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A fifty seven year-old male patient with mantle cell lymphoma (MCL) firstly diagnosed four years ago. After first chemo-radiotherapy the disease was in remission for two years. He was admitted with persistent dry cough and his computed tomography revealed left upper lobe atelectasis due to endobronchial tumoral involvement and narrowed right lower lobe bronchus surrounded by soft tissue density. Bronchoscopy revealed an endobronchial tumoral lesion obstructing left upper lobe bronchus, and three submucosal nodules located in right upper lobe, intermediate and middle lobe bronchi. The lesions were sampled by endobronchial cryobiopsy and histopathological and immunochemical investigation revealed mantle cell lymohoma infiltration. Endobronchial involvement of non-Hodgkin9s lymphomas (NHL), especially MCL is a very rare entity. To the best of our knowledge, this is the third case with endobrobchial involvement of MCL in the current literature. In any case of NHL with dry cough, wheeze or radiological atelectasis, endobronchial involvement should be born in mind and pathological confirmation is essential. Cryobiopsy is a safe method which is also more diagnostic yield, to sample such lesions.

Aim: To evaluate the diagnostic yield of pleural fluid total protein, albumin, globulin levels and pleural fluid albumin/globulin ratios in different diseases. Method: Retrospective review. All patients with pleural effusions of whose final diagnoses, pleural fluid and serum total protein, albumin and globulin were enrolled. Globulin levels were calculated as the difference between total proteins and albumin. Patients were grouped based on their diagnosis as; tuberculosis pleurisy (TP), parapneumonic effusion (PPE), malign pleural effusion (MPE) and others. Results: A total of 237 patients were enrolled.The average age was 64±16. Female/male ratio was 39/198. Pleural fluid total protein (p-tprot), albumin (p-alb), globulin (p-glob) levels and pleural fluid albumin/globulin ratios (p-alb/glob) were statistically significantly different between the study groups. Conclusion: Differential diagnosis of pleural effusions is sometimes a challenge for clinicians particularly in endemic areas of tuberculosis. Pleural fluid total protein, albumin and globulin levels and pleural fluid albumin/globulin ratios might have roles in the differential diagnosis of pleural effusions.

Objective: While developed countries do age estimation for the purpose of identifica - tion, in countries such as Turkey, it is used to determine the real age of a person with an already known identity because of inaccurate birth records. The aim of this article was to investigate whether the calcification degree of the first costal cartilage could be a marker for age determina - tion. Material and Methods: We retrospectively analyzed the postero-anterior chest x-rays of 471 patients (270 males, 201 females; mean age ± standard deviation 42.38±20.69 years) who presented to the radiology department for various reasons. The calcification degree of the right first costal cartilage was classified in four stages based on criteria used by Barchilon and Garamendi, and the patients were classified in seven groups regarding their ages. The correlation between the calcifi - cation stage of the right first costal cartilages and age group was analyzed by Spearman's rho. Re- sults: According to the first costal cartilage calcification stage, the mean ages were 5.56, 25.49, 45.39 and 66.02 at stage 0, 1, 2 and 3, respectively. The calcification degree of the right first costal carti - lage and age correlated significantly in males and females (Spearman's rho=0.904, p

