RELATIONSHIP BETWEEN TUBERCULOSIS AND FEMALE HORMONE LEVELS IN POST-MENOPAUSAL WOMEN.

Tuberculosis (TB) is an intracellular infection controlled by T-lymphocyte. After menopause, T-lymphocyte cells counts increase suggesting a possible link between T-lymphocyte cell counts and estrogen and progesterone levels. In this study we compared post-menopausal women with and without TB to determine any differences in estrogen and progesterone levels between the two groups. The study group consisted of 38 post-menapausal women hospitalized for TB at Dr Suat Seren Chest Diseases and Surgery Training and Research Hospital for Tuberculosis, in Izmir, Turkey. The control group consisted of 30 post-menopausal women without TB. Both groups were selected from patients without immunosuppressive diseases or malignancies in whom PPD testing was not contraindicated. The mean progesterone level in the control group was 0.3896 ± 0.2014 ng/ml and in the study group was 0.3607 ± 0.3006 ng/ml (p = 0.638). The mean estrogen level in the control group was 18.9873 ± 6.5332 pg/ml and in the study group was 26.2768 ± 14.3418 pg/ml; the difference was significant (p = 0.007). The body mass index in the study group was significantly (p = 0.034) lower than in the study group. In post-menopausal women, the mean estrogen level was significantly higher in participants with TB than those without TB.

Five Years' Evaluation of the BD ProbeTec System for the Direct Molecular Detection of Mycobacterium tuberculosis Complex in Respiratory and Nonrespiratory Clinical Samples.

In this study, Mycobacterium tuberculosis complex was detected by BD ProbeTec ET system in 4716 respiratory and 167 nonrespiratory samples [mostly (98%) smear negative). Sensitivity, specificity, positive and negative predictive values were 81.8%, 98.3, 85.1 and 97.9 for respiratory and 100%, 96.2, 64.7 and 100, for nonrespiratory samples, respectively. Among 149 (3.1%) ProbeTec DTB positive and culture negative samples, 72 (65 respiratory and seven nonrespiratory) (48.3%) were recovered from the patients who were evaluated as having TB infection. The system has been found as useful in early diagnosis of tuberculosis infection in association with the clinical, radiological and histopathological findings.

International Nosocomial Infection Control Consortium (INICC) national report on device-associated infection rates in 19 cities of Turkey, data summary for 2003-2012.

BACKGROUND: Device-associated healthcare-acquired infections (DA-HAI) pose a threat to patient safety, particularly in the intensive care unit (ICU). We report the results of the International Infection Control Consortium (INICC) study conducted in Turkey from August 2003 through October 2012. METHODS: A DA-HAI surveillance study in 63 adult, paediatric ICUs and neonatal ICUs (NICUs) from 29 hospitals, in 19 cities using the methods and definitions of the U.S. NHSN and INICC methods. RESULTS: We collected prospective data from 94,498 ICU patients for 647,316 bed days. Pooled DA-HAI rates for adult and paediatric ICUs were 11.1 central line-associated bloodstream infections (CLABSIs) per 1000 central line (CL)-days, 21.4 ventilator-associated pneumonias (VAPs) per 1000 mechanical ventilator (MV)-days and 7.5 catheter-associated urinary tract infections (CAUTIs) per 1000 urinary catheter-days. Pooled DA-HAI rates for NICUs were 30 CLABSIs per 1000 CL-days, and 15.8 VAPs per 1000 MV-days. Extra length of stay (LOS) in adult and paediatric ICUs was 19.4 for CLABSI, 8.7 for VAP and 10.1 for CAUTI. Extra LOS in NICUs was 13.1 for patients with CLABSI and 16.2 for patients with VAP. Extra crude mortality was 12% for CLABSI, 19.4% for VAP and 10.5% for CAUTI in ICUs, and 15.4% for CLABSI and 10.5% for VAP in NICUs. Pooled device use (DU) ratios for adult and paediatric ICUs were 0.54 for MV, 0.65 for CL and 0.88 for UC, and 0.12 for MV, and 0.09 for CL in NICUs. The CLABSI rate was 8.5 per 1,000 CL days in the Medical Surgical ICUs included in this study, which is higher than the INICC report rate of 4.9, and more than eight times higher than the NHSN rate of 0.9. Similarly, the VAP and CAUTI rates were higher compared with U.S. NHSN (22.3 vs. 1.1 for VAP; 7.9 vs. 1.2 for CAUTI) and with the INICC report (22.3 vs. 16.5 in VAP; 7.9 vs. 5.3 in CAUTI). CONCLUSIONS: DA-HAI rates and DU ratios in our ICUs were higher than those reported in the INICC global report and in the US NHSN report.

