Tuberkuloz ve toraks最新文献

Introduction: This study aimed to perform the segmentation of honeycomb cysts, traction bronchiectasis, and emphysematous lung parenchyma in highresolution computed tomography (HRCT) examinations using the deep learning method of artificial intelligence.

Materials and methods: The study included the cross-sectional images of 265 patients diagnosed with usual interstitial pneumonia between 2017 and 2021. Minimum intensity projection (MinIP) was performed on axial sections in the parenchymal window. Emphysema areas, traction bronchiectasis, and honeycomb cysts were segmented and labeled on the axial HRCT images. The dataset was divided into three parts, namely training, validation, and testing, at a ratio of 80, 10, and 10%, respectively. The results were calculated by selecting 50% as the threshold value for the intersection over union (Jaccard index) statistic.

Result: Of the 265 patients included in the study, 184 (69.4%) were male and 81 (30.6%) were female. Mean age of the patients was 73 ± 10 years. In the test group segmented as emphysema, the sensitivity, precision, F1 score, area under the curve (AUC), and accuracy values were calculated as 0.81, 0.90, 0.85, 0.86, and 0.75, respectively. In the test group segmented as traction bronchiectasis, the sensitivity, precision, F1 score, AUC, and accuracy values were found to be 0.95, 0.76, 0.85, 0.80, and 0.75, respectively. In the test group segmented as honeycomb cysts, the sensitivity, precision, F1 score, AUC, and accuracy values were 0.96, 0.92, 0.94, 0.88, and 0.90, respectively.

Conclusions: In this study, we successfully utilized the U-Net architecture, a deep learning technology, to accurately segment honeycomb cysts in MinIP images, one of the parameters that will help classify interstitial lung diseases (ILDs). We anticipate that our study will guide future studies on the classification of ILDs.

Introduction: First-line immunotherapy, alone or with chemotherapy, has revolutionized the treatment of metastatic non-small cell lung cancer (NSCLC). However, with multiple approved regimens, the optimal therapeutic choice is undefined due to a lack of direct comparative trials. This network meta-analysis was conducted to establish a hierarchy of efficacy for five landmark immunotherapy-based regimens to inform clinical and policy decisions.

Materials and methods: A network meta-analysis of five pivotal phase III trials (KEYNOTE-024, KEYNOTE-189, KEYNOTE-407, CheckMate 9LA, IMpower 110), all recently reimbursed in our country, was performed. We synthesized overall survival (OS) data for the total population and across subgroups defined by histology (squamous vs. non-squamous) and PD-L1 expression (<1%, 1-49%, ≥50%), with chemotherapy as the common comparator.

Result: Pembrolizumab-based therapies ranked consistently high. In nonsquamous NSCLC, pembrolizumab-chemotherapy was highest-ranked and significantly superior to the nivolumab-based combination (HR: 0.76, 95% CI: 0.58-0.99). In squamous disease, the combination of nivolumab, ipilimumab, and chemotherapy emerged as the highest-ranked regimen (SUCRA: 78.3%). By PD-L1 status, pembrolizumab monotherapy was topranked for ≥50% expression (SUCRA: 82.8%), while pembrolizumabchemotherapy was superior for the 1-49% subgroup (SUCRA: 87.5%). For PD-L1 negative (<1%) patients, a subgroup with substantial heterogeneity, no regimen showed a statistically significant OS benefit over chemotherapy.

Conclusions: Our analysis indicates pembrolizumab-based regimens, as monotherapy or with chemotherapy, offer the most robust and highestranking survival advantage across most key NSCLC subgroups. These findings provide a critical, evidence-based framework to guide individualized first-line treatment selection.

Introduction: Health literacy encompasses patients' abilities to access healthcare, comprehend health information, and make decisions based on that knowledge. We aimed to examine the relationship between dyspnea levels, acute exacerbations, hospitalizations, disease severity and comorbidities of chronic obstructive pulmonary disease (COPD) patients according to their health literacy levels.

Materials and methods: A total of 106 COPD patients were prospectively enrolled in our study. Demographic data, history, pulmonary function tests, COPD severity, comorbidities, health status, quality of life and the factors determining the course of the disease in the last year were collected. We also measured patients' health literacy using the Turkish version of the European Health Literacy scale.

