Variability in Stigma Severity During the COVID-19 Pandemic.

Objective The aim of this study was to investigate change in the stigma that emerged during the COVID-19 pandemic over time and the factors responsible for the change. Methods Individuals with COVID-19 who presented to Ankara Medicalpark and VM Medicalpark Hospitals' Internal Diseases and Chest Diseases polyclinic between May 2021 and April 2022 were examined. The volunteers were divided into two groups: those who had COVID-19 within the first six months of the pandemic (group 1) and those who had it in the second six months (group 2). The questionnaire assessing stigma consisted of 29 propositions that participants could mark whether they agreed with them or not. Results The median age of the volunteers was 38 years. Eighty-eight (69.3%) had the disease in the first six months of the pandemic and 39 (30.7%) in the second six months. Moreover, 76.1% of the participants in the first group and 94.9% of those in the second group did not agree with the statement "I thought COVID-19 was a punishment for me" (p=0.011). Further, 56.8% of the participants in the first group and 97.4% of those in the second group stated that they did not agree with the statement "Employers may terminate the employment of employees who they find out have contracted COVID-19" (p<0.001). 80.7% of the participants in the first group and 38.5% of those in the second group agreed with the statement "There was social discrimination against people who caught COVID-19" (p<0.001).  Conclusions At the beginning of the pandemic, the participants had concerns about losing their status and jobs, but this anxiety decreased over time. Stigma in the first six months of the pandemic was greater than that in the second six months, and discrimination related to stigma decreased with recognition of the disease and the increase in experience.

Effects of education on pain and anxiety before and after video-assisted thoracoscopic surgery.

Introduction: Video-assisted thoracoscopic surgery (VATS) is a common surgical procedure. Aim: To find out how educating patients using multimedia affects their pain and anxiety before and after VATS surgery. Material and methods: The study included 50 patients who underwent VATS between December 2017 and December 2018. The subjects were divided into two groups: the multimedia information group (MIG) and the control group (n = 25). The subjects underwent STAI-T testing, preoperative and postoperative STAI-S testing, and pulmonary function tests (PFT) before surgery and after surgery. Results: The patients in the MIG had higher baseline anxiety levels than those in the control groups. There were no significant differences between the two groups in terms of demographic information, surgical characteristics, or vital signs. There was a statistically significant difference in the preoperative (p = 0.001) and the postoperative (p = 0.0001) pain scores between MIG and control groups. The postoperative STAI-S scores of MIG increased, but this increase was not significant. In both groups, there was no significant difference in the changes in systolic blood pressure (p = 0.656) or respiratory rate (p = 0.05). There was no difference between post-training and pre- and post-operative pain scores in both groups. Conclusions: Providing multimedia information before surgery has some effect on pain. However, providing multimedia information does not reduce postoperative anxiety.

Research Burden of Interstitial Lung Diseases in Turkey - RBILD.

Introduction: The aim of our study is to investigate the etiological distribution of ILD in Turkey by stratifying the epidemiological characteristics of ILD cases, and the direct cost of initial diagnosis of the diagnosed patients. Material-Method: The study was conducted as a multicenter, prospective, cross-sectional, clinical observation study. Patients over the age of 18 and who accepted to participate to the study were included and evaluated as considered to be ILD. The findings of diagnosis, examination and treatment carried out by the centers in accordance with routine diagnostic procedures were recorded observationally. Results: In total,1070 patients were included in this study. 567 (53%) of the patients were male and 503 (47%) were female. The most frequently diagnosed disease was IPF (30.5%). Dyspnea (75.9%) was the highest incidence among the presenting symptoms. Physical examination found bibasilar inspiratory crackles in 56.2 % and radiological findings included reticular opacities and interlobular septal thickenings in 55.9 % of the cases. It was observed that clinical and radiological findings were used most frequently (74.9%) as a diagnostic tool. While the most common treatment approaches were the use of systemic steroids and antifibrotic drugs with a rate of 30.7% and 85.6%, respectively. The total median cost from the patient's admission to diagnosis was 540 Turkish Lira. Conclusion: We believe that our findings compared with data from other countries will be useful in showing the current situation of ILD in our country to discuss this problem and making plans for a solution.

