The role of LENT and PROMISE scores in predicting survival in malignant pleural effusion.

Background: Malignant pleural effusion (MPE) is a condition, that can be seen in 15% of patients diagnosed with cancer. Because of the short overall survival, it is important to identify the appropriate treatment. In addition to the palliation of secondary symptoms due to MPE, it should also be decided in which cases a more aggressive treatment is to be followed. The purpose of the study was to evaluate the performance of LENT and clinical PROMISE scores in predicting survival in patients with MPE. Methods: Age, sex, smoking history, Eastern Cooperative Oncology Group (ECOG) score, cancer type, history of chemotherapy/radiotherapy, laboratory values, and pleural fluid lactate dehydrogenase were recorded. The LENT and the PROMISE scores were calculated and risk categories were determined. During the follow-up, blood tests and tomography controls were performed on the patients as routine. The overall survival was calculated as the period from the date of diagnosis of MPE to death or until December 31, 2019. Results: A total of 169 patients were included. The median age was 65 (26-86). In the single-variable analysis, there was a significant increase in mortality risk in the poor performance score and if the LENT risk group progressed from the low-to medium-/high-risk group or PROMISE categories A to B, A to C or A to D. In multivariate analysis, mortality risk in 1, 3, 6, and 12 months increased significantly in poor performance score, in PROMISE category B, C, and D. In high LENT risk-group, an increased mortality risk was shown in only 12 months of survival. Conclusions: Our data show that poor performance score (ECOG 3-4), PROMISE category B, C, and D significantly increase mortality risk and the LENT score is inadequate in predicting survival.

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.

Correlation of preoperative PET/computer tomography 18F-fluorodeoxyglucose uptake (maximum standardized uptake value) with prognosis in patients with operated lung cancer.

PURPOSE: The aim of this study was to investigate the correlation of preoperative 18F-fluorodeoxyglucose PET/computed tomography maximum standardized uptake value (SUVmax) in operated non-small cell lung cancer (NSCLC) cases with other prognostic parameters and survival. PATIENTS AND METHODS: NSCLC patients treated by surgical resection were imaged with PET within 60 days before surgery. RESULTS: Overall, 525 cases consecutive patients were retrospectively reviewed. The median value of SUVmax in a total of 525 cases was 12.1, and the mean was 13.3 ± 7.13. Logistic regression analysis performed to identify the variables that have an impact on SUVmax revealed that histology [hazard ratio (HR: 1.893; 95% CI; P = 0.001) and T status (HR: 8.991; 95% CI; P = 0.000) are correlated with SUVmax. Kaplan-Meier analysis revealed a mean survival of 73.7 ± 1.95 months and a median survival of 85.6 ± 6.03 months. In the group with an SUVmax value of less than 10, the mean survival was 81.9 ± 3.02 months (76.0-87.8), and in the group with SUVmax greater than 10.1, the mean survival was 68.6 ± 2.4 months (63.9-73.3) (P = 0.000). In the multivariate analysis, SUVmax, age, tumor histology, lymph node metastasis, comorbid diseases and complete/incomplete status of the resection were identified as the factors predictive of prognosis. CONCLUSION: It is seen that preoperative SUVmax is a parameter with prognostic significance at least as much as histopathology, age, complete/incomplete status of resection and lymph node involvement.

Characteristics of hospitalised COVID-19 patients and parameters associated with severe pneumonia.

