Validation of the Turkish Version of the Sarcoidosis Health Questionnaire: A cross-sectional study.

OBJECTIVE AND AIM:  Sarcoidosis, a multisystemic granulomatous disease, generally results in a lower quality of life (QoL) because of its unexpected course and diverse clinical symptoms. The Sarcoidosis Health Questionnaire (SHQ) evaluates the QoL for people with sarcoidosis in terms of their health. This study set out to validate the SHQ in a group of Turkish sarcoidosis patients. METHODS:  The study included a total of 146 adult sarcoidosis patients (63 male and 83 female; mean age, 44±3.6 years; range, 27-63 years) between May 2019 and September 2021. Preparation, forward translation, reconciliation, back translation/back translation review, harmonization, finalization, and proofreading comprised the steps of the testing procedure for translation and cultural adaptation. The participants filled out three questionnaires, including the SHQ, 36-Item Short Form (SF-36) Health Survey, and King's Sarcoidosis Questionnaire (KSQ), and underwent pulmonary function tests (PFTs). RESULTS:  Of the patients, 95% had lung involvement, with a mean number of 1.3 organs involved. Each SHQ component displayed a moderate to high internal consistency, ranging from 0.806 to 0.844. The whole scale's Cronbach's alpha value was 0.781. The SHQ total score significantly correlated with physical component summary (p< 0.001, r=0.360) and mental component summary (p<0.001, r=0.352) scores of SF-36, and the general health status (p< 0.001, r=0.478), medication component (p<0.001, r=0.456), and eye component scores of KSQ (p<0.001, r=0.545). When patients were divided into groups based on organ involvement (p=0.01), oral steroid medication (p<0.001), and types of symptoms (P=0.021), there were significant differences in the total SHQ scores. CONCLUSION:  The Turkish version of SHQ can be a valid and accurate instrument for assessing the health of sarcoidosis patients in Turkey. When combined with normal physiological, radiological, and serological examinations, SHQ can assess the QoL of sarcoidosis patients and give useful new information.

The utility of neutrophil-to-lymphocyte ratio determined at initial diagnosis in predicting disease stage and discriminating between active and stable disease in patients with sarcoidosis: a cross-sectional study.

OBJECTIVE: To evaluate the utility of neutrophil-lymphocyte ratio (NLR) determined at initial diagnosis in predicting advanced disease stage and discriminating between active and stable disease in sarcoidosis. METHODS: A total of 465 patients with biopsy-proven sarcoidosis (age: 47 years, 70.5% females) were included in this retrospective cross-sectional study. Data on patient demographics, sarcoidosis stage, clinical status (stable and active), anti-inflammatory treatments, complete blood count, and inflammatory markers including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR) and platelet/mean platelet volume (MPV) ratio were recorded. NLR values were compared by subgrouping the patients according to the stage of sarcoidosis and clinical status, while the receiver operating characteristics (ROC) curve was plotted to determine the role of NLR in the identification of disease activity with the calculation of area under the curve (AUC) and cutoff value via ROC analysis. RESULTS: Overall, active, and stable disease was evident in 36 (7.8%) and 427 (92.2%) patients, respectively. Median NLR values were significantly higher in patients with active disease compared with stable disease (3.31 (2.34-4.31) vs. 2.29 (1.67-3.23), p = 0.005). Advanced sarcoidosis stage was associated with significantly higher NLR values at stages 0, I, II, III and IV, respectively (p = 0.001). ROC analysis revealed an NLR cutoff value of ≥2.39 (AUC (95% CI): 0.70 (0.62-0.79), p < 0.001) to discriminate between active and stable clinic with a sensitivity of 72.0% and specificity of 52.0%. The significantly higher percentage of patients with active vs. stable disease had NLR values ≥2.39 (74.0 vs. 47.0%, p = 0.002). CONCLUSION: Our findings indicate the potential utility of on-admission NLR values to predict the risk of advanced disease stage and to discriminate between active and stable disease in sarcoidosis. Measured via a simple, readily available, and low-cost test, NLR seems to be a valuable marker for monitoring disease activity and progression.

Diagnosis distribution in cases with granulomatous inflammation in lung, pleura, and lymph node biopsies: an experience from a tertiary level single center chest diseases and thoracic surgery hospital.

