Publications by authors named "Funda Coskun"

24 Publications

  • Page 1 of 1

Long-term oxygen treatment need is less frequent in eosinophilic COPD patients.

Clin Respir J 2021 Oct 9. Epub 2021 Oct 9.

Faculty of Medicine, Department of Pulmonology, Uludağ University, Bursa, Turkey.

Introduction: Eosinophilic airway inflammation is a recognized inflammatory pattern in subgroups of patients with chronic obstructive pulmonary disease (COPD). However, there are still conflicting results between various studies concerning the effect of eosinophils in COPD patients. Our aim with this study was to evaluate eosinophilic inflammation and its relation to the clinical characteristics in a group of COPD patients.

Methods: Stable COPD patients with FEV % predicted < 50 or with ≥ 1 exacerbation leading to hospital admission or ≥2 moderate or severe exacerbation history were consecutively enrolled from outpatient clinics.

Results: We included 90 male COPD patients, with a mean age of 63.3 ± 9.2. Mean FEV % predicted was 35.9 ± 11.3. Eosinophilic inflammation (eosinophil percentage ≥2%) was evident in 54 (60%) of the patients. Participants with eosinophilic inflammation were significantly older and had better FEV predicted % values. Eosinophilic COPD patients were characterized with better quality of life and fewer symptoms. COPD patients with noneosinophilic inflammation used supplemental long-term oxygen therapy (LTOT) more frequently compared to patients with eosinophilic inflammation (36.1% vs. 14.8%, p = 0.01). Eosinophilic inflammation is associated with less dyspnea severity measured by mMRC (OR: 0.542 95% CI: 0.342-0.859, p = 0.009) and less LTOT use (OR: 0.334 95% CI: 0.115-0.968, p = 0.04) regardless of age, severity of airflow limitation, and having frequent exacerbation phenotype.

Conclusion: Our study supports the growing evidence for a potential role of eosinophilic inflammation phenotype in COPD with distinctive clinical characteristics. Eosinophilic inflammation is inversely associated with dyspnea severity measured by mMRC and LTOT use independently from age, total number of exacerbations, St. George Respiratory Questionnaire (SGRQ) total score and FEV % predicted.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/crj.13451DOI Listing
October 2021

Effects of the COVID-19 pandemic on the follow-up and treatment of patients with idiopathic pulmonary fibrosis: a cross-sectional, multicentre phone call survey.

BMJ Open 2021 08 12;11(8):e050578. Epub 2021 Aug 12.

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

Objective: To learn about the attitudes and behaviours of patients with idiopathic pulmonary fibrosis (IPF) in relation to the difficulties experienced during the COVID-19 pandemic.

Design: A cross-sectional, multicentre phone call survey.

Setting: Four university hospitals in Turkey.

Participants: The study included patients with IPF receiving antifibrotics for at least 3 months and with doctor appointment and/or scheduled routine blood analysis between March and May 2020 (the first 3 months after the official announcement of the COVID-19 pandemic in Turkey).

Interventions: Phone calls (a 5 min interview) were performed in June 2020. A questionnaire and the Hospital Anxiety-Depression Scale were applied.

Main Outcome Measures: Patients' preferences for disease monitoring, patients' attitudes and behaviours towards IPF, drug continuation, COVID-19 diagnosis and anxiety/depression status.

Results: The study included 115 patients with IPF (82 male; mean age, 68.43±7.44 years). Of the patients, 73.9% had doctor appointment and 52.2% had scheduled routine blood testing; 54.5% of patients with doctor appointment self-cancelled their appointments and 53.3% of patients with scheduled routine blood testing did not undergo testing. Of the patients, 32.2% were on nintedanib and 67.8% were on pirfenidone; self-initiated drug discontinuation rate was 22.6%. The percentage of patients communicating with their physicians was 35.7%. The route of communication was by phone (34.8%). The frequency of depression and anxiety was 27.0% and 38.3%, respectively. The rates of drug discontinuation (35.1% vs 16.7%, p<0.05) and depression (37.8% vs 21.8%, p=0.07) were higher in nintedanib users than in pirfenidone users. Only two (1.7%) patients had COVID-19 diagnosis.

Conclusions: During the COVID-19 pandemic, a significant proportion (>50%) of patients self-cancelled their appointments and nearly a quarter of patients discontinued their medications. Providing a documentation of the problems experienced by patients with IPF about management of the necessary requirements during the COVID-19 pandemic, this study may be a model for patients with chronic diseases.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2021-050578DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8361704PMC
August 2021

SD-OCT assessment of macular and optic nerve alterations in patients recovered from COVID-19.

Can J Ophthalmol 2021 Jul 5. Epub 2021 Jul 5.

Bursa Uludag University School of Medicine, Department of Chest Diseases, Bursa, Turkey.

Objective: To quantify microstructutal alterations in the macula and peripapillary retinal nerve fibre layer (RNFL) in patients recovered from coronavirus disease 2019 (COVID-19) using spectral domain optic coherence tomography (SD-OCT).

