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Background: Lactate dehydrogenase (LDH) levels predict coronavirus disease 2019 (COVID-19) severity. We investigated LDH isoenzyme levels to identify the tissue responsible for serum LDH elevation in patients with COVID-19. Methods: Hospitalised COVID-19 patients with serum LDH levels exceeding the upper reference limit included. LDH isoenzymes were detected quantitatively on agarose gels. The radiological severity of lung involvement on computed tomography was scored as 0-5 for each lobe (total possible score, 0-25). Disease severity was determined using the World Health Organization (WHO) clinical progression scale. Results: In total, 111 patients (mean age, 59.96 ± 16.14), including 43 females (38.7%), were enrolled. The serum levels of total LDH and all five LDH isoenzymes were significantly higher in the severe group. The levels of all LDH isoenzymes excluding LDH5 positively correlated with the WHO score. LDH3 levels correlated with chest computed tomography findings (r2 = 0.267, p = 0.005). On multivariate analysis, LDH3 was an independent risk factor for the deterioration of COVID-19. Conclusions: LDH3 appears to be an independent risk factor for deterioration in patients with COVID-19. LDH elevation in patients with COVID-19 predominantly resulted from lung, liver and muscle damage.

Obstructive sleep apnea (OSA) and cystic fibrosis (CF) are chronic conditions that profoundly impact quality of life. OSA, characterized by repeated episodes of upper airway collapse, can exacerbate CF symptoms due to nocturnal airway obstruction. Recent studies highlight the prevalence of OSA in CF patients, especially in adults, and its detrimental effects on health and quality of life. From April 2019 to December 2021, we conducted a study with 104 bronchiectasis patients at Marmara University Pendik Training and Research Hospital. After exclusions, 70 participants (35 CF and 35 non-CF) were included. Sleep parameters were assessed with polysomnography, and depressive mood was evaluated using the Zung Self-Rating Depression Scale (SDS). Daytime sleepiness was measured using the Epworth Sleepiness Scale (ESS). The statistical analyses included t-tests, chi-square tests, and logistic regression. Among the CF patients, depressive mood was significantly associated with female sex (OR: 4.28, 95% CI: 1.27–12.04) and anemia (OR: 7.87, 95% CI: 1.50–41.27). Higher ESS scores indicated greater daytime sleepiness in the depressive groups (p = 0.051). Depressive CF patients also had a significantly longer disease duration and more frequent annual exacerbations. No significant differences were found in total sleep time, sleep efficiency, or sleep stages between the depressive and non-depressive groups. A lower forced vital capacity (FVC) was observed in the depressive CF patients, although not significantly. Depression is prevalent among adult CF patients with OSA, with significant associations with female sex and anemia. These findings underscore the need for integrated care addressing both physical and mental health aspects, including interventions for respiratory symptoms, anemia management, and sleep quality enhancement to improve overall quality of life. [ABSTRACT FROM AUTHOR]

OBJECTIVE: With the significant increase in the life expectancy of cystic fibrosis (CF) patients, many individuals now reach adulthood and develop specific coping strategies to maintain their physical and mental well-being. This study aims to evaluate coping styles and their relationship with mental health and Health-Related Quality of Life (H-RQoL) in adult CF patients. MATERIAL AND METHODS: Thirty adult CF patients completed the Hospital Anxiety and Depression Scale to assess anxiety and depression, the Cystic Fibrosis Questionnaire—Revised to evaluate quality of life, and the Brief Coping Orientation to Problems Experienced questionnaire to assess coping strategies. RESULTS: Twelve individuals (40%) met the diagnostic criteria for being at risk of experiencing anxiety and/or depression. Anxiety risk group exhibited lower life quality scores in the domains of vitality, emotional functioning, and role limitations (P = .027, P = .001, and P = .001, respectively). Patients reporting depressive symptoms had lower scores in emotional functioning and role limitations domains of quality of life (P = .005 and P = .018, respectively). Multivariate analysis indicated that depression and anxiety scores were significant predictors of emotional quality of life. In terms of coping strategies, “acceptance” was the most commonly preferred, while “substance use” was the least preferred strategy among all participants. Patients at risk of anxiety and/or depression often chose “avoidance” as their coping strategy. CONCLUSION: Anxiety and depressive symptoms are prevalent and associated with poorer H-RQoL in adult CF patients. These patients preferred to employ giving up strategy when dealing with the disease. Therefore, it is essential to screen adult CF patients for mental health risks and to work on improving their coping strategies. [ABSTRACT FROM AUTHOR]

Objectives: Drug-related problems (DRPs) result in serious problems among hospitalized patients, high rates of morbidity and mortality, and increased healthcare costs. This study aimed to identify DRPs by clinical pharmacist-led medication review in hospitalized probable patients with coronavirus disease-2019 (COVID-19) during the first wave of the COVID-19 pandemic. Materials and Methods: This retrospective cross-sectional study was conducted at the COVID-19 inpatient services of a tertiary university hospital in Türkiye for 3 months (between March 2020 and June 2020) and included hospitalized confirmed or probable COVID-19 patients. The World Health Organization and Turkish Ministry of Health Guidelines case definitions were used to define confirmed and probable COVID-19 patients. Six clinical pharmacy residents provided medication review services during their education and training. DRPs were classified based on the Pharmaceutical Care Network Europe V9.00. The physician's acceptance rate of clinical pharmacists' recommendations was assessed. Results: Among 202 hospitalized patients with probable or confirmed COVID-19, 132 (65.3%) had at least one drug-related problem. Two hundred and sixty-four DRPs were identified. Drug selection (85.6%) and dose selection (9.2%) were the most common causes of these problems. Among the 80 clinical pharmacist interventions, 48.8% were accepted by the physicians. Conclusion: Clinical pharmacists identified a significant number of DRPs during the COVID-19 pandemic, particularly those related to drug interactions and drug safety, such as adverse drug reactions. This study highlights the importance of detecting and responding to DRPs in the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Introduction Lifelong anticoagulation is the cornerstone of the chronic thromboembolic pulmonary hypertension (CTEPH) treatment regardless of the additional pulmonary endarterectomy, balloon pulmonary angioplasty, or medical treatment alone. Aim of this study was to evaluate the rate of oral anticoagulant preferences and document direct oral anticoagulants’ (DOACs’) safety, efficacy in the CTEPH population. Methods Patients’ demographic data obtained from database between September 2011 and April 2018. In-hospital events, death, venous thromboembolism (VTE) recurrence, bleeding events and anticoagulant therapy transition were recorded. Results We reviewed 501 CTEPH patients who observed 9.0 ± 8.5 years. All-cause death, all bleeding, recurrent VTE was observed in 15.6%, 31% and 12%. Forty-one patients (8.2%) were diagnosed as inoperable. Of all, 15.2% of operable patients remained as residual. All-cause mortality rates were 13.8% (57 pts.) in the warfarin group as compared with 9.7% (13 pts.) in rivaroxaban group (HR: 1.61, 95% CI, 0.89–2.99; p : 0.11). Higher bleeding events occurred with warfarin group (27.1%) as compared with rivaroxaban (24.6%; HR: 1.28, 95% CI, 0.86–1.88; p : 0.22). Major bleeding was significantly higher with warfarin group (HR: 1.94, 95% CI, 1.05–3.62; p : 0.03). Subgroup analysis of all-cause death revealed that this significance dominated by the rate of death according to bleeding events; warfarin versus those seen with rivaroxaban (4.85% vs. 2.2%; HR: 4.75, 95% CI: 1.12–20.16; p = 0.03). The rate of recurrent VTE was found 8.9% in the rivaroxaban group, 10.9% in warfarin group (HR: 1.21, 95% CI, 0.64–2.23; p : 0.55). Conclusion DOACs could be a safe and effective alternative for lifelong anticoagulant therapy in CTEPH patients. Rivaroxaban produced similar rates of thromboembolism and non-relevant bleeding compared to those associated with warfarin. The main difference was found with major bleeding that it was mainly associated with the death rate according to major bleeding. Using DOACs might be a more reasonable way to prevent bleeding events without increasing thromboembolic risk.

