The Journal of Tepecik Education and Research Hospital
Amaç: Türkiye'de tüberkülozluların (TB) tedavi ve takibi Verem Savaş Dispanserleri (VSD) tarafınd... more Amaç: Türkiye'de tüberkülozluların (TB) tedavi ve takibi Verem Savaş Dispanserleri (VSD) tarafından ücretsiz, doğrudan gözetimli olarak yapılmaktadır. Bu çalışmada Aydın ilindeki TB'li hastaların hastalığa özgü karakteristikleri ve doğrudan gözetimli tedavi (DGT) başarısını ortaya koymak amaçlanmıştır. Yöntem: İldeki dört VSD'nin dört yıl boyunca takip ve tedavi ettikleri TB'li hastalar incelenmiştir. Bu döneme ait kayıtlardan 6.557 hasta bilgisine ulaşılmış, kayıtları eksiksiz ve tedavi sonuçlarını içerenler çalışmaya alınmıştır. Hastaların demografik, mikrobiyolojik, tedavi sonuçları kaydedilmiştir. Bulgular: 1.023 erkek, 490 kadın, toplam 1.513 hasta çalışmaya dahil edildi. 1.126 (%74,4) hastaya akciğer, 387 (%25,5) hastaya akciğer dışı TB tanısı konulmuştu. Akciğer dışı TB'de en sık lenfadenit (%44,1), ikinci sıklıkta plevral TB (%41,6) saptandı. TB'nin kadınlarda daha genç yaşlarda, erkeklerde orta ve ileri yaşlarda görüldüğü tespit edildi (p=0,0001). En yüksek negatif mikroskopik inceleme sıklığı 18 yaş altında saptandı (p=0,0001). Akciğer dışı TB sıklığı kadınlarda anlamlı şekilde daha fazla ve tedaviyle kür oranı anlamlı şekilde daha düşüktü (p=0,0001). Akciğer ve akciğer dışı TB'liler karşılaştırıldığında; akciğer TB'de daha yüksek ilaç direnci ve kür oranı vardı (p=0,0001). İlaç direnci erkeklerde, 18-65 yaş aralığında ve akciğer TB'de daha sıktı. Sonuç: VSD takibindeki TB'li hastalarda tedavi başarısı %87,5 olarak bulunmuştur. TB kadınlarda daha genç yaşlarda, erkeklerde orta ve ileri yaşlarda görülmektedir. En yüksek negatif mikroskopik inceleme sıklığı 18 yaş altı hastalardadır. Akciğer dışı TB sıklığı kadınlarda daha fazladır ve tedaviyle kür oranı düşüktür. Akciğer ve akciğer dışı TB'de DGT ülkemizde pratik ve etkin bir tedavi yöntemidir. Anahtar Kelimeler: Akciğer tüberkülozu, akciğer dışı tüberküloz, ilaç direnci, doğrudan gözetimli tedavi Objective: In Turkey, patients with tuberculosis are treated and followed by Tuberculosis Dispensaries by free directly observed method. In the study, the demography, microbiology, disease localization, drug resistance, success of treatment in tuberculosis in Aydın city were assessed. Methods: In Turkey, patients with tuberculosis are treated and followed by Tuberculosis Dispensaries by free directly observed method. In the study, the disease characteristics and success of treatment in tuberculosis patients in Aydın city were assessed. Results: 1.023 men and 490 women, totally 1.513 patients were included. The diagnosis was pulmonary tuberculosis in 1.126 (74.4%), extra-pulmonary tuberculosis in 387 (25.5%). In extra-pulmonary tuberculosis; lympadenitis was most frequent (44.1%), where the second was pleural tuberculosis (41.6%). Tuberculosis was diagnosed in women on earlier ages, where on middle and advanced ages in men (p=0.0001). The higher frequency of smear negativity was
Amac: Sigara, insanlarin sagligini, sosyal ve ekonomik yasamini etkileyen onemli bir halk saglig... more Amac: Sigara, insanlarin sagligini, sosyal ve ekonomik yasamini etkileyen onemli bir halk sagligi sorunudur. Ulkemizde, ikinci basamak saglik kurulusunda, saglik calisanlari arasinda sigara icme prevalansini ele alan az sayida calisma bulunmaktadir. Bu yuzden biz de calismamizda, Ilce Devlet Hastanemizde farkli meslek gruplarinda gorev yapan saglik personelin sigara icimi uzerine etkili faktorleri ayrintili olarak incelemek, ozellikle calisma ortamlarinin etkisini arastirmak ve sigara birakma danisma hizmetleri ile ilgili bilgi duzeylerini ortaya koymayi amacladik. Gerec ve Yontem: Tanimlayici ve kesitsel nitelikteki calismamiz Ilce Devlet Hastanemizde gorev yapan ve calismayi kabul eden saglik personeli ile yapildi. Arastirmacilar tarafindan hazirlanan anket formlari katilimcilara uygulandi. Bulgular: Calismaya 158’i (%37.9) erkek, 259’u (%62.1) kadin toplam 417 kisi katildi. Saglik calisanlari arasinda sigara icme orani %32,8’di. Aktif sigara kullanan 137 personelin %74.5’ i si...
The Journal of Tepecik Education and Research Hospital, 2020
INTRODUCTION: Pulmonary tuberculosis in prisoners is higher than general population. The poor hea... more INTRODUCTION: Pulmonary tuberculosis in prisoners is higher than general population. The poor health care, poor nutrition, decreased physical activity and easy spread conditions increase the prevalence. In the study; it was aimed to compare pulmonary tuberculosis in prisoners with those in general population. METHODS: Totally 58 patients with pulmonary tuberculosis, 29 prisoners and 29 in general population diagnosed between 2010-2014 was included in the study. All of the records were got from software. Age, routine biochemical and hemogram values, smear test of the sputum and bronchial aspiration for asiodo resistant bacilli, culture, cytology, localization and sign (consolidation, nodule, cavitation) in chest radiography and treatments used were recorded. RESULTS: The mean age of the patients was 35.7 years. In comparison of the groups, serum protein level in general population was lower than the prisoners (p=0.007). The difference for creatinine levels was in borderline (p=0.05)....