Evaluation of antimicrobial susceptibilities of non-tuberculous mycobacteria against linezolid and tigecycline.

Mycobacterial susceptibility testing is important for the management of nontuberculous mycobacteria (NTM) infections. The aim of the study is to determine the susceptibilities of tigecycline (TGC) and linezolid (LZD) against NTM. The study was carried out using stocks of NTM strains in the tuberculosis department of the microbiology laboratory. It was designed a retrospective study. LZD and TGC sensitivities of study isolates were analyzed by microdilution. Forty NTM isolates have been studied. LZD and TGC sensitivities varied according to the NTM type. It is concluded that each isolate should be individually evaluated due to variable susceptibilities to LZD and TGC.

Correlation between chest CT severity scores and clinical and biochemical parameters of COVID-19 pneumonia.

BACKGROUND: The COVID-19 pandemic, which first appeared in Wuhan, China, in December 2019 and spread rapidly around the globe, continues to be a serious threat today. Rapid and accurate diagnostic methods are needed to identify, isolate and treat patients as soon as possible because of the rapid contagion of COVID-19. In the present study, the relation of the semi-quantitative scoring method with computed tomography in the diagnosis of COVID-19 in determining the severity of the disease with clinical and laboratory parameters and survival of the patients were investigated along with its value in prognostic prediction. MATERIAL AND METHOD: A total of 277 adult patients who were followed up in the chest diseases clinic because of COVID-19 pneumonia between 11.03.2020 and 31.05.2020 were evaluated retrospectively in the present study. Both lungs were divided into five regions in line with their anatomical structures, and semiquantitative radiological scoring was made between 0 and 25 points according to the distribution of lesions in each region. The relations between semiquantitative radiological score and age, gender, comorbidity, and clinical and laboratory parameters were examined. RESULTS: A significant correlation was detected between advanced age, lymphopenia, low oxygen saturation, high ferritin, D-dimer, and radiological score in the univariate analysis performed in the present study. The cut-off value of the semiquantitative radiology score was found to be 15 (AUC: 0.615, 95% CI: 0.554-0.617, p = 0.106) in ROC analysis. The survival was found to be better in cases with a radiology score below 15, in Kaplan-Meier analysis (HR: 4.71, 95% CI: 1.43-15.46, p < 0.01). In the radiological score and nonparametric correlation analyses, positive correlations were detected between CRP, D-dimer, AST, LDH, ferritin, and pro-BNP, and a negative correlation was found between partial oxygen pressure and oxygen saturation (p = 0.01, r = 0.321/0.313/0.362/0.343/0.313/0.333/-0.235/-0.231, respectively) CONCLUSION: It was found that the scoring system that was calculated quantitatively in thorax HRCTs in Covid-19 patients is a predictive actor in determining the severity and prognosis of the disease in correlation with clinical and laboratory parameters. Considering patients who have a score of 15 and above with semiquantitative scoring risky in terms of poor prognosis and short survival and close follow-up and early treatment may be effective to reduce mortality rates.

Molecular detection and identification of mycobacterium tuberculosis complex and four clinically important nontuberculous mycobacterial species in smear-negative clinical samples by the genotype mycobacteria direct test.

