Correlation of myeloid-derived suppressor cells with C-reactive protein, ferritin and lactate dehydrogenase levels in patients with severe COVID-19.

The novel coronavirus disease 2019 (COVID-19) remains a global health emergency, and understanding the interactions between the virus and host immune responses is crucial to preventing its lethal effects. The expansion of myeloid-derived suppressor cells (MDSCs) in COVID-19, thereby suppressing immune responses, has been described as responsible for the severity of the disease, but the correlation between MDSC subsets and COVID-19 severity remains elusive. Therefore, we classified patients according to clinical and laboratory findings-aiming to investigate the relationship between MDSC subsets and laboratory findings such as high C-reactive protein, ferritin and lactate dehydrogenase levels, which indicate the severity of the disease. Forty-one patients with COVID-19 (26 mild and 15 severe; mean age of 49.7 ± 15 years) and 26 healthy controls were included in this study. MDSCs were grouped into two major subsets-polymorphonuclear MDSCs (PMN-MDSCs) and monocytic MDSCs-by flow cytometric immunophenotyping, and PMN-MDSCs were defined as mature and immature, according to CD16 expressions, for the first time in COVID-19. Total MDSCs, PMN-MDSCs, mature PMN-MDSCs and monocytic MDSCs were significantly higher in patients with COVID-19 compared with the healthy controls (P < .05). Only PMN-MDSCs and their immature PMN-MDSC subsets were higher in the severe subgroup than in the mild subgroup. In addition, a significant correlation was found between C-reactive protein, ferritin and lactate dehydrogenase levels and MDSCs in patients with COVID-19. These findings suggest that MDSCs play a role in the pathogenesis of COVID-19, while PMN-MDSCs, especially immature PMN-MDSCs, are associated with the severity of the disease.

Remdesivir treatment for patients with moderate to severe COVID-19.

BACKGROUND: Remdesivir, which was first developed for the treatment of Ebola disease but failed to meet expectations, has become hope in the fight against the COVID-19 pandemic. This study aimed to evaluate risk factors for mortality and prognosis of adult moderate/severe COVID-19 patients treated with remdesivir, and safety and tolerability of 5 days of remdesivir treatment. METHODS: This multicenter prospective observational study was conducted in 14 centers in Turkey. Pregnancy or breastfeeding, multiorgan failure, or usage of vasopressors for septic shock, ALT > 5 × the upper limit of the normal range, or eGRF <30 mL/min or dialysis and receiving favipiravir were the exclusion criteria of the study. RESULTS: Among 500 patients, 494 patients were included in the study. On admission, 392 (79.3%) patients had moderate and 102 (20.6%) patients had severe COVID-19. The 28-day mortality was 10.1%. The median of the scores of the seven-category ordinal scale assessed on days 0, 3, 5, 7 were 4 and 3 on day 14. When the survival status of the patients was evaluated according to the time between the remdesivir start date and the end date of the symptoms, no statistically significant difference was found between the medians of the groups (p = 0.404). In multivariable analysis, age (OR, 1.05; 95%CI, 1.02-1.08; p = 0.003), SpO2 level on admission (OR, 3.03; 95%CI, 1.35-6.81; p = 0.007), heart rate (OR, 2.48; 95%CI, 1.01-6.07; p = 0.047), follow-up site at the hospital (clinic/ICU) (OR, 26.4; 95%CI, 11.6-60.17; p < 0.001) were independently associated with increased mortality. Grade 3 adverse event (AE) was observed in 4 (0.8%) patients. None of the patients experienced grade 4 or 5 AEs. DISCUSSION: Remdesivir is a safe and well-tolerated drug and older age, low SpO2 level on admission, tachycardia, and ICU admission are independently associated with increased mortality among patients with moderate/severe COVID-19 receiving remdesivir treatment.

Evaluation of the relationship between perceived social support, coping strategies, anxiety, and depression symptoms among hospitalized COVID-19 patients.

