Ezgi Demirdöğen

Mediastinal nodal classification in non–small cell lung cancer (NSCLC) at the N0/N1–N2/N3 treatment-defining boundary guides therapeutic strategy and is commonly finalized in multidisciplinary tumor board (MDT) meetings. We compared positron emission tomography/computed tomography (PET/CT) and endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) against MDT assignment and quantified discordance at this threshold. We retrospectively analyzed 114 consecutive NSCLC patients who underwent both PET/CT and EBUS-TBNA before MDT review. Nodal stage was dichotomized as N0/N1 vs N2/N3. Because the MDT decision incorporates both modalities, agreement with MDT is reported as observed agreement and Cohen κ together with the direction of discordance, rather than as sensitivity and specificity. In the subgroup with surgical mediastinal staging, both modalities and the MDT category were compared with histopathology. MDT assigned N2/N3 in 84 patients (73.7%). Relative to the MDT category, PET/CT over-classified 16 patients (14.0%) and under-classified 9 (7.9%). EBUS-TBNA under-classified 15 of the 43 patients it classified N0/N1 (34.9%), and under-classification persisted among the 25 patients in whom every sampled station was diagnostic (8/25, 32.0%); 12 of these 15 assignments rested on clinical–radiological course rather than histopathology. Agreement with the MDT category was 85.1% (κ = 0.662) for EBUS-TBNA and 78.1% (κ = 0.389) for PET/CT; because malignant cytology was definitional for the MDT category, 67 of 97 concordant EBUS-TBNA classifications (69.1%) were determined by that rule and do not measure EBUS-TBNA performance. Against surgical histopathology in 18 patients, PET/CT classified 11 of 13 pathologically N0 patients as N2/N3 (specificity 15.4%; 95% CI, 4.3–42.2) and EBUS-TBNA identified 2 of 5 with pathological N2 disease (sensitivity 40.0%; 95% CI, 11.8–76.9). At the treatment-defining nodal boundary, the two modalities diverged from the multidisciplinary decision in opposite directions: PET/CT over-classified nodal status, whereas EBUS-TBNA under-classified in approximately 1 in 3 patients it had assigned N0/N1, including those in whom sampling was complete, although most of these assignments rested on clinical course rather than tissue. These findings are consistent with guideline recommendations that PET-positive mediastinal nodes require tissue confirmation and that a negative endosonographic result be interpreted alongside pretest probability and station coverage.

Background: Influenza and pneumococcal vaccination are recommended for patients with bronchiectasis, but real-life vaccination rates and related clinical factors remain insufficiently characterized. Methods: This multicenter cross-sectional study used data from the Turkish Adult Bronchiectasis Database (TEBVEB), collected between March 2019 and January 2022 in 25 centers across Türkiye. A total of 839 adult patients with bronchiectasis were included and classified into four groups. Results: Overall, 44.3% of patients were non-vaccinated, 14.8% received pneumococcal vaccination only, 7.5% influenza vaccination only, and 33.4% received both vaccines. The prevalence of a known bronchiectasis etiology differed between pneumococcal- and both-vaccinated patients (PV and BV) and non-vaccinated patients (p<0.001). Emergency department admissions were least frequent in the BV group (p=0.004). BV patients had higher rates of Pseudomonas aeruginosa (21.4%, p=0.002) and MRSA isolation (3.0%, p=0.026). COPD prevalence was highest in the FV group (p=0.014). In multivariable analysis, ex-smoking (OR 1.53, 95% CI 1.04–2.24) and current smoking (OR 2.01, 95% CI 1.13–3.57) were positively associated with pneumococcal vaccination, whereas COPD (OR 0.88, 95% CI 0.79–0.99) and post-infectious etiology (OR 0.80, 95% CI 0.66–0.99) were negatively associated. Post-infectious etiology was independently associated with lower influenza vaccination rates (OR 0.49, 95% CI 0.36–0.66). In addition, higher educational status (university education) was associated with reduced influenza vaccination uptake (OR 0.43, 95% CI 0.23–0.83). Conclusion: Vaccination status in adults with bronchiectasis is associated with clinical characteristics, microbiological profile, and healthcare utilization.

