Aim: Interventional pulmonology involves both diagnostic and therapeutic procedures that primarily use a rigid bronchoscope. There is still a lack of consensus on case management, the choice of treatment method and treatment procedures. It is important to share the procedures adopted and the individual cases in interventional pulmonology, as this is still a developing field. Accordingly, we share here our first experiences in our newly founded interventional pulmonology unit. Material and Methods: This study is a retrospective cohort study based on a review of interventional procedures performed for diagnostic and therapeutic purposes between January 1, 2016, and June 30, 2018. Results: One hundred twenty-four interventional procedures were performed on 107 cases in our interventional pulmonology unit. The mean age of the patients was 54.3 +/- 17.5 years, and 71% were male, 29% were female. The reasons for the procedures were diagnostic in 16.9%, therapeutic in 35.4%, and both diagnostic and therapeutic in 47.7%. Of the procedures performed, 42.0% were for tumor excision due to malignant obstruction, 15.3% for diagnostic biopsy, 12.9% for total lung lavage, 16.1% to determine the etiology of hemoptysis, 9.7% for tracheal dilatation and stent applications, and 4% foreign body removal. Discussion: We believe that sharing interventional bronchology procedures will help more patients benefit from such treatments and contribute to the standardization of practices.

OBJECTIVE:Thoracic ultrasonography is widely used in imaging peripheral lesions and invasive interventional procedures. The aim of this study was to assess the diagnostic value of thoracic ultrasonography-guided transthoracic needle aspiration biopsy and the factors affecting the diagnosis of peripheral tumoral lung lesions. METHODS:The lesion size, biopsy needle type, number of blocks, complications, and pathology results were compared in 83 patients between January 2015 and July 2018. The cases with pathological non-diagnosis and definite pathological diagnosis were determined. For the assessment of the factors affecting diagnosis, the size of the lesions and the biopsy needle type were evaluated. Biopsy preparations containing non-diagnostic atypical cells were referred to a cytopathologist. The effect of the cytopathological examination on the diagnosis was also evaluated. RESULTS:Pathological diagnosis was made in 66.3% of the cases; cell type could not be determined in 22.9% of the cases, and they were referred to a cytopathologist. After the cytopathologist's examination, the diagnosis rate increased to 80.7%. Diagnosis rates were higher when using tru-cut than Chiba and higher in cases with tumor size >2 cm than smaller. CONCLUSION:Thoracic ultrasonography-guided transthoracic needle aspiration biopsy is a preferred approach to the diagnosis of peripheral tumoral lung lesions, given its high diagnostic rate, in addition to being cheap, highly suitable for bedside use, and safe, and the lack of radiation exposure.

BACKGROUND AND AIM: The use of tobacco and tobacco products is one of the biggest public health problems that continue to threaten human health worldwide. Thirdhand smoke (THS) is a new concept that emerges from tobacco use, and there are not enough studies on its effects on human health. Therefore, we aimed to determine the level of awareness of THS and the parameters affecting it in individuals who applied to a chest diseases hospital in Turkiye. METHODS: A total of 400 volunteers who admitted to our hospital between February and March 2022 were literate and accepted to participate in the study were included. Volunteers were given a questionnaire including the demographic characteristics and Baths-T survey, which was used to determine the awareness of THS. RESULTS: Of the 400 participants included in the study, 162 (40.5%) were females, 238 (59.5%) were males, and their mean age was 44.09 +/- 12.75 years. In our study, the mean Baths-T score was 35.1 +/- 6.74. The mean score of persistence and health beliefs was 15.51 +/- 3.54 and 19.58 +/- 3.74, respectively. It was determined that the total and two subdimension scores were statistically significantly higher in women than in men (p=0.019, 0.046, and 0.011). Awareness was statistically significantly lower in smokers and those with low education levels (p=0.001 and 0.014). CONCLUSIONS: We think that the male gender, low education level, and smokers, whose awareness level is low, should be the primary target group in informing about THS.

