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Öğe Astımda İnhale Kortikösteroid Kullanımı Göz İçi Basıncında Yükselmeye Veya Açık Açılı Glaukoma Yol Açar Mı?(Turgut Özal Tıp Merkezi Dergisi, 2000) Gunen, Hakan; Evereklioğlu, Cem; Doğanay, Selim; Borazan, MehmetBu çalışmamızda, astımlı hastalarda uzun süreli düşük doz irıhale kortikosteroid (KS) kullanımının, göz içi basıncı ve açık açılı glaukom üzerine etkisini araştırdık. Materyal ve Metod: Çalışmaya 5 yıldan fazla ve günde 1000 mcg/gün'den az dozda inhale KS kullanan ve diğer KS formlarını hiç kullanmamış 35 astımlı hasta alındı. Hasta ve yaşça benzer kontrol gruplarının (n=40) detaylı göz muayeneleri ve göz içi basıncı ölçümleri göz uzmanı tarafından yapıldı. Elde edilen bulgular gruplar içinde, gruplar arasında ve sağ ve sol gözlerde ayrı ayrı karşılaştırıldı. Bulgular: Ortalama göz içi basıncında hasta grubu (sağ göz =14.2±3.2, sol göz =14.3±3.1 mmHg) ve kontrol grubu (sağ göz =12.9±2.6, sol göz =13.0±2.7 mmHg) arasında fark saptanmadı (p>0.05). Bununla birlikte, hasta grubunda dört hastada (%11.4) göz içi basıncı, 20 mmHg'nin üzerinde idi ve açık açılı glaukom yoktu. Kontrol grubunda yüksek göz içi basıncı saptanmadı (p<0.05). Sonuç: Uzun süreli düşük doz inhale KS kullanımının, göz içi basıncında genel olarak belirgin yükselmeye yol açmamasına rağmen, KS kullanımına karşı hassas bir astımlı hasta alt grubunda açık açılı glaukoma sebebiyet vermeden yüksek göz içi basıncına neden olduğunu saptadık. Bu tip hastaların önceden saptanabilmeleri ve erken tedavi altına alınabilmeleri için, belli aralıklarla göz muayenesinden geçirilmeleri ve monitörize edilmeleri gerektiğini düşünüyoruz.Öğe Capacity of Carbon Monoxide Diffusion(Aves, 2011) Gulbas, Gazi; Gunen, HakanCarbon monoxide diffusion test provides important information in diagnosis and follow-up of parenchymal and vascular pulmonary diseases, if well-standardized and evaluated correctly. This review is prepared to contribute to the correct application and evaluation of this test.Öğe CPAP compliance in patients with obstructive sleep apnea syndrome(Springer Heidelberg, 2008) Yetkin, Ozkan; Kunter, Erdogan; Gunen, HakanObstructive sleep apnea syndrome (OSAS) is characterized by repeated cessations of breathing during sleep. Major symptoms of this disease are excessive daytime sleepiness, snoring, and witnessed apnea. Most of the patients are treated with CPAP. In this study, we aimed to evaluate the factors affecting adherence to the CPAP treatment. Seventy-one patients were enrolled to this study. Patients were divided into three groups according to CPAP usage. Group I consisted of patients who had never used CPAP, group II consisted of patients who had used CPAP occasionally, and group-III patients had used CPAP treatment regularly. Group-III patients had higher apnea hypopnea index (AHI) than groups I and II (respectively, 56.6 +/- 27.7, 26.3 +/- 7.5, and 32.3 +/- 7.06; p<0.000 for both). Oxygen desaturation index was significantly higher in group-III patients comparing to groups I and II (44.6 +/- 22.3, 15.9 +/- 8.3, and 25.6 +/- 9.5; p<0.000 for all). Our findings have shown that only very severe patients use the CPAP device regularly (mean AHI 56.6 +/- 27.7). Compliance to CPAP treatment seemed to be poor in patients with moderate to severe, AHI about 30, OSAS. Considering the well-established benefits of CPAP treatment in patients with true indications, patients should be encouraged to use CPAP regularly, and complications of OSAS should be keynoted.Öğe Inspiratory capacity and forced expiratory volume in the first second in exacerbation of chronic obstructive pulmonary disease(Wiley, 2008) Yetkin, Ozkan; Gunen, HakanObject. Periodic exacerbations of symptoms are the major cause of morbidity, mortality and health care costs in patients with chronic obstructive pulmonary disease (COPD). Dyspnea is the major factor affecting the comfort of patients in the exacerbation of COPI). In this study, we aimed to compare the value of forced expiratory volume in the first second (FEV1) and inspiratory capacity (IC) measured before and after treatment in exacerbations and in the improvement in clyspnea. Methods: Eighty-seven patients (male/female, 80/7; mean age, 63 +/- 7) with COPD exacerbation were included in this study. All subjects underwent spirometric tests on the first day and at the end of treatment. The subjects were asked to quantify the sensation of dyspnea that was described to them as a nonspecific discomfort associated