COVID-19 Pandemic and the Global Perspective of Turkish Thoracic Society.

It has been more than 3 months now since the first case of COVID-19 was reported in Turkey. Globally, the number of confirmed cases and deaths reached 9,653,048 and 491,128 respectively, as reported by 216 countries by June 27, 2020. Turkey had 1,396 new cases, 194,511 total cases, and 5,065 deaths by the same date. From the first case until today, the Turkish Thoracic Society (TTS) has been very proactive in educating doctors, increasing public awareness, undertaking academic studies, and assisting with public health policies. In the present report, social, academic, and management perspectives of the pandemic are presented under appropriate subtitles. During this critical public health crisis, TTS has once again demonstrated its readiness and constructive stance by supporting public health, healthcare workers, and the environment. This review summarizes the perspective of TTS on each aspect of the COVID-19 pandemic and casts light on its contributions.

Demographic, Clinical and Management Characteristics of Newly Diagnosed COPD Patients in Turkey: A Real-Life Study.

Purpose: In order to determine the clinical and sociodemographic characteristics of newly diagnosed treatment-naïve asthma and COPD patients in Turkey, a multicenter study in 2012 was initiated . We aimed to investigate the characteristics and therapies of COPD patients in the original study in more detail. Patients and Methods: This nation-wide, multicentric, non-interventional, prospective, real-life observational cohort study was conducted in 122 centers. The newly diagnosed patients were not receiving any treatment before the recruitment. Their general characteristics, the combined GOLD 2011 COPD categories and exacerbation histories were noted. The patients were followed up with 3 voluntary visits for 1 year. Their adherence to the inhaled treatment according to GOLD 2011 was evaluated during follow-up visits. Results: The study included 776 COPD patients. Their mean age was 59.4±9.1 years, and 11.9% of the patients were female. 35.1% of the patients were in the GOLD 2011 C and D category. 12.6% are frequent exacerbators, and 52.8% had at least one comorbid condition. 71.8% overtreatment rate was detected. Their attendance rates for three follow-up visits became 55.9%, 32.9% and 18.7%, respectively. The adherence rate to the treatment was measured as 81.9%. Conclusion: Although these patients were diagnosed for the first time, the GOLD C and D categories and frequent exacerbator phenotype were found at a high rate. They were usually prescribed an overtreatment regimen. We think that newly diagnosed COPD patients should be evaluated carefully, and best effort should be made to treat these patients in accordance with the recommendations of the major COPD guidelines.

Asthma control and adherence in newly diagnosed young and elderly adult patients with asthma in Turkey.

OBJECTIVE: This study aimed to evaluate the factors that affect asthma control and adherence to treatment in newly diagnosed elderly asthmatics in Turkey compared with younger patients. METHODS: This real-life prospective observational cohort study was conducted at 136 centers. A web-based questionnaire was administered to the patients who were followed up for 12 months. RESULTS: Analysis included 1037 young adult asthma patients (age <65 years) and 79 elderly asthma patients (age ≥65 years). The percentage of patients with total control in the elderly and young groups were 33.9% and 37.1% at visit 1, 20.0% and 42.1% (p = 0.012) at visit 2, and 50.0% and 49.8% at visit 3, respectively. Adherence to treatment was similar for both groups. Visit compliance was better in the elderly group than in the young group at visit 1 (72.2% vs. 60.8%, p = 0.045), visit 2 (51.9% vs. 34.9%, p = 0.002), and visit 3 (32.9% vs. 19.4%, p = 0.004). Adherence to treatment increased with asthma control in both groups (both p < 0.001) but decreased with the presence of gastritis/ulcer, gastroesophageal reflux, and coronary artery disease in the elderly. CONCLUSIONS: Asthma control and adherence to treatment were similar for the elderly and young asthma patients, though the follow-up rate was lower in young patients. The presence of gastritis/ulcer, gastroesophageal reflux and coronary artery disease had negative impacts on the adherence to treatment in elderly adult patients.

Real life profile of asthma and chronic obstructive pulmonary disease patients in Turkey.

