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Eraslan BZ, Fidan A, Baysal T, Cömert SS, Kıral N, Parmaksız ET. Effect of pulse methylprednisolone on prognosis in SARS-CoV-2 patients with severe pneumonia. Eur Rev Med Pharmacol Sci 2024; 28:1234-1240. [PMID: 38375729 DOI: 10.26355/eurrev_202402_35362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
OBJECTIVE This study aimed to evaluate the effect of pulse methylprednisolone treatment on prognosis in severe COVID-19 pneumonia. PATIENTS AND METHODS This retrospective cohort study included 128 patients hospitalized in our clinic for severe COVID-19 between March 2020 and February 2021. Standard treatment (plaquenil, favipravir, low molecular weight heparin, and antibiotics when necessary) was given to the patients in accordance with the Turkish Ministry of Health guidelines. After steroid treatment was included in the guidelines, dexamethasone 6 mg/day was administered along with standard treatment. In patients whose clinical condition did not improve despite this treatment, 250 mg/day methylprednisolone (pulse steroid therapy) was administered intravenous (i.v.) for 3 days, followed by a 40 mg/day maintenance dose. The group receiving methylprednisolone 250 mg/day for 3 days and the group receiving standard treatment without steroids were compared in terms of symptoms, comorbidities, laboratory and radiological findings, length of hospitalization, prognosis, intensive care unit (ICU) admission, and intubation. RESULTS Of the 128 patients included in the study, 85 (66.4%) were male, and the mean age was 61.7 ± 13.2 years (min: 25; max: 88). A total of 50 (39.1%) patients were transferred to the ICU, while the number of intubated patients was 37 (28.9%). Pulse methylprednisolone treatment was given to 98 (76.6%) patients, compared to the 30 (23.4%) patients who received only standard treatment. In total, 37 patients (28.9%) died. The presence of comorbid diseases (34.3% vs. 1.5%, p = 0.012), advanced age (67.7 vs. 59.3, p = 0.001), and not receiving steroid treatment (p = 0.046) significantly increased mortality. The mortality rate was 24.4% (24/98 patients) in the steroid therapy group and 43.3% (13/30 patients) in patients not receiving steroid therapy, and the difference was statistically significant (p = 0.046). Pulse steroid therapy also significantly decreased the rate of intubation (p = 0.014) and ICU admission (p = 0.007). In the logistic regression analysis that included comorbidity, advanced age, and pulse steroid therapy, advanced age (p = 0.022) and pulse steroid therapy (p = 0.048) were found to be effective independent variables of mortality. CONCLUSIONS The results showed that pulse i.v. methylprednisolone significantly reduced mortality in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients with severe pneumonia requiring hospitalization, in addition to significantly reducing the need for intensive care and intubation. In SARS-CoV-2 patients with severe pneumonia, pulse i.v. methylprednisolone may be useful as a standard treatment in patients who do not respond to dexamethasone.
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Affiliation(s)
- B Z Eraslan
- Department of Chest Diseases, University of Health Sciences Kartal Dr. Lütfi Kırdar City Hospital, Istanbul, Turkey.
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Kıral N, Fidan A, Eraslan B, Cömert SŞ, Sağmen SB. Effect of the COVID-19 pandemic on smoking habits in a tertiary hospital. Eur Rev Med Pharmacol Sci 2023; 27:1170-1175. [PMID: 36808365 DOI: 10.26355/eurrev_202302_31223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
OBJECTIVE The aim of this study was to identify changes in smoking behaviors along with the reasons thereof, 1 year after the pandemic started. Alterations in the smoking behavior of patients were investigated in the study. PATIENTS AND METHODS Patients admitted to our Smoking Cessation Outpatient Clinic between March 1st, 2019, and March 1st, 2020, and registered in the Tobacco Addiction Treatment Monitoring System (TUBATIS) were evaluated. Patients were called in March 2021 by the same physician who conducted the smoking cessation outpatient clinic. RESULTS When the first year of the pandemic was over, the smoking behavior of 64 (63.4%) patients did not change. Of the 37 patients who changed their smoking behavior, eight (21.6%) increased the amount of tobacco they consumed, twelve (32.5%) decreased the amount of tobacco they consumed, eight (21.6%) quit smoking, and nine (24.3%) relapsed smoking. When the reasons for the changes in smoking behavior were examined 1 year after the pandemic started, it was determined that the primary reason for patients who increased the amount of tobacco they consumed and started smoking again was stress, and the primary cause in those who reduced the number of cigarettes and quit smoking was health concerns due to the pandemic. CONCLUSIONS This result can be a guide for estimating smoking trends in future crises or pandemics and for making necessary plans during the pandemic period to increase the rate of smoking cessation.
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Affiliation(s)
- N Kıral
- Department of Chest Diseases, University of Health Sciences, Kartal Dr. Lutfi Kırdar City Hospital, Istanbul, Turkey.
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Beyhan Sagmen S, Fidan A. Can FVC/DLCO predict pulmonary hypertension in patients with chronic obstructive pulmonary disease? Eur Rev Med Pharmacol Sci 2022; 26:6658-6664. [PMID: 36196716 DOI: 10.26355/eurrev_202209_29766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The aim of the study was to investigate pulmonary function parameters in patients who did and did not have pulmonary hypertension, and the roles of forced vital capacity (FVC)/diffusing capacity of the lungs for carbon monoxide (DLCO) and FVC/DLCO/alveolar volume (VA) values in patients with COPD accompanied by pulmonary hypertension. PATIENTS AND METHODS This study included patients with stable and advanced COPD (groups C and D), who presented to the Chest Diseases outpatient clinic at our hospital. Parameters of age and sex, use of long-term oxygen therapy at home, and pulmonary function parameters were evaluated. In addition, systolic pulmonary artery pressure (sPAP) was evaluated on a transthoracic echocardiogram (TTE). Patients were grouped according to TTE sPAP values > 36, and those with normal sPAP values. The pulmonary function parameters of the two groups were compared. RESULTS PAP was found to be high in 19 patients (33.33%) and normal in 38 patients (66.67%). The BMI of the group with high PAP (23.54 ± 4.18) was also lower, compared to the group with normal PAP (26.91 ± 4.58) (p=0.010). The FVC/DLCO ratio of the group with high PAP (1.88 ± 0.69) was found to be higher compared to the group with normal PAP (0.90 ± 0.19) (p<0.001). The mean FVC/DLCO/VA ratio was higher in the group with high PAP (1.30 ± 0.68) compared to the group with normal PAP (p=0.001). When determining the height of PAP, cut-off values were examined for FVC/DLCO and FVC/DLCO/VA ratios. When the cut-off value for the FVC/DLCO ratio was taken as 1.31, the sensitivity was 96.8%, the specificity was 97.37%, the PPV was 95.00%, and the NPV was 92.86%. When the cut-off value for the FVC/DLCO/VA ratio was taken as 1.09, the sensitivity was 68.42%, the specificity was 97.37%, the PPV was 100.0%, and the NPV was 86.05%. CONCLUSIONS The FVC/DLCO and FVC/DLCO/VA ratios can be important to predict increased PAP in patients with COPD. Pulmonary function tests, which are performed as a routine, have gained importance in clinical practice for the detection of pulmonary hypertension in patients with COPD.
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Affiliation(s)
- S Beyhan Sagmen
- Department of Pulmonary Medicine, University of Health Science, Kartal Dr. Lutfi Kirdar Training and Research Hospital, Istanbul, Turkey.
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Sagmen SB, Kiral N, Fidan A, Torun Parmaksiz E, Dogan C, Comert S. Creatinine Clearance in Patients with Obstructive Sleep Apnea. Med Lab Tech J 2021. [DOI: 10.31964/mltj.v7i1.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
During an apnea, hemodynamic complications such as hypoxemia, a rise in systemic and pulmonary arterial pressure, and changes in heart rate occur in patients with obstructive sleep apnea (OSA). Potential mechanisms of OSA-associated renal dysfunction include renal hypoxia, hypertension, endothelial dysfunction. Hypertension is common in patients with OSA. This study aims to assess OSA patients' renal functions and investigate the creatinine clearance (CC) values across OSA patients with and without hypertension. The study included 530 individuals with OSA and 60 individuals with an apnea-hypopnea index (AHI) of <5. CC calculated with the Cockcroft-Gault Equation. Patients with OSA divide into two groups as the group of patients with hypertension (HT) (group 1) and without HT (group 2). The study included 339 (64%) male and 191 (36%) female patients. It found that 32.4% of OSA patients had HT (Group 1). There was a significant difference in CC and urea levels between groups 1 and 2 (p<0.001; p=0.005). While CC was low in the OSA group, CC values were not statistically significantly different between the OSA patients and the control group (p>0.05). A statistically significant difference was detected in urea and creatinine levels between the OSA and control groups (p=0.005; p=0.012). Creatinine clearance decreases in patients with OSA in the presence of HT. Patients with OSA often experience cardiovascular disorders, and glomerular endothelial dysfunction occurs in OSA patients.
