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1.
Tuberk Toraks ; 67(2): 102-107, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31414640

RESUMO

Introduction: Respiratory and cardiac functions in association with skeletal and neurophysiologic systems can be evaluated with cardiopulmonary exercise testing (CPET). Compared to treadmill exercise test, CPET provides more comprehensive data about the hemodynamic response to exercise. Materials and Methods: We aimed to evaluate the relationship with CPET findings and coronary lesions identified on angiography in patients with angina pectoris who underwent teradmill exercise, CPET and coronary angiography (CAG). By this way we sought to examine the CPET parameters that might be predictive for coronary artery disease (CAD) before diagnostic exercise test results and ischemia symptoms develop. Thirty patients in whom CAG was planned because of symptoms and exercise test results were enrolled in the study. Oxygen consumption (VO2), carbondioxide production (VCO2), minute ventilation (VE), maximum work rate (WR), DVO2/DWR and O2 pulse (VO2/HR) values were calculated. Significant CAD was defined as ≥ 50% narrowing in at least one of the coronary arteries. Result: The mean age was 60.4 ± 8.9 years ve 21 (65.6%) of subjects were male. On CAG, CAD was detected in 19 (59.4%) patients. Maximum heart rate, heart rate reserve (HRR), VE/VCO2 measured at anaerobic threshold (AT) and VO2(mL/kg/min) were significantly differed in patients with CAD than those without (p= 0.031; p= 0.041; p= 0.028; p= 0.03 respectively). Peak VO2, VO2/WR and O2 pulse values were higher in patients with normal angiographic results than those with CAD but the difference did not reach to statistical significance. Conclusions: The findings of our study indicate that among CPET parameters AT VE/VCO2, ATVO2 (mL/kg/dk) and HRR can have predictive value in the diagnosis of CAD. We think that these parameters might be used in the evaluation of patients with angina and dyspnea suspected of CAD. In conclusion parameters obtained during the test that are not influenced by patient's effort might increase the value of CPET in the diagnosis CAD.


Assuntos
Doença da Artéria Coronariana/diagnóstico , Teste de Esforço , Idoso , Angina Pectoris/diagnóstico , Angina Pectoris/fisiopatologia , Dióxido de Carbono/metabolismo , Angiografia Coronária , Doença da Artéria Coronariana/fisiopatologia , Teste de Esforço/métodos , Teste de Esforço/normas , Tolerância ao Exercício , Feminino , Frequência Cardíaca , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio , Testes de Função Respiratória
2.
Tuberk Toraks ; 67(1): 63-70, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31130137

RESUMO

Chronic obstructive pulmonary disease (COPD) is a major cause of mortality and morbidity around the world. The diagnosis od COPD is based on the presence of clinical symptoms and the fact that the ratio of post-bronhodilator forced expiratory volume in 1 second to forced expiratory vital capacity(FEV1/FVC) is less than 0.70. Persistent limitation of airflow which is a characteristics of COPD is reproducible and most common lung function test that is why it is usually measured by spirometry. The small airway diseases and the parenchymal destruction play a role in the pathogenesis of COPD at different rates over time resulting in chronic airflow limitation. These pathologies are not always together at the same time and the contribution of those to the development of COPD differ from one individual to another. The pathophysiological involvement of small airways in COPD has been confirmed. When the obstruction of the small airways occur either by mucus, smooth muscle hypertrophy, inflammatory infiltration or air wall thickening; then the consequence is the increased resistance and ventilation impairment. The parenchymal destruction can be estimated via scanning and at the initial assessment of a COPD patient, it gives information about the concomitant pulmonary diseases and/or differential diagnosis. There is an increasing interest on symptomatic individuals whose whose COPD diagnosis has not been confirmed yet with spirometry but diagnosis is based on alternative methods and approaches. Although these methods nowadays are commonly used for the clinical research, they will offer an opportunity to the clinician to find out the COPD patients at an early stage. Herein we will discuss the available methods other than spirometry in the early diagnosis of COPD before the overt disease is confirmed.


Assuntos
Diagnóstico Precoce , Pulmão/diagnóstico por imagem , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Espirometria/métodos , Volume Expiratório Forçado , Humanos , Pulmão/fisiopatologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Testes de Função Respiratória , Capacidade Vital
3.
Turk Thorac J ; 20(1): 69-89, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30664428

RESUMO

ÖZET: Günümüzde spirometre ölçümlerinin uygulama ve yorumlama nitelik güvencesi "American Thoracic Society / European Respiratory Society" standartlari ile belirlenmistir. Dünyada oldugu gibi ülkemizde de birçok laboratuvar bu standartlari kullanmaktadir. Buna karsin, farkli laboratuvarlardan farkli degerlendirme sonuçlari görebilmek mümkündür. Bu rapor, ülkemizdeki solunum fonksiyon testi laboratuvarlarinda yapilan degerlendirmelerin standardizasyonunu saglamak amaci ile hazirlanmistir.