Design: Retrospective, observational.

Participants: This comparative, cross-sectional study included patients who recovered from COVID-19 (Group 1) and age- and sex-matched normal controls (Group 2).

Methods: A comprehensive ophthalmic examination, including best-corrected visual acuity and biomicroscopic anterior and posterior segment examination was performed. SD-OCT analysis of the macula and peripapillary RNFL was obtained for each participant. In addition, patient demographics and comorbidities were recorded.

Results: 238 eyes of 122 subjects (Group 1: n = 63; Group 2: n = 59) were included. The incidence of coexisting comorbidity was higher in Group 1 (n = 26/63, 41.3%) compared with Group 2 (n = 12/59, 20.3%) (p = 0.013). The central foveal thickness (CFT) was significantly higher in Group 1 (271.0±26.8 µm) than Group 2 (263.2±22.0 µm) (p = 0.015). The average outer nuclear layer (ONL) thickness at central fovea in Group 1 (85.4±13.3 µm) was significantly thicker than that in Group 2 (81.4±15.2 µm) (p = 0.035). The mean peripapillary RNFL thickness of Group 1 (102.6±8.8 µm) and Group 2 (100.9±8.3 µm) were similar (p = 0.145). The mean choroidal thickness of groups at the fovea and at 1500 µm nasal and temporal to the fovea were not significantly different (p > 0.05 for all).

Conclusion: Significant thickness alterations in individual retinal layers and CFT was detected in post-COVID-19 patients. The increase in CFT and ONL thickness might be attributed to direct infection or viral-induced inflammatory response of retina.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcjo.2021.06.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8255111PMC
July 2021

Understanding university students' smoking behaviors towards tobacco-free campus policy.

Tuberk Toraks 2021 Mar;69(1):49-58

Department of Chest Diseases, Uludağ University Faculty of Medicine, Bursa, Turkey.

Introduction: Tobacco-free college campuses refer to colleges and universities that have implemented policies prohibiting the use of tobacco products at all indoor and outdoor campus locations. We aimed to evaluate university students' smoking behaviors and their attitudes towards "Tobacco-Free Campus Policy".

Materials And Methods: A total of 10,383 university students were included in this cross-sectional study. The questionnaire was sent via web-based student information system. Demographical variables, the frequency of tobacco use, the addiction levels of the smoker students, and their perspective on the Tobacco-Free Campus Policy were evaluated.

Result: The study population consisted of 5461 (52.6%) males and their mean age was 22.1 ± 3.9 years. Among the students, 3992 (38.4%) were current smokers and the age of first smoking was 16.5 ± 2.78 years. According to FTND scores, 15.1% of participants have high dependence, and 7.5% of them have very high dependence. There was a significant difference among participants who finds unacceptable "Tobacco-Free Campus Policy" in terms of gender (70.7% males vs. 29.3% females, p<0.001) and smoking habit (7% never smoker, 4.1% ex-smoker, 88.9% current smoker, p<0.001).

Conclusions: The Tobacco-Free Campus Policy is important to fight against the tobacco industry in order to protect the right to health of all tobacco users and those who do not use it and should be considered as a goal to be achieved in order to live in a healthy environment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5578/tt.20219906DOI Listing
March 2021

Is serum iron responsive protein-2 level associated with pulmonary functions and frequent exacerbator phenotype in COPD?

Tuberk Toraks 2020 Sep;68(3):252-259

Department of Chest Diseases, Faculty of Medicine, Uludag University, Bursa, Turkey.

Introduction: Chronic Obstructive Pulmonary Disease (COPD) exacerbations contribute to the overall severity in individual patients because they are associated with airway inflammation, pulmonary function loss, decreased quality of life and increased mortality. Although, identifying frequent exacerbator patients is important due to severe outcomes associated with frequent exacerbator phenotype in COPD patients there is no single biomarker which can differentiate this phenotype. Iron responding protein-2 (IRP2) is the protein product of IREB2 gene, which is a COPD susceptibility gene that regulates cellular iron homeostasis and has a key role in hypoxic conditions. Previous research indicates that IREB2 expression in lung tissue is associated with spirometric measurements and emphysema in COPD. In this study, our aim was to investigate whether serum IRP2 levels were associated with frequent exacerbator phenotype, to evaluate whether IRP2 levels in serum are associated with pulmonary functions and selected systemic inflammation biomarkers.

Materials And Methods: Designed as a single tertiary care center based, crosssectional study, included high risk (GOLD C, D) COPD patients who admitted to outpatient clinic consecutively between December 2015 and July 2016.

Result: The study included 80 COPD patients. Serum IRP2 levels were negatively correlated with FEV1 ml (r= -0.25, p= 0.02) and body weight (r= -0.35, p= 0.002) but not with markers of systemic inflammation. COPD patients with at least one exacerbation history in the last year tended to have higher IRP2 levels than patients without any exacerbation [12.3 (IQR 25-75: 10.4- 17.1) vs 10.5 (IQR 25-75: 8.8-18.5), p= 0.06].

