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   Table of Contents - Current issue
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May-August 2021
Volume 23 | Issue 2
Page Nos. 77-135

Online since Thursday, August 12, 2021

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REVIEW ARTICLES  

Potential health impacts and lung microbiome changes among smoking and smokeless tobacco use : A technical scan p. 77
Manikandan Sathiyaseelan, Krishnan Srinivasan, Jeneth Berlin Raj, Pajanivel Ranganadin, Balanehru Subramanian
DOI:10.4103/ejop.ejop_108_20  
Globally, 1.3 billion peoples use tobacco products daily, most of them from low- and middle-income countries. Every year, 8 million of the population died because of the usage of tobacco, as per the WHO report. Tobacco-related diseases, likely lung cancer, emphysema chronic obstructive pulmonary disease, and chronic respiratory diseases, are more common. Nicotine is a highly addictive chemical found in the tobacco plant and also in all other tobacco products. All tobacco products contain nicotine that causes the release of dopamine in the pleasure and motivation areas of the brain. Both smoking and smokeless tobacco products contain many harmful chemicals that affect the lung mucociliary clearance and also inactivate the immune system and lead to increases in the risk of infection and the development of deleterious bacterial growth in the lungs. In the lung microbiome, Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Pseudomonas aeruginosa bacterial species were found to a higher level in smoking tobacco users as that may increase morbidity and mortality. The lung microbiome changes taking place in the lung due to smokeless tobacco usage are less documented so far. In future research, microbiome studies help to understand disease pathogenesis.
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Intrathoracic manifestations of immunoglobulin G4-related disease: A pictorial review p. 83
Umran Ozden Sertcelik, Asli Oncel, Deniz Koksal
DOI:10.4103/ejop.ejop_112_20  
Immunoglobulin G4-related disease (IgG4-RD) is an increasingly recognized systemic fibro-inflammatory disease associated with elevated serum IgG4 levels. It affects virtually any organ system including the gastrointestinal system, salivary glands, periorbital tissues, kidneys, lungs, lymph nodes, central nervous system, large vessels, thyroid, and skin. Although the involved organ systems vary between studies and are influenced by the medical center and specialty, the most frequent manifestation of IgG4-RD is regarded to be type 1 autoimmune pancreatitis. The incidence of intrathoracic involvement is not known exactly, but it is thought to be relatively rare. Intrathoracic manifestations of IgG4-RD can be observed in airways (tracheobronchial stenosis, thickening of bronchovascular bundles), pulmonary parenchyma (nodules, masses, interstitial lung disease), pleura (pleural thickening, nodules, effusion), and mediastinum (lymphadenopathy, fibrosing mediastinitis). This review aimed to briefly describe the pathogenesis, histopathology, clinical features, diagnosis, and treatment of IgG4-RD; and make a pictorial review of its intrathoracic manifestations.
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ORIGINAL ARTICLES Top

Assessment of the approaches of pulmonologists to sedation in bronchoscopic procedures in Turkey : A survey study p. 89
Ozlem Sogukpinar, Ülkü Aka Aktürk, Ayperi Öztürk, Dilek Ernam
DOI:10.4103/ejop.ejop_99_20  
BACKGROUND: Sedation is recommended during fiberoptic bronchoscopy, which is a common procedure in clinical pulmonary practice. However, there is no consensus or a standard approach globally. The present study aimed to assess the approaches of pulmonologists to sedation before bronchoscopic procedures in Turkey. MATERIALS AND METHODS: The study is designed as a cross-sectional study, based on survey-generated data. Pulmonologists working in Turkey were sent a 23-item survey via E-mail. The recipients were sent three reminders to complete the survey, and the responses were analyzed. The data analysis was carried out using the Statistical Package for the Social Sciences for Windows 15.0 package program. RESULTS: A total of 79 pulmonologists participated in the survey, with a mean age of 43.8 ± 7.7 years. Among the respondents, 92.4% stated that they applied sedation before bronchoscopic procedures. Of the total, 92% of the respondents stated that they used midazolam for sedation, while 20% used propofol, 18.7% used fentanyl and 9% used diazepam. All of the respondents reported using local anesthesia before the bronchoscopic procedure, with lidocaine being preferred by all. CONCLUSIONS: It was determined that most of the pulmonologists applied sedation during bronchoscopy usually in the form of mild-to-moderate sedation, with midazolam being the preferred medication. Of the respondents, 75% believed that the applied sedation was sufficient. Surveys like this could play a role in improving the implementation and application of international guidelines in Turkey.