4.
Exp Clin Transplant ; 16 Suppl 1(Suppl 1): 70-74, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29527996

RESUMO

OBJECTIVES: Hemoptysis is a symptom that can be caused by airway disease, pulmonary parenchymal disease, or pulmonary vascular disease, or it can be idiopathic. Infection is the most common cause of hemoptysis, accounting for 60% to 70% of cases. Hemoptysis is also an initial symptom of diffuse alveolar hemorrhage syndrome, although it may be absent at presentation in one-third of patients. Diffuse alveolar hemorrhage is characterized by disruption of the alveolar-capillary basement membranes because of either injury or inflammation of the arterioles, venules, or capillaries, resulting in bleeding in alveolar spaces. To date, no study in the literature has investigated the cause of hemoptysis in renal transplant patients. In this retrospective study, we aimed to investigate the causes of hemoptysis in renal recipients. MATERIALS AND METHODS: The data included in this study were obtained from 352 renal transplant patients who were consulted by the pulmonology department regarding hemoptysis between 2011 and 2017 at Baskent University. Patient medical records were reviewed for demographic, clinical, radiographic, bronchoscopic features, and microbiology data. Immunosuppressive drugs and clinical outcome data were also noted. RESULTS: This study included 352 renal transplant patients (139 male patients with mean age of 34.9 ± 7 years and 113 female patients with mean age of 31.1 ± 5 years). Hemoptysis was detected in 17 patients (4.8%),with 3 (0.85%) having massive hemoptysis as a result of diffuse alveolar hemorrhage syndrome. Fourteen of our patient group (4%) had pneumonia, and Aspergillus species was detected in 5 patients (1.4%). The only reason for diffuse alveolar hemorrhage was immunosuppressive agents, including sirolimus and mycophenolate mofetil. CONCLUSIONS: Hemoptysis is an important respiratory symptom in renal transplant patients. Although community- or hospital-acquired pneumonia may result in hemoptysis, drug-induced diffuse alveolar hemorrhage and Aspergillus infection should be considered for causes in renal transplant patients.


Assuntos
Hemoptise/etiologia , Imunossupressores/efeitos adversos , Transplante de Rim/efeitos adversos , Pneumonia/etiologia , Aspergilose Pulmonar/etiologia , Adulto , Feminino , Hemoptise/induzido quimicamente , Hemoptise/diagnóstico , Hospitais Universitários , Humanos , Masculino , Registros Médicos , Pneumonia/diagnóstico , Aspergilose Pulmonar/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Turquia
5.
Exp Clin Transplant ; 16 Suppl 1(Suppl 1): 183-188, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29528024

RESUMO

OBJECTIVES: Despite improved success with solid-organ transplant procedures, recipients remain at risk for infections, including pneumonia, due to their immunosuppressive regimens. In solid-organ transplant patients, clinical findings of pneumonia can be nonspecific, and diagnosis of pneumonia may be difficult as several conditions (drug lung, hypervolemia, infections, hemorrhage) can led to pulmonary infiltrates, mimicking pneumonia in these patients. The role of mean platelet volume, a predictor of inflammatory disease, with elevated values inversely correlated with inflammatory problems, in the diagnosis of pneumonia has not yet been investigated in solid-organ transplant patients. Here, we retrospectively investigated mean platelet volume in diagnosis of pneumonia in transplant patients. MATERIALS AND METHODS: Medical records of solid-organ transplant patients from 2011 to 2016 were reviewed for demographic, clinical, radiographic, laboratory, and microbiology data. Transplant type, immunosuppressive drugs, and clinical outcomes were noted. Pneumonia diagnosis was based on clinical respiratory symptoms and signs, imaging findings, positive microbiological tests, pathologic findings, laboratory findings, or effective clinical treatment trials. RESULTS: Our study included 70 patients (47 male/23 female; mean age of 46 ± 14 years), comprising 26 liver and 44 renal transplant recipients. Pneumonia was diagnosed radiologically in 30 patients (42.9%), with procalcitonin positive in 11 patients (36.7%), C-reactive protein elevated in 29 patients (96.7%), and leukocytes increased in 6 patients (20%). When laboratory measurements were compared with mean platelet volume, mean platelet volume values were significantly lower in patients with pneumonia who had elevated procalcitonin levels (P = .038). CONCLUSIONS: We found that mean platelet volume for diagnosis of pneumonia in solid-organ transplant patients was not a promising tool. Considering the difficulties in caring for transplant patients with pulmonary infiltrates, clinical decisions should be based on clinical, laboratory, microbiological, and radiologic findings.


