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Öğe Can patients with moderate to severe acute respiratory failure from COPD be treated safely with noninvasive mechanical ventilation on the ward?(Dove Medical Press Ltd, 2016) Yalcinsoy, Murat; Salturk, Cuneyt; Oztas, Selahattin; Gungor, Sinem; Ozmen, Ipek; Kabadayi, Feyyaz; Oztim, Aysem AskimPurpose: Noninvasive mechanical ventilation (NIMV) usage outside of intensive care unit is not recommended in patients with COPD for severe acute respiratory failure (ARF). We assessed the factors associated with failure of NIMV in patients with ARF and severe acidosis admitted to the emergency department and followed on respiratory ward. Patients and methods: This is a retrospective observational cohort study conducted in a tertiary teaching hospital specialized in chest diseases and thoracic surgery between June 1, 2013 and May 31, 2014. COPD patients who were admitted to our emergency department due to ARF were included. Patients were grouped according to the severity of acidosis into two groups: group 1 (pH= 7.20-7.25) and group 2 (pH= 7.26-7.30). Results: Group 1 included 59 patients (mean age: 70 +/- 10 years, 30.5% female) and group 2 included 171 patients (mean age: 67 +/- 11 years, 28.7% female). On multivariable analysis, partial arterial oxygen pressure to the inspired fractionated oxygen (PaO2/FiO(2)) ratio <200, delta pH value <0.30, and pH value <7.31 on control arterial blood gas after NIMV in the emergency room and peak C-reactive protein were found to be the risk factors for NIMV failure in COPD patients with ARF in the ward. Conclusion: NIMV is effective not only in mild respiratory failure but also with severe forms of COPD patients presenting with severe exacerbation. The determination of the failure criteria of NIMV and the expertise of the team is critical for treatment success.Öğe Can red blood cell distribution width (RDW) level predict the severity of acute exacerbation of chronic obstructive pulmonary disease (AECOPD)?(Wiley-Hindawi, 2021) Alparslan Bekir, Sumeyye; Tuncay, Eylem; Gungor, Sinem; Yalcinsoy, Murat; Sogukpinar, Ozlem; Gundogus, Baran; Aksoy, EmineBackground Elevated red blood cell distribution width (RDW) levels were associated with mortality in patients with stable chronic obstructive lung pulmonary diseases (COPD). There are limited data about RDW levels in acute exacerbation of COPD (AECOPD). Aim/Objective The association of the RDW levels with the severity of AECOPD was evaluated according to admission location, (outpatient-clinic, ward and intensive care unit (ICU)). Methods Cross sectional retrospective study was designed in tertiary care hospital for chest diseases in 2015. Previously COPD diagnosed patients admitted to hospital outpatient-clinic, ward and ICU due to AECOPD were included in the study. Patients demographics, RDW, biomarkers (CRP, RDW, Neutrophil to lymphocyte ratio (NLR), platelet to mean platelet volume (PLT-MPV)) C-CRP, biochemistry values were recorded from hospital electronic system. RDW values were subdivided below 0.11% (low), above and equal 0.15% (high) and between 0.11%-0.15% (normal). Neutrophil to lymphocyte ratio (NLR) and platelet to mean platelet volume (PLT-MPV) were also calculated. Biomarker values were compared according to where AECOPD was treated. Results 2771 COPD patients (33% female) and 1429 outpatients-clinic, 1156 ward and 186 ICU were enrolled in the study. The median RDW values in outpatients-clinic, ward and ICU were 0.16 (0.09-0.26), 0.07 (0.01-0.14) and 0.01 (0.00-0.07) respectively (P < .001). In outpatient to ward and ICU, low RDW values were significantly increased (31%, 66%, 83%, respectively) and high RDW values significantly decreased (54%, 24%, 10%) (P < .001). According to attack severity, low RDW values were determined. Conclusion Patients with AECOPD, lower RDW values should be considered carefully. Lower RDW can be used for decision of COPD exacerbation severity and follow up treatment responseÖğe Delays in diagnosis in patients with pulmonary and extrapulmonary sarcoidosis(2019) Acarturk Tuncay, Eylem; Yalcinsoy, Murat; Gungor, Sinem; Selcuk, Engin