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   Table of Contents - Current issue
Coverpage
May-August 2019
Volume 21 | Issue 2
Page Nos. 81-141

Online since Friday, August 30, 2019

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REVIEW ARTICLE  

Third-hand smoke exposure and results p. 81
Emine Arguder
DOI:10.4103/ejop.ejop_31_19  
Diseases and deaths due to smoking are still a major public health problem, which is still the leading cause of death in the world. Today, the harmful effects of active smoking and second hand cigarette smoke on health are clearly known. However, the concept of third-hand smoke (THS) exposure, a new concept, is a relatively new definition in the area of environmental and public health. The third-hand smoke (THS) consists of residual cigarette smoke gases and particles that settle on the surface. Studies evaluating the presence of tobacco specific nitrosamines (TSNA) in house dust samples have shown that THS is an important source of exposure to TSNA. Investigations on animals estimating human exposure, it has been found that THS contains tobacco smoke compounds, which can stay for months on internal surfaces and in dust for months, and that it is re-released into the air as gaseous. In addition, surface chemicals in the surroundings and in dust can produce additional toxins as a result of various chemical reactions. Although it is premature to estimate the health impacts of THS as a whole, the health effects of TSNAs have been previously reported in the literature. Future studies should be directed at investigating the biological effects and consequences of THS on humans. This article will address the implications of THS exposure and the results of current studies conducted in this area.
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ORIGINAL ARTICLES Top

Effect of respiratory muscle training and pulmonary rehabilitation on exercise capacity in patients with interstitial lung disease: A prospective quasi-experimental study p. 87
Mohit Kaushal, Mir Shad Ali, Rahul Kumar Sharma, Deepak Talwar
DOI:10.4103/ejop.ejop_21_19  
BACKGROUND: Interstitial lung diseases (ILDs) are associated with skeletal muscle dysfunction, worsening exercise capacity, and poor health-related quality of life. The clinical relevance of respiratory muscle training (RMT) as part of pulmonary rehabilitation (PR) in patients with ILD largely remains unknown with limited research evidence. OBJECTIVE: To evaluate the effect of PR on exercise capacity in patients with ILD and to study its relation with the severity of disease. MATERIALS AND METHODS: Twenty-five patients diagnosed as ILD (clinical, radiological, or histopathological basis as per the American Thoracic Society/European Respiratory Society criteria) and willing for PR were enrolled in this prospective observational study conducted between 2016 and 2017 after obtaining informed consent. All cases were subjected to supervised exercise training thrice weekly for 8 weeks, tailored as per their capacity, in addition to pharmacologic and supportive treatment. Outcome measures including 6-min walk test (6MWT), respiratory muscle pressure, dyspnea (Borg scale), and spirometry were evaluated at baseline and 8 weeks and 6 months following completion of the program and were recorded in a prestructured pro forma. RESULTS: The mean age of patients was 63.28 ± 10.88 years with majority being nonsmokers (88%) and females (60%). There was a significant improvement in the mean 6MWT distance (P = 0.02), inspiratory muscle pressure (P = 0.047), and dyspnea after exercise training when compared to at 8 weeks from the baseline. The change in spirometry values was nonsignificant. The improvement in outcome parameters was transient with no significant difference from the baseline to at 6 months after stopping PR. CONCLUSION: Exercise training significantly improves respiratory muscle strength and functional capacity in patients with ILD. Larger studies with multidimensional analysis are required to investigate the promising outcome of PR in such patients.
