Ayşegül Baysak

Preoperative Mild Cognitive Dysfunction Predicts Pulmonary Complications After Coronary Artery Bypass Graft Surgery

OBJECTIVESnIn elderly patients with mild cognitive impairment, noncompliance with respiratory exercises, ineffective expectoration, reluctance in mobilization, and difficulty in learning the use of drugs such as inhalers were observed in the early postoperative period after coronary artery bypass graft surgery. It was hypothesized that respiratory complications may be more frequent in these patients, and so the postoperative respiratory complications in patients with preoperative mild cognitive impairment were compared with the postoperative respiratory complications of a control group.nnnDESIGNnA prospective cohort control.nnnSETTINGnA university hospital.nnnPARTICIPANTSnPatients undergoing elective coronary artery bypass graft surgery.nnnINTERVENTIONSnInvestigators separated 48 patients>70 years old who were scheduled for elective coronary artery bypass graft surgery into two groups: patients with preoperative mild cognitive impairment (group A, n = 25) and patients with no cognitive impairment (control group; group B, n = 23). The patients cognitive status was evaluated preoperatively by the Montreal Cognitive Assessment test.nnnMEASUREMENTS AND MAIN RESULTSnPulmonary functions and respiratory complications were evaluated via chest x-rays and spirometry tests preoperatively and postoperatively. A significant difference was observed between the groups, particularly with regard to atelectasis and prolonged ventilation (p<0.001 and p<0.05). No significant impairment was observed in the spirometry tests of the control group. However, a significant deterioration was observed in the postoperative spirometry tests of patients with preoperative mild cognitive impairment.nnnCONCLUSIONSnThis study suggested that mild cognitive impairment was associated with pulmonary complications after coronary artery bypass graft surgery.

A rare tumor of the lung: Pulmonary sclerosing hemangioma (pneumocytoma)

A 67-year-old woman was referred to our department for further evaluation of her abnormal, chest radiogram. Thorax computed tomography revealed a well-circumscribed, round mass in the middle lobe of the right lung. A thoracotomy was performed and pulmonary sclerosing hemangioma was diagnosed. We herein present a rare tumor of the lung.

N-acetylcysteine in patients with COPD exacerbations associated with increased sputum

SummaryBackgroundN-acetylcysteine (NAC) has been shown not to alter the clinical outcome in chronic obstructive pulmonary disease (COPD) exacerbations. However, NAC may improve symptoms through its mucolytic effect in the subgroup of patients with increased sputum production. The aims of this study were to determine whether NAC improves symptoms and pulmonary function in patients with COPD exacerbation and increased sputum production.MethodsThis was a placebo-controlled study, where patients with severe COPD and increased sputum production, who were hospitalized for an exacerbation, were included. They were randomized to receive either NAC 200xa0mg tid or placebo in addition to the usual treatment.ResultsForty-two patients were included and were equally distributed to NAC and placebo groups. The symptoms, namely, ease of sputum production and dyspnea at rest and on exertion significantly improved in both groups; but there was no difference in improvement between NAC and placebo groups (pu2009=u20090.96, 0.62, 0.31, respectively). Similarly, forced expiratory volume-one second (FEV1) and PaO2 levels improved significantly in NAC (964u2009±u2009599–1239u2009±u2009543xa0ml, pu2009<u20090.001, and 57.5u2009±u200914.5–70.5u2009±u200916.0xa0mmHg, pu2009<u20090.001, respectively) and placebo groups (981u2009±u2009514–1180u2009±u2009535xa0ml, pu2009<u20090.001 and 57.9u2009±u200914.3–68.7u2009±u200919.0xa0mmHg, pu2009<u20090.001, respectively), without any difference between the two groups (pu2009=u20090.52 and 0.57). There was no difference in the number of exacerbations during the 6-month follow-up period.ConclusionNAC does not have any beneficial effect on clinical outcomes in patients with severe COPD exacerbation associated with increased and/or viscous mucus production.ZusammenfassungGrundlagenEs ist gezeigt worden, dass N-acetylcystein (NAC) das klinische Outcome einer COPD Exazerbation nicht verändert. NAC könnte aber die Symptome einer COPD durch seine schleimlösende Wirkung in einer Untergruppe von Patienten mit vermehrter Sputumproduktion bessern. Ziel dieser Studie war es zu prüfen, ob NAC die Symptome und die Lungenfunktion bei Patienten mit einer Exazerbation einer COPD mit vermehrter Sputumproduktion bessern kann.MethodikIn diese Placebo-kontrollierte Studie wurden Patienten mit schwerer COPD und vermehrter Sputumproduktion, die wegen einer Exazerbation hospitalisiert worden waren, aufgenommen. Randomisiert erhielten sie zusätzlich zu ihrer Behandlung entweder 200xa0mg NAC 3x täglich oder Placebo.ErgebnisseZweiundvierzig Patienten wurden in die Studie aufgenommen. Sie erhielten – gleich verteilt – NAC oder Placebo. Die Symptome, nämlich die Leichtigkeit der Sputumproduktion und die Atemnot in Ruhe und bei Belastung besserten sich in beiden Gruppen signifikant. Allerdings gab es zwischen den beiden Gruppen (NAC oder Placebo) keinen Unterschied in der Besserung (pu2009=u20090,96, 0,62, 0,31). Ebenso besserten sich die FEV1 und die PAO2 Werte in der NAC (964u2009±u2009599 zu 1239u2009±u2009543xa0ml, pu2009<u20090,001, und 57,5u2009±u200914,5 zu 70,5u2009±u200916,0xa0mmHg, pu2009<u20090,001) und in der Placebo Gruppe (981u2009±u2009514 zu 1180u2009±u2009535xa0ml, pu2009<u20090,001 und 57.9u2009±u200914.3 zu 68.7u2009±u200919.0xa0mmHg, pu2009<u20090,001) ohne jeglichen Unterschied innerhalb der beiden Gruppen (pu2009=u20090,52 und 0,57). Es gab auch keinen Unterschied in der Anzahl der Exazerbationen während der 6-monatigen Kontrollperiode.SchlussfolgerungNAC hat keine günstige Wirkung auf das klinische Outcome bei Patienten mit Exazerbation einer schweren COPD mit gesteigerter und/oder visköser Schleimproduktion.

