Pulmonary Physician Consultancy in Emergency Services in Turkiye (PuPCEST) - a cross-sectional multicenter study.

Pulmonology is one of the branches that frequently receive consultation requests from the emergency department. Pulmonology consultation (PC) is requested from almost all clinical branches due to the diagnosis and treatment of any respiratory condition, preoperative evaluation, or postoperative pulmonary problems. The aim of our study was to describe the profile of the pulmonology consultations received from emergency departments in Turkiye. A total of 32 centers from Turkiye (the PuPCEST Study Group) were included to the study. The demographic, clinical, laboratory and radiological data of the consulted cases were examined. The final result of the consultation and the justification of the consultation by the consulting pulmonologist were recorded. We identified 1712 patients, 64% of which applied to the emergency department by themselves and 41.4% were women. Eighty-five percent of the patients had a previously diagnosed disease. Dyspnea was the reason for consultation in 34.7% of the cases. The leading radiological finding was consolidation (13%). Exacerbation of preexisting lung disease was present in 39% of patients. The most commonly established diagnoses by pulmonologists were chronic obstructive pulmonary disease (19%) and pneumonia (12%). While 35% of the patients were discharged, 35% were interned into the chest diseases ward. The majority of patients were hospitalized and treated conservatively. It may be suggested that most of the applications would be evaluated in the pulmonology outpatient clinic which may result in a decrease in emergency department visits/consultations. Thus, improvements in the reorganization of the pulmonology outpatient clinics and follow-up visits may positively contribute emergency admission rates.

Predictors of Mortality in Sarcoidosis.

Sarcoidosis is a systemic granulomatous disorder that affects individuals of all racial/ethnic origins and occurs at any time of life. Spontaneous remission is frequent and may occur in 2 of 3 patients, while the remaining cases have chronic, progressive disease, with some patients presenting with organ- and life-threatening involvements. Many reports have investigated which features may be related to poor outcomes in patients with sarcoidosis. Pulmonary hypertension and respiratory failure from pulmonary fibrosis are the most common complications associated with the cause of death in sarcoidosis. Other major causes of death include cardiac, neurologic, hepatic involvement, and hemoptysis from aspergilloma.

The Effect of Yoga on Early Clinical Outcomes and Pulmonary Functions in Patients Scheduled for Bariatric Surgery: a Randomized Controlled Study.

PURPOSE: The present research was undertaken to investigate the effect of yoga on pulmonary function and early clinical outcomes in patients scheduled for bariatric surgery. MATERIALS AND METHODS: This research with a randomized control group was performed on patients scheduled for bariatric surgery between October 2021 and June 2022 in the General Surgery Clinic of a University Hospital in Eastern Turkey. The sample consists of 100 randomized patients who received yoga breathing exercises and routine care. Pulmonary function test (PFT), posteroanterior chest X-rays (CXR), 6-min walk test, and oxygen saturation (SpO2) were applied as a pretest. The researcher practiced yoga for 40 min every day of the week. Post-test measurements were performed at the end of the yoga practice. Control group patients underwent the tests at the same intervals without any modifications to the standard clinical protocol. RESULTS: The difference between the control and experimental groups was significant in terms of post-test PFT measurements (p < 0.001). In the CXR of the patients, a statistically significant improvement was determined in 61.5% of the patients with yoga breathing practice (p < 0.001). Also, there was a significant increase in the 6-min walk test and SpO2 values in the experimental group (p < 0.05). CONCLUSION: Yoga practice positively affected the pulmonary function values of the patients.

The role of endobronchial ultrasound-guided transbronchial needle aspiration in the differential diagnosis of isolated mediastinal and/or hilar lymphadenopathy.