INTRODUCTION: Despite the presentation of similar symptoms, the airway diseases have different underlying pathophysiological processes and must be distinguished to enable the administration of appropriate treatment. In several studies the clinician- and patient-related causes of poor compliance to treatment in asthma/chronic obstructive pulmonary disease (COPD) patients have been evaluated. This study aimed to determine the clinical and sociodemographic characteristics of newly diagnosed treatment-naïve asthma and COPD patients in Turkey. MATERIALS AND METHODS: This national, multicentre, prospective, observational study was conducted in 122 centres. A questionnaire including items related to demographic, clinical, laboratory parameters was applied. All patients were intended to be followed-up for 12 months. RESULT: 1892 adult patients (1116 asthma and 776 COPD) from 122 centres were enrolled. Overall 95%, 86% and 65% of intermittent, mild persistent and moderate persistent asthma patients were over-treated. Among COPD patients, the percentages of over-treated patients were 66%, 79% and 82% for those with GOLD stage A, B and C. Physicians' adherence to guidelines was appropriate in 93% of severe persistent asthma patients and 89% of GOLD stage D COPD patients. Among patients with high compliance to treatment, proportion of asthma patients with total control was 44% and that of COPD patients at GOLD stage A was 41%. In consecutive two visits, this figure increased to 52% and 63% in asthma patients and 54% and 50% in COPD patients. CONCLUSIONS: The main findings are: (a) patients are frequently over-treated and (b) patients do not adhere to visits as expected, in both asthma and COPD.

Quality of life, depression and anxiety in young male patients with silicosis due to denim sandblasting.

The aim of this study was to estimate the quality of life, depression and anxiety in patients with silicosis due to denim sandblasting. This study was conducted on 50 young male patients with silicosis and 30 controls. A socio-demographic data form, Short Form-36 (SF-36), the Beck depression inventory (BDI) and the Beck anxiety inventory (BAI) were used to determine quality of life, depression and anxiety. The mean scores of SF-36, BDI and BAI were higher in the patients than in the controls. Correlation analysis revealed a strong negative correlation between all scales of SF-36 and BDI scores. Additionally, there was strong negative correlation between five scales of SF-36 and BAI scores. We suggest that silicosis might be detrimental to the quality of life and increase depression and anxiety in patients with silicosis due to denim sandblasting.

Adapted T cell interferon-gamma release assay for the diagnosis of pleural tuberculosis.

BACKGROUND: Better and more rapid tests are needed for the diagnosis of tuberculous pleural effusion (TPE), given the known limitations of conventional diagnostic tests. OBJECTIVES: To estimate diagnostic accuracy of the QuantiFERON-TB Gold In-Tube (QFT-GIT) test (and its components) using data-derived cutoffs in pleural fluid. METHODS: The QFT-GIT test was performed on whole blood and pleural fluid from 43 patients with TPE and 29 control subjects (non-TPE). To achieve the objective, QFT-GIT test, estimating likelihood ratios and receiver operating curve analysis were performed. RESULTS: The sensitivity and specificity using the QFT-GIT for the diagnosis of TPE were 48.8% and 79.3%, respectively, in pleural fluid. The best cutoff points for tuberculosis (TB) antigen, nil and TB antigen minus nil results were estimated at 0.70, 0.90 and 0.30 IU/ml, respectively. Area under the curve of TB antigen IFN-γ response was 0.86 (CI: 0.76-0.93), nil tube was 0.80 (CI: 0.69-0.89) and TB antigen minus nil tube was 0.82 (CI: 0.72-0.90). When the best cutoff scores of the nil tubes were set at this value, the results of a likelihood ratio of a positive and a negative test were 9.44 (7.4-12.0) and 0.37 (0.09-1.5), respectively. The percentages of indeterminate results in pleural fluid among the TPE cases were 42% (most of them caused by high nil IFN-γ values) using the QFT-GIT test. CONCLUSION: QFT-GIT test or its components have poor accuracy in the diagnosis of TPE, largely because of a high number of indeterminate results due to high background IFN-γ production in the TPE.

MDCT findings of denim-sandblasting-induced silicosis: a cross-sectional study.

BACKGROUND: Denim sandblasting is as a novel cause of silicosis in Turkey, with reports of a recent increase in cases and fatal outcomes. We aimed to describe the radiological features of patients exposed to silica during denim sandblasting and define factors related to the development of silicosis. METHODS: Sixty consecutive men with a history of exposure to silica during denim sandblasting were recruited. All CT examinations were performed using a 64-row multi-detector CT (MDCT). The nodules were qualitatively and semi-quantitatively analyzed by grading nodular profusion (NP) on CT images. RESULTS: Silicosis was diagnosed radiologically in 73.3% of patients (44 of 60). The latency period (the time between initial exposure and radiological imaging) and duration of silica exposure was longer in patients diagnosed with silicosis than in those without silicosis (p < 0.05). Nodules were present in all cases with centrilobular type as the commonest (63.6%). All cases of silicosis were clinically classified as accelerated and 11.4% had progressive massive fibrosis (PMF). Mild NP lesions were the most prevalent in all six zones of the lung. The NP score was significantly correlated with the duration of silica exposure, the latency period, presence of PMF, and pleural thickening. Enlarged lymphadenopathy was present in 45.5% of patients. CONCLUSIONS: The duration of exposure and the latency period are important for development of silicosis in denim sandblasters. MDCT is a useful tool in detecting findings of silicosis in workers who has silica exposure.

