Determining factors affecting the acceptability of spirometry: A survey study in a tertiary chest diseases center.

Introduction: Unlike other laboratory tests, spirometry requires the participant's full compliance with the maneuvers in the test for an acceptable test result. In this study, we aimed to determine the suitability of spirometric tests regarding acceptability and the factors associated with acceptability. Materials and Methods: Before the test, our 15-scale questionnaire, prepared by us in the respiratory function laboratory, was applied to the participants who requested spirometric examination in our hospital. Afterwards, patients were subjected to spirometric analysis. Spirogram results of the participants were evaluated by four clinicians who were experts in the field based on the acceptability criteria in the American Thoracic Society and European Respiratory Society Spirometry Standardization Guidelines. Participants were divided into two groups as those who met the acceptability criteria and those who did not. Both groups were compared regarding demographic data, comorbidities, education levels, and questions in the questionnaire. Results: The acceptability spirometry rate was 71.2%. The most common error among those who could not perform an acceptable test was the inability to complete the expiratory time to the time that would create a plateau, with 37.3%. Education level and acceptability of spirometry were not related (p= 0.228). Asthma was statistically significantly higher in the group that performed acceptable spirometry (p= 0.049). Acceptable spirometry rate was statistically significantly higher in the participants who had previously performed spirometric tests compared to the other group (p< 0.001). The test success of the participants who did not have success anxiety about the test was significantly higher than the other group (p= 0.033). Conclusion: Reduction of participants' anxiety and repetitive testing increases test acceptability. For this reason, in our clinical practice, we recommend that people who want a spirometry test relieve their anxiety about the test and repeat the test in unacceptable tests.

The association between glycemia and clinical outcomes in patients with diabetes mellitus and pulmonary thromboembolism

ABSTRACT Objective: Various studies have shown that diabetes mellitus (DM) increases the risk of thrombosis in the venous system as well as in the arterial system. In this study, it was aimed to evaluate the association between admission blood glucose levels and clinical severity, recurrence, and mortality in pulmonary embolism in patients with DM. Materials and methods: This study was designed as a retrospective cross-sectional study. Patients with DM who were admitted to a tertiary care hospital due to pulmonary embolism (PE) between 2014 and 2019 were included. Demographic characteristics, radiological findings, clinical class of embolism, and mortality data were retrieved from hospital records. Patients with and without recurrent disease, as well as patients who survived and died, were compared. Also, patients were classified according to quartiles of admission blood glucose levels. The quartiles were compared in terms of mortality, clinical, class, and recurrence. Results: Two hundred ninety-three patients with DM and PE were included in the study. Patients with adverse outcome had significantly higher admission blood glucose levels (respectively, 197.9 ± 96.30 mg/dL vs. 170.7 ± 74.26 mg/dL; p = 0.03). Patients in the third and fourth quartile of admission blood glucose levels (>152 mg/dL) had significantly more severe disease with a higher proportion of massive and sub-massive PE and higher pro-BNP levels (respectively, p = 0.01 and 0.02). Conclusion: Non-survived patients and recurrent disease were associated with higher admission blood glucose levels. Also, patients with admission blood glucose levels higher than 152 mg/dL tend to have clinically more severe diseases.

The association between glycemia and clinical outcomes in patients with diabetes mellitus and pulmonary thromboembolism.

Objective: Various studies have shown that diabetes mellitus (DM) increases the risk of thrombosis in the venous system as well as in the arterial system. In this study, it was aimed to evaluate the association between admission blood glucose levels and clinical severity, recurrence, and mortality in pulmonary embolism in patients with DM. Materials and methods: This study was designed as a retrospective cross-sectional study. Patients with DM who were admitted to a tertiary care hospital due to pulmonary embolism (PE) between 2014 and 2019 were included. Demographic characteristics, radiological findings, clinical class of embolism, and mortality data were retrieved from hospital records. Patients with and without recurrent disease, as well as patients who survived and died, were compared. Also, patients were classified according to quartiles of admission blood glucose levels. The quartiles were compared in terms of mortality, clinical, class, and recurrence. Results: Two hundred ninety-three patients with DM and PE were included in the study. Patients with adverse outcome had significantly higher admission blood glucose levels (respectively, 197.9 ± 96.30 mg/dL vs. 170.7 ± 74.26 mg/dL; p = 0.03). Patients in the third and fourth quartile of admission blood glucose levels (>152 mg/ dL) had significantly more severe disease with a higher proportion of massive and sub-massive PE and higher pro-BNP levels (respectively, p = 0.01 and 0.02). Conclusion: Non-survived patients and recurrent disease were associated with higher admission blood glucose levels. Also, patients with admission blood glucose levels higher than 152 mg/dL tend to have clinically more severe diseases.

