Bronchiectasis After Solid-Organ Transplant: A Retrospective Single Center Study.

OBJECTIVES: Bronchiectasis is characterized by abnormal, persistent, and irreversible enlargement of the bronchi. Many etiological factors have been described, but there are limited data on the development of bronchiectasis after organ transplantation. Our study is the first to study evaluate the frequency of bronchiectasis in heart and liver transplants as well as kidney transplants. Our aim is to analyze the frequency of bronchiectasis development after solid-organ transplant and the characteristics of the cases and to evaluate potential relationships. MATERIALS AND METHODS: We retrospectively analyzed data of patients who underwent solid-organ transplant at the Baskent University Faculty of Medicine Hospital through the hospital electronic information system. Demographic, clinical, and laboratory data and thoracic computed tomography scans were evaluated. RESULTS: The study included 468 patients (151 females/317 males). Kidney transplant was performed in 61.5% (n = 207), heart transplant in 20.3% (n = 95), and liver transplant in 18.2% (n = 85) of patients. Development of bronchiectasis was detected in only 13 patients (2.7%). We determined a 13.64-fold risk of developing bronchiectasis in patients with chronic obstructive pulmonary disease and 10.08-fold risk in patients with pneumonia by multivariate regression analyzes, in which all possible risk factors for the development of bronchiectasis after transplant were evaluated. CONCLUSIONS: The pathophysiology of transplantassociated bronchiectasis has not yet been clarified. Underlying diseases, recurrent pulmonary infections, and potential effects from immunosuppressive drugs may contribute to the pathogenesis of bronchiectasis. Further prospective studies are needed to include long-term health outcomes in transplant patients with and without bronchiectasis.

Influenza viruses and SARS-CoV-2 in adult: 'Similarities and differences'.

INTRODUCTION: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), causing a global pandemic starting from December 2019, showed a course that resulted in serious mortality in the world. In order to understand SARSCoV-2 better, here we aimed to compare the similar and different characteristics of Influenza viruses occurring in the same season with SARS-CoV-2. MATERIALS AND METHODS: A total of 144 patients (31 patients with COVID-19, 62 patients with H1N1 influenza, and 51 patients with influenza B) were included in the study. Demographic findings, chronic diseases, laboratory values, chest x-ray, and chest CT findings of the patients were evaluated retrospectively. RESULT: Median age of the COVID-19 patients and rate of male patients were higher than other patient groups (55 years; p< 0.001) (61% male; p< 0.001). The most common chronic medical conditions were hypertension and diabetes. Platelet numbers and alanine aminotransferase values were significantly higher in COVID-19 patients. Radiologically, bilateral (74.2%) and nonspecific distribution (58.1%), ground-glass opacities with consolidation (51.6%), patchy image (25.8%), ground-glass opacities with interstitial changes (22.6%) and halo sign (22.6%) were quite evident than other groups in COVID-19 patients (p< 0.05). CONCLUSIONS: We suggest that due to the higher PLT values observed in COVID-19 patients, initiation of anticoagulant therapy should be considered in the early stage and routine follow-up with d-dimer and fibrinogen should be applied for suspected patients. Moreover, attention should be paid in terms of possible liver toxicity of the drugs to be used in treatment due the higher ALT values observed in COVID-19 patients. Since we did not detect SARS-CoV-2 and influenza viruses concurrently in the same patient, it may be helpful to focus on only one virus in a patient with symptoms, and radiographic differences can be used to differentiate COVID-19 from influenza.

The Relationship between COVID-19 Severity and Bacillus Calmette-Guérin (BCG)/ Mycobacterium tuberculosis exposure history in healthcare workers: a multi-center study.

The COVID-19 pandemic has brought countries' health services into sharp focus. It was drawn to our group's attention that healthcare workers (HCWs) had a lower mortality rate against higher COVID-19 incidence compared to the general population in Turkey. Since risk of exposure to tuberculosis bacillus among healthcare workers are higher than the population, we aimed to investigate if there is a relationship between BCG and Mycobacterium tuberculosis exposure history with COVID-19 severity in infected HCWs. This study was conducted with 465 infected HCWs from thirty-three hospitals to assess the relationship between COVID-19 severity (according to their hospitalization status and the presence of radiological pneumonia) and BCG and Mycobacterium tuberculosis exposure history. HCWs who required hospital admission had significantly higher rates of chronic diseases, radiological pneumonia, and longer working hours in the clinics. Higher rates of history of contact and care to tuberculosis patients, history of tuberculosis, and BCG vaccine were observed in hospitalized HCWs. HCWs who had radiological pneumonia had a significantly increased ratio of history of care to tuberculosis patients and a higher family history of tuberculosis. The findings from our study suggest that the lower mortality rate despite the more severe disease course seen in infected HCWs might be due to frequent exposure to tuberculosis bacillus and the mortality-reducing effects of the BCG vaccine.

The evaluation of retinal and choroidal structural changes by optical coherence tomography in patients with chronic obstructive pulmonary disease.

PURPOSE: To evaluate the retinal nerve fiber layer (RNFL) thickness, ganglion cell-inner plexiform layer (GCL+) thickness, and macular choroidal thickness (mCT) in patients with chronic obstructive pulmonary disease (COPD) using spectral domain optical coherence tomography (SD-OCT). METHODS: A total of 79 COPD patients and 71 age- and sex-matched healthy individuals were enrolled in this prospective cross-sectional study. The patients were divided into two subgroups (with mild-to-moderate COPD and severe COPD) using spirometric data suggested by the Global Initiative for Chronic Obstructive Lung Disease guideline. The RNFL, GCL+, and mCT were compared between groups. RESULTS: The average and nasal RNFL thicknesses in the COPD group were significantly lower than those in control group (p = 0.023 and 0.027 respectively). Statistically significant reductions in average thickness and in those of all six wedge-shaped GCL+ sectors were evident in the COPD group compared with control group and were more marked in patients with severe COPD. The other RNFL data did not differ significantly between COPD and control groups. The mCT was somewhat thinner at all the measured locations in COPD group compared with control group, but statistically significance was not attained. CONCLUSIONS: The study results revealed significant average, nasal RNFL, global GCL+ loss, and a nonsignificant choroidal thinning in patients with COPD compared to healthy subjects. The eye seems to be one of the affected tissues during the natural course of the COPD.

What should be done in the event of simultaneous massive pulmonary embolism and myocardial infarction with ST elevation?

Massive pulmonary embolism (MPE) and acute myocardial infarction (AMI) are life-threatening conditions with well-known diagnosis and treatment. Symptoms and findings such as dyspnea, chest pain, hypotension, ECG changes and elevation of cardiac enzymes are seen in both diseases. However, MPE and AMI are rarely simultaneous in a single case. This report presents an 85-year-old patient with simultaneous MPE and AMI with ST elevation. While treatment strategies for both MPE and AMI have been adequately described, it is not clear which treatment to choose when both emergency pathologies occur simultaneously in one patient. This case report discusses the treatment of these two diseases in such a case.