Tugce Sahin Ozdemirel

Objective: Ongoing debates about the adequacy of the interstitial pneumonia with autoimmune features (IPAF) criteria highlight the need for further research. The objective of this study was to evaluate pulmonary involvement patterns alongside respiratory function parameters, clinical, radiological, pathological, and laboratory features, treatment choices, and the relationships among these findings.Methods: Patients who met the 2015 European Respiratory Society and American Thoracic Society IPAF classification criteria were included. Initial high-resolution computed tomography (HRCT) scans were independently evaluated by 2 pulmonologists and 1 radiologist. Interstitial pneumonia with autoimmune features patients were grouped by gender, HRCT patterns, and presence of Raynaud’s phenomenon (RP), and their characteristics were compared.Results: Of the 78 patients included in the study, 55.1% were male. The most frequent clinical features were RP and inflammatory arthritis or polyarticular morning joint stiffness. The most common autoantibodies were antinuclear antibodies (85.9%) and anti-double-stranded DNA (21.8%). The most prevalent radiologic pattern was nonspecific interstitial pneumonia (92.3%). All patients met the serological and morphological domains, while 45 (57.7%) fulfilled the clinical domain. Smoking history, weight loss, and dry mouth were found to be independent factors different between groups (P < .005). Photosensitivity and the presence of a fibrotic nonspecific interstitial pneumonia (f-NSIP) pattern were identified as independent predictors of RP.Conclusion: The certain findings should be carefully investigated as independently associated factors for IPAF in interstitial lung disease patients with autoimmune features: smoking history and weight loss in men, dry mouth in women, and photosensitivity and f-NSIP pattern in patients with RP.

Background: Combined pulmonary fibrosis and emphysema (CPFE) is characterized by upper-lobe emphysema and lower-lobe fibrosis, with preserved lung volumes, impaired gas exchange, and a poor prognosis. Antifibrotic treatment's role in CPFE remains limited. The study aimed to evaluate the impact of antifibrotic treatment on clinical characteristics and pulmonary function in CPFE. Methods: This retrospective study included patients diagnosed with CPFE between January 2020 and May 2023. Demographic data, high-resolution tomography findings, pulmonary function tests (FVC, DLCO, DLCO/VA), six-minute walk test results, and survival data were collected. Functional parameters were compared at baseline and during 6–12 months of follow-up. Results: Sixty-nine patients were included; 44 (63.8%) received antifibrotic therapy. Treated patients had higher baseline dyspnea scores (p=0.018), greater fibrosis extent, and lower DLCO/VA (70.3±22.1 vs 85.4±26.2; p=0.041), indicating more severe disease. Spirometric indices did not differ between groups. DLCO declined over time regardless of treatment (p=0.005). However, DLCO/VA showed a significant interaction with treatment over time (p=0.006), suggesting a potential treatment effect on gas exchange. Survival did not differ significantly (p=0.194). Outcomes were comparable between pirfenidone and nintedanib. Conclusion: Antifibrotic therapy was initiated in more symptomatic CPFE patients with impaired gas exchange. While lung volumes remained stable, diffusion capacity declined. Overall, the antifibrotic treatment may have a possible benefit on alveolar-capillary function.

Background: Hypersensitivity pneumonitis (HP) is an interstitial lung disease characterized by immune-mediated inflammation and variable degrees of fibrosis. Aims: To evaluate the clinical, radiological, and hematological features of patients diagnosed with HP. Study Design: Retrospective cross-sectional study. Methods: We included 100 patients diagnosed and followed for HP between 2020 and 2024. Demographic characteristics, pulmonary function test results, diffusing capacity, six-minute walk test findings, antigen exposure history, and high-resolution computed tomography (HRCT) patterns were retrospectively analyzed. Results: The mean age was 63 ± 14 years, with equal sex distribution. Sixty-five percent of patients had identifiable antigen exposure, predominantly related to birds or bird products (86.4%). Surgical lung biopsy confirmed the diagnosis in 29% of cases. The most common HRCT findings were reticulation (87%), ground-glass opacities (84.7%), and centrilobular nodules (75%); fibrotic features were present in 48% of patients. Glucocorticoids were the main treatment (77%), and antifibrotic therapy was used in 20% of cases. Neutrophil count showed a modest positive correlation with honeycombing (r = 0.27, p = 0.025). Basophil count demonstrated a mild association with bird-related antigen exposure (r = 0.26, p = 0.035). Conclusions: Peripheral neutrophil and basophil counts showed weak but statistically significant associations with fibrotic HRCT features and exposure patterns. These exploratory findings suggest that routinely available hematologic parameters may provide supportive information alongside radiologic and clinical data. Prospective studies are needed to validate their diagnostic and prognostic relevance in HP.

