The effects of inspiratory muscle warm-up prior to inspiratory muscle training during pulmonary rehabilitation in subjects with chronic obstructive pulmonary disease: a randomized trial.

BACKGROUND: While a whole-body warm-up may not adequately prepare the inspiratory muscles for exercise, inspiratory warm-up is an effective approach in preparing the inspiratory muscles for exertion. OBJECTIVES: To investigate the effects of inspiratory muscle warm-up performed prior to inspiratory muscle training (IMT) during pulmonary rehabilitation (PR) in patients with moderate-to-severe chronic obstructive pulmonary disease (COPD) and inspiratory muscle weakness. METHODS: Pulmonary function tests, maximal inspiratory and expiratory pressures (MIP and MEP), 6-minute walk test distance (6MWD), modified Medical Research Council Dyspnea Scale(mMRC), St. George's respiratory questionnaire and the 36-item short-form health survey were evaluated. Both groups performed IMT during PR for 8 weeks. The warm-up group (n = 15), in addition to the standard IMT group (n = 15), performed an inspiratory muscle warm-up protocol before each IMT session. RESULTS: At the end of the 8-week intervention, improvements in dyspnea (mMRC in score, p =0.033, effect size =0.76); exercise capacity (6MWD in meters, p =0.001, effect size =1.30); pulmonary function [forced expiratory volume in 1 second (FEV1) in %predicted, p =0.006, effect size =1.10]; and inspiratory muscle strength (MIP in cmH2O, p =0.001, effect siz e = 1.35) were significantly greater in the warm-up group. Moreover, there were significant improvements in health-related quality of life (HRQoL) sub-scores after the training in both groups (p <0.05). CONCLUSIONS: This study demonstrated improvements in both groups, surpassing or closely approaching the established minimal clinically important difference values for the respective outcomes. Performing a warm-up for inspiratory muscles before IMT boosts benefits for pulmonary function, inspiratory muscle strength, exercise capacity, dyspnea, and HRQoL in subjects with moderate-to-severe COPD and inspiratory muscle weakness.

Exposure to Fumes of a Vegetable Margarine for Frying: Respiratory Effects in an Experimental Model.

Deep frying is one of the strongest emission sources into indoor air. A vegetable margarine has recently been used in commercial kitchens. This study investigated the respiratory effects of exposure to its fumes in an experimental model. A setup with glass chambers was constructed. A chamber housed a fryer. The fumes were transported to the other chamber where 24 Wistar albino rats were placed in four randomized groups: acute, subacute, chronic, and control for the exposure durations. PM10 concentration in the exposure chamber was monitored to ensure occupational levels were obtained. Sacrification was performed 24 h after exposure. Lung, trachea, and nasal concha specimens were evaluated by two blinded histologists under a light microscope with hematoxylin-eosin. Mild mononuclear cell infiltration, alveolar capillary membrane thickening, alveolar edema, and diffuse alveolar damage, along with diffuse hemorrhage, edema, and vascular congestion in the interstitium were observed in the acute and subacute groups, and were overexpressed in the chronic group, whereas normal lung histology was observed in the control group. The results indicate that exposure to fumes of vegetable margarine for frying in commercial kitchens may cause pulmonary inflammation that becomes severe as the duration of the exposure increases.

Breathlessness Beliefs and Related Factors in Male Patients with Chronic Obstructive Pulmonary Disease.