INTRODUCTION: Isolated mediastinal and/or hilar lymphadenopathy (IMHL) has become an increasingly common finding as a result of the increased use of thoracic imaging modalities. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is accepted as the first step diagnostic method in the differential diagnosis of IMHL. OBJECTIVE: To determine the diagnostic yield of the procedure and to analyze clinical and sonographic findings that can be used to differentiate the etiology of lymph node pathologies. METHODS: Patients who underwent EBUS-TBNA procedure between March 2017 and March 2020 were included in this retrospective study. Demographic data, symptoms, comorbid diseases, and EBUS findings were obtained from the records of the patients. RESULTS: EBUS-TBNA provided a diagnosis in 88 patients out of 120 patients (granulomatous diseases n = 54, malignant diseases n = 21, and anthracotic lymph nodes n = 13), and 32 patients had a negative EBUS-TBNA. 22/32 negative EBUS-TBNA samples were true negatives (reactive lymphadenopathy). The sensitivity of the procedure was 89.8% while negative predict value was 68.7%, diagnostic yield of 91.6%. Patients with reactive lymph nodes had significantly more comorbidities (77.3%-19.4%, p < .001) and a lower number of lymph node stations (1.6 ± 0.8-2.7 ± 0.9, p < .001). Patients with anthracotic lymph nodes were older and mostly consisted of females (11/13, p < .001). CONCLUSION: EBUS-TBNA has high-diagnostic efficiency in the differential diagnosis of IMHL. The number and size of lymph node stations can provide useful information for differential diagnosis. Clinical follow-up can be a more beneficial approach in patients with reactive and anthracotic lymph nodes before invasive sampling.

Is the Perioperative Period No Longer a Problem for Adult Asthmatics under Control?-OPERA Study.

OBJECTIVES: Asthma is a global problem and chronic condition that persists through patient's entire life, during which the possibility of a surgical procedure is common. An accurate clinical and functional evaluation of respiratory functions and asthma control is needed in patients undergoing surgical procedures and requiring general anesthesia. The aim of this study was to disclose any possible relation between postoperative complications and some pre- and postoperative factors. MATERIALS AND METHODS: In this prospective cross-sectional study, randomly selected 111 asthmatic patients who presented to 10 different tertiary centers were included. The patients were evaluated at three different periods; any day between 1-7 days before surgery, and postoperative third and seventh to tenth days. RESULTS: Among the patients included in the study, 86 (77.5%) were women and mean age was 52.2±13.8 years. General anesthesia was the most common anesthesia type (89.2%), and 33.3% of patients had had a thoracoabdominal surgery. There was a statistically significant difference between pre- and postoperative third-day values, including ACT scores (22.2±3.16 and 21.59±3.84, respectively; p<0.001); forced expiratory volume during the first second (84.92±19.12 and 78.26±18.47, respectively; p<0.001); peak flow rate (79.51±21.12 and 70.01±19.72, respectively; p<0.001); and SaO2 (96.95±1.82 and 95.8±3.32, respectively; p<0.001). Bronchospasm and pain were the most common complications during the postoperative period. CONCLUSION: Controlled asthma under treatment steps 1-2-3 does not cause any serious postoperative pulmonary complications (PPCs). Therefore, achieving an optimal control level of asthma during the preoperative period must be considered the "gold standard" to reduce the risk of PPCs in asthmatic patients.

Prognostic value of copeptin in patients with acute pulmonary thromboembolism.

BACKGROUND AND AIMS: The aim of this study was to determine the level of copeptin, which is one of the new cardiac markers in acute pulmonary thromboembolism (PE) cases, and to determine the relationship between the severity of the disease, risk classification and hospital, first month, third month and 3-month total mortality. METHODS: The study included 100 cases with PE and 60 healthy control subjects. Copeptin was measured in control group. The risk grade of the cases was determined according to the sPESI index. Patients survival data at the first and third months were determined. This study was performed in patients with strict exclusion criteria for comorbidities known to be associated with increased risk of PE. RESULTS: sPESI was ≥1 in 68 (68%) of patients with acute PE. Mean serum copeptin levels were found statistically higher in patients with high risk compared to low-risk cases and controls (9.18 ± 3.29, 6.47 ± 2.29, and 5.26 ± 2.15, P < 0.0001, respectively). When the cut-off value of copeptin was taken as ≥7.87 with ROC analysis for predicting high sPESI score, the sensitivity of the copeptin was 78% and the specificity was 62% (AUC = 0.74, 95% CI = 0.63-0.85, P < <0.0001). When cases divided in the groups according to the cut-off value as 7.87, first month hospital mortality and 3-month total mortality rate was found statistically higher in patients with copeptin ≥7.87 (χ2 = 5.33 P < 0.05, χ2 = 3.88, P < 0.05 and χ2 = 4.26, P < 0.05 respectively). CONCLUSIONS: The results of our study showed that increased serum copeptin levels might predict the severity of PE as well as a promising marker of early mortality in high-risk cases according to sPESI.

