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

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

Peripheral Blood Eosinophilia and Neutrophil Lymphocyte Ratio in the Choice of Antibiotic and/or Steroid in Patients Hospitalized with Acute Exacerbations of Chronic Obstructive Pulmonary Disease.

OBJECTIVE: The choice of steroids and antibiotics is optional for the management of acute exacerbation of chronic obstructive pul- monary diseases according to international guidelines. The study hypothesized that the steroid and antibiotic choice can be decided by using the neutrophil-lymphocyte ratio and peripheral blood eosinophilia in patients with acute exacerbation of chronic obstructive pulmonary diseases. This would reduce the rate of re-hospitalization in 28 days. MATERIAL AND METHODS: Patients were hospitalized due to acute exacerbation of chronic obstructive pulmonary diseases from February 1, 2018, to January 31, 2019. Patients were divided into 2 groups: Sureyyapasa protocol group and conventional group. In the Sureyyapasa protocol group, patients were divided into 4 subgroups according to peripheral blood eosinophilia and neutrophil-lympho- cyte ratio values. Treatment success was defined as 5-7 days acute exacerbation of chronic obstructive pulmonary diseases treatment was enough to discharge and no re-hospitalization within 28 days. Treatment failure was defined that the hospital stay was longer than 7 days or transport to intensive care and death or readmission to the hospital due to acute exacerbation of chronic obstructive pulmonary diseases within 28 days after discharge. RESULTS: The Sureyyapasa protocol group (n = 96) and the conventional group (n = 95) were randomly selected. The conventional group and Sureyyapasa protocol group had similar hospital stay (P = .22), and antibiotic and steroid uses were significantly higher in the conventional group than the Sureyyapasa protocol group (antibiotic use 100% vs. 83%, P < .001 and steroid use 84% vs. 29%, P < .001, respectively). Treatment failure in the conventional Group (n = 23, 24%) is higher than the Sureyyapasa protocol group (n = 17, 18%). CONCLUSIONS: Initiating treatment by evaluating eosinophilia and neutrophil-lymphocyte ratio in patients with acute exacerbation of chronic obstructive pulmonary diseases in the ward reduces unnecessary antibiotic and steroid use and cost rates in hospitalizations.

Can red blood cell distribution width (RDW) level predict the severity of acute exacerbation of chronic obstructive pulmonary disease (AECOPD)?

BACKGROUND: Elevated red blood cell distribution width (RDW) levels were associated with mortality in patients with stable chronic obstructive lung pulmonary diseases (COPD). There are limited data about RDW levels in acute exacerbation of COPD (AECOPD). AIM/OBJECTIVE: The association of the RDW levels with the severity of AECOPD was evaluated according to admission location, (outpatient-clinic, ward and intensive care unit (ICU)). METHODS: Cross sectional retrospective study was designed in tertiary care hospital for chest diseases in 2015. Previously COPD diagnosed patients admitted to hospital outpatient-clinic, ward and ICU due to AECOPD were included in the study. Patients demographics, RDW, biomarkers (CRP, RDW, Neutrophil to lymphocyte ratio (NLR), platelet to mean platelet volume (PLT-MPV)) C-CRP, biochemistry values were recorded from hospital electronic system. RDW values were subdivided below 0.11% (low), above and equal 0.15% (high) and between 0.11%-0.15% (normal). Neutrophil to lymphocyte ratio (NLR) and platelet to mean platelet volume (PLT-MPV) were also calculated. Biomarker values were compared according to where AECOPD was treated. RESULTS: 2771 COPD patients (33% female) and 1429 outpatients-clinic, 1156 ward and 186 ICU were enrolled in the study. The median RDW values in outpatients-clinic, ward and ICU were 0.16 (0.09-0.26), 0.07 (0.01-0.14) and 0.01 (0.00-0.07) respectively (P < .001). In outpatient to ward and ICU, low RDW values were significantly increased (31%, 66%, 83%, respectively) and high RDW values significantly decreased (54%, 24%, 10%) (P < .001). According to attack severity, low RDW values were determined. CONCLUSION: Patients with AECOPD, lower RDW values should be considered carefully. Lower RDW can be used for decision of COPD exacerbation severity and follow up treatment response.

