Objective: The first decision to be made in the case of community-acquired pneumonia (CAP) is whe... more Objective: The first decision to be made in the case of community-acquired pneumonia (CAP) is whether hospitalization of the patient is mandatory. In this study, we aimed to investigate whether the addition of oxygenation parameters to CURB-65 has diagnostic value in predicting mortality in CAP. Patients and methods: A total of 903 CAP patients were included in the study. Patients with a CURB-65 score of 0 and 1 were classified as Group 1 and patients with a CURB-65 score of 2 or more were classified as Group 2. The prediction of mortality through Pneumonia Severity Index (PSI), CURB-65 and CURBS-65/CURBP-65 with the addition of SaO2 and PaO2 values; hence the four different models, was compared among all patient groups. Results: As a result, 3.3% of the cases in Group 1 and 12.7% of the cases in Group 2 died. In both CURB-65 groups, it was noted that the frequency of patients with SaO2 <90% was significantly higher in the dead group than in the alive patient group (p=0.009 and p=0.001, respectively). In the univariate analysis, PaO2<60, and SaO2<90 were significantly associated with mortality. Model 2 (CURBS-65) and Model 3 (CURBP- 65) were examined, SaO2<90 (OR 2.08) was found to have an effect on death. In predicting mortality by the receiver operating characteristics (ROC) analysis, it was understood that the CURBS-65 score had a slightly higher area under the curve (AUC) value than CURB-65. Conclusions: As a result, it has been shown that the use of CURBS-65 scoring instead of CURB-65 clinical scoring may be more useful in predicting mortality.
Aim: In the literature, there is no study that focuses on frequency of ICS use and the difference... more Aim: In the literature, there is no study that focuses on frequency of ICS use and the differences between ICS users and non-users in patients with pneumonia.Our aim is to search for differences regarding clinical characteristics,laboratory parameters,duration of hospitalization and response to treatment between ICS users and pneumonia patients. Methods: 1069 patients were included in the study.Patients(n:922) were divided into two groups as ICS users and non-users.Differential characteristics of pneumonia in ICS users were evaluated using regression analysis. Results: 227out of 922patients were using ICS.ICS use was associated with older age(p=0.0001),higher rates of smoking(p=0.02),higher values of PCO2(p=0.0001)and patchy infiltrations(p=0.011) on thorax computerized tomography(CT).On the other hand,it was associated with lower values of PO2(p=0.016),PO2/FiO2(p=0.017) and lower rates of mortality(p=0.006),less common fever(p=0.013),gastrointestinal symptoms(p=0.22),myalgia(p=0.015),pleural effusion (p=0.002) and consolidations on chest x-ray(p=0.01).Mean duration of hospitalization for ICS users was 14.35±5.57 days and 15,8±8,85 days for non-users(p=0.5).According to regression analyses,ICS was associated with lower prevalences of consolidations on chest x-ray(p=0.011) and pleural effusion (p=0.014) and higher prevalences of patchy infiltrations on thorax CT(p=0.003) and accompanying COPD(p=0,0001). Conclusion: ICS use is associated with better treatment response and lower mortality rates in hospitalized pneumonia patients in contrary to what is expected. New larger-scaled studies are warrented regarding our topic.
Introduction: Our aim was to document the range of collagen vascular disease (CVD)-ILD seen at ou... more Introduction: Our aim was to document the range of collagen vascular disease (CVD)-ILD seen at our department and the impact on survival. Results: Of 620 patients with ILD, 144 were found to have CVD-ILD after multidisciplinary team review (27 male, 117 female). At diagnosis, the mean age was 59 years. The CVDs were: progressive systemic sclerosis (PSS); 41, Sjogren9s syndrome (SS); 35, rheumatoid arthritis (RA); 28, undifferentiated-CVD; 14, systemic lupus erythematosus (SLE); 6, vasculitis; 8, anti-Jo-1 syndrome; 4, polymyositis 3, mixed connective tissue disease; 2, ankylosing spondylitis; 2, and antiphospholipid syndrome; 1. The thoracic HRCT available for 136 patients was compatible with non-specific interstitial pneumonia (NSIP); 52 cases, probable idiopathic pulmonary fibrosis (IPF); 27, definite IPF; 15, lymphocytic interstitial pneumonia; 2, early interstitial changes; 12, other patterns; 28. By right heart catheterisation, 18 had pulmonary hypertension (PSS; 11, SLE; 3, RA; 2, undifferentiated-CVD; 2), of whom 12 had early and 6 severe interstitial lung disease. At presentation, the PFTs showed FVC mean 2.19 L FEV 1 /FVC mean 83%, DL CO %predicted mean 58. On Kaplan-Meier analysis, mean survival was 82 months. By comparison with IPF, the survival for CVD-ILD is significantly better (p=0.047). Conclusion: The most common types of CVD-ILD are PSS, SS and RA. The most common pattern is NSIP. Pulmonary hypertension is most common in PSS.
Purpose Obstructive sleep apnea (OSA) is a common sleep disorder affecting health-related quality... more Purpose Obstructive sleep apnea (OSA) is a common sleep disorder affecting health-related quality of life (QoL), and OSA severity is not a reliable indicator for QoL. The aim of this study was (1) to evaluate the impact of gender on QoL and (2) to identify the predictors of QoL in OSA patients. Methods World Health Organization Quality of Life Scale short form (WHOQOL-Bref) was used for evaluating QoL in OSA patients undergoing polysomnography in sleep laboratory of a university hospital. Results Out of 197 patients (age 50.4 ± 12.1 years, AHI 38.5 ± 28.4/h), 139 (70.6%) were men and 79.2% had moderate-tosevere OSA. Female gender, increased BMI, higher Epworth sleepiness score (ESS), and lower oxygen saturations were associated significantly with poor QoL in terms of all domains (physical, psychological, social relationship, and environmental) of WHOQOL-Bref questionnaire. The indicators of OSA severity (AHI and ODI) correlated negatively only with the physical domain. The subjects with comorbid insomnia and OSA had lower physical and social scores than subjects with no insomnia, and women with insomnia had significantly worse QoL scores in all domains than the others. In the multivariate linear regression analysis, female gender, comorbid insomnia, increased sleepiness, and higher BMI were significantly associated with poor QoL. Conclusions Female gender, comorbid insomnia, and daytime sleepiness were the outstanding factors affecting health-related QoL negatively in OSA. Besides, the impact of OSA on QoL may be explained by the presence of daytime sleepiness rather than OSA severity.
