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Birsen Ocakli,1 Ipek Ozmen,1 Eylem Acartürk Tunçay,1 Sinem Gungor,1 Hilal Altinoz,1 Nalan Adiguzel,1 Zafer Ali Sak,2 Gokay Gungor,1 Zuhal Karakurt,1 Peri Arbak3 1University of Health Sciences, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey; 2Department of Chest Diseases, Harran University, Faculty of Medicine, Sanliurfa, Turkey; 3Department of Chest Diseases, Duzce University, Faculty of Medicine, Duzce, Turkey Purpose: This study was designed to evaluate errors in inhaler technique in COPD vs asthma patients and to investigate the association of poor inhaler technique with patient demographics and clinical variables. Patients and methods: A total of 509 adult patients with COPD (n=328) or asthma (n=181) who were currently using an inhaler device were included in this study. Data on patient demographics, duration of disease, type and duration of inhaler therapy, and assessment of inhaler technique were recorded. Results: Metered dose inhaler (MDI) was the most common type of inhaler used by a similarly high percentage of patients in both COPD (83.2%) and asthma (77.3%) groups. Failure to exhale before inhaling through device (75.8% and 68.5% for MDIs; 73.2% and 71.8% for Aerolizer®/Handihaler®; 53.1% and 66.7% for Turbuhaler®) was the most common error in inhaler technique, in both COPD and asthma groups. Device-specific errors in inhaler techniques were more common in asthma patients as compared with COPD patients, particularly for MDIs (P-values ranged from 0.046 to 0.0005), as associated with female gender (failure to press the buttons on both sides of Aerolizer®/Handihaler®, P=0.006), shorter duration of disease (failure to hold MDI or head in a vertical position, P

Emine Aksoy, Zuhal Karakurt, Sinem Gungor, Birsen Ocakli, İpek Ozmen, Elif Yildirim, Eylem Tuncay, Meltem Coban Agca, Nezihe Ciftaslan Goksenoglu, Nalan Adigüzel Respiratory Intensive Care Unit Clinic, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, Istanbul, Turkey Background: Complete blood count parameters provide novel inflammatory markers, namely neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR). We aimed to assess any differences in these novel inflammatory markers according to exacerbation severity in patients with COPD in both eosinophilic and neutrophilic endotypes. Method: This retrospective cross-sectional study was conducted at a tertiary education hospital. Previously diagnosed COPD patients admitted to the hospital with acute COPD exacerbation (AECOPD) were enrolled into the study. Patients were grouped according to COPD endotype, eosinophilic (peripheral blood eosinophil rate ≥2%) and neutrophilic (peripheral blood eosinophil rate

Birsen Ocakli, Eylem Acarturk, Emine Aksoy, Sinem Gungor, Fulya Ciyiltepe, Selahattin Oztas, Ipek Ozmen, Meltem Coban Agca, Cuneyt Salturk, Nalan Adiguzel, Zuhal Karakurt Department of Chest Diseases, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey Purpose: The aim of this study was to evaluate the impact of exposure to biomass smoke vs cigarette smoke on serum inflammatory markers and pulmonary function parameters in patients with chronic respiratory failure (CRF).Patients and methods: A total of 106 patients with CRF divided into age and gender-matched groups of cigarette-smoke exposure (n=55, mean [SD] age: 71.0 [12.0] years, 92.7% were females) and biomass smoke exposure (n=51, mean [SD] age: 73.0 [11.0] years, 94.1% were females) were included in this retrospective study. Data on patient demographics (age and gender), inflammatory markers, including neutrophil-to-lymphocyte ratio, C-reactive protein, platelet/mean platelet volume ratio, arterial blood gas analysis, and pulmonary function test findings, including forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC were obtained from medical records.Results: Carbon dioxide partial pressure levels were significantly higher in the biomass smoke exposure than in the cigarette smoke exposure group (mean [SD] 51.0 [8.0] vs 47.0 [8.0] mmHg, p=0.026, respectively). Spirometry revealed similarly low levels for FEV1 (%) (38.0 [16.0] vs 40.0 [12.0]%) and FVC (%) (45.0 [19.0] vs 39.0 [19.0]%) in cigarette-smoke and biomass smoke exposure groups, whereas biomass smoke exposure was associated with significantly higher FEV1/FVC (75.0 [14.0] vs 58.0 [12.0]%, p=0.001), lower FVC (mL) (mean [SD] 744.0 [410.0] vs 1,063.0 [592.0] mL, p=0.035) and lower percentage of patients with FEV1/FVC 70% and more prominent loss of vital capacity than cigarette smoke exposure seems to indicate the likelihood of at least 18 years of biomass exposure to be sufficiently high to be responsible for both obstructive and restrictive pulmonary diseases. Keywords: biomass exposure, cigarette smoke, inflammatory markers, spirometry, chronic respiratory failure

Murat Yalcinsoy,1 Cuneyt Salturk,2 Selahattin Oztas,2 Sinem Gungor,2 Ipek Ozmen,2 Feyyaz Kabadayi,2 Aysem Askim Oztim,2 Emine Aksoy,2 Nalan Adıguzel,2 Ozlem Oruc,2 Zuhal Karakurt2 1Department of Pulmonary Medicine, Inonu University Medical Faculty, Turgut Ozal Medical Center, Malatya, 2Department of Pulmonary Medicine, Sureyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey Purpose: Noninvasive mechanical ventilation (NIMV) usage outside of intensive care unit is not recommended in patients with COPD for severe acute respiratory failure (ARF). We assessed the factors associated with failure of NIMV in patients with ARF and severe acidosis admitted to the emergency department and followed on respiratory ward.Patients and methods: This is a retrospective observational cohort study conducted in a tertiary teaching hospital specialized in chest diseases and thoracic surgery between June 1, 2013 and May 31, 2014. COPD patients who were admitted to our emergency department due to ARF were included. Patients were grouped according to the severity of acidosis into two groups: group 1 (pH=7.20–7.25) and group 2 (pH=7.26–7.30).Results: Group 1 included 59 patients (mean age: 70±10 years, 30.5% female) and group 2 included 171 patients (mean age: 67±11 years, 28.7% female). On multivariable analysis, partial arterial oxygen pressure to the inspired fractionated oxygen (PaO2/FiO2) ratio

