Publications by authors named "Begüm Ergan"

35 Publications

Effects of Oral pH Changes on Smoking Desire.

Balkan Med J 2020 Dec 25. Epub 2020 Dec 25.

Dokuz Eylul University Faculty of Medicine, İzmir, Turkey.

Background: Nicotine addiction is associated with nicotine absorption from buccal mucosa and it is stated that the main factor that determines the nicotine absorption is saliva pH. In the literature, the effects of changes in saliva pH values after eating and drinking on smoking desire in the smokers were not questioned.

Aim: The main purpose of this study was to show the effect of saliva pH changes on smoking desire. The secondary aims were to show the effects of coffee and water drinking on saliva pH and the effects of smoking on oral-dental health (oral hygiene, gingival bleeding).

Study Design: Case-control.

Methods: A questionnaire was administered that included "Sociodemographic Data Form" and smoking history and Fagerström Test for Nicotine Dependence (FTND). Oral and dental examinations were performed with mirror sonds and using oral hygiene standard Silness and Leöe plaque index and DMFT Index (Index of Decayed Missing or Filled Teeth). Untreated saliva samples were taken and baseline saliva flow rate and pH values were measured. To assess pH changes, saliva pH was remeasured after sugar-free instant coffee and water consumption. Smoking desire was evaluated with Visual Analog Scale (VAS).

Results: There were 24 (55.8%) female and 19 (44.2%) male among the 43 smoking and 39 nonsmoking cases. Smoking was significantly associated with poor oral hygiene (in smokers 4.71 (←1.40), in nonsmokers 2.30 (←1.59); p<0.01). DMFT Index was higher in smokers than in nonsmokers (in smokers 6.45 (←3.69), in nonsmokers 3.87 (←2.67); p<0.01). Gingival bleeding was more prevalent in smokers (0.68 (←0.76)), than nonsmokers (1.20 (←0.90); p=0.009). Salivary flow rates were lower in smokers (in smokers 2.56 (←1.34), in nonsmokers 3.00 (←1.22), p=0.06). In both groups, pH values increased after coffee consumption and decreased after water; in smokers basal:6.67 (±0.41), pHcoffee: 6.93 (±0.36), pHwater: 6.85 (±0.33); in nonsmokers pHbasal: 6.84 (±0.37), pHcoffee: 7.02 (±0.37), pHwater: 6.97 (±0.31), p<0.01. The VAS values of smokers at basal 4.73 (±3.21); p<0.01, after coffee consumption 4.91 (±3.08); p<0.01 and after water 3.15 (±2.72); p<0.01.

Conclusion: The saliva pH increased after coffee consumption and decreased after drinking water. Besides VAS values decreased significantly after drinking water. The results suggest that a simple behavior such as drinking water may be used in conjunction with behavioral and cognitive therapies in the pursuit of smoking cessation.
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http://dx.doi.org/10.4274/balkanmedj.galenos.2020.2020-8-125DOI Listing
December 2020

COVID-19 Pandemic and the Global Perspective of Turkish Thoracic Society.

Turk Thorac J 2020 Nov 1;21(6):419-432. Epub 2020 Nov 1.

Department of Pulmonary Medicine, Koç University School of Medicine, İstanbul, Turkey.

It has been more than 3 months now since the first case of COVID-19 was reported in Turkey. Globally, the number of confirmed cases and deaths reached 9,653,048 and 491,128 respectively, as reported by 216 countries by June 27, 2020. Turkey had 1,396 new cases, 194,511 total cases, and 5,065 deaths by the same date. From the first case until today, the Turkish Thoracic Society (TTS) has been very proactive in educating doctors, increasing public awareness, undertaking academic studies, and assisting with public health policies. In the present report, social, academic, and management perspectives of the pandemic are presented under appropriate subtitles. During this critical public health crisis, TTS has once again demonstrated its readiness and constructive stance by supporting public health, healthcare workers, and the environment. This review summarizes the perspective of TTS on each aspect of the COVID-19 pandemic and casts light on its contributions.
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http://dx.doi.org/10.5152/TurkThoracJ.2020.20174DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7752113PMC
November 2020

Remdesivir for severe covid-19: a clinical practice guideline.

BMJ 2020 07 30;370:m2924. Epub 2020 Jul 30.

Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada.

Clinical Question: What is the role of remdesivir in the treatment of severe covid-19? This guideline was triggered by the ACTT-1 trial published in the on 22 May 2020.

Current Practice: Remdesivir has received worldwide attention as a potentially effective treatment for severe covid-19. After rapid market approval in the US, remdesivir is already being used in clinical practice.

Recommendations: The guideline panel makes a weak recommendation for the use of remdesivir in severe covid-19 while recommending continuation of active enrolment of patients into ongoing randomised controlled trials examining remdesivir.

How This Guideline Was Created: An international panel of patients, clinicians, and methodologists produced these recommendations in adherence with standards for trustworthy guidelines using the GRADE approach. The recommendations are based on a linked systematic review and network meta-analysis. The panel considered an individual patient perspective and allowed contextual factors (such as resources) to be taken into account for countries and healthcare systems.

The Evidence: The linked systematic review (published 31 Jul 2020) identified two randomised trials with 1300 participants, showing low certainty evidence that remdesivir may be effective in reducing time to clinical improvement and may decrease mortality in patients with severe covid-19. Remdesivir probably has no important effect on need for invasive mechanical ventilation. Remdesivir may have little or no effect on hospital length of stay.

