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    Coagulopathy and COVID?19
    (2020) Yazıcı, Onur; Bozkus, Fulsen; Demirci, Nilgun Yilmaz; Gülhan, Pınar Yıldız; Coskun, Funda
    Caused by severe acute respiratory syndrome?coronavirus?2 (SARS?CoV?2), coronavirus disease2019 (COVID?19) is a potentially fatal disease as a global public health issue. Several mechanismsmay be involved in mortality. One of these is coagulopathy and disseminated intravascular coagulationcaused by SARS?CoV?2. When patients have coagulation disorders, treatment becomes morechallenging and mortality rate increases accordingly. The aim of this article is to review the potentialmechanisms of coagulopathy in COVID?19 in light of literature data.
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    Factors associated with mortality in cases of idiopathic pulmonary fibrosis with mild to moderate functional impairment
    (Kare Publ, 2023) Sengul, Aysun; Ozyurek, Berna Akinci; Coskun, Funda; Yazici, Onur; Bozkus, Fulsen; Gulhan, Pinar Yildiz; Satici, Celal
    BACKGROUND AND AIM: Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive lung disease with a poor prognosis, characterized by advanced fibrosis. The course of the disease varies from patient to patient. The factors that determine the course of the disease are yet to be clarified. Here, we aimed to assess patient characteristics, overall mortality, and mortality -associated factors in our IPF patient cohort. METHODS: Our multicenter, retrospective cohort study reviewed the records of 169 patients diagnosed with IPF who had mild-to-moderate functional impairment and were followed up for at least one year from diagnosis until death between 2009 and 2019. RESULTS: The mean age of the 169 IPF patients was 69.7 +/- 8.8 years, and 73.4% were male. The diagnosis was established clinically and radiologically in 152 (89.9%) patients and histopathologically in 17 (10%) patients. A smoking history was found in 72.2% of the patients, with an average smoking quantity of 35.6 +/- 14.7 pack-years. Among the patients, 28 (16.6%) did not receive treatment, 87 (51.5%) received pirfenidone, and 54 (31.9%) nintedanib treatment. The median Gender, Age, and Physiology (GAP) score of the patients was 3. The mean forced vital capacity (FVC) was 79.6%+/- 19.7%, the mean diffusing capacity of the lungs for carbon monoxide (DLCO) was 52.8%+/- 14.5%, the median pulmonary hypertension score was 2, the mean pulmonary artery to-aorta (PA/Aorta) ratio was 0.85 +/- 0.15, the mean arterial partial pressure of oxygen (PaO2) was 66 +/- 10.7 mmHg, and the median right ventricular systolic pressure (RVSP) was 30 (range: 19-60) mmHg. The one-year mortality rate was 7.1%, the two-year mortality rate was 19.6%, and the three-year mortality rate was 42.5%. The factors associated with one-and two-year mortality were age, GAP score, RVSP, and non-treatment. The factors associated with three-year mortality were age, GAP score, non-treatment, and the PA/Aorta ratio. CONCLUSIONS: Antifibrotic therapy improves disease prognosis and can reduce mortality in patients diagnosed with IPF. Elevation of RVSP on echocardiography and PA/Aorta ratio on thoracic computed tomography can be used as predictors of mortality, similar to the GAP score.
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    Interstitial lung diseases and COVID?19
    (2020) Gülhan, Pınar Yıldız; Demirci, Nilgun Yilmaz; Bozkus, Fulsen; Yazıcı, Onur; Coskun, Funda
    There is continued lack of knowledge of the physiopathology and recovery processes of the newcoronavirus pneumonia. The complications are similar to those experienced with severe acuterespiratory syndrome and Middle East respiratory syndrome, since the new coronavirus is part ofthe same family. The new coronavirus infects both the epithelial cells of the airway and also alveolarepithelial cells (Type I and Type II pneumocyte). The Type I and Type II pneumocytes infected withthe human coronavirus (hCoV) play a critical role in mediating the lung pathology and host sensitivity.Both human and animal studies have demonstrated that an inflammatory process starts in the lungsfollowing hCoV infection and that an accumulation of monocyte–macrophage and neutrophils occurs.One of the earliest outcomes of rapid virus replication and increased proinflammatory cytokine/chemokine response is apoptosis of the epithelial and endothelial cells of the lung. The main effectof the new coronavirus on the body is an imbalance in the ratio of the cytokines produced by thebody in response to the abnormal immune reaction, resulting from the invasion of the virus. Thismanuscript details the pathophysiology of the new coronavirus associated with fibrosis and makesrecommendations for cases with interstitial lung disease.