A Case of Post-COVID-19 Fibrosis Mimicking Thoracic Manifestation of Ankylosing Spondylitis.

The most common thoracic manifestation form of ankylosing spondylitis is apical fibrocystic changes. It is also known as apical fibrobullous disease (AFBD). The patient was diagnosed with ankylosing spondylitis before 9 years. He suffered COVID-19 infection and passed an intensive care period. However, post-covid fibrosis (PCF) atypically affected dominantly apical zones. If we had no sequential CT evaluations, our case could be easily confused with AFBD. On CT taken before COVID-19, the lung apex was normal. Thus, it was confirmed that there was no rheumatologic thoracic manifestation in the patient before suffering from COVID-19 pneumonia. PCF created similar changes as AFBD. Our case is the first reported paper on this topic.

A case of B.1.1.7 SARS-CoV-2 UK strain with an atypical radiological presentation.

The new UK strain was first described in December 2020. It was seen for the first time in Turkey in February 2021. It is not yet known whether the new strain has different CT patterns compared to the classical type. We present a 68-years-old male patient with an atypical CT presentation in which GGOs are gathered around the areas of paraseptal emphysema accompanied by CT and clinical findings. This involvement is an unexpected pattern because of the atypical distribution of the GGO.

Should isoniazid prophylaxis be prescribed to the patients under tumor necrosis factor-alpha antagonists independent of tuberculin skin test?

INTRODUCTION: The aim of this study was to present the follow-up results of 110 patients who were given anti-tumor necrosis factor alpha (TNF-α) therapy for rheumatic and dermatologic diseases in a country with a high rates of active and latent tuberculosis bacillus infection. MATERIAL AND METHODS: Between February 2008 and January 2015, 110 cases in the age range of 23-77 who are using anti-TNF-α were included in the study retro-prospectively. RESULTS: 52.7% of them (n = 58) were male. The most common diagnoses were rheumatoid arthritis (42.7%) and ankylosing spondylitis (38.2%). Most frequently given treatment were infliximab 37.3% and etanercept 30.9%, respectively. The 65 patients whose first tuberculin skin test (TST) value "5 mm and above" was started daily 300 mg INH prophylaxis for 9 months but 3 patients had not been started because of refusing treatment. In only one case chemoprophylaxis has had to be interrupted because of high liver function test due to the INH prophylaxis. TST conversion was observed in 14 patients. Further follow-up, it was observed that 4 patients had TST's positivity. Isoniazide (INH) prophylaxis was started these 18 patients (42.9%). Although INH prophylaxis has been given in two patients, they developed active tuberculosis in follow-up. CONCLUSION: Considering the INH resistance in our country, all patients especially the ones with residual lesion and history of previous exposure, should be followed up closely during the anti-TNF-α treatment.

Evaluation of smoking cessation practice by physicians for hospitalized patients in a tertiary hospital.

OBJECTIVE: To investigate physicians' smoking cessation practice, consultation for smoking intervention for hospitalised patients and its determinants. METHODS: The cross-sectional study was conducted at Duzce University Hospital, Duzce, Turkey, from January to April 2013, and comprised hospitalised patients. The survey, including smoking habits and 5As (Ask, Advise, Assess, Assist and Arrange) steps of smoking intervention practiced by physicians was applied to those patients discharged from the hospital. SPSS 20 was used for statistical analysis.. RESULTS: Of the 502(31.6%) participants, 264(52.6%) were women and 238(47.4%) were men. The overall mean age was 52.8±18.2 years. Besides, 269(53.6%) respondents were at the level of elementary school education; 289(57.6%) had chronic disease; 119(23.7%) were current and 106(21.1%) were former smokers. The frequency of current smokers among men with chronic disease was significantly lower compared to those who did not have chronic disease (p=0.017). In women, the factor was insignificant (p=0.642). The physicians practiced the steps of "Ask, Advise, Assess, Assist and Arrange" on 354(70.5%), 240(47.9%), 194(38.7%), 88(17.6%) and 29(5.8%) patients for active smoking. Consultation during hospitalization significantly increased patient's effort to quit smoking after discharge (p=0.012). CONCLUSIONS: Smoking intervention by physicians for hospitalised patients was associated with the status of patient's gender, education level and chronic disease.

Comparison of smoking habits, knowledge, attitudes and tobacco control interventions between primary care physicians and nurses.