Introduction We investigated the role of oxidative stress in the pathogenesis of reexpansion pulmonary edema (RPE) and effect of alpha-lipoic acid (ALA) in the prevention of RPE. Material and methods There were 4 groups consisting of 10 rats in each group; control group (CG), α-lipoic acid group (ALAG), reexpansion pulmonary edema group (RPEG), reexpansion pulmonary edema plus α-lipoic acid group (RPE + ALAG). In all the groups, all rats were sacrificed 2 hours after the reexpansion of lungs. To indicate oxidative stress malondialdehyde (MDA), and to indicate antioxidant status superoxide dismutase (SOD), catalase (CAT) and glutathione peroxides (GPx) were measured in the lungs of rats. Results Mean MDA value was lower in CG (7.02 ±0.14) and in ALAG (6.95 ±0.11) than the other groups (p = 0.001). It was highest in RPEG (8.89 ±0.21) (p = 0.001). It was lower in RPE + ALA G (7.21 ±0.32) than RPEG (p = 0.001). Antioxidant levels: GPx (37.21 ±3.01), CAT (2.87 ±0.14) and SOD (100.12 ±12.39) were lowest in RPEG among all groups (p = 0.001). These values were GPx (45.21 ±3.54), CAT (3.24 ±0.21) and SOD (172.36 ±15.48) in RPE + ALA G and were greater than those of RPEG (p = 0.001). While normal pulmonary parenchyma was seen in 2 rats in RPE + ALAG, it was not seen in RPEG. Pulmonary edema was seen in 1 rat in RPE + ALAG; however, it was seen in 3 in RPEG. Conclusions Oxidative stress might have an important role in the pathogenesis of RPE. In addition, ALA treatment might contribute in preventing RPE.

A 21-year-old male having a history of 4 years of working at a denim factory as a sandblaster was diagnosed with pulmonary silicosis and he was also an active smoker. Productive cough, dyspnea on effort, night sweats, and weight loss in a short period of time were his complaints. Chronic occupational exposure to tiny particles of silicon dioxide can stimulate parenchymal inflammation, collagen synthesis and, ultimately pulmonary fibrosis called silicosis. A typical history of exposure and chest X-ray is usually enough for diagnosis. No effective treatment exists except supportive care. Although chest X-ray of the patient revealed bilateral disseminated micronodular densities, a peripherally diffuse prominent FDG [(F-18)-2-fluoro-2-deoxy-D-glucose] uptake in both lungs and faint FDG uptake in mediastinal lymph nodes demonstrating active inflammation regions were noted on PET (Positron Emission Tomography) scan. This case was presented to show the active disease discriminated by FDG PET from chronic changes detected by radiological studies. FDG PET can provide additional information to CT regarding the diagnosis of acute silicosis and the rare accelerated silicosis.

There are data about the relationship between morphologic findings on high-resolution computed tomography (HRCT) and the number of acid-fast bacilli (AFB) on sputum smears in patients with pulmonary tuberculosis (PTB). It was also shown that existence of cavities and airspace consolidation might be related to smear positivity in PTB patients. However, there is no study suggesting a relationship between AFB on sputum smears and radiologic extent of disease based on HRCT findings.In this study, we investigated a relationship between the degree of smear positivity and radiologic extent of disease based on HRCT findings and, the degree of smear positivity and different pulmonary parenchymal changes on HRCTs of the PTB patients.Sixty-one male patients with PTB (mean age: 22+/-3.2) were included into the study. HRCT images were assessed for patterns, distribution, and profusion of pulmonary abnormalities. Dividing the lungs into 3 zones, profusion of abnormalities was assessed. A profusion score was given. Patients were divided as smear positive and smear negative and compared for the scores of HRCT findings. Smear-positive patients were divided into 4 groups as per grading of the sputum AFB smear: group I (sputum 1+), group II (sputum 2+), group III (sputum 3+), and group IV (sputum 4+). Correlations were investigated between the degree of smear positivity and the scores of HRCT findings.A significant correlation between radiologic extent of the disease based on HRCT and the degree of smear positivity was found (r=0.63, P=0.0001). There were also significant correlations between the degree of smear positivity and the scores of different HRCT findings. Nodule, cavity, and bronchial lesions are the most important contributors of the predictive properties of the total score. There was significant differences for the scores of HRCT findings between smear-positive and smear-negative patients.Our study suggests that radiologic extent of disease based on HRCT findings in patients with PTB correlated with the degree of smear positivity. Different HRCT findings such as nodule, cavitation, ground-glass opacity, consolidation, and bronchial lesion are significantly associated with smear-positive PTB. Particularly, nodules, cavities, and bronchial lesions might be predictors of smear positivity in patients with PTB. This study also suggests that the thickness of cavity wall and the distance of cavity from central airways might be related to the degree of smear positivity.

