Comparison of LMWH versus UFH for hemorrhage and hospital mortality in the treatment of acute massive pulmonary thromboembolism after thrombolytic treatment : randomized controlled parallel group study.

PURPOSE: Current guidelines recommend the use of low molecular weight heparin (LMWH) for most haemodynamically stable patients with pulmonary thromboembolism (PTE), however, it is not clear whether LMWH is preferable to unfractionated heparin (UFH) for the treatment of massive PTE. We aimed to compare the use of LMWH versus UFH after thrombolytic treatment in the management of acute massive PTE for hemorrhage and hospital mortality. METHODS: The study, a randomized, single center, parallel design trial, included the patients who had confirmed the diagnosis of massive PTE according to clinical findings and computerized thorax angiography and no contraindication to the treatment between January 2011 and October 2013. After thrombolytic treatment, the patients assigned to therapy with LMWH or UFH. Any hemorrhage, major hemorrhage, and hospital mortality were assessed. RESULTS: A total of 121 patients, 71 female (58.7 %) and 50 male (41.3 %), who had massive PTE with an average age 62.6 ± 15.7 (ranges 22-87) were included for analyses in the study. They were allocated to either LMWH (n = 60) or UFH (n = 61) group. Although the occurrence of any adverse event (21.7 vs 27.9 %) and each individual type of adverse event were all lower in the LMWH group compared to UFH group (6.7 vs 11.5 %, 3.3 vs 9.8 %, and 15.0 vs 19.7 % for death, major hemorrhage, and any hemorrhage, respectively), the differences were not statistically significant. CONCLUSIONS: Our findings suggest that LMWH might be a better option in the management of the patients with massive PTE. Multi-center larger randomized controlled trials are required to confirm our results.

Serum and bronchial aspiration fluid HE-4 levels in lung cancer.

Human epididymis 4 (HE-4) protein has been proposed as a tumor marker for lung and ovarian cancer. This study was designed to measure HE-4 levels in bronchial aspiration fluid (BAF) of patients with lung cancer and to describe the relationship of BAF HE-4 with known systemic increase in serum HE-4 levels. Sixty-four patients with lung cancer, 38 with benign lung disease and 19 healthy subjects, were enrolled in our study. The BAF was obtained during routine bronchoscopic procedure in patient groups. HE-4 levels in serum and BAF were measured with the commercially available kit by an enzyme-linked immunosorbent assay. Serum HE-4 levels were significantly higher in patients with lung cancer group (204.2 ± 22.9 pmol/L) than in benign lung disease group (135 ± 26.9 pmol/L, p = 0.001) and healthy subjects (14.8 ± 7.0 pmol/L, p < 0.0001). No significant difference was observed in terms of BAF HE-4 values in two patient groups. BAF HE-4 levels were significantly higher than those of serum levels in both patient groups (p < 0.0001). Serum HE-4 level was correlated with tumor stage (p = 0.001) and age (p < 0.0001) in the lung cancer group. The areas under the receiver operating characteristic (ROC) curve of serum HE-4 was 0.784 (95 % confidence interval (CI), 0.701-0.867) and that of BAF HE-4 was 0.496 (95 % CI, 0.382-0.610). This study shows that a systemic increase in serum of HE-4 is more prominent than a local increase of HE-4 (BAF), so this may suggest the feasibility of using serum instead of BAF samples for HE-4 measurements in lung cancer cases.

Is atmospheric pressure change an Independent risk factor for hemoptysis?

OBJECTIVE: Hemoptysis is one of the most important and challenging symptoms in pulmonary medicine. Because of the increased number of patients with hemoptysis in certain periods of the year, we aimed to investigate whether atmospheric changes have an effect on the development of hemoptysis with or without a secondary cause. METHODS: The data of patients presenting with hemoptysis between January 2006 and December 2011 were analyzed. Data on the daily atmospheric pressure (hectopascal, hPa), relative humidity (%), and temperature ((o) C) during that time were obtained. RESULTS: A total of 232 patients with hemoptysis, 145 male (62.5%) and 87 female (37.5%) with an average age of 48.1(±17.6), were admitted to our hospital between 2006 and 2011. The highest admission rates were in the spring season, the highest in May (n=37, 15.9%), and the lowest admission rates were in December (n=10, 4.3%). A statistically significant negative correlation was found between the number of hemoptysis cases and mean atmospheric pressure but no relative humidity or outdoor temperature. CONCLUSION: Hemoptysis is very much influenced by weather factors; in particular, low atmospheric pressures significantly affect the development of hemoptysis. Fluctuations in atmospheric pressure may also play a role in hemoptysis.

