Investigation of the relationship between mean platelet volume and obstructive sleep apnea syndrome

Objective: Obstructive sleep apnea syndrome (OSAS) is characterized by recurrent upper airway obstruction and intermittent hypoxia during sleep. Intermittent hypoxia and increased inflammatory activity plays a role in increased risk of cardiovascular disease in the OSAS. OSAS is an important cause of morbidity and mortality and cardiovascular disorders are the most important complications of OSAS. Mean platelet volume (MPV) is a marker of platelet activation and function, and increased platelet volume is associated with increased platelet activity. Different diseases related with inflammation, hypoxia, vascular injury, thrombosis and atherosclerosis were found to be associated with MPV. In this study, we aimed to investigate the relationship between OSAS and MPV. Methods: In this retrospective study, data of sex and age matched 33 patients with moderate OSAS, 34 patients with severe OSAS and 30 healthy subjects were evaluated. Results: The mean MPV was found in control, moderate OSAS and severe OSAS groups as 7.83±1.00, 8.26±1.40 and 8.94±1.20 (fL) respectively. The mean MPV value was significantly higher in severe OSAS group than control subjects (p=0.001). In correlation analysis, there were positive correlation between MPV with apnea-hypopnea index and total sleep time, and negative correlation between MPV with platelet count and minimum oxygen saturation (Respectively, p=0.003 / R=0.295, p=0.030 / R=0.221, p=0.011 / R= -0.257, p=0.019 / R= -0.238). Conclusion: In this study, the increased MPV was associated with severe OSAS and the results of this study suggest that the platelet activation is increased in OSAS. Hypoxia caused by OSAS, due to the activated platelets, may play a role in the development of cardiovascular diseases which is an important cause of morbidity and mortality in OSAS. J Clin Exp Invest 2013; 4 (4): 492-49

The case of malignancy mimicking legionella pneumonia

Legionella pneumophila is a bacterium, which can grow inwater pipe networks and climate systems. Contaminationoccurs by aspiration of infected water or aerosol inhalation.It is usually presented with fever, bradycardia, andchange in mental status, hyponatremia, elevation of liverenzymes and deterioration of renal function. The definitediagnosis is established by detection of the antigens andcultivating in the culture medium. Also, malign lung tumorscan encounter with the same clinical findings, so lungcancer should be remembered in differential diagnosis.The patient hospitalized for the Legionella pneumophiladue to the physical examination and laboratory findingsduring the first evaluation in the emergency department.However, further examinations pointed to the cancer. Weaimed to emphasize the probability of malignant tumorsin terms of hyponatremia, increase in the liver enzymes,and failure in the renal functions, which were usually experiencedin emergency unit. J Clin Exp Invest 2013; 4(3): 390-392Key words: Legionella pneumophila, pneumonia, lung malignanc

Assessment of mean platelet volume in chronic obstructive pulmonary disease during stable period and acute exacerbation

Objective: Chronic obstructive pulmonary disease (COPD) is an important public health problem and it is associated with systemic inflammation. Mean platelet volume (MPV) is one of the markers indicating platelet activation, and it was found to be high in many diseases related to inflammation. In previous studies reported different results evaluating of MPV in COPD. In this study, we aimed to evaluate of C-reactive protein (CRP), white blood cell (WBC), and MPV in acute exacerbation of COPD and stable COPD patients. Methods: In this retrospective study, data of 40 patients with acute exacerbation of COPD, 43 stable COPD patients and 40 healthy subjects were evaluated. Results: The mean MPV, CRP and WBC were found in control, stable COPD and acute exacerbation of COPD groups, 7.9±1.1; 8.2±1.3 and 8.7±1.6 fL; 3.4±1.2; 5.2±3.5 and 27.5±23.6 mg/L; 7.8±1.6; 8.1±2.1 and 11.4±4.5 x103/ ϻL, respectively. The mean WBC and CRP in the acute exacerbation of COPD group were significantly higher than the other groups (for both values p ˂0.001). The mean MPV in the acute exacerbation of COPD group was found higher than in the other groups. The mean MPV values were significantly higher in patients of acute exacerbation than control subjects (p=0.030). Conclusion: The results of this study suggest that the increased MPV may be a marker for the evaluation acute exacerbation of COPD as well as the classic acute phase reactant CRP. J Clin Exp Invest 2013; 4 (4): 483-48

