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Introduction: We investigated the frequency of granulomatous lung diseases (GLD) in patients with granulomatosis ocular pathologies who referred to our clinic for differential diagnosis. Methods: Diagnosis of sarcoidosis or definitive tuberculosis was made with microbiological and/or histopathological findings. Patients who did not respond to immunosuppressive treatments, and had latent tuberculosis infection proven with PPD and/or Quantiferon-TB test were considered as possible ocular tuberculosis and antituberculosis treatments were given to these patients. Treatment response was evaluated with vision tests and clinical response. Results: Totally 200 patients (58% female, 42% male, age:46±3.9years) included. Ocular pathologies were uveitis in 65.6%, choroiditis in 20%, vascular pathologies in 6.5% and others 8%. Immunosuppressive treatment were given to 132 (66%) cases; 56 (41%) of them received steroid treatment. PPD performed in 173 patients (PPD:16.6±7mm) and PPD was ≥15mm in 125 of them. Quantiferon-TB test was positive in 85.5% of 166 cases. Sarcoidosis was diagnosed histopathologically in 7.5% (n=15/200), tuberculosis was diagnosed microbiologically or pathologically in 2% (n=4/200). Eighty-nine cases were considered as possible tuberculosis with clinical-radiological findings and the presence of latent tuberculosis. Antituberculosis treatment was given to these patients and 50 of them (56%) responded well. Conclusion: Only 9.5% of cases with ocular granulomatosis disease diagnosed definitively tuberculosis or sarcoidosis. In cases who do not respond to immunosuppressive treatments and have latent tuberculosis infection; initiating anti-tuberculosis treatment can provide good results.

Introduction: Minor salivary gland biopsy is used as a minimally invasive method in the diagnosis of sarcoidosis. To date, a few studies have shown that minor salivary gland biopsy is an diagnostic tool in differentiating sarcoidosis from tuberculosis. In this study we evaluated the diagnostic yield of minor salivary gland biopsy in patients with sarcoidosis. Material and methods: The study included patients with sarcoidosis who were diagnosed during the last 10 years in Pulmonary Department of Istanbul Medical Faculty. Baseline diagnostic tests, histopathological results and clinical findings were recorded. Results: Totally, 354 patients (270 female, 84 male, mean age: 46.48) with sarcoidosis were analyzed. Radiologically, 7.3% was stage 0, 46.6% was stage I, 33% was stage II, 9% was stage III, and 3.9% was stage IV. Respiratory functions were normal in 70%, diffusion capacity was normal in 66% and 18.8% had obstructive pattern, 10.9% had restrictive pattern in spirometry. The most common extrapulmonary involvement was skin (%22.8) and eye (%16.9). Minor salivary gland biopsy was performed in 215 cases and 49.3% of them had findings compatible with sarcoidosis. In 13.8% of the cases, the diagnosis was based on only minor salivary gland biopsy and clinical-radiological findings. Conclusion: In our study, salivary gland biopsy was diagnostic in half of the cases, and in 13.8% of the cases was diagnosed without any other invasive procedure. Therefore, it can be used as a priority biopsy method in patients with clinical and radiological suspicion of sarcoidosis.

Introduction: Risk of recurrence and bleeding, play a role in considering the optimal duration of treatment. The aim of the study was to determine the frequency of recurrence, risk factors for recurrence and bleeding in cases with VTE. Material-methods:: Study included 412 VTE patients (164 male, 248 female, mean age: 53.5years, follow-up period: 25.3months). Patient9s demographics, risk factors, comorbidities, clinical data, treatment and complications were recorded. Results: There was at least one risk factor in 341 (82.7%) patients and 71 (17.2%) of them were idiopathic. In 76 (18.4%) of the cases VTE recurrence developed. There was no difference between recurrent and non-recurrent groups according to age and sex. There was no relationship between recurrence and mortality. Recurrence was higher in DVT and / or PTE+DVT groups than PTE group (24% vs 14.2%, p=0.007). Idiopathic VTE was higher in recurrent cases (26.3% vs 15.2%, p=0.028). D-dimer levels were higher in recurrent cases at first year control (p=0.034). Hereditary risk factors were higher in recurrent cases (p=0.031). During VTE treatment, 37 (8.9%) of cases had bleeding however major bleeding rate was 3.6%. Duration of anticoagulant was longer in patients who had bleeding (22months vs 12months p=0.047). Bleeding rate was higher in patients with massive PTE (p=0.001) and in elderly patients (≥75years) (p=0.036). Conclusion: In our study, presence of DVT, idiopathic VTE, hereditary risk factors and high D-dimer levels at first year were found as related factors of recurrence. Risk of bleeding increased in recurrent cases, in elderly cases and in cases whose treatment duration was longer in the first VTE event.

