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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 A case with diffuse granulomatous inflammation mimicking malignancy [Maligniteyi taklit eden yaygın granülomatöz inflamasyon olgusu](Duzce University Medical School, 2017) Erçelik, Merve; Balbay, Ege Güleç; Arbak, Peri; Ataoğlu, ÖzlemA 59-year-old female patient was admitted to outpatient clinic with a 3-week dry cough and a 2-month exercise dyspnea (MRC 2). Within the last 3 months there was a loss of 5 kg. She has never smoked. She was a housewife. In thoracic computed tomography of the patient’s postero-anterior chest x-ray, the right lower quadrant is the opacity of the right atrium. A large number of nodules (5 mm in size) in both upper lobes of the lungs, and a common reticulonodular dancer in the middle lobe of the right lingula. The desired positron emission tomography of the patient with malignancy pre-diagnosis; right lobe of the lungs, reticular densities in the left lung, gastroesophageal junction, stomach fundus and large curvature in the dorsal wall of the nasopharynx, bilateral cervical lymphadenopathies, bilateral cervical lymphadenopathies, bilateral lymph nodes, right lobe of the lungs, right scapula and left iliac bone intense hypermetabolic involvement was detected. The axillary lymph node dissection was diagnosed as granulomatous lymphadenitis. The patient was accepted as sarcoidosis, inhaled steroid therapy was initiated and followed. © 2017, Duzce University Medical School. All rights reserved.Öğe The Clinical Correlations of Fatigue in Patients with Sarcoidosis(2022) Gülhan, Pınar Yıldız; Balbay, Ege Güleç; Kumbasar, Özlem Özdemir; Erçelik, Merve; Annakkaya, Ali Nihat; Arbak, Peri MeramObjective: Fatigue is considered a frequent and characteristic feature of sarcoidosis. This study was designed to determine the prevalence of fatigue in patients with sarcoidosis and to determine its potential clinical correlations in relation to symptom severity. Methods: A total of 56 sarcoidosis patients were included. Data on patient demographics, anthropometrics, disease characteristics, pulmonary function tests, 6-min walking distance (6MWD), blood biochemistry and hemogram findings were retrieved from hospital records. Psychometric instruments involved fatigue assessment scale (FAS), Beck Depression Inventory (BDI) and Short Form-36 (SF-36) for health-related QOL (HRQOL). Results: Mean±SD patient age was 50.9±11.9 years. Of 56 patients, 44 were females and 12 were males. When compared to FAS score <22 and FAS score ?22-34 subgroups, FAS score ?35 (severe fatigue) subgroup was associated with significantly higher patient age and significantly lower SF-36 physical health scores. Total FAS scores were correlated positively with age (r=0.349, p=0.008) and BDI scores (r=0.515, p<0.001), while negatively with MIP (r=-0.321, p=0.019) and SF-36 physical health (r=-0.402, p=0.003) and mental health (r=-0.351, p=0.009) scores. BDI score (OR 1.146, 95% CI: 1.020 to 1.288, p=0.021) was determined to be the single independent predictor of increased likelihood of a patient with sarcoidosis to have FAS score ?22. Conclusions: Our findings emphasize that deterioration in respiratory functions may contribute to development of fatigue among sarcoidosis patients, and besides the fatigue, depressive symptoms and anxiety should also be an integral part of the multidisciplinary management of sarcoidosis patients.Öğe Obstrüktif uyku apne sendromu'nda pozitif hava yolu basıncı tedavisine uyumun solunum fonksiyonlarıyla ilişkisi(Düzce Üniversitesi, 2020) Erçelik, Merve; Balbay, Ege GüleçAmaç: OUAS (Obstrüktif uyku apne sendromu); uyku sırasında tekrarlayan tam (apne) veya parsiyel (hipopne) üst solunum yolu obstrüksiyonu epizodları ve sıklıkla kan oksijen saturasyonunda düşmenin eşlik ettiği bir sendromdur. Polisomnografi (PSG) günümüzde OUAS tanısında kullanılan altın standart yöntemidir. Uyku apne sendromunun tedavi edilmesi, uyku ve yaşam kalitesinde düzelme sağlamanın yanında, hastalığa bağlı oluşan ciddi komplikasyonların birçoğunun önlenmesini de sağlar. Bu hastalıkta temel tedavi modalitesi pozitif havayolu basıncı (Positive Airway Pressure-PAP) uygulamasıdır. Ancak tedavide cihaz uyumu konusunda sorunlar yaşanmaktadır. Biz de çalışmamızda hastaların PAP tedavisine uyumunun solunum fonksiyon testleri (SFT) ile ilişkisini araştırmayı amaçladık. Gereç-Yöntem: 