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Background: Idiopathic pulmonary fibrosis (IPF) predominantly affects people over the age of 60 years and its incidence increases with age. Limited data is available on the use of antifibrotics in the elderly IPF population. We aimed to examine the tolerability and safety of antifibrotics (pirfenidone, nintedanib) in elderly patients with IPF in a real-world setting. Methods: Medical records of 284 elderly (≥75 years) and 446 non-elderly IPF patients (

Background: Polyomavirus BK virus infection is a significant complication of renal transplantation and is an important cause of allograft loss. Today, despite the innovations in the pharmaceutical industry, a curative treatment against the BK virus has not been developed. The management is not standardized and is generally based on reported experience from transplantation centers. However, the literature on the subject with large samples is limited. Therefore, we designed a study to present our countrywide experience with BK virus nephropathy (BKVN) in renal transplant recipients. Methods: Our study was conducted with thirty kidney transplant centers from all provinces of Turkey. Only cases with BKVN proven by allograft biopsy were included in our study. Demographic characteristics and laboratory values of the patients were obtained from the archives and electronic databases of the centers. Results: A total of 13.857 patients from 30 transplantation centers were screened. 207 BKVN cases proven by allograft biopsy were identified and included in the study. The mean age was 46.4±13.1, and 146 (70.5%) patients were male. Twenty-six patients did not receive any induction therapy, 144 patients received anti-T lymphocyte globulin (ATLG), and 37 patients received basiliximab after transplantation. 23.6% of the patients had acute rejection history in the first six months of renal transplantation. all were treated with pulse steroids, and 46 were also treated with ATLG. The mean time to diagnosis of BKVN was 15.8±22.2 months after transplantation. At the time of diagnosis, the patients’ mean creatinine level was 1.8±0.7 mg/dl, and the mean estimated glomerular filtration rate was 45.8±19.6 ml/min. While BKVN was solely reported in 181 cases, there were cellular rejection findings in 21 biopsy specimens and humoral rejection in 4 biopsy specimens. In addition of dose reduction or discontinuation of immunosuppressive drugs, eighteen patients were treated with cidofovir, 11 patients with leflunomide, 17 patients with quinolones, 15 patients with intravenous immunoglobulin (IVIG), five patients with cidofovir+IVIG, and 12 patients with leflunomide+IVIG. None of the patients who received leflunomide and leflunomide+IVIG had allograft loss. Allograft loss was observed in 12 (15%) of 78 patients treated with antivirals or immunomodulators. Allograft loss occurred in 32 patients (15%) during follow-up out of 207 patients with BKVN. Five patients were retransplanted, and none developed BKVN during the follow-up. Conclusions: BKVN is still a significant cause of allograft loss in kidney transplantation, which has not been fully elucidated. Leflunomide appears to be an effective treatment in these patients.

Introduction: National data on asthma characteristics and the factors associated with uncontrolled asthma seem to be necessary for every country. For this purpose, we developed the Turkish Adult Asthma Registry for patients with asthma aiming to take a snapshot of our patients, thereby assigning the unmet needs and niche areas of intervention. Methods: Case entries were performed between March 2018 and March 2022. A web-based application was used to record data. Study outcomes were demographic features, disease characteristics, asthma control levels, and phenotypes. Results: The registry included 2053 patients from 36 study centers in Turkey. Female subjects dominated the group (n = 1535, 74.8%). The majority of the patients had allergic (n = 1158, 65.3%) and eosinophilic (n = 1174, 57.2%) asthma. Six hundred nineteen (32.2%) of the patients had obese asthma. Severe asthma existed in 670 (32.6%) patients. Majority of cases were on step 3–5 treatment (n: 1525; 88.1%). Uncontrolled asthma was associated with low educational level, severe asthma attacks in the last year, low FEV1, existence of chronic rhinosinusitis and living in particular regions. Conclusion: The picture of this registry showed a dominancy of middle-aged obese women with moderate-to-severe asthma. We also determined particular strategic targets such as low educational level, severe asthma attacks, low FEV1, and chronic rhinosinusitis to decrease uncontrolled asthma in our country. Moreover, some regional strategies may also be needed as uncontrolled asthma is higher in certain regions. We believe that these data will guide authorities to reestablish national asthma programs to improve asthma service delivery.

Objective: We routinely calculate the pulmonary to systemic (Qp/Qs) ratio to avoid missing any left-to-right shunts in patients with precapillary pulmonary hypertension (PH). However, the pulmonary artery oxygen saturation (SpaO(2)) was lower than the mixed venous oxygen saturation (SmvO(2)) calculated using the formula; hence, the Qp/Qs ratio was calculated as less than "1" in some patients despite the absence of any detectable shunt. We hypothesized that this observation might have prognostic significance; however, to the best of our knowledge, it has not been investigated yet. Therefore, we aimed to examine the prognostic value of the Qp/Qs ratio in precapillary PH without left-to-right shunts.

Purpose: There are not many questionnaires that have proven validity and reliability in evaluating the level of physical activity in older patients with chronic obstructive pulmonary disease (COPD). In clinical and scientific studies, it is important to quickly determine the physical activity level of patients in terms of time management. The aim of the study was to examine the validity of the rapid assessment of physical activity (RAPA) questionnaire in older patients with COPD. Methods: A total of 105 older patients with COPD surveyed the short form of the International Physical Activity Questionnaire (IPAQ-SF) and after 2 weeks RAPA questionnaire as well. The IPAQ-SF was accepted as the gold standard for physical activity assessment in COPD. Furthermore, patients were assessed for a 6-min walking test (6MWT) and perceived dyspnea (with modified medical research dyspnea scale (mMRC)). Correlation coefficients (r) was used for the relationship between RAPA and IPAQ-SF. Results: There were significant positive correlations between RAPA and IPAQ-SF total score (r = 0.968, p< 0.001), 6MWT (r = 0.626, p< 0.001), in addition to significant negative correlation between the RAPA and mMRC scores (r = -0.454, p< 0.001). The RAPA showed good sensitivity (87.5%) and a specificity (100%) value. Positive and negative predictive values of the RAPA were 100% and 96.4% respectively. Conclusion: This study showed the RAPA was an easy-to-use, valid, and reliable questionnaire to measure physical activity levels in older patients with COPD.