Understanding The Recommendation: Most patients with severe covid-19 would likely choose treatment with remdesivir given the potential reduction in time to clinical improvement. However, given the low certainty evidence for critical outcomes and the fact that different perspectives, values, and preferences may alter decisions regarding remdesivir, the panel issued a weak recommendation with strong support for continued recruitment in randomised trials.
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http://dx.doi.org/10.1136/bmj.m2924DOI Listing
July 2020

Adjuvant Analgesic Use in the Critically Ill: A Systematic Review and Meta-Analysis.

Crit Care Explor 2020 Jul 6;2(7):e0157. Epub 2020 Jul 6.

Department of Medicine, McMaster University, Hamilton, ON, Canada.

This systematic review and meta-analysis addresses the efficacy and safety of nonopioid adjunctive analgesics for patients in the ICU.

Data Sources: We searched PubMed, Embase, the Cochrane Library, CINAHL Plus, and Web of Science.

Study Selection: Two independent reviewers screened citations. Eligible studies included randomized controlled trials comparing efficacy and safety of an adjuvant-plus-opioid regimen to opioids alone in adult ICU patients.

Data Extraction: We conducted duplicate screening of citations and data abstraction.

Data Synthesis: Of 10,949 initial citations, we identified 34 eligible trials. These trials examined acetaminophen, carbamazepine, clonidine, dexmedetomidine, gabapentin, ketamine, magnesium sulfate, nefopam, nonsteroidal anti-inflammatory drugs (including diclofenac, indomethacin, and ketoprofen), pregabalin, and tramadol as adjunctive analgesics. Use of any adjuvant in addition to an opioid as compared to an opioid alone led to reductions in patient-reported pain scores at 24 hours (standard mean difference, -0.88; 95% CI, -1.29 to -0.47; low certainty) and decreased opioid consumption (in oral morphine equivalents over 24 hr; mean difference, 25.89 mg less; 95% CI, 19.97-31.81 mg less; low certainty). In terms of individual medications, reductions in opioid use were demonstrated with acetaminophen (mean difference, 36.17 mg less; 95% CI, 7.86-64.47 mg less; low certainty), carbamazepine (mean difference, 54.69 mg less; 95% CI, 40.39-to 68.99 mg less; moderate certainty), dexmedetomidine (mean difference, 10.21 mg less; 95% CI, 1.06-19.37 mg less; low certainty), ketamine (mean difference, 36.81 mg less; 95% CI, 27.32-46.30 mg less; low certainty), nefopam (mean difference, 70.89 mg less; 95% CI, 64.46-77.32 mg less; low certainty), nonsteroidal anti-inflammatory drugs (mean difference, 11.07 mg less; 95% CI, 2.7-19.44 mg less; low certainty), and tramadol (mean difference, 22.14 mg less; 95% CI, 6.67-37.61 mg less; moderate certainty).

Conclusions: Clinicians should consider using adjunct agents to limit opioid exposure and improve pain scores in critically ill patients.
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http://dx.doi.org/10.1097/CCE.0000000000000157DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7340332PMC
July 2020

COVID-19 S: A new proposal for diagnosis and structured reporting of COVID-19 on computed tomography imaging.

Diagn Interv Radiol 2020 Jul;26(4):315-322

Department of Pulmonology and Critical Care, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey.

Purpose: Because of the widespread use of CT in the diagnosis of COVID 19, indeterminate presentations such as single, few or unilateral lesions amount to a considerable number. We aimed to develop a new classification and structured reporting system on CT imaging (COVID-19 S) that would facilitate the diagnosis of COVID-19 in the most accurate way.

Methods: Our retrospective cohort included 803 patients with a chest CT scan upon suspicion of COVID 19. The patients' history, physical examination, CT findings, RT PCR, and other laboratory test results were reviewed, and a final diagnosis was made as COVID 19 or non-COVID 19. Chest CT scans were classified according to the COVID 19 S CT diagnosis criteria. Cohen's kappa analysis was used.

Results: Final clinical diagnosis was COVID-19 in 98 patients (12%). According to the COVID-19 S CT diagnosis criteria, the number of patients in the normal, compatible with COVID 19, indeterminate and alternative diagnosis groups were 581 (72.3%), 97 (12.1%), 16 (2.0%) and 109 (13.6%). When the indeterminate group was combined with the group compatible with COVID 19, the sensitivity and specificity of COVID-19 S were 99.0% and 87.1%, with 85.8% positive predictive value (PPV) and 99.1% negative predictive value (NPV). When the indeterminate group was combined with the alternative diagnosis group, the sensitivity and specificity of COVID-19 S were 93.9% and 96.0%, with 94.8% PPV and 95.2% NPV.

Conclusion: COVID-19 S CT classification system may meet the needs of radiologists in distinguishing COVID-19 from pneumonia of other etiologies and help optimize patient management and disease control in this pandemic by the use of structured reporting.
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http://dx.doi.org/10.5152/dir.2020.20351DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7360076PMC
July 2020

Guidelines for Chronic Non-invasive Ventilation in COPD: From Experience to Evidence.

Arch Bronconeumol 2021 03 22;57(3):158-159. Epub 2020 Apr 22.

Department of Pulmonary and Critical Care, Dokuz Eylul University, School of Medicine, Izmir, Turkey.