C36. CASE REPORTS IN USE OF INTERVENTIONAL PULMONOLOGY STENTS, 2020
Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is an established mi... more Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is an established minimally invasive diagnostic tool for the evaluation of mediastinal and hilar lymphadenopathy. There is a paucity of data on its complications that usually include self-limiting bleeding, infections, and rarely pneumothorax/pneumomediastinum. CASE PRESENTATION: A 71-year-old male with a past medical history of cirrhosis, COPD with 45 pack-year smoking history, chronic hypoxic respiratory failure on 2 L/min home oxygen, OSA on BiPAP, was evaluated in pulmonary clinic for mediastinal and right hilar adenopathy. He underwent bronchoscopy with EBUS guided 21-gauge TBNA of station 7 lymph node. A chest xray post bronchoscopy was unremarkable. The patient was discharged with outpatient follow-up. He presented two days later with bilateral chest pain. A chest x-ray showed bilateral pleural effusions, and CTchest showed a 6.5 x 4.6 cm mass with partial cavitation in the subcarinal region of the mediastinum with intrinsic soft tissue gas. The patient was intubated due to worsening hypoxemic hypercapnic respiratory failure and started on broad-spectrum antibiotics. Repeat bronchoscopy did not show any bronco-mediastinal fistula but the narrowing of right lower lobe (RLL) medial segment with endobronchial tumor invasion. Endobronchial biopsies were obtained. EGD did not show esophago-mediastinal fistula. Hospital course was complicated by Strep mitis/oralis and Strep salivarius bacteremia followed by endocarditis. The pathology from both bronchoscopies was consistent with high-grade large B-cell lymphoma eroding into RLL parenchyma.
The Journal of Tepecik Education and Research Hospital, 2018
Amaç: Mahkûm olup akciğer kanseri tanısı alan hastalarda, mortalite ve özellikler halen çok açık ... more Amaç: Mahkûm olup akciğer kanseri tanısı alan hastalarda, mortalite ve özellikler halen çok açık değildir. Mahkûm akciğer kanserlilerin yaşam süresi ve sağkalımlarının genel populasyondaki akciğer kanseri tanılı hastalarla karşılaştırılması amaçlanmıştır. Yöntem: 2010-2014 tarihleri arasında takip edilen 27 mahkûm akciğer kanserli hasta ve 30 genel populasyona ait toplam 57 akciğer kanserli hastalar alındı. Çalışma retrospektif olgu serileri olarak tasarlandı. Hastaların yaşı, yaşam süresi, semptom süresi, toraks BT'deki en geniş tümör çapı, rutin biyokimyasal ve hemogram değerleri kaydedildi. Bulgular: Tümü erkek hastadan oluşan 57 hasta çalışmaya dahil edildi. Yaş ortalaması 60,46 yıl idi. İki grupta da en sık evre 4 hastalık belirlendi. En sık metastaz yeri akciğer, en sık yerleşim yeri ise üst lob lokalizasyonu idi. İki grup arasında semptom süresi, kalsiyum, C-reaktif protein, sedimantasyon değerleri mahkûm hastalarda anlamlı olarak daha yüksek saptandı (p<0,01). Yaşam süresi açısından karşılaştırıldığında, mahkûm akciğer kanseri hastalarının genel populasyona kıyasla daha az yaşam süresi saptandı. Sonuç: Mahkûm akciğer kanserliler genel populasyonda görülen akciğer kanserine göre daha kısa yaşam süresine sahiptir.
INTRODUCTION There is limited evidence about the prognostic value of FDG-PET/CT metrics in small ... more INTRODUCTION There is limited evidence about the prognostic value of FDG-PET/CT metrics in small cell lung cancer (SCLC) patients staged with TNM staging system. OBJECTIVES The aim of this study is to examine the prognostic value of pre-treatment FDG-SUVmax in patients with SCLC staged with 8th TNM staging system. METHODS A total of 344 (292 male) SCLC patients with pre-treatment FDG- PET/CT were included. One hundred fifty-three of cases were stage I-III, 191 were stage IV. SUVmax values were obtained for primary tumor, lymph nodes and metastases. Univariate and multivariate analysis were performed to determine the effect of pre-treatment SUVmax, with cut-off value of median, on progression-free and overall survival (PFS and OS). RESULTS Median OS and PFS for patients with stage I-III were 16.50 and 11.00 months, respectively. Median OS and PFS for patients with stage IV were 10.00 and 7.00 months, respectively. SUVmax of the primary tumor (PT), lymph nodes or metastasis were not associated with OS and PFS on univariate analysis. On multivariate analysis, SUVmax -PT with cut-off value of 11.60 was found to be an independent prognostic factor for OS in patients with stage I-III (HR;1.88, 95% CI:1.15-3.08, p=0.012). But the SUVmax -PT (HR; 1.60, 95% CI:0.99-2.60; p=0.057) for PFS was found to be a prognostic factor with marginal significance. SUVmax were not significantly associated with OS and PFS in patients with stage IV disease. CONCLUSION Pre-treatment SUVmax -PT (median cut-off 11.6) may have a prognostic value of OS and PFS in patients with TNM staged I-III SCLC.
