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    Combination of the Simplified Modified Geneva and Wells Clinical Prediction Scoring promise a good performance in pulmonary embolism diagnosis
    (Selçuk BAŞAK, 2021) Çoraplı, Gökhan; Topçu, Ayşe Füsun
    Background/Aim: Pulmonary thromboembolism (PTE) has high mortality and morbidity, is difficult to diagnose, and is generally preventable. Clinical scoring is used for early diagnosis. Two of these often-used scoring systems include the Wells and Simplified Modified Geneva scoring systems. We aimed to comparatively determine the values of the Wells and the Simplified Modified Geneva scoring systems in showing PTE. Methods: This prospective cohort study included 195 patients who underwent computerized tomography pulmonary angiography (CTPA) with suspected PTE between May 2018 and November 2018. The Wells and Simplified Modified Geneva scores of the patients were calculated. Wells Clinical Scoring results were grouped as having a weak/strong probability of PTE, while those of the Modified Geneva clinical scoring were categorized as possible/unlikely PTE. The analyses were performed with the SPSS package 21.0 program. Results: One hundred and nine (55.9%) patients presented to the emergency department and eighty-six (44.1%) patients visited the outpatient clinic for chest diseases. Of all cases, 83 (42.6%) were male and 112 (57.4%) were female. The mean age was 57.16 (18.62) years. Forty-one (21%) patients had PTE. The sensitivity and specificity of Wells Clinical Scoring for PTE were 87.8% and 83.8%, respectively, while those of the Simplified Modified Geneva Clinical Scoring were 82.9% and 53.3%, respectively. The chi-square analysis for two clinical scorings revealed a p-value of 0.001. The negative predictive values of Wells and Simplified Modified Geneva Scores were 96.2% and 92.1%, respectively. The positive predictive value was the highest in the emergency department (80% and 39.4%, respectively). When the two clinical scores were used together, the negative and positive predictive values were 95.6% and 61.1%, respectively. Conclusion: We found that Wells Clinical Scoring is superior to the Simplified Modified Geneva Score in terms of sensitivity and specificity. The use of these two clinical scores in the outpatient clinic was more useful in excluding PT, while in the emergency department, their combination was more effective in diagnosing it.
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    Prick Test Results and Total IgE Levels of Asthma Patients in A University Hospital
    (2019) Topçu, Ayşe Füsun; Hocanlı, İclal; Taylan, Mahşuk; Çil, Barış; Kabak, Mehmet
    Respiratory allergies are currently on the rise and affect all age groups. Aeroallergens play a major role in the pathogenesisof respiratory allergic diseases, especially in asthma and allergic rhinitis. Skin prick tests and specific blood tests can b eused to safely ascertain allergen-specific IgE. When correctly implemented, aeroallergens such as house mites, pollens, andpet allergens can be determined. Skin tests are widely used to assess sensitivity to allergens due to their relatively easyapplication and safety.The present study aims to delineate a regional allergen profile and compare this profile with that of other regions of thecountry. Furthermore, a comparison of total IgE elevation and prick test positivity was made to assess the sensitivity andspecificity of total IgE levels.One hundred and sixty seven patients over 18 years of age that applied to either in- or out-patient clinics, that had adiagnosis of asthma according to the criteria of GINA (the Global Initiative for Asthma) and had been attack -free for atleast one month were included. Forty one patients were male and 124 were female.The prick test was positive in 18.7%. Pollens (41.9%), mite (22.5%) and cochroach were the most frequently detectedallergens. Those that had serum IgE levels higher than the serum reference value had sign ificantly higher rate of prick testpositivity (p=0.029).The present study demonstrates inter-regional variability of allergen profiles and the direct correlation between total IgEelevation and prick test positivity. In cases where prick tests are not av ailable, allergen sensitivity can be determined bytotal IgE levels.
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    The proper use of inhalers in a third step hospital and its effect on treatment: Original study
    (Dicle Üniversitesi Tıp Fakültesi, 2019) Çil, Barış; Kabak, Mehmet; Topçu, Ayşe Füsun; Taylan, Mahşuk; Sezgi, Cengizhan
    Objective: The percentage of asthma patients that use their inhalers with the correct technique ranges between 10 and 60. Inappropriate use of inhaler leads to disuse of drug, diminished disease control and increased drug use. In this study, we aimed to determine the effect of proper inhaler therapy on the treatment and control of asthma and the effect of proper inhaler use on hospitalization due to asthma. Method: One hundred and sixty five asthma patients over 18 years of age that applied to either in- or out-patient clinics of a university hospital, that had a diagnosis of asthma according to the criteria of the Global Initiative for Asthma (GINA) and had been attack-free for at least one month were included. Patients were told to use their inhalers and any misuse were noted. Patients were put through the Asthma Control Test (ACT). Their forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and peak expiratory flow (PEF) values were also noted. Their hospitalization status for asthma in the last year was assessed and recorded. Results: One hundred patients used their asthma inhalers correctly, while 65 did not. Those that used their inhalers correctly had significantly higher ACT (p=0,0001), FEV1% (p=0,001) and PEF% (p=0,014). Discussion: Patients must be informed and trained for the correct use of their inhaler drugs. Patients seem to be under-informed on this subject and there are serious mistakes of use for all inhaler types. Correct use of inhalers leads to better control of disease, lower rate of asthma-related hospitalization, less drug waste and decreased treatment cost.
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    The role of pneumococcal pneumonia among community-acquired pneumonia in adult turkish population: Turkcap study
    (Aves Yayıncılık, 2021) Şenol, Esin; Çilli, Aykut; Günen, Hakan; Şener, Alper; Dumlu, Rıdvan; Ödemiş, Ayşe; Topçu, Ayşe Füsun
    OBJECTIVE: To evaluate the rate of pneumococcal pneumonia (PP) among patients with community-acquired pneumonia (CAP) in Turkey and to investigate and compare features of PP and non-PP CAP patients. MATERIAL AND METHODS: This multicenter, non-interventional, prospective, observational study included adult CAP patients (age ≥ 18 years). Diagnosis of PP was based on the presence of at least 1 positive laboratory test result for Streptococcus pneumoniae (blood culture or sputum culture or urinary antigen test [UAT]) in patients with radiographic findings of pneumonia. RESULTS: Four hundred sixty-five patients were diagnosed with CAP, of whom 59 (12.7%) had PP. The most common comorbidity was chronic obstructive pulmonary disease (30.1%). The mean age, smoking history, presence of chronic neurological disease, and CURB-65 score were significantly higher in PP patients, when compared to non-PP patients. In PP patients, 84.8% were diagnosed based ony on the UAT. The overall rate of PP patients among CAP was calculated as 22.8% considering the UAT sensitivity ratio of 63% (95% confidence interval: 45-81). The rate of intensive care treatment was higher in PP patients (P =.007). While no PP patients were vaccinated for pneumococcus, 3.8% of the non-PP patients were vaccinated (P =.235). Antibiotic use in the preceding 48 hours was higher in the non-PP group than in the PP group (31.8% vs. 11.1%, P =.002). The CURB-65 score and the rate of patients requiring inpatient treatment according to this score were higher in the PP group. CONCLUSION: The facts that PP patients were older and required intensive care treatment more frequently as compared to non-PP patients underline the burden of PP.