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.

The Efficacy of Hydroxychloroquine and Azithromycin Combination Therapy on Hospital Mortality in COVID 19 Pneumonia Patients.

BACKGROUND/AIM: Effective therapeutic approaches for SARS-CoV-2 pandemic are urgently needed. Hydroxychloroquine (HCQ) alone or in combination with azithromycin has been used in several countries, without any clear evidence. This study aimed to determine the effectiveness and safety of hydroxychloroquine as compared to hydroxychloroquine and azithromycin combination in patients with COVID-19 pneumonia. MATERIALS AND METHODS: This retrospective study evaluated all patients admitted to two university hospitals between 18 March and 20 May 2020 with the diagnosis of COVID-19 pneumonia. Out of 496 patients, 370 met the eligibility criteria and were included in the final analysis. The primary outcome was in-hospital mortality. Secondary outcomes were time to recovery, presence of severe acute respiratory infection (SARI), the requirement for oxygen therapy, and/or mechanical ventilation, length of hospital stay, and adverse events. RESULTS: A total of 222 patients received hydroxychloroquine and 148 were treated with HCQ and azithromycin combination. The in-hospital mortality rates were similar in the two groups (10.8% vs. 6.8%, respectively, p=0.186). Additionally, the needs for oxygen therapy, invasive mechanic ventilation (IMV) and intensive care unit (ICU) admission were not different. The rate of the requirement of non-invasive mechanic ventilation (NIV) was higher in patients receiving HCQ plus azithromycin (10.1% vs. 4.5%, p=0.035). Time to recovery was 3.5 days in HCQ and 5.0 days in HCQ plus azithromycin group (p<0.001). The median length of hospital stay was longer in patients with the combination therapy (7.0 vs. 5.5 days, p<0.001). Amongst all patients, only 3 patients developed electrocardiographic changes needing discontinuation of therapy. LIMITATIONS: Observational design of the study is the main limitation. CONCLUSIONS: The present findings suggest that adding azithromycin to HCQ is not associated with any improvement in clinical outcome and mortality in patients with COVID-19 pneumonia and supports the current knowledge not to include azithromycin in the initial treatment of COVID-19.

[Pneumococcal infections and protection with vaccination in adult chronic lung diseases]. / Eriskin kronik akciger hastaliklarinda pnömokok infeksiyonu ve asi ile korunma.

Pneumococcal infections are an important cause of mortality and morbidity in Chronic Lung Diseases. However, exacerbations, which make the treatment of diseases very difficult, and corticosteroids used during treatment carry a great risk of pneumococcal infection and adversely affect the treatment. The most rational way to reduce the negative impact of pneumococcal infections on the clinical and economic burden of Chronic Lung Diseases is vaccination of the risky population. Although, vaccination recommendations are well defined, recommended by national and international guidelines and are paid by health authorities, in Turkey, vaccination rates in adults with chronic lung disease is far below the expected. Since physicians are considered to be the most important and reliable resource that can guide their patients in vaccination, applying pneumococcal vaccination routinely in all patients with chronic lung diagnosis and making it a part of daily practice will greatly contribute to reducing the clinical and economic burden of pneumococcal infections in these patients. In this review, the effects of pneumococcal diseases on chronic lung diseases, the risk and clinical burden of pneumococcal diseases in chronic lung diseases are discussed in the light of guidelines and current literature, and the importance of protection from pneumonia in these patients is emphasized. In addition to general information and efficacy data about pneumococcal vaccines available in our country, application methods and access routes to vaccines are also described.

The effects of smoking on body composition, pulmonary function, physical activity and health-related quality of life among healthy women.

