Clinical results of high probability ventilation/perfusion scintigraphy in the diagnosis of pulmonary embolism.

Purpose: While computed tomography pulmonary angiography plays an effective role in the diagnosis and prognosis of pulmonary embolism (PE), there are not enough studies regarding ventilation/perfusion (V/Q) scintigraphy. We aimed to evaluate the clinical outcomes of PE patients whose V/Q scintigraphy was reported as high probability for PE. Method: Demographic data, Simplified Pulmonary Embolism Severity Index (SPESI), radiological findings, V/Q scintigraphy and echocardiographic (ECHO) findings, laboratory data, treatment information and comorbidities of 43 patients whose V/Q scintigraphy was reported as high probability for PE between January 2020 and January 2023 was recorded. Perfusion scintigraphy defects were classified as subsegmental, multiple subsegmental, segmental, and multiple segmental. Those with subsegmental, multiple subsegmental, and segmental perfusion defects were classified as Group 1, and those with multiple segmental defects as Group 2. Results: The mean age of the patients was 74 years (31-94), being 27 women (62.8 %) and 16 men (37.2 %), and there was no significant difference between the two groups. Multisegmental perfusion defect was detected in 23 (53.5 %) patients. 25 % of patients reported as high-probability PE had a SPESI score of ≥2. There was no significant difference between Groups 1 and 2 in terms of SPESI scoring. Perfusion defect had no significant correlation with SPESI score, D-Dimer, Troponin, pulmonary artery systolic pressure, right ventricular dilatation, and length of hospital stay. The presence of comorbidity was significantly positively correlated only with the SPESI score. There was no difference between the two groups regarding laboratory, radiological, echocardiographic findings, presence of comorbidity, unit of treatment, and duration of hospitalization. Conclusion: Parameters predicting clinical severity and providing treatment benefits are required in PE patients diagnosed with V/Q scintigraphy.

A rare cause of dysarthria: Legionnaires' disease.

PURPOSE/AIM OF THE STUDY: A case admitted with dysarthria and syncope and hyperintense lesion in the splenium of the corpus callosum, diagnosed as Legionnaires' disease by detecting Legionella antigen in the urine, and recovered only with antibiotic treatment is presented because it is rare in the literature. MATERIALS AND METHODS: When a 64-year-old female patient was admitted to the emergency department with complaints of sudden loss of consciousness and fainting at home, she had speech impairment, and her pulse oxygen saturation in room air was 88%. In the neurological examination, there was no pathological finding except dysarthria in the patient with no motor deficit. The patient had no respiratory complaints and had a recent travel history. In laboratory examinations, hyponatremia was detected with increased C-reactive protein and liver enzymes. Consolidation was observed in the lower right zone on chest computed tomography. Ampicillin + sulbactam (4x1 gr, intravenous) and clarithromycin (2 × 500 mg orally) were initiated. On cranial magnetic resonance, a hyperintense lesion was observed in the splenium of the corpus callosum in the oval T2 sequence. Legionella pneumophila serogroup 1 antigen in urine was reported as positive. On the fourth day of her hospitalization, the patient, whose CRP and liver enzyme values regressed, her hyponatremia improved, her pulse oxygen saturation increased to 92% in room air, and her speech became comprehensible, was discharged after oral antibiotic treatment was arranged. On the 12th day, the speech ability of the patient completely returned to normal. CONCLUSION: Legionella infection should be suspected in the presence of pneumonia and corpus callosum splenium lesion.

Lung cancer from suspicion to treatment: An indicator of healthcare access in Turkey.

