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OBJECTIVE: 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. MATERIAL AND METHODS: 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. RESULTS: 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. CONCLUSION: 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. [ABSTRACT FROM AUTHOR]

Objective: To identify the clinical characteristics and outcomes of hospital-acquired SARS-CoV-2 infection during the vaccination period nationwide in Turkey. Methods: COVID-19 patients followed in the pandemic services across Turkey between January 1, 2021, and March 31, 2022 were investigated retrospectively. Nosocomial COVID-19 was defined as a patient neither diagnosed with COVID-19 nor suspected COVID-19 at the hospital admission and was confirmed COVID-19 ≥5 days after hospital admission. The primary outcome of this study was in-hospital mortality; demographic features and vaccination status was compared between survivors and nonsurvivors. Results: During the study period, 15 573 COVID-19 patients were followed in 18 centers and 543 (3.5%) patients were nosocomial COVID-19. Most patients with nosocomial COVID-19 (80.4%) were transferred from medical wards. 162 (29.8%) of the patients with nosocomial COVID-19 admitted to the intensive care unit due to disease severity and 138 (25.4%) of the patients died during hospital stay. Advanced age (≥65 years) and number of comorbid diseases (≥2) was found to be associated with mortality in nosocomial COVID-19 (OR 1.74, 95% CI 1.11-2.74 and OR 1.60, 95% CI 1.02-2.56, respectively). Vaccination was associated with survival in nosocomial COVID-19 (OR 0.25, 95% CI 0.16-0.38). Conclusions: Patients with nosocomial COVID-19 had increased admission to intensive care units and higher mortality rate. Vaccination can decrease the in-hospital mortality rate. [ABSTRACT FROM AUTHOR]

