As known, older age and comorbidities are associated with poor clinical outcomes in patients with coronavirus disease 19. The aim of this study was to investigate the effect of the Charlson ...Comorbidity Index in predicting poor clinical outcomes in coronavirus disease 19 patients.
Demographic characteristics and poor clinical outcomes (presence of pneumonia, respiratory failure, intensive care unit admission, and mortality) of the patients were evaluated retrospectively. Classical and modified Charlson Comorbidity Index was calculated and adjusted according to age.
In this study, 106 women and 107 men were included. The comorbidity rate was 50.7% and the most common comorbidities were hypertension (21.6%) and diabetes mellitus (15%). The rates of respiratory failure, intensive care unit admission, and mortality were 15%, 2.3%, and 2.8%, respectively. Older age was a high risk for poor outcomes. Pneumonia (odds ratio: 6.6; 95% CI: 3.4-12.7), respiratory failure (odds ratio: 5.2; 95% CI: 2.03-13.2), and intensive care unit admission (odds ratio: 1.1; 95% CI: 1.01-1.1) were significantly higher in patients with comorbid diseases than patients without any comorbidity (P < .05). Both median-modified and classical Charlson Comorbidity Index and their age-adjusted scores were significantly higher in patients with poor outcomes.
It is suggested that evaluation of the Charlson Comorbidity Index might contribute to the management of the patients with coronavirus disease 19 by predicting risk group for poor clinical outcomes and mortality.
We evaluated the frequency of exacerbations and hospitalizations in chronic obstructive pulmonary disease (COPD) patients who continue to smoke.: We retrospectively analyzed the medical records of ...the COPD patients treated in Chest Diseases Clinic of Kocaeli University School of Medicine in 2007-2013. Their demographic characteristics, smoking status (non-smoker, current smoker, ex-smoker), Charlson Comorbidity Index (CCI), and history of COPD exacerbation and hospitalizations were evaluated. The cases of 120 patients (11 females, 9.2%; 109 males, 90.8%) were analyzed. Sixteen (13.3%) of the patients were current smokers, and 104 patients were ex-smokers (n=99) or non-smokers (n=5). The mean age was 69.7±7.9 years in the ex-smokers and 62.94±6.8 years in the current smokers. There were no significant differences between the current and ex-smokers regarding smoking history, FEV1 value, frequencies of exacerbations and hospitalization per year, or duration of follow-up. The initial stage of the COPD and the frequency of exacerbations were significantly correlated (p=0.003). The CCI values were significantly higher in the ex-smokers compared to current smokers (p=0.02). A correlation analysis of age, hospitalization and CCI revealed that age was significantly correlated with the hospitalization rate (p=0.02). Older age and the presence of comorbidities in ex-smokers might explain the similar rates of exacerbation and hospitalization between these current and ex-smokers.
Coronavirus disease 2019 (COVID-19) is a novel viral infection that has led to a global pandemic. The clinical spectrum of COVID-19 has a wide range from asymptomatic disease to severe disease, ...including acute respiratory distress syndrome and death. The most common symptoms are fever, cough, myalgia, and fatigue. Diarrhea, headache, sore throat, and hemoptysis are rare symptoms. There is no patient with COVID-19 presenting with massive hemoptysis in the literature. Here we present a case series of 3 patients with COVID-19 who were admitted to the emergency department with massive hemoptysis without any other symptoms.
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Aim: To evaluate smoking and COPD prevalence amongst teachers working in the schools of Kocaeli City, Turkey.Method: In this cross-sectional study, a questionnaire focusing on respiratory symptoms ...and smoking habits was adminis- tered to all participants who accepted to join the study. All sub- jects also underwent a physical examination and a pulmonary function test performed with portable spirometer. According to GOLD criteria, subjects who had post-bronchodilator FEV1/FVC < 70% and negative reversibility test were classi- fied as COPD.
