Smoking Cessation Success and Affecting Factors in Geriatric Patients.

Background: There are difficulties in the treatment of smoking cessation in elderly patients. However, elderly smokers who gave up smoking had lower rates of death from heart attack, stroke, and cancer, as well as improved cognitive function. This study aimed to investigate the affecting factors and the success of smoking cessation rate in patients aged 60 and over in Turkey. Methods: Six smoking cessation outpatient clinics from four provinces were included in the study. The records of 1,065 patients who applied to a smoking cessation outpatient clinic between 2016 and 2019 and who were 60 yr of age or older were scanned. Overall, 917 cases that could be reached after treatment were included in the study. Smoking cessation rates at the first month, 3rd month, 6th month, 9th month and 12th month were given. Results: Of the 917 cases, 65.1% were male and 34.9% were female. Smoking cessation rates were 45.6% on the first month, 39% on the third month, 35.1% on the sixth month, 31.2% on the ninth month, and 30.3% at the twelfth month. Smoking cessation success was higher in men than in women. Conclusion: Since the success of smoking cessation in the elderly was similar to that of adults. Since smoking is an independent risk factor for death in the elderly, there should be greater willingness to provide elderly patients with smoking cessation treatment to reduce physical function loss and promote healthier aging.

Tocilizumab treatment in COVID-19: A prognostic study using propensity score matching.

BACKGROUND: The potential role of interleukin-6 (IL-6) in coronavirus disease 2019 (COVID-19) pneumonia provides the rationale for investigating IL-6 signaling inhibitors. OBJECTIVES: To evaluate and report treatment responses to tocilizumab (TCZ) in COVID-19 patients and compare mortality outcomes with those of standard care. MATERIAL AND METHODS: Patients hospitalized with a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, diagnosed with reverse transcription polymerase chain reaction (RT-PCR) between March 2020 and April 2021, were enrolled in this single-center retrospective cohort study. Propensity score matching was performed in order to reduce confounding effects secondary to imbalances in receiving TCZ treatment. RESULTS: A total of 364 patients were included in this study. Two hundred thirty-six patients received standard care, while 128 patients were treated with TCZ in addition to standard care (26 (20.3%) patients received a dose of 400 mg intravenously once, while 102 (79.7%) patients received a total dose of 800 mg intravenously). In the propensity score-matched population, less noninvasive mechanical ventilation (p = 0.041) and mechanical ventilation support (p = 0.015), and fewer deaths (p = 0.008) were observed among the TCZ-treated patients. The multivariate adjusted Cox regression model showed a significantly higher survival rate among TCZ patients compared to controls (hazard ratio (HR): 0.157, 95% confidence interval (95% CI): 0.026-0.951; p = 0.044). The hazard ratio for mortality in the TCZ group was 0.098 (95% CI: 0.030-0.318; p = 0.0001 using log-rank test). CONCLUSIONS: This study determined that TCZ treatment in COVID-19 patients was associated with better survival, reduced need for mechanical ventilation and reduced hospital-associated mortality.

Birt-Hogg-Dubé Syndrome: Diagnostic Journey of Three Cases from Skin to Gene.

Birt-Hogg-Dube syndrome (BHDS) is a rare disorder characterized by the triad of cutaneous lesions, renal tumors, lung cysts and inactivation of the gene folliculin (FLCN). Here, we present three female patients diagnosed with BHDS. First case a 55-year-old female had flesh moles histopathology compatible with angiofibroma, multiple cysts in the lung and kidneys, FLCN gene mutations ('c.1285dupC [p.His429Profs*]' 11th exon and 'c.653G>A [p.Arg258His]' 7th exon). The second case a 76-year-old female had trichodiscoma on her skin, multiple cysts in the lung, spontaneous pneumothorax, FLCN gene mutation 'c.1285dupC (p.His429Profs*27) 11th exon' and, her son had renal carcinoma history under 50 years of age. Our third case, also the daughter of case 2, had dermal papules histopathology compatible with trichodiscoma, spontaneous pneumothorax, FLCN gene mutation 'c.1285dupC (p.His429Profs*27) 11th exon' and, parotid oncocytoma. Through our cases, we document the first case of two mutations ('c.1285dupC [p.His429Profs*]' 11th exon and 'c.653G>A [p.Arg258His]' 7th exon) in the same FLCN gene and the 11th known case of parotid oncocytoma associated with BHDS in the light of the literature.