BACKGROUND: Primary care providers are uniquely positioned to initiate smoking cessation. We aimed to evaluate knowledge levels about the health effects of smoking and attitudes toward smoking and tobacco control activities among primary care providers. METHODS: In the cross-sectional and primary care-based study, self-administered surveys modified from the WHO Global Health Professional Survey 5A steps of smoking cessation practice (Ask, Advise, Assess, Assist and Arrange) were provided to primary care physicians (PCPhs) and nurses (PCNs). RESULTS: Respondents included 1182 PCPhs and 1063 PCNs. The proportions of current and former smokers were significantly higher among PCPhs than among PCNs (34.4 vs. 30.7 % and 14.0 vs. 10.1 %, respectively; both P < 0.001). We observed that 77.2 % of PCPhs and 58.4 % of PCNs always or rarely practiced an "Ask" step about their patients' smoking status (P < 0.001). One-third of PCPhs (33.8 %) stated that they always practiced an "Ask" step, whereas only 27.6 % of PCNs always did so in their practice (P < 0.001). A small minority of primary care providers had advised patients to quit smoking, although there was a significant difference in this between PCNs and PCPhs (8.4 vs. 15.6 %; P < 0.001). Most PCPhs considered themselves competent in advising about smoking interventions, but only a minority of PCNs did so (75.1 vs. 17.3 %; P < 0.001). Among barriers to tobacco intervention measures, lack of time was the item most commonly cited by PCPhs, whereas low patient priority was most commonly cited by PCNs (35.9 and 35.7 %; P < 0.001). CONCLUSIONS: Smoking intervention practice by primary care nurses was quite low. Lack of time and low patient priority were identified as barriers by primary care providers. Strategies by which primary care providers could improve tobacco control should be established.

Evaluation of post-graduate training effect on smoking cessation practice and attitudes of family physicians towards tobacco control.

OBJECTIVE: Family physicians (FPs) are cornerstone for tobacco control. It was aimed to compare the effect of training on their smoking cessation practice, knowledge level and attitudes towards smoking and tobacco control. METHODS AND MATERIALS: The cross-sectional and multi-centered study was carried out using structured survey modified WHO based questionnaire. It was delivered to 1500 FPs randomly selected among approximately 23000 family physicians across the country. The study survey was self-reported by FPs, assessing their knowledge, attitudes, status of post-graduate training, and practice about tobacco control. Participants were assigned into two groups as non-trainee groups (Group 1) and post-graduate trainee (Group 2). RESULTS: The mean age was 38.4 ± 7.1 years-old. The percentage of male and female FPs in the study was 53.1% and 46.9%. The ratio of family physicians who participated in training program Group 2) was 26.5% (n = 327). The ratio of female FPs who participated the SCP training course was significantly higher than that of male FPs (27.3% versus 22.5%, p = 0.035). There was no significant difference for smoking status between groups (p = 0.686). When the number FPs whose consulted by the smokers over ≥ 5 a week was compared, the ratio of FPs was significantly higher in group 2 than group 1 (p < 0.001), but overall ratio of FPs (2.8%) who consulted within a week smokers was considerably lower Statements of Competence and confidence items stated by all FPs were 24.2% and 32.2%, respectively. Physicians who had attended post-graduate training on SCP were more competent and confident, compared to non-trained FPs (p = 0.002 and p = 0.001). CONCLUSION: Post-graduate training on tobacco control improved self-confidence and competence of FPs. With post-graduate training, significant improvement was seen in practical skills of physicians. A continuing training program should be introduced to FPs, to engage them for smoking cessation practice.

[The evaluation of geriatric patients aged 90 and over in the pulmonary department]. / Gögüs hastaliklari servisinde izlenen 90 yas ve üzeri geriatrik hastalarin degerlendirilmesi.

INTRODUCTION: Since the number of geriatric clinics in our country is inadequate, Chest physicians play a very important role in diagnosis, follow-up and treatment of that group of patients in many centers. In this study, 90 years and older geriatric patients hospitalized in pulmonology services was investigated regarding course of disease. MATERIALS AND METHODS: Ninety years and older geriatric patients hospitalized in Pulmonology Department of Duzce University and Duzce Ataturk State Hospital was retrospectively analyzed during three-year period between January 2010 and December 2012. RESULTS: Thirty (57.7%) out of 52 patients was women. The mean age was 93.3 ± 3.9. The most common cause of admission was pneumonia (65.4%). Hypertension was the most common concomitant disease (51.6%). Diabetes mellitus, congestive heart failure was other most common concomitant disease, respectively. 80.8% of all patients was accompanied by at least one concomitant disease. All patients had a mortality rate of 17.3%. CONCLUSION: The most common cause of admission and concomitant disease in 90 years and older geriatric patients was pneumonia and hypertension respectively. Most of the patients discharged from hospital. Further examination and treatment in patients over the age of 90 should be implemented.