Objective: Risk analysis models, which are used in the diagnostic algorithm of incidental pulmonary nodules, are based on patient data from developed countries. Mayo Clinic, Brock University and Herder are among the most known models. We aim to compare the reliability of these models in patients with indeterminate solid nodules and to investigate the contribution of the predictors used to the model. Methods: We analysed 305 patients who performed transthoracic needle biopsy and positron emission tomography/computed tomography for solid nodules, retrospectively. For all three models, the malignancy risk probabilities of patients were calculated, and patients were classified as low (<5%), moderate (60%) and high (<60%) risk groups. Later, the malignancy rates of each model in three different risk groups were compared within each other and among the models. Results: The malignancy rate is 73% in 305 patients. In the Mayo Clinic and Herder models, the difference in the low‐, medium‐ and high‐risk groups is significant (p < 0.001). In the medium‐risk group, the rate of malignancy is 96.8% in the Brock model. In the high‐risk group, the rate of malignancy in Herder is 88.3% and the rate of malignancy in Mayo Clinic is 28.8%. The optimal cutoff values for the Mayo Clinic, Brock University, and Herder were 29.6, 13.4 and 70 (AUC, respectively; 0.71, 0.67 and 0.73). Age, smoking, gender, size, emphysema and spiculation increase the likelihood of malignancy. Conclusion: Close results were obtained in all three models. In the high‐risk group, the Herder model has the highest reliability rate (odds ratio 3.3, confidence interval [1.1, 10.2]). Upper lobe predilection is not a reliable predictor. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Most exacerbations are mild to moderate, and antibiotic treatment for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is recommended for patients with severe exacerbations or severe underlying chronic obstructive pulmonary disease (COPD). Therefore, we aimed to investigate the patient factors that are associated with the prescription of antibiotics for inappropriate indication in AECOPD. MATERIAL AND METHODS: This study was an observational cross-sectional study conducted in an outpatient clinic. The patients diagnosed with AECOPD and prescribed an antibiotic by a pulmonary physician were enrolled in the study. These prescriptions were documented by the pharmacist who asked the patient about the three cardinal symptoms. Appropriate and inappropriate prescription groups were defined by the types of exacerbations, as defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) COPD report. RESULTS: There were 138 patients, predominantly male (83%), with a mean age of 64 (±9) years. A total of 64% of the prescriptions were appropriate; however, there were 50 (36%) patients with inappropriate antibiotic prescription according to the mentioned criteria. When we compared the patient factors between the appropriate and inappropriate antibiotic prescriptions, there was no statistically significant difference in terms of age, Forced expiratory volume in first second % (FEV1%) predicted, FEV1 ml, forced vital capacity (FVC) ml, FEV1/ FVC, and amount (packs/year) of smoking (p>0.05 for all parameters). FVC% was statistically significantly lower in the appropriate antibiotic prescription group compared with that in the inappropriate antibiotic prescription group (p=0.049). CONCLUSION: This study shows that most pulmonary physicians have a tendency to prescribe antibiotics for AECOPD according to the defined GOLD criteria. However, some of the physicians also prefer to prescribe antibiotics self-directedly, irrespective of the GOLD criteria. A physician-based questionnaire can be completed for future studies to define the underlying reasons for antibiotic prescription demands for cases of mild AECOPD. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Neuroendocrine tumors of the lungs are a clearly different group of tumors with definite ultrastructural, immunohistochemical, and molecular features. We reported and analyzed the incidence, clinicopathological features, surgery rates, responses to first-line therapy, and survival outcomes of this rare condition according to our lung cancer patient database. MATERIALS AND METHODS: We retrospectively collected the data of 62 patients who were histopathologically diagnosed with large cell neuroendocrine carcinoma of lung (LCNEC) between January 2010 and January 2016. RESULTS: The patients were predominantly (95%) men (male:female=59:3) with their average age being 60.3±8.6 years. Diagnosis was made by the fine-needle aspiration biopsy (NAB) in 7 patients, bronchoscopic transbronchial biopsy in 13, and surgery in 42. Nearly 43.5% of the patients presented with the tumor in the right upper lobe. Additionally, tumors of 46.8% patients could be observed in peripheral locations. Sixteen patients presented with stage 1, 17 with stage 2, 15 with stage 3, and 14 with stage 4. Median progression-free survival (PFS) was 29 months (SE: 12.2) (95% CI, 5.2-52.8 months). Progression-free survival (PFS) was significantly better in patients with low N, M0, early stage, p63 positive, and TTF-1 positive across the entire cohort. Overall survival (OS) was significantly better in patients with comparatively lower N, M0, low stage, and peripheral location. CONCLUSION: This study demonstrated a single-center experience with clinicopathologic factors and survival outcomes of LCNEC patients. [ABSTRACT FROM AUTHOR]

Objectives: Among the nodule types, the most controversial group are indeterminate solid nodules from 1 to 2 cm in size with the first choice being transthoracic needle biopsy (TTNB) or positron emission tomography (PET‐CT) or both methods together. However, no single diagnostic algorithm could be applied to all cases. This research discusses the diagnostic success of PET‐CT and TTNB. Materials and Methods: 407 Patients who referred to our hospital for any reason, with solid nodules with the size from 1 to 2 cmincidentally identified on the thoracic CT tests were investigated. Among the patients who underwent biopsy, 312 cases had PET‐CT, and maximum SUV (SUVmax) values of the nodules were examined. Values of ≥2.5 were accepted as hypermetabolic. Results: The mean age of the patients was 61 ± 10.8 years. 84 patients were female (20.6%) and 323 were male (79.4%). For TTNB; sensitivity, specificity and accuracy rates of all cases, who were correctly diagnosed, were 76.9%, 83.3% and 78.9%, respectively (P <.001). The 2.5 SUVmax cutoff value had sensitivity of 91%, specificity of 35.6%, accuracy of 75% (P =.034). The cutoff value of 49 years of age, nodule size of 16.4 mm, gender and 2.5 SUVmax value had high accuracy for benign‐malignant differentiation. No statistically significant difference was found in the upper lobe localization of nodule. Conclusion: A positive result from TTNB is a reliable finding; however, a negative result is not definitive. The high negative predictive value of PET‐CT is effective in preventing the unnecessary biopsies and surgical procedures. [ABSTRACT FROM AUTHOR]

