Pulmonary function test results and radiological findings 90-120 days after COVID-19 pneumonia: a single-center retrospective study

Background: Survivors of Coronavirus Disease 2019 (COVID-19) pneumonia may have permanent loss of lung function and radiological sequelae. There is a need for markers that predict patients for whom follow-up is required. Aim of the study: To identify the risk factors associated with post-COVID-19 radiological and functional findings. Material and Methods: This is a single-center retrospective study performed in a university hospital. We obtained the data from all hospitalized patients with COVID-19 pneumonia. We included those who underwent pulmonary function tests (PFT) and chest computerized tomography (CT) 90-120 days later. We analyzed initial and peak laboratory results (C-reactive protein (CRP), d-dimer, ferritin, and fibrinogen), and the length of hospital and intensive care unit (ICU) stay. We examined the relationship between baseline data and radiological findings and PFT. Results: Fifty-six patients were included in this study. Of these, 31 (55.4%) were women. The mean age of the patients was 55.05 ± 13.29 years. The mean peak ferritin, fibrinogen, d-dimer, and CRP values recorded during hospitalization follow-up were 285.56 ± 339.82, 518.59 ± 186.93, 1.99 ± 5.69, and 98.94 ± 80.77, respectively. The mean length of hospital and ICU stay were 10.21 ± 8.01 and 8.38 ± 8.90 days, respectively. In 18 (32.1%) patients, we observed a restrictive pattern on PFT, and 22 (39.3%) patients had an abnormal diffusion test. In 21 (37.5%) patients we observed ground glass opacities and in 4 (7.1%) patients reticulation was seen on their chest CT. A multivariate logistic regression analysis revealed that the first visit and peak fibrinogen values were significantly associated with abnormal PFT (p = 0.049, R2 = 0.272), while ferritin and CRP levels at the first visit and peak levels were significantly associated with an abnormality on chest CT (p < 0.001, p = 0.05, respectively). Conclusions: High initial and peak ferritin, fibrinogen, and CRP levels were associated with persistent radiological findings on chest CT and abnormal PFT at 90–120 follow-up after COVID-19 pneumonia.

The efficiency of precautions for pulmonary functions test laboratories during the COVID-19 pandemic: a real-life setting

Background: Recommendations were developed for pulmonary function test (PFT) laboratories during the Coronavirus Disease 2019 (COVID-19) pandemic. However, it is unknown whether these recommendations are effective and safe. Aim of the study: To assess how effective and safe the recommendations for PFT laboratories were during the COVID-19 pandemic. Material and methods: This is a single-center, questionnaire-based study performed between June and August of 2020 at the Akdeniz University hospital. We performed the questionnaire over the phone with technicians from different centers in Turkey. We asked the age, gender, years on the job, routines performed during the pandemic, how many PFTs per day they performed, features of the test room, use of personnel protective equipment, whether they performed triage before the test, and the results of those who had a COVID polymerase chain reaction (PCR) test or a COVID antibody test. Results: A total of 74 technicians from 69 centers were included in the study. Of the centers, 67 (90.5%) were located in tertiary hospitals. At the beginning of the pandemic, 65 (94.2%) centers closed for an average of 2.15 months. The average number of tests performed per day was 14.41 ± 11.88. All centers triaged patients before performing the tests. In 19 (27.5%) centers, a transparent nylon separator was placed between the patient and the technician. Two (0.27 %) technicians tested positive for COVID using PCR testing. Among the 12 (16.2%) technicians screened for COVID-19 antibodies, none of them were found to have COVID-19 antibodies. Conclusion: The recommendations for PFT laboratories seemed to be effective and safe, and the adherence to these recommendations by the technicians was optimal.

The Importance and Place of Methemoglobin and Carboxyhemoglobin Levels in the Diagnosis and Prognosis of Pulmonary Embolism

BACKGROUND

This is a retrospective study to investigate the effects of Carboxyhemoglobin (COHb) and Methemoglobin (MetHb) levels in the diagnosis and prognosis of Pulmonary Thromboembolism (PTE).

