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Öğe Do We Question Occupational and Environmental Exposure Adequately in the Outpatient Clinic of Chest Diseases?(2014) Balbay, Ege Güleç; Binay, Songül; Süner, Kezban Özmen; Çakıroğlu, Emine Banu; Arbak, Peri MeramAmaç: Göğüs hastalıklarında öykü alma aşamasında, bireylerin mesleki ve çevresel maruziyetleri ile sigara kullanma öykülerini ayrıntılı olarak kaydetmek hastalık tanısında çok önem taşımaktadır. Bu çalışmada, göğüs hastalıkları polikliniğinde alınan meslek anamnezlerinin kalitesini araştırmak planlanmıştır. Yöntemler: Tıp fakültesi göğüs hastalıkları polikliniğine ayaktan başvurmuş 320 ardışık hastanın (158 kadın, 162 erkek) kayıtları retrospektif olarak değerlendirildi. Kayıtlarda bireylerin meslek öykü- lerinin ayrıntılı olarak alınıp alınmadığı, çevresel maruziyetlerin ve sigara kullanımının sorgulanma şekli değerlendirildi. Bulgular: Kadın hastaların yaş ortalaması 51,6173 iken, erkeklerinki 55,116,1 idi. En sık karşılaşılan meslekler; ev hanımı (%37,5), çiftçi (%12,8) ve işçi (%12,2) idi. Ayrıntılı meslek öyküsü %21,9 oranında alınmış ve erkeklerde (%79) kadınlardan (%31) daha yüksek oranda bulunmuştu (p0.001). İşçilerin %60'ında çalışılan işyeri sorgulanırken, halen çalışılan işten önceki işler %10,6 oranında sorgulanmıştı. Toplam 9 bireye (%2,8) yaşadığı ortam sorulmuştu. Sigara kullanımı olguların %90,6'sında sorgulanmıştı. Toplam 290 sigara kullanan olgunun 183'üne (%63,1) paket.yıl sorgulaması yapılmıştı. Sonuç: Göğüs hastalıkları polikliniğinde ayrıntılı mesleki anamnez, çevresel maruziyet öyküsü ve sigara kullanımı öyküsü kayıtlarının yeterli derecede yapılmadığı gözlenmiştir.Öğe The Evaluation of Family Physicians' Knowledge on the Use of Inhalation Devices(Aves, 2015) Tanrıverdi, Elif; Süner, Kezban Özmen; Süner, Hasan; İliaz, Sinem; Annakkaya, Ali NihatObjective: Nowadays, inhalation techniques have an important role in treatment of asthma and chronic obstructive pulmonary disease (COPD). Correct application of inhalation devices is important for optimal therapeutic efficacy. Showing inhalation techniques to patients receiving inhaler therapy in more than one visit reduce the device usage errors. It is important to observe the deficiencies and errors of the patients in the primary health care where the patients frequently admitted. In our study we aimed to evaluate the knowledge of family physians on inhaler device usage in their clinical practice. Methods: Family physicians who work in primary health care services were visited face to face. Fifty family physicians who were in the institution at visit day and agreed to participate in the study were included in the study. The questionnaire consisting of 15 questions were asked each family physician. Then, seven different inhalation devices were evaluated with 10 step scoring system of inhaler device usage. Results: Twenty eight (56%) physicians were female and 22 (44%) were male. The mean age was 36.3 +/- 6.7 years and mean working time as a family physician was 5.12 +/- 2.8 years. Nineteen physicians participated to a meeting about usage of inhaler devices in the past. Average scores for inhaler devices were found 7.96 +/- 2.91 for metered-dose inhaler, 7.54 +/- 3.93 for discus, 7.28 +/- 4.04 for handihaler, 6.38 +/- 4.4 for aerolizer, 6.12 +/- 4.22 for turbuhaler, 5.98 +/- 4 for easyhaler and 5.72 +/- 4.59 for sanohaler, respectively. There was no relation between the inhaler devices usage scores and sex, age, duration of being family physician (p>0.05). The average scores of physicians who participated to a training were better than the physicians who didn't participate for metered-dose inhalers, turbuhaler, aerolizer and handihaler (p=0.049, p=0.05, p=0.013 and p=0.021, respectively). Conclusion: We thought that training of family physicians for inhaler devices is necessary to improve patients' compliance and successful treatment.