BACKGROUND: After the first case of coronavirus disease 2019 (COVID-19) was reported in China in December 2019, it caused a global pandemic, including Turkey. OBJECTIVES: The aim of this study was to analyse the characteristics of hospitalised COVID-19 patients and assess the parameters related to severe pneumonia. METHODS: Included in the study were hospitalised COVID-19 patients with positive naso-oropharyngeal swabs. Patients' demographics, admission symptoms, laboratory and radiological findings were recorded retrospectively. RESULTS: Of 1013 patients, 583 were males (57.6%) and 430 were females (42.4%), with a mean age of 53.7 ± 17.9. More than half of the patients had at least one comorbidities, the most common of which were hypertension and diabetes mellitus. Cough (59.8%), fatigue (49.5%) and fever (41.2%) were the most common presenting symptoms. Of the hospitalised COVID-19 patients, 84.9% had pneumonia and 83.5% had typical radiological COVID-19 appearances (94.5%: ground-glass areas). The most common laboratory findings were high C-reactive protein (CRP) (73.6%) and lactate dehydrogenase (LDH) (46.2%) levels, as well as lymphopenia (30.1%). Severe pneumonia was present in 28.1% of COVID-19 patients. Multivariate logistic regression analysis indicated that advanced age, hypotension, anaemia and elevated CRP and LDH serum levels were independent risk factors for the severity of COVID-19 pneumonia (P = .011, .006, .017, .003 and .001, respectively). CONCLUSION: This study, as one of the first multicentre studies about characteristics of COVID-19 in Turkey, may guide about disease-related parameters and severity of pneumonia. Age, blood pressure, complete blood count and routine biochemical tests (including CRP and LDH) would appear to be important parameters for the evaluation of the severity of COVID-19 pneumonia.

COVID-19 phobia in healthcare workers; a cross-sectional study from a pandemic hospital.

INTRODUCTION: Healthcare workers (HCWs) are at the forefront of the fight against coronavirus. The purpose of this study was to evaluate COVID-19 phobia levels of HCWs of a pandemic hospital and explore associated factors. MATERIALS AND METHODS: This was a descriptive cross-sectional study conducted on HCWs employed in a pandemic hospital. A total of 365 HCWs (95 physicians, 187 nurses and 83 assistant healthcare staffs) were included in the study. In order to evaluate COVID-19 phobia, coronavirus-19 phobia scale (C19P-S) was administrated. Chronophobia levels of frontline and nonfrontline HCWs were compared. Additionally, the effect of working in different departments, profession and associated factors on COVID-19 phobia was evaluated. RESULT: Overall, 172 HCWs completed the C19P-S and agreed to participate in the study. Mean total CP19P-S score of the HCWs included in the study was 50.1 ± 17.3. Of the study population, 59.3% participants were frontline HCWs and 40.7% were non-frontline HCWs. When frontline HCWs and nonfrontline HCWs were compared in terms of total C19P-S and subscales scores (psychological, psycho-somatic, economic, social), no statistically significant differences were found (p= 0.914, p= 0.687, p= 0.766, p= 0.347, p= 0.794, respectively).When the HCWs were divided into three groups according to departments (clinics, intensive care unit (ICU), emergency department) where they worked regardless of whether they cared for patients with COVID-19, HCWs employed in the ICUs had the highest scores regarding total C19P-S and subscales scores (p= 0.002, p= 0.001, p= 0.001, p= 0.012, p= 0.002,respectively) . Profession based comparison revealed no significant difference between the groups regarding total C19P-S score (p= 0.117). CONCLUSIONS: It is essential to make a comprehensive evaluation regarding the effects of pandemics on HCWs, not only for controlling the COVID-19 pandemic but also to protect the mental health of HCWs. Critical care professions appear to need particular attention among HCWs. The C19P-S, which assesses coronaphobia levels with psychological, psycho-somatic, economic, and social aspects could be a convenient screening tool for evaluating COVID-19 phobia levels in HWCs.

Efficacy and safety of an inactivated whole-virion SARS-CoV-2 vaccine (CoronaVac): interim results of a double-blind, randomised, placebo-controlled, phase 3 trial in Turkey.

