Elif Sen

Sarcoidosis caused by interferon therapy

Abstract:  Interferon alpha (IFN‐α) is an immunomodulator that is used as an antiviral agent in active chronic viral hepatitis C. IFN therapy can cause an induction or exacerbation of sarcoidosis. Although several reports in the gastroenterology literature have suggested an association between IFN therapy and sarcoidosis, this association has rarely been described elsewhere. A 47‐year‐old woman developed sarcoidosis after cessation of treatment with IFN and ribavirin for chronic hepatitis C. Her sarcoidosis showed liver, pulmonary and skin involvement. She continues to be monitored regularly in the Department of Pulmonary Diseases without steroid therapy. Her sarcoidosis improved spontaneously. We conclude that patients should be monitored for sarcoidosis during and after IFN therapy.

Is There Any Difference in the Use of Complementary and Alternative Therapies in Patients Asthma and COPD? A Cross-Sectional Survey

Background. Data on the use and efficacy of complementary and alternative medicine (CAM) in patients with asthma are limited, and there is a lack of studies documenting the use of CAM in patients with chronic obstructive pulmonary disease (COPD) in Turkey. Aim. To determine the prevalence of CAM usage in patients with asthma and COPD and to assess the clinical and demographic factors associated with the use of CAM. Materials and methods. A total of 521 patients (313 with asthma and 208 with COPD) were randomly enrolled into this cross-sectional survey. A face-to-face interview was conducted using a structured questionnaire. Results. One hundred sixty-three patients (52%) with asthma and 70 patients (33%) with COPD were reported to be using some form of CAM (p < 0.001). The most popular modalities were herbal remedies (46% and 28% in the two groups, respectively) and animal products (28% and 5% in the two groups, respectively). CAM-practicing asthma patients were typically younger with longer duration of disease and higher income than the CAM-practicing COPD patients. For the patients, the main source of information on CAM practices was their relatives and friends. Only a small number of the patients consulted with their physicians about CAM. The main reasons to use CAM for patients with asthma and COPD were harmlessness and symptomatic relief, respectively. CAM-related adverse effects and difficulties to obtain CAM were significantly higher in patients with asthma than in patients with COPD. Conclusion. There is a high prevalence of CAM usage in patients with asthma and COPD in Turkey. Hence, becoming familiar with CAM therapy and inquiring about patient practice of CAM as part of the routine medical history will allow the physicians to provide reliable information to their patients on these medical practices.

Uso precoz de la ventilación mecánica no invasiva en pacientes con insuficiencia respiratoria hipercápnica aguda ingresados en una sala de neumología: estudio prospectivo

BACKGROUND In recent years, the optimal location for noninvasive mechanical ventilation (NIMV) has been a matter of debate. Our aim was to detect the effectiveness of NIMV in acute hypercapnic respiratory failure (AHRF) in respiratory ward and factors associated with failure. METHODS 69 patients treated with NIMV in respiratory ward were prospectively evaluated. The success of NIMV was defined as absence of need for intensive care unit (ICU) transfer with patients discharge from hospital (group 1), failure of NIMV was defined as need for ICU transfer (group 2). RESULTS The mean age was significantly higher in group 2. The cause of respiratory failure was COPD in 51 patients, obesity-hypoventilation syndrome in 14 and kyphoscoliosis in 4 patients. NIMV was successful in 55 patients and unsuccessful in 14. There was no significant difference between the two groups for pretreatment pH, PaCO₂ and PaO₂/FiO₂. After 1h and 3h of NIMV there was significant improvement in group 1. After 3h of NIMV, in group 1 respiratory rate was significantly decreased. The pretreatment APACHE II score, respiratory rate, frequency of pneumoniae, associated complication and comorbid disease was significantly higher in group 2. The success rate was higher in patients with good compliance to NIMV. CONCLUSION NIMV can be successfully applied in patients with AHRF in respiratory ward. The associated factors with NIMV failure are absence of early improvement in blood gases and respiratory rate, bad compliance to NIMV, older age, presence of associated complication, comorbid disease, pneumonia and high baseline respiratory rate.

Melanoma pulmonar maligno: ¿es fácil determinar su origen?

El melanoma maligno que afecta al sistema respiratorio tiene un origen casi siempre metastasico y los tumores primarios verdaderos son muy frecuentes. En la bibliografia se han publicado aproximadamente 28 casos. Son necesarios estudios clinicos y anatomopatologicos detallados para considerar que el pulmon es la localizacion primaria del tumor. En este articulo se presenta el caso de un varon de 67 anos de edad con un melanoma pulmonar maligno primario en el lobulo inferior derecho. Tambien se realiza una revision de la bibliografia.

