[show abstract][hide abstract] ABSTRACT: BACKGROUND: The aim of this study was to assess the prevalence of Obstructive sleep apnoea syndrome (OSAS) in long-distance drivers located in the Zonguldak area and to show the correlation between OSAS and traffic accidents. METHODS: In this study, 241 long-distance drivers who were residents of Zonguldak province were interviewed face-to-face and a questionnaire regarding OSAS symptoms, occupational histories, and numbers of accidents was administered. Body mass measurements were also taken from participants. Patients who exhibited evidence of OSAS underwent polysomnography (PSG). RESULTS: Snoring was detected in 56% out of all participants, daytime sleepiness was observed in 26.6% and apnoea in 11.6%. All-night PSG was applied to 42 participants who had a high probability of clinical OSAS. Among these, eight had an apnoea-hypopnoea index (AHI) < 5. The prevalence of OSAS was 14.1%. There was a significant relationship between the ratio of traffic accidents per professional years and AHI (r = 0.571; p < 0.005). CONCLUSIONS: OSAS prevalence was higher among long-distance drivers in the Zonguldak region. Disease severity was directly proportional to traffic-accident risk, and thus represents a serious social problem.
Multidisciplinary respiratory medicine 02/2013; 8(1):10. · 0.05 Impact Factor
[show abstract][hide abstract] ABSTRACT: Chronic obstructive pulmonary disease (COPD) is a disease of increasing significance in terms of economic and social burden due to its increasing prevalence and high costs. Direct costs of COPD are mostly associated with hospitalization expenditures. In this study, our objective was to investigate the costs of hospitalization and factors affecting these costs in patients hospitalized due to acute exacerbation of COPD (AECOPD).
A total of 284 patients hospitalized AECOPD were included in the study. Data were examined retrospectively using the electronic hospital charts.
Mean duration of hospitalization was 11.38 ± 6.94 days among study patients. Rates of admission to the intensive care unit, initiation of non-invasive mechanical ventilation (NIMV) and invasive mechanical ventilation (MIV) were 37.3% (n=106), 44.4% (n=126) and 18.3% (n=52) respectively. The rate of mortality was 14.8% (n=42). Mean cost of a single patient hospitalized for an AECOPD was calculated as $1765 ± 2139. Mean cost of admission was $889 ± 533 in standard ward, and $2508 ± 2857 in intensive care unit (ICU). The duration of hospitalization, a FEV1% predicted value below 30%, having smoked 40 package-years or more, the number of co-morbidities, NIMV, IMV, ICU, exitus and the number of hospitalizations in the past year were among the factors that increased costs significantly. Hospital acquired pneumonia, chronic renal failure and anemia also increased the costs of COPD significantly.
The costs of treatment increase with the severity of COPD or with progression to a higher stage. Efforts and expenditures aimed at preventing COPD exacerbations might decrease the costs in COPD.
International journal of medical sciences 01/2012; 9(4):285-90. · 2.07 Impact Factor
[show abstract][hide abstract] ABSTRACT: We aimed to analyze the pre- and posttreatment serum asymmetric dimethylarginine (ADMA), nitrate (NO(3)), vitamin B(12) and homocysteine levels in pulmonary embolism (PTE) patients and to determine the prognostic value of these variables in predicting chronic thromboembolic pulmonary hypertension (CTEPH). This study was conducted in 64 patients. The patients were classified into the two groups: patients with normal pulmonary artery pressure (PAP) (group I) and patients with high PAP with persistent lung perfusion defects or who died at the end of 3 months of therapy (group II). We found statistically significant differences between two groups with respect to the partial oxygen pressure, the oxygen saturation, and the PAP, but there was no difference between the two groups with respect to the pretreatment ADMA, NO(3), or homocysteine levels. The vitamin B(12) levels were higher in group II. The NO(3) levels increased and the ADMA and vitamin B(12) levels decreased with treatment in both groups. These results suggest that these parameters are not predictive of the development of CTEPH.
