Gülistan Karadeniz

The impact of anti-smoking laws on high school students in Ankara, Turkey

ABSTRACT OBJECTIVE: To determine the factors affecting the smoking habits of high school students, their thoughts about changes resulting from anti-smoking laws, and how they are affected by those laws. METHODS: In this cross-sectional study, 11th-grade students at eight high schools in Ankara, Turkey, were invited to complete a questionnaire. RESULTS: A total of 1,199 students completed the questionnaire satisfactorily. The mean age of the respondents was 17.0 ± 0.6 years; 56.1% were female, of whom 15.3% were smokers; and 43.9% were male, of whom 43.7% were smokers (p < 0.001). The independent risk factors for smoking were male gender, attending a vocational school, having a sibling who smokes, having a friend who smokes, and poor academic performance. Of the respondents, 74.7% were aware of the content of anti-smoking laws; 81.8% approved of the restrictions and fines; and 8.1% had quit smoking because of those laws. According to the respondents, the interventions that were most effective were the (television) broadcast of films about the hazards of smoking and the ban on cigarette sales to minors. The prevalence of smoking was highest (31.5%) among students attending vocational high schools but lowest (7.5%) among those attending medical vocational high schools. Although 57.1% of the smokers were aware of the existence of a smoking cessation helpline, only 3.7% had called, none of whom had made any attempt to quit smoking. CONCLUSIONS: Although most of the students evaluated were aware of the harmful effects of smoking and approved of the anti-smoking laws, only a minority of those who smoked sought professional help to quit.

Predictive value of platelet-to-lymphocyte ratio in exacerbation of chronic obstructive pulmonary disease

AIM We aimed to assess the platelet-to-lymphocyte ratio (PLR) and platelet parameters in patients with chronic obstructive pulmonary disease (COPD). METHODS A total of 60 stable COPD patients, 50 acute exacerbation COPD patients and 50 healthy controls were enrolled in this study. RESULTS The platelet distribution width and PLR were higher and the mean platelet volume was lower in the COPD patients during acute exacerbation compared with the stable patients and controls. The PLR was negatively correlated with the forced expiratory volume in 1 s. CONCLUSION The PLR may be used as a useful and easily accessible tool for evaluating the ongoing inflammation during stable period and the disease severity during acute exacerbations in COPD patients.

A rare synchronous tumor: primary squamous cell lung cancer and adenoid cystic carcinoma of the tongue

Persence of multipl primary tumors in an organism is called as multiple primary cancer (MPC). Multipl tumors that occur at the same time are synchronized tumors, while those occuring at the different times called metachronous. MPCs are very rare entities. Here in we report a 96-year-old man who presented with synchronous MPC including squamous cell Lung cancer and tongue adenoid cystic carcinoma.

Septic Pulmonary Embolism

A 16-year-old female was referred for evaluation of fever of four days duration. The patient had a renal transplant done one week back and was found to be suffering from thrombosis of A.V. fistula in the upper extremity as per the history. The A.V.F thrombosis was confirmed by ultrasound examination. In addition patient had evidence thrombosis of the same upper limb.

Relationship between metabolic syndrome and epicardial fat tissue thickness in patients with chronic obstructive pulmonary disease.

Objective: An increase in epicardial fat tissue (EFT) thickness was found to be associated with metabolic syndrome (MS) and ischemic heart disease. MS is a comorbidity of chronic obstructive pulmonary disease (COPD) resulting from the accompanying systemic inflammation. The aim of our study was to investigate the usefulness of EFT thickness to predict MS in COPD patients. Methods: COPD patients admitted to our clinic during January–December 2014 and healthy controls were included in this prospective case-control study. Patients with comorbidities, COPD exacerbation, and malignancies were excluded. Patients and controls were compared in terms of anthropometric measurements, MS-related examination and laboratory findings, pulmonary function tests, and EFT thickness. The correlations between EFT thickness and markers of MS in COPD were evaluated using the Students t-test and logistic regression analysis. Results: COPD patients and controls were composed of 82 and 84 individuals, respectively. MS was diagnosed in 31 (37.8%) COPD patients. The EFT thickness was significantly higher in COPD patients than in the controls and was also higher in COPD patients with MS than in those without MS (all p<0.001). Each 1-mm increment of EFT raised the risk of MS two-fold (p=0.011, OR=2.08, 95% CI: 1.18–3.68). Increase in triglyceride level (p=0.004, OR=1.02, 95% CI: 1.01–1.03) and reduction in forced vital capacity (p=0.025, OR=0.26, 95% CI: 0.08–0.84) were found to be associated with increased MS risk. The cut-off value for EFT thickness in the prediction of MS in COPD patients was 6.75 mm (sensitivity: 83%, specificity: 65%). Conclusion: EFT thickness is a non-invasive and easily available parameter, which is valuable in the prediction of increased MS risk in COPD patients. Early diagnosis of patients at risk of MS may help to prevent ischemic heart disease in these patients.

