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Ayten O, Saylan B. Retrospective analysis of severe COVID-19 pneumonia patients treated with lopinavir/ritonavir: A comparison with survivor and non-survivor patients. S Afr J Infect Dis 2021; 35:233. [PMID: 34485485 PMCID: PMC8378208 DOI: 10.4102/sajid.v35i1.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 11/16/2020] [Indexed: 11/16/2022] Open
Abstract
Background Currently there is no proven medical treatment for COVID-19. We aimed to determine the factors affecting mortality and changes in clinical and laboratory findings in patients with severe COVID-19 pneumonia treated with lopinavir/ritonavir (Lpv/r). Methods Data of survivor and non-survivor severe COVID-19 pneumonia patients treated with Lpv/r were analysed retrospectively. Results A total of 73 patients, 26 (35.6%) females and 47 (64.4%) males were included in the study. The mean age of non-survivor and survivor patients was 64.3 ± 12 and 52.6 ± 12.2, respectively (p < 0.0001). Frequency of smoking and comorbid diseases was higher in non-survivor patients than in survivor patients (37% vs. 8.7% p = 0.003 and 92.6% vs. 28.3%, p < 0.0001, respectively). Age (Odds ratio [OR] 1.09, 95% confidence interval [95% CI] 1.03–1.14), smoking (OR 6.18, 1.7–22.42), presence of comorbid disease (OR 31.73, 6.26–153.56), coronary artery disease (OR 9.26, 1.79–47.77), arrhythmia (OR 13.8, 1.56–122.22), hypertension (OR 14, 4.28–45.74), diabetes (OR 7.22, 2–25.99) and congestive heart failure (OR 10.22, 1.13–92.93) were statistically associated with increased mortality (p < 0.05). Also increased neutrophil (OR 1.26, 1.08–1.46), C-reactive protein (CRP) (OR 1.01, 1.003–0.02), lactate dehydrogenase (LDH), (OR 1.002, 1.001–1.004), D-dimer (OR 1.001, 1.002–1.003), and aspartate transaminase (AST) levels (OR 1.05, 1.02–1.08 were associated with increased mortality. Conclusion The presence of advanced age, active smoking, comorbidity, especially hypertension, diabetes, arrhythmia, coronary artery disease, congestive heart failure and neutrophil, C-reactive protein, lactate dehydrogenase, D-dimer and aspartate transaminase were associated with mortality. The efficacy of Lpv/r, warrants further verification in future studies.
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Affiliation(s)
- Omer Ayten
- Department of Pulmonology Medicine, Faculty of Health Sciences, Sultan Abdulhamit Han Education and Training Hospital, Uskudar/Istanbul, Turkey
| | - Bengu Saylan
- Department of Pulmonology Medicine, Faculty of Health Sciences, Sultan Abdulhamit Han Education and Training Hospital, Uskudar/Istanbul, Turkey
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Baslilar S, Saylan B. Patients with hypertension hospitalized with COVID-19 pneumonia using angiotensinconverting enzyme inhibitors and angiotensin II receptor blockers or other antihypertensives: retrospective analysis of 435 patients. Ann Saudi Med 2021; 41:268-273. [PMID: 34618609 PMCID: PMC8497007 DOI: 10.5144/0256-4947.2021.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The angiotensin-converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARBs) are widely used for the treatment of hypertension (HT). Whether the use of these drugs increases the infectivity of novel coronavirus and results in an additional risk for morbidity and mortality of COVID-19 is a matter of interest. OBJECTIVES Assess the effect of ACEI/ARBs compared with other hypertensives on the clinical course and outcome in COVID-19 pneumonia. DESIGN Retrospective. SETTINGS Tertiary care hospital. PATIENTS AND METHODS We collected data on adult inpatients with COVID-19 pneumonia using ACEI/ARBs versus other antihypertensives between 15 March 2020, and 15 February 2021. MAIN OUTCOME MEASURES Severity, clinical course, mortality, and time to PCR negativity between patients using ACEI/ARBs and other antihypertensives. SAMPLE SIZE 435 RESULTS: ACEI/ARBs were used by 203 patients (46.6%) (median age: 71 [41-94] years), while 232 patients (53.4%) were using other antihypertensives (median age: 69 [22-93] years, P=.645 vs age of ACEI/ARB users). There were no statistically significant differences between the ACEI/ARBs users and non-users in the number of patients admitted to intensive care (65 cases [32%] vs. 74 cases [31.9%], P=.978), the median duration of stay in hospital (8 [1-54] days vs.7 [1-55] days, P=.806) the median duration of ICU stay (8 [1-40] days vs. 6 [1-25] days), and the mortality rate (48 cases [23.6%] vs. 61 [26.3%], P=.525). While the median days before transfer to the ICU was shorter in ACE/ARBI non-users (2 [1-15] days vs. 3 [1-21] days, P=.02), the difference was not important clinically. The median time to PCR negativity was similar in ACEI/ARBs users and non-users (13 [7-34] days for users and 13 [5-45] days for non-users), (P=.083). CONCLUSIONS ACEI/ARB use is probably unrelated to poor prognosis in COVID-19 pneumonia inpatients. ACEI/ARBs did not prolong the time to PCR negativity. We conclude that using ACEI/ARBs probably does not increase the infectivity of SARS-CoV-2. LIMITATIONS Pharmacological therapies were not discussed in detail. The use of corticosteroids may affect the time to PCR negativity. We could not analyze the effect of obesity because of a lack of data. CONFLICT OF INTEREST None.
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Affiliation(s)
- Seyma Baslilar
- From the Department of Pulmonology, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Bengu Saylan
- From the Department of Pulmonology, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
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Saylan B, Baslilar S, Kartaloglu Z. Comparative assessment of outcomes of smoking cessation therapies and role of free medications in successful long-term abstinence. Tob Induc Dis 2021; 19:51. [PMID: 34177413 PMCID: PMC8204741 DOI: 10.18332/tid/136422] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/02/2021] [Accepted: 05/05/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Long-term outcomes of smoking cessation treatments are crucial to optimize standards of cessation services, which are known to prevent excess morbidity and mortality. This study aimed to evaluate long-term outcomes of a smoking cessation program, to compare the success rates of interventions, to assess relapse rates after quitting, and to determine the duration until relapse. METHODS Patients admitted for smoking cessation between 2010–2018 were contacted to evaluate short- and long-term treatment outcomes. The patients were asked whether they were currently smoking, and whether they quit after smoking cessation treatment and the duration of abstinence. RESULTS The study included 579 patients (341 males) with a mean age of 50±12 years. The median time from the date of visit to the smoking cessation clinic to analysis was 5 years (range: 2–10). Of the patient, 436 used medications, including varenicline, bupropion, and nicotine replacement therapy (NRT). The overall quit rate was 31.8% by the primary intervention (varenicline: 45.5%, bupropion: 38.2%, NRT: 33%, psychosocial support: 4.2%), and quit rate was similar in the intervention groups (p=0.073). In the long-term, the quit rates were 19.6, 22.5, 25.9, and 21.7%, respectively (p=0.405). About 9% of the patients failed to quit smoking initially but succeeded for a while after the first intervention at the cessation clinic. The relapse rate after initial cessation was 19%. The longest period of abstinence was in patients using NRT (14±17 months), followed by the patients using varenicline (9.5±12.7 months) and bupropion (8.2±14.8 months). CONCLUSIONS Both short- and long-term quit rates with varenicline, bupropion, and NRT, were similar. The long-term quit rates among patients who did not use medication and received psychosocial support initially were comparable to those who used a smoking cessation drug.