Cuneyt Salturk,1 Zuhal Karakurt,1 Huriye Berk Takir,1 Merih Balci,2 Feyza Kargin,1 Ozlem Yazıcıoglu Mocin,1 Gokay Gungor,1 Ipek Ozmen,1 Selahattin Oztas,1 Murat Yalcinsoy,3 Ruya Evin,1 Murat Ozturk,1 Nalan Adiguzel1 1Respiratory Intensive Care Unit, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching and Research Hospital, 2Respiratory Intensive Care Unit, Kartal Kosuyolu Cardiovascular Disease and Surgery Teaching and Research Hospital, Istanbul, 3Respiratory Intensive Care Unit, Department of Chest Disease and Pulmonology, Inonu University Medical Faculty, Malatya, Turkey Introduction: The objective of this study was to compare the change in 6-minute walking distance (6MWD) in 1 year as an indicator of exercise capacity among patients undergoing home non-invasive mechanical ventilation (NIMV) due to chronic hypercapnic respiratory failure (CHRF) caused by different etiologies.Methods: This retrospective cohort study was conducted in a tertiary pulmonary disease hospital in patients who had completed 1-year follow-up under home NIMV because of CHRF with different etiologies (ie, chronic obstructive pulmonary disease [COPD], obesity hypoventilation syndrome [OHS], kyphoscoliosis [KS], and diffuse parenchymal lung disease [DPLD]), between January 2011 and January 2012. The results of arterial blood gas (ABG) analyses and spirometry, and 6MWD measurements with 12-month interval were recorded from the patient files, in addition to demographics, comorbidities, and body mass indices. The groups were compared in terms of 6MWD via analysis of variance (ANOVA) and multiple linear regression (MLR) analysis (independent variables: analysis age, sex, baseline 6MWD, baseline forced expiratory volume in 1 second, and baseline partial carbon dioxide pressure, in reference to COPD group).Results: A total of 105 patients with a mean age (± standard deviation) of 61±12 years of whom 37 had COPD, 34 had OHS, 20 had KS, and 14 had DPLD were included in statistical analysis. There were no significant differences between groups in the baseline and delta values of ABG and spirometry findings. Both univariate ANOVA and MLR showed that the OHS group had the lowest baseline 6MWD and the highest decrease in 1 year (linear regression coefficient -24.48; 95% CI -48.74 to -0.21, P=0.048); while the KS group had the best baseline values and the biggest improvement under home NIMV (linear regression coefficient 26.94; 95% CI -3.79 to 57.66, P=0.085).Conclusion: The 6MWD measurements revealed improvement in exercise capacity test in CHRF patients receiving home NIMV treatment on long-term depends on etiological diagnoses. Keywords: exercise capacity, non-invasive ventilation, 6-minute walking test, chronic respiratory failure

Dildar Duman, Emine Aksoy, Meltem Coban Agca, Nagihan Durmus Kocak, Ipek Ozmen, Ulku Aka Akturk, Sinem Gungor, Fatma Merve Tepetam, Selma Aydogan Eroglu, Selahattin Oztas, Zuhal Karakurt Sureyyapasa Chest Diseases and Thoracic Surgery Teaching Hospital, Istanbul, Turkey Background: COPD exacerbations requiring hospitalization increase morbidity and mortality. Although most COPD exacerbations are neutrophilic, approximately 10%–25% of exacerbations are eosinophilic.Aim: We aimed to evaluate mortality and outcomes of eosinophilic and non-eosinophilic COPD exacerbations and identify new biomarkers that predict survival.Methods: A retrospective observational cohort study was carried out in a tertiary teaching hospital from January 1, 2014 to November 1, 2014. All COPD patients hospitalized with exacerbations were enrolled in the study at their initial hospitalization and followed-up for 6 months after discharge. Electronic data were collected from the hospital database. Subjects’ characteristics, hemogram parameters, CRP levels, neutrophil-to-lymphocyte ratio (NLR), platelet-to-mean platelet volume ratio on admission and discharge, length of hospital stay (days), readmissions, and mortality were recorded. Patients were grouped according to peripheral blood eosinophil (PBE) levels: Group 1, >2% PBE, eosinophilic; Group 2, non-eosinophilic ≤2%. Patient survival after hospital discharge was evaluated by Kaplan–Meier survival analysis.Results: A total of 1,704 patients hospitalized with COPD exacerbation were included. Approximately 20% were classified as eosinophilic. Six-month mortality was similar in eosinophilic and non-eosinophilic groups (14.2% and 15.2%, respectively); however, the hospital stay length and readmission rate were longer and higher in the non-eosinophilic group (P

Duman D, Aksoy E, Agca MC, et al. International Journal of COPD. 2015;10(1):2469–2478.Page 2475, Table 4, the second column heading “Odds ratio” is incorrect. The correct column heading is “Hazard ratio”. Read the original article

The aim of this study was to histologically and histomorphometrically investigate the effect of locally applied bovine amniotic fluid (BAF) on osseointegration levels in implants. Adult female Sprague–Dawley rats weighing 300–350 g were used as subjects. The rats were divided into two groups: the sham–operated control group (n=10) and the local BAF group (n=10). Implant cavities were created in the tibias of all subjects under sterile saline cooling with rotating instruments. Local BAF was applied to all implant sockets before the implants were placed. Rats were sacrificed after a four–week osseointegration period. Histological staining was performed using hematoxylin and eosin staining to analyze the osseointegration. Examinations of the bone implant connection (BIC) and peri–implant bone formation (PBF) were performed using a light microscope and an image analyzer. As a result of the analysis, the mean BIC value was 40.3 ± 4.9 for the sham–operated control group and 45.2 ± 7.7 for the local BAF group. The mean PBF was 39.9 ± 6.3 for the sham control group and 40.5 ± 5.7 for the local BAF group. A statistically significant difference was found between the sham control group and the local BAF group for the BIC and PBF values (P>0.05; P: 0.11; P: 0.83). The application of local BAF to the implant socket did not have a clear positive effect on implant osseointegration. More studies are needed to clarify the association between local BAF and osseointegration.

