The performance of Khorana risk score for prediction of venous thromboembolism in patients with lung cancer: A retrospective cohort study.

Introduction: Cancer-related venous thromboembolism is one of the leading causes of mortality and morbidity in cancer patients. Lung cancer is the second most common cancer in the world and is closely related to venous thromboembolism. Venous thromboembolism affects survival in patients with cancer and it is important to be able to predict the possibility of thrombosis in patients with cancer. It was aimed to evaluate the predictive performance of the Khorana risk score in patients with lung cancer. Materials and Methods: The medical data of the patients followed up with lung cancer were analyzed retrospectively. Venous thromboembolism events in lung cancer patients were described. The relationship between the Khorana risk score and the risk of venous thromboembolism was investigated using the cumulative incidence function with compared risk models. Result: Eight hundred fourteen lung cancer patients were included in the study. Venous thromboembolism was detected in 79 (9.7%) of the patients. Sixty one (77.2%) of the patients had pulmonary embolism, 15 (19%) had peripheral deep vein thrombosis and three (3.8%) had venous thrombosis of other sites. The cumulative incidences of venous thromboembolism for high and intermediate Khorana risk scores were 10.1% and 9.7%, respectively (p= 0.09). The cumulative incidences of venous thromboembolism at 3, 6, 12, and 24 months were 4.7%, 5.8%, 6.4%, and 9.6% for the high-grade Khorana risk score; 4.6%, 5.7%, 6.3% and 7.8% for the intermediate Khorana risk score (p= 0.11). Conclusions: The Khorana risk score was not found useful in the risk stratification of venous thromboembolism (intermediate or high risk) in patients with lung cancer. New scoring systems are needed to calculate the risk of venous thromboembolism in patients with lung cancer.

Asthma-chronic obstructive pulmonary disease overlap: Results from a national-multicenter study.

Introduction: Patients with asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) have a greater disease burden than those with COPD or asthma alone. In this study, it was aimed to determine the prevalence, risk factors, and clinical features of ACO because there are limited national data in Türkiye. Materials and Methods: The study was conducted in a cross-sectional design in nine tertiary-care hospitals. The patients followed with a diagnosis of asthma or COPD for at least one year were enrolled in the study. The frequency of ACO and the characteristics of the patients were evaluated in the asthma and COPD groups. Result: The study included 408 subjects (F/M= 205/203, mean age= 56.24 ± 11.85 years). The overall prevalence of ACO in both groups was 20.8% (n= 85). The frequency was higher in the COPD group than in the asthma group (n= 55; 33.3% vs. n= 22; 9.8%), respectively (p= 0.001). Patients with ACO had similarities to patients with COPD in terms of advanced age, sex, smoking, exposure to biomass during childhood, being born in rural areas, and radiologic features. Characteristics such as a history of childhood asthma and allergic rhinitis, presence of chronic sinusitis, NSAID hypersensitivity, atopy, and high eosinophil counts were similar to those of patients with asthma (p<0.001). The annual decline in FEV1 was more prominent in the ACO group (mean= -250 mL) than in the asthma (mean change= -60 mL) and COPD (mean change= -230 mL) groups (p= 0.003). Conclusions: This study showed that ACO was common among patients with asthma and COPD in tertiary care clinics in our country. ACO should be considered in patients with asthma and COPD who exhibit the abovementioned symptoms.

Clinical Characteristics and Prognostic Factors of Patients With Stenotrophomonas maltophilia Pneumonia: 10-Year Experience From a Single Center.

