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Öğe Airway inflammatory markers in chronic obstructive pulmonary disease patients and healthy smokers(Medknow Publications & Media Pvt Ltd, 2013) Hacievliyagil, S. S.; Mutlu, Levent Cem; Temel, İlkbalBackground: Cigarette smoke with its toxic ingredients leads to chronic inflammations in the airways. Objectives: In this study, the effect of cigarette smoke on the levels of inflammatory markers, interleukin-6 (IL-6), interleukin-8 (IL-8), and tumor necrosis factor-alpha (TNF-) in induced sputum was investigated. Materials and Methods: Twenty patients with chronic obstructive pulmonary disease (COPD) (group I), 20 healthy smokers (group II), and 20 healthy nonsmokers (group III) were included in the study. The levels of IL-6, IL-8, and TNF- in induced sputum were measured in these groups, and comparison analysis between the groups and correlation analysis for smoking load (pack-years) and spirometric parameters were performed. Results: Mean age of the patients in groups I, II, and III were 61.2 1.7, 58.2 1.6, and 59.1 5.4 years, respectively (P > 0.05). Smoking loads of group I and group II were 38.6 2.1 and 29.5 2.3 pack-years, respectively (P < 0.05). All cytokine levels were significantly higher in group I than groups II and III (P < 0.05). In addition to this, mean cytokines levels were significantly higher in group II than group III (P < 0.05). Smoking load of group II subjects was positively correlated with IL-6, IL-8, and TNF- in induced sputum (P < 0.05). Conclusions: We found that inflammatory marker levels in induced sputum were significantly higher in COPD patients and smokers than nonsmokers. Moreover, there was a moderate positive correlation between IL-6, IL-8, and TNF- levels and smoking load in the healthy smokers. We think that further studies are needed to determine whether higher levels of cytokine levels in sputum might be helpful in predicting the healthy smokers who will develop COPD in future.Öğe Assesment of palliative care in lung cancer in Turkey (ASPECT study)(European Respiratory Soc Journals Ltd, 2015) Bülbül, Yılmaz; Özlu, Tevfik; Arınç, Sibel; Özyürek, Berna A.; Günbatar, Hülya; Şentürk, Ayşegül; Talay, Fahrettin; Mutlu, Levent Cem[No Abstract Available]Öğe Assessment of Palliative Care in Lung Cancer in Turkey(Karger, 2017) Bülbül, Y.; Özlu, T.; Arınç, Sibel; Özyürek, Berna A.; Günbatar, Hülya; Şentürk, Ayşegül; Talay, F.; Mutlu, Levent CemObjective: To investigate the symptoms of lung cancer in Turkey and to evaluate approaches to alleviate these symptoms. Subjects and Methods: This study included 1,245 lung cancer patients from 26 centers in Turkey. Demographic characteristics as well as information regarding the disease and treatments were obtained from medical records and patient interviews. Symptoms were evaluated using the Edmonton Symptom Assessment Scale (ESAS) and were graded on a scale between 0 and 10 points. Data were compared using the. 2, Student t, and Mann-Whitney U tests. Potential predictors of symptoms were analyzed using logistic regression analysis. Results: The most common symptom was tiredness (n = 1,002; 82.1%), followed by dyspnea (n = 845; 69.3%), appetite loss (n = 801; 65.7%), pain (n = 798; 65.4%), drowsiness (n = 742; 60.8%), anxiety (n = 704; 57.7%), depression (n = 623; 51.1%), and nausea (n = 557; 45.5%). Of the 1,245 patients, 590 (48.4%) had difficulty in initiating or maintaining sleep. The symptoms were more severe in stages III and IV. Logistic regression analysis indicated a clear association between demographic characteristics and symptom distress, as well as between symptom distress (except nausea) and well-being. Overall, 804 (65.4%) patients used analgesics, 630 (51.5%) received treatment