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Lütfiye Kiliç,1 Seda Tural Önür,2 Aslı Gorek Dilektasli,3 Gaye Ulubay,4 Arif Balcı5 1Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Pulmonologist, Department of Pulmonary Rehabilitation, University of Health Sciences, Istanbul, Turkey; 2Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Associate Professor, Department of Chest Diseases, University of Health Sciences, Istanbul, Turkey; 3Uludağ University, Faculty of Medicine, Associate professor, Department of Chest Diseases, Bursa, Turkey; 4Başkent University, Faculty of Medicine, Professor, Department of Chest Diseases, Ankara, Turkey; 5Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Physiotherapist, Department of Pulmonary Rehabilitation, University of Health Sciences, Istanbul, TurkeyCorrespondence: Lütfiye Kiliç, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey, Tel +90 532 397 7172, Email lutuf1@yahoo.comPurpose: We investigated the effect of pulmonary rehabilitation (PR) on airway resistance in chronic obstructive pulmonary disease (COPD) patients with severe airway obstruction and hyperinflation.Patients and Methods: This retrospective cohort study was conducted with data from severe COPD cases with those who underwent an 8-week PR program. Main inclusion criteria were having severe airflow obstruction (defined as a forced expiratory volume in one second (FEV1) < 50%) and plethysmographic evaluation findings being compatible with hyperinflation supporting the diagnosis of emphysema (presence of hyperinflation defined as functional residual capacity ratio of residual volume to total lung capacity (RV/TLC) > 120%). Primary outcomes were airway resistance (Raw) and airway conductance (Gaw) which were measured by body plethysmography, and other measurements were performed, including 6-minute walk test (6-MWT), modified Medical Research Council dyspnea scale (mMRC) and COPD assessment test (CAT).Results: Twenty-six severe and very severe COPD patients (FEV1, 35.0 ± 13.1%; RV/TLC, 163.5 ± 29.4) were included in the analyses, mean age 62.6 ± 5.8 years and 88.5% males. Following rehabilitation, significant improvements in total specific airway resistance percentage (sRawtot%, p = 0.040) and total specific airway conductance percentage (sGawtot%; p = 0.010) were observed. The post-rehabilitation mMRC scores and CAT values were significantly decreased compared to baseline results (p < 0.001 and p < 0.001, respectively). Although there were significant improvements in 6-MWT value (p < 0.001), exercise desaturation (ΔSaO2, p = 0.026), the changes in measured lung capacity and volume values were not significant.Conclusion: We concluded that PR may have a positive effect on airway resistance and airway conductance in COPD patients with severe airflow obstruction.Keywords: airway resistance, body plethysmography, airflow limitation, emphysema, lung mechanics

Aim: In the clinical course of Chronic Obstructive Pulmonary Disease (COPD), exacerbations thatare defined as worsening of respiratory symptoms (dyspnoea, cough, sputum production) may occur,which causes poor prognosis and require additional treatments. Cost-effective mortality predictors arevaluable for the treatment management of COPD. We aimed to investigate whether serum uric acid(UA) and serum uric acid to creatinine ratio (UCR) are predictors of mortality and hypoxemia in patientswith acute exacerbations of COPD (AECOPD).Material and Methods: 105 patients with AECOPD who were hospitalized in a reference chest hospitalbetween January 2014 and December 2018 were evaluated retrospectively in this cross-sectional study.The associations between UA and UCR and long-term mortality, hypoxemia, comorbidity, FEV1 value,and Global Strategy for the Diagnosis, Management and Prevention of Chronic Obstructive PulmonaryDisease (GOLD) stage were analyzed.Results: In the present study including 105 patients with AECOPD (97 males, mean age of 65±9 years),a significant correlation was found between hyperuricemia and mortality (95% CI:1.15-10.72, p=0.027;95% CI:1.16-4.12, p=0.016, respectively), while no correlation was found between UCR and mortality(p=0.051, p=0.053, respectively). Low UA level was associated with hypoxemia significantly (p=0.022),but no association was observed between UCR and hypoxemia (p=0.094).Conclusion: It appears that UA is more important for predicting long-term mortality in patients withAECOPD than UCR. We suggest that UA can be used as a biomarker of long-term mortality for theidentification of high-risk COPD patients that require frequent clinical follow-up and intense treatmentmanagement., Amaç: Kronik Obstrüktif Akciğer Hastalığı (KOAH) klinik seyrinde, kötü prognoza neden olan, ektedavi gerektiren, solunum semptomlarında (dispne, öksürük, balgam) kötüleşme olarak tanımlananalevlenmeler gözlenebilir. Maliyet-etkin mortalite öngörücüleri, KOAH’ın tedavi yönetimi için değerlidir.Akut KOAH alevlenmeleri olan serum ürik asit (ÜA) ve serum ürik asitin kreatinine oranının (ÜKO) mortalite ve hipoksemi için belirleyici olupolmadığını araştırmayı amaçladık.Gereç ve Yöntemler: Bu gözlemsel kesitsel çalışmada, Ocak 2014 ile Aralık 2018 arasında bir referans göğüs hastanesinde yatan 105KOAH alevlenmesindeki hasta retrospektif olarak değerlendirildi. ÜA ve ÜKO ile uzun vadeli mortalite, hipoksemi, komorbidite, FEV1 değeri,KOAH’ın tanı, tedavi ve önlenmesi için küresel strateji (GOLD) evreleri arasındaki ilişkiler analiz edildi.Bulgular: KOAH alevlenmesindeki toplam 105 hastayı (97’si erkek, ortalama yaş 65±9 yıl) içeren bu çalışmada hiperürisemi ile mortalitearasında anlamlı bir korelasyon bulunurken (sırasıyla, p=0.027; p=0.016), ÜKO ile mortalite arasında korelasyon bulunmadı (sırasıyla,p=0.051, p=0.053). Düşük ÜA seviyesi hipoksemi ile anlamlı olarak ilişkiliydi (p=0.022), ancak ÜKO ile hipoksemi arasında bir ilişki gözlenmedi(p=0.094).Sonuç: KOAH alevlenmesindeki hastaların uzun vadeli mortalitesini öngörmede serum ÜA’nin ÜKO’na göre daha değerli olduğugörülmektedir. Sık klinik takip ve yoğun tedavi yönetimi gerektiren yüksek riskli KOAH hastalarının tanımlanması için serum ÜA’in uzunvadeli mortalitenin biyobelirteci olarak kullanılabileceğini öneriyoruz.

