Characteristics of asthma in an older adult population according to sex and control level: why are asthma symptoms in older women not well-controlled?

OBJECTIVE: The older adult population in Turkey has increased by 22.6% in the last 5 years, and the characteristics of such patients with asthma remain uninvestigated. Therefore, we aimed to evaluate the characteristics of older adults with asthma according to sex and asthma control status to provide an in-depth overview of asthma in this population in Turkey. METHODS: The data of older adults (age 65 years and over) with asthma were obtained from a multicenter, cross-sectional asthma database registry (Turkish Adult Asthma Registry, TAAR) funded by the Turkish Thoracic Society. Comparisons were made based on sex and asthma control levels using the Global Initiative for Asthma (GINA) Asthma Symptom Control Questionnaire. RESULTS: Of the 2053 (11.5%) patients registered with the TAAR, 227 were older adults (median age, 69 (8), women, 75.8% (n = 172)). Of these, 46.5% (n = 101) had obesity to some degree. Compared with men, women had lower education, income levels, and employment rates. Additionally, women exhibited a higher prevalence of obesity, hypertension, and thyroid gland disease than men. Being female (OR: 2.99; 95% CI: 1.307-6.880), the presence of gastroesophageal reflux disease (OR: 2.855; 95% CI: 1.330-6.130), and a predicted forced expiratory volume in the first-second value lower than 80% (OR: 2.938; 95% CI: 1.451-5.948) were associated with poorly controlled asthma. CONCLUSIONS: Herein, older adults comprised 11.5% of adult patients with asthma. Being female poses a disadvantage in terms of both asthma prevalence and control in the older adult asthmatic population owing to the prevalence of comorbidities and socioeconomic sex-related distinguishing factors.

Investigation of the relationship between interferon-gamma receptor 1-56C/T gene polymorphism and genetic susceptibility to lung sarcoidosis: A cross-sectional study.

Objectives: This study aims to investigate the relationship between the interferon-gamma receptor 1 (IFNGR1) polymorphism and susceptibility to lung sarcoidosis. Patients and methods: The study included a total of 55 patients (13 males, 42 females; mean age: 46.5±9.1 years; range, 22 to 66 years) with lung sarcoidosis and 28 healthy controls (6 males, 22 females; mean age: 43.9±5.9 years; range 22 to 60 years) selected from the Turkish population. The polymerase chain reaction was used for genotyping of participants to determine single-nucleotide polymorphisms. Hardy-Weinberg equilibrium, which is considered an important tool for detecting genotyping errors, was tested. Allele and genotype frequencies of patients and controls were compared using logistic regression analysis. Results: The analyses showed no correlation between the tested IFNGR1 single-nucleotide polymorphism (rs2234711) and lung sarcoidosis (p>0.05). The categorization analysis according to the clinical features, laboratory, and radiographic characteristics showed no correlation between the tested polymorphism of IFNGR1 (rs2234711) and these characteristics (p>0.05). Conclusion: The results of the study showed that the tested gene polymorphism (rs2234711) of IFNGR1 was not associated with lung sarcoidosis. More comprehensive studies are needed to verify our results.

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

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

The effect of paclitaxel plus carboplatin chemotherapy on subclinical cardiotoxicity in patients with non-small cell lung cancer: A speckle tracking echocardiography-based study.

BACKGROUND: Although chemotherapy-induced cardiotoxicity is an emerging problem, limited information is available on the effects of chemotherapy on left ventricular (LV) mechanical functions in patients with non-small cell lung cancer (NSCLC). OBJECTIVE: We aimed to explore chemotherapy-induced alterations in cardiac mechanical functions in patients with NSCLC using speckle tracking echocardiography (STE). METHODS: Seventy-one patients with NSCLC and 34 age and sex matched control subjects were consecutively included. Based on their good performance status (Eastern Cooperative Oncology Group performance status), 39 patients were treated with paclitaxel plus carboplatin (PC) regimen and 32 patients were treated with vinorelbine plus cisplatin (VC) regimen. All patients and controls underwent conventional two-dimensional echocardiography and STE at baseline to assess their LV functions. The echocardiographic examinations of NSCLC patients were repeated after the chemotherapy regimens. RESULTS: None of the NSCLC patients developed any signs or symptoms of clinical heart failure during or after the chemotherapy. There were not any significant differences in LV ejection fraction between NSCLC patients and controls before and after chemotherapy. There were not any significant differences in baseline LV global longitudinal strain (GLS), radial strain (RS), and circumferential strain (CS) between NSCLC patients and controls. However, all LV GLS, RS and CS significantly decreased in patients treated with the PC regimen resulting in a significant difference compared to both VC group and controls while no significant decreases were observed in strain measures in VC group. CONCLUSION: Paclitaxel plus carboplatin, but not VC, may induce subclinical cardiotoxicity in patients with NSCLC, which may be detected by STE.