Mediators of Inflammation 01/2011; 2011:215057. · 3.88 Impact Factor
[show abstract][hide abstract] ABSTRACT: We aimed to analyze the pre- and posttreatment serum asymmetric dimethylarginine (ADMA), nitrate (NO3), vitamin B12 and homocysteine levels in pulmonary embolism (PTE) patients and to determine the prognostic value of these variables in predicting chronic thromboembolic pulmonary hypertension (CTEPH). This study was conducted in 64 patients. The patients were classified into the two groups: patients with normal pulmonary artery pressure (PAP) (group I) and patients with high PAP with persistent lung perfusion defects or who died at the end of 3 months of therapy (group II). We found statistically significant differences between two groups with respect to the partial oxygen pressure, the oxygen saturation, and the PAP, but there was no difference between the two groups with respect to the pretreatment ADMA, NO3, or homocysteine levels. The vitamin B12 levels were higher in group II. The NO3 levels increased and the ADMA and vitamin B12 levels decreased with treatment in both groups. These results suggest that these parameters are not predictive of the development of CTEPH.
Mediators of Inflammation 01/2011; 2011. · 3.88 Impact Factor
[show abstract][hide abstract] ABSTRACT: Intracardiac thrombus and pulmonary embolism is a very rare manifestation of Behçet's disease. A twenty-years-old man was admitted to hospital due to dyspnea, haemoptysis, fever and partially loss of vision. On dynamic thorax computed tomography (CT), there was aneurysmatic dilatation and thrombus in bilateral pulmonary artery segments and also findings of pulmonary thromboembolism. A diagnosis of Behçet's disease was made based on his clinical course and radiological findings. During treatment, the patient was admitted two times to the hospital because of recurrent pulmonary thromboembolism. At the 10th months of follow up, partially dissolution of the thrombi and pulmonary defects were observed and right ventricular thrombus was revealed by dynamic thorax CT. On a follow up period of 16 months the patient is still under treatment and doing well. We present this case because Behçet's disease is a rarely considered cause of recurrent pulmonary embolism and intracardiac thrombus which is seen under treatment.
[show abstract][hide abstract] ABSTRACT: The purpose of this study was to evaluate the usefulness of a new parameter, pleural adenosine deaminase (PADA), for separating transudative pleural effusion from exudative pleural effusion, and to compare the results with other tests (albumin gradient and protein gradient).
From November 2001 to January 2003, 359 consecutive patients with pleural effusion who underwent a diagnostic thoracentesis were included in the study. Effusions were individually classified as transudates or exudates after the careful evaluation of all clinical data and biochemical parameters of pleural fluid and serum of patients on the basis of Light's criteria. The means and standard deviations of PADA, pleural/serum ADA (P/S ADA) ratio, albumin gradient and protein gradient were evaluated for transudative and exudative effusions. The best cut-off values for each test were identified by using the receiver operating characteristic (ROC) curve. The optimum cut-off level was determined by selecting points of test values that provided the greatest sum of sensitivity and specificity.
There were 113 transudates and 246 exudates. For each test, differences in mean value between the transudate group and the exudate group were statistically significant (t test, P<0.001). The optimum cut-off levels for PADA and P/S ADA were 15.3 U/L and 0.66 U/L, respectively. ROC analysis confirmed previous recommendations for albumin gradient (12 g/L) and protein gradient (31 g/L). For detecting exudates, the PADA test yielded a sensitivity and specificity of 85.8% and 82.3%, respectively. Sensitivity and specificity of the albumin gradient were found to be 88.5% and 79.3%, and of the protein gradient 85% and 83.2%, respectively. The areas under the curve (AUC) data and accuracy demonstrated similar discriminative properties in the examined tests.
The measurement of PADA is suggested as a reliable test in the separation of pleural exudates from transudates with accuracy similar to that of the albumin gradient and protein gradient.
[show abstract][hide abstract] ABSTRACT: Gastroesophageal reflux is considered as a factor in pulmonary diseases. The aim of this study was to assess whether gastroesophageal reflux is associated with abnormalities in lung function in patients without respiratory disease.
Forty- four patients with reflux symptoms were studied prospectively. Standardized methods of esophageal manometry and ambulatory 24-h esophageal pH testing were used throughout the study period, along with a standardized reflux and respiratory symptom questionnaire. Spirometric measurements were performed in all patients.
Reflux to distal esophagus was observed in 9 patients, to proximal esophagus in 4 and to both distal and proximal in 20 of the 44 patients. Eleven patients revealed reflux neither to distal nor proximal esophagus. Respiratory function tests of these groups showed no significant differences (p>0.05).
There is no correlation between esophageal acid events and respiratory function tests. There are no data to answer the question of whether or not reflux precedes onset of cough/asthma. Better-designed prospective cohort studies may provide further insight.
