Evaluation of atherosclerosis as a risk factor in COPD patients by measuring the carotid intima-media thickness.

BACKGROUND: This study aimed to evaluate atherosclerosis as comorbidity by measuring the carotid (bulb and common carotid artery) Carotid intima-media thickness in COPD-diagnosed patients and to evaluate the relationship of atherosclerosis with the prevalence of COPD, hypoxemia and hypercapnia. METHODS: This study was conducted out between January 2019-December 2019 consisting of a total of 140 participants (70 COPD-diagnosed patients-70 healthy individuals). The COPD-diagnosed patients have been planned according to the selection and diagnosis criteria as per the GOLD 2019 guide. It is planned to evaluate as per prospective matching case-control study of the carotid thickness, radial gas analysis, spirometric and demographic characteristics of COPD diagnosed patients and healthy individuals. RESULTS: The average Carotid intima-media thickness in COPD patients was 0.8746±0.161 (p<0.05), and the thickness of the carotid bulb was 1.04±0.150 (p<0.05). In the control group, the average CCA intima-media thickness was 0.6650±0.139 (p<0.05), and the thickness of the carotid bulb was 0.8250±0.15(p<0.05) For the carotid thickness that has increased in COPD diagnosed patients a significant relationship is determined between hypoxemia (p<0.05) and hypercapnia(p<0.05). A significant relationship determined between CIMT and severity of COPD (p<0.05) The CIMT was high in COPD patients with hypoxemia and hypercapnia(p<0.05). CONCLUSION: Significant difference was determined between the severity (grades) of COPD (mild, moderate, severe, very severe) in carotid thickness. Also, CIMT was found to be high in patients who is in the early phases of the prevalence of COPD. In COPD-diagnosed patients, it was determined that severity of COPD, hypoxemia, hypercapnia and age were determining factors of atherosclerosis.

Does spirometric tests meet the acceptability criteria? Data from a tertiary chest hospital in Turkey.

INTRODUCTION: First step is to evaluate the quality of the test in interpreting spirometries. International societies have defined the acceptability criteria for spirometric tests. With this study, it was aimed to evaluate spirometric tests in terms of compliance with international acceptability criteria and to determine error types. MATERIALS AND METHODS: Spirometric manoeuvres held at a tertiary chest diseases hospital were evaluated as to whether the acceptability criteria of "American Thoracic Society/European Respiratory Society (ATS/ERS)" guideline were maintained or not. Errors determined were classified as unexplosive start of expiration, submaximal effort, cough, closure of glottis, missing closure of the loop ring and early termination of expiration. RESULT: Among tests evaluated (n= 510), 276 (54.1%) belonged to female and 234 (45.9%) to male subjects. Average age of subjects was 56.1 ± 15.0 years. It was noted that 318 (62.4%) of the tests met acceptability criteria, whereas 192 (37.6%) did not. The most frequently noted error type is submaximal effort by 30.2% followed by missing closure of the loop, early terminaton of expiration, coughing, unexplosive start of expiration and closure of glottis. In the tests whose spirometric maneuvers did not meet the criteria, the mean age of the patients was significantly higher than in the appropriate tests. When the cases were grouped according to their age, it was observed that the rate of conformity of spirometric examinations decreased significantly as the age range increased. CONCLUSIONS: Within this study it is the first time in our country that evaluation of spirometric studies has been made to see the rate of conformity with international standarts. Although it is thought that spirometric examinations are not technically appropriate in clinical practice throughout our country, there is no data in the literature. Although the center where the study is conducted is a tertiary chest diseases hospital, the data obtained reveal that in spirometric evaluations, a substantially non-standard examination was performed.

Lymphoepithelioma-like carcinoma of the lung: a rare case report and review of the literature.

