Objective: Sarcopenia, the gradual decline in skeletal muscle mass (SMM), strength, and functionality, has negative health consequences such as premature death and disability. It is prevalent in chronic lung disease (CLD). Timely recognition of sarcopenia is required for focused therapy. This study sought to analyze the rate of sarcopenia in patients with CLD and to assess the diagnostic accuracy of the sarcopenia screening tests: the SARC-F, SARC-CalF, and Ishii tests. Materials and Methods: This study comprised individuals diagnosed with CLD and referred for pulmonary rehabilitation. Sarcopenia was evaluated based on the European Working Group on Sarcopenia in Older People criteria (EWGSOP and EWGSOP2), utilizing handgrip strength, SMM index, and gait speed. The diagnostic accuracy of screening tests (SARC-F, SARC-CalF, and Ishii) was assessed by sensitivity, specificity, and the area under the curve (AUC) in the Receiver Ooperating Ccharacteristics. Results: A total of 227 patients, with a mean age of 59.00 ± 13.98 years, of whom 50.7% had chronic obstructive pulmonary disease (COPD), were included. The rate of probable sarcopenia was 41.2%, confirmed sarcopenia 2.5%, and severe sarcopenia 0.5%. The Ishii test exhibited the highest sensitivity (71.59%) and specificity (90.48%) for probable sarcopenia (AUC: 0.810); it also showed 100% sensitivity and substantial specificity (78.57%, AUC: 0.893) for confirmed sarcopenia. Conclusion: Sarcopenia is highly prevalent in CLD patients, underscoring the need for routine screening. Among the screening tools, the Ishii test exhibited the highest diagnostic accuracy, making it a valuable tool for early detection. Routine assessment and targeted interventions for sarcopenia could improve functional outcomes in CLD patients.

Kinürenin yolağı, yol boyunca oluşan metabolitler ve enzimler aracılığıyla neredeyse tüm bağışıklık tepkileriyle etkileşime girmektedir. Hız sınırlayıcı enzim olan indolamin 2,3-dioksijenaz (IDO), yolağın başlangıç adımında oksidoredüktaz olarak görev yapmakta olup triptofanın kinürenine dönüşümünü katalizler ve çeşitli enfeksiyöz hastalıkların patogeneziyle ilişkilendirilmiştir. Bu çalışmada, koronavirüs hastalığı 2019 [coronavirus diseases-2019 (COVID-19)] hastalarının serum IDO-1 düzeyleri, Th1-2- 17 ile ilişkili sitokinlerin düzeyleri ve hematolojik parametreler, hastalığın şiddeti (hafif, orta, şiddetli) göz önünde bulundurularak araştırılması amaçlanmıştır. Yüz otuz hasta ve 91 sağlıklı kontrol için IDO1 serum seviyeleri enzim ilişkili immünsorban assay [enzyme linked immunosorbant assay (ELISA)] yöntemi kullanılarak ölçülmüş ve karşılaştırılmıştır. IDO gen lokusundaki daha önce enflamasyonla ilişkilendirilmiş olan tek nükleotit polimorfizm [single nucleotid polymorphism (SNP)] bölgesi taranmıştır. SNP analizleri, erime eğrisi (melting curve) analiziyle gerçekleştirilmiştir. Kırk COVID-19 hastasının IDO-1 intronik varyant rs7820268 ve IDO-2 inaktivitesinden sorumlu rs4503083 SNP bölgeleri, elli iki sağlıklı kontrol ile karşılaştırmalı olarak incelenmiştir. Tüm sonuçlar istatistiksel olarak analiz edilmiş ve karşılaştırılmıştır. IDO-1 serum konsantrasyonları hasta grubunda sağlıklı kontrol grubuna göre anlamlı olarak düşük bulunmuştur (p< 0.0001). Ayrıca, şiddetli hasta grubundaki IDO-1 serum seviyeleri, hafif hasta grubundan daha düşük olarak belirlenmiştir (p= 0.026). Hasta grubunda IL-4, IL-6, IL-10, TNF-α serum seviyeleri anlamlı derecede yüksek bulunurken, IFN-γ seviyeleri düşük olarak tespit edilmiştir. IDO1 ve IL-6 seviyeleri arasında ise negatif bir korelasyon bulunmuştur (r= -0.3503, p= 0.0391). Hastalık şiddetine göre sınıflandırılan hasta gruplarında lenfosit, monosit, nötrofil ve akut faz reaktan değerleri karşılaştırıldığında anlamlı farklılıklar bulunmuştur. SNP analizi sonucunda, rs7820268 IDO-1 bölgesi için CC genotipi COVID-19 hasta grubunda sağlıklı kontrol grubuna göre önemli ölçüde daha yüksek bulunmuştur (p= 0.0017). Bu veriler, IDO-1 rs7820268 SNP bölgesindeki polimorfizmin COVID-19'a duyarlılıkla ilişkili olabileceğini düşündürmektedir.

