Assessment of Palliative Care in Lung Cancer in Turkey.

OBJECTIVE: To investigate the symptoms of lung cancer in Turkey and to evaluate approaches to alleviate these symptoms. SUBJECTS AND METHODS: This study included 1,245 lung cancer patients from 26 centers in Turkey. Demographic characteristics as well as information regarding the disease and treatments were obtained from medical records and patient interviews. Symptoms were evaluated using the Edmonton Symptom Assessment Scale (ESAS) and were graded on a scale between 0 and 10 points. Data were compared using the χ2, Student t, and Mann-Whitney U tests. Potential predictors of symptoms were analyzed using logistic regression analysis. RESULTS: The most common symptom was tiredness (n = 1,002; 82.1%), followed by dyspnea (n = 845; 69.3%), appetite loss (n = 801; 65.7%), pain (n = 798; 65.4%), drowsiness (n = 742; 60.8%), anxiety (n = 704; 57.7%), depression (n = 623; 51.1%), and nausea (n = 557; 45.5%). Of the 1,245 patients, 590 (48.4%) had difficulty in initiating or maintaining sleep. The symptoms were more severe in stages III and IV. Logistic regression analysis indicated a clear association between demographic characteristics and symptom distress, as well as between symptom distress (except nausea) and well-being. Overall, 804 (65.4%) patients used analgesics, 630 (51.5%) received treatment for dyspnea, 242 (19.8%) used enteral/parenteral nutrition, 132 (10.8%) used appetite stimulants, and 129 (10.6%) used anxiolytics/antidepressants. Of the 799 patients who received analgesics, 173 (21.7%) reported that their symptoms were under control, and also those on other various treatment modalities (dyspnea: 78/627 [12.4%], appetite stimulant: 25/132 [18.9%], and anxiolytics/antidepressants: 25/129 [19.4%]) reported that their symptoms were controlled. CONCLUSION: In this study, the symptoms progressed and became more severe in the advanced stages of lung cancer, and palliative treatment was insufficient in most of the patients in Turkey.

The effects of sildenafil on smoke induced lung inflammation in rats.

OBJECTIVE: Sildenafil is a selective and potent inhibitor of cyclic guanosine monophosphate specific phosphodiesterase-5 and has anti-inflammatory effects. The aim of the study was to evaluate the effects of sildenafil on smoke-induced lung inflammation. MATERIAL AND METHODS: Twenty-nine Wistar-Albino rats were enrolled into 3 groups as control, smoker and sildenafil groups. Smoker and sildenafil groups were exposed to cigarette smoke for 2 hours per day for 8 weeks. Sildenafil 10 mg/kg/day was administered to the sildenafil group by nasogastric lavage after smoke exposure. The degree of lung inflammation was scored histopathologically for each group. RESULTS: The inflammation score was 7.25±0.93 in the control group, 8.18±1.21 in the smoker group and 7.08±1.66 in the sildenafil group. There was a non-significant decrease of inflammation score in sildenafil group with respect to control or smoker groups. While there was no significant difference of oedema, hyperemia, hemorrhage and mononuclear cell infiltration scores among the groups, it was found that the thickness of interalveolar septum and alveolar distortion was decreased in sildenafil group. However this decrease was not statistically significant. CONCLUSION: This study suggests that sildenafil might reduce smoke-induced inflammation in rat lungs. Future studies are needed in order to investigate the clinical effectiveness of this finding in smoking related lung diseases.

Role of smoke-free legislation on emergency department admissions for smoking-related diseases in Kocaeli, Turkey.

Legislation banning smoking in all indoor public places was introduced in Turkey in July 2009. The aim of this study was to evaluate the role of smoke-free legislation on the number of emergency department admissions for smoking-related diseases in Kocaeli city. A retrospective analysis was made of hospital records from the first 6 months of 2009 and 2010 (before and after legislation). Total admissions for smoking-related diseases were 83 089 in 2009 and 64 314 in 2010, a 22.6% decrease. Time-series analysis showed that the decreases were significant for bronchitis and lower respiratory tract infections. Emergency admissions for chronic obstructive pulmonary disease, myocardial infarction and allergic rhinitis were lower but not significantly so. The number of patients admitted with asthma showed a non-significant increase. Smoke-free legislation might have important short-term effects on emergency department admissions, but further studies are needed in order to evaluate the long-term effects of legislation on smoking-related diseases.

Differentiation of lymphoma versus sarcoidosis in the setting of mediastinal-hilar lymphadenopathy: assessment with diffusion-weighted MR imaging.

