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Öğe Assessment of the frequency of deep venous thromboembolism in obstructive sleep apnea syndrome(Taylor & Francis Ltd, 2019) Bahar, Yağmur; Annakkaya, Ali Nihat; Şen, Çiğdem; Oktay, Mehtap; Aytekin, Fuat; Balbay, Öner AbidinThe present study aimed to investigate the frequency of deep venous thrombosis (DVT) among patients with obstructive sleep apnea syndrome (OSAS). Patients who referred the preliminary diagnosis of OSAS were included in this study. D-dimer levels of all patients were measured, and D-dimer (+) patients were evaluated by Doppler USG of the lower-extremity. Mean age of the patient group was 52 +/- 12 years and 31.8% (76/239) were women. The rate of D-dimer positivity among severe-OSAS cases (15/85) was significantly higher compared to the rest (13/154) (17.6% and 8.4%, respectively; p = 0.034). The risk of D-dimer positivity was elevated by 2.3 folds in severe-OSAS cases (OR: 2,324, 95% confidence interval: 1.048-5.152). Among 28 D-dimer (+) cases, 4 (14.2%) had DVT as demonstrated by USI of the lower-extremity. All four cases with DVT had severe OSAS. D-dimer was positive in 17.6% (15/85) of all severe OSAS cases. DVT was diagnosed in 4.7% (4/85) of severe-OSAS cases. DVT frequency was 26.6% (4/15) in D-dimer (+) severe-OSAS. Findings of this study indicate that severe-OSAS can be a significant risk factor for DVT. Additionally, data obtained in this study underline the benefits of questioning severe-OSAS patients with respect to DVT symptoms, investigating D-dimer levels and evaluating D-dimer (+) severe-OSAS cases for DVT prophylaxis.Öğe Bilinen kronik obstrüktif akciğer hastalığı solunum yetmezliği olan hastalarda avarege volume assured pressure support (avaps) ve bilevel positive airway pressure spontantimed (bPAAP-s/t) modlarının göz içi basınca etkileri(Düzce Üniversitesi, 2019) Aytekin, Fuat; Gülhan, Pınar YıldızGiriş: Kronik Obstruktif Akciğer Hastalığı (KOAH); tam olarak geri dönüşümlü olmayan, ilerleyici hava akımı kısıtlanması ile karakterize bir hastalıktır. Bu hastalık, zararlı gaz ve partiküllere özellikle sigara dumanına karşı oluşan enflamatuar bir süreç sonucu gelişir. İnflamasyon yalnızca akciğerlerle sınırlı olmayıp, sistemik özellikler de göstermektedir. Önlenebilir ve tedavi edilebilir bir hastalık olan KOAH, şiddeti ve sıklığı artan alevlenmelerle seyreder. Biz, bu çalışma ile 2018 Haziran-Aralık tarihleri arasında KOAH tanılı, Tip 2 solunum yetmezliği gelişmiş 40 hastada BPAP S/T ve AVAPS modlarının göz içi basınca (GİB) , santral korneal kalınlığa (SKK) olan etkisini saptamayı amaçladık. Materyal-metot: Çalışmamızda atak tedavisi biten, arter kan gazı düzelen hastalarda sabah rutin kan gazı tetkik edildi. Diyabet tanısı olmayan hastalarda; GİB, görme keskinliği ve santral kornea kalınlığı (SKK) ölçüldükten sonra; 4 saat boyunca başlangıçta uygun görülen moda göre (AVAPS-BPAP S/T) non invaziv mekanik ventilasyon tedavisi sonrası tekrar GİB, SKK değerlendirerek modların GİB'e olan etkisine bakıldı. Bulgular: Göz muayenesi bulgularından NMV tedavisi sonrası, tedavi öncesine göre ortalama intraoküler basıncın istatistiksel anlamlı düzeyde arttığı görüldü (12,3 mmHg ye karşı 13,6 mmHg; p=0.001, tablo IX ve Şekil 5). SKK; NMV tedavisi sonrasında istatistiksel anlamlılığa yakın düzeyde azalmaktaydı (p=0.057). Sonuç olarak NMV tedavisi sonrası GİB'de artma ve SKK'da incelme saptadık. Daha önce literatürde böyle bir çalışmaya rastlanmamıştır.Öğe A Case of Nephrotic Syndrome With Pneumocystis Jirovecii Infection(2019) Erçelik, Merve; Akın, Gül; Önenç, Kürşad; Aytekin, Fuat; Ataoğlu, Özlem; Elverişli, Mehmet FatihPneumocystis jirovecii pneumonia (commonly called Pneumocystis pneumonia or PCP) is an opportunistic infection that occurs in immunocompromised individuals. 26 year-old male patient admitted to nephrology department for hypervolemic hyponatremia and consulted to our clinic due to the desaturation. He has been diagnosed with collapsing glomerulonephritis and he was using cyclosporine and prednisolone. Postero-anterior chest X-ray showed a blunt left cardiodiaphragmatic sinus. After ten days the patient's hypoxia deepened. Repeated chest X-ray showed bilateral perihilar heterogeneous opacity. Pneumocystis jirovecii was detected in lavage culture. We presented a case of Pneumocystis Jirovecii pneumonia secondary to cyclosporin toxicity because of a rare case.