Predictive value of qsofa in early mortality risk stratification in acute pulmonary embolism.

BACKGROUND: Pulmonary Embolism Severity Index (PESI) and simplified PESI (sPESI) methods are used in the evaluation of patients with suspected acute pulmonary thromboembolism (PTE). OBJECTIVES: This study aimed to provide a rapid mortality risk stratification in patients with acute pulmonary thromboembolism (PTE) immediately after admission without relying on laboratory data by using quick sequential organ failure assessment (qSOFA), a three-parameter scoring system with proven efficiency used for swift prediction of organ dysfunction, and compare it with Pulmonary Embolism Severity Index (PESI) and simplified PESI (sPESI). METHODS: This study included outpatients and inpatients diagnosed with acute PTE in our clinic and whose PESI, sPESI and qSOFA scores were calculated for early mortality risk classification. RESULTS: A total of 123 patients who were objectively diagnosed with PTE and followed up were prospectively observed. When their qSOFA scores were compared with the early mortality risk stratification in acute PTE, patients with a high qSOFA score were determined to be in the high-risk group in the early mortality risk stratification (p < 0.001). Overall, 69.2% of 26 patients with a high qSOFA risk (≥2) were found to be in the high-risk group in the early mortality risk binary stratification in acute PTE (p < 0.0001). CONCLUSIONS: The qSOFA score provides guidance to identify patients with acute PTE with potentially life-threatening hemodynamic decompensation or collapse in need of reperfusion therapy.

Effect of tocilizumab on intensive care patients with Covid-19 pneumonia, a retrospective cohort study.

BACKGROUND: In this study, the efficacy of an IL-6 antagonist, Tocilizumab, administered in the early period was studied in intensive care patients with COVID-19 pneumonia followed by hypoxic and systemic inflammation not receiving mechanical ventilation support. METHODS: Patients with COVID-19 pneumonia who have signs of hypoxia and systemic inflammation and/or who have acute bilateral infiltrates on chest radiograph and who received tocilizumab treatment were compared with the patients who received standard medical therapy. Patients who were followed up with COVID-19 pneumonia and respiratory failure between March 2020 and March 2021 were retrospectively evaluated in the study. A 400 mg - 800 mg iv dose (depending on weight) of Tocilizumab was administered. The primary endpoint was determined as intensive care unit mortality. RESULTS: A total of 213 patients who were admitted with respiratory failure associated with COVID-19 to our third-level intensive care unit were evaluated. Of these patients, the study was conducted with 50 patients in the tocilizumab treatment group and 92 patients in the standard treatment group. During the intensive care period, 26 patients (28.3%) in the standard treatment group and 12 patients (24%) in the group receiving tocilizumab died. The adjusted hazard ratio for mortality in the tocilizumab group was 0.39 (95% confidence interval [CI], 0.186 to 0.808; p = 0.001 by log-rank test). During the intensive care period, 22 patients (24.8%) in the standart treatment group and 16 patients (32%) in the tocilizumab group were intubated. The adjusted hazard ratio for a primary outcome intubation in the tocilizumab group was 0.71 (95% confidence interval [CI], 0.355 to 1.424; p = 0.184 by log-rank test).

Diagnostic Value of Radiographic Characteristics of Mediastinal and Hilar Lymph Nodes in Sarcoidosis.

