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BACKGROUND AND AIM: This study aimed to obtain real-life data of patients diagnosed with chronic obstructive pulmonary disease (COPD) at least one year ago, including smoking history, inhaler device training, and the number of exacerbations. METHODS: This study was planned as a nationwide, prospective, observational, multicenter, and noninterventional study, and web-based electronic case forms were used to register the patients. RESULTS: A total of 460 patients from 11 centers were included, of whom 88.3% were males. Of the total patients, 137 (29.8%) were current smokers, and 292 (63.5%) were ex-smokers. One hundred twenty-four (29.6%) patients did not receive inhaler device training. Repeated inhaler device training in the follow-up visits was not performed in 255 (60.8%) patients. Of the total participants, 187 (41.0%) reported no exacerbations in the previous year. The mean number of exacerbations per person over the previous year was 1.19. The annual rates of influenza and pneumococcal vaccines were 34.8% and 4.2%, respectively. CONCLUSIONS: Patients should be trained more efficiently in the risks of COPD, use of inhaler devices, exacerbations, and improving quality of life. [ABSTRACT FROM AUTHOR]

OBJECTIVE: We aimed to determine the preoperative parameters that may predict postoperative pulmonary complications (POPCs) and the value of some current practical indexes in predicting POPCs. MATERIALS and METHODS: Our study is a retrospective cohort study carried out in 9 different centers. Patients admitted to the chest diseases outpatient clinic for preoperative evaluation were followed up during the 6-month study period. Patients with or without postoperative complications were evaluated retrospectively, and the effect of some parameters and indexes recorded during the preoperative evaluation of chest diseases on POPC development was investigated statistically. RESULTS: A total of 307 patients were included in the study. POPCs were observed in 100 patients (32.6%). About 13% of these complications were respiratory tract infections, 59% were respiratory failure, 45% were pleural effusion, and 42% were atelectasis, which were the most common pulmonary complications. The probability of experiencing POPCs by patients with chronic obstructive pulmonary disease (COPD) is 2.5 (1.18–5.67) times more than those without COPD. We determined that patients with the history of upper respiratory tract infection during the preoperative period are 5.3 times more likely to have POPCs; similarly, the number was 4.7 for patients undergoing cardiac operation and 3.3 for patients with interstitial infiltration. CONCLUSION: The risk of pulmonary complications was higher for those with the history of upper respiratory tract infection during the preoperative period, those undergoing cardiac surgery, those with the shortness of breath, those with the history of COPD, and those with the reticular/interstitial infiltrations in the chest X-ray. These parameters should be examined carefully in the preoperative period and should be careful in terms of pulmonary complications that may develop during the postoperative period. [ABSTRACT FROM AUTHOR]

Introduction: Glomerular filtration rate (GFR) and blood urea nitrogen (BUN) are important prognostic indicators for cardiovascular disease. However, data on the relationship between renal dysfunction (RD) and prognosis in patients with acute pulmonary embolism (APE) are limited. The estimated-GFR (eGFR), based on the Modification of Diet in Renal Disease (MDRD) equation, has been suggested as a possible prognostic marker in patients with APE; however, at present, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is thought to be more accurate than the MDRD equation for the estimation of RD. Objective: We investigated whether eGFRCKD-EPI or BUN could predict adverse outcomes (AOs) better than eGFRMDRD in normotensive patients with APE. Methods: Ninety-nine normotensive patients with APE (aged 22-96, 56% male) were enrolled in the study retrospectively. Adverse outcomes were defined as the occurrence of any of the following: death, cardiopulmonary resuscitation, use of vasopressors, thrombolysis, or mechanical ventilation. Results: In univariate analyses, age, gender (male), heart rate (>110 bpm), serum creatinine, BUN, cardiac troponin (cTn) positivity, right ventricle-left ventricle ratio, eGFRMDRD, and eGFRCKD-EPI were found to be significantly different between those with and without AOs. Comparing area under the curves for AO, we found statistically significant differences between eGFRCKD-EPI and eGFRMDRD (P = .01) but not between BUN and eGFRCKD-EPI or BUN and eGFRMDRD. Furthermore, 30-day mortality was 36% versus 11% in cTn-positive patients with an eGFRCKD-EPI < and ≤ 60 mL/min, respectively. Conclusion: There is a close relationship between RD and APE prognosis. We conclude eGFRCKD-EPI is a potential prognostic marker for risk stratification in normotensive patients with APE. [ABSTRACT FROM AUTHOR]

