The role of lung ultrasound and ultrasound elastography in diagnosis of interstitial lung diseases.

Introduction: Ultrasound elastography (US-E) is a novel, tissue stiffness-sensitive imaging method. We aimed to investigate whether lung ultrasound (US) and US-E can play a role in diagnosing interstitial lung diseases (ILDs) in which lung elasticity is affected due to fibrosis. Materials and Methods: A prospective cohort study. Patients with ILD were defined as ''ILD group'' and with other pulmonary diseases as ''control group". All subjects were examined and compared by lung US in B and elastography modes. Besides, the relationship between ultrasonography and high-resolution computerized tomography (HRCT) and chest X-ray findings was evaluated. Result: A total of 109 patients, 55 in ILD and 54 in the control group, with a mean age of 62 ± 14 years, were included. A positive correlation was found between the Warrick score (calculated from HRCT to determine the severity of ILD) and the number of B-lines (discrete vertical reverberation artifacts, indicating interstitial lung syndrome) in lung US (p= 0.001, r= 0.550) in the ILD group. In US-E, blue color (meaning more rigid tissue) dominated in the ILD group, and green color (indicating medium tissue stiffness) dominated in the control group (p= 0.001). Lung US diagnosed the ILD with 69% accuracy, 80% sensitivity, and 60% specificity compared to HRCT. Combined with chest X-ray, diagnostic accuracy was 74%, sensitivity 60%, and specificity 89%. Conclusions: Although lung US and US-E are not superior to gold standard HRCT in diagnosing ILDs, they can still be accepted as promising, novel, noninvasive tools, especially when combined with chest X-rays. Their role still needs to be clarified with further studies.

Can the ADO Index Be Used as a Predictor of Mortality from COVID-19 in Patients with COPD?

Background: Several studies have shown that the risk of mortality due to COVID-19 is high in patients with COPD. However, evidence on factors predicting mortality is limited. Research Question: Are there any useful markers to predict mortality in COVID-19 patients with COPD?. Study Design and Methods: A total of 689 patients were included in this study from the COPET study, a national multicenter observational study investigating COPD phenotypes consisting of patients who were followed up with a spirometry-confirmed COPD diagnosis. Patients were also retrospectively examined in terms of COVID-19 and their outcomes. Results: Among the study patients, 105 were diagnosed with PCR-positive COVID-19, and 19 of them died. Body mass index (p= 0.01) and ADO (age, dyspnoea, airflow obstruction) index (p= 0.01) were higher, whereas predicted FEV1 (p< 0.001) and eosinophil count (p= 0.003) were lower in patients who died of COVID-19. Each 0.755 unit increase in the ADO index increased the risk of death by 2.12 times, and each 0.007 unit increase in the eosinophil count decreased the risk of death by 1.007 times. The optimum cut-off ADO score of 3.5 was diagnostic with 94% sensitivity and 40% specificity in predicting mortality. Interpretation: Our study suggested that the ADO index recorded in the stable period in patients with COPD makes a modest contribution to the prediction of mortality due to COVID-19. Further studies are needed to validate the use of the ADO index in estimating mortality in both COVID-19 and other viral respiratory infections in patients with COPD.

Comparison of the muscle oxygenation during submaximal and maximal exercise tests in patients post-coronavirus disease 2019 syndrome with pulmonary involvement.

