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    A comprehensive assessment of ambient air quality in Canakkale city: Emission inventory, air quality monitoring, source apportionment, and respiratory health indicators
    (Turkish Natl Committee Air Pollution Res & Control-Tuncap, 2020) Mentese, Sibel; Mirici, Nihal Arzu; Elbir, Tolga; Tuygun, Gizem Tuna; Bakar, Coskun; Otkun, Muserref Tatman; Oymak, Sibel
    This comprehensive study aims to examine the relationships between ambient air quality (AAQ) and respiratory health of the participants residing in three different towns of Canakkale city, Turkey between August 2013 and 2014. AAQ measurements for bioaerosols, volatile organic compounds (VOCs), total particulate matter (PM) count, carbon dioxide (CO2), and carbon monoxide (CO) were performed and monthly pulmonary function test (PFT) was applied to volunteer participants residing in the study sites (n = 121) for one year. Additionally, concentrations of air pollutants for PM2.5/PM10, sulfur dioxide (SO2), nitrogen oxides, and ozone were gathered from AAQ monitoring stations. To estimate the contributions of the emission sources and their effects on human health in the region, an emission inventory was also prepared in the region and AERMOD modelling system was applied for the year of 2013. Accordingly, the industry was the most polluting sector for NOx and SO2, while road traffic and residential heating were the most polluting sectors for CO and PM10. Factor analysis revealed that organics, combustion, bioaerosol propagation, and ozone accumulation contributed to AAQ, in agreement with AQ modelling results. Can had the worst air quality (industrialized site), which affected the respiratory health indicators of the participants. Generalized linear model estimated that PF of the participants varied according to the residing district, gender, suffering from asthma, and lifelong smoking or environmental tobacco smoke exposure (p < 0.05). Also, PF of the participants were linked with VOCs levels in the Central town, total PM count in Lapseki, and ozone levels in Can (p < 0.05).
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    A long-term multi-parametric monitoring study: Indoor air quality (IAQ) and the sources of the pollutants, prevalence of sick building syndrome (SBS) symptoms, and respiratory health indicators
    (Turkish Natl Committee Air Pollution Res & Control-Tuncap, 2020) Mentese, Sibel; Mirici, Nihal Arzu; Elbir, Tolga; Palaz, Elif; Mumcuoglu, Deniz Tasdibi; Cotuker, Osman; Bakar, Coskun
    Poor indoor air quality (IAQ) can cause several respiratory diseases and symptoms. In this study, IAQ of 121 homes located in 3 different towns of Canakkale, Turkey was monitored throughout a year. Target air pollutants were particulate matter, volatile organic compounds (VOCs), bioaerosols, and Carbon dioxide (CO2), as well as air temperature and humidity. Moreover, pulmonary functions of the occupants were measured on a monthly basis. Also, occurrence of sick building syndrome (SBS) symptoms and other health related data were gathered from the occupants by a detailed questionnaire. The SBS is a situation related to indoor air pollution in which the occupants of a building experience health or comfort related adverse effects that appear to be associated directly to the time spent in the sick building. Results of this study showed that the highest indoor air pollutant levels were observed in Can town and the lowest levels were observed in Central town. Indoor levels of bioaerosols, particulate matter, benzene, Cladosporium spp., and Penicillium spp. as well as pulmonary functions of the occupants showed statistically significant differences between the locations of the homes (p < 0.001). Factor analysis implied that both indoor and outdoor originated sources contributed to IAQ. Even though the predominant SBS symptoms varied seasonally and spatially among the study sites, fatigue, cold-flu like symptoms, and difficulty in concentration occurred frequently. Correlations were found among the occurrence of SBS symptoms, measured IAQ parameters, and personal factors (p < 0.05). Performing more studies from the health and IAQ points of view improve public awareness.
