Attitude and Practice Toward Use of Cigarettes and Electronic Cigarettes Among Pregnant Women: A Questionnaire-Based Survey.

OBJECTIVE: This study aimed to evaluate attitude and practice toward use of regular tobacco cigarettes and electronic cigarettes among pregnant women. MATERIAL AND METHODS: A total of 1123 pregnant women participated on a voluntary basis in this questionnaire survey. Maternal characteristics, cigarette consumption parameters, and personal opinions regarding the adverse effects of smoking during pregnancy were evaluated. RESULTS: Active smokers composed 12.4% (9.4%: regular tobacco cigarettes, 3.0%: electronic cigarettes) of the study population. Smoking during the current pregnancy, particularly via regular tobacco cigarettes, was more likely for women with smoking during previous pregnancies (56.0% vs. 7.8%, P < .001), previous history of low birth weight infant delivery (16.1% vs. 8.6%, P = .013), premature delivery (16.7% vs. 7.0%, P < .001), and stillbirth (22.8% vs. 11.7%, P = .002). The presence versus absence of smoking during pregnancy was associated with a lower likelihood of being a housewife (70.5% vs. 80.5%, P = .010) and a higher likelihood of having an actively smoking mother (25.9% vs. 11.2%, P < .001) or partner (65.7% vs. 46.9%, P < .001). Regular tobacco cigarette users considered electronic cigarettes to have a higher risk of adverse impacts (11.1% vs. 2.9%, P = .012), while electronic cigarette users considered regular cigarettes to have a higher risk of nicotine exposure (55.9% vs. 13.0%, P < .001). CONCLUSION: Our findings indicate being employed, having an actively smoking mother or partner, as well as smoking in previous pregnancies, to be the risk factors for increased likelihood of smoking during pregnancy.

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.

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.

Is Obesity a Potential Risk factor for Poor Prognosis of COVID-19?

BACKGROUND: Coronavirus disease 2019 (COVID-19) continues to cause major mortality and morbidity worldwide even after a year of its emergence. In its early days, hypertension, diabetes, and cardiovascular diseases were noted as poor prognostic factors, while obesity gained attention at a later stage. In the present study, unfavorable clinical outcomes (transfer to the intensive care unit, invasive mechanical ventilation, and mortality) were investigated in obese patients with COVID-19. MATERIALS AND METHODS: In this retrospective study we analyzed patients with positive polymerase chain reaction test in tertiary care hospital between March-May 2020. They were divided into 3 groups according to body mass index (BMI) as normal, overweight, and obese (BMI: 18.5 - 24.99 kg/m², 25 - 29.99 kg/m², and ≥ 30 kg/m², respectively). We compared clinical features and laboratory findings of these groups and recorded adverse clinical outcomes. Multivariate logistic analysis was performed for unfavorable outcomes. RESULTS: There were 99 patients (35%), 116 (41%), and 69 patients (24%) in the normal-weight, overweight, and obese group, respectively. Among all patients, 52 (18%) patients were transferred to the intensive care unit (ICU), 30 (11%) patients received invasive mechanical ventilation (IMV), and 22 patients (8%) died. Obese patients had minimum 1 more comorbidity than normal BMI patients (73% vs. 50%, P = 0.002), and a longer median (interquartile range [IQR]) duration of hospitalization (8 [5 - 12] vs. 6 [5 - 9]) days, P = 0.006). Obese participants had higher concentrations of serum C-reactive protein, procalcitonin, ferritin than non-obese patients (P <0.05 in all). In a multivariate analysis, obesity was associated with ICU admission (adjusted odds ratio [aOR]: 2.99, 95% confidence interval [CI]: 1.26 - 7.04, P = 0.012). Moreover, IMV requirement was associated with obesity (aOR: 8.73, 95% CI: 2.44 - 31.20, P = 0.001). Mortality occurred in 16%, 9%, and 1% of the obese group, overweight group, and normal-weight group, respectively (Chi-square trend analysis, P = 0.002). CONCLUSION: Obesity is a risk factor for adverse outcomes and caused increased mortality, hence requiring close follow-up.

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.

Diagnostic value of CD4+, CD8+ and CD103+ lymphocytes in mediastinal lymph node specimens obtained via endobronchial ultrasonography for sarcoidosis.

