An unusual, life-threatening complication of EBUS-TBNA: Pneumoperitoneum.

Endobronchial ultrasound-guided with transbronchial needle aspiration (EBUS-TBNA) is a safe procedure. We present an unusual life-threatening complication after EBUS-TBNA in a 43-year-old female. She underwent EBUS-TBNA for enlarged lymph nodes evaluation. After EBUS-TBNA, a progressively worsening abdominal distension was observed. In computed tomography, subcutaneous emphysema, bilateral pneumothorax, pneumomediastinum and pneumoperitoneum were detected. This complication was successfully treated with chest tube insertion and bedside abdominal decompression. Even though EBUS-TBNA is considered to bear a low risk, the possibility of complication occurrence must be taken into account and clinicians must be more cautious about pulmonary barotrauma, especially when EBUS-TBNA is performed.

Highlights of clinical and laboratory parameters among severe COVID-19 patients treated with tocilizumab: a retrospective observational study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) can cause cytokine release syndrome (CRS), which leads to high mortality rates. Tocilizumab suppresses CRS by blocking the signal transduction of interleukin-6 (IL-6). OBJECTIVE: To evaluate the clinical and laboratory parameters associated with mortality among patients receiving tocilizumab treatment. DESIGN AND SETTING: Retrospective observational study conducted in the chest disease departments of two different training and research hospitals in the center of Ankara, Turkey. METHODS: Patients who were hospitalized and treated with tocilizumab in September 2020 were retrospectively analyzed. Their laboratory parameters and clinical characteristics were obtained from the hospital information system database. Comparative analyses were performed between the patients who died and the ones who survived. RESULTS: A total of 58 patients who received tocilizumab treatment were included in this study, among whom 35 (60.3%) died. There was no difference between the mortality and survival groups in terms of white blood cell (WBC), neutrophil, lymphocyte, ferritin or C-reactive protein (CRP) levels detected on admission. WBC, lymphocyte, neutrophil and CRP levels measured on the third and fifth days after tocilizumab administration were found to be significantly lower in the survival group (P < 0.05). In multiple logistic regression analysis, age and oxygen saturation were determined to be independent risk factors for mortality. CONCLUSION: Persistently high WBC, CRP and neutrophil levels and low lymphocyte levels could be considered to be valuable indicators of mortality among COVID-19 patients treated with tocilizumab. Age and low oxygen saturation are independent risk factors for mortality among patients receiving tocilizumab treatment.

Adverse effects associated with favipiravir in patients with COVID-19 pneumonia: a retrospective study

ABSTRACT BACKGROUND: Favipiravir is generally used in treating coronavirus disease 2019 (COVID-19) pneumonia in Turkey. OBJECTIVE: To determine the side effects of favipiravir and whether it is a good treatment option. DESIGN AND SETTING: Retrospective study conducted in Atatürk Chest Diseases and Chest Surgery Training and Research Hospital, Ankara, Turkey. METHODS: 357 patients who completed favipiravir treatment at the recommended dose were included. 37 patients with drug side effects and 320 patients without drug side effects were examined in two groups. RESULTS: Side effects were observed in 37 (10.36%) out of 357 patients using favipiravir. The most common side effect was liver dysfunction, in 26 (7.28%) of the patients. The following other side effects were also observed: diarrhea (1.4%), nausea (0.84%), abdominal pain (0.28%) and thrombocytopenia (0.28%). One patient (0.28%) presented both increased transaminases and nausea. CONCLUSION: In this study, it was determined that favipiravir may constitute an alternative for treating COVID-19 pneumonia given that its side effects are generally well tolerated and not serious.

Adverse effects associated with favipiravir in patients with COVID-19 pneumonia: a retrospective study.

BACKGROUND: Favipiravir is generally used in treating coronavirus disease 2019 (COVID-19) pneumonia in Turkey. OBJECTIVE: To determine the side effects of favipiravir and whether it is a good treatment option. DESIGN AND SETTING: Retrospective study conducted in Atatürk Chest Diseases and Chest Surgery Training and Research Hospital, Ankara, Turkey. METHODS: 357 patients who completed favipiravir treatment at the recommended dose were included. 37 patients with drug side effects and 320 patients without drug side effects were examined in two groups. RESULTS: Side effects were observed in 37 (10.36%) out of 357 patients using favipiravir. The most common side effect was liver dysfunction, in 26 (7.28%) of the patients. The following other side effects were also observed: diarrhea (1.4%), nausea (0.84%), abdominal pain (0.28%) and thrombocytopenia (0.28%). One patient (0.28%) presented both increased transaminases and nausea. CONCLUSION: In this study, it was determined that favipiravir may constitute an alternative for treating COVID-19 pneumonia given that its side effects are generally well tolerated and not serious.

