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Öğe Chest Diseases Clinic, Pandemic Experiences(Duzce Univ, 2020) Annakkaya, Ali Nihat; Gulhan, Pinar Yildiz; Balbay, Ege Gulec; Balbay, Oner Abidin; Arbak, Peri MeramAs the chest diseases clinic of Duzce Medical School, we were one of the departments that took an active role in the COVID-19 pandemic. Chest diseases department; It was one of the main branches in the differential diagnosis, treatment and follow-up of COVID-19 cases. In this process, our assistants, who were our hands and arms, were our fighters who were at the forefront of the pandemic process. During the pandemic process, we worked every day with an order consisting of a faculty member and two assistants. We continued our scientific meeting and assistant trainings online so that our training activities are not interrupted. On the one hand, we continued our scientific activities by participating in the studies, planning new research, and writing projects. As a result, when we look back, we have completed this difficult process by further enhancing our sense of solidarity that exists as a department in the pandemic process we experienced for the first time in our lives.Öğe Comparison of pirfenidone and corticosteroid treatments at the COVID-19 pneumonia with the guide of artificial intelligence supported thoracic computed tomography(Wiley, 2021) Acat, Murat; Gulhan, Pinar Yildiz; Oner, Serkan; Turan, Muhammed KamilAim We aimed to investigate the effect of short-term pirfenidone treatment on prolonged COVID-19 pneumonia. Method Hospital files of patients hospitalised with a diagnosis of critical COVID-19 pneumonia from November 2020 to March 2021 were retrospectively reviewed. Chest computed tomography images taken both before treatment and 2 months after treatment, demographic characteristics and laboratory parameters of patients receiving pirfenidone + methylprednisolone (n = 13) and only methylprednisolones (n = 9) were recorded. Pulmonary function tests were performed after the second month of the treatment. CT involvement rates were determined by machine learning. Results A total of 22 patients, 13 of whom (59.1%) were using methylprednisolone + pirfenidone and 9 of whom (40.9%) were using only methylprednisolone were included. When the blood gas parameters and pulmonary function tests of the patients were compared at the end of the second month, it was found that the FEV1, FEV1%, FVC and FVC% values were statistically significantly higher in the methylprednisolone + pirfenidone group compared with the methylprednisolone group (P = .025, P = .012, P = .026 and P = .017, respectively). When the rates of change in CT scans at diagnosis and second month of treatment were examined, it was found that the involvement rates in the methylprednisolone + pirfenidone group were statistically significantly decreased (P < .001). Conclusion Antifibrotic agents can reduce fibrosis that may develop in the future. These can also help dose reduction and/or non-use strategy for methylprednisolone therapy, which has many side effects. Further large series and randomised controlled studies are needed on this subject.Öğe Corticosteroid use in COVID-19 pneumonia(Turkish Assoc Tuberculosis & Thorax, 2021) Diken, Ozlem Ercen; Yildirim, Fatma; Gulhan, Pinar Yildiz; Ozkaya, Sevket; Simsek, Meltem; Yucel, Cihan; Dirican, AdemIntroduction: Coronavirus disease 2019 (COVID-19) has a 1-2% fatality rate, where no specific treatment has yet been defined. Although corticosteroids are recommended for selected COVID-19 patients without acute respiratory distress syndrome (ARDS) and septic shock, there is no consensus regarding patient subgroups, dose, and duration. In this study, it was aimed to examine the contribution of corticosteroid treatment to the management of COVID-19 pneumonia without ARDS, septic shock both in acute and recovery setting. Materials and Methods: The study population was divided into two as those who used corticosteroids during the recovery phase (who did not develop sufficient radiological or clinical improvement) and those who did so during the activation phase (non-ARDS/septic shock condition, clinical, laboratory or radiological progression). Results: We identified 47 patients, 26 of which were males, and mean age was 60.5 +/- 16.5 years. Seventeen patients were found to receive corticosteroids during the recovery phase and the rest (n- 30) during the activation period. After corticosteroid therapy, we found reduction of increased pre-treatment levels of D-dimer, ferritin, fibrinogen, CRI; increment of decreased pre-treatment lymphocyte count and saturation. Complete symptomatic improvement was detected in 6.9% and 17.6% of the patients in the activation phase and recovery phase, respectively. Complete radiological improvement was found in 11.5% and 35.3% of the patients in the activation phase and recovery phase, respectively. While corticosteroid treatment was initiated on day 4.2 +/- 2.6 and continued for a mean of 5.9 +/- 2.8 days in the activation group, it was started on day 8.1 +/- 11.3 and administered for 7.8 +/- 3.8 days in the recovery group. In both groups, methylprednisolone was given at a median dose of 40 mg/day. Conclusion: Short-term low-dose corticosteroid therapy may improve clinical, radiological, laboratory outcomes in the management of COVID-19 pneumonia during the activation period without ARDS and non-septic shock and during recovery period with no satisfactory response. Further randomized controlled studies will be useful in demonstrating its efficacy.