Atherogenic Indices Can Predict Atherosclerosis in Patients with Sarcoidosis.

BACKGROUND: Sarcoidosis, a multisystemic disease of unknown etiology, is characterized by non-caseating granulomatous inflammation. This study aimed to investigate the efficiency of atherogenic indices and ultrasonographic evaluation of carotid artery on predicting atherosclerosis in patients with sarcoidosis. METHODS: The study included 44 subjects followed with diagnosis of sarcoidosis and 53 age and gender matched healthy subjects as controls. Laboratory findings, pulmonary function tests and carotid artery ultrasonography of all participants were evaluated. RESULTS: Of the participants with sarcoidosis 70.5% was female and the mean age was 35.36±7.18 years, while 64.2% of the control group were female and the mean age was 33.58±8.13 years (P=0.511 and P=0.191, respectively). High-density-lipoprotein cholesterol level in the sarcoidosis group was significantly lower than that of the control group (P=0.017), while other cholesterol levels were higher than those of the controls (P<0.05). Intima-media thickness (IMT) and peak systolic velocity (PSV) of carotid artery were higher in patients with sarcoidosis (P<0.001 and P=0.009, respectively). Atherogenic indices (Atherogenic Index (AI), Atherogenic Coefficient (AC) and Cardiogenic Risk Ratio (CRR)) were higher in sarcoidosis group compared to the controls (P<0.001, for all parameters). IMT was positively correlated with PSV, AI, AC, and CRR. A positive correlation between PSV and atherogenic indices was also detected. CONCLUSIONS: Sarcoidosis may be a predisposing factor for atherosclerosis. Atherogenic indices, IMT of carotid artery and PSV might be considered predictors for atherosclerosis and cardiovascular diseases in asymptomatic sarcoidosis patients.

Quantitative computed tomography analysis of emphysema severity and distribution in chronic obstructive lung disease, correlation with clinical findings.

INTRODUCTION: This study aimed to evaluate the correlation between different densitometric parameters on chest computed tomography (CT) and pulmonary function tests (PFT) of patients with emphysema-predominant chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: A retrospective evaluation was made of 56 patients with COPD. The lungs were segmented into nine sections. Normal and emphysematous parenchyma were measured using low attenuation area percentage (%LAA), percentile density (PD), and mean lung density (MLD) parameters. The effects of emphysema distribution on PFT were evaluated using %LAA, PD, MLD, kurtosis and skewness methods. RESULT: Fifty-six patients, all diagnosed with COPD, were evaluated. The %LAA-910 method showed significant correlation with forced expiratory volume in one second (FEV1) compared to other densitometric parameters (p= <0.001, r= -0.556). Other densitometric parameters differed between segments in terms of sensitivity for FEV1. It was determined that right lung mid-zone segment involvement affected FEV1 more than other segments when the %LAA -910 method was used (p= <0.001, r= -0.569). %LAA -950 had the largest area under the curve in ROC curve analysis and was determined to have 2.2% diagnostic property for predicting Global Initiative for Obstructive Lung Disease (GOLD) AB-CD staging (sensitivity 81%, specificity 74%). CONCLUSIONS: Quantitative analysis is an objective method for determining the distribution and severity of emphysema. There was a significant correlation between densitometry and PFT values. Quantitative analysis may be considered suitable for use in evaluating the severity of emphysema and predicting the clinical findings of patients.

Comparison of the diagnostic efficacy and complications of transbronchial biopsy in elderly and young patients.