Differences in evaluation between geriatric and adult patients requiring pulmonary consultation

ObjectiveThe main aim of the study was to investigate the effects of age in pulmonary consultation and to evaluate differences between geriatric and adult patients.Material and methodsConsultation referrals to the clinic of chest diseases for patients from emergency, inpatient and outpatient clinics of a tertiary care general hospital between December 2010 and April 2011 were examined retrospectively. The patients were divided into two groups, namely those aged 65 years and over (geriatric patients) and those under the age of 65 years (adults).ResultsOut of 272 patients 135 (49.6 %) were geriatric patients and 137 (50.4 %) were adult patients. The mean age of the geriatric patients and adults was 75.6 ± 7.1 years and 49.7 ± 11.8 years, respectively. While the geriatric patients showed a significantly higher presence of pathologies in chest radiography, respiratory complaints and concomitant diseases compared to the adult group, the respiratory function test results were lower. The complaint of shortness of breath was higher in the geriatric group compared to the adult group (71 % in geriatric patients and 59.1 % in adults). The most common diagnosis was chronic obstructive pulmonary disease (COPD, 37 %) in the geriatric patients and asthma (27.7 %) in the adult patients. As to the results of consultations, treatment-oriented recommendations were given for 63 (46.6 %) geriatric patients and approval for operation was given for 75 (54.7 %) adult patients.ConclusionConsultants should take the age of patients into consideration during evaluation in order to achieve the most appropriate treatment plan for these patients and reduce the potential postoperative complications to a minimum.ZusammenfassungZielHauptzielsetzung der Studie war die Erforschung von möglichen Auswirkungen des Lebensalters eines Patienten bei einer pulmonologischen Konsiliaruntersuchung. Evaluiert werden sollten Unterschiede zwischen erwachsenen und geriatrischen Patienten.MethodenVorgenommen wurden retrospektive Auswertungen von pulmonologischen Konsiliaruntersuchungen, die von einer Klinik der Tertiärversorgung (Notaufnahme, Ambulanzen und Stationen) zwischen 12/2010 und 04/2011 angefordert worden waren. Die Patienten wurden in 2 Gruppen aufgeteilt, Patienten >65 (geriatrische Gruppe) und <65 Jahre (Erwachsenengruppe).ErgebnisseVon 272 Patienten waren 135 (49,6 %) geriatrische und 137 (50,4 %) erwachsene Patienten; die Lebensalter lagen bei 75,6 ± 7,1 bzw. 49,7 ± 11,8 Jahren. Im Vergleich mit der Gruppe erwachsener Patienten zeigten sich im geriatrischen Kollektiv mehr Pathologien auf Thorax-Röntgenaufnahmen, ferner wurden mehr atemwegsbezogene Beschwerden sowie Begleiterkrankungen angegeben und die Lungenfunktionsuntersuchungen wiesen weniger gute Resultate auf. Das Symptom Kurzatmigkeit wurde im geriatrischen Kollektiv häufiger angegeben als in der Erwachsenengruppe (71 vs. 59,1 %). Die am häufigsten gestellten Diagnosen waren chronisch obstruktive Lungenerkrankung (COPD, 37 %) bei den geriatrischen und Asthma bei den erwachsenen Patienten (27,7 %). Nach den Konsiliaruntersuchungen wurden behandlungsorientierte Empfehlungen für 63 (46,6 %) der geriatrischen Patienten gegeben, und eine Operation wurde bei 75 (54,7 %) der Erwachsenengruppe befürwortet.SchlussfolgerungenBei der Konsiliaruntersuchung sollte das Alter der Patienten berücksichtigt werden, um möglichst adäquate Therapiepläne erstellen zu können und potenzielle postoperative Komplikationen auf ein Minimum zu reduzieren

Urina em cavidade pleural: um achado inesperado

Ao Editor: O urinotorax e uma causa incomum de derrame pleural e e causado pelo vazamento de urina para a cavidade pleural atraves de um defeito anatomico no diafragma ou atraves do sistema linfatico.(1) O urinotorax e geralmente secundario a uropatias obstrutivas ou lesao (geralmente iatrogenica) traumatica do sistema urinario.(2) Uma mulher de 61 anos com uma historia de nefrolitiase foi internada em nossa instituicao com febre alta, diminuicao da producao de urina, falta de ar progressiva, e dor no peito a direita por dois dias. A paciente havia sido submetida a nefrolitotomia percutânea a direita tres dias antes da admissao e nao tinha historico de doenca pulmonar. O exame fisico revelava palidez e temperatura corporal de 38,4°C. Movimentos toracicos estavam diminuidos. A ausculta do hemitorax direito revelava macicez a percussao e abolicao de sons respiratorios, que sao achados consistentes com derrame pleural. Nao foram encontradas alteracoes em relacao aos outros sistemas. A radiografia de torax demonstrou significativo derrame pleural do lado direito (Figura 1), e TC de torax revelou derrame pleural a direita, septos finos, e atelectasia do pulmao subjacente (Figura 2). Os niveis sericos de ureia e creatinina foram 132 mg/dL e 3,9 mg/dL, respectivamente. Visto que o desconforto respiratorio desenvolveu-se subitamente e logo apos a nefrolitotomia percutânea, houve a suspeita de urinotorax. O diagnostico foi confirmado apos toracocentese, que produziu aproximadamente 1.100 mL de liquido pleural, com uma relacao entre o conteudo de creatinina no liquido pleural e aquela no soro foi de 1,78 (normal, < 1). Um dreno de 28 Fr foi inserido no quinto espaco intercostal direito a fim de drenar o derrame. A paciente foi tratada com antibioticos de largo espectro e cuidadosamente observada. A urografia intravenosa nao revelou uropatia obstrutiva causada por pedras nos rins. Como o diagnostico de urinotorax tinha sido confirmado, nao realizamos cintilografia para demonstrar uma ligacao entre o sistema urinario e a cavidade pleural. Houve um aumento gradual na producao de urina, acompanhado por uma reducao simultânea dos niveis sericos de ureia e creatinina. A drenagem da urina a partir do dreno ocorreu por sete dias, e o tubo foi retirado. No nono dia de internacao, a paciente era assintomatica e recebeu