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Noninvasive ventilation (NIV) for acute hypercapnic respiratory failure (AHRF) is an established treatment modality. Current evidence does not conclude any superiority between fixed pressure support (PS) and average volume-assured pressure support (AVAPS) modes. However, given the ability of rapid PaCO2 decline in AVAPS mode, we hypothesized that COPD patients with AHRF who did not show the desired reduction in PaCO2 with fixed-level PS-NIV might benefit from the AVAPS mode.Patients admitted to the non-ICU pulmonary ward with acute exacerbation of COPD (AECOPD) and AHRF were included consecutively in this observational study. Patients with hypercapnic respiratory failure due to obesity-hypoventilation, neurological diseases, or chest wall deformities were excluded. All patients started NIV treatment with fixed pressure support (PS) and patients who did not reach clinical and laboratory stability under PS-NIV treatment were switched to the average volume-assured pressure support (AVAPS) mode of NIV.Thirty-five COPD patients with hypercapnic respiratory failure were included. Under PS-NIV treatment, 14 (40%) patients showed a 17.9 (-0.0-29.2) percent change in terms of PaCO2, meaning no improvement or worsening. Therefore, these patients were treated with AVAPS mode. Arterial PaCO2 and pH levels significantly improved after AVAPS-NIV administration. AVAPS-NIV treatment created a significantly better PaCO2 change rate than using PS-NIV [-11.4 (-22.0 - -0.5) vs 8.2 (-5.3-19.5), p= 0.02]. Independent predictors of AVAPS mode requirement were higher Charlson Comorbidity Index [OR= 1.74 (95% CI= 1.02-2.97)] and higher PaCO2 upon admission [OR= 1.18 (95% CI= 1.03-1.35)]. Thirteen (92.8%) patients reaching significant clinical stability with AVAPS-NIV were able to return to fixed-level PS-NIV and maintain acceptable PaCO2 levels.Our study demonstrated that patients can benefit from AVAPSNIV despite insufficient response to fixed-level PS-NIV.

The potential role of interleukin-6 (IL-6) in coronavirus disease 2019 (COVID-19) pneumonia provides the rationale for investigating IL-6 signaling inhibitors.To evaluate and report treatment responses to tocilizumab (TCZ) in COVID-19 patients and compare mortality outcomes with those of standard care.Patients hospitalized with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, diagnosed with reverse transcription polymerase chain reaction (RT-PCR) between March 2020 and April 2021, were enrolled in this single-center retrospective cohort study. Propensity score matching was performed in order to reduce confounding effects secondary to imbalances in receiving TCZ treatment.A total of 364 patients were included in this study. Two hundred thirty-six patients received standard care, while 128 patients were treated with TCZ in addition to standard care (26 (20.3%) patients received a dose of 400 mg intravenously once, while 102 (79.7%) patients received a total dose of 800 mg intravenously). In the propensity score-matched population, less noninvasive mechanical ventilation (p = 0.041) and mechanical ventilation support (p = 0.015), and fewer deaths (p = 0.008) were observed among the TCZ-treated patients. The multivariate adjusted Cox regression model showed a significantly higher survival rate among TCZ patients compared to controls (hazard ratio (HR): 0.157, 95% confidence interval (95% CI): 0.026-0.951; p = 0.044). The hazard ratio for mortality in the TCZ group was 0.098 (95% CI: 0.030-0.318; p = 0.0001 using log-rank test).This study determined that TCZ treatment in COVID-19 patients was associated with better survival, reduced need for mechanical ventilation and reduced hospital-associated mortality.

İntraplevral streptokinaz etkinliğinin incelenmesi amacıyla, enfekte plevral sıvıda intraplevral streptokinaz tedavi (İPST) takiben cerrahi ihtiyacı, opere olan ve olmayan olgularda plevral sıvı parametrelerinin bu ihtiyacı öngörmedeki etkisinin değerlendirilmesi planlanmıştır. Kliniğimizde beş yıllık periyotta İPST uygulanan olgular retrospektif olarak incelenmiştir. Tüberküloz plörezi olguları çalışma dışı bırakılmıştır. Çalışmaya dahil edilen İPST uygulanmış 72 hastanın 58’i parapnömonik efüzyon (PPE), 10’u komplike parapnömonik efüzyon (KPE) ve 4’ü ampiyem idi. İPST sonrası 72.saat, 24saat öncesi ile karşılaştırıldığında plevral sıvı drenajının anlamlı düzeyde arttığı gözlenmiştir [0 ml (0–1000) karşı 650 ml (0-2935), p, We aimed to asses clinical efficacy of intrapleural streptokinase, as well as to examine the relationship between the need for surgery follow-ing intrapleural streptokinase treatment (IPST) and, ability to predict surgery requirement of the pleural fluid parameters in operated and non-operated groups. We retrospectively analysed data of patients treated with intrapleural streptokinase, within a period of five years, in our clinic. Tuberculosis pleurosiy cases were excluded. Seventy-two patients treated with intrapleural streptokinase were recruited. Of the patients 58 with parapneumonic effusion (PPE), 10 with complicated parapneumonic effusion (CPE) and 4 were diagnosed with empyema. A significant increase was observed when the pleural fluid drainage on the 72nd hour of IPST was compared to that measured 24 hours before treatment [0 ml (0–1000) vs. 650 ml (0-2935), p

