Neural Respiratory Drive During Different Dyspnea Relief Positions and Breathing Exercises in Individuals With COPD.

BACKGROUND: When the work load of the respiratory muscles increases and/or their capacity decreases in individuals with COPD, respiratory muscle activation increases to maintain gas exchange and respiratory mechanics, and perception of dyspnea occurs. The present study aimed to compare diaphragm and accessory respiratory muscle activation during normal breathing, pursed-lip breathing, and breathing control in different dyspnea relief positions, supine and side lying. METHODS: A cross-sectional study design was used. Sixteen individuals with COPD age between 40-75 y were included. Pulmonary function was evaluated by spirometry, muscle activation by surface electromyography, and dyspnea by the modified Borg scale. Muscle activation was measured in the diaphragm, scalene, sternocleidomastoid, and parasternal muscles. The evaluation was made in the dyspnea relief positions (sitting leaning forward, sitting leaning forward at a table, leaning forward with back against a wall, standing leaning forward, and high lying), seated erect, supine, and side lying. RESULTS: There were significant differences between the 8 positions (P < .001). There was no significant difference in muscle activation between sitting leaning forward and sitting leaning forward at a table position with analyzing post hoc test results (P > .99 for each muscle). However, muscle activation was lower in these 2 positions than in the other positions (P < .001 for each muscle). Muscle activation was greater in the supine position than in the other positions (P < .001 for each muscle). No difference was observed in muscle activation between the seated erect, leaning forward with back against a wall, standing leaning forward, high-lying, or side-lying positions (P > .05 for each muscle with a minimum P value of .09). CONCLUSIONS: The use of sitting leaning forward and sitting leaning forward at a table positions together with breathing control may help people with COPD to achieve more effective dyspnea relief and greater energy efficiency.

Multi-inflammatory Index as a Novel Mortality Predictor in Critically Ill COVID-19 Patients.

AIM: Systemic inflammation has a crucial role in the pathogenesis and mortality of Coronavirus disease 2019 (COVID-19). Multi-inflammatory index (MII) is a novel index related with systemic inflammation. In this study, we investigated the relationship between MII and in-hospital mortality in COVID-19 patients admitted to the intensive care unit (ICU). METHODS: We retrospectively analyzed the medical records of COVID-19 patients followed-up in the ICU of our institution between 01.04.2020 and 01.10.2021. Patients were classified into two groups according to mortality status as survivors and non-survivors. Various inflammatory parameters of the groups were compared and their efficacy in predicting mortality was investigated. RESULTS: Out of 348 study patients, 86 cases (24.7%) were in the survived group and 262 cases (75.3%) were in the dead group. The median age of the mortal group was significantly higher than that of the survived group (65.5 vs 76, P < .001). Multiple logistic regression analysis revealed that among all the included inflammatory parameters, MII showed the best efficacy for predicting mortality (OR: 0.999; 95% CI: 0.9991-0.9998; P = .003). CONCLUSION: MII, a new combination of Neutrophil to lymphocyte ratio (NLR) and C-reactive protein (CRP), is a simple and practical biomarker that can help us in the prediction of mortality in COVID-19 patients followed-up in the ICU.

Research Burden of Interstitial Lung Diseases in Turkey - RBILD.

Introduction: The aim of our study is to investigate the etiological distribution of ILD in Turkey by stratifying the epidemiological characteristics of ILD cases, and the direct cost of initial diagnosis of the diagnosed patients. Material-Method: The study was conducted as a multicenter, prospective, cross-sectional, clinical observation study. Patients over the age of 18 and who accepted to participate to the study were included and evaluated as considered to be ILD. The findings of diagnosis, examination and treatment carried out by the centers in accordance with routine diagnostic procedures were recorded observationally. Results: In total,1070 patients were included in this study. 567 (53%) of the patients were male and 503 (47%) were female. The most frequently diagnosed disease was IPF (30.5%). Dyspnea (75.9%) was the highest incidence among the presenting symptoms. Physical examination found bibasilar inspiratory crackles in 56.2 % and radiological findings included reticular opacities and interlobular septal thickenings in 55.9 % of the cases. It was observed that clinical and radiological findings were used most frequently (74.9%) as a diagnostic tool. While the most common treatment approaches were the use of systemic steroids and antifibrotic drugs with a rate of 30.7% and 85.6%, respectively. The total median cost from the patient's admission to diagnosis was 540 Turkish Lira. Conclusion: We believe that our findings compared with data from other countries will be useful in showing the current situation of ILD in our country to discuss this problem and making plans for a solution.

Frequency of Direct Oral Anticoagulants Usage in Acute Pulmonary Thromboembolism Treatment in Turkey (TUPEDO).

Background: Direct oral anticoagulants (DOACs) have been used in acute pulmonary thromboembolism as an alternative to warfarin due to drug interactions, narrow therapeutic range, and necessary close International Normalized Ratio (INR) monitoring. Phase 3 study results have reported that these drugs are at least as effective as warfarin and beneficial in terms of bleeding; however, studies that present up-to-date life data are necessary. Aims: To evaluate the frequency of using DOACs, which are prescribed with a limited number of indications in our country, and real-life data results. Study Design: Cross-sectional study. Methods: This cross-sectional survey collected the clinical data (history, current treatment, treatment duration, etc.) of patients with pulmonary thromboembolism and who applied to the physician for follow-up between October 15, 2019, and March 15, 2020. The researchers kept the patient records sequentially. Results: Data from 836 patients with acute pulmonary thromboembolism from 25 centers were collected, and DOAC was used in 320 (38.5%) of them. The most preferred DOAC was rivaroxaban (n = 294, 91.9%). DOAC was mostly preferred because it could not provide an effective INR level with warfarin (n=133, 41.6%). Bleeding was observed in 13 (4%) patients. Conclusion: The use of direct oral anticoagulants is becoming almost as widespread as conventional therapy. Real-life data results are important for their contribution to clinical practice.