Introduction: Arterial blood gas (ABG) sampling is difficult in patients with obesity hypoventilation syndrome (OHS) and neuromuscular diseases (NMD). Our aim was to investigate the usability of venous blood gas (VBG) analysis, to replace ABG. Material and Methods: Study included stabilized OHS and NMD patients. ABG was taken from all of the cases in the room air and peripheral VBG samples were taken within 5 minutes after ABG analysis. Results: Totally 82 cases (female:33, male:49, mean age:46.9years) with OHS (n=36) and NMD (n=46) were included. For all patients, there was a moderate positive correlation between arterial and pH values (rs=0.590, p For NMD patienst; there was moderate positive correlation between arterial and venous pH and PCO2 values (rs=0.542, rs=0.540, p Conclusion: We found a relationship between ABG and VBG for the values of pH, PCO2 and HCO3. As a results, VBG values (pH, pCO2, HCO3) can be used safely during treatment and follow-up period of the patients with OHS and NMD, instead of ABG.

28th International Congress of the European-Respiratory-Society (ERS) -- SEP 15-19, 2018 -- Paris, FRANCE, WOS: 000455567105150, …, European Respiratory Soc

Introduction: Impairment in pulmonary functions and sleep related breathing disorders in patients with lipid storage disease (LSD) are unknown. We aimed to evaluate impairment in pulmonary functions and sleep related breathing disorders in patients with LSD. Methods: Pulmonary functions (FEV1, FVC, upright-supine %FVC change, MIP, MEP, PCF), arterial blood gas analysis (ABG) and polysomnography of patients with LSD were evaluated. Results: Twenty-five patients with LSD are evaluated [17 male, 8 female; age:34.9±15.02years, BMI:26.5±3.4kg/m2(19-31kg/m2)]. MIP:72.2±32.7cmH2O ( 45mmHg). Obstructive sleep apnea (OSA) was found in 80% of patients (n=20; 9 mild, 9moderate, 2 severe). REM sleep had decreased in all patients (10.2%±6.1).For patients with OSA; apnea-hypopnea index (AHI):20.8±15.9/hour, apnea index:8.4±17.6/hour, hypopnea index:14.1±9/hour, REM AHI:30.6±19.7/hour, NREM AHI:19.7±16.6/hour, oxygen desaturation index (ODI):11.9±15.4/hour, REM-ODI:27.2±26.1/hour, NREM-ODI:11.4±15/hour. Nocturnal average SpO2: 94.9%±1.7, lowest SpO2:73.3%±13.9, time spent with SpO2 Conclusion: Pulmonary functions are adversely affected in LSD. Daytime hypercapnia, reduction in cough strength and OSA are frequent in LSD. ABG and polysomnography should be performed even pulmonary functions are normal in LSD.

Introduction: Pulmonary hypertension (PH) is a chronic, progressive disease with a high morbidity and mortality. Its pathobiology involves interacting pathways of prostacyclin (PGI2), endothelin, and nitric oxide (NO). There are few studies which evaluated exhale NO levels in patients with PH. Aim of this study was to investigate the levels of exhaled NO in PH patients. Methods: Patients who were followed in Istanbul Faculty of Medicine, Pulmonary Hypertension Outpatient Clinic were enrolled in this study. Exhaled NO levels of patients with PH were compared to age and gender matched healthy controls. Results: Data of 38 patients with PH (28 females, 10 males, age:54.5±16.3years) were compared to 80 healthy controls (55 females, 25 males, age:49.8±14.4years). Etiologies of PH were pulmonary arterial hypertension (PAH, n=24) and chronic thromboembolic pulmonary hypertension (CTEPH, n=14). NYHA functional class of the patients were mostly II (68.4%). Thirteen of them (41.9%) were given PH specific treatment (prostacyclin derivatives, endothelin receptor antagonists, phosphodiesterase inhibitors). Estimated systolic pulmonary arterial pressure (PAP) by transthoracic echocardiography was 64.9±28.2mmHg and TAPSE was 1.88±0.48. ProBNP measured 1169.2±2858.9pg/ml. Right heart catheterization revealed systolic PAP 87.1±39.4mmHg, mean PAP 55.9±25.4mmHg, PVR 7.9±5.3wood. Exhaled NO levels were lower in patients with PH than healthy controls (16.7±6.8ppb vs 19.8±7.7ppb, p=0.036). Exhaled NO levels were not different between patients with PAH and CTEPH (16.7±6 vs 16.7±7.7, p=0.458). Conclusions: Our study showed a significant reduction in exhaled NO levels in PH patients.