Background Coronavirus disease 2019 (COVID-19) is still an ongoing entity and every day we face new sequalae of the disease. We hereby present surgical results of patients who are treated for post-COVID chronic thromboembolic pulmonary hypertension. Methods Data were collected among patients who underwent pulmonary endarterectomy and had a diagnosis of post-COVID chronic thromboembolic pulmonary hypertension. All data were retrospectively reviewed from a prospectively conducted database. Operative mortality was described as death in hospital or within 30 days of surgery. Results Eleven patients (seven males, four females; median age, 52 [22–63] years) were identified. Pulmonary vascular resistance improved significantly from 572 dyn/s/cm−5 (240–1,192) to 240 (195–377) dyn/s/cm−5 (p < 0.005). Significant difference was also detected in median mPAP, as it decreased from 40 mm Hg (24–54) to 24 mm Hg (15–36) following surgery (p < 0.005). Mortality was observed in one patient due to sepsis on the fifth postoperative day. Median time from COVID-19 disease to surgery was 12 months (6–24). Median length of hospital stay of the survivors was 10 days (8–14). Conclusion In the new era of chronic thromboembolic pulmonary hypertension, hybrid approach including surgery, balloon pulmonary angioplasty, and medical treatment has been recommended. pulmonary endarterectomy is still the only curative treatment when the disease is surgically accessible. We hereby report the first publication of post-COVID chronic thromboembolic pulmonary hypertension patients who were surgically treated. As we see a lot of long-term symptoms and clinical manifestations in patients who had COVID-19, we should always remember chronic thromboembolic pulmonary hypertension in the differential diagnosis. [ABSTRACT FROM AUTHOR]

Background: Right heart functions are affected in patients with bronchiectasis as a result of pulmonary hypertension induced by chronic hypoxemia. Pulmonary artery wall thickness has recently been introduced as a sign of intensive and prolonged inflammation. The aim of this study was to analyze right ventricular and right atrial functions and to measure pulmonary artery wall thickness in patients with cystic fibro sis-b ronch iecta sis in comparison to those with noncystic fibro sis-b ronch iecta sis and healthy individuals. Methods: We studied 36 patients with cystic fibro sis-b ronch iecta sis, 34 patients with noncystic fibro sis-b ronch iecta sis, and 32 age- and sex-matched control subjects. Lung function tests were performed. All subjects underwent comprehensive echocardiographic evaluation including conventional, tissue Doppler, speckle-tracking, and pulmonary artery wall thickness measurements. Results: Right ventricular global longitudinal strain and global longitudinal right atrial strain during ventricular systole decreased in cystic fibro sis-b ronch iecta sis group compared with noncystic fibro sis-b ronch iecta sis and control groups (P < .001, both). Conversely, pulmonary artery wall thickness was increased in cystic fibro sis-b ronch iecta sis group in comparison to other groups (P < .001). Moreover, right ventricular global longitudinal strain was lower and pulmonary artery wall thickness was higher in patients with airflow obstruction (P < .001 and P = .025, respectively) than in those without. Only right ventricular global longitudinal strain was significantly correlated with pulmonary function test parameters. The negative effect of cystic fibrosis on right ventricular and right atrial functions was independent of age, gender, and disease duration. Conclusion: Our study showed that right ventricular and right atrial functions were deteriorated and pulmonary artery wall was thickened in cystic fibro sis-b ronch iecta sis patients more than noncystic fibro sis-b ronch iecta sis patients. Right ventricular global longitudinal strain detected subclinical right ventricular dysfunction and was associated with the severity of pulmonary disease. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate the muscle thickness, strength, and diaphragmatic function and relate them with clinical findings. Patients and methods: The cross-sectional study was conducted with 54 participants (27 males, 27 females; mean age; 24.5±5.3 years; range, 18 to 45 years) between January 2017 and October 2017. Of the participants, 31 were adult CF patients, and 23 were age-and sex-matched controls. Patient demographics, 6-min walk distance, body mass index (BMI), and fat-free mass index (FFMI) were evaluated. Each patient underwent pulmonary function tests. Quadriceps femoris thickness and diaphragm thickening fraction were assessed by ultrasonography. Upper extremity strength was measured with a handheld dynamometer. Results: There was no difference between the patients’ and controls’ BMI (p=0.052). However, patients’ FFMI was lower than the controls’ (p=0.010). The FFMI correlated with pulmonary function tests. Patients’ both right and left quadriceps femoris muscles were thinner than the controls (p=0.001 and p=0.001, respectively). Patients with pancreatic insufficiency had thinner muscles than patients without pancreatic insufficiency. The control group had a stronger handgrip than CF patients (33.5±10.1 vs. 24.5±9.2 kg, p=0.003). Conclusion: Peripheral muscle wasting and weakness and lower functional capacity are highly prevalent in CF patients. [ABSTRACT FROM AUTHOR]

