Immunological parameters associated with the severity of COVID-19 pneumonia in kidney transplant recipients.

PURPOSE: An outbreak of a novel respiratory disease due to coronavirus species was emerged in 2019 and named as Coronavirus Disease-2019 (COVID-19). Clinical and immunological factors affecting the course of COVID-19 in kidney transplant recipients (KTR) are not well-known. METHODS: In this prospective observational study, we presented 20 KTR with COVID-19 pnemonia and examined the factors predicting the severity of COVID-19. A total of 10 KTR without COVID-19 was used as control group. Lymphocyte subsets were determined by flow cytometry. In 13/20 patients, immunophenotyping was repeated 1 week later. RESULTS: Mean age of the patients was 50 ± 9 years. Patients were classified as mild-moderate (oxygen saturation: SO2 > 90%) and severe disease groups (SO2 ≤ 90%). Serum albumin and hemoglobin were lower and CRP, fibrinogen and peak D-dimer were higher in severe group. Peak CRP was inversely associated with nadir SO2 (r = - 0.68, p = 0.001). Neutrophil/lymphocyte ratio was higher in severe group (p = 0.01). CD3 + and CD4 + cells were lower and NK cell percentage (CD16 + 56 +) was higher in severe group. Percentage of spontaneously activated CD8 cells (CD8 + CD69 +) was higher in severe group. In comparison of KTR with and without COVID-19, CD8 + cells were lower but NK cell percentage was higher in KTR with COVID-19. CONCLUSION: In this pilot study, increased NK cells, activated CD8 + cells and decreased CD3 + and CD4 + cells were associated with severity of COVID-19 in KTR. Peripheral immunophenotyping of lymphocyte subtypes may provide prognostic information about the clinical course of COVID-19 in KTR.

Effect of 8-week Pulmonary Rehabilitation Program on Dyspnea and Functional Capacity of Patients on Waiting List for Lung Transplantation.

OBJECTIVES: The aim of this study was to evaluate the effect of comprehensive, 8-week outpatient pulmonary rehabilitation (PR) programme consisting of 60-min sessions twice a week under supervision on dyspnea and exercise capacity of patients who were lung transplantation (LTx) candidates. MATERIALS AND METHODS: Between March 2012 and December 2014, medical data of 23 patients on the waiting list for LTx who were referred to our PR unit and completed 16-session outpatient under direct supervision were retrospectively analyzed. Data on exercise capacity as assessed by 6-minute walking test (6MWT) and the rate of perceived dyspnea as assessed by the Borg scale and Medical Research Council (MRC) dyspnea scale were recorded. RESULTS: Of 23 patients 57% were males; the mean age was 35±10 (range: 16-48) years. Four patients were operated early, as an appropriate donor was available. Diagnosis was as follows: bronchiectasis (n=10, 44%), silicosis (n=7, 30%), sarcoidosis (n=2, 9%), idiopathic pulmonary fibrosis (n=1, 4%), chronic obstructive pulmonary disease (n=1, 4%), and others (n=2, 9%). At the end of the program, there was a significant improvement (median: 60 m) in 6MWT scores (360 [70-254] m vs. 300 [139-489] m; p=0.018). In addition, a clinical improvement was observed in Borg (p=0.000) and MRC scores (p=0.008). CONCLUSION: Our study results suggest that 8-week outpatient PR programme consisting of training twice a week is effective to decrease perceived dyspnea and to improve exercise capacity in patients who are on the waiting list for LTx.

A Case Report of A Drop Foot Developed After Common Femoral Artery Cannulation for Venoarterial Extracorporeal Membrane Oxygenation.

The drop foot cases that are associated with developing neuropathies as a result of acute compartment syndrome or femoral artery ischemia after having cannulation for venoarterial extracorporeal membrane oxygenation (VA-ECMO) have been reported rarely in literature. In this case report, female patients who are 21 years old and developed drop foot depending on ECMO during the process of lung transplantation will be presented as both to be one of the rare neurological complications connected to ECMO and its possible causes will be analyzed.

Factors affecting dropout in the smoking cessation outpatient clinic.