Interleukin-21: a potential biomarker for diagnosis and predicting prognosis in COVID-19 patients

Background/aim: COVID-19 patients have a wide spectrum of disease severity. Several biomarkers were evaluated as predictors for progression towards severe disease. IL-21 is a member of common γ-chain cytokine family and creates some specific effects during programming and maintenance of antiviral immunity. We aimed to assess IL-21 as a biomarker for diagnosis and outcome prediction in patients hospitalized with COVID-19. Materials and methods: Patients with a preliminary diagnosis of COVID-19 and pneumonia other than COVID-19 admitted to a tertiary care hospital were included consecutively in this comparative study. Results: The study population consisted of 51 patients with COVID-19 and 11 patients with non-COVID-19 pneumonia. Serum IL-21 concentration was markedly higher, and serum CRP concentration was significantly lower in COVID-19 patients compared to non-COVID-19 pneumonia patients. Within COVID-19 patients, 10 patients showed radiological and clinical progression. Patients with clinical worsening had lower lymphocyte count and haemoglobin. In addition to that, deteriorating patients had higher urea, LDH levels, and elevated concentration of both IL-6 and IL-21. The cut-off value of 106 ng/L for IL-21 has 80.0% sensitivity, %60.9 specificity for discriminating patients with clinical worsening. Multivariable analysis performed to define risk factors for disease progression identified IL-6 and IL-21 as independent predictors. Odds ratio for serum IL-6 concentrations ≥ 3.2 pg/mL was 8.07 (95% CI: 1.37-47.50, p = 0.04) and odds ratio for serum IL-21 concentrations ≥ 106 ng/L was 6.24 (95% CI: 1.04 ­ 37.3, p = 0.02). Conclusion: We identified specific differences in serum IL-21 between COVID-19 and non-COVID-19 pneumonia patients. Serum IL-21 measurement has promising predictive value for disease progression in COVID-19 patients. High serum IL-6 and IL-21 levels obtained upon admission are independent risk factors for clinical worsening.

Turkish Thoracic Society Experts Consensus Report: Recommendations for Pulmonary Function Tests During and After COVID 19 Pandemic.

The recommendation of conducting pulmonary function tests (PFTs) from different societies during and after the coronavirus disease (COVID-19) pandemic was rated by the experts of the Turkish Thoracic Society (TTS) and presented as the TTS experts consensus report. Information about the topic has been provided.Globally, as of mid-May 2020, there have been over 4.4 million confirmed cases of COVID-19. There are two main routes of transmission of COVID-19: respiratory droplets and contact transmission. PFTs are non-invasive tests that are commonly performed in routine assessment and follow-up of patients in the pulmonology units. However, PFTs may generate aerosols and require sharing common surfaces. With regard to the high prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the community, PFTs should not be performed routinely in confirmed or suspected patients with COVID-19 during the pandemic. Because of the risk of human-to-human transmission of COVID-19, PFTs should be restricted to a small patient population with selected indications. Triage for COVID-19 should be performed prior to testing. Only essential PFTs such as spirometry, diffusion capacity of the lungs for carbon monoxide (DLCO), arterial blood gas analysis, or pulse oximetry should be performed in the selected cases. Tests should be scheduled to allow sufficient time for donning and doffing of the technical personnel with the full personal protective equipment (PPE) (gown, a filtering respirator mask, goggles or full-face shield, and disposable gloves), ventilation of the room, and application of post-test cleaning and disinfection procedures of the equipment and the testing room.

Physiologic Effects of Oxygen Supplementation During Exercise in Chronic Obstructive Pulmonary Disease.

Supplemental long-term oxygen therapy (LTOT) is a well-established therapy that improves mortality in patients with chronic obstructive pulmonary disease (COPD) with resting hypoxemia. In the large number of patients with COPD who do not have severe resting hypoxemia but who desaturate with exercise, the clinical benefits that can be obtained by supplemental O2 therapy during exercise is an area of interest and active research. A summary of current evidence for benefits of supplemental O2 therapy and a review of physiologic mechanisms underlying published observations are reviewed in this article.

Diagnostic Accuracy of a Modified STOP-BANG Questionnaire with National Anthropometric Obesity Indexes.

OBJECTIVES: Obstructive sleep apnea (OSA) is a very common sleep-related disorder and has many medical complications. Although the STOP-BANG questionnaire is an attractive screening tool because of high sensitivity, it lacks power in specificity. The aim of the present study was to evaluate and compare the diagnostic accuracy of standard STOP-BANG and a modified STOP-BANG questionnaire, using national cut-off values for neck circumference that determined OSA, in a sleep center population. MATERIALS AND METHODS: One hundred eighty-five participants who were referred to the sleep-disordered breathing clinic were consecutively enrolled. We used 40 cm and 36 cm as the cut-off values for neck circumference, thus scoring patients accordingly and creating a modified STOP-BANG score with national anthropometric obesity indexes. RESULTS: The median neck circumferences were 41 (39-44) cm, 40 (37-42) cm, and 43 (40-45) cm for total population, female gender, and male gender, respectively. The mean STOP-BANG score was 4.5±1.5, and the mean modified STOP-BANG score was 4.9±1.5. Discrimination of OSA measured by area under the curve for both questionnaires is comparable (p>0.05). Sensitivity to define OSA (apnea-hypopnea index (AHI)≥5) was 92.2% and 93.8% for original and modified STOP-BANG questionnaire, respectively. Sensitivity for moderate (AHI≥15) and severe OSA (AHI≥30) was identical for both questionnaires. CONCLUSION: The STOP-BANG questionnaire has an excellent sensitivity, but modest specificity and adding national obesity indexes for neck circumference achieved similar results in terms of sensitivity and specificity with the original questionnaire.

