Bronchiectasis in Türkiye: Data from a Multicenter Registry (Turkish Adult Bronchiectasis Database).

Background: Bronchiectasis is a chronic lung disease characterized by permanent bronchial wall dilatation. Although it has been known as an orphan disease, it has recently gained attention because of registry-based studies and drug research. Aims: We aimed to use a multicenter database to analyze and compare data regarding the etiology, associated comorbidities, microbiological characteristics, and preventive strategies of bronchiectasis in Türkiye to those of other countries. Study Design: A multicenter prospective cohort study. Methods: The multicenter, prospective cohort study was conducted between March 2019 and January 2022 using the Turkish Adult Bronchiectasis Database, in which 25 centers in Türkiye participated. Patients aged > 18 years who presented with respiratory symptoms such as cough, sputum, and dyspnea and were diagnosed with non-cystic fibrosis bronchiectasis using computed tomography were included in the study. Demographic information, etiologies, comorbidities, pulmonary functions, and microbiological, radiological, and clinical data were collected from the patients. Results: Of the 1,035 study participants, 518 (50%) were females. The mean age of the patients was 56.1 ± 16.1 years. The underlying etiology was detected in 565 (54.6%) patients. While postinfectious origin was the most common cause of bronchiectasis (39.5%), tuberculosis was identified in 11.3% of the patients. An additional comorbidity was detected in 688 (66.5%) patients. The most common comorbidity was cardiovascular disease, and chronic obstructive pulmonary disease (COPD) and bronchiectasis was identified in 19.5% of the patients. The most commonly detected microbiological agent was Pseudomonas aeruginosa (29.4%). Inhaled corticosteroids (ICS) were used in 70.1% of the patients, and the frequency of exacerbations in the last year was significantly higher in patients using ICS than in nonusers (p < 0.0001). Age [odds ratio (OR): 1.028; 95% confidence interval (CI): 1.005-1.051], cachexia (OR: 4.774; 95% CI: 2,054-11,097), high modified medical research council dyspnea scale score (OR: 1,952; 95% CI: 1,459-2,611), presence of chronic renal failure (OR: 4,172; 95% CI: 1,249-13,938) and use of inhaled steroids (OR: 2,587; 95% CI: 1,098-6,098) were significant risk factors for mortality. Mortality rates were higher in patients with COPD than in those with no COPD (21.7-9.1%, p = 0.016). Patients with bronchiectasis and COPD exhibited more frequent exacerbations, exacerbation-related hospitalizations, and hospitalization in the intensive care unit in the previous year than patients without COPD. Conclusion: This is the first multicenter study of bronchiectasis in Türkiye. The study results will provide important data that can guide the development of health policies in Türkiye on issues such as infection control, vaccination, and the unnecessary use of antibiotics and steroids.

A mass vaccination site selection problem: An application of GIS and entropy-based MAUT approach.

Coronavirus disease (COVID-19) was recognized in December 2019 and spread very severely throughout the world. In 2022 May, the total death numbers reached 6.28 million people worldwide. During the pandemic, some alternative vaccines were discovered in the middle of 2020. Today, many countries are struggling to supply vaccines and vaccinate their citizens. Besides the difficulties of vaccine supply, mass vaccination is a challenging but mandatory task for the countries. Within this context, determining the mass vaccination site is very important for recovering, thus a five-step approach is generated in this paper to solve this real-life problem. Firstly the mass vaccination site selection criteria are determined, and secondly, the spatial data are collected and mapped by using Geographical Information System (GIS) software. Then, the entropy weighting method (EWM) is used for determining the relative importance levels of criteria and fourthly, the multiple attribute utility theory (MAUT) approach is used for ranking the potential mass vaccination sites. Lastly, ranked alternative sites are analyzed using network analyst tool of GIS in terms of covered population. A case study is conducted in Gaziantep city which is the ninth most population and having above-average COVID-19 patients in Turkey. As a result, the fourth alternative (around the Sehitkamil Monument) is chosen as the best mass vaccination site for the city. It is believed that the outcomes of the paper could be used by city planners and decision-makers.

