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Pneumothorax (PTX) and pneumomediastinum (PM) are frequently encountered in patients with Coronavirus disease 2019 (COVID-19) and complicate the management of these patients. In this study, we aimed to evaluate the risk factors that cause PTX/PM complications in patients hospitalized due to COVID-19 pneumonia and the effects of these complications on the course of the disease.A total of 503 patients with COVID-19 hospitalized in the COVID-19 ward or intensive care unit (ICU) between September 2020 and December 2020 were included in the study.The median age of patients was 65 (min-max, 21-99) years. Of the patients 299 (59.4%) were male and 204 (40.6%) were female. Of the cases, 26 (5.2%) developed PTX or PM. The patients who developed PTX/PM were older than patients who did not [58.5 (min-max, 21-96) vs 65 years (min-max, 22-99), p= 0.029]. The percentage of PTX/PM development was significantly higher in male patients [F/M= 4/22 (2/7.4%) vs 200/277 (98/92.6%), p= 0.007]. Hypertension as a comorbidity was more commonly seen in the group without PTX/PM (p= 0.007). Ground-glass opacity was the most common tomographic finding in both groups, it was significantly higher in those who did not develop PTX/PM (p0.001). The length of hospital stay was shorter in patients with PTX/PM (p0.001), but mortality was higher (p= 0.04).PTX/PM were relatively more common in COVID-19 patients. These complications may negatively affect the prognosis of the disease.

Purpose: The treatment of Pulmonary Embolism (PE) which is a life-threatening disease must be planned considering the risk-benefit relationship. In this study, patients with PE given thrombolytic therapy, low-molecular-weight heparin, and warfarin were monitored for 5 years to compare them in terms of hemorrhage side effects due to therapy. Method: A total of 219 patients were included in the study. 50.2% (n=109) of the patient’s were female and 49.8% (n=110) were male, (p=0.20). Clinical findings, radiologic and laboratory parameters, treatments and side effects were recorded. A total of 121 (55.25%) patients were given thrombolytic therapy (Group 1 n=121). Enoxaparin therapy was given to 205 patients (Group 2). During therapy maintenance, warfarin therapy was conducted for 159 patients (Group 3). Results: Cerebral hemorrhage observed in 1 case (0.83%) in group 1, 2 case (0.98%) in group 2 and 1 cases (0.62%) in group 3 (p>0.05). Gastrointestinal system (GI) bleeding happened 2 cases (1.65%) in group 1 and 2 cases (0.98%) in group 2 (p>0.05). Minor bleeding was observed at similar rates due to the treatments. There was no fatality due to hemorrhage. There is no significant difference in terms of death, recurrence, residual chronic thrombus, and chronic PE in the follow-up for five years between the rt-PA group (group1) and non-rt-PA group (p>0.05). Conclusion: According to our results; major hemorrhage was observed similarly in thrombolytic, enoxaparin, and warfarin therapy. Study results about the rate of cerebral hemorrhage related to thrombolytic therapy were low in contrast to the results reported in the literature before.

Background and objectives An effective treatment option is not yet available for SARS-CoV2, which causes the COVID-19 pandemic and whose effects are felt more and more every day. Ivermectin is among the drugs whose effectiveness in treatment has been investigated. In this study; it was aimed to investigate the presence of gene mutations that alter ivermectin metabolism and cause toxic effects in patients with severe COVID-19 pneumonia, and to evaluate the effectiveness and safety of ivermectin use in the treatment of patients without mutation. Materials and methods Patients with severe COVID19 pneumonia were included in the study, which was planned as a prospective, randomized, controlled, single-blind phase 3 study. Two groups, the study group and the control group, took part in the study. Ivermectin 200 mcg/kg/day for 5 days in the form of a solution prepared for enteral use added to the reference treatment protocol -hydroxychloroquine + favipiravir + azithromycin- of patients included in the study group. Patients in the control group were given only reference treatment with 3 other drugs without ivermectin. The presence of mutations was investigated by performing sequence analysis in the mdr1/abcab1 gene with the Sanger method in patients included in the study group according to randomization. Patients with mutations were excluded from the study and ivermectin treatment was not continued. Patients were followed for 5 days after treatment. At the end of the treatment and follow-up period, clinical response and changes in laboratory parameters were evaluated. Results A total of 66 patients, 36 in the study group and 30 in the control group were included in the study. Mutations affecting ivermectin metabolism was detected in genetic tests of six (16.7%) patients in the study group and they were excluded from the study. At the end of the 5-day follow-up period, the rate of clinical improvement was 73.3% (22/30) in the study group and was 53.3% (16/30) in the control group (p = 0.10). At the end of the study, mortality developed in 6 patients (20%) in the study group and in 9 (30%) patients in the control group (p = 0.37). At the end of the follow-up period, the average peripheral capillary oxygen saturation (SpO2) values of the study and control groups were found to be 93.5 and 93.0%, respectively. Partial pressure of oxygen (PaO2)/FiO2 ratios were determined as 236.3 ± 85.7 and 220.8 ± 127.3 in the study and control groups, respectively. While the blood lymphocyte count was higher in the study group compared to the control group (1698 ± 1438 and 1256 ± 710, respectively) at the end of the follow-up period (p = 0.24); reduction in serum C-reactive protein (CRP), ferritin and D-dimer levels was more pronounced in the study group (p = 0.02, p = 0.005 and p = 0.03, respectively). Conclusions According to the findings obtained, ivermectin can provide an increase in clinical recovery, improvement in prognostic laboratory parameters and a decrease in mortality rates even when used in patients with severe COVID-19. Consequently, ivermectin should be considered as an alternative drug that can be used in the treatment of COVID-19 disease or as an additional option to existing protocols.

