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Öğe Anti-inflammatory and anti-fibrotic effects of sirolimus on bleomycin-induced pulmonary fibrosis in rats(CANADIAN SOC CLINICAL INVESTIGATION, 2011) Tulek, Baykal; Kiyan, Esen; Toy, Hatice; Kiyici, Aysel; Narin, Cuneyt; Suerdem, MecitPurpose: Pulmonary fibrosis is a devastating disease with a poor prognosis. Although the diagnosis and pathophysiology of this disease have been better characterized over the past few years, there is no effective therapy for the disease. The aim of this study was to evaluate the anti-inflammatory and anti-fibrotic effects of sirolimus (SRL), which is a potential anti-fibrotic agent, by using bleomycin (BLM)-induced pulmonary fibrosis model in rats. Methods: A single intra-tracheal injection of BLM (2.5 U/kg) was administered and sirolimus (2.5 mg/kg/day) was given orally, beginning either one day before (early SRL) or nine days after (late SRL) the BLM administration. The effect of SRL on fibrosis was studied by analysis of cytokine levels in BAL fluid, measurement of lung tissue hydroxyproline (HPL) content and histopathological examination. Results: Both early and late SRL administrations caused a decrease in the levels of IL-13, PDGF-A and TGF-beta 1 (p=0.001) and an increase in IFN-beta levels (p=0.001) in BAL fluid. Early and late SRL also caused a decrease in HPL content (p=0.001). Early sirolimus caused a significant decrease in fibrosis score (p=0.001), while late SRL did not. Conclusion: Sirolimus was effective in BLM-induced pulmonary fibrosis model, especially in the early phases of the disease.Öğe Attentional control is partially impaired in obstructive sleep apnea syndrome(WILEY, 2013) Tulek, Baykal; Atalay, Nart Bedin; Kanat, Fikret; Suerdem, MecitObstructive sleep apnea syndrome is associated with executive cognitive impairment. An important question is whether impairment in executive functioning in obstructive sleep apnea syndrome is independent of dysfunction in attention. Attentional control is a subcomponent of executive functioning that is mediated by frontal lobe processing. In the current study, we investigated whether attentional control is deficient in obstructive sleep apnea syndrome. Attentional control processes were investigated through conflict adaptation and conflict frequency paradigms. These neuropsychological paradigms were assessed by using the Simon, Flanker and Stroop tasks. We additionally analysed post-error slowing data within these tasks. Error processing is another index of cognitive control that is mediated by frontal lobe functioning. Our sample consisted of 14 healthy adults and 24 patients with untreated moderate-severe obstructive sleep apnea syndrome. Results indicated that attentional control is partially dysfunctional among patients with obstructive sleep apnea syndrome. Attentional control processes were deficient when focal attention (Flanker task) processes were involved, but were intact when observed using the Simon and Stroop tasks. A non-significant trend in post-error slowing data suggested that error processing, assessed with the Flanker task, was diminished among patients with obstructive sleep apnea syndrome. These results support the view that obstructive sleep apnea syndrome leads to some amount of frontal lobe dysfunction, and that attentional control and error processing might be particularly affected by obstructive sleep apnea syndrome.Öğe Cognitive function in chronic obstructive pulmonary disease: Relationship to global initiative for chronic obstructive lung disease 2011 categories(WILEY-BLACKWELL, 2014) Tulek, Baykal; Atalay, Nart Bedin; Yildirim, Gulfem; Kanat, Fikret; Suerdem, MecitBackground and objective: Recently, comorbidities such as impaired cognitive function have been attracting more focus when considering the management of chronic obstructive pulmonary disease (COPD). Here we investigated the relationship between cognitive function and the categories given in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines in 2011. Specifically, after controlling for non-COPD covariates, we assessed the clinical features that may be predictive of cognitive impairment