Turgay Çelikel - Academia.edu (original) (raw)

Papers by Turgay Çelikel

Turkish thoracic journal, Jan 13, 2018

We aimed to obtain information about the characteristics of the ICUs in our country via a point p... more We aimed to obtain information about the characteristics of the ICUs in our country via a point prevalence study. This cross-sectional study was planned by the Respiratory Failure and Intensive Care Assembly of Turkish Thoracic Society. A questionnaire was prepared and invitations were sent from the association's communication channels to reach the whole country. Data were collected through all participating intensivists between the October 26, 2016 at 08:00 and October 27, 2016 at 08:00. Data were collected from the 67 centers. Overall, 76.1% of the ICUs were managed with a closed system. In total, 35.8% (n=24) of ICUs were levels of care (LOC) 2 and 64.2% (n=43) were LOC 3. The median total numbers of ICU beds, LOC 2, and LOC 3 beds were 12 (8-23), 14 (10-25), and 12 (8-20), respectively. The median number of ventilators was 12 (7-21) and that of ventilators with non-invasive ventilation mode was 11 (6-20). The median numbers of patients per physician during day and night were...

Noninvasive Mechanical Ventilation and Difficult Weaning in Critical Care, 2016

Intubations are among the most common invasive interventions performed in the intensive care unit... more Intubations are among the most common invasive interventions performed in the intensive care unit (ICU), and most ICU patients who require mechanical ventilation are intubated. Unplanned extubation (UE), an intubation-associated complication, is defined as the removal of an endotracheal tube by a patient or its accidental removal. The reported frequency of UE ranges between 3 and 16 % among patients on mechanical ventilatory support [1–3]. A previous study in our center showed a similar rate of extubation (11 %) [4]. Among its main causes are inadequate sedation and insufficient nursing care during positioning. Nevertheless, UE may occur even under optimal conditions where sedation is adequate and all necessary precautions are taken. Successful management of UE may result in shortened duration of intubation and reduced rate of complications associated with mechanical ventilation. On the other hand, failure to do so may lead to the need for reintubation, leading to an increased risk of complications.

Respiratory Medicine, 1996

Interleukin-8 (IL-8) is a recently described potent chemotactic factor that may be involved in th... more Interleukin-8 (IL-8) is a recently described potent chemotactic factor that may be involved in the pathogenesis of pleural e&sions. To understand the actual mechanisms mediating the inflammatory response, changes in cellular components and IL-8 level in pleural fluid of different aetiologies were evaluated. Thirty-four patients (19 male, 15 female) with a mean age of 46 f 22 years (range 1692) were included in the study. Of these, 13 had tuberculous pleural effusion, seven had empyema/parapneumonic pleural effusion, and 14 had malignant pleural effusion (seven adenocarcinoma, three ovarian carcinoma, two lymphoma, one chronic myeloid leukaemia, and one small cell carcinoma) with positive cytology. Differential cell counts in the pleural fluid were obtained using cytocentrifuge preparations. The concentrations of IL-8 in pleural fluid were measured by the ELISA method. Interleukin-8 was detected in all 34 pleural fluid samples. The serum IL-8 level was analysed only in the empyema/parapneumonic pleural effusion group The mean IL-8 levels of tuberculous, empyemalparapneumonic, and malignant pleural effusions were 1420 f 1049 pg ml-', 4737 f 2297 pg ml-i, and 1574* 1079pgml-i, respectively. The IL-8 levels in the empyema/parapneumonic group were significantly raised over malignant and tuberculous groups (PcO.02). The mean pleural fluid neutrophil counts in tuberculous, empyema/parapneumonic and malignant pleural effusions were 3 15 & 575 cells mm ~ 3, 11 136 % 12 452 cells mm ~ 3, and 635 & 847 cells mm-3, respectively (P<O.O03). There was a significant positive correlation between pleural IL-8 levels and neutrophil counts (rz0.46, P<O.O06). The levels of IL-8 in paired samples of serum and pleural fluid in the empyema/parapneumonic effusion group were compared, and the concentration of IL-8 was higher in the pleural effusion than serum (means, 4737 * 2297 pg ml ~ i and 130.0 * 62.5 pg ml-', respectively, PcO.03). There was a significant negative correlation between IL-8 concentrations in serum and pleural fluid (r=-0.80, PcO.03). This data suggests that production of IL-8 in pleural effusion may play a key role in initiation and maintenance of inflammatory reactions, especially in empyema/parapneumonic pleural effusions. It may offer the basis for introduction of novel anti-inflammatory agents in treatment.

