Effect of the presence of pneumonia on noninvasive ventilation success in chronic obstructive pulmonary disease cases with acute hypercapnic respiratory failure

Aim: To investigate the effect of the presence of pneumonia on the success of noninvasive mechanical ventilation (NIMV) in chronic obstructive pulmonary disease (COPD) cases with acute respiratory failure. Materials and methods: Sixty patients admitted to the intensive care unit (ICU) due to COPD exacerbation were included. The patients were divided into 2 groups as those with pneumonia (Group 1) and without pneumonia (Group 2). According to initial pH values, cases were also divided into 3 subgroups based on pH values. C-reactive protein (CRP), APACHE II scores, requirement of endotracheal intubation, mortality, and duration of ICU and hospital stay were also recorded. Results: NIMV success was found to be 85.5% in Group 1 and 51.1% in Group 2. Endotracheal intubation rates were higher in Group 2 (P = 0.008). NIMV failure was 70.1% in Group 2 and 10% in Group 1 in patients with severe acidosis. The APACHE II scores and CRP levels were significantly higher and independent risk factors in patients with NIMV failure (P < 0.002, P < 0.001). A significant difference was not found between groups in terms of duration of hospital and ICU stays and mortality. Conclusion: The presence of pneumonia in COPD cases is a factor that reduces NIMV success, but this does not affect mortality and the duration of ICU and hospital stay

Do N-terminal pro-brain natriuretic peptide levels determine the prognosis of community acquired pneumonia?

Objective: Pneumonia is a leading cause of mortality worldwide, especially in theelderly. The use of clinical risk scores to determine prognosis is complex and thereforeleads to errors in clinical practice. Pneumonia can cause increases in the levels of cardiacbiomarkers such as N-terminal pro-brain natriuretic peptide (NT-proBNP). The prognosticrole of the NT-proBNP level in community acquired pneumonia (CAP) remains unclear.The aim of this study was to evaluate the prognostic role of the NT-proBNP level in patientswith CAP, as well as its correlation with clinical risk scores. Methods: Consecutiveinpatients with CAP were enrolled in the study. At hospital admission, venous bloodsamples were collected for the evaluation of NT-proBNP levels. The Pneumonia SeverityIndex (PSI) and the Confusion, Urea, Respiratory rate, Blood pressure, and age ? 65years (CURB-65) score were calculated. The primary outcome of interest was all-causemortality within the first 30 days after hospital admission, and a secondary outcomewas ICU admission. Results: The NT-proBNP level was one of the best predictors of30-day mortality, with an area under the curve (AUC) of 0.735 (95% CI: 0.642-0.828; p< 0.001), as was the PSI, which had an AUC of 0.739 (95% CI: 0.634-0.843; p < 0.001),whereas the CURB-65 had an AUC of only 0.659 (95% CI: 0.556-0.763; p = 0.006).The NT-proBNP cut-off level found to be the best predictor of ICU admission and 30-day mortality was 1,434.5 pg/mL. Conclusions: The NT-proBNP level appears to be agood predictor of ICU admission and 30-day mortality among inpatients with CAP, witha predictive value for mortality comparable to that of the PSI and better than that of theCURB-65 score