The Turkish journal of gastroenterology: the official journal of Turkish Society of Gastroenterology 12/2005; 16(4):199-202. · 0.48 Impact Factor
[show abstract][hide abstract] ABSTRACT: To examine the diagnostic utility of pleural adenosine deaminase (PADA), pleural lactate dehydrogenase (PLDH), and several other biochemical tests in bronchogenic carcinoma and malignant mesothelioma, and to compare biochemical characteristics of their fluid with nonmalignant pleural effusions.
This study consisted of 226 patients diagnosed with malignant (75), tuberculous (65), and parapneumonic pleural effusions (86). We examined the following biochemical parameters in the pleural fluid and serum: adenosine deaminase, lactate dehydrogenase, glucose level, protein level, pleural fluid/serum ADA ratio (P/S ADA), P/S LDH ratio, and P/S protein ratio.
Parapneumonic pleural effusions had a significantly higher level of PLDH and of P/S LDH than malignant and tuberculous pleural effusions (P = 0.000), and malignant pleural effusions had a higher level of PLDH than tuberculous pleural effusions. Tuberculous and parapneumonic effusions had significantly higher levels of PADA than those of malignant effusions (P = 0.000). When the 54 patients having bronchogenic carcinoma were compared to the remaining 21 mesothelioma patients, the former had a lower median level of PADA (P = 0.001) with a higher level of PLDH (P = 0.05).
Our results show that high pleural LDH and low PADA levels are suggestive of pleural effusion due to bronchogenic carcinoma, whereas high levels of PADA alone can be indicative of tuberculous pleural effusion and high levels of both markers can show complicated parapneumonic effusions or empyema.
[show abstract][hide abstract] ABSTRACT: Drug-resistant tuberculosis is a serious problem throughout the world. Resistance to Rifampicin (RIF) is mainly caused by the mutations in the rpoB gene coding the beta-subunit of RNA polymerase. In this study, we aimed to detect the distribution of rpoB gene mutations in 80 RIF-resistant clinical Mycobacterium tuberculosis (MTB) isolates from Turkey. The rpoB gene was amplified by PCR and mutations leading to RIF resistance were determined by automated sequence analysis. A total of 72 of the 80 isolates (90%) were found to carry mutations in the amplified region, whereas eight isolates (10%) carried no mutations. Overall, 24 different missense mutations affecting 14 codons, and two deletion mutants were identified. Nine new mutations, six in the hot-spot region and three outside this region, were found. The codon numbers of the most frequently encountered mutations were 531 (51.4%), 526 (18.1%), 516 (13.9%), and 513 (12.5%). As a result, 90% of the RIF-resistant MTB isolates from the Turkish patients were found to carry a mutation in the rpoB gene, Ser531Leu being the most frequent one. Although molecular methods identify mutations leading to RIF resistance very quickly, results of the antimycobacterial susceptibility tests must be taken into consideration for the patients carrying no mutations in this region.
Microbial Drug Resistance 02/2004; 10(4):325-33. · 2.36 Impact Factor
[show abstract][hide abstract] ABSTRACT: There is a subclinical activation of coagulation and fibrinolysis system in lung cancer. Alterations in hemostatic system are seen frequently in lung cancer correlated with the prognosis of disease. In this prospective study, our purpose was to investigate the prognostic significance of hemostatic markers in patients with lung cancer. The study comprised 58 patients (22 squamous cell carcinoma, 16 adenocarcinoma, 20 small cell carcinoma). There were 55 men (95%)and 3 women (5%) with a mean age of 61 years range (36-74). Plasma level of platelets (PLT), prothrombin time (PT), active partial thromboplastin time (aPTT), antithrombin III (AT III), fibrinogen (F) and D-dimer level were measured before the initiation of any therapy. Patients were followed up for 17 (12-20) months. The median survival was determined as 6.4 months. Three histopathologic groups; squamous cell carcinoma, adenocarcinoma and small cell carcinoma were compared for the hemostatic parameters. There were no statistically significant differences among the histopathologic types for any of the parameters (P > 0.05). Patients were divided into two groups as patients without distant metastasis (stages I,II,III) and with distant metastasis (stage IV). The group with distant metastasis had higher level of D-dimer than the other group (P < 0.05). However, there were no statistically significant differences for D-dimer level between stages IIIB and IV (P > 0.05). Patients having high D-dimer and low AT III level had poor survival in our study. Thus, high level of D-dimer and low AT III level were determined as correlated with short survival (P < 0.05). These results suggest that elevated plasma level of D-dimer and low AT III level might be a sign of poor prognosis in patients with lung cancer.
