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Öğe Atypical Post-COVID Sequel: Bronchiectasis(2022) Afşin, EmineAlthough there have been many studies determining\rthe occurrence of post-COVID pulmonary fibrosis\rand thromboembolism, there are a limited number of\rstudies and case reports in literature on the development\rof bronchiectasis. The present study presents a\rcase of bronchiectasis sequel in the post-COVID 11th\rmonth. A 49-year-old male, non-smoker with diabetes\rmellitus and hypertension was admitted with exertional\rdyspnea. The patient had been followed up in\rthe hospital 11 months earlier for 1.5 months with\rsevere COVID-19 pneumonia and respiratory failure\rfor which he was treated with Favipiravir, pulse\rmethylprednisolone and broad-spectrum antibiotics.\rThere was no need for invasive mechanical ventilation,\rand no secondary bacterial infection was detected.\rCompared to the previous CT, a chest CT\rrevealed that bronchiectasis had persisted despite the\rdisappearance of fibrotic changes. In the coming\ryears, one of the first questions raised regarding the\retiology of bronchiectasis may be the patient’s\rCOVID-19 history.Öğe Clinical results of high probability ventilation/perfusion scintigraphy in the diagnosis of pulmonary embolism(Cell Press, 2023) Afşin, Emine; Afşin, HamdiPurpose: While computed tomography pulmonary angiography plays an effective role in the diagnosis and prognosis of pulmonary embolism (PE), there are not enough studies regarding ventilation/perfusion (V/Q) scintigraphy. We aimed to evaluate the clinical outcomes of PE patients whose V/Q scintigraphy was reported as high probability for PE. Method: Demographic data, Simplified Pulmonary Embolism Severity Index (SPESI), radiological findings, V/Q scintigraphy and echocardiographic (ECHO) findings, laboratory data, treatment information and comorbidities of 43 patients whose V/Q scintigraphy was reported as high probability for PE between January 2020 and January 2023 was recorded. Perfusion scintigraphy defects were classified as subsegmental, multiple subsegmental, segmental, and multiple segmental. Those with subsegmental, multiple subsegmental, and segmental perfusion defects were classified as Group 1, and those with multiple segmental defects as Group 2. Results: The mean age of the patients was 74 years (31-94), being 27 women (62.8 %) and 16 men (37.2 %), and there was no significant difference between the two groups. Multisegmental perfusion defect was detected in 23 (53.5 %) patients. 25 % of patients reported as highprobability PE had a SPESI score of >= 2. There was no significant difference between Groups 1 and 2 in terms of SPESI scoring. Perfusion defect had no significant correlation with SPESI score, D-Dimer, Troponin, pulmonary artery systolic pressure, right ventricular dilatation, and length of hospital stay. The presence of comorbidity was significantly positively correlated only with the SPESI score. There was no difference between the two groups regarding laboratory, radiological, echocardiographic findings, presence of comorbidity, unit of treatment, and duration of hospitalization. Conclusion: Parameters predicting clinical severity and providing treatment benefits are required in PE patients diagnosed with V/Q scintigraphy.Öğe Coexistence of COVID-19, Pseudomonas, and thoracic actinomycosis in a cystic bronchiectasis case(BMC, 2023) Afşin, Emine; Küçük, Furkan; Özçelik, Hüsna; Haktanır, Muhammed YavuzActinomycosis often leads to cervicofacial infections, but thoracic involvement may also occur. However, the development of empyema is rare. While being followed up with the diagnosis of asthma and bronchiectasis, our case was hospitalized for infected bronchiectasis. As empyema developed in the follow-up, the pleural effusion was drained by tube thoracostomy. Actinomycosis was diagnosed through pleural effusion cytology. Growth of Pseudomonas aeruginosa was observed in sputum culture, and SARS-CoV2 RT-PCR was also positive in nasopharyngeal sampling. Polymicrobial agents can often be detected in actinomycosis. Actinomycosis cases have also been reported in the post-COVID period. Our case is presented since it would be the first in the literature regarding the coexistence of COVID-19, Pseudomonas, and thoracic Actinomycosis (empyema).