Introduction The risk of tuberculosis is higher in cases who have used antiTNF treatments. However, it is not clearly known whether there is a relationship between other biologic agents and the risk of developing tuberculosis or not. We aimed to investigate the prevalence of active tuberculosis among patients with rheumatic disease treated with biologic drugs. Materials and methods The study was performed at a tertiary referral center from January 2015 to December 2019. A total of 2000 patients with rheumatic diseases were screened and 461 patients were enrolled in the study due to regular records. They were underwent LTBI screening tests and were followedup at least 1 year after TNF inhibitor treatment initiation. Result The median age of all patients was 48 (min-max: 19-80). 283 patients (61.3%) were female and 178 (38.7%) were male. The most common diseases were ankylosing spondylitis (67.2%), rheumatoid arthritis (26%) and psoriatic arthritis (5.2%). Anti-TNF treatments were given to 85.2% of all cases and other biologic treatments were given to 14.8%. Tuberculin skin test was applied to 429 patients and 70.4% positivity was found. Quantiferon-TB test was applied to 93 patients and 20.4% positivity was found. 320 patients were treated for LTBI due to positive tuberculin skin test and/or positive quantiferon-TB test. TB was developed in only one patient out of 393 patients who were treated with anti-TNF treatments and the the prevalence of TB development was found 255/100.000. Conclusions The incidence of tuberculosis was quite low in our patients with rheumatic disease who were receiving anti-TNF treatment compared to previous studies. Also, in patients who were using other biological treatments, no TB cases were developed.

Among the various clinical scoring methods used for the prediagnosis of pulmonary embolism (PE), Wells criteria is the most common. It relies on the findings and story of deep venous thrombosis (DVT), PE and malignancy. It is known that atrial fibrillation (AF) is a risk factor for PE like as DVT or malignancy. We aimed to evaluate the possibility of diagnosing more patients with PE by including AF in the Wells criteria. This prospective study included 250 patients admitted to the emergency department with PE findings. Wells scoring and Wells scoring with AF were performed for each patient. Out of 250 patients, 165 patients were diagnosed as PE. Wells score was >4 in 61.8% of patients with PE and 28.2% of patients without PE. Out of false negative 63 patients with PE, 21 of them had AF. According to Wells scoring with AF the score of 148 (89.7%) patients with PE diagnosis was ≥3, whereas the score of 45 (52.9%) patients without PE was ≥3. AF was detected in 15.8% of patients with PE. The sensitivity of Wells score with AF was significantly higher than that of the Wells score (p

INTRODUCTION: We aimed to investigate the relationship between smoking and the general characteristics, symptoms and clinical course of patients diagnosed with COVID-19 who were followed-up in the COVID ward in the first 2 months of the pandemic. METHODS: Patients over the age of 18 and diagnosed with COVID-19 were included retrospectively. The demographic data, symptoms, comorbidities of the patients, tobacco and tobacco-product use, disease severity, the patient's follow-up status in the ward or intensive care unit and the need for supportive treatment, and the relationship between tobacco-use and disease severity were evaluated. RESULTS: A total of 224 patients, 40.6% of whom were female, with a mean age of 57 years were included in the study. 32.6% of the patients were active smokers, 27.6% were quit-smoking, 13.4% passive-smokers and 26.3% never-smoked. Of the patients (n = 62) who quit smoking, 17 (27.4%) patients were quit smoking during the pandemic. The highest smoking rate was found in patients between the ages of 18-49 (44.7%). Dyspnea (45.2%), loss of smelling (31.5%), inability to taste (21.9%), chills-and-shivering (16.9%) were statistically higher in patients with active-smoking. Comparing the need for supportive treatments during the follow-up of the patients, the use of oxygen therapy was found to be significantly higher in patients with active-smoking and quit-tobacco use, while other supportive treatments were similar. When the rates of smoking status and death of the patients were compared, a proportionally higher mortality rate was found in active-tobacco users, but there was no significant difference. DISCUSSION AND CONCLUSION: While no significant difference on the effect of tobacco use on disease severity and mortality in our study, it is observed that the symptom of shortness of breath was higher in smokers in COVID-19 patients. Additionally, the need for oxygen treatment may increase significantly due to tobacco use in their life span.

Additional file 1: Supplementary Table 1. Laboratory parameter changes.

Behcet's disease is a chronic inflammatory multi-systemic vasculitis. Recurrent oral and genital aphthous ulcers, uveitis, arthritis, arterial aneurysms, venous thrombosis, gastrointestinal system lesions and skin lesions can be seen. Large, medium or small arteries and veins may be involved. While venous lesions cause occlusion, arterial lesions can cause both occlusion and aneurysm. Major forms of pulmonary involvement include pulmonary artery aneurysm, arterial and venous thrombosis, pulmonary infarction, recurrent pneumonia, and pleurisy. In Behcet's disease, pulmonary thromboembolism (PE) is often associated with endothelial damage. Neutrophils play an important role in the pathogenesis of thrombosis. Coagulation components such as fibrinogen, thrombin, factor Xa and factor VIIa activate the inflammatory cascade and induce vascular events. It is important to understand the pathogenesis of vascular events in determining the effective treatment strategy. Here we present a patient with Behcet's disease who was presented with pulmonary embolism and was investigated for the etiology of thrombosis.

