Association between pulmonologists' tobacco use and their effort in promoting smoking cessation in Turkey: a cross-sectional study.

BACKGROUND: A strategy to reduce the number of smoking-related deaths is to encourage the involvement of health-care professionals in tobacco-use prevention activities and cessation counseling. Previous studies have shown that physicians' smoking status affects their efforts to provide smoking cessation counseling. This study investigates the association between pulmonologists' tobacco use and their efforts in promoting smoking cessation during their routine clinical practices in Turkey. METHODS: This cross-sectional study was performed among active members of the Turkish Thoracic Society (TTS) between June 2010 and February 2011 using an Internet-based self-administered questionnaire. Participants gave their written informed consent. The survey included questions about responders' sociodemographics, smoking status, and their routine clinical practice for smoking cessation counseling using the basic 5A's (Ask, Advise, Assess, Assist, and Arrange) of smoking cessation counseling. According to the total score for the 5A's protocol, smoking cessation counseling was dichotomized into low- and high-effort groups in promoting smoking cessation. Pearson's chi-square test and t-test were used to compare groups and logistic regression models for the research question, which was approved by the TTS Scientific Ethical Committee. RESULTS: The response rate was 41 % (N = 699/1701); 9.9 % were current smokers, and 72.7 % indicated that they provided high effort in promoting smoking cessation. A univariate analysis showed that noncurrent smokers were more likely to make a high effort than current smokers (odds ratio [OR], 1.82; 95 % confidence interval [CI]: 1.09-3.05; P = 0.02). However, there was no association between tobacco use (current smoking) and making high effort in promoting smoking cessation after controlling for the two confounders, sex and practicing in smoking cessation outpatient clinic (OR, 1.47; 95 % CI: 0.86-2.50; P = 0.1). CONCLUSIONS: Despite low response rate in our study and suspicions of underreporting, the smoking rate among the pulmonologists in our study was high. Non-current smokers were more likely to provide high effort in promoting smoking cessation compared to current smokers in univariate analysis. However, after controlling for the two confounders, sex and practising in SCOC, there was no association between tobacco use and providing high effort in promoting smoking cessation. Thus, improving medical school education, specialty training and post-graduate training on smoking cessation counseling may positively affect physician' effort in promoting smoking cessation.

[The frequency of performing smoking cessation outpatient clinic in chest disease specialists who are members of Turkish Thoracic Society and factors affecting this performance]. / Türk Toraks Dernegi üyesi olan gögüs hastaliklari hekimleri arasinda sigara birakma poliklinigi yapilma sikligi ve iliskili faktörler.

INTRODUCTION: Although helping patients to stop smoking is a good clinical practice that has to be carried out by physicians everywhere and in every area, it is known that carrying out this help systematically in accordance to a programme in smoking cessation outpatient clinics significantly improves the chance of success. MATERIALS AND METHODS: The study is a cross-sectional survey performed among chest disease specialists who are members of Turkish Thoracic Society (TTS), between June 2010 and February 2011. As independent variables relevant to status of performing/not performing Smoking Cessation Outpatient Clinic (SCOC); sex, age (younger or older than 40), being graduated before or after 1996, being or not being in a consultant position, work place (Hospital of Ministry of Health/private hospital/university hospital), having or not having an education for smoking cessation help and being or not being member of a City Tobacco Control Committee (CTCC) were investigated. Data was collected via a web-questionnaire prepared by using WHO Global Health Professionals Questionnaire which was sent to members through TTS secreteriat. RESULTS: 41% (699/1701) of members of TTS responded. 39.5% of responders reported that they perform SCOC. When the factors possibly affecting the performance of SCOC are evaluated with logistic regression analysis; being graduated after 1996, having an education for smoking cessation help, being a member of CTCC and not being an active smoker are found to improve this performance. CONCLUSION: Our study showed that having an education for smoking cessation help (and tobacco control) makes chest disease specialists get more responsibility on this topic. Accordingly, continuous efforts for improving awareness of personal and social responsibilities of all physicians, especially chest disease specialists, have to be made to provide their taking active roles in tobacco control.

Obstructive sleep apnea is prevalent in patients with pulmonary embolism.

