Pınar Akın Kabalak

Uso precoz de la ventilación mecánica no invasiva en pacientes con insuficiencia respiratoria hipercápnica aguda ingresados en una sala de neumología: estudio prospectivo

BACKGROUND In recent years, the optimal location for noninvasive mechanical ventilation (NIMV) has been a matter of debate. Our aim was to detect the effectiveness of NIMV in acute hypercapnic respiratory failure (AHRF) in respiratory ward and factors associated with failure. METHODS 69 patients treated with NIMV in respiratory ward were prospectively evaluated. The success of NIMV was defined as absence of need for intensive care unit (ICU) transfer with patients discharge from hospital (group 1), failure of NIMV was defined as need for ICU transfer (group 2). RESULTS The mean age was significantly higher in group 2. The cause of respiratory failure was COPD in 51 patients, obesity-hypoventilation syndrome in 14 and kyphoscoliosis in 4 patients. NIMV was successful in 55 patients and unsuccessful in 14. There was no significant difference between the two groups for pretreatment pH, PaCO₂ and PaO₂/FiO₂. After 1h and 3h of NIMV there was significant improvement in group 1. After 3h of NIMV, in group 1 respiratory rate was significantly decreased. The pretreatment APACHE II score, respiratory rate, frequency of pneumoniae, associated complication and comorbid disease was significantly higher in group 2. The success rate was higher in patients with good compliance to NIMV. CONCLUSION NIMV can be successfully applied in patients with AHRF in respiratory ward. The associated factors with NIMV failure are absence of early improvement in blood gases and respiratory rate, bad compliance to NIMV, older age, presence of associated complication, comorbid disease, pneumonia and high baseline respiratory rate.

[Early use of noninvasive mechanical ventilation in patients with acute hypercapnic respiratory failure in a respiratory ward: a prospective study].

Background: In recent years, the optimal location for noninvasive mechanical ventilation (NIMV) has been a matter of debate. Our aim was to detect the effectiveness of NIMV in acute hypercapnic respiratory failure (AHRF) in respiratory ward and factors associated with failure. Methods: 69 patients treated with NIMV in respiratory ward were prospectively evaluated. The success of NIMV was defined as absence of need for intensive care unit (ICU) transfer with patients dishcarge from hospital (group 1), failure of NIMV was defined as need for ICU transfer (group 2).

Frequency of vitamin K oxidoreductase complex subunit-1 (VKORC1) polymorphisms and warfarin dose management in patients with venous thromboembolism

Warfarin works by inhibiting VKORC1, so polymorphisms of this gene modify the required drug dose. The aim of this study is to examine the relation between therapeutic weekly dose of warfarin and C1173T/G1639A polymorphism of VKORC1 in patients with VTE. Seventy-five patients with VTE were enrolled. Weekly warfarin doses and time (day) to reach therapeutic INR were evaluated retrospectively along with VKORC1–C1173T and G1639A alleles. The mean weekly warfarin dose was lower and time to reach therapeutic INR was shorter in homozygote alleles (AA and TT) (p < 0.05). The multivariate regression model was produced, R2 = 0.05% for age (p = 0.04), R2 = 6% for VKORC1 (p = 0.03), the model for estimating warfarin dose R2 = 17% (p > 0.05). In particular, patients who need overdose of warfarin or whose bleeding score is high, study of these polymorphisms can be considered.

Survival and prognostic factors of oligometastatic non-small cell lung carcinoma: A single center experience

Introduction: In patients without targeted-mutations platinum-based chemotherapy is still current treatment method with a median survival rates of 8-11 months. Patients with single side oligo-metastatic disease should be consider for curative aggressive therapies for both primary and metastatic sides for better survival (NCCN 2016). Method Totally 29 oligo-metastatic NSCLC (16 adenocarcinoma, 13 non-adenocarcinoma) patients was evaluated retrospectively. In addition to surgery concurrent and sequential chemo-radiotherapy (CRT) were accepted as curative approach. Results: 25 male and 4 female with median age 58. There were 9 patients in each group of surgery and chemoradiotherapy (CRT). Metastasectomy, SBRT and radiotherapy was performed for metastasis. Rest of individuals had systemic chemotherapy or supportive care. Median follow-up time was 14.7 months. Median overall survival (OS)was 35 months, progression-free survival (PFS) was 15.7 and survival after first progression (SAFP) was 15.7 months (Figure1 ). OS=37.4 months for surgery, 33.5 months for CRT, p>0.05, PFS=16.3 months for surgery, 15.6 months for CRT, p>0.05 and SFAP=17.2 months for surgery, 12.9 months for CRT, p>0.05. In univariate cox-regresson analyses increase in cT staging (23 months for T1-2 and 6.5 months for T3-4, p=0.01; HR (95%CI): 7.9 (1.5-41.2) and existance of treatment toxicity (19.3 vs 0.6 months, p=0.03; HR (95%CI): 8.46 (1.14-62.6) was related to poor SAFP (Figure 2). Synchronous type showed higher OS than metachronous (35.6 vs. 25.2 months p>0.05). Conclusion: Even oligometastasis means stage 4 disease in lung cancer, radically treated patients can have more than 2 years survival.