Quantitative computed tomography analysis of emphysema severity and distribution in chronic obstructive lung disease, correlation with clinical findings.

INTRODUCTION: This study aimed to evaluate the correlation between different densitometric parameters on chest computed tomography (CT) and pulmonary function tests (PFT) of patients with emphysema-predominant chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: A retrospective evaluation was made of 56 patients with COPD. The lungs were segmented into nine sections. Normal and emphysematous parenchyma were measured using low attenuation area percentage (%LAA), percentile density (PD), and mean lung density (MLD) parameters. The effects of emphysema distribution on PFT were evaluated using %LAA, PD, MLD, kurtosis and skewness methods. RESULT: Fifty-six patients, all diagnosed with COPD, were evaluated. The %LAA-910 method showed significant correlation with forced expiratory volume in one second (FEV1) compared to other densitometric parameters (p= <0.001, r= -0.556). Other densitometric parameters differed between segments in terms of sensitivity for FEV1. It was determined that right lung mid-zone segment involvement affected FEV1 more than other segments when the %LAA -910 method was used (p= <0.001, r= -0.569). %LAA -950 had the largest area under the curve in ROC curve analysis and was determined to have 2.2% diagnostic property for predicting Global Initiative for Obstructive Lung Disease (GOLD) AB-CD staging (sensitivity 81%, specificity 74%). CONCLUSIONS: Quantitative analysis is an objective method for determining the distribution and severity of emphysema. There was a significant correlation between densitometry and PFT values. Quantitative analysis may be considered suitable for use in evaluating the severity of emphysema and predicting the clinical findings of patients.

Comparison of the diagnostic efficacy and complications of transbronchial biopsy in elderly and young patients.

INTRODUCTION: Among bronchoscopic procedures, transbronchial biopsy (TBB) is considered a high-risk procedure. In this study, we aimed to investigate the indications, diagnostic efficacy and complications of TBB in the elderly, which is accepted as a sensitive group. MATERIALS AND METHODS: The study was designed as a multicenter retrospective observational study. Data of 4226 patients who underwent diagnostic bronchoscopy were scanned for this study. 791 patients who underwent transbronchial biopsy were included in this study. All patients were evaluated in terms of lung regions, diagnosis, and complications. RESULT: A total of 791 patients, 329 (41.6%) female patients, who underwent TBB were included in the study. Mean age of the patients was 54.54 ± 14.94 years. The most common indications were ILD (45.6%), malignancy (24.0%) and sarcoidosis (9.9%). Mean age of the elderly patients (n= 263) was 69.89 ± 4.83 years, and mean age of the young patients (n= 528) was 46.90 ± 11.28 years (p<0.001). In both age groups, the most common indication was ILD. Complications developed during and after the procedure in 51 of the young patients (9.7%) and in 21 of the elderly (8.0%) (p= 0.441). The most common complication was pneumothorax with 4.6% in the elderly, and pneumothorax with 5.9% in the young (p= 0.441). The most common diagnosis was malignancy (12.2%) in the elderly, as the most common diagnosis was malignancy (7.2%) in the young (p = 0.020). While anthracosis, ILD and organized pneumonia were the other common diagnoses in the elderly, sarcoidosis, anthracosis and organized pneumonia were the other common diagnoses in the young. The diagnosis of sarcoidosis was achieved more frequently in the young (6.6%) than in the elderly (0.8%) (p<0.001). CONCLUSIONS: Transbronchial biopsy can be performed safely in elderly patients, with similar diagnostic success and complication rates to younger patients.

A very rare fatal complication: bilateral reexpansion pulmonary edema after treatment of single side total pneumothothorax.

Reexpansion pulmonary edema is a rare but fatal clinical condition that develops during the treatment of pneumothorax, pleural effusion and collapsed lung after atelectasis. A 31-year-old male patient was referred to our clinic with the complaint of stinging back pain that started 3 days ago and dyspnea developed during the last 24 hours. Physical examination and radiologic examinations revealed total pneumothorax in the right hemithorax. After tube thoracostomy, his general condition deteriorated and bilateral reexpension edema developed in the lungs. The patient was admitted to the intensive care unit and was discharged on the 5th day after medical treatment. Our case is the first case of bilateral reexpansion pulmonary edema seen after unilateral spontaneous pneumothorax when literature review is performed. In order to emphasize the importance of rapid diagnosis and treatment, it is presented in the light of the literature.