INTRODUCTION: Smoking leads to more respiratory symptoms and negative effects on the health-related quality of life (HRQOL) in women than men for the same smoking burden. However, the relationship between smoking and body composition and its influencing factors remains unclear. In this study, we aim to investigate the effects of smoking on body composition, pulmonary function, physical activity and health-related quality of life (HRQOL) among healthy women. MATERIALS AND METHODS: A total of 73 young healthy women, current cigarette smokers and who had never smoked were included. The level of physical activity was assessed using the International Physical Activity Questionnaire; body mass index, circumference measurements, waist-to-hip ratio, skinfold measurements and body fat percentage were used to determine the body composition; HRQOL was assessed through the World Health Organization Quality of Life Instrument; level of depression and anxiety were evaluated using the Hospital Anxiety and Depression Scale; pulmonary functions were evaluated with spirometry. RESULT: We found higher incidence of respiratory symptoms and lower physical activity levels in smokers than those of non-smokers (p< 0.05). There was no significant difference between smokers and non-smokers in respect of HRQOL, depression and anxiety (p> 0.05). In smokers whom cigarette consumption more than 150 p-years, we observed positive correlations between cigarette consumption and arm circumference, waist circumference, waist-to-hip ratio (p< 0.05). CONCLUSIONS: Our results show that the smoking causes an increase in the incidence of respiratory symptoms and reduces the level of physical activity in healthy women. Additionally it leads to abdominal obesity depending on cigarette consumption.

Antibiotic treatment outcomes in community-acquired pneumonia

Background/aim: The optimal empiric antibiotic regimen for patients with community-acquired pneumonia (CAP) remains unclear. This study aimed to evaluate the clinical cure rate, mortality, and length of stay among patients hospitalized with community- acquired pneumonia in nonintensive care unit (ICU) wards and treated with a ß-lactam, ß-lactam and macrolide combination, or a fluoroquinolone. Materials and methods: This prospective cohort study was performed using standardized web-based database sheets from January 2009 to September 2013 in nine tertiary care hospitals in Turkey. Results: Six hundred and twenty-one consecutive patients were enrolled. A pathogen was identified in 78 (12.6%) patients. The most frequently isolated bacteria were S. pneumoniae (21.8%) and P. aeruginosa (19.2%). The clinical cure rate and length of stay were not different among patients treated with ß-lactam, ß-lactam and macrolide combination, and fluoroquinolone. Forty-seven patients (9.2%) died during the hospitalization period. There was no difference in survival among the three treatment groups. Conclusion: In patients admitted to non-ICU hospital wards for CAP, there was no difference in clinical outcomes between ß-lactam, ß-lactam and macrolide combination, and fluoroquinolone regimens.

Determinants and characteristics of tuberculosis in liver transplant recipients

Background/aim: Solid organ transplant (SOT) recipients have increased risk of tuberculosis (TB). We aimed to investigate the prevalence and features of TB in liver transplant (LT) recipients at our transplantation canter. Materials and methods: All patients who underwent LT between January 2004 and December 2013 and whose data were accessible were included in the study. Demographic features, tuberculin skin test (TST) results, and TB prevalence were recorded. Characteristics of LT recipients who developed TB were evaluated. Results: A total of 403 patients underwent LT during this period. Mean age was 47.27 ± 11.04 years; 280 (69.47%) were males. The TST was administered to 108 (25.91%) and the QuantiFERON-TB test to 1 patient. TST positivity was determined in 28 (25.93%). Latent TB infection (LTBI) treatment was not recommended to any of the LT candidates. In the posttransplant period, 5 patients (1.24%) developed TB over a median duration of 14 (min: 7, max: 84) months, 2 of whom were found to have had LTBI in the pretransplant period. Conclusion: The prevalence of TB in LT recipients at our center was similar to that in the current literature. LTBI screening, including risk factor assessment and TST/QuantiFERON-TB testing, is necessary in the early diagnostic workup for TB in LT recipients.

Clinical characteristics and outcome of healthcare associated pneumonia in Turkey.

