Factors Influencing Anxiety Levels in Oncology Patients: A Study on the Impact of Earthquakes.

OBJECTIVE: This study aims to explore the multifaceted factors influencing anxiety levels in oncology patients, with a specific focus on the impact of earthquakes in the context of Turkey. Our objective is to identify and understand sociodemographic, clinical, and lifestyle determinants associated with anxiety in cancer patients, examining how traumatic events, such as earthquakes, contribute to heightened anxiety levels. MATERIALS AND METHODS: A cross-sectional study was conducted, involving 149 oncology patients undergoing treatment at two prominent oncology centers in Turkey. The study collected comprehensive sociodemographic information and assessed anxiety levels using the Beck Anxiety Scale. The dataset was analyzed using SPSS 20.0 (IBM Corp., Armonk, NY), employing a range of statistical methods including descriptive statistics, independent t-tests, Mann-Whitney U tests, and Chi-square tests. RESULTS: The findings underscore several factors significantly linked to anxiety levels in oncology patients. Notably, women, younger patients (age <65), and individuals with specific cancer types exhibited higher anxiety levels. Elevated anxiety was also associated with compromised physical functioning, experiences of earthquakes, irregular sleep patterns, dietary habits, fatigue, and the use of antidepressants. CONCLUSION: This study provides insights into the intricate interplay of factors influencing anxiety levels in oncology patients. Understanding these determinants is paramount for tailoring effective psychosocial support and interventions. The results underscore the need for holistic approaches to enhance the overall quality of life for cancer patients. Gender, age, cancer type, physical well-being, lifestyle choices, and exposure to trauma all play pivotal roles in influencing anxiety levels. These findings hold practical implications for the development and implementation of targeted psychosocial interventions aimed at improving anxiety management and overall well-being for oncology patients.

Multicenter Study on Breast Cancer in the Geriatric Population: Insights for Effective Treatment Strategies.

OBJECTIVE: Breast cancer is common among women aged 65 and over. There is a significant lack of evidence regarding the treatment of breast cancer in patients in this age group due to the rare inclusion of these patients in clinical studies. However, it is known that survival in elderly patients with breast cancer is significantly reduced in those not receiving standard therapy. Several factors, including patients' comorbidities, performance status, life expectancy, and tumor pathological and molecular characteristics, can affect the outcomes of treatment. In this study, we aimed to update the knowledge in this field by assessing these factors among the geriatric population in our multicenter dataset. METHODS: This retrospective study analyzed data from 335 breast cancer patients aged 65 and over who received adjuvant radiotherapy at five oncology centers (Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Meram Medical Faculty - Necmettin Erbakan University, Konya, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul, Umraniye Training and Research Hospital, Istanbul, and Istanbul Oncology Hospital, Istanbul) between May 2010 and September 2022. Demographic, clinical, and pathological data were collected, including age, gender, clinical symptoms, tumor characteristics, treatment approaches, and outcomes. Statistical analyses, including descriptive statistics, Kaplan-Meier analysis, log-rank test, and Cox regression analysis, were performed using IBM SPSS Statistics for Windows, Version 22 (Released 2013; IBM Corp., Armonk, New York, United States), with a significance level of p < 0.05. RESULTS: The tumor characteristics and survival time of 335 breast cancer patients were examined. In the results, performance status, T stage, and perineural invasion were found to be factors affecting the survival of elderly breast cancer patients. In multivariate analysis, it was seen that performance status played an important role as an independent prognostic factor. CONCLUSION: The treatment of breast cancer in the geriatric age group necessitates a personalized approach, taking into account the patient's overall health status, life expectancy, and comorbidities.

The clinical, functional, and radiological effect of long-term used immunosuppressive therapy for post-COVID-19 interstitial lung disease.

