Objective: To identify the clinical characteristics and outcomes of hospital-acquired SARS-CoV-2 infection during the vaccination period nationwide in Turkey.
Methods: COVID-19 patients followed in ...the pandemic services across Turkey between January 1, 2021, and March 31, 2022 were investigated retrospectively. Nosocomial COVID-19 was defined as a patient neither diagnosed with COVID-19 nor suspected COVID-19 at the hospital admission and was confirmed COVID-19 ≥5 days after hospital admission. The primary outcome of this study was in-hospital mortality; demographic features and vaccination status was compared between survivors and non-survivors.
Results: During the study period, 15 573 COVID-19 patients were followed in 18 centers and 543 (3.5%) patients were nosocomial COVID-19. Most patients with nosocomial COVID-19 (80.4%) were transferred from medical wards. 162 (29.8%) of the patients with nosocomial COVID-19 admitted to the intensive care unit due to disease severity and 138 (25.4%) of the patients died during hospital stay. Advanced age (≥65 years) and number of comorbid diseases (≥2) was found to be associated with mortality in nosocomial COVID-19 (OR 1.74, 95% Cl 1.11-2.74 and OR 1.60, 95% Cl 1.02-2.56, respectively). Vaccination was associated with survival in nosocomial COVID-19 (OR 0.25, 95% Cl 0.16-0.38).
Conclusions: Patients with nosocomial COVID-19 had increased admission to intensive care units and higher mortality rate. Vaccination can decrease the in-hospital mortality rate.
Coronavirus-19 disease (COVID-19) is a worldwide health
emergency which has a high mortality ratio. Diagnosis requires
a positive quantitative real-time polymerase chain reaction
(qRT-PCR) test ...however there are radiological findings strongly
suggest the diagnosis of COVID-19. Here we reported a 63-yearold
woman presented with cough and dyspnea and medical
history of lung cancer and systemic lupus erythematosus (SLE).
Chest computed tomography demonstrated widespread
ground glass opacities in both lung fields that have been
reported to be compatible with COVID-19 pneumonia.
qRT-PCR test was negative for twice and radiological regression
after hydroxychloroquine, azithromycin and piperacillintazobactam
was not significant. Considering lung involvement
of SLE methylprednisolone was initiated, symptoms and
radiological findings improved. The underlying diseases may
mimic the COVID-19 infection or the signs and symptoms of the
disease may be seen together with COVID-19.
Aim: To evaluate smoking and COPD prevalence amongst teachers working in the schools of Kocaeli City, Turkey.Method: In this cross-sectional study, a questionnaire focusing on respiratory symptoms ...and smoking habits was adminis- tered to all participants who accepted to join the study. All sub- jects also underwent a physical examination and a pulmonary function test performed with portable spirometer. According to GOLD criteria, subjects who had post-bronchodilator FEV1/FVC < 70% and negative reversibility test were classi- fied as COPD.
Results: A total of 685 teachers were included female n = 307 (45%), male n = 378 (55%) with mean age 38.9 ± 8.9 years. Smoking habit was evaluated in 660 subjects: 291 (44.1%) were smokers, 252 (38.2%) were non-smokers and 117 (17.7%) were ex-smokers. Pulmonary function test was available in 651 subjects and 510 (78.3%) were defined as normal on spirometric analysis. Small airway obstruction was found in 115 of the cases (17.7%) in whom FEF25-75 level was found to be lower than 70% predicted. FEV1/FVC level was lower than 70% in 16 subjects (2.5%). Five subjects who had positive reversibility test were excluded from the study. The remaining 11 subjects who were considered as COPD consisted of 2 (18%) females and 9 (82%) males. Six of these subjects were aged over 40 years.
Conclusion: Spirometry has an important role in early diagno- sis of COPD. Spirometric evaluation of cases with risk factors for COPD could be helpful in diagnosing patients before the progressive decline in lung function begins. Further studies are needed to evaluate whether the interventional strategies at this stage such as smoking cessation could prevent the progression of disease.