OBJECTIVE: Dyspnea may be a debilitating factor for people with pulmonary problems as it may cause fear of movement. The aim of the present study was to determine the related factors with breathlessness beliefs, in other words, dyspnea-related fear of movement, in patients with chronic obstructive pulmonary disease. MATERIAL AND METHODS: Male patients with chronic obstructive pulmonary disease were included in the study. Breathlessness beliefs (Breathlessness Belief Questionnaire), perceived dyspnea severity (modified Medical Research Council Dyspnea Scale and modified Borg Scale), pulmonary function tests (forced vital capacity, forced expiration volume in 1 second, and peak expiratory flow), emotional status (Hospital Anxiety and Depression Scale), fatigue (Fatigue Impact Scale and Fatigue Severity Scale), physical activity level (International Physical Activity Questionnaire-Short Form), disease-related quality of life (St. George Respiratory Questionnaire), and generic quality of life (Short-Form 36) were evaluated. RESULTS: A total of 70 patients were included. Significant correlations were detected between breathlessness beliefs and perceived dyspnea severity, pulmonary function tests, emotional status, fatigue, physical activity level, disease-related quality of life, and generic quality of life (P < .001). No correlations were detected between physical characteristics and dyspnea-related fear of movement (P > .05). CONCLUSION: Dyspnea-related fear of movement was found to be strongly related to perceived dyspnea severity, pulmonary function tests, emotional status, fatigue, physical activity level, and quality of life; thus, including breathlessness beliefs assessment into clinical examination may help clinicians to understand their patients' needs comprehensively.

Can Some Viral Respiratory Infections Observed Before the Pandemic Announcement Be Related to SARS-CoV-2?

OBJECTIVE: There have been doubts that SARS-CoV-2 has been circulating before the first case was announced. The aim of this study was to evaluate the possibility of COVID-19 in some cases diagnosed to be viral respiratory tract infection in the pre-pandemic period in our center. MATERIAL AND METHODS: Patients who were admitted to our hospital's pulmonary diseases, infectious diseases, and intensive care clinics with the diagnosis of viral respiratory system infection within a 6-month period between October 2019 and March 12, 2020, were screened. Around 248 archived respiratory samples from these patients were analyzed for SARS-CoV-2 ribonucleic acid by real-timequantitative polymerase chain reaction. The clinical, laboratory, and radiological data of the patients were evaluated. RESULTS: The mean age of the study group was 47.5 (18-89 years); 103 (41.5%) were female and 145 (58.4%) were male. The most common presenting symptoms were cough in 51.6% (n = 128), fever in 42.7% (n = 106), and sputum in 27.0% (n = 67). Sixty-nine percent (n = 172) of the patients were pre-diagnosed to have upper respiratory tract infection and 22.0% (n = 55) had pneumonia, one-third of the patients (n = 84, 33.8%) were followed in the service. Respiratory viruses other than SARS-CoV-2 were detected in 123 (49.6%) patients. Influenza virus (31.9%), rhinovirus (10.5%), and human metapneumovirus (6.5%) were the most common pathogens, while none of the samples were positive for SARS-CoV-2 RNA. Findings that could be significant for COVID-19 pneumonia were detected in the thorax computed tomography of 7 cases. CONCLUSION: The negative SARS-CoV-2 real-time-quantitative polymerase chain reaction results in the respiratory samples of the cases followed up in our hospital for viral pneumonia during the pre-pandemic period support that there was no COVID-19 among our cases during the period in question. However, if clinical suspicion arises, both SARS and non-SARS respiratory viral pathogens should be considered for differential diagnosis.

Usefulness of a new parameter in functional assessment in patients with idiopathic pulmonary fibrosis: desaturation - distance ratio from the six-minute walk test.

