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Öğe Case of Prolonged Viral Shedding: Chronic, Intermittan COVID-1 9?(Aves, 2022) Kaya, Bilkay Serez; Yilmam, Ilker; Edis, Ebru Cakir; Karabulut, Derya; Mert, Tulin Elmaslar; Eryildiz, Canan; Demir, MuzafferCOVID-19 is a pandemic that has been affecting the entire world and has caused the death of approximately 2.8 million people. Although the duration of viral shedding varies, an average of 7-10 days is accepted. It is still unclear whether prolonged viral shedding means prolonged contagious period and whether COVID-19 will become chronic or not. This article presents a case with hematological malignancy (lymphoma) with the longest polymerase chain reaction positivity that we could find in the literature (110 days in total).Öğe Economic burden of nosocomial pneumonia in non-intensive care clinics(Turkish Assoc Tuberculosis & Thorax, 2015) Edis, Ebru Cakir; Hatipoglu, Osman Nuri; Yilmam, Ilker; Sut, NecdetIntroduction: Almost all data on the cost of nosocomial pneumonia (NP) in the literature is associated with ventilator- associated pneumonia. This study aims to determine the economic burden of nosocomial pneumonia in clinical inpatients. Materials and Methods: Data on costs of the 154 adult patients (97 male, 57 female; mean age 64.53 +/- 14.92) who were hospitalized in non-intensive care clinics and developed NP were recorded prospectively. The control group consisted of 148 patients without pneumonia matched for age (mean age 65.66 +/- 13.86), sex (94 male), diagnosis, and hospitalization date. Data obtained from both groups of patients for the number of hospitalization days and the data obtained from the hospital automation program (Avicenna) for costs were compared using the Mann-Whitney U test. Results: While the mean duration of hospitalization was 32.8 days in patients with NP, it was 9.8 (p< 0.0001) in the control group. The cost of hospital beds was $631 for NP patients and $153 for the controls (p< 0.0001). The total cost was $ 6241 for NP patients and $1117 for the controls (p< 0.0001). Conclusion: NP is a high-cost condition that increases the duration of hospitalization 3.5-fold, hospital-bed cost 4-fold, and the total cost 5-fold.Öğe Evaluation of insomnia in healthcare personnel after COVID-19 vaccination(Kare Publ, 2023) Yilmam, Ilker; Kaya, Bilkay Serez; Temelli, Suereyya; Edis, Ebru Cakir; Yulugkural, ZerrinBACKGROUND AND AIM: Sleep disturbances are common during Coronavirus Disease 2019 (COVID-19) infection. Coronasomnia is a concept used to identify sleep disturbances observed during the pandemic. Although coronasomnia has been described during and after coronavirus infection, no data on sleep disturbances seen after vaccinations have been found. The aim of this study was to detect the prevalence of sleep disturbances observed after COVID-19 vaccinations (specifically CoronaVac).METHODS: In April 2021, healthcare personnel who had received the CoronaVac vaccine were administered questionnaires to investigate potential adverse effects of the vaccine and any sleep disturbances. RESULTS: The study included 787 individuals, of whom 506 (64.3%) were women. The mean age was 35 +/- 9.6 (19-65) years. 303 (38.5%) healthcare workers reported adverse effects after vaccination. The most common adverse effects were exhaustion, muscle pain, and headache. At least one sleep disturbance (difficulty falling asleep, frequent awakening, difficulty maintaining sleep, excessive daytime sleepiness, and need to use sleeping pills) that did not exist before vaccination but occurred afterwards was found in 86 (10.9%) participants. Women had higher insomnia scores than men (p=0.02). An important result of the study is that the insomnia scores of healthcare workers who had COVID-19 are statistically higher than those who did not (p=0.02).CONCLUSIONS: Adequate sleep is important for both protection from infection and the immune response against infection. Although coronasomnia developing after the COVID-19 variant that was identified at the beginning of the pandemic is well-defined, we believe that effects such as sleep disorders that may develop after vaccination should be monitored in the long term and in a large population.Öğe Fat Embolism: Case Report(Aves, 2006) Ozdemir, Levent; Tabakoglu, Erhan; Gurlu, Vuslat; Hatipoglu, Osman Nuri; Altiay, Gundeniz; Yilmam, Ilker; Ozlen, BurcuFat embolism syndrome is a rare disorder which usually may be seen as a complication of long bone trauma. It becomes apparent 24-72 hours after injury with respiratory, neurological, urinary, ocular and cutaneous symptoms and sings. Our case is a 46 years old male patient who evaluated 30 hours after left tibia fracture for confusion, fever, dyspnea, tachypnea and a petechial rash on the anterior chest and anterior axillary folds. Chest radiograph was normal. The patient had hypoxemia and hypocapnia in arterial blood gases measurement. Ventilation perfusion scintigraphy revealed emboli with intermediate probability. No other etiology could be found to explain the state of confusion. Cotton-wool exudates and small haemorrhages were observed in retina. Many fat globules were found in urine samples. After steroid treatment, rapid clinical improvement was observed.