Introduction: Alveolar hemorrhage syndrome (AHS) whose cause could not be found is called as idiopathic pulmonary hemosiderosis (IPH). Method: Among the patients followed with a diagnosis of AHS since 2000, files of patients having diagnosis of IPH were investigated retrospectively. Results: 9 patients with IPH were detected. All patients were male. Hemosiderin laden macrophages were seen in biopsy samples or in BAL fluid in all of the patients. Associated Celiac disease was found in 3 patients. Seven patients had hemoptysis, 5 patients had dyspnea and 4 patients had cough. Anemia was detected in 6 patients. DLCO/VA% value was markedly increased (151%) in one of the 6 patients having diffusion test. None of the 8 patients having spirometry test had a FVC% value lower than 80%. Ground glass opacity was the most frequent finding in HRCT. Steroids were used for the treatment in 5 patients. Discussion and Conclusion: According to our results, Celiac disease should be investigated in all patients with IPH. Existence of patients without hemoptysis suggests that absence of hemoptysis does not need to rule out IPH. DLCO/VA was elevated only in one patient. Low or normal DLCO does not rule out IPH. Existence of ground glass opacity in HRCTs of a significant number of patients suggests that IPH should be kept in mind in the differential diagnosis of ground glass opacity.

Background: In several studies, it was shown that there was a marked decrease in serum levels of HDL-C during infection and inflammation in general. In particular, a decrease in the level of serum HDL-C was also shown in pneumonia. Correlations between inflammatory markers such as acute phase proteins, cytokines and serum HDL-C levels were shown. However, there are no studies indicating a correlation between serum HDL-C levels and the radiological extent of the disease (RED) in community-acquired pneumonia (CAP). Aim: We hypothesized that there could be a relationship between serum HDL-C levels and RED in CAP. Materials and methods: A case-controlled study, including 97 patients with CAP and 45 healthy subjects, was performed. Chest X-rays of CAP patients were scored for RED, and correlations were investigated between RED scores, serum lipid parameters, the erythrocyte sedimentation rate (ESR) and serum albumin levels. Results: The mean serum HDL-C level was lower in CAP patients than in controls. A significant and negative correlation between RED scores (REDS) and serum HDL-C levels was detected ( r = −0.64, P = 0.0001). There were also significant correlations between REDS and other lipid parameters. Significant correlations between ESR and serum HDL-C levels and between ESR and other serum lipid parameters were also found. Conclusion: It appears that serum HDL-C levels are generally lower in CAP cases than in healthy controls. Serum HDL-C levels and serum albumin levels might decrease and serum total cholesterol/HDL-C ratios and log (TG/HDL-C) values might increase proportionally with RED in CAP patients. These results might have some significance for individuals having long-standing and/or recurrent pneumonia and other cardiovascular risk factors.

Background: Pulmonary alveolar microlithiasis (PAM) is a rare, chronic lung disease with unknown etiology and with a nonuniform clinical course. Nonuniformity of clinical course might be related to the degree of pulmonary parenchymal alterations, which can be revealed with high resolution computed tomography (HRCT). However, HRCT findings of PAM were not fully described in the current literature. Aim: The aim of this study was to interpret and to contribute to describe HRCT findings of PAM and to investigate a correlation between profusion of micro nodules (MN) and pulmonary parenchymal alterations in patients with PAM. Material and methods: Ten male patients with PAM (mean age: 22 ± 3.2) were included into the study. HRCT images were assessed for patterns, distribution, and profusion of pulmonary abnormalities. Dividing the lungs into three zones, profusion of abnormalities was assessed. A profusion score (1–4) was given and the scores of each zone were then summed to obtain a global profusion score for HRCT ranging from 0 to 12. Also a parenchymal alteration score (PAS) was defined with respect to profusion of abnormalities. Chest X-rays were also scored. Results: All of ten patients with PAM had findings of interstitial lung disease in varying degrees on their HRCTs. HRCT findings of patients with PAM were as following: MN, parenchymal bands (PB), ground glass opacity (GGO) and, sub pleural interstitial thickening (SPIT) in 10 patients; interlobular septal thickening (ILST), in 9 patients; paraseptal emphysema (PSA) in 8 patients; centrilobular emphysema (CLA) in 7 patients; bronchiectasis (BE), confluent micro nodules (CMN) in 6 patients; peri bronchovascular interstitial thickening (PBIT) in 5 patients; panacinar emphysema (PANAA) in 3 patients; pleural calcification (PC) in 2 patients. A significant correlation between MN scores and PAS (r = 0.68, p = 0.031, MN scores and GGO scores (r = 0.69, p = 0.027) and, MN scores and CLA scores (r = 0.67, p = 0.034) was detected. We also found significant correlations between HRCT scores and results of pulmonary function tests (PFTs), HRCT scores and chest X-ray score (CXRS) and, CXRS and results of PFTs. Conclusion: We conclude that patients with PAM may have all findings of interstitial lung disease in varying degrees as well as MNs on their HRCTs. More importantly, this study suggests a proportional relationship between profusion of MNs and parenchymal alterations in patients with PAM. This study also suggests that the degree of parenchymal alterations closely related with the degree of pulmonary function loss in patients with PAM.