İnaktif Hepatit B’li bir hastada pnömonik varisella : Olgu sunumu

Nadir rastlanılmasına rağmen varicella zoster virus (VZV) ilişkili pnömoni, virüsün sıklıkla yetişkinleri etkileyen en ciddi komplikasyonudur ve yüksek mortaliteyle seyreder. Bu çalışmada Hepatit B virüs taşıyıcısı 29 yaşında bir erkek hastada VZV pnömonisi tanımlanmaktadır. Hasta beş gündür devam eden halsizlik, boğaz ağrısı, ateş, öksürük ve hafif dispne şikayetleri ile başvurdu. Ayrıca ekzantematöz veziküler döküntüleri vardı. Döküntüler saçlı deriyi de kapsayacak şekilde tüm vücuda yayılmıştı. Fakat hastanın ateşi yoktu ve vital bulgular normaldi. Deri muayenesi ile tüm vücutta papüloveziküllü yaygın polimorfik döküntü ve kabuklu lezyonlar görüldü. Serolojik bulgular, VZV IgM pozitif, VZV IgG pozitif ve HBsAg pozitif idi. Göğüs radyografisinde bilateral pnömonik infiltrasyonlar görüldü. Hastaya valasiklovir ve klaritromisin verildi. Deri lezyonları on gün sonra kayboldu ve hasta tam olarak iyileşti. Sonuç olarak yetişkin hastalarda nadiren oluşan VZV pnömonisinin erken tanısı ve antivirallerle etkin tedavisi ciddi komplikasyonların gelişmesini önleyebilir.Although rarely observed, varicella zoster virus (VZV)-related pneumonia is the most serious complication of the virus, which commonly affects adults and causes high mortality rates. In this study, we describe a case of VZV pneumonia in a 29-year-old male who is an inactive Hepatitis B virus carrier. The patient presented with a 5-day history of fatigue, sore throat, fever, cough and mild dyspnea. He also had an exanthematous vesicular rash. The rash had spread all over his body surface including the hairy skin. But he was not febrile and vital signs were normal. The skin examination exhibited a diffuse polymorphic rash with papules/vesicles, pustules and crusty lesions over the whole body. Serological findings were as follows: VZV IgM positive, VZV IgG positive and HBsAg positive. His chest X-ray showed bilateral pneumonic infiltrations. The patient was prescribed valacyclovir and clarithromycin. The skin lesions disappeared after ten days and the patient made a full recovery. We conclude that an early diagnosis of VZV pneumonia, which rarely occurs in adult patients and its effective treatment with antivirals may prevent the development of serious complications

Spontaneous Pneumothorax as a Rare Presentation of Invasive Pulmonary Aspergillosis: A Case Report

Invasive pulmonary aspergillosis is mainly seen in patients with immunosuppression. The disease has high morbidity and mortality. Invasive pulmonary aspergillosis is the most severe form of pulmonary diseases associated with Aspergillus. A patient was admitted with clinical symptoms of spontaneous pneumothorax, who had been receiving corticosteroid therapy 1mg/kg/day for 1.5 months due to interstitial lung disease. Aspergillus niger was isolated from the fluid taken from the chest tube. The patient who had been receiving voriconazole therapydied on the sixth day of treatment. This case was shared to emphasize that invasive pulmonary aspergillosis should recur to mind when cases receiving corticosteroid therapy due to chronic lung disease develop clinical symptoms of pneumothorax

The evaluation of health-care associated infections in intensive care unit of Mustafa Kemal University Medical School in 2011

