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   Table of Contents - Current issue
January-April 2020
Volume 22 | Issue 1
Page Nos. 1-71

Online since Thursday, April 30, 2020

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Idiopathic pulmonary fibrosis: What has changed in the diagnosis and treatment from past to present? Highly accessed article p. 1
Ceyda Anar, Oğuzhan Okutan, Aysun Şengül, Onur Yazici, Bülent Altinsoy
Idiopathic pulmonary fibrosis (IPF) is the most common and most fatal of all lung diseases that cause widespread scarring in the lungs. High-resolution computed tomography (HRCT) has high diagnostic value in the diagnosis of IPF. Patients exhibiting a pattern of usual interstitial pneumonia (UIP) can be diagnosed with IPF without the need for a biopsy if no other conditions exist that could cause this pattern. If no pattern of UIP exists, a multidisciplinary council should gather to discuss the HRCT and pathological and clinical findings and to decide upon a diagnosis. Appropriate supportive therapies such as oxygen therapy, pulmonary rehabilitation, and seasonal flu and pneumococcal vaccines should be included in the management of the disease. Comorbidities must be investigated and treated. There have been studies identifying the benefits of pirfenidone and nintedanib in patients with mild-to-moderate IPF. There is a lack of appropriate data to guide the selection between pirfenidone and nintedanib, and the patient's preferences and drug tolerance must be considered when making such a drug selection. There have been no randomized studies to date showing the benefits of drugs in severe IPF. The prevention of acid reflux may be beneficial, but the symptoms are obscure. Lung transplantation can be an option for young patients with a severe and progressive disease when there are no comorbidities to pose a contraindication.
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Impact of cognitive functions on the quality of spirometry performance in patients with COPD p. 17
Gulfem Yildirim, Mecit Süerdem, Nart Bedin Atalay, Fikret Kanat, Baykal Tülek
OBJECTIVE: We researched the relationship between the cognitive scores and the error codes which determine pulmonary function test (PFT) compliance accompanied by the phenotypic findings of chronic obstructive pulmonary disease (COPD) patients. MATERIALS AND METHODS: Patients in a stable condition with COPD, who were diagnosed with the criteria recommended in the international guidelines, were included in the study. PFTs were requested from all the patients during the regular outpatient admission. The following tests were applied to all the patients in a 30-min test session; COPD assessment test, modified British Medical Research Council and neurophysiological tests (Mini-Mental Test, Trail Making Test Part A and B, Clock Drawing Test, Straight and Backward Digit Span, Brown Peterson Task and Verbal Fluency Test). We analyzed the statistical relationship between data collected after cognitive tests and PFT quality data. RESULTS: The study was concluded with a total of 70 patients. When the PFT evaluations of the patients were examined, the percentage of patients who correctly fulfilled the repeatability criteria was found as 28%, who met the acceptability criteria as 57%, and who correctly fulfilled both criteria as 14%. The relationship between the results of patients, who fulfilled both repeatability and acceptability criteria correctly and incorrectly at the same time, with the backward digit span test results was found to be significant (P < 0.05). It was found that the Mini-Mental Test was significantly better in those who performed all of the repeatability and acceptability criteria without errors than the other groups. When the PFT criteria of the patients were evaluated according to the cognitive test results, it was determined that the relationship between the Mini-Mental Test and the results of performing the repeatability and acceptability criteria together was found to be statistically significant (P < 0.05). DISCUSSION AND CONCLUSION: Error codes that identify the compliance in PFTs could be used as predictors of cognitive impairment in COPD.
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Retrospective analysis of false positive ratio of our patients with lung cancer at positron emission tomography-CT screen p. 23
Hasan Oguz Kapicibasi, Pınar Mutlu, şahınur Aycan Alkan, Nihal Arzu Mirici, Buse Yuksel, Çoşkun Bakar
BACKGROUND: In lung cancer, staging is necessary to give the best treatment to the patient and to estimate the best prognosis. The aim of this study was to compare the pathology results of the lung masses and mediastinal lymph nodes and to evaluate the sensitivity and specificity values of positron emission tomography.computerized tomography (PET.CT) and to determine the maximal threshold of maximum standardized uptake volume (SUVmax). MATERIALS AND METHODS: We retrospectively evaluated the PET.CT SUVmax values and pathology results of the patients who had a mass, mediastinal lymph node, or scalene lymph node in our patients between 2016 and 2018. RESULTS: Fifty.one people and 75 pathology materials were included in our study. We used the receiver operating characteristic curve analysis to determine the cutoff value for SUVmax value and calculated the cutoff value as 6.65. In our study, the sensitivity and specificity were calculated as 63% and 71%, respectively. We calculated the positive predictive value as 73.5% and the negative predictive value as 61%. CONCLUSION: As a result, considering the common inflammatory and granulomatous diseases seen in our country, we concluded that benign diseases should be considered before malignancy in SUVmax value below 6.6. We continue to add new patients and new data to our study to find the most appropriate threshold of SUVmax value for the health values of our country.
