Does cryptogenic organizing pneumonia change seasonal?

BACKGROUND AND AIM: Meteorological factors affect the respiratory system, and the most important factor is the change in ambient temperature and humidity. We aimed to investigate the seasonal characteristics of patients diagnosed with cryptogenic organizing pneumonia. METHODS: The study included 84 cryptogenic organizing pneumonia, 55 chronic obstructive pulmonary disease, and 42 asthma patients. To determine the characteristics of the disease according to the seasons, the number of attacks and admissions was grouped according to the seasonal characteristics and analyzed for three groups. RESULTS: Among cryptogenic organizing pneumonia and chronic obstructive pulmonary disease patients, males significantly predominated (p<0.001). The hospitalization rate was highest in chronic obstructive pulmonary disease patients but similar to cryptogenic organizing pneumonia and asthma patients (p<0.001). The highest admission rate in cryptogenic organizing pneumonia patients was observed in spring (39.3% in spring, 26.2% in fall, 22.6% in winter, and 11.9% in summer). In winter, cryptogenic organizing pneumonia patients were admitted less frequently than chronic obstructive pulmonary disease and asthma patients. The neutrophil-to-lymphocyte ratio was higher in cryptogenic organizing pneumonia patients than in asthma patients and similar to chronic obstructive pulmonary disease patients. CONCLUSION: As a result of our study, the high rate of diagnosis and admission in the spring in cryptogenic organizing pneumonia suggested that the effect of allergens on the formation of cryptogenic organizing pneumonia should be investigated. In contrast, it should be kept in mind that cryptogenic organizing pneumonia may develop as a prolonged finding of involvement that may occur in the lung parenchyma due to lung infections and/or cold weather triggering during the winter months. In this regard, further studies can be conducted in which allergens and/or the history of infection in patients and meteorological variables are also evaluated.

Does cryptogenic organizing pneumonia change seasonal?

SUMMARY BACKGROUND AND AIM: Meteorological factors affect the respiratory system, and the most important factor is the change in ambient temperature and humidity. We aimed to investigate the seasonal characteristics of patients diagnosed with cryptogenic organizing pneumonia. METHODS: The study included 84 cryptogenic organizing pneumonia, 55 chronic obstructive pulmonary disease, and 42 asthma patients. To determine the characteristics of the disease according to the seasons, the number of attacks and admissions was grouped according to the seasonal characteristics and analyzed for three groups. RESULTS: Among cryptogenic organizing pneumonia and chronic obstructive pulmonary disease patients, males significantly predominated (p<0.001). The hospitalization rate was highest in chronic obstructive pulmonary disease patients but similar to cryptogenic organizing pneumonia and asthma patients (p<0.001). The highest admission rate in cryptogenic organizing pneumonia patients was observed in spring (39.3% in spring, 26.2% in fall, 22.6% in winter, and 11.9% in summer). In winter, cryptogenic organizing pneumonia patients were admitted less frequently than chronic obstructive pulmonary disease and asthma patients. The neutrophil-to-lymphocyte ratio was higher in cryptogenic organizing pneumonia patients than in asthma patients and similar to chronic obstructive pulmonary disease patients. CONCLUSION: As a result of our study, the high rate of diagnosis and admission in the spring in cryptogenic organizing pneumonia suggested that the effect of allergens on the formation of cryptogenic organizing pneumonia should be investigated. In contrast, it should be kept in mind that cryptogenic organizing pneumonia may develop as a prolonged finding of involvement that may occur in the lung parenchyma due to lung infections and/or cold weather triggering during the winter months. In this regard, further studies can be conducted in which allergens and/or the history of infection in patients and meteorological variables are also evaluated.

Comparison of clinical characteristics in adult patients under 65 years of age with and without Covid-19 pneumonia.