Background:Coronavirus disease 2019 (covid-19), which causes a pandemic in the world, has started to appear in turkey since march 2020. Healthcare workers are at the top of the groups most at risk for covid-19 infection, which can have a negative impact on psychological state.Objectives:It was aimed to evaluate anxiety and depression levels among healthcare workers.Methods:this cross-sectional study performed via an online survey in april 2020. Participants answered questions about sociodemographic features, personal views and experiences about covid-19 and the hospital anxiety and depression scale (hads).Results:A total of 300 healthcare workers,193 men and 107 women, participated in the survey. According to hads, 44.6% of participants scored above anxiety and 68.2% scored above depression cut-off points. Being younger than 50 and taking care of covid-19 patients in hospitals were independently associated with anxiety risk. Female gender, young age (less than 50) and having comorbidity were independent risk factors for depression.Conclusion:Healthcare workers were at high risk of anxiety and depression during covid-19 outbreak. For this reason, psychological support should be given, especially to the group with high risk.

The aim of this study is to determine the diagnostic performances of pleural procedures in undiagnosed exudative pleural effusions and to evaluate factors suggestive of benign or malignant pleural effusions in tertiary care centers. This was a multicenter prospective observational study conducted between January 1 and December 31, 2018. A total of 777 patients with undiagnosed exudative pleural effusion after the initial work-up were evaluated. The results of diagnostic procedures and the patients' diagnoses were prospectively recorded. Sensitivity, specificity, and accuracy estimates with 95% confidence intervals were used to examine the performance of pleural procedures to detect malignancy. The mean age ± SD of the 777 patients was 62.0 ± 16.0 years, and 68.3% of them were male. The most common cause was malignancy (38.3%). Lung cancer was the leading cause of malignant pleural effusions (20.2%). The diagnostic sensitivity and accuracy of cytology were 59.5% and 84.3%, respectively. The diagnostic sensitivity of image-guided pleural biopsy was 86.4%. The addition of image-guided pleural biopsy to cytology increased diagnostic sensitivity to more than 90%. Thoracoscopic biopsy provided the highest diagnostic sensitivity (94.3%). The highest diagnostic sensitivity of cytology was determined in metastatic pleural effusion from breast cancer (86.7%). The diagnostic performance increases considerably when cytology is combined with image-guided pleural biopsy in malignant pleural effusions. However, to avoid unnecessary interventions and complications, the development of criteria to distinguish patients with benign pleural effusions is as important as the identification of patients with malignant pleural effusions.

IntroductionThe search for biomarkers that could help in predicting disease prognosis in the Coronavirus Disease-2019 (COVID-19) outbreak is still high on the agenda.ObjectiveTo find out the efficacy of D-dimer and mean platelet volume (MPV) combination as a prognostic marker in hospitalized COVID-19 patients with bilateral infiltration.Materials and MethodsStudy design: Retrospective observational cohort. Patients who were presented to our hospital between March 16, 2020 and June 07, 2020 were reviewed retrospectively. The primary outcome of the study was specified as the need for intensive care, while the secondary outcomes were duration of treatment and hospitalization. Receiver operator curve (ROC) analyzes were carried out to assess the efficacy of D-dimer and MPV parameters as prognostic markers.ResultsBetween the mentioned dates, 575 of 1,564 patients were found to be compatible with COVID-19, and the number of patients who were included in the study was 306. The number of patients who developed the need for intensive care was 40 (13.1%). For serum D-dimer levels in assessing the need for intensive care, the area under the curve (AUC) was found to be 0.707 (95% CI: 0.620–0.794). The AUC for MPV was 0.694 (95% CI: 0.585–0.803), when D-dimer was ≥1.0 mg/L. When patients with a D-dimer level of ≥1.0 mg/L were divided into two groups considering the MPV cut-off value as 8.1, the rate of intensive care transport was found to be significantly higher in patients with an MPV of ≥8.1 fL compared to those with an MPV of <8.1 fL (32.6 vs. 16.0%, p = 0.043). For the prognostic efficacy of the combination of D-dimer ≥ 1.0 mg/L and MPV ≥ 8.1 fL in determining the need for intensive care, following values were determined: sensitivity: 57.7%, specificity: 70.8%, positive predictive value (PPV): 32.0%, negative predictive value (NPV): 84.0%, and accuracy: 63.0%. When D-dimer was ≥1.0, the median duration of treatment in MPV <8.1 and ≥8.1 groups was 5.0 [interquartile range (IQR): 5.0–10.0] days for both groups (p = 0.64). The median length of hospital stay (LOS) was 7.0 (IQR: 5.0–10.5) days in the MPV <8.1 group, while it was 8.5 (IQR: 5.0–16.3) days in the MPV ≥ 8.1 group (p = 0.17).ConclusionIn COVID-19 patients with a serum D-dimer level of at least 1.0 mg/L and radiological bilateral infiltration at hospitalization, if the MPV value is ≥8.1, we could predict the need for intensive care with moderate efficacy and a relatively high negative predictive value. However, no correlation could be found between this combined marker and the duration of treatment and the LOS.

