Tuberkuloz ve toraks最新文献

{"title":"The relationship between lipid biomarkers, inflammation and mortality in patients with tuberculosis.","authors":"Oğuzhan Acet, Kübra Bağir, Nazlıhan Yalçin, Ahmet Türk, Mehmet Sezai Taşbakan, Meltem Taşbakan, Tansu Yamazhan, Cengiz Çavuşoğlu","doi":"10.5578/tt.2026011166","DOIUrl":"10.5578/tt.2026011166","url":null,"abstract":"<p><strong>Introduction: </strong>Tuberculosis (TB) remains one of the leading infectious causes of mortality worldwide. The interaction between lipid metabolism and immune response plays a crucial role in TB pathogenesis. High-density lipoprotein (HDL) and other lipid parameters have increasingly attracted attention for their associations with inflammatory markers and survival. This study aimed to investigate the relationship between serum lipid levels, inflammatory markers, and survival in patients with TB.</p><p><strong>Materials and methods: </strong>Data from TB and non-tuberculous mycobacteria (NTM) patients followed at Ege University Faculty of Medicine Hospital between January 2017 and January 2024 were retrospectively analyzed. Lipid profile [HDL, low-density lipoprotein (LDL), total cholesterol, triglycerides] and inflammatory parameters (C-reactive protein, erythrocyte sedimentation rate, ferritin, albumin, lymphocyte count) were recorded at diagnosis. Lipid levels were categorized into tertiles based on interquartile distribution. Groups were compared in terms of inflammatory response, clinical features, and survival.</p><p><strong>Result: </strong>A total of 148 patients were included in the study, comprising 127 TB and 21 NTM cases. Median age was 59.0 years [Interquartile range (IQR): 45.0-71.0] in the TB group and 64.0 years (IQR: 38.0-72.0) in the NTM group. Among TB patients, 62.2% were male (n= 79). Mortality among TB patients was 17.3% (n= 22). Patients with low HDL levels had significantly higher CRP and ferritin levels and lower albumin levels (p< 0.05). LDL and total cholesterol levels were similarly associated with CRP, albumin, and lymphocyte count. A significant association was observed between HDL levels and sex, with low HDL levels being more frequent among males (p< 0.001). Increasing HDL and triglyceride levels were associated with a trend toward improved survival (p= 0.063; linear trend p= 0.041). No significant associations were found between lipid levels and cavity formation, pulmonary versus extrapulmonary involvement, or acid-fast bacilli smear results (p< 0.05). In multivariable analysis, older age and lower serum albumin levels were independently and significantly associated with mortality (p< 0.005).</p><p><strong>Conclusions: </strong>In patients with TB, serum lipid profiles show significant associations with systemic inflammatory markers. Low HDL levels were accompanied by a more pronounced inflammatory response. However, lipid biomarkers were not independently associated with mortality, suggesting that they may serve as complementary markers in the assessment of the inflammatory process rather than as direct prognostic indicators.</p>","PeriodicalId":519894,"journal":{"name":"Tuberkuloz ve toraks","volume":"74 1","pages":"9-20"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147535304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful and practical pirfenidone desensitization.","authors":"Şeyma Özden, Fatma Merve Tepetam, Dildar Duman, Fatma Terzioğlu Şahin","doi":"10.5578/tt.2026011120","DOIUrl":"https://doi.org/10.5578/tt.2026011120","url":null,"abstract":"","PeriodicalId":519894,"journal":{"name":"Tuberkuloz ve toraks","volume":"74 1","pages":"71-73"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147535294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Machine learning-extended sPESI for 1-year mortality prediction in pulmonary embolism.","authors":"Elvan Burak Verdi","doi":"10.5578/tt.2026011217","DOIUrl":"10.5578/tt.2026011217","url":null,"abstract":"<p><strong>Introduction: </strong>The simplified pulmonary embolism severity index (sPESI) is extensively used for bedside risk assessment in acute pulmonary embolism (PE). Nevertheless, its effectiveness is constrained by the dichotomization of physiological variables and a primary validation focus on 30-day outcomes only. We developed a machine learning (ML) extension to enhance prognostic precision and extend risk stratification to 12 months, using only bedside data.</p><p><strong>Materials and methods: </strong>In a retrospective cohort of 2547 adults with computed tomography pulmonary angiography confirmed PE, we developed logistic regression (LR), XGBoost, and multi-layer perceptron (MLP) models using a 10-item hybrid extension of sPESI that retained continuous age, heart rate, systolic blood pressure, and oxygen saturation alongside the six binary sPESI indicators. Models were trained and optimized using 12-month all-cause mortality as the target and were evaluated against 30, 180, and 365-day mortality on a held-out test set.