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Background: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods: WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings: Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0–4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2–6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation: In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. Funding: European Society of Intensive Care Medicine, European Respiratory Society.

BackgroundA collaboration between the University of Michigan (UM) Cystic Fibrosis Center (CFC) and Marmara University (MU) CFC was initiated in MU through conducting Quality Improvement projects (QIP). The global aim was to improve nutritional status of children with CF (cwCF), with a specific aim to increase the mean BMI percentile (BMIp) for cwCF by 10 percentile points in 12 months. MethodsBody mass index (BMI) percentiles of cwCF were categorized as: nutritionally adequate (BMIp >= 50%); at risk (BMIp 25%-49%); urgently at risk (BMIp 10%-25%); critically at risk (BMIp < 10%). Appropriate interventions were made according to BMIp category every three months. Forced expiratory volume in one-second percent predicted (FEV1pp), and health-related quality of life (HRQoL) were evaluated. ResultsOne hundred and eight-two cwCF with a mean age of 9.1 +/- 4.3 years were included in the project. Baseline BMIp increased from 25.6 to 37.2 at the 12th month (p < 0.001). In the critically at-risk group BMIp increased from 3.6 to 20.5 (p < 0.001), in the urgently at risk group from 15.9 to 30.8 (p < 0.001), in the at risk group from 37.0 to 44.2 (p < 0.079) and in the nutritionally adequate group the increase was from 66.8 to 69.5 (p < 0.301). FEV1pp also improved significantly, from 81.3 +/- 20.6 to 85.9 +/- 20.8 (p < 0.001). Physical functioning, eating problems, and respiratory symptoms domains of the HRQoL evaluation improved (p < 0.05). ConclusionThis project has led to significant improvements in BMIp, FEV1pp and HRQoL of cwCF; similar projects could easily be implemented by centers in other developing countries.

Objectives: Sputum acid-fact bacilli (AFB) and Xpert examinations are the most commonly used methods in early diagnosis for pulmonary tuberculosis. It becomes difficult for the clinician to initiate treatment in patients with negative sputum smear and Xpert examinations at the stage of diagnosis. Waiting for culture results for diagnosis causes delay in treatment and increases the risk of disease transmission. We aimed to investigate the contribution of bronchoscopic lavage (BL) obtained with flexible fiberoptic bronchoscopy (FOB) to the diagnosis of tuberculosis. Methods: The BL results of 36 patients hospitalized in the tuberculosis clinic who were clinically suspected of tuberculosis, but whose sputum AFB and Xpert results were negative, and whose bronchoscopic lavages were taken by FOB, were retrospectively evaluated. Results: BL Xpert examination was the method that made the most contribution to the diagnosis with a rate of 27.7%. BL smear AFB results did not contribute to the diagnosis statistically. Sputum and BL tuberculosis culture results were found to be close to each other. In total, the diagnosis of 50% of the patients was confirmed. Conclusions: Performing Xpert examinations on bronchoscopic materials of patients with negative sputum examinations significantly increase the rate of early diagnosis.

© 2022 All right reserved by the Turkish Society of Cardiovascular Surgery. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes (http://creativecommons.org/licenses/by-nc/4.0/).Background: This study aims to investigate whether the coexistence of advanced renal cell carcinoma and inferior vena cava tumor thrombus could be treated with a multidisciplinary approach and teamwork and to evaluate early and mid-term results. Methods: Between January 2017 and December 2020, a total of 33 patients (28 males, 5 females; mean age: 55.8±13.2 years; range, 27 to 76 years) who underwent radical nephrectomy and thrombectomy of the inferior vena cava were retrospectively analyzed. Demographic characteristics of the patients, types of operations, postoperative data, mortality and morbidity rates were recorded. Results: Of the patients, 12% (n=4) had Stage 2 tumor thrombus, 60.6% (n=20) had Stage 3 tumor thrombus, and 27% (n=9) had Stage 4 tumor thrombus. A total of 55% (n=19) of the patients had right-sided renal cell carcinoma, while 45% (n=14) of them had a left-sided mass. Totally, 66% (n=22) of the patients underwent primary inferior vena cava repair. The thrombectomy procedure and a Dacron® patch was applied with patch plasty in 24% (n=8) of the patients, and Dacron® graft interposition was applied to the inferior vena cava in 9% (n=3) of the patients. The mean follow-up was 20.3±13.0 (range, 2 to 70) months. Deep vein thrombosis was detected in the follow-up of seven (21%) patients, and no pulmonary thromboembolism was observed during the postoperative follow-up period. The mean length of stay in the intensive care unit was 1.39±0.6 (range, 1 to 3) days. The 30-day mortality rate was 3%, due to the loss of one patient from massive pulmonary embolism intraoperatively. Conclusion: Vascular surgical procedures performed regardless of the stage of the tumor thrombus provide satisfactory mid-term results in patients with advanced renal cell cancer. Amaç: Bu çalışmada, renal hücreli karsinom ve inferior vena kava tümör trombüs birlikteliğinin multidisipliner bir yaklaşım ve ekip çalışması ile tedavi edilip edilemeyeceği araştırıldı ve erken ve orta dönem sonuçları değerlendirildi. Ça­lış­ma pla­nı: Ocak 2017 - Aralık 2020 tarihleri arasında, radikal nefrektomi ile birlikte inferior vena kavaya trombektomi uygulanan toplam 33 hasta (28 erkek, 5 kadın; ort. yaş: 55.8±13.2 yıl; dağılım, 27-76 yıl) retrospektif olarak incelendi. Hastaların demografik özellikleri, ameliyat türleri, ameliyat sonrası verileri, mortalite ve morbidite oranları kaydedildi. Bulgular: Hastaların %12’sinde (n=4) Evre 2 tümör trombüsü, %60.6’sında (n=20) Evre 3 tümör trombüsü, %27’sinde (n=9) Evre 4 tümör trombüsü vardı. Hastaların toplam %55’inde (n=19) sağ taraflı renal hücreli karsinom ve %45’inde (n=14) sol taraflı kitle mevcuttu. Hastaların toplam %66’sında (n=22) inferior vena kava primer olarak onarıldı. Hastaların %24’üne (n=8) trombektomi ve yama plasti ile Dacron® yama uygulandı ve %9’una (n=3) inferior vena kavaya Dacron® greft interpozisyonu yapıldı. Ortalama takip süresi 20.3±13.0 (dağılım, 2-70) ay idi. Yedi (%21) hastanın takibinde derin ven trombozu saptandı ve ameliyat sonrası takip döneminde pulmoner tromboemboli saptanmadı. Yoğun bakım ünitesinde ortalama kalış süresi 1.39±0.6 (dağılım, 1-3) gün idi. Bir hasta ameliyat sırası masif pulmoner tromboemboli nedeniyle kaybedildiği için 30 günlük mortalite oranı %3 idi. So­nuç: İleri evre renal hücreli kanser hastalarında tümör trombüsünün evresinden bağımsız olarak yapılan vasküler cerrahi işlemler tatmin edici orta vadeli sonuçlar sağlar.

Background and Aim Pulmonary embolism (PE) is a potentially life-threatening disease in children. The objective of the study is to evaluate the utility of adult-based pulmonary embolism rule-out criteria (PERC), Pediatric PE Model, and D-dimer in the diagnosis of PE in children. Material and Methods The study consisted of patients under 18 years of age who were consulted to the Pediatric Pulmonology Clinic for the evaluation of PE. Patients were divided into two groups based on the confirmation of PE. The group with the presence of PE (n = 20) consisted of children who were diagnosed with PE. The group with the absence of PE (n = 28) consisted of children with clinically suspected PE but negative diagnostic imaging. Adult validated clinical decision PERC rule and Pediatric PE Model were retrospectively applied to the patients. Results In the study, PERC demonstrated a sensitivity of 60% and a specificity of 46% for the diagnosis of PE in children. When PE Model was evaluated for the children, it was found a 50% sensitivity and 75% specificity. Combining PE Model and PERC rule with D-dimer did not increase the specificity and sensitivity. Smoking was found to be relevant for PE in the childhood. Twenty-five percent of the patients had a genetic tendency for PE. All of the patients had an underlying disease as well. Conclusion None of the current risk assessment tools (PE Model, PERC, D-dimer) were found to be accurate in predicting PE. Further larger population studies are still required to develop a better diagnostic approach.