Although the sensitivity and specificity of nucleic acid amplification assays are high with smear-positive samples, the sensitivity with smear-negative and extrapulmonary samples for the diagnosis of tuberculosis in suspicious tuberculosis cases still remains to be investigated. This study evaluates the performance of the GenoType Mycobacteria Direct (GTMD) test for rapid molecular detection and identification of the Mycobacterium tuberculosis complex and four clinically important nontuberculous mycobacteria (M. avium, M. intracellulare, M. kansasii, and M. malmoense) in smear-negative samples. A total of 1,570 samples (1,103 bronchial aspiration, 127 sputum, and 340 extrapulmonary samples) were analyzed. When we evaluated the performance criteria in combination with a positive culture result and/or the clinical outcome of the patients, the overall sensitivity, specificity, and positive and negative predictive values were found to be 62.4, 99.5, 95.9, and 93.9%, respectively, whereas they were 63.2, 99.4, 95.7, and 92.8%, respectively, for pulmonary samples and 52.9, 100, 100, and 97.6%, respectively, for extrapulmonary samples. Among the culture-positive samples which had Mycobacterium species detectable by the GTMD test, three samples were identified to be M. intracellulare and one sample was identified to be M. avium. However, five M. intracellulare samples and an M. kansasii sample could not be identified by the molecular test and were found to be negative. The GTMD test has been a reliable, practical, and easy tool for rapid diagnosis of smear-negative pulmonary and extrapulmonary tuberculosis so that effective precautions may be taken and appropriate treatment may be initiated. However, the low sensitivity level should be considered in the differentiation of suspected tuberculosis and some other clinical condition until the culture result is found to be negative and a true picture of the clinical outcome is obtained.

Nontuberculous mycobacteria isolated from pulmonary specimens between 2004 and 2009: causative agent or not?

Nontuberculous mycobacteria were identified from 45891 samples of 19553 patients with a prediagnosis of pulmonary tuberculosis between November 2004 and January 2009. Among 10041 (21.9%) culture positive samples, 208 (2.1%) pulmonary samples recovered from 77 individual patients were differentiated as mycobacteria other than tuberculosis (MOTT). Proportion of mycobacteria evaluated as causative agent for clinical infection were found as 0.16% (n = 31), mostly M. avium complex, M. abscessus and M. kansasii. Additionally, M. fortuitum-peregrinum complex, M. simiae, M. szulgai / intermedium and M. scrofulaceum were found as causative agent in 2, 2, 2 and 1 patient, respectively. Identification of infections caused by environmental or opportunistic pathogen mycobacteria is required in rapid and accurate diagnosis, infection control and treatment planning of infections caused by M. tuberculosis complex and/or MOTT.

Patterns of drug resistance in pulmonary tuberculosis cases in the Izmir district, Turkey.

Antituberculosis drug resistance patterns were investigated among the new and previously treated pulmonary tuberculosis (TB) cases in Izmir district, retrospectively. Proportions of resistance patterns were determined using a number of resistant cases using as a denominator. Resistance to at least one drug was found in 304 (29.7%) patients in 1023 a total of tuberculosis cases. 182 new and 82 previously treated consecutive pulmonary tuberculosis cases were investigated. Patterns were examined as single and/or probable combinations of isoniazid (H), rifampicin (R), ethambutol (E) and streptomycin (S). Single drug resistance mode, mono S, and HS resistance patterns were the highest proportions in comparison with other modes and patterns in both new and previously treated cases. HRS pattern showed a significant proportion and proportions of quadruple mode were higher than triple mode in previously treated cases. Proportions of patterns associated with R were detected more than expected. Surveillance of proportions of anti-TB drug resistance is important as well as surveillance of resistance rates.

[Investigation of pyrazinamide resistance in multidrug-resistant tuberculosis cases in Hospital of Pulmonary Diseases, Izmir, Turkey]. / Izmir Gögüs Hastaliklari Hastanesinde çok ilaca dirençli tüberküloz olgularinda pirazinamid direncinin arastirilmasi.