Öğe The effects of non-invasive mechanic ventilator modes on intraocular pressure in COPD patients with hypercapnic respiratory failure(Wiley, 2020) Aytekin, Fuat; Gulhan, Pinar Yildiz; Teberik, Kuddusi; Balbay, Ege Gulec; Iritas, Ilter; Ercelik, Merve; Balbay, Oner AbidinBackground Chronic obstructive pulmonary disease (COPD) is not fully reversible disease that is characterized by progressive restricting airflow. Non-invasive mechanical ventilation (NIMV) treatment can be used in COPD patients who had type 2 respiratory failure. This study aimed to determine the effect of BPAP S/T and AVAPS modes on intraocular pressure (IOP), central corneal thickness (CCT) in 40 type 2 respiratory failure patients with COPD. Methods Forty patients with type 2 respiratory failure who were hospitalized between June and December 2018 with the diagnosis of COPD exacerbations were included to the study. Patients followed up without NIMV for 12 hours after the end of exacerbations treatments end. After IOP, visual acuity and CCT were measured in all patients at the same time (11.00 am), same NIMV treatment was applied to the patients for 4 hours (AVAPS-BPAP S/T). Then the measurements were repeated. The effects of these NIMV modes on IOP were evaluated. Results After NIMV treatment, it was observed that the mean IOP increased statistically significantly (13.3 vs 12.3 mm Hg; P = 0.001). After treatment with NIMV, there was a decrease for CCT close to statistical significance (P = 0.057) Conclusion As a result; increased IOP and thinning of CCT after NIMV treatment has been shown. The type of NIMV and the level of inspiratory pressure needed in hypercapnic respiratory failure seem to affect IOP and it should be cautiously used to increase IOP.Öğe Factors affecting compliance with positive airway pressure therapy in obstructive sleep apnea(Springer Heidelberg, 2021) Ercelik, Merve; Balbay, Ege Gulec; Gulhan, Pinar Yildiz; Cangur, Sengul; Arbak, Peri Meram; Aytekin, Fuat; Elverisli, Mehmet FatihObjective To investigate the factors affecting compliance with positive airway pressure (PAP) therapy and establish the relationship between compliance and pulmonary function tests (PFT) in patients with OSA. Material and methods In this prospective study, patients with OSA using PAP devices were questioned about the complaints related to the device. Depression and anxiety scales along with PFT parameters were also assessed. Results Of 98 participants, 63% were men. The mean age was 52.0 +/- 9.6 years. Sixty-seven percent of the patients were compliant with their devices. A significant difference was observed between the proportion of the participants compliant or non-compliant with the device, based on OSA severity (p < 0.05). Beck depression inventory (BDI) and Beck anxiety inventory (BAI) scores of the compliant patients were significantly lower than those of the non-compliant patients (p < 0.001, p = 0.044, respectively). No statistically significant difference was detected between the groups regarding individual pulmonary function tests (p > 0.05). The rates of nasal mask use, not having difficulty in tolerating CPAP, falling asleep, absence of abdominal distension, no facial sores, no air leakage, patients benefiting from the device, reduction in daytime sleepiness, and the belief that they are receiving appropriate therapy in participants compliant with the device were higher than those in non-compliant participants (p < 0.05). The rates of claustrophobia and discomfort due to pressure were significantly lower in patients compliant with the device than in the non-compliant patients (p < 0.05). Conclusion While no relationship was detected between PFT parameters and PAP therapy compliance, significant factors affecting the device compliance were detected.Öğe Hiperkapnik Solunum Yetmezliği Gelişen Kronik Obstrüktif Akciğer Hastalığı Hastalarında Noninvaziv AVAPS (Average Volume Assured Pressure Support) Modu(Duzce Univ, 2018) Balbay, Ege Güleç; Aytekin, Fuat; Balbay, Öner Abidin; Annakkaya, Ali Nihat; Arbak, Peri MeramAmaç: Bu çalışmada, AVAPS (Average Volume Assured Pressure Support) modu ile Noninvazif Mekanik Ventilasyon (NIV) uygulanan hastalarda hasta uyumu ve klinik başarı oranlarının araştırılması amaçlanmıştır. Gereç ve Yöntem: Hiperkapnik Solunum Yetmezliği Gelişen 22 Kronik Obstrüktif Akciğer Hastalığı tanılı hastaya AVAPS modu uygulandı. Başlangıç parametreleri olarak; AVAPS Modunda IPAP Max 20 cm H2O, IPAP Min 12 cm H2O, Hedef