Assuntos
Volume Plaquetário Médio , Transplante de Órgãos/efeitos adversos , Pneumonia/diagnóstico , Adulto , Biomarcadores/sangue , Proteína C-Reativa/análise , Calcitonina/sangue , Feminino , Humanos , Mediadores da Inflamação/sangue , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Pneumonia/sangue , Pneumonia/etiologia , Valor Preditivo dos Testes , Radiografia Torácica , Reprodutibilidade dos Testes , Estudos Retrospectivos , Resultado do Tratamento
6.
Tuberk Toraks ; 65(2): 117-130, 2017 Jun.
Artigo em Turco | MEDLINE | ID: mdl-28990891

RESUMO

The application quality of pulmonary function tests (PFT) carries high importance since it affects the quality of health services. "Chronic Diseases and Risk Factors in Turkey Study," which was published in 2013 showed that only 22.6% of PFTs performed in the secondary care institutions in our country were compatible with the standards. This finding reveals the standardization problem in spirometry applications in our country. Currently, the criteria for the application and evaluation of spirometer measurements were defined by American and European Respiratory Societies standards. Several laboratories use these standards in our country as in the world. But, national laboratory standards that are suitable for the conditions in our country have not been defined yet. This report was prepared to ensure the application of spirometry in optimal conditions, to minimize intra-laboratory and inter-laboratory differences and mistakes, and to standardize in our country. In this report, we focused on the standards concerning laboratory conditions, equipment, and technician specifications, test application, evaluation of test quality, infection control, and reference values.


Assuntos
Laboratórios/normas , Testes de Função Respiratória/normas , Sociedades Médicas/normas , Espirometria/normas , Humanos , Turquia
7.
Exp Clin Transplant ; 15(Suppl 1): 208-213, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28260470

RESUMO

OBJECTIVES: Patients with chronic renal failure are prone to pulmonary complications. Renal transplant recipients should undergo complete preoperative evaluation to determine risk of postoperative pulmonary complications. The American Society of Anesthesiologists classification and the Assess Respiratory Risk in Surgical Patients in Catalonia risk index correlate well with incidence of postoperative pulmonary complications. Here, we compared their accuracy in predicting pulmonary complications following renal transplant. MATERIALS AND METHODS: We retrospectively reviewed medical records of renal transplant recipients between years 2004 and 2015. We collected patient data on Assess Respiratory Risk in Surgical Patients in Catalonia risk index, including demographics, smoking history, comorbidities, preoperative pulmonary risk score, laboratory results, surgery information, history of lower respiratory tract infection 1 month pretransplant, urgency of surgery, American Society of Anesthesiologists classification, and pulmonary complications within 1 month posttransplant. RESULTS: Of 172 patients (123 males; mean age 38.82 y), 22 (12.8%) developed pulmonary complication during the first month posttransplant, including effusion (9 patients), pneumonia (10 patients), respiratory inefficiency (2 patients), and pulmonary embolism (1 patient). Atelectasis was observed in 95.4% of patients with complications. A positive correlation was observed between age and development of complications (r = 0.171; P = .025). Regarding risk score, 75% of patients at high risk and 19.5% at intermediate risk developed pulmonary complications. Patients with low-risk scores had significantly lower complications than intermediate- and high-risk groups (P < .001). A positive correlation was observed between preoperative risk score and complications (r = 0.34; P < .001). There was no association between the American Society of Anesthesiologists scores and postoperative complications (P = .7). CONCLUSIONS: The American Society of Anesthesiologists classification was found to be a weaker modality to predict pulmonary complications after renal transplant; as it relates to the general health status, than the Assess Respiratory Risk in Surgical Patients in Catalonia risk index.


Assuntos
Técnicas de Apoio para a Decisão , Falência Renal Crônica/cirurgia , Transplante de Rim/efeitos adversos , Pneumopatias/etiologia , Adulto , Tomada de Decisão Clínica , Feminino , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/diagnóstico , Pneumopatias/diagnóstico , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Resultado do Tratamento
8.
Exp Clin Transplant ; 15(Suppl 1): 214-218, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28260471

RESUMO

OBJECTIVES: Aspergillosis is a common fungal infection among solid-organ transplant recipients. Even after awareness of this infection occurs, there are still gaps in nonculture diagnostic tests, which can delay treatment initiation. Here, we aimed to define the common traits of pulmonary aspergillosis infection among solid-organ transplant recipients, thus shedding light on prevention and early diagnosis. MATERIALS AND METHODS: We conducted a database search of patients at Baskent University who had a positive aspergillosis culture between January 2010 and March 2016. Among 20 patients identified, 15 (mean age of 50.93 ± 11.17 y, 2 female and 13 male patients) with solid-organ transplant were included in the study. RESULTS: Of the 15 study patients, 7 were heart transplant, 6 were kidney transplant, and 2 were liver transplant recipients. Three patients had positive aspergillosis cultures from extrapulmonary specimens (1 brain biopsy and 2 wound swap cultures). Other patients with positive cultures were from bronchoalveolar lavage (6 patients), sputum (4 patients), both bronchoalveolar lavage and sputum (1 patient), and deep tracheal aspiration specimen (1 patient). Aspergillus fumigatus was the most common species. Mean hospitalization duration was 31.53 days (range, 2-135 d). Although all patients had positive culture results, 7 patients (46.7%) had negative galactomannan test results at the time of culture specimen collection. Positive galactomannan test results were statistically higher in 6 heart transplant patients (P = .045). All patients had fever at presentation, and 13 patients had been referred to the pulmonary disease department before positive culture results were obtained. CONCLUSIONS: Risk factors for pulmonary aspergillosis and its clinical presentation in solid-organ transplant recipients are still unclear. Although the expected time for aspergillosis infection in solid-organ transplant recipients is 6 months after transplant, clinicians must remember the nonspecific presentation of infections in these patients and be aware of the reliability of diagnostic tools.