Result: Our findings revealed that elderly COPD patients (p= 0.04) with advanced disease stages (p< 0.001), higher Charlson Comorbidity Index and Saint George Hospital Respiratory Questionnaire scores (p< 0.001), and lowincome (p= 0.02) had lower levels of health literacy. Moreover, patients with lower health literacy experienced more frequent exacerbations (p= 0.01), more severe exacerbations (p< 0.001), and higher rates of hospitalization (p< 0.001). Logistic regression analysis unveiled that GOLD stages (OR: 11.62, 95% CI: 3.36-26.25), and recent severe exacerbations within the last year (OR: 14.24, 95% CI: 5.41-38.13) stood out as the most strongly associated risk factors for poor health literacy.

Conclusions: COPD patients with low health literacy have a higher risk of severe disease. Recognizing the concept of health literacy and identifying risk factors associated with low health literacy are crucial steps in enhancing education, care, and social support for COPD patients. It emphasizes the need for tailored interventions and support for COPD patients, especially those with lower health literacy.

Introduction: Pulse oximeter is commonly used by chronic obstructive pulmonary disease (COPD) patients for long-term oxygen therapy (LTOT) to monitor oxygen levels. This study investigated the association between oximeter use, anxiety severity, symptom burden, and healthcare utilization in this population.

Materials and methods: This prospective observational study included 110 individuals with COPD who underwent LTOT. Data were collected on pulmonary function, modified Medical Research Council (mMRC) scores, and daily pulse oximeter use. Anxiety severity was assessed using the Beck Anxiety Inventory (BAI). Healthcare utilization in the previous year, including outpatient-treated and inpatient-treated exacerbations, intensive care unit admissions, and non-exacerbation-related hospital admissions, was analyzed. Linear regression analysis was performed to identify the independent predictors of nonexacerbation-related hospital admissions.

Result: Among the participants, 68 (61.8%) reported using a home pulse oximeter. There were no significant differences in BAI scores (p= 0.678), oxygen therapy duration (p= 0.530), or mMRC scores (p= 0.251) between the groups. However, non-users had significantly higher rates of non-exacerbation-related hospital admissions than users (p< 0.001). In multivariable analysis, not using pulse oximeter independently predicted more non-exacerbationrelated admissions (B= 1.63, 95% CI: 0.94-2.32, p< 0.001), whereas anxiety and physiological measures were not significant.

Conclusions: Pulse oximeter use was not associated with anxiety or symptom severity among the patients with COPD receiving LTOT. However, non-use of pulse oximeter was independently associated with increased non-exacerbation-related hospital admissions. These findings suggest that pulse oximeter may support patient self-management and reduce unnecessary healthcare utilization, without contributing to anxiety.

Introduction: Patients with acute medium-high risk pulmonary embolism (PE) may experience cardiovascular decompensation and sudden death. Our aim was to evaluate the impact of intravenous low-dose thrombolytic therapy on in-hospital mortality and intracranial bleeding in intermediate-high-risk PE.

Materials and methods: This single-centre, retrospective study included 128 patients with acute intermediate-high-risk PE. Patients were classified into two groups: Low-dose thrombolytic (0.6 mg/kg, maximum 50 mg, alteplase plus parenteral anticoagulant) group and anticoagulant (unfractionated and/or low molecular weight heparin) group. We compared in-hospital mortality, improvement in right ventricular (RV) failure, and haemorrhagic complications between the groups.

Result: Fifty-six patients received low-dose recombinant tissue-type plasminogen activator, and 72 patients were treated with anticoagulants. Patients in the low dose thrombolytic group were younger than the anticoagulant group (63.5 ± 15.5 vs. 70.3 ± 15.5; p= 0.016). There were no significant differences in baseline clinical, laboratory, and echocardiographic findings between the groups. Hemodynamic decompensation was significantly lower in the lowdose alteplase group than the anticoagulants group [1.8% vs. 11.1%; OR: 0.145, (95% CI: 0.018-1.2); p= 0.041]. In-hospital mortality rate was 5.5% in the anticoagulant group, and no death was seen in the low-dose thrombolysis group (p= 0.048). Low-dose alteplase significantly improved RV dysfunction compared with anticoagulants [76.8% vs. 40.3%, OR: 4.9 (95% CI: 2.25- 10.68), p< 0.001]. No intracranial hemorrhage was seen, and the incidence of extracranial major bleeding was similar between treatment groups [1.8% vs. 1.4%, OR: 1.29 (95% CI: 0.08-2.1); p= 0.857].