Objectives: Little is known about COVID-19 and less about the B.1.1.7. There is a need for clinical information and tests to help doctors deal with the pandemic. This study aimed to investigate clinical and laboratory differences between hospitalized non-variant COVID-19 and the B.1.1.7 variant. Methods: Data of 173 hospitalized non-variant COVID-19 and 176 B.1.1.7 variants were retrospectively investigated. D-dimer monocyte ratio (DMR) and ferritin monocyte ratio (FMR) values were calculated by dividing D-dimer and ferritin levels to monocyte count, respectively. Monocyte eosinophil ratio (MER) was obtained by dividing monocyte count by eosinophil levels. Results: Clinical stay, intensive care unit (ICU) stay, and severe disease rates were found to be higher in the non-variant COVID-19. Eosinophil and basophil levels remained lower, whereas ferritin, FMR, and MER were more elevated in the same group. On ROC analysis, areas under the curve (AUC) of ferritin and FMR were found as 0.7 (p = 0.001) and 0.75 (p = 0.001), respectively. Conclusions: The present study revealed that the B.1.1.7 variant had milder clinical manifestations, shorter clinic and ICU stay, and less severe disease rates than the non-variant COVID-19. Higher levels of ferritin, FMR, and MER may indicate the B.1.1.7 variant.

Objectives: We aimed to investigate the objective quantitative differences between the parenchymal computed tomography (CT) findings of idiopathic pulmonary fibrosis (IPF) patients diagnosed by surgical lung biopsy and by multidisciplinary discussion without biopsy. Methods: We performed parenchymal texture analyses in lung CT images of 116 IPF patients, 42 diagnosed by surgical lung biopsy, and 74 by multidisciplinary discussion without biopsy. The relative volumes of the ground-glass, reticular, honeycomb, hyperlucent, and normal parenchymal patterns were measured in six predefined sections of each lung by an automatic texture analysis software (CALIPER: Computer-Aided Lung Informatics for Pathology Evaluation and Rating). The results were compared between the two patient groups. Results: When the relative volumes of the parenchymal patterns were compared between the biopsied and non-biopsied groups in a total lung-based manner, the mean percentage of only the ground-glass pattern was significantly higher in the biopsied group. When compared between the corresponding lung sections, the percentages of the ground-glass pattern were higher in the biopsied group than those in the non-biopsied group at the bilateral central sections of the upper, middle, and lower lung zones. At the bilateral peripheral sections of the middle and lower lung zones, the sectional reticular pattern percentages were lower in the biopsied group than those in the non-biopsied group. Conclusions: CALIPER’s quantitative CT measurements revealed that the sectional relative volumes of the ground-glass and reticular patterns, but not of the honeycomb, normal, and hyperlucent parenchyma, were significantly different between some of the corresponding lung sections of the biopsied and non-biopsied IPF patients. This information may help a better understanding of the role of the CT findings in biopsy decisions and avoiding some of the unnecessary biopsies in suspected IPF patients.

European CF Society Neonatal Screening Working Group (ECFS NSWG): Sabine Renner , Max Zeyda , Elke de Wachter , Luc Regal , Felix Votava, Andrea Holubova, Marianne Skov , Tessa Morgan, Paul Bregeaut , Loretta O'Grady, Ines Bucci , Stefano Pantano , Simonetta Simonetti, Domenica De Venuto, Donatello Salvatore, Nicola Perrotti, Mimma Caloiero, Giuseppe Castaldo, Antonella Tosco, Francesca Righetti, Giovanna Pisi, Fiorella Battistini, Antonio Angeloni, Giuseppe Cimino, Giovanni Fiocchi, Antonella Angiolillo, Michela Cassanello, Luisella Alberti, Laura E Claut, Raffaele Badolato, Enza Pavanello, Benedetta Fabrizzi, Elisabetta Bignamini, Anna Cardillo, Mariangela Lombardo, Letizia Cocciadiferro, Lisa Termini, Daniela Dolce, Vito Terlizzi, Anna Tamanini, Francesca Pauro, Giancarlo la Marca, Elina Aleksejeva, Dita Gaidule-Logina, Stoika Fustik, Violeta Anastasovska, Marelle Bouva, Alastair Reid, Jennifer Cundick, Emma Lundman, Egil Bakkeheim, Katarzyna Zybert, Mariusz Oltarzewski, Laura Vilarinho, Victoria Sherman, Elena Kondratyeva, Sarah Smith, Gordana Vilotijevic Dautovic, Maria Knapkova, Zuzana Mydlova, Rosa Mª López, Valle Velasco, Felicitas Díaz Flores, Cristóbal Colón Mejeras, Eva Sl Pedersen, Ugur Ozcelik, Bulent Karadag, Halyna Makukh, Moat Stuart. European CF Society Neonatal Screening Working Group (ECFS NSWG): INSA - Laura Vilarinho Background: The aim of this study was to record the current status of newborn bloodspot screening (NBS) for CF across Europe and assess performance. Methods: Survey of representatives of NBS for CF programmes across Europe. Performance was assessed through a framework developed in a previous exercise. Results: In 2022, we identified 22 national and 34 regional programmes in Europe. Barriers to establishing NBS included cost and political inertia. Performance was assessed from 2019 data reported by 21 national and 21 regional programmes. All programmes employed different protocols, with IRT-DNA the most common strategy. Six national and 11 regional programmes did not use DNA analysis. Conclusions: Integrating DNA analysis into the NBS protocol improves PPV, but at the expense of increased carrier and CFSPID recognition. Some programmes employ strategies to mitigate these outcomes. Programmes should constantly strive to improve performance but large datasets are needed to assess outcomes reliably. Highlights: In 2022, newborn bloodspot screening (NBS) for CF is undertaken in 30 European countries, 26 of them are national programmes; Some programmes are still not achieving ECFS standards. Compared to 2014, there is an improvement in sensitivity but a deterioration in achieving a sufficient PPV; There continues to be a wide variety of approaches, but the majority of national programmes are now using DNA analysis as a 2nd tier; This survey demonstrates areas of good practice, but there is considerable scope for improvement in the quality of NBS for CF across Europe; The framework of the 20 parameters to calculate the 8 key outcomes should be part of any annual report of a CF NBS programme, and thus improve future surveys. The survey was funded by the European CF Society info:eu-repo/semantics/publishedVersion

BackgroundEffectiveness studies with biological therapies for asthma lack standardised outcome measures. The COMSA (Core Outcome Measures sets for paediatric and adult Severe Asthma) Working Group sought to develop Core Outcome Measures (COM) sets to facilitate better synthesis of data and appraisal of biologics in paediatric and adult asthma clinical studies.MethodsCOMSA utilised a multi-stakeholder consensus process among patients with severe asthma, adult and paediatric clinicians, pharmaceutical representatives, and health regulators from across Europe. Evidence included a systematic review of development, validity and reliability of selected outcome measures plus a narrative review and a pan-European survey to better understand patients’ and carers’ views about outcome measures. It was discussed using a modified GRADE (Grading of Recommendations Assessment, Development and Evaluation) Evidence to Decision framework. Anonymous voting was conducted using predefined consensus criteria.ResultsBoth adult and paediatric COM sets include forced expiratory volume in 1 s (FEV1) as z-scores, annual frequency of severe exacerbations and maintenance oral corticosteroid use. Additionally, the paediatric COM set includes the Paediatric Asthma Quality of Life Questionnaire and Asthma Control Test or Childhood Asthma Control Test, while the adult COM set includes the Severe Asthma Questionnaire and Asthma Control Questionnaire-6 (symptoms and rescue medication use reported separately).ConclusionsThis patient-centred collaboration has produced two COM sets for paediatric and adult severe asthma. It is expected that they will inform the methodology of future clinical trials, enhance comparability of efficacy and effectiveness of biological therapies, and help assess their socioeconomic value. COMSA will inform definitions of non-response and response to biological therapy for severe asthma.

