Publications by authors named "Ömer Araz"

69 Publications

Association of plasma netrin-1 level with inflammatory balance and comorbidities in patients with acute exacerbation of COPD.

Tuberk Toraks 2021 Mar;69(1):30-38

Department of Chest Diseases, Atatürk University Faculty of Medicine, Erzurum, Turkey.

Introduction: Chronic obstructive pulmonary disease (COPD) is a common lung disease characterized by airflow restriction and systemic inflammation. Netrin-1 is a protein mainly produced in the central nervous system and has proven anti-inflammatory activity. The aim of this study was to determine netrin-1 level and its relationship with comorbidities in patients with acute exacerbation of COPD.

Materials And Methods: The study included 232 patients aged over 40 years who were divided into 3 groups: Group 1: ex-smokers (≥ 20 pack-years) with COPD hospitalized for COPD exacerbation (n= 142), Group 2: current-smokers (≥ 20 pack-years) without COPD (n= 30), Group 3: a control group comprising healthy non-smokers (n= 60). Plasma netrin-1 levels were measured using commercial enzyme-linked immunosorbent assay (ELISA) kit.

Result: There were significant differences in forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC, C-reactive protein (CRP), and plasma netrin-1 levels between patients with acute exacerbation of COPD and current smokers without COPD, healthy controls (p= 0.001 for all). Netrin-1 levels at discharge were lower in COPD patients with diabetes mellitus (DM) compared to nondiabetic COPD patients (p= 0.01). Weak correlation was observed between netrin-1 level at admission and FEV1, FVC, partial pressure of oxygen, and CRP levels (r= 0.394, p= 0.01; r= -0.366, p= 0.01; r= -0.19, p= 0.05; r= 0.306, p= 0.01). Netrin-1 level at admission was also moderately correlated with smoking history (pack-years) (r= 0.579, p= 0.01).

Conclusions: Netrin-1 was elevated in acute exacerbation of COPD and may be an important element in inflammatory balance. Patients with both COPD and DM were found to have lower netrin-1 levels at discharge after resolution of the acute exacerbation.
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http://dx.doi.org/10.5578/tt.20219904DOI Listing
March 2021

A rare cause of pulmonary oedema: buried under an avalanche.

Br J Hosp Med (Lond) 2020 Dec 30;81(12). Epub 2020 Dec 30.

Department of Thoracic Surgery, Ataturk University, Erzurum, Turkey.

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http://dx.doi.org/10.12968/hmed.2020.0418DOI Listing
December 2020

Evaluation of the relationship of serum vitamin D levels in COVID-19 patients with clinical course and prognosis.

Tuberk Toraks 2020 Sep;68(3):227-235

Department of Pulmonary Diseases, School of Medicine, Ataturk University, Erzurum, Turkey.

Introduction: SARS-CoV-2 (COVID-19), which emerged in Wuhan, China in December 2019, infected more than six million people in a short time. In COVID-19, the relationship of many laboratory parameters to morbidity and mortality has been defined. In our study, we aimed to determine the relationship of serum vitamin D level to clinical course and prognosis.

Materials And Methods: This study included 108 patients; 88 patients who stayed in Ataturk University and Erzurum City Hospital between March 24, 2020 and May 15, 2020, who were identified as COVID-19 by real-time PCR method from the nasopharyngeal swab and 20 asymptomatic voluntary medical personnel who tested negative for real-time PCR after routine check-up in our hospital.

Result: In statistical analysis conducted between healthy control group and vitamin D levels of patients admitted due to COVID-19, it was observed that patients infected with COVID-19 had a lower level (p= 0.004). In 20 patients developing MAS, a lower level of vitamin D was observed (p= 0.004) compared to 68 patients who did not develop. In the comparison of vitamin D levels of the patients (n= 8) who developed exitus in their follow up due to COVID-19, it was observed that vitamin D levels were statistically significantly lower compared to the living (p= 0.009).

Conclusions: Due to COVID-19, pandemic, long-running quarantines caused insufficient use of sunlight and worsening of vitamin D deficiency. We wanted to draw attention again with our study to vitamin D which can be responsible for the heavy clinical course of COVID-19 and whose replacement is easy to apply.
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http://dx.doi.org/10.5578/tt.70027DOI Listing
September 2020

[Mortality prediction ability of phycians in intensive care units of Turkey (MOPAP)].

Tuberk Toraks 2020 Sep;68(3):205-217

Clinic of Chest Diseases, Hakkari State Hospital, Hakkari, Turkey.

Introduction: Intensive care physicians are increasingly involved in decision making about the prognosis of intensive care unit ICU patients. With this study; we aimed to evaluate the power of clinician foresight at prediction of mortality in patient at triage to intensive care and patient follow-up.

Materials And Methods: This study was conducted in ICUs located in various geographical regions of Turkey between January 1, 2017-April 30, 2017.The clinical research was planned as observational, multicenter, cross-sectional.

Result: A total of 1169 intubated patients were followed in 37 different ICU. At the beginning of the follow-up we asked the physician who will follow the patient in the ICU to give a score for the probability of survival of the patients. Scoring included a total of 6 scores from 0 to 5, with the "0" the worst probability "5" being the best. According to this distribution, only 1 (0.9%) of 113 patients who were given 0 points survived. Three (6.1%) of 49 with the best score of 5 died. Survival rates were significantly different in each score group (r: -0.488; p<0.001). After the combined mortality estimation scores based on the clinical observations of the physicians (0 and 1 point score was combined as non-survive, 4 and 5 score was combined as survived) 320 of the 545 patients were estimated to be dead and 225 were predicted survival. Sensitivity and spesifity of scoring system to predict mortality was 91.56% (95% CI: 87.96-94.37), 76.89% (95% CI: 70.82-82.23) respectively.