OBJECTIVE: In this study, it was aimed to investigate the diagnostic value of thorax computed tomography, which is a non-invasive method, in diagnosing sarcoidosis. MATERIALS AND METHODS: In our Faculty of Medicine, Department of Chest Diseases between January 1, 2013, and July 1, 2019, the data of 816 patients who underwent endobronchial ultrasonography for mediastinal lymph node sampling and other sampling methods, such as mediastinoscopy, thoracotomy, etc., if the histopathological diagnosis could not be reached, were retrospectively screened and 192 patients (sarcoidosis: 62, non-sarcoidosis: 130 patients) who met the inclusion criteria were included in the study. Patients diagnosed with sarcoidosis and patients diagnosed with non-sarcoidosis were compared in terms of thorax computed tomography findings (medi- astinal lymph nodes and lung parenchymal involvement). RESULTS: Right upper paratracheal (72.6 vs. 46.9%, P = .001) and paraaortic lymph node involvement (79.0% vs. 60.8%, P = .01), hilar symmetry (88.5 vs. 58.3%, P < .001), and homogeneity in lymph nodes (80.6% vs. 56.9%, P = .001) were found to be significantly higher in the sarcoidosis group. Lymph node sizes were smaller in the sarcoidosis group and the mean density (51.3 Hounsfield unit vs. 44.1 Hounsfield unit, P = .002) was significantly higher. In the multivariate logistic regression analysis, the presence of homogeneity in the lymph nodes is 4.3-fold more likely to increase sarcoidosis, the presence of hilar symmetry 9.1-fold, the involvement of the right lower paratracheal lymph node 2.7-fold, the mean lymphadenopathy density >48 Hounsfield unit 4.3-fold, the maximum diameter of lymphadenopathy less than 27.5 mm 4.7-fold. CONCLUSION: This study revealed that the localization, size, density, and homogeneity of mediastinal lymph nodes will help clinicians to diagnose patients with sarcoidosis without using invasive methods.

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.

Fungal culture results and clinical effects of bronchoscopy specimens.

Introduction: Early isolation of the fungal pathogen and early initiation of treatment affect mortality and morbidity rates. The purpose of this study was to reveal the frequency of determination of fungal pathogens in bronchoscopy unit patients. Materials and Methods: The study was designed retrospectively. All patients who underwent bronchoscopy for any reason were enrolled. The patients with suspected fungal infection were divided into three groups after the procedure: 1) Proven fungal infection, 2) Colonization, 3) Without infection. Result: One thousand one hundred and twenty-eight patients were included in the study. Fungal infection was suspected in 188 (16.7%) patients before bronchoscopy. After the examination of the bronchoscopic materials, it was determined that 59 (5.2%) patients had proven fungal infection, 148 (13.1%) patients had colonization, and 921 (81.7%) patients did not have fungal infection. The radiological findings of the patients that were indicative of fungal infection before bronchoscopy were observed as consolidation in 391 (34.7%) and nodule in 413 (36.6%). Fungal growth in bronchoscopic cultures was found in 186 (16.4%) patients, and the most common fungus was Candida albicans (C. albicans) in 110 (9.7%). The treatment was not changed according to the culture results in the patients. No treatment was initiated in the other 108 (98.2%) patients with C. albicans. One hundred and sixty-five (88%) of all fungal growths were detected in the BAL/bronchial lavage fluid. While 29 (45%) of them had not received antifungal treatment before, antifungal treatment was started after bronchoscopy. Conclusions: C. albicans was isolated the most among all bacterial and fungal agents in all patient groups that were immunosuppressed or not at a routine bronchoscopy unit. Diagnostic bronchoscopic sampling should be performed at the early stages of clinically or radiologically suspected fungal illness.

Timeline of critically ill 2019 SARS-CoV-2 cases after onset of illness: Intensive care data from Turkey.