The relationship of PET/CT SUVmax with EGFR mutation status and ALK rearrangement in lung adenocarcinoma.

OBJECTIVE: Epidermal growth factor receptor mutations (EGFRm) and rearrangement of the anaplastic lymphoma kinase gene (ALKr) can be targeted for precision therapy in lung adenocarcinoma (LADC). As molecular profiling is not available for all, patient stratification can be achieved using non-invasive and economic tools, such as positron emission tomography/computed tomography (PET/CT). We aimed to evaluate the relationships between fluorine-18-fluorodeoxyglucose (18F-FDG) PET/CT maximum standardized uptake value (SUVmax) of primary tumors (pSUVmax) and lymph nodes (nSUVmax) and the EGFRm and ALKr status in a large series of Turkish LADC patients. MATERIAL AND METHODS: In this retrospective study, medical records of histopathologically confirmed LADC patients were reviewed for demographic and clinical data. The 18F-FDG PET/CT pSUVmax nSUVmax were calculated and analyzed for their relationships with EGFRm and ALKr using multiple regression analysis. RESULTS: The study population consisted of 732 LADC patients with a mean age of 63±10 years. The frequencies of EGFRm and ALKr were 10.4% and 3.6%, respectively. Female gender, being a former- or never-smoker for EGFRm and age for ALKr were determined as independent risk factors (P<0.05). No significant differences in pSUVmax and nSUVmax were present between the patients with either EGFRm or ALKr compared to the wild-type genotype patients (P>0.05). CONCLUSION: We conclude that 18F-FDG PET/CT semi-quantitative parameter SUVmax could not be validated for the prediction of the EGFRm or the ALKr in our large series of 732 Turkish patients with LADC.

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

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

Metabolic syndrome may be more frequent in treatment-naive sarcoidosis patients.

INTRODUCTION: Sarcoidosis is a chronic granulomatous multisystem inflammatory disease. An association between sarcoidosis and subclinical atherosclerosis has recently been demonstrated. However, there are limited publications on metabolic syndrome (MetS) and its metabolic changes in sarcoidosis. In this study, we evaluated our hypothesis that the frequency of MetS may also be increased in treatment-naive, newly diagnosed sarcoidosis patients. METHODS: We included 133 newly diagnosed sarcoidosis patients, 133 age- and sex-matched controls, and 51 untreated rheumatoid arthritis (RA) patients as diseased controls. We then compared the frequency of MetS and MetS-related items in the three groups. The criteria defined for metabolic syndrome in the National Cholesterol Education Program (NCEP) Adult Treatment Panel III report (ATP III) were used to diagnose MetS. RESULTS: MetS was more common in sarcoidosis than controls (odds ratio, OR: 5.3; 95% confidence interval, CI 95%: 2.4-11.5; p < 0.001) and was similar to RA. In addition, triglyceride and glucose levels, diastolic blood pressure measurements, and waist circumference of female sarcoidosis patients were significantly higher than in controls. CONCLUSION: We show that MetS is a frequent feature of sarcoidosis even before treatment is started. Therefore, clinicians should be aware of MetS both during treatment and during the course of the disease to reduce the risk of cardiovascular events.

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.

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

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

Fibrin Glue and Partial Capitonnage in Giant Hydatid Cyst in a Pediatric Patient.

Surgical procedure is still used as the first choice in the treatment of pulmonary hydatid cysts. Video-assisted thoracoscopic surgery has started to be performed as a minimally invasive surgical option in recent years for lung hydatid cyst; however, few cases have been reported in the literature, especially in children. Thoracoscopic surgery experience is limited in pulmonary hydatid cyst for both adults and children. We present a pediatric case of giant lung hydatid cyst, in which we performed partial capitonnage with video-assisted thoracoscopic surgery and fibrin glue.

Are inflammatory and malnutrition markers associated with metabolic syndrome in patients with sarcoidosis?