Background and objective: Obstructive sleep apnea (OSA) and hyperlipidemia are independent risk f... more Background and objective: Obstructive sleep apnea (OSA) and hyperlipidemia are independent risk factors for cardiovascular disease. This study investigates the association between OSA and prevalence of hyperlipidemia in patients of the European Sleep Apnea Database (ESADA) cohort. Methods: The cross-sectional analysis included 11,892 patients (age 51.9±12.5 years, 70% male, body mass index (BMI) 31.3±6.6 kg/m 2 , mean Oxygen Desaturation Index (ODI) 23.7±25.5 events/h) investigated for OSA. The independent odds ratio (OR) for hyperlipidemia in relation to measures of OSA (ODI, Apnea Hypopnea Index, mean and lowest oxygen saturation) was determined by means of General Linear Model analysis with adjustment for important confounders like age, BMI, comorbidities, and study site. Results: Hyperlipidemia prevalence increased from 15.1% in subjects without OSA to 26.1% in those with severe OSA, p<0.001. Corresponding numbers in diabetic patients were 8.5% and 41.5%, p<0.001. Compared with ODI quartile I, patients in ODI quartiles II-IV had an
Authorship and contributorship Canan G€ und€ uz performed the study and collected data. € Ozen Ka... more Authorship and contributorship Canan G€ und€ uz performed the study and collected data. € Ozen Kac¸maz Bas¸o glu designed the study. Mehmet Sezai Tas¸bakan analyzed the study. All author contributed in writing the paper.
Background and objective: Obstructive sleep apnea (OSA) and hyperlipidemia are independent risk f... more Background and objective: Obstructive sleep apnea (OSA) and hyperlipidemia are independent risk factors for cardiovascular disease. This study investigates the association between OSA and prevalence of hyperlipidemia in patients of the European Sleep Apnea Database (ESADA) cohort. Methods: The cross-sectional analysis included 11,892 patients (age 51.9±12.5 years, 70% male, body mass index (BMI) 31.3±6.6 kg/m 2 , mean Oxygen Desaturation Index (ODI) 23.7±25.5 events/h) investigated for OSA. The independent odds ratio (OR) for hyperlipidemia in relation to measures of OSA (ODI, Apnea Hypopnea Index, mean and lowest oxygen saturation) was determined by means of General Linear Model analysis with adjustment for important confounders like age, BMI, comorbidities, and study site. Results: Hyperlipidemia prevalence increased from 15.1% in subjects without OSA to 26.1% in those with severe OSA, p<0.001. Corresponding numbers in diabetic patients were 8.5% and 41.5%, p<0.001. Compared with ODI quartile I, patients in ODI quartiles II-IV had an
Objective: To test the hypothesis that obstructive sleep apnea (OSA) is a risk factor for develop... more Objective: To test the hypothesis that obstructive sleep apnea (OSA) is a risk factor for development of postoperative atrial fibrillation (POAF) after cardiac surgery. Design: Retrospective analysis. Setting: Single-center university hospital Participants: Five-hundred forty-five patients in sinus rhythm preoperatively undergoing coronary artery bypass grafting (CABG), aortic valve replacement, mitral valve replacement/repair, or combined valve/CABG surgery from January 2008 to April 2011. Interventions: Retrospective review of medical records. Measurements and Main Results: Postoperative atrial fibrillation was defined as atrial fibrillation requiring therapeutic intervention. Of 545 cardiac surgical patients, 226 (41%) patients developed POAF. The risk was higher in 72 OSA patients than 473 patients without OSA (67% versus 38%, adjusted hazard ratio 1.83 [95% CI: 1.30-2.58], p < 0.001). Of the 32 OSA patients who used home positive airway pressure (PAP) therapy, 18(56%) developed POAF compared with 29 of 38 (76%) patients who did not use PAP at home (unadjusted hazard ratio 0.63 [95% CI: 0.35-1.15], p = 0.13). Conclusion: OSA is significantly associated with POAF in cardiac surgery patients. Further investigation is needed to determine whether use of positive airway pressure in OSA patients reduces the risk of POAF.
Clinical characteristics and outcome of healthcare associated pneumonia in Turkey Introduction: P... more Clinical characteristics and outcome of healthcare associated pneumonia in Turkey Introduction: Pneumonia in cases with preceding hospitalization, hemodialysis, intravenous therapy, wound care, or chemotherapy within the prior 30 days and residence in nursing homes are defined as healthcare associated pneumonia (HCAP). The aim of this study was to compare the demographic and laboratory data, isolated causative agents and prognosis of patients with communityacquired pneumonia (CAP) and HCAP in a large population in Turkey. Materials and Methods: The data of 785 cases (average age 65.3 ± 16.4, 530 male) registered to Turkish Thoracic Society Respiratory Infections Study Group CAP database (TURCAP) were examined. The demographic data, clinical history, pneumonia severity scores (PSI), laboratory and radiologic findings of the CAP and HCAP patients were compared.