OBJECTIVE: We aimed to evaluate the relationship between perceived social support, coping strategies, anxiety, and depression symptoms among hospitalized COVID-19 patients by comparing them with a matched control group in terms of age, gender, and education level. METHOD: The patient group (n = 84) and the healthy controls (HCs, n = 92) filled in the questionnaire including the socio-demographic form, Hospital Anxiety Depression Scale, Multidimensional Perceived Social Support Scale, and Brief Coping Orientation to Problems Experienced through the online survey link. RESULTS: The COVID-19 patients had higher perceived social support and coping strategies scores than the HCs. However, anxiety and depression scores did not differ significantly between the two groups. In logistic regression analysis performed in COVID-19 patients, the presence of chest CT finding (OR = 4.31; 95% CI = 1.04-17.95) was a risk factor for anxiety and the use of adaptive coping strategies (OR = 0.86; 95% CI = 0.73-0.99) had a negative association with anxiety. In addition, the use of adaptive coping strategies (OR = 0.89; 95% CI = 0.79-0.98) and high perceived social support (OR = 0.97; 95% CI = 0.93- 0,99) had a negative association with depression symptoms. CONCLUSIONS: Longitudinal studies involving the return to normality phase of the COVID-19 pandemic are needed to investigate the effects of factors such as coping strategies and perceived social support that could increase the psychological adjustment and resilience of individuals on anxiety and depression.

Impact of low molecular weight heparin administration on the clinical course of the COVID-19 disease

Background: Lymphopenia is the most important criterion of mortality and discharging feature for patients infected with coronavirus disease 2019 (COVID-19). This study aimed to investigate the clinical impact of a low molecular weight heparin (LMWH) treatment on the clinical course of COVID-19. Materials and methods: Patients' clinical symptoms, radiologic outcomes, hematologic, biochemical, D-dimer, and C-reactive protein (CRP) results were obtained from their medical records. Participants were separated into 2 groups: one was treated with LMWH and the other was not. Improvement in the patients was compared before and after treatment. Results: Ninety-six patients who were diagnosed with COVID-19 between April and May 2020 were retrospectively analyzed. The multivariable analysis showed that the count of lymphocytes, D-dimer, and CRP levels were significantly improved in the LMWH group, as compared to the control group (OR, (95% CI) 0.628 (0.248­0.965), P < 0.001); OR, (95% CI) 0.356 (0.089­0.674), P < 0.001, respectively). The area under the receiver operating characteristic (ROC) curve analysis was AUC: 0.679 ± 0.055, 0.615 ± 0.058, and 0.633 ± 0.057, respectively; the ß-value was found to be ­1.032, ­0.026, and ­0.465, respectively. Conclusion: The LMWH treatment group demonstrated better laboratory findings, including recovery in the lymphocyte count, CRP, and D-dimer results.

Cognitive function in chronic obstructive pulmonary disease: relationship to global initiative for chronic obstructive lung disease 2011 categories.

BACKGROUND AND OBJECTIVE: Recently, comorbidities such as impaired cognitive function have been attracting more focus when considering the management of chronic obstructive pulmonary disease (COPD). Here we investigated the relationship between cognitive function and the categories given in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines in 2011. Specifically, after controlling for non-COPD covariates, we assessed the clinical features that may be predictive of cognitive impairment in patients with COPD. METHODS: We recruited 119 stable patients with mild to very severe COPD. We administered a broad array of standardized neuropsychological tests that assessed cognitive functions in the domains of attention, memory, psychomotor coordination and language. RESULTS: Cognitive scores were significantly different between patients falling within GOLD 2011 categories. Scores were lower in patients with high future risk compared with low future risk. In parallel, there were significant differences in cognitive function between COPD patient subgroups when patients were grouped according to the forced expiratory volume in 1 s, exacerbation history and C-reactive protein levels. After controlling for non-COPD predictors, only exacerbation history remained a significant predictor of cognitive scores. CONCLUSIONS: The number of exacerbation events in a year may be used as a predictor of cognitive impairment in patients with COPD.

Assessment of ocular neurotoxicity in patients treated with systemic cancer chemotherapeutics.