BACKGROUND: Granulomatous inflammation is found in a wide range of diseases, and most commonly associated with sarcoidosis and tuberculosis. Granulomas are pathologically classified into two main groups; necrotic and non-necrotic. OBJECTIVES: The aim of this study was to evaluate the radiological, laboratory, and pathological findings of a large patient population with granuloma in biopsy samples, to determine the final diagnostic distribution. METHODS: This study was designed as a retrospective, descriptive, observational, cross-sectional study. It was conducted in patients with granulomatous inflammation detected in lung, pleural, mediastinal, hilar, and/or peripheral lymph node biopsies. Demographic information, radiological, microbiological, and laboratory results of the patients were obtained via the information processing system of the hospital. The diagnoses recorded were re-evaluated by at least two experienced clinicians and the final diagnosis distributions were made. RESULTS: A total of 392 patients were included in the study. Non-necrotizing inflammation was detected in 268 patients, and necrotizing granulomatous inflammation was found in 124 patients. The most common cause of non-necrotizing inflammation was sarcoidosis, and tuberculosis in the case of necrotizing inflammation. A total of 77.2% of sarcoidosis patients had non-necrotizing inflammation and 54.3% of the tuberculosis patients had necrotizing inflammation. In the diagnosis distribution of granulomatous inflammation sarcoidosis, mycobacterium infections (especially tuberculosis), sarcoid reaction due to malignancy, pneumoconiosis, granulomatosis with polyangiitis and hypersensitivity pneumonitis were detected, respectively. A total of 392 patients were diagnosed with 13 different diseases. In 15 patients (3.8%) no specific diagnosis could be made. CONCLUSIONS: The diagnosis of granulomatous inflammation detected in biopsy samples is common for clinicians and a differential diagnosis is difficult in many cases. A patient's clinical findings, laboratory results, and radiological appearance, should be evaluated in detail and a final diagnosis only made following a multidisciplinary discussion. The presence of necrosis in tissue samples alone is not a reliable finding for a final diagnosis.

IGFBP-4: A promising biomarker for lung cancer.

Background: Insulin-like growth factor binding protein-4 (IGFBP-4), a member of the insulin-like growth factor (IGF) family, transports, and regulates the activity of IGFs. The pregnancy-associated plasma protein-A (PAPP-A) has proteolytic activity towards IGFBP-4, and both proteins have been associated with a variety of cancers, including lung cancer. Thus, we aimed to evaluate the use of IGFBP-4 and PAPP-A as potential biomarkers for lung cancer. Methods: Eighty-three volunteers, including 60 patients with lung cancer and 23 healthy individuals, were included in this study. The patients with lung cancer were selected based on their treatment status, histological subgroup, and stage of the disease. Enzyme-linked immunosorbent assays were used to assess the serum levels of IGFBP-4 and PAPPA, whereas the IGF-1 levels were measured using a chemiluminescent immunometric assay. Results: The serum IGFBP-4 levels in all patient groups, regardless of the treatment status and histological differences, were significantly higher than those in the control group (p<0.005). However, the serum PAPP-A levels in the untreated patient group were found to be higher than those in the control group, but this difference was not statistically significant (p=0.086). Conclusions: The serum PAPP-A and IGFBP-4 levels are elevated in lung cancer. However, IGFBP-4 may have better potential than PAPP-A as a lung cancer biomarker.

The Relationship between COVID-19 Severity and Bacillus Calmette-Guérin (BCG)/ Mycobacterium tuberculosis exposure history in healthcare workers: a multi-center study.

The COVID-19 pandemic has brought countries' health services into sharp focus. It was drawn to our group's attention that healthcare workers (HCWs) had a lower mortality rate against higher COVID-19 incidence compared to the general population in Turkey. Since risk of exposure to tuberculosis bacillus among healthcare workers are higher than the population, we aimed to investigate if there is a relationship between BCG and Mycobacterium tuberculosis exposure history with COVID-19 severity in infected HCWs. This study was conducted with 465 infected HCWs from thirty-three hospitals to assess the relationship between COVID-19 severity (according to their hospitalization status and the presence of radiological pneumonia) and BCG and Mycobacterium tuberculosis exposure history. HCWs who required hospital admission had significantly higher rates of chronic diseases, radiological pneumonia, and longer working hours in the clinics. Higher rates of history of contact and care to tuberculosis patients, history of tuberculosis, and BCG vaccine were observed in hospitalized HCWs. HCWs who had radiological pneumonia had a significantly increased ratio of history of care to tuberculosis patients and a higher family history of tuberculosis. The findings from our study suggest that the lower mortality rate despite the more severe disease course seen in infected HCWs might be due to frequent exposure to tuberculosis bacillus and the mortality-reducing effects of the BCG vaccine.

Validity and Reliability of Turkish Version of Reaction Type Scale Against COPD.

OBJECTIVE: The aim of the study is to develop a scale that could assess illness perception and reaction in patients with chronic obstructive pulmonary disease (COPD). MATERIAL AND METHODS: The study was conducted in patients who were admitted in the pulmonary disease departments of a public and a private hospital. The study included 271 COPD patients. The COPD Perception and Reaction Scale, consisting of 54 items, was prepared as a Likert-type 5-point rating scale. In the validity phase of the study, expert judgments were obtained for content validity, and explanatory and confirmatory factor analyses (EFA and CFA) were then performed. The reliability of the scale in terms of internal consistency was tested with the Cronbach's alpha coefficient. RESULTS: According to the results of the EFA, the COPD Perception and Reaction Scale consists of 3 subdimensions and 23 items. Factors are termed behavioral reaction, emotional reaction, and spiritual reaction. According to the CFA, the goodness-of-fit indices obtained (χ2/df = (676.47/227) 2.98 and RMSEA = 0.056, NFI = 0.80, CFI = 0.96, NFI = 0.91, and AGFI = 0.85) suggest that the recommended model for the scale is acceptable. The Cronbach's alpha coefficient was 0.74; Cronbach's alpha values for the subdimensions were calculated as 0.87 for "emotional reaction," 0.76 for "behavioral reaction," and 0.79 for "spiritual reaction." CONCLUSION: The 23-item form of the COPD Illness Perception and Reaction Scale was demonstrated to be a valid and reliable scale for determining the perception and the reaction toward illness in COPD patients in Turkey.