This study aimed to determine the effects of bovine amniotic fluid combined with bone graft in treating peri-implant bone defects with guided bone regeneration. Twenty female Sprague–Dawley rats were divided into two groups. Bone sockets with a diameter of 4 mm in the coronal part and a diameter of 2.5 mm in the apical part of the implant were created into the corticocancellous bone in the metaphyseal parts of the right tibia bones of all subjects. Implants with a length of 4 mm and a diameter of 2.5 mm were placed in the bone sockets. In the sham surgery group (n = 10) was the circumferential bone defect equivalent to half of the 4-mm implant length, which occurred between the implant and the bone, filled with bovine xenograft. Bovine xenografts were filled with amniotic fluid mixture in the experimental group (n = 10). After 8 weeks of recovery, all rats were sacrificed. The implants were extracted from the soft tissues and the surrounding bone. Subsequently, the bones were decalcified and prepared for histological analysis. The percentage of newly regenerated bone (NRB) formation and fibrosis in the bone defect area around the implant was calculated from all sections. NRB was found in 37.4±4.4% of controls and 41.4±2.63% of test animals (P

In this study, it was aim to examine the local application of bovine amniotic fluid on bone fracture healing in rats. Twenty female sprague dawley rats included in the study were divided into 2 groups of 10. The sham group (n=10): Bone fractures were created in the right tibia bones of the rats and fixed with kirschner wire. After a four–week recovery period, the subjects were sacrificed. Local bovine amniotic fluid group (n=10): Bone fractures were created in the right tibia bones of the rats and local bovine amniotic fuid was applied during fixation with kirschner wire. After a four–week recovery period, the subjects were sacrificed. Samples from all subjects were decalcified, stained with hematoxylin and eosin, and new bone formation and fibrosis were analyzed. When the groups were evaluated in terms of new bone regeneration, it was determined that the new bone regeneration in the subjects treated with local bovine amniotic fluid were statistically significantly higher than sham group (P

Lathyrus taxa are used in different areas including nutritive, agricultural areas, and they are seen as the source of both protein and phenolics. Lathyrus taxa seeds contain a neurotoxic substance called ß-N-oxalyl-L-α,ß-diaminopropionic acid (ß-ODAP) in different amounts. Lathyrus species grown in Turkey is reported to have low ß-ODAP and high protein content. In this study, antioxidant activities, phenolic profiles, ß-ODAP and protein contents of six Lathyrus taxa were investigated. Total phenolic content (TPC) in Lathyrus taxa used was ranging from 0.17±0.05 to 5.10±0.02. The antioxidant activities were observed in a wide interval that IC50 values were between 7.05±0.11 to 1.15±0.08 mg/mL. The highest TPC and antioxidant activity were recorded for L. clymenum. In HPLC analysis, gallic, phydroxybenzoic, caffeic, chlorogenic acid and epicatechin in all of the extracts were determined. Also, ß-ODAP and protein contents in seeds of the Lathyrus taxa were found between 0.20-1.18 mg/g and 22.66-29.74%, respectively. ß-ODAP contents of investigated Layhyrus taxa were within the safe consumption range in terms of health (<2.00 mg/g). The investigated Lathyrus taxa were found to be excellent protein sources with low ß-ODAP content and contain natural antioxidants. As a result, this study has provided important data for wild Lathyrus taxa to be used as a cheap protein source and functional food for promoting health. [ABSTRACT FROM AUTHOR]

An endo-β-1,4-glucanase (EG), produced under submerged fermentation by local isolate Trichoderma atroviride, was purified using ammonium sulfate precipitation, column and ion exchange chromatography with 55.16 fold and a specific activity of 30.9 EU mg-1. The studies of PAGE, SDS-PAGE and zymogram test have been carried out. The EG had optimum activity at pH 5.0 and 50 °C respectively. Using CMC as substrate, the enzyme showed maximum activity (Vmax) of 6.7 (μmol glucose min-1) mL-1 with its corresponding Km (Michaelis-Menten constant) value of 1.12 mg mL-1. While the EG activity was activated by NaCl, inhibited by MgCl2 and MgSO4. Otherwise, Tween 80, Triton X-100 and the total saponins known as biosurfactants enhanced the EG activity. The obtained EG had low Km and high thermal stability. Additionally, usability of the EG in biotechnological application was investigated. The results showed that the EG had potentially sufficient effects on denim fabric and pretreated lignocellulosic wastes. [ABSTRACT FROM AUTHOR]

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Chronic obstructive pulmonary disease (COPD) frequently results in hospital readmission and contributes to increased morbidity and mortality. This multicenter prospective study aimed to identify factors that increase the risk of readmission within 30 to 90 days of severe COPD exacerbation. A total of 415 patients admitted to the emergency department (ED) or general pulmonology ward after discharge due to severe exacerbations from 13 tertiary centers in Turkey were included. Of the participants, 346 (83.4%) were male and 69 (16.6%) were female, with an average age of 69.0 ± 9.1 years. Readmissions within 30 and 90 days after the initial hospitalization occurred in 176 (42.4%) and 191 (46%) patients, respectively. Prospective data collection focused on exacerbation severity, disease severity, and the utility of initial admissions. Factors for 30 to 90 day readmission were analyzed using univariate and multivariate regression models. A 30-day readmission correlated significantly with Hospital Anxiety Depression Scale scores above 16 [odds ratio [OR] 95% confidence intervals [CI]: 1.9 (1.1-3.6); P = .042], severe exacerbation history in the previous year [OR 95% CI: 1.7 (1.1-2.9); P = .038], hospital-acquired pneumonia [OR 95% CI: 1.9 (1-4.1); P = .049)], and frequent antibiotic use in the previous year [OR 95% CI: 1.8 (1.2-2.7); P = .007]. Risk factors for 90-day readmissions included: Grades 3 to 4 tricuspid regurgitation [OR 95% CI: 2.2 (1.1-4.4); P = .024], 2 or more moderate COPD exacerbations [OR 95% CI: 1.9 (1.2-3.1); P = .010], severe exacerbation history in the previous year [OR 95% CI: 2.5 (1.5-4.2); P = .001], immunosuppression [OR 95% CI: 2.7 (1.2-5.7); P = .013], frequent antibiotic use the previous year [OR 95% CI: 1.5 (1-2.4); P = .048], hospitalization via the ED [OR 95% CI: 1.6 (1.1-2.6); P = .028]. To mitigate complications and readmissions, patients with a history of frequent severe COPD exacerbations, high anxiety and depression scores, frequent antibiotic requirements, immunosuppression, tricuspid regurgitation, hospital-acquired pneumonia, and those admitted to the ED should be prioritized for remote monitoring after initial discharge., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: This study aimed to evaluate attitudes toward and exposure to gender discrimination in work life by chest diseases specialists and thoracic surgeons., Methods: A total of 275 members of Turkish Thoracic Society (TTS) were included on a voluntary basis in this online cross-sectional questionnaire-survey using an internal member-only social media platform of TTS. The questionnaire form elicited items on sociodemographic characteristics, occupational characteristics and gender discrimination in work life (general opinions, attitudes and exposure)., Results: Female doctors (vs. males) were less likely to be a thoracic surgeon (13.8% vs. 34.5%, p  < 0.05) and a professor of thoracic surgery (0.0% vs. 26.7% vs. p  < 0.05), and more likely to consider housework as a considerable burden (89.8 vs. 73.6%, p  = 0.02) and the significant role of discriminatory, negative and dissuasive attitudes of male physicians in their career choice (67.6 vs. 35.6%, p  = 0.039). Male doctors were more likely to considered that men are more successful in specialties that require active physical strength (65.5 vs. 27.7%, p  = 0.005) and those with very long working hours and heavy shifts (57.5 vs. 39.4%, p  = 0.001). Female thoracic surgeons were more likely than males to consider that specialties with very long working hours and heavy shifts are more suitable for men (26.9 vs. 6.0%, p  = 0.027) and men are given priority in academic career promotion (64.0 vs. 13.3%, p  < 0.001). Younger (vs. older) females reported higher rate of exposure to gender discrimination ( p  = 0.041) and considerable impact of social roles on the specialty ( p  = 0.007), while female doctors working as a resident (33.8%) and a specialist (50.05%) indicated higher rate of exposure to gender discrimination during their career ( p  = 0.024)., Conclusion: In conclusion, our findings revealed that exposure to gender discrimination in work life was more commonly expressed by female members of TTS, particularly in terms of burden of social roles, career advancement options and leadership positions, along with significant role of discriminatory, negative and dissuasive attitudes of male physicians in their career choice. Accordingly, women remain underrepresented in thoracic surgery, particularly in the academic rank of full professor and in leadership positions with inability to promote after a definite step in their careers., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Ocakli, Yorgancioglu, Gungor, Topcu, Senol, Goktas, Kokturk, Tuncay, Gundogus, Altinoz, Yasin, Ozmen, Duru, Yildirim, Sevim, Ozturk, Uzaslan and the Turkish Thoracic Society Women and Lung Diseases Working Group.)