PURPOSE: Obstructive sleep apnea (OSA) syndrome causes systemic consequences due to hypoxia and endothelial dysfunction. The purpose of this study was to investigate whether OSA is more common in subjects with pulmonary embolism (PE). METHODS: This prospective study was conducted between November 2009 and December 2010 in the Department of Pulmonary Medicine of Gaziantep University. Twenty-eight patients with PE were included in the study group along with forty-five subjects with OSA as the control group. The control group was selected from among subjects who were referred to the sleep clinic. Full night polysomnography was performed for each subject. RESULTS: Mean apnea-hypopnea index (AHI) was found to be higher in the PE group compared with the control group (p=0.010). Severe OSA was detected in 21.4% of the PE group but in no controls (p=0.015). Sleep stage 2 was longer in control group whereas stage 1 and rapid eye movement (REM) sleep was longer in the PE group. Snoring and excessive daytime sleepiness were more common in the control group compared with the study group. AHI severity and thrombus localization were not significantly different between the groups (p=0.350). CONCLUSION: Our study findings suggest that OSA is more prevalent and severe in subjects with PE compared with control subjects. The clinical significance of less prevalent excessive daytime sleepiness and snoring in subjects with PE should be evaluated in further studies.

Risk Medicine and Transhumanism.

New developments in bioinformatics, artificial intelligence, and nano-biotechnologies will radically change the practice of medicine to be exhibited in the coming years. One approach that has the potential to carry this changing medical practice into a superhuman age and that has been dominating medical literature in recent years is the risk approach. This article aims to address the issue beyond the dichotomy of good or evil without wrapping the practice of medicine exhibited throughout the human body and history in the sacrament of holiness and falling into the traps of bioconservatism and solutionism.

Factors influencing compliance with continuous positive airway pressure ventilation in obstructive sleep apnea syndrome.

INTRODUCTION: Positive pressure ventilation is considered first line therapy in obstructive sleep apnea syndrome however compliance is limited by various factors. We aimed to investigate possible factors influencing compliance. MATERIALS AND METHODS: One hundred and forty patients were prescribed positive pressure ventilation for obstructive sleep apnea during June 2006-June 2008. Of these patients, 77% (n= 108) were reached by telephone and a questionnaire was administered regarding factors influencing treatment compliance. Airway passage was measured with C2 vertebrae level and narrowest airway passage on lateral skull radiographs. RESULTS: The mean age was 52.2 ± 12.3 years. Seventy one percent (n= 77) of subjects obtained the prescribed device. There was no difference in sex, age, marital status, educational level, symptoms, co-morbid conditions, and social security coverage between the subjects who have received the prescribed devices and who have not (p> 0.05). No difference was detected between these two groups of patients in view of Epworth sleepiness scale (ESS) and apnea hypopnea index (AHI). Mean duration of device usage was 6.3 ± 2.3 hours. The device use compliance was not affected by any of the following factors: age, gender, level of education, co-morbid diseases, ESS score, AHI, airway passage measurements, application of humidification and education concerning the device (p> 0.05). Patient (p= 0.057) and bed partners (p= 0.001) satisfaction about the device yielded higher compliance rates. CONCLUSION: Factors influencing compliance rates in obstructive sleep apnea syndrome seems to be related to satisfaction about the device use however upper airway morphology measured with C2 vertebrae level and narrowest airway passage has no impact on treatment compliance.

Churg-Strauss syndrome related to montelukast.

A young male with complaints of cough, dyspnea and hemoptysis was admitted. He was using fluticasone propionate and salmeterol for two years for his asthma. Leukotriene receptor antagonist was prescribed two weeks prior to his admission and no reduction of his inhaled steroid therapy was performed. Eosinophil count was detected as 1460/mm³ (15%) and immunoglobulin E level was 547 IU/mL. Thorax computerized tomography revealed patchy infiltration. Increased eosinophilic inflammation were detected in bronchoalveolar lavage fluid and transbronchial biopsy. He received prednisolone treatment for Churg-Strauss syndrome. Improvement was observed on three months follow up period. He has no complaint in his follow up.

COVID-19 Outbreak in Istanbul.