Objectives: The aim of this study was to investigate whether there was any difference with respect to prognostic markers, quality of life, depression frequencies, sleep disorders, and reflux symptoms ...between IPF patients with and without cough symptom. Methods: Patients with IPF who were admitted to Kocaeli University School of Medicine Chest Diseases Clinic were included in the study. Patients were divided into two groups according to the VAS (Visual Analog Scale) scores as cough group and without cough group following the initial evaluation including demographic information, disease duration and treatment. In each group, Leicester cough questionnaire, reflux questionnaire, Beck depression questionnaire, SGRQ (St George’s quality of life questionnaire) and Sleep Quality index were evaluated to determine whether there were any differences between groups. Results: No significant difference was observed between the groups in terms of age, gender and demographic findings. The smoking history was similar among the groups. The diffusion capacity was decreased in various degrees in all of the study population. It was shown that the Leicester Cough Questionnaire score was lower in the cough group (The cough group 86±24.9 the other group 111±18.9). Beck Depression Score revealed moderate level of depression in both groups (The cough group 22±10.74 the other grup 18±11.86). SGRQ symptom score was significantly higher in the cough dominant group (The cough group 344.8 (270.8-487.63) p=0.04). Sleep Quality deterioration was found in both groups. Conclusion: It is found that presence of cough in patients with IPF negatively affected the quality of life and was associated with the Sleep disorders and depression. It is thought that increasing the symptom awareness, especially cough and shortness of breath in these patients and evaluating the treatment options for palliation of symptoms will increase the quality of life and compliance of treatment. Future multicentre studies including more patients are needed to address this problem.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Sleep quality is known to be associated with the distressing symptoms of cancer. The purpose of this study was to analyze the impact of cancer symptoms on insomnia and the prevalence of sleep-related ...problems reported by the patients with lung cancer in Turkey.
Assesment of Palliative Care in Lung Cancer in Turkey (ASPECT) study, a prospective multicenter study conducted in Turkey with the participation of 26 centers and included all patients with lung cancer, was re-evaluated in terms of sleep problems, insomnia and possible association with the cancer symptoms. Demographic characteristics of patients and information about disease were recorded for each patient by physicians via face-to-face interviews, and using hospital records. Patients who have difficulty initiating or maintaining sleep (DIMS) is associated with daytime sleepiness/fatigue were diagnosed as having insomnia. Daytime sleepiness, fatigue and lung cancer symptoms were recorded and graded using the Edmonton Symptom Assessment Scale.
Among 1245 cases, 48.4% reported DIMS, 60.8% reported daytime sleepiness and 82.1% reported fatigue. The prevalence of insomnia was 44.7%. Female gender, patients with stage 3-4 disease, patients with metastases, with comorbidities, and with weight loss > 5 kg had higher rates of insomnia. Also, patients with insomnia had significantly higher rates of pain, nausea, dyspnea, and anxiety. Multivariate logistic regression analysis showed that patients with moderate to severe pain and dyspnea and severe anxiety had 2-3 times higher rates of insomnia.
In conclusion, our results showed a clear association between sleep disturbances and cancer symptoms. Because of that, adequate symptom control is essential to maintain sleep quality in patients with lung cancer.
The aim of this study was to evaluate whether there was a relationship between severity of multiple sclerosis (MS) exacerbation and pulmonary function test (PFT) and to determine the effect of ...theophylline, which was added to intravenous methylprednisolone, on serum Tumor Necrosis Factor (TNF)-alpha levels and clinical scores in MS relapses.
Double blind randomized controlled trial.
The baseline Expanded Disability Status Scale (EDSS) score was determined, PFT was performed and blood was taken for analysis of TNF- alpha in patients with MS exacerbation. Patients were randomly divided into two groups; group 1 received intravenous methylprednisolone+IV theophylline and group 2 intravenous methylprednisolone+placebo for 5 days. PFT and EDSS score were repeated and blood was taken for TNF-alpha on the 5(th) and 30(th) days of the treatment.
Twenty-four patients (14 female, 10 male) were included in the study. Mean age was 32.6±9, duration of disease was 5.4±4.2 years, number of exacerbations was 5±2. There was a significant correlation between the number of exacerbations and EDSS score (p=0.000, r=1). Restrictive PFT findings were detected in 8 and decrease in carbon monoxide diffusing capacity (DLCO) in 3 cases. In within-group analysis, EDSS score was found to be decreased on day 5 and still low on day 30 in the theophylline group (baseline 3±1.3; 5(th) day 2.4±1.6; 30(th) day 2±1.7). There was no statistically significant difference in the EDSS score of the placebo group (3±1.6; 2.8±1.7; 2.4±1.9 respectively). While serum TNF-alpha level was not changed in the placebo group, there was a non-significant decrease on day 5 and increase on day 30 in the theophylline group. There was no correlation between the clinical parameters, PFT and TNF-alpha level.
