[Show abstract][Hide abstract] ABSTRACT: Pulmonary embolism (PE) is a major cause of cardiovascular mortality and financial burden that affects the community. The diagnosis of PE can be difficult because of the nonspecific symptoms, which include cough, dyspnea, hemoptysis and pleuritic chest pain. Hereditary and acquired risk factors are associated with PE. Incidence of PE is increasing, associated with the development in the diagnostic methods. Evidence-based algorithms can help clinicians diagnose PE. Serum D-dimer level, computed tomography pulmonary angiogram (CTPA), ventilation-perfusion scintigraphy or echocardiography help to establish clinical probability and the severity of PE. Anticoagulation is the standard treatment for PE. However, thrombolytic treatment is a significant alternative in high risk of PE as it provides rapid clot resolution. This article reviews the risk factors, diagnostic algorithms, and methods of treatment in PE in the light of current information.
Archives of Medical Science 06/2014; 10(3):557-65. DOI:10.5114/aoms.2013.34325 · 2.03 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Epigenetic defines long-lasting changes in gene expression independently from DNA sequence. Current evidence revealed that epigenetic mechanisms may have role into immune response and asthma. The purpose of this article is to review basic epigenetic mechanisms in asthma.
Tuberkuloz ve toraks 06/2014; 62(2):165-9. DOI:10.5578/tt.6818
[Show abstract][Hide abstract] ABSTRACT: Background
Clinical parameters, biomarkers and imaging-based risk stratification are widely accepted in pulmonary embolism(PE). The present study has investigated the prognostic role of simplified Pulmonary Embolism Severity Index (sPESI) score and the European Society of Cardiology (ESC) model.
This prospective cohort study included a total of 1078 patients from a multi-center registry, with objectively confirmed acute symptomatic PE. The primary endpoint was all-cause mortality during the first 30 days, and the secondary endpoint included all-cause mortality, nonfatal symptomatic recurrent PE, or nonfatal major bleeding.
Of the 1078 study patients, 95 (8.8%) died within 30 days of diagnosis. There was no significant difference between non-low-risk patients ESC [12.2% (103 of 754;)] and high-risk patients as per the sPESI [11.6% (103 of 796)] for 30-day mortality. The nonfatal secondary endpoint occurred in 2.8% of patients in the the sPESI low-risk and 1.9% in the ESC low-risk group. Thirty-day mortality occurred in 2.2% of patients the sPESI low-risk and in 2.2% the ESC low-risk group (P=NS). In the present study, in the combination of the sPESI low-risk and ESC model low-risk mortality rate was 0%.
The sPESI and the ESC model showed a similar performance regarding 30-day mortality and secondary outcomes in the present study. However, the combination of these two models appears to be particularly valuable in PE.
Thrombosis Research 06/2014; 133(6). DOI:10.1016/j.thromres.2014.02.032 · 2.45 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: YKL-40 (chitinase-3-like-1) has been introduced as a marker of inflammation in asthma. The aim of this study was to determine the role of YKL-40 in asthma and to evaluate the relationship between YKL-40 and asthma severity.In the study, 60 non-smoker asthma patients without additional diseases (aged between 20-60 years, female: 34) were grouped [Group I: Well controlled asthma patients (n: 30), Group II: Patients during acute exacerbation of asthma (n: 30)]. Healthy non-smoker female individuals were included in Group III (n: 30) as a control group. The level of serum YKL-40 of all groups were determined by ELISA. Also, serum YKL- 40 level was correlated with age, asthma duration in years, body mass index (BMI), forced expiratory volume in first second/ forced vital capacity (FEV1/FVC, %), FEV1 (%), and total IgE levels of asthma patients. Mean serum YKL-40 level was highest in patients during acute exacerbation of asthma (36.36±10.49 ng/ml) while mean serum YKL-40 level was the lowest (13.20±5.60 ng/ml) in the control group. There was a negative significant correlation between the serum YKL-40 levels and FEV1 (%) in patients during acute exacerbation of asthma. There were no significant correlations between the serum YKL-40 levels and other variables in group II.We found that increased serum YKL-40 levels may be used as a marker for evaluation of asthma severity and genetic polimorphism.
