Browsing by Author "Çetin, N"

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    Reply to Letter to the Editor: How Does SARS-CoV-2 Fragment the QRS?
    Özdemir, IH; Özlek, B; Özlek, E; Özen, MB; Gündüz, R; Çetin, N
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    Comparison of anti-factorXa assay and rotational thromboelastogram in evaluating the efficacy of enoxaparine treatment in patients with acute coronary syndrome without ST-segment elevation
    Gündüz, R; Yildiz, BS; Özdemir, IH; Özen, MB; Çetin, N; Yavuzgil, O
    Purpose: The aim of this study was to compare anti-factor Xa assay and tromboelastogram in evaluation of efficacy of enoxaparin in patients with acute coronary syndrome without ST-segment elevation. Materials and Methods: Twenty-five patients with acute coronary syndrome were involved. Two blood samples were taken on admission and 4 hours after the subcutaneous injection of third dose of 1mg/kg enoxaparin to the patients. AntiFXa, tromboelastogram, activated coagulation time were calculated. Results: A non-significant increase in activated coagulation time was observed after the injection of enoxaparin. After injection enoxaparin thromboelastography parameters changed maximum amplitude(MA) increased (MA basal 65.4 +/- 11.9 after 63.4 +/- 7.8), R time increased (from 5 +/- 1.7 to 8.4 +/- 4.6,), K time increased (from 1.89 +/- 1.06 to 2.56 +/- 1.4), angle increased (from 66.34 +/- 5.6 to 57.9 +/- 11.4). AntiFXa increased. (from 0.122 +/- 0.06 to 0.501 +/- 0.359). Conclusion: Tromboelastography method can be used in assessment of efficacy of enoxaparin in patients with acute coronary syndrome without ST-Segment elevation.
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    Comparison of Access Site Complications After Early or Late Sheath Removal in Patients with PCI, Regardless of ACT Levels
    Özyurtlu, F; Özdemir, IH; Çetin, N; Yavuz, V
    Background: Despite the lack of supporting data, many clinics perform sheath removal 4-6 hours after femoral percutaneous coronary intervention to reduce the risk of possible access site complications. This study aims to examine the effects of sheath removal immediately after the procedure on access site complications and patient comfort. Methods: This prospective study included 349 patients who underwent percutaneous coronary intervention via the femoral site and 6 French guiding catheters. The sheath in the early group was removed immediately after the procedure without checking the activated clotting time levels but after 4 hours in the late group. Access site complications were recorded and patient comfort was evaluated using the Visual Analog Scale. Results: Patients were divided into 2 groups: patients in the early removal group (n = 171) and in the late removal group (n = 178). There was no statistically significant difference between the 2 groups in terms of access site complications. Three patients in the early removal group and 4 patients in the late removal group developed a hematoma. Six patients in the early removal group and 10 patients in the late removal group showed ecchymosis. The Visual Analog Scale score was statistically significantly lower in the early removal group compared with that in the late removal group [2 (1-3) vs. 3 (2-4), P < .001]. Conclusion: This study shows that immediate sheath removal is safe and more comfortable for patients with percutaneous coronary intervention who received weight-adjusted dose of heparin, regardless of the percutaneous coronary intervention levels after the procedure.
