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Öğe A comparison of idiopathic pulmonary fibrosis and chronic hypersensitivity pneumonia in terms of anterior mediastinal fat properties(2022) Bulut, Sertan; Çelik, Deniz; Ertürk, Hakan; Karamanlı, Harun; Şahin, Mustafa Engin; Sönmez, Özlem; Biber, ÇiğdemAim: The shape and physical properties of the anterior mediastinum can be easily affected by inflammatory lung diseases, tuberculosis, empyema, radiotherapy, chronic fibrotic lung diseases, previous surgery, and after steroid therapy. We planned to compare the properties of anterior mediastinal fat (AMF) in 3 different groups: patients with idiopathic pulmonary fibrosis (IPF), patients with chronic hypersensitivity pneumonia (cHP), and in the healthy control group. We investigate the AMF shape, dimensions, and AMF area properties on the images of high-resolution computed tomography (HRCT) and to find any difference between IPF and cHP patients in terms of AMF. Material and Method: The study comprises a total of 80 cases in the three groups. The first group comprises 26 cases diagnosed as IPF. The second group comprises 19 cases diagnosed as cHP. The third group comprises 35 control patients. The clinical, demographical, and AMF characteristics on HRCT were retrospectively evaluated. The AMF shape and area characteristics were compared between the three groups. Results: There was no statistical difference between the mean ages of cases, BMIs, and smoking status in IPF, cHP, and control groups. Gender distribution was found statistically significant between the 3 groups (p=0.001). A statistically significant difference was observed between the IPF and cHP groups in terms of FVC levels (2.67±0.59, 2.14±0.80, respectively; p=0.024). Also, a statistically significant difference was observed between the IPF and cHP groups in terms of DLCO levels (57.42±17.21; 77.31±35.21; respectively; p=0.016). In the evaluation of AMF shape properties between two groups (cHP and IPF), the concave figure was significantly more frequent in cHP group (p=0.014). The AMF area analyses revealed that the IPF group’s areas were significantly greater than the cHP and control group’s. The AP dimension of AMF analyses revealed that only the cHP group’s dimensions were significantly smaller than the control group’s (p=0.037). In the analysis of the transverse dimension of AMF, the IPF group’s dimensions were significantly greater than the cHP and control group’s (p<0.0001 and p=0.007; respectively) and also the cHP group’s dimensions were significantly greater than the control group’s (p<0.0001). Conclusion: The transverse length, total AMF area, and shape characteristics of AMF can be evaluated as a radiological marker for differential diagnosis of IPF and cHP, whose differential diagnosis may be difficult. Both the transverse length and AMF area can take greater values in the IPF group than in the cHP group.Öğe Association between vitamin D levels and frequency of disease exacerbations and hospitalizations in patients with COPD(2022) Bulut, Sertan; Karamanlı, Harun; Şahin, Mustafa Engin; Çelik, Deniz; Biber, ÇiğdemIntroduction: Chronic obstructive pulmonary disease (COPD) is a debilitating disorder that restricts the physical activity of patients who are deprived of sunlight, which is a source of vitamin D. The purpose of this study was to assess the relationship between vitamin D and the frequency of exacerbation and hospitalization among patients with COPD. Material and Method: In the main analysis, 303 patients with COPD (stage GOLD A to D) were included in a retrospective cohort study in Turkey. Serum levels of vitamin D (25-hydroxyvitamin D) were measured in 303 patients with COPD and were associated with pulmonary function, AECOPD frequency and hospitalization in the previous year. Results: For COPD patients, the mean reference level of 25 hydroxyvitamin D in serum was 12.5 ng/dL. In comparison to patients with a serious 25-hydroxyvitamin D deficiency (< 10 ng/dL, n=119 [39,3%]), patients with a moderate deficiency (10-19.99 ng/dL, n=100 [33%]), inadequate levels (20-29.99 ng/dL, n=49 [16,2%]) presented a different risk of exacerbation (incidence rate ratio, 2.3 [95% CI, 1.9-2.6], 1.6 [95% CI, 1.2-2.0], and 0.8 [95% CI, 0.3-1.2] respectively). In patients with desirable levels (> 30 ng/dL, n=34 [11,2%]), the risk was lower but not significant (incidence ratio, 0.7 [95% CI, 0.2-1.2]. In COPD patients, 25-hydroxyvitamin D rates are low correlated with 1-s forced expiratory volume (FEV1) (r=0.187, p=0.0013). Conclusion: 25-hydroxyvitamin D deficiency is a frequent occurrence in COPD and is correlated with the frequency of exacerbation and hospitalization in COPD patients.