Central and peripheral types of squamous cell carcinoma (SQCC) are classified in different categories due to different clinical-pathological features. Peripheral SQCC, according to histological pattern; it is classified into three subgroups as alveolar space-filling type, expanding type and combined type. Of these three subtypes, alveolar space-filling neither causes lymphatic vessel invasion nor lymph node metastasis and has the best prognosis. Herein, we present a rare case of squamous cell carcinoma that did not metastasize at two and a half years years from initial diagnosis.

Aim: multidrug-resistant (MDR) tuberculosis (TB) and drug-sensitive-TB have long treatment periods which affect patient compliance and treatment outcomes. We planned to determine the factors that will affect the management of this disease in the elderly population. Methods: in a period of two years, a total of 82 elderly patients with bacteriologically proven TB enrolled into our retrospective study between 2011-2018. The patients' demographic features, laboratory findings, and hospital records were analyzed. Results: we enrolled 67 (87.7%) patients with drug-sensitive TB and 15 (18.2%) MDR-TB in our study. In the study population, 73.2% (n=60) were male and the mean age was 75 +/- 9 years. When we compare treatment complications of MDR-TB and drug-sensitive-TB, we found out the rate of electrolyte imbalance, nephrotoxicity, and ocular toxicity more common among the MDR-TB group (p=0.008, p=0.008, and p=0.032, respectively). When we compare the mortality rate, cure, and treatment success between MDR-TB and drug sensitive TB, there were no statistically significant results (p=0.898, p=0.549, p=0.488; respectively). Conclusion: however, we think that this was due to the low sample size. Nevertheless, we should be careful in terms of complications management of the geriatric population., NA

Background CoronaVac, an inactivated whole-virion SARS-CoV-2 vaccine, has been shown to be well tolerated with a good safety profile in individuals aged 18 years and older in phase 1/2 trials, and provided a good humoral response against SARS-CoV-2. We present the interim efficacy and safety results of a phase 3 clinical trial of CoronaVac in Turkey. Methods This was a double-blind, randomised, placebo-controlled phase 3 trial. Volunteers aged 18-59 years with no history of COVID-19 and with negative PCR and antibody test results for SARS-CoV-2 were enrolled at 24 centres in Turkey. Exclusion criteria included (but were not limited to) immunosuppressive therapy (including steroids) within the past 6 months, bleeding disorders, asplenia, and receipt of any blood products or immunoglobulins within the past 3 months. The K1 cohort consisted of health-care workers (randomised in a 1:1 ratio), and individuals other than health-care workers were also recruited into the K2 cohort (randomised in a 2:1 ratio) using an interactive web response system. The study vaccine was 3 mu g inactivated SARS-CoV-2 virion adsorbed to aluminium hydroxide in a 0.5 mL aqueous suspension. Participants received either vaccine or placebo (consisting of all vaccine components except inactivated virus) intramuscularly on days 0 and 14. The primary efficacy outcome was the prevention of PCR-confirmed symptomatic COVID-19 at least 14 days after the second dose in the per protocol population. Safety analyses were done in the intention-to-treat population. This study is registered with ClinicalTrials.gov (NCT04582344) and is active but no longer recruiting. Findings Among 11 303 volunteers screened between Sept 14, 2020, and Jan 5, 2021, 10 218 were randomly allocated. After exclusion of four participants from the vaccine group because of protocol deviations, the intention-to-treat group consisted of 10 214 participants (6646 [65.1%] in the vaccine group and 3568 [34.9%] in the placebo group) and the per protocol group consisted of 10 029 participants (6559 [65.4%] and 3470 [34.6%]) who received two doses of vaccine or placebo. During a median follow-up period of 43 days (IQR 36-48), nine cases of PCR-confirmed symptomatic COVID-19 were reported in the vaccine group (31.7 cases [14.6-59.3] per 1000 person-years) and 32 cases were reported in the placebo group (192.3 cases [135.7-261.1] per 1000 person-years) 14 days or more after the second dose, yielding a vaccine efficacy of 83.5% (95% CI 65.4-92.1; p, TUSEB, We are grateful to all participants who volunteered to be part of this study and to all members of the clinical research teams of the participating sites. We thank TUSEB for funding the study and Omega-CRO for the statistical analyses and production of figures, and providing the study protocol. We also thank the members of the data and safety monitoring board for their contributions in the safe execution of this study.