Evaluation of Thiol/Disulfide Homeostasis in Lung Cancer.

OBJECTIVES: Lung cancer is one of the most common causes of mortality all around the world. The increased production of reactive oxygen species occurs with cell damage, and cysteine is an important factor in preventing oxidative damage by its functional thiol group. The objective of this study was to evaluate the relationship between thiol/disulfide homeostasis (TDH) and the risk factors, disease severity, and physical condition of patients with lung cancer. MATERIALS AND METHODS: This is a prospective, controlled, nonblinded study, which included healthy volunteers and patients diagnosed with lung cancer who had not yet started any treatment. RESULTS: There were 45 male (90%) and five female (5%) patients (mean age 64±9 years), and 41 male (82%) and nine female (18%) healthy volunteers (mean age 65±17 years) were included in this research. Overall, the thiol levels were lower in patients than the control group (p<0.001). The native thiol level means were 275±72 µmol/l in the patient group and 414±80 µmol/l in the control group, and the total thiol level means were 309±74 and 451±79 µmol/l, respectively. However, the disulfide parameter was not statistically significantly different between the two groups. There were no correlations between the tumor size and overall survival and the total thiol, native thiol, and disulfide levels. CONCLUSION: This study showed that there is a significant relationship between lung cancer and TDH, but there were no correlations with the disease stage and the clinical performance status.

Comparison of the International Classification of High-resolution Computed Tomography for occupational and environmental respiratory diseases with the International Labor Organization International Classification of Radiographs of Pneumoconiosis.

The International Classification of High-resolution Computed Tomography for Occupational and Environmental Respiratory Diseases (ICOERD) has been developed for screening and diagnosis of occupational lung diseases. We evaluated the association of icoerd with the International Labor Organization (ILO) classification and respiratory functions in pneumoconiosis. Chest x-rays of patients with pneumoconiosis were classified with ilo and icoerd using hrct, irregular opacity, pleural pathology, and emphysema was detected in 78, 19, and 53 patients, and using chest x-rays in 47, 4, and 14 patients, respectively. There was a significant correlation between ILO categories and ICOERD grades. There was a negative correlation between ILO categories and FEV1% and FVC%, whereas, ICOERD grades were not correlated with FEV1% and FVC%. HRCT was superior to chest x-rays to detect pneumoconiosis in early stage, but not in evaluating pulmonary functions.

A low-cost mobile adaptive tracking system for chronic pulmonary patients in home environment.

OBJECTIVE: The main objective of this study is presenting a real-time mobile adaptive tracking system for patients diagnosed with diseases such as asthma or chronic obstructive pulmonary disease and application results at home. The main role of the system is to support and track chronic pulmonary patients in real time who are comfortable in their home environment. It is not intended to replace the doctor, regular treatment, and diagnosis. MATERIALS AND METHODS: In this study, the Java 2 micro edition-based system is integrated with portable spirometry, smartphone, extensible markup language-based Web services, Web server, and Web pages for visualizing pulmonary function test results. The Bluetooth(®) (Bluetooth SIG, Kirkland, WA) virtual serial port protocol is used to obtain the test results from spirometry. General packet radio service, wireless local area network, or third-generation-based wireless networks are used to send the test results from a smartphone to the remote database. The system provides real-time classification of test results with the back propagation artificial neural network algorithm on a mobile smartphone. It also provides the generation of appropriate short message service-based notification and sending of all data to the Web server. In this study, the test results of 486 patients, obtained from Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital in Ankara, Turkey, are used as the training and test set in the algorithm. RESULTS: The algorithm has 98.7% accuracy, 97.83% specificity, 97.63% sensitivity, and 0.946 correlation values. The results show that the system is cheap (900 Euros) and reliable. CONCLUSIONS: The developed real-time system provides improvement in classification accuracy and facilitates tracking of chronic pulmonary patients.