Tuberculosis (TB) is an infectious disease caused by M. Tuberculosis Complex that involves both mainly lungs and other organs. Post-primary pulmonary TB is mostly seen in adults. It is usually located in apical region of lungs and makes cavitary lesions. We can see different clinical pictures in the areas of high incidence with TB. In the differential diagnosis of nodular and cavitary lesions in the lungs, metastatic lung cancer, wegener granulomatosis and TB are included. We report a case with different radiological appearance and a clinical sign that has extra-TB differential diagnosis which most possible cause is metastatic lung cancer.

We read the article ‘'N-terminal pro-brain-type natriuretic peptide (NT-pro-BNP) and mortality risk in early inflammatory polyarthritis (IP): results from the Norfolk Arthritis Registry (NOAR)’’ by Mirjafari et al 1 with interest. The authors aimed to measure serum NT-pro-BNP levels in a large, well-characterised inception cohort of patients with early IP and examine baseline association of NT-pro-BNP levels with IP disease phenotype, clinical cardiovascular disease (CVD) risk markers and subclinical atherosclerosis surrogates. They concluded that in early IP patients, elevated NT-pro-BNP is related to Health Assessment Questionnaire …

Dear Editor, We read the article titled “High levels of B-type natriuretic peptide (BNP) predict weaning failure from mechanical ventilation in adult patients after cardiac surgery” by Thiago Martins Lara et al. with interest (1). The authors aimed to evaluate whether serum levels of B-type natriuretic peptide are a predictor of weaning failure from mechanical ventilation after cardiac surgery. They concluded that high BNP levels are predictive of failure to wean from mechanical ventilation after cardiac surgery. Plasma levels of BNP are increased in disorders associated with intravascular volume overload, increased central venous pressure and left ventricular dysfunction. BNP secretion is directly proportional to left ventricular wall stress and blood volume. Because of these associations, there has been much interest in using BNP as a biomarker for heart failure (2). However, high levels of BNP are present in many cases for reasons unrelated to cardiac diseases. In several studies, BNP levels were higher in women than in men, independent of age. Although the reason for this difference is unknown, it is believed that estrogen may play a role. Furthermore, levels of BNP increase with age, and this difference is not associated with “age-related” diastolic dysfunction in either sex (3). Obese individuals have low circulating natriuretic peptide levels, and diabetes mellitus is also associated with low plasma levels of natriuretic peptide (4). In addition, elevated BNP levels may be observed in many diseases associated with hypervolemia, such as chronic renal failure, chronic liver disease and hyperaldosteronism (5). Furthermore, respiratory conditions, such as pulmonary embolism and chronic obstructive pulmonary disease, are associated with high levels of BNP in the absence of left heart failure. One of the most important conditions associated with elevated BNP levels is sepsis. Many studies have shown significantly higher BNP levels in patients with sepsis, and this effect was not related to myocardial dysfunction (6). In conclusion, high levels of BNP are presented as a predictive factor for failure to wean from mechanical ventilation after cardiac surgery in the study by Thiago Martins Lara et al. However, because BNP levels may be affected by many factors, the significance of those risk factors in weaning from mechanical ventilation after cardiac surgery should be considered in future large-scale prospective randomized clinical trials.