</p><p><strong>Result: </strong>Discrimination with the conventional sPESI attenuated over time (AUC= 0.727, 0.689, and 0.665 at 30 days, 180 days, and one year, respectively). The 10-item ML extension significantly enhanced prognostic performance compared with the conventional 6-item sPESI across all horizons (all p< 0.05). At the primary 12-month horizon, LR, XGBoost, and MLP achieved AUCs of 0.720, 0.726, and 0.712, respectively (vs. 0.665 for sPESI). At 30 days, the peak discrimination reached 0.796 (XGBoost). Moreover, ML increased 30-day specificity to 0.326-0.395 compared to 0.131 for sPESI, while maintaining high sensitivity (0.930-0.982). SHapley Additive exPlanations analyses demonstrated horizon-linked attribution shifts, with acute hemodynamic markers dominating early mortality predictions and age and malignancy emerging as the primary drivers at 12 months under horizonspecific evaluation.</p><p><strong>Conclusions: </strong>Preserving continuous physiological resolution within a familiar clinical framework enables ML to capture both acute instability and latent long-term vulnerability from the index presentation data alone. This bedsidefeasible pathway enhances long-horizon risk stratification and individualizes the management of patients.</p>","PeriodicalId":519894,"journal":{"name":"Tuberkuloz ve toraks","volume":"74 1","pages":"43-57"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147535291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Segmentation of honeycomb cysts, traction bronchiectasis and emphysematous lung parenchyma using the deep learning method.","authors":"Nevin Aydin, Hüseyin Yildirim, Füsun Alataş, Büşra Sariay, Burcu Mert, Serhat Demir, Özer Çelik, Ahmet Faruk Aslan, Alper Odabaş","doi":"10.5578/tt.2025041118","DOIUrl":"https://doi.org/10.5578/tt.2025041118","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to perform the segmentation of honeycomb cysts, traction bronchiectasis, and emphysematous lung parenchyma in highresolution computed tomography (HRCT) examinations using the deep learning method of artificial intelligence.</p><p><strong>Materials and methods: </strong>The study included the cross-sectional images of 265 patients diagnosed with usual interstitial pneumonia between 2017 and 2021. Minimum intensity projection (MinIP) was performed on axial sections in the parenchymal window. Emphysema areas, traction bronchiectasis, and honeycomb cysts were segmented and labeled on the axial HRCT images. The dataset was divided into three parts, namely training, validation, and testing, at a ratio of 80, 10, and 10%, respectively. The results were calculated by selecting 50% as the threshold value for the intersection over union (Jaccard index) statistic.</p><p><strong>Result: </strong>Of the 265 patients included in the study, 184 (69.4%) were male and 81 (30.6%) were female. Mean age of the patients was 73 ± 10 years. In the test group segmented as emphysema, the sensitivity, precision, F1 score, area under the curve (AUC), and accuracy values were calculated as 0.81, 0.90, 0.85, 0.86, and 0.75, respectively. In the test group segmented as traction bronchiectasis, the sensitivity, precision, F1 score, AUC, and accuracy values were found to be 0.95, 0.76, 0.85, 0.80, and 0.75, respectively. In the test group segmented as honeycomb cysts, the sensitivity, precision, F1 score, AUC, and accuracy values were 0.96, 0.92, 0.94, 0.88, and 0.90, respectively.</p><p><strong>Conclusions: </strong>In this study, we successfully utilized the U-Net architecture, a deep learning technology, to accurately segment honeycomb cysts in MinIP images, one of the parameters that will help classify interstitial lung diseases (ILDs). We anticipate that our study will guide future studies on the classification of ILDs.</p>","PeriodicalId":519894,"journal":{"name":"Tuberkuloz ve toraks","volume":"73 4","pages":"249-257"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145902155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"First-line immunotherapy-based regimens for metastatic non-small cell lung cancer: A network meta-analysis of landmark trials.","authors":"Rashad Ismayilov, Özden Altundağ","doi":"10.5578/tt.2025041169","DOIUrl":"10.5578/tt.2025041169","url":null,"abstract":"<p><strong>Introduction: </strong>First-line immunotherapy, alone or with chemotherapy, has revolutionized the treatment of metastatic non-small cell lung cancer (NSCLC). However, with multiple approved regimens, the optimal therapeutic choice is undefined due to a lack of direct comparative trials. This network meta-analysis was conducted to establish a hierarchy of efficacy for five landmark immunotherapy-based regimens to inform clinical and policy decisions.</p><p><strong>Materials and methods: </strong>A network meta-analysis of five pivotal phase III trials (KEYNOTE-024, KEYNOTE-189, KEYNOTE-407, CheckMate 9LA, IMpower 110), all recently reimbursed in our country, was performed. We synthesized overall survival (OS) data for the total population and across subgroups defined by histology (squamous vs. non-squamous) and PD-L1 expression (<1%, 1-49%, ≥50%), with chemotherapy as the common comparator.