Determining factors affecting the acceptability of spirometry: A survey study in a tertiary chest diseases center.

Introduction: Unlike other laboratory tests, spirometry requires the participant's full compliance with the maneuvers in the test for an acceptable test result. In this study, we aimed to determine the suitability of spirometric tests regarding acceptability and the factors associated with acceptability. Materials and Methods: Before the test, our 15-scale questionnaire, prepared by us in the respiratory function laboratory, was applied to the participants who requested spirometric examination in our hospital. Afterwards, patients were subjected to spirometric analysis. Spirogram results of the participants were evaluated by four clinicians who were experts in the field based on the acceptability criteria in the American Thoracic Society and European Respiratory Society Spirometry Standardization Guidelines. Participants were divided into two groups as those who met the acceptability criteria and those who did not. Both groups were compared regarding demographic data, comorbidities, education levels, and questions in the questionnaire. Results: The acceptability spirometry rate was 71.2%. The most common error among those who could not perform an acceptable test was the inability to complete the expiratory time to the time that would create a plateau, with 37.3%. Education level and acceptability of spirometry were not related (p= 0.228). Asthma was statistically significantly higher in the group that performed acceptable spirometry (p= 0.049). Acceptable spirometry rate was statistically significantly higher in the participants who had previously performed spirometric tests compared to the other group (p< 0.001). The test success of the participants who did not have success anxiety about the test was significantly higher than the other group (p= 0.033). Conclusion: Reduction of participants' anxiety and repetitive testing increases test acceptability. For this reason, in our clinical practice, we recommend that people who want a spirometry test relieve their anxiety about the test and repeat the test in unacceptable tests.

The impact of charlson comorbidity index on mortality from SARS-CoV-2 virus infection and A novel COVID-19 mortality index: CoLACD.

OBJECTIVE: The aim of this study is to find out the potential risk factors including charlson comorbidity index (CCI) score associated with death in COVID-19 patients hospitalised because of pneumonia and try to find a novel COVID-19 mortality score for daily use. METHODS: All patients diagnosed as confirmed or probable COVID-19 pneumonia whom hospitalised in our Chest Diseases Education and Research Hospital between March 11, 2020 and May 15, 2020 were enrolled. The optimal cut-off values, sensitivity and specificity values and odds ratios to be used in mortality prediction of the novel scoring system created from these parameters were calculated by ROC analysis according to the area under the curve and Youden index. RESULTS: Over 383 patients (n: 33 deceased, n: 350 survivors) univariate and multivariate regression analysis showed that CCI and lymphocyte ratio were prognostic factors for COVID-19-related mortality. Using this analysis, a novel scoring model CoLACD (CoVID-19 Lymphocyte ratio, Age, CCI score, Dyspnoea) was established. The cut-off value of this scoring system, which determines the mortality risk in patients, was 2.5 points with 82% sensitivity and 73% specificity (AUC = 0.802, 95% CI 0.777-0.886, P < .001). The risk of mortality was 11.8 times higher in patients with a CoLACD mortality score higher than 2.5 points than patients with a score lower than 2.5 (OR = 11.8 95% CI 4.7-29.3 P < .001). CONCLUSION: This study showed that by using the CoLACD mortality score, clinicians may achieve a prediction of mortality in COVID-19 patients hospitalised for pneumonia.

A promising tool for T-staging of lung cancer: Is convex probe endobronchial ultrasound superior to computed tomography in detecting invasion of mediastinal and hilar vessels?

BACKGROUND: In the present study, we aimed to compare performance of convex probe endobronchial ultrasound and computed tomography in detecting vascular invasion of mediastinal and hilar lesions. METHODS: Medical data of a total of 55 patients (47 males, 8 females; mean age 59.6±7.7 years; range, 29 to 76 years) who underwent convex probe endobronchial ultrasound for diagnosis and staging of lung cancer in a tertiary care hospital between May 2016 and December 2017 were retrospectively analyzed. The presence of vascular invasion was determined according to two main criteria: visualization of the tumor tissue within the vessel lumen and loss of vessel-tumor hyperechoic interface. All available contrast enhanced computed tomography images were retrospectively re-evaluated by a blinded radiologist. The intra-rater agreement between convex probe endobronchial ultrasound and computed tomography was analyzed. The sensitivity, specificity, positive and negative predictive values, and accuracy of both modalities were calculated. RESULTS: A total of 65 vessel-tumor interface areas of 55 patients were analyzed. Almost all mediastinal and hilar vascular structures including pulmonary arteries and veins, aorta, superior vena cava and its branches, and left atrium with pulmonary veno-atrial junctions could be easily assessed by convex probe endobronchial ultrasound. The intra-agreement of both modalities in detecting vascular invasion was k=0.268 (p=0.028). In nine patients with a surgical confirmation, the sensitivity, specificity, positive and negative predictive values, and accuracy values were 100%, 33.3%, 75.0%, 100%, and 77.7%, respectively for convex probe endobronchial ultrasound and 66.6%, 33.3%, 66.6%, 33.3%, and 55.5%, respectively for computed tomography. CONCLUSION: Convex probe endobronchial ultrasound can be used to detect vascular invasion alone or in conjunction with contrast-enhanced computed tomography. Hence, a T4 lesion would be better differentiated from T3 in clinical staging of lung cancer.