Malignant mesothelioma (MM) is an important health problem due to ongoing asbestos exposure. Environmental asbestos exposure leads to a high risk of MM in Turkey. The Turkish Mesothelioma Working Group and the Turkish Public Health Institute designed and performed the Turkey National Mesothelioma Surveillance and Environmental Asbestos Exposure Control Program (TUNMES-EAECP). The aim of this study was to analyze the results of the TUNMES-EAECP. Patients diagnosed with MM (code C45.0–C45.9) between 2008 and 2012 were identified. The “from case to the field” method was used to determine the villages with current or previous asbestos exposure. Special public health teams took soil samples from these villages, which were then examined using an X-ray diffractometer. Direct Standardized Average Annual Mesothelioma Incidence Rate (AMIR) and relative risk (RR) of MM were calculated. Finally, a projection on the incidence of MM between 2013 and 2033 was made. The number of confirmed MM cases was 5617 with a male to female ratio of 1.36. Mean age was 61.7 ± 13.4 (20–96) years. The median survival was eight (95% CI 7.6–8.4) months. Asbestos exposure continues in 379 villages, with 158,068 people still living in high risk areas. The standardized AMIR was 2.33/100,000 per year. The risk of MM was higher in males, in both sexes over the age of 40, in asbestos-containing provinces, and in those where the TUNMES was organized. Among the population with continuing asbestos exposure in rural areas, the number of MM cases between 2013 and 2033 was estimated as 2511. As such, the incidence of MM in Turkey is as high as in industrialized countries. Asbestos exposure in rural areas continues to be a serious problem in Turkey, which obviates the necessity for effective preventive measures.

Introduction: Tobacco-free college campuses refer to colleges and universities that have implemented policies prohibiting the use of tobacco products at all indoor and outdoor campus locations. We aimed to evaluate university students' smoking behaviors and their attitudes towards "Tobacco-Free Campus Policy". Materials and Methods: A total of 10,383 university students were included in this cross-sectional study. The questionnaire was sent via web-based student information system. Demographical variables, the frequency of tobacco use, the addiction levels of the smoker students, and their perspective on the Tobacco-Free Campus Policy were evaluated. Results: The study population consisted of 5461 (52.6%) males and their mean age was 22.1 +/- 3.9 years. Among the students, 3992 (38.4%) were current smokers and the age of first smoking was 16.5 +/- 2.78 years. According to FTND scores, 15.1% of participants have high dependence, and 7.5% of them have very high dependence. There was a significant difference among participants who finds unacceptable "Tobacco-Free Campus Policy" in terms of gender (70.7% males vs. 29.3% females, p< 0.001) and smoking habit (7% never smoker, 4.1% ex-smoker, 88.9% current smoker, p< 0.001). Conclusion: The Tobacco-Free Campus Policy is important to fight against the tobacco industry in order to protect the right to health of all tobacco users and those who do not use it and should be considered as a goal to be achieved in order to live in a healthy environment.

Interleukin-21: A Potential Biomarker For Diagnosis and Predicting Prognosis in COVID-19 Patients Abstract Introduction COVID-19 patients have a wide spectrum of disease severity. Several biomarkers were evaluated as predictors for progression towards severe disease. IL-21 is a member of common ?-chain cytokine family and creates some specific effects during programming and maintenance of antiviral immunity. We aimed to assess IL-21 as a biomarker for diagnosis and outcome prediction in patients hospitalized with COVID-19. Method Patients with a preliminary diagnosis of COVID-19 and pneumonia other than COVID-19 admitted to a tertiary care hospital were included consecutively in this comparative study. Results The study population consisted of 51 patients with COVID-19 and 11 patients with non-COVID-19 pneumonia. Serum IL-21 concentration was markedly higher and serum CRP concentration was significantly lower in COVID-19 patients compared to non-COVID-19 pneumonia patients. Within COVID-19 patients 10 patients showed radiological and clinical progression. Patients with clinical worsening had lower lymphocyte count and haemoglobin. In addition to that deteriorating patients had higher urea, LDH levels and elevated concentration of both IL-6 and IL-21. The cut-off value of 106 ng/L for IL-21 has 80.0% sensitivity, %60.9 specificity for discriminating patients with clinical worsening. Multivariable analysis performed to define risk factors for disease progression identified IL-6 and IL-21 as independent predictors. Odds ratio for serum IL-6 concentrations ? 3.2 pg/mL was 8.07 (95% CI: 1.37-47.50, p=0.04) and odds ratio for serum IL-21 concentrations ? 106 ng/L was 6.24 (95% CI: 1.04 ? 37.3, p=0.02). Conclusion We identified specific differences in serum IL-21 between COVID-19 and non-COVID-19 pneumonia patients. Serum IL-21 measurement has promising predictive value for disease progression in COVID-19 patients. High serum IL-6 and IL-21 levels obtained upon admission are independent risk factors for clinical worsening.