OBJECTIVE: The COVID-19 pandemic has demonstrated that the social determinants of health play a fundamental role in the course of the pandemic. This article aims to reveal the class dynamics of the COVID-19 epidemic in Istanbul, Turkey. MATERIAL AND METHODS: Spatial analysis and geographic information system data provided by Istanbul Metropolitan Municipality for March and April 2020 were used. Public transport mobility and turnstile data were analyzed. The data obtained were collated into thematic maps. RESULTS: Between March 16 and 24, 2020, the use of public transportation declined with the tightening of movement restrictions. However, despite the restrictions, an increase in transportation density was observed between 6 and 9 am and between 5 and 7 pm. Although the overall mobility toward outside the city has fallen due to travel restrictions, it has been observed that exit mobility continued between Gebze and Kocaeli, both industrial centers where blue-collar jobs dominate. Most of the mobility in the city is observed in Avcilar, Bahçelievler, Esenyurt, and Küçükçekmece, which are mostly blue-collar residential districts. On the Asian side, activity was observed in Kurtköy, Pendik, Samandira, Ümraniye, and Tuzla, areas where blue-collar workers predominantly reside. From March 25 to April 7, 2020, it was determined that the most intense activity areas of the blue-collar workers were Avcilar, Bahçelievler, Bagcilar, Çekmeköy, Esenyurt, Küçükçekmece, Ümraniye, and D-100 highway line. CONCLUSION: The density in the use of public transportation rose during the hours corresponding to the working hours of the workers who had to continue working despite the pandemic. In addition, the physical movement of blue-collar workers continued despite the travel restrictions imposed along the city borders where they worked and resided. Our data point to the importance of social protection measures for workers in general, and blue-collar workers in particular, for the management of the pandemic.

Will plain packaging of cigarettes achieve the expected? Perceptions among medical students.

INTRODUCTION: Plain packaging is one of the critical strategies in eliminating the promotion of tobacco products. Evidence indicates that plain packaging decreases the attractiveness of tobacco products and enhances the effectiveness of health warnings. This study aimed to explore the perceptions of undergraduate medical students of plain packaging and new pictorial warnings before they came into use in Turkey. METHODS: This qualitative study was carried out among undergraduate students in a Medical School in Istanbul in 2019. Participants were recruited through purposive sampling, and data were collected through focus group discussions. The participants were asked to discuss their perceptions regarding one original branded pack and ten plain package models. All discussions were audiotaped and thematic content analysis was conducted. RESULTS: A total of 72 students participated in the study. None of the students had seen plain packaging before. Most of the students perceived plain packaging as more favorable compared to the branded packs. The terms used to describe plain package were: 'appealing/desirable', 'attractive', 'beautiful', 'cool/eye-catching', 'charming', 'elegant', and 'special'. Some students indicated that they would have preferred plain packs over the branded ones if both types of products had been in the market and provided they were of the same brand. Pictorials had different impacts based on their content. At the same time, outer body deformities were perceived as 'real' and provoked unfavorable feelings; inner organ images were defined as 'imaginary' and had little to no impact. CONCLUSIONS: Plain packaging was perceived as a more attractive alternative to the conventional branded packs among most participants. We must be aware of the unforeseen effects of plain packaging among different subgroups in the new generations. We suggest using outer body deformities in the pictorials more frequently due to their higher impact.

Clinical Predictors of Response to Tocilizumab: A Retrospective Multicenter Study.

OBJECTIVE: A substantial number of patients with coronavirus disease-2019 (COVID-19) demonstrate severe infection. Cytokine storm is an underlying condition that worsens clinical outcomes. As an interleukin-6 receptor antagonist, tocilizumab is a promising treatment option for COVID-19. This study aimed to evaluate the clinical predictors of mortality for critically ill COVID-19 patients receiving tocilizumab therapy. MATERIAL AND METHODS: The retrospective cohort study was conducted in 4 centers' both wards and intensive care units between March 20 and May 20, 2020. Demographic, clinical, and laboratory data were consecutively drawn from medical records. The primary endpoint was in-hospital mortality. RESULTS: In this study, 39 patients (28.2% female) were included, and the mortality rate was 25.6% (n = 10). There was statistically significant difference between survivor and non-survivor groups regarding age (53.0 (46.5-65.0) vs. 75.0 (68.25-81.25), respectively,P = .001), CALL score (8.0 (7.0-10.0) vs. 12.0 (9.75-13.0), P = .001), GRAM score (119.5 (99.5-142.0) vs. 155.0 (129.8-226.0), P = .004), and white blood cell count (k/mL) (5.6 (3.8-8.6) vs. 8.0 (7.6-9.3), P = .003). The patients who were on invasive mechanical ventilation at the time of tocilizumab administration had a higher mortality rate (100% vs. 25.9%, P < .001). Besides, arterial partial pressure of oxygen/ fraction of inspiratory oxygen (PaO2/FiO2) ratio on day 7, but not on days 0, 1, and 3 of tocilizumab therapy, was associated with mortal- ity. C-reactive protein (mg/dL) tended to be lower in the survivor group; however, it was not statistically significant (68.4 (32.7-157.5) vs. 113.5 (77.7-219.0), P = .058). CONCLUSION: This study demonstrated that advanced age, increased leukocyte count, higher CALL and GRAM scores, and the need for invasive mechanical ventilation revealed a worse prognosis after tocilizumab treatment.

