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Öğe Can the progression of COVID-19 pneumonia be predicted?(2022) Üçsular, Fatma Demirci; Ayrancı, Aysu; Polat, Gülru; Yalnız, Enver; Güldaval, Filiz; Karadeniz, Gülistan; Unat, Damla SerçeBackground: Coronavirus disease-2019 (COVID-19) remains a major cause of morbidity and mortality. There are many parameters affecting the progression of the disease. The purpose of the present study was to evaluate and compare the initial data of patients hospitalized with the diagnosis of COVID-19 pneumonia, who progressed during the hospitalization period, with other patients who recovered or remained stable, and to investigate the risk factors that can be used to predict the disease progression. Materials and Methods: Patients, who received inpatient treatment with the diagnosis of COVID-19 pneumonia, were included in the study retrospectively. Two groups were created from all patients according to their progression in hospital follow-ups: Group 1: Progression group and group 2: Recovery/stabilization group. If patients had clinical, laboratory and/or radiological deterioration or died during follow-up, these patients were included in the progression group. If patients recovered or remained stable, these patients were also included in the recovery/stabilization group. The demographic data, initial hemogram, biochemical parameters and radiological data of the patients were recorded. Results: It was determined in the univariate analysis that the age, smoking status, comorbidity, heart disease, chronic obstructive pulmonary disease, cancer, dyspnea, fever, leukocytosis, lymphopenia, elevated neutrophil-lymphocyte ratio (NLR), C-reactive protein, albumin, lactate dehydrogenase, ferritin, D-dimer, troponin-T, pro-B-type natriuretic peptide (pro-BNP) were risk factors predicting disease progression all p-values<0.05. In the multivariate logistic regression analysis, it was found that fever, NLR, and D-dimer could be used to predict the disease progression (p<0.05). In the ROC analysis, the sensitivity of NLR was 83.3%, specificity 57.5%, and cut-off >3.545 [area under curve (AUC)=0.752; p<0.001]; the sensitivity of pro-BNP was 71.8%, specificity 73.8%, and cut-off >332.8 (AUC=0.752; p<0.001), the sensitivity of troponin-T was 81.2%, specificity was 60.6%, and cut-off was >4.58 (AUC=0.730; p<0.001) in predicting progression. Conclusion: The identification of risk factors predicting progression is important in reducing morbidity and mortality rates. Fever, NLR, D-dimer troponin-T and pro-BNP are important parameters that can be used to predict progression.Öğe Clinical characteristics and transmission routes of COVID-19 in the early period of the pandemic in a non-covid ward of chest diseases hospital(2021) Karadeniz, Gülistan; Gayaf, Mine; Güldaval, Filiz; Ayrancı, Aysu; Batum, Özgür; Polat, Gülru; Tatar, DursunObjective: In the early stages of the outbreak, Covid patients were followed-up in isolated Covid Wards, and the examinations of other pulmonary diseases continued in Non-Covid wards. Differential diagnosis between COVID-19 and infections caused by other pathogens is not adequately recognized. For this reason, it is even more difficult to identify patients who are infected with SARS-CoV2 or other pathogens. In the present study, the clinical characteristics and transmission routes of the Covid-19 cases in Non-Covid Wards within approximately 2 months’ time after the onset of the pandemic were analyzed speculatively. Method: In the early periods of the pandemic, quarantine wards were created for Covid patients in Chest Diseases Hospital, but there were also changes in Non-Covid patients and new Non-Covid hospitalizations. The clinical characteristics and transmission routes of the Covid cases in Non-Covid Ward were examined retrospectively and observationally between 10.03.2020 and 30.04.2020. Results: During this period, a total of 35 Covid cases were detected as a patient, companion and healthcare employees. The median age of the patients was 50 years (min-max 25-85). There were 17 patients (48.6%) who were not severe, and 18 severe patients (51.4%), and 10 (28.6%) patients died. A total of 25 (71,4%) of infected cases were verified with the SARS-CoV-2 Nucleic Acid Test, and 10 (28,6%) were diagnosed clinically and radiologically as possible COVID-19 cases. Being 65 years old or over, having comorbid diseases, especially COPD, the presence of dyspnea as a symptom and involvement on chest radiography were found to be significantly associated with survival (p0.027, 0.009, 0.038, 0.000 and 0.033, respectively). Lymphopenia, increase in neutrophil count, CRP and NLR value were found to be statistically related to survival (p 0.005, 0.001, 0.014 and 0.000, respectively). We found 4 super spreaders, one of whom was a companion, and 3 patients. Conclusion: Potential “super spreaders” can be the source of infection before the quarantine conditions are applied and comprehensive protection is implemented. For this reason, quarantine, use of personal protective equipment, application of social distancing, and the implementation of comprehensive preventive measures, such as disinfection, are crucial in controlling nosocomial infection.