A simple preparation of a paper strip test with a smartphone-based instrument for detecting dissolved mercury is still in development. This study aims to develop a smartphone-based colorimetric paper strip test using chitosan-stabilized silver nanoparticles for detecting dissolved mercury. The method demonstrated high sensitivity and selectivity for Hg 2+ ions, with detection limits comparable to UV-vis spectrophotometry. Silver ions embedded in the chitosan matrix were reduced by either sodium NaBH 4 or N 2 H 4 . Both chi-AgNP colloidal and chi-AgNP paper strips were tested for sensitivity of mercury(ii) solution detection with and without ion interference. The accuracy of colour change responding to the mercury concentration was recorded with several smartphones in a handmade cubical and a T-shape micro-studio. Only NaBH 4 gives colloidal chi-AgNPs relatively dispersed, and the colloidal chi-AgNPs become aggregated when AgNP interacts with mercury(ii) ions. The colour change of chi-AgNP paper strips responding to the concentration of mercury(ii) and quantified using a smartphone is consistent when confirmed with UV-vis spectrophotometric determination with a comparable limit of detection (0.76 μM). The inferring ions do not significantly affect mercury(ii) analyses. Therefore, the paper strip integrated with the smartphone is effectively used for mercury(ii) detection in water as long as the mercury concentration is >1 μM. This finding might inspire advanced technology with a larger number of data references, and machine learning involvement to develop more compatible and simple mercury detection., Competing Interests: The authors declare that there is no conflict of interest regarding the publication of this article. The authors confirmed that the paper is free of plagiarism., (This journal is © The Royal Society of Chemistry.)

Objective: To evaluate the clinical characteristics and treatment outcomes of patients with chronic pulmonary aspergillosis (CPA) and to determine risk factors for disease recurrence., Methods: A total of 43 patients with CPA (mean ± SD age: 61.4 ± 10.5 years, 83.7% were males) were included in this retrospective study. Data on demographic, clinical and disease-related characteristics, galactomannan (GM) test positivity in bronchoalveolar lavage (BAL) samples, histopathological diagnosis, imaging (CT) findings and CPA forms, antifungal therapy, recurrence rate and time to recurrence were recorded., Results: Chronic obstructive pulmonary disease (COPD;76.7%) was the leading predisposing factor, and the aspergillus nodule (37.2%) was the most prevalent CPA form.GM test positivity was noted in 89.7% (35/39) of BAL samples. Median duration of voriconazole treatment was 180 days. CPA recurrence was noted in 14.0% of patients, while the comorbid tuberculosis sequela (66.7% vs. 16.2%, p = 0.02) and mild immunosuppressive disorder (100.0% vs. 51.4%, p = 0.032) were significantly more common in patients with recurrence vs. those without recurrence. Recurrence rate was 50.0% (3 of 6 patients) in patients with simple aspergilloma, and ranged from 0.0% to 25.0% in those with other CPA forms. Treatment duration and time to recurrence ranged 70-270 days and 1.1-37 months, respectively in simple aspergilloma, while they were ranged 150-180 days and 30-43.3 months, respectively in other CPA forms., Conclusions: Our findings indicate the importance of considering CPA in differential diagnosis in patients with predisposing conditions, and emphasize the tuberculosis sequela, immunosuppressive disorder and the certain CPA forms managed with shorter duration of antifungal therapy (i.e., simple aspergilloma) as the potential risk factors of CPA recurrence., (© 2024. The Author(s), under exclusive licence to Springer Nature B.V.)

Antihistamines and glucocorticoids are commonly used to treat allergy symptoms and the inflammatory conditions. In present study, the in-vitro binding interactions a glucocortikoid, dexamethasone/an antihistamine, pheniramine with TSN (TSN) secreted from pancreas to small intestine for protein digestion were investigated by fluorescence emission spectroscopy (FES), UV-Vis spectroscopy, synchronous fluorescence spectroscopy (SFS), CD spectroscopy, FT-IR and molecular modeling methods. Also, the effect of these drugs on the catalytic activity of trypsin (TSN) was determined. The fluorescence quenching experiments indicated that each drugs quenched the intrinsic fluorescence of TSN with their increased concentrations. The results of SFS and UV-Vis spectra proved the interaction of dexamethasone and pheniramine with TSN. CD spectra showed that the secondary structure of enzyme was altered in the presence of the drugs. All these spectroscopy results were validated and explained by molecular docking and molecular dynamic simulation (MD) studies. The IC 50 values were determined as 0.0049 mM and 0.0038 mM for dexamethasone and pheniramine, respectively. So, both drugs have inhibition effect on the catalytic activity of TSN. The results of this study can provide valuable information in the field of pharmacokinetics and pharmacodynamics.Communicated by Ramaswamy H. Sarma.