INTRODUCTION: Pulmonary involvement is prevalent in patients with coronavirus disease 2019 (COVID-19). Arterial hypoxemia may reduce oxygen transferred to the skeletal muscles, possibly leading to impaired exercise capacity. Oxygen uptake may vary depending on the increased oxygen demand of the muscles during submaximal and maximal exercise. OBJECTIVE: This study aimed to compare muscle oxygenation during submaximal and maximal exercise tests in patients with post-COVID-19 syndrome with pulmonary involvement. METHODS: Thirty-nine patients were included. Pulmonary function (spirometry), peripheral muscle strength (dynamometer), quadriceps femoris (QF) muscle oxygenation (Moxy® device), and submaximal exercise capacity (six-minute walk test (6-MWT)) were tested on the first day, maximal exercise capacity (cardiopulmonary exercise test (CPET)) was tested on the second day. Physical activity level was evaluated using an activity monitor worn for five consecutive days. Cardiopulmonary responses and muscle oxygenation were compared during 6-MWT and CPET. RESULTS: Patients' minimum and recovery muscle oxygen saturation were significantly decreased; maximum total hemoglobin increased, heart rate, blood pressure, breathing frequency, dyspnea, fatigue, and leg fatigue at the end-of-test and recovery increased in CPET compared to 6-MWT (p < .050). Peak oxygen consumption (VO2peak) was 18.15 ± 4.75 ml/min/kg, VO2peak; percent predicted < 80% was measured in 51.28% patients. Six-MWT distance and QF muscle strength were less than 80% predicted in 58.9% and 76.9% patients, respectively. CONCLUSIONS: In patients with post-COVID-19 syndrome with pulmonary involvement, muscle deoxygenation of QF is greater during maximal exercise than during submaximal exercise. Specifically, patients with lung impairment should be evaluated for deoxygenation and should be taken into consideration during pulmonary rehabilitation.

Risk factors for post-acute sequelae of COVID-19 in hospitalized patients: An observational study based on a survey in a tertiary care center in Türkiye.

Introduction: Long COVID is a multisystem disease with various symptoms and risk factors. We aim to investigate the post-acute sequelae of COVID-19 and related risk factors in a tertiary care center. Materials and Methods: In this observational study, based on a survey of 1.977 COVID-19 patients hospitalized from April 2020 to January 2021, a retrospective assessment was carried out on 1.050 individuals who were reachable via telephone to determine their eligibility for meeting the inclusion criteria. Results: The data of 256 patients who reported at least one persistent symptom were analyzed. Long COVID prevalence was 24.3%. Among 256 patients (median age 52.8; 52.7% female; 56.63% had at least one comorbidity), dyspnea, fatigue, arthralgia-myalgia, cough, and back pain were the most common post-acute sequelae of COVID-19 (42.4%; 28.29%; 16.33%; 13.15% and 7.17%, respectively). The risk factors for the persistence of dyspnea included having lung diseases such as chronic obstructive pulmonary disease, a history of intensive care support, the requirement for long-term oxygen therapy, and a history of cytokine storm (p= 0.024, p= 0.026, p< 0.001, p= 0.036, p= 0.005, respectively). The correlation between lung involvement with post-discharge cough (p= 0.041) and dizziness (p= 0.038) was significant. No correlation between the symptoms with the severity of acute infection, age, and gender was found. When a multivariate regression analysis was conducted on the most common long COVID-related symptoms, several independent risk factors were identified. These included having lung disease for dyspnea (OR 5.81, 95% CI 1.08-31.07, p= 0.04); length of hospital stay for myalgia (OR 1.034, 95% CI 1.004-1.065, p= 0.024); and pulmonary involvement of over 50% during COVID-19 infection for cough (OR 3.793, 95% CI 1.184-12.147, p= 0.025). Conclusion: COVID-19 survivors will require significant healthcare services due to their prolonged symptoms. We hope that our findings will guide the management of these patients in clinical settings towards best practices.

Granulomatous Mediastinitis: A Rare Cause of Pulmonary Hypertension.