Pneumomediastinum is defined as an abnormal accumulation of air within the mediastinum. It occurs most often when increased alveolar pressure leads to alveolar rupture, and less frequently when there is perforation of the tracheobronchial tree. Pressure gradients then allow air to spread via the fascia to the surrounding soft tissues, mediastinum, and/or retroperitoneum. This is a report of a case of pneumomediastinum following endobronchial ultrasound- guided fine needle aspiration (EBUS/TBNA) of the mediastinal lymph nodes, widely regarded as a safe procedure. [ABSTRACT FROM AUTHOR]

Sarcoidosis is a multisystemic, granulomatous disease with particular involvement in the lungs and the intrathoracic lymph nodes. Pleural fluid has been reported to occur in 0% to 5% of the cases in the literature. Diagnosis depends on the presence of noncaseating granulomas in the biopsy sample and the exclusion of other possibilities. A 77-year-old woman with complaints of shortness of breath and a dry cough was found to have non-necrotizing granulomatous inflammation in pleural biopsy and computed tomography guided transthoracic Tru-Cut biopsy specimens. This was a rare case in which partial recovery was achieved through treatment with methylprednisolone for a year in reduced doses. [ABSTRACT FROM AUTHOR]

Objective: There is limited number of studies conducted on the use of capnography for CO2 monitorization in sleep laboratories. In this study, it was aimed to investigate the correlation between the CO2 value measured by transcutaneous carbon dioxide (tcCO2) monitorization and partial pressure of carbon dioxide (PaCO2) levels measured with arterial blood gas analysis in patients diagnosed with obstructive sleep apnea syndrome (OSAS) and Sleep-related hypoventilation/hypoxemic syndromes (SRHHS). Materials and Methods: Patients with bilevel positive airway pressure (BiPAP) treatment indication who were diagnosed with OSAS and SRHHS via polysomnography (PSG), were prospectively included in the study. Four arterial blood gas analyses were conducted from all participants (preand post-PSG, before and after manual bi-level positive airway pressure titration) in order to find PaCO2 levels against tcCO2 monitorization. Results: Totally 30 patients with sleep-related respiratory disease (SRRD), consisting of 18 patients with OSAS and COPD, and 12 patients with OSAS and obesity hypoventilation syndrome (OHS), were included in the study. A correlation was detected between average tcCO2 level and average PaCO2 level in night PSG (r=0.600; p<0.0001). Similarly, we found a correlation between average tcCO2 level and average PaCO2 level in BiPAP titration night measurements as well (r=0.812; p=0.001). Finally, a correlation was detected between the average PaCO2 value obtained from four blood gas samples measured in both nights and the average tcCO2 value taken from two capnographies (r=0.783; p<0.001). Conclusion: Comparing tcCO2 and PaCO2 values, it was determined that the average CO2 values measured by capnography correlated with the average of simultaneous arterial CO2 values measured before and after BiPAP titration. [ABSTRACT FROM AUTHOR]

Objective: Tuberculosis is still a major health problem in developing countries. The definite diagnose is culture for tubercule bacilli, but it takes time, so workers try to find new methods. It has been shown that the activity of serum adenosine deaminase (sADA) increases in patients with tuberculosis. In our study, we investigated the sADA levels, before and during treatment with the clinical, radiological, and laboratory parameters to determine whether it is a helpful parameter for diagnosis, also we researched whether sADA levels can be used for monitoring. Material and Method: 72 lung tuberculosis patients and 20 healthy individuals were examined between January 2007- June 2008. The patients' first, intermediary, and final sADA activities were measured with their clinical, radiological, and laboratory assessments. The initial levels of patients were compared with the control group and the first, intermediary and final sADA levels were compared to each other. Results: First sADA activities of patients were higher than the healthy group (p=0.000). An obvious decrease was observed during and after the treatment comparing to initial levels. The final sADA activities were still higher and the difference was significant (p=0.000). Conclusion: Although the definite diagnosis for pulmonary tuberculosis is culture of bacilli, we consider high sADA levels can be a helpful parameter for diagnosis, can be used in monitoring and response to the antituberculoterapy. We expect comprehensive studies with more extensive cases about this subject will contribute to the literature. [ABSTRACT FROM AUTHOR]