Pervin Korkmaz Ekren

Comparison of Bronchoalveolar Lavage and Mini-Bronchoalveolar Lavage in the Diagnosis of Pneumonia in Immunocompromised Patients

Background: Pneumonia is a major cause of morbidity and mortality in immunocompromised patients. Bronchoalveolar lavage (BAL) is commonly used to help diagnose and characterize pneumonia in these patients. Mini-BAL is a less-invasive, less-costly and less-cumbersome diagnostic tool than BAL. Objectives: In this study, we compared the diagnostic value of BAL and mini-BAL in the evaluation of pneumonia in immunocompromised patients with respiratory failure. Methods: Sixty-four respiratory samples were collected from 32 immunocompromised patients admitted to our respiratory intensive care unit with a clinical diagnosis of pneumonia and respiratory failure requiring invasive mechanical ventilation. A single BAL sample and a single mini-BAL sample were collected from each patient. Samples were examined for bacteriologic, mycologic, mycobacteriologic, and viral organisms. Results: The mean age of the patients was 56.0 ± 14.4 years. Of the 32 BAL samples, bacterial isolates were detected in 11 patients (34.4%) and on the other hand bacterial isolates were detected in 10 patients (31.3%) of the mini-BAL samples. Fungal isolates were detected in 11 patients (34.4%) from BAL samples and 13 patients (40.6%) from mini-BAL samples. Our analysis demonstrated a strong positive correlation between the results of BAL and mini-BAL testing (r = 0.850 and r = 0.821, respectively). Conclusion: In this study, we demonstrated a strong correlation between the isolation rates of bacteria and fungi in BAL and mini-BAL samples obtained from immunocompromised patients with pneumonia and respiratory failure. The data strongly support the use of mini-BAL sampling in such patients as a less-invasive, less-costly and simpler alternative to traditional BAL.

Expression of p63, TTF-1 and Maspin in Non-Small Cell Lung Carcinoma and Their Effect on the Prognosis and Differential Diagnosis.

Abstract Objective: Lung cancer is still the leading cause of cancer mortality. Antiapoptotic genes and protease inhibitors play an important role in the development of lung cancer. Material and Method: p63, TTF-1 and maspin expression and their role in the differential diagnosis, overall survival, progression-free survival and other clinicopathological characteristics of the patients were investigated in 80 surgically-resected non-small cell lung carcinomas. Results: The maximal tumor diameter range was 1.5-11 cm (mean: 4.06±1.8 cm). Forty-five (56.3%) tumors were adenocarcinoma, 23 (28.8%) squamous cell carcinoma, four (5%) large cell carcinoma, six (7.5%) large cell neuroendocrine carcinoma, one (1.2%) sarcomatoid carcinoma while one was (1.2%) both adenocarcinoma and squamous cell carcinoma. The patients with advanced TNM stage and a tumor diameter more than 3 cm had markedly poor survival. Immunohistochemically, p63 staining was present in 87.5% of squamous cell carcinomas, 4.3% of adenocarcinomas, 25% of large cell carcinomas, and 16.7% of large cell neuroendocrine carcinomas. Similarly, maspin was positive in 66.7% of squamous cell carcinomas and 17.4% of adenocarcinomas. The TTF-1 staining rate was higher in adenocarcinomas (84.8%). There was no immunoreactivity in squamous cell carcinomas (p<0.001). We found that p63 and TTF-1 had no significant effect on survival in either tumor group (p>0.05) while maspin has a negative prognostic effect in adenocarcinoma (p=0.048). Conclusion: This study suggests that p63 and TTF-1 are reliable markers in non-small cell lung carcinoma and can be used in differential diagnosis. Maspin has been identified as a prognostic marker in adenocarcinoma. However, more studies are required to elucidate the significance of maspin. Öz Amaç: Akciğer kanseri, kanser ölümlerinin önde gelen nedenlerindendir. Antiapopitotik genler ve proteaz inhibitörleri akciğer kanseri gelişiminde önemli role sahiptir. Gereç ve Yöntem: Seksen opere küçük hücreli dışı akciğer karsinom olgusunda p63, TTF-1 ve maspin ekspresyonunun ayırıcı tanıya olan katkıları, sağkalım ve hastalıksız sağkalım üzerine etkileri ve diğer klinikopatolojik özellikler değerlendirildi. Bulgular: Ameliyat materyallerinde izlenen tümörlerin çapları 1,5-11 cm arasında (ort. 4,06±1,8) olup, 45 (%56,3) adenokarsinom, 23 (%28,8) skuamöz hücreli karsinom, dört (%5) büyük hücreli karsinom, altı (%7,5) büyük hücreli nöroendokrin karsinom, bir (%1,2) sarkomatoid karsinom ve bir (%1,2) adenokarsinom ve skuamöz hücreli karsinom birlikteliğinden oluşmakta idi. İleri TNM evreli ve üç cm’den daha büyük tümör çapı olan olgular daha kötü prognozlu idi. İmmünohistokimyasal incelemede skuamöz hücreli karsinomların %87,5’i, adenokarsinomların %4,3’ü, büyük hücreli karsinomların %25’i ve büyük hücreli nöroendokrin karsinomların %16,7’si p63 ile pozitif boyandı. Benzer olarak maspin de skuamöz hücreli karsinomlarda %66,7 ve adenokarsinomlarda %27,4 oranında pozitifti. TTF-1 ekspresyonu, adenokarsinomlarda oldukça yüksek oranda idi (%84,8). Skuamöz hücreli karsinomlarda immünreaktivite izlenmedi (p<0.001). p63 ve TTF-1, her iki tümör grubunda sağkalım üzerine etkili değil iken, maspin immünreaktivitesi adenokarsinomlarda kötü prognostik faktör idi (p=0,048). Sonuç: Çalışmamızda, p63 ve TTF-1’in küçük hücreli dışı akciğer karsinomlarında güvenilir belirleyiciler oldukları ve ayırıcı tanıda kullanılabilecekleri gösterildi. Maspinin adenokarsinomlarda prognostik bir belirleyici olduğu saptandı. Ancak maspin ile ilgili tüm çalışmalar henüz net değildir ve daha fazla çalışmaya ihtiyaç duyulmaktadır.