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Septic shock in patients admitted to intensive care unit with COVID-19 pneumonia p. 95
Kazim Rollas, Gürsel Ersan, Çiler Zincircioğlu, Isa Sahar, Taner Çalişkan, Işil Köse Güldogan, Aykut Saritaş, Uğur Uzun, Nimet Senoğlu
DOI:10.4103/ejop.ejop_101_20  
BACKGROUND: The aim of this study was to determine mortality rates and to evaluate clinical features of coronavirus disease 2019 (COVID-19) patients with septic shock in intensive care unit (ICU). MATERIALS AND METHODS: The medical records of COVID-19 patients requiring ICU admission were retrospectively reviewed over a 3-month period. RESULTS: Forty patients with COVID-19 admitted to the ICU were screened. Two patients died within 24 h after ICU admission. After these patients were excluded, septic shock was detected in 11 (28%) of 38 patients during the 30-day follow-up period. Ten (91%) of the 11 patients with septic shock died in the ICU. Eight (72%) of the 11 patients had nosocomial infection during 30-day follow-up period. Six (54%) of 11 septic shock patients had positive culture results for bacterial pneumonia on the day of septic shock. The median time from symptom onset to septic shock was 14 (5–34) days. The median duration from ICU admission until septic shock was 8 (1–28) days. All of the patients with septic shock underwent invasive mechanical ventilation (IMV). CONCLUSION: COVID-19 patients with septic shock have higher mortality rates, percentage of nosocomial infection, and IMV requirement.
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Factors afffecting the treatment success of patients followed in the intensive care unit with community-acquired pneumonia p. 101
Nihan Cetin, Gülten Arslan, Banu Çevik Eler
DOI:10.4103/ejop.ejop_102_20  
BACKGROUND: Pneumonia developing in the community is defined as community-acquired-pneumonia (CAP) and causes serious mortality. We aimed to investigate the characteristics and factors affecting the treatment success of severe CAP patients in the intensive care unit (ICU). MATERIALS AND METHODS: Demographic characteristics (age and gender), presence of comorbidity, duration of ICU and intubation, laboratory data, chest X-ray findings, mechanical ventilation (MV) supports, presence of sepsis, septic shock, requirement of inotropic, reintubation, tracheostomy, microbiological etiology in cultures, nutritional characteristics, and mortality of 121 CAP cases who were admitted to our ICU within 4 years were recorded retrospectively. Pneumonia severity index, predisposition, infection, response, organ dysfunction (PIRO), confusion, urea, respiratory rate, blood pressure-Age (CURB-65), and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were examined. RESULTS: Mortality in male gender was found to be higher (P = 0.009). It was determined that the nonsurvivor patients stayed longer in the ICU (P = 0.006). Mortality rate was higher in patients with bilateral and multilobar infiltration (P < 0.001), pleural effusion (P = 0.001) on chest X-ray, who were admitted to the ICU as intubated (P = 0.01), and who required MV (P < 0.001) and tracheostomy (P = 0.002). Statistically significant relationship was found between duration of intubation (P = 0.01), presence of sepsis (P < 0.001), and septic shock (P = 0.003) on admission to ICU and mortality. Only, a positive correlation between procalcitonin (PCT) and negative correlation between SaO2 (P = 0.03) and pH (P = 0.009), pO2 (P = 0.006) in arterial blood gas from the laboratory values on admission to ICU and mortality was determined. CONCLUSIONS: It was concluded that male gender, intubation, tracheostomy, supports of MV and inotropic, presence of sepsis, septic shock and multilobar, bilateral infiltration and pleural effusion on chest X-ray, low levels of pH, pO2, SaO2, and SpO2 may be factors affecting mortality in CAP patients in the ICU, PCT values, APACHE II, CURB-65, and PIRO scores can be used as a marker to predict mortality.