2016-2018 tarihleri arasında Göğüs Hastalıkları Anabilim dalı Uyku Laboratuarında OUAS tanısı koyulmuş ve PAP titrasyonu için yatırılmış, titrasyonu başarı ile yapılmış, PAP raporu düzenlenmiş PAP cihazını temin etmiş ve kullanmaya başlamış, çalışmaya katılmaya kabul eden hastalar çalışmaya dahil edildi. Hasta uyumunu etkileyen demografik özellikler, cihaz ve maske ile ilişkili şikayetler ve depresyon, anksiyete ölçekleri ile beraber hastalarımızın SFT parametreleri değerlendirildi. Bulgular: Çalışmaya alınan 98 bireyin %63'ü (n=62) erkekti ve bireylerin yaş ortalaması 52±9,6 (29-72) idi. Hastaların %67'si kullanılan cihaza uyum göstermekteydi. OUAS derecesine göre cihaza uyum gösteren ve göstermeyen bireylerin oranları arasında anlamlı düzeyde bir farklılık vardı (p<0,05). Ağır OUAS tanılı hastalar daha uyumlu idi. Cihaza uyumlu hastaların beck depresyon (BDÖ) ve beck anksiyete ölçek (BAÖ) puanları, uyumlu olmayan hastalarda ölçülen değerlerinden anlamlı düzeyde daha düşüktü (sırasıyla p<0,001 p=0,044 ). Her bir solunum fonksiyon test değeri açısından gruplar arasında anlamlı düzeyde fark saptanmadı (p>0,05). Cihaza uyum gösteren bireylerde nazal maske kullanma oranı, CPAP'ı tolere etmede zorlanmama, uykuya dalmada güçlük çekmeme, karında şişlik, maske nedeniyle yüzde yara görülmemesi, hava kaçağı görülmemesi, cihazdan fayda görme, gündüz uykululuk halinde azalma, uygun tedavi uygulandığını düşünme oranları, cihaza uyum göstermeyenlerden anlamlı düzeyde daha yüksekti (p<0,05). Cihaza uyum gösterenlerde klostrofobi, basınçtan rahatsız olma, cihaza uyum göstermeyenlerden anlamlı düzeyde daha düşüktü (p<0,05 ). Bireylerin cihaza uyum sağlama durumunu etkilediği saptanan değişkenler alınarak oluşturulan ileriye doğru Wald çoklu lojistik regresyon modeli sonucunda BDÖ puanındaki artışın bireylerin cihaza uyum sağlamama Odds oranını 1,08 kat arttırdığı; hava kaçağı şikâyeti olan bireylerin şikayeti olmayan bireylere göre cihaza uyum sağlamama Odds oranının 6,82 kat; basınç rahatsızlığı şikâyeti olanların şikâyeti olmayan bireylere göre cihaza uyum sağlamama Odds oranının 5,21 kat; gündüz uykululuğunda azalma görülmeyen bireylerin görülenlere göre cihaza uyum sağlamama Odds oranının 5,87 kat daha fazla olduğu saptandı. Sonuç: SFT parametreleri ile PAP tedavisine uyum arasında ilişki saptanmamakla beraber, cihaz uyumuna etkisi olan anlamlı faktörler saptandı. OUAS tanılı hastalarda PAP tedavisine başlamadan önce, uyum açısından riskli gruplar tanımlanmalı, erken dönemde eğitim desteği sağlanmalıdır. Hastaların yakın takip edilmesi ve tedaviye bağlı şikayetlerinin çözümünün hastaların PAP tedavisine uyumunu arttıracağını düşünmekteyiz.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 Serum clara cell protein-16 level in non-smoker obstructive sleep apnea syndrome patients(European Respiratory Soc Journals Ltd, 2019) Balbay, Ege Güleç; Ataoğlu, Özlem; Erçelik, Merve; Şahin, İbrahim Ethem; Admış, Özlem; Arbak, Peri Meram…Öğe Serum Clara cell secretory protein (CC-16) in non-smoking patients with obstructive sleep apnea(Springer, 2020) Balbay, Ege Güleç; Ataoğlu, Özlem; Erçelik, Merve; Şahin, İbrahim Ethem; Admış, Özlem; Arbak, Peri MeramObjective: This study aimed to determine the association between the severity of obstructive sleep apnea (OSA) and serum Clara cell protein (CC16) levels in non-smoking patients with OSA. Methods: This prospective study included non-smoking patients who presented with sleep-related disturbances and underwent polysomnography (PSG). The serum CC16 level was measured and its relationship to PSG parameters was investigated. Results: The study included 128 patients (83 men) with a mean age of 48.4 ± 11.9. OSA was detected in 66 men (70%) and 29 women (30%) (p = 0.051). The severity of OSA was mild in 32 (25%), moderate in 28 (22%), and severe in 35 (27%) of the patients. There was no significant difference in CC16 levels between the OSA group (1746 ± 1006) and the OSA negative group (1721 ± 1201, p = 0.91) levels. There was no significant difference between the CC16 levels of the each four groups. Mean serum CC16 levels were significantly lower in OSA negative men than OSA positive men (777 vs 1462, p = 0.005). No significant difference was observed in CC16 values according to OSA severity in women. Conclusion: The serum CC16 level does not differ between non-smoking OSA patients and OSA negative patients. © 2020, Springer Nature Switzerland AG.