COVID-19: vaccination vs. hospitalization.

OBJECTIVE: Vaccination is the most efficient way to control the coronavirus disease 2019 (COVID-19) pandemic, but vaccination rates remain below the target level in most countries. This multicenter study aimed to evaluate the vaccination status of hospitalized patients and compare two different booster vaccine protocols. SETTING: Inoculation in Turkey began in mid-January 2021. Sinovac was the only available vaccine until April 2021, when BioNTech was added. At the beginning of July 2021, the government offered a third booster dose to healthcare workers and people aged > 50 years who had received the two doses of Sinovac. Of the participants who received a booster, most chose BioNTech as the third dose. METHODS: We collected data from 25 hospitals in 16 cities. Patients hospitalized between August 1 and 10, 2021, were included and categorized into eight groups according to their vaccination status. RESULTS: We identified 1401 patients, of which 529 (37.7%) were admitted to intensive care units. Nearly half (47.8%) of the patients were not vaccinated, and those with two doses of Sinovac formed the second largest group (32.9%). Hospitalizations were lower in the group which received 2 doses of Sinovac and a booster dose of BioNTech than in the group which received 3 doses of Sinovac. CONCLUSION: Effective vaccinations decreased COVID-19-related hospitalizations. The efficacy after two doses of Sinovac may decrease over time; however, it may be enhanced by adding a booster dose. Moreover, unvaccinated patients may be persuaded to undergo vaccination.

Evaluation of Exudative Pleural Effusions: A Multicenter, Prospective, Observational Study.

PURPOSE: The aim of this study is to determine the diagnostic performances of pleural procedures in undiagnosed exudative pleural effusions and to evaluate factors suggestive of benign or malignant pleural effusions in tertiary care centers. METHODS: This was a multicenter prospective observational study conducted between January 1 and December 31, 2018. A total of 777 patients with undiagnosed exudative pleural effusion after the initial work-up were evaluated. The results of diagnostic procedures and the patients' diagnoses were prospectively recorded. Sensitivity, specificity, and accuracy estimates with 95% confidence intervals were used to examine the performance of pleural procedures to detect malignancy. RESULTS: The mean age ± SD of the 777 patients was 62.0 ± 16.0 years, and 68.3% of them were male. The most common cause was malignancy (38.3%). Lung cancer was the leading cause of malignant pleural effusions (20.2%). The diagnostic sensitivity and accuracy of cytology were 59.5% and 84.3%, respectively. The diagnostic sensitivity of image-guided pleural biopsy was 86.4%. The addition of image-guided pleural biopsy to cytology increased diagnostic sensitivity to more than 90%. Thoracoscopic biopsy provided the highest diagnostic sensitivity (94.3%). The highest diagnostic sensitivity of cytology was determined in metastatic pleural effusion from breast cancer (86.7%). CONCLUSION: The diagnostic performance increases considerably when cytology is combined with image-guided pleural biopsy in malignant pleural effusions. However, to avoid unnecessary interventions and complications, the development of criteria to distinguish patients with benign pleural effusions is as important as the identification of patients with malignant pleural effusions.

Factors affecting compliance with positive airway pressure therapy in obstructive sleep apnea.

OBJECTIVE: To investigate the factors affecting compliance with positive airway pressure (PAP) therapy and establish the relationship between compliance and pulmonary function tests (PFT) in patients with OSA. MATERIAL AND METHODS: In this prospective study, patients with OSA using PAP devices were questioned about the complaints related to the device. Depression and anxiety scales along with PFT parameters were also assessed. RESULTS: Of 98 participants, 63% were men. The mean age was 52.0 ± 9.6 years. Sixty-seven percent of the patients were compliant with their devices. A significant difference was observed between the proportion of the participants compliant or non-compliant with the device, based on OSA severity (p < 0.05). Beck depression inventory (BDI) and Beck anxiety inventory (BAI) scores of the compliant patients were significantly lower than those of the non-compliant patients (p < 0.001, p = 0.044, respectively). No statistically significant difference was detected between the groups regarding individual pulmonary function tests (p > 0.05). The rates of nasal mask use, not having difficulty in tolerating CPAP, falling asleep, absence of abdominal distension, no facial sores, no air leakage, patients benefiting from the device, reduction in daytime sleepiness, and the belief that they are receiving appropriate therapy in participants compliant with the device were higher than those in non-compliant participants (p < 0.05). The rates of claustrophobia and discomfort due to pressure were significantly lower in patients compliant with the device than in the non-compliant patients (p < 0.05). CONCLUSION: While no relationship was detected between PFT parameters and PAP therapy compliance, significant factors affecting the device compliance were detected.

