Prognostic predictors for mortality of patients with COVID-19 in an intensive care unit.

INTRODUCTION: Fatality due to COVID-19 continues to be a challenge. Timely identification of critical COVID-19 patients is crucial for their close clinical follow-up and treatment. We aimed to identify the mortality predictors of critical COVID-19 patients. METHODOLOGY: We analyzed medical records of 232 out of 300 patients with COVID-19 hospitalized in the intensive care unit (ICU) whose medical records were available in the hospital database. Non-survivors and survivors were compared for parameters. Medical records of demographics, comorbidities, radiological signs, respiratory support, and laboratory tests on the first day of ICU admission were included. The durations of ICU stay and hospitalization were also evaluated. RESULTS: The patients with Acute Physiology and Chronic Health Evaluation II (APACHE-II) score above 28.5 and the patients with blood urea nitrogen (BUN) above 45.5 mg/dL were significantly more mortal (95% CI: 0.701, p = 0.0001; 95% CI: 0.599, p = 0.022; respectively). Partial oxygen pressure/fraction of inspired oxygen (P/F) ratio below 110.5 mmHg was a predictor for mortality (95% CI: 0.397, p = 0.018). Older age, smoking, crazy paving pattern on computed tomography (CT), and short duration of hospitalization were also predictors of mortality. The patients requiring invasive mechanical ventilation were significantly more mortal whereas the patients requiring high flow oxygen and non-invasive ventilation were significantly more likely to survive. CONCLUSIONS: We recommend evaluating APACHE-II score, BUN value, P/F ratio, age, smoking status, radiological signs on CT, length of hospitalization and modality of respiratory support upon ICU admission to identify critical patients with poor prognoses.

Relationship of CTLA4 and CD28 polymorphisms with lung involvement, HRCT findings and pulmonary function tests in Turkish patients with ankylosing spondylitis.

BACKGROUND AND AIMS: Ankylosing spondylitis (AS) is a multisystem disorder with ocular, pulmonary, and cardiovascular involvement. The incidence of pulmonary involvement varies from 1 to 52%. Abnormal T-cell function-derived immune responses are involved in AS pathogenesis. Numerous genes such as CTLA4 and CD28 control T-cell functions. In this study, we aimed to address the relationship between CTLA4 and CD28 polymorphisms and lung involvement in Turkish patients with AS. METHODS: A cross-sectional evaluation of 80 healthy and 89 AS subjects with no active infection or malignancy was performed to determine the relationship between pulmonary involvement and CTLA4 and CD28 gene polymorphisms. All patients were assessed for clinical, radiological, and spirometric findings. Descriptive statistics, chi-square tests, and independent-sample t-tests were used for statistical analyses. RESULTS: All patients with the CD28 CC genotype (n = 4) had abnormal HRCT, but it was not significant (p = 0.47). All of the normal HRCT patients have CD 28 T alleles. In addition to this data ; 4 patients who have not any T alleles have abnormal HRCT finding. It was significant and was considered that T genotype have protective effect (p= 0,047) on radiologic involvement but no other association was found between CTLA4 and CD28 gene polymorphism with respect to pulmonary function tests (PFT), diffusion capacity, and clinical characteristics in the Turkish patients with AS. CONCLUSION: Our results suggest a possible association of CTLA4 and CD28 variants with AS pulmonary involvement. Furthermore, these results may lead to the development of new therapeutic agents to control more aggressive forms of the disease. However, further studies are needed in larger populations.

The comparative value of pleural fluid adenosine deaminase and neopterin levels in diagnostic utility of pleural tuberculosis.

INTRODUCTION: The aim of the present study was to evaluate and compare the diagnostic accuracy of pleura levels of adenosine deaminase (ADA) and neopterin for the differential diagnosis of pleural tuberculosis (TP). PATIENTS AND METHODS: The study included 50 patients with TB, 27 patients with malignancies, and 24 patients with pleural effusion of non-tuberculous and non-malignant origin as controls. ADA and neopterin levels in pleural fluid were measured by spectrofotometric and ELISA method, respectively. RESULT: Pleural neopterin levels were significantly higher in patients with pleural TB than patients with malignancy (p< 0.001). Pleural ADA levels were significantly higher in patients with pleural TB than patients with malignancy (p< 0.001) and patients with benign non-tuberculosis effusions (p< 0.001). The mean levels of ADA and neopterin in pleural effusion were evaluated according to their underlying diseases for the diagnostic accuracy. As for pleural TB receiving operating characteristic curves identified the following results; The best cut-off value for pleural neopterin was 4.7 U/L and yielded a sensitivity and specificity of 86% and 72.55%, respectively. Taking a cut-off value of 42 U/L for pleural ADA, the sensitivity and the specificity were found to be 88% and 68.63%, respectively. CONCLUSIONS: In the diagnosis of pleural TB pleural neopterin level has a comparable sensitivity to pleural ADA activity. Both markers may find a place as a routine investigation in the coming days for early detection of TB. However, these tests should not be considered an alternative to biopsy and culture.

COPD: an underdiagnosed disease at hospital environment.