OBJECTIVE: The study aimed to investigate the use of Neutrophil/lymphocyte ratio, C-reactive protein/albumin ratio, controlling nutritional status, and prognostic nutritional index immune, inflammatory, and malnutrition markers Metabolic syndrome+ in sarcoidosis patients, as an early-stage marker. METHOD: This is a single-center and cross-sectional study that determines the association of Metabolic syndrome in patients with sarcoidosis. Patients were evaluated based on the National Cholesterol Education Program's Adult Treatment Panel III criteria. Neutrophil/lymphocyte ratio, C-reactive protein/albumin ratio, controlling nutritional status, and prognostic nutritional index values were simultaneously determined through blood test. RESULTS: A total of 253 patients diagnosed with sarcoidosis were included in this study. Metabolic syndrome- was detected in 37.2% of patients. The prevalence was significantly higher in females (p<0.001). Any degree of malnutrition assessed by controlling nutritional status had higher Metabolic syndrome (p=0.035). The Neutrophil/lymphocyte ratio cutoff value was 2.24, sensitivity was 70.53, specificity was 60.13, and Area Under the Curve value was 0.663 for predicting Metabolic syndrome in sarcoidosis patients. CONCLUSION: Neutrophil/lymphocyte ratio and controlling nutritional status are associated with the Metabolic syndrome+ in sarcoidosis patients. Thus, close monitoring of Neutrophil/lymphocyte ratio and controlling nutritional status increase in terms of Metabolic syndrome and immune malnutrition may be important in sarcoidosis patients.

IGFBP-4: A promising biomarker for lung cancer.

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

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.

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

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

Is there an association between sarcoidosis and atherosclerosis?

Sarcoidosis is a multisystemic chronic inflammatory disease that the specific etiology is not known clearly. The aim of this study is, to investigate the presence of subclinical atherosclerosis and endothelial dysfunction by using carotid intima-media thickness and flow-mediated dilatation measurements, measuring the copeptin values, which is a stress marker, and interpreting the association of copeptin values with these two variables in sarcoidosis patients without conventional risk factors for coronary artery disease. Seventy-four patients (50 f, 24 m) with histopathological diagnosis of sarcoidosis and 60 healthy volunteers (35 f, 25 m) with similar sociodemographic characteristics were included in this study. CIMT, FMD, and serum copeptin levels of all participants were measured. The values of CIMT and Copeptin in sarcoidosis patients were significantly higher (p = 0.001, p < 0.001 respectively), and FMD was significantly lower (p = 0.01) than the control group. In sarcoidosis patients not significant correlation found among CIMT with copeptin (r: 0.16, p = 0.18) and FMD with copeptin (r: 0.01, p = 0.96). With the demonstration of the presence of subclinical atherosclerosis and endothelial dysfunction, we suggest; sarcoidosis patients may be followed more closely in terms of cardiovascular diseases. And new studies are needed to investigate the pathophysiology and the effects of high copeptin levels in sarcoidosis patients.

Timing and magnitude of regional right ventricular function and their relationship with early hospital mortality in patients with acute pulmonary embolism.

OBJECTIVE: Right ventricular (RV) dysfunction in acute pulmonary embolism (APE) has been associated with increased mortality and morbidity. The aim of the present study was to assess the timing and magnitude of regional RV functions using speckle-tracking echocardiography (STE) and their relationship to early hospital mortality in patients with APE. METHODS: One hundred forty-two patients were prospectively studied at the onset of an acute episode and after a median follow-up period of 30 days. Their clinical and laboratory characteristics were recorded. For all patients, conventional two-dimensional echocardiography and STE were performed within 24 h after the diagnosis of APE. RESULTS: Twenty-eight (19.7%) patients died during the hospitalization follow-up. Patients who died during hospitalization were older and had higher high sensitivity cardiac troponin T levels, and a higher percentage of patients had simplified Pulmonary Embolism Severity Indexes. In STE analyses, they had lower RV free wall peak longitudinal systolic strain (PLSS) and higher RV peak systolic strain dispersion indexes. The time to PLSS difference between RV free wall and LV lateral was longer in patients who died during hospitalization than in those who survived, and this was an independent predictor of early hospital mortality with 85.7% sensitivity and 75.0% specificity in patients with APE. CONCLUSION: APE was associated with RV electromechanical delay and dispersion. Electromechanical delay index might be useful to predict early hospital mortality in patients with APE.

Assessment of right ventricular function and relation to mortality after acute pulmonary embolism: A speckle tracking echocardiography-based study.

