Mahsuk Taylan

Is a complete blood cell count useful in determining the prognosis of pulmonary embolism

SummaryBackgroundPulmonary embolism (PE) is the third cardiovascular cause of hospital admission, following acute coronary syndrome and stroke. Despite high-tech diagnostic methods and new treatment modalities, PEs continue to have a high mortality rate within the first 3 months. This study was designed to assess the additional prognostic value of a complete blood cell count, renal function markers, C-reactive protein, and simplified pulmonary embolism severity index (sPESI) scoring system in PE 100-day mortality.Materials and methodsThe study retrospectively enrolled 208 consecutive patients who were hospitalized with the diagnosis of an acute PE. The patients’ demographic characteristics and clinical and laboratory parameters were recorded from the hospital electronic database and patient’s case notes. The primary end point of the study was an adverse 100-day outcome, defined as death from any cause.ResultsThe all-cause mortality in the first 100 days was 14.42 %. The mean age was 57.87 ± 18.17 (range: 16–93) years. We included 79 (38 %) male and 129 (62 %) female individuals. Red cell distribution width (RDW) and sPESI were found to be statistically significant predictors of PE mortality by multivariate regression analysis. On multivariate regression analysis, RDW was associated with a 4.08-fold (95 % confidence interval: 1.229–13.335, P = 0.021) increase in PE mortality.ConclusionThe results of this study demonstrated that RDW and sPESI may be a useful guide in predicting 100-day mortality. The elevated RDW may alert physicians to possible poor prognosis.ZusammenfassungGrundlagenDie Pulmonalembolie (PE) ist nach dem akuten Koronarsyndrom und dem Schlaganfall der dritthäufigste kardiovaskuläre Grund für eine Aufnahme ins Spital. Trotz hochtechnisierter Diagnostik und neuen Behandlungsmethoden haben Patienten mit einer PE noch immer eine hohe Mortalität innerhalb der ersten 3 Monate nach dem Ereignis. Die vorliegende Studie hat es sich zum Ziel gemacht, den zusätzlichen prognostischen Wert eines kompletten Blutbilds (kBB), des CRPs, von Markern der Nierenfunktion und von einem vereinfachten PE-Schweregrad Index (sPESI) in Bezug auf die Mortalität innerhalb der ersten 100 Tagen nach einer PE zu erheben.Material und MethodenDie Studie erfasste retrospektiv 208 konsekutive Patienten (79 (38 %) Männer, 129 (62 %) Frauen), die wegen der Diagnose einer akuten PE hospitalisiert worden waren. Die demographischen Charakteristika und Laborparameter wurden aus den elektronisch gespeicherten Spitalsdaten und individuellen Krankengeschichten erhoben. Der primäre Endpunkt der Studie war Tod jeder Ursache innerhalb der ersten 100 Tage.ErgebnisseDie Gesamtmortalität betrug 14,42 % innerhalb der ersten 100 Tage. Das mittlere Alter der Patienten lag bei 57,87 ± 18,17 (range: 16–93) Jahren. Die multivariate Regressionsanalyse ergab, dass die Verteilung der Erythrozytenbreite (RDW) und der erhobenen sPESI statistisch signifikante Prädiktoren der Mortalität nach PE waren. In dieser Analyse war die RDW mit einem 4,08 fachen (95 % CI: 1,229–13,335, P = 0,021) Anstieg der Mortalität nach PE verbunden.SchlussfolgerungenDie Ergebnisse dieser Studie zeigen, dass die RDW und sPESI im Bezug auf die Beurteilung der Prognose nach PE nützlich sein können. Erhöhte RDW könnten den Arzt auf eine möglicherweise schlechtere Prognose hinweisen.

Alterations of the neutrophil-lymphocyte ratio during the period of stable and acute exacerbation of chronic obstructive pulmonary disease patients.

We aimed to investigate the importance of neutrophil–lymphocyte ratio (NLR) in patients with chronic obstructive pulmonary disease (COPD) for identifying the severity of inflammation and recognition of acute exacerbation.

