Tıp Fakültesi / Faculty of Medicine

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Author: search.filters.author.Kupeli, Elifsearch.filters.applied.f.language: search.filters.language.eng

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    Effect of CPAP Therapy on Mean Platelet Volume and Hematocrit in Obstructive Sleep Apnea Syndrome (OSAS)
    (2014) Cetin, Gulcan; Kupeli, Elif; Bozbas, Serife Savas; Eyuboglu, Fusun Oner; https://orcid.org/0000-0002-5826-1997; https://orcid.org/0000-0002-7230-202X; https://orcid.org/0000-0002-5525-8207; AAB-5345-2021; AAI-8064-2021; AAR-4338-2020
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    EBUS-TBNA: Popular But Not Universal
    (2014) Ulasli, Sevinc Sarinc; Kupeli, Elif; https://orcid.org/0000-0002-5826-1997; 24372957; AAB-5345-2021
    In recent years, the number of publications concerning interventional bronchoscopy has increased dramatically. The present paper focused on publications related to endobronchial ultrasound technique. Its aim was to provide an overview of the nature of publications about endobronchial ultrasound technique, especially with regard to the countries of origin of publications and the categories of journals in which these papers are published. Overall, the review demonstrates a limited use of endobronchial ultrasound technique in many countries.
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    "Pills" and the Air Passages A Continuum
    (2015) Kupeli, Elif; Khemasuwan, Danai; Tunsupon, Pichapong; Mehta, Atul C.; 0000-0002-5826-1997; 25560862; AAB-5345-2021
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    Conventional Transbronchial Needle Aspiration: from Acquisition to Precision
    (2015) Kupeli, Elif; Seyfettin, Pinar; Tepeoglu, Merih Demirel; 0000-0002-9894-8005; 0000-0002-5826-1997; 25593608; AAK-5222-2021; AAB-5345-2021
    INTRODUCTION: Conventional transbronchial needle aspiration (C-TBNA) is a minimally invasive, safe, and cost-effective technique in evaluating mediastinal lymphadenopathy. Previously we reported that the skills for C-TBNA can be acquired from the books. We studied the learning curve for C-TBNA for a single bronchoscopist at a tertiary-care center where ultrasound technology remains difficult to acquire. METHODS: We prospectively collected results of the first 99 consecutively performed C-TBNA between December 2009 and 2013. Patients were divided into 3 groups: (I): First 33, (II): Next 33 and (III): Last 33. Results were categorized as malignant, non-malignant or non-diagnostic. Diagnostic yield (DY), sensitivity (SEN), specificity (SPE), positive and negative predictive values (PPV, NPV), and accuracy (ACC) were calculated to learn the learning curve for C-TBNA. RESULTS: Total 99 patients (M:F = 62:37), mean age 58.2 +/- 11.5 years, mean LN diameter 26.9 +/- 9.8 mm underwent C-TBNA. Sixty-nine patients had lymph nodes (LNs) >20 mm in diameter. Final diagnoses were established by C-TBNA in 44 (yield 44.4%), mediastinoscopy 47, transthoracic needle aspiration 5, endobronchial biopsy 2 and peripheral LN biopsy 1. C-TBNA was exclusively diagnostic in 35.4%. Group I: DY: 42.4%, 64.7% in malignancies, 19% in benign conditions (P = 0.008). SEN, SPE, PPV, NPV, ACC = 70%, 100%, 100%, 66.6%, 78.7%, respectively. Group II: DY: 54.5% (36.4% exclusive), 88.2% in malignancies and 19% benign conditions (P = 0.000). SEN, SPE, PPV, NPV, ACC=72%, 100%, 100%, 53.3%, 78.7%, respectively. Group III: DY: 36.3% (27% exclusive), 100% in malignancies and 16% in benign conditions. SEN, SPE, PPV, NPV, ACC = 92.3%, 100%, 100%, 95.2%, 97%, respectively. No difference was found in relation to LN size or location and TBNA yield. CONCLUSION: C-TBNA can be easily learned and the proficiency can be attained with <66 procedures. In selected patients, its exclusivity could exceed 35%.
