Yaşar İncekara

Introduction: Community-acquired pneumonia (CAP) remains a major cause of morbidity and mortality in elderly patients. Early identification of high-risk individuals is crucial for improving outcomes. Biomarkers derived from routine laboratory tests, such as the lactate / albumin (L/A) ratio, may provide valuable prognostic information. Methodology: This retrospective, two-center observational study included patients aged ≥ 65 years who were hospitalized with CAP between January 2021 and December 2024. Demographic characteristics, comorbidities, clinical severity scores, and laboratory parameters obtained at hospital admission were analyzed. Laboratory-derived ratios, including L/A, C-reactive protein/albumin (CRP/A), procalcitonin/albumin (PCT/A), and lactate dehydrogenase/albumin (LDH/A), were calculated. Receiver operating characteristic (ROC) analysis and logistic regression were performed to assess predictors of in-hospital mortality. Results: A total of 150 patients were included, of whom 24% died during hospitalization. Non-survivors had significantly higher comorbidity burden, quick sepsis-related organ failure assessment (qSOFA) scores, lactate levels, and biomarker-based ratios. The L/A ratio was significantly associated with mortality (p < 0.001) and demonstrated moderate diagnostic performance (area under ROC, AUC = 0.263), with relatively favorable sensitivity and negative predictive value. Among the evaluated clinical scores, qSOFA showed the most balanced discriminatory performance. Multivariate analysis identified baseline oxygen saturation, Glasgow coma scale, albumin, and lactate levels as independent predictors of mortality. Conclusions: The L/A ratio is a readily available biomarker associated with mortality in elderly patients with CAP. Although not a standalone predictor, it may serve as a complementary prognostic tool alongside established clinical severity scores, particularly during early patient assessment.

Purpose: Acute pulmonary embolism (APE) is a potentially life-threatening condition requiring rapid risk stratification. Although computed tomography (CT) pulmonary angiography is the diagnostic gold standard, the prognostic value of CT-derived radiological markers remains incompletely defined. Material and methods: This retrospective study included 91 patients with APE. CT-derived radiological parameters – including the Qanadli obstruction index (QI), Mastora score, right ventricle/left ventricle (RV/LV) ratio, and RV wall thickness – were evaluated together with clinical severity scores (Pulmonary Embolism Severity Index [PESI], and its simplified version [sPESI]) and laboratory markers. Associations with disease severity and intensive care unit (ICU) admission were assessed using correlation and receiver operating characteristic (ROC) analyses. Results: Among the patients, 52.7% were female and 27.5% required ICU admission. PESI, sPESI, QI, Mastora score, and RV/LV ratio were significantly higher in ICU-admitted patients (all p < 0.01). QI correlated significantly with PESI (r = 0.433), disease severity (r = 0.565), D-dimer (r = 0.510), and troponin levels (r = 0.536) (all p < 0.001). The Mastora score showed similar significant associations with clinical severity indices, RV/LV ratio, and laboratory markers. ROC analysis demonstrated that PESI had the highest predictive accuracy for ICU admission (area under the curve, AUC = 0.849), followed by RV/LV ratio (AUC = 0.838), sPESI (AUC = 0.791), and both QI and Mastora score (AUC = 0.782). Platelet-to-lymphocyte ratio, systemic immune-inflammation index, and RV wall thickness were not significant predictors. Conclusions: CT-derived obstruction indices and RV/LV ratio provide clinically meaningful prognostic information for ICU requirement in APE, particularly when integrated with established clinical severity scores.

Recent studies have reported a relationship between obstructive sleep apnea syndrome (OSAS) and benign prostatic hyperplasia (BPH). In this study, we investigated the association between continuous positive airway pressure (CPAP) therapy and changes in lower urinary tract symptoms, uroflowmetric parameters, nocturia-related quality of life, and prostate-specific antigen (PSA) levels in male patients with OSAS and BPH. The primary endpoint was the change in International Prostate Symptom Score (IPSS), while secondary endpoints included changes in International Consultation on Incontinence Questionnaire Nocturia Quality of Life Questionnaire (ICIQ-NQoL), Qmax, Qavg, post-void residual urine volume, and PSA levels. This retrospective single-center observational study screened 352 male patients diagnosed with OSAS. Of these, 38 patients diagnosed with BPH who regularly used CPAP therapy for at least 6 months and met the inclusion criteria were included in the study. ICIQ-NQoL, the IPSS, uroflowmetric measurements and PSA levels were evaluated in all patients before and after CPAP treatment. The mean age of the 38 patients was 61.03 ± 8.63 years and the age ranged between 47 and 78 years. The Apnea-Hypopnea Index was significantly correlated with PSA, IPSS, and ICIQ-NQoL scores ( r = 0.400, P = .013; r = 0.397, P = .014; and r = 0.333, P = .041, respectively). Significant improvements were observed in IPSS, ICIQ-NQoL, Qmax, Qavg, and post-void residual urine volume following CPAP therapy (all P < .001), whereas no significant change was observed in PSA levels ( P = .29). CPAP therapy may be associated with improvements in lower urinary tract symptoms, uroflowmetric parameters, and nocturia-related quality of life in patients with OSAS and BPH; however, no significant change was observed in PSA levels.