Management of chronic obstructive pulmonary disease (COPD) includes interventions such as improvi... more Management of chronic obstructive pulmonary disease (COPD) includes interventions such as improving skills in coping with the disease. We aimed to examine the effect of self-management training on the quality of life and functional parameters in patients with moderate to severe COPD. Sixty-one consecutive patients with COPD were recruited in the study prospectively. The patients were randomized into two groups: self-management training (n=31) and standard care (n=30). Each patient was evaluated by spirometry, COPD assessment test (CAT), St George's respiratory questionnaire (SGRQ), hospital anxiety and depression scale (HADS), modified British Medical Research Council (mMRC) dyspnea scale, and short form-36 (SF-36). A team of physiotherapists, psychologists, pulmonary disease specialists, and dietitians provided self-management training and biweekly counseling via phone. At the end of three months, both the groups were re-evaluated using the same assessment parameters. We found no significant difference between the baseline demographic characteristics of the self-management training and standard care groups. We observed a reduction in CAT (p<0.001), SGRQ impact (p=0.013), activity subscales (p<0.001) and the total scores (p=0.020), and HADS anxiety (p=0.012) and depression (p=0.014) scores in the self-management training group after the education session. A significant increase in SF-36 physical function score was also observed (p=0.008). No significant improvement in the functional parameters was observed in either group; however, the change in FEV1 was more pronounced in the self-management training group than in the control group (p=0.017). The hospital readmissions and 1-year survival rates were similar for both the groups after receiving education (p>0.05). Our results suggest that the self-management training of the patients with COPD improves the quality of life and reduces the symptoms of depression and anxiety. Therefore, at the least, self-management training should be done as the first step of pulmonary rehabilitation in patients with COPD who cannot access pulmonary rehabilitation facilities.
Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a chronic, inflammatory airway dise... more Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a chronic, inflammatory airway disease associated with osteoporosis. Reduced bone mineral density (BMD) and impaired bone quality were shown to cause increased bone fragility and fractures in COPD patients. The aim of this study was to evaluate vitamin D levels and BMDs in Group A COPD patients. Methods: This case-control study involved 33 males aged 50 or above diagnosed with Group A COPD and 44 age-matched healthy males. Participants' serum vitamin D and other indicators were evaluated as well as lumbar and hip BMD of COPD patients. Results: Vitamin D levels were significantly lower in COPD patients (15.13 ± 6.02 ng/L) than controls (21.89 ± 4.49 ng/L). Two patients had a history of thoracic vertebral fracture. Lumbar (L1-L4) T scores were normal in 16 patients (48.5%) and indicated osteopenia in 15 (45.5%) and osteoporosis in 2 (6%). Hip femur total T scores were normal in 19 patients (57.6%) and indicated osteopenia in 14 (42.4%). Conclusion: Vitamin D deficiency/insufficiency is prevalent in COPD patients, and BMD decreases in the early period of the disease. Vitamin D and BMD should be evaluated in the early stages to prevent osteoporosis and its complications in COPD patients.
OBJECTIVE: Tuberculosis (TB) is a potential occupational threat for healthcare workers (HCWs) wor... more OBJECTIVE: Tuberculosis (TB) is a potential occupational threat for healthcare workers (HCWs) worldwide. We aimed to evaluate the tuberculin skin test (TST) and investigated if there was any difference between occupations. METHODS: This was designed as a prospective study. The analysis was performed on 331 participants. Purified protein derivative was administered to all cases. In addition, cases' age, gender, and smoking status were questioned and their comorbidities were recorded. Both shoulder areas were checked, and the Bacille Calmette-Guérin (BCG) scar counts were recorded. RESULTS: Out of a total of 331 participants, 207 were female and 124 were male; mean age was 39 ± 8 (min; 18, max; 61) and TST was 12 ± 6 mm. The cases were categorized by considering participants' exposure to TB (Group-1 - Doctor; Group-2 - Midwife-Nurse-Health Technician-Laboratorian; Group-3 - Technician-Administrative Staff; Group-4 - Secretary-Auxilliary Staff; and Group-5 - Security, Cleaning, Cafeteria Staff). When compared in terms of TST, there was a statistically significant difference (P < 0.001). The cases had at least 1 and maximum 3 BCG scars. Based on this, three groups were formed. Two hundred and twenty-three cases had 2 scars, 58 had 1, and 41 had 3. Significant difference was found among three groups, and similarly, there was a statistically significant difference in paired comparisons (P < 0.001; for all comparisons). While the difference was detected in the group with two BCG scars, there was no difference in other groups (P = 0.7, 0.001, and 0.5, respectively). There was a significant difference in terms of TST between genders (P < 0.001). CONCLUSION: Exposure to TB may vary according to professions, but the socioeconomic situation cannot be determined by professions.