The eating attitudes in patients with obstructive sleep apnea syndrome.

AIM: Obstructive sleep apnea syndrome (OSAS) patients show multiple physiological deficits and several neuropsychological comorbidities. The aim of this study was to investigate the eating attitudes in OSAS patients. MATERIAL AND METHODS: Polysomnography records of 157 were performed. Eating Attitudes Test (EAT), Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI) were applied to all participants. RESULTS: The mean age of the 157 individuals included in the study was 47.2 ± 11.4 (18-76) years and 36% (n = 56) of the individuals were female and 64% (n = 101) were male. When the patients were ranked according to the severity of OSAS, 38.2% (n = 60) were severe, 20.4% (n = 32) were moderate, 24.2% (n = 38) were mild, and 17.2% (n = 27) were OSAS negative. There was a significant difference in terms of the age-and-BMI-adjusted EAT score according to OSAS severity (p = .042). There was a significant difference in the age-and-BMI-adjusted value of the EAT according to the presence of OSAS (p = .011). After controlling age and BMI, no significant correlation was found between the EAT and the BDI (r = 0.012, p = .890) in patients with OSAS while there was a significant positive correlation EAT and the BAI (r = 0.177, p = .046). CONCLUSIONS: Considering the association of OSAS with psychiatric disorders, the presence of eating disorders (EDs) becomes an important and special topic. Treatment of patients with OSAS should not only aim to improve the patient's sleep apnea, but also to improve the patient's quality of life by evaluating the patient's psychological and physical functions.

Is sarcoidosis related to metabolic syndrome and insulin resistance?

Aim: To investigate the relationship between sarcoidosis and metabolic syndrome (MetS) and insulin resistance (IR).Method: In our study, 47 patients with sarcoidosis who applied to our outpatient clinic and 45 healthy individuals without chronic disease were included. All patients were evaluated for MetS according to the National Cholesterol Education Program's Adult Treatment Panel III (NCEP-ATP III) criteria. The presence of three of the five factors defined by ATP III for MetS was accepted as a diagnosis of MetS. IR is calculated using the HOMA-IR index.Results: The mean age of the 47 patients with sarcoidosis was 50.7 ± 12.2 years and the mean age of the 45 control groups was 42.9 ± 14.4 years. Almost 80% of the patients were diagnosed as stage 2 sarcoidosis. Distribution of the patients according to the use of steroid is; almost half of the patients (47%) received steroid previously or recently. Patients with sarcoidosis have a 7.66 relative risk for MetS, whereas they also have a 5.48 relative risk of insulin resistance development.Conclusion: This study shows that MetS is associated with increased sarcoidosis risk. MetS and IR diagnosis was higher in patients with sarcoidosis.

Do the levels of particulate matters less than 10 µm and seasons affect sleep?

Background: There are few studies showing that the increase in particulate matters less than 10 µm (PM10) values increases the apnea-hypopnea index (AHI). We aimed to investigate relationship between air quality parameters and the seasons with the AHI.Methods: This was a retrospective study that included 500 adults. Polysomnography (PSG) was performed on all patients. Oxygen saturation, air temperature, relative humidity, and PM10 values were recorded in Düzce for every year. The parameters of the national air quality network and sleep parameters of 500 individuals hospitalized between 2015 and 2017 were checked.Results: A total of 500 patients were included in the study, of whom 316 (63.2%) were male and 184 (36.8%) were female. While the AHI value of patients who presented during 2016 was 27.5, it had significantly declined to 20.2 in 2017 (p = .024). A significant decline was observed in AHI values of OSA patients from 2016 to 2017 (p = .043). A significant positive correlation was observed between REM-related AHI and relative humidity (r = 0.183, p = .002). Conclusions: This study showed a clear relationship between AHI and PM10 during winter when air pollution parameters are high in the region. PM10 emerged as a parameter that substantially increases the relative risk for OSA.

