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Babalık A, Rumeysa Hazine A, Erdal Donmez G, Akkan O, Kutluhan F, Balıkcı A, Catmabacak G, Koksalan K, Kuyucu T. Evaluation of 123 Cases with MDR TB (Multidrug Resistant Tuberculosis) Treatment. Tuberculosis (Edinb) 2018. [DOI: 10.1183/13993003.congress-2018.pa4745] [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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Mert A, Arslan F, Kuyucu T, Koç EN, Yılmaz M, Turan D, Altın S, Pehlivanoglu F, Sengoz G, Yıldız D, Dokmetas I, Komur S, Kurtaran B, Demirdal T, Erdem HA, Sipahi OR, Batirel A, Parlak E, Tekin R, Tunçcan ÖG, Balkan II, Hayran O, Ceylan B. Miliary tuberculosis: Epidemiologicaland clinical analysis of large-case series from moderate to low tuberculosis endemic Country. Medicine (Baltimore) 2017; 96:e5875. [PMID: 28151863 PMCID: PMC5293426 DOI: 10.1097/md.0000000000005875] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
The aim of this study was to determine the clinical features, and outcome of the patients with miliary tuberculosis (TB).We retrospectively evaluated 263 patients (142 male, 121 female, mean age: 44 years, range: 16-89 years) with miliary TB. Criteria for the diagnosis of miliary TB were at least one of the followings in the presence of clinical presentation suggestive of miliary TB such as prolonged fever, night sweats, anorexia, weight loss: radiologic criterion and pathological criterion and/or microbiological criterion; pathological criterion and/or microbiological criterion.The miliary pattern was seen in 88% of the patients. Predisposing factors were found in 41% of the patients. Most frequent clinical features and laboratory findings were fever (100%), fatigue (91%), anorexia (85%), weight loss (66%), hepatomegaly (20%), splenomegaly (19%), choroid tubercules (8%), anemia (86%), pancytopenia (12%), and accelerated erythrocyte sedimentation rate (89%). Tuberculin skin test was positive in 29% of cases. Fifty percent of the patients met the criteria for fever of unknown origin. Acid-fast bacilli were demonstrated in 41% of patients (81/195), and cultures for Mycobacterium tuberculosis were positive in 51% (148/292) of tested specimens (predominantly sputum, CSF, and bronchial lavage). Blood cultures were positive in 20% (19/97). Granulomas in tissue samples of liver, lung, and bone marrow were present in 100% (21/21), 95% (18/19), and 82% (23/28), respectively. A total of 223 patients (85%) were given a quadruple anti-TB treatment. Forty-four (17%) patients died within 1 year after diagnosis established. Age, serum albumin, presence of military pattern, presence of mental changes, and hemoglobin concentration were found as independent predictors of mortality. Fever resolved within first 21 days in the majority (90%) of the cases.Miliary infiltrates on chest X-ray should raise the possibility of miliary TB especially in countries where TB is endemic. Although biopsy of the lungs and liver may have higher yield rate of organ involvement histopathologicaly, less invasive procedures including a bone marrow biopsy and blood cultures should be preferred owing to low complication rates.
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Affiliation(s)
- Ali Mert
- Department of Internal Medicine, Istanbul Medipol University
| | - Ferhat Arslan
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University
| | - Tülin Kuyucu
- Sureyyapasa Chest Disease and Thoracic Surgery Training and Research Hospital
| | - Emine Nur Koç
- Sureyyapasa Chest Disease and Thoracic Surgery Training and Research Hospital
| | - Mesut Yılmaz
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University
| | - Demet Turan
- Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, Department of Chest Disease
| | - Sedat Altın
- Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, Department of Chest Disease
| | - Filiz Pehlivanoglu
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital
| | - Gonul Sengoz
- Department of Infectious Diseases and Clinical Microbiology, Haseki Training and Research Hospital
| | - Dilek Yıldız
- Department of Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul
| | - Ilyas Dokmetas
- Department of Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul
| | - Suheyla Komur
- Department of Infectious Diseases and Clinical Microbiology, Cukurova University Medical Faculty, Adana
| | - Behice Kurtaran
- Department of Infectious Diseases and Clinical Microbiology, Cukurova University Medical Faculty, Adana
| | - Tuna Demirdal
- Department of Infectious Diseases and Clinical Microbiology, Katip Celebi University
| | - Hüseyin A. Erdem
- Department of Infectious Diseases and Clinical Microbiology, Ege University, Izmir, Turkey
| | - Oguz Resat Sipahi
- Department of Infectious Diseases and Clinical Microbiology, Ege University, Izmir, Turkey
| | - Ayse Batirel
- Department of Infectious Diseases and Clinical Microbiology, LutfiKirdar Training and Research Hospital, Istanbul, Turkey
