Risk Factors Resulting in Early Readmissions After Discharge of COPD Exacerbations.

TEZ10051Tez (Uzmanlık) -- Çukurova Üniversitesi, Adana, 2016.Kaynakça (s. 57-64) var.viii, 70 s. : res. (bzs. rnk.), tablo ; 29 cm.Amaç: Günümüzde KOAH tüm dünyada önemli bir morbidite ve mortalite sebebidir. Özellikle KOAH alevlenmesi nedeniyle hastaneye yatan hastalarda taburculuk sonrası yeniden hastaneye başvuru ve sık yatışların sağ kalımı kısalttığı bilinmektedir. Bu çalışmada, KOAH alevlenmesi nedeni ile hastaneden taburculuk sonrası ilk bir ay içerisinde tekrar KOAH alevlenmesi nedeniyle yatırılan hastalarda “erken dönemde yeniden yatış” ile ilişkili risk faktörlerinin araştırılması amaçlanmıştır. Gereç ve Yöntem: Bu çalışmada Eylül 2015-Ocak 2016 tarihleri arasında Çukurova Üniversitesi Tıp Fakültesi Balcalı Hastanesi Göğüs Hastalıkları servisinde KOAH alevlenme nedeni ile yatan 54 hastadan taburculuk sonrası ilk bir ay içerisinde KOAH alevlenme nedeni ile yeniden hastaneye yatırılan hastalarda, yeniden hastaneye yatışa yol açan nedenler araştırıldı. Her hastaya ilk yatışlarında aydınlatılmış onam formu imzalatıldıktan sonra ayrıntılı komorbiditelerini ve medikal öyküsünü sorgulayan bir anket formu dolduruldu. Ayrıca solunum fonksiyon testi, arteryel kan gazı ölçümü, mMRC, ADO, DOSE indekslerine bakıldı. Çalışmaya katılan hastaların hastanedeki tedavi dönemi ve taburculuk dönemine ait bilgileri kaydedildi, taburculuktan sonraki ilk bir ay içerisinde tekrar KOAH alevlenme nedeniyle yatırılan hastalar belirlendi. Bulgular: Çalışmaya katılan 54 hastadan 13’ünün (%24,1) taburculuk sonrası ilk bir ay içerisinde yeniden hastaneye yattığı tespit edilmiştir. Çalışmamızdaki hastaların yaş ortalaması 64,24±9,95 idi ve %84,6’sını erkekler oluşturmaktaydı. Erken yeniden yatış olan grupta yaş ortalaması daha ileri görünmesine rağmen bu farklılık anlamlı boyutlarda değildi (p>0,05). Charlson komorbidite indeksi ile akciğer kanseri, orta-ağır böbrek hastalığı, metastatik solid tümör varlığı, WBC seviyeleri ve düşük sosyoekonomik seviyenin erken yeniden yatış olan grupta anlamlı derecede yüksek olduğu saptandı (sırasıyla P=0,029, P=0,012, P=0,015, P=0,024, P=0,019 ve P=0,057). Ayrıca postbronkodilatör FEV1/FVC’nin de erken yeniden yatış olan grupta anlamlı derecede daha düşük olduğu bulundu. Çoklu değişkenli regresyon analizi ile; taburculuk sonrası ilk 30 günde yeniden hastaneye yatış için önemli olan risk faktörleri Vücut Kitle İndeksi ve Charlson komorbidite indeks skoru olarak bulunmuştur. Bakılan diğer parametrelerde anlamlı bir sonuca ulaşılamamıştır. Sonuç: Biz bu çalışmamızda erken yeniden yatış riskini artıran nedenleri; komorbiditeler, serum WBC sayısı ve sosyoekonomik faktörler olarak tespit ettik. Hastalık ağırlığı gibi diğer olası risk faktörlerinin tespit edilememesinin ana nedenleri olarak; hasta sayısının azlığı ve çalışmanın kısa süreli olması olarak düşünülmüştür. Bu nedenle konunun daha geniş bir hasta grubunda çalışılmasına gereksinim vardır.Aim : COPD is an important disease of the whole world causing high morbidity in mortality nowadays. It is known that readmissions and frequent hospitalizations shortens the survival of patients with COPD. In this study, we aimed to determine the possible risk factors of early readmissions of COPD exacerbated patients in the first 30 days after discharge. Material and Method: In this study, 54 COPD patients, over 40 years of age who admitted to Çukurova University Department of Chest Diseases between September 2015- January 2016 and hospitalized for exacerbation of the disease enrolled regardless of the smoking status. The COPD-related readmissions of the participants in the first thirty days after discharge recorded in order to determine the possible reasons of early readmissions. After signature of informed consent form, each participant filled the survey form concerning about detailed comorbidities and medical history. Furthermore, some other potentially related factors as pulmonary function tests reflecting the severity of airflow limitation, arterial blood gas analysis, mMRC-ADO-DOSE indexes and detailed history of hospital stay and the first thirty days after discharge recorded . The participants have been followed up for a month about redmissions. Results : 13 (24,1%) of 54 patients readmitted to hospital in the first thirty days after discharge. The mean age of the patients was 64,24±9,95 and 84,6% were male. The early readmitted group’s mean age was higher than the non-readmitted group but the difference wasn’t statistically significant. Charlson comorbidity index scores, frequency of lung cancer, moderate-severe kidney disease, WBC count, socioeconomic status and metastatic solid tumors were significantly higher in the early readmitted group than the other group (respectively P=0,029, P=0,012, P=0,015, P=0,01, P=0,057 and P=0,024). Postbronchodilator FEV1/FVC level of the readmitted group was lower than the nonreadmitted group and the difference was statistically significant. Multivariate regression analysis showed that Charlson comorbidity index scores and body mass index were significant risk factors of early readmissions for first thirty days after discharge. Conclusion: In this study; comorbidities, serum WBC counts and socioeconomic factos were found to be related with increased early readmissions. These results were consistent with many other studies. Our study showed no significant association between some other probable risk factors as COPD severity and COPD early readmissions; this may be the result of small patient population and short duration of the follow-up. Thus, further studies with larger populutions are needed in order to clarify about this topic