Background: The most common cause of increased morbidity and death throughout the chronic kidney disease (CKD) process is atherosclerosis, which advances quickly and is linked to cardiovascular diseases (CVDs). Sclerostin levels in CKD and CVDs have a complicated connection. Objective: We examined the relationship between serum sclerostin levels and atherosclerosis in patients with stage 3, 4, or 5 CKD who were not receiving hemodialysis treatment. Patients and Methods: A total of 125 patients aged >18 years with CKD stage 3, stage 4 and non-dialysis stage 5 were enrolled in the study. Patients with obesity, uncontrolled hypertension, coronary artery disease, with active cancer or liver disease, malignant hematologic disorders, acute renal failure, acute or chronic infections, were excluded. As for the control group; healthy volunteers without any known illness, regular drug use, smoking, alcohol use, and obesity were recruited. Results: Study population was diagnosed as 39.2% with diabetes mellitus and 91.2% of patients with arterial hypertension. 54% of the patients were female. There was a positive correlation between serum sclerostin levels and carotid intima media thickness (CIMT). A negative correlation was found between serum sclerostin levels and GFR and 25-OH vitamin D levels. Sclerostin levels were found to be significantly higher in the group with high CIMT levels. There was no difference in terms of other parameters. Conclusion: Sclerostin levels were significantly higher in patients with abnormal CIMT independent of GFR, calcium, phosphorus and PTH values. This finding suggests that the serum sclerotin level can be used as a CVD marker in patients with CKD.

OBJECTIVE: This study aimed to focus on non-COVID-19 patients during the process when all physicians focused on COVID-19 patients. Patients with pulmonary diseases in the COVID-19 pandemic period were analyzed. MATERIAL AND METHODS: Non-COVID-19 cases who were hospitalized in the pulmonology clinic, outpatients, and patients who applied to the non-COVID-19 emergency service and requested a pulmonology consultation in the period from March 16, 2020 to May 15, 2020 and in the same period of the previous year (i.e., from March 16, 2019 to May 15, 2019) were included in this study. RESULTS: In the pandemic period, it was found that there was an 84% decrease in outpatient admissions, a 43% decrease in inpatients, and a 75% decrease in emergency services. During the pandemic period, in outpatient setting, male and younger case admissions increased, admissions with chronic obstructive pulmonary disease (COPD), and interstitial lung diseases decreased, whereas the frequency of admission to asthma, pneumonia, and pulmonary thromboembolism increased. In the period of the pandemic, patients with asthma, COPD, and lung cancer were less hospitalized, whereas patients with pulmonary thromboembolism, pneumonia, and pleural effusion were hospitalized more. In non-COVID-19 patient treatments during the pandemic period, usage of a metered dose inhaler increased. CONCLUSION: During the COVID-19 pandemic, non-COVID pulmonary pathologies decreased significantly, and there was a change in the profile of the patients. From now on, to be prepared for pandemic and similar extraordinary situations, to organize hospitals for the epidemic, to determine health institutions to which nonepidemic patients can apply, to make necessary plans in order not to neglect the nonepidemic patients, and to develop digital health service methods, especially telemedicine, would be appropriate.

Aim: We aimed to reveal the correlation of NLR rate, RDW and MPV values and with the findings of PET/CT regarding the prediction of disease progression and the clinical characteristics. Materials and methods: The treatment naive sarcoidosis cases, of whose PET/CT have been taken due to mediastinal lymphadenopathy of whose diagnosis have been confirmed by biopsy, were included in the study. Hematological parameters, clinical, radiological and PET/CT findings are evaluated. Results: 40 sarcoidosis and 40 healthy control cases were included in the study. NLR, RDW, MPV and the sedimentation values in the sarcoidosis group were determined statistically significantly higher. In patients having parenchymal involvement in PET/CT, the values of FVC%, DLCO, DLCO%, DLCO/VA and DLCO/VA% were determined significantly lower. High NLR and PET/CT LAP SUVmax values and low DLCO% values are statistically significantly correlated with one-year disease progression. For predicting the progression, for the NLR cut-off value 3.20, the area under the curve was determined as 0.79 (CI 62.2-96.5), sensitivity as 80.0%, specificity as 76.7% and for the PET/CT SUVmax cut-off value 9.5, the area under the curve was determined as 0.71 (CI 46.6-95.9), sensitivity as 70.0%, specificity as 82.1%. Conclusion: We determined that the values observed in routine hematologic examinations such as NLR, RDW and MPV, were high in sarcoidosis cases. In addition, the values of NLR, DLCO% and PET/CT SUVmax might be used in predicting the progression. At the same, once again we showed that the lung parenchyma involvement in PET/CT correlates with many pulmonary function parameters. (Sarcoidosis Vasc Diffuse Lung Dis 2017; 34: 242-250)