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    A 10-Year Experience of Tuberculosis in Solid-Organ Transplant Recipients
    (2015) Ulubay, Gaye; Kupeli, Elif; Birben, Ozlem Duvenci; Seyfettin, Emine Pinar; Dogrul, Mustafa Ilgaz; Ugurlu, Aylin Ozsancak; Eyuboglu, Fusun Oner; Haberal, Mehmet; 0000-0002-5525-8207; 0000-0002-3462-7632; 0000-0003-2478-9985; 0000-0003-3598-3986; 0000-0002-5826-1997; 25894157; AAR-4338-2020; AAJ-8097-2021; AAB-5064-2021; AAA-2925-2020; AAB-5345-2021
    Objectives: Tuberculosis remains an important problem in solid-organ transplant patients due to their immunocompromised state. The objective of the present study was to report the incidence, demographic characteristics, and various presentations of tuberculosis in solid-organ transplant recipients. Materials and Methods: We evaluated a total of 999 patients (male/female = 665/334, 661 renal and 338 liver transplants) who underwent solid-organ transplant between 2003 and 2013. The medical records of all patients were retrospectively reviewed. Patients' demographics, transplant type, primary site of tuberculosis specimen culture and pathology results, chest radiograph, and thoracic computed tomography findings, total blood count and chemistry were all recorded. Results: Among the 999 subjects, 19 patients (1.9%) (male/female: 15/4, mean +/- SD age, 42 +/- 18.5 y) were diagnosed with tuberculosis. The majority of patients (85%) were diagnosed with tuberculosis within 6 months after transplant, and 15% were diagnosed within 3 months. Most diagnoses of tuberculosis were based on histopathologic examination of biopsy material. Of these patients, 9 were diagnosed with pulmonary tuberculosis, 8 had extrapulmonary tuberculosis, and 2 had both. Nontuberculosis mycobacteria infections were detected in 3 patients. Conclusions: Even with a negative exposure history, tuberculosis can manifest as different clinic presentations in solid-organ transplant patients on immunosuppressive drugs, particularly in the first 6 months after transplant. Therefore, clinicians should always consider tuberculosis as the potential cause of an infectious disease with unknown cause to successfully diagnose and manage solid-organ transplant recipients.
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    Long-Term Pulmonary Infections in Heart Transplant Recipients
    (2015) Kupeli, Elif; Ulubay, Gaye; Akkure, Esma Sevil; Eyuboglu, Fusun Oner; Sezgin, Atilla; 0000-0002-5525-8207; 0000-0002-5826-1997; 0000-0003-2478-9985; 25894190; AAR-4338-2020; AAB-5345-2021; AAB-5064-2021
    Objectives: Pulmonary infections are life-threatening complications in heart transplant recipients. Our aim was to evaluate long-term pulmonary infections and the effect of prophylactic antimicrobial strategies on time of occurrence of pulmonary infections in heart transplant recipients. Materials and Methods: Patients who underwent heart transplantation between 2003 and 2013 at Baskent University were reviewed. Demographic information and data about immunosuppression and infectious episodes were collected. Results: In 82 heart transplant recipients (mean age, 33.85 y; 58 male and 24 female), 13 recipients (15.8%) developed pulmonary infections (mean age, 44.3 y; 9 male and 4 female). There were 12 patients who had dilated cardiomyopathy and 1 patient who had myocarditis before heart transplantation; 12 patients received immunosuppressive therapy in single or combination form. Pulmonary infections developed in the first month (1 patient), from first to third month (6 patients), from third to sixth month (1 patient), and > 6 months after transplantation (5 patients). Chest computed tomography showed consolidation (unilateral, 9 patients; bilateral, 4 patients). Multiple nodular consolidations were observed in 2 patients and a cavitary lesion was detected in 1 patient. Bronchoscopy was performed in 6 patients; 3 patients had Aspergillus fumigatus growth in bronchoalveolar lavage fluid, and 2 patients had Acinetobacter baumannii growth in sputum. Treatment was empiric antibiotics (6 patients), antifungal drugs (5 patients), and both antibiotics and antifungal drugs (2 patients); treatment period was 1-12 months in patients with invasive pulmonary aspergillosis. Conclusions: Pulmonary infections are the most common cause of mortality in heart transplant recipients. A. fumigatus is the most common opportunistic pathogen. Heart transplant recipients with fever and cough should be evaluated for pulmonary infections, and invasive pulmonary aspergillosis should be suspected if these symptoms occur within the first 3 months. Immediately starting an empiric antibiotic is important in treating pulmonary infections in heart transplant recipients.