BACKGROUND AND AIM: Persistent interstitial lung disease (ILD) after COVID-19 infection can lead to severe loss of respiratory function and a decrease in the quality of life. There is no consensus regarding the treatment of post-COVID-19-ILD. This study aims to investigate the effectiveness of immunosuppressive treatment for this group of patients. METHODS: This retrospective observational study included patients diagnosed with post-COVID-19-ILD from 2021 to 2022. Patients who had pulmonary symptoms, required prolonged oxygen therapy, and/or had restrictive pulmonary function test (PFT) and/or DLCO <80%, with diffuse parenchymal involvement on high-resolution computed tomography (HRCT), were given immunosuppressive treatment with methylprednisolone and/or mycophenolate mofetil (MMF) and followed up for 6 months. RESULTS: Among the 48 patients, 35 were treated. Two patients were excluded due to discontinued treatment and passed away before the study period ended. Of 33 cases, 21 (66.6%) were treated with methylprednisolone, 11 (33%) with methylprednisolone + MMF, and 1 (0.4%) with MMF alone. Comparing baseline and 6th-month data revealed significant improvement in mMRC score, saturation (SpO2), FVC, FVC%, FEV%, and DLCO% values (p<0.005). While regression was observed in all radiologic findings, regression in ground glass and reticulation was statistically significant (p<0.005). When the 1st and 6th-month data were compared, a significant increase was observed in SpO2 and DLCO% values (p=0.016) and there was a significant regression in reticulation radiologically (p=0.01). CONCLUSIONS: Long-term immunosuppressive therapy may be preferred in proper cases of post-COVID-19-ILD as an effective and safe treatment option that improves the quality of life, respiratory parameters, and radiologic findings.

Analysis of post-COVID symptoms and predisposing factors for chronic post-COVID syndrome.

Introduction: While there is sufficient information about acute COVID-19, which can cause a multisystemic and fatal disease, post-COVID syndrome and risk factors for this condition remain poorly known. We aimed to identify postCOVID symptoms and risk factors for chronic post-COVID syndrome through this study. Materials and Methods: This prospective cross-sectional study was conducted on 254 out of 384 COVID-19 patients admitted to our COVID-19 polyclinic between February and April 2021. The patients were questioned with a list of 37 symptoms at the fifth and twelfth weeks after disease onset via phone review, and their acute post-COVID (APC) and chronic post-COVID (CPC) symptoms were recorded. Data on risk factors were collected from the hospital's medical records system. Associations between symptom count in the CPC phase and age, sex, hospitalization, RT-PCR result, specific radiological findings, comorbidities, and long-term medications were evaluated. Result: Two hundred twenty-one patients had APC symptoms, and 138 patients had CPC symptoms. While the most common symptom was fatigue at week five, it was hair loss at week 12. Symptoms were observed significantly less in the CPC phase than in the APC phase (Z= -12.301, p= 0.00). Female sex and the presence of specific radiological findings were significantly associated with the occurrence of CPC symptoms (p= 0.03, p= 0.00, respectively). Long-term use of angiotensin-2 receptor blockers (ARBs) was correlated with a low symptom count in the CPC phase (p= 0.00). Conclusions: Female sex and the presence of specific radiological findings were risk factors for developing CPC. Long-term use of ARBs was associated with a low chronic post-COVID symptom burden. A substantial cluster of multisystemic symptoms was observed in both phases, and this condition highlights the requirement for customized outpatient management that includes long-term follow-up and treatment of COVID-19 patients. Identifying the high-risk patients that will develop persistent symptoms can guide this management.

Investigating the levels of depression, anxiety, sexual disorders, and other influencing factors in breast cancer patients: Turkish radiation oncology integrative group study (12-05).

The fear of death associated with cancer and the side effects of its treatments can have a detrimental psychological impact on breast cancer patients. Early detection and support services play a crucial role in alleviating the expected symptoms of depression, anxiety, and sexual dysfunction. The objective of our study is to assess the levels of depression, anxiety, and sexual dysfunction in breast cancer patients, as well as identify the factors that influence these conditions. The study involved 329 voluntarily participating breast cancer patients who had undergone surgery and were in the follow-up stage. Data were collected from 8 different centers after obtaining ethical approval. The assessment utilized tools such as the Sociodemographic Information Form, Beck Depression and Anxiety Scale, and Arizona Sexual Experiences Scale. Data analysis was performed using SPSS 20. The study included 329 breast cancer patients in the follow-up stage post-surgery. Their average age was 52.7 years (range: 27-83). Results indicated that 33.1% experienced moderate to severe depression, 18.2% reported severe anxiety, and 82.7% scored above 11 on the sexual scale. Factors linked to higher scores were mastectomy, surgical dissatisfaction, insufficient information on sexual side effects, and comorbidities like smoking and diabetes. The study emphasizes the importance of closely monitoring anxiety, depression levels, and sexual side effects in breast cancer treatment. It underscores the need to focus not only on reducing mortality rates but also on supporting patients' psychological and sexual well-being, ultimately improving their overall quality of life.