The Southeast Asian journal of tropical medicine and public health, 2009

Acute respiratory distress syndrome (ARDS) as a complication of malaria infection is rare but wit... more Acute respiratory distress syndrome (ARDS) as a complication of malaria infection is rare but with a very high mortality rate. We report the case of a patient who developed high fever, then respiratory distress during a trip to Haiti who was admitted to our hospital and diagnosed with malaria. During recovery the patient developed ARDS in the hospital.

Turkish Thoracic Journal, 2017

OBJECTIVES: Chronic obstructive pulmonary disease (COPD) is an inflammatory disease, in which chr... more OBJECTIVES: Chronic obstructive pulmonary disease (COPD) is an inflammatory disease, in which chronic and systemic inflammation plays an important role. By decreasing neutrophil infiltration and cytokine production, statins have anti-inflammatory mechanisms. MATERIALS AND METHODS: Fifty-seven patients who had diagnosis of chronic obstructive pulmonary disease according to GOLD guideline were included in the study; 20 of them were statin users. Statin users group were patients being under medication with regular simvastatin, atorvastatin or rosuvastatin 20 mg per day for at least the past 1 year. RESULTS: There was statistically no significant difference between patients with or without statin treatment with respect to; age, femalemale ratio, COPD severity level, medication used for COPD, pulmonary function tests results and smoking habits. COPD exacerbation frequency in patients using statins was significantly less than patients not using statins (p<0.05). Patient number with COPD exacerbation, antibiotic treatment and outpatient clinic administration and outpatient clinic administration frequency was significantly lower in statin using patients (p<0.05). CONCLUSION: COPD patients receiving statins have a lower frequency of COPD exacarbations, hospital administration and antibiotic treatment compared to patients not receiving statins.

American Journal of Respiratory and Critical Care Medicine, 1999

* Values are presented as mean (SD). † Severity of symptoms was based on patients' perception. * ... more * Values are presented as mean (SD). † Severity of symptoms was based on patients' perception. * Three patients showed serologic indication of recent Mycoplasma pneumoniae infection.

Tubercle and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 1993

Journal of Asthma, 1995

Cells need to interact with one another for the inflammatory response to occur. The intercellular... more Cells need to interact with one another for the inflammatory response to occur. The intercellular adhesion molecule-1 (ICAM-1), a member of the immunoglobulin supergene family, plays an important role in inflammation, and circulating ICAM-1 has been reported to be elevated in patients with some inflammatory disorders. To study the influence of asthma on circulating ICAM-1 levels, we measured concentrations of circulating ICAM-1 in patients with asthma. Fifteen patients (6 male, 9 female, mean age: 30 +/- 7 years) and 5 controls (2 male, 3 female, mean age: 25 +/- 6 years) were included in the study. Daily peak flow rates and symptom scores were monitored over a week in all patients and methacholine challenge tests were performed in 7 patients. The spirometric analysis of asthmatic patients demonstrated mean FEV1: 2.57 +/- 0.97 L (74.9 +/- 17.7% predicted), mean FEV1/FVC: 70.1 +/- 9.6%, mean bronchodilator response: 19.2 +/- 8.4%. The mean morning peak flow rate was 331.0 +/- 122.2 L/min, the mean evening peak flow rate 389.0 +/- 118.5 L/min, the mean peripheral eosinophil count 268 +/- 451/mm3, and the mean serum IgE level 327.4 +/- 238.2 IU/ml. The mean serum ICAM-1 levels of asthmatic patients and controls were 429 +/- 133 ng/ml and 405.0 +/- 81.0 ng/ml, respectively. There was no statistical difference between these levels. Furthermore, we could find no correlation between serum ICAM-1 levels and FEV1, serum IgE levels, peak flow rates, and symptom scores, or methacholine PD20 values in asthmatic patients. The results of this study suggest that serum ICAM-1 levels are not increased in asthmatic patients over controls and do not correlate with clinical asthma status.