A Case of Community Acquired Pneumonia Related Cavitary Lesion Due to Methicillin-Resistant Staphylococcus Aureus

Toplumda gelişen pnömoni, tüm dünyada yaygın ve ciddi bir hastalıktır. En sık etkenler Streptococcus pneumoniae ve Mycoplasma pneumoniae'dir. Toplum kökenli metisilin dirençli Staphylococcus aureus (TK-MRSA), sağlık bakımı risk faktörü olmayan, sağlıklı kişilerde pnömoni etkeni olarak karşımıza çıkar. TK-MRSA'nın neden olduğu kaviter pnömoni yüksek mortalite ve morbiditeye sahiptir. Bu nedenle erken tanı ve tedavi çok önemlidir. Bu yazıda, kaviter lezyonla ilişkili MRSA'ya bağlı toplumda gelişen pnömoni olgusunun sunulması amaçlanmıştırCommunity acquired pneumonia is a common and serious illness worldwide. The most common causative agents are Streptococcus pneumoniae and Mycoplasma pneumoniae. Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) emerges as agent of pneumonia in healthy people without health care risk factor. Cavitary pneumonia which is caused by CA-MRSA, has high mortality and morbidity. Therefore, early diagnosis and treatment are crucial. In this paper, we aimed to present a case of community-acquired pneumonia related cavitary lesion due to MRS

Endobronchial Actinomycosis Mimicking Lung Cancer: A Case Report

Pulmoner aktinomikozis genellikle orofarengeal sekresyonlarda bulunan organizmanın aspirasyonu sonucu oluşmaktadır. Akciğerde kitle lezyon, pnömonik lezyon ve/veya plevral tutuluma neden olmakla birlikte endobronşial lezyon oldukça nadir görülmektedir.63 yaşında sigara içmeyen erkek hasta 6 aydır devam eden kuru öksürük, eforla gelen nefes darlığı ve hırıltılı solunum şikayetleri ile kliniğimize başvurdu. 15 yıldır tip-2 diabeti olan hastanın toraks bilgisayarlı tomografisinde; sağ orta lobda kısmi kollaps ile sağ diafragma konturunda elevasyon vardı. Bronkoskopide; sağda intermediyer bronşta endobronşial lezyon izlendi. Biyopsi sonucunda malignite bulgusu yoktu, aktinomikozis kolonilerine rastlandı. 21 günlük oral penisilin temelli antibiyotik tedavisi sonucunda hastanın şikayetlerinde gerileme saptandı. Kontrol amaçlı yapılan bronkoskopik incelemede lezyonlarda belirgin gerileme izlendi. Sonuç olarak, endobronşial lezyonların ayırıcı tanısında, özellikle immünsüpresif hastalık varlığında, mantar enfeksiyonları da akılda tutulmalıdır.Pulmonary actinomycosis is usually occured as a result of aspiration of the organism contained in the oropharingeal secretions. It could cause a pulmonary mass, pneumonia or pleural involvement and also rarely an endobronchial lesion. A 63 year old nonsmoker male patient admitted our clinic with complaints of dry cough, dyspnea and wheezing which have been continiuing for 6 months. The patient with type 2 diabetes mellitus for 15 years had a partial collapse in right middle lobe and elevation at right diafragma contour in computerized tomography of the thorax . An endobronchial lesion in the intermediate bronchi was viewed with fiberoptic bronchoscopy. Biopsy result showed no finding of malignancy, colonies of actinomycosis were seen. As a result of oral penicillin based antibiotic therapy for 21 days, radiological and clinical regression were detected. A prominent regression was seen in the lesions at control bronchoscopy.As a result, for the differantial diagnosis of endobronchial lesions, especially if immunosupressive disease is present, fungal infections should also be kept in mind

