Pulmonary Physician Consultancy in Emergency Services in Turkiye (PuPCEST) - a cross-sectional multicenter study.

Pulmonology is one of the branches that frequently receive consultation requests from the emergency department. Pulmonology consultation (PC) is requested from almost all clinical branches due to the diagnosis and treatment of any respiratory condition, preoperative evaluation, or postoperative pulmonary problems. The aim of our study was to describe the profile of the pulmonology consultations received from emergency departments in Turkiye. A total of 32 centers from Turkiye (the PuPCEST Study Group) were included to the study. The demographic, clinical, laboratory and radiological data of the consulted cases were examined. The final result of the consultation and the justification of the consultation by the consulting pulmonologist were recorded. We identified 1712 patients, 64% of which applied to the emergency department by themselves and 41.4% were women. Eighty-five percent of the patients had a previously diagnosed disease. Dyspnea was the reason for consultation in 34.7% of the cases. The leading radiological finding was consolidation (13%). Exacerbation of preexisting lung disease was present in 39% of patients. The most commonly established diagnoses by pulmonologists were chronic obstructive pulmonary disease (19%) and pneumonia (12%). While 35% of the patients were discharged, 35% were interned into the chest diseases ward. The majority of patients were hospitalized and treated conservatively. It may be suggested that most of the applications would be evaluated in the pulmonology outpatient clinic which may result in a decrease in emergency department visits/consultations. Thus, improvements in the reorganization of the pulmonology outpatient clinics and follow-up visits may positively contribute emergency admission rates.

The Role of Pneumococcal Pneumonia among Community-Acquired Pneumonia in Adult Turkish Population: TurkCAP Study.

OBJECTIVE: To evaluate the rate of pneumococcal pneumonia (PP) among patients with community-acquired pneumonia (CAP) in Turkey and to investigate and compare features of PP and non-PP CAP patients. MATERIAL AND METHODS: This multicenter, non-interventional, prospective, observational study included adult CAP patients (age ≥ 18 years). Diagnosis of PP was based on the presence of at least 1 positive laboratory test result for Streptococcus pneumoniae (blood culture or sputum culture or urinary antigen test [UAT]) in patients with radiographic findings of pneumonia. RESULTS: Four hundred sixty-five patients were diagnosed with CAP, of whom 59 (12.7%) had PP. The most common comorbidity was chronic obstructive pulmonary disease (30.1%). The mean age, smoking history, presence of chronic neurological disease, and CURB-65 score were significantly higher in PP patients, when compared to non-PP patients. In PP patients, 84.8% were diagnosed based ony on the UAT. The overall rate of PP patients among CAP was calculated as 22.8% considering the UAT sensitivity ratio of 63% (95% confidence interval: 45-81). The rate of intensive care treatment was higher in PP patients (P = .007). While no PP patients were vaccinated for pneumococcus, 3.8% of the non-PP patients were vaccinated (P = .235). Antibiotic use in the preceding 48 hours was higher in the non-PP group than in the PP group (31.8% vs. 11.1%, P = .002). The CURB-65 score and the rate of patients requiring inpatient treatment according to this score were higher in the PP group. CONCLUSION: The facts that PP patients were older and required intensive care treatment more frequently as compared to non-PP patients underline the burden of PP.

[Mortality prediction ability of phycians in intensive care units of Turkey (MOPAP)]. / Türkiye'de yogun bakim ünitelerinde hekimin mortaliteyi öngörebilme gücü.

