Yedikule Teaching Hospital

Lung cancer patients are frail because they are usually diagnosed at an advanced age, are often accompanied by comorbidities, and are at high risk of chemotherapy toxicity. Choosing a safe and correct treatment is very important. In this study, we investigated the ability of VES-13, which measures patient frailty, to predict the side effects of chemotherapeutic drugs. This was a prospective, single-center observational study in which 131 patients aged ≥ 65 years who were scheduled to receive chemotherapy due to a lung cancer diagnosis were included. The VES-13 questionnaire was completed by all patients before treatment. Treatment-related toxicities (TRTs) while receiving chemotherapy treatment were assessed according to the National Cancer Institute Common Terminology Criteria for Adverse Events v4.03. The median age was 70 (65-85) years. There was hematologic toxicity in 46 (35.1%) patients and nonhematologic grade 3-5 toxicity in 33 (25.2%) patients. In the univariate analysis, VES-13 (OR = 8.40, p < 0.001), platinum chemotherapy (OR = 2.53, p = 0.016) and ECOG-PS (OR = 2.60, p = 0.018) were found to be predictive of TRT. In the multivariate analysis, VES-13 remained an independent predictive feature when the predictors were evaluated together (OR = 8.26, p < 0.001). The detection of abnormal scores with the VES-13 tool revealed a greater need for initial treatment dose reduction, treatment interruption, treatment discontinuation, blood transfusion and unexpected hospital admission (p = 0.012, p < 0.001, p < 0.001, p = 0.022, and p < 0.001, respectively). We believe that the VES-13 questionnaire is a useful tool for deciding on a chemotherapy and choosing the appropriate regimen and that it should be used in outpatient clinic conditions because it is easy and short to apply.

Purpose: Due to similar clinical, radiological, and pathological features, distinguishing tuberculosis (TB) from sarcoidosis can be challenging. We aimed to assess the significance of lipid levels and the triglyceride-glucose (TyG) index in differentiating TB from sarcoidosis.Methods: This retrospective observational study included 265 patients with newly diagnosed TB and 270 patients with sarcoidosis. Demographics and baseline levels of serum glucose, triglycerides (TG), total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and very-low-density lipoprotein (VLDL) were recorded. TyG indices were calculated separately. Data were compared between the TB and sarcoidosis groups using Chi-square and Student’s t-tests, and significant variables were assessed by logistic regression analysis. Discriminative ability was evaluated using receiver operating characteristic (ROC) analysis.Results: Males and younger individuals were more prevalent in TB (62% vs. 28%, p &amp;lt; 0.0001; 45.2 ± 17.1 vs. 48.8 ± 11.2 years, p = 0.004). Additionally, TG, total cholesterol, HDL, LDL, VLDL, and TyG index were significantly lower in the TB group (p &amp;lt; 0.0001 for all except HDL, where p = 0.001). Male sex, TG level, and TyG index were independent predictors for TB in logistic regression analysis. A cut-off value of 92.5 mg/dl for TG level predicted TB with 58% sensitivity and 80% specificity (AUC = 0.309, 95% CI 0.265-0.354). A cut-off value of 4.52 mg/dl for the TyG index predicted TB with 57% sensitivity and 80% specificity (AUC = 0.309, 95% CI = 0.265-0.354).Conclusion: TG level and TyG index appear to be hypothesis-generating biomarkers that may help explain metabolic differences between TB and sarcoidosis, rather than standalone diagnostic tools. Further prospective studies are warranted to clarify their potential adjunctive roles.

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.

Surgical treatment can achieve a cure in stage IA non-small-cell lung cancer (NSCLC). Although invasion of vascular, lymphatic, or perineural structures does not alter TNM staging, such features are sometimes considered when recommending adjuvant therapy. This study aimed to evaluate the impact of these invasion types on overall survival (OS) and disease-free survival (DFS) in stage IA NSCLC patients who did not receive adjuvant treatment. A total of 402 patients with pathological stage T1N0M0 NSCLC who underwent anatomical lung resection between January 2014 and December 2019 were retrospectively analyzed. Final staging was performed according to the 8th edition of the TNM classification. Pathology reports and follow-up data were reviewed. Demographic features, surgical details, postoperative complications, and tumor invasion patterns were examined in relation to OS and DFS using Jamovi (v2.5.3.0). In multivariable analysis, older age (HR 1.03, 95% CI 1.00-1.06, p = 0.05), male sex (HR 1.81, 95% CI 1.10-2.98, p = 0.01), and postoperative complications (HR 1.64, 95% CI 1.12-2.40, p = 0.01) independently predicted lower OS. While individual invasion types were not significantly associated with OS, their co-occurrence predicted poorer OS (HR 4.06, p = 0.05) and DFS (HR 12.74, p = 0.001). In subgroup analyses, lymphatic invasion was linked to reduced OS in male patients (HR 1.46, p = 0.04), while lymphatic and vascular invasion both negatively affected OS in squamous cell carcinoma (HR 1.72 and 1.98, respectively). When all three invasion types were present, prognosis worsened markedly in stage IA NSCLC. Sex- and histology-based risk assessment may help guide postoperative treatment decisions.