OBJECTIVES: Pulmonary rehabilitation (PR) is useful for patients with chronic obstructive pulmona... more OBJECTIVES: Pulmonary rehabilitation (PR) is useful for patients with chronic obstructive pulmonary disease (COPD) but not clear for patients with asthma. The aim of the present study was to evaluate the effectiveness of PR in patients with asthma by comparing patients with COPD. The study was designed as a retrospective case series. We recruited patients with COPD and asthma. MATERIALS AND METHODS: Demographics, respiratory symptoms, medications, smoking history, comorbidities, exercise capacity, respiratory function tests, and quality of life (QOL) were recorded. Exercise capacity was evaluated by the 6-minute walk test (6MWT), QOL with St. George's Respiratory Questionnaire (SGRQ), 36-item Short Form Health Survey (SF-36) Quality of Life Questionnaire, and Hospital Anxiety and Depression (HAD) Scale. RESULTS: Forty-two patients with asthma and 25 COPD who completed PR were included in the study. There was no difference in terms of age and sex between the groups (p=0.100 and p=0.365, respectively); however, body mass index was higher in the asthmatic group (p=0.007). Partial oxygen pressure (pO2) difference and arterial oxygen saturation (SpO2) difference were significantly higher in the COPD group than in the asthma group after PR (p<0.05). When the patients were compared before and after PR in both groups, a significant increase was detected in exercise capacity and QOL (6MWT, HADa, SGRQ, and SF-36 in all domains) (p<0.05). When two groups are contrasted according
Empyema necessitatis is pleural empyema fistulized out of the thorax including subcutaneous tissu... more Empyema necessitatis is pleural empyema fistulized out of the thorax including subcutaneous tissues. Although it is a rare complication, delayed diagnosis may cause significant morbidity and mortality. A 43-year-old male was admitted to the clinic with a complaint of fever and expectoration of foul-smelling sputum, and a pleural effusion was detected. Fluid was sampled by thoracentesis, and it was concordant with empyema. As the bacteriological culture was positive for Streptococcus intermedius, a combination of two antibiotics was initiated, and a tube thoracostomy was placed. Upon observing protuberance, erythema, temperature rise and fluctuation under skin on the right lower abdominal quadrant, it was drained surgically. Empyema necessitatis was diagnosed since the drained fluid had the same nature with the pleural fluid. Improvement of clinical, radiological and laboratory findings were obtained after antibiotic therapy.
in the form of exudate can occur during the course of both malignant and benign lung diseases. Ap... more in the form of exudate can occur during the course of both malignant and benign lung diseases. Approximately 42-72% of all exudative effusions develop secondary to malignant diseases (2,3). All cancers, especially lung cancers, metastasize to pleura and can cause effusion formation. In the initial evaluation of patients with lung cancer, pleural effusion is present in approximately 15% of the patients. During the course of the disease, in 50% of the patients with diffuse lung cancer, pleural effusion develops (4).
Reduced exercise capacity is a main feature of Interstitial Lung Diseases (ILDs) and it is relate... more Reduced exercise capacity is a main feature of Interstitial Lung Diseases (ILDs) and it is related to closely prognosis of these patients. Pulmonary Rehabilitation (PR) results to improve in peak exercise capacity, dyspnea and quality of life in ILDs. We aimed to evaluate the benefits of PR in patients with ILDs and to determine whether there are similar gains in patients with severe ILD. We recruited ILD stable patients. All patients were evaluated with pulmonary function test, exercise capacity [6-minute walking test (6MWD)], quality of life [Short Form-36 (SF-36), St. George's Respiratory Questionnare (SGRQ), Hospital anxiety and Depression (HAD)] before and after PR (8 week). 57 patients who completed PR program, 30 women and 27 men, included in this study. It was determined a significant difference in terms of quality of life and exercise capacity (p <0,05) before and after PR. When these patients were divided into two groups (DLCO <40% predicted, severe: group-1, and...
Background: Smoking tobacco has been found to be commonamong patients with psychiatric disorders ... more Background: Smoking tobacco has been found to be commonamong patients with psychiatric disorders like anxiety, depression, schizophrenia and affective disorders. Our aim in this study is to compare psychiatric symptoms with the daily amount of cigarette consumption and degree of nicotine addiction. Method: A cross-sectional study was designed. Group-1: 124 healthy active-smokers (66F/58M) and group-2: 127 healthy non-smokers (61F/66M) were recruited. The SCL-90-R (Symptom check list) and Fagerstrom Test (FT) was used to assess psychological symptoms and nicotine addiction level. Smoker was divided into 3 groups, light smokers (0-9), medium smokers (10-19) and heavy smokers (>20 cigarettes/day). Results: Daily amount of cigarette consumption appears to a positive correlation with somatization, depression, psychoticism, hostility and paranoid ideation. Nicotine addiction level shows a positive correlation with all psychological symptoms (table-1). Conclusion: This study showed that smokers, especially in patients with higher FT scores (7-10 p) have increased psychiatric symptoms and should be treated differently than other smokers to quitting tobacco.
Objectives. Exposure to ambient metals and air pollutants in urban environments has been associat... more Objectives. Exposure to ambient metals and air pollutants in urban environments has been associated with impaired lung health and inflammation in the lungs. Fractional exhaled nitric oxide (FeNO) is a reliable marker of airway inflammation. In this study, we aimed to compare the FeNO levels of three schools that have different distances from iron and steel industry zone for assessing the effects of heavy metals and air pollution on their respiratory health. Methods. Pulmonary function test and FeNO measurements were evaluated in 387 adolescents in three schools which have different distance from plant. Results. FeNO levels were significantly higher in School I (n=142; 18.89±12.3 ppb) and School II (n=131; 17.68±7.7 ppb) than School III (n=114; 4.28±3.9 ppb). Increased FeNO concentration was related to the distance of iron and steel industry zone in young adults. Conclusion. The FeNO concentrations in school children were inversely proportional to the distance from the steel mill. Th...
International Journal of Chronic Obstructive Pulmonary Disease, 2016
We aimed to assess the effects of comorbidities on COPD costs and to investigate the relationship... more We aimed to assess the effects of comorbidities on COPD costs and to investigate the relationship between comorbidities and clinical variables. Patients and methods: All patients hospitalized with a diagnosis of COPD exacerbation between January 1, 2014, and December 31, 2014, at all state hospitals of Aydın province, a city located in the western part of Turkey, were included in this study. The costs examined in the study pertained to medications, laboratory tests, hospital stays, and other treatment-related factors, such as consumption of materials, doctor visits, and consultation fees. Results: A total of 3,095 patients with 5,237 exacerbations (mean age, 71.9±10.5 years; 2,434 males and 661 females) were evaluated. For 880 of the patients (28.
