A life-threatening haemoptysis case that would have been defined as idiopathic before the COVID-19 era.

The coronavirus disease 2019 (COVID-19) is characterized by respiratory infection which can show very different clinical pictures, somewhat changing medical paradigm. Hemoptysis defined as idiopathic can be seen as much as 15%. Currently, increasing hemoptysis cases are being reported in medical coronavirus literature. We here present a hemoptysis case that would be defined as idiopathic before the COVID-19 era. After the first clinical picture, the case turned into a life-threatening hemoptysis. We studied the case comprehensively as clinical, pathogenetical, therapeutic and clinical practical aspects. Thus, we hypothesized that especially in the pandemic era, all hemoptysis cases must be evaluated as a possible life threatening infectious disease with unpredictable prognosis.

Mapping the tobacco retailers in edirne, Turkey.

OBJECTIVE: The youth smoking rate is on the rise in Turkey. Although many marketing bans have been effectively implemented, regulations related to retail tobacco outlets have gone unnoticed and have not been effectively supervised. In this study, we aimed to show the lack of legal regulation related to the high retail tobacco outlet density with displays. MATERIAL AND METHODS: In the center of Edirne, the marketing environment, numbers and geographical distribution of retail tobacco outlets were documented and mapped with geographical positions. RESULTS: There were 569 retail tobacco points of sale in 520 stores. We calculated one tobacco retail outlet per 270 people. This retail outlet density rate is above the national average and about four times higher than the density in Istanbul. Products especially attracting children, such as chocolate, sweet candy and chewing gum, were set up near the tobacco stands and were easy for children to recognize and reach. It can be seen on the city map that 47% of retail tobacco outlets are within 100 m of education, health or sport facilities. CONCLUSION: We concluded that one of the reasons for the increasing prevalence of cigarette use, especially among adolescents in Turkey, is deregulation of the retail tobacco marketing industry as a result of the privatization process of the national tobacco monopoly. Using mapping techniques can be useful in terms of controlling the retail marketing environment.

Did unprogrammed tobacco control efforts over seven years decrease smoking prevalence in the medical school?

Medical students will have significant roles in combating against death tool of tobacco. The aim of this study is to evaluate whether any decrease in the smoking prevalence of the medical students over seven years of many tobacco control efforts. A self-administered questionnaire was carried out among 764 of 854 (89.4%) medical students in order to determine the knowledge, attitudes and behaviors towards tobacco use. Chi-square tests, Student's t-test and multiple logistic regression methods were used. Results were compared with the historical control study that was done seven years ago with same methods. 25.9% of the students were smoker (36.6% of males, 16.3% of females), 4.9% was exsmoker and 69.2% was non-smoker. Quit rate was high among males than females (6.8% versus 3.3%, p< 0.05). When compared with historical cohort in 1999, smoking rate decreased only 3.8% for males and 5.5% for females, and quit rates were not higher. Lower curriculum year, and lower knowledge level about the harms of smoking and environmental tobacco smoke in lower grades, living in bachelor homes, easy access to smuggled cigarettes, using non-cigarette tobacco products were main factors for smoking. There was little decline in smoking rates of medical students despite of many local and national tobacco control efforts over seven years. Special attention and organized, programmed efforts are needed in medical schools in Turkey.

The cost of lung cancer in Turkey.

The aim of this study was to evaluate the individual and societal burden of lung cancer in Turkey. A total of 103 cases with lung cancer attended our department between January 2002 and February 2003 were included in our study prospectively. The primary outcome measure was the cost of disease until death of the patients or the end of study. All the costs were expressed as United States dollars (USD) and were estimated regarding the effective exchange rate at the time of recording. Descriptive statistics, chi-square, Fisher's exact test, Kaplan-Meier analysis and non-parametric "Bootsraping" tests were performed to evaluate the data. The average survival was 6.8 months. The estimated total direct cost for the entire group was 564.490 USD, and the direct cost per patient was 5.480 +/- 4.088 USD. The total cost of lung cancer in the study group was 1.473.530 USD, with a per-patient cost of 14.306 +/- 17.705 USD. The average direct cost per life year was 18.058 +/- 25.775 USD. Age, gender and histopathology did not affect the cost, whereas direct medical costs were increased with increasing stage. With the low life expectancy and cure rates, lung cancer has been alerting for the cost minimization and disease control measures.

Lung cancer histopathology in the Thrace region of Turkey and comparison with national data.

Following the trends in lung cancer (LC) morbidity and mortality rates can show past trends of cigarette smoking and can give clues on some geographical factors. The demographics of LC patients and the histopathologic distribution of their disease in the Thrace region of Turkey have yet to be defined. A retrospective chart review of primary LC patients admitted to the pulmonology department of Trakya University Hospital between 1992 and 2001 was performed. Charts were available for review in 521 of 567 patients. The mean age was 61 +/- 10 years (30-86 years) and 497 (95.4%) patients were male (male/female ratio= 20.7). When compared with national and international data, male/female ratio for the LC patients from Thrace region was higher than the ratio found from Turkey in general and also from other countries. Adenocarcinoma (ADC) was present in seven of the 24 (29.2%) of the females and prevalence of ADC was more than 2.5 times in females than males (p< 0.05). Squamous cell types were more common in males. Histopathological type did not vary with age in females, but small cell carcinoma was more prevalent in males under the age of 45 (44.7% if . 45 years old vs. 29.1% if > 45 years old, p< 0.05). These data may support that the LC associated with smoking is in the earlier phase of the epidemic in Thrace region. Monitoring the LC trend in our region can give clues on evolving cigarette design and smoking attitudes and geographic factors.

