Turkish Thoracic Journal最新文献

Objective: It has been suggested that Vitamin D Deficiency (VDD) worsens lung functions and COPD lowers vitamin D levels, but this has not been proven yet.

Material and methods: The study was carried out between January 2014 and September 2015. All the COPD patients with 25 (OH) D3 measurements were included in this study. The patients < 40-year-old, or with a smoking history of less than 10 package-year, or with asthma, bronchiectasis, pneumonia, tuberculosis, cancer, were excluded from the study. Medical records about age, gender, pulmonary function test, body mass index (BMI), annual exacerbations/hospitalizations, modified British Medical Research Council (mMRC) level and serum 25 (OH) D3 were obtained.

Results: The data of 216 (83.8% male) patients were examined in the study. The mean age was 66.88 ± 10.3 years. The mean vitamin D level was 21.1 ± 13.73 ng/mL. Of the patients, 57.9% had VDD, and even 19.9% were in severe VDD. Only 26.4% had adequate vitamin D level. There was a significant in BMI, FEV1, FVC, annual exacerbation and hospitalisations between the patients with vitamin D levels > 20 ng / mL and ≤ 20 ng / mL. Vitamin D level of patients with mMRC level 1 was significantly higher than those with mMRC 2, 3, 4 (respectively P = .03; P = .026; P = .014).

Conclusion: In this study, we found that lung function was worse in COPD patients with VDD and VDD increased with increasing severity of COPD.

Objective: Epidemiological studies have shown that mortality owing to the coronavirus disease 2019 (COVID-19) could be under-reported under different conditions. Excess mortality analysis is suggested as a useful tool in estimating the impact of the disease.

Material and methods: Mortality data between January 01 and May 18, 2020, were analyzed to evaluate the excess mortality owing to COVID-19 in Istanbul, the city most affected by the pandemic in Turkey. The average weekly percentage changes in the number of deaths in 4 previous years were compared with those in the year 2020 using excess mortality analysis.

Results: The number of deaths in Istanbul was significantly higher in 2020 (p=0.001), with a 10% weekly increase between the 10th and 15th weeks, which started to decrease until the 20th week. The excess mortality found during the study period was 4,084 deaths, higher than the officially reported COVID-19 mortality.

Conclusion: Our findings demonstrated that mortality owing to COVID-19 could be higher than the official figures reported by health authorities.

Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been declared as a pandemic by the World Health Organization. As this disease continues to spread worldwide, it has posed enormous challenges on the healthcare of several diseases, especially cancer, because hospital facilities have invested health resources for patients with COVID-19. Indeed, patients with lung cancer are particularly vulnerable because of their poor baseline lung function and cancer-related treatment. In addition, once infected, they are at an increased risk of pulmonary complications from COVID-19. Oncologists are thus facing a challenge as how to balance the treatment plans to control the disease while protecting the patients with lung cancer from COVID-19. In fact, it is crucial to provide individualized treatment recommendations to limit the risks during these difficult times. This review highlights the key challenges that oncologists face when diagnosing COVID-19 among patients with lung cancer and examines the current recommendations from available literature, clinical expertise, and expert opinions regarding managing lung cancer in the era of COVID-19. It also explores the treatment approach recommended for patients with lung cancer while avoiding putting them at excessive risk of contracting COVID-19 infection.

Small-bore pleural catheters are used to drain simple effusions effectively. They are less invasive and more comfortable than tube thoracostomy. As with any other intervention, these small catheters have their associated complications. Herein, we report a case of a young woman who was diagnosed with tuberculous pleural effusion. Easydrain pleural catheter was inserted to drain the effusion; it broke in situ because of improper insertion and was later removed using medical thoracoscopy. We emphasize on the need for proper training for doctors and staff regarding these procedures to avoid undue complications. We have also highlighted the importance of medical thoracoscopy in the removal of retained intrapleural foreign bodies.