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Affiliation(s)
- Bengu Saylan
- Department of Chest Diseases, Sultan 2. Abdulhamid Han Sample Training and Research Hospital, Istanbul, Turkey
| | - Seyma Baslilar
- Department of Chest Diseases, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Zafer Kartaloglu
- Department of Chest Diseases, Sultan 2. Abdulhamid Han Sample Training and Research Hospital, Istanbul, Turkey
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Samanci C, Saylan B, Gulsen G, Akkaya Y, Yesildal M, Akkaya Isik S, Ustabasioglu FE. CT visual quantitative evaluation of hypertensive patients with coronavirus disease (COVID-19): Potential influence of angiotensin converting enzyme inhibitors / angiotensin receptor blockers on severity of lung involvement. Clin Exp Hypertens 2021; 43:341-348. [PMID: 33583283 PMCID: PMC7885720 DOI: 10.1080/10641963.2021.1883051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 12/31/2020] [Accepted: 01/09/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE There is not enough data on the effect of angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) on lung involvement in patients with COVID-19 pneumonia and hypertension (HT). Our aim was to compare the lung involvement of the HT patients hospitalized for COVID-19 using ACEIs/ARBs with the patients taking other anti-HT medications. METHODS : Patients who have a diagnosis of HT among the patients treated for laboratory-confirmed COVID-19 between 31 March 2020 and 28 May 2020 were included in the study. One hundred and twenty-four patients were divided into two as ACEIs/ARBs group (n = 75) and non-ACEIs/ARBs group (n = 49) according to the anti-HT drug used. The chest CT involvement areas of these two groups were evaluated quantitatively by two observers including all lobes, and total severity score (TSS) was calculated. These TSS values were compared between drug groups and clinical groups. RESULTS In clinical classification; there were 4 (%3.2) asymptomatic, 5 (4.0%) mild type, 92 (74.1%) common type, 14 (11.3%) severe type, 9 (7.3%) critical type patients. ACEI/ARB group's TSS (mean±SD, 7.74 ± 3.54) was statistically higher than other anti-HT medication group (mean±SD, 4.40 ± 1.89) (p < .001). Likewise, severe-critical clinical type's TSS (mean±SD, 9.17 ± 3.44) was statistically higher than common type (mean±SD, 5.76 ± 3.07) (p < .001). Excellent agreement was established between the two blinded observers in the TSS measurements. CONCLUSIONS Quantitative evaluation of CT and TSS score can give an idea about the clinical classification of the patient. TSS is higher in ACEI/ARB group than non-ACEIs/ARBs group.
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Affiliation(s)
- Cesur Samanci
- Department of Radiology, MD Radiology Associate Professor Istanbul University-Cerrahpaşa Cerrahpaşa Faculty of Medicine
| | - Bengu Saylan
- Department of Pulmonary Medicine, MD Pulmonary Medicine Specialist Haydarpaşa Sultan Abdülhamidhan Training and Research Hospital, Turkey
| | - Gokce Gulsen
- Department of Radiology, MD Radiology Specialist Haseki Training and Research Hospital, Turkey
| | - Yuksel Akkaya
- Department of Microbiology and Clinical Microbiology, MD Microbiology and Clinical Microbiology Specialist Haydarpaşa Sultan Abdülhamidhan Training and Research Hospital, Turkey
| | - Melike Yesildal
- Department of Radiology, MD Radiology Assistant, Haydarpaşa Sultan Abdülhamidhan Training and Research Hospital, Turkey
| | - Sinem Akkaya Isik
- Department of Infectious Diseases, MD Haydarpaşa Sultan Abdülhamidhan Training and Research Hospital, Turkey
| | - Fethi Emre Ustabasioglu
- Department of Radiology, MD Radiology Assistant Professor Trakya University Medical Faculty, Turkey
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Caliskan T, Turkoglu O, Canoglu K, Ayten O, Saylan B, Okutan O, Kartaloglu Z. The Comparison Between Non-High Risk Patients with and Without Cancer Diagnosed with Pulmonary Embolism. Medeni Med J 2021; 36:30-35. [PMID: 33828887 PMCID: PMC8020190 DOI: 10.5222/mmj.2021.43066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 02/27/2021] [Indexed: 12/11/2022] Open
Abstract
Objective This study aimed to compare the pulmonary embolism (PE) location and clot burden on computed tomography pulmonary angiography (CTPA), the degree of right ventricular dysfunction (RVD), D-dimer, and cardiac troponin I (cTnI) levels, and the presence of a lower extremity deep venous thrombosis (DVT) in patients with and without cancer diagnosed with a non high risk pulmonary embolism (PE). Method We calculated Miller score for each patient for clot burden. The location of PE was also evaluated at CTPA. D-dimer and cardiac cTnI levels were measured. Patients had echocardiography for RVD and lower extremity color flow Doppler ultrasonography for DVT. Results The study included 71 patients with PE. The patients were divided into two groups according to the presence of cancer. There was no statistically significant difference for D-dimer levels (P=0.15), PE location (p=0.67), clot burden (P=0.34), RVD (P=0.28) and DVT (P=0.33) between groups (P=0.15). Cancer patients diagnosed as PE had statistically significantly higher levels of cTnI than those who were diagnosed as PE without cancer (P=0.03). Conclusion There was no significant difference between patients diagnosed as PE with and without cancer in terms of D-dimer levels, clot burden and emboli location, RVD and DVT. cTnI levels were higher in non-high risk PE patients with cancer than these patients without cancer.