Assuntos
Aspergillus fumigatus/isolamento & purificação , Transplante de Órgãos/efeitos adversos , Aspergilose Pulmonar/microbiologia , Transplantados , Adulto , Técnicas Bacteriológicas , Bases de Dados Factuais , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Transplante de Órgãos/mortalidade , Valor Preditivo dos Testes , Aspergilose Pulmonar/diagnóstico , Aspergilose Pulmonar/mortalidade , Aspergilose Pulmonar/terapia , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Turquia
9.
Exp Clin Transplant ; 15(Suppl 1): 249-253, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28260479

RESUMO

OBJECTIVES: Muscle wasting occurs in renal recipients due to decreased physical performance, and decreased respiratory muscle strength may occur due to changes in structure and function. Data are scarce regarding the roles of sarcopenia and nutritional status on respiratory muscle function in these patients. Here, we evaluated interactions among peripheral muscle strength, sarcopenia, nutritional parameters, and respiratory muscle function in renal transplant recipients. MATERIALS AND METHODS: Ninety-nine patients were prospectively enrolled between September and April 2016 at Baskent University. Forced vital capacity values (via pulmonary function tests), respiratory muscle strength (via maximal static inspiratory and expiratory pressures), and peripheral muscle strength (via hand grip strength test) were recorded. Nutritional parameters, fat weight, arm circumference, waist circumference, and C-reactive protein levels were also recorded. RESULTS: Of 99 patients, 68 were renal transplant recipients (43 men, mean age: 39.09 ± 10.70 y) and 31 were healthy participants (14 men, mean age: 34.94 ± 10.95 y). Forced vital capacity (P < .001, r = 0.65), maximal inspiratory (P = .002, r = 0.39) and expiratory (P < .001, r = 0.4) pressure, and hand grip strength showed significant relations in transplant recipients. Positive correlations were found between serum albumin levels and both hand grip strength (P = .16, r = 0.347) and forced vital capacity (P = .03, r = 0.436). Forced vital capacity was statistically different between renal recipients and healthy participants (P = .013), whereas maximal inspiratory and expiratory pressures were not (P > .05). No statistically significant relation was observed between biochemical parameters and maximal inspiratory and expiratory pressures (P ? .05). CONCLUSIONS: Respiratory function and peripheral muscle strength were significantly related in renal transplant recipients, with significantly lower peripheral muscle strength suggesting the presence of inadequate respiratory function. Peripheral and respiratory muscle training and nutritional replacement strategies could help to improve postoperative respiratory function.


Assuntos
Transplante de Rim/efeitos adversos , Força Muscular , Músculo Esquelético/fisiopatologia , Músculos Respiratórios/fisiopatologia , Sarcopenia/fisiopatologia , Adulto , Feminino , Força da Mão , Humanos , Masculino , Pressões Respiratórias Máximas , Pessoa de Meia-Idade , Avaliação Nutricional , Estado Nutricional , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Sarcopenia/diagnóstico , Sarcopenia/etiologia , Resultado do Tratamento , Turquia , Capacidade Vital
10.
Tuberk Toraks ; 65(4): 271-281, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29631525

RESUMO

Introduction: Colistimethate sodium (CMS) is frequently used in the treatment of nosocomial multidrug-resistant gram-negative infections. Nephrotoxicity is the most important side effect. The aim of this study is to evaluate the effect of colistin on nephrotoxicity and to assess prognosis in patients treated with CMS due to hospital-acquired pneumonia (HAP). Materials and Methods: Patients treated with CMS for HAP due to multidrug-resistant Pseudomonas aeruginosa or Acinetobacter baumannii were included in this cohort study. Result: We evaluated 281 patients treated with two different brands of CMS whose administration dose is different: imported (n= 58, low dose/kg) and domestic (n= 223, high dose/kg). Nephrotoxicity developed in 175 patients (62.3%). The median age (73 vs. 66 years, p= 0.004) and mortality rates were higher (66.9% vs. 52.8%, p= 0.022) in patients having nephrotoxicity. The patients receiving high dose/kg had higher nephrotoxicity rate (67.7% vs. 41.4%, p< 0.001). The clinical, bacteriological response and mortality rates of the whole group were 52.0%, 61.0%, 61.6%, respectively. The clinical and bacteriological response rates were similar in the different dose groups. Multivariate analysis showed that nephrotoxicity was associated with domestic brand depending on use of high dose (OR= 3.97), advanced age (ß= 0.29, p= 0.008), male gender (OR= 2.60), hypertension (OR= 2.50), red blood cells transfusion (OR= 2.54), absence of acute kidney injury (OR= 10.19), risk stage of RIFLE (OR= 11.9). Conclusions: Nephrotoxicity is associated with the use of high dose colistin, age, gender, hypertension, red blood cells replacement and RIFLE stage. The mortality rate is higher in patients developing nephrotoxicity.


