the literature. Our patient was discharged on the second postoperative day.

Immunization status in chronic obstructive pulmonary disease: A multicenter study from Turkey.

OBJECTIVE: The purpose of this study is to detect the prevalence and the factors associated with influenza and pneumococcal vaccination and outcomes of vaccination during 2013-2014 season in patients with chronic obstructive pulmonary disease (COPD) in Turkey. METHODS: This was a multicenter retrospective cohort study performed in 53 different centers in Turkey. RESULTS: During the study period, 4968 patients were included. COPD was staged as GOLD 1-2-3-4 in 9.0%, 42.8%, 35.0%, and 13.2% of the patients, respectively. Influenza vaccination rate in the previous year was 37.9%; and pneumococcus vaccination rate, at least once during in a life time, was 13.3%. Patients with older age, higher level of education, more severe COPD, and comorbidities, ex-smokers, and patients residing in urban areas had higher rates of influenza vaccination. Multivariate logistic regression analysis showed that advanced age, higher education levels, presence of comorbidities, higher COPD stages, and exacerbation rates were associated with both influenza and pneumococcal vaccination. The number of annual physician/outpatient visits and hospitalizations due to COPD exacerbation was 2.73 ± 2.85 and 0.92 ± 1.58 per year, respectively. Patients with older age, lower education levels, more severe COPD, comorbid diseases, and lower body mass index and patients who are male and are residing in rural areas and vaccinated for influenza had significantly higher rates of COPD exacerbation. CONCLUSIONS: The rates of influenza and pneumococcal vaccination in COPD patients were quite low, and the number of annual physician/outpatient visits and hospitalizations due to COPD exacerbation was high in Turkey. Advanced age, higher education levels, comorbidities, and higher COPD stages were associated with both influenza and pneumococcal vaccination.

The publication rates of abstracts presented at the Turkish Respiratory Society (TUSAD) annual congress: adequate or not?

OBJECTIVE: In this study, we aimed to determine the publication status of the abstracts presented at the Turkish Respiratory Society Congress between 2011 and 2014. METHODS: The abstracts were classified according to presentation type (oral presentations, poster discussion, etc.), study type, study design, topic, publication status, time interval between the presentation and the publication date, and the journal in which the article was published. The conversion rate of presentations into full-text articles in peer-reviewed journals were surveyed through Elsevier's Scopus. RESULTS: The total number of abstracts submitted in the congress was 2 009. In terms of study type, the majority of abstracts were case reports (56.4%) and the remainder was original research. Totally, 179 abstracts were published in an indexed journal with an overall publication rate of 8.9%. 18.3% of oral presentations were converted into full-text article. Publication rates according to study types were 14.8% for original researches and 4.4% for case reports. The first three subspecialties with the highest publication rates were "sleep related breathing disorders" (16.9%), "interventional pulmonology" (16.7%) and "pleural diseases" (15.2%). Median publication/acceptance time was 8.0 months (0-38). CONCLUSION: This is the first study evaluating the publication rates of abstracts presented in a respiratory congress. Although the number of presented abstracts in the congress increased year by year, prominently in the case reports, over all conversion rates were decreased. We put forward that encouraging the authors to conduct higher-quality investigations would raise the publication rate as well as improve the scientific quality of congress.

New Predictor of Atherosclerosis in Subjects With COPD: Atherogenic Indices.

BACKGROUND: We aimed to investigate the predictor role of the plasma levels of lipid parameters and atherogenic indices on development of atherosclerosis in subjects with COPD. METHODS: We retrospectively analyzed 104 male subjects diagnosed with stable COPD in hospital records. We excluded subjects with exacerbation, with known cardiovascular diseases and other chronic diseases, receiving anti-hyperlipidemic treatment, without sufficient past medical history, and lacking needed laboratory data. Additionally, 40 age-matched male healthy controls were also enrolled. C-reactive protein, total cholesterol, triglycerides, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol levels of COPD and the control group were analyzed. Atherogenic indices (atherogenic index of plasma, cardiogenic risk ratio, and atherogenic coefficient) were calculated. RESULTS: C-reactive protein, triglyceride, atherogenic index of plasma, cardiogenic risk ratio, and atherogenic coefficient values were significantly higher in subjects with stable COPD than in control subjects (P < .05 for all). High-density lipoprotein cholesterol level was significantly lower in subjects with COPD than in the control group (P < .001). C-reactive protein, lipid profiles, and atherogenic indices were similar in lower-risk (stage A and B) and higher-risk (stage C and D) subjects with COPD. Cardiogenic risk ratio and atherogenic coefficient were negatively correlated with FEV1 in all stable subjects with COPD and in higher-risk subjects with COPD (r = -0.27, P = .01 and r = -0.35, P = .01, respectively). CONCLUSIONS: We concluded that atherogenic indices (atherogenic index of plasma, cardiogenic risk ratio, atherogenic coefficient) could be considered as a useful predictor for atherosclerosis and cardiovascular diseases in stable COPD patients. Nevertheless, further prospective investigations on this issue are warranted.