A rare case of a patient with chronic obstructive pulmonary disease who developed secondary anthracofibrosis to biomass exposure, fibrosing mediastinitis due to anthracotic enlarged lymph nodes in the mediastinum, and pulmonary hypertension because of compres- sion of the lymph nodes on the pulmonary arteries is presented. This is a case report of a 71-year-old female patient who has been followed up with chronic obstructive pulmonary disease for 10 years, has no history of smoking, and has been exposed to biomass for many years. The patient, who had been hospitalized in various centers for the last 3 years due to progressive shortness of breath and dry cough, applied to us with dry cough and dyspnea complaints. On echocardiography, systolic pulmonary arterial pressure was found to be 59 mmHg. For the etiology of pulmonary hypertension, dual-energy thoracic computed tomography was performed with the suspicion of chronic thromboembolic pulmonary hypertension. No filling defect compatible with thromboembolism was detected. In right heart catheterization, mean pulmonary artery pressure was 27 mmHg, pulmonary capillary tip pressure was 7 mmHg, and pulmonary vascular resistance was 3.71 woods units. Endobronchial ultrasound was applied to the patient with the preliminary diagnoses of lymphoma, anthracosis, fibrosing mediastinitis, and infection. Widespread anthracosis was observed in all lobes and segments macroscopically. The lymph node in the subcarinal area was interpreted as anthracotic lymph node. Anthracosis is defined as black pigmentation involving the mucosal, and submucosal layers of the tracheobronchial tree and the lung parenchyma. If anthracosis is associated with luminal obliteration and/or mucosal proliferation causing obstruction, it is considered anthracofibrosis. In this case, we saw that secondary anthracofibrosis, fibrosing mediastinitis due to anthracotic enlarged lymph nodes in the mediastinum, and pulmonary hypertension may develop because of compression of the lymph nodes on the pulmonary arteries, and we wanted to draw attention to it was a rare case.

Elderly idiopathic pulmonary fibrosis patients remain on therapy despite higher incidence of adverse events and dose reductions.

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) predominantly affects people over the age of 60 years and its incidence increases with age. Limited data is available on the use of antifibrotics in the elderly IPF population. We aimed to examine the tolerability and safety of antifibrotics (pirfenidone, nintedanib) in elderly patients with IPF in a real-world setting. METHODS: Medical records of 284 elderly (≥75 years) and 446 non-elderly IPF patients (<75 years) were retrospectively analyzed in this multi-center study. Patient characteristics, treatments, adverse events (AEs), tolerability, hospitalizations, exacerbations, and mortality were compared between the elderly and non-elderly group. RESULTS: In the elderly group, the mean age was 79 years and the mean antifibrotic treatment duration was 26.1 months. The most commonly reported AEs were weight loss, loss of appetite and nausea. Elderly IPF patients had a significantly higher incidence of AEs (62.9% vs. 55.1%, p = 0.039) and dose reductions (27.4% vs. 18.1%, p = 0.003) than the non-elderly did, but the rate of discontinuation of antifibrotics was not different between groups (13% vs. 10.8%, p = 0.352). In addition, the severity of the disease, frequency of hospitalizations, exacerbations, and mortality rates were higher in elderly patients. CONCLUSION: The present study showed that elderly IPF patients experienced significantly increased AEs and dose reductions due to antifibrotic use, while the discontinuation rates of the drugs were similar to those of drugs used by non-elderly patients.

Oxidized Regenerated Cellulose can be a Cause of False Tumor Recurrence on PET/CT in Patients with Lung Cancer Treated Surgically.

Objectives: Regular follow-up of patients with lung cancer treated surgically is crucial to detect local recurrence or distant metastasis of the tumor. Postoperative follow-ups are performed with thorax computed tomography (CT) and, if necessary, positron emission tomography (PET)/CT. Sometimes, inflammatory tissue reactions due to the materials used during the surgery for hemostasis may cause the appearance of tumor recurrence in imaging modalities. In this study, we presented that oxidized regenerated cellulose (ORC) used intraoperatively may cause false tumor recurrence on PET/CT. Methods: The records of patients who had local tumor recurrence after lung cancer surgery was reviewed retrospectively. Inclusion criteria were the presence of local recurrence of cancer on PET/CT, specification of using ORC in the surgical notes, and histopathological diagnosis of the recurrence site of tumor was reported as a foreign body reaction. Data of patients were collected according to age, gender, surgery performed, adjuvant therapy status, resolution status and time ORC, and standard uptake value of 18F-fluorodeoxyglucose on PET/CT. Results: Eleven patients (1 female, 10 males) who met the criteria were included in the study. The median age was 64. Histopathological results of all patients were reported as foreign body reactions. The median detection time of PET/CT positivity after surgery was 139 days (range: 52-208 days). False tumor recurrence was resolved in 8 patients (72.7%) in their control radiological examinations and median resolution time was 334 days (range: 222-762 days). The median maximum standard uptake value of the lesions was 6.2 (1.7-11) on the PET/CT. Conclusion: ORC used intraoperatively in patients undergoing surgery for lung cancer may cause false tumor recurrence in imaging modalities in postsurgical follow-ups. When tumor recurrence is suspected in the follow-up of these patients, histopathological confirmation is necessary to prevent unnecessary operations and treatments.

