Assessment of Palliative Care in Lung Cancer in Turkey

OBJECTIVE

To investigate the symptoms of lung cancer in Turkey and to evaluate approaches to alleviate these symptoms.

SUBJECTS AND METHODS

This study included 1,245 lung cancer patients from 26 centers in Turkey. Demographic characteristics as well as information regarding the disease and treatments were obtained from medical records and patient interviews. Symptoms were evaluated using the Edmonton Symptom Assessment Scale (ESAS) and were graded on a scale between 0 and 10 points. Data were compared using the χ2, Student t, and Mann-Whitney U tests. Potential predictors of symptoms were analyzed using logistic regression analysis.

RESULTS

The most common symptom was tiredness (n = 1,002; 82.1%), followed by dyspnea (n = 845; 69.3%), appetite loss (n = 801; 65.7%), pain (n = 798; 65.4%), drowsiness (n = 742; 60.8%), anxiety (n = 704; 57.7%), depression (n = 623; 51.1%), and nausea (n = 557; 45.5%). Of the 1,245 patients, 590 (48.4%) had difficulty in initiating or maintaining sleep. The symptoms were more severe in stages III and IV. Logistic regression analysis indicated a clear association between demographic characteristics and symptom distress, as well as between symptom distress (except nausea) and well-being. Overall, 804 (65.4%) patients used analgesics, 630 (51.5%) received treatment for dyspnea, 242 (19.8%) used enteral/parenteral nutrition, 132 (10.8%) used appetite stimulants, and 129 (10.6%) used anxiolytics/antidepressants. Of the 799 patients who received analgesics, 173 (21.7%) reported that their symptoms were under control, and also those on other various treatment modalities (dyspnea: 78/627 [12.4%], appetite stimulant: 25/132 [18.9%], and anxiolytics/antidepressants: 25/129 [19.4%]) reported that their symptoms were controlled.

CONCLUSION

In this study, the symptoms progressed and became more severe in the advanced stages of lung cancer, and palliative treatment was insufficient in most of the patients in Turkey.

The prevalence of asthma and allergic diseases among adults 30-49 years of age in Bolu, Western Black Sea Region of Turkey

AIMS

To determine the prevalence of asthma, asthma-like symptoms and allergic diseases among adults 30-49 years of age in regions of Bolu.

MATERIALS AND METHODS

A questionnaire was given to families of students in schools in different areas of Bolu, Turkey. The European Community Respiratory Health Survey (ECRHS) and a questionnaire, including questions about the socioeconomic status and demographic characteristics of the participants, were responded to by 1403 people.

RESULTS

The prevalence of symptoms and diseases were as follows: wheezing in the last year 12.0% (n=168), asthma 8.7% (n=121), doctor-diagnosed asthma 3.6% (n=50), currently taking drugs for asthma 1.2% (n=17), allergic rhinitis 16.5% (n=230), and eczema 9.6% (n=134). The risk factors for each symptom or disease were as follows: for wheezing: smoking in the house (odds ratio [OR]=2.43 and 95% Confidence Limits [95%CL]=1.53-3.86), living in a non-concrete building (OR=2.17, 95%CL=1.27-3.69); for asthma: mold in the house (OR=1.70, 95% CL=1.05-2.76), living in a shanty (OR=2.76, 95%CL=1.30-5.85), smoking in the house (OR=1.51, 95%CL=1.02-2.22); for allergic rhinitis: being female (OR=1.55, 95%CL=1.08-2.24), living in a shanty (OR=5.81, 95%CL=2.06-16.39), a monthly income below $300 (OR = 1.74, 95%CL=1.13-2.69).

CONCLUSIONS

A high rate of undiagnosed and untreated people with asthma among adults 30-49 years of age is present in Bolu. Especially, while a low socioeconomic level was observed to increase the risk of asthma and allergic rhinitis, risk of wheeze and asthma was found to be elevated by smoking in house.

Is an elevated neutrophil-to-lymphocyte ratio a predictor of metabolic syndrome in patients with chronic obstructive pulmonary disease?

OBJECTIVE

This study aimed to evaluate the diagnostic value of the neutrophil-to-lymphocyte ratio (NLR) in early detection of metabolic syndrome (MetS) in patients with chronic obstructive pulmonary disease (COPD).

PATIENTS AND METHODS

We retrospectively enrolled hospital records of 140 COPD patients and 50 sex and age-matched healthy controls. The diagnostic values of NLR were estimated using the sensitivity, specificity, and area under the receiver operating characteristic curve (AUC).

RESULTS

In total, 140 patients with COPD of which 63 patients had MetS and 50 healthy subjects were included in the study. We found that the NLR values of the stable COPD patients were significantly higher than those of the controls (p < 0.001). Among patients with COPD, the NLR was significantly higher in patients with than without MetS (p < 0.001). The AUC of the NLR was 0.898 in patients with MetS. The optimal NLR cut-off was 2.56 and was validated in the testing set. For evaluation of MetS, the sensitivity and specificity were 84.1% and 84.4% in patients with COPD under the suggested cut-offs.

CONCLUSIONS

The NLR is a simple, effective, and practical predictor of MetS in patients with stable COPD. It has potential value in public health practice for management of patients with COPD.

The pure effects of obstructive sleep apnea syndrome on cardiac autonomic functions: heart rate turbulence analysis

OBJECTIVES

To demonstrate the pure effect of obstructive sleep apnea syndrome (OSAS) on cardiac autonomic function (CAF) using heart rate turbulence (HRT) parameters.