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    Associations among exposure to microbial, organic, and inorganic indoor/outdoor air pollution and respiratory problems in different towns of Canakkale, Turkey
    (Amer Chemical Soc, 2014) Mentese, Sibel; Otkun, Muserref Tatman; Bakar, Coskun; Mirici, Nihal Arzu; Cevizci, Sibel; Tasdibi, Deniz; Palaz, Elif
    [Anstract Not Available]
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    Associations between respiratory health and ambient air quality in Canakkale, Turkey: a long-term cohort study
    (Springer Heidelberg, 2018) Mentese, Sibel; Bakar, Coskun; Mirici, Nihal Arzu; Oymak, Sibel; Otkun, Muserref Tatman
    Few epidemiological studies investigating the association between air pollution and health are available in Turkey. The aim of this cohort-type study is to examine the relationships between ambient air quality, respiratory diseases, and decreases in pulmonary function over a year in three different towns in Canakkale: Canakkale Central town (region I), Lapseki town center (region II), and Can town (region III). Region III had four different sub-regions, which were Can town center (region III-A), and the villages located around Can town, namely Durali (region III-B), Kulfal (region III-C), and Yuvalar (region III-D). In the first stage of the study, a detailed questionnaire was completed by the participants (n = 1152) in face-to-face interviews and pulmonary function test (PFT) was performed. In the second stage of the study, PFT measurements were repeated 1 year after the first stage. Particulate matter, SO2, NO2, and ozone were gathered from air quality monitoring stations located in the centers of the three regions. The most polluted area was region III, while region I and region II were the least polluted areas. The risk of pulmonary function decline throughout a year was 2.1 times higher in region III, 2.4 times higher both in regions III-B and III-C, and 1.6 times higher for smokers in all regions. In the present study, ambient air quality was worse in region III (industrialized region), which influenced PFT scores and the prognostics for chronic respiratory diseases. The findings of this study should be considered for future investment plans in this region related to human and environmental health needs.
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    Comparison of Biomarkers in Blood and Urine According to Phenotypes in Chronic Obstructive Pulmonary Disease: Cross-Sectional Research
    (Turkiye Klinikleri, 2022) Hünerel, Oylum; Mutlu, Pınar; Mirici, Nihal Arzu; Çakir, Dilek Ülker; Türkön, Hakan; Gül, Abdulhakim Hasan
    Objective: Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality worldwide. Biomarkers have been recognized as an important tool in assessing COPD patients. In this study, we aimed to investigate the possible relationship between certain biomarkers and different COPD phenotypes. Material and Methods: Between January 1, 2017-December 31, 2017, a total of 85 patients who were admitted to the Çanakkale Onsekiz Mart University Faculty of Medicine Hospital Chest Diseases Outpatient Clinic with a diagnosis of COPD according to the Global Initiative for Chronic Obstructive Lung Disease 2017 Guidelines were included in this study. All patients filled in the COPD Assessment Test and modified Medical Research Council questionnaires. Patients were divided into 4 phenotypes: emphysema, chronic bronchitis, frequent exacerbation, and asthma COPD overlap syndrome (ACOS). Levels of C-reactive protein (CRP), desmosine, fibronectin, eotaxin, and interleukin (IL)-2 were measured and compared between the phenotypes. Results: The mean age was 64.56 years and 92.9% of the study population were males. Of 85 patients, 43 had emphysema, 13 had frequent exacerbation, 15 had chronic bronchitis, and 14 had ACOS phenotype. Blood fibronectin, eotaxin, and urine desmosine levels were significantly lower in patients with ACOS phenotype compared to the other phenotypes. In patients with the frequent exacerbation phenotype, the CRP level was significantly higher than that of the other three phenotypes. The IL-2 levels were similar in all phenotypes. Conclusion: Our study results suggest that these biomarkers may be useful in the differential diagnosis of COPD phenotypes. © 2022 by Türkiye Klinikleri.