in patients with COPD. Methods: We recruited 119 stable patients with mild to very severe COPD. We administered a broad array of standardized neuropsychological tests that assessed cognitive functions in the domains of attention, memory, psychomotor coordination and language. Results: Cognitive scores were significantly different between patients falling within GOLD 2011 categories. Scores were lower in patients with high future risk compared with low future risk. In parallel, there were significant differences in cognitive function between COPD patient subgroups when patients were grouped according to the forced expiratory volume in 1 s, exacerbation history and C-reactive protein levels. After controlling for non-COPD predictors, only exacerbation history remained a significant predictor of cognitive scores. Conclusions: The number of exacerbation events in a year may be used as a predictor of cognitive impairment in patients with COPD.Öğe The effect of cognitive functions on the ability to learn how to use a Diskus device in patients with chronic obstructive pulmonary disease(TURKISH RESPIRATORY SOC, 2018) Tulek, Baykal; Atalay, Nart Bedin; Kurtipek, Ercan; Yildirim, Gulfem; Kanat, Fikret; Suerdem, MecitOBJECTIVE: Dry powder inhalers are a group of inhaled medications commonly used for the treatment of chronic obstructive pulmonary disease (COPD). Although they can be more easily administered than metered dose inhalers, there is a high rate of errors in device use. The present study aims to evaluate the relationship between the ability to learn how to use a Diskus device and cognitive functions in patients with COPD. MATERIALS AND METHODS: The study included 30 inhaler-naive patients who were newly diagnosed with COPD. During their first visit, patients were administered a broad array of standardized neuropsychological tests and given a training on inhaler use. During the second visit, patients were divided into two groups according to their performance in the use of Diskus device: effective and ineffective. RESULTS: Twenty-nine patients who completed the study showed a negative correlation between the cognitive test scores and Diskus training parameters. The number of errors and duration of training increased as the cognitive scores decreased. In Visit 2, a comparison between patients with ineffective and effective use of the Diskus device showed that cognitive function scores were higher in those with effective use. CONCLUSIONS: Evaluation of cognitive functions in COPD patients is important in establishing an effective inhalation treatment.Öğe Effects of simvastatin on bleomycin-induced pulmonary fibrosis in female rats(SOC BIOLGIA CHILE, 2012) Tulek, Baykal; Kiyan, Esen; Kiyici, Aysel; Toy, Hatice; Bariskaner, Hulagu; Suerdem, MecitStatins reduce cholesterol levels by inhibiting 3-hydroxy-3-methylglutaryl coenzyme A reductase and have a major place in the treatment of atherosclerotic disease. Recent studies have shown anti-inflammatory properties of statins. The purpose of this study was to evaluate the anti-inflammatory effect of simvastatin on bleomycin (BLM)-induced pulmonary fibrosis in rats. A total of 31 female Sprague-Dawley rats were divided into four groups: (1) intratracheal (IT) phosphate-buffered saline (PBS) + intraperitoneal (IP) PBS (n=7); (2) IT BLM + IP PBS (n=8); (3) IT BLM + low dose (LD) simvastatin (1 mg/kg daily, n=8); (4) IT BLM + high dose (HD) simvastatin (5 mg/kg daily, n=8). Simvastatin was administered IP for 15 days, beginning 1 day prior to IT BLM. The effect of simvastatin on pulmonary fibrosis was studied by measurements of IL-13, PDGF, IFN-gamma, TGF-beta 1 levels in bronchoalveolar lavage (BAL) fluid and lung tissue hydroxyproline (HPL) content and by histopathological examination (Ashcroft score). BLM caused significant change in BAL fluid cytokine levels and increased both HPL content and histopathological score (p<0.001 for all). While LD simvastatin had no effect on cytokine levels, HD significantly reduced IL-13 (15.12 +/- 7.08 pg /ml vs. 4.43 +/- 2.34 pg/mL; p<0.05) and TGF-beta 1 levels (269.25 +/- 65.42 pg/mL vs. 131.75 +/- 32.65 pg/mL; p<0.05). Neither HD nor LD simvastatin attenuated HPL content or Ashcroft score. In conclusion, this study showed that LD simvastatin had no effect on a BLM-induced pulmonary fibrosis model, while the high dose caused partial improvement in profibrotic cytolcine levels.