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    Invasive Pulmonary Aspergillosis in Heart Transplant Recipients
    (2015) Kupeli, Elif; Ulubay, Gaye; Akkurt, Sevil Bayram; Eyulboglu, Fusun Oner; Sezgin, Atilla; 0000-0003-2478-9985; 0000-0002-5826-1997; 0000-0002-5525-8207; 25894189; AAB-5064-2021; AAB-5345-2021; AAR-4338-2020
    Objectives: Invasive pulmonary aspergillosis is the most common invasive mycosis in heart transplant recipients. Early clinical recognition of this complication is difficult and laboratory data is not specific. Our aim was to study the characteristics of invasive pulmonary aspergillosis infections in heart transplant recipients. Materials and Methods: Between 2007 and 2013, there were 82 patients who underwent heart transplant at our institution, including 6 patients who were diagnosed with invasive pulmonary aspergillosis. Medical records of these patients were reviewed for demographic, clinical, and radiographic features, microbiology data, serum galactomannan levels, antifungal treatment, and overall outcomes. Results: The most common species causing the infection was Aspergillus fumigatus. The infection was encountered irrespective of the duration since the transplant. Bronchoalveolar lavage with positive culture for Aspergillus species and/or abnormal serum galactomannan level was suggestive of invasive pulmonary aspergillosis. Conclusions: In our opinion, empiric antifungal therapy should be commenced as soon as invasive pulmonary aspergillosis is suspected in heart transplant recipients to reduce mortality. Although the duration of antifungal therapy for invasive pulmonary aspergillosis is debatable, heart transplant recipients may require long-term therapy to avoid recurrence.
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    Postoperative Pulmonary Complications in Living-Liver Donors: A Retrospective Analysis of 188 Patients
    (2015) Ulubay, Gaye; Dedekarginoglu, Balam Er; Kupeli, Elif; Sever, Ozlem Salman; Eyuboglu, Fusun Oner; Haberal, Mehmet; 0000-0003-2478-9985; 0000-0002-5525-8207; 0000-0002-5826-1997; 0000-0002-3462-7632; 25894187; AAB-5064-2021; AAR-4338-2020; AAB-5345-2021; AAJ-8097-2021
    Objectives: Living-donor liver transplant has become a viable option and an important source of hepatic grafts. The goal of this study is to establish postoperative pulmonary complications of liver donation surgery in our center. Materials and Methods: Data from 188 subjects (median age, 33.7 +/- 8.4 y; male/female, 51.1%/48.9%) who had liver donation surgery from 1988 to 2013 were analyzed retrospectively. Patient demographic and clinical features were recorded. Postoperative complications and the correlation of risk factors for postoperative pulmonary complications were investigated. Results: The incidence of early postoperative complications was 17% (n = 32), and 16 of these patients had postoperative pulmonary complications (8.5%); 2 of the postoperative pulmonary complications were detected on the day of surgery and the other 14 complications were observed between the second and seventh day after surgery. Most postoperative pulmonary complications were minor complications including atelectasis, pleural effusion, and pneumonia. There was 1 major postoperative pulmonary complication: pulmonary embolism that occurred on the fourth day after surgery in 1 patient. Late pulmonary complications also were reviewed and no late postoperative pulmonary complications were observed. There was no significant difference in early and late postoperative pulmonary complications between ex-smokers and smokers. Postoperative atelectasis was significantly higher in patients with body mass index <= 20 kg/m(2) than patients with body mass index > 21 kg/m(2) (P = .027). In our study population, no postoperative mortality was recorded. Conclusions: We believe that preoperative weight reduction strategies and early mobilization with postoperative respiratory physiotherapy could be important factors to reduce postoperative pulmonary complications in liver donors.
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    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.
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    A Curious Case of Pill Aspiration Response
    (2015) Kupeli, Elif; Khemasuwan, Danai; 0000-0002-5826-1997; 26033145; AAB-5345-2021