Is Mean Platelet Volume a Predictive Marker for the Development of Thrombosis in Patients with COVID-19 Infection?

Mean platelet volume (MPV) can provide important information about the course and prognosis of many diseases. MPV is an early indicator of platelet activation, which has an important role in the pathogenesis of thrombosis. In this study, we aimed to investigate whether MPV was a predictive marker for the development of thrombosis in hospitalized patients with COVID-19 infection. Fifty-seven patients whose courses were followed after the diagnosis of COVID-19 infection using a polymerase chain reaction test during the pandemic were included in the study. Our results demonstrated that there was a negative correlation between platelet count and MPV (r=0.470, p≤ 0.01), and there was a positive correlation between Platelet Distribution Width (PDW) and MPV (r=0,933, p≤ 0.01), but no significant correlation was found between the other variables and MPV.

Characteristics of our hypoxemic COVID-19 pneumonia patients receiving corticosteroids and mortality-associated factors.

BACKGROUND: COVID-19 is a disease associated with diffuse lung injury that has no proven effective treatment yet. It is thought that glucocorticoids may reduce inflammation-mediated lung injury, disease progression, and mortality. We aimed to evaluate our patient's characteristics and treatment outcomes who received corticosteroids for COVID-19 pneumonia. METHODS: We conducted a multicenter retrospective study and reviewed 517 patients admitted due to COVID-19 pneumonia who were hypoxemic and administered steroids regarding demographic, laboratory, and radiological characteristics, treatment response, and mortality-associated factors. RESULTS: Of our 517 patients with COVID-19 pneumonia who were hypoxemic and received corticosteroids, the mortality rate was 24.4% (n = 126). The evaluation of mortality-associated factors revealed that age, comorbidities, a CURB-65 score of ≥ 2, higher SOFA scores, presence of MAS, high doses of steroids, type of steroids, COVID-19 treatment, stay in the intensive care unit, high levels of d-dimer, CRP, ferritin, and troponin, and renal dysfunction were associated with mortality. CONCLUSION: Due to high starting and average steroid doses are more associated with mortality, high-dose steroid administration should be avoided. We believe that knowing the factors associated with mortality in these cases is essential for close follow-up. The use of CURB-65 and SOFA scores can predict prognosis in COVID-19 pneumonia.

Expert Opinion on Practice Patterns in Mild Asthma After the GINA 2019 Updates: A Major Shift in Treatment Paradigms from a Long-Standing SABA-Only Approach to a Risk Reduction-Based Strategy with the Use of Symptom-Driven (As-Needed) Low-Dose ICS/LABA.

PURPOSE OF REVIEW: This expert opinion, prepared by a panel of chest disease specialists, aims to review the current knowledge on practice patterns in real-life management of mild asthma and to address the relevant updates in asthma treatment by The Global Initiative for Asthma (GINA) to guide clinicians for the best clinical practice in applying these new treatment paradigms. RECENT FINDINGS: On the basis of the emerging body of evidence suggesting the non-safety of short-acting ß2-agonists (SABA)-only therapy and comparable efficacy of the as-needed inhaled corticosteroids (ICS)-formoterol combinations with maintenance ICS regimens, GINA recently released their updated Global Strategy for Asthma Management and Prevention Guide (2019). The new GINA 2019 recommendations no longer support the SABA-only therapy in mild asthma but instead includes new off-label recommendations such as symptom-driven (as-needed) low-dose ICS-formoterol and "low dose ICS taken whenever SABA is taken." The GINA 2019 asthma treatment recommendations include a major shift from long-standing approach of clinical practice regarding the use of symptom-driven SABA treatment alone in the management of mild asthma. This expert opinion supports the transition from a long-standing SABA-only approach to a risk reduction-based strategy, with the use of symptom-driven (as-needed) low-dose ICS/LABA in mild asthma patients, particularly in those with poor adherence to controller medications. The thoughtful and comprehensive approach of clinicians to these strategies is important, given that the exact far-reaching impact of this major change in management of mild asthma in the real-world settings will only be clarified over time.

