Sociodemographic and clinical risk factors associated with in-hospital tuberculosis mortality in Türkiye, 2008-2018.

Introduction: Tuberculosis (TB) is an infectious disease that can be fatal if left untreated or poorly treated, and it is associated with many morbidities. Deaths may provide better understanding of the associated factors and help guide interventions to reduce mortality. In this study, it was aimed to reveal some of the features that predict hospital mortality in patients with TB and to present some alarming findings for clinicians. Materials and Methods: Patients who had been hospitalized with the diagnosis of TB between January 2008 and December 2018 were included and analyzed retrospectively. In-hospital mortality because of any TB disease after the initiation of treatment in patients admitted to the TB Ward and the primary cause of mortality were taken as endpoint. Result: A total of 1321 patients with a mean age of 50.1 years were examined. Total mortality was 39.4% (521 deaths) and 13.1% were in-hospital deaths (173 deaths). Of the deaths, 61.8% (n= 107) occurred during the first month after TB treatment were started. On univariate analysis, age over 48.5 years, Charlson comorbidity index, extension of radiological involvement, hypoalbuminemia and lymphopenia were most predictive variables with higher odds ratios (respectively, p<0.001 for all). Conclusions: In-hospital tuberculosis disease mortality is related with older age, cavitary or extensive pulmonary involvement, low albumin levels, unemployment, cigarette smoking and especially those with concomitant malignancy and chronic pulmonary disease.

Salivary Lipids of Patients with Non-Small Cell Lung Cancer Show Perturbation with Respect to Plasma.

A comprehensive lipid profile was analyzed in patients with non-small cell lung cancer (NSCLC) using nanoflow ultrahigh-performance liquid chromatography-electrospray ionization-tandem mass spectrometry. This study investigated 297 and 202 lipids in saliva and plasma samples, respectively, comparing NSCLC patients to healthy controls. Lipids with significant changes (>2-fold, p < 0.05) were further analyzed in each sample type. Both saliva and plasma exhibited similar lipid alteration patterns in NSCLC, but saliva showed more pronounced changes. Total triglycerides (TGs) increased (>2-3-fold) in plasma and saliva samples. Three specific TGs (50:2, 52:5, and 54:6) were significantly increased in NSCLC for both sample types. A common ceramide species (d18:1/24:0) and phosphatidylinositol 38:4 decreased in both plasma and saliva by approximately two-fold. Phosphatidylserine 36:1 was selectively detected in saliva and showed a subsequent decrease, making it a potential biomarker for predicting lung cancer. We identified 27 salivary and 10 plasma lipids as candidate markers for NSCLC through statistical evaluations. Moreover, this study highlights the potential of saliva in understanding changes in lipid metabolism associated with NSCLC.

Detection of Pneumocystis jirovecii by PCR in patients with lung cancer: A preliminary study.

INTRODUCTION: Infection complications in lung cancer (LC), one of the most common cancers in the world, are still among the most important causes of death. Of them, P. jirovecii, which is as an opportunistic infection, causes a life-threatening type of pneumonia in cancer patients. This preliminary study aimed to determine the incidence and clinical status of P. jirovecii by PCR in lung cancer patients compared to the conventional method. MATERIAL AND METHODS: Sixty-nine lung cancer patients and fSorty healthy individuals were included in the study. After sociodemographical and clinical features were recorded, sputum samples were collected from attenders. Firstly, microscopic examination was made with Gomori's methenamine silver stain and then PCR was performed. RESULTS: P. jirovecii was detected in three of 69 lung cancer patients by PCR (4.3%), but not by microscopy. However, healthy individuals were negative for P. jirovecii by both methods. Based on clinical and radiological findings, P. jirovecii was evaluated as probable infection in one patient and colonization in the other two patients. Although PCR is more sensitive than conventional staining methods, it cannot distinguish probable and proven infections from pulmonary colonization. DISCUSSION: It is important to evaluate the decision of infection together with laboratory, clinical and radiological findings. Moreover, PCR may enable to know the colonization and to take precautions such as prophylaxis, due to the risk of colonization turning into an infection in immunocompromised patient groups. Further studies involving larger populations and evaluating the colonization-infection relationship in patients with solid tumors are needed.