Conclusions: Serum IRP2 level is significantly correlated with FEV1 mL but not with FEV1 % predicted and cannot be used to differentiate frequent exacer bator patients. Although IREB2 gene expressions in lung tissue and bronchoalveolar lavage results have significant associations with emphysema and FEV1/FVC, FEV1 %predicted in COPD patients, our results suggests serum IRP2 level is not as promising.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5578/tt.69934DOI Listing
September 2020

Serum CCL-18 level is a risk factor for COPD exacerbations requiring hospitalization.

Int J Chron Obstruct Pulmon Dis 2017 5;12:199-208. Epub 2017 Jan 5.

Department of Pulmonary Disesaes.

Introduction: Chemokine (C-C motif) ligand 18 (CCL-18) has been shown to be elevated in chronic obstructive pulmonary disease (COPD) patients. This study primarily aimed to evaluate whether the serum CCL-18 level differentiates the frequent exacerbator COPD phenotype from infrequent exacerbators. The secondary aim was to investigate whether serum CCL-18 level is a risk factor for exacerbations requiring hospitalization.

Materials And Methods: Clinically stable COPD patients and participants with smoking history but normal spirometry (NSp) were recruited for the study. Modified Medical Research Council Dyspnea Scale, COPD Assessment Test, spirometry, and 6-min walking test were performed. Serum CCL-18 levels were measured with a commercial ELISA Kit.

Results: Sixty COPD patients and 20 NSp patients were recruited. Serum CCL-18 levels were higher in COPD patients than those in NSp patients (169 vs 94 ng/mL, <0.0001). CCL-18 level was significantly correlated with the number of exacerbations (=0.30, =0.026), although a difference in CCL-18 values between infrequent and frequent exacerbator COPD (168 vs 196 ng/mL) subgroups did not achieve statistical significance (=0.09). Serum CCL-18 levels were significantly higher in COPD patients who had experienced at least one exacerbation during the previous 12 months. Overall, ROC analysis revealed that a serum CCL-18 level of 181.71 ng/mL could differentiate COPD patients with hospitalized exacerbations from those who were not hospitalized with a 88% sensitivity and 88.2% specificity (area under curve: 0.92). Serum CCL-18 level had a strong correlation with the frequency of exacerbations requiring hospitalization (=0.68, <0.0001) and was found to be an independent risk factor for hospitalized exacerbations in the multivariable analysis.

Conclusion: CCL-18 is a promising biomarker in COPD, as it is associated with frequency of exacerbations, particularly with severe COPD exacerbations requiring hospitalization, as well as with functional parameters and symptom scores.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2147/COPD.S118424DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5221541PMC
October 2017

GSTT1 and GSTM1 gene polymorphisims in sarcoidosis.

Sarcoidosis Vasc Diffuse Lung Dis 2016 Oct 7;33(3):253-257. Epub 2016 Oct 7.

Uludag University.

Introduction: Sarcoidosis is a granulomatous disease of unknown cause, which affects all systems, especially the lungs and the lymphatic system. Genetic and environmental factors are held accountable for the etiology. Based on the general opinion, sarcoidosis develops after exposure to a specific environmental agent by genetically susceptible individuals.  The present study aimed to evaluate the disease susceptibility of the GSTT1 and GSTM1 gene polymorphisms in the patients with sarcoidosis.

Method: The present study included 78 patients; 38 patients with histopathologically verified sarcoidosis and 40 control subjects. Multiplex PCR method was used to determine the GSTT1 and GSTM1 gene polymorphisms. The genotype was determined based on the bands formed in the agarose gel electrophoresis. The statistical analysis was done using the chi-square test.

Results: The positive/negative genotype rates were 79%/21% and 53%/47%, respectively in the case group for the GSTT1 and GSTM1 gene polymorphisms, whereas the positive/negative genotype rates were 77%/23% and 55%/45% in the control group. There was no statistically significant difference in the positive and negative genotypes compared with the case group and the control group for the GSTT1 and GSTM1 gene polymorphisms (p > 0.05).

Discussion: The results from the present study suggest that there is not any association with the control group for the disease susceptibility of the GSTT1 and GSTM1 gene polymorphisms in patients with sarcoidosis, and this result should be supported by large-scale studies because of the limited number of cases in the present study.
View Article and Find Full Text PDF

Download full-text PDF

Source
October 2016

Catheter-Directed Therapy in Acute Pulmonary Embolism with Right Ventricular Dysfunction: A Promising Modality to Provide Early Hemodynamic Recovery.

Med Sci Monit 2016 Apr 15;22:1265-73. Epub 2016 Apr 15.

Department of Pulmonary Medicine, Uludag University Faculty of Medicine, Bursa, Turkey.

