Can a modified-simplified pulmonary embolism severity index (m-sPESI) be used to predict the need for intensive care in hospitalized COVID-19 patients?

Severe acute respiratory syndrome-associated coronavirus-2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), which has been considered a pandemic by the World Health Organization (WHO). Clinical manifestations of COVID-19 disease may differ, most cases are mild, but a significant minority of patients may develop moderate to severe respiratory symptoms, with the most severe cases requiring intensive care and/or mechanical ventilatory support. In this study, we aimed to identify validity of our modified scoring system for foreseeing the approach to the COVID-19 patient and the disease, the treatment plan, the severity of morbidity and even the risk of mortality from the clinician's point of view. In this single center study, we examined the patients hospitalized with the diagnosis of COVID-19 between 01/04/2020 and 01/06/2020, of the 228 patients who were between 20 and 90 years of age, and whose polymerase chain reaction (PCR) tests of nasal and pharyngeal swab samples were positive. We evaulated 228 (92 male and 136 female) PCR (+) patients. Univariate analysis showed that advanced age (p < 0.001), hemoglobin (p < 0.001), troponin-I (p < 0.001), C-reactive protein (CRP) (p < 0.001), fibrinogen (p < 0.001), HT (p = 0.01), CAD (p = 0.001), DM (p < 0.001), history of malignancy (p = 0.008), along with m-sPESI scores (p < 0.001) were significantly higher in patients that needed intensive care due to COVID-19 infection. In the multivariable logistic regression analysis, only the m-sPESI score higher than ≥ 2 was found to be highly significant in terms of indicating the need for ICU admission (AUC 0.948; 84.6% sensitivity and 94.6% specificity) (p < 0.001). With an increasing number of hospitalized patients, healthcare providers are confronting a deluge of lab results in the process of caring for COVID-19 patients. It is imperative to identify risk factors for mortality and morbidity development. The modified sPESI scoring system, which we put forward, is successful in predicting the course of the disease at the presentation of the patient with COVID-19 disease and predicting the need for intensive care with high specificity and sensitivity, can detect the need for intensive care with high specificity and sensitivity.

Investigation of the effect of kinesiotaping on the respiratory function and depression in male patients with chronic obstructive pulmonary disease: a prospective, randomized, controlled, and single-blind study.

OBJECTIVES: We aimed to investigate the effect of kinesiotaping (KT) on the respiratory parameters as measured by spirometry and depression in the chronic obstructive pulmonary disease (COPD) patients. METHODS: In this prospective, randomized, controlled, single-blind study 42 male patients with COPD diagnosis were randomized into two groups. In Group1 (n = 21) routine COPD medical treatment plus kinesiotaping and in Group2 (n = 21) only routine COPD medical treatment was given. KT was changed on every fifth day (for a total of three times and 15 days). The patients were assessed using Visual Analog Scale (VAS) for difficulty experienced by the patients during respiration, respiratory function test (RFT), modified medical research council (mMRC) dyspnea scale and beck depression inventory (BDI). The data were obtained before treatment and posttreatment. RESULTS: In Group 1; statistically significant improvement was found in all parameters except for FVC and FVC % following treatment compared to pretreatment values. Comparison of the difference scores (the amount of recovery between posttreatment and pretreatment) of the two groups showed significantly superior improvement in Group1 for all parameters except for FVC, FVC % and FEV1% following the treatment (p < .05). CONCLUSIONS: The results of this study showed that supplementary kinesiotaping improved respiratory function and depression significantly compared to only routine medical treatment in COPD patients who were in stable condition.

The relationship between health literacy and disease specific costs in subjects with chronic obstructive pulmonary disease (COPD).

