The relation between thrombus burden and early mortality risk in inpatients diagnosed with COVID-19-related acute pulmonary embolism: a retrospective cohort study

BACKGROUND

COVID-19-related acute pulmonary thromboembolism (APE) is associated with poor outcomes in patients with COVID-19. There are studies investigating the association between thrombus burden and high risk of early mortality in the pre-COVID-19 period. This study aimed to evaluate the relationship between clot burden and early mortality risk in COVID-19-related APE patients.

METHODS

In this single-center retrospective cohort study, the data of hospitalized adult patients followed up for COVID-19-related APE between April 1, 2020, and April 1, 2021, were electronically collected. A radiologist evaluated the computed tomography (CT) findings and calculated the Mastora scores to determine clot burden. The early mortality risk group of each patient was determined using 2019 the European Society of Cardiology guidelines.

RESULTS

Of the 87 patients included in the study, 58 (66.7%) were male, and the mean age was 62.5±16.2 years. There were 53 (60.9%) patients with a low risk of mortality, 18 (20.7%) with an intermediate-low risk, and 16(18.4%) with an intermediate-high/high risk. The median total simplified Mastora scores were 11.0, 18.5, and 31.5 in the low, the intermediate-low, and the intermediate-high/high-risk groups, respectively (p = 0.002). With the 80.61% of post-hoc power of the study, intermediate-high/high early mortality risk was associated statistically significantly with the total simplified Mastora score (adj OR = 1.06, 95%CI = 1.02-1.11,p = 0.009). Total simplified Mastora score was found to predict intermediate-high/high early mortality risk with a probability of 0.740 (95% CI = 0.603-0.877): At the optimal cut-off value of 18.5, it had 75.0% sensitivity, 66.2% specificity, 33.3% positive predictive value, and 92.2% negative predictive value.

CONCLUSIONS

The total simplified Mastora score was found to be positively associated with early mortality risk and could be useful as decision support for the risk assessment in hospitalized COVID-19 patients. Evaluation of thrombus burden on CT angiography performed for diagnostic purposes can accelerate the decision of close monitoring and thrombolytic treatment of patients with moderate/high risk of early mortality.

Effect of chronic lung diseases on mortality of prevariant COVID-19 pneumonia patients

Background

The aim of the study is to assess the effect of chronic lung disease on mortality in patients hospitalized with the diagnosis of prevariant COVID-19 Pneumonia compared to patients without chronic lung disease.

Research design and methods

A cohort of 1,549 patients admitted to the pandemic clinic with a COVID-19 Pneumonia diagnosis was analyzed. Group 1 and Group 2 were compared in terms of the treatment they received, admission to intensive care, mortality and follow-up parameters.

Results

The patient group with COVID-19 and lung disease consisted of 231 participants (14.91%) (Group 1). The patient group with COVID-19 but without lung disease had 1,318 participants (85.19%). Group 1 cases were found to receive more oxygen therapy and mechanical ventilation than Group 2 cases (p ≤ 0.001), Following univariate and multiple logistic regression analyses, it was determined that patients with chronic lung disease had a 25.76% higher mortality risk [OR: 25.763, 95% CI (Lower-Upper) (2.445–271.465), p = 0.007].

Conclusion

It was found that chronic lung disease contributed significantly to mortality in this study. Among chronic lung diseases, Chronic Obstructive Pulmonary Disease (COPD), lung cancer and interstitial lung diseases (ILDs) were shown to be more effective than other chronic lung diseases in patients with prevariant COVİD-19 population.

Development and validation of nomogram to predict severe illness requiring intensive care follow up in hospitalized COVID-19 cases

BACKGROUND

Early identification of severe COVID-19 patients who will need intensive care unit (ICU) follow-up and providing rapid, aggressive supportive care may reduce mortality and provide optimal use of medical resources. We aimed to develop and validate a nomogram to predict severe COVID-19 cases that would need ICU follow-up based on available and accessible patient values.

