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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 Türkiye 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 Türkiye 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 [ABSTRACT FROM AUTHOR]

Objective: To investigate the effects of chronic obstructive pulmonary disease (COPD) in the dry eye status in men and to determine whether the hypoandrogenic status has any concomitant impact. Materials and Methods: We enrolled 80 patients with stable COPD and healthy volunteers individually matched on the basis of body mass index (BMI), age, and sex. Ocular surface testing included ocular surface disease index (OSDI) questionnaire, evaluation of meibomian gland dysfunction (MGD), tear fluorescein break-up time (TF-BUT), ocular surface staining with lissamine green (LG), Schirmer test with topical anesthesia, and Sirius meibographic analysis of meibomian gland area (MGA) loss. Bioavailable testosterone and free testosterone were measured using the measured total testosterone (TT), albumin, and sex hormone binding globulin (SHBG) levels. Results: Patients with COPD had lower levels of circulating androgens, decreased TF-BUT, and lower Schirmer score and greater LG staining score, MGD grade, and MG area loss than healthy controls (p<0.01). Forced expiratory volume in 1-second (FEV1), FEV1/forced expiratory vital capacity (FVC), and circulating androgen levels were inversely correlated to the OSDI score, LG staining, MGD grade, and MGA loss and showed positive correlation with TF-BUT and Schirmer score in COPD patients (p<0.01). However, when adjusted for androgen levels, FEV1 and FEV1/FVC ratio were negatively correlated to the Schirmer score (p<0.05). Conclusion: Male COPD patients had worse tear film parameters, and this finding was more notable in patients with lower androgen levels. Hypoandrogenic status in COPD patients attributes to the dry eye status of the patients, irrespective of their FEV1 and FEV1/FVC status. [ABSTRACT FROM AUTHOR]

Background/aim: It is known that the correlation of pulmonary function tests (PFT) with muscle dysfunction is insufficient. Here, we aimed to evaluate the diaphragm functions in individuals with Friedreich's ataxia (FRDA) and to examine its relationship with respiratory parameters and disease severity. Materials and methods: This prospective study, conducted between November and December 2022, at Erciyes University, included 14 individuals with genetically confirmed FRDA and an age- and gender-matched healthy control group of eight individuals. We examined pulmonary functions with spirometric methods and evaluated diaphragm excursion, and diaphragm thickness-expiratory (Tde) and - end of inspiration (Tdi) with ultrasonography during calm breathing. Thickening fraction (TF) calculated. Also, we examined PaCO2 at rest. The neurological status of individuals was assessed using the Scale for the Assessment and Rating of Ataxia (SARA). Results: The mean values of FEV1(lt), FEV1(%), FVC (lt), and FVC (%) were higher in the control group (p; <0.001, 0.013, <0.001, and 0.009, respectively). Also, mean Tdi, Tde, excursion and TF were lower in the FRDA group compared to the control group (p = 0.005, 0.294,0.005, and 0.019, respectively). The mean excursion value was 1.13 ± 0.54cm in the FRDA group and 1.71 ± 0.49cm in the control group. There is a strong, negative, and statistically significant correlation between SARA total score with excursion and TF (r = -0.7432, p = 0.002; r = -0.697, p = 0.008). There is no statistically significant relationship between excursion and BMI, standing-to-supine decrease in FVC, FEV1, and PaCO2. Also, the relationship between maximal inspiratory pressure (PImax) and excursion was moderate. Conclusion: Diaphragm ultrasound may reveal respiratory dysfunction better than PFT. Diaphragm excursion and TF are associated with disease scores in individuals with FDRA. Further studies are needed regarding the detection of alveolar hypoventilation. [ABSTRACT FROM AUTHOR]

Background: Although there are many studies presenting the efficacy of omalizumab in severe asthma, the data about the optimal treatment duration are still debated. Objective: In this study, we aimed to investigate the clinical effects of omalizumab discontinuation after 5 years of treatment in patients with omalizumab super-responders, the persistence of response and to compare the features of patients, whose symptoms are still well controlled and those who relapsed and re-treated with omalizumab. Methods: Clinical and laboratory data of 100 adult patients diagnosed with allergic severe asthma and treated with omalizumab between 2008 and 2020 were evaluated retrospectively. Demographic, clinical, functional, and laboratory parameters of the patients who were re-treated with omalizumab and those who did not need to be re-treated were compared. Results: There were 14 super-responder patients, who were treated with omalizumab for 5 years, and the treatment was discontinued then. Omalizumab was not restarted in 9 patients (64%) and was restarted in 5 (36%) patients. No significant difference was presented between these two groups in terms of demographic, clinical, functional, and laboratory parameters. The baseline total IgE levels of patients, who were re-treated with omalizumab, was found to be higher than those who were not, but this difference was not statistically significant (440 [229–864] IU/mL vs. 164 [85–293] IU/mL; p = 0.053, respectively). Conclusion: One of 3 patients was re-treated with omalizumab due to loss of asthma control after discontinuation of the treatment. Therefore, omalizumab's immunomodulatory effect may seem to persist in a majority of cases after discontinuation. Also, higher baseline total IgE levels might help to predict the cases that need re-treatment after discontinuation. [ABSTRACT FROM AUTHOR]

