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    Bronchiectasis in Türkiye: Data from a Multicenter Registry (Turkish Adult Bronchiectasis Database)
    (Galenos Publ House, 2024) Edis, Ebru Cakir; Cilli, Aykut; Kizilirmak, Deniz; Coskun, Ayson Sakar; Guler, Nurcan; Cicek, Sedat; Sevinc, Can
    Background: Bronchiectasis is a chronic lung disease characterized by permanent bronchial wall dilatation. Although it has been known as an orphan disease, it has recently gained attention because of registry -based studies and drug research. Aims: We aimed to use a multicenter database to analyze and compare data regarding the etiology, associated comorbidities, microbiological characteristics, and preventive strategies of bronchiectasis in T & uuml;rkiye to those of other countries. Study Design: A multicenter prospective cohort study. Methods: The multicenter, prospective cohort study was conducted between March 2019 and January 2022 using the Turkish Adult Bronchiectasis Database, in which 25 centers in T & uuml;rkiye participated. Patients aged > 18 years who presented with respiratory symptoms such as cough, sputum, and dyspnea and were diagnosed with non -cystic fibrosis bronchiectasis using computed tomography were included in the study. Demographic information, etiologies, comorbidities, pulmonary functions, and microbiological, radiological, and clinical data were collected from the patients. Results: Of the 1,035 study participants, 518 (50%) were females. The mean age of the patients was 56.1 +/- 16.1 years. The underlying etiology was detected in 565 (54.6%) patients. While postinfectious origin was the most common cause of bronchiectasis (39.5%), tuberculosis was identified in 11.3% of the patients. An additional comorbidity was detected in 688 (66.5%) patients. The most common comorbidity was cardiovascular disease, and chronic obstructive pulmonary disease (COPD) and bronchiectasis was identified in 19.5% of the patients. The most commonly detected microbiological agent was Pseudomonas aeruginosa (29.4%). Inhaled corticosteroids (ICS) were used in 70.1% of the patients, and the frequency of exacerbations in the last year was significantly higher in patients using ICS than in nonusers (p < 0.0001). Age [odds ratio (OR): 1.028; 95% confidence interval (CI): 1.005-1.051], cachexia (OR: 4.774; 95% CI: 2,054-11,097), high modified medical research council dyspnea scale score (OR: 1,952; 95% CI: 1,459-2,611), presence of chronic renal failure (OR: 4,172; 95% CI: 1,249-13,938) and use of inhaled steroids (OR: 2,587; 95% CI: 1,098-6,098) were significant risk factors for mortality. Mortality rates were higher in patients with COPD than in those with no COPD (21.7-9.1%, p = 0.016). Patients with bronchiectasis and COPD exhibited more frequent exacerbations, exacerbation -related hospitalizations, and hospitalization in the intensive care unit in the previous year than patients without COPD. Conclusion: This is the first multicenter study of bronchiectasis in T & uuml;rkiye. The study results will provide important data that can guide the development of health policies in T & uuml;rkiye on issues such as infection control, vaccination, and the unnecessary use of antibiotics and steroids.
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    Factors Associated with Mortality in Patients with Decubitus Ulcers Treated with Negative Pressure Wound Therapy
    (Bilimsel Tip Yayinevi, 2019) Tosun Tasar, Pinar; Karasahin, Omer; Timur, Ozge; Sevinc, Can
    Introduction: Decubitus ulcer is a common geriatric syndrome encountered in patients receiving palliative care support. Negative pressure wound therapy is one of the methods used to promote wound healing. the aim of this study was to determine factors associated with mortality in patients with decubitus ulcer treated with negative pressure wound therapy in our palliative care unit. Materials and Methods: Data from patients who were admitted to the palliative care unit for follow-up and who underwent negative pressure wound therapy due to decubitus ulcer were retrospectively evaluated. Categorical data were compared using chi-square test, and continuous data were compared using nonparametric Kruskal-Wallis and Mann-Whitney U tests. A Cox regression model was created including presence of microbiological response, presence of polymicrobial agent, presence of agent in initial wound culture, concurrent bacteremia, final C-reactive protein (CRP), final albumin, and final leukocyte counts. Results: the study included 53 palliative care patients. Their mean age was 73.6 +/- 17.3 years and 33 (62.3%) were females. Bacterial growth was detected in 39 (73.6%) of the wound site cultures obtained before treating decubitus ulcers with negative-pressure wound dressing. Multiple microorganisms were isolated in 17 (47.2%) of the positive cultures. Escherichia coli was the most common isolate (39.2%). Twenty-five (47.2%) patients died and 28 (52.8%) could be discharged. Positive culture before negative pressure wound therapy was associated with statistically higher mortality rate. A Cox regression model using the variables that differed significantly between the deceased and surviving patients (microbiological response, polymicrobial infection, agent detected in initial wound culture, concurrent bacteremia, and final CRP, albumin, and leukocyte counts) showed that the presence of multiple microorganisms in decubitis ulcer increased mortality by 3.793 fold and was an independent risk factor for mortality. Conclusion: in patients with decubitus ulcer treated with negative pressure wound therapy, the presence of pre-negative pressure wound therapy hypoalbuminemia, positive wound culture, and isolation of multiple agents are independent risk factors associated with higher mortality.