[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.

Regional distribution of genetic mutation in lung cancer in Turkey (REDIGMA).

INTRODUCTION: The results of standard chemotherapy in lung cancer are not very satisfactory, so it is important to identify genetic mutations that provide targeted therapies. Recent reports have suggested influences of racial difference on the frequency of mutation in lung cancer. We aimed to determine the frequency and regional distribution of genetic mutations of non-small cell lung cancer (NSCLC) in Turkey. MATERIALS AND METHODS: Regional distribution of genetic mutations in lung cancer in Turkey (REDIGMA) study was carried out as a prospective, cross-sectional, observational study in a large number of centers in which lung cancer patients were followed and could perform genetic mutation analysis on patients' biopsy materials. RESULT: The 703 patients (77.7% male, mean age 63.3 ± 12.5 years) who were diagnosed as NSCLC from 25 different centers were included in the study. Tumor samples from patients were reported as 87.1% adenocarcinoma, 6.4% squamous cell carcinoma and 6.5% other. Mutation tests were found to be positive in 18.9% of these patients. The mutations were 69.9% EGFR, 26.3% ALK, 1.6% ROS and 2.2% PDL. Mutations were higher in women and non-smokers (p<0.000, p<0.001). Again, the frequency of mutations in adenocarcinoma was higher in metastatic disease. There was no difference between the patient's age, area of residence, comorbidity and clinical stage and mutation frequency. CONCLUSIONS: Our study revealed that the EGFR mutation rate in Turkey with NSCLC was similar to East European, African-American and Caucasian patients, and was lower than in East Asia.

[Frequency of restless legs syndrome and relationship between depression, anxiety and sleep quality among medical school students]. / Tip fakültesi ögrencileri arasinda huzursuz bacak sendromu sikligi, depresyon, anksiyete ve uyku kalitesi arasindaki iliski.

INTRODUCTION: We aimed to investigate the relationship between frequency of restless legs syndrome (RLS), depression, anxiety and sleep quality among medical school students. MATERIALS AND METHODS: We applied a questionnaire to medical school students. This questionnaire includes some questions about demographic features of participants, questions related with RLS diagnosis, the pittsburgh sleep quality index (PSQI), beck-depression-scale (BDS), beck-anxiety scale (BAS) to all subjects. Participants diagnosed with RLS asked to response some additional questions related with RLS severity rating scale. All results compared between RLS diagnosed and healthy subjects. RESULT: A total of 402 medical school students, of whom 55.2% (n= 22) were female, were participated into this study. The ratio of subjects diagnosed as RLS was 16.9% (n= 68). The ratio of RLS diagnosed participants in female students was 18.0% (n= 40) and in male students was 15.6% (n= 28). Of 169 participants who got a poor sleep quality, 36 subjects (21.3%) was diagnosed as RLS. On the other hand, of 233 participants who got a good sleep quality, 32 subjects (13.7%) was diagnosed as RLS (p= 0.004). Score for the RLS severity ranging scale for participants who were diagnosed as RLS was positively correlated with both BDS and BAS scores (p= 0.002, r= 0.372 ve p< 0.001, r= 0.506, respectively). CONCLUSIONS: In this study, the rate of RLS in medical school students were higher than the rate presented in the literature. Additionaly, participants who were diagnosed as RLS in our study had worse sleep quality than healthy subjects. Moreover, RLS may be associated with some psychological mood disorders.

Total cervical tracheal rupture following blunt trauma.

Tracheal ruptures are rarely seen and potentially high life-threatening injuries. Cervical tracheal injuries occur due to the penetrant trauma rather than the blunt trauma. On the other hand, total cervical tracheal rupture due to the blunt trauma is so rare. A 32 year-old male patient was admitted to the emergency service with complaints of breathlessness and stridor resulting from a traffic accident. Thorax computed tomography of the patient revealed total cervical tracheal rupture under the cricoid cartilage level. Emergency tracheostomy was opened and distal airway safety was provided in operating room. The patient underwent an anastomosis with Collar's incision and was discharged in 16th days postoperatively without any complication other than hoarseness.

