Tuberkuloz ve toraks最新文献

Introduction: Intravenous fluids are commonly used to resuscitate cardiac surgery patients in the operating room and ICU, assuming they expand the intravascular compartment. However, the quantitative information for their distribution and shift between the tissue compartments is still lacking. This study aimed to assess how administered fluids distribute across compartments and their effects on micro- and macrocirculation during the long term of cardiac surgery.

Materials and methods: Thirty-three consecutive patients undergoing major cardiac surgery were prospectively enrolled. Information regarding the body fluid distribution [total body water (TBW), extracellular water (ECW), intracellular water (ICW)], sublingual microcirculation total vessel density (TVD), per-fused vessel density (PVD), and proportion of perfused vessel (PPV)], and hemodynamics were collected before surgery (T0), on the day of discharge from the intensive care unit (T1), and on the third day at the ward (T3). Correlations of the changes in microcirculatory and macrocircula-tory parameters were determined by linear regression.

Result: Twenty-four patients were included in the analysis with available data. Body weight significantly increased from 86.0 ± 13.6 kg to 91.6 ± 13.3 kg at T1 and decreased to 87.8 ± 12.9 kg at T3 (p< 0.001). While TBW and ECW varied in parallel with body weight, ICW showed a continuous decrease throughout the study process. TVD, PVD, and PPV significantly decreased at T1, then increased at T3, but all remained lower than baseline (p< 0.001 for TVD and PVD, p= 0.034 for PPV). A cut-off point of a 5% increase in body weight predicted a 10% decrease in TVD with a sensitivity of 0.833 and specificity of 0.666. Besides, a cut-off point of a 4% increase in body weight predicted a 10% decrease in PVD with a sensitivity of 0.94 and specificity of 0.75.

Conclusions: Administering fluid during operation and intensive care stay significantly reduces ICW and causes microcirculatory disturbances in cardiac surgery patients. Long-term microcirculation disturbances correlate with ECW and TBW in these patients.

Introduction: Tuberculosis (TB), a highly contagious disease, remains one of the leading causes of death globally. The proposed computer-assisted TB detection system enhances diagnostic accuracy and efficiency by integrating deep learning and segmentation techniques.

Materials and methods: It consists of two key subsystems: Automated field-ofview (FOV) recognition and TB bacilli segmentation. Using a motorized microscopic stage, the system systematically captures Ziehl-Neelsen-stained sputum smear images at 100x magnification. A customized Inception V3 model with transfer learning identifies FOVs containing TB bacilli, reducing variability and manual effort. Segmentation techniques, including coarse-level thresholding and shape descriptors like area, perimeter, and eccentricity, refine bacilli detection and eliminate artifacts.

Result: This study highlights the significant potential of deep learning and image processing techniques in advancing medical diagnostics, particularly TB detection. This framework has the potential to improve clinical outcomes and support global TB eradication efforts by providing a reliable tool for early TB diagnosis.

Conclusions: The system achieved a mean receiver operating characteristic score of 0.9505, a precision of 0.924, a recall of 0.882, and an F1 score of 0.902, demonstrating its potential to improve TB screening, particularly in resource-limited settings. By minimizing reliance on skilled technicians and enhancing diagnostic reliability, this approach offers a scalable solution for effective TB detection and severity assessment.

Introduction: Pulmonary atelectasis is a significant respiratory problem in children. This study aimed to investigate the underlying causes of atelectasis and evaluate the outcomes of flexible fiberoptic bronchoscopy (FFB) in pediatric patients with this condition.

Materials and methods: Clinical data and outcomes of 110 children who underwent FFB were retrospectively analyzed based on radiological imaging obtained at three and six months following the procedure, and the patients were categorized into three groups: Group 1 (complete resolution of atelectasis), Group 2 (partial resolution), and Group 3 (no resolution).

Result: Between January 2016 and December 2023, a total of 110 pediatric patients with pulmonary atelectasis underwent FFB. The most common bronchoscopic findings were mucus plugs and secretions (50%), foreign body aspiration (7.3%), and congenital airway anomalies (3.6%). In 30% of the patients, bronchoscopy findings were normal. Complete resolution of atelectasis was observed in 55.4% of patients following FFB. The median duration of atelectasis in Group 3 was 90 days, significantly longer than that found in the other two groups (p= 0.002). Additionally, the median hospitalization period prior to bronchoscopy in Group 3 was 21 days, which was also longer than that found in the other groups (p= 0.004). The median atelectasis score in Group 1 was 2.34 (range: 0.9-3.1), significantly lower than in Groups 2 and 3 (p= 0.005).

Conclusions: FFB is an effective tool for identifying the etiology of atelectasis in children. Prolonged duration of atelectasis and the presence of comorbidities were identified as risk factors for persistent, non-resolving atelectasis.