Aim: Interleukin-38 has been involved as an inflammatory mediator in rheumatic diseases. However, little is known about the role of IL-38 in the development of primary Sjögren’s syndrome. The present study aimed to evaluate the role of IL-38 in primary Sjögren’s syndrome and its clinical relevance.Material and Method:Between 2019 and 2020, 40 patients with primary Sjögren’s syndrome and 39 healthy participants were included in the study. The serum IL-38 level was measured by ELISA in all participants. The serum levels of IL-38 were compared with clinical and laboratory features. Results:The serum IL-38 levels between the patients with primary Sjögren’s syndrome and the controls were similar (58.0 pg/ml, min-max: 0-641.0 vs. 55.0 ng/ml, min-max: 0-338.0; p=0.511). No significant correlations were found between serum IL-38 level and SSDAI (r=-0.104, p=0.523). IL-38 level was mildly negatively correlated with RF (r=-0.364, p=0.021) and positively correlated with CRP (r=0.321, p= 0.044).Conclusion:The correlation of IL-38 with CRP and RF should be considered because it might be important clues for contribution to the disease process. IL-38 might be relevant to the heterogeneous nature of PSS and the future role of IL-38 might be a biomarker for specific clinical manifestations of pSS., Amaç: İnterlökin (IL)-38, otoimmün hastalıklarda rol oynamaktadır. Bununla birlikte, birincil Sjögren sendromunun gelişiminde IL-38'in rolü hakkında yeterli bilgi bulunmamaktadır. Bu çalışma, IL-38'in primer Sjögren sendromundaki rolünü ve klinik ilişkisini değerlendirmeyi amaçladı.Yöntemler: 2019-2020 yılları arasında primer Sjögren sendromlu 40 hasta ve 39 sağlıklı katılımcı çalışmaya dahil edildi. IL-38'in serum seviyesi, tüm katılımcılarda ELISA ile ölçüldü. IL-38'in serum seviyeleri klinik ve laboratuvar özellikleri ile karşılaştırıldı.Bulgular: Primer Sjögren sendromu hastaları ve kontrol grubu, serum IL-38 düzeyleri açısından benzerdi (58.0 pg/ml, min-maks: 0-641.0 ve 55.0 ng/ml, min-maks: 0- 338.0; p=0.511). Serum IL-38 düzeyi ile SSDAI arasında anlamlı bir ilişki bulunmadı (r=-0.104, p=0.523). IL-38 düzeyi RF ile orta derecede negatif (r=-0.364, p=0.021) ve CRP ile pozitif korelasyon (r=0.321, p= 0.044) bulundu.Sonuç: IL-38 Primer Sjögren sendromlu hastalarda CRP ve RF ile ilişkili bulunmuştur. IL-38'in gelecekteki rolü, pSS'nin spesifik klinik belirtileri için bir biyobelirteç olabilir.

BACKGROUND The antifibrotic drugs nintedanib and pirfenidone reduce disease progression in idiopathic pulmonary fibrosis (IPF) and have also shown to improve survival. Switching first-line antifibrotic drug may required in IPF due to disease progression or intolerable adverse effects. The aim of this study was to assess the safety and efficacy of second-line antifibrotic treatment in patients with IPF. MATERIAL AND METHODS This retrospective, multicenter study was conducted at three referral interstitial lung disease centers who received first-line antifibrotics more than one month and switched the treatment to a second-line antifibrotic agent during January 2016-June 2021. The drug's safety was evaluated based on the type of adverse effect. Disease progression was defined as an absolute decline in FVC of >10% within 12 months with or without radiological progression. RESULTS Among 629 consecutive patients with IPF, 66 patients switched antifibrotics. The median duration of antifibrotics was 13 (1-41) months prior to the switch, and 14 (2-42) months after the switch. The mean age was 70.6 ± 8.9 years and, median FVC (%) was 72.1 ± 18.7 at the initiation of first-line antifibrotics. The most common reason for the switch was disease progression (56%) followed by severe adverse effects (SAEs) (44%). SAEs were significantly less observed after the switch compared before the switch (43.9% vs12.1%, respectively, p

There are few data on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (COVID-19) infection in patients with idiopathic pulmonary fibrosis (IPF). The objective of this study is to describe the characteristics and outcomes of IPF patients confirmed COVID-19 infection.In this retrospective, multi-center, cohort study, patients from 4 hospital medical records with known IPF and a COVID-19 diagnosis were identified. Demographic and clinical outcome data were abstracted through a review of electronic medical records.Records for 46 patients with IPF and COVID-19 were abstracted. The mean age was 65±10 years. The most common symptom was dyspnea, followed by fever and cough. Ground-glass opacities (n = 35, 83.3%) and consolidations (n = 11, 26.1%) were the main imaging features of the disease in thorax computed tomography (CT). Twenty-four patients (52.1%) required hospitalization. Among the hospitalized patients, 16 (66.6%) were admitted to the intensive care unit (ICU), and 10 (41.6%) underwent invasive mechanical ventilation. Thirteen patients (28.2%) died of COVID-19 complications. Mortality rate was significantly associated with lower DLCO/VA, long term oxygen therapy and consolidation finding on CT of thorax (p0.05). On multivariable analysis, neither factor was associated with hospitalization or mortality.IPF patients represent a vulnerable population for COVID-19, according to the high rate of hospitalization, ICU requirement, and mortality rate. Measures to minimize the risk of COVID-19 infection remain key to protect IPF patients.

