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Background: This study aims to evaluate patients who tested positive for COVID-19 (Coronavirus Disease 2019) in the preoperative period while they were scheduled for surgery in a pandemic hospital and patients who were diagnosed with COVID-19 in the postoperative period as well.Materials and Method: A retrospective analysis was made on 420 patients who were planned to undergo surgery on March 11, 2020 (the beginning of the pandemic in our country) with a compulsory COVID-19 test in the preoperative evaluation. Among the patients examined, about 26 of them were found positive by the COVID PCR (polymerase chain reaction) test preoperative evaluation. 18 patients had a positive COVID PCR test after the operation. The recorded data included patient demographics, pre-op and post-op symptoms, laboratory and radiological findings, and a history of exposure to COVID-19.Results: We detected the additional disease in 88.6% of 44 evaluated patients, 25 men and 19 women. Symptoms were present in 50% of the patients. The most common symptoms were fever and cough. When postoperative and preoperative patients were compared, only fever symptoms were found to be statistically higher in patients with postoperative PCR positive. In terms of laboratory findings, lymphocyte level was statistically low and CRP (c- reactive protein) level was higher in postoperative patients.Conclusion: In the pre-op evaluation, there is no test or finding that ensures that the patient has not contracted COVID-19 for certain. It required a multidisciplinary assessment to minimize false-negative results. In the postoperative period, patients with positive COVID PCR test may have in-hospital contamination or transmission from patients’ relatives. Unnecessary hospital visits should be limited as much as possible.

Background: Coronavirus disease 2019 (covid-19), which causes a pandemic in the world, has started to appear in turkey since March 2020. Healthcare workers are at the top of the groups most at risk for covid-19 infection, which can have a negative impact on psychological state. Objectives: It was aimed to evaluate anxiety and depression levels among healthcare workers. Methods: this cross-sectional study performed via an online survey in april 2020. Participants answered questions about sociodemographic features, personal views and experiences about covid-19 and the hospital anxiety and depression scale (hads). Results: A total of 300 healthcare workers,193 men and 107 women, participated in the survey. According to hads, 44.6% of participants scored above anxiety and 68.2% scored above depression cut-off points. Being younger than 50 and taking care of covid-19 patients in hospitals were independently associated with anxiety risk. Female gender, young age (less than 50) and having comorbidity were independent risk factors for depression. Conclusion: Healthcare workers were at high risk of anxiety and depression during covid-19 outbreak. For this reason, psychological support should be given, especially to the group with high risk. Keywords: Healthcare workers; anxiety; depression; covid-19

As the COVID-19 pandemic progresses, awareness of uncommon presentations of the disease increases. Such is the case with pneumomediastinum. Recent evidence has suggested that these can occur in the context of COVID19 pneumonia, even in the absence of mechanical ventilation-related barotrauma. We present a patient with COVID-19 pneumonia complicated by pneumomediastinum.

Aim: Evidences showed that coronavirus disease 2019 (COVID-19) can cause increased coagulopahty due to many different mechanisms. We aimed to identfy features of patients newly diagnosed pulmonary embolism (PE) during COVID pneumonia and evaluate prognosis of those patients. Method: We conducted a multicenter retrospective study and examined files of patients who was diagnosed with PE within 45 days after or at the same time the diagnosis of COVID pneumonia. Results: 38 (36,9%) of patients was women and mean age was 59,8 years. 47 (45,6%) of patients had severe COVID pneumonia and 43 (41,7%) of patients had bilateral expansive infiltrations. 62 (60,2%) of patients had at least one comorbidity and macrophage activation syndrome occured 16 (15,5%) of all patients. In the 33 (32%) of patients, PE was diagnosed at the same time with COVID pneumonia. Mean PE occuring time was 8,8 days after COVID diagnosis. 37 (35,9%) of patients was taking anticoagulant prophylaxis. D-dimer levels of patients was 5,5 times the upper limit of normal at the beginning of the COVID pneumonia and 9,7 at the diagnosis of PE. Most of patients had thrombus in the bilateral or unilateral segmental/subsegmental arteries. 60 (58,3%) of patients had low PE early mortality risk. For PE treatment 79 (76,7%) of patients used low moleculer weight heparin, 16 (15,5%) unfractioned heparin and 8 (7,8%) direct oral anticoagulant. 7 (6,8%) of patients needed thrombolytic therapy. Mortality rate was 7,8%. Conclusion: We revealed characteristics of patients newly diagnosed PE during COVID pneumonia. Further studies ar needed to assess incidence of PE and factors releated with mortality in those patients.