INTRODUCTION Hyponatremia is shown to prolong hospitalization and increase mortality. The role of hyponatremia in chronic obstructive pulmonary disease is widely studied with a focus on hospitalized patients. OBJECTIVES To investigate whether hyponatremia increases the probability of re-exacerbations in non-hospitalized patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). METHODS Patients with AECOPD who required an emergency department (ED) visit and who were discharged home were included in this single-center, retrospective study. Demographics and laboratory values were compared between patients with hyponatremia (

Pulmonary sclerosing pneumocytoma is a rare, low-grade pulmonary tumor observed as unilateral or bilateral multiple nodules at a rate of 4%-5%. Among the autoimmune connective tissue disorders, those most commonly associated with lung malignancies are sclero- derma and rheumatoid arthritis. In this study, we report a rare case of a 55-year-old middle-aged Asian woman with slow-growing bilat- eral multiple pulmonary sclerosing pneumocytoma and scleroderma-rheumatoid arthritis overlap syndrome. The autoimmune disorders and pulmonary fibrosis of this case might have led to the development of PSP.

The objective of this study is to analyze chronic obstructive pulmonary disease exacerbation rates and the effect of patients' behavioral changes on the exacerbations during the pandemic.This study was conducted in a reference hospital for chest diseases and patients who were hospitalized with an exacerbation of chronic obstructive pulmonary disease between March 11, 2019, and March 11, 2020, were designated. Patients' chronic obstructive pulmonary disease exacerbations requiring emergency department visits and/or hospitalization were com- pared between the pre-pandemic and pandemic periods. Each patient was surveyed with 25 questions using telemedicine.Of all the 256 patients, 203 (79%) were male and the mean age was 66 ± 10 years. Compared to the previous year, emer- gency department visits and hospitalizations in our hospital were significantly lower and less frequent (P.0001, for both). Smoking habits decreased in 9% of patients, and 60% had hardly spent time outdoors. Only 3 patients reported to spend time indoors. The household mask-use rate while contacting the patient was 50%. As a chronic obstructive pulmonary disease patient, 33% expressed themselves as "feeling better." Overall, 92(36%) patients were recorded not to have any exacerbation, and 34 (13%) to have no attacks of worsening were managed at home. Novel exacerbation risk was found to independently correlate with younger age (odds ratio: 0.944, CI: 0.904-0.986, P = .010) and having more frequent episodes of exacerbation in the pre-pandemic period (odds ratio: 1.2, CI: 1.025-1.405, P = .023).Chronic obstructive pulmonary disease patients specifically benefited from confinements, restrictions, and lifestyle changes. Further studies are needed to better identify the most critical factors leading to these positive outcomes. A permanent patient management guideline for chronic obstructive pulmonary disease patients could be formulated where the weight of lifestyle factors is elevated.

Introduction and objective Silicon and metallic are two types of stents in use. In this study, we compared complications and long-term survival among patients who received silicon or fully covered, bifurcated self-expandable metallic stents (SEMS) for a malignant tracheobronchial obstruction and/or tracheo/bronchial oesophageal fistulas. Methods Patients in whom Y-shaped stents were used from January 2013 to June 2017 in our interventional pulmonology unit were evaluated retrospectively from patient files. Results Of the 47 patients, 30 (23 males, 76.7%) were in the silicon stent group and 17 (14 males, 82.4%) were in the covered SEMS group. No differences between the groups were detected in ECOG status, pathological properties of the disease, radiotherapy or chemotherapy history before the procedure, symptoms at presentation, or comorbidities. The most common symptom was dyspnoea (96.7% and 100%), and the most common comorbidity was chronic obstructive pulmonary disease (26.7% and 23.5%). A total of 20 complications (42.6%) were seen, with no significant difference between the groups (silicon, 40%; SEMS, 47.1%; P = . 62). Mean survival was 164.51 ± 38.83 days for the silicon stent group and 254.45 ± 103.32 days for the SEMS group (P = .588). No differences were observed in 30-, 90- or 180-day mortality between the two groups (P = .966, .846 and .534, respectively). Conclusions No significant differences in symptom palliation, insertion safety, complication rate or survival were detected between the two types of stent.

Introduction The interval from the peak to the end of the electrocardiographic T wave (Tp-Te) may correspond to malignant ventricular arrhythmias. In this study we aimed to assess Tp-Te variability and investigate the transmural dispersion of repolarisation in pulmonary sarcoidosis disease without proofed cardiac involvement. Material and methods This was a retrospective case-control study that included patients who had a pathologic and radiologic diagnosis of sarcoidosis. All data of the patients' demographic features and electrocardiographs were analysed. Results We enrolled 78 patients with sarcoidosis and 54 healthy volunteers as controls in our study. Men comprised 36% of the sarcoidosis group and 27% of controls. The mean age in the sarcoidosis and control group was 45.4 ±8.7 years (range: 23-58 years) and 44.6 ±11.9 years (range: 21-73 years), respectively. There was no significant difference between the groups for age or sex (p = 0.654, p = 0.246, respectively). There was a significant increase in Tp-Te results in all precordial leads in the sarcoidosis group compared with the control group (p < 0.05). Conclusions Pulmonary sarcoidosis is suspected to have cardiac involvement; therefore, we need to develop new approaches. We present strong evidence that Tp-Te intervals were increased in patients with pulmonary sarcoidosis, which suggests that there may be a link between sarcoidosis and ventricular arrhythmias without proofed cardiac involvement.