Conclusions: In this study, we concluded that the physicians who follow the patients in the ICU can predict the poor prognosis at the time of admission and the high mortality rate. The physician's opinion on mortality estimation should be considered in intensive care mortality scoring in addition to other laboratory and clinical parameters.
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http://dx.doi.org/10.5578/tt.70135DOI Listing
September 2020

Behçet's Disease: Different Systemic Manifestations at Different Ages.

Eurasian J Med 2020 Oct 2;52(3):304-306. Epub 2020 Jun 2.

Department of Pulmonary Disease, Ataturk University School of Medicine, Erzurum, Turkey.

Behçet's disease, an inflammatory condition, can involve various systems. The disease usually manifests with dermatologic and ocular signs but can also cause serious symptoms due to pulmonary or neurologic involvement. Although the onset may occur at any age, it typically emerges in the second to fourth decades of life. As in the case presented here, Behçet's disease can manifest with the central nervous system involvement early in life and pulmonary involvement in adulthood.
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http://dx.doi.org/10.5152/eurasianjmed.2019.19107DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7651753PMC
October 2020

Are Serum Interleukin 6 and Surfactant Protein D Levels Associated with the Clinical Course of COVID-19?

Lung 2020 10 12;198(5):777-784. Epub 2020 Sep 12.

Department of Pulmonary Diseases, Ataturk University School of Medicine, 25240, Erzurum, Yakutiye, Turkey.

Purpose: SARS-CoV-2 (COVID-19) has infected more than 7 million people worldwide in the short time since it emerged in Wuhan, China in December 2019. The aim of this study was to investigate the relationship between serum interleukin 6 (IL-6) and surfactant protein D (SP-D) levels and the clinical course and prognosis of COVID-19.

Materials And Methods: The study included a total of 108 individuals: 88 patients who were diagnosed with COVID-19 by real-time PCR of nasopharyngeal swab samples and admitted to the Atatürk University Pulmonary Diseases and the Erzurum City Hospital Infectious Diseases department between March 24 and April 15, and 20 asymptomatic healthcare workers who had negative real-time PCR results during routine COVID-19 screening in our hospital.

Results: Patients who developed macrophage activation syndrome had significantly higher IL-6 and SP-D levels at the time of admission and on day 5 of treatment compared to the other patients (IL-6: p = 0.001 for both; SP-D: p = 0.02, p = 0.04). Patients who developed acute respiratory distress syndrome had significantly higher IL-6 and SP-D levels at both time points compared to those who did not (p = 0.001 for all). Both parameters at the time of admission were also significantly higher among nonsurvivors compared to survivors (IL-6: p = 0.001, SP-D: p = 0.03).

Conclusion: In addition to IL-6, which has an important role in predicting course and planning treatment in COVID-19, SP-D may be a novel pneumoprotein that can be used in the clinical course, follow-up, and possibly in future treatments.
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http://dx.doi.org/10.1007/s00408-020-00393-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7486805PMC
October 2020

Can tissue elemental analysis be used to differentiate sarcoidosis and tuberculous lymphadenitis?

Tuberk Toraks 2020 Jul;68(2):126-134

Department of Chest Diseases, Faculty of Medicine, Atatürk University, Erzurum, Turkey.

Introduction: Sarcoidosis and tuberculous lymphadenitis are granulomatous inflammatory diseases. Differentiating lymph node involvement in these two diseases can be challenging. This study evaluated whether elemental analysis of tissue samples could facilitate the differentiation of these histopathologically and clinically similar diseases.

Materials And Methods: A total of 152 tissue samples were included: 57 caseating granulomatous inflammation, 58 non-caseating granulomatous inflammation, and 37 reactive lymph node specimens. The tissue samples were analyzed for calcium, magnesium, iron, copper, zinc, chrome, molybdenum, nickel and selenium with inductively coupled plasma-optical emission spectroscopy (ICP-OES).

Result: Comparison of element levels in the three groups revealed that caseating granulomatous inflammation had higher calcium content (662.6 ± 4.6 ppm, p< 0.001) and lower iron content (48.7 ± 83 ppm, p< 0.001) compared to non-caseating granulomatous inflammation. Compared to reactive lymph tissue, caseating granulomatous inflammation had higher calcium and lower iron and magnesium content while non-caseating granulomatous inflammation had higher levels of iron and lower magnesium; however, these differences were not statistically significant. In caseating granulomatous inflammation, a calcium cut-off value of 207 ppm yielded 85% specificity and 63% sensitivity. For iron, a cut-off value of 51 ppm had 74% specificity and 58% sensitivity.

Conclusions: High calcium and low iron levels in lymph tissue may be suggestive of caseating granulomatous inflammation and tuberculosis. In cases where differentiating between sarcoidosis and tuberculous lymphadenitis is difficult, performing tissue elemental analysis may provide additional supportive evidence for differential diagnosis.
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http://dx.doi.org/10.5578/tt.69691DOI Listing
July 2020

Comparison of High-Flow and Conventional Nasal Cannula Oxygen in Patients Undergoing Endobronchial Ultrasonography.

Intern Med J 2020 Aug 3. Epub 2020 Aug 3.

Department of Pulmonary Diseases, Ataturk University School of Medicine, 25240, Yakutiye, Erzurum, Turkey.