The objective of this study was to investigate the prevalence of discontinuation in the smoking cessation outpatient clinic (SCC) and to examine the features of noncompliance. We retrospectively included 1324 smokers into the study. Patients were divided into two groups, as those who discontinued (dropped out) follow-up (group 1) and those who stayed in follow-up (group 2). Of the total 1324 smokers, 540 (40.8%) patients were in group 1. The mean age, smoking pack-years, and Fagerstrom scores of group 1 were lower than group 2 (p = 0.001, p = 0.008, and p = 0.007, respectively). In addition, the choice of treatment was also different between groups (p < 0.001). Motivational/behavioral therapy and nicotine replacement therapy (NRT) were more common in group 1 compared with group 2. There was no difference among groups in gender, having household smokers, history of antidepressant treatment, previous quit attempts, and educational status (p > 0.05). Almost 40% of our patients did not come to their follow-up SCC visit. Younger age, lower Fagerstrom score, low amount of daily cigarette consumption, and being treated only with behavioral therapy or NRT were detected as the characteristics of the dropout group. Awareness of the characteristics of smokers who drop out of SCC programs may provide for the implementation of personalized treatment at the first appointment.

Cryptogenic organizing pneumonia: clinical and radiological features, treatment outcomes of 17 patients, and review of the literature.

BACKGROUND/AIM: We evaluated patients with cryptogenic organizing pneumonia (COP) who attended our clinic. MATERIALS AND METHODS: We retrospectively investigated the clinical and radiological findings, diagnostic methods, treatment, and follow-up outcomes of 17 patients who had been histopathologically diagnosed with COP. RESULTS: The mean age of the patients was 49.8 ± 10.4 years. The most common symptom was cough (n = 15; 88.2%) and the most common radiological finding (n = 10) was consolidation in the inferior lobes on thoracic computed tomography. The diagnosis of COP was made by open lung biopsy in 11 (64.7%) patients, transbronchial biopsy in 5 (29.4%), and video-assisted thoracoscopic surgery biopsy in 1 (5.9%). The mean follow-up period was 28.7 ± 25.0 (range: 3-85) months. Twelve patients received oral corticosteroid therapy and seven of them improved without any fibrotic changes. One patient refused treatment; a chest radiography of that patient was found to be normal at the end of the 20-month follow-up period. Three patients received no other therapy, as the lesion had been completely excised. CONCLUSION: Common symptoms included cough and dyspnea, while the main radiological presentation of COP was consolidation. Corticosteroids are a good treatment option in general, but relapse may occur.

Environmental exposure to asbestos: from geology to mesothelioma.

PURPOSE OF REVIEW: This article aims to review the geological background of environmental asbestos exposure and the distribution of asbestos-related disease (ARD) in association with naturally occurring asbestos (NOA), and discusses the potential health risks associated with exposure to non-occupational asbestos. RECENT FINDINGS: With the motion of continental and oceanic plates, in some parts of the world serpentinites in the lower layer of the oceanic plate move into the continental plate and form the so-called ophiolites. Ophiolites consist of soil and rocks containing serpentine-type asbestos. There is an increase in ARDs in regions close to ophiolites. Indoor exposure and outdoor exposure to NOA, outdoor exposure to industrial asbestos and mines, urbanization and construction works in NOA regions are the known sources and types of environmental asbestos exposure. SUMMARY: Although there is an expectance of decline in ARDs caused by industrial exposure to asbestos, the environmental exposure to asbestos is still a challenge waiting to be overcome.

Serum biomarkers in patients with mesothelioma and pleural plaques and healthy subjects exposed to naturally occurring asbestos.