Objective: Mepolizumab, an anti-interleukin 5 humanized monoclonal antibody, which is listed among the treatment options in the Global Initiative for Asthma 2020, is recommended as a step 5 therapy option for patients with uncontrolled severe eosinophilic asthma. Real-life data on adverse drug reactions of mepolizumab are limited. We aimed to analyze the safety profile of mepolizumab retrospectively among patients who were treated with mepolizumab with the diagnosis of eosinophilic severe asthma. Materials and Methods: Severe eosinophilic asthma patients from two different centers who were treated with mepolizumab between June 2018 and July 2020 were analyzed retrospectively. The data of the mepolizumab-related adverse event forms, which were filled out at each visit, were retrospectively evaluated. Results: Eighty three patients were included in the study. The most commonly reported adverse events which could be related to mepolizumab were myalgia/arthralgia, headache, and local injection site reactions. Nevertheless, none of these required the discontinuation of the drug. Mepolizumab-related adverse events that required discontinuation of mepolizumab treatment were observed in two (2.4%) cases but their association with the drug could not be clearly defined. Anaphylaxis or herpes infection was not detected in any of the cases. Conclusion: These outcomes reveal that mepolizumab is a well-tolerated drug in real-life. However, further large-scale real-life studies with long-term follow-up are still needed. [ABSTRACT FROM AUTHOR]

Background/aim: There is limited information about peripheral blood eosinophilia (PBE) and airway obstruction in sarcoidosis. Since pulmonary sarcoidosis affects the airways, it is often confused with asthma. The aims of the study are to investigate airway obstruction and PBE in sarcoidosis patients and to examine the similarity of clinical presentation with asthma. Materials and methods: The patients matching the ATS/ERS/WASOG diagnosis criteria and were between 18 and 80 years of age were included consecutively between 2018 and 2020. Other diseases causing granulomas were excluded. Results: A total of 84 patients were included of which 26 (31%) had a PBE level of ≥300 μL with no significant difference seen between sarcoidosis stage and PBE (p > 0.05). A significant (p < 0.05) decrease was only seen in FEV1 as the stage of sarcoidosis progressed. Respectively 31 (36.9%), 12 (14.3%) and 4 (4.8%) patients had an obstructive, restrictive and mixed respiratory function disorder. Twenty-four (28.6%) subjects with sarcoidosis had history of asthma. Spring fever, eczema, and skin/nose allergy were noticed in 17 (20.2%) of the patients. Conclusion: Mild PBE may be seen in sarcoidosis. Patients applying with PBE, airway obstruction, bronchial hyperreactivity along with spring fever, eczema, skin/nose allergy, wheezing, chest tightness, shortness of breath and cough may be also evaluated in terms of sarcoidosis. [ABSTRACT FROM AUTHOR]