BACKGROUND AND AIM: New parameters in the 6-minute walk test (6MWT) are needed for assessing exercise capacity in patients with idiopathic pulmonary fibrosis (IPF). To our knowledge, no previous study has investigated the potential of using the desaturation distance ratio (DDR) to assess exercise capacity specifically in patients with IPF. This study aimed to investigate whether DDR is a potential tool for assessing the exercise capacity of patients with IPF. METHODS: This study conducted with 33 subjects with IPF. Pulmonary function tests and a 6MWT were performed. To calculate the DDR, first, the difference between the patient's SpO2 at each minute and the SpO2 of 100% was summed together to determine the desaturation area (DA). Next, DDR was calculated using dividing DA by the 6-minute walk test distance (6MWD) (i.e., DA/6MWD). RESULTS: When correlations of 6MWD and DDR with changes (Δ) in the severity of perceived dyspnea were examined, 6MWD did not significantly correlate with ΔBorg. Conversely, there was a significant correlation between the DDR and ΔBorg (r= 0.488, p=0.004). There were significant correlations between 6MWD and FVC % (r=0.370, p=0.034), and FEV1 % (r=0.465, p=0.006). However, DDR was significantly more correlated with FVC % (r= -0.621, p< 0.001), FEV1 % (r= -0.648, p< 0.001). Moreover, there was a significant correlation between DDR and DLCO % (r= -0.342, p=0.052). CONCLUSIONS: The findings of this study suggest that DDR is a promising and more useful parameter for assessing patients with IPF.

COVID-19 in Liver Transplant Patients: A University Hospital Experience.

BACKGROUND: We aimed to examine the comorbidity, disease progress, and vaccination status of liver transplant patients followed up in our hospital who had COVID-19. METHODS: Liver transplant patients with COVID-19 were included between 11 March 2020 and 15 September 2022. Demographic data, disease progress, and COVID-19 vaccines were recorded. The SPSS 24.0 (IBM SPSS, Inc, Armonk, NY, United States) program was used for analysis. The data were analyzed using the χ2 test. P values < .05 were considered clinically significant. RESULTS: Sixteen SARS-CoV-2 polymerase chain reaction (+) patients were detected. Twelve (75.0%) patients were male; the mean age was 49.56 ± 14.0 years (24-76 years). The mean transplant time was 156.69 ± 54.05 months. Four (25.0%) of the 5 (31.3%) patients with comorbidities had hypertension, and 1 (6.3%) had diabetes. None of the patients had an underlying lung disease. All the patients received immunosuppressive therapy, and the most common combination was antimetabolite and calcineurin inhibitor (9 patients [69.2%]). Nine patients (56.3%) had a fever, whereas 6 (37.5%) had respiratory symptoms. Two (33.3%) had pneumonia. Five (31.4%) patients were hospitalized, and 1 (20%) was admitted to the intensive care unit due to non-invasive mechanical ventilation needs. No patient died due to COVID-19. A statistically significant correlation was found between the presence of fever, respiratory symptoms, and hospitalization (P < .05). Of those vaccinated, 10 (66.7%) were infected before the COVID-19 vaccination. CONCLUSIONS: The course of COVID-19 in liver recipients without any underlying disease other than transplantation is not different from that in the healthy population. Immunosuppressive therapy was continued in patients with the disease, and two-thirds did not require hospitalization.

The effect of oropharyngeal exercise in patients with moderate and severe obstructive sleep apnea using CPAP: a randomized controlled study.

PURPOSE: Obstructive sleep apnea (OSA) is an important public health problem. Beyond common treatment options, solution-oriented options are needed. Oropharyngeal exercise training may be a research area in this respect. This study aimed to evaluate the effects of oropharyngeal exercise (OPE) in addition to continuous positive airway pressure (CPAP) therapy in patients diagnosed with OSA. METHODS: Patients with moderate and severe OSA were screened from the electronic database of our hospital and 41 patients (20: exercise group; 21: control group) were included in the study. Each patient was assessed with CPAP usage time, maximal voluntary ventilation (MVV), maximum inspiratory and expiratory pressure (MIP-MEP), neck circumference, body mass index (BMI), waist-hip ratio, Epworth sleepiness score, Pittsburgh sleep quality index (PSQI), and short-form health survey (SF-36) in the first visit. The OPE was prescribed in addition to CPAP for the exercise group and performed by the patients for 3 months. At the end of the third month, groups were re-assessed with the same parameters. RESULTS: Most of the patients were men, and the mean age of the study population was 51.9 ± 7.4; the mean apnea-hypopnea index (AHI) in the last polysomnography report was 53.3 ± 27.4. In the exercise group, MVV (p = 0.003), MIP (p = 0.002), MEP (p = 0.024), and SF-36 energy/fatigue (p = 0.020) were observed to increase while the total PSQI score (p = 0.036) decreased. The neck circumference (p = 0.006) and BMI (p = 0.013) were found to be significantly decreased in the exercise group. CONCLUSIONS: We found that OPE training may have improved respiratory muscle strength as well as sleep quality and health-related quality of life in the exercise group. OPE along with CPAP therapy may be recommended in moderate and severe OSA patients who are willing to participate.