Background Chest-X-ray has several limitations in detecting the extent of pulmonary disease in sarcoidosis. It might not reflect the degree of pulmonary involvement in patients with sarcoidosis when compared to computed tomography of the thorax. We aimed to investigate the HRCT findings of pulmonary sarcoidosis and to find out the existence of possible relations between HRCT findings and PFTs. In addition, we aimed to investigate the accordance between HRCT findings and conventional chest-X-ray staging of pulmonary sarcoidosis. Method 45 patients with sarcoidosis with a mean age 29.7+/− 8.4 years were evaluated. Six of them were female and 39 were male. The type, distribution and extent of the parameters on HRCT/CTs were evaluated and scored. Chest-X-rays were evaluated for the stage of pulmonary sarcoidosis. Correlations were investigated between HRCT/CT parameter scores, Chest X-Ray stages and pulmonary function parameters. Results Nodule, micronodule, ground glass opacity and consolidation were the most common HRCT findings. There were significant correlations between pulmonary function parameters, HRCT pattern scores, and chest-X-ray stages. A significant correlation between chest-x-ray score and total HRCT score was found. Conclusions Pulmonary sarcoidosis patients might have various pulmonary parenchymal changes on HRCT. Thorax HRCT was superior to chest-X-ray in detecting pulmonary parenchymal abnormalities. The degree of pulmonary involvement might be closely related to the loss of pulmonary function measured by PFTs. Chest-X-ray is considered to have a role in the evaluation of pulmonary sarcoidosis.

Pulmonary sequestration is a rare, usually a cystic mass which is composed of nonfunctioning pulmonary tissue that does not communicate with the tracheobronchial tree. In computed tomography pulmonary sequestration is seen as usually a discrete mass lesion, with or without cystic changes, associated with local emphysematous areas located in lower lobes. We present a case of pulmonary sequestration located in apicoposterior segment of left upper lobe and presented as a solitary pulmonary nodule having smooth margins different from the classical radiological appearance of pulmonary sequestration.

The "Scimitar syndrome" is a rare congenital anomaly characterized by combination of partial or complete pulmonary venous return from the right lung to the inferior vena cava either above or below the diaphragm together with hypoplasia of the right lung and sometimes systemic arterial supply to the right lung. In this case, multimodality imaging findings such as the vein draining into the inferior vena cava, the presence of hypertrophied and dilated right ventricle, the absence of other cardiac abnormalities, displacement of the heart without malrotation and the mediastinum to the right, normal bronchial and vascular continuity in the whole lung, absence of pulmonary sequestration and systemic collaterals, normal perfusion and systolic functions of the left ventricle were reported.Scimitar sendromu, sağ akciğer pulmoner venöz dönüşün bir kısmının veya tamamının diyafragmanın altından ya da üstünden vena kava inferiora drenajı ile birlikte sağ akciğer hipoplazisi ve sağ akciğere sistemik kollateral varlığı ile karakterize nadir konjenital bir anomalidir. Bu vakada, inferior vena kavaya drene olan sağ pulmoner veni, mediasten ve kalbin sağa deviyasyonunu, tüm akciğerin korunmuş vasküler ve bronşiyal bütünlüğünü, akciğere sistemik kollaterallerin yokluğunu, pulmoner sekestrasyonun ve diğer kardiyak anomalilelerin yokluğunu, hipertrofik ve dilate sağ ventrikül ile normal perfüzyon ve sistolik fonksiyonları olan sol ventrikülü gösteren, farklı görüntüleme yöntemlerinden elde edilen bulgular sunulmuştur.