Objective: 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) not only gives information about anatomical features of lung lesions but also about their metabolic activity. This study aimed to determine the mediastinal and parenchymal pathologies of the lung with false-positive FDG involvement and characteristics that could benefit differential diagnosis. Materials and Methods: This study retrospectively analyzed 1,924 subjects that underwent 18F-FDG PET/CT from December 2010 to January 2015. Subjects with a maximum standardized uptake value (SUVmax) value of =2.5 in the lung tissue, mediastinal lymph nodes with no primary lung malignancy, and a benign pathology result were included. Results: The mean age of the 143 subjects was 61.7±11.0 years. The pathologies anthracosis, granulomatous inflammatory events, and organized pneumonia (OP) were 64 (45%), 36 (25%), and 18 (13%) cases, respectively, in order of frequency. The median SUVmax value of all lesions was 5.2 (min-max, 2.5-37.6). Moreover, mediastinal lymph node involvement was frequent (59%). The median SUVmax value of anthracotic lesions was significantly lower than the median SUVmax value of granulomatous and OP lesions (p<0.001 and p=0.007, respectively). No significant difference in the median SUVmax value was noted between granulomatous and OP lesions. Conclusion: Anthracosis and tuberculosis should be considered as benign causes of mediastinal lymph node positivity in developing countries. 18F-FDG PET/BT is an unreliable method for the differential diagnosis of benign diseases characterized by inflammation. Thus, metabolic activity evaluation is more suitable. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the present study was to determine the prevalence of atopy and allergic rhinitis by prick skin test with multi-test II applicator in patients with asthma. Material and Methods: In this study, 200 patients who were admitted to the Medical Faculty, Department of Pulmonary Disease and who was diagnosed asthma were evaluated prospectively. Pulmonary function test and twelve aeroallergens skin test were applied to patients. Total IgE levels and blood eosinophil counts were also measured. Atopic asthma was defined as the history of asthma with positive skin test. Results: Mean age of patients was 42.4±13.2 years old. 152 (76%) were women; 48 (24%) were men. 120 (60%) were skin test positive. Allergy to pollens (%69.2) was the most prevalent sensitization, followed by allergy to house dust mites, cockroach and molds (%56.7, %41.7, %7.5). Ninety-seven patients (48%) were allergic rhinitis. Conclusion: The results showed that asthma in 60% of the patients had an atopic background in Kayseri. Less than half of the asthmatic patients had associated rhinitis. The most frequent sensitization allergens that were determined by prick skin test with multi-test II applicator in patients with or without rhinitis were pollens in Kayseri. The frequency of house dust mite was second highest, of cockroach was third highest In patients with atopic asthma and allergic rhinitis, prevention should be provided against pollens and house dust mite to control the disease. [ABSTRACT FROM AUTHOR]

Gemcitabine is a nucleoside analog that has been increasingly used in the chemotherapy of solide tumors, including breast, pancreas ovary and non small cell lung cancer. It is generally well tolerated and has few side effects. Gemcitabine induced pulmonary complications range from mild dyspnea to death from ARDS. A 57- year- old man was treated with six cycles of gem­citabine because of pancreatic carcinoma in July, 2004.The patient had self limiting weakness, lack of appetite, nausea and no dyspnea in treatment period. One year later, he was admitted to a local hospital with exercises induced dyspnea. He had been given levofloxacin for 14 days. On admission to our hospital, his complaint kept on. A few inspiratory crackles were present at right base. CXR demonstrated interstitial infiltrations in the right lung lower zone. HRCT showed grand glass opacity and mild reticular patterns in right lung middle and lower lobes. Bronchoscopy was performed. Transbronchial biopsy revealed nonspecific interstitial pneumonia. Following the administration of oral corticosteroid, he had complete resolution of all signs and symptoms of gemcitabine toxicity. [ABSTRACT FROM AUTHOR]

Gemcitabine is a nucleoside analog that has been increasingly used in the chemotherapy of solide tumors, including breast, pancreas ovary and non small cell lung cancer. It is generally well tolerated and has few side effects. Gemcitabine induced pulmonary complications range from mild dyspnea to death from ARDS. A 57- year- old man was treated with six cycles of gem­citabine because of pancreatic carcinoma in July, 2004.The patient had self limiting weakness, lack of appetite, nausea and no dyspnea in treatment period. One year later, he was admitted to a local hospital with exercises induced dyspnea. He had been given levofloxacin for 14 days. On admission to our hospital, his complaint kept on. A few inspiratory crackles were present at right base. CXR demonstrated interstitial infiltrations in the right lung lower zone. HRCT showed grand glass opacity and mild reticular patterns in right lung middle and lower lobes. Bronchoscopy was performed. Transbronchial biopsy revealed nonspecific interstitial pneumonia. Following the administration of oral corticosteroid, he had complete resolution of all signs and symptoms of gemcitabine toxicity. [ABSTRACT FROM AUTHOR]