Assuntos
Antibacterianos/efeitos adversos , Colistina/análogos & derivados , Infecção Hospitalar/tratamento farmacológico , Insuficiência Renal/induzido quimicamente , Lesão Renal Aguda/induzido quimicamente , Adulto , Idoso , Antibacterianos/administração & dosagem , Estudos de Coortes , Colistina/administração & dosagem , Colistina/efeitos adversos , Farmacorresistência Bacteriana Múltipla , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia/tratamento farmacológico , Prognóstico
11.
Exp Clin Transplant ; 14(Suppl 3): 82-86, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27805520

RESUMO

OBJECTIVES: Patients who are being considered for renal transplant must undergo thorough preoperative pulmonary evaluation to determine risk of postoperative pulmonary complications. The aim of this study was to determine the relation between the preoperative pulmonary risk factor score and pulmonary complications in patients undergoing renal transplant. MATERIALS AND METHODS: Medical records of patients who underwent renal transplant at our institution between 2004 and 2015 were retrospectively reviewed. Patient demographics, smoking history, comorbidities, and preoperative pulmonary risk factors (age, oxygen saturation, hemoglobin level, type of incision, duration of surgery, history of lower respiratory tract infection 1 month before surgery, urgency of surgery), and type of pulmonary complications within 1 month after transplant were recorded. RESULTS: Our study included 131 patients (94 male patients; mean age of 38.25 ± 12.96 y). Of total patients, 21(16%) developed complications during the first month after transplant, with 10 of the 21 (7.6% overall) developing pulmonary complications. These complications were pleural effusion (2 patients), pneumonia (3 patients), respiratory failure (2 patients), and pulmonary embolism (1 patient). There were no deaths directly attributed to the pulmonary complications. A significant correlation was observed between the preoperative pulmonary risk factor score and postoperative pulmonary complications in renal transplant recipients (P = .003). A positive correlation between the preoperative pulmonary scores and postoperative pulmonary complications existed among life-long nonsmokers (r = 0.371; P = .003). CONCLUSIONS: Renal transplant is an established modality in treatment of chronic renal failure. Prevention of pulmonary complications is essential for successful outcomes following transplant. Health care professionals involved with renal transplant and transplant centers should be aware of preoperative pulmonary risk factors. Patients should be observed so that these risk factors can be reduced before planned transplant. Moreover, we also suggest that smoking history should be considered as a preoperative pulmonary risk factor as it was found to be a factor leading to postoperative pulmonary complications in our study.


Assuntos
Técnicas de Apoio para a Decisão , Falência Renal Crônica/cirurgia , Transplante de Rim/efeitos adversos , Pneumopatias/epidemiologia , Fumar/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Humanos , Incidência , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/epidemiologia , Pneumopatias/diagnóstico , Masculino , Registros Médicos , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fumar/epidemiologia , Fatores de Tempo , Resultado do Tratamento , Turquia/epidemiologia
12.
Exp Clin Transplant ; 14(Suppl 3): 87-90, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27805521

RESUMO

OBJECTIVES: Renal transplant is an important treatment option for end-stage renal disease. A successful kidney transplant improves the quality of life and reduces the mortality risk compared with maintenance dialysis in patients with end-stage renal disease. Several immunologic and nonimmunologic factors are responsible for graft outcomes in renal transplant patients. Our study was performed to evaluate the role of smoking on postoperative pulmonary complications and graft outcomes in renal transplant patients. MATERIALS AND METHODS: Our study retrospectively analyzed 1740 patients who had renal transplants between 1987 and 2014 at Baskent University. Patients with smoking data were included in the study. Patient demographic, smoking status, comorbid diseases, postoperative pulmonary complications, graft outcomes, and clinical features were recorded. The relation between postoperative pulmonary complications and risk factors was investigated. RESULTS: Our study included 131 adult renal transplant recipients who had smoking data. The incidence of postoperative pulmonary complications was 16% (21 patients) in the first month after surgery. Smoking history was found in 52 patients (39.7%). There was a statistically significant relationship between the presence of atelectasis and smoking history (P = .004). A positive and statistically significant correlation was detected between atelectasis and pack-years smoking (r = 0.424; P = .001). We evaluated graft rejection within 1 month after transplant regardless of being acute cellular or humoral rejection. The relation between smoking history and graft rejection within 1 month after transplant was significant (P = .011). CONCLUSIONS: Renal transplant patients who are smokers have an increased risk for early postoperative pulmonary complications. Furthermore, cigarette smoking contributes to allograft loss in renal transplant patients. Smoking cessation before surgery can reduce the risk of early postoperative complications.