for dyspnea, 242 (19.8%) used enteral/parenteral nutrition, 132 (10.8%) used appetite stimulants, and 129 (10.6%) used anxiolytics/antidepressants. Of the 799 patients who received analgesics, 173 (21.7%) reported that their symptoms were under control, and also those on other various treatment modalities (dyspnea: 78/627 [12.4%], appetite stimulant: 25/132 [18.9%], and anxiolytics/antidepressants: 25/129 [19.4%]) reported that their symptoms were controlled. Conclusion: In this study, the symptoms progressed and became more severe in the advanced stages of lung cancer, and palliative treatment was insufficient in most of the patients in Turkey. (C) 2016 S. Karger AG, BaselÖğe Association between drug resistant hypertension and increased osteoprotegerin levels in hypertensive male patients with non obstructive sleep apnea(Carbone Editore, 2014) Akyüz, Aydın; Oran, Mustafa; Alpsoy, Şeref; Mutlu, Levent Cem; Değirmenci, Hasan; Küçükyalçın, Volkan; Alp, RecepObjectives: Increased carotid intima-media thickness (IMT) reflects subclinical vascular damage and is related to obstructive sleep apnea (OSA) syndrome and hypertension. Osteoprotegerin OPG is a member of the tumor necrosis factor superfamily and increases leukocyte adhesion. The relationship between increased OPG and atherosclerosis is Well known, but there is still no evidence whether there is an association between OPG and resistant hypertension. This study investigated the association between OPG and drug resistant hypertension in patients With OSA and non-OSA. Patients and methods: We investigated the association between serum OPG levels and carotid IMT in patients With drug resistant hypertensive OSA (ODR) patients (n= 39) and drug resistant hypertensive non-OSA(NODR) patients (n=34) and drug-responsive hypertensive non-OSA controls (n=36). Results: OPG levels and carotid IMT were found to be higher in the ODR [12.4(5.9-19.5) and 0.89 +/- 0.51 and in the NODR group [11.9(5.7-17.6) and 0.88 +/- 0.6] compared with the controls [8.4(4.8-16.5) pmollL and 0.73 +/- 0.8 um], (p= 0.01 and p=0.01 for OPG and p<0.01 and p<0.01 for carotid IMT). The carotid IMT was positively correlated with OPG levels in the ODR. group (r=0.412, p=0.016) and in the NODR group(r=0.321, p=0.024) and with apnea hypopnea index (r=0.462, p<0.001) in the ODR. There was no correlation between OPG and apnea-hypopnea index (r=0.07, p=0.564) in the ODR group. Conclusions: Increased serum OPG levels were associated with subclinical carotid atherosclerosis in patients with ODR and NODR, but not with drug-response non-OSA controls.Öğe Association Between Serum Fetuin-A levels, Carotid Artery Stiffness, and Intima-Media Thickness in Patients With Normotensive Obstructive Sleep Apnea Syndrome(Sage Publications Inc, 2014) Akyüz, Aydın; Oran, Mustafa; Alpsoy, Şeref; Mutlu, Levent Cem; Akkoyun, Dursun Çayan; Güzel, Savaş; Alp, RecepIncreased carotid intima-media thickness (cIMT) and stiffness, reflecting subclinical atherosclerosis, are associated with obstructive sleep apnea syndrome (OSAS). The relationship between serum fetuin-A, which inhibits ectopic calcification, and atherosclerosis is unclear. Therefore, we investigated the association between serum fetuin-A levels and carotid artery stiffness and cIMT in patients with normotensive OSAS (n = 50) and non-OSAS controls (n = 38). Compared with controls, there were lower fetuin-A levels (59.4 +/- 6.5 vs 68.2 +/- 5.8 ng/mL, P = .029), higher mean cIMT (0.73 +/- 0.2 vs 0.63 +/- 0.3 mm, P < .001), and greater stiffness (beta) index (7.45 +/- 0.9 vs 5.2 +/- 0.7, P = .001) in the OSAS group. The cIMT and stiffness (beta) index were inversely correlated with fetuin-A levels (r = -.324, P = .033; r = -.466, P < .001, respectively) and positively correlated with apnea hypopnea index (r = .498, P < .001; r = .422, P = .001, respectively) in the OSAS group. Decreased serum fetuin-A levels were associated with subclinical carotid atherosclerosis in patients with normotensive OSAS.