Impact of Anxiety, Depression, and Coping Strategies on Health-Related Quality of Life in Patients with Cystic Fibrosis.

OBJECTIVE: With the significant increase in the life expectancy of cystic fibrosis (CF) patients, many individuals now reach adulthood and develop specific coping strategies to maintain their physical and mental well-being. This study aims to evaluate coping styles and their relationship with mental health and Health-Related Quality of Life (H-RQoL) in adult CF patients. MATERIALS AND METHODS: Thirty adult CF patients completed the Hospital Anxiety and Depression Scale to assess anxiety and depression, the Cystic Fibrosis Questionnaire-Revised to evaluate quality of life, and the Brief Coping Orientation to Problems Experienced questionnaire to assess coping strategies. RESULTS: Twelve individuals (40%) met the diagnostic criteria for being at risk of experiencing anxiety and/or depression. Anxiety risk group exhibited lower life quality scores in the domains of vitality, emotional functioning, and role limitations (P = .027, P = .001, and P = .001, respectively). Patients reporting depressive symptoms had lower scores in emotional functioning and role limitations domains of quality of life (P = .005 and P = .018, respectively). Multivariate analysis indicated that depression and anxiety scores were significant predictors of emotional quality of life. In terms of coping strategies, "acceptance" was the most commonly preferred, while "substance use" was the least preferred strategy among all participants. Patients at risk of anxiety and/or depression often chose "avoidance" as their coping strategy. CONCLUSION: Anxiety and depressive symptoms are prevalent and associated with poorer H-RQoL in adult CF patients. These patients preferred to employ giving up strategy when dealing with the disease. Therefore, it is essential to screen adult CF patients for mental health risks and to work on improving their coping strategies.

Determinants of Severe Nocturnal Hypoxemia in Adults with Chronic Thromboembolic Pulmonary Hypertension and Sleep-Related Breathing Disorders.

OBJECTIVES: We aimed to investigate the occurrence of sleep-related breathing disorders (SRBDs) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and addressed the effect of pulmonary hemodynamics and SRBD indices on the severity of nocturnal hypoxemia (NH). METHODS: An overnight polysomnography (PSG) was conducted in patients with CTEPH, who were eligible for pulmonary endarterectomy. Pulmonary hemodynamics (mean pulmonary arterial pressure (mPAP), pulmonary arterial wedge pressure (PAWP), pulmonary vascular resistance (PVR) measured with right heart catheterization (RHC)), PSG variables (apnea-hypopnea index (AHI)), lung function and carbon monoxide diffusion capacity (DLCO) values, as well as demographics and comorbidities were entered into a logistic regression model to address the determinants of severe NH (nocturnal oxyhemoglobin saturation (SpO2) < 90% under >20% of total sleep time (TST)). SRBDs were defined as obstructive sleep apnea (OSA; as an AHI ≥ 15 events/h), central sleep apnea with Cheyne-Stokes respiration (CSA-CSR; CSR pattern ≥ 50% of TST), obesity hypoventilation syndrome (OHS), and isolated sleep-related hypoxemia (ISRH; SpO2 < 88% under >5 min without OSA, CSA, or OHS). RESULTS: In all, 50 consecutive patients (34 men and 16 women; mean age 54.0 (SD 15.1) years) were included. The average mPAP was 43.8 (SD 16.8) mmHg. SRBD was observed in 40 (80%) patients, of whom 27 had OSA, 2 CSA-CSR, and 11 ISRH. None had OHS. Severe NH was observed in 31 (62%) patients. Among the variables tested, age (odds ratio (OR) 1.08, 95% confidence interval [CI] 1.01-1.15; p = 0.031), mPAP (OR 1.11 [95% CI 1.02-1.12; p = 0.012]), and AHI (OR 1.17 [95% CI 1.02-1.35; p = 0.031]) were independent determinants of severe NH. CONCLUSIONS: Severe NH is highly prevalent in patients with CTEPH. Early screening for SRBDs and intervention with nocturnal supplemental oxygen and/or positive airway pressure as well as pulmonary endarterectomy may reduce adverse outcomes in patients with CTEPH.