Background/aim: Sensitivity and symptoms related to animal proteins have been investigated in various occupational groups. However, data from horse farm workers are limited. We aimed to determine horse allergen sensitivity in the horse farm workers, and to evaluate its relationship with respiratory symptoms and functional parameters. Materials and methods: A total of 110 subjects were enrolled in the study. The study group consisted of 80 horse farm workers. Face-to-face surveys, skin prick tests (SPT), and pulmonary function tests (PFT) were performed in the study group. Control group consisted of 30 healthy subjects. SPT and PFTs were also performed for control group. The SPT test results of the horse farm workers were compared with the SPT results provided from the medical records of 1376 subjects who admitted to the outpatient clinic with respiratory symptoms. Results: Atopy rate was significantly higher in horse farm workers than in healthy subjects (41% and 13%, respectively; P = 0.008). Horse allergen sensitivity was positive 8/80 (10%) in horse farm workers, 0/30 in healthy subjects, and 32/1376 (2%) in medical records of subjects who were admitted to the outpatient clinic with respiratory symptoms. (P = 0.07, P = 0.001, respectively). There was no statistically significant relationship between respiratory symptoms and horse allergen sensitivity in horse farm workers (P = 0.67). However, mean FEV1 ratios were lower in horse farm workers with horse allergen sensitivity than healthy subjects (88.6% ± 17.9, 103.7 ± 10, P = 0.031, respectively). Conclusion: Atopy and animal allergen sensitization were significantly higher in horse farm workers, suggesting the relationship between the intensity of specific allergen exposure and the sensitization to this specific allergen. [ABSTRACT FROM AUTHOR]

Chronic obstructive pulmonary disease (COPD) is characterized by systemic inflammation that usually is caused by exposure to noxious particles or gases. Thymoquinone (TQ) prevents the production of inflammatory mediators, such as thromboxane B2 and leukotriene, by altering arachidonic acid metabolism. We investigated the preventive and curative effects of TQ on lung damage in rats caused by cigarette smoke (CS). We used 50 adult male rats, 30 of which were exposed to CS every day for 3 months. TQ in dimethylsulfoxide (DMSO) was administered intraperitoneally (i.p.) every day to ten animals to investigate the protective effects of TQ, and to ten other animals during the last 21 days to investigate the curative effect. Ten rats received saline for the last 21 days. Ten subjects were untreated controls. Ten controls that were not exposed to CS received TQ for the last ten days. Serum IL-8, IL-6, IL-1β and MMP-9 levels were measured using ELISA. IL-1β and IL-8 levels were elevated in the group exposed to CS compared to controls. IL-8 levels were decreased in the group that received only TQ compared to controls, which indicated the anti-inflammatory effect of TQ. The apoptotic index (AI) was increased in all groups that were exposed to CS compared to controls. The AI index was decreased in the group that received TQ for the last 21 days compared to the other CS groups. AI was increased in the group that received TQ daily compared to the other CS groups. Our findings indicate that TQ exerts curative effects for the inflammation caused by CS and may prevent apoptosis if administered in appropriate doses; however, long term TQ or DMSO exposure may produce cumulative toxic effects. [ABSTRACT FROM AUTHOR]

Background/aim: Oral corticosteroid (OCS)-dependent severe eosinophilic asthma with chronic rhinosinusitis with nasal polyps (SEACRSwNP) would be a suitable phenotype for mepolizumab treatment. This study evaluated the short-term efficacy of mepolizumab treatment in OCS-dependent SEA-CRSwNP. Materials and methods: Baseline and 24th week results [daily OCS doses, asthma exacerbation frequency, asthma control test (ACT) scores, blood eosinophil levels, FEV1 values, and numerical analog scale (NAS) of CRSwNP symptoms] of patients who were treated for at least 24 weeks with mepolizumab were retrospectively evaluated and compared. Results: A total of 16 patients were enrolled in the study. Mepolizumab was discontinued in one patient due to side effects. The daily OCS dosage was reduced from baseline in all patients, and at week 24 OCS was discontinued in 40% of the patients (baseline mean steroid dose: 9.2 ± 5.2 mg, 24th week: 1.3 ± 1.4 mg; P < 0.001). The number of asthma exacerbations within 24 weeks significantly decreased after beginning mepolizumab treatment (2.1 ± 2.7 vs. 0.07 ± 0.26; P = 0.012), and a significant increase in ACT scores (baseline mean ACT: 18 ± 5.7; 24th week mean ACT: 23.3 ± 3; P = 0.006) was observed despite the decrease in daily OCS dosages. There was no significant difference in FEV1 values between baseline and week 24. Evaluation of the general symptoms of CRSwNP, as per NAS, revealed that the baseline mean NAS was 5.6 ± 4.4, and the 24th week mean NAS was 3.2 ± 3.2 (P = 0.021). Conclusion: This is the first real-life study evaluating the short-term efficacy of mepolizumab treatment on OCS-dependent SEACRSwNP. This study demonstrates that mepolizumab is an effective and safe biologic for the treatment of this severe asthma subphenotype. [ABSTRACT FROM AUTHOR]

