The Outcome of Antifungal Prophylaxis with Posaconazole in Patients with Acute Myeloid Leukemia: A Single-Center Study

Objective: Invasive fungal infections (IFIs) are a significant cause of morbidity and mortality among neutropenic patients undergoing chemotherapy for acute myeloid leukemia (AML) and stem cell transplantation. The aim of this study was to evaluate the real-life impact of posaconazole prophylaxis. Materials and Methods: Eighty-four adult patients were included with AML under remission induction chemotherapy and posaconazole prophylaxis. The 34 patients in the control group did not receive primary antifungal prophylaxis. The period between June 2006 and January 2009, when antifungal prophylaxis was not administered (control group), was retrospectively compared to the period between December 2010 and May 2012 when primary oral posaconazole prophylaxis was administered in similar conditions (posaconazole group) according to the use of antifungal agents for treatment, breakthrough infections, galactomannan performance, and the necessity for performing bronchoalveolar lavage (BAL) procedures. Results: The two groups were compared according to the use of antifungal agents; progression to a different antifungal agent was found in 34/34 patients (100%) in the control group and in 9/84 patients (11%) in the posaconazole group (p<0.001). There were four breakthrough IFIs (4/84, 4.8%) in the posaconazole group and 34 IFIs in the control group (p<0.001). In addition, 15/34 patients (44%) in the control group required BAL compared to 11/84 patients (13%) in the posaconazole group (p<0.001). Posaconazole treatment was discontinued within 7-14 days in 7/84 patients (8.3%) due to poor oral compliance related to mucositis after chemotherapy. Conclusion: Posaconazole appears to be effective and well-tolerated protection against IFIs for AML patients

Efficacy of noninvasive mechanical ventilation in the treatment of acute exacerbations of COPD