Background: Oxygen therapy is required to prevent hypoxemia during the endobronchial ultrasonography(EBUS) procedure.

Aims: We aimed to compare the effectiveness of oxygen therapy delivered via high-flow nasal cannula(HFNC) and conventional nasal cannula(CNC) in patients undergoing EBUS. Primary outcome was proportion of the patients who desaturated. Patient compliance and satisfaction were also evaluated.

Methods: This single-center prospective interventional study was conducted in a tertiary hospital among patients who presented to the EBUS unit in 2018 and 2019. Patients were randomly assigned to the HFNC group or the CNC group.

Results: The study included 170 patients (111 men and 59 women) with a mean age of 58 ± 14 years. The number of patients experiencing desaturation while receiving oxygen was statistically significantly lower (P < 0.001) in HFNC group (n = 5) compared with CNC group (n = 26). Oxygen therapy was adjusted in 2 patients in the CNC group due to desaturation. Saturation was significantly higher in the HFNC group (P < 0.0001) at the end of the EBUS procedure. HR at the end of EBUS was lower in the HFNC group, but this difference was not statistically significant (96 ± 16 vs. 101 ± 19, P = 0.13). Five patients in the HFNC group and 18 patients in the CNC group reported discomfort during the procedure (P = 0.006).

Conclusion: Oxygen therapy delivered by HFNC seems to be safer and more effective than by CNC in patients undergoing EBUS. Oxygen therapy with HFNC may be considered as an alternative to CNC because it may increase patient comfort and thereby improve compliance. This article is protected by copyright. All rights reserved.
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http://dx.doi.org/10.1111/imj.15001DOI Listing
August 2020

A massive pulmonary thromboembolism after pulmonary endarterectomy: A case report.

Tuberk Toraks 2020 Mar;68(1):76-79

Department of Chest Diseases, Faculty of Medicine, Atatürk University, Erzurum, Turkey.

Pulmonary endarterectomy is a first choice treatment for chronic thromboembolic pulmonary hypertension which may be a complication of pulmonary thromembolism. Here, we present a 70-year-old female who admitted to our clinic with acute massive pulmonary thromboembolism after a pumonary endarterectomy operation because of non-compliance to anticoagulation treatment.
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http://dx.doi.org/10.5578/tt.69183DOI Listing
March 2020

Comparison of Functional Capacity and Symptoms of COPD Patients with and without Pulmonary Hypertension.

Eurasian J Med 2020 Jun 2;52(2):166-170. Epub 2020 Jun 2.

Department of Pulmonary Diseases, Ataturk University School of Medicine, Erzurum, Turkey.

Objective: Pulmonary hypertension (PH) is a common complication of chronic obstructive pulmonary disease (COPD) associated with a decrease in the survival rate of patients with COPD. Our aim was to investigate whether PH impairs the functional capacity and symptoms in patients with COPD. In addition, we aimed to evaluate the correlation between the functional capacity and symptoms score in patients with COPD.

Materials And Methods: This prospective cross-sectional study enrolled 64 patients with moderate to severe COPD, prospectively. All patients underwent the pulmonary function test, echocardiography, 6-minute walk test (6MWT), and cardiopulmonary exercise testing (CPET). We applied the modified Medical Research Council (mMRC) dyspnea scale and COPD Assessment Test (CAT) to all patients. The mean pulmonary arterial pressure (mPAP) >30 mmHg with echocardiography was considered as PH. The patients were grouped according to the presence of PH as COPD-PH (n=30) and COPD-nonPH (n=34).

Results: Hospitalization rate was higher in the COPD-PH group than in the COPD-nonPH group (p=0.006). The 6MWT results were lower in the COPD-PH group compared to the COPD-nonPH group (325±61 m vs. 354±46 m, respectively, p=0.025). In the COPD-PH group, the maximum oxygen consumption (VO) was lower, but the difference did not reach statistical significance (p=0.118). Although the maximum load and minute ventilation were lower in the COPD-PH group, the end-tidal pressure of CO (PETCO) was higher (p=0.033, p=0.036, and p=0.009, respectively). However, the CAT score and mMRC were similar between the groups (p=0.405 and p=0.238, respectively).

Conclusion: An elevated PAP in patients with COPD limits the exercise capacity. Using CPET in the functional evaluation of patients with COPD may be beneficial in the early detection of PH.
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http://dx.doi.org/10.5152/eurasianjmed.2020.19391DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7311132PMC
June 2020

Is it Cyst or Neoplasm? The Role of Thorax Magnetic Resonance Imaging.

Arch Bronconeumol 2020 Jun 20. Epub 2020 Jun 20.

Department of Pulmonary Diseases, Ataturk University School of Medicine, 25240 Erzurum, Turkey. Electronic address:

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http://dx.doi.org/10.1016/j.arbres.2020.05.029DOI Listing
June 2020

Could HIF-1α be a novel biomarker for the clinical course and treatment of pulmonary embolism?

Turk J Med Sci 2020 06 23;50(4):963-968. Epub 2020 Jun 23.

Department of Pulmonary Diseases, School of Medicine, Atatürk University, Erzurum, Turkey

Background/aim: Pulmonary embolism (PE) is associated with high morbidity and mortality rates if not diagnosed and treated rapidly. The aim of our study was to investigate the relationship between levels of hypoxia-induced factor-1 alpha (HIF-1α) and clinical course and prognosis in patients with intermediate low-risk, intermediate high-risk, and high-risk PE.

