Tuberkuloz ve toraks最新文献

Introduction: This study aimed to investigate whether coronavirus disease-2019 (COVID-19) leads to impaired pulmonary function, fibrotic-like abnormalities or psychological symptoms six months after discharge.

Materials and methods: This study involves 162 laboratory-confirmed patients with COVID-19 who were diagnosed in Ankara University Faculty of Medicine, Department of Chest Diseases from February 1, 2021 to July 1, 2023. All patients were diagnosed with COVID-19 pneumonia by thorax computed tomography (CT). Patients who applied to the outpatient clinic six months after COVID-19 treatment were included in the study. A total of 133 patients underwent thorax CT scan, pulmonary function tests, six minutes walking test simultaneously. Radiographic patterns were categorized into two groups (normal/non-fibrotic and fibrotic-like). Group A had 66 patients who either had no fibrotic or non-fibrotic changes, and 67 patients who had fibrotic-like changes were categorized as group B.

Result: Mean age of the study subjects was 55.95 ± 12.42 years, and 75 (56.4%) patients were male. Overall, median diffusing capacity of the lungs for carbon monoxide (DLCO) % predicted measured as 73.5% [IQR 61-88]. DLCO and six-minute walking distance were significantly lower in the fibroticlike pattern group (p< 0.001, p= 0.014, respectively). Reduced DLCO in patients with fibrotic-like pattern after six months was common. Presence of ground-glass opacities, reticulations and traction bronchiectasis correlated strongly with reduced diffusing capacity (r= -0.190 p= 0.043, r -0.305 p= 0.001, r -0.404 p< 0.001, respectively). We demonstrated that smoking history and intensive care unit (ICU) admisson during COVID-19 pneumonia were independent risk factors for fibrotic-like radiographic abnormalities.

Conclusions: Residual abnormalities resembling fibrosis were notably prevalent, particularly among severely ill patients, and impaired lung diffusion persisted in some individuals even six months post-discharge. Post-COVID-19 lung sequelae can persist and progress after hospital discharge, suggesting airways involvement and formation of new fibrotic-like lesions, mainly in patients who had been in the ICU and had smoking history.

Introduction: The negative effects of eosinophilic severe asthma and chronic rhinosinusitis with nasal polyps (CRSwNP) on quality of life are well known. The present study aimed to evaluate the impact of mepolizumab treatment on the quality of life of patients diagnosed with eosinophilic severe asthma and CRSwNP.

Materials and methods: Patients with CRSwNP and eosinophilic severe asthma who had been receiving mepolizumab 100 mg/month for at least six months as treatment were eligible for the study. Patients were assessed using quality of life and disease control questionnaires for both diseases before and during the sixth month of treatment.

Result: Forty-nine patients were included in the present study. Compared to the pre-treatment period, there was significant clinical improvement in quality of life for both rhinitis and asthma following mepolizumab treatment. The changes before and after the treatment were found as follows: Rhinitis Quality of Life Scale [44 (23-72); 25 (6-57); p< 0.001], Nasal Congestion Symptom Assessment Scale [13.0 (8-20); 9.0 (0-20); p< 0.001], Sino-Nasal Outcomes Test-22 (63.16 ± 17.9; 44.16 ± 21.33; p< 0.001), Asthma Quality of Life Questionnaire (111.06 ± 25.17; 142.67 ± 28.04; p< 0.001), Asthma Control Test [16 (6-21); 22 (14-25); p< 0.001]. Before mepolizumab treatment, 20 patients defined that CRSwNP and 29 patients defined that asthma affected their quality of life primarily. After six months of mepolizumab treatment, 38 patients defined that CRSwNP and 11 patients defined that asthma affected their quality of life primarily.

Conclusions: Our results showed that mepolizumab is an effective treatment option for eosinophilic severe asthma and CRSwNP in patients having both diseases. Before mepolizumab, most patients' quality of life was affected by asthma symptoms, but this changed, and their quality of life began to be affected primarily by CRSwNP symptoms. This suggests that mepolizumab treatment is more effective in suppressing asthma symptoms than suppressing nasal polyp symptoms.

Introduction: Previous studies have reported that diaphragm atrophy and dysfunction might occur during mechanical ventilation (MV), but the frequency, effect on mortality, underlying causes and functional outcomes of diaphragm and lung parenchymal changes during routine MV have not yet been fully understood.