OBJECTIVES: To determine the performance of diffusion-weighted magnetic resonance imaging in differentiating lymphoma from sarcoidosis in mediastinal-hilar lymphadenopathy. MATERIALS AND METHODS: Forty-four mediastinal-hilar lymphadenopathy were examined in 27 patients with T1- and T2-weighted conventional images. Then, two diffusion-weighted images were obtained with b = 0 and 1000 s/mm2 values and apparent diffusion coefficients (ADCs) were calculated. The statistical significance of differences between measurements was tested using the Student-t test. RESULTS: The ADC value in the lymphoma group was lower than in the sarcoidosis group, and the difference was statistically significant (p < 0.001). By using the cut-off value of 1.266 x 10(-3) mm2/s, ADC had a sensitivity of 100%, specificity of 81%, positive predictive value of 100%, and negative predictive value of 77% for the differentiation of lymphoma and sarcoidosis. With the cut-off value of 1,97 x 10(-3) mm2/s, ADC had a sensitivity of 50%, specificity of 99.4%, positive predictive value of 68%, and negative predictive value of 91%. CONCLUSIONS: Diffusion-weighted imaging may be useful besides other modalities in differentiating lymphoma from sarcoidosis in mediastinal-hilar lymphadenopathy.

The use of the CT90 value in predicting anxiety in OSA: could it be a useful parameter?

OBJECTIVE: Obstructive sleep apnea (OSA) is characterized by recurrent episodes of complete or partial obstruction of the upper airway leading to episodic desaturation. OSA patients often show symptoms of anxiety. Our study aimed to examine the presence and levels of anxiety in OSA and simple snoring relative to control subjects and to investigate the correlation between anxiety scores and polysomnographic, demographic, and sleepiness parameters. SUBJECTS AND METHODS: The study included 80 OSA, 30 simple snoring, and 98 control cases. Demographic, anxiety, and sleepiness data of all subjects were acquired. The Beck Anxiety Inventory (BAI) was used to determine the level of anxiety. The Epworth Sleepiness Scale (ESS) was used to evaluate the sleepiness level of participants. In addition, polysomnography recordings of those in the OSA and the simple snoring group were acquired. RESULTS: Significantly higher anxiety scores were found in patients with obstructive sleep apnea and simple snoring compared to the control group (p<0.01, p<0.01, respectively). From the polysomnographic data obtained from OSA and simple snoring subjects, the CT90 values (cumulative percentage of the time spent at saturations below 90%) and the AHI showed a weak positive correlation between the level of anxiety (p=0.004, r=0.271; p=0.04, r=0.196, respectively). CONCLUSIONS: Our study concluded that polysomnographic data showing the depth and duration of hypoxia may be more reliable in showing neuropsychological disorder and hypoxia-related comorbidities in OSA. The CT90 value can be used as a measure in the assessment of anxiety in OSA. Its advantage is that it can be measured with overnight pulse oximetry along with in-laboratory PSG and HSAT (home sleep apnea test).

COVID-19: booster(s) vs. hospitalization and Intensive Care Unit admission.

OBJECTIVE: As the pandemic continues, different vaccine protocols have been implemented to maintain the protection of vaccines and to provide protection against new variants. The aim of this study was to assess hospitalized patients' vaccination status and document the efficacy of boosters. PATIENTS AND METHODS: The patients that were hospitalized due to COVID-19 were enrolled from 28 hospitals in Turkey for five months from September 2021. 5,331 confirmed COVID-19 patients from collaborating centers were randomly enrolled to understand/estimate the distribution of vaccination status in hospitalized patients and to compare the efficacy of vaccination/booster protocols. RESULTS: 2,779 men and 2,552 women of which 2,408 (45.2%) were admitted to Intensive Care Units participated in this study. It was found that the highest risk reduction for all age groups was found in groups that received 4 doses. Four doses of vaccination for every 3.7 people under 50 years of age, for every 5.7 people in the 50-64 age group, and for every 4.3 people over 65 years of age will prevent 1 patient from being admitted to intensive care. Regardless of the type of vaccine, it was found that the risk of ICU hospitalization decreased in those who were vaccinated compared to those who were not vaccinated. Regardless of the type of vaccine, the ICU risk was found to decrease 1.25-fold in those who received 1 or 2 doses of vaccine, 1.18-fold in those who received 3 doses, and 3.26-fold in those who received 4 doses. CONCLUSIONS: The results suggested that the addition of a fourth dose is more effective in preventing intensive unit care even in disadvantaged groups.

Prevalence and Risk Factors of Allergies in Turkey (PARFAIT): results of a multicentre cross-sectional study in adults.