Molecular Prevalence of Microsporidia Infection in Patients with Lung Cancer.

Infections are still among the most important causes of morbidity and mortality in patients with lung cancer, which has the highest rate of cancer-related deaths in the world. Microsporidia, which are opportunistic parasitic fungi, primarily localize to the intestine by ingestion but can disseminate to the respiratory tract or can be acquired by spore inhalation. Cancer patients are at higher risk for microsporidia, a life-threatening infection, than the normal population is. We aimed to characterize the prevalence of microsporidia infection for the first time by evaluating the intestinal and respiratory tracts of patients with lung cancer. In this study, we investigated 98 patients with lung cancer and 103 healthy individuals for microsporidia infection and evaluated the clinical findings of patients who were found to be positive. Sputum and stool samples were tested by microscopic examination, in addition to pan-microsporidia and genus-specific polymerase chain reactions. Nine patients with lung cancer had positive results for microsporidia (9.2%), which was significantly higher than the rate in healthy individuals (P = 0.008), and most of them had clinical findings. Among these positive patients, polymerase chain reaction revealed microsporidia in the sputum samples of seven patients, the stool sample of one patient, and both the sputum and stool samples of one patient. Encephalitozoon cuniculi was identified as the predominant pathogen in 87.5% (7/8) of positive sputum samples. Microsporidia infection was significantly associated with advanced stages of cancer. However, in the control group, Encephalitozoon intestinalis was detected in the stool sample of an individual without clinical symptoms. Microsporidia, especially E. cuniculi, should be considered as a cause of respiratory tract infection as well as intestinal infection in cancer patients and should be screened in respiratory samples of these patients when they have pulmonary symptoms.

Comparison of Brock University, Mayo Clinic and Herder models for pretest probability of cancer in solid pulmonary nodules.

OBJECTIVE: Risk analysis models, which are used in the diagnostic algorithm of incidental pulmonary nodules, are based on patient data from developed countries. Mayo Clinic, Brock University and Herder are among the most known models. We aim to compare the reliability of these models in patients with indeterminate solid nodules and to investigate the contribution of the predictors used to the model. METHODS: We analysed 305 patients who performed transthoracic needle biopsy and positron emission tomography/computed tomography for solid nodules, retrospectively. For all three models, the malignancy risk probabilities of patients were calculated, and patients were classified as low (<5%), moderate (60%) and high (<60%) risk groups. Later, the malignancy rates of each model in three different risk groups were compared within each other and among the models. RESULTS: The malignancy rate is 73% in 305 patients. In the Mayo Clinic and Herder models, the difference in the low-, medium- and high-risk groups is significant (p < 0.001). In the medium-risk group, the rate of malignancy is 96.8% in the Brock model. In the high-risk group, the rate of malignancy in Herder is 88.3% and the rate of malignancy in Mayo Clinic is 28.8%. The optimal cutoff values for the Mayo Clinic, Brock University, and Herder were 29.6, 13.4 and 70 (AUC, respectively; 0.71, 0.67 and 0.73). Age, smoking, gender, size, emphysema and spiculation increase the likelihood of malignancy. CONCLUSION: Close results were obtained in all three models. In the high-risk group, the Herder model has the highest reliability rate (odds ratio 3.3, confidence interval [1.1, 10.2]). Upper lobe predilection is not a reliable predictor.

Outcomes of pulmonary rehabilitation after lung resection in patients with lung cancer.