Our eight years experience in postintubation/posttracheostomy tracheal stenosis.

INTRODUCTION: The most common cause of tracheal stenosis (TS) continues to be traumas according to the intubation and tracheostomy. Bronchoscopy is considered the gold standard for the detection and diagnosis of tracheobronchial pathology. There are several treatment options. We aimed to discuss our tracheal stenosis patients' treatment options, and their follow-up period. MATERIALS AND METHODS: Consecutive referred patients between 2009 and 2018 presenting with TS were reviewed for the study. Demographic characteristics, localization, length and degree of stenosis, treatment techniques, postoperative complications, and survival were recorded for all patients. RESULT: A total of 110 patients included. The mean age was 53.7 ± 16.7 (16-98 years) years. Of 110 patients, 54 (49.1%) were female. Most common type of stenosis was complex stenosis (74.5%). Mechanical dilatation was applied to all patients. Stenotic regions of 22 (20%) patients were cut with bronchoscopic scissor. Tracheal stents were inserted into trachea of 49 (44.5%) patients. During follow-up period; 36 of 110 (32.7%) patients had surgical resection. Six of 36 (16.7%) patients died during follow-up period (one of them died during surgery), 17 (47.2%) patients had total recovery after surgery. Thirteen of 36 (36.1%) patients had restenosis after surgery. CONCLUSIONS: Tracheal stenosis is a process seen after postintubation or posttracheostomy frequently and it has a wide range of management modalities. Although, it is believed that surgery is the most efficient technique in cases without medical contraindications, we determined that endoscopic interventions can be alternative therapeutic options for inoperable patients. Patients must be followed-up after interventional therapies because complications, and restenosis can usually be seen.

The relationship between platelet-to-lymphocyte ratio and pulmonary embolism severity in acute pulmonary embolism.

BACKGROUND: The aim of this study was to determine the level of platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR) in patients with acute pulmonary embolism (APE) according to high and low risk for early mortality based on simplified Pulmonary Embolism Severity Index (sPESI). In addition, it was investigated the relationship between PLR and NLR with systolic pulmonary artery pressure (sPAP), cardiac markers, disease severity and hospital, 1th month, 3th month and 3-month total mortality. METHODS: Our hospital's electronic patient database was searched for the patients with APE during last year and eighty-two patients retrospectively evaluated. Plasma D-dimer, troponin I (TnI), brain natriuretic peptide (BNP), hemogram values, sPAP from echocardiographic findings were recorded from database system. Hospital mortality was determined from files of cases and 1th, 3th month mortality and survival information were determined by phone calls with the patient and/or relatives. RESULTS: A percentage of 67.1% (55) of APE cases had sPESI≥1. There was no significant difference for age and sex between high and low risk patients according to sPESI (P>0.05). The mean serum BNP, TnI, sPAP, neutrophil counts, platelet counts, PLR and NLR was statistically increased and lymphocyte counts was statistically decreased in high risk patients according to sPESI compared with low risk patients (P<0.01 for BNP, PLR and NLR; P<0.05 for TnI, sPAP, neutrophil and platelet; P<0.01 for lymphocyte). There was no significantly difference for hospital and total 3-month mortality between high and low risk patients (P>0.05). When the cut-off value of PLO was taken as ≥156 by ROC analysis for the predicting of high sPESI, PLR had an area under the curve (AUC) in the receiver operating characteristic (ROC) curve of 0.704 (0.591-0.816; 95% CI; P<0.01) and the cut-off value of NLR was taken as ≥3.56 by ROC analysis for the predicting of high sPESI, NLR had an area under the curve (AUC) in the receiver operating characteristic (ROC) curve of 0.675 (0.556-0.794; 95% CI; P<0.05). An NLR level of 3.56 was taken as the cut-off between high and low risk patients according to sPESI, NLR had a sensitivity of 66% and specificity of 53%. When the cases were evaluated as two groups according to the cut-off value of 156; total 3-month mortality was statistically increased (χ2=6.896, P<0.01) and when the cases were evaluated as two groups according to the based NLR cut-off value of 3.56; hospital mortality, 3th month mortality and total 3-month mortality was statistically increased (χ2=4.771, P<0.05; χ2=4.383, P<0.05; χ2=9.101, P<0.01 respectively). CONCLUSIONS: PLR and NLR increased in patients with high risk, and PLR may have predicting value for 3-month mortality while NLR may have predicting value for hospital mortality, 3th month mortality and total 3-month mortality in patients with APE.