METHODS

Patients hospitalized with laboratory-confirmed COVID-19 between March 15, 2020, and June 15, 2020, were enrolled in this retrospective study with 35 variables obtained upon admission considered. Univariate and multivariable logistic regression models were constructed to select potential predictive parameters using 1000 bootstrap samples. Afterward, a nomogram was developed with 5 variables selected from multivariable analysis. The nomogram model was evaluated by Area Under the Curve (AUC) and bias-corrected Harrell's C-index with 95% confidence interval, Hosmer-Lemeshow Goodness-of-fit test, and calibration curve analysis.

RESULTS

Out of a total of 1022 patients, 686 cases without missing data were used to construct the nomogram. Of the 686, 104 needed ICU follow-up. The final model includes oxygen saturation, CRP, PCT, LDH, troponin as independent factors for the prediction of need for ICU admission. The model has good predictive power with an AUC of 0.93 (0.902-0.950) and a bias-corrected Harrell's C-index of 0.91 (0.899-0.947). Hosmer-Lemeshow test p-value was 0.826 and the model is well-calibrated (p = 0.1703).

CONCLUSION

We developed a simple, accessible, easy-to-use nomogram with good distinctive power for severe illness requiring ICU follow-up. Clinicians can easily predict the course of COVID-19 and decide the procedure and facility of further follow-up by using clinical and laboratory values of patients available upon admission.

Comparison of decentration, tilt and lenticular astigmatism of ıntraocular lens between sutured and sutureless scleral fixation techniques

PURPOSE

To evaluate at six months the intraocular lens (IOL) decentration, tilt and lenticular astigmatism between foldable sutured and sutureless scleral fixation IOLs compared to conventional phacoemulsification surgery.

METHODS

We retrospectively reviewed records for 22 eyes with sutureless scleral fixation, 16 eyes with sutured scleral fixation and 23 eyes with conventional phacoemulsification. IOL decentration and angle of IOL tilt were compared on Scheimpflug images 6 months after surgery. Lenticular astigmatism is described as the difference between refractive and net corneal astigmatism.

RESULTS

The angle of tilt in both meridians was significantly lower in the sutureless group than in the sutured group (P=0.008 horizontally and P=0.002 vertically). IOL decentration did not show a significant difference between the three groups in either horizontal or vertical meridians (P˃0.05). Lenticular astigmatism was significantly lower in the sutureless and control groups than in the sutured group (P=0.003 and P<0.001).

CONCLUSION

In addition to being relatively quick and easy to perform, the sutureless scleral fixation technique showed superior results in terms of IOL tilt and lenticular astigmatism at the six-month follow-up compared to the sutured technique.

Evaluation of dynamic thiol/disulfide redox state in community-acquired pneumonia

Objectives

To compare dynamic thiol/disulfide homeostasis between patients with community-acquired pneumonia (CAP) and healthy controls.

Methods

This prospective, case-control study was conducted in the Department of Pulmonary Diseases, Ankara Ataturk Training and Research Hospital, Yildirim Beyazit University, Ankara, Turkey, between August 2016 and August 2017. In total, 50 hospitalized patients with CAP and 35 healthy individuals were enrolled. Patients with comorbidities and smokers were excluded. The thiol/disulfide state was evaluated in each group. Thiol levels (native/total) and % polymorhonuclear leukocytes and C-reactive protein levels association were evaluated in patients with CAP.

Results

There was no significant difference between the CAP and control groups in age or gender (both, p>0.05). The disulfide (SS) levels were similar between the 2 groups (p=0.148). The total thiol (TT) and native thiol (SH) levels were significantly lower (all, p=0.001) and the SS/TT levels were significantly higher (p=0.019) in the CAP group compared with the controls.

Conclusions

This study showed that the oxidant/antioxidant ratio was shifted to the oxidative side in CAP patients. An abnormal thiol/disulfide state may be an important factor in the pathogenesis and monitoring the treatment response. The thiol resources may use for treatment in CAP and may positively affect the prognosis.