Use of Radiology, D-Dimer, and Mean Platelet Volume Combination as a Prognostic Marker in Hospitalized Coronavirus Disease-19 Patients.

INTRODUCTION: The search for biomarkers that could help in predicting disease prognosis in the Coronavirus Disease-2019 (COVID-19) outbreak is still high on the agenda. OBJECTIVE: To find out the efficacy of D-dimer and mean platelet volume (MPV) combination as a prognostic marker in hospitalized COVID-19 patients with bilateral infiltration. MATERIALS AND METHODS: Study design: Retrospective observational cohort. Patients who were presented to our hospital between March 16, 2020 and June 07, 2020 were reviewed retrospectively. The primary outcome of the study was specified as the need for intensive care, while the secondary outcomes were duration of treatment and hospitalization. Receiver operator curve (ROC) analyzes were carried out to assess the efficacy of D-dimer and MPV parameters as prognostic markers. RESULTS: Between the mentioned dates, 575 of 1,564 patients were found to be compatible with COVID-19, and the number of patients who were included in the study was 306. The number of patients who developed the need for intensive care was 40 (13.1%). For serum D-dimer levels in assessing the need for intensive care, the area under the curve (AUC) was found to be 0.707 (95% CI: 0.620-0.794). The AUC for MPV was 0.694 (95% CI: 0.585-0.803), when D-dimer was ≥1.0 mg/L. When patients with a D-dimer level of ≥1.0 mg/L were divided into two groups considering the MPV cut-off value as 8.1, the rate of intensive care transport was found to be significantly higher in patients with an MPV of ≥8.1 fL compared to those with an MPV of <8.1 fL (32.6 vs. 16.0%, p = 0.043). For the prognostic efficacy of the combination of D-dimer ≥ 1.0 mg/L and MPV ≥ 8.1 fL in determining the need for intensive care, following values were determined: sensitivity: 57.7%, specificity: 70.8%, positive predictive value (PPV): 32.0%, negative predictive value (NPV): 84.0%, and accuracy: 63.0%. When D-dimer was ≥1.0, the median duration of treatment in MPV <8.1 and ≥8.1 groups was 5.0 [interquartile range (IQR): 5.0-10.0] days for both groups (p = 0.64). The median length of hospital stay (LOS) was 7.0 (IQR: 5.0-10.5) days in the MPV <8.1 group, while it was 8.5 (IQR: 5.0-16.3) days in the MPV ≥ 8.1 group (p = 0.17). CONCLUSION: In COVID-19 patients with a serum D-dimer level of at least 1.0 mg/L and radiological bilateral infiltration at hospitalization, if the MPV value is ≥8.1, we could predict the need for intensive care with moderate efficacy and a relatively high negative predictive value. However, no correlation could be found between this combined marker and the duration of treatment and the LOS.

Diagnostic value of CD4+, CD8+ and CD103+ lymphocytes in mediastinal lymph node specimens obtained via endobronchial ultrasonography for sarcoidosis.