BACKGROUND: Sedation is recommended during fiberoptic bronchoscopy, which is a common procedure in clinical pulmonary practice. However, there is no consensus or a standard approach globally. The present study aimed to assess the approaches of pulmonologists to sedation before bronchoscopic procedures in Turkey. MATERIALS AND METHODS: The study is designed as a cross-sectional study, based on survey-generated data. Pulmonologists working in Turkey were sent a 23-item survey via E-mail. The recipients were sent three reminders to complete the survey, and the responses were analyzed. The data analysis was carried out using the Statistical Package for the Social Sciences for Windows 15.0 package program. RESULTS: A total of 79 pulmonologists participated in the survey, with a mean age of 43.8 ± 7.7 years. Among the respondents, 92.4% stated that they applied sedation before bronchoscopic procedures. Of the total, 92% of the respondents stated that they used midazolam for sedation, while 20% used propofol, 18.7% used fentanyl and 9% used diazepam. All of the respondents reported using local anesthesia before the bronchoscopic procedure, with lidocaine being preferred by all. CONCLUSIONS: It was determined that most of the pulmonologists applied sedation during bronchoscopy usually in the form of mild-to-moderate sedation, with midazolam being the preferred medication. Of the respondents, 75% believed that the applied sedation was sufficient. Surveys like this could play a role in improving the implementation and application of international guidelines in Turkey.

Following the first reported cases of pneumonia of unknown etiology at the end of 2019 in Wuhan city, Hubei province, China, the causative agent was demonstrated to be a new coronavirus that has not been defined in humans before. The World Health Organization (WHO) named this virus as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the disease caused by the virus as coronavirus disease-19 (COVID-19). The disease spread rapidly to other countries through human-to-human transmission, and WHO declared a pandemic on March 11, 2020. As of April 2020, the number of individuals infected with SARS-CoV-2 and COVID-19 related deaths continue to increase rapidly worldwide. The main reason for the increase in the rate of infection is person-to-person transmission, while the main reason for the increase in mortality rate is the lack of a proven medical treatment specific to COVID-19 and the severe course of the disease in the elderly with low immunity. While a vast majority of individuals infected with SARS-CoV-2 are asymptomatic or recover after displaying mild symptoms, hospitalization is required in 14% of cases and severe disease requiring intensive care admission is seen in 5% of the infected individuals. WHO and national guidelines do not make clear recommendations regarding treatments for symptomatic patients. Currently, there is no vaccine or specific antiviral treatment for COVID-19, however supportive care, isolation and protective measures and experimental drugs/treatments are being used for the management of COVID-19. Medical treatments being used for COVID-19, aim to prevent the entry of the virus into the cell, to inhibit or reduce its replication, and to suppress the increased inflammatory response. In addition, "convalescent" plasma, which includes antibodies of patients who were completely recovered from the infection, is among the treatment options.

OBJECTIVES:The choice of treatment according to the inflammation type in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) has been of recent interest. This study investigated the role of novel biomarkers, hospital outcomes, and readmission rates in the first month in patients with eosinophilic or neutrophilic AECOPD. MATERIALS AND METHODS:We conducted a retrospective observational cohort study in a Chest Teaching Hospital with hospitalized AECOPD patients. Subjects' characteristics, hemogram results, C-reactive protein (CRP), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), platelet/mean platelet volume (PLT/MPV), length of hospital stay, mortality, and steroid use were recorded. Eosinophilic AECOPD defined as peripheral blood eosinophilia (PBE) was >2% and neutrophilic AECOPD as PBE ≤2%. Readmission within 28 days of discharge was recorded. RESULTS:Of 2727(31.5% females) patients, eosinophilic AECOPD was found in 510 (18.7%) patients. Leucocytes, CRP, NLR, and PLR were significantly higher in neutrophilic AECOPD than in eosinophilic AECOPD (p<0.001). Steroid use and mortality rate were 45% and 0.6% in eosinophilic AECOPD and 71%, and 1.4% in neutrophilic AECOPD, respectively (p=0.001, p=0.19). Age >75 years, albumin <2.5 g/dL, CRP >50 mg/dL, and PLT/MPV <20×103 were found to be risks factors for hospital mortality (p<0.05 each). Readmission rates within 28 days of discharge were 5% (n=136), and this rate was higher in eosinophilic AECOPD patients not taking steroids (p<0.001). CONCLUSION:NLR, PLR, and CRP levels were higher in neutrophilic AECOPD compared with eosinophilic AECOPD. These markers decreased with treatment in neutrophilic AECOPD. A PLT/MPV ratio of <20×103 resulted in an increased mortality rate. Thus, appropriate steroid therapy may reduce readmission rates in the first 28 days after discharge in eosinophilic AECOPD.