Aim: Elderly people encounter COVID-19 more frequently due to physiological changes associated with aging and underlying potential health conditions.The study aims to evaluate the impact of baseline patient characteristics on short- and long-term mortality in elderly patients aged 65 and over, classified as youngest-old, middle-aged, or oldest-old, who applied to the pandemic outpatient clinic and had not yet been vaccinated. Materials and Methods: Symptomatic patients who attended the emergency department were enrolled in the study. Demographic data, symptoms, comorbidities, thoracic computed tomography (CT), and laboratory results were recorded at admission. The primary outcomes were all-cause short-term (within six months) and long-term (within four years) mortality. Results: The study consists of 393 participants, with a mean age of 67.4 ± 9.8 years and 52.2% male. Considering the death rates in the last four years, it was determined that 72 (18.3%) cases died in the short term, and 104 (26.5%) cases died in the long term. It was found that chronic renal failure (CRF), coronary artery disease (CAD), middle-old and oldest-old-aged patients compared to the 50-64 age group were independent predictors of overall short-term mortality. It was determined that the following factors independently predicted overall long-term mortality: male gender, CAD, malignancy, CRF, fever, and dyspnea symptoms, and the patients of the youngest-old, middle-old, and oldest-old relative to the 50–64 age group. Conclusion: Advanced age, male gender, symptoms of shortness of breath and fever, high D-dimer levels, the presence of CAD, malignancy, and CRF were related to a higher risk of death from COVID-19 infection in the elderly.

BackgroundThis study aimed to evaluate attitudes toward and exposure to gender discrimination in work life by chest diseases specialists and thoracic surgeons.MethodsA total of 275 members of Turkish Thoracic Society (TTS) were included on a voluntary basis in this online cross-sectional questionnaire-survey using an internal member-only social media platform of TTS. The questionnaire form elicited items on sociodemographic characteristics, occupational characteristics and gender discrimination in work life (general opinions, attitudes and exposure).ResultsFemale doctors (vs. males) were less likely to be a thoracic surgeon (13.8% vs. 34.5%, p < 0.05) and a professor of thoracic surgery (0.0% vs. 26.7% vs. p < 0.05), and more likely to consider housework as a considerable burden (89.8 vs. 73.6%, p = 0.02) and the significant role of discriminatory, negative and dissuasive attitudes of male physicians in their career choice (67.6 vs. 35.6%, p = 0.039). Male doctors were more likely to considered that men are more successful in specialties that require active physical strength (65.5 vs. 27.7%, p = 0.005) and those with very long working hours and heavy shifts (57.5 vs. 39.4%, p = 0.001). Female thoracic surgeons were more likely than males to consider that specialties with very long working hours and heavy shifts are more suitable for men (26.9 vs. 6.0%, p = 0.027) and men are given priority in academic career promotion (64.0 vs. 13.3%, p < 0.001). Younger (vs. older) females reported higher rate of exposure to gender discrimination (p = 0.041) and considerable impact of social roles on the specialty (p = 0.007), while female doctors working as a resident (33.8%) and a specialist (50.05%) indicated higher rate of exposure to gender discrimination during their career (p = 0.024).ConclusionIn conclusion, our findings revealed that exposure to gender discrimination in work life was more commonly expressed by female members of TTS, particularly in terms of burden of social roles, career advancement options and leadership positions, along with significant role of discriminatory, negative and dissuasive attitudes of male physicians in their career choice. Accordingly, women remain underrepresented in thoracic surgery, particularly in the academic rank of full professor and in leadership positions with inability to promote after a definite step in their careers.