Kronik Obstrüktif Akciğer Hastalığında (KOAH), mortalite ve morbiditenin en önemli nedeni akut alevlenmelerdir. KOAH akut atakta hava yolu rezistansının ve dinamik hiperinflasyonun artışı ile solunum kaslarının iş yükü artar. Zayıflamış solunum kaslarının artmış iş yükünü karşılayamaması ile karbondioksit retansiyonu ve solunumsal asidoz ortaya çıkar. KOAH akut alevlenmelerinde uygulanan medikal tedavilere rağmen, olguların %25'inde entübasyon ve mekanik ventilasyon ihtiyacı ortaya çıkar. En uygun yoğun bakım şartlarında dahi invazif mekanik ventilasyonun mortalitesi %50 civarındadır. Son 10-15 yıldır noninvazif mekanik ventilasyon uygulamasının, standart medikal tedaviye göre birçok yönden daha etkili olduğu bildirilmektedir. Bu çalışmada; KOAH'a bağlı akut hiperkapnik solunum yetmezliği ile başvuran 40 olgudan, 20 olguya standart medikal tedavi, kalan 20 olguya ise standart medikal tedaviye ek olarak BİPAP (BİPAP, Respironics İnc. Murrayville PA. ABD) ile noninvazif mekanik ventilasyon uygulandı. Tüm hastalarda ekspiratuar pozitif basınç (EPAP) 4 cmH₂O ve inspiratuar pozitif basınç (IPAP) 10 cmH₂O ayarlanıp, 1 cmH₂O düzeyinde artışlar ile , tolare edilebilen en yüksek değere ulaşıldı. Mortalite oranları; noninvazif mekanik ventilasyon grubunda 2/20 (%10), standart medikal tedavi grubunda 4 / 20 (%20) idi. Hastanede kalma süreleri noninvazif mekanik ventilasyon grubunda 14 ± 5 gün, standart medikal tedavi grubunda 18.4 ± 8.2 gündü (p > 0.05). Noninvazif mekanik ventilasyon grubunda, başlangıç ile tedavi sonundaki kan pH değerleri (sırasıyla 7.272 ± 0.08 7.431 ± 0.05, p > 0.001), ve PaCO₂ değerlerinde (sırasıyla 90.2 ± 15.9, 55.9 ± 10.3, p 0.05)olup istatistiksel olarak anlamlıyken, PaCO₂ değerleri (sırasıyla 68.1 ± 22.3, 63.7 ± 14.6, p > 0.05) olup istatistiksel olarak anlamlı düzelme yoktu. Noninvazif mekanik ventilasyon grubu ile medikai tedavi grubu birbiri ile karşılaştırıldığında, pH ve PaCO₂ düzeylerinde, noninvazif mekanik ventilasyon grubunda istatistiksel olarak anlamlı daha belirgin düzelme mevcuttu (p 50 mmHg). 20 patients used standard medical therapy (Oxygen 2 Umin by nasal canula, intravenous aminophyllin, subcutaneous heparin, antibiotics, aerosolized salbutamol, ipratropium bromid and budesonid or flutikazon), 20 patients used noninvasive positive pressure ventilation with bilevel ventilators in addition to standard medical therapy. The expiratory positive airway pressure (EPAP) and inspiratory positive airway pressure (IPAP) were adjusted 4 cmH₂O and 10 4cmH₂O respectively in all patients. Noninvasive positive pressure ventilation (NPPV) was applied intermittently for 10-12 hours/day through nasal mask (15 patients) or facial mask (5 patients). Comparisons of blood gases with noninvasive positive pressure ventilation group and standard medical therapy group; the pH values (7.272 ± 0.08 and 7.431 ± 0.05, p0.05) demonstrated no significant improvement in statistical terms. In a comparison made between NIMV group and standard medical therapy group; statistically the more evident and considerable improvement in pH and pCO₂ levels of NIMV group was observed with respect to standart medical therapy group ( p0.05). Duration of hospitalization was 14.0 ± 5.0 days in the NIMV group and 18.0 ± 8.2 days in SMT group (p >0.05). While 85% of the cases (17/20) in NIMV group have been successfuly treated, for the 6 cases in standard medical therapy group whose general medical states and blood gases got worse, invasive or non-invasive mechanical ventilation were applied. The rate of accomplishment in medical therapy group has been determined as 70% (14/20). In conclusion; In patients with acute respiratory failure due to COPD who received NPPV there was a significant rise in pH, a reduction in PaCO₂, duration of hospitalization and in hospital mortality rate. Noninvasive mechanical ventilation has been found to be a more effective treatment option than standard medical options in COPD dependent acute hypercapnic respiratory insufficiency cases

Postgraduate Students’ Research Self-Efficacy Beliefs and Computer Attitudes

This study aims to investigate the research self-efficacy beliefs and computer attitudes of post-graduate students. The correlations between the research selfefficacy beliefs and computer attitudes is also measured and it is tried to found out whether self-efficacy beliefs and computer attitudes differentiate according to gender and post-graduate levels of the students or not. The Research Self-Efficacy Scale (Bieschke and others, 1993) and the General Attitude toward Computer Scale (Rosen and Weil, 1992) were applied to 72 voluntary post-graduate students at the Karadeniz Technical University. The result showed a significant correlation between the research self-efficacy and computer attitudes of the post graduate students. The finding also revealed that the self-efficacy beliefs and computer attitudes differentiate significantly according to post-graduate levels and gender of the postgraduate student

Effects of the COVID-19 pandemic on the follow-up and treatment of patients with idiopathic pulmonary fibrosis: a cross-sectional, multicentre phone call survey