Materials And Methods: The study included 240 subjects in 4 groups: a healthy control group (n = 60, mean age = 60 ± 15.2, female/male = 30/30 ), intermediate low-risk PE group (n = 60, mean age = 60 ± 12,5, female/male = 27/33), intermediate high-risk PE group (n = 60, mean age = 61,4 ± 14,8, female/male = 36/24), and high-risk PE group (n = 60, mean age = 62,3 ± 15, female/male = 33/27). Plasma HIF-1α levels were measured using commercial enzyme-linked immunosorbent assay (ELISA) kit.

Results: Comparison of HIF-1α levels revealed a statistically significant difference between the groups in proportion to clinical scoring (P = 0.001 for all). Comparison of initial HIF-1α and troponin levels in intermediate high-risk PE patients given thrombolytic therapy and those treated with enoxaparin sodium showed that HIF-1α levels were significantly higher in the group that received thrombolytic therapy (P = 0.001), while there was no difference in troponin levels (P = 0.146).

Conclusion: HIF-1α can be used in the PE clinical risk stratification and monitoring of PE and may also serve as a valuable early indicator in intermediate high-risk PE, for which early reperfusion therapy is important.
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http://dx.doi.org/10.3906/sag-1908-93DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7379473PMC
June 2020

Metastases of Alveolar Echinococcosis to the Skin, Pleura, Ribs, and the Xiphoid Process: A Case Report.

Arch Bronconeumol 2021 03 4;57(3):228. Epub 2020 May 4.

Department of Radiology, Ataturk University School of Medicine, 25240 Erzurum, Turkey.

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http://dx.doi.org/10.1016/j.arbres.2020.02.013DOI Listing
March 2021

Current Pharmacological Approach to ARDS: The Place of Bosentan.

Authors:
Omer Araz

Eurasian J Med 2020 Feb;52(1):81-85

Department of Pulmonary Disease, Ataturk University School of Medicine, Erzurum, Turkey.

Acute respiratory distress syndrome is characterized by dyspnea at presentation, tachypnea on physical examination, findings of bilateral infiltration in chest radiography, refractory hypoxia, and high mortality. Although the main treatment approach is to address the underlying disease, there are also pharmacological and nonpharmacological options for supportive treatment. There is currently no pharmacological agent with proven efficacy in this syndrome, and many drugs are being studied for this purpose. One of these is the endothelin receptor antagonist bosentan.
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http://dx.doi.org/10.5152/eurasianjmed.2020.19218DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7051234PMC
February 2020

Is Vimentin the Cause or Effect of Obstructive Sleep Apnea Development?

Lung 2020 04 22;198(2):275-282. Epub 2020 Feb 22.

Department of Pulmonary Diseases, Ataturk University School of Medicine, 25240, Erzurum, Turkey.

Purpose: In obstructive sleep apnea (OSA), hypoxia secondary to apnea and hypopnea and the resulting systemic inflammatory response are the main causes of comorbidities. The aim of this study was to investigate the relationship between OSA and vimentin, which plays an important role in the activation of cells that synthesize inflammatory cytokines.

Materials And Methods: The study included 150 OSA patients (50 mild, 50 moderate, and 50 severe OSA) and 50 patients without OSA as a control group. Plasma vimentin levels were measured from peripheral blood samples using a commercial enzyme-linked immunosorbent assay (ELISA) kit.

Results: The OSA patients in our study had significantly higher body mass index, apnea-hypopnea index (AHI), triglyceride level, mean oxygen desaturation, and plasma vimentin levels compared to the healthy control group (p = 0.007, 0.001, 0004, 0.001, and 0.001, respectively). Plasma vimentin level was significantly higher in the moderate and severe OSA groups compared to the control and mild OSA groups (p = 0.001 for all). There was no difference between severe and moderate OSA. There were significant correlations between plasma vimentin levels and OSA patients' AHI and mean oxygen desaturation (r = 0.46, p = 0.001; r = 0.214, p = 0.005).

Conclusion: In this study, we observed significant positive correlations between plasma vimentin level and OSA severity, weight, AHI, and mean oxygen desaturation. Vimentin may have utility as a biomarker in the follow-up and treatment of OSA.
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http://dx.doi.org/10.1007/s00408-020-00341-6DOI Listing
April 2020

The diagnostic value of fiberoptic bronchoscopy in ruptured lung hydatid cysts.

Turk Gogus Kalp Damar Cerrahisi Derg 2019 Jul 25;27(3):350-354. Epub 2019 Jun 25.

Department of Thoracic Surgery, Atatürk University Faculty of Medicine, Erzurum, Turkey.

Background: This study aims to evaluate the diagnostic yield of fiberoptic bronchoscopy in ruptured pulmonary hydatid cysts indistinguishable from pulmonary masses on imaging techniques.

Methods: Between January 2000 and January 2018, a total of 45 consecutive patients (27 males, 18 females; mean age 46.4±13.5 years; range, 23 to 78 years) who underwent fiberoptic bronchoscopy to establish the definitive diagnosis following radio-diagnostic procedures were retrospectively analyzed. Data including demographic and clinical characteristics of the patients, preoperative diagnostic studies, bronchoscopic findings, and postoperative diagnosis were recorded.

Results: Endobronchial hyperemia (n=42) and purulent secretion (n=34) are the most common findings of bronchoscopy. The most specific finding was the presence of pieces of cystic membranes in 23 patients. Scolices were seen in five patients in bronchial aspirate. In one patient, both pieces of cystic membranes and scolices in bronchial aspirate were detected. The preliminary diagnosis of a hydatid cyst was made based on these findings in 28 patients (62.2%) preoperatively. The definitive diagnosis of a hydatid cyst was confirmed through thoracotomy in all patients.