COPD: Journal of Chronic Obstructive Pulmonary Disease, 2010

Alterations in the neuroendocrine system occur during critical illness. Chronic obstructive pulmo... more Alterations in the neuroendocrine system occur during critical illness. Chronic obstructive pulmonary disease (COPD) itself causes hormonal changes. The aim of this study was to determine neu roendocrine hormones of COPD patients with acute respiratory failure and to investigate the relationship between hormonal changes, mortality, and morbidity. We enrolled 21 patients (13 F/8 M) with COPD exacerbation requiring artificial airway support. Blood samples were collected on admission to the ICU, and on the day of hospital discharge. Eighteen healthy people were included as controls. Female patients had lower luteinizing hormone (LH), follicle stimulating hormone (FSH), and free triiodothyronine (fT3), and higher prolactin (PRL) levels than controls on admission to the ICU (FSH: 70.3 vs. 29.3 mlU/mL; LH: 26.6 vs. 6.8 mlU/mL; fT3: 2.9 vs. 2.0 pg/mL; PRL: 12.4 vs. 21.3 ng/mL). Male patients had low testosterone and TSH and high PRL but only changes in TSH and PRL reached statistical significance (testosterone: 3.5 vs. 1.5 ng/mL, TSH: 1.1 vs. 0.5 ulU/mL, PRL: 9.7 vs. 14.2 ng/mL). Female patients had lower fT3 than males (fT3(female): 2.7 vs. fT3(male): 2.0 pg/mL). On follow-up, significantly elevated FSH and fT3 and decreased estradiol concentrations were documented among recovered women (FSH: 28.4 vs. 46.6 mlU/mL, fT3(,): 2.0 vs. 2.6 pg/mL, E(2): 27.7 vs. 19.0 pg/mL). Patients had high C-reactive protein levels and acute physiologic and chronic health evaluation II scores. Mortality rate was 9.5% and a negative correlation between E(2) and duration of noninvasive mechanical ventilation and length of hospital stay was found in male patients. Men and women with acute respiratory failure in the presence of COPD develop significant changes in the neuroendocrine axis. Hormonal suppression vanishes with disease improvement.

Respiration, 1998

Airway inflammation plays a pivotal role in asthma. Over the last 10 years, evidence has accumula... more Airway inflammation plays a pivotal role in asthma. Over the last 10 years, evidence has accumulated for the potential role of lymphocytes in airway inflammation. Since cyclosporin A (Cyc-A) can profoundly influence lymphocyte activation, it is appropriate to consider this drug as a novel antiasthmatic. The effect of inhalation of low doses of Cyc-A on airway inflammation remains unclear. The purpose of this study was to investigate the bronchoalveolar lavage (BAL), peripheral blood cell profiles, and lung biopsy specimens in Cyc-A-pretreated rats. Twenty-nine rats (8 controls, 10 ovalbumin sensitized, and 11 Cyc-A inhaling and ovalbumin sensitized) were included in the study. A commercial intravenous Cyc-A solution was given as a single dose of 20 mg/kg 1 h prior to inhalation of ovalbumin via nebulizer. The total number of BAL cells significantly increased in rats inhaling Cyc-A when compared with ovalbumin-sensitized rats (2.37 +/- 2.34 x 10(6)/ml and 1.01 +/- 0.49 x 10(6)/ml respectively, p < 0.05). There was a significant increase in the percentage of lymphocytes (14.5 +/- 8.5 versus 27.4 +/- 7.4%, p < 0.03), a nonsignificant increase in the percentage of eosinophils (0.8 +/- 1.0 versus 3.0 +/- 4.6%), and a significant decrease in the percentage of polymorphonuclear leukocytes (9.4 +/- 6.9 versus 3.4 +/- 3.8%, p < 0.01) and macrophages (75.4 +/- 5.1 versus 50.2 +/- 11.8%, p < 0.02) in BAL in the ovalbumin-sensitized group as compared with controls. Differential cell counts revealed a higher percentage of neutrophils and macrophages in the BAL of Cyc-A-pretreated rats than in that of the ovalbumin-sensitized group (26.3 +/- 26.8 versus 3.4 +/- 3.8%, p < 0.01 and 66.1 +/- 7.7 versus 50.2 +/- 11.8%, p < 0.02). There was a nonsignificant decrease of lymphocytes and eosinophils in the Cyc-A-pretreated group when compared with the ovalbumin-sensitized group (27.4 +/- 7.4 versus 21.1 +/- 12.4 and 3.0 +/- 4.6% versus 2.4 +/- 2.6%). The peripheral blood total white blood cell count decreased in the ovalbumin-sensitized and Cyc-A-pretreated groups as compared with the control group (2,520 +/- 1,098/mm3, 3,591 +/- 2,251/mm3, and 5,975 +/- 2,787/mm3, respectively, p < 0.01). In addition, peripheral eosinophilia was detected in the Cyc-A-pretreated group when compared with controls and the ovalbumin-sensitized group (6.9 +/- 4.7, 2.4 +/- 1.1, and 2.6 +/- 2.4%, respectively, p < 0.01). Light-microscopic examination of the airways revealed prominent eosinophilia in tracheal, bronchial, and bronchiolar sections in the ovalbumin-sensitized group: counts were 1.8 +/- 2.3/HPF, 10.3 +/- 11.4/HPF, 63.3 +/- 45.0/HPF, respectively. Cyc-A resulted in a decrease of the eosinophil counts/HPF to 0/HPF in trachea (p < 0.05), to 4.3 +/- 9.4/HPF in bronchi (p < 0.02), to 19.4 +/- 38.4 in bronchioles (p < 0.004). In conclusion, the present study supports the theory that locally administered inhaled low-dose Cyc-A is effective on inflammatory cells of sensitized airways and peripheral cells. It may therefore be useful in elucidating the inflammatory mechanisms involved in asthma.