Introduction: Sarcoidosis is a chronic and inflammatory multisystemic disease of unknown origin that causes various clinical manifestations. Epidemiologic data vary by numerous variables such as age, geographical location, sex, race, as well as genetic and environmental factors. Epidemiologic data help better characterize the heterogeneous disease of sarcoidosis, as in many other diseases, and facilitate a prognostic assessment. Thus, the present study sought to analyze epidemiologic data and changes in diagnostic strategies used in sarcoidosis over time.

Materials and methods: The study reviewed patients who were diagnosed with sarcoidosis between January 01, 2011 and December 31, 2020, and had non-necrotizing granulomatous inflammation in at least one thoracic biopsy material.

Result: Data from a total of 1.200 patients, of whom 768 (64%) were females and 432 were males (female/male: 1.77), were reviewed over a 10-year period. The results showed an increasing trend in the frequency of sarcoidosis in the 10-year period and an increasing incidence for males after 2015. The rate of asymptomatic patients was 15%, and asymptomatic sarcoidosis was significantly higher in males than in females. After 2012, video-assisted mediastinoscopy was replaced with endobronchial ultrasoundguided transbronchial needle aspiration as the preferred diagnostic technique.

Conclusions: Epidemiologic data associated with sarcoidosis are likely to continue changing because of multiple factors such as health policies and technological changes and development. We believe that it is necessary to constantly monitor epidemiological changes in different geographical regions in the world.

Introduction: Many studies have shown that the diagnostic value of lung ultrasound is much better than chest radiography in selected patients in emergency departments, intensive care units and inpatient clinics. However, there is insufficient data on the routine use of lung ultrasonography (LUS) in chest diseases outpatient clinics. The main aim of this study was to determine the diagnostic value of routine use of AUS in outpatients.

Materials and methods: One hundred and twenty-nine patients were included in the study. Lung ultrasound was performed by a pulmonologist on the same day as chest radiography (CXR), unaware of the patient's clinical and radiologic information. Chest radiographs of the patients were evaluated by two independent experts after patient recruitment was completed. The clinical final diagnosis (CFD), which was accepted as the reference standard, was obtained from hospital automation records.

Result: Patients were divided into two groups as those with pulmonary pathology (n= 74) and those without pulmonary pathology (n= 55) according to CFD. The sensitivity and specificity values of LUS and CXR were 48.05% and 50.64% and 78.85% and 84.62%, respectively. The rates of detection of pulmonary disease by LUS and CXR were similar (McNemar test, p< 0.05). There was moderate agreement between the two tests in assessing the presence of pulmonary pathology (kappa= 0.484, p< 0.05). Female sex and obesity negatively affected the diagnostic accuracy of LUS (p< 0.05), whereas age and symptom duration had no effect (p< 0.05). Mean LUS duration was 8.02 minutes.

Conclusions: The study demonstrated that LUS can contribute as a preliminary diagnostic tool with or without CXR in outpatient settings. Especially in situations where chest radiography is unavailable or contraindicated, such as pregnancy, LUS can safely contribute to the diagnosis of lung disease.

Introduction: The objective of this study was to investigate the impact of two different doses of alteplase, a thrombolytic therapy, specifically half-dose (50 mg) and full-dose (100 mg), on short-term (7 days) and long-term (1 year) mortality and morbidity in the treatment of pulmonary embolism (PE).

Materials and methods: A retrospective cohort study was conducted at the Department of Chest Diseases of Erciyes University Faculty of Medicine Hospital from January 1, 2010 to October 31, 2021. The study enrolled patients diagnosed with PE who underwent treatment with either 50 mg or 100 mg of alteplase. In total, 58 patients participated, with 41 receiving a 50 mg dose of alteplase and 17 receiving a 100 mg dose of alteplase treatment.

Result: Of the patients, 62.1% (n= 36) were female, with a mean age of 63 ± 14.5 years. Mean length of hospital stay was 9.2 ± 7.4 days. Mortality rate of the patients who had PE and received half-dose treatment was 36.5%, and mortality rate of the patients who received full-dose treatment was 17.6%. Mean time to mortality for non-survivors was 126.1 ± 355.4 days. Of the 18 patients who did not survive, 44.4% (n= 8) died within the first seven days, 50% (n= 9) between days eight and 365, and 5.6% (n= 1) after 365 days. In-hospital mortality occurred in 25.9% of the patients (n= 15), with no statistically significant relationship found between mortality status, time to death, in-hospital mortality, vasopressor use, ventilation support requirement, cardiopulmonary resuscitation, and the dose of alteplase treatment (p> 0.05). The comparison of survival rates by the administered alteplase treatment dose revealed no significant relationship (p= 0.187). Notably, there was no in-hospital mortality among the patients under the age of 65 who received a full dose of alteplase treatment, and this result was statistically significant (p= 0.010).

Conclusions: Upon comprehensive evaluation of the data gathered from our study, short-term mortality was significant in favor of the group receiving full dose in patients under 65 years of age. However, it is worth noting that longterm mortality and bleeding rates were comparable in both groups.