Conclusion: Bronchoscopy is a particularly valuable method in the definitive diagnosis of ruptured lung hydatid cysts. The definite diagnosis is based on the visualization of the endobronchial membrane during bronchoscopy or scolices in the bronchial aspirate. It can be also used to prevent complications such as bronchial dissemination and asphyxia due to intra-bronchial membrane pieces.
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http://dx.doi.org/10.5606/tgkdc.dergisi.2019.17479DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7021436PMC
July 2019

Evaluation of the Roflumilast Effect Supplemented with Linezolid in Pleural Empyema in Rats Caused by Intrapleural Staphylococcus aureus Inoculation.

Jpn J Infect Dis 2020 Jan 30;73(1):1-7. Epub 2019 Aug 30.

Department of Pulmonary Diseases, Ataturk University School of Medicine.

In addition to tube drains, pleural empyema is treated with antibiotics and anti-inflammatory drugs. We aimed to evaluate the anti-inflammatory activity of roflumilast combined with linezolid in a rat model of pleural empyema induced by Staphylococcus aureus. A total of 40 rats were divided into 7 groups: sham (n = 4), S. aureus inoculation (n = 6), S. aureus + 10 mg/kg linezolid (n = 6), S. aureus + 5 mg/kg roflumilast (n = 6), S. aureus + 10 mg/kg linezolid + 5 mg/kg roflumilast (n = 6), S. aureus + 10 mg/kg roflumilast (n = 6), and S. aureus + 10 mg/kg linezolid + 10 mg/kg roflumilast (n = 6). Animals were administered linezolid 1 h before and 12 h after inoculation with S. aureus. Roflumilast was administered orally as a single dose 30 min before inoculation with S. aureus. Compared to linezolid treatment alone, linezolid combined with 5 mg/kg roflumilast significantly improved TNF-α, IL-1β, vasodilation/congestion, and tissue/pleural polynuclear leukocyte (PNL) infiltration (p < 0.05). Linezolid combined with 10 mg/kg roflumilast also provided a significant improvement in TNF-α, IL-1β, IL-6, endothelin-1, vasodilation/congestion, mesothelial cell damage, lung tissue PNL, and pleural PNL compared to linezolid alone (p < 0.05). Due to its anti-inflammatory effects and significant impact on recovery, roflumilast can be used in conjunction with antibiotherapy for the treatment of pleural empyema.
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http://dx.doi.org/10.7883/yoken.JJID.2019.164DOI Listing
January 2020

Relevance of Pulmonary Alveolar Echinococcosis.

Arch Bronconeumol 2020 12 14;56(12):779-783. Epub 2019 Aug 14.

Ataturk University, Medical Faculty, Department of Thoracic Surgery, Erzurum, Turkey.

Background: Pulmonary alveolar echinococcosis (PAE) is a chronic disease caused by Echinococcus multilocularis with very low incidence in developed countries.

Methods: This single-center, retrospective study included 34 patients who were diagnosed with PAE between January 2001 and February 2019 (15 males, 19 females, mean age: 52.4±15.8 years, age range: 28-78 years) in Ataturk University Medical School, Erzurum, Turkey.

Results: The liver was the primary involved organ in all cases. Pulmonary involvement was detected in 13.0% (34/261) of all cases with hepatic alveolar echinococcosis (AE), and three patients (8.8%) had both pulmonary metastasis and brain metastasis. The route of spread to the lungs based on radiological data was hematogeneous in 25 patients (73.5%), transdiaphragmatic in three patients (8.8%) and both hematogeneous and transdiaphragmatic in six patients (17.7%). AE showed bilateral involvement in 19 patients (55.9%), whereas only the right lung was involved in 12 patients (35.3%) and the left lung in three patients (8.8%). Of the patients, five underwent surgery due to PAE and 29 patients received medical therapy with albendazole. A total of three patients died during the follow-up period (2, 5 and 10 years after the diagnosis of PAE), while 31 patients continued with follow-up and treatment for a mean duration of 5.4±3.8 years (1-14 years).

Conclusions: Patients with hepatic AE must, as a matter of course, be screened for possible lung involvement. Albendazole therapy may slow down disease progression in patients with widespread pulmonary involvement who are not eligible for surgery.
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http://dx.doi.org/10.1016/j.arbres.2019.07.014DOI Listing
December 2020

The Frequency of Monocyte Chemoattractant Protein-1 Gene Polymorphism in Obstructive Sleep Apnea Syndrome.

Lung 2019 10 6;197(5):585-592. Epub 2019 Aug 6.

Department of Pulmonary Diseases, Ataturk University School of Medicine, 25240, Erzurum, Turkey.

Purpose: In obstructive sleep apnea syndrome (OSAS) many proinflammatory cytokines are released from activated endothelial cells due to repeated decreases in arterial oxygen saturation. Some of these proinflammatory cytokines are involved in the etiology of coronary artery disease (CAD). Although the association between OSAS and CAD is known, risk factors for CAD have not been determined in this patient group. Monocyte chemoattractant protein-1 (MCP-1) is a proinflammatory cytokine that plays a key role in the development of atherosclerosis. In this study, we compared the frequency of MCP1 rs1024610-rs1024611 single-nucleotide polymorphisms (SNPs) in OSAS patients with no comorbidity, OSAS patients with no comorbidity except CAD, and healthy individuals.

Material And Methods: The study included 301 subjects. Two hundred one patients with OSAS (OSAS only and OSAS + CAD groups) and 100 healthy control subjects underwent polysomnography. MCP1 rs1024610 and rs1024611 mutation frequencies were determined.

