Tuberkuloz ve Toraks-Tuberculosis and Thorax最新文献

Introduction: The genetic risk factors for Coronavirus disease-2019 (COVID19)-associated pulmonary fibrosis (CAPF) are not clearly defined. Mutations in the genes encoding telomerase reverse transcriptase (TERT) and mucin 5B (MUC5B) are well-known genetic risk factors for pulmonary fibrosis. In this study, we aimed to show whether the most common proven mutations of pulmonary fibrosis affect the development of CAPF.

Materials and methods: Forty-eight patients who were matched for age, gender, COVID-19 disease severity, and respiratory support type and needed high flow nasal cannula, non-invasive mechanical ventilator, or invasive mechanical ventilator due to COVID-19 were followed up prospectively. Eighteen patients were excluded from the follow-up due to known structural lung disease, collagen tissue disease, and occupational exposure to fibrosis. The patients were called for follow-up three months after discharge, and CT was performed. Those with fibrosis (n= 15) in the third-month follow-up CT were included in the CAPF group, and those with complete resolution (n= 15) were included in the control group. Blood samples were taken for genetic analysis.

Result: TERT gene study revealed that six (40%) of the fibrosis group was normal, while five were heterozygous (33.3%). MUC5B polymorphism was not detected in 10 (66.7%) of the fibrosis group.

Conclusions: Individuals with TERT mutations may be at a higher risk for CAPF. Further studies are needed to clarify the genetic risk factors for CAPF.

Introduction: COVID-19 survivors may take longer to regain full well-being. This study aimed to investigate clinical and functional evaluation and radiologic changes in the third month after COVID-19.

Materials and methods: A total of 126 patients were assessed in the third month for symptoms, pulmonary function, exercise capacity, radiologic imaging, and quality of life after being discharged following COVID-19 treatment. Two radiologists evaluated the initial and follow-up images.

Result: At the third month follow-up visit, the most common persisting symptoms were shortness of breath (32.5%), cough (12.7%), and muscle pain (12.7%). At the follow-up visit, oxygen saturations at rest and after a sixmin walking test were lower in patients with prior intensive care hospitalization compared to those without (p<0.001, p= 0.004). Computed tomography (CT) scans revealed persisting pulmonary pathologies in 64.6% of patients at the third month follow-up. The most common pathologies on follow-up thoracic CT were fibrotic-like changes in 44.2% and ground-glass opacities (GGO) in 33.3%. Regression analysis unveiled that age [95% confidence interval (CI), 1.01 to 1.15; p= 0.020], male sex (95% CI, 4.06 to 95.3, p<0.001), first CT severity score (95% CI, 1.02 to 1.41, p= 0.028), duration of hospitalization (95% CI, 1.02 to 1.18, p= 0.012), oxygen saturation (95% CI, 0.86 to 0.96, p<0.001) were independent predictors of fibrotic-like changes.

Conclusions: In the third month following COVID-19, the most common symptom was dyspnea, and the most common radiological findings were fibrotic-like changes and GGO. Longer follow-up studies of COVID-19 survivors are needed to observe lasting changes.

Ocrelizumab is an anti-CD20 monoclonal antibody used in the treatment of primary progressive and relapsing multiple sclerosis (MS). Although cases of organizing pneumonia have been reported in association with other antiCD20 agents such as rituximab, there is insufficient data in the literature on Ocrelizumab-associated lung involvement. Herein, we present a case of organizing pneumonia in a 37-year-old female patient with multiple sclerosis following Ocrelizumab use.

Introduction: It is known that there is a relationship between severe exacerbations of chronic obstructive pulmonary disease(COPD) requiring hospitalization with loss of forced expiratory volume in one second (FEV1), impaired quality of life, and increased mortality. The aim of this study was to investigate factors [health-related quality of life with COPD Assessment Test (CAT), physical activity, FEV1, PaO2] affecting the time to first exacerbation (TTFE) after discharge in patients hospitalized with exacerbation.

Materials and methods: Seventy-five patients who were hospitalized due to COPD acute exacerbation were included in the study and were prospectively monitored. First exacerbation after discharge was recorded. During the first three days of hospitalization, patients were fitted with a pedometer on any of these days; 24-hour step counts were recorded and CAT was administered through face-to-face interviews. Data on age, sex, PaO2, FEV1, and comorbidities were recorded. The median value of the CAT scores of the participants were taken as the cut-off point. High scores were considered as an indicator of poor quality of life. Cox regression models were created for multivariate analyses and hazard ratios (HR) with 95% confidence interval (95% CI) provided.

Result: There was a statistically significant relationship between the TTFE and CAT score (p= 0.001), FEV1 (pred %) (p= 0.02) and PaO2 (p= 0.02). No statistically significant relationship was found between TTFE and the number of steps used as an indicator of physical activity (p= 0.3). In multivariate analysis, age and sex adjusted CAT and PaO2 significantly affected the TTFE (HR= 2.06 CI 95%= 1.17-3.65 and HR= 5.50 CI 95%= 2.09-14.49, respectively) while adjusted FEV1 (pred %) was not significantly affected the TTFE (HR= 1.54 CI 95%= 0.88-2.70).

Conclusions: The results of this study suggest that using CAT may be an easy-to-apply and practical tool to help identify patients with an increased risk of exacerbation. No significant correlation was found with the daily number of steps, which is an easily measurable indicator of physical activity.