INTRODUCTION: Among bronchoscopic procedures, transbronchial biopsy (TBB) is considered a high-risk procedure. In this study, we aimed to investigate the indications, diagnostic efficacy and complications of TBB in the elderly, which is accepted as a sensitive group. MATERIALS AND METHODS: The study was designed as a multicenter retrospective observational study. Data of 4226 patients who underwent diagnostic bronchoscopy were scanned for this study. 791 patients who underwent transbronchial biopsy were included in this study. All patients were evaluated in terms of lung regions, diagnosis, and complications. RESULT: A total of 791 patients, 329 (41.6%) female patients, who underwent TBB were included in the study. Mean age of the patients was 54.54 ± 14.94 years. The most common indications were ILD (45.6%), malignancy (24.0%) and sarcoidosis (9.9%). Mean age of the elderly patients (n= 263) was 69.89 ± 4.83 years, and mean age of the young patients (n= 528) was 46.90 ± 11.28 years (p<0.001). In both age groups, the most common indication was ILD. Complications developed during and after the procedure in 51 of the young patients (9.7%) and in 21 of the elderly (8.0%) (p= 0.441). The most common complication was pneumothorax with 4.6% in the elderly, and pneumothorax with 5.9% in the young (p= 0.441). The most common diagnosis was malignancy (12.2%) in the elderly, as the most common diagnosis was malignancy (7.2%) in the young (p = 0.020). While anthracosis, ILD and organized pneumonia were the other common diagnoses in the elderly, sarcoidosis, anthracosis and organized pneumonia were the other common diagnoses in the young. The diagnosis of sarcoidosis was achieved more frequently in the young (6.6%) than in the elderly (0.8%) (p<0.001). CONCLUSIONS: Transbronchial biopsy can be performed safely in elderly patients, with similar diagnostic success and complication rates to younger patients.

A review of venous thromboembolism in COVID-19: A clinical perspective.

Coronavirus disease-19 (COVID-19) started in Wuhan, China in December 2019 and spread to all around the world in a short period of time. Hospitalized patients with COVID-19 mostly could suffer from an abnormal coagulation activation risk with increased venous thrombosis events and a poor clinical course. The reported incidence rates of thrombotic complications in hospitalized COVID-19 patients vary between 2.6 and 85% (both in non-critically ill and critically ill patients). The risk of venous thromboembolism is not known in non-hospitalized patients with COVID-19. There are numerous studies and guidelines for administration of thromboprophylaxis for COVID-19 cases. All hospitalized COVID-19 patients should take pharmacological thromboprophylaxis if there is no contraindication. However, there is no consensus on this issue. In this review, we discussed all these approaches in a critical perspective.

[Mortality prediction ability of phycians in intensive care units of Turkey (MOPAP)]. / Türkiye'de yogun bakim ünitelerinde hekimin mortaliteyi öngörebilme gücü.

INTRODUCTION: Intensive care physicians are increasingly involved in decision making about the prognosis of intensive care unit ICU patients. With this study; we aimed to evaluate the power of clinician foresight at prediction of mortality in patient at triage to intensive care and patient follow-up. MATERIALS AND METHODS: This study was conducted in ICUs located in various geographical regions of Turkey between January 1, 2017-April 30, 2017.The clinical research was planned as observational, multicenter, cross-sectional. RESULT: A total of 1169 intubated patients were followed in 37 different ICU. At the beginning of the follow-up we asked the physician who will follow the patient in the ICU to give a score for the probability of survival of the patients. Scoring included a total of 6 scores from 0 to 5, with the "0" the worst probability "5" being the best. According to this distribution, only 1 (0.9%) of 113 patients who were given 0 points survived. Three (6.1%) of 49 with the best score of 5 died. Survival rates were significantly different in each score group (r: -0.488; p<0.001). After the combined mortality estimation scores based on the clinical observations of the physicians (0 and 1 point score was combined as non-survive, 4 and 5 score was combined as survived) 320 of the 545 patients were estimated to be dead and 225 were predicted survival. Sensitivity and spesifity of scoring system to predict mortality was 91.56% (95% CI: 87.96-94.37), 76.89% (95% CI: 70.82-82.23) respectively. CONCLUSIONS: In this study, we concluded that the physicians who follow the patients in the ICU can predict the poor prognosis at the time of admission and the high mortality rate. The physician's opinion on mortality estimation should be considered in intensive care mortality scoring in addition to other laboratory and clinical parameters.

Endobronchial valve vs coil for lung volume reduction in emphysema: results from a tertiary care centre in Turkey.