BackgroundPaediatric diffuse alveolar haemorrhage (DAH) is a rare heterogeneous condition with limited knowledge on clinical presentation, treatment and outcome.MethodsA retrospective, descriptive multicentre follow-up study initiated from the European network for translational research in children's and adult interstitial lung disease (Cost Action CA16125) and chILD-EU CRC (the European Research Collaboration for Children's Interstitial Lung Disease). Inclusion criteria were DAH of any cause diagnosed before the age of 18 years.ResultsData of 124 patients from 26 centres (15 counties) were submitted, of whom 117 patients fulfilled the inclusion criteria. Diagnoses were idiopathic pulmonary haemosiderosis (n=35), DAH associated with autoimmune features (n=20), systemic and collagen disorders (n=18), immuno-allergic conditions (n=10), other childhood interstitial lung diseases (chILD) (n=5), autoinflammatory diseases (n=3), DAH secondary to other conditions (n=21) and nonspecified DAH (n=5). Median (IQR) age at onset was 5 (2.0–12.9) years. Most frequent clinical presentations were anaemia (87%), haemoptysis (42%), dyspnoea (35%) and cough (32%). Respiratory symptoms were absent in 23%. The most frequent medical treatment was systemic corticosteroids (93%), hydroxychloroquine (35%) and azathioprine (27%). Overall mortality was 13%. Long-term data demonstrated persistent abnormal radiology and a limited improvement in lung function.ConclusionsPaediatric DAH is highly heterogeneous regarding underlying causes and clinical presentation. The high mortality rate and number of patients with ongoing treatment years after onset of disease underline that DAH is a severe and often chronic condition. This large international study paves the way for further prospective clinical trials that will in the long term allow evidence-based treatment and follow-up recommendations to be determined.

Objective: The objective of this study was to evaluate and compare knowledge, attitude, and practice patterns between pulmonologists and allergists for adult asthma in Turkey. Methods: Questionnaire-based data were gathered from 236 pulmonologists and 62 allergists, who had been members of the Turkish Thoracic Society and Turkish National Society of Allergy and Clinical Immunology in January-March 2021. Univariate and multivariate statistics were used to determine the factors associated with primary reliever preferences. Results: Of the 298 physicians, 39% encountered at least five asthma patients daily. Spirometer was used frequently by both the allergists (82.3%) and pulmonologists (77.5%) for asthma diagnosis. Budesonide was the most preferred inhaler corticosteroid. Formoterol/budesonide was the most preferred ICS/LABA combination, followed by beclomethasone/formoterol and fluticasone/salmeterol for asthma treatment. For mild asthmatics, formoterol/ICS was the most preferred (72.6%) reliever among allergists, whereas salbutamol was the most preferred (66.1%) among pulmonologists (p < 0.001). Age and workplace were associated with salbutamol preference of doctors for mild asthmatics. Age, specialty, and patient examination time were significantly associated with salbutamol preference for severe asthmatics. Conclusions: The use of diagnostic tools, such as a spirometer, for asthma diagnosis was compatible with the guidelines. While recent updates of the guidelines indicate that salbutamol should not be used solely in mild asthmatics due to its harmful effects in long-term use, it still was the most preferred drug by pulmonologists. Postgraduate education programs are needed to improve compliance with the guidelines.

OBJECTIVESSurgical management of pulmonary metastases in colorectal cancer patients is a debated topic. There is currently no consensus on this matter, which sparks considerable risk for international practice variation. The European Society of Thoracic Surgeons (ESTS) ran a survey to assess current clinical practices and to determine criteria for resection among ESTS members.METHODSAll ESTS members were invited to complete an online questionnaire of 38 questions on current practice and management of pulmonary metastases in colorectal cancer patients.RESULTSIn total, 308 complete responses were received (response rate: 22%) from 62 countries. Most respondents consider that pulmonary metastasectomy for colorectal pulmonary metastases improves disease control (97%) and improves patients’ survival (92%). Invasive mediastinal staging in case of suspicious hilar or mediastinal lymph nodes is indicated (82%). Wedge resection is the preferred type of resection for a peripheral metastasis (87%). Minimally invasive approach is the preferred approach (72%). For a centrally located colorectal pulmonary metastasis, the preferred form of treatment is a minimally invasive anatomical resection (56%). During metastasectomy, 67% of respondents perform mediastinal lymph node sampling or dissection. Routine chemotherapy is rarely or never given following metastasectomy (57% of respondents).CONCLUSIONSThis survey among the ESTS members underlines the change in practice of pulmonary metastasectomy with an increasing tendency in favour of minimally invasive metastasectomy and surgical resection is preferred over other types of local treatment. Criteria for resectability vary and controversy remains regarding lymph node assessment and the role of adjuvant treatment.

Background: A collaboration between the University of Michigan (U of M) Cystic Fibrosis Center (CFC) and Marmara University (MU) CFC was initiated to improve the health status of people with cystic fibrosis (pwCF) at MU through implementing Quality Improvement (QI) initiatives. The main aim was to improve lung function in children with FEV1pp

OBJECTIVES: The underlying mechanisms for the development of chronic thromboembolic pulmonary hypertension and prognostic biomarkers are not clear yet. Thus, our aim is to assess and identify new biomarkers for the expression of 84 key genes linked to angiogenesis. METHODS: Patients who had levels more than 1000 dynes·sec·cm(−5) were included in the test group, and the other patients were included in the control group. Twelve specimens were taken from the patients. RT(2) Profiler PCR Array (Qiagen) was used to quantify the expression of the 84 key genes. RESULTS: Eight patients (6 male, 2 female, median age 54.4 ± 13.1 years) who underwent pulmonary endarterectomy were included. Pulmonary vascular resistance improved significantly from 811 ± 390 dyn/s/cm(−5) to 413.3 ± 144.9 dyn/s/cm(−5) (P .005) after surgery. Median length of hospital stay was 11.62 ± 2.97 days. The test group had a distinct pattern of impaired angiogenic and antiangiogenic genes. The expression levels of TGFA, TGFB1, THBS2, THBS1, TGFBR1, SERPINE1, SERPINF1, TGFB2, TIMP2, VEGFC, IFNA1, TNF, CXCL10, NOS3, IGF1, and MMP14 were downregulated in the specimens from the patients who had higher pulmonary vascular resistance values, whereas some genes, including PDGFA, showed upregulation that was statistically nonsignificant in the same group. CONCLUSIONS: These results can lead to the development of new markers that could predict adverse outcomes of patients with CTEPH. Identification of new markers that are related to worse outcomes would enable screening patients for early diagnosis and treatment.

Background/Aim: The performance of the right ventricular myocardium is crucial in various pathological states and the right ventricular dysfunction has a prognostic value in pulmonary embolism. We sought to bring out which parameters were helpful in predicting a normal right ventricular function in patients with acute pulmonary embolism.Methods: Consecutive 100 acute pulmonary embolism patients, who were hospitalized and confirmed by computed tomography angiography, were enrolled in this cohort study. All patients’ demographics, symptoms on admission, risk factors, electrocardiography and laboratory findings, and hemodynamic parameters were assessed. Echocardiography was performed in the first 24 hours. The study group of pulmonary embolism patients was divided into two groups based on their basic characteristics: Patients with normal right ventricular function and patients with right ventricular failure.Results: The average age of the patients was 63 (16) years, with 48 (48%) of them being male. Twenty three patients (23%) had normal RV functions. According to the multiple logistic regression analysis, age (P=0.041, OR: 1.174, 95% CI: 1.007 to 1.368), oxygen saturation (P=0.026, OR: 1.372, 95% CI: 1.039 to 1.812) and heart rate (P=0.049, OR: 1.160, 95% CI: 1.001 to 1.346) were independent predictors of normal RV function. The setting in which all three parameters (Age, Heart rate, Oxygen saturation) were positive was considered AHO index=1, with a positive predictive value of 100% a sensitivity of 44%, a negative predictive value of 85.6% and a specificity of 100% (AUC: 0.717, 95% CI: 0.619 to 0.803) for normal RV function.Conclusion: In acute pulmonary embolism patients who were younger than 53 years of age with a heart rate of ≤118 bpm and an oxygen saturation of >90% (AHO index=1), right ventricular functions were normal. Accordingly, without the need of computed tomography angiography or echocardiography, the clinician may predict normal right ventricular function with available demographic and noninvasive hemodynamic parameters.