PURPOSE: This study investigated the diagnostic accuracy of the serum biomarkers osteopontin and mesothelin in discriminating mesothelioma patients from those with other, benign conditions and whether levels of the biomarkers differed in subjects who had inhaled naturally occurring asbestos compared with a non-exposed control group. METHODS: This cross-sectional study studied 24 subjects with mesothelioma, 279 subjects with pleural plaques, 123 "healthy exposed," and 120 control subjects. The Kruskal-Wallis test was performed to compare mesothelin and osteopontin levels of the groups, and receiver operating characteristics curves were generated to determine diagnostic yields of both biomarkers. Multiple linear regression analyses were used to identify associated covariates with osteopontin and mesothelin levels. RESULTS: Serum osteopontin and mesothelin levels were higher in mesothelioma than in benign asbestos-related diseases and healthy exposed subjects. Both biomarker levels were independently associated with mesothelioma, age and smoking pack years. Mesothelin levels were also associated with body mass index. The sensitivity and specificity of osteopontin in distinguishing mesothelioma from the three other groups were 75 and 86 %, respectively; those of mesothelin were 58 and 83 %, respectively. The sensitivity and specificity to discriminate mesothelioma from pleural plaques and healthy subjects were 93 and 73 %, respectively, if osteopontin and mesothelin levels were higher than their optimal cut off levels. CONCLUSIONS: The combination of serum osteopontin and mesothelin levels can help to distinguish mesothelioma from benign asbestos-related diseases and asbestos-exposed subjects.

Is living close to ophiolites related to asbestos related diseases? Cross-sectional study.

OBJECTIVE: To determine the rate of pleural plaques and malignant mesothelioma and other factors that affect people living close to ophiolites. METHODS: The study population was comprised of 2970 volunteers who resided <10 km from an ophiolitic unit. Control group comprised of 157 residents >25 km from ophiolites. Information gathered from the patients included presence of pleural plaques on chest X-ray, distance from ophiolites, gender, smoking status, duration of asbestos exposure, and body mass index (BMI). Mineralogical analysis of soil and rock samples was performed by X-ray diffraction. RESULTS: Among the 2970 study participants, those who lived close to ophiolites, 9.8% had asbestos related disease (3 malignant mesothelioma, 289 pleural plaques). No asbestos related disease (ARD) was identified in the control group. Male gender (OR: 2.63, 95% 1.9-3.5, p < 0.001), advanced age (5% increase for every year p < 0.001), residential proximity to ophiolites (for every 1 km proximity, a 12% increase p < 0.001), and low BMI (for every 1 unit decrease, 3.6% increase p < 0.001) were associated with increased risk of ARD. CONCLUSION: The rate of ARD is higher in residents living close to ophiolites. Important risk factors for developing ARD were age, male gender, proximity to an ophiolite site, and low BMI.

High risk of malignant mesothelioma and pleural plaques in subjects born close to ophiolites.

BACKGROUND: Ophiolites, a special sequence of geologic rock units, are known sources of naturally occurring asbestos. The aim of this study was to test whether the occurrence of malignant mesothelioma (MM) or pleural plaques (PPs) in the province of Sivas, Turkey, is determined by the proximity of the patient's birthplace to ophiolites and, if so, to establish the magnitude of the risk. METHODS: The birthplaces of patients with MM or PPs (cases) and patients with prostate or breast cancer (control subjects), diagnosed between 2000 and 2010 and identified through a mandatory cancer registry or from hospital records (PPs), were located on a geologic map, and the nearest distance to ophiolites was measured. The relation of MM or PPs with distance to ophiolites was analyzed by logistic regression. Samples of soil and house plaster were determined by x-ray diffraction. RESULTS: Patients with MM (n = 100) or PPs (n = 133) were born significantly nearer to ophiolites (median distance, 4.5 km for men, 0 km for women) than were patients with prostate cancer (n = 161) or breast cancer (n = 139) (median distance, 20 km for both). ORs were 1.6 (men) ( P < .001) and 2.0 (women) ( P < .001) for every 5-km decrease in the distance of birthplace to ophiolites for MM, compared with prostate and breast cancer, respectively. CONCLUSION: In this area without substantial industrial asbestos use, there is an association between the occurrence of mesothelioma (and of PPs) and the proximity of the subject's birthplace to ophiolites.

A cross sectional observational study on the influence of chronic obstructive pulmonary disease on activities of daily living: the COPD-Life study.