</p><p><strong>Result: </strong>Pembrolizumab-based therapies ranked consistently high. In nonsquamous NSCLC, pembrolizumab-chemotherapy was highest-ranked and significantly superior to the nivolumab-based combination (HR: 0.76, 95% CI: 0.58-0.99). In squamous disease, the combination of nivolumab, ipilimumab, and chemotherapy emerged as the highest-ranked regimen (SUCRA: 78.3%). By PD-L1 status, pembrolizumab monotherapy was topranked for ≥50% expression (SUCRA: 82.8%), while pembrolizumabchemotherapy was superior for the 1-49% subgroup (SUCRA: 87.5%). For PD-L1 negative (<1%) patients, a subgroup with substantial heterogeneity, no regimen showed a statistically significant OS benefit over chemotherapy.</p><p><strong>Conclusions: </strong>Our analysis indicates pembrolizumab-based regimens, as monotherapy or with chemotherapy, offer the most robust and highestranking survival advantage across most key NSCLC subgroups. These findings provide a critical, evidence-based framework to guide individualized first-line treatment selection.</p>","PeriodicalId":519894,"journal":{"name":"Tuberkuloz ve toraks","volume":"73 4","pages":"299-308"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145902170","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the health literacy characteristics of patients with chronic obstructive pulmonary disease.","authors":"Övgü Velioğlu Yakut, Duygu Ecer, Miraç Öz, Aslıhan Gürün Kaya, Fatma Arslan, Öznur Yildiz","doi":"10.5578/tt.2025041141","DOIUrl":"https://doi.org/10.5578/tt.2025041141","url":null,"abstract":"<p><strong>Introduction: </strong>Health literacy encompasses patients' abilities to access healthcare, comprehend health information, and make decisions based on that knowledge. We aimed to examine the relationship between dyspnea levels, acute exacerbations, hospitalizations, disease severity and comorbidities of chronic obstructive pulmonary disease (COPD) patients according to their health literacy levels.</p><p><strong>Materials and methods: </strong>A total of 106 COPD patients were prospectively enrolled in our study. Demographic data, history, pulmonary function tests, COPD severity, comorbidities, health status, quality of life and the factors determining the course of the disease in the last year were collected. We also measured patients' health literacy using the Turkish version of the European Health Literacy scale.</p><p><strong>Result: </strong>Our findings revealed that elderly COPD patients (p= 0.04) with advanced disease stages (p< 0.001), higher Charlson Comorbidity Index and Saint George Hospital Respiratory Questionnaire scores (p< 0.001), and lowincome (p= 0.02) had lower levels of health literacy. Moreover, patients with lower health literacy experienced more frequent exacerbations (p= 0.01), more severe exacerbations (p< 0.001), and higher rates of hospitalization (p< 0.001). Logistic regression analysis unveiled that GOLD stages (OR: 11.62, 95% CI: 3.36-26.25), and recent severe exacerbations within the last year (OR: 14.24, 95% CI: 5.41-38.13) stood out as the most strongly associated risk factors for poor health literacy.</p><p><strong>Conclusions: </strong>COPD patients with low health literacy have a higher risk of severe disease. Recognizing the concept of health literacy and identifying risk factors associated with low health literacy are crucial steps in enhancing education, care, and social support for COPD patients. It emphasizes the need for tailored interventions and support for COPD patients, especially those with lower health literacy.</p>","PeriodicalId":519894,"journal":{"name":"Tuberkuloz ve toraks","volume":"73 4","pages":"258-267"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145902096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of pulse oximeter in anxiety and exacerbations in COPD patients: A prospective observational study.","authors":"Nur Aleyna Yetkin, Fatma Yiğit Erarslan, Burcu Baran, Bilal Rabahoğlu, Nuri Tutar, İnci Gülmez","doi":"10.5578/tt.2025041142","DOIUrl":"10.5578/tt.2025041142","url":null,"abstract":"<p><strong>Introduction: </strong>Pulse oximeter is commonly used by chronic obstructive pulmonary disease (COPD) patients for long-term oxygen therapy (LTOT) to monitor oxygen levels. This study investigated the association between oximeter use, anxiety severity, symptom burden, and healthcare utilization in this population.</p><p><strong>Materials and methods: </strong>This prospective observational study included 110 individuals with COPD who underwent LTOT. Data were collected on pulmonary function, modified Medical Research Council (mMRC) scores, and daily pulse oximeter use. Anxiety severity was assessed using the Beck Anxiety Inventory (BAI). Healthcare utilization in the previous year, including outpatient-treated and inpatient-treated exacerbations, intensive care unit admissions, and non-exacerbation-related hospital admissions, was analyzed. Linear regression analysis was performed to identify the independent predictors of nonexacerbation-related hospital admissions.