Tuberculosis (TB) is the second most frequent cause of death in the world, after AIDS. Delay in diagnosing TB is an important worldwide problem. It seriously threatens public health. Cell-mediated immune responses play an important role in the pathogenesis of TB infection. The course of Mycobacterium tuberculosis (MTb) infection is regulated by two distinct T cell cytokine patterns. Melatonin is a biomolecule (mainly secreted by the pineal gland) with free radical scavenging, antioxidant and immunoregulatory properties. Melatonin has both its direct and indirect immunomodulatory effects on the immune system. In this study, we measured plasma melatonin and urine 6-hydroxy melatonin sulphate (6-HMS) concentrations in patients with newly diagnosed TB for the purpose of investigating whether there was a relationship between their levels and MTb infection. Thirty-one newly diagnosed patients presenting with active TB and 31 healthy subjects as the control group were included in this study. Blood and 24-h urine samples were collected from all individuals. Plasma melatonin levels and urine 6-HMS were measured. Our results show that in patients with TB, mean melatonin and 6-HMS concentrations were significantly lower than in the control subjects (p = 0.037, p < 0.001, respectively). We believe that the treatment of TB patients with melatonin might result in a wide range of health benefits including improved quality of life and reduced severity of infection in these patients. Supplementation with melatonin may be considered as an adjunctive therapy to classic treatment of pulmonary TB, especially during the acute phase of infection.

Background Chitotriosidase is an accepted marker of macrophage activation. In this study, we investigated serum chitotriosidase levels in pulmonary tuberculosis (PTB). Methods Forth-two patients with PTB and 30 healthy subjects were enrolled in the study. The radiological extent of PTB, radiological sequela after treatment, and the degree of smear positivity were assessed. Chitotriosidase levels were measured by a fluorometric method. Results The serum chitotriosidase levels of the PTB patients were significantly higher than those of the control subjects (39.73±24.97 vs. 9.63±4.55 nmol/mL/h, P

BACKGROUND The aim of the present study was to investigate serum lactate dehydrogenase (LD) levels in patients with silicosis due to denim sandblasting (SDDS) and also to investigate possible correlations between serum LD levels and the degree of radiological extent of disease (RED) and pulmonary function tests. METHODS Forty-four males with SDDS and 32 healthy male subjects were included in the study. Patients and healthy controls were compared for serum LD levels. Correlations between serum LD levels, RED and spirometric values were investigated. RESULTS Patients with SDDS had significantly higher serum LD levels than healthy controls. Patients with complicated SDDS had significantly higher serum LD levels than patients with simple SDDS. Significant correlations were found between serum LD levels and RED values. Significant correlations were found between serum LD levels and spirometric parameters. CONCLUSIONS High serum LD levels might be considered as a marker of pulmonary parenchymal involvement in patients with SDDS. This study also suggests that the increase in serum LD levels might be closely related to the degree of pulmonary involvement in SDDS patients.