Öğe Asymmetric dimethylarginine contributes to airway nitric oxide deficiency in patients with COPD(Wiley, 2017) Aydın, Murat; Altıntaş, Nejat; Mutlu, Levent Cem; Bilir, Bülent; Oran, Mustafa; Tülübaş, Feti; Gürel, AhmetIntroductionAsymmetric dimethylarginine (ADMA) and nitric oxide (NO) show their mechanism of action reciprocally, the balance between these molecules contributes to the tight regulation of airways tone and function. ObjectivesThe aim of this study to determine the serum levels of ADMA and NO in patients with chronic obstructive pulmonary disease (COPD) and establish whether their level vary in relation to forced expiratory volume in 1s (FEV1), to assess their role in pathophysiology of COPD. Materials and MethodsThis study consisted of 58 patients with COPD and 30 healthy subjects. Serum ADMA and NO levels were measured using enzyme-linked immunosorbent assay and the colorimetric method, respectively. ResultsSerum ADMA levels were significantly higher, however, NO levels were lower in patients with COPD compared with controls. ADMA levels were inversely correlated with NO levels. Serum ADMA and NO were significantly correlated with FEV1. Multivariable logistic regression analysis revealed that serum ADMA and NO were independently and significantly associated with the presence of COPD. Multiple linear regression analysis showed that COPD was positively associated with ADMA, additionally COPD and ADMA were independently and inversely associated with NO. NO levels were decreased, ADMA levels were increased compliant with progression of COPD stages. ConclusionWhile circulating ADMA is higher, NO is lower in COPD and both show a strong correlation to the degree of airflow limitation. ADMA seems to be a possible new marker of prognosis of COPD and can be a novel therapeutic target for the treatment of COPD.Öğe Asymmetric dimethylarginine contributes to airway nitric oxide deficiency in patients with COPD (Meeting Abstract)(European Respiratory Soc Journals Ltd, 2015) Aydın, Murat; Altıntaş, Nejat; Mutlu, Levent Cem; Bilir, Bülent; Oran, Mustafa; Tukubas, Feti; Topçu, Birol[No Abstract Available]Öğe Carotid intima-media thickness in chronic obstructive pulmonary disease and survival: A multicenter prospective study(Wiley, 2019) Gulbas, Gazi; Turan, Onur; Sarıoğlu, Nurhan; Diken, Özlem Ercen; Ogan, Nalan; Kadioglu, Esra Ekbic; Suerdem, Mecit; Mutlu, Levent CemIntroduction Chronic obstructive pulmonary disease (COPD) is associated with increased cardiovascular morbidity and mortality. Carotid intima-media thickness (CIMT) is a noninvasive method assessing atherosclerosis. Objective It was aimed to determine relationship and survival between COPD and CIMT. Methods CIMT was measured using Doppler ultrasound (USG) in 668 stable COPD patients at 24 centers. Patients were followed-up for 2 years. Results There were 610 patients who completed the study. There were 200 patients CIMT with <0.78 mm (group 1), and 410 with CIMT >= 0.78 mm (group 2). There was a significant difference at the parameters of age, gender, smoking load, biomass exposure, GOLD groups and degree of airway obstruction (FEV1) between groups 1 and 2. Our results revealed positive correlations between mean CIMT and age, smoking load (pack-years), biomass exposure (years), exacerbation rate (last year), duration of hypertension (years) and cholesterol level; negative correlations between CIMT and FEV1 (P < 0.05). According to logistic regression model, compared with group A, risk of CIMT increase was 2.2-fold