Osman Nuri Hatipoglu

Hospital-Acquired Pneumonia Developed in Non-Intensive Care Units

Background: There are few studies about hospital-acquired pneumonia (HAP) developing in non-intensive care units (non-ICUs). Objectives: The aim of this study was to determine the incidence rate of non-ICU HAP, the risk factors associated with mortality and the survival rates of HAP patients at 6 weeks and 1 year. Patients and Methods: Between March 2005 and February 2006, 154 adult patients (97 males) with HAP were prospectively evaluated. Immunocompromised patients who were developing pneumonia were excluded from the study. The HAP incidence was calculated and survival was noted at 6 weeks and 1 year later. Kaplan-Meier methods were used for survival analysis; Cox regression was used to identify the risk factors associated with HAP-induced mortality. Results: During the study, and not counting those in the ICU, 45,679 adult patients were hospitalized. Of these, 154 patients developed HAP (incidence 3.3 cases/1,000 patients). The mean age of those developing HAP was 64.53 ± 14.92 years (range 15–98). Survival rates at the 3rd, 7th, 14th, 42nd and 365th day were 91, 89, 69, 49 and 29%, respectively. Independent risk factors associated with 6-week mortality were: age [relative risk (RR) 1.026; 95% confidence interval (CI) 1.008–1.045], chronic renal failure (RR 1.8; 95% CI 1.087–3.086), aspiration risk (RR 2.86; 95% CI 1.249–6.564), steroid use (RR 2.35; 95% CI 1.306–4.257), and multilobar infiltration (RR 2.1; 95% CI 1.102–4.113). Conclusion: HAP – even if it develops in non-ICU environments – is hard to treat and has a higher mortality rate.

Levels of superoxide dismutase and malondialdehyde in primary spontaneous pneumothorax.

The aim of the present study is to determine whether patients with primary spontaneous pneumothorax (PSP) are subject to oxidative stress. For this purpose, we measured the activities of red blood cell superoxide dismutase, which is an antioxidant enzyme, and the level of plasma malondialdehyde, which is one of the lipid peroxidation markers, in a group of patients with PSP. The study was carried out with 16 patients with PSP and 24 healthy individuals. The two groups were similar to each other in terms of sex, age and smoking attitudes. Erythrocyte superoxide dismutase activity was found to be significantly lower in patients with PSP than in the control group (p < 0.01). The plasma malondialdehyde levels were significantly high in patients with PSP (p < 0.01). Our results suggest that oxidative stress may contribute to the pathogenesis of PSP.

Sonography of the chest using linear‐array versus sector transducers: Correlation with auscultation, chest radiography, and computed tomography

The primary purpose of our study was to compare the efficacies of two sonographic (US) probes, a high‐frequency linear‐array probe and a lower‐frequency phased‐array sector probe in the diagnosis of basic thoracic pathologies. The secondary purpose was to compare the diagnostic performance of thoracic US with auscultation and chest radiography (CXR) using thoracic CT as a gold standard.

Acinetobacter pneumonia: Is the outcome different from the pneumonias caused by other agents.

BACKGROUND: The principal aim of the present study was to determine whether Acinetobacter spp. pneumonia differs from hospital-acquired pneumonias (HAPs) caused by other agents with respect to therapeutic success and survival rate. METHODS: This study includes 140 adult patients diagnosed with HAPs caused by identified etiologic agents between March 2005 and February 2006. These patients were divided into two groups according to the agent responsible for their infection (Acinetobacter spp. [n = 63] or non-Acinetobacter spp. [n = 77]). The groups were compared in terms of risk factors, therapeutic success and six-week survival rates. RESULTS: Previous antibiotic use and the risk of aspiration were independent factors responsible for the development of Acinetobacter spp. pneumonia. Hypoalbuminemia, steroid use and the use of a mechanical ventilator were determined to be mortality-associated independent risk factors for Acinetobacter spp. pneumonia. The clinical success rate at the end of therapy was 41.6% and, at the sixth week, the survival rate was 35% among patients in whom Acinetobacter spp. was the causative agent. Conversely, in the control group, these values were 43 and 32%, respectively (P > 0.05). We found that the use of the appropriate antibiotics for the treatment of Acinetobacter spp. pneumonia was an important factor in survival (P < 0.001). CONCLUSION: The outcomes of Acinetobacter spp. pneumonia do not differ from HAPs associated with non-Acinetobacter spp. in terms of therapeutic success and survival rates.

