Tuberkuloz ve Toraks-Tuberculosis and Thorax最新文献

Introduction: Noninvasive ventilation (NIV) for acute hypercapnic respiratory failure (AHRF) is an established treatment modality. Current evidence does not conclude any superiority between fixed pressure support (PS) and average volume-assured pressure support (AVAPS) modes. However, given the ability of rapid PaCO2 decline in AVAPS mode, we hypothesized that COPD patients with AHRF who did not show the desired reduction in PaCO2 with fixed-level PS-NIV might benefit from the AVAPS mode.

Materials and methods: Patients admitted to the non-ICU pulmonary ward with acute exacerbation of COPD (AECOPD) and AHRF were included consecutively in this observational study. Patients with hypercapnic respiratory failure due to obesity-hypoventilation, neurological diseases, or chest wall deformities were excluded. All patients started NIV treatment with fixed pressure support (PS) and patients who did not reach clinical and laboratory stability under PS-NIV treatment were switched to the average volume-assured pressure support (AVAPS) mode of NIV.

Result: Thirty-five COPD patients with hypercapnic respiratory failure were included. Under PS-NIV treatment, 14 (40%) patients showed a 17.9 (-0.0-29.2) percent change in terms of PaCO2, meaning no improvement or worsening. Therefore, these patients were treated with AVAPS mode. Arterial PaCO2 and pH levels significantly improved after AVAPS-NIV administration. AVAPS-NIV treatment created a significantly better PaCO2 change rate than using PS-NIV [-11.4 (-22.0 - -0.5) vs 8.2 (-5.3-19.5), p= 0.02]. Independent predictors of AVAPS mode requirement were higher Charlson Comorbidity Index [OR= 1.74 (95% CI= 1.02-2.97)] and higher PaCO2 upon admission [OR= 1.18 (95% CI= 1.03-1.35)]. Thirteen (92.8%) patients reaching significant clinical stability with AVAPS-NIV were able to return to fixed-level PS-NIV and maintain acceptable PaCO2 levels.

Conclusions: Our study demonstrated that patients can benefit from AVAPSNIV despite insufficient response to fixed-level PS-NIV.

Introduction: Respiratory abnormalities in obstructive sleep apnea syndrome (OSAS) are corrected with positive pressure ventilation treatments. We investigated the effect of positive airway pressure (PAP) treatment on the serum level of ischemia-modified albumin (IMA), an oxidative stress product, in OSAS patients with higher body mass index (BMI) and indication for PAP treatment.

Materials and methods: Seven consecutive female and 23 male patients with a BMI of ≥30 kg/m2 who were diagnosed as having OSAS according to ICSD3 criteria and were planned for PAP, were included. The Epworth Sleepiness Scale and STOP-Bang Questionnaire were performed. Morning arterial blood gas, hemogram, biochemistry, insulin, and IMA were measured after polysomnography and after three months of PAP.

Result: There were no significant changes in lactate, CRP, and serum electrolyte levels measured before and after PAP, except for potassium. When 30 patients were compared in terms of serum IMA levels at baseline and after treatment, the mean baseline value was 0.56 absorbance units (ABSU), and the 3rd-month follow-up IMA value was 0.53 ABSU (p= 0.537). The mean serum fasting insulin level was 15.85 µIU/mL and 11.6 (p= 0.002) and the mean HOMA index was 4.4 and 3.0 (p= 0.001), respectively.

Conclusions: Serum IMA levels seem not to be an appropriate marker for the evaluation of PAP treatment in OSAS patients with higher BMI. PAP is associated with a decrease in the fasting insulin level, HOMA index, and hematocrit, but not with serum electrolytes except potassium.

Introduction: Pulmonary function tests are used in the evaluation of the respiratory system. Maneuvers during spirometry can create aerosols and spread viruses such as SARS-CoV-2. Measures due to the pandemic can negatively affect both the number and the quality of the spirometry tests. There are no comparative studies on this subject.

