Publications by authors named "Nilufer Aylin Acet Ozturk"

8 Publications

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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.
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http://dx.doi.org/10.1111/crj.13451DOI Listing
October 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.
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http://dx.doi.org/10.1016/j.jcjo.2021.06.019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8255111PMC
July 2021

Interleukin-21: a potential biomarker for diagnosis and predicting prognosis in COVID-19 patients

Turk J Med Sci 2021 10 21;51(5):2274-2284. Epub 2021 Oct 21.

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

Background/aim: COVID-19 patients have a wide spectrum of disease severity. Several biomarkers were evaluated as predictors for progression towards severe disease. IL-21 is a member of common γ-chain cytokine family and creates some specific effects during programming and maintenance of antiviral immunity. We aimed to assess IL-21 as a biomarker for diagnosis and outcome prediction in patients hospitalized with COVID-19.

Materials And Methods: Patients with a preliminary diagnosis of COVID-19 and pneumonia other than COVID-19 admitted to a tertiary care hospital were included consecutively in this comparative study.

Results: The study population consisted of 51 patients with COVID-19 and 11 patients with non-COVID-19 pneumonia. Serum IL-21 concentration was markedly higher, and serum CRP concentration was significantly lower in COVID-19 patients compared to non-COVID-19 pneumonia patients. Within COVID-19 patients, 10 patients showed radiological and clinical progression. Patients with clinical worsening had lower lymphocyte count and haemoglobin. In addition to that, deteriorating patients had higher urea, LDH levels, and elevated concentration of both IL-6 and IL-21. The cut-off value of 106 ng/L for IL-21 has 80.0% sensitivity, %60.9 specificity for discriminating patients with clinical worsening. Multivariable analysis performed to define risk factors for disease progression identified IL-6 and IL-21 as independent predictors. Odds ratio for serum IL-6 concentrations ≥ 3.2 pg/mL was 8.07 (95% CI: 1.37-47.50, p = 0.04) and odds ratio for serum IL-21 concentrations ≥ 106 ng/L was 6.24 (95% CI: 1.04 – 37.3, p = 0.02).

Conclusion: We identified specific differences in serum IL-21 between COVID-19 and non-COVID-19 pneumonia patients. Serum IL-21 measurement has promising predictive value for disease progression in COVID-19 patients. High serum IL-6 and IL-21 levels obtained upon admission are independent risk factors for clinical worsening.
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http://dx.doi.org/10.3906/sag-2102-24DOI Listing
October 2021

Diagnostic performance of EBUS-TBNA and its interrelation with PET-CT in patients with extra-thoracic malignancies.

Tuberk Toraks 2020 Sep;68(3):285-292

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

Introduction: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a well-established diagnostic tool for lung cancer, sarcoidosis, and suspected metastatic extra-thoracic malignancy (ETM). Patients with primary ETM often have hypermetabolic mediastinal/hilar lymph node enlargement in the PET-scan done for initial staging or post treatment followup. We aimed to determine the diagnostic performance of EBUS-TBNA and the relationship between PET-SUV values and diagnosis of malignancy metastasis in patients with ETM.

Materials And Methods: Results of EBUS-TBNA in ETM patients with suspected MLN metastasis were retrospectively analysed (May 2016 to July 2019). Non-malign results were confirmed for surgery or clinical/radiological followup. Lymph nodes with a high FDG-uptake (SUV > 2.5, MLN) were reported as suspicious for metastasis.

Result: Of the 588 EBUS procedures, 109 were included in the analysis. Patient' mean age was 62.5 ± 10.1 years; there were 35 men and 74 women. Primary malignancies were breast cancer in 33, gastrointestinal in 23, female genital tract in 17, head and neck in 14, genitourinary cancer in 13, malignant melanoma in 6, sarcoma in 2 and kaposi sarcoma in 1. According to EBUS-TBNA smear and cell block histopathologic evaluations, 16 patients' results (14.7%) were malignant compatible with metastasis of ETM. Among the 93 patients with non-malignant diagnosis, EBUS-TBNA revealed a granulomatous lympadenitis compatible with sarcoid reaction in 7 and tuberculosis in 2. A total of 9 patients underwent surgical procedures after EBUSTBNA, with a definitive histological diagnosis of granulomatous lymphadenitis in 2, malignancy in 5 and, reactive lymph node in 2. Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of EBUS-TBNA were 76.19% (95% CI 52.83-91.78), 100% (95% CI 95.89-100.00), 100%, 94.62% (95% CI 89.12-97.12) and 95.4%, respectively.