in group B, 9.7-fold in group C and 4.4-fold in group D (P < 0.05). Risk of CIMT increase was also related with cholesterol level (P < 0.05). Compared with infrequent exacerbation, it was 2.8-fold in the patients with frequent exacerbation (P < 0.05). The mean survival time was slightly higher in group 1, but not significant (23.9 vs 21.8 months) (P > 0.05). Conclusion This study is the first regarding CIMT with combined GOLD assessment groups. It has revealed important findings supporting the increase in atherosclerosis risk in COPD patients. We recommend Doppler USG of the carotid artery in COPD patients at severe stages.Öğe Childhood asthma and vitamin D deficiency in Turkey: is there cause and effect relationship between them?(Bmc, 2013) Uysalol, Metin; Mutlu, Levent Cem; Saraçoğlu Varol, Gamze; Karasu, Erkut; Güzel, Savaş; Kayaoğlu, Semra; Uzel, NedretBackground: Epidemiological studies show that vitamin D deficiency and insufficiency are common worldwide and associated with many diseases including asthma. Our aim was to evaluate vitamin D insufficiency and its clinical consequences. Methods: This cross-sectional study was carried out on 170 children consisted of 85 who were asthmatic and 85 who were not, aged 2 to 14 years in Tekirdag, Turkey, from September 2009 to May 2010. Children's basal serum D vitamin levels were determined, and their eating habits, vitamin D intake, exposure to sunlight and use of health services during the previous year were investigated. The severity of asthma and levels of asthma control were assessed according to the Global Initiative for Asthma guidelines. Results: The difference between mean vitamin D levels in the asthmatic group (mean +/ SD) 16.6 +/ 8.5 ng/mL and the healthy control group (mean +/- SD) 28.2 +/- 19.5 ng/mL was found to be statistically significant (p < 0.001). Children in the asthma group had less exposure to sunlight and ate a diet less rich in vitamin D (p < 0.001). A significant difference was observed between the groups regarding the frequency of respiratory tract infections leading to emergency unit admissions and number of hospitalizations (p < 0.001). It was also shown that a decrease in vitamin D level increased the severity of asthma (p < 0.001) and decreased the frequency of controlled asthma (p = 0.010). Conclusion: This study has demonstrated the correlation between plasma 25 (OH) D levels and childhood asthma. Evidently, this relationship being influenced by multiple factors other than vitamin D, further studies should be conducted to explore the interrelation between all such factors.Öğe Cystic fibrosis diagnosed in a nineteen-year-old case(2023) Yılmaz, Meltem; Mutlu, Levent CemCystic fibrosis is the most common autosomal recessive hereditary disease in white populations. It is characterized by the formation of abnormal secretions in the exocrine glands located in the sweat and salivary glands, tracheobronchial tree, large intestine, and pancreas. The severity of the clinic depends on the type of \"cystic fibrosis transmembrane regulatory protein\" gene mutation. Although most cases are diagnosed in infancy or childhood, some patients are also diagnosed during adolescence and adulthood. We report a case of a 19-year-old patient who was followed up with a diagnosis of asthma and bronchiectasis since childhood and diagnosed with cystic fibrosis.