Pyrazinamide (PZA) is one of primary drugs for antituberculous treatment. The aim of this study was to determine the rates of PZA resistance in multidrug-resistant (MDR) and susceptible Mycobacterium tuberculosis (MTB) strains isolated from patients who were admitted to our hospital. MDR strains have been isolated between 2005-2007 years, and susceptible strains were chosen randomly among the collection of the strains of the same period. MTB isolates were grown in BACTEC 960 full automatized broth system (Becton Dickinson, Sparks, MD) and Lowenstein-Jensen solid medium. Identification was done by radiometric BACTEC 460 NAP procedure. Antibiotic susceptibility testing against conventional anti-tuberculous drugs (streptomycin, isoniazide, rifampisin, etambutol) was performed by the radiometric BACTEC 460 system and PZA susceptibility was worked out by BD MGIT 960 PZA Kit (Becton Dickinson, Sparks, MD) with the use of 100.0 microg/ml critical concentrations of PZA. As a result, two of the 65 (3.1%) MTB susceptible strains and 16 of 63 (25.4%) MDR-MTB isolates were found resistant to PZA. In conclusion, due to the high PZA resistance rate in MDR-MTB isolates, susceptibility testing against PZA should be done in MDR-TB cases; however, since PZA resistance rate was low in new susceptible cases, it was thought that testing susceptibility of PZA is not necessary as a routine procedure in our region.

Contributing factors to mortality rates of pulmonary tuberculosis in intensive care units.

BACKGROUND: Tuberculosis (TB) remains an important health problem worldwide. TB patients sometimes require intensive care unit (ICU) treatment. The aim of this study is to establish special features and mortality rates of pulmonary TB patients in ICUs and identify the factors contributing to ICU mortality. METHODS: Medical records of adult patients (>18 years) with a diagnosis of TB who were admitted to the ICU of a referral hospital for chest diseases between 2004 and 2010 were reviewed retrospectively. Demographic characteristics, comorbidities, APACHE II scores, symptoms, radiologic appearance of the disease, bacteriological and laboratory investigations, need and type of mechanical ventilation support (invasive, non-invasive), characteristics related to ICU stay, length of ICU stay, mortality and factors affecting mortality were recorded and analysed. RESULTS: Forty patients (33 male) with active pulmonary TB with a median age of 55 years (43-63 years) and a median APACHE II score of 22 (17-26) were followed up in the ICU. Patients who needed invasive mechanical ventilation had significantly longer ICU stays than patients who were treated with non-invasive ventilation or medical therapy (Log rank p = 0.014). Mortality was 72.5%. The only independent risk factor for mortality was having an APACHE II score ≥18. CONCLUSION: The mortality of TB patients who needed ICU support remains high. This higher mortality rate seems related to multi-organ failure, requiring invasive mechanical ventilation and high APACHE II scores.

In vitro antibacterial activities of oral care products against ventilator-associated pneumonia pathogens.

BACKGROUND: Oral and oropharyngeal decontamination is one of the main issues for preventing ventilator-associated pneumonia (VAP). OBJECTIVE: The objective of the study was to detect and compare in vitro antibacterial activities of 3 oral care products (OCP) against major VAP pathogens. METHODS: Stabilized hydrogen peroxide (H(2)O(2)); 0.2% chlorhexidine gluconate (CHX); and a commercial product including glucose oxidase, lactoperoxidase, lysozyme, and lactoferrin (GLLL) were selected for this study. In total, 32 VAP isolates were studied by 2 different methods. Bacterial suspension was inoculated onto OCP-absorbed plates in the first method, and OCP was dropped onto bacteria inoculated plates in the second method. Two different bacterial suspensions were used as 10(-2) and 10(-4) dilutions of 0.5 McFarland turbidity. RESULTS: In the first method, 6 (18%), 6 (18%), and 0 isolates in 10(-2) dilution and 13 (40%), 19 (59.3%), and 2 (6.2%) isolates in 10(-4) dilution of 0.5 McFarland bacterial turbidity were inhibited by CHX, H(2)O(2), and GLLL, respectively. In the second method, 31 (96.8%), 30 (93.7%), and 0 isolates in 10(-2) dilution and 32 (100%), 32 (100%), and 5 (15.6%) isolates in 10(-4) dilution were suppressed. In all dilutions and methods, antibacterial activity of CHX and H(2)O(2) were found more effective than GLLL against VAP pathogens (P < .05). CONCLUSION: CHX and H(2)O(2) have good antibacterial effects against most isolated VAP pathogens in vitro. They could be suggested as oropharyngeal decontamination agents for reducing VAP incidence.