A prospective, multicentre clinical trial comparing cisplatin plus gemcitabine with cisplatin plus etoposide in patients with locally advanced and metastatic non-small cell lung cancer.

Objective:  Cisplatin‐gemcitabine (PG) and cisplatin‐etoposide (PE) combinations are active regimens for non‐small cell lung cancer (NSCLC). The present study aimed to compare PG with PE in the treatment of patients with stage IIIB and IV NSCLC.

A New Clinical Model in Pulmonary Embolism and Its Correlation With V/P Scan Results

The study was prospectively designed to assess the correlation between a new clinical model empirically developed for acute pulmonary embolism (PE) and ventilation/perfusion (V/P) scan results. One hundred sixty consecutive patients with suspected acute PE underwent clinical evaluation before V/P scintigraphy. The clinical probability of PE was categorized according to a structured clinical model empirically developed as low, intermediate, or high, and the results were compared with those of V/P scintigraphy. Forty, 61, and 59 patients were classified as low, intermediate, and high clinical probability, respectively. Seventy-five percent (30/40) of the patients with low clinical probability were also of low scintigraphic probability or had a normal result (rs: 0.39, p=0.000); 28% (17/61) of the patients with intermediate clinical probability demonstrated intermediate scintigraphic probability (rs: 0.20, p=0.012); and 68% (40/59) of the patients with high clinical probability were also of high scintigraphic probability (rs: 0.43, p=0.000). Overall, the correlation of two scoring systems was statistically significant (rs: 0.39, p=0.000). Unilateral leg swelling (p=0.027), syncope or near syncope (p=0.002), amputation of a hilar artery (p=0.007), and electrocardiographic signs of right ventricular overload (p=0.000) prevailed in patients with high scintigraphic probability. “Syncope-near syncope or hemodynamic collapse” PLUS “electrocardiographic signs of right ventricular overload or hypoxemia” combination had the most significant correlation with a high scintigraphic probability (rs: 0.31; p=0.000). In conclusion, the new clinical model empirically developed was significantly successful to provide comparable results with V/P scan. This consistency was particularly prominent in patients with low or high clinical probability for PE.

Melatonin administration acutely decreases the diffusing capacity of carbon monoxide in human lungs

Background: Most physiological measurements of the pulmonary diffusing capacity use carbon monoxide (CO) as a tracer gas. Similar to CO, melatonin binds the hemoglobin in the blood. Objective: The present study was designed to assess the effect of exogenous melatonin administration on pulmonary functions including diffusing capacity for carbon monoxide (DLCO) in healthy subjects. Methods: The study was performed in a randomized, double-blind, placebo-controlled manner. DLCO was measured in 22 healthy male volunteers (age 18–25 years) who were randomized to melatonin (n = 11) and placebo administration (n = 11). At baseline, DLCO, alveolar volume (VA) and other spirometric parameters such as forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF) and maximal voluntary ventilation (MVV) were measured. DLCO was then corrected for the hemoglobin concentration. Measurements were repeated in a double-blind fashion 60 min after the administration of melatonin (1 mg) or placebo. Results: DLCO was significantly decreased (39.31 ± 4.75 vs. 34.82 ± 6.18 ml/min/mm Hg) 60 min after the melatonin administration (p = 0.01), while FEV1, FVC, FEV1/FVC, PEF and MVV values did not demonstrate significant differences. Placebo administration did not result in significant alteration in any of these parameters. Conclusions: In healthy subjects, oral administration of melatonin acutely influences the DLCO without affecting other pulmonary function test results. We conclude that melatonin may have a reducing effect on the DLCO in the lungs.