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Salepci B, Özdoğan S, Altunok EÇ, Naziroğlu T, Kıral N, Parmaksız ET, Fidan A, Sağmen SB, Doğan C, Cömert SS. Comparative Analysis of Three Different Drug Distribution Schemes for Smoking Cessation. Turk Thorac J 2021; 22:110-117. [PMID: 33871333 DOI: 10.5152/turkthoracj.2020.19111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 04/01/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to compare the success rate of 3 different drug prescription policies: Free drugs with online system prescription, free drugs with doctor's prescription, and drugs paid for by patients with doctor's prescription. MATERIAL AND METHODS The effect of 2 different Ministry of Health (MoH) projects with free-of-charge and self-payment pharmacotherapies for smoking cessation were compared. Patients who completed 6 months of pharmacotherapy and follow-up were evaluated. The first period was free-of-charge medication, which was determined by an online system, the following period was the self-payment period, and the third period was free medication, which was prescribed by a doctor. In all the groups, smoking habits in pack years and comorbidities of the patients were recorded, and pulmonary function tests (PFTs) and expiratory carbon dioxide (CO2) measurements were performed. Patients who had an expiratory CO2 level >5 ppm at the control visits were accepted as quitters. RESULTS A total of 829 patients with 438 patients in the first free-of-charge period (group 1), 111 in the self-payment period (group 2), and 280 in the second free-of-charge period (group 3) were enrolled in the study. Smoking cessation rates were significantly higher in the self-payment medication group (25%) according to the MoH's free-of-charge project groups. There was no difference in smoking cessation rates between the 2 free-of-charge medication project groups (15% in group 1 and 11% of group 3). Among all the patients, we compared 124 patients who quit smoking with 705 patients who did not. The quitters were older, mostly male, and heavier smokers. In addition, the number of patients with chronic obstructive pulmonary disease and obstructive PFT rates were higher among the quitters. Their dependency score, PFTs, and the use of free medication was lower, and treatment duration was longer. Independent factors that increased smoking cessation success were longer treatment duration, lower dependency score, and self-payment of medication. CONCLUSION Free medications provided via 2 different modalities did not increase the smoking cessation success. Paying for the medication, lower dependency score, and longer treatment duration increased smoking cessation success independently.
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Affiliation(s)
- Banu Salepci
- Department of Chest Diseases, Yeditepe University School of Medicine, İstanbul, Turkey
| | - Sevda Özdoğan
- Department of Chest Diseases, Yeditepe University School of Medicine, İstanbul, Turkey
| | - Elif Çiğdem Altunok
- Department of Biostatistics and Medical Informatics, Yeditepe University School of Medicine, İstanbul, Turkey
| | - Tuba Naziroğlu
- Department of Chest Diseases, Health Sciences University Kartal Dr. Lütfi Kırdar Education and Research Hospital, İstanbul, Turkey
| | - Nesrin Kıral
- Department of Chest Diseases, Health Sciences University Kartal Dr. Lütfi Kırdar Education and Research Hospital, İstanbul, Turkey
| | - Elif Torun Parmaksız
- Department of Chest Diseases, Health Sciences University Kartal Dr. Lütfi Kırdar Education and Research Hospital, İstanbul, Turkey
| | - Ali Fidan
- Department of Chest Diseases, Health Sciences University Kartal Dr. Lütfi Kırdar Education and Research Hospital, İstanbul, Turkey
| | - Seda Beyhan Sağmen
- Department of Chest Diseases, Health Sciences University Kartal Dr. Lütfi Kırdar Education and Research Hospital, İstanbul, Turkey
| | - Coşkun Doğan
- Department of Chest Diseases, Health Sciences University Kartal Dr. Lütfi Kırdar Education and Research Hospital, İstanbul, Turkey
| | - Sevda Sener Cömert
- Department of Chest Diseases, Health Sciences University Kartal Dr. Lütfi Kırdar Education and Research Hospital, İstanbul, Turkey
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Beyhan Sagmen S, Dogan C, Comert S, Kiral N, Torun Parmaksiz E, Fidan A, Ozdemir Barisik N, Karabulut Gul S. The importance of Ki-67 proliferation index in small cell lung cancer. Lung Cancer 2020. [DOI: 10.1183/13993003.congress-2020.1732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Doğan C, Fidan A, Cömert SŞ, Kıral N, Salepçi B, Parmaksıza ET, Çağlayan B. Can PET-CT predict diagnostic success in ultrasonography-guided transthoracic fine needle aspiration biopsies in lung cancers? Pulmonology 2020; 26:275-282. [PMID: 32044295 DOI: 10.1016/j.pulmoe.2019.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 12/14/2019] [Accepted: 12/19/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To examine any correlations between tumor maximum standard uptake values (SUVmax) in positron emission tomography-computed tomography (PET-CT) and homogeneous/heterogeneous tumor FDG uptake in PET-CT, and the diagnostic success of the procedure in thoracic ultrasonography (US)-guided transthoracic fine needle aspiration biopsy (TFNAB). METHODS The files of patients who underwent thoracic US-guided TFNAB between 2013 and 2018 were examined. Patients who underwent thoracic US-guided TFNAB and were diagnosed as having primary lung cancer were considered as the US-TFNAB diagnostic group. Patients whose disease was diagnosed as primary lung cancer using a different diagnostic method (e.g. CT-guided biopsies, fiberoptic bronchoscopy) due to a lack of diagnosis despite undergoing thoracic US-guided TFNAB were allocated to the US-TFNAB non-diagnostic group. The clinical and radiologic characteristics and PET-CT parameters of the two groups were compared. RESULTS A total of 104 patients were included in the study; 79 (76%) patients whose disease was diagnosed using US-guided TFNAB, and 25 (24%) patients whose primary lung cancer could not be diagnosed with US-guided TFNAB. The mean SUVmax value of the US-TFNAB diagnostic group was 19.5 ± 10.1, whereas it was 15.1 ± 8.9 in the US-TFNAB non-diagnostic group (p = 0.016). Whether a lesion showed homogeneous or heterogeneous FDG uptake did not effect diagnostic success (p = 0.289). SUVmax value was the only effective independent factor in the diagnostic success of the procedure (p = 0.035). CONCLUSIONS High SUVmax values in PET-CT in lung cancers may increase the diagnostic success of US guided-TFNAB procedures.
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Affiliation(s)
- C Doğan
- Department Of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey.
| | - A Fidan
- Department Of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - S Ş Cömert
- Department Of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - N Kıral
- Department Of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - B Salepçi
- Department Of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - E T Parmaksıza
- Department Of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - B Çağlayan
- Departmentof Chest Diseases, Koç University, Istanbul, Turkey
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Dogan C, Kiral N, Parmaksız E, Fidan A, Çağlayan B, Salepçi B, Cömert S. Thoracic ultrasonography in the evaluation of lung parenchyma in interstitial lung diseases. Eurasian J Pulmonol 2020. [DOI: 10.4103/ejop.ejop_67_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Torun Parmaksiz E, Kiral N, Dogan C, Fidan A, Beyhan Sagmen S, Comert S. The Coexistence of Malignancy and Sarcoidosis or Sarcoid-Like Reactions. Turk Thorac J 2019. [DOI: 10.5152/turkthoracj.2019.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Kiral N, Firildak K, Fidan A, Torun Parmaksiz E, Beyhan Sagmen S, Eraslan B, Dogan C, Sener Comert S. The Comparison of Hospitalized Patients with Health-Care-Associated Pneumonia and Community-Acquired Pneumonia. Turk Thorac J 2019. [DOI: 10.5152/turkthoracj.2019.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Fidan A, Sener Comert S, Yalman N, Beyhan Sagmen S, Dogan C, Eraslan B, Torun Parmaksiz E, Kiral N. The Role of Proton Pump Inhibitors in the Development and Course of Pneumonia. Turk Thorac J 2019. [DOI: 10.5152/turkthoracj.2019.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Beyhan Sagmen S, Comert S, Turan Erkek E, Küçüköz Uzun A, Doğan C, Yılmaz G, Kıral N, Fidan A, Yılmaz Haksal Ç, Torun Parmaksız E. Can We Predict Bleomycin Toxicity with PET-CT? Acta Haematol 2019; 142:171-175. [PMID: 31454795 DOI: 10.1159/000502374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/26/2019] [Indexed: 01/30/2023]
Abstract
AIM Bleomycin is an antitumor antibiotic used successfully to treat a variety of malignancies, predominantly germ cell tumors and Hodgkin's lymphoma (HL). The major limitation of bleomycin therapy is the potential for life-threatening interstitial pulmonary fibrosis. Early identification of asymptomatic patients who may develop toxicity is important. We aimed to evaluate fluorodeoxyglucose positron-emission tomography (FDG-PET/CT) findings to predict bleomycin toxicity (BT) early after chemotherapy with doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) chemotherapy before clinical symptoms and radiological changes occur. MATERIALS AND METHODS HL patients who were treated with ABVD were evaluated. SUVmax values of lung parenchyma were analyzed in FDG-PET/CT at diagnosis and after 4 cycles of chemotherapy in all patients. At the end of the chemotherapy cycles, lung parenchymal SUVmax values of patients with BT and without BT were compared statistically. RESULTS Twenty (66.7%) male and 10 (33.3%) female patients with HL were included. Five (16.7%) HL patients developed BT. In 3 HL patients, BT was determined after 5 cycles and in 2 patients, BT was seen after 6 cycles. In all 5 of these patients with BT, FDG uptake in PET-CT was increased after 4 cycles of chemotherapy and BT was predicted before clinical and radiological findings by FDG-PET/CT. After 4 cycles of chemotherapy, lung parenchymal SUVmax of patients with BT (3.24 ± 0.76) was significantly higher than in patients without toxicity (1.84 ± 0.52) (p < 0.001). In patients with BT, a significant increase was established in lung parenchymal SUVmax after 4 cycles of chemotherapy when compared to the time of diagnosis (p = 0.043). CONCLUSION BT can be fatal. Early detection of BT is essential in clinical practice. FDG-PET/CT can predict BT before clinical and radiological findings occur.
