Murat Yalcinsoy

Everolimus is one of the immunosuppressive drugs used in solid organ transplantation. Many side effects have been described for these immunosuppressive drugs, similar to other drugs in this category. The purpose of this case presentation is to draw attention to drug-induced pneumonitis, which is a rare and life-threatening side effect of everolimus. A nineteen-year-old female patient who received liver transplantation for toxic hepatitis was admitted to our institute with cough and dyspnea. Everolimus had been started in conjunction with tacrolimus therapy 6 months prior to admission. Her chest imaging were consistent with pneumonitis. Markers of infection and cultures were all negative. After discontinuation of everolimus, symptoms and radiological findings resolved. The adverse effects of the drug should be kept in mind while investigating possible infectious agents in liver transplant recipients who are prone to opportunistic infections.

Objectives. Endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) has been recognized as the first method of choice in the diagnosis of mediastinal and hilar lesions. Although the procedure is commonly used, there is no study assessing its contribution to the duration required for diagnosis and treatment. In this study, we aimed to determine the extent of diagnosis and treatment delays when using the EBUS‐TBNA procedure and to address the possible factors contributing to these delays. Materials and Methods. The demographic data, pathological diagnosis, need for additional procedures, symptoms, presenting complaints, and the time until the beginning of treatment were recorded retrospectively in all patients who had undergone EBUS‐TBNA. Results. A total of 134 patients (mean age 60.7 ± 12 years, M/F: 78/56) were included. Delay of the patients was found in 60.4% (n = 81), delayed referral in 35.8% (n = 48), diagnosis delays in 84.3% (n = 113), treatment delays in 38.8% (n = 52), and total delay in 73.1% (n = 98) of the patients. A statistically significant association was found between referral delay and total delay with age groups (p = 0.006) and between patient delay and the presence of symptoms (p = 0.027). EBUS‐TBNA was found to have the lowest effect among all delay parameters (β: 0.104, p < 0.001) in the regression analysis. When diagnosis times’ subgroups were compared, EBUS‐TBNA was found to have the least effect (correlation coefficient: 0.134, p = 0.004). Conclusion. We found that approximately ¾ of the patients had a delay and this is not acceptable in real terms. Considering that the patient burden is increasing day by day, it is necessary to make a radical change in health care or a change in strategy in order to prevent delays. EBUS‐TBNA, which is in the diagnosis delay subgroup, is less invasive and accelerates the process.

OBJECTIVE: Endobronchial ultrasound-guided transbronchial needle aspiration has been successfully applied in both diagnosis and staging of mediastinal and hilar lymphadenopathies and masses, especially in malignant cases. However, the optimal procedure of Endobronchial ultrasound-guided transbronchial needle aspiration to further increase diagnostic yield and minimize processing complexity remains controversial. This study aims to compare aspiration biopsy (Endobronchial ultrasound-guided transbronchial needle aspiration) and non-aspiration biopsy (Endobronchial ultrasound-guided transbronchial needle capillary sampling) in terms of sample adequacy, diagnosis, and quality in malignant cases. METHODS: Between March 2018 and June 2020, Endobronchial ultrasound- guided was performed sequentially on patients with mediastinal and/or hilar lymph nodes that were considered malignant. Each lymphadenopathy was sampled with and without aspiration. A single-blinded pathologist evaluated the samples. RESULTS: A total of 84 lymph nodes evaluations of 51 patients were included. Most samples were taken from the right lower paratracheal lymph nodes ( n=27, 32.2%) and subcarinal LN (n=21, 25%). The mean size of the lymph nodes was 21.21 +/- 8.257 (8-40) mm. The agreement between the two procedures in terms of sample adequacy and diagnostic yield was 69.1% (95%CI 58-78.7, p=0.076). In addition, according to the goodness-of-fit statistics, the kappa values were 0.255 (p=0.015) and 0.302 (p=0.004) for sample adequacy and diagnostic yield, respectively. There was no difference between the two procedures in relation to complications. CONCLUSION: Although the agreement between the two procedures is weak, Endobronchial ultrasound-guided transbronchial needle capillary sampling can be performed with less personnel, without reducing diagnostic yield and tissue adequacy. These findings can assist clinicians in determining the optimal procedure for Endobronchial ultrasound-guided.

COVID-19 pandemic,deaths,Malatya

This study aimed to evaluate the prognostic value of inflammatory markers determined during admission among patients with sarcoidosis with chronic and remission groups. This study was designed as retrospective single-center study. Patients with sarcoidosis without treatment and who had at least two years of follow-up were included in this study. Patients were divided into two groups as chronic and remission. The primary outcome is to evaluate hematological parameters in remission and chronic sarcoidosis groups. Out of 348 patients with sarcoidosis, 142 patients without treatment and followed up for at least two years were included in this study. Groups had similar demographic features with the predominance of females (80.4 and 77.9%, respectively) and stage I disease (78.6 and 68.6%, respectively). Lymphocyte count [median (IQR) 1.7 (1.3-2.3) 109/L versus 2.1 (1.6-2.4) 109/L, p=0.034] was significantly lower, whereas neutrophil to lymphocyte ratio (NLR) was significantly higher [median (IQR) 2.6 (2.0-3.1) versus 2.0 (1.6-2.8), p=0.006] at admission in the chronic group. No significant difference was determined in inflammatory parameters at admission between groups. Lower lymphocyte count and higher neutrophil to lymphocyte ratio were determined in patients with chronic sarcoidosis compared with the remission group, based on monitoring of radiological staging up to five-year after the initial diagnosis. Accordingly, the identification of neutrophil to lymphocyte ratio at diagnosis seems to be a potential prognostic marker in patients with sarcoidosis beside its low cost and easy determination in routine clinical practice.