The incidence of acute kidney injury and its association with mortality in patients diagnosed with COVID-19 followed up in intensive care unit.

INTRODUCTION: The kidneys are some of the most frequently affected organs during coronavirus disease 2019 (COVID-19). This multicenter study evaluated the incidence of and risk factors for acute kidney injury (AKI) in COVID-19 patients followed up in intensive care unit (ICU) and its association with mortality. METHODS: Three hundred twenty-eight patients diagnosed with COVID-19 and hospitalized in ICU were included. Risk factors associated with AKI and mortality were evaluated. RESULTS: Eighty-eight patients (27.9%) were diagnosed with AKI. AKI was significantly associated with older age, higher baseline creatinine level, lower albumin level, and coexistence of cardiovascular disease and chronic obstructive pulmonary disease. Mortality in the entire study group was significantly associated with AKI, older age, requirement of invasive mechanical ventilation, higher neutrophil level, lower lymphocyte, and albumin levels. CONCLUSION: AKI is frequently seen during the course of COVID-19 and is associated with high mortality. Identifying AKI-related risk factors appears essential in the management of COVID-19 patients.

Quantitative evaluation of computed tomography findings in patients with pulmonary embolism: the link between D-Dimer level and thrombus volume.

OBJECTIVE: To investigate the correlation of D-dimer levels and computed tomography properties of pulmonary embolism. METHODS: A total of 58 treated patients with diagnosis of properties of pulmonary embolism were retrospectively studied. All patients underwent a D-dimer blood test. In computed tomography images, septal angle, interventricular septal thickness, and the diameters of all cardiac chambers and pulmonary arteries were measured. The thrombus volume (load) and density at all pulmonary arteries (main, right, left pulmonary arteries, and segmental arteries) were calculated. RESULTS: A significant correlation was found between D-dimer and total thrombus volume (p=0.009, r=0.342). Total thrombus volume and total thrombus density were calculated with mean value of 23.40±60.63 ml and 66.16±38.48 hounsfield unit (HU), respectively. Right ventricle/left ventricle ratio showed positive correlation with the D-dimer level (p=0.02). CONCLUSION: Increased D-dimer levels with RV/LV ratio and their correlation with total thrombus volume suggest that it may be a prognostic factor.

Relationship between serum soluble endothelial protein C receptor level and COVID-19 findings.

Coronavirus-related disease-2019 (COVID-19)-associated coagulopathy presents predominantly with thrombosis and leads to complications in close association with inflammatory process. Soluble endothelial protein C receptor (sEPCR), which is the soluble form of EPCR, reduces the anticoagulant and anti-inflammatory activity of activated protein C. The purpose of this study is to investigate the relationship between sEPCR and the laboratory parameters and thorax computed tomography (CT) findings in the course of COVID-19. Twenty-five laboratory-confirmed [reverse transcription-quantitative polimerase chain reaction (RT-qPCR) positive] and 24 clinically diagnosed (RT-qPCR negative) COVID-19 patients were enrolled in the study. Blood specimens were collected for sEPCR and haematological and biochemical parameter measurement. Thorax CT was performed to detect COVID-19 findings. These parameters from RT-qPCR positive and negative patients were then compared. Although there was no difference between the groups in terms of symptoms, the time between the onset of symptoms and the admission time was shorter in RT-qPCR positive group (P = 0.000). sEPCR levels were significantly higher in the RT-qPCR positive group (P = 0.011). Patients with ground-glass opacity and bilateral involvement on thorax CT have higher serum sEPCR levels (P = 0.012 and 0.043, respectively). This study has shown for the first time that serum sEPCR levels, which is a member of coagulation cascade and has also been reported to be associated with inflammation, is higher in patients with positive RT-qPCR test and patients with GGO or bilateral involvement on thorax CT regardless of the PCR result.