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Factors associated with residual pulmonary thromboembolism detected by computed tomography pulmonary angiography p. 29
Ozer Ozdemir, Sinem Ermin, Pelin Özdemir, Özgür Batum, Bengi Sari Islam, Bahri Gümüs, Ufuk Yilmaz
BACKGROUND: Complete resolution of pulmonary vascular obstruction is not totally achieved in patients with acute pulmonary thromboembolism (PE). In this study, we tried to identify the factors associated with residual PE. MATERIALS AND METHODS: Patients with a diagnosis of acute PE from two centers were retrospectively analyzed. Residual PE was detected by computed tomography (CT) pulmonary angiography. Investigated parameters were unprovoked PE, clinical severity index (pulmonary embolism severity index score), D-dimer, troponin I, central pulmonary embolism, clot burden (Qanadli score), CT indexes of right ventricle (RV) overload (RV/left ventricle and pulmonary artery/aorta), massive PE, coexisting deep venous thrombosis signs and symptoms, and follow-up CT time. RESULTS: On univariate analysis, follow-up CT time and clot burden at the time of diagnosis were significantly associated with residual PE (P = 0.02 and P = 0.002, respectively). Initial D-dimer levels were higher in patients with residual PE although statistical significance was not reached (P = 0.08). On multivariate analysis, clot burden and follow-up CT time remained significant (hazard ratio [95% confidence interval] of 4.31 [1.31–14.12] and 2.47 [0.92–6.62], respectively). CONCLUSION: Our results suggest that higher clot burden may be an independent predictor for residual PE along with the timing of follow-up CT.
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Peak oxygen consumption measurement and postoperative outcome in patients with early-stage lung cancer p. 36
Ferhad Ibrahimov, Deniz Koksal, Sevinc Sarinc Ulasli, Erkan Dikmen, Yigit Yilmaz, Funda Aksu, Emin Maden, Riza Dogan, Salih Emri
INTRODUCTION: In early-stage lung cancer (LC) patients, the best survival rates are achieved when the patient undergoes surgical resection. Cardiopulmonary exercise testing is an important preoperative test because of its ability to detect disturbance in the oxygen transport system, which is, in turn, related to the development of postoperative complications. OBJECTIVES: The aim of the study is to investigate the value of peak oxygen consumption (peakVO2) to determine postoperative pulmonary complications (PPCs) in LC patients with surgical resection. MATERIALS AND METHODS: LC patients who were candidates for surgery between February 2015 and 2017 were included in this prospectively conducted study. PeakVO2 measurement was performed by utilizing cycle ergometry during incremental exercise. All patients were on follow-up for PPCs for a period of 30 days postoperatively. RESULTS: The study included 41 patients (mean age: 63.9 ± 9.7 years) who had undergone surgical resection (28 lobectomies/13 pneumonectomies). There was no mortality, but 8 (19.5%) PPCs were observed. Mean peakVO2 values were not different in patients with and without PPCs. When the patients were divided into two groups based on absolute forced expiratory volume 1 second (FEV1) (≤1.5 L and >1.5 L) and ppo FEV1% (≤30% and >30%); mean peakVO2, mean stay days in intensive care unit and hospital, and PPC rates were similar between groups. Fourteen patients with FEV1≤1.5 L and 11 patients with ppo FEV1≤30% underwent successful surgical resections. CONCLUSION: PeakVO2 measurement prevents patients to be deprived of a surgical resection, which is an important treatment modality for LC. PPCs were in acceptable limits in patients with a value of peakVO2≥15 ml/kg/min.