Background and Objective: Pulmonary alveolar proteinosis (PAP) is a rare disease of inappropriate alveolar surfactant accumulation. The study objective was to compare Greece–Türkiye–Cyprus cohorts, followed‐up for 20 years. Methods: Data were retrieved retrospectively by chart review. Results: One hundred and thirty patients, Greece 39, Türkiye 87, Cyprus 4, were included; 115 (89%) autoimmune (a)PAP, 13 (10%) secondary, 1 (1%) hereditary. Abnormal anti‐GM‐CSF antibody titre was available in 86/115 patients, further analyzed for aPAP. Forty (46%) were male, with median (IQR) age at diagnosis of 40 (31–50) years. At median (IQR) duration of clinical follow‐up of 39 (18–78) months, three patients died. Non‐survivors had higher rates of cardiovascular disease [67% vs. 5%, p < 0.001], LTOT (67% vs. 13%, p = 0.001), pulmonary fibrosis [67% vs. 5%] and worse functional status at follow‐up [FVC% pred 49 (29) vs. 87 (74–97); p = 0.026, DLCO% pred 21 (46) vs. 72 (58–82); p = 0.016]. aPAP patients were stratified by therapy group (no WLL‐no i‐GM‐CSF, WLL alone, i‐GMCSF alone and both WLL and iGM‐CSF). WLL was more frequently performed in Türkiye and i‐GMCSF alone in Greece ( p = 0.006). All therapies were effective. No difference was detected on outcome when sole iGM‐CSF was compared to WLL alone or in combination with iGM‐CSF [deceased/alive 0%/100% vs. 7%/93%, p = 0.491]. Sole iGM‐CSF significantly ameliorated clinical and functional parameters of disease severity [DLCO% ( p = 0.013), SatO ₂ ( p = 0.002), 6MWT ( p = 0.026)]. Across all therapy groups, pulmonary fibrosis eliminated beneficial response to treatment. Conclusion: This first real‐life comparison of aPAP cohorts originating from three countries showed the non‐inferiority of sole iGM‐CSF treatment. Fibrosis negatively affects response to treatment and survival.

Accurate species-level identification of Aspergillus is clinically important because closely related species may differ in virulence and antifungal susceptibility. This study evaluated the discriminatory capacities of the ITS, β-tubulin (benA), and calmodulin (CaM) loci using an in silico multilocus approach. Whole-genome sequences from the NCBI GenBank and RefSeq databases were used to construct an in-house reference library. Barcode regions were extracted in silico using published primer pairs and analyzed for sequence length variation, nucleotide differences, single nucleotide polymorphisms, insertions/deletions, and candidate species reduction patterns. Principal coordinate analysis (PCoA) was performed to visualize genetic relationships among species. Most clinically important species exhibited similar barcode length distributions and clustered according to Aspergillus sections. PCoA results were largely consistent with section classification, with the first two coordinates explaining 20.4% and 18.2% of the total variation. Sequential analysis using a ≥99% sequence identity threshold showed that ITS had the lowest discriminatory capacity, whereas benA achieved the greatest reduction in candidate species and resolved the highest number of taxa. CaM displayed the highest sequence variation in pairwise comparisons of closely related species. Although A. flavus and A. austwickii remained indistinguishable across all three loci, additional differences were detected in the cyp51A region. These findings indicate that section-oriented marker selection and prior in silico evaluation can improve the efficiency and discriminatory performance of sequence-based Aspergillus identification workflows.

Objectives: Cystic fibrosis-related diabetes (CFRD) is the most common comorbidity in patients with cystic fibrosis (CF). This study aimed to determine the prevalence and risk factors of CFRD using data from the CF Registry of Türkiye (CFRT). Methods: All patients with CF who underwent diabetes screening in 2022 or earlier were included in the study. The clinical and demographic characteristics of patients with CFRD, pre-diabetes (impaired glucose tolerance, impaired fasting glucose, indeterminate glucose tolerance), and those with normal screening results (NSR) were compared. Results: Of the 1,702 patients registered in the data system in 2022, 916 patients from 21 centers who underwent diabetes screening were included in the study. CFRD was diagnosed in 102 patients (11.2 %), there were 56 patients (6.1 %) with pre-diabetes, and NSR were found in 757 patients (82.7 %). The youngest patient diagnosed with diabetes was 6 years old. In patients with CFRD, the median age of patients was found to be higher (pPseudomonas aeruginosa (P. aeruginosa) colonization (p<0.001), severe mutations (60.8 %, p<0.001), and pancreatic insufficiency (56.1 %, p<0.001) were more frequent; median FEV1% and FVC% values were significantly lower (p<0.001 and p<0.002, respectively) compared to non-diabetic patients. Conclusions: CFRD is associated with impaired pulmonary function, poor nutritional status, and increased chronic bacterial colonization of the airways. Advanced age, decreased respiratory function, severe genotype, and pancreatic insufficiency are risk factors for CFRD.

Turkish Thoracic Society Declaration on Peace and Health the Importance of Breathing in a World Without War - Thoracic Research and Practice