[Identification of atypical mycobacteria isolated from clinical specimens by line probe assay (LIPA)]. / Klinik örneklerden izole edilen atipik mikobakterilerin "line probe assay" (LIPA) yöntemiyle tanimlanmasi.

The aim of this study was the identification of atypical mycobacteria isolated from various samples of patients prediagnosed as tuberculosis between November 2004 and June 2006 by a commercial polymerase chain reaction (PCR) based reverse hybridization kit (INNO-LiPA Mycobacteria v2, Innogenetics NV, Belgium). A total of 21,060 samples obtained from 9660 patients were included to the study. After decontamination and homogenization processes, the samples were cultivated in automated MGIT Bactec 960 system and the diagnosis of atypical mycobacteria was performed in 4532 (21.5%) culture positive samples with NAP test by using Bactec 460 TB system. After DNA isolation, PCR method was performed by using the primers specific for mycobacterial 16S-23S spacer region. PCR products were then hybridized with the probes specific for Mycobacterium species on nitrocellulose strips according to the recommendations of the manufacturer and evaluated. Additionally, two different versions of another commercial Line Probe Assay (LiPA) kit [GenoType Mycobacterium and GenoType Mycobacterium AS (Additional Species), Hain Lifescience, Germany] were used for the detection of unidentified mycobacterial strains. In our study period, 10 different Mycobacterium species were identified from 44 (1%) respiratory tract samples (sputum, bronchial aspiration fluid, bronchoalveolar lavage) belonging to 30 patients. While repeated atypical mycobacterial growth was found in 13 patients on different days, 17 patients showed atypical mycobacterial growth only in one sample or in separate multiple samples taken within the same day. The species distribution among patients were as follows; M. fortuitum-M. peregrinum complex (n=5), M. intracellulare (n=4), M. avium complex (n=4), M. chelonae complex (n=4), M. gordonae (n=4), M. kansasii (n=3), M. szulgailintermedium (n=2), M. simiae (n=1) and M. scrofulaceum (n=1). Two of four samples which were unidentified by INNO-LiPA and GenoType MTBC were identified as M. szulgai/intermedium by GenoType Mycobacterium AS and the other two were found as unidentified atypical mycobacteria (Mycobacterium spp.). As a result, the frequency of atypical mycobacteria isolated in our hospital was thought to be low, however, species-level identification might be useful for the planning of therapy in such patients. In addition, after NAP test, INNO-LiPA and GenoType Mycobacterium were useful tests in microbiological identification of atypical mycobacteria, and GenoType Mycobacterium AS test could be applied in mycobacterial strains which were not identified by the former assays.

Assessment of Extrapulmonary Tuberculosis in Two Provinces of Turkey.