Fibulin-3 as a Diagnostic Biomarker in Patients with Malignant Mesothelioma

BACKGROUND New tumour biomarkers are being intensely investigated for malignant mesothelioma (MM). Fibulin-3 is produced in MM but its role remains uncertain. The aim of this study was to evaluate the validity of measuring serum fibulin-3 in the diagnosis and prognosis of MM. MATERIALS AND METHODS This prospective study was performed on 43 patients and 40 healthy controls who were admitted to our hospital between January 2012 and January 2014. Data from MM patients, including demographic and clinical features, routine laboratory data, levels of serum fibulin-3, and treatment outcomes were defined as potential prognostic factors. The receiver operating characteristic (ROC) curve for fibulin-3 was used to detect the cut-off value with highest sensitivity and specificity. Univariate survival analysis was performed using the Kaplan-Meier method in patients with MM. Afterwards, the possible factors identified with univariate analyses were entered into the cox regression analysis. RESULTS Our results revealed that patients with MM had significantly higher serum levels of fibulin-3 than controls. The results showed that the best cut-off point was 36.6 ng/ml with an AUC (area under the curve)=0.976, sensitivity=93.0% and specificity=90.0. In our study, the initial significant poor prognostic factors were advanced stage, high white blood cell count, high platelet count, high C-reactive protein (p<0.05 for each variable). Later, according to multivariate analysis the results showed only advanced stage as significant parameter (p=0.040). CONCLUSIONS We determined that real use for serum fibulin-3 was not for prognosis but for diagnosis in MM. Also advanced stage was associated with poor MM prognosis.

Alterations in platelet count and mean platelet volume as predictors of patient outcome in the respiratory intensive care unit

Thrombocytopenia is associated with increased mortality in intensive care unit (ICU) patients. Mean platelet volume (MPV) reflects platelet function and activation. Elevated MPV is associated with poor outcomes and increased mortality rate in diseases that are commonly encountered in the respiratory ICU.

Adult Diagnosis Of Swyer-James-Macleod Syndrome: Retrospective Analysis Of Four Cases

Swyer-James-Macleod syndrome (SJMS) is a rare constrictive bronchiolitis with air-flow obstruction and a decreased number and diameter of ipsilateral peripheral pulmonary vessels. This syndrome is characterized by unilateral hyperlucency on chest radiography. Computed tomography provides useful additional information. The diagnosis is usually made in childhood but sometimes occurs in adulthood. The disease often presents with dyspnea, decreased exercise tolerance, cough, hemoptysis, and recurrent pulmonary infections. SJMS may be confused with asthma or pulmonary embolism due to similar symptoms and may result in inappropriate therapy. This case series examined the clinical and imaging spectrum of four patients who were diagnosed with SJMS in adulthood.

A single imaging modality in the diagnosis, severity, and prognosis of pulmonary embolism.

Introduction. This study aimed to investigate the currency of computerized tomography pulmonary angiography-based parameters as pulmonary artery obstruction index (PAOI), as well as right ventricular diameters for pulmonary embolism (PE) risk evaluation and prediction of mortality and intensive care unit (ICU) requirement. Materials and Methods. The study retrospectively enrolled 203 patients hospitalized with acute PE. PAOI was calculated according to Qanadli score. Results. Forty-three patients (23.9%) were hospitalized in the ICU. Nineteen patients (10.6%) died during the 30-day follow-up period. The optimal cutoff value of PAOI for PE 30th day mortality and ICU requirement were found as 36.5% in ROC curve analysis. The pulmonary artery systolic pressure had a significant positive correlation with right/left ventricular diameter ratio (r = 0.531, P < 0.001), PAOI (r = 0.296, P < 0.001), and pulmonary artery diameter (r = 0.659, P < 0.001). The patients with PAOI values higher than 36.5% have a 5.7-times increased risk of death. Conclusion. PAOI is a fast and promising parameter for risk assessment in patients with acute PE. With greater education of clinicians in this radiological scoring, a rapid assessment for diagnosis, clinical risk evaluation, and prognosis may be possible in emergency services without the need for echocardiography.

High social anxiety and poor quality of life in patients with pulmonary tuberculosis.

AbstractPulmonary tuberculosis (PT) has been previously related with various psychosocial adverse consequences including stigmatization and social isolation.Social anxiety is a psychiatric condition that may be associated with social isolation and fear of social exclusion.To date no study has investigated social anxiety and its impact on quality of life (QoL) among patients with PT. Therefore, we aimed to determine the severity of social anxiety in a group of patients with PT.Among patients who were recently discharged from hospital with the diagnosis of PT 94 patients and 99 healthy control subjects who had similar demographical features have been included in the study. A psychiatrist interviewed all participants and a semistructured interview form, which was prepared by the authors, Liebowitz Social Anxiety Scale (LSAS), and Short Form-36 were administered to them.Patients with PT showed higher levels of performance avoidance and social avoidance than healthy control subjects. They reported lower QoL scores across all dimensions. Among patients women showed higher levels of LSAS subscale scores and total score. Fear of social exclusion was predicted by perceived illness severity and emotional role difficulty. On the other hand, perceived illness severity was predicted by fear of exclusion and sedimentation level.PT patients seem to experience higher levels of social anxiety and associated fear of social exclusion that add to their worse QoL during the earlier months of their disease. Among them fear of social exclusion is related with perceived illness severity.