Öğe Clinical effects of T790M mutation in EGFR tyrosine kinase inhibitor resistant NSCLC patients(2021) Anar, Ceyda; Kömürcüoğlu, Berna; Polat, Gülru; Büyükşirin, Melih; Batum, Özgür; Erdoğan, Kadri Murat; Güldaval, FilizINTRODUCTION: To compare patient characteristics between the T790M-positive and T790M-negative populations, and to analyze the post-progression survival (PPS) after initial tyrosine kinase inhibitor (TKI) failure in order to investigate the prognosis in patients undergoing rebiopsy. METHODS: We investigated the patient characteristics, including the initial EGFR-TKI response and T790M status at the time of rebiopsy or liquid biopsy, subsequent treatment after resistance to the initial EGFR-TKI (the presence of EGFR-TKI re-challenge), treatment just before biopsy and/or rebiopsy (EGFR-TKIs or chemotherapy), the timing of the rebiopsy (just after the initial EGFR-TKI failure or others). RESULTS: No difference was found between the two groups with T790M mutation positive and negative in terms of age, gender, and metastasis location. Only patients with positive T790M mutation had higher progression after TKI use compared to negative ones (p: 0.000). The progression-free median survival in patients using TKI was 19.33 months in the group with T790M mutation and 22.25 months in the negative group. Overall survival was found to be 75 months and 27.5 months in the T790M positive and negative group, respectively, and this was statistically significant. (p: 0.009). DISCUSSION AND CONCLUSION: Overall survival was significantly longer in the T790M positive group than in the T790M negative group. In addition, liquid biopsy can be performed several times for patients with progression after EGFR-TKI use and who do not want to undergo tissue biopsyÖğe Do the Amount of Fluid, Histopathology, Radiology and Pleurodesis Status Affect the Survival in Malignant Pleural Effusions?(2021) Büyükşirin, Melih; Tatar, Dursun; Karadeniz, Gülistan; Polat, Gülru; Aksel, Nimet; Güldaval, Filiz; Üçsular, Fatma DemirciINTRODUCTION: The primary objective of this study was to identify the most common pleural malignancies leading to malign pleural effusion (MPE). The secondary objective was to evaluate the relationship between the amount of fluid and radiological findings, etiologies, treatment methods and survival. METHODS: We retrospectively included cases of MPE with a tissue diagnosis. RESULTS: The most common causes of MPE were lung cancer (73%), breast cancer (8.3%) and mesothelioma (7%). In patients who were offered chemical pleurodesis, pleurodesis was successful in nearly 31.1%. No relation wasfound between the amount of pleural fluid and cell type,survival, pulmonary, extrapulmonary malignancy and mesothelioma, Patients live longer if pleurodesis was successful (p = 0.005). Median survival of patients with MPE due to pulmonary, extrapulmonary and mesothelioma, ORCID: 0000-0002-8939-336X respectively were 77 ± 12.8, 150 ± 48.4 and 365 ± 0 days. The survival of the patients with mesothelioma was significantly longer than others (P: 0.000). DISCUSSION AND CONCLUSION: The main cause of MPE was lung cancer, followed by breast cancer, unknown primary and mesothelioma. Chemical pleurodesis was a viable palliative measure for MPE. Successful pleurodesis had a significant contribution to the survival.Öğe Effect of host risk factors in identifying mortality in COVID-19 pneumonia and a new COVID-19 mortality index: Co-AMSCA(Kare Publ, 2022) Gayaf, Mine; Anar, Ceyda; Polat, Gülru; Ayrancı, Aysu; Güldaval, Filiz; Karadeniz, Gülistan; Batum, ÖzgürBACKGROUND AND AIM: The purpose of the study was to examine the host risk factors related to mortality in patients hospitalized with coronavirus disease 2019 (COVID-19) pneumonia and to find a COVID-19 mortality score based on these factors. METHODS: Subjects hospitalized with COVID-19 pneumonia between March 11, 2020, and October 1, 2020, were retrospectively analyzed. The age, gender, smoking status, body mass index, blood group, severity of pneumonia, comorbidity, reverse transcriptase-polymerase chain reaction positivity, use of angiotensin-converting enzyme (ACE) inhibitors, radiological changes, and mortality rates of the patients who had proven COVID-19 pneumonia were recorded. Patients were divided into two groups according to mortality status, and the two groups were compared. The cutoff values, sensitivity and specificity values, and odds ratios were calculated to predict mortality of the new scoring system. RESULTS: A total of 422 patients (51 mortal and 371 nonmortal) participated in the study. The univariate regression analysis showed that age, male gender, smoking, comorbidity, and using ACE inhibitors were prognostic host risk factors for COVID-19-related mortality. A new scoring model with the combination of risk factors named Co-AMSCA was created in the study. The cutoff value of the system was found to be 3.5 with 88.4% sensitivity and 65.5% specificity. The mortality risk in patients with a Co-AMSCA mortality score above 3.5 points was 7.8 times higher than that in patients whose score was lower than 3.5 points. In multivariate logistic regression analysis, older age and smoking were significant risk factors for mortality. CONCLUSIONS: A mortality score was created based on host risk factors, which are easy to calculate and do not need laboratory tests and do not waste the time of the clinicians. This study showed that by using Co-AMSCA scoring model, it is possible to achieve a mortality prediction in COVID-19 patients who are hospitalized due to pneumonia.