Quantitative evaluation of computed tomography findings in patients with pulmonary embolism: the link between D-Dimer level and thrombus volume

SUMMARY OBJECTIVE: To investigate the correlation of D-dimer levels and computed tomography properties of pulmonary embolism. METHODS: A total of 58 treated patients with diagnosis of properties of pulmonary embolism were retrospectively studied. All patients underwent a D-dimer blood test. In computed tomography images, septal angle, interventricular septal thickness, and the diameters of all cardiac chambers and pulmonary arteries were measured. The thrombus volume (load) and density at all pulmonary arteries (main, right, left pulmonary arteries, and segmental arteries) were calculated. RESULTS: A significant correlation was found between D-dimer and total thrombus volume (p=0.009, r=0.342). Total thrombus volume and total thrombus density were calculated with mean value of 23.40±60.63 ml and 66.16±38.48 hounsfield unit (HU), respectively. Right ventricle/left ventricle ratio showed positive correlation with the D-dimer level (p=0.02). CONCLUSION: Increased D-dimer levels with RV/LV ratio and their correlation with total thrombus volume suggest that it may be a prognostic factor.

Carotid intima-media thickness in chronic obstructive pulmonary disease and survival: A multicenter prospective study.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is associated with increased cardiovascular morbidity and mortality. Carotid intima-media thickness (CIMT) is a noninvasive method assessing atherosclerosis. OBJECTIVE: It was aimed to determine relationship and survival between COPD and CIMT. METHODS: CIMT was measured using Doppler ultrasound (USG) in 668 stable COPD patients at 24 centers. Patients were followed-up for 2 years. RESULTS: There were 610 patients who completed the study. There were 200 patients CIMT with <0.78 mm (group 1), and 410 with CIMT ≥ 0.78 mm (group 2). There was a significant difference at the parameters of age, gender, smoking load, biomass exposure, GOLD groups and degree of airway obstruction (FEV1) between groups 1 and 2. Our results revealed positive correlations between mean CIMT and age, smoking load (pack-years), biomass exposure (years), exacerbation rate (last year), duration of hypertension (years) and cholesterol level; negative correlations between CIMT and FEV1 (P < 0.05). According to logistic regression model, compared with group A, risk of CIMT increase was 2.2-fold in group B, 9.7-fold in group C and 4.4-fold in group D (P < 0.05). Risk of CIMT increase was also related with cholesterol level (P < 0.05). Compared with infrequent exacerbation, it was 2.8-fold in the patients with frequent exacerbation (P < 0.05). The mean survival time was slightly higher in group 1, but not significant (23.9 vs 21.8 months) (P > 0.05). CONCLUSION: This study is the first regarding CIMT with combined GOLD assessment groups. It has revealed important findings supporting the increase in atherosclerosis risk in COPD patients. We recommend Doppler USG of the carotid artery in COPD patients at severe stages.

Desquamative interstitial pneumonia: Risk factors, laboratory and bronchoalveolar lavage findings, radiological and histopathological examination, clinical features, treatment and prognosis.

Desquamative interstitial pneumonia is a type of smoking-associated major idiopathic interstitial pneumonia, which is characterized by accumulation of alveolar macrophages in alveolar lumens and septa and develops secondary to mainly active or passive exposure to cigarette smoke. Desquamative interstitial pneumonia mostly occurs in male smokers in association with non-specific symptoms responsive to steroid therapy and has a better prognosis than usual interstitial pneumonia. To date, no large-scale clinical studies have been performed on desquamative interstitial pneumonia patients. Factors responsible for the scarcity of data on the clinical course of this condition include the retrospective nature of the available information as well as its rare occurrence. Despite this, a general consensus exists as to the nature of its symptoms, association with smoking, age and gender distribution, findings of respiratory function tests, steroid responsivity and mortality. The objective of the present review article was to report on desquamative interstitial pneumonia and to describe its etiology, risk factors and clinical features, as well as the laboratory, bronchoalveolar lavage, radiological and histopathological findings, and the treatment and prognosis of affected patients.

Effect of CPAP on New Endothelial Dysfunction Marker, Endocan, in People With Obstructive Sleep Apnea.