Objective: We aimed to investigate the effect of inhaled corticosteroids (ICS) in the outcomes of... more Objective: We aimed to investigate the effect of inhaled corticosteroids (ICS) in the outcomes of community acquired pneumonia (CAP), as well as to determine if ICS usage is exist among the risk factors for mortality in those patients. Material-Method: In this retrospective cross-sectional multicentre study, 1069 hospitalized CAP patients were investigated using CAP Database of Turkish Thoracic Society (TURKCAP Database). The patients were divided into two groups, depending on their ICS use. The data were analyzed by appropriate statistical methods. Results: 172 (75,8%) of the 227 patients who were on ICS had COPD and 37 (16,3%) had asthma. There were fewer patients with fever among ICS-users compared to non-ICS users (p=0.013), and less muscle pain (p=0.015) and fewer GIS symptoms (p=0.022). No statistically significant difference was found between ICS use/ type of ICS and the duration of hospitalization (p=0.286). The multivariate regression analysis showed that patients using ICS had lower body temperature and, less crackles/bronchial sound. In the multivariate logistic regression model lung cancer (OR:6.75), glucose (OR:1.01) and CURB-65 (OR:1.72) were significantly associated with mortality in the CAP patients. ICS usage were not found to be associated with mortality. Conclusion: The use of ICS by the patients with CAP admitted to the hospital is not independently related with any radiological pattern, hospitalization duration and mortality. ICS
Pneumonia in cases with history of hospitalisation, hemodialysis, accomodation in nursing homes, ... more Pneumonia in cases with history of hospitalisation, hemodialysis, accomodation in nursing homes, receving ambulatory intravenous therapies and having decubitus ulcers is defined as health care associated pneumonia (HCAP). The comparison of demographic data, isolated causative agents and prognosis of patients with community acquired pneumonia (CAP) and HCAP is aimed. The patients with HCAP and CAP registered by seven centers in the Turkish Thoracic Society Respiratory Infections Study Group pneumonia database were retrospectively evaluated. 785 cases (530 male, average age 65.3±16.4) were evaluated, 207 (26.4%) were diagnosed with HCAP and 578 (73.6%) with CAP. Among HCAP cases, 140/207 (17.8%) had recent hospitalisation in last 90 days, 28/207 (3.6%) went under hemodialysis in previous 30 days and 22/207 (2.8%) stayed in nursing homes. Pneumonia severity index (PSI), was 103.9±37.2 in HCAP and 94.6±35.4 in CAP (p=0.002). The most frequently isolated causitive microorganisms were; P.aeruginosa, A.baumannii and S.pneumoniae in HCAP and S.pneumoniae and P.aeruginosa in CAP. Although length of stay in hospital was higher in HCAP than CAP (8.6±5.5 vs 7.5±6.1 days, p=0.03), the differences in ratios of length of stay in critical care unit were not statistically significant (%9.7 vs %9.3) (p>0.005). Despite the mortality ratio in HCAP was higher than CAP (8.7% vs 5.7%), the difference was not statistically significant (p=0.14). HCAP require special approach in the means of different reference data, range of isolated agents and prognosis other than CAP. Therapies involving gram negative microorganisms resistant to empirical antibiotherapies should be considered.
The CURB-65 score is sensitive for determining patients with severe illness yet lacks sensitivity... more The CURB-65 score is sensitive for determining patients with severe illness yet lacks sensitivity towards other factors dealing with milder cases. The purpose of this study was to investigate factors that determine the need for hospitalization patients not requiring hospitalization according to CURB-65. METHODS: The study was undertaken on 964 patients diagnosed with community-acquired pneumonia who were hospitalized and recorded to the Turkish Thorasic Society Pneumonia Study Group Database. Patients were categorized into 2 groups according to CURB-65 score 0-1 (Group 1) and CURB-65 score 2 and higher (Group 2). RESULTS: 247 of the total of 964 patients were categorized into Group 1 while 717 of them were Group 2. The mean age of Group 1 was 49.3 years and Group 2 was 71.4 years (p=0.0001). The average paO2 value of Group 1 was 63,4 while for Group 2 this value was 59,6. Co-existing morbidities (COPD, DM, CVI,heart failure) were present in 179 patients in Group 1 and in 640 patients in Group 2 (p=0.0001). The mean duration of hospitalization was 14,18 ± 5,39 days in Group 1 and 15,85 ± 8,88 days in Group 2 (p=0,468). The rates of mortality were 3,64% (n=9) in Group 1 and 11,42% (n=82) in Group 2 (p=0,0001). Saturations were below 90% in 55,5% (n=5) of the deaths in Group 1 and 56,09% (n=46) of the deaths in Group 2. The mean PSI scores in Group 1 was 67,27 ± 27,13) and in Group 2 was 109,75± 32,67 (p=0,0001). CONCLUSIONS: When considering the mean age of the groups, we believe that hospitalization for the younger patients in Group 1 was based on the fact that these patients were hypoxic for their age. Therefore we propose that the saturation parameter should be added to the CURB 65 scoring system (CURB(S) 65) as it is a better determinant for hospitalization in the younger patient group and may also serve as a predictor to determine mortality in all age groups. CLINICAL IMPLICATIONS: By adding saturation parameter to the CURB 65 score we believe that we will have more success in identifying younger patients who require hospitalization for community acquired pneumonia. According to the results of the study saturation parameter can also be used as a predictor for the rate mortalite. DISCLOSURE: The following authors have nothing to disclose: sakine nazik bahçecioğlu, Nurdan köktürk, Ayse Baha, Canan Gunduz, sezai tasbakan, abdullah sayiner, aysin coskun, feride durmaz, aykut cilli, burcu celenk, oguz kilinc, seda salman, armagan hazar, fatma tokgoz No Product/Research Disclosure Information
In this study, we evaluated the relation between PSI, A-DROP, CURB-65, and SOAR indices and inves... more In this study, we evaluated the relation between PSI, A-DROP, CURB-65, and SOAR indices and investigate the importance of these indices in mortality in adult patients with community acquired pneumonia (CAP). METHODS: 788 patients registered to "Pneumonia Data Base" that prepared by Turkish Thoracic Society Respiratory Infections Scientific Assembly between January 2009 and January 2013 were included to the study.Socio-demographic findings, symptoms, comorbidities, habits, history, physical examination findings, laboratory and radiological findings, pneumonia severity groups, treatment result, duration of hospitalization, and cost of disease treatment of patients were obtained from "Pneumonia Data Base". Indices above were calculated for each patient.According to patients status, control of patients were done different duration and symptoms,physical examination findings, laboratory and radiological findings,and treatment results were recorded. RESULTS: There were 68% of male and mean age was 65,59±16,99 years.89,3% patients were hospitalized.47,4% of patients were totally cured, 36,4% were partially cured, and mortality rate was 7,8%.Mean scores of PSI,CURB-65,SOAR and A-DROP were 99.5±35.1, 2.17±0.97, 1.59±1.07 and 2.10±1.03 respectively.When treatment results were compared with these indicese there was relation between treatment results and indices(p<0.001).There was relation between procalcitonin and treatment results but this relation was not observed between CRP and treatment results.Indices mentioned above were correlated with each other but they were not corraleted with procalcitonin and CRP.