Comparison of thiol/disulphide homeostasis parameters in patients with COPD, asthma and ACOS

OBJECTIVE

Chronic obstructive pulmonary disease (COPD), asthma and asthma-COPD overlap syndrome (ACOS) are obstructive pulmonary disorders with different manifestations. Status of oxidation in tissues is important in obstructive pulmonary disorders. Smoking, acute exacerbations of COPD and asthma were associated with a marked imbalance in oxidant or antioxidant status due to increased oxidative stress in tissues and blood. Oxidative conditions may cause a reversible formation of mixed disulphides among protein thiol groups. The aim of this study was to compare parameters related with thiol/disulphide homeostasis in patients with COPD, asthma and ACOS.

PATIENTS AND METHODS

Patients (n= 135, 69 females, 66 males) who were referred with a diagnosis of COPD, asthma or ACOS were included in the study. Thiol/ disulphide homeostasis parameters in blood were analysed by a newly established method that measures the exact thiol/ disulphide status in the body.

RESULTS

The patients with COPD, asthma or ACOS were similar for demographic parameters other than age and number of cigarettes smoked. Measured thiol/disulphide homeostasis parameters were similar among these patient groups. When these biochemical measurements were adjusted for age and number of cigarettes by using regression analysis, similarity for thiol/disulphide homeostasis parameters among patient groups persisted.

CONCLUSIONS

To best of our knowledge, this is the first study to compare thiol/disulphide homeostasis parameters in COPD, asthma and ACOS patients. Similarity of thiol/disulphide homeostasis parameters among these patient groups supports the current view of Dutch hypothesis that COPD, asthma and ACOS share similar pathophysiological features but display different clinical manifestations.

A case of pulmonary artery hydatid cyst observed on endobronchial ultrasound

Hydatid cyst (HC) is a parasitic disease that may involve many organs, especially the lung and the liver. Pulmonary artery location of the hydatid cyst is extremely rare, but it may cause life-threatening complications. We report a case of a hydatid cyst that completely filled the left main pulmonary artery and its distal part without cardiac involvement. Thoracic computed tomography showed filling defects in the pulmonary arteries. Endobronchial ultrasound was performed for differential diagnosis and it showed a cystic lesion. Hydatid cyst-specific IgE and hem agglutination test results were positive. In the literature, cases like this in which the diagnosis of pulmonary hydatid cyst is made by endobronchial ultrasound are not usually seen. Although many imaging modalities such as plain chest radiography, cross-sectional imaging (MDCT and MRI), echocardiography and conventional pulmonary angiography have been used in the diagnostic approach, we recommend endobronchial ultrasound for the differential diagnosis of cases with cystic formation.

Importance of biomarkers in risk stratification of pulmonary thromboembolism patients

INTRODUCTION

Patients with pulmonary thromboembolism (PTE) are classified into 3 groups according to the clinical risk factors associated with mortality. High-risk patients and some of the intermediate-risk patients should be treated immediately to decrease the high mortality risk. Although clinical risk level of PTE can be determined by using echocardiography to evaluate right ventricle overload and pulmonary artery pressure findings, it may not be available in all emergency settings.

AIM

The purpose of the study was to define the laboratory biomarkers, which can be used in place of echocardiography for PTE risk stratification.

METHODS

Patients (n = 98) were divided into 3 groups as high-risk (n = 13), intermediate-risk (n = 50), and low-risk (n = 35) groups, according to clinical risk factors at the first referral to hospital. Hepatic, cardiac, and renal markers were evaluated and compared among 3 groups.

RESULTS

Among biomarkers examined, lactate dehydrogenase, urea, creatinine, uric acid, troponin I, N-terminal-pro-B-type natriuretic peptide, creatine kinase-MB, D-dimer, and erythrocyte sedimentation rate (ESR) levels were found different between groups. All of these biomarkers except for ESR had positive correlation, whereas ESR had negative correlation with the mortality risk. An analysis of covariance for the age difference among patient groups showed that all the biomarkers other than urea and D-dimer levels remained significantly different among risk groups.