Arterial stiffness in obstructive sleep apnoea: Is there a difference between daytime and night-time?

BACKGROUND AND OBJECTIVE: Obstructive sleep apnoea syndrome (OSAS) is a common chronic systemic disease in the general population, with known associated cardiovascular outcomes. We aimed to investigate arterial stiffness in OSAS patients and compare daytime and night-time values with control subjects. METHODS: A total of 104 patients undergoing investigation for OSAS with polysomnography also underwent pulse wave velocity (PWV) and augmentation index (AIx) measurements with Mobil-O-Graph for 24 h. Eighty-two patients were found to have OSAS and 22 did not have OSAS and acted as controls. RESULTS: PWV values of the 82 OSAS patients during the 24-h period, both daytime and night-time, were significantly higher than that of the control subjects. Moreover, night-time levels of AIx were significantly higher in OSAS patients than control subjects (P = 0.025). PWV during night-time was higher than daytime measurements in OSAS patients (P = 0.012). Apnoea hypopnoea index (AHI) was significantly correlated with PWV and AIx over 24 h (P = 0.0001, r = 0.412; P = 0.002, r = 0.333, respectively). Positive correlations were also found between oxygen desaturation index (ODI) with PWV and AIx during the night (P = 0.0001, r = 0.480; P = 0.002, r = 0.325, respectively). However, daytime AIx was not significantly correlated with ODI (P = 0.052, r = 0.205). CONCLUSION: OSAS patients, without known cardiovascular disease, have increased PWV, indicating an increased arterial stiffness, compared with control subjects and correlations between AHI and arterial stiffness indices suggest increased arterial stiffness with increased disease severity. Therefore, arterial stiffness should be considered as a possible cause for cardiovascular complications in OSAS patients.

Endobronchial ultrasound: an unusual diagnostic tool for pulmonary embolism.

Pulmonary thromboembolism (PTE) is an emergent and common pulmonary vascular disease. The most common diagnostic method for PTE is computer-aided tomography angiography. Endobronchial ultrasonography (EBUS) is used in diagnosis and staging of lung cancer via transbronchial needle aspiration from mediastinal lymphadenopathies and central masses. Diagnosis of PTE with EBUS is not common, although this technique helps to monitor pulmonary vasculature. The present case, a 60-year-old female patient to whom EBUS was applied because of mediastinal lymphadenopathy, was diagnosed as incidental PTE.

Effects of nondipping pattern on systemic inflammation in obstructive sleep apnea.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is a highly prevalent chronic systemic disease in the general population with high morbidity and mortality. Nondipping pattern-failure to drop blood pressure levels in nighttime-is also seen in OSAS patients. We aim to investigate dipping and nondipping patterns of OSAS patients and to compare inflammatory markers. MATERIALS AND METHODS: Patients with the confirmed diagnosis of OSAS with polysomnography underwent ambulatory blood pressure monitoring. During monitoring, patients with decreased nighttime mean systolic blood pressures 10 % or more were defined as dippers, and the patients without this amount of decrease were defined as nondippers. Peripheral venous blood samples were collected for the analysis of IL-2, IL-6, IL-8, IL-10, IL-12, and TNF-α. Results were compared with convenient statistical tests. RESULTS: According to monitoring results, 34 of 62 OSAS patients were dipper and 28 of 62 patients were nondipper. Demographic characteristics, OSAS severity, and Apnea Hypopnea Index were similar in both groups. When inflammatory markers were compared between two groups, IL-2 levels were found to be significantly different (p = 0.014). CONCLUSION: In conclusion, nondipping pattern appears to be associated with increased serum IL-2 levels indicating the increased inflammatory response independently from OSAS severity, and this pattern should be evaluated carefully for possible cardiovascular complications.

Aggressive hydatid cysts: characteristics of six cases.