Öğe Effectiveness Of Clinical Parameters And Laboratory Values In Predicting The Clinical Course of Sarcoidosis(2022) Çelik, Deniz; Bulut, SertanAim: The natural course of sarcoidosis is heterogeneous. There is no clear marker that can predict the course of this disease and its characteristics over months/ years. We aimed to analyze our patients' data to identify a prediction parameter at admission. Methods: The patients with sarcoidosis and followed-up between 2015-01-01 and 2020-12-31 comprised the study group. The patients were staged by a Scadding staging system. Improvement or deterioration in at least two of the clinical-laboratoryradiological parameters indicates regression, stable disease, progression, or relapse of sarcoidosis. Results: The study group comprised four cases (6.9%) defined as stage 0; fifteen cases (25.86%) as stage 1; 39 cases (67.24%) were defined as stage 2. The mean age at diagnosis was 40.84±13.56 in stage 0 + stage 1 group, while it was 48.05±13.36 in the stage 2 group (p=0.06). 74.1% of the cases were women. The female/male ratio was found at 2.86. 57 out of 58 cases had a pathological diagnosis (EBUS TBNA). While PFTs values and DLCO were significantly lower at advanced stages but the same statistical significance was not identified between these values and the clinical course of the disease. As a result of the multivariate analysis, it was observed that only the presence of chest pain at admission affected the progression of the disease in the follow-up period. Conclusion: Sarcoidosis is a multi-systemic disease and there is no clear finding for predicting the poor prognosis of the disease. We conclude that chest pain symptom at admission is valuable predictive finding and can be used as a clue for the progression at follow-upÖğe Predicting Hospitalization, Exacerbation and Mortality in Bronchiectasis Using Bronchiectasis Severity İndex and FACED Scores(2022) Bulut, Sertan; Karamanlı, Harun; Çelik DenizObjective: Bronchiectasis (BC) is a multifaceted and etiologically diverse condition and, as a result, no single endpoint can be used to determine its general severity and prognosis. Two different validated scores are currently being used to evaluate the seri ousness bronchiectasis: The bronchiectasis severity index (BSI) and the FACED score. It is aimed at comparing the bronchiectasis severity assessment questionnaires whichs are two different validated outcomes for mortality, exacerbation, and hospitalizations. Material and Methods: Medical records for 107 subjects with NCFB, for which BSI and FACED scores could be calculated, were reviewed retrospectively. The corre lations between the parameters and the BSI or FACED score were evaluated and a linear regression analysis was conducted to identify the independently associated variables of the BSI and FACED score. Results: The mean scores of FACED and BSI were 3.5±1.9 and 9.8±4.7, respectively. A statistically significant relationship was found between the FACED and BSI scores (p<0.0001), Pearson Chi-square (p=0.0001), and tau-b de Kendall (0.59; p=0.0001). It was showed a 60.7% similarity between the two scales by Kappa test (p<0.0001). BSI and FACED reported an area under ROC curve (AUC) for exacerbations of 0.758 and 0.755; and for hospitalizations (due to BE exacerbations) of 0.864 and 0.597, re spectively. The sensitivity of the BSI is higher (86% versus 59%) than the FACED rating. Conclusion: Patients tended to obtain a higher BSI score relative to the FACED score, although the correlation between the two scales was statistically significant. BSI is a helpful clinical predictor tool for identifying patients at risk of death, hos pitalization, and exacerbation in health-care systems.