CONCLUSIONS

At emergency conditions in which echocardiography assessment is not available, PTE patients who have increased levels of certain hepatic, cardiac, and renal biomarkers should cautiously be evaluated for having an increased risk for mortality. Increased levels of these biomarkers may guide the consideration for thrombolytic treatment.

A rare cause of crazy-paving and mediastinal lymphadenopathy: congestive heart failure

Crazy-paving sign is a pattern seen on multislice computed tomography images of the lungs. It is characterized by a reticular pattern superimposed on ground-glass opacity. It was first described in the late 1980s in patients with pulmonary alveolar proteinosis, but has now been described in some other diseases of the lung. Enlarged mediastinal lymph nodes can be seen in infectious and specific inflammatory diseases and malignancies. The present report describes a case of a 44-year-old man in whom congestive heart failure presented with a crazy-paving appearance and enlarged lymph nodes of the lungs on the chest computed tomography scan.

The relationship between hs-CRP and asthma control test in asthmatic patients

BACKGROUND

High sensitive C-reactive protein (hs-CRP) has been shown to be associated with asthma in recent studies. However, the relationship between hs-CRP and the control of asthma has not been clearly identified yet.

OBJECTIVE

To investigate the association of hs-CRP with asthma control test (ACT), which reveals the degree of asthma control, and to compare hs-CRP in adults with mild and moderate asthma in chronic, stable asthmatic patients.

METHODS

Thirty patients with physician-diagnosed asthma (11 mild, 19 moderate), and 30 healthy patients were enrolled in the study. In addition to medical history and physical examination, asthma was assessed according to GINA guideline. Respiratory function tests (RFT) and ACT were performed. The serum hs-CRP levels of all cases patients were measured.

RESULTS

The levels of hs-CRP in asthmatic patients were significantly higher than those in the control cases (p=0.002). The serum hs-CRP levels in the moderate asthmatics were significantly higher than those in the mild asthmatic ones (p=0.04). When asthmatic cases were divided into two groups according to ACTs; the levels of hs-CRP in the groups of ACT≤20 (uncontrolled groups) were significantly higher than the groups of ACT≥20 (controlled groups) (p=0.02). The hs-CRP levels showed significant correlations with ACT (p=0.00, r=-0.91) and asthma severity (p=0.04, r=038) in asthmatic patients.

CONCLUSION

In conclusion it was shown that hs-CRP is related with asthma severity and ACT, and hs-CRP is a potential sensitive marker which reveals the severity and the control of asthma.

Homocysteine and serum-lipid levels in pulmonary embolism

Pulmonary embolism (PE) is a fatal disease that arises from genetic and environmental factors. There is little evidence for low high-density lipoprotein cholesterol (HDL-C) with hyperhomocysteinemia to lead to PE. Therefore, we evaluated homocysteine levels and lipid profile in PE patients and to display risk for PE. Forty six patients with proven PE and 46 healthy controls were included in the study. Homocysteine and serum lipid levels were calculated and compared in both groups. There were no significant differences between two groups in terms of total cholesterol, triglyceride, and low-density lipoprotein cholesterol. In PE group, HDL-C levels were found significantly lower in comparison to the control group (P = .004). Mean homocysteine levels were significantly higher in PE group than in the control group (P = .001). High-density lipoprotein cholesterol levels were significantly low in which homocysteine levels were high in the PE group. We thought that low HDL-C level with hyperhomocysteinemia is susceptible to PE.

Comparative clinical trial of topical anaesthetic agents for cataract surgery with phacoemulsification: lidocaine 2% drops, levobupivacaine 0.75% drops, and ropivacaine 1% drops

PURPOSE

To assess the safety and efficacy of topical lidocaine, levobupivacaine, and ropivacaine in cataract surgery with phacoemulsification.