BACKGROUND: Bronchoscopic lung volume reduction (BLVR) by either the endobronchial valve (EBV) or coil (EBC) procedure is recommended for severe emphysematous patients. BLVR applications generally help healthy lung areas ventilate more comfortably by reducing the hyperinflation and improving the contraction capacity of diaphragm. OBJECTIVES: Compare our experience with valve and coil BLVR devices. DESIGN: Retrospective. SETTING: Single tertiary care centre. PATIENTS AND METHODS: Demographic data, vital signs, pulmonary function tests (PFTs), the six-minute walking test (6MWT), vital signs, arterial blood gases and complications were recorded. MAIN OUTCOME MEASURES: Change in PFTs and completion of the 6MWT. SAMPLE SIZE: 60 Turkish men with a diagnosis of chronic pulmonary lung disease. RESULTS: Clinical and demographic characteristics were similar in patients who underwent EBV and EBC. Thirty (96.8%) EBV patients and 27 (93.1%) of the EBC patients were able to properly complete the PFT before the procedures, but all complied after the procedures. Significant improvement in PFTs were achieved after the procedure and there were no statistically significant differences in post-procedure performance. For the 6MWT, the completion rate improved from 15 (48.4%) to 19 (61.3%) patients in the EBV patients (P=.125) and from 19 (65.5%) to 21 (72.4%) patients in the EBC patients (P=.500). There was no significant difference in completion rates for the walking test for either group (median 32 meters in EBV patients and 37 meters in EBC patients; P=.652). Vital signs and arterial blood gases were similar in the two groups. The rates of complications were similar in both groups. CONCLUSION: Endobronchial valves and coils are safe and effective methods for BLVR for patients with severe emphysema. LIMITATIONS: Relatively small sample, retrospective design, single-centre retrospective study. CONFLICT OF INTEREST: None.

The Effect of Serum Electrolyte Disturbances and Uric Acid Level on the Mortality of Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

OBJECTIVES: The aim of the study was to determine the prevalence of electrolyte and uric acid disturbances and their effects on mortality in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). MATERIALS AND METHODS: This study included all consecutive AECOPD patients who were managed at our Chest Diseases department between May 2017 and December 2017. Medical records of all the subjects were reviewed, and data were collected retrospectively. Eighty-one patients with AECOPD and 103 subjects in the control group were enrolled retrospectively. The association between the COPD and control groups and biochemical parameters in patients with and without long-term oxygen therapy and noninvasive mechanical ventilation treatment in COPD patients were compared with mortality. RESULTS: Serum magnesium, phosphorus, potassium, sodium, and calcium (Ca levels were higher in control subjects than in COPD patients (p=0.006, p=0.015, and p<0.001, respectively). While serum levels of Ca and K were significantly lower and serum level of uric acid was higher in deceased COPD patients than in alive AECOPD patients (p=0.023, p=0.001, and p=0.033, respectively), serum levels of Mg, P, and other biochemical parameters were similar. CONCLUSION: Serum Ca, K, and uric acid levels during the exacerbation period were significant predictors of mortality in COPD patients. In conclusion, the levels of these parameters should be measured and corrected during AECOPD treatment to decrease mortality.

A very rare fatal complication: bilateral reexpansion pulmonary edema after treatment of single side total pneumothothorax.

Reexpansion pulmonary edema is a rare but fatal clinical condition that develops during the treatment of pneumothorax, pleural effusion and collapsed lung after atelectasis. A 31-year-old male patient was referred to our clinic with the complaint of stinging back pain that started 3 days ago and dyspnea developed during the last 24 hours. Physical examination and radiologic examinations revealed total pneumothorax in the right hemithorax. After tube thoracostomy, his general condition deteriorated and bilateral reexpension edema developed in the lungs. The patient was admitted to the intensive care unit and was discharged on the 5th day after medical treatment. Our case is the first case of bilateral reexpansion pulmonary edema seen after unilateral spontaneous pneumothorax when literature review is performed. In order to emphasize the importance of rapid diagnosis and treatment, it is presented in the light of the literature.

Morphological overview of cardiovascular comorbidities in chronic obstructive pulmonary disease: Frank's sign.