INTRODUCTION: This study was designed to identify the impact of chronic obstructive pulmonary disease (COPD) on activities of daily living, life styles and needs in patients. PATIENTS AND METHODS: Participants of this national, multi-centered, cross-sectional observational study included 497 stable COPD patients from 41 centers. The mean age (standard deviation; SD) was 63.3 (9.3) years with 59.0% of the patients under the age of 65, and 89.9% of the participants were male. Sociodemographic and COPD-related data were gathered at enrollment and during the 1-month telephone follow-up. RESULTS: The mean (SD) COPD duration was 7.3 (6.5) years in the overall population while 5.4 (4.6) years for patients who recieved COPD diagnosis at least one year after the onset of symptoms. Dyspnea was the most common (83.1%) symptom and walking up stairs (66.6%) was the most difficult activity to be performed. Majority of the patients were aware of COPD as a chronic disease (63.4%), requiring ongoing treatment (79.7%), mainly caused by smoking (63.5%). 59% of the patients were under the age of 65 years-old. In 84% of patients, graduation from at least a primary school was identified. Results revealed an average number of two dependants that were obliged to look after per patient, ability to go on an outing in 91% of the patients, and going grocery shopping with ease in more than two-thirds of the study population. There was no significant difference in regular use of medication device across different educational or age groups. The top three COPD treatment expectations of the patients were being able to breathe (24.1%), walking (17.1%), and walking up stairs (11.7%), while shortness of breath (43.3%) was the first priority treatment need. CONCLUSION: In contrast to the common view that COPD prevalance is higher in old age population, this study showed that the rate of the disease is higher among younger patients than expected; indispensability of out of the house activities in majority of patients; and use of regular medication device to be independent of educational level and the age of COPD patients. Our findings indicate that the likelihood of COPD patient population to be composed of younger and active individuals who do not spend majority of their time at home/in bed as opposed to popular belief. Therefore, availability of a portable and easy to use device for medication seems to be important to enhance daily living.

[Semirigid thoracoscopy in the diagnosis of pleural effusion: first four cases in Turkey]. / Plevral efüzyon tanisinda semirijid torakoskopi: Türkiye'de ilk dört olgu.

Medical thoracoscopy is a valuable tool in the management and investigation of pleural diseases. It has advantages when compared to conventional closed pleural biopsy and video-assisted thoracoscopic surgery. However, the use of this technique is limited in Turkey. The present report is about the first experience with semi-rigid thoracoscope that was implemented in our country. Four patients underwent medical thoracoscopy in September 2009 with the new device. All patients were referred due to non-diagnostic closed pleural biopsy. The use of the device was simple and fabulous views were obtained. All biopsy specimens of the 4 patients were histologically adequate. Definite diagnosis was enabled in 3 of the 4 patients when clinical features and CT findings combined with thoracoscopic specimens. The design is similar to the fiberoptic bronchoscope, respiratory physicians can easily adapt to its use. It is also compatible with most video operating systems and light sources used in endoscopy suites. The convenient use and compatibility with most endoscopic systems are raising the importance of the device. However, biopsy size from semirigid thoracoscope might cause diagnostic difficulty when compared to rigid thoracoscope.

Silicosis in denim sandblasters.

BACKGROUND: During the past 2 decades, silica sand has been used widely in sandblasting denim in Turkey, which has resulted in an epidemic of silicosis. This study was conducted to summarize the clinical outcomes of formerly healthy young people who became disabled or died because of working in the textile industry. METHODS: The medical records of patients with silicosis due to denim sandblasting who were seen at our institution between 2001 and 2009 were reviewed. Follow-up data were assessed. Compensation and vital status of patients were determined, and survival analysis was performed. RESULTS: Thirty-two male patients diagnosed with silicosis due to denim sandblasting over an 8-year period were identified. Mean age was 31.5 years. They worked as denim sandblasters for a mean 66.4 h/wk for a median 28.5 months. Their mean cumulative exposure time to silica sand was 12,957 h. The median follow-up period was 29 months (range 3-101 months). The median latency period (time elapsed between initial exposure and diagnosis) was 5.5 years (range 2-14 years). Six of the followed patients (19%) died of progressive massive fibrosis. Nine of the patients (28%) were compensated because of silicosis. Just two patients with silicosis received compensation before they died. The mean survival rate was 78 months. The estimated 5-year survival rate was 69% for denim sandblasters with silicosis. CONCLUSIONS: Silicosis in young individuals after exposure in the textile sector suggests a lack of awareness of the hazards of silica outside of the traditional occupations associated with silicosis. Death from silicosis in young people suggests overexposure and unsafe working conditions as a result of a lack of control.