Effects of supervised exercise program and home exercise program in patients with systemic sclerosis: A randomized controlled trial.

AIM: To compare the effects of supervised exercise and home exercise program in patients with systemic sclerosis (SSc). METHODS: Thirty-seven SSc patients were included. Patients with SSc were allocated into 2 groups as supervised and home exercise. Breathing, aerobic and resistance exercises were performed with a physiotherapist for 12 weeks in the supervised exercise group. Breathing, posture and aerobic exercises were given to the home exercise group as a home program for 12 weeks. All patients were assessed at baseline and 12 weeks later in terms of functional capacity, pulmonary functions, respiratory-peripheral muscle strength, dyspnea severity, health-related quality of life (HRQoL) and fatigue level. RESULTS: Significant improvements were observed in the functional capacity, measured by 6 minute walking test in the supervised exercise group (before = 376.21 ± 65.50, after = 518.78 ± 75.84 m) and home exercise group (before = 384.44 ± 68.14, after = 432.7 ± 70.8 m; (P < .05). Respiratory-peripheral muscle strength (with the exception of inspiratory muscle strength and upper limb strength in the home exercise group) and HRQoL were significantly increased and fatigue level was significantly decreased in the supervised exercise and home exercise groups (P < .05). However, pulmonary functions and dyspnea severity were significantly improved only in the supervised exercise group (P < .05). The supervised exercise program was found superior to the home exercise program for change in all parameters (P < .05). CONCLUSION: This study suggests that exercise interventions should be applied in addition to the medical treatments of patients with SSc as supervised and home exercise programs play an important role in the functionality and health status of these patients.

The effect of Oxygen application with nCPAP for the prevention of desaturation during EBUS-TBNA.

PURPOSE: EBUS-TBNA is a frequently used diagnostic method for mediastinal/hilar lymphadenopathies and masses. This procedure is performed with intravenous sedation (IVS). During IVS, patients often develop hypoxemia and nasal oxygen delivery is insufficient in some patients. The aim of this study was to investigate the effect of oxygen application with nCPAP on hypoxemia during EBUS-TBNA. METHODS: Patients with EBUS-TBNA indication who did not have any serious heart-lung disease were randomly divided into two groups. One group received only oxygen and the other group received nCPAP+oxygen. Patient characteristics, arterial oxygen saturations, anesthetic agents, CPAP pressures, oxygen concentrations and processing times were recorded during the procedure. Practitioner satisfaction was evaluated at the end. RESULTS: 29 nCPAP+oxygen, 31 oxygen patients were included in the study. There were no significant differences in terms of age, sex, smoking history and presence of additional diseases in two groups. Neck circumference, BMI and STOP BANG questionnaire values were similar. Desaturation time was significantly longer in oxygen group than nCPAP+oxygen group (316±390 sec, 12±118 sec, respectively, p=0,019). Snoring was detected during the procedure in 22 patients in the oxygen group and in 11 patients in the nCPAP group (p=0,01). There were no serious complications in both groups. Practitioner satisfaction was higher in the nCPAP group but this was not statistically significant (p=0,052). CONCLUSION: Oxygen application by nCPAP during EBUS-TBNA under IVS, significantly reduces desaturation time. Oxygen delivery with nCPAP seems to be a better choice especially for the patients with high Mallampati index.