Diffusion of Innovations-Informed Knowledge Translation Strategy to Implement Optimal Safe Nursing Workforce Policy in Practice.

AIM: This study aims to develop a free, limited-edition workshop as an effective knowledge translation strategy to enhance nurse leader-perceived self-efficacy for competence using Park's Sweet Spot Theory and to evaluate its effectiveness over time. METHOD: This is a study showing the process of developing a study protocol and its details. RESULTS: A 2-day workshop was developed for innovators and early adopters among nurse leaders with a macro-level influence based on Rogers's diffusion of innovations theory, which consists of an introduction of Park's Sweet Spot Theory, hands-on experience, a summary session, and a presentation of a certificate of completion. The workshop will be held at the University of Alberta Faculty of Nursing, using the "enabling blends" mode. A hybrid design of comparative effectiveness research and analysis of change will be utilized to assess nurse leader-perceived self-efficacy. CONCLUSION: This protocol is significant as the first step in providing scientific rationales on how to effectively implement new knowledge-optimal safe nurse staffing levels derived from Park's Sweet Spot Theory-into the right (safe yet efficient) nursing workforce policy-making to alleviate global nursing shortages.

No more unimplementable nurse workforce planning.

Objective: This paper aims to spur thought-provoking practical debates on current nurse workforce staffing and scheduling systems in relation to a critical review of Ang and colleagues' (2018) article entitled "Nurse workforce scheduling in the emergency department: A sequential decision support system considering multiple objectives."Design: Discussion paper on a practical discourse in connection with the aforementioned published article.Discussion: Mathematical Programming (optimisation) (MP)-based nursing research has been published for nearly thirty years almost exclusively in industrial engineering or health business administration journals, demonstrating a widening gap between nursing research and practice. Nurse scientists' knowledge and skill of MP is insufficient, as are their interdisciplinary collaborations, setting back the advancement of nursing science. Above all, nurse scientists skilled in decision science are desperately needed for that analytic intellection which is rooted in the 'intrinsic nature and value of nursing care.' It is imperative that nurse scientists be well-prepared for the new age of the Fourth Industrial Revolution through both an education in MP and interdisciplinary collaboration with decision science experts in order to prevent potential stereotyped MP-based algorithm-driven destructive influences.Conclusions: The current global nursing shortage makes optimal nursing workforce staffing and scheduling more important. MP helps nurse executives and leaders to ensure the most efficient number of nurses with the most effective composition of nurse staffing at the right time for a reasonable cost. Nurse scientists urgently need to produce a new nursing knowledge base that is directly implementable in nursing practice.Impact Statement: Nurse scientists should take the leading role in producing the mathematical programming-integrated knowledge base that is directly implementable in practice.

Persistent Post-COVID Symptoms and the Related Factors.

OBJECTIVE: The recently emerged coronavirus 2019 disease is an infectious disease that predominantly affects the respiratory system. In this study, we aimed to evaluate the persistent post-COVID symptoms and the related factors. MATERIAL AND METHODS: This study was conducted on 396 post-COVID patients. The demographic (age, gender, body mass index, smoking, location and duration of treatment, and date of post-COVID follow-up visit) and clinical (symptoms during and after the infection, comorbidities) data were evaluated by interview and a questionnaire. RESULTS: The mean age of the patients was 50.25 years (min-max: 19-85). There were equal numbers of males (n = 198) and females (n = 198) in the study. The mean body mass index was 27.94 (min-max: 17.90-44.92). The majority of patients (n = 222, 56.1%) had been treated at home, while the rates of patients admitted to ward and intensive care unit were 37.1% (n = 147) and 6.8% (n = 27), respectively. The number of patients with at least 1 persistent symptom during post-COVID follow-up visit was 348 (87.9%). The symptoms during the infection included fatigue (n = 339, 85.6%), cough (n = 373, 68.9%), joint pain (n = 267, 67.4%), appetite loss (n = 234, 59.1%), dyspnea (n = 231, 58.3%), while the persistent post-COVID symptoms were fatigue (n = 222, 56.1%), cough (n = 174, 43.9%), dyspnea (n = 171, 43.2%), and chest pain (n = 171, 43.2%). No significant relationships between post-COVID symptoms and age, body mass index, comorbidity, duration from diagnosis to a follow-up visit, and COVID-19 pneumonia during the infection were found, while a statistically significant relationship regarding gender was found. CONCLUSION: There is still a lack of knowledge about the long-term consequences of coronavirus 2019 disease. Moreover, no standardized method exists for categorizing patients into post-COVID controls.