Astımlı hastalarda depo akarı duyarlılığı ve ilişkili faktörler

Introduction: The aim of the study was to investigate the storage mite sensitivity and related factors in patients with asthma or asthma and rhinitis. Patients and Methods: 149 patients with asthma or asthma and rhinitis were included to the study. Prick test was performed after addition of Acarus siro (A. siro), Lepidoglyphus destructor (L. destructor), Glycophagus domesticus (G. domesticus) and Tyrophagus putrescentiae (T. putrescentiae) to the standart prick test. Living conditions, smoking history, allergic diseases status, seasonal variations in symptoms were evaluated by a questionnaire. Besides, respiratory screening spesific IgE, L. destructor spesific IgE was examined in a group of patients who were allergic to storage mites according to prick tests. Results: Prick test results showed that; 115 of the patients were sensitized while 34 of them were not. House dust mite sensitivity was detected as mite 58.3%.The storage mite sensitivity for at least one of the studied species was detected in 61.7% of patients. The sensitivity rates were 50.4%, 48.7%, 47%, %40 for A. siro, L. destructor, G. domesticus and T. putrescentiae, respectively. The storage mite sensivity was found higher in the patients from the rural areas (p< 0.05). L. destructor IgE positiveness was detected in 9.1% of the group that antibody levels were examined. Positive reaction was detected for at least one of the storage mite species in %22.7 of the patients who were considered as not sensitized according to the results of the standart prick tests. Conclusion: As a result, storage mites are important allergens in subjects who live in rural areas and close contact with barn, haymow, bin and pantry. Addition of storage mite allergens to the standart prick test panel of patients living in rural area is suitable

Investigation of the relationship between cord clamping time and risk of hyperbilirubinemia

Background: Although the relationship between umbilical cord clamping time and various parameters such as hemoglobin (Hb) levels, iron deficiency, and risk of neonatal jaundice has previously been studied, to the best of our knowleadge there have been no studies investigating the relationship between cord clamping time and the risk of significant hyperbilirubinemia. We aimed to investigate the relationship between the time of umbilical cord clamping and transcutaneous bilirubin (TcB) measurements made on various postnatal hours, Hb and serum total bilirubin (STB) levels measured on postnatal 4th day, and the risk of development of significant hyperbilirubinemia requiring phototherapy treatment. Methods: Eligible newborns were divided into two groups on the basis of the time of cord clamping: those clamped late (60 seconds or more; Group I) and those clamped early (less than 60 seconds; Group II). Groups were compared with respect to the parameters of cord Hb, postnatal TcB measurements at 6th, 48th, 96th and 168th hours, and 96th hour Hb, STB and direct bilirubin levels. Results: TcB levels at the 96th and 168th hour were significantly higher in Group I when compared to Group II (p < 0.001 and p < 0.001, respectively). The 96th hour STB level was significantly higher in Group I when compared to Group II (p < 0.001). The need of phototherapy requirement was higher in Group I when compared to Group II (p=0.001). Increase in cord blood Hb for each 1 gr/dl caused a 3.94-fold increased risk in the requirement of phototherapy treatment. Cord clamping time showed statistically significant positive correlations with both cord blood and 96th hour venous Hb levels, with both 96th hour and 168th hour TcB levels, and with 96th hour STB levels. Conclusions: Newborns whose cords are clamped late should be followed up closely with respect to high postnatal bilirubin levels and other risks associated with significant hyperbilirubinemia requiring phototherapy treatment

Human metapneumovirus pneumonia: case report

İlk kez 2001’de tanımlanan human metapnömovirüs (hMPV), 10 yaş altı çocuklarda üst ve alt solunum yolu enfeksiyonlarında izole edilebilen bir virus olsa da ülkemizde bu virusla ilgili olarak yayınlanmış fazla sayıda çalışmaya rastlanmamıştır. Human metapneumovirus tanısında altın standart yöntem RT-PCR yöntemidir. Pnömoni kliniği ve laboratuvar bulguları ile başvuran hastalarda viral/bakteriyel pnömoni ayırıcı tanısında PCR gibi ileri tanı yöntemlerinin hızlı ve etkili bir şekilde kullanılması, hastalara gereksiz antibiyotik tedavisi uygulanmasının önüne geçilmesi ve gerekli durumlarda uygun antiviral tedavinin verilebilmesi açısından önemli katkı sağlayacaktır. Bu makalede solunum sıkıntısı bulguları ve oksijen gereksinimi ile başvuran ve enfeksiyon etkeninin human metapneumovirus olarak tespit edildiği 18 aylık hasta sunulmuş ve 2 yaş altı çocuklarda solunum yolu enfeksiyonlarında klasik solunum yolu viruslarına göre çok daha ender rastlanan ve son yıllarda tanımlanmış bir virus olan human metapnömovirüs ile etken olarak karşılaşılabileceği vurgulanmak istenmiştir