Iranian journal of allergy, asthma, and immunology 09/2013; 12(3):247-53. · 0.99 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Symptomatic thoracic aortic aneurysms (TAA) are rare. A 72 year-old man was admitted to our chest disease clinic suffering from back pain for the past two years. Posteroanterior chest X-ray showed left hilar enlargement. Computerised thorax tomography (CTT) images were taken and a saccular TAA 8 cm in diameter was found. An endovascular stent graft was successfully implanted in the patient. In this paper, we aim to show that TAA should be considered as a differential diagnosis of patients with chronic back pain and hilar enlargement.
[Show abstract][Hide abstract] ABSTRACT: Objective: Unlike seasonal influenza, seen in previous years, the strain identified in the 2009 influenza-A pandemic involved high mortality. In this study, prognostic factors and general characteristics of pneumonia cases developed in Turkey during the H1N1 pandemic between October 2009 and January 2010 were analyzed. Study Design: Multicenter retrospective study. Material and Methods: This multicentric retrospective study was conducted between August and October 2010 and patients' data were collected by means of standard forms. Results: The study included 264 pneumonia cases, collected from 14 different centers. Mean age was 47.5 +/- 18.6 years. Nineteen patients (7.2%) were pregnant or had a new birth and comorbid diseases were detected in 52.3% of all patients. On admission, 35 (13.8%) cases had altered mental status. Overall, 32.6% were treated in intensive care units (ICU) and invasive/non-invasive mechanical ventilation was performed in 29.7%. The mean duration of ICU stay was 2.9 +/- 6.2 and total hospital stay was 12.0 +/- 9.4 days. Mortality rate was 16.8% (43-cases). The length of ICU treatment, total hospital stay, and mortality were significantly higher in H1N1-confirmed patients. Mortality was significantly higher in patients with dyspnea, cyanosis, and those who had altered mental status on admission. Patients who died had significantly higher rate of peripheral blood neutrophils, lower platelet counts, higher BUN, and lower SaO(2) levels. Conclusion: This study showed that pneumonia developed during H1N1 pandemic in our country had resulted in a high mortality. Mortality was especially high among patients with cyanosis, altered mental state and those with lower SaO(2).
Balkan Journal of Medical Genetics 03/2013; 30(1):68-73. DOI:10.5152/balkanmedj.2012.089 · 0.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Chitinase enzymes that hydrolize chitin and some articficial substrates are expressed in human despite lacking of the endogenous chitin within the body. Chitinases phatophysiological functions within human are not fully known. Recent evidence revealed that chitinases may have role into some processes of immune responses and inflammatory system. In this review, we discuss the role of chitinases in lung diseases based on the available information from the literature.
[Show abstract][Hide abstract] ABSTRACT: Background and purpose:
We aimed to underline the importance of serum S100B protein as a useful biochemical marker in patients with obstructive sleep apnea syndrome (OSAS).
Material and methods:
Forty-three newly diagnosed patients with OSAS (median apnea-hypopnea index [AHI, events/ hour]: 37.5 [range 11.3-137]) and 25 subjects with AHI < 5 (median AHI: 4.4 [range 0.7-4.8]) were included in the study. Serum S100B protein level was tested in serum samples taken after polysomnography in both groups and the difference between OSAS patients and the control group regarding that level was assessed. In addition, the association of S100B protein serum level with age, body mass index, AHI, mean O2 saturation percentage during sleep, minimum O2 saturation value (%) at the end of the apneas, and the time spent at an O2 saturation less than 90% were analyzed in the OSAS patient group.
Median serum S100B protein level was 133.7 pg/ mL (range 20.97-230.70 pg/mL) in patients with OSAS and 16.1 pg/mL (range 10.1-22.9 pg/mL) in the control group (p < 0.005). Serum S100B protein level did not correlate with any studied variable (p > 0.05 for each correlation coefficient).
Serum S100B protein level is increased in patients with OSAS and may be a useful biochemical marker in those patients.
