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Introduction: Cancer-related venous thromboembolism is one of the leading causes of mortality and morbidity in cancer patients. Lung cancer is the second most common cancer in the world and is closely related to venous thromboembolism. Venous thromboembolism affects survival in patients with cancer and it is important to be able to predict the possibility of thrombosis in patients with cancer. It was aimed to evaluate the predictive performance of the Khorana risk score in patients with lung cancer., Materials and Methods: The medical data of the patients followed up with lung cancer were analyzed retrospectively. Venous thromboembolism events in lung cancer patients were described. The relationship between the Khorana risk score and the risk of venous thromboembolism was investigated using the cumulative incidence function with compared risk models., Result: Eight hundred fourteen lung cancer patients were included in the study. Venous thromboembolism was detected in 79 (9.7%) of the patients. Sixty one (77.2%) of the patients had pulmonary embolism, 15 (19%) had peripheral deep vein thrombosis and three (3.8%) had venous thrombosis of other sites. The cumulative incidences of venous thromboembolism for high and intermediate Khorana risk scores were 10.1% and 9.7%, respectively (p= 0.09). The cumulative incidences of venous thromboembolism at 3, 6, 12, and 24 months were 4.7%, 5.8%, 6.4%, and 9.6% for the high-grade Khorana risk score; 4.6%, 5.7%, 6.3% and 7.8% for the intermediate Khorana risk score (p= 0.11)., Conclusions: The Khorana risk score was not found useful in the risk stratification of venous thromboembolism (intermediate or high risk) in patients with lung cancer. New scoring systems are needed to calculate the risk of venous thromboembolism in patients with lung cancer.

Introduction: Patients with asthma-chronic obstructive pulmonary disease (COPD) overlap (ACO) have a greater disease burden than those with COPD or asthma alone. In this study, it was aimed to determine the prevalence, risk factors, and clinical features of ACO because there are limited national data in Türkiye., Materials and Methods: The study was conducted in a cross-sectional design in nine tertiary-care hospitals. The patients followed with a diagnosis of asthma or COPD for at least one year were enrolled in the study. The frequency of ACO and the characteristics of the patients were evaluated in the asthma and COPD groups., Result: The study included 408 subjects (F/M= 205/203, mean age= 56.24 ± 11.85 years). The overall prevalence of ACO in both groups was 20.8% (n= 85). The frequency was higher in the COPD group than in the asthma group (n= 55; 33.3% vs. n= 22; 9.8%), respectively (p= 0.001). Patients with ACO had similarities to patients with COPD in terms of advanced age, sex, smoking, exposure to biomass during childhood, being born in rural areas, and radiologic features. Characteristics such as a history of childhood asthma and allergic rhinitis, presence of chronic sinusitis, NSAID hypersensitivity, atopy, and high eosinophil counts were similar to those of patients with asthma (p<0.001). The annual decline in FEV1 was more prominent in the ACO group (mean= -250 mL) than in the asthma (mean change= -60 mL) and COPD (mean change= -230 mL) groups (p= 0.003)., Conclusions: This study showed that ACO was common among patients with asthma and COPD in tertiary care clinics in our country. ACO should be considered in patients with asthma and COPD who exhibit the abovementioned symptoms.

Objective: The aim of the study is to evaluate the functional status and quality of life parameters of patients in the 1st and 6th months post-COVID and to determine contributing factors., Background: The effects of COVID-19 can continue in the post-COVID period. The mostcommon post-COVID symptoms are weakness, fatigue, nonproductive cough and exertionaldyspnea., Method: The radiological findings of the patients at diagnosis, post-COVID 1st and 6th months; functional status and quality of life parameters at the 1st and 6th months of the post-COVID period were compared, and the factors affecting them were evaluated. The relationship between radiological involvement, quality of life and functional status parameters was investigated., Results: Six months after the COVID infection, inpatient's resting oxygen saturation and effort capacity were comparable, even though they were significantly lower in the first month post-COVID. There was a correlation between functional and quality of life measures at 1 and 6 months after COVID-19 infection. In all patients, a significant improvement was found in the functional status and quality of life scales at 6 months after post-COVID infection compared to the 1st month. Even though radiological findings of both groups improved within the first month after COVID-19 infection, there remained a difference between them that disappeared after six months., Conclusion: It was found that in the post-COVID period, the severity of the disease had a negative effect on functional measurements and quality of life; however, regardless of the severity of the disease, after six months improvements in radiological findings, effort capacity, and quality of life measures were noted (Tab. 2, Fig. 5, Ref. 20). Text in PDF www.elis.sk Keywords: post-COVID, quality of life, functional measurements, chest x-ray.