Objective: To evaluate the association between nocturnal hypoxemia burden—expressed as the percentage of total sleep time spent below 90% oxygen saturation (%T90/TST)—and atherogenic indices, including the atherogenic index of plasma (AIP), Castelli risk index I (CRI-I), and Castelli risk index II (CRI-II), in obstructive sleep apnea syndrome (OSAS); and to assess pre–post changes after adherent continuous positive airway pressure (CPAP) therapy. Methods: Single-centre retrospective–prospective cohort of adults with moderate–severe OSAS. Hypoxemia burden was quantified as the percentage of total sleep time with peripheral oxygen saturation (SpO₂) < 90% (%T90/TST) and grouped as Low (≤5%), Mild (>5–≤10%), Moderate (>10–≤25%), and Severe (>25%). The lipid panel—total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (TG)—and atherogenic indices (AIP, CRI-I, CRI-II) were compared across %T90 groups and within patients before and after ≥3 months of adherent CPAP (device-verified ≥4 h/night on ≥70% of nights). Results: One hundred and four patients were included. Higher %T90 was associated with a progressively more atherogenic profile: LDL-C ( p = 0.027), TC ( p < 0.001), TG ( p < 0.001) and CRI-I ( p < 0.001), CRI-II ( p = 0.006), AIP ( p < 0.001) were significantly higher in the >25% group versus ≤5%. The lowest nocturnal SpO₂ (peripheral oxygen saturation) did not correlate significantly with lipids/indices. After adherent CPAP, LDL-C (118.0 → 102.5 mg/dL), TC (199.0 → 182.0 mg/dL), TG (152.5 → 129.0 mg/dL) and CRI-I (4.37 → 3.94), CRI-II (2.58 → 2.24), AIP (0.55 → 0.46) decreased significantly (all p < 0.001), while HDL-C did not change ( p = 0.570). Primary endpoints (CRI-I/II, AIP) remained significant after Bonferroni correction. Conclusion: In OSAS, greater hypoxemia burden (%T90/TST) is linked to a more atherogenic lipid profile, and adherent CPAP is associated with a meaningful reduction in atherogenic load (AIP, CRI-I/II). These findings indicate that nocturnal hypoxaemia, captured using index-based measurements (AIP, Castelli I/II) as well as traditional lipids, is associated with a general reduction in atherogenic risk.

Background: Sarcoidosis is a multisystem inflammatory disorder characterized by non-caseating granulomas, most commonly affecting the lungs and intrathoracic lymph nodes. Angiotensin-converting enzyme (ACE) levels and calcium abnormalities are recognized biomarkers, while ^18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is increasingly used to assess disease activity. However, neither provides sufficient diagnostic accuracy alone. Therefore, this study aimed to investigate the relationship between FDG-PET/CT metabolic findings and serum ACE and calcium (Ca²⁺) levels as surrogate indicators of inflammatory metabolic intensity in sarcoidosis. Methods: In this retrospective single-center study, 127 patients with pulmonary sarcoidosis who underwent PET/CT at diagnosis were evaluated. Demographic and clinical data, ACE, and Ca²⁺ levels were recorded. FDG uptake in mediastinal, pulmonary, and extrapulmonary sites was analyzed, and correlations with biomarkers were assessed. Results: The cohort included 89 females (70.1%) and 38 males (29.9%), mean age 51.3 ± 11.9 years. FDG uptake was most frequent in mediastinal lymph nodes (84.3%) and lung parenchyma (40.9%). ACE levels correlated weakly with total SUVmax (r = 0.214, p = 0.019). Calcium levels correlated with extrapulmonary SUVmax (r = 0.327, p = 0.001) and were higher in patients with extrapulmonary involvement (p = 0.045). No associations were found between symptom presence and biomarkers or SUVmax values. Conclusions: FDG-PET/CT metabolic parameters, particularly total and extrapulmonary SUVmax, demonstrated modest yet statistically significant associations with ACE and calcium levels. These findings suggest that a combined biomarker-imaging approach may provide complementary information regarding inflammatory metabolic intensity and systemic involvement; however, the results should be interpreted as exploratory and require validation in prospective studies.

