Numan Ekim

Gazi University, Engüri, Ankara, Turkey

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Publications (24)60.16 Total impact


  • No preview · Article · Sep 2015 · European Respiratory Journal
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    ABSTRACT: Introduction: Unnecessary diagnostic tests are usually ordered to most of the patients with dyspnea or pleuritic chest pain, because of the worse outcomes of missed diagnosis of pulmonary embolism (PE). To identify rates and causes of over investigation for PE and to search whether it was possible to reduce this over investigation by using Wells score and Pulmonary Embolism Rule Out Criteria (PERC). Materials and methods: A retrospective observational cohort study performed in an emergency department of a tertiary care university hospital. All patients who were ordered diagnostic with the suspicion of PE were included in the study. They were grouped into two as PE (+) and PE (-) and compared. Results: Among 108 patients, 53 (49%) were diagnosed as PE (+) and overdiagnosis was present in 55 (51%) patients i.e., PE (-). The sensitivity of high Wells score was 43%, specificity 78%, positive predictive value 66% and negative predictive value 59%. PERC criteria found to be negative (when all of the eight criteria were fulfilled) in only five patients. The sensitivity of the test was 98%, specificity 7%, positive predictive value 50%, negative predictive value 80%. When individual parameters of PERC were evaluated solely for the exclusion of PE; "no leg swelling" and "no previous deep venous thrombosis or PE history" were found significantly negatively correlated with PE diagnosis (p= 0.001, r= -0.325 and p= 0.013, r= -0.214 respectively). Conclusion: Over investigation of PE in emergency departments still remains as an important problem. In order to prevent this, the clinical prediction rules must be developed further and their use in combination should be searched in future studies.
    No preview · Article · Mar 2014 · Tuberkuloz ve toraks
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    ABSTRACT: DVT/PE/Pulmonary Hypertension PostersSESSION TYPE: Original Investigation PosterPRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PMPURPOSE: There is limited number of studies regarding the predictive factors for prognosis of Pulmonary thromboembolism (PE), which is a recurrent disease and has many chronicle sequelas. The aim of this study is to investigate the prognosis of PTE (in terms of recurrence, complications, survival and mortality) and factors affecting the prognosis.METHODS: Patients who were hospitalized for PTE between January 1998-January 2010, whose files consisted valid clinical and contact information were involved in the study (n: 245). The information regarding PTE treatment, recurrence, survival, complications and development of malignancy were recorded.RESULTS: Mean treatment time was10.4±13.4 months. Recurrence and mortality rates were 13.0% and 14.3% respectively. Co-existent cancer (HR: 2.711, p=0.04) and immobility (HR: 2.846, p=0.014) were independent predictors of mortality. Atherosclerotic cardiac disease (OR: 2.4, p=0.04) and diagnosis of DVT in follow-up (OR: 23, p=0.0001) were independent predictors of recurrent PE. PE complications like chronic thromboembolic pulmonary hypertension (%0.8) and chronic respiratory failure (%3.7) were more frequently observed in patients with older age, more comorbid conditions and recurrent PE. Malignity was diagnosed in 5.7% of idiopathic cases during the follow up, however this ratio was not different from the patients with risk factors for PE.CONCLUSIONS: Pulmonary thromboembolism is an important disease with high mortality rate and severe complications.CLINICAL IMPLICATIONS: To improve the personal and financial outcomes of the disease all risk factors affecting the prognosis (recurrence, complications and mortality) should be investigated to develop more effective treatment and follow-up strategies.DISCLOSURE: The following authors have nothing to disclose: Fusun KolatKirkpantur, I.Kivilcim Oguzulgen, Numan EkimNo Product/Research Disclosure Information.