INTRODUCTION: Pneumonia in cases with preceding hospitalization, hemodialysis, intravenous therapy, wound care, or chemotherapy within the prior 30 days and residence in nursing homes are defined as healthcare associated pneumonia (HCAP). The aim of this study was to compare the demographic and laboratory data, isolated causative agents and prognosis of patients with community-acquired pneumonia (CAP) and HCAP in a large population in Turkey. MATERIALS AND METHODS: The data of 785 cases (average age 65.3 ± 16.4, 530 male) registered to Turkish Thoracic Society Respiratory Infections Study Group CAP database (TURCAP) were examined. The demographic data, clinical history, pneumonia severity scores (PSI), laboratory and radiologic findings of the CAP and HCAP patients were compared. RESULT: Out of 785 cases, 207 (26.4%) were diagnosed with HCAP and 578 (73.6%) with CAP. Among HCAP cases, 140/207 (67.6%) had preceding hospitalization in the last 90 days, 28/207 (13.5%) were on a hemodialysis program during the previous 30 days and 22/207 (10.6%) were staying in nursing homes. Patients with HCAP more frequently had comorbidities (93.2% vs. 81.6%; p= 0.001) and higher PSI scores (103.9 ± 37.2 vs. 94.6 ± 35.4; p= 0.002) compared to patients with CAP. A causative microorganism was isolated in only 12.1% (70/578) of CAP and 14.5% (30/207) of HCAP patients. The length of stay in hospital was higher in HCAP than CAP (8.6 ± 5.5 vs. 7.5 ± 6.1 days, p= 0.03); however the rates of treatment failure, intensive care unit admission and mortality were similar. CONCLUSIONS: In comparison to CAP, HCAP patients tend to have more severe disease, despite have no difference in mortality. The current criteria for HCAP do not predict worse clinical outcomes. Further work is required to define local risk factors for multidrug-resistant pathogens.

[Comparison of the combination and quinolone therapy in community acquired pneumonia]. / Toplumda gelisen pnömonidekombinasyon ve kinolon tedavisininkarsilastirilmasi.

INTRODUCTION: Objective of this study is to compare the difference between the length of hospitalisation, cost of treatment and treatment outcome of patients diagnosed with community acquired pneumonia and treated with beta-lactam-macrolide combination or fluoroquinolone monotherapy, according to 2009 Turkish Thoracic Society (TTS) Guide of Diagnosis and Treatment of Community Acquired Pneumonia in Adults (TTSCAPG). PATIENTS AND METHODS: Patients diagnosed with community-acquired pneumonia (CAP) between November 2010 and November 2011 in our hospital were included. The data was entered into TTS pneumonia database. Cases were examined for their accordance with TTSCAPG. Clinical outcomes of the patients treated with beta-lactam-macrolide combination or fluoroquinolone, were compared. RESULTS: One hundred and fifty six patients diagnosed with community-acquired pneumonia were included. 67.3% of the patients were treated according to the guideline. Of the patients treated in accordance with the guideline, 86.7% were treated with beta-lactam-macrolide combination and 13.3% with fluoroquinolone. Of the patients treated with combination therapy, the treatment was effective in 77.7%, ineffective in 11.8% and 10.6% resulted in death; where as the patients treated with fluoroquinolone, the treatment was effective in 84.7%, ineffective in 15.4%, none of them resulted in death. CONCLUSION: Cases diagnosed with community-acquired pneumonia and treated according to the TTSCAPG guideline were evaluated for effectiveness of combination therapy versus fluoroquinolone; no statistically difference in terms of age, diseases, length of stay, treatment outcomes, cost of treatment could be established. There was only a numerical difference between mortality outcomes of the two antibiotherapy groups compared, however the statistical difference was not significant.

[The frequency of performing smoking cessation outpatient clinic in chest disease specialists who are members of Turkish Thoracic Society and factors affecting this performance]. / Türk Toraks Dernegi üyesi olan gögüs hastaliklari hekimleri arasinda sigara birakma poliklinigi yapilma sikligi ve iliskili faktörler.