Background: Pulmonary hypertension is a complex syndrome that encompasses a diverse group of pathophysiologies predisposed by different environmental and genetic factors. It is not clear to which extent the universal risk classification schemes can be applied to cohorts in individual pulmonary hypertension centers with differing environmental backgrounds, genetic pools, referral networks. Aims: To explore whether the recommended risk classification schemes could reliably be used for mortality prediction in an unselected pulmonary hypertension population of a tertiary pulmonary hypertension center. Study Design: A retrospective cross-sectional study. Methods: We retrospectively screened our hospital database for the patients with pulmonary hypertension between 2015 and 2022. The grouping of pulmonary hypertension was made as follows in accordance with current guidelines: Group 1: patients with pulmonary arterial hypertension, Group 2: patients with pulmonary hypertension associated with left heart disease, Group 3: patients with pulmonary hypertension associated with lung disease and/or hypoxia, and Group 4: patients with pulmonary hypertension associated with pulmonary artery obstructions. Then, we compared the predicted and observed mortality rates of four different risk classification schemes (REVEAL, REVEAL-Lite, ESC/ERS and COMPERA). Results: We identified 723 cases in our pulmonary hypertension database, the final study population consisted of 549 patients. The REVEAL, REVEAL-Lite and European Society of Cardiology/ European Respiratory Society risk scores significantly underestimated the mortality risk in the low-risk stratum (5.3% vs. 1.9%, P < 0.001; 5.3% vs. 2.9%, P = 0.015 and 6.3% vs. 1%, P < 0.001, respectively) and overestimated the mortality risk in the high-risk stratum (11.8% vs. 25.8%, P < 0.001; 10.4% vs. 25.1%, P < 0.001 and 13.2% vs. 30%, P < 0.001, respectively). Although the COMPERA 4-strata model significantly underestimated the risk in low- and intermediatelow risk strata (4.9% vs. 1.5%, P < 0.001 and 6.8% vs. 2.8%, P = 0.001, respectively), it was accurate in intermediate-high and highrisk groups (10.1% vs. 8.7%, P = 0.592 and 15.6% vs. 22%, P = 0.384, respectively). The analyses limited only to group 1 pulmonary hypertension patients gave similar results. Conclusion: The established risk classification schemes may not perform as good as expected in unselected pulmonary hypertension populations and this may have important implications on management decisions. Tertiary centers should not uncritically accept the published risk prediction models and consider modifying current risk scores according to their own patient characteristics. [ABSTRACT FROM AUTHOR]

Objective: Coagulopathy is thought to play an important role in the development of severe COVID-19. High D-dimer levels have been reported in Chinese cohort studies. However, ethnicity has significant implications for thrombotic risk. Our aim in this study is to determine the effect of D-dimer measurements on disease prognosis and mortality in Turkish patients with COVID-19. Patients and Methods: The study was designed retrospectively. Patients over the age of 18 who were admitted to our hospital were included in the study. Results: The study included 226 patients. According to the World Health Organization staging, 75(33.2%) patients, according to the staging of Siddiqi et al., 67 (29.7%) patients progressed. In the ROC analysis performed to predict mortality, AUC value for D-dimer was found to be 82.25% (95%CI 74.8%-89.71%). When the cut-off value for D-dimer was accepted as ≥3.25mg/L, specificity was 94.15%, correctly classified rate 88.5%, positive likelihood ratio as (LR):5.69, negative LR:0.71. Conclusion: As a result, similar to the Chinese cohorts, elevated D-dimer measurements increase disease progression and mortality in Turkish patients with COVID-19. D-dimer levels of 3.25 mg/L and above, strongly determine the risk of increased mortality in the Turkish Caucasian ethnic group. [ABSTRACT FROM AUTHOR]

Objectives Behçet's disease (BD) is a unique systemic vasculitis mainly involving veins, in contrast to other vasculitides. Prior studies have shown that pulmonary arteries (PAs) have a similar structure to systemic veins. In this study we aimed to assess PA wall thickness by transthoracic echocardiography (TTE) in BD patients compared with healthy controls (HCs) and patients with non-inflammatory pulmonary embolism (NIPE). Methods Patients with BD (n  = 77) and NIPE (n  = 33) and HCs (n  = 57) were studied. PA wall thickness was measured from the mid-portion of the main PA with TTE by two cardiologists blinded to cases. Results PA wall thickness was significantly lower in HCs [3.6 mm (s. d. 0.3)] compared with NIPE [4.4 mm (s. d. 0.5)] and BD [4.4 mm (s. d. 0.6)] (P  < 0.001 for both). PA wall thickness was similar between BD and NIPE (P  = 0.6). Among patients with BD, PA wall thickness was significantly higher in patients with major organ involvement compared with mucocutaneous limited disease [4.7 mm (s. d. 0.4) vs 3.7 (0.4), P  < 0.001], HCs and NIPE (P  < 0.001 and P  = 0.006, respectively). PA wall thickness was comparable between patients with vascular and non-vascular major organ involvement [4.6 mm (s. d. 0.5) vs 4.7 (0.3), P  = 0.3]. Conclusion We observed that PA wall thickness was significantly higher in BD with major organ involvement compared with patients with only mucocutaneous limited disease, HCs and NIPE. These results suggest that increased PA wall thickness may be a sign of severe disease with major organ involvement in BD. [ABSTRACT FROM AUTHOR]

Thrombosis due to hypercoagulable state is an important cause of morbidity and mortality in coronavirus disease 2019 (COVID-19). Increased D-dimer levels are an important marker of the presence and risk of thrombosis. In this report, we present that a 59-yearold male patient developed thrombosis in the distal radial arteries despite normal D-dimer level. The patient was treated with enoxaparin, iloprost infusion, and cilostazol. This case should lead us to be very careful that people diagnosed with COVID-19 with normal D-dimer levels may also have thrombosis. [ABSTRACT FROM AUTHOR]