Öğe Demographic and Asthma-Related Characteristics of Asthmatics Using Pressurized Metered Dose Inhalers and Dry Powder Inhalers(Mary Ann Liebert, Inc, 2024) Aksu, Kurtulus; Solak, Gurgun Tugce Vural; Mutlu, Levent Cem; Mutlu, Pinar; Sahin, Gorkem Vayisoglu; Ture, Ezgi Erdem; Yormaz, BurcuBackground: Asthma controller medications can be delivered via pressurized metered dose inhaler (pMDI) or dry powder inhaler (DPI) devices.Objective: This study aimed to evaluate the frequency of exacerbations and satisfaction rate with device use in asthmatics using pMDIs or DPIs.Methods: A multicenter, cross-sectional study was conducted in adults who used pMDIs or DPIs with correct inhaler technique and good adherence for asthma treatment. Demographic and asthma-related characteristics of the subjects and data regarding device satisfaction were collected through a face-to-face interview in the outpatient clinic. Rates of pMDI and DPI users and the data were compared between the two groups.Results: The study included 338 patients (mean age: 48.6 +/- 14.5 years, 253 [74.9%] women). Among participants, 96 (28.4%) were using pMDI and 242 (71.6%) were using DPI. The age of patients using pMDI were significantly lower compared with DPI users. No significant difference was observed in terms of device satisfaction and clinical outcomes of asthma between pMDI and DPI users with good inhaler technique and good adherence.Conclusion: More asthmatics use DPIs, however, pMDIs are used in younger asthmatic patients. No significant difference in terms of device satisfaction and clinical outcomes of asthma was observed between pMDI and DPI users.Öğe Desquamative interstitial pneumonia: Risk factors, laboratory and bronchoalveolar lavage findings, radiological and histopathological examination, clinical features, treatment and prognosis(Spandidos Publ Ltd, 2019) Diken, Özlem Ercen; Şengül, Aysun; Beyan, Ayse Coskun; Ayten, Omer; Mutlu, Levent Cem; Okutan, OguzhanDesquamative interstitial pneumonia is a type of smoking-associated major idiopathic interstitial pneumonia, which is characterized by accumulation of alveolar macrophages in alveolar lumens and septa and develops secondary to mainly active or passive exposure to cigarette smoke. Desquamative interstitial pneumonia mostly occurs in male smokers in association with non-specific symptoms responsive to steroid therapy and has a better prognosis than usual interstitial pneumonia. To date, no large-scale clinical studies have been performed on desquamative interstitial pneumonia patients. Factors responsible for the scarcity of data on the clinical course of this condition include the retrospective nature of the available information as well as its rare occurrence. Despite this, a general consensus exists as to the nature of its symptoms, association with smoking, age and gender distribution, findings of respiratory function tests, steroid responsivity and mortality. The objective of the present review article was to report on desquamative interstitial pneumonia and to describe its etiology, risk factors and clinical features, as well as the laboratory, bronchoalveolar lavage, radiological and histopathological findings, and the treatment and prognosis of affected patients.Öğe Effect of CPAP on Hemocyte Profile C-reactive Protein and Fibrinogen Levels in People with Obstructive Sleep Apnea(Galenos Publ House, 2023) Yilmaz, Meltem; Mutlu, Levent CemAim: Obstructive sleep apnea syndrome (OSAS) is a common sleep disorder characterized by repeated episodes of apnea and hypopnea during sleep. The repetitive hypoxemic and hypercapnic events can lead to increased proinflammatory cytokine production, endothelial dysfunction, oxidative stress, metabolic dysregulation, and insulin resistance in OSAS patients. In previous studies, some of the hemogram values increased in patients with OSAS and a decrease in these increased values was observed with continuous positive airway pressure (CPAP) treatment. CPAP is the most effective method for treating OSAS and alleviating the patients' symptoms. The aim of this study was to assess the effect of three-month CPAP therapy hemocyte profile in people