Lung cancer from suspicion to treatment: An indicator of healthcare access in Turkey.

BACKGROUND: Lung cancer is the leading cause of cancer-related deaths worldwide. Before beginning lung cancer treatment, it is necessary to complete procedures such as suspecting lung cancer, obtaining a pathologic diagnosis, and staging. This study aimed to investigate the processes from suspicion of lung cancer to diagnosis, staging, and treatment initiation. METHODS: The study was designed as a multicenter and cross-sectional study. Patients with lung cancer from various health institutions located in all geographic regions of Turkey were included in the study. The sociodemographic and clinical characteristics of the patients, the characteristics of the health institutions and geographic regions, and other variables of the lung cancer process were recorded. The time from suspicion of lung cancer to pathologic diagnosis, radiologic staging, and treatment initiation, as well as influencing factors, were investigated. RESULTS: The study included 1410 patients from 29 different medical centers. The mean time from the initial suspicion of lung cancer to the pathologic diagnosis was 48.0 ± 52.6 days, 39.0 ± 52.7 days for radiologic staging, and 74.9 ± 65.5 days for treatment initiation. The residential areas with the most suspected lung cancer cases were highly developed socioeconomic zones. Primary healthcare services accounted for only 0.4% of patients with suspected lung cancer. The time to pathologic diagnosis was longer in the Marmara region, and the wait time for staging and treatment initiation was longer in Eastern and Southeastern Anatolia. Patients who presented to chest disease referral hospitals with peripheral lesions, those with early-stage disease, and those who were diagnosed surgically had significantly longer wait times. CONCLUSION: The time between pathologic diagnosis, staging, and treatment initiation in lung cancer was longer than expected. Increasing the role of primary healthcare services and distributing socioeconomic resources more equally will contribute to shortening the time to diagnosis and improve treatment processes for lung cancer.

Evaluation of skeletal muscle mass as a predictor of prognosis in patients treated in hospital for COVID-19 infection.

SUBJECTIVE: Skeletal muscle indexes are known to be one of the important prognostic indicators in many clinical situations. This study aims to evaluate the effects of laboratory values and muscle mass measures such as skeletal muscle area (SMA), skeletal muscle index (SMI), skeletal muscle density (SMD) and skeletal muscle gauge (SMG) obtained from the 12th thoracic vertebra (T12) level of patients hospitalized for COVID-19 infection on prognosis. METHODS: The patients' age, comorbidity index (CCI) scores, gender, anthropometric criteria such as height, weight, and BMI, laboratory values, development of NIMV and IC need during follow-up, length of hospital stay, and hospital mortality were retrospectively screened. The relationship between clinical and laboratory variables, SMA, SMI, SMD, and SMG values, and patient outcomes such as the need for non-invasive mechanical ventilation (NIMV), need for intensive care, and mortality was investigated using multivariate logistic regression analysis. RESULTS: It was shown in multilinear regression analysis that T12SMD (ß=-0.254; p=0.036), albumin (ß=-0.465; p=0.005), and procalcitonin values (ß=-0.292; p=0.026) were independent risk factors on mortality for intensive care in patients hospitalized due to COVID-19 infection. T12SMD has been shown to be significantly associated with various negative outcomes such as mortality, need for NIMV, and need for intensive care independently of body mass index (BMI) in our study (Tab. 5, Fig. 2, Ref. 25).

Balance impairment and cognitive dysfunction in patients with chronic obstructive pulmonary disease under 65 years.