Resumo Fundamento O padrão pressórico não-dipper é definido por uma redução inferior a 10% na pressão arterial noturna e está associado a doenças cardiovasculares. Acredita-se que a inflamação desempenhe um papel na patogênese da doença pulmonar obstrutiva crônica (DPOC) e no padrão pressórico não-dipper e ambas as doenças estão associadas a uma qualidade de vida mais baixa. Objetivo O objetivo deste estudo foi o de investigar os efeitos do padrão pressórico não-dipper em pacientes com DPOC. Métodos Foi realizado um estudo transversal incluindo 142 pacientes com DPOC. O Questionário Respiratório de Saint George e a Escala de Qualidade de Vida Euro foram utilizados para a coleta de dados. Para entender a rigidez arterial, o índice de aumento e a velocidade da onda de pulso foram medidos; subsequentemente, foi realizada a monitorização ambulatorial da pressão arterial de 24 horas. Foi aplicado um modelo de regressão logística multivariável para entender a relação entre as diferentes variáveis independentes e o padrão pressórico. Foram considerados estatisticamente significativos valores de p inferiores a 0,05. Resultados Como resultado, 76,1% (n = 108) dos pacientes apresentaram o padrão pressórico não-dipper. Os pacientes com padrão não-dipper apresentaram valores mais altos de proteína C reativa (OR: 1,123; IC 95%: 1,016;1,242), índice de aumento (OR: 1,057; IC 95%: 1,011;1,105) e pontuação total no Questionário Respiratório de Saint George (OR: 1,021; IC 95%: 1,001;1,042), em comparação com os pacientes com padrão dipper. Adicionalmente, com o aumento do número de pessoas que habitavam o domicílio, verificou-se que o padrão pressórico não-dipper era mais frequente (OR: 1,339; IC 95%:1,009;1,777). Conclusão O padrão pressórico não-dipper pode aumentar o risco cardiovascular ao desencadear a inflamação e pode afetar adversamente o prognóstico da DPOC diminuindo a qualidade de vida relacionada à doença. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0) Abstract Background Non-dipper blood pressure is defined by less than a 10% reduction in nighttime blood pressure, and it is associated with cardiovascular disease. Inflammation is thought to play a role in the pathogenesis of both chronic obstructive pulmonary disease (COPD) and non-dipper blood pressure pattern, and both diseases are associated with lower quality of life. Objective The aim of this study was to investigate the effects of non-dipper blood pressure pattern in patients with COPD. Methods A cross-sectional study was carried out with 142 patients with COPD. The Saint George Respiratory Questionnaire and the Euro Quality of Life Scale were used to collect data. To understand arterial stiffness, the augmentation index and pulse wave velocity were measured, and 24-hour ambulatory blood pressure monitoring was subsequently performed. A multivariable logistic regression model was used to understand the relationship between different independent variables and blood pressure pattern. P values lower than 0.05 were considered statistically significant. Results As a result, 76.1% (n = 108) of the patients had non-dipper blood pressure pattern. Non-dipper patients had higher C-reactive protein (OR:1.123; 95% CI:1.016;1.242), augmentation index (OR: 1.057; 95% CI: 1.011;1.105) and Saint George Respiratory Questionnaire total score (OR: 1.021; 95% CI: 1.001;1.042) than dipper patients. Also, as the number of people living at home increased, non-dipper blood pressure pattern was found to be more frequent (OR: 1.339; 95% CI: 1.009;1.777). Conclusion Non-dipper blood pressure pattern may increase cardiovascular risk by triggering inflammation and may adversely affect the prognosis of COPD by lowering the disease-related quality of life. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)