with the act of breathing. The patients quantified dyspnea by pointing to a score on a large Borg scale from 0 to 10 arbitrary units. In the beginning and at the end of treatment, forced vital capacity (FVC), FEV1, forced expiratory flow rate between 25% and 75% of FVC (FEF25-75), peak expiratory flow rate (PEF), IC and Borg score (BS) values were compared. Results: After treatment of COPD exacerbations, FEV1, FEF25-75, PEF and IC significantly increased, and the BS significantly decreased compared to the initial values. The increase in IC was more significantly correlated with the improvement in BS compared with FEV1 Admission and discharge day BS was negatively correlated with FEV1, FEF25-75 and IC. Conclusion: We have shown a more dramatic improvement in IC compared with FEV, in patients treated as a result of acute exacerbation of COPD. These data suggest that IC may be more useful than FEV1 during acute exacerbation of COPD. Moreover, IC better reflects the severity of dyspnea. in these patients.Öğe Prevalence of COPD: First epidemiological study of a large region in Turkey(Elsevier, 2008) Gunen, Hakan; Hacievliyagil, Suleyman Savas; Yetkin, Ozkan; Gulbas, Gazi; Mutlu, Levent Cem; Pehlivan, ErkanBackground: Although chronic obstructive pulmonary disease (COPD) is one of the leading causes of mortality and morbidity worldwide, epidemiological data oil COPD is very limited. This study was designed to obtain some baseline data on COPD in the Malatya region of Turkey. Methods: Sixty clusters from urban and rural regions were randomly selected. Ten and seven consecutive households were included in the study from each urban and rural cluster, respectively. A validated questionnaire on the epidemiology of COPD was completed for each participant over 18 by a Pulmonary physician. Each subject underwent standard spirometric measurement and early bronchodilation testing. Results: A total of 1160 participants completed the study (93%). Some 6.9% of the participants were found to have COPD (F/M = 1/4). While the prevalence of COPD was 18.1 % in current smokers over 40 years of age, the prevalence was 4.5% among younger smokers. Some 25.5% of the women and 57.2% of the men were current smokers. Biomass exposure, as a sole reason for COPD, was significantly common among female patients living in rural areas (54.5%). In the development of COPD, the relative risk ratio of cigarette smoke was found to be 3.4 and 3.3 times higher than biomass exposure and occupational exposure, respectively. Conclusions: Smoking rate and COPD prevalence were found to be unexpectedly high in the region, and biomass exposure is still an important cause of COPD, particularly among females living in rural areas. We think that national policies against smoking and biomass exposure should be implemented immediately. (C) 2009 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.Öğe Prevalence of malnutrition in COPD and its relationship with the parameters related to disease severity(Dove Medical Press Ltd, 2018) Mete, Burak; Pehlivan, Erkan; Gulbas, Gazi; Gunen, HakanObjective: The aim of the study was to determine the nutritional status and anthropometric values in a group of patients with COPD and to examine the relationship between these factors and disease severity. Methods: A total of 105 COPD patients were included in this cross-sectional study. The patients underwent spirometric exmination. Mini nutritional assessment form was applied, and the anthropometric values of the patients were measured by bioelectrical impedance method. Nutrient registration forms were given using a 3-day, 24-hour recall method to assess the nutrient uptake. COPD severity was determined using the Global Initiative for Chronic Obstructive Lung Disease criteria, and the correlations between nutritional status and disease severity parameters were measured. Results: The prevalence of malnutrition in our patients with COPD was found to be 17%. Spirometric parameters were found to be significantly lower in patients with low body mass index (BMI) and malnutrition. As the modified Medical Research Council dyspnea scale score increased, the frequency of malnutrition increased (P=0.002). Positive significant correlation was found between spirometric variables and muscle mass and fat external tissue volume of the patients. Patients receiving higher protein content in diet showed a better muscle mass amount (P<0.001). Conclusion: Our study results confirmed that malnutrition is an important and frequently encountered problem in COPD patients, and spirometric values of the patients with malnourishment and with low BMI are significantly lower. We think that nutritional status should be evaluated in every COPD patient, and nutritional intake should be tailored individually.