Özlem Erçen Diken

Electromagnetic navigation‐guided TBNA vs conventional TBNA in the diagnosis of mediastinal lymphadenopathy

Conventional transbronchial needle aspiration (C‐TBNA) is a safe method for the diagnosis of hilar and mediastinal lymphadenopathy (MLN). However, diagnostic yield of this technique varies considerably. Electromagnetic navigation bronchoscopy (ENB) is a new technology to increase the diagnostic yield of flexible bronchoscopy for the peripheral lung lesions and MLN. The aim of this prospective study was to compare the diagnostic and sampling success of ENB‐guided TBNA (ENB‐TBNA) in comparison with C‐TBNA while dealing with MLN.

Predictive Value of STOP-BANG on OSAS-Related Complications Following Coronary Artery Bypass Grafting

BACKGROUND: The time and conditions may not be suitable for performing polysomnography (PSG) before urgent or emergent surgeries, for example, a coronary artery bypass graft. Unavailability in many centers, critical clinical situation, and inability to arrange a timely scheduled appointment are other limitations for PSG. In this study, we aimed to investigate if the STOP-BANG Questionnaire may predict obstructive sleep apnea syndrome (OSAS) related postoperative pulmonary alterations during coronary artery surgery. METHODS: Sixty-one subjects who were scheduled to undergo elective isolated coronary artery bypass graft surgery and were consulted for preoperative pulmonary assessment were recruited to the study. The STOP-BANG Questionnaire was used with the subjects; then their relationship with postoperative complications was assessed. RESULTS: Results of the STOP-BANG Questionnaire revealed that 36.1% of subjects were at high risk for OSAS. Three groups were established according to the STOP-BANG Questionnaire (low risk, group 1; moderate risk, group 2; high risk, group 3) and study parameters, including PEEP value in ventilator, detection of apnea at ventilator, CPAP time after extubation, SpO2 1 h after extubation, postoperative hypoxemia, need for CPAP, and ICU length of stay revealed significant relationships among these groups. CONCLUSIONS: The STOP-BANG Questionnaire may predict the OSAS risk and OSAS-related pulmonary complications for patients who are candidates for a coronary artery bypass graft and unable to be evaluated with PSG before surgery due to technical or time-related limitations.

Rivaroxaban vs. warfarin on extended deep venous thromboembolism treatment: A cost analysis:

Background Standard treatment for deep venous thromboembolism involves parenteral anticoagulation overlapping with a vitamin K antagonist, an approach that is effective but associated with limitations including the need for frequent coagulation monitoring. The direct oral anticoagulant rivaroxaban is similarly effective to standard therapy as a single-drug treatment for venous thromboembolism and does not require routine coagulation monitoring. The aim of this analysis was to project the long-term costs and outcomes for rivaroxaban compared to standard of care (tinzaparin/warfarin). Methods A total of 184 patients who were under anticoagulant therapy with warfarin or rivaroxaban for extended deep venous thromboembolism were retrospectively evaluated; 59 received rivaroxaban and 125 received warfarin therapy. Assessments were made on age, gender, place of residence, the duration of anticoagulation, mean international normalized ratio value, the effective rate of international normalized ratio (time in the therapeutic range), bleeding-related complication rate, duration of hospitalization due to complications, the number of annual outpatient department admission, cost for drug, cost for hospitalization, cost for outpatient department admission and international normalized ratio measurements. Results The annual outpatient cost is higher in warfarin group (147.09 ± 78 vs. 62.32 ± 19.79 USD p < 0.001). But annual drug cost is higher in rivaroxaban group (362.6 vs. 71.55 ± 31.01 USD p < 0.001). Overall cost of rivaroxaban group is higher than warfarin group (476.25 ± 36.78 vs. 364.82 ± 174.44 USD). Warfarin is not cost-effective when non-drug costs (342.5 ± 174.44 vs. 113.65 ± 36.77) and hospital costs (173.85 ± 122.73 vs. 64.9 ± 23.55 USD) were analyzed. Conclusion This analysis suggests that rivaroxaban has lower costs than warfarin in terms of outpatient department admission and hospital costs due to complications; however, warfarin was more economic when all cost parameters were considered. Time in the therapeutic range was found as 56% for warfarin that should be taken into account while analyzing costs and benefits.

