Nazan Bayram

A comparative analysis of machine learning methods for classification type decision problems in healthcare

Advanced analytical techniques are gaining popularity in addressing complex classification type decision problems in many fields including healthcare and medicine. In this exemplary study, using digitized signal data, we developed predictive models employing three machine learning methods to diagnose an asthma patient based solely on the sounds acquired from the chest of the patient in a clinical laboratory. Although, the performances varied slightly, ensemble models (i.e., Random Forest and AdaBoost combined with Random Forest) achieved about 90% accuracy on predicting asthma patients, compared to artificial neural networks models that achieved about 80% predictive accuracy. Our results show that non-invasive, computerized lung sound analysis that rely on low-cost microphones and an embedded real-time microprocessor system would help physicians to make faster and better diagnostic decisions, especially in situations where x-ray and CT-scans are not reachable or not available. This study is a testament to the improving capabilities of analytic techniques in support of better decision making, especially in situations constraint by limited resources.

First report of pulmonary Nocardia otitidiscaviarum infection in an immunocompetent patient from Turkey

Nocardiosis is a rare disease, and worldwide, respiratory and disseminated infections are most often due to Nocardia asteroides which is recognised increasingly as an opportunistic infection in patients with underlying chronic debilitating disease or immunodeficiency. However, infection with N. otitidiscaviarum and pulmonary nocardiosis in an immune‐competent host remains very rare. We report a 65‐year‐old immune‐competent male with pulmonary N. otitidiscaviarum infection in whom complete cure was provided with a 6 months of antibiotic combination including trimethoprim‐sulfomethaxazol. This is the first report of pulmonary N. otitidiscaviarum infection in an immune‐competent patient from Turkey.

Bronchiolitis obliterans in a Case of Juvenile Rheumatoid Arthritis Presented with Pneumomediastinum

We present a case of bronchiolitis obliterans associated with juvenile rheumatoid arthritis in whom pneumomediastinum was the presenting manifestation. Diagnosis of bronchiolitis obliterans was made on the basis of the clinical history, pulmonary function tests and high-resolution computerized tomography scan findings. Pneumomediastinum resolved in a few days following high-dose nasal oxygen. This case shows that bronchiolitis obliterans can occur in patients with juvenile rheumatoid arthritis. Complicating pneumomediastinum in such cases should be considered as an indication of underlying bronchiolitis obliterans.

Radiological Findings and Outcomes of Bronchial Artery Embolization in Cryptogenic Hemoptysis

Management of cryptogenic massive hemoptysis is difficult, and conservative treatment may be inadequate to stop the hemorrhage. Surgery is not a reasonable option because there is no underlying identifiable pathology. This study aimed to investigate the radiologic findings and bronchial artery embolization outcomes in cryptogenic hemoptysis, and to compare the results with non-cryptogenic hemoptysis. We evaluated 26 patients with cryptogenic hemoptysis and 152 patients with non-cryptogenic hemoptysis. A comparison of the bronchial artery abnormalities between the cryptogenic and non-cryptogenic hemoptysis groups showed that only extravasation was more statistically significant in the cryptogenic hemoptysis group than in the non-cryptogenic hemoptysis group, while the other bronchial artery abnormalities, such as bronchial artery dilatation, hypervascularity, and bronchial-to-pulmonary shunting, showed no significant difference between groups. Involvement of the non-bronchial systemic artery was significantly greater in the non-cryptogenic hemoptysis group than in the cryptogenic hemoptysis group. While 69.2% of patients with cryptogenic hemoptysis also had hypervascularity in the contralateral bronchial arteries and/or ipsilateral bronchial artery branches other than the bleeding lobar branches, this finding was not detected in non-cryptogenic hemoptysis. Embolization was performed on all patients using polyvinyl alcohol particles of 355-500 µm. Hemoptysis ceased in all patients immediately after embolization. While recurrence of hemoptysis showed no statistically significant difference between the cryptogenic and non-cryptogenic hemoptysis groups, it was mild in cryptogenic hemoptysis in contrast to mostly severe in non-cryptogenic hemoptysis. Transarterial embolization is a safe and effective technique to manage cryptogenic hemoptysis.

Gender differences with respect to psychiatric comorbidity in obstructive sleep apnea syndrome.

Objectives: Psychiatric disorders are common in obstructive sleep apnea syndrome (OSAS); however, interrelating factors influencing psychiatric comorbidity (PC) in OSAS are unclear. The aim of this study is to investigate gender related differences with PC in OSAS. Methods: Data of patients diagnosed as OSAS in University of Gaziantep from January 2006 to January 2010 were retrospectively evaluated. Polysomnographic data were recorded with Viasys Sleep Screen (Viasys Healthcare, Germany). Patients younger than 18 years old were excluded. Results: PC was present in 53.1% of OSAS patients. The rate of male subjects with PC was 42.6%; however, 76.26% of females had PC (P = 0.00). Age (P = 0.00) and body mass index (BMI) (P = 0.00) were higher in patients with PC. Ferritin levels were lower in patients with PC (P = 0.00). Male subjects with PC were older and had lower sleep efficiency and longer rapid eye movement latency than males without PC. BMI was the only contributory factor to PC in female subjects. Conclusion: PC in OSAS is common, especially in females. Apnea hypopnea index does not seem to influence probability of PC.