PURPOSE: Hydatid cyst (HC) disease is a zoonotic disease caused by the larvae of Echinococcus granulosus. We report our experience of treating HC manifesting aggressive characteristics. METHODS: Between January, 2010 and December, 2013, 40 patients underwent surgery for HC disease in our department. The subjects of this study were six patients whose disease followed an aggressive and invasive clinical course. The HC disease in these patients involved the vertebrae, chest wall, mediastinum, diaphragm, and lung, with destruction of the lung. RESULTS: There were four men and two women, with a mean age of 47 years (range 12-81 years). Treatment consisted of cystectomy and additional procedures, such as corpectomy and resection of the chest wall, approaching the liver and spleen with phrenotomy and lobectomy. One patient suffered prolonged biliary drainage, and another had a bronchopleural fistula and atelectasis. One patient died of empyema 1 month postoperatively. The mean hospital stay was 9 days. CONCLUSION: In some patients, HCs can act as an aggressive tumor, involving the surrounding tissues, organs, and even bony structures. Aggressive HCs may cause various sequelae and require extended surgical interventions in addition to cystectomy.

Effect of nutritional status in individuals with chronic obstructive pulmonary disease undergoing pulmonary rehabilitation.

BACKGROUND AND OBJECTIVE: Chronic obstructive pulmonary disease (COPD) is considered a worldwide major public health problem. Weight loss, muscle and fat mass depletion are common nutritional problems in COPD patients and are determinant factors in pulmonary function, health status, disability and mortality. We aimed to assess the relationships between nutritional status and perception of dyspnoea, pulmonary function tests (PFT), exercise capacity and health-related quality of life (HRQoL) using the subjective global assessment (SGA) in COPD patients who were referred for pulmonary rehabilitation programme. METHODS: A total of 163 patients with stable COPD who are candidates for outpatient pulmonary rehabilitation programme were included in this study. Nutritional status for all patients was assessed by SGA. Association of SGA scores (A, B and C) and anthropometric measurements, PFT, dyspnoea scales (Medical Research Council and resting BORG scale), HRQoL (St. George Respiratory Questionnaire and Chronic Respiratory Diseases Questionnaire) and exercise testing (shuttle walking test) were studied for statistical significance. RESULTS: Based on SGA, 9.2% of patients were severely malnourished (SGA-C). There were significant decreases in forced expiratory volume in the first second (FEV1 ) (P = 0.009), Medical Research Council scales (P < 0.001) and exercise capacity (incremental shuttle walking test (P = 0.001) and endurance shuttle walking test (P = 0.009)) in SGA-C. Deterioration in anthropometric measurements and HRQoL measures were observed in malnourished patients. CONCLUSIONS: Identifying the nutritional status and determining any requirement for nutritional supplement is an important component of comprehensive pulmonary rehabilitation programme. SGA is an easy and practical method to assess nutritional status in pulmonary rehabilitation candidate patients with stable COPD.

Might psoriasis be a risk factor for obstructive sleep apnea syndrome?

BACKGROUND: It is believed that psoriasis is a chronic systemic inflammatory disease. Obstructive sleep apnea syndrome (OSAS) is a disease influencing all systems and characterized by intermittent partial or complete obstruction of the upper respiratory tract during sleep. In our study, we aimed to investigate the frequency of OSAS in patients previously diagnosed with psoriasis in order to investigate a potential association between chronic inflammation psoriasis and OSAS. METHODS: Thirty-three patients diagnosed with psoriasis by biopsy were enrolled into the study. Demographics of patients, Psoriasis Area Severity Index (PASI), Dermatology Life Quality Index (DLQI), and Epworth Sleepiness Scale were examined. All patients underwent polysomnography. RESULTS: OSAS was determined in 18 of 33 patients with psoriasis (54.5 %). Eleven of the 18 patients had mild, 2 had moderate, and 5 had severe OSAS. Mean age was significantly higher in the OSAS group in comparison with non-OSAS group (54.4 ± 15.5 vs 39.4 ± 11.8, respectively, p < 0.05). Mean PASI was higher in the OSAS group in comparison with that of non-OSAS group, and the difference was not significant, although mean DLQI was lower (p > 0.05). It is believed that this was caused by the small patient population. CONCLUSION: We detected that the frequency of OSAS in patients with psoriasis was much higher than that in the normal population. Though OSAS is not easy to diagnose without detailed testing, it should be investigated in psoriatic patients with long disease duration and high PASI score, and patients refractory to conventional systemic treatment. Physicians treating patients with psoriatic disease should incorporate this life-altering comorbidity into their assessment of disease and selection of treatment.