Neurologia i neurochirurgia polska 11/2012; 46(5):450-455. DOI:10.5114/ninp.2012.31355 · 0.64 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective: The first influenza virus pandemic of the 21st century began in Mexico in 2009 and spread rapidly all over the world. We described the clinical and epidemiologic characteristics of the 31 patients admitted to the Deparment of Chest Disease due to influenza A (H1N1) virus infection. Material and Method: In this study we evaluated 51 patients with high clinical suspicion for Influenza A (H1N1) virus infection. We used real time reverse transcriptase chain reaction test (RT-PCR) test for diagnosis. Thirty-one (15 female, 16 male) of 51 patients RT-PCR test were positive for Influenza A (H1N1) virus infection. Demographic features, clinical and laboratory characteristics of these patients were assessed. Results: The mean age of Influenza A (H1N1) virus infected patients was 40.8±13.1. Cough was the most common symptom (90%) and 11 patients (35%) had pneumonia. Leucopenia (48.3%), C reactive protein elevation (90.3%) and creatine phosphokinase elevation (71%) were notable laboratory findings. T and B lymphocyte subgroups were also evaluated and compared with Turkish adult normals. Lymphocyte subgroups were not different in the patients with influenza A (H1N1) virus statistically. Conclusion: Influenza virus may cause pandemias with different subgroups. Although most Influenza A (H1N1) virus infected patients hospitalized in our clinic had progressed well but pulmonary complications should be considered.
Turk Toraks Dergisi 06/2012; 13(13). DOI:10.5152/ttd.2012.11
[Show abstract][Hide abstract] ABSTRACT: With this study, we aimed at evaluating demographic data, clinical, laboratory findings in pulmonary embolism (PE) and the relationship of these findings with the embolism location region and responses of the patients to the treatment of the embolism in order to contribute to the patient management in decreasing mortality.
Clinical findings, accompanying diseases, risk factors, serum D-dimer and creatinine levels, imaging modalities and mortality rates of 205 patients (female: 98, male: 107) diagnosed with PE were examined retrospectively. The relationship between the qualifier variables was evaluated using Chi-square test.
Average age of the patients was 61.55±14.44 years and 86 (42%) patients were above 65 years. Most common complaint was dyspnea (85%), most frequent coexisting disease was congestive heart failure (19%). Deep vein thrombosis (DVT) (30.7%) was the most frequently seen risk factor. Pulmonary embolism was mostly in the right lobe pulmonary artery (32.1%). It was observed that the higher ages of patients the more frequency of proximal located embolism was (p<0.005), especially lobar artery involvement was observed to be high (p=0.032). An early mortality rate was 4.9% and late mortality rate was 11.2%.
In the patients with complaint of dyspnea who are at elder ages and have accompanying diseases, PE should be considered. PE is generally localized in the main pulmonary arteries, which emphasizes crucial importance of early diagnosis and treatment in reduction of mortality.
Anadolu kardiyoloji dergisi: AKD = the Anatolian journal of cardiology 03/2012; 12(2):142-9. DOI:10.5152/akd.2012.040 · 0.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study was designed to evaluate the levels of hepcidin in the serum of patients with chronic obstructive pulmonary disease (COPD).
In the study, 74 male patients (ages 45-75) in a stable period for COPD were grouped as Group I: Mild COPD (n:25), Group II: Moderate COPD (n:24), and Group III: Severe COPD (n:25). Healthy non-smoker males were included in Group IV (n:35) as a control group. The differences of hepcidin level among all the groups were examined. Also, in the patient groups with COPD, hepcidin level was compared with age, body mass index, cigarette (package/year), blood parameters (iron, total iron binding capacity, ferritin, hemoglobin, hematocrit [hct]), respiratory function tests, and arterial blood gas results.
Although there was no difference between the healthy control group and the mild COPD patient group (P=0.781) in terms of hepcidin level, there was a difference between the moderate (P=0.004) and the severe COPD patient groups (P=0.002). The hepcidin level of the control group was found to be higher than the moderate and severe COPD patient groups. In the severe COPD patients, hepcidin level increased with the increase in serum iron (P=0.000), hct (P=0.009), ferritin levels (P=0.012), and arterial oxygen saturation (SaO(2), P=0.000).
The serum hepcidin level that is decreased in severe COPD brings into mind that it may play a role in the mechanism to prevent hypoxemia. The results suggest that serum hepcidin level may be a useful marker in COPD. Larger prospective studies are needed to confirm our findings between hepcidin and COPD.