Background and aim: Obstructive sleep apnea (OSA) is an independent risk factor for dyslipidemia.... more Background and aim: Obstructive sleep apnea (OSA) is an independent risk factor for dyslipidemia. The current study examined the effects of positive airway pressure (PAP) treatment on lipid status in the European Sleep Apnea Database (ESADA). Methods: The prospective cohort study enrolled 1564 OSA subjects (74% male, mean age 54±11y, body mass index (BMI) 32.7±6.6 kg/m 2 and apnea-hypopnea index (AHI) 40.3±24.4 n/h) undergoing PAP therapy for at least 3 months (mean 377.6 ± 419.5 days). Baseline and follow-up total cholesterol (TC) from 9 centers were analyzed. Repeated measures and logistic regression tests (adjusted for age, sex, change in weight, lipid lowering medication, PAP compliance and treatment duration) were used for comparing the changes in TC levels. Incident risk for coronary heart disease events (CHD) was calculated according to the Framingham CHD risk score (estimated from age, BMI, blood pressure, and TC). Results: Adjusted means of TC decreased from 194.2 mg/dl to 189.3 mg/dl during follow-up (p=0.019). A clinically significant (10%) reduction of TC at PAP follow-up was observed in 422 patients (27%). Duration of PAP therapy was identified as independent predictor for TC reduction, which implies an approximately 10% risk reduction for incident CHD events (from 26.7% to 24.1% in males, from 11.2% to 10.1% in females, p<0.001 respectively). Conclusion: The present study demonstrates a significant decrease in TC after long-term PAP treatment. Based on the close association of elevated TC levels with increased CV mortality, identification and treatment of OSA may have beneficial effects on overall cardiovascular risk.
The co-existence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA... more The co-existence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) is a common phenomenon referred to as overlap syndrome (OS). In the present study, we evaluated the prevalence of OS in mild hypoxemic COPD patients without OSA symptoms and compared characteristics of OS and COPD patients. Forty five COPD patients (mean FEV1 1671.3±532.0 ml) with mild hypoxemia presenting no sleep apnea symptoms (96% men, mean age 67.7±8.5 years) were involved in this study. Clinical characteristics were recorded, biochemical analysis and polygraphy were performed. Twenty-six patients with a RDI of ≥15 events/h were defined as OS (58%). When OS (n=26) and COPD without OSA (n=19) groups were compared, BMI (29.6±6.6 vs. 25.6±4.9kg/m(2) ; p=0.03), TNF-α level (24.8±8.1 vs. 3.6±0.8 ng/ml; p=0.03) and sleep time with SpO2 <90% (23.9±29.4 vs. 9.7±21.9%; p=0.02) were significantly increased in OS. Univariate analysis showed a correlation between RDI and BMI (p<0.01), E...
Giriş: Hastaneye yatış, hemodiyaliz programında bulunma, sağlık bakım evlerinde yaşama, önceki 30... more Giriş: Hastaneye yatış, hemodiyaliz programında bulunma, sağlık bakım evlerinde yaşama, önceki 30 günde evde yara bakımı öyküsü, ayaktan intravenöz tedavi ve kemoterapi öyküsü olan olgularda toplumda gelişen pnömoniler, sağlık bakımı ilişkili pnömoni (SBİP) olarak adlandırılmaktadır. Türkiye'de geniş bir popülasyonu kapsayan çalışmamızda, hastanede yatan toplumda gelişen pnömoni (TGP) ve SBİP olgularının başvuru özelliklerinin, laboratuvar verilerinin, etken dağılımlarının ve prognozlarının karşılaştırılması amaçlanmıştır.Materyal ve Metod: Türk Toraks Derneği Solunum Sistemi İnfeksiyonları Çalışma Grubu Pnömoni Veri Tabanı (TURCAP)'na yedi merkez tarafından kayıt edilmiş olan 785 (ortalama yaş 65.3 ± 16.4, 530 erkek) TGP ve SBİP olguları değerlendirilmiştir. Demografik özellikler, klinik öykü, pnömoni ağırlık skorları, laboratuvar ve radyolojik bulgular karşılaştırılmıştır.Bulgular: 785 olguda 207 (%26.4)'si SBİP ve 578 (%73.6)'i TGP tanısı almıştır. 207 SBİP olgusu...
The novel coronavirus disease (COVID-19) is similar to connective tissue disease-associated inter... more The novel coronavirus disease (COVID-19) is similar to connective tissue disease-associated interstitial lung diseases (CTD-ILD) in many aspects. However, patients with CTD-ILD have required particular attention during the pandemic since they are at high risk due to -immunosuppressive treatments. Thus, prompt decisions for diagnosis and treatment initiation have become more important than earlier for these patients during the pandemic. Radiological perspectives have become inevitable for the differential diagnosis of this group ¬during the pandemic, particularly to obtain rapid and accurate results that allow the physicians to start treatment immediately. However, in addition to radiological images, a definitive diagnosis also requires access to extensive information regarding patient history, including characteristics of comorbidities, and clinical and serological findings. Consequently, the differential diagnosis of COVID-19 and CTD-ILD can yield accurate treatment regimens that d...