INTRODUCTION: The aim of the present study is to investigate the diagnostic value of the CD4+, CD8+ and CD103+ lymphocyte sub-groups in mediastinal lymph nodes, as an adjunctive marker in sarcoidosis. MATERIALS AND METHODS: The present study is a single-center, prospective cohort study designed in a reference center for chest diseases. Forty-six patients who underwent endobronchial ultrasound (EBUS)-guided mediastinal lymph node sampling with a preliminary diagnosis of sarcoidosis were enrolled. The different lymphocyte subgroups were counted by flow cytomeytry in lymph node biopsy samples. Based on the final diagnosis, subjects were divided into two groups: sarcoidosis and non-sarcoidosis. Lymphocyte subset analysis were compared between the groups. RESULT: The final diagnoses were sarcoidosis in 31 (67%) and non-sarcoidosis in 15 patients (33%). The total cell counts, lymphocyte ratios, CD8+ T lymphocyte ratios and CD4/CD8 ratios were similar in both groups (p> 0.05). CD4+ T lymphocyte rates were higher in patients with sarcoidosis (p= 0.017). CD103 subset analysis revealed significantly lower CD103+CD4+, CD103+CD8+ lymphocytes and CD103+CD4+/CD4+ ratios in sarcoidosis (p= 0.008, p= 0.048, p= 0.014, respectively). CONCLUSIONS: Cytological examination of EBUS-guided lymph node samples may provide substantial findings in differential diagnosis of sarcoidosis. Patients with sarcoidosis have higher CD4+ lymphocytes, lower CD103+CD4+ lymphocytes and CD103+CD4+/CD4+ and CD103+CD8+ lymphocyte ratios. These subsets of lymphocytes in lymph node biopsies may be novel predictors of sarcoidosis diagnosis.

Correlation between the Diagnostic Yield from the Bronchoalveolar Lavage Fluid Analysis and Clinicoradiological Findings in Sarcoidosis.

OBJECTIVES: The diagnosis of sarcoidosis is frequently challenging, requiring a search for less invasive, more reliable diagnostic methods. The bronchoalveolar lavage fluid (BALF) analysis has been used in the differential diagnosis of sarcoidosis for many years with a wide sensitivity and specificity rates. The objective of the study is to investigate whether diagnostic performance of the BALF analysis is altered by clinicoradiological findings of patients with sarcoidosis. MATERIALS AND METHODS: The present study is a retrospective, single-center, observational study, designed in a sarcoidosis outpatient clinic in a training hospital. Patients who had undergone the bronchoalveolar lavage BAL procedure at diagnosis were included in the study. Demographics, clinical and detailed chest X-ray, and high-resolution computed tomography (HRCT) findings at diagnosis were recorded. According to the diagnostic performance, the BALF results were grouped as "diagnostic" and "non-diagnostic," and recorded parameters were compared between the groups. RESULTS: Considering the BALF analysis of all the 257 patients, the mean lymphocyte ratio was 41±17.5 (5-80), and the mean CD4/CD8 was 5.5±4.7 (0.1-24.7). The BALF analysis was diagnostic in 56% (n=145) of patients. Diagnostic performance of the procedure did not correlate with any of the demographic data, smoking status, spirometric findings, chest X-ray staging, HRCT findings, and tomography scoring. Extrapulmonary involvement was significantly more frequent in the diagnostic group (66% vs. 34%, p=0.006). CONCLUSION: BALF results signal sarcoidosis in more than half of the patients. The diagnostic role of BALF is greater in patients with extrapulmonary involvement.

Hyponatremia prolongs hospital stay and hypernatremia better predicts mortality than hyponatremia in hospitalized patients with community-acquired pneumonia.

INTRODUCTION: Dysnatremia is reported to have a prognostic effect in various diseases. A limited number of studies have been published on dysnatremiarelated parameters and clinical outcome in patients with pneumonia. The aim of the study is to analyze the factors related to baseline dysnatremia and to evaluate the clinical outcome of dysnatremia on hospital stay, 30-day and 1-year mortality in hospitalized patients with community-acquired pneumonia (CAP). MATERIALS AND METHODS: The study is a two-centre, retrospective, crosssectional study. According to the baseline corrected sodium values, hospitalized patients with CAP were grouped as hyponatremia (<135 mmol/L), normonatremia (135-145 mmol/L) and hypernatremia (> 145 mmol/L). RESULT: Of all the 471 patients included, 119 (25.3%) had hyponatremia and 25 (5.3%) had hypernatremia. Higher leucocytes and lower albumin values correlated with hyponatremia while female gender, higher leucocytes and urea levels correlated with hypernatremia. Baseline hyponatremia prolonged hospital stay (9.2 ± 5.6, vs. 7.5 ± 4.6, respectively, p= 0.001) and increased 1-year mortality. On the other hand, hypernatremia predicted 30-day (40%, vs. 10%, p<0.001) and independently predicted 1-year mortality (p< 0.001). CONCLUSIONS: In hospitalized patients with CAP, baseline hyponatremia prolongs hospital stay while hypernatremia signals a worse outcome both in the short term and long term.