The Journal of Tepecik Education and Research Hospital
Amaç: Türkiye'de tüberkülozluların (TB) tedavi ve takibi Verem Savaş Dispanserleri (VSD) tarafınd... more Amaç: Türkiye'de tüberkülozluların (TB) tedavi ve takibi Verem Savaş Dispanserleri (VSD) tarafından ücretsiz, doğrudan gözetimli olarak yapılmaktadır. Bu çalışmada Aydın ilindeki TB'li hastaların hastalığa özgü karakteristikleri ve doğrudan gözetimli tedavi (DGT) başarısını ortaya koymak amaçlanmıştır. Yöntem: İldeki dört VSD'nin dört yıl boyunca takip ve tedavi ettikleri TB'li hastalar incelenmiştir. Bu döneme ait kayıtlardan 6.557 hasta bilgisine ulaşılmış, kayıtları eksiksiz ve tedavi sonuçlarını içerenler çalışmaya alınmıştır. Hastaların demografik, mikrobiyolojik, tedavi sonuçları kaydedilmiştir. Bulgular: 1.023 erkek, 490 kadın, toplam 1.513 hasta çalışmaya dahil edildi. 1.126 (%74,4) hastaya akciğer, 387 (%25,5) hastaya akciğer dışı TB tanısı konulmuştu. Akciğer dışı TB'de en sık lenfadenit (%44,1), ikinci sıklıkta plevral TB (%41,6) saptandı. TB'nin kadınlarda daha genç yaşlarda, erkeklerde orta ve ileri yaşlarda görüldüğü tespit edildi (p=0,0001). En yüksek negatif mikroskopik inceleme sıklığı 18 yaş altında saptandı (p=0,0001). Akciğer dışı TB sıklığı kadınlarda anlamlı şekilde daha fazla ve tedaviyle kür oranı anlamlı şekilde daha düşüktü (p=0,0001). Akciğer ve akciğer dışı TB'liler karşılaştırıldığında; akciğer TB'de daha yüksek ilaç direnci ve kür oranı vardı (p=0,0001). İlaç direnci erkeklerde, 18-65 yaş aralığında ve akciğer TB'de daha sıktı. Sonuç: VSD takibindeki TB'li hastalarda tedavi başarısı %87,5 olarak bulunmuştur. TB kadınlarda daha genç yaşlarda, erkeklerde orta ve ileri yaşlarda görülmektedir. En yüksek negatif mikroskopik inceleme sıklığı 18 yaş altı hastalardadır. Akciğer dışı TB sıklığı kadınlarda daha fazladır ve tedaviyle kür oranı düşüktür. Akciğer ve akciğer dışı TB'de DGT ülkemizde pratik ve etkin bir tedavi yöntemidir. Anahtar Kelimeler: Akciğer tüberkülozu, akciğer dışı tüberküloz, ilaç direnci, doğrudan gözetimli tedavi Objective: In Turkey, patients with tuberculosis are treated and followed by Tuberculosis Dispensaries by free directly observed method. In the study, the demography, microbiology, disease localization, drug resistance, success of treatment in tuberculosis in Aydın city were assessed. Methods: In Turkey, patients with tuberculosis are treated and followed by Tuberculosis Dispensaries by free directly observed method. In the study, the disease characteristics and success of treatment in tuberculosis patients in Aydın city were assessed. Results: 1.023 men and 490 women, totally 1.513 patients were included. The diagnosis was pulmonary tuberculosis in 1.126 (74.4%), extra-pulmonary tuberculosis in 387 (25.5%). In extra-pulmonary tuberculosis; lympadenitis was most frequent (44.1%), where the second was pleural tuberculosis (41.6%). Tuberculosis was diagnosed in women on earlier ages, where on middle and advanced ages in men (p=0.0001). The higher frequency of smear negativity was
Amac: Sigara, insanlarin sagligini, sosyal ve ekonomik yasamini etkileyen onemli bir halk saglig... more Amac: Sigara, insanlarin sagligini, sosyal ve ekonomik yasamini etkileyen onemli bir halk sagligi sorunudur. Ulkemizde, ikinci basamak saglik kurulusunda, saglik calisanlari arasinda sigara icme prevalansini ele alan az sayida calisma bulunmaktadir. Bu yuzden biz de calismamizda, Ilce Devlet Hastanemizde farkli meslek gruplarinda gorev yapan saglik personelin sigara icimi uzerine etkili faktorleri ayrintili olarak incelemek, ozellikle calisma ortamlarinin etkisini arastirmak ve sigara birakma danisma hizmetleri ile ilgili bilgi duzeylerini ortaya koymayi amacladik. Gerec ve Yontem: Tanimlayici ve kesitsel nitelikteki calismamiz Ilce Devlet Hastanemizde gorev yapan ve calismayi kabul eden saglik personeli ile yapildi. Arastirmacilar tarafindan hazirlanan anket formlari katilimcilara uygulandi. Bulgular: Calismaya 158’i (%37.9) erkek, 259’u (%62.1) kadin toplam 417 kisi katildi. Saglik calisanlari arasinda sigara icme orani %32,8’di. Aktif sigara kullanan 137 personelin %74.5’ i si...
The Journal of Tepecik Education and Research Hospital, 2020
INTRODUCTION: Pulmonary tuberculosis in prisoners is higher than general population. The poor hea... more INTRODUCTION: Pulmonary tuberculosis in prisoners is higher than general population. The poor health care, poor nutrition, decreased physical activity and easy spread conditions increase the prevalence. In the study; it was aimed to compare pulmonary tuberculosis in prisoners with those in general population. METHODS: Totally 58 patients with pulmonary tuberculosis, 29 prisoners and 29 in general population diagnosed between 2010-2014 was included in the study. All of the records were got from software. Age, routine biochemical and hemogram values, smear test of the sputum and bronchial aspiration for asiodo resistant bacilli, culture, cytology, localization and sign (consolidation, nodule, cavitation) in chest radiography and treatments used were recorded. RESULTS: The mean age of the patients was 35.7 years. In comparison of the groups, serum protein level in general population was lower than the prisoners (p=0.007). The difference for creatinine levels was in borderline (p=0.05)....