Results: A total of 685 teachers were included female n = 307 (45%), male n = 378 (55%) with mean age 38.9 ± 8.9 years. Smoking habit was evaluated in 660 subjects: 291 (44.1%) were smokers, 252 (38.2%) were non-smokers and 117 (17.7%) were ex-smokers. Pulmonary function test was available in 651 subjects and 510 (78.3%) were defined as normal on spirometric analysis. Small airway obstruction was found in 115 of the cases (17.7%) in whom FEF25-75 level was found to be lower than 70% predicted. FEV1/FVC level was lower than 70% in 16 subjects (2.5%). Five subjects who had positive reversibility test were excluded from the study. The remaining 11 subjects who were considered as COPD consisted of 2 (18%) females and 9 (82%) males. Six of these subjects were aged over 40 years.
Conclusion: Spirometry has an important role in early diagno- sis of COPD. Spirometric evaluation of cases with risk factors for COPD could be helpful in diagnosing patients before the progressive decline in lung function begins. Further studies are needed to evaluate whether the interventional strategies at this stage such as smoking cessation could prevent the progression of disease.
Objectives: The aim of this study was to investigate whether there was any difference with respect to prognostic markers, quality of life, depression frequencies, sleep disorders, and reflux symptoms ...between IPF patients with and without cough symptom. Methods: Patients with IPF who were admitted to Kocaeli University School of Medicine Chest Diseases Clinic were included in the study. Patients were divided into two groups according to the VAS (Visual Analog Scale) scores as cough group and without cough group following the initial evaluation including demographic information, disease duration and treatment. In each group, Leicester cough questionnaire, reflux questionnaire, Beck depression questionnaire, SGRQ (St George’s quality of life questionnaire) and Sleep Quality index were evaluated to determine whether there were any differences between groups. Results: No significant difference was observed between the groups in terms of age, gender and demographic findings. The smoking history was similar among the groups. The diffusion capacity was decreased in various degrees in all of the study population. It was shown that the Leicester Cough Questionnaire score was lower in the cough group (The cough group 86±24.9 the other group 111±18.9). Beck Depression Score revealed moderate level of depression in both groups (The cough group 22±10.74 the other grup 18±11.86). SGRQ symptom score was significantly higher in the cough dominant group (The cough group 344.8 (270.8-487.63) p=0.04). Sleep Quality deterioration was found in both groups. Conclusion: It is found that presence of cough in patients with IPF negatively affected the quality of life and was associated with the Sleep disorders and depression. It is thought that increasing the symptom awareness, especially cough and shortness of breath in these patients and evaluating the treatment options for palliation of symptoms will increase the quality of life and compliance of treatment. Future multicentre studies including more patients are needed to address this problem.
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The study aims to evaluate the awareness and knowledge of COVID-19 among healthcare workers.
A questionnaire was applied to healthcare workers working at Kocaeli University Faculty of Medicine and ...University of Kyrenia, Dr. Suat Günsel Hospital, to evaluate the coronavirus disease 2019 awareness and level of knowledge.
A total of 598 healthcare workers participated in the study. Two-thirds of the respondents were from Turkey, while one-third were from the Turkish Republic of Northern Cyprus. The general symptoms of coronavirus disease 2019 were well known in the general population. Awareness of most symptoms was significantly lower in the Turkish Republic of Northern Cyprus group. It was well known that coronavirus disease 2019 can be asymptomatic in some patients and it can be contagious. The necessity of wearing surgical masks on sick individuals was less known in the Turkish Republic of Northern Cyprus group (96.6% vs 61.6%; P = .000). While handwashing was found similar in both groups for protection from coronavirus disease 2019 transmission, social distance and mask recommendations were lower in the Turkish Republic of Northern Cyprus group (P < .05). The concern about transmitting the virus to themselves and their relatives was more significant in the Turkish Republic of Northern Cyprus group than the Turkey group (84.4% vs 96.5%; P = .000). And 92.2% of the healthcare workers thought they should stay in an alternative place instead of their homes.