Background/Aim: Pulmonary thromboembolism (PTE) has high mortality and morbidity, is difficult to diagnose, and is generally preventable. Clinical scoring is used for early diagnosis. Two of these often-used scoring systems include the Wells and Simplified Modified Geneva scoring systems. We aimed to comparatively determine the values of the Wells and the Simplified Modified Geneva scoring systems in showing PTE. Methods: This prospective cohort study included 195 patients who underwent computerized tomography pulmonary angiography (CTPA) with suspected PTE between May 2018 and November 2018. The Wells and Simplified Modified Geneva scores of the patients were calculated. Wells Clinical Scoring results were grouped as having a weak/strong probability of PTE, while those of the Modified Geneva clinical scoring were categorized as possible/unlikely PTE. The analyses were performed with the SPSS package 21.0 program. Results: One hundred and nine (55.9%) patients presented to the emergency department and eighty-six (44.1%) patients visited the outpatient clinic for chest diseases. Of all cases, 83 (42.6%) were male and 112 (57.4%) were female. The mean age was 57.16 (18.62) years. Forty-one (21%) patients had PTE. The sensitivity and specificity of Wells Clinical Scoring for PTE were 87.8% and 83.8%, respectively, while those of the Simplified Modified Geneva Clinical Scoring were 82.9% and 53.3%, respectively. The chi-square analysis for two clinical scorings revealed a p-value of 0.001. The negative predictive values of Wells and Simplified Modified Geneva Scores were 96.2% and 92.1%, respectively. The positive predictive value was the highest in the emergency department (80% and 39.4%, respectively). When the two clinical scores were used together, the negative and positive predictive values were 95.6% and 61.1%, respectively. Conclusion: We found that Wells Clinical Scoring is superior to the Simplified Modified Geneva Score in terms of sensitivity and specificity. The use of these two clinical scores in the outpatient clinic was more useful in excluding PT, while in the emergency department, their combination was more effective in diagnosing it.

© 2022 Wiley Periodicals LLC.Objectives: Postoperative ventilatory strategies in patients with esophageal atresia (EA) and tracheoesophageal fistula (TEF) may have an impact on early postoperative complications. Our national Esophageal Atresia Registry was evaluated to define a possible relationship between the type and duration of respiratory support on postoperative complications and outcome. Study Design: Among the data registered by 31 centers between 2015 and 2021, patients with esophago-esophageal anastomosis (EEA)/tracheoesophageal fistula (TEF) were divided into two groups; invasive ventilatory support (IV) and noninvasive ventilatory support and/or oxygen support (NIV-OS). The demographic findings, gestational age, type of atresia, associated anomalies, and genetic malformations were evaluated. We compared the type of repair, gap length, chest tube insertion, follow-up times, tensioned anastomosis, postoperative complications, esophageal dilatations, respiratory problems requiring treatment after the operation, and mortality rates. Results: Among 650 registered patients, 502 patients with EEA/TEF repair included the study. Four hundred and seventy of patients require IV and 32 of them had NIV-OS treatment. The IV group had lower mean birth weights and higher incidence of respiratory problems when compared to NIV-OS group. Also, NIV-OS group had significantly higher incidence of associated anomalies than IV groups. The rates of postoperative complications and mortality were not different between the IV and NIV-OS groups. Conclusion: We demonstrated that patients who required invasive ventilation had a higher incidence of low birth weight and respiratory morbidity. We found no relation between mode of postoperative ventilation and surgical complications. Randomized controlled trials and clinical guidelines are needed to define the best type of ventilation strategy in children with EA/TEF.

SUMMARY – Background: The novel coronavirus disease 2019 (COVID-19) has a broad spectrum of clinical manifestations, the most common serious clinical manifestation of the coronavirus infection being pneumonia. Unfortunately, the optimal treatment approach is still uncertain. However, many studies have been conducted on the effectiveness of several medications in the treatment of COVID-19 infection. The aim of this study was to evaluate the effectiveness of the hydroxychloroquine (HCQ) + favipiravir (FAV) treatment regimen and HCQ alone by comparing the patient’s clinical response and laboratory results on the fifth day of treatment in patients hospitalized due to COVID-19 infection. Patients and methods: This retrospective cohort study was conducted in Malatya Training and Research Hospital between March 2020 and July 2020. The study included 69 patients with confirmed COVID-19 with pneumonia. The patients were divided into 2 groups, those receiving HCQ alone and those receiving the HCQ + FAV combination. Results: A total of 69 patients were included in the study, and the mean age was 60.09±15.56 years. A statistically significant decrease was observed in C-reactive protein (CRP) levels, at the end of the fifth day, in patients who received HCQ + FAV treatment (p=0.002), whereas there was no decrease in CRP levels in patients who received HCQ treatment alone. In addition, an increase in lymphocyte count and a better fever response was observed at the end of the fifth day in patients who received HCQ + FAV (p=0.008). However, there was no statistical difference between both treatment regimens in terms of hospital stay and treatment results (p=0.008, p=0.744, p=0.517). Conclusion: Although the combination of HCQ + FAV treatment was observed to be effective on CRP levels and fever response in patients with COVID-19 pneumonia, there was no difference in terms of hospital stay and discharge.

Copyright © The authors 2022.Bronchiectasis is being diagnosed increasingly in children and adolescents. Recurrent respiratory exacerbations are common in children and adolescents with this chronic pulmonary disorder. Respiratory exacerbations are associated with an impaired quality-of-life, poorer long-term clinical outcomes and substantial costs to the family and health systems. The European Respiratory Society (ERS) clinical practice guideline for the management of children and adolescents with bronchiectasis provided a definition of acute respiratory exacerbations for clinical use but to date there is no comparable universal definition for clinical research. Given the importance of exacerbations in the field, this ERS task force sought to obtain robust definitions of respiratory exacerbations for clinical research. The panel was a multidisciplinary team of specialists in paediatric and adult respiratory medicine, infectious disease, physiotherapy, primary care, nursing, radiology, methodology, patient advocacy and parents of children and adolescents with bronchiectasis. We used a standardised process that included a systematic literature review, parents\" survey and a Delphi involving 299 physicians (54 countries) caring for children and adolescents with bronchiectasis. Consensus was obtained for all four statements drafted by the panel as the disagreement rate was very low (range 3.6% to 6.4%). The panel unanimously endorsed the four consensus definitions for: non-severe and severe exacerbations as an outcome measure; non-severe exacerbation for studies initiating treatment and; resolution of a non-severe exacerbation; for clinical trials involving children and adolescents with bronchiectasis. This ERS task force proposes using these internationally derived, consensus-based definitions of respiratory exacerbations for future clinical paediatric bronchiectasis research.

Aim: Point of sales (POS) advertising bans had been legislated in many countries without adequate enforcement. The aim of this study is to identify new products and devices at POS that could facilitate tobacco or nicotine use. Method: Shadow reporting at POS methodology developed by Framework Convention Alliance was used to investigate the products sold in four commercially dense districts of Istanbul. POS in one kilometer radius were visited by walking tour at each district. The products their display and compliance with legislation were noted. Results: Out of 198 POS visited 31 sell a product called "menthol ball". These were tiny colorful balls of menthol mixed with other various aromas that are sold together with an instrument that stab the end of a standard cigarette and insert the ball into the cigarette. The POS closest to schools were more likely to stock metholl balls. Majority of the POS placed the menthol balls close to candies, mints, chewing gums at eye level of children, just below the cigarette shelf. Conclusion: Tobacco industry uses menthol to sustain addiction among adolescents. Menthol use in cigarettes was banned on 5th January 2020 in Turkey. Using menthol balls to "make your own cigarette" is a novel technique developed by the industry to appeal the youth. Public health community needs to be vigilant and take actions.

