THE FACTORS INFLUENCING DELAY OF DIAGNOSIS IN LUNG CANCER

Akciğer kanseri dünya çapında en önemli mortalite nedenlerinden biridir. Tanı gecikmesi, hastada emosyonel strese, kür ve etkili palyasyon sağlayacak tedavilerin gecikmesine neden olmaktadır. Bu çalışmada; akciğer kanserli hastalarda tanı ve tadavi gecikmesini etkileyen faktörlerin araştırılması amaçlanmıştır. Histopatolojik tanısı konmuş 106 akciğer kanserli hastanın semptomlarının başlangıcından doktora başvurusuna geçen süre (SB), başvurudan patolojik tanıya (BP), başvurudan tedavi başlangıcına (BT), semptom başlangıcından tedavi başlangı- cına (ST) geçen süre retrospektif olarak değerlendirildi. Semptom başlangıcından doktor başvurusuna kadar geçen süre ile hastaların cinsiyeti, mesleği, yaşadığı yer, lezyonun lokalizasyonu, malignite öyküsü, kronik akciğer hastalığı varlığının ilişkisi değerlendirildi. Semptom başlangıcından tedavi başlangıcına kadar geçen sürenin lezyonun lokalizasyonu, malignite öyküsü, kronik akciğer hastalığı olması ile ilişkisi değerlendirildi. Hastaların evrelerine göre SB, BP ve BT’ye geçen süre değerlendirildi. SB ve BP sırasıyla 42.5±61.6, 61.7±55.6 gündü. En hızlı başvuran vena kava süperior sendromlu hastayı, hemoptzisi ve nörolojik semptomları olan hastalar izlemekteydi. Hastanın cinsiyetinin, mesleğinin SB’yi, yaşadığı yerin, lezyon lokalizasyonunun, malignite öyküsünün ve kronik akciğer hastalığı varlığının SB ve ST’yi etkilemediği bulundu. Evreler arasında SB, BP, BT açısından fark izlenmedi. Çalışmamızda akciğer kanserli hastalarda semptom başlangıcından doktora başvuruya ve tedavi başlangıcına kadar geçen süreler önerilenden daha uzun bulundu. Bu gecikmeyi hastanın yaşadığı yer, mesleği, kronik akciğer hastalığı olması, kendisinde başka kanser, ailesinde akciğer kanseri olmasının ve lezyonun lokalizasyonunun etkilemediği görüldü. Semptomlar başladıktan sonra en kısa sürede akciğer kanseri tanısını koyup etkin tedavinin uygulanabilmesi için tanı gecikmesini etkileyen faktörleri belirlemeye yönelik ileri araştırmalara ihtiyaç vardır.Lung cance r is worldwide important cause of mortality. Diagnostic delay results emotional stress and treatment delay. The aim was to investigate factors influencing delay in diagnosis and treatment of lung cancer. Histopathologically proven 106 patients with lung cancer were enrolled.Time from initiation of symptom to reference to doctor (SR) and to treatment (ST), from reference to pathological diagnosis (RP) and to treatment (RT) were evaluated retrospectively. The relationship between SR and gender, profession, living place, localization of lesion, malignancy history, presence of chronic lung disease was evaluated. The relationship between ST and living place, localization of lesion, malignancy history, presence of chronic lung disease was evaluated. SR, RP and RT were evaluated according to stages of patients. SR and RP were respectively 42.5±61.6, 61.7±55.6 days. Most rapid reference was acquired to patient who had vena cava superior syndrome, was followed up by patients who had hemoptysis and neurologic symptoms. Gender and profession was not effective on SR. Localization of lesion, malignancy history, presence of chronic lung disease were not affective on SR and ST .There was no difference between stages of the disease in the means of SR, RP and RT. In this report SR and ST was found longer than suggested. It is shown taht this delay was not affected from living place, presence of chronic lung disease, malignancy history, localization of lesion. Further studies are nececcary to clarify reasons of diagnostic delay of lung cancer patients to apply appropriate treatment as soon as possible

Comparison of Severity Scoring Systems in Community-Acquired Pneumonia

Objective: The aim of this study was to compare the ability of CURB-65, pneumonia severity index and SMART-COP systems to predict 30-day mortality and the need for intensive respiratory and vasopressor support (IVRS). Methods: We included 84 cases with community acquired pneumonia (CAP) and followed up for 30 days. The scores were calculated at admission and associated with the 30-day mortality and the need for intensive respiratory and vasopressor support. Results: The mean age of patients was 58.6±18.7 years. The 30-day mortality level for CAP was 7.1%. Fourteen of 84 patients (16.7%) with CAP were followed in ICU. The area under curve (AUC) values of the three systems (CURB-65, PSI, and SMART-COP) for 30-day mortality were 0.89, 0.89 and 0.91, respectively, and for the need for IRVS was 0.88, 0.91 and 0.93, respectively. Conclusion: The three systems accurately detected the need for IRVS and the 30-day mortality, but none individually demonstrated any advantage over the others

Dietary Intake Of Patients With Moderate To Severe Copd In Relation To Fat-Free Mass Index: A Cross-Sectional Study

Background Fat-free mass (FFM) depletion has been shown to be a better predictor of mortality than BMI in chronic obstructive pulmonary disease (COPD) patients. The specific aim of the current study was to assess the nutritional status of stable COPD patients in relation to fat free mass index profiles. Methods We investigated 65 male moderate-to-severe stable COPD patients. A self-reported questionnaire was applied about general characteristics and smoking history. Nutritional intake was assessed by using a 54–item quantitative food frequency questionnaire. Weight, height, mid-upper arm circumference (MUAC), waist circumference (WC), handgrip strength and body composition measurements were taken by a trained dietitian. The data were analyzed with SPSS 15.0 software. Results The mean age of the patients was 62.1 ± 8.9 years. Among all of the patients 13.8% was underweight (BMI < 21 kg/m2) and 18.5% had a low fat-free mass index (FFMI < 16 kg/m2). The percentages of the patients who did not meet the daily recommended intakes (RNI) were highest for magnesium (93.8%) and calcium (92.3%). Mean daily consumptions of milk-yogurt, red meat and fruits were significantly low in the low FFMI group compared to normal FFMI group (for all; p < 0.05). Patients with normal FFMI had significantly higher weight, height, WC, MUAC, handgrip strength, fat and fat-free mass than the patients with low FFMI (for all; p < 0.05). Conclusions Dieticians should be aware of COPD patients with low FFMI in order to evaluate the nutritional intake and therefore plan nutritional strategies to improve prognosis of the disease.PubMedWoSScopu

Lung Diseases due to Nontuberculous Mycobacteria: Report of 5 Cases

Nontuberculous mycobacteria (NTM) are commonly isolated from environmental sources such as water and soil. Lung disease due to NTM commonly occurs in structural lung disease. Here, we report five cases of NTM. We identified two cases of Mycobacterium abscessus, one of M. chelonae, one of M. gordoneae, and one of M. szulgai by polymerase chain reaction (PCR). One of the patients with M. abscessus, despite aggressive treatment, died, whereas the other was alive and had no clinical and radiological progression without treatment. Without treatment, the progression of disease was not seen in the case of M. chelonae and that of M. gordoneae. Clinicoradiological regression occurred in the case of M. szulgai that was treated with HRZE. For correct diagnosis and the successful treatment of NTM pulmonary disease, knowledge of clinical, radiological, and microbiological findings is important