Aim: The aim of this study is to develop and explain an easy-to-use severity score calculation tool to predict severe COVID-19 cases that would need intensive care unit (ICU) follow-up.Material method: The study was carried out in patients with laboratory-confirmed COVID-19 hospitalized in Ankara City Hospital between March 15, 2020, and June 15, 2020. The outcome was severe illness that required ICU follow-up. Univariate and binary logistic regression were used to create a prediction model by using potential predictive parameters obtained on the day of hospitalization. Youden’s J index was calculated with receiver-operator characteristic curves analysis in order to evaluate cut-off points, and predicted probability was calculated. The accuracy of the prediction model was tested by calculating the area under curve (AUC). Results: Of the total of 1022 patients, 152 had a severe illness and required ICU follow-up. Among 68 variables, 20 parameters met the potential predictive factor condition for severe illness and were included in the development process for ANKARA CITY HOSPITAL COVID-19 SEVERITY SCORE (ACCSES). The ACCSES calculation tool was created by the final 9 parameters (sex, oxygen saturation, hemoglobin, platelet count, glomerular filtration rate, aspartate transaminase, procalcitonin, ferritin, and D-dimer). AUC was 0.96 (95% CI, 0.95-0.98).Conclusion: We developed a simple, accessible, easy to use calculation tool, ACCSES, with good distinctive power for a severe illness that required ICU follow-up. The clinician can easily predict the course of COVID-19 and decide the procedure and facility of further follow-up simply using available clinical and laboratory values of patients upon admission.

Background Early identification of severe COVID-19 patients who will need intensive care unit (ICU) follow-up and providing rapid, aggressive supportive care may reduce mortality and provide optimal use of medical resources. We aimed to develop and validate a nomogram to predict severe COVID-19 cases that would need ICU follow-up based on available and accessible patient values. Methods Patients hospitalized with laboratory-confirmed COVID-19 between March 15, 2020, and June 15, 2020, were enrolled in this retrospective study with 35 variables obtained upon admission considered. Univariate and multivariable logistic regression models were constructed to select potential predictive parameters using 1000 bootstrap samples. Afterward, a nomogram was developed with 5 variables selected from multivariable analysis. The nomogram model was evaluated by Area Under the Curve (AUC) and bias-corrected Harrell's C-index with 95% confidence interval, Hosmer–Lemeshow Goodness-of-fit test, and calibration curve analysis. Results Out of a total of 1022 patients, 686 cases without missing data were used to construct the nomogram. Of the 686, 104 needed ICU follow-up. The final model includes oxygen saturation, CRP, PCT, LDH, troponin as independent factors for the prediction of need for ICU admission. The model has good predictive power with an AUC of 0.93 (0.902–0.950) and a bias-corrected Harrell's C-index of 0.91 (0.899–0.947). Hosmer–Lemeshow test p-value was 0.826 and the model is well-calibrated (p = 0.1703). Conclusion We developed a simple, accessible, easy-to-use nomogram with good distinctive power for severe illness requiring ICU follow-up. Clinicians can easily predict the course of COVID-19 and decide the procedure and facility of further follow-up by using clinical and laboratory values of patients available upon admission.

Objectives: To compare dynamic thiol/disulfide homeostasis between patients with community-acquired pneumonia (CAP) and healthy controls. Methods : This prospective, case-control study was conducted in the Department of Pulmonary Diseases, Ankara Ataturk Training and Research Hospital, Yildirim Beyazit University, Ankara, Turkey, between August 2016 and August 2017. In total, 50 hospitalized patients with CAP and 35 healthy individuals were enrolled. Patients with comorbidities and smokers were excluded. The thiol/disulfide state was evaluated in each group. Thiol levels (native/total) and % polymorhonuclear leukocytes and C-reactive protein levels association were evaluated in patients with CAP. Results : There was no significant difference between the CAP and control groups in age or gender (both, p greater than 0.05). The disulfide (SS) levels were similar between the 2 groups ( p= 0.148). The total thiol (TT) and native thiol (SH) levels were significantly lower (all, p= 0.001) and the SS/TT levels were significantly higher ( p= 0.019) in the CAP group compared with the controls. Conclusions : This study showed that the oxidant/antioxidant ratio was shifted to the oxidative side in CAP patients. An abnormal thiol/disulfide state may be an important factor in the pathogenesis and monitoring the treatment response. The thiol resources may use for treatment in CAP and may positively affect the prognosis. Saudi Med J 2018; Vol. 39 (5): 495-499 doi: 10.15537/smj.2018.5.22111 How to cite this article: Parlak ES, Alisik M, Hezer H, Karalezli A, Hasanoglu HC, Erel O. Evaluation of dynamic thiol/disulfide redox state in community-acquired pneumonia. Saudi Med J . 2018 May;39(5):495-499. doi: 10.15537/smj.2018.5.22111.