BACKGROUND: Tuberculosis (TB) is one of the main health issues in Turkey. Extrapulmonary TB cases have significant proportion comparing pulmonary TB cases. The aim of the study was to evaluate the extrapulmonary tuberculosis (EPTB) cases in two regions of Turkey, which have different demographic and socioeconomic characteristics. METHODS: In this retrospective cohort study, EPTB cases between 2000 and 2005 in Van and Izmir Provinces of Turkey were analyzed and compared for symptoms, age groups, vaccination status, diagnostic procedures and social-economical conditions within two provinces. Descriptive analytic methods were used. RESULTS: Total of 397 EPTB cases were reviewed retrospectively in Izmir and Van provinces. Pleural TB was most often seen EPTB form (47.6% vs. 32.6%) and female/male ratio was similar in both groups. Patients were in older ages in Izmir Province. Chest pain (20% vs. 32%), cough (33% vs. 26%) and night sweatiness (29% vs. 36%) were leading complaints. Low BCG vaccination rate and higher childhood EPTB were found in Van group, in contrary elderly EPTB was more often in of Izmir group. CONCLUSION: Frequency of severe forms of EPTB is more often in younger ages in lower social economical condition areas.

Drug resistance of Mycobacterium tuberculosis in Western Turkey: a retrospective study from 1100-bed teaching hospital.

OBJECTIVE: This study was planned to establish resistance profile of Mycobacterium tuberculosis strains in the West part of Turkey. METHODS: The data were collected by searching records of tuberculosis (TB) division of microbiology laboratory in 1999 and 2001, retrospectively. RESULTS: Susceptibilities of the all first-line anti-TB drugs ratio were 76% in 1999 and 83.5% in 2001. Drug resistance of against isoniazid (INH), rifampicin (RMP), ethambutol (EMB) and streptomycin (SM) were detected 11.9, 10.2, 11.92, 10.88% and 9.9, 9.27, 6.36, 8.56% for 1999 and 2001, respectively. Multidrug resistance (MDR)-TB rate was found on the high level (6.6 and 5.8%). CONCLUSIONS: It was thought that resistance rates of M. tuberculosis strains should be followed regularly and reasons for the high rates should be investigated. It was concluded that development of the national TB policy was the main issue for solving the present problems dealing with management of TB. SUMMARY: M. tuberculosis is one of the important emerging pathogens. Multidrug and polidrug strains have been increasing around the world. This study was planned to define drug resistance patterns for monitoring drug-resistant TB in Western Turkey. It is suggested that a close collaboration between academic researchers and TB system workers would be organized for further studies.

Surgical site infection rates in 16 cities in Turkey: findings of the International Nosocomial Infection Control Consortium (INICC).

BACKGROUND: Surgical site infections (SSIs) are a threat to patient safety; however, there were no available data on SSI rates stratified by surgical procedure (SP) in Turkey. METHODS: Between January 2005 and December 2011, a cohort prospective surveillance study on SSIs was conducted by the International Nosocomial Infection Control Consortium (INICC) in 20 hospitals in 16 Turkish cities. Data from hospitalized patients were registered using the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) methods and definitions for SSIs. Surgical procedures (SPs) were classified into 22 types according to International Classification of Diseases, Ninth Revision criteria. RESULTS: We recorded 1879 SSIs, associated with 41,563 SPs (4.3%; 95% confidence interval, 4.3-4.7). Among the results, the SSI rate per type of SP compared with rates reported by the INICC and CDC NHSN were 11.9% for ventricular shunt (vs 12.9% vs 5.6%); 5.3% for craniotomy (vs 4.4% vs 2.6%); 4.9% for coronary bypass with chest and donor incision (vs 4.5 vs 2.9); 3.5% for hip prosthesis (vs 2.6% vs 1.3%), and 3.0% for cesarean section (vs 0.7% vs 1.8%). CONCLUSIONS: In most of the 22 types of SP analyzed, our SSI rates were higher than the CDC NHSN rates and similar to the INICC rates. This study advances the knowledge of SSI epidemiology in Turkey, allowing the implementation of targeted interventions.

Markers of lower respiratory tract infections in emergency departments.