Surgical Treatment of Another Sequalae of COVID-19: Post-COVID CTEPH.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is still an ongoing entity and every day we face new sequalae of the disease. We hereby present surgical results of patients who are treated for post-COVID chronic thromboembolic pulmonary hypertension. METHODS: Data were collected among patients who underwent pulmonary endarterectomy and had a diagnosis of post-COVID chronic thromboembolic pulmonary hypertension. All data were retrospectively reviewed from a prospectively conducted database. Operative mortality was described as death in hospital or within 30 days of surgery. RESULTS: Eleven patients (seven males, four females; median age, 52 [22-63] years) were identified. Pulmonary vascular resistance improved significantly from 572 dyn/s/cm-5 (240-1,192) to 240 (195-377) dyn/s/cm-5 (p < 0.005). Significant difference was also detected in median mPAP, as it decreased from 40 mm Hg (24-54) to 24 mm Hg (15-36) following surgery (p < 0.005). Mortality was observed in one patient due to sepsis on the fifth postoperative day. Median time from COVID-19 disease to surgery was 12 months (6-24). Median length of hospital stay of the survivors was 10 days (8-14). CONCLUSION: In the new era of chronic thromboembolic pulmonary hypertension, hybrid approach including surgery, balloon pulmonary angioplasty, and medical treatment has been recommended. pulmonary endarterectomy is still the only curative treatment when the disease is surgically accessible. We hereby report the first publication of post-COVID chronic thromboembolic pulmonary hypertension patients who were surgically treated. As we see a lot of long-term symptoms and clinical manifestations in patients who had COVID-19, we should always remember chronic thromboembolic pulmonary hypertension in the differential diagnosis.

Primary Immun Deficiency in Patients with Non-Cystic Fibrosis Bronchiectasis and Its Relationship with Clinical Parameters.

OBJECTIVE: Bronchiectasis is characterized by chronic respiratory infection. The role of immunodeficiency in this disease is poorly studied in relation to clinical indices. The primary aim of this study was to determine the frequency of these neglected altered immune status by evaluating immunoglobulins, lymphocyte subsets, complement levels, and neutrophil function, and to assess its relationship with clinical parameters in adult patients with non-cystic fibrosis bronchiectasis (NCFB). MATERIAL AND METHODS: A total of 74 (30 men and 44 women with a mean age of 47±17 years) adult patients with stable NCFB were enrolled in this study. The bronchiectasis severity index (BSI) and FACED (F:FEV1, A: Age, C: Chronic colonization, E: Extension, D: Dyspnea) scores were assessed. Peripheral blood samples were collected for the detection of total IgG, IgA, IgM, IgE, and IgG subclasses and C3 and C4 levels. The counts of CD3, CD4, CD8, CD19, CD16/56 expressing peripheral blood lymphocytes and neutrophil oxidative function were evaluated. RESULTS: In the study population, BSI and FACED severity index scores increased with longer duration of the disease (p=0.01 and p=0.040, respectively). Of the 74 patients, 27 (37%) showed humoral aberrations. The number of male patients were higher in this group (p=0.03). High serum total IgE levels were associated with high scores in BSI (moderate-severe group versus mild group, p=0.030). Patients with bronchiectasis demonstrated lower CD3+ T cell count, lower CD4+ T helper cell percentage, and lower CD4+ T cell count (p=0.031, p=0.030, p=0.029, respectively) than healthy subjects. A significant negative correlation was found between the percentage and count of CD16/56+ natural killer (NK) cells and the number of exacerbations within the past year (r=-0.230, p=0.049 and r=-0.264, p=0.023, respectively). CONCLUSION: Humoral aberrations in adult patients with NCFB were found to be frequent. IgE levels were related to high scores for disease severity indices. Furthermore, patients with low percentage and counts of NK cells had higher rates of exacerbations. These results emphasize the importance of immune function assessment in adult patients with NCFB.

Risk factors for bronchoscopic complications in patients over 75 years of age.

