Impact of posaconazole prophylaxis and antifungal treatment on BAL GM performance in hematology malignancy patients with febrile neutropenia: a real life experience.

BACKGROUND: Diagnostic accuracy of galactomannan measurements is highly variable depending on the study population, diagnostic procedures, and treatment procedures. We aimed to evaluate the effect of posaconazole prophylaxis and empiric antifungal treatment upon diagnostic accuracy of GM measurements in bronchoalveolar lavage (BAL), bronchial lavage (BL), and serum in hematological malignancy population. METHODS: Patients hospitalized in a single tertiary care center with hematologic malignancies undergoing fiberoptic bronchoscopy (FOB) with a preliminary diagnosis of IPA were retrospectively included. RESULTS: In all the study population (n = 327), AUC for BAL, BL, and serum GM were as follows: 0.731 [0.666-0.790], 0.869 [0.816-0.912], and 0.610 [0.540-0.676] with BL samples having the best diagnostic value. GM measurements in patients under posaconazole prophylaxis (n = 114) showed similar diagnostic performance. While specificity was similar between patients with and without posaconazole prophylaxis, sensitivity of GM measurements was lower in patients with prophylaxis. Analyses with patient classified according to antifungal treatment at the time of FOB procedure (n = 166) showed a decreased diagnostic accuracy in serum GM and BAL GM measurements related with the duration of treatment. However, BAL, BL, and serum GM measurements presented similar sensitivity and specificity in higher cut-off values in longer durations of antifungal treatment. CONCLUSION: Our study shows that posaconazole prophylaxis and active short-term (3 days) antifungal treatment do not significantly affect overall diagnostic performance of GM measurements in bronchoalveolar lavage and bronchial lavage samples. However, using different cut-off values for patients receiving active treatment might be suggested to increase sensitivity.

Comparison of BAP65, DECAF, PEARL, and MEWS Scores in Predicting Respiratory Support Need in Hospitalized Exacerbation of Chronic Obstructive Lung Disease Patients.

OBJECTIVE: Prognostic models aid clinical practice with decision-making on treatment and hospitalization in exacerbation of chronic obstructive lung disease (ECOPD). Although there are many studies with prognostic models, diagnostic accuracy is variable within and between models. SUBJECTS AND METHODS: We compared the prognostic performance of the BAP65 score, DECAF score, PEARL score, and modified early warning score (MEWS) in hospitalized patients with ECOPD, to estimate ventilatory support need. RESULTS: This cross-sectional study consisted of 139 patients. Patients in need of noninvasive or invasive mechanical ventilation support are grouped as ventilatory support groups (n = 54). Comparison between receiver operating characteristic curves revealed that the DECAF score is significantly superior to the PEARL score (p = 0.04) in discriminating patients in need of ventilatory support. DECAF score with a cutoff value of 1 presented the highest sensitivity and BAP65 score with a cutoff value of 2 presented the highest specificity in predicting ventilatory support need. Multivariable analysis revealed that gender played a significant role in COPD exacerbation outcome, and arterial pCO2 and RDW measurements were also predictors of ventilatory support need. Within severity indexes, only the DECAF score was independently associated with the outcome. One-point increase in DECAF score created a 1.43 times higher risk of ventilatory support need. All severity indexes showed a correlation with age, comorbidity index, and dyspnea. BAP65 and DECAF scores also showed a correlation with length of stay. CONCLUSION: Objective and practical classifications are needed by clinicians to assess prognosis and initiate treatment accordingly. DECAF score is a strong candidate among severity indexes.

Development and validation of a simple risk scoring system for a COVID-19 diagnostic prediction mode.

