Tacettin Örnek

Clinical Factors Affecting the Direct Cost of Patients Hospitalized with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Background: Chronic obstructive pulmonary disease (COPD) is a disease of increasing significance in terms of economic and social burden due to its increasing prevalence and high costs. Direct costs of COPD are mostly associated with hospitalization expenditures. In this study, our objective was to investigate the costs of hospitalization and factors affecting these costs in patients hospitalized due to acute exacerbation of COPD (AECOPD). Methods: A total of 284 patients hospitalized AECOPD were included in the study. Data were examined retrospectively using the electronic hospital charts. Results: Mean duration of hospitalization was 11.38 ± 6.94 days among study patients. Rates of admission to the intensive care unit, initiation of non-invasive mechanical ventilation (NIMV) and invasive mechanical ventilation (MIV) were 37.3% (n=106), 44.4% (n=126) and 18.3% (n=52) respectively. The rate of mortality was 14.8% (n=42). Mean cost of a single patient hospitalized for an AECOPD was calculated as

Smoking Prevalence, Behaviour and Nicotine Addiction among Coal Workers in Zonguldak, Turkey

1765 ± 2139. Mean cost of admission was

The results of computed tomography guided tru-cut transthoracic biopsy: complications and related risk factors

889 ± 533 in standard ward, and

Syncope as a presentation of acute pulmonary embolism.

2508 ± 2857 in intensive care unit (ICU). The duration of hospitalization, a FEV1% predicted value below 30%, having smoked 40 package-years or more, the number of co-morbidities, NIMV, IMV, ICU, exitus and the number of hospitalizations in the past year were among the factors that increased costs significantly. Hospital acquired pneumonia, chronic renal failure and anemia also increased the costs of COPD significantly. Conclusion: The costs of treatment increase with the severity of COPD or with progression to a higher stage. Efforts and expenditures aimed at preventing COPD exacerbations might decrease the costs in COPD.

Investigation of obstructive sleep apnoea syndrome prevalence among long-distance drivers from Zonguldak, Turkey

Smoking Prevalence, Behaviour and Nicotine Addiction among Coal Workers in Zonguldak, Turkey: Murat Unalacak, et al. Department of Family Medicine, Zonguldak Karaelmas University, Faculty of Medicine, Turkey—To assess the smoking status of coal workers, as coal dust exposure and concomitant cigarette smoking contribute to the increased prevalence of pulmonary interstitial fibrosis, chronic obstructive pulmonary disease and other pulmonary diseases. A survey was conducted to determine the smoking prevalence, behaviour and nicotine addiction in coal workers. The target population consisted of 475 underground coal workers who lived in Zonguldak city of Turkey, and we reached 389 of them. Each subject completed a detailed smoking history questionnaire (included 56 question). Chest X‐rays and pulmonary function tests were performed to evaluate patients’ related diseases and complications. Smoking status of the workers was as follows; Sixty‐nine never smokers (17.7%), 62 ex‐smokers (15.9%) and 258 current smokers (66.3%). The mean age of starting smoking was similar among ex and current smokers (15.9 ± 4.2 versus 15.0 ± 4.0). The most common reason for starting smoking was smoking interest (50%) and friends’ influence (15.5%). The most frequent reason stated for successful smoking cessation was experience of smoking—related symptoms or development of a medical condition (51%). The most important reason given by current smokers for smoking cessation attempts was increased chance of developing lung cancer, pneumoconiosis and other diseases (22.9%). Nicotine addiction was assessed by the Fagerstroem test. Mild (0–3 points), moderate (4–6) and severe (7 or more) addiction ratios were found to be 39.1%, 44.2% and 16.7 % respectively. Ex‐smokers had the highest prevalence of large and small airway obstruction on spirometry. Smoking prevalence is high in coal workers living in Zonguldak city of Turkey. Most of the smokers know that smoking is dangerous and want to quit smoking. A detailed smoking history during medical surveillance may help the occupational physician to develop a system in which such individuals can be referred to comprehensive smoking cessation programs.

Enoxaparin-associated giant retroperitoneal hematoma in pulmonary embolism treatment.

