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Öğe Assessment of atrial electromechanical delay and influential factors in patients with obstructive sleep apnea(Springer Heidelberg, 2012) Yagmur, Julide; Yetkin, Ozkan; Cansel, Mehmet; Acikgoz, Nusret; Ermis, Necip; Karakus, Yasin; Tasolar, HakanThe interaction between moderate-to-severe obstructive sleep apnea (OSA) and cardiac arrhythmias, especially atrial fibrillation (AF), is well known. We aimed to determine whether atrial electromechanical parameters assessed by tissue Doppler imaging (TDI) would be affected in moderate-to-severe OSA, and detect the influential factors of atrial electromechanical parameters in these patients. Interatrial and intra-atrial electromechanical delay was measured by TDI in patients with moderate-to-severe OSA (n = 64) and control subjects (n = 39). P-wave dispersion (PWD) was calculated on the 12-lead ECG. Interatrial and intra-atrial electromechanical delay was significantly higher in the OSA group when compared with the controls (52.26 +/- 12.9 vs 29.61 +/- 11.26, P < 0.0001 and 18.90 +/- 8.13 vs 8.71 +/- 5.46, P < 0.0001; respectively). PWD was higher in the OSA group (46.09 +/- 13.40 ms vs 34.10 +/- 10.75 ms, P < 0.0001). Interatrial electromechanical delay had a positive correlation with PWD (r = 0.490, P < 0.0001), left atrial (LA) diameter (r = 0.383, P = 0.002), LA volume index (r = 0.354, P = 0.004), and apnea-hypopnea index (r = 0.365, P = 0.003). In addition, interatrial electromechanical delay was negatively correlated with the magnitude of the lowest oxygen saturation percentage (r = -0.498, P < 0.0001). This study showed that interatrial and intra-atrial electromechanical delay and PWD were prolonged in patients with moderate-to-severe OSA. LA dilatation, hypoxemia, and the severity of the disease may contribute a prolongation in interatrial electromechanical delay via atrial structural and electrical alterations, which may predict the risk of future AF development in patients with moderate-to-severe OSA.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 Effect of CPAP on sleep spindles in patients with OSA(Elsevier Science Bv, 2018) Yetkin, Ozkan; Aydogan, DenizObjective: Consequences of OSAS include excessive daytime sleepiness, divided sleep architecture, impaired neurocognitive performance, and significant psychosocial disruption. In this study we aimed to evaluate sleep spindles changes before and after PAP treatment in patient with OSA. Methods: Seventy-three consecutive patients (M/F:61/12) who applied to Sleep Disorders Center of Inonu University Hospital and met the inclusion criteria were enrolled to this study. Full-night polysomnography and CPAP titration were performed. Results: Mean AHI were detected as 43,8 +/- 24,4 and mean oxygen saturation was 79% in patients under full night PSG. Singificant increasing were observed on spindle count under CPAP titration (192 +/- 98.vs 347 +/- 165 per hour p < 0.001)) and also significant increasing was recorded on oxygen saturation (79 15 vs 94 +/- 4% p < 0.001). Conclusion: Both spindle count and oxygen saturation were recorded to be significantly increased under CPAP titration while there was a significant decrease in apnea-hypopnea. We have shown that significant increase in number of spindles can be achieved with CPAP treatment, those to be decreased in patient with OSA. Number of spindles may play a role as an indicator of better outcome in OSA patients.Öğe Effect of cpap on sleep spindles in patients with osa(Elsevıer scıence bv, po box 211, 1000 ae amsterdam, netherlands, 2018) Yetkin, Ozkan; Aydogan, DenizObjective: Consequences of OSAS include excessive daytime sleepiness, divided sleep architecture, impaired neurocognitive performance, and significant psychosocial disruption. In this study we aimed to evaluate sleep spindles changes before and after PAP treatment in patient with OSA. Methods: Seventy-three consecutive patients (M/F:61/12) who applied to Sleep Disorders Center of Inonu University Hospital and met the inclusion criteria were enrolled to this study. Full-night polysomnography and CPAP titration were performed. Results: Mean AHI were detected as 43,8 +/- 24,4 and mean oxygen saturation was 79% in patients under full night PSG. Singificant increasing were observed on spindle count under CPAP titration (192 +/- 98.vs 347 +/- 165 per hour p < 0.001)) and also significant increasing was recorded on oxygen saturation (79 15 vs 94 +/- 4% p < 0.001). Conclusion: Both spindle count and oxygen saturation were recorded to be significantly increased under CPAP titration while there was a significant decrease in apnea-hypopnea. We have shown that significant increase in number of spindles can be achieved with CPAP treatment, those to be decreased in patient with OSA. Number of spindles may play a role as an indicator of better outcome in OSA patients.