The Prevalence and Risk Factors of Allergies in Turkey (PARFAIT) study was planned to evaluate the prevalence of and risk factors for asthma and allergic diseases in Turkey. The present analysis used data from 25,843 parents of primary school children, obtained from a cross-sectional questionnaire-based study. A total of 25,843 questionnaires from 14 centres were evaluated. In rural areas, the prevalences asthma, wheezing, allergic rhinitis and eczema in males were: 8.5% (95% confidence interval (CI) 7.9-9.1%), 13.5% (95% CI 12.8-14.2%), 17.5% (95% CI 16.7-18.2%) and 10.8% (95% CI 10.2-11.4%), respectively; and in females were: 11.2% (95% CI 10.9-11.8%), 14.7% (95% CI 14.3-15.1%), 21.2% (95% CI 20.4-22.0%) and 13.1% (95% CI 12.4-13.8%), respectively. In urban areas, the corresponding prevalences in males were: 6.2% (95% CI 5.8-6.6%), 10.8% (95% CI 10.3-11.3%), 11.7% (95% CI 11.4-12.0%) and 6.6% (95% CI 6.2-7.0%), respectively; and in females were: 7.5 % (95% CI 7.9-7.1%), 12.0% (95% CI 11.7-12.3%), 17.0% (95% CI 16.4-17.6%) and 7.3% (95% CI 6.9-7.7%), respectively. Having an atopic first-degree relative or any other atopic diseases had significant effects on the prevalence of allergic diseases. Housing conditions, such as living in a shanty-type house, visible moulds at home and use of wood or biomass as heating or cooking material were associated with one or more allergic diseases. Although genetic susceptibility is strongly associated, country- and population-based environmental factors may contribute to increased prevalence rates of allergic diseases.

Protective effects of N-acetylcysteine on peroxidative changes of the fetal rat lungs whose mothers were exposed to cigarette smoke.

BACKGROUND: This experimental study investigated the protective effects of N-acetylcysteine (NAC) on peroxidative changes in fetal lungs in the offspring of rats exposed to cigarette smoke. METHODS: Thirty fetal rats used for analysis, were divided into three groups as follows: control group (n = 10), whose mothers were exposed to fresh air; group I (n =10), whose mothers were exposed to cigarette smoke; and group II (n =10), whose mothers were exposed to cigarette smoke and given 10 mg/kg per day NAC. In groups I and II, smoke exposure was started 4 weeks before the pregnancy, and continued to the 14th day of pregnancy, and in Group II, NAC was administered intraperitoneally for 14 days. The mothers and their fetuses were decapitated on the 14th day of pregnancy. Malondialdehyde (MDA) and glutathione (GSH) levels were determined in the lung tissues of fetuses to determine the oxidant-antioxidant balance. RESULTS: While tissue MDA levels in Group I were found significantly higher than the control group (129.7+/-65.4 versus 63.4 +/-15.4 nmol/100 mg protein, P <0.05), GSH levels were significantly lower (17.1+/-7.3 versus 45.4 + 8.1 nmol/mg protein, P <0.01). Furthermore, in Group II, MDA levels were significantly lower (56.9+/-20.6 versus 129.7+/-65.4 nmol/100 mg protein, P <0.05), and GSH levels were significantly higher (34.57+/-10.7 versus 17.1+/-7.3 nmol/mg protein, P <0.0001) when compared with Group I. No statistically significant difference was found in tissue MDA and GSH levels between Group II and the control group (P >0.05). CONCLUSIONS: These results suggest that smoke exposure during pregnancy causes oxidative damage in fetal lungs. This smoke-induced damage might be prevented by NAC.

The Effect of Continuous Positive Airway Pressure on Basal Metabolism Rate in Patients with Severe Obstructive Sleep Apnoea Syndrome

ABSTRACT Objective: To assess the effect of the continuous positive airway pressure (CPAP) treatment on basal metabolism rate (BMR) in patients with severe obstructive sleep apnoea syndrome (OSAS). Methods: Demographic characteristics, body mass index (BMI), apnoea-hypopnoea index (AHI) and smoking history of the patients were recorded. Basal metabolism rate was measured via indirect calorimetry in the morning following nights of polysomnography and CPAP titration. Basal metabolism rate, oxygen consumption (VO2) and carbon dioxide output (VCO2) levels were compared before and after CPAP administration. Results: A total of 25 patients with a mean age of 51.4 ± 13.7 years were included in the study: 6 (24%) female and 19 (76%) male. A significant reduction in the BMR (p = 0.049), VO2 (p = 0.042) and VCO2 (p = 0.008) values were observed after a single night administration of CPAP as compared to before treatment. Furthermore, it was detected that this reduction provided by CPAP treatment was more significant in current smokers, patients with AHI > 60 and BMI ≥ 30. Conclusion: It is suggested that there is a correlation between BMR and the severity of OSAS, and it is possible to provide a significant reduction in BMR with single night administration of CPAP depending on the patient's smoking history, degree of obesity and disease severity.

