Elif Yilmazel Ucar

Effectiveness of pharmacologic therapies on smoking cessation success: three years results of a smoking cessation clinic

BackgroundPharmacologic therapies have an important role in the success of interventions for smoking cessation. This study aims to determine the efficacy of several pharmacologic treatments in patients who applied to a smoking cessation clinic.MethodsThis retrospective study includes 422 patients who presented to our smoking cessation clinic between January 2010 and June 2013, used the pharmacologic treatment as prescribed and completed the one-year follow-up period. All patients were assessed using the Fagerström Test for Nicotine Dependence (FTND) and received both behavioral therapy and pharmacotherapy. Patients’ smoking status at one year was assessed by telephone interview.ResultsThe patients were 24.3% female (103/422) and 75.7% male (319/422) with a mean age of 38 ± 10 years. Patients were divided into three groups: varenicline (166 patients), bupropion (148 patients) and nicotine replacement therapy (108 patients).The smoking cessation rates of these groups were 32.5%, 23% and 52.8%, respectively, and were statistically significant (p > 0.001). The overall success rate was 35%. Further analysis revealed that pharmacologic therapy (p > 0.001) and gender (p = 0.01) were factors that showed statistically significant effects on smoking cessation rates. Males had higher success rates than females. The overall relapse rate was 21.6% and the bupropion group showed the highest relapse rate among treatment groups. Lack of determination emerged as the most important factor leading to relapse.ConclusionNicotine replacement therapy was found to be more effective at promoting abstinence from smoking than other pharmacologic therapies.

Silicosis Appears Inevitable Among Former Denim Sandblasters: A 4-Year Follow-up Study

BACKGROUND The course of denim sandblasting silicosis is unknown. We aimed to reevaluate former sandblasters studied in 2007 for incident silicosis, radiographic progression, pulmonary function loss, and mortality and to examine any associations between these outcomes and previously demonstrated risk factors for silicosis. METHODS We defined silicosis on chest radiograph as category 1/0 small opacity profusion using the International Labor Organization classification. We defined radiographic progression as a profusion increase of two or more subcategories, development of a new large opacity, or an increase in large opacity category. We defined pulmonary function loss as a ≥ 12% decrease in FVC. RESULTS Among the 145 former sandblasters studied in 2007, 83 were reassessed in 2011. In the 4-year follow-up period, nine (6.2%) had died at a mean age of 24 years. Of the 74 living sandblasters available for reexamination, the prevalence of silicosis increased from 55.4% to 95.9%. Radiographic progression, observed in 82%, was associated with younger age, never smoking, foreman work, and sleeping at the workplace. Pulmonary function loss, seen in 66%, was positively associated with never smoking and higher initial FVC % predicted. Death was associated with never smoking, foreman work, number of different denim-sandblasting places of work, sleeping at the workplace, and lower pulmonary function, of which only the number of different places worked remained in multivariate analyses. CONCLUSIONS This 4-year follow-up suggests that almost all former denim sandblasters may develop silicosis, despite short exposures and latency.

Roles of Ki-67, p53, transforming growth factor-β and lysyl oxidase in the metastasis of lung cancer

Most lung cancer (LC) patients have metastatic disease at time of diagnosis, which influence the treatment regimen and is the most important prognostic factor. The main purpose of our study was to evaluate the relationship between cell proliferation (Ki‐67 label index), p53, transforming growth factor‐β (TGF‐β) and lysyl oxidase (LOX), and the metastatic stages of different lung cancers. The secondary aim was to correlate these parameters with the standardized uptake value (SUVmax) of the primary lesion during positron emission tomography‐computed tomography (PET‐CT).

Combination and comparison of two models in prognosis of pulmonary embolism: Results from TUrkey Pulmonary Embolism Group (TUPEG) study☆

BACKGROUND Clinical parameters, biomarkers and imaging-based risk stratification are widely accepted in pulmonary embolism(PE). The present study has investigated the prognostic role of simplified Pulmonary Embolism Severity Index (sPESI) score and the European Society of Cardiology (ESC) model. METHODS This prospective cohort study included a total of 1078 patients from a multi-center registry, with objectively confirmed acute symptomatic PE. The primary endpoint was all-cause mortality during the first 30days, and the secondary endpoint included all-cause mortality, nonfatal symptomatic recurrent PE, or nonfatal major bleeding. RESULTS Of the 1078 study patients, 95 (8.8%) died within 30days of diagnosis. There was no significant difference between non-low-risk patients ESC [12.2% (103 of 754;)] and high-risk patients as per the sPESI [11.6% (103 of 796)] for 30-day mortality. The nonfatal secondary endpoint occurred in 2.8% of patients in the the sPESI low-risk and 1.9% in the ESC low-risk group. Thirty-day mortality occurred in 2.2% of patients the sPESI low-risk and in 2.2% the ESC low-risk group (P=NS). In the present study, in the combination of the sPESI low-risk and ESC model low-risk mortality rate was 0%. CONCLUSIONS The sPESI and the ESC model showed a similar performance regarding 30-day mortality and secondary outcomes in the present study. However, the combination of these two models appears to be particularly valuable in PE.

Two different dosages of nebulized steroid versus parenteral steroid in the management of COPD exacerbations: a randomized control trial.