Protective efficacy of pirfenidone in rats with pulmonary fibrosis induced by bleomycin.

BACKGROUND: Bleomycin causes increased production of reactive oxygen species, leads to pulmonary toxicity, fibroblast activation, and fibrosis. OBJECTIVES: This study aimed to evaluate the protective effect of pirfenidone on bleomycin-induced lung toxicity in rats. METHODS: Twenty-eight adult rats were randomly divided into 3 groups; Bleomycin (B group, n=10), Bleomycin and Pirfenidone (B-PND group, n=13), and the control group (n=5). The bleomycin regimen was administered for 9 weeks. Pirfenidone was administered at 100 mg/kg daily. Total antioxidant level (TAS), total oxidant level (TOS), tumor necrosis factor (TNF-α), transforming growth factor (TGF-ß1), matrix metalloproteinase-2 (MMP-2), plasminogen activator inhibitor (PAI) levels were studied. Histopathologically, sections were stained with Hematoxylin-eosin and Masson-trichrome for grading-scoring according to the Ashcroft score. RESULTS: Stage 3 fibrosis was observed in 50% of the B group rats, stage 3 and higher fibrosis was never detected in the B-PND group and the difference was statistically significant (p=0.003). When evaluating tissue inflammation, the inflammation was higher in the B-PND group than in the other groups (p<0.001). Pleuritis was detected in all rats in group B, while was not observed in B-PND and control group (p<0.001). The TAS level was found to be significantly higher in group B than in group B-PND (p=0.034), while no difference was found between TOS, TNF-α, MMP-2, PAI, TGF-ß1. CONCLUSIONS: Pirfenidone had a statistically significant protective effect in bleomycin-induced lung fibrosis and pleuritis in rats.  Despite the presence of inflammation in the tissue, no significant changes were observed in inflammation markers in the peripheral blood. Novel serum biomarkers are needed to indicate the presence of inflammation and fibrosis in the lung.

The role of endobronchial ultrasonography elastography in the diagnosis of hilar and mediastinal lymph nodes.

BACKGROUND: Endobronchial ultrasonography (EBUS) is a minimally invasive diagnostic tool in the diagnosis of mediastinal lymph nodes (LNs) and has sonographic features. We aimed to investigate the diagnostic accuracy of EBUS elastography, which evaluates tissue compressibility integrated into EBUS, on malignant vs. benign mediastinal-hilar LNs. METHODS: A single-center, prospective study was conducted at the University of Health Sciences Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital between 01/10/2019 and 15/11/2019. The features of 219 LNs evaluated by thoracic computed tomography (CT), positron emission tomography (PET)/CT, EBUS sonography and EBUS elastography were recorded. The LNs sampled by EBUS-guided fine needle aspiration were classified according to EBUS elastography color distribution findings as follows: type 1, predominantly nonblue (green, yellow, and red); type 2, part blue, part nonblue; type 3, predominantly blue. The strain ratio (SR) was calculated based on normal tissue with the relevant region. RESULTS: The average age of 131 patients included in the study was 55.86 ± 13 years, 76 (58%) were male. Two hundred and nineteen lymph nodes were sampled from different stations. Pathological diagnosis of 75 (34.2%) LNs was malignant, the rest was benign. When EBUS B-mode findings and pathological results were compared, sensitivity was 65.33%, specificity 63.19%, positive predictive value (PPV) 48%, negative predictive value (NPV) 77.8%, and diagnostic yield (DY) 64%. When the pathological diagnoses and EBUS elastography findings were compared, while type 1 LNs were considered to be benign and type 3 LNs malignant, sensitivity 94.12%, specificity 86.54%, PPV 82.1%, NPV 95.7%, and DY 89.5%. SR of malignant LNs was significantly higher than benign LNs (p < 0.001). When the classification according to color scale and SR were compared, no difference was found in DY (p = 0.155). DISCUSSION: The diagnostic accuracy of EBUS elastography is high enough to distinguish malignant LN from benign ones with the SR option. When compared with EBUS-B mode sonographic findings, it was found to have a higher diagnostic yield.

Revisiting the Radical Radiotherapy-Radiochemotherapy Results in Anal Canal Cancers: (TROD Gastrointestinal Group Study 02-005).

