Risk factors for the development of interstitial lung disease following severe COVID-19 pneumonia and outcomes of systemic corticosteroid therapy: 3-month follow-up

BACKGROUND

We aimed to evaluate the pulmonary involvement status, its related factors, and pulmonary function test (PFT) results in the first month follow-up in patients who were discharged for severe Covid-19 pneumonia, and to assess the efficacy of corticosteroid treatment on these parameters in severe pulmonary involvement patients.

METHODS

We retrospectively analyzed all consecutive patients who applied to our COVID-19 follow-up clinic at the end of the first month of hospital discharge. Functional and radiological differences were compared after 3 months of corticosteroid treatment in severe pulmonary involvement group. Results We analyzed 391 patients with "pulmonary parenchymal involvement" (PPIG) and 162 patients with "normal lung radiology" (NLRG). 122 patients in the PPIG (corticosteroid-required interstitial lung disease group (CRILD)) had severe pulmonary involvement with frequent symptoms and required corticosteroid prescription. Pulmonary involvement was more common in males and elder patients (P<0.001, for both). Being smoker and elderly were associated with a higher risk-ratio in predicting to be in PPIG (OR:2.250 and OR:1.057, respectively). Smokers, male and elderly patients, and HFNO2 support during hospitalization were risk factors for being a patient with CRILD (OR:2.737, OR:4.937, OR:4.756, and OR:2.872, respectively). After a three-months of methylprednisolone medication, a good response was achieved on radiological findings and PFT results in CRILD.

CONCLUSIONS

In conclusion, after severe COVID-19 pneumonia, persistent clinical symptoms and pulmonary parenchymal involvement would be inevitable in elder and smoker patients. Moreover, corticosteroid treatment in patients with severe parenchymal involvement was found to be effective in the improvement of radiological and functional parameters.

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.

Comparing ICU admission rates of mild/moderate COVID-19 patients treated with hydroxychloroquine, favipiravir, and hydroxychloroquine plus favipiravir

BACKGROUND

In this study, we aimed to compare the intensive care unit (ICU) admission rate of hospitalized mild/moderate COVID-19 patients treated with hydroxychloroquine (HCQ), favipiravir, and HCQ plus favipiravir.

METHODS

Single center retrospective designed observational study conducted in Ankara City Hospital. Patients who were hospitalized between March 15, 2020 and June 1, 2020 in COVID-19 inpatient clinics with laboratory confirmed diagnosis of COVID-19 were included in the study. An inverse probability of treatment weighting (IPTW) for multiple treatment groups approach was used to balance the differences in several variables on admission.

RESULTS

Among 2441 patients hospitalized with diagnosis of COVID-19 during the study period, 824 were eligible for the analysis. Median age of patients was 42 (18-93 years). Among all, 347 (43.2%) of the patients had mild disease, 470 (56.8%) had pneumonia. Propensity scores ranged from 0.1841 to 0.9381 in the HCQ group, from 0.03643 to 0.29885 in the favipiravir group, and from 0.03542 to 0.56184 in the HCQ plus favipiravir group. After IPTW for multiple treatment groups was applied, all the covariates in the planned propensity score had weighted standardized effect sizes below 10% which were ranged from 0.005 to 0.092. Multivariate analysis of treatment effect (adjusted effect of treatment) was indicated that there is no statistically significant difference between HCQ, favipiravir, and HCQ plus favipiravir treatment. After using combination of SMOTE and Bootstrap resampling approach, we found no statistically significant difference between HCQ and HCQ plus favipiravir groups in terms of ICU admission. However, compared with the HCQ group, ICU admission rate was statistically significantly higher in the favipiravir group. We obtained the similar results after the sensitivity analysis.

CONCLUSIONS

HCQ with or without favipiravir treatment is associated with reduced risk of ICU admission compared to favipiravir alone in mild to moderate COVID-19 adult patients.

Thiol-disulfide as a novel indicator of obstructive sleep apnea

INTRODUCTION

Obstructive sleep apnea (OSA) is an oxidative stress disease, which has been considered to be a notable risk and associated with increased cardiovascular morbidity and mortality. Thiol-disulfide homeostasis is as a novel indicator of oxidative stress.

OBJECTIVES

We aimed to evaluate thiol-disulfide homeostasis in a large patient population with OSA.

