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Chronic obstructive pulmonary disease (COPD) that is the third leading cause of death in the world is one of the main economic burden. The cost is primarily due to COPD exacerbations and hospitalizations. We aimed to determine the factors associated with increasing costs in severe COPD exacerbation. It was a multicenter and prospective observational recording study. 294 patients who severe COPD exacerbation were included in the study. An amount of more than 429.58 euros was accepted as increasing costs (IC). Factors associated with IC were determined by regression analysis. Mean age was 69.90 ± 9.79/years (minimum: 40 maximum: 95), mean costs were 594.9 ± 70.9 euros. About 83.7% of the patients were male, 24.1% (71) were active smokers, and 81% (238) had at least 1 comorbidity. Factors associated with IC in the regression analysis were delay of discharge (due to prolonged consultation), antibiotic use longer than 7 days, need to enteral/parenteral feeding, application of pulmonary rehabilitation (physiotherapy) at hospitalization, and refusal to be discharged. The increasing costs in severe COPD exacerbation depends not only treatment but also the patient's social status and hospital-related factors. We think that the cost of severe COPD exacerbation can be reduced by interventions on interchangeable factors such as patient's social status and hospital-related factors.

Objective: Carbon monoxide poisoning is an important cause of morbidity and mortality all over the world. In our study, it was aimed to determine the clinical and laboratory parameters that may be effective in deciding the need for hyperbaric oxygen therapy in the management of cases., Materials and Methods: From January 2012 to the end of December 2019, 83 patients who applied to a university hospital pediatric emergency department in İstanbul with the diagnosis of carbon monoxide poisoning were included. Demographic characteristics, carbon monoxide source, exposure duration, treatment approach, physical examination findings, Glasgow Coma Score, laboratory results, electrocardiogram, cranial imaging, and chest x-ray were evaluated from the records., Results: The median age of the patients was 56 (37.0-100.0) months and 48 (57.8%) of them were male. The median time of exposure to carbon monoxide was 5.0 (0.5-3.0) hours in those who received hyperbaric oxygen therapy and was significantly higher than those who received normobaric oxygen therapy (P < .001). Myocardial ischemia, chest pain, pulmonary edema, and renal failure were not detected in any of the cases. The median lactate level was detected as 1.5 (1.0-2.15) mmol/L in those who received normobaric oxygen therapy and 3.7 (3.17-4.62) mmol/L in those who received hyperbaric oxygen therapy, and the difference between them was statistically significant (P < .001)., Conclusions: A guideline containing precise clinical and laboratory parameters for hyperbaric oxygen therapy in children has not been developed yet. In our study, carbon monoxide exposure duration, carboxyhemoglobin levels, neurological symptoms, and lactate levels were found to be guiding parameters in determining the need for hyperbaric oxygen therapy.

Objectives: The diagnosis of sarcoidosis is frequently challenging, requiring a search for less invasive, more reliable diagnostic methods. The bronchoalveolar lavage fluid (BALF) analysis has been used in the differential diagnosis of sarcoidosis for many years with a wide sensitivity and specificity rates. The objective of the study is to investigate whether diagnostic performance of the BALF analysis is altered by clinicoradiological findings of patients with sarcoidosis., Materials and Methods: The present study is a retrospective, single-center, observational study, designed in a sarcoidosis outpatient clinic in a training hospital. Patients who had undergone the bronchoalveolar lavage BAL procedure at diagnosis were included in the study. Demographics, clinical and detailed chest X-ray, and high-resolution computed tomography (HRCT) findings at diagnosis were recorded. According to the diagnostic performance, the BALF results were grouped as "diagnostic" and "non-diagnostic," and recorded parameters were compared between the groups., Results: Considering the BALF analysis of all the 257 patients, the mean lymphocyte ratio was 41±17.5 (5-80), and the mean CD4/CD8 was 5.5±4.7 (0.1-24.7). The BALF analysis was diagnostic in 56% (n=145) of patients. Diagnostic performance of the procedure did not correlate with any of the demographic data, smoking status, spirometric findings, chest X-ray staging, HRCT findings, and tomography scoring. Extrapulmonary involvement was significantly more frequent in the diagnostic group (66% vs. 34%, p=0.006)., Conclusion: BALF results signal sarcoidosis in more than half of the patients. The diagnostic role of BALF is greater in patients with extrapulmonary involvement.

Background/aims: The aim of this study was to compare the dynamic thiol/disulfide (SS) homeostasis and ischemia-modified albumin (IMA) concentration between healthy subjects and patients with mild acute pancreatitis (AP)., Materials and Methods: A total of 28 patients with AP (AP group) and 35 age- and sex-matched healthy individuals (control group) were included in this study. Serum thiols/SS and IMA concentrations were measured and compared between the two groups., Results: The mean serum native thiol (SH) and total thiol (TT) levels were significantly lower in the AP group than in the control group (224.7±80.3 μmol/L vs. 314.66±87.5 μmol/L, p<0.001 and 273.3±76.8 vs. 346.9±79 μmol/L, p<0.001, respectively). SS levels were significantly higher in the AP group than in the control group (24.2±11.1 μmol/L vs. 16.1±9.9 μmol/L, p<0.054). There were no differences in the IMA concentration and the mean IMA/albumin ratio (IMAR) between both the groups., Conclusion: We found that mild AP may affect serum thiol and SS levels, and cause impaired thiol/SS homeostasis.

Objectives: Chronic respiratory diseases exert a global health burden with high health care costs, morbidity, and mortality. The aim of the present study was to investigate the effect of pulmonary rehabilitation (PR) on emergency admission and hospitalization rates of patients with chronic respiratory disease., Materials and Methods: In this retrospective cohort study, hospitalization rates and emergency admissions of patients before (December 2014-December 2015) and after PR (January 2015-December 2016) were investigated. Patients with chronic respiratory diseases were included. Chronic obstructive pulmonary disease (COPD) patients were classified based on the Global Initiative Chronic Obstructive Pulmonary Disease assessment scheme. PR was applied by three physiotherapists over 8 weeks (2 days/week). Data on patient demographics, clinical and anthropometric data, spirometry, exercise capacity, and quality of life before and after PR were acquired., Results: This study evaluated 51 patients, of whom 76% were men. A total of 37 (73%) COPD patients and 14 (27%) non-COPD patients (7 bronchiectasis, 4 interstitial lung disease, and 3 kyphoscoliosis) were included. The patients exhibited significantly improved incremental shuttle walk test (ISWT) and endurance test scores (p<0.05) after PR. Similar to exercise capacity, the patients exhibited significantly improved Modified Medical Research Council (mMRC) score, St. George's Respiratory Questionnaire (SGRQ), anxiety and depression scores (p<0.05) after PR. In COPD patients, differences in pre- and post-PR ISWT, COPD assessment test, mMRC, and SGRQ scores were statistically significant (p=0.001). The number of emergency admissions and hospitalizations significantly decreased after PR (p=0.001; p=0.001). The post-PR FEV 1 % of COPD significantly increased (p=0.029)., Conclusion: Pulmonary rehabilitation leads to an increase in exercise capacity as well as improved quality of life, resulting in a decrease in emergency admissions and hospitalization rates. Considering the cost of hospitalization, it is important to add PR to the management of patients with chronic respiratory diseases, in addition to medical therapy.