OBJECTIVE: The present research aims to evaluate the effects of chest X-rays on mortality among patients who were hospitalized due to the exacerbation of chronic obstructive pulmonary disease (COPD) in intensive care unit (ICU) of a secondary care hospital. MATERIALS AND METHODS: Sixty-three patients (39 males, 60.9%), who were hospitalized in ICU due to COPD exacerbation between December 1, 2011, and December 31, 2012, were retrospectively reviewed in this study. Data, including demographics, smoking history, arterial blood gas measurements, posterior-anterior lung radiography (PALR) findings and mortality, were collected from the medical records. RESULTS: The mean age of the patients was 70.5 years (standard deviation [SD]: 13.3, range 44–88 years). Of all the cases, 42 (85.7%) had at least one comorbidity. The most common comorbidities were hypertension (34, 53.9%) and heart failure (19, 30.2%). Mean duration of hospital stay was 8 days (SD: 5.7, range: 2–26). Mechanical ventilation support was required in 17 (27%) cases. In total, seven female and four male patients died during hospitalization (17.7%). PALR indicated emphysema in 60.3%, infiltration in 54%, bronchiectasis in 31.7%, and unilateral or bilateral pleural effusion in 27% of the cases. Infiltration and pleural effusion in PALR were more common among the patients who died (died/alived 10/11 vs. 24/52, P = 0.008 and 6/11 vs. 11/52, P = 0.026, respectively). The multivariate model for mortality showed that only age (odds ratio 0.821, CI: 0.687–0.948, P = 0.044) was independently related to mortality. CONCLUSION: As a basic imaging method, PALR still remains as an important diagnostic tool for COPD patients hospitalized in ICU, and it may contribute to the prediction of mortality.

Background: Diagnosing Pulmonary Thromboembolism (PE) remains difficult due to its non-specific symptoms and signs. There is currently no single, reliable, non-invasive diagnostic test sufficiently sensitive to consistently diagnose suspected PE. The aim of this study was to determine the sensitivity and specificity of multi-organ ultrasonography combined with clinical scores and elevated D-dimer levels for the diagnosis of non-massive PE. Materials and Methods: Between November 2015 and July 2016, a total of 92 consecutive patients with a moderate to high clinical suspicion of PE were evaluated in the emergency setting of our hospital. Those who met the inclusion criteria were enrolled into the study. The demographic, clinical and radiological features of the included patients and their laboratory findings were recorded. At the first assessment the Wells clinical scores were calculated and plasma D-dimer levels were measured using a quantitative enzyme-linked immunosorbent assay. Patients included in the study underwent Thoracic Ultrasonography (TUS), duplex sonography of their lower extremity veins, echocardiography and multislice Computerized Tomography Pulmonary Angiography (CTPA) within 24 h. All statistical analyses were carried out using the SPSS software (version: 16.0; SPSS Inc., Chicago, IL, USA). The chi-squared test was performed to compare categorical variables between groups, while ttests were used for normally distributed continuous variables. Analyses of sensitivity, specificity, Negative Predictive Value (NPV) and Positive Predictive Value (PPV) were conducted using cross-tables in SPSS. A p-value<0.05 was considered significant. Results: Of the 92 patients, 74 met the inclusion criteria and were included in the study. The mean age of the patients was 55.2 ± 17.4 y old, and 56.8% were male. While PE was diagnosed in 49 (66.2%) patients according to the results of the multislice CTPA (the reference test), PE was not detected in 25 (33.8%) patients. When multi-organ ultrasonography was consistent with PE and evaluated together with increased Ddimer levels, the sensitivity for identifying PE was found to be 89.8%, specificity was 88%, PPV was 93.6% and NPV was 81.5%. Conclusion: Multi-organ ultrasonography is a more effective and reliable test for diagnosing PE than single-organ ultrasonography. It has a high sensitivity and specificity, especially in the emergency setting. This approach may facilitate immediate treatment decisions when CTPA is not available or feasible.