METHODS

A total of 230 with OSA and 40 healthy controls were included in the study. Inclusion criteria for OSA patients are having apnoea-hypopnoea index of ≥5/hour, being more than 18 years of age and having no previous treatment for OSA. Thiol-disulfide analysis was done for the patients and control group. Blood thiol-disulfide homeostasis was analysed using the new automatic method, developed by Erel and Neşelioğlu.

RESULTS

Among all OSA subjects, 149 (64.8%) were males and the mean ages of the patients were 53.38 ± 10.22. Total thiol, native thiol (SH) and disulfide (SS) levels were significantly lower in OSA group compared to the control group (P < .001, P < .001 and P = .039 respectively). Also, total thiol and native thiol (SH) were significantly different between the groups according to OSA severity (mild-moderate to severe OSA) (P < .001 and P < .001 respectively). Thiol-disulfide redox parameters were correlated with apnoea-hypopnoea index (AHI) scores.

CONCLUSION

The present prospective study showed that thiol/disulfide homeostasis was unbalanced in OSA patients. Especially, in OSA patients have low level of thiol/disulfide redox parameters when compared to healthy subjects. Evaluating thiol-disulfide homeostasis in OSA may be a contributing aspect to assessment and monitoring of the patient.

[Determination of anthropometric measurements in obstructive sleep apnea syndrome in Turkish population]

Introduction

In this study, we aimed to determine the values of anthropometric measurements and rates used in the evaluation of obstructive sleep apnea syndrome (OSAS) in our country.

Materials and Methods

Twenty accredited sleep centers in thirteen provinces participated in this multicenter prospective study. OSAS symptoms and polysomnographic examination and apnea-hypopnea index (AHI) ≥ 5 cases OSAS study group; patients with AHI < 5 and STOP-Bang < 2 were included as control group. Demographic characteristics (age, sex, body mass index-BMI) and anthropometric measurements (neck, waist and hip circumference, waist/hip ratio) of the subjects were recorded.

Result

The study included 2684 patients (81.3% OSAS) with a mean age of 50.50 ± 0.21 years from 20 centers. The cases were taken from six geographical regions of the country (Mediterranean, Eastern Anatolia, Aegean, Central Anatolia, Black Sea and Marmara Region). Demographic characteristics and anthropometric measurements; age, neck, waist, hip circumference and waist/ hip ratios and BMI characteristics when compared with the control group; when compared according to regions, age, neck, waist, hip circumference and waist/hip ratios were found to be statistically different (p< 0.001, p< 0.001, p< 0.05, respectively). When compared by sex, age, neck and hip circumference, waist/hip ratio, height, weight and BMI characteristics were statistically different (p< 0.001, respectively). Neck circumference and waist/hip ratio were respectively 42.58 ± 0.10 cm, 0.99 ± 0.002, 39.24 ± 0.16 cm, 0.93 ± 0.004 were found in women.

Conclusions

The neck circumference was lower than the standard value in men, but higher in women. The waist/hip ratio was above the ideal measurements in both men and women. In this context, the determination of the country values will allow the identification of patients with the possibility of OSAS and referral to sleep centers for polysomnography.

Long-term results of low-dose tissue plasminogen activator therapy in acute pulmonary embolism

Recombinant tissue plasminogen activator (rt-PA) is the most commonly used thrombolytic agent in patients with high risk and intermediate to high mortality risk acute pulmonary embolism (PE). Clinical trials have shown early efficacy and safety of low-dose rt-PA. This study investigated the effects of low-dose rt-PA treatment on acute PE in long-term prognosis, recurrence of pulmonary thromboembolism, or the development of late complications. In this study, 48 patients undergoing low-dose rt-PA for the relative contraindications of thrombolytic therapy and 48 patients undergoing standard-dose therapy were evaluated retrospectively. Long-term follow-up investigated the chronic PE, recurrence, and causes of morbidity and mortality.

In both treatment groups, embolism-induced mortality and overall mortality rates were similar in the first 30 days (p=1.000, p=0.714, respectively). Overall mortality rates in long-term follow-up were 41.7% in the low-dose treatment group and 16.7% in the standard-dose treatment group (p=0.013). The mortality rate at the first year was higher in the low-dose-treated group (p=0.011) and most of the deaths were due to accompanying comorbidities. There was no difference in PE recurrence and duration of recurrence between the groups (p=0.598, p=0.073, respectively). Intracranial hemorrhage due to therapy developed in one patient in both groups.

Low-dose thrombolytic therapy in acute PE reduces PE-related mortality in the early period. Long-term follow-up showed that thrombolytic therapy did not affect mortality rates independently of the dose and PE recurrence.