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Affiliation(s)
- Tayfun Caliskan
- Health Sciences University, Sultan 2. Abdulhamit Han Training and Research Hospital, Department of Pulmonology, Istanbul, Turkey
| | - Ozlem Turkoglu
- Health Sciences University, Sultan 2. Abdulhamit Han Training and Research Hospital, Department of Radiology, Istanbul, Turkey
| | - Kadir Canoglu
- Health Sciences University, Sultan 2. Abdulhamit Han Training and Research Hospital, Department of Pulmonology, Istanbul, Turkey
| | - Omer Ayten
- Health Sciences University, Sultan 2. Abdulhamit Han Training and Research Hospital, Department of Pulmonology, Istanbul, Turkey
| | - Bengu Saylan
- Health Sciences University, Sultan 2. Abdulhamit Han Training and Research Hospital, Department of Pulmonology, Istanbul, Turkey
| | - Oguzhan Okutan
- Health Sciences University, Sultan 2. Abdulhamit Han Training and Research Hospital, Department of Pulmonology, Istanbul, Turkey
| | - Zafer Kartaloglu
- Health Sciences University, Sultan 2. Abdulhamit Han Training and Research Hospital, Department of Pulmonology, Istanbul, Turkey
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Caliskan T, Saylan B. Smoking and comorbidities are associated with COVID-19 severity and mortality in 565 patients treated in Turkey: a retrospective observational study. ACTA ACUST UNITED AC 2020; 66:1679-1684. [PMID: 33331576 DOI: 10.1590/1806-9282.66.12.1679] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 09/02/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE We aimed to explore the prevalence of smoking rates and comorbidities and evaluate the relationship between them and disease severity and mortality in inpatients with COVID-19. METHODS COVID-19 patients were divided into the following groups: clinic group, intensive care unit (ICU) group, survivors, and non-survivors. Non-COVID-19 patients were included as a control group. The groups were compared. RESULTS There was no difference between patients with and without COVID-19 in terms of smoking, asthma, diabetes, dementia, coronary artery disease (CAD), hypertension, chronic renal failure and arrhythmia (p>0.05). Older age (Odds ratio (OR), 1.061; 95% confidence interval (CI): 1.041-1.082; p< 0.0001), chronic obstructive pulmonary disease (COPD) (OR, 2.775; 95% CI: 1.128-6.829; p=0.026) and CAD (OR, 2.696; 95% CI: 1.216-5.974; p=0.015) were significantly associated with ICU admission. Current smoking (OR, 5.101; 95% CI: 2.382-10.927; p<0.0001) and former smoking (OR, 3.789; 95% CI: 1.845-7.780; p<0.0001) were risk factors for ICU admission. Older age (OR; 1.082; 95% CI: 1.056-1.109; p<0.0001), COPD (OR, 3.213; 95% CI: 1.224-8.431; p=0.018), CAD (OR, 6.252; 95% CI: 2.171-18.004; p=0.001) and congestive heart failure (CHF) (OR, 5.917; 95% CI 1.069-32.258; p=0.042), were significantly associated with mortality. Current smoking (OR, 13.014; 95% CI: 5.058-33.480; p<0.0001) and former smoking (OR, 6.507; 95% CI 2.731-15.501; p<0.0001) were also risk factors for mortality. CONCLUSION Smoking, older age, COPD, and CAD were risk factors for ICU admission and mortality in patients with COVID-19. CHF was not a risk factor for ICU admission; however, it was a risk factor for mortality.