Assuntos
Rejeição de Enxerto/etiologia , Falência Renal Crônica/cirurgia , Transplante de Rim/efeitos adversos , Pneumopatias/etiologia , Fumar/efeitos adversos , Adulto , Aloenxertos , Comorbidade , Feminino , Rejeição de Enxerto/imunologia , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto , Hospitais Universitários , Humanos , Imunidade Celular , Imunidade Humoral , Falência Renal Crônica/complicações , Falência Renal Crônica/diagnóstico , Pneumopatias/diagnóstico , Pneumopatias/prevenção & controle , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Abandono do Hábito de Fumar , Prevenção do Hábito de Fumar , Fatores de Tempo , Resultado do Tratamento , Turquia
13.
Exp Clin Transplant ; 14(Suppl 3): 116-120, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27805529

RESUMO

OBJECTIVES: Systemic infection is among the common complications after solid-organ transplant and is associated with increased mortality and morbidity. Because it has prognostic significance, timely diagnosis and treatment are crucial. Procalcitonin is a propeptide of calcitonin and has been increasingly used as a biomarker of bacterial infection. Here, we investigated procalcitonin's role in identifying infectious complications in solid-organ transplant recipients. MATERIALS AND METHODS: We retrospectively evaluated the records of 86 adult patients who underwent solid-organ transplant (between 2011 and 2015) with procalcitonin levels determined at our center. Clinical and demographic variables and laboratory data were noted. Relation between C-reactive protein and procalcitonin serum levels were compared in patients who were diagnosed as having pneumonia on clinical, microbiologic, and radiologic findings. RESULTS: Mean age of our patients was 45.5 ± 13.4 years (range, 18-70 y), with 61 male patients (70.9%). We included 26 liver, 44 kidney, 14 heart, and 2 heart and renal transplant recipients. Procalcitonin was positive in 43 patients (50%). Of the 39 patients who were diagnosed with pneumonia, procalcitonin was positive in 18 patients (46.2%). There was a significant correlation between serum levels of procalcitonin and C-reactive protein (r = 0.45; P < .001) and neutrophil count (r = 0.24; P = .025). There was no correlation between mortality and procalcitonin level, CRP level, or leukocyte count (P > .05). CONCLUSIONS: Our findings indicate that procalcitonin is a promising biomarker to detect infectious complications in transplant recipients. Physical examination and radiologic findings of bacterial pneumonia may be nonspecific, and in a considerable number of immunocompromised patients the site of infection could not be identified. Serum levels of procalcitonin should not be used as sole criteria for clinical decision making; however, it can guide us in therapy of such conditions in addition to currently used serum markers of infection.


Assuntos
Calcitonina/sangue , Transplante de Órgãos/efeitos adversos , Pneumonia Bacteriana/sangue , Adolescente , Adulto , Idoso , Biomarcadores/sangue , Proteína C-Reativa , Feminino , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Masculino , Registros Médicos , Pessoa de Meia-Idade , Pneumonia Bacteriana/diagnóstico por imagem , Pneumonia Bacteriana/imunologia , Pneumonia Bacteriana/microbiologia , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Turquia , Regulação para Cima , Adulto Jovem
14.
Exp Clin Transplant ; 14(Suppl 3): 125-129, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27805531

RESUMO

OBJECTIVES: Postoperative pleural effusions are common in patients who undergo cardiac surgery and orthotopic heart transplant. Postoperative pleural effusions may also occur as postcardiac injury syndrome. Most of these effusions are nonspecific and develop as a harmless complication of the surgical procedure itself and generally have a benign course. Here, we investigated the cause and clinical and laboratory features of postoperative early and late pleural effusions in orthotopic heart transplant patients. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 50 patients who underwent orthotopic heart transplant between 2004 and 2015 at Baskent University. Patient demographics and clinical and laboratory data, including cause of heart failure, presence of pleural effusions at chest radiography in the first year after transplant, timing of onset, microbiologic and biochemical analyses of pleural effusions, and treatment strategies were noted. RESULTS: Mean age of patients was 39.22 ± 13.83 years (39 men, 11 women). Reason for heart failure was dilated cardiomyopathy in most patients (76%). Nineteen patients (38%) had postoperative pleural effusions, with 15 patients (78.9%) with pleural effusion during the first week after transplant. Of these, 4 patients had recurrent pleural effusion. A diagnostic thoracentesis was performed in 10 patients, with 4 showing transudative effusion and 6 showing exudative effusion secondary to infection (2 patients), postcardiac injury syndrome (1 patient), and hemothorax (3 patients). Aspergillus fumigatus was detected by quantitative culture from pleural effusion in 1 patient. Tube thoracoscopy drainage was performed in 10 patients (25%), and 2 patients received antibiotic therapy. CONCLUSIONS: Pleural effusions are frequent after cardiac transplant. Complications may occur in a small portion of patients, with most effusions being nonspecific and having a benign course with spontaneous resolution. Early diagnostic thoracentesis could improve postoperative outcomes in these patients.