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    Prognostic implication of uncontrolled hypertension in hospitalized patients with COVID-19
    Özdemir, IH; Özlek, B; Özen, MB; Gündüz, R; Çetin, N
    Objective: In this study, we aimed to investigate the effect of hypertension (HT) and antihypertensive treatment on prognosis, which is one of the cardiovascular risk factors affecting the prognosis of COVID-19. Methods: We included 117 patients diagnosed with COVID-19 by nasopharyngeal polymerase chain reaction (PCR). The patients were divided into a hypertensive group and a control group. Biochemical, complete blood count and imaging data of the patients were recorded. Mortality of patients with and without HT was evaluated. The effect of antihypertensive therapy on mortality was evaluated. Results: In thorax CT, ground glass opacity and pneumonic consolidation were found statistically significantly higher in the hypertensive group (p <0,001). Hospital stay duration (days) of the patients were significantly longer in the hypertensive group and need for intensive care unit was statistically higher in the hypertensive group (p <0,001). Mortality of hypertensive patients was higher than of those without hypertension (p <0,001). There was no statistically significant difference in mortality in antihypertensive treatment groups (p = 0,801). Conclusion: Hypertension is an important risk factor that increases mortality in COVID-19 patients. Uncontrolled hypertension was common in most patients. Inflammatory parameters are higher especially in patients with uncontrolled hypertension. Patients with uncontrolled hypertension have a higher risk of mortality. There is no data to suggesting that the use of ACEI/ARB worsens prognosis. High blood pressure on admission to the hospital is important and the patient's current antihypertensive therapy should not be discontinued.
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    Comparison of Framingham risk score and atherogenic indices as a predictor of atherosclerosis in patients with myocardial bridge in left anterior descending artery
    Çetin, N; Özlek, B; Özdemir, IH; Yildiz, BS; Yavuz, V; Tikiz, H
    Background Myocardial bridge (MB) is generally considered as a benign condition, but it may trigger atherosclerosis, especially in the adjacent proximal coronary artery segment. In this study, we aimed to investigate whether the Framingham risk score (FRS) or atherogenic indices are risk factors for coronary atherosclerosis in patients with MB in the left anterior descending coronary artery (LAD). Methods We performed a retrospective study evaluating 155 patients who have MB in LAD. The patients were evaluated in two groups according to the presence of atherosclerosis (74 patients in atherosclerotic group vs. 81 patients in non-atherosclerotic group). Baseline characteristics, FRS and atherogenic indices were reviewed between groups. Significant independent risk factors for coronary atherosclerosis were investigated by logistic regression analysis. Results Patients in atherosclerotic group were significantly older (58.15 +/- 10.04 vs. 50.22 +/- 9.27 years, p < .001) and 74.3% of the patients were male. While the mean FRS in the atherosclerotic group was 21.20 +/- 8.81, it was 12.79 +/- 8.61 in the non-atherosclerotic group (p < .001). Among the atherogenic indices, only LDL-c/HDL-c ratio was significantly higher in the atherosclerotic group (3.49 +/- 1.2 vs. 3.11 +/- 0.98, p:.033). Multivariable analysis showed that age (OR: 1.08, 95% CI 1.03-1.13, p < .001) and FRS (OR: 1.06, 95% CI 1.01-1.11, p:.012) were independently associated with the presence of atherosclerotic lesion. Conclusions FRS is an easily applicable predictor in clinical practice that indicates the presence of coronary atherosclerosis in patients with MB in LAD.
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    Prognostic value of C-reactive protein/albumin ratio in hypertensive COVID-19 patients
    Özdemir, IH; Özlek, B; Özen, MB; Gündüz, R; Çetin, N; Özlek, E; Yildiz, BS; Bilge, AR
    Objectives The aim of this study was to investigate the relationship between the C-reactive protein/albumin ratio and the prognosis of hypertensive COVID-19 patients. Methods It was designed as a single center retrospective study. PCR positive COVID-19 patients who were followed up in the intensive care unit (ICU) and received antihypertensive treatment were included in the study. The patients were divided into two groups as survivor and non-survivor. C-reactive protein/albumin (CAR) ratios of the patients were compared. The cut-off value was determined as a mortality predictor. The effect of CAR on mortality was evaluated using Logistic Regression analysis. Results 281 patients were included in the study. Groups consisted of 135 (non-survivor) and 146 (survivor) patients. CAR was significantly higher in the non-survivor group (p<0.001). The area under the ROC curve for CAR for mortality was 0.807, with sensitivity of 0.71 and specificity of 0.71. The cut-off value for CAR was calculated as 56.62. In logistic regression analysis, CAR increases mortality 4.9 times compared to the cut-off value. Conclusion CAR is a powerful and independent prognostic marker for predicting mortality and disease progression in hypertensive COVID-19 patients.
