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Background: This study aims to identify predictive factors for pulmonary fibrosis development in COVID-19 patients by analyzing thorax CT (computed tomography) findings, serum prolidase activity, MMP-1, MMP-7, TGF-β values, laboratory findings, and demographic characteristics. Materials and methods: The investigation involved 68 patients, both male and female, aged 18 years and older, who were volunteers and had been diagnosed with confirmed COVID-19. The pulmonologist and the radiologist evaluated the thorax CT by consensus. Patients were evaluated in two categories, group 1 and group 2, based on the status of fibrotic changes, and 3-month fibrosis scores were calculated. Findings in both lungs were calculated and noted for the lobes, considering lobar spread. Correlations between quantitative parameters were assessed with Spearman’s rho correlation coefficient. Comparisons between independent samples were evaluated using either the independent sample t-test or the Mann–Whitney U test. We evaluated the relationship between categorical variables using the Pearson chi-square test and Fisher’s exact test. Results: Serum prolidase activity, MMP-1, MMP-7, and TGF-β biomarkers were not statistically significant among groups. LDH was found to be significantly high in the group with fibrotic changes. Additionally, the group with fibrotic changes also had higher levels of fibrinogen. The percentage of neutrophils, the severity of the disease, muscle–joint pain and fatigue symptoms, and the length of hospitalization stay were correlated with the total scores of fibrosis at the third month. In the group with fibrotic changes, the duration of muscle–joint pain and fatigue symptoms and the length of hospitalization were longer than in the other group. Conclusions: The group with fibrotic changes showed an increase in biomarkers. However, this increase did not reach a statistically significant level, suggesting that the third month may be an early period for these changes. The group with fibrotic changes showed high levels of LDH, one of the most important laboratory parameters of pulmonary fibrosis risk factors, along with fibrinogen, suggesting that these parameters are valuable in predicting pulmonary fibrosis. Patients with fibrotic changes can experience specific symptoms, commonly seen in COVID-19.

Anemia is reported to be an independent predictor of hospitalizations and survival in COPD. However, little is known of its impact on short-term survival during severe COPD exacerbations. The primary objective of this study was to determine whether the presence of anemia increases the risk of death in acute respiratory failure due to severe COPD exacerbations. Consecutive patients with COPD exacerbation who were admitted to the intensive care unit with the diagnosis of acute respiratory failure and required either invasive or noninvasive ventilation (NIV) were analyzed. A total of 106 patients (78.3% male; median age 71 years) were included in the study; of them 22 (20.8%) needed invasive ventilation immediately and 84 (79.2%) were treated with NIV. NIV failure was observed in 38 patients. Anemia was present in 50% of patients, and 39 patients (36.8%) died during hospital stay. When compared to nonanemic patients, hospital mortality was significantly higher in the anemic group (20.8% vs 52.8%, respectively; P=0.001). Stepwise multivariate logistic regression analysis showed that presence of anemia and NIV failure were independent predictors of hospital mortality with odds ratios (95% confidence interval) of 3.99 ([1.39-11.40]; P=0.010) and 2.56 ([1.60-4.09]; P<0.001), respectively. Anemia was not associated with long-term survival in this cohort. Anemia may be a risk factor for hospital death in severe COPD exacerbations requiring mechanical ventilatory support.

Background/Objective: This study aimed to investigate the relationship between the pulmonary arterial computed tomography obstruction index ratio (CTOI) and the simplified pulmonary embolism severity index (sPESI), one of the clinical probability scoring modalities, in determining the severity of PE and to determine whether CTOI is a mortality marker. Methods: The study included 117 patients diagnosed with PE via computed tomography pulmonary angiography (CTPA). The CTOI was determined according to the localization of the embolus and the obstruction caused by the embolus in the vessel. Patients were divided into two groups, namely low-risk and high-risk groups, according to their sPESI values. Patient deaths up to six months after PE diagnosis were recorded. Results: According to the sPESI classification, although the CTOI was higher in the high-risk group compared to the low-risk group, no significant difference was found between the groups. The mortality rate was significantly higher in the high-risk group. After six months of follow-up, there was no difference in the CTOI rate between the patients who died and those who survived. Conclusions: Although CTPA is the gold standard for diagnosing PE, it would be more appropriate to use it together with clinical findings to determine the severity of the disease. Further evaluation is needed to investigate the usefulness of the obstruction index and CT findings of right ventricular dysfunction for classifying patient risk and determining therapeutic options.

