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Eurasian J Pulmonol: 19 (1)
Volume: 19  Issue: 1 - April 2017
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COVER PAGES
1.Cover

Pages I - IX (25 accesses)

EDITORIALS
2.Editorial
Levent Dalar
Page X (34 accesses)

REVIEW ARTICLE
3.Electronic Cigarette (E-Cigarette) Using: Toxicological Aspects
Gülşen Göney
doi: 10.5152/ejp.2016.49358  Pages 1 - 7 (68 accesses)
The use of electronic cigarettes (e-cigarettes) has increased dramatically over the past few years. Moreover, no sufficient scientific evidence is available confirming the safety, efficacy also toxicity of e-cigarette’s. The aim of this review is evaluate and giving information about the toxic effects of e-cigarette’s using and its chemicals.

RESEARCH
4.Effects of Varenicline on Cardiovascular Parameters and Oxidative Stress
Nurhan Sarıoğlu, Gülten Erken, Erkan Ayhan, Fuat Erel, Taha Gürbüzer, Ömür Karaca, Özlem Yavuz
doi: 10.5152/ejp.2016.73644  Pages 8 - 12 (203 accesses)
Objective: Pharmacotheraphy is recommended for smoking cessation in clinical practice. However, the cardiovascular safety of smoking cessation drugs has been questioned. Our goal is to evaluate the effects of the smoking cessation drug varenicline on some cardiovascular parameters and oxidative stress in subjects.
Methods: Twenty-six smokers without cardiovascular diseases and 25 healthy subjects were enrolled in the study. Total oxidant status (TOS), total antioxidant status (TAS), and urotensin II levels were determined in blood samples. Echocardiography was performed in all individuals. Smokers were assessed with the measurements mentioned above at the beginning of the treatment (V0 group) and at the end (third month, V3 group). The same measurements were performed once in the control group (C).
Results: Aortic strain and distensibility measurements in the V0 group were found to be significantly lower than those in the C group. No significant changes were observed after varenicline treatment. TOS values in the V0 group were found to be higher than those in the V3 and C groups, but these differences were not statistically significant. However, TAS values of the V3 group were found to be significantly lower than those of the V0 group. There were no differences between the groups in terms of diastolic dysfunction and urotensin II levels.
Conclusion: Our study revealed that varenicline may decrease TAS in smokers thanks to smoking cessation. Varenicline does not seem to have negative effects on aortic stiffness. Further studies are needed to confirm these results.

5.How Successful is Non-Invasive Ventilation Treatment that is Initiated in the Emergency Department in Cases of COPD Exacerbations with Acute Hypercapnic Respiratory Failure? Can We Predict Treatment Failure?
Meltem Çoban Ağca, Fatma Tokgöz Akyıl, Dildar Duman, Aysun Mısırlıoğlu Kosif, Mustafa Akyıl, Sibel Arınç, Tülin Sevim
doi: 10.5152/ejp.2016.15870  Pages 13 - 18 (36 accesses)
Objective: We aimed to investigate the success rate of non-invasive ventilation (NIV) in wards and the predictors of failure in cases of chronic obstructive pulmonary disease (COPD)-related acute hypercapnic respiratory failure (AHRF).
Methods: The was a retrospective study conducted in a tertiary teaching hospital between May 2011 and 2013. Patients who were admitted to the emergency department (ED) because of COPD with AHRF were evaluated; 544 patients who initially received NIV in ED and were transferred to wards were included. Patient characteristics, baseline and follow-up pH values, and partial arterial carbon dioxide (PaCO2) values were recorded. Baseline pH values were categorized as severe (pH<7.26), moderate (pH≥7.26–7.30), and mild (pH≥7.30) acidosis. According to the in-hospital outcome, patients were classified in 2 groups: Group 1: home discharge, Group 2: death or intensive care unit transfer.
Results: Treatment resulted in success in 477 (88%) patients. Albumin levels were significantly low and the mean Charlson index (CI) score was significantly high in Group 2. Admission pH and PaCO2 values did not affect the treatment outcome. Patients in Group 2 had higher PaCO2 and lower pH values as well as a lower level of decrease in PaCO2 values within 2 hours of treatment in ED. Similarly, higher PaCO2 and lower pH values at the end of the first day in wards were indicative of NIV failure (p<0.05).
Conclusion: The success rate of NIV in wards in cases of AHRF is high. Patients with low albumin levels and higher CI scores have worse response to treatment. pH or PaCO2 values after a few hours of treatment and not the baseline pH or PaCO2 values are better predictors than the baseline pH and PaCO2 values.

