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OBJECTIVES The coronavirus disease 2019 (COVID-19) pneumonia may cause cystic features of lung parenchyma which can resolve or progress to larger blebs. Pneumothorax was more likely in patients with neutrophilia, severe lung injury and a prolonged clinical course. The timely diagnosis and management will reduce COVID-19-associated morbidity and mortality. METHODS We present 11 cases of spontaneous pneumothorax managed with chest tube thoracostomy or high-dose oxygen therapy. Isolated spontaneous pneumothorax was detected in all cases. RESULTS Eight cases were male and 3 cases were female. There were bilateral ground-glass opacities or pulmonary infiltrates in the parenchyma of the 10 cases. We detected neutrophilia, lymphopaenia and increased C-reactive protein, Ferritin, lactate dehydrogenase, D-Dimer, interleukin-6 levels in almost all cases. Chest tube thoracostomy was sufficient to treat pneumothorax in our 9 of case. In 2 cases, pneumothorax healed with high-dose oxygen therapy. Favipiravir and antibiotic treatment were given to different 10 patients. In our institution, all patients with COVID-19 infection were placed on prophylactic or therapeutic anticoagulation, unless contraindicated. The treatments of patients diagnosed with secondary spontaneous pneumothorax during the pandemic period and those diagnosed with secondary spontaneous pneumothorax in the previous 3 years were compared with the durations of tube thoracostomy performed in both groups. CONCLUSIONS The increased number of cases of pneumothorax suggests that pneumothorax may be a complication of COVID-19 infection. During medical treatment of COVID-19, pneumothorax may be the only reason for hospitalization. Although tube thoracostomy is a sufficient treatment option in most cases, clinicians should be aware of the difficulties that may arise in diagnosis and treatment.

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

OBJECTIVES The aim of the current study was to investigate Erectile dysfunction (ED) in asthma patients without comorbidity and the relationship between the level of asthma control and ED. METHODS Forty male patients aged 24-50 years with controlled-to-uncontrolled asthma and 20 healthy volunteers were included in this study. The International Index of Erectile Function Questionnaire (IIEF) for ED was used. RESULTS Evaluation of the IIEF scores for ED showed that 23 (57.5%) of the asthma patients and 4 (20.0%) of the controls had various degrees of ED, and the difference was statistically significant. In total, 25% of asthma patients had mild ED, 22.5% moderate ED, and 10% severe ED. Severe, moderate and mild ED was more frequent in the asthma group. Of the 23 patients who had various degrees of ED, 13 were in the uncontrolled asthma group. While all asthma patients with severe ED were in the uncontrolled asthma group, of the 9 asthma patients with moderate ED, 6 were in the uncontrolled asthma group, 2 were in the partially controlled asthma group and one was in the controlled asthma group. Additionally, of the 10 asthma patients with mild ED, 3 were in the uncontrolled asthma group, 2 were in the partially controlled asthma group and 5 were in the controlled asthma group. CONCLUSION The current study showed that ED is frequent and more severe in asthma patients than controls with same age. A highly negative correlation was found between ED degree and asthma control severity.

Nurcan Kırıcı Berber,1 Özkan Yetkin,2 Talat Kılıç,2 Ä°lhami Berber,3 Mehmet Özgel4 1Department of Chest Disease Clinic, Malatya Training and Research Hospital, 2Department of Pulmonary Medicine, Inonu University Faculty of Medicine, Turgut Ozal Medical Center, 3Department of Haemotology Clinic, 4Department of Thoracic Surgery Clinic, Malatya Training and Research Hospital, Malatya, Turkey Background: COPD is preventable and treatable and is characterized by completely nonreversible airflow obstruction. In this study, we aimed to investigate the effect of long-term oxygen therapy on patients with stage 4 COPD who were followed up and treated at the polyclinic or clinic service. We evaluated the effects of oxygen therapy on energy metabolism and physical activity in patients with COPD.Methods: Nineteen patients with COPD (16 male/3 female), treated with oxygen therapy for the first time, were included in this study. Analysis of arterial blood gases and pulmonary function test was performed. Metabolic Holter device (SenseWear® Armband) was placed pre- and post-oxygen therapy on the patients’ arm for at least 3 days. This device captures Holter data in a digitized electronic system, and the daily average value was calculated from the data.Results: Post-oxygen treatment showed a significant increase in energy expenditure by patients with COPD (pretreatment, 1,497±596 joule; posttreatment, 2,977±5,985 joule; P=0.044). Moreover, number of steps during walking (pretreatment, 2,056±256; posttreatment, 2,120±195; P=0.03), resting (pretreatment, 6.36±3.31 hours; posttreatment, 3.47±2.19 hours; P