The predictive role of computed tomography on respiratory complications following coronary artery bypass surgery

1 Özlem Erçen Diken1, Adem İlkay Diken2, Adnan Yalçınkaya2, Sertan Özyalçın2, Muhammed Onur Hanedan3 1Department of Chest Diseases, Hitit University Faculty of Medicine, Çorum, 2Department of Cardiovascular Surgery Hitit University Faculty of Medicine, Çorum, 3Department of Cardiovascular Surgery, University of Health Sciences Faculty of Medicine, Ahi Evren Research and Training Hospital, Trabzon, Turkey Pulmonary risk and coronary surgery The predictive role of computed tomography on respiratory complications following coronary artery bypass surgery

Alpha-1 Antitrypsin Levels and Polymorphisms in Interstitial Lung Diseases

BACKGROUND/AIM Alpha-1 antitrypsin deficiency may be a potential predisposing factor for interstitial lung fibrosis. We investigated alpha-1 antitrypsin levels and its polymorphisms in patients with interstitial lung disease. MATERIALS AND METHODS A total of 103 interstitial lung disease patients were compared. RESULTS The mean alpha-1 antitrypsin level in idiopathic interstitial pneumonia patients was 1.67 ± 0.33 g/L, and it was 1.54 ± 0.37 g/L in patients with nonidiopathic interstitial pneumonia (P = 0.13). Low alpha-1 antitrypsin levels were more frequently observed in nonidiopathic interstitial pneumonia patients compared with idiopathic interstitial pneumonia, but the difference was not statistically significant (8.9% vs. 0%, respectively, P = 0.4). In 100 patients, the normal PiMM genotype was detected, while abnormal ones (PiMZ, n = 2, 1.9%; PiMS, n = 1, 0.97%) were determined in three cases. When the frequency of alpha-1 antitrypsin polymorphism in interstitial lung disease patients was compared with the data of the healthy population, no significant difference was detected for the PiMZ and PiMS variants (P = 0.15 and P = 0.44, respectively). CONCLUSION Lower levels of serum alpha-1 antitrypsin were more frequent in nonidiopathic interstitial pneumonia patients than idiopathic interstitial pneumonia without an increase in genetic polymorphism. The difference was not statistically significant.

A Case of Achalasia Causing Aspiration Pneumonia

Achalasia is a rare disease that can mimic respiratory symptoms. Chest pain occurs in up to half of patients with achalasia and aspiration pneumonia may occur rarely. In the absence of radiological suspicion of achalasia, a patient may initially be managed for respiratory conditions with subsequent development of complications like aspiration pneumonia, leading to a diagnostic delay. Therefore, this case presentation aims at contributing to clinicians’ awareness regarding this condition. A 36 year old female patients presented to our chest diseases department with chest pain and high fever. A contrast enhanced computed tomography of lung suggested achalasia and pneumonia. Achalasia was confirmed and treated with upper gastrointestinal endoscopy and barium swallow study. Treatment for aspiration pneumonia resulted in clinical and radiological improvement. A possible diagnosis of achalasia should be borne in mind by pulmonologists in the differential diagnosis of patients presenting with respiratory symptoms.

Neutrophilic Alveolitis and High Serum Pro-Brain Natriuretic Peptide Level may be Indicators of Pulmonary Functional Impairment in Connective Tissue Disorders

Objectives This study aims to assess the role of several diagnostic tests and tools, immune markers, and the association between serum pro-brain natriuretic peptide levels and other parameters in patients with collagen tissue disorders with pulmonary involvement. Patients and methods In this prospective study, 62 patients (17 males, 45 females; mean age 58.1±13.6 years; range 24 to 87 years) with pulmonary involvement of connective tissue disorders were evaluated using several functional parameters (six-minute walking test, serum pro-brain natriuretic peptide, echocardiographic measurement of the pulmonary pressure, respiratory functional parameters, and blood pressure measurement), bronchoalveolar lavage differential cytology and/or flow cytometric analysis. Results Duration of disease was 7.6 years. Diagnoses included rheumatoid arthritis (38.7%), scleroderma (38.7%), primary Sjögrens syndrome (16.1%), mixed collagen tissue disorder (4.8%), and systemic lupus erythematosus (1.6%). Pulmonary hypertension was present in 38.7% of the patients with the highest incidence of rheumatoid arthritis showing reduced respiratory functions, partial oxygen pressure, and six-minute walk distance, as well as increased serum pro-brain natriuretic peptide and neutrophilic alveolitis. Conclusion High serum pro-brain natriuretic peptide levels and neutrophilic alveolitis may provide diagnostic clues for a possible diagnosis of pulmonary hypertension and impaired respiratory functions.