with OSAS. Materials and Methods: Forty patients were included in the study. Data including clinical assessment, full previous polysomnography reports, and baseline and after CPAP therapy, complete blood profile (leukocytes, neutrophils, lymphocytes, hemoglobin, hematocrit, platelets, MPV, PDW, MCV, N/L, and P/L, CRP and fibrinogen) of the participants were collected from the electronic medical record. Results: All patients who completed the study were CPAP compliant (5.53 +/- 0.39 h/night). After three months of CPAP treatment, the mean levels leukocytes, lymphocytes, hemoglobin, hematocrit, MPV, MCV, N/L, and P/L, CRP and fibrinogen were significantly decreased compared to baseline values. Conclusion: Our study showed significant decrease in hemoglobin, hematocrit, leukocyte, lymphocyte, MPV, MCV, N/L, and P/L, CRP and fibrinogen after three-month CPAP therapy.Öğe Effect of CPAP on New Endothelial Dysfunction Marker, Endocan, in People With Obstructive Sleep Apnea(Sage Publications Inc, 2016) Altıntaş, Nejat; Mutlu, Levent Cem; Akkoyun, Dursun Çayan; Aydın, Murat; Bilir, Bülent; Yılmaz, Ahsen; Malhotra, AtulObstructive sleep apnea (OSA) is associated with increased cardiovascular (CV) morbidity and mortality. Endocan is a surrogate endothelial dysfunction marker that may be associated with CV risk factors. In this study, we tested whether serum endocan is a biomarker for OSA. Serum endocan levels were measured at baseline in 40 patients with OSA and 40 healthy controls and after 3 months of continuous positive airway pressure (CPAP) treatment in the patients with OSA. All participants were evaluated by full polysomnography. Flow-mediated dilatation (FMD) and carotid intima media thickness (cIMT) were measured in all participants. Endocan levels were significantly higher in patients with OSA than in healthy controls. After adjusting confounders, endocan was a good predictor of OSA. Endocan levels correlated with OSA severity (measured by the apnea-hypopnea index [AHI]). After 3 months of CPAP treatment, endocan levels significantly decreased. Endocan levels were significantly and independently correlated with cIMT and FMD after multiple adjustments. The cIMT and FMD also had significant and independent correlation with AHI. Endocan might be a useful marker for the predisposition of patients with OSA to premature vascular disease.Öğe Expert Opinion on Practice Patterns in Mild Asthma After the GINA 2019 Updates: A Major Shift in Treatment Paradigms from a Long-Standing SABA-Only Approach to a Risk Reduction-Based Strategy with the Use of Symptom-Driven (As-Needed) Low-Dose ICS/LABA(Current Medicine Group, 2022) Özşeker, Zeynep Ferhan; Aksu, Kurtuluş; Mutlu, Levent Cem; Mutlu, Pınar; Öztürk, CanPurpose of Review This expert opinion, prepared by a panel of chest disease specialists, aims to review the current knowledge on practice patterns in real-life management of mild asthma and to address the relevant updates in asthma treatment by The Global Initiative for Asthma (GINA) to guide clinicians for the best clinical practice in applying these new treatment paradigms. Recent Findings On the basis of the emerging body of evidence suggesting the non-safety of short-acting beta 2-agonists (SABA)-only therapy and comparable efficacy of the as-needed inhaled corticosteroids (ICS)-formoterol combinations with maintenance ICS regimens, GINA recently released their updated Global Strategy for Asthma Management and Prevention Guide (2019). The new GINA 2019 recommendations no longer support the SABA-only therapy in mild asthma but instead includes new off-label recommendations such as symptom-driven (as-needed) low-dose ICS-formoterol and low dose ICS taken whenever SABA is taken. The GINA 2019 asthma treatment recommendations