ZusammenfassungEINLEITUNG: Die transthorakale Biopsie (TTB) ist eine gut definierte und effiziente Methode zur Gewinnung von Gewebe für die histopathologische Diagnose pulmonaler Läsionen. Sie ist weniger invasiv als chirurgische Verfahren und hat eine bessere diagnostische Aussagekraft als Fein-Nadel-Biopsien (FNAB), vor allem bei der Beurteilung benigner Läsionen. In der vorliegenden Studie präsentieren wir unsere mit TTB erhobenen Ergebnisse, sowie die Komplikationen beziehungsweise die damit verbundenen Risikofaktoren. MATERIAL UND METHODEN: 102 Patienten, bei denen zwischen Jänner 2003 und Dezember 2007 pulmonale Läsionen mittels CT gezielter TTB evaluiert wurden, sind in die Studie aufgenommen. TTB assoziierte Komplikationen wurden festgehalten. Faktoren, wie die Tiefe und Größe der Läsion, sowie das Ausmaß eines um die Läsion bestehenden Emphysems wurden mit χ2-Test evaluiert. ERGEBNISSE: Von den gewonnenen Gewebeproben waren 51 % histopathologisch malign und 49 % benign. Bei 15,7 % der 102 Prozeduren entstand ein Pneumothorax. Das Risiko der Entwicklung eines Pneumothorax stieg signifikant mit dem Abstand der Läsion von der Pleura, mit der Größe der Läsion, sowie mit dem Ausmaß emphysematöser Veränderungen rund um die Läsion. SCHLUSSFOLGERUNG: Die Komplikationsrate der TTB ist mit der der FNAB vergleichbar. In Zentren, wo die zytologische Diagnostik von pulmonalen Läsionen insuffizient ist, empfehlen wir die routinemäßige Anwendung der CT-gezielten TTB, da diese ebenso verlässlich ist, wie die FNAB.SummaryINTRODUCTION: Transthoracic biopsy (TTB) is a well-defined and effective method used for pathologic sampling in the diagnosis of the pulmonary lesions. It is less invasive in comparison to surgical procedures. In addition, diagnostic rate of tru-cut biopsy is higher than that of fine needle aspiration biopsy (FNAB) especially for benign lesions. In this study, we presented tru-cut transthoracic biopsy (TTB) procedure results and the frequency of TTB complications with related risk factors. MATERIAL AND METHODS: A total of 102 patients were evaluated by CT scan guided tru-cut TTB in the diagnosis of lung lesions between January 2003 and December 2007. The complications due to tru-cut TTB were recorded. The factors such as the lesion depth, the lesion size, and the emphysematous changes that accompany the lesion were evaluated through χ2 test. RESULTS: Among the samples, 51% malignancy and 49% benign pathology were observed. Pneumothorax developed in 15.7% of the 102 procedures. It was found that the lesions distance from the pleura, the size of the lesion, and emphysematous changes around the lesion significantly increased the risk of pneumothorax. DISCUSSION: The tru-cut biopsy complications are similar to those of FNAB. In the centers where cytologic examination is insufficient in the diagnosis of lung lesions, tru-cut biopsy should be routinely performed as it is a reliable biopsy technique compared to FNAB.

Pneumonia in patients with novel influenza A (H1N1) virus in Southeastern Turkey

Purpose Syncope is an atypical presentation for acute pulmonary embolism (APE). There are conflicting data concerning syncope and prognosis of APE. Patients and methods One hundred and seventy-nine consecutive patients aged 22–96 years (median, 68 years) with APE were retrospectively enrolled in the study. Results Prevalence of syncope was 13% (n=23) at the time of presentation. Compared to patients without syncope, those with syncope had a higher rate of central embolism (83% vs 43%, respectively, P=0.002), right ventricular dysfunction (91% vs 68%, P=0.021), and troponin positivity (80% vs 39%, P=0.001) but not 30-day mortality (13% vs 10%, P=0.716). Multivariate analysis showed that central localization (odds ratio: 9.08) and cardiac troponin positivity (odds ratio: 4.67) were the independent correlates of the presence of syncope in the patients with APE. Frequency of cardiopulmonary disease was lower, and duration from symptom onset to hospital admission was shorter in patients with syncope (P=0.138 and 0.118, respectively), although not significant. Conclusion Syncope most likely represents an intermediate condition between massive APE and hypotension. In APE patients with syncope, the prognosis seems to depend on the underlying pathology, the patient’s age, comorbidities and duration from symptom onset to hospital admission, and the use of thrombolytic therapy.

The Impact of Obstructive Sleep Apnoea and Nasal Continuous Positive Airway Pressure on Circulating Ischaemia-Modified Albumin Concentrations

BackgroundThe aim of this study was to assess the prevalence of Obstructive sleep apnoea syndrome (OSAS) in long-distance drivers located in the Zonguldak area and to show the correlation between OSAS and traffic accidents.MethodsIn this study, 241 long-distance drivers who were residents of Zonguldak province were interviewed face-to-face and a questionnaire regarding OSAS symptoms, occupational histories, and numbers of accidents was administered. Body mass measurements were also taken from participants. Patients who exhibited evidence of OSAS underwent polysomnography (PSG).ResultsSnoring was detected in 56% out of all participants, daytime sleepiness was observed in 26.6% and apnoea in 11.6%. All-night PSG was applied to 42 participants who had a high probability of clinical OSAS. Among these, eight had an apnoea-hypopnoea index (AHI) < 5. The prevalence of OSAS was 14.1%. There was a significant relationship between the ratio of traffic accidents per professional years and AHI (r = 0.571; p < 0.005).ConclusionsOSAS prevalence was higher among long-distance drivers in the Zonguldak region. Disease severity was directly proportional to traffic-accident risk, and thus represents a serious social problem.