30-day Readmission After an Acute Exacerbation of Chronic Obstructive Pulmonary Disease is Associated with Cardiovascular Comorbidity.

OBJECTIVE: Readmission after hospitalization for a chronic disease is a major concern of interest for health care quality. Our aim was to investigate the predictors and rates of early readmission after an acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in a tertiary care hospital. MATERIAL AND METHODS: Over a 3-year period, patients hospitalized in our pulmonary disease clinic with a diagnosis of chronic obstructive pulmonary disease (COPD) and who had an index hospitalization for AECOPD were included. Readmission was defined as rehospitalization within 30 days of AECOPD discharge. Demographics, comorbidities, exacerbations, prior intensive care unit (ICU) stay, and long-term oxygen therapy (LTOT), blood eosinophil count, and antibiotic and/or steroid treatment at the index AECOPD admission were recorded. RESULTS: Fifty-two (17.3%) readmissions occurred in 300 patients. Readmissions were due to AECOPD in 46.2%, pneumonia in 19.2%, and cardiovascular disease in 15.4% patients. Twenty-one (40%) of the readmitted patients were frequent exacerbators. After adjusting for individual and clinical predictors, the odds ratio for readmission was 2.11 (95% CI, 1.07-4.15, P = .03) for those with congestive heart failure, 3.30 (95% CI, 1.05-9.75, P = .04) for those with arrhythmia, and 1.99 (95% CI, 1.04-3.81, P = .04) for LTOT users prior to AECOPD. CONCLUSION: A significant majority of patients readmitted after an AECOPD mainly suffered from recurrent AECOPD. Associated congestive heart failure, arrhythmia, and prior LTOT were risk factors identified for early AECOPD readmissions in our study. Better recognition of readmission risk factors might help to reduce readmission rates of AECOPD.

Pneumocystis jirovecii Pneumonia in Solid-Organ Transplant Recipients: A National Center Experience.

OBJECTIVES: Immunosuppressive therapies have impro-ved survival in solid-organ transplant recipients at the expense of increased prevalence of opportunistic infections. We investigated the prevalence, risk factors, and prognosis of Pneumocystis jirovecii pneumonia in solid-organ transplant recipients who were followed by our transplant unit. MATERIALS AND METHODS: We conducted a retrospective observational study using medical record reviews to identify all adult solid-organ transplant recipients who underwent bronchoscopy and bronchoalveolar lavage between January 2011 and 2018. We collected clinical characteristics, including risk factors and prognosis. Pneumocystis jirovecii pneumonia symptoms com-patible with microscopy and/or positive nucleic acid amplification assays were defined as proven infection by P. jirovecii pneumonia. RESULTS: We identified 312 adult solid-organ transplants (114 renal, 1 kidney and pancreas, 197 liver) in this period. Overall, 113 (36.2%) pulmonary disease consultations were performed in the posttransplant stage, and 46 (40.7%) patients underwent bronchoalveolar lavage with P. jirovecii screening. We identified 18 patients who tested positive for P. jirovecii infection according to nucleic acid amplification assay; 3 were not proven, and 7 had a transplant date before 2011. The prevalence was 8/312 (2.6%); of these 8 patients, 5 had the same genotype cluster. Median P. jirovecii pneumonia development time was longer in renal transplant recipients (P = .016). Only renal transplant recipients were offered Pneumocystis prophylaxis for 6 months. Concomitant viral infection including cytomegalovirus was the only significant factor for P. jirovecii pneumonia development (P = .028). Intensive care admission was 40% (n = 6), and disease-related mortality was 33% (n = 5). CONCLUSIONS: The overall prevalence of P. jirovecii pneumonia in solid-organ transplant recipients was similar to other single-center reports. Prophylaxis prevented early posttransplant P. jirovecii pneumonia. However, P. jirovecii pneumonia may develop at any posttransplant stage, and viral infections other than cytomegalovirus should also be considered as a predictor.