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Affiliation(s)
- Seda Beyhan Sagmen
- Pulmonary Medicine, University of Health Sciences Kartal Dr. Lutfi Kirdar Training and Research Hospital, Kartal, Turkey,
| | - Sevda Comert
- Pulmonary Medicine, University of Health Sciences Kartal Dr. Lutfi Kirdar Training and Research Hospital, Kartal, Turkey
| | - Esra Turan Erkek
- Hematology, University of Health Sciences Kartal Dr. Lutfi Kirdar Training and Research Hospital, Kartal, Turkey
| | - Aysun Küçüköz Uzun
- Nuclear Medicine, University of Health Sciences Kartal Dr. Lutfi Kirdar Training and Research Hospital, Kartal, Turkey
| | - Coşkun Doğan
- Pulmonary Medicine, University of Health Sciences Kartal Dr. Lutfi Kirdar Training and Research Hospital, Kartal, Turkey
| | - Guven Yılmaz
- Hematology, University of Health Sciences Kartal Dr. Lutfi Kirdar Training and Research Hospital, Kartal, Turkey
| | - Nesrin Kıral
- Pulmonary Medicine, University of Health Sciences Kartal Dr. Lutfi Kirdar Training and Research Hospital, Kartal, Turkey
| | - Ali Fidan
- Pulmonary Medicine, University of Health Sciences Kartal Dr. Lutfi Kirdar Training and Research Hospital, Kartal, Turkey
| | - Çağla Yılmaz Haksal
- Nuclear Medicine, University of Health Sciences Kartal Dr. Lutfi Kirdar Training and Research Hospital, Kartal, Turkey
| | - Elif Torun Parmaksız
- Pulmonary Medicine, University of Health Sciences Kartal Dr. Lutfi Kirdar Training and Research Hospital, Kartal, Turkey
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Kiral N, Turkes G, Fidan A, Torun Parmaksiz E, Dogan C, Beyhan Sagmen S, Eraslan B, Sener Comert S. Does the Etiology of Hemoptysis Vary Over Years? Turk Thorac J 2019. [DOI: 10.5152/turkthoracj.2019.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Beyhan Sagmen S, Dogan C, Comert S, Kiral N, Fidan A, Torun Parmaksiz E. Prognostic Value of Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio in Lung Cancer. Med Lab Tech J 2019. [DOI: 10.31964/mltj.v5i1.211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Numerous studies determined that the neutrophil/lymphocyte (NLR) and platelet/lymphocyte ratios (PLR) had prognostic value in several cancer types. This study aimed to evaluate the relationship between NLR and PLR values with the survival time of lung cancer patients. Patients diagnosed with lung cancer between January 2014 and December 2016, were retrospectively evaluated. Demographic characteristics, disease stages, laboratory parameters recorded, and the relationship of NLR and PLR values with the survival time and the disease stage evaluated. NLR and PLR were categorized into two groups. SPSS 17.0 software package was used for the statistical analysis. ROC analysis, Student T-test, Chi-square, and Mann-Whitney U test were used. Mean age of 62±8 years were included in the study. In the NSCLC group, the average NLR and PLR values were 4±3.35 and 194.6±144.4 respectively. Regarding the NSCLC group, the overall survival time was shorter in the subgroup with an NLR >3.43 (13.1 months) compared to the subgroup with an NLR ≤3.43 (24.3 months). The mean survival time was shorter in the group with a PLR > 136.9 compared to the group with a PLR ≤136.9 (15.9 and 24.6 months respectively). Subgroups consisting of survivors and non-survivors in the NSCLC group showed a statistically significant difference considering neutrophil and lymphocyte count, CRP, NLR, and PLR values (p<0.05). As NLR and PLR values are easily accessible, they have an essential role in the prognosis of lung cancer as well as other cancer types.
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Doğan C, Kıral N, Parmaksız ET, Çağlayan B, Sağmen SB, Salepçi B, Fidan A, Cömert SŞ. Ultrasonographic evaluation of lung parenchyma involvement in sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis 2019; 36:130-140. [PMID: 32476946 DOI: 10.36141/svdld.v36i2.7312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 01/16/2019] [Indexed: 12/19/2022]
Abstract
Purpose To use ultrasonography (USG) for the evaluation of lung parenchyma in patients with sarcoidosis, andto compare the USG findings with the results of a high-resolution computerized tomography (HRCT) and pulmonary function test-carbon monoxide diffusion test (PFT-DLCO), which are commonly used methods in the evaluation of parenchymal involvement in sarcoidosis. Material and Methods Patients with sarcoidosis and healthy controls were enrolled in the study between January 2015 and December 2017. The clinical findings, HRCT and PFT-DLCO results of all subjects were recorded, and USG findings and comet tail artifact (CTA) measurements were recorded by another pulmonologist. The USG, HRCT and SFT-DLCO findings were compared between the two groups. Based on the findings of theclinical-radiologic investigations and PFT-DLCO, as the current gold standard in diagnosis, the sensitivity and specificity of USG in demonstrating lung parenchyma involvement in sarcoidosis patients were estimated. Findings The sarcoidosis group consisted of 79 patients and the control group included 34 subjects. The mean number of CTAs in the sarcoidosis and control groups was 33.4 and 25, respectively (p=0.001). In the sarcoidosis group, the number of CTAs in patients with DLCO% <80 and ≥80% was 37.4 and 29.7, respectively (p=0.011), and a negative correlation was identified between the number of CTAs and DLCO% (p=0.019 r=-0.267). The mean number of CTAs in patients with and without parenchymal involvement in HRCT was 36 and 25.5, respectively (p=0.001). The number of CTAs in the patients with sarcoidosis with a normal DLCO% value (≥80%) was higher than in the control group (p=0.014). The diagnostic sensitivity and specificity of thoracic USG were found to be 76% and 53%, respectively. Conclusion The number of CTAs in patients with sarcoidosis was higher than that of the healthy controls. The number of CTAs in patients with sarcoidosis with parenchymal involvement in HRCT and/or a low DLCO (<80%) was also elevated. Thoracic USG has a high sensitivity (76%) in demonstrating parenchymal involvement in patients with sarcoidosis.
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Affiliation(s)
- Coşkun Doğan
- Department of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Nesrin Kıral
- Department of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Elif Torun Parmaksız
- Department of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Benan Çağlayan
- Department Of Chest Diseases, Koç University, Istanbul, Turkey
| | - Seda Beyhan Sağmen
- Department of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Banu Salepçi
- Department of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Ali Fidan
- Department of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Sevda Şener Cömert
- Department of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
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Dogan C, Kıral N, Parmaksız E, Zengin Ö, Çağlayan B, Fidan A, Cömert S, Salepçi B, Sağmen S. The efficacy of positron emission tomography-CT in simultaneously detected nodules in patients with lung cancer. Eurasian J Pulmonol 2019. [DOI: 10.4103/ejop.ejop_77_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Dogan C, Fidan A, Kıral N, Parmaksız E, Salepçi B, Çağlayan B, Cömert S. Characteristics of metachronous second primary lung cancers. Eurasian J Pulmonol 2019. [DOI: 10.4103/ejop.ejop_58_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Dogan C, Kıral N, Parmaksız ET, Zengin O, Sagmen SB, Fidan A, Comert SS. Simultaneously detected nodules in lung cancers. Lung Cancer 2018. [DOI: 10.1183/13993003.congress-2018.pa1763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Doğan C, Cömert SŞ, Çağlayan B, Sağmen SB, Parmaksız ET, Kıral N, Fidan A, Salepçi B. A New Modality for the Diagnosis of Bleomycin-induced Toxicity: Ultrasonography. Arch Bronconeumol 2018; 54:619-624. [PMID: 30032934 DOI: 10.1016/j.arbres.2018.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/22/2018] [Accepted: 06/06/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate the role of ultrasonography (USG) in the diagnosis of bleomycin-induced pulmonary toxicity (BT). MATERIAL AND METHODS The study included patients with suspected BT during treatment with bleomycin due to various oncologic diseases between June 2015 and May 2017. The patients initially underwent clinical and high-resolution computed tomography (HRCT) examinations and pulmonary function tests (PFT)-diffusing capacity of the lung for carbon monoxide (DLCO), followed by registration of USG findings-number of comet tail artifact (CTA) images by a different pulmonologist. We compared the findings from USG, HRCT, and PFT-DLCO tests between BT and non-BT groups. With the diagnosis based on clinical-radiologic and PFT-DLCO assessments taken as the gold standard, we determined the sensitivity and specificity of the USG outcomes for diagnosis of BT. RESULTS The study included a total of 30 patients. Nine patients were diagnosed as having BT according to their clinical and radiologic findings and PFT-DLCO measurements. The mean number of CTA images was 68.7±22 in patients with BT vs 28.2±9.3 in those without BT (P<.001). The difference in CTA images between the patients with and without ground glass density was statistically significant (28.3±9.5 and 64.6±24.5, respectively, P<.001). In patients with BT, there was a negative correlation between the number of CTAs and DLCO% and FVC% values (P=.004; P=.016). USG had a sensitivity of 100%, and a specificity of 95% diagnosing BT in selected patients. CONCLUSION In bleomycin-induced toxicity, USG findings are correlated with HRCT and PFT-DLCO findings, with a remarkably increased number of CTAs in BT. Thoracic USG examination is a diagnostic tool with a high sensitivity and specificity for diagnosing BT.
