Effect of pulse methylprednisolone on prognosis in SARS-CoV-2 patients with severe pneumonia.

OBJECTIVE: This study aimed to evaluate the effect of pulse methylprednisolone treatment on prognosis in severe COVID-19 pneumonia. PATIENTS AND METHODS: This retrospective cohort study included 128 patients hospitalized in our clinic for severe COVID-19 between March 2020 and February 2021. Standard treatment (plaquenil, favipravir, low molecular weight heparin, and antibiotics when necessary) was given to the patients in accordance with the Turkish Ministry of Health guidelines. After steroid treatment was included in the guidelines, dexamethasone 6 mg/day was administered along with standard treatment. In patients whose clinical condition did not improve despite this treatment, 250 mg/day methylprednisolone (pulse steroid therapy) was administered intravenous (i.v.) for 3 days, followed by a 40 mg/day maintenance dose. The group receiving methylprednisolone 250 mg/day for 3 days and the group receiving standard treatment without steroids were compared in terms of symptoms, comorbidities, laboratory and radiological findings, length of hospitalization, prognosis, intensive care unit (ICU) admission, and intubation. RESULTS: Of the 128 patients included in the study, 85 (66.4%) were male, and the mean age was 61.7 ± 13.2 years (min: 25; max: 88). A total of 50 (39.1%) patients were transferred to the ICU, while the number of intubated patients was 37 (28.9%). Pulse methylprednisolone treatment was given to 98 (76.6%) patients, compared to the 30 (23.4%) patients who received only standard treatment. In total, 37 patients (28.9%) died. The presence of comorbid diseases (34.3% vs. 1.5%, p = 0.012), advanced age (67.7 vs. 59.3, p = 0.001), and not receiving steroid treatment (p = 0.046) significantly increased mortality. The mortality rate was 24.4% (24/98 patients) in the steroid therapy group and 43.3% (13/30 patients) in patients not receiving steroid therapy, and the difference was statistically significant (p = 0.046). Pulse steroid therapy also significantly decreased the rate of intubation (p = 0.014) and ICU admission (p = 0.007). In the logistic regression analysis that included comorbidity, advanced age, and pulse steroid therapy, advanced age (p = 0.022) and pulse steroid therapy (p = 0.048) were found to be effective independent variables of mortality. CONCLUSIONS: The results showed that pulse i.v. methylprednisolone significantly reduced mortality in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients with severe pneumonia requiring hospitalization, in addition to significantly reducing the need for intensive care and intubation. In SARS-CoV-2 patients with severe pneumonia, pulse i.v. methylprednisolone may be useful as a standard treatment in patients who do not respond to dexamethasone.

Effect of the COVID-19 pandemic on smoking habits in a tertiary hospital.

OBJECTIVE: The aim of this study was to identify changes in smoking behaviors along with the reasons thereof, 1 year after the pandemic started. Alterations in the smoking behavior of patients were investigated in the study. PATIENTS AND METHODS: Patients admitted to our Smoking Cessation Outpatient Clinic between March 1st, 2019, and March 1st, 2020, and registered in the Tobacco Addiction Treatment Monitoring System (TUBATIS) were evaluated. Patients were called in March 2021 by the same physician who conducted the smoking cessation outpatient clinic. RESULTS: When the first year of the pandemic was over, the smoking behavior of 64 (63.4%) patients did not change. Of the 37 patients who changed their smoking behavior, eight (21.6%) increased the amount of tobacco they consumed, twelve (32.5%) decreased the amount of tobacco they consumed, eight (21.6%) quit smoking, and nine (24.3%) relapsed smoking. When the reasons for the changes in smoking behavior were examined 1 year after the pandemic started, it was determined that the primary reason for patients who increased the amount of tobacco they consumed and started smoking again was stress, and the primary cause in those who reduced the number of cigarettes and quit smoking was health concerns due to the pandemic. CONCLUSIONS: This result can be a guide for estimating smoking trends in future crises or pandemics and for making necessary plans during the pandemic period to increase the rate of smoking cessation.

Can PET-CT predict diagnostic success in ultrasonography-guided transthoracic fine needle aspiration biopsies in lung cancers?

OBJECTIVE: To examine any correlations between tumor maximum standard uptake values (SUVmax) in positron emission tomography-computed tomography (PET-CT) and homogeneous/heterogeneous tumor FDG uptake in PET-CT, and the diagnostic success of the procedure in thoracic ultrasonography (US)-guided transthoracic fine needle aspiration biopsy (TFNAB). METHODS: The files of patients who underwent thoracic US-guided TFNAB between 2013 and 2018 were examined. Patients who underwent thoracic US-guided TFNAB and were diagnosed as having primary lung cancer were considered as the US-TFNAB diagnostic group. Patients whose disease was diagnosed as primary lung cancer using a different diagnostic method (e.g. CT-guided biopsies, fiberoptic bronchoscopy) due to a lack of diagnosis despite undergoing thoracic US-guided TFNAB were allocated to the US-TFNAB non-diagnostic group. The clinical and radiologic characteristics and PET-CT parameters of the two groups were compared. RESULTS: A total of 104 patients were included in the study; 79 (76%) patients whose disease was diagnosed using US-guided TFNAB, and 25 (24%) patients whose primary lung cancer could not be diagnosed with US-guided TFNAB. The mean SUVmax value of the US-TFNAB diagnostic group was 19.5 ±â€¯10.1, whereas it was 15.1 ±â€¯8.9 in the US-TFNAB non-diagnostic group (p = 0.016). Whether a lesion showed homogeneous or heterogeneous FDG uptake did not effect diagnostic success (p = 0.289). SUVmax value was the only effective independent factor in the diagnostic success of the procedure (p = 0.035). CONCLUSIONS: High SUVmax values in PET-CT in lung cancers may increase the diagnostic success of US guided-TFNAB procedures.