Two different dosages of nebulized steroid versus parenteral steroid in the management of COPD exacerbations: a randomized control trial.

BACKGROUND: The study aimed to compare the efficacy and safety of nebulized steroid (NS) with systemic corticosteroids (SC) and to determine optimal NS dose in the treatment of patients with COPD exacerbations requiring hospitalization. MATERIAL AND METHODS: The study was a randomized, parallel design trial. Eligible patients (n=86) were randomly allocated to 1 of the 3 treatment groups: parenteral corticosteroid (PS) (n=33), 4 mg (NB) (n=27), or 8 mg NB (n=26). Partial pressure of arterial oxygen (PaO2), carbon dioxide (PaCO2), pH, and oxygen saturation (SaO2) were evaluated at baseline, 24 h, 48 h, and discharge. Airway obstruction (forced vital capacity [FVC] and forced expiratory volume 1 s [FEV1]) was evaluated at admission and discharge. RESULTS: There were no significant differences between the groups for all parameters at all time periods, except for higher FEV1 value in the 8-mg NB group at baseline. In groups, significant differences were determined for FVC, FEV1, PaO2, and SaO2 (p<0.001), but not for PaCO2 and pH, in comparison to their baseline values. As adverse events, hyperglycemia and oral moniliasis were observed in the PS group (n=4) and in the NB groups (n=5), respectively, and treatment change was required in 9 patients (2 patients in the PS group and 7 patients in the NB groups) (p=0.57). CONCLUSIONS: Nebulized budesonide may be used as an alternative to SC because of its equal effectiveness and lesser systemic adverse effects. The choice of optimal dosage needs to be evaluated carefully because adverse effect and dropout rates varied according to dosage. However, there is a need for further studies including more severe cases and evaluating long-term outcomes or relapses comparing the 3 arms.

Effectiveness of pharmacologic therapies on smoking cessation success: three years results of a smoking cessation clinic.

BACKGROUND: Pharmacologic therapies have an important role in the success of interventions for smoking cessation. This study aims to determine the efficacy of several pharmacologic treatments in patients who applied to a smoking cessation clinic. METHODS: This retrospective study includes 422 patients who presented to our smoking cessation clinic between January 2010 and June 2013, used the pharmacologic treatment as prescribed and completed the one-year follow-up period. All patients were assessed using the Fagerström Test for Nicotine Dependence (FTND) and received both behavioral therapy and pharmacotherapy. Patients' smoking status at one year was assessed by telephone interview. RESULTS: The patients were 24.3% female (103/422) and 75.7% male (319/422) with a mean age of 38 ± 10 years. Patients were divided into three groups: varenicline (166 patients), bupropion (148 patients) and nicotine replacement therapy (108 patients).The smoking cessation rates of these groups were 32.5%, 23% and 52.8%, respectively, and were statistically significant (p > 0.001). The overall success rate was 35%. Further analysis revealed that pharmacologic therapy (p > 0.001) and gender (p = 0.01) were factors that showed statistically significant effects on smoking cessation rates. Males had higher success rates than females. The overall relapse rate was 21.6% and the bupropion group showed the highest relapse rate among treatment groups. Lack of determination emerged as the most important factor leading to relapse. CONCLUSION: Nicotine replacement therapy was found to be more effective at promoting abstinence from smoking than other pharmacologic therapies.

Low-molecular-weight heparin use with thrombolysis: is it effective and safe? Ten years' clinical experience.