Impairment in heart functions and prognostic role of N‑terminal pro‑brain natriuretic peptide in patients with chronic obstructive pulmonary disease exacerbation

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) with comorbidities andcardiovascular disease is the most frequent one. The role of natriuretic peptides in determiningprognosis of COPD exacerbations is not yet clear. The frequency of pathologic findings of transthoracicechocardiography (TTE) during COPD exacerbation showed wide variability. This study aims toevaluate the predictive role of N-terminal pro-brain natriuretic peptide (NT-proBNP) in determiningthe short-term prognosis of patients hospitalized with COPD exacerbation. As a secondary outcome,we aimed to investigate the frequency of TTE findings in these patients.MATERIALS AND METHODS: Eighty-six consecutive patients with COPD exacerbationwere included. NT-proBNP levels were measured and TTE was carried out to whole of theparticipants at administration. The primary outcome was development of “event” (readmissionor rehospitalization or mortality) within 30 days. The predictive role of NT-proBNP level for thedevelopment of “event” was evaluated. As a secondary outcome of the study, the frequency ofTTE findings was recorded.RESULTS: NT-proBNP level of the patients who developed event within 30 days had significantlyhigher than who did not (2343.16 ± 4107.17 pg/mL vs. 843.22 ± 2349.96 pg/mL, P = 0.001).A high negative correlation was found between NT-proBNP level and “time to event” (r =-0.992, P < 0.001). Multivariable logistic regression analysis showed that NT-proBNP levelwas an independent predictor for the development of “event” (P < 0.001) and the cutoff pointof it was found to be 303.5 pg/mL (0.639 sensitivity and 0.720 specificity). The most frequentechocardiographic findings were pulmonary hypertension (54.7%) and left ventricle diastolicdysfunction (39.5%).CONCLUSION: NT-proBNP level is a strong predictor for short-term prognosis of patients hospitalizedwith COPD exacerbation. Further and larger studies are needed to determine exact role of NT-proBNPin long-term prognosis of these patient

Smoking habits of university students and level of their knowledge about the topic