Objective: To investigate the relationship between serum values of magnesium and the parameters of the pulmonary function tests (PFT) in patients with chronic asthma. Subjects and Methods: This study recruited 50 patients with chronic stable asthma and 40 healthy individuals as a control group. Data on age, sex, severity of asthma, PFT, and details of drug therapy were obtained from each group. Serum magnesium, potassium, phosphorus, calcium, and sodium levels were also measured. To evaluate differences between groups, the Student t test or Mann-Whitney U test was performed for continuous variables, and the χ2 test for categorical variables. Results: In the asthma group, 10% (n = 9) of the patients had hypomagnesemia and 5.5% (n = 5) had hypophosphatemia. Patients with asthma were divided into two groups: the hypomagnesemic group (n = 9) and the normomagnesemic group (n = 41). Forced expiratory volume in 1 s (FEV1), FEV1%, peak expiratory flow (PEF), and PEF% were lower in the hypomagnesemic group than in the normomagnesemic group (p = 0.02). Multiple logistic regression analysis revealed a statistically significant association between hypomagnesemia and PFT in the hypomagnesemic asthmatic group. The correlations of age with FEV1, FEV1%, PEF, and PEF% were as follows: p = 0.00, r = 0.29; p = 0.00, r = 0.43; p = 0.03, r = 0.22; p = 0.00, r = 0.38; and p = 0.03, r = 0.22, respectively. The correlation of serum magnesium levels with PFT (FEV1, FEV1%, PEF, PEF%) were as follows: p = 0.001, r = 0.29; p = 0.001, r = 0.43; p = 0.03, r = 0.22; and p = 0.001, r = 0.38, respectively. The other electrolytes were within the normal range in both groups. Conclusion: In this study, hypomagnesemia and hypophosphatemia were found to be the most common electrolyte abnormalities in patients with chronic stable asthma. FEV1, FEV1%, PEF, and PEF% were significantly lower in asthmatic patients with hypomagnesemia compared to asthmatic patients with normomagnesemia.

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Angiotensin converting enzyme inhibitors (ACEi) can increase ACE2 in human tissues and increase the adhesion of Sars-CoV-2. In our study, we aimed to investigate the relationship between serum ACE level with antihypertensive drugs (especially ACEi) and clinical severity. METHODS: A total of 200 symptomatic Sars-CoV-2 patients who were hospitalized or diagnosed in an outpatient clinic were included in the study. The patients were divided into 4 groups as mild, moderate, severe and very severe. There were 43 patients in the mild, 54 patients in the moderate, 53 patients in the severe, and 50 patients in the very severe patient group. Later, 200 patients were divided into 2 groups as mild-moderate (n:97) and severe-very severe patient group (n:103). Serum ACE, complete blood count, C-reactive protein (CRP), procalcitonin and biochemical analysis were evaluated. The demographic data, comorbidities, medications and symptoms of the patients were recorded. RESULTS: The mean age of mild, moderate, severe and very severe patients was 50.4±21.51, 57.13±14.81, 64.34±13.02, 74.88±11.18 respectively (p

Objectives: A water pipe (hookah) is a tobacco smoking tool which is thought to be more harmless than a cigarette, and there are no adequate studies about its hazards to health. Water-pipe smoking is threatening health of the youth in the world today. The objective of this study has been to investigate the carbon monoxide (CO) levels in breath, examine the changes in pulmonary function tests (PFT) and to assess the change of the oxidative stress parameters in blood after smoking a water pipe. Material and Methods: This study is a cross-sectional analytical study that has included 50 volunteers who smoke a water pipe and the control group of 50 volunteers who smoke neither a cigarette nor a water pipe. Carbon monoxide levels were measured in the breath and pulmonary function tests (PFTs) were performed before and after smoking a water pipe. Blood samples were taken from either the volunteer control group or water-pipe smokers group after smoking a water pipe for the purpose of evaluation of the parameters of oxidative stress. Results: Carbon monoxide values were measured to be 8.08±7.4 ppm and 28.08±16.5 ppm before and after smoking a water pipe, respectively. This increment was found statistically significant. There were also significant reductions in PFTs after smoking a water pipe. Total oxidative status (TOS), total antioxidant status (TAS) and oxidative stress index (OSI) were found prominently higher after smoking a water pipe for the group of water-pipe smokers than for the control group. Conclusions: This study has shown that water-pipe smoking leads to deterioration in pulmonary function and increases oxidative stress. To the best of our knowledge this study is the only one that has shown the effect of water-pipe smoking on oxidative stress. More studies must be planned to show the side effects of water-pipe habit and protective policies should be planned especially for young people in Europe. Int J Occup Med Environ Health 2017;30(5):731–742

WOS: 000409974000010, Objective: This study aimed to evaluate the contribution which effective factors on who self-quitting smoking. Methods: The study had been included in over 18 years old people who not received any pharmacological treatment or psychological support. The research was performed at the 95% +/- 3.09 confidence interval. Age, gender, educational status, occupation, monthly income, smoking situation and effective factors on self-quitting smoking. Results: The participants had been 50.9% (509) male and 49.5 (498) female. Median age was 35 (18-87) years old; female's median age 35 (18-83) and male's median age 36 (18-87). From Istanbul 351 (35%), Ankara 301 (30%), Konya 207 (20%), Antalya 148 (15%) were people interviewed. This study had been the most effective factor in unassisted smoking cessation one's own disease. The second factor had been getting fear of sick and third family pressure. The most people had been quit smoking due to diseases of respiratory system. The most fearful disease was cancer. Financial status was forth effective factor on quitting smoking. Conclusion: As a result effective factors on unassisted smoking cessation had been getting fear of sick as well as own disease. Therefore, in the process of quitting smoking, and especially young people in the project will be designed to prevent smoking was thought should be given to these issues. Also important in this regard is increasing the cigarette sales price. The compliance with laws issued to prevent smoking in closed areas, in particular young people can influence their thoughts about the hazards of smoking., Turkish Respiratory Society, This study was supported by the Turkish Respiratory Society.

