Pneumothoraxes after CT-guided percutaneous transthoracic needle aspiration biopsy of the lung: A single-center experience with 3426 patients.

Introduction: The purpose of this study is to determine how long patients who developed pneumothorax were followed up on in the emergency department, how many patients required chest tube placement, and what factors influenced the need for a chest tube in patients who underwent computed tomography (CT)-guided percutaneous transthoracic fine needle aspiration biopsy (PTFNAB). Materials and Methods: Patients who developed pneumothorax following CT-guided PTFNAB were analyzed retrospectively. In cases with pneumothorax, the relationship between chest tube placement and the size of the lesion, the lesion depth from the pleural surface, the presence of emphysema, and the needle entry angle were investigated. It was determined how long the patients were followed up in the emergency department, when a chest tube was placed, and when patients who did not require chest tube placement were discharged. Result: CT-guided PTFNAB was performed in 3426 patients within two years. Pneumothorax developed in 314 (9%) cases and a chest tube was placed in 117 (37%). The risk factor for chest tube placement was found to be the lesion depth from the pleural surface. The lesion depth from the pleural surface of >24 mm increased the risk of chest tube placement by 4.8 times. Chest tubes were placed at an average of five hours (5.04 ± 5.57). Conclusions: This study has shown that in cases with pneumothorax that required chest tube placement, the lesion depth from the pleural surface is a risk factor. Patients who developed pneumothorax on CT during the procedure had chest tubes placed after an average of five hours.

Effects of a home-based pulmonary rehabilitation program with and without telecoaching on health-related outcomes in COVID-19 survivors: a randomized controlled clinical study.

OBJECTIVE: To compare the effects of a home-based pulmonary rehabilitation (PR) program with and without telecoaching on health-related outcomes in COVID-19 survivors. METHODS: A total of 42 COVID-19 patients who completed medical treatment were randomly divided into two groups: the study (telecoaching) group (n = 21) and the control (no telecoaching) group (n = 21). Both groups participated in an 8-week home-based PR program including education, breathing exercises, strength training, and regular walking. The study group received phone calls from a physiotherapist once a week. Both groups of patients were assessed before and after the program by means of the following: pulmonary function tests; the modified Medical Research Council dyspnea scale; the six-minute walk test; extremity muscle strength measurement; the Saint George's Respiratory Questionnaire (to assess disease-related quality of life); the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36, to assess overall quality of life); and the Hospital Anxiety and Depression Scale. RESULTS: In both groups, there were significant improvements in the following: FVC; the six-minute walk distance; right and left deltoid muscle strength; Saint George's Respiratory Questionnaire activity domain, impact domain, and total scores; and SF-36 social functioning, role-physical, role-emotional, and bodily pain domain scores (p < 0.05). Decreases in daily-life dyspnea, exertional dyspnea, and exertional fatigue were significant in the study group (p < 0.05), and the improvement in SF-36 social functioning domain scores was greater in the study group (p < 0.05). CONCLUSIONS: A home-based PR program with telecoaching increases social functioning and decreases daily-life dyspnea, exertional dyspnea, and exertional fatigue in COVID-19 survivors in comparison with a home-based PR program without telecoaching.

Effects of a home-based pulmonary rehabilitation program with and without telecoaching on health-related outcomes in COVID-19 survivors: a randomized controlled clinical study / Efeitos de um programa de reabilitação pulmonar domiciliar com e sem telecoaching nos desfechos relacionados à saúde em sobreviventes da COVID-19: estudo clínico controlado randomizado