Validity and reliability of the Turkish version of the Multidimensional Dyspnea Profile in outpatients with respiratory disease

Background/aim: Dyspnea is the subjective feeling of breathing discomfort, which is a significant problem for patients with heart and respiratory disease and also an important determinant of exercise tolerance, quality of life, and mortality in various diseases. Most of the scales are not enough to investigate the multidimensional effects of dyspnea; therefore, the Multidimensional Dyspnea Profile (MDP) was developed and validated in many languages. This study aimed to translate and culturally adapt the MDP into Turkish and investigate the psychometric properties of this adapted version in outpatients with respiratory disease. Materials and methods: The MDP was translated and culturally adapted into Turkish following published guidelines. A total of 170 outpatients with respiratory disease were included to assess psychometric properties. The factorial structure was investigated using a principal component analysis. Two situations were used in this study evaluating dyspnea in activity-related and resting conditions. We formulated 17 hypotheses for each MDP domain (in total 68) to assess construct validity, and correlations were investigated between the MDP and measures of body mass index, pulmonary function test, other dyspnea assessments, anxiety, depression, and health-related quality of life. To investigate the test-retest reliability, the MDP was administered again after 1-h and 1 week Results: Internal consistency of the MDP was excellent (Cronbach's alpha coefficients ranged from 0.89 to 0.93). The exploratory factor analysis revealed 2 components explaining a 70% and 76% variance. Overall, 64 of the 68 predetermined hypotheses (94%) were confirmed to test construct validity. The MDP showed excellent test-retest reliability for a 1-hperiod (intraclass correlation coefficient values ranged from 0.98 to 0.99). However, test-retest reliability decreased moderate-to-high after 1 week (0.53­0.80). Conclusion: The MDP was successfully translated and culturally adapted into Turkish and this version showed good psychometric properties including the factorial structure, internal consistency, test-retest reliability, and construct validity to assess multidimensional aspects of dyspnea.

Determinants and characteristics of tuberculosis in liver transplant recipients

Background/aim: Solid organ transplant (SOT) recipients have increased risk of tuberculosis (TB). We aimed to investigate the prevalence and features of TB in liver transplant (LT) recipients at our transplantation canter. Materials and methods: All patients who underwent LT between January 2004 and December 2013 and whose data were accessible were included in the study. Demographic features, tuberculin skin test (TST) results, and TB prevalence were recorded. Characteristics of LT recipients who developed TB were evaluated. Results: A total of 403 patients underwent LT during this period. Mean age was 47.27 ± 11.04 years; 280 (69.47%) were males. The TST was administered to 108 (25.91%) and the QuantiFERON-TB test to 1 patient. TST positivity was determined in 28 (25.93%). Latent TB infection (LTBI) treatment was not recommended to any of the LT candidates. In the posttransplant period, 5 patients (1.24%) developed TB over a median duration of 14 (min: 7, max: 84) months, 2 of whom were found to have had LTBI in the pretransplant period. Conclusion: The prevalence of TB in LT recipients at our center was similar to that in the current literature. LTBI screening, including risk factor assessment and TST/QuantiFERON-TB testing, is necessary in the early diagnostic workup for TB in LT recipients.

Multiple distant metastases in a case of malignant pleural mesothelioma.

INTRODUCTION: Malignant pleural mesothelioma (MPM) is a malignant of mesodermal neoplasm and arises from multipotential mesothelial or subserosal cells of the pleura, pericardium and peritoneum. CASE: A seventy five year-old male patient was admitted with chest and lower limb pain. He was a heavy smoker and exposed to environmental asbestos in his childhood. PET-CT scans showed multiple pathological FDG uptakes in lungs and other organs. Biopsies performed from lung and anterior thigh muscles were reported as epitheloid type malignant pleural mesothelioma. DISCUSSION: We emphasize that unexpected distant metastases can be observed in MPM and occasionally primary diagnosis can be determined by the biopsy of the metastatic regions. This case also points out the role of PET-CT in the staging of malign mesothelioma by determining different metastatic sites.