INTRODUCTION: Stenotrophomonas maltophilia infection is gaining importance as an important cause of nosocomial pneumonia. S. maltophilia infection occurs especially in patients with a history of immunosuppression, comorbidity, or multiple antibiotherapy uses. A retrospective 10-year study was carried out to determine the clinical characteristics of all patients with S. maltophilia pneumonia, antibiotic resistance pattern, and risk factors associated with hospital mortality. MATERIALS AND METHODS: Hospitalized pneumonia patients with S. maltophilia culture positivity were identified, and their medical records were reviewed. Risk factors associated with hospital mortality were analyzed. Any variable with a significant association with mortality in the univariate analysis was entered in a multivariate forward stepwise logistic regression model to identify independent risk factors for death. RESULTS: Seventy-two patients (mean age: 67.3 years, 65.2% males) with S. maltophilia pneumonia were included in the study. All patients had at least one comorbidity. The most common comorbidities were chronic obstructive pulmonary disease, diabetes mellitus, chronic renal failure, malignancy, and cardiac diseases. Percentage resistance to trimethoprim-sulfamethoxazole (5.5%) was lower than that for fluoroquinolones (12.5%). By using multivariate analysis, respiratory insufficiency needed mechanical ventilation, low hemoglobin level, age>65 years, previous antibiotic usage, and hypotension were the independent prognostic factors for mortality. CONCLUSION: S. maltophilia is emerging as an important pathogen with an increased risk of mortality in patients with respiratory insufficiency who need mechanical ventilation, a low hemoglobin level, >65 years of age, previous antibiotic usage, and hypotension. Empiric therapy should include agents active against S. maltophilia, such as newer fluoroquinolones and trimethoprim-sulfamethoxazole.

Lung cancer from suspicion to treatment: An indicator of healthcare access in Turkey.

BACKGROUND: Lung cancer is the leading cause of cancer-related deaths worldwide. Before beginning lung cancer treatment, it is necessary to complete procedures such as suspecting lung cancer, obtaining a pathologic diagnosis, and staging. This study aimed to investigate the processes from suspicion of lung cancer to diagnosis, staging, and treatment initiation. METHODS: The study was designed as a multicenter and cross-sectional study. Patients with lung cancer from various health institutions located in all geographic regions of Turkey were included in the study. The sociodemographic and clinical characteristics of the patients, the characteristics of the health institutions and geographic regions, and other variables of the lung cancer process were recorded. The time from suspicion of lung cancer to pathologic diagnosis, radiologic staging, and treatment initiation, as well as influencing factors, were investigated. RESULTS: The study included 1410 patients from 29 different medical centers. The mean time from the initial suspicion of lung cancer to the pathologic diagnosis was 48.0 ± 52.6 days, 39.0 ± 52.7 days for radiologic staging, and 74.9 ± 65.5 days for treatment initiation. The residential areas with the most suspected lung cancer cases were highly developed socioeconomic zones. Primary healthcare services accounted for only 0.4% of patients with suspected lung cancer. The time to pathologic diagnosis was longer in the Marmara region, and the wait time for staging and treatment initiation was longer in Eastern and Southeastern Anatolia. Patients who presented to chest disease referral hospitals with peripheral lesions, those with early-stage disease, and those who were diagnosed surgically had significantly longer wait times. CONCLUSION: The time between pathologic diagnosis, staging, and treatment initiation in lung cancer was longer than expected. Increasing the role of primary healthcare services and distributing socioeconomic resources more equally will contribute to shortening the time to diagnosis and improve treatment processes for lung cancer.

Radiological findings based comparison of functional status in patients who have post-covid lung injury or idiopathic pulmonary fibrosis.

BACKGROUND: Following COVID-19 infection, some patients acquired lung injury and fibrosis. Idiopathic pulmonary fibrosis is characterized by lung fibrosis. Both post-COVID lung injury and idiopathic pulmonary fibrosis cause loss of respiratory function and involvement of the lung parenchyma. We aimed to compare respiratory related functional characteristics and radiological involvement between post-COVID lung injury and idiopathic pulmonary fibrosis. METHODS: A single center, cross-sectional study was applied. Patients with post-COVID lung injury and idiopathic pulmonary fibrosis included in the study. All patients underwent the 6-minute walk test, as well as the Borg and MRC scales. Radiological images were evaluated and scored for lung parenchymal involvement. The impact of post-COVID lung injury and idiopathic pulmonary fibrosis on respiratory functions of were compared. The relationship of functional status and radiological involvement, as well as the effect of potential confounding factors were investigated. RESULTS: A total of 71 patients were included in the study. Forty-eight (67.6%) of the patients were male and the mean age was 65.4 ± 10.3 years. Patients with post-COVID lung injury had greater 6-minute walk test distance and duration, as well as higher oxygen saturations. The MRC and Borg dyspnea scores were comparable. At radiologic evaluation, ground glass opacity scores were higher in patients with post-COVID lung injury, whereas pulmonary fibrosis scores were higher in patients with idiopathic pulmonary fibrosis. However, the total severity scores were similar. While pulmonary fibrosis score was found to have a negative correlation with 6-minute walk test distance, test duration, and pre- and post-test oxygen saturation levels, there was a positive correlation with oxygen saturation recovery time and MRC score. There was no relationship between ground glass opacity and the functional parameters. CONCLUSIONS: Despite having equal degrees of radiological involvement and dyspnea symptom severity, PCLI patients exhibited higher levels of functional status. This might be due to different pathophysiological mechanisms and radiological involvement patterns of both diseases.