Objective: The first decision to be made in the case of community-acquired pneumonia (CAP) is whe... more Objective: The first decision to be made in the case of community-acquired pneumonia (CAP) is whether hospitalization of the patient is mandatory. In this study, we aimed to investigate whether the addition of oxygenation parameters to CURB-65 has diagnostic value in predicting mortality in CAP. Patients and methods: A total of 903 CAP patients were included in the study. Patients with a CURB-65 score of 0 and 1 were classified as Group 1 and patients with a CURB-65 score of 2 or more were classified as Group 2. The prediction of mortality through Pneumonia Severity Index (PSI), CURB-65 and CURBS-65/CURBP-65 with the addition of SaO2 and PaO2 values; hence the four different models, was compared among all patient groups. Results: As a result, 3.3% of the cases in Group 1 and 12.7% of the cases in Group 2 died. In both CURB-65 groups, it was noted that the frequency of patients with SaO2 <90% was significantly higher in the dead group than in the alive patient group (p=0.009 and p=0.001, respectively). In the univariate analysis, PaO2<60, and SaO2<90 were significantly associated with mortality. Model 2 (CURBS-65) and Model 3 (CURBP- 65) were examined, SaO2<90 (OR 2.08) was found to have an effect on death. In predicting mortality by the receiver operating characteristics (ROC) analysis, it was understood that the CURBS-65 score had a slightly higher area under the curve (AUC) value than CURB-65. Conclusions: As a result, it has been shown that the use of CURBS-65 scoring instead of CURB-65 clinical scoring may be more useful in predicting mortality.
Aim: In the literature, there is no study that focuses on frequency of ICS use and the difference... more Aim: In the literature, there is no study that focuses on frequency of ICS use and the differences between ICS users and non-users in patients with pneumonia.Our aim is to search for differences regarding clinical characteristics,laboratory parameters,duration of hospitalization and response to treatment between ICS users and pneumonia patients. Methods: 1069 patients were included in the study.Patients(n:922) were divided into two groups as ICS users and non-users.Differential characteristics of pneumonia in ICS users were evaluated using regression analysis. Results: 227out of 922patients were using ICS.ICS use was associated with older age(p=0.0001),higher rates of smoking(p=0.02),higher values of PCO2(p=0.0001)and patchy infiltrations(p=0.011) on thorax computerized tomography(CT).On the other hand,it was associated with lower values of PO2(p=0.016),PO2/FiO2(p=0.017) and lower rates of mortality(p=0.006),less common fever(p=0.013),gastrointestinal symptoms(p=0.22),myalgia(p=0.015),pleural effusion (p=0.002) and consolidations on chest x-ray(p=0.01).Mean duration of hospitalization for ICS users was 14.35±5.57 days and 15,8±8,85 days for non-users(p=0.5).According to regression analyses,ICS was associated with lower prevalences of consolidations on chest x-ray(p=0.011) and pleural effusion (p=0.014) and higher prevalences of patchy infiltrations on thorax CT(p=0.003) and accompanying COPD(p=0,0001). Conclusion: ICS use is associated with better treatment response and lower mortality rates in hospitalized pneumonia patients in contrary to what is expected. New larger-scaled studies are warrented regarding our topic.
Introduction: Our aim was to document the range of collagen vascular disease (CVD)-ILD seen at ou... more Introduction: Our aim was to document the range of collagen vascular disease (CVD)-ILD seen at our department and the impact on survival. Results: Of 620 patients with ILD, 144 were found to have CVD-ILD after multidisciplinary team review (27 male, 117 female). At diagnosis, the mean age was 59 years. The CVDs were: progressive systemic sclerosis (PSS); 41, Sjogren9s syndrome (SS); 35, rheumatoid arthritis (RA); 28, undifferentiated-CVD; 14, systemic lupus erythematosus (SLE); 6, vasculitis; 8, anti-Jo-1 syndrome; 4, polymyositis 3, mixed connective tissue disease; 2, ankylosing spondylitis; 2, and antiphospholipid syndrome; 1. The thoracic HRCT available for 136 patients was compatible with non-specific interstitial pneumonia (NSIP); 52 cases, probable idiopathic pulmonary fibrosis (IPF); 27, definite IPF; 15, lymphocytic interstitial pneumonia; 2, early interstitial changes; 12, other patterns; 28. By right heart catheterisation, 18 had pulmonary hypertension (PSS; 11, SLE; 3, RA; 2, undifferentiated-CVD; 2), of whom 12 had early and 6 severe interstitial lung disease. At presentation, the PFTs showed FVC mean 2.19 L FEV 1 /FVC mean 83%, DL CO %predicted mean 58. On Kaplan-Meier analysis, mean survival was 82 months. By comparison with IPF, the survival for CVD-ILD is significantly better (p=0.047). Conclusion: The most common types of CVD-ILD are PSS, SS and RA. The most common pattern is NSIP. Pulmonary hypertension is most common in PSS.
Purpose Obstructive sleep apnea (OSA) is a common sleep disorder affecting health-related quality... more Purpose Obstructive sleep apnea (OSA) is a common sleep disorder affecting health-related quality of life (QoL), and OSA severity is not a reliable indicator for QoL. The aim of this study was (1) to evaluate the impact of gender on QoL and (2) to identify the predictors of QoL in OSA patients. Methods World Health Organization Quality of Life Scale short form (WHOQOL-Bref) was used for evaluating QoL in OSA patients undergoing polysomnography in sleep laboratory of a university hospital. Results Out of 197 patients (age 50.4 ± 12.1 years, AHI 38.5 ± 28.4/h), 139 (70.6%) were men and 79.2% had moderate-tosevere OSA. Female gender, increased BMI, higher Epworth sleepiness score (ESS), and lower oxygen saturations were associated significantly with poor QoL in terms of all domains (physical, psychological, social relationship, and environmental) of WHOQOL-Bref questionnaire. The indicators of OSA severity (AHI and ODI) correlated negatively only with the physical domain. The subjects with comorbid insomnia and OSA had lower physical and social scores than subjects with no insomnia, and women with insomnia had significantly worse QoL scores in all domains than the others. In the multivariate linear regression analysis, female gender, comorbid insomnia, increased sleepiness, and higher BMI were significantly associated with poor QoL. Conclusions Female gender, comorbid insomnia, and daytime sleepiness were the outstanding factors affecting health-related QoL negatively in OSA. Besides, the impact of OSA on QoL may be explained by the presence of daytime sleepiness rather than OSA severity.