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http://dx.doi.org/10.1016/j.arbres.2020.03.016DOI Listing
March 2021

Defining "stable chronic hypercapnia" in patients with COPD: the physiological perspective.

Eur Respir J 2020 02 12;55(2). Epub 2020 Feb 12.

Dept of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany.

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http://dx.doi.org/10.1183/13993003.02365-2019DOI Listing
February 2020

Are pulmonologists well aware of planning safe air travel for patients with COPD? The SAFCOP study.

Int J Chron Obstruct Pulmon Dis 2019 22;14:1895-1900. Epub 2019 Aug 22.

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

Background: Patients with respiratory diseases are more prone to health risks of air travel.

Purpose: The aim of this study was to investigate the current knowledge and attitudes of Turkish pulmonary physicians for air travel in patients with chronic obstructive pulmonary disease (COPD).

Participants And Methods: A questionnaire was developed and administered either by congress mobile phone application or by e-mail. A total of 242 physicians participated in the study (75 by mobile phone application and 167 through the e-mail).

Results: Among participants, only 30.6% reported that they usually inform COPD patients about possible risks of air travel in their routine practice. A preflight assessment was performed by 61.2% of them and a fit to fly report was prepared by 34.3%. The most common methods/tests used for preflight assessment were reported as oxygen saturation with pulse oximetry, arterial blood gas analysis, and pulmonary function tests (51.2%, 50.8%, and 49.6%, respectively). When the participants were asked to plan safe air travel in two clinical case scenarios, only 16.2% were able to answer both cases correctly.

Conclusion: This study shows that a standard approach for preflight assessment in patients with COPD is lacking and an active initiative is needed to increase awareness and education for fit to fly concept for COPD among pulmonologists.
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http://dx.doi.org/10.2147/COPD.S210854DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6709818PMC
April 2020

European Respiratory Society guidelines on long-term home non-invasive ventilation for management of COPD.

Eur Respir J 2019 09 28;54(3). Epub 2019 Sep 28.

Dept of Pneumology, Cologne Merheim Hospital, Kliniken der Stadt Köln gGmbH, Witten/Herdecke University, Cologne, Germany.

Background: While the role of acute non-invasive ventilation (NIV) has been shown to improve outcome in acute life-threatening hypercapnic respiratory failure in COPD, the evidence of clinical efficacy of long-term home NIV (LTH-NIV) for management of COPD is less. This document provides evidence-based recommendations for the clinical application of LTH-NIV in chronic hypercapnic COPD patients.

Materials And Methods: The European Respiratory Society task force committee was composed of clinicians, methodologists and experts in the field of LTH-NIV. The committee developed recommendations based on the GRADE (Grading, Recommendation, Assessment, Development and Evaluation) methodology. The GRADE Evidence to Decision framework was used to formulate recommendations. A number of topics were addressed under a narrative format which provides a useful context for clinicians and patients.

Results: The task force committee delivered conditional recommendations for four actionable PICO (target population-intervention-comparator-outcome) questions, 1) suggesting for the use of LTH-NIV in stable hypercapnic COPD; 2) suggesting for the use of LTH-NIV in COPD patients following a COPD exacerbation requiring acute NIV 3) suggesting for the use of NIV settings targeting a reduction in carbon dioxide and 4) suggesting for using fixed pressure support as first choice ventilator mode.

Conclusions: Managing hypercapnia may be an important intervention for improving the health outcome of COPD patients with chronic respiratory failure. The task force conditionally supports the application of LTH-NIV to improve health outcome by targeting a reduction in carbon dioxide in COPD patients with persistent hypercapnic respiratory failure. These recommendations should be applied in clinical practice by practitioners that routinely care for chronic hypercapnic COPD patients.
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http://dx.doi.org/10.1183/13993003.01003-2019DOI Listing
September 2019

Factors Affecting Cost of Patients with Severe Community-Acquired Pneumonia in Intensive Care Unit.

Turk Thorac J 2019 10 30;20(4):216-223. Epub 2019 Jul 30.

Department of Anesthesia and Reanimation, Akdeniz University School of Medicine, Antalya, Turkey.

Objectives: The aim of this study is to investigate the factors affecting cost in patients with severe community-acquired pneumonia (CAP) who were admitted to the intensive care unit (ICU).

Materials And Methods: This retrospective cohort study was conducted between January 2013 and December 2016. A total of 291 sequential patients with severe CAP were included in the study. Patients' demographic and clinical data; the need for invasive mechanical ventilation or non-invasive mechanical ventilation; intensive care severity (ICU) scores, including Acute Physiology and Chronic Health Evaluation (APACHE II), Sepsis-related Organ Failure Assessment, Quick SOFA, pneumonia severity index (PSI); and Confusion, Urea, Respiratory Rate, and Blood Pressure-65 (CURB-65) scores were obtained from medical records and recorded for all cases.

Results: The mean age of 291 patients was 68.4±16.8 years, and 61% were female. The median length of ICU stay was 7 days. Forty-six percent of patients had chronic obstructive pulmonary disease (COPD), and 42% had hypertension. The mean cost of each hospitalization was US$ 2722 (TL 5578). The highest cost was found in the group of patients aged 50-59 years, and the lowest cost was found in the patients aged <50 years. A statistically significant relationship was found between ICU severity scores and health cost. The cost of patients in PSI class V, APACHE II (>20 points), and CURB-65 score were higher. The presence of COPD, atrial fibrillation, congestive heart failure, hypoalbuminemia, mental state deterioration, in-hospital mortality, severe sepsis, septic shock, mechanical ventilation requirement, and haloperidol and vasopressor usage were associated with higher cost, while the use of florokinolon was associated with lower cost.