BACKGROUND: Acute respiratory tract infections are the common causes for admission to emergency department. Appropriate diagnosis and initiating treatment on time are important for reducing morbidity and mortality rate due to lower respiratory tract infection (LRTI). The aim of this study is to determine if C-reactive protein (CRP) levels and white blood cells (WBC) count are considerable markers to help rapid diagnosis and prediction of antibiotic need for lower respiratory infections in emergency departments. The relationships between infectious agents and those markers have also been evaluated. METHODS: Study subjects and control group were selected by defined criteria. Patients were analyzed and assessed for CRP and WBC, sputum Gram stain and culture besides routine laboratory tests and chest X-Rays. RESULTS: One hundred and ninety four episodes out of 175 patients were evaluated for the study. CRP level and WBC count were detected significantly higher in patients ofstudy group than in those of control group. Pseudomonas aeruginosa and Haemophilus influenzae were the pathogens most often isolated. CONCLUSION: In conclusion, CRP and WBC sputum are important markers for diagnosis of LRTI at the emergency departments and results of microbiological analysis of respiratory specimens were correlated with these markers. TRIAL REGISTRATION: Registation number of ethic committee of Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital: 28.04.2006/114.

Drug resistance in pulmonary tuberculosis in new and previously treated cases: experience from Turkey.

The emergence of drug resistance is a major problem for tuberculosis (TB) control. The aim of this study was to determine the rates of resistance against TB drugs in patients with pulmonary tuberculosis (PTB). Data from 387 patients with active PTB between the years of 1999 and 2004 from the Research and Education Hospital for Chest Diseases and Chest Surgery were evaluated retrospectively. The patients were categorized as new, re-treatment, extrapulmonary and chronic cases. The study group consisted of 268 (69%) new, 57 (14.7%) re-treatment, 49 (12.6%) extrapulmonary and 13 (3.3%) chronic TB cases. The rates of resistance to isoniazid (INH), rifampicin (R), ethambutol (E) and streptomycin (S) were calculated separately for each group. The resistance to any of the drugs was 7.8% in the new cases, 58.5% in the re-treatment cases and 100% in the chronic cases. The multidrug-resistance (MDR)-TB rates were found to be 2.16%, 11.3% and 92.3% among the new, re-treatment and chronic cases, respectively. These data are important as they reflect the drug resistance rates during the pre-notification time period in western Turkey.

C-reactive protein measurements as a marker of the severity of chronic obstructive pulmonary disease exacerbations.

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease of the lungs. Acute exacerbations of COPD (AE-COPD) are a result of infectious or non-infectious instances. In our study, we aimed to determine whether serum C-reactive protein (CRP) levels are predictive indicators for disease severity and prognosis in hospitalized patients with AE-COPD. A total of 64 patients (36 regular ward and 28 ICU patients) were included in the study. Cases were identified and classified according to the Global Initiative for COPD. The first CRP test levels at acceptance at the ward or intensive care unit were counted in the study. CRP levels of patients in intensive care were significantly higher than those of patients in the regular ward. Mean values of CRP were detected to be 6.28 ± 6.53 mg/dl in the regular ward cases and 16.9 ± 12.03 mg/dl in the ICU patients (p < 0.01). The stage of COPD did not indicate a significant difference in terms of CRP values. Mean CRP values were found to be 16.02 ± 6.95 mg/dl in mortal cases and 9.76 ± 11.09 mg/dl in survivors (p < 0.01). High CRP levels were considered as a prognostic parameter and indicator of severity of AE-COPD. Increased mortality risk was found to be associated with high CRP values.

Tracheobronchopathia osteochondroplastica: four cases.

Tracheobronchopathia osteochondroplastica (TO) is a rare and benign disorder of unknown cause affecting the large airways. It is characterized by the presence of multiple osseous and cartilaginous nodules in the submucosa of the trachea and main bronchi that is characterized by the progression of submucosal bone and/or cartilage including nodules through the lumen of trachea and bronchus. We present four cases that were diagnosed TO while investigating for the causes of hemoptysis and chronic cough. We plan to emphasize TO in differential diagnosis in proper patients.