Obstructive sleep apnea (OSA) is associated with increased cardiovascular (CV) morbidity and mortality. Endocan is a surrogate endothelial dysfunction marker that may be associated with CV risk factors. In this study, we tested whether serum endocan is a biomarker for OSA. Serum endocan levels were measured at baseline in 40 patients with OSA and 40 healthy controls and after 3 months of continuous positive airway pressure (CPAP) treatment in the patients with OSA. All participants were evaluated by full polysomnography. Flow-mediated dilatation (FMD) and carotid intima media thickness (cIMT) were measured in all participants. Endocan levels were significantly higher in patients with OSA than in healthy controls. After adjusting confounders, endocan was a good predictor of OSA. Endocan levels correlated with OSA severity (measured by the apnea-hypopnea index [AHI]). After 3 months of CPAP treatment, endocan levels significantly decreased. Endocan levels were significantly and independently correlated with cIMT and FMD after multiple adjustments. The cIMT and FMD also had significant and independent correlation with AHI. Endocan might be a useful marker for the predisposition of patients with OSA to premature vascular disease.

Reduction Mammaplasty Effect on Pulmonary Function and Arterial Blood Gas in the Overweight Female.

BACKGROUND: This study sought to prospectively determine whether reduction mammaplasty improves the results of pulmonary function tests (PFTs) and arterial blood gas (ABG) measurements among overweight or obese women with macromastia and assess whether these changes are correlated with participant weight and body mass index (BMI) changes. METHODS: Thirty women who were overweight or obese and underwent bilateral reduction mammaplasty were included in this study. PFT and ABG measurements were performed within a 4-week period before reduction mammaplasty and 3 months after reduction mammaplasty. The following selected PFT parameters were used to diagnose the restrictive patterns of ventilatory defects: forced vital capacity (FVC), forced expiratory volume at one second (FEV1), the ratio of FEV1 to FVC expressed as a percentage (FEV1/FVC%), and the average FVC flow rate of 25-75 % (FEF 25-75 %). The ABG measurements included PaO2, PaCO2, HCO3, oxygen saturation, and pH. RESULTS: A significant difference was found between certain preoperative and postoperative PFTs (i.e., predicted FVC%, predicted FEV1% and predicted FEF 25-75 %) and between all of the preoperative and postoperative ABG measurements (pH, PaO2, PaCO2, HCO3, and Sat O2). A significant positive correlation was found between specimen weight and improvements in FEF 25-75 % and Sat O2. A significant positive correlation was found between the percentage reduction in BMI and the improvements in FEF 25-75 % and FVC. CONCLUSIONS: Overweight or obese women who underwent reduction mammaplasty showed significant improvements in certain PFT and all of the ABG measurements at 3 months after surgery. The more resected breast tissue predicts greater improvements in FEF 25-75 % and Sat O2, and greater reductions in BMI predicted increased improvements in FEF 25-75 % and FVC.

Growth Differentiation Factor-15 Is a Novel Biomarker Predicting Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

Exacerbations in chronic obstructive pulmonary disease (COPD) reduce quality of life and are associated with a more rapid deterioration of the disease. Growth differentiation factor-15 (GDF-15) is a novel candidate exacerbation biomarker. In this study, we aimed to assess GDF-15 as a biomarker of acute exacerbation of COPD (AE-COPD). Lung function parameters, arterial blood gas analysis, and circulating levels of GDF-15, C-reactive protein (CRP), and fibrinogen were assessed in 29 patients on admission to the hospital for AE-COPD, in 29 age-, gender-, and body mass index (BMI)-matched patients with stable COPD, and 29 matched controls with normal lung function. Patients with AE-COPD had higher circulating concentrations of GDF-15 (p < 0.001), CRP (p < 0.001), and fibrinogen (p < 0.002) compared with patients with stable COPD and healthy controls. GDF-15 levels correlated with systemic inflammatory marker CRP in patients with AE-COPD (r = 0.677, p < 0.001) and with stable COPD (r = 0.417, p = 0.024). Multivariate logistic regression analysis revealed GDF-15 (odds ratio 18.16, 95% confidence interval (CI) 2.51-134.32; p = 0.005) as an independent predictor of AE-COPD. In receiver operating characteristic analysis, GDF-15 achieved an area under the curve of 0.78 for the identification of AE-COPD. In conclusion, GDF-15 is a novel blood biomarker of AE-COPD that is more sensitive than that of CRP. GDF-15 may offer new insights into the pathogenesis of AE-COPD.