WOS:000455820300004, PubMed ID: 30683024, Introduction: Sleep quality is known to be associated with the distressing symptoms of cancer. The purpose of this study was toanalyze the impact of cancer symptoms on insomnia and the prevalence of sleep-related problems reported by the patients with lung cancer in Turkey. Materials and Methods: 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. Results: 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. Conclusion: 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., Giriş: Uyku kalitesinin, kanser semptomlarının şiddetiyle ilişkili olduğu bilinmektedir. Bu çalışmada, Türkiye’de akciğer kanseri hastalarında uyku ile ilişkili sorunların prevalansı ve kanser semptomlarının insomnia üzerine etkisinin araştırılması amaçlandı. Materyal ve Metod: Türkiye’de 26 merkezin katılımıyla gerçekleştirilen, akciğer kanserli olguların dahil edildiği çok merkezli bir çalışma olan ASPECT çalışması verileri, bu hastalarda görülen uyku sorunları, insomni ve bunların kanser semptomları ile ilişkisi yönüyle yeniden değerlendirildi. Hastaların demografik özellikleri ve hastalıkları hakkında bilgi, hasta ile yüz yüze görüşülerek ve hastane kayıtları aracılığıyla derlendi. Uykuyu başlatma ve sürdürme zorluğu (DIMS) ile gündüz artmış uyku hali veya yorgunluk tanımlayan olgular insomni olarak değerlendirildi. Gündüz uyku hali, yorgunluk ve akciğer kanseri semptomları Edmonton Semptom Değerlendirme Skalası kullanılarak kaydedildi. Bulgular: Katılan 1245 olgunun, %48.4’ünde DIMS, %60.8’inde gündüz uyku hali ve %82.1’inde yorgunluk mevcuttu. Insomni prevalansı %44.7 olarak bulundu. Kadın cinsiyet, evre 3-4 hastalık, metastatik hastalık, komorbid hastalıklar ve kilo kaybı 5 kg olan olgularda insomnia oranı anlamlı olarak daha yüksekti. Diğer yandan insomnisi olan hastalarda ağrı, bulantı, dispne ve anksiyete semptomları anlamlı düzeyde yüksek bulundu. Multivariate lojistik regresyon analizi, orta ileri şiddetli ağrısı ve dispnesi olan, ayrıca ciddi anksiyetesi olan hastalarda insomni sıklığının 2-3 kat fazla olduğunu ortaya koydu. Sonuç: Çalışmamız, kanser semptomları ile uyku kalitesi arasında yakın bir ilişki olduğunu ortaya koymuştur. Bu nedenle, akciğer kanserli hastalarda kaliteli bir uyku için, kanser semptomların yeterince kontrol edilmesi gereklidir.

WOS: 000391457100008, PubMed ID: 27780164, Objective: To investigate the symptoms of lung cancer in Turkey and to evaluate approaches to alleviate these symptoms. Subjects and Methods: This study included 1,245 lung cancer patients from 26 centers in Turkey. Demographic characteristics as well as information regarding the disease and treatments were obtained from medical records and patient interviews. Symptoms were evaluated using the Edmonton Symptom Assessment Scale (ESAS) and were graded on a scale between 0 and 10 points. Data were compared using the. 2, Student t, and Mann-Whitney U tests. Potential predictors of symptoms were analyzed using logistic regression analysis. Results: The most common symptom was tiredness (n = 1,002; 82.1%), followed by dyspnea (n = 845; 69.3%), appetite loss (n = 801; 65.7%), pain (n = 798; 65.4%), drowsiness (n = 742; 60.8%), anxiety (n = 704; 57.7%), depression (n = 623; 51.1%), and nausea (n = 557; 45.5%). Of the 1,245 patients, 590 (48.4%) had difficulty in initiating or maintaining sleep. The symptoms were more severe in stages III and IV. Logistic regression analysis indicated a clear association between demographic characteristics and symptom distress, as well as between symptom distress (except nausea) and well-being. Overall, 804 (65.4%) patients used analgesics, 630 (51.5%) received treatment for dyspnea, 242 (19.8%) used enteral/parenteral nutrition, 132 (10.8%) used appetite stimulants, and 129 (10.6%) used anxiolytics/antidepressants. Of the 799 patients who received analgesics, 173 (21.7%) reported that their symptoms were under control, and also those on other various treatment modalities (dyspnea: 78/627 [12.4%], appetite stimulant: 25/132 [18.9%], and anxiolytics/antidepressants: 25/129 [19.4%]) reported that their symptoms were controlled. Conclusion: In this study, the symptoms progressed and became more severe in the advanced stages of lung cancer, and palliative treatment was insufficient in most of the patients in Turkey. (C) 2016 S. Karger AG, Basel

WOS: 000328580000001 PubMed: 24346118 Background: Occupational exposure to cotton dust causes several diseases affecting the lungs, but only limited information is available on effects of long-term exposure. In this study, we aimed to evaluate longitudinal changes in selected parameters of pulmonary function in textile workers. Material/Methods: This prospective cohort study began with 196 textile workers in 2006 and was completed in 2011 with 49 workers. We used standardized tests for pulmonary function on participants on the first day of the workweek in June of 2006 and 2011. Environmental samples of cotton dust were gathered with a vertical elutriator. Loss of pulmonary function was assessed based on gender and smoking status. Results: The mean number of years participants worked in the textile factory was 7.61 +/- 1.83 years, and the mean age was 35.3+5.8 years. The annual FEV1 loss of all workers was 53.2 ml, giving a ratio of annual FEV1 loss to baseline FEV1 of 1.4%. Pulmonary function parameters of all participants in 2011 were significantly lower than those in 2006 (for all, p0.05). Conclusions: This study provides the first data on pulmonary functional loss in Turkish textile workers and supports the findings of other cohort studies that workers with long-term exposure to cotton dust may lose some pulmonary function. The ratio of annual FEV1 loss to baseline FEV1 appears to be a more accurate and comparable method than annual FEV1 loss for evaluating pulmonary functional loss.