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    Comparison of hyperbaric oxygen, ozone, and dexpanthenol therapies in rats with acute lung injury
    (Kare Publ, 2022) Yilmaz, Merve; Mutlu, Pinar; Mirici, Nihal Arzu; Kapicibasi, Hasan Oguz; Bagla, Aysel Guven; Gulen, Meltem Ickin; Korpinar, Sefika
    BACKGROUND AND AIM: Acute respiratory distress syndrome (ARDS) is a fatal disease pre-senting with respiratory failure. Patients with ARDS account for a considerable portion of patients staying in the intensive care unit (ICU). Therefore, advances in the treatment of these patients are of great importance. Direct or indirect injury to the lung initiates an inflammatory process. This results in impaired integrity of the alveolar-capillary membrane, pulmonary edema, and severe hy-poxia. The present study compared hyperbaric oxygen (HBO), ozone, and dexpanthenol therapies administered to rats with experimentally induced ARDS, as well as the efficacy of these therapies. METHODS: Thirty-two male Wistar Albino rats were used in the study. The rats were divided into four groups. All groups were administered antibiotherapy for 5 days after administering live Escherichia coli. Group 1 (control group) rats received intraperitoneal saline. Group 2 rats were treated with HBO. Group 3 rats received an oxygen + ozone mixture. Group 4 rats received dex-panthenol. After 5 days, anesthesia was administered to all rats, blood gases were collected from the abdominal aorta, and then the rats were sacrificed. Some of the collected blood was used for cytokine assays. The right lung tissues were used for histopathological examination. The left lung tissues were used to measure enzyme levels. RESULTS: Histopathologically, there were intra-alveolar hemorrhage, edema, intensive inflam-matory cell infiltration, fibrosis, collapse, type 2 alveolar cells, and macrophage accumulation in all groups. In terms of fibrosis/alveolar septal thickening, the dexpanthenol group had a sig-nificantly lower mean score than the control and HBO groups. In terms of alveolar collapse, the dexpanthenol group had a significantly lower mean score than all other groups. In terms of increased macrophage and type II alveolar cell counts, the ozone group had a significantly lower mean score than all other groups. There was no significant difference in immunohistochemical staining between the groups. In terms of superoxide dismutase levels, the dexpanthenol group had a significantly lower score than the control group. Regarding IL-10 levels, the ozone group had a significantly higher score than the control and HBO groups. The dexpanthenol group had a significantly higher score only than the HBO group. Regarding PaO2 levels, the ozone group had a significantly higher score than all groups. The ozone group had a significantly lower score on PaCO2 levels than all groups. CONCLUSIONS: Among the treatments, the HBO therapy increased cell injury. The ozone therapy produced anti-inflammatory effect and histopathologically positive outcomes. The ozone therapy provided significant improvement in arterial oxygenation. The dexpanthenol therapy produced antioxidant effect and histopathologically positive outcomes. The antifibrotic effect was prominent in the dexpanthenol therapy. Further studies are needed to generalize the use of these treatments in ARDS.
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    Contribution of spirometry to early diagnosis of chronic obstructive pulmonary disease in primary health care centers
    (Tubitak Scientific & Technological Research Council Turkey, 2013) Erdoğan, Aysel; Ucar, Elif Yilmazel; Araz, Omer; Sağlam, Leyla; Mirici, Nihal Arzu
    Aim: Chronic obstructive pulmonary disease (COPD) is a common disease with increasing prevalence and mortality. We aimed to determine COPD prevalence in primary health care centers. Materials and methods: Pulmonary function tests (PFTs) and face-to-face interviews were administered to 500 patients older than 40 years of age and attending a primary health care center with any symptoms. An early reversibility test was performed on patients with a forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) ratio below 70%. The survey results, PFTs, and early reversibility test results were evaluated according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. All parameters were compared for groups with and without COPD. Results: COPD was diagnosed in 25 (5%) of the patients. Of these patients, 60% were female and 40% were male. According to GOLD guidelines, 48% of the patients had mild COPD, 36% of them had moderate COPD, and 16% of them had severe COPD. According to their history and physical examination, 72 (14.4%) participants had been previously suspected of having COPD. PFTs revealed that 59 of them did not have COPD. Conclusion: The utilization of spirometers in primary health care centers is important both for early diagnosis and to prevent misdiagnosis of COPD.