BACKGROUND: There is no data on the use of subcutaneous low-molecular-weight heparin (SC LMWH) in cases that require thrombolysis. OBJECTIVE: Having used SC LMWH with thrombolytics for more than 10 years, we aimed to review our data, share our experiences and find out whether the use of SC LMWH with thrombolytics had been effective and safe. METHOD: This is a retrospective cohort study. Patients who were diagnosed as acute pulmonary embolism (PE) and received either SC LMWH treatment or SC LMWH with thrombolytics in our hospital (a tertiary hospital) between 2000 and 2010 were included in the study. For both treatments, the rates of mortality and complications were calculated. RESULTS: A total of 392 patients, 210 female (53.5%) and 182 male (46.5%) with an average age of 60 years, ±16 SD, with acute PE, were included in the study. Of these patients, 107 (27.2%) were massive and 285 (72.8%) were nonmassive and were administered SC LMWH plus thrombolytics and only SC LMWH, respectively. The mortality rate was 16.8% (18 of 107) in patients who were massive and 3.5% (10 of 285) for those who were nonmassive (p < 0.001). Major hemorrhage occurred in 3.7% (n = 4) and 0.7% (n = 2) and minor hemorrhage in 12.1% (n = 13) and in 3.8% (n = 11) of the cases who received SC LMWH plus thrombolytics and SC LMWH, respectively. CONCLUSION: SC LMWH use with thrombolytics seems to be feasible and safe. Prospective, large, randomized control trials are still required in order to confirm these results.

Bone mineral density in patients with obstructive sleep apnea syndrome.

PURPOSE: Obstructive sleep apnea syndrome (OSAS) is a disorder that is characterized by repetitive pauses in breathing during sleep. Airway obstruction episodes can lead to ischemia or hypoxia in tissues. Hypoxia may also have an effect on bone metabolism. In this study, we aim to investigate both the bone metabolic abnormalities and bone mineral density (BMD) in OSAS patients compared to individuals without OSAS. METHODS: Twenty-one male patients with OSAS and 26 control subjects, also male, enrolled in this study. Serum calcium, phosphorus, alkaline phosphatase, and urinary desoxypiridinoline levels were measured in all participants, and BMD was evaluated using DEXA (Hologic QDR 2000). The BMD was measured in the lumbar spine (L1-L4), the femoral neck, and total femur region. RESULTS: No statistically significant difference was noted between the two groups with respect to demographic data, except for body mass index (BMI). We adjusted the statistical analyses in line with the BMI and noted significant differences between OSAS patients and control subjects with regard to lumbar L1-L4 t score, lumbar L1-L4 BMD, and femoral neck BMD values (p ≤ 0.001). We find significant correlations with lumbar L1-L4 BMD (r = -0.4; p = 0.023) and lumbar L1-L4 t score values (r = -0.5; p = 0.012). CONCLUSION: Our study indicates that there is a relationship between OSAS and osteoporosis. However, further controlled studies comprising a greater number of patients are needed to investigate the relationship between osteoporosis and OSAS.

Persistence of nosocomial pathogens on various fabrics.

OBJECTIVE: Fabrics can become contaminated with high numbers of microorganisms that may be pathogenic to patients in a hospital setting and can play an important role in the chain of infection. The aim of this study was to investigate the survival of several clinical bacterial and fungal isolates on several fabrics commonly used in hospitals. MATERIALS AND METHODS: Bacterial and fungal survival was tested on the following materials, each of which are commonly used in our hospital: 100% smooth cotton, 60% cotton-40% polyester, 100% wool and 100% silk. One isolate each of Candida albicans, Candida tropicalis, Candida krusei, Candida glabrata, Candida parapsilosis, Geotrichum candidum, Aspergillus fumigatus, Cryptococcus neoformans, vancomycin resistant Enterococcus faecium (VRE, methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum beta-lactamase (ESBL) positive Escherichia coli, inducible beta-lactamase (IBL) positive Pseudomonas aeruginosa, IBL-positive Acinetobacter baumannii and Stenotrophomonas maltophilia were used to contaminate fabrics. The survival of these microorganisms was studied by testing the fabric swatches for microbial growth. RESULTS: The median survival times for all the tested bacteria and fungi were as follows: 26 days on cotton, 26.5 days on cotton-polyester, 28 days on silk, and 30 days on wool. Among the bacterial species tested, E. faecium had the longest survival time on cotton-polyester fabrics. For the fungal isolates, it was observed that C. tropicalis and C. krusei survived for the shortest amount of time on cotton fabrics in the present study. CONCLUSION: This survival data indicate that pathogenic microorganisms can survive from days to months on commonly used hospital fabrics. These findings indicate that current recommendations for the proper disinfection or sterilization of fabrics used in hospitals should be followed to minimize cross-contamination and prevent nosocomial infections.

