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Objective: Obstructive Sleep Apnea syndrome (OSAS) is characterized by recurrent complete or partial narrowing of the upper respiratory tract during sleep and frequently a decrease in blood oxygen saturation. Upper respiratory tract gap is determined by the balance between collapsing effect of negative intraluminal pressure during inspiration and upper airway dilator muscle activity. In this study, we aimed to describe the relationship among the lung volumes and airway resistance, which are not thought to be directly taken a part in OSAS pathogenesis, and OSAS cases at different severity. Materials and Methods: Our study has been conducted on 105 cases 26 (24.8%) of which are female and 79 (75.2%) male who were applied polisomnography in the Ministry of Health İstanbul Süreyyapaşa Chest Diseases and Chest Surgery Training and Research Hospital, Chest Disease Clinic between January 2008 and May 2008. Whole body plethysmography was performed to cases which filled patient information form containing identity informations, body mass index (BMI), neck circumference, additional disease situation, smoking anamnesis and Epworth sleepiness scale (ESS). Pulmonary function tests, lung volumes and airway resistances were recorded by looking at the expected % values for age, color and weight. Results: Patients were divided into 4 groups according to apnea-hypopnea index; 25.7% of them were diagnosed with simple snoring, 21.9% mild OSAS, 22.9% moderate OSAS, and 29.5% severe OSAS. The expiratory reserve volume (ERV) in severe OSAS was found lower than the other OSAS groups. No difference was determined in terms of respiratory function tests, airway resistance and lung volumes. While the BMI and neck circumference were high in the severe OSAS group, there was no difference among the groups in the ESS according to the severity of the disease. Conclusion: In conclusion, in our study OSAS severity is not affected by other lung volumes except airway resistance and ERV.

Objectives Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a new, minimally invasive, bronchoscopic technique used in the evaluation of inthrathoracic lymph nodes.Use of sedation drugs before the procedure differs among centres. There is no standardization about sedation before EBUS-TBNA.We used a policy decision to shift from use of propofol with midazolam vs midazolam alone in a large tertiary hospital to evaluate the diagnostic yield and safety of EBUS-TBNA procedure. Methods Files of all the patients who were performed EBUS-TBNA between the dates of September 2010 and May 2014 were surveyed. All the EBUS-TBNA cases were performed under sedation of propofol and midazolam with an accompanying anesthesiologist in the beginning, however, sedation is applied with midazolam without an accompanying anesthesiologist after April 2013 due to changes in sedation policy. The diagnostic yield and complication rates were compared by chi-squared analysis between two groups. Results The files of 340 EBUS-TBNA performed patients were evaluated. Of the patients 274 eligible patients were analysed. 152 patients who fulfilled the inclusion criteria were analysed in propofol-midazolam (P) sedated group and 122 patients were analysed in midazolam (M) group. There is no statistically significant difference between two different sedated groups in terms of age and gender. Diagnostic value was detected as 77.6% in P group and 85.7% in M group and the difference was not statistically significant. No difference between complication rates of both groups was observed. Conclusion Both sedation-types for performing EBUS-TBNA showed similar diagnostic value and complication rates in our study. Propofol with midazolam application requires with an accompanying anaesthesiologist, therefore, it increases cost. EBUS-TBNA procedures had been performed in safe with no decrease in diagnostic yield under moderate sedation.

Introduction Tuberculosis drug resistance can be assessed by physicians with different approaches on issues such as the choice of treatment protocol and duration of treatment. Materials and methods In this study, we aimed to evaluate the treatment regimens and treatment results of patients with non multi-drug resistant tuberculosis (MDR-TB) drug resistance implemented in different chest disease clinics in our hospital. The 167 culture-positive patients with nonMDR-TB drug resistance diagnosed between 2008-2010 were analyzed retrospectively. Patients' age, gender, previous TB treatments, bacteriological cruise, drug resistance patterns and treatment outcomes were analyzed. Result One hundred sixty-seven patients with eligible data were evaluated; there were 117 (70.1%) men and 50 (29.9%) women, mean age was 42.35 (18-90) years, respectively. Among mono drug resistance; H resistance in 75 (44.9%) patients and R resistance in 11 patients was detected. In 19 (11.4%) patients HS resistance was detected as multiple drug resistance. One hudred and twenty-five (74.9%) were new cases. When treatment the results of in all patients evaluated, 136 (81.4%) of the patients achieved treatment success. Sixty-four (51.2%) of the new TB cases treated with "standard treatment protocols for new cases" (2HRZE/4H) and 51 (40.8%) of them treated with "other treatment protocols". Ten (23.8%)of the recurrent TB cases" standard treatment for recurrent cases (2HRZES/HRZE/5HRE) and 9 (21.4%) 33 (19.8%) of them treated with other protocols. The combination of the rthe treatment protocol and descriptive information about the duration of the treatment could not be created as 33 (19.8%) of the cases left without completing their treatment. Conclusions As a result of the analysis, patients have completed their treatment, there was no significant difference in treatment outcomes. Patients with Non MDR-TB drug resistance should be monitored well and should be careful in terms of MDR-TB.