Purpose While the number of COVID‐19 cases is increasing day by day, there is limited information known about the hematological and laboratory findings of the disease. We aimed to investigate whether serum ferritin level predicts mortality, is a marker for rapid progression for inpatients. Methods Our study included 56 patients who were died due to COVID‐19 as the study group, and 245 patients who were hospitalized and recovered as the control group. The laboratory data of the patients were evaluated from the first blood tests (pre) taken from the first moment of admittion to the hospital and the blood tests taken from before the patient's discharge or exitus (post) were evaluated retrospectively. Results The mean age of the nonsurvivor group was 62.0 ± 15.7 and the mean age of the control group was 54.34 ± 13.03. Age and length of stay are significantly higher in the nonsurvivor group. When comparing the pre and post values of ferritin, according to the two groups separately, there was no significant difference in the control group and a high level of significance was observed in the nonsurvivor group (p

Seda Tural Onur,1 Samim Emet,2 Sinem Nedime Sokucu,1 Imran Onur2 1Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Chest Disease, Zeytinburnu, Istanbul, Turkey; 2Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey Introduction: The interval from the peak to the end of the electrocardiographic (ECG) T wave (Tp–Te) can estimate cardiovascular mortality and ventricular tachyarrhythmias.Objectives: In this study, we aimed to define a new ECG parameter in patients with COPD.Methods: This was a cross-sectional observational study that included COPD patients who were diagnosed previously and followed up in the outpatient clinic. All data of the patients’ demographic features, history, spirometry, and electrocardiographs were analyzed.Results: We enrolled 134 patients with COPD and 40 healthy volunteers as controls in our study. Patients already known to be having COPD who were under follow-up for their COPD and diagnosed as having COPD according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria were included. Men comprised 82.8% of the COPD group and 73.2% of controls. The mean age in the COPD and control group was 60.2±9.4 and 58.2±6.7 years, respectively. There was no significant difference between the groups for age or sex (p=0.207, p=0.267, respectively). There were 46 (34.3%) patients in group A, 23 (17.2%) patients in group B, 26 (19.4%) patients in group C, and 46 (29.1%) patients in group D as COPD group. There was a significant increase in Tp–Te results in all precordial leads in the COPD group compared with the control group (p

Objective: The mechanism of biological treatment molecule called omalizumab used in asthma treatment is thought to be versatile; however, the mechanism still remains unknown. This study was undertaken in severe asthma patients underwent omalizumab treatment, in order to investigate the relationship between biomarker expression and disease characteristics related to the immune system. Methods: Consecutive patients with severe asthma disease (n=15; Group IA, pretreatment and Group IB, post-treatment) underwent omalizumab treatment. Control group was age- and sex-matched including 25 healthy in Group II. Blood samples from both the groups were taken during their first visit (Group IA and II) and then after 12 months of treatment in asthmatic patients (Group IB). Serum levels of homocysteine (Hcy), eosinophil cationic peptide (ECP), 25-hydroxyvitamin D (25(OH)D), interleukin-1β (IL-1β), soluble OX2 (sCD200) and clinical follow-up tests including fractional exhaled nitric oxide (FeNO), asthma control test (ACT), and pulmonary function tests were evaluated. Results: After the treatment, 25(OH)D levels and pulmonary function tests, including forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) levels, were significantly increased. Furthermore, total immunoglobulin E (IgE), Hcy, ECP, FeNO, and sCD200 levels were dramatically diminished. Regression analysis revealed positive correlations between ACT-FEV1 and ACT- FVC and between FeNO-age and FeNO-ECP for Group IA patients. Negative correlations were detected between ACT-IgE, age-FEV1, FeNO-FEV1, and FeNO-FVC for Group IA patients. Conclusion: Our results suggest that the potential use of serum biomolecules in concordance to the clinical status of the asthmatic patients might be a follow-up tool for the omalizumab therapy.

Objective: Immune responses can change with exercise. We aimed to show the changes in cytokine levels pre- and post-exercise in patients with asthma. Methods: In this prospective control trial, data of 32 patients with asthma that was under control were classified into two groups, pre- and post-exercise. Serum IL-1β and monocyte IL-1β, IL-2, and IL-10 expressions were evaluated using enzyme-linked immunosorbent assay. The patients were advised to walk for at least 30 min for 4 days/week for 12 weeks. Results: There was no significant difference in demographic properties of the participants. Monocyte IL-1β levels in the pre- and post-exercise groups were 1.99±0.35 and 1.01±0.22 pg/mL, respectively (p=0.003). IL-10 levels in the pre- and post-exercise groups were 1.64±0.02 and 1.21±0.03 pg/mL, respectively (p=0.04). IL-2 levels in the pre- and post-exercise groups were 0.64±0.045 and 0.32±0.09 pg/mL, respectively (p=0.001). However, there was a significant difference in serum IL-1β and monocyte IL-1β, IL-2, and IL-10 levels between the groups (p=0.02, p=0.003, p=0.04, and p=0.001, respectively). Conclusion: Systemic inflammatory parameters that are commonly elevated in asthma may improve by exercise. The elucidation of the mechanism of immune control in patients with asthma is useful for the future treatment of asthma.