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Importance of neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in chronic obstructive pulmonary disease exacerbations p. 110
Elif Babaoglu, Sevinc Sarinc Ulasli, Emine Keles, Elif Tugce Korkmaz, Deniz Koksal, Salih Emri
DOI:10.4103/ejop.ejop_106_20  
BACKGROUND: The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are markers of inflammation. Many cells and mediators have been found to be involved in the progression of chronic obstructive pulmonary disease (COPD). We aimed to evaluate the association of the NLR and PLR with treatment options, length of hospital stay, and mortality of patients with COPD exacerbation in this study. MATERIALS AND METHODS: We retrospectively collected the data of COPD patients who were hospitalized with the diagnosis of COPD exacerbation. Demographic data, NLR, PLR, number of exacerbations in the last year, length of hospital stay, and deceased patients were evaluated. Correlations between NLR and PLR with length of hospital stay and treatment options were analyzed. NLR and PLR values were compared between deceased and survived patients. RESULTS: One hundred and nineteen patients were included in the study. The mean age of patients was 68.74 ± 9.2 years, and the mean length of hospital stay was 19.5 ± 13.5 days. The median NLR and PLR values were 3.7 (minimum–maximum: 1–10.8) and 109 (minimum–maximum: 7.4–890), respectively. NLR values were found to be higher in patients who required systemic steroid or invasive mechanical ventilation (IMV) (P = 0.001, P = 0.017). The cutoff value of NLR was 2.65 with 73.8% sensitivity and 54.9% specificity (area under the curve [AUC]: 0.675, P = 0.001) for systemic steroid requirement, and the cutoff value of NLR for IMV requirement was 4.19 with 77.8% sensitivity and 70.4% specificity (AUC: 0.741, P = 0.017). However, PLR values were not related with systemic steroid or IMV. CONCLUSION: NLR seems to be a superior prognostic inflammatory marker than PLR in COPD exacerbation for predicting treatment options.
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Awareness of occupational diseases among research assistants working in a medical faculty hospital: An exploratory study on a neglected area p. 116
Nur Şafak Alici, Berkay Suzer, Muzaffer Utkan Ecemis, Gokce Kasabali, Gamze Dinler, Sirin Sanli, Oguzhan Kuzgun, Ali Burkay Nakipoglu, Arif Hikmet Çimrin
DOI:10.4103/ejop.ejop_110_20  
INTRODUCTION: Occupational diseases are conditions that are preventable and that are actually frequently encountered by physicians in daily practice. The present study, involving research assistants working in a medical faculty hospital clinic where there is the potential to diagnose occupational disease measures, aimed to analyze their level of awareness of the diagnosis, treatment, and monitoring of occupational diseases. MATERIALS AND METHODS: This is a descriptive study, for which an exploratory survey was administered to 126 resident physicians in a medical faculty hospital. The survey items were related to the physicians' knowledge of the definition of “occupational disease,” whether they took work and occupational history in daily practice, the status of diagnosis of occupational diseases in their own fields of specialization and the procedure followed in the event of a diagnosis, and their opinions of the significance of diagnosing occupational diseases. RESULTS: Among the participants, 77 (62.1%) were found to ask the patients about their occupation, with the reasons given for not doing so being stated as patient load and busy schedule by 16 (12.9%) and limited time by 9 (3%) of the participants. Approximately 60% of the participants were able to define the term “occupational disease,” however, only 37.9% were aware of the laws on occupational health and safety. CONCLUSIONS: The findings indicate that there is a significant lack of knowledge on occupational disease in medical education. As such, education should be provided during both medical school and specialization training regarding the duties, powers, and responsibilities of physicians related to occupational diseases.