BACKGROUND AND AIM: This study aimed to determine treatment outcomes and factors affecting prognosis in patients diagnosed with anal canal cancer who received radical radiotherapy (RT) or radiotherapy combined with chemotherapy (CT-RT) in radiation oncology centers in Turkey and compare the results with literature. MATERIAL AND METHOD: The study included 193 patients with anal canal cancer reported between 1995 and 2019, of which 162 had complete data. The study was conducted in 11 radiation oncology centers, and a joint database was shared among them. Patients received radiotherapy doses of 45 Gy to 60 Gy. Data analysis was done using SPSS for Windows version 20. RESULTS: Median follow-up was 48.51 months (2-214). All patients received radiotherapy, and 140 (86.4%) received concurrent chemotherapy. Radiotherapy doses of 50.4 Gy to 60 Gy were administered to 74 patients (45.7%) using 2-dimensional-3-dimensional (2D-3D) conformal therapy and 70 patients (43.2%) using intensity modulated radiotherapy technique (IMRT). Acute phase hematologic toxicity was observed in 62 patients (38.3%), and nonhematologic toxicity in 123 patients (75.9%). The 5-year overall survival (OS) rate was 75.1% and disease-specific survival (DSS) rate was 76.4%. OS without colostomy was achieved in 79,8 % at 5 years, and complete response in 112 patients (69.1%). OS rate was significantly higher in 142 patients with positive response (P < .000) and 112 with complete response (P < .000). Anemia (P < .002), local progression, and systemic progression (P < .000) resulted in lower OS (P < .002). In univariate analysis, factors affecting OS rate were: gender, age, stage, lymph node status, T stage, RT treatment duration, and treatment planning with PET fusion, which were found to be statistically significant. Completing radiotherapy in less than 45 days, concurrent chemotherapy, and continued administration of mitomycin and 5 FU as chemotherapy had a significant positive effect on overall survival. OS rate was higher in patients receiving RT dose of 58 Gy or less and undergoing IMRT planning in radiotherapy. IMRT was associated with lower acute and late side effects. CONCLUSION: Radiochemotherapy is the primary treatment for anal canal cancer and advanced radiotherapy techniques may increase survival by reducing side effects and improving treatment continuation. Higher treatment doses require further investigation. The efficacy of treatment can be improved by including patients treated with modern radiotherapy techniques in multicenter prospective studies using new and more effective chemotherapy and immunotherapy agents.

Does shortening the duration of radiotherapy treatment in breast cancer increase the risk of radiation pneumonia: A retrospective study.

Randomized studies evaluating hypofractionation and conventional fractionation radiotherapy treatments (RT) in patients with breast cancer have shown that hypofractionation achieves similar results to conventional fractionation in terms of survival and local control rates. It has also been shown that their long-term toxicities are similar. This study aimed to evaluate the effects of hypofractionated radiotherapy (H-RT) and conventional radiotherapy (C-RT) on lung toxicity and identify factors affecting this toxicity in patients with breast cancer. The study included 118 patients who underwent adjuvant RT following breast-conserving surgery (BCS). Out of these, 63 patients were assigned to receive C-RT, while the remaining 55 were assigned to receive H-RT. To clarify, we treated 63 patients with C-RT and 55 patients with H-RT. 60 patients were treated using 3-dimensional conformal radiotherapy (3DCRT) and 58 patients were treated using intensity modulated radiotherapy (IMRT). The patients were evaluated weekly for toxicity during radiotherapy (RT) treatment and were called every 3 months for routine controls after the treatment. The first control was performed 1 month after the treatment. Statistical analysis was performed using the SPSS20 program, and a P value of <.005 was considered statistically significant. The study found that the median age of the participants was 54.9 years and tomographic findings were observed in 70 patients. Radiological findings were detected at a median of 5 months after RT. The mean lung dose (MLD) on the treated breast side (referred to as ipsilateral lung or OAR) was 10.4 Gy for the entire group. Among patients who received 18 MV energy in RT, those with an area volume (V20) of the lung on the treated breast side >18.5%, those with a mean dose of the treated breast side lung (ipsilateral lung) >10.5 Gy, and those who received concurrent hormone therapy had significantly more tomographic findings. However, patients treated with YART had fewer tomographic findings. No symptomatic patients were observed during the follow-up period. Our findings show that the risk of lung toxicity is similar with H-RT and C-RT, and H-RT can be considered an effective and safe treatment option for breast cancer. The key factors affecting the development of lung toxicity were found to be the type of RT energy used, RT to the side breast, volume receiving 20 Gy in the side lung, side lung mean dose, and simultaneous hormonal therapy.