Organizing Pneumonia as a Histopathological Term.

OBJECTIVES: Organizing pneumonia (OP) is an interstitial lung disease characterized by granulation tissue buds in alveoli and alveolar ductus, possibly accompanied by bronchiolar involvement. Histopathologically, OP may signify a primary disease and be observed as a contiguous disease or as a minor component of other diseases. In this study, the clinical significance of histopathological OP lesions and clinical and radiological features of patients with primary OP were examined. MATERIAL AND METHODS: Between January 2011 and January 2015, of 6,346 lung pathology reports, 138 patients with OP lesions were retrospectively evaluated. According to the final diagnoses, patients were grouped as reactive OP (those with final diagnosis other than OP) and primary OP (those with OP). Patients with primary OP were classified according to etiology as cryptogenic and secondary OP. Radiological evaluation was conducted within a categorization of "typical," "focal," and "infiltrative." RESULTS: Of 138 patients, 25% were males and the mean age was 54±14 years. Pathologically, 61% of patients had reactive OP and 39% had primary OP. All reactive OP lesions were reported using surgical specimens, and the most frequent primary diagnoses were malignancy (65%), infection (15%), interstitial lung diseases other than OP (7%), and bronchiectasis (5%). Other diagnoses included bullae, foreign body, hamartoma, bronchogenic cyst, and bronchopleural fistula. Of all the primary OP patients, 48 had cryptogenic OP and six had secondary OP. Radiological involvement was consistent with typical OP in 30%, focal OP in 63%, and infiltrative OP in 7% of the patients. All focal OP lesions were defined using surgical resections. Positron emission computed tomography (PET-CT) was recorded in 28 patients. In 11 patients, lymphadenomegaly was comorbid. The mean widest diameter of focal opacity was 2.7±1.2 (1.2-4.9) cm, and the mean the maximum standardized uptake value (SUVmax was 6.1±3.9 (1.7-16.7). CONCLUSION: OP lesions generally present as a minor component of other diseases. In patients with OP, cryptogenic OP and radiological focal OP is more frequently observed. Most focal OP lesions are detected using surgical resections because of malignant prediagnosis owing to elevated SUVmax.

A Rare Case of Progressive Dyspnea and Bilateral Lung Infiltration in a Young Male.

Pulmonary lymphangitic carcinomatosis (PLC) is defined as infiltration of the lymphatic vessels and perilymphatic connective tissue with tumor cells, which is secondary to malignancy. Therefore, it rarely appears as an initial finding preceding a diagnosis of malignancy. A 30-year-old male patient was hospitalized in our clinic with a pre-diagnosis of interstitial lung disease owing to the complaints of dry cough, progressive dyspnea, and acute respiratory insufficiency. He was diagnosed with signet ring cell carcinoma, which is a histologic subtype of adenocarcinoma, via gastroscopy, and lung involvement was consistent with PLC. Regardless of the patient age, PLC should be considered in differential diagnoses of progressive dyspnea, acute respiratory failure, and widespread interstitial lung involvement.

The predictors of mortality in IPF - Does emphysema change the prognosis?