Comparison of neutrophil lymphocyte ratio, platelet lymphocyte ratio, and mean platelet volume and PCR test in COVID-19 patients.

OBJECTIVE: The polymerase chain reaction test, used in the diagnosis of COVID-19, can be positive with delay, and thorax tomography is used for the diagnosis of the disease. We aimed to compare the relation between thorax tomography findings, PCR test results, and neutrophil lymphocyte ratio; platelet lymphocyte ratio and mean platelet volume neutrophil lymphocyte ratio; platelet lymphocyte ratio and mean platelet volume in COVID-19 patients. METHODS: COVID-19 patients were divided into three groups, according to baseline laboratory and thorax tomography findings: Group A: thorax tomography finding positive - polymerase chain reaction test positive; Group B: thorax tomography finding negative - polymerase chain reaction test positive; and Group C: thorax tomography finding positive - polymerase chain reaction test negative. Neutrophil lymphocyte ratio, platelet lymphocyte ratio, and mean platelet volume values were compared between these three groups. RESULTS: Group C neutrophil lymphocyte ratio level and polymerase chain reaction level were statistically higher than that of group B (p<0.001 in both). Mean platelet volume was not statistically significant between groups (p>0.005 for all). A positive correlation was detected between neutrophil lymphocyte ratio and C-reactive protein (r=0.421, p<0.001). Similarly, positive correlation was found with polymerase chain reaction and C-reactive protein (r=0.243, p=0.001). CONCLUSIONS: The thorax tomography finding can be detected earlier in the disease before the polymerase chain reaction test. The sensitivity of the polymerase chain reaction test varies according to the tester, the way of performing it, and the quality of the test. Therefore, especially in patients with polymerase chain reaction negative and thorax tomography findings, neutrophil lymphocyte ratio and platelet lymphocyte ratio levels should be evaluated, and patients should be followed up upon suspicion of COVID-19 diagnosis.

Effect of rhinophototherapy on nasal congestion in patients with seasonal allergic rhinitis.

OBJECTIVE: The aim of the present study was to objectively and subjectively evaluate the effects of adding rhinophototherapy to intranasal beclomethasone dipropionate to treat nasal congestion in patients with seasonal allergic rhinitis. METHOD: Seventy-five seasonal allergic rhinitis patients were randomly divided into two groups. Patients in Group 1 received intranasal beclomethasone dipropionate for two weeks and patients in Group 2 had rhinophototherapy added to the same medical therapy as Group 1. The effectiveness of treatments was evaluated with the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), Nasal Obstruction Symptom Evaluation scale (NOSE) questionnaires and active anterior rhinomanometry. RESULTS: After treatment, significant improvement was observed in Group 2 vs Group 1 in terms of RQLQ (p = 0.011) and NOSE (p = 0.001) scores. In Group 2, significant differences were observed between before and after treatment for inspiratory total nasal resistance (p = 0.004). However, no significant differences vs. baseline were observed in Group 1. CONCLUSION: Our study shows that adding intranasal phototherapy with a combination of UVA, UVB and visible light therapy to nasal beclomethasone dipropionate treatment objectively improves nasal patency in patients with seasonal allergic rhinitis.

Comparison of neutrophil lymphocyte ratio, platelet lymphocyte ratio, and mean platelet volume and PCR test in COVID-19 patients

SUMMARY OBJECTIVE: The polymerase chain reaction test, used in the diagnosis of COVID-19, can be positive with delay, and thorax tomography is used for the diagnosis of the disease. We aimed to compare the relation between thorax tomography findings, PCR test results, and neutrophil lymphocyte ratio; platelet lymphocyte ratio and mean platelet volume neutrophil lymphocyte ratio; platelet lymphocyte ratio and mean platelet volume in COVID-19 patients. METHODS: COVID-19 patients were divided into three groups, according to baseline laboratory and thorax tomography findings: Group A: thorax tomography finding positive - polymerase chain reaction test positive; Group B: thorax tomography finding negative - polymerase chain reaction test positive; and Group C: thorax tomography finding positive - polymerase chain reaction test negative. Neutrophil lymphocyte ratio, platelet lymphocyte ratio, and mean platelet volume values were compared between these three groups. RESULTS: Group C neutrophil lymphocyte ratio level and polymerase chain reaction level were statistically higher than that of group B (p<0.001 in both). Mean platelet volume was not statistically significant between groups (p>0.005 for all). A positive correlation was detected between neutrophil lymphocyte ratio and C-reactive protein (r=0.421, p<0.001). Similarly, positive correlation was found with polymerase chain reaction and C-reactive protein (r=0.243, p=0.001). CONCLUSIONS: The thorax tomography finding can be detected earlier in the disease before the polymerase chain reaction test. The sensitivity of the polymerase chain reaction test varies according to the tester, the way of performing it, and the quality of the test. Therefore, especially in patients with polymerase chain reaction negative and thorax tomography findings, neutrophil lymphocyte ratio and platelet lymphocyte ratio levels should be evaluated, and patients should be followed up upon suspicion of COVID-19 diagnosis.