Background: In this study, we aimed to examine the effectiveness of pulmonary rehabilitation applied after resection in patients with lung cancer. Methods: Between October 2017 and December 2019, a total of 66 patients (53 males, 13 females; median age: 65 years; range, 58 to 70 years) who underwent lung resection for non-small cell lung cancer and who were not administered any chemotherapy or radiotherapy regimen were included in the study. An eight-week comprehensive outpatient pulmonary rehabilitation program was applied to half of the patients, while the other half received respiratory exercise training. After the intervention, the results of both groups were compared. Results: In the pulmonary rehabilitation group, forced vital capacity value (p=0.011), six-minute walking distance (p<0.001), and Short Form-36 physical function, mental health, vitality scores increased significantly, while all scores of St. George's Respiratory Questionnaire, dyspnea (p<0.001) and anxiety score (p=0.041) significantly decreased. In the group given breathing exercise training, only dyspnea (p=0.046) and St. George's Respiratory Questionnaire symptom scores (p=0.038) were decreased. When the changes in the groups after pulmonary rehabilitation were compared, the decrease in dyspnea perception was significantly higher in the pulmonary rehabilitation group (p<0.001). Conclusion: Pulmonary rehabilitation program applied after lung resection in patients with non-small cell lung cancer reduces dyspnea and psychological symptoms, increases exercise capacity, and improves quality of life. It should be ensured that patients with lung cancer who have undergone lung resection are directed to the pulmonary rehabilitation program and benefit from this program.

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.

Antibiotic resistance rates and penicillin MIC distribution in patients with streptococcal pneumonia between 2013-2019, and use of antibiotics in clinical practice.

PURPOSE: The purpose of the present study is to investigate the antibiotic resistance rates and use of antibiotics in patients with streptococcal pneumonia in a reference tertiary care hospital for pulmonary diseases in Izmir, Turkey. METHODS: A total of 1224 cases with streptococcal pneumonia between 2013 and 2019 were included in the study, retrospectively. Drug susceptibility testing for penicillin and other antibiotics were performed according to the recommendations of EUCAST criteria. Clinical data and general characteristics were collected and evaluated for each patient in accordance with the susceptibility testing report. RESULTS: Totally, resistance rates for trimethophrim-sulfamethoxazole, penicillin (oxacillin), erythromycin, tetracycline, clindamycin and levofloxacin resistance were 63.5%, 39.8%, 37.7%, 37.6%, 28.8%, and 4.8%, respectively. Antibiotic resistance was not detected against vancomycin,teicoplanin and linezolid. Multidrug resistance rate was found to be 27.1%. It was observed that there was a statistically significant decrease in trimethophrim-sulfamethoxazole, penicillin (oxacillin), erythromycin, clindamycin and levofloxacin resistance rates by years (p: 0.000, 0.004, 0.000, 0.001, 0.010, respectively). The penicillin MIC distribution was higher at the range of 0.12-2 â€‹µg/mL and there was statistical difference among the ranges of MIC values for the representative years (p:0.033). Among the antibiotics investigated, the most commonly used antibiotic was moxifloxacin. CONCLUSIONS: Trimethophrim-sulfamethoxazole resistance rate has been found higher than other antibiotics. As penicillin MIC values were at the range of 0.12-2 â€‹µg/mL frequently, high doses of penicillin treatment might be required in some patients. It is noteworthy that significant decrease in resistance rates in penicillin, erythromycin, clindamycin and tetracycline could be due to the vaccination programme carried out since 2008 in Turkey. As the empiric use of quinolones is high it would be more appropriate to use it according to the susceptibility testing. It is important to determine the regional antimicrobial susceptibility for Streptococcus pneumoniae to select appropriate empirical antimicrobials in the clinical practice.

A Pilot Study on the Evaluation of Cryptosporidium Infection in Patients with Lung Cancer: Respiratory Cryptosporidiosis.