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    Evaluation of Coronary Sinus Strain in Patients with Dipper and Non-Dipper Hypertension
    Akçay, S; Turker, Y; Kobat, MA; Çetin, N; Bilge, AR; Tezcan, UK
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    The Echocardiographic Evaluation of Right Ventricular Function in Patients with Non-Dipper Hypertension
    Akçay, S; Bilge, AR; Turker, Y; Yavuz, V; Çetin, N; Dalgic, O
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    Hydroxychloroquine/azithromycin treatment, QT interval and ventricular arrhythmias in hospitalised patients with COVID-19
    Özdemir, IH; Özlek, B; Özen, MB; Gündüz, R; Çetin, N; Bilge, AR
    Background Hydroxychloroquine (HCQ) and azithromycin (AZM) are widely used in off-label treatment of novel coronavirus disease (COVID-19). However, cardiac safety of these drugs is still controversial in COVID-19. Therefore, we aimed to evaluate association of HCQ or HCQ + AZM treatment regimens, corrected QT (QTc) interval and malignant ventricular arrhythmias in hospitalized patients. Methods This is a single-center, retrospective and observational study. All data were extracted from the electronic medical records. The initial and post-treatment mean QTc intervals were calculated and compared in patients with HCQ alone or HCQ + AZM therapy. Associated factors with QTc prolongation, the incidence of ventricular arrhythmia during treatment and in-hospital mortality because of ventricular arrhythmias were evaluated. Results Our cohort comprised 101 hospitalized COVID-19 patients (mean age of 49.60 +/- 18 years, 54.4% men). HCQ + AZM combination therapy group (n = 56) was more likely to have comorbidities. After 5-days treatment, 19 (18.8%) patients had QTc prolongation, and significant increase in the QTc interval was observed in both two groups (P < .001). However, HCQ + AZM combination group had significantly higher Delta QTc compared to HCQ group (22.5 +/- 18.4 vs 7.5 +/- 15.3 ms, P < .001). All of 101 patients completed the 5-days treatment without interruption. Also, no malignant ventricular arrhythmia or death secondary to ventricular arrhythmia occurred during the treatment in both groups. Conclusions The present study revealed that although HCQ + AZM treatment was independently associated with QTc prolongation, none of patients experienced malignant ventricular arrhythmia or death during treatment. Further prospective studies are needed to determine the exact implications of these drugs on arrhythmias in patients with COVID-19.
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    The effect of long-term continuous positive airway pressure treatment on systolic and diastolic function in patients with obstructive sleep apnoea syndrome: A five year observational study
    Bilge, AR; Yavuz, V; Çetin, N; Dalgiç, O; Kum, G; Yilmaz, H; Tikiz, H
    Objective: Evaluation of the long-term effects of continuous positive airway presure (CPAP) on mean heart rate and left ventricular systolic and diastolic parameters in obstructive sleep apnea syndrome (OSAS) using conventional and tissue Doppler techniques. Methods: This prospective cohort study is designed to evaluate the long-term effects of CPAP treatments in normotensive OSAS patients. Initially 40 patients aged from eighteen to fifty five with documented OSAS syndrome were evaluated within one month of CPAP treatment. All had high self-reported compliance with treatment. From the latter, 21 patients with uninterrupted CPAP therapy (for at least 5 years, 5 hours per day) were included in the study and further evaluated with treatment. The left ventricular systolic function was assessed on apical four-chamber view using modified Simpson method and diastolic function was evaluated with classic transmitral pulsed and tissue Doppler techniques. Paired t test and Wilcoxon signed rank test had been used to compare the clinical and echocardiography data before and after treatment period. Results: A comparison of values assessed after one month and after 5 years of CPAP therapy, revealed a significant increase in the acceleration time(AT) Em/Am ratio and ejection time (ET) (AT: p=0.04; Em/Am ratio p=0.03 ET: p=0.04) while a significant decrease was observed on deceleration time (DT), isovolumetric relaxation time (IRT), myocardial performance index (MPI), mitral regurgitation (MR) and 24 hour mean heart rate (HR) in all subjects (DT: p=0.02; IVRT: p=0,04; MPI: p=0,01; MR: p=0.001; HR: p=0.004). Conclusion: We observed a significant improvement in the left ventricular systolic and diastolic function and a significant decrease of 24-hour heart rate and mitral regurgitation with unchanged ejection fraction of the left ventricle with long-term CPAP treatment similar to short-term treatment studies. The long-term maintenance of the beneficial effect of CPAP throughout the 5 year long-term treatment can be one of the pathophysiologic mechanisms that may explain the decrease of cardiovascular mortality observed with long-term CPAP therapy in OSAS patients.