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., Competing Interests: Declaration of Competing Interest The authors declare that they have no potential competing interests including any financial, personal or other relationships with the other people or organizations that could inappropriately influence or be perceived to influence the presented work., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background/aim: Characteristics of asthma in the elderly population is not well-known. The aim of the present study was to evaluate asthma in the elderly population, to compare disease characteristics between patients diagnosed <60 (aged asthma) and ≥60 (elderly asthma) years of age., Materials and Methods: The study was a prospective, multicenter, cross-sectional type. A questionnaire was filled out to patients 60 years of age and over, that have been followed for asthma for at least 3 months. Asthma Control Test (ACT), eight-item Morisky Medication Adherence Scale (MMAS-8) was filled out, inhaler device technique was assessed., Results: A total of 399 patients were included from 17 tertiary care centers across the country. Mean age was 67.11 years and 331 (83%) were female. The age at asthma diagnosis was ≥60 in 146 (36.6%) patients. Patients diagnosed ≥60 years were older (p < 0.001), had higher education level (p < 0.001), more commonly had first-degree relative with asthma (p = 0.038), asthma related comorbidities (p = 0.009) and accompanying rhinitis/rhinosinusitis (p = 0.005), had better asthma control (p = 0.001), were using less controller medications (p = 0.014). Inhaler technique was correct in 37% of the patients with no difference in between the groups. Treatment compliance was better in elderly asthma patients (p < 0.001). In the multivariate logistic regression analysis, having well-controlled asthma (odds ratio = 1.61, CI = 1.04-2.51), and high medication adherence rate (odds ratio = 2.43, CI = 1.48-4.0) were associated with being in the elderly asthma group., Conclusion: The characteristics of asthma are different among patients aged 60 years and over which seems to be related to onset age of asthma. In our cohort, the elderly asthma patients had higher education level, and treatment adherence and asthma control was better. Patients diagnosed ≥60 years of age did not have more severe disease., Competing Interests: Conflicts of interest: None, (© TÜBİTAK.)

Introduction: National data on asthma characteristics and the factors associated with uncontrolled asthma seem to be necessary for every country. For this purpose, we developed the Turkish Adult Asthma Registry for patients with asthma aiming to take a snapshot of our patients, thereby assigning the unmet needs and niche areas of intervention., Methods: Case entries were performed between March 2018 and March 2022. A web-based application was used to record data. Study outcomes were demographic features, disease characteristics, asthma control levels, and phenotypes., Results: The registry included 2053 patients from 36 study centers in Turkey. Female subjects dominated the group ( n  = 1535, 74.8%). The majority of the patients had allergic ( n  = 1158, 65.3%) and eosinophilic ( n  = 1174, 57.2%) asthma. Six hundred nineteen (32.2%) of the patients had obese asthma. Severe asthma existed in 670 (32.6%) patients. Majority of cases were on step 3-5 treatment (n: 1525; 88.1%). Uncontrolled asthma was associated with low educational level, severe asthma attacks in the last year, low FEV 1 , existence of chronic rhinosinusitis and living in particular regions., Conclusion: The picture of this registry showed a dominancy of middle-aged obese women with moderate-to-severe asthma. We also determined particular strategic targets such as low educational level, severe asthma attacks, low FEV 1, and chronic rhinosinusitis to decrease uncontrolled asthma in our country. Moreover, some regional strategies may also be needed as uncontrolled asthma is higher in certain regions. We believe that these data will guide authorities to reestablish national asthma programs to improve asthma service delivery.

Introduction: Stenotrophomonas maltophilia infection is gaining importance as an important cause of nosocomial pneumonia. S. maltophilia infection occurs especially in patients with a history of immunosuppression, comorbidity, or multiple antibiotherapy uses. A retrospective 10-year study was carried out to determine the clinical characteristics of all patients with S. maltophilia pneumonia, antibiotic resistance pattern, and risk factors associated with hospital mortality., Materials and Methods: Hospitalized pneumonia patients with S. maltophilia culture positivity were identified, and their medical records were reviewed. Risk factors associated with hospital mortality were analyzed. Any variable with a significant association with mortality in the univariate analysis was entered in a multivariate forward stepwise logistic regression model to identify independent risk factors for death., Results: Seventy-two patients (mean age: 67.3 years, 65.2% males) with S. maltophilia pneumonia were included in the study. All patients had at least one comorbidity. The most common comorbidities were chronic obstructive pulmonary disease, diabetes mellitus, chronic renal failure, malignancy, and cardiac diseases. Percentage resistance to trimethoprim-sulfamethoxazole (5.5%) was lower than that for fluoroquinolones (12.5%). By using multivariate analysis, respiratory insufficiency needed mechanical ventilation, low hemoglobin level, age>65 years, previous antibiotic usage, and hypotension were the independent prognostic factors for mortality., Conclusion: S. maltophilia is emerging as an important pathogen with an increased risk of mortality in patients with respiratory insufficiency who need mechanical ventilation, a low hemoglobin level, >65 years of age, previous antibiotic usage, and hypotension. Empiric therapy should include agents active against S. maltophilia, such as newer fluoroquinolones and trimethoprim-sulfamethoxazole., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Kızılırmak et al.)