Bu çalışmada, hastanemiz yoğun bakım ünitesinde 2011 yılında gelişen sağlık hizmeti ile ilişkili infeksiyonların değerlendirilmesi amaçlanmıştır. Yoğun bakım ünitesinde hastaya dayalı, aktif, prospektif sürveyans yapılmıştır. Hastane infeksiyonu tanısında Hastalık Kontrol ve Önleme Merkezi (CDC) tanı kriterleri kullanılmıştır. İzole edilen infeksiyon etkenleri konvansiyonel yöntemler ve VİTEK2 Compact (bioMérieux, Fransa) otomatize sistemle tanımlanmıştır. Antibiyotik duyarlılık testleri Klinik ve Laboratuvar Standartları Enstitüsü (CLSI) kriterlerine göre disk difüzyon yöntemi ile yapılmıştır. Çalışma boyunca yoğun bakım ünitesinde 415 hasta 3654 hasta günü izlenmiştir. Bu sürede 70 hastane infeksiyonu tanımlanmış, hastane infeksiyonu hızı % 16.9; hastane infeksiyonu insidans dansitesi binde 19.2 olarak hesaplanmıştır. Hastane infeksiyonu tanısı alan hastalardan 71 mikroorganizma izole edilmiş, bunların 36’sını Gram negatif bakteriler, 17’sini Gram pozitif bakteriler ve 18’ini kandida türleri oluşturmuştur. Tüm sağlık hizmeti ile ilişkili infeksiyonların yaklaşık yarısı kateter ilişkili üriner sistem infeksiyonu (% 47.1), % 35.7’si kan dolaşımı infeksiyonu ve % 17.1’i ventilatör ilişkili pnömoni olarak tespit edilmiştir. Sürveyans çalışmaları sonucu her merkezin mikroorganizma dağılımı ve direnç durumlarını belirleyerek bu doğrultuda akılcı antibiyotik kullanımına önem vermesi, dirençli mikroorganizmalarla mücadelede başarı sağlayacaktır.The aim of the present study was to evaluation the health-care associated infections developing in intensive care unit of our hospital in 2011. Based on the patient, active, prospective surveillance is made in intensive care unit. Centers for Disease Control and Prevention (CDC) diagnostic criteria were used for nosocomial infection diagnosis. Infectious agents isolated were identified by conventional methods and VITEK2 Compact System (bioMérieux, France). According to the standards of Clinical and Laboratory Standards Institute (CLSI); antibiotics susceptibility tests were performed by using disc diffusion method. During the study, 415 patients were observed on 3654 patients’ days in intensive care unit. This period, 70 nosocomial infections were described. Nosocomial infection rate of 16.9 %, nosocomial infection incidence density was calculated as 19.2 per thousand. Totally 71 microorganisms were isolated; 36 of them were determined as Gram negative bacteria while 17 were Gram positive bacteria and 18 were Candida spp. Urinary tract catheter-associated infection (47.1 %) was approximately half of the health-care associated infections, followed by bloodstream infections (35.7 %), and ventilator associated pneumonia (17.1 %). As a result of surveillance studies each center determining the distribution of microorganisms and resistance status give importance to the rational use of antibiotics in this direction will ensure success in the fight against with resistant microorganisms

The case of malignancy mimicking legionella pneumonia

Legionella pneumophila su şebekelerinde, klima sistemlerinde çoğalabilen bakteridir. Bulaşma kontamine suların aspirasyonu veya aerosol inhalasyonu ile olmaktadır. Klinikte ateş, bradikardi, şuur bozukluğu, hiponatremi, karaciğer enzim artışı ve böbrek fonksiyon bozukluğu görülebilmektedir. Kesin tanı antijenlerin saptanması ve kültürde üretimle konmaktadır. Akciğer maligniteleri de aynı klinikle karşımıza çıkabilmekte bu nedenle ayırıcı tanı da düşünülmesi gerekmektedir. Acil servisteki ilk değerlendirmede klinik ve laboratuar sonuçları Legionella pneumophila ile uyumlu olan olgu pnömoni ön tanısıyla yatırıldı. Ancak yapılan ileri tetkik ve sonuçlarla olguda malignite tespit edildi. Bu yazıda acilde sık karşılaşılan hiponatremi, karaciğer enzim artışı ve böbrek fonksiyon bozukluğu gibi durumlarda legionella ve malignitelerin akılda tutulması vurgulanmak istendiLegionella pneumophila is a bacterium, which can grow in water pipe networks and climate systems. Contamination occurs by aspiration of infected water or aerosol inhalation. It is usually presented with fever, bradycardia, and change in mental status, hyponatremia, elevation of liver enzymes and deterioration of renal function. The definite diagnosis is established by detection of the antigens and cultivating in the culture medium. Also, malign lung tumors can encounter with the same clinical findings, so lung cancer should be remembered in differential diagnosis. The patient hospitalized for the Legionella pneumophila due to the physical examination and laboratory findings during the first evaluation in the emergency department. However, further examinations pointed to the cancer. We aimed to emphasize the probability of malignant tumors in terms of hyponatremia, increase in the liver enzymes, and failure in the renal functions, which were usually experienced in emergency unit. J Clin Exp Invest 2013; 4 (3): 390-39