C36. CASE REPORTS IN USE OF INTERVENTIONAL PULMONOLOGY STENTS, 2020
Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is an established mi... more Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is an established minimally invasive diagnostic tool for the evaluation of mediastinal and hilar lymphadenopathy. There is a paucity of data on its complications that usually include self-limiting bleeding, infections, and rarely pneumothorax/pneumomediastinum. CASE PRESENTATION: A 71-year-old male with a past medical history of cirrhosis, COPD with 45 pack-year smoking history, chronic hypoxic respiratory failure on 2 L/min home oxygen, OSA on BiPAP, was evaluated in pulmonary clinic for mediastinal and right hilar adenopathy. He underwent bronchoscopy with EBUS guided 21-gauge TBNA of station 7 lymph node. A chest xray post bronchoscopy was unremarkable. The patient was discharged with outpatient follow-up. He presented two days later with bilateral chest pain. A chest x-ray showed bilateral pleural effusions, and CTchest showed a 6.5 x 4.6 cm mass with partial cavitation in the subcarinal region of the mediastinum with intrinsic soft tissue gas. The patient was intubated due to worsening hypoxemic hypercapnic respiratory failure and started on broad-spectrum antibiotics. Repeat bronchoscopy did not show any bronco-mediastinal fistula but the narrowing of right lower lobe (RLL) medial segment with endobronchial tumor invasion. Endobronchial biopsies were obtained. EGD did not show esophago-mediastinal fistula. Hospital course was complicated by Strep mitis/oralis and Strep salivarius bacteremia followed by endocarditis. The pathology from both bronchoscopies was consistent with high-grade large B-cell lymphoma eroding into RLL parenchyma.
The Journal of Tepecik Education and Research Hospital, 2018
Amaç: Mahkûm olup akciğer kanseri tanısı alan hastalarda, mortalite ve özellikler halen çok açık ... more Amaç: Mahkûm olup akciğer kanseri tanısı alan hastalarda, mortalite ve özellikler halen çok açık değildir. Mahkûm akciğer kanserlilerin yaşam süresi ve sağkalımlarının genel populasyondaki akciğer kanseri tanılı hastalarla karşılaştırılması amaçlanmıştır. Yöntem: 2010-2014 tarihleri arasında takip edilen 27 mahkûm akciğer kanserli hasta ve 30 genel populasyona ait toplam 57 akciğer kanserli hastalar alındı. Çalışma retrospektif olgu serileri olarak tasarlandı. Hastaların yaşı, yaşam süresi, semptom süresi, toraks BT'deki en geniş tümör çapı, rutin biyokimyasal ve hemogram değerleri kaydedildi. Bulgular: Tümü erkek hastadan oluşan 57 hasta çalışmaya dahil edildi. Yaş ortalaması 60,46 yıl idi. İki grupta da en sık evre 4 hastalık belirlendi. En sık metastaz yeri akciğer, en sık yerleşim yeri ise üst lob lokalizasyonu idi. İki grup arasında semptom süresi, kalsiyum, C-reaktif protein, sedimantasyon değerleri mahkûm hastalarda anlamlı olarak daha yüksek saptandı (p<0,01). Yaşam süresi açısından karşılaştırıldığında, mahkûm akciğer kanseri hastalarının genel populasyona kıyasla daha az yaşam süresi saptandı. Sonuç: Mahkûm akciğer kanserliler genel populasyonda görülen akciğer kanserine göre daha kısa yaşam süresine sahiptir.
INTRODUCTION There is limited evidence about the prognostic value of FDG-PET/CT metrics in small ... more INTRODUCTION There is limited evidence about the prognostic value of FDG-PET/CT metrics in small cell lung cancer (SCLC) patients staged with TNM staging system. OBJECTIVES The aim of this study is to examine the prognostic value of pre-treatment FDG-SUVmax in patients with SCLC staged with 8th TNM staging system. METHODS A total of 344 (292 male) SCLC patients with pre-treatment FDG- PET/CT were included. One hundred fifty-three of cases were stage I-III, 191 were stage IV. SUVmax values were obtained for primary tumor, lymph nodes and metastases. Univariate and multivariate analysis were performed to determine the effect of pre-treatment SUVmax, with cut-off value of median, on progression-free and overall survival (PFS and OS). RESULTS Median OS and PFS for patients with stage I-III were 16.50 and 11.00 months, respectively. Median OS and PFS for patients with stage IV were 10.00 and 7.00 months, respectively. SUVmax of the primary tumor (PT), lymph nodes or metastasis were not associated with OS and PFS on univariate analysis. On multivariate analysis, SUVmax -PT with cut-off value of 11.60 was found to be an independent prognostic factor for OS in patients with stage I-III (HR;1.88, 95% CI:1.15-3.08, p=0.012). But the SUVmax -PT (HR; 1.60, 95% CI:0.99-2.60; p=0.057) for PFS was found to be a prognostic factor with marginal significance. SUVmax were not significantly associated with OS and PFS in patients with stage IV disease. CONCLUSION Pre-treatment SUVmax -PT (median cut-off 11.6) may have a prognostic value of OS and PFS in patients with TNM staged I-III SCLC.