Conclusions: EBUS-TBNA sampling has high diagnostic performance. Histopathological confirmation requirement for MLN should be kept in mind in patients with ETM, even they have negative EBUS results.
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http://dx.doi.org/10.5578/tt.70045DOI Listing
September 2020

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

Guillain-Barré Syndrome in a Patient With Minimal Symptoms of COVID-19 Infection.

Muscle Nerve 2020 09 4;62(3):E54-E57. Epub 2020 Jul 4.

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

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http://dx.doi.org/10.1002/mus.26992DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7300697PMC
September 2020

Diagnostic Accuracy of a Modified STOP-BANG Questionnaire with National Anthropometric Obesity Indexes.

Turk Thorac J 2019 04 1;20(2):103-107. Epub 2019 Apr 1.

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

Objectives: Obstructive sleep apnea (OSA) is a very common sleep-related disorder and has many medical complications. Although the STOP-BANG questionnaire is an attractive screening tool because of high sensitivity, it lacks power in specificity. The aim of the present study was to evaluate and compare the diagnostic accuracy of standard STOP-BANG and a modified STOP-BANG questionnaire, using national cut-off values for neck circumference that determined OSA, in a sleep center population.

Materials And Methods: One hundred eighty-five participants who were referred to the sleep-disordered breathing clinic were consecutively enrolled. We used 40 cm and 36 cm as the cut-off values for neck circumference, thus scoring patients accordingly and creating a modified STOP-BANG score with national anthropometric obesity indexes.

Results: The median neck circumferences were 41 (39-44) cm, 40 (37-42) cm, and 43 (40-45) cm for total population, female gender, and male gender, respectively. The mean STOP-BANG score was 4.5±1.5, and the mean modified STOP-BANG score was 4.9±1.5. Discrimination of OSA measured by area under the curve for both questionnaires is comparable (p>0.05). Sensitivity to define OSA (apnea-hypopnea index (AHI)≥5) was 92.2% and 93.8% for original and modified STOP-BANG questionnaire, respectively. Sensitivity for moderate (AHI≥15) and severe OSA (AHI≥30) was identical for both questionnaires.

Conclusion: The STOP-BANG questionnaire has an excellent sensitivity, but modest specificity and adding national obesity indexes for neck circumference achieved similar results in terms of sensitivity and specificity with the original questionnaire.
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http://dx.doi.org/10.5152/TurkThoracJ.2018.18074DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6453628PMC
April 2019

Lung cancer diagnosed with Mycobacterium tuberculosis or nontuberculosis mycobacteria concomitantly.

Tuberk Toraks 2017 Dec;65(4):291-295

Clinic of Chest Diseases, Bursa Prof. Dr. Turkan Akyol Chest Diseases Hospital, Bursa, Turkey.

Introduction: The concomitant occurrence of disease of Mycobacterium tuberculosis or nontuberculosis mycobacteria (NTM) and lung cancer has been reported in previous studies. We aimed to determine characteristics of the patients with lung cancer diagnosed with M. tuberculosis or NTM concomitantly.

Materials And Methods: From 2010 to 2015, the patients diagnosed with lung cancer and M. tuberculosis or NTM concomitantly were enrolled in the study. Patient data were collected retrospectively.

Result: Concomitant M. tuberculosis or NTM and lung cancer were diagnosed in 17 cases (1.2% of total lung cancer cases, 0.9% of total tuberculosis cases). M. tuberculosis was isolated from 11 (64.8%) patients and NTM disease was from 6 (35.2%) patients. Squamous cell carcinoma was the most common histological type. Tumoral stage was often advanced as stage III- IV (76.5%). Bronchial lavage smear positivity foracid-fast bacilli was found only in 4 (23.5%) patients. Tuberculosis treatment therapy was started only in 4 (23.5%) patients who had bronchial lavage smear positivity for acid-fast bacilli. So tuberculosis treatment was delayed for other 13 (76.5%) patients with bronchial lavage smear negative for acid-fast bacilli. Seven out of 17 (41.1%) patients died.

Conclusions: Physicians should consider concomitant M. tuberculosis or NTM when managing lung cancer. Tuberculosis patients may be mis diagnosed as lung cancer or vice versa.
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http://dx.doi.org/10.5578/tt.59675DOI Listing
December 2017
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