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    Diagnostic value of pleural fluid lactate dehydrogenase/adenosine deaminase ratio in differentiating parapneumonic effusion from tuberculous pleurisy
    (Wolters Kluwer Medknow Publications, 2021) Anar, Ceyda; Yavuz, Melike Yuksel; Alici, Ibrahim Onur; Guldaval, Filiz; Buyuksirin, Melih
    Objective The purpose of this study was to determine the diagnostic value of pleural fluid lactate dehydrogenase (LDH)/pleural fluid adenosine deaminase (ADA) ratio in differentiating pleural effusions owing to tuberculous pleurisy (TBP) and parapneumonic effusion (PPE). Patients and methods The data of 272 patients (140 patients with TBP and 132 patients with PPE) between January 2012 and October 2018 were analyzed retrospectively. Demographic data of all patients; concurrent serum glucose, albumin, protein, and LDH values; and pleural fluid pH, glucose, albumin, protein, and ADA results have been reviewed. Results Pleural fluid ADA values were statistically significantly higher in the TBP group than PPE (P<0.001). The median values of pleural fluid LDH/ADA ratio between TBP and PPE groups were 16.10 (12.53) and 32.90 (34.45), respectively, which was found to be significantly lower in TBP group (P<0.001). Pleural fluid LDH/ADA ratio's sensitivity, specificity, positive predictive value, and negative predictive value were 90, 59.85, 70.4, and 84.9%, respectively, in the diagnosis of TBP for values less than 28 (P<0.001). Conclusion The ratio of pleural fluid LDH/ADA determined from routine biochemical analysis predicts TBP at value of 28. Measurement of this parameter may help clinicians distinguish between TBP and PPE.
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    Pneumothoraxes after CT-guided percutaneous transthoracic needle aspiration biopsy of the lung: A single-center experience with 3426 patients
    (Turkish Assoc Tuberculosis & Thorax, 2023) Polat, Gulru; Ozdemir, Ozer; Unat, Damla Serce; Karadeniz, Gulistan; Ayranci, Aysu; Unat, Omer Selim; Buyuksirin, Melih
    Introduction: The purpose of this study is to determine how long patients who developed pneumothorax were followed up on in the emergency department, how many patients required chest tube placement, and what factors influenced the need for a chest tube in patients who underwent computed tomography (CT)-guided percutaneous trans -thoracic fine needle aspiration biopsy (PTFNAB).Materials and Methods: Patients who developed pneumothorax following CT-guided PTFNAB were analyzed retrospectively. In cases with pneumotho-rax, the relationship between chest tube placement and the size of the lesion, the lesion depth from the pleural surface, the presence of emphysema, and the needle entry angle were investigated. It was determined how long the patients were followed up in the emergency department, when a chest tube was pla-ced, and when patients who did not require chest tube placement were discharged.Results: CT-guided PTFNAB was performed in 3426 patients within two years. Pneumothorax developed in 314 (9%) cases and a chest tube was placed in 117 (37%). The risk factor for chest tube placement was found to be the lesion depth from the pleural surface. The lesion depth from the pleural surface of >24 mm increased the risk of chest tube placement by 4.8 times. Chest tubes were placed at an average of five hours (5.04 +/- 5.57).Conclusion: This study has shown that in cases with pneumothorax that required chest tube placement, the lesion depth from the pleural surface is a risk factor. Patients who developed pneumothorax on CT during the procedure had chest tubes placed after an average of five hours.
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    Risk Factors for Presence of Resistant Microorganisms in Sputum Cultures of Patients with Infectious Exacerbations of Chronic Obstructive Lung Disease
    (Bilimsel Tip Yayinevi, 2022) Buyuksirin, Melih; Senol, Gunes; Polat, Gulru; Ayranci, Aysu; Guldaval, Filiz; Serce Unat, Damla
    Introduction: Antibiotics reduce the risk of short-term mortality. Certain bacteria may be resistant to initial regimens which is related to mortality. The aim of this study was to find risk factors for the presence of resistant bacteria during exacerbation of Chronic Obstructive Pulmonary Disease (COPD). Materials and Methods: Ethics committee approval was obtained for the study. The patients hospitalized with an exacerbation of COPD between 2015 and 2020 were retrospectively ieviewed. The patients with a sputum culture result were divided into: Group A with conventional microorganisms (susceptible to initial antibiotic regimen) and Group B with non-conventional microorganisms (resistant to initial antibiotic regimen). The risk factors for Group B microorganisms were investigated. Results: One hundred and nineteen patients were included in the study. Median age was 68 (40-88) years. There were 22 patients in Group A and 97 in Group B. Most common microorganism in Group A was Haemophilus influenza (12.6%). Most encountered microorganisms in Group B were Pseudomonas aeruginosa (49.6%). Male sex (HR= 2.9; 95% CI= 0.9-9.5; p= 0.073), age >61 (HR=4.8; 95% CI= 1.7-13.6; p= 0.003), and >5 hospitalizations last year (HR= 8.2; 95% CI= 0.9-67.7; p= 0.051) were found to be independent risk factors for resistant microorganisms. Conclusion: Proposed risk factors for the isolation of multidrug resistant microorganism in patients hospitalized with COPD exacerbations should be considered when choosing the initial antibiotic regimen.