| | - Emine Parlak
- Department of Infectious Diseases and Clinical Microbiology, Atatürk University Faculty of Medicine, Erzurum, Turkey
| | - Recep Tekin
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Dicle University, Diyarbakir, Turkey
| | - Özlem Güzel Tunçcan
- Department of Clinical Microbiology and Infectious Diseases, Gazi University Hospital, Ankara, Turkey
| | - Ilker Inanc Balkan
- Department of Infectious Diseases and Clinical Microbiology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Osman Hayran
- Faculty of Medicine, Department of Public Health, Medipol University, Istanbul, Turkey
| | - Bahadır Ceylan
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medipol University, Istanbul, Turkey
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Topçuoğlu ÖB, Afşar GÇ, Saraç S, Oruç Ö, Kuyucu T. In the Absence of Co-Morbidities Mean Platelet Volume is not A Severity Indicator in OSAS. Electron J Gen Med 2016. [DOI: 10.15197/ejgm.1555] [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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Babalık A, Ulus IH, Bakirci N, Kuyucu T, Arpag H, Dagyildiz L, Çarpaner E. Pharmacokinetics and serum concentrations of antimycobacterial drugs in adult Turkish patients. Int J Tuberc Lung Dis 2014; 17:1442-7. [PMID: 24125448 DOI: 10.5588/ijtld.12.0771] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To document the pharmacokinetics and serum concentrations of first-line anti-tuberculosis drugs in adult Turkish patients with pulmonary tuberculosis (PTB). DESIGN Consenting 21 adult patients (aged 38 ± 4 years, 10 female and 11 male) with newly diagnosed active PTB participated in the study. Blood samples were collected 1, 2, 4, 6 and 24 h after simultaneous isoniazid (INH), rifampicin (RMP), pyrazinamide (PZA) and ethambutol (EMB) ingestion. Serum concentration-time profiles, maximum serum concentrations, time to achieve maximum serum concentrations, the half-life and the areas under the serum concentration-time curve for each of the four drugs were determined. RESULTS Wide variations in pharmacokinetic parameters were observed among patients. In respectively 8 (38%), 17 (81%), 3 (14%) and 1 (5%) patients, the maximum INH, RMP, PZA and EMB serum concentrations were below the accepted therapeutic concentrations. CONCLUSION Our data show that the serum concentrations of anti-tuberculosis drugs varied considerably in the study patients. Therapeutic drug monitoring is necessary to identify patients with subtherapeutic INH and RMP serum concentrations.
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Affiliation(s)
- A Babalık
- Süreyyapaşa Chest Disease and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey
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Ozlu T, Bülbül Y, Taşbakan S, Kılıç H, Kuyucu T, Yıldız T, Ozdemir T, Duru S, Oztuna F, Adıgüzel N, Sağlam L, Coşkun AŞ, Ornek T, Gündüz G, Filiz A, Ozdemir L, Okumuş G. General Characteristics and Prognostic Factors of Pneumonia Cases Developed During Pandemic (H1N1) Influenza-A Virus Infection in Turkey. Balkan Med J 2013; 30:68-73. [PMID: 25207072 DOI: 10.5152/balkanmedj.2012.089] [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: 06/16/2012] [Accepted: 09/17/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Unlike seasonal influenza, seen in previous years, the strain identified in the 2009 influenza-A pandemic involved high mortality. In this study, prognostic factors and general characteristics of pneumonia cases developed in Turkey during the H1N1 pandemic between October 2009 and January 2010 were analyzed. STUDY DESIGN Multicenter retrospective study. MATERIAL AND METHODS This multicentric retrospective study was conducted between August and October 2010 and patients' data were collected by means of standard forms. RESULTS The study included 264 pneumonia cases, collected from 14 different centers. Mean age was 47.5±18.6 years. Nineteen patients (7.2%) were pregnant or had a new birth and comorbid diseases were detected in 52.3% of all patients. On admission, 35 (13.8%) cases had altered mental status. Overall, 32.6% were treated in intensive care units (ICU) and invasive/non-invasive mechanical ventilation was performed in 29.7%. The mean duration of ICU stay was 2.9±6.2 and total hospital stay was 12.0±9.4 days. Mortality rate was 16.8% (43-cases). The length of ICU treatment, total hospital stay, and mortality were significantly higher in H1N1-confirmed patients. Mortality was significantly higher in patients with dyspnea, cyanosis, and those who had altered mental status on admission. Patients who died had significantly higher rate of peripheral blood neutrophils, lower platelet counts, higher BUN, and lower SaO2 levels. CONCLUSION This study showed that pneumonia developed during H1N1 pandemic in our country had resulted in a high mortality. Mortality was especially high among patients with cyanosis, altered mental state and those with lower SaO2.