Öğe FAKTİTİYÖZ HEMOPTİZİ: INTRAVENÖZ OPİYAT BAĞIMLISI BİR OLGUDA BEKLENMEDİK ODAK(İzmir Göğüs Hastalıkları Hastanesi, 2014) Süner, Kezban Özmen; Balbay, Ege Güleç; Binay, Songül; Akın, NeşeAğızdan kan gelme şikayeti ile başvuran ve anestezi teknisyeni olduğunu belirten 37 yaşında erkek hasta hemoptizi etyolojisi araştırılmak amacıyla yatırıldı. Hastaya çekilen toraks tomografisinde herhangi bir pulmoner patoloji saptanmadı. Bronkoskopik, laringoskopik, ekokardiyografik ve nazogastrik değerlendirmelerde herhangi bir patoloji saptanmadı. Hastanın elinde bir üniversiteden alınmış evre 4 mide adenokarsinomu olduğunu belirtir rapor bulunmaktaydı. Hasta servis takiplerinde ağrı yakınması olduğunu ifade ederek ısrarla narkotik analjezik talebinde bulundu. Hastanın çelişkili ifadeleri, fizik muayenede kollarda kesi izleri saptanması ve yoksunluk sendromu benzeri belirtileri olması üzerine hastanın kimliği ve iddia ettiği malignite tanısı hakkında şüphelerimiz oluştu. Sonraki hemşire izlemlerinde tesadüfen hastanın intravenöz kanülden enjektörle aldığı kanı ağızdan geliyormuş gibi tükürdüğü gözlemlendi. Sonuç olarak; intravenöz ilaç bağımlılarında gelişebilecek özellikle kardiyolojik veya pulmoner hemoptizi nedenlerinden başka bu olguda olduğu gibi beklenmedik nedenleri de göz ardı etmemeliyiz. Faktitiyöz neden; özellikle tıbbi öyküsü olan ve şüpheli davranış sergileyen olgularda etyolojisi aydınlatılamayan hemoptizi ayırıcı tanısında mutlaka düşünülmelidir.Öğe Is obstructive sleep apnea syndrome a risk factor for pulmonary thromboembolism?(Lippincott Williams & Wilkins, 2012) Süner, Kezban Özmen; Annakkaya, Ali Nihat; Toru, Ümran; Dumlu, Talha; Balbay, Ege Güleç; Arbak, Peri Meram; Süner, HasanBackground In many studies, obstructive sleep apnea (OSA) has been shown to be an independent risk factor for cardiovascular disease. Conversely, there are few reports establishing possible relation between OSA and venous thromboembolism (VTE). In this study, the aim is to evaluate OSA via polysomnography in patients with pulmonary embolism and drawing the attention of clinicians to the presence of obstructive sleep apnea syndrome (OSAS) may be a risk factor for pulmonary embolism. Methods Fifty consecutive patients who were diagnosed with pulmonary embolism (PE) were evaluated prospectively for OSAS. Polysomnographic examination was conducted on 30 volunteer patients. The frequency of OSAS in PE was determined and PE cases were compared to each other after being divided into two groups based on the presence of a major risk factor. Results The study consisted of a total of 30 patients (14 females and 16 males). In 56.7% of the patients (17/30), OSAS was determined. The percent of cases with moderate and severe OSAS (apnea hipoapnea index >15) was 26.7% (8/30). Patients who had pulmonary thromboembolism (PTE) without any known major VTE risk (n=20), were compared to patients with VTE risk factors (n=10), and significantly higher rates of OSAS were seen (70% and 30% respectively; P=0.045). The mean age of the group with major PE risk factors was lower than the group without major PE risk factors (52 years old and 66 years old, respectively; P=0.015), however, weight was greater in the group with major PE risk factors (88 kg and 81 kg, respectively; P=0.025). By multivariate Logistic regression analysis, in the group without any visible major risk factors, the only independent risk factor for PE was OSAS (P=0.049). Conclusions In patients with PTE, OSA rates were much higher than in the general population. Moreover, the rate for patients with clinically significant moderate and severe OSA was quite high. PTE patients with OSA symptoms (not syndromes) and without known major risk factor should be examined for OSA. There seems to be a relationship between OSA and PTE. However, whether this relationship is a causal relationship or a relationship due to common risk factors or long-term complications of OSA is not clear. Further comprehensive studies on those special topics are needed to clarify these points. Chin Med J 2012;125(20):3712-3718Öğe Obstructive sleep apnoea syndrome in patients with primary open-angle glaucoma(Hong Kong Acad Medicine Press, 2014) Balbay, Ege