PURPOSE: Cisplatin and Paclitaxel are two chemotherapeutic agents known to produce neurotoxicity when used for cumulative dose regimens. In this study we aim to assess their toxicity in the optic nerve, and to evaluate the retinal nerve fibre layer (RNFL) thickness and visual field changes in lung cancer patients treated with Cisplatin and Paclitaxel. METHODS: Fifteen patients who were treated intravenously with 75 mg/m(2) cisplatin and 175 mg/m(2) paclitaxel every 3 weeks, up to a maximum of six courses, were enrolled in this prospective clinical trial. All patients underwent complete ophthalmological assessments before their treatments began, as well as three months after the completion of their treatments. The RNFL thickness measurements were performed using optical coherence tomography (OCT). Functional testing included the use of frequency-doubling technology (FDT) perimetry and the Humphrey visual field analyser (HFA). The main outcome measurements included the average RNFL thicknesses and visual field indices (mean deviation [MD] and pattern standard deviation [PSD]). RESULTS: The median age of the 15 patients (nine male and six female) was 63.49 years old (range: 53-77). The average RNFL thickness measurement during the baseline examination was 103.73 µm (range: 97-111). Three months after the cessation of treatment the RNFL thickness declined to 97.4 µm (range: 91-102). Statistical analysis showed a significant thinning between the two measurements (p = 0.032). The MD and PSD values recorded by the HFA demonstrated no statistically significant changes 3 months after the cessation of treatment (p > 0.207 and p > 0.186, respectively). There were statistically significant decreases in both the MD (0.48 to -1.13 dB) and PSD (2.13 to 0.65 dB) indices measured by the FDT perimetry (p = 0.041 and p = 0.025, respectively). CONCLUSIONS: In our study, the systemic administration of Cisplatin and Paclitaxel affected the peripapillary RNFL thicknesses and visual field indices as revealed by FDT perimetry. OCT and FDT perimetry may be adjunctive tools for the screening of ocular toxicity in patients treated with these agents.

Attentional control is partially impaired in obstructive sleep apnea syndrome.

Obstructive sleep apnea syndrome is associated with executive cognitive impairment. An important question is whether impairment in executive functioning in obstructive sleep apnea syndrome is independent of dysfunction in attention. Attentional control is a subcomponent of executive functioning that is mediated by frontal lobe processing. In the current study, we investigated whether attentional control is deficient in obstructive sleep apnea syndrome. Attentional control processes were investigated through conflict adaptation and conflict frequency paradigms. These neuropsychological paradigms were assessed by using the Simon, Flanker and Stroop tasks. We additionally analysed post-error slowing data within these tasks. Error processing is another index of cognitive control that is mediated by frontal lobe functioning. Our sample consisted of 14 healthy adults and 24 patients with untreated moderate-severe obstructive sleep apnea syndrome. Results indicated that attentional control is partially dysfunctional among patients with obstructive sleep apnea syndrome. Attentional control processes were deficient when focal attention (Flanker task) processes were involved, but were intact when observed using the Simon and Stroop tasks. A non-significant trend in post-error slowing data suggested that error processing, assessed with the Flanker task, was diminished among patients with obstructive sleep apnea syndrome. These results support the view that obstructive sleep apnea syndrome leads to some amount of frontal lobe dysfunction, and that attentional control and error processing might be particularly affected by obstructive sleep apnea syndrome.

Serum C-reactive protein and procalcitonin levels in non-small cell lung cancer patients.

AIM OF THE STUDY: The basic uses of C-reactive protein (CRP) and procalcitonin (PCT) in clinical practice are in the diagnosis and follow-up of infectious disease. The fact that CRP already achieves high levels in cases with lung cancer, however, limits its diagnostic specificity. Procalcitonin may be an important marker in the differential diagnosis of lung cancer patients who have fever and high CRP levels. Our objective in this study was to determine the levels of CRP and PCT in patients with newly diagnosed non-infectious non-small cell lung cancer (NSCLC) and to relate these results to patient and disease characteristics. MATERIAL AND METHODS: Serum CRP and PCT levels were measured in 79 histopathologically proven NSCLC patients and 20 healthy controls. Results were compared with demographic and clinical variables in patients with NSCLC. RESULTS: Serum CRP concentrations were significantly higher in NSCLC patients compared to the control group [38.30 (7.79-185) mg/dl vs. 7.79 (3.36-26.10) mg/dl; p < 0.001]. There was no significant difference between the two groups in PCT levels (p > 0.05). A mild, positive correlation was found between CRP level and tumor diameter. When comparing CRP levels in the lung cancer patients grouped according to age, sex, smoking status, clinical TNM staging and performance status (PS), the only significant difference found was that for PS score. CONCLUSIONS: High serum CRP levels in non-infectious NSCLC patients are mainly related to PS status and weakly to tumor size. Adding serum PCT measurement may contribute to exclusion of infections in patients with NSCLC.