Tidal volüm=İdeal kilo x 6 ml/kg, EPAP 5 cm H2O ayarları ile başlanıp hastanın tolere ettiği ölçüde arttırılacak ve SaO2 ≥ %90 olacak şekilde verildi. Hastaların NIV bağlandıktan sonra 1, 2, 8 ve 24. saatlerde arter kan gazı kontrolleri, nabız, solunum sayısı, Borg dispne skalası ölçümleri yapıldı. Bulgular: Çalışmaya dahil edilen yaş ortalaması 70±10 olan 22 hastanın %72,7 (n:16)’si erkekti. Hastaların %59 (n:13)’unda 24 saat içerisinde PH değerleri normal aralığına ulaştı. Hastaların NMV öncesi PH, PCO2, PaO2/FiO2 ve Borg dispne skalası değerler ile NMV uygulamasının 1, 2, 8, 24 saat PH, PCO2, PaO2/FiO2 ve Borg dispne skalası değerleri karşılaştırıldığında istatistiksel anlamlı olarak PH (p<0,001) ve Pa02/FiO2 (p=0,002) değerlerinde artma, PCO2 ve Borg dispne skalası değerlerinde sırasıyla (p<0,001, p<0,001) azalma olduğu görüldü. İzlenen parametrelerinde tümünde 1. Saatte anlamlı değişiklik görüldü. Hiçbir hastada uyumsuzluk izlenmedi. Servis takipleri sonucunda hastaların %95 (n:21)’i evine taburcu edilebildi. Sonuç: AVAPS modu ile NIV uygulanmasında hasta uyumu ve klinik başarı oranlarının yüksek olduğu görüldü.Öğe Relationship between Diagnosis Period and Internal and External Air Quality in Patients with Tuberculosis(2020) Gülhan, Pınar Yıldız; Elverişli, Mehmet Fatih; Erçelik, Merve; Aytekin, Fuat; Balbay, Öner; Arbak, PeriObjective: The aim of this study was to investigate the relationship between bacteriological case definitionsand indoor and outdoor air quality parameters in tuberculosis (TB).Materials and Methods: A total of 200 patients with TB diagnosed and treated in our hospital during 2012-2018 were included to this study. The air monitoring measurement parameters of the National Air QualityNetwork [particulate matter 10 (PM10), sulfur dioxide (SO2), air temperature, air pressure, and relativehumidity] for the same time period were obtained from the web page http://laboratory.cevre.gov.tr/Default.ltr.aspx.Results: Of the 200 patients, 62.5% (125) were males and 37.5% (75) were females. The rate of diagnosisbased on culture and smear positivity was 48.4% (31), which was significantly higher than that in the clinic[10.9% (7)] among patients who used stove for warming. The rate of diagnosis based on culture and smearpositivity [52.1% (25)] was significantly higher than that in the clinic [8.3% (4)] among patients who were exposed to biomass. The univariate analysis revealed no significant independent effect of warming and biomassuse on case definition. According to the case definitions, the mean values of PM10, SO2, and temperature inthe diagnosed month showed no statistically significant difference. The humidity level in the month was significantly higher, during which cases diagnosed using smear and culture positivity were compared with casesdiagnosed using only culture positivity (p=0.023).Conclusion: This study indicates that biomass used as a cooking fuel is a risk factor for pulmonary TB, implying that TB occurrence can be reduced significantly by lowering or preventing the exposure to cookingsmoke emitted from biomass fuel.Öğe Waterpipe (narghile, hookah) tobacco smoking-induced acute eosinophilic pneumonia(Turkish Respiratory Soc, 2018) Annakkaya, Ali Nihat; Balbay, Ege Güleç; Öztürk, Özlem; Önal, Binnur; Aytekin, Fuat; Balbay, Öner AbidinAcute eosinophilic pneumonia (AEP) is characterized by a febrile illness, diffuse pulmonary infiltrates, hypoxemic respiratory failure, and pulmonary eosinophilia. A temporal relationship has been described in a number of patients between the development of AEP and the recent onset of cigarette smoking. A 22-year-old male patient with no known chronic disease was admitted to the emergency service for 3 days with the complaints of cough, fever, dyspnea, and pleuritic chest pain. He was formerly a nonsmoker but was a waterpipe (narghile, hookah) tobacco smoker as a new habit once a night for the last 2 months. The erythrocyte sedimentation rate and C-reactive protein are elevated. Arterial blood gases revealed moderate hypoxemia. Computed tomography scans included bilateral, random, and patchy ground-glass opacities and also small bilateral pleural effusions. Echocardiograhic examination was normal. We had accepted the patient as an acute eosinophilic pneumonia due to rapid response to corticosteroid treatment, no microorganism in bronchoalveolar lavage (BAL) culture, and predominant eosinophilia was observed (70%-80%) in BAL.
