Massive Hemoptysis: Danger is Real, Promptness is Essential

WOS: 000436167400001PubMed ID: 2975580

Pleural empyema due to Salmonella typhi

65 years old female was admitted to hospital with fever, purulant sputum and dispnea. The patient has hepatic chirosis secondary to autoimmun hepatitis and hepatocelluler carsinoma. Immunosupressive treatment is used for autoimmun hepatitis. In physical examination matite and diminished respiratory sounds were determined at right hemithorax. Ascitis was determined in abdominal examination. Chest X-ray showed pleural effusion in right hemithorax. Seroushemoragical fluid was aspirated by thorasynthesis. Pleural fluid pH was 6.9 and had an exudative nature. The patient was the diagnosed as empyema. Right tube thorachostomia was performed and sulbactam-ampicillin 6 g/day therapy was started. In patient's ascit fluid no bacteria and leucocytes was seen. Salmonella typhi was isolated from pleural fluid. No microorganisms were isolated from ascit fluid, urine and stool culture. Klebsiella pneumoniae is isolated in patient's hemoculture. Clinical improving was detected. Chest X-ray showed totaly regretion of pleural fluid and the tube thoracostomy removed. We presented this case because of rarely seen microorganism (S. typhi) in immuncompromised patients a cause of pleural empyema which is frequently seen gastrointestinal infections

The Effects of Smoking Properties and Demographic Properties on the Results of Smoking Cessation Therapy

We aimed to evaluate the effects of demographics and therapy modalities on the outcome of smoking cessation therapies in our clinic. 230 people filled a questionnaire via telephones interview. 68 persons who quitted smoking were defined as controls, and 101 subjects who couldn't quit were defined as the case group. There was no significant difference between case and control groups for age, gender and education. Presence of systemic and pulmonary disease did not affect quitting. Being married decreases the risk of not quitting by 0.4 times. At 6th month, 48.6% of those using bupropion, 35.9% of those using nicotine replacement therapy (NRT), 44,4% of those using combination therapy, and 17.6% of those having undergone only education program quitted. Eight of the bupropion, 18 of the NRT, 2 of the combination therapy, and 2 of the only education groups were not smoking at the end of the first year. The period of therapy was 4.71 +/- 6.43 weeks in case group and 6.64 +/- 3.14 weeks in control group. The difference was significiant. 55.6% of the cases and 86.2% of the controls had sufficient therapy (4 weeks) periods. It's shown that sufficient duration of therapy decreases the risk of not quitting about 0.2 times (OR 0.2, 95% CI 01-0.5, p=0.000). It was determined that the mean duration of restarting smoking was 2.4 +/- 1.9 months at the first attemp to stop smoking. Quitting rate can be increased by using therapies at least four weeks, and additional controls after six months are necessary to prevent recurrences

The effects of environmental tobacco smoke exposure before starting to smoke on cigarette quitting therapies

We aimed to determine the effects of environmental tobacco smoke (ETS) exposure before starting to smoke on cigarette quitting therapies and to determine source environment/individuals for ETS exposure. 230 individuals were contacted. We investigated person/s with ETS exposure before starting to smoke, places/duration of exposure, sources of exposure, therapy methods/durations recommended. Training seminar was also assumed as a therapy method. Those who were administered nicotine replacement and/or bupropion for a minimum of one week, 169 patients who only attended the training programme were evaluated. 68 patients who stopped smoking defined as controls, 101 patients who did not were defined as cases. There was no difference between case and control groups in terms of ages at initiation of smoking, ages at initiation of regular smoking, number of cigarettes per-day, total package-year and nicotine dependence score. 218 patients were found to have ETS exposure before starting to smoke. The highest ETS exposure was determined to be indoors (85.7%) and of paternal origin (77.2%). The rates of cigarette smoke exposure of maternal origin were 32.7% in cases, 25.4% in controls (p= 0.009 OR= 2.8). The mother being a smoker was found to increase the risk of not being able to stop smoking by 2.8 times. The number of people causing ETS exposure was higher in cases compared to controls (p= 0.044). ETS exposure have negative effects on the outcomes of cigarette quitting therapies. Indoor ETS exposure is the leading source of exposure. Therefore, indoor ETS exposure should be prevented, mothers should be trained concerning this matter

Preliminary studies on the prevalence and genotyping of Echinococcus granulosus infection in stray dogs in Van Province, Turkey