Antimicrobial Susceptibility and Clonal Relation Between Acinetobacter baumannii Strains at a Tertiary Care Center in Turkey.

Background: Acinetobacter baumannii is an opportunistic pathogen, related with nosocomial infections such as bacteremia, urinary tract infections, and ventilator-associated pneumonia. Multidrug resistant (MDR) A. baumannii strains are first line causes of infection, especially in patients hospitalized at intensive care units (ICUs). Infection with MDR A. baumannii strains has a longer duration at ICUs and hospitals. There are studies using molecular methods which can differentiate MDR A. baumannii strains at the clonal level. This helps controlling these resistant strains and prevents their epidemy. Objectives: The aim of our study was to investigate the antimicrobial susceptibility and clonal relationship between the A. baumannii strains isolated from our ICU. Materials and Methods: The identification and antimicrobial susceptibility of 33 A. baumannii strains were performed by automatized Vitek version 2.0. The clonal relationship among A. baumannii strains was analyzed using enterobacterial repetitive intergenic consensus (ERIC) polymerase chain reaction (PCR). Results: A total of 33 A. baumannii strains were included in this study. A. baumannii complex strains were classified into seven clusters based on the fingerprint results. Our results revealed that two main clusters were responsible for the prevalence of A. baumannii complex strains at the ICU. Conclusions: MDR A. baumannii strains cause an increment in morbidity and mortality, particularly in ICUs. The use of molecular epidemiological methods can help us with the detection of the pathogen and preventing from spreading of these resistant strains.

Vancomycın resıstant enterococcus bacteremıa ın a patıent wıth Pneumocystis jiroveci pneumonıa , granulocystıc sarcoma and acute respıratory dıstress syndrome

In this case report we aimed to present a patient with granulocytic sarcomaa, neutropenic fever, ARDS and Pneumocystis jirovecii pneumoniae that was hospitalized in our intensive care unit. The patient recovered and then developed vancomycin resistant enterococci (VRE) bacteremia due to port catheter during follow up. The patient had risk factors for VRE bacteremia and he was administered linezolide without removing the catheter. He was discharged with recovery.

Clinical characteristics of patients with bronchioloalveolar carcinoma: a retrospective study of 44 cases.

BACKGROUNDnBronchioloalveolar carcinoma (BAC) is considered a subtype of adenocarcinoma of the lung. Recently BAC has been variously termed adenocarcinoma in situ, minimally invasive adenocarcinoma, lepidic predominant invasive adenocarcinoma, and invasive mucinous adenocarcinoma. The aim of the study was to analyze and detect prognostic factors of patients with BAC over a 7-year period.nnnMATERIALS AND METHODSnThis retrospective single-center study included 44 patients with BAC. The impact on survival of fifteen variables (gender, age, smoking status, cough, dyspnea, hemoptysis, fever, chest pain, sputum, metastasis number, Karnofsky performance status, pT, pN, TNM stage, cytotoxic chemoterapy) were assessed.nnnRESULTSnMedian age was 55 years (38-83). Most patients were male (63.6%) and stage IV (59.1%). Twenty-one patients (47.7%) received cytotoxic chemotherapy (platinum-based regimens) for metastatic disease. Objective response rate was 33.3% (4 partial, 3 complete responses). Stable disease was observed in nine in patients (42.8%). Disease progression was noted in 5 (23.8%). The median OS for all patients was 12 months (95%CI, 2.08-22.9 months). Independent predictors for overall survival were: Karnofsky performance status (HR:3.30, p 0.009), pN (HR:3.81, p 0.018), TNM stage (HR:6.49, p 0.012) and hemoptysis (HR:2.31, p 0.046).nnnCONCLUSIONSnKarnofsky performance status, pN, TNM stage and hemoptysis appear to have significant impact on predicting patient survival in cases of BAC.