PATIENTS AND METHODS

A total of 64 patients with OSAS and 30 age- and gender-matched healthy subjects were enrolled. All subjects had normal coronary arteries and were free from diabetes mellitus (DM) and hypertension (HT). The HRT parameters (TO, turbulence onset; TS, turbulence slope) were obtained from 24-h ambulatory electrocardiogram (ECG) recordings. HRT parameters were compared between groups, and the relationship between HRT and the apnea-hypopnea index (AHI) was examined.

RESULTS

No between-group differences were found in age or gender. Mean TO was significantly higher in the OSAS group than in healthy controls (0.89 ± 0.5, -0.08 ± 0.26; p < 0.001; respectively). The mean TS did not differ between the two groups (2.81 ± 3.06 versus 3.14 ± 2.33; p = 0.212). The AHI was positively correlated with TO (r = 0.845, p < 0.001). The multiple logistic regression analysis revealed that after adjustment for other variables, TO was a significant and independent predictor of AHI, OR 2.394 (95% CI: 1.596-3.591).

CONCLUSIONS

HRT (TO in particular) is correlated with AHI. Thus, impaired HRT may be an important factor underlying the occurrence of arrhythmia and sudden cardiac death in patients with OSAS.

The impact of gender, family and type of school on smoking in adolescents in Eyup, Istanbul, Turkey

OBJECTIVE

The aim of this study was to determine the influence of smoking habits and education of family, parents, the type of school and gender on smoking in adolescents.

METHODS

This cross-sectional study was performed on 1062 students from eight high schools in Eyup, Istanbul.

RESULTS

Twenty-five per cent of students were current smokers (30.1% of boys [n = 551], 20.9% girls [n= 511] 95% CI [26%, 34%] and [17%, 24%] respectively, (p < 0.05). Smoking rate was highest in vocational high schools and lowest in super high schools (33% [n = 406, 95% CI (29%, 38%)] and 11% [n = 127, 95% CI (6%, 17%)] respectively, p < 0.05). Smoking rate was higher in mothers (31.6% [n = 174, 95% CI (25%, 39%)] vs 15.5% [n = 336, 95% CI(12%, 19%)] and siblings (27.7% [n = 141, 95% CI (20%, 35%)] vs 18% [n = 350, 95% CI (14%, 22%)] of the female students who smoke than of those who did not smoke (p < 0.05). The rate of smoking in the siblings of 'smoker' boys was higher than that of 'non-smoker' boys (44.6% [n = 130, 95% CI (36%, 53%)] and 26.1% [n = 402, 95% CI (22%, 30%)] respectively; p < 0.05). The education level of 28%, [n = 82, 95% CI (19%, 39%)] of the mothers of 'smoker' girls, and of 19.6% [n = 429, 95% CI (16%, 23%)] of 'non-smoker' girls was high school and above (p < 0.05). The rate of high school and above education was higher in parents of male students who smoke than that in nonsmokers [45.1% and 27.9%, 95% CI (33%, 55%)] and (24%, 32%), respectively, p < 0.05. Number of smokers saying "Yes" in support of controlling smoking was less than non-smokers (p < 0.05).

CONCLUSION

Smoking rate was higher in boys, in vocational high schools and seems to be influenced by smoking habits and higher educational levels of their family members. This influence differs according to gender. Anti-tobacco messages should target family, friends and schools of adolescents.

Changes in malondialdehyde levels in bronchoalveolar fluid and serum by the treatment of asthma with inhaled steroid and beta2-agonist

OBJECTIVE

Oxidative stress plays an important role in the pathogenesis of asthma. Recent data suggest that clinical indices of the patients with asthma may not correlate with the underlying inflammatory process. We aimed to measure the level of malondialdehyde (MDA), which is a marker of lipid peroxidation, a free radical-mediated process, before and after a well-accepted treatment of asthma.

METHODOLOGY

Nine non-smoking females and five non-smoking males with mild-moderate asthma were included. Twenty-four age- and sex-matched, non-smoking healthy people (17 females and seven males, mean age 32.1 years, range 20-59) were included for control. After initial evaluation, spirometry, bronchoscopy with bronchoalveolar lavage (BAL), and blood sample were maintained. The patients were treated with twice-daily salmeterol inhaler (100 microg/d) and fluticasone propionate inhaler (500 microg/d). One month later the investigations were repeated. Serum MDA levels before treatment were compared with both the levels after treatment and levels of controls. Malondialdehyde levels of BAL were compared before and after treatment.

RESULTS

Serum MDA level of the patient before treatment was 6.7+/-0.8 nmol/mL, significantly higher than that of healthy controls; 3.8+/-0.4, P < 0.001. One month after the treatment, serum MDA level decreased to 5.3+/-0.7 nmol/mL (P < 0.001). However, this level is still significantly higher than healthy controls (P < 0.0001). Forced expiratory volume in 1 s level of the patients increased from 2.43+/-0.79 L to 3.50+/-1.21 L after the treatment (P < 0.001).

CONCLUSION

Although treatment with beta2-agonist and corticosteroid inhalers for the duration of 1 month reduced lipid peroxidation significantly, it was still at a level significantly higher than healthy controls. The treatment may need a longer duration to improve lipid peroxidation or an alternative regimen which is more effective in controlling inflammation may be warranted.