</p><p><strong>Result: </strong>Among the participants, 68 (61.8%) reported using a home pulse oximeter. There were no significant differences in BAI scores (p= 0.678), oxygen therapy duration (p= 0.530), or mMRC scores (p= 0.251) between the groups. However, non-users had significantly higher rates of non-exacerbation-related hospital admissions than users (p< 0.001). In multivariable analysis, not using pulse oximeter independently predicted more non-exacerbationrelated admissions (B= 1.63, 95% CI: 0.94-2.32, p< 0.001), whereas anxiety and physiological measures were not significant.</p><p><strong>Conclusions: </strong>Pulse oximeter use was not associated with anxiety or symptom severity among the patients with COPD receiving LTOT. However, non-use of pulse oximeter was independently associated with increased non-exacerbation-related hospital admissions. These findings suggest that pulse oximeter may support patient self-management and reduce unnecessary healthcare utilization, without contributing to anxiety.</p>","PeriodicalId":519894,"journal":{"name":"Tuberkuloz ve toraks","volume":"73 4","pages":"277-285"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145902168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenging diagnosis of central nervous system tuberculosis with joint involvement.","authors":"Ahmet Melih Şahin, Elif Şen, Zehra Akkaya, Turan Acican","doi":"10.5578/tt.2025041096","DOIUrl":"https://doi.org/10.5578/tt.2025041096","url":null,"abstract":"","PeriodicalId":519894,"journal":{"name":"Tuberkuloz ve toraks","volume":"73 4","pages":"309-313"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145902177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current front-line treatment strategies in EGFR-mutated advanced NSCLC: Balancing efficacy with risks of interstitial lung disease and venous thromboembolism.","authors":"Bahadır Köylü, Abdurrahman Koç","doi":"10.5578/tt.2025041115","DOIUrl":"https://doi.org/10.5578/tt.2025041115","url":null,"abstract":"","PeriodicalId":519894,"journal":{"name":"Tuberkuloz ve toraks","volume":"73 4","pages":"314-318"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145902135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of intravenous low-dose thrombolytics on in-hospital mortality in patients with intermediate-high-risk pulmonary embolism.","authors":"Aycan Yüksel, Ceren Ilgar Akelma, Nalan Ogan, Esen Sayin Gülensoy, Evrim Eylem Akpinar","doi":"10.5578/tt.2025041198","DOIUrl":"https://doi.org/10.5578/tt.2025041198","url":null,"abstract":"<p><strong>Introduction: </strong>Patients with acute medium-high risk pulmonary embolism (PE) may experience cardiovascular decompensation and sudden death. Our aim was to evaluate the impact of intravenous low-dose thrombolytic therapy on in-hospital mortality and intracranial bleeding in intermediate-high-risk PE.</p><p><strong>Materials and methods: </strong>This single-centre, retrospective study included 128 patients with acute intermediate-high-risk PE. Patients were classified into two groups: Low-dose thrombolytic (0.6 mg/kg, maximum 50 mg, alteplase plus parenteral anticoagulant) group and anticoagulant (unfractionated and/or low molecular weight heparin) group. We compared in-hospital mortality, improvement in right ventricular (RV) failure, and haemorrhagic complications between the groups.</p><p><strong>Result: </strong>Fifty-six patients received low-dose recombinant tissue-type plasminogen activator, and 72 patients were treated with anticoagulants. Patients in the low dose thrombolytic group were younger than the anticoagulant group (63.5 ± 15.5 vs. 70.3 ± 15.5; p= 0.016). There were no significant differences in baseline clinical, laboratory, and echocardiographic findings between the groups. Hemodynamic decompensation was significantly lower in the lowdose alteplase group than the anticoagulants group [1.8% vs. 11.1%; OR: 0.145, (95% CI: 0.018-1.2); p= 0.041]. In-hospital mortality rate was 5.5% in the anticoagulant group, and no death was seen in the low-dose thrombolysis group (p= 0.048). Low-dose alteplase significantly improved RV dysfunction compared with anticoagulants [76.8% vs. 40.3%, OR: 4.9 (95% CI: 2.25- 10.68), p< 0.001]. No intracranial hemorrhage was seen, and the incidence of extracranial major bleeding was similar between treatment groups [1.8% vs. 1.4%, OR: 1.29 (95% CI: 0.08-2.1); p= 0.857].</p><p><strong>Conclusions: </strong>Among the patients with acute intermediate-high-risk PE, low dose alteplase may be preferred safely without increasing the risk of major bleeding and reduced in-hospital mortality compared to heparin.</p>","PeriodicalId":519894,"journal":{"name":"Tuberkuloz ve toraks","volume":"73 4","pages":"239-248"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145902112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}