BackgroundA major public health hazard is youth e-cigarette use. Although new, e-cigarette health hazards are becoming well-known in the literature. E-cigarette sale restrictions and laws differ globally. In this cross-sectional study, we studied medical university students’ tobacco and e-cigarette use and characteristics in a country where sales and import of e-cigarettes are banned. The primary objective is to determine the prevalence of electronic cigarette use and understand consumption patterns among medical faculty students in this setting.Materials and methodsThe questionnaire was sent using a web-based student information system. Sociodemographic features, tobacco and e-cigarette use, consumption patterns, and e-cigarette risk perceptions were covered in 54 questions.ResultsThe study comprised 1,054 students (48.7% male) aged 21.5 ± 2.6 years who completed the questionnaire. 37.7%, 20.9% and 23.6% have smoked cigarettes, e-cigarettes, or water pipes. Current cigarette smokers were 17.0%, e-cigarette users 4.0%, and water pipe smokers 4.5%. E-cigarette users were 52.3% dual smokers. The most common symptoms reported by e-cigarette users were cough (58.4%) and dyspnea (54.2%). Multivariable models showed that the male sex, greater monthly income, and a current smoker friend were independent risk factors for e-cigarette ever use, while the male sex, paternal current smoking, and close friends’ current smoking status were risk factors for dual use among medical trainees. Many medical students who used electronic cigarettes underestimated nicotine’s health hazards and harmful chemicals in e-cigarettes. Despite e-cigarette sales being prohibited in our country, 56.4% and 25.4% of e-cigarette users provided e-cigarettes from tobacco shops and through online sales, respectively.ConclusionMedical university students use tobacco most often by smoking cigarettes. Despite medical university students being aware of the health hazards of e-cigarettes, the current use of electronic cigarettes is 4.0%. Male sex, greater monthly income, and having current smoker friends are independent risk factors for e-cigarette use, while paternal smoking is a risk factor for dual use among medical trainees. Although in the country, sales of e-cigarettes are banned, ever-use rates for e-cigarettes were remarkably high at 20.9%, and the ease of accessing e-cigarettes was striking.

Objective: Prognostic models aid clinical practice with decision-making on treatment and hospitalization in exacerbation of chronic obstructive lung disease (ECOPD). Although there are many studies with prognostic models, diagnostic accuracy is variable within and between models. Subjects and Methods: We compared the prognostic performance of the BAP65 score, DECAF score, PEARL score, and modified early warning score (MEWS) in hospitalized patients with ECOPD, to estimate ventilatory support need. Results: This cross-sectional study consisted of 139 patients. Patients in need of noninvasive or invasive mechanical ventilation support are grouped as ventilatory support groups (n = 54). Comparison between receiver operating characteristic curves revealed that the DECAF score is significantly superior to the PEARL score (p = 0.04) in discriminating patients in need of ventilatory support. DECAF score with a cutoff value of 1 presented the highest sensitivity and BAP65 score with a cutoff value of 2 presented the highest specificity in predicting ventilatory support need. Multivariable analysis revealed that gender played a significant role in COPD exacerbation outcome, and arterial pCO2 and RDW measurements were also predictors of ventilatory support need. Within severity indexes, only the DECAF score was independently associated with the outcome. One-point increase in DECAF score created a 1.43 times higher risk of ventilatory support need. All severity indexes showed a correlation with age, comorbidity index, and dyspnea. BAP65 and DECAF scores also showed a correlation with length of stay. Conclusion: Objective and practical classifications are needed by clinicians to assess prognosis and initiate treatment accordingly. DECAF score is a strong candidate among severity indexes.

Non-cystic fibrosis bronchiectasis (NCFB) is one of the chronic lung diseases that has increased in prevalence as a result of the widespread use of radiographic imaging. Malnutrition in NCFB increases the risk of infection by increasing inflammation and decreasing body composition and function. Skeletal muscle cross-sectional area (SMA) and skeletal muscle index (SMI) are used to assess nutritional status in chronic respiratory diseases. For SMA and SMI determination by using thorax CT (TCT), L1 SMA can be used as an alternative to L3 (Sanders et al, International Journal of COPD, 2019:14). To the best of our knowledge, this is the first study to compare the results of a nutritional evaluation of NCFB patients using L1 SMA, SMI to exacerbation. Our study aims to analyse the role of nutritional risk score NRS-2002 levels and skeletal muscle index (SMI)(mm²/m²) of the L1 section in assessing malnutrition risk and its effect on the number of exacerbations over the last year. The cross-sectional study comprised 86 stable NCFB patients, who had undergone a TCT during the previous year. TCT L1 SMI and SMA, subdivided into total, paraspinal, and intercostal muscle areas were analyzed based on the number of exacerbations ≥3 in the previous year and the NRS-2002≥3. 43% of the participants reported ≥3 exacerbations in the previous year. 18.6% of patients had an NRS-2002 score ≥3. SMI in the group with NRS-2002 ≥3 was found to be lower(p<0.021). The L1 paraspinal muscle area was lower in the group that experienced ≥3 exacerbations(p=0.045). The available and accessible L1 SMA and SMI can be used to manage NCFB and predict the risk of malnutrition and exacerbation.