6.Effects of Provided Trainings Regarding Non-Invasive Mechanical Ventilation on the Knowledge Level of Nurses
Sonay Göktaş, Ebru Kıraner, Pınar Doğan, Berrin Tunalı
doi: 10.5152/ejp.2016.05706  Pages 19 - 24 (38 accesses)
Objective: Having experienced members in the team for obtaining successful outcomes in non-invasive mechanical ventilation (NIMV) is important. The aim of our study is to determine the effectiveness of training on nurse’s level of knowledge about NIMV
Methods: This study was done with 70 nurses who were working at an university hospital. The data collection tools that were used were form for individual characteristics and knowledge test questions form consisting of multiple-choice for NIMV. Firstly, Pre-tests have been collected in the survey. Secondly, courses regarding NIMV indications, contraindications and patients management topics were given verbally by researchers. Finally, final tests were performed and data were collected. Analyzing for data were used frequency, percentage, wilcoxon and dependent samples Mc Nemar tests.
Results: Mean age were 33.2±7.3, 87.1% were female, 68.6% had bachelor degrees. Of 47.1% were working in intensive care. 54.3% often provide care to NIMV applied patients. 94.7% mentioned that they don’t have any knowledge of NIMV applications. The differences between the pre-post training scores were higher statistically (p<0.001). It was determined that knowledge levels of nurses about NIMV indications and contraindications after training increased statistically significantly. (p<0.05).
Conclusion: In our research it was understood that nurses’ knowledge has increased significantly after the training for non-invasive applications. By means of these trainings that will develop the affective, cognitive and psychomotor skills of nurses, it is expected to reveal the results of the extensive research and successful outcomes for NIMV applications will increase.

7.The Reasons for Non-Adherence in Pulmonary Rehabilitation Programs
Ipek Candemir, Dicle Kaymaz, Pınar Ergün
doi: 10.5152/ejp.2016.85547  Pages 25 - 29 (35 accesses)
Objective: Pulmonary Rehabilitation (PR), a multidisciplinary treatment modality, is recommended in management of COPD. Structure, experience of units /centers, contents of the program are as important as patient-specific factors.To our knowledge, there is no data regarding the success of PR in Turkey. This study was performed in order to determine the reasons for nonadherence in patients who underwent PR programs in Turkey.
Methods: Demographic data, initial assessment parameters of 143 patients were collected retrospectively, examined. Age, smoking history, FEV1%, health related quality of life, dyspnea score, body composition and psychological status of all patients who were divided into two group according to completion of PR were compared. The reasons of non-completion were asked from patients who did not complete PR by phone, their answers were recorded.
Results: Thirty two patients did not complete (22.3%) multidisciplinary, comprehensive, an individualized outpatient PR program.The most common reason for non-adherence except all medical conditions including exacerbations was inability to comprehend efficacy and contents of PR program. While mean walking distance of patients who completed PR was 241±128.9, other group’s distance was 183.4±119.9 m, endurance time was 7.03±6.32, 4.89±5.3 min (respectively, p=0.02). Although total SGRQ and all domains’ scores of patients who did not complete PR were higher, only impact domain scores, MRC scores were significantly higher (p=0.045, 0.01 respectively). Body composition, psychosocial status of patients did not differ significantly.
Conclusion: Patients with advanced dyspnea, decreased exercise capacity should be continuously, vigorously informed of possible gains in order to increase success rate of programs, adherence to programs should be reinforced by patient-specific individualized PR programs.