Objective: Differential diagnosis of idiopathic pulmonary fibrosis (IPF) is important among fibrotic interstitial lung diseases (ILD). This study aimed to evaluate the rate of IPF in patients with fibrotic ILD and to determine the clinical-laboratory features of patients with and without IPF that would provide the differential diagnosis of IPF.

Material and methods: The study included the patients with the usual interstitial pneumonia (UIP) pattern or possible UIP pattern on thorax high-resolution computed tomography, and/or UIP pattern, probable UIP or possible UIP pattern at lung biopsy according to the 2011 ATS/ERS/JRS/ALAT guidelines. Demographics and clinical and radiological data of the patients were recorded. All data recorded by researchers was evaluated by radiology and the clinical decision board.

Results: A total of 336 patients (253 men, 83 women, age 65.8±9.0 years) were evaluated. Of the patients with sufficient data for diagnosis (n=300), the diagnosis was IPF in 121 (40.3%), unclassified idiopathic interstitial pneumonia in 50 (16.7%), combined pulmonary fibrosis and emphysema (CPFE) in 40 (13.3%), and lung involvement of connective tissue disease (CTD) in 16 (5.3%). When 29 patients with definite IPF features were added to the patients with CPFE, the total number of IPF patients reached 150 (50%). Rate of male sex (p<0.001), smoking history (p<0.001), and the presence of clubbing (p=0.001) were significantly high in patients with IPF. None of the women <50 years and none of the men <50 years of age without a smoking history were diagnosed with IPF. Presence of at least 1 of the symptoms suggestive of CTD, erythrocyte sedimentation rate (ESR), and antinuclear antibody (FANA) positivity rates were significantly higher in the non-IPF group (p<0.001, p=0.029, p=0.009, respectively).

Conclusion: The rate of IPF among patients with fibrotic ILD was 50%. In the differential diagnosis of IPF, sex, smoking habits, and the presence of clubbing are important. The presence of symptoms related to CTD, ESR elevation, and FANA positivity reduce the likelihood of IPF.

Objectives: There are various anatomic variations in the tracheobronchial system. The frequency in studies with bronchoscopy was contradictory. This study aimed to investigate the tracheobronchial tree of the deceased patients with anatomical dissection.

Material and methods: We made anatomical dissections on 204 cases in the Council of Forensic Medicine, Ministry of Justice. The deceased patients who were older than 12 years of age and of Turkish origin were included in this study consecutively.

Results: Of the 204 cases, 161 (78.9%) were males and 43 (21.1%) were females. The mean age was 44.15±19.23 years. Anatomical variations were found to be present in 200 cases (98% of total). The highest degree of variation of the right upper lobe was noted to be 16.6% (34/204). An anomalous arrangement (with three segments or different placement) of the middle lobe was noted in 16.1% of cases. For the basal lower lobe, b8+(b9+b10) pattern and basal orifice with four segments were noted to be the most frequent anatomical variant in the right and left lungs, respectively. The most frequent tracheobronchial variations were as follows: apical basal lobe with two subsegments in the right and left (39.7%), left lower lobe basal orifice with four segments (34.8%), left upper lobe with three segments (25.5%), and right lower lobe basal orifice with three main segmental bronchi (21.1%).

Conclusion: The tracheobronchial tree exhibits highly individualistic features. The knowledge of the frequency of different variations obtained in different studies and normal anatomic variants in return makes doing therapeutic or diagnostic interventions easier and more accurate.

The screening test for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) disease 2019 (COVID-19) has not been performed in healthcare workers (HCWs) yet, although HCWs are at a high risk of infection. COVID-19 is detected in 5%-15% of HCWs according to published studies. Nevertheless, it may be higher than the rates indicated in published studies. Based on this fact, the current recommendation of studies in the literature is to screen COVID-19 in HCWs. In this review, studies on SARS-CoV-2 screening in HCWs will be reconsidered, and the frequency and target group in whom screening should be performed will be emphasized.