Conclusion: The presence of certain comorbidities and high disease severity in patients with severe CAP hospitalized in ICU increase the cost of inpatient treatment. The need for mechanical ventilation during treatment and the presence of sepsis/septic shock are additional factors that increase the cost.
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http://dx.doi.org/10.5152/TurkThoracJ.2018.18084DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6777659PMC
October 2019

Basic Concepts for Tidal Volume and Leakage Estimation in Non-Invasive Ventilation.

Turk Thorac J 2019 04 1;20(2):140-146. Epub 2019 Apr 1.

Department of Pulmonary and Critical Care, Dokuz Eylül University School of Medicine, İzmir, Turkey.

Non-invasive ventilation (NIV) aims to maintain sufficient alveolar ventilation, improve pulmonary gas exchange, assist respiratory muscles, and decrease work of breathing. Monitoring variables such as leaks, tidal volume, and minute ventilation during therapy is crucial to assess the effectiveness of NIV. However, most of the time, leaks and tidal volume are not measured but estimated by NIV devices. Moreover, there are limited data for the accuracy and reliability of these estimations. Herein, we address some technical considerations for tidal volume and leakage estimation during NIV and its impact in clinical practice.
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http://dx.doi.org/10.5152/TurkThoracJ.2018.177DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6453637PMC
April 2019

Current Statement of Intensive Care Units in Turkey: Data obtained from 67 Centers.

Authors:
Özlem Ediboğlu Özlem Yazıcıoğlu Moçin Ezgi Özyılmaz Cüneyt Saltürk Tuğba Önalan Gülşah Seydaoğlu Turgay Çelikel Hüseyin Arıkan Sena Ataman Cenk Kıraklı Zerrin Özçelik Sema Kultufan İskender Kara Atilla Kara Emine Dağlı Selma Duru Bülbül Kadriye Kahveci Metin Dinçer Nimet Şenoğlu Hüseyin Özkarakaş İlhan Bahar Melike Cengiz Atilla Ramazanoğlu Burcu Çelik Ümmügülsün Gaygısız Gülay Kır Ahmet Bindal Belgin Akan Işıl Özkoçak Turan Fatma Yıldırım Burcu Başarık Zeliha Arslan Ulukan Serdar Efe Murat Sungur Şahin Temel Seval İzdeş Derya Hoşgün Nurhan Karadeniz Eylem Tuncay Nezihe Çiftarslan Gökşenoğlu İlim Irmak Utku Datlı Avşar Zerman Devrim Akdağ Levent Özdemir Gülseren Elay Yücel Karaçayır Arzu Topeli Pervin Hancı Esat Kıvanç Kaya Pınar Güven Hilal Sazak Semih Aydemir Gülbin Aygencel Yusuf Aydemir Zahide Doğanay Özgür Kömürcü Volkan Hancı Emre Karakoç Didem Sözütek Güven Coşkun Güngör Ateş Civan Tiryaki Ayşe Nur Soytürk Nermin Kelebek Girgin Gülbahar Çalışkan Oben Bıyıklı Necati Gökmen Uğur Koca Aydın Çiledağ Kezban Özmen Süner İsmail Cinel Mustafa Kemal Arslantaş Fethi Gül Recai Ergün Nafiye Yılmaz Defne Altıntaş Leyla Talan Murat Yalçınsoy Mehmet Nezir Güllü Perihan Ergin Özcan Günseli Orhun Yusuf Savran Murat Emre Tokur Serdar Akpınar Pelin Şen Gül Gürsel İrem Şerifoğlu Ender Gedik Öner Abidin Balbay Türkay Akbaş Sinem Cesur Hülya Yolacan Seda Beyhan Sağmen Pervin Korkmaz Ekren Feza Bacakoğlu Begüm Ergan Ersin Günay Muzaffer Sarıaydın Dursun Ali Sağlam Sait Karakurt Emel Eryüksel Funda Öztuna Emine Sevil Ayaydın Mürtezaoğlu Hakan Cinemre Ahmet Nalbant Öznur Yağmurkaya Tuğba Mandal Belgin İkidağ

Turk Thorac J 2018 10 13;19(4):209-215. Epub 2018 Sep 13.

Clinic of Intensive Care Unit, American Hospital, Gaziantep, Turkey.

Objectives: We aimed to obtain information about the characteristics of the ICUs in our country via a point prevalence study.

Material And Methods: This cross-sectional study was planned by the Respiratory Failure and Intensive Care Assembly of Turkish Thoracic Society. A questionnaire was prepared and invitations were sent from the association's communication channels to reach the whole country. Data were collected through all participating intensivists between the October 26, 2016 at 08:00 and October 27, 2016 at 08:00.

Results: Data were collected from the 67 centers. Overall, 76.1% of the ICUs were managed with a closed system. In total, 35.8% (n=24) of ICUs were levels of care (LOC) 2 and 64.2% (n=43) were LOC 3. The median total numbers of ICU beds, LOC 2, and LOC 3 beds were 12 (8-23), 14 (10-25), and 12 (8-20), respectively. The median number of ventilators was 12 (7-21) and that of ventilators with non-invasive ventilation mode was 11 (6-20). The median numbers of patients per physician during day and night were 3.9 (2.3-8) and 13 (9-23), respectively. The median number of patients per nurse was 2.5 (2-3.1); 88.1% of the nurses were certified by national certification corporation.