Introduction We aimed to evaluate the efficacy of flexible bronchoscopic cryoextraction in the treatment of airw ay obstruction arise from mucus plugs and blood clots and present our experience. Materials and methods The present study evaluated patients who previously underwent unsuccessful flexible bronchoscopy for the removal of secretions and blood clots in the central airway and who underwent flexible bronchoscopic cryoextraction between January 2013-November 2017. Result The study included seven patients with a mean age of 58.29 ± 18.56 years (28-76). Three patients underwent bedside intervention in the intensive care unit, and four patients underwent an intervention in the bronchoscopy unit. Seven patients underwent a total of nine sessions of cryoextraction. Severe complications or mortality did not occur during the cryoextraction sessions. Conclusions Flexible bronchoscopic cryoextraction offers a safe treatment strategy as an alternative to rigid bronchoscopy in patients in whom airway patency cannot be achieved using other flexible bronchoscopic interventions. and accuracy of PET was higher compared to CT with this cut-off value.

Background: Using innovative and scientific methods increases the rate of quitting in smokers. Short message service (SMS) is a communication tool widely used and well integrated in many people’s daily lives. To increase adherence to appointments in smoking cessation clinics (SCC), it is thought that increased compliance could be achieved by falling outside the traditional methods. SMS has been shown to increase the compliance of patients with SCC appointments. Aims: In this study, we aimed to evaluate the effect of SMS in the compliance of patients with SCC follow-up visits and smoking cessation success. Study Design: Case-control study. Methods: Our study was a controlled, open, prospective study. We enrolled 436 cases applied to SCC of Yedikule Training and Research Hospital between 01.10.2013-30.06.2014 and agreed to follow-up with SMS. SMS was sent to the patients to remind them of appointments at the SCC and to query their smoking state. Results: Two hundred-and-eighty seven (65.8%) of the patients were male and 149 (34.2%) were female. The mean age was 45±12 years. In this study, 296 (67.9%) patients had graduated from primary school. Our patients’ smoking state was queried by telephone at the 6-month follow-up and we contacted 348 patients. According to this, 88 (25.3%) patients were not smoking, and 260 (74.7%) patients were smokers. Therefore, the smoking cessation rate was 24% (n=60) in patients who did not respond to SMS reminders at all, and 28.6% (n=28) in patients answering any SMS at least once (p=0.377). Smoking cessation rate of the patients invited by SMS but who did not attend any control visits was 19.1%, and it was 34.5% in patients coming to a control visit at least once. This difference was statistically significant (p=0.001). Conclusion: In our study, there was increased success of smoking cessation in patients coming to control visits. We think that this may result from the possibly increased compliance to SCC appointments following reminders by SMS, and that this may also increase smoking cessation success.

Objective: Inelaborate use of new quinolones with strong anti-tuberculosis (TB) activity leads to difficulty in diagnosis and more importantly, quinolone-resistant Mycobacterium tuberculosis. We aimed to determine the frequency of quinolone use in patients who were referred to our hospital for suspected TB and to evaluate the association between quinolone use and different clinical laboratory parameters. Methods: Between November 15 and December 15, 2013, all patients who were admitted to the TB outpatient clinic with no previous diagnosis of TB were included in this study. Demographic and clinical laboratory findings and history of antibiotic use were recorded. Patients’ quinolone use were questioned by showing fluoroquinolone antibiotic boxes’ photographs available on the market. The departments of the doctors who prescribed quinolones were recorded. Results: The mean age of 179 patients included in the study was 37±16 (15–89) years. Among these, 113 patients (63.1%) were male. Seventy five patients (41.9%) were diagnosed as tuberculosis according to the clinical-radiological and/or bacteriological findings. Of 179 patients, 58.1% (n=104) had been prescribed antibiotics for current complaints before referral to our clinic. Sixteen patients (15%) had been recommended fluoroquinolones. Fluoroquinolones were prescribed by seven internal medicine specialists, five pulmonologists, three emergency medicine specialists, and one family medicine practitioner. Among 16 fluoroquinolones prescribed, nine were moxifloxacin, four were levofloxacin, and three were gemifloxacin. Quinolone use revealed a significant inverse relationship only with the presence of hemoptysis (p=0.04). Conclusion: Besides increased educational activities regarding the rational use of antibiotics in recent years, the quinolone group of antibiotics is still prescribed for suspected TB cases. To avoid quinolone-resistant M. tuberculosis strains, further education is required.