Öğe COVID-19 and comorbidities: Predictors, clinical course, relationship with diseaseseverity, and outcome(2021) Afşin, Emine; Coşgun, MehmetAim: COVID-19 disease has a broad spectrum ranging from asymptomatic course to death. While data showthat the prognosis of the disease will be poor in the presence of comorbidity, we witness the death of patientswith no comorbidities in our clinical practice. This study aimed to investigate the effect of comorbidity on theclinical course and mortality of COVID-19 pneumonia. Methods: 155 Rt-PCR (+) adult patients hospitalized at İzzet Baysal State Hospital (Bolu, Turkey) diagnosedwith severe and critical pneumonia between August 2020 and February 2021 were included in this single center, retrospective study. The patients were divided into two groups with and without comorbidity, comparedthe severity of inflammation parameters, radiological involvement, and oxygen requirement, and evaluatedtheir effects on mortality and hospitalization duration. Results: There was no significant difference in the severity of the computed tomography (CT) involvement,the oxygen requirement, inflammation markers, and duration of hospitalization in patients with comorbiditiescompared to those without. When we evaluated the patients with comorbidities in general and their subgroups,the relationship with mortality was not significant. The severity of CT involvement, high oxygen requirement,and inflammation markers such as lymphocyte, lymphocyte ratio, LDH, CRP, troponin, ferritin levels werefound to be associated with mortality.Conclusions: In this study, we found that the presence of comorbidity did not affect mortality and durationof stay and that the severity of radiological involvement, the severity of hypoxemia, and the increase ininflammation markers were the determinants of mortality.Öğe Evaluation of quality of life after pulmonary embolism(Edizioni Minerva Medica, 2024) Afşin, Emine; Kayakıran, OrhanBACKGROUND: Post-pulmonary embolism syndrome, characterized by dyspnea, decreased exercise capacity, and worsening quality of life, may develop after pulmonary embolism (PE). The PE Quality of Life (PEmb-QoL) Questionnaire can detect this syndrome early. METHODS: The PEmb-QoL Questionnaire was filled in by telephone interview with the patients who were followed up with the diagnosis of PE in the third month after discharge. Data on risk factors, symptoms, laboratory and radiological findings, clinical status, and treatment for PE were recorded. RESULTS: There was a positive correlation between age and duration of hospitalization with the PEmb-QoL Questionnaire Score and a negative correlation with left ventricle ejection fraction (LVEF). Duration of hospitalization was also correlated with simplified PE Severity Index (sPESI), low LVEF, and thrombolytic therapy use. The PEmb-QoL Questionnaire Score was higher in those without deep vein thrombosis. The location of the thrombus (in the main pulmonary artery, bilateral or unilateral), increased pulmonary artery pressure, and Right Ventricle/Left Ventricle Ratio of >1 in computed tomography and echocardiography were not associated with the PEmb-QoL Questionnaire Score. CONCLUSIONS: Patients with low LVEF, advanced age, long-term hospitalization, high sPESI Score, and using thrombolytics should be followed closely in terms of post-PE syndrome. © 2023 EDIZIONI MINERVA MEDICA.Öğe Factors affecting pognosis and mortality in severe Covid-19 pneumonia patients(Sestre milosrdnice University Hospital, 2023) Afşin, Emine; Demirkol, Muhammed EminFatality rate in coronavirus disease 2019 (COVID-19) cases has been reported to be 3.4% worldwide. The aim of this study was to evaluate the factors that determine prognosis and mortality in severe COVID-19 pneumonia patients. Eighty adult patients with severe COVID-19 pneumonia vember 2020 were included in this retrospective single-center study. Demographic and laboratory data, severity of radiological involvement, comorbidities, agents used in treatment, and clinical results were recorded, and data were grouped as survivors and non-survivors. The mean patient age was 67.8 +/- 12.6 years. There were 59 (73.8%) male patients. Comorbid diseases were present in 53 (66.3%) patients. There was no significant relationship between patient age, gender, smoking status or presence of comorbidity and mortality (p>0.05). The variables such as pulmonary involvement above 50%, intubation, or ferritin (>434.8 mu g/L), troponin I (>14.05 ng/L) and procalcitonin (>0.125 ng/mL) as the sole variables of laboratory data