Contribution of combined use of different ultrasound modes to evaluate mediastinal lymph nodes.

Background: To determine the contribution to diagnostic rates of the evaluation of the sonographic characteristics of lymph nodes with EBUS together with vascularity. Methods: In the present study, patients who underwent the Endobronchial ultrasound (EBUS) procedure were evaluated retrospectively. Patients were classified as benign or malignant by using the sonographic features of EBUS. EBUS-Transbronchial Needle Aspiration (TBNA) confirmed histopathologically with lymph node dissection or in cases where no disease progression was observed clinically or radiologically in at least 6 months of follow-up. Malignant lymph node diagnosis was based on histological examination. Results: Evaluation was made of 165 patients comprising 122 (73.9%) males and 43 (26.1%) females with a mean age of 62.0 ± 10.7 years. Malignant disease was diagnosed in 89 (53.9%) cases and benign disease in 76 (46.1%) cases. The success level of the model was seen to be approximately 87%. The Nagelkerke R2 value was calculated as 0.401. The probability of malignancy increased 3.86-fold (95% CI: 2.61-5.11) in lesions of diameter ≥20 mm compared to lesions <20 mm, 2.58-fold (95% CI: 1.48-3.68) in lesions not determined with central hilar structure (CHS) compared to those determined with CHS, 6.85-fold (95% CI: 4.67-9.03) in lymph nodes observed with necrosis compared to those without necrosis, and 1.51-fold (95% CI: 0.41-2.61) in lymph nodes with a vascular pattern (VP) score of 2-3 compared to those with a VP score of 0-1. Conclusion: Visualization of coagulation necrosis with EBUS-B mode and the determination of VP 2-3 in power Doppler mode were seen to be the most important criteria of malignancy.

Human(ized) monoclonal antibodies in atopic patients - state of the art.

Asthma is an important chronic disease affecting a lot of people worldwide. Treatment options for asthma like biological agents are being developed more frequently nowadays. Despite a lot of treatment options, some patients still remain symptomatic. As more and more practitioners choose treatment with biologic agents as a convenient way of therapy, biologic agents and other valuable methods must be discovered in order to cope with a growing number of treatment agents. This manuscript emphasizes on new generation monoclonal human(ized) antibodies in asthmatics and off-label use . The first developed biologic agent is the anti-immunoglobulin E monoclonal antibody called omalizumab. Currently it is an approved treatment option for asthma.

Anti-IgE Significantly Changes Circulating Interleukin-25, Vitamin-D and Interleukin-33 Levels in Patients with Allergic Asthma.

BACKGROUND: Multi-center, randomized-controlled trials and observational studies have demonstrated that, in severe asthmatic patients receiving omalizumab treatment, the frequency of exacerbations, the number of urgent adverse events, and the need for oral steroids tend to decrease. MATERIALS AND METHODS: This study included a total of 32 patients. The patients were divided into two groups as Group IA (pre-omalizumab) and Group IB (post-omalizumab). Serum IL-25 and IL-33 levels were measured and the number of emergency admissions, length of hospitalization (day), Asthma Control Test (ACT) scores, eosinophil cationic protein (ECP), and fractional exhaled nitric oxide (FeNO) value were analyzed. RESULTS: ACT and FeNO values increased after omalizumab treatment, while IL-33, IL-25 levels decreased after the completion of omalizumab treatment. Furthermore, there was a weak, positive, and significant relationship between the changes in the ECP levels and IL-33 levels (r=0.38, p=0.03). CONCLUSION: To the best of our knowledge, this is the first study to compare circulating IL-25 and IL-33 levels with specific IgE synthesis in the literature. Multivariate correlation analysis showed that the changes in serum IL-33 levels were significantly correlated with the changes in the mite sIgE levels and length of hospital stay (Fmodel=11.2, p=0.01, r2=0.45). On the other hand, there was no significant relationship between the other variables and changes in the IL-25 levels.

Levofloxacin Induced Toxic Epidermal Necrolysis: Successful Therapy with Omalizumab (Anti-IgE) and Pulse Prednisolone.

BACKGROUND Toxic epidermal necrolysis (TEN) is characterized by widespread erythematous and bullous lesions on the skin. Nowadays, considerable progress has been made in the understanding of its pathogenesis. Immunologically it is similar to graft-versus-host disease. Therefore, we may propose that TEN is a disorder of cell-mediated immunity. CASE REPORT Our patient was a 74-year-old white female who had pneumonia and was positive for hepatitis C virus (HCV), and who had been on levofloxacin therapy. After the first levofloxacin dose, erythematous dusky red macules occurred on her extremities and trunk, and on the following day, confluent purpuric lesions tended to run together over 85% of her body. Her biopsy results indicated TEN. Laboratory testing for serum ECP (eosinophil cationic peptide) and serum immunoglobulin (Ig) levels were performed, and blister fluid was investigated. The patient responded positively to omalizumab treatment and after treatment laboratory tests revealed decreased high sensitive CRP, ECP, IgG1, IgG2, IgG3, IgG4, IgA, and IgM levels. CONCLUSIONS To the best of our knowledge, this is the first case of a patient with HCV who developed cutaneous adverse drug reaction on levofloxacin medication and recovered with omalizumab treatment. This is the first documentation of omalizumab treatment of a TEN patient.