Conclusions: Among the patients with acute intermediate-high-risk PE, low dose alteplase may be preferred safely without increasing the risk of major bleeding and reduced in-hospital mortality compared to heparin.

Introduction: Eosinophilia is a hematologic finding that may indicate a wide range of underlying conditions, from common allergic diseases to rare and potentially life-threatening disorders such as hypereosinophilic syndrome (HES), eosinophilic granulomatosis with polyangiitis (EGPA), and systemic mastocytosis. A structured diagnostic approach is crucial to identify the underlying etiology and guide appropriate treatment.

Materials and methods: This retrospective cross-sectional study evaluated 232 adult patients with peripheral blood absolute eosinophil counts ≥1000 cells/µL, who were referred to a tertiary immunology and allergy clinic between January 2018 and December 2022. Demographic, clinical, and laboratory data were analysed. Diagnoses were grouped according to eosinophil count severity: Mild (1000-1499 cells/µL), moderate (1500-4999 cells/µL), and severe (≥5000 cells/µL). Diagnoses were based on established international guidelines, supported by laboratory, radiological, immunological, and genetic investigations.

Result: The most commonly observed diagnoses included atopic diseases (53.4%), with allergic bronchopulmonary aspergillosis (ABPA, 11.6%), nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (6%), and chronic eosinophilic pneumonia (3%) occurring less frequently. Rare conditions included EGPA (1.7%), HES (1.7%), parasitic infections (1.3%), systemic mastocytosis (0.4%), and Gleich syndrome (0.4%). Innate immune defect was detected in 0.4%. Molecular testing identified myeloid variant HES in four patients (FIP1L1-PDGFRA and PDGFRB mutations). The etiology remained undetermined in 19.8% of the patients. Atopic diseases were the most frequent diagnosis across all eosinophilia severity groups (38.3% vs. 14.2% vs. 0.8% p< 0.001 respectively).

Conclusions: Atopic diseases are the most common cause of eosinophilia in adults, but clinicians must remain vigilant for less common but clinically significant diagnoses such as ABPA, HES, EGPA, and systemic mastocytosis. Managing eosinophilia effectively depends on a multidisciplinary strategy that incorporates algorithm-based decision-making to support accurate diagnosis.

Introduction: Fungal organisms are increasingly isolated from respiratory samples of patients with cystic fibrosis (CF), yet their clinical relevance remains incompletely understood. This study aimed to assess the frequency of colonization and clinical characteristics of CF patients with fungal colonization.

Materials and methods: We retrospectively reviewed CF patients followed at the Pediatric Pulmonology Division of Ege University between January 2011 and December 2022. Those with at least one respiratory culture analyzed for fungi were included. Fungal colonization was defined as the growth of the same species in at least 50% of cultures within one year. Demographic, clinical, spirometric, and microbiological data were evaluated.

Result: Among the 98 patients, median age was 9.6 years (1.7-32.1), and 54.1% were male. Fungal growth was detected in 51 patients (52.0%), and 37 (37.7%) met the criteria for colonization. Candida albicans (32.7%) and Aspergillus fumigatus (13.3%) were the most commonly isolated species. Patients with fungal colonization were older (p< 0.001), more likely to have chronic Pseudomonas aeruginosa colonization (p< 0.001), had more inhaled antibiotic use (p< 0.001), CF-related liver disease (p= 0.018), and had lower FEV1% (p= 0.005) and body mass index z-scores (zBMI) (p< 0.001). Regression analyses identified lower zBMI (95% CI: 0.527-0.948; p= 0.021) and P. aeruginosa colonization (95% CI: 1.237-8.809; p= 0.017) as independent predictors of fungal colonization.

Conclusions: Fungal colonization is common in children with CF and is associated with older age, impaired lung function, lower zBMI, and P. aeruginosa co-colonization. These findings support the need for routine fungal surveillance and further prospective studies to clarify clinical implications. Further research is needed to determine whether these relationships are causal.