Background: Following COVID-19 infection, some patients acquired lung injury and fibrosis. Idiopathic pulmonary fibrosis is characterized by lung fibrosis. Both post-COVID lung injury and idiopathic pulmonary fibrosis cause loss of respiratory function and involvement of the lung parenchyma. We aimed to compare respiratory related functional characteristics and radiological involvement between post-COVID lung injury and idiopathic pulmonary fibrosis., Methods: A single center, cross-sectional study was applied. Patients with post-COVID lung injury and idiopathic pulmonary fibrosis included in the study. All patients underwent the 6-minute walk test, as well as the Borg and MRC scales. Radiological images were evaluated and scored for lung parenchymal involvement. The impact of post-COVID lung injury and idiopathic pulmonary fibrosis on respiratory functions of were compared. The relationship of functional status and radiological involvement, as well as the effect of potential confounding factors were investigated., Results: A total of 71 patients were included in the study. Forty-eight (67.6%) of the patients were male and the mean age was 65.4 ± 10.3 years. Patients with post-COVID lung injury had greater 6-minute walk test distance and duration, as well as higher oxygen saturations. The MRC and Borg dyspnea scores were comparable. At radiologic evaluation, ground glass opacity scores were higher in patients with post-COVID lung injury, whereas pulmonary fibrosis scores were higher in patients with idiopathic pulmonary fibrosis. However, the total severity scores were similar. While pulmonary fibrosis score was found to have a negative correlation with 6-minute walk test distance, test duration, and pre- and post-test oxygen saturation levels, there was a positive correlation with oxygen saturation recovery time and MRC score. There was no relationship between ground glass opacity and the functional parameters., Conclusions: Despite having equal degrees of radiological involvement and dyspnea symptom severity, PCLI patients exhibited higher levels of functional status. This might be due to different pathophysiological mechanisms and radiological involvement patterns of both diseases., (© 2023. The Author(s).)

Introduction: Post-COVID period is considered to be 12 weeks after the COVID-19 infection. Patients in the post-COVID period may have prolonged or newly developed symptoms. Depending on the prolonged effects of the disease, respiratory and functional parameters may be affected. The aim of the study is to investigate the effect of COVID-19 infection on respiratory and functional parameters in the post-COVID period., Materials and Methods: A cross-sectional study was conducted to evaluate the functional parameters of patients with COVID-19 in the post-COVID period. Subjects with a history of microbiologically proven COVID-19 infection were evaluated with 6-minute walk test results, Borg, and MRC results at least 12 weeks after COVID-19 infection. The relationship between demographic characteristics, comorbidities, vaccination status, and severity of disease with 6-minute walk test results and dyspnea scales in the post-COVID period was investigated., Result: Two hundred seventeen patients were included in the study. The mean age of the patients was 48.6 ± 14.9 years and 126 (58.1%) of them were female. 142 (65.4%) of the patients were completely vaccinated against COVID-19 and 75 (34.6%) patients were incompletely vaccinated or unvaccinated. 158 (72.8%) patients had mild disease, 51 (23.5%) patients had moderate disease, and eight (3.7%) patients had severe disease. Those with a history of moderate or severe disease had significantly worsened functional parameters in the postCOVID period compared to those with mild COVID-19. The Borg scale and MRC dyspnea scale values were significantly higher in women (p= 0.008, p= 0.002, respectively). Functional parameters of those who were completely vaccinated against COVID-19 and those who were incompletely or unvaccinated individuals in the post-COVID period were similar., Conclusions: The functional parameters of people with moderate or severe COVID-19 disease were found to be significantly impaired in the post-COVID period. While the effect of smoking and vaccination status on functional parameters in the post-COVID period could not be demonstrated, disease severity and accompanying comorbidity were found to be effective.

Objective: As the pandemic continues, different vaccine protocols have been implemented to maintain the protection of vaccines and to provide protection against new variants. The aim of this study was to assess hospitalized patients' vaccination status and document the efficacy of boosters., Patients and Methods: The patients that were hospitalized due to COVID-19 were enrolled from 28 hospitals in Turkey for five months from September 2021. 5,331 confirmed COVID-19 patients from collaborating centers were randomly enrolled to understand/estimate the distribution of vaccination status in hospitalized patients and to compare the efficacy of vaccination/booster protocols., Results: 2,779 men and 2,552 women of which 2,408 (45.2%) were admitted to Intensive Care Units participated in this study. It was found that the highest risk reduction for all age groups was found in groups that received 4 doses. Four doses of vaccination for every 3.7 people under 50 years of age, for every 5.7 people in the 50-64 age group, and for every 4.3 people over 65 years of age will prevent 1 patient from being admitted to intensive care. Regardless of the type of vaccine, it was found that the risk of ICU hospitalization decreased in those who were vaccinated compared to those who were not vaccinated. Regardless of the type of vaccine, the ICU risk was found to decrease 1.25-fold in those who received 1 or 2 doses of vaccine, 1.18-fold in those who received 3 doses, and 3.26-fold in those who received 4 doses., Conclusions: The results suggested that the addition of a fourth dose is more effective in preventing intensive unit care even in disadvantaged groups.