Serum Cystatin C Levels in COPD: Potential Diagnostic Value and Relation between Respiratory Functions.

BACKGROUND: The aim of this study was to determine the level of serum cystatin C (CysC) in patients with Chronic Obstructive Pulmonary Disease (COPD) during exacerbation and stable periods and to investigate its potential diagnostic value and the relationship between CysC levels and the pulmonary function test (PFT). METHODS: One hundred twenty-six patients with COPD (68 in stable periods, 58 during exacerbation periods) and 50 healthy subjects were included in the study. PFT, body mass index (BMI), white blood cell counts, C-reactive protein (CRP), serum urea and creatinine levels were evaluated in both groups of patients. CysC levels were measured in all participants. RESULTS: Serum CysC levels were statistically higher in both COPD groups than the control group (p<0.001 for both) although there was no statistically significant difference between COPD groups (p>0.05). CysC levels showed negative correlation with forced expiratory volume in 1 second (FEV1) and a positive correlation with C-reactive protein (CRP) levels in patients with stable COPD. There was a positive correlation between serum CysC levels and serum urea, creatinine, CRP levels in patients with COPD exacerbation (r=0.333, p=0.011; r=0.260, p=0.049; r=0.414, p<0.01 respectively). When stable COPD and control groups were evaluated, serum CysC had an area under the curve (AUC) in the receiver operating characteristic (ROC) curve of 0.951 (0.909-0.994 95% CI: p<0.001). CONCLUSIONS: Our results showed that CysC levels increased in both COPD groups. Increased CysC levels may be related with lung function decline and inflammation in COPD patients. In addition, CysC levels may be a potential indicator for the diagnosis of COPD.

Sleep disturbances in patients with lung cancer in Turkey.

INTRODUCTION: Sleep quality is known to be associated with the distressing symptoms of cancer. The purpose of this study was to analyze the impact of cancer symptoms on insomnia and the prevalence of sleep-related problems reported by the patients with lung cancer in Turkey. MATERIALS AND METHODS: Assesment of Palliative Care in Lung Cancer in Turkey (ASPECT) study, a prospective multicenter study conducted in Turkey with the participation of 26 centers and included all patients with lung cancer, was re-evaluated in terms of sleep problems, insomnia and possible association with the cancer symptoms. Demographic characteristics of patients and information about disease were recorded for each patient by physicians via face-to-face interviews, and using hospital records. Patients who have difficulty initiating or maintaining sleep (DIMS) is associated with daytime sleepiness/fatigue were diagnosed as having insomnia. Daytime sleepiness, fatigue and lung cancer symptoms were recorded and graded using the Edmonton Symptom Assessment Scale. RESULT: Among 1245 cases, 48.4% reported DIMS, 60.8% reported daytime sleepiness and 82.1% reported fatigue. The prevalence of insomnia was 44.7%. Female gender, patients with stage 3-4 disease, patients with metastases, with comorbidities, and with weight loss > 5 kg had higher rates of insomnia. Also, patients with insomnia had significantly higher rates of pain, nausea, dyspnea, and anxiety. Multivariate logistic regression analysis showed that patients with moderate to severe pain and dyspnea and severe anxiety had 2-3 times higher rates of insomnia. CONCLUSIONS: In conclusion, our results showed a clear association between sleep disturbances and cancer symptoms. Because of that, adequate symptom control is essential to maintain sleep quality in patients with lung cancer.

