No abstract

Background and aimChronic obstructive pulmonary disease (COPD) patients with acute respiratory failure (ARF) frequently require admission to the intensive care unit (ICU) for application of mechanical ventilation (MV). We aimed to determine whether comorbidities and clinical variables present at ICU admission are predictive of ICU mortality.MethodsA retrospective, observational cohort study was performed in a tertiary teaching hospital’s respiratory ICU using data collected between January 2008 and December 2012. Previously diagnosed COPD patients who were admitted to the ICU with ARF were included. Patients’ demographics, comorbidities, body mass index (BMI), ICU admission data, application of noninvasive and invasive MV (NIV and IMV, respectively), cause of ARF, length of ICU and hospital stay, and mortality were recorded from their files. Patients were grouped according to mortality (survival versus non-survival), and all the variables were compared between the two groups.ResultsDuring the study period, a total of 1,013 COPD patients (749 male) with a mean age (standard deviation) of 70±10 years met the inclusion criteria. Comorbidities of the non-survival group (female/male, 40/131) were significantly higher compared with the survival group (female/male, 224/618): arrhythmia (24% vs 11%), hypertension (42% vs 34%), coronary artery disease (28% vs 11%), and depression (7% vs 3%) (P<0.001, P<0.035, P<0.001, and P<0.007, respectively). Logistic regression revealed the following mortality risk factors: need of IMV, BMI <20 kg/m2, pneumonia, coronary artery disease, arrhythmia, hypertension, chronic hypoxia, and higher acute physiology and chronic health evaluation II (APACHE II) scores. The respective odds ratios, confidence intervals, and P-values for each of these were as follows: 27.7, 15.7–49.0, P<0.001; 6.6, 3.5–412.7, P<0.001; 5.1, 2.9–8.8, P<0.001; 2.9, 1.5–5.6, P<0.001; 2.7, 1.4–5.2, P<0.003; 2.6, 1.5–4.4, P<0.001; 2.2, 1.2–3.9, P<0.008; and 1.1, 1.03–1.11, P<0.001.ConclusionPatients with severe COPD and cardiac comorbidities and cachexia should be closely monitored in ICU due to their high risk of ICU mortality.

Our results show that patients with pulmonary hamartomas may have coexisting lung malignancies.

Objectives. To measure delays from onset of symptoms to initiation of treatment in patients with smear-negative and smear-positive pulmonary tuberculosis and to identify reasons for these delays. Methods. A total of 136 newly diagnosed pulmonary tuberculosis patients were interviewed using a structured questionnaire. Results. The patients were divided into two groups. Group 1 included 65 smear-negative patients. There were 71 smear-positive patients in group 2. The median application interval was 10 days in group 1 and 14 days in group 2. While 24.6% of the patients had patient delay in group 1, patient delay was present in 33.8% of the patients in group 2 (P > 0.05). The median health care system interval was 41 days in group 1 and 16 days in group 2 (P < 0.0001). The most common reason for patient delay was neglect of symptoms by patient in both groups. A low index of suspicion for tuberculosis by physicians was the most common reason for doctor delays. Conclusions. Delays are common problem in smear-negative and smear-positive pulmonary tuberculosis patients. Delays should be reduced to reach an effective tuberculosis control. Education of public and physicians about tuberculosis is the most important effort to reduce delays.

Pulmonary sequestration is defined as a portion of abnormal lung tissue that does not communicate with the tracheobronchial tree through a normally located bronchus and has an abnormal vascular supply [1]. It was first described by Rektorzik in 1861, but the term "sequestration" was introduced by Pryce in 1946 in a 7-case report [2,3]. This extremely rare disorder accounts for 0.16% to 6.4% of all pulmonary congenital malformations [3]. Depending on its location, pulmonary sequestration is generally subdivided into intralobar and extralobar sequestration [4]. Extralobar pulmonary sequestration accounts for 14%-25% of cases [2]. It is most frequently diagnosed in the first 6 months of life, but is seen incidentally, though rarely, in older children and adults [5]. We present an adult case with extralobar pulmonary sequestration. Case ReportA 36-year-old Turkish female, a non-smoker, was admitted to our department with complaints of chest and back pain for five years. Her past history was unremarkable. A chest X-ray (CxR) showed an area of opacity behind the cardiac silhouette in the lower area of the left hemithorax (figure 1). On admission, her resting pulse rate was 86 beats per min., blood pressure 100/70 mmHg, and respiratory rate 18 breaths per min. Her respiratory system and general examinations revealed no significant abnormalities. Full blood count and biochemical tests were normal. Erythrocyte sedimentation rate was 20 mm/h. During hospital stay, the patient was given a course of antibiotics, but opacity in the left lower area persisted. A Computed Tomography (CT) scan of the thorax with intravenous contrast showed a 9 x 7 cm in size ovoid mass with necrosis in the lower left lobe. It revealed two aortic branches directed toward the pulmonary opacity (figure 2), which is consistent with a suspicion of pulmonary sequestration. Bronchoscopic examination revealed a normal endobronchial appearance. Bronchial lavage examination was negative for acid-fast bacilli. Her thoracic Magnetic Resonance (MR) angiography showed an arterial supply from descending thoracic aorta. Pulmonary functional tests were within normal limits. The patient was referred to surgery, and a left-sided thoracotomy was performed. The lesion was located within the pleural space between the diaphragm and the lower lobe. Four arteries arising from the descending aorta were identified. The anomalous pulmonary tissue was removed by mass excision. Pathologic examination of surgical material obtained diagnosis of extralobar pulmonary sequestration. The patient still remains in excellent condition after nearly two years from the operation. We described the case of a 36-year-old Turkish female with an extralobar pulmonary sequestration who suffered from chest and back pain for five years without any evidence of pulmonary infection. A chest X-ray showed an area of opacity behind the cardiac silhouette in the lower area of the left hemithorax. A CT scan of the thorax with intravenous contrast showed a 9 x 7 cm in size ovoid mass with necrosis in the...