Objective To learn about the attitudes and behaviours of patients with idiopathic pulmonary fibrosis (IPF) in relation to the difficulties experienced during the COVID-19 pandemic. Design A cross-sectional, multicentre phone call survey. Setting Four university hospitals in Turkey. Participants The study included patients with IPF receiving antifibrotics for at least 3 months and with doctor appointment and/or scheduled routine blood analysis between March and May 2020 (the first 3 months after the official announcement of the COVID-19 pandemic in Turkey). Interventions Phone calls (a 5 min interview) were performed in June 2020. A questionnaire and the Hospital Anxiety-Depression Scale were applied. Main outcome measures Patients' preferences for disease monitoring, patients' attitudes and behaviours towards IPF, drug continuation, COVID-19 diagnosis and anxiety/depression status. Results The study included 115 patients with IPF (82 male; mean age, 68.43 +/- 7.44 years). Of the patients, 73.9% had doctor appointment and 52.2% had scheduled routine blood testing; 54.5% of patients with doctor appointment self-cancelled their appointments and 53.3% of patients with scheduled routine blood testing did not undergo testing. Of the patients, 32.2% were on nintedanib and 67.8% were on pirfenidone; self-initiated drug discontinuation rate was 22.6%. The percentage of patients communicating with their physicians was 35.7%. The route of communication was by phone (34.8%). The frequency of depression and anxiety was 27.0% and 38.3%, respectively. The rates of drug discontinuation (35.1% vs 16.7%, p50%) of patients self-cancelled their appointments and nearly a quarter of patients discontinued their medications. Providing a documentation of the problems experienced by patients with IPF about management of the necessary requirements during the COVID-19 pandemic, this study may be a model for patients with chronic diseases

Akci��er Kanserli Hastalarda Plazma D-Dimer D�Zeylerinin Prognostik De��eri

Aim: Activation of coagulation and fibrinolysis pathways is frequently associated with malignancy. The objective of our study was to detect D-dimer levels in lung cancer patients and to determine whether there is any relationship between the stage of cancer and survival. Method: From January 2005 to April 2007, sixty-five patients with histologically or cytologically confirmed lung cancer, treated at our institution were enrolled in the study. In each case, appropriate treatment modalities were recruited based on the clinical evaluation. Patients were followed up via phone calls to the patients themselves or their family members. Survival period was recorded as starting from the time of diagnosis to the date of death or termination of the study. Commercially available reagents were used to measure the levels of D-dimer. Result: There was no significant difference between histological types and tumor stages in terms of D-dimer levels. The plasma D-dimer levels in the alive patients were significantly lower than patients that died (p <0.05). High plasma D-dimer concentrations turned out to be a strong predictor of poor outcome (median survival period in patients with normal D-dimer levels was 426 days [95% CI, 275-576 days] vs. 179 days [95% CI, 68-289 days] in patients with increased D-dimer levels; log rank statistics, 7.05; p <0.05). Cox regression analyses showed that D-dimer (p <0.05) was a prognostic factor, independent of age and stage. Conclusion: We found that D-dimer was a prognostic factor, independent of age and disease stagesAmaç: Malignitelerde koagülasyon ve fibrinolitik yolağın aktivasyonu sık görülür. Çalışmamızın amacı akciğer kanserli hastalarda D-dimer düzeylerini belirlemek ve kanser evresi, sürvi ve D-dimer düzeyleri arasındaki araştırmaktı. Metod: Ocak 2005-Nisan 2007 tarihleri arasında merkezimizde tedavi edilen histolojik veya sitolojik olarak akciğer kanseri tanısı doğrulanmış 65 olgu çalışmaya alındı. Tüm olgular klinik değerlendirmelerine göre uygun yöntem ile tedavi edildi. Hastaların izlemi telefonla kendileri veya aile üyeleri ile görüşülerek yapıldı. Sürvi periyodu tanının konulduğu tarihten öldüğü veya çalışmanın tamamlandığı tarihe kadar geçen süre olarak tanımlandı. Bulgular:Histolojik türler veya tümör evreleri arasında d-dimer düzeyleri açısından anlamlı farklılık saptanmadı. Plazma D-dimer düzeyleri yaşayan olgularda ölenlere göre anlamlı düzeyde düşük saptandı (p<0.05). Normal D-dimer düzeyi olanlar ortalama 426 gün (%95 GA 275-576 gün), yüksek D-dimer düzeyi olanlar ortalama 179 gün (%95 GA 68-289 gün) yaşadı ve plazma D-dimer düzeyi kötü prognozun güçlü bir belirteci olarak saptandı. Cox regresyon analizinde plazma D-dimer düzeyi yaş ve evreden bağımsız bulundu. Sonuç: Akciğer kanserli hastalarda d-dimer düzeyi yaş ve evreden bağımsız prognostik faktördür