AIM: In the present study, we aimed to investigate the relationship between health literacy levels and disease specific costs in subjects with chronic obstructive pulmonary disease (COPD) who were staged according to GOLD. METHODS: This was a descriptive study. The Health Literacy Scale of the European Union was filled out by all of the participants. Costs related to COPD were taken into account. RESULTS: Compared to health literacy, the total cost of health care and the cost of admission to the emergency room seemed to be higher for subjects with inadequate health literacy levels than for subjects with significant levels of illness (p = .05 and p = .006, respectively). As the number of comorbidities increased, total and emergency department admission costs increased (p < .001 and p = .003, respectively). There was a difference between GOLD stages according to total, pulmonary disease and emergency service costs. CONCLUSIONS: In this study, it was determined that health literacy is an important factor affecting health expenditures with COPD subjects. With the improvement of health literacy, subjects are expected to reduce the overall cost burden of the disease.

Does occupational air pollution threaten the lung health of indoor workers more than those of bus drivers?: a cross-sectional study.

AIM: This study aimed to evaluate the lung health between professional bus drivers and white collar workers in metropolis municipality from Turkey. MATERIAL AND METHODS: Out of 126 bus drivers and 1100 office employees, data were analyzed from 243 indoor employees and 57 bus drivers. Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC, forced expiratory flow (FEF) 25-75% were measured, some data were collected with a questionnaire (work and environmental anamnesis, symptoms, smoking). RESULTS: The mean (±SD) values for FVC, FVC percent predicted value, FEV1, FEV1 percent predicted value, FEV1/FVC were 4.33 ± 0.99L, 96.5 ± 18.2%, 3.31 ± 0.87L, 84.5 ± 18.2%, 76.30 ± 9.23%, respectively. Sixty-six participants (22%) had FEV1/FVC proportions of less than 70%. After weighing for the propensity scores, there was a significant difference between bus drivers and indoor workers concerning FEV1/FVC grouping; while 65 (26.1%) indoor workers had FEV1/FVC proportions less than 70%, there were only two (3.9%) bus drivers (Chi-Square = 12.009, p = .001). The mean spirometry values were significantly different between the two groups in favor of the bus drivers (p < .05). Night cough was much more seen in the indoor workers (Chi-Square test = 9.019, p = .003). CONCLUSION: We conclude that there are no health risks associated with bus driving in a metropolitan city, concerning lung functions.

The relationship of thiol/disulfide homeostasis in the etiology of patients with obstructive sleep apnea: a case-control study.

AIM: Obstructive sleep apnea syndrome (OSAS) is a chronic and incapacitating disease that often requires lifelong care. This study aimed to evaluate the thiol/disulfide homeostasis in patients with OSAS, to compare the thiol/disulfide levels with the control group and to investigate their relationship with the severity of the disease. MATERIAL AND METHODS: Patients who were admitted to the department of chest diseases, and diagnosed with OSAS using polysomnographic analysis (n = 186) and 144 patients who underwent polysomnography due to some reasons but ruled out of having OSAS were included in the study. Serum total thiol (TT), native thiol (SH), and disulfide thiol (SS) levels were measured from the participants; SS/SH, SS/TT, and SH/TT percent ratios were calculated and compared between the patient and control groups. RESULTS: The mean (±SD) age of the patients and control participants was 52.0 ± 11.5 years and 44.9 ± 13.2 years, respectively. Compared to the control group, patients with OSAS had significantly lower SH (239.3 ± 56.3 µmol/L vs. 258.6 ± 65.3µmol/L, t = 2.70, p =.007) and TT levels (273.2 ± 60.1 µmol/L vs. 292.9 ± 67.5µmol/L, t = 2.64, p=.010). Age (OR = 1.04), serum albumin (OR = 12.67), ischemia-modified albumin (IMA) (OR = 0.12), SH (OR = 0.81), and TT (OR = 1.17) were independent predictors of OSAS. CONCLUSIONS: These results support the idea that decreased ST and TT levels are related to increased oxidative stress. On the other hand, impaired thiol balance may play a significant role in the pathogenesis of OSAS.

Fibulins: a new biomarker for pulmonary thromboembolism?