Background: Coronavirus disease 2019 (COVID-19) can cause asymptomatic, mild upper respiratory tract symptoms and pneumonia in young persons. How the disease will progress in each patient is still unknown. Therefore, we aimed to investigate the prognostic markers of the development of pneumonia and the clinical characteristics of patients under 65 years with COVID-19 confirmed by a positive reverse transcriptase polymerase chain reaction test. Methods: In this retrospective study, a total of 271 patients admitted in our unit were included. The patients were divided into two groups, those who did and those who did not develop pneumonia. Their clinical features, treatment protocols, and laboratory parameters were recorded retrospectively. Results: Pneumonia developed in 67.9% (n = 184) of the cases. The age in the pneumonia group was higher than that in the non-pneumonia group (p < 0.001). In the logistic regression analysis, the symptom and co-morbidity status were examined according to the presence of pneumonia; hypertension (HT) (OR: 4525, 95% CL: 1,494-13,708) was the most important risk factor for pneumonia. When age and laboratory values were examined according to the presence of pneumonia, advanced age (OR: 1.042, 95% CL: 1.01-1.073), low albumin (OR: 0.917, 95% CL: 0.854-0.986), and high troponin (OR: 1.291, 95% CL: 1.044-1.596) were identified as risk factors for pneumonia. Conclusion: In this article, HT (22.3%, P < 0.001) has been considered as an important risk factor, whereas association of diabetes mellitus (21.2%, P 0.029) and smoking (25.0%, P 0.038) was also significant. The median age of the group was 51 (41.5-58) in the group developing pneumonia and 41 (30-48) in the non-developing group. Young patients with these predictive factors should be more carefully evaluated by further diagnostic procedures, such as thoracic computed tomography.

Prognostic Significance of Red Cell Distribution Width in Idiopathic Pulmonary Fibrosis and Combined Pulmonary Fibrosis Emphysema.

OBJECTIVE: The red cell distribution width (RDW) is an inexpensive, readily available prognostic indicator of several diseases. RDW has been assessed as a prognostic biomarker in patients with idiopathic pulmonary fibrosis (IPF) in only one study; furthermore, the relationship between the RDW and combined pulmonary fibrosis emphysema (CPFE) has yet to be reported. SUBJECTS AND METHODS: This single-center study was conducted between January 2015 and December 2018 in the Atatürk Chest Diseases and Chest Surgery Education and Research Hospital. Baseline characteristics, laboratory results, and survival status of patients were recorded. RESULTS: The RDW value was significantly higher in the CPFE group than in the IPF group (median [IQR 25-75]; 16.8 [15.5-19] vs. 15.3 [13.7-16.8], p = 0.028). High RDW values were correlated with carbon monoxide diffusion capacity (DLCO) (r: -0.653 p = 0.001), 6-minute walking test (6MWT) distance (r: -0.361 p = 0.017), arterial partial oxygen pressure (PaO2) (r: -0.692 p < 0.001), and systolic pulmonary arterial pressure (SPAP) (r: 0.349 p = 0.022) in patients with fibrotic lung disease. The RDW value was significantly higher in the exitus group than in the survivors (median [IQR 25-75]; 18.4 [15.4-19] vs. 15.2 [13.5-17.2], p = 0.016). A univariate Cox regression analysis identified DLCO, SPAP, PaO2, and RDW as potential covariates of mortality. In a multivariate analysis, the DLCO (HR 1.21, 95% CI 1.11-1.47, p = 0.012) and RDW level (HR 1.65, 95% CI 1.09-2.47, p = 0.023) remained independent predictors of mortality. CONCLUSION: High RDW values appear to be a simple prognostic factor in patients with IPF or CPFE.

Is Onodera's prognostic nutritional index (OPNI) a prognostic factor in small cell lung cancer (SCLC)?