Materials and methods: The tests conducted in the spirometry laboratory between November 2019 and November 2021 were evaluated.

Result: Four hundred forty patients were included in the study. 50.5% of the patients were male and the mean age was 61.8 ± 16.5 years. The age, gender, height, and weight of the patients were similar. 75.2% (331) of the tests were evaluated as successful. The most common errors in tests were early termination (84.1%), uncooperative patients (29%), and poor effort (22.4%). The types of errors were not different between the two periods. The median number of tests performed for each patient was six. The total number of spirometry tests performed were 262 and 178 for 2019 and 2021 (p= 0.011), but test success remained unchanged over the years (p= 0.513). There was no significant difference between the three operators and the test success (p= 0.909), which was similar for both periods. However, the number of tests performed until the successful maneuver varied significantly (p= 0.009), and fewer maneuvers were required before the pandemic.

Conclusions: According to this study, the measures taken during the pandemic did not affect the quality of spirometry, but they did lead to more tests being done up until the successful maneuver was performed.

Introduction: In patients with NSAID-Exacerbated Respiratory Disease (N-ERD), respiratory symptoms occur as a result of the use of cyclooxygenase (COX)-1 inhibitor non-steroidal anti-inflammatory drugs (NSAIDs). Patients with N-ERD generally tolerate selective COX-2 inhibitor NSAIDs. However, respiratory symptoms may be exacerbated in patients with N-ERD due to the intake of selective COX-2 inhibitor NSAIDs. The aim of this study was to evaluate which selective or partial COX-2 inhibitor NSAID is safer in patients with N-ERD.

Materials and methods: Forty-nine patients with a history of respiratory hypersensitivity reactions to NSAIDs (N-ERD) who underwent a drug challenge test with celecoxib, nimesulide, meloxicam, and paracetamol between January 2021-April 2022 were retrospectively evaluated.

Result: Of the 49 patients who underwent the drug challenge tests, 16 (32.7%) were male and 33 (67.3%) were female and the mean age was 37.67 ± 11.62 years. The most common comorbidities were chronic urticaria [n= 21 (42.9%)] and allergic rhinitis [n= 21 (42.9%)]. As a result of drug challenge tests, celecoxib, nimesulide, meloxicam, and paracetamol drug challenge tests were positive in 2 (4.1%), 8 (16.3%), 7 (14.3%) and 11 (22.4) patients, respectively. The rate of allergic reaction to celecoxib was statistically significantly lower than other drugs (p= 0.001). In paired comparisons of the drugs, the allergic reaction rate with celecoxib was statistically significantly lower than with nimesulide (p= 0.031) and paracetamol (p= 0.004).

Conclusions: Selective COX-2 inhibitor NSAIDs are safe in patients with N-ERD. NSAIDs should be prescribed to these patients following general medical precautions and drug challenge tests.

Clinicians and radiologist nowadays frequently encounter pulmonary nodules in children, thanks to the widespread use of computed tomography (CT) thorax. Most pulmonary nodules are benign; however, a small number of pulmonary nodules indicate pulmonary malignancy in children, requiring prompt diagnosis and treatment. Incidentally diagnosed pulmonary nodules are common and naturally cause anxiety in families and in clinicians, leading to successive examinations. For this reason, the creation of algorithms for the diagnosis and follow-up of pulmonary nodules, and the definition of advanced imaging requirements will facilitate the management of these patients; early diagnosis and treatment will be provided in patients with malignant tumors, and unnecessary interventions will be minimized in patients with benign nodules. This review is designed to explore current information on nodule definition, diagnostic evaluation, and management in the pediatric age group based on previously obtained data.