BACKGROUND AND AIM: Chronic obstructive pulmonary disease (COPD) is a serious disease with morbidity and mortality due to delayed diagnosis until significant symptoms arise. We aimed to assess the utility of spirometry and COPD Assessment Test (CAT) in detecting undiagnosed COPD patients in a localized area. MATERIAL AND METHODS: People who came to the hospital for patient visit or examination with a smoking history of > 10 pack-years (> 40 years old), and with no known chest disease were invited to study. The participants completed a questionnaire and performed spirometry. Spirometry was performed according to ATS/ERS Task Force on spirometry. COPD was defined as according to the Global Initiative for Chronic Obstructive Lung Disease guidelines. RESULTS: There were 800 subjects screened, and 648, capable of performing spirometry, were included to the study. The mean age was 48.3 ± 9.0 and 38 % of the study population was male. Post-bronchodilator FEV1/FVC ratio was lower than 0.70 in 17 % of the subjects. Median (25-75 percentiles) total CAT scores and among the questions of CAT; cough, phlegm, chest tightness and breathlessness scores for COPD and non-COPD subjects were; 15(9-22) vs 12(6-18) (p = .004), 2(1-3) vs 1(0-2) (p < .001), 2(0-3) vs 1(0-3) (p = .004), 3(1-4) vs 2(0-3) (p > .001), 4(3-5) vs 3(2-4) (p = .001), respectively. Symptom prevalence was as follows: exertional dyspnea 91 %, dyspnea 80.9 %, cough 56.3 % and phlegm 58.3 % in COPD. CONCLUSION: Our study showed that spirometric screening together with the CAT questionnaire may improve the awareness of disease and may determine undiagnosed patients.

[The clinical value of autofluorescence bronchoscopy for precancerous lesions in operable primary lung cancer patients]. / Primer akciger karsinomu nedeniyle opere edilecek hastalarda otofloresan bronkoskopi ile prekanseröz lezyonlarin arastirilmasi.

INTRODUCTION: The aim of the present study is to show the role of autofluorescence bronchoscopy (AFB) compare with white light bronchoscopy (WLB) in detecting synchronous cancer and precancerous lesions in cases with operable primary lung cancer. MATERIALS AND METHODS: Fourty-nine patients were included in the study. WLB findings were grouped as group 1 normal, group 2 erithema or edema, group 3 nodular lesions or mucosal abnormality. AFB findings were grouped as group 1 normal, group 2 light brownish abnormal areas, group 3 brownish abnormal areas. Biopsies were obtained from group 2 and 3 patients. In 12 (24.5%) of the patients no areas were suspected and no biopsies were taken. RESULTS: Twenty-six (53%) of 49 patients did not show abnormal biopsy results in any of the specimens. One (2%) patient had metaplasia, 1 (2%) patient had dysplasia, 1 (2%) patient had in situ carcinoma. The diagnostic accuracy rates for the detection of synchronous cancer and precancerous lesions using WLB and AFB were as follows respectively: sensitivity 77.8% vs. 100%; specificity 37.5% vs. 3%; positive predictive value 21.9% vs. 24.3%; negative predictive value 88.2% vs. 100%. The relative sensitivity of AFB to WLB is 1.28. CONCLUSION: This study demonstrated that, AFB is an effective method in detecting synchronous cancer and precancerous lesions because of its low specificity it is more likely to be complementary to WLB.

[The frequency and properties of REM related obstructive sleep apnea among the patients with mild related obstructive sleep apnea]. / Hafif obstrüktif uyku apneli hastalarda REM ile iliskili obstrüktif uyku apne sikligi ve özellikleri.

INTRODUCTION: The question if REM related obstructive sleep apnea (OSA) is a specific clinical entity or if it is an early sign of severe sleep disordered breathing as there is high occurrence of REM OSA in mild and moderate cases, recently have attracted the investigators. In this study, we aimed to see the frequency of REM related OSA among patients with mild OSA; and also to evaluate relation between apnea and daytime sleepiness among REM related OSA patients. MATERIALS AND METHODS: One hundred thirty four patients with mild OSA [Apnea hipopnea index (AHI)= 5-15] among 1267 patients with polysomnography examination at sleep laboratory of Bezmialem University Hospital between 1st August 2010 and 29th February 2012 were retrospectively evaluated. Patients having REM AHI/non-REM AHI ≥ 2 and non-REM AHI < 15 are considered as REM related OSA. RESULTS: Eighty (59%) of 134 patients with mild OSA were considered as REM related OSA. When REM related OSA and non REM OSA are compared for age, gender, daytime sleepiness, body mass index, neck surround and aditional diseases; mean age of REM related OSA group was found only significantly lower. Number of AHI in REM was over 15 at 87.3% of REM related OSA group and over 30 at 39.3% of them. There was no relation between REM AHI and daytime sleepiness symptom (p= 0.81). CONCLUSION: We may consider the result of lower mean age in REM related OSA group as a supporting result for early sign of severe sleep disordered breathing. We consider to follow up this group of patients to answer the question about subject.