ABSTRACT Objective: To compare the effects of a home-based pulmonary rehabilitation (PR) program with and without telecoaching on health-related outcomes in COVID-19 survivors. Methods: A total of 42 COVID-19 patients who completed medical treatment were randomly divided into two groups: the study (telecoaching) group (n = 21) and the control (no telecoaching) group (n = 21). Both groups participated in an 8-week home-based PR program including education, breathing exercises, strength training, and regular walking. The study group received phone calls from a physiotherapist once a week. Both groups of patients were assessed before and after the program by means of the following: pulmonary function tests; the modified Medical Research Council dyspnea scale; the six-minute walk test; extremity muscle strength measurement; the Saint George's Respiratory Questionnaire (to assess disease-related quality of life); the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36, to assess overall quality of life); and the Hospital Anxiety and Depression Scale. Results: In both groups, there were significant improvements in the following: FVC; the six-minute walk distance; right and left deltoid muscle strength; Saint George's Respiratory Questionnaire activity domain, impact domain, and total scores; and SF-36 social functioning, role-physical, role-emotional, and bodily pain domain scores (p < 0.05). Decreases in daily-life dyspnea, exertional dyspnea, and exertional fatigue were significant in the study group (p < 0.05), and the improvement in SF-36 social functioning domain scores was greater in the study group (p < 0.05). Conclusions: A home-based PR program with telecoaching increases social functioning and decreases daily-life dyspnea, exertional dyspnea, and exertional fatigue in COVID-19 survivors in comparison with a home-based PR program without telecoaching.

RESUMO Objetivo: Comparar os efeitos de um programa de reabilitação pulmonar (RP) domiciliar com e sem coaching por telefone (telecoaching) nos desfechos relacionados à saúde em sobreviventes da COVID-19. Métodos: Um total de 42 pacientes com COVID-19 que completaram o tratamento médico foram aleatoriamente divididos em dois grupos: o grupo com telecoaching (grupo de estudo; n = 21) e o grupo sem telecoaching (grupo controle; n = 21). Ambos os grupos participaram de um programa de RP domiciliar que teve 8 semanas de duração e incluiu educação, exercícios respiratórios, treinamento de força e caminhada regular. O grupo de estudo recebeu telefonemas de um fisioterapeuta uma vez por semana. Ambos os grupos foram avaliados antes e depois do programa por meio de testes de função pulmonar, escala modificada de dispneia do Medical Research Council, teste de caminhada de seis minutos, mensuração da força muscular dos membros superiores e inferiores, Saint George's Respiratory Questionnaire (para avaliar a qualidade de vida relacionada à doença), Medical Outcomes Study 36-item Short-Form Health Survey (SF-36, para avaliar a qualidade de vida global) e Hospital Anxiety and Depression Scale. Resultados: Em ambos os grupos, houve melhoria significativa da CVF; da distância percorrida no teste de caminhada de seis minutos; da força dos músculos deltoides direito e esquerdo; da pontuação obtida nos domínios "atividade" e "impacto" do Saint George's Respiratory Questionnaire, bem como da pontuação total no questionário; e da pontuação obtida nos domínios "aspectos sociais", "função física", "função emocional" e "dor corporal" do SF-36 (p < 0,05). A redução da dispneia na vida diária, da dispneia aos esforços e da fadiga aos esforços foi significativa no grupo de estudo (p < 0,05), e a melhoria da pontuação obtida no domínio "aspectos sociais" do SF-36 foi maior no grupo de estudo (p < 0,05). Conclusões: Um programa de RP domiciliar com telecoaching melhora os aspectos sociais e diminui a dispneia na vida diária, a dispneia aos esforços e a fadiga aos esforços em sobreviventes da COVID-19 em comparação com um programa de RP domiciliar sem telecoaching.

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.

The comparison of exacerbation and pneumonia before and after conjugated pneumococcal vaccination in patients with chronic obstructive pulmonary disease, and the effect of inhaled corticosteroid use on results.