[Functional parameters and affecting factors in post-COVID period]. / Post-COVID dönemde fonksiyonel parametreler ve etkileyen faktörler.

Introduction: Post-COVID period is considered to be 12 weeks after the COVID-19 infection. Patients in the post-COVID period may have prolonged or newly developed symptoms. Depending on the prolonged effects of the disease, respiratory and functional parameters may be affected. The aim of the study is to investigate the effect of COVID-19 infection on respiratory and functional parameters in the post-COVID period. Materials and Methods: A cross-sectional study was conducted to evaluate the functional parameters of patients with COVID-19 in the post-COVID period. Subjects with a history of microbiologically proven COVID-19 infection were evaluated with 6-minute walk test results, Borg, and MRC results at least 12 weeks after COVID-19 infection. The relationship between demographic characteristics, comorbidities, vaccination status, and severity of disease with 6-minute walk test results and dyspnea scales in the post-COVID period was investigated. Result: Two hundred seventeen patients were included in the study. The mean age of the patients was 48.6 ± 14.9 years and 126 (58.1%) of them were female. 142 (65.4%) of the patients were completely vaccinated against COVID-19 and 75 (34.6%) patients were incompletely vaccinated or unvaccinated. 158 (72.8%) patients had mild disease, 51 (23.5%) patients had moderate disease, and eight (3.7%) patients had severe disease. Those with a history of moderate or severe disease had significantly worsened functional parameters in the postCOVID period compared to those with mild COVID-19. The Borg scale and MRC dyspnea scale values were significantly higher in women (p= 0.008, p= 0.002, respectively). Functional parameters of those who were completely vaccinated against COVID-19 and those who were incompletely or unvaccinated individuals in the post-COVID period were similar. Conclusions: The functional parameters of people with moderate or severe COVID-19 disease were found to be significantly impaired in the post-COVID period. While the effect of smoking and vaccination status on functional parameters in the post-COVID period could not be demonstrated, disease severity and accompanying comorbidity were found to be effective.

Impact of the COVID-19 Pandemic on Diagnosis of Lung Cancer.

Non-COVID hospital admissions decreased during the COVID-19 pandemic and follow-up of people in the lung cancer risk group was delayed. There are not enough studies on the effects of the pandemic period on the diagnosis of lung cancer. In this study, it was aimed to determine the characteristics of patients diagnosed with lung cancer in the pre-pandemic and pandemic period and to investigate the effects of the pandemic on the diagnosis of lung cancer. Patients with newly diagnosed lung cancer 16 months before and after the detection of the first COVID-19 case were retrospectively analyzed for their characteristics at the time of diagnosis. Age, gender, pathological diagnosis, distant organ metastasis status, and also pathological stages at the time of diagnosis of the patients were analyzed. Two hundred forty-six patients were included in the study. One hundred forty-five of the patients were diagnosed in the pre-pandemic period and 101 during the pandemic period. Mean age of patients was 64.24 years and 91.87% were male. Pathological diagnosis distributions were similar in the pre-pandemic group and the pandemic period group. Distant organ metastases were present in 59.31% of the pre-pandemic group and 65.35% of the pandemic group. There was no significant difference in terms of the stages of the patients at the time of diagnosis. Number of patients diagnosed with lung cancer during the pandemic period was lower. The characteristics of the patients were similar. These results may have resulted from the decrease in applications to health institutions due to social isolation and fear of COVID-19 infection, and limitations in accessing health services.

The investigated case of etiology of chylous pleural effusion: Ataxia-telangiectasia.