    No preview · Article · Oct 2013 · Chest
  • Ayhan Varol · N. Köktürk · Hatice Kilic · M. Aydoǧdu · Numan Nadir Ekim
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    ABSTRACT: Aim: To identify the quantitative D-dimer levels in pulmonary thromboembolism (PTE) and hospitalized-community acquired pneumonia (CAP) patients, and to determine the alteration of D-dimer levels with anticoagulant or antibacterial therapy. It is not well known that the quantitative analysis of D-dimer has a role in the differential diagnosis of PTE from other diseases. Materials and methods: Serum D-dimer levels were measured and compared prospectively with a latex-enhanced immunoturbidimetric method at admission, before initiating any antibiotic or anticoagulant therapy and then at days 3, 10, and 30 of treatment in PTE and CAP patients. Results: A total of 80 patients (45 PTE and 35 CAP), with a mean age of 61 ± 16 years, were included in the study. Mean D-dimer levels at admission were significantly higher in the PTE group than in the CAP group (3388 ± 2080 vs. 1190 ± 1089 N/L, P = 0.001). After initiating the anticoagulant therapy, a significant decrease in D-dimer levels was identified in the PTE group, but not in the CAP group, on day 3 (678 ± 652 μ/L vs. 724 ± 907 μ/L). In the receiver operating characteristic curve analysis, D-dimer levels of>1700 μ/L were statistically significant as a cut-off value for the diagnosis of PTE (AUC: 0.820; 95% CI: 0.73-0.92). Conclusion: Although serum quantitative D-dimer levels cannot be used solely for the differential diagnosis of CAP and PTE, they might be helpful in making the decision to perform further diagnostic methods. Since D-dimer levels decreased more rapidly and significantly in PTE than CAP cases, they might be used as a marker for monitoring the treatment response in patients with PTE, but this must be proven with more comprehensive studies.
    No preview · Article · Aug 2012 · Turkish Journal of Medical Sciences
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    ABSTRACT: Electrocardiography (ECG) is a simple, valuable and easily applicable test that can be used in supporting the diagnosis and assessing the severity of pulmonary thromboembolism (PTE). In this study, it was aimed to identify the role of ECG scoring in diagnosis and follow up of PTE in comparison with community acquired pneumonia (CAP). Methods: Patients with the diagnosis of PTE and CAP were included in the study prospectively between January 2007 and January 2009. ECG scorings were evaluated by two different cardiologists by the method described by Daniel et al at admission (day 0) and day 3, 10 and onemonth of treatment. Median values of ECG scorings were compared between days and between groups. Results: Forty-five patients with PTE, 35 patients with CAP were included in the study. Although no statistically significant difference was identified between the ECG scorings of the two groups in each measurement point, ECG scores decreased more rapidly in PTE group within days. Within the PTE group, day 0 ECG score was identified higher in submassive patients than nonmassive ones (p=0.001). Conclusions: Although ECG score did not differentiate PTE fromCAP, depending on its rapid decrease in PTE, it can be used in the follow up. For submassive PTE patients that must be diagnosed and treated immediately, ECG scorings can be used to support the diagnosis and to assess the clinical severity.
    No preview · Article · Jul 2012 · Hong Kong Journal of Emergency Medicine
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    ABSTRACT: Background and Aim: Pulmonary embolism (PE) is a common and serious disease that can result in death unless emergent diagnosis is made and treatment is initiated. In this study, we aimed to identify whether there is still a delay in the diagnosis of PE and to identify the time to delay in diagnosis and factors leading to this delay. Methods: This is a prospective observational cohort study performed in an emergency department (ED) of a tertiary care university hospital between September 2008 and September 2010. The rate and cause of delay in diagnosis were analyzed among patients with PE. The "delay" was defined as diagnosing after first 24 hours of symptom onset. Results: Among the 53 patients who were diagnosed with PE, a delay in diagnosis was present in 49 (93%) of them. Total delay time was 6.8 ± 7.7 days. In 33 (62%) patients, there was a delay of 4.6 ± 6.5 days due to patient-related factors. Delay in diagnosis after admission to hospital was 2.2 ± 2.9 days in 40 (75%) patients. In multivariate regression analysis, being female and having chest pain and cough were identified as significant factors causing patient-related delay. Unilateral leg edema, recent operation, and previous venous thromboembolism (VTE) history were the significant factors causing PE diagnosis without a delay. On the other hand, systemic hypertension as comorbidity was the only factor leading to physician-related delay. Conclusion: The delay in diagnosis of PE in EDs still remains as an important problem. While being female and having chest pain and cough are significantly and independently associated with patient delay in diagnosis, the unilateral leg edema, recent operation, and previous VTE history cause physicians to diagnose on time. On the other hand, having hypertension as comorbidity may lead to physician delay. In order to prevent the delay in diagnosis, hospital-associated factors must be elucidated totally and more interventions must be made to increase public and professional awareness of the disease.