Öğe The differentiation of metastatic mediastinal lymph nodes From benign hypermetabolic lesions(2022) Bulut, Sertan; Çelik, Deniz; Karamanlı, Harun; Aktaş, Zafer; Özmen, Özlem; Ertürk, Hakan; Gürçay, Nesrin; Biber, ÇiğdemBackground Anthracosis may cause a positron emission tomography/computed tomography (PET/CT) false positivity in mediastinal and hilar lymph nodes. We aimed to evaluate the radiological features and the maximum standardized uptake values (SUVmax) of the mediastinal lymph nodes with anthracosis or squamous cell lung cancer metastasized. Methodology Patients diagnosed with anthracosis or squamous cell lung cancer with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) between January 1, 2015, and November 15, 2020, in a tertiary hospital were enrolled. The squamous cell subtype of lung cancer was selected due to its association with tobacco use, biomass, and air pollution. Anthracosis may occur due to the same etiologic reasons. Results A total of 190 patients met the study enrollment criteria, of which 86 were diagnosed with anthracosis and 33 with squamous cell lung cancer lymph metastasis. Median values for short axis, long axis, SUVmax, shape features, and presence of calcification were found significantly different between the groups. In receiver operating characteristic (ROC) analysis, the SUVmax cut-off value was calculated as 6.61. With this cutoff value, the negative predictive value (NPV) was 92.5% and the positive predictive value (PPV) was 54% for differentiating anthracosis and malignant lymph nodes metastasis. Conclusions We conclude that the evaluation of the shape and metabolic activities of the anthracotic lymph nodes detected by PET/CT together with EBUS-TBNA granted a more accurate staging of the patients and more cancer patients will benefit from surgical treatment.Öğe The Effects Of Tumor Localization On Small Cell Lung Cancer And Its Association With Prognosis(Acta Medica Alanya, 2022) Bulut, Sertan; Çelik, DenizAim: Lung cancer is classified as non-small cell lung cancer (NSCLC) and small-cell lung cancer (SCLC) as pathological subtypes. SCLC is associated with a significantly short life expectancy, and it constitutes 10-15% of all lung cancers. Previous studies showed that lung cancer is mostly dominated by the upper lobe and is more common in the right lung than in the left. The main aim of this study is to analyze the localization of the tumor in the right and left lung in aggressive and malignant SCLC patients by comparing it with determinants such as anatomical features, demographic features, laboratory features, including the association with peripheral-central localizations, especially overall survival. Methods: There were four hundred forty-six lung cancer patients diagnosed in a chest diseases clinic in a tertiary training and research hospital between 31.03.2014 and 31.03.2020. Of these, twenty percent (n=90) were diagnosed as SCLC. Among ninety patients, six were excluded from the study due to incomplete medical SCLC records, and finally, eighty-four patients with SCLC were included in the study. Results: We classified eighty-four patients into two groups as right and left lung localized SCLC and analyzed all the data. We found that the left lung tumor group had the more extensive-stage disease and had significantly high CRP levels (p=0.027, p=0.045, respectively). When we analyzed the data such as demographic characteristics, diagnostic methods, overall survival, treatment characteristics, stage characteristics, anatomical features of the right and left tumor groups, we found that there were no significant differences.We use univariate and then multivariate analysis for survival. We found that being sixty-five years old and over (p=0.014), high CRP levels (p=0.016), having centrally localized tumors (p=0.01), having poor performance status (p<0.0001), and having no treatment for primary cancer (p=0.001) were associated with worse survival. Conclusion: Primary treatment of SCLC patients should start promptly. We found that the central location of the tumor as anatomical localization may be associated with worse survival. Also, we found that the left lung tumor group had the more extensive-stage disease and had significantly high CRP levels. Being sixty-five years old and over, high CRP levels, having poor performance status, and having no treatment for primary cancer were significantly associated with worse survival.