Introduction: In a resource-constrained situation, a clinical risk stratification system can assist in identifying individuals who are at higher risk and should be tested for COVID-19. This study aims to find a predictive scoring model to estimate the COVID-19 diagnosis." Materials: Patients who applied to the emergency pandemic clinic between April 2020 and March 2021 were enrolled in this retrospective study. At admission, demographic characteristics, symptoms, comorbid diseases, chest computed tomography (CT), and laboratory findings were all recorded. Development and validation datasets were created. The scoring system was performed using the coefficients of the odds ratios obtained from the multivariable logistic regression analysis." Result: Among 1187 patients admitted to the hospital, the median age was 58 years old (22-96), and 52.7% were male. In a multivariable analysis, typical radiological findings (OR= 8.47, CI= 5.48-13.10, p< 0.001) and dyspnea (OR= 2.85, CI= 1.71-4.74, p< 0.001) were found to be the two important risk actors for COVID-19 diagnosis, followed by myalgia (OR= 1.80, CI= 1.08- 2.99, p= 0.023), cough (OR= 1.65, CI= 1.16-2.26, p= 0.006) and fatigue symptoms (OR= 1.57, CI= 1.06-2.30, p= 0.023). In our scoring system, dyspnea was scored as 2 points, cough as 1 point, fatigue as 1 point, myalgia as 1 point, and typical radiological findings were scored as 5 points. This scoring system had a sensitivity of 71% and a specificity of 76.3% for a cut-off value of >2, with a total score of 10 (p< 0.001). Conclusions: The predictive scoring system could accurately predict the diagnosis of COVID-19 infection, which gave clinicians a theoretical basis for devising immediate treatment options. An evaluation of the predictive efficacy of the scoring system necessitates a multi-center investigation.

Pilot study for immunoglobulin E as a prognostic biomarker in coronavirus disease 2019.

BACKGROUND: Laboratory biomarkers to estimate the severity of coronavirus disease 2019 (COVID-19) are crucial during the pandemic since resource allocation must be carefully planned. AIMS: To evaluate the effects of basal serum total immunoglobulin E (IgE) levels and changes in inflammatory parameters on the clinical progression of patients hospitalised with COVID-19. METHODS: Patients hospitalised with confirmed COVID-19 were included in the study. Laboratory data and total IgE levels were measured on admission. Lymphocyte, eosinophil, ferritin, d-dimer and C-reactive protein parameters were recorded at baseline and on the 3rd and 14th days of hospitalisation. RESULTS: The study enrolled 202 patients, of which 102 (50.5%) were males. The average age was 50.17 ± 19.68 years. Of the COVID-19 patients, 41 (20.3%) showed clinical progression. Serum total IgE concentrations were markedly higher (172.90 (0-2124) vs 38.70 (0-912); P < 0.001) and serum eosinophil levels were significantly lower (0.015 (0-1.200) vs 0.040 (0-1.360); P = 0.002) in clinically worsened COVID-19 patients when compared with stable patients. The optimal cut-off for predicting clinical worsening was 105.2 ng/L, with 61% sensitivity, 82% specificity, 46.3% positive predictive value and 89.2% negative predictive value (area under the curve = 0.729). Multivariable analysis to define risk factors for disease progression identified higher total IgE and C-reactive protein levels as independent predictors. CONCLUSIONS: Our single-centre pilot study determined that total IgE levels may be a negative prognostic factor for clinical progression in patients hospitalised due to COVID-19 infection. Future studies are required to determine the impact of individuals' underlying immune predispositions on outcomes of COVID-19 infections.

AVAPS-NIV treatment in hypercapnic respiratory failure with insufficient response to fixed-level PS-NIV.