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Using fractional exhaled nitric oxide level to differentiate asthma–COPD overlap syndrome from chronic obstructive pulmonary disease p. 42
Volkan Taskin, Nedim Akgün, Fikret Kanat, Mecit Süerdem, Baykal Tülek
INTRODUCTION: Measurement of fractional exhaled nitric oxide (FeNO) is a simple, noninvasive, reproducible, and convenient method for assessing airway inflammation. We here assessed the value of FeNO for distinguishing asthma-COPD overlap syndrome (ACOS) and chronic obstructive pulmonary disease (COPD) in patients hospitalized due to exacerbation of COPD. METHODS: A total of 100 consecutive patients diagnosed with COPD and hospitalized due to disease exacerbation were included and divided into the COPD-alone group and ACOS group. FeNO was measured at the beginning of hospitalization and at discharge. RESULTS: There was no correlation between FeNO values measured at the time of hospitalization and hospital duration (r = −0.10, P = 0.334). However, the mean FeNO value at the beginning of hospitalization was significantly higher in the ACOS group than in the COPD-alone group (25.5 [11–149] vs. 13.0 [5–50]; P < 0.001). The initial FeNO value was a good predictor of ACOS, with an optimum value of 18.5 parts per billion (sensitivity, 80%; specificity, 80%; positive and negative predictive values, 63.6% and 90.6%, respectively). CONCLUSION: The FeNO level can identify ACOS in patients hospitalized for COPD exacerbation, providing a new diagnostic tool for the clinical management of ACOS and COPD.
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Impairment in heart functions and prognostic role of N-terminal pro-brain natriuretic peptide in patients with chronic obstructive pulmonary disease exacerbation p. 48
Evrim Eylem Akpinar, Can Ateş, Serdar Akpinar, Derya Hoşgün
INTRODUCTION: Chronic obstructive pulmonary disease (COPD) with comorbidities and cardiovascular disease is the most frequent one. The role of natriuretic peptides in determining prognosis of COPD exacerbations is not yet clear. The frequency of pathologic findings of transthoracic echocardiography (TTE) during COPD exacerbation showed wide variability. This study aims to evaluate the predictive role of N-terminal pro-brain natriuretic peptide (NT-proBNP) in determining the short-term prognosis of patients hospitalized with COPD exacerbation. As a secondary outcome, we aimed to investigate the frequency of TTE findings in these patients. MATERIALS AND METHODS: Eighty-six consecutive patients with COPD exacerbation were included. NT-proBNP levels were measured and TTE was carried out to whole of the participants at administration. The primary outcome was development of “event” (readmission or rehospitalization or mortality) within 30 days. The predictive role of NT-proBNP level for the development of “event” was evaluated. As a secondary outcome of the study, the frequency of TTE findings was recorded. RESULTS: NT-proBNP level of the patients who developed event within 30 days had significantly higher than who did not (2343.16 ± 4107.17 pg/mL vs. 843.22 ± 2349.96 pg/mL, P = 0.001). A high negative correlation was found between NT-proBNP level and “time to event” (r = −0.992, P < 0.001). Multivariable logistic regression analysis showed that NT-proBNP level was an independent predictor for the development of “event” (P < 0.001) and the cutoff point of it was found to be 303.5 pg/mL (0.639 sensitivity and 0.720 specificity). The most frequent echocardiographic findings were pulmonary hypertension (54.7%) and left ventricle diastolic dysfunction (39.5%). CONCLUSION: NT-proBNP level is a strong predictor for short-term prognosis of patients hospitalized with COPD exacerbation. Further and larger studies are needed to determine exact role of NT-proBNP in long-term prognosis of these patients.
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Relationship between FACED and Bronchiectasis Severity Index in the evaluation of bronchiectasis severity: Cross-sectional study p. 55
Hikmet Coban
INTRODUCTION: In the same patients with bronchiectasis, it is aimed to compare the bronchiectasis severity scoring questionnaires (Bronchiectasis Severity Index [BSI] and FACED), which are two different scorings validated for the prognosis of the disease. METHODS: A cross.sectional study was performed in 94 patients (51 males and 43 females) who were diagnosed with bronchiectasis. The severity of bronchiectasis was calculated according to FACED and BSI scores of all patients and relationship between the severity of both scorings were examined. Wilcoxon test was applied to paired samples after both scorings were grouped according to the bronchiectasis severity. RESULTS: Frequency of patients with mild, moderate, and severe FACED was 59 (62.8%), 27 (28.7 %), and 8 (8.5%), respectively. There were 41 (43.6%), 23 (24.5%), and 30 (31.9%) patients with low, intermediate, and high BSI was, respectively. The mean scores of FACED and BSI were 2.0 } 1.9 and 6.6 } 4.8, respectively. A statistically significant relationship was observed between FACED and BSI scores (P < 0.001). Both scores were statistically different when evaluated according to the severity of bronchiectasis (P < 0.001), and the FACED scale illustrated the lowest scores. The percentage of similarity was found 62.7% among the both scales. It was showed a 68% similarity between the two scales by Kappa test (P < 0.001). DISCUSSION: Patients tend to score with a higher BSI compared to the FACED score, although the correlation between the two scales is statistically significant. This situation may be due to evaluation of body mass index, hospitalization, exacerbations, chronic colonization by other microorganisms, and the presence of cystic bronchiectasis in the BSI score.