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Background/aim: Rheumatoid pulmonary nodule can be detected in up to 32% of rheumatoid arthritis (RA) patients and approximately one-third of nodules may cavitate. We aimed to evaluate characteristics of patients with RA developing cavitary pulmonary nodular (CPN) lesions under disease-modifying antirheumatic drugs (DMARDs), follow-up of both cavitary and solid nodules, and their outcome with the treatment. Materials and methods: RA patients who presented with CPN lesions during follow-up were recruited retrospectively in this case series analysis. Total numbers and mean diameters of cavitary and solid nodules in each thorax computed tomography (CT) have been determined and followed up by two experienced pulmonary physicians. Moreover, changes in treatment after the development of the CPN lesions and characteristics of cavitary nodules were collected. Results: Eleven patients with CPN lesions were reported. At the time of CPN diagnosis, more patients were taking leflunomide than methotrexate (81% vs 19%). Half of the patients were receiving biologic therapy and only 18% were taking anti-TNF drugs. After a median of 24 (3-65) months of follow-up, the regression of CPN lesions was determined in 45% (5/11) of patients. Four of these 5 (80%) patients were switched to a treatment regimen without leflunomide and three of them to nonanti-TNF biologic treatment or targeted synthetic DMARDs (tocilizumab, tofacitinib, and rituximab). Conclusion: CPN lesions seen in RA patients are often pulmonary manifestations of the underlying disease; however, one must rule out malignancies or infections. If lesions progress under DMARDs, it is advised to discontinue synthetic DMARDs (LEF/MTX) and switch to another biological DMARD with different modes of action. [ABSTRACT FROM AUTHOR]

This prospective observational study describes the pharmacokinetic characteristics of favipiravir in adult patients hospitalized for mild to moderate COVID‐19 with a positive RT‐PCR test. Favipiravir was administered for 5 days, with a loading dose of 3200 mg and a maintenance dose of 1200 mg/day. Serial blood samples were collected on Day 2 and Day 4 of the therapy. Laboratory findings of the patients (n = 21) and in‐hospital mortality were recorded. Favipiravir concentrations exhibited substantial variability and a significant decrease during the treatment of COVID‐19. The median favipiravir trough concentration (C0‐trough) on Day 2 was 21.26 (interquartile range [IQR], 8.37–30.78) μg/mL, whereas it decreased significantly to 1.61 (IQR, 0.00–6.41) μg/mL on Day 4, the area under the concentration–time curve decreased by 68.5%. Day 2 C0‐trough of female patients was higher than male patients. Our findings indicate that favipiravir concentrations show significant variability during the treatment of COVID‐19 and therapeutic drug monitoring may be necessary to maintain targeted concentrations. [ABSTRACT FROM AUTHOR]

Objective: Patients with cystic fibrosis (CF) and non-CF bronchiectasis are prone to exacerbations of pulmonary infections. C-reactive protein (CRP) and procalcitonin (PCT) are inflammatory markers. The aim of this study is to evaluate the role of CRP and PCT on exacerbations of CF and non-CF bronchiectasis. Patients and Methods: The medical records of18 CF (52 hospitalizations) and 20 non-CF bronchiectasis patients (51 hospitalizations) were reviewed retrospectively. CRP, PCT levels and, white blood cell (WBC) counts on admission and follow-up were evaluated. Results: C-reactive protein levels correlated with PCT levels on admission in all patients. Baseline PCT levels were markedly higher (>0.5µg/L) in 12% of CF and 10% of non-CF bronchiectasis patients, however, baseline CRP values were markedly higher (>5mg/L) in 96% of CF and non-CF bronchiectasis patients (p=0.760 and p=0.100, respectively). Baseline CRP and PCT levels were positively correlated with hospitalization length (r=0.501, p=0.001 and r=0.289, p=0.04, respectively) in CF patients, but not in non-CF bronchiectasis. Conclusion: Our study shows the potential utility of these biomarkers to determine the severity of the exacerbation particularly predicting hospitalization length in CF patients. Both biomarkers could be able to guide antibiotic treatment of infective exacerbations in CF and non-CF bronchiectasis patients. [ABSTRACT FROM AUTHOR]

Background: Antiphospholipid syndrome is an autoimmune disease characterized by the occurrence of venous and/or arterial thrombosis. Chronic thromboembolism is one of the known established pathogenesis of pulmonary hypertension, known as chronic thromboembolic pulmonary hypertension. Pulmonary endarterectomy is the treatment of choice for chronic thromboembolic pulmonary hypertension. The aim of this study is to evaluate the efficacy and risk of pulmonary endarterectomy in patients with antiphospholipid syndrome-associated chronic thromboembolic pulmonary hypertension. Methods: Data were prospectively collected and retrospectively analyzed, for patients who underwent pulmonary endarterectomy between March 2011 and March 2020. Results: Seventeen patients (4 male and 13 female) were identified. Thirteen patients had primary antiphospholipid syndrome and 4 had secondary antiphospholipid syndrome. The mean age was 34.82 ± 10.07 years and the mean time interval between the diagnosis and surgery was 26.94 ± 17.35 months. Dyspnea on exertion was the main symptom in all patients. Seven patients had previous deep vein thrombosis, 5 patients had a history of recurrent abortions, and 2 patients had hemoptysis. Following surgery, mean pulmonary artery pressure decreased from 47.82 ± 13.11 mm Hg to 22.24 ± 4.56 mm Hg (P < .001), and pulmonary vascular resistance improved from 756.50 ± 393.91 dyn/s/cm-5 to 298.31 ± 132.84 dyn/s/cm-5 (P < .001). There was no in-hospital mortality with a mean follow-up of 75.29 ± 40.21 months. The functional capacity of all patients improved from 269.46 ± 111.7 m to 490 ± 105.34 m on a 6-minute walking test. Conclusions: Pulmonary endarterectomy is a safe and curative treatment in patients with antiphospholipid syndrome-associated chronic thromboembolic pulmonary hypertension. It has a favorable outcome by increasing the quality of life. A multidisciplinary experienced chronic thromboembolic pulmonary hypertension team is critical in the management of these unique patients. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to investigate the long-term use of bottle-positive expiratory pressure (PEP) in addition to breathing exercises as a home-based rehabilitation aid on exercise capacity, spirometric parameters, and quality of life in chronic obstructive pulmonary disease (COPD) patients. Patients and methods: From a total of 30 patients with stable moderate-to-severe COPD, 24 (22 males, 2 females; mean age: 62.4+7.2 years; range, 40 to 75 years) were included in the final study and randomized into two groups: the group that performed breath retaining techniques and the group that was instructed to use the bottle-PEP in addition to these techniques. Patients were evaluated with modified Medical Research Council scale, COPD assessment test (CAT), spirometry, St. George's Respiratory Questionnaire (SGRQ), and 6-min walk distance (6MWD) before, three months and six months after the initiation of the program. Results: In the bottle-PEP group, patients' mean 6MWD increased from 380.6±67.6 to 444.1±22.0 m (p=0.002), the mean CAT score decreased from 17.8±36.8 to 12.9±6.2 (p=0.03), and the mean SGRQ total score significantly decreased from 57.1±23.1 to 47.6±21.9 (p<0.05) after three months. The improvement in 6MWD continued in six months but disappeared in SGRQ and CAT scores. In the exercise group, only the 6MWD improved, and there were no significant improvements in other parameters regardless of time. There were no significant differences between the groups in any of the parameters at any follow-up session. Conclusion: While bottle-PEP does not significantly contribute when added to breathing exercises in patients with moderate-to-severe COPD in improving function and quality of life, it can be used as a safe choice in patients' home rehabilitation programs. [ABSTRACT FROM AUTHOR]

