The relati?on between adherence to posi?ti?ve ai?rway pressure treatment and pulmonary functi?ons i?n obstructi?ve sleep apnea syndrome

YÖK Tez No: 632416Amaç: 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 (p0,05). 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 (p0,05). Rates of nasal cannula use, tolerance of CPAP, ability to fall asleep quickly, no abdominal discomfort or facial lacerations due to the mask, no leakage of oxygen, benefit from the device, reduction in daytime sleepiness and the thought that adequate and appropriate treatment had been administered in patients who complied with the device were significantly higher than those who were not compliant (p<0,05). Claustrophobia, discomfort concerning pressure were also significantly lower in complying patients than non-complying patients (p<0,05). A forward Wald multiple logistic regression model was established using variables which were found to affect the patients' compliance rates, which showed that an increase BDS scale score increased the non-compliance odds ratio by 1,08, the complaint of air leakage by 6,82, pressure discomfort by 5,21, and absence of improvement in daytime sleepiness by 5,87. Result: Whereas an association between PFT parameters and compliance to PAP treatment wasn't established, statistically significant factors that affected device compliance were detected. In patients with OSAS, high-risk groups in terms of compliance should be identified before starting PAP treatment, and educational support should be provided. Our view is that close followups of patients and solution of their complaints regarding treatment could improve their compliance with PAP treatment

Maligniteyi Taklit Eden Yaygın Granülomatöz İnflamasyon Olgusu

Elli dokuz yaşında kadın hasta 3 haftadır devam eden kuru öksürük ve 2 aydır olan efor dispnesi (MRC 2) ile polikliniğimize başvurdu. Son 3 ay içerisinde 5 kg kaybı mevcuttu. Hiç sigara içmemişti. Mesleği ev hanımı idi. Hastanın postero-anterior akciğer grafisinde sağ alt zonda sağ atriyum kenarını silen opasite olması üzerine çekilen toraks bilgisayarlı tomografisinde; her iki akciğer üst loblarda büyüğü 5 mm olmak üzere birkaç adet nodül, solda lingula ve sağda orta lobda yine yaygın retikülonodüler dansiteler izlendi. Hastanın malignite ön tanısıyla istenen pozitron emisyon tomografisinde; nazofarenks dorsal duvarında, bilateral servikal lenfadenopatilerde, her iki akciğerde parankim nodüllerinde, sağ akciğer hiler alanda, sol akciğerde retiküler dansitelerde, gastroözafagial bileşkede, mide fundus ve büyük kurvaturunda, karaciğerde, iliak istasyonlarda multipl lenfadenopatilerde, sağ skapula ve sol iliak kemik iliğinde yoğun hipermetabolik tutulum saptandı. Yapılan axiller lenf nodu diseksiyonu granülomatöz lenfadenit olarak saptandı. Hasta sarkoidoz olarak kabul edildi, inhale steroid tedavisi başlandı ve takibe alındı

A case with diffuse granulomatous inflammation mimicking malignancy [Maligniteyi taklit eden yaygın granülomatöz inflamasyon olgusu]

A 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

Türk tiyatrosu’na adanmış bir yaşam öyküsü : Nurhan Karadağ

Ankara : İhsan Doğramacı Bilkent Üniversitesi İktisadi, İdari ve Sosyal Bilimler Fakültesi, Tarih Bölümü, 2016.This work is a student project of the The Department of History, Faculty of Economics, Administrative and Social Sciences, İhsan Doğramacı Bilkent University.by Özer, Abdürrahim

Ankara

Ankara : İhsan Doğramacı Bilkent Üniversitesi İktisadi, İdari ve Sosyal Bilimler Fakültesi, Tarih Bölümü, 2012.This work is a student project of the The Department of History, Faculty of Economics, Administrative and Social Sciences, İhsan Doğramacı Bilkent University.by Selin Akyüz.Akyüz, Selin. HIST 200-02AKYÜZ HIST 200-02/D 2011-1

The eating attitudes in patients with obstructive sleep apnea syndrome

WOS: 000513593400001PubMed: 32048528Aim: Obstructive sleep apnea syndrome (OSAS) patients show multiple physiological deficits and several neuropsychological comorbidities. The aim of this study was to investigate the eating attitudes in OSAS patients. Material and methods: Polysomnography records of 157 were performed. Eating Attitudes Test (EAT), Beck Depression Inventory (BDI), and the Beck Anxiety Inventory (BAI) were applied to all participants. Results: The mean age of the 157 individuals included in the study was 47.2 +/- 11.4 (18-76) years and 36% (n = 56) of the individuals were female and 64% (n = 101) were male. When the patients were ranked according to the severity of OSAS, 38.2% (n = 60) were severe, 20.4% (n = 32) were moderate, 24.2% (n = 38) were mild, and 17.2% (n = 27) were OSAS negative. There was a significant difference in terms of the age-and-BMI-adjusted EAT score according to OSAS severity (p = .042). There was a significant difference in the age-and-BMI-adjusted value of the EAT according to the presence of OSAS (p = .011). After controlling age and BMI, no significant correlation was found between the EAT and the BDI (r = 0.012, p = .890) in patients with OSAS while there was a significant positive correlation EAT and the BAI (r = 0.177, p = .046). Conclusions: Considering the association of OSAS with psychiatric disorders, the presence of eating disorders (EDs) becomes an important and special topic. Treatment of patients with OSAS should not only aim to improve the patient's sleep apnea, but also to improve the patient's quality of life by evaluating the patient's psychological and physical functions

A Case of Nephrotic Syndrome With Pneumocystis Jirovecii Infection

WOS: 000487340900025Pneumocystis 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

Is sarcoidosis related to metabolic syndrome and insulin resistance?

WOS: 000473823900001PubMed: 31250684Aim: 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

Do the levels of particulate matters less than 10 mu m and seasons affect sleep?

WOS: 000483191800001PubMed: 31441672Background: 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

Serum clara cell protein-16 level in non-smoker obstructive sleep apnea syndrome patients

European-Respiratory-Society (ERS) International Congress -- SEP 28-OCT 02, 2019 -- Madrid, SPAINWOS: 000507372407393…European Respiratory So