INTRODUCTION: Although helping patients to stop smoking is a good clinical practice that has to be carried out by physicians everywhere and in every area, it is known that carrying out this help systematically in accordance to a programme in smoking cessation outpatient clinics significantly improves the chance of success. MATERIALS AND METHODS: The study is a cross-sectional survey performed among chest disease specialists who are members of Turkish Thoracic Society (TTS), between June 2010 and February 2011. As independent variables relevant to status of performing/not performing Smoking Cessation Outpatient Clinic (SCOC); sex, age (younger or older than 40), being graduated before or after 1996, being or not being in a consultant position, work place (Hospital of Ministry of Health/private hospital/university hospital), having or not having an education for smoking cessation help and being or not being member of a City Tobacco Control Committee (CTCC) were investigated. Data was collected via a web-questionnaire prepared by using WHO Global Health Professionals Questionnaire which was sent to members through TTS secreteriat. RESULTS: 41% (699/1701) of members of TTS responded. 39.5% of responders reported that they perform SCOC. When the factors possibly affecting the performance of SCOC are evaluated with logistic regression analysis; being graduated after 1996, having an education for smoking cessation help, being a member of CTCC and not being an active smoker are found to improve this performance. CONCLUSION: Our study showed that having an education for smoking cessation help (and tobacco control) makes chest disease specialists get more responsibility on this topic. Accordingly, continuous efforts for improving awareness of personal and social responsibilities of all physicians, especially chest disease specialists, have to be made to provide their taking active roles in tobacco control.

[Smoking related behaviours in Izmir]. / Izmir halkinin tütün kullanma özelliklerinin belirlenmesi.

INTRODUCTION: The aim of the study is to determine the people's smoking related behaviours, using tobacco products except cigarette and characteristics about second hand smoke in Izmir. MATERIALS AND METHODS: Questionnaire including 47 questions was performed to 600 people, who were selected by Turkey Statistics Instutition to present population of Izmir. RESULTS: 53.7% of participants were female and 46.3% was male; the mean age was 41.5 ± 15.6. 232 (39%) were smoking, 257 (42%) never smoked and 111 (19%) quited smoking. The average age for a new smoker is 18.7 ± 6.6; men start smoking earlier than women statistically (p= 0.0001). 10.7% of participants were using tobacco products except cigarette. The smoke cessation percentage of women was statistically significantly higher than men(p= 0.006). 70.7% of active smokers were thinking about quitting. CONCLUSION: The frequency of smoking was higher than Turkey's avarage in Izmir. The mean age of starting smoking was below 18. There must be extra effort for preventing women and under 18 age who are the targets of tobacco industry from smoking. Use of tobacco products except cigarette, especially water pipe may be an emerging problem for men, high education level and under age of 35 population. Although most of the participants know about their rights of protection from smoke and the harms of second hand smoke, it is worrying to see that children have to face second hand smoke in special ownerships. Most of the smokers think to quit smoking and use medical methods for quitting. The people who think about quitting should be guided to smoking cessation clinics; by this way, the more we use scientific methods for quitting, the more we get high quit rates of smoking.

[The changes in smoking related behaviours and second hand smoke after the smoking ban in Izmir]. / 4207 sayili yasanin yürürlüge girmesinden sonra sigara içme davranislari ve pasif maruziyet ile ilgili degisikliklerin saptanmasi