Background: Tuberculosis (TB) is a worldwide contagious disease which can be mortal if the treatment is inadequate. TB management requires close cooperation between patients and health care workers (HCWs). The stigma amongst HCWs may have serious consequences. The aim of this study is to investigate the factors of TB related stigma in HCWs. Materials and Method: 19 questions (Figure 1) were asked to 175 HCWs by using email based poll. Demographical properties of participants were recorded. The stigmatization points from -2 to +2 were given by the answers from "I strongly disagree" to "I strongly agree". Participants were divided into stigma-positive and negative groups using the total stigma score. Stigma related factors were analyzed by using SPSS-20 stats program. Results: The participants mean age was 42.06 ± 9.85 years (25-66) with 58.3% women and contained specialists (43.4%), academicians, assistant physician, general practitioners and nurses. The majority of participants worked in a governmental (53.1%) and tertiary hospitals (62.9%)(Table 1). In chi-square test, female gender (p= 0.036), nursing department (p=0.005) and having low education (p=0.001) were found significantly related positive stigma. Female group (p = 0.047, OR = 3.83), no case group (p=0.017, OR=33.20), 11 - 30 cases/year group (p=0.02, OR=20.55), 31 - 100 cases/year group (p= 0.047, OR= 15.54) were found as independent factors related stigmatization by performing binary logistic regression analysis. Conclusion: Some educational programs can be prepared for stigma positive HCWs which might be beneficial to solve TB related stigma amongst HCWs.

WOS: 000435396300006 PubMed: 30020040 Introduction: Welding produces miscellaneous gases and particles that has various impact on respiratory system and long term exposure may result "welders'lung". The aim of this study is to describe the radiological findings of welders' and make an awereness for welders radilogical findings. Materials and Methods: The clinical and radiological findings of welders' who had hospital applications with respiratory symptoms between January 2010-January 2017 were evaluated retrospectively. Results: A total of 16 male welders with mean age 37 +/- 8 years had the mean duration of welding occupation 12 +/- 7 years. The most common symptoms were coughing (87%), sputum production (63%) and dyspnoea (63%). Thirteen welders were working in shipyards and 3 in construction business and other workplaces. Three (19%) patients had rhonchi on physical examination and these patients had decreased FEV1/FVC values below 70% on spirometry. Poorly-defined centrilobular micronodules that were not clearly visible on chest radiographs observed on thorax high resolution computed tomography. Bronchoscopy was performed to 7 patients. Iron-positive pigment granules and ferruginous bodies were revealed in 3 patients' bronchoalveolar lavage. Conclusion: Welders' chest X-ray deserve a closer look. In pulmonary radiology, there may be radiographical findings ranging from small ill defined nodules to groundglass opacites. Physcians should look more careful to welders' chest X-ray and incase of suspicious findings best can be detected on high HRCT. An awareness for the radiological findings will also reduce interventional procedures in these patients hereby, occupational history must be included in daily practice of physicians.