Results: Body mass index, apnea-hypopnea index, triglyceride levels, and mean oxygen desaturation were significantly higher in the OSAS patients than in the healthy population (p < 0.05). In MCP1 rs1024611 SNP analysis, homozygous mutation was significantly more common in the OSAS + CAD group than in the OSAS and control groups (p < 0.001). MCP1 rs1024610 SNP analysis showed no significant differences among the study groups.

Conclusion: OSAS patients with homozygous MCP1 rs1024611 SNP are at higher risk for CAD. The MCP1 rs1024610 SNP was not associated with incidence of CAD. Patients with OSAS and MCP1 rs1024611 homozygous mutation are more susceptible to CAD and early detection and treatment may significantly reduce mortality and morbidity.
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http://dx.doi.org/10.1007/s00408-019-00256-xDOI Listing
October 2019

The association of OSAS and uvula: the role of MRI in this egg-chicken problem in OSAS.

Sleep Breath 2020 Jun 26;24(2):465-470. Epub 2019 Jun 26.

Department of Pulmonary Disease, Faculty of Medicine, Ataturk University, Yakutiye, 25240, Erzurum, Turkey.

Purpose: Obstructive sleep apnea syndrome (OSAS) is a condition resulting from repetitive partial or complete upper airway obstruction, and its etiology remains uncertain. Polysomnography is the gold standard diagnostic test for OSAS. However, there are long wait times for this evaluation, so questionnaires or ancillary diagnostic methods are used to select appropriate patients. One of these is magnetic resonance imaging (MRI). The present study aimed to investigate the association between clinical features of OSAS and uvular changes on MRI.

Materials And Methods: A total of 102 participants, 80 with OSAS and 22 controls, were included in the study. All participants underwent full-night polysomnography, MRI, and anthropometric measurements.

Results: In comparisons of MRI measurements of the uvula, statistically significant differences in uvular length, thickness, and angle were observed between the OSAS and control groups. MRI measurement significantly associated with apnea-hypopnea index was uvular thickness. Evaluation of anthropometric and MRI measurements revealed statistically significant associations between waist circumference and uvular thickness, uvular width, and oropharyngeal space among the OSAS patients.

Conclusion: Thickened uvula on MRI is associated with the presence of OSAS, and its thickness is well correlated with the severity of the diseases. Thus, it may be a reliable indicator of OSAS and could be used as a supportive finding to identify patients suitable for referral for diagnostic polysomnography.
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http://dx.doi.org/10.1007/s11325-019-01879-3DOI Listing
June 2020

A novel, rapid and sensitive UPLC-MS/MS method for the determination of macitentan in patients with pulmonary arterial hypertension.

Biomed Chromatogr 2019 May 18;33(5):e4502. Epub 2019 Feb 18.

Department of Analytical Chemistry, Faculty of Pharmacy, Ataturk University, Erzurum, Turkey.

Macitentan is an endothelin receptor antagonist commonly used in the treatment of pulmonary arterial hypertension (PAH). A novel, rapid, simple and sensitive UPLC-MS/MS method was developed and validated for pharmacokinetic study and the determination of macitentan in PAH patients. Macitentan and bosentan, which are used as internal standards, were detected using atmospheric pressure chemical ionization in positive ion and multiple reaction monitoring mode by monitoring the mass transitions m/z 589.1 → 203.3 and 552.6 → 311.5, respectively. Chromatographic separation was performed on a reverse-phase C18 column (5 μm, 4.6 × 150 mm) with an isocratic mobile phase, which consisted of water containing 0.2% acetic acid-acetonitrile (90:10, v/v) at a flow rate of 1 mL/min. Retention times were 1.97 and 1.72 min for macitentan and IS, respectively. The calibration curve with high correlation coefficient (0.9996) was linear in the range 1-500 ng/mL. The lower limit of quantitation and average recovery values were determined as 1 ng/mL and 89.8%, respectively. This method is the first UPLC-MS/MS method developed and validated for the determination of macitentan from human plasma. The developed analytical method was fully validated for linearity, selectivity, specificity, accuracy, precision, sensitivity, stability, matrix effect and recovery according to US Food and Drug Administration guidelines. The developed method was applied successfully for pharmacokinetic study and the determination of macitentan in PAH patients.
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http://dx.doi.org/10.1002/bmc.4502DOI Listing
May 2019

The effect of surgical specimen-derived phosphorus and lead concentrations in non small cell lung cancer patients on disease course.

Tuberk Toraks 2018 Dec;66(4):334-339

Department of Chest Diseases, Faculty of Medicine, Ataturk University, Erzurum, Turkey.

Introduction: Lung cancer is one of the leading causes of cancer-related mortality. There are many exogenic and endogenic factors associated with the development of lung cancer. One of these factors is trace elements. Under- or overabundance of trace elements can disrupt cellular functions and lead to the formation of cancer. In this study we conducted elemental analysis of lung cancer tissue and normal lung tissue to investigate the role of tissue trace element concentrations in lung cancer.

Materials And Methods: Elemental analysis was performed on 30 lung cancer tissue samples and a control group of 15 normal lung tissue samples, all taken from patients diagnosed, treated and followed at our hospital between 2005 and 2010. The solubilized tissue samples were analyzed for the presence of 19 elements using inductively coupled plasma-optical emission spectroscopy (ICP-OES). Total element amounts in the tissue were calculated.