Instability of Tear Film after Novel Coronavirus Disease: A Noninvasive and No Contact Method by a Scheimpflug-Placido Disc Topographer.

PURPOSE: To compare the topographical tear film break-up time (T-BUT) between individuals recovering from COVID-19 and control subjects using a noninvasive and noncontact technique with a Scheimpflug-Placido disc topographer. METHODS: One-hundred and twenty-two eyes from 61 post-COVID-19 patients and 124 eyes from 62 control subjects were included in this prospective study. All participants underwent detailed ophthalmological examination including best-corrected visual acuity, intraocular pressure measurements, slit lamp examination, and fundoscopy as well as qualitative and quantitative evaluation of the noninvasive first tear film break-up time (NIF-BUT) and noninvasive average tear film break-up time (NIAvg-BUT) with T-BUT measured with a Sirius (CSO - Costruzione Strumenti Oftalmici S. r. l., Italy) corneal topography device. RESULTS: The mean NIF-BUT in post-COVID-19 and control patients was 5.2 ± 3.4 vs. 6.5 ± 3.2 sec, respectively. The mean NIAvg-BUT in the corresponding groups was 7.5 ± 3.5 vs. 8.8 ± 3.0 sec, respectively. Both NIF-BUT and NIAvg-BUT were significantly lower in the post-COVID-19 group than in controls (p = 0.004 vs. 0.020). Topographical tear film break-up at any time during the test (17 sec) was observed qualitatively in 79 eyes (64.8%) in the post-COVID-19 group and 57 eyes (46%) in the control group (p = 0.003). Moreover, temporal quadrant involvement occurred significantly more frequently in the post-COVID-19 group (p = 0.028). CONCLUSION: Tear film stability assessment based on T-BUT showed shorter NIF-BUT and NIAvg-BUT in post-COVID-19 patients as compared to the control group. Our results suggest that post-COVID-19 patients have impaired stability of tear film, and therefore require closer monitoring regarding dry eye. In addition, tear film instability in post-COVID-19 patients can be reliably detected using a noninvasive and noncontact technique that is more comfortable for both patients and physicians.

Evaluation of criteria and COVID-19 patients for intensive care unit admission in the era of pandemic: A multi-criteria decision making approach.

BACKGROUND AND OBJECTIVE: The COVID-19 pandemic results in an intense flow of patients to hospitals especially to the intensive care units (ICUs) to be treated. The ICUs will therefore be confronted with a massive influx of patients (e.g. Spain and Italy). However, if the number of patients is higher than the resources available in ICUs, rationing decisions such as determining and evaluating the criteria for ICU admission becomes essential. In this case, the decision of which patients will be admitted to the ICUs may put significant pressure on healthcare personnel. The goal of this paper is to determine the criteria to be used in the decision of admission of COVID-19 patients to the ICUs. METHODS: A three-step methodology is applied. In the first step, the evaluation criteria are determined, and then the criteria are prioritized using a fuzzy analytical hierarchy process (AHP) in an uncertain and multiple-criteria environment choice. Finally, COVID-19 patients are ranked using the Multi-Objective Optimization Method by Ratio Analysis to find out which patient is more urgent. RESULTS: According to experts' evaluation of ICU admission criteria, "increment of >2 in SOFA score" seems the most dominant factor among others. The proposed methodology is tested on 10 anonymous COVID-19 positive patients being treated in a public hospital and the ICU admission results are discussed. CONCLUSIONS: Obtained priorities and ranking is in line with the hospitals' behavior that potentially depicts the usefulness and validity of the proposed approach.