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    Covid19 Tanısı: X-Işını ve Kan Ölçüm Verileri Arasında Karşılaştırmalı Yaklaşım
    (2022) Öztaş, Ali Emre; Boncukcu, Dorukhan; Özteke, Ege; Demir, Mahir; Mirici, Nihal Arzu; Mutlu, Pınar
    Covid-19 virüsü dünya üzerinde büyük bir etki bırakmıştır ve yayılmaya devam etmektedir. Daha fazla yayılmasını engellemek için koronavirüs hastalarına erken tanı koymak oldukça önemlidir. Her ne kadar akciğer X-Işını görüntüsü tanısı ile çözüm en hızlı ve en kolay yöntem olsa da ortalama bir radyoloğun X-Işını verilerini kullanarak tanı koymadaki doğruluğu tamamen mesleki deneyimine dayanmaktadır. Yani, daha deneyimsiz radyologların hata yapma olasılığı daha fazladır. Bu nedenle tutarlı sonuçlar verebilen bir yapay zekâ modeli üretilmesi istenmektedir. Çalışmamızda göğüs X-Işını görüntüleri ve sıradan kan ölçüm verileri kullanılarak sınıflandırma yapılmış ve sonuçları karşılaştırılmıştır. X-Işını verileri hem açık kaynak çalışmalardan hem de yerel bir hastaneden anonim olarak toplanmıştır ve yaklaşık 7200 görüntüye sahiptir. Kan ölçümü sonuçları da yine aynı yerel hastaneden toplanmıştır. Göğüs X-Işını verilerinin tanısı için yaygın olarak kullanılan evrişimsel sinir ağı algoritmalarından ResNet, SqueezeNet, DenseNet ve VGG kullanılmıştır. Sonuçlar, SqueezeNet modelinin daha yüksek AUC değeri vermesiyle birlikte, diğer algoritmaların da %85 üstünde bulma ve tutturma değeri sağladığını göstermektedir. Covid-19’un kan ölçümlerinden tanısı için ise çok katmanlı yapay sinir ağı ve destek vektör makinası kullanılmıştır. Kan ölçüm verileri kullanarak sınıflandırma kısıtlı bir veri kümesi üzerinde yapılmış olsa da yapay sinir ağı ve destek vektör makinası için doğruluk oranları sırasıyla %76 ve %82 olarak bulunmuştur. Genelleme yapılırsa X-Işını yoluyla tanının kan ölçümü yoluyla yapılan tanıdan daha uygulanabilir olduğu ve Covid tanısında yapay zekânın insanlardan daha doğru sonuç çıkardığı sonucuna ulaşılmıştır.
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    Evaluating the clinical, radiological, microbiological, biochemical parameters and the treatment response in COVID-19 pneumonia
    (2022) Mutlu, Pınar; Mirici, Nihal Arzu; Gönlügür, Uğur; Öztoprak, Bilge; Özer, Şule; Resorlu, Mustafa; Akçalı, Alper
    Aim: The coronavirus disease (COVID-19) has led to over 200,000,000 confirmed cases and over 4,250,000 confirmed deaths worldwide. The present study aimed to explore the links between epidemiological, clinical, biochemical, microbiological, and radiological data and treatment responses of inpatients with COVID-19 pneumonia. Material and Method: The study included 131 patients hospitalized for COVID-19 pneumonia. Laboratory values such as complete blood count, coagulation profile, AST, LDH, sedimentation, CRP, BUN, creatinine, and D-dimer of the patients were analyzed. The diagnosis of COVID-19 was established by RT-PCR testing of respiratory tract samples. Thoracic CT images were used to determine the severity of involvement in patients. Statistical analyses were performed to establish the differences between the groups and the relationships between the variables. Results: The most common comorbidities of the patients were hypertension (35.1%) and diabetes mellitus (24.5%). The patients with fever, cough, and dyspnea and who were PCR positive had the highest radiological involvement severity score. The involvement severity scores were negatively correlated with the lymphocyte count, lymphocyte percentage, and albumin levels (p<0.05). Concerning prognostic risk factors, the mean percentages of lymphocytes and eosinophils were significantly higher in the fully recovered patients than those in the intensive care unit (p<0.05). Conclusion: Our study identified the percentages of lymphocytes and eosinophils as prognostic factors. Identifying the risk factors that predict the possibility of disease progression on admission may contribute to physicians' patient management, increase the therapeutic effect, and reduce the COVID-19 mortality rate.
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    Nutritional assessment via anthropometric and biochemical measurements with stable COPD
    (Tubitak Scientific & Technological Research Council Turkey, 2012) Meral, Mehmet; Araz, Omer; Yilmazel Ucar, Elif; Yilmaz, Nusret; Mirici, Nihal Arzu
    Aim: Nutritional assessment is important for the management of chronic obstructive pulmonary disease (COPD). This study aims at investigating the relation between the anthropometric and biochemical parameters for nutritional assessment with pulmonary function tests in COPD. Materials and methods: This is a prospective, cross-sectional study. Thirty-nine patients with stable COPD were enrolled the study. We evaluated the anthropometric [body mass index (BMI), skinfold thickness (SFT), and arm muscle circumference (AMC)), biochemical [serum total protein, albumin, transferrin, and blood urea nitrogen (BUN)], and spirometric [forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), and FEV1/FVC] measurements, as well as the correlations among them. Results: There was a significant positive correlation between BMI and the other anthropometric parameters. There was no statistically significant correlation between the spirometric measurements and the biochemical parameters. We detected a positive correlation between SFT and serum albumin and total protein, and a negative correlation between BUN and AMC. Conclusion: Anthropometric and biochemical parameters may be used for nutritional assessment and nutritional support as criteria in stable COPD patients.