Chronic obstructive pulmonary disease phenotypes in Turkey: the COPET study-a national, multicenter cross-sectional observational study.

BACKGROUND: While mortality rates decrease in many chronic diseases, it continues to increase in COPD. This situation has led to the need to develop new approaches such as phenotypes in the management of COPD. We aimed to investigate the distribution, characteristics and treatment preference of COPD phenotypes in Turkey. METHODS: The study was designed as a national, multicenter, observational and cross-sectional. A total of 1141 stable COPD patients were included in the analysis. RESULTS: The phenotype distribution was as follows: 55.7% nonexacerbators (NON-AE), 25.6% frequent exacerbators without chronic bronchitis (AE NON-CB), 13.9% frequent exacerbators with chronic bronchitis (AE-CB), and 4.8% with asthma and COPD overlap (ACO). The FEV1 values were significantly higher in the ACO and NON-AE than in the AE-CB and AE NON-CB (p < 0.001). The symptom scores, ADO (age, dyspnoea and FEV1 ) index and the rates of exacerbations were significantly higher in the AE-CB and AE NON-CB phenotypes than in the ACO and NON-AE phenotypes (p < 0.001). Treatment preference in patients with COPD was statistically different among the phenotypes (p < 0.001). Subgroup analysis was performed in terms of emphysema, chronic bronchitis and ACO phenotypes of 1107 patients who had thoracic computed tomography. A total of 202 patients had more than one phenotypic trait, and 149 patients showed no features of a specific phenotype. DISCUSSION: Most of the phenotype models have tried to classify the patient into a certain phenotype so far. However, we observed that some of the patients with COPD had two or more phenotypes together. Therefore, rather than determining which phenotype the patients are classified in, searching for the phenotypic traits of each patient may enable more effective and individualized treatment.

Evaluation of Exudative Pleural Effusions: A Multicenter, Prospective, Observational Study.

PURPOSE: The aim of this study is to determine the diagnostic performances of pleural procedures in undiagnosed exudative pleural effusions and to evaluate factors suggestive of benign or malignant pleural effusions in tertiary care centers. METHODS: This was a multicenter prospective observational study conducted between January 1 and December 31, 2018. A total of 777 patients with undiagnosed exudative pleural effusion after the initial work-up were evaluated. The results of diagnostic procedures and the patients' diagnoses were prospectively recorded. Sensitivity, specificity, and accuracy estimates with 95% confidence intervals were used to examine the performance of pleural procedures to detect malignancy. RESULTS: The mean age ± SD of the 777 patients was 62.0 ± 16.0 years, and 68.3% of them were male. The most common cause was malignancy (38.3%). Lung cancer was the leading cause of malignant pleural effusions (20.2%). The diagnostic sensitivity and accuracy of cytology were 59.5% and 84.3%, respectively. The diagnostic sensitivity of image-guided pleural biopsy was 86.4%. The addition of image-guided pleural biopsy to cytology increased diagnostic sensitivity to more than 90%. Thoracoscopic biopsy provided the highest diagnostic sensitivity (94.3%). The highest diagnostic sensitivity of cytology was determined in metastatic pleural effusion from breast cancer (86.7%). CONCLUSION: The diagnostic performance increases considerably when cytology is combined with image-guided pleural biopsy in malignant pleural effusions. However, to avoid unnecessary interventions and complications, the development of criteria to distinguish patients with benign pleural effusions is as important as the identification of patients with malignant pleural effusions.

Anxiety and depression levels of healthcare workers during Covid-19 pandemic.