INTRODUCTION: We aimed to evaluate the prognostic value of Onodera's prognostic nutritional index (OPNI) in patients with Small-cell lung cancer (SCLC). MATERIALS AND METHODS: This study retrospectively examined 109 patients diagnosed with SCLC between January 2008 and October 2018 in our hospital. Patients were divided into two groups according to the median of OPNI values. RESULTS: A significant difference was observed between the groups in terms of neutrophil percentage, lymphocyte count, lymphocyte percentage, C-reactive protein (CRP), albumin, lactat dehidrogenase (LDH) and neutrophil to lymphocyte ratio (NLR) (P < 0.05). LDH, CRP, neutrophil percentage and NLR (P = 0.008, P < 0.001, P = 0.001, P < 0.001, respectively) were significantly higher and albumin, lymphocyte count and lymphocyte percentage (P < 0.001, P < 0.001, P = 0.001, respectively) were significantly lower in the low OPNI group. Survival analyses have shown that mortality rates and lifespan are similar in the two groups. CONCLUSION: The OPNI may be a helpful tool for determining the prognosis in SCLC.

Broncholithiasis presenting with lithoptysis.

Broncholithiasis is defined as calcified or ossified material in the bronchial lumen. The most frequently seen symptoms are a non-productive cough and hemoptysis. Occasionally, broncholytic expectoration can be seen, which is known as lithoptysis. As this is not a common finding, a case diagnosed with lithoptysis is presented here.

Paclitaxel-induced dermal hypersensitivity lesions: 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography.

Paclitaxel is frequently used for the treatment of patients with nonsmall cell lung cancer. Hypersensitivity reactions (HSRs) have been one of the toxicities observed with administration of paclitaxel. Here, we presented a case of a 49-year-old man with a history of right lung mass proven by biopsy to be a nonsmall cell lung cancer (squamous cell carcinoma) who developed HSR during therapy. In addition to the hypermetabolic primary malignancy, a positron emission tomography/computed tomography (PET/CT) scan showed multiple hypermetabolic skin lesions at several parts of the body. These cutaneous lesions were resolved in the restaging PET/CT scan performed after completion of the six cycles of chemotherapy. This is the first documented case of comparative PET/CT findings of a paclitaxel-induced hypersensitivity.

Does advanced lung inflammation index (ALI) have prognostic significance in metastatic non-small cell lung cancer?

BACKGROUND: Lung cancer is the most commonly diagnosed and death-related cancer type and is more frequent in males. Non-small-cell lung cancer (NSCLC) accounts for about 85% of all case. In this study, it was aimed to research the relationship between advanced lung inflammation index (ALI) and the primary mass maximum standardized uptake value (SUVmax) and C-reactive protein (CRP) at initial diagnosis and the prognostic value of ALI in determining the survival in metastatic NSCLC. METHODS: A total of 112 patients diagnosed as stage 4 non-small-lung cancer in our hospital between January 2006 and December 2013 were included in this study. ALI was calculated as body mass index (BMI) × serum albumin/neutrophil-to-lymphocyte ratio (NLR). The patients were divided into two groups as ALI < 18 (high inflammation) and ALI ≥ 18 (low inflammation). The log-rank test and Cox proportional hazard model were used to identify predictors of mortality. RESULTS: Evaluation was made of 94 male and 18 female patients with a mean age of 59.7 ± 9.9 years. A statistically significant negative relationship was determined between ALI and CRP values (P < .001), but no relationship was found between ALI and SUVmax values (P = .436). The median survival time in patients with ALI < 18 was 12 months and, in those with ALI ≥ 18, it was 16 months (P = .095). CONCLUSION: ALI is an easily calculated indicator of inflammation in lung cancer patients. Values <18 can be considered to predict a poor prognosis.

Relation between neutrophil/lymphocyte ratio and primary tumor metabolic activity in patients with malign pleural mesothelioma.