The relationship between frontal QRS-T angle and the severity of newly diagnosed chronic obstructive pulmonary disease.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is characterised by persistent airflow restriction and respiratory symptoms. Studies demonstrated that cardiac arrhythmias and cardiovascular mortality increased in these patients as a result of altered myocardial repolarization. Frontal QRS-T angle is a novel marker of myocardial depolarization and repolarization heterogeneity. In this study, we aimed to investigate the relationship between frontal QRS-T angle and disease severity in patients with newly diagnosed COPD. METHODS: A total of 104 newly diagnosed COPD patients were included in this study. Patients were divided into two groups according to GOLD (Global Obstructive Lung Disease) stage as follows: patients with mild and moderate COPD (group I), and severe and very severe COPD (group II). Frontal QRS-T angle was calculated from the automatic report of the electrocardiography device. RESULTS: Frontal QRS-T angle was significantly higher in group II patients compared with in group I patients (43.0 [25.5-60.0] vs. 20.0 [12.0-32.0], P < .001). The best cut-off value of frontal QRS-T angle for predicting severe-very severe COPD was ≥34.5°. Correlation analysis showed that frontal QRS-T angle was negatively correlated with FEV1/FVC (r = -.524, P < .001) and MEF25-75 (r = -.453, P < .001). Multivariate logistic regression analysis was showed that frontal QRS-T angle was the only independent predictor of severe-very severe COPD (OR: 1.051, 95% CI: 1.024-1.079, P < .001). CONCLUSIONS: Frontal QRS-T angle is an easily obtainable marker form surface electrocardiography. In this study, we have shown for the first time that frontal QRS-T angle was significantly increased in patients with severe and very severe COPD.

Obstructive sleep apnea syndrome as a potential cause of sexual dysfunction in women : Sexual dysfunction in women.

BACKGROUND: Obstructive sleep apnea (OSA) is defined as the cessation of respiration due to recurrent and partial or complete blockade of the upper airways during sleep. Nocturnal hypoxemia due to OSA may accompany these conditions, with significant negative impact on the life quality of patients leading to mental and/or sexual dysfunction. OSA as a cause of sexual dysfunction in women has been subject to very little research. The goal of this study was to examine the effect of OSA on sexual functions in women suffering from this disorder. METHODS: Patients with OSA were categorized into two groups, those with and those without sexual dysfunction. RESULTS: When women with OSA and healthy women were compared, age (p < 0.001), body mass index (BMI) (p < 0.001), Beck Anxiety Inventory (BAI) (p < 0.001), Beck Depression Inventory (BDI) (p = 0.001), there was a significant difference in the Arizona Sexual Experience Scale (ASEX), (p = 0.02). When women with OSA were compared in terms of sexual dysfunction, a significant difference was found in apnea-hypopnea index (AHI) (p = 0.01) and ASEX (p < 0.001). There were no significant differences in hormonal parameters between the two groups. CONCLUSION: Sexual dysfunction in females is a largely under-recognized but important condition. Symptoms caused by OSA may include sexual dysfunction which may increase the prevalence of depression and anxiety, further reducing the quality of life.

Tracheal Lipoma Mimicking Asthma.

Primary tracheal tumors are very rare and 10%-20% are benign tumors. Tracheal lipoma is extremely rare and only a few cases have been reported in the literature. A 69-year-old male patient presented to the emergency department with complaints of shortness of breath, respiratory distress, chest pain and cough. Chest CT scan showed a round mass in the topography of the trachea that almost caused airway obstruction. The lesion was resected endoscopically and the pedicle base was cauterized. Tracheal lipoma is a rare condition that should lie in the differential diagnosis of treatment-resistant asthma.

Old Habits Die Hard - Asbestos Exposure.