METHODS

One hundred and five patients scheduled for cataract surgery with topical anaesthesia were randomly allocated into 3 groups of 35 patients each to receive eye drops of lidocaine 2%, levobupivacaine 0.75%, or ropivacaine 1% every 5 min starting 30 min before surgery. Patients graded their pain using a 0-10-point verbal pain score (VPS) at different stages of the procedure. The levels of patient and surgeon satisfaction, the duration of surgery, complications, and the need for supplemental anaesthesia were recorded.

RESULTS

There was no significant difference in duration of surgery and demographic variables among the groups. At the intraoperative period, end of surgery, and postoperative first hour the mean VPS in the lidocaine group was significantly higher than the others (P<0.01), but no significant difference was found between the levobupivacaine and ropivacaine groups. At incision and 24 h after surgery, it was not significantly different among the groups. Surgeon and patient satisfaction scores were significantly better in the levobupivacaine and ropivacaine groups than in the lidocaine group (P<0.01).

CONCLUSIONS

Topical anaesthesia with levobupivacaine and ropivacaine were safe, feasible and more effective than lidocaine in cataract surgery. Levobupivacaine and ropivacaine provided sufficient and long-lasting analgesia without the need of supplemental anaesthesia for each patient.

Pleural adenosine deaminase in the separation of transudative and exudative pleural effusions

OBJECTIVE

The purpose of this study was to evaluate the usefulness of a new parameter, pleural adenosine deaminase (PADA), for separating transudative pleural effusion from exudative pleural effusion, and to compare the results with other tests (albumin gradient and protein gradient).

METHODS

From November 2001 to January 2003, 359 consecutive patients with pleural effusion who underwent a diagnostic thoracentesis were included in the study. Effusions were individually classified as transudates or exudates after the careful evaluation of all clinical data and biochemical parameters of pleural fluid and serum of patients on the basis of Light's criteria. The means and standard deviations of PADA, pleural/serum ADA (P/S ADA) ratio, albumin gradient and protein gradient were evaluated for transudative and exudative effusions. The best cut-off values for each test were identified by using the receiver operating characteristic (ROC) curve. The optimum cut-off level was determined by selecting points of test values that provided the greatest sum of sensitivity and specificity.

RESULTS

There were 113 transudates and 246 exudates. For each test, differences in mean value between the transudate group and the exudate group were statistically significant (t test, P<0.001). The optimum cut-off levels for PADA and P/S ADA were 15.3 U/L and 0.66 U/L, respectively. ROC analysis confirmed previous recommendations for albumin gradient (12 g/L) and protein gradient (31 g/L). For detecting exudates, the PADA test yielded a sensitivity and specificity of 85.8% and 82.3%, respectively. Sensitivity and specificity of the albumin gradient were found to be 88.5% and 79.3%, and of the protein gradient 85% and 83.2%, respectively. The areas under the curve (AUC) data and accuracy demonstrated similar discriminative properties in the examined tests.

CONCLUSIONS

The measurement of PADA is suggested as a reliable test in the separation of pleural exudates from transudates with accuracy similar to that of the albumin gradient and protein gradient.

Hospital based survey of lung cancer in Turkey, a developing country, where smoking is highly prevalent