The awareness and knowledge level of coronavirus disease 2019 is higher in Turkey than in Turkish Republic of Northern Cyprus related to the increased number of coronavirus disease 2019 cases in Turkey. Continuous education programs can contribute to improving the level of knowledge and reducing anxiety.
A Case of Lipoid Pneumonia Argun Baris, Serap; Omak Kaya, Fulya; Gumustas, Sevtap ...
Turkish Thoracic Journal,
09/2019, Volume:
20, Issue:
1
Journal Article
Peer reviewed
Open access
Introduction: A large number of non-infectious pathologies can mimic pneumonia, leading to significant diagnosis and treatment problems. Here we present a patient diagnosed with lipoid pneumonia. ...Case Presentation: A 55-year-old male patient presented with a 1-week history of cough, sputum and chest pain. There was no medical history. He was an active smoker and he had 30 package/year of smoking. On the chest X-ray, there were infiltrations in the upper zone of the left lung. The laboratory tests included WBC: 11863 (79.36% neutrophil), hemoglobin: 13.9, hematocrit: 41.8, CRP: 8.68 mg/dl, and sedimentation: 39 mm/h. External centered thoracic CT was consulted with the Radiology Department. Thorax CT revealed left hilar and aortopulmonary mediastinal lymphadenopathies, consolidation (11x5 cm size) including air bronchograms in the upper lobe of the left lung, passing the major fissure and extending to the superior segment of lower lobe. There was a fat density in the consolidation and the radiologic preliminary diagnosis was lipoid pneumonia. He had no history of aspiration. Bronchoscopy revealed a smooth-surfaced polyp in the anterobasal segment of the left lower lobe. There was no evidence of infection in the bronchoscopic evaluation. Bronchial lavage gram, culture, ARB and mycobacteria culture results were negative. Bronchial lavage cytology was nonspecific. A biopsy from the endobronchial lesion revealed a liposomal nodule with myxoid stroma. The patient was diagnosed as lipoid pneumonia with negative signs of infectious pneumonia. Spontaneous regression was observed during the diagnostic procedures. Conclusion: In patients with pulmonary infiltration, it is considered that radiological and clinical findings should be evaluated together with non-infectious pathologies that mimic pneumonia.
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Objectives: The blood pressure (BP) has circadian rhythm and fluctuates over a 24-hour period. A ≥10% decrease in average blood pressure at night according to daytime BP was defined as dipper ...hypertension (DHT), and decrease less than 10% was defined as non-dipper hypertension (NDHT). The aim of our study was to investigate the prevalence of obstructive sleep apnea syndrome (OSAS) in NDHT patients. Methods: Twenty-three patients with NDHT and 12 patients with DHT according to ambulatory blood pressure monitoring were included in the study between October 2017 and October 2018. Demographic characteristics, Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI) and polysomnography scores were recorded. Results: Fifteen of the participants were female (42,9%) and 20 (57,1%) were male. The mean age was 56,1±12,03 years. Age, gender, demographic characteristics, smoking history and ESS scores were similar between NDHT and DHT groups. The presence of HT in the family, the use of general preventive strategies and the therapeutic options in the management of hypertension were similar. While there was no difference between the groups in terms of other comorbidities, cardiovascular comorbidities were significantly higher in the NDHT group (p=0.04). As expected in the NDHT, the mean night systolic blood pressure was high. Furthermore, the mean diastolic blood pressure at night was also higher in NDHT group than DHT group (p=0,004). According to PSQI score, 54,3% of the patients had poor sleep quality. Twelve (63,2%) of the patients with poor sleep quality were in the NDHT group and 7 (38,8%) were in the DHT group, but the difference was not significant. In addition, subjective sleep quality was found to be worse in NDHT group (p=0,013). OSAS was detected in 32 (91,4%) of the study population. The prevalence of OSAS was higher in NDHT patients than in DHT group, but the difference was not significant (95,7% vs 83,3%, p=0,2). The median apnea-hypopnea index (AHI), the mean oxygen desaturation index and desaturation time were similar between the groups. Conclusion: Overall OSA prevalence was found to be over 90% in our study population, and OSAS prevalence was higher in NDHT patients than in DHT group, but the difference was not statistically significant. Moreover, the rate of poor sleep quality was higher and subjective sleep quality was significantly lower in NDHT patients. A large number of multicenter prospective studies are needed to assess OSAS prevalence and sleep quality in NDHT patients.