INTRODUCTION: The aim of the study is to determine the views about law, change of second hand smoke (SHS) quantity, people's smoking related behaviours after the publishment of law which prohibits use of tobacco products in closed public areas. MATERIALS AND METHODS: Questionnaire including 47 questions was performed to 600 people, who were selected by Turkey Statistics Instutition to present population of Izmir. RESULTS: 53.7% of participants were female and 46.3% was male; the mean age was 41.5 ± 15.6. 98% of all participants were aware of the law and 91.5% of them were supporting it. 42% of participants who succeeded in quitting had managed it after the ban. Restriction of areas, rise of prices and effects of SHS were the most popular reasons of reducing/quitting smoking after the law. Non-smokers were exposed to SHS at homes; 35.1%, at vehicles: 14.9%, at work places: 14.4%. The number of smoking cigarettes was reduced by 3.19 cigarettes/day. The rate of violation of the ban was 32.3%; only 21.3% of violators were warned. 96.4% of law supporters found law successful and sufficient. CONCLUSION: A big amount of participants thinks about quitting in Izmir; law is thought to have important effect on this decision. SHS has reduced mostly in public areas with ban, but law must be enlarged to prevent SHS at private areas such as houses, vehicles and workplaces. As a result; the ban encouraged smokers to quit and reduced SHS at public areas. We believe that paying more attention for law sanction and extending the borders of law and reviewing the ban, will make our country more smoke free from now.

Effectiveness of a Program to Raise Awareness About Pneumococcal Vaccination Among Physicians and Patients with Chronic Respiratory Diseases: A Multicenter Cohort Study.

OBJECTIVE: There is a need to increase patient and clinician awareness on the effectiveness of pneumococcal vaccination in at-risk groups. The aim of the study was to evaluate the effect of reminders for physicians and patients using the vaccination tracking system created in the hospital information management system (HIMS) on the vaccination rate, and the effect of pneumococcal vaccination on pneumonia-related hospitalization and mortality over a 12-month period. MATERIAL AND METHODS: This prospective observational cohort study was undertaken during a 2-year period in 3 tertiary care centers. Patients were followed up for 12 months following vaccination, and hospital admissions and mortality were recorded via HIMS. During the campaign, HIMS transmitted pneumococcal immunization reminder messages in accordance with guideline recommendations to physicians' computers and patients' mobile phones. Educational posters on pneumococcal vaccination were posted in outpatient clinics. Regular seminars on the evidence for pneumococcal vaccination were organized. All patients who were hospitalized during the follow-up period for chronic obstructive pulmonary disease (COPD), asthma, lung cancer, or pneumonia were analyzed in relation to their vaccination history regarding clinical outcomes. RESULTS: A total of 29530 patients were included in the study. During the study period, the annual vaccination rate increased by 74.4% and reached 4.8% in 3 hospitals (P = .001). The rates were 3.9% in patients older than 65 years without comorbidities and 5.2% in those with COPD and asthma (P = .002). In pneumococcal vaccine recipients, pneumonia-related hospital mortality was lower (relative risk (RR) = 0.19, CI 0.09-0.35, P < .001). CONCLUSION: It is possible to raise the rate of pneumococcal vaccination through awareness campaigns. Individuals with COPD and asthma are more willing to receive pneumococcal vaccination. Among patients hospitalized for pneumonia, prior pneumococcal vaccination is associated with lower mortalit.

Comparison of two scores for short-term outcomes in patients with COPD exacerbation in the emergency department: the Ottawa COPD Risk Scale and the DECAF score.