ÖZAmaç: COVID-19 ile ilgili temel epidemiyolojik verilerin hızlı bir şekilde analizedilmesi ve raporlanması hastane hizmetlerinin ve sağlık iş gücününplanlanması için önemlidir. Bu çalışmada büyük bir üniversite hastanesindeyeni kurulan COVID-19 sürveyans sisteminin iş akışını ve bileşenlerinitanımlayıcı istatistikler eşliğinde sunmak amaçlanmıştır.Gereç ve Yöntem: Sürveyans sisteminin temel bileşenleri veri giriş noktaları,betik temelli veri temizliği, veri analizi, görselleştirme ve raporlamaydı.Verilerin çoğu hastane bilgi sisteminden elde edildi. Sistemin çıktılarınısunmak için 19 Mart 2020 ile 31 Aralık 2020 tarihleri arasında U07.3 kodugirilmiş tüm hastalar çalışmaya alındı. Toplam hasta sayıları, toplam günlükbaşvuru sayısı ve hastaneye yatış sayıları hesaplandı.Bulgular: Çalışma süresince pandemi acil servise ve pandemi çocuk acil servisetoplam 42.669 başvuru oldu. Hastanemize başvurup U07.3 kodu girilmiş olan39.201 hastanın 6.470’inde SARS-CoV-2 RNA pozitif saptandı. 18 yaş ve üzerikesin vakaların 977’sinin (16,7%) hastane yatışı vardı. Test pozitiflik oranı%13,8’di. Mayıs, Haziran ve Temmuz aylarında yoğun bakımda yatan kesinvaka sayısı diğer aylara göre azdı.Sonuç: Erken dönemde kurulan sürveyans sistemi ile zamandan tasarrufedilmiş ve personel üzerindeki iş yükü azaltılmıştır. Hastanelerdeki bulaşıcıhastalıklar sürveyans sistemleri gittikçe artmakta olan sürveyans verisiyle başedebilecek şekilde düzenlenmelidir.Anahtar Sözcükler: epidemiyoloji, sürveyans, COVID-19, SARS-CoV-2, veriyönetimi ABSTRACTObjective: Rapid analysis and reporting of basic epidemiologic parametersrelated to COVID-19 are key for assessing the needs of associated hospitalservices and the workforce. This study aims to present the workflow and thecomponents of the newly established COVID-19 surveillance system withdescriptive statistics of COVID-19 burden in a large university hospital.Materials and Methods: Main components of the structure underlining thesurveillance system were data entries, script-based data manipulation, dataanalysis, visualization and reporting. Data was primarily derived from thehospital information system. To illustrate the output, we included all patientsdiagnosed with the U07.3 code in Dokuz Eylul University hospital betweenMarch 19, 2020 and December 31, 2020. The total count of new SARS-CoV-2RNA positive cases, daily admissions and hospitalizations were presented.Results: There were 42,669 hospital admissions during the allocated period.Among 39,201 patients who were admitted to the hospital and were given aU07.3 code, 6,470 patients were positive for SARS-CoV-2 RNA. Of theconfirmed cases aged ≥18 years, 977 (16.7%) received inpatient care. The totaltest positivity ratio was 13.8%. During the months of May, June and July 2020the total number of SARS-CoV-2 PCR positive cases in the intensive care unitwas relatively low.Conclusion: Establishing a new surveillance system in the early phase of thepandemic saved time, allowed for the smarter allocation of resources andreduced overall staff workloads. Communicable diseases surveillance systemsin hospitals should be adapted to handle the large volume of data emerging inthe COVID-19 pandemic.Keywords: epidemiology, surveillance, COVID-19, SARS-CoV-2, datamanagement

ObjectiveTo learn about the attitudes and behaviours of patients with idiopathic pulmonary fibrosis (IPF) in relation to the difficulties experienced during the COVID-19 pandemic.DesignA cross-sectional, multicentre phone call survey.SettingFour university hospitals in Turkey.ParticipantsThe study included patients with IPF receiving antifibrotics for at least 3 months and with doctor appointment and/or scheduled routine blood analysis between March and May 2020 (the first 3 months after the official announcement of the COVID-19 pandemic in Turkey).InterventionsPhone calls (a 5 min interview) were performed in June 2020. A questionnaire and the Hospital Anxiety-Depression Scale were applied.Main outcome measuresPatients’ preferences for disease monitoring, patients’ attitudes and behaviours towards IPF, drug continuation, COVID-19 diagnosis and anxiety/depression status.ResultsThe study included 115 patients with IPF (82 male; mean age, 68.43±7.44 years). Of the patients, 73.9% had doctor appointment and 52.2% had scheduled routine blood testing; 54.5% of patients with doctor appointment self-cancelled their appointments and 53.3% of patients with scheduled routine blood testing did not undergo testing. Of the patients, 32.2% were on nintedanib and 67.8% were on pirfenidone; self-initiated drug discontinuation rate was 22.6%. The percentage of patients communicating with their physicians was 35.7%. The route of communication was by phone (34.8%). The frequency of depression and anxiety was 27.0% and 38.3%, respectively. The rates of drug discontinuation (35.1% vs 16.7%, pConclusionsDuring the COVID-19 pandemic, a significant proportion (>50%) of patients self-cancelled their appointments and nearly a quarter of patients discontinued their medications. Providing a documentation of the problems experienced by patients with IPF about management of the necessary requirements during the COVID-19 pandemic, this study may be a model for patients with chronic diseases.

Background: Histology represents the major source of information to define a usual interstitial pneumonia (UIP) pattern. However, the procedure is associated with significant morbidity and mortality. The aim of this study was to evaluate morbidity and mortality of surgical lung biopsy (SLB) in diagnosing UIP. Methods: Patients undergoing SLB with the ultimate diagnosis of UIP were studied. Clinical data concerning medical history, histology, pulmonary functions, radiology, length of hospital stay (LOS), morbidity and mortality status were retrospectively recruited from four hospitals. Results: The study included consecutive 93 patients with a SLB diagnosis of UIP. Mean age was 61 ± 8 years, with one third of the patients were ≥65 years. In 58 cases (62.4%), the biopsy was performed by video-assisted thoracoscopic surgery, in 35 (37.7%) by limited thoracotomy. Eighty patients (86%) had possible UIP, 12 (12.9%) had inconsistent with UIP and one (1.1%) had UIP pattern on high-resolution computed tomography. The mean LOS was 5.47 ± 3.16 days. LOS was associated with smoking status (P = 0.024), type of biopsy (P = 0.00), 6-min walk test (P = 0.00) and number of biopsy (P = 0.00). There was no in-hospital and 30-day mortality in our cohort, and 90-day mortality rate was 1.1%. In seven patients (7.5%), we observed postoperative morbidities, predominantly prolonged air leakage (7.5% of all cases). Postoperative morbidity was only associated with the type of SLB. Patients with limited thoracotomy showed greater morbidity rates (17.1% versus 1.7%, P = 0.011). Conclusion: SLB is a relatively safe procedure in the diagnosis of UIP and can be performed in suitable patients with suspected UIP/idiopathic pulmonary fibrosis. WOS:000623102700001 33645001 Q3

