Determination of the factors contributing to depression and anxiety in advanced stage lung cancer patients.

Background: The diagnosis of cancer and initiation of treatment disrupt physical, emotional, and socio-economical stability of the patients by reducing the quality of lives and ultimately leading to depression and anxiety. We aimed to observe the indicators for anxiety and depression among lung cancer (LC) patients by comparing with other cancer (OC) patients. Methods: This study has been conducted between 2017 and 2019. Questionnaires were provided for both LC and OC patients. Results: Two hundred and thirty patients with the ages varied between 18 and 86 (median: 64.0) were included in the study. A total of 115 patients (case group) were diagnosed as LC, and the remaining were with OC diagnosis (control). No difference was determined between the groups in means of median anxiety and depression scores. Patients who required assistance in hospital procedures, daily life activities, and self-care had higher depression and anxiety scores (p < 0.05) compared to those did not require assistance. Anxiety and depression scores in OC groups showed a remarkable difference according to performance status (p < 0.001). The depression score of the patients who stated that they did not know their social rights was remarkably higher than those of the patients who stated that they know their social rights. We found no relationship between depression and anxiety scores because of disease caused income loss and expense increase. Conclusion: For LC patients, declaration of requirement for assistance and supportive care in daily life can be an important indication for anxiety and depression. Lung cancer patients, especially those informed by health care professionals and provided psychosocial support following the information, require a patient-specific professional management approach.

Platelet-to-Lymphocyte Ratio as an Indicator to Predict Decreased Carbon Monoxide Diffusion of the Lung in Patients with Testicular Cancer.

OBJECTIVE: To investigate whether the use of diffusing capacity of the lungs for carbon monoxide (DLCO) and neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) could be used to predict bleomycin-induced pulmonary toxicity in patients with testicular cancer (TCa). STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Ankara Oncology Training and Research Hospital, Turkey, between 2017 and 2020. METHODOLOGY: Data of 40 patients with TCa, who were followed at cancer centre from 2017-2020 and received 3-4 cycles of BEP protocol were retrospectively screened and included who met the criteria for inclusion in the study. All patients with TCa, who were older than 18 years of age and had no secondary malignancy and comorbidity, were included in this study. RESULTS: A statistically significant negative correlation was found between DLCO change and NLR, PLR (r:-0.558, p:0.002 for NLR; r:-0.462 p:0.012 for PLR). A statistically significant positive correlation was found between DLCO change and lymphocyte level (r:0.436, p:0.018). The NLR and PLR were statistically higher in the group with a decrease of ≥10% in DLCO compared to the group with no decrease or a decrease of ≤10% in DLCO (for NLR; 3.03 ± 1.45 and 1.68 ± 0.73, respectively, p = 0.005; for PLR 187.72 ± 66.90 and 124.72 ± 47.99, respectively, p = 0.008). Multivariate regression analysis showed a statistically significant relationship between PLR increase and a decrease of ≥10% in DLCO. CONCLUSION: PLR and LDH could be used as independent predictive biomarkers for DLCO decline which is used to identify bleomycin-induced pulmonary toxicity. Key Words: Bleomycin, Markers of inflammation, Platelet-to-lymphocyte ratio (PLR), Pulmonary diffusing capacity, Testicular cancer.

Five-Year Trends in Direct Costs of Chronic Obstructive Pulmonary Disease in Turkey: COPDTURKEY-3.

OBJECTIVE: Chronic obstructive pulmonary disease (COPD) is one of the major causes of mortality and morbidity worldwide. The aim of this study was to reveal the trend in direct costs related to COPD between 2012 and 2016, and to evaluate hospital costs in 2016, together with their subcomponents. MATERIAL AND METHODS: A population-based descriptive study was conducted using administrative healthcare data in Turkey. The total direct cost of COPD diagnosis-treatment for each year from 2012 to 2016, was calculated. The distribution of the hospital's COPDrelated costs for the year 2016 was also examined, together with morbidity data. RESULTS: The direct costs of the patients who were admitted to step 1, step 2, and step 3 health care centers between 2012 and 2016 increased by 41% [895 041 403TL ($496 930 501) in 2012 to 1 263 288 269TL ($417 834 197) in 2016]; the increase was 60% and 24%, for inpatient and outpatient groups respectively. In the year 2016, the direct total cost was 1003TL ($332) per patient. In 2016, mean specialist consultations per patient with mean cost per specialist consultation, and mean emergency visits per patient with mean cost per emergency visit, were 1.7, 42 TL ($14), and 0.4, 71TL ($23) respectively. For the inpatient group, the mean number of hospitalizations per patient, mean number of hospitalization days, and the mean cost per hospitalization were 0.4, 6.5, and 1926TL ($637), respectively. CONCLUSION: When the readmissions of patients with COPD were evaluated together with the costs, and compared with the statistics from other countries, it was found that the costs per patient were lower in Turkey. However, the reasons for the significant rise in inpatient costs compared to outpatient costs should be investigated. Further investigations are required regarding pulmonary rehabilitation, home health care services, preventive measures for infections, management of comorbidities, and treatment optimization, which may reduce hospitalizations.