MATERIALS AND METHODS

Cases that were confirmed with PTE diagnosis using CT Pulmonary Angiography (CTPA) or Ventilation/Perfusion Scintigraphy were accepted as pulmonary embolism. And patients which were excluded using the same methods were accepted as the control group. Patients with carbon monoxide poisoning, Chronic Obstructive Pulmonary Disease (COPD), sepsis, pneumonia, asthma, idiopathic pulmonary fibrosis, bronchiectasis, decompensated cardiac failure or those who used drugs that cause methemoglobinemia (sulphanomides, dapson, phenacetin, primacine, benzocaine) were not included in the study.

RESULTS

In our study, 462 patients were examined with an initial PTE diagnosis. Among these patients, 107 patients who met the inclusion criteria were included in the study. The mean age of all patients was 56.44 ±17.3 years (21-86) and the mean age of patients with PTE diagnosis was 55.3 years and the mean age of excluded patients was 59 years (p:0.27). When the blood gas parameters of both groups were compared, COHb levels in the groups with PTE diagnosis were statistically significantly higher (p=0.001), and the PO₂ levels in the group excluded for PTE diagnosis were statistically significantly higher (p=0.028). In our study, six of our patients (8.1%) died in the early stages because of PTE.

CONCLUSION

In our study, COHb level was found to be statistically significant in the group with PTE. However, this value was not higher than the normal COHb level in the blood. We found that MetHb and COHb levels were not statistically significant in the prognosis of PTE.

Doppler ultrasonography versus venography in the detection of deep vein thrombosis in patients with pulmonary embolism

In patients with acute pulmonary embolism (PE) the frequency of deep vein thrombosis (DVT) varies between 13-93%. The aim of this study was to compare Doppler ultrasonography (DUSG) and venography in the detection of DVT in patients with PE. Fifty-one patients who were clinically diagnosed as having PE from January 1st 2001 to January 31st 2005 were entered into the study and comorbid conditions and risk factors were noted. The diagnosis of PE was confirmed by ventilation-perfusion (V/Q) scintigraphy, spiral tomography and angiotomography while the diagnosis of DVT was made by DUSG and venography. DVT was confirmed by both DUSG and venography in 19 (37,3%) patients. In the remaining 32 patients DUSG was negative. Venography confirmed DVT in 6 of these patients while in 26 no DVT was found. The sensitivity and specifity of DUSG in the diagnosis of DVT were 76% and 100% respectively and the negative and positive predictive values were 81% and 100% respectively. The mean d-dimer concentration was 1,187 in patients with DVT and 641 in patients without DVT (p > 0.05). Aquired risk factors were found in 4 of 6 patients with DVT, CRP was elevated in 5 (83%) and ALT-AST were elevated in 2 (33%). Although DUSG alone is considered sufficient for the diagnosis of DVT, venography still remains the gold standard in the diagnosis of DVT. Especially in patients with PE, where the diagnosis of DVT may increase the success of treatment, venography or other diagnostic tools may be used instead of a second DUSG if the first DUSG is negative.

Diagnostic value of transbronchial needle aspiration cytology in sarcoidosis

OBJECTIVE

Sarcoidosis is a systemic granulomatous inflammation that occurs as a result of disturbed immune regulation in individuals exposed to certain environmental agents. Although tissue sampling is considered the "gold standard" for the diagnosis of sarcoidosis, a medically treated disease, minimally invasive diagnostic methods are preferred instead of surgical tissue sampling. Transbronchial needle aspiration has been reported as an effective diagnostic method.