OBJECTIVE: Balance and cognitive problems may develop in COPD. Studies investigating cognitive functions are mostly in elderly patients, and the number of studies on balance impairment is less than studies about cognitive dysfunction in COPD. We aimed to evaluate both balance and cognitive functions in patients with COPD under 65 years. METHODS: A total of 60 COPD patients and 60 healthy control group were enrolled. The patients with COPD were divided into two groups due to dyspnea severity. Demographic data and dyspnea scores of all patients were recorded. BECK depression scale, standardized Mini Mental Test (MMT), and BERG balance scale were applied to the individuals. Factors affecting BERG balance scale were evaluated. RESULTS: BERG balance scale and MMT values were found to be significantly lower in patients with COPD compared with the control group (p = 0.009). It was observed that the mean values of BERG balance scale and MMT were significantly low in the severe dyspnea group. BERG scale had significant correlations with MMT (rho = 0.331, p = 0.001), BECK (rho = -0.222, p = 0.016), age (rho = -0.318, p = 0.018), MMRC (rho = -0.368, p < 0.001), CAT (rho = -0.338, p = 0.008), FEV1% (rho = 0.307, p = 0.017), SpO2 (rho = 0.448, p < 0.001), and number of hospitalization per year (rho = -0.316, p = 0.014). According to the results of multiple linear regression analysis, the effect of oxygen saturation on BERG was found to be statistically significant (B = 0.512, p = 0.008). CONCLUSIONS: Balance tests in patients with COPD under the age of 65 are significantly low when compared with healthy controls at the same age. Balance and cognitive functions are significantly associated with each other. It may be beneficial to perform balance and cognitive function tests earlier even at the beginning of the treatment period of COPD, and strategies should be planned to prevent the progression of functional losses.

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.

The effect of Oxygen application with nCPAP for the prevention of desaturation during EBUS-TBNA.

PURPOSE: EBUS-TBNA is a frequently used diagnostic method for mediastinal/hilar lymphadenopathies and masses. This procedure is performed with intravenous sedation (IVS). During IVS, patients often develop hypoxemia and nasal oxygen delivery is insufficient in some patients. The aim of this study was to investigate the effect of oxygen application with nCPAP on hypoxemia during EBUS-TBNA. METHODS: Patients with EBUS-TBNA indication who did not have any serious heart-lung disease were randomly divided into two groups. One group received only oxygen and the other group received nCPAP+oxygen. Patient characteristics, arterial oxygen saturations, anesthetic agents, CPAP pressures, oxygen concentrations and processing times were recorded during the procedure. Practitioner satisfaction was evaluated at the end. RESULTS: 29 nCPAP+oxygen, 31 oxygen patients were included in the study. There were no significant differences in terms of age, sex, smoking history and presence of additional diseases in two groups. Neck circumference, BMI and STOP BANG questionnaire values were similar. Desaturation time was significantly longer in oxygen group than nCPAP+oxygen group (316±390 sec, 12±118 sec, respectively, p=0,019). Snoring was detected during the procedure in 22 patients in the oxygen group and in 11 patients in the nCPAP group (p=0,01). There were no serious complications in both groups. Practitioner satisfaction was higher in the nCPAP group but this was not statistically significant (p=0,052). CONCLUSION: Oxygen application by nCPAP during EBUS-TBNA under IVS, significantly reduces desaturation time. Oxygen delivery with nCPAP seems to be a better choice especially for the patients with high Mallampati index.

Management of a glottic squamous cell carcinoma with cutaneous metastasis.

INTRODUCTION: Oral cavity malignancies constitute 30% of head and neck cancers. The most common distant metastatic sites of glottic carcinoma are usually lung, liver and bone. Although the cutaneous metastasis of head and cancers have been reported with an incidence of 0.7-2.4%, skin metastasis of glottic carcinoma is extremely rare. CASE REPORT: A 69-year-old male patient was admitted to the emergency department with hemoptysis, dyspnea, weakness in lower extremities and difficulty in swallowing. There were subcutaneous lesions with a diameter of 2-5 cm in the scalp, posterior chest wall, nose and abdomen. In addition, there was an ulcerating, painful mass on the right lateral part of the tongue. The biopsy of lesions on tongue and skin revealed a glottic squamous cell carcinoma with cutaneous metastasis.Management and outcome: The patient was treated with cisplatin 50 mg/m2 on day 1, cetuximab 500 mg/m2 on day 1 and 5-fluorouracil 1000 mg/m2 daily on days 1 and 2, repeated every two weeks. After the first cycle of chemotherapy, the lesions on the skin regressed and dysphagia improved. DISCUSSION: There are limited data about the incidence, diagnostic measures and treatment modalities of glottic cancer with cutaneous metastasis. Our case could provide an important experience to literature by its atypical presentation and treatment-sensitive nature.