Turkish Thoracic Journal最新文献

Objective: To evaluate the clinical features and outcomes of patients who were admitted with a diagnosis of coronavirus disease 2019 (COVID-19) but who were not confirmed with polymerase chain reaction (PCR) positivity.

Material and methods: This is a retrospective analysis of all patients admitted to two tertiary care centers between March 15 and May 15, 2020, with a diagnosis of COVID-19. From a common database prepared for COVID-19, we retrieved the relevant data and compared the clinical findings and outcomes of PCR-positive patients with those of PCR-negative cases who had been diagnosed on the basis of typical clinical and radiographic findings.

Results: A total of 349 patients were included in the analysis, of which 126 (36.1%) were PCR-negative. PCR-negative patients were younger (54.6 ± 20.8 vs. 60.8 ± 18.9 years, P = .009) but were similar to PCR-positive patients in terms of demographics, comorbidities, and presenting symptoms. They had higher lymphocyte counts (1519 ± 868 vs. 1331 ± 737/mm3, P = .02) and less frequently presented with bilateral radiographic findings (68.3% vs. 79.4%, P = .046) than PCR-positive patients. Besides, they had less severe disease and better clinical outcomes regarding admission to the intensive care unit (9.6% vs. 20.6%, P = .023), oxygen therapy (21.4% vs. 43.5%, P < .001), ventilatory support (3.2% vs. 11.2%, P = .03) and length of hospital stay (5.0 ± 5.0 vs. 9.7 ± 5.9 days, P < .001).

Conclusion: This study confirms that about one-third of the COVID-19 patients are PCR-negative and diagnosed based on clinical and radiographic findings. These patients have a more favorable clinical course, shorter hospital stays, and are less frequently admitted to the intensive care unit.

Melanoma is an uncommon tumor and represents about 1.5% of all neoplasms. In the mediastinum, it presents as a primary neoplasm or metastasis. Diagnosis is essential for the adoption of the best therapy. Endosonography-guided fine needle aspiration (EUS-FNA) obtains cell samples and, when associated with other auxiliary exams such as immunohistochemistry, is useful to identify and differentiate primary and/or metastatic mediastinal lesions from a wide variety of other neoplasms. The endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) sensitivity is low and similar to endobronchial ultrasound-guided transbronchial needle biopsy (EBUS-TBNB) performed with the ProCore 25G or 22G needle. Thus, the diagnosis of this type of tumor becomes a great challenge. The authors report the first case in the literature of metastatic mediastinal melanoma derived from malignant cutaneous melanoma, which was submitted to Endosonography-guided fine needle biopsy (EUS-FNB) with the new ProCore 20G, to obtain tissue, being confirmed by histological examination of the specimens obtained with a single puncture.

Objective: Compassion fatigue is representative of the cost of caring and is reported to have significant negative effects. Compassion fatigue needs to be better understood in order to define, prevent, and intervene. The aim of this study is to determine the level of compassion fatigue and possible predictors (demographics, vocational features, satisfaction, and psychological capital) in physicians and nurses working in chest diseases and thoracic surgery hospital.

Material and methods: This cross-sectional study was conducted with 205 clinicians (83 physicians, 122 nurses) working face-toface with in-patients. Data were collected with a semi-structured interview, the Professional Quality of Life Scale, and the Psychological Capital Scale.

Results: The average age of the participants was 31.96 ± 8.60 years, most of them (67.3%) were women. The average compassion fatigue score was 20.15 ± 8.58 for the physicians and 17.16 ± 9.49 for the nurses, and the difference was found to be statistically significant (P = .01). However, in the regression analysis, it was determined that the profession did not have a significant effect, and that dissatisfaction with the colleagues increased the compassion fatigue 2.5-fold (P = .03). It was found that low resilience, one of the subscales of the Psychological Capital Scale, increased compassion fatigue 2.14-fold (P = .007). Other professional variables and demographic characteristics were not significantly related to compassion fatigue (P > .05).

Conclusion: The results of this study show the importance of the relationship and resilience among colleagues in the prevention of compassion fatigue. It also points out that physicians are at risk of developing compassion fatigue.

Objective: To evaluate the clinical outcomes of patients with different stages of small-cell lung cancer (SCLC) who underwent surgical treatment.

Material and methods: This retrospective study consisted of 13 patients with SCLC at a tertiary care health center. This study was conducted between 2011 and 2018 at Gaziantep University Faculty of Medicine, Thoracic Surgery Department. Patient follow-up data were collected from medical files. Patients were analyzed according to age, sex, site of resection, clinical stage, pathological stage, recurrence, operation type, chemotherapy, radiotherapy.