Non-COVID hospital admissions decreased during the COVID-19 pandemic and follow-up of people in the lung cancer risk group was delayed. There are not enough studies on the effects of the pandemic period on the diagnosis of lung cancer. In this study, it was aimed to determine the characteristics of patients diagnosed with lung cancer in the pre-pandemic and pandemic period and to investigate the effects of the pandemic on the diagnosis of lung cancer. Patients with newly diagnosed lung cancer 16 months before and after the detection of the first COVID-19 case were retrospectively analyzed for their characteristics at the time of diagnosis. Age, gender, pathological diagnosis, distant organ metastasis status, and also pathological stages at the time of diagnosis of the patients were analyzed. Two hundred forty-six patients were included in the study. One hundred forty-five of the patients were diagnosed in the pre-pandemic period and 101 during the pandemic period. Mean age of patients was 64.24 years and 91.87% were male. Pathological diagnosis distributions were similar in the pre-pandemic group and the pandemic period group. Distant organ metastases were present in 59.31% of the pre-pandemic group and 65.35% of the pandemic group. There was no significant difference in terms of the stages of the patients at the time of diagnosis. Number of patients diagnosed with lung cancer during the pandemic period was lower. The characteristics of the patients were similar. These results may have resulted from the decrease in applications to health institutions due to social isolation and fear of COVID-19 infection, and limitations in accessing health services., Competing Interests: Conflict of InterestThe authors declare no competing interests., (© The Author(s), under exclusive licence to Springer Nature Switzerland AG 2022, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

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 (β [95% CI]: 4.71 [2.31-7.11]; p = 0.001), favipiravir (β [95% CI]: 3.55 [2.56-4.55]; p = 0.001) and HCQ (β [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., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer BH declared a shared affiliation with the authors, II and AK to the handling editor at the time of review., (Copyright © 2022 Babayigit, Kokturk, Kul, Cetinkaya, Atis Nayci, Argun Baris, Karcioglu, Aysert, Irmak, Akbas Yuksel, Sekibag, Baydar Toprak, Azak, Mulamahmutoglu, Cuhadaroglu, Demirel, Kerget, Baran Ketencioglu, Ozger, Ozkan, Ture, Ergan, Avkan Oguz, Kilinc, Ercelik, Ulukavak Ciftci, Alici, Nurlu Temel, Ataoglu, Aydin, Cetiner Bahcetepe, Gullu, Fakili, Deveci, Kose, Tor, Gunluoglu, Altin, Turgut, Tuna, Ozturk, Dikensoy, Yildiz Gulhan, Basyigit, Boyaci, Oguzulgen, Borekci, Gemicioglu, Bayraktar, Elbek, Hanta, Kuzu Okur, Sagcan, Uzun, Akgun, Altinisik, Dursun, Cakir Edis, Gulhan, Oner Eyuboglu, Gultekin, Havlucu, Ozkan, Sakar Coskun, Sayiner, Kalyoncu, Itil and Bayram.)

Objective: Vaccination is the most efficient way to control the coronavirus disease 2019 (COVID-19) pandemic, but vaccination rates remain below the target level in most countries. This multicenter study aimed to evaluate the vaccination status of hospitalized patients and compare two different booster vaccine protocols., Setting: Inoculation in Turkey began in mid-January 2021. Sinovac was the only available vaccine until April 2021, when BioNTech was added. At the beginning of July 2021, the government offered a third booster dose to healthcare workers and people aged > 50 years who had received the two doses of Sinovac. Of the participants who received a booster, most chose BioNTech as the third dose., Methods: We collected data from 25 hospitals in 16 cities. Patients hospitalized between August 1 and 10, 2021, were included and categorized into eight groups according to their vaccination status., Results: We identified 1401 patients, of which 529 (37.7%) were admitted to intensive care units. Nearly half (47.8%) of the patients were not vaccinated, and those with two doses of Sinovac formed the second largest group (32.9%). Hospitalizations were lower in the group which received 2 doses of Sinovac and a booster dose of BioNTech than in the group which received 3 doses of Sinovac., Conclusion: Effective vaccinations decreased COVID-19-related hospitalizations. The efficacy after two doses of Sinovac may decrease over time; however, it may be enhanced by adding a booster dose. Moreover, unvaccinated patients may be persuaded to undergo vaccination., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)

Ataxia-telangiectasia is an autosomal recessive, rare, neurodegenerative multisystem disorder characterized by ataxia-telangiectasia, cerebellar ataxia, oculocutaneous telangiectasia, immunodeficiency, progressive respiratory failure associated with increased malignancy risk. Clinical diagnosis is made with ataxia-telangiectasia mutated (ATM) gene. Our case, who was diagnosed as ataxia-telangiectasia while investigating the etiology of chylous pleural effusion, is presented because of its rare occurrence.