BACKGROUND: CoronaVac, an inactivated whole-virion SARS-CoV-2 vaccine, has been shown to be well tolerated with a good safety profile in individuals aged 18 years and older in phase 1/2 trials, and provided a good humoral response against SARS-CoV-2. We present the interim efficacy and safety results of a phase 3 clinical trial of CoronaVac in Turkey. METHODS: This was a double-blind, randomised, placebo-controlled phase 3 trial. Volunteers aged 18-59 years with no history of COVID-19 and with negative PCR and antibody test results for SARS-CoV-2 were enrolled at 24 centres in Turkey. Exclusion criteria included (but were not limited to) immunosuppressive therapy (including steroids) within the past 6 months, bleeding disorders, asplenia, and receipt of any blood products or immunoglobulins within the past 3 months. The K1 cohort consisted of health-care workers (randomised in a 1:1 ratio), and individuals other than health-care workers were also recruited into the K2 cohort (randomised in a 2:1 ratio) using an interactive web response system. The study vaccine was 3 µg inactivated SARS-CoV-2 virion adsorbed to aluminium hydroxide in a 0·5 mL aqueous suspension. Participants received either vaccine or placebo (consisting of all vaccine components except inactivated virus) intramuscularly on days 0 and 14. The primary efficacy outcome was the prevention of PCR-confirmed symptomatic COVID-19 at least 14 days after the second dose in the per protocol population. Safety analyses were done in the intention-to-treat population. This study is registered with ClinicalTrials.gov (NCT04582344) and is active but no longer recruiting. FINDINGS: Among 11 303 volunteers screened between Sept 14, 2020, and Jan 5, 2021, 10 218 were randomly allocated. After exclusion of four participants from the vaccine group because of protocol deviations, the intention-to-treat group consisted of 10 214 participants (6646 [65·1%] in the vaccine group and 3568 [34·9%] in the placebo group) and the per protocol group consisted of 10 029 participants (6559 [65·4%] and 3470 [34·6%]) who received two doses of vaccine or placebo. During a median follow-up period of 43 days (IQR 36-48), nine cases of PCR-confirmed symptomatic COVID-19 were reported in the vaccine group (31·7 cases [14·6-59·3] per 1000 person-years) and 32 cases were reported in the placebo group (192·3 cases [135·7-261·1] per 1000 person-years) 14 days or more after the second dose, yielding a vaccine efficacy of 83·5% (95% CI 65·4-92·1; p<0·0001). The frequencies of any adverse events were 1259 (18·9%) in the vaccine group and 603 (16·9%) in the placebo group (p=0·0108) with no fatalities or grade 4 adverse events. The most common systemic adverse event was fatigue (546 [8·2%] participants in the vaccine group and 248 [7·0%] the placebo group, p=0·0228). Injection-site pain was the most frequent local adverse event (157 [2·4%] in the vaccine group and 40 [1·1%] in the placebo group, p<0·0001). INTERPRETATION: CoronaVac has high efficacy against PCR-confirmed symptomatic COVID-19 with a good safety and tolerability profile. FUNDING: Turkish Health Institutes Association.

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.

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.

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.

Diagnostic efficacy of EBUS-TBNA in benign diseases in a population with a high prevalence of tuberculosis.

SETTING: Although endobronchial ultrasonography-transbronchial needle aspiration (EBUS-TBNA) has a well-known place in the staging and diagnosis of lung cancer, the place of EBUS is not clear in the diagnosis of benign diseases, especially in countries with a high prevalence of tuberculosis. AIM: The aim of this study is to investigate the diagnostic efficacy of EBUS-TBNA in benign diseases in a population with a high prevalence of tuberculosis. MATERIAL AND METHODS: Between October 2011 and March 2018, 1077 EBUS-TBNA was applied. RESULTS: The diagnosis was reached with mediastinoscopy or video assisted thoracic surgery (VATS) in 41 (74.5%) and with the second EBUS-TBNA performed in 14 (25.5%) of 55 EBUS practices in 41 patients with malignancy diagnosis. The final diagnosis was achieved with clinical/radiological features in 7 (77.7%) cases of sarcoidosis, with VATS/mediastinoscopy in 2 (22.2%) cases, with EBUS-TBNA performed for the second time in 6 (54.5%) tuberculosis cases and with acid-resistance bacilli reproduction in Lowenstein-Jensen culture in 5 (45.4%) cases. Two hundred and ninety-five (79.7%) patients were accepted as "benign disease" due to the absence of radiological and clinical progression of lesions in the follow-up. CONCLUSION: The diagnostic accuracy of EBUS-TBNA is high in benign diseases such as sarcoidosis and tuberculosis.