Conclusion: In terms of the number of staff, there is a need for specialist physicians, especially during the night and nurses in our country. It was thought that the number of ICU-certified nurses was comparatively sufficient, yet the target was supposed to be 100% for this rate.
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http://dx.doi.org/10.5152/TurkThoracJ.2018.170104DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6196900PMC
October 2018

The use of bronchoscopy in critically ill patients: considerations and complications.

Expert Rev Respir Med 2018 08 12;12(8):651-663. Epub 2018 Jul 12.

b Department of Clinical , Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit, S. Orsola-Malpighi Hospital, Alma Mater University , Bologna , Italy.

Introduction: Flexible bronchoscopy has been well established for diagnostic and therapeutic purposes in critically ill patients. Areas covered: This review outlines the clinical evidence of the utility and safety of flexible bronchoscopy in the intensive care unit, as well as specific considerations, including practical points and potential complications, in critically ill patients. Expert commentary: Its ease to learn and perform and its capacity for bedside application with relatively few complications make flexible bronchoscopy an indispensable tool in the intensive care unit setting. The main indications for flexible bronchoscopy in the intensive care unit are the visualization of the airways, sampling for diagnostic purposes and management of the artificial airways. The decision to perform flexible bronchoscopy can only be made by trade-offs between potential risks and benefits because of the fragile nature of the critically ill. Flexible bronchoscopy-associated serious adverse events are inevitable in cases of a lack of expertise or appropriate precautions.
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http://dx.doi.org/10.1080/17476348.2018.1494576DOI Listing
August 2018

Should I stay or should I go? COPD and air travel.

Eur Respir Rev 2018 Jun 13;27(148). Epub 2018 Jun 13.

Dept of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit, S. Orsola-Malpighi Hospital, Alma Mater University, Bologna, Italy.

Chronic obstructive pulmonary disease (COPD) is a challenging respiratory problem throughout the world. Although survival is prolonged with new therapies and better management, the magnitude of the burden resulting from moderate-to-severe disease is increasing. One of the major aims of the disease management is to try to break the vicious cycle of patients being homebound and to promote an active lifestyle. A fundamental component of active daily life is, of course, travelling. Today, the world is getting smaller with the option of travelling by air. Air travel is usually the most preferred choice as it is easy, time saving, and relatively inexpensive. Although it is a safe choice for many passengers, the environment inside the aeroplane may sometimes have adverse effects on health. Hypobaric hypoxaemia due to cabin altitude may cause health risks in COPD patients who have limited cardiopulmonary reserve. Addressing the potential risks of air travel, promoting proactive strategies including pre-flight assessment, and education of COPD patients about the "fitness to fly" concept are essential. Thus, in this narrative review, we evaluated the current evidence for potential risks of air travel in COPD and tried to give a perspective for how to plan safe air travel for COPD patients.
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http://dx.doi.org/10.1183/16000617.0030-2018DOI Listing
June 2018

Silicosis in Turkey: Is it an Endless Nightmare or is There Still Hope?

Turk Thorac J 2018 Apr 1;19(2):89-93. Epub 2018 Apr 1.

Department of Pulmonary and Critical Care, Dokuz Eylül University School of Medicine, İzmir, Turkey.

Silicosis is an ancient but still life-threatening occupational lung disease because of its incurable nature. Although its risks are known in many occupational settings and effective control strategies are well established, new cases, even epidemics, continue to occur in different sectors of Turkey. Before taking action, defining the magnitude of the problem is essential. In this concise review, we aimed to present the current situation of silicosis in Turkey. According to the data available to date, silicosis continues to be a major health problem in different sectors. Sandblasting seems to have the highest risk for the development of silicosis. Disease onset at early age and history of short exposure duration may indicate intense silica exposure. After denim sandblasters, dental technicians seem to be the new and recently recognized high-risk occupation group as per the increasing reports. Because of the lack of a definite treatment of silicosis, prevention of the disease should be the main target. Better occupational disease registry systems would be useful to assess the magnitude of the problem. In addition to implementing the necessary regulations, a close inspection of the workplaces for potential risks is essential. Other social and economic factors related with the occurrence of disease, such as unregistered employment rate and unlicensed and uninsured work, should also be considered. Finally, optimal healthcare and better living conditions for patients with silicosis should be ensured.
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http://dx.doi.org/10.5152/TurkThoracJ.2018.040189DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937816PMC
April 2018

Occupational Risk Factors and the Relationship of Smoking with Anxiety and Depression.

Turk Thorac J 2018 Apr 3;19(2):77-83. Epub 2018 Jan 3.

Division of Occupational Medicine, Department of Chest Diseases, Hacettepe University School of Medicine, Ankara, Turkey.

Objectives: The aim of the present study was to evaluate the relation of smoking with anxiety and depression in workers who were exposed to occupational risk factors. For this purpose, working time, smoking status, nicotine dependence, and respiratory functions of the workers who were exposed to physical and/or chemical harmful substances were evaluated and the presence of anxiety/depression was investigated.