BACKGROUND Catheter-directed therapy (CDT) for pulmonary embolism (PE) is considered as an alternative to systemic thrombolysis (ST) in patients with hemodynamically unstable acute PE who are considered at high bleeding risk for ST. We aimed to evaluate the efficacy and safety of CDT in the management of acute PE with right ventricular dysfunction (RVD). The primary outcomes were mortality, clinical success, and complications. Secondary outcomes were change in hemodynamic parameters in the first 24 hours following the procedure. MATERIAL AND METHODS Medical records of consecutive patients diagnosed as having acute massive or submassive PE with accompanying RVD treated by immediate CDT at our institution from January 2007 to January 2014 were reviewed. Patient characteristics, mortality, achievement of clinical success, and minor and major bleeding complications were analyzed in the overall study group, as well as massive vs. submassive PE subgroups. Change in hemodynamic parameters in the second, eighth, and 24th hours after the CDT procedure were also analyzed. RESULTS The study included 15 consecutive patients (M/F=10/5) with a mean age of 54.2 ± 16.6 years who underwent immediate CDT. Nine of the patients had submassive PE, and 6 had massive PE. In-hospital mortality rate was 13.3% (95% CI, 0.04-0.38). One major, but not life-threatening, bleeding episode was evident in the whole group. Hemodynamic parameters were stabilized and clinical success was achieved in 14/15 (93.3%; 95% CI, 70.2-98.8) of the patients in the first 24 hours. Notably, the hemodynamic recovery was significantly evident in the first 8 hours after the procedure. CONCLUSIONS CDT is a promising treatment option for patients with acute PE with RVD with no fatal bleeding complication. In experienced centers, CDT should be considered as a first-line treatment for patients with acute PE and RVD and contraindications for ST, with the advantage of providing early hemodynamic recovery.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4835153PMC
http://dx.doi.org/10.12659/msm.897617DOI Listing
April 2016

[The Pneumocystis jirovecii colonization in bronchoalveolar lavage (BAL) and bronchial washing and the comparison of methods which are used in diagnosis].

Tuberk Toraks 2013 ;61(4):303-11

Department of Chest Diseases, Faculty of Medicine, Uludag University, Bursa, Turkey.

Introduction: Pneumocystis pneumonia (PCP) which is caused by Pneumocystis jirovecii is usually seen in the patients whose immune system is supressed. It is seriously seen an opportunist infection. In our study; totally 100 bronchoalveolar lavage (BAL) and bronchial washing samples collected by pulmonary disease department. Which belong to the patients in the clinics, and out patient clinic of the bronchoscopy material were evaluated.

Materials And Methods: The BAL and bronchial washing were evaluated by the help of methenamine silver stain (Gomori/Grocott), toluidine blue O stain, Wright-Giemsa stain, immun fluorescent antibody (IFA) stain, nested polymerase chain reaction (PCR).

Results: In the BAL and bronchial washing samples the agent couldn't be shown by the help of methenamine silver (Gomori/Grocott), toluidine blue O, Wright-Giemsa staining. In 13 patients with IFA test the cysts of P. jirovecii were determined. In 16 patients with nested PCR; the DNA of P. jirovecii were determined. In 8 patients by using PCR and IFA test P. jirovecii was determined. When the samples which had P. jirovecii were analyzed; 13 of them were BAL and 8 of them were bronchial washing. When the phenomenon groups were evaluated according to age, gender, smoking, hypertension, diabetes mellitus, chronic obstructive pulmonary disease (COPD), cerebrovascular accident (CVA), congestive cardiac failure (CCF), staying in the hospital in the last three months, using antibiotics and radiological findings; there wasn't a statistical meaningful relation between P. jirovecii positivity and these situations. When the phenomenon groups were evaluated according to PCR and IFA positivity; in IFA and PCR positive patients for immunosupressive there was a meaningful differances (p= 0.003). The positive 28.6 % of cases were immunosuppressed and the 3.8% of PCR or IFA negative cases were immunosupressed. When PCR method was compared with IFA which is called gold standard for sensitivity and specificity; sensitivity was found 61.5% and specificity was found 90.8%. IFA and PCR diagnosis test results were compatible (With McNemar test p= 0.581).

Conclusion: Diagnostic sensitivity of staining methods for P. jirovecii in immunocompromised HIV negative patients are found to be low and it was shown that IFA and nested PCR methods have not parallel results.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5578/tt.2954DOI Listing
March 2015

Association between self reported snoring, STOP questionnaire and postoperative pulmonary complications in patients submitted to ortophaedic surgery.

Multidiscip Respir Med 2013 Jan 18;8(1). Epub 2013 Jan 18.

Pulmonary Medicine Department, School of Medicine,, University of Uludag, Bursa, Turkey.

Background: Obstructive sleep apnea (OSA) may increase perioperative complications. The aim of this study was to determine the relationship among postoperative pulmonary complication, snoring and STOP questionnaire in patients with ortophaedic surgery.