Öğe Hospital-Acquired Pneumonia Developed in Non-Intensive Care Units(Karger, 2009) Edis, Ebru Cakir; Hatipoglu, Osman N.; Yilmam, Ilker; Eker, Alper; Tansel, Ozlem; Sut, NecdetBackground: There are few studies about hospital-acquired pneumonia (HAP) developing in non-intensive care units (non-ICUs). Objectives: The aim of this study was to determine the incidence rate of non-ICU HAP, the risk factors associated with mortality and the survival rates of HAP patients at 6 weeks and 1 year. Patients and Methods: Between March 2005 and February 2006, 154 adult patients (97 males) with HAP were prospectively evaluated. Immunocompromised patients who were developing pneumonia were excluded from the study. The HAP incidence was calculated and survival was noted at 6 weeks and 1 year later. Kaplan-Meier methods were used for survival analysis; Cox regression was used to identify the risk factors associated with HAP-induced mortality. Results: During the study, and not counting those in the ICU, 45,679 adult patients were hospitalized. Of these, 154 patients developed HAP (incidence 3.3 cases/1,000 patients). The mean age of those developing HAP was 64.53 +/- 14.92 years (range 15-98). Survival rates at the 3rd, 7th, 14th, 42nd and 365th day were 91, 89, 69, 49 and 29%, respectively. Independent risk factors associated with 6-week mortality were: age [relative risk (RR) 1.026; 95% confidence interval (CI) 1.008-1.045], chronic renal failure RR 1.8; 95% CI 1.087-3.086), aspiration risk (RR 2.86; 95% CI 1.249-6.564), steroid use (RR 2.35; 95% CI 1.306-4.257), and multilobar infiltration (RR 2.1; 95% CI 1.102-4.113). Conclusion: HAP - even if it develops in non-ICU environments-is hard to treat and has a higher mortality rate. Copyright (C) 2009 S. Karger AG, BaselÖğe Hospital-acquired pneumonia in patients receiving immunosuppressive therapy(Galenos Publ House, 2010) Edis, Ebru Cakir; Hatipoglu, Osman Nuri; Yilmam, Ilker; Eker, Alper; Tansel, Ozlem; Sut, Necdet; Tekgunduz, EmreObjective: The aims of this study were to determine the clinical success rates, effect of neutropenia on treatment success rates, risk factors related to mortality, and survival in patients who developed hospital-acquired pneumonia (HAP) while receiving immunosuppressive therapy. Materials and Methods: Forty-three adult patients receiving immunosuppressive therapy who developed HAP were included in this prospective study. Transplantation patients and human immunodeficiency virus (HIV)-positive patients were not included. Antibiotic treatment was managed by a multidisciplinary team. The Kaplan Meier method was used for the survival analysis and Cox regression was used for the identification of mortality-related independent risk factors. The relationship between neutropenia and the clinical success rate was determined using the chi-square test. Results: Although anti-pseudomonal antibiotics were started empirically in 40 of the 43 patients (93%) at the beginning of the treatment, the most frequently isolated pathogens were Acinetobacter spp. and Escherichia coli. The success rate at the end of the treatment was 65.1%. The survival rates for the 3(rd), 14(th), 42(nd), and 365(th) days were 97%, 86%, 58%, and 19%, respectively. Elevated levels of urea [Hazard Ratio=1.01 (95% Cl: 1.00-1.02)] and blood glucose [HR=1.01 (95% Cl: 1.00-1.02)] were found to be independent risk factors affecting survival. The treatment success rate was higher in patients without neutropenia (n=23) than in those with neutropenia (n=20) (p=0.05). Conclusion: The treatment success rate was low in patients who developed HAP while receiving immunosuppressive therapy. (Turk J Hematol 2010; 27: 20-4)Öğe The Importance of Pathogen Identification in the Success of Treatment of Hospital Acquired Pneumonias(Aves, 2010) Edis, Ebru Cakir; Hatipoglu, Osman Nuri; Yilmam, Ilker; Eker, Alper; Tansel, Ozlem; Sut, NecdetObjective: The aim of this study was to determine the effects of identification of the pathogens and specific and appropriate treatments, and the success of these treatments for subjects who acquired HAP non-ICU. Material and Method: The analyzed data was obtained from the records of 154 consecutive HAP patients who acquired pneumonia non-ICU. We investigated whether the factor was identified, whether patients received a specific therapy according to the results of a culture antibiogram, and whether the patients received appropriate antibiotics therapy initially. Results: When the groups treated specifically (n=78) and empirically (n=76) were compared, there were no significant differences between the clinical success rates. The difference was not significant between the group given an appropriate antibiotherapy initially (n=42) and the group whose initial therapy was changed according to the culture antibiogram after the factor was found (n=36). When the group given appropriate initial antibiotherapy (n=42) was compared with all the other patients (n=112), the difference between the clinical success rates was not significant. The most remarkable result of the study was the success rate being significantly higher in the group in which the pathogen could not be identified (n=66) compared with the group in (n=88) which the pathogen was identified (p=0.022). Conclusion: The clinical success rate was low in microorganism-caused HAPs with a potential for drug resistance and having the characteristic of developing rapid resistance, such as Acinetobacter spp. and Pseudomonas spp, even though specific treatment was administered. These results indicate that the prevention of infections that occur with such microorganisms is more important than the treatment.