The association between Cytomegalovirus co-infection with Pneumocystis pneumonia and mortality in immunocompromised non-HIV patients

Impact of Cytomegalovirus (CMV) co‐infection pneumonia in non‐HIV patients with Pneumocystis jirovecii pneumonia (PCP) is unclear.

Evaluation of nephrotoxicity and prognosis in patients treated with colistin due to hospital-acquired pneumonia

Introduction Colistimethate sodium (CMS) is frequently used in the treatment of nosocomial multidrug-resistant gram-negative infections. Nephrotoxicity is the most important side effect. The aim of this study is to evaluate the effect of colistin on nephrotoxicity and to assess prognosis in patients treated with CMS due to hospital-acquired pneumonia (HAP). Materials and Methods Patients treated with CMS for HAP due to multidrug-resistant Pseudomonas aeruginosa or Acinetobacter baumannii were included in this cohort study. Result We evaluated 281 patients treated with two different brands of CMS whose administration dose is different: imported (n= 58, low dose/kg) and domestic (n= 223, high dose/kg). Nephrotoxicity developed in 175 patients (62.3%). The median age (73 vs. 66 years, p= 0.004) and mortality rates were higher (66.9% vs. 52.8%, p= 0.022) in patients having nephrotoxicity. The patients receiving high dose/kg had higher nephrotoxicity rate (67.7% vs. 41.4%, p< 0.001). The clinical, bacteriological response and mortality rates of the whole group were 52.0%, 61.0%, 61.6%, respectively. The clinical and bacteriological response rates were similar in the different dose groups. Multivariate analysis showed that nephrotoxicity was associated with domestic brand depending on use of high dose (OR= 3.97), advanced age (β= 0.29, p= 0.008), male gender (OR= 2.60), hypertension (OR= 2.50), red blood cells transfusion (OR= 2.54), absence of acute kidney injury (OR= 10.19), risk stage of RIFLE (OR= 11.9). Conclusions Nephrotoxicity is associated with the use of high dose colistin, age, gender, hypertension, red blood cells replacement and RIFLE stage. The mortality rate is higher in patients developing nephrotoxicity.