BackgroundThe aim of this study was to evaluate the prevalence of anxiety, depression, sleep, and associated factors in caregivers of children with spinal muscular atrophy (SMA). Materials and MethodsBeck Depression Inventory (BDI), the State-Trait Anxiety Inventory-State (STAI-S), the State-Trait Anxiety Inventory-Trait (STAI-T), and Pittsburgh Sleep Quality Index (PSQI) were used to assess the anxiety, depression, and sleep quality of the caregivers of children with SMA. Higher scores indicated worse outcome for all three questionnaires. ResultsFifty-six caregivers of children with SMA were included in the study. Median age of children was 6 (3.2-10) years and mean age of the caregivers was 37.0 +/- 6.5 years. Median scores of the BDI, STAI-S, STAI-T, and PSQI were 12 (7.2-17), 35.5 (31-44), 40.5 (35-48), and 7.0 (5.0-10.0), respectively. There was a positive correlation between BDI and PSQI scores (p < 0.05). There was a negative correlation between the age of the caregivers and PSQI, BDI, STAI-T scores (p = 0.01, r = -0.341; p = 0.006, r = -0.364; p = 0.003, r = -0.395, respectively). There was a negative correlation between the age of the patients and the PSQI scores of the caregivers (p = 0.01, r = -0.33). There was a negative correlation between BDI scores and household income (p = 0.01, r = -0.34). ConclusionCaregivers of children with SMA had elevated depression and anxiety levels and they also had decreased sleep quality. Economic and social support resources are needed to help caregivers of those children.

Background: Prolonged survival of patients with chronic respiratory failure increased the number of patients receiving long-term home ventilation (LTHV). This study aimed to describe the aetiology and patterns of the use of LTHV in Istanbul. Methods: This cross-sectional study included children on home invasive ventilation (IV) and non-invasive ventilation (NIV) from six tertiary hospitals. Data including underlying diagnosis and LTHV were collected from patients' charts. Results: Study included 416 patients. The most common diagnoses were neuromuscular (35.1%) and neurological diseases (25.7%). While 49.5% (n=206) received NIV, 50.5% (n=210) of the patients received IV. The median age at initiation of LTHV was lower in the IV group (10 vs. 41 months, p

Amaç: Akut negatif basınç pulmoner ödemi genel anestezialan hastalarda ekstübasyondan kısa bir süre sonra ortaya çıkan birkomplikasyondur. Ayrıca ekstübasyondan önce endotrakeal tüpün ısırılmasınabağlı olarak da oluşabilir.Olgusunumu: 52 yaşında erkek hastaya ventriküloperitoneal şantoperasyonu planlandı. Genel anestezi uygulandı. Solunum ve hemodinamikdeğişkenler ameliyat süresince stabil seyretti. Ameliyat sonunda anestezikilaçlar kesildi, endotrakeal tüpünlümenive orofarenks aspire edildi. Hastayaorofarengeal airway yerleştirileceği esnada hasta endotrakeal tüpünü ısırıp tıkadı ve güçlübir şekilde solunum eforu yapmaya başladı. Hızlıca desatüre oldu ve endotrakeal tüp içinden pembe köpüklüsekresyon geldi. Bilateral difüz krepitan raller mevcuttu. Akciğer grafisindebilateral pulmoner ödem saptandı. Hasta yoğun bakım ünitesine transfer edildi,sedasyon uygulandı ve volum kontrollü pozitif basınçlı mekanik ventilasyonbaşlandı. Hasta ameliyat sonrası 12. saatteekstübe edildi ve üçüncü gün servise gönderildi.Tartışma:Ekstübasyon planı iyi yapılmalıdır. Aspirasyon ve ekstübasyon, derin anestezialtında veya hasta tamamen uyanık olduğunda uygulanmalıdır. Orofarengeal airwayekstübasyondan önce, yeterli anestezi derinliği altında yerleştirilmelidir. Orofarengealairway endotrakeal tüpün ısırılmasını ve bunabağlı gelişebilecek negatif basınçpulmoner ödemi riskini azaltsa da tamamenönleyemeyebilir. Negatif basınçpulmoner ödemi tedavisinde, obstrüksiyonun ciddiyetineve hipoksinin derecesine bağlı olarak invaziv veya non-invaziv mekanikventilasyon tercih edilebilir. Negatifbasınç pulmoner ödemi’nin erken teşhisi ve tedavisi hayatkurtarıcıdır., Background: Acute negative pressure pulmonary edema is acomplication that usually occurs shortly after extubation in patients receivinggeneral anesthesia. It mayalso occur due to the bite of the endotracheal tube prior extubation.Case presentation: A52-year-old male patient was scheduled for ventriculoperitoneal shunt operation.General anesthesia was applied. Respiratory and hemodynamic variables werestable during surgery. At the end of the surgery, anesthetic drugs werediscontinued, the lumen of the endotracheal tube and oropharynx were aspirated.When oropharyngeal airway was placed the patient bit and occluded his endotrachealtube, and began exerting breathing effort. Rapid desaturation was observed andpink foamy secretion came through the endotracheal tube. Bilateral diffusecrackles were present. A chest X-ray revealed bilateral pulmonary edema. Thepatient was transferred to the intensive care unit, sedation was applied andvolume controlled positive pressure mechanical ventilation was started. Thepatient was extubated at the 12th postoperative hour and sent to theward on the third postoperative day. Discussion: The extubation plan should be done well. Aspirationand extubation should be performed either under deep anesthesia or when thepatient is fully awake. Oropharyngeal airway should be placed under adequatedepth of anesthesia before extubation. Although oropharyngeal airway reduces the risk of biting of the endotrachealtube and subsequent development of negative pressure pulmonary edema, it maynot prevent it completely. In negative pressure pulmonary edema treatment,invasive or non-invasive mechanical ventilation may be preferred depending onthe severity of obstruction and degree of hypoxia. Early diagnosis andtreatment of negative pressure pulmonary edema is life-saving.

Background/Aim: Pulmonary embolism is a quite common and usually fatal disease. This study aimed to investigate the predictive value of the right ventricular volume in terms of pulmonary embolism and its laterality using imaging techniques. Methods: This case-control study included patients who underwent tomography with a pre-diagnosis of pulmonary embolism between January 2016 and January 2018. The study group included patients diagnosed with pulmonary embolism, while the control group consisted of those with an excluded diagnosis of embolism. The gender, age, echocardiography, right ventricular volume, embolism location, computed tomography results, morbidity, and mortality of the patients were recorded. Among 253 patients who underwent chest tomography with a diagnosis of pulmonary embolism, the data of 149 patients were obtained. There were 64 individuals in the control group and 85 individuals in the patient group.Results: In the study group, the length of hospital stay was 10.0 (range, 15.0-6.0) days, the systolic blood pressure was 125.5 (28.8) mmHg, the diastolic blood pressure was 77.8 (17.8) mmHg, and the heart rate was 103.4 (28.1) min. The ROC analysis of right ventricular volume revealed 81.2% sensitivity and 67.2% specificity (AUC: 0.850; P=0.001; 95% CI 0.789-0.910; cut-off: 103.7) in showing pulmonary embolism. There was a positive correlation between right ventricular volume and D-dimer (r: +0.739, P=0.001) in the control group and no correlation between the two in the study group (r: -0.178, P=0.139).Conclusion: Measuring the right ventricular volume with the software will contribute to the treatment and referral of patients with suspected pulmonary thromboembolism who underwent chest tomography. Thus, time and financial waste can be avoided by preventing unnecessary patient transfers, and early transfer of real patients can contribute to the reduction of mortality and morbidity.