Burak; Tokgoz Akyil, Fatma; Yavuz, Dilek; Sucu, Pakize; Alpaslan Bekir, Sumeyye; Ocakli, Birsen; Aksoy, EmineAim: Sarcoidosis is a multisystemic disease with typical or atypical pulmonary and extra-pulmonary symptoms or frequently without symptoms. Presence of typical clinical findings and symptoms contribute to rapid diagnosis, whereas asymptomatic progression leads to delays in the diagnosis. The aim of this study was to investigate the delay in diagnosis in between patients with pulmonary and/or extra-pulmonary involvement and related symptoms and those without symptoms. Material and Methods: Patients in the sarcoidosis clinics between 2010-2015, were retrospectively evaluated. The cases were grouped according to the presence or absence of symptoms (pulmonary and/or extra-pulmonary). The groups were compared with regard to the delay in diagnosis. Results: Among the 300 patients, 209 (69%) were female. The mean age was 43±11.68. The disease was stage I in 67.3%, stage II in 23.7%, stage III in 5.7% and stage 0 in 3.3% of the patients. No significant difference was observed between symptomatic and asymptomatic patients with regard to total duration until diagnosis (p=0.78). A statistically significant difference was observed between patients groups with regard to physician-related delayed diagnosis(p=0.026). The mean delay in physician-related diagnosis was observed to be longer in asymptomatic cases (21.44 days) compared to patients with pulmonary symptoms (13.66 days)(p=0.036). In asymptomatic cases, the mean duration of physician-related delayed diagnosis (21.44 days) was observed to be longer in comparison with patients with extra-pulmonary symptoms (12.79 days)(p=0.016). In patient-related delayed diagnosis, no difference was observed between groups with regard to the duration until diagnosis(p=0.78). Conclusion: Comparison of delayed diagnosis between patients with or without pulmonary and/or extra-pulmonary symptoms revealed a longer duration of delay in asymptomatic cases compared to symptomatic cases. The timing of diagnosis is very important in sarcoidosis in order to reduce morbidity and mortality; a suspicious approach to asymptomatic patients will increase the possibility of diagnosis and prevent delayed diagnosis.Keywords: Sarcoidosis; diagnosis; delay; extrapulmonary symptoms.Öğe Delays in diagnosis in patients with pulmonary and extrapulmonary sarcoidosis(2019) Tuncay Acarturk, Eylem; Yalcinsoy, Murat; Gungor, Sinem; Selcuk, Engin Burak; Tokgoz Akyil, Fatma; Yavuz, Dilek; Sucu, Pakize; Alpaslan Bekir, Sumeyye; Ocaklı, Birsen; Aksoy, EmineAbstract: Aim: Sarcoidosis is a multisystemic disease with typical or atypical pulmonary and extra-pulmonary symptoms or frequently withoutsymptoms. Presence of typical clinical findings and symptoms contribute to rapid diagnosis, whereas asymptomatic progressionleads to delays in the diagnosis. The aim of this study was to investigate the delay in diagnosis in between patients with pulmonaryand/or extra-pulmonary involvement and related symptoms and those without symptoms.Material and Methods: Patients in the sarcoidosis clinics between 2010-2015, were retrospectively evaluated. The cases weregrouped according to the presence or absence of symptoms (pulmonary and/or extra-pulmonary). The groups were compared withregard to the delay in diagnosis.Results: Among the 300 patients, 209 (69%) were female. The mean age was 43±11.68. The disease was stage I in 67.3%, stage IIin 23.7%, stage III in 5.7% and stage 0 in 3.3% of the patients. No significant difference was observed between symptomatic andasymptomatic patients with regard to total duration until diagnosis (p=0.78). A statistically significant difference was observedbetween patients groups with regard to physician-related delayed diagnosis(p=0.026). The mean delay in physician-relateddiagnosis was observed to be longer in asymptomatic cases (21.44 days) compared to patients with pulmonary symptoms (13.66days)(p=0.036). In asymptomatic cases, the mean duration of physician-related delayed diagnosis (21.44 days) was observed to belonger in