Introduction: Noninvasive ventilation (NIV) for acute hypercapnic respiratory failure (AHRF) is an established treatment modality. Current evidence does not conclude any superiority between fixed pressure support (PS) and aver-age volume-assured pressure support (AVAPS) modes. However, given the ability of rapid PaCO2 decline in AVAPS mode, we hypothesized that COPD patients with AHRF who did not show the desired reduction in PaCO2 with fixed-level PS-NIV might benefit from the AVAPS mode.Materials and Methods: Patients admitted to the non-ICU pulmonary ward with acute exacerbation of COPD (AECOPD) and AHRF were included con-secutively in this observational study. Patients with hypercapnic respiratory failure due to obesity-hypoventilation, neurological diseases, or chest wall deformities were excluded. All patients started NIV treatment with fixed pres-sure support (PS) and patients who did not reach clinical and laboratory stability under PS-NIV treatment were switched to the average volume -as-sured pressure support (AVAPS) mode of NIV.Results: Thirty-five COPD patients with hypercapnic respiratory failure were included. Under PS-NIV treatment, 14 (40%) patients showed a 17.9 (-0.0-29.2) percent change in terms of PaCO2 , meaning no improvement or worsening. Therefore, these patients were treated with AVAPS mode. Arterial PaCO2 and pH levels significantly improved after AVAPS-NIV administration. AVAPS-NIV treatment created a significantly better PaCO2 change rate than using PS-NIV (-11.4 (-22.0 --0.5)vs 8.2 (-5.3-19.5), p= 0.02]. Independent predictors of AVAPS mode requirement were higher Charlson Comorbidity Index (OR= 1.74 (95% CI= 1.02-2.97)] and higher PaCO2 upon admission (OR= 1.18 (95% CI= 1.03-1.35)]. Thirteen (92.8%) patients reaching signif-icant clinical stability with AVAPS-NIV were able to return to fixed-level PS-NIV and maintain acceptable PaCO2 levels.Conclusion: Our study demonstrated that patients can benefit from AVAPS-NIV despite insufficient response to fixed-level PS-NIV.

Malnutrition in non-cyctic fibrosis bronchiectasis (NCFB) patients may develop as a result of insufficient nutrient intake and inflammation, which may increase the frequency of exacerbations. Our study aims to evaluate the nutritional status of NCFB patients and understand whether malnutrition is a risk factor for NCFB exacerbations. NCFB patients9 demographics, pulmonary function tests, bronchiectasis severity index (BSI), anthropometric measurements, bioimpedance analysis, hand-grip strength (HGS), muscle mass by thoracic CT L1 skeletal muscle index (SMI) and malnutrition evaluation by NRS-2022 were recorded. The frequency of exacerbations and hospitalizations was recorded according to the last 1 year medical records. A total of 86 cases (M/F:44/42 and 60,52±2,82 with a mean years of age) were enrolled. In the high-risk malnutrition group (NRS-2002≥3); BMI, FFMI, upper arm circumference, calf circumference, SMI, HGS were significantly reduced, whereas a significant increase in the BSI, frequency of hospitalization for exacerbation were observed. In cases with an exacerbation frequency ≥2 in the previous year; FVC (mL), and HGS were significantly reduced whereas BSI got worsened. In logistic regression analysis, each unit increase in BSI scores increased the risk of having ≥2 exacerbations in the previous year by 1.04 times. Each unit increase in the HGS is associated with a reduction in risk of ≥2 exacerbations in the previous year by 2%; the presence of male gender reduced the risk of malnutrition by 19%, a one unit increase in FFMI reduced the risk of malnutrition by 6%. Based on our results, simple and reproducible tests that we may utilize in daily practice to manage NCFB will help us forecast exacerbation and malnutrition.