Öğe Do the levels of particulate matters less than 10 mu m and seasons affect sleep?(Taylor & Francis Ltd, 2020) Gulhan, Pinar Yildiz; Balbay, Ege Gulec; Elverisli, Mehmet Fatih; Ercelik, Merve; Arbak, PeriBackground: There are few studies showing that the increase in particulate matters less than 10 mu m (PM10) values increases the apnea-hypopnea index (AHI). We aimed to investigate relationship between air quality parameters and the seasons with the AHI. Methods: This was a retrospective study that included 500 adults. Polysomnography (PSG) was performed on all patients. Oxygen saturation, air temperature, relative humidity, and PM10 values were recorded in Duzce for every year. The parameters of the national air quality network and sleep parameters of 500 individuals hospitalized between 2015 and 2017 were checked. Results: A total of 500 patients were included in the study, of whom 316 (63.2%) were male and 184 (36.8%) were female. While the AHI value of patients who presented during 2016 was 27.5, it had significantly declined to 20.2 in 2017 (p = .024). A significant decline was observed in AHI values of OSA patients from 2016 to 2017 (p = .043). A significant positive correlation was observed between REM-related AHI and relative humidity (r = 0.183, p = .002). Conclusions: This study showed a clear relationship between AHI and PM10 during winter when air pollution parameters are high in the region. PM10 emerged as a parameter that substantially increases the relative risk for OSA.Öğe The Effect of Continuous Positive Airway Pressure (CPAP) Therapy on Serum Caspase-3 Level in Patients with Obstructive Sleep Apnea (OSA)(Springer Heidelberg, 2024) Kaypak, Mustafa Kemal; Annakkaya, Ali Nihat; Davran, Fatih; Gulhan, Pinar Yildiz; Yuregir, UgurIntroductionIntermittent hypoxemia has an important role in the physiopathogenesis of obstructive sleep apnea (OSA) complications. Increased apoptosis due to intermittent hypoxemia may be an important clinical entity in OSA. In this study, we aimed to evaluate caspase-3 enzyme level, which is an indirect marker of increased apoptosis in patients with OSA and to evaluate the effect of OSA treatment with continuous positive airway pressure on caspase-3 enzyme level.Materials and methodsThis study included 141 consecutive patients admitted to the sleep-disordered breathing laboratory within 6 months. Caspase-3 was measured in routine blood samples obtained on the morning of polysomnography (PSG) performed at night. The compliance of the patients to CPAP treatment was evaluated and caspase-3 levels were checked again after treatment.ResultsA total of 141 patients, 39 females (27,7%) and 102 males (72,3%) were included in the study. The mean age of the patients was 49 +/- 12 years (min-17, max-77). According to PSG results, OSA was detected in 95.7% (135/141) of the cases. Mild OSA was 35 (24.8%), moderate OSA 39 (27.7%) and severe OSA 61 (43.3%) cases. Median caspase-3 enzyme levels were similar in men and women in the study group. There was no statistically significant difference in hemogram parameters and caspase-3 enzyme levels between the groups divided according to the presence and severity of OSA. It was determined that caspase-3 enzyme level did not change significantly after 3 months of CPAP treatment in OSA compared to pretreatment. Caspase-3 was found to have a negative correlation with both the percentage of daily use of CPAP therapy and the percentage of CPAP device use for more than 1 h per night. It was found that the control caspase-3 level decreased statistically significantly as the percentage of daily use of CPAP therapy increased (r = -0.397, p = 0.030). It was found that the control caspase-3 level decreased statistically significantly as the percentage of CPAP therapy use for more than 1 h per night increased (r = -0.411, p = 0.024).ConclusionThe results of this study did not reveal a relationship between the severity of OSA and caspase-3 levels. However, blood caspase-3 levels decreased as treatment compliance increased, suggesting that CPAP treatment may correct increased apoptosis in OSA. There is a need for more comprehensive studies on this issue.Öğe The Effect Of L-Carnitine And Alpha Lipoic Acid Administration With Exercise In Old Rats On Energy Metabolism Related To Oxidative Stress Parameters(Marmara Univ, Inst Health Sciences, 2024) Kalkan, Kardelen Kocaman; Sirin, Neslihan; Tepe, Atakan; Gok, Ali; Altas, Tolga; Agan, Kagan; Gulhan, Pinar YildizObjective: This study aims to contribute novel insights by investigating the potential positive effects of a combined dietary supplement and exercise program on mitochondrial oxidative stress and energy metabolism in aging. Focusing on the protective impact of Alpha Lipoic Acid (ALA), a potent antioxidant, against exercise-induced mitochondrial oxidative stress in rats, we also assess how L-Carnitine administration affects exercise ability by analyzing resistin and HbA1c levels, indicators linked to insulin resistance and cellular sensitivity. Method: In this 10-day study, 42 old male Sprague Dawley rats (weighing 400 +/- 10 g, aged 15-17 weeks) were divided into six groups (n=7): Control, Exercise, L-Carnitine, Alpha Lipoic Acid (ALA), L-Carnitine+Exercise, ALA+Exercise. Relevant groups received