include a major shift from long-standing approach of clinical practice regarding the use of symptom-driven SABA treatment alone in the management of mild asthma. This expert opinion supports the transition from a long-standing SABA-only approach to a risk reduction-based strategy, with the use of symptom-driven (as-needed) low-dose ICS/LABA in mild asthma patients, particularly in those with poor adherence to controller medications. The thoughtful and comprehensive approach of clinicians to these strategies is important, given that the exact far-reaching impact of this major change in management of mild asthma in the real-world settings will only be clarified over time.Öğe Genetic Risk Factors in Chronic Obstructive Pulmonary Disease(Wolters Kluwer Medknow Publications, 2012) Mutlu, Levent Cem; Guelbas, Gazi; Günen, HakanThe role of genetic factors in development of chronic obstructive pulmonary disease (COPD) is accepted in general. However, other than alpha-1 antitrypsin deficiency which alone can lead to COPD, the studies performed longer than half a century did not yield any certain result on the genetics of COPD. Regarding the data available, it can be said that addition of environmental factors like cigarette smoking on interrelations between genetic abnormalities are responsible for COPD development. No doubt that the role of genetics on COPD development will continue to be one of the important research issues in future too.Öğe Growth Differentiation Factor-15 Is a Novel Biomarker Predicting Acute Exacerbation of Chronic Obstructive Pulmonary Disease(Springer/Plenum Publishers, 2015) Mutlu, Levent Cem; Altıntaş, Nejat; Aydın, Murat; Tülübaş, Feti; Oran, Mustafa; Küçükyalçın, Volkan; Kaplan, Gizem; Gürel, AhmetExacerbations in chronic obstructive pulmonary disease (COPD) reduce quality of life and are associated with a more rapid deterioration of the disease. Growth differentiation factor-15 (GDF-15) is a novel candidate exacerbation biomarker. In this study, we aimed to assess GDF-15 as a biomarker of acute exacerbation of COPD (AE-COPD). Lung function parameters, arterial blood gas analysis, and circulating levels of GDF-15, C-reactive protein (CRP), and fibrinogen were assessed in 29 patients on admission to the hospital for AE-COPD, in 29 age-, gender-, and body mass index (BMI)-matched patients with stable COPD, and 29 matched controls with normal lung function. Patients with AE-COPD had higher circulating concentrations of GDF-15 (p < 0.001), CRP (p < 0.001), and fibrinogen (p < 0.002) compared with patients with stable COPD and healthy controls. GDF-15 levels correlated with systemic inflammatory marker CRP in patients with AE-COPD (r = 0.677, p < 0.001) and with stable COPD (r = 0.417, p = 0.024). Multivariate logistic regression analysis revealed GDF-15 (odds ratio 18.16, 95 % confidence interval (CI) 2.51-134.32; p = 0.005) as an independent predictor of AE-COPD. In receiver operating characteristic analysis, GDF-15 achieved an area under the curve of 0.78 for the identification of AE-COPD. In conclusion, GDF-15 is a novel blood biomarker of AE-COPD that is more sensitive than that of CRP. GDF-15 may offer new insights into the pathogenesis of AE-COPD.Öğe Kot kumlamaya bağlı olarak gelişen iki silikozis olgusu(2011) Ermiş, Hilal; Gülbaş, Gazi; Yumrutepe, Tuncay; İn, Erdal; Mutlu, Levent Cem; Günen, Hakan; Aydın, N. EnginBilinen en eski meslek hastalıklarından biri olan silikozis, solunabilir büyüklükteki silika kristallerinin akciğer dokusunda geri dönüşümsüz ve ilerleyici bir fibrotik reaksiyon oluşturması ile karakterize tedavisi olmayan bir hastalıktır. Son yıllarda özellikle küçük ve denetimsiz atölyelerde uygunsuz koşullarda yapılan kot kumlama işi hastalığın gelişiminde farklı bir işkolu haline gelmiştir. 