Amac : Pasif icicilik sigara icmeyen bireylerin tutun dumanina istemsiz olarak maruziyetini tanimlar ve onemli bir halk sagligi problemidir. Tum dunyada, cocuklarin %40'i ve sigara icmeyen yetiskinlerin %34'u sigara dumanina maruz kalmaktadir. Uzun suredir tutun dumaninin sigara icmeyen kisilerde sagliga zararli etkileri oldugu bilinmektedir. Biz de bu calisma ile, hastanemiz Sigara Birakma ve Gogus Hastaliklari Poliklinigimize basvuran hasta ve yakinlarinin pasif iciciligin saglik uzerine etkileri hakkinda bilgi ve goruslerini degerlendirmeyi amacladik. Materyal ve Metot : Calismamiz, hastanemiz Sigara Birakma ve Gogus Hastaliklari Poliklinigi’ne basvuran, hasta ve hasta yakinlarindan gonullu olan kisiler ile yapildi. Gonullu olan kisilere, demografik ozellikleri ve pasif iciciligin saglik uzerindeki etkileri hakkinda bilgi ve goruslerini degerlendiren anket uygulandi. Ankette pasif iciciligin tanimi ve sonuclarini iceren 17 ifade bulunmakta idi. Katilimcilara bu ifadeler icin “Katiliyorum”, “Katilmiyorum” ya da “Bilmiyorum” secenekleri sunuldu. Bulgular : Calismaya 520 kisi dahil edildi. Katilimcilarin yas ortalamasi 42,73 ± 15,40, 328’si (%63,10) erkek ve 192’si (%36,90) kadindi. Katilimcilarin %41,70’i halen sigara icmekte, %42,50’si hic sigara icmemis, %15,80’i ise sigarayi birakmisti. Katilimcilarin cogu (%89,10) pasif iciciligin tanimini biliyordu. Pasif icicilik kalp hastaligi, astim, akciger kanseri, bronsit, zature, kalp-damar hastaliklari, KOAH riskini artirdigina yonelik ifadelere katilim yuksek iken, diabetes mellitus, demans, ani bebek olumu gibi riskleri artirdigina ait ifadelere katilim ise dusuk duzeyde bulundu. “Sigara icenlerin bebeklerinde uykuda ani bebek olumu daha fazla gorulur” ve “Sigara icenlerin cocuklarinda oksuruk, balgam ve hisiltili solunum daha fazla gorulur” ifadelerine halen sigara icenlerin katilimi hic sigara icmemis ve sigarayi birakanlara gore daha azdi (sirasiyla p=0,037 ve p=0,005). “Sigara icenlerin cocuklarinda oksuruk, balgam ve hisiltili solunum daha fazla gorulur” ifadesine katilmayanlarin cogunlugunu erkekler olusturmaktaydi (p= 0,033). Sonuc : Calismamizda katilimcilarin pasif iciciligin saglik uzerindeki olumsuz etkilerinin bir kismi hakkinda bilgi sahibiydiler. Her ne kadar ulkemizde on yildir uygulanmakta olan dumansiz hava sahasi politikasi toplumun sigara dumaninin etkileri hakkinda farkindaligini artirsa da yeterli degildir. Pasif iciciligin zararlarindan korunmak kapali alanlarda sigara icilmesinin onlenmesi ve toplum bilincinin artirilmasi ile mumkun olabilir. Ozellikle cocuklar uzerindeki etkilerin bilinmesi ebeveynlerin cocuklarinin sagligini korumaya yonelik tedbirler almasini saglayacaktir.

Recombinant tissue plasminogen activator (rt-PA) is the most commonly used thrombolytic agent in patients with high risk and intermediate to high mortality risk acute pulmonary embolism (PE). Clinical trials have shown early efficacy and safety of low-dose rt-PA. This study investigated the effects of low-dose rt-PA treatment on acute PE in long-term prognosis, recurrence of pulmonary thromboembolism, or the development of late complications. In this study, 48 patients undergoing low-dose rt-PA for the relative contraindications of thrombolytic therapy and 48 patients undergoing standard-dose therapy were evaluated retrospectively. Long-term follow-up investigated the chronic PE, recurrence, and causes of morbidity and mortality. In both treatment groups, embolism-induced mortality and overall mortality rates were similar in the first 30 days (p=1.000, p=0.714, respectively). Overall mortality rates in long-term follow-up were 41.7% in the low-dose treatment group and 16.7% in the standard-dose treatment group (p=0.013). The mortality rate at the first year was higher in the low-dose-treated group (p=0.011) and most of the deaths were due to accompanying comorbidities. There was no difference in PE recurrence and duration of recurrence between the groups (p=0.598, p=0.073, respectively). Intracranial hemorrhage due to therapy developed in one patient in both groups. Low-dose thrombolytic therapy in acute PE reduces PE-related mortality in the early period. Long-term follow-up showed that thrombolytic therapy did not affect mortality rates independently of the dose and PE recurrence.