OBJECTIVE: Although the damages to health that are caused by asbestos exposure are known, the mineral continues to be in use. Our main purpose in the study was to determine the relationship between awareness and asbestos use. MATERIAL AND METHODS: A total of 100 residents from the Armutova village of Ergani District in the Diyarbakir province of Turkey, with previous asbestos exposure were studied between January 2010 and December 2010. Exposure to asbestos was questioned in all participants. Asbestos doses were measured in the setting where they lived. The pulmonary function tests (PFTs) including forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were performed, and chest radiography was taken. RESULTS: The duration of asbestos exposure was found to be associated with reduced PFTs and the pathological lung findings on radiology. Although 97% of the participants were aware of asbestos and its health risks, the rates of its use were significantly higher, and associated with excessive exposure levels. Longer duration of asbestos exposure was significantly associated with reduced FVC. There were more prominent reductions in FEV1 with longer durations of asbestos exposure. CONCLUSION: The high rates of asbestos use indicate that changing habits, particularly among individuals residing in rural areas, is difficult. In our country, the main route of asbestos exposure is through the environment, which is at least as hazardous as occupational exposure.

Analysis of sports injuries related with shooting.

BACKGROUND: Athletes typically maintain rigorous training and work programs to be able to participate in competitions. An injury that occurs during the competition that causes withdrawal from the competition and a possible departure from sports, can render results athletes' and their support staff's efforts as meaningless. The early detection of injuries in the competition and developing preventive training programs can help ensure that participating in competitions and the associated preparatory efforts are not wasted. In this study, the sports injuries discussed occurred during training and competition events of the Turkish Shooting Sportive group. Body parts of injuries are determined and exercise programs focused on the affected body parts are developed. METHODS: A total of 729 athletes (285 female, 444 male) who participated in Turkish Shooting Sports Championship during the 2010-2011 competition period participated in the study. Athletes were given a questionnaire that was developed prior to the event, and the questionnaire was filled in during interviews conducted one-on-one. Data was collected from the questionnaire and SPSS v.16.0 was used to analyze the results. The study was completed in six months. RESULTS: The results showed that the most of the injuries that occurred during training were strain and muscle tears whereas most of the injuries occurred during the actual competition were strain, muscle tears, tendinitis, and sprain. The results also indicated that during training, the most frequently-occurring injuries were in shoulder, calf-thigh, hand and wrist; whereas during the competition, it was manifested in the shoulder, foot and ankle. CONCLUSIONS: Muscle strengthening, stretching and proprioception exercises for these body parts should be included as part of the athletic training program.

Crystal and molecular structures of 1-[3-(3,4-dimethoxyphenyl)-2-propenoyl]pyrrolidine.

The crystal structure of 1-[3-(3,4-dimethoxyphenyl)-2-propenoyl]pyrrolidine (C15H19NO3) (I) has been determined by X-ray analysis. It crystallizes orthorhombic space group Pbca with a = 24.295(3), b = 15.086(3), c = 7.552(3)A, V = 2768(1)A3, Z = 8, Dcalc = 1.254 g/cm3, mu = (Mo K(alpha)) = 0.87 cm(-1). The title compound has analgesic activity of cycloaliphatic amine part. The molecule is deviated from planar configuration.

Crystal structure of 3,3-dichloro-N-p-methoxyphenyl-4-(2-phenylstryl)-2-azetidinone.

3,3-Dichloro-N-p-methoxyphenyl-4-(2-phenylstryl)-2-azetidinone (C22H15Cl2NO2) was studied by X-Ray analysis, which indicated a monoclinic space group, P2(1)/c, with a = 9.619(5), b = 13.879(4), c = 14.161(5)A, beta = 100.16(3)degrees, V = 1860.8(13)A3, Z = 4, Dc = 1.414 g cm(-3), micro(Mo Kalpha) = 0.366 mm(-1) and F000 = 816. The structure was solved by direct methods and refined to R = 0.041 for 4026 reflections [I > 2sigma(I). The beta-lactam ring (2-azetidinone) has antimicrobial affects. The substituents of the methoxyphenyl and phenyl substituents do not change the activity property of the beta-lactam ring, and the activity properties depend on the planarity of the beta-lactam ring.

Crystal structure of [N,N'-bis(5-chlorosalicylidene)-1,3-diaminopropane]iron(II).

The crystal structure of the title compound has been determined. The coordination geometry about the iron(II) center is a tetrahedrally distorted square plane formed by the four-coordinate N2O2 donor set of the Schiff-base imine-phenol ligand. Molecules of the title compound are not planar. The two Schiff-base moieties, which themselves are reasonably planar, are inclined at an angle of 31.5(1) degrees.