    No preview · Article · Apr 2012 · Clinical and Applied Thrombosis/Hemostasis
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    ABSTRACT: The aim of this study is to evaluate the plasma total homocysteine level in patients with venous thromboembolism (VTE) and to investigate the effect of different risk factors on plasma levels. Ninety-three-patients with VTE and 37-control participants diagnosed with other than VTE were included in the study. Plasma homocysteine levels and the factors affecting plasma homocysteine levels were evaluated. Plasma homocysteine level was higher among patients with VTE compared to the controls independent from vitamin B12 and folate levels. The prevalence of hyperhomocysteinemia in VTE was 63%. Plasma homocysteine level was higher in patients with PE than deep venous thrombosis (DVT; 23 ± 13.7 vs 16 ± 5.8 μmol/L, P = .018). With regression analysis hyperhomocysteinemia was found to be associated with a 4.8-fold increased risk of VTE. Hyperhomocysteinemia is a common and possibly modifiable risk factor that should be considered when screening patients with VTE. Secondary causes of hyperhomocysteinemia especially vitamin B12 deficiency should be monitored in patients with VTE to prevent recurrences.
    Full-text · Article · Oct 2011 · Clinical and Applied Thrombosis/Hemostasis
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    ABSTRACT: Presence of high fever may cause confusion in differential diagnosis of pulmonary embolism (PE) versus pneumonia. The aim of this study is to investigate the diagnostic value of serum procalcitonin (PCT) in differential diagnosis of PE and community-acquired pneumonia (CAP). A total of 24 patients with proven PE and 22 patients with CAP were included in the study. The study population was subdivided as PE patients with fever (group 1, n = 8) and without fever (group 2, n = 16); and CAP (group 3, n = 22). Serum PCT and systemic inflammatory markers were measured at the initial diagnosis and the third day of the treatment. The relation of PCT level with the other systemic inflammatory markers was investigated in each measurement point. The initial mean serum PCT level in group 3 (2.24 ± 0.99 ng/mL) was statistically higher than group 1 (0.48 ± 0.77 ng/mL) and group 2 (0.14 ± 0.17 ng/mL; P = .000, .000, respectively). Procalcitonin level at the initial (2.24 ± 0.99 ng/mL) and the third day of treatment (0.92 ± 0.62 ng/mL) in group 3 showed a statistically significant reduction (P = .000). There were no statistically significant reduction in PCT levels by anticoagulation in groups 1 and 2 (P = .262, .119, respectively). Other systemic inflammatory markers including interleukin 6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor α (TNF-α) levels statistically significantly decreased with anticoagulant and antimicrobial therapy. This study suggested that serum PCT level may be valuable for differentiating PE patients with or without fever from patients with CAP.