Lymphoepithelioma-like carcinoma (LELC), is a rare type of cancer and typically occurs in pharyngeal and foregut-derivative organs, Including the salivary glands, thymus, stomach and liver (1). Pulmonary LELC typically affects the young and non-smoking population, and is associated with Ebstein-Barr virus (EBV) infection (1,2). We present an rare case with a pulmonary mass on CT scan of the thorax, which was subsequently proved as a LELC of the lung and a brief review of the relevant literature. The patient is a 51-year old man, presented with shorthness of breath and cough for 1 months. Chest x-ray was normal (Figure 1). Chest CT scan showed a 30-25 mm heterogeneously enhanced mass lesion with well defined margin, In the left lower lobe of the lung (Figure 2). Bronchoscopy showed no endobronchial lesion. After the PET-CT, the patient was staged as cT2aN1M0 (Stage 2B) (Figure 3). He received video-assisted thoracoscopic surgery of left lower lobe of lung and mediastinal lymph nodes dissection (Figure 4,5). His Ebv-Dna is Positive in blood tests. The pathology, immunohistochemical staining,and in situ hybridization results confirmed LELC of lung (Figure 6). Using in situ hybridization with exhibition of abundant EBV-encoded small nuclear RNA, in the majority of tumor cells is done. He received 4 cycles of induction chemotherapy with cysplatine and vinoralbine. The patient was discharged from hospital with close follow-up. No recurrence has been detected so far. Primary pulmonary LELC is a rare malignant tumor which accounts for only 0.9% of all primary lung cancer (1,2). Previous studies have demonstrated that pulmonary LELC is strongly associated with EBV infection (1,2). The majority of pulmonary LELC patients receive complete resection, as well as chemotherapy and radiotherapy based on their clinical stage (1,2). Comparing to other non-small cell cancer (NSCLC), pulmonary LELC is more sensitive to chemotherapy and radiotherapy (1,2). LELC of lung may be mistaken histopathologically for metastatic nasopharyngeal carcinoma or lymphoma. Its association with latent EBV infection have major implications for diagnosis and treatment. We present this case, because, its an unusual case with a pulmonary mass of the thorax, which was proved as a LELC of the lung.

Turkish Thoracic Society Early Career Members Task Force Group's Virtual Congress Notes: European Respiratory Society International Congress 2020.

In this article, Early Career Task Force Group members of the Turkish Thoracic Society summarize the European Respiratory Society 2020 virtual congress. Current developments in the field of respiratory diseases were compiled with the addition of sessions specific to coronavirus disease 2019 this year. Almost all of the congress sessions were examined, and the important and striking results of the congress were highlighted. Congress sessions were attended by expert researchers, and the prominent messages of each session were highlighted in short summaries. They were then grouped under relevant titles and ranked in order of meaning and relation. It was finalized by a team of researchers.

Unclear Issues Regarding COVID-19.

Scientists from all over the world have been intensively working to discover different aspects of Coronavirus disease 2019 (COVID-19) since the first cluster of cases was reported in China. Herein, we aimed to investigate unclear issues related to transmission and pathogenesis of disease as well as accuracy of diagnostic tests and treatment modalities. A literature search on PubMed, Ovid, and EMBASE databases was conducted, and articles pertinent to identified search terms were extracted. A snow-ball search strategy was followed in order to retrieve additional relevant articles. It was reported that viral spread may occur during the asymptomatic phase of infection, and viral load was suggested to be a useful marker to assess disease severity. In contrast to immune response against viral infections, cytotoxic T lymphocytes decline in SARS-CoV-2 infection, which can be partially explained by direct invasion of T lymphocytes or apoptosis activated by SARS-CoV-2. Dysregulation of the urokinase pathway, cleavage of the SARS-CoV-2 Spike protein by FXa and FIIa, and consumption coagulopathy were the proposed mechanisms of the coagulation dysfunction in COVID-19. False-negative rates of reverse transcriptase polymerase chain reaction varied between 3% and 41% across studies. The probability of the positive test was proposed to decrease with the number of days past from symptom onset. Safety issues related to infection spread limit the use of high flow nasal oxygen (HFNO) and continuous positive airway pressure (CPAP) in hypoxic patients. Further studies are required to elucidate the challenging issues, thus enhancing the management of COVID-19 patients.