Community-acquired pneumonia in patients with chronic obstructive pulmonary disease requiring admission to the intensive care unit: risk factors for mortality.

PURPOSE: The aims of this study are to identify factors predicting mortality in patients with chronic obstructive pulmonary disease (COPD) and community-acquired pneumonia (CAP) requiring intensive care unit (ICU) admission and to examine whether noninvasive ventilation treatment reduces mortality. MATERIALS AND METHODS: An analysis was performed on data from patients with CAP hospitalized in the ICUs of 19 different hospitals in Turkey between October 2008 and January 2011. Predictors of mortality were assessed by both univariate and multivariate statistical analyses. RESULTS: Two hundred eleven patients with COPD and CAP were included. The overall ICU mortality was 23.9%. Noninvasive ventilation treatment (odds ratio [OR], 0.12; 95% confidence interval [CI], 0.03-0.49; P = .003), hypertension (OR, 0.13; 95% CI, 0.02-0.93; P = .042), bilateral infiltration (OR, 13.92; 95% CI, 2.94-65.84; P = .001), systemic corticosteroid treatment (OR, 0.19; 95% CI, 0.35-0.96; P = .045), length of ICU stay (OR, 0.65; 95% CI, 0.47-0.89; P = .007), and duration of invasive mechanical ventilation (OR, 1.11; 95% CI, 1.01-1.22; P = .032) were independent factors related to mortality. CONCLUSION: Noninvasive ventilation, hypertension, systemic corticosteroid treatment, and shorter ICU stay are associated with reduced mortality, whereas bilateral infiltration and longer duration of invasive mechanical ventilation are associated with increased risk of mortality in patients with COPD and CAP requiring ICU admission.

Metabolic syndrome and carotid intima-media thickness in chronic obstructive pulmonary disease.

BACKGROUND: The aim of this study is to investigate the prevalence of metabolic syndrome (MetS), carotid intima media thickness (IMT), and serum C-reactive protein (CRP) levels in patients with chronic obstructive pulmonary disease (COPD), and the possible relationships among them. METHODS: Fifty stable COPD patients and 40 healthy controls were included in the study. The participants were further divided into four groups according to their smoking status. Pulmonary function tests were performed in COPD patients. Anthropometric measurements and blood chemistry analysis, serum CRP levels and carotid intima-media thickness (IMT) measurements were performed in all the study population. RESULTS: Prevalence of metabolic syndrome was 43% in COPD patients and 30% in the control group (p = 0.173). FEV1% and FEV1/FVC were higher in COPD patients with MetS (p = 0.001 and p = 0.014, respectively) compared to those without MetS. Prevalence of MetS was significantly different among the COPD patients with different stages (p = 0.017) with the highest value in stage 2 (59%). Carotid IMT was significantly higher in COPD patients than in control group (1.07 ± 0.25 mm and 0.86 ± 0.18 mm, respectively; p < 0.001). Serum CRP levels were not different in COPD patients and controls, however they were higher in individuals with MetS compared to those without MetS regardless of COPD presence (p = 0.02). CONCLUSIONS: Early markers of atherogenesis, in terms of carotid IMT, were found to be higher in COPD patients than in healthy controls. MetS prevalence was observed to decrease as the severity of airflow obstruction increased. Therefore, screening COPD patients for these cardiovascular risk factors would be a novel approach even in absence of symptoms.

Mortality indicators in community-acquired pneumonia requiring intensive care in Turkey.