Turkish Thoracic Society's Statement Report on Electronic Cigarettes and Heated Tobacco Products.

Tobacco addiction, which causes the death of more than 8.5 million people in the world every year, is a preventable global public health problem. There are 1.1 billion adult smokers worldwide and 60% of them desire or intend to quit but unfortunately, the tobacco industry continues to profit at the expense of people's lives by marketing electronic cigarettes and heated tobacco products as a smoking cessation method and they continue to poison young people with new threat tobacco products, promising a "smoke-free future" Turkish Thoracic Society is actively involved in the implementation of the National Tobacco Control Program to protect public health and has warned and raised awareness of new threats to the youth, such as electronic cigarettes and heated tobacco products. The purpose of this report is to provide information about electronic cigarettes and heated tobacco products and to present TTJ's position on the subject.

The association of antiviral drugs with COVID-19 morbidity: The retrospective analysis of a nationwide COVID-19 cohort.

Background and objectives: Although several repurposed antiviral drugs have been used for the treatment of COVID-19, only a few such as remdesivir and molnupiravir have shown promising effects. The objectives of our study were to investigate the association of repurposed antiviral drugs with COVID-19 morbidity. Methods: Patients admitted to 26 different hospitals located in 16 different provinces between March 11-July 18, 2020, were enrolled. Case definition was based on WHO criteria. Patients were managed according to the guidelines by Scientific Board of Ministry of Health of Turkey. Primary outcomes were length of hospitalization, intensive care unit (ICU) requirement, and intubation. Results: We retrospectively evaluated 1,472 COVID-19 adult patients; 57.1% were men (mean age = 51.9 ± 17.7years). A total of 210 (14.3%) had severe pneumonia, 115 (7.8%) were admitted to ICUs, and 69 (4.7%) were intubated during hospitalization. The median (interquartile range) of duration of hospitalization, including ICU admission, was 7 (5-12) days. Favipiravir (n = 328), lopinavir/ritonavir (n = 55), and oseltamivir (n = 761) were administered as antiviral agents, and hydroxychloroquine (HCQ, n = 1,382) and azithromycin (n = 738) were used for their immunomodulatory activity. Lopinavir/ritonavir (ß [95% CI]: 4.71 [2.31-7.11]; p = 0.001), favipiravir (ß [95% CI]: 3.55 [2.56-4.55]; p = 0.001) and HCQ (ß [95% CI]: 0.84 [0.02-1.67]; p = 0.046) were associated with increased risk of lengthy hospital stays. Furthermore, favipiravir was associated with increased risks of ICU admission (OR [95% CI]: 3.02 [1.70-5.35]; p = 0.001) and invasive mechanical ventilation requirement (OR [95% CI]: 2.94 [1.28-6.75]; p = 0.011). Conclusion: Our findings demonstrated that antiviral drugs including lopinavir, ritonavir, and favipiravir were associated with negative clinical outcomes such as increased risks for lengthy hospital stay, ICU admission, and invasive mechanical ventilation requirement. Therefore, repurposing such agents without proven clinical evidence might not be the best approach for COVID-19 treatment.

Gender differences with respect to psychiatric comorbidity in obstructive sleep apnea syndrome.

OBJECTIVES: Psychiatric disorders are common in obstructive sleep apnea syndrome (OSAS); however, interrelating factors influencing psychiatric comorbidity (PC) in OSAS are unclear. The aim of this study is to investigate gender related differences with PC in OSAS. METHODS: Data of patients diagnosed as OSAS in University of Gaziantep from January 2006 to January 2010 were retrospectively evaluated. Polysomnographic data were recorded with Viasys Sleep Screen (Viasys Healthcare, Germany). Patients younger than 18 years old were excluded. RESULTS: PC was present in 53.1% of OSAS patients. The rate of male subjects with PC was 42.6%; however, 76.26% of females had PC (P = 0.00). Age (P = 0.00) and body mass index (BMI) (P = 0.00) were higher in patients with PC. Ferritin levels were lower in patients with PC (P = 0.00). Male subjects with PC were older and had lower sleep efficiency and longer rapid eye movement latency than males without PC. BMI was the only contributory factor to PC in female subjects. CONCLUSION: PC in OSAS is common, especially in females. Apnea hypopnea index does not seem to influence probability of PC.