Introduction. We sought to identify possible risk factors associated with mortality in patients with high-risk pulmonary embolism (PE) after intensive care unit (ICU) admission. Patients and Methods. PE patients, diagnosed with computer tomography pulmonary angiography, were included from two ICUs and were categorized into groups: group 1 high-risk patients and group 2 intermediate/low-risk patients. Results. Fifty-six patients were included. Of them, 41 (73.2%) were group 1 and 15 (26.7%) were group 2. When compared to group 2, need for vasopressor therapy (0 vs 68.3%; p<0.001) and need for invasive mechanical ventilation (6.7 vs 36.6%; p=0.043) were more frequent in group 1. The treatment of choice for group 1 was thrombolytic therapy in 29 (70.7%) and anticoagulation in 12 (29.3%) patients. ICU mortality for group 1 was 31.7% (n=13). In multivariate logistic regression analysis, APACHE II score >18 (OR 42.47 95% CI 1.50–1201.1), invasive mechanical ventilation (OR 30.10 95% CI 1.96–463.31), and thrombolytic therapy (OR 0.03 95% CI 0.01–0.98) were found as independent predictors of mortality. Conclusion. In high-risk PE, admission APACHE II score and need for invasive mechanical ventilation may predict death in ICU. Thrombolytic therapy seems to be beneficial in these patients.

Crizotinib is a multi-targeted inhibitor approved for the treatment of advanced non-small cell lung cancer (NSCLC) patients with positive proto-oncogene l-kinase (ROS1). Most of the adverse effects associated with crizotinib are mild to moderate. However, acute interstitial lung disease (ILD), which may sometimes be fatal, may develop in some patients.Here, we present a case with crizotinib-induced ILD in the patient treated with crizotinib due to metastatic adenocarcinoma. The patient was admitted to our department with dyspnea and severe hypoxemia within the second month of crizotinib treatment. Clinical and radiological findings suggested that ILD arose from crizotinib treatment. Both clinical and radiological improvements were observed after a corticosteroid treatment with the discontinuation of crizotinib treatment. The patient was discharged, but died due to his primary disease. In conclusion, in the patients with NSCLC treated with crizotinib, new-onset respiratory symptoms should be kept in mind for ILD due to crizotinib, and the treatment should be started at an early period.

Background: The clinical spectrum of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is broad; it can range from asymptomatic cases to mild upper respiratory tract illness, respiratory failure, and severe multiorgan failure resulting in death. Therefore, it is important to identify the clinical course of the disease and the factors associated with mortality. Objective: The aim of this study is to identify the risk factors associated with the severity of the disease, intensive care unit admission, and mortality in COVID-19 patients. Methods: A total of 1075 patients with clinical and radiological findings compatible with COVID-19 pneumonia and positive SARS-CoV-2 PCR were selected and retrospectively screened. All included patients were classified according to the 7th edition of the 2019 Coronavirus Disease Guidelines published by the National Health Commission of China. Results: It was observed that elevated white blood count (WBC) increased the severity of COVID-19 by 3.26 times and the risk of intensive care unit (ICU) admission by 3.47 times. Patients with high D-dimer levels had a 91% increased risk, and those with high fibrinogen levels had a 2.08 times higher risk of severe disease. High C-reactive protein (CRP) values were found to increase disease severity by 6.89 times, mortality by 12.84 times, and ICU admission by 3.37 times. Conclusions: Identifying the factors associated with disease severity, ICU admission, and mortality in COVID-19 patients could help reduce disability and mortality rates in pandemics.

OBJECTIVES: The aim of the present study was to evaluate the relation of smoking with anxiety and depression in workers who were exposed to occupational risk factors. For this purpose, working time, smoking status, nicotine dependence, and respiratory functions of the workers who were exposed to physical and/or chemical harmful substances were evaluated and the presence of anxiety/depression was investigated. MATERIAL AND METHODS: Male workers who were exposed to occupational risk factors such as solvents, heavy metals, and dust and visited the outpatient clinic for occupational diseases within a one-year period were included. Pulmonary Function Test and Fagerström Test for Nicotine Dependence were performed. Anxiety and depression statuses of the workers were assessed using the Hospital Anxiety and Depression Scale. RESULTS: The mean age of 665 male workers was 45 y (range, 38-48 y), and they were most commonly exposed to solvents (45.9%), followed by heavy metal fume/dust (20.9%). Of the workers, 252 (37.9%) had anxiety, 294 (44.2%) had depression, and 171 (25.7%) had both. More than half of the workers in each occupation/exposure group were smokers. Respiratory complaints were present in 34% of the workers. According to the regression analysis, the presence of respiratory system complaints was found to be a significant risk factor for anxiety, depression, and anxiety plus depression. CONCLUSION: In conclusion, smoking and anxiety/depression were found to be the conditions affecting more than half of the workers with occupational exposure. Cite this article as: Ergün D, Ergün R, Ergan B, Kar Kurt Ö. Occupational Risk Factors and the Relationship of Smoking with Anxiety and Depression. Turk Thorac J 2018: 19; 77-83.