Introduction: Pneumococcal infections and exacerbations are important causes of mortality and morbidity in chronic obstructive pulmonary disease (COPD). The use of inhaled corticosteroids and pneumococcal vaccination are suggested for the control of the disease progression and exacerbations. The aim of this study is to assess the effect of pneumococcal conjugate vaccine on pneumonia and exacerbation in COPD patients using inhaled corticosteroids (ICSs). The secondary aim is to analyze the effect of ICS use and different ICS types, if administered, on exacerbation and pneumonia incidence in the study population. Materials and Methods: Medical records of 108 adult patients with COPD who were vaccinated with the pneumococcal conjugate vaccine (PCV13) were retrospectively evaluated. The number of acute exacerbations and pneumonia within one year before and after vaccination were evaluated in all included COPD patients. The comparison analysis was also performed based on the ICS types. Result: There were statistically significant differences between the mean numbers of pneumonia and exacerbations before and after vaccination (p<0.05). There were no significant differences in the mean pneumonia attacks and acute exacerbations between patients using ICS and not using ICS (p> 0.05). Conclusions: This study revealed that PCV13 provides a significant decrease in both exacerbation and pneumonia episodes in COPD patients. On the other hand, the use of ICSs and the types of ICSs were not found to have adverse effects on pneumonia and acute exacerbations in vaccinated COPD patients.

Correlation between chest CT severity scores and clinical and biochemical parameters of COVID-19 pneumonia.

BACKGROUND: The COVID-19 pandemic, which first appeared in Wuhan, China, in December 2019 and spread rapidly around the globe, continues to be a serious threat today. Rapid and accurate diagnostic methods are needed to identify, isolate and treat patients as soon as possible because of the rapid contagion of COVID-19. In the present study, the relation of the semi-quantitative scoring method with computed tomography in the diagnosis of COVID-19 in determining the severity of the disease with clinical and laboratory parameters and survival of the patients were investigated along with its value in prognostic prediction. MATERIAL AND METHOD: A total of 277 adult patients who were followed up in the chest diseases clinic because of COVID-19 pneumonia between 11.03.2020 and 31.05.2020 were evaluated retrospectively in the present study. Both lungs were divided into five regions in line with their anatomical structures, and semiquantitative radiological scoring was made between 0 and 25 points according to the distribution of lesions in each region. The relations between semiquantitative radiological score and age, gender, comorbidity, and clinical and laboratory parameters were examined. RESULTS: A significant correlation was detected between advanced age, lymphopenia, low oxygen saturation, high ferritin, D-dimer, and radiological score in the univariate analysis performed in the present study. The cut-off value of the semiquantitative radiology score was found to be 15 (AUC: 0.615, 95% CI: 0.554-0.617, p = 0.106) in ROC analysis. The survival was found to be better in cases with a radiology score below 15, in Kaplan-Meier analysis (HR: 4.71, 95% CI: 1.43-15.46, p < 0.01). In the radiological score and nonparametric correlation analyses, positive correlations were detected between CRP, D-dimer, AST, LDH, ferritin, and pro-BNP, and a negative correlation was found between partial oxygen pressure and oxygen saturation (p = 0.01, r = 0.321/0.313/0.362/0.343/0.313/0.333/-0.235/-0.231, respectively) CONCLUSION: It was found that the scoring system that was calculated quantitatively in thorax HRCTs in Covid-19 patients is a predictive actor in determining the severity and prognosis of the disease in correlation with clinical and laboratory parameters. Considering patients who have a score of 15 and above with semiquantitative scoring risky in terms of poor prognosis and short survival and close follow-up and early treatment may be effective to reduce mortality rates.

Research Burden of Interstitial Lung Diseases in Turkey - RBILD.