Hemoptysis is a serious clinical condition, particularly in geriatric patients, due to age-related physiological changes and multiple comorbidities. This study aims to evaluate the etiologies, interventional management strategies, and outcomes of hemoptysis in patients aged 65 years and older. This single-center, retrospective observational study analyzed 1,383 geriatric patients who presented with hemoptysis between 2012 and 2022. Demographic characteristics, comorbidities, bleeding severity, biochemical parameters, and interventional procedures including fiberoptic bronchoscopy, rigid bronchoscopy, and bronchial artery embolization were evaluated. The mean age of the patients was 72.66 ± 6.04 years, and 76.9% were male. Lung cancer was identified as the most common cause of hemoptysis. Minimal bleeding was the most frequent presentation (49.5%). No statistically significant relationship was found between age, bleeding volume, or mortality. Interventional procedures were performed at similar rates across all age groups, and the success and safety of bronchoscopic and embolization interventions were comparable to those reported in younger populations. Biochemical parameters showed no correlation with bleeding severity or mortality. Age alone is not a determinant of hemoptysis severity or mortality. Interventional pulmonary procedures are safe and effective in geriatric patients. Biochemical parameters do not predict hemoptysis outcomes. These findings support an individualized, evidence-based approach to hemoptysis management in elderly patients.

Solunum egzersizlerinin kullanım amacı akciğer hacimlerinin arttırılmasını sağlamaktır. Egzersizler herhangi bir alet kullanmaksızın yapılabileceği gibi, insentif spirometre yardımıyla da benzer eforlarla gerçekleştirilebilir. Diğer taraftan bu iki yöntemin etkinliklerinin karşılaştırıldığı bir çalışmaya rastlanmamıştır. Çalışmamızın amacı aletsiz solunum egzersizleri ile aletli solunum egzersizinin akciğer kapasiteleri üzerine etkilerinin incelenmesidir. Çalışmaya 18-30 yaş arasında olan, herhangi bir hastalık tanısı bulunmayan sağlıklı, genç erişkinler dahil edildi. Katılımcılar aletli solunum egzersizleri (AGr) ve aletsiz solunum egzersizleri (NonAGr) olmak üzere randomize olarak iki gruba ayrıldı ve 8 hafta boyunca telerehabilitasyon yöntemiyle egzersiz programına alındı. Katılımcıların akciğer hacimleri solunum fonksiyon testi ile fiziksel aktivite düzeyleri ise Uluslararası Fiziksel Aktivite Kısa Formu ile değerlendirildi. Çalışmaya toplamda 2 erkek 26 kadın olmak üzere 28 genç erişkin kişi dahil edildi. AGr de yaş ortalaması 22 yıl iken NonAGr’de 21 yıl idi (p=0,017). Grup içi analizlerde AGr’de FEV1/FVC (p=0,032), PEF (p=0,023) ve PEF % değerlerinde (p=0,013) anlamlı gelişme tespit edildi. NonAGr’de sadece PEF% değerlerinde (p=0,002) anlamlı fark vardı. Gruplar arası fark analizinde ise iki grup arasında istatistiksel olarak anlamlı bir farklılık gözlenmedi. Telerehabilitasyon yöntemiyle uygulanan aletli ve aletsiz solunum egzersizlerinin akciğer hacimlerine olumlu etkisi vardır. Uygulanan yöntemlerden elde edilen kazanımlarsa benzerdir ve birbirlerinin yerine kullanılabilir.

Metal hypersensitivity after Nuss procedure is a known complication, but there is no accepted treatment guideline available. Patients undergoing Nuss procedure between 2013 and 2023 were examined retrospectively. Patients with known allergy, positive blood, and/or culture tests, and redo cases were excluded. Nine of 307 (2.9%) patients developed postoperative allergy. No significant difference was found between single or double bar patients. All were treated with medical protocol. No premature bar removal was necessitated. Medical treatment was successful in postoperative metal allergy after Nuss procedure. Ruling out other causes like surgical technical problems or infections is necessary for correct diagnosis and accurate treatment.