Introduction: Why do only some of patients who are prescribed angiotensin converting enzyme inhibitors (ACE‐I) develop cough? The pathogenesis of ACE‐I‐induced cough remains controversial and requires further studies. Objective: We aim to investigate whether asthma is a contributing cause of ACE‐I‐induced cough. Methods: Patients attending a cardiology clinic between March 2016 and March 2017 who were diagnosed with ACE‐I induced cough were included in this study. ACE‐I‐induced cough was defined as cough which developed within 4 weeks after initiation of ACE‐I therapy and which improved within 4 weeks after discontinuation of the ACE‐I. Patients who had received ACE‐I treatment for at least 6 months without side effects were included in the study as a control group. Face‐to‐face questionnaires, pulmonary function tests (PFT) and skin prick tests were applied to all the patients. If there was discordance between asthma history and PFT results, a methacholine bronchial provocation test (BPT) was performed. Results: A total of 43 patients with ACE‐I induce cough were compared with 50 controls. Bronchial hyperreactivity (BHR), rhinitis, atopy and family history of asthma were more frequent in patients with ACE‐I induced cough (P <.001). Patients with ACE‐I‐induced cough had significantly higher incidence of diagnosed asthma [OR = 8.28 (95%CI: 3.26‐21.03) P <.001]. Conclusions: Asthma and an atopic background constitute a substantial risk factor for ACE‐I induced cough. The presence of underlying asthma should be investigated in patients diagnosed with ACE inhibitor induced cough. However, the fact that most asthma patients tolerate ACE‐I therapy, indicates that other cofactors are likely involved. [ABSTRACT FROM AUTHOR]