AIM: Bronchoscopy is a widely used, well-tolerated diagnostic and therapeutic intervention and has a low complication rate. The aim of this study was to describe the rates of bronchoscopic complications and risk factors in a group of patients 75 years' old and above. METHODS: To investigate the rate of complications and risk factors in the older patients, we carried out a retrospective cohort study of 240 patients above 75 years of age who had bronchoscopy for various reasons. RESULTS: Complication rate was found to be 3.7% in the older patients group which was not different from the control group (1.2%, p > 0.05). No significant relationship was found between age group and complication development (p > 0.05). The type of procedures did not show any effect on complication development between age groups and individually. We found that anemia (OR 7.2, 95% CI 1.2-41.2), percutaneous gastrostomy (OR 9.9, 95% CI 1.6-58), immobility (OR 11.9, 95% CI 2.6-33.5) and procedures performed in the intensive care unit (OR 7.4, 95% CI 1.4-37.5) were significant risk factors for complication. CONCLUSIONS: In the older patients group, bronchoscopy is a safe procedure regardless of the type of procedures performed and age. It has been shown that anemia, PEG presence, immobility and intensive care patients are associated with increased complication.

Perioperative management of massive pulmonary hemorrhage after pulmonary endarterectomy.

BACKGROUND: This study aims to evaluate our approaches and outcomes in patients who developed hemoptysis following pulmonary endarterectomy. METHODS: Pulmonary endarterectomy was performed in 460 patients at Kartal Kosuyolu Training and Research Hospital between March 2011 and September 2017. Clinical characteristics, perioperative management and postoperative outcomes of 10 patients (2.1%) (4 males, 6 females; mean age 48.3±16.5 years; range 21 to 76 years) with massive pulmonary hemorrhage following pulmonary endarterectomy were evaluated. RESULTS: Mean period of diagnosis for chronic thromboembolic pulmonary hypertension was 17±13.6 months. All patients were New York Heart Association functional class II (n=2), III (n=5) or IV (n=3). For the treatment of massive pulmonary hemorrhage, intraoperative extracorporeal membrane oxygenation was used in six patients (60%), while conservative treatments were used in four patients (40%). In-hospital mortality rate was 50% (n=5); the causes for mortality were septic shock in two patients, multiple organ failure in two patients and intracranial hemorrhage in one patient. Survival was achieved in two patients on extracorporeal membrane oxygenation and three patients receiving conservative treatment. Functional and hemodynamic improvement was observed in all surviving patients. CONCLUSION: Despite the relatively low incidence of massive pulmonary hemorrhage after pulmonary endarterectomy, it is a potentially fatal complication. Our approach focuses on early diagnosis with a multidisciplinary team and management with bronchoscopy, bronchial blockers and use of extracorporeal membrane oxygenation. The choice of treatment depends on the site and origin of the hemorrhage, the availability of equipment and expertise, and the potential short- and long-term advantages and disadvantages.

Outcomes of Patients with Behçet's Syndrome after Pulmonary Endarterectomy.

BACKGROUND: Behçet's syndrome (BS) is a multisystem disorder and is not known as a risk factor for chronic thromboembolic pulmonary hypertension (CTEPH), for which the treatment of choice is pulmonary endarterectomy (PEA). The aim of this study was to review our experience in the surgical treatment of CTEPH in patients with BS. METHODS: Data were collected prospectively for consecutive patients with BS who underwent PEA over a 6-year period. RESULTS: We identified nine patients (seven males, two females, mean age: 34.7 ± 9.9 years) with BS. The mean disease duration before PEA was 88.0 ± 70.2 months. All patients but one received immunosuppressive therapy before the surgery. Exercise-induced dyspnea presented symptoms in six patients. One patient had associated intracardiac thrombosis. PEA was bilateral in five patients, unilateral in three, and lobar in one. No perioperative mortality was observed; however, one patient died four weeks after PEA due to massive hemoptysis. Morbidity was observed in two patients. The systolic pulmonary artery pressure fell significantly from 59.0 ± 22.7 mm Hg to 30.0 ± 6.5 mm Hg after surgery (p = 0.031). Pulmonary vascular resistance also improved significantly from 611.8 ± 300.2 to 234.7 ± 94.9 dyn/s/cm5 (p = 0.031). After a median follow-up of 29.4 months, all patients improved to the New York Heart Association (NYHA) functional class I and II. CONCLUSION: Patients with BS may suffer recurrent pulmonary embolism and develop CTEPH. In patients who do not respond to anticoagulation or immunosuppressive therapy, PEA may be a therapeutic option when thrombotic lesions are surgically accessible. Due to the high risk of perioperative mortality, the procedure should be undertaken in centers with experience.