OBJECTIVE: Cardiovascular diseases are the most common and important comorbidities in patients with chronic obstructive pulmonary disease (COPD). Literature indicates that there may be a relationship between diagonal earlobe crease (DELC) and coronary artery disease (CAD). Accordingly, the present study aimed to assess the relationship with DELC and cardiac comorbidities in patients with COPD during routine physical examination. MATERIALS AND METHODS: In this prospective cohort study, we evaluated the demographic data, pulmonary function test (PFT) results, lipid profile, oxygen saturation, and the presence of DELC in patients with COPD and control subjects. RESULTS: DELC was diagnosed in 155 (62%) of COPD patients and these patients had a higher prevalence of CAD (p = 0.044). Moreover, DELC was diagnosed in 135 men (68.5%) and 20 (37.7%) women in the COPD group (p<0.001) and in 39 (48.8%) men and 14 (56.0%) women in the control group (p = 0.527). On the other hand, CAD was diagnosed in 18% of patients with early-stage COPD (n = 104) and in 30.8% of patients with late-stage COPD (n = 146) (p = 0.041). The sensitivity and specificity of DELC positivity in predicting CAD were 80.65% and 44.15% in COPD patients, respectively. CONCLUSION: The presence of cardiac comorbidities in COPD patients may play a vital role in the severity of the disease, exacerbations, and may also reduce the treatment response. Accordingly, an earlobe examination of patients with COPD may be useful in predicting the presence of cardiac comorbidities with high sensitivity.

A different technique in the treatment of intraparenchymally located needle aspiration: turn it around-see-move out.

Although foreign body aspiration is common in children and the elderly, it is very rare in young people. However, headscarf needle aspiration is common in Muslim societies, especially in young people. In needle aspirations that cannot be removed by bronchoscopic methods, thoracotomy is frequently essential method due to the sliding of the needle to the distal part of the lung. A 21-year-old female patient was referred from our emergency department to our clinic with the preliminary diagnosis of needle aspiration. Needle was not visualized by fiberoptic bronchoscopy. Video-assisted thoracoscopic surgery (VATS) was performed and the needle was removed successfully by a maneuver which we encountered for the first time in the literature. Our patient was discharged on the second postoperative day.

Effects of clipping endoscopic thoracal sympathectomy at Th4 on cardiopulmonary functions, quality of life and psychosocial functions.

BACKGROUND: In this study, we evaluated the cardiopulmonary and psychosocial effects of endoscopic thoracal sympathectomy (ETS) by clipping procedure at the level of Th4 and effects of ETS on quality of life of patients with hyperhidrosis. METHODS: We performed a prospective study in 52 patients complaining of local sweating who applied to our clinic. Cardiac maximal treadmill stress test (CMTST), pulmonary function tests, Beck anxiety-depression inventory, Liebowitz social anxiety scale and SF-36 quality of life questionnaires were administered at preoperative period and postoperative 6th month. RESULTS: In the pulmonary function test, we found a minimal decrease in FEV1, and FEV1/FVC. There were no significant change in 'resting pulse rate', 'resting systolic and diastolic blood pressures' during CMTST between before and after operation. There was a significant difference in peak heart rate before CMTST, post-exercise diastolic blood pressure, and age-predictive maximal heart rate between before and after clipping procedure. In the SF-36 questionnaire, all parameters were improved. In the Beck depression-anxiety inventory and the Liebowitz social anxiety scale significant improvement was achieved in all parameters. CONCLUSION: ETS by clipping procedure at the Th4 level is advised to be a safe and effective method for management of hyperhidrosis patients.

Regional distribution of genetic mutation in lung cancer in Turkey (REDIGMA).