Oncological outcomes for encapsulated papillary carcinoma of the breast: Multicentric study of Turkish Society for Radiation Oncology breast cancer study group (TROD 06-014 study).

BACKGROUND: Encapsulated papillary carcinoma (EPC) is a rare malignant papillary breast cancer accounting for approximately .5%-2% of all breast tumors. The aim of this multicenter study was to evaluate clinicopathologic features of EPC in addition to oncological outcomes and radiotherapy (RT) details. METHODS: From 10 different academic hospitals in Turkey, we obtained pathology reports of 80 patients with histologically confirmed EPC between 2005 and 2022. Demographic, diagnostic, and treatment data were collected from medical records, retrospectively. Local failure, distant progression, toxicity-adverse effects, overall survival (OS), and disease-free survival were evaluated, and survival analyzes were performed using the Kaplan-Meier method. RESULTS: Eighty patients with the diagnosis of misspelled sorry (ECP) were retrospectively evaluated. The median age of the patients was 63 (range, 35-85). After a median follow-up of 48 (range; 6-206) months, local recurrence was observed in three patients (4%). Local recurrence was less common in the patients who received whole breast RT with a tumour bed boost (p = .025). There were not any distant metastasis or disease-related death. RT was applied to 61% of the cases, and no treatment-related grade 3 or higher toxicity was reported in any of the patients. Five year OS, cancer-specific survival (CSS), and  were observed as 85%, 100%, and 96%, respectively. CONCLUSIONS: ECP is a rare, slow-progressing breast carcinoma associated with good prognosis, it is a disease of elderly patient, and usually occurs in postmenopausal women. It responds extremely well to optimal local treatments and appropriate adjuvant treatments on a patient basis, and has excellent OS and CSS ratios.

Frequency of alpha-1 antitrypsin deficiency and unexpected results in COPD patients in Turkey; rare variants are common.

BACKGROUND: Alpha-1 antitrypsin (α1-AT) is a protease inhibitor that is largely released from liver cells. It inhibits neutrophil elastase and its deficiency increases the risk of developing chronic obstructive pulmonary disease (COPD). The frequency of α1-AT deficiency has been reported with different prevalence rates in different parts of the world. The most common α1-AT variant causing α1-AT deficiency is the Pi*Z allele. In this study, we aimed to determine the frequency of the α1-AT genotypic variant in COPD patients in our country. METHODS: In this study, 196 consecutive COPD patients admitted to our clinic were included. In addition to recording the demographic data of the volunteers, a dry drop of blood sample was taken from the fingertip for the SERPINA1 genotype study. RESULTS: One hundred and fifty-eight (80.6%) of the patients were male and the mean age was 56.92 ± 9.84 years. A variant in the SERPINA1 gene was detected in a total of 14 (7.1%) COPD patients. Pi*ZZ homozygous variant was detected in only 1 (0.51%) patient, while Pi*MZ was detected in 3 (1.53%) patients. The Pi*S variant was never detected. Various rare heterozygous variants were detected in 9 (4.6%) patients and a single point mutation was found in one (0.51%) patient. Serum α1-AT levels were significantly lower in patients with variants compared to the Pi*MM group (p < 0.001). DISCUSSION: In this study, which investigated the genotypic α1-AT variant frequency in COPD patients for the first time in our country, we found that the percentage of homozygous Pi*ZZ patients was 0.51%, but when heterozygous α1-AT gene variant and single point mutation were included, the frequency was 7.1%. At the same time, while the Pi*S variant was never detected, rare variants were found more frequently than expected.

Changes in the Number of Newly Diagnosed Lung Cancer Patients Before and During the COVID-19 Pandemic: A Single-Center Experience.