Nitrofurantoin is an antimicrobial agent commonly used for urinary tract infections. This drug may cause pulmonary toxicities, the manifestations of which range from acute self-limiting reactions to chronic pathologies. Here, we report the case of a 72-year-old male who was admitted with progressive cough and dyspnea for 4 months. On physical examination, his respiratory rate was 26/min and oxygen saturation was 84% at rest while breathing room air. Chest examination revealed bilaterally fine crackles. His thorax computed tomography showed bilateral widespread ground-glass opacities and interlobular and intralobular septal thickening. His blood test revealed antinuclear antibody positivity. He had been using nitrofurantoin for a long time for urinary tract infection. He had a high score on Naranjo Adverse Drug Reaction Probability Scale. When he was a diagnosed, he had a respiratory failure due to lung damage. Patients using nitrofurantoin should be followed up closely for drug toxicity.

Aim: Clinical features in sarcoidosis are very variable and can present with numerous phenotypes depending on organ involvements, clinical onset (acute, subacute, and chronic) and response to therapy. In this study, we aimed to evaluate the clinical findings, diagnostic methods and treatments of patients with sarcoidosis by 10-years data in our hospital in Turkey.Materials and Methods: The study was carried out between January 2018 and January 2019. The patients were screened retrospectively from the hospital information system. Clinical details were collected using a structured data collection form.Results: 172 patients were included in our study. 122 (70.9%) were female and 50 (29.1%) were male. The mean age at diagnosis was50.18 ± 13.73 years in all patients, while female patients’ mean age was 52.86 ± 13.06, male patients’ was 43.66 ± 13.24 (p

We present 2 cases of pulmonary thromboembolism (PTE). The first case, a 50-year-old man, was admitted to the emergency department because of sudden onset dyspnea and left side chest pain. He was diagnosed with intermediate-risk (submassive) PTE, and thrombolytic treatment was commenced. The patient fully recovered, but 5 days later, he was diagnosed with a new, high-risk PTE. The second patient, a 23-year-old woman, presented with syncope, dyspnea, and chest pain for 2 days. She was diagnosed with high-risk (massive) PTE. Thrombolytic treatment was commenced, and the patient fully recovered, too. But the later patient was also diagnosed with a new PTE 4 days later. We applied repeated thrombolytic treatment in the patients due to repeated PTE. The first patient fully recovered and was discharged from the hospital, but the second patient died because of gastrointestinal bleeding and renal insufficiency. A repeated thrombolytic treatment could be an alternative treatment for these patients, considering treatment's risks.

Background/aim: Exhaled CO level provides an objective measure of a patient's smoking status. The relationship between CO levels and nicotine dependence is controversial. The aim of this study is to evaluate the relationship between exhaled CO levels and nicotine dependence as well as to demonstrate that exhaled CO levels may be used as a marker of nicotine dependence. Materials and methods: Two hundred eighty-nine patients (132 females, 157 males) were included in the study. Smoking duration, the age of smoking initiation, exhaled CO levels, and Fagerström Test for Nicotine Dependence (FTND) scores were recorded. The relationship between FTND scores and exhaled CO levels was investigated. Results: There was a statistically significant correlation between FTND score and exhaled CO levels (P < 0.001). We found that a cut-off score of 7.5 ppm for exhaled CO may be useful as a marker for heavy smoking. The sensitivity and specificity of this cut-off score for exhaled CO was 69.3% and 49.3%, respectively (P < 0.001). Conclusion: We found that exhaled CO levels significantly correlated with FTND scores. For patients who are unable to provide reliable answers to questions in the FTND, exhaled CO measurements may be used as an alternative test for estimating the status of heavy smoking.

Objective: To identify the etiologic and demographic features of uveitis cases admitted to the Ankara Ataturk Education and Research Hospital in Turkey and to determine the frequency of lung disease in these cases. Materials and Methods: The records of 140 uveitis cases followed up in our hospital were retrospectively examined. The patients underwent systemic and complete ophthalmologic examinations. Laboratory and radiological examinations were performed for the etiology of uveitis. The age and sex of the patients, anatomic localization, and the etiology of uveitis were evaluated. Results: The mean age±standard deviation of 140 patients included in the study was 39.6±14.9 years. The proportion of fe- male/male was 61 (43.6%)/79 (56.4%). The cases were put into 4 groups according to their anatomical localizations: anterior uveitis (48.6%; n=68), posterior uveitis (28.6%; n=40), panuveitis (31.1%; n=31), and intermediate uveitis (0.7%; n=1). Idio- pathic uveitis accounted for the majority of all cases (n=69, 49.3%). Behcet's disease was the second most common diagnosis (n=41, 29.3%), followed by uveitis associated with sarcoidosis (n=8, 5.7%). Anterior uveitis was the most common anatomical localization (n=68, 48.6%) and posterior uveitis followed it (n=40, 28.6%). Conclusion: The etiologic distribution of uveitis varies with the geographical location. The most frequently seen form of uveitis in our clinic is idiopathic. Among diseases leading to uveitis and primarily affecting the lung, Behcet's disease comes first and it is followed by sarcoidosis.