Ataxia-telangiectasia is an autosomal recessive, rare, neurodegenerative multisystem disorder characterized by ataxia-telangiectasia, cerebellar ataxia, oculocutaneous telangiectasia, immunodeficiency, progressive respiratory failure associated with increased malignancy risk. Clinical diagnosis is made with ataxia-telangiectasia mutated (ATM) gene. Our case, who was diagnosed as ataxia-telangiectasia while investigating the etiology of chylous pleural effusion, is presented because of its rare occurrence.

Use of Tobacco Products in Turkish Children and Young People: Is there an Alarm for Hookah Use?

OBJECTIVES: In the recent years, it has been observed that the use of hookah, a tobacco product, has increased in children and young people in Turkey. This study was conducted to determine the prevalence of cigarette and hookah use in children and young people specific to age and gender and to define the factors relevant to the use of hookah. MATERIALS AND METHODS: The study was conducted with secondary/high school students between 11 and 17 years of age (Survey 1, n=4718) and with university students between 18 and 23 years of age (Survey 2, n=1588) as two groups, which made a total of 6306 students. The students were asked to fill in a questionnaire which consisted of questions about socio-demographic data and the use of tobacco and tobacco products. RESULTS: It was determined that the use of cigarette and hookah was high in males, and it increased as the age increased in both genders (p<0.05). It was also determined that parents and friends using cigarette and hookah affected the use of cigarette and hookah in the study groups in both surveys (p<0.05). Additionally, it was determined that the educational level of the parents and being of a high social class were the social determiners of hookah use (p<0.05). CONCLUSION: It is important that we fight against the use of all tobacco products, especially in young people. Education about the damages of tobacco and applying tobacco products should start at an early age, and accurate tobacco control models may provide support in this field.

[Evaluation of physians, patients, relatives and society of opinions on the told lung cancer diagnosis]. / Hekimlerin, hasta yakinlarinin ve toplumun akciger kanseri tanisinin söylenmesine iliskin görüslerinin degerlendirilmesi.

INTRODUCTION: In our country, this is usually done by patient relatives. In this study, we aimed to investigate the thought of doctors who done the diagnosis, doctors who arrange the treatment, first degree relatives of patients with lung cancer, and population as a control. MATERIALS AND METHODS: 310 subjects (100 doctors, 110 first degree realtives of patients, and 100 subjects as a control) were included to the study. The mean age was 39.77 ± 11.44 years and there was 170 females. 46% of doctors were giving cancer treatment (chemotheraphy/radiotheraphy). RESULT: 84.5% of subjects were answered the question (Do you want to know the diagnosis of lung cancer if you are lung cancer?) as "yes" and the answers were not different between groups (p> 0.05). 72 of doctors were giving information about diagnosis of patients. This ratio was 89.1% in doctors who arrange lung cancer treatment whereas it was 57.4% in doctors who do not arrange cancer treatment. The percent age of learning of diagnosis of lung cancer throughout the time in doctors, population, and patient's relatives were 19%, 34%, and 59% respectively (p< 0.05). Information about quality of life was more important in relatives of patients (87%) than population (65%) and doctors (63%) (p< 0.05). Quality of life was more important for doctors who arrange lung cancer treatment (76.7)% than doctors who did not (48.8%) (p< 0.05). Patients who were more children wanted to stay with their family at end stage of disease (p< 0.05). CONCLUSIONS: According to this study we think that doctors should say the diagnosis of lung cancer in the form of they understand, inform the patients and relatives about treatment, and quality of life and this can increase patient trust to doctor and compliance of patients to the treatment.

The Role of Endobronchial Biopsy in the Diagnosis of Pulmonary Sarcoidosis.