BACKGROUND: Lung cancer is the leading cause of cancer-related deaths worldwide. Before beginning lung cancer treatment, it is necessary to complete procedures such as suspecting lung cancer, obtaining a pathologic diagnosis, and staging. This study aimed to investigate the processes from suspicion of lung cancer to diagnosis, staging, and treatment initiation. METHODS: The study was designed as a multicenter and cross-sectional study. Patients with lung cancer from various health institutions located in all geographic regions of Turkey were included in the study. The sociodemographic and clinical characteristics of the patients, the characteristics of the health institutions and geographic regions, and other variables of the lung cancer process were recorded. The time from suspicion of lung cancer to pathologic diagnosis, radiologic staging, and treatment initiation, as well as influencing factors, were investigated. RESULTS: The study included 1410 patients from 29 different medical centers. The mean time from the initial suspicion of lung cancer to the pathologic diagnosis was 48.0 ± 52.6 days, 39.0 ± 52.7 days for radiologic staging, and 74.9 ± 65.5 days for treatment initiation. The residential areas with the most suspected lung cancer cases were highly developed socioeconomic zones. Primary healthcare services accounted for only 0.4% of patients with suspected lung cancer. The time to pathologic diagnosis was longer in the Marmara region, and the wait time for staging and treatment initiation was longer in Eastern and Southeastern Anatolia. Patients who presented to chest disease referral hospitals with peripheral lesions, those with early-stage disease, and those who were diagnosed surgically had significantly longer wait times. CONCLUSION: The time between pathologic diagnosis, staging, and treatment initiation in lung cancer was longer than expected. Increasing the role of primary healthcare services and distributing socioeconomic resources more equally will contribute to shortening the time to diagnosis and improve treatment processes for lung cancer.

The incidence of deep venous thrombosis in Parkinson's disease.

INTRODUCTION: Venous thromboembolism is one of the causes of sudden death in Parkinson's Disease (PD). Few studies have investigated the correlation between PD and deep venous thrombosis (DVT). This study aimed to investigate the frequency of DVT in PD patients prospectively. MATERIAL AND METHOD: Demographic characteristics of 37 PD patients without known risk factors for DVT, disease duration, Hoehn-Yahr (H - Y) stage, oxygen saturation (SpO2) and heart rate values with pulse oximetry, use of assistive devices, waist and knee circumference measurements, and modified Medical Research Council (mMRC) dyspnea score was recorded. Both legs were evaluated for thrombus by Doppler venous ultrasound (US). RESULTS: With the H-Y stage of the disease duration, a positive correlation was determined between the H-Y stage and mMRC. Disease duration was negatively correlated with BMI and positively correlated with the need for assistance. Assistive device use was positively associated with age and mMRC. DVT was detected in only one patient. When our patients' files were reviewed after 1.5 years, one patient was hospitalized with the diagnosis of submassive pulmonary embolism. CONCLUSION: Attention should be paid to the development of DVT in elderly patients with advanced stages of PD, progression in the H-Y stage, use of assistive devices, and progression in dyspnea scoring. There is also a need for studies on the benefit of DVT prophylaxis in PD patients with a high risk of venous thromboembolism.

Coexistence of COVID-19, Pseudomonas, and thoracic actinomycosis in a cystic bronchiectasis case.

Actinomycosis often leads to cervicofacial infections, but thoracic involvement may also occur. However, the development of empyema is rare. While being followed up with the diagnosis of asthma and bronchiectasis, our case was hospitalized for infected bronchiectasis. As empyema developed in the follow-up, the pleural effusion was drained by tube thoracostomy. Actinomycosis was diagnosed through pleural effusion cytology. Growth of Pseudomonas aeruginosa was observed in sputum culture, and SARS-CoV2 RT-PCR was also positive in nasopharyngeal sampling. Polymicrobial agents can often be detected in actinomycosis. Actinomycosis cases have also been reported in the post-COVID period. Our case is presented since it would be the first in the literature regarding the coexistence of COVID-19, Pseudomonas, and thoracic Actinomycosis (empyema).

FACTORS AFFECTING PROGNOSIS AND MORTALITY IN SEVERE COVID-19 PNEUMONIA PATIENTS.