Antituberculosis drug resistance and associated risk factors in the European section of Turkey.

BACKGROUND: We carried out this study in order to establish the prevalence of antituberculosis drug resistance in Mycobacterium tuberculosis strains and to determine risk factors for the development of resistance in Trakya region of Turkey. METHODS: Pattern of drug resistance in 214 M. tuberculosis isolates from patients with tuberculosis treated at the regional tuberculosis dispensaries were included in the study. RESULTS: Isolates of 105 (49.1%) were resistant to only one drug, and 62 (29.0%) were resistant to more than one drug. The total resistance rates to streptomycin, isoniazid, rifampicin, ethambutol and isoniazid + rifampicin were 29.0%, 27.1%, 21.5%, 10.3% and 11.6%, respectively. The secondary resistance rates in all drugs and combinations were higher than primary resistance rates (p<0.001). Step wise logistic regression revealed that (i) non-compliance with treatment increases the chances of development of resistance by 15 times [p<0.00001, 95% confidence intervals (95% CI) : 4.16 to 56.70], and (ii) a regimen of inadequate treatment increases the chance of development of drug resistance by 10.5 times (p<0.01, 95% CI=2.66 to 49.80). CONCLUSIONS: We propose that specially trained physicians should institute antituberculosis therapy and medication should be practiced under direct observation in this region.

Thallium-201 SPECT in advanced non-small cell lung cancer: in relation with chemotherapeutic response, survival, distant metastasis and p53 status.

PURPOSE: The aim of this study was to evaluate the relationship between 201Tl tumor uptake, chemotherapeutic response, metastasis, p53 status and survival in non-small cell lung cancer (NSCLC). METHODS: A total of 23 patients underwent 201Tl SPECT. In 9 patients, 2nd 201Tl SPECT study were performed 1 week after the 3rd cycle of chemotherapy (ChT), and early (ER) and delayed (DR) tumor/normal lung ratios and retention indices (RI) were obtained. In 15 patients p53 status was assayed with immuno-histochemical staining. The patients were divided into subgroups after the 3rd cycle of ChT; responders [R(+) (n = 10)] and non-responders [R(-) (n = 13)], distant metastasis [(M1) n = 11] and [(M0) n = 12], and mutant p53 status [p(+) n = 7, p53(-) n = 8]. RESULTS: The differences for ER, DR and RI values between all of the subgroups were not statistically significant. ER and DR of responders decreased significantly after ChT; from to 2.46 to 1.36 (p = 0.04) and 2.29 to 1.53 (p = 0.04), respectively. In the non-responder group, both ER and DR slightly increased after ChT (p > 0.05). CONCLUSION: Our results suggest that in NSCLC, there was a weak correlation between higher 201Tl ratios and positive response to chemotherapy, absence of distant metastasis, and p53(-) status. Significant 201Tl uptake decrease after chemotherapy indicates that delayed 201Tl uptake can be used in evaluating the chemotherapeutic response.

99mTc-MIBI SPET in non-small cell lung cancer in relationship with Pgp and prognosis.

Higher technetium-99m methoxyisobutylisonitrile (MIBI) uptake in non-small cell lung cancer (NSCLC) has been reported to be associated with a positive response to chemotherapy. It has previously been found that in tumour cells, P-glycoprotein (Pgp) expression is of importance for tracer uptake. However, some studies have indicated that Pgp expression does not play an important role in (99m)Tc-MIBI uptake in NSCLC; indeed, a negative correlation between (99m)Tc-MIBI uptake and Pgp expression has been reported. Against the background of conflicting results, our aim was to evaluate the relationship between (99m)Tc-MIBI uptake, prognosis and Pgp expression in NSCLC. A total of 37 patients with NSCLC underwent (99m)Tc-MIBI single-photon emission tomography (SPET) before chemotherapy. In 19 patients both Pgp and p53 expression, and in two patients only p53 expression (due to the limited biopsy material), were measured with immunohistochemical staining. (99m)Tc-MIBI uptake was significantly higher in responders than in non-responders: 3.09+/-1.14 vs 2.24+/-0.88 ( P<0.03) and 3.09+/-1.08 vs 2.37+/-1.06 ( P<0.05) for the early ratio (ER) and the delayed ratio (DR), respectively. The wash-out rate (WR) of responders was not significantly different from that of non-responders. We found no significant differences in ER, DR and WR among the groups positive or negative for Pgp and p53 status. There was a significant positive correlation between the survival rate and both ER and DR: r=0.49 ( P=0.003) and r=0.40 ( P=0.018), respectively. Patients with ER and DR values above 3 showed significantly longer survival than those with values below 3: 14.7+/-8.5 months vs 7.3+/-5.1 months ( P<0.009) and 13.2+/-8.4 months vs 7.4+/-5.3 months ( P<0.04) for ER and DR, respectively. However, interestingly, and in contrast to expectations, patients with a Pgp score of +2 showed significantly longer survival (12.9+/-6.7 months) than those with Pgp scores of +1 (4.4+/-3.0 months) or - (negative) (3.8+/-2.2 months) ( P<0.009 and P<0.02, respectively). Our results suggest that in NSCLC, patients with higher (99m)Tc-MIBI uptake tend to show a positive response to chemotherapy, and patients with ER and DR values above 3 have a significantly better prognosis. We also found that Pgp expression seems to play only a minor role in (99m)Tc-MIBI uptake. Our finding that patients with ER and DR values above 3 have a better prognosis needs to be confirmed in larger series of patients.