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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: We aimed to determine the frequency of antibiotics use for possible secondary bacterial pneumonia among hospitalized COVID-19 adults and its association with transfer to intensive care unit (ICU). Material and Method: Hospitalized COVID-19 adults of a tertiary hospital followed retrospectively from 10 March through 31 December 2020, for possible secondary bacterial pneumonia and their transfer to ICU (if any). Patients with bacterial infections other than pneumonia were excluded. Possible bacterial pneumonia was defined as imaging compatible with bacterial pneumonia, together with (at least one of) cough sputum, body temperature above 37°C, leukocyte count over 10000/µL and/or procalcitonin level over 0.16µg/L. Results: Of the 724 eligibles, nine patients with a bacterial infection other than pneumonia were excluded, leaving 715 for analyses. Over a median of 7 (IQR=6) days of follow-up, 462 (64.6%) of the patients received antibiotics, while 253(35.4%) did not. Thirty-three (7.1%) of the patients receiving antibiotics were transferred to ICU, compared to 26 (10.3%) out of those who did not receive antibiotics: the risk of ICU was 0.70 (95%CI=0.43–1.14). In logistic regression analysis, transfer to ICU was lower, yet not statistically significant, among antibiotic receivers (0.56; 95%CI=0.30–1.03), adjusting for age, gender, comorbidity, COVID-19 severity, use of favipiravir, azithromycin, and hydroxychloroquine. Conclusion: Antbiotic use did not statistically significantly affect transfer to ICU. Prospective cohorts are warranted for conclusive evidence to discard the potential for type 2 errors or ineffectiveness of ampiric treatment due to amtimicrobial resistance, and to further validate diagnostic criteria and appropriateness of ampiric regimens. [ABSTRACT FROM AUTHOR]

Objective: Food and beverage preferences and exercise activities suppress the desire to smoke and extend the cessation period. The aim of the present study was to investigate effects of food consumption and physical activities on the success of a smoking cessation program. Methods: In our retrospective cohort study, demographics, smoking cessation therapy features, levels of addiction, treatment results, food preferred in case of desire to smoke during follow-up, and physical activities of 119 patients monitored within the scope of smoking cessation program in our site were recorded. The data of the groups with successful and unsuccessful smoking cessation were analyzed by comparison. Results: The successful group had more patients who quit smoking within the first one month in the treatment process and gained weight than the unsuccessful group (p<0.001 and p<0.001, respectively). Compared to the successful group, the unsuccessful group recorded a higher level of addiction and relapse (p=0.04, p=0.001, respectively). The use of varenicline and nicotine gum among pharmacological treatments did not differ between groups, nicotine patch was more frequently used higher in the unsuccessful group (p=0.046). The successful group also had more patients who consumed hedonic diet among the behavioral strategies in case of urge to smoke (p=0.04). Conclusion: The preference for hedonic foods in case of urge to smoke in patients who underwent smoking cessation treatment and implementing multiple strategies are associated with the success of the treatment, unlike exercise activity. This study may provide preliminary support for an eating strategy using a dietary plan and multi-strategy for the success of smoking cessation programs. [ABSTRACT FROM AUTHOR]