SUMMARY Objectives: Clinical and radiological features of 36 patients with breast cancer were investigated retrospectively. Materials and methods: Patients with breast cancer who had pulmonary complaints and radiologic abnormalities observed during oncology follow-ups were hospitalized, and investigated in clinics of chest disease. Pulmonary lesions were classified into 2 groups; Group I: malignant lesions due to metastasis of breast cancer, and Group II: nonmalignant lesions. Results: The mean age of the patients was 52.4±14.8 (28-93) years. Thirty-four patients were previously diagnosed with unilateral and 2 patients with bilateral ductal breast carcinoma. Twenty seven percent (n=10) of the patients were smokers (mean 10.7±6.81 pack-years). The mean time between the detection of breast cancer and the manifestations of pulmonary symptoms was 57.02±53.83 (3-180) months). The most common radiological abnormality was pleural effusion (n=23;63.9 %). Twenty-seven (75 %) patients had malignant (Group I), and 9 (25 %) patients had nonmalignant (Group II) pulmonary lesions. Malignant histopathology (n=27) was established by pleural fluid cytology in 13 (48.1 %), fiber optic bronchoscopy in 8 (29.6 %), pleural biopsy in 4 (14.8 %), CT guided transthoracic needle aspiration biopsy in 1 (3.7 %) and thoracotomy in 1 (3.7 %) patient, respectively. Mean time interval between the diagnosis of breast cancer and the detection of malignant pleural effusion was 69.91±64.21 (3-180) months. Nine (25 %) patients had nonmalignant pulmonary lesions including pneumonia in 3 (33.3 %), pulmonary thromboembolism and DVT in 3 (33,3 %), tuberculosis in 2 (22.2 %) and pulmonary fibrosis in 1 (11,1 %) patient. Conclusion: Pulmonary manifestations of breast cancer are most commonly related to metastases and can be observed in long time after the diagnosis of breast cancer. Besides, these nonmalignant reasons should be kept in mind and histopathologic confirmation should me made.

INTRODUCTION To present the treatment outcome in tuberculosis patients with sputum smear positivity in the third month of category 1 treatment regimes. PATIENTS AND METHODS A total of 1024 patients with tuberculosis treated in Ministry of Health Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital from January 2004 to December 2005 were included in this retrospective cohort study. Categorization and appropriate treatment of tuberculosis was performed according the World Health Organization guidelines. RESULTS Of overall 1024 patients, 655 (64%) were determined to receive category 1 treatment while sputum smear positivity was identified in 11 of them [2%; mean (SD) age: 46 (17.9) years] in the third month. Continuation phase treatment was initiated in these 11 patients. Sputum conversion was evident in six of 10 cases in the 4th month, in three cases in the 5th month and in one case in the 6th month. None had culture positivity after the 3rd month. Of 11 cases, 10 completed therapy with major drugs in six months and treatment outcome was cure. No relapse was identified after five years later. CONCLUSION Based on our data we recommend that the continuing phase should be started in cases with positive sputum smear at the end of the extended initial phase.

Setting: Inpatient clinic at Ministry of Health Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital Objective: To identify risk factors associated with persistent sputum positivity at the end of 2 months of direct observed treatment Design: Retrospective cohort study concerning evaluation of medical records of 547 patients with smear positive tuberculosis treated at our clinic from January 2004 to December 2005 Results: Of 547 patients with AFB positive smears, late conversion occurred in 11.9% while early conversion in 88.1%. Males composed 54.7% of the population, 31.9% of the population was ≤25 years old, 37.5% had exposure to tobacco, 15.7% had any drug resistance, 8.9% had co-morbid diabetes mellitus and 16.0% had extensive radiologic involvement. Based on significant association between sputum smear conversion and smoking for more than 20 package/year ( [Med-Science 2012; 1(4.000): 351-62]

Multidrug resistant tuberculosis has been a challenging situation in the clinical practice with respect to appropriate clinical treatment and management of the disease. The likelihood of resistance development is known to be lower in lesions with lesser percentages of the bacterial population. The present paper was designed to present a rare case of pulmonary multidrug resistant tuberculosis with extrapulmonary involvement to emphasize the consideration of genital tuberculosis with possible infertility in patients admitting with a scrotal mass.