BACKGROUND: Severe community-acquired pneumonia (SCAP) is a fatal disease. This study was conducted to describe an outcome analysis of the intensive care units (ICUs) of Turkey. METHODS: This study evaluated SCAP cases hospitalized in the ICUs of 19 different hospitals between October 2008 and January 2011. The cases of 413 patients admitted to the ICUs were retrospectively analyzed. RESULTS: Overall 413 patients were included in the study and 129 (31.2%) died. It was found that bilateral pulmonary involvement (odds ratio (OR) 2.5, 95% confidence interval (CI) 1.1-5.7) and CAP PIRO score (OR 2, 95% CI 1.3-2.9) were independent risk factors for a higher in-ICU mortality, while arterial hypertension (OR 0.3, 95% CI 0.1-0.9) and the application of non-invasive ventilation (OR 0.2, 95% CI 0.1-0.5) decreased mortality. No culture of any kind was obtained for 90 (22%) patients during the entire course of the hospitalization. Blood, bronchoalveolar lavage, and non-bronchoscopic lavage cultures yielded enteric Gram-negatives (n=12), followed by Staphylococcus aureus (n=10), pneumococci (n=6), and Pseudomonas aeruginosa (n=6). For 22% of the patients, none of the culture methods were applied. CONCLUSIONS: SCAP requiring ICU admission is associated with considerable mortality for ICU patients. Increased awareness appears essential for the microbiological diagnosis of this disease.

Serum and pleural fluid N-Terminal-Pro-B-Type natriuretic peptide concentrations in the differential diagnosis of pleural effusions.

Currently, new biomarkers like N-Terminal-Pro-B-Type natriuretic peptide (NT-proBNP) have been used in the differential diagnosis of pleural effusions. In our study, we aimed to investigate the diagnostic value of NT-proBNP, especially in cardiac originated pleural effusions. Forty-five patients with pleural effusions were included in the study. NT-proBNP levels and biochemical markers involved in the Light's criteria were analyzed in pleural fluid and serums of the patients. Pleural fluid culture, AFB smear, cytology were performed where they were indicated according to the clinical evaluation. In patients, to whom cardiac pathology was considered to be; cardiological evaluation and echocardiography were also done. Thirty-eight pleural effusions were exudative and, 7 were transudative according to the Light's criteria. Final diagnosis were malignant effusion in 13, infection (tuberculosis/pneumonia) in 10, congestive heart failure in 21, and other conditions related with pleural effusion in 1 of the patients. Median (25th to 75th percentiles) NT-proBNP levels of serum and pleural fluid due to congestive heart failure (CHF) were 4747 pg/mL (931-15754) and 4827 pg/mL (1290-12.430) while median NT-proBNP levels of serum and pleural fluid related with non-cardiac reasons were 183 pg/mL (138-444) and 245 pg/mL (187-556) respectively. NT-proBNP levels of serum and pleural fluid were significantly high in CHF (p< 0.001 for both). When four groups were compared serum and pleural fluid NT-proBNP levels were highest in the CHF group which was followed by malignancy, infection and others (p< 0.001 for both). Fourteen of 21 patients who were accepted to have congestive heart failure as the final diagnosis by a cardiological evaluation had an exudative pleural fluid according to the Light's criteria. Serum and pleural fluid NT-proBNP levels were higher in transudates and this reached statistically significance for pleural fluid (p= 0.009). We suggest that measurement of pleural fluid NT-proBNP is a smart approach and pleural fluid NT-proBNP can reflect cardiac origin of effusions better than serum NT-proBNP and Light's criteria.

An unusual presentation of bronchial rupture.

Persistent hydropneumothorax was diagnosed in a 62-year-old female with a history of blunt trauma, although she was treated with chest tube and closed underwater seal drainage. Computed tomography and fiberoptic bronchoscopy findings were consistent with "fallen lung" syndrome. Fiberoptic bronchoscopy also found a cavitary lesion at the right tracheobronchial angle. Forceps biopsy of the cavitary lesion indicated bronchogenic carcinoma. Our final diagnosis was tracheobronchial complete rupture and fallen lung syndrome secondary to malignancy.