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Affiliation(s)
- Tevfik Ozlu
- Department of Chest Diseases, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Yılmaz Bülbül
- Department of Chest Diseases, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Sezai Taşbakan
- Department of Chest Diseases, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Hatice Kılıç
- Clinic of Chest Diseases, Atatürk Education and Research Hospital, Ankara, Turkey
| | - Tülin Kuyucu
- Clinic of Chest Diseases, Süreyyapaşa Chest Diseases and Thoracic Surgery Education and Research Hospital, İstanbul, Turkey
| | - Tekin Yıldız
- Department of Chest Diseases, Faculty of Medicine, Dicle University, Diyarbakır, Turkey
| | - Tarkan Ozdemir
- Clinic of Chest Diseases, Chest Diseases Hospital, Çorum, Turkey
| | - Serap Duru
- Clinic of Chest Diseases, Dışkapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey
| | - Funda Oztuna
- Department of Chest Diseases, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Nalan Adıgüzel
- Clinic of Chest Diseases, Süreyyapaşa Chest Diseases and Thoracic Surgery Education and Research Hospital, İstanbul, Turkey
| | - Leyla Sağlam
- Department of Chest Diseases, Faculty of Medicine, Atatürk University, Erzurum, Turkey
| | - Ayşin Şakar Coşkun
- Department of Chest Diseases, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Tacettin Ornek
- Department of Chest Diseases, Faculty of Medicine, Zonguldak Karaelmas University, Zonguldak, Turkey
| | - Gazi Gündüz
- Clinic of Chest Diseases, Dr. Suat Seren Chest Diseases and Thoracic Surgery Education and Research Hospital, İzmir, Turkey
| | - Ayten Filiz
- Department of Chest Diseases, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Levent Ozdemir
- Clinic of Chest Diseases, Dörtyol State Hospital, Hatay, Turkey
| | - Gülfer Okumuş
- Department of Chest Diseases, Faculty of Medicine, Istanbul University, İstanbul, Turkey
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Kuyucu T, Güçlü SZ, Saylan B, Demir C, Senol T, Güner S, Koyuncu E, Ozen F, Oztürk S, Cangül Z, Ağanoğlu S, Ozkaya S, Ocak SC, Akkurt H, Intepe YS, Bayrak MG, Güler T, Bekçi TT, Soyyiğit S, Seyfettin S, Kula O, Akbay MO, Büyükgöze B, Asal G, Başlilar S, Oztürk O. A cross-sectional observational study to investigate daily symptom variability, effects of symptom on morning activities and therapeutic expectations of patients and physicians in COPD-SUNRISE study. Tuberk Toraks 2012; 59:328-39. [PMID: 22233302 DOI: 10.5578/tt.3268] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a lung disease characterized with limitation of airflow that is not completely reversible, progressive deterioration of airways and systemic inflammation. This study has been planned to determine daily symptom variability of patients, expectations of patient and physicians from treatment and patient profiles. A total of 514 patients with COPD from 25 centers were included in this national, multicenter, cross-sectional observational study. Data regarding demographic features, concomitant diseases, history and treatment of COPD and expectations of patients and physicians were all obtained in a single visit. Mean [standard deviation (SD)] age of the patients was 64.1 (9.5) years; age range was 41-92 years, 50% of the patients were younger than 65 years and 91% were males. Educational level of the patients was at least primary school in 80.2%; and 54.3% (30.4%) of the patients had at least one concomitant disease, particularly a cardiovascular disease. Mean (SD) duration of having COPD was 5.4 (4.6) years. The majority of patients were at moderate (43.2%) and severe (35.0%) COPD stages and one or more exacerbations per year was determined in 71%. Inhaled beta-2 agonists (84.2%), inhaled steroids (76.3%) and inhaled long-acting anti-cholinergics (70.0%) were the most commonly used medications. Dyspnea (99.0%), sputum production (92.8%) and wheezing (90.5%) were the most common symptoms, and symptom variability for dyspnea (41.1%), sputum production (61.0%) and cough (53.5%) were seen the most in the morning hours (p< 0.001). Most commonly affected morning activity was climbing up/down the stairs (point of effect: 6.7), followed by wearing socks/shoes (point of effect: 4.3) and showering/bathing (point of effect: 4.2) by COPD. Major treatment expectations of patients were greater symptomatic relief (82.3%) and greater mobility (70.0%), faster symptomatic relief (61.1%) and improvement in morning activities (59.3%); while major treatment expectations of physicians included increased quality of life (100.0%) and decreased morbidity (96.0%). Quitting smoking was the most commonly recommended (88.3%) and implemented (67.9%) non-drug protective approach aimed at decreasing the frequency of exacerbations. Consequently, our results demonstrate that COPD is not a disease of only the elderly, is an important healthcare issue that often disrupt daily living of the patients due to inadequate disease awareness leading to overlooking of the symptoms by patient and physicians, and that a patient-centered approach based on the living standards, life expectancies and preferences of patients was crucial in patient management.
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Affiliation(s)
- Tülin Kuyucu
- Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital, Istanbul, Turkey.
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Abstract
Turner's syndrome is a chromosomal disease frequently associated with autoimmune disorders including thyroid disease, inflammatory bowel disease, diabetes mellitus and juvenile rheumatoid arthritis. Recent reports have described an association of celiac disease with Turner's syndrome. We present an additional patient with Turner's syndrome associated with celiac disease. A girl aged 15- 7/12 yr was seen for the complaints of delayed growth and puberty, abdominal pain and chronic diarrhea. She was diagnosed as having celiac disease and a gluten-free diet was initiated. Despite one year of strict diet no signs of puberty were observed. She was then evaluated again for absence of puberty, and 45,XO karyotype Turner's syndrome was diagnosed.
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Affiliation(s)
- D Arslan
- Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
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