Methods: 1,406 consecutive records of patients who had undergone elective ortophaedic surgery during the period January 2005-December 2008 were investigated retrospectively. Demographic information, sleep symptoms, STOP questionnaire, comorbidities and outcome data were collected.

Results: There were 289 (20.5%) snorers and 1,117 (79.5%) non-snorers in the study group. There was no significant difference between snorer and non-snorer patients (p > 0.05) in the prevalence of pneumonia and respiratory failure. But in snorer patients the rate of postoperative atelectasis was significantly higher than in non-snorer group (p < 0.0001). The STOP Questionnaire was given to 1,406 patients and 147 (10.4%) out of them were classified at high risk of OSA. There was no significant difference in the prevalence of pneumonia and respiratory failure between low and high risk group (p > 0.05). However, in high risk patients the occurrence of postoperative atelectasis was significantly higher than in low risk group (p < 0.0001).

Conclusion: Postoperative atelectasis was significantly more prevalent in the high risk group according to STOP questionnaire.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/2049-6958-8-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3598696PMC
January 2013

ACE gene I/D polymorphism and risk of sarcoidosis development in Turkish patients.

Tuberk Toraks 2012 ;60(3):201-6

Clinic of Chest Diseases, Corum Chest Diseases Hospital, Corum, Turkey.

Introduction: Etiology of sarcoidosis is unknown but the prevalence of disease in different ethnic groups and identical twins, family characteristics indicate that genetic predisposition is a possible factor. The angiotensin-converting enzyme (ACE) has been implicated in the pahophysiology of sarcoidosis. The aim of this study is to investigate the influence of a polymorphism in I/D (Insertion/Deletion) of the ACE gene on the susceptibility to sarcoidosis.

Patients And Methods: Our study included 70 Turkish patients who had histopathological diagnosis of sarcoidosis and 69 healthy age and sex matched control subjects. Polymerase chain reaction was used for analysing an I/D polymorphism in the gene coding for ACE. Genotyping was done according to bands that were formed on the agarose gel electrophoresis. Chi-square test was used for statistical analysis and p< 0.05 was accepted as significance.

Results: Although the D allele was more frequent in the sarcoidosis patients group, the frequency of the D allele was 67% and 54% respectively in the sarcoidosis and the control group. No significant difference in allele frequencies of I/I, I/D, D/D polymorphisms was observed between the sarcoidosis and control group (p> 0.05). Similarly allele frequencies of I/I, I/D, D/D polymorphisms was not different between sarcoidosis patients with extrapulmonary involvement and sarcoidosis patients without extrapulmonary involvement (p> 0.05).

Conclusion: Our findings have showed that contribution of ACE gene polymorphisms to susceptibility of disease development in Turkish sarcoidosis patients is not different from the healthy control subjects.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5578/tt.3935DOI Listing
December 2012

[Impaired myocardial performance in sarcoidosis].

Tuberk Toraks 2010 ;58(4):401-7

Department of Cardiology, Faculty of Medicine, Uludağ University, Bursa, Turkey.

Despite myocardial sarcoid involvement has been reported in 20-27% in autopsy series, only 5% of the patients are clinically symptomatic. This study was planned to evaluate right and left ventricular functions in patients with early stage sarcoidosis (stage I and II) without any findings of cardiac involvement with Tei index which globally shows systolic and diastolic functions of the ventricles was used. Seventy-two patients under follow-up for sarcoidosis without cardiac involvement (53 women, 19 men; mean age 49.1 ± 10.3 years) and nineteen age-matched healthy control subjects (14 women, 5 men; mean age 48.7 ± 6.5 years) were enrolled in the study. All subjects were evaluated with two-dimensional and Doppler echocardiography. Right and left ventricle Tei indices (myocardial performance index) were calculated from measured Doppler parameters. Peak velocity of the mitral A wave (A) was higher, peak velocity of the mitral E wave, E/A ratio were lower; and ejection time was shorter in patients with sarcoidosis (p< 0.05) compare to controls. Peak velocity of the tricuspid A wave was higher, E wave deceleration time was longer and E/A ratio was lower (p< 0.05) in sarcoidosis group. While left ventricular Tei index was higher in patients with sarcoidosis (p= 0.021), right ventricular Tei index was similar to healthy controls' (p>0.05). Left ventricular myocardial performance is disturbed in patients with early stage sarcoidosis. This can be related to a subclinical involvement of sarcoidosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
April 2011

Impaired left ventricular systolic and diastolic functions in patients with early grade pulmonary sarcoidosis.

Eur J Echocardiogr 2010 Dec 31;11(10):809-13. Epub 2010 May 31.

Department of Cardiology, Uludag University Faculty of Medicine, 16059 Gorukle, Bursa, Turkey.

Aims: Cardiac sarcoidosis is symptomatic in only 5% of patients, and it is an independent predictor of mortality and carries a very poor prognosis. In our study, we aimed to assess left ventricle (LV) systolic and diastolic functions with tissue Doppler imaging (TDI) in patients with early grade pulmonary sarcoidosis.