The Relationship between COVID-19 Severity and Bacillus Calmette-Guérin (BCG)/ Mycobacterium tuberculosis exposure history in healthcare workers: a multi-center study.

The COVID-19 pandemic has brought countries' health services into sharp focus. It was drawn to our group's attention that healthcare workers (HCWs) had a lower mortality rate against higher COVID-19 incidence compared to the general population in Turkey. Since risk of exposure to tuberculosis bacillus among healthcare workers are higher than the population, we aimed to investigate if there is a relationship between BCG and Mycobacterium tuberculosis exposure history with COVID-19 severity in infected HCWs. This study was conducted with 465 infected HCWs from thirty-three hospitals to assess the relationship between COVID-19 severity (according to their hospitalization status and the presence of radiological pneumonia) and BCG and Mycobacterium tuberculosis exposure history. HCWs who required hospital admission had significantly higher rates of chronic diseases, radiological pneumonia, and longer working hours in the clinics. Higher rates of history of contact and care to tuberculosis patients, history of tuberculosis, and BCG vaccine were observed in hospitalized HCWs. HCWs who had radiological pneumonia had a significantly increased ratio of history of care to tuberculosis patients and a higher family history of tuberculosis. The findings from our study suggest that the lower mortality rate despite the more severe disease course seen in infected HCWs might be due to frequent exposure to tuberculosis bacillus and the mortality-reducing effects of the BCG vaccine.

Pneumothorax as an initial manifestation of obstructive sleep apnea syndrome.

CASE REPORT: A sixty-five-year-old man with bullous lung disease was admitted to emergency service with chest pain and dyspnea that developed during sleep. Pneumothorax was diagnosed both clinically and radiologically. After the chest drainage, the patient presented with a prolonged air leak that required thoracotomy. Further history and occurrence of pneumothorax during sleep suggested that obstructive sleep apnea might play a role in the development of pneumothorax. Nocturnal polysomnography later confirmed the diagnosis of severe obstructive sleep apnea syndrome. DISCUSSION: We hypothesized that obstructive sleep apnea may be a risk factor for pneumothorax especially in patients with bullous lung disease, and pneumothorax may be listed in the complications of obstructive sleep apnea syndrome.

The effect of costal cartilage resection on the chest wall development: a morphometric evaluation.

OBJECTIVE: In repair of thoracic wall deformities, there is a debate in the literature regarding the optimal age and the type and number of costal cartilage resections. We evaluated the effect of costal cartilage resections on the chest wall development in young rabbits. METHODS: Fifty apparently healthy, 6 weeks of age, male New Zealand white rabbits were evaluated in five groups, each including 10 subjects. Group 1 served as control for the observation of normal thoracic development. Rabbits in group 2 underwent partial and rabbits in group 3 underwent total resections of the right third and fourth costal cartilages; those in group 4 underwent partial and rabbits in group 5 underwent total resections of the right third to sixth costal cartilages. Anteroposterior, horizontal and vertical diameters of the chest were measured before operation and repeated at 24 weeks of age. RESULTS: Upper and lower anteroposterior diameters of the thoracic wall and horizontal diameters of the left hemithorax differed significantly among groups (p=0.011, p=0.004, and p=0.002, respectively). Upper anteroposterior diameter was 49 mm in group 1 and 44 mm in group 3 (p=0.009). Lower anteroposterior diameter in group 5 (66 mm) was significantly less than that in group 1 (70 mm) (p=0.039) and there was also a statistically significant difference between group 4 (71 mm) and group 5 (66 mm) (p=0.002). Horizontal diameters of the left hemithorax in group 3 (32 mm; p=0.005) and 5 (32 mm; p=0.008) were significantly different when compared to group 1 (26 mm). Growth in right hemithorax was statistically less than that in left side in all operated groups except in group 2. CONCLUSIONS: Thoracic resections in young rabbits have demonstrated that the costal cartilage resection is not an innocent procedure as it severely affects the chest wall development especially in anteroposterior direction and the thoracic growth is markedly retarded when growth centers of the ribs are not preserved and/or four or more ribs are resected.

Risk factors for postoperative pulmonary complications in upper abdominal surgery.