comparison with patients with extra-pulmonary symptoms (12.79 days)(p=0.016). In patient-related delayed diagnosis, nodifference was observed between groups with regard to the duration until diagnosis(p=0.78).Conclusion: Comparison of delayed diagnosis between patients with or without pulmonary and/or extra-pulmonary symptomsrevealed a longer duration of delay in asymptomatic cases compared to symptomatic cases. The timing of diagnosis is veryimportant in sarcoidosis in order to reduce morbidity and mortality; a suspicious approach to asymptomatic patients will increasethe possibility of diagnosis and prevent delayed diagnosis.Öğe Diagnostic Value of Adenosine Deaminase Level for the Differential Diagnosis of Tuberculosis and Malignancy in Exudative Lymphocytic Pleurisy(Aves, 2016) Altinsoy, Bulent; Yalcinsoy, Murat; Unver, Edhem; Gungor, Sinem; Mihmanli, Aydanur; Akkaya, EsenObjective: To evaluate the diagnostic performance of adenosine deaminase (ADA) levels in patients with exudative lymphocytic pleurisy for the differential diagnosis of tuberculous pleurisy (TBP) and malignant pleural effusion (MPE). Methods: Data on patients with exudative lymphocytic pleurisy were retrospectively analyzed. The study population comprised 54 patients. Thirty-seven were diagnosed with TBP and 17 were diagnosed with MPE. Results: Significant differences were determined in terms of age and ADA, total protein, albumin, and LDH levels between the TBP and MPE groups. The optimal cut-off value of ADA levels was 35.1 U/L for diagnosing TBP. Sensitivity and specificity were 92% and 100%, respectively. Logistic regression analysis was performed to assess independent variables associated with TBP. Independent predictive factors in the model were ADA (OR: 1.21, 95% CI: 1.06-1.39, p=0.006)], and (OR: 0.92, 95% CI: 0.84-1.00, p=0.052)]. The AUC value by the regression equation was 0.979 (p<0.001). When patients were categorized according to age (<50 ve >= 50), two different cut-off values (> 13.51 and > 35.1) for each age range were found in all, but one, TBP patients. Conclusion: ADA levels are useful for the diagnosis of TBP in cases where pleural biopsy cannot be performed or that are inconclusive in making a diagnosis of TBP. In this group, reducing the conventional cut-off value and/or performing an age-based approach seems to improve the diagnostic performance of ADA levels.Öğe Evaluation of Patients with COVID-19 Followed Up in Intensive Care Units in the Second Year of the Pandemic: A Multicenter Point Prevalence Study(Aves, 2024) Gungor, Sinem; Ediboglu, Ozlem; Mocin, Ozlem Yazicioglu; Adiguzel, Nalan; Tuncay, Eylem; Iscanli, Insa Guel Ekiz; Er, BerrinOBJECTIVE: A 1 -day point prevalence study was planned to obtain country data by determining the clinical characteristics, follow-up and treatment methods of coronavirus disease 2019 (COVID-19) cases that required intensive care unit (ICU) treatment in the second year of the pandemic. MATERIAL AND METHODS: All patients who were hospitalized in the ICUs due to COVID-19 between March 11, 2022, 08.00 AM, and March 12, 2022, 08.00 AM, were included in the study. Demographic characteristics, intensive care and laboratory data, radiological characteristics, and follow-up results of the patients were recorded. RESULTS: A total of 811 patients from 59 centers were included in the study, 59% of the cases were male, and the mean age was 74 +/- 14 years. At least one comorbid disease was present in 94% of the cases, and hypertension was the most common. When ICU weight scores were examined, Acute Physiology and Chronic Health Evaluation -II: 19 (15-27) and Sequential Organ Failure Assessment: 7 (4-10) were seen. Sepsis was present in 37% (n = 298) of cases. PaO2/FiO2 ratios of the patients were 190 the highest and 150 the lowest and 51% of the cases were followed via invasive mechanical ventilation. On the study day, 73% bilateral involvement was seen on chest x-ray, and ground -glass opacities (52%) were the most common on chest tomography. There was growth in culture in 40% (n = 318) of the cases, and the most common growth was in the tracheal aspirate (42%). CONCLUSION: The clinical course of COVID-19 is variable, and ICU follow-up was required due to advanced age, comorbidity, presence of respiratory symptoms, and widespread radiological involvement. The need for respiratory support and the presence of secondary infection are important issues to be considered in the follow-up. Despite the end of the second year of the pandemic and vaccination, the high severity of the disease as well as the need for follow-up in ICUs has shown that COVID-19 is an important health problem.