Materials and methods: The lung parenchyma and diaphragm of 50 patients were investigated using ultrasound (USG) on day 1, 5, and 10 of MV therapy.

Result: Mean age of the patients was 64.90 ± 15.96 years. Mean MV duration was 90.18 ± 21.09 days. Mean thickening fraction (TFdi) on day 1, 5, and 10 was 40.77 ± 15.42, 39.85 ± 16.85, and 43.57 ± 19.10, respectively. Mean diaphragm amplitude on day 1, 5, and 10 was 1.70 ± 0.74, 1.76 ± 0.74, and 1.70 ± 0.71, respectively. Mean diaphragmatic thickness at the end of expiration (Tde) on day 1, 5, and 10 was 0.18 ± 0.08, 0.17 ± 0.06, and 0.16 ± 0.05, respectively. There was no significant change between measurement days by TFdi, diaphragmatic amplitude (DA), and Tde values. On admission, TFdi was less than 20% in 8% of the patients, DA was less than 1 cm in 12%, and Tfde was less than 0.2 cm in 52%. There was no significant difference by the TFdi, DA and lung ultrasonography (LUS) scores of the non-surviving and surviving patients. An analysis of imaging results and LUS scores indicated that LUS values were measured higher in patients with infiltration on chest radiography. In addition, LUS scores significantly decreased from day 1 to day 5 and day 10, and from day 5 to day 10.

Conclusions: Diaphragm dysfunction may occur as a result of MV therapy or associated with an inflammatory process, including sepsis. Assessment of diaphragmatic function by USG on admission to the intensive care unit may help to better recognize and manage diaphragmatic dysfunction. LUS provides information about the lung parenchyma as important as chest X-ray and facilitates bedside patient evaluation.

Introduction: Early diagnosis with newborn screening programs and prolonged life expectancy with new treatment strategies have made cardiovascular disease (CVD) one of the important issues in cystic fibrosis (CF). In the early stages of CVD, it is difficult to recognize and follow-up increased arterial stiffness with conventional methods. Different measurement methods are needed. Therefore, in this study, we aimed to use arterial stiffness measurements in the follow-up of children with CF.

Materials and methods: This is a follow-up study examining the changes in arterial stiffness in children with CF by repeating hemodynamic measurements [augmentation index (AIx) and pulse wave velocity (PWV)]. We repeated hemodynamic measurements and CF-related CVD risk factors (Atherosclerosis risk factors: Fasting blood sugar, lipid profiles, and HbA1c) and systemic inflammation markers [C-reactive protein (CRP) and immunoglobulin G and pulmonary function tests] in children undergoing routine annual complication evaluation and examined changes during follow-up.

Result: Hemodynamic measurements could be repeated in 37 of 52 patients due to inclusion criteria. Mean age of the study group was 12 ± 4.5 years and 48.6% were female. There was a statistically significant increase in high density lipoprotein, HbA1c, and CRP and a decrease in low density lipoprotein and FEV1 at the follow-up. Heart rate, central blood pressure, augmented pressure, and PWV were similar. AIx, peripheral systolic blood pressure (SBP), and mean arterial pressure were increased significantly (p< 0.05). The increase in AIx was greater than expected for age and greater in female patients and in those with low body mass index, moderate-severe disease, and high CRP levels. Also, the change in AIx was positively correlated with changes in peripheral SBP and CRP.

Conclusions: This is the first study to evaluate the use of PWV and AIx in the follow-up of children with CF and showed that arterial stiffness measured with AIx increased at follow-up. The use of markers of arterial stiffness in CF from childhood onwards may enable early detection and monitoring of CVD risk and future prevention.

Introduction: Chronic exposure to biomass smoke is a significant health concern, particularly in rural areas where women are primarily responsible for household cooking using organic fuels. This study aimed to evaluate the impact of biomass smoke exposure on pulmonary function and its associated risk factors among elderly women.

Materials and methods: A total of 474 women were screened, of whom 115 were exclusively exposed to biomass smoke, and 32 participants aged ≥65 years were included in the elderly cohort. Pulmonary function tests were performed using a calibrated spirometer, assessing reduced forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio. Logistic and linear regression analyses were conducted to explore the relationship between pulmonary outcomes and exposure duration, demographic characteristics, and comorbidities.