Parenchymal density changes in acute pulmonary embolism: Can quantitative CT be a diagnostic tool? A preliminary study.

PURPOSE: Determine the ability of quantitative CT (QCT) in defining parenchymal density changes in acute pulmonary embolism (PE). MATERIAL & METHODS: Mean lung density (MLD) and percentage distribution values (PDV) were calculated in 34 patients suspected of PE using software application based on computerized volumetric anatomical segmentation. RESULTS: Total, left, and right MLD differed significantly between emboli positive(n=23) and negative(n=11) groups(p<0.006, p<0.009, p<0.014). PDVs differed between groups (p<0.05) except for LUZ and RLZ. When PE was present in lobe &/segment branches, PDVs were significantly lower except RUZ. CONCLUSION: QCT is a promising application for defining parenchymal density changes in PE revealing potential functional impact of emboli. This preliminary study suggests QCT could provide added value to CTPA in peripheral PE.

Influence of Statin Therapy on Exacerbation Frequency in Patients with Chronic Obstructive Pulmonary Disease.

OBJECTIVES: Chronic obstructive pulmonary disease (COPD) is an inflammatory disease, in which chronic and systemic inflammation plays an important role. By decreasing neutrophil infiltration and cytokine production, statins have anti-inflammatory mechanisms. MATERIALS AND METHODS: Fifty-seven patients who had diagnosis of chronic obstructive pulmonary disease according to GOLD guideline were included in the study; 20 of them were statin users. Statin users group were patients being under medication with regular simvastatin, atorvastatin or rosuvastatin 20 mg per day for at least the past 1 year. RESULTS: There was statistically no significant difference between patients with or without statin treatment with respect to; age, female-male ratio, COPD severity level, medication used for COPD, pulmonary function tests results and smoking habits. COPD exacerbation frequency in patients using statins was significantly less than patients not using statins (p<0.05). Patient number with COPD exacerbation, antibiotic treatment and outpatient clinic administration and outpatient clinic administration frequency was significantly lower in statin using patients (p<0.05). CONCLUSION: COPD patients receiving statins have a lower frequency of COPD exacarbations, hospital administration and antibiotic treatment compared to patients not receiving statins.

Extranodal pulmonary marginal zone B-cell lymphoma.

AIM: Extranodal mucosa-associated lymphoid tissue (MALT) arises a number of epithelial tissues, including the stomach, salivary gland, lung, small bowel, and elsewhere. Here we present a male patient with an uncommon site of extranodal MALT such as a pelvic mass diagnosed after a long period of evaluation, which initially presented with an incidental pulmonary nodule. METHOD: We report a 60 years old man presenting with pulmonary nodules and consolidation. He refused invasive procedures and 3 years later was administered to our clinic with disseminated pulmonary nodules on chest X-ray. Subsequently a thin needle aspiration biopsy was performed and candida geotrichum was suspected in the specimen of the lung biopsy by light microscopic examination. After this time the patient was referred to our clinic, bronchoscopy, mediastinoscopy and abdominal computerized tomography (CT) scans were performed. RESULTS: Lymphoid hyperplasia was seen in the mediastinal lymph nodes biopsy specimens and the pelvic mass (52 × 18 mm) on the superior iliac muscles not related to any organs. Thin needle biopsy revealed MALT lymphoma and pathological examination of pulmonary nodule was similar to pelvic mass (MALT lymphoma). After the diagnosis, the thin needle biopsy of lung was repeated. The specimen appeared to be similar to the pelvic mass (MALT lymphoma) in the pathologic examination. The patient survived 5 years after initial diagnosis. CONCLUSION: MALT has an affinity for the different tissues however has not been located in the pelvis. Our case represent an unusual presentation in a 60 years old man with lung and a pelvic mass.