BACKGROUND: Combined idiopathic pulmonary fibrosis (IPF) and emphysema (CPFE) has been reported to be more common in male smokers. A number of studies comparing CPFE patients with fibrosis-only patients have reported a similar prognosis while others have reported a significantly shorter survival. OBJECTIVES: In present study, we aimed to compare baseline characteristics of patients with IPF according to emphysema presence. We asssessed the prognostic value of emphysema along with each other parameter. METHODS: We retrospectively reviewed the clinical, baseline radiological, laboratory and physiological parameters of 92 patients who were diagnosed with IPF. The patients were divided into two groups: those without emphysema (Group 1) and with emphysema (Group 2). All-cause mortality was recorded, and the impact of the variables on survival was evaluated. RESULTS: Emphysema was recorded in 23 patients, all of whom were male. While ever-smoker rate was higher in Group 2 laboratory and physiologic parameters were similar. Radiologically, the presence of honeycombing, ground glass opacity, the extension and symmetry of involvement did not differ between the Groups. The median survival time was 29±4 months. Patients in Group 1 and 2 had a median survival of 34 and 9 months, respectively. In univariate analysis; radiological presence of emphysema and honeycombing, male gender, lower baseline levels of albumin and oxygen saturation, forced vital capacity and carbon monoxide diffusing capacity were detected as predictors of mortality. CONCLUSION: In present study, IPF with emphysema was more common in male smokers. When emphysema accompanies IPF, life expectancy is remarkably worse, but not independently so.

Supervivencia en exacerbaciones de la enfermedad pulmonar obstructiva crónica que requirieron ventilación no invasiva en planta / Patient Outcome after Chronic Obstructive Pulmonary Disease Exacerbations Requiring Non-invasive Ventilation during Hospitalization

Introducción: La introducción de la ventilación no invasiva (VNI) durante las exacerbaciones agudas hipercápnicas de la enfermedad pulmonar obstructiva crónica (EPOC) en plantas de hospitalización general ha demostrado ser eficaz, pero hay escasos datos sobre el pronóstico de estos pacientes. El objetivo de este estudio fue investigar la evolución intrahospitalaria y a largo plazo de pacientes con exacerbaciones de la EPOC que requirieron terapia VNI durante su ingreso en plantas de hospitalización general. Métodos: En este estudio de cohortes retrospectivo y unicéntrico se incluyó a pacientes con exacerbaciones hipercápnicas de la EPOC ingresados en planta entre los años 2011 y 2013. Se recabaron datos clínicos, analíticos y de supervivencia tras una mediana de 27 meses y se analizaron los factores predictivos de la mortalidad durante el ingreso y a largo plazo. Resultados: Se registraron datos de un total de 574pacientes (357varones, edad media 68±11 años). Durante el periodo de hospitalización fallecieron 24pacientes (4,1%). Se observó que la mortalidad durante la hospitalización era mayor en los pacientes que presentaban concentraciones de hematocrito y albúmina más bajas y recuentos leucocitarios más altos en el momento del ingreso, y en aquellos con pH bajo y PaCO2 alta 24h más tarde. La mediana de tiempo de supervivencia de esta cohorte fue de 27meses. Las tasas de mortalidad a los 3 y 6meses y a un año fueron del 14,5, 19,5 y 30%, respectivamente. En el análisis univariante, se observó que la menor supervivencia a largo plazo estaba relacionada con la edad avanzada, un índice de Charlson alto y concentraciones de hematocrito y albúmina bajas en el momento del ingreso, y un pH bajo al cabo de 24h. En el análisis multivariante, los factores de predicción de la mortalidad más sólidos fueron la edad avanzada y las bajas concentraciones de albúmina. Conclusión: Tras una exacerbación de la EPOC que haya requerido VNI, la esperanza de vida es corta. El hemograma inicial y los resultados de la gasometría arterial del segundo día pueden pronosticar la mortalidad durante la hospitalización. Los indicadores más sólidos de mala evolución a largo plazo son la edad avanzada y las bajas concentraciones de albúmina. Es posible que estos pacientes requieran un seguimiento más estrecho

Introduction: Noninvasive ventilation (NIV) during hospitalization for acute hypercapnic exacerbations of chronic obstructive pulmonary disease (COPD) has been shown to be effective, but data on the prognosis of such patients is limited. The aim of this study was to investigate in-hospital and long-term outcome in patients with COPD exacerbations requiring NIV treatment during hospitalization. Methods: Between 2011 and 2013, hospitalized subjects with hypercapnic COPD exacerbations were included in this retrospective single-center cohort study. Subjects’ clinical and laboratory data and survival status after a median of 27 months were recorded. The predictive factors of in-hospital and long-term mortality were analyzed. Results: A total of 574 patients (357 men, mean age 68±11 years) were recorded. During hospitalization, 24 (4.1%) patients died. In-hospital mortality was negatively affected by lower baseline values of hematocrit, albumin, and pH, and by higher baseline leucocytes and higher 24h PaCO2. Median survival of the cohort was 27 months. Mortality at 3 and 6 months, and 1 year were 14.5%, 19.5%, and 30%, respectively. In the univariate analysis, reduction in long-term survival was found to be related to older age, higher Charlson score, lower baseline levels of hematocrit and albumin, and lower pH level after 24h. In the multivariate analysis, older age and lower albumin were identified as the strongest predictors of mortality. Conclusion: Life expectancy after a COPD exacerbation requiring NIV treatment is short. Baseline blood counts and day 2 arterial blood gases levels may predict in-hospital mortality. The strongest indicators of poorer long-term outcome were advanced age and lower albumin. Such patients may need closer follow-up