INTRODUCTION Polypharmacy of respiratory medications is commonly seen in COPD patients. Reduction of COPD therapy in patients with overtreatment may have benefits by providing adherence to the guideline recommendations. We aimed to investigate effects of treatment de-escalation in COPD. METHODS This multi-center, prospective study was carried out in four pulmonary outpatient clinics. Overtreated patients (according to GOLD 2017) were recommended to undergo de-escalation of treatment (reduction group I), and those who were under appropriate treatment were recommended a stepwise de-escalation (reduction group II). Patients who declined de-escalation were in non-reduction group I. Non-reduction group II consisted of patients under appropriate treatment. Inhalation device skill, symptom control and quality of life (QOL) were assessed at baseline and 6-month follow-up. RESULTS At baseline visit, 55.9% of participants (76/136) were overtreated. There were de-escalation in 54 patients (35: reduction group I, 19: reduction group II). Non- reduction groups I and II included 37 and 45 patients, respectively. FEV 1 of patients with appropriate treatment improved significantly (p=0.033). There was a significant improvement in QOL in reduction group I (p=0.005) and II (p=0.011). Patients who reduced/quitted smoking during follow-up recorded significant improvements in FEV 1 and drug inhalation skills score (p=0.034 and p=0.023, respectively). Overtreatment had an estimated additional cost of 119.57$/year for each patient. CONCLUSION Overtreatment is a common problem in COPD. De-escalation of inhaler medications can improve QOL. Appropriate treatment according to guidelines positively affects respiratory parameters. Reduction/discontinuation of smoking improves both inhaler adherence and spirometric measurements. De-escalation of inhaler treatment should be considered in overtreated patients.

Introduction: Preoperative evaluation is a procedure which helps to show the risk of perioperative problems, reduce and prevent postoperative complications. Method: Preoperative consultations which were performed by chest disease department of our hospital between August and November 2015 were examined retrospectively. Results: There were 141 patients with 82 men (58.2%) and 59 women (41.8%) with mean age of 70 ± 13.3. 67 patients had at least one pulmonary symptom (cough, dyspnea and sputum). There were orthopedic (31.5%), abdominal (23.8%), head-neck (18.2%), cardiovascular (12.4%) surgeries.and endoscopies (14.1%). The rate of postoperative complications was 13.5%. Seven patients died after operations. There was no relationship between postoperative complications and an abnormality in pulmonary function test and chest X-ray, the presence of comorbidities, smoking history, a chest disease consultation regarding high-risk surgery and the anatomic location of operation (p=0.341, 0.182, 0.410, 0.064 and 0.338 respectively). Postoperative complications were significantly higher in patients with the presence of physical examination signs (on thorax oscultation) and pulmonary symptoms (p=0.007 ve 0.019 respectively). Conclusion: There is no consensus about an ideal scoring system which reflects pulmonary risk factors objectively in preoperative evaulation. As we are planning to have a cohort study to create a new scoring system, this pilot study specifies the importance of of physical examination signs (on thorax oscultation) and pulmonary symptoms in preoperative evaluation.

Introduction - Objective: The new Gold Assessment of COPD now includes more than spirometry results which is also assessing the risks and symptoms about COPD. We aimed to see the changes in treatment protocols of pulmonologists in COPD patients after Combined Assessment of COPD. Method: COPD patients followed by a few clinics were assessed observationally. They were categorized by Spirometry Classification and Combined Assessment of COPD. The treatment protocols were evaluated if they were suitable for both classifications. Results: 307 patients were included in the study. It was reported that treatment protocols were suitable for 40.4% both, 30.9 % combined and 20.8% spirometric classification. 51.8% of patients were using an unsuitable therapy for spirometric and 38.4% for combined assessment. 98% of unsuitable treatment was overtreatment. 58% of patients were using LABA + LAMA + ICS. Improper ICS usage, the most common type of improper drug usage, was found to be 97.1% in combined, 93.1% in spirometric classification. Conclusions: There is a high rate of impropriety to treatment protocols of classifications of COPD. It was remarkable that most of the unsuitable usage was about ICS therapy. It was thinked that it could be about the high usage of combined devices in our country.