Validation of the NoSAS score for screening sleep-disordered breathing: A sleep clinic- based study in Turkey

Background/aim: The NoSAS score is a new tool for the identification of high-risk patients for sleep-disordered breathing (SDB). The aim of this study was to validate the NoSAS score in a sleep clinical population in Turkey and compare its performance with the Epworth Sleepiness Scale (ESS), STOP-Bang, and Berlin questionnaires for high-risk SDB. Materials and methods: This was a retrospective study. Patients who had a full-night PSG examination between 01.03.2017 and 01.01.2018 at the sleep center of our hospital were included in the study. Demographic characteristics, anthropometrics measurements, ESS, STOP-Bang, and Berlin scores were collected from the existing data of the patients. The NoSAS score was subsequently calculated based on available data. Predictive parameters for each screening questionnaires were calculated to compare the discriminative power of those for high-risk SDB. Results: A total of 450 patients were included in the study. The sensitivity, specificity, PPV, and NPV of the NoSAS score were 81%, 51.2%, 88.2%, and 37.5% for an AHI (apnea­hypopnea index) ≥ 5 event/h and 84.5%, 38.2%, 66%, and 63.4% for an AHI ≥ 15 event/h, respectively. AUC percentages for the NoSAS score, STOP-Bang questionnaire, Berlin questionnaire, and ESS were 0.740, 0.737, 0.626, and 0.571 for an AHI ≥ 5 events/h and 0.715, 0.704, 0.574, and 0.621 for an AHI ≥ 30 events/h. The NoSAS score had a false negative rate of 2.9% for severe SDB. Conclusion: The NoSAS score had a good degree of differentiation for SDB and can be used as an easily applicable, subjective, and effective screening tool in a sleep clinical population in Turkey. Not only in moderate to severe SDB but also in mild SDB, the NoSAS score performed better than the other 3 screening tools.

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.

Compliance With the Legislation of the Smoking Cessation Clinic in Turkey.

OBJECTIVES: The number of smoking cessation outpatient clinics (SCCs) is increasing day by day in Turkey. The objective of this study is to evaluate the situation of smoking cessation clinics in our country. MATERIALS AND METHODS: The SCC list was obtained from the website of the Ministry of Health of the Republic of Turkey. A total of 305 centers from 80 cities were called by telephone, and a questionnaire including questions about polyclinics was directed to SCC employees whose verbal consent was obtained. RESULTS: Of the 305 SCCs, 183 could be reached, 33 of which did not provide outpatient services. A questionnaire was directed to 146 SCCs. A total of 347 doctors work in these centers. Of these 146 SCCs, 69 (47.3%) accepted patients with appointments and 77 (52.7%) accepted patients directly. The specializations of physicians in the SCCs were as follows: 84 (57.5%) were chest disease specialists, 30 (20.5%) were general practitioners, 10 (6.8%) were psychiatrists, 12 (8.2%) were other branch physicians, 6 (4.1%) were family physicians, and 3 (2.1%) were public health physicians. A total of 125 (85.6%) physicians working in SCCs received smoking cessation training. Only 35 (24%) SCCs have one or more provincial tobacco control members. Eighty (54.8%) SCCs had a separate SCC room, 74 (50.7%) had a waiting room for the patients, and 63 (43.2%) had a carbon monoxide (CO) measurement device in the SCC. CONCLUSION: All physicians in Turkey are able to provide smoking cessation services, but the chest physicians are mostly responsible for this task. In addition to increasing the number of SCCs, it is very important to increase the quality and comply with the standards.

Metabolic activity of primary tumour on PET/CT has a relationship with survival in stages I-III small-cell lung carcinoma.