Results: The study group consisted of 3 females and 10 males (n = 13). The mean age of the patients was 65 ± 9.3 (52-85) years. The most common location of the primary tumor was the right upper lobe (6 patients, 46.2%). The mean tumor size was 4.36 ± 2.38 cm (1-8.5). In our study, 3 patients had already metastases (2 brain and 1 had metastases in more than 2 anatomic sites). Patients with solitary metastases, who underwent lung resection and metastasis excision had similar survival according to patients without metastases.

Conclusion: Our results show that surgical treatment in SCLC could be contributed to the survival of patients. Therefore, patients must be given a chance for surgery, especially considering that the advances in diagnostic and surgical capabilities have increased the likelihood of early diagnosis and effective surgery.

Objective: Providing medications to patients free of charge is thought to be one of the factors affecting the success of smoking cessation. The aim of this study was to investigate the effect of providing free access to stop-smoking medications on the treatment adherence and short term success of quitting smoking.

Material and methods: All smokers who applied to a smoking cessation outpatient clinic between September 2017 and December 2019 were included in this retrospective study. Data were collected from patients' files filled using an initial evaluation and follow-up protocol.

Results: During the study period, 518 smokers applied to our polyclinic for smoking cessation counseling. Medical therapy was prescribed for 411 (85.4%) of 481 patients who were supported by behavioral therapy. The patients had a mean age of 41.2 years, and 64.7% were male. Only 22.9% of smokers prescribed stop-smoking medications were able to obtain them for free. Patients who got the medications completely free of charge were 4 times more adherent to treatment. The success rate of quitting smoking at the end of the third month was 22.2%. The strongest effect was achieved by the full treatment compliance. At the end of 3 months, the success of quitting smoking was 14.1 times higher for those who were fully adherent to treatment than non-adherents.

Discussion: According to our study results, the most effective success factors in short-term smoking cessation are patient compliance to treatment and free supply of stop-smoking medications, one of the main determinants of treatment adherence.

Lung cancer is the leading cause of cancer-associated mortality, with a 5-year survival of 19% for all types of lung cancer. Lymphoid malignancies of the lung have a significantly better prognosis, with 5-year survival approaching 90%, making it very important to identify these patients. As the signs and symptoms, laboratory investigations, and radiological features are non-specific and vague and the histological confirmation is invasive, they are usually either not diagnosed or diagnosed very late. We present a case of an elderly male who was treated for months with antituberculosis treatment (ATT) before being properly evaluated and diagnosed with primary pulmonary marginal cell lymphoma. This case was unique for having gross pleural effusion as a presenting feature and having been diagnosed with the help of radial endobronchial ultrasound (EBUS).

Objective: The prevalence of radiological involvement is considered a poor prognostic factor for coronavirus disease 2019 (COVID- 19). In our study, we aimed to investigate the threshold value of the chest X-ray (CXR) score, which would require the patient to be transferred to the intensive care unit (ICU) through scoring the CXR of COVID-19 patients receiving in-patient treatment.

Material and methods: The patients that tested positive for COVID-19 on the basis of the polymerase chain reaction (PCR) test, who was hospitalized in our hospital between the dates of March 15 and May 30, 2020, were included in the study. The CXRs of these patients taken during hospitalization were scored. The threshold value of the CXR score of the patients transferred to the ICU was calculated. Patients were grouped according to the threshold value of the CXR score, and demographic data and other recorded parameters were compared.

Results: A total of 301 patients were included in this retrospective cross-sectional study. It was determined that finding of a CXR score threshold value of 5 or above during hospitalization predicted a transfer to the ICU with 90% sensitivity and 80% specificity. The use of broad-spectrum antibiotics, the laboratory parameters (leukocyte, neutrophil, C-reactive protein (CRP), procalcitonin, troponin, D-dimer, ferritin), and rate of transfer to ICU were found to be significantly higher in the group with a CXR score of 5 and above, compared to the group with CXR score below 5 (P < .001 in each).

Conclusion: Finding high CXR scores during hospitalization due to COVID-19 may act as a warning in terms of the severity of the disease. It may be beneficial to examine the chest X-ray images during hospitalization with utmost care and take these images into account.

Objective: The COVID-19 pandemic is progressing rapidly, sending the world into a great panic. Healthcare professionals have responded by embarking on a concerted search for therapies to cure and prevent COVID-19. Recently, interferon (IFN) has emerged as a potential therapy as it is associated with reducing lung inflammation and suppressing viral replication. This research paper assessed the efficacy of high-dose nebulized IFN α 2b in severe COVID-19 pneumonia.