The aim of this study was to evaluate the relationship of the pre-treatment blood neutrophil/lymphocyte count ratio (NLR) with the maximum standard uptake value (SUVmax) of primary masses on positron emission tomography/computed tomography (PET/CT) taken before treatment in patients diagnosed with malignant pleural mesothelioma (MPM) and to evaluate the contribution to prognosis. A retrospective evaluation was made of 73 patients diagnosed with MPM in our hospital between January 2006 and January 2014. The SUVmax value of the primary mass on pre-treatment PET/CT, the haemogram parameters (Hb, Hct, NLR, MPV, PLT) at the time of diagnosis, the progression history, the date of the final visit, and the date of death of exitus patients was recorded from patient files PET/CT. The study group comprised 37 males (50.7%) with a mean age of 56.1 ± 11.4 years. The median survival time of these patients was 13 months. The survival time of the patient group aged <55 years was significantly longer (P = .006). Although the survival time of patients with NLR < 3 and SUVmax < 5 was longer, the difference was not statistically significant (P = .63, P = 0.08). A statistically significant difference was determined between the mean (or median) SUVmax values of the patient groups with NLR < 3 and NLR ≥3 (P = .019) with the SUVmax value of the NLR < 3 group found to be low. In conclusion, in patients with MPM, NLR ≥3 and high SUVmax values at the time of diagnosis can be considered an indicator of poor prognosis but are not a guide in the prediction of progression.

Coronary flow reserve is impaired in patients with obstructive sleep apnea.

STUDY OBJECTIVES: Obstructive sleep apnea (OSA) is common in adult populations. Accumulating data indicate that it is independently associated with a variety of cardiovascular diseases and has prognostic importance in affected cases. In this study, we aimed to evaluate coronary flow reserve (CFR) in patients with OSA and controls. METHODS: Sixty-one patients undergoing an overnight polysomnography were enrolled in this study. Patients with an apnea-hypopnea index (AHI) >5 were accepted as OSA group (n = 45) and those with an AHI <5 were taken as controls (n = 16). Using Doppler echocardiography at baseline and following dipyridamole infusion, coronary peak flow velocities were obtained. CFR was calculated as the ratio of peak diastolic flow to baseline diastolic flow. A CFR value <2 was accepted as impaired coronary microvascular function. RESULTS: The mean age was 50.8 ± 10.8 years, of which 16 (26.2%) were female. Both groups had similar features with regard to demographic and clinical variables. The mean value of CFR was significantly lower in patients with OSA compared to those controls (2.24 ± 0.46 vs. 2.74 ± 0.62, respectively, P = 0.001). An abnormal CFR value was observed in 12 (26.7%) patients with OSA and in 1 (6.3%) participant in control group. CONCLUSIONS: The findings of this study indicate that CFR, an indicator of coronary microvascular function, is significantly impaired in patients with OSA. Coronary microvascular function, an early sign of atherosclerosis, can be evaluated noninvasively in these patients might be used as a predictor of cardiovascular risk.

The Evaluation of FDG PET/CT Scan Findings in Patients with Organizing Pneumonia Mimicking Lung Cancer.

OBJECTIVE: Organizing pneumonia (OP) is a rare lung condition that is characterized by the presence of polypoid tissues due to fibroblastic plugs within respiratory bronchioles, alveolar ducts and sacs. The three main radiologic patterns of OP include typical, solitary-focal and infiltrative forms. The maximum standardized uptake value (SUVmax) on positron emission tomography-computed tomography (PET/CT) may be high in benign conditions such as OP as well as malignant diseases. The aim of our study was to investigate PET-CT characteristics of OP in patients mimicking lung cancer. METHODS: The clinical and radiologic characteristics of 50 patients who were referred to our hospital for PET/CT evaluation due to suspicion of lung malignancy, and who were pathologically diagnosed as OP between 2009 and 2013 were retrospectively reviewed. RESULTS: The mean age of the patients was 58.2 years. Ninety-six percent of patients (48) were male. Radiologic evaluation revealed 27 (54%) focal involvement, 10 (20%) consolidation with air-bronchogram (typical), 1 (2%) infiltrative and 12 (24%) other types of involvement (multiple nodules and cavitary lesions). The mean SUVmax value of the lesions on PET/CT was calculated as 6.5. Mediastinal lymph node involvement (at least one station) was detected in 76% of our study group with a mean SUVmax value of 3.27. CONCLUSION: OP may cause false positive results on PET/CT. However, PET/CT results may be used as a guide for invasive procedures that should be performed when there is suspicion of malignancy.