Background The relationship between chronic obstructive pulmonary disease (COPD) exacerbations and gastroesophageal reflux (GER) has been investigated less than asthma-GER. We aimed to evaluate the presence of GER in patients with COPD and its impact on exacerbations. Methods We included 24 patients with stable mild-moderate stage COPD and 19 volunteers as the control group. We conducted a gastroesophageal reflux disease (GERD) symptom questionnaire, gastroscopy, manometry, and an ambulatory 24-h pH-impedance study. Results According to the GERD questionnaire, only 5 (20.8%) patients with COPD had typical GER symptoms. According to the 24-h pH-impedance study, the mean DeMeester score (DMS) was 38.1 ± 34.6 in the COPD group and 13.3 ± 16.8 in the control group (p = 0.01). The acid reflux (DMS > 14.7) rate was higher in patients with COPD than in controls (73.9% vs 26.3%, p = 0.01). The symptom association probability positivity rate was 17.4% (n = 4) in the COPD group, which was similar to the controls (p = 0.11). The mean proximal extension rate of reflux (Z 17 cm) was 26.4 ± 12.9% in the COPD group. The proximal extent of reflux was positively correlated with the number of COPD exacerbations per year (p = 0.03, r = 0.448). In the motility results, only 2 (20%) patients in the control group had a minor motility disorder. Seventeen (70.8%) patients in the COPD group had a minor motility disorder, and 4 (16.7%) had major motility disorders (p Conclusion In our study, gastroesophageal reflux was frequent in patients with COPD, but only a quarter had typical reflux symptoms. The proximal extent of reflux may trigger frequent exacerbations of COPD.

Acquired immune deficiency syndrome (AIDS) is an immune system disease caused by the human immunodeficiency virus (HIV). The purpose of this review is to investigate the correlation between an immune system destroyed by HIV and the frequency of pneumonia. Observational studies show that respiratory diseases are among the most common infections observed in HIV-infected patients. In addition, pneumonia is the leading cause of morbidity and mortality in HIV-infected patients. According to articles in literature, in addition to antiretroviral therapy (ART) or highly active antiretroviral therapy (HAART), the use of prophylaxis provides favorable results for the treatment of pneumonia. Here we conduct a systematic literature review to determine the pathogenesis and causative agents of bacterial pneumonia, tuberculosis (TB), nontuberculous mycobacterial disease, fungal pneumonia, Pneumocystis pneumonia, viral pneumonia and parasitic infections and the prophylaxis in addition to ART and HAART for treatment. Pneumococcus-based polysaccharide vaccine is recommended to avoid some type of specific bacterial pneumonia.

INTRODUCTION The number of studies that target nonpharmacologic treatments for chronic obstructive pulmonary disease (COPD) are increasing because no existing pharmacologic treatment modality for COPD leads to significant improvement in lung function.Positive effects can be observed in patients with COPD using nutritional support alone or as an adjunct to exercise. In this study, we aimed to evaluate the awareness of chest physicians about the nutritional state of patients with COPD. MATERIALS AND METHODS A questionnaire consisting of 15 multiple choice questions was conducted to 121 chest physicians. The questions were formed to evaluate the awareness of chest physicians on the patients' nutritional state and the importance of nutrition in COPD follow-up. RESULT In total, of the 121 physicians, only 3 (2.5%) reported undertaking routine assessment for nutritional state of patients with COPD. The rates of physicians who routinely questioned patients about weight loss and loss of appetite were 56.2% (n= 68) and 51.2% (n= 62), respectively. Forty-five (37.2%) physicians said that they usually started nutritional support if they detected weight loss in patients with COPD. CONCLUSION Although there is limited data on the benefits of nutritional supplementation for patients with COPD, some studies have suggested advantages of nutritional support against the progress of COPD. Our study showed that routine screening for malnutrition in patients with COPD is rare among chest physicians and this did not differ according to the hospitals in which they worked or from where they took their residency training. There is a need for further studies emphasizing the importance of nutritional state in the progress of COPD.

Sulfasalazine is a compound of 5-aminosalicylic acid and sulfapyridine joined by an azo bond. There are only case reports in the literature about pulmonary toxicity caused by this drug. A 23-year old man diagnosed as ulcerative colitis 3 months ago admitted to our hospital with a 1 month history of fever, cough, dyspnoea. He didn9t respond to antibiotics. He was a nonsmoker and had been on sulfazalazine and mesalazine treatment for 8 weeks. All of his medications were held on admission. He had fever (38.6 °C) with respiratory rate of 20/min with normal oxygen saturations in room air Physical examination revealed crepitation over right lung on auscultation. Chest radiograph showed multilobar pulmonary infiltrates dominated right lung peripherally. He has peripheral eosinophilia. For differential diagnosis, an autoimmune screen, Ig E level and parasite search in his feces was negative. Sputum culture was negative for pathogenic bacteria and acid-fast bacilli. HRCT revealed patchy consolidations at all zones of the right lung and upper zone of left lung, peribronchial and interlobuler septal thickenings, ground glass opasities. No endobronchial pathology was detected. Bronchoalveolar lavage done from medial segment of right middle lobe was negative for viral, tuberculous and fungal infections. The differential cell count showed 20% eosinophils. After withdrawal of sulfazalazine, pulmonary infiltrates started to regress in the control chest radiograph but respiratory symptoms were not resolved completely so oral prednisone treatment was started. 2 weeks later, his chest radiograph was dramatically improved with near complete resolution of the pulmonary infiltrates. The patient is in our follow up for 6 months without any symptoms.

