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

he COVID-19-related death rate varies between countries and is affected by various risk factors. This multi center 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, corre sponding 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

Learning platform for smoking cessation project: From begining to date

Although 35% of the adults in Turkey are current smokers, the number of trained physicians and smoking cessation (SC) clinics are not enough to meet the demand. Aim: This national project aimed to create the necessary infrastructure for providing SC therapy all-around the country and to train physicians in this topic. This project was run by Turkish Thoracic Society Tobacco Working Group and supported by a grant from Pfizer Foundation. Methods: For this purpose, an organization network including field training teams was planned. The training materials were prepared and standardized. A website of the project including a wide e-learning platform was created (www.sigarabirakmadaogrenmezemini.org). Results: Firstly, a central training program was planned. Forty volunteers from all regions of Turkey were participated to this program. Afterwards, field training programs were started to perform by these trainers. From the beginning field training sessions were performed in 11 cities with more than 300 participants. The project website was visited by 10.369 visitors and 518 participants completed e-training module since April 2011. Conclusion: The SÖZ project enabled a training ground that will last for years; a professional website and a trainer staff to generalize the program. Through this project, the integration of SC intervention in all health service steps will be provided, the number of SC clinics in Turkey will increase, and in future smoking rate will reduce in our country

Acute Respiratory Distress Syndrome and Hepatotoxicity Associated with Single Dose Nitrofurantoin Use

Nitrofurantoin is a synthetic nitrofuran compound. It is generally used in urinary tract infections, either alone or in combination with other antibiotics. A number of adverse effects may develop in different body systems during nitrofurantoin treatment; however, concomitant pulmonary and hepatotoxicity are rare. In this paper, we present a case of acute respiratory distress syndrome and hepatotoxicity following administration of a single dose of nitrofurantoin

Measuring sustainability of tobacco control by market and consumption data in Turkey

Background Turkey has been recognized as a leader in tobacco control, implementing all MPOWER policies. However, reports have indicated challenges in the sustainability of the success. This study aims to investigate the change in dynamics of tobacco manufacturing, marketing and consumption in the country as a measure of efficacy in policy implementation. Methods The data were obtained from Surveys of Turkish Statistics Institute and Tobacco and Alcohol Regulatory Authority, Global Tobacco Adult and Youth Surveys, Euromonitor reports. Results Turkish tobacco market is controlled by 5 transnational companies. Tobacco production increased by 40% between 2011-2016 in contrast to the reduction of 23 % in 2008-2011 period. Non-cigarette tobacco product manufacturing has increased by 82 % in the last decade. Tobacco production per capita increased from 1.11 kg in 2011, to 1.46 kg in 2016. Annual domestic cigarette sales of 91 billion sticks in 2011 soared up to 105 billion sticks in 2016. Cigarette exportation increased by 290 % between 2003-2016, while tobacco industry revenue due to domestic cigarette sales and exporation increased by 354%and 244% respectively. Between 2010-2015 increase in cigarette sales were reported as 12% in volume and 85% in revenue. The number of smokers reached to 15.7 million in 2015. By 2016 40 % of men and %13 women were smoking cigarettes (in total 26.5%). Current smokers in 13-15 age group increased from 6.9 % in 2003 to 8.4% in 2009 and to 10.4 % in 2012. Tobacco related mortality was unchanged between 2011-2015, 124.8/100.00 and 123.7/100.000 respectively. [Tobacco production in Turkey] Conclusions Starting from 2011 tobacco control has shown a downhill trend in Turkey, all gained seems to be lost by 2016. The reasons for this change must be investigated in order to restore sucess not only for Turkey but for all the countries which may follow the same path

Is "hookah cafe" a tool to bypass smoke-free law?

Background In Turkey consumption of tobacco products in all indoor places are banned since 2009. Hookah and cigarettes which do not contain tobacco but used in a way to imitate the tobacco products are considered as tobacco products since 2013. The objective of this study was to determine hookah consumption in enclosed spaces of licensed hospitality establishments in Istanbul. Methods This is a cross-sectional study. There are 428 hospitality establishments licensed to offer hookah tobacco products in Istanbul. Seven districts which encompass 51.2% of all the licensed establishments were selected as the study area. Sample size was calculated as 141 establishments assuming a violation rate of 50%, margin of error of 0.05, confidence level of 95% and a 10% non-response. Establishments were selected through simple random sampling. Data were collected through direct observation and presences of hookah use, smoking, signage display were noted. Observations were carried out after 3:00 PM for 10 minutes. Results Of the 141 establishments 128 were accessed (90.8%). The majority were cafes (68.8%) and 3.1% had kids menu. Only 57.0% had existence of open terrace and 68.8% had extensions with removable panels. Of the establishments 15.6% had < 100 meters distance from formal education institutions. Among all 50.7% had no-smoking sign display, and of these only 61.5% were appropriate in terms of size and content. Violation for cigarette smoking and hookah use were 73.4% and 78.1%, respectively. In only four establishments health warnings were present on hookah bowls and two were appropriate in terms of size and content. Conclusions The absence of open terraces, lack of no-smoking signage, health warnings on hookah bowls, proximity to educational institutions and violations indicate problems with licensing and inspection procedures. Hookah premises without open spaces render detection of cigarette smoking impossible. There is a need to revise the methods of enforcement

Obstructive sleep apnea is prevalent in patients with pulmonary embolism

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