3 yıldır kot kumlama işinde çalışan 20 ve 28 yaşlarında iki erkek hasta, nefes darlığı ve kilo kaybı şikayetleri ile kliniğimize başvurdu. Posteroanterior akciğer grafilerinde ve toraks bilgisayarlı tomografilerinde özellikle her iki üst ve orta zonlarda ve periferik bölgelerde yoğun yerleşimli, yaygın retikülonodüler ve nodüler opasiteler izlendi. Solunum fonksiyon testlerinde restriktif tipte ventilasyon bozukluğu saptandı. Birinci olgumuza transbronşiyal biyopsi ile silikozis tanısı kondu. İkinci olgu ise ilki ile benzer yakınmaları, radyolojik bulguları ve mesleksel maruziyet öyküsü nedeniyle ileri girişimsel inceleme yapılmadan tanı aldı. İş gücünün ucuz olduğu gelişmekte olan ülkelerde kot kumlama işinde çalışanlarda bir toplum sağlığı sorunu haline gelen silikozis çalışma şartlarının düzeltilmesi ile önlenebilir. Kotlar beyazlarken kararan hayatlara son vermek için daha fazla önlem alınması gerektiği inancındayız.Öğe Kronik obstrüktif akciğer hastalığında genetik risk faktörleri(2012) Mutlu, Levent Cem; Gülbaş, Gazi; Günen, HakanKronik obstrüktif akciğer hastalığı (KOAH) oluşumunda genetik faktörlerin rolünün önemli olduğu fikri genel olarak kabul edilmektedir. Bununla birlikte, yarım asırdan uzun süredir yapılan birçok çalışmadan ?-1 antitripsin eksikliğinin tek başına KOAHa yol açabileceği bilgisi dışında kesin bir sonuç elde edilememiştir. Elimizdeki veriler ışığında, birçok gen bozuklukları arasındaki etkileşimlerin üstüne eklenen sigara dumanı gibi çevresel faktörlerin KOAH oluşumdan sorumlu olduğu söylenebilir. Şüphesiz gelecekte de KOAH oluşumunda genetik risk faktörleri, üzerinde en fazla çalışılan konulardan biri olmaya devam edecektir.Öğe Kronik Obstrüktif Akciğer Hastalığında Solunum Fonksiyonlarının ve Pulmoner Arter Basıncının Sağ ve Sol Ventrikül Diyastolik Fonksiyonları Üzerine Etkisi(2013) Alpsoy, Şeref; Akyüz, Aydın; Akkoyun, Dursun Çayan; Oran, Mustafa; Mutlu, Levent Cem; Topçu, Birol; Yalçın, Banu ÇiçekGiriş: Bu çalışmada, kronik obstrüktif akciğer hastalığı (KOAH) olan kişilerde konvansiyonel ve doku Doppler ekokardiyografi yle sağ ve sol ventrikül diyastolik fonksiyonlarını değerlendirmeyi, solunum fonksiyonları ve pulmoner arter basıncının diyastolik fonksiyonlar üzerine etkisini araştırmayı amaçladık. Hastalar ve Yöntem: KOAH'lı 60 hasta ve 40 sağlıklı birey iki boyutlu, M-mode, konvansiyonel ve doku Doppler ekokardiyografi yle değerlendirildi. Tüm bireylere solunum fonksiyon testleri (SFT) ile birinci saniyedeki zorlu ekspiratuvar volüm [forced expiratory volume in 1 second (FEV)] ve zorlu vital kapasite [forced vital capacity (FVC)] tayini yapıldı. FEV, FEV/FVC ve ortalama pulmoner arter basıncı (OPAB) ile diyastolik fonksiyon parametreleri arasındaki ilişkiyi araştırmak için korelasyon ve regresyon analizi yapıldı.Bulgular: KOAH grubunda sağ ventrikül çapı ve serbest duvar kalınlığı daha fazla, triküspit E ve E/A, triküspit lateral annulus E' ve E'/A', mitral annulus septal E' ve E'/A' değerleri daha düşük, mitral E/mitral annulus septal E' değeri daha yüksekti (p değerleri < 0.05). FEVile triküspit lateral annulus E' ve E'/A' arasında pozitif korelasyon vardı. Triküspit E/A, triküspit lateral annulus E' ve E'/A', mitral annulus septal E' ve E'/A' değerleriyle FEV/FVC arasında pozitif, OPAB arasında negatif korelasyon vardı. Mitral E/mitral annulus septal E'değeriyle FEV/FVC arasında negatif, OPAB ile pozitif korelasyon vardı. FEV/FVC, triküspit lateral annulus E' ve E'/A', mitral annulus septal E' ve E'/A' için belirleyiciydi.Sonuç: KOAH hastalarında sağ ve sol ventrikül diyastolik fonksiyonları bozulmaktadır. Bu hastalarda, kronik hipoksi ve pulmoner basınç artışı sağ ve sol ventrikül diyastolik fonksiyon bozukluğu gelişmesinde etkili faktörlerdir.