Background/aim: Tracheobronchomalacia (TBM) leads to the obstruction of expiratory airflow and interference with secretion clearance. Stabilization of the airway wall using a silicon stent or laser coagulation of the posterior wall may be treatment options.1397645907This study aimed to retrospectively analyze which interventional bronchoscopic method could be used to provide airway stabilization and gain control of symptoms and for whom this method could be used. Materials and methods: Fifteen patients who had received treatment in our interventional pulmonology unit were analyzed. We analyzed the techniques used, stent duration, complications, and long-term treatment success retrospectively. Results: Stents were used in 10 patients: 4 patients had silicon Y-stents and 4 patients had silicon tracheal stents. Stents were removed due to early migration in 3 patients. In 5 of the 71397645907cases, the stent was removed due to frequent obstructions of the stent due to recurrent severe mucostasis. A suitable stent was not found for one patient who had an extremely enlarged trachea. Good clinical results were achieved in just two cases. The frequency of admissions to the emergency room and hospitalizations were diminished during the follow-up time in these two patients. Conclusion: Silicon stents may be a good treatment option in selected patients with TBM and dynamic collapse. However, our patients were high-risk; thus, the criteria for candidates for bronchoscopic treatment should be carefully defined.

INTRODUCTION: Many studies have evaluated the relationship between the NLR and PLR in patients with obstructive sleep apnea (OSA), and have shown that they are related to inflammation. We evaluated whether 3 months of continuous positive airway pressure (CPAP) treatment in patients with moderate to severe OSA without any comorbidities would affect the NLR and PLR values. METHODS: Full blood count parameters were evaluated before and after 3 months of CPAP treatment in patients with a diagnosis of moderate to severe OSA without any comorbidities. RESULTS: Twenty-nine patients (18 [62.1%] males) were enrolled. The mean body mass index (BMI) was 34.85±5.75 kg/m2, the apnea-hypopnea index score was 49.85±27.42, and CPAP was 9.34±1.77. No significant change in BMI was observed after the third month of treatment. Although the Epworth Sleepiness Scale (ESS) score decreased significantly (p=0.000), no changes were observed in the NLR, PLR, or C-reactive protein level (p>0.05). Mean platelet volume and red blood cell distribution width changed significantly after treatment (p=0.01; p

Studies on sCD200 (OX-2), 25-hydroxyvitamin-D (25(OH)D), homocysteine (hcy), eosinophil cationic peptide (ECP), d-dimer, CXCL8 and fractional exhale nitric oxide concentrations in allergic patients in Mediterranean regions under various climatic conditions have not been performed. In this report, blood samples were taken in May and June during times of high air pollination. This study was performed to compare serum biomolecule concentrations in allergic patients and matched controls and to evaluate the characteristics of allergic disease.The study participants (n = 129) included 25 healthy individuals (controls) and 104 allergic patients. Consecutive patients with managed allergic disease (Group II, III, IV and V) above the age of 18 years were included.In the control group, there was a significant positive correlation between ECP level and body mass index (BMI). Positive correlations among ECP, IgE and OX-2 levels were detected in Group IV. In Group V patients, positive correlations between age and IgE and between BMI and 25(OH)D were identified. Statistical analysis revealed positive correlations among basophil, eosinophil and OX-2 levels, and a negative correlation between ECP and age in Group V.Overall, these data suggest that hcy, 25(OH)D and OX-2 may be useful biomarkers for conventional clinical measurements.

Objectives Increased awareness and understanding of chronic obstructive pulmonary disease (COPD) is important for its management, but there are limited data regarding the basic knowledge among patients with COPD. This study aimed to evaluate the basic information and knowledge of patients who were specifically provided with a medical exemption certificate for COPD. Material and methods This cross-sectional, observational, single-center study was conducted at an outpatient clinic of our hospital and included 201 consecutive ambulatory patients who visited the outpatient clinic between January 01, 2015 and June 30, 2015. Data regarding sex, age, educational level, symptoms, smoking history, years since diagnosis, years since obtaining the exemption certificate, and COPD GOLD (Global Initiative for Chronic Obstructive Lung Disease-GOLD) stage were obtained. A questionnaire comprising 15 questions was used. Results The question regarding the organ primarily affected by COPD was correctly answered as "lung" by 145 (72%) of patients. In addition, 152 (76%) patients declared that they knew the localization of the affected organ; only 44 (22%) patients correctly located the organ on an image. Only seven (3.5% of the total) patients could correctly write "chronic obstructive pulmonary disease." Conclusion The lack of awareness among patients with COPD emphasizes the lack in the field of patient education. Simple questionnaires can be used to determine and also to improve the awareness and basic knowledge among patients with chronic diseases.

Background: Cigarette smoking is one of the most common addictions worldwide. Muslim smokers reduce the number of cigarettes they smoke during Ramadan due to the long fasting hours. Objectives: We aimed to share our experience in a smoking cessation clinic during Ramadan by analyzing the efficacy and adverse effects of once-daily dosing of bupropion or varenicline in a fasting group compared with conventional dosing in a non-fasting group. Methods: We analyzed 57 patients who attended our smoking cessation clinic during Ramadan of 2014 and 2015, and at least one follow-up visit. For the fasting patients, we prescribed bupropion or varenicline after dinner (once daily) as the maintenance therapy. We recorded demographic characteristics of the patients, fasting state, drugs taken for smoking cessation, and the dosage of the medication. At the first follow-up visit, adverse effects seen with the treatment were recorded. We conducted telephone interviews 6months after the first visits of the patients to learn the current smoking status of the groups. Results: Of the total 57 patients, 20 (35.1%) were fasting and 37 (64.9%) were not fasting. Fasting and non-fasting patients were similar for sex, age, smoking pack-years, marital status, educational status, and mean Fagerstrom scores (p >.05). Adverse effects and quit rates after 6 months of follow-up were similar between the fasting and non-fasting groups (p >.05). Conclusion: Although our sample size was small, we found no difference in the rates of adverse effects or smoking cessation using a single daily oral dose of bupropion or varenicline between a fasting group and a non-fasting group that received conventional dosing., NA