MATERIAL AND METHOD

In this study, transbronchial needle aspiration cytology samples were assessed from 38 patients where sarcoidosis was suspected clinically and radiologically. The existence of epithelioid histiocytes and/or giant cells that formed granulomas was used as a cytological diagnostic criterion for chronic granulomatous inflammation. The presence of lymphocytes and/or germinal center cells, and of histiocytes in lymph nodes was regarded as adequate sampling criteria.

RESULTS

A total of 31 out of the 38 patients were diagnosed as sarcoidosis with clinical, radiological and microbiological findings, after chronic granulomatous inflammation was considered by cytologic assessment. Cytologic diagnosis was achieved in: 4 of 7 patients with sampling from a single lymph node region, 25 of 28 patients with sampling from two different lymph node regions and 2 of 3 patients with sampling from three different lymph node regions. Two of the 7 patients who could not be diagnosed cytologically underwent a transbronchial parenchyma biopsy and the rest were diagnosed histologically from mediastinoscopic lymph node sampling.

CONCLUSION

We would like to emphasize that transbronchial needle aspiration is a successful diagnostic method. We highlighted the adequacy criteria of cytological sampling and the encountered cytological findings of chronic granulomatous inflammation.

Effect of a cholesterol rich diet, recurrent infection and possible treatment modalities on the pulmonary vascular system: an experimental study

OBJECTIVE

Infection may lead to inflammation, atherosclerosis and thrombotic vascular events. The atherosclerotic effect of hypercholesterolaemia on the vascular system is well-known. However, limited studies were done on the therapeutic and preventative agents. The aim of this study was to investigate the effects of infection and cholesterol rich diet combined with an antibiotic, anti-inflammatory agent and red wine on the pulmonary vascular system.

METHODS

Fifty-nine rats were evaluated. Six groups were created: Control-Group I (n = 10); infection --Group II (n = 9), infection-cholesterol rich diet--Group III (n = 12), infection-cholesterol rich diet-cefepime--Group IV (n = II); infection-cholesterol rich diet-diclofenac potassium--Group V (n = 9); infection-cholesterol rich diet and red wine--Group VI (n = 8). Blood samples of rats were collected for cholesterol analysis every month. Sections of central pulmonary arteries were examined for thickness of the intima and medial wall by computerised image analysis.

RESULTS

There was a statistically significant difference in serum cholesterol levels and in thickness of the intima between the groups (p = 0.000). The rest of the groups had more intimal thickening than Group I (p = 0.000). Group III had thicker intima than Groups IV and V (p = 0.009, p = 0.011 respectively). There was no significant difference between the groups in thickness of media (p = 0.432).

CONCLUSION

Infection and cholesterol rich diet have a synergistic effect on atherosclerosis in pulmonary arteries. However antibiotics and anti-inflammatory agents could be useful in prevention.

Lung involvement in patients with primary Sjögren's syndrome: what are the predictors?

The aim of this study was to investigate the prevalence, predictors and radiological findings of primary Sjögren's syndrome (pSS)-associated lung involvement. This retrospective cohort study included 123 patients with demographic, clinical, laboratory and radiological data who were diagnosed with pSS. Lung involvement was defined based on the presence of pulmonary signs/symptoms and/or impaired pulmonary function tests along with alterations in high-resolution computerized tomography (HRCT). Thirty patients (24.4%) had pulmonary signs/symptoms at the initial presentation and/or during the follow-up period. Based on the criteria, 14 patients (11.4%) were defined as having pSS with lung involvement. The smoking rate, male/female ratio and the mean ages were found to be higher in patients with lung involvement (P < 0.05). Positive IgM-rheumatoid factor (RF), anti-La and anti-Ro results, the presence of hypergammaglobulinemia and lymphopenia had high specificity despite the low sensitivity rates to detect pSS-associated lung disease. A significant difference was found in forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV(1)) results between the patients with and without lung involvement. Impaired FEV(1) had high specificity and positive predictive value compared to impaired FVC, particularly in non-smoker patients. The most frequent HRCT finding was ground-glass attenuation (64.3%). Other common findings were bronchiectasis, reticular pattern and honeycombing. The lesions involved predominantly the lower lobes. In conclusion, the presence of hypergammaglobulinemia and lymphopenia, positivity for RF, anti-La and anti-Ro, and impaired (FVC) and/or FEV(1) values could be the predictive parameters with a high specificity despite the low sensitivity rates. Smoking history, male gender and age are also risk factors. These parameters may be helpful to distinguish pSS-associated lung involvement from lung disorders unrelated to pSS.