were found to have significant relationship with increased mortality (p<0.05). Mortality was significantly higher in patients using steroid pulse therapy + tocilizumab, steroid pulse therapy + hydroxychloroquine, or solely steroid pulse therapy, while it was significantly lower in patients receiving azithromycin therapy and those in the plasma + steroid pulse therapy group. The severity of pulmonary involvement, intubation, and increase in inflammation markers such as ferritin, troponin and procalcitonin were found to be significantly associated with mortality (p<0.05). Treatment approaches with azithromycin and plasma + steroid pulse therapy were found to reduce mortality.Öğe Have the number of pulmonary embolism cases increased during the COVID-19 pandemic?(Termedia Publishing House Ltd, 2022) Afşin, Emine; Özsarı, Emine; Konuk, Suat; Kocadağ, Derya; Bacaksız, EmreBackground. Coagulation disorders, endothelial dysfunction, immobility and dehydration contribute to deep vein throm-bosis (DVT) and pulmonary embolism (PE) in COVID-19 patients. While the prevalence of PE accompanying COVID-19 is high, the number of studies on its long-term effects is limited in literature. Objectives. We expanded this process and aimed to evaluate a one-year period before and during the pandemic. We sought an answer to the question: "Is there a change in the frequency and clinical course of PE?" Material and methods. Retrospectively, all patients admitted to our pulmonology clinic diagnosed with PE between October 2018-2019 (pre-pandemic) and April 2020-2021 (pandemic period) were included in the study. PE patients hospitalized due to COVID-19 infection were not included in the study. Results. The prevalence of PE cases increased by 43% in the first year of the pandemic, and there was no significant difference in terms of symptoms, localisation and extent of thrombus in the pulmonary artery, DVT frequency, systolic pulmonary artery pressure (PABs) values, right heart load, frequency of thrombolytic therapy and mortality rates. A significant decrease was observed in predisposing factors of pulmonary embolism only in the postoperative period (7 patients (77.8%) before the pandemic; 2 patients (22.2%) during the pandemic; p = 0.029). Conclusions. PE cases are encountered more frequently during the pandemic process, and no significant change was seen in patient's clinical findings and mortality.Öğe The incidence of deep venous thrombosis in Parkinson's disease(Taylor & Francis Ltd, 2023) Afşin, Emine; Coşgun, Zeliha; Kurul, Ramazan; Türkoğlu, Şule AydınIntroductionVenous thromboembolism is one of the causes of sudden death in Parkinson's Disease (PD). Few studies have investigated the correlation between PD and deep venous thrombosis (DVT). This study aimed to investigate the frequency of DVT in PD patients prospectively.Material and MethodDemographic characteristics of 37 PD patients without known risk factors for DVT, disease duration, Hoehn-Yahr (H - Y) stage, oxygen saturation (SpO2) and heart rate values with pulse oximetry, use of assistive devices, waist and knee circumference measurements, and modified Medical Research Council (mMRC) dyspnea score was recorded. Both legs were evaluated for thrombus by Doppler venous ultrasound (US).ResultsWith the H-Y stage of the disease duration, a positive correlation was determined between the H-Y stage and mMRC. Disease duration was negatively correlated with BMI and positively correlated with the need for assistance. Assistive device use was positively associated with age and mMRC. DVT was detected in only one patient. When our patients' files were reviewed after 1.5 years, one patient was hospitalized with the diagnosis of submassive pulmonary embolism.ConclusionAttention should be paid to the development of DVT in elderly patients with advanced stages of PD, progression in the H-Y stage, use of assistive devices, and progression in dyspnea scoring. There is also a need for studies on the benefit of DVT prophylaxis in PD patients with a high risk of venous thromboembolism.