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Assesment of symptom burden and related factors of patients with lung cancer in a palliative care unit p. 93
Derya Kizilgoz, Havva Yeşildağlı, Pinar Akin Kabalak, Tuba İnal Cengiz, Ülkü Yilmaz
DOI:10.4103/ejop.ejop_30_18  
INTRODUCTION AND AIM: Symptom palliation is important in terms of improving quality of life and therapy compliance in patients diagnosed with lung cancer. In this study, we intend to describe the tumor symptoms and related factors with Edmonton Symptom Assessment Scale (ESAS) in patients who admitted to a palliative care unit. MATERIALS AND METHODS: Two hundred and ninety patients with lung cancer who admitted to our tertiary outpatient palliative clinic were retrospectively reviewed. Pathological diagnosis, stage, demographic features, comorbidities, treatment modalities, and ESAS score were recorded. Survival was analyzed using Kaplan–Meier analysis. RESULTS: There was no relation between stage of disease and ESAS score. The mean sleep variance score was significantly higher in Stage IV patients compared to all other groups (P = 0.038). The scores of cough and how they felt themselves were significantly higher in patients with metastatic lymph node (n = 30; P = 0.016 and P = 0.027, respectively). The presence of diabetes mellitus was found to be significantly related to higher sadness and anxiety score (P = 0.046 and P = 0.023, respectively). Treatment modalities (Group 1: best supportive care [n = 22] and Group 2: others [n = 268]) did not affect the mean ESAS score (P > 0.05). The overall survival and mean ESAS score were not related (P > 0.05). CONCLUSION: ESAS contributes significantly to improve general medical condition of patients with lung cancer. Comorbidities should be considered along with ESAS during cancer management. Symptom score evaluation and proper palliative treatment is important in lung cancer patients. Anyway, the treatment period of lung cancer is already difficult enough, so physicians should facilitate this process for patients.
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Proadrenomedullin determining clinical severity and analyzing prognostic value for pneumonia p. 97
Sedat Demirsoy, Oğuzhan Okutan, Zafer Kartaloglu, Dilaver Taş, Ömer Ayten, Kadir Canoglu
DOI:10.4103/ejop.ejop_47_18  
AIMS: In pneumonia patients, we need practical biomarkers that can contribute to the diagnosis, prognosis and the prediction of mortality, and that can direct therapy and treatment setting. In this study, the diagnostic importance and value to predict prognosis and mortality are investigated for plasma proadrenomedullin (proADM) levels in pneumonia patients. MATERIALS AND METHODS: Sixty-three consecutive patients who had been diagnosed with pneumonia, as well as 54 volunteers as the control group, making 117 in total, enrolled in this study. The participants' ProADM, leukocyte count, erythrocyte sedimentation rate, C-reactive protein, and procalcitonin levels were measured, and their pneumonia severity index (PSI) and CURB-65 scores were calculated. RESULTS: Plasma proADM levels were higher in the controls. When we compare patients' proADM levels in the initiation, and after the treatment, patients' proADM levels were lower on the 7th day after the treatment. No significant supremacy was identified over the other markers. The ProADM levels were significantly correlated with PSI stages, but in deciding of the site of care, the distribution of proADM levels for the PSI and CURB-65 risk groups (as low and high risk) were statistically irrelevant. The mean proADM levels among the patients who developed complications were slightly higher than the others, but not to a statistically significant degree. A relationship was identified between the clinical severity scores and complications, and short-term mortality was 7.93%. The plasma proADM levels among the nonsurvivors were 0.7 nmol/L and 0.90 nmol/L in the survivors. Given these data, proADM failed to predict mortality while PSI and CURB-65 were superior predictors. CONCLUSION: Using proADM levels alone to predict pneumonia prognosis and mortality and deciding upon a therapy setting makes no sense, although in consideration of previous studies, proADM would be useful as a supplementary contributor to clinical severity scores.
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The relationship between quantitative positron emission tomography parameters, the invasive lung adenocarcinoma grading system of International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society, and survival p. 107
Ulkü Yilmaz, Özlem Özmen, Funda Demirağ, Tuba İnal Cengiz, Pınar Akın Kabalak, Derya Kizilgöz, İbrahim Onur Alıcı, Göktürk Fındık
DOI:10.4103/ejop.ejop_49_18  
BACKGROUND: The impact of newly defined subtypes and grades of adenocarcinoma on the survival and their reflection on imaging methods and nuclear medicine practices are popular research topics. AIMS: The aim of the study is to investigate quantitative positron emission tomography (PET) parameters and the adenocarcinoma grading system of the International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society in terms of survival and potential prognosis prediction value in operated lung adenocarcinoma patients. STUDY DESIGN: One hundred and seventy-nine patients who were surgically treated for adenocarcinoma of the lung were included in the study. 2-deoxy-2-(18F) fluoro-D-glucose (FDG) PET/computerized tomography (CT) was applied for initial staging. MATERIALS AND METHODS: For quantitative evaluation, maximum standardized uptake values (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary tumors were calculated. RESULTS: There was a statistically significant relation between grade and radiological appearance, but tumor grade and SUVmax, TLG, and MTV parameters showed no significant correlation. Pathological tumor size and PET/CT had strong correlation (P < 0.001, r = 0.816). There was no relationship between mortality and tumor grade (P = 0.980). SUVmax, MTV, and TLG were more predictive for survival than disease grade (P = 0.022, 0.044, and 0.012, respectively). Survival differences were observed according to the cutoff values for TLG (49.66) and MTV (9.68) (P < 0.05). Vascular invasion and central settlement were related to lymph node involvement (P < 0.001). When the tumor/lymphadenopathy SUVmax ratio was <2.5, risk of metastatic lymph node was higher (P < 0.001). CONCLUSION: Metabolic parameters are still superior to new adenocarcinoma grading system in terms of survival. Measurement of tumor size on PET/CT is an important predictive value about pathological T-stage.