Serum Clara cell secretory protein (CC-16) in non-smoking patients with obstructive sleep apnea.

OBJECTIVE: This study aimed to determine the association between the severity of obstructive sleep apnea (OSA) and serum Clara cell protein (CC16) levels in non-smoking patients with OSA. METHODS: This prospective study included non-smoking patients who presented with sleep-related disturbances and underwent polysomnography (PSG). The serum CC16 level was measured and its relationship to PSG parameters was investigated. RESULTS: The study included 128 patients (83 men) with a mean age of 48.4 ± 11.9. OSA was detected in 66 men (70%) and 29 women (30%) (p = 0.051). The severity of OSA was mild in 32 (25%), moderate in 28 (22%), and severe in 35 (27%) of the patients. There was no significant difference in CC16 levels between the OSA group (1746 ± 1006) and the OSA negative group (1721 ± 1201, p = 0.91) levels. There was no significant difference between the CC16 levels of the each four groups. Mean serum CC16 levels were significantly lower in OSA negative men than OSA positive men (777 vs 1462, p = 0.005). No significant difference was observed in CC16 values according to OSA severity in women. CONCLUSION: The serum CC16 level does not differ between non-smoking OSA patients and OSA negative patients.

An Investigation of Latex Sensitivity and Respiratory Complaints in Workers in a Rubber-Based Material Manufacturing Industry.

OBJECTIVE: To present study aimed to investigate the prevalence of latex sensitivity in a workplace that produced rubber-based vehicle seals. METHOD: The serum latex-specific IgE levels, respiratory complaints, PFT, serum interleukin (IL)-4, IL-5, IL-8, IL-10, IL-13 levels of all male workers (n = 108) exposed to latex in the workplace, which produced rubber seals, were compared with the control group (n = 52). RESULTS: The rates of latex-specific IgE >0.10 kU/L in the workers and control group were 12.3% and 4.1%, respectively ( P = 0.147). There was no difference in IL-4, IL-5, IL-10, and IL-13 levels between latex-specific IgE-positive, and -negative participants. CONCLUSION: Latex sensitivity was higher in workers who used rubber as a raw material than in the control group but it was not statistically significant.

Perceived Need for Mental Health Services Among Healthcare Workers During the Coronavirus Disease-19 Pandemic in Turkey: A Multicenter Cross-sectional Study

Background: The coronavirus disease-2019 pandemic has contributed to work-related psychosocial risks in healthcare workers. Aims: To evaluate the perceived need for mental health services and related factors in Turkish healthcare workers practicing in pandemic hospitals. Study Design: Cross-sectional study. Methods: Data were collected from face-to-face interviews with healthcare workers at 19 pandemic hospitals in 13 provinces between September and November 2021. The study survey included the evaluation of the perceived need for and utilization of mental health services in the previous year, as well as sociodemographic, health-related, and work-related characteristics, the General Health Questionnaire-12, the World Health Organization Quality of Life-BREF (WHOQoL-BREF) questionnaire, and the Fear of coronavirus disease-2019 scale (FCV-19S). Results: Of 1,556 participants, 522 (33.5%) reported a perceived need for mental health services, but only 133 (8.5%) reported receiving these services. Multiple logistic regression analysis of the perceived need for mental health services revealed significant relationships with lower age, female sex, being a current smoker, having a chronic disease, having a mental disorder, coronavirus disease-2019 contact within the last three months in settings other than the home or workplace, a positive coronavirus disease-2019 vaccination history, being a physician, being a non-physician healthcare professional, and coronavirus disease-2019 contact within the last three months at work. After adjustment for these characteristics, higher General Health Questionnaire-12 and FCV-19S scores and lower WHOQoL-BREF domain scores were related to the perceived need for mental health services in logistic regression analyses. Conclusion: The findings indicate a substantial need for mental health services amongst Turkish healthcare workers during the pandemic and outline participants' characteristics regarding high-priority groups for the intervention. Future research may focus on developing actions and evaluating their efficiency.