Comparison of the Anti-inflammatory Effects of Proanthocyanidin, Quercetin, and Damnacanthal on Benzo(a)pyrene Exposed A549 Alveolar Cell Line.

Phytochemical compounds are emerging as a new group of anti-inflammatory, antioxidant, and anti-cancer agents that help minimize toxicity in patients with pulmonary diseases. The goal of this study was to investigate the potential curative effects of Quercetin (QC), Damnacanthal (DAM), and Proanthocyanidine (PA) on inflammatory mediators and oxidative stress parameters and to examine the viability of the A549 cell line treated with benzo(a)pyrene (BaP) in vitro. The A549 cell line was treated with BaP, a BaP/QC combination, a BaP/DAM combination, and BaP/PA combination. Inflammatory markers, oxidative stress parameters, mRNA expression levels of apoptotic and antiapoptotic proteins, and cell viability were assessed, and the results were compared. There were higher levels of lactate dehydrogenase after BaP treatment of A549 cell lines. Interferon-γ level significantly decreased in the QC, DAM, and PA-treated group (P < 0.001). IL-1ß and TNF-α levels significantly decreased after PA and QC treatments (P < 0.001). Some of the oxidative stress markers (NO, MDA, TOS) and OSI decreased, while antioxidant (GSH) levels increased after treatment with QC, DAM, and PA. The QC and DAM treatments profoundly upregulated apoptotic gene expression and downregulated antiapoptotic gene expression. Viability of QC, DAM, and PA-treated cells was found to be significantly higher in comparison to the control and BaP-treated groups (p < 0.001). Our results revealed that A549 cell lines treated with BaP-stimulated necrosis produced higher level of inflammatory cytokines and oxidative stress parameters. Treatments with PA, QC, and DAM reduced inflammatory response induced by BaP exposure.

An unusual metastasis of lung adenocarcinoma: Biceps brachii muscle.

Skeletal muscle metastasis of nonsmall cell lung carcinoma (NSCLC) is a rare occurrence, and the most effective treatment modality is currently unknown. In this case presentation, we report a patient with NSCLC who underwent palliative radiotherapy for biceps muscle metastasis of NSLCS. Our case was a 49-year-old woman who had lung adenocarcinoma with biceps muscle metastasis. She had been followed up for 2 years due to Stage IV lung adenocarcinoma from whom a biopsy was taken from a painful mass in right arm that was found to be compatible with metastasis of lung adenocarcinoma. She had palliative radiotherapy for her painful mass and systemic chemotherapy was planned. After palliative radiotherapy, the pain originating from the metastatic mass in right biceps muscle alleviated. Palliative radiotherapy can be a valuable treatment option for cases with skeletal muscle metastasis.

Evaluation of IL-8 nasal lavage levels and the effects of nasal involvement on disease severity in patients with stable chronic obstructive pulmonary disease.

Interleukin 8 (IL-8) is used to evaluate the severity of inflammation in the airways. The aim of this study was to evaluate patients with chronic obstructive pulmonary disease (COPD) for the presence of upper respiratory tract involvement by questioning patients regarding nasal symptoms and by measuring levels of IL-8 in nasal lavage material. A total of 47 COPD patients and 23 healthy controls were enrolled in this study. Pulmonary function tests were performed for all participants who were asked to complete a Sinonasal Outcome Test-20 (SNOT-20) questionnaire on the same day, as a measure of quality of life. Median IL-8 level in nasal lavage specimens of COPD patients with stable disease was higher than that of healthy controls. An increase in cigarette pack-years was significantly associated with an increase in nasal IL-8 levels. Similarly, IL-8 levels correlated positively with stage of COPD. A significant link between number of visits to the emergency department and stage of disease was observed. Patients with COPD had a significantly higher mean SNOT-20 severity score compared to healthy controls. Proper management of sinonasal disease may help to decrease the number of COPD attacks and consequently improve quality of life.