8.Immunomodulatory Effect of Exercise in Patients with Asthma
Seda Tural Önür, Arzu Didem Yalçın
doi: 10.5152/ejp.2016.86548  Pages 30 - 33 (202 accesses)
Objective: Immune responses can change with exercise. We aimed to show the changes in cytokine levels pre- and post-exercise in patients with asthma.
Methods: In this prospective control trial, data of 32 patients with asthma that was under control were classified into two groups, pre- and post-exercise. Serum IL-1β and monocyte IL-1β, IL-2, and IL-10 expressions were evaluated using enzyme-linked immunosorbent assay. The patients were advised to walk for at least 30 min for 4 days/week for 12 weeks.
Results: There was no significant difference in demographic properties of the participants. Monocyte IL-1β levels in the pre- and post-exercise groups were 1.99±0.35 and 1.01±0.22 pg/mL, respectively (p=0.003). IL-10 levels in the pre- and post-exercise groups were 1.64±0.02 and 1.21±0.03 pg/mL, respectively (p=0.04). IL-2 levels in the pre- and post-exercise groups were 0.64±0.045 and 0.32±0.09 pg/mL, respectively (p=0.001). However, there was a significant difference in serum IL-1β and monocyte IL-1β, IL-2, and IL-10 levels between the groups (p=0.02, p=0.003, p=0.04, and p=0.001, respectively).
Conclusion: Systemic inflammatory parameters that are commonly elevated in asthma may improve by exercise. The elucidation of the mechanism of immune control in patients with asthma is useful for the future treatment of asthma.

9.Validity and Reliability of Asbestos Knowledge and Awareness Questionnaire for Environmental Asbestos Exposure in Rural Areas
Selma Metintaş, Güntülü Ak, Şenay Yılmaz, Filiz Boğar, Muzaffer Metintaş
doi: 10.5152/ejp.2016.57441  Pages 34 - 40 (44 accesses)
Objective: There is no treatment for asbestos–related diseases, but they can be prevented. One of the first interventions is to improve the knowledge level of people in order to protect people from asbestos and asbestos–related diseases. The present study was conducted to develop a questionnaire for measuring the knowledge and awareness level of asbestos and also assess its validity and reliability in a rural population that is exposed to asbestos environmentally.
Methods: A questionnaire, interviewer–administered, that included 37 items was employed on a convenient sample consisting of adult persons who attended a tertiary teaching hospital in Eskişehir where asbestos exposure is widespread in its rural areas. After assessment of validity and reliability of the results, the questionnaire was refined to 19 items and one subscale.
Results: A total of 760 participants were included in this study. The mean age of participants was 53.2±15.1 years and 51.6% of them were male. The discrimination and difficulty indices of the asbestos knowledge and awareness questionnaire ranged between 20.0–60.5% and 0.39–0.98, respectively. Cronbach’s alpha coefficient was 0.951 for overall items. The median (min–max) and mean (SD) score of the study population were 30 (19–56) and 33.9 (11.9), respectively. The score increased correspondingly with greater knowledge levels.
Conclusion: This questionnaire is a practical and easy tool to apply with acceptable reliability and validity on high-risk adults in rural areas with environmental asbestos exposure.

10.Transbronchial Biopsy: Our Experience in 5 Year
Tülin Sevim, Fatma Tokgöz Akyıl, Meltem Ağca, Ayşe Alp Ersev, Emine Aksoy, Nilüfer Kongar, Oğuz Aktaş
doi: 10.5152/ejp.2016.96729  Pages 41 - 45 (36 accesses)
Objective: Transbronchial biopsy (TBB) is an old diagnostic method applied via fiberoptic bronchoscopy. The diagnostic value and complication rate of the procedure were found to vary in previous studies. In present study, the diagnostic value of TBB was analysed.
Methods: All medical files of 308 patients who underwent TBB between May 2010-May 2015 in our clinic were reviewed retrospectively. According to the final diagnoses, the diagnostic value and complication rates of TBB, the contribution of the additional samples of the same bronchoscopic session to the diagnoses, and the requirement of any additional invasive procedure were investigated.
Results: Of all the patients, 63% were female and the mean age was 51 (17-85). Bronchoalveolar lavage was taken in 257 patients. Ten percent of the procedures could not reach lung parenchyma. TBB was diagnostic in 105 (34%) patients. Fifty (16%) patients were diagnosed via other samples of the same session, 15 (5%) resolved spontaneously, 28 (9%) were diagnosed via other clinical findings, 41 (14%) did not accept further invasive method or were lost-to follow-up. Sixty-nine (22%) underwent an additional invasive procedure. The most frequent final diagnosis was sarcoidosis and the diagnostic value of TBB was 49%. Diagnostic rate of TBB was lower in fibrotic interstitial lung diseases (ILD) and malignancy whereas higher in non-fibrotic ILD. No mortality was seen related to TBB, pneumothorax was seen in 6%; non-massive bleeding in 3%, respiratory failure in 0.3%.
Conclusion: Transbronchial biopsy is a procedure having a higher diagnostic value in certain diseases and has an acceptable morbidity. When combined with other bronchoscopic samples, the need for further invasive methods decreases significantly.