Material And Methods: Male workers who were exposed to occupational risk factors such as solvents, heavy metals, and dust and visited the outpatient clinic for occupational diseases within a one-year period were included. Pulmonary Function Test and Fagerström Test for Nicotine Dependence were performed. Anxiety and depression statuses of the workers were assessed using the Hospital Anxiety and Depression Scale.

Results: The mean age of 665 male workers was 45 y (range, 38-48 y), and they were most commonly exposed to solvents (45.9%), followed by heavy metal fume/dust (20.9%). Of the workers, 252 (37.9%) had anxiety, 294 (44.2%) had depression, and 171 (25.7%) had both. More than half of the workers in each occupation/exposure group were smokers. Respiratory complaints were present in 34% of the workers. According to the regression analysis, the presence of respiratory system complaints was found to be a significant risk factor for anxiety, depression, and anxiety plus depression.

Conclusion: In conclusion, smoking and anxiety/depression were found to be the conditions affecting more than half of the workers with occupational exposure.
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http://dx.doi.org/10.5152/TurkThoracJ.2017.17055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5937814PMC
April 2018

How should we monitor patients with acute respiratory failure treated with noninvasive ventilation?

Eur Respir Rev 2018 Jun 13;27(148). Epub 2018 Apr 13.

Northern Rehabilitation Centre Cardio-Pulmonary Group, Vila Nova de Gaia, Respiratory Medicine Units of Trofa-Saúde Alfena Hospital and Braga-Centro Hospital and Faculty of Medicine University of Porto, Porto, Portugal.

Noninvasive ventilation (NIV) is currently one of the most commonly used support methods in hypoxaemic and hypercapnic acute respiratory failure (ARF). With advancing technology and increasing experience, not only are indications for NIV getting broader, but more severe patients are treated with NIV. Depending on disease type and clinical status, NIV can be applied both in the general ward and in high-dependency/intensive care unit settings with different environmental opportunities. However, it is important to remember that patients with ARF are always very fragile with possible high mortality risk. The delay in recognition of unresponsiveness to NIV, progression of respiratory failure or new-onset complications may result in devastating and fatal outcomes. Therefore, it is crucial to understand that timely action taken according to monitoring variables is one of the key elements for NIV success. The purpose of this review is to outline basic and advanced monitoring techniques for NIV during an ARF episode.
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http://dx.doi.org/10.1183/16000617.0101-2017DOI Listing
June 2018

A rare cause of noninvasive ventilation failure: tracheal stenosis.

Tuberk Toraks 2017 Dec;65(4):333-336

Intensive Care Unit, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.

Noninvasive ventilation is the first line treatment of choice in acute respiratory failure in many diseases including post-extubation respiratory failure. Herein we report a case unresponsive to noninvasive ventilation due to tracheal stenosis. A 49- year -old female was admitted to intensive care unit after successful resuscitation of cardiac arrest. During the follow-up, she was extubated on 16th day and then transferred to the coronary ward. Four days later, she started to have progressive dyspnea and difficulty in breathing. Arterial blood gas evaluation showed respiratory acidosis with moderate hypercapnia. Noninvasive ventilation was initiated with the diagnosis of cardiogenic pulmonary edema however she did not respond to noninvasive ventilation therapy. Pulmonary consultation revealed that she had a new onset stridor. She had an urgent fiberoptic bronchoscopy which revealed severe tracheal stenosis. Tracheal stenosis should be considered in patients who do not respond to noninvasive ventilation after extubation like in our case.
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http://dx.doi.org/10.5578/tt.53863DOI Listing
December 2017

Evaluation of nephrotoxicity and prognosis in patients treated with colistin due to hospital-acquired pneumonia.

Tuberk Toraks 2017 Dec;65(4):271-281

Department of Chest Diseases, Faculty of Medicine, Ege University, Izmir, Turkey.

Introduction: Colistimethate sodium (CMS) is frequently used in the treatment of nosocomial multidrug-resistant gram-negative infections. Nephrotoxicity is the most important side effect. The aim of this study is to evaluate the effect of colistin on nephrotoxicity and to assess prognosis in patients treated with CMS due to hospital-acquired pneumonia (HAP).

Materials And Methods: Patients treated with CMS for HAP due to multidrug-resistant Pseudomonas aeruginosa or Acinetobacter baumannii were included in this cohort study.

Result: We evaluated 281 patients treated with two different brands of CMS whose administration dose is different: imported (n= 58, low dose/kg) and domestic (n= 223, high dose/kg). Nephrotoxicity developed in 175 patients (62.3%). The median age (73 vs. 66 years, p= 0.004) and mortality rates were higher (66.9% vs. 52.8%, p= 0.022) in patients having nephrotoxicity. The patients receiving high dose/kg had higher nephrotoxicity rate (67.7% vs. 41.4%, p< 0.001). The clinical, bacteriological response and mortality rates of the whole group were 52.0%, 61.0%, 61.6%, respectively. The clinical and bacteriological response rates were similar in the different dose groups. Multivariate analysis showed that nephrotoxicity was associated with domestic brand depending on use of high dose (OR= 3.97), advanced age (β= 0.29, p= 0.008), male gender (OR= 2.60), hypertension (OR= 2.50), red blood cells transfusion (OR= 2.54), absence of acute kidney injury (OR= 10.19), risk stage of RIFLE (OR= 11.9).

