Turkish Thoracic Journal最新文献

Objective: To compare class I/II cystic fibrosis transmembrane conductance regulator (CFTR) mutations to class III-V mutations with regards to cystic fibrosis disease severity markers in children.

Material and methods: This study was designed as a cross-sectional study in Antalya province, located on the south coast of Turkey. The study included 38 cystic fibrosis patients aged between 0.6 and 18 years. The CFTR genotype of the patients was categorized into 2 groups based on the presence or absence of class I or class II mutations in any of the alleles. Group I comprised 8 homozygous, 8 with unknown alleles, and 8 compound heterozygous patients, and group II comprised 11 homozygous and 3 compound heterozygous patients. The groups were analyzed in respect of cystic fibrosis disease severity markers, such as spirometry, ShwachmanKulczycki score, body mass index (BMI), sweat chloride concentration, chronic Pseudomonas aeruginosa infection, annual exacerbation frequency, and severe exacerbations requiring hospitalization during the previous year.

Results: In the comparison of group I and group II patients, a significant difference was observed in pancreas insufficiency (83.3% vs. 35.7%; P = .005), chronic P. aeruginosa infection (58.3% vs. 7.1%; P = .002), cough severity score (1.7 ± 1.1 vs. 0.9 ± 1.5; P = .029), number of severe exacerbations requiring hospitalization during the previous year (0.9 ± 1 vs. 0.3 ± 0.8; P = .03), and sweat chloride levels (76.7 ± 15.2 vs. 61 ± 22.3; P = .02). All these values were higher in group I patients. The mean BMI values (15.8 ± 2.2 vs. 17.6 ± 2.8; P = .03) were lower in group I patients.

Conclusion: There seems to be a difference between class I/II CFTR mutations and class III-V mutations on the severity of the disease in cystic fibrosis patients.

Objective: During the COVID-19 pandemic, physicians have been working for long hours, with the fear of contracting the disease and infecting their families. Therefore, there are great concerns about the mental health of physicians. In this research, we aimed to reveal the factors that affect the burnout among physicians working during the pandemic.

Material and methods: This is a cross-sectional study involving physicians working during the pandemic in health institutions that admit COVID-19 patients. A questionnaire form consisting of the "Sociodemographic Data Form" and the "Maslach Burnout Inventory (MBI)" was used. The questionnaire was sent to the contact numbers of physicians via the internet. The target population was reached through the communication groups of the Turkish Thoracic Society and other professional associations, the communication groups of health institutions, and also through personal correspondence. Burnout was evaluated with the scores of each participant from the 3 subscales of Emotional Exhaustion (EE), Depersonalization (DP), and Lack of Accomplishment (LA).

Results: Of the 1177 physicians who participated in the survey, 893 answered the survey completely. Females comprised 56.70% (n = 506) of the respondents, and the mean age was 38.63 (±11.65). The residents (41%, n = 366) and specialists (31%, n = 277) made up the majority of the physicians. Eighty-six percent (n = 768) of the physicians had difficulty in obtaining personal protective equipment (PPE). It was determined that 81.7% (n = 730) of the 893 physicians were actively working in pandemic units (outpatient clinics, emergencies, inpatient clinics, intensive care units), and burnout was significantly higher in these physicians (P < .01). After excluding other confounding factors by regression analysis, their Maslach total scores and EE scores were found to be significantly high (P = .001).

Conclusion: Working in pandemic units and facing difficulty in accessing PPE are identified as the most important risk factors for burnout. Hence, we can say that working with PPE, and with the managers' discretion and support, the physicians' burnout can be prevented.

Objective: Globally, the morbidity and mortality caused by exposure to household air pollution from the use of solid fuels remain a significant public health burden. This study assessed the levels of PM2.5 in households using clean and unclean fuels and their associations with the respiratory health of women and children.

Material and methods: Daytime PM2.5 sampling was done in 62 households (31 in each group) in Isiohor, a suburban community in southern Nigeria using Casella CEL-712 Microdust Pro Real-time Dust Monitor. Validated American Thoracic Society questionnaire was used to assess respiratory symptoms.

Results: PM2.5 levels exceeded World Health Organization-recommended limits in most households. The median (range) concentration of PM2.5 was lower in households using clean fuels (26 (14 to 358) μg/m3) than those using unclean fuels (29 (14 to 650) μg/m3). This difference was not statistically significant (P = .272). At least 1 respiratory symptom was reported by women (25.8% vs. 22.6%) and children (64.5% vs. 77.4%) in household using clean and unclean fuels, respectively. The most commonly reported respiratory symptoms were being woken up by an attack of cough (41.9% vs. 51.6% ) and cough first thing in the morning (16.1% vs 38.7%) for clean and unclean fuels, respectively (P = .046). More children in household using unclean fuel missed school for up to a week because of respiratory illness when compared to those in households using clean fuel, 61.3% vs. 29.0% (P = .011). In the sample as a whole, burning of candles in the house (22.6%) was associated with respiratory symptoms (Adjusted Odds Ratio = 14.81, 95% CI 1.79 to 122.51) among the women.