Lung carcinoma is one of the most common cancers and the leading cause of cancer-related death worldwide. Increasing evidence has shown that Cryptosporidium spp., an opportunistic parasite, is associated with cancers, causing life-threatening infections. The most common clinical form of Cryptosporidium is intestinal infections. However, respiratory cryptosporidiosis has rarely been documented, although the parasite infects respiratory epithelial cells and gastrointestinal (GIS) epithelial cells. To evaluate respiratory cryptosporidiosis in patients with lung cancer, we investigated Cryptosporidium spp. in patients with lung cancer (n = 69) in comparison with healthy groups (n = 40). Sputum and stool samples were examined microscopically and by polymerase chain reaction (PCR). Two cancer patients were diagnosed with respiratory cryptosporidiosis (2.9%), on PCR examination of the sputum samples. Cryptosporidium spp. was detected in the stool samples of one patient (1.5%) and 2 healthy individuals (5.4%) by PCR and microscopy. First, respiratory cryptosporidiosis was documented in 2 patients with lung cancer. Cryptosporidium is an important agent of the respiratory tract and GIS infections in cancer patients. These new findings highlight the molecular prevalence of Cryptosporidium spp., an opportunistic infection, in patients with lung cancer. Respiratory cryptosporidiosis should also be considered when patients have respiratory symptoms.

Factors Affecting the Risk of Interstitial Lung Disease Development in Hospitalized Patients With COVID-19 Pneumonia.

BACKGROUND: Coronavirus disease 2019 (COVID-19) related chronic lung changes secondary to severe disease have become well known. The aim of this study was to determine the risk factors that affect the development of interstitial lung disease in subjects with COVID-19 pneumonia who were hospitalized. METHODS: Patients hospitalized with COVID-19 pneumonia between June 2020 and March 2021 were retrospectively analyzed. Smoking histories, comorbidities, reverse transcriptase polymerase chain reaction test results, laboratory parameters at the time of the diagnosis, oxygen support, the use of corticosteroids with dosage and duration data, the need for ICU care were recorded. High-resolution computed tomographies (HRCT) were obtained for study population in their 3-6 months follow-up visit. The subjects were classified as having residual parenchymal lung disease if a follow-up HRCT revealed parenchymal abnormalities except pure ground-glass opacities (the residual disease group). The control group consisted of the subjects with normal chest radiograph or HRCT in their follow-up visit or the presence of pure ground-glass opacities. Two groups were compared for their demographic and clinical abnormalities, laboratory parameters, treatment regimens, and the need for ICU care. RESULTS: The study included 446 subjects. The mean ± SD age was 58.4 ± 13.87 years, with 257 men (57.6%). Although 55 subjects had normal HRCT features on their follow-up HRCT, 157 had abnormal lung parenchymal findings. Univariate logistic regression analysis revealed statistically significant results for age, sex, corticosteroid treatment, and the need for ICU care for predicting interstitial lung disease development (P < .001, P = .003, P < .001, and P < .001, respectively). Also, the residual disease group had significantly higher leukocyte and neutrophil counts and lower lymphocyte counts (P < .001, P < .001, P = .004, respectively). Correlated with these findings, neutrophil-to-lymphocyte ratios and platelet-to-lymphocyte ratios were significantly higher in the residual disease group (P < .001 and P = .008, respectively). CONCLUSIONS: Residual parenchymal disease was observed 3-6 months after discharge in one third of the subjects hospitalized with COVID-19 pneumonia. It was observed that interstitial lung disease developed more frequently in older men and in those subjects with more-severe disease parameters.

FDG PET/CT signs of proven pulmonary hydatid cyst: is there any clue?