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INTRODUCTION: Ventilator-associated pneumonia (VAP) is an important cause of mortality and morbidity in critically ill patients. We sought to determine the prognostic value of procalcitonin (PCT) and C-reactive protein (CRP) kinetics in critically ill patients who developed VAP. METHODS: Patients who were admitted to the intensive care unit (ICU) and developed VAP were eligible. Patients were followed for 28 days after the pneumonia diagnosis and blood samples for PCT and CRP were collected on the day of the pneumonia diagnosis (D0), and days 3 (D3) and 7 (D7) after the diagnosis. Patients were grouped as survivors and non-survivors, and the mean PCT and CRP values and their kinetics were assessed. RESULTS: In total, 45 patients were enrolled. Of them, 22 (48.8%) died before day 28 after the pneumonia diagnosis. There was no significant difference between the survivor and non-survivor groups in terms of PCT on the day of pneumonia diagnosis or CRP levels at any point. However, the PCT levels days 3 and 7 were significantly higher in the non-survivor group than the survivor group. Whereas PCT levels decreased significantly from D0 to D7 in the survivor group, CRP did not. A PCT level above 1 ng/mL on day 3 was the strongest predictor of mortality, with an odds ratio of 22.6. CONCLUSION: Serum PCT was found to be a superior prognostic marker compared to CRP in terms of predicting mortality in critically ill patients who developed VAP. The PCT level on D3 was the strongest predictor of mortality in VAP [ABSTRACT FROM AUTHOR]

OBJECTIVES: Domiciliary non-invasive mechanical ventilation (NIMV) is presumed to decrease hospital admissions and mortality in very severe chronic obstructive pulmonary disease (COPD) patients. This study was aimed to investigate the clinical data and mortality among COPD patients receiving domiciliary NIMV treatment. MATERIAL AND METHODS: A total of 40 COPD patients who were prescribed domiciliary NIMV at discharge between January 2010 and December 2011 were contacted by phone regarding their current health status, and the electronic patient charts of 34 patients who used NIMV regularly were retrospectively reviewed. RESULTS: The mean age of the patients was 67±15 years and 59% of them were females. The mean length of hospital stay was 14.5±6.82 days. Rate of admission to intensive care unit and use of invasive mechanical ventilation was 56% and 27%, respectively. The median follow up duration was 17 months. The 6-months, 1-year, 2-years and overall mortality rates were 24%, 38%, 50% and 56%, respectively. For patients surviving at least one year after domiciliary NIMV initiation (n=21), the mean number of hospitalizations in the year before-and after-NIMV initiation were 1.38±1.28 and 0.57±0.93 (p=0.003), respectively. Mean daily NIMV use was 8.91±4.46 hours. Mean daily NIMV use of the patients with a lifespan ≤2 years was higher than that of the patients with a lifespan >2 years (11.82±4.02 hours/day versus 6.0±2.62 hours/day, respectively) (p<0.001). Long term oxygen was prescribed for the first time to 62% of the patients using NIMV. CONCLUSION: Domiciliary NIMV may have numerous beneficial effects such as decreasing hospital admissions for acute COPD exacerbations and related costs. It is very important in the battle against COPD, a disease with significant morbidity, mortality and economic burden. [ABSTRACT FROM AUTHOR]

Objective: Sleep disorders are important public health issues that decrease the individuals' quality of life by affecting their productivity and performance in a negative way. The frequency of sleep disorders among people who work shifts with irregular sleep patterns is apparent. For healthcare providers, most of whom work shifts, the available data related to obstructive sleep apnea syndrome (OSAS) are insufficient. Also, this is the first study that has been conducted using an all-night polysomnography (PSG) for health staff in our country. In our study, we aimed to investigate the prevalence of snoring and OSAS among the nurses and resident doctors working at our hospital. Methods: Face-to-face interviews were performed with all nurses and resident doctors who worked at our hospital and agreed to participate in our study. All-night PSG examination was recommended to participants with concurrent witnessed apnea and/or excessive daytime sleepiness (EDS) with snoring. The frequency of OSAS was evaluated in cases exposed to polysomnography, and those with and without OSAS were compared in terms of shift rates. Results: The study included 257 participants. Of these, 63% were nurses and 37% were resident doctors; overall, 34.2% of the cases were male. The mean age was 28.8±3.7 (19-39) years and the mean body mass index was 24.03±3.85 kg/m2. Among the participants, the mean number of monthly night shifts was 7.6±3.8. Also, 28.8% of the participants (n=74) experienced snoring, 2.7% (n=7) had witnessed apnea, and 7.8% (n=20) had EDS (Epworth sleepiness scale=11). Four (1.6%) of the 20 participants who were proposed to undergo PSG refused this examination. Sixteen cases were exposed to PSG (6.2%). According to the PSG results, the prevalence of OSAS was 4.7% among all healthcare providers and 5.1% among the health staff working shifts. Of the cases with OSAS, 91.7% (11/12) were working shifts while 83.3% (204/245) of those without OSAS were working shifts (p=0.697). All of the cases diagnosed with OSAS were male, but 31% of the cases without OSAS were male (p<0.001). Conclusion: For those healthcare providers who are engaged in duties requiring significant amounts of attention and concentration, the symptoms related to sleep disorders should be questioned and diagnostic evaluation and treatment should be performed for suspected cases. [ABSTRACT FROM AUTHOR]