Öğe Lung cancer from suspicion to treatment: An indicator of healthcare access in Turkey(Elsevier Sci LTD, 2023) Afşin, Emine; Kızılırmak, Deniz; Kaya, Zeynep Yılmaz; Gökçimen, Gizem; Havlucu, Yavuz; Özyurt, Beyhan CengizBackground: Lung cancer is the leading cause of cancer-related deaths worldwide. Before beginning lung cancer treatment, it is necessary to complete procedures such as suspecting lung cancer, obtaining a pathologic diagnosis, and staging. This study aimed to investigate the processes from suspicion of lung cancer to diagnosis, staging, and treatment initiation. Metbods: The study was designed as a multicenter and cross-sectional study. Patients with lung cancer from various health institutions located in all geographic regions of Turkey were included in the study. The socio-demographic and clinical characteristics of the patients, the characteristics of the health institutions and geographic regions, and other variables of the lung cancer process were recorded. The time from suspicion of lung cancer to pathologic diagnosis, radiologic staging, and treatment initiation, as well as influencing factors, were investigated. Results: The study included 1410 patients from 29 different medical centers. The mean time from the initial suspicion of lung cancer to the pathologic diagnosis was 48.0 +/- 52.6 days, 39.0 +/- 52.7 days for radiologic staging, and 74.9 +/- 65.5 days for treatment initiation. The residential areas with the most suspected lung cancer cases were highly developed socioeconomic zones. Primary healthcare services accounted for only 0.4% of pa-tients with suspected lung cancer. The time to pathologic diagnosis was longer in the Marmara region, and the wait time for staging and treatment initiation was longer in Eastern and Southeastern Anatolia. Patients who presented to chest disease referral hospitals with peripheral lesions, those with early-stage disease, and those who were diagnosed surgically had significantly longer wait times. Conclusion: The time between pathologic diagnosis, staging, and treatment initiation in lung cancer was longer than expected. Increasing the role of primary healthcare services and distributing socioeconomic resources more equally will contribute to shortening the time to diagnosis and improve treatment processes for lung cancer.Öğe Methanol Intoxication in the Differential Diagnosis of COVID-19(2022) Afşin, Emine; Küçük, Furkan; Kalfaoğlu, Melike ElifAlthough central nervous system findings are promi nent in methanol intoxication, the lungs are also affected. There have been several studies in literature describing autopsy-based lung findings, while there have been no clinical cases reported on to date. We present here a case identified radiologically as pul monary edema that was included in the differential diagnosis of COVID-19.Öğe Post-COVID pulmonary function test evaluation(AVES, 2022) Afşin, Emine; Demirkol, Muhammed EminOBJECTIVE: Since the lung is the most affected organ by COVID-19 disease, we aimed to evaluate the pulmonary function test, presence of hypoxemia, and Post-COVID-19 Functional Status Scale in 3- to 6-month post-COVID period. MATERIAL AND METHODS: Post-COVID-19 Functional Status Scale, pulse oxygen saturation, and pulmonary function test were evaluated in 67 outpatients/inpatients after 3-6 months following COVID-19 (positive reverse transcription-polymerase chain reaction on nasopharyngeal swab) disease. Pre-COVID pulmonary function test parameters were available in 33 patients, and these were compared with post-COVID pulmonary function test parameters. RESULTS: We found 20.9% (14 patients) restrictive and 11.9% (8 patients) obstructive patterns in pulmonary function test. Of those with forced vital capacity < 80%, 53.3% were patients without known lung diseases. When pulmonary function test values before and after COVID-19 were compared, only a loss of 130 mL in forced expiratory volume in 1 second was determined (P =.005). About 65.4% of the patients with dyspnea were in the group without a lung disease (P =.002) and 66.7% of patients with forced expiratory volume in 1 second and forced vital capacity of <80% had dyspnea complaint (P = 0.048, P = 0.012). Oxygen saturation was lower in patients with lung disease (P =.012) and was significantly lower in patients with forced vital capacity < 80% (P =.023). No correlation was found between Post-COVID-19 Functional Status Scale and pulmonary function test parameters (P >.05). Smoking, hospitalization, oxygen support, and the severity of computed tomography involvement did not impact pulmonary function test. CONCLUSION: In post-COVID patients, the major disorder in the respiratory function test was determined as a restriction. However, advanced tests such as lung volumes and carbon monoxide diffusing capacity (DLCO) measurement and high-resolution lung tomography are needed to differentiate in terms of physical functional limitation or parenchymal fibrosis.