Can exercise capacity assessed by the shuttle walk test predict the development of post-operative complications in patients with lung cancer?

INTRODUCTION: The objective of this study was to assess the role of shuttle walk test in predicting post-operative complications in lung cancer resection surgery. PATIENTS AND METHODS: A consecutive series of patients who were candidate for lung resection surgery with the diagnosis of early stage lung cancer were included to this study. All patients in this study evaluated for exercise capacity testing with shuttle walk test. RESULTS: Twenty for patients were included in this study. Mean age was 61.5 ± 8.6 years. Pneumonectomy, lobectomy, bilobectomy and wedge resection were performed in 11 (46%), 10 (42%), 2 (8%), and 1 (4%) patients, respectively. Complications occurred only in six patients. There was no statistically significant relationship between risk for development of post-operative complication and age, incremental shuttle walk test, endurance shuttle walk test and exercise capacity evaluated with peak VO2 (mL/kg/minute) (p> 0.05). CONCLUSION: Shuttle walk tests (incremental and enduronce) had a limited role in predicting post-operative complications in lung cancer resections.

[Effects of COPD on cognitive functions: a case control study]. / KOAH'in kognitif fonksiyonlar üzerine etkisi: Bir olgu kontrol çalismasi

INTRODUCTION: Assessment of disease severity, effects of disease on health status and future events should be considered to direct treatment strategies in chronic obstructive pulmonary disease (COPD) management. Although extrapulmonary effects of COPD are well known, effects of COPD on cognitive functions have not been evaluated sufficiently. therefore we aimed to determine cognitive functions of copd patients in the present study. MATERIALS AND METHODS: 112 COPD patients with moderate, severe and very severe irreversible airway obstruction and 44 age matched healthy subjects without COPD and systemic diseases as control group were enrolled to the study. Mini mental state examination (MMSE) was performed to evaluate cognitive functions. MMSE results were compared between patient and control groups. Moreover relationship between exacerbation frequency and cognitive functions was evaluated. RESULTS: Total 156 subjects as 112 COPD patients and 44 healthy subjects were included to the study. Mean age of COPD patients was 65.03 ± 7.63 years, and mean age of control group was 63.63 ± 8.96 years (p= 0.364). Mean score of MMSE in COPD patients was 23.8 ± 4.39, and mean score of MMSE in control group was 26.7 ± 2.88. We determined a significant difference in terms of MMSE scores betweeen patient and control group (p< 0.0001). MMSE scores and FEV1 values were significantly different among patients with moderate, sevre and very severe airflow obstruction (p= 0.001; p< 0.0001 respectively). We found a significant negative correlation between MMSE results and exacerbation frequency during last year (p= 0.003; r= -0.239). CONCLUSION: Lower MMSE scores of COPD patients than subjects in control group indicates the impairment of cognitive functions in COPD patients. Moreover a negative relationship between MMSE scores with exacerbation frequency during last year suggests that prevention from exacerbation can decrease cognitive impairment in COPD patients. We believe that assessment of cognitive functions and preventive strategies should be considered in COPD management.

Pulmonary Langerhans cell histiocytosis; characteristics of 11 cases.

INTRODUCTION: Pulmonary Langerhans cell histiocytosis (PLCH) is a rarely seen disease of younger population. Almost all of the patients were smoker. In this study we aimed to evaluate the characteristics, diagnosis, treatment modalities and prognosis of 11 cases with PLCH. MATERIALS AND METHODS: We retrospectively reviewed our case series of eleven patients who were pathologically diagnosed as PLCH. The median age was 35 years (19-51) and male to female ratio (M/F) was 5/6. All of the patients were symptomatic. The most common symptoms were dyspnea (81.8%) and dry cough (72.7%). Mean duration of the symptoms was 10.8 months. All patients except two of them were smoker (81.8%). All patients were also passive smokers. RESULTS: Bilateral cystic appearance (n= 9, 81.8%), interstitial findings [septal and peribronchovascular thickening (72.7%) and nodular pattern (54.5%)] were common radiological findings. Spontaneous pneumothorax was present in two cases. All patients were diagnosed with surgical biopsies (90.9%) or transbronchial parenchymal biopsy (9.1%). Smoking cessation (81.8%) and immunosupression therapy (methylprednisolone) were the treatment modalities. Mean follow-up period was 5.40 ± 1.78 years. Generally, symptoms were improved with smoking cessation or methylprednisolone therapy. One patient was readmitted to our clinic with recurrent pneumothorax. In conclusion, it should be kept in mind that passive smoking is also responsible in the pathogenesis of PLCH. CONCLUSION: Exact consensus for PLCH treatment was not present except a few recommendations. In the future, with the understanding of the pathogenesis of the disease, new therapeutic agents will be discovered for this rare condition.