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    Investigation of parameters associated with mortality in a palliative care unit
    (Termedia Publishing House Ltd, 2023) Vural, Murat Furkan; Tasar, Pinar Tosun; Karasahin, Omer; Sevinc, Can; Sahin, Sevnaz
    Introduction: Effective palliative care reduces unnecessary hospital admissions and intensive care length of stay. The present study aimed to investigate the parameters associated with mortality in patients receiving palliative care support. Material and methods: This prospective observational study was conducted among inpatients in a palliative care unit. Results: A total of 177 patients hospitalized in the palliative care unit were included in the study. Of the patients, 84 (47.5%) were female and the mean age was 72.49 +/- 15.12 years. At the end of the follow-up period in the palliative care unit, 67 patients (37.9%) had died. A one -unit increase in albumin was associated with 66.6% lower odds of mortality [odds ratio (OR): 0.334, 95% confidence interval (CI): 0.141-0.791; p = 0.013] and a one -unit increase in Karnofsky performance scales (KPS) score was associated with 4.8% lower odds of mortality (OR: 0.952, 95% CI: 0.925-0.980; p = 0.001). In contrast, the odds of mortality were 4.851 times higher in patients with congestive heart failure (95% CI: 1.716-13.717; p = 0.003), 4.442 times higher in patients with solid organ malignancy (95% CI: 1.420-13.894; p = 0.01), 3.727 times in the presence of hypoxia at admission (95% CI: 1.504-9.239; p = 0.005), and 3.626 times higher in patients who developed an infection during follow-up (95% CI: 1.523-8.635; p = 0.004). Conclusions: The results of this study suggest that congestive heart failure, solid organ malignancy, hypoxia at admission, infection during follow-up, and low albumin level and KPS score may be indicators of poor outcome.
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    Risk factors for carbapenem-resistant Klebsiella pneumoniae infection in a palliative care centre
    (Termedia Publishing House Ltd, 2022) Tasar, Pinar Tosun; Akpinar, Busra; Karasahin, Omer; Ceylan, Goktug; Sevinc, Can; Uyanik, Hamidullah; Sahin, Sevnaz
    Introduction: Klebsiella pneumoniae (KP) is a gram-negative bacterium in the Enterobacteriaceae family. It is common among patients receiving palliative care. This study aimed to examine the risk factors for carbapenem-resistant KP (CRKP) infection in our palliative care unit. Material and methods: This retrospective observational study was conducted in patients found to have KP infection in the palliative care centre of our hospital. Culture results were identified through the microbiological laboratory database. The patients' demographic and clinical characteristics were obtained from hospital electronic records. The Charlson Comorbidity Index (CCI) was calculated retrospectively for each patient. Results: The median age of the 88 patients included in the study was 73 years, and 54 (61.4%) were male. The isolated pathogen was CRKP in 55 patients (62.5%). The presence of central venous catheter, tracheostomy, urinary catheter, and intensive care follow-up before admission to the palliative care unit were significantly more common in patients with CRKP-positive cultures. The presence of significant risk factors for carbapenem resistance and univariate logistic regression were used to create a logistic regression model. The results indicated that parenteral nutrition and CCI were independent risk factors that increased the risk of CRKP infection by 3.704 and 1.447 times, respectively. Conclusions: The prevalence of CRKP is higher in patients receiving parenteral nutritional support. This demonstrates the importance of early transition to enteral nutrition if there is no contraindication. High CCI is a significant risk factor for the development of CRKP infection.