Objective: To evaluate serum copeptin levels in acute pulmonary embolism (APE) patients and healthy controls and to determine the role of the serum copeptin level in the diagnosis and severity of APE. Methods: This prospective, case-control study was conducted in the Department of Chest Diseases. Fifty patients newly diagnosed with pulmonary embolism and 39 healthy individuals were enrolled. The diagnosis of APE was confirmed by computed tomography angiography. Copeptin levels were evaluated in both groups. All APE patients were evaluated with echocardiography to identify right ventricular dysfunction and to measure the pulmonary artery systolic pressure (PASP). Patients with APE were classified according to the risk of early mortality. The correlation between early mortality risk and PASP and copeptin levels was evaluated in patients with APE. Results: There was no significant difference between the APE and control groups in age or gender (both, p>0.05), and serum copeptin levels were similar between the two groups (p=0.309). The relationship between serum copeptin levels and early mortality risk and PASP in the APE group was also evaluated. There was no correlation between early mortality risk and serum copeptin levels and PASP. Conclusion: The serum copeptin level, which is an important prognostic marker for cardiovascular diseases, may not be a suitable biomarker for APE.

Radiation-induced lung diseases are common after radiotherapy of the chest wall or intrathoracic organs. The damage of radiations is ground-glass opacity, consolidation, fibrosis, traction bron chiectasis, and volume loss. Development of pleural fluid or a new mass is rarely seen. A solid lesion was detected in the computed thoracic tomography of 53 year-old male patient. The lesion was at the apex of the right lung, 66x61 mm in size and invading the trachea, esophagus and right subclavian artery. Weekly chemotherapy and radiotherapy were applied concurrently, and the tumor was quickly disappeared, leaving its place to an unexpected cavitary lesion. The case has been reported because of its rarity in the literature.

Background: Thrombolytic therapy is considered to be the most effective treatment for high risk/life-threatening PE, and could also be effective for some intermediate risk PE with right ventricular dysfunction and/or myocardial. In this study, we aimed to evaluate the long-term efficacy and safety of half-dose recombinant tissue plasminogen activator (rt-PA) in PE treatment. Materials and Methods: 96 patients with the diagnosis of massive or submassive PE, who had thrombolytic therapy were evaluated retrospectively. 46 patients who were treated with 50 mg/1 hour (h) rt-PA were included in the study group. In the control group, 46 patients who treated with 100mg/2 h intravenous infusion of rt-PA were included. All patients were evaluated for radiological findings, echocardiographic changes, PE recurrence, chronic PE, and all-cause mortality. Result: There were no significant differences between the groups in terms of demographic data, the type of embolism, average symptom durations, initial systolic pulmonary artery pressures (sPAP) and oxygen saturation values, D-Dimer and troponin (p> 0.05). There was no difference between groups in terms of mortality rates in the first month and after the first year of treatment (p = 0.384, p = 1.000, respectively). Fifth year survival rates were similar between the groups (p> 0.05). Conclusion: It is considered that with half-dose treatment and reduced bleeding complications and also with sharing data that is indicating the same efficacy, the optimal therapeutic dose may change in the future.

Background: Endothelial damage and dysfunction are risk factors for venous thromboembolism and are strongly associated with increased oxidative stress and inflammation. Objectives: The aim of this prospective case–control study is to evaluate relationship between dynamic thiol/disulfide homeostasis and high-density lipoprotein cholesterol (HDL-C) levels in both patients with pulmonary embolism (PE) and healthy control. Methods: This study enrolled 45 patients newly diagnosed with PE and 39 healthy individuals. The diagnosis of PE was confirmed by spiral computed tomography. In both groups, the thiol/disulfide status and plasma HDL-C levels were evaluated. Results: There was no significant difference between the PE and control groups in age or gender (both p>0.05). The disulfide (SS) levels were similar between the two groups (p=0.340). The total thiol, native thiol (SH), and HDL-C levels were significantly lower (all p=0.001), and the SS/SH levels were significantly higher (p=0.009), in the PE group compared with the controls. We also evaluated the HDL-C and thiol/disulfide status parameters in the PE group. Correlation analysis showed a significant positive correlation between HDL-C and the native and total thiol measurements and a significant negative correlation between HDL-C and SH/SS. Conclusion: This study showed that the oxidative/antioxidative balance shifted towards the oxidative side in PE. Abnormal thiol/disulfide status and lower HDL-C levels may be important factors in the pathogenesis of PE.

Background: Oxidative stress and environmental oxidants resulting from oxidant/antioxidant imbalance play an important role in respiratory tract diseases and inflammation. Objectives: The aim of this prospective case–control study is to evaluate dynamic thiol/disulfide homeostasis relationship between patients with community-acquired pneumonia (CAP) and healthy control. Methods: This study enrolled 38 patients with CAP and 35 healthy individuals. The patients with comorbidies and smokers were excluded. In both groups, the thiol/disulfide status levels were evaluated. Results: There was no significant difference between the pneumonia and control groups in age or gender (both p>0.05). The disulfide (SS) levels were similar between in the two groups (p=0,066). The total thiol, native thiol (SH), SS/SH levels were significantly lower in the CAP group compared with the controls (respectively; p=0,001; p=0,001; p=0,028). We also evaluated the pneumonia severity index (PSI) and thiol/disulfide status parameters in the CAP group. Correlation analysis showed a significant negative correlation between PSI and the native and total thiol measurements (respectively; r=-0,341, p=0,036; r=-335, p=0,40). Conclusion: This study showed that the oxidative/antioxidative balance shifted to the oxidative side in the CAP. Abnormal thiol/disulfide status may be an important factor in the pathogenesis of the CAP.