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Evaluation of ghrelin and leptin in chronic obstructive pulmonary disease p. 114
Pelin Uysal, Hafize Uzun
DOI:10.4103/ejop.ejop_72_18  
OBJECTIVE: Recent studies suggest an important role for ghrelin and leptin in pathogenesis of inflammatory respiratory diseases. Therefore, the present study aimed to investigate ghrelin and leptin levels in the circulation that might be associated with the development of obstruction. METHODS: Stable chronic obstructive pulmonary disease (COPD) patients (n = 119) and matched healthy controls (n = 27) were recruited. The COPD patients were classified into four groups (A, B, C, and D) according to the Revised Global Initiative for Chronic Obstructive Lung Disease guidelines. RESULTS: Compared to controls, significantly decreased leptin and ghrelin levels were observed in all COPD patient groups. Plasma ghrelin concentration was higher in Group A (P < 0.001), Group B (P < 0.001), and Group C (P < 0.05) when compared with the Group D. Plasma leptin concentration was significantly decreased in Group D patients when compared with Group A (P < 0.001) and Group B (P < 0.001). Ghrelin levels were positively correlated with forced expiratory volume in 1 s (FEV1) (r = 0.822; P < 0.001), FEV1/forced vital capacity (FVC) (r = 0.431; P < 0.01), and leptin (r = 0.808; P < 0.001) in Group D. Leptin showed positive correlation with FEV1 (r = 0.856; P < 0.001) and FEV1/FVC (r = 0.376; P < 0.05) in Group D. FEV1 was positively correlated with ghrelin levels (r = 0.639; P < 0.001) and leptin levels (r = 0.602; P < 0.001) in Group C. CONCLUSION: The data of the present study showed that the serum ghrelin and leptin levels are lower in patients with COPD. Since ghrelin and leptin correlate with FEV1 in severe group of patients, they seem to be a potential biomarker candidate of prognosis in COPD. Decreased ghrelin and leptin levels might be associated with the development of obstruction.
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The profile of electronic cigarette users in Turkey p. 122
Gülsen Goney, Aykut Topdemir, Burcu Nal
DOI:10.4103/ejop.ejop_79_18  
OBJECTIVE: Data on electronic cigarette (e-cigarette) use patterns are limited worldwide. This paper examines user profile of e-cigarettes in Turkey. MATERIALS AND METHODS: This is a descriptive study. E-cigarette users (≥18 ages) in Turkey were asked to participate in a web-based survey. The participants provided information on their use history, patterns of e-cigarette use, content of e-liquid (amount of nicotine, types of food additives, kinds of products purchased, etc.), attitudes regarding the product, and information on the concurrent use of classic cigarettes. RESULTS: The online questionnaire was completed by 480 e-cigarette users. The results indicated that e-cigarette users have high incomes (100%), previous smoking dependency (100%), and a mean age of 35 ± 6, and the majority of them are male (99.2%). They use e-cigarettes primarily to quit smoking or to reduce the harm associated with smoking (65.4%, 11.1%, respectively). The e-cigarette users (15.6%) intend to quit smoking by gradually reducing their e-liquid nicotine concentrations. The majority of them (76%) think that e-cigarettes and e-liquids could be harmful to children. Of them, 46.6% used second-generation e-cigarettes and 53.3% used third-generation e-cigarettes with direct dripping. CONCLUSION: This study is the first description of the attitudes and use of e-cigarette users in Turkey. Results show that most of the users began to use e-cigarettes in order to quit smoking. According to the study findings, we propose an urgent need for an evaluation by health authorities for e-cigarette use and smoking cessation.