PURPOSE: Pulmonary hydatid cyst (PHC) can imitate many diseases. Sometimes, positron emission tomography/computed tomography (PET/CT) is performed in terms of malignancy exclusion for complicated cysts. Although some specific findings (doughnut sign) have been identified in hydatid cyst of the liver, there is no specific sign described for PHC. The aim of this study is to investigate the presence of a common finding in PHC patients scanned with PET/CT inadvertently. MATERIALS AND METHODS: From January 2015 to 2020, patients proven to have PHC were analyzed retrospectively. From all the patients, only 17, having a previous PET/CT, were included the study. Lesions were evaluated in three groups according to FDG uptake: A, negative; B, focal; C, doughnut sign. RESULTS: The total number of patients was 17. Nine of the patients were male and the median age was 41.94 + 14.68 (16-65) years. SUV max of the lesions ranged from 0.5 to 15.8 (mean ± SE: 4.68). According to the FDG uptake of the lesions, five were in Group A, two in Group B, and the remaining ten (58.8%) in Group C with doughnut sign. To correlate the CT findings with PET/CT findings, doughnut sign, which is a typical finding of hydatid cysts of liver, is seen in only four patients in Group 1-classified cysts which are non-complicated. But in Group 2 (n = 3) and 3(n = 4), the finding of doughnut sign is three in both groups. CONCLUSIONS: PET/CT is not a recommended imaging technique for PHC, but in cases where a definitive diagnosis is difficult, interpreting PET/CT findings is significant. This study demonstrates that previously described doughnut sign for liver hydatid cysts is also common for perforated pulmonary cysts. According to our knowledge, this is the first largest series of determining PET/CT findings of PHC. Further larger series will contribute to the literature.

Clinical Differences Between Elderly and Non-elderly Patients with COVID-19.

OBJECTIVE: Comorbidity frequency and mortality rates are higher in elderly patients with COVID-19. The disease is also more severe in elderly patients. This study aims to examine the characteristics of the COVID-19 disease, severity, comorbidities, and mortality rates in elderly patients by comparing them with nonelderly patients. MATERIAL AND METHODS: This study was designed as a retrospective study. 469 patients who were followed up in outpatient, inpatient, and intensive care units with the diagnosis of COVID-19 between March 11, 2020, and June 01, 2020, were retrospectively included in the study. Patients were divided into two groups who were ≥65 years named as the "elderly group" and <65 years referred to as "nonelderly". Survival data was generated from the death notification system on August 02, 2020. RESULTS: A total of 469 patients including elderly(n=101) and nonelderly(n=368) were included in the study retrospectively. The inci- dence of severe pneumonia(31%/12.6%) and critical illness(16%/5.8%), comorbidity (85%/37.2%) and hospitalization time(8/5 days) were significantly higher in the elderly group(p<0.05). 23 (22.8%) of elderly patients and 27(7.3%) of nonelderly patients died (p=0.000). Mortality was found to be 3.5 times higher than in the non-elderly group. The expected survival time was 145.85 days(CI 95%:133- 158.66) in the elderly patients and 170.36 days(CI 95%:166-174.6) in the nonelderly patients (p<0.000). In ROC analysis, the sensitivity of age was 86%(73.3-94.2), specificity was 66.83%(62.1-71.3), and the cut-off>56 (AUC:0.775; p <0.001) in predicting mortality. CONCLUSION: Mortality is high, comorbidities are more frequent, and the disease is more severe in elderly patients with COVID-19. Age above 56 can be used as a cut-off to predict mortality.

Quantitative CT in mortality prediction in pulmonary fibrosis with or without emphysema.

AIM: We aimed to evaluate the quantitative CT analysis of patients with CPFE in comparison with IPF and emphysema. METHODS: Patients with CPFE(n:36), IPF(n:38) and emphysema(n:32) were retrospectively included in the study with the approval of the ethics committee. RESULTS: There was a positive correlation between total lung volume and FVC%, TLCO% and 6 MWT, and negative correlation between mMRC and mortality. Negative correlation was found between right, left lung density and FVC%, TLCO% and 6 MWT, and positive correlation between mortality. Also, total lung volume, right and left lung densities were significant in predicting mortality and cut-off values are ≤3831,> -778 and> -775, respectively (p = 0.040, 0.020, 0.013). CONCLUSION: Quantitative CT are guiding in predicting mortality of the disease.