Can ADMA play a role in determining pulmonary hypertension related to chronic obstructive pulmonary disease?

BACKGROUND AND AIMS: Asymmetric dimethylarginine (ADMA) decreases the levels of nitric oxide by inhibiting nitric oxide synthases. In this study, the possible role of ADMA in determining pulmonary hypertension (PH) in chronic obstructive pulmonary disease (COPD) patients was investigated. METHODS: Stable COPD patients who were admitted to pulmonology outpatient clinic were involved in the study. Forty healthy volunteers, with similar ages and sexes, were accepted as the control group. COPD patients were divided into two groups: 40 patients without PH (COPD group) and 40 COPD-related PH patients (COPD-PH group). Pulmonary function test, echocardiography and arterial blood analyses of all patients were performed. RESULTS: The mean age of patients was 69.21 ± 10.62, and 15 of these patients were females. There was no significant difference between the two COPD groups in terms of age and sex (P > .05). There was no difference in PaO2 , SaO2 , FEV1 and FEV1 /FVC values between the two COPD groups (P > .05). Serum ADMA levels were similar in the control and the COPD group (0.42 ± 0.13 vs 0.43 ± 0.15), but it was significantly higher in the COPD-PH group compared to the control and the COPD group (0.49 ± 0.14). A negative correlation was determined between serum ADMA levels and SaO2 levels (r = -.247, P = .028). A significant positive correlation observed between ADMA and systolic pulmonary artery pressure values (r = .627, P < .001) CONCLUSIONS: In conclusion, high levels of serum ADMA levels may be able to determine the presence of PH.

Predictors of Mortality in Pulmonary Sarcoidosis.

OBJECTIVE: The goal of this study was to assess the prognostic strength of factors in predicting respiratory death in a large cohort of patients with sarcoidosis with at least 8 years' follow-up. METHODS: Data were collected on age, sex, self-declared race, time of death, spirometry findings, diffusing capacity for carbon monoxide, chest radiograph stage, extent of fibrosis on high-resolution CT (HRCT) scanning, and presence of precapillary pulmonary hypertension (PH). The Gender-Age-Physiology (GAP) index and Walsh model criteria for high vs low risk were calculated. RESULTS: A total of 452 patients were identified who had complete pulmonary function testing and chest imaging. The median age at time of entry into the study was 50 years (range, 25-78 years). PH was confirmed by right heart catheterization in 29 (6.4%). Of 452 patients, 42 died during the time of the study, including 38 (8.4%) who died of sarcoidosis-associated respiratory failure and 4 who died of non-sarcoidosis causes. The overall mortality from sarcoidosis was 3.9% and 9.0% at 5 and 10 years, respectively. Alive patients were significantly younger than patients who died from sarcoidosis. Increased mortality was seen for black patients, stage 4 chest radiographs, > 20% fibrosis on HRCT scanning, or PH. The two composite scores (GAP and the Walsh model) were predictive of increased mortality according to univariate analysis. Using the Cox proportional hazards regression model, only age, extent of fibrosis on HRCT scanning, and PH were independent predictors of mortality. CONCLUSIONS: Although most patients with sarcoidosis do well, increased mortality was seen in those patients who were older, had extensive fibrosis on HRCT scanning, or who had PH.

Differential Expression of MicroRNAs in Chronic Obstructive Pulmonary Disease.