    Full-text · Article · Oct 2011 · Clinical and Applied Thrombosis/Hemostasis
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    ABSTRACT: Severe community-acquired pneumonia (CAP) is an important cause of intensive care unit (ICU) admissions. Many different pneumonia scoring systems have been developed in order to assess the severity of pneumonia and to decide the ICU follow-up and treatment. But still debate is going on about their performances and also they have not been tested yet if they can predict ICU mortality in severe CAP patients requiring mechanical ventilation. The aim of this study is to evaluate the performances of pneumonia and ICU scores in predicting mortality in CAP patients requiring mechanical ventilation. A retrospective observational cohort study. The files of mechanically ventilated CAP patients were reviewed and demographic, clinic and laboratory characteristics were recorded. Scoring systems of pneumonia [revised American Thoracic Society (ATS) criteria, CURB-65, pneumonia severity index (PSI)] and ICU [Acute Physiology Assessment and Chronic Health Evaluation (APACHE) II, Sequential Organ Failure Assessment] were compared for mortality prediction. Thirty eight female and 63 male, a total of 101 severe CAP patients, with the mean age of 68 +/- 16 years, were included in the study. ICU mortality rate was assessed as 55%. Ninety percent of all patients met the revised ATS criteria and 92% of them met the PSI scoring system for ICU admissions. Although the CURB-65, PSI, revised ATS criteria were not found valuable to predict mortality, the increased APACHE II score was found to be related with increased mortality rate (for APACHE II > 20 odds ratio: 3, 95% CI: 1.2-7, p= 0.024). These results suggest that instead of the pneumonia scoring systems the APACHE II score can best predict the ICU mortality. So, more attention should be paid for severe CAP patients with APACHE II score > 20.
    Full-text · Article · Jan 2010 · Tuberkuloz ve toraks
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    ABSTRACT: Polymorphism in plasminogen activator inhibitor-1 gene is suggested to be associated with an increased risk of venous thromboembolism. The aim of this study was to investigate the association of plasminogen activator inhibitor-1 gene polymorphism and its coexistence with factor-V-Leiden and prothrombin-20210 mutations in pulmonary thromboembolism. The authors investigated plasminogen activator inhibitor-1 4G/5G polymorphism, factor-V-Leiden, and prothrombin-20210 mutations in 143 pulmonary thromboembolism patients and 181 controls. Plasminogen activator inhibitor-1 4G/4G, 4G/5G, and 5G/5G gene polymorphisms and prothrombin-20210 mutations were not different between cases and controls. Factor-V-Leiden mutation was present in 21.0% and 7.7% of the cases and controls, respectively, P = .001. Neither different plasminogen activator inhibitor-1 genotypes and 4G allele nor coexistence of the allele with factor-V-Leiden or prothrombin-20210 was associated with the risk of recurrence. As a result, plasminogen activator inhibitor-1 gene polymorphism or its concomitant presence with mentioned mutations was not found to be associated with increased risk for pulmonary thromboembolism or recurrent disease in this study.
    No preview · Article · Jan 2008 · Clinical and Applied Thrombosis/Hemostasis
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    ABSTRACT: Foreign body aspiration has a wide range of outcomes, including immediate resolution, acute asphyxia, recurrent pulmonary disease and death. A 52-year-old man was misdiagnosed with asthma and pneumonia for 6 months. A thoracic computed tomography (CT) scan showed an endobronchial lesion in the right main bronchus. Fiberoptic bronchoscopy was performed and the teeth were detected in the right main bronchus, in addition to tracheal bronchus. Aspirated teeth were removed using a rigid bronchoscope under general anesthesia. The patient having a trauma should always be carefully and systematically examined for foreign bodies. A rapid diagnosis depends on high clinical suspicion, clinical signs and radiological findings and the clinician must be aware of all complications of foreign body aspiration.
