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.

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.

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