Can LENT Prognostic score (LDH, ECOG performance score, blood neutrophil/lymphocyte ratio, tumor type) change the clinical approach in malignant pleural effusion?

INTRODUCTION: The aim of this study was to evaluate the predictive power of LENT (LDH in pleural fluid, Eastern Cooperative Oncology Group [ECOG] performance status, neutrophil-lymphocyte ratio in the serum, and tumor type) score which is a current prognostic score in patients with MPE and to determine its effect on survival and its status in clinical decision making. In addition, it was aimed to compare LENT score with the conventional but subjective score ECOG. MATERIALS AND METHODS: A retrospective observational study was conducted reviewing the medical records of patients managed for MPE (malign pleural effusion) between 2008 and 2018. LENT prognostic score was calculated in the patients. The ECOG score calculated for the same patients was compared in terms of mortality. RESULT: A total of 191 patients with malignant pleural effusion, 118 males (61.7%) and 73 females (38.2%), were included in the study. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for identifying overall survival were 69.8 %, 100%, 100% and 18.8%, respectively at the LENT score > 4 (p= 0.000). At ECOG PS >2, the sensitivity, specificity, PPV, NPV were as the same as the LENT score >4 for identifying overall survival. In all patients, overall median survival according to the LENT score was 662/119/33 days in low/moderate/high risk groups, respectively. Cox regression analysis indicated that having a moderate LENT score (p= 0.004, OR: 2.21, CI: 1.29 -3.78%) and high LENT score (p= 0.000, OR: 4, 50 CI: 2.57-7.89%) were predictors for overall survival in all patients due to MPE. In ROC analysis, there was no difference in mortality in erms of both LENT and ECOG at 1st, 6th and 12th months. CONCLUSIONS: LENT is a better scoring system than ECOG in predicting early mortality, while both ECOG and LENT have almost the same power in predicting mortality. However, LENT is slightly more objective but more difficult to calculate because it contains laboratory findings. Thus, both scoring systems can be used to predict mortality in patients with malignant pleural effusions. Neither of them has superiority to each other.

Which one is superior in predicting 30 and 90 days mortality after COPD exacerbation: DECAF, CURB-65, PSI, BAP-65, PLR, NLR.

Objectives: The major scores associated with the mortality after COPD exacerbations were; DECAF, CURB-65, PSI and BAP-65 scores. We aimed to compare these scores in predicting 30- and 90-day mortality in patients hospitalized with exacerbation of COPD.Methods: The data of 141 patients who were hospitalized with the diagnosis of COPD exacerbation between January 2018 and March 2019 and accepted to participate in the study were prospectively recorded.Results: Age, mean modified-medical-research-council (mMRC) dyspnea score, pleural effusion, neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), presence of atrial fibrillation (AF), PaCO2 pressure values were found to be significantly higher at both 30 and 90-days deceased group, while hemoglobin, albumin and pH values were significantly lower (all p < 0.05). DECAF, CURB-65, PSI and BAP-65 scores were significantly higher for both 30 and 90-days mortality (all p < 0.05). DECAF, CURB-65, PSI, BAP-65 scores, PLR, NLR predicted to 30 day and 90 day mortality. But, CURB-65 found (OR 2.968 and 2.284, respectively) superior to others in predicting 30 and 90-days mortality.Conclusions: CURB-65 score is a significant, simple and feasible score for predicting 30 and 90 days mortality in COPD exacerbation and may be routinely used in all patients hospitalized with COPD exacerbation.

Comparison of typical and atypical computed tomography patterns regarding reversibility and fibrosis in pulmonary sarcoidosis.