Background/Objectives: Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive fibrosing interstitial disease that incurs significant healthcare costs due to diagnostic and treatment needs. This study aimed to estimate healthcare expenses related to IPF diagnosis, treatment, and follow-up, including factors affecting overall expenditure. Methods: This retrospective cohort study included 276 IPF patients from a tertiary hospital (2013–2022). Diagnostic and treatment costs were analyzed, including antifibrotic medications (pirfenidone and nintedanib), diagnostic tests (pulmonary function tests and performance evaluation tests), and interventions (fiberoptic bronchoscopy, imaging modalities). Costs in Turkish Lira were converted to United States dollars. Statistical analysis was performed using non-parametric tests to evaluate expenditure correlations with demographic, clinical, and treatment parameters, which included the Mann–Whitney and Spearman Rank Correlation tests when appropriate. Results: The median healthcare expenditure was USD 429.1 (9.13–21,024.57). Inpatient costs (USD 582.67; USD 250.22 to USD 1751, 25th and 75th percentile, respectively) were higher than outpatient costs (USD 192.36; USD 85.75 to USD 407.47, 25th and 75th percentile, respectively). Antifibrotic regimens did not differ significantly in cost or duration (Z = 0.657; p = 0.511) (mean pirfenidone duration: 1.1 ± 1.0 years; mean nintedanib duration: 0.6 ± 0.9 years). Diagnostic tests, particularly pulmonary function tests (PFT) (p: 0.001, Rho: 0.337), diffusing capacity of the lungs for carbon monoxide (DLCO) (p: 0.001, Rho: 0.516), and high-resolution computed tomography (HRCT) (p: 0.001, Rho: 0.327), were the primary drivers of costs. Longer treatment duration was positively correlated with expenditure (Rho: 0.264, p: 0.001 and Rho: 0.247, p: 0.006 for pirfenidone and nintedanib, respectively) while age showed a weak negative correlation (Rho = −0.184, p = 0.002). Gender and type of antifibrotic regimen did not show any significant effect on costs. Discussion: Diagnostic and follow-up testing were the main contributors to costs, driven by reimbursement requirements and the progressive nature of IPF. Antifibrotic medications, although expensive, provided clinical stability, potentially reducing hospitalization needs but increasing long-term care expenses. Variations in healthcare systems affect expenditures, with Turkey’s universal coverage lowering costs compared to Western countries. The study’s main limitations include being a single-center, retrospective study and its inability to include comorbidities and disease severity in the statistical analysis. Conclusions: IPF management is resource-intensive, with diagnostic tests and follow-up driving costs independent of demographics and treatment modality. Anticipating higher expenditures with prolonged survival and evolving treatment options is crucial for healthcare budget planning. Preparation of healthcare policies accordingly to these observations, which must include an overall increase in cost due to treatment duration and survival, remains a crucial aspect of budget control.

Pulmonary Langerhans cell histiocytosis (PLCH) is a rare interstitial lung disease of unknown etiology, typically affecting individuals aged 20 to 40. Characteristic high-resolution computed tomography findings may obviate the need for biopsy. This study aims to raise awareness by describing clinical and imaging features of PLCH. This single-center retrospective cohort (2016–2024) included 26 confirmed PLCH patients. Demographics, smoking history, comorbidities, symptoms, lab results, 6-minute walk distance, pulmonary function tests, diffusion capacity for carbon monoxide (DLCO), and high-resolution computed tomography findings were reviewed. Median age was 46 years; 84.6% had a smoking history. Cough (46.2%) and dyspnea (53.8%) were common. Radiologically, cysts and nodules predominated. Initial DLCO was lower in dyspneic patients (P = .035). Over median 2.5 years of follow-up, pulmonary function tests and DLCO values remained stable. Early recognition of PLCH radiological features and smoking cessation are crucial. Despite limitations, these findings reinforce known patterns and highlight the need for larger, prospective studies.

Aims: The airway flora has been recognized as non-sterile, and sputum sampling is recommended for hospitalized patients with respiratory infections. Empiric antibiotic treatment is often initiated without culture confirmation, potentially contributing to antimicrobial resistance. This study aims to assess the influence of demographic factors, prior antibiotic use, and other risk factors on resistant respiratory cultures in ward-admitted patients. Methods: A single-center cohort study was conducted in a pulmonary medicine ward of a tertiary hospital between the dates of March 2024 and September 2024. Patients over 18 years old with sputum, bronchoalveolar lavage (BAL), or endotracheal aspiration culture results were included. Demographic characteristics, comorbidities, vaccination status, prior infections, respiratory support needs, antibiotic history, and hospital admission records were collected. Nonparametric statistical analyses were used to evaluate associations, including the Mann-Whitney U and Kruskal-Wallis tests. Results: Among 70 patients (mean age 68 ±9 years, 87% male), chronic obstructive pulmonary disease (COPD) (71.4%) was the most prevalent comorbidity. A total of 75.7% of cultures were from sputum samples, with Pseudomonas spp. (27.1%), Klebsiella pneumoniae (20%) and Escherichia coli (14.3%) being the most frequently isolated organisms. Resistant cultures were more common in patients with intensive care unit (ICU) admission history (p=0.007), intubation history (p=0.003), and non-invasive mechanical ventilation (NIMV) use (p=0.038). No correlation was found between prior antibiotic use and resistance. Conclusion: ICU admission and respiratory support requirements were key risk factors for resistance. Contrary to previous studies, prior antibiotic use and comorbidities did not significantly impact resistance rates. These findings highlight the need for targeted antimicrobial stewardship and careful risk assessment among patients requiring pulmonary ward admission.