Öğe Prognostic role of simplified Pulmonary Embolism Severity Index and the European Society of Cardiology Prognostic Model in short- and long-term risk stratification in pulmonary embolism(Professional Medical Publications, 2014) Kilic, Talat; Gunen, Hakan; Gulbas, Gazi; Hacievliyagil, Suleyman Savas; Ozer, AliObjectives: Hemodynamic status, cardiac enzymes, and imaging-based risk stratification are frequently used to evaluate a pulmonary embolism (PE). This study investigated the prognostic role of a simplified Pulmonary Embolism Severity Index (sPESI) score and the European Society of Cardiology (ESC) model. Methods: The study included 50 patients from the emergency and pulmonology department of,one medical center between October 2005 and June 2006. The ability of the sPESI and ESC model to predict short-term (in-hospital) and long-term (6-month and 6-year) overall mortality was assessed, in addition to the accurancy of the sPESI and ESC model in predicting short-term adverse events, such as cardiopulmonary resuscitation, or major bleeding. Results: Of the 50 patients, the in-hospital and 6-year mortality rates were 14% and 46%, respectively. Fifteen (30%) of these experienced adverse events during hospitalization. Importantly, patients classified as low-risk according to the sPESI had no short-term adverse events as opposed to 4.8 % in the ESC low-risk group. They also had no in-hospital, 6-month, or 6-year mortality compared to 4.8%, %14.3, and %23.8, respectively, in the ESC low-risk group. Conclusions: The sPESI predicted short-term and long-term survival. The exclusion of short-term adverse events does not appear to require imaging and laboratory testing.Öğe Role of tuberculosis in COPD(European Respiratory Soc Journals Ltd, 2015) Gunen, Hakan; Yakar, Halil Ibrahim; Pehlivan, Erkan; Atagun, Pinar; Aydogan, Selma; Babalik, Aylin; Selvi, Ummuhan[Abstract Not Available]Öğe The role of tuberculosis in COPD(Dove Medical Press Ltd, 2017) Yakar, Halil Ibrahim; Gunen, Hakan; Pehlivan, Erkan; Aydogan, SelmaBackground: Influence of tuberculosis (TB) on the natural course of COPD has not been well known. This study was designed to investigate the effects of history of TB on the long-term course of COPD. Methods: Patients hospitalized with COPD exacerbation were consecutively included (n=598). Cases were classified into two categories: those with TB history and those without. Clinical, demographic, and radiological features were meticulously recorded, and patients were followed up for hospitalizations due to exacerbation and for overall mortality. Results: A total of 93 patients (15%) had a history of TB. On average, patients with past TB history were 4 years younger than the rest of the patients (P=0.002). Our study revealed that patients with past TB were diagnosed with COPD 4 years earlier and died 5 years earlier as compared to the patients without TB. In addition, in the past TB group, rate of hospital admissions per year was higher compared to the group that lacked TB history (2.46 +/- 0.26 vs 1.56 +/- 0.88; P=0.001). Past TB group had higher arterial carbon dioxide tension (PaCO2) and lower forced expiratory volume in 1 second (FEV1; P=0.008 and P=0.069, respectively). Median survival was 24 months for patients who had past TB and 36 months for those who had not. Kaplan-Meier analysis revealed that although 3-year survival rate was lower in patients with past TB, it was not statistically significant (P=0.08). Cox regression analysis showed that while factors such as age, PaCO2, hematocrit, body mass index (BMI) and Charlson index affected mortality rates in COPD patients (P<0.05), prior history of TB did not. Conclusion: Our results showed that a history of TB caused more hospitalizations, reduced respiratory functions and increased PaCO2. It was found that, despite similarity of the overall mortality, COPD diagnosis and death occurred 5 years earlier in patients with past TB. We conclude that history of TB has an important role in the natural course of COPD.Öğe Steroids in acute exacerbations of chronic obstructive pulmonary disease: are nebulized and systemic forms comparable?