Öğe Familial Sarcoidosis: An Analysis of Twenty-Eight Cases(Aves, 2016) Duman, Dildar; Sevim, Tulin; Sertcelik, Lale; Akkan, Olga; Gungor, Sinem; Yalcinsoy, Murat; Erdem, IpekObjective: Sarcoidosis is a multisystemic disease, exact cause of disease is unknown but it is assumed that genetic predisposition and ethnic factors play a role in etiology. Studies related with familial sarcoidosis is limited and only case reports about familial sarcoidosis is available from our country. We aimed to evaluate the prevelance of familial sarcoidosis and clinical findings of cases with familial sarcoidosis. Methods: We retrospectively documented file records of 678 patients diagnosed with sarcoidosis and followed up in outpatient clinic of sarcoidosis from January 1996 to February 2016. 28 familial sarcoidosis cases in 14 families were enrolled into the study. Their demographic findings, family relationship, symptoms, laboratory and pulmonary function test results, radiological apperances, diagnostic methods, treatments were recorded. Results: Twenty-eight sarcoidosis patients out of 678 reported as familial cases, giving a prevelance of familial sarcoidosis as 4%. There were 8 sarcoidosis sib, 4 sarcoidosis mother-child, 1 sarcoidosis father-child and 1 sarcoidosis cousin relationship. Female/male ratio was 1.8, mean age of the study population was 43, most freguent symptoms were cough and dyspnea, stage 2 was mostly seen according to chest X-ray, most common CT appearance was mediastinal lymphadenopathy and mediastinoscopy was the most freguent diagnostic method. Conclusion: This study is important to lead interrogation of family in patients with suspected sarcoidosis and future studies investigating familial aggregation in sarcoidosis.Öğe Idiopathic Chronic Eosinophilic Pneumonia: Retrospective Analysis of 17 Cases from a Single Center in Turkey(Aves, 2016) Arinc, Sibel; Kasapoglu, Umut Sabri; Gungor, Sinem; Agca, Meltem; Yalcinsoy, Murat; Irmak, Ilim; Guney, PinarObjective: Idiopathic chronic eosinophilic pneumonia (ICEP) is a rare eosinophilic lung disorder with an unknown etiology and is characterized by subacute or chronic respiratory and general symptoms, alveolar and/or peripheral eosinophilia, and the accumulation of eosinophils in the lungs. We aimed to present diagnostic test results and follow-up outcomes of 17 patients who were diagnosed with ICEP in our hospital in light of literature. Methods: Between 2008 and 2013, we examined 17 cases of ICEP. We evaluated clinical and laboratory findings together with the long-term follow-up data. Results: The patients had a mean age of 40.8 years at presentation, and the female/male ratio was 0.8. The most common symptoms were cough (94%), shortness of breath (76%), and high fever (35%). Bronchoalveolar lavage eosinophil percentages of the patients ranged from 3% to 80%. Nine (53%) patients experienced recurrence. Six patients were maintained on low dose steroid due to repeating relapses. Among these patients, 7 (77.7%) had a total IgE level of above 500/IU/mL. Conclusion: Relapses are common in ICEP after the withdrawal of corticosteroid treatment or during dose reduction. We point out the importance of the close monitoring of patients for identifying relapse. A higher total IgE level during diagnosis may serve as a predictor of recurrence.