To reveal the diagnostic and prognostic significance of eosinophilic pleural effusions (EPEs) and assess their clinical implications.
Seventy EPEs from 60 patients among 697 consecutive pleural ...effusions were investigated from 1996-2005 at Kocaeli University Hospital, Kocaeli, Turkey. Koss and Light's criteria were applied in the analysis, which comprised macroscopic, cytopathologic, biochemical and microbiologic examinations.
Overall, cancerous underlying conditions were diagnosed in 22 patients (13 malignant and 9 paramalignant), 36.7% of EPEs. Benign causes were found in 43.3% (26 of 60) of the patients. Twelve pleural effusions (20.0%) were idiopathic. The comparison of pleural fluid and peripheral blood findings disclosed no significant difference among the various subgroups.
EPE could be associated with inflammatory, benign, cancerous and paramalignant conditions. A closer search for a definite causes is warranted in the setting of EPEs, especially in populations with a high prevalence of tuberculosis and malignancy, such as in Kocaeli, Turkey, an industrial city in a developing country.
Objective: To determine post-discharge mortality and associated factors of the first-wave multicenter Turkish Thoracic Society (TTD)-TURCOVID study.
Methods: In this retrospective cohort study, we ...analyzed the data of 18 of 26 centers included in the first TTD-TURCOVID study, and 1 112 cases diagnosed with COVID-19 between 11 March and 31 July 2020 participated in the study. All causes of death after COVID-19 discharge were recorded.
Results: The mean age of the patients was (51.07±16.93) years, with 57.6% male patients. In the cohort group, 89.1% of COVID-19 treatment locations were hospital wards, 3.6% were intensive care units (ICUs), and 7.2% were community outpatients. In the longterm follow-up, the in-hospital mortality rate was 3.6% (95% CI 2.64.8), the post-discharge mortality rate was 2.8% (95% CI 1.9-3.9), and the total mortality was 6.3% (95% CI 5.0-7.8). After discharge, 63.3% of mortality overall occurred during the first six months. Mortality rates in post-discharge follow-ups were 12.7% (95% CI 8.0-30.6) in cancer patients, 10.8% (95% CI 6.3-22.9) in chronic obstructive pulmonary disease patients, 11.1% (95% CI 4.4-22.7) in heart failure patients, 7.8 (95% CI 3.8-14.3) in atherosclerotic heart disease patients, and 2.3% (95% CI 0.8-5.6) in diabetes mellitus patients. In smokers/ex-smokers, the all-mortality rates were higher than in non-smokers.
Conclusions: This multicenter study showed that patients over 65 years of age, males, former/active smoker, ICU stay, lung, heart disease, and malignancy should be followed up for at least the first six months after discharge due to COVID-19.
Besides chest disease specialists, primary care physicians also have a great role in prevention and treatment of chronic obstructive pulmonary disease (COPD). The aim of this study was to evaluate ...the knowledge levels of primary care physicians about COPD before and after post graduate course. The level of knowledge was evaluated by a questionnaire including questions about COPD definition, prevalence, etiology, pathology, diagnostic methods, physical examination findings and treatment. Then a postgraduate course was performed about COPD and questionnaire forms were refilled. Ninety two physicians filled the questionnaire forms before and after seminar. Fifty of the physicians were female, 42 were male, mean age was 33.7 +/- 8.5 and duration of profession was 9.6 +/- 8 years. Thirty-six (39.2%) of physicians have attended a post graduate seminar on COPD previously. All physicians answered the questions about the most dominant sex that COPD was seen and etiologic agents correctly. Most of the physicians answered the questions about diseases that defined as COPD, pathology and physical examination findings incorrectly. There was no difference in number of correct answers between the physicians who have previously attended a post graduate seminar or not. Duration of profession was not correlated with correct answers. After the seminar, the number of correct answers increased significantly. Since most of the physicians answered the questions which are quite important in primary care such as COPD definition and physical examination findings incorrectly, it is thought that post graduate seminars about COPD should be performed more frequently. After the seminar, we observed significant increase in correct answers however long-term stability of this knowledge is needed to be determined in future studies.
The aim of this study is to evaluate the presence of neurocognitive dysfunctions, depression and anxiety and the effect of positive airway pressure (PAP) therapy on these alterations in Obesity ...Hypoventilation Syndrome (OHS) patients.
Ten healthy normal and obese controls, 10 OHS and 10 OSAS patients were included in the study. Short form-36, Beck Depression Scale and State-Trade Anxiety Inventory (STAI 1-2) were performed. Wisconsin Card Sorting Test (WCST), Montreal Cognitive Assessment Scale (MOCA), Enhanced Cued Recall (ECR) and Mini Mental Test (MMT) were used for neurocognitive evaluation. All tests were repeated after one night PAP therapy in OHS and OSAS groups.