Role of Toll-Like Receptors in Tuberculosis Infection

Background One-third of the world’s population is infected with Mycobacterium tuberculosis. Investigation of Toll-like receptors (TLRs) has revealed new information regarding the immunopathogenesis of this disease. Toll-like receptors can recognize various ligands with a lipoprotein structure in the bacilli. Toll-like receptor 2 and TLR-4 have been identified in association with tuberculosis infection. Objectives The aim of our study was to investigate the relationship between TLR polymorphism and infection progress. Methods Twenty-nine patients with a radiologically, microbiologically, and clinically proven active tuberculosis diagnosis were included in this 25-month study. Toll-like receptor 2 and TLR-4 polymorphisms and allele distributions were compared between these 29 patients and 100 healthy control subjects. Peripheral blood samples were taken from all patients. Genotyping of TLR-2, TLR-4, and macrophage migration inhibitory factor was performed. The extraction step was completed with a Qiagen mini blood purification system kit (Qiagen, Ontario, Canada) using a peripheral blood sample. The genotyping was performed using polymerase chain reaction-restriction fragment length polymorphism. Results In total, 19 of the 29 patients with tuberculosis infection had a TLR-2 polymorphism, and 20 of the 100 healthy subjects had a TLR-2 polymorphism (P < 0.001). The TLR-4 polymorphism and interferon-γ allele distributions were not statistically correlated. Conclusions Toll-like receptor 2 polymorphism is a risk factor for tuberculosis infection. The limiting factor in this study was the lack of investigation of the interferon-γ and tumor necrosis factor-α levels, which are important in the development of infection. Detection of lower levels of these cytokines in bronchoalveolar lavage specimens, especially among patients with TLR-2 defects, will provide new data that may support the results of this study.

Diagnostic Yield of Bronchoscopy with C-Arm Scopy in Cases without Endobronchial Lesion

1 Jülide Çeldir Emre1, Ayşegül Baysak2, Adnan Tolga Öz2, Gürsel Çok3, Tuncay Göksel3 1Turgutlu State Hospital, Manisa, 2Izmir University School of Medicine, Department of Chest Diseases Izmir, 3Ege University School of Medicine Department of Chest Diseases Izmir, Turkey Diagnostic Yield of Bronchoscopy with C-Arm Scopy Diagnostic Yield of Bronchoscopy with C-Arm Scopy in Cases without Endobronchial Lesion

Adherence to Current COPD Guidelines in Turkey

ABSTRACT Introduction-objective: Despite the availability of national and international guidelines, chronic obstructive pulmonary diseases (COPD) treatment is not always prescribed according to these recommendations. We aimed to see if COPD patients in Turkey have been treated appropriately according to COPD guidelines. Methods: This is a cross-sectional study carried out in six different chest diseases clinics. The COPD outpatients were categorized by spirometry classification (SC) and the combined classification (CC) of COPD. The treatment protocols were evaluated to check whether they were suitable for both classifications. Results: Overall, 307 patients were included in the study. Of the treatment protocols, 40.4% were suitable for both classifications: 30.9% for CC and 20.8% for SC. A total of 51.8% of the patients were reported to be using an unsuitable therapy for SC and 38.4% for CC. Ninety-eight per cent of the unsuitable treatment was overtreatment. Fifty-eight per cent of the patients were using LABA + LAMA + ICS. Improper ICS usage was identified in 97.1% in CC, 93.1% in SC. The cost savings of all patients in one year would be 17,099

Two-Years Follow-up Results of a Smoking Cessation Clinic in a State Hospital

with an appropriate treatment protocol following COPD guidelines. Conclusion: The most common type of inappropriate COPD treatments is overtreatment, generally with ICS. As treatment protocols following COPD guidelines change over time, there is still a low rate of adherence by clinicians in their clinical practice to guideline recommendations. Awareness of these guidelines by pulmonary specialists should be improved.