INTRODUCTION: Intensive care physicians are increasingly involved in decision making about the prognosis of intensive care unit ICU patients. With this study; we aimed to evaluate the power of clinician foresight at prediction of mortality in patient at triage to intensive care and patient follow-up. MATERIALS AND METHODS: This study was conducted in ICUs located in various geographical regions of Turkey between January 1, 2017-April 30, 2017.The clinical research was planned as observational, multicenter, cross-sectional. RESULT: A total of 1169 intubated patients were followed in 37 different ICU. At the beginning of the follow-up we asked the physician who will follow the patient in the ICU to give a score for the probability of survival of the patients. Scoring included a total of 6 scores from 0 to 5, with the "0" the worst probability "5" being the best. According to this distribution, only 1 (0.9%) of 113 patients who were given 0 points survived. Three (6.1%) of 49 with the best score of 5 died. Survival rates were significantly different in each score group (r: -0.488; p<0.001). After the combined mortality estimation scores based on the clinical observations of the physicians (0 and 1 point score was combined as non-survive, 4 and 5 score was combined as survived) 320 of the 545 patients were estimated to be dead and 225 were predicted survival. Sensitivity and spesifity of scoring system to predict mortality was 91.56% (95% CI: 87.96-94.37), 76.89% (95% CI: 70.82-82.23) respectively. CONCLUSIONS: In this study, we concluded that the physicians who follow the patients in the ICU can predict the poor prognosis at the time of admission and the high mortality rate. The physician's opinion on mortality estimation should be considered in intensive care mortality scoring in addition to other laboratory and clinical parameters.

A rare complication of endobronchial ultrasound-guided transbronchial needle aspiration: Pericardial empyema.

Endobronchial ultrasound (EBUS)-guided transbronchial biopsy procedure is widely used for the diagnosis of mediastinal lymphadenopathy. It is a safe method and the complication rate of procedure is <1%. Rarely, the fatal complications may develop after the intervention. Here, we present a case of pericardial empyema occurred as a complication of EBUS-guided transbronchial biopsy procedure.

Does the neutrophil-to-lymphocyte ratio have any importance between subjects with obstructive sleep apnea syndrome with obesity and without obesity?

INTRODUCTION: An increase in the incidence of OSAS (obstructive sleep apnoea syndrome) has been seen due to the reported association between OSAS and obesity. Subjects are predisposed to cardiovascular disease due to systemic inflammation caused by the interactions between obesity and OSA. Inflammatory markers could be used to predict the degree of systemic inflammation, which could be a prognostic factor for future adverse events such as metabolic risks. One marker that has recently started being used as an indicator of systemic inflammation is neutrophil-to-lymphocyte ratio (NLR). MATERIALS AND METHODS: The aim is to evaluate NLR, which is a easily measured parameter of systemic inflammation in OSAS subjects with and without obesity. 155 subjects were assigned to four different groups according to their body mass indices. Comparisons of white blood cell, neutrophil, lymphocyte, NLR values and anthropometric measurements were done for each group. RESULT: The NLR and neutrophil counts of group 4 were statistically significant and higher than those of groups 1, 2 and 3. The lymphocyte counts of group 4 were the lowest amongst all groups, these values were lower than the lymphocyte counts of groups 1, 2 and 3 with statistically significant differences (p< 001). A positive correlation was found between the body mass index and lymphocyte count values of obese OSAS subjects (r= 0.027, p= 353). CONCLUSIONS: The NLR ratio was found to be increasing by obesity grade and reveals that the associated inflammatory response also increases. The NLR ratio might be used as an inflammatory marker in obese OSAS subjects.

Pulmonary mucormycosis mimicking an endobronchial mass.

Mucormycosis is an opportunistic fungal infection that can infect different regions of the body. This entity may present in rhinocerebral, pulmonary, cutaneous, and disseminated forms. Although pulmonary mucormycosis is usually seen as an invasive parenchymal consolidation or cavitation, it may rarely present as an endobronchial mass. We describe a case of endobronchial mucormycosis in which the fungal mass was completely removed via rigid bronchoscopy before medical therapy.

Protective Effects of Alpha-Lipoic Acid on Methotrexate-Induced Oxidative Lung Injury in Rats.

OBJECTIVE: Oxidative stress is one of the major causes of methotrexate induced lung injury (MILI). Alpha-lipoic acid (ALA), which occurs naturally in human food, has antioxidative and anti-inflammatory activities. The aim of this study was to research the potential protective role of ALA on MILI in rats. METHODS: Twenty one rats were randomly subdivided into three groups: control (group I), methotrexate (MTX) treated (group II), and MTX+ALA treated (group III). Lung injury was performed with a single dose of MTX (20 mg/kg) to groups 2 and 3. On the sixth day, animals in all groups were sacrificed by decapitation and lung tissue and blood samples were removed for histological examination and also measurement the levels of interleukin-1-beta (IL-1ß), malondialdehyde (MDA), glutathione (GSH), tumour necrosis factor-alpha (TNF-α), myeloperoxidase (MPO), and sodium potassium-adenosine triphosphatase (Na+/K+ATPase). RESULTS: In MTX group tissue GSH, Na+/K+ATPase activities were lower, tissue MDA, MPO and plasma IL-1?, TNF-? were significantly higher than the other groups. Histopathological examination showed that lung injury was less severe in group 2 according to group 3. CONCLUSIONS: Oxidative damage of MTX in rat lung is partially reduced when combined with ALA.