Clinical value of detection of metastasis of carina in patients with non-small cell lung cancer.

BACKGROUND: Although the utility of blind biopsy in the detection of metastasis in the carina has been reported, submucosal fine needle aspiration (SMFNA) has not been evaluated. We investigated how SMFNA of the main carina and upper-lobe carina in addition to blind biopsy affect management of patients with NSCLC. METHODS: Thirty-five patients were evaluated. During fiberoptic bronchoscopy (FOB), five blind biopsy and three SMFNA specimens were collected from normal-appearing main carina (n = 35) and/or upper-lobe carina (n = 18). Subjects were staged for operability using traditional staging system, without knowing the blind biopsy or SMFNA results. Then, patients were staged again after results were made known. RESULTS: Thirty-five NSCLC patients were analyzed. The management of 12 patients (34%) was changed according to our results. Out of the patients, 8, 5 and one had microscopic metastasis in the main carina, ipsilateral upper-lobe carina and both, respectively. Although SMFNA were more diagnostic compared to blind forceps biopsy, there was no statistically difference between them. These procedures increased the success of detection of microscopic metastasis and the results changed management of those cases. CONCLUSION: SMFNA adds valuable information to blind biopsy, and their combination changed the management in one quarter of our NSCLC patients.

The effect of pulmonary hypertension on left ventricular diastolic function in chronic obstructive lung disease: a tissue Doppler imaging and right cardiac catheterization study.

BACKGROUND: Pulmonary hypertension (PH) caused by chronic obstructive lung disease (COLD) essentially involves the right heart. Also left ventricular (LV) systolic and diastolic functions may be affected. OBJECTIVES: The aim of this study was to investigate the effect of on LV diastolic function in patients with COLD. METHODS: A total of 47 patients with COLD and 20 controls were included in this study. All patients underwent Doppler echocardiography, tissue Doppler imaging examinations and right cardiac catheterization. The patients were divided into 2 subgroups according to mean pulmonary arterial pressure (mPAP): patients without PH (group1, n = 25) and with PH (group 2, n = 22). The following measurements were taken: peak velocity of early diastolic filling (E), peak late filling with atrial contraction (A), E/A ratio, deceleration time (DT) of E, isovolumic relaxation time (IVRT), early (Em) and late (Am) diastolic mitral lateral annulus velocity. RESULTS: Mitral E/A < 1 and Em < 8 cm/sec were higher in group 2 than in group 1 and the control group. There were significant correlations between mPAP and both mitral E/A (r:- 0.60) and Em (r:- 0.45). In multivariate model, mPAP was not found to be significant on mitral E/A ratio < 1, but there was a significant effect on mitral Em < 8 cm/sec (odds ratio [OR]:1.14, P < 0.05). CONCLUSION: This study shows that LV diastolic dysfunction in COLD is closely correlated to PH levels. Although increased mPAP may affect the mitral E/A ratio, it seems to have no effect on mitral E/A < 1, whereas it has an independent effect on Em < 8 cm/sec.

Analysis of HLA class I and II alleles regarding to lymph node and distant metastasis in patients with non-small cell lung cancer.