Amaç: Tütün kullanımı, dünyadaki en önemli önlenebilir ölüm nedenidir. Sigara içenlerin 1/3?ü 13 ya?ından, %90?ı ise 20 ya?ından önce sigaraya başlar. Bu nedenle sigara firmaları sistemli biçimde çocuklara ve gençlere yönelmektedir. Bu çalışmanın amacı, sigara firmalarının hedefleri içinde olan üniversite öğrencilerinin tütün kullanımı ile ilgili bilgi düzeyini ölçmek ve gençlerin tütün kullanımı ile ilgili tutumunu değerlendirmektir. Gereç ve yöntem: Çalışmaya Ufuk Üniversitesi Tıp Fakültesi (TF), Hukuk Fakültesi (HF) ve Hemşirelik Yüksek Okulu (HYO) öğrencileri arasından gönüllü olan 324 genç alındı. The Global Youth Tobacco Survey Collaborative Group tarafından hazırlanan ?Global Youth Tobacco Survey? (GYTS) adlı ankete nargile kullanımı ile ilgili sorular eklenip, üniversite etik kurulu onayıyla öğrencilere uygulandı. Bulgular: Öğrencilerin %38?i halen sigara içmekteydi. Sigara içme oranı en yüksek HF, en düşük TF öğrencilerinde bulundu (p<0.05). Sigaranın zararlarıyla ilgili ders alma oranı TF?de en yüksekti (p<0.001). Erkek öğrencilerde sigara ve nargile içme oranı kız öğrencilere göre daha yüksekti (p<0.05, p<0.001). Sigara içenlerin çoğu (%79) sigaraya üniversiteden önce ba?lamı?tı. Hukuk fakültesindeki öğrencilerde ve erkek öğrencilerin arkada?larında sigara içme oranı daha yüksek bulundu (p<0.001). Yüzde 15.4?ü hem sigara hem nargile içerken, %12.7?si sadece nargile içiyordu. Üç yüz bir öğrenci (%92.9) sigaranın, 234 öğrenci (%72.2) nargilenin zararlı olduğunu biliyordu. İki yüz seksen beş öğrenci (%85) pasif içiciliğin zararlı olduğunu belirtti. Öğrencilerin %76.2?si kapalı alanlarda sigara içme yasağını destekliyordu. Halen sigara içmekte olan 99 öğrencinin %62?si sigarayı hemen bırakmak istiyordu, ancak %59?u sigarayı bırakmaları için yardım veya tavsiye almamıştı. Sonuç: Çalı?mamızda, öğrencilerin %79?unun üniversite öncesi sigaraya başlaması, önlemlerin küçük yaşlarda alınması gerektiğini bir kez daha göstermiştir. Bu eğitim sırasında, özellikle bilgi düzeyi daha düşük olduğu için, nargilenin zararlarının da vurgulanması gerekmektedir. Sigaraya başlamış olan gençlerin çoğu sigarayı bırakmak istemektedir. Bu konuda yeterli desteğin verilmesi için gerekli düzenlemeler yapılmalıdır.Aim: Smoking is the most important preventable cause of death in the world. One third of the smokers start smoking before the age of 13 and 90% start before the age of 20. Therefore, cigarette companies systematically target young people. The aim of this study is to determine the level of knowledge of university students and to evaluate their attitude about smoking. Material and methods: Three hundred twenty four students from faculty of medicine (MF), faculty of law (LF) and nursing school (NS) of Ufuk University were included in the study. A questionnaire prepared by Youth Tobacco Survey Collaborative Group and named ?Global Youth Tobacco Survey? (GYTS) was performed after adding some questions about use of nargile (water-pipe). Results: Thirty eight percent of the students were current smokers. The smoking rate was highest in LF and lowest in MF (p&lt;0.05). The learning rate of the damage smoking can cause was highest among MF students (p&lt;0.001). Smoking and water-pipe use were more prevelant among males (p&lt;0.05, p,0.001). Most of the smokers (%79) had started smoking before university. Smoking rate was higher among LF students and friends of males (p&lt;0.001). Among the students,15.4% was smoking both cigarette and water-pipe, 12.7% only water-pipe. While, 92.9% of students had known that smoking was harmfull, only 72.2% of them was aware of the damage water-pipe can cause. Two hundred eighty five students (85%) indicated that passive-smoking was harmfull and 76.2% of them supported prohibition of smoking. Although, 62% of 99 current smokers wanted to stop smoking, 59% of them did not take any help or advice. Conclusion: Seventy nine percent of the students who were included in the study started smoking before university. This result showed once again that efforts to prevent smoking should start at early ages. Because of the low level of knowledge, the damages of water-pipe should be emphasized. Since most of the young people who are current smokers want to stop smoking, supportive preventions must be arranged

Systemic inflammation and metabolic syndrome in stable COPD patients

Introduction: Chronic obstructive pulmonary disease (COPD) has extrapulmonary effects that seems to be related with systemic inflammation. The relationship between metabolic syndrome which is an important determinant of systemic inflammation in general population and COPD is still not clear. The aim of the current study was to investigate the frequency of metabolic syndrome and C-reactive protein (CRP) levels, as a marker of systemic inflammation in stable COPD patients with different severity levels and in age and sex matched control group. Patients and Methods: Ninety-one stable COPD patients and 42 control subjects were included in the study. The severity level in patients with COPD were determined according to GOLD (Global Initiative for Chronic Obstructive Lung Disease) criteria. ATP III (The National Cholesterol Education Program’s Adult Treatment Panel III) was used in diagnosis of metabolic syndrome. Hs-CRP levels were measured in venous samples of patients and control subjects. Results: The frequency of metabolic syndrome was found higher in patient group than control subjects, especially in GOLD stages I, II (p= 0.004). Abdominal obesity, hypertension, hyperglycemia components of metabolic syndrome were significantly more prevalent in patient group (p< 0.0001). Increased CRP levels were higher in control and patient groups in all GOLD stages, with metabolic syndrome than without metabolic syndrome (p= 0.047, p= 0.217, p< 0.001, p= 0.05, p= 0.467). Conclusion: The study showed that frequency of metabolic syndrome was higher in stable COPD patients than control subjects and general Turkish population. Abdominal obesity, hypertension and hyperglycemia were significantly more prevalent in patient group. Systemic inflammation was more intense in COPD patients with metabolic syndrome than without metabolic syndrome