Progressive pulmonary fibrosis (PPF) is defined as the presence of at least two of the three criteria, which are worsening respiratory symptoms, functional decline, and radiological progression in patients with interstitial lung disease with radiological pulmonary fibrosis for known or unknown reasons other than IPF, within the previous year (1). A conditional recommendation has been made for nintedanib in the treatment of PPF, and further studies are needed for pirfenidone (1). In this review, the diagnostic and therapeutic approach to progressive pulmonary fibrosis with its new name, previously known as progressive fibrotic interstitial lung diseases, will be discussed, accompanied by updates.

Introduction: In malignant pleural mesothelioma (MPM), useful tools are needed to predict survival. Thus, we aimed to evaluate the LENT score, and demonstrate the performance of the LENT score in predicting survival in patients with MPM.

Materials and methods: This was a retrospective, observational single-center study. Sixty-nine patients diagnosed with MPM who had pleural effusion (March 2009-December 2020) were divided into groups according to their LENT score and compared. Median survivals were estimated and compared according to the LENT score and parameters of the LENT score.

Result: Fifty-four patients were in the low-LENT score group, 15 patients were in the moderate-LENT score group, and there were no patients in the highLENT score group. The two groups had similar characteristics in terms of age, gender, and histological subtype distribution. There were no patients with ECOG-PS 0 in the moderate-LENT score group. Serum neutrophil-tolymphocyte ratio (NLR), pleural lactate dehydrogenase (LDH), patients with serum NLR> 9, and patients with pleural LDH> 1500 were significantly higher in the moderate-LENT score group (p= 0.002, 0.001, <0.01, <0.01, respectively). Fifty patients had died during a median follow-up of 38.6 ± 6.5 (95% CI= 25.84-51.41) months. The median survival for all patients was 28.63 ± 3.2 (95% CI= 22.33-34.92) months, higher than the original study. It was 30.97 ± 2 months in the low-LENT score group, and 20.7 ± 3.4 months in the moderate-LENT score group (p= 0.98). The median survival for patients with pleural LDH<1500 was significantly higher than for patients with pleural LDH> 1500 (p= 0.006) (30.97 vs. 16.73 months), while ECOG-PS (0 vs. 1) and NLR (<9 vs. >9) showed no differences.

Conclusions: The survival in our resultant groups was higher than those reported in the original study, and the LENT score had no discriminatory ability for predicting survival in patients with MPM. We nevertheless believe that before reaching more definite conclusions, further large-scale multicenter prospective studies are needed to better define the clinical utility of the LENT score.

Introduction: Anthracosis is a kind of pneumoconiosis that may cause parenchymal and bronchiolar injury and mediastinal lymphadenopathy. In this study, we aimed to investigate F-18 fluorodeoxyglucose (FDG) positron emission tomography/computerized tomography (PET/CT) findings of patients who had anthracosis diagnosis with endobronchial ultrasonography (EBUS).

Materials and methods: The patients who underwent EBUS-transbronchial needle aspiration (TBNA) and were diagnosed with anthracosis in a five year period were included in the study. The diagnosis was confirmed by surgery/ radiological stability. Demographic characteristics such as age, sex, smoking status, and occupational and environmental exposures were recorded. The characteristics: diameter (short axis), shape, central hilar structure, necrosis sign, echogenicity, and margins measured by EBUS, and maximum standardized uptake value (SUV max value) by PET/CT of the lymph node stations were evaluated.

Result: One hundred thirty-three patients with 239 lymph node stations were investigated. Biomass exposure was detected in nearly half of the patients (n= 55, 41.4%) and occupational exposure was detected in 32 (24.1%) patients. Eighty-six (64.7%) patients had more than 20 packs/years of smoking history. Most of the lymph nodes (80.8%) have a higher PET/CT SUV max value than 2.5. The mean diameter of the lymph nodes measured by thorax CT (16.2 ± 6.5 mm) and EBUS (12.7 ± 5.6 mm) did not show any difference according to PET/CT SUV max value of ≥2.5 or not (p> 0.05). Subcarinal lymph nodes were significantly larger than the other lymph node stations. The lymph nodes with necrosis sign (p= 0.028), absence of central hilar structure (p= 0.013), and heterogeneous echogenicity (p= 0.008) were statistically significantly related to higher SUV max value.

Conclusions: Anthracosis should be considered as a cause of false-positive PET/CT results for mediastinal lymph nodes, especially in patients with a history of occupational and environmental exposure including biomass and smoking.

Glucocorticoids are the primary treatment choices for sarcoidosis. However, some patients are resistant to corticosteroids or have side effects and may not respond to alternative treatments added to reduce corticosteroid therapy. Evidence has demonstrated the critical role of Infliximab [anti-tumor necrosis factor (TNF)-α] which is a chimeric IgG1 monoclonal antibody in the pathogenesis of granulomatous inflammation. In this paper, we present a patient who improved clinically and radiologically with infliximab treatment, which was initiated due to the development of serious side effects associated with corticosteroids; however, following unresponsiveness to other therapeutic drugs initiated due to relapse, restarted infliximab, and developed an early hypersensitivity reaction. With infliximab, the frequency of early-type hypersensitivity reactions is 2-3%. In such cases, drug desensitization is an effective and safe treatment option. Different desensitization protocols have been defined with infliximab, and the frequency of reactions during desensitization has been reported as 29%, especially in the last step. With the desensitization protocol we have modified, patients with a history of early-type hypersensitivity reaction with infliximab will have the chance to take this effective drug more safely and effortlessly.