Objective: Although the underlying pathology of chronic thromboembolic pulmonary hypertension (CTEPH) is mechanical obliteration of the major pulmonary vessels, high pulsatile stress penetrating into the normal distal pulmonary microvasculature resulting from reduced pulmonary arterial compliance (CPA) may cause progressive deterioration in pulmonary hemodynamics. Hypothetically, balloon pulmonary angioplasty (BPA) may be beneficial in reducing CPA and pulsatile stress in patients with CTEPH. Methods: In total, 26 patients with available pre- and post-BPA right heart catheterization results were included in the study. BPA was performed in a series of staged procedures by 2 experienced interventional cardiologists. Results: The median CPA showed a 59.2% increase (1.03 to 1.64 mL/mm Hg, p=0.005). The median pre-BPA pulsatile stress product decreased by 20.7% (4,266 to 3,380 mm Hg/min, p=0.003). A linear regression model established that the percent change in CPA after BPA accounted for 21.8% of the explained variability in the change in 6-minute walk test (p=0.009). Conclusion: Our results indicate that BPA decreases CPA and pulmonary pulsatile stress. These changes may be partly responsible for the improvement in functional capacity after BPA. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Bronchiectasis is a chronic suppurative lung disease that significantly impacts the patients' quality of life. The aim of this study is to evaluate the relationship between quality of life and patient's psychological status and bronchiectasis disease severity indexes in patients with non-cystic fibrosis bronchiectasis. We also aimed to investigate the validity and reliability of Turkish version of Quality of Life Questionnaire-Bronchiectasis (V3.1) in Turkish adult bronchiectatic patients. MATERIAL AND METHODS: In total, 90 stable non-cystic fibrosis bronchiectatic adult patients were enrolled in this study. At baseline, dyspnea score, body mass index, lung function tests, sputum cultures, number of exacerbations and hospital admissions, and disease severity indexes were recorded. All of the participants underwent quality of life assessment using both Quality of Life Questionnaire-Bronchiectasis V3.1 and Short Form-36 questionnaires, and psychological status was evaluated by using Hospital Anxiety and Depression Scale. RESULTS: In all study participants, anxiety was diagnosed in 27/90 (30%) of patients, and depression was diagnosed in 37/90 (41%) of patients. Patients with anxiety and depression had lower quality of life scores in various domains (P = .026-.001), and Hospital Anxiety and Depression Scale scores negatively correlated with several quality of life domains (r = -0.216 to 0.343). Female patients had higher risk for depression (55% vs 22%, P = .002) and worse quality of life than males (P = .016-.038). Several life quality scores of both instruments were worse in patients with moderate-severe disease severity indexes when compared with those of mild groups. Moreover, Turkish version of newly described Quality of Life Questionnaire-Bronchiectasis V3.1 questionnaire was found to be a reliable and valid instrument to evaluate the quality of life. CONCLUSION: These results emphasize the importance of mental health and disease severity as significant determinants of the life quality in patients, particularly female patients with non-cystic fibrosis bronchiectasis. [ABSTRACT FROM AUTHOR]

Both quality of life (QoL) and caregiver burden are essential constructs in patients with pulmonary hypertension (PH) however; their relationship has never been investigated before. The aim of this study was to evaluate if there was any relationship between patients' QoL and caregiver burden. Patients with PH and their caregivers were included. Patients' age, sex, World Health Organization (WHO) functional class, systolic pulmonary arterial pressure (sPAP), and six-minute walk distances (6MWD) were recorded. Patients' QoL was assessed using emPHasis-10 and caregiver burden with the Zarit Caregiver Burden Scale. 72 patient-caregiver dyads were included. Caregiver burden was significantly correlated with the QoL(r = 0.39 p <.003), but was not correlated with other clinical parameters. Patients' QoL showed significant negative correlation with the 6MWD(r = −0.46 p <.005). There is a moderate correlation between QoL and caregiver burden. Clinical parameters influence QoL, but they do not affect caregiver burden. [ABSTRACT FROM AUTHOR]

Background/aim: Tumor necrosis factor-alfa (TNF-a) antagonists are extensively utilized in the treatment of inflammatory rheumatic diseases and also shown to be effective in Behçet’s disease (BD) patients with major organ involvement. In this study, we aimed to reevaluate the incidence of tuberculosis (TB) infection after anti-TNFa treatments and to reveal the risk of TB in BD. Methods: Data of patients who received anti-TNFa treatment between 2005 and 2018 were assessed retrospectively. Demographic features, TNF-a antagonist type/treatment time, tuberculosis skin test (TST) and QuantiFERON results, isoniazid prophylaxis status, and concomitant corticosteroid (CS) treatments were collected. Results: A total of 1277 (male/female = 597/680; median age = 49 years) patients were treated with TNF-a antagonist for a median of 33 months (Q1:12, Q3:62). Thirteen (1%) patients developed TB during the follow-up period. Within 13 TB-positive patients, 7 of them had pulmonary, and 7 had extrapulmonary TB. Although, the median time of (month) TNF-a antagonist treatment was higher in TB-positive patients than negative ones, the difference was not statistically significant (48 and 33 months, respectively, p = 0.47). Similarly, TB-positive patients were treated with CSs more than TB-negative patients (80% vs. 60%). Time from the initiation of TNF-a antagonist treatment to the diagnosis of TB had a median of 40 months (Q1-Q3: 22-56). There was a statistically significant increase of TB development in BD patients than non-BD patients after TNF-a antagonists (7.5% vs. 0.8%, respectively, p = 0.007). When we combined our patients with the other series from Turkey, among 12928 patients who received TNF-a antagonists, TB was positive in 12 (3.9%) of 305 BD patients compared to 112 (0.9%) of 12623 non-BD patients (p < 0.00001). Conclusion: Our results suggest a higher frequency of TB infections in BD patients with TNF-a antagonists. As biologic agents are increasingly used for major organ involvement in current practice for BD, screening mechanisms should be carefully implemented. [ABSTRACT FROM AUTHOR]