The association of antiviral drugs with COVID-19 morbidity: The retrospective analysis of a nationwide COVID-19 cohort.

Background and objectives: Although several repurposed antiviral drugs have been used for the treatment of COVID-19, only a few such as remdesivir and molnupiravir have shown promising effects. The objectives of our study were to investigate the association of repurposed antiviral drugs with COVID-19 morbidity. Methods: Patients admitted to 26 different hospitals located in 16 different provinces between March 11-July 18, 2020, were enrolled. Case definition was based on WHO criteria. Patients were managed according to the guidelines by Scientific Board of Ministry of Health of Turkey. Primary outcomes were length of hospitalization, intensive care unit (ICU) requirement, and intubation. Results: We retrospectively evaluated 1,472 COVID-19 adult patients; 57.1% were men (mean age = 51.9 ± 17.7years). A total of 210 (14.3%) had severe pneumonia, 115 (7.8%) were admitted to ICUs, and 69 (4.7%) were intubated during hospitalization. The median (interquartile range) of duration of hospitalization, including ICU admission, was 7 (5-12) days. Favipiravir (n = 328), lopinavir/ritonavir (n = 55), and oseltamivir (n = 761) were administered as antiviral agents, and hydroxychloroquine (HCQ, n = 1,382) and azithromycin (n = 738) were used for their immunomodulatory activity. Lopinavir/ritonavir (ß [95% CI]: 4.71 [2.31-7.11]; p = 0.001), favipiravir (ß [95% CI]: 3.55 [2.56-4.55]; p = 0.001) and HCQ (ß [95% CI]: 0.84 [0.02-1.67]; p = 0.046) were associated with increased risk of lengthy hospital stays. Furthermore, favipiravir was associated with increased risks of ICU admission (OR [95% CI]: 3.02 [1.70-5.35]; p = 0.001) and invasive mechanical ventilation requirement (OR [95% CI]: 2.94 [1.28-6.75]; p = 0.011). Conclusion: Our findings demonstrated that antiviral drugs including lopinavir, ritonavir, and favipiravir were associated with negative clinical outcomes such as increased risks for lengthy hospital stay, ICU admission, and invasive mechanical ventilation requirement. Therefore, repurposing such agents without proven clinical evidence might not be the best approach for COVID-19 treatment.

The predictors of COVID-19 mortality in a nationwide cohort of Turkish patients.

The COVID-19-related death rate varies between countries and is affected by various risk factors. This multicenter registry study was designed to evaluate the mortality rate and the related risk factors in Turkey. We retrospectively evaluated 1500 adults with COVID-19 from 26 centers who were hospitalized between March 11 and July 31, 2020. In the study group, 1041 and 459 cases were diagnosed as definite and highly probable cases, respectively. There were 993 PCR-positive cases (66.2%). Among all cases, 1144 (76.3%) were diagnosed with non-severe pneumonia, whereas 212 (14.1%) had severe pneumonia. Death occurred in 67 patients, corresponding to a mortality rate of 4.5% (95% CI:3.5-5.6). The univariate analysis demonstrated that various factors, including male sex, age ≥65 years and the presence of dyspnea or confusion, malignity, chronic obstructive lung disease, interstitial lung disease, immunosuppressive conditions, severe pneumonia, multiorgan dysfunction, and sepsis, were positively associated with mortality. Favipiravir, hydroxychloroquine and azithromycin were not associated with survival. Following multivariate analysis, male sex, severe pneumonia, multiorgan dysfunction, malignancy, sepsis and interstitial lung diseases were found to be independent risk factors for mortality. Among the biomarkers, procalcitonin levels on the 3rd-5th days of admission showed the strongest associations with mortality (OR: 6.18; 1.6-23.93). This study demonstrated that the mortality rate in hospitalized patients in the early phase of the COVID-19 pandemic was a serious threat and that those patients with male sex, severe pneumonia, multiorgan dysfunction, malignancy, sepsis and interstitial lung diseases were at increased risk of mortality; therefore, such patients should be closely monitored.

Relationship between Diagnosis Period and Internal and External Air Quality in Patients with Tuberculosis.

