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Hakan Gunen,1 Nurdan Kokturk,2 Sibel Nayc&inodot;,3 Sevket Ozkaya,4 Birsen P&inodot;nar Y&inodot;ld&inodot;z,5 Onur Turan,6 Aziz Gumus,7 Metin Akgun,8 Alev Gurgun,9 Candan Ogus,10 Arzu Mirici,11 Elif Sen,12 Nazan Bayram,13 Volkan Eken,14 Hakan Erkus14 1Department of Pulmonary Medicine, Sureyyapasa Training and Research Centre for Chest Diseases and Thoracic Surgery, Istanbul, Turkey; 2Department of Pulmonary Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey; 3Department of Pulmonary Medicine, Mersin University School of Medicine, Mersin, Turkey; 4Department of Pulmonary Medicine, VM Medical Park Samsun Hospital, Samsun, Turkey; 5University of Health Sciences, Yedikule Chest Disease and Surgery Training and Research Hospital, Pulmonology, Istanbul, Turkey; 6Department of Pulmonary Medicine, Izmir Katip Çelebi University, &Idot;zmir, Turkey; 7Department of Pulmonary Medicine, Recep Tayyip Erdogan University, Faculty of Medicine, Rize, Turkey; 8Department of Pulmonary Medicine, Atatürk University School of Medicine, Erzurum, Turkey; 9Department of Pulmonary Medicine, Ege University School of Medicine, &Idot;zmir, Turkey; 10Department of Pulmonary Medicine, Akdeniz University Medical Faculty, Antalya, Turkey; 11Department of Pulmonary Medicine, Canakkale 18 Mart University, Canakkale, Turkey; 12Department of Pulmonary Medicine, Ankara University School of Medicine, Ankara, Turkey; 13Department of Pulmonary Medicine, Gaziantep University, Sahinbey Research Hospital, Gaziantep, Turkey; 14GlaxoSmithKline, Istanbul, TurkeyCorrespondence: Hakan Gunen, Department of Pulmonary Medicine, Sureyyapasa Training and Research Centre for Chest Diseases and Thoracic Surgery, Istanbul, Turkey, Tel +90 532 621 16 99, Fax +90 216 421 41 10, Email hgunen@yahoo.com Nurdan Kokturk, Department of Pulmonary Medicine, Faculty of Medicine, Gazi University, Ankara, Turkey, Tel +90 532 627 91 11, Fax +90 312 212 90 19, Email nkokturk@gazi.edu.tr; kokturk.nurdan@gmail.comPurpose: GOLD 2019 proposed a novel treatment decision tool for follow-up based on the predominant trait (exacerbation or dyspnea) of patients, alongside treatment escalation and de-escalation strategies. This study was designed to provide an up-to-date snapshot of patient and disease characteristics, treatment pathways, and healthcare resource use (HRU) in COPD in real life, and comprehensively examine patients considering GOLD 2019 recommendations.Patients and Methods: This mixed design, observational, multicenter (14 pulmonology clinics) study included all patients with a documented COPD diagnosis (excluding asthma-COPD overlap [ACO]) for ≥ 12 months, aged ≥ 40 years at diagnosis who had a COPD-related hospital visit, spirometry test and blood eosinophil count (BEC) measurement under stable conditions within the 12 months before enrollment between February and December 2020. Data were collected cross-sectionally from patients and retrospectively from hospital medical records.Results: This study included 522 patients (GOLD group A: 17.2%, B: 46.4%, C: 3.3%, D: 33.1%), of whom 79.5% were highly symptomatic and 36.2% had high risk of exacerbation. Exacerbations (n = 832; 46.6% moderate, 25.5% severe) were experienced by 57.5% of patients in the previous 12 months. Inter-rater agreement between investigators and patients regarding the reason for visit was low (κ coefficient: 0.338, p = 0.001). Inhaled treatment was modified in 88 patients at index, mainly due to symptomatic state (31.8%) and exacerbations (27.3%); treatment was escalated (57.9%, mainly switched to LABA+LAMA+ICS), inhaler device and/or active ingredient was changed (36.4%) or treatment was de-escalated (5.7%). 27% had ≥ 1 hospital overnight stay over 12 months. Emergency department visits and days with limitation of daily activities were higher in group D (p < 0.001).Conclusion: Despite being on-treatment, many patients with COPD experience persistent symptoms and exacerbations requiring hospital-related HRU. A treatable trait approach and holistic disease management may improve outcomes by deciding the right treatment for the right patient at the right time.Keywords: COPD, GOLD, exacerbation, COPD treatment, eosinophilia