Conclusion: The use of unclean fuel was associated with higher levels of PM2.5. The household air pollution resulting from the use of unclean fuels and activities like burning of candles in the home may compromise the respiratory health of women and children.

Objective: In this study, we aimed to investigate the effectiveness of a smoking cessation initiative for workers who are smokers in a textile factory located in Denizli, Turkey.

Material and methods: This retrospective cohort was conducted by using the occupational health and safety unit records of 821 workers who are smokers. All participants underwent cognitive behavioral therapy, and in case of need, a suitable pharmacological treatment was initiated. The status of smoking cessation was checked at the end of the third month with a carbon monoxide breath monitor. A chi-square test was performed to make comparisons between categorical variables. Logistic regression analysis (backward) was used to evaluate the factors related to the smoking cessation status.

Results: The ratio of participants who gave up smoking was 74.3%, and 63% of them used a pharmaceutical aid to quit smoking. Working in the department of finishing and using a pharmaceutical aid to quit smoking were related to increased success in smoking cessation.

Conclusion: Outcomes of our study emphasize that workplace-based smoking cessation programs may create a huge impact on smoking cessation among workers. Pharmacological aid and cognitive behavioral therapy have been associated with success in quitting smoking.

Objective: The first choice for treatment in severe and moderate obstructive sleep apnea syndrome (OSAS) is positive airway pressurem (PAP) devices. However, despite proper titration, respiratory events may persist, while central respiratory events may increase or emerge for some patients. The primary aim of this study is to compare the clinical, demographic, and polysomnographic features of patients with different titration results.

Material and methods: The patients who underwent automatic PAP (APAP) titration with the nasal mask in our clinic due to moderate or severe OSAS in 2017 were included in the study. The clinical, demographic, and polysomnographic characteristics of patients with successful (good) titration, "unacceptable" APAP titration, and treatment-emergent central apnea syndrome (TECSA), were recorded retrospectively and evaluated comparatively with statistical methods.

Results: Out of 942 titration tests with APAP, 37 patients were diagnosed as TECSA (3.9%), while unacceptable (unsuccessful) titrationresults were seen only in 20 patients (2.1%). For the successful titration group, 44 consecutive patients were recruited. In the TECSA group, the central apnea index and minimum SpO2 were higher during the diagnostic polysomnography (PSG). In the unacceptable titration group, the baseline minimum SpO2 was lower. The lower sleep efficiency, lower stage N3 sleep, and longer rapid eye movement (REM) and sleep latencies were observed in the TECSA group during the titration test. The diagnostic accuracy of PAP device recordings was found to be moderate (kappa value: 0.533).

Conclusion: The baseline polysomnographic features, including higher central apnea index and minimum SpO2, may raise suspicion for titration failures for which a laboratory-based titration can be scheduled.

We report a case of pulmonary cysticercosis manifesting as a mass lesion. Cysticercosis confined to lungs is a rare manifestation of human cysticercosis. The disease mainly affects the central nervous system, skeletal muscles, and eyes. Pulmonary involvement is rare and usually presents as bilateral pulmonary nodules. The diagnosis was made based on positive enzyme-linked immunosorbent assay (ELISA) for anticysticercal antibodies, and the patient was started on antiparasitic therapy along with steroids. Symptomatic and radiological improvement was seen. There is no previous case report of isolated pulmonary cysticercosis presenting as mass lesion.

Objective: Aspirin desensitization is recommended for patients with nonsteroidal anti-inflammatory drug (NSAID) hypersensitivity, in whom asthma is uncontrolled despite medical treatment, and/or frequent endoscopic sinus surgery (ESS) is required due to nasal polyps. There are few studies in the literature on long-term follow-up of patients undergoing regular aspirin treatment after desensitization. This study aims to evaluate the effect of regular aspirin treatment on respiratory function, symptom control, quality of life, and the number of nasal surgeries required during a period of 12 years.

Material and methods: A total of 18 patients were included in the study in 2006; 11 patients were excluded and 7 patients regularly taking aspirin for 12 years were evaluated. Oral aspirin desensitization was performed at 4-6 weeks following the ESS. Patients receiving 300 mg/day aspirin were followed up in control visits every 3 months. Nasal and respiratory system examinations and pulmonary function test were performed, and all patients responded to the SF-36 Quality of Life scale during each visit.

Results: There was no change in respiratory function parameters following the12-year aspirin treatment. There was no statistically significant improvement in the quality of life; however, the need for ESS due to the recurrence of nasal polyps decreased significantly (P = .000). At the 12-year follow-up, all symptom scores improved, but improvement in the postnasal drip score was statistically significant (P = .046).

Conclusion: Long-term regular treatment with aspirin at a dose of 300 mg/day in patients with N-ERD improved symptom scores, and alleviated the need for ESS due to nasal polyp recurrence.