OBJECTIVES: This study aimed to investigate the additional diagnostic value of endobronchial biopsy (EBB) in the diagnosis of pulmonary sarcoidosis. MATERIALS AND METHODS: This retrospective cross-sectional study included 59 patients with a preliminary diagnosis of sarcoidosis who were admitted to the Pulmonary Diseases Outpatient Clinic of a tertiary healthcare center between January 2005 and October 2012. The socio-demographic characteristics of the patients as well as clinical and radiological findings were recorded. All patients, irrespective of the presence of an endobronchial lesion (EBL), underwent fiberoptic bronchoscopy (FOB); two to four specimens were taken using EBB from the carina of the right middle lobe in the patients with EBL. RESULTS: Of the patients, 39 (66.1%) had normal bronchoscopic findings, while 5 had EBL. Diagnosis was based on EBB in 11 patients (18.6%). Six patients (15.3%) with normal bronchial mucosae were pathologically diagnosed by EBB. There was no statistically significant relationship between the diagnostic ratio of EBB and disease stage, extrapulmonary involvement, FOB findings, elevated lymphocyte rate in bronchoalveolar lavage (≥ 13%), a CD4/CD8 ratio of ≥ 3.5, and serum angiotensin-converting enzyme (ACE) level (p> 0.05). CONCLUSION: EBB not only offers the advantage of a high diagnostic ratio in patients with mucosal abnormalities but also contributes to pathological diagnosis in patients with normal mucosa. We recommend using EBB to support diagnosis with a low complication rate for patients undergoing FOB with a preliminary diagnosis of sarcoidosis in healthcare centers, where endobronchial ultrasound (EBUS) is unavailable.

Patient and physician delay in the diagnosis and treatment of non-small cell lung cancer in Turkey.

AIM: The early diagnosis and treatment of lung cancer are important for the prognosis of patients with lung cancer. This study was undertaken to investigate patient and doctor delays in the diagnosis and treatment of NSCLC and the factors affecting these delays. MATERIALS AND METHODS: A total of 1016 patients, including 926 (91.1%) males and 90 (8.9%) females with a mean age of 61.5±10.1 years, were enrolled prospectively in this study between May 2010 and May 2011 from 17 sites in various Turkish provinces. RESULTS: The patient delay was found to be 49.9±96.9 days, doctor delay was found to be 87.7±99.6 days, and total delay was found to be 131.3±135.2 days. The referral delay was found to be 61.6±127.2 days, diagnostic delay was found to be 20.4±44.5 days, and treatment delay was found to be 24.4±54.9 days. When the major factors responsible for these delays were examined, patient delay was found to be more frequent in workers, while referral delay was found to be more frequent in patients living in villages (p<0.05). We determined that referral delay, doctor delay, and total delay increased as the number of doctors who were consulted by patients increased (p<0.05). Additionally, we determined that diagnostic and treatment delays were more frequent at the early tumour stages in NSCLC patients (p<0.05). DISCUSSION: The extended length of patient delay underscores the necessity of educating people about lung cancer. To decrease doctor delay, education is a crucial first step. Additionally, to further reduce the diagnostic and treatment delays of chest specialists, multidisciplinary management and algorithms must be used regularly.

Putative bronchopulmonary flagellated protozoa in immunosuppressed patients.

Flagellated protozoa that cause bronchopulmonary symptoms in humans are commonly neglected. These protozoal forms which were presumed to be "flagellated protozoa" have been previously identified in immunosuppressed patients in a number of studies, but have not been certainly classified so far. Since no human cases of bronchopulmonary flagellated protozoa were reported from Turkey, we aimed to investigate these putative protozoa in immunosuppressed patients who are particularly at risk of infectious diseases. Bronchoalveolar lavage fluid samples of 110 immunosuppressed adult patients who were admitted to the Department of Chest Diseases, Hafsa Sultan Hospital of Celal Bayar University, Manisa, Turkey, were examined in terms of parasites by light microscopy. Flagellated protozoal forms were detected in nine (8.2%) of 110 cases. Metronidazole (500 mg b.i.d. for 30 days) was given to all positive cases and a second bronchoscopy was performed at the end of the treatment, which revealed no parasites. In conclusion, immunosuppressed patients with bronchopulmonary symptoms should attentively be examined with regard to flagellated protozoa which can easily be misidentified as epithelial cells.

Effect of smoke-free legislation on smoking cessation rates in teachers in Manisa, Turkey.