Background and objective: Obstructive sleep apnea (OSA) and hyperlipidemia are independent risk f... more Background and objective: Obstructive sleep apnea (OSA) and hyperlipidemia are independent risk factors for cardiovascular disease. This study investigates the association between OSA and prevalence of hyperlipidemia in patients of the European Sleep Apnea Database (ESADA) cohort. Methods: The cross-sectional analysis included 11,892 patients (age 51.9±12.5 years, 70% male, body mass index (BMI) 31.3±6.6 kg/m 2 , mean Oxygen Desaturation Index (ODI) 23.7±25.5 events/h) investigated for OSA. The independent odds ratio (OR) for hyperlipidemia in relation to measures of OSA (ODI, Apnea Hypopnea Index, mean and lowest oxygen saturation) was determined by means of General Linear Model analysis with adjustment for important confounders like age, BMI, comorbidities, and study site. Results: Hyperlipidemia prevalence increased from 15.1% in subjects without OSA to 26.1% in those with severe OSA, p<0.001. Corresponding numbers in diabetic patients were 8.5% and 41.5%, p<0.001. Compared with ODI quartile I, patients in ODI quartiles II-IV had an
Authorship and contributorship Canan G€ und€ uz performed the study and collected data. € Ozen Ka... more Authorship and contributorship Canan G€ und€ uz performed the study and collected data. € Ozen Kac¸maz Bas¸o glu designed the study. Mehmet Sezai Tas¸bakan analyzed the study. All author contributed in writing the paper.
Background and objective: Obstructive sleep apnea (OSA) and hyperlipidemia are independent risk f... more Background and objective: Obstructive sleep apnea (OSA) and hyperlipidemia are independent risk factors for cardiovascular disease. This study investigates the association between OSA and prevalence of hyperlipidemia in patients of the European Sleep Apnea Database (ESADA) cohort. Methods: The cross-sectional analysis included 11,892 patients (age 51.9±12.5 years, 70% male, body mass index (BMI) 31.3±6.6 kg/m 2 , mean Oxygen Desaturation Index (ODI) 23.7±25.5 events/h) investigated for OSA. The independent odds ratio (OR) for hyperlipidemia in relation to measures of OSA (ODI, Apnea Hypopnea Index, mean and lowest oxygen saturation) was determined by means of General Linear Model analysis with adjustment for important confounders like age, BMI, comorbidities, and study site. Results: Hyperlipidemia prevalence increased from 15.1% in subjects without OSA to 26.1% in those with severe OSA, p<0.001. Corresponding numbers in diabetic patients were 8.5% and 41.5%, p<0.001. Compared with ODI quartile I, patients in ODI quartiles II-IV had an
Objective: To test the hypothesis that obstructive sleep apnea (OSA) is a risk factor for develop... more Objective: To test the hypothesis that obstructive sleep apnea (OSA) is a risk factor for development of postoperative atrial fibrillation (POAF) after cardiac surgery. Design: Retrospective analysis. Setting: Single-center university hospital Participants: Five-hundred forty-five patients in sinus rhythm preoperatively undergoing coronary artery bypass grafting (CABG), aortic valve replacement, mitral valve replacement/repair, or combined valve/CABG surgery from January 2008 to April 2011. Interventions: Retrospective review of medical records. Measurements and Main Results: Postoperative atrial fibrillation was defined as atrial fibrillation requiring therapeutic intervention. Of 545 cardiac surgical patients, 226 (41%) patients developed POAF. The risk was higher in 72 OSA patients than 473 patients without OSA (67% versus 38%, adjusted hazard ratio 1.83 [95% CI: 1.30-2.58], p < 0.001). Of the 32 OSA patients who used home positive airway pressure (PAP) therapy, 18(56%) developed POAF compared with 29 of 38 (76%) patients who did not use PAP at home (unadjusted hazard ratio 0.63 [95% CI: 0.35-1.15], p = 0.13). Conclusion: OSA is significantly associated with POAF in cardiac surgery patients. Further investigation is needed to determine whether use of positive airway pressure in OSA patients reduces the risk of POAF.
Clinical characteristics and outcome of healthcare associated pneumonia in Turkey Introduction: P... more Clinical characteristics and outcome of healthcare associated pneumonia in Turkey Introduction: Pneumonia in cases with preceding hospitalization, hemodialysis, intravenous therapy, wound care, or chemotherapy within the prior 30 days and residence in nursing homes are defined as healthcare associated pneumonia (HCAP). The aim of this study was to compare the demographic and laboratory data, isolated causative agents and prognosis of patients with communityacquired pneumonia (CAP) and HCAP in a large population in Turkey. Materials and Methods: The data of 785 cases (average age 65.3 ± 16.4, 530 male) registered to Turkish Thoracic Society Respiratory Infections Study Group CAP database (TURCAP) were examined. The demographic data, clinical history, pneumonia severity scores (PSI), laboratory and radiologic findings of the CAP and HCAP patients were compared.