OBJECTIVES: Fibulin-1, -2, -4, and -5 have important role in several vascular diseases. We aimed to investigate if fibulin-4 and -5 can be used as a biomarker for pulmonary thromboembolism (PTE). METHODS: This is a prospective case control study. Thirthy patients diagnosed with PTE and 31 in the control group. Data on demographic characteristics, length of hospital stay, blood cell counts, troponin and BNP levels, arterial blood gases, radiological reports, indication for thromboembolitic treatment, intensive care unit (ICU) requirement, and loss of life were recorded for the patients group. Serum Fibulin-4 and Fibulin-5 levels were measured. RESULTS: Fibulin 4 levels correlated positively with female gender (p < .01, r = 0.433). Positive results were found in 14 (46.7%) patients for PESI.0.1; in 7 (23.3%) patients for D-dimer; in 7 (23.3%) patients for troponin-I; in 7(23.3%) patients for BNP. Median values for Fibulin 4 level were significantly higher in patients positive for BNP. Fibulin-5 level was found to be correlated with the presence of embolism (p = .041, r = 0.263). CONCLUSIONS: Fibulin-4 and -5 have been shown to be relevant to cardiovascular biology and diseases. Experimental studies and observations in humans show that they may play a role in several cardiovascular diseases particularly pulmonary embolism.

[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.

How Does Smoking Cessation Affect Disease Activity, Function Loss, and Quality of Life in Smokers With Ankylosing Spondylitis?

BACKGROUND: Ankylosing spondylitis (AS) is a chronic systemic inflammatory disease that can progressively restrict spinal mobility. OBJECTIVE: This study aimed to investigate how smoking cessation by AS patients affects disease activity and their psychological state, physical mobility, lung function, and quality of life. MATERIALS AND METHODS: This was a longitudinal, single-blind, controlled, and observational study on 92 AS patients. Pulmonary function test, Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Metrology Index, chest expansion, Short-Form 36, and Ankylosing Spondylitis Quality of Life were evaluated. The patients were divided into smokers (group 1 = 54) and nonsmokers (group 2 = 38). The smokers were divided further into subgroups of those who quit smoking (group 1a = 17) and those who did not (group 1b = 37). Groups 1a and 1b patients were compared in terms of their baseline data and data 6 months after smoking cessation. In addition, group 1a patients' baseline data and data 6 months after smoking cessation were compared statistically. RESULTS: There was no statistically significant difference between groups 1a and 1b after 6 months in terms of the evaluated parameters, except for BASDAI. Bath Ankylosing Spondylitis Disease Activity Index was significantly lower in group 1a than group 1b (p = 0.02), indicating that. When the baseline data and data after 6 months of group 1a were compared, a significant improvement was found in BASDAI (p = 0.001), Bath Ankylosing Spondylitis Functional Index (p = 0.001), chest expansion (p = 0.001), ankylosing spondylitis quality of life (p = 0.003), and subparameters physical function (p = 0.015), physical role strength (p = 0.05), power/live/vitality (p = 0.025), social functioning (p = 0.039), pain (p = 0.036), and general health perception (p = 0.05) of Short-Form 36, as well as forced expiratory volume in the first second (p = 0.003) and forced vital capacity (p = 0.007). CONCLUSIONS: We observed significant improvements in disease activity, physical mobility, and quality of life in AS patients who quit smoking.

Can we predict patients that will not benefit from invasive mechanical ventilation? A novel scoring system in intensive care: the IMV Mortality Prediction Score (IMPRES)

Background/aim: The present study aimed to define the clinical and laboratory criteria for predicting patients that will not benefit from invasive mechanical ventilation (IMV) treatment and determine the prediction of mortality and prognosis of these critical ill patients. Materials and methods: The study was designed as an observational, multicenter, prospective, and cross-sectional clinical study. It was conducted by 75 researchers at 41 centers in intensive care units (ICUs) located in various geographical areas of Turkey. It included a total of 1463 ICU patients who were receiving invasive mechanical ventilation (IMV) treatment. A total of 158 parameters were examined via logistic regression analysis to identify independent risk factors for mortality; using these data, the IMV Mortality Prediction Score (IMPRES) scoring system was developed. Results: The following cut-off scores were used to indicate mortality risk: <2, low risk; 2­5, moderate risk; 5.1­8, high risk; >8, very high risk. There was a 26.8% mortality rate among the 254 patients who had a total IMPRES score of lower than 2. The mortality rate was 93.3% for patients with total IMPRES scores of greater than 8 (P < 0.001). Conclusion: The present study included a large number of patients from various geographical areas of the country who were admitted to various types of ICUs, had diverse diagnoses and comorbidities, were intubated with various indications in either urgent or elective settings, and were followed by physicians from various specialties. Therefore, our data are more general and can be applied to a broader population. This study devised a new scoring system for decision-making for critically ill patients as to whether they need to be intubated or not and presents a rapid and accurate prediction of mortality and prognosis prior to ICU admission using simple clinical data.