daily oral gavage doses of L - Carnitine (50 mg/ml) and ALA (18 mg/ml). Exercise groups underwent treadmill sessions. On day 10, blood samples were quantitatively analyzed for HbA1c and Resistin levels using a Cusabio ELISA assay kit (China). Results: ALA supplementation synergistically reduced resistin and HbA1c levels, individually and combined with exercise. Conversely, L-Carnitine supplement, alone or with exercise, increased resistin levels but it caused a decrease in HbA1c levels. Conclusion: The data indicated a minor, insignificant decrease in resistin levels for the exercise and ALA groups, with a statistically significant difference in HbA1c levels among all groups. Exercise alone positively impacted both HbA1c and resistin levels, suggesting a potential counteraction of age-related oxidative stress and a positive influence on energy metabolism through an appropriate diet and exercise program. Further studies are required to explore specific metabolic pathways and relationships identified in our findings.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 The evaluation of both the expression and serum protein levels of Caspase-3 gene in patients with different degrees of SARS-CoV2 infection(Wiley, 2021) Gulhan, Pinar Yildiz; Eroz, Recep; Ataoglu, Ozlem; Ince, Nevin; Davran, Fatih; Ozturk, Cihadiye Elif; Balbay, Oner AbidinTo evaluate the effects of Caspase-3 (CASP3) gene expression and serum levels on preventing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. A total of 41 individuals (male: 21; female: 20) with SARS-CoV-2 infection were included in the current study. Hemograms were examined from patient blood samples, and CASP3 gene expression levels were detected. Also, human CASP3 levels were determined from the serum samples of patients. The mean age of patients was 56.220 +/- 18.937 years. Significant differences were detected among all groups for CASP3 2-Delta Delta Ct (p = 0.014) and CASP3 concentration (p = 0.024). The relationship between CASP3 2-Delta Delta Ct levels and hemoglobin (p = 0.023), between CASP3 2-Delta Delta Ct levels and C-reactive protein (CRP) (p = 0.001), between CASP3 2-Delta Delta Ct levels and ferritin (p = 0.003), between CASP3 2-Delta Delta Ctlevels and lactate dehydrogenase (p = 0.001), and between CASP3 2-Delta Delta Ct levels and SpO(2) (p = 0.006) were statistically significant. Also, the relationship between CASP3 concentration levels and SpO(2) was statistically significant (p < 0.046). The CASP3 gene and/or its products have an important function to prevent injury caused by SARS-CoV-2 infection. They play crucial roles in maintaining cellular homeostasis and viability. Perhaps CASP3 levels may provide information about the severity of the disease.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 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, CelalBACKGROUND 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.Öğe An Investigation of Latex Sensitivity and Respiratory Complaints in Workers in a Rubber-Based Material Manufacturing Industry(Lippincott Williams & Wilkins, 2023) Elverisli, Mehmet Fatih; Gulhan, Pinar Yildiz; Mungan, Dilsad; Ercelik, Merve; Sahin, Ibrahim Ethem; Balbay, Ege Gulec; Coban, SeyitObjectiveTo present study aimed to investigate the prevalence of latex sensitivity in a workplace that produced rubber-based vehicle seals.MethodThe serum latex-specific IgE levels, respiratory complaints, PFT, serum interleukin (IL)-4, IL-5, IL-8, IL-10, IL-13 levels of all male workers (n = 108) exposed to latex in the workplace, which produced rubber seals, were compared with the control group (n = 52).ResultsThe rates of latex-specific IgE >0.10 kU/L in the workers and control group were 12.3% and 4.1%, respectively (P = 0.147). There was no difference in IL-4, IL-5, IL-10, and IL-13 levels between latex-specific IgE-positive, and -negative participants.ConclusionLatex sensitivity was higher in workers who used rubber as a raw material than in the control group but it was not statistically significant.Öğe Is sarcoidosis related to metabolic syndrome and insulin resistance?(Taylor & Francis Ltd, 2020) Gulhan, Pinar Yildiz; Balbay, Ege Gulec; Ercelik, Merve; Yildiz, Seyma; Yilmaz, Mehmet AlperAim: To investigate the relationship between sarcoidosis and metabolic syndrome (MetS) and insulin resistance (IR). Method: In our study, 47 patients with sarcoidosis who applied to our outpatient clinic and 45 healthy individuals without chronic disease were included. All patients were evaluated for MetS according to the National Cholesterol Education Program's Adult Treatment Panel III (NCEP-ATP III) criteria. The presence of three of the five factors defined by ATP III for MetS was accepted as a diagnosis of MetS. IR is calculated using the HOMA-IR index. Results: The mean age of the 47 patients with sarcoidosis was 50.7 +/- 12.2 years and the mean age of the 45 control groups was 42.9 +/- 14.4 years. Almost 80% of the patients were diagnosed as stage 2 sarcoidosis. Distribution of the patients according to the use of steroid is; almost half of the patients (47%) received steroid previously or recently. Patients with sarcoidosis have a 7.66 relative risk for MetS, whereas they also have a 5.48 relative risk of insulin resistance development. Conclusion: This study shows that MetS is associated with increased sarcoidosis risk. MetS and IR diagnosis was higher in patients with sarcoidosis.