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Affiliation(s)
- Coşkun Doğan
- Department of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey.
| | - Sevda Şener Cömert
- Department of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Benan Çağlayan
- Department of Chest Diseases, Koç University, Istanbul, Turkey
| | - Seda Beyhan Sağmen
- Department of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Elif Torun Parmaksız
- Department of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Nesrin Kıral
- Department of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Ali Fidan
- Department of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Banu Salepçi
- Department of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
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Doğan C, Fidan A, Parmaksız ET, Cömert SŞ, Salepçi B, Çağlayan B. Can positron emission tomography/computed tomography be predictive of diagnostic success in endobronchial biopsies performed through a fiber-optic bronchoscopy in lung cancer? Ann Thorac Med 2018; 13:182-189. [PMID: 30123338 PMCID: PMC6073782 DOI: 10.4103/atm.atm_8_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 04/06/2018] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The purpose of this study is to investigate the effect of homogeneous/heterogeneous (necrotic) involvement and maximum standardized uptake value (SUVmax) value of the lesion on positron emission tomography-computed tomography (PET-CT) of patients who underwent fiberoptic bronchoscopy (FOB) for prediagnosis of lung cancer and biopsy for endobronchial lesion on the diagnostic success of biopsy procedure. METHODS Between January 2014 and December 2016, patients with final diagnosis of pulmonary malignancy as determined by FOB biopsy and patients who failed to be diagnosed by FOB biopsy and diagnosed with pulmonary malignancy by a different diagnostic method were examined. These patients were divided into two groups as those with diagnosis by FOB biopsy (Group 1) and those who failed to be diagnosed by this method and diagnosed with pulmonary malignancy by a different diagnostic method (Group 2). The SUVmax values of the two groups were compared with lesion characteristics of homogeneous, heterogeneous involvement/presence of necrotic component as shown by PET-CT. Group data were assessed by Chi-square test and Mann-Whitney U-test. In all tests, P < 0.05 was considered significant. FINDINGS A total of 193 participants with a mean age of 61 ± 9.4 were included in the study. There were 128 (66.3%) cases in Group 1 and 65 (33.7%) cases in Group 2. The mean SUVmax value was 16.4 in Group 1 and 15.1 in Group 2. There was no statistically significant difference between the two groups (P = 0.329). Homogeneous involvement was present in 103 (80.3%) cases in Group 1 versus 42 (64.6%) cases in Group 2. In the presence of homogeneous PET-CT involvement, diagnosis rate by biopsy was significantly higher (P = 0.016). CONCLUSION We concluded that the high SUVmax value of the mass lesion on PET-CT did not increase the diagnostic value of the biopsy procedure in patients prediagnosed with lung cancer and that the diagnostic success of FOB biopsy was poor in cases where PET-CT showed heterogeneous involvement of the mass lesion.
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Affiliation(s)
- Coşkun Doğan
- Department of Chest Diseases, Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Ali Fidan
- Department of Chest Diseases, Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Elif Torun Parmaksız
- Department of Chest Diseases, Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Sevda Şener Cömert
- Department of Chest Diseases, Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Banu Salepçi
- Department of Chest Diseases, Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Benan Çağlayan
- Department of Chest Diseases, Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
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Parmaksız ET, Inal A, Salepci B, Comert S, Fidan A, Kiral N, Doǧan C, Caglayan B. Relationship of asymmetric dimethylarginine levels with disease severity and pulmonary hypertension in chronic obstructive pulmonary disease. Lung India 2018; 35:199-203. [PMID: 29697075 PMCID: PMC5946551 DOI: 10.4103/lungindia.lungindia_11_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: Asymmetric dimethylarginine (ADMA) has emerged as a risk marker for many conditions related to pulmonary hypertension (PH); however, little is known about ADMA and symmetric dimethylarginine (SDMA) plasma concentrations in chronic obstructive pulmonary disease (COPD). Our interest centers on the role of ADMA in regulation of endothelial function in COPD and secondary PH. The aim of the present study was to evaluate the serum ADMA, SDMA, and L-arginine concentrations in COPD and its association with PH. Methods: Patients with diagnosis of COPD underwent pulmonary function tests, echocardiography, and laboratory investigations including ADMA, SDMA, and L-arginine. Results: Serum concentrations of ADMA, SDMA, and L-arginine tend to increase as COPD progresses. Patients with PH had higher concentrations of ADMA, SDMA, and L-arginine compared to cases with normal pulmonary arterial pressure (PAP); the difference was not statistically significant. Conclusions: Our results show that increased ADMA, SDMA, and L-arginine concentrations are associated with increased PAP measurements in patients with COPD, however, the relationship is not statistically significant.
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Affiliation(s)
- Elif Torun Parmaksız
- Department of Pulmonology, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey
| | - Ali Inal
- Department of Clinical Immunology, Baskent University, Istanbul Hospital, Istanbul, Turkey
| | - Banu Salepci
- Department of Pulmonology, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey
| | - Sevda Comert
- Department of Pulmonology, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey
| | - Ali Fidan
- Department of Pulmonology, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey
| | - Nesrin Kiral
- Department of Pulmonology, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey
| | - Coşkun Doǧan
- Department of Pulmonology, Dr. Lutfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey
| | - Benan Caglayan
- Department of Pulmonology, Koç University, Istanbul, Turkey
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Dogan C, Sağmen S, Parmaksız E, Fidan A, Kıral N, Salepçi B, Cömert S. Features of endobronchial metastases from extrathoracic malignancy and positron emission tomography-computerized tomography findings. Eurasian J Pulmonol 2018. [DOI: 10.4103/ejop.ejop_10_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Salepci B, Caglayan B, Nahid P, Parmaksiz ET, Kiral N, Fidan A, Comert SS, Dogan C, Gungor GA. Vitamin D Deficiency in Patients Referred for Evaluation of Obstructive Sleep Apnea. J Clin Sleep Med 2017; 13:607-612. [PMID: 27998376 DOI: 10.5664/jcsm.6554] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 11/04/2016] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES A recent study reported an association between obstructive sleep apnea (OSA) and low vitamin D levels. In this study, we measured vitamin D levels in patients referred for evaluation of suspected OSA and sought to identify associated risk factors for vitamin D deficiency. Our objective was to determine whether evaluations of patients with suspected OSA should include routine screening for vitamin D deficiency. METHODS Using a cross-sectional study design, we measured vitamin D levels in consecutively enrolled patients referred for an OSA evaluation to Dr. Lutfi Kirdar Kartal Training and Research Hospital in Istanbul, Turkey. We conducted full-night polysomnography and compared vitamin D levels both between patients with OSA and patients without OSA and across the various severity levels of OSA. We evaluated the association between vitamin D levels and various clinical and demographic characteristics, including the apnea-hypopnea index and body mass index. RESULTS From April 2014 to June 2015, 195 patients were referred for OSA evaluation. Of these, 181 patients (93%) consented to participate and underwent full polysomnography and measurement of vitamin D levels. The mean ± standard deviation age was 49 ± 12 years and body mass index of 31 ± 6 kg/m2. Polysomnography led to the diagnosis of OSA in 162 of the patients (89.5%): 52 (32%) were categorized as having mild OSA, 38 (23.5%) as having moderate OSA, and 72 (44.5%) as having severe OSA. Vitamin D level was 15.5 ± 11.6 ng/mL (95% confidence interval; 13-17 ng/mL) and 134 patients (74%) met the criterion for vitamin D deficiency (< 20 ng/mL). Sex, vitamin D levels, and percentage of patients with vitamin D deficiency were similar in patients with and without OSA (P > .05). Vitamin D levels were similar across OSA severity categories (P = .68). We found no association between vitamin D levels and the apnea-hypopnea index or body mass index. CONCLUSION A large proportion of patients referred for OSA evaluation had vitamin D deficiency. Vitamin D levels did not differ by OSA diagnosis status or severity. Patients referred for polysomnography should undergo routine screening for vitamin D deficiency as well as clinically indicated treatment to prevent associated comorbidities.
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Affiliation(s)
- Banu Salepci
- University of Medical Sciences İstanbul, Kartal Dr. Lutfi Kirdar Teaching and Research Hospital, Chest Diseases Clinic, Istanbul, Turkey
| | - Benan Caglayan
- İstanbul, Koç University Medical Faculty, Chest Diseases Clinic, Istanbul, Turkey
| | - Payam Nahid
- University of California, San Francisco, San Francisco General Hospital, Division of Pulmonary and Critical Care Medicine, San Francisco, California
| | - Elif Torun Parmaksiz
- University of Medical Sciences İstanbul, Kartal Dr. Lutfi Kirdar Teaching and Research Hospital, Chest Diseases Clinic, Istanbul, Turkey
| | - Nesrin Kiral
- University of Medical Sciences İstanbul, Kartal Dr. Lutfi Kirdar Teaching and Research Hospital, Chest Diseases Clinic, Istanbul, Turkey
| | - Ali Fidan
- University of Medical Sciences İstanbul, Kartal Dr. Lutfi Kirdar Teaching and Research Hospital, Chest Diseases Clinic, Istanbul, Turkey
| | - Sevda Sener Comert
- University of Medical Sciences İstanbul, Kartal Dr. Lutfi Kirdar Teaching and Research Hospital, Chest Diseases Clinic, Istanbul, Turkey
| | - Coskun Dogan
- University of Medical Sciences İstanbul, Kartal Dr. Lutfi Kirdar Teaching and Research Hospital, Chest Diseases Clinic, Istanbul, Turkey
| | - Gulten Aktin Gungor
- University of Medical Sciences İstanbul, Kartal Dr. Lutfi Kirdar Teaching and Research Hospital, Chest Diseases Clinic, Istanbul, Turkey
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Dogan C, Comert SS, Caglayan B, Gencer S, Torun Parmaksiz E, Fidan A, Musaffa Salepci B. Is H3N2 Pneumonia Different from Other Community-Acquired Pneumonia? Eurasian J Pulmonol 2016. [DOI: 10.5152/ejp.2015.72691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Salepci B, Caglayan B, Fidan A, Parmaksiz ET, Kiral N, Comert SS, Dogan C, Coskun E. The Effect of Pulmonary Function Testing on the Success of Smoking Cessation. Respir Care 2016; 61:1073-80. [PMID: 26932380 DOI: 10.4187/respcare.04490] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND In several studies, low spirometric levels have been shown to increase the success rates of smoking cessation, whereas other studies have indicated that pulmonary function has no effects on quitting smoking. Given the fact that there are contradictory results on this subject, we aimed to investigate the effect of identifying airway obstruction via spirometry and its explanation to subjects on the success rate of smoking cessation in the short term. METHODS Subjects who were admitted to the smoking cessation out-patient clinic, underwent pulmonary function tests (PFTs) and completed at least 3 months of the cessation program following their admittance were included in the study. At the first interview, all subjects were asked about their comorbid diseases and smoking habits. PFTs were performed. Subjects who had an obstruction on PFT were informed that their condition was smoking-related, and that further deterioration could be prevented following smoking cessation. Then the smoking cessation date was determined together with the subject, and one of the smoking cessation medicines was prescribed. All subjects were given control appointments twice for the first month and once per month for the following 2-month follow-up period. Subjects who had CO levels between 0 and 5 parts per million were considered as non-smokers. RESULTS The mean age of the 563 subjects was 41.9 ± 12.1 y 340 subjects (60.4%) were male. A total of 162 subjects (28.8%) came to the follow-up visits following the first interview. The success of smoking cessation for 3 months was 11.3% for all subjects and 39.5% for subjects who came to follow-up visits. Of the subjects with obstruction on PFT; 22.8% stopped smoking, whereas 8.4% of the subjects without obstruction did so (P < .001). The percentage of subjects with obstruction on PFT was significantly higher (P < .001) and the FEV1 % (P = .005), FEV1/FVC (P < .001), and forced expiratory flow 25-75% (P = .008) levels were significantly lower in the quitters compared with the non-quitters. Logistic regression analysis showed that age (P = .001) and the presence of obstruction on PFT (P = .029) were independent variables. CONCLUSIONS Advanced age and the presence of obstruction on PFT increase the success of smoking cessation. Pulmonary function tests should be performed on all patients who apply to smoking cessation out-patient clinics, and patients should be informed about their condition.