Symptomatic recurrence of SARS-CoV-2 infection in healthcare workers recovered from COVID-19

There is rising concern that patients who recover from COVID-19 may be at risk of recurrence. Increased rates of infection and recurrence in healthcare workers could cause the healthcare system collapse and a further worsening of the COVID-19 pandemic. Herein, we reported the clinically symptomatic recurrent COVID-19 cases in the two healthcare workers who treated and recovered from symptomatic and laboratory confirmed COVID-19. We discuss important questions in the COVID-19 pandemic waiting to be answered, such as the protection period of the acquired immunity, the severity of recurrence and how long after the first infection occurs. We aimed to emphasize that healthcare workers should continue to pay maximum attention to the measures without compromising

Lung cancer from suspicion to treatment: An indicator of healthcare access in Turkey

Background: Lung cancer is the leading cause of cancer-related deaths worldwide. Before beginning lung cancer treatment, it is necessary to complete procedures such as suspecting lung cancer, obtaining a pathologic diagnosis, and staging. This study aimed to investigate the processes from suspicion of lung cancer to diagnosis, staging, and treatment initiation. Metbods: The study was designed as a multicenter and cross-sectional study. Patients with lung cancer from various health institutions located in all geographic regions of Turkey were included in the study. The socio-demographic and clinical characteristics of the patients, the characteristics of the health institutions and geographic regions, and other variables of the lung cancer process were recorded. The time from suspicion of lung cancer to pathologic diagnosis, radiologic staging, and treatment initiation, as well as influencing factors, were investigated. Results: The study included 1410 patients from 29 different medical centers. The mean time from the initial suspicion of lung cancer to the pathologic diagnosis was 48.0 +/- 52.6 days, 39.0 +/- 52.7 days for radiologic staging, and 74.9 +/- 65.5 days for treatment initiation. The residential areas with the most suspected lung cancer cases were highly developed socioeconomic zones. Primary healthcare services accounted for only 0.4% of pa-tients with suspected lung cancer. The time to pathologic diagnosis was longer in the Marmara region, and the wait time for staging and treatment initiation was longer in Eastern and Southeastern Anatolia. Patients who presented to chest disease referral hospitals with peripheral lesions, those with early-stage disease, and those who were diagnosed surgically had significantly longer wait times. Conclusion: The time between pathologic diagnosis, staging, and treatment initiation in lung cancer was longer than expected. Increasing the role of primary healthcare services and distributing socioeconomic resources more equally will contribute to shortening the time to diagnosis and improve treatment processes for lung cancer

Lung cancer from suspicion to treatment: An indicator of healthcare access in Turkey

Background: Lung cancer is the leading cause of cancer-related deaths worldwide. Before beginning lung cancer treatment, it is necessary to complete procedures such as suspecting lung cancer, obtaining a pathologic diagnosis, and staging. This study aimed to investigate the processes from suspicion of lung cancer to diagnosis, staging, and treatment initiation. Methods: The study was designed as a multicenter and cross-sectional study. Patients with lung cancer from various health institutions located in all geographic regions of Turkey were included in the study. The sociodemographic and clinical characteristics of the patients, the characteristics of the health institutions and geographic regions, and other variables of the lung cancer process were recorded. The time from suspicion of lung cancer to pathologic diagnosis, radiologic staging, and treatment initiation, as well as influencing factors, were investigated. Results: The study included 1410 patients from 29 different medical centers. The mean time from the initial suspicion of lung cancer to the pathologic diagnosis was 48.0 ± 52.6 days, 39.0 ± 52.7 days for radiologic staging, and 74.9 ± 65.5 days for treatment initiation. The residential areas with the most suspected lung cancer cases were highly developed socioeconomic zones. Primary healthcare services accounted for only 0.4% of patients with suspected lung cancer. The time to pathologic diagnosis was longer in the Marmara region, and the wait time for staging and treatment initiation was longer in Eastern and Southeastern Anatolia. Patients who presented to chest disease referral hospitals with peripheral lesions, those with early-stage disease, and those who were diagnosed surgically had significantly longer wait times. Conclusion: The time between pathologic diagnosis, staging, and treatment initiation in lung cancer was longer than expected. Increasing the role of primary healthcare services and distributing socioeconomic resources more equally will contribute to shortening the time to diagnosis and improve treatment processes for lung cancer