Anti-E ve Rh uygunsuzluğu birlikteliği: immünizasyondan hangisi sorumlu?

The frequency of hemolytic disease of the newborn due to maternal antibodies of subgroup incompatibility other than anti-D (Rh) antibodies has increased in recent years after the common use of anti-D (Rh) immunoglobulins in Rh incompatibilitiy. In this article a newborn who was hospitalized because of jaundice and diagnosed to have E minor blood group incompatibility is presented, and it is emphasized that the underlying etiologic factor may be subgroup incompatibility rather than Rh incompatibility in cases with seemingly Rh-Rh incompatibility who have mild jaundice and a positive direct Coombs test.Son yıllarda Rh uygunsuzluğu nedeni ile Rh (D) immünglobülinlerin yaygın bir biçimde kullanılması sonucunda anti-D dışındaki maternal Ig-G tipi kan grubu antikorların neden olduğu subgrup uyuşmazlığına bağlı yenidoğanın hemolitik hastalığının önemi giderek artmıştır. Bu yazıda yenidoğan döneminde sarılık tanısı ile yatırılan ve anti-E’ye bağlı subgrup uygunsuzluğu tespit edilen bir vaka sunulmuş, görünürde Rh-Rh uygunsuzluğu olan ve hafif sarılıkla giden, direkt Coombs testi pozitif olan vakalarda etiyolojinin Rh uygunsuzluğu olmayabileceği, daha hafif şiddette gidebilen subgrup uygunsuzluğu olabileceği vurgulanmak istenmiştir

A year's retrospective evaluation of patients hospitalized with the diagnosis of ischemic stroke at Kocatepe University Medicine Faculty Neurology Clinic

OBJECTIVE: The aim of this study is to describe the etiological, demographical and clinical features and determine the risk factors of acute ischemic stroke patients, who were hospitalized and treated at Afyon Kocatepe University (AKU) Medical School Neurology Department within a year. METHODS: The stroke subtypes of 104 acute ischemic stroke patients hospitalized at AKU Medical School Neurology Department within a year were classified according to TOAST (Trial of Org 10172 Stroke Treatment) retrospectively. The distribution of risk factors based on gender was evaluated. RESULTS: Of the 104 stroke patients, 49 (47.1%) were males, 55 (52.9%) were females. The age range of the patients was between 23 and 92 and the mean age was 66.79 ± 15.05 years. Stroke was present in the carotid artery perfusion area in 84 patients (80.8%) and in the vertebro-basilar perfusion region in 20 (19.2%) patients. Hypertension, which was found in 61patients (58.7%), was at the top of the risk factors. The difference was statistically significant based on the hypertension, when the risk factors were assessed according to gender. The etiological classification based on the TOAST criteria was as follows: ischemic stroke resulting from small artery disease in 32 (30.8%), cardioembolic stroke in 27 (26%), and great artery atherosclerosis in 22 (21.2%) patients. The etiological factors of 5 (4.8%) patients were rare causes and in 18 (17.3%) no etiology could be found despite the investigation. CONCLUSION: The most important risk factors of ischemic stroke, which is a common entity in the elderly, are hypertension and diabetes mellitus. The strokes caused by small artery diseases are the most common type based on the classification of TOAST criteria. There is limited number of studies evaluating the stroke epidemiology in our country; therefore further studies are needed to assess this issue