Background/aim Phase III trials have demonstrated a significant efficacy and an acceptable safety for pirfenidone in patients having mild to moderate idiopathic pulmonary fibrosis (IPF). Real-life data on the use of pirfenidone 200 mg tablets are limited. This study aimed to investigate the efficacy and safety of pirfenidone 200 mg tablets for the treatment of IPF in a real-life setting. Materials and methods A retrospective, multicenter study conducted in four university hospitals in XXX between January 2017 and January 2019. Clinical records of patients diagnosed with mild to moderate IPF and receiving pirfenidone (200 mg tablets, total 2400 mg/day) were reviewed retrospectively and consecutively. Pulmonary function measurements including forced vital capacity (FVC%) and diffusing capacity of the lungs for carbon monoxide (DLCO%) were analyzed at baseline and after 6-month of pirfenidone treatment. Descriptive statistics were expressed as mean, standard error or median (minimum-maximum), number and percentage, where appropriate. Results The study included 82 patients, of whom 87.8% were males (mean age, 66 years). After 6-month of treatment, 7 patients discontinued the treatment. Of the remaining 75 patients, 71 (94.6%) remained stable, 4 (5.4%) had progressive disease as evident by a decline in the FVC% of at least 10% while on treatment, and 45 (61.3%) had improved cough. At least one adverse event (AE) associated with the treatment was observed in 28 (37.3%) patients. Conclusion Pirfenidone 200 mg was effective and well tolerated and associated with relatively mild and manageable AEs in IPF patients.

Aims and Objectives: Kinesiophobia is defined as fear of movement and activity resulting from a feeling of vulnerability to painful injury or reinjury. Although there are studies concerning kinesiophobia and its relationship with clinical variables in various chronic diseases, there are limited data about kinesiophobia in COPD. The aim of this study was to evaluate the relationship between kinesiophobia, dyspnea level, functional exercise capacity and quality of life in patients with COPD. Methods: Thirty-seven patients with moderate/severe COPD were participated in this study. Dyspnea level was determined using the modified Medical Research Council Dyspnea Scale. Kinesiophobia was measured using Tampa Scale of Kinesiophobia (TSK). Six-Minute Walk Test was used to evaluate functional exercise capacity. Nottingham Health Profile scale Health-related quality of life energy level, pain, emotional reactions, sleep, social isolation and physical abilities sub-domains were used to assess quality of life. Results: TSK score was significantly associated with dyspnea level, functional exercise capacity, pain and physical abilities (p 0.05) Conclusions: Dyspnea level, functional exercise capacity and quality of life subdomains are all positively associated with higher degree of kinesiophobia in patients with COPD. It is important that kinesiophobia should be evaluate in routine assessments because of its effects on main outcomes of pulmonary rehabilitation programs.

aim of this study was to assess diaphragm thickness (DT) and mobility (DM) and to investigate their relationship to clinical parameters in patients with non-cystic fibrosis (non-CF) bronchiectasis. Thirty-eight patients with non-CF bronchiectasis were enrolled in this cross-sectional study. DT was measured using ultrasound at different lung volumes (at residual volume [DTRV], functional residual capacity [DTFRC] and total lung capacity [DTTLC]). DM was measured using ultrasound during quiet breathing (DMQB) and deep breathing (DMDB). Disease severity, pulmonary function, respiratory muscle strength, exercise capacity and physical activity were assessed. DTRV correlated with disease severity (r = 0.332, p = 0.042), FEV1% (r = 0.387, p = 0.016) and FVC% (r = 0.405, p = 0.012). DTFRC correlated with FVC% (r = 0.331, p = 0.042). DTTLC correlated with disease severity (r = 0.430, p = 0.007) and total physical activity time (r = 0.379, p = 0.019). DMDB correlated with disease severity (r = -0.380, p = 0.019), FEV1% (r = 0.369, p = 0.023) and FVC% (r = 0.405, p = 0.012). DT is related to disease severity, pulmonary function and physical activity, while DM is related to disease severity and pulmonary function in patients with non-CF bronchiectasis. (E-mail: tanrverdiaylin@gmail.com) ? 2020 World Federation for Ultrasound in Medicine & Biology. All rights reserved.