OBJECTIVE: The aim of this study was to investigate the relationship between bacteriological case definitions and indoor and outdoor air quality parameters in tuberculosis (TB). MATERIALS AND METHODS: A total of 200 patients with TB diagnosed and treated in our hospital during 2012-2018 were included to this study. The air monitoring measurement parameters of the National Air Quality Network [particulate matter 10 (PM10), sulfur dioxide (SO2), air temperature, air pressure, and relative humidity] for the same time period were obtained from the web page http://laboratory.cevre.gov.tr/Default.ltr.aspx. RESULTS: Of the 200 patients, 62.5% (125) were males and 37.5% (75) were females. The rate of diagnosis based on culture and smear positivity was 48.4% (31), which was significantly higher than that in the clinic [10.9% (7)] among patients who used stove for warming. The rate of diagnosis based on culture and smear positivity [52.1% (25)] was significantly higher than that in the clinic [8.3% (4)] among patients who were exposed to biomass. The univariate analysis revealed no significant independent effect of warming and biomass use on case definition. According to the case definitions, the mean values of PM10, SO2, and temperature in the diagnosed month showed no statistically significant difference. The humidity level in the month was significantly higher, during which cases diagnosed using smear and culture positivity were compared with cases diagnosed using only culture positivity (p=0.023). CONCLUSION: This study indicates that biomass used as a cooking fuel is a risk factor for pulmonary TB, implying that TB occurrence can be reduced significantly by lowering or preventing the exposure to cooking smoke emitted from biomass fuel.

The effects of non-invasive mechanic ventilator modes on intraocular pressure in COPD patients with hypercapnic respiratory failure.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is not fully reversible disease that is characterized by progressive restricting airflow. Non-invasive mechanical ventilation (NIMV) treatment can be used in COPD patients who had type 2 respiratory failure. This study aimed to determine the effect of BPAP S/T and AVAPS modes on intraocular pressure (IOP), central corneal thickness (CCT) in 40 type 2 respiratory failure patients with COPD. METHODS: Forty patients with type 2 respiratory failure who were hospitalized between June and December 2018 with the diagnosis of COPD exacerbations were included to the study. Patients followed up without NIMV for 12 hours after the end of exacerbations treatments end. After IOP, visual acuity and CCT were measured in all patients at the same time (11.00 am), same NIMV treatment was applied to the patients for 4 hours (AVAPS-BPAP S/T). Then the measurements were repeated. The effects of these NIMV modes on IOP were evaluated. RESULTS: After NIMV treatment, it was observed that the mean IOP increased statistically significantly (13.3 vs 12.3 mm Hg; P = 0.001). After treatment with NIMV, there was a decrease for CCT close to statistical significance (P = 0.057) CONCLUSION: As a result; increased IOP and thinning of CCT after NIMV treatment has been shown. The type of NIMV and the level of inspiratory pressure needed in hypercapnic respiratory failure seem to affect IOP and it should be cautiously used to increase IOP.

Covid-19: The Biggest Threat of the 21st Century: In Respectful Memory of the Warriors All Over the World.

Since the first case was diagnosed in China, the new coronavirus infection (COVID-19) has become the number one issue in the world and it seems to remain trend-topic for a long time. Until 17 April, it affected 210 countries, infected over 2 million people and caused approximately 150000 deaths. Although the course of the disease ranges from asymptomatic state to severe ARDS; the majority of patients reveal only mild symptoms. Though adults are the most commonly affected group; it can also be seen in newborns and elderly patients. Unfortunately, elderly patients are the most vulnerable group with higher mortality. Elderly patients, smokers and patients with comorbid conditions are most affected by the disease. In certain diagnostical tool is the real-time reverse transcription-polymerase chain reaction (real-time RT-PCR) test. However, it can be resulted in false-negative results and in this case the computed thorax tomography (CT) is one of the most important tools with high sensitivity. Besides the supportive treatment, most commonly used agents are immunomodulatory drugs such as plaquenil and azitromycin, and anti-virals including oseltamivir, ritonavir-lopinavir, favipiravir. Until a vaccine or a specific therapy invented, the most important intervention to control the disease is to fight against transmission. This is a real war and the doctors are the soldiers.