PURPOSE: Right ventricular (RV) dysfunction is a common condition that is related to increased adverse outcomes in patients with acute pulmonary embolism (APE). Our aim was to assess timing and magnitude of regional RV function using speckle tracking echocardiography (STE) and to evaluate their relationship to long-term mortality in patients after APE. METHODS: In total, 147 patients were enrolled at the onset of an APE episode and followed for 12 ± 1.1 months. For all patients, the clinical, laboratory, and echocardiography examinations were performed at the diagnosis of APE and at the end of the 1-year follow-up. RESULTS: Of the 147 patients, 44 (29.9%) died during the 1-year follow-up after APE. The patients who died had lower RV free wall peak longitudinal systolic strains (PLSS) and left ventricular (LV) PLSS and higher RV peak systolic strain dispersion (PSSD) index which means the electromechanical dispersion when compared with the survivors. The difference in time to PLSS between the RV free wall and LV lateral wall (RVF-LVL) which means the electromechanical delay was longer in patients who died than in those who survived during follow-up, and this difference was an independent predictor of mortality at 1 year of follow-up after APE, with 86.4% sensitivity and 81.7% specificity. At the end of 1-year follow-up, the RV free wall PLSS and the LV global PLSS increased, whereas the RV PSSD index and the difference in time to PLSS between the RVF and LVL decreased. CONCLUSIONS: Acute pulmonary embolism was associated with RV dysfunction and RV electromechanical delay and dispersion. These parameters improved at the end of 1-year follow-up. The electromechanical delay index might be a useful predictor of mortality in patients after APE.

Influence of comorbidities in long-term survival of chronic obstructive pulmonary disease patients.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of mortality and morbidity around the world, with comorbidities in COPD being common and having a negative effect on survival. We investigate the effects of comorbidities on long-term survival of COPD patients. METHODS: The study included patients with COPD who were hospitalized with an exacerbation. The demographic characteristics, hematological and biochemical parameters, pulmonary function test parameters and comorbidities of the patients were obtained from the hospital database and patient records, and the mortality of the patients was assessed at two years. The parameters considered to be related to mortality were analyzed using the Cox regression method. RESULTS: A total of 826 patients with COPD were included in the study, and the rate of patients with at least one comorbidity was 84.5%. The most common comorbidities were hypertension (n=394, 47.7%), heart failure (n=244, 29.5%) and DM (n=173, 20.9%). In a Cox regression analysis, the Charlson Comorbidity Index was strongly associated with mortality (P=0.000). In Kaplan-Meier analysis, a significant association was noted between the increasing number of comorbidities and long-term mortality, when compared to the patients without comorbidity (comorbidity numbers 1, 2 and ≥3; HR: 1.37, P=0.032, HR: 1.40, P=0.028 and HR: 1.65, P=0.000, respectively). CONCLUSIONS: Increasing number of comorbidities in COPD patients with severe exacerbation were found to negatively affect long-term survival. We consider both the evaluation and treatment of comorbidities to be important in the reduction of long-term mortality in patients with COPD.

Rare Lung Tumors: Alveolar Adenoma-Four Case Reports.

Alveolar adenoma is one of the rarely seen benign tumors of the lung, to date, one or two series have been reported. In this study, four rare alveolar adenoma cases were presented, thereby contributing to the existing scarce data.

Relation of Warrick Score and Polysomnographic Parameters in Patients with Interstitial Lung Disease.

BACKGROUND Obstructive sleep apnea (OSA) is often reported in connection with interstitial lung disease. As yet, there is insufficient data on the association of OSA severity parameters with lung involvement. We purposed to assess the frequency of OSA in our study group and to investigate the relationship between radiological involvement and OSA severity parameters. MATERIAL AND METHODS The study included 79 patients with interstitial lung disease who underwent spirometry, a carbon monoxide diffusion test (DLCO), high-resolution computed tomography, and polysomnography. The data were analyzed using SPSS 22 software. RESULTS Of the 79 patients, 53 patients (67.1%) had OSA, and there was a negative correlation between DLCO and the mean time spent with oxygen saturation levels below 90% (r=-0.686, P=0.001). The Warrick score was used as an indicator of the extent and severity of pulmonary involvement and was positively correlated with the apnea-hypopnea index, oxygen desaturation index, and the mean time spent with oxygen saturation below 90% (r=0.275, P=0.014; r=0.264 P=0.019; r=0.235, P=0.038). CONCLUSIONS In our study, a significant relationship was found between the Warrick score and the OSA severity parameters, as determined by polysomnography. Polysomnographic examinations might be useful, especially in patients with a Warrick score greater than 15, to avoid possible complications.