There was no correlation between severity of MS and PFT findings. It is suggested that theophylline might be effective in MS exacerbations since it caused decreases in clinical scores; studies with longer treatment duration are needed to clarify its possible anti-inflammatory effect.
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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.
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.
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.
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.
Çevresel sigara dumanı maruziyetinin, en önemli halk sağlığı sorunlarından biri olduğu bildirilmektedir. Türkiye'de çocukların yaklaşık %75'inin çevresel sigara dumanına maruz kaldığı tahmin ...edilmektedir. Bu çalışmada ilkokul çocuklarının ebeveynlerinin sigara içme alışkanlıkları bir anket ile belirlenmiştir. Daha sonra ebeveynlerin verdiği bilgiye göre çocukların çevresel sigara dumanına maruzuyeti ile çocukların idrar kotinin düzeyleri arasındaki ilişki araştırılmıştır. Ebeveynlerin verdiği bilgiye göre çocuklardan %57.8'inin babasının, %23.3'ünün annesinin aktif sigara içicisi olduğu saptanmıştır. Çocukların %69.8'inin evinde en az bir sigara içicisi olduğu, %53.4'ünün ise evde sigara dumanına maruz kaldığı saptanmıştır. Evde sigara dumanına maruz kalan çocukların idrar kotinin düzeyleri, evinde sigara içicisi olmayan çocuklarınkinden istatistiksel olarak anlamlı derecede yüksek bulunmuştur. Bu sonuçlar çocukların çevresel sigara dumanına maruziyetnin yüksek oranlarda olduğunu ve bu maruziyetin saptanmasında ebeveynlerden alınan bilgilerin yanı sıra objektif bir belirleyici olan kotinin düzeyinin de çalışılması gerektiğini göstermiştir.
Environmental tobacco smoke (ETS) has been regarded as one of the most important public health issues. It has been es-timated that approximately 75% of Turkish children are exposed to ETS. In this study the parental smoking habits were determined. Then, the relationship between parent-reported estimates of children's exposure to ETS in the home and children's urinary cotinine levels was examined. According to the reports of parents, 57.8% of the fathers and 23.3% of the mot-hers were current smokers, 69.8% of the children came from homes with smokers, and 53.4% had daily exposure to ETS. .Urinary cotinine levels were significantly higher in the exposed group than the nonexposed group. This data showed that ETS exposure was prevalent and a combination of a parent-report and a biological measures is suggested as the most informative estimate of ETS expossure in children.
As known, older age and comorbidities are associated with poor clinical outcomes in patients with coronavirus disease 19. The aim of this study was to investigate the effect of the Charlson ...Comorbidity Index in predicting poor clinical outcomes in coronavirus disease 19 patients.
Demographic characteristics and poor clinical outcomes (presence of pneumonia, respiratory failure, intensive care unit admission, and mortality) of the patients were evaluated retrospectively. Classical and modified Charlson Comorbidity Index was calculated and adjusted according to age.
In this study, 106 women and 107 men were included. The comorbidity rate was 50.7% and the most common comorbidities were hypertension (21.6%) and diabetes mellitus (15%). The rates of respiratory failure, intensive care unit admission, and mortality were 15%, 2.3%, and 2.8%, respectively. Older age was a high risk for poor outcomes. Pneumonia (odds ratio: 6.6; 95% CI: 3.4-12.7), respiratory failure (odds ratio: 5.2; 95% CI: 2.03-13.2), and intensive care unit admission (odds ratio: 1.1; 95% CI: 1.01-1.1) were significantly higher in patients with comorbid diseases than patients without any comorbidity (P < .05). Both median-modified and classical Charlson Comorbidity Index and their age-adjusted scores were significantly higher in patients with poor outcomes.
It is suggested that evaluation of the Charlson Comorbidity Index might contribute to the management of the patients with coronavirus disease 19 by predicting risk group for poor clinical outcomes and mortality.