[Health-care associated pneumonia]. / Saglik bakimiyla iliskili pnömoni.

INTRODUCTION: Health-care associated pneumonia (HCAP) is defined as pneumonia that develops in patients with a history of recent hospitalization, hemodialysis as an outpatient, residence in a nursing home, outpatient intravenous therapy and home wound care. MATERIALS AND METHODS: We retrospectively assessed patients who have been hospitalized in Department of Chest Diseases, Akdeniz University, Faculty of Medicine due to HCAP between 1 January 2009 and 1 June 2012. Of the total 195 pneumonia cases, 76 (38.9%) was HCAP and 119 (61.1%) was CAP. RESULTS: Among HCAP cases, 61 (80.3%) had recent hospitalisation in the last 90 days, 7 (9.2%) went under hemodialysis in the last 30 days, 3 (3.9%) had a history of decubitus management in house, 1 (1.3%) had a long term accomodation in social-care center and 1 (1.3%) had a history of infusion therapy at home. Comorbidity in HCAP group was higher than CAP group (94.6% vs resp. 73.1%; p< 0.001) and mean PSI scores were also higher in HCAP group (104.4 - 90.2; p< 0.05). A causative microorganism was detected in 18 HCAP (23.6%) and in 11 CAP (9.2%) cases. It was determined that appropriate treatment was started in 73.7% of HCAP cases and 98.3% of CAP cases according to national and international guidelines (p< 0.001). Both mean hospitalization duration (12.7 ± 1.1 vs 7.8 ± 0.5 days, resp; p< 0.05) and mortality rates (22.4% vs 4.2%; p< 0.001) were higher in HCAP group. Furthermore, mean cost of hospitalization was also greater for HCAP group than CAP group (4150.6 ± 892 TL vs 2078.7 ± 571 TL; respectively p< 0.05). CONCLUSION: In conclusion; patient characteristics, comorbidity status, causative organisms, duration and cost of hospitalization and prognosis of patients with HCAP was different from patients with CAP.

The accuracy of autotitrating CPAP-determined residual apnea-hypopnea index.

PURPOSE: Autotitrating continuous positive airway pressure (auto-CPAP) devices not only titrate CPAP pressures but also measure residual respiratory events. The aim of the present study was to determine the accuracy of auto-CPAP-derived residual apnea-hypopnea index (AHI). METHODS: We studied 137 consecutive patients (72.3% men) with obstructive sleep apnea from January 2008 to December 2010 who underwent in-laboratory overnight polysomnography (PSG) using auto-CPAP. We excluded patients with comorbidities like congestive heart disease, chronic obstructive pulmonary disease, or hypoventilation syndromes and patients with central sleep apnea. Residual AHI obtained from the auto-CPAP device by smart card (CPAP-AHI) was compared simultaneously with AHI from an overnight PSG on auto-CPAP (PSG-AHI) using Bland-Altman analysis and Wilcoxon signed-rank test. RESULTS: The mean AHI on the diagnostic study was 45.08 ± 1.8. During the titration, auto-CPAP markedly suppressed the respiratory events (PSG-AHI, 3.40 ± 0.20). On the other hand, CPAP-AHI was 3.35 ± 0.17. Bland-Altman analysis showed good agreement between auto-CPAP-AHI and PSG-AHI (AHI mean difference of 0.05, and the limits of agreement for the AHI were from +4.9 to -4.8). Two methods have also been compared with paired samples t test and no statistically significant difference was found (p > 0.05). CONCLUSION: Auto-CPAP can identify residual respiratory events equivalent to the use of PSG in a selected population.

[A pharmacovigilance study in chest diseases outpatient clinic]. / Gögüs hastaliklari polikliniginde farmakovijilans çalismasi.

INTRODUCTION: Adverse drug reactions is an important healthcare issue, it causes excess morbidity and mortality. The aim of this study was to determine the adverse drug reactions in patients who admitted to the outpatient clinic of respiratory diseases and to improve some clinical strategies if they are preventable. PATIENTS AND METHODS: This study is a prospective observational study which was performed to determine adverse drug reaction in patients who admitted to the outpatient clinic of respiratory diseases. RESULTS: During the 15 months of study period a total of 114 adverse reactions were reported in 92 out of 18.130 patients. Most of the adverse reactions were related with gastrointestinal system, central nervous system and cardiovascular system. The most of the adverse events were associated with fixed inhaled formoterol-budesonide combination and inhaled tiotropium. The most frequently reported reactions were hoarseness, xerostomia, headache and dizziness. Poliuri and cough were less frequently reported reactions. CONCLUSION: Most of the adverse reactions were of limited intensity but some of these side effects might effect patients compliance. Serious adverse events were not detected.