Introduction: The aim of our study is to investigate the etiological distribution of ILD in Turkey by stratifying the epidemiological characteristics of ILD cases, and the direct cost of initial diagnosis of the diagnosed patients. Material-Method: The study was conducted as a multicenter, prospective, cross-sectional, clinical observation study. Patients over the age of 18 and who accepted to participate to the study were included and evaluated as considered to be ILD. The findings of diagnosis, examination and treatment carried out by the centers in accordance with routine diagnostic procedures were recorded observationally. Results: In total,1070 patients were included in this study. 567 (53%) of the patients were male and 503 (47%) were female. The most frequently diagnosed disease was IPF (30.5%). Dyspnea (75.9%) was the highest incidence among the presenting symptoms. Physical examination found bibasilar inspiratory crackles in 56.2 % and radiological findings included reticular opacities and interlobular septal thickenings in 55.9 % of the cases. It was observed that clinical and radiological findings were used most frequently (74.9%) as a diagnostic tool. While the most common treatment approaches were the use of systemic steroids and antifibrotic drugs with a rate of 30.7% and 85.6%, respectively. The total median cost from the patient's admission to diagnosis was 540 Turkish Lira. Conclusion: We believe that our findings compared with data from other countries will be useful in showing the current situation of ILD in our country to discuss this problem and making plans for a solution.

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.

Frequency of Direct Oral Anticoagulants Usage in Acute Pulmonary Thromboembolism Treatment in Turkey (TUPEDO).

Background: Direct oral anticoagulants (DOACs) have been used in acute pulmonary thromboembolism as an alternative to warfarin due to drug interactions, narrow therapeutic range, and necessary close International Normalized Ratio (INR) monitoring. Phase 3 study results have reported that these drugs are at least as effective as warfarin and beneficial in terms of bleeding; however, studies that present up-to-date life data are necessary. Aims: To evaluate the frequency of using DOACs, which are prescribed with a limited number of indications in our country, and real-life data results. Study Design: Cross-sectional study. Methods: This cross-sectional survey collected the clinical data (history, current treatment, treatment duration, etc.) of patients with pulmonary thromboembolism and who applied to the physician for follow-up between October 15, 2019, and March 15, 2020. The researchers kept the patient records sequentially. Results: Data from 836 patients with acute pulmonary thromboembolism from 25 centers were collected, and DOAC was used in 320 (38.5%) of them. The most preferred DOAC was rivaroxaban (n = 294, 91.9%). DOAC was mostly preferred because it could not provide an effective INR level with warfarin (n=133, 41.6%). Bleeding was observed in 13 (4%) patients. Conclusion: The use of direct oral anticoagulants is becoming almost as widespread as conventional therapy. Real-life data results are important for their contribution to clinical practice.

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 the Level of CRP in Acute Pulmonary Embolism Determine Early Mortality?

OBJECTIVE: The purpose of this study was to determine the prognostic role of C-Reactive Protein (CRP) in acute PE. MATERIAL AND METHODS: Two hundred and twenty patients with acute PE were consecutively enrolled and followed for 30 days after discharge. Serum CRP and NT-proBNP were determined. Right ventricular function was evaluated by transthoracic echocardiography. RESULTS: There was a significant difference in age, S-PESI, and CRP levels between the early mortality group and without early mortality group. There was statistically no significant difference between the groups with and without early mortality in terms of gender distribution and whether or not they received thrombolytic therapy for DVT. Pulmonary infarct, pleural fluid, or both have no effect on early mortality. There was no correlation between CRP and pro-BNP, right/left ventricular ratio. The serum CRP levels at diagnosis were significantly higher in patients with PE and with pleural effusion and pulmonary infarct than those in PE patients without pleural effusion and pulmonary infarct (4.75±4.91 ng/mL, 9.67±8.02 ng/mL; p<0.0003). CONCLUSION: High levels of CRP owing to inflammation in pulmonary embolism associated with effusion and infarction reveals why early mortality is significant in this group. CRP may help in the risk stratification of patients with acute PE, especially those with effusion and pulmonary infarction. CRP is an inexpensive and easily applicable biochemical marker, which can be used to predict early mortality.

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.

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.

[Pneumococcal infections and protection with vaccination in adult chronic lung diseases]. / Eriskin kronik akciger hastaliklarinda pnömokok infeksiyonu ve asi ile korunma.