Introduction: GOLD define airflow obstruction by fixed ratio (FR), whereas ATS/ERS spirometry guidelines recommend lower limits of normal (LLN) for diagnosing COPD. Aim: To determine if there is a difference between the two diagnostic criteria for respiratory morbidity and exacerbations. Material methods: COPD patients underwent spirometry. Patients with FEV1/FVC<0,70 were classified as FR+; FEV1/FVC≥0,70 and FVC≥80%predicted as FR-; FEV1/FVC <LLN as LLN+; FEV1/FVC ≥LLN and FVC≥LLN as LLN-. The study population was grouped as FR-/LLN-, FR+/ LLN+, and FR+/LLN-. Respiratory morbidity and exacerbations were compared between concordant and discordant groups. 2012-GLI norms were used to define LLN. Results: GOLD and GLI-LLN criterion identified 71.6%, 15.8%, 26% and 57.4%, 20.3%, 22.3% as obstructive, restrictive and normal spirometry, respectively. Patients with airflow obstruction according to either FR or LLN had the highest respiratory comorbidity than those who met neither criteria. Compared with FEV1/FVC≥0,70, in patients with FEV1/FVC<0,70, the age, sex, and smoking-adjusted hazard ratio was 3.7(95%CI:1.7–8,1;p=0.001) for exacerbations. Compared with COPD patients with FEV1/FVC≥LLN, those with FEV1/FVC<LLN, the adjusted hazard ratio was 2.3(95%CI:1.4–3.9;p=0.002) for exacerbations. Adjusted HR for exacerbations were 6.2(2.2-17.1), 3.7(1.7-8.1) for FR+/LLN+ and FR+/LLN- groups as compared to FR-/LLN- group. Conclusion: Patients with airflow obstruction according to FR had more respiratory comorbidity and were more likely to exacerbate than those with LLN only. Patients with FR+ but LLN- were also more likely to have exacerbations than those with FR-/LLN-.

Introduction: In a resource-constrained situation, a clinical risk stratification system can assist in identifying individuals who are at higher risk and should be tested for COVID-19. This study aims to find a predictive scoring model to estimate the COVID-19 diagnosis. Materials and Methods: Patients who applied to the emergency pandemic clinic between April 2020 and March 2021 were enrolled in this retrospective study. At admission, demographic characteristics, symptoms, comorbid diseases, chest computed tomography (CT), and laboratory findings were all recorded. Development and validation datasets were created. The scoring system was performed using the coefficients of the odds ratios obtained from the multivariable logistic regression analysis. Results: Among 1187 patients admitted to the hospital, the median age was 58 years old (22-96), and 52.7% were male. In a multivariable analysis, typical radiological findings (OR= 8.47, CI= 5.48-13.10, p< 0.001) and dyspnea (OR= 2.85, CI= 1.71-4.74, p< 0.001) were found to be the two important risk factors for COVID-19 diagnosis, followed by myalgia (OR= 1.80, CI= 1.082.99, p= 0.023), cough (OR= 1.65, CI= 1.16-2.26, p= 0.006) and fatigue symptoms (OR= 1.57, CI= 1.06-2.30, p= 0.023). In our scoring system, dyspnea was scored as 2 points, cough as 1 point, fatigue as 1 point, myalgia as 1 point, and typical radiological findings were scored as 5 points. This scoring system had a sensitivity of 71% and a specificity of 76.3% for a cut-off value of >2, with a total score of 10 (p< 0.001). Conclusion: The predictive scoring system could accurately predict the diagnosis of COVID-19 infection, which gave clinicians a theoretical basis for devising immediate treatment options. An evaluation of the predictive

Background: Combined pulmonary fibrosis and emphysema (CPFE) has been recognised as a phe-notype of pulmonary fibrosis. We aimed to compare serum surfactant protein-A (SP-A), surfactant protein-D (SP-D) and Krebs von den Lungen-6 (KL-6) levels, functional parameters, in CPFE and IPF (idiopathic pul-monary fibrosis) patients. Methods: Patients diagnosed with ???CPFE??? and ???IPF??? were consecutively included in 6 months as two groups. The patients with connective tissue diseases are excluded. Results: In this study, 47 patients (41 males, 6 females) with CPFE (n = 21) and IPF (n = 26) with a mean age of 70.12 ?? 8.75 were evaluated. CPFE patients were older, had more intense smoking history, had lower DLCO/VA, lower FVC, and worse six-minute walking distance than the IPF group (p=0.005, p=0.027, p=0.02, p<0.001, p=0.001, respec-tively). Serum KL-6 levels were higher in CPFE group compared to IPF group [264.70 U/ml (228.90-786) vs 233.60 (101.8-425.4), p<0.001]. Serum KL-6 levels of 245.4 U/ml and higher have 81% sensitivity and 73% specificity for the discrimination of CPFE from IPF. Conclusions: Our study has shown that serum KL-6 level is a promising biomarker to differentiate CPFE from IPF. In CPFE cases respiratory and functional parameters are worse than those of pure fibrosis cases.