[Pulmonary manifestations of polyvinyl chloride exposure]. / Polivinil klorür maruziyetinin pulmoner sisteme etkileri.

There is currently no national data on the effects of polyvinyl chloride (PVC) exposure on pulmonary function. In this study we recruited workers and administrative staff from two PVC plants between July 2008 and July 2009. A questionnaire, pulmonary function tests, carbon monoxide diffusion capacity, and peak flows were recorded. Particulate matter analyses were performed by the Adana Central Laboratory of the Directorate of Occupational Health and Safety. Data were analyzed with SPSS 13.0 software. Nine of the 147 subjects were female. The incidence of a cough was more common in the administrative group. Of the study population, 59.1% were smokers. Tobacco addiction significantly increased cough and dyspnea [OR= 1.10 (1.00-1.20, 95% CI) p= 0.007 and OR= 1.08 (1.02-1.14, 95% CI), p= 0.008, respectively]. Dust exposure was correlated with the incidence of a cough [OR= 0.20 (0.04-0.80, 95% CI) p= 0.008]. The period of work correlated with sputum production [OR= 1.00 (1.00-1.02, 95% CI) p= 0.044]. The FVC% was significantly higher in the administrative group, and FEV1/FVC and DLCO were higher in the exposed group. Tobacco addiction increased the risk of airflow limitation, as evaluated by FEV1/FVC < 70% and FEF25-75 < 50% [OR= 1.15 (1.06-1.25, 95% CI) p= 0.001 and OR= 1.09 (1.02-1.17, 95% CI) p= 0.010, respectively]. Tobacco addiction and increasing duration of work had a negative influence on DLCO in the exposed group (r= -0.270, p= 0.025 and r= -0.210, p= 0.037). In the exposed group PEF variability was significantly greater on workdays, compared with rest days. This study shows that tobacco consumption has a greater affect on the airways than PVC dust exposure. A median of 36 months exposure to PVC dust had no significant impact on pulmonary function parameters, except for DLCO and PEF variability.

Combined transbronchial needle aspiration and PET/CT for mediastinal staging of lung cancer.

In this study, we aimed to evaluate the performance of transbronchial needle aspiration (TBNA) combined with positron emission tomography/computed tomography (PET/CT) for the staging of lung cancer. Twenty-five patients having lymphadenopathies greater than 1 cm on thorax CT and maximum standardized uptake value (SUVmax) ≥ 2.5 on PET/CT were included in this prospective study performed between March 2006 and March 2008. Forty-three lymphnode stations were sampled by using TBNA. Surgical histology, as confirmed by mediastinoscopy, was accepted as the "gold standard". The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of combined TBNA and PET/CT for correct lymph node staging were 67%, 100%, 100%, 76% and 84%; respectively. The initial clinical staging was downstaged after TBNA in 13/19 (69%) patients with adequate TBNA samples, whereas staging was correct in 17/19 (89%) patients assessed by combined TBNA and PET/CT. Staging was completed by TBNA, without mediastinoscopy, in 6/25 (24%) patients. Among the clinical factors that were assessed, only the PET SUVmax was associated with positive TBNA results [odds ratio (OR) 1.27, 95% CI 1.004-1.61, p= 0.046]. A PET SUVmax ≥ 5 was eleven times more likely in patients with positive TBNA results [OR 10.68, 95% CI 1.91-59.62, p< 0.01]. In conclusion, the combination of TBNA with PET/CT increased the sensitivity of TBNA. Combined TBNA and PET/CT may also allow adequate mediastinal staging of lung cancer in most patients with enlarged lymph nodes, and reduce the need for mediastinoscopy. The SUVmax cut off point for a positive TBNA result was ≥ 5.

The predictors of COVID-19 mortality in a nationwide cohort of Turkish patients.