Methods And Results: The study population included 55 patients with Grade I-II sarcoidosis (41 females, 14 males, mean age: 47.9 ± 10.1) and 22 healthy subjects. LV lateral and septal wall early myocardial peak velocity (E(m)), late myocardial peak velocity (A(m)), E(m) to A(m) ratio, myocardial relaxation time (RT(m)), myocardial systolic wave (S(m)) velocity, isovolumic acceleration (IVA), myocardial pre-contraction time (PCT(m)), contraction time (CT(m)), and the PCT(m) to CT(m) ratio were measured. No statistically significant difference was detected between the groups according to age, gender, body mass index, systolic and diastolic blood pressure, or heart rate. LV systolic parameters, LV septal, and lateral wall IVA, were significantly lower, and the PCT(m) to CT(m) ratio (P = 0.026) was higher at the septal annulus as compared with control group. E(m), a LV diastolic parameter, was significantly lower at the septal annulus.

Conclusion: Cardiac sarcoid involvement is not rare and is treatable. It should be identified at an early stage. TDI, especially IVA, may be a suitable tool for the early detection of subclinical LV sarcoid involvement.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ejechocard/jeq070DOI Listing
December 2010

Immune thrombocytopenia associated with pulmonary tuberculosis.

J Infect Chemother 2010 Feb;16(1):42-4

Department of Pulmonary Medicine, School of Medicine, University of Uludag, Bursa, Turkey.

Many hematological abnormalities, such as pancytopenia, anemia, and leukocytosis, can be associated with tuberculosis (TB). Immune thrombocytopenic purpura (ITP) is an extremely rare event in TB. We report a 46-year-old male patient who was admitted to hospital with a history of weight loss, combined with hemoptysis, fever, cough, sputum, general malaise, and night sweats. Physical examination revealed a body temperature of 38.8 °C, and petechiae distributed over the lower extremities. Laboratory findings were as follows: erythrocyte sedimentation rate, 84 mm/h; white blood cells, 7070/mm3; hemoglobin, 11.7 g/dl; and platelet count, 4000/mm3. On Ziehl-Neelsen stain of sputum, acid-fast bacilli were observed. Antituberculosis therapy was started, together with prednisolone, 0.5 mg/kg per day, from the day of admission. He was treated successfully with the steroid and antituberculous drugs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10156-009-0003-6DOI Listing
February 2010

Relationship between disease severity and D-dimer levels measured with two different methods in pulmonary embolism patients.

Multidiscip Respir Med 2010 Jun 30;5(3):168-72. Epub 2010 Jun 30.

Pulmonology Department, School of Medicine, Uludag University, Bursa, Turkey.

Pulmonary embolism (PE) is diagnosed with increasing frequency nowadays due to advances in the diagnostic methods and the increased awareness of the disease. There is a tendency to use non invasive diagnostic methods for all diseases. D-dimer is a fibrin degradation product. We aimed to detect the relationship between disease severity and the D-dimer levels measured with two different methods. We compared D-dimer levels in cases of massive vs. non-massive PE. A total of 89 patients who were diagnosed between 2006 and 2008 were included in the study. Group 1 included patients whose D-dimer levels were measured with the immunoturbidimetric polyclonal antibody method (D-dimerPLUS®), while Group 2 patients made use of the immunoturbidimetric monoclonal antibody method (InnovanceD-DIMER®). In each group, the D-dimer levels of those with massive and non-massive PE were compared, using the Mann Whitney U test. The mean age of Group 1 (25 F/26 M) was 56.0 ± 17.9 years, and that of Group 2 (22 F/16 M) was 52.9 ± 17.9 years. There was no statistical difference in gender and mean age between the two groups (p > 0.05). In Group 1, the mean D-dimer level of massive cases (n = 7) was 1444.9 ± 657.9 μg/L and that of nonmassive PE (n = 34) was 1304.7 ± 350.5 μg/L (p > 0.05). In Group 2, the mean D-dimer level of massive cases (n = 6) was 9.7 ± 2.2 mg/L and that of non-massive PE (n = 32) was 5.9 ± 1.3 mg/L (p < 0.05). The mean D-dimer levels of massive cases as measured with the immunoturbidimetric monoclonal antibody method were significantly higher. Pulmonary embolism patients whose D-dimer levels are higher (especially higher than 6.6 mg/L) should be considered as possibly having massive embolism. Diagnostic procedures and management can be planned according to this finding.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/2049-6958-5-3-168DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3463048PMC
June 2010

Evaluation of thyroid hormone levels and somatomedin-C (IGF-1) in patients with chronic obstructive pulmonary disease (COPD) and relation with the severity of the disease.

Tuberk Toraks 2009 ;57(4):369-75

Uludağ Universitesi Tip Fakültesi, Göğüs Hastaliklari Anabilim Dali 16050, Bursa, Turkey.