Objective: Eosinophilic asthma with chronic rhinosinusitis and/or nasal polyposis (EA-CRS/NP) is a subphenotype of adult-onset eosinophilic asthma. Blood eosinophil levels are shown to be highly elevated in patients with EA-CRS/NP and have potential for tissue infiltration. We aimed to demonstrate the clinical features of the patients who have a blood eosinophil level above 10% and have thorax computed tomography findings due to blood eosinophilia. Methods: Patients who were followed up in our clinic between 2012 and 2017 were retrospectively evaluated. Inclusion criteria were as follows: 1) Eosinophilic severe asthma, 2) eosinophilia >10%, 3) chronic sinusitis and/or nasal polyps, 4) patients with pathologic findings on thorax computed tomography, 5) regular follow-up for at least 1 year. Results: We identified 36 patients who met the above criteria. We defined this group as "Eosinophilic Asthma with chronic Rhinosinusitis and/or nasal polyposis with Radiological findings related to blood eosinophilia" (EARR). The mean age was 44.9 ± 11 years and 64% were females. Nasal polyps, aspirin exacerbated respiratory disease, and atopy, were present in 81%, 47%, and 25% of the patients, respectively. The mean blood eosinophil count was 1828.6 cells/mm3 (19%). The majority of EARR patients had upper lobe dominant ground-glass opacities. The mean follow-up period was 3.2 ± 2.5 years. EARR patients did not evolve into eosinophilic granulomatous polyangiitis in the follow-up. Conclusions: This phenotype is the first eosinophilic asthma sub-phenotype reported in the literature. EARR is the final stage of the allergic march of EA-CRS/NP. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Omalizumab is a monoclonal antibody that is used as add-on therapy for treating moderate-to-severe persistant atopic asthma in patients with persistant symptoms and frequent exacerbations, despite step 4 treatment according to GINA guidelines. Real-life studies on omalizumab treatment are limited in Turkey. Thus, the present study aims to assess the clinical efficacy and treatment outcomes of omalizumab in patients with atopic severe persistant asthma. MATERIALS AND METHODS: Patients with atopic severe persistant asthma who were treated with omalizumab between 2009 and 2017 were retrospectively evaluated. Baseline and last results of the following variables were compared: symptom scores (GINA categorical), controller medications, blood eosinophil counts, forced expiratory volume in 1 second (FEV1) values, and the number of exacerbations that were treated with systemic corticosteroids for at least 3 days within the last 1 year. The effect of coexisting aspirin-exacerbated respiratory disease (AERD) on these parameters was also analyzed. Step-down of other asthma medications was attempted in patients with symptom control and in those without an exacerbation history within the last 6 months. RESULTS: Thirty-eight patients (mean age, 50 years; females, 30) were included in this study, of whom four showed AERD. After treating with a mean time of 30±22.1 (min: 6, max: 92) months, 26 (68%) patients showed complete controlled disease and 12 (32%) showed partly controlled disease, of whom all had uncontrolled disease before. Mean exacerbation rates within the last 1 year decreased by approximately 76% (9.4±8.4 vs. 1.8±1.5; p<0.001) and FEV1 values increased by approximately 14% (2075±729 vs. 2321±800 cc; p=0.001) compared with baseline levels. Although the reduction in eosinophil count was not significant in all patients (503.8±524.8 vs. 370.8±314.5; p=0.134), repeated measures analysis of variance revealed a more prominent reduction in eosinophil count in the AERD group than in the non-AERD group, independent from the treatment period (F: 4.23, p=0.049). The mean inhaled corticosteroid dose (budesonide eq., 1063±397 vs. 958±439 mcg; p=0.084), the number of other controller medications, and the number of patients with long-term systemic steroid use decreased after omalizumab treatment. No serious adverse events were recorded during the follow-up CONCLUSION: Our results confirm that omalizumab significantly improves disease control and is a safe add-on therapy. In addition, in suitable patients with controlled disease over time, the step-down of other asthma medications will be appropriate. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Eosinophilic granulomatosis with poliangiitis (EGPA) which was previously called Churg-Strauss Syndrome, is classified into eosinophilic and vasculitic phases. To characterize the eosinophilic and vasculitic phases of the disease in terms of clinical findings, serology, and treatment. MATERIALS AND METHODS: We included 15 EGPA patients in the study. The clinical, serological, and therapeutic characteristics and the treatment responses of the patients were recorded. RESULTS: Thirteen patients were classified as being in the eosinophilic phase and two were classified as being in the vasculitic phase of EGPA. Initial symptoms were worsening asthma in all patients (n=15; 100%). All patients had rhinosinusitis, and 66.6% had hypersensitivity to nonsteroidal anti-inflammatory drugs. The two patients in the vasculitic phase did not have nasal polyposis. Pulmonary and nervous system involvement were the most common symptoms. The erythrocyte sedimentation rates (ESRs) of the two patients in the vasculitic phase were 65 mm/h and 55 mm/h, while ESR was normal in eosinophilic-phase patients. Antineutrophil cytoplasmic antibodies (ANCA) was detected in one patient (6.6%) who was in the vasculitic phase (Case 15). The disease was under control with higher doses of methylprednisolone in the vasculitic phase (Case 14: 12 mg/day, Case 15: 10 mg/day) than in the eosinophilic phase. Relapse was detected in the two patients in the vasculitic phase. Oral corticosteroid was not discontinued in any case, and no mortality was reported. CONCLUSION: Patients with eosinophilic phase or vasculitic phase EGPA had similar clinical onset. However, higher ESR, ANCA positivity, and extrapulmonary organ involvement were only found in patients in the vasculitic phase. Corticosteroid responsiveness was very good in all patients in the eosinophilic phase, and the disease could be controlled with a very low maintenance dose of a corticosteroid. [ABSTRACT FROM AUTHOR]

Background: Obesity represents a major risk factor for Obstructive Sleep Apnea Syndrome (OSAS). Brain-derived neurotrophic factor (BDNF) affects the mechanisms that regulate weight, eating behavior, and metabolism. This project aims to investigate the possible association of BDNF gene polymorphism with obesity and OSAS, and to contribute knowledge to the understanding of the pathophysiology of OSAS. Methods: The subjects included in this study were selected among the individuals who were hospitalized in the Erciyes University Medical School Chest Diseases Sleep Medicine Laboratory. Subjects were divided into four groups based on the presence of OSAS and/or obesity. Group 1 included OSAS+ obesity+ patients, Group 2 included OSAS+ obesity− patients, Group 3 included OSAS− obesity+ patients, and Group 4 included OSAS− obesity− patients. The targeted patient number per each study group was 45, but only 32 patients could be enrolled into Group 3. Results: Out of a total number of 167 subjects, 117 (70.1 %) had BDNF 196G/G, 48 (28.7 %) had BDNF 196G/A, and 2 (1.2 %) had BDNF 196A/A genotype. Of 48 subjects having BDNF 196G/A genotype, 32 (66.6 %) were obese, and 16 (33.3 %) were non-obese. Out of 90 subjects with OSAS, 64 (71.1 %) had BDNF 196G/G, and 25 (27.8 %) had BDNF 196G/A genotype. Out of 77 subjects without OSAS, BDNF 196G/G, and BDNF 196G/A genotypes were detected in 53 (68.8 %) and 23 (29.9 %) subjects, respectively. A statistically significant difference was demonstrated between the four study groups in terms of BDNF rs6265 polymorphism ( p = 0.013). This difference was attributed to OSAS+ obesity− Group, in which BDNF 196G/G genotype was more common and BDNF 196G/A polymorphism was less common than the patients in other groups. Conclusion: In conclusion, BDNF 196G/A genotype was found to be more frequent among obese patients compared to the non-obese individuals, but it was not significantly related to OSAS in the present study. BDNF196G/G genotype was more common and BDNF 196G/A polymorphism was less common among OSAS+ obesity- subjects compared to the other study groups. [ABSTRACT FROM AUTHOR]