Introduction: Hepatotoxicity is one of the most frequent adverse events occurring during tuberculosis treatment that may negatively affect treatment compliance, clinical outcome. This study was designed to evaluate management, risk factors related to hepatotoxicity during tuberculosis treatment. Patients and Methods: Hospitalized patients for tuberculosis treatment at Sureyyapasa Chest Diseases, and Chest Surgery Training and Research Hospital were included, between January 2004 and December 2007. Prevalence of hepatotoxicity, risk factors were evaluated among tuberculosis patients under anti-tuberculosis treatment according to World Health Organization (WHO) guideline. Hepatotoxicity was defined any elevated liver function tests with accompanying symptoms. Age, gender, past history of anti-tuberculosis treatment, extensity of radiological findings, co-morbid disorders and drug resistance were the risk factors evaluated in terms of development and recurrence of hepatotoxicity. Results: Of 1443 patients (38.37 ± 16.74 years; 64.5% were males), 106 (7.3%) was identified to develop hepatotoxicity on an average of 20 days after beginning treatment and lasting an average of 14 days. Hepatotoxicity for once in 78.3% (n= 83) of patients and more than once in 21.7% (n= 23) patients. All anti-tuberculosis drugs was continued at full dosage after the normalization of liver enzyme in 76.4% (n= 81). In recurrence a step-by-step treatment was re-started by exclusion of responsible drug/s. Treatment was administered without modification of WHO regimes in 79.2%. Pyrazinamide was omitted in 15 cases while rifampicin only in one patient. Triple drug regimen with isoniazid, ethambutol and streptomycin was used in six cases. Quinolon was added to treatment only in one patient. Presence of a co-morbidity was determined to be significant predictor of hepatotoxicity development OR= 3.093 (CI= 1.95-4.89; p= 0.000) past history of anti-tuberculosis treatment was significantly associated with recurrence (p= 0.027). There was no hepatotoxicity dependent mortality. Conclusion: Hepatotoxicity can be successfully management of hepatotoxicity without second line tuberculosis drugs in ongoing treatment regime.

Introduction: The present study was designed to determine the distribution of tuberculosis patients according to their occupations in Turkey. Patients and Methods: A total of 757 patients with bacteriologically and histopathologically confirmed diagnosis of tuberculosis and under the tuberculosis treatment were included in this retrospective descriptive study. Medical records of patients admitted to the Ministry of Health Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital between the years of 2004 and 2007 were evaluated in terms of patient demographics and the occupations. Occupations were classified into 10 groups according to the International Standardization Classification Occupation (ISCO-88). Results: Males composed 67% of the overall population [mean age (SD) was 41.3 (16.4) years]. Recurrent and newly diagnosed tuberculosis patients composed 81 and 19% of the patients, respectively. The most frequently identified major occupational groups were; craft and related workers (32%), plant and machine operators and assembler (10%), followed by the subgroups of textile, garment and related trades workers (12.9%), motor vehicle drivers (5.8%). The youngest subgroup among the most popular subgroups with a mean age (SD) of 29.5 (11.1) years, was textile, garment and related trades workers while the subgroup of mining and construction laborers was the oldest with a mean age (SD) of 63.9 (7.9) years. In all occupational subgroups, the frequency of males was higher than females. In female patients, the most frequently identified subgroup was, textile, garment and related trades workers while, mining and construction laborers, motor vehicle drives, building frame and related trades workers were composed solely of males. The frequency of newly diagnosed patients was significantly higher than former tuberculosis patients in the occupational subgroups. Conclusion: It seems crucial to improve conditions of workplaces with arrangements enabling healthier environment such as adequate ventilation, appropriate living space as well as routine health controls of employees especially for the textile industry.

Introduction: Lung diseases caused by biomass exposure cause a significant health hazard particularly amongst women. The present study was designed to investigate biomass exposure in women suffering from lung disease. Materials and Methods: A total of 100 women {[} mean (SD) age: 55.13 (17.65) years] hospitalized for chronic obstructive pulmonary disease (COPD), asthma, bronchiectasis, tuberculosis or interstitial lung disease were included in this study conducted between September 2008-March 2009 in three chest disease clinics at Sureyyapasa Chest Diseases and Chest Surgery Training and Research Hospital. Data collection on biomass exposure was based on application of hospital-based survey questionnaire including items on occupation, level of education, place of birth (location, region), exposure to biomass fuel fumes for heating and cooking purposes (animal dung, wood, charcoal, dried plant) and years of exposure with animal dung, wood, charcoal, dried plant. Results: COPD in 22\% patients, lung carcinoma in 12\%, bronchitis in 8\%, tuberculosis in 26\%, and interstitial lung disease in 17\% were the diagnosis for hospitalization. The most identified occupation was housewifery 86\%. Active, former and nonsmokers composed 6\%, 22\% and 72\% of the population. Birth place was village in 67\% patients while districts in 9\%. According to regional distribution, the most common place of birth was Central Anatolia region in (29\%). Exposure to biomass fuels was identified in all of patients including wood (92\%), animal dung (30\%), charcoal (23\%), and dry plant (23\%). Mean (SD) years of exposure was identified to be 52.6 (17.9) years for wood, 40.8 (17.9) years for animal dung, 48.1 (20.8) years for dry plant and 38.5 (21.4) years for charcoal. The most common type of biomass exposure was wood in village (97\%), city (79\%) and county (89\%). Conclusion: Findings indicating impact of biomass exposure in women seem to emphasize the need for analytic epidemiologic studies assessment measuring biomass exposure levels-particularly for women and young children.