    No preview · Article · Jan 2008 · Dental Traumatology

  • No preview · Article · Oct 2007 · Chest
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    ABSTRACT: Pulmonary embolism (PE) is a major health problem associated with a significant morbidity and mortality. Immediate recognition of submassive and massive cases is extremely important in order to commencement of early and appropriate therapy that could be life saving. The aim of this study was to assess the ability of two scoring systems, electrocardiography (ECG) and simplified Wells (sWells) clinical scorings in predicting anatomic severity of PE. Hence, ECG and sWells scorings were combined in order to test the hypothesis if this new scoring does enhance the prediction of severity. Fifty six patients with proven PE with high (50 patients) and moderate (six patients)-probability of ventilation/perfusion (V/Q) scan were retrospectively studied. Baseline ECGs were analysed by two independent observers in order to constitute ECG scorings. Baseline sWells scores were also calculated. Anatomic severity of PE was calculated by scintigraphically and categorized into mild (<50% perfusion defect) (group 1), and severe (50% perfusion defect) (group 2) diseases. The mean of ECG scores, sWells scores and the combined scores were 5.23+/-3.42 and 5.85+/-3.82; 6.60+/-1.88 and 7.03+/-2.40; and 10.73+/-3.60 and 11.60+/-4.32 in groups 1 and 2, respectively (p>0.05). An ECG score of 6.5 predicted severe disease (perfusion defect 50%) with a sensitivity of 41.7% and a specificity of 82%). sWells and combined scores did not provide better sensitivity or specificity values based on ROC curve analysis. Our results indicated that ECG scoring could be valuable test in predicting anatomic severity of PE, adding sWells scoring to ECG scoring did not provide any beneficial effect.
    Preview · Article · Jul 2007 · Respiratory Medicine
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    ABSTRACT: Hemoptysis is an important symptom that requires broad evaluation, including invasive procedures. Nevertheless, in a considerable number of patients, the cause of hemoptysis may not be adequately determined despite extensive investigations. Factitious hemoptysis is a manifiestation of Munchausen syndrome that describes a group of patients who intentionally produce or feign symptoms or disabilities. Although the disorder is rare, it is believed to be under recognized and under reported. Therefore, there is an urgent need for increased awareness of the disease in order to avoid unnecessary, expensive and sometimes dangerous medical treatment and manipulations. We report a case of Munchausen hemoptysis as a reminder that factitious origins should be added in the differential diagnosis of hemoptysis of unclear etiology.
    No preview · Article · Mar 2006 · Southern Medical Journal
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    ABSTRACT: Cryptococcus neoformans is a widely distributed saprophytic fungus that may cause opportunistic infections in normal and immunocompromised individuals particularly in patients with HIV infection. Disseminated infection in HIV-negative individuals is occasionally seen: a 57-year-old HIV-negative Turkish female initially presented with enlarged mediastinal lymph nodes and a large pulmonary parenchymal nodule, eventually diagnosed with disseminated cryptococcosis and tuberculosis.
    No preview · Article · Aug 2005 · Mycoses
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    ABSTRACT: This study was planned to investigate the characteristics of clinical and laboratory findings of patients with fever diagnosed as pulmonary embolism (PE) in comparison with PE patients without fever and patients with community-acquired pneumonia (CAP). Thirty-nine PE patients with fever without other identifiable causes (18 received antibiotics and 21 did not receive antibiotics) (study groups) were included in the study. 22 patients with PE without fever and 21 patients diagnosed with CAP were retrospectively selected as control groups. Daily peak body temperature, risk factors for PE, symptoms, and physical and laboratory findings at admission were recorded. Patients with CAP demonstrated higher body temperature than PE patients with fever (38.5+/-0.6 versus 37.8+/-0.6 degrees C, P=0.0001). Fever patterns were similar between the three groups of patients who had fever. The leukocyte count and the erythrocyte sedimentation rate (ESR) were slightly higher in the group of PE with fever versus PE without fever (11,465.6+/-4229.4/mm, 51.1+/-34.7/mm/h versus 10,777.3+/-4927.6/mm, 35.2+/-30.1/mm/h, respectively) (P>0.05). The group of CAP showed significantly highest values of leukocyte count and ESR (15,490.5+/-5606.3/mm, 69.1+/-35.9/mm per h, respectively) (P<0.05). This study suggested that fever might accompany with PE. The presence of slight leukocytosis and increased ESR may not securely differentiate PE patients with fever from patients with CAP.