OBJECTIVE: The coronavirus disease-2019 pandemic has affected the entire health system and patients other than coronavirus-infected patients. Hospital admissions of cancer patients decreased during the closure periods due to the pandemic. This study was conducted to determine whether there was an effect on the hospital admissions of newly diagnosed lung cancer patients in Turkey during the corona- virus disease-2019 pandemic. MATERIAL AND METHODS: In this retrospective study, newly diagnosed lung cancer patients were recorded from the Hospital Information Management System between January 1, 2017, and December 31, 2020, at our tertiary hospital. The number of newly diag- nosed lung cancer patients diagnosed in 2020 was compared with each year from 2017 to 2019. RESULTS: Between 2017 and 2020, 15 150 newly diagnosed lung cancer cases were analyzed. According to Global Cancer Observatory data, in 2018, 34 703 newly diagnosed lung cancer cases, and in 2020, 41 264 newly diagnosed lung cancer cases were observed in Turkey. Although a decrease was not observed in the number of patients according to Global Cancer Observatory data, both the total number of patients admitted to our hospital and the number of newly diagnosed lung cancer patients decreased in 2020. The number of newly diagnosed lung cancer patients by year was 4030 patients in 2017, 4004 patients in 2018, 4391 patients in 2019, and 2725 in 2020, respectively. In 2020, newly diagnosed lung cancer patients decreased by 38%, 32%, and 32% compared to 2019, 2018, and 2017, respectively. Also, a significant decrease was seen in the number of newly diagnosed lung cancer patients in the months with clo- sure due to the pandemic compared to the months without closure. CONCLUSION: There was a significant decrease in hospital admissions of newly diagnosed lung cancer cases in the coronavirus dis- ease-2019 pandemic in our referral hospital. Precautions should be considered to diagnose and treat lung cancer patients in specialized centers during a pandemic due to epidemic diseases such as coronavirus disease-2019.

Evaluation of Nutritional Status and Anxiety Levels in Patients Applying to the Radiation Oncology Outpatient Clinic during the COVID-19 Pandemic: Turkish Society for Radiation Oncology Group Study (TROD 12:02).

Cancer patients often face malnutrition, which negatively affects their response to cancer treatment. This study aims to analyze the effects of the COVID-19 pandemic on nutritional status and anxiety in cancer patients with different types and stages of cancer. This is a cross-sectional cohort study that includes 1,252 patients with varying cancer types from 17 radiation oncology centers. The nutritional risk scores (NRS-2002) and coronavirus anxiety scale (CAS) scores of all patients were measured. NRS-2002 ≥ 3 and CAS ≥ 5 were accepted as values at risk. Of all patients, 15.3% had NRS-2002 ≥ 3. Breast cancer was the most prevalent cancer type (24.5%) with the lowest risk of nutrition (4.9%, p < 0.001). Nutritional risk was significantly higher in patients with gastrointestinal cancer, head and neck cancer, and lung cancer (p < 0.005) and in patients with stage IV disease (p < 0.001). High anxiety levels (CAS ≥ 5) were significantly related to voluntary avoidance and clinical postponement of hospital visits due to the pandemic (p < 0.001), while clinical postponement was particularly frequent among patients with NRS-2002 < 3 (p = 0.0021). Fear and anxiety in cancer patients with COVID-19 cause hesitations in visiting hospitals, leading to disrupted primary and nutritional treatments. Thus, nutritional monitoring and treatment monitoring of cancer patients are crucial during and after radiotherapy.

Coexistence of tuberculosis and COVID-19 pneumonia: A presentation of 16 patients from Turkey with their clinical features.

Introduction: Coronavirus disease 2019 (COVID-19) and tuberculosis are serious and mortal diseases worldwide. There are few studies about the association between tuberculosis and COVID-19 pneumonia. We aimed to describe the characteristics of tuberculosis and COVID-19 co-infection cases in light of the literature. Materials and Methods: Tuberculosis patients who applied to the tuberculosis outpatient clinic between September 1-September 30, 2020, and patients hospitalized in the COVID-19 service between June 1- September 30, 2020, were retrospectively screened. Patients with tuberculosis and COVID-19 co-infection were recorded. Clinical, radiological, laboratory data, and treatments were recorded and analyzed. For the diagnosis of tuberculosis, sputum acid-resistant bacillus (ARB) smear or culture positivity or pathological diagnosis were used. For the diagnosis of COVID-19, positive real-time reverse transcription-polymerase chain reaction and/or typical radiological findings were sought. Result: Seven hundred and fifty-one patients' data at the tuberculosis outpatient clinic, 229 patients' data at the COVID-19 clinic were screened. Sixteen patients meet the criteria. COVID-19 infection rate in tuberculosis patients was 2.1%. Sixty-nine percent of the patients had received COVID-19 disease during diagnosis or initial tuberculosis treatment phase. There were no drugdrug interactions between anti-tuberculosis drugs and COVID-19 treatment. During the COVID-19 treatment, one patient (6%) died, 15 (94%) patients completed the treatment. Conclusions: : In our study, no effect of the coexistence of TB and COVID-19 on morbidity or mortality was observed. Although the number of patients is small, it can be said that patients with early TB disease and with widespread involvement may be riskier for COVID-19 infection. Frequent hospital visits by TB patients may be a risk for COVID-19. It may be beneficial to carry out the diagnosis and treatment of tuberculosis patients by tuberculosis dispensaries as in our country or authorized units to reduce the risk of hospital admissions and COVID-19 transmission.