Respiratory Medicine 02/2004; 98(2):93-8. · 2.59 Impact Factor
[show abstract][hide abstract] ABSTRACT: A 63-year-old woman was admitted to our clinic with arthralgia, microhematuria and a pleural based solid mass in lower lobe basal segment of right lung seen in computerised tomogram of thorax. She was diagnosed as Wegener's granulomatosis by histopathological findings of right thoracotomy, wedge resection and decortication. The patient had positive antineutrophil cytoplasmic antibodies (c-ANCA) in serum and tissue specimens. Histopathologic examination of the renal biopsy specimen revealed the diagnosis of tubulointerstitial nephritis. We report this case because of the unusual histologic type of renal involvement by reviewing the literature.
[show abstract][hide abstract] ABSTRACT: SUMMARY EVALUATION OF INTRATHORACIC GOITER CASES SEEN IN COMPUTERIZED THORAX TOMOGRAPHY Intrathoracic goiters are rare but have to be considered as diagnostic possibility in all mediastinal masses. The aim of this study was to analyze the intrathoracic goiter and to point out the diagnostic problems. In our clinic, for a period of one year (2002-2003) 293 consecutive patients underwent thorax computerized tomography (CT) for different reasons. Int- rathoracic goiter was found in 24 (8.1%) patients. The diagnostic procedures include physical examination, chest radi- ography, thyroid ultrasonography, thyroid scintigraphy, eventually combine with fine needle aspiration biopsy (FNAB) in indicated patients. FT3, FT4 and TSH testing were performed. Intrathoracic goitre was found in 24 (8.1%) patients. Out of 24 patients, 15 had not a definitive diagnosis of thyroid disease until this time. Eleven women and 13 men inc-
[show abstract][hide abstract] ABSTRACT: SUMMARY LUNG CANCER AND PLEURAL EFFUSION (A RETROSPECTIVE ANALYSIS) We analysed retrospectively 96 patients with pleural effusion out of 620 patients with lung cancer in whom diagnosis were established at our clinic in the course at January 1990-December 2000. The series included 84 men (87.5%), 12 women (12.5%), with a mean age of 57.01 ± 10.4 years. The prevalence of smokers were 66%. Of all the cases 15.48 % had pleural effusion; 96.8% were exudate and 3.1% were transudate. Out of 96 patients with pleural effusions, 64 (66.6%) were malignant pleural effusion, 32 (33.3%) were paramalignant. Of the 64 cases with malignant pleural effu- sion; cytology and cytology + pleural biopsy was positive in 60.9%, 9.4% respectively. Although cytology was negative in 29.7% pleural biopsy found positive. Adenocarcinoma was found the leading cause of malignant pleural effusion with 50%. Secondly, small cell carcinoma and epidermoid carcinoma were found with 17.18%.
[show abstract][hide abstract] ABSTRACT: The purpose of this study was to evaluate the level of oxidative stress before and after treatment in asthma patients, and also to define whether erdosteine, a mucolytic agent with antioxidant activity, has an additional benefit to treatment. We analyzed oxidative stress by using malondialdehyde (MDA) level and antioxidant defense system by using superoxide dis- mutase (SOD) activation. We prospectively studied 41 (9 male, 32 female) consecutive mild to moderate asthma patients who were treated in our hospital between August 2003 and February 2004. Patients were divided into two groups ran- domly. The study was planned as double-blinded placebo confirmed study. MDA levels and SOD activity were detected in serum of patients before and after 15 day period of treatment. MDA levels at baseline and after the therapy were found 13.32 ± 8.43 and 11.19 ± 8.76 nmol/mL, and SOD activity were found 7.71 ± 4.04 and 8.20 ± 3.60 U/mL, respective- ly. Although there was no significant increase in the SOD activity after the therapy, we found statistically significant reduc- tion in the level of MDA in each group (p< 0.05). In the patients of group 1 who had taken erdostein and group 2, the differences in SOD activity at baseline and after the therapy were 0.46 ± 2.59 and 0.52 ± 2.77 (p= 0.611), respectively and the differences in MDA level were 2.22 ± 5.02 and 2.03 ± 4.43 (p= 0.72), respectively. As a conclusion; we found