WOS: 000350052900006 PubMed ID: 25549699 Background: The differential diagnostic utilities of the levels of soluble interleukin (IL)-12p40 and the IL-2 receptor in sera and pleural effusions were evaluated in patients with exudative pleural effusions. Methods: We enrolled a total of 120 patients with exudative pleural effusions. The clinical, radiological, and histopathological diagnoses were tuberculous pleurisy in 52, malignant pleurisy in 39, and parapneumonic effusions in 29 patients. Results: We measured serum IL-12p40 and adenosine deaminase (ADA) levels in patients with tuberculous pleurisy and in a control group treated for pleural effusion to determine if such levels were useful in the diagnosis of pleural effusion (p < 0.005). Definite microbiological or histopathological diagnoses of tuberculous pleurisy or pleural effusion were recorded, and we found that ADA and serum soluble IL-2 receptor levels aided in diagnosis (p < 0.001). The levels of ADA and soluble IL-2 in pleural effusions afforded sensitivities and specificities of 84.62% and 82.69% and of 70.59% and 80.88%, respectively. The soluble IL-2 receptor level afforded a sensitivity and specificity of 82.69% and 52.9%. IL-12p40 levels in pleural effusions and sera afforded sensitivities and specifi cities of 80.77% and 80.77% and of 60.29% and 39.71%, respectively. Conclusion: Soluble IL-2 receptor levels in patients with tuberculous pleurisy serve as markers of disease in non-endemic countries, similarly to ADA levels.

Reaching the differential diagnosis of tuberculosis and sarcoidosis can be difficult due to granulomatous inflammation. Determining alkaline phosphatase (ALP) activity in serum for the differential diagnosis of tuberculosis and sarcoidosis. This study comprised 104 acid-fast bacilli (AFB) positive patients with pulmonary tuberculosis, 90 patients with biopsy-proven sarcoidosis and 43 healthy controls were included. ALP activity was measured at the first admission of the patients. There was a significant difference between the tuberculosis and the control (p= 0.03). Also, there was a significant difference between the tuberculosis and sarcoidosis (p= 0.034) According to the comparison of tuberculosis and sarcoidosis, the cut-off value was determined as 71.50 IU/L, which had sensitivity of 80%, specificity of 51%, PPV of 66%, NPV of 69%, accuracy of 67%, and the AUC was 0.728. ALP, as a little-known marker for tuberculosis and sarcoidosis, was increased in the pulmonary tuberculosis compared with the sarcoidosis. As such, it may be a useful tool for the differentiation of tuberculosis and sarcoidosis.

Seda Tural Onur,1 Sinem Nedime Sokucu,1 Levent Dalar,2 Sinem Iliaz,1 Kaan Kara,1 Songül Buyukkale,3 Sedat Altin1 1Department of Chest Diseases, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, 2Department of Pulmonary Medicine, Faculty of Medicine, Istanbul Bilim University, 3Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey Background: Malignant mesothelioma (MM) is an aggressive asbestos-related pleural tumor. The incidence is increasing with intensive use of asbestos in developing countries. We need an easily accessible, inexpensive, and reliable method for determining the low survival time prognosis of this tumor. The aim of our study was to investigate the viability of neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) as prognostic indicators in MM. Patients and methods: Thirty-six patients with MM, whose histopathologic diagnosis and follow-up were performed by our clinic and whose complete archive data were accessible, were included in this retrospective study. The patients’ histopathologic disease types and stages, complete blood count parameters at diagnosis, and survival were recorded. Results: Eighteen of the patients with MM were male and the remaining 18 of them were female; the average follow-up period was 24.83±3.61months. The PLR levels of the patients were statistically significant (P

Background: Self-expandable metallic stents (SEMS) can be used to treat malignant obstructions and fistulas of the central airways. SEMS can be placed using different methods. Recently, a rigid bronchoscope has been used for stent placement without the need for fluoroscopy. We retrospectively evaluated patients for whom SEMS were placed using a rigid bronchoscope, without employing guidewires or fluoroscopy. We describe the intra- and post-procedural complications of the method. Methods: Data collected between January 2014 and July 2015 were retrospectively evaluated by reference to hospital records. Results: The mean patient age was 58.14 ± 8.48 years (44–72 years) and 13 out of the 14 patients were male. Twelve had lung cancer, one a thyroid papillary carcinoma with a bronchomediastinal fistula, and one an esophageal carcinoma with a tracheoesophageal fistula. Covered metallic Y-shaped stents were placed in all patients. Before placement, argon plasma coagulation was performed on two patients, diode laser treatment on four, and de-obstruction on nine. No procedure-related mortality was noted. Only two patients required follow-up in the intensive care unit; they were moved to a regular ward after two days. No patient required stent replacement or repositioning. The most common early complication was mucus plugs. Conclusion: Endobronchial placement of covered self-expandable metallic stents was safe and readily performed in patients with airway obstructions. Neither fluoroscopic nor guidewire guidance was required. Neither patients nor staff were exposed to radiation, and costly guidewire guidance was not necessary. The procedure is cost-effective.