Güleç; Balbay, Öner Abidin; Annakkaya, Ali Nihat; Süner, Kezban Özmen; Yüksel, Harun; Tunç, Murat; Arbak, Peri MeramObjective: To investigate the prevalence of obstructive sleep apnoea syndrome in patients with primary open-angle glaucoma. Design: Case series. Setting: School of Medicine, Duzce University, Turkey. Patients: Twenty-one consecutive primary open-angle glaucoma patients (12 females and 9 males) who attended the out-patient clinic of the Department of Ophthalmology between July 2007 and February 2008 were included in this study. All patients underwent polysomnographic examination. Results: The prevalence of obstructive sleep apnoea syndrome was 33.3% in patients with primary open-angle glaucoma; the severity of the condition was mild in 14.3% and moderate in 19.0% of the subjects. The age (P = 0.047) and neck circumference (P = 0.024) in patients with obstructive sleep apnoea syndrome were significantly greater than those without the syndrome. Triceps skinfold thickness in glaucomatous obstructive sleep apnoea syndrome patients reached near significance versus those without the syndrome (P = 0.078). Snoring was observed in all glaucoma cases with obstructive sleep apnoea syndrome. The intra-ocular pressure of patients with primary open-angle glaucoma with obstructive sleep apnoea syndrome was significantly lower than those without obstructive sleep apnoea syndrome (P = 0.006 and P = 0.035 for the right and left eyes, respectively). There was no significant difference in the cup/disc ratio and visual acuity, except visual field defect, between primary open-angle glaucoma patients with and without obstructive sleep apnoea syndrome. Conclusions: Although it does not provide evidence for a cause-effect relationship, high prevalence of obstructive sleep apnoea syndrome in patients with primary open-angle glaucoma in this study suggests the need to explore the long-term results of coincidence, relationship, and cross-interaction of these two common disorders.Öğe Obstrüktif uyku apne sendromu pulmoner tromboemboli için bir risk faktörü müdür?(Düzce Üniversitesi, 2011) Süner, Kezban Özmen; Annakkaya, Ali NihatGiriş ve Amaç: Yapılan birçok çalışmada Obstrüktif Uyku Apne Sendromu'nun (OSAS) kardiyovasküler hastalıklar için bağımsız bir risk faktörü olduğu gösterilmiştir. Ancak OSAS ile venöz tromboemboli (VTE) arasındaki ilişkiyi ortaya koyan çalışmalar yetersizdir. Bu çalışmada Pulmoner Emboli (PE) tanısı alan hastalarda OSAS sıklığını polisomnografik olarak ortaya koyup OSAS varlığının pulmoner emboli için bir risk faktörü olabileceğini klinisyenlerin dikkatine sunmak amaçlanmıştır.Yöntem: Düzce Üniversitesi Tıp Fakültesi Göğüs Hastalıkları Servisinde PE tanısı alan ardışık 50 hasta prospektif olarak OSAS sıklığı yönünden değerlendirildi. Çalışmaya katılmayı kabul eden klinik durumu uygun gönüllü 30 olguya Polisomnografik inceleme yapıldı. Apne-Hipopne İndeksi 5'in üzerinde olan hastalar OSAS olarak kabul edildi. PE'de OSAS sıklığı tespit edildi ve PTE olguları majör risk faktörü olup olmamasına göre iki gruba ayrılarak karşılaştırıldı.Bulgular: 28-85 yaşları arasında (61±15,ortalama±SD), 14 kadın, 16 erkek toplam 30 olgu çalışmaya dahil oldu. Nonmasif PE 24 olgu (%80), submasif PE 3 olgu (%10), kronik pulmoner tromboemboli 2 olgu (%6,7) ve masif pulmoner emboli 1 olgu (%3,3) mevcuttu. Olguların %56,7'sinde (17/30) OSAS tespit edildi. Orta ve ağır OSAS (AHİ > 15) olanların oranı ise %26,7 (8/30) idi. Bilinen majör VTE riski olmayan pulmoner tromboembolisi olan hastalarda (n=20), VTE risk faktörü olan hastalara göre (n=10) anlamlı olarak daha yüksek oranda OSAS tespit edildi (sırasıyla %70; 14/20 ve %30; 3/10, p=0.045). Majör PTE risk faktörü olan grubun yaş ortalaması daha düşük, (66 ve 52, p=0.015) kilosu ise daha yüksek (81 ve 88 p=0.025) bulundu. Majör risk faktörü olmayan grupta BUN düzeyleri anlamlı olarak daha yüksekti. PTE majör risk faktörü olan ve olmayan grupta vücut kitle indeksi, hematokrit düzeyi, AHİ ve diğer polisomnografik bulgular yönünden anlamlı fark saptanmadı. Yapılan multivaryant lojistik regresyon analizinde görünür majör risk faktörü olmayan grupta PTE için tek bağımsız risk faktörünün OSAS olduğu tespit edildi (p=0.049).Sonuç: PTE'si olan olgularda OSAS oranları toplumdan çok daha yüksek oranda bulundu. Çalışmanın sonuçları OSAS'nın PTE için bağımsız bir risk faktörü olabileceğini düşündürmektedir. Bu konuda daha kapsamlı çalışmalara gereksinim vardır.