Tuberkuloz ve toraks最新文献

Introduction: Cat is a source of allergens that can cause allergic rhinitis (AR), conjunctivitis and/or asthma. This study aimed to compare demographic characteristics, frequency of asthma development, duration of asthma development, and characteristics of the patients with AR and with AR/asthma in adult patients who have adopted a cat in adulthood and have allergic symptoms after exposure to cats.

Materials and methods: Symptoms, physical examination findings, complete blood count, skin prick test (SPT) and/or specific immunoglobulin E (sp IgE) and pulmonary function test results of adult cat owners with allergic symptoms due to isolated cat allergy between January 2021 and February 2025 were retrospectively evaluated.

Result: Isolated cat allergy was detected by SPT and/or sp IgE measurement in 203 patients with allergic symptoms. Median age of the patients was 29 (18-69) years. A total of 71 patients (35%) experienced asthma and AR/ conjunctivitis symptoms upon exposure to cat allergens. Only patients with AR/conjunctivitis had been exposed to cat for median 24 (12-180) months. In patients with AR/conjunctivitis and asthma, median duration of cat exposure was 36 (12-300) months. Patients with AR/conjunctivitis developed allergic symptoms after a median of 13.5 (11-120) months following cat exposure. In patients with asthma, asthma symptoms developed after a median of 24 (11- 150) months. The severity of AR increased as the number of cats exposed to, cat sp IgE level, total IgE level and eosinophil count increased. Median eosinophil count in patients with a history of asthma attacks was 470 (110- 990) and was statistically significantly higher than in patients without a history of attacks (p= 0.014).

Conclusions: Cats have become one of the major allergens in our country in recent years. The number of patients presenting to allergy clinics with allergic symptoms after having encountered cats is increasing day by day. These patients should be advised to stay away from cats, if possible, but patients who do not agree to stay away from cats should be closely monitored for the development of asthma.

Introduction: Recent studies have shown that Gene Xpert MTB/RIF (Xpert) and Gene Xpert MTB/RIF ultra (Xpert-U) tests outperform traditional microbiological methods in detecting tuberculosis (TB) and identifying rifampicin resistance. This research aimed to examine their diagnostic accuracy and clinical relevance.

Materials and methods: This retrospective cohort study included patients aged 18 years and older with pulmonary or extrapulmonary samples analyzed by Xpert, Xpert-U, and conventional diagnostic methods between January 2016 and June 2020. The diagnostic performance of Xpert and Xpert-U was compared across four patient groups: A) Microscopy-culture-positive pulmonary TB, B) Microscopy-negative, culture-positive pulmonary TB, C) Pulmonary TB cases, and D) Extrapulmonary TB cases.

Result: A total of 1.366 samples (1.280 pulmonary, 86 extrapulmonary) were analyzed using Xpert and Xpert-U, including 1.042 males (76.3%) and 324 females (23.7%), with an average age of 54 years. For pulmonary TB, Xpert showed an overall sensitivity of 99.29% and specificity of 49.23%. Xpert-U demonstrated similar sensitivity at 98.56%, with an improved specificity of 89.66%. In extrapulmonary TB, Xpert-U achieved 100% sensitivity with a specificity of 70.59%.

Conclusions: Xpert and Xpert-U tests offer high sensitivity for detecting Mycobacterium tuberculosis, greatly improving the timely diagnosis and management of TB, especially in cases with low bacterial loads or drug resistance.

Introduction: Obstructive sleep apnea syndrome (OSAS) is characterized by recurrent apnea/hypopneas that cause a decrease in oxygen saturation during sleep. Male sex, greater age, obesity, large neck circumference (NC) and hypertension (HT) increase the tendency to OSAS. Diagnosis is important in terms of prognosis and selection of appropriate treatment. Polysomnography (PSG), which is the gold standard diagnostic method, is expensive, time-consuming and requires special equipment, therefore care must be taken in selecting patients for PSG. In this study, we aimed to investigate the effectiveness of Berlin, STOP-BANG and Epworth Sleepiness Scale (ESS) in predicting the diagnosis of OSAS by comparing with PSG.

Materials and methods: In our study, 136 patients who underwent PSG at the Sleeping Unit in Department of Chest Diseases, Ankara University Faculty of Medicine, and sleep questionnaires were applied to patients at their admissions. Apnea-hypopnea index values of the patients were compared with the questionnaires.

Result: Of the patients, 82 (60.3%) were males, and mean age of the patients who participated in the study was 50.9 years. Mean body-mass index (BMI) of all patients was 31.9 kg/m2. It was observed that 56 (41.2%) of the patients had a diagnosis of HT. Mean NC was 41.9 cm. The most effective questionnaire for predicting the diagnosis of OSAS was determined as STOPBANG Questionnaire (%98), was followed by the Berlin Questionnaire (%88). ESS (%63) was found to be the least effective questionnaire.

Conclusions: OSAS is a common syndrome with high morbidity in the population; it is important to suspect and diagnose the disease. It was concluded that the STOP-BANG Questionnaire, which includes parameters such as symptoms, age, BMI, NC and HT, is highly effective in patient selection for PSG and may help clinicians to predict the diagnosis of OSAS.