Introduction:Echinococcus granulosus is a zoonotic helminth of the Taeniidae family living in the small intestines of dogs. The hydatid cyst, which is the larval form of this parasite, is observed in sheep, goat, cattle, and many other organisms including humans. It causes a disease called cystic echinococcosis. Identification of strains of E. granulosus in dogs is critical in parasite control and eradication where possible. This study aims to determine the genotype of E. granulosus eggs and prevalence of this parasite in the faeces of dogs in the Van Province using the copro-PCR method

A case scenario study for the assessment of physician's behavior in the management of COPD: the WHY study

WOS: 000443757800002PubMed ID: 30233165Purpose: COPD diagnosis is mainly based on clinical judgment of physicians. Physicians do not also refer to COPD guidelines in their daily practice. This study aimed to assess attitudes of physicians regarding COPD diagnosis, treatment, and follow-up and to identify the factors influencing physicians' decisions in clinical practice. Patients and methods: Fifty physicians were selected from 12 EuroStat NUTS 2 regions and asked to assess seven fictitious case scenarios. The following five scenarios described patients with COPD: Case Global Initiative for Chronic Obstructive Lung Disease (GOLD) A-smoker and Case GOLD A-nonsmoker were previously undiagnosed patients presenting with dyspnea, Case GOLD D-smoker and GOLD B-exsmoker were COPD patients presenting with exacerbation, Case GOLD B-smoker was a previously diagnosed COPD patient with dyspnea in stable phase, Case asthma-COPD overlap syndrome, and Case obesity hypoventilation syndrome. Patients' history, physical examination findings, pulmonary function tests, and X-ray images were prepared before the study by an experts' committee and provided to the physicians upon their request, until they reached a final decision. The physicians completed a questionnaire including information about their clinical practices and institutions. Results: According to the GOLD 2015 recommendations, of the physicians, 44% performed guideline-concordant diagnosis in the first five scenarios, who were all COPD patients, and 6% performed guideline-concordant diagnosis in all cases. There was a negative correlation between high workload and making a guideline-concordant diagnosis (P=0.038, rho =-0.417). Even when the physicians made a guideline-concordant diagnosis of COPD, only a minority (10%-22%) used the GOLD classification. Logistic regression analysis revealed that working in a tertiary health care center was a significant factor in favor of establishing a guidelineconcordant diagnosis of COPD (P=0.029, OR = 6.139 [95% CI: 1.20-31.32]). Conclusion: Management of COPD patients in Turkey does not generally follow the GOLD criteria but is rather based on physicians' clinical experience. Heavy workload appears to adversely affect the correctness of clinical decisions.Novartis Pharmaceuticals, TurkeyWe thank Clinical Research Manager Clinical Research Organization who provided editorial support and performed statistical analysis funded by Novartis Pharmaceuticals, Turkey

The Effect of Smoking on COVID-19 Symptom Severity: Systematic Review and Meta-Analysis

Background. Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SAR2-COV-2) and was first identified in Wuhan, China, in December of 2019, but quickly spread to the rest of the world, causing a pandemic. While some studies have found no link between smoking status and severe COVID-19, others demonstrated a significant one. The present study aimed to determine the relationship between smoking and clinical COVID-19 severity via a systematic meta-analysis approach. Methods. We searched the Google Scholar, PubMed, Scopus, Web of Science, and Embase databases to identify clinical studies suitable for inclusion in this meta-analysis. Studies reporting smoking status and comparing nonsevere and severe patients were included. Nonsevere cases were described as mild, common type, nonintensive care unit (ICU) treatment, survivors, and severe cases as critical, need for ICU, refractory, and nonsurvivors. Results. A total of 16 articles detailing 11322 COVID-19 patients were included. Our meta-analysis revealed a relationship between a history of smoking and severe COVID-19 cases (OR=2.17; 95% CI: 1.37–3.46; P<.001). Additionally, we found an association between the current smoking status and severe COVID-19 (OR=1.51; 95% CI: 1.12–2.05; P<.008). In 10.7% (978/9067) of nonsmokers, COVID-19 was severe, while in active smokers, severe COVID-19 occurred in 21.2% (65/305) of cases. Conclusion. Active smoking and a history of smoking are clearly associated with severe COVID-19. The SARS-COV-2 epidemic should serve as an impetus for patients and those at risk to maintain good health practices and discontinue smoking. The trial is registered with the International Prospective Register of Systematic Reviews (PROSPERO) CRD42020180173

Comparison of two scores for short-term outcomes in patients with COPD exacerbation in the emergency department: the Ottawa COPD Risk Scale and the DECAF score