Background: Coronavirus disease 2019 (covid-19), which causes a pandemic in the world, has started to appear in turkey since march 2020. Healthcare workers are at the top of the groups most at risk for covid-19 infection, which can have a negative impact on psychological state. Objectives: It was aimed to evaluate anxiety and depression levels among healthcare workers. Methods: this cross-sectional study performed via an online survey in april 2020. Participants answered questions about sociodemographic features, personal views and experiences about covid-19 and the hospital anxiety and depression scale (hads). Results: A total of 300 healthcare workers,193 men and 107 women, participated in the survey. According to hads, 44.6% of participants scored above anxiety and 68.2% scored above depression cut-off points. Being younger than 50 and taking care of covid-19 patients in hospitals were independently associated with anxiety risk. Female gender, young age (less than 50) and having comorbidity were independent risk factors for depression. Conclusion: Healthcare workers were at high risk of anxiety and depression during covid-19 outbreak. For this reason, psychological support should be given, especially to the group with high risk.

Comparison of the diagnostic efficacy and complications of transbronchial biopsy in elderly and young patients.

INTRODUCTION: Among bronchoscopic procedures, transbronchial biopsy (TBB) is considered a high-risk procedure. In this study, we aimed to investigate the indications, diagnostic efficacy and complications of TBB in the elderly, which is accepted as a sensitive group. MATERIALS AND METHODS: The study was designed as a multicenter retrospective observational study. Data of 4226 patients who underwent diagnostic bronchoscopy were scanned for this study. 791 patients who underwent transbronchial biopsy were included in this study. All patients were evaluated in terms of lung regions, diagnosis, and complications. RESULT: A total of 791 patients, 329 (41.6%) female patients, who underwent TBB were included in the study. Mean age of the patients was 54.54 ± 14.94 years. The most common indications were ILD (45.6%), malignancy (24.0%) and sarcoidosis (9.9%). Mean age of the elderly patients (n= 263) was 69.89 ± 4.83 years, and mean age of the young patients (n= 528) was 46.90 ± 11.28 years (p<0.001). In both age groups, the most common indication was ILD. Complications developed during and after the procedure in 51 of the young patients (9.7%) and in 21 of the elderly (8.0%) (p= 0.441). The most common complication was pneumothorax with 4.6% in the elderly, and pneumothorax with 5.9% in the young (p= 0.441). The most common diagnosis was malignancy (12.2%) in the elderly, as the most common diagnosis was malignancy (7.2%) in the young (p = 0.020). While anthracosis, ILD and organized pneumonia were the other common diagnoses in the elderly, sarcoidosis, anthracosis and organized pneumonia were the other common diagnoses in the young. The diagnosis of sarcoidosis was achieved more frequently in the young (6.6%) than in the elderly (0.8%) (p<0.001). CONCLUSIONS: Transbronchial biopsy can be performed safely in elderly patients, with similar diagnostic success and complication rates to younger patients.

Relationship between chest computed tomography findings and clinical conditions of coronavirus disease (COVID-19): A multicentre experience.

AIMS: This study aimed to investigate the clinical and chest computed tomography (CT) features associated with clinical parameters for coronavirus disease (COVID-19) in the capital of Turkey, Ankara. MATERIALS AND METHODS: Epidemiological, clinical features, laboratory findings and radiological characteristics of 1563 hospitalised patients with COVID-19 in Ankara were collected, reviewed and analysed in this study. The risk factors associated with disease severity were investigated. RESULTS: Non-severe (1214; 77.7%) and severe cases (349; 22.3%) were enrolled in the study. Compared with the non-severe group, the severe group were significantly older and had more comorbidities (ie, hypertension, diabetes mellitus, cardiovascular disease and chronic kidney disease). Smoking was more common in the severe group. Severe patients had higher respiratory rates and higher incidences of cough and dyspnoea compared with non-severe patients. Compared with the non-severe patients, the severe patients had increased C-reactive protein (CRP), procalcitonin, neutrophil to lymphocyte ratio (NLR) and CRP/albumin ratio and decreased albumin. The occurrence rates of consolidation, subpleural sparing, crazy-paving pattern, cavity, halo sign, reversed halo sign, air bronchogram, pleural thickening, micronodule, subpleural curvilinear line and multilobar and bilateral involvement in the CT finding of the severe patients were significantly higher than those of the non-severe patients. CONCLUSIONS: Many factors are related to the severity of COVID-19, which can help clinicians judge the severity of the patient and evaluate the prognosis. This cohort study revealed that male sex, age (≥55 years), patients with any comorbidities, especially those with cardiovascular disease, dyspnoea, increased CRP, D-dimer and NLR, and decreased lymphocyte count and CT findings of consolidation and multilobar involvement were predictors of severe COVID-19.