BACKGROUND: This study aimed to investigate the associations of miRNA with COPD patients. OBJECTIVES: Chronic obstructive pulmonary disease (COPD) is characterized by progressive and largely irreversible airflow limitation. COPD is one of the most common causes of death globally and it is still a serious public health problem worldwide. Pathogenesis of COPD is multifactorial including genetics and environmental factors. MATERIAL AND METHODS: Sixty patients who were diagnosed with COPD according to GOLD guidance and 40 controls were involved in the study. This study was separated into four groups according to GOLD guidance. miR_16, miR_17, miR_29c, miR_92, miR_125, miR_126, miR_146, miR_155, miR_181, mir_122 expressions from the total miRNAs obtained were worked on by using real time-PCR method. The p-values are calculated based on a Student's t-test of the replicate 2^ (- Delta Ct) values for each gene in the control group. RESULTS: The miRNAs expressions in normal and COPD patients were found differentially. The miR-29c (p = 0.043) and -126 (p = 0.012) were found significantly different compared to control group. When their expressions are evaluated according to stage, miR-92 expression showed down regulation stage II and no change was observed in other miRNAs. miR-29c and miR-126 expressions showed significant differences in stage III and only miR-126 expression showed significant difference in stage IV. CONCLUSIONS: These results show that miRNA evaluations may give information about the diagnosis, staging and prognosis of the disease. In this study, we demonstrated that miR-29c and -126 are essential for the development of COPD.

The Incidence and Related Risk Factors of Chronic Thromboembolic Pulmonary Hypertension after Acute Pulmonary Embolism.

OBJECTIVES: More than half of (> 50%) the patients with choronic thromboembolic pulmonary hypertension (CTEPH) have no acute pulmonary embolism history with clinical signs, so determining the actual incidence and prevalence of CTEPH is difficult. This study aimed to investigate the incidence of CTEPH and the risk factors that may be associated with CTEPH in patients with acute pulmonary thromboembolism (PTE). MATERIAL AND METHODS: Three hundred and eighteen patients with acute pulmonary embolism diagnosed by thorax CT or ventilation/perfussion scintigraphy in our clinic were included into this study. Patients with risk factors for pulmonary hypertension other than thromboembolic disease were excluded from the study. Patients with pulmonary hypertension (PHT) (systolic PAB > 35 mmHg) determined by echocardiography performed in the 6th month were enrolled into the study. RESULTS: Fifty-seven of the 112 patients were female, and the mean age was 57.09 ± 17.30 (16-86) years. Presence of PHT was determined in the 6th month in 45 of the 112 patients (8 of them were symptomatic) and CTEPH incidence (symptomatic + asymptomatic) was identified as 40.16%. Symptomatic CTEPH incidence was calculated as 7.14%. When we searched about the risk factors that may have a role in the development of CTEPH; we determined that CTEPH risk was increased 4.59 times by only being male (95% CI 1.071-19.683, p= 0.040), 218 times by previous history of DVT (95% CI 1.235-38543.073, p= 0.041), and 56.903 times by PaO2 < 80 mmHg (95% CI 2.656-1219.228, p= 0.010). CONCLUSION: CTEPH development after PTE is a situation that can occur in many patients. If probable risk factors are known, patients can be closely monitorized for CTEPH development.

Serum Heat Shock Protein Levels and the Relationship of Heat Shock Proteins with Various Parameters in Chronic Obstructive Pulmonary Disease Patients.

OBJECTIVES: Chronic Obstructive Pulmonary Disease (COPD) is accompanied by increased cellular stress and inflammation. Most of the Heat Shock Proteins (HSPs) have strong cytoprotective effects. The role of HSPs in COPD pathogenesis has not determined completely. We investigated the serum level of HSPs in COPD patients, smokers without COPD and healthy non-smoking controls. Also, we evaluated the relationship of HSPs with various parameters (inflammatory, oxidative, functional status, quality of life) in COPD patients. MATERIAL AND METHODS: The levels of stress protein (HSP27, HSP70, HSP60, HSP90, CyPA), interleukin-6, C-reactive protein and malondialdehyde were measured in 16 healthy non-smoker, 14 smokers without COPD and 50 patients with stable COPD. Pulmonary function tests (PFT) and arterial blood gases parameters were measured. Health Related Quality of Life was evaluated and exercise capacity was measured with 6 minute walking test. RESULTS: Only HSP27 levels was significantly higher in COPD patients when compared with both healthy non-smoker and smokers without COPD (for both, p< 0.001). There was a weak-moderate negative correlation between serum levels of HSP27 and PFT parameters and between HSP27 levels and PaO2. Serum levels of HSP27 showed a weak-moderate positive correlation with symptom, activity and total scores. Subjects evaluated only smokers without COPD and patients with COPD; HSP27 had an area under the curve (AUC) in the receiver operating characteristic (ROC) curve of 0.819 (0.702-0.935; 95% CI; p= 0.000). CONCLUSION: Increased serum levels of HSP27 was found in COPD patients and our results showed sensitivity and specificity of serum HSP27 as diagnostic markers for COPD.