Incidence of tuberculosis disease and latent tuberculosis infection in patients with end stage renal disease in an endemic region.

AIM: Patients in chronic renal failure suffer impaired cellular immunity and have an increased risk of tuberculosis (TB). Our aim in this multicenter study was to determine the incidence of TB and to evaluate latent tuberculosis infection (LTBI) in hemodialysis patients. METHODS: We retrospectively evaluated the frequency of TB in 779 dialysis patients at 13 hemodialysis centers in five different cities in Southeast Turkey. The tuberculin skin test (TST) was conducted in 733 patients to detect LTBI. RESULTS: The mean age of the patients was 51.2 +/- 15.9 years; 398 (51.1%) of the patients were female, and 53.9% of patients had a BCG scar. The mean dialysis duration time was 35.1 +/- 33.4 months. TB was diagnosed in 34 cases. The incidence rate of TB in patients undergoing hemodialysis was 3.1%. Ten patients had a history of TB before beginning hemodialysis, and 24 patients had a history of TB after beginning hemodialysis. A diagnosis of TB was made based on clinical data in eight patients and microbiologically or pathologically in 26 patients. The median time between the initiation of dialysis to the diagnosis of TB was 11 months. Extrapulmonary TB occurred in 45.8% of cases, and the most common site of involvement was the lymph nodes. The TST was positive in 61.8% of TB patients and in 37.5% of those with no history of TB. CONCLUSIONS: The incidence of TB is high in hemodialysis patients, and they should be evaluated periodically to exclude insidious infection and reduce morbidity and mortality.

Environmental asbestos-related pleural plaque in southeast of Turkey.

It is known that many malignant and benign pleural diseases occur due to environmental exposure to mineral fibers. Calcified pleural plaque (CPP) is an important sign of asbestos exposure on chest radiographic examination. To study the possible change in the prevalence of CPP and diffuse pleural thickening 3 decades after cessation of asbestos exposure. CPP were detected in 29.9% of the villagers; 4.7% had diffuse pleural thickening and 0.7% had asbestosis. The significant variable for CPP and diffuse pleural thickening was age. The youngest villager with CPP was 33 years of age and the prevalence of CPP increased with an increase in age. The reason for our cases with CPP being of advanced age is the discontinuation of asbestos exposure. This finding enables us to suggest that environmental asbestos-related disease will gradually decrease in future decades.

Pregnancy complicated by superior vena cava thrombosis and pulmonary embolism in a patient with Behcet disease and the use of heparin for treatment.

Behcet disease is a multisystemic vasculitis of unknown origin. Vascular involvement has been considered to result from systemic vasculitis, occurs in 5-10% of these patients. We report a 34-year-old pregnant woman complicated by superior vena cava thrombosis, and pulmonary embolism in a patient with Behcet disease.

Does biomass exposure affect serum MDA levels in women?

It is believed that the inhalation of biomass fuel, a substance that is used for bread baking and heating in rural areas, is associated with chronic obstructive pulmonary disease (COPD) and pulmonary symptoms. The products of biomass are claimed to affect the oxidant/antioxidant imbalance, which plays a significant role in such a disease COPD. In our study, the serum level of malonyldialdehyde (MDA) was accepted as a marker of oxidant/antioxidant imbalance, and it was measured by the thiobarbituric acid method. A total of 43 women living in the central and rural areas of Diyarbakir was chosen randomly for the study and they were divided into two groups. The first group, also called the study population, consisted of 28 women living in rural areas. The mean age of the sample was 43 yr (range 31-63 yr). All were healthy and nonsmokers. Among these women the mean duration of the exposure to biomass was 12 h/wk for 25 yr. The mean MDA level (+/-SD) was 3281 +/- 0.789 nmol/ml. The second group, the control population, consisted of 15 healthy women of age 42 yr (range 30-65 yr). They were again nonsmokers and healthy. These women were selected from the central Diyarbakir. The mean MDA level (+/-SD) was 1.474 +/- 0.630 nmol/ml. The difference between two populations were statistically significant (p < 0.0001). In conclusion, we believe that the high level of serum MDA in women is a result of biomass exposure.