BACKGROUND: Pulmonary complications are the most frequent cause of postoperative morbidity and mortality in upper abdominal surgery (UAS). We aimed to examine the influence of possible preoperative, operative and postoperative risk factors on the development of early postoperative pulmonary complications (POPC) after UAS. METHODS: A prospective study of 60 consecutive patients was conducted who underwent elective UAS in general surgical unit. Each patient's preoperative respiratory status was assessed by an experienced chest physician using clinical examination, chest radiographs, spirometry and blood gas analysis . Anaesthetical risks, surgical indications, operation time, incision type, duration of nasogastric catheter and mobilization time were noted. Forty-eight hours after the operation, pulmonary examinations of the patients were repeated. RESULTS: Postoperative pulmonary complications were observed in 35 patients (58.3%). The most common complication was pneumonia, followed by pneumonitis, atelectasis, bronchitis, pulmonary emboli and acute respiratory failure. The presence of preoperative respiratory symptoms and the spirometric parameter of forced expiratory volume in 1 s/forced vital capacity were the most valuable risk factors for early prediction of POPC. The sensitivity, specificity and diagnostic efficiency of the presence of preoperative respiratory symptoms in the POPC prediction were 70, 61 and 66%, respectively. CONCLUSION: We recommend a detailed pulmonary examination and spirometry in patients who will undergo UAS by chest physicians to identify the patients at high risk for POPC, to manage respiratory problems of the patients before surgery and also to help surgeons to take early measures in such patients before a most likely POPC occurrence. Improvement of lung function in those patients at risk for POPC before operation may decrease morbidity in surgical patients.

Pleural complications of hydatid disease.

OBJECTIVE: The aim of this retrospective study was to review pleural and pericardial complications of patients with hydatid cysts and to analyze the management of therapy for these patients. METHODS: Between 1991 and 2001, 43 (29.7%) of 145 patients presented with pleural and pericardial complications. These patients had spontaneous pneumothorax (6.2%), empyema (7.6%), pleural thickening (10.3%), hepatopleural fistula (2.8%), pericarditis (2.1%), and hepatobronchial fistula (0.7%). There were 22 male and 21 female patients, with a mean age of 30 years. RESULTS: The most common symptom was chest pain (79.1%). In 37 (86.1%) of 43 patients, the cysts were unilateral. The ratio of ruptured cysts was 88.4%. In most of the patients, hydatid cysts developed in the right lung (62.9%) and the lower lobes of the lung (70.4%). Multiple cysts were found in 8 (18.6%) patients. The most common surgical techniques were cystotomy with capitonnage (55.7%) and decortication (69.8%). Radical lung resection was used in 14% of the patients. The morbidity rate was 16.3%, and the mortality rate was 2.3%. The mean follow-up was 19 months with no recurrence. CONCLUSIONS: Although lung-preserving surgical interventions should be preferred, radical surgical procedures have been used more commonly in patients with pleural complications of hydatid cysts, and the postoperative morbidity rate was higher in these patients. Because of this, the surgical treatment should be carried out before the development of pleural complications. In addition, echinococcosis should be considered and included in the differential diagnosis of spontaneous pneumothorax and empyema.

Inferior laryngeal paraganglioma presenting as plunging goiter.

Paragangliomas are uncommon slow-growing neuroendocrine tumors that may arise from the extra-adrenal paraganglia. Paragangliomas of the inferior and superior laryngeal paraganglia are known as laryngeal paraganglioma. Inferior laryngeal paraganglioma, which is also called subglottic paraganglioma, is very seldomly observed. To our knowledge only 24 patients with subglottic paraganglioma have been found. We present a 77-year-old male patient who has been previously followed-up for cervical goiter, which has a progressive enlargement into the mediastinum, causing severe tracheal obstruction. The tumor was completely and easily resected via median sternotomy with collar incision and finally diagnosed as inferior laryngeal paraganglioma. The present case is the first subglottic laryngeal paraganglioma descending into the visceral compartment of the mediastinum in the literature.

Cold abscess of the chest wall as an unusual complication of BCG vaccination.