Effect of Asbestos Exposure on the Frequency of EGFR Mutations and ALK/ROS1 Rearrangements in Patients With Lung Adenocarcinoma: A Multicentric Study.

OBJECTIVE: The aim of this study is to investigate the effect of asbestos exposure on cancer-driver mutations. METHODS: Between January 2014 and September 2018, epidermal growth factor receptor (EGFR), anaplastic lymphoma receptor tyrosine kinase (ALK), and c-ros oncogene 1 receptor tyrosine kinase gene (ROS1) alterations, demographic characteristics, asbestos exposure, and asbestos-related radiological findings of 1904 patients with lung adenocarcinoma were recorded. RESULTS: The frequencies of EGFR mutations, ALK, and ROS1 rearrangements were 14.5%, 3.7%, and 0.9%, respectively. The rates of EGFR mutations and ALK rearrangements were more frequent in asbestos exposed non-smokers (48.7% and 9%, respectively). EGFR mutation rate was correlated to female gender and not-smoking, ALK rearrangement rate was correlated to younger age, not-smoking, and a history of asbestos exposure. CONCLUSIONS: The higher rate of ALK rearrangements in asbestos-exposed lung adenocarcinoma cases shows that asbestos exposure may most likely cause genetic alterations that drive pulmonary adenocarcinogenesis.

Five-Year Trends in Direct Costs of Chronic Obstructive Pulmonary Disease in Turkey: COPDTURKEY-3.

OBJECTIVE: Chronic obstructive pulmonary disease (COPD) is one of the major causes of mortality and morbidity worldwide. The aim of this study was to reveal the trend in direct costs related to COPD between 2012 and 2016, and to evaluate hospital costs in 2016, together with their subcomponents. MATERIAL AND METHODS: A population-based descriptive study was conducted using administrative healthcare data in Turkey. The total direct cost of COPD diagnosis-treatment for each year from 2012 to 2016, was calculated. The distribution of the hospital's COPDrelated costs for the year 2016 was also examined, together with morbidity data. RESULTS: The direct costs of the patients who were admitted to step 1, step 2, and step 3 health care centers between 2012 and 2016 increased by 41% [895 041 403TL ($496 930 501) in 2012 to 1 263 288 269TL ($417 834 197) in 2016]; the increase was 60% and 24%, for inpatient and outpatient groups respectively. In the year 2016, the direct total cost was 1003TL ($332) per patient. In 2016, mean specialist consultations per patient with mean cost per specialist consultation, and mean emergency visits per patient with mean cost per emergency visit, were 1.7, 42 TL ($14), and 0.4, 71TL ($23) respectively. For the inpatient group, the mean number of hospitalizations per patient, mean number of hospitalization days, and the mean cost per hospitalization were 0.4, 6.5, and 1926TL ($637), respectively. CONCLUSION: When the readmissions of patients with COPD were evaluated together with the costs, and compared with the statistics from other countries, it was found that the costs per patient were lower in Turkey. However, the reasons for the significant rise in inpatient costs compared to outpatient costs should be investigated. Further investigations are required regarding pulmonary rehabilitation, home health care services, preventive measures for infections, management of comorbidities, and treatment optimization, which may reduce hospitalizations.

Is there any difference between oral preemptive pregabalin vs. placebo administration on response to EBUS-TBNA under sedation?