Objective: Computed tomography pulmonary angiography (CTPA) is used for the main diagnosis in acute pulmonary embolism (APE). Determining the thrombus location in the pulmonary vascular tree is also important for predicting disease severity. This study aimed to analyze the correlation of the thrombus location and the clot burden with the disease severity and the risk stratification in patients with APE. Methods: The study included patients with APE diagnosed by CTPA who were admitted to the hospital between January 28, 2016, and July 1, 2019. Data collected were markers of severity in APE, including patient demographics, comorbidities, length of hospital stay, pulmonary embolism severity index (PESI) score, modified PESI score, Wells score, risk stratification according to the American Heart Association, systolic blood pressure (SBP), right ventricle diameter to left ventricle diameter ratio, pulmonary arterial pressure, brain natriuretic peptide, troponin, D-dimer, and plasma lactate levels, and vessel location of the thrombus, clot burden score, ratio of the pulmonary artery trunk diameter/aortic diameter, superior vena cava diameter (SVC) by CTPA, and survival. All parameters were analyzed in correlation with clot load and vessel location. Results: Thrombus vascular location was found to be correlated with risk stratification and negatively correlated with SBP. Simplified Mastora score was correlated with risk stratification, SVC diameter, and D-dimer and negatively correlated with SBP. Occlusion of both the pulmonary artery trunk and any pulmonary artery with thrombus was associated with massive APE. Conclusion: The level of the occluded vessel on CTPA may provide the ability to risk-stratify, and the clot burden score may be used for assessing both risk stratification and cardiac strain. [ABSTRACT FROM AUTHOR]

Background: We aimed to evaluate the pulmonary involvement status, its related factors, and pulmonary function test (PFT) results in the first month follow-up in patients who were discharged for severe Covid-19 pneumonia, and to assess the efficacy of corticosteroid treatment on these parameters in severe pulmonary involvement patients., Methods: We retrospectively analyzed all consecutive patients who applied to our COVID-19 follow-up clinic at the end of the first month of hospital discharge. Functional and radiological differences were compared after 3 months of corticosteroid treatment in severe pulmonary involvement group. Results We analyzed 391 patients with "pulmonary parenchymal involvement" (PPIG) and 162 patients with "normal lung radiology" (NLRG). 122 patients in the PPIG (corticosteroid-required interstitial lung disease group (CRILD)) had severe pulmonary involvement with frequent symptoms and required corticosteroid prescription. Pulmonary involvement was more common in males and elder patients (P<0.001, for both). Being smoker and elderly were associated with a higher risk-ratio in predicting to be in PPIG (OR:2.250 and OR:1.057, respectively). Smokers, male and elderly patients, and HFNO2 support during hospitalization were risk factors for being a patient with CRILD (OR:2.737, OR:4.937, OR:4.756, and OR:2.872, respectively). After a three-months of methylprednisolone medication, a good response was achieved on radiological findings and PFT results in CRILD., Conclusions: In conclusion, after severe COVID-19 pneumonia, persistent clinical symptoms and pulmonary parenchymal involvement would be inevitable in elder and smoker patients. Moreover, corticosteroid treatment in patients with severe parenchymal involvement was found to be effective in the improvement of radiological and functional parameters.

Introduction: Pneumothorax (PTX) and pneumomediastinum (PM) are frequently encountered in patients with Coronavirus disease 2019 (COVID-19) and complicate the management of these patients. In this study, we aimed to evaluate the risk factors that cause PTX/PM complications in patients hospitalized due to COVID-19 pneumonia and the effects of these complications on the course of the disease., Materials and Methods: A total of 503 patients with COVID-19 hospitalized in the COVID-19 ward or intensive care unit (ICU) between September 2020 and December 2020 were included in the study., Result: The median age of patients was 65 (min-max, 21-99) years. Of the patients 299 (59.4%) were male and 204 (40.6%) were female. Of the cases, 26 (5.2%) developed PTX or PM. The patients who developed PTX/PM were older than patients who did not [58.5 (min-max, 21-96) vs 65 years (min-max, 22-99), p= 0.029]. The percentage of PTX/PM development was significantly higher in male patients [F/M= 4/22 (2/7.4%) vs 200/277 (98/92.6%), p= 0.007]. Hypertension as a comorbidity was more commonly seen in the group without PTX/PM (p= 0.007). Ground-glass opacity was the most common tomographic finding in both groups, it was significantly higher in those who did not develop PTX/PM (p<0.001). The length of hospital stay was shorter in patients with PTX/PM (p<0.001), but mortality was higher (p= 0.04)., Conclusions: PTX/PM were relatively more common in COVID-19 patients. These complications may negatively affect the prognosis of the disease.