(Lippincott Williams & Wilkins, 2009) Gunen, Hakan; Mirici, Arzu; Meral, Mehmet; Akgun, MetinPurpose of review Systemic corticosteroids are strongly recommended in the treatment of exacerbations of chronic obstructive pulmonary disease (COPD). As COPD patients are usually elderly and are relatively immobile, side effects of systemic corticosteroids frequently outweigh their beneficial effects. On the contrary, nebulized corticosteroid solutions have a negligible systemic side-effect profile. In this review, as an alternative to systemic corticosteroids, the place of nebulized corticosteroids in exacerbation periods of COPD was summarized. Recent findings The number of trials in the literature is increasing. Regarding the available data, high dose nebulized budesonide was found as effective as systemic corticosteroids in exacerbations of COPD. The side-effect profile, blood glucose level in particular, is better for nebulized budesonide. Summary Findings from recent studies are giving a positive impression on the role of high dose nebulized budesonide in exacerbations of COPD. However, larger and statistically high powered trials testing different types of nebulized corticosteroid solutions with varying dosages are still lacking. Before recommending the routine use of nebulized corticosteroids in exacerbations, present findings need to be confirmed with further studies of high quality.Öğe UARS presenting with the symptoms of anxiety and depression(Versita, 2010) Kunter, Erdogan; Yetkin, Ozkan; Gunen, HakanUpper airway resistance syndrome (UARS) is a condition where the apnea-hypopnea index is less than 5 and respiratory-effort related arousal index is more than 10. The clinical presentation of UARS may be the same as obstructive sleep apnea-hypopnea syndrome (OSAS); it sometimes shows up with symptoms hardly suggestive of a sleep-disordered breathing. A 17 year-old male patient had applied to a local psychiatry clinic and complained of chronic fatigue, insomnia, behavioral and academic problems and was treated for anxiety and depression. After a period of unresponsive treatment, he was sent to a sleep center for evaluation of insomnia, which turned out to be a fragmented, unrefreshing sleep episode. Polysomnographical evaluation revealed that he had UARS without OSAS. His complaints decreased dramatically after he received CPAP treatment. This case shows that UARS should be considered in young patients with functional somatic syndromes even if the clinical presentation does not apparently imply the condition.Öğe Yüksek Doz İnhale Fluticasone Propionate Ve Budesonide İn Astımlı Hastalarda Sistemik Yan Etki Potansiyellerinin Karşılaştırılması(Turgut Özal Tıp Merkezi Dergisi, 2000) Gunen, HakanÇalışmamızda astım tedavisinde en çok tercih ediien inhale kortikosteroidler (KS) olan Fluticasone Propionate (FP) ve Budesonide (B)'in sistemik yan etki yapma potansiyellerini sabah ölçülen plazma kortizol düzeylerine bakarak karşılaştırmayı amaçladık. Materyal ve Metot: Çalışmaya en az 6 aydır minimum 1000 mcg/gün inhale FP (n=33) veya B (n=36) kullanan toplam 69 orta-persistan veya Heri evre astımlı hasta dahii edildi. Bulgular: FP kullanan 1. gruptaki hastaiann yaş ortalaması 49.2±15.2 yıl, B kullanan 2. gruptaki hastaların yaş ortalaması ise 48.1±12.2 yıl idi (p>0.05). Hastaların tamamı en az 20 gündür hiçbir sistemik ilaç kullanmıyordu. Sabah kortizol düzeyi ölçümleri 08.00 ve 09.00 arasında yapıldı. Birinci grubun ortalama sabah kortizol değeri 10.3±4.6 mcg/dl, 2. grubunki ise 10.4±5.4 mcg/di seviyesindeydi (p>0.05). Kontrol grubu olarak alınan 20 kişilik herhangi bir Haç kullanmayan yaşça benzer sağlıklı hastane personelinin ortalama sabah kortizol düzeyi ise 16.0±5.3 mcg/dl olup, 1. grubun ortalama kortizol düzeyleri kontrol grubuna göre istatistiki olarak anlamlı derecede düşüktü (pO.Ol). 1. gruptaki 4 hastanın (%12.1), 2. gruptaki 6 hastanın (%16.7) sabah plazma kortizol düzeyleri klinik olarak önemli sonuçlar doğurabilecek kadar düşük ölçülürken, kontrol grubunda bu derecede düşük bir değere rastlanmadı. Çalışmamızda yüksek doz inhale FP ve B kullanan astımlı hasta gruplan arasında sistemik yan etkilere yol açma potansiyeli açısından fark bulunmazken (p>0.05); FP kullanan hastaların %12.1'inde ve B kullananların ise %16.7'sinde ciddi klinik sonuçlar doğurabilecek derecede düşük kortizol seviyeleri tesbit edildi. Sonuç: Biz bu tip yüksek doz inhale steroid kullanan ve sistemik yan etkilere karşı hassas hastaiann önceden saptanabilmesi amacı ile belli aralıklarla sabah kortizol düzeylerinin ölçülmesi gerektiğini düşünüyoruz.