The aim of this study was to investigate the relation of HLA alleles in patients with non-small cell lung cancer (NSCLC). The incidence of class I and II HLA alleles of 63 patients with NSCLC were prospectively compared with the incidence of class I and II HLA alleles with 88 healthy controls. The number of cases with stage I and II (early stage) was 12 and there were 51 cases with stage III and IV (advanced stage). Metastasis rates of the regional lymph node in patients were as follow; N(0): n=10; N(1): n=13; N(2): n=26 and N(3): n=14. Lymph node metastasis was detected by pathological staging in 15 cases and by clinical staging in 48 cases. Lymph node metastasis was searched in all patients by a helical thorax CT. All distant metastasis were investigated by thorax CT, abdominal CT, brain CT or MRI and bone scintigraphy, and distant organ metastasis was detected in 25 cases. The patients and healthy controls were typed for HLA class I and II alleles. HLA-A2 was an independent risk factor for both critical lymph node (N(2 and 3)) involvement and distant metastasis. HLA-B44, -CW6 and -CW7 frequencies appear to be significant in controls compared to patients. HLA-A2 frequency was higher in patients with advanced stage than early stage, while HLA-A26, -B35 and -CW4 frequencies were more expressed in patients with early stage than in patients with advanced stage. Compared with controls, frequency of HLA-DRB1*07, -DQ02 and -DQ07 were lower expressed in patients. Compared patients with advanced stage, HLA-DRB1*07 was higher in patients with early stage. HLA-A2 was an independent risk factor for lymph node and distant metastasis, and the allele was significantly higher in patients with critical lymph node for surgery and distant metastasis. HLA-A26 appeared to be a significance protective allele against to metastases.

Prevalence and risk factors of allergies in Turkey: Results of a multicentric cross-sectional study in children.

The Prevalence And Risk Factors of Allergies in Turkey (PARFAIT) study was planned to evaluate prevalence and risk factors of asthma and allergic diseases and also to find out which geographical variables and/or climatic conditions play a role determining the prevalence of allergic diseases in Turkish school children. Study was planned as cross-sectional questionnaire-based. About 25,843 questionnaires from 14 centers were appropriate for analysis. Parental history of allergy, having an atopic sibling and other atopic disease in index case was significant risk factors for all allergic diseases. Breast feeding decreased the risk of current asthma (OR: 0.92, CI: 0.86-0.99) and wheezing (OR: 0.93, CI: 0.87-0.99) but not allergic rhinitis and eczema. Respiratory infection in the past was an important risk factor for the occurrence of allergic diseases especially for asthma which was increased 4.53-fold. Children exposed to household smoke were significantly at higher risk of asthma, wheezing, and allergic rhinitis (OR: 1.20, CI: 1.08-1.33; OR: 1.21, CI: 1.09-1.34; and OR: 1.32, CI: 1.21-1.43, respectively). All allergic diseases were increased in those children living in areas which have altitude of below 1000 m and mean yearly atmospheric pressure above 1000 mb. The study has suggested that household and country-specific environmental factors are associated with asthma, wheezing, allergic rhinitis, and eczema risk during childhood in Turkey.

Relationship between serum levels of some acute-phase proteins and stage of disease and performance status in patients with lung cancer.

BACKGROUND: Lung cancer is the leading cause of cancer death in both developed and developing countries. The aim of the present study was to compare serum levels of alpha1-acid glycoprotein, ceruloplasmin, transferrin, ferritin, and albumin with tumor stage, distant metastasis, lymphadenopa thy, and patient performance status in patients with non-small-cell lung cancer and those with small-cell lung cancer. MATERIAL/METHODS: The study was carried out in 46 patients with primary lung cancer (39 men and 7 women) and 34 healthy subjects as the control group. RESULTS: Serum ceruloplasmin and ferritin levels were higher and transferrin and albumin levels were lower both in non-small-cell and small-cell lung cancer patients than in controls. The levels of alpha1-acid glycoprotein and ferritin associated with both performance status and lymph node metastasis. CONCLUSIONS: Measurement of alpha1-acid glycoprotein and ferritin levels could be a useful prognostic factor in addition to performance status in patient with primary lung cancer.

Pigeon breeder's lung in childhood: is family screening necessary?