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Affiliation(s)
- Banu Salepci
- Chest Diseases Clinic, Dr Lutfi Kirdar Kartal Teaching and Research Hospital, Istanbul, Turkey.
| | - Benan Caglayan
- Chest Diseases Clinic, Dr Lutfi Kirdar Kartal Teaching and Research Hospital, Istanbul, Turkey
| | - Ali Fidan
- Chest Diseases Clinic, Dr Lutfi Kirdar Kartal Teaching and Research Hospital, Istanbul, Turkey
| | - Elif Torun Parmaksiz
- Chest Diseases Clinic, Dr Lutfi Kirdar Kartal Teaching and Research Hospital, Istanbul, Turkey
| | - Nesrin Kiral
- Chest Diseases Clinic, Dr Lutfi Kirdar Kartal Teaching and Research Hospital, Istanbul, Turkey
| | - Sevda Sener Comert
- Chest Diseases Clinic, Dr Lutfi Kirdar Kartal Teaching and Research Hospital, Istanbul, Turkey
| | - Coskun Dogan
- Chest Diseases Clinic, Dr Lutfi Kirdar Kartal Teaching and Research Hospital, Istanbul, Turkey
| | - Esma Coskun
- Chest Diseases Clinic, Dr Lutfi Kirdar Kartal Teaching and Research Hospital, Istanbul, Turkey
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Salepci B, Fidan A, Caglayan B, Torun Parmaksiz E, Kiral N, Comert SS, Aktin Gungor G, Salepci E. Can a Computer-Based Prescription of Free Medication Increase Smoking Cessation Rates Efficiently? Turk Thorac J 2015. [DOI: 10.5152/ttd.2015.4940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Salepci B, Fidan A, Çağlayan B, Parmaksız ET, Kıral N, Cömert SŞ, Güngör GA, Salepci E. Can a Computer-Based Prescription of Free Medication Increase Smoking Cessation Rates Efficiently? Turk Thorac J 2015; 17:15-21. [PMID: 29404116 DOI: 10.5578/ttj.17.1.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Accepted: 09/18/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVES In 2011, in the context of a research project, bupropion and varenicline were distributed to smoking cessation clinics by the Ministry of Health of Turkey to be prescribed free of charge by a computer-based system. In the present study, we compared smoking cessation rates between patients who were prescribed free medications during the period of the project and those who had to pay for their medication. MATERIAL AND METHODS Six hundred four patients who applied during the project period were given either bupropion or varenicline, which were prescribed using an algorithm-based computer system. Three hundred sixteen patients who applied after that period were prescribed medicines deemed appropriate by the attending physician but had to pay for the medication on their own. Follow-up visits were arranged for one year. Carbon monoxide (CO) levels in the expired air were used as indicators of cessation. RESULTS A total of 537 patients began treatment, of which 438 (81.6%) applied during the first period (group 1) and 99 (18.4%) applied during the second period (group 2). The mean age and concomitant disease presence were higher in the second-period patients (p< 0.05). Advanced age, comorbidities, pathological findings in spirometry, and chest X-ray were also higher in those who paid for the cost of their treatment (p= 0.009, 0.001, 0.006, 0.001, respectively). Smoking cessation rates were found to be 14.8% and 27.3% after six months (p= 0.008) and 10.7% and 18.2% after one year (p= 0.059), respectively, for group 1 and group 2. Age, dependence score, cigarettes smoked (as pack-years), and percentage of patients who paid for the treatment were found to be significantly higher (p< 0.001, 0.021, 0.018, 0.001, respectively) for those who quit smoking at the end of six months. For the patients who quit smoking at the end of one year, age was found to be significantly higher (p= 0.008), and the number of males was higher, although the difference was not statistically significant (p= 0.05). When logistic regression analysis was applied, age, dependence score, and paid treatment were found to be independent variables (p= 0.002, 0.008, 0.012, respectively) for those who quit smoking at the end of six months. Only age was found to be an independent variable for those who quit smoking at the end of one year (p= 0.029). CONCLUSION More smokers could receive treatment by the distribution of free drugs. However, quitting rates at the end of six months were higher when patients had to pay for their treatment. On the other hand, quitting rates at the end of one year were not affected by whether the treatment was paid for or free of charge. The most important factor increasing quitting rates at the end of six months and one year was found to be advanced age.
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Affiliation(s)
- Banu Salepci
- Clinic of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
| | - Ali Fidan
- Clinic of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
| | - Benan Çağlayan
- Clinic of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
| | - Elif Torun Parmaksız
- Clinic of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
| | - Nesrin Kıral
- Clinic of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
| | - Sevda Şener Cömert
- Clinic of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
| | - Gülten Aktin Güngör
- Clinic of Chest Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
| | - Egehan Salepci
- Student of 6 Grade, Trakya University Faculty of Medicine, Edirne, Turkey
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Salepci B, Fidan A, Parmaksiz ET, Coskun E, Kiral N, Caglayan B. Does Small Airway Obstruction in Pulmonary Function Tests Affect End-Expiratory CO Levels? Chest 2015. [DOI: 10.1378/chest.2270107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Kiral N, Caglayan B, Salepci B, Torun Parmaksiz E, Fidan A, Comert SS, Yavuzer D, Partal M. Endobronchial ultrasound-guided transbronchial needle aspiration in diagnosing intrathoracic tuberculous lymphadenitis. Med Ultrason 2015; 17:333-338. [PMID: 26343082 DOI: 10.11152/mu.2013.2066.173.nki] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
AIMS Patients with suspected tuberculosis without pulmonary lesions and with intrathoracic lymphadenopathy often pose a diagnostic challenge. The aim of this study was to describe the diagnostic utility of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in patients with isoleted intrathoracic lymphadenopathy due to tuberculosis (TB). MATERIALS AND METHODS Cases with tuberculous lymphadenitis (TBLA) as the final diagnosis were analysed among patients in whom EBUS-TBNA had been performed. All patients underwent routine clinical assessment and a CT scan prior to EBUS-TBNA. Demographic data, pathological findings, and microbiological results were recorded. All patients received 6-month antituberculous treatment, followed-up regularly and recovered both on clinical and radiological basis. RESULTS Forty-four patients were included. EBUS-TBNA diagnosed TB intrathoracic lympadenopathy in 42 (95.4%) patients. In 2 patients, EBUS-TBNA was not able to confirm a diagnosis and additional procedures were required. Cytopathological findings alone revealed TB in 32 (72.7%) patients. One of the patients (2.2%) was smear positive while microbiological investigations provided a positive culture of TB in 22 (50%) patients. TB culture was positive in 10 of 12 patients in whom cytopathologic evaluation was not able to diagnose. Addition of mycobacterium culture to cytopathologic investigation s improved the diagnostic yield from 72.7% to 95.4%. CONCLUSION EBUS-TBNA is a safe and effective first line investigation for evaluating isolated intrathoracic tuberculous lympadenopathy. Addition of mycobacterium culture to cytopathologic investigation improves the sensitivity of EBUS-TBNA.