Impact of obstructive sleep apnea-related symptoms on surgical wound complications in breast cancer patients: pilot study in a tertiary health center in Turkey.

PURPOSE: Wound healing is an important factor influencing morbidity following surgical procedures. The association of obstructive sleep apnea (OSA) with numerous postoperative complications has been previously reported. In this study, we report the impact of OSA-related symptoms on wound complications in breast cancer patients in the postoperative period. METHODS: Breast cancer patients were enrolled for a prospective observational study. Outcome measures included sociodemographic data, self-reported sleep-wake questionnaires (Berlin questionnaire, STOP-BANG, and Epworth sleepiness scale [ESS]) as well as type of surgery, smoking status, duration of anesthesia, the need for postoperative opioid drugs, and complications for surgical wounds. Patients' general preoperative health status was quantified by using American Society of Anesthesiologists (ASA) scores. RESULTS: A total of 132 women were included in the study, of whom 61% (n = 81) underwent mastectomy, and 39% (n = 51) had breast conserving surgery. Mean ESS score of the study group was 7.7 ± 0.5. Multivariant analysis identified, either being at medium high risk by STOP-BANG questionnaire (OR:1.77, p: 0.04) or being at high risk by Berlin questionnaire (OR:1.96, p: 0.04) as well as high BMI (OR:2.76 95% CI:1.73-4.65, p: 0.02), smoking history (OR:3.04 95% CI: 2.25-3.86, p: 0.01) and type of surgery (OR:2.64 95% CI: 1.63-2.89, p: 0.03) were independent factors for wound healing. CONCLUSIONS: The study results suggest that patients with high risk for OSA have a tendency to develop postoperative wound complications after breast cancer surgery. This study lays groundwork for further scrutiny using more robust methodology.

Determination of related factors about diagnostic and treatment delays in patients with smear-positive pulmonary tuberculosis in Turkey

Background/aim: This study aimed to analyze delays in diagnosis and treatment by defining the related demographic and clinical factors, to reveal obstacles, and to develop essential attempts to help reduce treatment delays. Materials and methods: We created a questionnaire on the subject of delays in diagnosis and treatment in tuberculosis (TB) control to be administered to the patients. The forms were distributed to dispensaries across the country by the General Directorate of Public Health via an official letter. Results: The study included 853 new patients with smear-positive pulmonary TB. The mean patient delay was 18.06 ± 22.27 days, the mean diagnosis delay was 35.63 ± 34.86 days, and the mean treatment delay was 0.90 ± 2.39 days. We found no association between sex, age, literacy, residential location, the presence of chronic respiratory diseases, and patient delay. It was determined that patient delay was shorter for patients with hemoptysis, fever, dyspnoea, and chest pain. In women, the diagnosis delay was longer than in men. Conclusion: In the diagnosis process of patients with tuberculosis, it was determined that there was an improvement in the patient delay; however, the improvement in the diagnosis delay was still not acceptable as an ideal duration.

The Geographical Distribution of Morbidity Caused By Chronic Obstructive Pulmonary Disease in Turkey: COPDTURKEY-2

Background: Chronic obstructive pulmonary disease (COPD) is one of the most prevalent causes for morbidity and mortality, and it creates a cumulative economic and social burden. Aims: To determine the distribution of the prevalence of patients in Turkey who were diagnosed with COPD and their morbidity rates, according to the regions and cities they belong to. Moreover, the study contributes to the prevention and cure services of COPD that should be planned in the future. Study Design: A retrospective cohort. Methods: The database of the Social Security Institution from 2016 has been scanned. All the data with prescription registration, with the code ICD-10, J44.0-J44.9, which were aimed for diagnosing and/or cure, have been evaluated with a retrospective cohort. Results: In 2016, 955,369 patients who were admitted as outpatients to the hospitals were diagnosed with COPD. The average number of annual COPD cases that were admitted was 2.09. Twenty percent (20%) of the outpatient applications were via emergency room. The rate of hospitalization among the applicants was 17.75%, with a total of 1,994,325. The average annual number of hospitalizations of men was higher than that of women. The average number of hospitalization days was 6.52. The region with the highest prevalence of outpatient admission and hospitalization was the Black Sea Region. Conclusion: The high rate of hospitalization was considered to be the outcome of the insufficient "outpatient" management.