A 24-year-old woman presented with chronic cough and noisy breathing. Chest x-ray revealed diffuse irregularity and narrowing of the tracheal lumen. Thorax computed tomography showed irregularity, stenosis, and areas of ossification throughout the trachea and both main bronchia. Flexible bronchoscopy revealed multiple nodules protruding into the tracheal lumen. Histopathology of the nodules confirmed the diagnosis of "tracheobronchopathia osteochondroplastica." Tracheobronchopathia osteochondroplastica is a rare, benign disease that is characterized by multiple cartilaginous and osseous submucosal nodules protruding through tracheal lumen and large bronchia. The etiology is still unexplained.

To the Editor: Streptococcus pneumoniae is the most common micro-organism which causes respiratory tract diseases affecting all age groups. The increasing frequency of pneumococcal strains resistant to penicillin has been reported all over the world. The emergence of drug-resistant strains threatens to complicate the management of respiratory infections due to pneumococcus. Ataturk Chest Disease and Thoracic Surgery Centre is one of the biggest training hospitals for pulmonary disease in Turkey. Nine-thousand inpatients and 60,000 outpatients with respiratory diseases are treated every year. Bacteriological examinations of materials obtained from …

Background: Tuberculosis is the leading cause of exudative pleural effusion. The present study was designed to evaluate the patient profile in a 3-year cohort of pleural tuberculosis patients. Methods: A total of 174 patients with pleural tuberculosis (mean(SD) age was 36.1 (17.3) years, 64.9% were males) followed up in our clinic from 2004 to 2007 were included in this study. Data on diagnostic methods, pleural fluid findings and clinical features of patients were recorded based on retrospective evaluation of the medical records. Diagnostic thorasynthesis was performed in patients with pleural effusion. Concomitant analysis of pleural fluid and blood biochemistry (glucose, LDH, protein levels), ADA values and cytology of pleural fluid were performed. Tuberculosis patients were categorized and treated in accordance with WHO guidelines. Patients were invited to attend monthly visits for the cohort analysis after discharge. Results: The frequency of patients below and above 35 years of age was 51.1 and 48.9%, respectively. Parenchymal lesion was evident in 22.4% of patients while pleural fluid was detected in 50.6% of patients. Lymphocytic fluid was detected in 98%. Mean (SD) level for ADA in the pleural fluid was 76.9(41.2) U/L. Pleural biopsy revealed granulomatous infection in 53.8% and chronic pleuritis in 46.2% of patients. There was a significant relation of age over 35 years to presence of chronic infection in pleural biopsy (OR: 3.11 (1.33-7.23)) and co-morbid disorder (OR: 23.53 (5.33-103.93)). Pleural biopsy was performed in 38.2% of patients who were younger than 35 years while in 51.7% of patients who were older than 35 years. The frequency of granulomatous infection diagnosis was significantly higher in patients younger than 35 years when compared to older patients (54.8% vs. 45.2 %; p=0.02). Conclusion: In our study including homogenous distribution of patients in terms of being younger and older than 35 years of age, pleural biopsy was performed more commonly in older patient in order to eliminate possible underlying malignancy. However the diagnostic power of pleural biopsy was determined to be poor. Accordingly, after elimination of other causes of the exudate development, initiation of tuberculosis treatment based on ADA and cell count results seems reasonable [Med-Science 2013; 2(1.000): 374-85]