Pulmonary Physician Consultancy in Emergency Services in Turkiye (PuPCEST) - a cross-sectional multicenter study.

Pulmonology is one of the branches that frequently receive consultation requests from the emergency department. Pulmonology consultation (PC) is requested from almost all clinical branches due to the diagnosis and treatment of any respiratory condition, preoperative evaluation, or postoperative pulmonary problems. The aim of our study was to describe the profile of the pulmonology consultations received from emergency departments in Turkiye. A total of 32 centers from Turkiye (the PuPCEST Study Group) were included to the study. The demographic, clinical, laboratory and radiological data of the consulted cases were examined. The final result of the consultation and the justification of the consultation by the consulting pulmonologist were recorded. We identified 1712 patients, 64% of which applied to the emergency department by themselves and 41.4% were women. Eighty-five percent of the patients had a previously diagnosed disease. Dyspnea was the reason for consultation in 34.7% of the cases. The leading radiological finding was consolidation (13%). Exacerbation of preexisting lung disease was present in 39% of patients. The most commonly established diagnoses by pulmonologists were chronic obstructive pulmonary disease (19%) and pneumonia (12%). While 35% of the patients were discharged, 35% were interned into the chest diseases ward. The majority of patients were hospitalized and treated conservatively. It may be suggested that most of the applications would be evaluated in the pulmonology outpatient clinic which may result in a decrease in emergency department visits/consultations. Thus, improvements in the reorganization of the pulmonology outpatient clinics and follow-up visits may positively contribute emergency admission rates.

Effectiveness of the polyglycolic acid patch in preventing prolonged air leakage after pulmonary decortication.

AIM: This study aimed to investigate the effectiveness of an absorbable polyglycolic acid patch (PGA) in the early prevention of alveolar air leaks after pulmonary decortication operations. METHODS: Between January 2016 and December 2019, files of 185 patients with pleural effusion, empyema, or hemothorax were examined retrospectively. Thirty-five patients who underwent decortication surgery were included in the study. Two-way posteroanterior (PA) chest x-ray, computed tomography (CT), pulmonary function tests (PFT), arterial blood gas, hemogram, and biochemical tests were performed for all patients before the operation. The patients were divided into two groups. Group 1 was composed of 16 patients (45.7%) with standard decortication, and Group 2 was formed with 19 patients (54.3%) with standard decortication + PGA patch. RESULTS: The median age was 55 years (minimum = 25, maximum = 75) and the vast majority (82.9%; n = 29) of patients were males. There was no significant difference between groups in age, aetiology, or sex. The most common etiological cause in both Group 1 and Group 2 was nonspecific infection (56.3% and 73.7%, respectively). When Group 2 and Group 1 were compared regarding median times (day) of air leak cessation (Group 2 = 4; Group 1 = 8.5), chest drain removal (Group 2 = 5; Group 1 = 10), and hospital discharge times (Group 2 = 8; Group 1 = 13),the durations were statistically significantly shorter in Group 2 than in Group 1 (P < 0.001). CONCLUSION: Use of the PGA patch in pulmonary decortication operations significantly reduced the duration of air leaks, drain removal, and discharge time from the hospital in the postoperative period.

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.

The relationship between nasal mucociliary clearance time and the degree of smoking dependence in smokers with obstructive sleep apnea syndrome.