Serum telomerase levels in smokers and smokeless tobacco users as Maras powder.

INTRODUCTION: To the best of our knowledge, no previous study regarding the serum telomerase levels in Maras powder users (MPUs) has been founded. The aim of the current study was to investigate serum telomerase levels in smokers and MPUs. MATERIALS AND METHODS: The study was carried out with 98 patients (36 MPUs, 32 smokers and 30 non-smokers). Blood samples were collected, and after having measured the serum telomerase and malondialdehyde (MDA) levels of the patients, comparison were made between the groups. RESULT: It has been observed that the serum telomerase and MDA levels of smokers (p< 0.001) and MPUs (p< 0.001) were significantly higher compared to those of the non-smoker control subjects. In addition, the levels of serum telomerase and MDA were observed to be higher in the MPU group compared to those of the smoker group (p< 0.001). CONCLUSIONS: The levels of serum telomerase and MDA were observed to be higher among MPUs and smokers. In this context, it may be useful to further measure and assess telomerase activity in such patients in order to better determine the harmful effects associated with these habits.

Can We Predict the Perioperative Pulmonary Complications Before Laparoscopic Sleeve Gastrectomy: Original Research.

BACKGROUND: The increasing prevalence of obesity in worldwide is one of the most serious chronic public health problems and is considered to be a global epidemic. Bariatric surgical procedures have also been applied more often with increased prevalence of obesity. As a result, the incidence of surgical complications has increased. Preoperative evaluation is quite important for these patients. AIMS: The aim of our study is to determine the predictors of perioperative pulmonary complications of laparoscopic sleeve gastrectomy. STUDY DESIGN: The study is a cross-sectional study. METHODS: One hundred eighty-three consecutive patients who received laparoscopic bariatric surgery were followed up during 3 months. Patients were divided into two groups A and B. Group A being the patients who had perioperative pulmonary complications (n = 28) and group B being patients who had not (n = 155). Pulmonary function test (PFT), body mass index (BMI), preoperative oxygen saturation, age, gender, comorbid diseases, and smoking history were compared between these groups. RESULTS: Mean age, size, weight, BMI, PFT parameters of groups A and B were close to each other. The strongest predictors of perioperative pulmonary complications were duration of smoking in current smokers and low baseline oxygen saturation. CONCLUSIONS: Preoperative oxygen saturation and smoking history may help to predict perioperative complications of laparoscopic sleeve gastrectomy.

The Effect of Working in a Smoke-Free Workplace on use of Smoking and Smokeless Tobacco.

OBJECTIVES: The aim of this study was to evaluate whether smokeless tobacco (Maras powder) use increased among smokers working at smoke-free workplaces or not. MATERIAL AND METHODS: In Kahramanmaras city, 242 male workers who were current or former smokers, working at strictly smoke-free workplaces were included in this study. A total of 21 questions, including the Fagerstrom Test for Nicotine Dependence, were asked. RESULTS: All the participants were male with a mean age of 29.33±6.66 years, and the age range was 17-55 years. Current smokers were 90 (37.2%) and former smokers were 152 (62.8%). Former smokers were asked the reason why they quit smoking; the predominant reasons were the health hazards of smoking and the financial burden of cigarettes. The quitting rate was significantly higher among married participants (p=0.023). Maras powder users were 184 (76%), users who never smoked were 54 (22.3%), and former users were 4 (1.7%). We asked the Maras powder users if they had been using it before the smoking bans, and 96 workers (51.1%) answered "no." The question "Did the use of Maras powder increase with smoking bans"? was asked, and 118 workers (62.8%) answered "yes." The level of education among Maras powder users was significantly lower than non-users (p=0.001). CONCLUSION: Working in smoke-free workplaces is associated with increased rates of quitting smoking and also with increased use of Maras powder, a local form of oral smokeless tobacco.

