Outcome of Patients Admitted to Intensive Care Units due to Influenza-Related Severe Acute Respiratory Illness in 2017-2018 Flu Season: A Multicenter Study from Turkey.

BACKGROUND: Influenza can cause severe acute respiratory illness (SARI), which occurs as local outbreaks or seasonal epidemics with high intensive care unit (ICU) admission and mortality rates. Mortality is mainly due to SARI. OBJECTIVE: The aim of this study was to evaluate the outcome of patients admitted to ICU due to influenza-related SARI in 2017-2018 flu season in Turkey. METHODS: A retrospective multicenter study was conducted in 13 ICUs with a total of 216 beds from 6 cities in Turkey. All adult patients (over 18 years) admitted to the ICUs in 2017-2018 flu season (between September 1, 2017, and April 30, 2018) because of SARI and with a positive nasopharyngeal swab for influenza were included in the study. RESULTS: A total of 123 cases were included in the study. The mean age of patients was 64.5 ± 17.5 years, and 66 (53.7%) patients were older than 65 years. The ICU mortality was 33.9%, and hospital mortality was 35.6%. Invasive mechanical ventilation (IMV), acute kidney injury (AKI), hematologic malignancy, and >65 years of age were the factors affecting mortality in influenza. CONCLUSION: SARI due to influenza carries a high mortality rate, and IMV, AKI, presence of hematologic malignancy, and older age are independent risk factors for mortality.

Do N-terminal pro-brain natriuretic peptide levels determine the prognosis of community acquired pneumonia?

OBJECTIVE: Pneumonia is a leading cause of mortality worldwide, especially in the elderly. The use of clinical risk scores to determine prognosis is complex and therefore leads to errors in clinical practice. Pneumonia can cause increases in the levels of cardiac biomarkers such as N-terminal pro-brain natriuretic peptide (NT-proBNP). The prognostic role of the NT-proBNP level in community acquired pneumonia (CAP) remains unclear. The aim of this study was to evaluate the prognostic role of the NT-proBNP level in patients with CAP, as well as its correlation with clinical risk scores. METHODS: Consecutive inpatients with CAP were enrolled in the study. At hospital admission, venous blood samples were collected for the evaluation of NT-proBNP levels. The Pneumonia Severity Index (PSI) and the Confusion, Urea, Respiratory rate, Blood pressure, and age ≥ 65 years (CURB-65) score were calculated. The primary outcome of interest was all-cause mortality within the first 30 days after hospital admission, and a secondary outcome was ICU admission. RESULTS: The NT-proBNP level was one of the best predictors of 30-day mortality, with an area under the curve (AUC) of 0.735 (95% CI: 0.642-0.828; p < 0.001), as was the PSI, which had an AUC of 0.739 (95% CI: 0.634-0.843; p < 0.001), whereas the CURB-65 had an AUC of only 0.659 (95% CI: 0.556-0.763; p = 0.006). The NT-proBNP cut-off level found to be the best predictor of ICU admission and 30-day mortality was 1,434.5 pg/mL. CONCLUSIONS: The NT-proBNP level appears to be a good predictor of ICU admission and 30-day mortality among inpatients with CAP, with a predictive value for mortality comparable to that of the PSI and better than that of the CURB-65 score.

Extensive Exposure to Tear Gases in Ankara.

OBJECTIVES: The most common chemical substances used as mass control agents are chloroacetophenone, chlorobenzylidene malononitrile, and oleoresin capsicum. These agents not only have local and rapid effects but also have systemic and long-term effects. The aim of the present study was to discuss the patterns of tear gas exposure and to investigate its effects on respiratory functions. MATERIALS AND METHODS: A face-to-face survey was conducted in 86 individuals who had been exposed to tear gas indoor and outdoor during the public protests in June 2013. RESULTS: The most frequently reported respiratory complaints included cough, dyspnea, phlegm, and chest pain. Spirometry measurements including forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were also performed. Indoor exposers have lower mean % predicted FVC and FEV1 values than outdoor exposers. All complaints and signs were more common in indoor exposure to tear gas than in outdoor exposure. CONCLUSION: Safety of the chemicals used as mass control agents during protests is doubtful as these agents are associated with several health risks.