Skeletal and respiratory muscle dysfunction has been previously described in patients with other etiologic subgroups of pulmonary arterial hypertension (PAH) but has never been investigated in patients with PAH due to congenital heart diseases (CHD). This study aims to show the involvement of skeletal and respiratory muscles in these patients. This cross-sectional study included patients with PAH due to CHD and healthy controls. Patients' demographic properties, six-minute walk tests; shoulder abduction, handgrip, knee extension, and ankle dorsiflexion muscle strength, maximum inspiratory (MIP) and expiratory pressures (MEP) were measured. Deltoid, flexor digitorum superficialis, and profundus, tibialis anterior and rectus femoris muscles were visualized with ultrasonography and their cross-sectional areas (CSA) were also measured in both groups. Twelve patients and 12 controls were included. Mean MIP was 104.22±32.57 cm H2O for healthy participants while 61.33±29.74 cm H2O for patients (p<0.001). For mean MEP, it was 100.08±26.05 cm H2O in healthy participants and 69.75±39.79 cmH2O in controls (p=0.004). When the strength of skeletal muscles was compared, there were significant differences between the groups in all measurements except for bilateral grip strength. In the correlation analysis, MIP and MEP values showed no significant correlations with clinical parameters. They showed significant moderate correlations with skeletal muscle strength. When CSAs of the muscles were compared, there were significant differences in all measurements except for left FDS and FDP and bilateral rectus femoris. This study showed that in patients with pulmonary arterial hypertension due to CHD, respiratory muscle strength is significantly worse than healthy participants. Patients had also significantly worse skeletal muscle strength except for grip strength. [ABSTRACT FROM AUTHOR]

Objective: Current literature has conflicting results on the role of steroids in the treatment of coronavirus disease 2019 (COVID-19) pneumonia. This study aims to evaluate the effects of steroids on clinical recovery, duration of hospitalization, and time needed for the cessation of oxygen treatment. Patients and Methods: We retrospectively analyzed the medical records of patients hospitalized for COVID-19 between March and May 2020. Patient age, laboratory parameters, clinical stages, radiologic scores, length of hospital stay, and time needed for the cessation of oxygen supplementation were compared. Results: Thirteen patients were treated with steroids, and 12 controls were included in the analysis. Regarding the laboratory parameters, the groups were similar except for lymphocyte percentage (9.8 ± 3.2, 7.0 ± 2.9; p=0.033), which was higher, and D-dimer levels (0.75 (0.60-1.43), 1.57 (0.91-2.29); p=0.047), which were lower in the steroid group on admission. Steroid treatment provided a tendency of decrease in time to cessation of oxygen supplementation (6.23 ± 3.4 vs 7.67 ± 2.1, p=0.217). Conclusion: Although, systemic steroids, started in the subacute period, did not affect the length of hospital stay, they provided a tendency of decrease in the time until the cessation of oxygen supplementation in the subacute period. [ABSTRACT FROM AUTHOR]

Objective: Sarcoidosis is a systemic granulomatous disease rarely complicated by pulmonary hypertension (PH). The prevalence of PH in sarcoidosis is unclear and has differences between ethnic groups. This study aimed to investigate the prevalence and predictors of PH in a Turkish cohort. Methods: The study included 55 patients with biopsy-proven sarcoidosis in a single center. All patients underwent detailed transthoracic echocardiography (TTE) to assess the probability of PH as recommended. Right heart catheterization (RHC) was performed for patients with intermediate-high risk of PH. Patients with mean pulmonary artery pressure >20 mm Hg by RHC were defined as PH. Demographic and clinical characteristics, laboratory data, spirometry, 6-min walk test, and TTE were compared between low and intermediate-high risk PH groups. Results: The probability of PH was low with 47 patients. Eight patients had intermediate-high probability of PH, and two of them refused to undergo RHC. Of six intermediate-high probability patients, three had PH, and all of them had post-precapillary PH. The prevalence of PH in sarcoidosis was 5.5% (3/55). Six-minute walk distance (6 MWD) and diastolic parameters (E/A ratio, E' wave, and left atrial volume) were significantly lower, and New York Heart association class and N-terminal probrain natriuretic peptide (NT-proBNP) level were higher in intermediate-high risk PH patients compared with low-risk PH patients. Conclusion: The frequency of PH in sarcoidosis was 5.5% in a Turkish cohort. NT-proBNP, 6 MWD, diastolic function parameters, and myocardial strain parameters can be useful predictors of PH in patients with sarcoidosis, besides known echocardiographic parameters. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Bronchiectasis is characterized by chronic respiratory infection. The role of immunodeficiency in this disease is poorly studied in relation to clinical indices. The primary aim of this study was to determine the frequency of these neglected altered immune status by evaluating immunoglobulins, lymphocyte subsets, complement levels, and neutrophil function, and to assess its relationship with clinical parameters in adult patients with non-cystic fibrosis bronchiectasis (NCFB). MATERIAL AND METHODS: A total of 74 (30 men and 44 women with a mean age of 47±17 years) adult patients with stable NCFB were enrolled in this study. The bronchiectasis severity index (BSI) and FACED (F:FEV1, A: Age, C: Chronic colonization, E: Extension, D: Dyspnea) scores were assessed. Peripheral blood samples were collected for the detection of total IgG, IgA, IgM, IgE, and IgG subclasses and C3 and C4 levels. The counts of CD3, CD4, CD8, CD19, CD16/56 expressing peripheral blood lymphocytes and neutrophil oxidative function were evaluated. RESULTS: In the study population, BSI and FACED severity index scores increased with longer duration of the disease (p=0.01 and p=0.040, respectively). Of the 74 patients, 27 (37%) showed humoral aberrations. The number of male patients were higher in this group (p=0.03). High serum total IgE levels were associated with high scores in BSI (moderate-severe group versus mild group, p=0.030). Patients with bronchiectasis demonstrated lower CD3+ T cell count, lower CD4+ T helper cell percentage, and lower CD4+ T cell count (p=0.031, p=0.030, p=0.029, respectively) than healthy subjects. A significant negative correlation was found between the percentage and count of CD16/56+ natural killer (NK) cells and the number of exacerbations within the past year (r=-0.230, p=0.049 and r=-0.264, p=0.023, respectively). CONCLUSION: Humoral aberrations in adult patients with NCFB were found to be frequent. IgE levels were related to high scores for disease severity indices. Furthermore, patients with low percentage and counts of NK cells had higher rates of exacerbations. These results emphasize the importance of immune function assessment in adult patients with NCFB. [ABSTRACT FROM AUTHOR]