Background: Determination of the prognostic factors which affects the mortality and morbidity in COVID-19 patients, has an importance in terms of planning the treatment and follow-up strategy. Material and Method: Patients who had COVID-19 diagnosis via microbiologically and/or radiologically between March and October 2020 in a tertiary-care university hospital were recorded retrospectively. Only adult patients (≥18 years) with clinical spectrum of moderate, severe and critical illness were included in the study according to National Institutes of Health (NIH) guideline. A p value of less than 0.05 was considered significant. Ethical committee approval was given from the Uludag University with decision number 2020-22/11. Also, the permission from Republic of Turkey, Ministry of Health was given. Results: A total number of 257 patients were included in the study. 30-day mortality rate was recorded as 14.4%. In univariate analysis; age, chronic renal failure, malignancy, cerebrovascular disease, number of comorbidities >2, dyspnea, cough, NIH severe and critical illness, oxygen saturation, respiratory rate, systolic and diastolic blood pressure, qSOFA, GCS, MEWS, SOFA, CURB-65, CCI, CRP, procalcitonin, CK, D-dimer, lymphocyte and thrombocyte levels, neutrophile-to-lymphocyte ratio, AST, albumin, hemoglobin, CK-MB, fibrinogen, LDH and potassium levels were found as statistically significant (p

Obstrüktif uyku apne sendromu (OUAS) hastalarında vasküler hastalık riski artmıştır. Bu hastalarda kardiyovasküler hastalık gelişimine ait kesin mekanizma bilinmemektedir. Fibrinojen normal plazmanın ana bileşenidir. Akut faz reaktanı olan fibrinojen düzeyleri inflamatuar yanıtın bir parçası olarak yükselmektedir. Fibrinojenin koroner arter hastalığı ve inme için bağımsız risk faktörü olduğu gösterilmiştir. Çalışmamızda yeni orta/ağır OUAS tanısı almış hastalarda ve non-apneik olgularda plazma fibrinojen düzeylerini karşılaştırmayı ve polisomnografi (PSG) parametreleri ile ilişkisini değerlendirmeyi amaçladık. Tüm gece PSG sonrası yeni tanı almış 50 orta ve ağır OUAS olgusu ile 33 nonapneik kontrol olgu çalışmaya dahil edilmiştir. uyku çalışmasının ardından sabah 8.00-9.00 saatleri arasında kan örnekleri alınarak plazma fibrinojen düzeyleri Clauss metodu ile ölçülmüştür. Her iki grup arasında yaş, cinsiyet, sigara alışkanlığı açısından fark saptanmadı. Plazma fibrinojen düzeyleri OUAS grubunda (4.2 ± 0.14 g/L) kontrol grubuna göre anlamlı derecede yüksek bulundu (p

Background Combined pulmonary fibrosis and emphysema (CPFE) has been recognised as a phenotype of pulmonary fibrosis. We aimed to compare serum surfactant protein-A (SP-A), surfactant protein-D (SP-D) and Krebs von den Lungen-6 (KL-6) levels, functional parameters, in CPFE and IPF (idiopathic pulmonary fibrosis) patients. Methods Patients diagnosed with 'CPFE' and 'IPF' were consecutively included in 6 months as two groups. The patients with connective tissue diseases are excluded. Results In this study, 47 patients (41 males, 6 females) with CPFE (n = 21) and IPF (n = 26) with a mean age of 70.12 ± 8.75 were evaluated. CPFE patients were older, had more intense smoking history, had lower DLCO/VA, lower FVC, and worse six-minute walking distance than the IPF group (p=0.005, p=0.027, p=0.02, p0.001, p=0.001, respectively). Serum KL-6 levels were higher in CPFE group compared to IPF group [264.70 U/ml (228.90-786) vs 233.60 (101.8-425.4), p0.001]. Serum KL-6 levels of 245.4 U/ml and higher have 81% sensitivity and 73% specificity for the discrimination of CPFE from IPF. Conclusions Our study has shown that serum KL-6 level is a promising biomarker to differentiate CPFE from IPF. In CPFE cases respiratory and functional parameters are worse than those of pure fibrosis cases.