Results of Tobramycin Inhalation Therapy in Patients with Noncystic Fibrosis Bronchiectasis with Pseudomonas aeruginosa Colonization: Real Life Management.

Background: Inhaled antibiotics for treating bronchiectasis have been investigated in the cystic fibrosis population since 1981 and long-term clinical benefits have been reported. However, studies on noncystic fibrosis bronchiectasis (NCFB) have only been performed more recently. Owing to limited evidence, inhaled antibiotics are not currently approved for treating NCFB by the U.S. Food and Drug Administration and the European Medicines Agency. The aim of this study was to evaluate the efficacy and safety of tobramycin inhalation therapy in patients with bronchiectasis with Pseudomonas aeruginosa (PA) colonization. Methods: In this retrospective cross-sectional study, NCFB patients who were Pseudomonas positive on three consecutive cultures 1 month apart and receiving tobramycin inhalation therapy were evaluated. Evaluation of the following parameters was done in this study: age, gender, smoking history, symptoms, pulmonary function test results, sputum culture results, tobramycin treatment duration, side effects of tobramycin and response evaluation, and hospital admissions before and after treatment. Treatment with 300 mg tobramycin through nebulizer twice daily for 28 days on-off cycles for a total of 6 months was considered to be one treatment period. The approvals for the study were received by the local ethics committee and institutional review board. Results: Of the 27 patients, 21 patients completed the first period, 7 patients completed the second period, 4 patients completed the third period, and 1 patient completed the fourth period. Sputum culture was negative in 10 (47.6%) of the 21 patients who completed the first period. Decreased sputum purulence and quantity, dyspnea, and cough were observed during treatment. The frequency of hospitalizations before treatment was 1.24 ± 1.36, whereas after treatment, it decreased to 0.52 ± 0.91, this difference was statistically significant (p = 0.019). The most common side effect was increased dyspnea after nebulization in five patients. Conclusion: Tobramycin inhalation appears to be a well-tolerated treatment in patients with PA colonization with bronchiectasis. This treatment may decrease the hospitalization rates and improve the symptoms.

Evaluation of Serum Biomarkers in Patients with Sarcoidosis: Can Visfatin Be a New Biomarker for Sarcoidosis?

OBJECTIVES: Sarcoidosis is a chronic systemic inflammatory disease that affects multiple organ systems. The role of biomarkers in the diagnosis and prognosis of sarcoidosis is increasing. Interest in the role of adipose tissue-mediated inflammation in the pathogenesis of inflammatory diseases has increased in recent years. Visfatin is a proinflammatory adipocytokine that has been studied for several inflammatory diseases such as diabetes mellitus, obesity, and metabolic syndrome. We aimed to assess serum visfatin levels in sarcoidosis and its relationship with other markers of inflammation such as C-reactive protein (CRP), angiotensin-converting enzyme (ACE) and erythrocyte sedimentation rate (ESR). MATERIALS AND METHODS: We enrolled 59 patients with sarcoidosis and 21 healthy controls and measured plasma levels of visfatin, along with serum CRP, ESR, and ACE using ELISA (enzyme-linked immunosorbent assay) kits (Blue Gene Biotech, Shanghai, China). RESULTS: Visfatin levels did not differ significantly between the patients and control subjects (29.9±15.8 ng/mL for patients and 23.93±16.73 ng/mL for controls, p=0.15), and there was no correlation between visfatin and serum CRP, ACE, or ESR in patients with sarcoidosis. CONCLUSION: Visfatin is recently being discussed as a biomarker for inflammatory diseases in several studies, and results are controversial. In our study, no differences were found in the serum levels of visfatin between patients with sarcoidosis and the control group.