Background: The International Labour Organization (ILO) Classification of Radiographs of Pneumoconioses is used as the primary tool to determine compensation for pneumoconiosis in Turkey., Aims: We aimed to evaluate how the ILO classification applied, but obtaining chest radiographs in the workplace for screening until the completion of compensation claim files by the referral centres, based on the ILO reading., Methods: The study included 320 digital chest radiographs previously taken for screening from eight different ceramic factories and having finalised claim files by referral centres. We used an expert reference panel consisting of five ILO readers to re-evaluate all the radiographs independently using ILO standard films and reached a conclusion based on the agreement among at least three readers. The evaluation primarily included technical quality and silicosis diagnosis with an ILO 1/0 or above small profusion. The results were compared with previous findings., Results: Sixty-three (20%) chest radiographs were unacceptable for classification purposes according to the ILO technical quality grades. Among the remaining 257 chest radiographs, we diagnosed 103 with silicosis (40%), while the referral centres diagnosed 182 (71%). A discrepancy was found between our results and previous evaluations. We diagnosed silicosis in 50% and 17% of the previous silicosis and normal evaluations, respectively., Conclusions: Our findings suggest that the use of the ILO classification for compensation claims may be problematic due to the way of its implementation in Turkey in addition to its subjectivity., (© The Author(s) 2022. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Objective: To evaluate the utility of neutrophil-lymphocyte ratio (NLR) determined at initial diagnosis in predicting advanced disease stage and discriminating between active and stable disease in sarcoidosis., Methods: A total of 465 patients with biopsy-proven sarcoidosis (age: 47 years, 70.5% females) were included in this retrospective cross-sectional study. Data on patient demographics, sarcoidosis stage, clinical status (stable and active), anti-inflammatory treatments, complete blood count, and inflammatory markers including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR) and platelet/mean platelet volume (MPV) ratio were recorded. NLR values were compared by subgrouping the patients according to the stage of sarcoidosis and clinical status, while the receiver operating characteristics (ROC) curve was plotted to determine the role of NLR in the identification of disease activity with the calculation of area under the curve (AUC) and cutoff value via ROC analysis., Results: Overall, active, and stable disease was evident in 36 (7.8%) and 427 (92.2%) patients, respectively. Median NLR values were significantly higher in patients with active disease compared with stable disease (3.31 (2.34-4.31) vs. 2.29 (1.67-3.23), p = 0.005). Advanced sarcoidosis stage was associated with significantly higher NLR values at stages 0, I, II, III and IV, respectively (p = 0.001). ROC analysis revealed an NLR cutoff value of ≥2.39 (AUC (95% CI): 0.70 (0.62-0.79), p < 0.001) to discriminate between active and stable clinic with a sensitivity of 72.0% and specificity of 52.0%. The significantly higher percentage of patients with active vs. stable disease had NLR values ≥2.39 (74.0 vs. 47.0%, p = 0.002)., Conclusion: Our findings indicate the potential utility of on-admission NLR values to predict the risk of advanced disease stage and to discriminate between active and stable disease in sarcoidosis. Measured via a simple, readily available, and low-cost test, NLR seems to be a valuable marker for monitoring disease activity and progression.

Introduction: Investigations of muscle dysfunction in patients with idiopathic pulmonary fibrosis (IPF) are limited to peripheral muscles. However, decreased thoracic muscle mass is known and deterioration of chest wall muscle strength is not clear., Objective: The aims of the present study were to evaluate pectoralis muscle strength located on the chest wall and to investigate the relationship of spirometric measurements and respiratory muscle strength with pectoralis muscle strength., Methods: Elderly patient with IPF (mean disease duration 7.47±7.04 years) and the age-and sex-matched healthy volunteers were recruited in this cross-sectional study. The pulmonary function test was performed by a portable spirometer for spirometric variables and a gas analyzer for diffusing capacity for carbon monoxide (DL CO ). Maximal inspiratory (MIP) and expiratory pressure (MEP) were measured with mouth pressure device. Modified Medical Research Council Dyspnea Scale (MMRC) was used to determined dyspnea severity. The pectoralis muscle strength was assessed isometrically during shoulder joint horizontal adduction movement with a handheld dynamometer., Results: A total of 17 patients with IPF (9 males, mean age 69.06±3.94 years) and 19 healthy controls (10 males, mean age 70.95 ±4.99 years) were included. Patients with IPF had lower pectoralis muscle strength than healthy controls (p<0.001). Significant relationships were found between pectoralis muscle strength and MIP (r=0.79, p<0.001), MEP (r=0.81, p<0.001), FEV 1 % (r=0.54, p=0.02), FVC% (r=0.68, p<0.003) and DL CO (r=0.61, p=0.009). With multiple linear regression analysis, pectoralis muscle strength was the only independent predictor of FVC% (adjusted R 2 =0.37, p<0.05)., Conclusion: In patients with IPF, pectoralis muscle strength decreases and is associated with pulmonary function. In particular pectoralis muscle strength is likely to have an important impact on FVC%. Therefore, we consider that this test should be included routinely in chest diseases and rehabilitation clinics. The trial was registered U.S. National Library of Medicine clinical trial registry (https://clinicaltrials.gov, Trial ID: NCT04803617)., (Copyright: © 2021 SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES.)