Introduction: COVID-19 pneumonia typically presents with high fever, cough, and shortness of breath and on thorax computed tomography (CT) peripheral ground glass opacities help the diagnosis. Although typical imaging findings for COVID-19 pneumonia are specified in thorax CT, these findings can confused with other diseases. The aim of this study is to investigate the roles of radiological imaging and laboratory findings in the differential diagnosis of COVID-19 pneumonia and acute heart failure (AHF). Materials and Methods: In the present study, 74 patients who admitted to the emergency department with respiratory distress during the pandemic period and received a diagnosis of COVID-19 pneumonia and AHF were included. Laboratory data and radiological findings of the patients, at the time of admission, were evaluated. Results: On admission, there was no difference in age, gender between two groups. However, COVID-19 exposure history was found significantly higher in COVID-19 pneumonia patients group (p< 0.001). Fever, cough, and fatigue were found significantly higher in the COVID-19 pneumonia patients group (p< 0.001). There was difference of lesions distribution between the two groups, centrally distributed lesions were found significantly higher in acute heart failure patients (p< 0.001). Pleural effusion and cardiomegaly were found significantly higher in AHF patients (p< 0.001, p< 0.001). Counts of the white blood cells and lymphocytes were found significantly lower in COVID-19 pneumonia patients 0.003, p= 0.009). COVID-19 pneumonia patients had significantly higher levels of CRP ferritin, LDH and CK compared with AHF patients (p< 0.001, p< 0.001, p= 0.002, p= 0.013). However the level of NT-proBNP was found significantly higher in the AHF patients group (p< 0.001). Conclusion: We believe that laboratory data and thorax CT findings can provide beneficial clinical information in differentiating COVID-19 pneumonia from AHF during the pandemic.

Aim: Treatment rates of multidrug-resistant tuberculosis (MDR-TB) vary from clinic to clinic. In this study, the characteristics of MDR-TB patients followed in two clinics of our hospital and their relationship with treatment results were investigated. Material and Method: This observational retrospective cohort study performed in a government hospital which is one of the important reference center for management of tuberculosis in Turkey. Seventy-nine adult MDR-TB cases who'm diagnosed and treated between 2004-2014 were retrospectively enrolled into the study. Results: Of the patients with MDR-TB, 58 were male, 21 were female, mean age was 36.24 ± 13.75 and all of them were HIV (-). 64 patients completed treatment, 15 patients still under treatment. The average hospitalization time was 162.76. Radiologically, 11 patients had diffuse disease and 68 patients had limited disease. The mean number of patients who received second-line drugs were 5.18 ± 0.5 and drug-related side effects developed in 36 patients. Cure was achieved in 84.4% of the patients, 7.8% discontinued the treatment, 7.8% died during the treatment and there wasn’t any treatment failure. Conclusion: In our study, we think that the factors that increase the success of MDR-TB treatment are: young age, low resistance to second line medication, prolongation of hospitalization, good compliance with treatment, low rate of ofloxacin use in previous treatment, use of fluoroquinolones in new patients, surgery in selected patients.

Introduction: Cytomegalovirus (CMV), is the most common opportunistic infection, remains a cause of life-threatening disease and allograft rejection in liver transplant (LT) recipients. The purpose of this case series is to state that CMV may lead to severe pneumonia along with other bacteria. Methodology: CMV pneumonia was diagnosed with the thoracic computed tomography (CT) scan findings, bronchoscopic biopsy, real time quantitative Polymerase Chain Reaction (qPCR) and clinical symptoms. For extraction of CMV DNA from the clinical sample, EZ1 Virus Mini Kit v2.0 (Qiagen, Germany) was used, and aplification was performed with CMV QS-RGQ Kit (Qiagen, Germany) on Rotor Gene Q 5 Plex HMR (Qiagen, Germany) device. Results: All recipients had severe pneumonia, leukopenia, thrombocytopenia and at least two-fold increase in transaminases on seventh, twenty-eighth and twenty-second days after surgery, respectively. Thoracic CT scan revealed as diffuse interstitial infiltration in the lung parenchyma. Bronchoscopy, Gram-staining and culture from bronchoalveolar lavage (BAL) fluid were performed in all of them. During bronchoscopy, a bronchial biopsy was administered to two recipients. One recipient could not be performed procedure because of deep thrombocytopenia. PCR results were positive from serum and BAL fluid. Bronchial biopsy was compatible with CMV pneumonia. However, Pseudomonas aeruginosae was found in two cases and Klebsiella pneumoniae in one case BAL fluid cultures. Conclusions: CMV pneumonia can be seen simultaneously with bacterial agents due to the indirect effects of the CMV. It should be kept in mind that CMV pneumonia may cause severe clinical courses and can be mortal.