The purpose of this study was to elucidate the asthma knowledge level of primary-secondary school teachers in Bursa, and factors associated with this subject.In our study 1812 teachers from 64 randomly selected primary schools in Bursa were included.It was known by the vast majority of participants that asthma symptoms, asthma is not a contagious disease and may be familial, medications taken by inhalation. It was known by 64.1% of the teachers that asthmatic children do not mind doing sports. Approximately one of the two teachers knew that the medication were not addictive.The knowledge level of the teachers was related to female gender and age. We think that an asthma education program is needed for Turkish teachers to increase their understanding about what asthma is, its impact and how to meet the needs of a child with asthma to achieve improved wellbeing and school attendance.

We aimed the determine to diagnostic value and efficacy of endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) in suspicion of pulmonary sarcoidosis. We retrospectively analyzed 23 patients who underwent EBUS-TBNA for evaluation of sarcoidosis with enlarged hilar and/or mediastinal lymph nodes on thoracic competed tomography (CT) during the period of May 2016 to February 2017. In addition to cytologic examination, all of the patients EBUS-TBNA samples were also sent for mycobacterial cultures. Mean age of the patients was 43±14 and, 13 of them were female. Seventeen of 23 patients had a final diagnosis of sarcoidosis. One patient was ultimately diagnosed with tuberculous lymphadenitis and another one diagnosed with Mycobacterium other than tuberculous -M. avium ssp- infection. Diagnostic accuracy of EBUS-TBNA was 91.3%, and the rate of sarcoidosis was 94.4% in patients with granulomatous lymphadenitis. EBUS-TBNA is a safe and effective procedure in the assessment of patients with suspected benign hilar/mediastinal lymphadenitis. In addition to cytopathologic assessment, mycobacterial culture examination is playing a crucial role in differential diagnosis of granulomatous lymphadenitis., Bu çalışmada, pulmoner sarkoidoz şüphesiyle endobronşial ultrason kılavuzluğunda transbronşial iğne aspirasyon (EBUS-TBİA) yapılan olgularda EBUS-TBİA tanı değeri ve etkinliğinin incelenmesi hedeflendi. Mayıs 2016- Şubat 2017 döneminde toraks bilgisayarlı tomografide (BT) büyük hiler/mediastinal lenf nodları olan ve sarkoidoz ön tanısıyla EBUS-TBİA yapılan 23 hastanın verileri retrospektif incelendi. Tüm örnekler, sitolojik incelemeye ek olarak mikobakteriyel kültür için de laboratuvara gönderildi. Yaş ortalaması 43±14 ve olguların 13ü kadın idi. Yirmiüç olgunun 17si sarkoidoz, bir hasta tüberküloz lenfadenit, bir diğeri de tüberküloz dışı mikobakteri -M. avium ssp- tanısı aldı. EBUS-TBİA tanı doğruluğu %91.3 ve granülomatöz lenfadenit saptanan olgularda sarkoidoz tanı oranı ise %94.4 bulundu. Benign mediastinal/hiler lenf nodu şüphesiyle yapılan EBUS-TBİA, etkili ve güvenli bir yöntem olarak değerlendirildi. Sitolojik değerlendirmeye ek olarak yapılacak mikobakteriyel kültür inceleme, granülomatöz lenfadenit ayırıcı tanısında kritik rol oynamaktadır.