Duloxetine and pregabalin in neuropathic pain of lung cancer patients.

INTRODUCTION: Neuropathic pain occurs in 1% of the population and is difficult to manage. This chronic pain causes psychological distress and impacts patient's quality of life, especially in cancer patients. The aim of this study was to show and compare the efficacy of pregabalin and duloxetine, which are reported in the group of first-line treatment at European Federation of Neurological Societies (EFNS) guidelines on the pharmacological treatment of neuropathic pain (2010 revision) in lung cancer patients by using visual analogue scale (VAS) and Leeds Assessment of Neuropathic Symptoms and Sign (LANSS). PATIENTS AND METHODS: A prospective, randomized, open label, 3 month of study was conducted. A total of 44 patients that were diagnosed with neuropathic pain (14 women and 30 men) were included in the study. Patient's LANSS and VAS values were recorded before treatment. Then, 22 patients undergo pregabalin and 22 patients undergo duloxetine therapy. But due to side effects (dizziness, constipation), two patients had stopped to use pregabalin. Their LANSS and VAS values were recorded after 1 and 3 months of therapy. RESULTS: When we compare LANSS and VAS scores before treatment, after 1 and 3 months of treatment with pregabalin and duloxetine, a significant decrease was observed in both groups at the 1 and 3 months (p < .01). Duloxetine is superior to pregabalin in reducing the LANSS scores when we compare two groups. CONCLUSIONS: Both duloxetine and pregabalin are effective in the treatment of neuropathic pain of lung cancer patients. And as far as we know, this is the first study comparing the efficacy of duloxetine and pregabalin in the neuropathic pain of lung cancer patients.

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.

A special association between Charcot-Marie-Tooth type 1A disease and relapsing remitting multiple sclerosis.

BACKGROUND: Central nervous system involvement has been reported in different subtypes of Charcot-Marie-Tooth (CMT) diseases. The increasing number of cases with CMT and MS may provide further information about the common pathway of demyelination and MS pathogenesis. CASE PRESENTATION: We report the case of a 21-year-old woman with CMT1A and MS. Bilateral rest and intention tremor, steroid associated psychotic episodes, and severe disability at an early age were unexpected aspects of this case. CONCLUSION: PMP22, the target protein in CMT1A, shares partial homology with other CNS proteins. PMP22 gene might be relevant to a common pathway of the demyelinating process.

Our eight years experience in postintubation/posttracheostomy tracheal stenosis.

INTRODUCTION: The most common cause of tracheal stenosis (TS) continues to be traumas according to the intubation and tracheostomy. Bronchoscopy is considered the gold standard for the detection and diagnosis of tracheobronchial pathology. There are several treatment options. We aimed to discuss our tracheal stenosis patients' treatment options, and their follow-up period. MATERIALS AND METHODS: Consecutive referred patients between 2009 and 2018 presenting with TS were reviewed for the study. Demographic characteristics, localization, length and degree of stenosis, treatment techniques, postoperative complications, and survival were recorded for all patients. RESULT: A total of 110 patients included. The mean age was 53.7 ± 16.7 (16-98 years) years. Of 110 patients, 54 (49.1%) were female. Most common type of stenosis was complex stenosis (74.5%). Mechanical dilatation was applied to all patients. Stenotic regions of 22 (20%) patients were cut with bronchoscopic scissor. Tracheal stents were inserted into trachea of 49 (44.5%) patients. During follow-up period; 36 of 110 (32.7%) patients had surgical resection. Six of 36 (16.7%) patients died during follow-up period (one of them died during surgery), 17 (47.2%) patients had total recovery after surgery. Thirteen of 36 (36.1%) patients had restenosis after surgery. CONCLUSIONS: Tracheal stenosis is a process seen after postintubation or posttracheostomy frequently and it has a wide range of management modalities. Although, it is believed that surgery is the most efficient technique in cases without medical contraindications, we determined that endoscopic interventions can be alternative therapeutic options for inoperable patients. Patients must be followed-up after interventional therapies because complications, and restenosis can usually be seen.