Unclear Issues Regarding COVID-19.

Scientists from all over the world have been intensively working to discover different aspects of Coronavirus disease 2019 (COVID-19) since the first cluster of cases was reported in China. Herein, we aimed to investigate unclear issues related to transmission and pathogenesis of disease as well as accuracy of diagnostic tests and treatment modalities. A literature search on PubMed, Ovid, and EMBASE databases was conducted, and articles pertinent to identified search terms were extracted. A snow-ball search strategy was followed in order to retrieve additional relevant articles. It was reported that viral spread may occur during the asymptomatic phase of infection, and viral load was suggested to be a useful marker to assess disease severity. In contrast to immune response against viral infections, cytotoxic T lymphocytes decline in SARS-CoV-2 infection, which can be partially explained by direct invasion of T lymphocytes or apoptosis activated by SARS-CoV-2. Dysregulation of the urokinase pathway, cleavage of the SARS-CoV-2 Spike protein by FXa and FIIa, and consumption coagulopathy were the proposed mechanisms of the coagulation dysfunction in COVID-19. False-negative rates of reverse transcriptase polymerase chain reaction varied between 3% and 41% across studies. The probability of the positive test was proposed to decrease with the number of days past from symptom onset. Safety issues related to infection spread limit the use of high flow nasal oxygen (HFNO) and continuous positive airway pressure (CPAP) in hypoxic patients. Further studies are required to elucidate the challenging issues, thus enhancing the management of COVID-19 patients.

What We Learned about COVID-19 So Far? Notes from Underground.

The novel coronavirus pandemic poses a major global threat to public health. Our knowledge concerning every aspect of COVID-19 is evolving rapidly, given the increasing data from all over the world. In this narrative review, the Turkish Thoracic Society Early Career Taskforce members aimed to provide a summary on recent literature regarding epidemiology, clinical findings, diagnosis, treatment, prevention, and control of COVID-19. Studies revealed that the genetic sequence of the novel coronavirus showed significant identity to SARS-CoV and MERS-CoV. Angiotensin-converting enzyme 2 receptor is an important target of the SARS-CoV-2 while entering an organism. Smokers were more likely to develop the disease and have a higher risk for ICU admission. The mean incubation period was 6.4 days, whereas asymptomatic transmission was reported up to 25 days after infection. Fever and cough were the most common symptoms, and cardiovascular diseases and hypertension were reported to be the most common comorbidities among patients. Clinical manifestations range from asymptomatic and mild disease to severe acute respiratory distress syndrome. Several patients showed typical symptoms and radiological changes with negative RT-PCR but positive IgG and IgM antibodies. Although radiological findings may vary, bilateral, peripherally distributed, ground-glass opacities were typical of COVID-19. Poor prognosis was associated with older age, higher Sequential Organ Failure Assessment score, and high D-dimer level. Chloroquine was found to be effective in reducing viral replication in vitro. Likewise, protease inhibitors, including lopinavir/ritonavir, favipiravir, and nucleoside analogue remdesivir were proposed to be the potential drug candidates in COVID-19 management. Despite these efforts, we still have much to learn regarding the transmission, treatment, and prevention of COVID-19.

COVID-19 Treatment at a Glance.

As coronavirus disease 2019 (COVID-19) spreads across the world, the ongoing clinical trials are leading to a big race worldwide to develop a treatment that will help control the pandemic. Unfortunately, COVID-19 does not have any known effective treatment with reliable study results yet. In this pandemic, there is not a lot of time to develop a new specific agent because of the rapid spread of the disease. The process of developing a vaccine is long and requires hard work. Although the pathophysiology of the disease is not fully understood, some of the proposed treatment alternatives are based on old evidence and some have been used with the idea that they might work owing to their mechanism of action. The efficacy, reliability, and safety of the currently available treatment alternatives are therefore a matter of debate. Currently, the main therapies used in the treatment of COVID-19 are antiviral drugs and chloroquine/hydroxychloroquine. Other proposed options include tocilizumab, convalescent plasma, and steroids, but the mainstay of the treatment in intensive care units remains supportive therapies.