Assuntos
Insuficiência Cardíaca/cirurgia , Transplante de Coração/efeitos adversos , Derrame Pleural/etiologia , Adulto , Antibacterianos/uso terapêutico , Drenagem/métodos , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/etiologia , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pleural/diagnóstico , Derrame Pleural/microbiologia , Derrame Pleural/terapia , Recidiva , Estudos Retrospectivos , Fatores de Risco , Toracentese , Toracoscopia , Fatores de Tempo , Resultado do Tratamento , Turquia
15.
Expert Rev Respir Med ; 10(1): 99-108, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26616764

RESUMO

AIM: To compare the effects of calisthenic and cycle exercises with no exercise in chronic obstructive pulmonary disease patients. METHOD: Forty-seven participants were allocated to either a cycle or calisthenic exercise or control group. Outcome measures, including Saint George Respiratory Questionnaire, pulmonary functions, cardiopulmonary exercise testing, Fitness Testing, and Hospital Anxiety-Depression, Modified Medical Research Council Dyspnea, Fatigue Severity, Fatigue Impact Scales, were performed before and after the intervention. RESULTS: The change in VE/VCO2 significantly differed (p = 0.01) between two exercise groups. Physical fitness, quality of life, anxiety-depression, dyspnea and fatigue changed significantly in exercise groups, with no between-group differences. There were no significant improvements in control group. CONCLUSION: Calisthenics are as safe and effective as cycle exercise and could be included in comprehensive treatment programs.


Assuntos
Terapia por Exercício , Doença Pulmonar Obstrutiva Crônica/reabilitação , Idoso , Ciclismo , Terapia por Exercício/métodos , Tolerância ao Exercício , Fadiga , Feminino , Ginástica , Humanos , Masculino , Pessoa de Meia-Idade , Aptidão Física , Psicologia , Ventilação Pulmonar , Qualidade de Vida
16.
Exp Clin Transplant ; 13 Suppl 3: 110-4, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26640928

RESUMO

OBJECTIVES: Cardiovascular and respiratory system complications are the most common causes of early mortality after liver transplant. We evaluated the causes of respiratory failure as an early postoperative pulmonary complication in liver transplant recipients. MATERIALS AND METHODS: Patients who underwent orthotropic liver transplant between 2001 and 2014 were retrospectively evaluated. Clinical and demographic variables and pulmonary complications at the first and second visit after transplant were noted. The first visit was within the first week and the second was between 1 and 4 weeks after transplant. An arterial oxygen saturation value below 90% in room air for at least 1 day was considered a medically significant respiratory failure. RESULTS: Our study included 204 (148 men and 56 women; mean age 43.0.4 ± 13.06 y) adult liver transplant recipients (46 from deceased and 158 from living donors). At the first visit after transplant, 161 patients (79%) had postoperative pulmonary complications, including pleural effusion accompanied by atelectasis (47.1%), only atelectasis (17.2%), and only pleural effusion (10.3%). At the second visit, complications included atelectasis associated with pleural effusion (12.3%) and pneumonia (12.3%). All patients had documented respiratory failure at the first visit, and 92 patients (45.1%) had respiratory failure at the second visit. Causes of respiratory failure at the first visit included atelectasis in 35 patients (17.2%) and atelectasis accompanied by pleural effusion in 96 patients (47.1%). At the second visit, 25 of 161 patients (25.3%) had respiratory failure due to pneumonia. Other causes included atelectasis accompanied by pleural effusion (24.2%) and pleural effusion (23.2%). Ninety-seven patients had no pulmonary complications. The mortality rate was 6.4% within the first visit and 8.7% within the second visit. CONCLUSIONS: Pneumonia, atelectasis, and pleural effusion can cause respiratory failure within the first month after liver transplant. Early pulmonary examination, diagnosis, and treatment can improve patient survival.