INTRODUCTION: The aim of this study was to investigate the relationship between nasal mucociliary clearance time (NMCT), degree of smoking dependence, cumulative smoking burden and OSAS severity in smokers. MATERIAL AND METHODS: 123 patients (Group 1) with OSAS and 92 healthy controls (Group 2) were included in the study. Group 1 was divided into smokers (Group 1a) and non-smokers (Group 1b). In Group 1a, cumulative smoking burden and Fagerström nicotine dependence test (FNDT) were questioned. Saccharin test was applied to Groups 1 and 2. Student-t, Mann-Whitney-U, Anova, Kruskal-Wallis tests were used to compare the means. RESULTS: NMCT was higher in Group 1 than Group 2 (p = 0.005). The duration of NMCT was higher in Group 1A than Group 1B (p = 0.002). In Group 1a, NMCT values of mild and moderate OSAS patients were longer than in Group 1b (p = 0.02, p = 0.01, respectively). NMCT values of patients with mild dependence were shorter than those with moderate or severe dependence (p = 0.032, p < 0.001, respectively). CONCLUSION: Mucociliary clearance time was higher in smokers with OSAS than non-smokers. While OSAS has a negative effect on mucociliary clearance, smoking also exacerbates the condition.

Evaluation of Syrian refugees' emergency service admissions in the western region of Turkey.

Immigration increases physical, mental, and social health problems. Emergency departments constitute resources that refugees can easily access and where they frequently present. Physicians from every specialty (chest diseases, thoracic surgery, internal diseases, etc.) may be consulted if needed. We aimed to compare demographic data and clinical characteristics of Syrian refugees and Turkish citizens in our emergency department. This study was an observational cross-sectional study. It included patients who presented to the Adult Emergency Department between April 1 and July 1, 2018. The patients were grouped into Syrian refugee and Turkish citizen groups. Patient age, gender, International Statistical Classification of Disease and Related Health Problems (ICD-10) diagnostic codes, and judicial case status were recorded from physician-patient outpatient clinic data records. Disease diagnoses and judicial cases were statistically compared between the two groups. A total of 30,749 patients presented to the emergency department during the study period. Of these, 999 were Syrian refugees. The mean ages of the Syrian refugees and Turkish citizens were significantly different. There were also differences between the two groups in the top five diagnostic codes (M79-Soft tissue disorders, J39-Other disorders of the upper respiratory tract; R51-Headache; R10-Abdominal and pelvic pain; M54-Dorsalgia). A comparison of the judicial cases also revealed a difference in mean age between the groups. Fewer specific disease diagnoses were identified among Syrian refugees. This may be explained by difficulties related to language barriers between the refugees and healthcare personnel.

The Relationship between COVID-19 Severity and Bacillus Calmette-Guérin (BCG)/ Mycobacterium tuberculosis exposure history in healthcare workers: a multi-center study.

The COVID-19 pandemic has brought countries' health services into sharp focus. It was drawn to our group's attention that healthcare workers (HCWs) had a lower mortality rate against higher COVID-19 incidence compared to the general population in Turkey. Since risk of exposure to tuberculosis bacillus among healthcare workers are higher than the population, we aimed to investigate if there is a relationship between BCG and Mycobacterium tuberculosis exposure history with COVID-19 severity in infected HCWs. This study was conducted with 465 infected HCWs from thirty-three hospitals to assess the relationship between COVID-19 severity (according to their hospitalization status and the presence of radiological pneumonia) and BCG and Mycobacterium tuberculosis exposure history. HCWs who required hospital admission had significantly higher rates of chronic diseases, radiological pneumonia, and longer working hours in the clinics. Higher rates of history of contact and care to tuberculosis patients, history of tuberculosis, and BCG vaccine were observed in hospitalized HCWs. HCWs who had radiological pneumonia had a significantly increased ratio of history of care to tuberculosis patients and a higher family history of tuberculosis. The findings from our study suggest that the lower mortality rate despite the more severe disease course seen in infected HCWs might be due to frequent exposure to tuberculosis bacillus and the mortality-reducing effects of the BCG vaccine.

The effectiveness of blood amount used in pleurodesis to prevent prolonged air leakage.