Background: Malignant Pleural Effusion (MPE) is a complication of advanced malignancy occurring commonly in patients with lung cancer, lymphoma and breast cancer. Pleurodesis is often used to prevent re-accumulation of fluid and to help respiratory status. The size of the catheter (small versus large) to be used for pleurodesis, however, continues to be debated. Objective: To describe a tertiary hospital experience in patients requiring pleurodesis for malignant pleural effusion, with a comparison of small-bore catheter and large-bore catheter outcomes. Methods: Retrospective chart abstraction study of patients who received chemical pleurodesis with talc via catheter for malignant pleural effusions between 1 January 2012 and 31 December 2014 in our hospital. Small-bore (8-10 F) versus large-bore (28-32 F) catheter outcomes of interest were length of stay (LOS) post-catheterization and total LOS. Results: A total of 185 patients were included in the study, of whom 67 (36.2%) received a small-bore catheter and 118 (63.8%) a large-bore catheter groups, respectively. Lung cancer was the most common primary malignancy. Using propensity-score matched analyses, post-catheterization LOS was shown to be significantly shorter in the small-bore catheter group (1.8 d; p<0.001), however, total LOS was not different between the two groups (p=0.89). The pain VAS score was significantly lower in small bore catheter group than in large bore catheter group (p<0.001). The success rates were similar in the two groups (p=0.68). Conclusion: In our study post-procedure length of hospital stay is shorter when talc pleurodesis is conducted via small-bore catheter as compared to large-bore catheter. The success rates of pleurodesis were found to be similar regardless of the type of tube inserted. In addition, the pain VAS score was significantly lower in small bore catheter group than the large one.

Abstract Objective: To determine the prevalence of abdominal aortic aneurysm (AAA) in patients with chronic obstructive pulmonary disease (COPD) and to assess the characteristics of these patients. Materials and Methods: Stable COPD patients (age, >40 years) were included in the study between January 2014 and June 2014. Patients with acute exacerbations and a previous lung resection were excluded. Data regarding demographic characteristics were recorded. The modified Medical Research Council (mMRC) dyspnea scale was used to assess the severity of breathlessness. The COPD Assessment Test (CAT) was performed. Abdominal aortic diameter was measured using abdominal ultrasonography (AUS), and AAA was diagnosed as an aortic diameter of ≥30 mm at the renal artery level. Results: In total, 82 patients were examined. AAA was detected in five (6.1%) patients. Diabetes mellitus, hypertension, and coronary artery disease were present in four patients with AAA. The average mMRC score was 3.2±0.4, and the mean CAT score was 18.4±6.0. Aneurysmal diameter was >50 mm in four patients and 37 mm in one patient. Statistically significant differences were found between patient with AAA and those without AAA with respect to the mean abdominal aortic diameters at the renal artery and iliac artery levels (p=0.012 and 0.002, respectively). Conclusion: Our findings suggest that AAA is associated with COPD, with a prevalence rate of 6.1%. AAA is usually asymptomatic until a clinical status of rupture, which is associated with a higher mortality risk. Early diagnosis of AAA is lifesaving. In COPD patients, AAA might be easily determined using AUS, which is a noninvasive and relatively cheap procedure.