In this paper, we report on clinical and laboratory findings of pigeon breeder's lung (PBL) in a mother and her 2 children: 2 with the chronic recurrent form, and 1 with the chronic insidious form without any symptoms or signs, who was diagnosed during family screening. The index case was diagnosed as having primary pulmonary hypertension on admission. However, on evaluation, the diagnosis was of pigeon breeder's lung in the index case and her symptomatic mother. High-resolution computerized tomography (HRCT) revealed interstitial lung disease in an asymptomatic sister of the index case. All cases responded to steroid treatment, and at the end of the third month, HRCT findings disappeared. In conclusion, in patients with acute respiratory symptoms and rapidly recovering pulmonary hypertension after hospitalization, PBL should be remembered. All family members of the index case should be screened by HRCT in terms of interstitial lung disease, even if they are asymptomatic.

Clinical and social characteristics of the patients with tuberculosis in Eastern Anatolia.

Tuberculosis (TB) is an important public-health problem. The risk factors for TB are well-known. However, there may be some regional differences. In this study, we aimed to investigate the demographic characteristics and regional risk factors for TB and to discuss possible explanations for the difference. The study included totally 253 hospitalized patients (145 male and 108 female, with an average age 38+/-18) with TB (117 pulmonary and 136 extrapulmonary) between 1997 and 2004. Their demographic and clinical characteristics were reviewed. TB frequency was higher among the non-working females in urban area (38.3%). TB was also common in farmers which are male (19.8%). TB frequency was higher in the school persons including students, the teachers and the school officials (14.6%) and in the building workers compared with the other workers. There were a history of previous TB, TB exposure (mostly from family members) and associated disease in 10.3%, 14.2% and 17.4% of cases, respectively. The most encountered associated disease was diabetes. The results indicate that TB was most common among non-working females and was also increased among the men in rural areas, and schools seem to be an important source of TB transmission. Thus, an effective control program covering the treatment of cases with active disease, such as directly observed treatment, and especially preventive measures should be considered to control the disease transmission in our region.

Barometric pressure and the incidence of pulmonary embolism.

OBJECTIVES: Reports in the literature suggest that weather changes may play a role in venous thrombotic disease. An increase in patients with pulmonary embolism (PE) during the spring season led us to investigate the relationship between atmospheric pressure (AP) and the incidence of PE, as diagnosed in most of the patients by helical CT angiography, and in the minority of patients by conventional pulmonary angiography and lung scanning. METHODS: We retrospectively investigated the charts of 91 consecutive patients with a diagnosis of PE who were evaluated by the Department of Pulmonary Medicine between August 2000 and September 2004. We documented AP changes as recorded by the Erzurum Provincial Department of Meteorology. Of the 91 patients, the diagnosis of PE was made by helical CT angiography in 84 patients, isotope lung scan in 5 patients, and conventional pulmonary angiography in 2 patients. RESULTS: More patients presented in the spring months (March, n = 15; April, n = 10; and May, n = 12) than during other seasons (p < 0.001). The frequency of PE was inversely related to general average AP (r = - 0.70; p < 0.01). When the average seasonal AP was correlated with the incidence of PE, however, the relationship was found to not be statistically significant (r = - 0.66; p = 0.34). There was no correlation between the severity of PE or mortality and AP. CONCLUSIONS: The incidence of PE was significantly higher in the spring months, when AP was low. A regional study to capture all PE patients will need to be done to confirm our findings. Other meteorologic factors should be investigated regarding their effect on thromboembolic disease.

Glutathione peroxidase, glutathione-S-transferase, catalase, xanthine oxidase, Cu-Zn superoxide dismutase activities, total glutathione, nitric oxide, and malondialdehyde levels in erythrocytes of patients with small cell and non-small cell lung cancer.