Serum Endothelial Monocyte-Activating Polypeptide–II: A Novel Biomarker in Patients with Non–Small-Cell Lung Cancer

BACKGROUND Endothelial monocyte-activating polypeptide-II (EMAP-II) is a proinflammatory cytokine with antiangiogenic properties. Serum EMAP-II levels have not been investigated previously in non-small-cell lung cancer (NSCLC). The aim of this study was to examine the relationship between serum EMAP-II levels and clinicopathologic features, including prognosis, in patients with NSCLC. PATIENTS AND METHODS We measured serum EMAP-II levels in 30 healthy control subjects and 48 patients with untreated NSCLC by enzyme linkedimmunosorbent assay. RESULTS Patients with NSCLC had significantly higher serum EMAP-II levels than did the control group (492 pg/mL +/- 1126 pg/mL vs. 266 pg/mL +/- 1013 pg/mL; P = .015). No significant association was found between serum EMAP-II levels and various clinicopathologic features (age, smoking history, performance status, histopathology, tumor stage, lymph node stage, or distant metastasis). Median survival time was 10.13 months (range, 2-53.8 months). The high-EMAP-II (>or= 100 pg/mL) group had a shorter survival compared with the low-EMAP-II (< 100 pg/mL) group (P = .023), and the serum EMAP-II level was still an important predictor of survival in a multivariate analysis, along with disease stage. CONCLUSION Our results showed that serum EMAP-II levels are significantly higher in patients with NSCLC than in healthy subjects and suggest it is of potential prognostic value.

Adherence to GOLD guideline treatment recommendations among pulmonologists in Turkey

Background Low adherence to Global initiative for chronic Obstructive Lung Disease (GOLD) guideline recommendations has been reported worldwide. There has been no study on the adherence to GOLD guidelines for COPD treatment in Turkey. Objectives To investigate the rates of adherence to GOLD 2010 guidelines for COPD treatment among pulmonologists. Design A multi-center, cross-sectional, observational study was carried out in eleven pulmonary outpatient clinics across Turkey. Adherence to GOLD was evaluated through hospital records. Demographic and clinical data were recorded. Results Study included 719 patients (mean age: 62.9±9.7 years; males 85.4%) of whom 16 was classified as GOLD Stage I, 238 as II, 346 as III, and 119 as IV, and only 59.5% received appropriate treatment. Rates of guideline adherence varied across GOLD stages (I, 6.3%; II, 14.7%; III, 84.4%; and IV, 84%). Causes of inappropriate therapies were overtreatment (Stage I, 100% and Stage II, 91.1%), undertreatment (Stage III, 3.3% and Stage IV, 10.9%) and lack of treatment (Stage II, 3.8%; Stage III, 2.3%; and Stage IV, 5.9%). The most preferred regimen (43.4%) was long-acting β2-agonist-inhaled corticosteroid-long-acting muscarinic antagonist. Overall, 614 patients (89%) received treatment containing inhaled corticosteroid. Conclusion Pulmonologists in Turkey have low rates of adherence to GOLD guidelines in COPD treatment. Inappropriateness of therapies was due to overtreatment in early stages and excessive use of inhaled corticosteroid (ICS) in all disease stages.

Does the 2017 revision improve the ability of GOLD to predict risk of future moderate and severe exacerbation

In 2017 update, GOLD separated spirometry from ABCD classification.

Clinical characteristics of elderly patients with pulmonary embolism and risk factors for recurrence

Introduction: Elderly patients are at increased risk for pulmonary embolism (PE) and recurrence. Aim: To define clinical characteristics of elderly PE patients and risk factors for recurrence. Method: We retrospectively analysed PE patients aged 75 and over between 2010 and 2015. Results: There were 73 patients. Main risk factors for PE were:bedridden (24.6%), recent hospitalization (13.7%), active cancer (12.3%), recent surgery (5.4%) and previous deep vein thrombosis (DVT) history (6.8%). In hospital mortality was 2.7% (2 patients). One patient with previous multiple myeloma who was entubated due to respiratory failure and other patient died during catheter directed thrombolysis. Forty patients (56.3%) were discharged with warfarin, 30 (42.3%) with low molecular heparin and one with rivaroxaban. There wasn9t any in hospital bleeding. After discharge 5 patients (6.8%) had bleeding (3 epistaxis, 1 hematuria and 1 gastrointestinal). Patient with gastrointestinal bleeding died. Others didn9t need interventional procedures for bleeding. Eleven PE and 5 previous DVT total 16 (21.9%) venous thromboembolism (VTE) patients had recurrent PE. Statistically significant risk factors for recurrence were inadequate treatment of index VTE (p 0.048) and previous DVT history (p 0.048). Bedridden, recent hospitalization, comorbidities and discharge with warfarin or LMWH and treatment duration were not statistically significantly different between two groups. Conclusion: Duration of anticoagulation should comply with guidelines. Prophylaxis with LMWH is mandatory for hospitalized patients with previous VTE history. Major bleeding risk is low and shouldn9t be a reason for inadequate treatment or prophylaxis.