PURPOSE: This study aims to investigate whether there is a significant difference between typical and atypical parenchymal patterns in the development of fibrosis, which is the most crucial factor affecting morbidity in pulmonary sarcoidosis. METHODS: In our hospital, 145 cases with Siltzbach Types 2 and 3 sarcoidoses diagnosed by clinical, radiological, and histopathologic were retrospectively investigated. Perilymphatic nodules, accompanying mosaic attenuation, and interlobular septal thickening and central peribronchovascular bunch-like thickening on high-resolution computed tomography were assessed as typical. Solid nodules, galaxy finding, consolidation, ground-glass opacity, isolated mosaic attenuation, and interlobular septal thickening, and pleural fluid were accepted as atypical findings. Findings indicating fibrosis were fine and rough reticular opacity, traction bronchiectasis, volume loss, and cystic changes. For the analysis of variables, SPSS 25.0 program was used. RESULTS: Ten (16%) of the 61 cases with typical findings and 16 (19%) of the 84 with atypical findings developed fibrosis (P = 0.827). The mean age of cases with fibrosis was higher. With the cut-off of 50 years, sensitivity was 61.5%, and specificity was 68.9%. The highest fibrosis rate was in cases with ground glass pattern (n = 7/17), whereas higher reversibility rates were in those with miliary pattern (n = 9/12) and galaxy sign (n = 5/6). CONCLUSION: The incidence of fibrosis is higher in the atypical group with no significant difference. The incidence of fibrosis differs in each atypical pattern, being highest in ground-glass opacity and lowest in the miliary pattern.

What are the Differences Between Smoker and Non-smoker COPD Cases? Is it a Different Phenotype?

OBJECTIVE: The most important risk factor for chronic obstructive pulmonary disease (COPD) is smoking. However, more than 25% of patients do not have a history of smoking. The intent of this study is to identify characteristics of COPD patients that are non-smokers. MATERIAL AND METHODS: The records of patients with COPD were retrospectively reviewed. Smoking history, comorbidities, exacerbations, biomass, and environmental tobacco smoke (ETS) exposures were identified. Also, age, gender, pulmonary function test (PFT) values, modified Medical Research Council (mMRC) dyspnea scores were recorded. Non-smokers exposed to any of the COPD risk factors above were grouped and the data were analyzed to determine the specific characteristics of COPD that applied to them. RESULTS: A total of 706 COPD patients were analyzed with a mean age of 67.2 ± 9.4. Of these patients, 93 (13.2%) were female and 613 (86.8%) were male. Of the 706 patients, 128 (18.1%) were non-smokers. The percentage of male patients having COPD was significantly lower in the non-smoker group (P < .001). However, biomass, ETS exposure in childhood, and a history of previous respiratory infection were significantly higher in the non-smoker group (P < .001). The mean body mass index (BMI) was greater in non-smokers than smokers. CONCLUSION: Non-smokers with COPD have more biomass, ETS exposure, and infection history in childhood. They also have less impairment of airflow limitation, better symptom scores, and greater BMIs. Smoking history can be used to determine a different phenotype.

Value of Cancer Ratio plus and Cancer Ratio Formulation in Distinguishing Malignant Pleural Effusion from Tuberculosis and Parapneumonic Effusion.

Background: The aim of our study is to determine the clinical availability accessibility of cancer ratio and cancer ratio plus formulations, previously validated and reported to have clinical value in distinguishing malignant pleural effusion from tuberculosis pleurisy and parapneumonic effusion. Materials and Methods: Retrospective study of patients hospitalized with Malignant Pleural Effusion (MPE), tuberculosis (TPE) and pararapneumonic effusion (PPE) between 2009 and 2018. Results: Totally 232 patients, 101(43.5 %) having MPE, 86 (37.1 %) having PPE and 45 (19.4 %) TPE were examined. When compared with each other, "serum LDH / PS Lymphocyte %", "Cancer ratio" and "Cancer ratio plus" values were statistically different between the groups (p = 0.021, p <0.001 and p = 0.015, respectively). In multivariate logistic regression analysis, cancer ratio, serum LDH: pleural fluid lymphocyte count ratio was in positive correlation with MPE. The sensitivity and specificity of "cancer ratio", "cancer ratio plus" and "ratio of serum LDH: pleural fluid lymphocyte count" were 84.2 % (95% CI 75.6- 90.7) and 52.7 (95% CI 43.8- 61.5), and 82.2 % (95% CI 73.3- 89.1) and 45.8 (95%CI 37.1- 54.7), 53.5% (95% CI 43.3- 63.5) and 67.2% (95% CI 0.68-0.94) at the cut-off level of >14.25, >28.7, and >636, respectively. When considering only MPE and TPE patients, the specificity of cancer ratio and cancer ratio plus increased. Conclusion: The cancer ratio plus rate (the ratio of "cancer ratio"formulation to the percentage of differential pleural lymphocyte count) was almost the same as the cancer ratio in separating the malignant pleural effusion from the TPE and PPE, while it has better specificity only in differentiating malignant effusions from tuberculosis effusions.