Introduction: Noninvasive ventilation (NIV) for acute hypercapnic respiratory failure (AHRF) is an established treatment modality. Current evidence does not conclude any superiority between fixed pressure support (PS) and average volume-assured pressure support (AVAPS) modes. However, given the ability of rapid PaCO2 decline in AVAPS mode, we hypothesized that COPD patients with AHRF who did not show the desired reduction in PaCO2 with fixed-level PS-NIV might benefit from the AVAPS mode. Materials and Methods: Patients admitted to the non-ICU pulmonary ward with acute exacerbation of COPD (AECOPD) and AHRF were included consecutively in this observational study. Patients with hypercapnic respiratory failure due to obesity-hypoventilation, neurological diseases, or chest wall deformities were excluded. All patients started NIV treatment with fixed pressure support (PS) and patients who did not reach clinical and laboratory stability under PS-NIV treatment were switched to the average volume-assured pressure support (AVAPS) mode of NIV. Result: Thirty-five COPD patients with hypercapnic respiratory failure were included. Under PS-NIV treatment, 14 (40%) patients showed a 17.9 (-0.0-29.2) percent change in terms of PaCO2, meaning no improvement or worsening. Therefore, these patients were treated with AVAPS mode. Arterial PaCO2 and pH levels significantly improved after AVAPS-NIV administration. AVAPS-NIV treatment created a significantly better PaCO2 change rate than using PS-NIV [-11.4 (-22.0 - -0.5) vs 8.2 (-5.3-19.5), p= 0.02]. Independent predictors of AVAPS mode requirement were higher Charlson Comorbidity Index [OR= 1.74 (95% CI= 1.02-2.97)] and higher PaCO2 upon admission [OR= 1.18 (95% CI= 1.03-1.35)]. Thirteen (92.8%) patients reaching significant clinical stability with AVAPS-NIV were able to return to fixed-level PS-NIV and maintain acceptable PaCO2 levels. Conclusions: Our study demonstrated that patients can benefit from AVAPSNIV despite insufficient response to fixed-level PS-NIV.

Understanding university students' smoking behaviors towards tobacco-free campus policy.

INTRODUCTION: Tobacco-free college campuses refer to colleges and universities that have implemented policies prohibiting the use of tobacco products at all indoor and outdoor campus locations. We aimed to evaluate university students' smoking behaviors and their attitudes towards "Tobacco-Free Campus Policy". MATERIALS AND METHODS: A total of 10,383 university students were included in this cross-sectional study. The questionnaire was sent via web-based student information system. Demographical variables, the frequency of tobacco use, the addiction levels of the smoker students, and their perspective on the Tobacco-Free Campus Policy were evaluated. RESULT: The study population consisted of 5461 (52.6%) males and their mean age was 22.1 ± 3.9 years. Among the students, 3992 (38.4%) were current smokers and the age of first smoking was 16.5 ± 2.78 years. According to FTND scores, 15.1% of participants have high dependence, and 7.5% of them have very high dependence. There was a significant difference among participants who finds unacceptable "Tobacco-Free Campus Policy" in terms of gender (70.7% males vs. 29.3% females, p<0.001) and smoking habit (7% never smoker, 4.1% ex-smoker, 88.9% current smoker, p<0.001). CONCLUSIONS: The Tobacco-Free Campus Policy is important to fight against the tobacco industry in order to protect the right to health of all tobacco users and those who do not use it and should be considered as a goal to be achieved in order to live in a healthy environment.

Is serum iron responsive protein-2 level associated with pulmonary functions and frequent exacerbator phenotype in COPD?

INTRODUCTION: Chronic Obstructive Pulmonary Disease (COPD) exacerbations contribute to the overall severity in individual patients because they are associated with airway inflammation, pulmonary function loss, decreased quality of life and increased mortality. Although, identifying frequent exacerbator patients is important due to severe outcomes associated with frequent exacerbator phenotype in COPD patients there is no single biomarker which can differentiate this phenotype. Iron responding protein-2 (IRP2) is the protein product of IREB2 gene, which is a COPD susceptibility gene that regulates cellular iron homeostasis and has a key role in hypoxic conditions. Previous research indicates that IREB2 expression in lung tissue is associated with spirometric measurements and emphysema in COPD. In this study, our aim was to investigate whether serum IRP2 levels were associated with frequent exacerbator phenotype, to evaluate whether IRP2 levels in serum are associated with pulmonary functions and selected systemic inflammation biomarkers. MATERIALS AND METHODS: Designed as a single tertiary care center based, crosssectional study, included high risk (GOLD C, D) COPD patients who admitted to outpatient clinic consecutively between December 2015 and July 2016. RESULT: The study included 80 COPD patients. Serum IRP2 levels were negatively correlated with FEV1 ml (r= -0.25, p= 0.02) and body weight (r= -0.35, p= 0.002) but not with markers of systemic inflammation. COPD patients with at least one exacerbation history in the last year tended to have higher IRP2 levels than patients without any exacerbation [12.3 (IQR 25-75: 10.4- 17.1) vs 10.5 (IQR 25-75: 8.8-18.5), p= 0.06]. CONCLUSIONS: Serum IRP2 level is significantly correlated with FEV1 mL but not with FEV1 % predicted and cannot be used to differentiate frequent exacer bator patients. Although IREB2 gene expressions in lung tissue and bronchoalveolar lavage results have significant associations with emphysema and FEV1/FVC, FEV1 %predicted in COPD patients, our results suggests serum IRP2 level is not as promising.