European Respiratory Society International Congress 2018: four shades of epidemiology and tobacco control.

In this article, early career members and experienced members of the Epidemiology and Environment Assembly of the European Respiratory Society highlight and summarise a selection of six sessions from the Society's annual congress, which in 2018 was held in Paris, France. The topics covered in these sessions span from cutting-edge molecular epidemiology of lung function to clinical, occupational and environmental epidemiology of respiratory disease, and from emergent tobacco products to tobacco control.

Turkish Thoracic Society Consensus Report: Interpretation of Spirometry.

ÖZET: Günümüzde spirometre ölçümlerinin uygulama ve yorumlama nitelik güvencesi "American Thoracic Society / European Respiratory Society" standartlari ile belirlenmistir. Dünyada oldugu gibi ülkemizde de birçok laboratuvar bu standartlari kullanmaktadir. Buna karsin, farkli laboratuvarlardan farkli degerlendirme sonuçlari görebilmek mümkündür. Bu rapor, ülkemizdeki solunum fonksiyon testi laboratuvarlarinda yapilan degerlendirmelerin standardizasyonunu saglamak amaci ile hazirlanmistir.

Serum CCL-18 level is a risk factor for COPD exacerbations requiring hospitalization.

INTRODUCTION: Chemokine (C-C motif) ligand 18 (CCL-18) has been shown to be elevated in chronic obstructive pulmonary disease (COPD) patients. This study primarily aimed to evaluate whether the serum CCL-18 level differentiates the frequent exacerbator COPD phenotype from infrequent exacerbators. The secondary aim was to investigate whether serum CCL-18 level is a risk factor for exacerbations requiring hospitalization. MATERIALS AND METHODS: Clinically stable COPD patients and participants with smoking history but normal spirometry (NSp) were recruited for the study. Modified Medical Research Council Dyspnea Scale, COPD Assessment Test, spirometry, and 6-min walking test were performed. Serum CCL-18 levels were measured with a commercial ELISA Kit. RESULTS: Sixty COPD patients and 20 NSp patients were recruited. Serum CCL-18 levels were higher in COPD patients than those in NSp patients (169 vs 94 ng/mL, P<0.0001). CCL-18 level was significantly correlated with the number of exacerbations (r=0.30, P=0.026), although a difference in CCL-18 values between infrequent and frequent exacerbator COPD (168 vs 196 ng/mL) subgroups did not achieve statistical significance (P=0.09). Serum CCL-18 levels were significantly higher in COPD patients who had experienced at least one exacerbation during the previous 12 months. Overall, ROC analysis revealed that a serum CCL-18 level of 181.71 ng/mL could differentiate COPD patients with hospitalized exacerbations from those who were not hospitalized with a 88% sensitivity and 88.2% specificity (area under curve: 0.92). Serum CCL-18 level had a strong correlation with the frequency of exacerbations requiring hospitalization (r=0.68, P<0.0001) and was found to be an independent risk factor for hospitalized exacerbations in the multivariable analysis. CONCLUSION: CCL-18 is a promising biomarker in COPD, as it is associated with frequency of exacerbations, particularly with severe COPD exacerbations requiring hospitalization, as well as with functional parameters and symptom scores.

A Novel Spirometric Measure Identifies Mild COPD Unidentified by Standard Criteria.