Peripapillary Choroidal Thickness and Retinal Nerve Fiber Layer in Untreated Patients with Obstructive Sleep Apnea-Hypopnea Syndrome: A Case–Control Study

Context: Retroperitoneal hematoma may usually occur as a result of trauma. A life threatening retroperitoneal hematoma is not expected complication of anticoagulation treatment and rarely reported. Low molecular weight heparins (Enoxaparin) which are used as effective and safe medicine in the venous thromboemboly treatment have some major complications such as hematomas of different organs. We aim to present a giant spontaneous retroperitoneal hematoma after anticoagulant treatment of pulmonary embolism with enoxaparin. Case Report: A 73-year-old male patient with the diagnosis of pulmonary embolism underwent anticoagulant treatment (enoxaparin). In the second day of admission, the patient had an episode of abdominal and back pain. Abdominal ultrasonography and computerized tomographic scan revealed a giant retroperitoneal hematoma. Enoxaparin treatment was then stopped and the supportive treatment was started. In the following days, hemoglobin levels returned to normal and a control CT revealed regression of hematoma size. Conclusion: The anticoagulant treatment with enoxaparin may lead to severe hematomas. Therefore, the clinical suspicion is required especially in elderly patients and patients with impaired renal function for retroperitoneal hematoma, when they suffer from acute abdominal pain.

Prognostic Value of Renal Dysfunction Indicators in Normotensive Patients With Acute Pulmonary Embolism

ZusammenfassungZiel dieser Studie war es, die klinischen Charakteristika, sowie die Röntgen- und Laborbefunde von hospitalisierten Patienten mit einer neuen, labormäßig gesicherten, Infektion mit dem Schweine-Grippe Influenza A Virus (S-OIV) mit Pneumonie zu beschreiben. Es wurden 56 zwischen Oktober und Dezember 2009 wegen einer Pneumonie stationär aufgenommene Patienten, die auf S-OIV getestet worden waren, retrospektiv ausgewertet. 33 dieser Patienten hatten einen positiven Befund. Sie wurden mit den 23 Patienten mit negativem Befund verglichen. Die Mortalität der Patienten mit positivem Befund lag bei 24,2 %. Von den 33 Patienten hatten 42,4 % zumindest eine zugrunde liegende Erkrankung und 4 (12 %) Patientinen waren schwanger oder post partum. 14 der Patienten mit S-OIV Infektion wurden in einer Intensivstation behandelt. Das häufigste Symptom war Atemnot. Die mittlere Spitzen – Körpertemperatur während des stationären Aufenthaltes war in dieser Gruppe mit 39,42 ± 0,70 Grad Celsius höher als in der Gruppe mit negativem S-OIV Befund (38,51 ± 1,05) (p = 0,001). Auch die Thrombozytopenie sowie der Anstieg der Creatin-Kinase und der Laktatdehydrogenase waren statistisch signifikant ausgeprägter. Bei den Patienten mit S-OIV Infektion war eine bilaterale Infiltration im Vergleich häufiger. Obwohl sich manche klinischen Daten und Röntgen- sowie Laborbefunde der Patienten mit S-OIV Infektion von den bei S-OIV negativen Patienten erhobenen Befunden signifikant unterschieden, sollten unseres Erachtens alle Patienten mit einer Pneumonie während einer Pandemie auf Influenza A getestet werden.SummaryThe objective of this study was to describe the clinical characteristics and the radiological and laboratory findings of the hospitalised patients who had novel, laboratory-confirmed, swine-origin influenza A virus (S-OIV) infection with pneumonia. Between October and December 2009, 56 patients hospitalised for pneumonia who were tested for S-OIV infection were retrospectively evaluated. Thirty-three patients had positive S-OIV infections. In addition, 23 of the 56 patients who had negative test results for S-OIV infection were compared with the positive group. The mortality rate amongst the patients with S-OIV infection was 24.2%. Of the 33 patients, 42.4% had at least one underlying medical condition and 4 (12%) patients were pregnant or postpartum. Fourteen patients (42.4%) with S-OIV infection were followed up in an intensive care unit. The most common symptom was dyspnea. The mean peak body temperature during hospital stay (39.42 ± 0.70) was higher in this group than in the negative group (38.51 ± 1.05) (p = 0.001). Thrombocytopenia, increased creatine kinase and elevated lactate dehydrogenase levels were statistically significant. Bilateral infiltration was more common in the patients with S-OIV infection. Although some laboratory, radiological and clinical data show a significant difference between the patients with S-OIV pneumonia and the negative group, each patient presenting with signs of pneumonia during pandemia should be tested for Influenza A.