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    THE PREDICTORS OF IN-HOSPITAL MORTALITY IN HYPERTENSIVE ELDERLY INTENSIVE CARE UNIT PATIENTS WITH CORONAVIRUS DISEASE 2019
    Çetin, N; Özdemir, IH
    Introduction: Advanced age is an important prognostic indicator for the mortality of coronavirus disease 2019, especially in patients over 65. Patients with chronic underlying conditions such as hypertension showed the worst outcomes. This study aimed to identify predictors of mortality in elderly hypertensive patients hospitalized in intensive care units.Materials and Methods: Demographic, clinical, treatment, and laboratory data were extracted from electronic medical records and compared between survivors and non-survivors. Univariate and multivariate logistic regression methods were used to explore the indicators of in-hospital mortality.Results: One hundred and ninety-eight patients with a median age of 75 years (65-94 years) were included in this study, of whom 95 were discharged from the intensive care units, and 103 died. Shortness of breath [hazard ratio (HR): 1.65, 95% confidence interval (CI): 1.04-2.61, p: 0.034], C-reactive protein (CRP)/albumin ratio (>51.32) (HR: 1.83, 95% CI: 1.12-2.97, p: 0.015), serum creatinine (>1.62 mg/dl) (HR: 2.04, 95% CI: 1.13-3.33, p: 0.001), aspartate transaminase (>34 u/l) (HR: 1.99, 95% CI: 1.28-3.09, p: 0.002), D-dimer (>781 ng/ml) (HR: 1.59, 95% CI: 1.04-2.43, p: 0.031), leukocyte (>12,000 acute accent 103/mu l) (HR: 1.68, 95% CI: 1.09-2.59, p: 0.018) and lymphocyte count, (<= 660 acute accent 103/mu l) (HR: 1.76, 95% CI: 1.17-2.63, p: 0.006) were independent predictors for mortality in elderly hypertensive patients.Conclusion: Using these predictors with cut-off values can identify patients at risk of death and needing aggressive intervention earlier in the disease course.