OBJECTIVES: To improve our knowledge and understand how to deal with non-adherence to the support programs and to determine the rate and possible factors related to non-adherence in subjects who attended our smoking cessation clinic. MATERIALS AND METHODS: This was a case-control study that included 550 subjects who applied to our smoking cessation clinic between June 1, 2011 and December 31, 2011. After a 1-year follow-up period, subjects were divided into two groups: adherent (controls) and non-adherent (cases). Sociodemographic and clinical parameters and smoking habits were evaluated. A p value <0.05 was considered significant. RESULTS: Of the 550 subjects, the number of cases (non-adherent) was 135 (24.6%), and the number of controls (adherent) was 415 (75.4%). Age to begin smoking was significantly young in subjects with non-adherence to the program (p=0.026). The rate of receiving pharmacotherapy was significantly high in subjects with adherence (p<0.0001). No difference was found between the groups according to varenicline, bupropion, nicotine gum, or combined therapy use, whereas nicotine patch use alone significantly increased the rate of non-adherence (p=0.022). Multivariable logistic regression analysis showed that the age to begin smoking (p=0.045, odds ratio (OR): 1.05, 95% confidence interval (CI): 0.86-0.99) and pharmacotherapy (p<0.0001, OR: 5.00, 95% CI: 2.80-8.94) were independent variables that affected adherence to the program. CONCLUSION: Care should be taken in the follow-up period when providing no pharmacotherapy and with subjects who started smoking at a young age.

OBJECTIVE:While the incidence of sarcoidosis peaks between 20 and 39 years, it is comparatively low in elderly subjects. We sought to determine whether there are age-dependent differences in the demographic and laboratory characteristics of patients with sarcoidosis. MATERIALS AND METHODS:We retrospectively collected information from our database using the International Classification of Disease (ICD) diagnostic code D86 between 2008 and 2014. Patients were divided into three groups: 20-39 years old (Group 1), 40-59 years old (Group 2), and 60-80 years old (Group 3). RESULTS:A total of 3988 patients with code of D86 were included in the study. After the exclusion of non-eligible patients, the number of cases in Groups 1, 2, and 3 were 276, 641, and 352, respectively. The groups were compared according to demographic characteristics, ICD diagnostic codes, and laboratory parameters. The ratio of female patients was significantly higher in Group 3 than in Groups 1 and 2 (p=0.000). There was no difference in diagnostic codes of the ICD subgroups between groups (p=0.19). While the level of blood-urea nitrogen was significantly higher in Group 3 patients than in other groups (p=0.000), serum angiotensin-converting enzyme (ACE) values were found to be significantly low in Group 3 (p=0.010). The mean ACE values did not differ between females and males (50.8±39.3 and 59.1±45.5 mg/dL, respectively) (p=0.18). CONCLUSION:The majority of patients with sarcoidosis were female in all age groups and pulmonary sarcoidosis was the most common presentation of the disease. Elderly patients (≥60 years) with sarcoidosis had lower serum ACE levels than younger patients.

Background: Influenza and pneumococcal vaccinations are recommended in chronic obstructive pulmonary disease patients to decrease associated risks at all stages. Although the prevalence of chronic obstructive pulmonary disease is high in our country, as previously reported, vaccination rates are low. Aims: To assess the vaccination rates of chronic obstructive pulmonary disease patients and factors that may affect these. Study Design: Multi-centre cross-sectional study. Methods: Patients admitted to the chest diseases clinics of six different centres between 1 February 2013 and 1 January 2014 with a pre-diagnosis of Chronic obstructive pulmonary disease according to the Global initiative for chronic obstructive lung disease criteria, who were in a stable condition were included in the study. The survey, which included demographic characteristics, socio-economic status, severity of disease and vaccination information, was first tested on a small patient population before the study. The survey was completed by the investigators after obtaining written informed consent. Results: The average age of the 296 included patients was 66.3±9.3 years and 91.9% were male. Of these, 36.5% had the influenza vaccination and 14.1% had the pneumococcal vaccination. The most common reason for not being vaccinated was ‘no recommendation by doctors’: 57.2% in the case of influenza vaccinations, and 46.8% in the case of pneumococcal vaccinations. Both vaccination rates were significantly higher in those patients with comorbidities (influenza vaccination p<0.001; pneumococcal vaccination p=0.06). There was no significant correlation with age, gender, smoking and severity of disease (p>0.05). Vaccination rates were significantly higher in those with a white-collar occupation and higher education level, and who presented to a university hospital (p<0.001). Conclusion: Medical professionals do not request vaccinations as often as the International Guidelines suggest for chronic obstructive pulmonary disease patients. Awareness of the importance of these vaccinations among both doctors and patients needs to be addressed