Antiemetic drugs are used to control excessive vomiting and nausea and generally absorbed through gastrointestinal tract. In present study, the in-vitro binding interactions two of the antiemetic drugs (dimenhydrinate and ondansetron) between Trypsin (Tsn) secreted from pancreas to small intestine for protein digestion were investigated by fluorescence emission spectroscopy (FES), UV-VIS spectroscopy, synchronous fluorescence spectroscopy (SFS), FT-IR spectroscopy and molecular modeling methods. Also, the effect of these drugs on the catalytic activity of Tsn was determined. The fluorescence quenching experiments indicated that each drugs quenched the intrinsic fluorescence of Tsn with their increased concentrations. The results of SFS and UV-VIS spectra proved the interaction of dimenhydrinate and ondansetron with Tsn. FT-IR spectra showed that the secondary structure of enzyme was altered in the presence of the drugs. All these spectroscopy results were validated and explained by molecular docking studies. Both drugs have inhibition effect on the catalytic activity of Tsn and the IC 50 values were determined as 2.6 × 10 -4  M and 6.4 × 10 -4  M for dimenhydrinate and ondansetron, respectively. Docking results revealed that the hydrogen bond interaction of dimenhydrinate with active-site residue Ser195 and ondansetron with active-site residues His57 and Ser195 hydrogen bonds might be cause the inhibition of enzyme activity. The results of this study can provide valuable information in the field of pharmacokinetics and pharmacodynamics., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Coronavirus disease 2019 (COVID-19) continues to cause major mortality and morbidity worldwide even after a year of its emergence. In its early days, hypertension, diabetes, and cardiovascular diseases were noted as poor prognostic factors, while obesity gained attention at a later stage. In the present study, unfavorable clinical outcomes (transfer to the intensive care unit, invasive mechanical ventilation, and mortality) were investigated in obese patients with COVID-19., Materials and Methods: In this retrospective study we analyzed patients with positive polymerase chain reaction test in tertiary care hospital between March-May 2020. They were divided into 3 groups according to body mass index (BMI) as normal, overweight, and obese (BMI: 18.5 - 24.99 kg/m², 25 - 29.99 kg/m², and ≥ 30 kg/m², respectively). We compared clinical features and laboratory findings of these groups and recorded adverse clinical outcomes. Multivariate logistic analysis was performed for unfavorable outcomes., Results: There were 99 patients (35%), 116 (41%), and 69 patients (24%) in the normal-weight, overweight, and obese group, respectively. Among all patients, 52 (18%) patients were transferred to the intensive care unit (ICU), 30 (11%) patients received invasive mechanical ventilation (IMV), and 22 patients (8%) died. Obese patients had minimum 1 more comorbidity than normal BMI patients (73% vs. 50%, P = 0.002), and a longer median (interquartile range [IQR]) duration of hospitalization (8 [5 - 12] vs. 6 [5 - 9]) days, P = 0.006). Obese participants had higher concentrations of serum C-reactive protein, procalcitonin, ferritin than non-obese patients ( P <0.05 in all). In a multivariate analysis, obesity was associated with ICU admission (adjusted odds ratio [aOR]: 2.99, 95% confidence interval [CI]: 1.26 - 7.04, P = 0.012). Moreover, IMV requirement was associated with obesity (aOR: 8.73, 95% CI: 2.44 - 31.20, P = 0.001). Mortality occurred in 16%, 9%, and 1% of the obese group, overweight group, and normal-weight group, respectively (Chi-square trend analysis, P = 0.002)., Conclusion: Obesity is a risk factor for adverse outcomes and caused increased mortality, hence requiring close follow-up., Competing Interests: No conflicts of interest., (Copyright © 2021 by The Korean Society of Infectious Diseases, Korean Society for Antimicrobial Therapy, and The Korean Society for AIDS.)

Aim: This study aimed to investigate the use of defunctioning stomas after rectal cancer surgery in Australia and New Zealand, as current practice is unknown., Methods: From the Binational Colorectal Cancer Audit database, data on rectal cancer patients who underwent a resection between 2007 and 2019 with the formation of an anastomosis were extracted and analysed. The primary outcome was the rate of defunctioning stoma formation. Secondary outcomes were anastomotic leakage (AL) rates and other postoperative complications, length of hospital stay (LOS), readmissions and 30-day mortality rates between stoma and no-stoma groups. Propensity score matching was performed to correct for differences in baseline characteristics between stoma and no-stoma groups., Results: In total, 2581 (89%) received a defunctioning stoma and 319 (11%) did not. There were more male patients in the stoma group (65.5% vs. 57.7% for the no-stoma group; P = 0.006). The median age was 64 years in both groups. The stoma group underwent more ultra-low anterior resections (79.9% vs. 30.1%; P < 0.0001), included more American Joint Committee on Cancer Stage III patients (53.7% vs. 29.2%; P < 0.0001) and received more neoadjuvant therapy (66.9% vs. 16.3%; P < 0.0001). The AL rate was similar in both groups (5.1% vs. 6.0%; P = 0.52). LOS was longer in the stoma group (8 vs. 6 days; P < 0.0001) with higher 30-day readmission rates (14.9% vs. 8.3%; P = 0.003). After propensity score matching (n = 208 in both groups), AL rates remained similar (2.9% for stoma vs. 5.8% for no-stoma group; P = 0.15), but stoma patients required less reoperations (0% vs. 8%; P = 0.016). The stoma group had higher postoperative ileus rates and an increased LOS., Conclusion: In Australia and New Zealand, most patients who underwent rectal cancer resections with the formation of an anastomosis received a defunctioning stoma. A defunctioning stoma does not prevent AL from occurring but is mostly associated with a lower reoperation rate. Patients with a defunctioning stoma experienced a higher postoperative ileus rate and had an increased LOS., (© 2021 The Authors. Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.)

Background: The most common thoracic injury in children, resulting in trauma, is pulmonary contusion (PC). Bone marrow-derived mesenchymal stem cells (BM-MSCs) are used in wound healing and many other diseases. This study aims to examine the effects of BM-MSCs on PC healing in rats., Materials and Methods: A total of 45 male Wistar albino rats were used. Four groups were formed. BM-MSCs were labeled with the green fluorescent protein. PC was observed in the control group. In group II, PC occured and left to spontaneous healing. In group III, PC formed and BM-MSCs were given. In group IV, BM-MSCs were given without PC formation. Subjects were sacrificed 1 week later. Whether there was any difference in terms of BM-MSC involvement and lung injury score was investigated. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS), version 17.0, software (SPSS Inc., Chicago, IL), and p value of <0.05 was considered statistically significant., Results: BM-MSCs were collected much more in the lungs in group III than in group IV. Group III had a lower lung injury score value than group II., Conclusion: The greater involvement of the BM-MSCs in the injury site, and further reductions in lung injury score suggest that BM-MSCs are contributing to the healing of the injury. The use of BM-MSCs in risky patients with diffuse PC may be an alternative treatment to conventional methods., (Copyright © 2020 Elsevier Inc. All rights reserved.)