Background Combined pulmonary fibrosis and emphysema (CPFE) has been recognised as a phenotype of pulmonary fibrosis. We aimed to compare serum surfactant protein-A (SP-A), surfactant protein-D (SP-D) and Krebs von den Lungen-6 (KL-6) levels, functional parameters, in CPFE and IPF (idiopathic pulmonary fibrosis) patients. Methods Patients diagnosed with 'CPFE' and 'IPF' were consecutively included in 6 months as two groups. The patients with connective tissue diseases are excluded. Results In this study, 47 patients (41 males, 6 females) with CPFE (n = 21) and IPF (n = 26) with a mean age of 70.12 ± 8.75 were evaluated. CPFE patients were older, had more intense smoking history, had lower DLCO/VA, lower FVC, and worse six-minute walking distance than the IPF group (p=0.005, p=0.027, p=0.02, p<0.001, p=0.001, respectively). Serum KL-6 levels were higher in CPFE group compared to IPF group [264.70 U/ml (228.90-786) vs 233.60 (101.8-425.4), p<0.001]. Serum KL-6 levels of 245.4 U/ml and higher have 81% sensitivity and 73% specificity for the discrimination of CPFE from IPF. Conclusions Our study has shown that serum KL-6 level is a promising biomarker to differentiate CPFE from IPF. In CPFE cases respiratory and functional parameters are worse than those of pure fibrosis cases.

Tobacco addiction, which causes the death of more than 8.5 million people in the world every year, is a preventable global public health problem. There are 1.1 billion adult smokers worldwide and 60% of them desire or intend to quit but unfortunately, the tobacco industry continues to profit at the expense of people's lives by marketing electronic cigarettes and heated tobacco products as a smoking cessation method and they continue to poison young people with new threat tobacco products, promising a "smoke-free future" Turkish Thoracic Society is actively involved in the implementation of the National Tobacco Control Program to protect public health and has warned and raised awareness of new threats to the youth, such as electronic cigarettes and heated tobacco products. The purpose of this report is to provide information about electronic cigarettes and heated tobacco products and to present TTJ's position on the subject.

BACKGROUND:Laboratory biomarkers to estimate the severity of coronavirus disease 2019 (COVID-19) are crucial during the pandemic since resource allocation must be carefully planned.AIMS:To evaluate the effects of basal serum total immunoglobulin E (IgE) levels and changes in inflammatory parameters on the clinical progression of patients hospitalised with COVID-19.METHODS:Patients hospitalised with confirmed COVID-19 were included in the study. Laboratory data and total IgE levels were measured on admission. Lymphocyte, eosinophil, ferritin, d-dimer and C-reactive protein parameters were recorded at baseline and on the 3rd and 14th days of hospitalisation.RESULTS:The study enrolled 202 patients, of which 102 (50.5%) were males. The average age was 50.17 ± 19.68 years. Of the COVID-19 patients, 41 (20.3%) showed clinical progression. Serum total IgE concentrations were markedly higher (172.90 (0-2124) vs 38.70 (0-912); P < 0.001) and serum eosinophil levels were significantly lower (0.015 (0-1.200) vs 0.040 (0-1.360); P = 0.002) in clinically worsened COVID-19 patients when compared with stable patients. The optimal cut-off for predicting clinical worsening was 105.2 ng/L, with 61% sensitivity, 82% specificity, 46.3% positive predictive value and 89.2% negative predictive value (area under the curve = 0.729). Multivariable analysis to define risk factors for disease progression identified higher total IgE and C-reactive protein levels as independent predictors.CONCLUSIONS:Our single-centre pilot study determined that total IgE levels may be a negative prognostic factor for clinical progression in patients hospitalised due to COVID-19 infection. Future studies are required to determine the impact of individuals' underlying immune predispositions on outcomes of COVID-19 infections.