Bacillus-Calmette-Guérin (BCG) vaccination often results in local adverse effects; however, serious or long-term complications are rare. The involvement of sternum among skeletal BCG osteomyelitis is a rarely seen complication of BCG vaccination. Such a complication may confuse with a chest wall tumor and a surgical intervention may be needed for the definite diagnosis. A 9-month-old infant who had a parasternal cold abscess in the anterior chest wall and sternal osteomyelitis of tuberculosis in the late period of BCG vaccination of whom the etiological diagnosis was histopathologically confirmed after surgery is presented and the preoperative diagnostic problems are discussed.

Comparison between pulmonary and hepatopulmonary hydatidosis.

OBJECTIVES: To compare the clinical features and the surgical approaches between single pulmonary (SPH) and hepatopulmonary hydatidosis (HPH). METHODS: The hospital and follow-up records of 141 patients who had undergone surgery for pulmonary hydatidosis in our clinic between January 1991 and January 2001 were reviewed. Forty-nine patients (34.8%) had concomitant liver cysts in addition to the pulmonary cysts and they were regarded as HPH (Group I). The remaining 92 (65.2%) patients had SPH (Group II). Both groups were compared according to their clinical, radiological and surgical features. RESULTS: Seventeen (34.7%) male and 32 (65.3%) female patients had HPH. The mean age of the patients with HPH was significantly higher than the age of those with SPH (P<0.05) and the frequency of hepatopulmonary localization, which is contrary to single pulmonary cyst, was significantly higher in females (P<0.05). The majority (67.3%) of the cysts located in the liver were solitary. Multiple pulmonary cysts were in higher ratio in Group II, compared to Group I (45.7 vs. 22.8%) and bilateral pulmonary cyst ratio was higher in Group II, as well (26.5 vs. 13%) (P<0.05). In 14 patients (28.6%), the concomitant cysts localized in the dome of liver were extirpated via right thoracophrenotomy, and in one of them sternophrenotomy was performed. There was no statistically significant difference associated with the postoperative complications and hospital stay between groups. No recurrence and mortality were recorded in Group II. CONCLUSIONS: Multi-organ localizations (especially liver) should be examined in all patients with pulmonary hydatid cysts. HPH is more frequent in female patients over 40 years of age. The pulmonary cysts in HPH show a tendency to be bilateral and multiple. HPH should be regarded as a different entity since it can cause either economic or labour loss due to the multi-operations and prolonged postoperative care. The operative strategy and approach should be different in hepatopulmonary cysts especially if they locate in the right or bilateral lung. One-session operation with the improvements of its techniques and methods should be considered in selected cases.

Comparison of pulmonary hydatid cysts in children and adults.

BACKGROUND: The purpose of the present study was to compare the clinical features and the surgical approaches of the pulmonary hydatid cysts in children and adults. METHODS: One hundred and thirty-four patients, operated on for pulmonary hydatid cysts over the last 10 years were retrospectively evaluated in two groups: 39 children who were younger than 18 years old (29%) and 95 adults (71%). The patients in each group were analysed according to their clinical, radiological and surgical findings. RESULTS: The frequency of pulmonary hydatid cysts in children was significantly higher in boys (74%) than in girls (26%). However, there was no sex tendency in adults (52% in male vs 48% in women). The sex difference in hydatid cyst frequencies between adults and children was significant (P < 0.05). Among preoperative pleural complications, pneumothorax (15.5%) in children and empyema (11%) in adults were more frequent. The frequency of concomitant hepatic cysts was less in children than in adults (33%vs 79%). Huge pulmonary cysts (=10 cm) were more common in children (31%) than in adults (22%). Cystotomy with capitonnage was the most frequently preferred method in both groups. Postoperative complications developed in six children (16%) and 19 adults (19%), and were more frequent in patients with huge cysts (27%vs 16%). No recurrence was observed in both groups. CONCLUSIONS: Isolated pulmonary cysts are more common in children than adults. The cysts also tend to be bigger in children than adults. The frequency of concomitant hepatic cysts is less in children. Because of higher lung expansion ability and improvement capacity in children, resection should be avoided and lung saving surgical procedures should be performed. In spite of differences observed in the clinical features it does not change the treatment of pulmonary hydatid cysts in children.

[Diagnostic efficiency of pseudocholinesterase level in discrimination of transudates-exudates]. / Transüda-eksüda ayriminda plevral sivi psödokolinesteraz düzeyinin tanisal degeri.