Evaluation of efficacy and safety of pirfenidone 200 mg tablets in patients with idiopathic pulmonary fibrosis in a real-life setting

Background/aim: Phase III trials have demonstrated a significant efficacy and an acceptable safety for pirfenidone in patients having mild to moderate idiopathic pulmonary fibrosis (IPF). Real-life data on the use of pirfenidone 200 mg tablets are limited. This study aimed to investigate the efficacy and safety of pirfenidone 200 mg tablets for the treatment of IPF in a real-life setting. Materials and methods: A retrospective, multicenter study conducted in four university hospitals in Turkey between January 2017 and January 2019. Clinical records of patients diagnosed with mild to moderate IPF and receiving pirfenidone (200 mg tablets, total 2400 mg/day) were reviewed retrospectively and consecutively. Pulmonary function measurements including forced vital capacity (FVC%) and diffusing capacity of the lungs for carbon monoxide (DLCO%) were analyzed at baseline and after 6-month of pirfenidone treatment. Descriptive statistics were expressed as mean, standard error or median (minimum-maximum), number and percentage, where appropriate. Results: The study included 82 patients, of whom 87.8% were males (mean age, 66 years). After 6-month of treatment, 7 patients discontinued the treatment. Of the remaining 75 patients, 71 (94.6%) remained stable, 4 (5.4%) had progressive disease as evident by a decline in the FVC% of at least 10% while on treatment, and 45 (61.3%) had improved cough. At least one adverse event (AE) associated with the treatment was observed in 28 (37.3%) patients. Conclusion: Pirfenidone 200 mg was effective and well tolerated and associated with relatively mild and manageable AEs in IPF patients

Serum Carcinoembryonic Antigen Level As A Predictive Marker For Distant Metastasis In Non-Small Cell Lung Cancer

Aim: Elevated serum CEA (S-CEA) levels are sometimes attributable to the production of CEA by malignant cells, and in turn, the antigen itself can enhance the metastatic potential of malignant cells. We investigated the predictive role of S-CEA level for distant metastasis in nonsmall cell lung cancer (NSCLC). Methods: Consecutive 116 NSCLC patients referred to our department were retrospectively investigated. S-CEA levels was compared according to age, gender, smoking habits, histological type, distant metastases and clinical disease stage in all patients. Results: There were no significant relationship between S-CEA level and age, gender and smoking habits. There was significant difference in S-CEA level between M0 and M1 patients (p<0.001). S-CEA levels were not significantly different between symptomatic and silent metastases NSCLC patients (p=0.103). We could not find significant differences in S-CEA levels between T1-2 and T3-4 (p=0.141), N0-1 and N2-3 (p=0.672). In NSCLC, the area under the ROC curve was 0.728 (p<0.001), S-CEA threshold of 6.4 ng/mL has predictive sensitivity and specificity, for distant metastases as 69.8% and 73.0% respectively. In multivariate analysis including age, gender, smoking status, histologic type and S-CEA level that only S-CEA levels qualified as an independent predictive factor for distant metastases (p=0.001). Conclusion: We conclude that S-CEA levels were significant for predicting distant metastases. High levels of S-CEA may be an indication to perform routine investigation of distant metastases even in the absence of symptoms and signs

A Fatal Complication of Dermatomyositis: Spontaneous Pneumomediastinum

Interstitial lung disease (ILD) is a negative prognostic factor associated with increased morbidity and mortality in patients with dermatomyositis (DM). Spontaneous pneumomediastinum is a rare complication of DM and it can be fatal. We present a 48-year-old woman with DM and ILD complicated by pneumomediastinum without pneumothorax and subcutaneous emphysema