Background/aim: The aim of this study is to evaluate the effects of preemptive oral pregabalin on hemodynamic response, anxiety, sedation, and recovery in patients who underwent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) under sedation with intravenous ketamine-propofol combination. Materials and methods: Sixty patients were included in this study, and patients were randomly divided into two equal groups to receive the placebo (Group 1) versus pregabalin 150 mg (Group 2) one hour prior to EBUS- TBNA procedure. Patients received 0.25 mg kg-1 ketamine and 0.25 mg kg-1 propofol mixture (ketofol) for sedation. Timing of the parameters was defined as follows; T0: in hospital ward before pregabalin or placebo administration, T1: premedication, T2: in operating room, T3: before the procedure, T4: initiation, T5: 3 min after induction, T6: 6 min after induction, T7: 9 min after induction, and T8: 12 min after induction. Hemodynamic parameters, severity of coughing, sedation and anxiety scores, and complications were recorded. The level of satisfaction of the bronchoscopist and the patients were evaluated at the end of the procedure. Results: The heart rate and mean arterial pressure were significantly higher in Group 1 (P = 0.008, P = 0.04). Total doses of anesthetics, recovery time, and desaturation rate were significantly higher in Group 1 (P = 0.014, P = 0.001, P = 0.045). In Group 2, SpO2 level was significantly higher at various time periods (T1; P = 0.025, T4; P =0.043, T6; P = 0.001, T7; P = 0.003, T8; P < 0.001). The severity of coughing was found significantly lower in Group 2 (T4; P = 0.011, T5; P = 0.01, T6; P = 0.02, T7; P = 0.03, T8; P < 0.01). Anxiety scores were significantly lower in Group 2 (P < 0.001). Conclusion: Preemptive oral pregabalin, in addition to sedation with ketamine-propofol combination, was effective in providing limited hemodynamic response, restricted coughing reflex, and lower anxiety during EBUS-TBNA. Besides, with pregabalin usage, decreased anesthetics consumption, lower complication rate, and shorter recovery time might have contributed to safety of the procedure and comfort of the bronchoscopist.

The Clinical Impact of Re-biopsies in Lung Adenocarcinoma: a Retrospective Multicenter Study.

If a patient's cancer progresses while undergoing targeted therapy, a re-biopsy is not mandatory. But when evaluating the benefits and risks on a case-by-case basis (transformation to small cell, assessing for a clinical trial), physicians should inform patients about the possible need for a re-biopsy (5). This was a retrospective and multicentre study. A total of 644 patients with lung adenocarcinoma were reviewed, 625 of whom were ruled eligible. From them, 399 were found to show disease progression, and 126 re-biopsies were performed. Progression status, re-biopsy sites, success of obtaining adequate tissue, molecular patterns after re-biopsy and subsequent treatments were analysed. Survival differences among patients with disease progression were then examined according to re-biopsy status. Overall, 625 patients with adenocarcinoma and a median age of 61.4 were evaluated. Initial tyrosine kinase inhibitor (TKI) usage numbered 37 patients (5.9%). Progression was diagnosed in 399 (63.8%) patients, out of which 26 (31.6%) underwent re-biopsies. The successful number of re-biopsies was 103 (81.7%). No complications were observed after any of the biopsy procedures. Subsequent treatments were changed in 15 patients (11.9%), who began new TKI treatments. Poor performance status was the most common reason for not performing a biopsy (n = 65; 23.8%), followed by the physician's decision (n = 40; 14.6%). Re-biopsies can demonstrate the new characteristics of a tumour and can detect the activation of pre-existing clones, making possible new treatment opportunities for patients. According to the performance status of the patient and the availability of the progressive lesion, we should increase the rate of re-biopsies before the decision to follow up with the best supportive care.

The Geographical Distribution of Morbidity Caused By Chronic Obstructive Pulmonary Disease in Turkey: COPDTURKEY-2

Background: Chronic obstructive pulmonary disease (COPD) is one of the most prevalent causes for morbidity and mortality, and it creates a cumulative economic and social burden. Aims: To determine the distribution of the prevalence of patients in Turkey who were diagnosed with COPD and their morbidity rates, according to the regions and cities they belong to. Moreover, the study contributes to the prevention and cure services of COPD that should be planned in the future. Study Design: A retrospective cohort. Methods: The database of the Social Security Institution from 2016 has been scanned. All the data with prescription registration, with the code ICD-10, J44.0-J44.9, which were aimed for diagnosing and/or cure, have been evaluated with a retrospective cohort. Results: In 2016, 955,369 patients who were admitted as outpatients to the hospitals were diagnosed with COPD. The average number of annual COPD cases that were admitted was 2.09. Twenty percent (20%) of the outpatient applications were via emergency room. The rate of hospitalization among the applicants was 17.75%, with a total of 1,994,325. The average annual number of hospitalizations of men was higher than that of women. The average number of hospitalization days was 6.52. The region with the highest prevalence of outpatient admission and hospitalization was the Black Sea Region. Conclusion: The high rate of hospitalization was considered to be the outcome of the insufficient "outpatient" management.