Association between serum fetuin-A levels, carotid artery stiffness, and intima-media thickness in patients with normotensive obstructive sleep apnea syndrome.

Increased carotid intima-media thickness (cIMT) and stiffness, reflecting subclinical atherosclerosis, are associated with obstructive sleep apnea syndrome (OSAS). The relationship between serum fetuin-A, which inhibits ectopic calcification, and atherosclerosis is unclear. Therefore, we investigated the association between serum fetuin-A levels and carotid artery stiffness and cIMT in patients with normotensive OSAS (n = 50) and non-OSAS controls (n = 38). Compared with controls, there were lower fetuin-A levels (59.4 ± 6.5 vs 68.2 ± 5.8 ng/mL, P = .029), higher mean cIMT (0.73 ± 0.2 vs 0.63 ± 0.3 mm, P < .001), and greater stiffness (ß) index (7.45 ± 0.9 vs 5.2 ± 0.7, P = .001) in the OSAS group. The cIMT and stiffness (ß) index were inversely correlated with fetuin-A levels (r = -.324, P = .033; r = -.466, P < .001, respectively) and positively correlated with apnea hypopnea index (r = .498, P < .001; r = .422, P = .001, respectively) in the OSAS group. Decreased serum fetuin-A levels were associated with subclinical carotid atherosclerosis in patients with normotensive OSAS.

Serum fetuin-A levels are associated with carotid intima-media thickness in patients with normotensive chronic obstructive pulmonary disease.

BACKGROUND: There are contradictory reports about the relationship between fetuin-A and atherosclerotic process. Coronary artery disease is the most important cause of mortality in patients with chronic obstructive pulmonary disease (COPD). We aimed to investigate the association of serum fetuin-A level with mean carotid intima-media thickness (cIMT) and ankle-brachial index (ABI) in COPD. METHODS: We evaluated the association of serum fetuin-A level, mean cIMT and ABI in normotensive subjects with COPD (n = 65) and with non-COPD (n = 50). RESULTS: Fetuin-A level was significantly lower (63.5 ± 19.8 ng/mL, 72.9 ± 16.2 ng/mL, p = 0.035) and C-reactive protein level higher (4 [1-10] vs. 3 [1-12] mg/dL, p = 0.034) in COPD patients than the control group. Compared to controls, fetuin-A level was significantly lower (63.5 ± 19.8 ng/mL, 72.9 ± 16.2 ng/mL, p = 0.035) and mean cIMT higher (0.69 [0.50-0.98] vs. 0.62 [0.44-0.98] mm, p = 0.034, respectively) in the COPD group. There was a significant negative correlation between mean cIMT and fetuin-A levels (r = -0.320, p = 0.032). Age (b ± SE: 0.002 ± 0.001, p = 0.008) and fetuin-A (b ± SE: -0.002 ± 0.001, p = 0.035) were decisive for the mean cIMT. CONCLUSIONS: There are increased cIMT values, decreased fetuin-A levels, but unchanged ABI values in patients with normotensive COPD. Age and fetuin-A were predictors for cIMT, while fetuin-A was negatively correlated with cIMT.

Childhood asthma and vitamin D deficiency in Turkey: is there cause and effect relationship between them?