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    TAKOTSUBO CARDIOMYOPATHY IN A MALE PATIENT WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE
    Bayturan, Ö; Çetin, N; Yavuz, V; Yurdam, F; Uludag, Ö; Tezcan, UK
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    Multi-Center Experience of Coronary Artery Perforation During Percutaneous Coronary Intervention: Clinical and Angiographic Characteristics, Management, and Outcomes Between 2010 and 2020
    Gündüz, R; Yildiz, BS; Çetin, N; Özgür, S; Çizgici, AY; Tülüce, K; Tülüce, SY; Özen, MB; Duman, S; Bayturan, O
    Background: Coronary artery perforations are one of the most feared, rare, and catastrophic complication of percutaneous coronary intervention. Despite the remarkable increase in coronary angiography and percutaneous coronary intervention, there is no large database that collects coronary artery perforation for the Turkish population. Our study aimed to report our experience over a 10-year period for clinical and angiographic characteristics, management strategies, and outcomes of coronary artery perforation during the percutaneous coronary intervention at different cardiology departments in Turkey. Methods: The study data came from a retrospective analysis of 48 360 percutaneous coronary intervention procedures between January 2010 and June 2020. A total of 110 cases who had coronary artery perforation during the percutaneous coronary intervention were found by angiographic review. Analysis has been performed for the basic clinical, angiographic, procedural characteristics, the management of coronary artery perforation, and outcome of all patients. Results: The coronary artery perforation rate was 0.22%. Out of 110 patients with coronary artery perforation, 66 patients showed indications for percutaneous coronary intervention with acute coronary syndrome and 44 patients with stable angina pectoris. The most common lesion type and perforated artery were type C (34.5%) and left anterior descending (41.8%), respectively. The most observed coronary artery perforation according to Ellis classification was type III (37.2%). Almost 52.7% of patients have a covered stent implanted in the perforated artery. The all-cause mortality rate of coronary artery perforation patients in the hospital was 18.1%. Conclusion: The observed rate of coronary artery perforation in our study is consistent with the studies in this literature. However, the mortality rates related to coronary artery perforation are higher than in other studies in this literature. Especially, the in-hospital mortality rate was higher in type II and type III groups due to perforation and its complications. Nevertheless, percutaneous coronary intervention should be done in selected patients despite catastrophic complications.
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    Permanent atrial fibrillation portends poor outcomes in hospitalized patients with COVID-19: A retrospective observational study
    Özdemir, IH; Özlek, B; Çetin, N
    Background: Data specifically addressed to whether atrial fibrillation (AF) would contribute to increasing the risk for severe forms of novel coronavirus disease (COVID-19) or worse prognosis remain unclear. Hence, we sought to assess the association of permanent AF with in-hospital outcomes in patients with COVID-19. Methods: This was a single-centered, retrospective, observational study including consecutive hospitalized patients with COVID-19. The primary outcome for the study was defined as all cause in-hospital mortality. Clinical characteristics and outcomes of patients with AF were compared to patients without AF. Results: Three hundred and fifty hospitalized COVID-19 patients (median age of 55 years, 55.4% men) were enrolled. Of them 40 (11.4%) had AF. Patients with AF were older; were more likely to have co-morbidities, abnormal chest radiography findings and deteriorated laboratory parameters such as D-dimer, troponin, albumin, urea. In-hospital mortality was higher in patients with AF compared to patients without AF (32.5% vs. 13.5%, log-rank p = 0.002, RR 2.40). The number of patients who needed intensive care unit (55% vs. 31%, p = 0.002) and invasive mechanical ventilation (35% vs 15.2%, p = 0.002) were also higher in the AF group. In addition, length of in-hospital stay was longer in patients with AF (median 8 vs. 7 days, p = 0.008). After adjustment for age and co-morbidities, multivariable analyses revealed that AF (HR: 2.426, 95% CI: 1.089-5.405, p = 0.032) was independently associated with in-hospital death. Conclusions: AF was seen with together markers of severe COVID-19, and the presence of AF was an independent predictor of in-hospital mortality in patients with COVID-19. (c) 2021 Elsevier Inc. All rights reserved.