Öğe The Effect of Smoking on the Carriage of Potential Pathogens in Nasopharynx(Erciyes Univ Sch Medicine, 2010) Yetkin, Gulay; Ay, Selma; Yetkin, Ozkan; Tastekin, Nese; Gucluer, NilayPurpose: Smoking is associated with an increased risk of respiratory tract infections in adults and also with oral colonization by some potentially pathogenic microorganisms. Smoking or passive exposure is enhancing bacterial adherence of pathogenic bacteria to the epithelial cells of the oropharingeal mucous membrane. The aim of this study is to determine the effect of active smoking on colonization of potential aerobic pathogens and in the nasopharynx. We evaluated Haemophilus Influenza, Moraxella catarrhalis, Streptococcus pneumoniae, Streptococcus pyogenes, Neisseria meningitidis, Staphylococcus aureus and Candida albicans strains. Material and Methods: Study population; 77 healty hospital personel has been selected from several services. Cultures were obtained using sterile swabs. Specimens collected from the nasopharynx through the mouth. Smokers were classified three groups as: mild smokers (n: 29; 0-10 package/year), moderate (n: 16; 11-20 package/year) and heavy (n: 12; 25+ package/year). Cultures were evaluated with semiquantitative technics (roll plate) Results: We isolated Staphylococcus aureus from 3 specimens, Neisseria meningitidis 1, Acinetobacter 'waif/ 1, E.coll 1, intense Candida alb/cans from 12 specimens, afew mold (Candida albicans ye Candida spp.) from 8 specimens, Haemophilus aphrophilus 1 and Group A If haemolytic streptococcus from 1 specimen. We have isolated pathogenic bacteria from 24 of 57 (8.42) smokers and 4 of 20 (8.20) nonsmokers (p<0.05). Conclusion: Distribution of pathojens in three groups described in smokers as follows; mild smokers (6 pathogcn/29 person) (6 pathogen) (/020), moderate (8 pathogen/16 person) (8 pathogen) (%50), and heavy smokers (10 pathogen/12 person) (10 pathogen) (8.83) (p<0.05). All growth rates within these groups have reisen up in comparison with nonsmokers.Öğe The effects of home oxygen therapy on energy metabolism in patients with COPD(Dove Medical Press Ltd, 2018) Berber, Nurcan Kirici; Yetkin, Ozkan; Kilic, Talat; Berber, Ilhami; Ozgel, MehmetBackground: COPD is preventable and treatable and is characterized by completely nonreversible airflow obstruction. In this study, we aimed to investigate the effect of long-term oxygen therapy on patients with stage 4 COPD who were followed up and treated at the polyclinic or clinic service. We evaluated the effects of oxygen therapy on energy metabolism and physical activity in patients with COPD. Methods: Nineteen patients with COPD (16 male/3 female), treated with oxygen therapy for the first time, were included in this study. Analysis of arterial blood gases and pulmonary function test was performed. Metabolic Holter device (SenseWear (R) Armband) was placed pre- and post-oxygen therapy on the patients' arm for at least 3 days. This device captures Holter data in a digitized electronic system, and the daily average value was calculated from the data. Results: Post-oxygen treatment showed a significant increase in energy expenditure by patients with COPD (pretreatment, 1,497 +/- 596 joule; posttreatment, 2,977 +/- 5,985 joule; P=0.044). Moreover, number of steps during walking (pretreatment, 2,056 +/- 256; posttreatment, 2,120 +/- 195; P=0.03), resting (pretreatment, 6.36 +/- 3.31 hours; posttreatment, 3.47 +/- 2.19 hours; P<0.03), and sleeping (pretreatment, 4.23 +/- 2.13 hours; posttreatment, 2.33 +/- 1.42 hours; P<0.00) showed significant differences. Increased daily energy expenditure in patients with respiratory failure was detected with long-term oxygen therapy. In addition, the immobility of patients decreased and duration of physical activity increased in patients with COPD. Conclusion: In this study, positive effects of long-term oxygen therapy have been demonstrated with respect to energy metabolism and physical activity of patients with COPD. Thus, we recommend that medication adherence and long-term oxygen therapy should begin early in patients with COPD.