Öğe A rare cause of dysarthria: Legionnaires' disease(Taylor & Francis Ltd, 2023) Afşin, Emine; Küçük, Furkan; Yıldız, Serpil; Ersoy, SadettinPurpose/Aim of the StudyA case admitted with dysarthria and syncope and hyperintense lesion in the splenium of the corpus callosum, diagnosed as Legionnaires' disease by detecting Legionella antigen in the urine, and recovered only with antibiotic treatment is presented because it is rare in the literature.Materials and MethodsWhen a 64-year-old female patient was admitted to the emergency department with complaints of sudden loss of consciousness and fainting at home, she had speech impairment, and her pulse oxygen saturation in room air was 88%. In the neurological examination, there was no pathological finding except dysarthria in the patient with no motor deficit. The patient had no respiratory complaints and had a recent travel history. In laboratory examinations, hyponatremia was detected with increased C-reactive protein and liver enzymes. Consolidation was observed in the lower right zone on chest computed tomography. Ampicillin + sulbactam (4x1 gr, intravenous) and clarithromycin (2 x 500 mg orally) were initiated. On cranial magnetic resonance, a hyperintense lesion was observed in the splenium of the corpus callosum in the oval T2 sequence. Legionella pneumophila serogroup 1 antigen in urine was reported as positive. On the fourth day of her hospitalization, the patient, whose CRP and liver enzyme values regressed, her hyponatremia improved, her pulse oxygen saturation increased to 92% in room air, and her speech became comprehensible, was discharged after oral antibiotic treatment was arranged. On the 12th day, the speech ability of the patient completely returned to normal.ConclusionLegionella infection should be suspected in the presence of pneumonia and corpus callosum splenium lesion.Öğe A rare cough complication: Internal oblique muscle hematoma(Elsevier Inc., 2021) Afşin, Emine; Coşgun, ZelihaCough-related hematomas occur most frequently in the rectus sheath and retroperitoneum while lateral abdominal wall hematomas are rarely reported. Intramuscular hematoma might be mistaken for tumors and acute inflammatory diseases of the abdomen. A definite diagnosis is made with computerized tomography. In the case presented in this study, a 78-year-old female patient who had cough and shortness of breath for 1 week applied to the outpatient clinic with complaints of ecchymosis on the left side of the abdomen accompanied by swelling and pain under the left rib. The International Normalized Ratio of the patient, who used Warfarin sodium 5mg / day for mitral valve replacement, was in the effective range (INR: 2.4). Superficial ultrasound revealed a heterogeneous lesion with a well-circumscribed, hypoechoic and locally cystic component in the lateral abdominal wall in the left subcostal area. On computerized tomography, the lesion in the left internal oblique muscle of 27 × 60 mm, heterogeneous density, and with smooth borders was classified as Type 2 hematoma. Hemodynamics of the patient were stable and did not exceed INR 3 in follow-up, and there was no decrease in hemoglobin values. The patient's ecchymosis disappeared on the fifth day, and control ultrasonography showed the hematoma was partially resorbed. The aim of this study is to emphasize that conservative methods should be applied and surgery should be avoided as much as possible in internal oblique muscle hematoma. © 2021Öğe Tracheal schwannoma mimicking asthma(Taylor and Francis Ltd., 2024) Afşin, Emine; Yakşi, Osman; Önal, Ali Can; Bacaksız, EmreSchwannoma in primary neurogenic tumors of the trachea is an extremely rare disease. A 21-year-old male patient with stridor was followed up with a diagnosis of asthma for two years. While no lesion was observed in the chest X-ray, tracheal schwannoma was diagnosed in the case who underwent tracheotomy due to the lesion obstructing the trachea almost completely on chest CT. The clinical findings of the patient improved ultimately in the postoperative period. We aimed to discuss the approach and follow-up of the disease with our case, although it is rare that schwannoma might be in the differential diagnosis of masses with upper airway obstruction. © 2022 Informa UK Limited, trading as Taylor & Francis Group.