[Turkish Thoracic Society national spirometry and laboratory standards]. / Türk Toraks Dernegi ulusal spirometri ve laboratuvar standartlari.

The application quality of pulmonary function tests (PFT) carries high importance since it affects the quality of health services. "Chronic Diseases and Risk Factors in Turkey Study," which was published in 2013 showed that only 22.6% of PFTs performed in the secondary care institutions in our country were compatible with the standards. This finding reveals the standardization problem in spirometry applications in our country. Currently, the criteria for the application and evaluation of spirometer measurements were defined by American and European Respiratory Societies standards. Several laboratories use these standards in our country as in the world. But, national laboratory standards that are suitable for the conditions in our country have not been defined yet. This report was prepared to ensure the application of spirometry in optimal conditions, to minimize intra-laboratory and inter-laboratory differences and mistakes, and to standardize in our country. In this report, we focused on the standards concerning laboratory conditions, equipment, and technician specifications, test application, evaluation of test quality, infection control, and reference values.

Approach of pulmonologists in Turkey to noninvasive mechanical ventilation use at home for chronic respiratory failure.

INTRODUCTION: To define approach of pulmonologists in Turkey to noninvasive mechanical ventilation (NIV) use for chronic respiratory failure (CRF), the most currently applied technique for home mechanical ventilation. PATIENTS AND METHODS: A 38-question survey, developed and tested by the authors, was distributed throughout Turkey to 2205 pulmonologists by e-mail. RESULT: Twenty-seven percent of the pulmonologists responded (n=596). Domiciliary NIV was reported to be prescribed by 340 physicians [57.1% of all responders and 81% of pulmonologists practicing NIV at clinical practice (n= 420)]. NIV prescription was associated with physician's title, type of hospital, duration of medical license, total number of patients treated with NIV during residency and current number of patients treated with NIV per week (p< 0.05). Main estimated indications were listed as chronic obstructive pulmonary disease (median, 25-75 percentile of the prescriptions: 75%, 60-85), obesity hypoventilation syndrome (10%, 2-15), overlap syndrome (10%, 0-20) and restrictive lung disease (5%, 2-10). For utilization of NIV at home, Bilevel positive airway pressure-spontaneous mode (40%, 0-80) and oronasal mask (90%, 60-100) were stated as the most frequently recommended mode and interface, respectively. Pressure settings were most often titrated based on arterial blood gas findings (79.2%). Humidifier was stated not to be prescribed by approximately half of the physicians recommending domicilliary NIV, and the main reason for this (59.2%) was being un-refundable by social security foundation. CONCLUSION: There is a wide variation in Turkey for prescription of NIV, which is supposed to improve clinical course of patients with CRF. Further studies are required to determine the possible causes of these differences, frequency of use and patient outcomes in this setting.

The relationship between driving simulation performance and obstructive sleep apnoea risk, daytime sleepiness, obesity and road traffic accident history of commercial drivers in Turkey.

BACKGROUND: Driving performance is known to be very sensitive to cognitive-psychomotor impairment. The aim of the study was to determine the relationship between obesity, risk of obstructive sleep apnoea (OSA), daytime sleepiness, history of road traffic accident (RTA) and performance on a driving simulator, among commercial drivers. METHODS: We examined commercial vehicle drivers admitted to Psycho-Technical Assessment System (PTAS), which is a computer-aided system that includes a driving simulator test and tests assessing psychomotor-cognitive skills required for driving. Risk of OSA and daytime sleepiness were assessed by the Berlin Questionnaire and the Epworth Sleepiness Scale (ESS), respectively. RESULTS: A total of 282 commercial vehicle drivers were consecutively enrolled. The age range was 29-76 years. Thirty drivers were at high risk of OSA. Median ESS of the group was 2 (0-20). Forty-seven percent of the subjects at high risk of OSA failed in early reaction time test, while 28% of the drivers with low risk of OSA failed (p = 0.03). The obese drivers failed the peripheral vision test when compared with non-obese drivers (p = 0.02). ESS was higher for drivers with a history of RTA when compared to those without RTA (p = 0.02). CONCLUSIONS: Cognitive-psychomotor functions can be impaired in obese and high risk of OSA patients. In our opinion, requiring obese and/or high risk of OSA drivers to take PTAS tests that assess driving skills and psychomotor-cognitive functions crucial to those skills would significantly improve road traffic safety, which is of considerable importance to public health.