Objective: We aimed to investigate the effect of inhaled corticosteroids (ICS) in the outcomes of... more Objective: We aimed to investigate the effect of inhaled corticosteroids (ICS) in the outcomes of community acquired pneumonia (CAP), as well as to determine if ICS usage is exist among the risk factors for mortality in those patients. Material-Method: In this retrospective cross-sectional multicentre study, 1069 hospitalized CAP patients were investigated using CAP Database of Turkish Thoracic Society (TURKCAP Database). The patients were divided into two groups, depending on their ICS use. The data were analyzed by appropriate statistical methods. Results: 172 (75,8%) of the 227 patients who were on ICS had COPD and 37 (16,3%) had asthma. There were fewer patients with fever among ICS-users compared to non-ICS users (p=0.013), and less muscle pain (p=0.015) and fewer GIS symptoms (p=0.022). No statistically significant difference was found between ICS use/ type of ICS and the duration of hospitalization (p=0.286). The multivariate regression analysis showed that patients using ICS had lower body temperature and, less crackles/bronchial sound. In the multivariate logistic regression model lung cancer (OR:6.75), glucose (OR:1.01) and CURB-65 (OR:1.72) were significantly associated with mortality in the CAP patients. ICS usage were not found to be associated with mortality. Conclusion: The use of ICS by the patients with CAP admitted to the hospital is not independently related with any radiological pattern, hospitalization duration and mortality. ICS
Pneumonia in cases with history of hospitalisation, hemodialysis, accomodation in nursing homes, ... more Pneumonia in cases with history of hospitalisation, hemodialysis, accomodation in nursing homes, receving ambulatory intravenous therapies and having decubitus ulcers is defined as health care associated pneumonia (HCAP). The comparison of demographic data, isolated causative agents and prognosis of patients with community acquired pneumonia (CAP) and HCAP is aimed. The patients with HCAP and CAP registered by seven centers in the Turkish Thoracic Society Respiratory Infections Study Group pneumonia database were retrospectively evaluated. 785 cases (530 male, average age 65.3±16.4) were evaluated, 207 (26.4%) were diagnosed with HCAP and 578 (73.6%) with CAP. Among HCAP cases, 140/207 (17.8%) had recent hospitalisation in last 90 days, 28/207 (3.6%) went under hemodialysis in previous 30 days and 22/207 (2.8%) stayed in nursing homes. Pneumonia severity index (PSI), was 103.9±37.2 in HCAP and 94.6±35.4 in CAP (p=0.002). The most frequently isolated causitive microorganisms were; P.aeruginosa, A.baumannii and S.pneumoniae in HCAP and S.pneumoniae and P.aeruginosa in CAP. Although length of stay in hospital was higher in HCAP than CAP (8.6±5.5 vs 7.5±6.1 days, p=0.03), the differences in ratios of length of stay in critical care unit were not statistically significant (%9.7 vs %9.3) (p>0.005). Despite the mortality ratio in HCAP was higher than CAP (8.7% vs 5.7%), the difference was not statistically significant (p=0.14). HCAP require special approach in the means of different reference data, range of isolated agents and prognosis other than CAP. Therapies involving gram negative microorganisms resistant to empirical antibiotherapies should be considered.
The CURB-65 score is sensitive for determining patients with severe illness yet lacks sensitivity... more The CURB-65 score is sensitive for determining patients with severe illness yet lacks sensitivity towards other factors dealing with milder cases. The purpose of this study was to investigate factors that determine the need for hospitalization patients not requiring hospitalization according to CURB-65. METHODS: The study was undertaken on 964 patients diagnosed with community-acquired pneumonia who were hospitalized and recorded to the Turkish Thorasic Society Pneumonia Study Group Database. Patients were categorized into 2 groups according to CURB-65 score 0-1 (Group 1) and CURB-65 score 2 and higher (Group 2). RESULTS: 247 of the total of 964 patients were categorized into Group 1 while 717 of them were Group 2. The mean age of Group 1 was 49.3 years and Group 2 was 71.4 years (p=0.0001). The average paO2 value of Group 1 was 63,4 while for Group 2 this value was 59,6. Co-existing morbidities (COPD, DM, CVI,heart failure) were present in 179 patients in Group 1 and in 640 patients in Group 2 (p=0.0001). The mean duration of hospitalization was 14,18 ± 5,39 days in Group 1 and 15,85 ± 8,88 days in Group 2 (p=0,468). The rates of mortality were 3,64% (n=9) in Group 1 and 11,42% (n=82) in Group 2 (p=0,0001). Saturations were below 90% in 55,5% (n=5) of the deaths in Group 1 and 56,09% (n=46) of the deaths in Group 2. The mean PSI scores in Group 1 was 67,27 ± 27,13) and in Group 2 was 109,75± 32,67 (p=0,0001). CONCLUSIONS: When considering the mean age of the groups, we believe that hospitalization for the younger patients in Group 1 was based on the fact that these patients were hypoxic for their age. Therefore we propose that the saturation parameter should be added to the CURB 65 scoring system (CURB(S) 65) as it is a better determinant for hospitalization in the younger patient group and may also serve as a predictor to determine mortality in all age groups. CLINICAL IMPLICATIONS: By adding saturation parameter to the CURB 65 score we believe that we will have more success in identifying younger patients who require hospitalization for community acquired pneumonia. According to the results of the study saturation parameter can also be used as a predictor for the rate mortalite. DISCLOSURE: The following authors have nothing to disclose: sakine nazik bahçecioğlu, Nurdan köktürk, Ayse Baha, Canan Gunduz, sezai tasbakan, abdullah sayiner, aysin coskun, feride durmaz, aykut cilli, burcu celenk, oguz kilinc, seda salman, armagan hazar, fatma tokgoz No Product/Research Disclosure Information
In this study, we evaluated the relation between PSI, A-DROP, CURB-65, and SOAR indices and inves... more In this study, we evaluated the relation between PSI, A-DROP, CURB-65, and SOAR indices and investigate the importance of these indices in mortality in adult patients with community acquired pneumonia (CAP). METHODS: 788 patients registered to "Pneumonia Data Base" that prepared by Turkish Thoracic Society Respiratory Infections Scientific Assembly between January 2009 and January 2013 were included to the study.Socio-demographic findings, symptoms, comorbidities, habits, history, physical examination findings, laboratory and radiological findings, pneumonia severity groups, treatment result, duration of hospitalization, and cost of disease treatment of patients were obtained from "Pneumonia Data Base". Indices above were calculated for each patient.According to patients status, control of patients were done different duration and symptoms,physical examination findings, laboratory and radiological findings,and treatment results were recorded. RESULTS: There were 68% of male and mean age was 65,59±16,99 years.89,3% patients were hospitalized.47,4% of patients were totally cured, 36,4% were partially cured, and mortality rate was 7,8%.Mean scores of PSI,CURB-65,SOAR and A-DROP were 99.5±35.1, 2.17±0.97, 1.59±1.07 and 2.10±1.03 respectively.When treatment results were compared with these indicese there was relation between treatment results and indices(p<0.001).There was relation between procalcitonin and treatment results but this relation was not observed between CRP and treatment results.Indices mentioned above were correlated with each other but they were not corraleted with procalcitonin and CRP.