In this study, 80 cases with pleural effusion hospitalized at the departments of Chest Diseases and Internal Medicine in the Medical School of Selcuk University, and 30 healthy people as control group were studied. Regarding to the diagnosis, pleural fluids were classified into two groups as follows; transudates and exudates. Difference between the mean pleural pseudocholinesterase levels of transudates and exudates was statistically significant (p< 0.001). Similar significance was also obtained in the mean pleural fluid/serum pseudocholinesterase ratios of the groups (p< 0.001). In determination of exudative fluids both sensitivity and specificity of the pleural fluid pseudocholinesterase level was 100%. Sensitivity and specificity of the pleural fluid/serum pseudocholinesterase ratio were 90 and 87%, respectively. We have concluded that pleural pseudocholinesterase level and pleural fluid/serum pseudocholinesterase ratio can be used as a parameter with high diagnostic efficiency in discrimination of pleural effusions as exudates and transudates.

[Diagnostic efficiency of serum lipid-bound sialic acid level in malignant pleural effusions]. / Malignite kaynakli plevra sivilarinda lipide bagli sialik asit düzeyi tayininin tanisal degeri.

In this study, pleural fluid and serum lipid-bound sialic acid (LBSA) levels of 68 cases with pleural effusion hospitalised at the department of Chest Diseases in the Medical School of Selçuk University, and serum LBSA levels of 30 healthy individuals as control group were studied. Pleural effusions of 32 cases were due to malignancy of which considerably lung cancer. In the other 36 cases the causes were nonmalignant in origin. Levels of mean serum LBSA in malignant and benign groups were significantly higher than control group (p< 0.001). However, difference of the mean serum LBSA levels of malignant and benign groups was not statistically significant. We found the mean pleural fluid LBSA level of 23.34 mg/dL in malignant group and it was significantly higher than benign group (17.97 mg/dL) (p< 0.05). It was observed that there was no significant statistical difference between the pleural fluid to serum LBSA ratios of malignant and benign groups. In differential diagnosis of malignant pleural effusions, sensitivity and specificity of pleural fluid LBSA were 91%, and 51%, respectively. In conclusion, for the differentiation of malignant pleural effusions LBSA is not believed to be a reliable tumor marker since it may also increase in various chronic and inflammatory diseases. Despite of that, in cases with a suspicion of malignancy, the increased level of pleural fluid LBSA may be useful as a supportive parameter.

Phenotyping of chronic obstructive pulmonary disease using the modified Bhalla scoring system for high-resolution computed tomography.

BACKGROUND: Identifying different phenotypes of chronic obstructive pulmonary disease (COPD) is important for both therapeutic options and clinical outcome of the disease. OBJECTIVE: To characterize the phenotypes of COPD according to high-resolution computed tomography (HRCT) findings; and to correlate HRCT scores obtained using the modified Bhalla scoring system with clinical and physiological indicators of systemic inflammation. METHODS: The present study included 80 consecutive patients with stable COPD. HRCT scans were evaluated by two independent radiologists according to the modified Bhalla scoring system. RESULTS: Fifty-four patients exhibited morphological changes on HRCT examination while 26 had no pathological findings. Patients with HRCT findings had lower spirometric measurements and higher levels of inflammation, and reported more exacerbations in the previous year compared with patients with no findings on HRCT. Patients with morphological changes were classified into one of three groups according to their HRCT phenotype(s): emphysema (E) only, E + bronchiectasis (B)/peribronchial thickening (PBT) or B/PBT only. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC ratio, C-reactive protein (CRP) levels and the number of exacerbations among the groups were significantly different. Pairwise comparisons between the E only and E+B/PBT groups showed significantly lower FVC, FEV1 and FEV1/FVC values, and higher CRP levels and number of exacerbations compared with the B/PBT group. No significant differences were found between the E+B/PBT and the B/PBT groups. An inverse correlation was found between the total HRCT score and FVC, FEV1 and FEV1/FVC; the correlation was positive with CRP level, erythrocyte sedimentation rate and number of exacerbations. CONCLUSION: The present study exposed the intimate relationship between phenotype(s) characterized by HRCT and scoring for morphological abnormalities; and clinical and functional parameters and inflammatory markers. The inclusion of HRCT among routine examinations for COPD may provide significant benefits both in the management and prognosis of COPD patients.