11.Is Tuberculosis a Challenge in the Management of Lung Cancer?
Deniz Köksal, Derya Kızılgöz, Ayşenaz Özcan, Özge Şafak Koşan, Nilgün Kalaç, Mine Berkoğlu
doi: 10.5152/ejp.2016.92485  Pages 46 - 50 (37 accesses)
Objective: The coincidence of tuberculosis (TB) and lung cancer (LC) at the initial diagnosis or the development of TB during the course of LC is a challenge in the management of both diseases. Herein we reviewed 10 LC patients who coincidentally had TB and evaluated the challenges in the management of both diseases.
Methods: The files of patients were retrieved from an archive, and available study forms were completed.
Results: The study included 10 LC and TB patients during a 4 year-period. The sites of TB were the lung (seven patients), mediastinal lymph nodes (LN) (one patient), cervical LN (one patient), and subcutaneous nodules (one patient). LC and TB were simultaneously diagnosed in four patients. The diagnosis of pulmonary TB was confirmed by sputum culture two months after LC diagnosis in four patients. TB was diagnosed later in the follow-up period in two patients. Only one patient with early-stage LC who had undergone surgical resection tolerated anti-TB therapy well. In one patient, TB caused the over-staging of LC. In one patient, LC had progressed during the course of anti-TB therapy. Hepatotoxicity was the leading adverse reaction due to anti-TB therapy.
Conclusion: These patients highlighted the importance of considering TB in the course of LC, especially in countries with a high TB prevalence. TB may cause the advanced staging of LC at the initial diagnosis; chemotherapy may worsen the TB course or cause reactivation TB. Reactivation TB may be considered as the progression of LC without tissue diagnosis or sputum analysis. The tolerability of anti-TB therapy is poor in these patients.

CASE REPORT
12.Erlotinib Treatment in a Case of Lung Adenocarcinoma Mimicking Interstitial Lung Disease
Şenay Yılmaz, Güntülü Ak, Muzaffer Metintaş
doi: 10.5152/ejp.2016.14622  Pages 51 - 53 (40 accesses)
Lung adenocarcinoma (LA) may occur with a radiographic appearance of localized tumor in the parenchyma or with diffuse parenchymal infiltration as interstitial lung disease (ILD). In our country, erlotinib is a tyrosine kinase inhibitor used in Epidermal Growth Factor Receptor (EGFR) mutation-positive patients who are resistant to first-line chemotherapy. A 48-year-old patient presented to our hospital with weakness and shortness of breath on exertion. Mediastinal enlargement and bilateral multinodules were observed in the chest X-ray. Ordinary blood laboratory values and arterial blood–gas analysis findings were normal. Lung function tests showed moderate restrictive ventilation and reduction of diffusing capacity based on the predicted value. A thorax computed tomography scan showed multiple mediastinal lymphadenopathies and bilateral diffuse perilymphatic nodule spread. The patient diagnosed with LA on the basis of endo–bronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Because of bilateral diffuse involvement of the lung, platinum-based combination chemotherapy was recommended. The progression of disease had occurred after two cycles, and a second-line treatment with erlotinib (150 mg/day) was initiated. A decrease in all lesions was observed in patient follow-up. The treatment with erlotinib was well tolerated. There was no adverse event for 6 months. This case was presented for the choice of LA that mimicked ILD and for the significant clinical and radiological responses to erlotinib in patients with EGFR mutation.



 
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