Background: While clinical decision rules have been developed to evaluate exacerbations and decisions on hospitalisation and discharge in emergency departments (EDs) in patients with chronic obstructive pulmonary disease (COPD), these rules are not widely used in EDs. In this study, we compare the predictive efficacy of the Ottawa Chronic Obstructive Pulmonary Disease Risk Scale (OCRS) and the Dyspnea, Eosinopenia, Consolidation, Acidemia, and Atrial Fibrillation (DECAF) score in estimating the short-term poor outcome of patients in our ED with exacerbations of COPD. Methods: This single-centre prospective observational study was conducted over 6 months. Patients with acute exacerbations of COPD admitted to the ED during the study period were included in the study. A poor outcome was defined as any of the following: readmission and requiring hospitalisation within 14 days of discharge, requiring mechanical ventilation on the first admission, hospitalisation for longer than 14 days on the first admission, or death within 30 days. The sensitivity and specificity of the OCRS and the DECAF score for a poor outcome and for mortality were calculated. Results: Of the 385 patients who participated in the study, 85 were excluded based on the exclusion criteria. 66% of the patients were male, and the mean age was 70.15±10.36 years. A total of 20.7% of all patients (n=62) experienced poor outcomes. The sensitivity of an OCRS score <1 for predicting a poor outcome in patients was 96.8% (95% CI 88.8-99.6%) and the specificity was 18.5% (95% CI 13.8-24.0%). The sensitivity and specificity of an OCRS score <2 were 83.3% (95% CI 35.9-99.6%) and 65.5% (95% CI 59.6-70.7%), respectively. The sensitivity and specificity of a DECAF score <1 were 88.7% (95% CI 78.1-95.3%) and 34.5% (95% CI 28.4-40.9%), respectively. When the DECAF score was <2, sensitivity and specificity were 69.3% (95% CI 56.4-80.4%) and 74.8% (95% CI 68.8-80.2%), respectively. Conclusion: Our physicians achieved high specificity but low sensitivity in predicting a poor outcome. The OCRS is the more sensitive of the two tools, while the DECAF score is more specific in predicting a poor outcome when all threshold values are evaluated. While both tools may results in unnecessary hospitalisation, they can reduce the incidence of hospital discharge of patients with exacerbations of COPD who will develop poor outcomes in the ED.

Does Pneumococcal Vaccination Have an Effect on Hospital Costs?

OBJECTIVE: It is known that inpatient hospital costs are much higher than outpatient services. It was aimed to investigate the effect of pneumococcal vaccination on hospitalizations. MATERIAL AND METHODS: The direct hospitalization costs, length of stay, and factors of the vaccinated and unvaccinated patients in the same hospital during the 12-month follow-up of the patients who received pneumococcal vaccine between November 15, 2018, and November 15, 2020, in 3 chest diseases and thoracic surgery training and research hospitals were analyzed by obtaining Hospital Information Management System records. Data were collected with Statistical Package for the Social Sciences version 23 program (IBM Corp.; Armonk, NY, USA) , and statistical evaluation was made. RESULTS: The mean age of 800 hospitalized patients, of whom 400 were unvaccinated and 400 were vaccinated, was 68.48 ± 11.97. There was no significant difference in the mean age of vaccinated and unvaccinated patients (P > .05). Five hundred sixty-six patients (70.8%) were aged 65 and over. Two hundred eighty (51.2%) of men were vaccinated and 120 (47.2%) of women were vaccinated, and there was no significant difference (P > .05). The mean hospital stay of these patients was 11.01 days, and those in the vaccinated group had an average mean hospital stay of 9.11 days and those in the unvaccinated group had a mean hospital stay less than 12.91 days (P < .001). Total 1-year hospitalization costs were $501.653.53 and the cost per person was calculated as $627.07. The cost per capita for the vaccinated group was $550.52, which was lower than the average cost of the unvaccinated group ($703.62) (P < .05). When comparing the status of being vaccinated, comorbidity, mortality, mean length of stay, chronic obstructive pulmonary disease, and heart disease were found to be statistically significant (P < .05). CONCLUSION: In our study, it was revealed that vaccination of patients hospitalized in chest disease hospitals with the pneumococcal vaccine reduced the average length of hospital stay by 41.7% and the cost of hospitalization by 27.8%.

Smoking Cessation Success and Affecting Factors in Geriatric Patients.