Fatality rate in coronavirus disease 2019 (COVID-19) cases has been reported to be 3.4% worldwide. The aim of this study was to evaluate the factors that determine prognosis and mortality in severe COVID-19 pneumonia patients. Eighty adult patients with severe COVID-19 pneumonia hospitalized and monitored at Izzet Baysal State Hospital (Bolu, Turkey) between August and November 2020 were included in this retrospective single-center study. Demographic and laboratory data, severity of radiological involvement, comorbidities, agents used in treatment, and clinical results were recorded, and data were grouped as survivors and non-survivors. The mean patient age was 67.8±12.6 years. There were 59 (73.8%) male patients. Comorbid diseases were present in 53 (66.3%) patients. There was no significant relationship between patient age, gender, smoking status or presence of comorbidity and mortality (p>0.05). The variables such as pulmonary involvement above 50%, intubation, or ferritin (>434.8 µg/L), troponin I (>14.05 ng/L) and procalcitonin (>0.125 ng/mL) as the sole variables of laboratory data were found to have significant relationship with increased mortality (p<0.05). Mortality was significantly higher in patients using steroid pulse therapy + tocilizumab, steroid pulse therapy + hydroxychloroquine, or solely steroid pulse therapy, while it was significantly lower in patients receiving azithromycin therapy and those in the plasma + steroid pulse therapy group. The severity of pulmonary involvement, intubation, and increase in inflammation markers such as ferritin, troponin and procalcitonin were found to be significantly associated with mortality (p<0.05). Treatment approaches with azithromycin and plasma + steroid pulse therapy were found to reduce mortality.

Post-COVID Pulmonary Function Test Evaluation.

OBJECTIVE: Since the lung is the most affected organ by COVID-19 disease, we aimed to evaluate the pulmonary function test, presence of hypoxemia, and Post-COVID-19 Functional Status Scale in 3- to 6-month post-COVID period. MATERIAL AND METHODS: Post-COVID-19 Functional Status Scale, pulse oxygen saturation, and pulmonary function test were evaluated in 67 outpatients/inpatients after 3-6 months following COVID-19 (positive reverse transcription-polymerase chain reaction on nasopharyngeal swab) disease. Pre-COVID pulmonary function test parameters were available in 33 patients, and these were compared with post-COVID pulmonary function test parameters. RESULTS: We found 20.9% (14 patients) restrictive and 11.9% (8 patients) obstructive patterns in pulmonary function test. Of those with forced vital capacity < 80%, 53.3% were patients without known lung diseases. When pulmonary function test values before and after COVID-19 were compared, only a loss of 130 mL in forced expiratory volume in 1 second was determined (P = .005). About 65.4% of the patients with dyspnea were in the group without a lung disease (P = .002) and 66.7% of patients with forced expiratory volume in 1 second and forced vital capacity of .05). Smoking, hospitalization, oxygen support, and the severity of computed tomography involvement did not impact pulmonary function test. CONCLUSION: In post-COVID patients, the major disorder in the respiratory function test was determined as a restriction. However, advanced tests such as lung volumes and carbon monoxide diffusing capacity (DLCO) measurement and high-resolution lung tomography are needed to differentiate in terms of physical functional limitation or parenchymal fibrosis.

Tracheal schwannoma mimicking asthma.

Schwannoma in primary neurogenic tumors of the trachea is an extremely rare disease. A 21-year-old male patient with stridor was followed up with a diagnosis of asthma for two years. While no lesion was observed in the chest X-ray, tracheal schwannoma was diagnosed in the case who underwent tracheotomy due to the lesion obstructing the trachea almost completely on chest CT. The clinical findings of the patient improved ultimately in the postoperative period. We aimed to discuss the approach and follow-up of the disease with our case, although it is rare that schwannoma might be in the differential diagnosis of masses with upper airway obstruction.

A rare cough complication: Internal oblique muscle hematoma.

Cough-related hematomas occur most frequently in the rectus sheath and retroperitoneum while lateral abdominal wall hematomas are rarely reported. Intramuscular hematoma might be mistaken for tumors and acute inflammatory diseases of the abdomen. A definite diagnosis is made with computerized tomography. In the case presented in this study, a 78-year-old female patient who had cough and shortness of breath for 1 week applied to the outpatient clinic with complaints of ecchymosis on the left side of the abdomen accompanied by swelling and pain under the left rib. The International Normalized Ratio of the patient, who used Warfarin sodium 5mg / day for mitral valve replacement, was in the effective range (INR: 2.4). Superficial ultrasound revealed a heterogeneous lesion with a well-circumscribed, hypoechoic and locally cystic component in the lateral abdominal wall in the left subcostal area. On computerized tomography, the lesion in the left internal oblique muscle of 27 × 60 mm, heterogeneous density, and with smooth borders was classified as Type 2 hematoma. Hemodynamics of the patient were stable and did not exceed INR 3 in follow-up, and there was no decrease in hemoglobin values. The patient's ecchymosis disappeared on the fifth day, and control ultrasonography showed the hematoma was partially resorbed. The aim of this study is to emphasize that conservative methods should be applied and surgery should be avoided as much as possible in internal oblique muscle hematoma.