Feasibility of the interferon-gamma enzyme-linked immunospot assay in chronic renal failure patients and immunocompetent subjects: a head-to-head comparison.

Diagnosis of latent Mycobacterium tuberculosis infection (LTBI) by the tuberculin skin test (TST) is hampered due to anergy and impaired sensitivity in chronic renal failure (CRF) patients. We aimed to compare the diagnostic performance of the TST with that of interferon-gamma immunospot (T-SPOT.TB®) assay in diagnosing LTBI in CRF and immunocompetent (IC) patients. A total of 74 CRF and 75 IC patients prospectively underwent the TST and T-SPOT.TB. Latent M. tuberculosis infection estimated by TST and T-SPOT.TB was detected in 69% and 43 of CRF; 52 and 35% of IC patients, respectively. The sensitivity and specificity of the T-SPOT.TB were 73 and 74% in IC, whereas 50 and 55% in CRF patients. In conclusion, the prevalence of LTBI was noteworthy in both IC and CRF patients. T-SPOT.TB was less sensitive and specific than the IC group in CRF patients. Both T-SPOT.TB and TST were not associated with the TB exposure.

Psychometric properties of the Turkish version of the Fagerström test for nicotine dependence.

INTRODUCTION: The Fagerström Test for Nicotine Dependence (FTND), modified from Fagerström Tolerance Questionnairre (FTQ), is used to determine whether a smoker trying to quit will need nicotine replacement therapy to treat with drawal symptoms. The FTND has been translated into many languages and has been referred to in the smoking literature worldwide. However, only a few studies have examined the psychometric propertiesof the non-English FTND versions. This study aimed to assess the psychometric properties of the Turkish version of the FTND. MATERIALS AND METHODS: Confirmatory factor analysis (CFA) was used to test the factor structure of the Turkish version of the questionnaire using a large sample from two smoking cessation clinics in Istanbul, Turkey. Our study comprised 502 smokers who entered one of these smoking cessation clinics between October 1 and December 31, 2011. All subjects gave informed consent to the study. We assessed the validity of the FTND using CFA, and we calculated Cronbach's alpha coefficients to determine reliability. RESULT: One-factor CFA included all of the items on the FTND. All items loaded on this factor with a score of 0.40 or higher. The goodness of fit statistics were adequate, with a Comparative Fit Index (CFI) of 0.922, a Tucker-Lewis Index (TLI) of 0.902, and a root-mean-square error of approximation (RMSEA) of 0.081. Two-factor CFA comprised the three "morning smoking" items, and the three "smoking pattern" items. The factor loadings and the goodness-of-fit statistics confirmed that the FTND has a two-factor structure. CONCLUSIONS: Analyses confirmed that the Turkish version of the FTND has a two-factor structure with moderate reliability. This study found that using a total score as an estimate of nicotine dependence may limit the assessment of specific smoking dependency and tailoring intervention approaches. We suggest that a two-factor FTND in clinical practice would more accurately determine the nicotine dependence of patients.

Approach of pulmonologists in Turkey to noninvasive mechanical ventilation use in acute respiratory failure.