Background/aim: We aimed to report outcomes of pregnant patients with asthma under omalizumab treatment and their infants in our country., Materials and Methods: Patients with asthma who received omalizumab for at least 6 months and at least one dose during their pregnancy were retrospectively evaluated using a questionnaire regarding their disease and therapy and the health of their infants., Results: Twenty pregnant patients and their 23 infant’s data were analyzed. The mean delivery age was 31.8 ± 7.4 years. They received omalizumab for 28.9 ± 21.8 months. Eight (36.4%) patients showed exacerbation of the disease during pregnancy. Forced expiratory volume in 1 s (FEV1) and asthma control test (ACT) scores at the starting time of omalizumab administration, first month of the pregnancy, and after delivery were 71 ± 18%, 83.4 ± 10.5%, and 80.5 ± 13% (FEV1), and 11.9 ± 4.9, 20.2 ± 2.6, and 20.4 ± 2.2 (ACT), respectively. One patient gave birth to twin infants, two patients to two infants each in different years, and 17 to one infant each. Three (13%) infants had low birth weight and five (21.7%) were born prematurely. No congenital anomalies were detected. Seven (30.4%) infants presented atopic diseases during their life., Conclusion: Omalizumab treatment during pregnancy seems to be safe for both patients and their infants., Competing Interests: The authors declare that they have no conflicts of interest related to the submitting work. However, they report that unrelated to the submitted work; Gemicioglu B received grants from Novartis, Deva, Abdi Ibrahim, Sanofi, Astra Zeneca, GSK, Chiesi, Sandoz. Karakaya G received grants from Novartis, Astra Zeneca, GSK, Meda. Bavbek S received grant from Astra Zeneca, Novartis, GSK. Ediger D received grant from Novartis, Sanofi, AstraZeneca, GSK, MSD. Oğuzulgen IK received grants from AstraZeneca, GSK, Deva. Özşeker ZF received grants from Novartis, Abdi İbrahim, Deva. Yorgancıoğlu A received grant from Novartis, Deva, Abdi Ibrahim, Sanofi, Astra Zeneca, GSK, Chiesi, Sandoz., (This work is licensed under a Creative Commons Attribution 4.0 International License.)

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., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

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.

Objectives: In the recent years, it has been observed that the use of hookah, a tobacco product, has increased in children and young people in Turkey. This study was conducted to determine the prevalence of cigarette and hookah use in children and young people specific to age and gender and to define the factors relevant to the use of hookah., Materials and Methods: The study was conducted with secondary/high school students between 11 and 17 years of age (Survey 1, n=4718) and with university students between 18 and 23 years of age (Survey 2, n=1588) as two groups, which made a total of 6306 students. The students were asked to fill in a questionnaire which consisted of questions about socio-demographic data and the use of tobacco and tobacco products., Results: It was determined that the use of cigarette and hookah was high in males, and it increased as the age increased in both genders (p<0.05). It was also determined that parents and friends using cigarette and hookah affected the use of cigarette and hookah in the study groups in both surveys (p<0.05). Additionally, it was determined that the educational level of the parents and being of a high social class were the social determiners of hookah use (p<0.05)., Conclusion: It is important that we fight against the use of all tobacco products, especially in young people. Education about the damages of tobacco and applying tobacco products should start at an early age, and accurate tobacco control models may provide support in this field.

Background: Subjects with chronic obstructive pulmonary disease (COPD) present increased mortality and poor health-related quality of life (HRQoL) as compared with the general population. The objective of this study was to evaluate whether an improvement in QoL after 1 year of proper management is a predictor of survival in a cohort of patients followed up for 10 years., Methods: In this prospective study, 306 COPD patients were assessed for eligibility between January 2003 and September 2003. Thirty-five patients were excluded due to failure to meet inclusion criteria or declining to participate and 20 patients were also excluded subsequently because they could not complete the questionnaire. Two hundred and fifty one patients were assessed at the beginning. St. George Respiratory Questionnaire (SGRQ) and pulmonary function test (PFT) were performed at the initial visit and the end of the first year. Mortality information was obtained from hospital records and direct family interviews., Results: A comparison between respiratory diseases mortality according to baseline paramaters reveals that age and presence of cardiac comorbidity indicates a higher risk of death and associated with worse QoL. After a cox regression analysis, the relative risk of death of any cause related to baseline QoL score was 1.042 (95% CI: 1.028-1.057), and 1.030 (95% CI: 1.011-1.050) for respiratory cause mortality. However, the relative risk of death when there was a deterioration in QoL after one year of follow up was 1.175 (95% CI: 1.130-1.221) for all-cause mortality and 1.214 (95% CI: 1.151-1.280) for respiratory cause mortality., Conclusions: A QoL worsening in the initial year of follow up more strongly predicts 10-year mortality of any cause and for respiratory diseases than the baseline assessment alone predicts, among patients with COPD., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

Background/aim: The optimal empiric antibiotic regimen for patients with community-acquired pneumonia (CAP) remains unclear. This study aimed to evaluate the clinical cure rate, mortality, and length of stay among patients hospitalized with community- acquired pneumonia in nonintensive care unit (ICU) wards and treated with a β-lactam, β-lactam and macrolide combination, or a fluoroquinolone., Materials and Methods: This prospective cohort study was performed using standardized web-based database sheets from January 2009 to September 2013 in nine tertiary care hospitals in Turkey., Results: Six hundred and twenty-one consecutive patients were enrolled. A pathogen was identified in 78 (12.6%) patients. The most frequently isolated bacteria were S. pneumoniae (21.8%) and P. aeruginosa (19.2%). The clinical cure rate and length of stay were not different among patients treated with β-lactam, β-lactam and macrolide combination, and fluoroquinolone. Forty-seven patients (9.2%) died during the hospitalization period. There was no difference in survival among the three treatment groups., Conclusion: In patients admitted to non-ICU hospital wards for CAP, there was no difference in clinical outcomes between β-lactam, β-lactam and macrolide combination, and fluoroquinolone regimens.