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Affiliation(s)
- Nesrin Kiral
- Dr. Lutfi Kirdar Kartal Training and Research Hospital Department of Chest Diseases, Istanbul, Turkey.
| | - Benan Caglayan
- Dr. Lutfi Kirdar Kartal Training and Research Hospital Department of Chest Diseases, Istanbul, Turkey
| | - Banu Salepci
- Dr. Lutfi Kirdar Kartal Training and Research Hospital Department of Chest Diseases, Istanbul, Turkey
| | - Elif Torun Parmaksiz
- Dr. Lutfi Kirdar Kartal Training and Research Hospital Department of Chest Diseases, Istanbul, Turkey
| | - Ali Fidan
- Dr. Lutfi Kirdar Kartal Training and Research Hospital Department of Chest Diseases, Istanbul, Turkey
| | - Sevda Sener Comert
- Dr. Lutfi Kirdar Kartal Training and Research Hospital Department of Chest Diseases, Istanbul, Turkey
| | - Dilek Yavuzer
- Dr. Lutfi Kirdar Kartal Training and Research Hospital Department of Pathology, Istanbul, Turkey
| | - Mualla Partal
- Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Department of Microbiology, Istanbul, Turkey
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Salepci B, Fidan A, Çağlayan B, Parmaksız E, Aktürk Ü, Kıral N, Cömert SŞ, Saraç G, Salepçi E. Overnight Transcutaneous Carbon Dioxide Monitoring in Eucapnic Patients with Obstructive Sleep Apnea Syndrome. Turk Thorac J 2015; 16:10-15. [PMID: 29404071 DOI: 10.5152/ttd.2014.4337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 08/29/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVES We monitored increases in CO2 levels during sleep by measuring transcutaneous pCO2 (PtcCO2) to determine its relationship with polysomnographic data in normocapnic patients with obstructive sleep apnea syndrome (OSAS). MATERIAL AND METHODS Between October 2011 and December 2012, 139 patients underwent PtcCO2 monitoring with polysomnography. All patients were evaluated with arterial blood gas (ABG) measurements and pulmonary function tests (PFTs). We excluded 13 patients with COPD and/or daytime hypercapnia and 29 patients whose PtcCO2 records could not be evaluated. RESULTS The patients' mean age was 46.8±10.3 years. Fifty-nine patients (60.8%) were male, and 38 (39.2%) patients were female. The mean overnight PtcCO2 was ≤45 mm Hg in 84 (86.6%) patients and >45 mm Hg in 13 (13.4%) patients. In the group with PtcCO2>45 mm Hg, 10 patients had an apnea-hypopnea index (AHI) >15, and 3 patients had an AHI<15, without a statistically significant difference (p=0.078). The mean apnea and apnea/interapnea periods were similar. The mean PtcCO2 values correlated with time spent when the SpO2 was <90% (r=0.220, p<0.031). When we grouped the patients by AHI, 60 (61.8%) patients had an AHI>15 (moderate to severe OSAS), and 37 (37.2%) had an AHI<15 (mild OSAS). Of the former group, 16.7% had a mean PtcCO2 >45 mm Hg, whereas this ratio was 8.1% in the latter group. The difference was not statistically significant (p=0.359). In the group with an AHI>15, the highest PtcCO2 levels were significantly higher (p<0.05). CONCLUSION We conclude that seemingly eucapnic OSAS patients may experience hypercapnia when sleeping, and PtcCO2 monitoring may be useful in the early diagnosis of hypercapnia.
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Affiliation(s)
- Banu Salepci
- Department of Chest Disease, Dr. Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
| | - Ali Fidan
- Department of Chest Disease, Dr. Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
| | - Benan Çağlayan
- Department of Chest Disease, Dr. Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
| | - Elif Parmaksız
- Department of Chest Disease, Dr. Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
| | - Ülkü Aktürk
- Department of Chest Disease, Dr. Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
| | - Nesrin Kıral
- Department of Chest Disease, Dr. Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
| | - Sevda Şener Cömert
- Department of Chest Disease, Dr. Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
| | - Gülşen Saraç
- Department of Chest Disease, Dr. Lütfi Kırdar Kartal Training and Research Hospital, İstanbul, Turkey
| | - Egehan Salepçi
- Department of Chest Disease, Trakya University Faculty of Medicine, Edirne, Turkey
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Fidan A. Chronic Obstructive Pulmonary Disease and Anaemia. Eurasian J Pulmonol 2014. [DOI: 10.5152/ejp.2014.46873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Salepci B, Torun Parmaksiz E, Kiral N, Sarac G, Sener Comert S, Fidan A, Caglayan B. Factors That Affect Auto-Continuous Positive Airway Pressure Level Designated During Titration Night in Patients with Obstructive Sleep Apnoea. Turk Thorac J 2014. [DOI: 10.5152/ttd.2014.3742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Cömert SS, Acar H, Doğan C, Cağlayan B, Fidan A. [Clinical, radiological and bronchoscopic evaluation of inhalation injury cases treated at a burn center]. ULUS TRAVMA ACIL CER 2013; 18:111-7. [PMID: 22792816 DOI: 10.5505/tjtes.2012.99233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND We aimed to introduce inhalation injury, pulmonary complications and mortality-related factors on the basis of clinical, radiological and bronchoscopic findings in patients with inhalation burns. METHODS Between January 2009 and January 2010, patients hospitalized in the intensive care unit (ICU) of a burn center who were diagnosed as inhalation burn and underwent bronchoscopy were included in the study. Demographic findings, burn type, burn percentage, clinical-laboratory features, chest Xray findings on the first and fifth days, and bronchoscopic lesions were obtained from patient files. Bronchoscopic findings were classified, and bronchoscopic score for each patient was calculated. Clinical, laboratory and radiological findings, length of stay in the ICU, and bronchoscopic scores of patients who were discharged versus of those who died were compared, and mortality-related factors were investigated. RESULTS Twenty-nine patients (25 male, 4 female; mean age 40.1 +/- 3.4 years) were included. Radiological abnormalities were found in 41.3% and 65.5% of patients on the first and fifth days of hospitalization, respectively. There were no complications related to bronchoscopy. Percentage of burn and duration of stay in the ICU were higher in patients who died than in discharged patients (20.4%-48.5%, p = 0.003; mean: 7.0-13.7 days, p = 0.037, respectively). Of patients who died, 79.1% showed radiological abnormality and 50% had acute respiratory distress syndrome (ARDS) on the fifth day of hospitalization. There were no pathologic findings on chest X-ray and no ARDS was seen on the fifth day in patients who were discharged (p < 0.05). CONCLUSION Inhalation burns in patients with cutaneous burns cause a high percentage of pulmonary complications and increase mortality. Bronchoscopy must be performed early for diagnosis, and close follow-up of these patients is necessary.
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Affiliation(s)
- Sevda Sener Cömert
- Dr.Lütfi Kirdar Kartal Eğitim ve Araştirma Hastanesi, Göğüs Hastaliklari Kliniği, Istanbul, Turkey.
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Comert SS, Caglayan B, Akturk U, Fidan A, Kıral N, Parmaksız E, Salepci B, Kurtulus BAO. The role of thoracic ultrasonography in the diagnosis of pulmonary embolism. Ann Thorac Med 2013; 8:99-104. [PMID: 23741272 PMCID: PMC3667453 DOI: 10.4103/1817-1737.109822] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 12/23/2012] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES: The diagnosis of pulmonary embolism (PE) is still a problem especially at emergency units. The purpose of study was to determine the diagnostic accuracy of thoracic ultrasonography (TUS) in patients with PE. METHODS: In this prospective study, 50 patients with suspected PE were evaluated in Department of Pulmonary Diseases of a Training and Reasearch Hospital between January 2010 and July 2011. At the begining, TUS was performed by a chest physician, subsequently for definitive diagnosis computed tomography pulmonary angiography were performed in all cases as a reference method. Other diagnostic procedures were examination of serum d-dimer levels, echocardiography, and venous doppler ultrasonography of the legs. Both chest physician and radiologist were blinded to the results of other diagnostic method. Diagnosis of PE was suggested if at least one typical pleural-based/subpleural wedge-shaped or round hypoechoic lesion with or without pleural effusion was reported by TUS. Presence of pure pleural effusion or normal sonographic findings were accepted as negative TUS for PE. RESULTS: PE was diagnosed in 30 patients. It was shown that TUS was true positive in 27 patients and false positive in eight and true negative in 12 and false negative in three. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of TUS in diagnosis of PE for clinically suspected patients were 90%, 60%, 77.1%, 80%, and 78%, respectively. CONCLUSIONS: TUS with a high sensitivity and diagnostic accuracy, is a noninvasive, widely available, cost-effective method which can be rapidly performed. A negative TUS study cannot rule out PE with certainty, but positive TUS findings with moderate/high suspicion for PE may prove a valuable tool in diagnosis of PE at bedside especially at emergency setting, for critically ill and immobile patients, facilitating immediate treatment decision.
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Affiliation(s)
- Sevda Sener Comert
- Department of Pulmonary Diseases, Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
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Salepci B, Caglayan B, Kiral N, Parmaksiz ET, Comert SS, Sarac G, Fidan A, Gungor GA. CPAP adherence of patients with obstructive sleep apnea. Respir Care 2013; 58:1467-73. [PMID: 23431305 DOI: 10.4187/respcare.02139] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Continuous positive airway pressure (CPAP) and bi-level positive airway pressure (BPAP) are the gold standard treatments for obstructive sleep apnea syndrome (OSAS), but CPAP/BPAP is not well tolerated and requires long-term follow-up. OBJECTIVE We prospectively assessed subjective and objective adherence and factors that affect adherence in OSAS patients. METHODS Subjects using CPAP/BPAP were questioned about adverse effects of CPAP/BPAP and were assessed with the Epworth Sleepiness Scale (ESS) at the first, third, sixth, and twelfth month, and once every 6 months after the first year. CPAP/BPAP use and objective and subjective adherence were assessed. Subjects who used CPAP/BPAP for at least 4 hours per night for at least 70% of the days monitored were regarded as adherent, and those who did not were considered non-adherent. The relationships between adherence and demographic data, polysomnography findings, ESS scores, and adverse effects were statistically analyzed. RESULTS Six-hundred forty-eight subjects who were diagnosed with OSAS by polysomnography and accepted to use CPAP/BPAP in our sleep center between January 2005 and June 2011 were included. Four-hundred fifty-one subjects (69.6%) were men, and 197 (30.4%) were women. Two-hundred forty-eight (38.3%) subjects attended follow-ups, 246 (37.9%) were called by telephone, and 154 (23.8%) could not be reached. Of the whole population, 63.9% had obtained their CPAP/BPAP machine. In the 248 subjects who attended follow-ups, subjective adherence was 85.1% and objective adherence was 64.5%. Improvement in ESS score (P < .001) and satisfactory sleep (P < .001) were found to be significantly higher in the adherent group. Chest discomfort, difficulty falling asleep, and sleep disturbances were significantly higher in the non-adherent group (all P < .01). CONCLUSIONS Of the whole population, just 38.3% attended follow-ups. The objective adherence was lower than the subjective adherence in subjects who attended follow-ups. Younger subjects were more adherent, and the most important factors that correlated with adherence were substantial improvement of daytime sleepiness and effect of CPAP/BPAP on satisfactory sleep. CONCLUSIONS CPAP/BPAP adherence should be followed with objective monitoring.