INTRODUCTION: Noninvasive mechanical ventilation (NIV) has been increasingly used worldwide for acute respiratory failure (ARF), especially in patients with chronic lung disorders. We aimed to define the approach of pulmonologists in Turkey to NIV use for ARF management. MATERIALS AND METHODS: A 38-question survey, developed and tested by authors, was distributed by e-mail to a total of 2.205 pulmonologists in Turkey. RESULT: Response rate was 27% (n= 596). Seventy-one percent of responders were practicing NIV in clinic. NIV use was found to be associated with responder's academic title, age, duration of medical license, type of physician's hospital and its region, patient load, NIV experience during residency, and duration of NIV and intensive care unit (ICU) experience (p< 0.001). Based on sub-group analysis of responders using NIV, median number of NIV patients followed-up per week was 4 [interquartile range (IQR): 2-6]. Most of the NIV users reported employment of wards (90%) and/or ICUs (86%) to follow-up patients, while 8.4% of the responders were applying NIV only in ICU's. Chronic obstructive lung disease (COPD) (99.5%), obesity hypoventilation syndrome (93.7%) and restrictive lung disease (89.4%) were the most common indications. Majority of NIV users (87%) were applying NIV to > 60% of patients with COPD, and success rate in COPD was reported as over 60% by 93% of users. Oronasal mask (median and IQR 90, 80-100%, respectively) and home care NIV ventilators (median and IQR 50, 10-85%, respectively) were the most commonly utilized equipment. CONCLUSIONS: NIV use in ARF varies based on hospital type, region and, especially, experience of the physician. Although consistent with guidelines and general practice, NIV use can still be improved and increased.

Understanding the Impact of Pulmonary Rehabilitation on Airway Resistance in Patients with Severe COPD: A Single-Center Retrospective Study.

Purpose: We investigated the effect of pulmonary rehabilitation (PR) on airway resistance in chronic obstructive pulmonary disease (COPD) patients with severe airway obstruction and hyperinflation. Patients and Methods: This retrospective cohort study was conducted with data from severe COPD cases with those who underwent an 8-week PR program. Main inclusion criteria were having severe airflow obstruction (defined as a forced expiratory volume in one second (FEV1) <50%) and plethysmographic evaluation findings being compatible with hyperinflation supporting the diagnosis of emphysema (presence of hyperinflation defined as functional residual capacity ratio of residual volume to total lung capacity (RV/TLC) >120%). Primary outcomes were airway resistance (Raw) and airway conductance (Gaw) which were measured by body plethysmography, and other measurements were performed, including 6-minute walk test (6-MWT), modified Medical Research Council dyspnea scale (mMRC) and COPD assessment test (CAT). Results: Twenty-six severe and very severe COPD patients (FEV1, 35.0 ± 13.1%; RV/TLC, 163.5 ± 29.4) were included in the analyses, mean age 62.6 ± 5.8 years and 88.5% males. Following rehabilitation, significant improvements in total specific airway resistance percentage (sRawtot%, p = 0.040) and total specific airway conductance percentage (sGawtot%; p = 0.010) were observed. The post-rehabilitation mMRC scores and CAT values were significantly decreased compared to baseline results (p < 0.001 and p < 0.001, respectively). Although there were significant improvements in 6-MWT value (p < 0.001), exercise desaturation (ΔSaO2, p = 0.026), the changes in measured lung capacity and volume values were not significant. Conclusion: We concluded that PR may have a positive effect on airway resistance and airway conductance in COPD patients with severe airflow obstruction.

The Knowledge and Attitude about New Generation Tobacco Products among Physicians.

OBJECTIVE: Health hazards of e-cigarettes including "e-cigarette or vaping product use-associated lung injury" are better understood today. Just as e-cigarettes, heated tobacco products release toxic emissions. We aimed to determine the knowledge and attitude about new generation tobacco products among physicians who were the members of an organization for health care professionals, the majority of whom are pulmonologists. MATERIAL AND METHODS: In this cross-sectional study, a self-administered online questionnaire-based survey was conducted among the physicians from April to October 2019. The survey included questions about demographics (gender, age, graduation date from medical institution, and academic title), their smoking status, their knowledge and attitudes toward new generation tobacco products, and additionally about whether new generation tobacco products can be used to aid in smoking cessation. RESULTS: Among the 506 members who responded to the survey, 56.7 % were female; the mean age was 42.4 ± 10.9 years (20-74). About 74.5% were pulmonologists, 5.5% were thoracic surgeons, and 20% were other physicians. Among the responders, the frequency of those who have not heard of new generation tobacco products before was determined as 9.5%, 24.5%, and 41.3%. At least 58.9% of participants lacked the knowledge necessary to discuss these products with their patients and the rate reached 76.7% for the heated tobacco product. To the question of whether new generation tobacco products can be used in smoking cessation, 68.4% responded "I never agree that they can be used." Non-current smokers (P = .003), elders (P = .001), those who had training on smoking cessation assistance (P = .001), and those who had experience in smoking cessation assistance (P = .009) were significantly more prevalent in the group who answered: "I never agree that they can be used." CONCLUSION: Physicians must become considerably more knowledgeable about the new generation tobacco products and hazards. Otherwise, these new tobacco products may pose new threats to national and global tobacco control efforts.