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Objectives: Several cross-sectional studies have shown that low serum levels of Vitamin D are linked to impaired lung function. It is thought that vitamin D may affect the course of asthma by effects ...such as anti-inflammatory effect, prevention of respiratory infections and reduction of steroid resistance. Vitamin D has been suggested to alter chemokine expression of human airway smooth muscle cells and additionally inhibit the expression of the steroid resistance gene. Methods: Thirty-five healthy controls and 60 patients with asthma were included in the study between December 2016 and February 2017. Demographic characteristics and pulmonary function tests (PFT) were recorded and laboratory tests (serum vitamin D, calcium, phosphate, parathormone and alkaline phosphatase) were measured. Asthma control test (ACT) was performed to asthmatics. Partipicians with decreased vitamin D level were consulted with Endocrinology Department for vitamin D replacement therapy. ACT and PFT were repeated after three months therapy in asthmatics. Results: There were 95 individuals; 76 females and 19 males, There were no significant difference between age, gender and demographic characteristics between asthmatics and control group. Smoking status and passive smoking rates were similar. Vitamin D levels were similar in paticipants with turban user and nonusers. There was no significant difference between daily sun exposure, calcium containing diet and menauposal status. Serum phosphate, calcium, alkaline phosphatase, parathormone and 25(OH)D vitamin levels were similar in both groups. Vitamin levels were low in about 90% of both groups. On the first admission, 71,7% of asthmatics were uncontrolled, while the rate of uncontrolled patients decreased to 13,2% after the post-replacement evaluation. There was a significant increase of ACT with respect to vitamin D replacemet therapy (22.4±2.7 vs 16±5.4, p=0.001). There was also significant increase in PFT parameters including FVC (L), FVC (%), FEV1/FVC after replacement therapy and p values were respectively p=0.007; p=0.014 and p=0.008. The mean BMI were high in both groups (≥30 kg/m2). The mean ACT score was lower in obese asthmatics than in non-obese patients, but the difference was not significant (15.3±5.4 vs. 17.5±4.8, p=0.1). Presence of controlled or uncontrolled disease was similar between the obese and non obese groups (p=0.7). Conclusion: It is suggested that vitamine D replacement therapy had positive effects on asthma control and pulmonary functions but further multicentre, prospective studies with large number of cases are needed to evaluate the effect of vitamine D replacement therapy on these parameters.
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Background: Environmental tobacco smoke (ETS) in the home continues to be a major health risk for children around the world. Measuring ETS is a central feature of clinical and epidemiological ...studies, with children’s exposure often assessed through parental estimates. The authors examined the relationship between parent‐reported estimates of children’s exposure to ETS and children’s urinary cotinine levels and evaluated the ETS exposure and its effect on respiratory health in children.
Methods: A total of 188 school children were included in the study. Parents were asked to complete a questionnaire about their smoking habits, their children’s respiratory morbidity status and housing conditions. Urinary cotinine levels were measured in children.
Results: According to the responses, 72.3% of the children came from households with smokers, and 34.6% had daily exposure to ETS. When urine cotinine levels of >10 ng/mL were used as the yardstick of exposure, 76% of the children were identified as ETS exposed. No relation was detected between the symptoms of respiratory tract diseases and ETS exposure. To determine the amount of ETS exposure, the contribution of parental reports was low.
Conclusion: To evaluate the level of ETS exposure of children, the parents’ reports were not reliable. The addition of a biological measure results in a more informative estimate of ETS exposure in children.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
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