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Characteristics of asthma–chronic obstructive pulmonary disease overlap among chronic obstructive pulmonary disease and asthma patients: Based on one center cross-sectional study p. 122
Onur Turan, Fatoş Polat, Ayşe Gizem Eren Kara, Kaan Sözmen
DOI:10.4103/ejop.ejop_4_21  
BACKGROUND: Asthma-chronic obstructive pulmonary disease overlap (ACO) is a disease characterized by persistent airflow obstruction with several features of both asthma and chronic obstructive pulmonary disease (COPD). AIM: The aim was to find patients who meet ACO criteria among COPD and asthmatics. MATERIALS AND METHODS: This cross-sectional study included outpatients who applied to our pulmonology outpatient clinic with the previous diagnosis of asthma and COPD in 2019. These participants were evaluated to determine whether they met criteria of ACO. The diagnostic criteria in Global Initiative for Asthma (GINA)-Chronic Obstructive Lung Disease (GOLD), Spanish, and American Thoracic Society (ATS) Guidelines were used as the diagnostic assessment for ACO. RESULTS: There were 156 men (56%) and 123 women (44%) with a mean age of 56.7 ± 15.6. Of the 279 patients analyzed, 25 (9%) met the ACO diagnostic criteria; 137 (49.1%) had COPD, and 117 (41.9%) had asthma. 5.5% of COPD and 12.7% of asthma patients were given the diagnosis of ACO. Eighty eight percent of ACO patients met the diagnostic criteria of GINA-GOLD, whereby 64% of them met Spanish, and 68% met ATS Guideline Criteria. Patients with ACO were of older age, had more comorbidities, higher rates of smoking, and worse spirometry parameters when compared with asthmatics (P < 0.01, P < 0.01, P = 0.017, and P < 0.01, respectively). ACO patients had a higher rate of female gender, higher mean age and more allergic symptoms than COPD patients (all P < 0.01). CONCLUSION: There were more patients who were given the diagnosis of ACO in asthma group when compared with COPD group. Clinicians may consider the diagnosis of ACO in smokers and older asthmatics and in COPD patients with atopic symptoms.
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CASE REPORTS Top

Multiple pulmonary hyalinizing granulomas mimicking widespread lung metastasis p. 128
Hakki Celik, Naciye Sinem Gezer, Duygu Gurel, Emine Cagnur Ulukus
DOI:10.4103/ejop.ejop_58_20  
Pulmonary hyalinizing granuloma (PHG) is a rare benign lesion that can be unilaterally or bilaterally presented in the form of solitary or multiple nodules and masses. It may also be related to mediastinal and retroperitoneal fibrosis, autoimmune diseases, tumors, or infectious diseases. The definitive diagnosis of PHG can only be made by pathological evaluation. A 64-year-old male applied to the hospital to undergo an inguinal hernia repair operation. Preoperative chest imaging revealed multiple pulmonary nodules with lobulated contours and regular margins scattered throughout both lungs. Pathologic evaluation revealed that nodules were consistent with PHG. In addition, soft-tissue density observed around the abdominal aorta was compatible with retroperitoneal fibrosis, which may accompany this disease.
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Manual chest physiotherapy during whole-lung lavage in pulmonary alveolar proteinosis p. 132
Umut Bahcaci, Songul Atasavun Uysal
DOI:10.4103/ejop.ejop_33_20  
Pulmonary alveolar proteinosis (PAP) is a diffuse lung disease that appears after the accumulation of lipoproteinaceous material in the alveoli. We aimed to compare the effects of using chest physiotherapy during a whole-lung lavage (WLL) to those without its use in a PAP case. A 33-year-old male patient with complaints of difficulty breathing, coughing, and dyspnea was admitted to the hospital. After the patient underwent a chest screening and diagnostic tests, WLLs were planned for his left and right lungs on separate days. Manual chest physiotherapy, including tapotement and vibration, was performed during the right WLL at the physician's request. Much more lipoproteinaceous material was visually detected in the saline collection bottles after the WLL using manual tapotement and vibration when compared to the WLL without tapotement and vibration. The improvement in the patient's clinical status was supported by chest X-ray and auscultation results.
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