Öğe Lung carcinoma patients aged eighty years over and prognostic factors affecting survival(Turkish Assoc Tuberculosis & Thorax, 2017) Kasapoglu, Umut Sabri; Gungor, Sinem; Arinc, Sibel; Yalcinsoy, Murat; Misirlioglu, Aysun; Akbay, Ozlem MakbuleIntroduction: Almost 50% of all cancers and 70% of cancer deaths occur in cases aged 65 years and more. Thus diagnosis, treatment and follow up in old cases gain importance. Since there a limited number of study that show age-mortality relation in lung cancer cases aged 80 years and over, issues may arise in diagnosis and treatment process of these cases. In this study, we aimed to evaluate general characteristics of lung cancer cases aged 80 years or over and factors that affect survey. Materials and Methods: Between 2010 and 2013, the retrospective cohort study was done in Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital and 100 cases of lung carcinoma were examined. Results: In the study, 70% of the cases were male and 30% were female. Median age was 83 +/- 2.91 (80-92) years. 71% of the cases were found to be suffering from a comorbid disease; 29% did not have any comorbid disease. Dyspnea (56%), cough (50%) and chest pain (41%) were the most frequent symptoms. Histopathologically, 41% of the patients diagnosed with adenocarcinoma and 40% were diagnosed with squamous cell carcinoma. Median survival time was 2.73 months (% 95 CI 0.96-4.49) and 1-year survival rate was 17%. Length of time of the cases with smoking history was found shorter than of cases without smoking history (p=0.013). Life expectancy of the cases with advanced disease and performance score of 3-4 was detected to be short (p=0.006, p< 0.001). Compared to the cases who operated on and had chemoradiotherapy, length of life who had symptomatic treatment was shorter (p< 0.001). Conclusion: Despite the comorbidity in lung cancer cases aged 80 years and over, life expectancy of the cases who had surgical and/or chemoradiotherapy treatment is longer. While deciding on treatment methods on these cases, patient's performance must be taken into consideration.Öğe Prognostic value of inflammatory markers determined during diagnosis in patients with sarcoidosis: chronic versus remission(Assoc Medica Brasileira, 2021) Bekir, Sumeyye Alparslan; Yalcinsoy, Murat; Gungor, Sinem; Tuncay, Eylem; Akyil, Fatma Tokgoz; Sucu, Pakize; Yavuz, DilekOBJECTIVE: This study aimed to evaluate the prognostic value of inflammatory markers determined during admission among patients with sarcoidosis with chronic and remission groups. METHODS: This study was designed as retrospective single-center study. Patients with sarcoidosis without treatment and who had at least two years of follow-up were included in this study. Patients were divided into two groups as chronic and remission. The primary outcome is to evaluate hematological parameters in remission and chronic sarcoidosis groups. RESULTS: Out of 348 patients with sarcoidosis, 142 patients without treatment and followed up for at least two years were included in this study. Groups had similar demographic features with the predominance of females (80.4 and 77.9%, respectively) and stage I disease (78.6 and 68.6%, respectively). Lymphocyte count [median (IQR) 1.7 (1.3-2.3) 109/L versus 2.1 (1.6-2.4) 109/L, p=0.034] was significantly lower, whereas neutrophil to lymphocyte ratio (NLR) was significantly higher [median (IQR) 2.6 (2.0-3.1) versus 2.0 (1.6-2.8), p=0.006] at admission in the chronic group. No significant difference was determined in inflammatory parameters at admission between groups. CONCLUSION: Lower lymphocyte count and higher neutrophil to lymphocyte ratio were determined in patients with chronic sarcoidosis compared with the remission group, based on monitoring of radiological staging up to five-year after the initial diagnosis. Accordingly, the identification of neutrophil to lymphocyte ratio at diagnosis seems to be a potential prognostic marker in patients with sarcoidosis beside its low cost and easy determination in routine clinical practice.