Tuberculosis verrucosa cutis in a patient with long-standing generalized lichen planus: improvement of lichen after antitubercular polychemotherapy.

Tuberculosis verrucosa cutis (TBVC) is a rare form of skin tuberculosis in Western communities, and is generally seen in certain risk groups. A 52‐year‐old housewife with recalcitrant generalized cutaneous and mucosal lichen planus (LP) of more than a 20‐year duration presented with an erythematous‐edematous plaque with a warty surface containing deep hemorrhagic fissures and numerous orifices draining purulent material on the back of her left hand. On the basis of clinical, histological and bacteriological findings, TBVC was diagnosed. The patient was successfully treated with isoniazid, rifampicin, ethambutol and pyrazinamide. Interestingly, all lichen lesions improved completely with this therapy. To the best of our knowledge, this is the first documented case of TBVC associated with LP, which was cured by antitubercular polychemotherapy. The case is presented because it reflects a possible reciprocal causal relationship between two cutaneous conditions of different natures.

Fatal Giant Aortic Thrombus Presenting With Pulmonary Edema in a Patient With Chronic Obstructive Pulmonary Disease

Thrombus formation in a morphologically normal a aorta is a very rare event. A 50-year-old man with a his- s tory of chronic obstructive pulmonary disease, pre- e sented to the emergency department with pulmonary C edema. Transthoracic and transesophageal echocardio- t graphy revealed a highly mobile, pedunculated floating c thrombus in the descending thoracic aorta 3-4 cm dis- t tal to the origin of the left subclavian artery. The orig- t inal lumen of the aorta was almost obliterated by the thrombus. The aortic wall was free of any atheroma. Thrombolytic treatment was administered, but 3 hours d after starting streptokinase, he developed sudden and severe low-back pain accompanied by loss of lower-extremity pulses which were patent on admission. Cardiopulmonary arrest developed within an hour and the patient died despite resuscitation. The potential causes of aortic thrombus, the clinical spectrum that the patients may present, diagnostic methods, and therapeutic options are discussed.

Severe Asthma Attack in a Patient with Premenstrual Asthma: Hot Pepper Is the Possible Trigger

Mild to severe deterioration of asthmatic symptoms during the premenstrual period has been reported in 30–40% of female asthmatics [1]. Although most of the authors suggest that alteration of hormonal status during the menstrual cycle has an important role, none has been able to demonstrate the exact mechanisms in the etiology of this entity [2]. We present a case who was admitted to the emergency room of Gaziantep University Hospital for a severe premenstrual asthma attack which had begun after handling fresh red hot pepper for several hours. After the addition of the leukotriene receptor antagonist (LRA) montelukast to her medication, her asthma has been better controlled even during the premenstrual periods for the last 16 months. A 38-year-old asthmatic woman was brought to the emergency room for loss of consciousness following an acute dyspnea episode in July 1999. On physical examination, she had an irregular breathing pattern, cyanosis and markedly diminished breath sounds. Her blood pressure was 160/100 mm Hg and pulse rate was 140 per minute. Arterial blood gas analysis revealed acute hypercapnic respiratory failure (pH 7.08, PaO2 45 mm Hg, PaCO2 77 mm Hg, HCO3 22.8 mmol/l). Chest X-ray showed no abnormality. Initial efforts to treat the acute attack with conventional medication failed and immediate intubation was performed for mechanical ventilation. Additionally, she was given 60 mg of methylprednisolone, 0.5 mg/kg/h aminophylline by continuous infusion and a mixture of 2.5 mg of salbutamol and 0.5 mg of ipratropium bromide via nebulizer every 4 h. Her condition stabilized the next day and she was then weaned from mechanical ventilation. Reviewing her medical records showed that she had been regularly followed at our asthma clinic with the diagnosis of premenstrual asthma for the last 10 years. However, she had never been admitted to the emergency room for an acute asthma attack until that day on which she chopped almost 20 kg of hot pepper with bear hands to make a traditional pepper sauce. She was discharged from the hospital 1 week later with LRA montelukast added to her medical regimen including metered-dose inhaler forms of salmeterol (200 Ìg/day) and fluticasone (500 Ìg/day) plus oral prednisolone (30 mg/day) and oral theophylline (400 mg/day). Oral prednisolone was discontinued with tapering after 1 month. On her follow-up during the last 16 months, neither significant deterioration of her asthma nor marked drops in her PEFR measurements occurred even during her premenstrual periods. To our knowledge, there is no report in the English medical literature that stresses the provocative effect of fresh hot pepper in asthmatic subjects. However, capsaicin, which is the irritant extract of hot pepper, is known as a potent bronchoconstrictor [3]. Therefore, we suggest that it was most likely her prolonged exposure to hot pepper that triggered off this acute severe asthmatic attack in our case. To date, therapeutic strategies for premenstrual asthma (PMA) have been limited to some case studies. Besides theories on the hormonal alterations during the premenstrual period, Nakasato et al. [4] recently suggested that leukotrienes are partly involved in the pathogenesis of PMA, and that LRAs may be useful in patients with PMA. In the presenting case, similarly, asthmatic symptoms were adequately controlled with the addition of the LRA montelukast during the 16 months of follow-up. In conclusion, we suggest that preparing pepper sauce at home or working in a hot pepper processing plant may be dangerous for asthmatic subjects because severe asthma attacks may be provoked by prolonged handling of hot pepper. We also suggest that LRAs may be considered in subjects with premenstrual asthma before hormonal therapy (gonadal releasing hormone analogs or progesterone) to avoid the side effects, related to these drugs, such as bone loss or cardiovascular complications.