Obezite ile astım ve düşük vücut kitle indeksi (VKl) ile kronik obstrüktif akciğer hastalığı (KOAH) varlığının ilişkili olduğu önceki çalışmalarda ortaya konmuştur. VKl değerlerindeki azalmada tümör ...nekrozis faktör-alfa (TNF-$\alpha$) düzeylerinin rolü olduğu düşünülmektedir. Bu çalışmanın amacı, astımlı ve KOAH'lı hastalarda balgam ne serum TNF-$\alpha$ düzeylerini tespit etmek ve bu değerlerin VKl ile ilişkisini saptamaktır. Çalışmaya 30 adet orta persistan astım oe 26 orta-ağır stabil KOAH tanılı birey dahil edildi. VKl değerleri belirlenen hastalarda hipertonik salin ile balgam indüklendi ve serum TNF-$\alpha$ tetkiki için kan alındı. Astımlı ve KOAH'lı hastalar arasında yaş, balgam ve serum TNF-$\alpha$ düzeyleri açısından anlamlı farklılık saptanırken (balgam TNF-a: Astım; 513 ±151 pg/mL-KOAH: 333 ± 126 pg/mL, p< 0.001; serum TNF-a: Astım; 332 ± 114 pg/mL-KOAH: 197 ± 81 pg/mL, p< 0.001), VKl açısından fark tespit edilmedi (astım; 28 ± 5.7-KOAH; 26.6 ± 12.9, p=0.1). VKl değerlerine göre hastalar zayıf, normal, şişman ve obez olmak üzere dört gruba ayrıldılar. Astımlı hastaların 12 (%40)'si obez ve 11 (%36) 'i şişman olarak değerlendirilirken, KOAH'lı hastaların 9 (%34) 'u zayıf olarak değerlendirildi. Bu dört grup balgam-serum TNF-$\alpha$ ve sigara içimi açısından karşılaştırıldığında ne astımlı ne de KOAH'lı hastalarda anlamlı fark tespit edilmedi. Balgam ve serum TNF-$\alpha$ düzeyleri ile VKl arasında korelasyon izlenmezken, KOAH'lı hastalarda serum TNF-$\alpha$ ile sigara öyküsü ue hastalık süresi arasında anlamlı korelasyon saptandı. Astımlı hastaların çoğu şişman ve obez grupta iken KOAH'lılarda böyle bir farklılık tespit edilmemiştir. Indüklenmiş balgam TNF-$\alpha$ düzeylerinin, VKl ile ilişkili olduğu bilinen serum TNF-$\alpha$ düzeylerine ek bir katkısı saptanamamıştır.
Previous studies have revealed the relationship between asthma with obesity and low body mass index (BMl) with chron-ic obstructive pulmonary disease (COPD). Tumor necrosis factor-alpha (TNF-$\alpha$) is thought to be related with low BMl. The aim of this study was to determine sputum and serum TNF-$\alpha$ levels in patients with COPD and asthma and to evaluate whether these parameters had correlation with BML Thirty patients with moderate persistent asthma and 26 patients with moderate severe COPD were Included. After BMl values were calculated, sputum was induced by inhalation of hypertonic saline solution and blood was drawn for analysis of serum TNF-$\alpha$ levels. There were significant differences in age, serum and sputum TNF-$\alpha$ levels between asthma and COPD subjects (Sputum TNF-a: asthma; 513 ± 151 pg/mL-COPD: 333 ± 126 pg/mL, p< 0.001; Serum TNF-$\alpha$: asthma; 332 ± 114 pg/mL-COPD: 197 ±81 pg/mL, p< 0.001), however there was no difference in BMI (asthma; 28 ± 5.7-COPD; 26.6 ± 12.9, p= 0:1). Patients were diuided into four categories according to their ESMI values as underweight, normal, overweight and obese. In asthmatics; there were 12 (40%) obese and 11 (36%) over-weight patients while 9 (34%) of COPD patients were underweight. No significant difference was observed among these four groups according to serum-sputum TNF-$\alpha$ and smoking history both in asthmatics and in COPD subjects. While there was no correlation between BMI and serum- sputum TNF-$\alpha$ levels, BMI was significantly correlated with both smoking history and duration of disease in COPD patients. As a result, most of the asthmatic patients were described as overweight and obese while no such variation was noted in the COPD patients. The induced sputum TNF-$\alpha$ levels has no additional benefit on serum TNF-$\alpha$ levels which has already known to be associated with BMI.
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