While the trend of cigarette consumption in some developed countries is on the decline, it has been noted that in many developing countries, smoking is on the increase. Compared to developed countries, there are more male smokers than female smokers in these countries. The aim of this study was to investigate the prevalence and characteristics of the smoking habit in patients having lung cancer (LC) and to find out if there is any relationship with the smoking habit and the pathological diagnosis in our patient population. This hospital-based study was carried out between 1990 and 1996 in two major medical centres. LC was diagnosed in 1046 patients, 966 of whom were males (93%), and the remaining 80 (7%) of whom were females. Upon diagnosing the male patients, it was noted that 83% were current smokers (CS), 12% were ex-smokers (ES defined as abstinence from smoking at least for 1 year), and the remaining 5% were non-smokers (NS). In the female population the findings were as follows, 16% were CS; 8% were ES, and 76% were NS. The period of abstinence in the ES was 10 years or less in 77% of the patients. Among the male patients, squamous cell carcinoma was the most common tumor type seen in the CS group (46%) while adenocarcinoma (45%) was the most commonly seen tumor in the NS group. On the other hand, in the females, CS, the most commonly noted tumor types were small cell (54%), and adenocarcinoma (39%) was most frequently found in NS group. These results indicate that ES patients having LC in this study was quite low. On the other hand, in contrast to the findings of many other studies, from developed countries, the majority of male LC patients were in the CS group, however the majority of female LC patients were in the NS group. This smoking habit data obtained from our LC patients suggests that, similar to underdeveloped or developing countries, smoking cessation rates are very low in men during the past decade, and interestingly smoking rates may increase in women in the near future in our country.

Evaluation of pentavalent Tc-99m DMSA scintigraphy in small cell and nonsmall cell lung cancers

AIM

The purpose of this study was to evaluate the clinical usefulness of Tc-99m (V) DMSA in patients suspected of lung cancer and determine whether this agent may have value in differentiation between small cell (SCLC) and non-small cell (NSCLC) lung carcinoma.

METHODS

Thirty-six patients with clinical and radiological suspicion of primary lung carcinoma were injected 450-600 MBq of Tc-99m (V) DMSA intravenously. Whole body and planar anterior, posterior thorax images were obtained 4-5 h after injection of the radioactive complex.

RESULTS

Histopathological results confirmed 23 NSCLC, 10 SCLC and 1 metastatic lung carcinoma and 2 lung abscess. Nineteen of the 23 (82%) NSCLC and all of the 10 (100%) SCLC cases showed Tc-99m (V) DMSA uptake. Single metastatic lung cancer also accumulated radiotracer. Lung abscess did not show uptake. Lesion/Nonlesion (L/N) ratio of SCLC (1.59 +/- 0.32) and NSCLC (1.43 +/- 0.19) tumour types did not show statistical difference (p > 0.05). Tc-99m (V) DMSA whole body imaging also showed bone metastases.

CONCLUSION

Tc-99m (V) DMSA is a noninvasive and cheap imaging method to detect malignant lung cancers and their bone metastases but, differentiation of SCLC and NSCLC is not possible.

Evaluation of Pentavalent Tc-99m DMSA Scintigraphy in Small Cell and Nonsmall Cell Lung Cancers

Aim: The purpose of this study was to evaluate the clinical usefulness of Tc-99m (V) DMSA in patients suspected of lung cancer and determine whether this agent may have value in differentiation between small cell (SCLC) and non-small cell (NSCLC) lung carcinoma. Methods: Thirty-six patients with clinical and radiological suspicion of primary lung carcinoma were injected 450-600 MBq of Tc-99m (V) DMSA intravenously. Whole body and planar anterior, posterior thorax images were obtained 4-5 h after injection of the radioactive complex. Results: Histo-pathological results confirmed 23 NSCLC, 10 SCLC and 1 metastatic lung carcinoma and 2 lung abscess. Nineteen of the 23 (82%) NSCLC and all of the 10 (100%) SCLC cases showed Tc-99m (V) DMSA uptake. Single metastatic lung cancer also accumulated radiotracer. Lung abscess did not show uptake. Lesion/Nonlesion (L/N) ratio of SCLC (1.59 ± 0.32) and NSCLC (1.43 ± 0.19) tumour types did not show statistical difference (p >0.05). Tc-99m (V) DMSA whole body imaging also showed bone metastases. Conclusion: Tc-99m (V) DMSA is a noninvasive and cheap imaging method to detect malignant lung cancers and their bone metastases but, differentiation of SCLC and NSCLC is not possible.