[Investigation of Mycobacterium bovis subsp. bovis among the strains of Mycobacterium tuberculosis complex isolated in Düzce Province, Turkey]. / Düzce ilinde izole edilen Mycobacterium tuberculosis kompleks suslarinda Mycobacterium bovis subsp. bovis varliginin arastirilmasi.

Throughout the history of mankind, tuberculosis (TB) has caused serious illness and still continues to do so. Archaeobiological studies indicated that TB in humans dates back to 4000-8000 BC, and cases were shown to be due to Mycobacterium bovis subsp.bovis rather than Mycobacterium tuberculosis. Moreover, this situation was thought to begin with domestication of animals, consumption of their milk, and living together in the same environment with them. Over time, with the consumption of boiled milk and with the establishment of separate animal shelters, M.bovis subsp. bovis infection began to be seen rarely. Today, M.bovis infection is mostly transmitted from animals to humans and very rarely from humans to other humans. The most significant means of transmission of the infection are to the gastrointestinal tract via consumption of raw milk and to the respiratory system via droplet infection from the animals with disease. In this study, it was planned to investigate the cause of occurrence of TB in cattles in Düzce in the past few years along with the presence of bovine type TB in cases of human tuberculosis. We aimed to carry out subtype determination of the M.tuberculosis complex (MTBC) strains isolated in our mycobacteriology laboratory between the years 2004-2014, and evaluate the clinical and sociodemographic data of patients in whom M.bovis subsp. bovis was detected. The strains that were selected for the study have been isolated from radiometric BACTEC™ 12B broth and/or Löwenstein-Jensen (LJ) media between 2004-2009, and BACTEC™ MGIT™ (Mycobacteria Growth Indicator Tube) and/or LJ media between 2009-2014 periods. The GenoType MTBC Kit (Hain-Lifescience GmbH, Germany) was used in the study for determination of the subspecies. Extraction and amplification of DNA and hybridizations were performed according to test procedure in order to investigate the presence of subtypes of the MTBC species in skimmed milk from collections stored at -20°C. In the study, MTBC strains isolated from 220 patients (217 adults, 3 children; 145 male, 75 female) were evaluated and 217 (98.6%) of them were identified as M.tuberculosis/M.canettii and three (1.4%) as M.bovis subsp. bovis. When the distribution of the isolates were evaluated according to the years, it was noted that three (2.8%) cases out of 106 patients within the last three years, were found to be infected with M.bovis subsp. bovis, while none were detected in the 114 cases from the previous years. This data emphasized a parallel course with the reported cases of cattle tuberculosis in recent years. The risk factors, clinical and sociodemographic features, treatment process, outcomes, and mycobacteriological findings of those three patients were reviewed. Accordingly, the first case was a 63-year-old female with diabetes mellitus and chronic renal failure, who was dealing with animal husbandry. She was diagnosed as miliary TB on July 2012 and completed her treatment schedule. The second case, who was also dealing with animal husbandry was a 85-year-old male with prostate carcinoma. This case was diagnosed as pulmonary TB on December 2013, however he has quited the treatment and died two months later. The third case, a 27-year-old female was admitted to the hospital with a cervical mass that developed when she was working as a seasonal laborer. She was diagnosed to have lymph node TB in September 2014 and completed her treatment schedule. The strains isolated from the first and third cases were found to be susceptible to streptomycin (STR), isoniazid (INH), rifampicin (RIF) and ethambutol (EMB), while the strain isolated from the second case was susceptible to STR, INH and RIF, but resistant to EMB. All of the three isolates were resistant to pyrazinamide. As a result, it was concluded that large-scaled and attentive monitoring of TB infections in animals, as well as searching for M.bovis subsp. bovis in TB cases, especially in high-risk groups would be essential for an accurate diagnosis.