INTRODUCTION: The results of standard chemotherapy in lung cancer are not very satisfactory, so it is important to identify genetic mutations that provide targeted therapies. Recent reports have suggested influences of racial difference on the frequency of mutation in lung cancer. We aimed to determine the frequency and regional distribution of genetic mutations of non-small cell lung cancer (NSCLC) in Turkey. MATERIALS AND METHODS: Regional distribution of genetic mutations in lung cancer in Turkey (REDIGMA) study was carried out as a prospective, cross-sectional, observational study in a large number of centers in which lung cancer patients were followed and could perform genetic mutation analysis on patients' biopsy materials. RESULT: The 703 patients (77.7% male, mean age 63.3 ± 12.5 years) who were diagnosed as NSCLC from 25 different centers were included in the study. Tumor samples from patients were reported as 87.1% adenocarcinoma, 6.4% squamous cell carcinoma and 6.5% other. Mutation tests were found to be positive in 18.9% of these patients. The mutations were 69.9% EGFR, 26.3% ALK, 1.6% ROS and 2.2% PDL. Mutations were higher in women and non-smokers (p<0.000, p<0.001). Again, the frequency of mutations in adenocarcinoma was higher in metastatic disease. There was no difference between the patient's age, area of residence, comorbidity and clinical stage and mutation frequency. CONCLUSIONS: Our study revealed that the EGFR mutation rate in Turkey with NSCLC was similar to East European, African-American and Caucasian patients, and was lower than in East Asia.

[Frequency of restless legs syndrome and relationship between depression, anxiety and sleep quality among medical school students]. / Tip fakültesi ögrencileri arasinda huzursuz bacak sendromu sikligi, depresyon, anksiyete ve uyku kalitesi arasindaki iliski.

INTRODUCTION: We aimed to investigate the relationship between frequency of restless legs syndrome (RLS), depression, anxiety and sleep quality among medical school students. MATERIALS AND METHODS: We applied a questionnaire to medical school students. This questionnaire includes some questions about demographic features of participants, questions related with RLS diagnosis, the pittsburgh sleep quality index (PSQI), beck-depression-scale (BDS), beck-anxiety scale (BAS) to all subjects. Participants diagnosed with RLS asked to response some additional questions related with RLS severity rating scale. All results compared between RLS diagnosed and healthy subjects. RESULT: A total of 402 medical school students, of whom 55.2% (n= 22) were female, were participated into this study. The ratio of subjects diagnosed as RLS was 16.9% (n= 68). The ratio of RLS diagnosed participants in female students was 18.0% (n= 40) and in male students was 15.6% (n= 28). Of 169 participants who got a poor sleep quality, 36 subjects (21.3%) was diagnosed as RLS. On the other hand, of 233 participants who got a good sleep quality, 32 subjects (13.7%) was diagnosed as RLS (p= 0.004). Score for the RLS severity ranging scale for participants who were diagnosed as RLS was positively correlated with both BDS and BAS scores (p= 0.002, r= 0.372 ve p< 0.001, r= 0.506, respectively). CONCLUSIONS: In this study, the rate of RLS in medical school students were higher than the rate presented in the literature. Additionaly, participants who were diagnosed as RLS in our study had worse sleep quality than healthy subjects. Moreover, RLS may be associated with some psychological mood disorders.

The publication rates of abstracts presented at the Turkish Respiratory Society (TUSAD) annual congress: adequate or not?

OBJECTIVE: In this study, we aimed to determine the publication status of the abstracts presented at the Turkish Respiratory Society Congress between 2011 and 2014. METHODS: The abstracts were classified according to presentation type (oral presentations, poster discussion, etc.), study type, study design, topic, publication status, time interval between the presentation and the publication date, and the journal in which the article was published. The conversion rate of presentations into full-text articles in peer-reviewed journals were surveyed through Elsevier's Scopus. RESULTS: The total number of abstracts submitted in the congress was 2 009. In terms of study type, the majority of abstracts were case reports (56.4%) and the remainder was original research. Totally, 179 abstracts were published in an indexed journal with an overall publication rate of 8.9%. 18.3% of oral presentations were converted into full-text article. Publication rates according to study types were 14.8% for original researches and 4.4% for case reports. The first three subspecialties with the highest publication rates were "sleep related breathing disorders" (16.9%), "interventional pulmonology" (16.7%) and "pleural diseases" (15.2%). Median publication/acceptance time was 8.0 months (0-38). CONCLUSION: This is the first study evaluating the publication rates of abstracts presented in a respiratory congress. Although the number of presented abstracts in the congress increased year by year, prominently in the case reports, over all conversion rates were decreased. We put forward that encouraging the authors to conduct higher-quality investigations would raise the publication rate as well as improve the scientific quality of congress.