Amaç: Bu çalışmada amacımız pulmoner hipertansiyonlu (PH) hastalarda 6-dakika pegboard ring testinin (6PBRT) psikometrik özelliklerinin araştırılmasıydı.Yöntem: Bu çalışmaya 31 PH hastası dahil edildi. Üst ekstremite fonksiyonu 6PBRT ile ölçüldü. Kas kuvveti için dijital dinamometre ile omuz fleksör, omuz abdüktör, dirsek ekstansör ve dirsek fleksör kasları ve el dinamometresi ile kavrama kuvveti ölçülmüştür. Günlük yaşam aktivitelerinin limitasyonu Milliken Günlük Yaşam Aktiviteleri Ölçeği ile değerlendirildi. Test-tekrar test güvenilirliğini belirlemek için sınıf içi korelasyon katsayısı (ICC) kullanıldı.Sonuçlar: 6PBRT için ICC değeri 0,98 (95% CI: 0,82–0,99) idi. SEM ve MDC değerleri sırasıyla 5,9 ve 16,4 olarak hesaplandı. 6PBRT bilinen grupların geçerliliğini gösterdi ve NYHA Sınıf III olan hastalar 6PBRT'de Sınıf II hastalara göre anlamlı derecede düşük skorlara sahipti (p=0,005). 6PBRT yaş (r=-0,628, p, Purpose: This study aimed to investigate the psychometric properties of the 6-minute pegboard ring test (6PBRT) in patients with pulmonary hypertension (PH).Methods: This study included 31 patients with PH. The upper extremity function was measured with the 6PBRT. Muscle strength was measured for shoulder flexor, shoulder abductor, elbow extensor, and elbow flexors muscles using with a digital dynamometer, and handgrip strength with the hand dynamometer. Limitation of the activities of daily living was evaluated with the Milliken Activities of Daily Living Scale. Intra-class correlation coefficient (ICC) was used to determine test-retest reliability.Results: The 6PBRT showed excellent test-retest reliability with the ICC=0.98 (95% CI: 0.82–0.99). The SEM and MDC were calculated as 5.9 and 16.4, respectively. The patients with NYHA Class III had significantly lower scores in the 6PBRT compared to the patients with Class II (p=0.005) showing the known-groups validity of the 6PBRT. The 6PBRT was significantly and strongly correlated with age (r=-0.628, p

Background and Aims Hematuria is one of the most common laboratory findings in nephrology practice. In different regions of the world, the etiologic causes differ. To date, there is no enough data regarding the clinical and histopathologic characteristics of primary glomerular diseases (PGD) patients with hematuria in our country. Method Data were obtained from national multicenter (47 centers) data entered into the Turkish Society of Nephrology Glomerular Diseases (TSN-GOLD) database between May 2009 and June 2019. The data of all PGD patients over the age of 16 years who were diagnosed with renal biopsy and had hematuria data were included in the study. The biopsy samples were processed using a light microscopy and immunofluorescence examination. Demographic characteristics such as age, sex, indications for biopsy, primary glomerular diseases, comorbidities, laboratory and biopsy findings of all patients were also recorded. Hematuria was defined as the presence of at least 5 red blood cells/hpf. Results Data of 3394 patients were included to the study after the exclusion of patients with secondary glomerulonephritis and patients with missing biopsy findings. While 1699 (50.1%) patients had hematuria, 1695 (49.9%) patients did not have hematuria. Demographic, laboratory, and histopathological characteristics of patients with and without hematuria are given in Table. Patients with hematuria had statistically higher systolic blood pressure (SBP), serum blood urea nitrogen, creatinine, albumin, levels and urine pyuria, however, these patients had statistically lower age, body mass index, presence of hypertension and diabetes, eGFR, 24-hour proteinuria, serum total, HDL and LDL-cholesterol and C3 levels when compared with patients without hematuria. Figure depicted the etiologic causes of patients with and without hematuria. According to histopathological findings, number of global sclerotic glomeruli, cellular and fibrocellular crescents, the levels of mesangial proliferation, endocapillary proliferation, exudative changes in glomeruli, severe tubular atrophy, interstitial inflammation, subendothelial deposition, moderate and severe IgA and C3 deposition were found to be significantly higher and the levels of basal membrane thickening, interstitial fibrosis, subepithelial deposition, severe IgG staining were found to be significantly lower in patients with hematuria. Conclusion This is the first multicenter national report regarding the demographic and histopathologic data of PGD patients with or without hematuria. Hematuria, a feature of nephritic syndrome, was found at a higher than expected in the PGDs presenting with nephrotic syndrome in our national database.

Objective Pulmonary arterial hypertension (PAH) is a rare disease. Although muscle strength, exercise capacity, quality of life, and activities of daily living of patients with PAH are affected, it is not known how they are affected by disease severity. The purpose of the present study was to investigate effects of disease severity on upper extremity muscle strength, exercise capacity, and performance of activities of daily living in patients with PAH. Methods Twenty-five patients with disease severity classified according to the New York Heart Association (NYHA) as functional class II (n=14) or class III (n=11) were included in the study. Upper-extremity exercise capacity and limitations in performing activities of daily living were assessed with 6-minute pegboard and ring test (6PBRT) and the Milliken activities of daily living scale (MAS), respectively. Shoulder flexion, elbow extension, elbow flexion muscle strength, and handgrip strength were measured with dynamometer. Results There were no significant differences in age, gender, body mass index, or mean pulmonary artery pressure between groups (p>0.05). The 6PBRT, MAS, and elbow flexion (right) and grip strength (right and left) results were significantly lower in NYHA III group than in NYHA II group (p=0.004, p=0.002, p=0.043, p=0.002 and p=0.003, respectively). There was no significant difference in shoulder flexion, elbow flexion (left), or elbow extension between groups (p>0.05). Conclusion Results suggest that upper extremity exercise capacity, elbow flexion muscle strength (right), and handgrip strength decrease and that limitations in activities of daily living grow as disease severity increases in patients with PAH. When planning rehabilitation programs, disease severity should be considered and evaluations and treatments for the upper extremities should be included.