Aim: D-Dimer (DD) is product of solid phase fibrin degradation and accepted as a marker of endogenous fibrinolysis. It has been reported that there is a relationship between pulmonary tuberculosis and hypercoagulable state. Clinicians may have difficulties in diagnosis of tuberculous pleurisy in endemic areas. In this study we Aim: ed to investigate the diagnostic value of pleural fluid and plasma D-Dimer levels and their correlation with other clinical and laboratory parameters in patients with tuberculous pleurisy. Material and Methods: Sixty four patients with pleural effusion, including tuberculous pleurisy (35 patients) malignant pleural effusion (9 patients) parapneumonic pleural effusion (7 patients), congestive heart failure (7 patients), nonspecific pleurisy (4 patients) and connective tissue disorder (2 patients), constituted the study population. Pleural fluid and plasma D-dimer levels, in addition, serum and pleural fluid adenosine deaminase, glucose, lactate dehydrogenase, total protein and albumin were quantified in all patients. The extent of pleural effusion in tuberculous pleurisy was assessed by radiologically. Results: Pleural fluid D-Dimer levels were significantly differed in patients with tuberculous pleurisy (490.79±224.1 mcg/ml) from those in non-tuberculous pleural effusion (107.97±119.51 mcg/ml). In tuberculous group, there was a negative correlation (r=-0.473) between plasma and pleural fluid D-Dimer levels. Plasma D-Dimer levels showed a positive correlation (r=0.49) with pleural fluid glucose levels while the same parameter showed a negative correlation with pleural fluid adenosine deaminase levels (r=-0.45). Pleural fluid D-Dimer levels correlated positively with serum lactate dehydrogenase (r= 0.485) and negatively with pleural fluid/serum protein ratio and pleural fluid glucose levels (r=-0.341 and r=-0.449 respectively). Radiological pleural effusion score was correlated positively (r=0.642) with pleural fluid D-Dimer levels in patients with tuberculous pleurisy. Diagnostic parameters of pleural fluid D-Dimer were assessed as specifity:90%, sensitivity:74% positive predictive value:90% negative predictive value:74% and accuracy: %81. Conclusions: In Conclusions : , pleural fluid and plasma D-Dimer levels are increased in tuberculous pleurisy with respect to non-tuberculous effusions indicating hypercoagulable state in tuberculosis. We suggested that pleural fluid D-Dimer quantification may have some contribution to diagnosis of tuberculous pleurisy.

Background: Low serum total cholesterol (TC) concentrations in patients with pulmonary tuberculosis (PTB) have been demonstrated. It was shown that a cholesterol-rich diet might accelerate the sterilization rate of sputum cultures in PTB patients. It is known that smear positivity might be related to the radiological extent of disease (RED) in PTB patients. Objective: We hypothesized that there might be a relationship between initial serum TC concentrations; the degree of RED (DRED) and the degree of smear positivity (DSP) in PTB patients. Method: Eighty-three PTB patients and 39 healthy controls were included in the study. Serum TC, TG, HDL-C, VLDL-C and LDL-C concentrations were determined in all subjects. PTB patients were classified for their chest X-ray findings as minimal/mild, moderate and advanced. Correlations between serum lipid concentrations, DRED and DSP (0, 1+, 2+, 3+, 4+) were investigated. PTB patients and controls were also compared for serum lipid concentrations. Results: Significant differences between PTB patients and controls were detected for serum TC, HDL-C and LDL-C concentrations. On stepwise logistic regression analysis, DRED was found as one of the significant independent predictors of serum TC levels. We also found significant correlations between DRED and serum HDL-C concentrations ( r = − 0.60, p = 0.0001) and between DRED and serum LDL-C concentrations ( r = − 0.28, p = 0.011). There were also significant correlations between DSP and serum lipid concentrations. Conclusion: Our study suggests that serum TC, HDL-C and LDL-C concentrations are generally lower in patients with PTB than those in healthy controls. In addition, changes in these parameters might be related to DRED and DSP in PTB patients.