Öğe The effects of PAP therapy on energy metabolism in patients with obstructive sleep apnea syndrome(Turkish Assoc Tuberculosis & Thorax, 2019) Geckil, Aysegul Altintop; Yetkin, OzkanIntroduction: In this study, changes in energy metabolism before and after treatment were compared in obstructive sleep apnea syndrome (OSAS) patients who received positive airway pressure therapy. Materials and Methods: Thirty-nine patients (22 male, 17 female) were admitted to study. Patients for PAP therapy who had moderate to severe in polysomnography were included. Values of energy metabolism were recorded during three days via metaboic holter device, before and after PAP therapy. Results: The mean age of the patients was 51.53 +/- 11.16 year. In 15 (38.46%) of the patients BPAP, and in 24 (61.54%) of the patients CPAP treatment started. Three days after using metabolic holter device: the total daily energy consumption of the patients was found to be 482,4 +/- 296.1 kcal/day before treatment and 524.5 +/- 343.1 kcal/day after treatment (p < 0.0001); patients' daily physical activity was 7867 +/- 3319 steps/day before treatment and 12.416 +/- 1451 steps/day after treatment, which was considered statistically significant (p < 0001); the total daily resting period of the patients was 7.90 +/- 1.36 hours/day before treatment and 7.44 +/- 1.42 hours/day after treatment, considered statistically significant (p < 0001); the total sleep duration of the patients was 5.50 +/- 1.88 hours/day before treatment and 5.87 +/- 1.20 hours/day after treatment, considered statistically significant (p < 0001). Conclusion: In our study, we found that daily physical activity and energy consumption increased with PAP treatment. With PAP treatment, obesity, diabetes and hypertension can be controlled. In our study, since PAP treatment was effective with effective sleep, the immobilization time was decreased and therefore the duration of daytime physical activity was prolonged. With these effects, patients' compliance with treatment increases. In conclusion, PAP treatment should be recommended in patients with moderate and severe OSAS.Öğe Ignored Identity of Age-Dependent Increase in Pulmonary Embolism Atrial Fibrillation(Elsevier, 2019) Yetkin, Ertan; Cuglan, Bilal; Turhan, Hasan; Ozturk, Selcuk; Yetkin, Ozkan[Abstract Not Available]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 Mediastinal Tuberculosis Lymphadenitis Complicated with Pulmonary Tuberculosis(Bilimsel Tip Publishing House, 2007) Yetkin, Ozkan; Pembegul, Irem; Mutlu, Levent Cem; Yildirim, ZekiTuberculosis is a growing health problem especially in developing countries. Tuberculosis lymphadenitis is the most frequent occurrence of extrapulmonary tuberculosis. In our case, there was widening of upper mediastinum on chest x-ray and thoracic CT scans demonstrated multilocular abscess on the upper mediastinum which was laying to paratracheal site. Acit-fast bacilli was positive on pus obtained by USG guided fine needle aspiration. Antituberculosis treatment was given. Homogenius infiltration were determined in chest X-ray on the left upper zone 7th day of treatment and fever increased. Although extended spectrum antibiotics treatment were given fever continued and no regression on chest X-ray. Acit-fast bacilli was positive on sputum analysis. We though that mediatinal abcess fistulised to lung parenchima because initial sputum acit-fast bacilli was negative and patient described sputum with pus. Antituberculosis treatment was continued and acit-fast bacilli became negative on sputum.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 Pulmonary Complications Following Liver Transplantation: Assessment of Risk Factors and Outcome(Wiley-Blackwell, 2014) Otan, Emrah; Karakas, Serdar; Yetkin, Ozkan; Aydin, Cemalettin; Unal, Bulent; Yilmaz, Sezai[Abstract Not Available]Öğe Saddle Pulmonary Embolism Visualized by Real Time Three-Dimensional Echocardiography(Wiley, 2012) Yagmur, Julide; Atas, Halil; Cansel, Mehmet; Akturk, Erdal; Yetkin, OzkanSaddle pulmonary embolism is defined as a visible thromboembolus straddling the bifurcation of the main pulmonary artery. It is very unusual to visualize a pulmonary artery thrombus on transthoracic echocardiography. We describe a case of a saddle embolus of the main pulmonary artery visualized by real time three-dimensional echocardiography and successfully treated with intravenous unfractionated heparin, followed by oral anticoagulation achieving a complete dissolution of the thrombus. (Echocardiography 2012;29:E8-E9)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.