Turkish Thoracic Society's Statement Report on Electronic Cigarettes and Heated Tobacco Products.

Tobacco addiction, which causes the death of more than 8.5 million people in the world every year, is a preventable global public health problem. There are 1.1 billion adult smokers worldwide and 60% of them desire or intend to quit but unfortunately, the tobacco industry continues to profit at the expense of people's lives by marketing electronic cigarettes and heated tobacco products as a smoking cessation method and they continue to poison young people with new threat tobacco products, promising a "smoke-free future" Turkish Thoracic Society is actively involved in the implementation of the National Tobacco Control Program to protect public health and has warned and raised awareness of new threats to the youth, such as electronic cigarettes and heated tobacco products. The purpose of this report is to provide information about electronic cigarettes and heated tobacco products and to present TTJ's position on the subject.

The Age-Dependent Role of Th22, Tc22, and Tc17 Cells in the Severity of Pneumonia in COVID-19 Immunopathogenesis.

Coronavirus disease 2019 (COVID-19) has clinical manifestations ranging from mild symptoms to respiratory failure, septic shock, and multi-organ failure. Lymphocytes are divided into different subtypes based on their cytokine production pattern. In this study, we investigated the role of cytokine expressions of CD4+ T (T helper [Th]1, Th2, Th17, Th22) and CD8+ T cell subtypes (T cytotoxic [Tc]1, Tc2, Tc17, Tc22) in the pathogenesis of COVID-19. Peripheral blood mononuclear cells (PBMCs) were extracted with Ficoll by density gradient centrifugation from blood samples of 180 COVID-19 patients (children and adults) and 30 healthy controls. PBMCs were stimulated with PMA and Ionomycin and treated with Brefeldin A in the fourth hour, and a 10-colored monoclonal antibody panel was evaluated at the end of the sixth hour using flow cytometry. According to our findings, the numbers of Th22 (CD3+, CD4+, and interleukin [IL]-22+) and Tc22 (CD3+, CD8+, IL-22+) cells increased in adult patients regardless of the level of pneumonia (mild, severe, or symptom-free) as compared with healthy controls (p < 0.05). In addition, the number of Tc17 (CD3+, CD8+, and IL-17A+) cells increased in low pneumonia and severe pneumonia groups compared with the healthy controls (p < 0.05). Both IL-22 and IL-17A production decreased during a follow-up within 6 weeks of discharge. Our findings suggest that the increase in only IL-22 expressed Tc22 cells in the 0-12 age group with a general symptom-free course and higher levels of Th22 and Tc22 in uncomplicated adult cases may indicate the protective effect of IL-22. On the contrary, the association between the severity of pneumonia and the elevation of Tc17 cells in adults may reveal the damaging effect of IL-22 when it is co-expressed with IL-17.

Serum Krebs von den Lungen-6: promising biomarker to differentiate CPFE from IPF.