BACKGROUND:The potential role of interleukin-6 (IL-6) in coronavirus disease 2019 (COVID-19) pneumonia provides the rationale for investigating IL-6 signaling inhibitors.OBJECTIVES:To evaluate and report treatment responses to tocilizumab (TCZ) in COVID-19 patients and compare mortality outcomes with those of standard care.MATERIAL AND METHODS:Patients hospitalized with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, diagnosed with reverse transcription polymerase chain reaction (RT-PCR) between March 2020 and April 2021, were enrolled in this single-center retrospective cohort study. Propensity score matching was performed in order to reduce confounding effects secondary to imbalances in receiving TCZ treatment.RESULTS:A total of 364 patients were included in this study. Two hundred thirty-six patients received standard care, while 128 patients were treated with TCZ in addition to standard care (26 (20.3%) patients received a dose of 400 mg intravenously once, while 102 (79.7%) patients received a total dose of 800 mg intravenously). In the propensity score-matched population, less noninvasive mechanical ventilation (p = 0.041) and mechanical ventilation support (p = 0.015), and fewer deaths (p = 0.008) were observed among the TCZ-treated patients. The multivariate adjusted Cox regression model showed a significantly higher survival rate among TCZ patients compared to controls (hazard ratio (HR): 0.157, 95% confidence interval (95% CI): 0.026-0.951; p = 0.044). The hazard ratio for mortality in the TCZ group was 0.098 (95% CI: 0.030-0.318; p = 0.0001 using log-rank test).CONCLUSIONS:This study determined that TCZ treatment in COVID-19 patients was associated with better survival, reduced need for mechanical ventilation and reduced hospital-associated mortality.

Introduction: Our knowledge has gaps regarding severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) replication levels and its association to severity of Coronavirus disease 2019 (COVID-19). The aim of this study was to investigate the association of SARS-CoV-2 viral load with disease severity and serum biomarkers in COVID-19 patients. Methodology: Viral load was determined via cycle threshold (Ct) values of SARS-CoV-2 real-time reverse transcriptase-polymerase chain reaction (RT-PCR) in 214 adult patients. Ct values were compared with clinical severity, biochemical and hematological biomarkers. Results: Clinical course of the disease was mild (49.1%), moderate (40.2%), and severe (10.7%). Median Ct value was 28.2 (IQR: 22.2–33.8) during the first week of the disease. Ct values were lower within five days after symptom onset [lowest Ct value on the third day (median: 24, IQR: 20.6–32.3)], but they increased significantly during the second and third weeks. No association was detected between admission Ct values and disease severity. Gender, age, co- morbidity, and mortality did not differ significantly in patients with low (≤ 25) and high (> 25) Ct values. White blood cell, neutrophil, platelet, and especially lymphocyte counts, were significantly lower in patients with low Ct values. Conclusions: No definitive/clear correlation between SARS-CoV-2 viral load and severity and mortality was found in the studied COVID-19 patients. However, neutrophil, platelet, and especially lymphocyte count were significantly lower in patients with a high viral load.

BACKGROUND AND AIM: Obstructive sleep apnea (OSA), having an increased inflammatory state due to an imbalance between sympathetic and parasympathetic activity, intermittent hypoxia, and increased cytokines, may aggravate the immune response for COVID-19 infection. Our aim was to evaluate the effect of OSA upon inflammatory response and length of stay in patients with favorable outcomes. METHODS: Patients admitted to an outpatient clinic after being hospitalized for treatment of COVID-19 were included consecutively in this cross-sectional multicenter observational study. STOP-Bang Questionnaire and a cut-off value of 3 points were used to identify patients with a high risk of OSA. RESULTS: Study population consisted of 201 patients with a median STOP-Bang score of 2.0 (1.0-4.0) points. According to the cut-off value of 3 points, 94 (46.8%) patients were classified as high-risk OSA patients. High-risk OSA patients were older, had many comorbidities such as hypertension, coronary artery disease, and diabetes mellitus, had higher serum D-dimer, ferritin, C-reactive protein, and procalcitonin measurements, and had a longer hospital stay. Possible risk factors associated with length of stay were age, lymphocyte count, and total STOP-Bang score. Multivariable analysis revealed that a 1 point increase in STOP-Bang score results in a 0.43 day longer hospital stay. CONCLUSIONS: Prevalence of OSA within COVID-19 patients with favorable outcomes is similar to the general population. However, the length of stay is related to the presence of high-risk OSA. Our study, therefore, suggests that OSA is related to delayed improvement of COVID-19 infection.