Acute respiratory failure and tracheal obstruction in patients with posterior giant mediastinal (intrathoracic) goiter

The extension of a thyroid goiter into the mediastinum, commonly known as a substernal goiter, is commonly located in the anterior mediastinum. Substernal enlargement of a goiter can cause compression of several mediastinal structures including the trachea. Tracheal compression may rarely lead to acute respiratory failure. We present a patient with tracheal compression and respiratory failure due to a posterior mediastinal goiter in the light of the literature.

Decoy Receptor-2 Small Interfering RNA (siRNA) Strategy Employing Three Different siRNA Constructs in Combination Defeats Adenovirus-Transferred Tumor Necrosis Factor-Related Apoptosis-Inducing Ligand Resistance in Lung Cancer Cells

Tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) selectively induces apoptosis in cancer cells but not in normal cells. However, studies have indicated that more than half of human tumors exhibit TRAIL resistance. Although the mechanism of TRAIL resistance is not understood, it represents a barrier to any TRAIL-mediated gene therapy approach. In addition, no correlation between TRAIL receptor (TRAIL-R) expression profile and TRAIL resistance has been demonstrated in cancer cells. In this study, three different lung cancer cell lines and three different primary cell cultures established from patients with lung cancer (two patients with squamous cell lung carcinoma and one with adenocarcinoma) were screened for sensitivity to adenoviral delivery of TRAIL. Whereas TRAIL-resistant primary lung cell cultures and the A549 lung cancer cell line exhibited high levels of surface decoy receptor-2 (DcR2/TRAIL-R4) expression, TRAIL-sensitive lung cancer cell lines (HBE and H411) failed to express it. A DcR2 short interfering RNA (siRNA) approach involving three different siRNA constructs in combination downregulated DcR2/TRAIL-R4 expression and sensitized lung cancer cells to TRAIL-induced apoptosis. Immunohistochemical staining of samples from 10 patients with lung carcinoma suggested that high-level DcR2/TRAIL-R4 expression is a common phenotype observed in patients with non-small cell lung carcinoma.

The effects of recurrent Pseudomonas aeruginosa infection on pulmonary parenchyma and vasculature in rats fed on a cholesterol-rich diet

It has been demonstrated that both hypercholesterolemia and infectious agents are contributing factors in atherosclerosis but their combined effect on the pulmonary vascular bed is not known. To answer this question, the authors tried to demonstrate the effects of recurrent infection on pulmonary parenchyma and vascular system in cholesterol-fed rats. Sixty-six rats were randomly divided into 4 groups: Groups I (control), II (cholesterol-rich diet), III (recurrent pulmonary Pseudomonas aeruginosa infection), IV (cholesterol-rich diet + recurrent infection). After 6 months serum cholesterol levels didn't increase in any of the groups. Central pulmonary artery wall thickness was increased in group IV (P < .0001). Although not significant, peripheral pulmonary artery wall thickness was increased in group IV. In rats fed on a cholesterol-rich diet, recurrent infection caused a significant increase in atherosclerosis, although serum cholesterol levels didn't increase. Infection and cholesterol-rich diet have a synergistic effect on atherosclerosis in the pulmonary vascular system in rats even in the absence of hypercholesterolemia.