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Affiliation(s)
- Tayfun Caliskan
- Assistant Professor, Department of Pulmonology, Sultan 2. Abdulhamit Han Training and Research Hospital, Health Sciences University, Istanbul, Turkey
| | - Bengu Saylan
- Pulmonologist, Department of Pulmonology, Sultan 2. Abdulhamit Han Training and Research Hospital, Health Sciences University, Istanbul, Turkey
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Canoglu K, Saylan B. Therapeutic dosing of low-molecular-weight heparin may decrease mortality in patients with severe COVID-19 infection. Ann Saudi Med 2020; 40:462-468. [PMID: 33307734 PMCID: PMC7733641 DOI: 10.5144/0256-4947.2020.462] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/03/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Venous thromboembolism or extensive thrombosis is relatively common in patients with severe COVID-19 infection and has been associated with increased mortality. During the current COVID-19 pandemic, several prophylactic doses and types of low-molecular-weight heparin (LMWH) are being used worldwide; however, there are no high-quality studies or recommendations for an optimal prophylactic LMWH dose. OBJECTIVES Investigate the relationship between coagulation parameters and the LMWH dose, and mortality and ICU admission in hospitalized patients with severe COVID-19 pneumonia. DESIGN Retrospective. SETTING Tertiary care hospital. PATIENTS AND METHODS Data on clinical features, coagulation parameters and anticoagulant medications of inpatients with severe COVID-19 were collected for the period between 11 March 2020 and 31 April 2020. MAIN OUTCOME MEASURES Mortality and ICU admission for prophylactic dose LMWH (0.5 mg/kg twice daily) and therapeutic dose LMWH (1 mg/kg twice daily). SAMPLE SIZE 154 cases. RESULTS Ninety-eight (63.6%) patients were treated with the LMWH prophylactic dose and 56 (36.4%) patients were treated with the therapeutic dose. Forty-four (44.9%) of 98 patients using the prophylactic dose LMWH died, while 10 (17.9%) of 56 patients using the therapeutic dose LMWH died (P=.001). Mortality was 6.4-fold higher in the prophylactic dose LMWH users than in the therapeutic dose LMWH users (OR=6.5, 95% CI: 2.4-17.6, P<.001). CONCLUSIONS Therapeutic dosing of LMWH may decrease mortality in patients with severe COVID-19 infected pneumonia. More aggressive thromboprophylaxis regimens using higher doses of heparin should be evaluated in prospective studies. LIMITATIONS Lack of information about bleeding complications. LMWH was not compared with other anticoagulant therapies. There was no comparison between our two groups on the APACHE score. Used different doses of LMWH in different clinics in our hospital. Single-center, retrospective study. CONFLICT OF INTEREST None.
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Affiliation(s)
- Kadir Canoglu
- From the Department of Pulmonology, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Bengu Saylan
- From the Department of Pulmonology, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
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Ozturk C, Kaya A, Bilgin C, Yucesoy L, Ikidag B, Demirel M, Baslilar S, Saylan B, Senol T, Aganoglu S, Can G, Dogrul M, Cam M, Erdogan N, Batum O, Turan M, Demir C, Torun S, Cirit M, Turan M, Kelesoglu A, Yasar S, Uzunay O, Melek K, Altiparmak O. Evaluation of Inhaler Technique and Patient Satisfaction With Fixed-Combination Budesonide/Formoterol Dry-Powder Inhaler in Chronic Obstructive Pulmonary Disease (COPD): Data on Real-Life Clinical Practice in Turkey. Chest 2013. [DOI: 10.1378/chest.1688796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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