Patient Outcome after Chronic Obstructive Pulmonary Disease Exacerbations Requiring Non-invasive Ventilation during Hospitalization. / Supervivencia en exacerbaciones de la enfermedad pulmonar obstructiva crónica que requirieron ventilación no invasiva en planta.

INTRODUCTION: Noninvasive ventilation (NIV) during hospitalization for acute hypercapnic exacerbations of chronic obstructive pulmonary disease (COPD) has been shown to be effective, but data on the prognosis of such patients is limited. The aim of this study was to investigate in-hospital and long-term outcome in patients with COPD exacerbations requiring NIV treatment during hospitalization. METHODS: Between 2011 and 2013, hospitalized subjects with hypercapnic COPD exacerbations were included in this retrospective single-center cohort study. Subjects' clinical and laboratory data and survival status after a median of 27 months were recorded. The predictive factors of in-hospital and long-term mortality were analyzed. RESULTS: A total of 574 patients (357 men, mean age 68±11 years) were recorded. During hospitalization, 24 (4.1%) patients died. In-hospital mortality was negatively affected by lower baseline values of hematocrit, albumin, and pH, and by higher baseline leucocytes and higher 24h PaCO2. Median survival of the cohort was 27 months. Mortality at 3 and 6 months, and 1 year were 14.5%, 19.5%, and 30%, respectively. In the univariate analysis, reduction in long-term survival was found to be related to older age, higher Charlson score, lower baseline levels of hematocrit and albumin, and lower pH level after 24h. In the multivariate analysis, older age and lower albumin were identified as the strongest predictors of mortality. CONCLUSION: Life expectancy after a COPD exacerbation requiring NIV treatment is short. Baseline blood counts and day 2 arterial blood gases levels may predict in-hospital mortality. The strongest indicators of poorer long-term outcome were advanced age and lower albumin. Such patients may need closer follow-up.

Two Chronic Granulomatous Disease Diagnosed in Adult Age.

Chronic granulomatous disease (CGD) is a rare, inherited primary immunodeficiency that is usually diagnosed at adulthood and is presented with recurrent bacterial and fungal infections. In this case report, two adult cases of CGD have been presented. A 29-year-old woman was referred to our clinic with hypoxic respiratory failure, with a pre-diagnosis of multidrug resistant tuberculosis (TB). Her lung biopsy had been reported as granulomatous inflammation, she had not responded to a 5 month anti-TB treatment. A complete medical history consisted of 4 occasions of treatment with anti-TB drugs and that her sister and brother had undergone TB therapy. However, since childhood, a TB bacilli had never been isolated microbiologically in the siblings. Patient's parents were third degree consanguineous. The patient still had a purulent drainage around the operation site. Microbiological studies of the wound drainage and respiratory tract have not encountered any specific microorganism. Investigation of an immunodeficiency has proved CGD through nitroblue tetrazolium test. Her siblings has been diagnosed as CGD as well. Second case, a 19-year-old male, has been admitted to our clinic with complaints of fever, chest pain and an abscess lesion in the anterior chest wall. His medical history comprised 3 recurrences of pneumonia within last 2 years. In physical examination, a 3 × 5 cm fluctuant swelling lesion on the anterior chest wall. Radiologically, new pneumonic consolidations were detected. Sputum specimens did not provide any specific microorganism, cultures of the chest-wall abscess fluid grew aspergillus. His parents had been living in the same village but no consanguinity was known. Due to recurrent infections, immunodeficiency tests had been investigated. He was diagnosed as CGD due to dihydrorhodamin test. These two cases signify that, in our country where consanguinity is common, etiology of recurrent unexplained infections, abscesses and granulomas should be investigated and CGD should be in differantial diagnosis list.