Fatigue is one of the most important symptom of chronic respiratory diseases. However fatigue in patients with asthma has not been adequately investigated. The aim of this study was to determine the fatigue, exercise capacity, daily activities, anxiety and depression in patients with asthma and assess the relationships between these parameters. METHOD: Study were conducted in Istanbul University Faculty of Medicine, Department of Chest Diseases. Subjects with neurological problems, smokers and patients with cognitive impairment are not included in the study. The demographic characteristics of the participants were recorded. The “Fatigue Severity Scale (FSS)” and “Fatigue Impact Scale (FIS)” is used to assess fatigue. London Chest Activities of Daily Living Scale (LCADL) is used for the evaluation of daily activities, Hospital Anxiety and Depression Scale(HAD) are used for evaluate anxiety and depression. 6-minute walk test(MWT) is used to determine the exercise capacity. RESULT: Twenty subjects with asthma (52.8±9.9 years) and age matched 20 healthy volunteers participated the study. There was statistically significant difference found in fatigue impact and fatigue severity scales, LCADL and 6MWT (p CONCLUSION: Our study results showed the patients with asthma has low exercise capacity compared with healthy subjects and the possible reason of that is fatigue.Studies with larger sample size groups needed for further researches.

Aims: CYP2A6 and CYP2A13 genes are sub grouped in CYP2A gene cluster and have important role in nicotine detoxification mechanisms. We aimed to determine the variants of CYP2A6 and CYP2A13 in smokers and non-smokers. Material and Methods: 64 smokers and 36 non-smokers were included in the study. DNAs were isolated from 100 peripheral blood samples. The amplicants of genes using the primers which were designed by “Primer-BLAST” program were sequenced in “Illimuna-MiseqQ-platform. Results: Mean age was 47±13 for smokers, and 34±12 for non-smokers. The age and gender difference between smokers and non-smokers was significant (p Conclusion: The full genome sequence in CYP2A6 and CYP2A13 genes analysed for the first time in our study. CYP2A6 gene variants distrubition and numbers with the different haplotypes were significantly increased (5 and 6 in smokers, 3 and 10 in non-smokers) . CYP2A13 gene variants were increased in smokers compared to non-smokers. The result supports that the variant haplotypes could be effective in maintaining the smoking addiction. This study was supported by Istanbul Univesity, BAP-ONAP support program .

Introduction: Ehlers-Danlos syndrome (EDS) is an uncommon cause of hemoptysis and spontaneous hemopneumothorax. We present a case with recurrent hemoptysis who had bronchial artery pathology and anomalous pulmonary venous return associated with EDS. Case: Twenty-years-old female presented with recurrent hemoptysis for two years. Thoracic tomography was normal. Six months of antituberculosis therapy were given due to M. tuberculosis growth in sputum cultures. Ear-nose-throat examination revealed lesions in bilateral nasal conchae and lesions were cauterized. As the hemoptysis persisted, a diagnostic bronchoscopy was performed and revealed an active source of bleeding at the orifice of superior segment of the right lower lobe. Bronchial artery ligation was performed via right thoracotomy. Echocardiogram revealed mitral and tricuspid valve prolapsed. Ophthalmologic examination was performed due to atypical localization of pupils. Bilateral coloboma, nistagmus and ectopia lentis were found. Patient history was positive for spontaneous ecchymosis, premature loss of teeth, increased joint laxity. Genetic physicians found these findings to be consistent with EDS type 6. Skin and subcutaneous tissue biopsies were performed and the definitive diagnosis was made using electron microscopy, fibroblast culture and mutation analysis. A hereditary transmission could not be demonstrated. Pulmonary angiography revealed a tortuous course in distal branches of bronchial arteries and early venous return consistent with arteriovenous fistula. Bilateral bronchial artery embolization was performed. Patient9s hemoptysis regressed. Conclusion: In this care, EDS was found as an uncommon cause of hemoptysis.

Introduction: Levels of adipokines in obstructive sleep apnea (OSA) and different OSA stages remains contraversial. Additionally adipokines levels in OSA with hypercapnia, pulmonary hypertension remains unknown. We examined serum levels of leptin and adiponectin in different subgroups of OSA. Methods: Obese subjects who were admitted to sleep laboratory were included. All subjects underwent spirometry, arterial blood gas analysis, polysomnography and transtoracic echocardiography. Serum levels of leptin and adiponectin were recorded. Results: Analysis included 146 OSA subjects (81 females, 65 males, age:49.8±10.7years, BMI:40.3±4.9kg/m 2 , 47.9% severe OSA). Of all subjects 37.7% had daytime hypercapnia, 61.6% had metabolic syndrome and 28.7% had pulmonary hypertension. Females had higher leptin and adiponectin levels (p 2 (p Discussion: Levels of adipokines were different especially in OSA subjects with malign obesity, female gender and severe disease.