Introduction: Bronchoscopic biopsies and bronchial washings (BW) are commonly used together for the diagnosis of centrally located tumors. This study aimed to investigate the clinical relevance of routinely collecting BWs in patients who simultaneously had biopsies for visible endobronchial lesions in the current molecular analysis-driven personalized medicine era., Materials and Methods: We retrospectively reviewed the patients who underwent fiberoptic bronchoscopy (FOB) between October 2011 and December 2016. Patients who had both BW and biopsy specimens (EBB: endobronchial forceps biopsy and/or EBNA: endobronchial needle aspiration biopsy) for visible endobronchial lesions were included in this study. Demographic and clinical data, macroscopic findings during FOB, pathology results, and final diagnoses were collected from the hospital database., Result: The study included 269 patients (220 males/49 females) with a mean age of 61.6 ± 10.6 years. While the overall diagnostic yield of FOB was 71.4%, the diagnostic yields of bronchoscopic procedures were 68.2% for EBB, 83.3% for EBNA, and 19.7% for BW. Only three patients (1.1%) with undiagnostic biopsies had positive BW cytology revealing merely malignant epithelial cells., Conclusions: BW provided a negligible diagnostic contribution in 1.1% (n= 3) of the patients. These three patients had undergone further diagnostic procedures for making a proper therapeutic management plan. In the era of personalized therapy, it is logical to obtain more biopsy in the time spent for BWs.

As coronavirus disease 2019 (COVID-19) spreads across the world, the ongoing clinical trials are leading to a big race worldwide to develop a treatment that will help control the pandemic. Unfortunately, COVID-19 does not have any known effective treatment with reliable study results yet. In this pandemic, there is not a lot of time to develop a new specific agent because of the rapid spread of the disease. The process of developing a vaccine is long and requires hard work. Although the pathophysiology of the disease is not fully understood, some of the proposed treatment alternatives are based on old evidence and some have been used with the idea that they might work owing to their mechanism of action. The efficacy, reliability, and safety of the currently available treatment alternatives are therefore a matter of debate. Currently, the main therapies used in the treatment of COVID-19 are antiviral drugs and chloroquine/hydroxychloroquine. Other proposed options include tocilizumab, convalescent plasma, and steroids, but the mainstay of the treatment in intensive care units remains supportive therapies.

The novel coronavirus pandemic poses a major global threat to public health. Our knowledge concerning every aspect of COVID-19 is evolving rapidly, given the increasing data from all over the world. In this narrative review, the Turkish Thoracic Society Early Career Taskforce members aimed to provide a summary on recent literature regarding epidemiology, clinical findings, diagnosis, treatment, prevention, and control of COVID-19. Studies revealed that the genetic sequence of the novel coronavirus showed significant identity to SARS-CoV and MERS-CoV. Angiotensin-converting enzyme 2 receptor is an important target of the SARS-CoV-2 while entering an organism. Smokers were more likely to develop the disease and have a higher risk for ICU admission. The mean incubation period was 6.4 days, whereas asymptomatic transmission was reported up to 25 days after infection. Fever and cough were the most common symptoms, and cardiovascular diseases and hypertension were reported to be the most common comorbidities among patients. Clinical manifestations range from asymptomatic and mild disease to severe acute respiratory distress syndrome. Several patients showed typical symptoms and radiological changes with negative RT-PCR but positive IgG and IgM antibodies. Although radiological findings may vary, bilateral, peripherally distributed, ground-glass opacities were typical of COVID-19. Poor prognosis was associated with older age, higher Sequential Organ Failure Assessment score, and high D-dimer level. Chloroquine was found to be effective in reducing viral replication in vitro. Likewise, protease inhibitors, including lopinavir/ritonavir, favipiravir, and nucleoside analogue remdesivir were proposed to be the potential drug candidates in COVID-19 management. Despite these efforts, we still have much to learn regarding the transmission, treatment, and prevention of COVID-19.