Relation of the frequency and mortality of pulmonary thromboembolism with meteorological parameters

Objective:The objective of this study is to find the relationship between incidence rate and mortality of acute pulmonary thromboembolism (PTE), and seasonal and meteorological factors. Materials and methods: The data from 234 patients who were hospitalized due to acute PTE in the emergency service or policlinics between 2001 and 2008 were investigated retrospectively. Cases that developed APE (acute pulmonary embolism) in the hospital were excluded. Seasons and months in which acute PTE was diagnosed were recorded. Mortality rates by months and seasons were evaluated. The mean pressure, temperature and humidity values were evaluated for periods of three days, seven days and one month before the day of presentation. The effects of meteorological factors on the severity (massive or non-massive) and mortality of APE were investigated. Results: The incidence rate of acute APE showed a significant difference according to seasons (p=0.000). APE was diagnosed most commonly in spring and winter. The mean pressure values for three days, seven days and one month and the mean humidity values for three days for the dead patients were found to be significantly lower than those of the survived ones (p<0.05). The mortality rate for patients admitted in summer was significantly higher than the rates for other seasons (p=0.02). There were no seasonal differences among the massive APE incidences. Mortality rates were higher in summer because of the nonmassive APE patients rather than the massive patients. Conclusion: Acute PE is a disease whose incidence and mortality rates are affected by meteorological factors. (www.actabiomedica.it)OBJECTIVE The objective of this study is to find the relationship between incidence rate and mortality of acute pulmonary thromboembolism (PTE), and seasonal and meteorological factors. MATERIALS AND METHODS The data from 234 patients who were hospitalized due to acute PTE in the emergency service or policlinics between 2001 and 2008 were investigated retrospectively. Cases that developed APE (acute pulmonary embolism) in the hospital were excluded. Seasons and months in which acute PTE was diagnosed were recorded. Mortality rates by months and seasons were evaluated. The mean pressure, temperature and humidity values were evaluated for periods of three days, seven days and one month before the day of presentation. The effects of meteorological factors on the severity (massive or non-massive) and mortality of APE were investigated. RESULTS The incidence rate of acute APE showed a significant difference according to seasons (p=0.000). APE was diagnosed most commonly in spring and winter. The mean pressure values for three days, seven days and one month and the mean humidity values for three days for the dead patients were found to be significantly lower than those of the survived ones (p<0.05). The mortality rate for patients admitted in summer was significantly higher than the rates for other seasons (p=0.02). There were no seasonal differences among the massive APE incidences. Mortality rates were higher in summer because of the nonmassive APE patients rather than the massive patients. CONCLUSION Acute PE is a disease whose incidence and mortality rates are affected by meteorological factors.

Chronic Necrotizing Pulmonary Aspergillosis in a Case with Ankylosing Spondylitis

Ankylosing spondylits is a prototype of spondyloarthropathy tropates. During the progression of ankylosing spondylitis, which can destroy many systems, pleuroparanchymal involvement occurs rarely. The most commonly observed lesion is the fibrobullous disease on the upper lobes. Chronic aspergillus colonization has been reported in a quite significant percentage of the patients with ankylosing spondylits (50-65%). Pulmonary aspergilloma is the most observed clinical form in patients with ankylosing spondylitis. Invasive pulmonary aspergillosis occurs especially in patients with immunesupression. Here we shall present a case with ankylosing spondylitis complicated by chronic necrotizing pulmonary aspergillosis which is a form of invasive pulmonary aspergillosis. (Tur Toraks Der 2012; 13: 83-6)

Factor V Leiden Mutation Accompanying Recurrent Massive Pulmonary Thromboembolism

ÖZET Nefes darlığı, sağ bacakta şişlik, fenalaşma şikâyetleriyle acil servise başvuran ve alt ekstremite venöz Doppler ultrasonografisinde derin ven trombozu, bilgisayarlı toraks tomografisinde sol ana pulmoner arter ve her iki taraf segmenter arter dallarında trombüs saptanan 46 yaşında kadın hastada, hipotansiyon gelişmesi üzerine pulmoner emboli tanısıyla streptokinaz infüzyonu başlandı. Trombolitik tedavi sonrası nefes darlığı şikâyeti gerileyen ve hemodinamisi düzelen hastaya antikoagülan tedavi uygulandı. Hastanın takibinin 5. gününde -antikoagülan tedavi altında ikenani başlayan nefes darlığı, siyanoz ve hipotansiyon gelişmesi üzerine, reküren masif pulmoner tromboemboli ön tanısı ile rt-PA tedavisi uygulandı. Uygulama sonrası hastanın hemodinamisi düzeldi, siyanozu ve nefes darlığı şikâyeti geriledi. Yapılan tetkiklerde hastada heterozigot Faktör V Leiden mutasyonu saptandı. Antikoagülan tedavi ile birlikte vena cava inferior filtresi takıldı. Hasta 3 aydır takibimiz altında yaşamını sürdürmektedir.