Repeated Thrombolytic Treatment for Recurrent Pulmonary Thromboembolism: A Report of 2 Cases and a Literature Review

We present 2 cases of pulmonary thromboembolism (PTE). The first case, a 50-year-old man, was admitted to the emergency department because of sudden onset dyspnea and left side chest pain. He was diagnosed with intermediate-risk (submassive) PTE, and thrombolytic treatment was commenced. The patient fully recovered, but 5 days later, he was diagnosed with a new, high-risk PTE. The second patient, a 23-year-old woman, presented with syncope, dyspnea, and chest pain for 2 days. She was diagnosed with high-risk (massive) PTE. Thrombolytic treatment was commenced, and the patient fully recovered, too. But the later patient was also diagnosed with a new PTE 4 days later. We applied repeated thrombolytic treatment in the patients due to repeated PTE. The first patient fully recovered and was discharged from the hospital, but the second patient died because of gastrointestinal bleeding and renal insufficiency. A repeated thrombolytic treatment could be an alternative treatment for these patients, considering treatment's risks.

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.

Endobronchial ultrasound-guided transbronchial needle biopsy for the diagnosis of mediastinal lymphadenopathy in patients with extrathoracic malignancies

BACKGROUND/AIM

Mediastinal lymphadenopathy is common in extrathoracic malignancies and should not always be considered a metastatic lesion. The purpose of this study is to determine the diagnostic value of endobronchial ultrasound-guided transbronchial needle biopsy (EBUS-TBNA) in patients with extrathoracic malignancies.

MATERIALS AND METHODS

This study included 54 consecutive patients with extrathoracic malignancies who had suspected mediastinal metastases and had undergone EBUS-TBNA for diagnosis.

RESULTS

Using EBUS-TBNA, 27 of 54 patients (50%) were diagnosed with mediastinal metastases. Among patients with mediastinal metastases, 2 (3.7%) had a sarcoid-like reaction, 5 (9.3%) had tuberculosis, and 17 (31.5%) had reactive lymph nodes. In 3 cases (5.5%), a specific diagnosis could not be determined following EBUS-TBNA. Two patients underwent surgical staging of their mediastinal lymphadenopathy, which allowed the detection of mediastinal metastases in 1 patient and that of reactive lymph nodes in the other. The sensitivity, specificity, negative predictive value, and diagnostic accuracy of EBUS-TBNA for the diagnosis of extrathoracic malignancies were calculated as 93%, 100%, 92.6%, and 96.3%, respectively.

CONCLUSION

EBUS-TBNA is a safe and effective procedure. We should consider whether EBUS-TBNA should be the primary diagnostic tool for the diagnosis of mediastinal lymphadenopathy in patients with extrathoracic malignancies.

[Importance of polymerase chain reaction in patients with histopathological diagnosis of granulomatous disease by EBUS-TBNA: a preliminary report]

INTRODUCTION

Transbronchial needle aspiration (TBNA) by the guide of endobronchial ultrasonography (EBUS) is a diagnostic method which may be used in diagnosing benign granulomatous diseases in contemporary practice. In this study, we planned to evaluate the diagnostic value of TBNA by the guide of EBUS for benign granulamatous diseases and to investigate the impact of cytological, microbiologic and tuberculosis (TB)-polimerase chain reaction (PCR) results in specimens.

MATERIALS AND METHODS

Thirty-four patients (20 female, 14 male) who had EBUS-TBNA and histopathological diagnosis of granülamatous inflammatory reaction were included in the study. The mean age of patients was 49.62 ± 12.72 years (26-72). The specimens provided by EBUS-TBNA were evaluated for pathologic, microbiologic, and molecular (TB-PCR) examinations.

RESULTS

As a result of clinical, radiological and laboratory studies of the patients with granulomatous inflammation, 13 (38.2%) patients had TB, 21 (61.7%) patients had sarcoidosis. Diagnoses of histopathological granuloma were established by EBUS-TBNA in 30 (88.2%) patients among patients with isolated mediastinal lymphadenopathies. Seven of mediastinal TB lymphadenopathies patients were TB-PCR positive. The sensitivity of PCR was 54% and the specificity was 100%, general efficiency of the test was found to be 82%.

CONCLUSION

In cases with granulomatosis lymphadenopathies, TB-PCR specimens which achieved by EBUS-TBNA results provided important contribution for the TB diagnosis. Therefore, we thought that TB-PCR is a diagnostic method to be studied in the cases who investigating for mediastinal lymphadenopathies.