Community Palliative Care in Turkey: A Collaborative Promoter to a New Concept in the Middle East.

The Middle East has been struggling with basic issues of cancer care, and in specific, palliative care, at the primary health care level in the communities. The Middle East Cancer Consortium designated this issue as the highest priority of its activities in the region. Following basic and advanced courses and national and international workshops, local governments recognized the essentiality of developing palliative care services in their respective countries. As the result of these training activities, in 2010, the Ministry of Health in Turkey initiated a novel program whereby population-based and home-based palliative care teams were developed throughout the country, including peripheral regions in the countries where appropriate care was not available. This initiative led to a dramatic increase in the number of cancer patients receiving palliative care at their homes. The Turkish initiative can serve as a model to other countries in the Middle East and beyond it.

Pulmonary rehabilitation in interstitial lung diseases.

INTRODUCTION: Interstitial lung diseases are characterised by dyspnea on exertion, low quality of life, cough and exercise intolerance. The aim of this study was to evaluate the effects of comprehensive pulmonary rehabilitation in patients with interstitial lung disease. MATERIALS AND METHODS: Data from patients who were referred to pulmonary rehabilitation with the diagnosis of interstitial lung diseases were included to this study. Ten patients with interstitial lung disease participated to our outpatient, 8 weeks, comprehensive pulmonary rehabilitation programme. Dyspnea was assessed with the Medical Research Council (MRC) scale; health related quality of life was assessed with the St.George's Respiratory Questionnaire (SGRQ). Exercise capacity was measured using the incremental shuttle walk test (ISWT) and endurance shuttle walk test (ESWT); anxiety and depression were assessed with the hospital anxiety depression scale (HADS). All parameters were recorded before and after pulmonary rehabilitation programme. RESULTS: Dyspnea sensation, anxiety and depression scores decreased after pulmonary rehabilitation (p: 0.023, p: 0.026, p: 0.039 respectively). Also impact domains of SGRQ significantly reduced (Z= 1.988; p= 0.047).The difference between median values of ISWT results before and after pulmonary rehabilitation was 60 meters. Although it was not statistically significant (Z= 1.863; p= 0.063), the level of increment was higher than the minimaly important clinical differance for ISWT. CONCLUSION: Our results showed that comprehensive pulmonary rehabilitation programmes were benefical for patients with interstitial lung diseases and it should be regarded as a standard care in this population from the early stages.

[Hemoptysis in a case with partial pulmonary artery agenesis and diagnostic delay]. / Parsiyel pulmoner arter agenezisi olan olguda hemoptizi ve tanisal gecikme.

Hemoptysis is an important respiratory symptom that may be fatal. Despite of the advanced diagnostic procedures, etiology of hemoptysis in some patients remains unclear. The partial pulmonary artery agenesis and systemic shunt was detected by us, in a 25 year-old female patient which has been hemoptysis with unknown etiology for 5 years. Symptoms of the patient was taken under control by embolisation procedure. The aim of this report is to take attention to this rare cause of hemoptysis and to emphasize that pulmonary angiography should be considered in the diagnosis of the hemoptysis with unknown etiology.