[Lung cancer and intensive care: which patient how long?] / Akciger kanseri ve yogun bakim: hangi hasta ne kadar?

Lung cancer still remains the leading cause of cancer death among all the cancer types. Early diagnosis is the most important factor for efficient treatment and disease management. Nowadays, several new methodologies are being used in clinical practise for diagnosis, staging and treatment of disease. Therefore, survival is prolonged even in patients who are not eligible for surgery. This has led to increase in the acceptance of lung cancer patients in intensive care units (ICU) due to both the disease and the treatments applied and also due to the comorbidity of the patients. However, it is unclear which lung cancer patient will benefit from intensive treatment. In this review, we shared the ICU admission reasons and prognosis of the early stage and advanced stage lung cancer patients and when these patients were referred to ICU and treatment modalities in ICU were discussed.

[Storage mite sensitivity and related factors in asthmatic patients]. / Astimli hastalarda depo akari duyarliligi ve iliskili faktörler.

INTRODUCTION: The aim of the study was to investigate the storage mite sensitivity and related factors in patients with asthma or asthma and rhinitis. PATIENTS AND METHODS: 149 patients with asthma or asthma and rhinitis were included to the study. Prick test was performed after addition of Acarus siro (A. siro), Lepidoglyphus destructor (L. destructor), Glycophagus domesticus (G. domesticus) and Tyrophagus putrescentiae (T. putrescentiae) to the standart prick test. Living conditions, smoking history, allergic diseases status, seasonal variations in symptoms were evaluated by a questionnaire. Besides, respiratory screening spesific IgE, L. destructor spesific IgE was examined in a group of patients who were allergic to storage mites according to prick tests. RESULT: Prick test results showed that; 115 of the patients were sensitized while 34 of them were not. House dust mite sensitivity was detected as mite 58.3%.The storage mite sensitivity for at least one of the studied species was detected in 61.7% of patients. The sensitivity rates were 50.4%, 48.7%, 47%, %40 for A. siro, L. destructor, G. domesticus and T. putrescentiae, respectively. The storage mite sensivity was found higher in the patients from the rural areas (p< 0.05). L. destructor IgE positiveness was detected in 9.1% of the group that antibody levels were examined. Positive reaction was detected for at least one of the storage mite species in %22.7 of the patients who were considered as not sensitized according to the results of the standart prick tests. CONCLUSIONS: As a result, storage mites are important allergens in subjects who live in rural areas and close contact with barn, haymow, bin and pantry. Addition of storage mite allergens to the standart prick test panel of patients living in rural area is suitable.

Evaluation of IL-8 nasal lavage levels and the effects of nasal involvement on disease severity in patients with stable chronic obstructive pulmonary disease.

Interleukin 8 (IL-8) is used to evaluate the severity of inflammation in the airways. The aim of this study was to evaluate patients with chronic obstructive pulmonary disease (COPD) for the presence of upper respiratory tract involvement by questioning patients regarding nasal symptoms and by measuring levels of IL-8 in nasal lavage material. A total of 47 COPD patients and 23 healthy controls were enrolled in this study. Pulmonary function tests were performed for all participants who were asked to complete a Sinonasal Outcome Test-20 (SNOT-20) questionnaire on the same day, as a measure of quality of life. Median IL-8 level in nasal lavage specimens of COPD patients with stable disease was higher than that of healthy controls. An increase in cigarette pack-years was significantly associated with an increase in nasal IL-8 levels. Similarly, IL-8 levels correlated positively with stage of COPD. A significant link between number of visits to the emergency department and stage of disease was observed. Patients with COPD had a significantly higher mean SNOT-20 severity score compared to healthy controls. Proper management of sinonasal disease may help to decrease the number of COPD attacks and consequently improve quality of life.

Performance evaluation of MR-proadrenomedullin and other scoring systems in severe sepsis with pneumonia.