Background   Combined pulmonary fibrosis and emphysema (CPFE) has been recognised as a phenotype of pulmonary fibrosis. We aimed to compare serum surfactant protein-A (SP-A), surfactant protein-D (SP-D) and Krebs von den Lungen-6 (KL-6) levels, functional parameters, in CPFE and  IPF (idiopathic pulmonary fibrosis) patients. Methods Patients diagnosed with 'CPFE' and 'IPF' were consecutively included in 6 months as two groups. The patients with connective tissue diseases are excluded. Results           In this study, 47 patients (41 males, 6 females) with CPFE (n = 21) and IPF (n = 26) with a mean age of 70.12 ± 8.75 were evaluated. CPFE patients were older, had more intense smoking history, had lower DLCO/VA, lower FVC, and worse six-minute walking distance than the IPF group (p=0.005, p=0.027, p=0.02, p<0.001, p=0.001, respectively). Serum KL-6 levels were higher in CPFE group compared to IPF group [264.70 U/ml (228.90-786) vs 233.60 (101.8-425.4), p<0.001]. Serum KL-6 levels of 245.4 U/ml and higher have 81% sensitivity and 73% specificity for the discrimination of CPFE from IPF. Conclusions   Our study has shown that serum KL-6 level is a promising biomarker to differentiate CPFE from IPF. In CPFE cases respiratory and functional parameters are worse than those of pure fibrosis cases.

Prognostic factors for COVID-19 patients.

INTRODUCTION: Determining prognostic factors in patients with coronavirus disease (COVID-19) can have great impact on treatment planning and follow-up strategies. Herein, we aimed to evaluate prognostic factors and clinical scores for confirmed COVID-19 patients in a tertiary-care hospital in the Bursa region of Turkey. METHODOLOGY: Patients who had been diagnosed with COVID-19 microbiologically and/or radiologically between March and October 2020 in a tertiary-care university hospital were enrolled retrospectively. Adult patients (≥ 18 years) with a clinical spectrum of moderate, severe, or critical illness were included. The dependent variable was 30-day mortality and logistic regression analysis was used to evaluate any variables with a significant p value (< 0.05) in univariate analysis. RESULTS: A total of 257 patients were included in the study. The mortality rate (30-day) was 14.4%. In logistic regression analysis, higher scores on sequential organ failure assessment (SOFA) (p < 0.001, odds ratio (OR) = 1.86, 95% CI = 1.42-2.45) and CURB-65 pneumonia severity criteria (p = 0.001, OR = 2.60, 95% CI = 1.47-4.57) were found to be significant in predicting mortality at admission. In deceased patients, there were also significant differences between the baseline, day-3, day-7, and day-14 results of D-dimer (p = 0.01), ferritin (p = 0.042), leukocyte (p = 0.019), and neutrophil (p = 0.007) counts. CONCLUSIONS: In our study of COVID-19 patients, we found that high SOFA and CURB-65 scores on admission were associated with increased mortality. In addition, D-dimer, ferritin, leukocyte and neutrophil counts significantly increased after admission in patients who died.

Association of SARS-CoV-2 cycle threshold (Ct) values with clinical course and serum biomarkers in COVID-19 patients.

INTRODUCTION: Our knowledge has gaps regarding severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) replication levels and its association to severity of Coronavirus disease 2019 (COVID-19). The aim of this study was to investigate the association of SARS-CoV-2 viral load with disease severity and serum biomarkers in COVID-19 patients. METHODOLOGY: Viral load was determined via cycle threshold (Ct) values of SARS-CoV-2 real-time reverse transcriptase-polymerase chain reaction (RT-PCR) in 214 adult patients. Ct values were compared with clinical severity, biochemical and hematological biomarkers. RESULTS: Clinical course of the disease was mild (49.1%), moderate (40.2%), and severe (10.7%). Median Ct value was 28.2 (IQR: 22.2-33.8) during the first week of the disease. Ct values were lower within five days after symptom onset [lowest Ct value on the third day (median: 24, IQR: 20.6-32.3)], but they increased significantly during the second and third weeks. No association was detected between admission Ct values and disease severity. Gender, age, co-morbidity, and mortality did not differ significantly in patients with low (≤ 25) and high (> 25) Ct values. White blood cell, neutrophil, platelet, and especially lymphocyte counts, were significantly lower in patients with low Ct values. CONCLUSIONS: No definitive/clear correlation between SARS-CoV-2 viral load and severity and mortality was found in the studied COVID-19 patients. However, neutrophil, platelet, and especially lymphocyte count were significantly lower in patients with a high viral load.