Background/aim Dyspnea is the subjective feeling of breathing discomfort and a significant problem for patients with heart and respiratory disease and also an important determinant of exercise tolerance, quality of life, and mortality in various diseases. Most of the scales are not enough to investigate the multidimensional effects of dyspnea; therefore, the Multidimensional Dyspnea Profile (MDP) was developed and validated into many languages. This study was aimed to translate and culturally adapt the MDP into Turkish and investigate the psychometric properties of this adapted version in outpatients with respiratory disease. Materials and methods The MDP was translated and culturally adapted into Turkish following published guidelines. A total of 170 outpatients with respiratory disease were included to assess psychometric properties. Factorial structure was investigated using a principal component analysis. Two situations were used in this study evaluating dyspnea in activity-related and resting conditions. We formulated 17 hypotheses for each MDP domain (in total 68) to assess the construct validity and the correlations were investigated between the MDP and measures of body mass index, pulmonary function test, other dyspnea assessments, anxiety, depression, and health-related quality of life. To investigate the test-retest reliability, the MDP was administered again after one hour and one week. Results Internal consistency of the MDP was excellent (Cronbach?s alpha coefficients ranged from 0.89 to 0.93). The exploratory factor analysis revealed two components explaining 70 and 76% of variance. Overall, 64 of the 68 predetermined hypotheses (94%) were confirmed to test construct validity. The MDP showed excellent test-retest reliability for a one-hour period (intraclass correlation coefficient values ranged from 0.98 to 0.99). However, the test-retest reliability decreased moderate-to-high after a one-week period (0.53 to 0.80). Conclusion The MDP was successfully translated and culturally adapted into Turkish and this version showed good psychometric properties including the factorial structure, internal consistency, test-retest reliability, and construct validity to assess multidimensional aspects of dyspnea.

Purpose: It is known that tobacco smoke exposure is a risk factor for the development of pulmonary arterial hypertension PAH . In addition, tobacco smoke exposure can cause numerous health problems. This study aimed to compare functional capacity, respiratory muscle strength, and physical activity level between the patients with PAH who have or do not have tobacco smoke exposure. Methods: Seventeen patients with PAH who has tobacco smoke exposure and 20 nonsmoker patients were included in this cross-sectional study. Tobacco smoke exposure was defined as current smokers, ex-smokers, and passive smokers. The study outcomes included the maximal inspiratory and expiratory pressure measurement, 6-minute walk test, and physical activity. Results: There was no significant difference for age, gender, body mass index, pulmonary arterial pressure, and functional class between the two groups p>0.05 . Inspiratory muscle strength p=0.035 , functional exercise capacity p=0.040 and physical activity level p=0.034 were lower in patients with tobacco smoke expose compared to the nonsmokers. Conclusion: The results of this study showed that functional capacity, respiratory muscle strength, and physical activity level were significantly lower in patients with tobacco smoke expose than the nonsmoker patients with PAH. These findings suggest that tobacco smoking is not only associated with PAH risk but also numerous health problems, specifically important ones for this population

Background: Timed up and go (TUG) and sit to stand (STS) tests that required less space and easier to be performed in respiratory and cardiac diseases for assessing functionality. Aim was to test the reliability of TUG and 30-second STS (30STS) tests and determine the validity of TUG and 30STS tests in patients with Pulmonary Hypertension (PH). Methods: Thirty-eight patients with diagnosed PH were included. We collected TUG, 30STS, quadriceps muscle strength, physical activity level, and 6MWT. Intra-class correlation coefficient (ICC) was used to determine test-retest reliability and correlations with quadriceps muscle strength, physical activity level and 6MWT for validity of the TUG and 30STS tests. Results: The TUG and 30STS tests were associated with age, functional class, muscle strength, physical activity and functional exercise capacity in patients with PAH (p < 0.05). 6MWT was associated with age, functional class, muscle strength, physical activity and functional exercise capacity (p < 0.05). ICC (95%) for TUG test and 30STS were 0.96 (0.93-0.98) and 0.95 (0.90-0.97), respectively. Conclusions: The TUG and 30STS tests were reliable and valid tests for measuring physical performance in PH. This study supports using the TUG and 30STS tests as practical assessment tools in patients with PH. (C) 2020 Elsevier B.V. All rights reserved.

Background: Patients with pulmonary arterial hypertension (PAH) present impairments in muscle strength and exercise capacity. There is growing evidence about the benefits of neuromuscular electrical stimulation (NMES) in patients with respiratory diseases, except in patients with PAH. The aim of this study was to investigate the effects of NMES on muscle strength, and other physical and psychosocial variables in patients with PAH. Methods: Patients with PAH were randomly divided into two groups as NMES and control. The NMES was applied to the bilateral deltoid and quadriceps femoris muscles with 50 Hz for 3 days/week, 8 weeks for the NMES group. Muscle strength, muscle cross-sectional area and thickness, arterial stiffness, exercise capacity, functional mobility and balance, balance confidence, fatigue, physical activity, and quality of life were assessed at baseline and after 8 weeks by blinded assessors. Results: There was no significant difference in the demographic and clinical characteristics between the patient groups (p > 0.05). The improvements in muscle strength, muscle cross-sectional area and thickness, pulse wave velocity, exercise capacity, functional mobility and balance, balance confidence, fatigue, physical activity, and quality of life were significantly higher in the NMES group compared to the control group (p < 0.05). Conclusions: This study suggests that NMES intervention is safe and effective for patients with PAH. (C) 2020 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Objective: Interstitial lung disease (ILD) may create sleep disturbances due to chronic disease-related stress, respiratory abnormalities and adverse effects of treatment. We aimed to determine the quality of sleep in ILD patients, and the incidence of Obstructive sleep apnea syndrome (OSAS) in these patients. Materials and Methods: Taken to this study were 52 patients who were followed up in our center due to ILD. Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI) were applied to the patients. Spirometry and diffusion test were performed. Polysomnography (PSG) was performed to 27 patients whose ESS were more than or equal to 10. Results: Demographic characteristics, body mass index, spirometry and diffusion measurements, PSQI global score and the sub-components of it didn’t show difference according to ESS daytime sleepiness. Sleep quality of 44% of the patients was determined to be poor by PSQI. PSQI global score and sub-components weren’t correlated with apnea-hypopnea index, stage 1 latency, sleep efficiency and nocturnal desaturation (p>0.05) in 27 patients who underwent PSG. We observed increased stage 1 sleep and decreased stage 2-3 and rapid eye movement sleep. As nocturnal hypoxemia was seen arousals (p=0.000, r=0.698) increased. OSAS was diagnosed in 19 (70%) of subjects. Conclusion: Although ILD patients don’t have daytime hypoxemia; they may have nocturnal hypoxemia and OSAS, which may effect their sleep quality. Therefore ILD patients should be evaluated for daytime sleepiness, and sleep-related breathing disorders.