Öğe Flexible bronchoscopy may decrease respiratory muscle strength: premedicational midazolam in focus(BIOMED CENTRAL LTD, 2012) Tulek, Baykal; Kanat, Fikret; Tol, Sule; Suerdem, MecitBackground: Flexible bronchoscopy (FB) is a procedure accepted to be safe in general, with low complication rates reported. On the other hand, it is known that patients with pre-existing respiratory failure have developed hypoventilation following FB. In this study the effects of FB on respiratory muscle strength were investigated by measuring maximum respiratory pressures. Methods: One hundred and forty patients, aged between 25 and 90 years, who had undergone diagnostic bronchoscopy between February 2012 and May 2012, were recruited to the study. Pre- and post-procedure maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured. A correlation between the MIP and MEP changes and patient characteristics and FB variables were investigated. Results: Significant decreases in both MIP and MEP values were observed following FB (p < 0.001 for both). Decreases were attributed to the midazolam used for sedation. Significant decreases in respiratory muscle strengths were observed especially in the high-dose midazolam group, compared to both low-dose and non-midazolam groups. Conclusions: It was determined that respiratory muscle weakness may arise post-procedure in patients who have undergone FB, and this is constitutively related to midazolam premedication. Respiratory muscle weakness might play a role in potential hypoventilation in critical patients who undergo FB.Öğe Phenotyping of chronic obstructive pulmonary disease using the modified Bhalla scoring system for high-resolution computed tomography(HINDAWI LTD, 2013) Tulek, Baykal; Kivrak, Ali Sami; Ozbek, Seda; Kanat, Fikret; Suerdem, MecitBACKGROUND: Identifying different phenotypes of chronic obstructive pulmonary disease (COPD) is important for both therapeutic options and clinical outcome of the disease. OBJECTIVE: To characterize the phenotypes of COPD according to high-resolution computed tomography (HRCT) findings; and to correlate HRCT scores obtained using the modified Bhalla scoring system with clinical and physiological indicators of systemic inflammation. METHODS: The present study included 80 consecutive patients with stable COPD. HRCT scans were evaluated by two independent radiologists according to the modified Bhalla scoring system. RESULTS: Fifty-four patients exhibited morphological changes on HRCT examination while 26 had no pathological findings. Patients with HRCT findings had lower spirometric measurements and higher levels of inflammation, and reported more exacerbations in the previous year compared with patients with no findings on HRCT. Patients with morphological changes were classified into one of three groups according to their HRCT phenotype(s): emphysema (E) only, E + bronchiectasis (B)/peribronchial thickening (PBT) or B/PBT only. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC ratio, C-reactive protein (CRP) levels and the number of exacerbations among the groups were significantly different. Pairwise comparisons between the E only and E+B/PBT groups showed significantly lower FVC, FEV1 and FEV1/FVC values, and higher CRP levels and number of exacerbations compared with the B/PBT group. No significant differences were found between the E+B/PBT and the B/PBT groups. An inverse correlation was found between the total HRCT score and FVC, FEV1 and FEV1/FVC; the correlation was positive with CRP level, erythrocyte sedimentation rate and number of exacerbations. CONCLUSION: The present study exposed the intimate relationship between phenotype(s) characterized by HRCT and scoring for morphological abnormalities; and clinical and functional parameters and inflammatory markers. The inclusion of HRCT among routine examinations for COPD may provide significant benefits both in the management and prognosis of COPD patients.