Result: Concentrations of magnesium, potassium, zinc, manganese, lead, boron, chromium and phosphorus were significantly higher in the patient group compared to the control group. Deceased patients had significantly lower phosphorus concentrations and significantly higher lead concentrations than the other patients.

Conclusions: Elevated levels of magnesium, potassium, zinc, manganese, lead, boron, chromium and phosphorus in lung cancer tissue indicate that these elements may play a role in the development of lung cancer. The results of our evaluation of the association between trace elements and lung cancer suggest that, together with other factors, low phosphorus concentration and high lead concentration in tumor tissue may influence disease course.
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http://dx.doi.org/10.5578/tt.67834DOI Listing
December 2018

Sulfasalazine-Induced Interstitial Fibrosis.

Eurasian J Med 2018 Oct;50(3):207-209

Department of Pulmonary Diseases, Ataturk University School of Medicine, Erzurum, Turkey.

Sulfasalazine has been used in the treatment of inflammatory bowel disease for over 60 years. Although the drug is frequently associated with gastrointestinal adverse effects, pulmonary adverse effects are very rare. Herein, we report a case of interstitial fibrosis resulting from 4-month sulfasalazine therapy for ulcerative colitis in a patient under long-term follow-up in our clinic due to chronic obstructive pulmonary disease.
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http://dx.doi.org/10.5152/eurasianjmed.2018.17302DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6263240PMC
October 2018

Acute respiratory distress syndrome after the use of gadolinium contrast agent.

Respir Med Case Rep 2018 24;25:336-338. Epub 2018 Oct 24.

Department of Pulmonary Diseases, Ataturk University, School of Medicine, 25240, Erzurum, Turkey.

Acute respiratory distress syndrome (ARDS) is a life-threatening medical emergency. The etiology of ARDS can involve various causes. ARDS associated with the use of iodinated contrast media is rarely reported, and the literature includes only one case of ARDS due to gadobutrol. A 46-year-old female patient presented to our emergency department with shortness of breath, wheezing, swelling of the lips, and difficulty swallowing about 30 minutes after undergoing magnetic resonance imaging with 6.5 ml (0.1 ml/kg) gadobutrol (Gadovist) contrast for a submandibular mass. She was treated for anaphylaxis, then immediately evaluated using chest x-ray and arterial blood gas analysis. Based on the findings, she was diagnosed with ARDS and started on continuous positive airway pressure (CPAP) ventilatory support and methylprednisolone at a dose of 1 mg/kg/day. On day 3 of follow-up, all symptoms had completely regressed.
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http://dx.doi.org/10.1016/j.rmcr.2018.10.018DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6223103PMC
October 2018

The effect of unilateral forced nostril breathing on sleep in healthy right-handed men: a preliminary report.

Sleep Breath 2018 09 1;22(3):769-772. Epub 2018 Mar 1.

Department of Pulmonary Diseases, Ataturk University School of Medicine, 25240, Erzurum, Turkey.

Purpose: Although we spend about one-third of our lives in sleep and recognize its necessity for good health, sleep has only been partially elucidated in the last century. The nasal cycle of congestion and decongestion during sleep has various effects on human physiology. The aim of the present study was to investigate the effect of unilateral forced nostril breathing on sleep.

Methods: Twenty-one healthy male volunteers aged 18-24 years were included in the study. Only individuals with right-hand dominance were included. Subjects were observed during sleep for three nights under different conditions: no obstruction (normal sleep) on the first night, right nasal obstruction on the second night, and left nasal obstruction on the third night.

Results: The main findings of our study are that sleep efficiency, NREM stage III, and total sleep duration were greater during left nasal obstruction (right nostril dominant respiration), while apnea-hypopnea index (AHI), frequency of periodic limb movements, and oxygen desaturation were higher during right nasal obstruction (left nostril dominant respiration).

Conclusion: The nasal cycle has a significant impact on sleep which is reflected in sleep recordings. Our result supports that nasal obstructions, due to deviations, concha hypertrophy, or congestion/decongestion, might affect the physiology of respiration and sleep. Nasal obstruction should be taken into consideration when evaluating patients in sleep laboratories and further studies are required to elucidate the situation in the patients with nasal obstruction.
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http://dx.doi.org/10.1007/s11325-018-1648-0DOI Listing
September 2018

Comparison of long-term outcomes of 50 and 100 mg rt-PA in the management of acute pulmonary thromboembolism.

Clin Respir J 2018 Apr 9;12(4):1628-1634. Epub 2017 Nov 9.

Department of Pulmonary Diseases, Ataturk University School of Medicine, Yakutiye, 25240 Erzurum, Turkey.

Background: Pulmonary thromboembolism (PTE) is a life-threatening disease. In this study, we aimed to evaluate long-term outcomes of the use of 50 mg recombinant tissue-type plasminogen activator (rt-PA) in the management of PTE in terms of relapse, pulmonary hypertension (PH), mortality and hemorrhage and to compare with the use of 100 mg rt-PA.

Methods: The study was designed as a retrospective cohort. Patients who were diagnosed as acute PTE and received either 50 or 100 mg rt-PA in a tertiary care hospital between 2010 and 2015 were included in the study. Rates of relapse, PH, mortality (in-hospital and long-term) and hemorrhage (major and minor) were calculated for each treatment group.

Results: A total 117 patients, 73 females and 44 males, were evaluated. Eighty-three patients were administered 100 mg rt-PA, and 34 were administered 50 mg rt-PA. The mean age was lower in the 100 mg group compared to the 50 mg group (61 ± 15 vs 69 ± 14 years). There was a significant decrease in PH in each group at 3 months follow-up (P < .001). Although statistically nonsignificant, the relapse rate was lower in the 50 mg rt-PA group, but the 5-year mortality rate was higher in 50 mg rt-PA group (35.2% vs 27.7%, P = .50). Mortality was associated with older age and presence of malignancy.