Pneumococcal infections are an important cause of mortality and morbidity in Chronic Lung Diseases. However, exacerbations, which make the treatment of diseases very difficult, and corticosteroids used during treatment carry a great risk of pneumococcal infection and adversely affect the treatment. The most rational way to reduce the negative impact of pneumococcal infections on the clinical and economic burden of Chronic Lung Diseases is vaccination of the risky population. Although, vaccination recommendations are well defined, recommended by national and international guidelines and are paid by health authorities, in Turkey, vaccination rates in adults with chronic lung disease is far below the expected. Since physicians are considered to be the most important and reliable resource that can guide their patients in vaccination, applying pneumococcal vaccination routinely in all patients with chronic lung diagnosis and making it a part of daily practice will greatly contribute to reducing the clinical and economic burden of pneumococcal infections in these patients. In this review, the effects of pneumococcal diseases on chronic lung diseases, the risk and clinical burden of pneumococcal diseases in chronic lung diseases are discussed in the light of guidelines and current literature, and the importance of protection from pneumonia in these patients is emphasized. In addition to general information and efficacy data about pneumococcal vaccines available in our country, application methods and access routes to vaccines are also described.

Insidious Hughes Stovin Syndrome: Journey From Pulmonary Embolism to Pulmonary Arterial Aneurysm.

Hughes-Stovin syndrome (HSS) is a rare disease characterized by deep vein thrombosis and pulmonary and/or bronchial artery aneurysms. A 28-year-old female patient was followed-up for 5 months with pulmonary embolism. When she presented with hemoptysis at her 5th month, pulmonary artery aneurysm was detected on thoracic CT angiography. The abdominal magnetic resonance (MR) angiography revealed thrombus in the inferior vena cava. Because she didin't carry the criteria for Behcet's disease, she was diagnosed as Hughes-Stovin Syndrome (HSS) and steroid treatment was started. The patient who had a response to the treatment, stay in remission for a long time. The prognosis was poor in patients with HSS, and aneurysmal rupture was the main cause of death. In order to emphasize the fact that, when the pulmonary arterial aneurysm is seen, in view of the possibility of Behçet or its variant HSS,rapid onset of treatment can be life-saving. A rare female case is presented in the light of the literature.

Characteristics of Patients with Large-Cell Neuroendocrine Carcinoma of the Lung.

OBJECTIVES: Neuroendocrine tumors of the lungs are a clearly different group of tumors with definite ultrastructural, immunohistochemical, and molecular features. We reported and analyzed the incidence, clinicopathological features, surgery rates, responses to first-line therapy, and survival outcomes of this rare condition according to our lung cancer patient database. MATERIALS AND METHODS: We retrospectively collected the data of 62 patients who were histopathologically diagnosed with large cell neuroendocrine carcinoma of lung (LCNEC) between January 2010 and January 2016. RESULTS: The patients were predominantly (95%) men (male:female=59:3) with their average age being 60.3±8.6 years. Diagnosis was made by the fine-needle aspiration biopsy (NAB) in 7 patients, bronchoscopic transbronchial biopsy in 13, and surgery in 42. Nearly 43.5% of the patients presented with the tumor in the right upper lobe. Additionally, tumors of 46.8% patients could be observed in peripheral locations. Sixteen patients presented with stage 1, 17 with stage 2, 15 with stage 3, and 14 with stage 4. Median progression-free survival (PFS) was 29 months (SE: 12.2) (95% CI, 5.2-52.8 months). Progression-free survival (PFS) was significantly better in patients with low N, M0, early stage, p63 positive, and TTF-1 positive across the entire cohort. Overall survival (OS) was significantly better in patients with comparatively lower N, M0, low stage, and peripheral location. CONCLUSION: This study demonstrated a single-center experience with clinicopathologic factors and survival outcomes of LCNEC patients.