Öğe A Revised Treatment Approach for Hospitalized Patients with Eosinophilic and Neutrophilic Exacerbations of Chronic Obstructive Pulmonary Disease(Bilimsel Tip Publishing House, 2018) Aksoy, Emine; Gungor, Sinem; Agca, Meltem Coban; Ozmen, Ipek; Duman, Dildar; Kocak, Nagihan Durmus; Akturk, Ulku AkaOBJECTIVES: The choice of treatment according to the inflammation type in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) has been of recent interest. This study investigated the role of novel biomarkers, hospital outcomes, and readmission rates in the first month in patients with eosinophilic or neutrophilic AECOPD. MATERIALS AND METHODS: We conducted a retrospective observational cohort study in a Chest Teaching Hospital with hospitalized AECOPD patients. Subjects' characteristics, hemogram results, C-reactive protein (CRP), neutrophil/lymphocyte ratio (NLR), platelet/ lymphocyte ratio (PLR), platelet/mean platelet volume (PLT/MPV), length of hospital stay, mortality, and steroid use were recorded. Eosinophilic AECOPD defined as peripheral blood eosinophilia (PBE) was >2% and neutrophilic AECOPD as PBE Q%. Readmission within 28 days of discharge was recorded. RESULTS: Of 2727(31.5% females) patients, eosinophilic AECOPD was found in 510 (18.7%) patients. Leucocytes, CRF,' NLR, and PLR were significantly higher in neutrophilic AECOPD than in eosinophilic AECOPD (p<0.001). Steroid use and mortality rate were 45% and 0.6% in eosinophilic AECOPD and 71%, and 1.4% in neutrophilic AECOPD, respectively (p=0.001, p=0.19). Age >75 years, albumin <2.5 g/dL, CRP >50 mg/dL, and PLT/MPV <20x103 were found to be risks factors for hospital mortality (p<0.05 each). Readmission rates within 28 days of discharge were 5% (n=136), and this rate was higher in eosinophilic AECOPD patients not taking steroids (p<0.001). CONCLUSION: NLR, PLR, and CRP levels were higher in neutrophilic AECOPD compared with eosinophilic AECOPD. These markers decreased with treatment in neutrophilic AECOPD. A PLT/MPV ratio of <20x103 resulted in an increased mortality rate. Thus, appropriate steroid therapy may reduce readmission rates in the first 28 days after discharge in eosinophilic AECOPD.Öğe A revised treatment approach for hospitalized patients with eosinophilic and neutrophilicexacerbations of chronic obstructive pulmonary disease(Bılımsel tıp publıshıng house, bukres sokak no 3-20 kavaklıdere, ankara, 00000, turkey, 2018) Aksoy, Emine; Gungor, Sinem; Agca, Meltem Coban; Ozmen, Ipek; Duman, Dildar; Kocak, Nagihan Durmus; Akturk, Ulku Aka; Tuncay, Eylem; Salturk, Cuneyt; Yalcinsoy, MuratOBJECTIVES: The choice of treatment according to the inflammation type in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) has been of recent interest. This study investigated the role of novel biomarkers, hospital outcomes, and readmission rates in the first month in patients with eosinophilic or neutrophilic AECOPD. MATERIALS AND METHODS: We conducted a retrospective observational cohort study in a Chest Teaching Hospital with hospitalized AECOPD patients. Subjects' characteristics, hemogram results, C-reactive protein (CRP), neutrophil/lymphocyte ratio (NLR), platelet/ lymphocyte ratio (PLR), platelet/mean platelet volume (PLT/MPV), length of hospital stay, mortality, and steroid use were recorded. Eosinophilic AECOPD defined as peripheral blood eosinophilia (PBE) was >2% and neutrophilic AECOPD as PBE Q%. Readmission within 28 days of discharge was recorded. RESULTS: Of 2727(31.5% females) patients, eosinophilic AECOPD was found in 510 (18.7%) patients. Leucocytes, CRF,' NLR, and PLR were significantly higher in neutrophilic AECOPD than in eosinophilic AECOPD (p<0.001). Steroid use and mortality rate were 45% and 0.6% in eosinophilic AECOPD and 71%, and 1.4% in neutrophilic AECOPD, respectively (p=0.001, p=0.19). Age >75 years, albumin <2.5 g/dL, CRP >50 mg/dL, and PLT/MPV <20x103 were found to be risks factors for hospital mortality (p<0.05 each). Readmission rates within 28 days of discharge were 5% (n=136), and this rate was higher in eosinophilic AECOPD patients not taking steroids (p<0.001). CONCLUSION: NLR, PLR, and CRP levels were higher in neutrophilic AECOPD compared with eosinophilic AECOPD. These markers decreased with treatment in neutrophilic AECOPD. A PLT/MPV ratio of <20x103 resulted in an increased mortality rate. Thus, appropriate steroid therapy may reduce readmission rates in the first 28 days after discharge in eosinophilic AECOPD.