Conclusions: Our results suggest that both doses of rt-PA have similar efficacy. The high mortality rate in the 50 mg group may have resulted from patient selection.
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http://dx.doi.org/10.1111/crj.12721DOI Listing
April 2018

Acute respiratory distress syndrome; A rare complication caused by usage of ruxolitinib.

Respir Med Case Rep 2017 18;22:243-245. Epub 2017 Sep 18.

Department of Pulmonary Diseases, Ataturk University School of Medicine, 25240, Erzurum, Turkey.

Ruxolitinib-associated acute respiratory distress has rarely been reported, mostly due to discontinuation of treatment. Herein we report a 58-year-old male patient with primary myelofibrosis who presented with malaise and dyspnea 15 days after initiation of the treatment. The patient was diagnosed as mild acute respiratory distress syndrome (ARDS). After excluding other potential causes such as infection and cardiac pathologies, it was considered secondary to ruxolitinib use. The medication was discontinued and 1 mg/kg methylprednisolone was given to prevent cytokine rebound syndrome and continuous positive airway pressure therapy was prescribed for ARDS. Symptomatic improvement and complete radiological resolution was observed. This case suggests that ARDS may develop secondary to ruxolitinib use and ARDS should be keep in mind in the cases with respiratory symptoms who were on treatment.
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http://dx.doi.org/10.1016/j.rmcr.2017.09.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5608559PMC
September 2017

Predictive Value of Mean Platelet Volume for Pulmonary Embolism Recurrence.

Lung 2017 08 15;195(4):497-502. Epub 2017 Jun 15.

Department of Pulmonary Diseases, Ataturk University School of Medicine, 25240, Erzurum, Turkey.

Purpose: Recurrence is a major clinical problem in patients with pulmonary embolism and can affect mortality. The decision to discontinue treatment is important for recurrence and is based on patients' clinical features as well as certain blood parameters. Our aim in this study was to evaluate whether mean platelet volume (MPV) and platelet distribution width (PDW) have utility as new predictive parameters for recurrence and mortality in pulmonary embolism.

Materials And Methods: A total of 440 patients with pulmonary embolism underwent computed tomography, Doppler ultrasonography, and echocardiography before and at the conclusion of treatment. Thrombocyte count, MPV, PDW, and D-dimer parameters were also evaluated at the same time points.

Results: MPV and PDW were significantly higher in deceased patients (8.8 ± 1.2 fl and 17.4 ± 0.8) compared to surviving patients (7.7 ± 0.9 fl and 17 ± 0.9) (p < 0.0001). Initial MPV and PDW were also significantly higher in patients with recurrence (8.4 ± 0.7 vs 7.6 ± 0.8 fl, p < 0.0001 and 17.3 ± 0.8 vs 16.9 ± 0.9, p = 0.002, respectively) than in patients without recurrence. At the end of treatment, MPV was still higher in patients with recurrence compared to patients without recurrence (8.7 ± 0.5 and 7.5 ± 0.7 fl, respectively, p < 0.0001). MPV values over 8.05 fl at the end of treatment predicted recurrence with 91% sensitivity and 77% specificity.

Conclusion: MPV seems to be an indicator of recurrence in pulmonary embolism and may have utility in the prediction of recurrence. Elevated MPV can also be used to predict mortality in pulmonary embolism.
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http://dx.doi.org/10.1007/s00408-017-0020-7DOI Listing
August 2017

Assessment of right ventricular systolic and diastolic parameters in pulmonary sarcoidosis.

J Investig Med 2016 Mar 12;64(3):759-63. Epub 2016 Feb 12.

Department of Cardiology, Erzurum Training and Research Hospital, Erzurum, Turkey.

The clinical manifestations of cardiac involvement are seen in about 5% of patients with sarcoidosis; however, the incidence of cardiac involvement is higher in the autopsy series. About 14% of patients with pulmonary sarcoidosis (PS) without known cardiac involvement had diastolic dysfunction.We aimed to determine the role of parameters of right ventricular (RV) systolic and diastolic function in patients with PS without evidence of cardiac symptoms. Our study population consisted of 28 patients with grades 1-4 PS and 24 healthy subjects. This study was a clinical prospective cohort study. RV end-diastolic area was found to be significantly higher in the PS group (p=0.032). RV fractional area change (RVFAC) and tricuspid annular plane systolic excursion (TAPSE) were shown to be statistically lower in the PS group as compared to the control group (p<0.001). However, pulmonary arterial systolic pressure was significantly higher in the PS group (p=0.003). The tricuspid E velocity and E/A ratio were found to be significantly lower in the PS group (p=0.025 and 0.009, respectively), while the tricuspid A velocity and myocardial performance index (MPI) were found to be significantly lower in the control group (p=0.034 and 0.007, respectively). Early detection of cardiac involvement in PS is crucial because of the increased morbidity and risk of sudden cardiac death. RV diastolic Doppler parameters, tissue Doppler MPI, RVFAC and TAPSE are practical and cheap techniques in the diagnosis of cardiac involvement in patients with PS. A thorough transthorasic echocardiographic examination including RV systolic and diastolic functions and tissue Doppler MPI should constitute the mainstay of initial management and follow-up in PS.
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http://dx.doi.org/10.1136/jim-2015-000027DOI Listing
March 2016