The contribution of hospital-based home health services in pulmonary diseases: Current Practice in Turkey.

BACKGROUND: The medical management of chronic respiratory diseases becomes more difficult with the increase in the rate of the elderly population. Monitoring and treating chronic respiratory diseases at home are more comfortable for both the patient and their relatives. Therefore, countries need to develop policies regarding home health services (HHS) according to the state of their social, cultural, and financial infrastructure. OBJECTIVE: The objective of this study is to show the role and contribution of hospital-based HHS regarding respiratory disorders, and to evaluate the model and its efficiency. STUDY DESIGN: The design of this study was cross-sectional. Data were obtained from the Ministry of Health of Turkey with official permission. Data were collected for HHS concerning respiratory diseases between 2011 and 2017. Age and sex distribution, the number of recorded patients, the number of visits for pulmonary diseases, the distribution of institutional visits, and the quantitative alterations within the years were investigated. STUDY POPULATION: The study population was based on patients with respiratory disorders who were given HHS as directed by the Ministry of Health of Turkey. RESULTS: Between 2011 and 2017, the majority of patients with pulmonary diseases, mostly those with chronic obstructive pulmonary disease, asthma, and lung cancer, visited government hospitals (78%). The number of house visits concerning pulmonary disorders increased nearly ten times, but hospitalization due to respiratory diseases decreased (13.5% in 2011 to 12.9% in 2017). CONCLUSION: Hospital-based HHS in pulmonary diseases can be considered as an appropriate model for implementation for countries like Turkey, those that have inadequate hospice-type health service infrastructure.

National Control of Tuberculosis: Does Primary Health Care System Play a Crucial Role in the Fight Against Tuberculosis?

OBJECTIVES: To analyze the tuberculosis control studies in a primary health care center and to observe the changes throughout the years. MATERIALS AND METHODS: Data of patients followed up between 2005 and 2014 in the Elazig Dispensary were investigated retrospectively. RESULTS: Of the total 1,251 patients, 51.6% were male. Majority of patients were aged between 15 and 24 (19.9%), 25 and 35 (18.5%), and over 65 (14.4%). While the rate of a sputum smear examination was 71.6%, the positivity rate for Acid-Fast bacilli was 55.5%. It was detected that the drug sensitivity test was applied in only 25.8% of all patients. The treatment success of all patients was 85.8%. The cure rate of smear-positive cases was found to be 26.35%. The rate of the relapsing patients was 9.1%. An overall treatment response rate was found to be 87.4%. CONCLUSION: The control of tuberculosis in primary health care is partially successful and insufficient. The rate of smear-positive defaulters was found to be high in young adult individuals, which indicates that the contamination is probably still going on at a dangerous rate. Furthermore, the overall rate of microscopic examination, sputum culture, and drug sensitivity tests performed in patients in the primary health care system is low and should be improved immediately.

[Determination of anthropometric measurements in obstructive sleep apnea syndrome in Turkish population]. / Türk popülasyonunda obstrüktif uyku apne sendromunda rol oynayan antropometrik ölçümlerin belirlenmesi.

INTRODUCTION: In this study, we aimed to determine the values of anthropometric measurements and rates used in the evaluation of obstructive sleep apnea syndrome (OSAS) in our country. MATERIALS AND METHODS: Twenty accredited sleep centers in thirteen provinces participated in this multicenter prospective study. OSAS symptoms and polysomnographic examination and apnea-hypopnea index (AHI) ≥ 5 cases OSAS study group; patients with AHI < 5 and STOP-Bang < 2 were included as control group. Demographic characteristics (age, sex, body mass index-BMI) and anthropometric measurements (neck, waist and hip circumference, waist/hip ratio) of the subjects were recorded. RESULT: The study included 2684 patients (81.3% OSAS) with a mean age of 50.50 ± 0.21 years from 20 centers. The cases were taken from six geographical regions of the country (Mediterranean, Eastern Anatolia, Aegean, Central Anatolia, Black Sea and Marmara Region). Demographic characteristics and anthropometric measurements; age, neck, waist, hip circumference and waist/ hip ratios and BMI characteristics when compared with the control group; when compared according to regions, age, neck, waist, hip circumference and waist/hip ratios were found to be statistically different (p< 0.001, p< 0.001, p< 0.05, respectively). When compared by sex, age, neck and hip circumference, waist/hip ratio, height, weight and BMI characteristics were statistically different (p< 0.001, respectively). Neck circumference and waist/hip ratio were respectively 42.58 ± 0.10 cm, 0.99 ± 0.002, 39.24 ± 0.16 cm, 0.93 ± 0.004 were found in women. CONCLUSIONS: The neck circumference was lower than the standard value in men, but higher in women. The waist/hip ratio was above the ideal measurements in both men and women. In this context, the determination of the country values will allow the identification of patients with the possibility of OSAS and referral to sleep centers for polysomnography.