Pulmonary aspergillosis may be classified under three categories depending on whether the patient is atopic or immunocompromised: invasive, chronic necrotizing, and allergic bronchopulmonary aspergillosis (ABPA), which is an immunological pulmonary disorder caused by hypersensitivity to Aspergillus spp., manifesting with poorly controlled asthma. ABPA is diagnosed using major and minor criteria. Herein, we present two ABPA cases with endobronchial signs on bronchoscopy. Asthmatic 31-year-old male and 59-year-old female patients were admitted with dyspnea and bilateral rhonchi. Total IgE levels were elevated. Peripheral eosinophilia was also present. Chest computed tomography revealed consolidated areas, peribronchial micronodules, ground-glass appearance, and increased nodular densities. Bronchoscopy showed brownish-yellow membranes on the bronchial mucosa of these patients. Aspergillus spp. growth was observed in bronchial lavage culture. ABPA is a curable disease only if diagnosed correctly. Notwithstanding the large number of cases reported to date, we aimed to emphasize the importance of bronchoscopic examination in endobronchial fungal infections.

Introduction: This study aims to investigate the relationship between induced sputum eosinophilia and pulmonary functions in ex-smoker asthma patients controlled with an ICS/LABA therapy.

Materials and methods: Asthma patients who are known to use ICS/LABA regularly for at least three months, without an attack in the last month, quit smoking (5-20 pack-years) and have asthma under control (ACT> 20), and concurrent with induced sputum cytology who had spirometry and lung volume measurements were included in the study. Cytology results, induced sputum eosinophil and neutrophil counts, FEV1 (L), FEV1 (%), FVC (L), FVC (%), RV (L), RV (%) and RV/TLC (%) values of all patients were recorded. The relationship between sputum neutrophil and eosinophil count and pulmonary function test parameters was evaluated.

Result: Seventeen (68%) of the patients were female, eight (32%) were male, and the mean age was 49.7 ± 13.6 years. The mean sputum eosinophil percentage was 9.4 ± 16.7, and the neutrophil percentage was 71.4 ± 20.5. A positive correlation was found between induced sputum eosinophil percentage values and FEV1 (L) (r= +0.472; p= 0.01) and FVC (L) (r= +0.502; p= 0.01). No correlation was found between the FEV1/FVC%, FEV1%, FVC%, RV (L), RV%, and RV/TLC% values and the percentage of induced sputum eosinophils (p> 0.05).

Conclusions: It was observed that controlled asthmatic patients with induced sputum eosinophilia treated with ICS/LABA and who quit smoking had high FVC (L) and FEV1 (L) levels.

Introduction: To evaluate the quality of life and anxiety level of school-age children with chronic cough, and changes with treatment.

Materials and methods: Patients aged between 6-18 years with a chronic cough were included in this study. A control group was designed, and the scale scores were compared with each other.

Result: The mean age of the 82 patients was 10.9 ± 3.8 years, 62 (75.6%) had at least one specific cough marker. Forty patients (48.8%) were diagnosed with asthma. At their first visit, the psychosocial health scores and the total scale scores (sum of physical and psychosocial total scores) were lower than the control group for both patients and parents. After the resolution of cough, their scores increased to the same level with the control group. It was also found that the level of anxiety was significantly higher than in the control group both before treatment and after the resolution period (p<0.001 and =0.008, respectively).

Conclusions: Asthma was the leading cause of chronic cough. Quality of life is impaired in children with chronic cough. Anxiety level in these patients increases and after symptoms improve, continues to be higher than that of healthy children.

Anthropometric indices continue to be important measurements especially in predicting obesity and various diseases it causes. The fact that these measurements are very simple to apply and provide clinicians with important information especially in identifying cardiometabolic diseases cannot be overlooked. The use of these indices without the need for complex measurements or laboratory tests gives rapid results on the risks of chronic diseases. Obesity is an important risk factor in obstructive sleep apnea syndrome, and anthropometric measurements showing body fat distribution are of great importance. In addition to the diagnosis of the disease, it is extremely important that the measurements reflecting obesity which is directly related to weight should not be ignored in predicting additional cardiometabolic diseases in this patient group. An ever-increasing variety of anthropometric measurements that reflect abdominal obesity with objective data enables the diagnosis of the disease as well as the determination of cardiometabolic risks of patients with asymptomatic sleep apnea syndrome.