INTRODUCTION: There is limited evidence about the prognostic value of FDG-PET/CT metrics in small cell lung cancer (SCLC) patients staged with TNM staging system. OBJECTIVES: The aim of this study is to examine the prognostic value of pretreatment FDG-SUVmax in patients with SCLC staged with 8th TNM staging system. METHODS: A total of 344 (292 male) SCLC patients with pretreatment FDG- PET/CT were included. One hundred fifty-three of cases were stages I-III, 191 were stage IV. SUVmax values were obtained for primary tumour, lymph nodes and metastases. Univariate and multivariate analysis were performed to determine the effect of pretreatment SUVmax, with cut-off value of median, on progression-free and overall survival (PFS and OS). RESULTS: Median OS and PFS for patients with stages I-III were 16.50 and 11.00 months, respectively. Median OS and PFS for patients with stage IV were 10.00 and 7.00 months, respectively. SUVmax of the primary tumour (PT), lymph nodes or metastasis were not associated with OS and PFS on univariate analysis. On multivariate analysis, SUVmax -PT with cut-off value of 11.60 was found to be an independent prognostic factor for OS in patients with stages I-III (HR;1.88, 95% CI:1.15-3.08, P = .012). But the SUVmax -PT (HR; 1.60, 95% CI: 0.99-2.60; P = .057) for PFS was found to be a prognostic factor with marginal significance. SUVmax were not significantly associated with OS and PFS in patients with stage IV disease. CONCLUSION: Pretreatment SUVmax -PT (median cut-off 11.6) may have a prognostic value of OS and PFS in patients with TNM staged I-III SCLC.

A new perspective for pulmonary thromboembolism radiology: 'Pulmonary vein sign'.

INTRODUCTION: Pulmonary thromboembolism (PTE) is a clinical condition that can result in sudden death. Computed tomography pulmonary angiography (CTPA) is the most sensitive imaging technique for the diagnosis of PTE. Filling defects in the pulmonary veins, which can be identified in areas adjacent to PTE, have been named the 'pulmonary vein sign' (PVS). OBJECTIVES: The aim of our study is to determine the frequency, sensitivity and specificity of PVS due to the decreased venous drainage in the affected area in PTE patients. METHODS: Patients who were admitted to the emergency department due to the suspicion of PTE and who underwent CTPA were evaluated retrospectively. The study group consisted of the patients who had an arterial filling defect on CTPA and were diagnosed with PTE. The control group consisted of the patients who had no arterial filling defect on CTPA. RESULTS: This study included 286 patients with a mean age of 62(20-94) years. The PVS was detected in 51(32.7%) of the patients in the study group and in 15(11.5%) of the patients in the control group. The PVS had a sensitivity of 32.69%, a specificity of 88.46%, a positive predictive value of 77.27% and a negative predictive value of 52.27% for PTE. The PVS was significantly more common in the patients having PTE in the bilateral pulmonary arteries or the main pulmonary arteries. CONCLUSION: Despite low sensitivity, the presence of PVS on CTPA is a radiographic marker with high specificity for PTE. To use in practice, there is need for studies with large numbers of patients.

The prognostic role of neutrophil-lymphocyte ratio and platelet-lymphocyte ratio in patients with stage III non-small cell lung cancer treated with concurrent chemoradiotherapy.

BACKGROUND: Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) have been shown to be prognostic markers in various types of cancers. In this study, we retrospectively investigated the prognostic role of NLR and PLR in stage III non-small cell lung cancer patients (NSCLC) treated with concurrent chemoradiotherapy (CCRT). MATERIALS AND METHODS: Seventy-nine stage III NSCLC patients treated with definitive CCRT were retrospectively evaluated. All patients received conformal RT with a total dose of 60-66 Gy with CCRT. The optimal cutoff values identified by receiver operating characteristic curve were 155 for PLR and 3.21 for NLR for overall survival (OS) and 142 and 3.21, respectively, for progression-free survival (PFS). RESULTS: Median age of the study population was 58 years with 72 (91%) males. Stages IIIA, IIIB, and IIIC were found in 21 (26.6%), 48 (60.8%), and 10 (12.7%) patients, respectively. Patients with a PLR <155 had a significantly longer OS (P = 0.038) compared with patients who had a higher PLR. The NLR and other parameters were not found to be in correlation with OS. In multivariable analysis, the PLR and lymphocyte count were significantly associated with OS (hazard ratio [HR]: 2.29, 95% confidence interval [CI]: 1.29-4.08, P = 0.005 and HR: 2.00, 95% CI: 1.17-3.42, P = 0.011, respectively). The PLR and lymphocyte count were identified as independent prognostic factors of poor PFS (HR: 2.08, 95% CI: 1.17-3.69, P = 0.012 and HR: 1.83, 95% CI: 1.08-3.08, P = 0.024, respectively). CONCLUSION: Our results support the prognostic role of pretreatment PLR and lymphocyte count in stage III NSCLC patients treated with concurrent radiotherapy.

