Introduction: Cytisine is a plant-derived alkaloid that has gained attention as a cost-effective pharmacotherapy for smoking cessation. This study aimed to compare the real-world effectiveness and safety of cytisine versus nicotine replacement therapy (NRT) among individuals enrolled in a smoking cessation program. Methods: This non-randomized observational study included 476 patients who received pharmacological treatment for smoking cessation between January 2024 and January 2025 at a tertiary smoking cessation clinic. Patients were grouped according to treatment modality: cytisine or NRT. The primary outcome was continuous abstinence at 6 months, based on self-reported smoking status without biochemical verification. Secondary outcomes included tolerability and factors associated with cessation success. Results: Of the 229 patients treated with cytisine, 124 (54.1%) achieved 6-month abstinence, compared to 77 of 247 patients (31.2%) in the NRT group (p<.001). Female sex and the presence of diabetes mellitus were independently associated with higher cessation success. Both treatments were generally well tolerated; no serious adverse events were reported. Cytisine users most commonly reported mild gastrointestinal symptoms and sleep disturbances. Conclusions: Cytisine was significantly more effective than NRT in achieving 6-month continuous abstinence in a real-world setting, with a comparable safety profile. Certain subgroups, such as women and patients with diabetes, may benefit more from pharmacologic cessation support. Implications: This study provides supportive evidence for the routine clinical use of cytisine as a first-line smoking cessation treatment, especially in low- and middle-income countries. Its affordability, tolerability, and short treatment duration offer distinct advantages for public health implementation.

BACKGROUND: Early recognition of malignant pleural effusion is important for prognosis and treatment planning. Quantitative, noninvasive imaging parameters may aid in diagnosing pleural malignancy. This study investigated the diagnostic value of mean grayscale intensity (MGI) measurements obtained from thoracic ultrasound images for differentiating benign and malignant pleural effusions. METHODS: In this prospective observational study, 101 patients with pleural effusion were enrolled. MGI measurements were performed on stored thoracic ultrasound images using ImageJ software. Patients were classified as having benign or malignant pleural effusion based on cytological and/or histopathological findings or, in patients without pathological confirmation, two negative pleural fluid cytology examinations, the absence of additional clinical or radiological findings suggestive of malignancy, and regression of the pleural effusion during follow-up. Independent predictors of malignant pleural effusion were evaluated using multivariable logistic regression analysis, and diagnostic performance was assessed using receiver operating characteristic (ROC) curve analysis. RESULTS: Among the 101 patients, 59 had benign pleural effusion and 42 had malignant pleural effusion. The median MGI was significantly higher in malignant than in benign pleural effusions (21 vs. 18, P = 0.03). In multivariable logistic regression analysis, MGI remained independently associated with malignant pleural effusion (odds ratio: 1.052, 95% confidence interval [CI]: 1.003–1.103; P = 0.03). ROC analysis yielded an area under the curve of 0.62 (95% CI: 0.513–0.734). The optimal cutoff value was 24.25, with a sensitivity of 40.48% and a specificity of 79.66%. CONCLUSION: MGI values obtained from thoracic ultrasound images were significantly higher in malignant pleural effusions and remained independently associated with pleural malignancy. Although MGI should not be considered a standalone diagnostic tool, it may serve as a quantitative, noninvasive imaging parameter that complements clinical, radiological, and ultrasonographic assessment.

This retrospective study aimed to evaluate the association between routinely measured clinical and laboratory parameters and ICU mortality in patients admi

Objectives: Although transudative pleural effusions are generally associated with benign conditions, a subset may represent malignant pleural effusions (MPE). Because pleural fluid cytology is often not performed in transudative effusions, malignancy may be underdiagnosed. We aimed to identify predictors of malignancy in transudative pleural effusions and develop a clinical prediction score. Methods: We conducted a retrospective cohort study including patients with transudative pleural effusion who underwent pleural fluid cytological analysis between January 2022 and January 2026 at a tertiary chest diseases center. Among 3253 patients who underwent thoracentesis, 314 patients with transudative pleural effusions were included. Clinical, radiological, laboratory, and pleural fluid characteristics were analyzed. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of MPE. A simplified risk score was developed from the final multivariable model and internally validated using bootstrap resampling. Results: Among 314 patients, 24 (7.6%) were diagnosed with MPE. In multivariable analysis, pleural pathology on thoracic computed tomography (CT) (OR 7.07, 95% CI 2.61–19.16), parenchymal nodule/mass OR 5.18, 95% CI 1.85–15.54), pleural fluid lactate dehydrogenase (LDH) > 150 U/L (OR 5.09, 95% CI 1.86–13.93), and pleural fluid glucose < 100 mg/dL (OR 3.52, 95% CI 1.12–11.1) were independent predictors of MPE. The 16-point scoring system showed excellent discriminative performance (AUC 0.89). Bootstrap validation confirmed good calibration and model robustness. Conclusions: In patients with transudative pleural effusions, pleural pathology on thoracic CT, parenchymal nodule or mass, pleural fluid LDH > 150 U/L, and pleural fluid glucose < 100 mg/dL were independent predictors of MPE. A simple 16-point prediction score derived from these variables demonstrated excellent discriminative performance and may assist in identifying patients who warrant pleural fluid cytological evaluation despite transudative pleural fluid characteristics.