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Characteristics of metachronous second primary lung cancers p. 127
Coşkun Dogan, Ali Fidan, Nesrin Kıral, Elif Torun Parmaksız, Banu Salepçi, Benan Çağlayan, Sevda Şener Cömert
DOI:10.4103/ejop.ejop_58_19  
AIM: In this study, we aimed to investigate the characteristics of metachronous second primary lung cancer (MSPLC) and the differences between primary lung cancer (PLC) and metachronous lung cancer. MATERIALS AND METHODS: Patients diagnosed with lung cancer between January 2014 and December 2016 were retrospectively studied. MSPLC tumor cases and a new diagnosis of PLC were evaluated. Clinical, radiological, and demographic findings of the two groups, previous histopathologic diagnosis of MSPLC, histopathologic diagnosis of lung cancer in both groups, stages of treatment, and treatment history were recorded. All data were analyzed using the Chi-square, t-test, Kaplan–Meier, and Log-rank method. In all tests, P < 0.05 was considered statistically significant. RESULTS: There were 53 (16.1%) cases in MSPLC group and 277 (83.9%) cases in the PLC group. There were no statistically significant differences between clinical, radiological, and demographic findings, cancer histopathologies, tumor stages, oncological, and surgical treatment characteristics of the cases (P > 0.05). The most frequent primary cancers were laryngeal carcinoma (11 cases) in the MSPLC group, with higher age (64 and 61, P = 0.01, respectively). Tumor size was smaller (44 mm and 52 mm, respectively) than the PLC group (P = 0.03). All other characteristics of both groups (P > 0.05) and survival were similar (15 months and 17 months, P = 0.87, respectively). CONCLUSION: Among the lung cancers diagnosed in our clinic, 16% were detected as MSPLC. MSPLC group were older than the PLC group and tumor size is lower than the PLC group. There was no significant difference in treatment options and survival between the two groups.
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CASE REPORTS Top

It is not always easy to differentiate between primary and metastatic pulmonary malignant melanoma p. 132
Hakan Keskin, Sirin Akdeniz Baysal
DOI:10.4103/ejop.ejop_48_18  
Primary pulmonary malignant melanoma is an extremely rare tumor, and its diagnosis is just as difficult to clinically verify. Since malignant melanomas can metastasize even after many years, detailed past medical history and thorough physical examination of the patient are imperative in verifying the diagnosis. In this article, where we present a case with a histopathological diagnosis of malignant melanoma, we would like to emphasize that malignant melanoma can metastasize even many years after treatment.
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Nontuberculous mycobacteria: Trick or treat – A case of Mycobacterium lentiflavum p. 135
Deniz Dogan Mulazimoglu, Hülya Simsek, Beyhan Çakar, Oya Kayacan
DOI:10.4103/ejop.ejop_81_18  
Mycobacterium lentiflavum is a relatively rare cause of infection. Cases of human diseases have been reported. Most of the patients are immunocompromised. Here, we present an immunocompetent patient with pulmonary disease. The patient has come with chronic cough and hemoptysis. On computed thoracic tomography, there were bilateral cavitating centriacinar nodules, bronchiectasis, and tree-in-bud pattern. Microbiological analysis of bronchoalveolar lavage fluid grew M. lentiflavum. Her symptoms are relieved with ethambutol, clarithromycin, and rifabutin. Nontuberculous mycobacteria are an emerging problem worldwide. Necessity of treatment depends on the patient.
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LETTERS TO EDITOR Top

Preoperative chest disease and postoperative pulmonary complications: Anticipated results still need further examination p. 138
Habib Md Reazaul Karim, Chinmaya Kumar Panda
DOI:10.4103/ejop.ejop_40_19  
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Preoperative chest disease and postoperative pulmonary complications: Anticipated results still need further examination – Author's reply p. 140
Ozlem Ercen Diken
DOI:10.4103/ejop.ejop_65_19  
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