Can the Usage of the Chest X-Ray Scoring During Hospitalization in Patients with COVID-19 Predict the Severity of the Disease?

OBJECTIVE: The prevalence of radiological involvement is considered a poor prognostic factor for coronavirus disease 2019 (COVID- 19). In our study, we aimed to investigate the threshold value of the chest X-ray (CXR) score, which would require the patient to be transferred to the intensive care unit (ICU) through scoring the CXR of COVID-19 patients receiving in-patient treatment. MATERIAL AND METHODS: The patients that tested positive for COVID-19 on the basis of the polymerase chain reaction (PCR) test, who was hospitalized in our hospital between the dates of March 15 and May 30, 2020, were included in the study. The CXRs of these patients taken during hospitalization were scored. The threshold value of the CXR score of the patients transferred to the ICU was calculated. Patients were grouped according to the threshold value of the CXR score, and demographic data and other recorded parameters were compared. RESULTS: A total of 301 patients were included in this retrospective cross-sectional study. It was determined that finding of a CXR score threshold value of 5 or above during hospitalization predicted a transfer to the ICU with 90% sensitivity and 80% specificity. The use of broad-spectrum antibiotics, the laboratory parameters (leukocyte, neutrophil, C-reactive protein (CRP), procalcitonin, troponin, D-dimer, ferritin), and rate of transfer to ICU were found to be significantly higher in the group with a CXR score of 5 and above, compared to the group with CXR score below 5 (P < .001 in each). CONCLUSION: Finding high CXR scores during hospitalization due to COVID-19 may act as a warning in terms of the severity of the disease. It may be beneficial to examine the chest X-ray images during hospitalization with utmost care and take these images into account.

Use of Radiology, D-Dimer, and Mean Platelet Volume Combination as a Prognostic Marker in Hospitalized Coronavirus Disease-19 Patients.

INTRODUCTION: The search for biomarkers that could help in predicting disease prognosis in the Coronavirus Disease-2019 (COVID-19) outbreak is still high on the agenda. OBJECTIVE: To find out the efficacy of D-dimer and mean platelet volume (MPV) combination as a prognostic marker in hospitalized COVID-19 patients with bilateral infiltration. MATERIALS AND METHODS: Study design: Retrospective observational cohort. Patients who were presented to our hospital between March 16, 2020 and June 07, 2020 were reviewed retrospectively. The primary outcome of the study was specified as the need for intensive care, while the secondary outcomes were duration of treatment and hospitalization. Receiver operator curve (ROC) analyzes were carried out to assess the efficacy of D-dimer and MPV parameters as prognostic markers. RESULTS: Between the mentioned dates, 575 of 1,564 patients were found to be compatible with COVID-19, and the number of patients who were included in the study was 306. The number of patients who developed the need for intensive care was 40 (13.1%). For serum D-dimer levels in assessing the need for intensive care, the area under the curve (AUC) was found to be 0.707 (95% CI: 0.620-0.794). The AUC for MPV was 0.694 (95% CI: 0.585-0.803), when D-dimer was ≥1.0 mg/L. When patients with a D-dimer level of ≥1.0 mg/L were divided into two groups considering the MPV cut-off value as 8.1, the rate of intensive care transport was found to be significantly higher in patients with an MPV of ≥8.1 fL compared to those with an MPV of <8.1 fL (32.6 vs. 16.0%, p = 0.043). For the prognostic efficacy of the combination of D-dimer ≥ 1.0 mg/L and MPV ≥ 8.1 fL in determining the need for intensive care, following values were determined: sensitivity: 57.7%, specificity: 70.8%, positive predictive value (PPV): 32.0%, negative predictive value (NPV): 84.0%, and accuracy: 63.0%. When D-dimer was ≥1.0, the median duration of treatment in MPV <8.1 and ≥8.1 groups was 5.0 [interquartile range (IQR): 5.0-10.0] days for both groups (p = 0.64). The median length of hospital stay (LOS) was 7.0 (IQR: 5.0-10.5) days in the MPV <8.1 group, while it was 8.5 (IQR: 5.0-16.3) days in the MPV ≥ 8.1 group (p = 0.17). CONCLUSION: In COVID-19 patients with a serum D-dimer level of at least 1.0 mg/L and radiological bilateral infiltration at hospitalization, if the MPV value is ≥8.1, we could predict the need for intensive care with moderate efficacy and a relatively high negative predictive value. However, no correlation could be found between this combined marker and the duration of treatment and the LOS.