Cases Diagnosed with Swyer James Macleod Syndrome in Adulthood.

Swyer-James-MacLeod syndrome or unilateral hyperlucent lung syndrome is a rare disease characterised by hypoplasia of the pulmonary artery, unilateral hyperlucent lung and usually bronchiectasis. The syndrome was first described by Swyer and James in 1953 in a child case, and in the following year 9 adult cases were reported by MacLeod. We retrospectively reviewed 6 adult cases, five female and one male, who were followed-up with the diagnosis of Swyer-James-MacLeod syndrome between 2005 and 2012 in our clinic. The clinical and radiological features of these 6 cases are presented in the light of the literature.

Eosinophilic Lung Disease: Accompanied with 12 Cases.

OBJECTIVES: Eosinophilic lung diseases are a rare group of heterogeneous diseases characterized by the increase of the eosinophil ratio in airways and lung parenchyma. In our clinic, patients diagnosed with eosinophilic lung disease were evaluated with their clinical features and prognoses. MATERIAL AND METHODS: In our clinic, 12 cases that were diagnosed and followed up for eosinophilic lung disease [eosinophilic granulomatosis with polyangiitis (EGPA, Churg-Strauss syndrome) (n=4), chronic eosinophilic pneumonia (CEP) (n=7), and simple pulmonary eosinophilia (Löffler's syndrome) (n=1)] were retrospectively evaluated. RESULTS: Of the 12 cases, 8 were females, and the average age was 43 (28-72) years. All cases were undergoing bronchodilator therapy with asthma diagnosis (2 months-40 years). Additionally, 4 of the cases had sinusitis, and 1 had allergic rhinitis. The most common complaints of the patients were difficulty in breathing and coughing, and the duration of complaints was a median of 2 months. Peripheral eosinophilia and total IgE elevation were present during the admission of all cases; additionally, leucocyte elevation was recorded in 10 of them, anemia in 4 of them, and thrombocytosis in 4 of them. Moreover, 43% of the recorded DLCO values were lower than normal. Of the 10 cases that underwent bronchoalveolar lavage (BAL), the eosinophil ratio was above 25% in 7 subjects. Of the 8 cases that underwent transbronchial biopsy, eosinophil-involving infiltration was detected in 6 subjects. Additional findings in cases diagnosed with EGPA were nasal polyposis (n=1), sinusitis (n=2), polyneuropathy (n=1), cardiac involvement (n=2), and skin involvement in biopsy (n=1). Spontaneous recovery was observed in the patient diagnosed with simple pulmonary eosinophilia during the follow-up that was performed based on the history and laboratory and BAL results of the patient. Prednisolone treatment was started for all cases, except for simple pulmonary eosinophilia, and their controls were performed. Relapse was observed in eight cases (EGPA: 4, CEP: 4); during the relapse treatment of one case diagnosed with EGPA, exitus occurred. One case rejected treatment despite the presence of peripheral eosinophilia, and the other cases are being followed-up without medication. CONCLUSION: Given that the clinical pictures in pulmonary eosinophilia syndromes are on a wide spectrum, a specific diagnosis is important. Progression may differ in each patient, and a close follow-up is necessary during and after the treatment.

Diagnostic yield of closed pleural brushing.

The aim of this study was to assess the diagnostic yield of closed pleural brushing (CPBR) in the diagnosis of malignant pleural effusion. Twenty-one adult patients (20 men and 1 woman); aged 62.9 +/- 8.6 were participated to this prospective study. Thoracentesis, CPBR and closed pleural biopsy (CPB) following the brushing were applied to every patient. While CPBR provided diagnosis in 12 (57.1%) of 21 cases, in 3 of these 12 cases, pleural fluid cytology (PFC) and CPB were negative. The sensitivities of PFC, CPBR and CPB in the diagnosis of malignant effusions were 33%, 57% and 52%, respectively. When three procedures were used in combination, the sensitivity increased to 67%. When CPBR is performed in addition to PFC and CPB, the yield of the diagnosis increased 14% additionally. There was no mortality due to these interventions. Complications were chest pain in 3 (14.2%) cases, hypotension in 2 (9.5%) cases, cough in 1 (4.8%) case, pneumothorax in 1 (4.8%) case, and hemothorax in 1 (4.8%) case. In conclusion, CPBR as a safe, simple and well tolerated procedure provides high diagnostic yield in diagnosis of patients with malignant pleural effusion.