Introduction: This study aimed to compare diagnostic delay (Patient delay and health system delay) and treatment problems of tuberculosis among refugees during the coronavirus disease-2019 pandemic and determine access to healthcare and affecting factors.

Materials and methods: This cross-sectional study involved 62 patients who presented to the tuberculosis clinic and were diagnosed between 2019 and 2021.

Result: Among the participants, 45.2% were refugees. While 64.3% of the refugees reported that they experienced fear and unwillingness to present to a health institution due to pandemic conditions, this frequency was 52.9% among Turkish citizens. Mean patient delay was 37.29 days among the refugees and 26.74 days among the Turkish citizens. A significant difference was found between patient delay and health system delay times in the groups according to citizenship. Patient delay was statistically significant in the refugee group according to educational status. A negative correlation was found between the mean knowledge total score and diagnostic delay. Four Turkish participants and six refugees died.

Conclusions: This study was the first to demonstrate the diagnostic experienced by refugees. A significant difference was found between patient delay and health system delay times in groups according to citizenship. Patient delay was statistically significant in the refugee group according to educational status. A negative correlation was found between the mean knowledge total score and diagnostic delay. As a result, it is crucial to prevent diagnostic delays in refugee and immigrant healthcare and ensure the resilience of tuberculosis management during the pandemic.

Introduction: This study aimed to examine and compare the characteristics of post tuberculosis (PTB) and non-tuberculosis (NTB) bronchiectasis patients of Central India retrospectively.

Materials and methods: Bronchiectasis patients who underwent bronchoscopy were diagnosed by high resolution computed tomography (CT) scans, and PTB versus NTB were assessed clinically, radiologically, microbiologically and on the basis of spirometry.

Result: Mean age of the total 90 patients was 52.54 ± 16.33 years. Maximum patients were in the age group above 60 years old. Overall major symptoms were cough (n= 78, 86.66%), dyspnea (n= 65, 72.22%) and fever (n= 44, 48.88%). The proportion of the male population was more in the PTB group (n= 26, 59.09% vs. n= 18, 40.91%, p= 0.387). Bilateral and unilateral bronchiectasis were predominantly present in NTB (n= 34, 73.91%) and PTB (n= 18; 40.91%) respectively. The most common radiological variant of bronchiectasis found in all patients was a cystic type (n= 52, 89.66%); however, the presence of varicose was significantly higher in PTB than NTB group (n= 8, 18.18% vs. n= 2, 4.35%, p= 0.037). Body mass index in NTB (21.79 ± 4.93 kg/m2) was significantly higher than that of PTB group (18.89 ± 3.60 kg/m2) with p-value of 0.004. The proportion of patients with Pseudomonas aeruginosa infection in bronchoalveolar lavage (BAL) of PTB group (n= 12, 27.27%) was more than the NTB group (n= 10, 21.74%). 22.73% (n= 10) patients had a reactivation of TB in the PTB and 8.70% (n= 04) in NTB group. On spirometry, the proportion of patients with obstructive findings was significantly higher in NTB than PTB group (30.43% vs. 6.82%, p= 0.004).

Conclusions: The most prominent underlying cause of bronchiectasis was PTB, with unilateral, varicose subtype being significantly more prevalent on thorax CT. Re-infection was the primary cause of exacerbations in bronchiectasis patients, with Pseudomonas being the most common infectious agent. Our study also contributes to the data pool on bronchiectasis patients in India.

Introduction: In the post coronavirus disease-2019 era, as the pandemic's impact diminishes, the state of our intensive care units (ICUs) remains as crucial as the well-being of individuals. While numerous studies have explored the pandemic's effects on patients, our focus is to examine its impact on ICUs.

Materials and methods: A total of 72 patients who were admitted to the chest diseases ICU due to hypercapnic or hypoxic respiratory failure between October 2018-April 2020 and December 2022-December 2024 and who developed ventilator-associated pneumonia during their follow-up were included in our study.

Result: While Klebsiella pneumoniae and Acinetobacter baumannii cogrowth was observed in 4 of 30 patients (13.3%) pre-pandemic, it increased to 16 of 42 patients (38.1%) post-pandemic. Extensively drug-resistant (XDR) cases rose from 6 (20%) pre-pandemic to 34 (81%) post-pandemic (p< 0.001). A significant post-pandemic decline in carbapenem and beta-lactam susceptibility was noted (p< 0.001 for all). Although susceptibility to ceftazidime-avibactam, the most effective antibiotic for K. pneumoniae, decreased, the change was not statistically significant (p= 0.09). Multivariate regression analysis identified advanced age, coronary artery disease, low ejection fraction, and XDR resistance as factors increasing mortality (p= 0.03, 0.04, 0.04, 0.001, respectively).

Conclusions: During the pandemic, our ICU, where patients were treated with broad-spectrum antibiotics for a long time, has cured many patients but could not prevent the development of multi-drug resistance and XDR Acinetobacter and Klebsiella. Failure to take the necessary precautions will cause significant effects of the silent pandemic.