Öğe A life-threatening haemoptysis case that would have been defined as idiopathic before the COVID-19 era(Turkish Assoc Tuberculosis & Thorax, 2021) Yilmam, Ilker; Karlikaya, Celal; Serez Kaya, Bilkay; Kula, Osman; Emmungil, HakanThe coronavirus disease 2019 (COVID-19) is characterized by respiratory infection which can show very different clinical pictures, somewhat changing medical paradigm. Hemoptysis defined as idiopathic can be seen as much as 15%. Currently, increasing hemoptysis cases are being reported in medical coronavirus literature. We here present a hemoptysis case that would be defined as idiopathic before the COVID-19 era. After the first clinical picture, the case turned into a life-threatening hemoptysis. We studied the case com-prehensively as clinical, pathogenetical, therapeutic and clinical practical aspects. Thus, we hypothesized that especially in the pandemic era, all hemoptysis cases must be evaluated as a possible life threatening infectious disease with unpredictable prognosis.Öğe A retrospective evaluation of patients with sleep breathing disorders in single center, Edirne province(Turkish Assoc Tuberculosis & Thorax, 2023) Korucuoglu, Cemile; Yilmam, Ilker; Yildiz, Ethem; Altiay, GuendenizIntroduction: Our aim was to investigate the characteristics of patients with preliminary diagnosis of sleep breathing disorder studied in Edirne province, to identify the risk factors and comorbid conditions, to determine the diagnostic distribution of our sleep patients by analyzing the results of polysomnogra-phy and PAP titration, and to understand their problems related to treatment compliance and device use.Materials and Methods: Our study retrospectively evaluated the results of 956 patients who had sleep-related complaints in our region and underwent full nocturnal polysomnography and PAP titration with a preliminary diagnosis of sleep breathing disorder.Results: A total of 956 patients were enrolled in the study, of whom 641 (67.1%) were males and 315 (32.9%) were females. Of our patients, 49.7% had severe obstructive sleep apnea (OSA), 18.2% had moderate OSA, 17.9% had mild OSA, 11.4% had REM-dependent OSA, and 8.4% had position -supine-dependent OSA. Hypertension was the most common comorbid condition in 44% of our patients, and diabetes mellitus in 25%. It was deter-mined that 228 (57.9%) of 394 patients who were recommended to use the PAP device received the device, and 71.5% of these patients could use the device in a compatible manner.Conclusion: Patients with appropriate symptoms can be diagnosed with a high probability of OSA in our region. The fact that a substantial group of patients diagnosed with OSA and recommended to use the PAP device did not receive the device or the proportion of those who could not use the device was high is one of the notable findings of the study.Öğe VEGF, IL-17 and IgG4 levels of patients with lung sequelae in post-COVID-19 period(Turkish Assoc Tuberculosis & Thorax, 2022) Arslan, Nevra Gullu; Aksakal, Sengul; Yilmam, Ilker; Gorgun, SelimVEGF, IL-17 and IgG4 levels of patients with lung sequelae in post-COVID-19 period Introduction: Although the epidemiological and clinical characteristics of COVID-19 patients have been described; the pathogenesis of the disease and its long-term consequences are still unclear. Pulmonary fibrosis is one of these late outcomes. In this study we evaluated Interleukin-17 (IL-17), vascular endothelial growth factor (VEGF), and immunoglobulin G4 (IgG4) levels of COVID-19 infected patients with different clinical course and their effect on pulmonary fibrosis in post-COVID period. Materials and Methods: In total, 90 patients were evaluated. Among the patients who presented for a control visit between 3-12 weeks after acute infection; patients with signs of pulmonary sequelae radiologically (traction bronchiectasis, interseptal thickening, disorders in parenchyma architecture) were classified as Group I (n= 32), patients who recovered without sequelae radiologically as Group II (n= 32). The Control group included healthy individuals who did not have COVID-19, and was classified as Group III (n= 26). Results: The mean age in Group I was significantly higher than Group II and III (p< 0.001). There was a statistically significant difference between the VEGF and IL-17 values based on the patient group they are in (p< 0.05). Vascular endothelial growth factor values of Group I and III were significantly lower than the patients in Group II (p< 0.001). IL-17 values of Group I and II were found to be significantly lower than Group III (p= 0.005). There was no statistically significant relationship between groups in terms of IgG4 values. Conclusion: In our study, it was observed that the profibrotic effects of VEGF, IL-17, and IgG4 were not dominant in patients who recovered with pulmonary sequelae after COVID; therefore, it is thought that different mechanisms mentioned or not yet revealed may cause this outcome.