Primary ciliary dyskinesia; Rare genetic disorder; Lung diseases Discinesia ciliar primaria; Trastorno genético raro; Enfermedades pulmonares Discinesia ciliar primària; Trastorn genètic rar; Malalties pulmonars Primary ciliary dyskinesia (PCD) is a rare genetic disorder characterised by impaired mucociliary clearance leading to irreversible lung damage. In contrast to other rare lung diseases like cystic fibrosis (CF), there are only few clinical trials and limited evidence-based treatments. Management is mainly based on expert opinions and treatment is challenging due to a wide range of clinical manifestations and disease severity. To improve clinical and translational research and facilitate development of new treatments, the clinical trial network for PCD (PCD-CTN) was founded in 2020 under the framework of the European Reference Network (ERN)-LUNG PCD Core. Applications from European PCD sites interested in participating in the PCD-CTN were requested. Inclusion criteria consisted of patient numbers, membership of ERN-LUNG PCD Core, use of associated standards of care, experience in PCD and/or CF clinical research, resources to run clinical trials, good clinical practice (GCP) certifications and institutional support. So far, applications from 22 trial sites in 18 European countries have been approved, including >1400 adult and >1600 paediatric individuals with PCD. The PCD-CTN is headed by a coordinating centre and consists of a steering and executive committee, a data safety monitoring board and committees for protocol review, training and standardisation. A strong association with patient organisations and industrial companies are further cornerstones. All participating trial sites agreed on a code of conduct. As CTNs from other diseases have demonstrated successfully, this newly formed PCD-CTN operates to establish evidence-based treatments for this orphan disease and to bring new personalised treatment approaches to patients.

Background/Aim: Continuous positive airway pressure (CPAP) is the most effective treatment for obstructive sleep apnea (OSA), but adequate patient compliance is required for treatment to achieve clinical success. This study aimed to determine factors affecting compliance with CPAP therapy in patients with OSA. Methods: In this retrospective cohort study, the records of patients that started CPAP treatment due to OSA between January 1, 2018 and August 30, 2020 were reviewed. The patients were divided into two groups based on their CPAP compliance: Group 1 included those who used CPAP regularly, and Group 2 included irregular users. Parameters such as age, gender, body mass index, apnea-hypopnea index, and educational status were compared between the groups. Results: Baseline apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) of patients using CPAP regularly were higher than irregular users (P=0.003, P=0.045, respectively). There was no significant difference between the groups in terms of age, gender, and body mass index (P=0.542, P=0.120 and P=0.796, respectively). In multivariate logistic regression analysis, low AHI, low ODI and low educational level were independent risk factors affecting CPAP compliance (P=0.010, P=0.016 and P=0.047, respectively). Conclusion: According to the results of this study, low AHI and ODI levels and low education status were risk factors for non-compliance with CPAP treatment. Therefore, patients with these features may require closer follow-up for early identification of CPAP treatment failure due to non-compliance.

Background/Aim: In the treatment of chronic respiratory failure, long-term oxygen therapy at home (LTOT) and domiciliary noninvasive mechanical ventilation (NIV) are important components of home care. The aim was to evaluate the compliance of geriatric patients with LTOT/NIV at home and their access to health services in the last year.Methods: Screening of 669 patients who were hospitalized in our pulmonary intensive care unit between 30.09.2019 and 30.09.2020 revealed a total of 109 patients over 80 years of age with chronic respiratory failure. Among them, 70 died after discharge. Six of the 39 surviving cases were excluded from the study because they were discharged without any LTOT and/or NIV devices, and the COVID-19 PCR tests of 4 patients were positive after discharge. The remaining 29 patients over 80 years of age were enrolled in the study. After questioning the patient's care status, caregivers were asked whether the patients were compliant with NIV and/or LTOT devices at home and their usage in terms of hours during the day and nighttime. In non-compliant patients, the reasons were acquired, and the answers were noted. They were asked whether they gave up on healthcare services and scheduled check-ups, had difficulties in getting a doctor's appointment, and whether they were incompliant with the appointments they made. If the answers were yes, they asked about their reasons for each question. Results: The median age was 85 (80-96) years, and 65.5% (n=19) of the cases were female. The diagnosis which led to hospitalization in 86.2% (n=25) of the patients was hypercapnic respiratory failure. Fifteen patients (51.7%) with LTOT and 9 patients (81.8%) with NIV did not use their devices as recommended. The patients' caregivers expressed that 22 patients (75.8%) could not meet their basic needs and 17 patients (77.2%) did not receive home care services provided by the Ministry of Health. Although the need arose in the post-discharge period, it was observed that 24 patients (82.7%) were not taken to the doctor and 20 patients (68.9%) did not schedule doctor visits after discharge. All caregivers stated that they were afraid of the COVID-19 pandemic and catching the COVID-19 disease from the emergency rooms and outpatient clinics.Conclusions: Our patients' compliance with the LTOT device was poor and 51.7% of the patients used the device less than recommended. Moreover, the patients were mostly incompliant with domiciliary NIV treatment. Receiving nonspecific home care services did not have any effect on LTOT and/or NIV compliance. It was observed that disruption in doctor visits and patient admissions leads to the decreased compliance with LTOT and/or NIV devices and loss of motivation to use these devices. The cases in this study avoided all kinds of admissions to the hospital due to the COVID-19 pandemic. In such conditions, structured and specific home care services for geriatric respiratory failure patients become more important. Continuing education and motivation at home will increase the quality of life of the patients and improve compliance.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was declared a global pandemic by WHO on March 11, 2020. Coronavirus disease (COVID-19) is the infectious disease caused by SARS-CoV-2. It is transmitted from person to person through droplets, progresses asymptomatically in 70% of the sufferers, while it may manifest itself in severe clinical conditions, ranging from viral upper respiratory tract infection to pneumonia, sepsis, septic shock, and even acute respiratory distress syndrome (ARDS), in symptomatic patients. Studies on the epidemiological and clinical features of COVID-19 have shown that these patients can develop symptoms of mild or severe acute respiratory infection. In cases with mild symptoms, upper respiratory tract symptoms such as fever, dry cough, and fatigue may develop, and abnormal chest CT findings may also be present. In cases with severe symptoms, dyspnea, diarrhea, severe pneumonia, ARDS or multiple organ failure develop, and mortality rates vary between 4.3% and 15% according to different study reports.

Kronik obstrüktif akciğer hastalığı (KOAH) yüksek morbidite ve mortalite oranları olan, yaşlı popülasyonda yaygın olarak görülen ve prevalansı yaşla birlikte artan kronik respiratuar bir problemdir. Yaşlı nüfus oranının dünya genelinde artmasıyla birlikte KOAH özellikle gelişmiş ülkelerde majör bir halk sağlığı problemi olmuştur ve en yüksek mortalite nedenleri arasında yer almaktadır. Yaşa bağlı olarak akciğerlerde meydana gelen fizyolojik değişiklikler ve çevresel faktörler nedeniyle KOAH prevalansı yaşlılarda yüksektir. Pulmoner rehabilitasyon ve inhaler farmakolojik ajanlar, KOAH'lı yaşlıların bireysel tedavisinde önemli bir yere sahiptir. Pulmoner rehabilitasyon yaşlılarda fonksiyonel egzersiz kapasitesinin ve sağlıkla ilgili yaşam kalitesinin geliştirilmesinde; dispnenin, sağlık hizmetlerinin kullanımı ve sağlık maliyetlerinin azaltılmasında etkindir. Yapılan çalışmalar KOAH'lı yaşlı bireylerin, pulmoner rehabilitasyondan genç hastalar kadar fayda görmekte olduğunu, dolayısıyla yaşın pulmoner rehabilitasyon için bir dışlama kriteri olmadığını göstermektedir. Hastalığın akut alevlenme dönemlerinde bile yaşlılarda pulmoner rehabilitasyonun etkin olduğu görülmüştür. Bu derlemede KOAH tanısı olan yaşlı bireylerde pulmoner rehabilitasyonun bileşenleri olan aerobik ve dirençli egzersizler, respiratuar kas kuvvet eğitimi, diafragmatik solunum ve fiziksel aktivitenin etkinliği güncel literatür ışığında tartışılacaktır., Chronic obstructive pulmonary disease (COPD) is a chronic respiratory problem with high morbidity and mortality rates and common in the elderly population with increasing prevalence by aging. COPD is among the highest causes of mortality and has been a major public health problem, especially in developed countries, as the elderly population increases worldwide. The prevalence of COPD is high in the elderly due to age-related physiological changes in the lungs and environmental factors. Pulmonary rehabilitation and inhaler pharmacological agents play an important role in the individual treatment of the elderly with COPD. Pulmonary rehabilitation is effective in improving functional exercise capacity and health-related quality of life; reducing dyspnea, the use of health services and health costs in the elderly. Studies have shown that elderly individuals with COPD benefit from pulmonary rehabilitation as much as younger patients, and therefore age is not an exclusion criterion for pulmonary rehabilitation. Even in acute exacerbations, pulmonary rehabilitation is effective in the elderly. In this review; aerobic and resistant exercises, respiratory muscle strength training, diaphragmatic respiration and physical activity, the components of pulmonary rehabilitation in elderly individuals with COPD, will be discussed in the light of the current literature.