Öğe Is Bacterial Profile and Antibiotics Resisance Changed in The Patients with Lower Respiratory tract İnfeciton Hospitalized to Tertiary Chest Diseases Hospital?(Bolu Abant İzzet Baysal Üniversitesi, 2023) Polat, Gülru; Şenol, Güneş; Ayrancı, Aysu; Unat, Damla Serçe; Güldaval, Filiz; Türk, Merve Ayık; Topaloğlu, İhsanObjective: Lower respiratory tract infections (LRTIs) are a major cause of mortality and morbidity in hospital admissions and inpatients. In this study, it was aimed to investigate the isolated factors, antibiotic resistance rates, previous hospitalization, and antibiotic use of patients in hospitalized LRTI cases. Materials and Methods: In this study, the demographic and clinical characteristics, microbiological features of the patients who were hospitalized with the diagnosis of LRTI and found to have growth in the cultures of the respiratory tract samples between 2013-2018 were investigated using a cross-sectional descriptive method. Results: We analyzed 484 agents isolated from 469 patients and their antibiotic resistance profiles. The mean age of the cases was 63.9 years. The most isolated agent was Pseudomonas aeruginosa (n= 220; 45.5%). One (6%) penicillin and three (17%) macrolide resistant isolates were detected in 17 isolated strains of S. pneumonia. H. influenza was isolated in 34 cases. In the case, 8% ampicillin and 12% quinolone resistance were reported. Conclusion: We concluded that when starting empirical antibiotic therapy, it is necessary to consider increasing quinolone resistance and P. aeruginosa being the causative agent in almost half of the cases, questioning the frequency of previous hospitalizations and antibiotic use, and considering local antibiotic resistance patterns.Öğe Prognostic effects of neutrophil-lymphocyte rates in serum and pleural fluids in malignant pleural fluids(2021) Ayrancı, Aysu; Yavuz, Melike Yüksel; Anar, Ceyda; Karadeniz, Gülistan; Polat, Gülru; Büyükşirin, Melih; Güldaval, FilizObjective: Various studies have reported that the neutrophil-to-lymphocyte ratio in the serum (sNLR) may serve as a cost-effective and useful prognostic factor in patients with various cancer types. We investigated the clinical impact of NLR as a prognostic factor in malign pleural effusion (MPE) and sNLR on prognosis in MPE. Method: We retrospectively reviewed all of the patients who were diagnosed MPE. The relationship between sNLR and neutrophil-to-lymphocyte ratio in the malign pleural effusion (mNLR) value, age, Eastern Cooperative Oncology Group (ECOG), histopathologic type, serum albumin and lactate dehydrogenase (LDH) with survival were investigated. Results: A total of 222 patients with a mean age of 65.7±11.5 were included in the study. Patients with a mNLR value ?0.42 and a serum NLR value ?4.75 had a shorter survival (p: 0.000). Multivariate analysis, which showed that survival was significantly related mNLR value > 0.42 and/or sNLR value > 4.75 (Odds Ratio (OR): 2.66, %95 CI, 1,65-4,3 p: 0.001), serum LDH > 210 (OR = 1.8, %95 CI, 1,33-2,46 p: 0.001) and age > 65 (OR = 1.9, %95 CI, 1,41-2,55 p = 0.001). Conclusion: sNLR and mNLR may act as a simple, useful, and cost-effective prognostic factor in patients with MPE. Furthermore, these results may serve as the cornerstone of further research into the mNLR in the future. Although further studies are required to generalize our results, this information will benefit clinicians and patients in determining the most appropriate therapy for patients with MPE.Öğe What are the differences between smoker and non-smoker COPD cases? is it a different phenotype?(2021) Güldaval, Filiz; Polat, Gülru; Doruk, Sibel; Karadeniz, Gülistan; Ayrancı, Aysu; Türk, Merve; Anar, CeydaOBJECTIVE: The most important risk factor for chronic obstructive pulmonary disease (COPD) is smoking. However, more than 25% of patients do not have a history of smoking. The intent of this study is to identify characteristics of COPD patients that are non-smokers.MATERIAL AND METHODS: The records of patients with COPD were retrospectively reviewed. Smoking history, comorbidities, exacerbations, biomass, and environmental tobacco smoke (ETS) exposures were identified. Also, age, gender, pulmonary function test (PFT) values, modified Medical Research Council (mMRC) dyspnea scores were recorded. Non-smokers exposed to any of the COPD risk factors above were grouped and the data were analyzed to determine the specific characteristics of COPD that applied to them.RESULTS: A total of 706 COPD patients were analyzed with a mean age of 67.2 ± 9.4. Of these patients, 93 (13.2%) were female and 613 (86.8%) were male. Of the 706 patients, 128 (18.1%) were non-smokers. The percentage of male patients having COPD was significantly lower in the non-smoker group (P < .001). However, biomass, ETS exposure in childhood, and a history of previous respiratory infection were significantly higher in the non-smoker group (P < .001). The mean body mass index (BMI) was greater in non-smokers than smokers.CONCLUSION: Non-smokers with COPD have more biomass, ETS exposure, and infection history in childhood. They also have less impairment of airflow limitation, better symptom scores, and greater BMIs. Smoking history can be used to determine a different phenotype.