Introduction - Objective: Migraine is a diseases characterized with severe headaches,with neurological and systemic findings.It is known that atopic disorders may be related with migraine.The purpose of this study is to investigate the prevalence of migraine and to examine whether there is a relationship between atopic disorders,parental history and migraine in asthma patients. Method: A total of 288 asthma outpatients were included. The presence of headache, atopic symptoms and parental history about asthma, atopic disorders and migraine were asked. The patients with headache were consultated by neurology department.The diagnosis of migraine was confirmed by International Headache Society(IHS) criteria. Results: 60.4% of patients described a headache.There were 94 patients (32.6%) with migraine. Atopic symptoms were present in 86.8% of patients.There were asthma in 47.9%,atopic symptoms in %39.6 and migraine in 22.2% of parents. Patients with atopic symptoms were found to have significantly high rate of headache (p=0.007). There was a significant relationship between headache in asthmatic patients and the parental history of asthma(p=0.01), atopic symptoms (p=0.015) and migraine( p=0.038).The prevalence of migraine was significantly high in patients with parental atopic symptoms (p=0.002). Conclusions: There is a high prevalence of migraine headaches in patients with asthma.The coexistence of asthma and headaches may be related with a similar pathophysiological mechanism, in which parental history and common genetic compounds may play role.The headaches,atopic symptoms and family history should be questioned,and clinicians should be careful about the presence of migraine in asthma patients.

Introduction: Chronic obstructive pulmonary disease (COPD) may cause some psychiatric disorders such as depression and anxiety, similar to other chronic diseases.We aimed to assess if the diagnosis of COPD and beginning of bronchodilator therapy may affect the quality of life and physiological status of the patients. Method: Newly diagnosed COPD outpatients were included.Pulmonary function tests (PFT), Hospital Anxiety and Depression Scale (HADS),Beck Depression Scale and St. George9s Respiratory Questionnaire (SGRQ) were performed at the first visit and six months later. Results: There were high scores of anxiety in 23.5% and depression in 38.2%(HADS)-52.9% (BECK) of 90 newly diagnosed COPD patients(71 men-19 women) at the first visit. The symptoms of anxiety decreased to 19%,depression to 33.3% (HADS)/47.6% (BECK) six months later. Besides, there was improvement in FEV1 and FVC levels in 57.1% of patients.All the participants with lower spirometrics levels (42.9%) were still smoking. 65% of patients decribed a regression in pulmonary symptoms after 6 months treatment. There was improvement in quality of live according to SGRQ in 68.1% of participants. There was negative correlation between FEV1 levels and SGRQ score (p=0.045).There was a significant relationship between the regression of anxiety-depression scores and cessation of smoking after the diagnosis of COPD (p=0.003 and 0.026). Conclusions: Pulmonary symptoms may regress with the bronchodilator therapy at newly diagnosed COPD patients, which causes an improvement in pulmonary functions, physiological status and quality of life. Cessation of smoking will be the best contribution to this situation.

INTRODUCTION The present study was designed to evaluate inhaler techniques and patient satisfaction with fixed-combination budesonide/formoterol dry-powder inhaler chronic obstructive pulmonary disease (COPD) in Turkey in real-life clinical practice. PATIENTS AND METHODS A total of 442 patients with COPD [mean (SD) age: 63.2 (10.6) years, 76.5% were males] were included in this cross-sectional study conducted at 25 outpatient clinics across Turkey. Data on socio-demographic characteristics, characteristics of COPD, inhaler technique and satisfaction with dry-powder inhaler were recorded at a single crosssectional visit performed at the study enrolment. RESULTS Patients were characterized by prominence of moderate to severe (78.1%) COPD, high rate of regular use of overall COPD medications (89.4%) and Turbuhaler® for an average of 33.7 months, predominance of males (76.5%), primary education (85.7%), urban location (68.3), ex-smokers (61.1%) and spending time outdoors for ≥ 4 hour/day (62.0%). Use of correct techniques was evident in majority of patients (≥ 94%), whereas inhalation maneuvers including breathing out gently away from mouthpiece without blowing into it (71.9%) and holding the breath for 5-10 seconds (78.3%) were performed correctly by lesser percent of patients especially in the older group (≥ 65 years, p< 0.05). Overall percent of patients with the feeling that she/he used the inhaler very/fairly correctly was 73.3%, while 86% of patients identified that they were very/fairly satisfied with the inhaler, irrespective of age and educational status. CONCLUSION In conclusion, our findings revealed the majority of patients are able to use Turbuhaler® correctly regardless of the educational status, while older age was associated with higher rate of errors in inhalation maneuvers in the real clinical practice in Turkey. Majority of our patients identified Turbuhaler® to be very/fairly convenient regarding ease of use, portability, and usability with an overall self-confidence in using the inhaler correctly among 73% and the satisfaction rate of 86%; irrespective of age and educational level.