Ultrasound guided fine-needle aspiration biopsy of metastases in nonpalpable supraclavicular lymph nodes in lung cancer patients.

BACKGROUND AND OBJECTIVES: To assess frequency and significance of enlarged nonpalpable supraclavicular lymph nodes with routine ultrasound (US) evaluation and US-guided fineneedle aspiration biopsy (FNAB) for the diagnosis and staging of patients with lung cancer. MATERIALS AND METHODS: 106 consecutive patients with lung cancer and nonpalpable supraclavicular lymph nodes were evaluated with cervical US for the presence of pathological lymph nodes. FNAB was performed in patients with nodes with short-axis > 5 mm, rounded shape and missing echogenic hilum. RESULTS: 27 (25.5%) patients had enlarged supraclavicular lymph nodes on US. Fourteen patients (13.2%) had cytologically proven lymph node involvement. Supraclavicular lymph node metastasis was more frequent in patients with mediastinal invasion (p = 0.0001) and patients with enlarged lymph nodes on upper paratracheal stations on thorax CT (p = 0.0001). No relation was found between supraclavicular lymph node involvement and T stage (p = 0.27), distant metastasis (p = 0.50) or histological type (p = 0.80). Three patients were upstaged from IIIA to IIIB status. US-guided FNAB was the only diagnostic method in 2 patients. CONCLUSION: US-guided FNAB is a simple and safe procedure which can document N3 stage of disease in lung cancer patients. Thereby more invasive and expensive diagnostic procedures can be avoided in selected lung cancer patients.

Community-acquired Burkholderia cepacia pneumonia: a report of two immunocompetent patients.

Burkholderia cepacia is a gram-negative bacilli leading to pneumonia with poor prognosis and usually seen in patients with immunosuppression or with structural lung diseases. This report is about two patients with no underlying disease diagnosed as B. cepacia pneumonia mimicking malignancy and tuberculosis. Bronchoscopy was applied on both patients since no response to treatment with wide spectrum antibiotics and negative sputum smears for acid-fast bacili. B. cepacia was isolated from bronchial lavage culture. Antibiogram revealed sensitivity to quinolones in both cases. Radiological and clinical complete remission was seen in patients by quinolones. The current cases showed that community-acquired Burkholderia pneumonia is possible in healthy patients. Bronchial washing is important in diagnosis.

[Thoracic findings in neurofibromatosis]. / Nörofibromatoziste torasik bulgular.

Neurofibromatosis type 1 (von Recklinghausen' disease) is an autosomal dominant hereditary syndrome. It is characterized with multiple light brown (café-au-lait) spots, Lisch nodules and neurofibromas. Thorax and lungs are affected in various forms. Four cases with symptoms of thoracic involvement were investigated in our clinic. Mean age was 46. All cases had dyspnoea and cough; two of them had chest pain. Skin lesions of neurofibromatosis type 1 (NF 1) were pathologically confirmed in all cases. Moreover, case 3 had diffuse interstitial fibrosis and honeycomb pattern. Case 2 had thorax deformity, kyphoscoliosis and intrathoracic benign mass. Case 1 had two neurofibrosarcoma masses on the right hemithorax. Case 4 had multiple intrathoracic neurofibromas. Cases 1 and 3 died within two years after diagnosis due to malignancy and respiratory failure, respectively. Cases 2 and 4 are still under our control.

[Churg-Strauss syndrome (two case reports)]. / Churg-Strauss sendromu (iki olgu nedeniyle).

Churg-Strauss syndrome is a necrotizing vasculitis with multiple organ involvement characterized by asthma, peripheral blood eosinophilia, eosinophilic tissue infiltration and extravascular granulomas. A 35 years-old male with 6-months history of asthma and a 43 years-old female with 4-years history of asthma, were further examined due to clinical worsening and lesions on chest radiographs. They were finally diagnosed as Churg-Strauss syndrome. Clinical and radiological response to oral corticosteroid therapy was obtained.