Background/aim: The reliability and validity of the Turkish version of the Leicester Cough Questionnaire (LCQ) have been evaluated before. This study aimed to validate the Turkish version of the LCQ in chronic obstructive pulmonary disease (COPD) patients with cough., Materials and Methods: COPD (GOLD B, C, D) patients over age 40 (n = 75) and healthy volunteers as a control group (n = 75) were included. A sociodemographic data form, the LCQ, the Short Form-36 (SF-36) quality of life questionnaire, and the World Health Organization Quality of Life Brief Form for Turkish people were completed. The internal reliability of the LCQ was determined using the Cronbach alpha coefficient (>0.6) and its repeatability by the intraclass consistency coefficient (P < 0.05) was accepted as significant., Results: For internal consistency, Cronbach alpha coefficients of all subscales of the LCQ, physical, psychological, and social, were found as 0.72, 0.86, and 0.83, respectively, with 0.92 for the total index. There was significant internal consistency for all subscales and the total index (Cronbach alpha coefficients of >0.6). In test–retest reliability, the correlation coefficient ranged between 0.71 and 0.80 for each question and was calculated as r = 0.89 for total LCQ score (P < 0.001)., Conclusion: The Turkish version of the LCQ has been found to have acceptable reliability and validity for use in Turkish COPD patients with chronic cough.

Background: Omalizumab has demonstrated therapeutic benefits both in controlled clinical trials and real-life studies. However, research concerning the long-term effects and tolerability of omalizumab is needed. The main objective of this study was to evaluate the effectiveness and tolerability of treatment with omalizumab for up to 5 years., Methods: A multicenter, retrospective, chart-based study was carried out to compare documented exacerbations, hospitalizations, systemic steroid requirement, FEV1, and asthma control test (ACT) results during 1 year prior to omalizumab treatment versus at 1, 3, and 5 years of treatment. Adverse events and reasons for discontinuation were also recorded at each time point., Results: Four hundred and sixty-five patients were enrolled in the study. Outcome variables had improved after the 1st year and were sustained after the 3rd and 5th years of treatment with omalizumab. Omalizumab treatment reduced the asthma exacerbation rate by 71.3% (p < 0.001) at 1 year, 64.3% (p < 0.001) at 3 years, and 54.8% (p = 0.002) at 5 years. The hospitalization rate also decreased; by the 5th year of the treatment no patients were hospitalized. ACT results had also improved significantly: 12 (p < 0.001) at 1 year, 12 (p < 0.001) at 3 years, and 12 (p = 0.002) at 5 years. Overall, 12.7% of patients reported adverse events (most of these were mild-to-moderate) and the overall dropout rate was 9.0%., Conclusion: Omalizumab had a significant effect on asthma outcomes and this effect was maintained over 5 years. The drug was found to be generally safe and treatment compliance was good., (© 2018 S. Karger AG, Basel.)

Introduction: In our country, this is usually done by patient relatives. In this study, we aimed to investigate the thought of doctors who done the diagnosis, doctors who arrange the treatment, first degree relatives of patients with lung cancer, and population as a control., Materials and Methods: 310 subjects (100 doctors, 110 first degree realtives of patients, and 100 subjects as a control) were included to the study. The mean age was 39.77 ± 11.44 years and there was 170 females. 46% of doctors were giving cancer treatment (chemotheraphy/radiotheraphy)., Result: 84.5% of subjects were answered the question (Do you want to know the diagnosis of lung cancer if you are lung cancer?) as "yes" and the answers were not different between groups (p> 0.05). 72 of doctors were giving information about diagnosis of patients. This ratio was 89.1% in doctors who arrange lung cancer treatment whereas it was 57.4% in doctors who do not arrange cancer treatment. The percent age of learning of diagnosis of lung cancer throughout the time in doctors, population, and patient's relatives were 19%, 34%, and 59% respectively (p< 0.05). Information about quality of life was more important in relatives of patients (87%) than population (65%) and doctors (63%) (p< 0.05). Quality of life was more important for doctors who arrange lung cancer treatment (76.7)% than doctors who did not (48.8%) (p< 0.05). Patients who were more children wanted to stay with their family at end stage of disease (p< 0.05)., Conclusions: According to this study we think that doctors should say the diagnosis of lung cancer in the form of they understand, inform the patients and relatives about treatment, and quality of life and this can increase patient trust to doctor and compliance of patients to the treatment.