BACKGROUND: In chronic obstructive pulmonary disease, both smaller and larger airways are affected. FEV1 mainly reflects large airways obstruction, while the later fraction of forced exhalation reflects reduction in terminal expiratory flow. In this study, the objective was to evaluate the relationship between spirometric ratios, including the ratio of forced expiratory volume in 3 and 6 seconds (FEV3/FEV6), and small airways measures and gas trapping at quantitative chest CT scanning, and clinical outcomes in the Genetic Epidemiology of COPD (COPDGene) cohort. METHODS: Seven thousand eight hundred fifty-three current and ex-smokers were evaluated for airflow obstruction by using recently defined linear iteratively derived equations of Hansen et al to determine lower limit of normal (LLN) equations for prebronchodilator FEV1/FVC, FEV1/FEV6, FEV3/FEV6, and FEV3/FVC. General linear and ordinal regression models were applied to the relationship between prebronchodilator spirometric and radiologic and clinical data. RESULTS: Of the 10,311 participants included in the COPDGene phase I study, participants with incomplete quantitative CT scanning or relevant spirometric data were excluded, resulting in 7,853 participants in the present study. Of 4,386 participants with FEV1/FVC greater than or equal to the LLN, 15.4% had abnormal FEV3/FEV6. Compared with normal FEV3/FEV6 and FEV1/FVC, abnormal FEV3/FEV6 was associated with significantly greater gas trapping; St. George's Respiratory Questionnaire score; modified Medical Research Council dyspnea score; and BMI, airflow obstruction, dyspnea, and exercise index and with shorter 6-min walking distance (all P < .0001) but not with CT scanning evidence of emphysema. CONCLUSIONS: Current and ex-smokers with prebronchodilator FEV3/FEV6 less than the LLN as the sole abnormality identifies a distinct population with evidence of small airways disease in quantitative CT scanning, impaired indexes of physical function and quality of life otherwise deemed normal by using the current spirometric definition.

Catheter-Directed Therapy in Acute Pulmonary Embolism with Right Ventricular Dysfunction: A Promising Modality to Provide Early Hemodynamic Recovery.

BACKGROUND Catheter-directed therapy (CDT) for pulmonary embolism (PE) is considered as an alternative to systemic thrombolysis (ST) in patients with hemodynamically unstable acute PE who are considered at high bleeding risk for ST. We aimed to evaluate the efficacy and safety of CDT in the management of acute PE with right ventricular dysfunction (RVD). The primary outcomes were mortality, clinical success, and complications. Secondary outcomes were change in hemodynamic parameters in the first 24 hours following the procedure. MATERIAL AND METHODS Medical records of consecutive patients diagnosed as having acute massive or submassive PE with accompanying RVD treated by immediate CDT at our institution from January 2007 to January 2014 were reviewed. Patient characteristics, mortality, achievement of clinical success, and minor and major bleeding complications were analyzed in the overall study group, as well as massive vs. submassive PE subgroups. Change in hemodynamic parameters in the second, eighth, and 24th hours after the CDT procedure were also analyzed. RESULTS The study included 15 consecutive patients (M/F=10/5) with a mean age of 54.2 ± 16.6 years who underwent immediate CDT. Nine of the patients had submassive PE, and 6 had massive PE. In-hospital mortality rate was 13.3% (95% CI, 0.04-0.38). One major, but not life-threatening, bleeding episode was evident in the whole group. Hemodynamic parameters were stabilized and clinical success was achieved in 14/15 (93.3%; 95% CI, 70.2-98.8) of the patients in the first 24 hours. Notably, the hemodynamic recovery was significantly evident in the first 8 hours after the procedure. CONCLUSIONS CDT is a promising treatment option for patients with acute PE with RVD with no fatal bleeding complication. In experienced centers, CDT should be considered as a first-line treatment for patients with acute PE and RVD and contraindications for ST, with the advantage of providing early hemodynamic recovery.

Laparoscopic Sleeve Gastrectomy Improves Excessive Daytime Sleepiness and Sleep Quality 6 Months Following Surgery: A Prospective Cohort Study.

INTRODUCTION: Obstructive sleep apnea (OSA) is one of the most important co-morbid conditions related with morbid obesity. Bariatric procedures are associated with significant improvement in OSA. The aim of the current study was to evaluate the effect of bariatric surgery on daytime sleepiness and quality of sleep in patients that had undergone laparoscopic sleeve gastrectomy. METHODS: Fifty-nine patients were prospectively enrolled in the study. Pre-operative and post-operative (6 months) demographics, medical history, weight, and height of the patients were recorded, and patients were asked to complete Pittsburg Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) questionnaires. OSA screenings were performed using the STOP-Bang questionnaire. RESULTS: The mean age of the patients was 37.1 ± 1.2 years and 76% were female. Pre-operative and post-operative median (range) BMIs were 47 kg/m(2) (39-67 kg/m(2)) and 35 kg/m(2) (25-44 kg/m(2)), respectively (P < 0.001). The mean ± standard deviation excess weight loss was 51.6 ± 13.2%. In univariate analysis, total PSQI, STOP-Bang, and ESS scores were found to significantly improve 6 months after surgery (all P < 0.001). Multivariate mixed-model analysis showed a high correlation between the decrease in BMI and all key predictors. Mixed-model analysis revealed that every 1 kg/m(2) decrease in BMI was associated with a 0.32, 0.13, and 0.26 improvements in PSQI, STOP-Bang, and ESS scores, respectively (all P < 0.001). CONCLUSION: Laparoscopic sleeve gastrectomy is associated with rapid weight loss and improvements in sleep quality, daytime sleepiness, and the risk of OSA 6 months after surgery.