Background The study aimed to compare the efficacy and safety of nebulized steroid (NS) with systemic corticosteroids (SC) and to determine optimal NS dose in the treatment of patients with COPD exacerbations requiring hospitalization. Material/Methods The study was a randomized, parallel design trial. Eligible patients (n=86) were randomly allocated to 1 of the 3 treatment groups: parenteral corticosteroid (PS) (n=33), 4 mg (NB) (n=27), or 8 mg NB (n=26). Partial pressure of arterial oxygen (PaO2), carbon dioxide (PaCO2), pH, and oxygen saturation (SaO2) were evaluated at baseline, 24 h, 48 h, and discharge. Airway obstruction (forced vital capacity [FVC] and forced expiratory volume 1 s [FEV1]) was evaluated at admission and discharge. Results There were no significant differences between the groups for all parameters at all time periods, except for higher FEV1 value in the 8-mg NB group at baseline. In groups, significant differences were determined for FVC, FEV1, PaO2, and SaO2 (p<0.001), but not for PaCO2 and pH, in comparison to their baseline values. As adverse events, hyperglycemia and oral moniliasis were observed in the PS group (n=4) and in the NB groups (n=5), respectively, and treatment change was required in 9 patients (2 patients in the PS group and 7 patients in the NB groups) (p=0.57). Conclusions Nebulized budesonide may be used as an alternative to SC because of its equal effectiveness and lesser systemic adverse effects. The choice of optimal dosage needs to be evaluated carefully because adverse effect and dropout rates varied according to dosage. However, there is a need for further studies including more severe cases and evaluating long-term outcomes or relapses comparing the 3 arms.

Liver dysfunction in patients with acute pulmonary embolism

Aim:  Although liver injury due to cardiac, chronic respiratory and circulatory failure has been reported, this has yet to be studied in patients with pulmonary embolism (PE). We investigated liver injury in patients with acute PE.

Is There a Relationship between Obstructive Sleep Apnea Syndrome Severity and Nesfatin-1?

Background: Obstructive sleep apnea syndrome (OSAS) and obesity frequently occur together. The relationship between increased appetite and obesity is well known; however, despite existing knowledge about the relationship between OSAS and obesity, it is not fully understood. Objectives: This study aimed to evaluate the relationship between OSAS and the appetite-suppressing hormone nesfatin-1 independent of body mass index (BMI). Methods: A total of 134 cases were included in the study; 102 with OSAS (OSAS group) and 32 healthy controls (control group). All cases underwent polysomnography, and nesfatin-1 levels were determined. Results: Nesfatin-1 levels were significantly lower in the OSAS group compared to the control group (3,776.5 ± 204.8 and 4,056.2 ± 101.5 pg/ml, respectively; p < 0.001). In addition, there was a statistically significant negative correlation between nesfatin-1 and the apnea hypopnea index (r = -0.543; p < 0.001). The statistically significant relationship persisted after adjusting for confounding intergroup factors such as age, gender and BMI (p < 0.001). In the OSAS group, there was a statistically significant correlation between nesfatin-1 and neck circumference (r = -0.304; p = 0.02) but not between nesfatin-1 and BMI and waist circumference. There was no statistically significant difference in nesfatin-1 levels between the sexes. Conclusion: OSAS patients have lower nesfatin-1 levels compared to controls, and a greater nesfatin-1 deficit corresponds to an increased severity of OSAS and an increased neck circumference. Replacement therapy may be a potential treatment for obese OSAS patients who have lower nesfatin-1 levels, which may have additional benefits through appetite suppression and weight loss.

Low-Molecular-Weight Heparin Use with Thrombolysis: Is it Effective and Safe? Ten Years' Clinical Experience

Background: There is no data on the use of subcutaneous low-molecular-weight heparin (SC LMWH) in cases that require thrombolysis. Objective: Having used SC LMWH with thrombolytics for more than 10 years, we aimed to review our data, share our experiences and find out whether the use of SC LMWH with thrombolytics had been effective and safe. Method: This is a retrospective cohort study. Patients who were diagnosed as acute pulmonary embolism (PE) and received either SC LMWH treatment or SC LMWH with thrombolytics in our hospital (a tertiary hospital) between 2000 and 2010 were included in the study. For both treatments, the rates of mortality and complications were calculated. Results: A total of 392 patients, 210 female (53.5%) and 182 male (46.5%) with an average age of 60 years, ±16 SD, with acute PE, were included in the study. Of these patients, 107 (27.2%) were massive and 285 (72.8%) were nonmassive and were administered SC LMWH plus thrombolytics and only SC LMWH, respectively. The mortality rate was 16.8% (18 of 107) in patients who were massive and 3.5% (10 of 285) for those who were nonmassive (p < 0.001). Major hemorrhage occurred in 3.7% (n = 4) and 0.7% (n = 2) and minor hemorrhage in 12.1% (n = 13) and in 3.8% (n = 11) of the cases who received SC LMWH plus thrombolytics and SC LMWH, respectively. Conclusion: SC LMWH use with thrombolytics seems to be feasible and safe. Prospective, large, randomized control trials are still required in order to confirm these results.

Frequency of Class I and II HLA alleles in patients with lung cancer according to chemotherapy response and 5-year survival

Lung cancer is the most common cause of cancer death in the world, and the most common type is non‐small‐cell lung cancer (NSCLC). At present, surgical resection, chemotherapy, and radiation therapy are the main treatments for patients with NSCLC, but unfortunately outcome remains unsatisfactory.

DCE-MRI findings of invasive aspergillosis in patient with acute myeloid leukemia

Thoracic radiography and high resolution computerized tomography is used to diagnose pulmonary infections in immunosuppressed patients, although in some cases these do not provide enough information about the lesion. Dynamic contrast‐enhanced magnetic resonance imaging may be useful in these cases, especially for the characterization of cavitary lesions and assessment of their contrast diffusion.