Background and Objectives: Acute exacerbation of idiopathic pulmonary fibrosis (IPF-AE) often results in severe respiratory distress requiring treatment in the intensive care unit and has a high mortality rate. Identifying prognostic markers and assessing disease severity are crucial for clinicians to gain detailed insights. The mean platelet volume-to-platelet count ratio (MPR) is an inflammatory marker commonly used in malignancies. This study aimed to evaluate MPR and other factors affecting mortality in patients with IPF-AE who were monitored in the intensive care unit (ICU). Materials and Methods: This retrospective study was conducted on patients monitored in the ICU for IPF-AE between 2017 and 2023. Demographic characteristics, vital signs, laboratory and imaging findings, and administered treatments were reviewed. MPR was calculated by dividing the mean platelet volume by the platelet count. The primary endpoint was defined as 1-month in-hospital mortality. Results: A total of 59 patients monitored in the ICU for IPF-AE were included in the study. The mean age of the patients was 62.75 years, and 81.4% of the participants were male. During the 30-day follow-up period, 62.7% of the patients died. The need for invasive mechanical ventilation (IMV) was significantly associated with increased mortality (p < 0.001). The optimal cutoff value for MPR was determined to be 0.033, with a sensitivity of 83.7% and specificity of 63.64%, indicating its predictive value for mortality (AUC: 0.764; 95% CI: 0.635–0.864; p < 0.001). Conclusions: In this study, the need for IMV emerged as a critical parameter in predicting mortality in patients with IPF-AE. Additionally, the use of the MPR as a prognostic biomarker may offer a novel approach in the management of IPF patients. These findings could contribute to the development of strategies aimed at early intervention in IPF patients. Further studies with larger sample sizes are needed to validate these results. This study has demonstrated that MPR is a significant prognostic biomarker for predicting mortality in patients with IPF-AE who are managed in the intensive care unit. The potential use of MPR as a biomarker in clinical decision-making may provide new approaches to the management of IPF patients. Additionally, the need for IMV in IPF-AE emerges as a critical parameter for predicting mortality. These findings may contribute to the development of early intervention strategies for IPF patients. Further studies with larger cohorts are needed to validate these results.

Introduction and Objective: Acute exacerbation of idiopathic pulmonary fibrosis (IPF-AE) often results in severe respiratory distress requiring treatment in the intensive care unit and has a high mortality rate. Identifying prognostic markers and assessing disease severity are crucial for clinicians to gain detailed insights. The mean platelet volume-to-platelet count ratio (MPR) is an inflammatory marker commonly used in malignancies. This study aimed to evaluate MPR and other factors affecting mortality in patients with IPF-AE who were monitored in the intensive care unit (ICU). Materials and Methods: This retrospective study was conducted on patients monitored in the ICU for IPF-AE between 2017 and 2023. Demographic characteristics, vital signs, laboratory and imaging findings, and administered treatments were reviewed. MPR was calculated by dividing the mean platelet volume by the platelet count. The primary endpoint was defined as 1-month in-hospital mortality. Results: A total of 59 patients monitored in the ICU for IPF-AE were included in the study. The mean age of the patients was 62.75 years, and 81.4% of the participants were male. During the 30-day follow-up period, 62.7% of the patients died. The need for invasive mechanical ventilation (IMV) was significantly associated with increased mortality (p<0.001). The optimal cutoff value for MPR was determined to be 0.033, with a sensitivity of 83.7% and specificity of 63.64%, indicating its predictive value for mortality (AUC: 0.764; 95% CI: 0.635–0.864; p<0.001). Conclusions: In this study, the need for IMV emerged as a critical parameter in predicting mortality in patients with IPF-AE. Additionally, the use of the MPR as a prognostic biomarker may offer a novel approach in the management of IPF patients. These findings could contribute to the development of strategies aimed at early intervention in IPF patients. Further studies with larger sample sizes are needed to validate these results.

Aims: COVID-19 is a multisystemic disease characterized by endothelial dysfunction. The improper activation of the coagulation cascade may lead to thromboembolic events, which are presumed to contribute to the disease’s overall high morbidity and mortality. This research examines the role of thrombophilia mutations in patients diagnosed with post-COVID pulmonary thromboembolism. Methods: Between May 2020 and December 2020, 61 patients were diagnosed with pulmonary thromboembolism (PTE). Thirty-two patients were positive in COVID-19 -RT-PCR testing, and 29 patients were identified with non-COVID PTE. All PTE diagnoses were made by thorax computed tomographic angiography. Demographic characteristics, genetic mutation results, and laboratory values of the patients were retrospectively evaluated. Results: The median age of patients was 56 years (25-81), and most patients (n=43,70.5%) were male. There was no difference between factor 5 Leiden mutation, while prothrombin 20210A mutation was more commonly observed in post-COVID patients (p