OHS patients had the lowest scores of physical (PF) and social functioning (SF) in SF-36. The total number of persistent errors and incorrect answers were the highest in OHS group in WCST. The scores of MOCA, ECR and MMT were lower; depression and anxiety scores were higher in OHS group than in controls (
= 0,00). There was a significant increase in the completed categories in OHS after PAP therapy (
= 0,03). There were also significant increases in MOCA, ECR and MMT scores and significant decreases in depression and anxiety scores with respect to PAP therapy.
Cognitive dysfunction, depression and anxiety are important under-recognized comorbidities in OHS. It is suggested that short term PAP therapy had positive effects on neurocognitive functions, depression and anxiety but further multicentre, prospective studies with large number of cases are needed to evaluate the effect of long term PAP therapy on these parameters.
Background and objectives
Although several repurposed antiviral drugs have been used for the treatment of COVID-19, only a few such as remdesivir and molnupiravir have shown promising effects. The ...objectives of our study were to investigate the association of repurposed antiviral drugs with COVID-19 morbidity.
Methods
Patients admitted to 26 different hospitals located in 16 different provinces between March 11–July 18, 2020, were enrolled. Case definition was based on WHO criteria. Patients were managed according to the guidelines by Scientific Board of Ministry of Health of Turkey. Primary outcomes were length of hospitalization, intensive care unit (ICU) requirement, and intubation.
Results
We retrospectively evaluated 1,472 COVID-19 adult patients; 57.1% were men (mean age = 51.9 ± 17.7years). A total of 210 (14.3%) had severe pneumonia, 115 (7.8%) were admitted to ICUs, and 69 (4.7%) were intubated during hospitalization. The median (interquartile range) of duration of hospitalization, including ICU admission, was 7 (5–12) days. Favipiravir (
n
= 328), lopinavir/ritonavir (
n
= 55), and oseltamivir (
n
= 761) were administered as antiviral agents, and hydroxychloroquine (HCQ,
n
= 1,382) and azithromycin (
n
= 738) were used for their immunomodulatory activity. Lopinavir/ritonavir (β 95% CI: 4.71 2.31–7.11;
p
= 0.001), favipiravir (β 95% CI: 3.55 2.56–4.55;
p
= 0.001) and HCQ (β 95% CI: 0.84 0.02–1.67;
p
= 0.046) were associated with increased risk of lengthy hospital stays. Furthermore, favipiravir was associated with increased risks of ICU admission (OR 95% CI: 3.02 1.70–5.35;
p
= 0.001) and invasive mechanical ventilation requirement (OR 95% CI: 2.94 1.28–6.75;
p
= 0.011).
Conclusion
Our findings demonstrated that antiviral drugs including lopinavir, ritonavir, and favipiravir were associated with negative clinical outcomes such as increased risks for lengthy hospital stay, ICU admission, and invasive mechanical ventilation requirement. Therefore, repurposing such agents without proven clinical evidence might not be the best approach for COVID-19 treatment.
Background: The aim of this study is to evaluate the presence of neurocognitive dysfunctions, depression and anxiety and the effect of positive airway pressure (PAP) therapy on these alterations in ...Obesity Hypoventilation Syndrome (OHS) patients. Methods: Ten healthy normal and obese controls, 10 OHS and 10 OSAS patients were included in the study. Short form-36, Beck Depression Scale and State-Trade Anxiety Inventory (STAI 1-2) were performed. Wisconsin Card Sorting Test (WCST), Montreal Cognitive Assessment Scale (MOCA), Enhanced Cued Recall (ECR) and Mini Mental Test (MMT) were used for neurocognitive evaluation. All tests were repeated after one night PAP therapy in OHS and OSAS groups. Results: OHS patients had the lowest scores of physical (PF) and social functioning (SF) in SF-36. The total number of persistent errors and incorrect answers were the highest in OHS group in WCST. The scores of MOCA, ECR and MMT were lower; depression and anxiety scores were higher in OHS group than in controls (p = 0,00). There was a significant increase in the completed categories in OHS after PAP therapy (p = 0,03). There were also significant increases in MOCA, ECR and MMT scores and significant decreases in depression and anxiety scores with respect to PAP therapy. Conclusions: Cognitive dysfunction, depression and anxiety are important under-recognized comorbidities in OHS. It is suggested that short term PAP therapy had positive effects on neurocognitive functions, depression and anxiety but further multicentre, prospective studies with large number of cases are needed to evaluate the effect of long term PAP therapy on these parameters.