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Affiliation(s)
- Banu Salepci
- Department of Chest Diseases, Dr Lutfi Kirdar Kartal Teaching and Research Hospital, Istanbul, Turkey.
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Comert S, Dogan C, Fidan A, Salepci B, Kiral N, Caglayan B. The Correlation of Different Pneumonia Severity Classifications with Each Other According to the Indications for Hospitalization. Turk Thorac J 2013. [DOI: 10.5152/ttd.2012.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Parmaksız ET, Caglayan B, Salepci B, Comert SS, Kiral N, Fidan A, Sarac G. The utility of endobronchial ultrasound-guided transbronchial needle aspiration in mediastinal or hilar lymph node evaluation in extrathoracic malignancy: Benign or malignant? Ann Thorac Med 2012. [PMID: 23189097 PMCID: PMC3506100 DOI: 10.4103/1817-1737.102171] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Newly arising enlarged or hypermetabolic mediastinal/hilar lymph nodes (LNs) in patients with previously diagnosed extrathoracic malignancies raise suspicion of metastasis. Relatively high proportion of these LNs is due to a benign condition. We aimed to determine frequency of malignant LNs and role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) for clarification of the origin of suspicious LNs in these patients. METHODS Consecutive patients with a known extrathoracic malignancy and suspected hilar/mediastinal LN were included in this prospective study. Computed tomography (CT) of thorax and positron emission tomography-CT of all patients were taken. LNs with short axis >1 cm at CT of thorax and SUV ≥ 2.5 were accepted suspicious for malignancy. All patients underwent EBUS-TBNA for pathological verification of LNs. Patients with benign diagnosis either underwent invasive procedures or were followed up. The results were evaluated for frequency of malignant hilar/mediastinal LNs and sensitivity, specificity, and diagnostic values of EBUS-TBNA. RESULTS A total of 48 cases with a mean age of 57.4±11.6 were included. All cases had the diagnosis of an extrathoracic malignancy. 78 LNs were aspirated with EBUS-TBNA in 48 cases (1.62 LNs/patient). The mean short axis of aspirated LNs was 1.51±0.63. Results of EBUS-TBNA revealed malignancy in 15 cases (31.2%), tuberculosis in six cases (12.5%), sarcoidosis in four cases (8.3%), and reactive adenitis in 23 cases (48%). The sensitivity, specificity, and negative predictive value of EBUS-TBNA for malignancy were 83.3%, 100%, and 90.9%, respectively. When both benign and malignant diseases were considered, sensitivity, specificity, negative predictive value, and diagnostic accuracy of EBUS-TBNA were 89.2%, 100%, 86.9%, and 93.7%, respectively. CONCLUSIONS The ratio of benign LNs in patients with extrathoracic malignancies is relatively high. EBUS-TBNA is a safe, minimally invasive, and effective method for clarification of intrathoracic LNs.
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Affiliation(s)
- Elif T Parmaksız
- Department of Pulmonary Diseses, Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
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Caglayan B, Salepci B, Dogusoy I, Fidan A, Sener Comert S, Kiral N, Yavuzer D, Sarac G. The role of convex probe endobronchial ultrasound guided transbronchial needle aspiration in the diagnosis of malignant mediastinal and hilar lymph nodes. Iran J Radiol 2012; 9:183-9. [PMID: 23407664 PMCID: PMC3569549 DOI: 10.5812/iranjradiol.3882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 09/04/2012] [Accepted: 09/08/2012] [Indexed: 11/22/2022]
Abstract
Background In the diagnosis of malignant lymph nodes (LNs) and staging of lung cancer, sampling of mediastinal and hilar LNs is essential. Mediastinoscopy is known as the gold standard. Convex probe (CP) endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) is a noninvasive and highly sensitive diagnostic method in mediastinal and hilar LN sampling. Objectives Evaluating the role of CP-EBUS-guided TBNA in the diagnosis of mediastinal and hilar LNs suspicious of malignancy. Patients and Methods One hundred twenty patients with a known lung malignancy or hilar/mediastinal LNs detected by thoracic computed tomography (CT) and/or positron emission tomography (PET)-CT suspicious for malignancy were included in this prospective study. The procedure was performed by Olympus 7.5 MHz CP endoscope and EU C2000 processor by the oral route under topical anesthesia and conscious sedation. After visualization of LNs, their dimensions were recorded. Aspiration was considered as “insufficient” if there were inadequate lymphocytes on the smears. Diagnosis of “malignancy” on cytologic examination was considered as the “final diagnosis”. If diagnosis was negative for malignancy, more invasive procedures were performed to confirm the diagnosis. Results Twenty four females and 96 male patients (mean age, 57.8 ± 9.1) were included. A total of 177 LN stations were aspirated in 120 patients. In 82 patients, the diagnosis was malignant by EBUS-guided TBNA and in the remaining 38; the diagnosis was established by further invasive procedures. Of the 38 EBUS-guided TBNA negative patients, 28 were diagnosed as non-malignant and 10 were malignant. The sensitivity, diagnostic accuracy and negative predictive value of CP EBUS-guided TBNA were 89.1%, 91.6% and 73.6%, respectively. No major complications were seen. Conclusion As an alternative method to mediastinoscopy, EBUS-guided TBNA is a safe and noninvasive procedure with high sensitivity in the diagnosis of malignant mediastinal LNs.
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Affiliation(s)
- Benan Caglayan
- Department of Pulmonary Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Banu Salepci
- Department of Pulmonary Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Ilgaz Dogusoy
- Department of Thoracic Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ali Fidan
- Department of Pulmonary Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Sevda Sener Comert
- Department of Pulmonary Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
- Corresponding author: Sevda Sener Comert, Pembekosksok, Emek apt. No: 16 D: 14 34732 Merdivenkoy Kadikoy, Istanbul, Turkey. Tel.: +90-2163505187, Fax: +90-2164421884, E-mail:
| | - Nesrin Kiral
- Department of Pulmonary Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Dilek Yavuzer
- Department of Pathology, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
| | - Gulsen Sarac
- Department of Pulmonary Diseases, Dr. Lütfi Kırdar Kartal Training and Research Hospital, Istanbul, Turkey
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Dogan C, Kiral N, Comert SS, Fidan A, Caglayan B, Salepci B. Tuberculosis Frequency in Patients Taking TNF-alpha Blokers. ACTA ACUST UNITED AC 2012. [DOI: 10.5152/ttd.2012.22] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Salepci BM, Fidan A, Kiral N, Torun Parmaksiz E, Sarac G, Sener Comert S, Caglayan B. Frequency of COPD and Asthma in Patients with Obstructive Sleep Apnea Syndrome and Their Effects on Severity of Obstructive Sleep Apnea Syndrome and Quality of Sleep. ACTA ACUST UNITED AC 2012. [DOI: 10.5505/solunum.2012.87049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Çağlayan B, Salepçi B, Fidan A, Kiral N, Cömert SS, Yavuzer D, Demirhan R, Saraç G. Sensitivity of convex probe endobronchial sonographically guided transbronchial needle aspiration in the diagnosis of granulomatous mediastinal lymphadenitis. J Ultrasound Med 2011; 30:1683-1689. [PMID: 22124004 DOI: 10.7863/jum.2011.30.12.1683] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate the sensitivity and diagnostic value of convex probe endobronchial sonographically guided transbronchial needle aspiration (EBUS-TBNA) in the diagnosis of granulomatous mediastinal lymphadenitis. METHODS Patients clinically and radiologically suspected to have granulomatous mediastinal disease and followed in our clinic between October 2008 and July 2010 were included. Convex probe EBUS with local anesthesia and under conscious sedation and EBUS-TBNA from hilar and mediastinal lymph nodes were performed after physical examination, chest radiography, computed tomography of the thorax, and routine biochemical analysis. Detection of noncaseating/caseating granulomas was accepted as sufficient for diagnosis of sarcoidosis/tuberculosis in the presence of clinical and radiologic findings. For patients whose EBUS-TBNA results were nondiagnostic, a definitive diagnosis was reached by invasive procedures. The sensitivity of EBUS-TBNA in the diagnosis of granulomatous lymphadenitis and diagnostic accuracy in granulomatous hilar/mediastinal lymphadenopathies was calculated. RESULTS Seventy-two patients were included in study (20 male and 52 female; mean age ± SD, 46.22 ± 13.94 years). In 72 cases, 121 lymph node aspirations were performed. The average lymph node short axis was 1.96 cm. With EBUS-TBNA among the 72 cases, 35 were diagnosed as sarcoidosis and 16 as tuberculous lymphadenitis. A definitive diagnosis could not be reached with EBUS-TBNA in 21 cases. As a result, 9 of these EBUS-TBNA-negative cases were diagnosed as reactive lymphadenitis, 9 as sarcoidosis, and 3 as tuberculosis by invasive procedures. The sensitivity values of EBUS-TBNA for diagnosis of sarcoidosis, tuberculosis, and granulomatous diseases were 79.5%, 84.2%, and 80.9%, respectively. The diagnostic accuracy of EBUS-TBNA for granulomatous diseases was 83.3%. No major complications occurred. CONCLUSIONS In the diagnosis of granulomatous lymphadenitis, EBUS-TBNA, with high sensitivity and a minimum complication rate, is an alternative to mediastinoscopy.