    No preview · Article · Aug 2005 · Blood Coagulation and Fibrinolysis
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    ABSTRACT: In order to better define the clinical characterization of pulmonary embolism (PE) in the elderly, the clinical and laboratory findings were compared in older (> or = 65 years old) and younger (< 65 years old) patients. The study group comprised 149 patients (58 older and 91 younger) who received a final diagnosis of PE and were retrospectively evaluated. The severity of PE was assessed by calculating the pulmonary vascular obstruction scores (PVOs) scintigraphically: PVOs > or = 50% was defined as severe disease. Dyspnea was the most frequent symptom in both groups. Chest pain and hemoptysis were less frequent in older patients (48.3% vs 79.1%, p = 0.001; 6.9% vs 20.9%, p = 0.021, respectively) whereas syncope occurred more often in the older group (27.6% vs 9.9%, p = 0.005). PVOs > or = 50% occurred in 55.1% of older and 32.9% of younger patients (odds ratio: 1.67, 95%confidence interval: 1.118-2.507, p = 0.013). The clinical presentation of PE can be subtle or atypical in elderly patients and hence they may have more severe disease. Therefore, a high clinical suspicion is required in order to prevent delays in diagnostic work-up and initiation of appropriate treatment.
    No preview · Article · Aug 2005 · Circulation Journal
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    ABSTRACT: Certain clinical findings raise the suspicion of pulmonary embolism (PE) and may be useful in selecting patients for further diagnostic testing. Three prediction rules for PE have been described recently: Wells' rule (WR), Geneva rule (GR) and Miniati' rule (MR). The aim of present study is to compare the predictive accuracy of the three methods on the basis of our patients' results. Eighty-five patients admitted to our department with suspicion of PE were included into the study. Sixty-three patients were discharged with the diagnosis of PE, whereas in 22 patients, the initial PE diagnosis was ruled out. The three methods for assessing the clinical probability of PE classified similar proportions of patients into the low, intermediate and high clinical probability categories. The frequencies of PE in each method (WR, GR and MR) were 5%, 64% and 14% in the low category, 90%, 80% and 75% in the intermediate category and 100%, 100% and 94% in the high category (p = 0.001, 0.064, 0.001) respectively. When we compared the performances of WR and GR, including all possible total score values, the area under the ROC curve (AUC) was 0.99 for the WR (p= 0.001) and 0.74 for the GR (p= 0.001). When we used only the three probability categories (low, intermediate, high), AUC was 0.96 for the WR (p= 0.001), 0.64 for the GR (p= 0.04), and 0.7 for the MR (p= 0.005). In conclusion, the present study indicates that clinical assessment is a fundamental step in the diagnostic work-up of PE. The Wells' method performs better than other two methods.
    No preview · Article · Feb 2005 · Tuberkuloz ve toraks
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    ABSTRACT: Background: Tissue-plasminogen activator is a key protein of fibrinolytic system. In recent years the relation between t-PA, its genetic polymorphisms and arterial or venous thrombosis were investigated in different populations. The aim of this study is to investigate the role of t-PA gene polymorphism in Turkish venous thromboembolism (VTE) patients. Methods: A case-control study was performed. We investigated the t-PA insertion/deletion (I/D) polymorphism in 93 VTE patients and 146 controls without VTE. Recurrent cases and documented risk factors for PTE were recorded. Results: Cases and controls did not differ with respect to the different t-PA genotypes. The prevalence of I allele was 44.1%, 44.5% in cases and controls respectively (OR = 0.95, 95% CI: 0.78-1.24, p > 0.05). Different t-PA genotypes had no effect on recurrent disease. No gender difference was observed with respect to the different t-PA genotypes. There was no significant difference for genotype frequency between PTE patients with documented risk factors and unprovoked cases. Conclusions: In conclusion there was no association between t-PA genotype and VTE in this group of Turkish population. It was also found that genotype frequencies for t-PA in both VTE and control subjects seems different from those reported from western part of the world.
    No preview · Article · Feb 2005 · Journal of Thrombosis and Thrombolysis

  • No preview · Article · Sep 2004 · Thrombosis and Haemostasis