Background: There are difficulties in the treatment of smoking cessation in elderly patients. However, elderly smokers who gave up smoking had lower rates of death from heart attack, stroke, and cancer, as well as improved cognitive function. This study aimed to investigate the affecting factors and the success of smoking cessation rate in patients aged 60 and over in Turkey. Methods: Six smoking cessation outpatient clinics from four provinces were included in the study. The records of 1,065 patients who applied to a smoking cessation outpatient clinic between 2016 and 2019 and who were 60 yr of age or older were scanned. Overall, 917 cases that could be reached after treatment were included in the study. Smoking cessation rates at the first month, 3rd month, 6th month, 9th month and 12th month were given. Results: Of the 917 cases, 65.1% were male and 34.9% were female. Smoking cessation rates were 45.6% on the first month, 39% on the third month, 35.1% on the sixth month, 31.2% on the ninth month, and 30.3% at the twelfth month. Smoking cessation success was higher in men than in women. Conclusion: Since the success of smoking cessation in the elderly was similar to that of adults. Since smoking is an independent risk factor for death in the elderly, there should be greater willingness to provide elderly patients with smoking cessation treatment to reduce physical function loss and promote healthier aging.

The presence of symptoms within 6 months after COVID-19: a single-center longitudinal study.

BACKGROUND: Characterizing the post-COVID health conditions is helpful to direct patients to appropriate healthcare. AIMS: To describe the presence of symptoms in COVID-19 patients within 6 months after diagnosis and to investigate the associated factors in terms of reporting symptoms. METHODS: Data of DEU-COVIMER (a telephone interview-based COVID-19 follow-up center established in a tertiary care hospital) was analyzed for SARS-CoV-2 RNA positive participants aged ≥ 18 years from November 1st, 2020, to May 31st, 2021. Symptom frequencies were stratified by demographic and clinical characteristics at one, three, and 6 months after diagnosis. With the patients who had symptoms at baseline, generalized estimating equations were applied to identify the factors associated with reporting of symptoms. RESULTS: A total of 5610 patients agreed to participate in the study. Symptom frequency was 37.2%, 21.8%, and 18.2% for the first, third, and sixth months. Tiredness/fatigue, muscle or body aches, and dyspnea/difficulty breathing were the most common symptoms in all time frames. In multivariate analysis, older age, female gender (odds ratio OR 1.74, 95% confidence interval 1.57-1.93), bad economic status (OR 1.37, 1.14-1.65), current smoking (OR 1.15, 1.02-1.29), being fully vaccinated before COVID-19 (OR 0.53, 0.40-0.72), having more health conditions (≥ 3 conditions, OR 1.78, 1.33-2.37), having more symptoms (> 5 symptoms, OR 2.47, 2.19-2.78), and hospitalization (intensive care unit, OR 2.18, 1.51-3.14) were associated with reporting of symptoms. CONCLUSIONS: This study identifies risk factors for patients who experience post-COVID-19 symptoms. Healthcare providers should appropriately allocate resources prioritizing the patients who would benefit from post-COVID rehabilitation.

Clinical Predictors of Response to Tocilizumab: A Retrospective Multicenter Study.

OBJECTIVE: A substantial number of patients with coronavirus disease-2019 (COVID-19) demonstrate severe infection. Cytokine storm is an underlying condition that worsens clinical outcomes. As an interleukin-6 receptor antagonist, tocilizumab is a promising treatment option for COVID-19. This study aimed to evaluate the clinical predictors of mortality for critically ill COVID-19 patients receiving tocilizumab therapy. MATERIAL AND METHODS: The retrospective cohort study was conducted in 4 centers' both wards and intensive care units between March 20 and May 20, 2020. Demographic, clinical, and laboratory data were consecutively drawn from medical records. The primary endpoint was in-hospital mortality. RESULTS: In this study, 39 patients (28.2% female) were included, and the mortality rate was 25.6% (n = 10). There was statistically significant difference between survivor and non-survivor groups regarding age (53.0 (46.5-65.0) vs. 75.0 (68.25-81.25), respectively,P = .001), CALL score (8.0 (7.0-10.0) vs. 12.0 (9.75-13.0), P = .001), GRAM score (119.5 (99.5-142.0) vs. 155.0 (129.8-226.0), P = .004), and white blood cell count (k/mL) (5.6 (3.8-8.6) vs. 8.0 (7.6-9.3), P = .003). The patients who were on invasive mechanical ventilation at the time of tocilizumab administration had a higher mortality rate (100% vs. 25.9%, P < .001). Besides, arterial partial pressure of oxygen/ fraction of inspiratory oxygen (PaO2/FiO2) ratio on day 7, but not on days 0, 1, and 3 of tocilizumab therapy, was associated with mortal- ity. C-reactive protein (mg/dL) tended to be lower in the survivor group; however, it was not statistically significant (68.4 (32.7-157.5) vs. 113.5 (77.7-219.0), P = .058). CONCLUSION: This study demonstrated that advanced age, increased leukocyte count, higher CALL and GRAM scores, and the need for invasive mechanical ventilation revealed a worse prognosis after tocilizumab treatment.