Background and aim The 4-meter gait speed (4MGS), a functional performance test, is increasingly used to predict health outcomes. This study investigated 4MGS, nutritional status, frailty, and daily living activities in tertiary care pulmonary diseases ward patients. Methods Patients were assessed for nutritional status, activities of daily living, and frailty using the Mini Nutritional Assessment (MNA) Test, Barthel Questionnaire, and FRAIL scale. Those with 4MGS < 1 m/sec were classified as having slow gait speed. Results 80 patients (F/M: 21/59, mean age 58 ± 19) were included. Diagnoses included pneumonia, chronic obstructive pulmonary disease, pleural effusion, and interstitial lung disease. Patients had a 4MGS of 0,74 ± 0,24 m/sn, MNA score of 14.0 [IQR 25–75:11.0–19.8] points, Barthel index of 95 [IQR 25–75:70–100] points, FRAIL scale of 3 [IQR 25–75:1.0–4.0], and a hand-grip strength of 18.8 [IQR 25–75:15.7–25.9] kg. Slow gait speed patients had lower MNA, FRAIL scores, and handgrip strength. Multivariable regression analysis showed that slower gait speed was associated with lower serum protein level (B = 0.013, SE = 0.005, 95% CI: 0.004 to 0.022, p = 0.004), lower hand grip strength (B = -0.002, SE = 0.001, 95% CI: -0.003 to -0.00006, p = 0.041) and malnutrition risk (B = 0.024, SE = 0.007, 95% CI: 0.011 to 0.038, p < 0.001). Discussion and conclusion 4MGS correlates with comorbidities, frailty, grip strength, and nutritional status in hospitalized pulmonary patients. Slow gait patients are more malnourished despite similar age, sex, BMI, and comorbidities.

Introduction: Our knowledge has gaps regarding severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) replication levels and its association to severity of Coronavirus disease 2019 (COVID-19). The aim of this study was to investigate the association of SARS-CoV-2 viral load with disease severity and serum biomarkers in COVID-19 patients. Methodology: Viral load was determined via cycle threshold (Ct) values of SARS-CoV-2 real-time reverse transcriptase-polymerase chain reaction (RT-PCR) in 214 adult patients. Ct values were compared with clinical severity, biochemical and hematological biomarkers. Results: Clinical course of the disease was mild (49.1%), moderate (40.2%), and severe (10.7%). Median Ct value was 28.2 (IQR: 22.2–33.8) during the first week of the disease. Ct values were lower within five days after symptom onset [lowest Ct value on the third day (median: 24, IQR: 20.6–32.3)], but they increased significantly during the second and third weeks. No association was detected between admission Ct values and disease severity. Gender, age, co-morbidity, and mortality did not differ significantly in patients with low (≤ 25) and high (> 25) Ct values. White blood cell, neutrophil, platelet, and especially lymphocyte counts, were significantly lower in patients with low Ct values. Conclusions: No definitive/clear correlation between SARS-CoV-2 viral load and severity and mortality was found in the studied COVID-19 patients. However, neutrophil, platelet, and especially lymphocyte count were significantly lower in patients with a high viral load.

Turkthoracj, Turkish Thoracic Journal