Chronic obstructive pulmonary disease (COPD) has recently become a significant cause of mortality and morbidity. In the present study, we aimed to investigate the relationship between the severity of the disease and levels of serum thyroid hormones and somatomedin-C [Insulin-Like Growth Factor (IGF-1)]. Sixty one COPD cases (group 1) were enrolled. Control group (group 2) consisted of 20 healthy individuals. Blood samples were obtained for the analysis of arterial blood gases and hormone levels and respiratory function tests were performed on the same day. Measured hormone levels were compared between group 1 and group 2. Among thyroid hormone levels, there was no significant difference in thyroid stimulating hormone and free T3 between group 1 and 2 whereas free T4 levels were significantly higher in group 1 (p< 0.01). Additionally, mean IGF-1 levels were significantly lower in group 1 (p< 0.005). When three groups, classified according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria, were compared, significant differences were observed between mild-moderate COPD cases and severe patients with respect to free T3 and IGF-1 levels (p< 0.05). Hormone levels in COPD patients change depending on the severity of the disease. In the future hormone therapies can use for the COPD treatments. Further studies with larger sample sizes are required to confirm our conclusions.
View Article and Find Full Text PDF

Download full-text PDF

Source
March 2010

Low-grade urinary albumin excretion in normotensive/non-diabetic obstructive sleep apnea patients.

Sleep Breath 2008 Aug 12;12(3):217-22. Epub 2008 Mar 12.

Department of Pulmonary Medicine, School of Medicine, University of Uludağ, Bursa, Turkey.

Previous studies have indicated that high levels of urinary albumin excretion (UAE) are associated with an increased incidence of cardiovascular morbidity and mortality. This study examined the association between UAE and obstructive sleep apnea syndrome (OSAS). The study included 35 newly diagnosed OSAS patients and 11 nonapneic controls. Subjects with diabetes mellitus, hypertension, a history of renal failure, cardiac failure, coronary heart disease, collagen tissue disease, high serum creatinine, and urinary infection, and who use angiotensin-converting enzyme inhibitors and were women were excluded from the study. A single void morning urine sample at the baseline examination was used to measure UAE. There were no significant differences in the age, body mass index (BMI), and smoking habits of the OSAS patients and controls. UAE of the OSAS group was significantly higher than that of the control group (23.3 +/- 6.1 microg/min vs. 6.5 +/- 2.1 microg/min, respectively; P = 0.002). UAE was positively correlated to length of time spent at an oxygen saturation of <90% (r = 0.503, P = 0.002) and BMI (r = 0.361, P = 0.033). Regression analyses (r (2) = 0.504, P < 0.0001) showed that the length of time spent at an oxygen saturation of <90% (P < 0.0001) was risk factor for UAE, independent of age and BMI. Our study supports the notion that low-grade UAE is associated with non-hypertensive/non-diabetic OSAS, independent of age and BMI. Low-grade UAE may be a marker for subclinical vascular damage that predisposes OSAS patients to future cardiovascular disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11325-008-0169-7DOI Listing
August 2008

[The evaluation to relationship between serum vascular endothelial growth factor (VEGF) level, metastases and other tumor markers in patients with lung cancer].

Tuberk Toraks 2008 ;56(1):50-5

Department of Chest Diseases, Faculty of Medicine, Uludağ University, Bursa, Turkey.

Vascular endothelial growth factor (VEGF) is a potent mediator of angiogenesis. Increased expression of VEGF may be associated with advanced stage and poor prognosis in patients with lung cancer. We investigated the relationship between serum VEGF level and lung cancer stage. We also studied the correlation between serum VEGF level and some other tumor markers. Forty newly diagnosed lung cancer (31 non-small cell, 9 small cell) patients and 25 age-matched controls were enrolled in this study. Serum VEGF levels of lung cancer group (345.16 +/- 159.36 pg/mL) were significantly higher than that of the control group (230.36 +/- 47.87 pg/mL) (p< 0.001). The area under the ROC curve was 0.727 (p< 0.05) for serum VEGF threshold of 249.8 pg/mL predictive sensitivity and specificity, for lung cancer were respectively 70.0% and 76.0%. There were no significant relationship between serum VEGF level and age, gender, histologic type, lung cancer stage, distant metastases and site of metastases. In addition, there were no correlation between serum VEGF level and other tumor markers (NSE, CYFRA 21-1, CEA, CA125, LDH).
View Article and Find Full Text PDF

Download full-text PDF

Source
April 2009

Relief from sleep apnea after radiation and chemotherapy.

Clin Lung Cancer 2007 Sep;8(8):502-3

Department of Pulmonary Medicine, School of Medicine, University of Uludag, Bursa, Turkey.