Background and aim: Obstructive sleep apnea (OSA) is an independent risk factor for dyslipidemia.... more Background and aim: Obstructive sleep apnea (OSA) is an independent risk factor for dyslipidemia. The current study examined the effects of positive airway pressure (PAP) treatment on lipid status in the European Sleep Apnea Database (ESADA). Methods: The prospective cohort study enrolled 1564 OSA subjects (74% male, mean age 54±11y, body mass index (BMI) 32.7±6.6 kg/m 2 and apnea-hypopnea index (AHI) 40.3±24.4 n/h) undergoing PAP therapy for at least 3 months (mean 377.6 ± 419.5 days). Baseline and follow-up total cholesterol (TC) from 9 centers were analyzed. Repeated measures and logistic regression tests (adjusted for age, sex, change in weight, lipid lowering medication, PAP compliance and treatment duration) were used for comparing the changes in TC levels. Incident risk for coronary heart disease events (CHD) was calculated according to the Framingham CHD risk score (estimated from age, BMI, blood pressure, and TC). Results: Adjusted means of TC decreased from 194.2 mg/dl to 189.3 mg/dl during follow-up (p=0.019). A clinically significant (10%) reduction of TC at PAP follow-up was observed in 422 patients (27%). Duration of PAP therapy was identified as independent predictor for TC reduction, which implies an approximately 10% risk reduction for incident CHD events (from 26.7% to 24.1% in males, from 11.2% to 10.1% in females, p<0.001 respectively). Conclusion: The present study demonstrates a significant decrease in TC after long-term PAP treatment. Based on the close association of elevated TC levels with increased CV mortality, identification and treatment of OSA may have beneficial effects on overall cardiovascular risk.
The co-existence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA... more The co-existence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) is a common phenomenon referred to as overlap syndrome (OS). In the present study, we evaluated the prevalence of OS in mild hypoxemic COPD patients without OSA symptoms and compared characteristics of OS and COPD patients. Forty five COPD patients (mean FEV1 1671.3±532.0 ml) with mild hypoxemia presenting no sleep apnea symptoms (96% men, mean age 67.7±8.5 years) were involved in this study. Clinical characteristics were recorded, biochemical analysis and polygraphy were performed. Twenty-six patients with a RDI of ≥15 events/h were defined as OS (58%). When OS (n=26) and COPD without OSA (n=19) groups were compared, BMI (29.6±6.6 vs. 25.6±4.9kg/m(2) ; p=0.03), TNF-α level (24.8±8.1 vs. 3.6±0.8 ng/ml; p=0.03) and sleep time with SpO2 <90% (23.9±29.4 vs. 9.7±21.9%; p=0.02) were significantly increased in OS. Univariate analysis showed a correlation between RDI and BMI (p<0.01), E...
Giriş: Hastaneye yatış, hemodiyaliz programında bulunma, sağlık bakım evlerinde yaşama, önceki 30... more Giriş: Hastaneye yatış, hemodiyaliz programında bulunma, sağlık bakım evlerinde yaşama, önceki 30 günde evde yara bakımı öyküsü, ayaktan intravenöz tedavi ve kemoterapi öyküsü olan olgularda toplumda gelişen pnömoniler, sağlık bakımı ilişkili pnömoni (SBİP) olarak adlandırılmaktadır. Türkiye'de geniş bir popülasyonu kapsayan çalışmamızda, hastanede yatan toplumda gelişen pnömoni (TGP) ve SBİP olgularının başvuru özelliklerinin, laboratuvar verilerinin, etken dağılımlarının ve prognozlarının karşılaştırılması amaçlanmıştır.Materyal ve Metod: Türk Toraks Derneği Solunum Sistemi İnfeksiyonları Çalışma Grubu Pnömoni Veri Tabanı (TURCAP)'na yedi merkez tarafından kayıt edilmiş olan 785 (ortalama yaş 65.3 ± 16.4, 530 erkek) TGP ve SBİP olguları değerlendirilmiştir. Demografik özellikler, klinik öykü, pnömoni ağırlık skorları, laboratuvar ve radyolojik bulgular karşılaştırılmıştır.Bulgular: 785 olguda 207 (%26.4)'si SBİP ve 578 (%73.6)'i TGP tanısı almıştır. 207 SBİP olgusu...
The novel coronavirus disease (COVID-19) is similar to connective tissue disease-associated inter... more The novel coronavirus disease (COVID-19) is similar to connective tissue disease-associated interstitial lung diseases (CTD-ILD) in many aspects. However, patients with CTD-ILD have required particular attention during the pandemic since they are at high risk due to -immunosuppressive treatments. Thus, prompt decisions for diagnosis and treatment initiation have become more important than earlier for these patients during the pandemic. Radiological perspectives have become inevitable for the differential diagnosis of this group ¬during the pandemic, particularly to obtain rapid and accurate results that allow the physicians to start treatment immediately. However, in addition to radiological images, a definitive diagnosis also requires access to extensive information regarding patient history, including characteristics of comorbidities, and clinical and serological findings. Consequently, the differential diagnosis of COVID-19 and CTD-ILD can yield accurate treatment regimens that d...
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