Aim: Complication rates are low and endobronchial ultrasound guided needle aspiration (EBUS-TBNA) is generally regarded as a safe procedure, but there is a very limited number of studies evaluating the efficacy and safety of the procedure in advanced ages. The aim of this study is to assess the safety and performance outcomes of EBUS-TBNA in elderly.Methods: It was a retrospective observational study; patients who received EBUS-TBNA between September 2016 and January 2018 were evaluated. We analyzed patient's characteristics, doses of midazolam, and lidocaine used, regions of lymph node biopsies, and complications. Also, functionality and general physical status of patients over 65 years of age were evaluated.Results: During study period 132 cases of EBUS-TBNA were evaluated. 39 (29.5%) cases were aged 70 years, and over. There were more comorbidities in older group. Performance status of older group was worse. Furthermore, when evaluated according to American College of Cardiology (ACC)/American Heart Association (AHA) and American Society of Anesthesiologists (ASA), the older group was found to be composed of the riskier patients. When patients aged between 65 and 69, and over 70 compared, older patient's Barthel, EQ 5-D, SGA, and G8 scores were found to be worse. Despite that, there was no difference in the frequency, and types of complications between both groups. Diagnostic performance was not different between age groups.Conclusions: Independent from comorbidities, general health status, and functionality EBUS-TBNA procedure in 70-year-old and over patients is a safe minimally invasive procedure. [ABSTRACT FROM AUTHOR]

Aim Bronchoscopy is a widely used, well-tolerated diagnostic and therapeutic intervention and has a low complication rate. The aim of this study was to describe the rates of bronchoscopic complications and risk factors in a group of patients 75 years' old and above. Methods To investigate the rate of complications and risk factors in the older patients, we carried out a retrospective cohort study of 240 patients above 75 years of age who had bronchoscopy for various reasons. Results Complication rate was found to be 3.7% in the older patients group which was not different from the control group (1.2%, p > 0.05). No significant relationship was found between age group and complication development (p > 0.05). The type of procedures did not show any effect on complication development between age groups and individually. We found that anemia (OR 7.2, 95% CI 1.2-41.2), percutaneous gastrostomy (OR 9.9, 95% CI 1.6-58), immobility (OR 11.9, 95% CI 2.6-33.5) and procedures performed in the intensive care unit (OR 7.4, 95% CI 1.4-37.5) were significant risk factors for complication. Conclusions In the older patients group, bronchoscopy is a safe procedure regardless of the type of procedures performed and age. It has been shown that anemia, PEG presence, immobility and intensive care patients are associated with increased complication. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether serum vitamin D levels were related to the risk of anxiety and depression among patients with chronic obstructive pulmonary disease (COPD), as well as their spirometry parameters, disease severity, and other clinical findings. Materials and Methods: Ninety-two stable patients with COPD aged over 18 years with no exacerbations in the previous month were included. Symptom severity was assessed using the modified Medical Research Council (mMRC) dyspnea scale and COPD Assessment Test (CAT) scores. Spirometry tests were performed and previous hospitalization histories were recorded to determine ABCD groups of the patients according to their combined COPD assessments. Their Body mass index, airflow Obstruction, Dyspnea and Exercise capacity (BODE) indices were calculated and the Hospital Anxiety and Depression Scale (HADS) was administered. Serum vitamin D levels were determined using immune electrochemiluminescence. Results: According to the HADS scores, 16 patients (17.4%) had the risk of anxiety and 29 (31.5%) had the risk of depression. The risk of anxiety differed significantly (P= 0.016 Fischer's exact test) between the ABCD groups. Anxiety scores were positively correlated with both mMRC (r= 0.315; P= 0.002) and CAT (r= 0.445; P= 0.000) scores. Similarly, depression scores correlated positively with mMRC (r= 0.249; P= 0.017) and CAT (r= 0.373; P= 0.000) scores. Neither anxiety nor depression scores were significantly correlated with % of predicted FEV1. Serum vitamin D levels were inversely correlated with anxiety (r= -0.215; P= 0.039) and depression (r= -0.244; P= 0.019) scores. Anxiety scores were positively correlated with BODE although not statistically significantly (r= 0.199; P= 0.058). Conclusion: A negative correlation was revealed between serum vitamin D levels and HADS scores, and symptom scores were positively correlated to HADS scores, independent of % of predicted FEV1. [ABSTRACT FROM AUTHOR]

Objectives: Statins are lipid lowering agents which have pleiotropic and anti-inflammatory effects. Beneficial effects of statins have been shown in many inflammatory and asthmatic diseases. However, the results are still not consistent. The aim of this study is to determine the clinical and anti-inflammatory effects of rosuvastatin in asthmatic patients. Patients and Metods: A case control study among asthmatic patients was conducted. One hundred and thirty-six participants were screened. Seventy-four patients were eligible. Fifty-one patients have completed the trial. Twenty-five patients with blood levels of low-density-lipoprotein (LDL) above 130mg/dL, were treated with rosuvastatin 40mg for 8 weeks in addition to their standard treatment for asthma; 26 asthmatic patients were followed as control group. In both groups baseline and 8th week evaluation were recorded including pulmonary function test (PFT), bronchial provocation test (PD20), induced sputum and serum inflammatory markers, asthma control test (ACT) and quality of life scores (QoL). Results: Statin group showed improvement in FEV1/FVC (pp) (85.8±11.1% vs 90.2±8.8% P<0.043), FEF 25-75 % (63.6±7.8 % vs 74.6±8.4 %, P<0.0001) and FEF25-75(L/sc) (3.51±0.4 vs 4.1±0.4 P<0.05) and no change was seen in non-statin group (P>0.05) at the end of the 8-week treatment. Treatment with rosuvastatin resulted in decreased sputum eosinophilia percentage (P<0.05); IL-6 and TNFalpha levels (P<0.05) however, bronchial challenge test, ACT and QoL domains did not change in both groups (P>0.05). Conclusion: An 8-week treatment with 40mg rosuvastatin in asthma decreased the peripheral eosinophilia, total IgE levels and inflammatory markers in the induced sputum samples. Beneficial effects in PFT have also been observed. However, ACT and QoL domains were not affected. The implication of this study is that rosuvastatin could potentially have anti-inflammatory effects on asthmatic airways. Prospective randomised trials to evalute the clinical effects of rosuvastatin are warranted. [ABSTRACT FROM AUTHOR]