BACKGROUND: This study aims to investigate the effects of different amounts of blood used in autologous blood patch pleurodesis on clinical outcomes in patients with secondary spontaneous pneumothorax. METHODS: Between January 2015 and April 2019, a total of 42 patients (36 males, 6 females; mean age 52.1±16.0 years; range, 25 to 83 years) with SSP treated in our clinic with persistent air leakage for more than seven days were retrospectively analyzed. The patients were divided into two groups as receiving 60 mL autologous blood patch pleurodesis (Group 1, n=20) and 120 mL autologous blood patch pleurodesis (Group 2, n=22). Data including age, gender, operation side, complications, recurrence rates, time to tube withdrawal, and length of hospital stay were recorded and compared between the groups. RESULTS: The mean duration of air leakage was 3.3±2.4 (range, 1 to 11) days, the mean number of pleurodesis was 1.6±0.7 (range, 1 to 3), the mean time to tube withdrawal was 5.2±3.3 (range, 1 to 16) days, the mean length of hospitalization was 7.1±3.6 (range, 3 to 18) days. There were statistically significant differences in all variables analyzed between Group 1 and Group 2 (p<0.001). CONCLUSION: Autologous blood patch pleurodesis is an effective and safe method in the treatment of prolonged air leakage in secondary spontaneous pneumothorax. In addition, 120 mL of blood seems to be more effective option for pleurodesis.

What is the emergency application differences concerning diseases pertinent to the chest between Turkish citizens and Syrian refugees: A cross-sectional study.

AIM: Millions of Syrians were displaced after the Syrian civil war broke in 2011. Turkey hosts the largest number of refugees. This study aimed to describe the disease patterns of Syrian refugees applying to an emergency department. MATERIAL AND METHODS: The study included patients who presented to an emergency department between 2017 and 2018. Study data were retrieved from the hospital's electronic medical records registry. The main study outcome was the ICD-10 codes pertinent to "chest diseases." Additionally, analyzed data were nationality, age, sex, triage status on admission, hospitalization status, and examination date. RESULTS: The number of emergency department admissions included in the study period was 378 487 persons, of which 14 262 (3.8%) were Syrian refugees. A total of 62 345 diagnoses (16.5%) were related to the respiratory system. Turkish patients had a significantly higher median age than Syrian refugees. Also, there were significantly more women among Syrian applicants, and acute bronchitis and asthma were more common among Syrian patients. However, the hospitalization rates were similar between the two groups. Moreover, Syrian patients had more applications during the summer seasons and had higher "Yellow" labels in the emergency triage. CONCLUSION: There are differences in the disease patterns of Syrian refugees and Turkish citizens applying to the emergency department. This may be explained by the difficulty in communication which, to our opinion, may be reversed as language barriers are overcome and adaptation to the society is completed over time.

Evaluation of nasal mucociliary clearance using saccharin test in smokers: A prospective study.

BACKGROUND AND AIM: Nasal mucociliary clearance time (NMCT) can be measured with the saccharine clearance test which is an inexpensive and easy method. The aim of the present study was to compare and evaluate NMCT using the saccharine clearance test in smokers and non-smokers. MATERIALS AND METHODS: Eighty-five patients whose ages ranged from 18 to 65 years were included in the study. Fifty of the patients were smokers (Group 1) while 35 were healthy, non-smoking volunteers (Group 2). Saccharin clearance test was used to evaluate NMCT in both groups. The results obtained were compared and the statistical analyses were performed using the Statistical Package for Social Sciences (SPSS). RESULTS: NMCT was statistically significantly higher in Group 1 as compared to Group 2 (P < .001, Mann-Whitney U test). However, in cumulative smoking duration (pack-year), Fagerström test values and gender categories, there was no statistically significant difference in the average NMCT values of the two groups (P = .943 vs P = .812 respectively), P = .45). CONCLUSION: Mucociliary activity, the primary defence mechanism of the respiratory epithelium, is significantly depressed in smokers. Our findings showed that the said depression is not associated with the number of cigarettes smoked, duration of smoking or nicotine dependence.