Amaç: Çalışmamızın amacı, obez ve nonobez obstrüktif uyku apne sendromu (OUAS) hastalarında; doku doppler (DD) ekokardiyografi ile sağ ventrikül sistolik ve diyastolik fonksiyonlarının ve pulmoner arter basınçlarını (PAB) karşılaştırmaktı.Gereç ve Yöntem: Çalışmamıza Uyku Laboratuarında polisomnografik inceleme yapılmış ve orta ya da ağır OUAS tanısı konmuş 35 nonobez ve 34 obez olmak üzere 69 hasta alındı. Tüm hastalarda M-mode, iki boyutlu inceleme, renkli akım Doppler ve Doku Dopler yardımıyla sol ventrikül ve sağ ventrikül boyutları, sol atrium (LA) ve sağ atrium (RA) boyutları, sol ventrikül ve sağ ventrikül sistolik ve diyastolik fonksiyonları ve sistolik PAB’ ları ölçüldü.Bulgular: Her iki grupta da RV diyastolik fonksiyonlarında bozulma saptanmış olup, obez grupta anlamlı olarak daha fazla bozulma saptanmıştır (lateral triküspit annuler bölge geç diyastolik miyokardial hız A’a: nonobez hastalarda 0.13 ±0.03 ve obez hastalarda 0.11±0.04). Obez grupta ortalama sistolik PAB anlamlı olarak daha yüksek bulunmuştur (Sırasıyla 31.2±5.6 ve 27.1±5.8).Sonuç: Obstrüktif Uyku Apne Sendromu kardiyovasküler morbidite ve mortaliteyi arttırır. Çalışmamızda orta ve ağır OUAS hastalarında doku doppler incelemesi ile SV ve RV diyastolik fonksiyonlarında bozulma saptanmıştır. Obezite OUAS‟tan bağımsız olarak bu bozukluğa katkıda bulunmaktadır., Purpose: The aim of our study was to compare the right ventricular systolic and diastolic functions and pulmonary artery pressure (PAP) in obese and non-obese patients with obstructive sleep apnea syndrome (OSAS) by tissue Doppler imaging (TDI) echocardiography.Materials and Methods: This study was conducted with 69 patients, 34 obese and 35 non-obese, diagnosed moderate or severe OSAS by an overnight polysomnographic sleep study. In all patients, LV (left ventricle) and RV (right ventricle) size, left atial (LA) and RA (right atrial) dimensions, LV and RV systolic and diastolic functions and systolic PAPs were measured by M-mode, two-dimensional analysis, color flow Doppler and TDI.Results: RV diastolic dysfunction was detected in both groups; this impairment was significantly higher in the obese group (lateral tricuspid late diastolic myocardial annular zone velocity A'a: 0.13 ± 0.03 in non-obese patients and 0.11 ± 0.04 in obese patients). The mean systolic PAP was significantly higher in obese patients (31.2±5.6, 27.1±5.8, respectively)Conclusion: Obstructive Sleep Apnea Syndrome increases cardiovascular morbidity and mortality. In our study,left ventricul and right ventricul diastolic dysfunction was determined by tissue Doppler imaging in patients with moderate and severe Obstructive Sleep Apnea Syndrome. Obesity contributes to this impairment regardless of Obstructive Sleep Apnea Syndrome .

Aim: Air pollution affects many people globally and there are allegations and studies that it leads to serious health problems, such as pulmonary thromboembolism. In this study, we investigated the possible relationship between air conditions and pulmonary thromboembolism.Methods: This study was carried out by archive scanning. Patients with acute dyspnea who were shown to have PE by contrast-enhanced CT were included in the analysis. Patients with a history of trauma, malignancy, recent surgical intervention, or immobility were excluded from the study. On the day of complaints, Particulate matter 10 (PM10), sulfur dioxide (SO2), air temperature and air pressure values were obtained online from the relevant institution of Environment and Urban Ministry. These 215 patients’ data were then evaluated statistically.Results: Results suggest that the incidence of pulmonary embolism was higher on days when PM10 (P, Amaç: Hava kirliliği, dünyada pek çok kişiyi etkiliyor ve pulmoner tromboembolizm gibi ciddi sağlık sorunlarına yol açtığına dair iddialar ve araştırmalar var. Bu çalışmada, hava koşulları ile pulmoner tromboembolizm arasındaki olası ilişkiyi araştırdık. Yöntemler: Bu çalışma arşiv taramasıyla gerçekleştirildi. Kontrastlı BT ile PE olduğu gösterilen akut nefes darlığı olan hastalar analize dahil edildi. Travma, malignite, yakın zamanda cerrahi müdahale veya hareketsizlik öyküsü olan hastalar çalışma dışı bırakıldı. Şikayet günü Çevre ve Şehircilik Bakanlığı'nın ilgili kurumundan Partikül madde 10 (PM10), kükürt dioksit (SO2), hava sıcaklığı ve hava basıncı değerleri online olarak alındı. Bu 215 hastanın verileri daha sonra istatistiksel olarak değerlendirildi. Bulgular: Bulgular, pulmoner emboli insidansının PM10 (P

Objective: Diabetes mellitus is a metabolic disorder described as hyperglycemia induced by insulin deficiency or resistance. Increasing evidence in studies has shown that the lung is the target of diabetic complications. According to traditional medicine theories, cinnamon is considered a supportive treatment method for diabetics. The aim of this study is to investigate the effect of cinnamon on the immunohistochemical expression of VEGF and NF-κB in lung tissue of streptozotocin-induced experimental diabetic rats.Material and Method: Thirty-two male rats were randomly divided into four groups: Diabetes, Diabetes + cinnamon, Cinnamon, and Control. The immunohistochemical expression of VEGF and NF-κB in the lung tissue was determined by using the streptavidin-biotin complex method.Results: It was determined that while cinnamon application alone did not change VEGF expression in lung tissue, the decreased VEGF expression in the diabetes group increased with the cinnamon application. When the immunostaining in the groups was examined no difference was observed in NF-κB immunoreaction between the control and cinnamon groups. As a remarkable finding, in the diabetic group's lung tissue, there were strong positive NF-κB reactions. In addition, a weak positive NF-κB reaction was detected in the diabetes+cinnamom group.Conclusion: As a result, in our study cinnamon caused decreased the increase in NF-κB expression caused by diabetes and increased the decreased VEGF expression. In conclusion, we believe that this study will be useful in understanding possible cytokine mechanism changes that may occur in the lung tissue due to diabetes and in the development of treatment methods., Amaç: Diabetes mellitus, insülin eksikliği veya direncinin neden olduğu hiperglisemi olarak tanımlanan metabolik bir hastalıktır. Çalışmalarda artan kanıtlar, akciğerin diyabetik komplikasyonların hedefi olduğunu göstermiştir. Geleneksel tıp teorilerine göre tarçın, şeker hastaları için destekleyici bir tedavi yöntemi olarak kabul edilmektedir. Bu çalışmanın amacı, tarçının streptozotosin ile indüklenen deneysel diyabetik sıçanların akciğer dokusunda VEGF ve NF-κB'nin immünohistokimyasal ekspresyonu üzerindeki etkisini araştırmaktır.Gereç ve Yöntem: Otuz iki erkek sıçan rastgele dört gruba ayrıldı: Diyabet, Diyabet + tarçın, Tarçın ve Kontrol. VEGF ve NF-κB'nin akciğer dokusunda immünohistokimyasal ekspresyonu, streptavidin-biotin kompleksi kullanılarak belirlendi.Bulgular: Tarçın uygulamasının tek başına akciğer dokusunda VEGF ekspresyonunu değiştirmezken, diyabet grubunda tarçın uygulaması ile azalmış VEGF ekspresyonunun arttığı belirlendi. Gruplardaki immün boyama incelendiğinde, kontrol ve tarçın grupları arasında NF-κB immünreaksiyonu açısından bir fark gözlenmedi. Dikkat çekici bir bulgu olarak, diyabetik grubun akciğer dokusunda güçlü pozitif NF-κB reaksiyonları vardı. Ayrıca diyabet+cinnamom grubunda zayıf pozitif NF-κB reaksiyonu tespit edildi.Sonuç: Sonuç olarak bizim çalışmamızda tarçın diyabetin neden olduğu NF-κB ekspresyonundaki artışın azalmasına, azalmış VEGF ekspresyonunun ise artmasına neden olmuştur. Sonuç olarak, bu çalışmanın diyabete bağlı olarak akciğer dokusunda meydana gelebilecek olası sitokin mekanizması değişikliklerinin anlaşılmasında ve tedavi yöntemlerinin geliştirilmesinde faydalı olacağı kanaatindeyiz.