Background While clinical decision rules have been developed to evaluate exacerbations and decisions on hospitalisation and discharge in emergency departments (EDs) in patients with chronic obstructive pulmonary disease (COPD), these rules are not widely used in EDs. In this study, we compare the predictive efficacy of the Ottawa Chronic Obstructive Pulmonary Disease Risk Scale (OCRS) and the Dyspnea, Eosinopenia, Consolidation, Acidemia, and Atrial Fibrillation (DECAF) score in estimating the short-term poor outcome of patients in our ED with exacerbations of COPD. Methods This single-centre prospective observational study was conducted over 6 months. Patients with acute exacerbations of COPD admitted to the ED during the study period were included in the study. A poor outcome was defined as any of the following: readmission and requiring hospitalisation within 14 days of discharge, requiring mechanical ventilation on the first admission, hospitalisation for longer than 14 days on the first admission, or death within 30 days. The sensitivity and specificity of the OCRS and the DECAF score for a poor outcome and for mortality were calculated. Results Of the 385 patients who participated in the study, 85 were excluded based on the exclusion criteria. 66% of the patients were male, and the mean age was 70.15±10.36 years. A total of 20.7% of all patients (n=62) experienced poor outcomes. The sensitivity of an OCRS score <1 for predicting a poor outcome in patients was 96.8% (95% CI 88.8–99.6%) and the specificity was 18.5% (95% CI 13.8–24.0%). The sensitivity and specificity of an OCRS score <2 were 83.3% (95% CI 35.9–99.6%) and 65.5% (95% CI 59.6–70.7%), respectively. The sensitivity and specificity of a DECAF score <1 were 88.7% (95% CI 78.1–95.3%) and 34.5% (95% CI 28.4–40.9%), respectively. When the DECAF score was <2, sensitivity and specificity were 69.3% (95% CI 56.4–80.4%) and 74.8% (95% CI 68.8–80.2%), respectively. Conclusion Our physicians achieved high specificity but low sensitivity in predicting a poor outcome. The OCRS is the more sensitive of the two tools, while the DECAF score is more specific in predicting a poor outcome when all threshold values are evaluated. While both tools may results in unnecessary hospitalisation, they can reduce the incidence of hospital discharge of patients with exacerbations of COPD who will develop poor outcomes in the ED

Three atypical pulmonary hydatidosis lesions mimicking bronchial cancer from Turkey

WOS: 000266757500019PubMed ID: 19579706Hydatid disease is endemic in Turkey Echinococcus granulosus causes cystic echinococcosis mostly in the liver and lung. Although pulmonary hydatid cysts can be diagnosed by clinical and radiological findings, atypical or complicated lung lesions may be misdiagnosed. In the present study, three cases with hemoptysis and atypical lung lesions were diagnosed and treated as lung cancer or tuberculosis based on the clinical and laboratory findings along with the imaging data and fiberoptic bronchoscopy evaluation. Eventually pathological examination of the bronchoscopic biopsy material confirmed the definitive diagnosis as Pulmonary hydatidosis. The three patients presented herein emphasize the importance of considering pulmonary hydatid disease in the definitive diagnosis of atypical lung lesions Such as bronchial carcinoma in echinococcosis endemic areas

The Effectiveness of a Smoking Cessation Initiative Among Employees in a Textile Factory

OBJECTIVE: In this study, we aimed to investigate the effectiveness of a smoking cessation initiative for workers who are smokers in a textile factory located in Denizli, Turkey. MATERIAL AND METHODS: This retrospective cohort was conducted by using the occupational health and safety unit records of 821 workers who are smokers. All participants underwent cognitive behavioral therapy, and in case of need, a suitable pharmacological treatment was initiated. The status of smoking cessation was checked at the end of the third month with a carbon monoxide breath monitor. A chi-square test was performed to make comparisons between categorical variables. Logistic regression analysis (backward) was used to evaluate the factors related to the smoking cessation status. RESULTS: The ratio of participants who gave up smoking was 74.3%, and 63% of them used a pharmaceutical aid to quit smoking. Working in the department of finishing and using a pharmaceutical aid to quit smoking were related to increased success in smoking cessation. CONCLUSION: Outcomes of our study emphasize that workplace-based smoking cessation programs may create a huge impact on smoking cessation among workers. Pharmacological aid and cognitive behavioral therapy have been associated with success in quitting smoking.Pfizer PFE Ilaclari A.S.Digitization procedure of raw data used in this publication was funded by Pfizer PFE Ilaclari A.S