The association of body mass index values with severity and phenotype of sleep-disordered breathing.

INTRODUCTION: To investigate the relationship between body mass index (BMI) and the severity of obstructive sleep apnea (OSA) and to determine the BMI cut-off values for sleep-disordered breathing among adult population. MATERIALS AND METHODS: Data from 515 patients were evaluated retrospectively. These included demographic data, BMI, apnea-hypopnea index (AHI), oxygen saturation (SaO2) and oxygen desaturation index (ODI). The BMI cutoff value for sleep-disordered breathing was determined and comparisons were made between two groups of patients (BMI ≤ 33 and BMI > 33). Descriptive and comparative analyses were performed using SPSS, version 24. RESULT: Higher BMI values were found to be correlated with diagnosis and severity of OSA and reduced sleep efficiency. Patients in the BMI > 33 group had significantly higher rates of co-morbid diseases than patients in the BMI ≤ 33 group. Patients with BMI ≤ 33 had significantly lower ODI values than patients with BMI > 33. In patients with BMI > 33, arousal index was significantly higher and SaO2 values were lower than those with BMI ≤ 33. In rapid eye movement (REM) sleep-related OSA, BMI values were higher than positional/classical OSA. CONCLUSIONS: Patients with higher BMI experienced frequent nocturnal oxygen desaturation periods resulting in higher arousal indexes and decreased sleep efficiency. REM sleep-related OSA and high BMI values together may lead to increased nocturnal oxygen demand. We recommend the threshold values of BMI > 33 to be considered for screening OSA among adult population.

Impact of Acupuncture on Chronic Insomnia: A Report of Two Cases with Polysomnographic Evaluation.

OBJECTIVE: This report aimed to present the acupuncture treatment response of two patients who were evaluated with polysomnography. CLINICAL FEATURES: Acupuncture treatment was planned for two patients who refused medical treatment with chronic insomnia. Polysomnographic evaluation was performed at baseline and 1 month after acupuncture treatment. CONCLUSION: Remarkable improvement was determined in polysomnographic parameters of both cases. After acupuncture treatment, improvements in subjective symptoms such as unrefreshing sleep, morning headache, reduced motivation and daytime performance, tiredness, sleep disturbances, fatigue, and mood worsening in the morning were also observed. Clinical studies with more cases with polysomnographic evaluation are necessary to investigate the effectiveness of acupuncture in the treatment of insomnia.

Lung cancer associated with a single simultaneous solitary metastatic lesion in stomach: a case report with the review of literature.

Metastatic tumors of the stomach are rare. Although neoplasms from almost every tissue have been reported to metastasize to the stomach, lung cancer is a rare cause. We report the case of 46-years-old man presented with superior Vena Cava syndrome. Histopathological diagnosis was non-small cell lung cancer with computed tomography-guided needle biopsy of lung. Since gastric symptoms occurred during follow up of patient, upper gastrointestinal endoscopy performed. Upper gastrointestinal endoscopy and biopsy showed metastasis of stomach secondary to primary squamous cell lung cancer and additionally lack of another distant site metastasis indicated that gastric region was the single site of tumor spread.

Pandemic 2009 H1N1 influenza in patients with hematopoietic stem cell transplantation and hematologic malignancy: single center experience.

Although valuable information on many aspects of the pandemic 2009 H1N1 influenza came to light in a relatively short period of time, the disease course among immunocompromised patients is largely unknown. In this study, we present the results of active H1N1 surveillance in 32 patients who were treated at our hematology/stem cell transplantation clinic between December 2009 and January 2010. We also report the clinical and laboratory features of patients with laboratory-proven disease and try to define the impact of novel H1N1 disease on their outcome. Eight patients in the hematology clinic and 7 patients in the hematology/stem cell transplantation unit tested positive for pandemic H1N1 infection. Patients were treated with oral oseltamivir for 5-15 days. In 10 patients the infection was limited to the upper respiratory tract. But in 5 patients it was complicated with lower respiratory diseases. Three of them required intensive care support with mechanic ventilation and all died during follow-up. As the clinical and radiological findings of H1N1 infection are nonspecific in nature, we should have a high index of suspicion in immunocompromised patients. Therefore, beginning empiric oseltamivir therapy while waiting for laboratory results and increasing the dose/duration of therapy in laboratory-confirmed cases could be life saving.