The aim of study was to optimize fermentation parameters for inulinase production from Rhizopus oryzae by a statistical approach and to carry out purification of inulinase. Five isolated fungal strains were screen out inulin degradation by using Lugol's iodine solution. R. oryzae exhibited maximum zone of clearance around the colony and was used as an inulinase producer. The effect of carbon sources (inulin, glucose, maltose, sucrose, lactose, onion peel, stevia root, wheat bran) as medium component and fermentation parameters (temperature (25-45 °C), initial pH (4-7), time (3-7 days)) on inulinase production was investigated by Plackett-Burman Design. Wheat Bran (WB) , temperature, pH, and incubation time were found to be significant for the production of inulinase ( P  < 0.05). Furthermore, Box-Behnken Design was employed to optimize fermentation conditions. The maximum experimental results for inulinase activity and specific activity were 348.36 EU/mL and 3621.78 EU/mg, respectively. The results were obtained at 5 days of incubation time, 35 °C of incubation temperature, initial pH of 5.5, and 2% (w/v) WB. Also, inulinase was purified by using ammonium sulfate precipitation, gel filtration chromatography with 2.19-fold and its molecular weight was found as 89.12 kDa. The optimal pH and temperature of the purified enzyme were 4.0 and 60 °C, respectively. Furthermore, the purified enzyme showed excellent stability at 60 °C. In conclusion, the present study offers cost-effective method to produce inulinase from Rhizopus oryzae . Also, it can be suggested that the purified inulinase has strong potential for usage in production of fructose syrup and other industrial areas., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© Association of Food Scientists & Technologists (India) 2020.)

Background: This study was designed to evaluate the influence of gender on the inhaler technique of subjects on inhaler therapy and to determine the factors predicting the correct inhaler technique and a change of inhaler device., Methods: A total of 568 adult subjects (276 male, 292 female) on inhaler therapy were included in this cross-sectional, observational study. Data on sociodemographic characteristics, inhaler therapy, subject-reported difficulties, and technician-reported errors in inhaler technique were recorded., Results: A change of inhaler device was noted in 71.0% of male subjects and 77.4% of female subjects, and this was based on the physicians' decision in most cases (41.7% and 51.7%, respectively). A higher percentage of female subjects reported difficulties with using inhalers (63.7% vs 40.6%, P < .001). Overall, having received training on the inhaler technique was associated with a higher likelihood of correct inhaler technique (odds ratio 12.56, 95% CI 4.44-35.50, P < .001) and a lower risk of device change (odds ratio 0.46, 95% CI 0.27-0.77, P = .004)., Conclusions: Errors in the inhaler technique, including inhalation maneuvers and device handling, were common in subjects on inhaler therapy. Subject-reported difficulties with using inhalers were more prevalent among female subjects, whereas errors in the inhaler technique identified by direct observation were similarly high in both genders. Overall, a lack of training on the inhaler technique predicted a higher likelihood of errors in the inhaler technique and a change of inhaler device., Competing Interests: The authors have disclosed no conflicts of interest., (Copyright © 2020 by Daedalus Enterprises.)

Magnetic nanoparticles were coated with polyvinyl alcohol and activated with glutaraldehyde for trypsin immobilization. The prepared magnetic nanoparticles were characterized by transmission electron microscopy, fourier transform infrared spectroscopy, thermal gravimetric analysis, zeta potential meter and vibrating sample magnetometer. Free and immobilized trypsin showed optimum activity at pH 6.0, 30 °C and pH 7.0, 40 °C, respectively. Immobilized trypsin was more stable than the free enzyme at 40 °C. After immobilization, K m of the immobilized trypsin increased, however, V max value was almost the same with free trypsin. According to the results, the immobilized trypsin retained 50 % of its initial activity, whereas free trypsin retained 19 % of its initial activity after 12-days at 4 °C. Immobilized trypsin sustained 56 % of its initial activity after eight times of successive reuse. The performance of the immobilized trypsin was evaluated by digestion of cytochrome c. The peptide fragments in digest solution were determined by using MALDI-TOF mass spectrometry. Immobilized trypsin showed effective proteolytic activity in shorter time (15 min) than free trypsin (24 h). Hence, immobilized trypsin on the polyvinyl alcohol coated magnetic nanoparticles could be promising biocatalyst for large-scale proteomics studies and practical applications., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Polypyrrole (PPy) and PPy-containing chitosan-coated Fe 3 O 4 have been electrochemically polymerized on pencil graphite electrodes (PGEs). After the resulting electrodes were characterized by SEM-EDS analysis, glucose-6-phosphate dehydrogenase (G6PD) was immobilized onto these electrodes via glutaraldehyde. The biosensors prepared for the chronopotentiometric detection of glucose-6-phosphate (G6P) at 0.25 mAcm -2 were studied and optimized at different parameters such as the pH of supporting electrolyte, the temperature, and NADP + and G6P concentrations related with the analytical performance of the biosensors. PPy/G6PD (BS-1) and CS/Fe 3 O 4 -PPy/G6PD (BS-2) biosensors showed a broad linear response in the concentration range 0.025-0.25 mM and 0.0025-0.05 mM, and their detection limits for G6P and the RSD values were determined as 0.008 mM and 0.002 mM and 3.80% and 4.60% after 15 times usage, respectively. The interference study with various major blood components such as urea, glucose, and cysteine was performed to evaluate the selectivity of the biosensors. The proposed BS-2 biosensor showed almost free response from available interferences in blood serum with a recovery of 91 to 110%. The developed biosensors could be used in the G6P level measurement of medical samples.