Effects of education on pain and anxiety before and after video-assisted thoracoscopic surgery.

Introduction: Video-assisted thoracoscopic surgery (VATS) is a common surgical procedure. Aim: To find out how educating patients using multimedia affects their pain and anxiety before and after VATS surgery. Material and methods: The study included 50 patients who underwent VATS between December 2017 and December 2018. The subjects were divided into two groups: the multimedia information group (MIG) and the control group (n = 25). The subjects underwent STAI-T testing, preoperative and postoperative STAI-S testing, and pulmonary function tests (PFT) before surgery and after surgery. Results: The patients in the MIG had higher baseline anxiety levels than those in the control groups. There were no significant differences between the two groups in terms of demographic information, surgical characteristics, or vital signs. There was a statistically significant difference in the preoperative (p = 0.001) and the postoperative (p = 0.0001) pain scores between MIG and control groups. The postoperative STAI-S scores of MIG increased, but this increase was not significant. In both groups, there was no significant difference in the changes in systolic blood pressure (p = 0.656) or respiratory rate (p = 0.05). There was no difference between post-training and pre- and post-operative pain scores in both groups. Conclusions: Providing multimedia information before surgery has some effect on pain. However, providing multimedia information does not reduce postoperative anxiety.

Variability in Stigma Severity During the COVID-19 Pandemic.

Objective The aim of this study was to investigate change in the stigma that emerged during the COVID-19 pandemic over time and the factors responsible for the change. Methods Individuals with COVID-19 who presented to Ankara Medicalpark and VM Medicalpark Hospitals' Internal Diseases and Chest Diseases polyclinic between May 2021 and April 2022 were examined. The volunteers were divided into two groups: those who had COVID-19 within the first six months of the pandemic (group 1) and those who had it in the second six months (group 2). The questionnaire assessing stigma consisted of 29 propositions that participants could mark whether they agreed with them or not. Results The median age of the volunteers was 38 years. Eighty-eight (69.3%) had the disease in the first six months of the pandemic and 39 (30.7%) in the second six months. Moreover, 76.1% of the participants in the first group and 94.9% of those in the second group did not agree with the statement "I thought COVID-19 was a punishment for me" (p=0.011). Further, 56.8% of the participants in the first group and 97.4% of those in the second group stated that they did not agree with the statement "Employers may terminate the employment of employees who they find out have contracted COVID-19" (p<0.001). 80.7% of the participants in the first group and 38.5% of those in the second group agreed with the statement "There was social discrimination against people who caught COVID-19" (p<0.001).  Conclusions At the beginning of the pandemic, the participants had concerns about losing their status and jobs, but this anxiety decreased over time. Stigma in the first six months of the pandemic was greater than that in the second six months, and discrimination related to stigma decreased with recognition of the disease and the increase in experience.

An extremely rare case of multiple calcifying tumor of the pleura.

Calcifying fibrous tumors are uncommon lesions. These lesions are made up of hyalinized collagenous fibrotic tissues interspersed with lymphoplasmacytic infiltrates and extensive dystrophic calcifications mimicking psammomatous features. Calcifying tumor of pleura is rarely presented. Multiple calcifying tumor of pleuras have been reported extremely seldom. Forty-year-old male patient was admitted to our clinic with complaints of dyspnea. Because of the multiple soft tissue formations at the pleural region with the largest diameter of 2 cm on thorax computed tomography, surgical intervention was planed. Frozen sections of pleural biopsies that were taken during video-assisted thoracoscopic surgery were reported as calcifying fibrous tumor. Because of the presence of multiple lesions and pleural adhesions, curative pleural decortication was performed. This case is presented with extremely rare entity of multiple calcifying tumor of plevras.