CHEST Journal, 1998

Study objective: To compare the efficacy of standard medical therapy (ST) and noninvasive mechani... more Study objective: To compare the efficacy of standard medical therapy (ST) and noninvasive mechanical ventilation additional to standard medical therapy in hypercapnic acute respiratory failure (HARF). Design: Single center, prospective, randomized, controlled study. Setting: Pulmonary medicine directed critical care unit in a university hospital. Patients: Between March 1993 and November 1996, 30 HARF patients were randomized to receive ST or noninvasive positive pressure ventilation (NPPV) in addition to ST. Interventions: NPPV was given with an air-cushioned face via a mechanical ventilator (Puritan Bennett 7200) with initial setting of 5 cm H20 continuous positive airway pressure and 15 cm H20 pressure support. Results: At the time of randomization, patients in the ST group had (mean ± SD) Pao2 of 54 ± 13 mm Hg, Paco2 of 67 ± 11 mm Hg, pH of 7.28 ± 0.02, and respiratory rate of 35.0 ± 5.8 breaths/min. Patients in the NPPV group had Pao2 of 55 ± 14, Paco2 of 69 ± 15, pH of 7.27 ± 0.07, and respiratory rate of 34.0 ±8.1 breaths/min. With ST, there was significant improvement of only respiratory rate (p < 0.05). However, with NPPV, Pao2 (p < 0.001), Paco2 (p < 0.001), pH (p < 0.001), and respiratory rate (p < 0.001) improved significantly compared with baseline. Six hours after randomization, pH (p < 0.01) and respiratory rate (p < 0.01) in NPPV patients were significantly better than with ST. Hospital stay for NPPV vs ST patients was, respectively, 11.7 ± 3.5 and 14.6 ± 4.7 days (p < 0.05). One patient in the NPPV group required invasive mechanical ventilation. The conditions of six patients in the ST group deteriorated and they were switched to NPPV; this was successful in four patients, two failures were invasively ventilated. Conclusion: This study suggests that early application of NPPV in HARF patients facilitates improve¬ ment, decreases need for invasive mechanical ventilation, and decreases the duration of hospitalization. (CHEST 1998; 114:1636-1642) Key words: acute respirator)7 failure; chronic obstructive pulmonary disease; hypercapnic acute respiratoiy failure; hypoxemia; intensive care unit; mechanical ventilation; noninvasive ventilation Abbreviations: ACV = assist-control ventilation; ARF = acute respiratory failure; CPAP = continuous positive airway pressure; Fio2 = fraction of inspired oxygen; HARF = hypercapnic acute respiratoiy failure; LOS = length of hospital stay; NPPV = noninvasive positive pressure ventilation; PEEP = positive end-expiratory pressure; PSV = pressure support ventilation; Spo2 = pulse oximetric saturation; ST = standard medical therapy

BACKGROUND. Extraorbital sebaceous carcinoma (SC) is a rare carcinoma of the skin but is known to... more BACKGROUND. Extraorbital sebaceous carcinoma (SC) is a rare carcinoma of the skin but is known to have a good prognosis in terms of metastasis and survival. OBJECTIVE. To discuss and emphasize through the clinical and histopathologic findings and the aggressive potential of extraorbital SC and to review the corresponding literature. METHODS. We present an unusual form of extraorbital SC that has followed an aggressive course and that has metastasized rapidly. RESULTS. Local excision of the primary cutaneous tumor with negative margins did not prevent the rapid and fatal internal organ metastases. The patient did not benefit from the docetaxel chemotherapy regimen applied after the distant metastases were developed. CONCLUSION. Extraorbital SC may show a poor prognosis. Both the dermatologic surgeon and the dermatologist should be cautious of the risk of local recurrence and distant metastasis when dealing with extraorbital SC.