INTRODUCTION: The aim of the present study is to investigate the diagnostic value of the CD4+, CD8+ and CD103+ lymphocyte sub-groups in mediastinal lymph nodes, as an adjunctive marker in sarcoidosis. MATERIALS AND METHODS: The present study is a single-center, prospective cohort study designed in a reference center for chest diseases. Forty-six patients who underwent endobronchial ultrasound (EBUS)-guided mediastinal lymph node sampling with a preliminary diagnosis of sarcoidosis were enrolled. The different lymphocyte subgroups were counted by flow cytomeytry in lymph node biopsy samples. Based on the final diagnosis, subjects were divided into two groups: sarcoidosis and non-sarcoidosis. Lymphocyte subset analysis were compared between the groups. RESULT: The final diagnoses were sarcoidosis in 31 (67%) and non-sarcoidosis in 15 patients (33%). The total cell counts, lymphocyte ratios, CD8+ T lymphocyte ratios and CD4/CD8 ratios were similar in both groups (p> 0.05). CD4+ T lymphocyte rates were higher in patients with sarcoidosis (p= 0.017). CD103 subset analysis revealed significantly lower CD103+CD4+, CD103+CD8+ lymphocytes and CD103+CD4+/CD4+ ratios in sarcoidosis (p= 0.008, p= 0.048, p= 0.014, respectively). CONCLUSIONS: Cytological examination of EBUS-guided lymph node samples may provide substantial findings in differential diagnosis of sarcoidosis. Patients with sarcoidosis have higher CD4+ lymphocytes, lower CD103+CD4+ lymphocytes and CD103+CD4+/CD4+ and CD103+CD8+ lymphocyte ratios. These subsets of lymphocytes in lymph node biopsies may be novel predictors of sarcoidosis diagnosis.

Behaviours and opinions of adolescent students on smoking.

INTRODUCTION: Smoking is one of the major causes of preventable diseases, disability and death in the globe and Turkey. In our study, the knowledge of students about smoking addiction and which organ in the body is damaged due to smoking are aimed to be determined. MATERIALS AND METHODS: Surveys were applied to students of private university preparatory training center on the Anatolian side of Istanbul. In the conducted survey, the questions related with students' demographic characteristics, themselves, their families and friends smoking addiction, the reasons to start smoking, whether they want to quit smoking, whether they try to quit smoking and which of the organs that they know smoking is harmful were asked. The data obtained were transferred to the Statistical Package for the Social Sciences (SPSS) for Windows. RESULT: Out of 358 students who answered the survey completely, 152 students (42.4%) were male, 206 (57.6%) were female. Students were between the ages of 16-20 and the mean age was 18 ± 1.15. When asked about their smoking addiction, 84 (23.5%) of total actively continued to smoke. Total of 14 students (3.9%) smoked and then stopped smoking, 260 students (72.6%) have never smoked. Curiosity was the most commonly reported reason to start smoking (39%) and for the second row, they indicated to start smoking due to tobacco user friends (30.6%). CONCLUSIONS: More and more young people begin smoking at an earlier age and they transfer the problems of this bad addiction to the later years of their lives. There should be fight resolutely against actions and conditions encouraging smoking both as a state and society and in order to rescue young people from this bad addiction, it should continue to take steps which facilitate accessibility to supportive institutions.

Inflammatory myofibroblastic tumor: a rare tumor of the lung.

Inflammatory myofibroblastic tumor (IMT) is a rare lesion, representing 0.04-1.2% of all lung tumors. Brunn first described it in 1939, but its etiology remains uncertain. A 16-year-old patient was admitted to our hospital for further examination following abnormal radiological findings. The physical examination showed no abnormality, and routine hematological and biochemical parameters were within normal range. Chest radiograph revealed homogenous opacity of the right upper lobe with regular margins. Thoracic CT showed a nodular lesion, 30×26 mm in dimensions, with lobular contours in the right hilar. Bronchoscopic examination showed a vascular endobronchial lesion in the anterior right upper lobe, with bleeding when palpated. She underwent right thoracotomy for diagnostic and therapeutic purposes since bronchoscopic biopsy failed because of bleeding. With a pathological diagnosis of IMT, the present report discusses her case accompanied by relevant literature as it is a very rare type of lung tumor. IMT is a rare benign tumor. The diagnosis is difficult to make before surgery since its clinical and radiological features are variable and nonspecific. Although it is a benign lesion, it should be completely resected and patients should be closely monitored following the resection in order to avoid local invasion and recurrence.