Result: Among all participants, obstructive lung disease (FEV1/FVC< 70%) was observed in 84.3%, while restrictive patterns were found in 16.7%. Prolonged biomass smoke exposure was significantly associated with lower FEV1, FVC, and FEV1/FVC ratios (p< 0.001). Multivariate logistic regression identified exposure duration as an independent predictor of obstruction [Odds ratio (OR)= 1.25, 95% confidence interval (CI)= 1.08-1.44, p< 0.001]. In the elderly subgroup, logistic regression confirmed a significant association between biomass exposure duration and obstruction (OR= 1.26, 95% CI= 1.02-1.57, p= 0.035), while linear regression revealed a negative correlation between exposure duration and FEV1/FVC ratio (β= -0.65, 95% CI= -0.09 to -0.03, p< 0.001).

Conclusions: Prolonged exposure to biomass smoke is strongly associated with deteriorated pulmonary function, particularly among elderly women. These findings underscore the urgent need for targeted interventions to reduce biomass smoke exposure and improve respiratory health in vulnerable rural populations.

Introduction: Pulmonary tuberculosis (PTB) remains a major global health challenge, with Indonesia bearing a substantial disease burden. Genetic predisposition, particularly vitamin D receptor (VDR) gene polymorphisms, has been implicated in PTB susceptibility. However, findings remain inconsistent across populations. This study examines the association of four VDR polymorphisms (FokI, ApaI, BsmI, and TaqI) with PTB susceptibility in three Indonesian ethnic groups, while also evaluating sociodemographic and lifestyle risk factors.

Materials and methods: A case-control study was conducted among 267 participants from Makassar, Bugis, and Toraja ethnic groups in South Sulawesi, Indonesia. Participants were categorized into active PTB (n= 88), latent PTB, and healthy control groups. Genotyping of VDR polymorphisms was performed using polymerase chain reaction-restriction fragment length polymorphism. Sociodemographic factors, smoking habits, alcohol consumption, and education levels were recorded. Statistical analyses included chi-squared tests, logistic regression for odds ratio (OR) calculations, and receiver operating characteristic (ROC) curve analysis to assess the discriminatory power of genetic markers (AUC values). The optimal diagnostic threshold was determined using the Youden index.

Result: The FokI CC genotype was significantly associated with PTB risk (p= 0.014; OR= 2.12, 95% CI: 1.18-3.79), whereas the TT genotype showed a protective effect. The ApaI TT genotype also exhibited a strong association with PTB susceptibility (p< 0.001; OR= 2.65, 95% CI: 1.63-4.29). No significant associations were found for BsmI and TaqI polymorphisms. Sociodemographic analysis revealed that lower education levels and smoking significantly increased PTB risk (p= 0.006 and p= 0.011, respectively). ROC analysis for combined FokI CC and ApaI TT genotypes yielded an AUC of 0.76 (95% CI: 0.68-0.84), demonstrating moderate predictive power.

Conclusions: This study highlights the multifactorial nature of PTB susceptibility, emphasizing the role of VDR gene polymorphisms, education, and lifestyle factors. The findings support the integration of genetic screening into PTB risk assessment and underscore the need for targeted public health interventions in genetically diverse populations.

Introduction: Diffuse pulmonary ossification (DPO) refers to the unusual formation of mature bone tissue within the lung parenchyma. It has been shown to be associated with a number of cardiac and chronic lung diseases. The relation between DPO and idiopathic pulmonary fibrosis (IPF) has been shown in the literature. We examined DPO, which is the supporting computed tomography (CT) finding of IPF. In this way, it was aimed to distinguish cases with an IPF-like pattern non-invasively.

Materials and methods: A retrospective analysis included 89 cases exhibiting a CT pattern typical of usual interstitial pneumonia (UIP). The cases were divided into two groups: One with an IPF diagnosis and the other with a nonIPF diagnosis. The presence of DPO was then assessed in each case according to the criteria outlined in the literature. Finally, the occurrence of DPO was compared between the IPF group and the non-IPF group.

Result: Forty-seven of 89 cases had a diagnosis of IPF (52.8%). DPO was observed in 31 patients (34.8%). Presence of DPO was detected in 28 (59.6%) patients in the IPF group. The presence of DPO was detected in 3 (7.1%) cases in the non-IPF UIP patient group. A moderate correlation was found between IPF and DPO, and a moderate correlation was found between IPF and the male sex (r= 0.549; r= 0.311, respectively).

Conclusions: DPO is an important finding to support the diagnosis of IPF.