Lymph node characteristics of sarcoidosis with endobronchial ultrasound.

BACKGROUND: Sonographic features of lymph nodes on endobronchial ultrasound (EBUS) have been shown to be useful in prediction of malignancy in mediastinum and hilum. The aim of this study was to assess the utility of morphologic features of mediastinal and/or hilar lymph nodes obtained by EBUS in patients with sarcoidosis. MATERIALS AND METHODS: We retrospectively reviewed the records of 224 patients with mediastinal/hilar lymph node enlargements who underwent EBUS for diagnostic purpose. The lymph nodes were characterized based on the EBUS images as follows: (1) Size; based on short-axis dimension, <1 cm or ≥1 cm, (2) shape; oval or round, (3) margin; distinct or indistinct, (4) echogenicity; homogeneous or heterogeneous, (5) presence or absence of central hilar structure, and (6) presence or absence of granular (sandpaper) appearance. RESULTS: One hundred (24.4%) nodes exhibited indistinct margins while 309 (75.6%) had distinct margins. One hundred and ninety nine (48.7%) nodes were characterized as homogeneous, and 210 (51.3%) nodes as heterogeneous. Granular appearance was observed in 130 (31.8%) lymph nodes. The presence of granules in lymph nodes on EBUS had the highest specificity (99.3%) for the diagnosis of sarcoidosis. Logistic regression analysis revealed the finding of distinct margin alone as an independent predictive factor for the diagnosis of sarcoidosis. CONCLUSIONS: The presence of granular appearance in lymph nodes by EBUS had the highest specificity (99.3%) for the diagnosis of sarcoidosis. Lymph nodes having distinct margins tend to suggest sarcoidosis.

Combination and comparison of two models in prognosis of pulmonary embolism: results from TUrkey Pulmonary Embolism Group (TUPEG) study.

BACKGROUND: Clinical parameters, biomarkers and imaging-based risk stratification are widely accepted in pulmonary embolism(PE). The present study has investigated the prognostic role of simplified Pulmonary Embolism Severity Index (sPESI) score and the European Society of Cardiology (ESC) model. METHODS: This prospective cohort study included a total of 1078 patients from a multi-center registry, with objectively confirmed acute symptomatic PE. The primary endpoint was all-cause mortality during the first 30days, and the secondary endpoint included all-cause mortality, nonfatal symptomatic recurrent PE, or nonfatal major bleeding. RESULTS: Of the 1078 study patients, 95 (8.8%) died within 30days of diagnosis. There was no significant difference between non-low-risk patients ESC [12.2% (103 of 754;)] and high-risk patients as per the sPESI [11.6% (103 of 796)] for 30-day mortality. The nonfatal secondary endpoint occurred in 2.8% of patients in the the sPESI low-risk and 1.9% in the ESC low-risk group. Thirty-day mortality occurred in 2.2% of patients the sPESI low-risk and in 2.2% the ESC low-risk group (P=NS). In the present study, in the combination of the sPESI low-risk and ESC model low-risk mortality rate was 0%. CONCLUSIONS: The sPESI and the ESC model showed a similar performance regarding 30-day mortality and secondary outcomes in the present study. However, the combination of these two models appears to be particularly valuable in PE.