Mucormycosis is an opportunistic fungal infection that is rare but has a fatal course, occurs especially in patients with immunodeficiency, and is caused by fungi in the Zygomycetes class. Since the infection is generally caused by inhalation of spores, mostly the paranasal sinuses and lungs are affected. Diabetes mellitus and hematologic malignancies are the most common underlying diseases. It usually initiates like bacterial pneumonia, and its clinical and radiologic findings are nonspecific. Thus, a high index of suspicion is necessary. Combined medical and surgical treatment methods are recommended. We aimed to present a case of pulmonary mucormycosis with a course of endobronchial involvement. [ABSTRACT FROM AUTHOR]

Upper extremity deep vein thrombosis is rather than lower extremity deep vein thrombosis. Its frequency is 4% of all body thrombosis. It is characterized by edema, pain and loss of function at the affected extremity. We presented a patient who developed pulmonary embolism due to upper extremity deep vein thrombosis. After low molecular weight heparin therapy started deep vein thrombosis resolved immediately and patient discharged from hospital by oral warfarin therapy. Patient without a central catheter may develop pulmonary embolism due to upper extremity deep vein thrombosis and further investigation is required in these patients. [ABSTRACT FROM AUTHOR]

Upper extremity deep vein thrombosis is rather than lower extremity deep vein thrombosis. Its frequency is 4% of all body thrombosis. It is characterized by edema, pain and loss of function at the affected extremity. We presented a patient who developed pulmonary embolism due to upper extremity deep vein thrombosis. After low molecular weight heparin therapy started deep vein thrombosis resolved immediately and patient discharged from hospital by oral warfarin therapy. Patient without a central catheter may develop pulmonary embolism due to upper extremity deep vein thrombosis and further investigation is required in these patients. [ABSTRACT FROM AUTHOR]

It has been shown that Long Term Oxygen Therapy (LTOT) improves polycythemia secondary to hypoxemia and right heart failure, decreases pulmonary hypertension, improves quality of life and increases life expectancy in COPD patients. In our study we aimed to evaluate clinical data, mortality, patient's adherence and efficiency of the therapy in COPD patients receiving LTOT. Mean age was 70.5%±9.7 and 57% of the participiants were male. It was shown that one year hospital admission count after LTOT (0.56±0.79) was decreased according to one year hospital admission count before LTOT (1.14±1.64). When arterial blood gas values after LTOT compared to the values at the time prescription PaO2 was increased (47.9±4, 53.4±9) and PaCO2 was decreased (56.1±11, 50.5±11). Although there was no significant difference in pulmonary artery pressure after LTOT, a significant increase was determined in hematocrit (38.37±6, 40.14±6). 41.1% of the patients had at least once device maintanence, and after LTOT only 38.4% had a clinical control due to COPD. The most common reason for irregular use was lack of necessity. Mean daily oxygen usage was 13.88±4.35 hours/day and 68.8% of the patients were using 15 hours or more. Mean follow-up of the patients were 17.85±14.53 (1-55) months and mortality rate in this period was 67%. Mortality was higher in LTOT with 15hours/day or more compared to less than 15 hours (respectively 54.6%, 12.5%). In conclusion, all patients with an indication for LTOT should be followed by national registry system and monitored in terms of technical services. Patients adherence and routine controls should be provided. [ABSTRACT FROM AUTHOR]

Background: Bronchoalveolar lavage is considered a helpful tool in the diagnosis of diffuse parenchimal lung diseases such as sarcoidosis. CD4/CD8 ratio is higly specific but not sensitive to distinguish sarcoidosis and other intestitial lung diseases. We aimed to compare the diagnostic value of CD4/CD8 ratio and other lmphocyte subpopulations such as CD3+16+56, CD103+, CD4+CD103+, CD8+CD103+ in bronchoalveolar lavage to distinguish sarcoidosis and other nonsarcoidosis interstitial lung diseases., Methods: Using the bronchoscopy records from 2006 to 2013, we evaluated 68 patients with biopsy proven sarcoidosis and 72 patients with clinicoradiological and/or biopsy proven diffuse parenchimal lung diseases. Cut off values, sensitivity and specificity were given for aforementioned parameters., Results: Bronchoalveolar lavage CD4/CD8 ratio, CD4+ T lymphocyte percentage, CD4+103+, CD3+CD103-, CD8+CD103+/CD103+ ratio were significantly higher in sarcoidosis than other diffuse parenchimal lung diseases whereas CD3+103+, CD3+16+56+, CD8+, CD8+CD103+, CD8+CD103+/CD8+ were significantly lower. Best cut off value of CD4/CD8 was 1.34 with sensitivity and specificity 76.4%, 79.4% respectively. The cut off values of CD4/CD8 of >3.5 and >2.5 had specificity 95.9% and 95.3%, respectively and sensitivity 52%, 41%, respectively., Conclusion: CD4/CD8 ratio is highly specific but not sensitive for sarcoidosis diagnosis. Thus, BAL flow cytometry is not diagnostic alone without appropriate clinicoradiological and/or histopathological findings.