Effects of positive airway pressure therapy on exercise parameters in obstructive sleep apnea.

BACKGROUND AND OBJECTIVES Obstructive sleep apnea (OSA) is common in adult population and may cause many adverse clinical results. We aimed to investigate possible changes in cardiopulmonary exercise capacity in OSA patients after positive airway pressure treatment. DESIGN AND SETTINGS Patients who were admitted to Gaziantep University Pulmonary Diseases Sleep Center and diagnosed OSA were included. Studies carried out between May 2010 and July 2011. Sixty-five consecutive patients were included in this prospective study. PATIENTS AND METHODS Sixty-five adult sleep clinic patients diagnosed with OSA by polysomnography and in whom continuous positive airway pressure (CPAP) ventilation therapy was indicated were included. Cardiopulmonary exercise capacity was assessed by bicycle ergometry during diagnostic workup and at least 4 weeks later. RESULTS There were 57 (87.7%) males. The mean age was 45.29 (10.57) years, apnea-hypopnea index 38.02 (23.19 events/h, body mass index 31.72 (4.87) kg/m2. Patients were grouped with respect to compliance with CPAP. The peak oxygen consumption (VO2) did not change in the CPAP compliant group (n=33) (22.52 [6.62] mL/[min.kg] to 21.32 [5.26] mL/[min.kg]; P=.111), and decreased from 21.31 (5.66) mL/(min.kg) to 19.92 (5.40) mL/(min.kg) (P=.05) in the CPAP noncompliant group. Work rate increased from 84.0% to 85.0% in the CPAP compliant group and decreased from 79.6% to 77.1% in the noncompliant group (P=.041). In the group that used the device, ventilation (VE)/VCO2 at anaerobic threshold (AT) declined from 28.42 to 27.36; however, it increased from 27.41 to 27.81 in the group that did not use the device (P=.033). CONCLUSIONS Decline in the exercise capacity was prevented in patients with OSA after 4 weeks of CPAP therapy. The changes in VE/VCO2 at AT suggest the reversal of pathophysiologic changes in OSA with the CPAP therapy that may improve cardiac function and cause more efficient ventilation.

CT findings related to exposure to polyvinyl chloride

BACKGROUND Although some adverse health effects of exposure to polyvinyl chloride (PVC) are well known, there is limited evidence of its effects on the respiratory system. AIMS To assess the pulmonary effects of exposure to PVC with high-resolution computed tomography (HRCT). METHODS Workers and administrative staff of two PVC production plants completed questionnaires and went through pulmonary function testing and HRCT. Analysis of PVC dust in the work environment was performed by the Directorate of Occupational Health and Safety. RESULTS In total, 104 PVC-exposed workers and 43 administrative controls participated. HRCT revealed pleural and/or parenchymal changes in 55% of the exposed subjects. Pleural thickening was detected in 14 subjects, 13 of whom were in the exposed group (P < 0.05). Isolated pleural thickening without parenchymal involvement was present in seven workers, who were all in the exposed group (P < 0.05). Pleural thickening was frequently bilateral and localized to the parietal and visceral pleura. Round opacities, heterogeneous attenuation and ground-glass opacities were only detected in the exposed group (P < 0.05). Exposure to dust increased the risk of findings on HRCT (odds ratio (OR) 4.2, P < 0.05). There were no correlations between pulmonary function tests or respiratory symptoms and HRCT findings. HRCT changes were more common in subjects with forced mid-expiratory flow (FEF(25-75)) < 50% (P < 0.001). CONCLUSIONS This study found that exposure to PVC dust, at levels below the legal limit for respirable particulate matter, was associated with parenchymal changes and pleural thickening on HRCT.