The prevalence of asthma, allergic rhinitis, and atopy in Antalya, Turkey

Bronchial asthma is a common chronic inflammatory disorder of the airways that causes serious morbidity and mortality. The prevalence of the disorder has been increasing, especially in developed countries. The population-based asthma prevalence studies provide data from Ankara, Istanbul, Gaziantep, Trabzon, Izmnir, and Kayseri in our country and asthma prevalence ranges between 1.4 and 3%. However, the prevalence of adult asthma in our city was not known. We aimed to determine the prevalence of asthma, allergic rhinitis, and atopy in the adult population of Antalya and compare the data with other countries and other regions of our country. The European Commission Respiratory Health Survey, the first study to assess the geographical variation in asthma and allergic diseases, provided comparable data from 22 countries and 140,000 individuals. Therefore, the European Commission Respiratory Health Survey protocol was preferred in our study. The first stage consisted of 1000 subjects; of these 1000 subjects, 200 subjects were randomly selected for the second stage. The response rates were 99.5 and 55.4% for stages I and II, respectively. The current prevalence of asthma, allergic rhinitis, and atopy in Antalya was 9.4, 27.7, and 31.1%, respectively. The most prevalent type of sensitization was mite allergy detected in 31 (20.9%) subjects. Sensitization to more than one allergen was frequent in subjects with asthma and allergic rhinitis. Bronchial asthma, allergic rhinitis, and atopy are frequent in our city and when compared with previous studies performed in Turkey, the highest results were in Antalya.

Tracheal stenosis aftertracheostomy or intubation: review with special regard to cause and management

To investigate the management outcomes of patients who developed tracheal stenosis after tracheostomy or intubation, we reviewed the courses of 45 patients who had experienced tracheal stenosis at a single institution, over 19 years from February 1985 through January 2004. There were 38 tracheal and 7 infraglottic stenoses. Twenty-nine stenoses were associated with the stoma, 12 with the cuff, and 2 with the endotracheal tube resulting in infraglottic lesions; the remaining 2 were double stenoses. Eleven patients were treated by bronchoscopic surgery, and 34 patients were treated by tracheal or laryngotracheal resection. The overall success rate was 93%. The complication rate was 18%. A 2nd operation was required in 3 patients, and 1 of the 3 died of sepsis. Our management strategy of treating tracheal stenosis with resection and end-to-end anastomosis has been associated with good outcomes. Management of infraglottic stenosis is difficult, particularly when there is a large laryngeal defect or when there have been previous surgical attempts at the same site.

Effect of chronic Pseudomonas aeruginosa infection on the development of atherosclerosis in a rat model

In order to investigate the possible relationship between atherosclerosis and chronic Pseudomonas aeruginosa infection, 66 Wistar rats were given five separate intratracheal inoculations of either P. aeruginosa or sterile saline at 4-week intervals. The rats were divided into four groups: group 1 was infected with P. aeruginosa and fed a diet containing cholesterol 1% w/v; group 2 was infected with P. aeruginosa and fed a normal diet; group 3 was not infected and was fed a diet containing cholesterol 1% w/v; and group 4 (the control group) was not infected and was fed a normal diet. One month after the final inoculation, the rats were killed humanely; computerised image analysis was used to evaluate sections of the aorta and heart, and the maximal wall thickness of the aorta and coronary artery. The aortic wall thickness was significantly greater for group 1 (329.53 +/- 58.06 microm) compared to groups 2 (190.59 +/- 27.81 microm; p < 0.0001), 3 (262.90 +/- 61.12 microm; p < 0.0004) and 4 (158.00 +/- 30.30 microm; p < 0.0001). Similarly, the coronary artery wall thickness was significantly greater for group 1 (72.96 +/- 10.67 microm) compared to groups 2 (35.07 +/- 8.53 microm; p < 0.0001), 3 (41.45 +/- 10.22 microm; p < 0.0001) and 4 (32.30 +/- 5.27 microm; p < 0.0001). These findings strengthen the hypothesis that chronic infection plays a role in the pathogenesis of atherosclerosis.