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    Fragmented QRS is a marker of mortality in patients with severe COVID-19: A retrospective observational study
    Ozdemir, IH; Özlek, B; Özen, MB; Gündüz, R; Çetin, N; Özlek, E; Yildiz, BS; Tikiz, H
    Objective: In this study, we aimed to investigate the association of fragmented QRS (f-QRS) with in-hospital death in patients with severe novel coronavirus disease 2019 (COVID-19). Methods: This was a retrospective and observational study. A total of 201 consecutive patients with severe COVID-19 were enrolled. Demographic data, laboratory parameters, medications, electrocardiographic (ECG) findings, and clinical outcomes were recorded. Patients with and without f-QRS were compared, and predictors of all-cause in-hospital mortality were analyzed. Results: A total of 135 patients without f-QRS (mean age of 64 years, 43% women) and 66 patients with f-QRS (mean age of 66 years, 39% women) were included. C-reactive protein (CRP), D-dimer, troponin I, ferritin levels, and CRP to albumin ratio were significantly higher in patients with f-QRS. The need for invasive mechanical ventilation (63.6% vs. 41.5%, p=0.003) and all-cause in-hospital mortality [54.5% vs. 28.9%, log rank p=0.001, relative risk 1.88, 95% confidence interval (CI) 1.16-4.78] were significantly higher in patients with f-QRS. A number value of f-QRS leads >= 2 yields sensitivity and specificity (85.3% and 86.7%, respectively) for predicting in-hospital all-cause mortality. Multivariable analysis showed that f-QRS (odds ratio: 1.041, 95% Cl: 1.021-1.192, p=0.040) were independently associated with in-hospital death. Conclusion: This study revealed that the presence of f-QRS in ECG is associated with higher in-hospital all-cause mortality in patients with severe COVID-19. f-QRS is an easily applicable simple indicator to predict the risk of death in these patients.
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    ERS International Virtual Congress 2021: Highlights from the Turkish Thoracic Society Early Career Members
    Senel, MY; Karadogan, D; Vardaloglu, I; Develi, E; Çelik, S; Hizal, M; Özsezen, B; Öncel, A; Can, I; Hürsoy, N; Uyar, K; Karakas, FG; Er, B; Asfuroglu, P; Gürsoy, TR; Eyuboglu, TS; Çakir, EP; Ademhan, D; Karaoglanoglu, S; Emiralioglu, N; Öztürk, NAA; Marim, F; Güçlü, ÖA; Çetin, N; Topçu, DÖ; Çelik, P; Akgün, M
    This review aimed to highlight some important points derived from the presentations of the European Respiratory Society 2021 Virtual International Congress by a committee formed by the Early Career Task Group of the Turkish Thoracic Society. We summarized a wide range of topics including current developments of respiratory diseases and provided an overview of important and striking topics of the congress. Our primary motivation was to give some up-to-date information and new developments discussed during congress especially for the pulmonologists who did not have a chance to follow the congress. This review also committed an opportunity to get an overview of the newest data in the diverse fields of respiratory medicine such as post-coronavirus disease 2019, some new interventional and technologic developments related to respiratory health, and new treatment strategies.
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    Safety of once-or twice-daily dosing of non-vitamin K antagonist oral anticoagulants (NOACs) in patients with nonvalvular atrial fibrillation: A NOAC-TR study
    Emren, SV; Zoghi, M; Berilgen, R; Özdemir, IH; Çelik, O; Çetin, N; Enhos, A; Köseoglu, C; Akyüz, A; Dogan, V; Levent, F; Dereli, Y; Dogan, T; Basaran, Ö; Karaca, I; Karaca, Ö; Otlu, YÖ; Özmen, Ç; Cosar, S; Sümerkan, M; Gürsul, E; Inci, S; Onrat, E; Ergene, O
    Once-daily dosing of non-vitamin K antagonist oral anticoagulants (NOACs) may increase patient adherence to treatment but may also be associated with a higher risk of bleeding. In this study, we investigated the adherence to once-or twice-daily dosing of NOACs and the risk of bleeding in nonvalvular atrial fibrillation (NVAF) patients. This multicenter cross-sectional study, conducted between 1 September 2015 and 28 February 2016, included 2214 patients receiving NOACs for at least 3 months, due to NVAF. Patients receiving once-daily or twice-daily NOAC doses were 1: 1 propensity score matched for baseline demographic characteristics and the presence of other diseases. The medication adherence was assessed by the 8-item Morisky Medication Adherence Scale. Risk factors were investigated in relation to minor and major bleeding. The mean age of patients was 71 +/- 10 years, and 53% of the patients were women. The medication adherence was lower in patients receiving twice-daily NOAC doses compared to once-daily-dose group (47% versus 53%, p = 0.001), and there was no difference between the groups in terms of minor (15% versus 16%, p = 0.292) and major bleeding (3% versus 3%, p = 0.796). Independent risk factors for bleeding were non-adherence to medication (OR: 1.62, 95% CI: 1.23-2.14, p = 0.001), presence of 3 or more other diseases (OR: 10.3, 95% CI: 5.3-20.3, p < 0.001), and HAS-BLED (Hypertension, Abnormal renal and liver function, Stroke, Bleeding, Labile INR, Elderly, Drugs or alcohol) score (OR: 4.84, 95% CI: 4.04-5.8, p < 0.001). In summary, the once-daily dose of NOACs was associated with increased patient adherence to medication, while it was not associated with bleeding complications.