Summary Background A patent foramen ovale (PFO) is not widely recognized as a factor contributing to hypoxemia in patients with chronic obstructive pulmonary disease (COPD). We therefore sought to clarify the prevalence and clinical significance of a PFO in patients with COPD, and to analyze the factors related to its occurrence. Methods This study included 52 consecutive stable patients with COPD and 50 healthy controls. The demographic and clinical features of the study group were noted. To test for a PFO, standard and contrast transthoracic echocardiographic examinations were performed while resting and during the Valsalva maneuver (VM). Patients performed 6-min walking tests (6 MWT), and the distances traveled were measured. Results During VM, we detected a PFO in 23 COPD patients and 10 healthy controls ( P 0.01 ). A PFO was detected while resting in 11 COPD patients, but in none of the controls ( P = 0.001 ). Comparison of multiple parameters between COPD patients with and without a PFO during VM did not reveal any clinically significant differences. When we compared COPD patients with and without a PFO during resting, however, we found that the former had longer durations of disease, lower P aO 2 and S aO 2 , higher dyspnea scores, shorter distances walked during 6 MWT and higher desaturation rates ( P 0.05 ). Logistic regression analysis showed that longer duration of disease, lower S aO 2 and higher systolic pulmonary artery pressure were independent predictors of the occurrence of a PFO in resting COPD patients. Conclusions The prevalence of a PFO is higher in patients with COPD than in healthy individuals. The presence of a PFO while resting may contribute significantly to the deterioration of arterial oxygenation and performance status. These findings indicate that a PFO may be a principle cause of hypoxemia in patients with COPD.

Objective: Our previous study demonstrated the presence of environmental tremolite and chrysotile asbestos fiber exposure in Hekimhan town in Malatya located in eastern Turkey. The aim of this study was to investigate whether environmental asbestos exposure increases the incidence of lung cancer and mesothelioma. Method: One hundred and forty-nine patients with mesothelioma and lung cancer living in the center or in the towns of Malatya were retrospectively analyzed. The Incidences of lung cancer and mesothelioma were calculated. Results: The incidences of lung cancer and mesothelioma were 3.39/100,000 and 0.21/100,000, respectively, for the whole population of Malatya; while they were 8.23/100,000 and 1.45/100,000 in Hekimhan. The incidences were strikingly high (22.39/100,000 for lung cancer and 7.46/100,000 for mesothelioma) in Arguvan, another town in Malatya where an analysis for asbestos could not be performed. The overall incidence in Turkey was reported as 5.9/100,000 by the Health Ministry in 1994. The incidences of lung cancer were nearly 1.3-fold higher in Hekimhan and fourfold higher in Arguvan then in the general population of Turkey. Conclusion: The incidences of mesothelioma and lung carcinoma in Hekimhan were higher than those of the general population in Turkey, suggesting a role of environmental asbestos exposure in lung cancer and mesothelioma.

Oxidative stress has been implicated in the pathogenesis of bleomycin-induced lung fibrosis and many antioxidant agents have been studied for prevention and treatment of the disease in animals and humans. We therefore examined whether Ginkgo biloba (Gb), a flavonoid-rich antioxidant, inhibits bleomycin-induced lung fibrosis in rats. Male Sprague-Dawley rats were given a single dose of bleomycin (2.5 mg/kg, intratracheally) in pulmonary fibrosis groups and saline in controls. First dose of Gb was given a day before the bleomycin injection and continued until sacrifice. At day 14, fibrotic changes in lung were estimated to occur by Aschoft's criteria and lung hydroxyproline content. Bleomycin challenge provoked severe pulmonary fibrosis with marked increase in hydroxyproline content of lung tissue and typical histological findings, which is prevented by Gb. Hydroxyproline level was significantly higher (13.51+/-0.87 mg/g dried tissue) in bleomycin treated rats than controls (9.2+/-1.33), and its level was remained to the control levels (7.38+/-0.76) in rats treated with prophylactic Gb. On the other hand, bleomycin injection significantly reduced activities of glutathione peroxidase, superoxide dismutase and catalase in lung tissue which is prevented by Gb. Also, bleomycin injection resulted in a marked increase of malondialdehyde and nitrite level which is attenuated by Gb. The data suggest that Gb has a potent antioxidant activity in the model of bleomycin-induced lung fibrosis in rats, and therefore has a potent antifibrotic activity against bleomycin-induced lung fibrosis model in rats.