Objectives: This study aimed to investigate the additional diagnostic value of endobronchial biopsy (EBB) in the diagnosis of pulmonary sarcoidosis., Materials and Methods: This retrospective cross-sectional study included 59 patients with a preliminary diagnosis of sarcoidosis who were admitted to the Pulmonary Diseases Outpatient Clinic of a tertiary healthcare center between January 2005 and October 2012. The socio-demographic characteristics of the patients as well as clinical and radiological findings were recorded. All patients, irrespective of the presence of an endobronchial lesion (EBL), underwent fiberoptic bronchoscopy (FOB); two to four specimens were taken using EBB from the carina of the right middle lobe in the patients with EBL., Results: Of the patients, 39 (66.1%) had normal bronchoscopic findings, while 5 had EBL. Diagnosis was based on EBB in 11 patients (18.6%). Six patients (15.3%) with normal bronchial mucosae were pathologically diagnosed by EBB. There was no statistically significant relationship between the diagnostic ratio of EBB and disease stage, extrapulmonary involvement, FOB findings, elevated lymphocyte rate in bronchoalveolar lavage (≥ 13%), a CD4/CD8 ratio of ≥ 3.5, and serum angiotensin-converting enzyme (ACE) level (p> 0.05)., Conclusion: EBB not only offers the advantage of a high diagnostic ratio in patients with mucosal abnormalities but also contributes to pathological diagnosis in patients with normal mucosa. We recommend using EBB to support diagnosis with a low complication rate for patients undergoing FOB with a preliminary diagnosis of sarcoidosis in healthcare centers, where endobronchial ultrasound (EBUS) is unavailable., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.

Aim: The early diagnosis and treatment of lung cancer are important for the prognosis of patients with lung cancer. This study was undertaken to investigate patient and doctor delays in the diagnosis and treatment of NSCLC and the factors affecting these delays., Materials and Methods: A total of 1016 patients, including 926 (91.1%) males and 90 (8.9%) females with a mean age of 61.5±10.1 years, were enrolled prospectively in this study between May 2010 and May 2011 from 17 sites in various Turkish provinces., Results: The patient delay was found to be 49.9±96.9 days, doctor delay was found to be 87.7±99.6 days, and total delay was found to be 131.3±135.2 days. The referral delay was found to be 61.6±127.2 days, diagnostic delay was found to be 20.4±44.5 days, and treatment delay was found to be 24.4±54.9 days. When the major factors responsible for these delays were examined, patient delay was found to be more frequent in workers, while referral delay was found to be more frequent in patients living in villages (p<0.05). We determined that referral delay, doctor delay, and total delay increased as the number of doctors who were consulted by patients increased (p<0.05). Additionally, we determined that diagnostic and treatment delays were more frequent at the early tumour stages in NSCLC patients (p<0.05)., Discussion: The extended length of patient delay underscores the necessity of educating people about lung cancer. To decrease doctor delay, education is a crucial first step. Additionally, to further reduce the diagnostic and treatment delays of chest specialists, multidisciplinary management and algorithms must be used regularly., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Introduction: Awareness of the healthcare providers on chronic obstructive pulmonary disease (COPD), which is an important cause of mortality and morbidity in our country and all over the world, and on pulmonary rehabilitation (PR) which plays an important role in its nonpharmacological treatment will provide effectiveness in diagnosis and treatment of COPD. The present study aimed at determining knowledge level of the healthcare providers about COPD and PR., Materials and Methods: In this cross-sectional study, family practitioners and staff of home-care in central county of Manisa City were applied a questionnaire in order to determine their knowledge level on COPD and pulmonary rehabilitation during the in-service training on "pulmonary rehabilitation, home-care services for the pulmonary diseases, and respiratory exercises.", Results: 65.5% of the healthcare providers responded to the survey. Rate of those correctly knowing at least one of four items was 97.2%. No responder knew all items correctly. Average value for correct answers was 5.30 ± 2.1 (range: 1-10). The physicians, men, and those working in family health centers had higher level of knowledge on COPD compared to nonphysician healthcare providers (p = 0.006), women (p = 0.002), and those working in other practices (p = 0.019), respectively., Conclusion: Knowledge level of the primary healthcare providers on COPD and PR remains inadequate. Dynamic postgraduate training on this topic will be useful in referring the patients to centers giving service for this condition.

Flagellated protozoa that cause bronchopulmonary symptoms in humans are commonly neglected. These protozoal forms which were presumed to be "flagellated protozoa" have been previously identified in immunosuppressed patients in a number of studies, but have not been certainly classified so far. Since no human cases of bronchopulmonary flagellated protozoa were reported from Turkey, we aimed to investigate these putative protozoa in immunosuppressed patients who are particularly at risk of infectious diseases. Bronchoalveolar lavage fluid samples of 110 immunosuppressed adult patients who were admitted to the Department of Chest Diseases, Hafsa Sultan Hospital of Celal Bayar University, Manisa, Turkey, were examined in terms of parasites by light microscopy. Flagellated protozoal forms were detected in nine (8.2%) of 110 cases. Metronidazole (500 mg b.i.d. for 30 days) was given to all positive cases and a second bronchoscopy was performed at the end of the treatment, which revealed no parasites. In conclusion, immunosuppressed patients with bronchopulmonary symptoms should attentively be examined with regard to flagellated protozoa which can easily be misidentified as epithelial cells.