Conclusions: Nephrotoxicity is associated with the use of high dose colistin, age, gender, hypertension, red blood cells replacement and RIFLE stage. The mortality rate is higher in patients developing nephrotoxicity.
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http://dx.doi.org/10.5578/tt.59748DOI Listing
December 2017

Acute cardiac events in severe community-acquired pneumonia: A multicenter study.

Clin Respir J 2018 Jul 17;12(7):2212-2219. Epub 2018 Apr 17.

Department of Respiratory Diseases, Akdeniz University, School of Medicine, Antalya, Turkey.

Introduction: An increased risk of cardiovascular complications has been defined in community-acquired pneumonia (CAP), but limited data is available for patients with severe CAP.

Objective: The aim of the present study was to define the prevalence, characteristics, risk factors and impact on mortality of acute cardiac events in patients with severe CAP during short and long term.

Method: This investigation was a multicenter, retrospective cohort sudy of patients with severe CAP. Cardiac events were defined as cardiac arrhytmia, congestive heart failure and myocardial infarction. A logistic regression analysis was performed to identify predictors for acute cardiac events and mortality.

Results: Of 373 patients (mean age 68 ± 16, 61.4% male), 56 (15%) developed a cardiac event (43 arrhythmia, 11 congestive heart failure and 2 myocardial infarction). Patients who developed an acute cardiac event were older, had more severe disease, pleural effusion, hypoalbuminemia, hyponatremia and more acidosis. Also, beta-blocker and diuretic use were more significant in these patients. In-hospital mortality was significantly higher in patients who developed cardiac events (29.6% vs 11%, P < .001). According to the logistic regression analysis, haloperidol, vasopressor or diuretic use, hypoalbuminemia and age were the predictors for acute cardiac events. Acute cardiac events were significantly associated with in-hospital mortality (OR 2.1; 95%CI 1.03-4.61, P = .04), but not associated with 90-day mortality.

Conclusion: Our findings demonstrated that acute cardiac events are seen in a substantial proportion of patients with severe CAP and their occurence significantly associated with in-hospital mortality.
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http://dx.doi.org/10.1111/crj.12791DOI Listing
July 2018

A Rare Vascular Anomaly during Central Venous Catheterization: A Persistent Left-Sided Superior Vena Cava.

Turk Thorac J 2018 Jan 21;19(1):46-48. Epub 2017 Jul 21.

Department of Intensive Care Unit, Dokuz Eylül University School of Medicine, İzmir, Turkey.

A persistent left-sided superior vena cava (PLSVC) is the most frequent abnormality of the venous system; however, it is not a very well-known variation among physicians. Herein we report the case of a patient with a PLSVC who was diagnosed after central venous catheterization (CVC). An 80-year-old man was admitted to the emergency room with cardiopulmonary arrest. After the return of spontaneous circulation, CVC was blindly performed from the left jugular vein without any complications. However, routine chest X-ray after catheterization revealed that the catheter was moving down directly to the left heart. Thoracic computed tomography showed the right brachiocephalic vein draining into the left brachiocephalic vein and forming the left superior vena cava in front of the aortic arch. The left superior vena cava merged into the right atrium after crossing the left pulmonary artery. CVC is widely used in clinical practice, and therefore clinicians should be aware of possible variations in central veins, particularly during blind catheterization.
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http://dx.doi.org/10.5152/TurkThoracJ.2017.17020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5783053PMC
January 2018

I want to break free: liberation from noninvasive ventilation.

Eur Respir J 2017 07 5;50(1). Epub 2017 Jul 5.

Dept of Pulmonary and Critical Care, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.

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http://dx.doi.org/10.1183/13993003.00674-2017DOI Listing
July 2017

[Turkish translation and transcultural adaptation of Severe Respiratory Insufficiency (SRI) questionnaire].

Tuberk Toraks 2017 03;65(1):66-68

Department of Chest Diseases, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey.

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March 2017

Long-Term Oxygen Therapy in COPD Patients Who Do Not Meet the Actual Recommendations.

COPD 2017 Jun 16;14(3):351-366. Epub 2017 May 16.

b Department of Clinical, Integrated and Experimental Medicine (DIMES), Respiratory and Critical Care Unit, S. Orsola-Malpighi Hospital , Alma Mater University , Bologna , Italy.

Chronic respiratory failure due to chronic obstructive pulmonary disease (COPD) is an increasing problem worldwide. Many patients with severe COPD develop hypoxemic respiratory failure during the natural progression of disease. Long-term oxygen therapy (LTOT) is a well-established supportive treatment for COPD and has been shown to improve survival in patients who develop chronic hypoxemic respiratory failure. The degree of hypoxemia is severe when partial pressure of oxygen in arterial blood (PaO) is ≤55 mmHg and moderate if PaO is between 56 and 69 mmHg. Although current guidelines consider LTOT only in patients with severe resting hypoxemia, many COPD patients with moderate to severe disease experience moderate hypoxemia at rest or during special circumstances, such as while sleeping or exercising. The efficacy of LTOT in these patients who do not meet the actual recommendations is still a matter of debate, and extensive research is still ongoing to understand the possible benefits of LTOT for survival and/or functional outcomes such as the sensation of dyspnea, exacerbation frequency, hospitalizations, exercise capacity, and quality of life. Despite its frequent use, the administration of "palliative" oxygen does not seem to improve dyspnea except for delivery with high-flow humidified oxygen. This narrative review will focus on current evidence for the effects of LTOT in the presence of moderate hypoxemia at rest, during sleep, or during exercise in COPD.
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http://dx.doi.org/10.1080/15412555.2017.1319918DOI Listing
June 2017

High-Resolution Computed Tomography and Pulmonary Function Findings of Occupational Arsenic Exposure in Workers.