Oxidative Status and Acute Phase Reactants in Patients with Environmental Asbestos Exposure and Mesothelioma

Background and Objectives. The aim of this study was to investigate inflammatory indicators and oxidative status in patients with asbestos exposure with and without mesothelioma and to compare results with data from healthy subjects. Methods. Eighty people with exposure to environmental asbestos and without any disease, 46 mesothelioma patients, and a control group of 50 people without exposure to environmental asbestos were enrolled in this prospective study. Serum total oxidant level (TOL), total antioxidant capacity (TAC), and oxidative stress index (OSI), CRP, transferrin, ceruloplasmin, α-1 antitrypsin, ferritin, and copper levels were measured. Results. Mesothelioma group exhibited higher TOL, OSI, α1-antitrypsin, ferritin and copper levels as compared to the other groups (P < 0.001, P = 0.007, P < 0.0001, P < 0.001, and P < 0.001, resp.). Transferrin was lower in the mesothelioma group than in the other two groups (P < 0.001). The asbestos group had higher TOL, TAC, α1-antitrypsin, and transferrin levels (P < 0.001, P < 0.001, P < 0.001, and P < 0.001, resp.), as well as lower OSI and ferritin levels as compared to the control group (P < 0.001 and P < 0.001). Conclusions. We believe that elevated acute phase reactants and oxidative stress markers (TOL and OSI) in the mesothelioma group can be used as predictive markers for the development of asbestos-related malignancy.

The Relationship of Fluid Overload as Assessed by Bioelectrical Impedance Analysis with Pulmonary Arterial Hypertension in Hemodialysis Patients

Background Pulmonary arterial hypertension (PAH) is common disease among hemodialysis (HD) patients and is associated with increased morbidity and mortality. However, its pathogenesis has not been completely elucidated. We aimed to evaluate the frequency of PAH in HD patients, as well as the relationship between fluid status and PAH. Material/Methods We enrolled 77 HD patients in this study. Multifrequency bioimpedance analysis (BIA) was used to assess fluid status. BIA was performed before and 30 min after the midweek of HD. Overhydration (OH)/extracellular water (ECW)% ratio was used as an indicator of fluid status. Fluid overload was defined as OH/ECW ≥7%. Echocardiographic examinations were performed before and after the HD. Pulmonary arterial hypertension was defined as systolic pulmonary artery pressure at rest (sPAP) higher than 35 mmHg. Results PAH was found in 33.7% of the HD patients. OH/ECW and the frequency of fluid overload were significantly higher in HD patients with PAH than those without PAH, whereas serum albumin and hemoglobin levels were significantly lower. sPAP level was significantly higher in HD patients with fluid overload than in those without fluid overload after hemodialysis session. Furthermore, sPAP, OH/ECW levels, and the frequency of PAH were significantly reduced after HD. We also found a significant positive correlation between sPAP and OH/ECW. Multivariate logistic regression analysis demonstrated fluid overload to be an independent predictor of PAH after HD. Conclusions PAH is prevalent among HD patients. This study demonstrated a strong relationship between fluid overload and PAH in HD patients.

Histopathological and Biochemical Effects of Ecballium elaterium on Sepsis-Induced Lung Injury

ABSTRACT Purpose: The aim of this study was to investigate the role of Ecballium elaterium (EE) on sepsis-induced lung injury. Materials and Methods: A total of 30 male rats were divided into three groups as follows: control, sepsis, and treatment groups (sepsis + EE) with each group containing 10 rats. A rat model of sepsis induced by cecal ligation and puncture (CLP) was used. In the treatment group, rats were injected intraperitoneally with 2.5 mg/kg EE after CLP. Interleukin-6 (IL-6), tumor necrosis factor (TNF)-α, total antioxidant status (TAS), total oxidant status (TOS), and oxidative stress index (OSI) values after a 24-hr period were measured via cardiac puncture. Animals were harvested after the procedure and biochemical analysis was done and histopathological changes of the tissue sections of lungs were examined thereafter. Results: A statistically significant decrease was observed in the IL-6 (p < .05), TNF-α (p < .05), and TOS (p < .01) levels in the sera of the treatment group compared to those of the sepsis group. Following the treatment, the TOS (p = .01) and OSI (p < .05) levels in the lung tissue of rats indicated a statistically significant decrease compared to those of the sepsis group. The histopathological follow-up undertaken after the administration of the EE treatment to septic rats showed significantly lower values of alveolar wall thickness (p < .001), interstitial edema (p = .018), and neutrophil infiltration (p = .047). Conclusion: EE treatment may have beneficial effects on sepsis-induced lung injury, and therefore has potential for clinical use.