Objective: This study investigated the attitudes of Turkish adults towards the ban on smoking in public areas and compared annual smoking cessation rates before (pre-2009) and after (post-2009) the ban became law, using data from a survey of teachers., Methods: A self-reported questionnaire was used to collect data from teachers in Manisa, Turkey. Annual smoking rates were calculated. Joinpoint regression analysis was used to identify when a significant change occurred in the annual smoking cessation rate., Results: Questionnaire response rate was 79.6% (579/727); 47.8% (277) of respondents were male. Smoking prevalence among men and women was 32.7% and 24.7%, respectively, and 97.3% of nonsmokers and 75.5% of current everyday smokers supported the law changes. Results of the Joinpoint analysis showed no significant change in annual smoking cessation rate between 2001-2002 and 2006-2007; but there were significant reductions in smoking rates between 2007-2008 and 2010-2011., Conclusions: Teachers in Turkey have a positive attitude to the law on smoking. The smoking cessation rate in teachers was significantly increased by changes in legislation.

Introduction: Internal and external air pollution that is gradually increasing due to urbanization and industrialization has a negative impact on the lung health. A health survey has been applied to evaluate the respiratory symptoms, respiration functions and smoking habbits of the workers of Izmir Konak Municipality whom have been reported to have a high rate of smoking habbit and be affected by the external air pollution due to their being working in the field by the Municipality's doctor., Materials and Methods: Questionnaire that are composed of the topics of work anamnesis, environmental anamnesis, curriculum vitae, symptoms (coughing, sputum, wheezing, dyspnea, hemoptysis) and smoking have been executed to 301 workers by face to face interview and their chest X-rays have been reviewed., Results: Dyspnea on exertion, sputum in the morning, wheezing and morning cough have been the most frequently observed complaints (respectively 37.2%, 32.2%, 27.9% and 24.9%). Sanitary workers have reported sputum in the morning more while maintanance shop workers have reported wheezing more (p values respectively 0.009, 0.008). No significance has been observed while the workers are evaluated one by one regarding to their work groups. No significant difference was identified between the addiction of smoking and nicotin addiction or pulmonary function test and chest X-rays (p> 0.05) but active smoking was much more seen in drivers (p= 0.047)., Conclusion: Although working on the hazardous work branch does not institute a sharp distinction, it becomes significant to trace and lead the workers in order to obtain their lung health protection in long term. Informing and influencing the workers about the harms of smoking and the ways to quit has been the most considerable acquisition of this survey.

Spontaneous tension haemopneumothorax is a very rare condition. Forty two-year- old male patient who applied with sudden onset of dyspnea, chest pain was tachypneic, tachycardic, cyanotic and hypotensive. This is the second case of spontaneous tension haemopneumothorax in English literature, according to our knowledge. We present this case because of being a rare condition.

Quality of life (QoL) is being recognized as an important outcome when evaluating chronic obstructive pulmonary disease (COPD) patients. This study aims at identifying the relation between QoL parameters and mortality and morbidity in COPD patients by using the St. George Respiratory Questionnaire (SGRQ). In this prospective study, 251 COPD patients as defined by American Thoracic Society (ATS) criteria were included. A total of 218 patients (86.85%) were male and mean age was 65.55 years. A pulmonary function test (PFT) and SGRQ were performed at the beginning, first, and second years. During a two-year follow-up, the first exacerbation day, the number of exacerbations and intubations, the number and duration of hospitalizations, hospitalizations in an intensive care unit, and exitus day were recorded. When the correlation between FEV(1), SGRQ scores, and these parameters was investigated, there was significant correlation between these parameters, and this correlation was more significant in SGRQ scores than FEV(1) (Pearson correlation test). The activity score of SGRQ was found to be more useful than other scores (Cox regression analysis). Not only PFT but also QoL questionnaires are useful in determining the prognosis of COPD. QoL questionnaires provide a valid and standardized estimate of the overall impact of COPD, and can complement spirometric measurements of baseline assessment of patients in routine practice.

In this study, effect of long term smoking on sensitivity of cough reflex was investigated. Healthy, current smoker male and female was evaluated by capsaicin cough challenge test and they were compared with healthy, non-smoker persons with similar age and gender, prospectively. In current smokers, there were 50 male and 39 female, in non-smoker control group, there were 20 male and 21 female. Mean and log C5 dosage in current smoker and non-smoker groups and mean and log C5 dosage in current smoker according to gender were calculated by using Mann-Whitney U-test. Results of capsaicin cough challenge test in current and non-smoker groups were evaluated by using Pearson Chi-Square test and Fisher's Exact test. In current smokers comparison of results of capsaicin cough challenge test with smoking history (age with first smoking, duration, pocket year and smoking per day) was evaluated by using Mann-Whitney U-test. Mean C5 and mean log C5 dosage were found decreased in current smokers when they were compared to control group (p< 0.00). In current smoker group mean C5 and mean log C5 dosage were found decreased in male (p< 0.002). When the results of capsaicin cough challenge test were compared between current smoker and control groups, sensitivity of cough reflex in concentration with 0.49, 0.98, 1.95, 3.9, 7.8, 15.6 microM was significantly decreased in current smoker group. Also there was a significant correlation between concentration with 0.98, 1.95, 3.9, 7.8, 15.6, 31.2 microM, and duration of smoking and pocket year of smoking. Also there was a correlation between concentration with 15.6, 31.2, 62.5, 125 microM and smoking per day. This results were correlated with hypothesis about inhibition of C-fibers with nicotin or decrease of C-fibers' sensitivity due to induction of neuropeptide wasting.