Hypereosinophilic syndomes (HESs) include potentially lethal multisystem disorders characterized by eosinophilic infiltration of a variable spectrum of target organs, predominantly the skin, heart, lungs, gastrointestinal tract, and nervous system. Based on recent advances in molecular and genetic diagnostic techniques and increasing experience with differences in clinical features and prognosis, subtypes have been defined, including "myeloproliferative-HES ", "lymphocytic-HES", "familial eosinophilia", "overlap HES", "undefined HES" ("complex undefined HES", "simple undefined HES", "episodic undefined HES") and "eosinophil associated diseases" (such as Churg-Strauss syndrome). HES should be kept in mind in the differential diagnosis of eosinophilic lung diseases especially in patients with peripheral eosinophilia and pulmonary infiltrates. Corticosteroids represent an effective firstline approach to decreasing eosinophil counts in the majority of cases. Imatinib might be used for corticosteroid nonresponders. We herein report a patient with "complex undefined HES" who had disease resistant to corticosteroids, but who had a significant response after treatment with imatinib. [ABSTRACT FROM AUTHOR]

Fixed drug eruption (FDE) with oxicams is very rare. FDE due to tenoxicam has been reported in several case reports. Skin patch test with the suspected or responsible drug is applied on sites of previous lesions developing with FDE. Recently, the test has been used quite often for diagnosis of FDE although results are variable. Our case was a 63-year-old woman who had developed itching and erythematous lesions 3-5 cm in size localized on her hands and elbows 3-4 hours after the intake of tenoxicam and ranitidine. The lesion became vesiculobullous a few days later. After two weeks, it resolved with hyperpigmentation. The diagnosis of tenoxicaminduced FDE was confirmed after applying patch and provocation tests. Here we described a case of bullous fixed drug eruption due to tenoxicam and we demonstrated the contribution of skin patch tests to the FDE diagnosis. [ABSTRACT FROM AUTHOR]

Background and Aims Intrathoracic lymphadenopathy usually occurs as a result of neoplasm, granulomatous diseases, infections or reactive hyperplasia. Conventional transbronchial needle aspiration ( C- TBNA) is a cheap and safe procedure for diagnosing intrathoracic lymphadenopathy. The aim of this study was to assess the learning curve and diagnostic accuracy of C- TBNA after an observational education programme. Methods In the present study, we retrospectively evaluated our first 62 C- TBNA procedures at Erciyes University between May 2012 and December 2012 after an observational education programme. The first 31 patients were defined as group A, and the second 31 patients as group B. Results One hundred and seven lymph nodes were sampled in 62 patients by C- TBNA. Adequate lymph node samples were obtained in 52 of the 62 patients (83.8%). In these 52 patients, two patients had a diagnosis of 'suspicious of malignancy' by C- TBNA, and these patients were excluded from the analysis. In the remaining 50 cases who had adequate results, the sensitivity, specificity, positive predictive value ( PPV), negative predictive value ( NPV) and diagnostic accuracy per patient were 80.6%, 92.9%, 96.7%, 65.0% and 84.0%, respectively. The diagnostic accuracy rates of C- TBNA for Group A and B were 72.0% (18/25) and 96.0% (24/25), and the difference was statistically significant ( P < 0.05). Conclusion C- TBNA is a useful diagnostic procedure for sampling intrathoracic lymphadenopathies and masses that are adjacent to the bronchial system. An observational education programme is helpful for learning C- TBNA. The diagnostic yield improves in time, and approximately 30 procedures may be sufficient to achieve successful results. [ABSTRACT FROM AUTHOR]