OBJECTIVE: This study investigated the attitudes of Turkish adults towards the ban on smoking in public areas and compared annual smoking cessation rates before (pre-2009) and after (post-2009) the ban became law, using data from a survey of teachers. METHODS: A self-reported questionnaire was used to collect data from teachers in Manisa, Turkey. Annual smoking rates were calculated. Joinpoint regression analysis was used to identify when a significant change occurred in the annual smoking cessation rate. RESULTS: Questionnaire response rate was 79.6% (579/727); 47.8% (277) of respondents were male. Smoking prevalence among men and women was 32.7% and 24.7%, respectively, and 97.3% of nonsmokers and 75.5% of current everyday smokers supported the law changes. Results of the Joinpoint analysis showed no significant change in annual smoking cessation rate between 2001-2002 and 2006-2007; but there were significant reductions in smoking rates between 2007-2008 and 2010-2011. CONCLUSIONS: Teachers in Turkey have a positive attitude to the law on smoking. The smoking cessation rate in teachers was significantly increased by changes in legislation.

[A health survey in the workers of municipality]. / Belediye çalisanlarinda akciger sagligi taramasi

INTRODUCTION: Internal and external air pollution that is gradually increasing due to urbanization and industrialization has a negative impact on the lung health. A health survey has been applied to evaluate the respiratory symptoms, respiration functions and smoking habbits of the workers of Izmir Konak Municipality whom have been reported to have a high rate of smoking habbit and be affected by the external air pollution due to their being working in the field by the Municipality's doctor. MATERIALS AND METHODS: Questionnaire that are composed of the topics of work anamnesis, environmental anamnesis, curriculum vitae, symptoms (coughing, sputum, wheezing, dyspnea, hemoptysis) and smoking have been executed to 301 workers by face to face interview and their chest X-rays have been reviewed. RESULTS: Dyspnea on exertion, sputum in the morning, wheezing and morning cough have been the most frequently observed complaints (respectively 37.2%, 32.2%, 27.9% and 24.9%). Sanitary workers have reported sputum in the morning more while maintanance shop workers have reported wheezing more (p values respectively 0.009, 0.008). No significance has been observed while the workers are evaluated one by one regarding to their work groups. No significant difference was identified between the addiction of smoking and nicotin addiction or pulmonary function test and chest X-rays (p> 0.05) but active smoking was much more seen in drivers (p= 0.047). CONCLUSION: Although working on the hazardous work branch does not institute a sharp distinction, it becomes significant to trace and lead the workers in order to obtain their lung health protection in long term. Informing and influencing the workers about the harms of smoking and the ways to quit has been the most considerable acquisition of this survey.

[Sensitivity of cough with capsaicin in smokers]. / Sigara içenlerde kapsaisin ile öksürük duyarliligi.

In this study, effect of long term smoking on sensitivity of cough reflex was investigated. Healthy, current smoker male and female was evaluated by capsaicin cough challenge test and they were compared with healthy, non-smoker persons with similar age and gender, prospectively. In current smokers, there were 50 male and 39 female, in non-smoker control group, there were 20 male and 21 female. Mean and log C5 dosage in current smoker and non-smoker groups and mean and log C5 dosage in current smoker according to gender were calculated by using Mann-Whitney U-test. Results of capsaicin cough challenge test in current and non-smoker groups were evaluated by using Pearson Chi-Square test and Fisher's Exact test. In current smokers comparison of results of capsaicin cough challenge test with smoking history (age with first smoking, duration, pocket year and smoking per day) was evaluated by using Mann-Whitney U-test. Mean C5 and mean log C5 dosage were found decreased in current smokers when they were compared to control group (p< 0.00). In current smoker group mean C5 and mean log C5 dosage were found decreased in male (p< 0.002). When the results of capsaicin cough challenge test were compared between current smoker and control groups, sensitivity of cough reflex in concentration with 0.49, 0.98, 1.95, 3.9, 7.8, 15.6 microM was significantly decreased in current smoker group. Also there was a significant correlation between concentration with 0.98, 1.95, 3.9, 7.8, 15.6, 31.2 microM, and duration of smoking and pocket year of smoking. Also there was a correlation between concentration with 15.6, 31.2, 62.5, 125 microM and smoking per day. This results were correlated with hypothesis about inhibition of C-fibers with nicotin or decrease of C-fibers' sensitivity due to induction of neuropeptide wasting.