Coronavirus-19 disease (COVID-19) is a worldwide health
emergency which has a high mortality ratio. Diagnosis requires
a positive quantitative real-time polymerase chain reaction
(qRT-PCR) test ...however there are radiological findings strongly
suggest the diagnosis of COVID-19. Here we reported a 63-yearold
woman presented with cough and dyspnea and medical
history of lung cancer and systemic lupus erythematosus (SLE).
Chest computed tomography demonstrated widespread
ground glass opacities in both lung fields that have been
reported to be compatible with COVID-19 pneumonia.
qRT-PCR test was negative for twice and radiological regression
after hydroxychloroquine, azithromycin and piperacillintazobactam
was not significant. Considering lung involvement
of SLE methylprednisolone was initiated, symptoms and
radiological findings improved. The underlying diseases may
mimic the COVID-19 infection or the signs and symptoms of the
disease may be seen together with COVID-19.
BACKGROUND:
Clarithromycin is an antimicrobial agent that can be used for treatment of chronic obstructive pulmonary disease (COPD) exacerbations with bronchodilator therapy. However, it has also ...been shown that clarithromycin has antiinflammatory effects by the inhibition of cytokine production.
OBJECTIVE:
To evaluate the antiinflammatory effect of clarithromycin on serum and sputum interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α), and leukotriene B4 levels in patients with COPD.
METHODS:
Thirty men with mild to moderate COPD were enrolled in this prospective, single-center, double-blind, placebo-controlled study. None of the patients was receiving systemic or inhaled corticosteroids during the study. Subjects received either clarithromycin or placebo for 14 days. Before and after this treatment period, spirometric tests and arterial blood gas analysis were performed, blood was drawn for measurement of serum inflammatory markers, and sputum was induced.
RESULTS:
There were no statistically significant differences in baseline clinical or laboratory parameters between the groups. After the treatment, the induced sputum total cell counts, and IL-8 and TNF-α levels decreased significantly in the clarithromycin group compared with pretreatment levels (mean ± SD IL-8 1606 ± 367.3 vs 882 ± 143.6 pg/mL, p = 0.001; TNF-α 638.2 ± 287.5 vs 390 ± 235 pg/mL, p = 0.001). Similarly, decreases in serum inflammatory markers were found in the clarithromycin group while there was no significant change in the placebo group.
CONCLUSIONS:
This study demonstrated that the decrease in IL-8 and TNF-α levels might be related to the antiinflammatory effect of clarithromycin. Thus, we suggest that the use of clarithromycin in COPD exacerbations may either treat the infection or help control the inflammation. Future studies are needed to determine the clinical significance of these findings.
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Differential diagnosis of idiopathic pulmonary fibrosis (IPF) is important among fibrotic interstitial lung diseases (ILD). This study aimed to evaluate the rate of IPF in patients with fibrotic ILD ...and to determine the clinical-laboratory features of patients with and without IPF that would provide the differential diagnosis of IPF.
The study included the patients with the usual interstitial pneumonia (UIP) pattern or possible UIP pattern on thorax high-resolution computed tomography, and/or UIP pattern, probable UIP or possible UIP pattern at lung biopsy according to the 2011 ATS/ERS/JRS/ALAT guidelines. Demographics and clinical and radiological data of the patients were recorded. All data recorded by researchers was evaluated by radiology and the clinical decision board.
A total of 336 patients (253 men, 83 women, age 65.8±9.0 years) were evaluated. Of the patients with sufficient data for diagnosis (n=300), the diagnosis was IPF in 121 (40.3%), unclassified idiopathic interstitial pneumonia in 50 (16.7%), combined pulmonary fibrosis and emphysema (CPFE) in 40 (13.3%), and lung involvement of connective tissue disease (CTD) in 16 (5.3%). When 29 patients with definite IPF features were added to the patients with CPFE, the total number of IPF patients reached 150 (50%). Rate of male sex (p<0.001), smoking history (p<0.001), and the presence of clubbing (p=0.001) were significantly high in patients with IPF. None of the women <50 years and none of the men <50 years of age without a smoking history were diagnosed with IPF. Presence of at least 1 of the symptoms suggestive of CTD, erythrocyte sedimentation rate (ESR), and antinuclear antibody (FANA) positivity rates were significantly higher in the non-IPF group (p<0.001, p=0.029, p=0.009, respectively).
The rate of IPF among patients with fibrotic ILD was 50%. In the differential diagnosis of IPF, sex, smoking habits, and the presence of clubbing are important. The presence of symptoms related to CTD, ESR elevation, and FANA positivity reduce the likelihood of IPF.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
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