A Scoring System to Determine the Risk Factors Causing Recurrent Pulmonary Thromboembolism.

BACKGROUND: The risk of recurrence in pulmonary embolism is the highest in the first week after the acute event. Although it decreases over time, it may remain high for months depending on compliance with treatment and the nature of the underlying risk factor. Our study aimed to identify risk factors that lead to recurrence in pulmonary thromboembolism (PTE) patients and establish an easy-to-use scoring system that determines the risk of recurrence after the first embolism. METHODS: We retrospectively evaluated 1452 patients who were diagnosed with acute PTE between 7/1/2014 and 7/1/2019. Demographic data, comorbidities and clinical data of the patients, and risk factors were recorded. The relationship of the examined parameters with recurrent PTE was evaluated. RESULTS: Diabetes mellitus (DM), hypertension, obesity, and the presence of at least one hereditary risk factor were found to be associated with recurrence. The sensitivity of our score was 66.9%, the specificity was 63.2%, the positive predictive value was 19%, and the negative predictive value was 93.7%. The risk of recurrence in the patients identified as high-risk in the scoring system was 3.47 times higher than those identified as low-risk. CONCLUSION: In terms of risk of recurrence, special attention should be paid to patients with diabetes, HT, obesity and any of the hereditary risk factors. Using scoring systems to determine the risk of recurrence will be valuable and interesting as it is easy-to-use, gives quick results and provides quantitative results.

The comparison of exacerbation and pneumonia before and after conjugated pneumococcal vaccination in patients with chronic obstructive pulmonary disease, and the effect of inhaled corticosteroid use on results.

Introduction: Pneumococcal infections and exacerbations are important causes of mortality and morbidity in chronic obstructive pulmonary disease (COPD). The use of inhaled corticosteroids and pneumococcal vaccination are suggested for the control of the disease progression and exacerbations. The aim of this study is to assess the effect of pneumococcal conjugate vaccine on pneumonia and exacerbation in COPD patients using inhaled corticosteroids (ICSs). The secondary aim is to analyze the effect of ICS use and different ICS types, if administered, on exacerbation and pneumonia incidence in the study population. Materials and Methods: Medical records of 108 adult patients with COPD who were vaccinated with the pneumococcal conjugate vaccine (PCV13) were retrospectively evaluated. The number of acute exacerbations and pneumonia within one year before and after vaccination were evaluated in all included COPD patients. The comparison analysis was also performed based on the ICS types. Result: There were statistically significant differences between the mean numbers of pneumonia and exacerbations before and after vaccination (p<0.05). There were no significant differences in the mean pneumonia attacks and acute exacerbations between patients using ICS and not using ICS (p> 0.05). Conclusions: This study revealed that PCV13 provides a significant decrease in both exacerbation and pneumonia episodes in COPD patients. On the other hand, the use of ICSs and the types of ICSs were not found to have adverse effects on pneumonia and acute exacerbations in vaccinated COPD patients.

[Leptomeningeal metastasis of EGFR (+) lung adenocarcinoma: a case report]. / EGFR (+) akciger adenokarsinomunun leptomeningeal metastazi: Olgu sunumu.

Leptomeningeal metastasis is a very rare complication of infiltration of leptomeninges and subarachnoid space with malignant cells. It is an indicator of poor prognosis. Its incidence is 3.8% in non-small cell lung carcinoma (NSCLC). This rate is higher in patients with epidermal growth factor receptor (EGFR) mutation. Brain magnetic resonance imaging (MRI) is the first choice in the diagnosis. The diagnosis of leptomeningeal metastasis is difficult and often bypassed because it is rare and does not cause gross mass lesions such as brain metastasis. Systemic chemotherapy, intrathecal therapy, cranial radiotherapy and targeted treatment agents are an option in the treatment. It has been shown that targeted therapies can be promising because of the ability to switch to cerebrospinal fluid in appropriate patients. We present the case with EGFR positive lung adenocarcinoma whit leptomeningeal metastasis (LM) due to its rarity, difficulty in diagnosis and its association with EGFR mutation.