An epidemiologic study of physician-diagnosed chronic obstructive pulmonary disease in the Turkish population: COPDTURKEY-1

Background/aim: Chronic obstructive pulmonary disease (COPD) is a common disease characterized by persistent airflow limitation and respiratory symptoms. It is a leading cause of morbidity and mortality all over the world. Our data on COPD in Turkey are limited. This study was intended to examine the epidemiologic characteristics of COPD in the Turkish population, between 2012 and 2016. Materials and methods: This population-based, descriptive, surveillance study examined physician-diagnosed COPD prevalence, incidence, and mortality in Turkey. The database of the Social Security System of Turkey was scanned and ICD-10 J44.0-J44.9 codes for diagnostic and/ or therapeutic purposes were evaluated retrospectively. Results: In 2016, there were 3,434,262 cases of COPD (56.2% men) in Turkey, and the mean age of patients was 61.62 ± 14.76 years. From 2012 to 2016, the annual overall prevalence rates of physician-diagnosed COPD rose from 4.3% to 5.8%, which was a 35.0% relative increase (P < 0.05). In women, this rate rose from 3.7% to 5.1% (38% increase), and in men, it rose from 4.9% to 6.7% (37% increase). During the study period, the overall incidence decreased from 8.5 per 1000 adults in 2012 to 6.3 per 1000 adults in 2016, representing a decrease of 26.6% (P < 0.001). The annual incidence rates of physician-diagnosed COPD decreased 25.4% in women and 27.9% in men. The overall mortality was 4.3% in 2012, and 4.2% in 2016. The mortality rate in women was 3.5% in 2012 and 3.7% in 2016, and 5% in 2012 and 4.7% in 2016 in men. The mean prevalence by region was 5.26% (range 3.79%­7.65%). The Black Sea region had the highest COPD prevalence. Conclusion: COPD is a very common and serious cause of morbidity and mortality in Turkey, as it is worldwide. Current data will contribute to a better understanding of the epidemiologic dimension of COPD in our country.

Carotid intima-media thickness in chronic obstructive pulmonary disease and survival: A multicenter prospective study.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is associated with increased cardiovascular morbidity and mortality. Carotid intima-media thickness (CIMT) is a noninvasive method assessing atherosclerosis. OBJECTIVE: It was aimed to determine relationship and survival between COPD and CIMT. METHODS: CIMT was measured using Doppler ultrasound (USG) in 668 stable COPD patients at 24 centers. Patients were followed-up for 2 years. RESULTS: There were 610 patients who completed the study. There were 200 patients CIMT with <0.78 mm (group 1), and 410 with CIMT ≥ 0.78 mm (group 2). There was a significant difference at the parameters of age, gender, smoking load, biomass exposure, GOLD groups and degree of airway obstruction (FEV1) between groups 1 and 2. Our results revealed positive correlations between mean CIMT and age, smoking load (pack-years), biomass exposure (years), exacerbation rate (last year), duration of hypertension (years) and cholesterol level; negative correlations between CIMT and FEV1 (P < 0.05). According to logistic regression model, compared with group A, risk of CIMT increase was 2.2-fold in group B, 9.7-fold in group C and 4.4-fold in group D (P < 0.05). Risk of CIMT increase was also related with cholesterol level (P < 0.05). Compared with infrequent exacerbation, it was 2.8-fold in the patients with frequent exacerbation (P < 0.05). The mean survival time was slightly higher in group 1, but not significant (23.9 vs 21.8 months) (P > 0.05). CONCLUSION: This study is the first regarding CIMT with combined GOLD assessment groups. It has revealed important findings supporting the increase in atherosclerosis risk in COPD patients. We recommend Doppler USG of the carotid artery in COPD patients at severe stages.