Abstract Background Rapid and accurate diagnosis of tuberculosis (TB) is crucial to facilitate early treatment of infectious cases and thus to reduce its spread. To improve the diagnosis of TB, more rapid diagnostic techniques such as antibody detection methods including enzyme-linked immunosorbent assay (ELISA)-based serological tests and immunochromatographic methods were developed. This study was designed to evaluate the validity of an immunochromatographic assay, ICT Tuberculosis test for the serologic diagnosis of TB in Antalya, Turkey. Methods Sera from 72 patients with active pulmonary (53 smear-positive and 19 smear-negative cases) and eight extrapulmonary (6 smear-positive and 2 smear-negative cases) TB, and 54 controls from different outpatient clinics with similar demographic characteristics as patients were tested by ICT Tuberculosis test. Results The sensitivity, specificity, and negative predictive value of the ICT Tuberculosis test for pulmonary TB were 33.3%, 100%, and 52.9%, respectively. Smear-positive pulmonary TB patients showed a higher positivity rate for antibodies than smear-negative patients, but the difference was not statistically significant. Of the eight patients with extrapulmonary TB, antibody was detected in four patients. Conclusion Our results suggest that ICT Tuberculosis test can be used to aid TB diagnosis in smear-positive patients until the culture results are available.

The aim of the study is to determine the association between respiratory swallow patterns in amyotrophic lateral sclerosis (ALS) patients. Furthermore, it aims to clarify the role of the dysphagia limit in defining the relationship between swallowing disorders and respiratory disorders. Functional rating scales were used to describe swallowing and respiratory function. Swallowing was observed using the dysphagia limit. Dysphagia limit is the volume at which a second or more swallows are required to swallow the whole bolus. Laryngeal and chest movement sensors, pulmonary function tests, submental, and diaphragm electromyography activity were used to evaluate the relationship between swallowing and respiratory phase. Of the 27 patients included in the study, 14 were dysphagic and 13 were non-dysphagic. Tests showed normal respiratory function in 11 of the non-dysphagic patients and 3 of the dysphagic patients. There was a high correlation between the dysphagia limit and Amyotrophic Lateral Sclerosis Functional Rating Scale swallowing parameters. Non-dysphagic patients were able to swallow during inspiration but only six patients in the dysphagic group were able to swallow during inspiration. The occurrence of dysphagia in ALS is related to piecemeal deglutition and respiration consistency during swallowing. Detecting the timing of disturbances in the relationship between swallowing and respiration may be a way of identifying dysphagia. Dysphagia limit may be a useful, complementary test for assessing swallowing disturbances in amyotrophic lateral sclerosis.

Sarcoidosis is an idiopathic granulomatous disease. It usually affects the lung. The diagnosis may be problematic since the known causes of granulomatous inflammation must be excluded. This multicenter study aimed to evaluate the clinical presentations and diagnostic approaches of sarcoidosis. The study protocol was sent via internet, and the participants were asked to send the information (clinical, radiological and diagnostic) on newly diagnosed sarcoidosis cases. 293 patients were enrolled within two years. Pulmonary symptoms were found in 73.3% of the patients, and cough was the most common one (53.2%), followed by dyspnea (40.3%). Constitutional symptoms were occured in half of the patients. The most common one was fatigue (38.6%). The most common physical sign was eritema nodosum (17.1%). The most common chest radiograhical sign was bilateral hilar lymphadenomegaly (78.8%). Staging according to chest X-ray has revealed that most of the patients were in Stage I and Stage II (51.9% and 31.7%, respectively). Sarcoidosis was confirmed histopathologically in 265 (90.4%) patients. Although one-third of the bronchoscopy was revealed normal, mucosal hyperemi (19.8%) and external compression of the bronchial wall (16.8%) were common abnormal findings. The 100% success rate was obtained in mediastinoscopy among the frequently used sampling methods. Transbronchial biopsy was the most frequently used method with 48.8% success rate. Considering sarcoidosis with its most common and also rare findings in the differential diagnosis, organizing the related procedures according to the possibly effected areas, and the expertise of the team would favour multimodality diagnosis.

Pneumocystis carinii (P. carinii) is an organism which was previously considered as a protozoan but recently it was shown to be more related to fungi. P. carinii increasingly causes opportunistic infections in immunocompromised patients. In this study, we detected P. carinii oocysts by indirect immunofluorescence test in 33 specimens obtained from 31 patients with haematological malignancies who had symptoms of pneumonia and investigated probable risk factors (corticosteroid usage, neutropenia duration, severe or mild neutropenia and type of haematological malignancy) for P. carinii pneumonia in P. carinii (+) patients. Although not statistically significant, PCP incidence was higher in relapsed acute leukemia (AL) patients (62.5%), patients with prolonged neutropenia (57.1%), and who received high dose ARA-C therapy (62.5%). P. carinii (+) patients were treated with trimethoprim-sulfamethoxazole. Six patients with PCP did not respond to therapy and died (50%). In conclusion PCP is not infrequent in AL (especially relapsed AL) and, indirectly we can suggest that chemoprophylaxis may be considered for these patients when they were in severe and prolonged neutropenia after high dose ARA-C therapy.