Balkan Med J 2017 May 6;34(3):263-268. Epub 2017 Apr 6.

Department of Dermatology, Ufuk University School of Medicine, Ankara, Turkey.

Background: The number of studies where non-malignant pulmonary diseases are evaluated after occupational arsenic exposure is very few.

Aims: To investigate the effects of occupational arsenic exposure on the lung by high-resolution computed tomography and pulmonary function tests.

Study Design: Retrospective cross-sectional study.

Methods: In this study, 256 workers with suspected respiratory occupational arsenic exposure were included, with an average age of 32.9±7.8 years and an average of 3.5±2.7 working years. Hair and urinary arsenic levels were analysed. High-resolution computed tomography and pulmonary function tests were done.

Results: In workers with occupational arsenic exposure, high-resolution computed tomography showed 18.8% pulmonary involvement. In pulmonary involvement, pulmonary nodule was the most frequently seen lesion (64.5%). The other findings of pulmonary involvement were 18.8% diffuse interstitial lung disease, 12.5% bronchiectasis, and 27.1% bullae-emphysema. The mean age of patients with pulmonary involvement was higher and as they smoked more. The pulmonary involvement was 5.2 times higher in patients with skin lesions because of arsenic. Diffusing capacity of lung for carbon monoxide was significantly lower in patients with pulmonary involvement.

Conclusion: Besides lung cancer, chronic occupational inhalation of arsenic exposure may cause non-malignant pulmonary findings such as bronchiectasis, pulmonary nodules and diffuse interstitial lung disease. So, in order to detect pulmonary involvement in the early stages, workers who experience occupational arsenic exposure should be followed by diffusion test and high-resolution computed tomography.
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http://dx.doi.org/10.4274/balkanmedj.2016.0795DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5450867PMC
May 2017

Antibiotic Decision in Severe Chronic Obstructive Pulmonary Disease Exacerbations.

Respiration 2017 22;94(1):75. Epub 2017 Apr 22.

Medical Intensive Care Unit, Department of Pulmonary and Critical Care, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey.

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http://dx.doi.org/10.1159/000472719DOI Listing
August 2017

Evaluation of dental technician's pneumoconiosis using chest X-rayand HRCT: correlation between radiological and functional findings.

Turk J Med Sci 2017 Feb 27;47(1):252-259. Epub 2017 Feb 27.

Department of Pulmonary and Critical Care, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey.

Background/aim: This study aimed to compare high-resolution computed tomography (HRCT) findings with those of chest X-ray (CXR) and to evaluate the relationship of pulmonary function test (PFT) parameters with HRCT and CXR findings in cases of dental technician's pneumoconiosis.

Materials And Methods: CXR, PFT, and HRCT data of 89 dental technicians who were diagnosed with pneumoconiosis were retrospectively evaluated.

Results: The cases of 24 dental technicians (27%) classified as normal (Category 0) based on CXR were evaluated as Category 1 according to HRCT. There was an inverse correlation of PFT parameters with nodular profusion score in CXR and all HRCT parameters. In this participant sample, small opacities were predominant (70% of the individuals), and worsening of PFT parameters was associated with the prevalence of pulmonary parenchymal changes.

Conclusion: In the present study, micronodules detected using HRCT had an effect on pulmonary function worsening, which has not been reported in previous studies.
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http://dx.doi.org/10.3906/sag-1604-146DOI Listing
February 2017

Mortality Related Risk Factors in High-Risk Pulmonary Embolism in the ICU.

Can Respir J 2016 29;2016:2432808. Epub 2016 Nov 29.

School of Medicine, Intensive Care Unit, Dokuz Eylül University, Izmir, Turkey.

. We sought to identify possible risk factors associated with mortality in patients with high-risk pulmonary embolism (PE) after intensive care unit (ICU) admission. . PE patients, diagnosed with computer tomography pulmonary angiography, were included from two ICUs and were categorized into groups: group 1 high-risk patients and group 2 intermediate/low-risk patients. . Fifty-six patients were included. Of them, 41 (73.2%) were group 1 and 15 (26.7%) were group 2. When compared to group 2, need for vasopressor therapy (0 vs 68.3%; < 0.001) and need for invasive mechanical ventilation (6.7 vs 36.6%; = 0.043) were more frequent in group 1. The treatment of choice for group 1 was thrombolytic therapy in 29 (70.7%) and anticoagulation in 12 (29.3%) patients. ICU mortality for group 1 was 31.7% ( = 13). In multivariate logistic regression analysis, APACHE II score >18 (OR 42.47 95% CI 1.50-1201.1), invasive mechanical ventilation (OR 30.10 95% CI 1.96-463.31), and thrombolytic therapy (OR 0.03 95% CI 0.01-0.98) were found as independent predictors of mortality. . In high-risk PE, admission APACHE II score and need for invasive mechanical ventilation may predict death in ICU. Thrombolytic therapy seems to be beneficial in these patients.
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http://dx.doi.org/10.1155/2016/2432808DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5153485PMC
July 2017