BACKGROUND: Epidemiological studies show that vitamin D deficiency and insufficiency are common worldwide and associated with many diseases including asthma. Our aim was to evaluate vitamin D insufficiency and its clinical consequences. METHODS: This cross-sectional study was carried out on 170 children consisted of 85 who were asthmatic and 85 who were not, aged 2 to 14 years in Tekirdag, Turkey, from September 2009 to May 2010. Children's basal serum D vitamin levels were determined, and their eating habits, vitamin D intake, exposure to sunlight and use of health services during the previous year were investigated. The severity of asthma and levels of asthma control were assessed according to the Global Initiative for Asthma guidelines. RESULTS: The difference between mean vitamin D levels in the asthmatic group (mean +/- SD) 16.6 +/- 8.5 ng/mL and the healthy control group (mean +/- SD) 28.2 +/- 19.5 ng/mL was found to be statistically significant (p < 0.001). Children in the asthma group had less exposure to sunlight and ate a diet less rich in vitamin D (p < 0.001). A significant difference was observed between the groups regarding the frequency of respiratory tract infections leading to emergency unit admissions and number of hospitalizations (p < 0.001). It was also shown that a decrease in vitamin D level increased the severity of asthma (p < 0.001) and decreased the frequency of controlled asthma (p = 0.010). CONCLUSION: This study has demonstrated the correlation between plasma 25 (OH) D levels and childhood asthma. Evidently, this relationship being influenced by multiple factors other than vitamin D, further studies should be conducted to explore the interrelation between all such factors.

[The concordance of manuel (visual) scoring and automatic analysis in sleep staging]. / Uyku evrelemesinde manuel (görsel) evreleme ile otomatik evrelemenin uyumu.

Full night polysomnography (PSG) remains the gold standard diagnostic test for the evaluation of sleep and the detection of sleep disorders. The computer-assisted scoring methods have been developed to accelerate the scoring. It is said that there was a concordance up to 80% between these scoring softwares and manual scoring. According to our experiences, it is not matched with this belief. In this study, we intend to examine whether the results of automatic analysis match with manual (visual) evaluation. The PSG records of 30 cases with a diagnosis of obstructive sleep apnea syndrome (OSAS) are chosen randomly. We compare the results of automatic analysis with the results of two scorers who have a concordance of 80-95% and at least 1000 PSG scoring experiences. We evaluated 21.060 epochs of 18 men with 48.83 + or - 13.51 ages, and 12 women with 44.56 + or - 14.28 ages. In automatic analysis; total sleep time (p= 0.003) and sleep efficiency (p= 0.004) were low. AHI (p= 0.802) and ODI (p= 0.193) values were high. The epochs scored differently were 8819 epochs (41.88%). The stage I (88.43%) scored mostly different, was allocated to be awake (572 epochs). Stage II and stage IV were scored as stage III in 2276 and 983 epochs respectively. REM epochs were allocated to stage II (574 epochs). The differences in recording times and sleep architecture of PSG tests which examed by automatic analysis will affect all other parameters. Thus, we believe that it will make mistakes in the diagnosis and treatment of sleep disorders.

Prevalence of COPD: first epidemiological study of a large region in Turkey.

BACKGROUND: Although chronic obstructive pulmonary disease (COPD) is one of the leading causes of mortality and morbidity worldwide, epidemiological data on COPD is very limited. This study was designed to obtain some baseline data on COPD in the Malatya region of Turkey. METHODS: Sixty clusters from urban and rural regions were randomly selected. Ten and seven consecutive households were included in the study from each urban and rural cluster, respectively. A validated questionnaire on the epidemiology of COPD was completed for each participant over 18 by a pulmonary physician. Each subject underwent standard spirometric measurement and early bronchodilation testing. RESULTS: A total of 1160 participants completed the study (93%). Some 6.9% of the participants were found to have COPD (F/M=1/4). While the prevalence of COPD was 18.1% in current smokers over 40 years of age, the prevalence was 4.5% among younger smokers. Some 25.5% of the women and 57.2% of the men were current smokers. Biomass exposure, as a sole reason for COPD, was significantly common among female patients living in rural areas (54.5%). In the development of COPD, the relative risk ratio of cigarette smoke was found to be 3.4 and 3.3 times higher than biomass exposure and occupational exposure, respectively. CONCLUSIONS: Smoking rate and COPD prevalence were found to be unexpectedly high in the region, and biomass exposure is still an important cause of COPD, particularly among females living in rural areas. We think that national policies against smoking and biomass exposure should be implemented immediately.