The COVID-19-related death rate varies between countries and is affected by various risk factors. This multicenter registry study was designed to evaluate the mortality rate and the related risk factors in Turkey. We retrospectively evaluated 1500 adults with COVID-19 from 26 centers who were hospitalized between March 11 and July 31, 2020. In the study group, 1041 and 459 cases were diagnosed as definite and highly probable cases, respectively. There were 993 PCR-positive cases (66.2%). Among all cases, 1144 (76.3%) were diagnosed with non-severe pneumonia, whereas 212 (14.1%) had severe pneumonia. Death occurred in 67 patients, corresponding to a mortality rate of 4.5% (95% CI:3.5-5.6). The univariate analysis demonstrated that various factors, including male sex, age ≥65 years and the presence of dyspnea or confusion, malignity, chronic obstructive lung disease, interstitial lung disease, immunosuppressive conditions, severe pneumonia, multiorgan dysfunction, and sepsis, were positively associated with mortality. Favipiravir, hydroxychloroquine and azithromycin were not associated with survival. Following multivariate analysis, male sex, severe pneumonia, multiorgan dysfunction, malignancy, sepsis and interstitial lung diseases were found to be independent risk factors for mortality. Among the biomarkers, procalcitonin levels on the 3rd-5th days of admission showed the strongest associations with mortality (OR: 6.18; 1.6-23.93). This study demonstrated that the mortality rate in hospitalized patients in the early phase of the COVID-19 pandemic was a serious threat and that those patients with male sex, severe pneumonia, multiorgan dysfunction, malignancy, sepsis and interstitial lung diseases were at increased risk of mortality; therefore, such patients should be closely monitored.

Impact of CPAP treatment on cardiac biomarkers and pro-BNP in obstructive sleep apnea syndrome.

OBJECTIVE: To evaluate the effect of continuous positive airway pressure (CPAP) therapy on pro-brain natriuretic peptide (BNP) and cardiac markers in patients with obstructive sleep apnea syndrome and normal cardiac function. METHODS: Thirty-three consecutive patients with sleep apnea syndrome were analysed for serum pro-BNP and cardiac markers prior to and after 6 months of CPAP therapy. RESULTS: Twenty five patients had normal (83.3%) while remaining five (16.7%) revealed high pro-BNP values. We did not detect any significant difference between severity of obstructive sleep apnea syndrome and serum pro-BNP levels (p = 0.534). A statistically significant difference was not observed between basal and sixth-month creatine kinase (CK), creatine kinase-MB (CK-MB), troponin I, pro-BNP, aspartate transaminase (AST), and CK levels in patients with sleep apnea syndrome (p > 0.05). CONCLUSION: Obstructive sleep apnea syndrome does not induce myocardial damage enough to increase serum pro-BNP, CK, CK-MB, troponin I, and AST levels. Markers sensitive to ischemia could be preferred to evaluate effect of obstructive sleep apnea syndrome.

COVID-19 Pandemic Threatening Prison Population.

The prison population is one of the high-risk groups for coronavirus disease 2019 (COVID-19) pandemic. Apart from being in disadvantageous settings of "social distancing," people in prisons are frequently elderly and with multiple comorbidities as a reflection of discriminatory punitive policies worldwide. Although the universal human rights principles ensure that prisoners, like everyone else, live their lives in a healthy environment and access qualified healthcare when they are sick, without being discriminated, the prison conditions make it difficult to comply with these principles. In this review, the basic principles and recommendations on this subject have been reviewed in the context of the COVID-19 outbreak. In addition, the situation in Turkey's prisons was reviewed immediately before the transition to a "controlled social life."

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.

Diffuse alveolar haemorrhage due to 5-nitroimidazole treatment.

Diffuse alveolar haemorrhage (DAH) is indicated by the presence of red blood cells, fibrin and haemosiderin deposits in the lung parenchyma. We present a case of DAH in a 25-year-old male following 5-nitroimidazole treatment. The first episode of haemoptysis occurred following metronidazole treatment 10 months previously. The second episode of haemoptysis occurred following ornidazole treatment 10 days before admission. During his first admission, the patients haemoglobin concentration decreased to 40 g/L. The CXR was normal, whereas high resolution CT of the lungs revealed a diffuse acinonodular pattern. Serological tests for connective tissue diseases were negative. The haemorrhagic appearance of the BAL fluid obtained during fibreoptic bronchoscopy was consistent with DAH. Microbiological analysis of the BAL fluid showed no evidence for bacterial or mycobacterial infection. Haemosiderin laden macrophages were detected in BAL fluid and lung biopsy specimens. DAH due to use of 5-nitroimidazole was diagnosed on the basis of the patient's previous history and complete recovery following treatment with corticosteroid. This is the first reported case of DAH due to use of 5-nitroimidazole. Physicians should be aware of this side-effect when prescribing this group of drugs to patients.