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Affiliation(s)
- Benan Çağlayan
- Departments of Pulmonary Diseases, Research Hospital, Istanbul, Turkey.
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Comert S, Dogan C, Diktas S, Fidan A, Kiral N, Sarac G, Caglayan B. Etiologic Distribution and Specifications of Hemoptysis as a Cause of Hospitalization. Chest 2011. [DOI: 10.1378/chest.1119687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Comert S, Caglayan B, Akturk U, Fidan A, Kiral N, Torun E, Salepci B. The Role of Thoracic Ultrasonography in the Diagnosis of Pulmonary Embolism. Chest 2011. [DOI: 10.1378/chest.1118380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Fidan A, Kiral N, Comert S, Diktas S, Salepci B, Caglayan B. Tracheal Stenosis as a Complication of Wegener's Granulomatosis. Chest 2011. [DOI: 10.1378/chest.1119794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Fidan A, Caglayan B, Arman B, Karadayi N. Endobronchial primary pulmonary meningioma. Saudi Med J 2008; 29:1512-1513. [PMID: 18946586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Affiliation(s)
- Ali Fidan
- Department of Chest Diseases, Dr. Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey.
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Caglayan B, Torun E, Turan D, Fidan A, Gemici C, Sarac G, Salepci B, Kiral N. Efficacy of iodopovidone pleurodesis and comparison of small-bore catheter versus large-bore chest tube. Ann Surg Oncol 2008; 15:2594-9. [PMID: 18594928 DOI: 10.1245/s10434-008-0004-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 05/14/2008] [Accepted: 05/15/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND To evaluate the efficacy of iodopovidone as an agent for pleurodesis in malignant pleural effusion (MPE) and to compare the efficacy of small-bore catheter (Pleuracan, Braun, Melsungen, Germany) and conventional large-bore chest tube in pleural fluid drainage and sclerotherapy. METHODS Patients with MPE were prospectively consecutively randomized into two groups between August 2004 and February 2007: pleurodesis via conventional (32F) chest tube (group 1) and small-bore catheter (group 2), both using iodopovidone. After 3 months' follow-up, response rates (complete or partial), complication rates, and duration of procedures within whole group, group 1, and group 2 were compared. Statistical analyses were performed by Mann-Whitney U, chi(2), and Fisher's exact test. RESULTS Forty-three pleurodeses were performed in 41 patients. The response was complete in 26 (60.5%) and partial in 12 (27.9%), and the overall success rate was 88.4%. The response rate was not associated with the type of inserted tube (P = .750), pleural fluid pH (P = .290), or pleural fluid lactate dehydrogenase (P = .727). In group 1 (n = 20), 12 demonstrated complete and 6 demonstrated partial response, with a 90% success rate; success was 86.9% in group 2, with complete response in 14 and partial response in 6 patients. Success rates were similar in the two groups (P = 1.000). Of 43 procedures, complications were observed in 14 (32.5%), and complication rates were 35% and 30.4% in groups 1 and 2, respectively (P = .750). The most frequent complication was pain (16.2%), followed by fever, subcutaneous emphysema, dyspnea, and hypotension. CONCLUSION Iodopovidone is an effective, inexpensive, safe, and easily available alternative in chemical pleurodesis in MPE. The success rates of pleurodesis were found to be similar regardless of the type of the tube inserted.
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Affiliation(s)
- Benan Caglayan
- Department of Chest Diseases, Dr. Lutfi Kirdar Kartal Training and Research Hospital, E-5 Yanyol Denizer Caddesi, Cevizli, Kartal, Istanbul, Turkey.
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Torun E, Fidan A, Cağlayan B, Salepçi T, Mayadağli A, Salepçi B. [Prognostic factors in small cell lung cancer]. Tuberk Toraks 2008; 56:22-29. [PMID: 18330751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
In order to find out prognostic factors and treatment results in small cell lung cancer (SCLC), 40 patients diagnosed in one year period were prospectively analysed. Following history and physical examination, patients were grouped according to ECOG performance scale and underwent Chest X-ray and thoracic computerized tomography (CT). Complete blood count, biochemical analyses, tumor markers were taken. Abdominal USG or CT, bone scintigraphy, cranial CT or MRI and bone marrow biopsy were made for detection of metastases. Limited stage patients received chemotherapy and thoracic RT, whereas cases with extensive disease received chemotherapy. Nineteen cases had limited and 21 had extensive disease. When laboratory findings between 2 stages were compared, LDH, SGOT and GGT were significantly higher in extensive stage (p= 0.005, 0.015, 0.001, respectively). Overall median survival was 6 +/- 1 months, cumulative survival in 6 and 12 months were 39% and 20.72%, respectively. Median survival was 10 +/- 2 months in limited stage and 3 +/- 1 months in extensive stage, with a statististically significant difference. Univariate analyses showed that incresed LDH, CA15-3, GGT and SGOT levels, hipoproteinemia and poor performance scale were poor prognostic signs (p= 0.024, 0.032, 0.047, 0.013, 0.021 ve 0.013, respectively), however multivariate analyses revealed no significant difference. Other blood tests, pleural effusion, age, mediastinal lymph node metastases and weight loss had no prognostic effect. Stage was found to be progniostic factor with both univariate and multivariate analyses (p= 0.045).
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Affiliation(s)
- Elif Torun
- Department of Chest Diseases, Dr. Lütfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey.
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Salepçi B, Eren A, Cağlayan B, Fidan A, Torun E, Kiral N. The effect of body mass index on functional parameters and quality of life in COPD patients. Tuberk Toraks 2007; 55:342-349. [PMID: 18224501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
Malnutrition increases dyspnea and exercise intolerance in chronic obstructive pulmonary disease (COPD) patients by effecting respiratory muscle strength (RMS) and thereby decreasing quality of life (QoL). This is a prospective study conducted to find out the differences due to pulmonary function tests (PFT), arterial blood gases (ABG), RMS, exercise capacity (EC) and QoL in COPD patients having low and normal body mass index (BMI). The study was carried out between April 2003-June 2004 and included 65 male COPD patients with a mean age of 63.4 +/- 9.6. The patients were grouped into 2: Low BMI group (BMI < 21) and normal BMI group (BMI= 21-28). All patients were investigated with PFT (spirometry, maximal inspiratory and expiratory pressures, diffusion capacity), ABG analyses, Modified Medical Research Council (MMRC) dyspnea scale, determination of EC by 6 minutes walking test (6 MWT) and determination of QoL by Turkish version of St. George Respiratory Questionnaire (SGRQ). Of these cases, 29 (44.6%) had low and 36 (55.4%) had normal BMI; MMRC was higher in the first group without statistical significance (p= 0.074). The first group demonstrated significantly lower diffusion capacity (DLco) and DLco%, PEmax, PEmax%, RMS and RMS% (p< 0.05). ABG analyses, 6 MWT results and SGRQ symptom scores revealed no significant difference. As a conclusion, BMI is closely related to dyspnea score, RMS and QoL in COPD patients, therefore in patients with low BMI pulmonary rehabilitation programs including nutritional support should accompany medical treatment.
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Affiliation(s)
- Banu Salepçi
- Department of Chest Diseases, Dr. Lütfi Kirdar Kartal Education and Research Hospital, Istanbul, Turkey
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Caglayan B, Akturk UA, Fidan A, Salepci B, Ozdogan S, Sarac G, Torun E. Transbronchial needle aspiration in the diagnosis of endobronchial malignant lesions: a 3-year experience. Chest 2005; 128:704-8. [PMID: 16100157 DOI: 10.1378/chest.128.2.704] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES To establish the diagnostic yield of transbronchial needle aspiration (TBNA) and its contribution to conventional diagnostic techniques (CDT) such as forceps biopsy, bronchial washing, and bronchial brushing in the diagnosis of malignant endobronchial lesions. DESIGN Retrospective clinical study. PATIENTS One hundred fifteen lung cancer patients MEASUREMENT AND RESULTS We reviewed files of 115 lung carcinoma cases diagnosed in our clinic from 2001 to 2003 with endobronchial lesions sampled by CDT and TBNA. The lesions were classified into three groups: exophitic mass lesion (EML), submucosal disease, and peribronchial disease. The diagnostic yield of TBNA and CDT was compared to that of the combination of CDT and TBNA with respect to the type and location of the lesion and the histopathologic subgroups. Of the 115 cases, histology findings were confirmed by TBNA in 91 cases (79%), CDT in 75 cases (65%), and TBNA plus CDT in 105 cases (91%). The difference of the diagnostic yield of CDT vs TBNA plus CDT was statistically significant (p < 0.001). In peribronchial disease, the sensitivity of TBNA plus CDT was significantly better than CDT (87% vs 52%, p < 0.001). In EML and submucosal disease, addition of TBNA to CDT improved sensitivity from 85 to 100% and from 84 to 97%, respectively (p > 0.05). Regarding localization, the addition of TBNA to CDT increased sensitivity in the trachea and main bronchi, and in right upper and middle lobe lesions (p < 0.05). By the addition of TBNA to CDT, small cell lung cancer and non-small cell lung cancer cases demonstrated improvements in sensitivity from 74 to 100% and 61 to 87%, respectively. This significant difference (p < 0.05) was attributed to the peribronchial disease group. CONCLUSION In the case of peribronchial disease, the addition of TBNA to CDT improves the diagnostic yield of the bronchoscopic examination.
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Affiliation(s)
- Benan Caglayan
- Department of Chest Diseases, Kartal Education and Research Hospital, Istanbul, Turkey.
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