Chemoresistant placental site trophoblastic tumor with hilar lymph node metastasis: an unusual site of involvement.

BACKGROUND: Placental site trophoblastic tumor (PSTT) is an uncommon variant of gestational trophoblastic diseases. In most cases, disease is confined to the uterus and treated with a simple hysterectomy. However, 30% of these patients will present with metastatic disease. Patients with metastases frequently have progression of disease and die despite aggressive multiagent chemotherapy. CASE: We present a case of 33-year-old female with PSTT and metastases to the hilar lymph nodes of the right lung. Primary surgical treatment consisting of abdominal hysterectomy and unilateral salpingo-oophorectomy was followed by six cycles of EMA/CO (etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine) chemotherapy. After the completion of chemotherapy, betahCG titers stayed within normal range, but a repeated CT scan of chest revealed enlargement of the hilar lymph nodes. The patient underwent right thoracotomy with hilar lymph nodes resection. The resected nodules were pathologically consistent with primary PSTT. CONCLUSION: In this case report, we have determined a PSTT with hilar region metastasis other than parenchyma of lung and confirmed the chemoresistant nature of tumor with the guidance of the previous reports.

Risk factors associated with postoperative pulmonary complications following oncological surgery.

The purpose of our study was to determine the incidence of different postoperative pulmonary complications (PPCs) and their associated risk factors in patients who have undergone various elective surgical procedures in an oncological surgery center. Ninety five adult patients were studied prospectively for one year period. For the study group, predictors of pulmonary complications of interest were determined as age, gender, body mass index, co morbid conditions (preexisting history of chronic obstructive pulmonary disease, asthma, bronchiectasis, restrictive lung disease), site and type of the operation, smoking history, The American Society of Anesthesiologists (ASA) physical status, physical examination and chest X- Ray findings, pulmonary function tests, type and duration of anesthesia, surgical incision site and length and presence of nasogastric tube suction. The PPC rate of our study group was 40% (38/95). Atelectasis and bronchospasm were the most frequently observed PPCs (13.7%) Among all the risk factors taken into consideration, only three were found to be significant independent predictors of pulmonary complications according to multivariate analysis as follows: incision location concerning abdomen (p= 0.008), duration of anesthesia per hour (p= 0.0001), values of FEV1 < 50% (p= 0.007). Our data revealed that the incidence of PPCs was high in our study group when compared to results of general population. Application of major resection surgeries for cancer patients can be an explanation for this result. Shortening the duration of surgery, avoiding general anaesthesia in selected group of patients may reduce the risk of PPCs.

Serum interleukin-6 levels correlate with malnutrition and survival in patients with advanced non-small cell lung cancer.

AIM: To investigate the level of interleukin-6 in advanced non-small cell lung cancer and to analyze the relationship with malnutrition and survival. METHODS AND STUDY DESIGN: Seventy-one newly diagnosed advanced non-small cell lung cancer patients were enrolled in this prospective study. Malnutrition was defined by using subjective global assessment. Performance status was assessed by the Karnofsky scale. Serum levels of albumin, transferrin, C-reactive protein, lymphocytes/mm3, lactate dehydrogenase and growth hormone were determined before treatment. The patients were followed, and the factors affecting survival were analyzed. RESULTS: The mean follow-up after diagnosis was 180 days. IL-6 levels increased in 48 (68%) of 71 patients. According to the subjective global assessment, 28 (39%) patients were well nourished and 43 (61%) were malnourished. Of the 43 malnourished patients, 29 (41%) were moderately malnourished or suspected of being malnourished and 14 (20%) were severely malnourished. The IL-6 level was related to impaired performance status (P = 0.0001), severe malnutrition (P = 0.004), increased C-reactive protein (P = 0.013), higher growth hormone (P = 0.025) and transferrin (P = 0.03) levels. On univariate analysis, impaired performance status, moderate and severe malnutrition, decreased serum albumin and transferrin, a raised IL-6 and lactate dehydrogenase levels were the significant prognostic factors for survival. Multivariate analysis indicated that a raised IL-6, severe malnutrition and a low serum level of albumin were independent prognostic factors for survival in patients with advanced non-small cell lung cancer. CONCLUSIONS: IL-6 secretion may play a role in the pathophysiology of malnutrition in advanced lung cancer. Results show a relation between elevated IL-6 serum levels and malnutrition, poor performance status, acute phase response and shorter survival in patients affected by advanced non-small cell lung cancer.