Turkish Thoracic Society's Statement Report on Electronic Cigarettes and Heated Tobacco Products.

Tobacco addiction, which causes the death of more than 8.5 million people in the world every year, is a preventable global public health problem. There are 1.1 billion adult smokers worldwide and 60% of them desire or intend to quit but unfortunately, the tobacco industry continues to profit at the expense of people's lives by marketing electronic cigarettes and heated tobacco products as a smoking cessation method and they continue to poison young people with new threat tobacco products, promising a "smoke-free future" Turkish Thoracic Society is actively involved in the implementation of the National Tobacco Control Program to protect public health and has warned and raised awareness of new threats to the youth, such as electronic cigarettes and heated tobacco products. The purpose of this report is to provide information about electronic cigarettes and heated tobacco products and to present TTJ's position on the subject.

Prevalence of Gastrointestinal Symptoms and Clinical Outcomes in Hospitalized Coronavirus Disease 2019 Patients: A Single-Center Study from Turkey.

BACKGROUND: In patients with coronavirus disease 2019, the gastrointestinal symptoms have been reported increasingly in addition to the respiratory system symptoms. The studies show that the prevalence of gastrointestinal system symptoms and how the gastrointestinal system contributes to the severity and prognosis of the disease is still not clear. This study aims to find the prevalence of gastrointestinal symptoms and the correlation between the gastrointestinal symptoms and the clinical results in hospitalized patients diagnosed with coronavirus disease 2019. METHODS: This study retrospectively analyzes patients diagnosed with coronavirus disease 2019 and hospitalized in the pandemic unit between March 2020 and August 2020 and compares their demographic and clinical characteristics, laboratory and radiologic findings, coronavirus disease 2019 treatments received, the clinical course of the disease, and the gastrointestinal symptoms. RESULTS: In our study, we included 322 patients diagnosed with coronavirus disease 2019 and hospitalized; 39 patients (12.1%) were admitted to the hospital with at least one gastrointestinal symptom (nausea and vomiting, diarrhea, abdominal pain, and the loss of taste). Nausea and vomiting are the most common gastrointestinal symptoms with a prevalence of 7.1%, followed by diarrhea with 2.8%, the loss of taste with 2.2%, and abdominal pain with 1.5%. The mean age and D-dimer levels of the patients showing gastrointestinal symptoms were lower than those who did not have any gastrointestinal symptoms. We did not find a significant correlation between the presence of the gastrointestinal symptoms and the severity of the disease, treatment received, risk of acute respiratory distress syndrome and septic shock, admission to the intensive care unit, the need for mechanical ventilation, the mortality rate or the length of hospitalization in the medical floor or the intensive care unit. CONCLUSION: In this study, we observed that 12.1% of coronavirus disease 2019 patients apply to the hospital due to gastrointestinal symptoms. Furthermore, the gastrointestinal symptoms do not seem to affect the severity and the course of the disease, it is important to identify coronavirus disease 2019 patients showing unusual symptoms such as the gastrointestinal symptoms at an early stage to protect healthcare professionals from infection risk.