Chronic obstructive pulmonary disease (COPD) is the fourth most common cause of death in the world. Risk of developing community acquired pneumonia (CAP) and invasive pneumococcal disease (IPH) increased in patients with COPD compared to those without comorbidities. Pneumonia severity, intensive care unit admission ve mortality rates increased in COPD patients who are diagnosed with CAP. According to national and international guidelines, pneumococcal and influenza vaccination are recommended in all stages of COPD management. Pneumococcal vaccinations, 13-valent conjugate vaccine (PCV13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23), are recommended for all patients > 65 years of age. The PPSV23 is also recommended for younger COPD patients with significant comorbid conditions including chronic heart disease. Influenza and pneumococcal vaccination for COPD may reduce hospitalization, frequency of exacerbations and also prevent exacerbations. Taking into account the low immunization rates of COPD patients in our country, it is important to increase the sensitivity of physicians in this issue., Kronik obstruktif akciğer hastalığıdır (KOAH) dünyada en sık dördüncü ölüm nedenidir. KOAH olgularında komorbiditesi olmayanlara göre toplumda gelişen pnömoni (TGP) ve invaziv pnömokokal hastalık (İPH) gelişme riski artmaktadır. TGP tanısı alan KOAH olgularında KOAH olmayan hastalara göre pnömoni şiddeti, yoğun bakım yatışı ve mortalite oranları da artış göstermektedir. Stabil KOAH yönetiminde tüm evrelerde, ulusal ve ulusararası kılavuzlarda pnömokok aşılama ve yıllık influenza aşılama önerilmektedir. 23-valanlı pnömokokal polisakkarit aşı (23PPA) ve 13-valanlı konjuge pnömokok aşı (13KPA) ile pnömokokal aşılama, >65 yaş olan tüm erilkinlerde önerilmektedir. Daha genç olan KOAH olgularında da özellikle kronik kalp hastalığı gibi ciddi komorbidite varlığında 23PPA ile aşılama önerilir. İnfluenza ve pnömokok aşılama ile KOAH alevlenmeleri çoğunlukla önlenebilir ya da sıklığı ve hastane yatışı azaltılabilir. Ülkemizde KOAH hastalarının düşük bağışıklama oranlarını dikkate alarak, bu konuda hekimlerin duyarlılığını arttırmak önem arz etmektedir.

Although pulmonary tuberculosis is common in Turkey, parotid gland tuberculosis is rarely seen. A 39 years old female presented with left side swelling on her face. The diagnosis was made excisional biopsy. Histologic examination of the operative specimen revealed necrotising granuloma concordant with tuberculosis.

“4. European Congress for Bronchology and Interventional Pulmonology (ECBIP)” Kongresi’nde sözlü bildiri olarak sunulmuştur. Bu çalışmada, pulmoner sarkoidoz şüphesiyle endobronşial ultrason kılavuzluğunda transbronşial iğne aspirasyon (EBUS-TBİA) yapılan olgularda EBUS-TBİA tanı değeri ve etkinliğinin incelenmesi hedeflendi. Mayıs 2016- Şubat 2017 döneminde toraks bilgisayarlı tomografide (BT) büyük hiler/mediastinal lenf nodları olan ve sarkoidoz ön tanısıyla EBUS-TBİA yapılan 23 hastanın verileri retrospektif incelendi. Tüm örnekler, sitolojik incelemeye ek olarak mikobakteriyel kültür için de laboratuvara gönderildi. Yaş ortalaması 43±14 ve olguların 13’ü kadın idi. Yirmiüç olgunun 17’si sarkoidoz, bir hasta tüberküloz lenfadenit, bir diğeri de tüberküloz dışı mikobakteri -M. avium ssp- tanısı aldı. EBUS-TBİA tanı doğruluğu %91.3 ve granülomatöz lenfadenit saptanan olgularda sarkoidoz tanı oranı ise %94.4 bulundu. Benign mediastinal/hiler lenf nodu şüphesiyle yapılan EBUS-TBİA, etkili ve güvenli bir yöntem olarak değerlendirildi. Sitolojik değerlendirmeye ek olarak yapılacak mikobakteriyel kültür inceleme, granülomatöz lenfadenit ayırıcı tanısında kritik rol oynamaktadır. We aimed the determine to diagnostic value and efficacy of endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) in suspicion of pulmonary sarcoidosis. We retrospectively analyzed 23 patients who underwent EBUS-TBNA for evaluation of sarcoidosis with enlarged hilar and/or mediastinal lymph nodes on thoracic competed tomography (CT) during the period of May 2016 to February 2017. In addition to cytologic examination, all of the patient’s EBUS-TBNA samples were also sent for mycobacterial cultures. Mean age of the patients was 43±14 and, 13 of them were female. Seventeen of 23 patients had a final diagnosis of sarcoidosis. One patient was ultimately diagnosed with tuberculous lymphadenitis and another one diagnosed with Mycobacterium other than tuberculous -M. avium ssp- infection. Diagnostic accuracy of EBUS-TBNA was 91.3%, and the rate of sarcoidosis was 94.4% in patients with granulomatous lymphadenitis. EBUS-TBNA is a safe and effective procedure in the assessment of patients with suspected benign hilar/mediastinal lymphadenitis. In addition to cytopathologic assessment, mycobacterial culture examination is playing a crucial role in differential diagnosis of granulomatous lymphadenitis.