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    Primary Pulmonary Actinomycosis Mimicking Malignancy
    (Galenos Yayincilik, 2018) Mutlu, Pinar; Mirici, Nihal Arzu; Guven, Merve Ilcin
    The diagnosis of primary pulmonary actinomycosis (PPA) is still an important challenge in clinical practice due to its clinical and radiographic similarity with other infections and malignant diseases. Currently, the diagnosis can be only made histopathologically. A 67-year-old male patient was admitted to our clinic with the complaints of cough and hemoptysis for the past two months. His physical examination was non-specific. An increased non-homogeneous density was observed in the middle zone of the left hemithorax on chest X-ray. Thoracic computed tomography revealed a hypodense mass. Positron emission tomography revealed a hypermetabolic activity in the malignant mass. The patient was diagnosed with pulmonary actinomycosis through transthoracic fine needle aspiration biopsy. In conclusion, PPA should be considered in the differential diagnosis in patients with malignancy in the presence of predisposing risk factors.
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    Retrospective analysis of false positive ratio of our patients with lung cancer at positron emission tomography-CT screen
    (Wolters Kluwer Medknow Publications, 2020) Kapicibasi, Hasan Oguz; Mutlu, Pinar; Alkan, Sahinur Aycan; Mirici, Nihal Arzu; Yuksel, Buse; Bakar, Coskun
    BACKGROUND: In lung cancer, staging is necessary to give the best treatment to the patient and to estimate the best prognosis. The aim of this study was to compare the pathology results of the lung masses and mediastinal lymph nodes and to evaluate the sensitivity and specificity values of positron emission tomography-computerized tomography (PET-CT) and to determine the maximal threshold of maximum standardized uptake volume (SUVmax). MATERIALS AND METHODS: We retrospectively evaluated the PET-CT SUVmax values and pathology results of the patients who had a mass, mediastinal lymph node, or scalene lymph node in our patients between 2016 and 2018. RESULTS: Fifty-one people and 75 pathology materials were included in our study. We used the receiver operating characteristic curve analysis to determine the cutoff value for SUVmax value and calculated the cutoff value as 6.65. In our study, the sensitivity and specificity were calculated as 63% and 71%, respectively. We calculated the positive predictive value as 73.5% and the negative predictive value as 61%. CONCLUSION: As a result, considering the common inflammatory and granulomatous diseases seen in our country, we concluded that benign diseases should be considered before malignancy in SUVmax value below 6.6. We continue to add new patients and new data to our study to find the most appropriate threshold of SUVmax value for the health values of our country.
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    The evaluation of nose functions in chronic obstructive pulmonary disease
    (2019) Çil, Özge Çağlar; Mutlu, Pınar; Mirici, Nihal Arzu; Oymak, Sibel; Dereköy, Sefa
    Aim: The aim of this study was to assess the nasal and olfactory functions of patients with chronic obstructive pulmonary disease(COPD).Material and Methods: This prospective study included patients followed-up with COPD in the pulmonary diseases clinic. Patientswith COPD without any nasal disease or systemic disease were included in the study. After routine ear nose throat examination wasperformed, patients with no nasal pathology had the saccharin test and Sniffin’ Sticks tests applied. The control group consistedof volunteers that were living in the same region. The same tests applied to the control group too and the results were compared.Results: There were no significant differences between patient group and control group in terms of categorical variables such asgender, age, smoking status, living area... It was found that the odor functions of COPD patients were significantly affected whencompared with the control group. Odor test results were significantly lower in the patient group (p: 0.0001). In addition, mucociliaryfunction was decreased in COPD patients.Conclusions: It was found that the smell and mucociliary functions of COPD patients were worse than the individuals of the sameage and this situation had a significant effect on the quality of life of the patients.