Effect of thyroid function on COPD exacerbation frequency: a preliminary study.

BACKGROUND: Frequent exacerbations of chronic obstructive pulmonary disease (COPD) have negative effects on quality of life and survival. Thus, factors related to exacerbations should be determined. We aimed to evaluate the effects of thyroid function on quality of life and exacerbation frequency in COPD patients. METHODS: The study population (n = 128) was divided into 3 groups (Group 1: COPD patients with hypothyroidism (n = 44); Group 2: COPD patients with normal thyroid function tests (n = 44); Group 3: Healthy subjects (n = 40)). Pulmonary function tests, maximum inspiratory pressure (MIP) and maximum expiratory pressure (MEP) measurements were performed. Quality of life questionnaire (Short Form 36, SF-36) was carried out. Patients were followed up for one year and number of exacerbations was recorded. RESULTS: FVC, FEV1/FVC, and FEF 25-75% measurements were statistically different between group 1 and 2 (p = 0.041, p = 0.001, p = 0.009 respectively). Although MEP values were significantly different between group 1 and 2 (p = 0.006), there was no significant difference in MIP values between groups (p = 0.77). Quality of life scores in group 1 and 2 were significantly lower than control group. Exacerbation frequency was significantly higher in group 1 than in group 2 (p = 0.017). TSH values and exacerbation frequency had positive correlation (p < 0.0001; r = 0.82). CONCLUSIONS: The results of the present study suggest that thyroid function has an effect in exacerbation frequency of COPD. Decrease in exacerbation numbers with early detection of impairment in thyroid function will have positive contribution on quality of life in COPD patients.

Value of serum and induced sputum surfactant protein-D in chronic obstructive pulmonary disease.

BACKGROUND: Surfactant Protein D (SP-D) is an important marker in chronic obstructive pulmonary disease (COPD). Serum SP-D levels increase while lung production of SP-D decreases in COPD. SP-D is a specific biomarker for monitoring COPD, assessment of exacerbation frequency and arrangement of treatment modalities. In the present study, we aimed to investigate the correlation between serum and induced sputum SP-D levels with severity and acute exacerbations of COPD. METHOD: 20 healthy subjects, older than 40 years, with at least 10 pack/years smoking history (group 1), 20 stage I-II COPD patients (group 2) , and 20 stage III-IV COPD patients (group 3) were enrolled in the study. All subjects performed pulmonary function tests. Venous blood samples were taken to determine complete blood count, C-reactive protein(CRP) and serum SP-D levels. Induced sputum samples were obtained to determine SP-D level. COPD patients were followed up for acute exacerbations for 6 months. RESULTS: Serum SP-D levels of group 3 were the highest and induced sputum SP-D levels of group 2 were the lowest among the three groups. SP-D levels of induced sputum decreased in patients with increasing number of cigarette pack/years (p = 0.03, r = -0.115), whereas serum SP-D levels increased in these patients (p = 0.0001, r = 0.6 ). Induced sputum SP-D levels in COPD patients receiving inhaled corticosteroid treatment were significantly higher than in patients who were not receiving inhaler corticosteroid treatment (p = 0.005). An inverse correlation between serum SP-D levels and FEV1 (%) was found and there was a positive correlation between the serum SP-D levels and exacerbations frequency in 6-month follow up period (p = 0.049 ,r = -0.252; p = 0.0001, r = 0.598 respectively). CONCLUSION: Our study demonstrates the adverse effects of smoking on local SP-D levels since low levels of induced sputum SP-D were found in the group of current smokers, who were not receiving inhaled corticosteroid treatment. Relationship between serum SP-D and COPD exacerbations frequency suggests that serum SP-D level may be used as a lung-specific biomarker during the follow up and progression of COPD.