Assuntos
Transplante de Fígado/efeitos adversos , Pulmão/fisiopatologia , Insuficiência Respiratória/etiologia , Transplantados , Adulto , Diagnóstico Precoce , Feminino , Humanos , Transplante de Fígado/mortalidade , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Insuficiência Respiratória/diagnóstico , Insuficiência Respiratória/mortalidade , Insuficiência Respiratória/fisiopatologia , Insuficiência Respiratória/terapia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
17.
Exp Clin Transplant ; 13 Suppl 3: 140-3, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26640935

RESUMO

OBJECTIVES: Heart transplant is the best treatment for end-stage heart failure. Respiratory insufficiency after heart transplant is a potentially serious complication. Pulmonary complications, pulmonary hypertension, allograft failure or rejection, and structural heart defects in the donor heart are among the causes of hypoxemia after transplant. In this study, we evaluated the prevalence of hypoxemia and respiratory insufficiency in patients with orthotopic heart transplant during the early postoperative period. MATERIALS AND METHODS: We retrospectively evaluated the medical records of 45 patients who had received orthotopic heart transplant at our center. Clinical and demographic variables and laboratory data were noted. Oxygen saturation values from patients in the first week and the first month after transplant were analyzed. We also documented the cause of respiratory insufficiency and the type of treatment. RESULTS: Mean age was 35.3 ± 15.3 years (range, 12-61 y), with males comprising 32 of 45 patients (71.1%). Two patients had mild chronic obstructive pulmonary disease and 1 had asthma. Twenty-five patients (55.6%) had a history of smoking. Respiratory insufficiency was noted in 9 patients (20%) during the first postoperative week. Regarding cause, 5 of these patients (11.1%) had pleural effusion, 2 (4.4%) had atelectasis, 1 (2.2%) had pneumonia, and 1 (2.2%) had acute renal failure. Therapies administered to patients with respiratory insufficiency were as follows: 5 patients had oxygen therapy with nasal canula/mask, 3 patients had continuous positive airway pressure, and 1 patient had mechanical ventilation. One month after transplant, 2 patients (4.4%) had respiratory insufficiency 1 (2.2%) due to pleural effusion and 1 (2.2%) due to atelectasis. CONCLUSIONS: Respiratory insufficiency is a common complication in the first week after orthotopic heart transplant. Identification of the underlying cause is an important indicator for therapy. With appropriate care, respiratory insufficiency can be treated successfully.


Assuntos
Transplante de Coração/efeitos adversos , Insuficiência Respiratória/epidemiologia , Insuficiência Respiratória/terapia , Adolescente , Adulto , Asma/epidemiologia , Criança , Pressão Positiva Contínua nas Vias Aéreas , Feminino , Humanos , Hipóxia/epidemiologia , Hipóxia/terapia , Masculino , Registros Médicos , Pessoa de Meia-Idade , Oxigenoterapia , Derrame Pleural/epidemiologia , Derrame Pleural/terapia , Prevalência , Atelectasia Pulmonar/epidemiologia , Atelectasia Pulmonar/terapia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Insuficiência Respiratória/diagnóstico , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/terapia , Estudos Retrospectivos , Fatores de Risco , Fumar/efeitos adversos , Fumar/epidemiologia , Fatores de Tempo , Resultado do Tratamento , Turquia/epidemiologia , Adulto Jovem
18.
Exp Clin Transplant ; 13 Suppl 1: 214-8, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25894157

RESUMO

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.


Assuntos
Transplante de Rim/efeitos adversos , Transplante de Fígado/efeitos adversos , Infecções Oportunistas/epidemiologia , Tuberculose/epidemiologia , Adulto , Antituberculosos/uso terapêutico , Técnicas Bacteriológicas , Biópsia , Feminino , Humanos , Hospedeiro Imunocomprometido , Imunossupressores/efeitos adversos , Incidência , Masculino , Pessoa de Meia-Idade , Mycobacterium tuberculosis/isolamento & purificação , Infecções Oportunistas/diagnóstico , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/imunologia , Infecções Oportunistas/microbiologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Tuberculose/imunologia , Tuberculose/microbiologia , Turquia/epidemiologia
19.
Exp Clin Transplant ; 13 Suppl 1: 223-7, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25894159

RESUMO

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.


Assuntos
Transplante de Rim/efeitos adversos , Transplante de Fígado/efeitos adversos , Embolia Pulmonar/epidemiologia , Adulto , Anticoagulantes/uso terapêutico , Coagulação Sanguínea/efeitos dos fármacos , Coagulação Sanguínea/genética , Comorbidade , Feminino , Predisposição Genética para Doença , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Imunossupressores/efeitos adversos , Incidência , Masculino , Registros Médicos , Pessoa de Meia-Idade , Embolia Pulmonar/sangue , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/tratamento farmacológico , Embolia Pulmonar/genética , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Turquia/epidemiologia , Varfarina/uso terapêutico
20.
Exp Clin Transplant ; 13 Suppl 1: 340-5, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25894187

RESUMO

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.


Assuntos
Hepatectomia/efeitos adversos , Transplante de Fígado/efeitos adversos , Doadores Vivos , Pneumopatias/etiologia , Adulto , Feminino , Humanos , Transplante de Fígado/métodos , Pneumopatias/diagnóstico , Pneumopatias/prevenção & controle , Masculino , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
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