Öğe Reactive and proactive control of cognitive functions in obstructive sleep apnea(EUROPEAN RESPIRATORY SOC JOURNALS LTD, 2012) Tulek, Baykal; Atalay, Nart Bedin; Kanat, Fikret; Suerdem, Mecit[Abstract not Available]Öğe Relationship between the ability to learn dry-powder inhaler use and the cognitive functions in patients with COPD(EUROPEAN RESPIRATORY SOC JOURNALS LTD, 2015) Tulek, Baykal; Atalay, Nart Bedin; Kurtipek, Ercan; Yildirim, Gulfem; Kanat, Fikret; Suerdem, Mecit[Abstract not Available]Öğe Respiratory failure caused by giant thymolipoma(ELSEVIER SCIENCE INC, 2008) Ceran, Sami; Tulek, Baykal; Sunam, Guven; Suerdem, MecitThe authors present the case of a 31-year-old woman with a massive anterior mediastinal tumor who presented with respiratory failure. A thoracic computed tomographic scan suggested a mediastinal lipomatous mass, and an operation was performed. Resection of the tumor resulted in immediate improvement in the patient's pulmonary status, and the histopathologic examination revealed thymolipoma. Because thymolipoma can attain enormous dimensions and compress adjacent structures, it should be immediately resected.Öğe Serum C-reactive protein and procalcitonin levels in non-small cell lung cancer patients(TERMEDIA PUBLISHING HOUSE LTD, 2013) Tulek, Baykal; Koylu, Habibe; Kanat, Fikret; Arslan, Ugur; Ozer, FarukAim Of the Study: The basic uses of C-re, active protein (CRP) and procalcitonin (PCT) in clinical practice are in the diagnosis and follow-up of infectious disease. The fact that CRP already achieves high levels in cases with lung cancer, however, limits its diagnostic specificity. Procalcitonin may be an important Marker in the differential diagnosis of lung cancer patients who have fever and high CRP levels. Our Objective in this Study was to determine the levels of CRP and PCT in patients with newly diagnosed noninfectious non-small tell lung cancer (NSCLC) and to relate these results to patient and disease Characteristics. Material and Methods: Serum CRP and PCT levels were Measured in 79 histopathologically proven NSCLC patients and 20 healthy controls. Results were compared with demographic and clinical variables in patients with NSCLC. Results: Serum CRP concentrations were significantly higher in NSCLC patients compared to the Control group [38.30 (7.79-185) mg/dl vs. 7.79 (3.36-26.10) mg/dl; p < 0.001] There was no significant difference between the two groups in PCT levels (p > 0.05). A mild, positive correlation was found between CRP level and tumor diameter. When comparing CRP levels in the lung cancer patients grouped according to age, sex, smoking status, clinical TNM staging and performance status (PS), the only significant difference found was that for PS Score. Conclusions: High serum CRP levels in non-infectious NSCLC patients are mainly related to PS status and weakly to tumor size. Adding serum PCT measurement may contribute to exclusion of infections in patients with NSCLC.Öğe Serum C-reactive protein and procalcitonin levels in non-small cell lung cancer patients -- 2(EUROPEAN RESPIRATORY SOC JOURNALS LTD, 2012) Tulek, Baykal; Koylu, Habibe; Kanat, Fikret; Arslan, Ugur; Ozer, Faruk[Abstract not Available]Öğe Synchronous, Multiple Primary Lung Cancers: A Report of Three Cases(AVES, 2015) Tulek, Baykal; Baba, Fusun; Inan, Esra; Kanat, Fikret; Suerdem, MecitMultiple primary lung cancers (MPLC) are named synchronous if determined simultaneously with the index tumor, and metachronous if the second tumor is diagnosed with an accepted time after the first tumor. It is important for both the rate of survival and treatment alternatives to differentiate synchronous MPLCs from the metastases of the primary lung tumors, and also from the multiple pulmonary metastases of the extra pulmonary tumors. In this study, clinical characteristics, diagnosis and treatment processes of three synchronous MPLC cases diagnosed in our department were assessed.Öğe Using fractional exhaled nitric oxide level to differentiate asthma-COPD overlap syndrome from COPD(EUROPEAN RESPIRATORY SOC JOURNALS LTD, 2018) Taskin, Volkan; Kanat, Fikret; Suerdem, Mecit; Gurel, Nedim; Tulek, Baykal[Abstract not Available]