Use of adjuvant chemotherapy for nonsmall cell lung cancer: Is advanced age a prognostic factor?

PURPOSE: In patients with nonsmall cell lung cancer (NSCLC), the effect of age on adjuvant chemotherapy (CT) after primary surgical treatment is controversial. The aim of this study was to investigate the effect of age and other clinical variables on survival in NSCLC patients who received adjuvant CT. MATERIALS AND METHODS: NSCLC patients who underwent primary resection and received adjuvant CT between January 2012 and January 2016 were included in the study. The patients were divided into two age groups: (1) patients >65 years old (older patient group) and (2) patients ≤ 65 years old (young patient group). The effects of clinical variables such as age, histology, pT stage, pN stage, pTNM stage, adjuvant thoracic radiotherapy, and recurrence status on survival were assessed using the log-rank test and multivariable Cox regression analysis. RESULTS: A total of 91 NSCLC patients who received adjuvant CT after complete resection were included in the study. The median age of the patients was 60 (36-73) years. Eighty-six percent of the patients were male. 49.4% had squamous NSCLC and 50.6% had nonsquamous NSCLC. 59% had stage I and II disease and 41% had stage III disease. The mean overall survival was 61.9 months [95% confidence interval (CI) 51.28-72.69] in the young patient group and 73.1 months (95% CI 60.24-85.94) in the older patient group . The mean disease-free survival was 47.0 months (95% CI 37.81-56.23) in the young patient group and 51.1 months (95% CI 40.68-57.17) in the older patient group (P = 0.119 and P = 0.407, respectively). Pathological stage III [heart rate (HR): 2.615, P = 0.014] and presence of recurrence (HR: 2.496, P = 0.019) were found to be independent risk factors. However, age did not show statistical significance (HR: 0.428, 95% CI 0.128-1.427, P = 0.167). CONCLUSION: In NSCLC patients who underwent complete resection and received adjuvant CT, advanced age had no prognostic effect on survival.

Evaluation of inhaler technique and patient satisfaction with fixed-combination budesonide/formoterol dry-powder inhaler in chronic obstructive pulmonary disease (COPD): data on real-life clinical practice in Turkey.

INTRODUCTION: The present study was designed to evaluate inhaler techniques and patient satisfaction with fixed-combination budesonide/formoterol dry-powder inhaler chronic obstructive pulmonary disease (COPD) in Turkey in real-life clinical practice. PATIENTS AND METHODS: A total of 442 patients with COPD [mean (SD) age: 63.2 (10.6) years, 76.5% were males] were included in this cross-sectional study conducted at 25 outpatient clinics across Turkey. Data on socio-demographic characteristics, characteristics of COPD, inhaler technique and satisfaction with dry-powder inhaler were recorded at a single crosssectional visit performed at the study enrolment. RESULTS: Patients were characterized by prominence of moderate to severe (78.1%) COPD, high rate of regular use of overall COPD medications (89.4%) and Turbuhaler® for an average of 33.7 months, predominance of males (76.5%), primary education (85.7%), urban location (68.3), ex-smokers (61.1%) and spending time outdoors for ≥ 4 hour/day (62.0%). Use of correct techniques was evident in majority of patients (≥ 94%), whereas inhalation maneuvers including breathing out gently away from mouthpiece without blowing into it (71.9%) and holding the breath for 5-10 seconds (78.3%) were performed correctly by lesser percent of patients especially in the older group (≥ 65 years, p< 0.05). Overall percent of patients with the feeling that she/he used the inhaler very/fairly correctly was 73.3%, while 86% of patients identified that they were very/fairly satisfied with the inhaler, irrespective of age and educational status. CONCLUSION: In conclusion, our findings revealed the majority of patients are able to use Turbuhaler® correctly regardless of the educational status, while older age was associated with higher rate of errors in inhalation maneuvers in the real clinical practice in Turkey. Majority of our patients identified Turbuhaler® to be very/fairly convenient regarding ease of use, portability, and usability with an overall self-confidence in using the inhaler correctly among 73% and the satisfaction rate of 86%; irrespective of age and educational level.