Superior vena cava syndrome (SVCS) can result from extrinsic compression by a primary tumor, mediastinal lymph nodes metastases, benign lesions, or intraluminal thrombosis. The association between obstructive sleep apnea and SVCS has not been extensively evaluated. To our knowledge, only 5 cases of obstructive sleep apnea in SVCS have been reported in the literature. We presented a 53-year-old man who was admitted with dyspnea, edema of the face, and excessive daytime sleepiness. Chest radiography and computed tomography revealed lung cancer. A biopsy of the tumor revealed squamous cell carcinoma. Obstructive sleep apnea was diagnosed by polysomnography (apnea hypopnea index: 13 per hour). After radiation and chemotherapy, edema of the face, snoring, and daytime sleepiness were alleviated, and the patient's apnea hypopnea index decreased to 0.6 per hour. In conclusion, there is a relationship between obstructive sleep apnea and SVCS.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3816/CLC.2007.n.036DOI Listing
September 2007

Low level of IGF-1 in obesity may be related to obstructive sleep apnea syndrome.

Lung 2007 Sep-Oct;185(5):309-314. Epub 2007 Aug 27.

Department of Pulmonary Medicine, School of Medicine, University of Uludag, Bursa, Turkey.

The aim of this study was to compare serum insulin-like growth factor (IGF-1) levels in patients with obstructive sleep apnea syndrome (OSAS) with those of nonapneic controls and to determine the risk factors of low IGF-1 levels in patients with OSAS. The study included 39 newly diagnosed moderate-to-severe OSAS patients and 36 nonapneic controls. Overnight polysomnography (PSG) was performed in all patients. The circulating levels of IGF-1 in the OSAS group were significantly lower than those of the control group (p < 0.05). There was a significant negative correlation between IGF-1 and logarithmic transformation (Ln) of the apnea-hypopnea index (AHI), duration of apnea-hypopnea, arousal index, average desaturation, and oxygen desaturation index (ODI). The result of stepwise regression analyses showed that OSAS (p = 0.001) was a risk factor for a low IGF-1 level, independent of age, gender, and body mass index (BMI). Our findings demonstrated that there was a significant negative correlation between IGF-1 and Ln AHI and that OSAS reduced the circulating levels of IGF-1.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00408-007-9026-xDOI Listing
December 2007

Breast and osteoarticular tuberculosis in a male patient.

Diagn Microbiol Infect Dis 2007 Aug 16;58(4):477-9. Epub 2007 May 16.

Department of Pulmonary Medicine, School of Medicine, University of Uludağ, Bursa, Turkey.

Breast tuberculosis is an uncommon illness. It is predominant in young women. To our knowledge, only 7 cases of tuberculous mastitis in men have been reported in the English literature since 1945. Furthermore, there are no male patients who have breast and osteoarticular tuberculosis in the literature. We presented a 41-year-old man who was admitted with a fixed tender mass in the right retromammary region and pain in the right hip. Mycobacterium tuberculosis colonies were isolated from the semisolid mass of breast. Histopathologic examination revealed caseous granulomatous infection in the right hip synovial tissue. He was treated successfully with only antituberculous drugs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.diagmicrobio.2007.03.010DOI Listing
August 2007

Clinical effectiveness of nebulised budesonide in the treatment of acute asthma attacks.

Tuberk Toraks 2006 ;54(2):128-36

Department of Allergic Chest Diseases, Faculty of Medicine, Uludağ University, Bursa, Turkey.

Nebulized budesonide (NB) might offer topical anti-inflammatory activity and be an alternative to systemic corticosteroid (SC) in the treatment of acute asthma. The aim of this study was to compare the effect of NB with SC on lung function and clinical findings of adult patients with acute asthma. Thirty patients admitted to clinic with asthma attack (F/M: 26/4; mean age: 47.1 +/- 2.1 years) were enrolled to the study. The patients were randomized into three groups; Group I were treated with NB alone (4 mg/day), Group II SC alone (1 mg/kg/day methylprednisolone), Group III NB plus SC. Pulmonary functions and respiratory symptom scores were measured and recorded before and during 7 days of study. Spirometric parameters significantly improved in all groups at 7th day significantly (p< 0.05) without a difference among groups (p> 0.05). FEV(1) % levels increased significantly at the first day of study in Group I and III (p< 0.05), but didn't change in Group II until 5th day of study. The mean symptom scores decreased significantly at the second day in Group I (p< 0.05), and at the 4th day in other groups. NB with or without SC improved successfully airway obstruction and symptoms in patients hospitalized with acute asthma attack as the 1st treatment day in comparison with SC alone and this effect lasted for 7 days. Regarding the superior safety profile and comparable efficacy with SC, NB might be an alternative to the patients with moderate-severe asthma attacks.
View Article and Find Full Text PDF

Download full-text PDF

Source
October 2006

An analysis of patients diagnosed with pulmonary embolism in terms of clinical and meteorological data.

Saudi Med J 2006 Apr;27(4):555-7

Department of Biostatistics, Uludag University Medical School, Gorukle 16059, Bursa, Turkey.

View Article and Find Full Text PDF

Download full-text PDF

Source
April 2006
-->