Introduction: This study aimed to evaluate the epidemiological, clinical, laboratory characteristics and treatment and clinical outcomes of severe COVID19 cases from a 3rd degree intensive care unit in Turkey. Materials and Methods: The study was conducted in a level three, 16-bed COVID intensive care unit. The investigation was planned as a retrospective and observational study. Patients who were admitted with COVID-19 pneumonia and respiratory failure in the intensive care unit between March 2020 and March 2021 and followed up due to critical illness were evaluated. Result: A total of 213 patients that were admitted to the intensive care unit with the diagnosis of COVID-19 pneumonia were included in the study. Median age of the patients was 66 (IQR 56.5-74) years, and 134 (62.9%) were males. One hundred and sixty-six (77.9%) of the patients had at least one comorbidity. Patients were followed up mainly with invasive mechanical ventilation [104 (48.8%)] and high flow nasal cannula [67 (31.5%)]. Median number of days was 7 (IQR 4-10) and included the first symptom onset to intensive care admission. The time to intubation was 9 (IQR 4-15) days, and the median day to intensive care discharge was 16 (IQR 11-23). After the symptoms started, first tocilizumab 9 (IQR 5-11) and pulse steroid treatment 8 (IQR 3-11) were found to be close to each other. In total, 95 (44.6%) of the 213 patients died. Conclusions: SARS-CoV-2 associated viral disease can progress after simple symptoms to hospital admission in a median of four days and to intensive care admission requiring intubation in a median of nine days. We believe that a better understanding of the clinical course of COVID-19 and its change between centers can be revealed through sharing information from different countries and centers.

Extracorporeal membrane oxygenation experiences during COVID-19 pandemic, third wave with younger patients: A retrospective observational study.

OBJECTIVES: In this article, the results of severe coronavirus disease 2019 (COVID-19) cases followed with extracorporeal membrane oxygenation (ECMO) support in a 3-month period in the third wave when there were an increased number of cases of young patients in our intensive care unit (ICU) were presented. METHODS: The study was carried out with all COVID-19 patients who were given ECMO support in our tertiary referral hospital ICU after obtaining the consent of the Ministry of Health Scientific Research Platform and after the approval of the local ethics committee. Patient data were obtained retrospectively from intensive care bedside follow-up charts and computer records. The demographic and clinical characteristics of the patients were presented in average, median, and percentages. The data of the patients were evaluated and compared with the current literature. RESULTS: ECMO treatment was applied in seven patients who were followed up with severe COVID-19 pneumonia in the last 3 months. Venovenous extracorporeal membrane oxygenation (VV-ECMO) was applied to all patients. Five (71.5%) of seven patients were weaned from ECMO. Four (57.2%) of seven patients were discharged from the ICU and hospital in good health. While two of the patients had a cesarean section (C/S) before ECMO, one patient underwent C/S under ECMO. All three newborns were delivered via C/S and all were premature (C/S dates were 35 weeks, 32 weeks, and 27 weeks), and all were discharged from the hospital in good health. CONCLUSION: Our experience shows that ECMO in COVID-19 patients is a lifesaving treatment option that can be successfully applied in severe acute respiratory distress syndrome cases who do not respond to conventional treatments.

Effect of early or delayed administration of warfarin with heparin on thrombosis in pulmonary thromboembolism.

OBJECTIVE: The aim of this study was to investigate the effect of early or delayed warfarin administration with unfractionated heparin (UFH) on coagulation parameters in pulmonary thromboembolism (PTE). PATIENTS AND METHODS: This study was performed between November 2006 and July 2007. Thirty-three patients with PTE were sequentially slotted to early (n = 16) and delayed (n = 17) warfarin treatment groups. In the early group, both UFH infusion and warfarin were started simultaneously and in the delayed group, warfarin was added (1-3 days later) based on when partial thromboplastin time reached the therapeutic level with UFH. The proteins C and S, D-dimer, hematocrit levels, and platelet counts for all patients were studied prior to treatment and 6, 24, and 48 h after warfarin treatment. In order to determine the overall effect of early and delayed warfarin treatment on clot formation, a thromboelastogram was performed simultaneously. RESULTS: In both groups, a similar chronological decrease in protein C levels reaching maximum at 24 h with warfarin treatment was observed. However, intragroup or intergroup decreases in protein S levels were not different. On thromboelastogram, INTEM and EXTEM clotting times were significantly prolonged chronologically, but this prolongation was not different between groups. CONCLUSION: The suppressor effect of warfarin on proteins C and S in the early period of double anticoagulant treatment did not appear to aggravate the risk of thrombosis in patients with PTE in whom warfarin was started simultaneously with UFH.