Valores pretratamiento e inducidos por el tratamiento de enolasa específica de neurona en pacientes con cáncer de pulmón microcítico: estudio prospectivo, abierto / Pre-treatment and Treatment-Induced Neuron-specific Enolase In Patients With Small-Cell Lung Cancer: An Open Prospective Study

FundamentoLa enolasa específica de neurona (EEN) es el marcador tumoral más sensible para el carcinoma de pulmón microcítico en el momento del diagnóstico. El objetivo del presente estudio fue revisar la utilidad de sus valores séricos como factor pronóstico en pacientes con este cáncer y determinar la correlación entre los valores y el estadio de la enfermedad y la respuesta a la quimioterapia.MétodosEn este estudio prospectivo, se evaluaron pacientes con carcinoma de pulmón microcítico para su respuesta a la quimioterapia, supervivencia sin progresión de la enfermedad y supervivencia global. El criterio de valoración se designó como la muerte del paciente debida a la enfermedad. Los análisis de EEN se efectuaron antes y después de completar la quimioterapia.ResultadosSe incluyeron en el estudio 65 pacientes. Los niveles de EEN fueron significativamente más altos en los pacientes que fallecieron de la enfermedad. En pacientes que respondieron al tratamiento los valores pretratamiento fueron significativamente más bajos. Los valores postratamiento no se correlacionaron significativamente con la respuesta a la quimioterapia, supervivencia libre de progresión, supervivencia global y pronóstico de los pacientes. El cambio de los valores de EEN entre el intervalo pre y postratamiento no se correlacionó significativamente con la respuesta al tratamiento, supervivencia libre de progresión y supervivencia global.ConclusionesLes posible que los valores de EEN no guarden relación con el estadio de la enfermedad. No obstante, en pacientes con carcinoma de pulmón microcítico, en la predicción de una respuesta apropiada a la quimioterapia pueden usarse unos valores bajos previos al tratamiento. Los valores séricos postratamiento y la tasa del cambio entre los valores pre y postratamiento no se relacionaron con la respuesta a la quimioterapia, supervivencia libre de progresión y supervivencia global(AU)

BackgroundNeuron-specific enolase (NSE) is the most sensitive tumor marker for small-cell lung carcinoma (SCLC) at the time of diagnosis. The main purpose of this study was to review the usefulness of serum NSE level as a prognostic factor in patients with SCLC and to determine the correlation between the NSE level and the stage of disease and response to chemotherapy.MethodsIn this prospective study, patients with SCLC were evaluated for response to chemotherapy, survival without disease progression, and overall survival. The end point was designated at patient death due to SCLC. NSE assays were performed before and after completion of chemotherapy.ResultsSixty-five patients were included in study. NSE levels were significantly higher in patients who died of SCLC. The pre-treatment NSE levels in patients who responded to treatment were significantly lower. The post-treatment NSE levels were not significantly correlated with response to chemotherapy, progression-free survival, overall survival, and prognosis of patients. Change in the NSE level between the pre- and post-treatment periods was not significantly correlated with response to treatment, progression-free survival, and overall survival.ConclusionsNSE levels might not be related with the stage of the disease. However, a low pre-treatment NSE level might be used in predicting good response to chemotherapy in patients with SCLC. The post-treatment serum NSE levels and the rate of change between pre- and post-treatment serum levels of NSE were not related with response to chemotherapy, progression-free survival, and overall survival(AU)