INTRODUCTION:We aimed to assess the relationship between peripheral eosinophilia and neutrophil/lymphocyte ratio with hospital admissions and re-admissions with chronic obstructive pulmonary disease (COPD) exacerbations.MATERIALS AND METHODS:An observational cohort study was carried out in a tertiary teaching hospital. Subjects with previously diagnosed COPD and who were admitted as outpatients with acute exacerbations were included. The subjects' characteristics, complete blood count (CBC) parameters, neutrophil to lymphocyte rate (NLR), C-reactive protein (CRP), mean platelet volume (MPV) on admission and re-admission within the first 28 days. Patients were grouped according to their peripheral blood eosinophilia levels; group 1, > 2% (eosinophilic), group 2, ≤ 2% (non-eosinophilic or neutrophilic). The recorded data from the two groups were compared.RESULT:1490 eligible COPD subjects were enrolled. Approximately 42% were classified as eosinophilic. The non-eosinophilic group had a significantly higher leukocyte count, neutrophil percentage, and NLR than the eosinophilic group. The NLR value in patients with repeat re-admissions was higher than the average, i.e., 4.50 (p= 0.001). MPV and CRP measured on admission and re-admission were similar in both groups. The rate of hospital re-admission within 28 days was significantly higher in patients with a non-eosinophilic attack.CONCLUSIONS:When a patient is admitted to outpatients with a NLR greater than 4.50 and with a non-eosinophilic exacerbation they have an increased risk of re-admission in the first month. Higher NLR values and non-eosinophilic exacerbations may be helpful for the early detection of potential acute attacks in COPD patients, and may be indicators for antibiotic management.

AIM: One of the common complication of advanced malignancy is malign pleural effusion(MPE).MPE causes progressive dyspnea,chronic cough,chest pain and reduced physical activity resulting lower quality of life(QoL)in patients.To prevent the reaccumulation of MPE and to improve QoL,pleurodesis has been performed.In this study it was hypothesized that patients with small bore catheter have shorter length of hospital stay(LOS)post-catheterization than patients with large bore catheter. METHODS: Adult patients who have been performed pleurodesis for malignant pleural effusions between 1 January 2012 and 31 December 2014 were enrolled into the study.Patients were classified into two groups according to catheter type;small-bore and large-bore catheter. RESULTS: Of the eligible 221 patients,67 ot them in small bore group and 118 of them in large bore catheter group were remained.While LOS post-catheterization was significantly shorter in small bore catheter group than large bore group(p<0.001),total length of hospital stay was not different between groups(p=0.89). The overlap range of propensity scores was found to be acceptable between groups to compare them.Length of stay post-catheterization was 1.8 days shorter with small bore catheter than large bore catheter by linear regression analysis adjusted to propensity scores(95%CI:-0.9 to -2.8,p<0.001). CONCLUSIONS: In this study it was found that LOS post-catheterization was significantly shorter with small bore catheter than large bore ones. Pleurodesis with small bore catheter is helpful to decrease post-procedure hospital stay which may be important for reducing costs and QoL in patients with advanced malignancy.

Background and Objective: There is some concern among physicians that a positive history of adverse reactions to drugs and/or atopic disease remains a risk factor for developing a hypersensitivity reaction to local anesthetics (LA). In the present study we aimed allergy testing to LA is justified in patients with a positive history of hypersensitivity reactions to drugs additionally by atopy and atopic diseases. Patients and Methods: A standard questionnaire regarding demographic data, history of atopic disease (asthma, allergic rhinitis, atopic dermatitis, urticaria) was filled out, total IgE and eosinophil count were assesed for each patient. Skin prick tests (SPT), intradermal test (IDT) and subcutaneus incremental challenge test (ICT) were perfomed step by step with adrenaline free aritmal (lidokain HCL 2%, Osel) and citanest (prilokain HCL 2%, Astra Zeneca). Results: 239 patients with history of drug allergy were admitted. When we look at the results of skin tests and provocations with LA; while positive results of SPT werent found, 3 of IDT and 4 of ICT were positive. Of the all 4 patients that reacted to LA, had rhinosinusitis and a positive SPT reaction with aeroallergens, 1 had also food allergy, 2 had asthma. Conclusion: There is no increased risk requiring performing skin and provocation test for LA in the patients with a history of hypersensitivity reaction to drugs alone but additionally by presence of atopy, atopic disease and multidrug allergy history can increase the risk of LA allergy, the amount of evidence is scarce.