We read the article “Airway obstruction in systolic heart failure — chronic pulmonary disease (COPD) or congestion?” by Brenner S et al., with interest [1]. The authors aimed to estimate the prevalence, correlates and prognostic impact of true COPD in patients with systolic heart failure (SHF). They concluded that airway obstruction is a dynamic phenomenon in SHF. Therefore, a valid diagnosis of COPD in SHF demands serial pulmonary function testing (PFT) under stable conditions with special attention to hyperinflation. They suggested that in order to avoid potentially harmful overtreatment, bronchodilators should only be permanently applied if COPD has been unequivocally confirmed. COPD and heart failure are closest friends, have common features. Etiologic factors, clinical presentation and laboratory findings may be similar. Therefore, differential diagnosis and management of this disease have been a problem for clinicians at all times [2,3]. Many studies found a high prevalence of COPD inpatientswith heart failure. As in the present study, we think that especially patients with heart failure have an exaggerated diagnosis of COPD. That's why, for distinguishing these two diseases, it is important to reveal and determine the clinical, laboratory, echocardiographic and radiological data [4]. In the present study, the authors used the PFT changes after 6 months of therapy as the powerful tool in the differential diagnosis of COPD and heart failure which is also supported by the body plethysmography. We think that body plethysmography may have a pivotal role in this diagnostic strivingbecause PFTmeasures alonedonot have the power to differentiate between both diseases. Although the diagnosis of COPD was excluded by reversible PFT in the present study, we know that there are different phenotypes of COPD with reversible PFT in clinical practice. Additionally, although it is not mentioned in the presented study, we consider that radiological findings may have pivotal role in differential diagnosis. Chest X-ray does not give strong evidence to distinguish both diseases because cardiothoracic ratio adversely affected by hyperinflated lungs and left ventricular dilatation can be masked by right ventricular enlargement caused by COPD. The observation of parenchymal changes such as emphysema and interstitial edema in CT scans may be helpful. Finally, sodium retention and lifestyle change programs such as exercise are frequent priorities for mortality and morbidity in people with heart failure [5]. Furthermore, the frequency and severity of hospitalization may be associated with HF risk factors including increasing age, anemia, duration of diabetes, obstructive sleep apnea, obesity, hypertension, lifestyle programs and psychological disturbances [6]. In this point of view, if future follow-up studies assess the patients with systolic heart failure according to sodium intake and lifestyle change programs, it'll contribute to the literature. In conclusion, we think that these two diseases will continue to be close friends for a while. To shorten this period, diagnosis, treatment and outcomes should be examined with great care and more studies should be done.

We read the article “Airway obstruction in systolic heart failure (SHF) — Chronic obstructive pulmonary disease (COPD) or congestion?” by Susanne Brenner et al. with interest [1]. The authors aimed to estimate the prevalence, correlates and prognostic impact of true COPD in patients with SHF. They concluded that COPD is over-diagnosed in SHF. Also, COPD has a pronounced impact on survival only when proven by pulmonary function testing (PFT) under stable conditions. Chronic obstructive pulmonary disease and heart failure are prevalent comorbidities affecting a huge proportion of the world population, responsible for significantmorbidity andmortality [2]. COPD is a cluster of heterogenic disorders, characterized by expiratory flow limitation that is not completely reversible and in most cases progressive. A clinical diagnosis of COPD should be considered in any patient who has dyspnea, chronic coughor sputumproductionandhistoryof exposureof risk factors such as smoking. Spirometry is only one parameter for establishing the clinical diagnosis of COPD [3]. In the presented study [1], about half of the patients (45.6%) in the study population had never smoked. Similarly, the rate of never-smokers in patients with diagnosis of COPD was 28%. And there is no information on the presence of other risk factors. Since COPD is characterizedbyfixedairflowobstruction, thismay lead tomisdiagnosisof various diseases with fixed airflow obstruction such as tuberculosis, bronchiectasis and lung cancer [4]. For these reasons, in patients (28%) without any risk factors may had received the wrong diagnosis. At this point, radiological images are important for the differential diagnosis. Another reason for the continuation of fixed airway obstruction in patients with no history of exposure to risk factors may be the continuation of decompensated left heart failure. Although they found that the mean ejection fraction of patients with proven COPD was 41% [1], population-based studies show that approximately half of all patients with heart failure have preserved left ventricular systolic function (HF-PEF) [5]. So, the continuation of fixed airwayobstructionmaybe associatedwith not only SHF but alsoHF-PEF. Finally, we think that further studies will mention these factors in patients with airway obstruction.

authors aimed to evaluate the effect of inhaled bronchodilators on pulmonary function and dyspnea in patients with chronic heart failure (HF). They concluded that inhaled bronchodilators have the potential to improve pulmonary function in patients with chronic HF, especially in those with airway obstruction. However, improvement in dyspnea at rest after bronchodilation did not correlate to improvement in pulmonary function. They suggested that inhaled bronchodilators may have an additional role in the management of these patients. Heart failure is a common clinical syndrome characterized by dyspnea, fatigue, and signs of volume overload, which may include peripheral edema and pulmonary rales. 2 The most common