Lung cancer is a common pathology with high mortality due to late diagnosis. Glutathione peroxidase (GSH-Px), glutathione-S-transferase (GST), catalase (CAT), xanthine oxidase (XO), Cu-Zn superoxide dismutase (Cu-Zn SOD) activities, total glutathione (TGSH), nitric oxide (NO*), and malondialdehyde (MDA) levels were investigated in erythrocytes of patients with non-small-cell lung cancer (NSCLC) and small-cell lung cancer (SCLC), and healthy control group. We aimed to investigate serum GSH, GSH-dependent enzymes activities (GSH-Px and GST), XO, CAT, Cu-Zn SOD activity, and NO*, and MDA levels in patients with NSCLC and with SCLC and correlate with the cancer stage. Erythrocyte MDA, NO*, TGSH levels and erythrocyte SOD, CAT and XO activities were significantly higher in patients with NSCLC and SCLC than in controls. Slightly increased erythrocyte GSH-Px and GST activities were not significantly different from the controls. Erythrocyte MDA level positively correlated with erythrocyte NO* levels in patients with early stage (I+II) in NSCLC groups. Erythrocyte MDA level positively correlated with erythrocyte XO activity in patients with advanced stage (III+IV) in NSCLC groups. However, no other correlation could be found among the parameters in healthy controls and patients with NSCLC and with SCLC. Results obtained in this study indicate significant changes in antioxidant defence system in NSCLC and SCLC patients, which may lead to enhanced action of oxygen radical, resulting in lipid peroxidation.

Serum IL-18 levels in tuberculosis: comparison with pneumonia, lung cancer and healthy controls.

OBJECTIVE: The aim of the present study was to document the serum IL-18 levels in patients with pulmonary tuberculosis (P-TB), extrapulmonary tuberculosis (EP-TB), pneumonia, lung cancer and in healthy controls, and to investigate whether it may assist in the differential diagnosis of P-TB. METHODOLOGY: A total of 116 patients were included in the study. The study population consisted of patients with P-TB, EP-TB, pneumonia and lung cancer and controls. P-TB patients were graded according to sputum positivity and extent of disease. Serum levels of IL-18 (ELISA) were compared between groups and with other clinical measures of disease. RESULTS: Compared with the controls, all groups of patients had increased serum levels of IL-18. The highest mean concentration of IL-18 was observed in P-TB. Serum levels of IL-18 in the patients with P-TB correlated well with the extent of disease. CONCLUSIONS: Although increased serum levels of IL-18 were not specific for TB, the increased levels may favour active TB in radiologically advanced disease where CXR findings are difficult to interpret, and sputum smears or cultures are not helpful.

[The pathogens and their antibiotic sensitivities in hospital-acquired pneumonia cases]. / Hastane kökenli pnömoni olgularinda etkenler ve antibiyotik duyarliliklari.

Dynamic precautions in the early diagnosis and treatment of hospital acquired pneumonias are necessary because of their high mortality. In these patients, invasive diagnostic approaches may be needed since clinical and radiological findings and other non-invasive approaches frequently fail to establish the diagnosis. Thirty eight patients were prospectively included in the study. Average age of patients was 45.5 +/- 16.4 years; 31 were males (81.6%) and 7 (18.4%) were females. Pneumonia was detected in 9 (23.7%) cases during the first five days and in 29 (76.3%) cases after the fifth day of admission to the hospital. Bronchoscopic interventions diagnostic purpose were carried out in 25 (65.8%) patients. The culture results were negative in 7 (18.4%) cases. While more than one pathogen was determined on the cultures of 16 (42.1%) patients only one pathogen was isolated in the cultures of 15 (39.4%) cases. The frequently isolated pathogen on cultures was Staphylococci (45.4%). Other pathogens were Enterobacter spp., Pseudomonas spp., Escherichia coli, Serratia and Streptococcus pneumoniae according to their frequency on cultures. High resistance rates to the third generation cephalosporins were determined. Eleven of 17 deaths in 38 pneumonia cases were attributable to pneumonia. As a conclusion, isolation of pathogen and antibiotic resistance should be determined in the cases with hospital acquired pneumonia. Invasive diagnostic interventions were not avoided when necessary. Although pro-BAL and PSB methods were expensive, their use in selected cases may prevent unnecessary antibiotic use and contribute to a decrease in mortality rate.