With this study, we aimed at evaluating demographic data, clinical, laboratory findings in pulmonary embolism (PE) and the relationship of these findings with the embolism location region and responses of the patients to the treatment of the embolism in order to contribute to the patient management in decreasing mortality. Clinical findings, accompanying diseases, risk factors, serum D-dimer and creatinine levels, imaging modalities and mortality rates of 205 patients (female: 98, male: 107) diagnosed with PE were examined retrospectively. The relationship between the qualifier variables was evaluated using Chi-square test. Average age of the patients was 61.55±14.44 years and 86 (42%) patients were above 65 years. Most common complaint was dyspnea (85%), most frequent coexisting disease was congestive heart failure (19%). Deep vein thrombosis (DVT) (30.7%) was the most frequently seen risk factor. Pulmonary embolism was mostly in the right lobe pulmonary artery (32.1%). It was observed that the higher ages of patients the more frequency of proximal located embolism was (p<0.005), especially lobar artery involvement was observed to be high (p=0.032). An early mortality rate was 4.9% and late mortality rate was 11.2%. In the patients with complaint of dyspnea who are at elder ages and have accompanying diseases, PE should be considered. PE is generally localized in the main pulmonary arteries, which emphasizes crucial importance of early diagnosis and treatment in reduction of mortality.

Objectives To explore the rate of pneumoconiosis in dental technicians (DTP) and to evaluate the risk factors. Material and Methods Data of 893 dental technicians, who were admitted to our hospital in the period January 2007–May 2012, from 170 dental laboratories were retrospectively examined. Demographic data, respiratory symptoms, smoking status, work duration, working fields, exposure to sandblasting, physical examination findings, chest radiographs, pulmonary function tests and high-resolution computed tomography results were evaluated. Results Dental technicians’ pneumoconiosis rate was 10.1% among 893 cases. The disease was more common among males and in those exposed to sandblasting who had 77-fold higher risk of DTP. The highest profusion subcategory was 3/+ (according to the International Labour Organization (ILO) 2011 standards) and the large opacity rate was 13.3%. Conclusions To the best of our knowledge, it was the largest DTP case series (N = 893/90) in the literature in English. Health screenings should be performed regularly for the early diagnosis of pneumoconiosis, which is an important occupational disease for dental technicians.

Thiamine plays a pivotal role in energy metabolism. The aim of the study was to determine serial whole blood TPP concentrations in critically ill patients receiving chronic diuretic treatment before ICU admission and to correlate TPP levels with clinically determined serum phosphorus concentrations. This observational study was performed in 15 medical ICUs. Serial whole blood TPP concentrations were measured by HPLC at baseline and at days 2, 5 and 10 after ICU admission. A total of 221 participants were included. Of these, 18% demonstrated low TPP concentrations upon admission to the ICU, while 26% of participants demonstrated low levels at some point during the 10-day study period. Hypophosphatemia was detected in 30% of participants at some point during the 10-day period of observation. TPP levels were significantly and positively correlated with serum phosphorus levels at each time point (P < 0.05 for all). Our results show that 18% of these critically ill patients exhibited low whole blood TPP concentrations on ICU admission and 26% had low levels during the initial 10 ICU days, respectively. The modest correlation between TPP and phosphorus concentrations suggests a possible association due to a refeeding effect in ICU patients requiring chronic diuretic therapy. •In adult critically ill patients receiving diuretics prior to ICU admission, we demonstrated low thiamine levels in 18% of 221 participants on ICU admission and in 26% during the initial 10 ICU days, respectively.•The correlation pattern between TPP and phosphorus levels suggests a possible association with refeeding in adult medical ICU patients requiring chronic diuretic therapy.