Malignancy and Pulmonary Thromboembolism: Comparison of Symptomatic Cases with the Incidental Ones

ABSTRACT Objective: The use of advanced techniques of computed tomography (CT) has resulted in increased incidentally detected pulmonary embolism in oncology patients undergoing routine cancer staging CT scans. The aim of this study was to compare the symptomatic and incidental pulmonary emboli cases in oncologic patients. Methods: The medical data of the patients diagnosed with pulmonary embolism (ICD: I.26) and had an underlying malignancy were evaluated retrospectively from their hospital records between the years of 2009 and 2013. The results of their right ventricle dilatations were evaluated from the thorax CT. Results: There were 38 women (44.2%) and 48 men (55.8%), totalling 86 patients. Their mean age was 61.7 ± 11.9 years and the median duration of their follow-up was 6 months. Their most common underlying malignancies were gastrointestinal (29.4%), lung (22.4%), genitourinary (21.2%) and breast cancers (10.6%). Their pulmonary thromboembolism was diagnosed incidentally on routine control thorax CT in 39 of the cases (45.3%). When the incidental cases were compared with the symptomatic ones, no statistically significant difference was found with respect to the type of malignancy, history of chemotherapy, the presence of metastasis and evidence of septum flattening on the thorax CT. The presence of bilateral thrombus was found to be increased in the symptomatic cases compared with the incidental ones and the difference was statistically significant (p = 0.026). It was found that the right ventricle/left ventricle ratio was significantly higher in symptomatic cases (p = 0.03) than in the incidental ones. Conclusion: A considerable number of pulmonary thromboemboli episodes could be asymptomatic in malignant patients. It is suggested that the submassive clinical course and preserved right ventricle functions could be the reason for the asymptomatic events.

A case of fever of unknown origin: necrotizing sarcoid granulomatosis.

Necrotizing sarcoid granulomatosis is a rare type of vasculitis; its etiology and pathogenesis are still unknown. The disease primarily affects the lungs, although extra-pulmonary involvement has been reported. The typical symptoms are cough, chest pain, dyspnea, and weight loss; high temperatures have been reported in rare cases. We present the case of a 65-year-old woman who was diagnosed with lymph node tuberculosis, for which she received treatment for six months. The patient experienced no improvement in her symptoms, which included fever, weakness and dyspnea. A re-evaluation of previously collected thoracoscopic biopsy material revealed compatibility with necrotizing sarcoid granulomatosis.

Role of smoke-free legislation on emergency department admissions for smoking-related diseases in Kocaeli, Turkey

Legislation banning smoking in all indoor public places was introduced in Turkey in July 2009. The aim of this study was to evaluate the role of smoke-free legislation on the number of emergency department admissions for smoking-related diseases in Kocaeli city.A retrospective analysis was made of hospital records from the first 6 months of 2009 and 2010 [before and after legislation]. Total admissions for smoking-related diseases were 83 089 in 2009 and 64 314 in 2010, a 22.6% decrease. Time-series analysis showed that the decreases were significant for bronchitis and lower respiratory tract infections.Emergency admissions for chronic obstructive pulmonary disease, myocardial infarction and allergic rhinitis were lower but not significantly so. The number of patients admitted with asthma showed a non-significant increase. Smoke-free legislation might have important short-term effects on emergency department admissions,but further studies are needed in order to evaluate the long-term effects of legislation on smoking-related diseases

La législation sur l'interdiction de fumer dans tous les lieux publics intérieurs a été adoptée en Turquie en 2009. L'objectif de la présente étude était d'évaluer les effets de la législation antitabac sur le nombre de patients admis aux urgences pour des maladies liées au tabagisme dans la ville de Kocaeli. Une analyse rétrospective des dossiers hospitaliers a été réalisée, et celle-ci portait sur les six premiers mois de 2009 [avant l'adoption de la législation] ainsi que sur les six premiers mois de 2010 [après l'adoption de la législation]. Le nombre total d'hospitalisations pour des maladies liées au tabagisme était de 83 089 en 2009 et de 64 314 en 2010, représentant une baisse de 22,6 %.L'analyse des séries chronologiques a démontré que les diminutions étaient importantes pour la bronchite et les infections des voies respiratoires inférieures. Le nombre d'hospitalisations en urgence pour la bronchopneumopathie chronique obstructive, l'infarctus du myocarde et la rhinite allergique était inférieur mais la baisse n'était pas significative. Le nombre de patients asthmatiques hospitalisés a augmenté de manière non significative. Une législation antitabac peut produire d'importants effets à court terme sur le nombre d'hospitalisations au service des urgences,mais des études supplémentaires sont requises afin d'évaluer les effets à long terme de la législation sur les maladies liées au tabagisme