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    Lung cancer from suspicion to treatment: An indicator of healthcare access in Turkey
    Kizilirmak, D; Kaya, ZY; Gökçimen, G; Havlucu, Y; Özyurt, BC; Gündogus, B; Esendagli, D; Kaya, BS; Yilmam, I; Aydemir, Y; Çolak, M; Afsin, E; Çetin, N; Idikut, A; Degirmenci, C; Tapan, ÖO; Gürkan, CG; Kocatürk, CI; Simsek, GÖ; Kalafat, CE; Niksarlioglu, EYÖ; Serdaroglu, ME; Karcioglu, O; Özyurt, S; Madran, EK; Bayrak, BY; Alasgarova, Z; Toprak, OB; Uçar, EY; Topal, BN; Baris, SA; Guliyev, E; Güzel, E; Küçük, S; Ocakli, B; Ketencioglu, BB; Selçuk, NT; Akyüz, MS; Özgür, ES; Yetkin, NA; Çetinkaya, PD; Deniz, PP; Atli, S; Çetindogan, H; Karakas, FG; Yilmaz, ES; Ergün, D; Ergcn, R; Tulay, CM; Ünsal, M; Demirkaya, I; Marim, F; Kaya, I; Demirdögen, E; Dilektasli, AG; Ursavas, A; Çelik, P
    Background: Lung cancer is the leading cause of cancer-related deaths worldwide. Before beginning lung cancer treatment, it is necessary to complete procedures such as suspecting lung cancer, obtaining a pathologic diagnosis, and staging. This study aimed to investigate the processes from suspicion of lung cancer to diagnosis, staging, and treatment initiation. Metbods: The study was designed as a multicenter and cross-sectional study. Patients with lung cancer from various health institutions located in all geographic regions of Turkey were included in the study. The socio-demographic and clinical characteristics of the patients, the characteristics of the health institutions and geographic regions, and other variables of the lung cancer process were recorded. The time from suspicion of lung cancer to pathologic diagnosis, radiologic staging, and treatment initiation, as well as influencing factors, were investigated. Results: The study included 1410 patients from 29 different medical centers. The mean time from the initial suspicion of lung cancer to the pathologic diagnosis was 48.0 +/- 52.6 days, 39.0 +/- 52.7 days for radiologic staging, and 74.9 +/- 65.5 days for treatment initiation. The residential areas with the most suspected lung cancer cases were highly developed socioeconomic zones. Primary healthcare services accounted for only 0.4% of pa-tients with suspected lung cancer. The time to pathologic diagnosis was longer in the Marmara region, and the wait time for staging and treatment initiation was longer in Eastern and Southeastern Anatolia. Patients who presented to chest disease referral hospitals with peripheral lesions, those with early-stage disease, and those who were diagnosed surgically had significantly longer wait times. Conclusion: The time between pathologic diagnosis, staging, and treatment initiation in lung cancer was longer than expected. Increasing the role of primary healthcare services and distributing socioeconomic resources more equally will contribute to shortening the time to diagnosis and improve treatment processes for lung cancer.
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    Intramedullary spinal cord abscess suspected of Brucella infection
    Helvaci, M; KasIrga, E; Çetin, N; Yaprak, I