A Case of Pulmonary Alveolar Microlithiasis Diagnosed by Transbronchial Biopsy.

Pulmonary alveolar microlithiasis is a rare infiltrative pulmonary disease, in which intraalveolar accumulation of small stones (microliths) consisting of calcium phosphatite occurs. It is an autosomal recessive disorder. The disease occurs as a result of the disruption of type IIb sodium phosphate cotransporter in type II alveolar cells after the mutation of SLC34A2. Majority of patients are diagnosed between age 20 and 40. Here, we present a case of alveolar microlithiasis that was diagnosed with transbronchial biopsy.

Plasma concentrations of isoniazid and rifampin are decreased in adult pulmonary tuberculosis patients with diabetes mellitus.

Plasma isoniazid and rifampin concentrations, but not pyrazinamide and ethambutol concentrations, were decreased by about 50% (P < 0.05) in diabetic pulmonary tuberculosis patients. The prevalences of subnormal plasma isoniazid, rifampin, pyrazinamide, and ethambutol concentrations were 49% or 100% (P < 0.01), 66% or 100% (P < 0.05), 30% or 50% (P = 0.198), and 32% or 21% (P = 0.742) in nondiabetic or diabetic tuberculosis patients, respectively. These data show that plasma concentrations of isoniazid and rifampin were greatly reduced in diabetic tuberculosis patients.

Analysis of young and elderly advanced stage nonsmall-cell lung carcinoma cases.

OBJECTIVE: Even though there have been considerable improvements in the diagnosis and treatment of lung cancer, the prognostic factors for elderly patients with advanced nonsmall-cell lung cancer (NSCLC) remain insufficient. Therefore, our aim is to compare the prognostic factors for elderly and young cases with advanced stage NSCLC. METHODS: The data of 370 advanced stage young (<65 years old) and elderly (>or=65 years old) NSCLC patients (Stage IIIB or IV) treated between 1995 and 2008 were retrospectively evaluated for the study at the oncology department. Demographic characteristics, treatment response, comorbidities, pleural effusion, performance status, and overall survival (OS) were correlated with patient clinical features and smoking habits at the time of diagnosis. RESULTS: Of the 370 patients, 284 (76.8%) were in the younger group and 86 (23.2%) were in the older group. The rates of stages (IIIB, IV) were similar in the elderly and younger groups. At the time of diagnosis, poor performance status, comorbidity, weight loss, anemia, and smoking status were more effective prognostic factors for elderly cases than younger ones. The treatment responses were also significantly different between the two age groups when the presenting symptom was weight loss: 18.7% of the younger group had progressive disease compared with 57.1% of the older group (P = 0.017). CONCLUSION: We concluded that treatment responses of the younger group were less affected by weight loss. These analyses suggest that weight loss at presentation can be useful in predicting disease response in patients with advanced stage elderly NSCLC.

Evaluation of pulmonary hydatid cyst cases.

BACKGROUND: The incidence of pulmonary hydatid cyst has been high in developing countries such as Turkey. OBJECTIVE: The aim of this study was to evaluate the clinical presentation, treatment and outcomes of pulmonary hydatid cyst disease at a tertiary centre. METHODS: A total of 138 patients, aged between 9 and 72 years with pulmonary hydatid cyst were diagnosed between 2000 and 2008 in 2nd thoracic surgery clinic at our hospital. Clinical characteristics of patients, epidemiological features, cyst diameters and localizations, laboratory findings, surgical approaches were recorded and analyzed. RESULTS: The most frequent symptoms of pulmonary hydatid cyst were chest pain and cough (44.9%, 37.6%). According to cyst size, there was no difference between younger than twenty and older age groups (p>0.05). Twenty-two patients had complicated cyst cases. Most of them were symptomatic (90.9%). Association of complicated cyst with hepato-pulmonary involvement was significantly higher as compared with single hydatid cyst (p=0.01). Cystectomy was performed in 84.05% of patients and post-operative mortality was seen in only one patient due to pulmonary embolism. CONCLUSION: Association of lung and liver hydatid cyst increased the risk of occurrence of a complicated pulmonary hydatid cyst. Choice of surgical approach had satisfactory results and post-operative mortality was low.