Methods: This is a retrospective study. It commenced on April 9 and ended on June 17, 2020. Researchers selected participants from hospitalized patients aged 18 years and above who were diagnosed with severe COVID-19 pneumonia. Other inclusion criteria were bilateral pneumonia on lung or chest X-ray scan and severe respiratory distress. SMART-COP, which is a risk stratification scoring tool, and radiologic severity index (RSI) were used to assess pneumonia severity. Patients in the treatment cohort received nebulized IFN α 2b at a dose of 10 million IU every 12 hours for 5 days, in addition to standard treatment. Patients in the control cohort received standard treatment only.

Results: Seventy-three patients met the inclusion criteria; 37 were included in the treatment cohort and 36 in the control cohort. Mechanical ventilation was needed in 14 of 36 (38.9%) patients in the control cohort, compared with 6 of 37 (27.4%) patients in the treatment cohort (HR 5.62 [95% CI 1.81-17.48]; P = .003). For pneumonia severity, there was a hazard ratio (HR) of 3.72 [95% CI 1.74- 7.98]; P = ·.01. After 5 days of treatment, chest X-rays indicated significant beneficial changes in the treatment group (HR 2.24 [CI 1.05-4.79]; P = .036). Multivariate analysis revealed that pneumonia severity and RSI remained higher in the control group. The HR was 3.44 [95% CI 1.49-7.94]; P = .004 and 2.26 [95% CI 0.99-5.16]; P = .05, respectively. There was an increase in liver aminotransferases in 5 (14%) participants in the control cohort and 3 (8%) participants in the treatment cohort.

Conclusion: High-dose nebulized IFN α 2b has potential efficacy in mitigating severe COVID-19 pneumonia. This study established that administering high-dose nebulized IFN α 2b significantly reduces pneumonia severity in COVID-19 patients. We also found a strong relationship between using nebulized IFN α 2b and reduced need for mechanical ventilation among patients with severe COVID-19 pneumonia. However, a well-designed control trial is needed to confirm the drug's efficacy in reducing the COVID-19 pneumonia severity.

Objective: To determine the predictive value of esophageal dilatation as observed in high-resolution computed tomography (HRCT) for the diagnosis of systemic sclerosis (SSc) in patients with interstitial lung disease (ILD).

Methods: Our sample consisted of patients diagnosed with SSc and proven interstitial lung involvement with available HRCT exams (n = 20). Individuals with other forms of rheumatic ILD were included as a control group (n = 20). Two blinded radiologists independently reviewed the images for the presence of esophageal dilatation, measured at 3 different levels. Interobserver agreement was tested with Lin's concordance correlation coefficient (CCC). Independent t-test was used to compare maximum esophageal diameters between groups. Friedman's test was used to evaluate differences between the 3-level measurements. Receiver operating characteristic analysis was performed.

Results: There was a substantial correlation between both readers (CCC = 0.9802-0.9919). Esophageal dilatation was significantly associated with SSc (P = .0012). The optimal calculated cut-off value to differentiate SSc from other ILDs was 18.5 mm (sensitivity and specificity of 70 and 90%, respectively; area under the curve 0.819), measured 1 cm above the diaphragmatic hiatus.

Conclusion: HRCT may have a discriminative role in the presence of both ILD and esophageal dilatation for the diagnosis of SSc. Our results suggest that a cut-off value for the esophageal diameter of 18.5 mm might propose the diagnosis of SSc with reasonable confidence.

Primary antibody deficiency diseases result from a genetic defect that causes misfunction of 1 or more of the immune system elements. Due to the increased awareness among physicians and the success of new treatment modalities, the number of pediatric patients reaching adult age and the number of patients diagnosed in adult age is increasing. Adult patients comprise more than half of the total cases. Primary antibody deficiencies are the most common immunodeficiency type in adults, and these may cause recurrent upper and lower respiratory tract infections and result in the development of bronchiectasis. Among non-infectious pulmonary complications, any type of interstitial lung disease may be seen; however, a special type seen in patients with common variable immunodeficiency, namely granulomatous lymphocytic interstitial lung disease, is the one most commonly investigated. Underlying or accompanying immunodeficiency may be present in patients with asthma and chronic obstructive pulmonary disease, especially if the disease requires frequent hospitalizations and/or is severe. Early diagnosis and appropriate management of primary antibody deficiency diseases in patients with respiratory symptoms are crucial to decrease complications and increase survival.