Accurate differentiation between non-cancerous, benign, and malignant lung cancer remains a diagnostic challenge due to overlapping clinical and imaging characteristics. This study proposes a multimodal machine learning (ML) framework integrating positron emission tomography/computed tomography (PET/CT) anatomic-metabolic parameters, sarcopenia markers, and inflammatory biomarkers to enhance classification performance in lung cancer. A retrospective dataset of 222 patients was analyzed, including demographic variables, functional and morphometric sarcopenia indices, hematological inflammation markers, and PET/CT derived parameters such as maximum and mean standardized uptake value (SUVmax, SUVmean), metabolic tumor volume (MTV), total lesion glycolysis (TLG). Five ML algorithms-Logistic Regression, Multi-Layer Perceptron, Support Vector Machine, Extreme Gradient Boosting, and Random Forest-were evaluated using standardized performance metrics. Synthetic Minority Oversampling Technique was applied to balance class distributions. Feature importance analysis was conducted using the optimal model, and classification was repeated using the top 15 features. Among the models, Random Forest demonstrated superior predictive performance with a test accuracy of 96%, precision, recall, and F1-score of 0.96, and an average AUC of 0.99. Feature importance analysis revealed SUVmax, SUVmean, total lesion glycolysis, and skeletal muscle index as leading predictors. A secondary classification using only the top 15 features yielded even higher test accuracy (97%). These findings underscore the potential of integrating metabolic imaging, physical function, and biochemical inflammation markers in a non-invasive ML-based diagnostic pipeline. The proposed framework demonstrates high accuracy and generalizability and may serve as an effective clinical decision support tool in early lung cancer diagnosis and risk stratification.

The present study investigates the prognostic significance of systemic inflammation markers in patients with early-stage non-small cell lung cancer (NSCLC), who underwent surgical treatment. We retrospectively analyzed data from 2,159 patients, who underwent lung resection for stage I-IIA NSCLC in nine centers between the years 2010 and 2022. In order to compare survival, we grouped the patients by preoperative neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), and pan-immune inflammation value (PIV). The mean overall survival (OS) was significantly shorter in patients with high NLR (102.7 vs. 109.4 months, p = 0.040). A low LMR was associated with worse OS (101 vs. 110.3 months, p < 0.001) and worse disease-free survival (DFS) (100.2 vs. 108.6 months, p = 0.020). A high PLR was a poor prognostic factor for both OS (104.1 vs. 110.1 months, p = 0.017) and DFS (102.5 vs. 108.7 months, p = 0.021). A high PIV was associated with worse DFS (101.2 vs. 109.8 months, p = 0.003). Patients with high PIV had longer time to chest tube removal (6.9 vs. 6.7 days, p = 0.049) and longer hospital stays (8.6 vs. 8.2 days, p < 0.001). Complication rates were higher in patients with lower LMR (33.8% vs. 29.4%, p = 0.028) and higher PLR (38.1% vs. 33.1%, p = 0.016). In our multicenter study, OS was worse in patients with high PLR, high NLR, and low LMR. DFS was worse in patients with high PIV, high PLR, and low LMR. NLR, LMR, PLR, and PIV were associated with OS and DFS in early-stage NSCLC, but none of the circulating inflammatory markers proved to be statistically significant in the multivariate analysis.

This study aims to determine the prognostic role of the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and systemic inflammation response index (SIRI) in predicting 5-year mortality in patients with idiopathic pulmonary fibrosis(IPF). The median age was 67 years (IQR:49–91), with 87% being male.Smoking history was present in 75% of cases. Dyspnea was more prevalent in the mortality group (p<0.001). Pulmonary hypertension was associated with increased mortality (p=0.042), while gastroesophageal reflux was more common in survivors (p=0.028). According to survival modeling, univariate Cox regression analysis identified male gender,reduced FVC(%), decreased DLCO(%), and an elevated MLR (>0.37) as significant risk factors for mortality. In the multivariate Cox regression analysis, male gender (HR:11.3267,95% CI:1.5131-84.7909, p=0.018), an increased MLR (>0.37) (HR:2.3613,95% CI:1.1236-4.9624,p=0.023), and lower DLCO(%) (HR:0.9695,95% CI:0.9515-0.9878,p=0.001) remained independent prognostic factors for mortality. These findings emphasize the prognostic significance of systemic inflammation markers and pulmonary function parameters in idiopathic pulmonary fibrosis, with male gender, elevated monocyte-to-lymphocyte ratio, and reduced DLCO identified as independent mortality predictors. <fig><object-id>erj;66/suppl_69/PA5087/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>