Aim: Haemoptysis is a clinical condition characterised by blood in the airways and is difficult to manage even for experienced clinicians. Bronchoscopy is a crucial tool in the treatment and evaluation of haemoptysis. However, we see that it is not used sufficiently in diagnosis and treatment. Within the scope of our research, we aimed to investigate the place and importance of bronchoscopy in haemoptysis through our bronchoscopy applications in patients we follow with the diagnosis of haemoptysis. Material and Method: The files and data of patients who were admitted to the Pulmonary Diseases Department and Intensive Care Unit with the diagnosis of haemoptysis or who were followed up as outpatients and underwent bronchoscopy were retrospectively reviewed. Results: Bronchoscopy findings were normal in 18% of patients, endobronchial lesions (EBL) in 18%, external compression in 1%, mucosal-submucosal infiltration, increased raying in 4%, narrowing of orifices in 2%, mucosal petechiae-vascularity increased in 2%, fragile mucosal hyperaemia-oedema in 12%, active haemorrhage in 5%, haemoptysis residues-coagulum in 37%, and purulent secretion in 1%. While no findings were observed in 19% of the patients during bronchoscopy and no procedure was performed, 55% received topical applications, 7% received only thermal applications, and 19% received both thermal and endobronchial treatments (EBT). Conclusion: We believe that our study will support the existing literature by revealing that bronchoscopy plays an important role in the diagnosis and treatment processes of patients with haemoptysis and that this method has the potential to increase its clinical contributions in the future.

Objective: This study aimed to evaluate the appropriateness of antibiotic therapy and discharge prescriptions in patients with lower respiratory tract infections (LRTIs) using the Medication Appropriateness Index (MAI) criteria. Methods: A retrospective cross-sectional study was conducted between January 2022 and January 2024 at a tertiary training and research hospital. A total of 111 patients diagnosed with community-acquired pneumonia, acute/chronic bronchitis, or infectious exacerbations of COPD and asthma were included. Prescriptions were evaluated independently by two physicians based on the ten MAI domains. Results: All prescriptions were fully appropriate regarding indication, effectiveness, dosage, and directions (100%). No clinically significant drug–drug or drug–disease interactions were detected. Unnecessary antibiotic duplication occurred in 4.5% of cases, and cost appropriateness was achieved in 68%. Monotherapy was predominant during hospitalization, while a trend toward narrower-spectrum and more cost-effective regimens was observed at discharge. Conclusion: According to MAI assessment, overall clinical appropriateness of antibiotic prescribing was high. Reducing unnecessary duplication and promoting cost-effective alternatives may further strengthen rational antibiotic use and antimicrobial stewardship practices.

Purpose: We aimed to explore the impact of the lactate dehydrogenase to albumin (LDH/ALB) ratio, an independent indicator of prognosis associated with the clinical course and mortality in lower respiratory tract infections (LRTI). Materials and Methods: This study included patients aged 18 to 90 who presented to the emergency department or pulmonology outpatient clinic of a training and research hospital between December 2021 and January 2023 and were admitted to the pulmonology ward or intensive care unit with a diagnosis of lower respiratory tract infection (LRTI). The data from the patients' initial admission whether through the emergency department, pulmonology outpatient clinic, pulmonology ward, or ICU were evaluated for inclusion in the study. Results: A total of 200 patients were included in the study. The LDH/ALB ratios were significantly higher in deceased (ex) patients compared to survivors (p<0.001). In the ROC curve analysis for mortality prediction, the LDH/ALB ratio demonstrated a strong predictive value, with an area under the curve (AUC) of 0.801 (p<0.001). Conclusion: LDH/ALB ratio may be an independent prognostic ındıcator for in-hospital mortality and ICU hospitalization decision in patients with LRTI.

Background and aim: There is limited data on the correlation between findings of lower respiratory tract infections detected by chest computed tomography but not by chest radiography and sputum culture results. The aim of this study is to evaluate the relationship among sputum culture results, chest radiographic findings and computed tomography outcomes in patients diagnosed with lower respiratory tract infections.Materials and Methods: Between January 2021 and September 2023, the clinical and radiological findings of patients diagnosed with lower respiratory tract infections, both those with and without positive sputum cultures, were retrospectively evaluated.Results: In the studied cohort, 65.4% (n = 172) of the patients were male and 34.6% (n = 91) were female, with an overall mean age of 67.18 ± 13.77 years. On chest computed tomography, consolidation was observed in 39.53% (n = 34) of patients with positive sputum cultures, compared to 23.72% (n = 42) of patients with negative cultures (p = 0,005). Furthermore, necrotising pneumonia findings were noted in 5.81% (n = 5) of culture‐positive patients and 1.13% (n = 2) of culture‐negative patients (p = 0.034). Infiltrative changes were detected in 81.4% (n = 70) of patients with positive cultures and 66.6% (n = 118) of patients with negative cultures on chest radiography (χ² = 20,492; p < 0.001).Conclusion: The identification of findings on chest radiography is notably challenging in patients diagnosed with lower respiratory tract infections due to the presence of non‐consolidative infiltrates and their respective anatomical locations. Moreover, the probability of detecting radiological findings on chest radiographs is enhanced in patients exhibiting positive sputum cultures.