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The effects of preoperative pulmonary rehabilitation on early postoperative period following lung transplantation p. 59
Esra Pehlivan, Lütfiye Kılı, Arif Balcı, Esra Yazar, Nur Dilek Bakan
CONTEXT: Although pulmonary rehabilitation (PR) has become a preoperative standard practice, the fact that studies do not include groups of patients who do not receive preoperative PR restricts to introduce the real benefit of the rehabilitation process in lung transplantation (LTx). AIMS: We aimed to investigate the effect of preoperative PR before LTx on postoperative period. SETTINGS AND DESIGN: Retrospective, parallel design. SUBJECTS AND METHODS: Between March 2012 and October 2014, medical records of patients who underwent LTx were analyzed. There were two parallel groups. (1) Study group (n = 15) included the patients with received preoperative PR for at least 8 weeks. (2) Control group (n = 12) included the patients with underwent LTx without preoperative PR as appropriate donor was found. Time to intubation, length of intensive care unit (ICU) stay, and postoperative early mortality were evaluated. STATISTICAL ANALYSIS USED: Shapiro–Wilk, Fisher' exact test, Mann–Whitney U-test, Wilcoxon rank test. RESULTS: A total of 27 patients with LTx surgery, whose mean age was 40.6 (11.4) and 40% of females were included in the study. There were no significant differences in demographic characteristics between two groups, except the age (P = 0.005). The study group intubation time (2 [0–7] days) was shorter than control group (3 [1–12] days) (P = 0.02). There was no significant difference in the length of ICU stay postoperatively (P = 0.19) and postoperative early mortality rate (P = 0.65). CONCLUSIONS: Our study results suggest that preoperative PR may shorten time to intubation in patients undergoing LTx. Therefore, referral of LTx to PR centers and preoperative PR is of utmost importance for postoperative LTx.
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Unilateral absence of pulmonary artery: A rare cause of dyspnea in a 77-year-old woman p. 64
RK Chopra, Mohanakrishnan Jayamani, Ganesh Pratap
Isolated unilateral absence of pulmonary artery is quite rare and usually associated with congenital cardiac defects. It is usually diagnosed in childhood with recurrent respiratory tract infections and signs of pulmonary hypertension. It rarely remains asymptomatic until adulthood and may present with dyspnea, hemoptysis, and recurrent respiratory infections later, while it can rarely be an incidental finding of other imaging. Surgical management in early days of life will prevent pulmonary hypertension while in adults it is aimed to treat the complications. Here, we report the case of a 77-year-old female, a mother of five children. She came with worsening of dyspnea for a week, and her computed tomography pulmonary angiography showed absence of left pulmonary artery accompanying hypoplastic lung. Ventilation perfusion imaging showed absence of perfusion of the left lung. She had severe pulmonary hypertension and was managed with long-term oxygen therapy, diuretics, and vasodilators.
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Rare intrathoracic metastases of renal cell carcinoma p. 67
Mustafa Suat Bolat, Burçn Çelik, Hüseyin Ulaş Çınar
Renal cell carcinoma (RCC) can often metastasize to bone, liver and lung, but unusual metastasis may also occur. However, intrathoracic extrapulmonary metastases are rarely being reported. Because RCC is chemo- and radioresistant tumor, early diagnosis of the disease is essential and complete resection of the tumor can provide longer cancer-free survival and better quality of life. We aimed to draw attention to the importance of excision of intrathoracic extrapulmonary metastasis, particularly in asymptomatic patients who had previously undergone radical nephrectomy for RCC. Clinicians should be cautious that delay in the diagnosis of atypical metastasis is associated with poor prognosis. Therefore, early diagnosis and management of unusual localization of a solitary RCC metastasis are of paramount importance for cancer-free survival and better quality of life. Our aim was to report very rare intrathoracic metastases of renal tumors and to discuss their management. We also needed to report that the early diagnosis of such atypical metastases would contribute to patient survival as presented in this report.
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Proadrenomedullin and prognostic value for pneumonia p. 70
Beuy Joob, Viroj Wiwanitkit
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Proadrenomedullin determining clinical severity and analyzing prognostic value for pneumonia p. 71
Sedat Demirsoy, Oguzhan Okutan, Zafer Kartaloglu, Dilaver Tas, Omer Ayten, Kadir Canoglu
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