Browsing by Author "Dogrul, Ilgaz"

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Approach of pulmonologists in Turkey to noninvasive mechanical ventilation use in acute respiratory failure
(2016) Ugurlu, Aylin Ozsancak; Kivanc, Tulay; Dogrul, Ilgaz; 26963304
Introduction: Noninvasive mechanical ventilation (NIV) has been increasingly used worldwide for acute respiratory failure (ARF), especially in patients with chronic lung disorders. We aimed to define the approach of pulmonologists in Turkey to NIV use for ARF management. Materials and Methods: A 38-question survey, developed and tested by authors, was distributed by e-mail to a total of 2.205 pulmonologists in Turkey. Results: Response rate was 27% (n=596). Seventy-one percent of responders were practicing NIV in clinic. NIV use was found to be associated with responder's academic title, age, duration of medical license, type of physician's hospital and its region, patient load, NIV experience during residency, and duration of NIV and intensive care unit (ICU) experience (p<0.001). Based on sub-group analysis of responders using NIV, median number of NIV patients followed-up per week was 4 [interquartile range (IQR): 2-6]. Most of the NIV users reported employment of wards (90%) and/or ICUs (86%) to follow-up patients, while 8.4% of the responders were applying NIV only in ICU's. Chronic obstructive lung disease (COPD) (99.5%), obesity hypoventilation syndrome (93.7%) and restrictive lung disease (89.4%) were the most common indications. Majority of NIV users (87%) were applying NIV to > 60% of patients with COPD, and success rate in COPD was reported as over 60% by 93% of users. Oronasal mask (median and IQR 90, 80-100%, respectively) and home care NIV ventilators (median and IQR 50, 10-85%, respectively) were the most commonly utilized equipment. Conclusion: NIV use in ARF varies based on hospital type, region and, especially, experience of the physician. Although consistent with guidelines and general practice, NIV use can still be improved and increased.
Long-Term Risk of Pulmonary Embolism in Solid-Organ Transplant Recipients
(2015) Kupeli, Elif; Ulubay, Gaye; Dogrul, Ilgaz; Birben, Ozlem; Seyfettin, Pinar; Ugurlu, Aylin Ozsancak; Eyuboglu, Fusun Oner; Haberal, Mehmet; 0000-0002-3462-7632; 0000-0003-3598-3986; 0000-0002-5525-8207; 0000-0003-2478-9985; 0000-0002-5826-1997; 25894159; AAJ-8097-2021; AAA-2925-2020; AAR-4338-2020; AAB-5064-2021; AAB-5345-2021
Objectives: Solid-organ transplant recipients can develop chronic hypercoagulation that increases the incidence of pulmonary embolism. Here, we evaluate the frequency of pulmonary embolism in solid-organ transplant recipients during the first 10 years after transplantation and evaluate the risk factors for its development. Materials and Methods: The medical records of solid-organ transplant recipients who were treated between 2003 and 2013 were retrospectively reviewed. The reviewed data included demographics, type of transplant, comorbidities, procoagulation factors, thromboembolism prophylaxis, and the timing and extent of pulmonary embolism. Results: In total, 999 solid-organ transplant recipients are included in this study (661 renal and 338 liver transplant recipients) (male: female ratio = 665:334). Twelve renal (1.2%) and 1 liver transplant recipient (0.3%) were diagnosed with pulmonary embolism. Pulmonary embolism developed 1 year after transplantation in 10 patients: 1 patient developed pulmonary embolism < 3 months after transplantation, and the other 9 patients developed pulmonary embolism within 3 to 6 months. No patients had a prior history of deep venous thrombosis or pulmonary embolism. Five patients received tacrolimus, 7 patients received sirolimus, and 1 patient received cyclosporine. Ten patients received prednisolone, and 8 patients received mycophenolate mofetil. All patients were homozygous normal for factor V Leiden and prothrombin genes. One patient was homozygous abnormal, and 1 patient had a heterozygous mutation in the methylenetetrahydrofolate reductase gene. Two patients were treated with low-molecular-weight heparin, while the remaining patients received warfarin. Eight patients were treated for 6 months, and the remainder received longer treatments. Conclusions: Here, the incidence of pulmonary embolism in solid-organ transplant recipients is 1.2%. Renal transplant recipients are at higher risk of developing pulmonary embolism than liver transplant recipients. The factors that increase the risk of pulmonary embolism in solid-organ transplant recipients appear to be multifactorial and include genetic predisposition.
Role of Procalcitonin in Differential Diagnosis of Pneumonia and Pulmonary Congestion Associated With End-Stage Renal Failure
(2016) Akcay, Sule; Dogrul, Ilgaz; Sezer, Siren; Haberal, Mehmet; 0000-0002-8360-6459; 0000-0002-3462-7632; 27805517; AAB-5175-2021; AAJ-8097-2021
Objectives: We aimed to determine the role of procalcitonin in distinguishing between infectious and noninfectious causes, specifically the cause of the infiltrative appearances detected on lung radiographs of patients with end-stage renal failure receiving hemodialysis. Materials and Methods: Sixty-six patients between 19 and 87 years of age were enrolled. Patients were divided into 3 groups, with each group consisting of 22 patients: group 1 comprised pneumonia patients without end-stage renal failure, group 2 comprised pulmonary congestion patients with end-stage renal failure, and group 3 were healthy participants. All demographic and clinical characteristics of patients and healthy participants were noted, anteroposterior lung radiographs were taken, and blood samples were obtained for complete blood count, C-reactive protein, and procalcitonin measurements. Patients in group 2 received control posteroanterior lung radiography. Results: Group 1 demonstrated a significantly lower mean procalcitonin value than group 2 (P =.001) but significantly higher mean C-reactive protein and leukocyte levels (P <.05). In terms of mean C-reactive protein and leukocyte levels, there was no difference between groups 2 and 3 (P >.05). The classification performed by recognizing 0.5 ng/mL as the cutoff point for procalcitonin resulted in no significant differences between groups 1 and 2 (P =.103). However, a significant difference (P =.014) was found between these groups when basing the classification as 1.5 ng/mL cutoff point in group 2 and 0.5 ng/mL cutoff point in group 1. Procalcitonin level was below 1.5 ng/mL in all group 2 patients. Conclusions: Our findings support that procalcitonin has no superiority over C-reactive protein in diagnosis of community-acquired pneumonia. Moreover, at procalcitonin values below 1.5 ng/mL in patients with end-stage renal failure who have pulmonary congestion but without clinical signs of infection, infiltrative appearances on lung images may be attributed to hypervolemia, which would in turn prevent unnecessary antibiotic therapies. We believe that measurement of C-reactive protein is still preferable to procalcitonin in revealing the inflammatory response due to its cost-effectiveness and ease in performance and the high diagnostic performance in transplant candidates.