Aim and objective The aim of the study was to investigate the relationship between smoking history, functional exercise capacity and airway obstruction severity in patients with chronic obstructive pulmonary disease (COPD). Methods Thirty patients with stable COPD participated in this study. Demographic value and smoking history (pack-years) were recorded. Pulmonary function tests were performed. Functional exercise capacity was evaluated with six minute walking test (6MWT). The Pearson correlation coefficient was calculated to examine the correlation between the variables. Results The mean of age (years), smoking history (pack-years), forced expiratory volume in 1 second (FEV1 %), 6MWT distance (m) were 74.60, 47.30, 55.03, 382.70 respectively. The smoking history had significant negative correlation with FEV1 % (r=-0.374, p=0.042) and 6MWT distance (r=-0.426, p=0.019). Conclusions The study showed that smoking history had significant negative correlation with functional exercise capacity and airway obstruction severity in patients with COPD. By reducing cigarette consumption, functional exercise capacity can be increased and the severity of airway obstruction can be decreased.

Introduction: Muscle strength impairment has been shown before in patients with Pulmonary Arterial Hypertension (PAH). Neuromuscular electrical stimulation (NMES) has been proposed to increase muscle strength in patients with chronic diseases who are unable or unwilling to exercise. However, effects of NMES in patients with PAH remains unclear. Aims: To investigate the effects of NMES on physical and psychosocial variables in patients with PAH. Method: In totally 22 patients (treatment=11, control=11) completed this study. For the treatment group, NMES was applied to the bilateral deltoid and quadriceps femoris muscles with 50 Hz for 3 days/week, 8 weeks. Muscle strength (hand-held dynamometer), muscle cross-sectional area and thickness (ultrasound), arterial stiffness (pulse wave velocity), exercise capacity (6 Minute Walk Test), physical activity (IPAQ), and quality of life (Nottingham Health Profile) were assessed. Results: There was no significant difference in the demographic and clinical characteristics between the groups (p>0.05). Patients in the treatment group showed a significant improvement in muscle strength, grip strength, rectus femoris muscle cross-sectional area and quadriceps femoris muscle thickness, pulse wave velocity, 6 minutes walking distance, physical activity level and quality of life from the baseline assessments (p Conclusion: This study showed that the NMES increases peripheral muscle strength, muscle cross-sectional area and thickness, exercise capacity, physical activity level, and quality of life, reduced arterial stiffness. The NMES intervention is an effective method for cardiopulmonary rehabilitation in patients with PAH.

Background and aim: There are not many questionnaire that have proven validity and reliability in evaluating the level of physical activity in COPD patients. The RAPA questionnaire has proven validity and reliability. The aim of the study was to examine the validity of the RAPA questionnaire in COPD patients. Method: It was estimated that at least 21 patients were necessary in order to identify correlations ≥ 0.6 based on corellations in the study done before (Cekok, F.K. et al. Geriatrics & Gerontology International 2017; 11:1837-1842)., accepting an alpha risk of 0.05 and a beta risk of 0.05 in a two-tailed test (bilateral). Hence, 21 patients surveyed short form of International Physical Activity Questionnaire (IPAQ-SF) and after 2 weeks RAPA questionnaire as well. The IPAQ-SF was accepted as the gold standard for physcial activity assessment in COPD. Furthermore, patients were assessed for a 6-min walking test (6MWT), and perceived dyspnea (with modified medical research dyspnea scala (mMRC)). Spearman’s rank correlation coefficients (rs) was used for the relationship between RAPA and IPAQ. Correlations between RAPA and 6MWT and mMRC was also analyzed. Results: Therefore, there were significant positive correlations between RAPA and IPAQ-SF total score (rs=0.92, P Conclusion: The present study showed the RAPA was an easy-to-use, valid and reliable measure of physical activity among COPD patients.

PURPOSE Assessment of balance performance is important for both diagnostic and therapeutic reasons in clinical practice. Although the ideal exercise prescription is unknown for patients with pulmonary arterial hypertension (PAH), balance training may be effective for this population if they have balance impairments, such as other patients with cardiopulmonary diseases. The present study aimed to evaluate static and dynamic balance performance and balance confidence in individuals with and without PAH. METHODS Eighteen participants with PAH and 12 apparently healthy volunteers were included in this cross-sectional study. Balance performance was assessed by Balance Master System. Static balance performance was assessed by the modified Clinical Test of Sensory Interaction on Balance and unilateral stance test. Limits of stability was used for the assessment of dynamic balance performance. Balance confidence was determined using the Activities Balance Confidence scale. RESULTS There was no significant difference in age, gender, and body mass index between the 2 groups. There was no significant difference in modified Clinical Test of Sensory Interaction on Balance and unilateral stance variables between the patients and healthy controls. Reaction time (forward), movement velocity (backward), directional control (backward), endpoint excursion (backward), and maximum excursion (backward) variables that were the subgroups of limits of stability were significantly different between the 2 groups (P < .05). Balance confidence was significantly lower in patients with PAH (P < .001). CONCLUSION This study suggests that although static balance performance was preserved, patients with PAH had decreased dynamic balance performance and balance confidence without a significant fall history compared with healthy controls.