Management of chronic obstructive pulmonary disease (COPD) includes interventions such as improvi... more Management of chronic obstructive pulmonary disease (COPD) includes interventions such as improving skills in coping with the disease. We aimed to examine the effect of self-management training on the quality of life and functional parameters in patients with moderate to severe COPD. Sixty-one consecutive patients with COPD were recruited in the study prospectively. The patients were randomized into two groups: self-management training (n=31) and standard care (n=30). Each patient was evaluated by spirometry, COPD assessment test (CAT), St George's respiratory questionnaire (SGRQ), hospital anxiety and depression scale (HADS), modified British Medical Research Council (mMRC) dyspnea scale, and short form-36 (SF-36). A team of physiotherapists, psychologists, pulmonary disease specialists, and dietitians provided self-management training and biweekly counseling via phone. At the end of three months, both the groups were re-evaluated using the same assessment parameters. We found no significant difference between the baseline demographic characteristics of the self-management training and standard care groups. We observed a reduction in CAT (p<0.001), SGRQ impact (p=0.013), activity subscales (p<0.001) and the total scores (p=0.020), and HADS anxiety (p=0.012) and depression (p=0.014) scores in the self-management training group after the education session. A significant increase in SF-36 physical function score was also observed (p=0.008). No significant improvement in the functional parameters was observed in either group; however, the change in FEV1 was more pronounced in the self-management training group than in the control group (p=0.017). The hospital readmissions and 1-year survival rates were similar for both the groups after receiving education (p>0.05). Our results suggest that the self-management training of the patients with COPD improves the quality of life and reduces the symptoms of depression and anxiety. Therefore, at the least, self-management training should be done as the first step of pulmonary rehabilitation in patients with COPD who cannot access pulmonary rehabilitation facilities.
Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a chronic, inflammatory airway dise... more Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a chronic, inflammatory airway disease associated with osteoporosis. Reduced bone mineral density (BMD) and impaired bone quality were shown to cause increased bone fragility and fractures in COPD patients. The aim of this study was to evaluate vitamin D levels and BMDs in Group A COPD patients. Methods: This case-control study involved 33 males aged 50 or above diagnosed with Group A COPD and 44 age-matched healthy males. Participants' serum vitamin D and other indicators were evaluated as well as lumbar and hip BMD of COPD patients. Results: Vitamin D levels were significantly lower in COPD patients (15.13 ± 6.02 ng/L) than controls (21.89 ± 4.49 ng/L). Two patients had a history of thoracic vertebral fracture. Lumbar (L1-L4) T scores were normal in 16 patients (48.5%) and indicated osteopenia in 15 (45.5%) and osteoporosis in 2 (6%). Hip femur total T scores were normal in 19 patients (57.6%) and indicated osteopenia in 14 (42.4%). Conclusion: Vitamin D deficiency/insufficiency is prevalent in COPD patients, and BMD decreases in the early period of the disease. Vitamin D and BMD should be evaluated in the early stages to prevent osteoporosis and its complications in COPD patients.
OBJECTIVE: Tuberculosis (TB) is a potential occupational threat for healthcare workers (HCWs) wor... more OBJECTIVE: Tuberculosis (TB) is a potential occupational threat for healthcare workers (HCWs) worldwide. We aimed to evaluate the tuberculin skin test (TST) and investigated if there was any difference between occupations. METHODS: This was designed as a prospective study. The analysis was performed on 331 participants. Purified protein derivative was administered to all cases. In addition, cases' age, gender, and smoking status were questioned and their comorbidities were recorded. Both shoulder areas were checked, and the Bacille Calmette-Guérin (BCG) scar counts were recorded. RESULTS: Out of a total of 331 participants, 207 were female and 124 were male; mean age was 39 ± 8 (min; 18, max; 61) and TST was 12 ± 6 mm. The cases were categorized by considering participants' exposure to TB (Group-1 - Doctor; Group-2 - Midwife-Nurse-Health Technician-Laboratorian; Group-3 - Technician-Administrative Staff; Group-4 - Secretary-Auxilliary Staff; and Group-5 - Security, Cleaning, Cafeteria Staff). When compared in terms of TST, there was a statistically significant difference (P < 0.001). The cases had at least 1 and maximum 3 BCG scars. Based on this, three groups were formed. Two hundred and twenty-three cases had 2 scars, 58 had 1, and 41 had 3. Significant difference was found among three groups, and similarly, there was a statistically significant difference in paired comparisons (P < 0.001; for all comparisons). While the difference was detected in the group with two BCG scars, there was no difference in other groups (P = 0.7, 0.001, and 0.5, respectively). There was a significant difference in terms of TST between genders (P < 0.001). CONCLUSION: Exposure to TB may vary according to professions, but the socioeconomic situation cannot be determined by professions.