In this article, Early Career Task Force Group members of the Turkish Thoracic Society summarize the European Respiratory Society 2020 virtual congress. Current developments in the field of respiratory diseases were compiled with the addition of sessions specific to coronavirus disease 2019 this year. Almost all of the congress sessions were examined, and the important and striking results of the congress were highlighted. Congress sessions were attended by expert researchers, and the prominent messages of each session were highlighted in short summaries. They were then grouped under relevant titles and ranked in order of meaning and relation. It was finalized by a team of researchers.

Giriş: Çok sayıda insanı etkileyebilen, sistemik granülomatöz bir akciğer hastalığı olan sarkoidozun etiyolojisi ve patogenezi hala tam olarak bilinmemektedir. Tanısı non-kazeöz granülomların gösterilmesi ve diğer granülomatöz hastalıkların dışlanmasıyla konulmaktadır. Bu nedenle tanı ve takipte kullanılabilecek hassas biyobelirteçlere ihtiyaç vardır. Bu çalışmanın amacı sarkoidozlu hastalarda plazma protaşikinin-1 düzeyinin tanı değerini araştırmaktır.Yöntem: Göğüs hastalıkları kliniğince takipli 42 sarkoidozlu hasta ve 38 kişilik kontrol grubu çalışmaya dahil edildi. Tüm hastaların klinik, radyolojik ve laboratuvar verileri kaydedildi. Sarkoidoz hastalarında ve sağlıklı kontrol grubunda plazma protaşikinin-1 düzeyleri incelendi.Bulgular: Sarkoidoz hastalarının ve kontrol grubunun plazma protaşikinin-1 düzeyleri sırasıyla 1124.25±1117.25 ng/L, 1319.37±1357.38 ng/L olarak bulundu. İstatistiksel olarak anlamlı olmamasına rağmen (p=0.338) sarkoidoz hastalarında protaşikinin-1 düzeyinde azalma saptandı. Ek olarak hastaların lenfosit düzeyleri de kontrol grubuna göre anlamlı olarak düşük bulundu (p=0.007). Diğer laboratuvar bulguları (lökosit, nötrofil, monosit, eozinofil sayısı, CD4 +, CD8 +, bronkoalveoler lavaj (BAL) CD4 +, BAL CD8 +, nötrofil / lenfosit oranı) ile de plazma protaşikinin-1 arasında istatistiksel olarak anlamlı korelasyon bulunmadı.Sonuç: Literatür taramamıza göre çalışmamız sarkoidozlu hastalarda bir biomarker olarak plazma protaşikinin-1 düzeylerini araştıran ilk çalışmadır. Sarkoidozlu hastalarda plazma protaşikinin-1 düzeyi hafif azalsa da istatistiksel olarak anlamlı bulunmamış ve bir biomarker olarak kullanılabilmesi için yeterli veri sağlanamamıştır. Bu konuda daha fazla ve kapsamlı araştırmalara ihtiyaç vardır., Introduction: The etiology and pathogenesis of sarcoidosis, a systemic granulomatous lung disease affecting many people, still remain unknown. Sarcoidosis is diagnosed by demonstrating non-caseous granulomas and ruling out granulomatous diseases. Therefore, sensitive biomarkers used in diagnosis and follow-up processes are needed. Our aim is to investigate diagnostic value of plasma protachykinin-1 (TAC1) levels in sarcoidosis patients.Methods: Forty-two sarcoidosis patients followed-up by the department of chest diseases, and 38 controls were included into the study. Clinical, radiological and laboratory data of patients were recorded, and plasma TAC1 levels were analyzed in patients and healthy controls. Results: Plasma TAC1 levels of sarcoidosis patients and controls were found as 1124.25±1117.25 ng/L and 1319.37±1357.38 ng/L, respectively. Although not statistically significant (p=0.338), a decrease was found in TAC1 levels of sarcoidosis patients. Additionally, patients’ lymphocyte levels were also found significantly lower than controls (p=0.007). No statistically significant correlation was found between other laboratory findings, including leukocyte, neutrophil, monocyte, eosinophil count, cluster of differentiation 4 (CD4) CD4 +, CD8 +, bronchoalveolar lavage (BAL) CD4 +, BAL CD8 + and neutrophil/lymphocyte ratio (NLR), and plasma TAC1 levels.Conclusions: To the best of our knowledge, our study is the first to investigate plasma TAC1 levels as a biomarker in sarcoidosis patients. Although plasma TAC1 levels were slightly decreased in sarcoidosis patients, the decrease was not statistically significant, and no adequate data were provided for the use of plasma TAC1 level as a biomarker. We consider more comprehensive research are needed to elucidate the entity.

Amaç: Günümüzde COVID-19 için kanıtlanmış bir medikal tedavi yoktur. Çalışmamızda ağır seviyeli olmayan COVID-19 pnömoni hastalarında LPV/r ve FVR tedavilerinin etkinliğini değerlendirerek, LPV/r ile FVR ile tedavi edilen hastalar arasındaki klinik sonuçları karşılaştırmayı amaçladık.Yöntemler: Bu çalışma retrospektif bir kohort çalışmasıdır. Lopinavir/ritonavir ve FVR ile tedavi edilen ağır seviyeli olmayan COVID-19 pnömoni hastalarının verileri incelendi. Bulgular: 33'ü (%36,2) LPV/r ve 58'i (%63,8) FVR ile tedavi edilen, toplam 91 ağır seviyeli olmayan COVID-19 pnömoni hastası çalışmaya dahil edildi. LPV/r grubunun yaş ortalaması 53,1 (13), FVR grubunun yaş ortalaması 57,2 (17,4) idi (P=0,24). Her iki grup arasında komorbidite varlığı açısından istatiksel olarak anlamlı fark yoktu (P=0,06). FVR hastalarının LPV/r hastalarına göre radyolojik ağırlık skoru daha yüksekti ancak bu istatistiksel olarak anlamlı değildi (sırasıyla 8,67 (3,7) ve 7,66 (3,22), P=0,2). FVR hastalarının başvuru esnasındaki SpO2 seviyeleri LPV/r hastalarına göre daha düşük, CRP seviyeleri daha yüksekti (sırasıyla 92,22 (2,8) ve 97,87 (2,05), P, Aim: There is no proven medical treatment for COVID-19 to date. We aimed to evaluate the effectiveness of LPV/r and FVR treatments in non-severe COVID-19 pneumonia patients and compare the clinical outcomes.Methods: In this retrospective cohort study, the data of non-severe COVID-19 pneumonia patients treated with lopinavir/ritonavir and FVR were analyzed. Results: A total of 91 non-severe COVID-19 patients, 33 (36.2%) treated with LPV/r and 58 (63.8%) treated with FVR, were included in the study. The mean ages of the LPV/r group and FVR group were 53.1 (13) years and 57.2 (17.44) years, respectively (P=0.24). There was no statistically significant difference between the two groups in terms of comorbidities (P=0.06). FVR patients had higher radiological weight scores than LPV/r patients, but this was not statistically significant (8.67 (3.7) vs 7.66 (3.22) P=0.2, respectively). While SpO2 levels of FVR patients at the time of admission were lower than those of LPV/r patients, CRP levels were higher (92.22 (2.8) vs 97.87 (2.05), P

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