The optimal treatment approach of haemodynamically stable patients with acute pulmonary embolism (PE) remains controversial. Absence of RV dilatation or the ratio of RVD/LVD ( [Med-Science 2020; 9(4.000): 939-49]

Cardiac sarcoidosis is an infiltrative, granulomatous inflammatory disease of the myocardium. Generally, it can be difficult to diagnose cardiac sarcoidosis clinically because of the non-specific nature of its clinical manifestations. This property can be based on the presence of any clinical evidence of sarcoidosis in the other organs. We present two cases of cardiac sarcoidosis so as to demonstrate its different clinical manifestations. The first patient displayed no cardiac symptoms; the electrocardiogram showed an incidental right bundle branch block. Her cardiac magnetic resonance imaging (CMRI) revealed late-phase opaque material enhancement involving the inferior and inferoseptal segment of the left ventricle. The second patient was severely symptomatic in terms of cardiac involvement, and a transthoracic echocardiogram revealed global hypokinesia and septal brightness; his ejection fraction decreased to 45 %. These cases highlighted the challenges encountered in the diagnosis and treatment of cardiac sarcoidosis. CMRI should be considered in all patients who have suspected findings for cardiac involvement.

Background Endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) is a diagnostic method for tuberculosis (TB). This study was conducted to determine the efficiency of polymerase chain reaction (PCR) testing for detecting TB lymphadenitis in samples obtained by EBUS-TBNA. Materials and Methods A total of 93 consecutive patients with hilar/mediastinal lymphadenopathies and diagnosed with granulomatous diseases through histopathological evaluation were included in the study. The specimens provided by EBUS-TBNA were evaluated through pathological, microbiological, and molecular tests. Results Eighty-nine (95.7%) of the 93 patients had histopathologically granulomatous diseases by EBUS-TBNA. Tuberculosis was diagnosed in 27 (30.3%) patients and sarcoidosis was diagnosed in 62 (69.7%) patients. Four (4.3%) patients were diagnosed through mediastinoscopy. Endobronchial ultrasound–guided transbronchial needle aspiration had an overall diagnostic efficiency in TB of 96.9%, a sensitivity of 90.9%, and a specificity of 100%. Mycobacterium tuberculosis PCR was positive in 17 of the 30 patients. The sensitivity of PCR was 56.7%, the specificity was 100%, and the general efficiency of the test was 96.4%. Conclusions As a result, the use of M. tuberculosis PCR in the EBUS-TBNA specimens provides a rapid and an accurate diagnosis of TB. Therefore, we recommend the use of M. tuberculosis PCR in the EBUS-TBNA specimens as a rapid diagnostic method for mediastinal lymphadenopathies in patients with suspected TB.

Introduction Patients with pulmonary thromboembolism (PTE) are classified into 3 groups according to the clinical risk factors associated with mortality. High-risk patients and some of the intermediate-risk patients should be treated immediately to decrease the high mortality risk. Although clinical risk level of PTE can be determined by using echocardiography to evaluate right ventricle overload and pulmonary artery pressure findings, it may not be available in all emergency settings. Aim The purpose of the study was to define the laboratory biomarkers, which can be used in place of echocardiography for PTE risk stratification. Methods Patients (n = 98) were divided into 3 groups as high-risk (n = 13), intermediate-risk (n = 50), and low-risk (n = 35) groups, according to clinical risk factors at the first referral to hospital. Hepatic, cardiac, and renal markers were evaluated and compared among 3 groups. Results Among biomarkers examined, lactate dehydrogenase, urea, creatinine, uric acid, troponin I, N-terminal–pro–B-type natriuretic peptide, creatine kinase–MB, D-dimer, and erythrocyte sedimentation rate (ESR) levels were found different between groups. All of these biomarkers except for ESR had positive correlation, whereas ESR had negative correlation with the mortality risk. An analysis of covariance for the age difference among patient groups showed that all the biomarkers other than urea and D-dimer levels remained significantly different among risk groups. Conclusions At emergency conditions in which echocardiography assessment is not available, PTE patients who have increased levels of certain hepatic, cardiac, and renal biomarkers should cautiously be evaluated for having an increased risk for mortality. Increased levels of these biomarkers may guide the consideration for thrombolytic treatment.

Reactive airway dysfunction syndrome (RADS) is a disease that causes bronchial hyper-reactivity with asthma-like symptoms within 24 hours, and it causes high-level irritant exposure in patients who did not have any previous lung disease. In general, the patient’s radiological findings are normal, although some changes are often seen. Pulmonary edema is rarely seen radiologically. In a 43-year-old female patient’s thorax computed tomography (CT) scan after the inhalation of a mixture of hydrochloric acid and sodium hypochloride, ground glass opacities, which implies bilaterally pulmonary edema, are detected. This case is presented because RADS is rarely accompanied by pulmonary edema.