Amaç: Behçet hastalığı (BH), diğer vaskülitlerin aksine, temelde venöz yapıların tutulumuyla giden bir sistemik vaskülittir. Önceki çalışmalar pulmoner arterlerin (PA) ince duvarlı, düşük dirençli ve artmış kompliansa sahip yapılar oluşu sebebiyle, sistemik venlere benzer özellikte olduğunu göstermiştir. Yakın zamanda grubumuz tarafından, Doppler ultrasonografi ile Behçet hastalarının alt ekstremite venlerinde artmış ven duvar kalınlığı gösterilmişti. Bu çalışmada, Behçet hastalarında transtorasik ekokardiyografi (TTE) ile ölçülen PA duvar kalınlığının, sağlıklı kontroller (SK) ve nonenflamatuvar pulmoner embolili (NIPE) hastalarla karşılaştırılması amaçlanmıştır. Yöntem: Bu çalışmaya, 77 Behçet, 33 NIPE hastası ve 57 SK dahil edildi. PA duvar kalınlığı deneyimli bir kardiyolog tarafından TTE ile, ana PA'nın orta kısmından (pulmoner kapağın yaklaşık 1-2 cm distalinden) ölçüldü (Şekil 1). Bulgular: PA duvar kalınlığı SK'de, NIPE ve Behçet hastalarına kıyasla anlamlı olarak daha düşüktü (her ikisi analiz için p<0,001). PA duvar kalınlığı, majör organ tutulumu olan Behçet hastalarında, SK ve NIPE'ye göre anlamlı olarak daha yüksek bulundu (sırasıyla p<0,001 ve p=0,027). PA duvar kalınlığı, vasküler, oküler ve nörolojik tutulumu olan hastalarda, sadece mukokutanöz tutulumu olan Behçet hastalarına göre daha yüksekti (tüm analizler için p<001) (Tablo 1). Tartışma: Bu çalışmada, majör organ tutulumu olan Behçet hastalarında PA duvar kalınlığının majör organ tutulumu tipinden bağımsız olarak, sadece mukokutanöz tutulumu olan Behçet hastalarına göre anlamlı olarak daha yüksek olduğu bulunmuştur. BH'de PA tutulumu, hastalığın seyrinde, yaygın vasküler enflamasyonun venöz damarlarla sınırlı olmadığını düşündürmektedir. Sadece majör organ tutulumu olan hastalarda saptanan artmış PA duvar kalınlığı, daha ciddi bir hastalığın belirtisi ve hastalık takibi sırasında majör organ tutulumunun habercisi olabilir. [ABSTRACT FROM AUTHOR]

Hajj, the pilgrimage to Mecca and surrounding holy sites is a religions exercise, which every physically able Muslim must undertake once in his of her lifetime. Every year 1.5 million Muslim pilgrims converge in Saudi Arabia for the world's largest annual gathering. This unique event, which might possess some public health implications on a global scale, is exhausting both physically and mentally for every pilgrim due to extreme heat and crowded accommodation. Therefore it's essential that the physicians are aware of the health risks and surroundings of the pilgrims in order to provide appropriate preparation. Apart from mandatory meningococcus vaccination, immunizations against pneumococcus and influenza should be recommended, appropriate physical training to increase their endurance beforehand must be emphasized and education about hygiene possible complications should be provided. To minimize the health risks that arise due to gathering of masses there are many standard precautions in effect however recent issues such as Middle East Respiratory Syndrome Coronavinis (MERS-CoV), Ebola hemorrhagic fever and cholera epidemics mandate new precautions. In this article we aim to address the health risks pilgrims face and how physicians can provide better counseling before this travel. [ABSTRACT FROM AUTHOR]

Afatinib improves survival in metastatic non–small-cell lung cancer driven by activating epidermal growth factor receptor mutations. QT interval prolongation is a possible side effect of targeted anticancer drugs, but this has not been reported before with afatinib. We report a case of metastatic pulmonary adenocarcinoma with epidermal growth factor receptor exon 19 deletion who was treated with first-line afatinib. The patient was started on afatinib with a total dose of 40 mg/day and experienced grade 3 (>500 ms) QT interval prolongation in the seventh week. Dose was interrupted and then reduced to 30 mg/day after the event repeated. QT prolongation occurred only once with the reduced dose and radiologic oligoprogression was detected. Local therapy was performed and afatinib was continued as 30 mg/day. To the best of our knowledge, this case marks the first QT interval prolongation associated with afatinib. It is prudent to perform a baseline cardiologic evaluation and electrocardiogram monitoring in non-small cell lung cancer patients treated with this drug. [ABSTRACT FROM AUTHOR]

Amaç: İzole pulmoner vaskülit (IPV) oldukça nadir görülen birtek organ vaskülitidir. Özellikle büyük pulmoner damarlarm tutulmasıyla tanımlanan IPV ile ilgili literatürde son derece az sayıda vaka bildirimi mevcuttur. Bu çalışmada merkezimizde ta-ldpli 3 IPV vakası sunulmaktadır. Olgu 1 : 50 yaşında erkek, kronik pulmoner tromboemboli (KTEPH) nedeniyle 6 aydır dışmerkez tabipliyken pulmoner endarterektomi operasyonu yapılarak kinliğimize yönlendirilmişti. Operasyon öncesi görüntüleme ve tetkikleri Tablo PS-293'de özetlenmiştir. Fizik muayenesi, sorgulamasında, tetkiklerinde sistemik vaskülit düşündürecek bulgu yoktu. Endarterektomi materyalinin histopatolojisi pulmoner vaskülit ile uyumlu olan hastaya IPV tanısıyla 1 mg/kg/gün prednol başlandı. Steroid azaltılırken azatiopürin tedavisi eklenen hasta 5 yıldır bu tedaviyle remisyonda izlenmektedir. Olgu 2: 39 yaşında kadın, 1 yıldır dış merkezde KTEPH'le tabipli olup merkezimize endarterektomi içüı yönlendirilmişti. Değerlendirme sonucunda sistemik vaskülit bulgusu saptanmadı. Operasyon öncesi görüntüleme ve tetkikleri Tablo PS-293'de özetlenmiştir. Ancak operasyon öncesinde başka nedenle açıklanamayan akut faz yüksekliği olan hastaya operasyon öncesi 32 mg/gün metilprednizolon tedavisi başlandı. Endarterektomi materyalmin histopatolojisi vaskülitle uyumlu olan hastanın tedavisine, postop steroid azaltılırken azatiopürin eklendi. Bir yıllık takip sonrasında relaps nedeniyle steroid tedavisi 1 mg/kg/gün yapıldı ve 3 kür 1000 mg sildofosfamid verildi. Sonrasında idame azatiopürmle 1 yıldır remisyonda olarak izlenmektedir. [ABSTRACT FROM AUTHOR]