OBJECTIVES: Pulmonary rehabilitation (PR) is useful for patients with chronic obstructive pulmona... more OBJECTIVES: Pulmonary rehabilitation (PR) is useful for patients with chronic obstructive pulmonary disease (COPD) but not clear for patients with asthma. The aim of the present study was to evaluate the effectiveness of PR in patients with asthma by comparing patients with COPD. The study was designed as a retrospective case series. We recruited patients with COPD and asthma. MATERIALS AND METHODS: Demographics, respiratory symptoms, medications, smoking history, comorbidities, exercise capacity, respiratory function tests, and quality of life (QOL) were recorded. Exercise capacity was evaluated by the 6-minute walk test (6MWT), QOL with St. George's Respiratory Questionnaire (SGRQ), 36-item Short Form Health Survey (SF-36) Quality of Life Questionnaire, and Hospital Anxiety and Depression (HAD) Scale. RESULTS: Forty-two patients with asthma and 25 COPD who completed PR were included in the study. There was no difference in terms of age and sex between the groups (p=0.100 and p=0.365, respectively); however, body mass index was higher in the asthmatic group (p=0.007). Partial oxygen pressure (pO2) difference and arterial oxygen saturation (SpO2) difference were significantly higher in the COPD group than in the asthma group after PR (p<0.05). When the patients were compared before and after PR in both groups, a significant increase was detected in exercise capacity and QOL (6MWT, HADa, SGRQ, and SF-36 in all domains) (p<0.05). When two groups are contrasted according
Empyema necessitatis is pleural empyema fistulized out of the thorax including subcutaneous tissu... more Empyema necessitatis is pleural empyema fistulized out of the thorax including subcutaneous tissues. Although it is a rare complication, delayed diagnosis may cause significant morbidity and mortality. A 43-year-old male was admitted to the clinic with a complaint of fever and expectoration of foul-smelling sputum, and a pleural effusion was detected. Fluid was sampled by thoracentesis, and it was concordant with empyema. As the bacteriological culture was positive for Streptococcus intermedius, a combination of two antibiotics was initiated, and a tube thoracostomy was placed. Upon observing protuberance, erythema, temperature rise and fluctuation under skin on the right lower abdominal quadrant, it was drained surgically. Empyema necessitatis was diagnosed since the drained fluid had the same nature with the pleural fluid. Improvement of clinical, radiological and laboratory findings were obtained after antibiotic therapy.
in the form of exudate can occur during the course of both malignant and benign lung diseases. Ap... more in the form of exudate can occur during the course of both malignant and benign lung diseases. Approximately 42-72% of all exudative effusions develop secondary to malignant diseases (2,3). All cancers, especially lung cancers, metastasize to pleura and can cause effusion formation. In the initial evaluation of patients with lung cancer, pleural effusion is present in approximately 15% of the patients. During the course of the disease, in 50% of the patients with diffuse lung cancer, pleural effusion develops (4).
Reduced exercise capacity is a main feature of Interstitial Lung Diseases (ILDs) and it is relate... more Reduced exercise capacity is a main feature of Interstitial Lung Diseases (ILDs) and it is related to closely prognosis of these patients. Pulmonary Rehabilitation (PR) results to improve in peak exercise capacity, dyspnea and quality of life in ILDs. We aimed to evaluate the benefits of PR in patients with ILDs and to determine whether there are similar gains in patients with severe ILD. We recruited ILD stable patients. All patients were evaluated with pulmonary function test, exercise capacity [6-minute walking test (6MWD)], quality of life [Short Form-36 (SF-36), St. George's Respiratory Questionnare (SGRQ), Hospital anxiety and Depression (HAD)] before and after PR (8 week). 57 patients who completed PR program, 30 women and 27 men, included in this study. It was determined a significant difference in terms of quality of life and exercise capacity (p <0,05) before and after PR. When these patients were divided into two groups (DLCO <40% predicted, severe: group-1, and...
Background: Smoking tobacco has been found to be commonamong patients with psychiatric disorders ... more Background: Smoking tobacco has been found to be commonamong patients with psychiatric disorders like anxiety, depression, schizophrenia and affective disorders. Our aim in this study is to compare psychiatric symptoms with the daily amount of cigarette consumption and degree of nicotine addiction. Method: A cross-sectional study was designed. Group-1: 124 healthy active-smokers (66F/58M) and group-2: 127 healthy non-smokers (61F/66M) were recruited. The SCL-90-R (Symptom check list) and Fagerstrom Test (FT) was used to assess psychological symptoms and nicotine addiction level. Smoker was divided into 3 groups, light smokers (0-9), medium smokers (10-19) and heavy smokers (>20 cigarettes/day). Results: Daily amount of cigarette consumption appears to a positive correlation with somatization, depression, psychoticism, hostility and paranoid ideation. Nicotine addiction level shows a positive correlation with all psychological symptoms (table-1). Conclusion: This study showed that smokers, especially in patients with higher FT scores (7-10 p) have increased psychiatric symptoms and should be treated differently than other smokers to quitting tobacco.
Objectives. Exposure to ambient metals and air pollutants in urban environments has been associat... more Objectives. Exposure to ambient metals and air pollutants in urban environments has been associated with impaired lung health and inflammation in the lungs. Fractional exhaled nitric oxide (FeNO) is a reliable marker of airway inflammation. In this study, we aimed to compare the FeNO levels of three schools that have different distances from iron and steel industry zone for assessing the effects of heavy metals and air pollution on their respiratory health. Methods. Pulmonary function test and FeNO measurements were evaluated in 387 adolescents in three schools which have different distance from plant. Results. FeNO levels were significantly higher in School I (n=142; 18.89±12.3 ppb) and School II (n=131; 17.68±7.7 ppb) than School III (n=114; 4.28±3.9 ppb). Increased FeNO concentration was related to the distance of iron and steel industry zone in young adults. Conclusion. The FeNO concentrations in school children were inversely proportional to the distance from the steel mill. Th...
International Journal of Chronic Obstructive Pulmonary Disease, 2016
We aimed to assess the effects of comorbidities on COPD costs and to investigate the relationship... more We aimed to assess the effects of comorbidities on COPD costs and to investigate the relationship between comorbidities and clinical variables. Patients and methods: All patients hospitalized with a diagnosis of COPD exacerbation between January 1, 2014, and December 31, 2014, at all state hospitals of Aydın province, a city located in the western part of Turkey, were included in this study. The costs examined in the study pertained to medications, laboratory tests, hospital stays, and other treatment-related factors, such as consumption of materials, doctor visits, and consultation fees. Results: A total of 3,095 patients with 5,237 exacerbations (mean age, 71.9±10.5 years; 2,434 males and 661 females) were evaluated. For 880 of the patients (28.
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