Öğe Relationship between Respiratory Tract Complaints, Functional Status, and Smoking in Hairdressers, Auto Painters, and Carpenters(Hindawi Publishing Corporation, 2014) Toru, Ümran; Arbak, Peri Meram; Süner, Kezban Özmen; Yavuz, Özlem; Karataş, NaciyeBackground and Aim. It was observed that occupation and smoking increased each other's effects on the development of airway diseases. We aimed to search the relationship between respiratory symptoms, smoking, and occupation. Materials and Methods. 225 employees in Duzce, Turkey, were applied a survey questioning respiratory complaints, pulmonary function tests (PFTs) and cotinine measurements in urine. Results. Cough (26.7%), phlegm (30.7%), and chest tightness (21.3%) were encountered more in carpenters compared to other groups and phlegm was statistically higher at significant level compared to other groups. The complaints of cough (30.4%), phlegm (27.4%), and chest tightness (21.5%) were significantly higher in individuals whose cotinine level was above 500 ng/mL and forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) ratio, maximum midexpiratory flow rate (MMFR) values were significantly lower. Dyspnea complaint of auto painters whose cotinine level was below 500 ng/mL was significantly higher and also expected MMFR% value of this group was significantly lower compared to other groups. While age had independent effect on respiratory function tests, type of the job was found to be independently effective on MMFR. Conclusion. Smoking increases respiratory complaints of employees. In auto painters, the occupation causes airway disease regardless of smoking.Öğe Respiratory symptoms and pulmonary function tests in security and safety products plant workers(E-Century Publishing Corp, 2014) Balbay, Ege Güleç; Toru, Ümran; Arbak, Peri Meram; Balbay, Öner Abidin; Süner, Kezban Özmen; Annakkaya, Ali NihatObjective: Lock and key factory workers are under the risk of metal pneumoconiosis and occupational asthma. In this cross-sectional study, it's aimed to evaluate the relationship between metal dust exposure and respiratory symptoms, pulmonary function tests of workers in different section of lock and key factory. Methods: 54 male workers (mean age, 32.8 +/- 5.4) in a security and safety products plant were evaluated for respiratory symptoms, pulmonary function tests and smoking habits. Results have been interpreted by comparison of the painting (28/54) and grinding group workers (26/54). Results: There was no significant difference between painting (32.1 +/- 4.8) and grinding (33.6 +/- 6.1) groups regarding mean age (P > 0.05). Smokers were in significantly higher in grinding group (18/26). Cough and sputum were reported 14.3% (4/28) in painting and 3.8% (1/26) in grinding workers (P > 0.05). Chest tightness was seen in 7.1% and 7.7% of painting and grinding workers, respectively (P > 0.05). But no chest tightness was reported in both groups when they were away work. Breathlessness was seen in 10.7% and 7.7% of painting and grinding workers, respectively (P > 0.05). Breathlessness was similar in both groups (7.1% vs. 3.8%) when they were away work. When comparing painting and grinding workers respiratory functions no significant difference observed. Chest radiography in painting and grinding workers showed hyperlucency (3.6% vs. 11.4%), respectively. Conclusion: Painting groups in lock and key factory workers had more but statistically insignificant respiratory complaints. Interestingly, chest tightness was only observed when both groups were at work. It was thought that ventilation and using personal protective equipment in factory could provide significant benefits.