Purpose: Whether pathologic alterations of right ventricle (RV) in chronic obstructive pulmonary disease (COPD) affect intra- and interventricular dyssynchrony due to changes in mechanical activation of the septum and RV is unclear. The aim of this study was to determine mechanical activation and its changes after pulmonary rehabilitation program (PRP) with speckle tracking echocardiography (STE) in COPD patients., Methods: After the exclusion of 15 patients due to poor echogenicity and 5 patients not tolerating PRP out of 69 consecutive COPD patients undergoing PRP, the remaining 49 patients and 41 healthy subjects were enrolled. The mechanical activations of both ventricles were evaluated at admission and after PRP with STE., Results: Chronic obstructive pulmonary disease patients had intra- and interventricular dyssynchrony compared to controls. The interventricular dyssynchrony assessed by time to peak longitudinal systolic strain (PLSS) difference between RV free wall and left ventricle (LV) lateral wall and intraventricular dyssynchrony assessed by RV peak systolic strain dyssynchrony (PSSD) index were improved after PRP. In all, 18 patients were hospitalized due to symptoms of right heart failure within 1 year. The time to PLSS difference between RV free wall and LV lateral wall and RV PSSD index were independent predictors of hospitalization. Receiver operating characteristics (ROC) analysis revealed that a time to PLSS difference between RV free wall and LV lateral wall >15 ms predicted hospitalization within 1 year with 77.8% sensitivity and 64.5% specificity., Conclusions: Chronic obstructive pulmonary disease was associated with intra- and interventricular dyssynchrony. PRP had an important impact on the improvement of both intra-, and interventricular dyssynchrony, which might be used in predicting hospitalization within 1 year., (© 2018 Wiley Periodicals, Inc.)

Background: Although right ventricular (RV) dysfunction in pulmonary diseases has been associated with increased morbidity, tools for RV dysfunction identification are not well defined., Objective: The aim of this study was to evaluate the magnitude of RV dysfunction by means of speckle tracking echocardiography (STE) in patients with chronic obstructive pulmonary disease (COPD) and to investigate whether STE could be used as an index of RV improvement after a pulmonary rehabilitation (PR) program., Methods: Forty-six patients with COPD undergoing PR program and 32 age-sex matched healthy subjects were enrolled. RV function was evaluated at admission and after PR program by conventional two-dimensional echocardiography (2DE) and STE. In addition, exercise tolerance of subjects was evaluated using the six-minute walk test (6MWT)., Results: COPD patients had worse RV function according to STE and 2DE as well. STE was more sensitive than conventional 2DE in determining RV improvement after PR program - RV global longitudinal strain (LS): 20.4 ± 2.4% vs. 21.9 ± 2.9% p < 0.001 and RV free wall LS: 18.1 ± 3.4% vs. 22.9 ± 3.7%, p < 0.001). RV free wall LS was directly related to distance walked at baseline 6MWT (r = 0.58, p < 0.001) and to the change in the 6MWT distance (6MWTD ∆) (r = 0.41, p = 0.04)., Conclusions: We conclude that STE might be as effective as 2DE for evaluation of global and regional RV functions. STE may become an important tool for assessment and follow-up of COPD patients undergoing PR program to determine the relationship between RV function and exercise tolerance.

Background: Lipid-based emulsions can be useful for the management of canine atopic dermatitis (cAD). 18-beta glycyrrhetinic acid (GRA), a component of liquorice root, has anti-inflammatory and anti-pruritic effects., Hypothesis/objectives: To evaluate the effects of a topical lipid emulsion containing ceramides, fatty acids and GRA on clinical signs of cAD and skin barrier in a randomized, double-blinded, placebo-controlled trial., Methods: Client owned (n = 45) dogs with nonseasonal, mild/moderate AD, received either treatment or placebo for three months. Skin lesions, pruritus, transepidermal water loss (TEWL) and global assessment (GA) were evaluated., Results: Fourteen dogs receiving treatment and 14 receiving the placebo completed the study. After one month ≥50% reduction in pruritus was seen in seven of 14 dogs (50%) in the Treatment group, and in two of 14 dogs (14.3%) in the Control group (P = 0.047). After two and three months, significant reduction in pruritus was not seen. For Canine Atopic Dermatitis Extent and Severity Index (CADESI), TEWL and GA, there were no significant findings over time or between groups., Conclusions and Clinical Relevance: The emulsion had some transient beneficial clinical effects. However, it was not effective in controlling pruritus as a monotherapy. Further studies should examine whether owner compliance was a factor in the steady decline of effect on pruritus scores. Further studies evaluating its role as an adjunctive therapy are indicated., (© 2017 ESVD and ACVD.)

The aim of this study was to determine the prevalence of pearly penile papules (PPP) among young men in Eskisehir, Turkey. This was a prospective, non-randomized, cross-sectional study. From December 2014 to September 2015, 2613 consecutive male patients who were referred to the dermatology outpatient clinic were included in the study. Patients were inspected for the presence of PPP, localization, and association with human papilloma virus (HPV). A total of 2613 patients were included in the study. The average age of the patients was 21.33±2.08 (mean ± Standard Deviation (SD); ranging from 18 to 24) years. All of the patients were white and circumcised men. Of the 2613 patients, 449 (17.18%) PPP were observed. PPP were localized on the corona of the glans penis (100%), coronal sulcus (18.9%), frenulum (15.1%), ventral shaft (5.3%), and dorsal shaft of the penis (2.4%). Of the 449 patients with PPP, 23 (5.3%) underwent treatment; 73 (16.2%) would consider removal, 7 (1.5%) had a previous treatment for HPV, and 5 (1.1%) had HPV. PPP are encountered very commonly in the pubertal age in boys and young men. All medical practitioners should be familiar with PPP. Their similarity to genital warts may generate a false apprehension of venereal disease and may lead to unwanted and hazardous treatments. Therefore, better health education is needed.

Background: There is limited data about ICU, short and long-term mortality prediction of severe CAP with neutrophil-to-lymphocyte ratio (NLR): N-terminal proB- type natriuretic peptide (NT-proBNP): C-reactive protein (CRP)., Aim: Besides the known severity indexes of ICU, can NLR, NT-proBNP, CRP predict ICU, short and long term mortality?, Methods: A retrospective cohort study was carried out in a level III ICU of a tertiary training hospital for chest diseases and thoracic surgery., Results: Over the study period, a total of 143 patients were enrolled in the study. The APACHE II scoring showed a significantly higher predicting performance for ICU mortality (p = 0.002). The performance for predicting short term mortality NLR (p = 0.039) and long term mortality NTproBNP (p = 0.002) had a significantly higher performance. The survival analysis revealed that mortality was significantly higher in patients with CURB65 score ≥ 4 (p = 0.047)., Conclusion: NLR, NTproBNP > 2000pg/mL can be used to predict pneumonia severity in ICU alike CURB65 and PSI. Higher NLR, APACHE II and atrial fibrillation can cause an important mortality factor in long term. Consequently, clinicians should take an attention for good cardiac evaluation and cardiac follow-up of patients with CAP (Tab. 4, Fig. 3, Ref. 36).