BACKGROUND: In sepsis, risk assessment is as crucial as early and accurate diagnosis. In this study, we aimed to evaluate the prognostic value of mid-regional proadrenomedullin (MR-proADM) with other scoring systems in severe sepsis and septic shock patients due to community acquired pneumonia (CAP). METHODS: Patients were divided into 2 groups as severe sepsis and septic shock due to CAP (group 1, n=31) and only CAP group (group 2, n=26). Serum MR-proADM, procalcitonin (PCT), C-reactive protein (CRP), and d-dimer level were analyzed. Acute Physiological and Chronic Health Evaluation (APACHE) II score, Sequential Organ Failure Assessment (SOFA) score, and Pneumonia Severity Index (PSI) were performed for all patients. RESULTS: There was no difference between groups in terms of serum MR-proADM levels (P=0.780). Serum MR-proADM was not found a significant value for the prediction of death within the 4 and 8 weeks in all patients. SOFA score was the most significant to predict mortality in 4 and 8 weeks (P<0.001). The combination of SOFA score and serum MR-proADM was a strong factor to predict death in 4 weeks (specifity 86.8% and sensitivity 66.7%). The combination of MR-proADM, SOFA score, and APACHE II score was found 75.0% sensitive and 71.4% specific to predict mortality within 4 weeks in group 1. CONCLUSIONS: The MR-proADM does not correlate with mortality or disease severity to predict mortality. The combination of SOFA, APACHE II scores, and MR-proADM was efficient to predict prognosis and mortality rate in severe sepsis or septic shock patients.

Incidence of pulmonary embolism during COPD exacerbation.

OBJECTIVE: Because pulmonary embolism (PE) and COPD exacerbation have similar presentations and symptoms, PE can be overlooked in COPD patients. Our objective was to determine the prevalence of PE during COPD exacerbation and to describe the clinical aspects in COPD patients diagnosed with PE. METHODS: This was a prospective study conducted at a university hospital in the city of Ankara, Turkey. We included all COPD patients who were hospitalized due to acute exacerbation of COPD between May of 2011 and May of 2013. All patients underwent clinical risk assessment, arterial blood gas analysis, chest CT angiography, and Doppler ultrasonography of the lower extremities. In addition, we measured D-dimer levels and N-terminal pro-brain natriuretic peptide (NT-pro-BNP) levels. RESULTS: We included 172 patients with COPD. The prevalence of PE was 29.1%. The patients with pleuritic chest pain, lower limb asymmetry, and high NT-pro-BNP levels were more likely to develop PE, as were those who were obese or immobile. Obesity and lower limb asymmetry were independent predictors of PE during COPD exacerbation (OR = 4.97; 95% CI, 1.775-13.931 and OR = 2.329; 95% CI, 1.127-7.105, respectively). CONCLUSIONS: The prevalence of PE in patients with COPD exacerbation was higher than expected. The association between PE and COPD exacerbation should be considered, especially in patients who are immobile or obese.

Systemic inflammation and metabolic syndrome in stable COPD patients.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) has extrapulmonary effects that seems to be related with systemic inflammation. The relationship between metabolic syndrome which is an important determinant of systemic inflammation in general population and COPD is still not clear. The aim of the current study was to investigate the frequency of metabolic syndrome and C-reactive protein (CRP) levels, as a marker of systemic inflammation in stable COPD patients with different severity levels and in age and sex matched control group. PATIENTS AND METHODS: Ninety-one stable COPD patients and 42 control subjects were included in the study. The severity level in patients with COPD were determined according to GOLD (Global Initiative for Chronic Obstructive Lung Disease) criteria. ATP III (The National Cholesterol Education Program's Adult Treatment Panel III) was used in diagnosis of metabolic syndrome. Hs-CRP levels were measured in venous samples of patients and control subjects. RESULTS: The frequency of metabolic syndrome was found higher in patient group than control subjects, especially in GOLD stages I, II (p= 0.004). Abdominal obesity, hypertension, hyperglycemia components of metabolic syndrome were significantly more prevalent in patient group (p< 0.0001). Increased CRP levels were higher in control and patient groups in all GOLD stages, with metabolic syndrome than without metabolic syndrome (p= 0.047, p= 0.217, p< 0.001, p= 0.05, p= 0.467). CONCLUSION: The study showed that frequency of metabolic syndrome was higher in stable COPD patients than control subjects and general Turkish population. Abdominal obesity, hypertension and hyperglycemia were significantly more prevalent in patient group. Systemic inflammation was more intense in COPD patients with metabolic syndrome than without metabolic syndrome.