Anaphylaxis is potentially fatal immediate-type reaction due to the release of bioactive mediators from mast cells and basophils. Anaphylaxis typically occurs through an IgE-dependent immunologic mechanism, most commonly triggered by foods, stinging insect venoms, or medications. Medications, physical factors (e.g exercise, cold) can also trigger anaphylaxis through an IgE-independent immunologic mechanism and through direct mast cell stimulation. Idiopathic anaphylaxis is a diagnosis of exclusion that should be made only after other causes of anaphylaxis and other differential diagnoses have been considered. Patients with idiopathic anaphylaxis may also experience anaphylaxis from recognized causes such as exercise, medication, or food. Hereditary angioedema is one of the differential diagnosis of the idiopathic anaphylaxis. This report describes the assessment of the one case of idiopathic anaphylaxis accompanied with exercise and drug induced anaphylaxis in which a diagnosis of hereditary angioedema was made erroneously. [ABSTRACT FROM AUTHOR]

Anaphylaxis is potentially fatal immediate-type reaction due to the release of bioactive mediators from mast cells and basophils. Anaphylaxis typically occurs through an IgE-dependent immunologic mechanism, most commonly triggered by foods, stinging insect venoms, or medications. Medications, physical factors (e.g exercise, cold) can also trigger anaphylaxis through an IgE-independent immunologic mechanism and through direct mast cell stimulation. Idiopathic anaphylaxis is a diagnosis of exclusion that should be made only after other causes of anaphylaxis and other differential diagnoses have been considered. Patients with idiopathic anaphylaxis may also experience anaphylaxis from recognized causes such as exercise, medication, or food. Hereditary angioedema is one of the differential diagnosis of the idiopathic anaphylaxis. This report describes the assessment of the one case of idiopathic anaphylaxis accompanied with exercise and drug induced anaphylaxis in which a diagnosis of hereditary angioedema was made erroneously. [ABSTRACT FROM AUTHOR]

Aim: To assess the etiology, underlying disease, treatment procedures, and mortality rate of lung abscesses by dividing the patients into community-acquired lung abscess (CALA) and nosocomial lung abscess (NLA) subgroups. Materials and methods: We reviewed and analyzed data on 62 adult cases of CALA and NLA treated during 2000--2011 at a tertiary university hospital in Turkey. Results: Of these 62 patients, 44 had CALA and 18 had NLA. Etiologic microorganisms were isolated in 20 of the 44 patients (45.4%) in the CALA group and in 15 of the 18 patients (83.3%) in the NLA group. Among these patients, Staphylococcus aureus (20.0%) and Pseudomonas aeruginosa (26.7%) were the most common microorganisms in the CALA and NLA groups, respectively. Computed tomography-guided drainage was performed in 20 patients in the study and the abscess was cured in 17 (85%) patients. The overall mortality rate was 12.9%. It was 4.5% and 33.3% in the CALA and NLA groups, respectively (P < 0.05). Conclusion: Lung abscess continues to be a significant cause of morbidity and mortality despite appropriate treatment. Medical therapy is started empirically, and so it is important to separate patients into subgroups of CLA or NLA. [ABSTRACT FROM AUTHOR]

Pulmonary capillary hemangiomatosis (PCH) is an idiopathic disease characterized with pulmonary hypertension (PH) caused by the proliferation of numerous capillaries within alveolar walls of the lung. Administration of vasodilator therapy, in contrast to primary PH, is risky due to possible fatal pulmonary edema; therefore, differentiation of PCH and primary PH is of significant importance. Since the clinical features of PCH are vague and histopathologic examination may not be usually feasible due to unstable conditions of the patients, radiological findings may help establish the diagnosis. A 17-year-old girl presented with exertional dyspnea and fatigue. PH was observed with both two-dimensional Doppler echocardiography and right heart catheterization. The diffuse ground glass opacifications of both lungs and the signs of PH on computed tomography (CT) raised the suspicion of PCH. The diagnosis was then confirmed with histopathologic examination. We herein report this rare pediatric case of PCH with emphasis on CT imaging findings. [ABSTRACT FROM AUTHOR]

Pulmonary hypertension is an important determinant of morbidity and mortality in many diseases, including congenital heart disease and respiratory disease. Fibrosing mediastinitis is a rare disorder caused by proliferation of acellular collagen. In fibrosing mediastinitis, clinical presentation is determined by compression to the vital mediastinal organs. Fibrosing mediastinitis may rarely lead to pulmonary veno-occlusive disease. In this case report, a 16 year old boy with pulmonary arterial hypertension was presented. His right pulmonary artery was completely occluded secondary to idiopathic fibrosing mediastinitis. The patient died after mediastinal biopsy. Herein, we discussed pulmonary arterial hypertension secondary to idiopathic fibrosing mediastinitis in children. [ABSTRACT FROM AUTHOR]