Kronik obstruktif akciğer hastalığıdır (KOAH) dünyada en sık dördüncü ölüm nedenidir. KOAH olgularında komorbiditesi olmayanlara göre toplumda gelişen pnömoni (TGP) ve invaziv pnömokokal hastalık (İPH) gelişme riski artmaktadır. TGP tanısı alan KOAH olgularında KOAH olmayan hastalara göre pnömoni şiddeti, yoğun bakım yatışı ve mortalite oranları da artış göstermektedir. Stabil KOAH yönetiminde tüm evrelerde, ulusal ve ulusararası kılavuzlarda pnömokok aşılama ve yıllık influenza aşılama önerilmektedir. 23-valanlı pnömokokal polisakkarit aşı (23PPA) ve 13-valanlı konjuge pnömokok aşı (13KPA) ile pnömokokal aşılama, >65 yaş olan tüm erilkinlerde önerilmektedir. Daha genç olan KOAH olgularında da özellikle kronik kalp hastalığı gibi ciddi komorbidite varlığında 23PPA ile aşılama önerilir. İnfluenza ve pnömokok aşılama ile KOAH alevlenmeleri çoğunlukla önlenebilir ya da sıklığı ve hastane yatışı azaltılabilir. Ülkemizde KOAH hastalarının düşük bağışıklama oranlarını dikkate alarak, bu konuda hekimlerin duyarlılığını arttırmak önem arz etmektedir. Chronic obstructive pulmonary disease (COPD) is the fourth most common cause of death in the world. Risk of developing community acquired pneumonia (CAP) and invasive pneumococcal disease (IPH) increased in patients with COPD compared to those without comorbidities. Pneumonia severity, intensive care unit admission ve mortality rates increased in COPD patients who are diagnosed with CAP. According to national and international guidelines, pneumococcal and influenza vaccination are recommended in all stages of COPD management. Pneumococcal vaccinations, 13-valent conjugate vaccine (PCV13) and 23-valent pneumococcal polysaccharide vaccine (PPSV23), are recommended for all patients > 65 years of age. The PPSV23 is also recommended for younger COPD patients with significant comorbid conditions including chronic heart disease. Influenza and pneumococcal vaccination for COPD may reduce hospitalization, frequency of exacerbations and also prevent exacerbations. Taking into account the low immunization rates of COPD patients in our country, it is important to increase the sensitivity of physicians in this issue.

Disseminated infections caused by members of the Fusarium fujikuroi species complex (FFSC) occur regularly in immunocompromised patients. Here, we present the first human case caused by FFSC-member Fusarium andiyazi. Fever, respiratory symptoms and abnormal computerised tomography findings developed in a 65-year-old man with acute myelogenous leukaemia who was under posaconazole prophylaxis during his remission-induction chemotherapy. During the course of infection, two consecutive blood galactomannan values were found to be positive, and two blood cultures yielded strains resembling Fusarium species, according to morphological appearance. The aetiological agent proved to be F. andiyazi based on multilocus sequence typing. The sequencing of the internal transcribed spacer region did not resolve the closely related members of the FFSC, but additional data on partial sequence of transcription elongation factor 1 alpha subunit did. A detailed morphological study confirmed the identification of F. andiyazi, which had previously only been reported as a plant pathogen affecting various food crops.

OBJECTIVE: Systemic inflammation is important in pathophysiology of obstructive sleep apnea (OSA) and its comorbidity. Neutrophil to lymphocyte ratio (N/L ratio) is a novel inflammation index that has been shown to independently predict poor clinical outcomes. In this study, we aimed to evaluate the role of N/L ratio in OSA patients and comparing with other well-known inflammatory marker, C-reactive protein (CRP). PATIENTS AND METHODS: We conducted a retrospective analysis of 481 patients with mild, moderate and severe OSA (163,158 and 160 patients, respectively) and leukocyte profiles of 80 sex-, age-and body mass index-matched healthy controls. Patients were excluded if they had underlying cancer, chronic inflammatory disease, any systemic infection, uncontrolled hypertension and diabetes mellitus, a known acute coronary syndrome, valvular heart disease, a known thyroid, renal or hepatic dysfunction. RESULTS: We found that N/L Ratio in severe OSA patients was significantly higher compared with mild, moderate, OSA patients and healthy controls (p < 0.001). However, there was no difference between mild and moderate OSA patients (p = 0.636). There was also no significant difference between mild-moderate OSA patients and healthy groups (p = 0.150). CRP levels were not different in all OSA stages (p = 0.595). By Spearman correlation, there was no correlation between CRP and N/L ratio. CONCLUSIONS: N/L ratio, which is quick, cheap, easily measurable novel inflammatory marker with routine complete blood count analysis, is a surrogate marker of obstructive sleep apnea severity.