The relation between distant metastasis and genetic change type in stage IV lung adenocarcinoma patients at diagnosis.

INTRODUCTION: Brain metastasis prevalence is higher in patients with positive epidermal growth factor receptor (EGFR) mutation, anaplastic lymphoma kinase (ALK) and C-ROS oncogene 1 (ROS-1) fusion change in lung adenocarcinoma. OBJECTIVES: The purpose of our study is to investigate the relation between the genetic change type and the initial distant metastasis in stage IV lung adenocarcinoma patients with genetic changes. METHODS: The study was conducted between January 2007 and December 2018 in a retrospective fashion with patients who had lung cancer diagnosed as stage IV adenocarcinoma. The relation between genetic mutation change (EGFR, ALK or ROS-1) and distant metastasis was analysed. RESULTS: A total of 845 patients were included in the study. The median age was 62 (28-88). It was determined that lung and pleura metastases were more frequent at a significant level in patients with positive EGFR mutation (P = 0.032, P = 0.004, respectively). In patients with positive ALK fusion change, pleura metastasis was determined to be more frequent (P = 0.001). Multiple metastases were determined to be significantly more in patients with positive ALK fusion change than single metastasis (P = 0.02). CONCLUSION: In patients with EGFR mutant lung adenocarcinoma, lung and pleura metastasis is more frequent and pleura metastasis is more frequent in ALK positive adenocarcinoma. Additionally, multiple organ metastases are higher in ALK positive lung adenocarcinoma.

Clinical presentation of health care workers with symptoms of coronavirus disease 2019 at the Izmir tertiary education hospital, during an early phase of the pandemic.

INTRODUCTION: The aim of this study is to investigate and report on the data regarding the clinical characteristics and outcomes of healthcare workers with COVID-19 at tertiary education hospitals from Turkey. MATERIALS AND METHODS: This was a single center, retrospective, descriptive and observational study using cross-sectional data, which were collected from confirmed COVID-19 patients at a tertiary education hospital. Patients' demographic and clinical characteristics, mortality rates, and the factors associated with hospitalization were analyzed. RESULT: By May 15, 2020, 480 patients were diagnosed with COVID-19 in our hospital where 49 (10.2%) of whom were HCWs. The mean age was 40.0 ± 8.45 (75.5% female). The most common symptoms were cough (32.7%), fever (30.6%), and myalgia (14.3%). Comorbidities were present in 32.7% of the patients. Most of the HCWs were nurses (53.1%) and physicians (18.4%), and the remaining 14 (28.6%) were cleaning and administrative staff. The severity of the disease was mild in 65.3% and severe in 34.7% HCWs. Leukocyte, neutrophil, lymphocyte and platelet values were statistically lower in hospitalized patients. There was a statistically significant relationship between the presence of infiltration on the chest X-ray, and the patient's symptoms with the severity of the disease (respectively p= 0.002 and 0.009). CONCLUSIONS: In conclusion, the frequency of COVID-19 in healthcare workers is high. The study presents the characteristics of HCWs infected with coronavirus from a single center in Turkey.