Prevalence of chronic obstructive pulmonary disease in kocaeli: an industrialised city in Turkey.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is an important cause of mortality worldwide. AIMS: The aim of this study was to establish the prevalence of chronic obstructive pulmonary disease (COPD) in residents who were ≥40 years old and living in a heavily industrialised city of Turkey, Kocaeli, using the Burden of Obstructive Lung Disease Initiative questionnaire. STUDY DESIGN: Cross-sectional study. METHODS: 1035 residents ≥40 years old and living in Kocaeli were surveyed. Spirometry and the basic BOLD questionnaire was performed. RESULTS: 946 subjects entered into the analysis. The prevalence of stage I or higher COPD was 13.3% (8.7% for women and 16.5% for men), the prevalence of COPD at GOLD stage II or higher was 7.1% (4.1% for women and 9.2% for men). We also noted a high prevalence of COPD in never-smokers. CONCLUSION: Besides cigarette smoking, occupational exposure to fumes, chemicals and dusts might have also contributed to the high prevalence of COPD noted in residents who were ≥40 years old and living in Kocaeli, Turkey.

Conventional vs. endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of mediastinal lymphadenopathies.

The aim of this study was to determine whether or not radial probe endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) is superior to conventional TBNA in the diagnosis of mediastinal lymphadenopathies in routine clinical practice. Consecutive patients, who were referred for TBNA, were randomized to conventional TBNA and EBUS-guided TBNA groups. Patients were also grouped according to the anatomic location of the pathologic lymph nodes to evaluate if there was a difference in the diagnostic yield with respect to lymph node station. Patients with subcarinal lymph nodes were designated as group A and patients with lymph nodes at station 2 (upper paratracheal), 3 (prevascular and retrotracheal), and 4 (lower paratracheal) were designated as group B. A 21-G aspiration needle was used during the procedure. Sixty patients with a mean age of 56.15 ± 15.32 years were included in the study. Thirty patients each underwent EBUS-TBNA and conventional TBNA. The overall diagnostic yield of conventional TBNA was 33.3% (10/30), while EBUS-TBNA had a yield of 66.7% (20/30; p= 0.010). In patients with subcarinal lymph nodes, the yield of conventional TBNA was 33.3% (4/12) compared to 62.5% (5/8) in the EBUS-guided group (p= 0.362). In patients with mediastinal lymph nodes other than subcarinal lymph nodes, EBUS-TBNA had a significantly higher yield compared to conventional TBNA [33.3% (6/18) vs. 68.2% (15/22) for conventional and EBUS-TBNA groups, respectively; p= 0.028]. In conclusion, the diagnostic yield of EBUS-TBNA was superior to the yield of conventional TBNA at stations other than subcarinal region. We suggest that EBUS is a useful tool to guide TBNA in the evaluation of mediastinal lymph nodes.

Routine using pattern and performance of diagnostic tests for tuberculosis on a university hospital.

INTRODUCTION: Nucleic acid amplification tests to detect Mycobacterium tuberculosis in clinical specimens are used increasingly as a laboratory tool. We aimed to investigate the routine using pattern and the effects on therapeutic decision of diagnostic tests for tuberculosis in our hospital. METHODS: In this descriptive study, we investigated retrospectively the routine using pattern and the effects on therapeutic decision of diagnostic tests for tuberculosis. Patients with discordant results were clinically evaluated retrospectively by a chest physician. Samples were tested for the presence of M. tuberculosis by a smear technique, M. tuberculosis culture growth technique (Löwenstein-Jensen and/or BACTEC-960), and IS6110 polymerase chain reaction (PCR). RESULTS: Culture positivity was 7.2% (83 of 1159 patients). In total, 198 (62.4%) were tested with PCR, acid-fast bacilli, and culture. On the basis of culture results as a gold standard, sensitivity, specificity, positive predictive value, and negative predictive value of PCR were 46%, 89%, 23%, and 93.5%, respectively. CONCLUSIONS: Selection of appropriate patients for further testing and exclusion of low-risk patients from microbiologic testing by experienced clinicians may help to optimize the positive predictive value of PCR.

Diffusion-weighted MRI in the characterization of pleural effusions.

PURPOSE: To evaluate the value of diffusion-weighted imaging (DWI) in the differential diagnosis of pleural effusions. MATERIALS AND METHODS: 58 pleural effusions (21 transudative, 37 exudative) were included in this prospective study. Single-shot echo-planar spin echo DWI was performed with two b factors (500 and 1000 s/mm (2)), and apparent diffusion coefficients (ADCs) were calculated. On diffusion- weighted (DW) trace images, signal intensity (SI) of the pleural effusions was visually compared to the SI of the paraspinal muscles with the use of a 3-point scale: 0: isointense, 1: moderately hyperintense, 2: significantly hyperintense. For quantitative evaluation, effusion- to-paraspinal muscle SI ratios, and ADCs of the effusions were compared between the groups. RESULTS: On visual evaluation, most of the transudative effusions were isointense, while most of the exudative effusions were hyperintense on DWI with b factors of 500 and 1000 s/mm (2). Quantitatively, with a b factor of 500 and 1000 s/mm(2), effusion-to-paraspinal muscle SI ratios of the exudative effusions were significantly higher than those of transudative effusions. The ADCs of the exudative effusions were significantly lower than those of transudative effusions (mean ADC was 3.3 x 10 (-3)+/- 0.7 mm(2)/s for exudative effusions, and 3.7 x 10 (-3)+/-0.3 mm(2)/s for transudative effusions). Setting the cutoff value at 3.6 x 10(-3), ADC had a sensitivity of 71% and a specificity of 63% for differentiating transudative from exudative effusions. CONCLUSION: DWI may help in the differential diagnosis of pleural effusions.