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    The phenotypic characteristics and course of chronic obstructive pulmonary disease (COPD) and their association with serum complement C3 levels
    (Kare Publ, 2024) Alkan, Sahinur Aycan; Mirici, Nihal Arzu; Cakir, Dilek Ulker; Esen, Enes; Demirbaglar, Damla
    BACKGROUND AND AIM: Chronic Obstructive Pulmonary Disease (COPD) is a respiratory condition characterized by a chronic inflammatory response and is a common cause of mortality. Recent studies have begun to elucidate the role of the complement system in the pathogenesis of COPD. The primary goal of COPD treatment has been symptom control, but the importance of phenotypic assessments and classifications in COPD management is re-emerging. In this study, we investigate the association between the phenotypic characteristics and course of COPD and the complement system, focusing on serum Complement Component 3 (C3) levels. METHODS: The study included 81 patients. To measure complement C3 levels, a single tube of blood was collected from each participant. Body Mass Index (BMI), COPD Assessment Test (CAT), and modified Medical Research Council (mMRC) dyspnea scale were calculated. Hemograms, pulmonary function tests, and lung tomography scans were retrospectively reviewed. RESULTS: An increase in neutrophil predominance in serum was observed in advanced grades of COPD during stable periods. Lymphocyte counts and percentages were lower in advanced grades (p=0.041, p=0.016, p=0.032). Higher C3 levels were found in the group with a higher neutrophil count (p=0.032). The mean C3 level was higher in the high BMI group (p=0.049). Tomography scans were available for 55 patients. A lower mean C3 level was observed in the group with increased emphysema percentage, though the difference was not significant. The COPD grade, Forced Expiratory Volume in 1 second (FEV1) value, CAT-mMRC score, smoking status, exacerbation frequency, and inhaled steroid use did not show a significant correlation with C3 levels.
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    Uygun antitüberküloz tedaviye rağmen paradoks radyolojik progresyon
    (2012) Gönlügür, Uğur; Koşar, Şule; Mirici, Nihal Arzu
    Tüberkülozlu hastalarda, tedavinin başlamasından sonra, önceki lezyonlarda klinik veya radyolojik olarak kötüleşme görülmesi ya da yeni lezyonların ortaya çıkmasına paradoks yanıt adı verilmektedir. Paradoks yanıtın tanımlanmasındaki zorluklar nedeniyle, bu konu sadece tıbbi değil hukuki açıdan da önem taşımaktadır. Bu raporda, antitüberküloz tedavi esnasında paradoks kötüleşme gösteren bir olgu sunulmaktadır. İnsan immünyetmezlik virusu (HIV) negatif olan 68 yaşındaki bir erkek hasta, öksürük, göğüs ağrısı ve kilo kaybı şikayetiyle başvurmuştur. Toraks bilgisayarlı tomografide sağ akciğer üst lobun apikal ve posterior segmentlerini tutan düzensiz sınırlı homojen olmayan bir opasite saptanmıştır. Balgam örneğinde aside dirençli basil (ARB) varlığının saptanması üzerine, eş zamanlı başka bir hastalığı olmayan olguya aktif akciğer tüberkülozu tanısı konulmuş ve dörtlü tedavi (izoniazid 300 mg/gün, rifampisin 600 mg/gün, pirazinamid 2 g/gün, etambutol 1.5 g/gün) başlanmıştır. Tedavinin birinci ayının sonunda radyolojik lezyonlarda artış gözlenmiş; bronkoskopide endobronşiyal lezyon izlenmemiştir. Bronşiyal lavaj sıvısında ARB saptanmamıştır. Tedavi protokolü değiştirilmemiş ancak radyolojik lezyonlar tedrici olarak gerileme göstermiştir. Sonuç olarak, uygun antitüberküloz tedavi alan olgularda önceki pulmoner infiltras- yonlarda geçici bir kötüleşme ortaya çıkabileceği ve takipte altın standardın, radyolojik değil mikrobiyolojik yöntemler olduğu akılda tutulmalıdır. Ayırıcı tanıda, eş zamanlı hastalık varlığı, ilaç reaksiyonu, hasta uyumsuzluğu ve tedavi başarısızlığı dikkate alınmalıdır. Bu olgu, tüberkülozun ülkemizdeki yaygınlığı nedeniyle konunun önemini bir kez daha vurgulamak amacıyla sunulmuştur.